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Home My WebLink AboutES-UST REP. 9/22/2004 Per it Operate i;1~:¡\> PERMIT ID # 0 15-021-002185i~':)J~~ ,.<) RALPHS GROCERY CZk~f'f{ :~¡ h \\... '\1 LOCATION 5200 ~SLd@KDALE W¡',¡Y" ,_",...' ¡,~ f'B~RSFIEbF);¡¡'FêSA~\~ Vi ?(., t,c '.., -'~ ., ',I! ~ )} ~~ P~l k"~~.~¡ . ,-" ,,' dr- i7 _oJ:: JW:-<-i! "~':':..-\ ~(¡; .~> "¡.,.:~~~}j r ;i...",......\... \.., '\ '_\ t~ !" 't, · ,'{ " ~\;.:. \ ,,> /~' ,/ . ',: ._~, . ~ '<;~ j- / ,I [ . "'!I~' :1\ i1JÞ< ". ./' t"' A""::"" I,' ")/i<-!' ~,~ '" ~ .... ....;¡ ,\. ('l ~, ~,r . " ' \ ", ~ '''' "~:o,:,~ ¡ '1 J) \.' 1 1 "h'" ,.' ," .I' .. 'Ii ': ''','" , l:b...z~<~ ii...), f., '>1 ¡('" , " ,f" _,~ -, ...~"](....,,_~...,....,......~"'"...,....'f', ~ .f ~~JI- " '>.. ~-.... ..J."",,~ ~.' , ' ",if' ... ~:'~"'::'"", ~ ; 17- . { l " -~.)~';"". ,..".' ~~""'''''''~\'M\~~ ' t , r . '/',.. ,,',;-.. :,::........ ,,' .i~þ;i- '..,''''':~'' Issued by: to Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This oermit is issued for the followina: o Hazardous Materials Plan o Underground Storage of Hazardous Materia_ o Risk Management Program . .. o Hazardous Waste On-Site Treatment 93309 -, ~' Bakersfield Fire Department. OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 JUN 2 2 20Ò1 Approved by: . Issue Date Expiration Date: June 30, 2003 . ~ , / ~~ . . ~ZARDOUS MATERIAL D.LOSURE e SITE PLAN Chemical Inventory & Business Emergency Plan . . 1 1 :1 2 L 3 4 CALI FOr¿NIA AVE. 4 5 ¡:.. 5 ~~ISf'f œ~e. tll'\E.')CrcA'L.l ¡: 6 7 "PARt'tt4l:r lof' PAt2.¡¿jÑE-a Ldt, 7 8 V\', 8 I 9 f 9 ~ . I!ID ~ ~ 10 g @ . 10 ~ ¡~ PÅ~I Ne. ..L..Þ1- J2A:LpHS 11 ~ "53 11 ~ I I ll.I 12 <= 12 ""- V\ ~ ~ 13 ! tfi 13 tm:l @~ 14 PAE14 Nr&, Lcrt.- <® 14 15 ' 1 ~ NM r ® 15 6u (Z.(:{ eR- n¡:. 16 16 17 vA£MJ+ Lot 17 Ralphs Grocery Company - Store # ~5-3 ADDRESS CITY 52.00 gfoQ:::DALE 1-IW4 BA.KEJ2SR E.LD --------- '- Per it Operil.te ---~oìl ¡ " to Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: ~ Hazardous Materials Plan o Underground Storage of Hazardous Materials o Risk Management Program o Hazardous Waste On-Site Treatment PERMIT ID# 015-021-002185 L RALPH'S GROCERY SToRE/ft' l?< LOCATION: 5200 STOCKDALE HWYl' I'} t~·, ..'J :; '.'¡ TANK 015-000-2185-001 015-000-2 i 85-002 ~ARQ9Q~ SUB$~ANC~~:. ' ~Qj~t\~_~Ih ':' ," "~"',,"P ..",~ '~!"~i'~~'''''.· Rl!GÙLAR UNLEADEJ),QA~~Ê' " 20000 PREMÌUM UNLEADE[j''G!4:~E 80000 'i . . ;',' . ..~~' '..' . ~- ,: \~ "-l..,;-'. :í ~," ~}A' . Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SERVICES' 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: Issue Date June 30, 2003 e . CA Cert. No. 28506 I City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (661) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to the issuing agency: Use the space below to enter the following infonnation in the fonnat of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. This permit is issued on this 8TH January'.2002 to: RALPH'S GROCERY STORE #653 Permit #015-021-002185 5200 Stockdale Hwy Bakersfield, California 93309 )" ,.:.., " I -- -- FACILlTYNAME~\ fA^ is G{'ÙCeNð~ INSPECTION DATE '1/z.z-/dV Section 2: Underground Storage Tanks Program o Routine M Combined 0 Joint Agency Type of Tank ~1)N F Type of Monitoring CJ....M CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave.. 3 rd 'Floo r, Bakersfield. C A 93301 o Multi-Agency Number of Tanks Type of Piping ~ Complaint t>W£ ORe-inspection OPERA TION C V COMMENTS Proper tank data on tile X' Proper owner/operator data 011 tilc )( Pennit fees current X Certification of Financial Responsibility x: Monitoring record adequate and current ')( Maintenance records adequate and current v... Failure to correct prior UST violations 1)(. Has there been an unauthorized release? Yes No -....J Section 3: Aboveground Storage Tanks Program AGGREGATE CAP ACHY Number of Tanks TANK SIZE(S) Type of Tank OPERA TION Y N COMMENTS SPCC available SPCC on tile with OES Adequate secondary protection Propcr tank placarding/labeling Is tank used to dispensc MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: Office of 26-3979 J,~lfµ Business Site Responsible Party Whitc, Fnv, Svcs, Pink, Busincss Cory It RALPHS 5200 STOCKDALE HWY BAKERSFIELD CA.93308 B1298634005001 SEP 22. 2004 3:01 PM SYSTEM STATUS REPORT - - - - - - - - - -. ALL FUNCT IONS NORf"lAL 'NENTORY REPORT I:UNLEADED 'LUf"1E 12587 GAL .LAGE 7116 GAL ¡'Yo ULLAGE= 5145 GAL VOLUME 12471 GAL 'I GHT 69.55 I NCII1...,... fER VOL 0 GALS ^ ¡'fER 0 . 00 INCHES Y,'liP 73.1 DEG F T 2: PREr"1 I Ur"1 VOLUr"1E ULLAGE 9œ~ ULLAGE= TC VOLUI"1E HEIGHT WATER VOL ~~ATER TEf"l!> 6672 GALS 1145 GALS 363 GALS 6589 GALS '32.71 INCHES o GALS 0.00 INCHES 77.7 DEG F M M M M MEND M M M M M e UNIFIED PROGRAM IN'ECTION CHECKLIST ~~~~~~ðt':it.~1"dt.-.;:~~~~~~fil:W~~WÃffW~~~ÿ¡ß:~~t SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 ::~~~.~~~=~~1f~I....-_._ .__..u INSATION DATE INSPECTION TIME -.--- c:!__7,z.Lº~ ~-'----...--..-..,-- PHONE No. No. of Employees ---." ~-------...--" ...-'--..1-..-......' .... FACILlTYCONTACT Business ID Number 15-021- Section 1: Business Plan and Inventory Program' LJ Routine 1a( Combined LJ Joint Agency o Multi-Agency o Complaint aRe-inspection C V ( c=comPlianCe) V=Violation OPERATION COMMENTS _!_E.__~!~~.F'~~~~_~ER,~~~~..HAN~_"__,,,_____..______,,__ ,_,____,,_,_, ,_,___._ ,..",., &'__, a _~USINESS_~~~,~~_~~~"':..I~~~,~_M!'~'~~~~~~~!'~:___ ,_,.., "....____,.,_ ._____ ~_~- VIS~~=!~~RES_~_,..__",_..,,_,_,_____ ,_,_________,___,____, _____.".. ~____~_, C~~~:~~,O_~~~~~~~~_________.._._"..., ______.,_"",___,___ __ _,,______, ~ a' VERIFICATION OF INVENTORY MATERIALS -_..- - ,--".-.._- ------"------.--.-..-.. ....- .---.- ...- ------...- "..--.--- -.._-.- "--- ---. .. ....- -"~'--'--"-----'-.--'---" ---'--- -_.~- ------,-.-----.----.- .-." ---'---'-- ----~----_.-_.~--------.~----------~._--_._-------_._------------- .-..._--~_._----_._-- -'- --.-----..---.--- -._--- --.- u. ..______._..____...._..__.__.._.. _.__..._ ~ LJ VERIFICATION OF QUANTITIES _______________...._____._._~___.__.__._.._.._______.___,,______...._..____.___..._.___________.___ _._.______ _..._ __.__._.__.._._._.___~____u ._ __.._ ___ _._______._._.__.,_____..._ ìt__~,_ VER~':~~~~~ OF ,~~~~I~~__ _,__ ",__.___,,_,..'..,____ ,___,___ ,___ ,,__.__,_.. ..._,.... _,....._,.. .,.,____,_,._, ~~,..,~_~~~-=~_~E~~~~~~~~_~~~~~I~_____ _...,.____,___, ,_, ....,____" .. __ __,.. ,. ,,_, ," _ ,._ ,_____ ___. ___,..,_ _____,,____ a VERIFICATION OF MSDS AVAILABILlTYE -----.-----.---.-.----.-----.-----.----- ..-....-...---.--......-.----- --- ----~---._._----_.._---_..- a VERIFICATION OF H~AT TRAINING td C] VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES .~----_._----_.__._..__..._---_._-~--~-_...~--- ---.-.------ -- .-..--.-----.---..----.--- It a EMERGENCY PROCEDURES ADEQUATE n__ ___ _.__._..____.__.____...._.______._.___.~_ __.n___________..____ ______ ._____ __. ._____. . ----..----...----------.--------.-.-. --.-.- ------..----.-----..---.------------.-------...----.,----.----. --.. -'-'- -.---.... -..- ....---- ---- ----_.~ ~ a CONTAINERS PROPERLY LABELED ~..~..,'~O~~=~==_~I~~____,_____,.,__"_"'__,_..._~____.. ~ a FIRE PROTECTION _~.___________.n__.__._._.._._____ ..____._____.___ _n__._ ____.___..._____._ ~ C] SITE DIAGRAM ADEQUATE & ON HAND ..-------.-- ._.-~---- -. -. ------ -.-------.----- ..--._-_. --.._-_.----------~ -'-- -"--.- .. -.-.-..- -.---' -----. ..~---_._._._---..._--_.- --. -------------._---_... _________.___._...____.... _n___..._.~___ ___ -- --. ----..-.. ---- ----- . ._._~-.. ._--._.-------~._.- ANY HAZARDOUS WASTE ON SITE?: C] YES !\NO EXPLAIN: QUESTIONS REGARDIN THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 rJI~tòr (Please Print} . -~, ---..'Firep;:evention1st:inIShiftOfS¡te"--' 0" Uhite ' Environmental Services Yellow, Station Copy ~.~.~~~.~-- Business Site Responsible Party (Please Print) ~ N 12 Pink· Business Copy \. s·~. . 02-16-04 07:50am From-TAIT EN~NTAL 714-560-8237 ' T-954 P 01/01 '''-. SEP 25 2002 10.52 BKSFLD ~IRE PRfVEMTION (661)~o2-2172 F-250 p.2 CITY OF BAK;ERSFlELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM FUEL MONJTO!u;NG CERTIFICATION .. , '.' ,'.:. ,...... . ',., I ' :.: . l ,... ... FACILITY ~a.lph. $ '"# G 53 ADDRESS $3-0D S-foc-*d~/e. t/wv:. g~k~-.2.yÇ'~£.l) . . OPERATORS NAME æ.9./I'A 5 OWNERS NAME 12~1 ¿J.A $ .~~'~_;,:'. ..,..'. .. ~~:~: ::....' .. ., , .. NAMBOFMONlTORMANUPA~V..p~e.Y'·· ¡l¿¿or /YJA-'Û.J ~r DOES FAClUTY HA VB DISPBNSBR,PANS"l .¥SS~.<_.~. NO_ ~ 'fê.sf- Øí, q I p¿.,¿.¿;; O/J/ y, TANK. t# . VO~UME CONTBNTS '" ...... '. . ',' .. .. ,. '" ..... .........,.. " ... ".....-.-.. . NAMEOFTBSTINOCOMPANY .7Zf; r CONTRACI'œS LICENSE #. . ~ß,ß.':".D 9. 6 .." NAME & PHONE NUMBER OF CONTACT PBRSON.¡9vA-?V TArl/Jc ~YYI/)r~AJ DATE&TIMBTPSTISTOBBCONDU~ 2-;)..7-0 Y <; ~ .. ...... -. .. ....._- . I ~ :::z.,¡!,,~~~ S~ON!!-':f.URE OF APPUCANT ..' ",J. fì' ~ t[ ... ...._.._.___' pATE ... .,.-...----...,......, . I' .:....:.._.~...:_.;__. -4_· 'n ...... 1'- .;.' ~\d ''-/ / 01-28-04 11:24am From-T~IT EN~MENT~L -~. 714-580-8237 T-889 P,01/01 BKSFLD FIRE PREVENTION (661)852-2172 F-858 p.2 SEP 25 2002 10:52 CITY OF BAnRSFlELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326·3979 'I"'~' APPLICA 110N TO PERFORM FUEL l\'IONIT01UNG CERTIFICATION , . .... ." l ,..... ,... :...: ~:. . ' .: ~ . ; .. "'. . : .... . FACILITY !2.A / ,tJ 1-1 5 ADDRESS .s-zo~ Sl-t?ê-!rÞ&t /~ /-1tA.) V OPERATORS NAME ~ I PH? OWNERS NAMB· J2at p}.l. 5 ,...', r,;,: roO -',' , ,,~,~.. "" ..., ,'. .- .............. . .. . NAME OF MONITOR MANUf'1\~ .v'~.er.: J'2po.r' DOES FACILlTYHAVB DISPBNSER..PANS? ~~'..:...., NO_ TANK t# , ;\- , Y°l:UMB .. ., '6)10 ~ . , '. ',: :ß\C·..,,.: . '.' CONTBNTS R.c-f - (trJ{f/r/ VfCtIi\... ·r '- f' , . . 'M''''', .. . ..- -......."..... . ..... ...~P ......... ...., NAMBOPTBSTINOCOMPANY'YA-l'( ß.A.)V Sy~? CONTRACTORSUCENSB' S2?rð7:P¿¡ ~ NAME & PHONE NUMBER OF CONTACI' PERSÒN ~ -n,l'"C£.-..b"o,,;kJ..J 71 'I-:$"6 r- 6~/6 DATE &. TJMB TBST IS TO BB CONDUCTED '2 - "'3 - 0'1 t£- 10 ~ ' J ~..~¿i/01 I APPROVED BY .., . _____._,.PJ\1'B , , ðÄ~~~~.A-7~ ~GN~'.f.URB OF APPUCANT ,. ..---..--.....".... ,. ....,-. p' ........ ·}f '" '\tJ 12/113/213133 '<7 16:22 661392a e PAGE 132/13 MONITORING SYSTEM CERTIFICATION FOI' Use ßy All JW'udict¡'ons Within the Stale ,!(Ca/jfomia . Alllho/'iI)' Cifed: Chnprer 6.7, Health ana Safety Code; Chaput!· 16, Divi.rion 3, Title 23" California Code ojR(!g¡¡JC/rions Thi:.< fOl'l\1l1.1l1St be U!led to dcc:ument testing &\n.d servicing ofmonj,tori'ng equipment. A sepwl.~ c.ertiñcation Or reno,'t must be Drè\J~ln~<! ;fuL@.monitOl'lne. SV:ittml control pane! by the technician who perfonTIS the work. A copy ofthi! form must be provided to the to\I.\\' ~Y~[~\1 owuçr/opeJ'ator. The (,n,vncr/ope.rator must submit a coµy of this form to the local ag~ncy regulating UST system$ within 30 d¡;¡ys 0f r.:-st d¡1[~. A. Gt=nerallnformad,on ,f~c.ilily Nnn)~:i<AL't'Jt' 5 ~ Roc..1ë f!.. y Sit\." Addr¡:3~: _~_t;JD tS7ò <.~ 'Þ~ ~'þV"y Fac ilit) C ontac{ Person: Mal(¡::iMo~id of Monitoring System: t.lL~-~ Bldg, No.; .__ City: 15At:-fÕt-S Ff.EI-Þ Zip: ___.~...:'~.. .. Contact Phone No.: ( ) w., ___ Tf..-$. $ "S'b Date of Testing/Servicing: ./:J. I ~/Q?_ T¡I~ .to: ___(,¿.r.L~~ Tuk ID:., ~.,..,""--- œ"""Jpo-'Cmf... G:\lIging Probe. Mode!: '1rt¿;':.:.l 0 In-Tank Gauging Probe, Model: __.__._ '___,_"u ~þnnuur Sp~e or Vau!t Sensor. Model·.;J--;;¡ 0 .A.nnular Spo.c'" or Va.ult S~ngor. Made!: !Jii(jìoiping Sump I Trench Scnsor(s). Model: ~~ 0 Piping Sump I Trench SeOSOI'(S). ModeL ifFiU Sump Sensor($), ' Model: ~':!L CJ Fill Suri1p Sensor(s). Model: o ~ht1J1¡c.l1J Lint l.è3k Detector, ModeJ: CJ MechanicaJ Line Leak Detector. Model: 1W"1:I.::wvnic l.inc Lct\k Deleel()r. Model: ?LL 1:::> 0 Electronic Line Leak Detector, Model: o I!!.l1k O\'crlilll High-uvcl SeLlSor. ModeJ: _~_.~ 0 Tank Overfill I High~Level Sensor, Mode!: __.. o Or.hcr s ed e ut me1\t [' e and mude! in Secdoll E On Pa ,e 2 . a Other s eei e ui ment ~ and mode! in Section E on Pa c :n. T~lD:b1 - ( TJlnldD:_ !f ~-rarl." G:lUging Prob~. MOde!:';'¡ ,4,6--1 0 II\-Tank Gauging Probe. Model: ¡(' ~I\uladpac~ or Vuull S-:nsor, Modc:l; 6';~ 0 Annular Sp¡u:e orValll{ Sensor. Model: rJ'"ßi'ping, Sump I Trench Seo~or(~). Model: ~ ~ --- 0 Piping Sump I Trench SenSòr(s). Model: _n rr Fill Sump gC'Jsorls), Mod-:!; -AÆ..J:L-.... [J Fill Slimp Sensor(!). Model: o ~Þ.l1ictll Une Leak DeteCTo.r, Model: I:] Mechanical Line Leak Detector, Model: 1iI"1:1,:.:tl·ol\ic Line J..l!ak Detector. . Mode\; ~E__.__ Q EleC\rQl\ic Line Leak Detector. Mt)de:l: =---==--==-= o J;ulk O~'errjJ I High·Lcvel Sensor, Mode]: __~_ 0 To.nk Ovcrt1l1l High-Level Sensor. Model:., .______ o Orh¢r :I ~.:j.' i: IIi meM and m()d~1 In Section E 01'1 Po e 2 . 0 Other s ccif1 e ui ment e ~\I1.d model in SCClion Eon Pa 'e 2 , ~~iS. ..1S:1'~~~Õ¡;-~~~~'ent Sensorl!!). Model: ~ ë~.__ ~~iS, ns:~:e~~ontl\mme¡,t Sensorls). Model: ~ ~Q.~ ,q ÐP.::_-=--_ S11~3r V~he(~), . Shear Valve(s). . o Dis )~lIser Conrainmenr Floa! s and Chain s , 0 Dis enser Containment Float S slid Chain ; . Dis~lSCI'lD: tt:~ Dispenser ID; æ--r~~U.s~f Containment Sensor{s). Model: ¿:(~ 1. 0 Dispenser Containment Seosor(s), Model: 5r'Sh.;:u· V9!ve(s), (J Shcllr Valve{s), Û Db )çn~~r COnlaÎnmc:-nt Floil! s and Chaíll(~), 0 Dis e.nser ContÐinmem Floar(s and Chain s). Ç>ijPi!,lstl'lD: Db¡u~nset JD: (~(Ù~'~lhi~1' COnTtlinrnent Sensor(s). ModeL: :2 "l1:~.~ Q Dispenser Conrninmcnt Sensor(s). Modcl: __,'___' ... (!1'$hc:'nr V¡L!Y<I(s). D Shear Valvc(s). CJDi~ ~ns~' C"J1hl.i]1ment FIOilt S JII1d ChDin(s . a Dis e.nScr Conrs.inmènt Float S Bnd Chain s . ·.JftJ)~ nl.:JJh)' COl1ll1iM more rnnks Or dispensers, copy this fOI'J'n, Inc1udc informlltion for every t9J'1lc and dispensef B.t thl1 fi1cility, C. C~rtification - 1 certify tllat the equipment ic:lMtit1ed In tills document was io.spected/serviced in accordance with the ma11UraCUJI'l"I'S' ~uid~lìtlè~. AUllched to tb.is Certificatìon is information (e.g. monul'acturen' checklists) nec.essal')' to verify tllllt thls inform:lti,ull is ~un',\ct ~lId II Plot Ph\o showing rile Iflyout oi' monitorin¡¡; equ~t. For IIny equip ~ pillblc or geneutin" suçh r~ports, 1 bave: abo , 1I[~!l~hl!d \Copy o~·thereR0':.Ì;M~I!Ck,¡IJ/ (¿t 4~~ lir'System ~ - p , ort TedJUlcloan Name (prlllt): ~ "" ,_ SI.g!), . .,.,..-- Ct::rr11k::ltiùI1No.:~cJ/O Licen.se, No.: C61/D40-. #809850 'fèSÜllg Company Narne: RICH ENVI.RONME!!!-L Phone No.:(661 .J~3-868~,~,____. Sh~A¡jdJ'~s!>: S~'D '57ð¿j!."þAtL f#v'L. ÈA#Ep.r~fi:¡;pDateofTtsti.ng!SerViCing;~L/O? ....1·'-..··..--···· ~I_-·--.'- ....--.-...--- . ....----- -' ----..-.. .page t of 3 031/1J MOIli[orill~ System Certification , 12/10/2003 16:22 661392a e PAGE 03/13 ,. .D. Iú:sults of Te::jti1JglServicing ~ùÜI\an~ V~I'~k¡l.1lL1~talled: --1;):;)..~.E.._D..,_....... ...,.,..._...__ . Ç,~\':lc_.!lIt' [ùIlOWII\'" Cßl'cklist: II" (j(\~ _ !_ Q Na.:,.. 15 the auà¡bl~ alarn1 operMional? I, ~k:; ~ ü NL1* h the visual ¡larm. 0 erarion;ll? f~ \;~t ~ !'!o'" Were all se.tlsors visuaIJ ÎJIS. ec~¢d fLu~ctionall tc:n.e and c.onfim1ed 0 era~,On£l]? I ~ U N()'I' Werè all SellSOrg insudJed at lowesT þ01l'lt of secondary ':onta.uunent and posltlot'\ed !l0 that other equipmeuc will I, ,.._"..::: M[ inœrfel'e with their r~r operauon? r«-y~·;-¡ 0 Nù'" If alarms are rela.yed LO a remote monítorin.g snl[lon. is all communicatiollS equipment (e.s. 1110dem) ! 0 NiA ùpèratioIlJilJ? ~s 0 N.)'" roar pl'euurized pjpin~ system,s, docs the turbine autoauuicall}' £h~lr åOwn if ¡h.e piping secondaJ')' conmiruni&m (.) NiA IUL)!ljcoring SYStçl)1 deceCt9 1'1 leak, fails to Opel'f"~¡¡¡ elecrricaUy cliscONtécted? If yes: which $~nJ)f,)r~ inirim", posirive shur·down? (Check &/11 (JIf,1t apply) on3L1mpffJ'CJ1ch Sensol's; .Q15fsPenser Co~enr Sensors, ~ Did O~l contìrß1 ositive sbuc-down du.e to ,leak, §lli! se{l$or C¡Uul'eJdiscon.nection? f!r\Ies; 0 No. I '$' ~~'~-::--_... 0 Nu" For rank systems that uIilize d\e monitoring system as the primary tank overfill warning devict: (i.t:.. ;-~;-. I~:' /0 C) N..A l}1çch";Ojclll avc.rtill pr~venti)n vaive i.s installed), is the overfil1 wl\rní~g alarm visible and. audible ~ d\è rank. fill OlD[ S and 0 el'1Hm" 1'0 erJy? 11 so at wont ercenc of.tflok ca flCIC does !.he a.lann en '~ér'? ~v '1., I' '...1_'. 'i-:j;* l' -, N~ Was l:my moniwring equipment replaced? lfyes, identitY !!pecific set1S0r~, probes, Or oth~t eqLJÍpmem replaceù ...... and I ¡st the n\anuD:lcturer liame aDd mod~¡ tor aU re laccroelH a.rts in Secrion E, beJow. 1\ W Y...~" r œ'Nù Was liquid found inside nay secondary containment systems designed as dry systems? (Check all fhat CIpply) a L" .... ! Product' 0 Water. If yes, describe causes În See cion B, below. I' ~., í 0 Nù" We\S mOJ1itoril1 T s stem seHI Nvit!wed to eI:l~\J.re ro er settio s7 AIt'ach set u \'~~ \ a No· \s all monJrorÌJ117 e ui ment 0 )eratîonal er manufacturer's s ecifieaeiol\s? I .~... ~ i.. III ,-);:c[Íou Iì b~l/Jw. describe bow and when these deficiencies were or wiIJ be corrected. £. CtHl1lllen c.s: -......,.....- -_...._....._I_,·_-.~........_---··.. .......... ....-......--......- .........-...-. ., .--...---.-...--.......- _""'''-'-'-'''<0- . ......-.-.........-. ................. ....-. ""'- ..... ·.·.0 ,..... _.__.___._........_.... --_....'~................__...... --.....-.---......-.......-... .....-.. .....-......."....-.. ..... ..--....-.................,...... .-. ., ..----..--....---.....- ....~. ...._". .... .... .--.--.-- '.".'''' ..-..........-.... .'--'--"- .. .-. .......--.-......-..-....... ........-...,...-.- .--.-.-..-.. _ _..._____.__.H_...-··_ ...----.. ....... ."--'" _...··...w,_·____..·....· . -----.--.-- -...... ...-.....- ..... _ -...--....--..,,.......-..-.... .............- ..-.. . -...---- _ . ,,-- ......--........----- ,'.-'- J..__ -........-.................-.--..........-. -~-.---_......- .--...... ----.-. ..-. .,-.--. ....-......--- .. ... -....---... Page 2 M3 U3/01 12/10/2003 16:22 661392_ e PAGE 04/13 }~. ~¡).-·f¡H1Ji G~\U"ii:.g / SIR Equipb.1et\t: ¿C:Ck t1iis box if tank: gauging is used only tOl' ¡nv~ntory l;ol1trùl. o Check this box if rlO tank gauging or SIR equipmenr is in.staHçd. 'T~hi:-; :-;~~tion must be cOl1.1.pleted ifin~tan.k. gauging oquipment is used to perform leak. detection monitoring. C<.I'!'.I!.!0 ~ th<¡! r~lu\)\vj'lu cheçkliu' I¡=g-~i~_-=-J_'?~ .!:II13 all input wiring beel' Ìl:13peCted tor proper enl'1jl and tel'mi.l'letion. including testu,g for ground faults? - U y~~ ! 0 NQ* Were :1011 tank gaugh1g -probes visually inspectc:4 (01' dlln1t'1ge and rosidue buildup? Ii 0 ··~~~:t~_~~1IÞ·' Was Elccurlilc,y ofsysrem prodllCT level re¡.di]1gs tested? ~.::,:~ I 0 No'" w~ flc;cllracy OfgY3l'~m water ¡tlved r~lIdillgs tested? o \.;:$1 U N)'~ Were all probes reinstalled properl)'? @,\"~,~__.J 0 No'" W~r; ¡¡JJ itE:ms 011 thè cquipn'\dD.t n1f111ufactuJ'e¡·'s maintenance check]ist complet.ed? " iu rill' :;ç~fi4)tJ H, beJow, describe how and wb~n r.hese del.'i.ciencies were or will be corrected. <G, J.i.Üo; l_c~J.. j)~tcctors (LLD): o Check this box ifLLDs are not installed. Ü.\)¡Jlèr~ r}~ fol1owine- c eck ist: Œ?\' ,t:- 0 N ~ For equipment srnrr-lIp or annual equipme~ati()n, was a leak simulated to veri1)t LLD perform:mce? . 0 0 N/A (Che"k llll th4/ apply) Simulated Jem, rate: "g,p.h.; 00_1 g.p.h: 00.2 g.pJ1. ~~. 0 No" Were, all LLDs confirmed apèrationaJ and accurate within regulatory reql.llremcnts? I!f '\ ~s !O No" Was ù]e testing appnratus properl)' calibrated? o \'.;s a . . 1'01' mechanical LLDs, does the LLD restrict product flow if it detects a. leak? L~ ær'Y-.;s For eiectronic LLDs, doesth~ turbine Quto,,",adcaJly shut offïfthe LLD detects a leak? .. o No¡: -- f-o NiA ,I I1l"'Y¢s 1 D Nv" For eleen'onie LLDs, does the tm'bine automatically shut off if any portion of tbe moniToring system ís disabkc1 I ! -0 N/A Or dis¡:onn~ct~d? ·~O No· For electronic LLDs, does ib~ tllrbiœ automatically shut off if any portion of the monitoring system malfuJ.1ctions .~~-- o N/A or tail:! n test? o No· For electronic LLD~, have aU accessibie wiring connections been vis~lally inspected? ..~rg ~~; Were aU items on the eqllipm~m manllfacturer's I\\alntenllnce checklist completed? j ===..........,.' h " 111 rJll: $~rlUl\ H, below, describe how and Whèn tbese deficiencies were or wJll be corrected. H. Ü.munems; ._," ". ~ _,__,._____.__..__....~~.____..__......,__....·_..,_4.......__._......___._ ...., ...---.... .....,.....~._- .'. ..... ....--- .-...--.....---...-..--.. --------.- ..'__.__oA.___".___-....··_.___ . ". . .-....-. -----,-'...,_............... .... -...,.---..-...-- ._.._--,,~.., ,.-..... "',.......- -.-.....-.... -_........--.-..... ___..n ...___.._ ___..__ --.---..-....-...-...- .Pa (le 3 01'3 OJ/UJ 12/18/2883 16:22 661392_ e PAGE 85/13 MØ.nil()I'illg .system Certlflcallon S it\': !\,¡,1dr~5S: _ 5 ~t:;;70 UST Monitoring Site Plan ... A CS,()"(P~ H~I 7:L~il2SFI(¿Ø J"'c-n : :.I:~ .~. :r:-)~ ~e,:/: (j) f: : : rpi/~ : , . '-¥J ' .vUfr'\..··' · .. ,I · . . . . . :6:::' · A~I."'\-Œi2: : · . , .1A~¡2. ,~) :Ia~· . . . , . Mql'\·t~ .il!: . . . , . 'c.A'5 /f{~ ~ 't, :'1D~: , '!,5,D . J. ~ . {:) fö~/<.7>~ n ~ ~ 'tfJi'V' Dare map was drawn: I '2¡ _?j~~.. Instructions If ~¡)U 11l1"~ady have a dÜ~gram that shows all req~Üred information, you may include it, rather than this page, with y¡)ur Ml)fliwriug SY$tcm Cert¡fica.ticll. On your site plan, show the gen.era.1 layout of tan.ks and piping. Clönrty tdcntify 1.¡)~:ìTjons of tl1~ following equipment, jf in~ta.\led: m.onitoring system control panels; SC'nSors m01'lítor\1ig tal'!k \u'IT\\Jlar sp¿c~~, ::ìumps, dispenser pans, spj]J cOlltaìnerg, 01' other seconda.ry contaÏJ.rment areas; mochan.ical or electronic line leak d¢f¢..:t<..1ÎS; Md ill-li1nk (iquid level prQbes (if l!sed for l~k detection). It\ the spa.c.e provjd~d, t'tQt~ the date th.iR Site PLan \"¡l,~ pr~p,j"ed. Page _ot'_ 115111(1 \' '. e 661392. 12/10/2003 16:22 PAGE 06/13 MONITOR CERT. FAILURE REPORT saE: NAME: R.,4t Pil'S 6- f2v G lEt!. Y MP~Sa: 5~OO sroc-/<þA-L-£ ~ý CIT'i: 16~~ t:A- 1;;1.... }' -or) :; "t -'~ SIGNA S¡n CON'IACT: THE FOLI.OWING COMPONENTS ~ ilJi:PI.ACED/R.EPAIEŒD TO C01G't.2'J)~ '1'B1i: MONZTOIt C~~I~¡CA~¡O~ ~ST¡~~. LIST OF PAJi\['S æpI..ACED/REPAI:RSD: . REl?AI:RS: /l/ 0 /~ LAB01\: .;f/O~ P~'1'S INSTALI..1i:I.): A/ð~ ~. ¡. 12/16/2663 16:22 ro£IVER SETUP: 2:KMA DIVISON OFFICE -310-900-6965 m TVP£: FACSIMIL6 }RT NO::2 m\"' NO: 5 ~RY OBtAI¡:': 6 ~NPIR~T10N REPORT: OFF 3:TRANSPORT co 2S-9045 NR TYP£: rACSIMJt..E )RT NO: 2 ;TR\' NO: 15 STR"i DELA't': 6 )NFIRMATION REPORT: OFf 4: TRANSpORT CO 28-9046 ;VR TVPE: FAOS I M t LE: ~RT NO: 2 ETR't NO: 5 STR"t'· DELAY: 6 ~NFIRMATION'REPORT:OFF 5: TRANSPORT co 28-9045 iNR TVPE: FACB 1M I L.6 ORT NO: 2 ETR\{ NO: 6 ETRY DEUW: 6 ONPIRMATION REPORT: OFF UTO PlAt. TIME SETUP: . 2:KMA D{VISON OFFlCE IAL. DAILY tAt TIME: 4:00 AM ECE rVER REPORTS: Sl{STliI'1 STATUS INVENTOR\' : PRESSURE I.LD REBUt!: LAST DEI..lVERV : a : TRANSPORT CO 'IAL DAIL.'i .¡AL TIME: 7;00 AM :£OEIVER RBPORTB: INV£N"tORY I 4: TRAIISPOIn' co IIAL DAIL.Y IIAL TIME: 1 :00 PM !ECS I VER REPORTS: INVENTOR\' I 6: TRANSPORT CO IIAL DAIL.Y rIAL. TIME: 5:00 PM :ECEIVER REPORTS: I NVENTORV 661392_ ~-~~~ šNU Oy M~~~ DISABLED AUTO DIAl. ALARM SSTUP - - - - - - - - - - - - D 2:KMA DIVISON OFFICE I N-TANK ALARMS ALt,:HIGH WATER At.ARM AL.t.:LOW PRODUCT ALARM Al.L: INVALID FUEl. LEVEL ALL:PROßE OUT ' ALL:HIGH WATER WARNING ALl. : DEL ¡VERY NEtmED ALt.:MAX PRODUCT ALARM LX QUID SENSOR ALMa ALL ::FUEL AJ..A:RM ALL:aRNSOR OUT AIARM AtL:SHOR'r ALARM ALL.:HtGH L[QutP ALARM ALL:LOW L.IGUID AL.ARI'1 EX'Œ~NAL t NPUTS ALL : E)(T~N I NPU1' AL.ARM PRESSURE LINE LEAK ALL. : G80SS LINE FA I L ALL. I PL.LD OPEN ALARM ALL : PLLD SHUTDOWN ALARM ALL :L<>W PRESSURE ALARM ALL: CONT HANDLS Al.M ' ALL : F'UBI. OUT ;. ' ALL : LN EQU I P FAULT ALM P 3: TRANSPORT CO IN-TANK AlARMS ALL : OVERF I LL ALARM ALL:L.OW PRODUCT ALARM AU. : HI CH PRO,DUCT ALARt1 " ALL: DEL I VERY NEEDED . ALL:MAX PRODUCT ALARI1 , I D 4: TRANSPORT CO ' - NO ALARM ASSIGNMENTS - IN-TANK SETUP e - - - - - - - - - - - - T 1: UNLEAPEP :ÞRODlCI" CODE' THERMAL COEFF TANK PIAHS1'SR TANK PROf'II..S FULL. VOL 87.9 INCH VOL 68.6 INCH VOL 2~.:3 INCH VOL ,1 ,DOC7G,o; 117,171 4 PTS; 1 970~ 1631~ 10l? 391 I FLOAT SIZE: 4.0 IN. WATER WARNI NG : 1 Q HICH WATER LIMIT: 0:0 MAX OR LASEL VOl: 19703 OVERFILL LIMIT.: 90% HIGH PRODOOT : 17~~ DELIVERV LtM1T 18Iâ: 295~ 6?~ 60 a.oo 0.00 LOW PRODUCT : ,LEAK ALARM LIMIT: ~SUDDEN LOSS LIMIT: ¡TANK TILT : i PROSS OFFSET : !MANIFOLDED TANKa I TIt: I'«>NE I ¡ UAK MIN PERIODIC: ! : i , .! LEAK M I N ANNUAL : ! , - 5% 986 9~~ : PliR I OD I C TEST TYPE . . STAND~ D 6:TRANSPORT co : ANNUAL TEST PAIL . . j - NO AL.ARM ASSIGNMENTS - ALARM DISAa~ 'PERIODIC TæT FAIL ! : ALARM PlBASLEd ',GROSS TEST PAIL' I '; AL.ARM D 16ABL~ . ' ~ANN TEST AVEMGING: OFF! rPSR TEEl1' AVERAQIN(H Ot:F: I , . TANK TEat NOT I ¡:y : OFF: ! \TNK TaT SIPHON aR6AK:O~ : ¡DEL!VERY' DELAV : 6 MÙ~ i: . tUl!,.. .T_~~~~~- ~J'; }'~ ..9~ , ' . ! :' .._~ . . .. I II, " ." .:.. " ,r, PAGE 67/13 T 2:PRSMl/J'1 PRODUCT CODE THSRMAL COEFF TANX' II I AMETiR TANK PROFI!.;E Fut.¡, VOL 8e.6 I NCH VOL 59.1 INCH VOL 29.5 INCH VOL : 2 : .000700 : llB.13 : 4 PTS ; 7917 : 6382 : 399~ : 1090 FLOAT SIZE: 4.0 IN. WATER WAANII«J : 1 HIGH WATER LIMIT: :3:g . MAX OR L.A'9EL VOL; 7817 OVERFILL LIMIT: 90~ . 7035 HIGH PRO"""......· ,. 960- '........., T. ~SLIV~R\' LIMIT ; 71~ 781 LOW PRODUCT ~ LEAK ALARM LIMIT: SUDDEN LOSS LIMIT: TANK TIL.T : PROBE OFfSET KOINIPOLD2D TANKS Ti: NONE LSAK MIN PERIOOIC: LEAK Ml N ANNUAL : 2q2 15 50 0.00 0.00 5% 390 5" 390 PER I OD I C TEST TYPE , STANDARD ANNUAL teST PAIL ALARM P,I BAS LED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM D 1 SAaLé:D ANN TEaT AVeRAGING: O}l!F PER,TEST AVERAGING: OFF TANJ< TEST NOT 1 f'i : OFF TN!< TaT en PHON SREAK: OFF DSLI~'t DEt.A"i : 5 MIN PUMP THRESHOLP : 10.00% .. _.. -. .. .. 12/10/2003 16:22 . - '.- -. .-.... - - - - - - - ~ ~ - - - rEST ON DATE : ALL TANK JAN 1. 1 996 I ~TART TIME : DISABLED " fEST RATE : 0 . 20 GAL/HR! JURAT I ON : 2 HOURS ' , . raT EARLY 8TOP; D [6ABLED . -EAK TEST REPORT FORMAT I NORMAL )RE8BURE 1.1 NE LEAK SETUP . - - - - - - - - - - - ~ 1: UNLEADED rYp:¡ ,.51 N ENVIRN GFLEXII .. I NE LENGTH: 180 FEET 3HUTDOWN RA'I'E:· 3 .0 OPH ..ow PRESSURE SHUTOFF: YÐS. ~OW P~SSURE: lOPS I r 1: UNLEADED )1 ePENSE MODE: STANDARD ~NSOR: NON-VENTSD >RESBURE OFFSET: Q..ÇlPSl ÕI 2:PREMIUM rfIP:l.5IN ENVIRN GFLEXII ~INE 1..ENGTH: lBD FEET 3HUTDOWN RAT5:, :3,'0 GPH ..ow PRESSURE SHIJI'OFF. : YES ..ow PRESSURE: 1 0 P91 ! r 2 : PREMIUM ) I SPiNSE MODE: BTANPARD ENSOR: NON-VSNTSD )REasUJŒ OFFSET: O. OPS t . , .INS LEAK LOCKOUT SETUP i . - - - - - - - - - - -I .OCKOUT SCHEDUt.E >AlLY JTART T tME: D I SASLE!) JTOP T t ME : D J SABLED 661392_ LIQUID SENSOR SßTUP - - - - - - - - - - - _: L 1:87-92 ANNULAR DUAL FLOAT H't'DR08TATIC ' CATEGORY : ANNULAH SPACE L 2: 87 -8TP sUMP TRI-STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 3:87-FILL SUMP TRt~6TATE <StNGLE FLOAt> CAT£OORY : PIPING BUMP L 4:92-STP SUMP " TRt-eTATE (BINGLE FLOAT); CATEGORY : BTP BLI'1P , L 5:92-FILL SUMP TRr-ßTATE (SINGLE FL.OAT) CATEGORY : PIPING SUMP :. ¡ L 6:DISPENSER PAN 1-~ ;: TRI -S'I'ATE (Sll'CL2 Fl,OAT> I : CAnGORY : D I aPENSER! PAN: i , I i i L '7:DIBPBNBER PAN 3-4 ¡! . TRI~STAT£ (61~LE fLOAT); : CATEGOR't : DISPENSER' PAN, ¡ L e IDU3PENBER PAN 5-6 ; TRI -STATE <Sl NGLE FLOAn~ OATEGOR\' : DISPENaSR PAN I.. 9:D1SPENsgR PAN 7-9 TR J -STATE ( 13 I NrJL'E FLOAT>'...... CATEQO~ DISPENSER PA~ . ,. E><TERNAL INPUT SSTUp· - - - - - - - - - - - ~ I 1 ;EMERI3ENCY SHUT-OW' STANDARD ' NORMAL.L.\I OPEN , , .... . ... - , e OUTPl1f RgLAy SETUP . - - - - - - - - - - -I, R 1 :AUI:1l2t.E ALARM TYPE: . STANDARD NORMALLY OPEN I N-TANK AlARMS AU. :OVERF I LL ALARM ALL :SUDPEN LOas ALARM: ALL;HIGH PRODUCT ALARM AL.L:PROBE OUT ALL :MAX PRODUCT ALARM LIGUID SENSOR ALMS' ALL :PUEL ALARM EXTERNAL I,.pUTS ALL :SXTERN I ~PUTALAR'"1 R 2:tNSIDE STORE ALARM i TYPE; STANPARD NORMAU,Y OPSN IN-TANK ALARMS ALL : OVERt' I LL ALARM ALL: SUDDEN LOBS ALARM ALLtHIGH PRODUCT ALARM AIJ.,: PROBE OUT ! ALL:MAX PRODUCT ALARM; LIQUID SENSOR ALMa ALL: FLŒt. ALARM AI.L:SENSOR our ALARM ALL:SHORT ALARM ,._-,---- - !\ ,j, PAGE 08/13 PLl.D 1.1 NE D t,SASLE SETUP ~ - - - - - - - - - - - Q 1: UNLEAPED I N-TANJ< ALARMS T 1 :HIGH WATER ALARM T 1: LOW PRODUCT ALARM LIQUID SENSOR ALI"S L 1: FUEL ALARM L 2: FUEL AL.ARM L (3: PUEl. ALARM LIS; FUEl. ALARM L 7 :FLIEL AL.ARM L 8: FUEL ALARM L 9 ;Pun ALARM PRESSURE LINE l.,EAK iii '1 :PLLD OPEN ALARM Iii 1: CONT HANDL.E ALM Q 2:PREMILJ1 IN-TANK Al.AAMS T. 2: HIGH I.*\TER ALARM T 2:LOW PROPLCT ALARM LIQUID SENSOR ALMS L 1 ;PUEL ALAAM L 4: FUEL At.ARM I.. 6:fUSL ALARM L 6: FUEL ALAAI1 L 7: FUEt. ALARM L S:FUEL :ALARM L 9 :FUQ, ALARM ' PRESSURE L I HE t.EAX Q 2:PLLD ,OPEN ALARM Q :2 :CONT HANDLE ALM: , I RECONCIL1A'1'tON SETUP - - - - - - - - - - - - AUTOMATIC DAILY CLOS,ING T1tœ: 2:00 H'I . ' PER10DIO RSCONCILJPiT'[ON MODS: MON~HI..V· TEMP COMPENSATION: STANDARD SLS SLOT 'tUEL MiTiR TANK - - - - - - - - - - - - TANK. MAP WT't' _----..__0_. ,- 12/1e/2e03 16:22 ~LPHS 5200 STOOKDALE HWY ~KERBFIELD OA.9S30B 31298634005001 )EC ~. 200~ 6:55 PM SVSTEM STATUS REPORT - - - - - - - - - - - - ALL fUNCTIONS NO~MAL 661392a. ALARM HISTORY REPORT i ---- IN-TANK ALARM __J T :2:PREMJUM OVERFILL ALARM JAN 31. 2003 10:03 AM JAN 30. 2003 10:22 AM' JAN 22. 20C~ e:56 PM, HIGH PRODUCT ALARM I JAN 31. 200~ 10:07 AMI e ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 1:e7-~2 ANNULAR ANNULAR SPACE LOW L I QU ID ALARM DEC 9. 2003 6:27 PM FUEL ALARM JUL 14. 200~ 9:02 PM FUEL ALARM JUL 14. 2002 G:06 PM ¡OFTWARE REV 1 S 1 ON LEVEL IERSIÖN 122.00 jOFTWARE~ 346122-lUU-A :REATED _ 01.10.16.Q9.35 M ~ ~ ~ MEND M ~ M ~ MM. ~ ~ END M ~ . ~ M 10 SOFTWARE MODULE \YSTEM FEATURES: PERIODIC IN-TANK TEa~ ANNUAL IN-TANK TEElTB ! iLARM HistORY ~RT ,--- I N-1ANK ALARM ----- . 1 :UNI..EADEP vERF I LL ALARM UN 5. 200S 7:4é PM AV 21. 2003 '0:22 PM flV 6. 2008 3:12 AM UDDEN LOSS AlARM OV 13. 2002 11:46 AM ELIVERV NEEDED OV 17. 2003 Q:CG PM OV 3. 2QQS 8:09 PM C7 ~1. 20QS' B:4B PM M M ~ ~ END ~ ~ ~ ~ ~ ALARM HISTORV JŒ;PORT : 1 N-TANK ALARM --' T ~: ( ~ ~ ~ (,.END:,i'!:,~,.,~ 1(' ALARM HISTORY REPORT t N-TANJ< ALARM --';.-- . T 4: M ~ ~ M ~ END M M ~ * ~ ALARM HI STORY REPORT -~--- SENSOR ALA~ ----- L 2:87-8TP BI.t1P BTÞ BUMP FU~L ALARM DEe 9. 2003 5:54 PM FUEL ALARM JUN J9. 2002 lD:27 AM 1= UEL A1.ARM JAN II. 2002 4:04 PM M ~ * . . £ND ( ~ ~ K . ( , PAGE 09/13 ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 3;87-FILL SUMP P 1 P I Nt;¡ S"",P FUEL 'ALARM DEC :9, 2003 6:27 PM SETUP DATA WARN I NO JAN ., 1996 8:02 AM M ~ M M M END ~ ~ * M ~ ,.. ALARM HI6TO~JROB.T. ----- SENSOR ALARM ----- L 4:92-B"fp BUMP STP a!J'1P FUEL ALARM DEe 9. 2003 5:55 PM FUEL ALARM JAN 11. 2002 4:03 PM $TUP DATA WARNING JAN 1. 1996 8:02 AM M * ~ M . END . . ~ ~ M .. 12/10/2003 16:22 'ILARM H19TOR\' REPORT ----- SE.NBOR AI..ARt1 ---- L 5:92-FtLL BUMP PIPING aUMP FUSL. ALARM PSC S. 2003 6:34 PM SETUP DATA WARNING JAN I. 1996 8:02 AM ~ ~ M M * END ~ M M ~ ~ ALARM HISTORV REPORT ----- SENSOR ALARM ---- L 6:DISPSNaER PAN 1-2 DISPENSER PAN FUEL AI.A'RM DEe 9. ~003 6i27 PM FUEL ALARM NOV 14. 2002 2;24 PM FUEL ALARM JUN 19. 2D02 1:52 PM I€ M . IE " END IE ~ IE IE ¡ ALARM HIBTORV R8PORT ----- SENSOR ALARM --- ~ 7:DISPENSER PAN S-4 DJ SÆNSER PAN ' FUEL ALARM DEC ~, 2003 ~:27 PM FUEL. ALARM JUL 8. 2002 10;01 AM FUEl. ALARM JUN 19. 2002 2:16 PM M IE ~ _ IE END IE M ~ " 661392_ ALARM HI STORV ¡(£PORT ----- SENSOR ALARM --~ L e:DISÞENBER PAN 6~6! DISPENSER PAN ~ FUEl.. ALARM ' DEC 9. 2003 6 i 27 PM i ' ! FUEL ALARM MAR 12. 2D03 7i46 PM FUEL ALARM JAN 11. 2002 3:54 PM, M M ~ ~ ~ END M M M M ALARM HISTOR\' REPORT ----- SENSOR ALARM --- L 9:D[SPENBER PAN 7-8 DISPENSER PAN FUEL ALARM PEC 9. 2003 6:27 PM! FUEL ALARM NOV 12. 2002 6:31 PM FUEL ALARM JUN 19, 2002 3:25 PH; e ALARM HISTORV REPORT ----- SENBOR ALARM ----- Lil: OTI-I£R SENSORS . . M . wEND . ~ . H ~ ALARM HISTORY JŒPORT ----- SENaOR ~LARM ----- LL2: OTHER SENSORS M'* . * MEND M . ~ M M PAGE 113/13 ALARM HtßTORY' :m=;>ORT ----- SENSOR ALARM 1.-' 4: OTHER SENSORS * " . M M EHD* . . ~ * Ar..AAM H [arORII REPORT ----- SENSOR ALARM ----- L16; OTI-lER sENSORS ~ K ~ . " SND . . MM. ì I toO' -ALARtf'fH STORY REPÖRT u, 'p' i ----- SSNSOR ALARM : . Ll;3: : OTHE¡¡¡ BENBORS " M M M ~ END . M M M, ALARM H I STORY REPORT ----- SSNBOR ALARM -- LIC: OTHER eENBORS M W M W ~ ~Nn . w w . . IE . . END . M M M M ,1, ., III ALARM H [STORY REPORT ----- SSNSQR ALARM ----- L16: otHER SSNSORß * M M W MEND M . M . W .¡- 12/10/2003 16:22 ALARM HlaTORY IŒPORT - EXTERNAL 1 NPUT ALARM 1 t :EMERGE~V SHuT-Off' EXTERN 1 NPlIT ALARM JAN 1L. 2002 a:23 PM EXTERN IN~UT NORMAL JAN ii. 2002 a:~9 PM M ~ . * ~ END . " N M M ALARM HISTORV REPORT ~ EXTERNAL INPUT A1..ARM . 1 2: * ~ ~ ~ M END _ . * ~ . ALARM HIBTÖRV REPORT ----- SENSOR ALARM ---~. 9 1: OTHER EmN60Ra M MM. ~ END ~ */. ~ .: 661392_ ALARM HI STORY REPORT ----- SENSOR ALARM --- Q ~;n OTHER SENSORS . w ~ M WEND M " M Nj 1 ALARM HISTORY REPORT -----·,SENSOR ALARM ~-. . ::3: OTHER SENSORS ~ ~ ~ M ~ END W M M ~, ALARM HISTORY RSPORT I ----- SENSOR ALARM -:--' II 4: OTHER SiNSORS , . .. . . . ~ . . . J I I I '''-1 e ALARM HISTORV REPORT ---- PRODUCT ALARM ---- F 1 õ UNLEADED M W W . ~ END ~ ~ M W W ALARM HISTORV R~ORT ---- PRODUCT ALARM ----I F 2:UNLEADEP ì ~ W W . ~ END M ~ ~ ~ M ALARM HISTORY' RêPO¡n ---- PRODUct ALARM ---- F 3:UN!.EADED M M M ~ ~ 5ND * M M " M -. ,..".,". .... .n ..... . , PAGE 11/13 ALARM H ISTOR'i R~ORT ---- PRODUCT ALARM ~--- F 4õUNL.EADED M W W M w END W . * . * ALARM HISTO!<\I RSPORT ----- SENSOR ALARM ----- Q 1: UNLEADED PLLD SHUTDOWN ALARM DEC 9~ 2DOæ 6:27 PM PLUI SHU'I'DOWN ALARM DEC 9~ 2003 5:54 PM PL1J) SHUTOOWN ALARM DEC g~ 20Q3 4:23 PM GROSS 1.1 NE :FAIL DEC 9. 2003 4:23 PM PLL.D SHUTDOWN ALARM OCT 14. 2003 12:11 PM GRose LINE rAIL OCT 14. 2003 12:11 PM PLL.P SHUTDOL.lN ALARM JUL 27. 2003 11:49 AM GROßS LINE FAIL JUL 27~ 2003 11:49 AM PLW SHIJI'DOWN ALARM JUN 3. 2003 1;28 PM GROas LJI'Œ FAIL JUN 3. 2003 1:28 PM ~ ~ ~ M M END ~ M M M M ., , ., 12/10/2003 16:22 t"Uo....,..." n¿!:II1\J/Oty l'I~rUI'II ----- SENSOR ALARM -_. Q 2:PR£MWM PLLP SHUTDOWN ALARM PEO 9. 2Q0:3 Ei :40 PM' GROSS LINE FAit nee s. ~003 S:4D ~ PLLl) SHIJI'DOWN ALARM : Dee g. 2003 6:34 PM Pl.LD SHurnOwN ALARM : Dee 9. 200a 6:27 PM PLLD SHUTDOWN ALARM I DEe 9. 2D03 5:65 ~ PLLP SHUTPOWN ALARM DBC, 9. 2003 6:42 PM GROSS LINE FAIL DEC 9. 20a~ 5:42 PM PLLP BHUTDOWN ALARM MAR 12. 200J 7:46 PM PLt.D BHutÐOWN ALARM NOV 14. 2002 2:24 p~ PLLD SHUTDOWN AlARM NOV 12. 2002' 6:31 ~ . . . w ~ END . W ~ * * ALARM HISTO~ REPORT ----- SENSOR ALARM .----- Q :3: . . . ~ MEND M M MM. 661392.1 ALARM HISTOR~ REPORT ----- SENSOR ALARM --~ Q 1: UNLEADED PLLP SHUTDOWN ALAJii1 DEC 9. 2003 6:27 PM PLLD BHIJI"DOWN ALARM Dse 9. 200G 5:54 PM, i PLLP SHUTDOWN ALARM DEC 9. 2003 4:23 PM GROSS LINE FAIL DEC 9. 200~ 4:23 PM P1.LD SHUTDOWN ALARM OCT 14. 2003 12:11 PM GROSS LINE FAIL OCT 14. 2003 12:11 PM PLLP BHuTDOWN ALARM JUL ~7. ~OO~ 11 :49 AM GROSS LINE FAIL JUL 27. 20.03 11 :48 AM PLLD SHUTDOWN ALARM JUN 3. 2DCß 1:2e PM GROSS LINE FAIL JUN 3. 2003 1: 29 Pt1 , ..... M'. ..... : . i . i e J~"",,"",,"µ , 5:200 aTOCKDALE HWV &AKERaFt!LD CA.9D30e 51298g34C05001 Dee 9. 2aca 6:~8 PM 6"í6TEM STATUS R¡pORT - - - - - - - - - - - - ALL FUNCTIONS NORMAL SVST£M SET UP - - - - - - -- - - - - DEC 9. 2003 6:58 PM SI/STEM UN Ira U.é. BIfSTEM lANGLJAÇE ENGLISH aYSTEM PATE/TIME FORMAT MaN ; bD WY~ HH:tt1: B8 ~ ,. RAl..~HS 5200 STOOKDAL.£ HW'I/' BAlatJi?SPJELD ,CA. 933.08 S1298634a05001 ! SHI~T TIME 1 : 6:00 AM :·SH:IPT 12m: 2 : DISABLED · SH1tT TIME' 3 : DISAB'tp · SHl1f1' TIME 4 : DlSAJ3L£P 'TANK PER 181' NEEPED WRN DISABLED TANK ANN TST NEEDED" WRN DlBAS1.ED 1.INS RE-ENAfILE METHOD PASS LINE TEST 1..1 NE PER TST NEEDED WRN DlBAB1.£D LINE. AN" TST NEEDED WRN DI~l.ED PRiNT TO VOL.UMES , SNAS1--ED TeM~ COMPENSATION VALUE (D£O F ): 60.0 B'tl-qX HEIGHT OFFSET · PI elA.SL!D H-PROTOCOL DATA PORMAT H&:1~ PRSCl e I ON TBST DURAT I ON ~IH2 DAYLi! QHT BAV t NO T I ME &:NAEI~ . STAArt DATE APR WEEK ,1 SUN BTAA!r TIME , '2: OJ) AM ; ENP DATa , OOT : WEEK 6 BUN , END 'rIME , 2:00 AM ! : R!¡..prRECT LOCAL PRINTOUT :DISA9I.2D · EURo' PROTOCOL PREPIX ,ti S ',. ~ -... .!- PAGE 12/13 SYSTEM .SEC.t:JR.l..1Y:,',; ~ ,., CODE, : OOElQ~';,·., i ,., COMMUNI CAT I o Nil SETUP - - - - - - - PORT SETT I NOS: COMM BOARD : 1 (RS-232) SAUD RATE : 9600 .PAR I T\i : ODD STOP SIT : 1 STOP DATA LENGTH: 7 DATA RS-232 SECURITY CODS : DISAB1.BP COt1'1 BOARD I 2 < FXMOÐ > SAUD RATE : 2400 PAR I T'I : OPD STOP BIT : 1 STOP DATA LENGTH: 7 DATA RB-232 SacURIT~, CODE : DISABLED DIAL NPE : TONE ANMR ON : 1 RING MOPJ:M SETUP STRING DIAL TONE INTERVAL: ::32 AUTO TAAM!lIj)T,S:ET.1'INGS: AUTO J.EAK ALARM L.IMIT DISASL.ED AUTO HIGH WATER LIMIT DISABLED AUTO OVERFILL LIMIT DISABLED AUTO LOW PRODUCT DlBAJaLED AUTO THEFT LIMIT D I ElAS1.ED ' Auro DEL I V£R!t START DISABLED AUTO ,DEL I VE:R~ END D I SASLED AUTO ,EXTERNAL I NPUT ON DISABLED AUTO EXTERNAL I NPtrr: OFF D t$AB1.ED AUTO æt\ÐOR PUEL AI...ARM DISABLED AUTO SENSO~ WATER ALARM DJSA&t.eD AUTO SENSOR OUT AJ.ARM D IBASLED ¡ I '! , , ..;¡;.. ',3: MONIT.ING SYSTEM CERTIFeATION For Use By All Jurisdictions Within the State of California ,'¡mhoril)' CiTed: Chapcer 6.7, Health and Sajèry Code; Chapter 16, Division 3, Title 23, Califòrnia Code ofRegulU!ions This form must be lIsed to document testing and servicing of monitoring eqlÜpment. A separate certification or report must be prepared for <:-itch monÜoring svstem control panel by the œchnician who performs the work. A copy of this form must be provided to the tank syslèm owuer/opennor. The owner/operator must submit a copy of this form to the local agency regulatíng UST systems wirhin 30 chl)s L)f re-sr dare. }\,. Gtßerallnformation . FaciljlyName: RAL~tt'~ b R.OL(Z(l..Y Sir.: A.ddress: _?Q c::JO 616 <k þA\-£' t+vv-y FaciEr) Contact Person: _ lVL-'Ü.:.c;lVlodel of MonÜoring System: t/I£€Þ~-~¡- Bldg. No.: 15At~f-5 FtE£Þ Zip: _____.__ City: Comact Phone No.: ( TLS·- :J ~ Date of Testing/Serv icing: Tank ID: o In-Tank Gauging Probe. Model: o Annular Space or Vault Sensor. Model: o Piping Sump / Trench Sensor(s). Modd: o FilJ Sump 5ensor(s). Modd: o Mechanical Line Leak Detector. Model: o Electronic Line Leak Detector. Model: o Tank Overfill / High-LeveJ Sensor. Model: o Other ls eci', e ui ment t e and model in Section E on Pa Tank ID: o In-Tank Gauging Probe. Model: o Annular Space or Vault Sensor. Model: o Piping Sump I Trench Sensor(s). Model: o Fill Sump Sensor(s). Model: o Mechanical Line Leak Derector. tvlodel: o Electronic Line Leak DetecTOr. Model: o Tank Overíìll / Hígh-Level Sensor. Model: o Orher (s eci e ui ment tv e and model in Section E on Pa Dís~er ID: V~enser Containment Sensor(s). Model: ~ tOtS' cYShear Valvels). o Dis enser Containment FJoat(s) and Chain(s). Dispenser ID: o Dispenser Containment Sensor(s). Model: o Shear VaJve(s). o Dis enser Containmem Floatls) and Chainls). Dispenser ID: o Dispenser Comainmem 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 faciliry, B. 1ïn'ciltOl-Y of Equipment Tested/Certified Clièd~ rhe " ) )rù r¡¡He bùxes (0 indiclltc s ccitic e ui ment ins Jecred/serviced: !lj~'l~¡~'i~:'__.1¿~L - l]('"jP-Lll1k Gauging Probe. Model: ~..LJ-{,- -I l!3'" }l1nular Space or Vaulr Sensor. Model: ~ Jo:r (Jd"ßiping Sump ¡ Trench Sensor(s). Model: ~D'ß ¡g"FilJ Sump Sensor(s). Model: B~"8 o ~,.1· 'J¡,mica! Line Leak Detector. Model: \W"1:kèrrùnic Line Leak Dereclùr. Model: ?LL.'D OLmk OvertìU / High-Level Sensor. Model: , o ºrJl~r lS eeil'\' e ui menr r' e and model in Section E on Pile 2). 1'¡~ lD: '"f>, V1 - ( i!f ~- rank Gauging Prob.:. Model: íØ' ~nular Spaœ or Vault Sensor. Model: (J""~i~g Sun~p / Trench Sensor(s). Model: ff FiJI ::'ump ::sensúrls). Model: o ~wlical Line Leak Derector. Model: l2"Í::kWÙilic Line Leak Derecror. Model: o T~Ulk Ovtr!ìJj / High-Level Sensor. Model: o Urher (5 ecifv è·( ui menr ry e and model in Secrion E on Pae 2). Disj!J'-!ìser In: , (j"'"Pfspenser Conrãinmenr Sensor(s). Model: ~ ~- ~Shèar Valve(s), ,0 .1)js~lIser Conrainmenr F]oar(s) and Chajn(s), Dis~lser lD: Ó-r lJn)~ensèr Comainment Sensor(s). Model: t1d"3hear Valve(s). o D!s en?.:r Comainmenr FJoilr(s) and Chain(s). J?i*"uSéI' lD: ¡Y~';lbèr Comainment Sensor(s). Model: ~hè';U' VaJvels). (][)j~pèIlSè:r .cùnrainmenr Floar(s and Chain(s). "Ifrll.; facility contains more ranks or dispensers, copy this tòrm. ~ A-lr T "3 (:):..J. ~O~ ~é) y¿¿,V b(ø(f I~ I~/O~~ e '», e 2), I: I I -I C. Certification -1 certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guiddines. Artached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is ~orrec( ànd a Plot Plan showing the layout of monitoring equ~t. For any equip t C' pable of generating such. reports, l h.ave ,\Iso a([ached a copy of the reR0r:..tj,(fheck ,lIiI tf'lt appJJ!)¿, é"System s - p e ort l'.:chnician Name (prim): ~ ¡<:"~0.L. Sign' . Cercification No.: 3c..)/o Tesrlng Company Name: RICH ENVIRONMENTAL Silè Ai.1l1ress; Sd.o'D '5Tbc..K..ÞAt.¿ ¡-iwy Moni£oring System Certification License. No.: C61/D40- # 809850 .- Phone No.:(661 ) 392 -8 6 8 7 "" Ev'tj($jl.fFJt'£pDate of TestinglSel'Vicing:Æ¡ / y/~? Page 1 of3 03/01 ~... 4., e e ù. 1-(csuUS of Tesring/Servicing I r):;;J 0 () S0Ú\\ elf': Ver:>Íon Insr;;¡lled: . CÙÚJ,¡.,.tc'IC: (Ìlè îül1o'winu checklist: II ~þ6 \ 0 No'" Is the a~dible alarm ° er~rion~l? I~" '~ U No'" Is d1e visual alarm ° eranol1ül? = Y.;:~s_ I 0 No'" \Vere all sensors ~isualJ ins ected, fLU~ctionall tested, and c.ontìI1l1ed ° era.r.i,onal? . \,~S l 0 No" Were all sensors 1l1stalled at lowest pOtnt of secondary comalrunent and poslUoned so that other equlpmenr will ¡ _~ not imerfere with their 1'0 Jer 0 eraÜon? Ih?Y~'~'1 0 No" If alarms are relayed [Q a remote monitoring station, is all cOl1ul1lll1ications equipment (e.g. modem) o N/A operational? I-~s 0 No" For ~re~surized piping SYSEëillS, d, ~e.s the wrbine aLH~marical!y shut .down if th" e piping seco~dary comainmenr , 0 N/A mODJwnng system deœCIS a leak, taIls to ope~'are IS electrically dlscolillecred? If yes: whIch sensors iniri<l{è I , r-.~ I. I positive shut-down? (Check c¡ll thaI apply) 'ump/Trench Sensors; 'V"uispenser Co~~iJ4:menr Sensors. II _L ¡ Did 'ou confirm ositive shut-down due TO leaks and sensor failure/disconnection? I!r)!es; 0 No. r&" \è:'--' U No" For rank sysrems that milize the monitoring system as the primary rank overfill warning device (i.e. no II 0 NiA l~1c;cha.nical overtìlJ pr~vention valve~s insralled), is the overfill warni~g alarm visible and. audible ~ the rank :1 hll omr(s) and 0 eranng 1'0 erly? It so, ar whar ercenr of tank ca aCI does the alarm [rlV er? 'tv 'Yo r CJ Y èS'· Was any monirori.ng equipmem replaced? If yes, identifY specific sensors, probes, or orher equipment replaced 'I and lisr rhe manutàctw'er name and model for all re lacement am in Secrion E, below. o Y (::;" I No Was liquid fOlilld inside any secondary containment sysrems designed as dry systems? (Check all ¡hat apply) 0 Product; 0 Water. If es, describe causes in Secrion E, below. ~ I 0 No' Was monitoriuo s stem set-n reviewed to ensure ro er sortino,? Artach set u Yy ö - 0 No* Is all monirorino' e ui mem 0 erational er manufacturer's specifications? i, in S;;¡;rion £ bèlûw, describe bow and when these deficiencies were or will be corrected. (jcabk £. COÜl111encs: ...-..-----.. ....~--------_.- ----- -.-.---- .__.-..~----_.__.._.__. --- .,-.._---. 0".-_--· ______. n. .__ _____.... . ..--..--,...--.--- ~---_. . -...----.-- ----.---. ------ . ~. .-- -. - .-----.--. Page 2 of 3 (13/(11 !> 4:. e e ¿eCk this box if tank: gal~ging is used only for inventory control. a Check This box if nO tank gauging or SIR equipment is inswlkd. F. .iLn-'-i\wk G.iugíng / SIR Equipment: ThLS sèccion mUST be completed ifin-tank gauging eqlÜpment is u.sed to perform leak detection monitoring, (\:'''i,£idl: r¡¡~ füUowing checkliSt: I 0 \,,~ J U Nü:~ Has all inpur wiring been inspected for proper entry and termination, including testing for ground faults? r~\TI u No'" Were all {all!.:: gauging probt;;s visually inspected for damage and residue buildup? LJ ìc'~ 0 No" Was accuracy of sysœm product level readings tesred? I Ü \'è:l u No" Was accuracy of sysœm warer levè! readings reseed? I: 0 ~~d i 0 No" Were all probes reinstalled properly? l[~,\":; j 0 No" Were al1 irems on the equipmèm manufacrurer's maintenance checklist completed? -, " l¡¡ dlt· SetrjûLl fl., below, describe how and when these deficiencies were or will be corrected. ~~. Line Lë.~k ûc;:te.crors (LLD): o Check this box ifLLDs are not installed. C)¡Ú')!dè rile (üllûwin' cnecldist: y ,~:S No'" For equipment :Start-up or annual equipment ceIJiti..cation, was a leak simulated to verify LLD performance? N/A (Chec'k aff ¡h(Jf appM Simulared leak rate: ~.p.h.; 00.1 g.p.h; 00.2 g.p.h. Were aU LLDs confirmed operational and accurate within regulatory requirements? Was the resting apparatlJs properly calibrated? For mechanical LLDs, does the LLD restrict product flow if it detects a leak? N/A No" N/A \'èS 0 No'" !O NiA ~ ~ No'" -' ION! A ~ Yc:':) 0 No" N/A No'" Were all items on the equipment manufacturer's maintenance checklist completed? ,< in ihe :)e¡:[Ìün H, below, describe how and when these deticiencies were or will be corrected. For electronic LLDs, does the turbine automatically slmt off if the LLD detects a leak? For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disablèd or disconnected? For elecrronic LLDs, does the: turbine automatically shm off if any p0l1ion of the monitoring system maltì.mcrions or tàìls a rest? For elecrronic LLDs, have all accessible wiring cormectÌons been visually inspected? H. ('úüìmeBIs: -_.~.," -".~,-,,-.-.,...--- --'-" .----- _._-~--_..__._---- -----.-- ------. .-.-----------, .....--.".----.-.-.- .-- ..---.-"- ---'..._---,- Page 3 of3 03/01 >- -"1-;, e " lVLoniwciug System Certification SiT" A.ddr,,~~: 5~t:::'C> UST Monitoring Site Plan ~ ./J tj to ~I<.PA-LE ttl.A.Ål 731t-~£12SF 1~¿2> ¿4ï ~ :(:)rv ~:c,/: :(J):f: : : (!)fJ~ : ;) IU~ if . . . . . . . . . . .¿/i5It1!iR- ~ .& :~o~: "'~,. V()v9Y'L , . . , .. yl - . . . . . ,D A ~ t"l,L:kt2: : ., .~~¡2. . ~,"j,o . . . . . ~ 5 Tõ~/Z þ,4tA:£ .t::!-w-( . Dare map was drawn: J 2¡ q /0..3. Instructions If) au alrèady have a diagram that shows all required information, you may include it, rather than this page, with yaur Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify loc~ìTiüns 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 kak derè<.:rors; and in-rank liquid level probes (if used for leak detection). In the space provided, note the date this Site Pian \\.<1':: prepáred. Page _ of_ 05/00 I;;)., 7' ~-;J ~~r- ;:¡ ,~'> e e MONITOR CERT. FAILURE REPORT SITE NAME: R#-PJr5 612oc.fZl-Y ADDRESS : Š-~ vc> ST 0'-1< þA-L£ tft.J II' CITY: ~~r/£l-þ c/I- SIGNAT TECHNICIAN: SITE CONTACT: THE FOLLOWING COMPONENTS WEPJi: RJi:i>LACED/REPAIRED TO COMPLETE THE MONITOR CERTIFICATION TESTING. LIST OF PARTS REPLACED/REPAIRED: REPAIRS: /lit'> /£ LABOR: ~O~ PARTS INSTALLED: 4/Z> AJ;: RECE rVER SETUP: D 2:KMA DIVISON OFFICE 1-310-900-5865 RCVR TVPE: FACSIMILE PORT NO: 2 RETRV NO: 5 RETRV DELAV: 6 'CONFIRMATION REPORT: OFF D 3:TRANSPORT CO 328-9045 RCVR TVPE: FACSIMILE PORT NO: 2 RETRV NO: 5 RETRV DELAV: 6 CONFIRMATION REPORT: OFF D 4:TRANSPORT CO 328-9045 RCVR TVPE: FACSIMILE PORT NO: 2 RETRV NO: 5 RETRVDELAV: 6 CONFIRMATION REPORT: D 5:TRANSPORT CO ! 3:28-9045 , RCVR TVPE: FACSIMILE PORT NO: 2 RETRV NO: 5 RETRV DELAV: 6 CONFIRMATION REPORT: OFF' AUTO DIAL TIME SETUP: D 2:KMA DIVISON OFFICE DIAL DAILV DIAL TIME: 4:00 AM RECEIVER REPORTS: SVSTEM STATUS I NVENTORV : PRESSURE LLD RESULT: LAST DELIVER"I D 3:TRANSPORT CO DIAL DAIL"I DIAL TIME: 7:00 AM RECEIVER REPORTS: I NVENTORV D 4:TRANSPORT CO DIAL DAIL"I DIAL TIME: 1 : 00 PM RECEIVER REPORTS: I NVENTOR"I D 5:TRANSPORT CO DIAL DAIL"I DIAL TIME: 5:00 PM RECEIVER REPORTS: I NVENTOR"I RS-232 END OF MESSAGE DISABLE_ AUTO DI~ALARM SETUP ------ - - - - - OFF D 2:KMA DIVISON OFFICE IN-TANK ALARMS ALL:HIGH WATER ALARM ALL:LOW PRODUCT ALARM ALL:INVALID FUEL LEVEL ALL:PROBE OUT ' ALL:HIGH WATER WARNING ALL:DELIVERY NEEDED ALL:MAX PRODUCT ALARM LIQUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM ALL:HIGH LIQUID ALARM ALL:LOW LIQUID ALARM EXTERNAL INPUTS ALL:EXTERN INPUT ALARM PRESSURE LINE LEAK ALL:GSOSSLINE FAIL ALL:PLLD OPEN ALARM ALL:PLLD SHUTDOWN ALARM ALL:LOW PRESSURE ALARM ALL :qONT HANDLE ALM ; . . ALL: FUEL OUT ' ALL:LNEQUIP FAULT ALM D 3:TRANSPORT CO IN-TANK ALARI"IS ALL:OVERFILL ALARM ALL:LOW PRODUCT ALARM ALL:HIGH PRQDUCT ALAR~ " ALL: DEL I VER~ NEEDED . · .... ALL:MAX PRODUCT ALARM' .t D 4:TRANSPORT CO - NO ALARM ASSIGNMENT.S - :D 5:TRANSPORT CO - NO ALARM ASSIGNMENTS '·..r I . I IN-TANK SETUP ----- A- - -. - T 1: UNLEADED PRODUCT CODE' THERMAL COEFF TANK DIAMETER TANK PROFILE FULL VOL 87.9 INCH VOL 58.6 INCH VOL 29.3 INCH VOL FLOAT SIZE: 4.0 WATER WARNING : . HIGH WATER LIMIT: , MAX OR LABEL VOL: OVERFILL LIMIT : ~, HIGH PRODUCT DELIVER"I LII"IIT LOW PRODUCT : LEAK ALARM LIMIT: SUDDEN LOSS LIMIT: TANK TILT : PROBE OFFSET MANIFOLDED TANKS T#: NONE LEAK MIN PERIODIC: LEAK MIN ANNUAL : : 1 : . 0007QQ : 117.1.71 4 PTS; 19?O~ 1631g 1 0 1 7,~ 391?! 1.0 3.Q 19703 90% 17732 95% 1 ana 15% :295~ 608, 1~ 5a 0.00 0.00 5%, 985 5~ 986 PERIODIC TEST TYPE , STANDARþ 'ANNUAL TEST FAIL: ' ALARM DISABLEd 'PERIODIC TEST FAIL i ALARM DISABLEd. GROSS TEST FAIL I ALARM DISABLE9 [ANN TEST AVERAGI NG: OFFI ¡PER TEST AVERAGING: OF~ .TANK TEST NOTIF"I: OFF; : I ,TNK TST SIPHON BREAK:OF~ ¡DEL IVER"I DELA"I : 5 MIN 14 ,rUMP THRESH.0.LD.:: "L)'~ ..go~ ; I ,", f ' L..__ - .- T 2:PREMIUM PRODUCT CODE THERMAL COEFF TANK DIAMETER TANK PROFItE FULL VOL 88.6 INCH VOL 59.1 INCH VOL 29.5 INCH VOL : 21 : .000700 : 118.13 : 4 PTS 7817 6382 3993 1080 IN.; FLOAT SIZE: 4.0 IN. WATER WARNING : 1 0 HIGH WATER LIMIT: 3:0 MAX OR LABEL VOL: 7817 OVBRFILL LIMIT: 90~~ , 7035 HIGH PRODUCT --: 95% 7426 D~IVER"I LIMIT 10% 781 LOW PRODUCT : LEAK ALARM LIMIT: SUDDEN LOSS LIMIT: TANK TILT : PROBE OFFSET 242 15 50 0.00 0.00 MANIFOLDED TANKS T#: NONE LEAK MIN PERIODIC: 5% 390 LEAK MIN ANNUAL : 5% ' 390 PERIODIC TEST T"IPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ' \ ALARM DISABLED I GROSS TEST FAIL ALARM DI SABLED ' ANN TEST AVERAGING: OFF PER TEST AVERAG I NO : OFF TANK TEST NOTIF"I: OFF TNK TST SIPHONSREAK:OFF DELIVER"I DELAY 5 MIN PUMP THRESHOLD 10.00% LEAK TEST METHOD TEŠ+-OÑ D~E ~ ÃLL TAÑK- JAN 1. 1 '3'36 START TIME : DISABLED ,~ I TEST RATE : 0 . 20 GAL/HR' DURATION : 2 HOURS . TST EARLY STOP: DISABLED . LEAK TEST REPORT FORMAT " NORMAL ' PRESSURE LINE LEAK SETUP ------ - ----- Q 1: UNLEADED TYP: 1.5IN ENVIRN GFLEXI I LINE LENGTH: 180 FEET SHUTDOWN RATE: 8.0 GPH LOW PRESSURE SHUTOFF:YES LOW PRESSURE: 10 PSI T 1: UNLEADED DISPENSE MODE: STANDARD SENSOR: NON-VENTED PRESSURE OFFSET: 0~9PSI Q 2 : PREMIUM TYP:l.5IN ENVIRN GFLEXII LINE LENGTH: 150 FEET SHUTDOWN RATE: 8..0 GPH LOW PRESSURE SHUTOFF:YES¡ LOW PRESSURE: 10 PSI T 2:PREMIUM DISPENSE MODE: STANDARD SENSOR: NON-VENTED PRESSURE OFFSET: O.OPSI LINE LEAK LOCKOUT SETUP - - - - - - - - - - -, - , LOCKOUT SCHEDULE DAILY START TIME: DISABLED STOP TIME : DISABLED :I~U:D ~~OR_S~T~P_ L 1:87-'32 ANNULAR DUAL FLOAT HYDROSTATIC CATEGORY : ANNULAR SPACE L 2:87-STP SUMP , TRI-STATE {SINGLE FLOAT> CATEGORY : STP SUMP L 3:87-FILL SUMP , TRI-STATE {SINGLE FLOAT>: CATEGORY : PIPING SUMP L 4:92-STP SUMP TR I -STATE (S I NGLE FLOAT >, ' CATEGORY : STP SUMP L 5:92-FILL SUMP TRI-STATE <SINGLE FLOAT) CATEGORY : PIPING SUMP L 6:DISPENSER PAN 1-~ \ TR I -STATE <S 1 NGLE FLOAT:) CATEGORY : DISPENSER~ PAN, L 7 :DISPENSER PAN 3-4¡ TR I -STATE (S I NGLE FLOAT). CATEGORY : DISPENSER PAN, L 8 :DISPENSER PAN 5-6: TR I -STATE (S~ NGLE FLOAT)¡ CATEGORY: DŒSPENSERPA(I L 9:DISPENSER PAN 7-6 I' TRI -STATE <SI NGLE FLOAn'~'- CATEG9RY : DISPENSER PA~ ..- " EXTERNAL INPUT SETUP' - - - - - - - - - - I l:EMERGENCY SHUT-OFF. STANDARD NORMALLY OPEN ~U:P~T_R~L~Y~4iÞ~ _ _! R 1: AUD I BLE ALARM TYPE: . STANDARD NORMALLY OPEN IN-TANK ALARMS ALL:OVERFILL ALARM ALL:SUDDEN LOSS ALARM ALL:HIGH PRODUCT ALARM ALL:PROBE OUT ALL:MAX PRODUCT ALARM LIQUID SENSOR ALMS ALL:FUEL ALARM EXTERNAL INPUTS ALL:EXTERN I~PUTALAR~ R 2: INSIDE STORE ALARM! TYPE: . STANDARD NORMALLY OPEN IN-TANK ALARMS ALL:OVERFILL ALARM , ALL: SUDDEN LOSS ALARM j ALL.:HIGH PRODUCT ALARM ALL.:PROBE OUT I ALL :MAX PRODUCT ALARM i I LIQUID SENSOR ALMS i ALL.:FUEL ALARM : AL.L.:SENSOR OUT ALARM AL.L:SHORT ALARM ------ - ,v; PLLD LINE DI,SABLE SETUP - - - - - - - - - - - - Q 1: UNLEADED IN-TANK ALARMS T 1: HIGH WATER ALARM T l:LOW PRODUCT ALARM LIQUID SENSOR AL.MS L 1: FUEL ALARM L 2:FUEL. ALARM L'3:FUEL AL.ARM L6:FUEL ALARM L 7:FUEL AL.ARM L 8:FUEL AL.ARM L 9:FUEL ALARM PRESSURE LINE LEAK Ql:PL.LD OPEN ALARM Ql:CONT HANDLE ALM Q 2:PREMIUM IN-TANK ALARMS T 2:HIGHWATER ALARM T 2:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 1: FUEL. ALARM L 4:FUEL ALARM 1.. 5:FUEL ALARM L6:FUEL AL.ARM L. 7:FUELALARM LS:FUELALARM L9:FUEL AL.ARM PRESSURE LINE LEAK Q 2:PLLDOPEN ALARM Q2:CONT HANDLE ALM RECONCILIATION SETUP - -" - - - - - - - - AUTOMATIC DAILY CLOS.ING TIME: 2:00 AM . PERIODIC RECONCILIATION MODE: MONTHLY TEMP COMPENSATION STANDARD . BUS, SLOT FUEL METER TANK - - -- - - - - - ~ TANK. MAP EMPTY ,'. .--'---.. .."--- ----- ,RALP,.HS ~, , 520Ò STOC~LE HWY BAKERSFIELD CA.93308 B1298634005001 'DEC 9. 2003 6:55 PM SYSTEM STATUS REPORT - - - - - - - - - - - - ALL FUNCTIONS NORMAL ALARM ~TORY REPORT ---- I~ANK ALARM -- T 2:PREMIUM OVERFILL ALARM JAN 31. 2003 10:03 AM JAN 30. 2003 10:22 AM JAN 22. 2003 8:56 PM HIGH PRODUCT ALARM I JAN 81. 2003 10:07 AM ! ALARM HISTORY RE~ ----- SENSOR ALARM L 1:87-92 ANNULAR ANNULAR SPACE LOW LIQUID ALARM DEC 9. 2008 6:27 PM FUEL ALARM JUL 14. 2002 9:02 PM FUEL ALARM JUL 14. 2002 6:06 PM SOFTWARE REVISION LEVEL VERS ION 122.00 SOFTWARE~ 346122-100-A CREATED - 01.10.16.09.35 ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ~ ~ ~ ~ END ~ w ~ ~ * NO SOFTWARE MODULE SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL I N-TANK TESTS . I ALARM HISTORY REPORT ---- IN-TANK ALARM T 1: UNLEADED OVERFILL ALARM JUN 5. 2008 7:46 PM MAY 21. 2008 10:22 PM MAY 6. 2008 8:12 AM SUDDEN LOSS ALARM , NOV 13. 2002 11:45 AM , DEL I VERY NEEDED NOV 17. 2003 6:06 PM NOV 3. 2003 8:09 PM OCT 31. 2003' 8:48 PM ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ALARM HISTORY REPORT I N-TANK ALARM --; T 3: ~ ~ :IE :IE *END..~,~" ,ìoE ìoE ALARM HISTORY REPORT IN-TANK ALARM ----- T 4: ìoE ìoE * ìoE ~ END * * >t * ~" ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 2:87-STP SUMP STP SUMP FUEL ALARM DEC 9. 2008 5:54 PM FUEL ALARM JUN 19. 2002 10:27 AM FUEL ALARM JAN 11. 2002 4:04 PM ~ ~ ~ ìoE ~ END ~ ~ * ~ ~ .' .", ,v' ALARM HISTORY REPORT ----- SENSOR ALARM L 3:87-FILL SUMP PIPING SUMP FUEL ALARM DEC 9. 2003 6:27 PM SETUP DATA WARNING JAN 1. 1996 8:02 AM ~ ~ ~ * ~ END * ~ ~ * ~ i, , ALARM HISTORY~QRT ----- SENSOR ALARM'----- L 4:92-STP SUMP STP SUMP FUEL ALARM DEC 9. 2003 5:55 PM FUEL ALARM JAN 11. 2002 4:03 PM SETUP DATA WARNING JAN L 1 996 8: 02 AM ~ ~ ~ ~ ~ END ~ * * ~ ~ ALA~M HISTORY REPORT ...,~, ----- SENSOR ALARM L 5:92-FILL SUMP PIPING SUMP FUEL ALARM DEC 9. 2003 6:34 PM SETUP DATA WARNING JAN 1. 1996 8:02 AM I IE...... IE IE END IE IE IE ìoE ~ ALARM HISTORV REPORT ----- SENSOR ALARM ---. L 6:DISPENSER PAN 1-2 DISPENSER PAN FUEL ALARM DEC 9. 2003 6:27 PM FUEL ALARM NOV 14. 2002 2:24 PM FUEL ALARI"! JUN 19. 2002 1:52 PM ìoE ... ìoE ìoE ìoE END ìoE ~ ìoE ìoE ALARM HISTORV REPORT ----- SENSOR ALARM --- L 7:DISPENSER PAN 3-4 DISPENSER PAN FUEL ALARM DEC 9. 2003 6:27 PM FUEL ALARM JUL 8. 2002 10:01 AM FUEL ALARM JUN 19. 2002 2:16 PM ... ~ *- ~ ... END ... ... ... ~ ALARM HI~RY REPORT ! ----- S~R ALARM --l L 8:DISPENSER PAN 5-6i DISPENSER PAN i FUEL ALARM I DEC 9. 2003 6:27 PM! ! FUEL ALARM MAR 12. 2003 7:45 PM FUEL ALARM JAN 11. 2002 3:54 PM ~ ... ... ~ ... END ... ìoE ... ... ALARM HISTORV REPORT ----- SENSOR ALARM --~ L 9:DISPENSER PAN 7-8 DISPENSER PAN FUEL ALARM DEC 9. 2003 6:27 PM! FUEL ALARM NOV 12. 2002 6:31 PM: FUEL ALARM JUN 19. 2002 3:25 PM: ìoE ... ... ... ìoE END ìoE ... ìoE ìoE, ALARM HISTORY REPORT ---~- SENSOR ALARM LID: OTHER SENSORS ALARM HISTORY REPO~ ----- SENSOR ALAR~--- Lll: OTHER SENSORS ~ ... ... ... ~ END ~ ~ ìoE ~ ìoE ALARM HISTORV REPORT ----- SENSOR ALARM ~---- LL2: OTHER SENSORS ìoE:~ ìoE ~ ~ END ~ ... ~ ... ~ ¡ f-'" -ALARM' H I STÖRV-wRm)RT-~"" ! i ----- SENSOR ALARM 'L13: OTHER SENSORS WI", ~ ~ ~ END ìoE ~ ìoE IE ~ --- . -". ~ ,v' ALARM HISTORV REPORT ----- SENSOR ALARM L14: OTHER SENSORS ... ... ... ... IE END IE ìoE ... ~ ... ALARM HISTORV REPORT ----- SENSOR ALARM L15: OTHER SENSORS ìoE W ìoE ~ ... END ... ~ ... ... ... ALARM HISTORV REPORT ----- SENSOR ALARM L16: OTHER SENSORS ... ... ... ... ... END ... ... ~ ... ~ ALARM HISTORY REPORT '-.. ,.,- - EXTERNAL INPUT ALARM I I:EMERGENCY SHUT-OFF EXTERN INPUT ALARM JAN 11. 2002 3:23 PM EXTERN INPUT NORMAL JAN 11. 2002 3:29 PM ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ALARM HISTORY REPORT - EXTERNAL INPUT ALARM I 2: ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ALARM HISTÒRY REPORT ----- SENSOR ALARM g 1: OTHER SENSORS ~ ~ ~ ~ ~ END ~ ~/~ ~ ~: ALARM HISTORY REPORT ----- ~OR ALARM g 2: OTHER SENSORS . . . . . END . . . '1 \ ALARM HISTORY REPORT ------SENSOR ALAR/"1 --, g 3: OTHER SENSORS ~ " ~ ~ ~ END ~ ~ " ¡,E¡ ALARM HISTORY REPORT I ----- SENSOR ALARM -- iI 4: OTHER SENSORS ¡ · · · · · END · · · 1 I I I ! J --- --I ALARM HISTORY REPORT ---- PRODUCT ALe ---- F 1: UNLEADED ~ * * * ~ END ~ ~ ~ ~ * , ALARM HISTORY REPORT ---- PRODUCT ALARM F 2:UNLEADED ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ALARM HISTORY REPORT ---- PRODUCT ALARM F 3: UNLEADED * ~ ~ ~ ~ END ~ ~ * ~ ~ .. '-r\ ------ . v· ALARM HISTORY REPORT ---- PRODUCT ALARM F 4:UNLEADED ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ALAR/"1 HISTORY REPORT ----- SENSOR ALARM ----- Q 1: UNLEADED PLLD SHUTDOWN ALARM DEC 9. 2003 6:27 PM PLLD SHUTDOWN ALARM DEC 9. 2003 5:54 PM PLLD SHUTDOWN ALARM DEC 9. 2003 4:23 PM GROSS LINE FAIL DEC 9. 2003 4:23 PM PLLD SHUTDOWN ALARM OCT 14. 2003 12:11 PM GROSS LINE FAIL OCT 14. 2003 12:11 PM PLLD SHUTDOWN ALARM JUL 27. 2003 11:48 AM GROSS LINE FAIL JUL 27. 2003 11:48 A/"1 PLLDSHUTDOWN ALAR/"1 JUN 3. 2003 1:28 PM GROSS LINE FAIL JUN 8. 2003 1:28 PM ~ ~ * ~ * END W ~ ~ * ~ ALARI1 HI STORV REPORT í --~- SENSOR ALARI"! n' Q 2:PREMIUM PLLD SHUTDOWN ALARM DEC 9. 2003 6:40 PM GROSS LINE FAIL · DEC 9. 2003 6:40 P~ PLLD SHUTDOWN ALARM DEC 9. 2003 6:34 pM ¡ ¡ PLLD SHUTDOWN ALARM ~ DEC 9. 2003 6:27 PM 1 PLLD SHUTDOWN ALARM : DEC 9. 2003 5:55 PM PLLD SHUTDOWN ALARM DEC 9. 2003 5:42 PM GROSS LINE FAIL 'DEC 9. 2003 5:42 PM PLLD SHUTDOWN ALARM MAR 12. 2003 7:45 PM PLLD SHUTDOWN ALARM NOV 14. 2002 2:24 P~ PLLD SHUTDOWN ALARM NOV 12. 2002 6:31 PM ~ ~ ~ ~ ~ END ~ ~ * ~ * I ALARM HISTORV REPORT ----- SENSOR ALARM .----- Q 3: ~ ~ ~ * * END * ~ ~ * ~ ALARM HIS1ifY REPORT ' ----- SE~ ALARM --~ Q 1: UNLEADED PLLD SHUTDOWN ALARM DEC 9. 2003 6:27 PM PLLD SHUTDOWN ALARM DEC 9. 2003 5:54 PM PLLD SHUTDOWN ALARM DEC 9. 2003 4:23 PM GROSS LINE FAIL DEC 9. 2003 4:23 PM PLLD SHUTDOWN ALARM OCT 14. 2003 12:11 PM GROSS LINE FAIL OCT 14. 2003 12:11 PM PLLD SHUTDOWN ALARM JUL 27. 2008 11:48 AM GROSS LINE FAIL JUL 27. 20Q3 11:48 AM PLLD SHUTDOWN ALARM JUN 3. 2003 1:28 PM GROSS LINE FAIL JUN 3. 2003 1:28 PM .,. c" ---'_ ,- ~ -" .. . i ! 4<:t<~J;.PH~ 5200 eTOCKDALE HWV BAKERSFIELD CA.933~ B1298634005001 ' '. DEC 9. 2003 6:58 PM SYSTEM STATUS REPORT - - - - - - - - - - - - ALL FUNCTIONS NORMAL SVSTEt1 SETUP ------ - DEC 9. 2003 6:58 PM SYSTEM UNITS U.S. SVS~EM LANGUAGE EN LISH Sye EM DATE/TIME FORMAT MÖN¡DD YYYY HH:MM:SS xM ! ' RALPHS , 52.00. STOCKDALE HWY BAJ(I$RSFIELD,CA.93808 Bl~~e634005001 ' SH;I'~T TIME 1 6:00 AM :SHrUrT TIM~, 2 Dl SA:aL~.D SHlF.T TIME:3 DISABU::D SH~'~T TIME 4 DISABLED TANK PER TST NEEDED WRN ,D I I3~BLED , TANK'ANN!ST NEEDEDWRN DIß~LED LINE RE-ENABLE METHOD PAßS LINE TEST LINE PER TST NEEDED WRN DISABLED LIN~ ANN TST NEEDED WRN ·D I SASLED PRINT TC VOLUMES , ENfi'I¥--ED TEMP COMPENSATION VALUE (DEG F ): 60.0 STrex HEIGHT OFFSET ,D I $A;BLED , H-~ROTOCOL DATA FORMAT HE J G¡HT PREQISIQNTEST DURATION HOURS: 12 DA'(LiI GHT SAV I NG T I ME £NASLED ,STARrI' DATE .APR I WEEK SUN STAR¡I' TlME .' 2:ap'AM ',~~~',PA~iEK 6 SUN INC'TIME ~iOp AM RE-orDIRECT LOCAL PRINTOUT PlSA¡)LED ' , EUROPROTOCOL PREFIX .vI S i BYST, E!'1SEC'\;\~'i,' ". i CODE: OOC/ljþtJ!;' " 1\ 'f II '-'.". P' . COMMUNICATIONS SETUP - - - - - - - - - - - - PORT SETTINGS: COMM BOARD 1 (RS-232) BAUD RATE 9600 PARITY ODD STOP BIT 1 STOP DATA LENGTH: 7 DATA RS-232 SECURITY CODE : DISABLED COMM BOARD 2 (FXMOD) BAUD RATE 2400 PARITY ODD STOP BIT : t STOP DATA LENGTH: 7 DATA RS-232 SECURIT'I CODE : DISABLED DIAL TYPE : TONE ANSWER ON : t RING MODEM SETUP STRING DIAL TONE INTERVAL: 32 , I ".: I I' I AUTO TRANSMlT SETTINGS: .,w.", - AUTO LEAK ALARM LIMIT DISABLED AUTO HIGH WATER L1MIT DISABLED AUTO OVERFILL LIMIT DISABLED AUTO LOW PRODUCT DISABLED AUTO THEFT LIMIT DISABLED AUTO DELIVERY START DISABLED AUTO DEL I VERV END DISABLED AUTO EXTERNAL INPUT ON DISABLED AUTO EXTERNAL INPUT OFF DISAaLED AUTO SENSOR FUEL AL,ARM DISASLED AUTO SENSOR WATER ALARM DISASLED AUTO SENSOR OUT ALARM DISABLED - - -~ ~ N~~ 06 2003 12:32 1IjFLD FIRE PREVENTION (W) 852-2172 ! p. 1 11/06/2003 18:42 6613923521 PAGE 01/01 *COpy B~QUESTED PL2ASE FAX(661)392-0621 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 171S Chester Ave., Bakersfield, CA (661) 326-3979 FAX (661) 326-0576 APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION FACILITY ~"AL.rtt~ (í'iZOCXJfl....'-I ADDRESS ~aQO ~":frh(" k1JAl.r~ t+w'i OPERATORS NAME ~~'E~FI1ê..Ü) J t...A- OWNERS NAME NAMBOFMONIfORMANlJFACTURER. ~, r2Jí -'1l..S" '$SD DOBS FACILITY HA VB DfSP.BNSER. PANS?' YES~ NO_ TANK' f .2 VOLT.JMB ~ q oo¡) ~ DaD CONTENTS ----1tAl J-....'r] ~M-q( - NAME OFT.BSTINO COMPANY_. ~ICH ENVIRONMENIJI\L CON"tRACTORS UCENSB if 90-1072 NAME Ii: PHONE NUMBER OF CONTACT PERSON JAMES RrCH DAm & TIME TEST IS TO BECONDUCTBD . \ \ ~Ö~ J 661) 392-8687 \ "C()8M /1 ./i~, ~Lo APPROVSDBY /1~-o'3 DATE YA fi'GNA OF APPUCANT RALPHS 52iJCI ~3TOCKDALE Hlò.I'i BAKERSFIELD CA,93308 B 129863400:,00 1 DÐ.7. :::00::3 12: 07 Ft" f:ì.....E:TEll :CjTi~TU~3 FŒPORT -------.. ALL ! '11, ,r (iN~::; NORt"IAL INVENTOkY REPORT T l:UNLEADED VOLL~E 15249 GALS ULLAGE 4454 GALS 9 [Ij;:: ULLAI:;E= 248:3 GALE; TC VOLUf"JE 1 5237 GALS HE I GHT 82. :34 INCHES WATER VOL 0 GALS WATER 0,00 INCHES TEMP 61.1 DEG F T ~~Ef"11 UI"l 'v'O~ = ULLAGE 90% ULLA(;E = TC \/OLur"lE HEIGHT I...JATER VOL WATER TEr"lP 5EA6 GALS 2171 I:;ALS 1~: :j'3 GALS ~;b37 GALS 78.98 INCHES o G{\LS 0.00 INCHES 62. 1 DEe F M M M M MEND M M M M M ";:III RALF'f'Ü:; 520[1 ~3TOCKDALE HVf'i BAKERSFIELD CA.933G8 B 12'386:3400500 1 DEC 17. 2[10:3 6:[10 . I N\iENTOR\' F:EPORT T 1 :UNLERDED '>JOLUr"1E '3474 GALS ULLAGE 10229 GALS 90~:; ULL¡j,GE= :3258 GALS TC \JOLUt"lE 9450 GALS HEIGHT 55.49 INCHES I"JATER \lOL 0 GALB I."JA TEF: 0.00 INCHES TEt'W 6:3.5 DEG F T 2: FREt"1 [ Ur"1 \/OLUI"IE 4940 '::;ALS ULLAGE 2877 C;ALS 90:\ ULLf,GE = 2 0 '35 G~I TC \!OLUr"IE 4'327 Gi- HEIGHT 70. :31 ¡/'oIc fS [,NiTER \/OL CJ GALS WATEF: 0.00 I NCHEf3 TEf"1P 63.6 DEG F M M M M MEND M ~ ~ ~ ~ \, " e CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 F ACILITY NAME~ ~ G I'M f f'\ s4o\I'L INSPECTION DATE l ~I c/03 Section 2: Underground Storage Tanks Program o Routine ~ombined 0 Joint Agency Type of Tank nWç Type of Monitoring d l-M. o Multi-Agency 0 Complaint Number of Tanks 'Z- Type of Piping d)U¡F' ORe-inspection OPERA TION C V COMMENTS Proper tank data on tile :v / V / Proper owner/operator data on tiJe / Pennit fees current / vi Certification of Financial Responsibility l., I I Monitoring record adequate and current V' Maintenance records adequate and current ./ Failure to correct prior UST violations l...- / / Has there been an unauthorized release? Yes No V Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGA TE CAPACITY Number of Tanks OPERA TION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfil1/overspil1 protection? c~comPI;'n':i~v;OI,;~;on, y~y," '~ d~ Inspector: _k, '~{) Office of Environmental Services (805) 326-3979 White, Fnv, Svcs. N=NO Pink - Business Copy UNIFIED PROGRAM I.PECTION CHECKLIST ~~~~~~i:~'W:;.~~'!'{mlti!ifJ'r)}:ç!R~~rlW~~j;~~T~ SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY d:l~l~___&,tdL(l~._"--5:\o.tL,_"_...._,,.___,~_.._____,_,,.___,.__,.,..._ ...,.,__.", ,_, ._ .'..'-'...'-..-':l:ilb~i---, :::CTION TI~:__,_ ADDRESS '\ PHONE No. No. of Employees _--5.olo..O-_ __ - ,..s-:lo.t.L{J',-__ _..llw-~ - -- - -----,.. -- -- -- -- - --, --,- - .. ,- --- - ,-, -, ,- '-r~S1': lt3. ßJ_ ~- - ..-----.., ,no FACILlTYCONTACT'" Business 10 Number 15-021- e Section 1: .Business Plan and Inventory Program LJ Routine ~ Combined o Joint Agency LJ Multi-Agency LJ Complaint LJ Re-inspection C V ~ ( C=Compliance ) V=Violation OPERATION COMMENTS ApPROPRIATE PERMIT ON HAND --~--~~~:-:S--~'~:~~~~~:C~~O;~~~~"~~~~URATE --,,-,,--,--.-.. ----.,-,.. -.,.-,- ,..,- "'.- -.,....,,-, -------,..-,-----.-....--,-- ;7c;---~ISIB~-:~DR~~;'-,--,-n--'-'--'n-'-..-' ---....---.-,-,-, ,-.,.,..,--,-- -....,.,--- . ,-,---..... ,------,-- ~- CO~;~~~~CCU-;AN~;-'--------'----"-,---,m-- ,----.., ,-" . -, ,. n'...."'__,..___ ;7'~'~'~E;;~;~~~~..~·~~ ;N~E~;~~-:~~~·~I:~~-··-..--'-·no-""--,....- -- -. --.-,,-------,-.,- ,.,.. . ",.-,., " ... ,. "-,,,.-.. --"-,-,-.,--,,, --~·--'~~RI~~ATIO~~;-~~:~;I~~~-'-----·-·-----m-..m-'"- ....---,..".,..-,---- -,..--, ." ,..--,-,."..,-"-,,, ~;f~~:~~~§~~::MA~~Al~~=~---- ..-.+~...~=--~=~=. -.-,..-,~-~'~...~~~'--~=~~..~...,- ~-V~;;;,;~,ON_;,_;;_MS~~ ~:':~,~~--- ._j----- _un . -. ---- ------ [i;6V~R;FIC~~~~~..~;H:rM~~-~~~~I~~-'-u"'--"--'--'-I·n -..-- .., -, ,.. -,. -- ..-.-,-~--~~--.. .,. -.-/--..,-...-.-.....-----~,-,..---,-,-..-,-,- ._.._no_.._ 'n·_"'_'· ....... ---.---f..., ..-.---..-... ..---....,.--.-.- .-,- 19" LJ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ '~-'-~~~~~~'~C~ PROC'~~~~~; AD~QU~~~-'--'--- -.. .,.,,---,- ·'·1--·-··--· - .....-- ----,-.., ..'....0.... ..--- ,.,-...--.....--.--,...--.,'-----, '...-. 7o-.c';~~~I~~~;~;~~~~ Y -~~~;~~ -" ----,-, .m, --.. - - - - , - --,.. - - ,-, -. --, , .. .., .. ...., ,- " ,- --, ,-- ,-, " ,·u_ -, ,-" 70H~;;-S~~EPING ---- - --- ... --- - -I· - - -.. _nun___ u_ - ¡jT~' -~~~~ ~R~~;~T~~~"--" ,- - ,__~u~,______" ,--, - - . , - - - - -- ---...,,----------- D7rJ'&T-;'DI~~~:~-A~~~~T~·&u'O~ 'H~N~"-'-'--.. ..,. -- -'" .----",--------, -, ..., ,-..,-----,. "'.00.' no --, n ,." ---,--".-----,...--,----- --" ------------ ---------.--. ANY HAZARDOUS WASTE ON SITE?: LJ YES , ~No EXPLAIN: INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention 1st-In/Shift of Site * ~ _ ---- _ _ .----.-.- --------.------------------------------.-...--. White - Environmental Services Yellow, Station Copy Pink, Business Copy 11/06/2003 10:42 661392» -- PAGE 01/01 *COpy REQUESTED PLEASE FAX(661)392-0621 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 FAX (661) 326-0576 APPLICA TION TO PERFORM FUEL MONITORING CERTIFICATION FACUJTYJ'AI ,PH~ (-nzOCx.:{I...,''¡ ADDRESS ~~OO ~Th(, kDAl.£ ttw'-l OPERATORS NAME fDA·\<:..:E~~FI E..ÇD 1 c...A- OWNERS NAME NAME OF MONITOR MANUFACTURER ~. ~ ~S... 3:5D DOES FACILITY HAVE DISPENSER PANS? YES~ NO_ TANK # f .2. VOLUME 2o, üoJ ~ DaD CONTENTS -..J1N J--r7 _Çkç.Al1- q ( - NAME OF TESTING COMPANY_RICH ENVIRONMEfoJTAL CONTRACTORS LICENSE 11 90-1072 NAME & PHONE NUMBER OF CONTACT PERSON JAMES RICH DATE & TIME TEST IS TO BE CONDUCTED \ \ µ&\(y~ /i '. It, r£dJrJo J. 661 ) 392-8687 \ '. ()()f> m APPROVED BY DATE J/~~3 I=t' I !"- I~ I LrJ cO IT" IT" , , , u.s. Postal ServiceTM ,','I·,," CERTIFIED MAILM RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) =t' o o o , " , . , , " , , I -QFFICIAL USE I 'I' í Þostage $ ;../ -tertifled Fee Postmark Return Reclept Fee Here (Endorsement Required) Restricted Delivery Fee (Endorsement Required) r ,0 ILrJ 1.-'1 I IT1 Total Postage 1 ru 10 Sent 0 10 !"- ~¡;Äji£'Nõ., or PO Box No. ëitY.-Stãië;:Z¡'p DAVE PUG LIS RALPH'S GROCERY CO 1101 W ARTESIA BLVD COMPTON CA 90220 Certified Mail Provides: 'SaJSIISU) "00" eunr '009£ WJ0.:l Sd , · A mailing receipt I' c"" · A unique Identifier for your mailpiece · A record of delivery kept by the Postal Service for two years Important Reminders: · Certified Mail may ONLY be combined with Arst-Class Mai~ or Priority Mail@. I · Certified Mail Is not available for any class of intemational{Óàil. t · NO INSURANCE COVERAGE IS PROVIDED with Ce~1fI6d Mail. For valuables, please consider Insured or Registered Mail. \.{ I · For an additional feel a Return Receipt may be requested to provide proof of delivery. To obtain Re um Receipt service, pfease complete and attach a Return I Receipt (PS Form 3811), to the article and add applicable postage to cover the, fee. Endorse maUplece 'Retum Receipt Requested". To receive a fee waiver for a duplicate return receipt, a USP~ postmark on your Certified Mail receipt is I reqUIred. · For an additional fee. delivery may be restricted to the addressee or : addressee's authorized agent. Advise the clerk or mark the mailpiece with the ' endorsement "Restricted1Je/ivery". · If a postmark on the Certified Mail receipt is desired, please present the arti- , cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail. ' IMPORTANT: Save Ihis receipl and present it when making an inquiry. Inlernel access 10 delivery information Is nol available on mall addressed to APOs and FPOs. .. e October 6, 2003 J ~), CERTIFIED MAIL Dave Puglis Ralph's Grocery Co. 110 1 W. Artesia Boulevard Compton, CA 90220 Re: Failure To Perform Or Submit Fuel Monitor Certification Ralph's #653 @ 5200 Stockdale Hwy., Bakersfield, CA FIRE CHIEF RON FRAZE NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE ADMINISTRATIVE SERVICES 2101 "W Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAJ( (661) 395-1349 Dear Mr. Puglis: SUPPRESSION SERVICES 2101 MHo Street Baketsfield. CA 93301 VO/ÇE(661) 326-3941 FlIX,(ö61) 395-1349 > I J PREVENTION SERVICES FIRE SAFETY SERVICES· ENVIRONMENTAl SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAJ( (661) 326-0576 Our records indicate that your annual maintenance certification on your leak detection system was past due 01/08/03. You are currently in violation of Section 2641(J) of the California Code of Regulations. PUBLIC EDUCATION 1715 ChesterAvè. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 "Equipment and devices used to monitor underground storage tanks shall be installed, calibrated, operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks at least once per calendar year for operability and running condition." FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAJ( (661) 326-0576 You are hereby notified that you have thirty (30) days, November 2, 2003, to either perform or submit your annual certification to this office. Failure to comply will result in revocation of your permit to operate your underground storage system. TRAINING,DIVlSION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAJ( (661) 399-5763 Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely yours, Ralph E. Huey Director of Prevention Services By: It t~ Steve Underwood Fire InspectorlEnvironmental Code Enforcement Officer Office of Environmental Services SBU/db ~~ Ye/V~ de WrY/'I//l~ ..%/" .~oPe .r~ A ~~" UNIFIED PROGRA.IECTION 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 £44'¡ '..J' ADDRESS J¿;Jc/ô 0~ C.A:.O¡Y./,¿:::- FACILITYCO~) /l4rl~Y ,----._------------_.._-- __.____~~~.___u_~_~__._~_._.__.'_ ::/~; PHONE No, '~-;4'¿"? INSPECTION '9ME / Y.:Jd ~A..S r ~----- ~ No. of Employees ----.--- --_._-_.__..._-~---_.- Business ID Number 15-021- c:;e¿..;J/¿}' $ection'1: Business Plan and Inventory Program (] Combined CJ Joint Agency (] Multi-Agency (] Complaint (] Re-ìnspection C V ( C=Compliance ) V=Violation OPERATION COMMENTS a ApPROPRIATE PERMIT ON HAND -------.------------------------- .---.--.------.. .~-,-------------~._--~-_._._._------_._-_._--------_.~---_._~._._- ~ BUSINESS PLAN CONTACT ~~FO~~~~~~,~~~~~~_=__"'__"__,_ _"~~~_~~_,_!!~Æ!~~,_:'!~~___~~~~_,_ a VISIBLE ADDRESS _._----~--------------_.__._._-.. _..----_._--~---_......_-------~~._--_._..__._-_.._-_.-._--- -_..------_.~----_..._----~--_.- a CORRECT OCCUPANCY ---~----_._--_._- ------<._._---_._~_...__._.. --------..-.-----------..---.--------,,-------------. ._---_.-----, Jia l ~__ VERIFICATION OF INVENTORY MATERIALS --.-.-----.-- -~----_._-_.- ._-------_. - -_.-------- - -~--------.._._-,----_._--------_._----- - ._,--_. ._--_._,--_.-- VERIFICATION OF QUANTITIES ---------------.-------.--------............... --------------_.-------._---._----<--------.- _.~.-._.._------------_._~-_._.~._-._-- ~ VERIFICATION OF LOC~I~~___________,__, _____,________'_______,,__,______'________"____ Ç(" 0' PROPER SEGREGATION OF MATERIAL . -~--,--------------_.._._-----~ ---------.----.----------.--..--..----------------- ----------.---.,-.---.-.---- a VERIFICATION OF MSDS AVAILABllITYE ----------.--..------- -.,----.-- -~~-_._.----------- -----.~-----~-_._---~--~------------------ ----- a VERIFICATION OF HAT MAT TRAINING ----------.--------.---- -------~-----_.._--------_._--_._---------_._--_._~--, "-.-----.----.---- (] VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES -----~---_._-------_.._--_._---- --------~-----~.._._-_._.._--,--.---~,---_.._-----,._----.---------.-- (] EMERGENCY PROCEDURES ADEQUATE ------_._---<._------_._--~_..---- --_.---------_...._._-_..~------------~-----~-------~--.~->---_._~---------_._.._--_. CONTAINERS PROPERLY LABELED F: :::::::aUA~-& ON H;;~~~~=~~-~W~=~--=-=---==--~~=~=-~-=~- ~ ^~ 011 ClU..tC c-)r')~f<~~~'S '--" ~ oS-CO \ ~tGJ-ì~Y).~ ¿ ,p ~ "" ,~f ;::;;;') ç(,-=, L,J V ANY HAZARDOUS WASTE ON SITE?: aYES EXPLAIN: QUES;;:~?RD~~;E ;:;;661) 326-3~i)~ Inspector Badge No. Business Site espo J It. M ~ d ~vY\ ~ White . Environmental Services Yellow· Stalion Copy Pink, Business Copy FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 'W 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£ SAfETY SEIMCES. EIMROHMENTAL SEIMCES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326.0576 PUBLIC EDUCATION 1715 Chester AvÌl. Bakersfield, CA 93301 VOICE (661) 326-3696 FAJ( (661) 326.0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326.0576 TRAINING DIVISION 5642 VIctor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAJ( (661) 399·5763 '. e: January 22,2003 Ralph's Cardlock 5200 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. Sincere~ I )if£1 Steve Underwood Fire InspectorÆnvironmental Code Enforcement Officer Office of Environmental Services SBU/dc ~"Y~ ~ 't?on~ ~ ~0Pe .!T~ A W~?·" .' - T\,,4.Ji ~'\~~ ~~ ~ ,,' ,~!,_ _). ,i~,i~~,~:" :"" "" ,,""",,""" ,""': ¡' """"i"'! " i ....,~~,~___, _:",~ ~~ '" ~J (_..".'- ~ .. - DEVELOPMENT Setting the Standard 12/10/02 .,----.....- - Mr. Underwood, Enclosed are the results of989 testing performed at Ralph's facility #653 located at 5200 Stockdale Blvd., Bakersfield. Also enclosed is a copy of the original repair permit - and the correction notice left by Howard Wines while he was on site witnessing the 989 water test of the disp~ns~r b~~s~I apologize for the delay in getting this to you. If you have any questions or ifthere is anything I can help witl1, please call me @'909~376- 6488. Regards, Scott Covey Convenience Store Specialists California Office: 760-244-6215 Fax: 760-244,2703 P.O. Box 403723, Hesperia, CA 92340,3723 CA License #716404 Arizona Office: 480-829-1179 Fax: 480,829,1266 1403 West Tenth Place, Suite B,104, Tempe, AZ 85281 AZ license #B 1,128314 _&2 14:sø RALPHS RETRIL ~1H¡N1ENi=N:E ..)¡I:./ 00" <;...JO. I . V...J' \J..J "'~ " . r.tNG._ß]:-'O~çß CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 \- ~ ¡:;: ( PERMIT APPUCATION TO CONSTRUCTIMODIFY UNDERGROUND STORAGE TANK I I ' 'I'Y1E OF APPUCA nON (CHECK) [ JNEW FACn..rrY ~ jMOD!J7ICATtON OF FAC1LrrY [}NEWTANK INSTAUATtON AT EXISTING FACn.rrY STAATtNGDA"Œ /¡-/l-OJ- PROPOSBDCOMPL.ETrONDATE //- '¡l{-O'L ~~~="1~¥~ar~JkAg;~:~rrNO. ZrPCX>DE· TYPE OF BUSnŒSS I _ L ~ 6 _ APN" , TA1'lKOWNER- 'b..~/J?ú ¡().5 ,<J,æ..,o¡/¿;;- PHONE NO. ADoa~ CITY - ZU'CODE~ CONTRACTOR ~~ z:. ~~~¡C~nl~ CA UC!NSENO. ADDRESS fb ðð:Jt vtJ 3 7 Ø).3 c~/ ct. ZIP CODE 9;; 3lI tJ PHONe NO. ~ <:f Cl q - </7 7 ~ 3 ~ð CrIY BUSINESS LiCENSE NO. WORKMAN COM? NO. INSURER. BR.tFFLYDESCRJBE11ŒWOIlICTOBëDON£ t.<::&? c>vr-.?#:?z. ÆtØTß;t!-9c- J ¡P¡¡~ L/II/ð ~//f//~rJ ~l!{Y¿ ~ ~ mA/lt, ¿:J/-5;tO£5Em4~ 4?~II/.ø~T.é"~~ /N' /1/~-;;~~7L. A-Jxe7S.,. /"';-sQJ¿/ .A/¿)(/ t!'ð,o.,m(ùum",-:v/" 7CE'¿'>~I;7e.3T po/'5Pd::r -s4..5VVYJ, .~,a¡c v¿iO .:Sÿ31l'7.V1, WATER TO FACIL.ITY PROVIDED BY ~ I) . DEPTH TO GROUND WATER. ,v /~ SOIL TY.I'£EXPECTED ATSrTE. IV/A NO. OFTANXS TO BE INSTALLED f2? ARE'nŒY FOR MOTOR FUEL ,A./ A YES N:) SPILL PIlEVENTtON CON'ffiOL AND COUNTER. MEASURES PLAN ON FILE V YES NO ( . SECT10N FOR MOTOR FUEL TA1« NO. VOLUME UNI.EADED REGULAR PREMlUM DIESEL AVIATION SECTION FOR NON MOTOR nrEL STORAGE TANKS TANK NO. VOLUME CHEMICAL STOReD (NO BRAND HAMS) CAS NO. CHEMICAL PREVIOUSLY STORED ([P KNOWN) r APPl1CATION DATE FOÎl omcw. USE ONt Y FACD.1lY NO. 1'10. OF TANKS FEES $ 1 1'HE APPIJCAm" HAS RECEIVED. UNDERSTANDS. AND WD.L COMPLY wrm THE ATTACHED CONDmONS OF THIS P£lUdrr AND ANY OTHER STATE, LOCA.LAND FEDERAL RBGtn..All0NS. ~. ~ ~ """:' COM;-"LI':I1!D tJNDBIl PENALTY o' PEIUUItY. AND TO "THE BEST Of MY KNOWW>OE,IS .Jd$;j ~k ~ 61<..'/AN ~OLV5ì...'- APPROVED BY: I . APPLrCANT KAME (PRINT) TOTAL P.Ø3 PS, ):, ,':~¡¡ "i. ,g"~r,~ SIOU g' "h.k S!"'m ,':, ,T .,bi., Sumps, Fill Sump...d Und" Disp..." C'ntotnm,"t :-".-:.,~1;",:,~~,,' Ö;.':;J~e.cori_~aÍ"Y Ç9,~t~~ÌI~~n!_ Cert,CicationForrn . ,': ' , '. , ':-.::.:.~:::,~~~;;}JHf-', '.:~i~~;¡;~"E',·'W¡PHS iF' ..,., ;',,-:' .:,:-~,:~ ' ::>.. ,,^ "".. ,.:. :..,.. ì .- .' ,,,, ; ,:, .::" >~:',~, ,'" ' . ;i~::¥~:~~~~():~N :i~f~éi!itý)#ß~tZ,';5~':' "C.ity: ~/!'1:¡<€,es J.-iEL:¿)· ':'cfA. ~<' ::'Tt3t1ng Co~tiâç{o~f,l?~v..ßitV. '1-1 IH.2AN/)'/-J ~¡W?\(~¡~~~?4~;;:~:~ê~~:;;" . " ;~:'" ",' """ .:.,,'.~ ' ;',~' . '~{£;S,tòf Add2!;::;.' '-', ' 89 9\ D .' Turbine Sumps 87. 19 91 D87 JD (nonh. slave. etc.) Manufacturer e , '-: ~~-' ..:..-, , Stàì-t'Time (to) . Water'Level ' Time (t.) Water Level ,,:~. Timé' (t]) W.'ter Level - .Jil1)i~(~J) :;.._. Wàter·tevel . ,.:~-%:.... ", .~,';~. iTame (4) ;.. . , "W:l~rLc'ÿ;í : ?:ó~f;~~·~?Y·.-·~'w._:~~,. . i~itn~~sjd,ts, ;~ Time (t¡) .,.," Water Level Time (t]) Water Level Time (t,) Water Level Time (t4) Water Level Te,t Rt3ults Signature ,..j., >. \ ~~ .. .*J < ;" z' ~ '. '=: ,. ~.:213 J.;).I ~,~/3 :l. :;¿/3 "d.~i~ .",!, ~, ¥:' 4,'570 1/,5{,9 if. 10 '1/,57 Ò 87 87 1991 D ~t~ft Tinié (to) Wlter uvel Tlm.e (tl) J .~. wì[têr LeÝc1 " Time (t1) Water Level Time (h) , WiterLevel ~. ... _,t..,. _ ~. ",..,'...;. ;" '.~ Manulactüj'er St¡í-t Ti~e <te)' Water Level : J . . ~ ~...,: ",. Page ~ '. 89 91 D Time (t,) W~ter Level Time (tt> Water Level Time (t]).. Water Level Time-{tJ " 'W2tÚ,Level .. .' " Test Results . Signàtare . :.tEP!) T~tD~~'e: ::,,~;¿I tii.·', .~,; . ',>.- ':,;,~,~.c/: ''"K6 ag .,'"j;/..:.:"ë-.,. "Tecb. Nlme: 4ÆAN/'JA- . <:":', 91 D f f t f t I .,,,,' --~~ .'~''f.'!f ",f '·2·:~'l:. ~ ¡:\\ ··~l 87 89 91 D 17 89 91D &7 89 91 D t~ ?:,:2/ 3~OI g 5", (;,{)-/ 3·D I 5,QJ 3..D s: 6~/93.01 '. . :~,~'l' 1 . " " 1 .~ ,; ..;. .~.-! .~ .'~liJJ¿~··, ~ '..~ --- t \ I! j ì 1 Fail Fail Pass Fail Pass ,;.J~ ' ' ~,' ,_ '_' , .,_ . :___ ;F, _ /J ~':::~,~', " " . ' , -~,--~~. -~---~-------,----) ; ../ --"~--~-- ~~-- .. -._'.._.._- _._-,-_.~---- - - - ---;:-~.-'tK '".... ~ '. . / el Fuel Daily Report e / / ~~ Client: RA/.ßJ-/S -:IF t,S~ Date: II J In ¡;:::; Site Address: Project #: City, State, Zip: ß¡::)KERSF.IFLD (1A Client Contact: Scope Of Work: SB q f?C¡ TF.ST Prepared By: 1<Cú¡(87V H.. 4/2IìNI.)¡q roG e Weather: Temperature: &3 Employee's Equipment & Vendors I!! I!! Change Name g Equipment :I Vendor POt Order 0 ::c ::c V/N "RF/~orAI J-/ /)~~ "" 1/030 - 3i/5 Materials Subcontractors DescriDtlon IQtv PO ComDanv Activity Field Activities: F:// ~ /1 /:/,'( 01'" h .$'ofJ v S'~.s r~"U_ I. £~,~./ £'.r- -.51< '7 Ý'c,. r-fL~i) 7;.:> /- '/.. f :>;., ?J¡ J; L<../¿t../.- V" -' d's~<-:J~ ..:> 5'// ~I ¿¿?4.S'Se.J, ¡f) ~--- -v~ /.! _ .¡lo/,'('AH'.p d' /J)ro/,J~ / A . I;' UA? /hCt. I- , -' , .11"(/........5, v v / Notes & Safety observations r~/> l' c.... '" II f... or" a.r~ . ... J 4...l-c..-¿" ",:;", 7e-...-!¥!.· c:... _ ¿... ~ .I <"' A-I'''{' ¿ r.J, ~/"~ //,oj. ~ ~ "IA $'--~ / , ./ . Fuel aDDroval: Client ADDroval: Date " ",__;""';' ,.;,.'-:"'; ,.--V-. ~~:.. ~<.... -':-..,...-;,~-:-~. ':'4.~ ~,,-.:':":".-:r ....~ --- . -.. -....------ -------"'. You are hereby required to make the following corrections at the above location: . . ~ - . .. -. '-'. ,..~ -",--,' -.~"'..- ~... , ~.-- , ·"'..,:~CO~ECTI.N NQJrICE 04880 "'., BAKERSFIELD FIRE DEPARTMENT Location $2-00 $TO(!¿()A,ib¿ d.4:fFJV ~<"P..\ r S J:Z 6:; ~ Name Cor. No. (!) ?Lc;o.~~ bGi. 3. 2~. Q$"ì'6 ¡¿ t SV(. 7:> ç: S. ~ c; íì ~ "'T~ <; '(;/VG ANt) .At Sò p~pt.<¡¡, r ua.. 2E::I'A'a. -ro .-;:~ r.:¡ 'ß<i. ;2£... 'Y£'5>7 Completion Date for Corrections Date , f .111 /0"2- UhD/:;7..., FD 1950 Wuvés Inspector 326-3951 ,~ ~ 3 ¡X<' ~ ~ ~\¡\\ '\ ~~ ~tP~V ~C 12/137/213132 1313:43 e 761324427133 e PAGE 131 ÇPI DEVELOPMEN'f FACSIMILE TRANSMITTAL SHEET TO, Steve Underwood fROM: .Amanda Tullio COMPANY: DATE.: 1.2/10/2002 F.\X N'tJMBEJ\: 661-852-2172 TOTAL NO, OF P.hCBS INCLUDINC COV.8R: 6 PHONE NUMBER: 661-326-3979 SENDER'S REFERENCE NUMBER: 909-477-3200 ItÉ: SBND£JtS FAX NUMBER: 909-477-3044 o UR.GENT D FOR. REVIEW o PLEASE COMMENT 0 PLEASE R.EPLY o PLEASE RECYCLE NOTES/COMMENTS: CP OF.VELOPMENT 8513 ROCHESTER. AVENUE RANCHO CUCAMON~A. CA. 91730 J e e 12/137/213132 013:43 7682442783 PAGE 132 " [-I I DEVELOPMENT Setting the Slondord 12/10/02 Mr. Underwood. Enclosed are the results of989 testing performed at Ralph's facility #653 located at 5200 Stockdale Blvd., Bakersfield Also enclosed is a copy of the original repair permit and the correction notice left by Howard Wines while he was on site witnessing the 989 water test of the dispenser boxes. I apologize for the delay in getting this to you. If you have any questions or if there is anything I can help with, please call me @ 909~376- 6488. Regards, Scott Covey ColtVénlence Store Specialists California Offjç~; 760-244-6215 Fox: 760.244-2703 P_O. Box 403723, Hesperia. CA 92340-3723 CA Lice"~e #716.404 Arizona Otfjçe: 480-829-1179 Fax: 480.829-1266 1.403 We~t Tenth PloGe. Suite 8-1Q4, Tempe. AZ S'52BJ AZ liconae #B 1.128314 ( . t. j 12/07/2002 00:43 (' TANK NO. VQUJME e 7602442703 e PAGE 03 '-- P~dN.. ßJ:. "O~~ß CITY OF BAKERSFIELD O~CEOF~O~~NTALSER~CES 1715 Chester Ave., BakenfieJd, CA (661) 326--3979 CATION TO CONSTRUCfJMODIFYUNDERGItOVND STORAGE TANK _ NO' NO SECnON 'DR M010H rø¡:L UNL!ADJ!D asouw. l'REMlU'M DIESEL A vtATtON - TAl« NO. UC11ON'Pokt'totf MOWJt hJEL5mltA.Œ tANKS V~15 CHEM[~LsroR.œ CAS NO. œEM1CAL PJØ'tOUS1.Y S1œED (NO~1tA.ND NAMB) tIP KNOWN) . FOR.OIRCW. aSE OHL Y I JJIIIUCATJONDA1ã FAalllYNO., ~~ - IfO.OFTAHKS· FEeSS , J '1'fœAP1'LlCANT HASUCEJYm. UNÐERSTANDS. AND WUCOUPLYWUH 'nŒATTAQWD CONDmONSOf TIDS PmGlrt Atm ANY onrea $'rAn. LOCA.LAND n:DBRAL JæOuz.ATtONs. ;£ HAS BEliN ~PLI!:I'!rJ UNDJIR PENALTY OF tEtUURY, ANt)TQ THE BEST Of MY KNOWLaXiE. 18 ,I~~. () (Jj~!.II~MJ'IJi~./ B~"¡Ä"; ~()W5'-'- . AP'ROVEDBY: ' ,AI'PL1CI.NTKAMe:(I1UN't) UCANTSZONATUIlE TOTAL. P. 03 ~ e 7602442703 12/07/2002 00:43 · CORRECTION NOTICE 04880 BAKERSFIELD FIRE DEPARTMENT location $' 2. 0<:.") So 'ioc 1:( í).A..L.¿ ..Lt w V Name '~l..?lrl "s ..t:t 6:;.3 You are bereby required to mala: the following corrections at the above location: Cor. No. /1) ?l Gasé C.o~ 6,)f"t. "'1.C"t='t: ~ (,GI. 32b, o~G t_--" Qc~v(. -r:;.. d(: -;;.'& <;O'8Q ~t:';.T..~ ANi) i\l.. S-:) Ç"o1. 11. 4- ,.,,~þ.,.. ,..) ¡::" ~...r-- (':"().'Lo P.t.c ~ I) r..pp,- fro,::, .,.,:~,;J ~\t2. Vr, '~f r:; < 1/11, '< ,.,~y..J ?G~- ,T ~:~R 2.::i. P,ð. -(.2, r.:.. ?(:I - (.?: ..- i~ "}!2. "!u <;;2 '=t ~q ;<l! ... "'ç~-r . '~¡;;(')~c.::I-' . .." -'-.., , l ~ .i Ä /// /I'~ '"";;{.., .- ~" ..:......-....... i' -;;', .~. / .." ... ..) J/ - .. ; Completion Date for Corrections Date f t /'7 /0'2... 110ù/',,7 .. . ~-' ... tA),.....·é-; FO'~ --------. ....-....---. Inspector 326-3951 e PAGE 04 ,'~ ..": ¡ :1 ;] I ,;j 1 " ,1 ,~1 :1 j ~ ; :j . i ':j ,,'j . 'j i J ':1 :~ ;j :\ , ì ~í .; '1 ., .j J .J ;~ 1 ..l ,1 " ':.;¡ '-; .} i :1 .J '·1 ',:J -:.. ':j {:-.~.,. :.': '.__. "~D~t~·~;~~r.~ ~ttln&~ lu~\¡ Sy5le.m ' . ':, T~ib1n,~ s~-mPJI Fì\\ ~~mpul1d tJnÚr:Db~tDSu Conh}nm~nt;, . r.T~'\:::: ...-.!.·~:;:St,t,Dnd.'~Y ç~l!farnJ.!1~~~ Cuti~uII~I1,FD~. ,>. " , : '.:. " ' . .:'" ,,'.' ,;;:; "',~:'.'/:;/:'::' . - .,., '. P12i: .... ',:oJ, '. ,: ,'. Tbile (tl) , : WaaerLevtl ."", " l1me~~ : W.ìuLevel ,', , ,T,imi'(tJ) _, / " .. ~.'te~tev'l, ..' . . '.. ":$><';~i.d'::"" - 'i 1,/ - .;'-:'l,' '~~,( , ;.:.;';,:'. ~;V " ,',._,.."...,;.,',.,.;,_,.,,_-:~.:.:_~~,~,1l, ' ,I!i~~,~e.,cl . '" ..,. ' '. .' '. '.' -.', ' . :'~ ._~ ~~~¥~î.~;i ,...,-' Pass" ":F~U ,.:-. Turbine Sump" JD (BOm, slave. ere.) M.nuracÍa1rcr S 1.~{'Í'¡~ë. (t~) " Wlt~rt.eytl . e ,-- ., - ., (Y) e~ ~ ~ ('. CS) l.O I"- )--. "::¡,,::.),.: ~fr.i.:..~::,;;._._,-:.':,."., ; ~!~f~¡;)-:'~f: "._ 1I....sc:.:~·i*~'fi<.o'i:..i~~õð"~·_·"-.. :~.-'.:. ~ ,,;~,: ~Stãrt Timc (I.) '; . : -', -~1-; ·WitëiLt;.·el' ':'. (Y) ~ CS) CS) Time- (t)) .:'::. W1Itt:r Lev';t Time (11) Water Level 1"iD1' (I~) Water Level Till1l (14) Water Lcvel TtJt Resules ('. CS) CS) ('. "- I"- CS) "- ('. .-1 Signature -,. .. ~~,rtTuñè (tG) . \'; : Wltir Le've1 ~ :" . T!~I (tJ) :.~ 'd;' '~ '.' WàterLeVe1"' Time (tð Wiler Level Time (tJ) . . / Wifer Level /: . . .- v' . Time (t¡> ' / '_ ,WaœrLevcl' , ,T~ ~~. ... .'!!:'I'-¥:.'ffiÜt' ~. .~_ ~:: ~" ;...........J,l ~-. ~.;,;.... .I! ,If. 91 0 ..17 ,.19 91 0 17 .9 ,. D nl9'~1 D . .. -Al/A " ---- ~' -/, V ~!II ~ ~'-~1 .-.,.. ..V 1· ~..-. . l:;l ~ on.!}.. .. ". ~ .'. ~ ..;/,,It . J.. ' ",... ./ ... t 001\ ". . . -- .. .. .. . ". ~~....~-'- PðSS .!a~1 'PaD ~.':,.f:~·i.l'i 'Pass '- .;~/....;_ "'-''-., '·1 .. -" ..,. .a~Jt~i.fi,~·.;.. "..!,'"\. ; - - j,"'" .. Fin· Sum p¡, . 10 11UIrth. sll.vc t1C.} M.l\úr..ctut~r .. .. .'¡'-~ . .~.. .. '. " .1<',::/. "; ::':~~~~ ~~: .:(.:':.:\'. 1'1 111 9' D nU\)l D I' '19 ,. D n I' 91 0 ,N1A-- .. ~ ¡:"'~ t ri~;i :!- .jr,¡A / / h ,r / " ~",," .. ".." Pass . f,~L ,'~s :~ P .' ';"f" ~,,' ~'.""'. ~~: ',~~i-- "'~ . ¡Eo.': _;~.-;'i:,:~.' .:~~..... ..-- I~L 0.' ..~'YJ~~.. )W~ -Y¡~:~Y~;~~:r$ ~1~~.~ - __ ..~t~/ .~. ';~:,,~!"~ ." ..::,.-~--'. ~'~'. . ·~~t· .~ "~~)~ ,¡~' 'ÌD(~3i,ç(~:;::~ir~'" :?~0~~~~&t1Ji :~~~Ù·;·<. .~ )b.w'~~.. ' ~. '-.' ~-,,,;,~.;~ ~1~'4.""Õ'¡>':"·"">< .; ~?~-i ~:;~~~~~ ~~~~~~t·jW· ~:~i3 'rff:ß'76'5~~l:1fíg ß':'oí? ~.~/1 )·(510 5". {;jJ, :3.'0/ g ~.~/3 lj.5b9 ç.{,~1 3·0/1 ~::ti~el 11 : / 3 In· Tl~c (h~ J..;;J./3 "f·51D 5, ~ .Dr/~:·. ·WaarLåVe1 ·'·..v· , ~.;lja 'l/.S1IJ 5: b ~/9 3.0/1' : '. '~:i:~ievcl !e:2. FaiJ( ¡@,Si..J.Fai11 /Pass )yw. '~1', ~ ~ A ':-)J r //.~.J./ // .I 1777) !'-""'1"7" 'f / .r/ 7V, 7"0../":;! ., ;-'IF , y / ...... ~ ~ .. :¡. .. . '. ,.. -..'~ : ; Sti'it Timl(t.} Wltl' uvel Time (t¡) Water Level 'fist bulb SlÎn~tllrl! . ~.:.... '". . ...... -.-. -. .. . .- \'. :'.;.:-~..:.-=.:: \ :':::.:.;;:'~.;¡~/ ~ f~:{~~:f~-:.~~.f:-~ --.o;~::'.:' ...... /' ../ f'u . /V/ I ;/ / , .. 1 " j Pass ~ 'rail Fail Flil }la» Fail Pass Pass ". .~.. ........ :¡ ( . ...., l ~-;~~,' , , "'..' ...-: . "~: . .__r.. . ....._.__.~----- ......- .-- - ", " 12/87/2082 08:43 e 7602442783 e CPI Fuel Daily Report cucnt: RA¡PJ.¡S~¿S}i Data: ,,7/'" /...... , Site Addrus: Project #: 7 " City, State. Zip; ~K€/?SF..rF.J..D (?A Client. Cantilct: Scope Of Work: SB q ~9 T"¡:-.-.s-r Prepared By: &;:G..,\"ffl'V H.. .4~~µDt4 Weather. ~()(; T8ftI1KIrature: ¿, '3 f> Employee's Equipment & Vendors i ~ Chanae Name Equipment ¡ VeaCH" POtI order :s: :J: VIM ""D. J..I ./'I_A -- IIn:lO - US" Materials Subcontractors DoaeriDtlOO ¡OW PO comDi&tiV ActIvitY FÌéId Activities: F.'lJ &. II ~/:< ði!",.~.. fI'" I?______.t: . .1...(_ t.. ,~~ it: " ..('/1'" ..s /) q ~. 7:. ...,,l ') i:;.:../- .".i.~&___-", 'A ')oJ. :>1" :7]/s --tl A411.S'54.../' ð M,J;$..J.- _ L:!. - J .-/'~""'r- ~, .ø>"'<v.:J.... j ~ ¿./¿¡.,. ~= t ' "/YV-s: " , ,Ii'"> V v / Notes & Sefetv observations ¿:~Þ'> r ' ",,1/ l.c..'ðr" 0""-",<-_ c.. .....L~ ÁA ./ ~A c.._ I~"'. ~ _ ....L"'¿ . _4..J M-,.~ u;."..L ~.4t- "{ ú....__ " .. ,/ FUel aœrQV8J: Client ~: Date PAGE 86 '1 e e p1010187.jpg (1280x960x24b jpeg) RALPHf3 5200 ~3TOCKDALE Hl,',)\;' BAKERSFIELD CA.93308 BI2986:34[105001 DEC 2. 2002 10:28 AM '::':" ~r"l c'l"" TIJc· REn,""R'T t_' J.. ~_I H ~_I '.. r ,_, - - - - - - - - - - - - ALL FUNCTIONS NORMAL I r',j\lENTORV FŒPO¡;::T T 1: Ut\LEADED \/OLUt"1E ULLAGE 90% ULLAGE= TC VOLUt"lE HEIGHT ~JATER VOL I.,',JATER lUIP T 2: F'REI'-'lI Ut"1 \/OLUt"1E ULLAGE ig;_~tÎ~~E: HEIGHT I...HHER \/OL ["'JATER TEI'-'lP 7123 12580 10609 7117 45.00 o 0.00 71 .8 4:31 t. ~:501 2719 4:312 t12.88 o 0.00 73.9 GALE~ GALt~ GALS GALE:~ I NCHE~3 GALS I NC HE~3 DEG F GALE GALS GALS GAL~3 Ir',JCHES GALS INCHES DEG F M M M ~ ~ END ~ M M ~ M . . CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME Qo..~~\. ~ tntt9t'c'I'Y -stOlt( INSPECTION DATE {2- ~ -0 L- Section 2: Underground Storage Tanks Program o Routine al'Combined 0 Joint Agency Type of Tank PWF Type of Monitoring ~ l '''' o Multi-Agency 0 Complaint Number of Tanks ;l Type of Piping a fÖW'F ORe-inspection OPERA TION C V COMMENTS Proper tank data on tile t / Proper owner/operator data on tile v / Permit fees current , ~ Certification of Financial Responsibility ..........v Monitoring record adequate and current ./ V V Maintenance records adequate and current ./ V - 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 SPCC on tile with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspilI protection? C=CompJiance V=Violation Y=Yes N=NO In,p'",o, .L ítÆ~1Q Oftìce of Environmental Services (805) 326-3979 White - rnv, Sves. ~~ Business Site Responsible Party Pink - Business Copy It . CITY OF BAKERSFIEI.D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKI..IST . 1715 Chester Ave., 3rd Hoor, Bakersfield, CA 93301 FACILITY NAME Q.(.I..l~~ ADDRESS FACILITY CONTACT INSPECTION TIME ~p(r AI ~\-ort. INSPECTION OA TE j l-l. - 0 1- PHONE NO. ~(q - cg5f~ 0 3 ~t;{ BUSINESS 10 NO. 15-2) 0- NUMBER OF EMPLOYEES J Section 1: Business Plan and Inventory Program o Routine a;rCombined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERA TION C V COMMENTS Appropriate permit on hand l/ J Business plan contact information accurate L.- V Visible address '~ V Correct occupancy \.... V· Veri fication of inventory materials Ie V Verification of quantities I....... V Verification oflocation ...... y Proper segregation of material ./ ,/ Verification of MSDS availability ,¡;;/ ,/ Verification of Haz Mat training , l V Verification of abatement supplies and procedures I........ V Emergency procedures adequate .....v Containers properly labeled 1......- v Housekeeping VI.- V v Fire Protection Site Diagram Adequate & On Hand / C=Compliance V=Violation Any hazardous waste on site?: Explain: DYes )6 No White· Env, Svcs. Yellow· Stalion Copy Pink - Business Copy Inspector: Questions regarding this inspection? Please call us at (661) 326-3979 """" . . - RETAIL MAINTENANCE \ JOE TA YLOR I DIRECTOR Phone # (310) 884·2896 Fax # (310) 8841.2567 - -\ IFAX TRANSMITTAL DATE: November 20, 2002 TO; Howard H. Wines III Hazard Materials Specialist City of Bakersfield Fire D,ept. Office of Environmental Services FAX: (661) 326.0576 FROM: Joe Taylor SUBJECT: Copy of SB 989 Test dated 6/19/02 Number of Pages (Including Cover) = to Sir, Per the correct notice you Issued yesterday... The attached Is from Franzen·HiII Corp. on Ralphs' fuel center at Stockdale and California In Bakersfield. . In reviewing the attached, it would appear that the recent repairs made by CPI and yesterday's re-inspection have satisfactorily resolved the open issues noted at the dispenser containment boxes. Additionally. CPI was to have faxed a copy of their modification permit to you yesterday. If that didn't happen, please let me know and I will follow-up wI CPl. If you have any questions, please contact me at (310) 884-2896. Thank you. 0T/TØ'd ¿9SG Þ88 ØT~ 3J~N31NI~W lI~13~ SHdl~~ t£:Tt GØØG-øe-~ON ,......v..w~ """"'- WI."" .e""'-' I... '-"'-'-'. I "' , .... ~ ...,.~ ........, ....,......,... I ,-...... ~.. ~ .flIþ , .\ Ralphs Grocery COmpAD)\ P..O. Box 54143 "I Los Angeles, CA 90054 (310) 884-9000 Please deliver to: Date: 11/18/02 Name: Joe Taylor Firm: Telephone: 1 Fax #: This fax is from: Name: Dan De La Rosa, Director Corporate BraDds Telephone: (310) 884-4199 1 FAX Number: (310) 884-4246 Message: Re: Equipment testing Number of pages intluding cover: 9 H:~ Øi/~Ø'd ¿9Së Þ88 Øi~ 3J~N31NI~W lI~13~ SHdl~~ ~S:H æe~-æ-t"ION NOr1e-2æ2 08: 53 ~u~ 1~ U~ u,_~~. ~ EXEC. MKTG. __ .jUI Ijt4 't&"IÞ t'.~tJ::I ~IU COIpOiatIan '1100 NORtH J Eh kf:.(i I TULARI!. CA 113274-1931 ' (55B) _4977 Fax (559) 888-1481 CU5TOJIER#:73327 1NVDICE!1J: 81392 INVOICE DATI!: 06125/02 DUE DATE: 07J2fJ/02 BILL ~ Ralph's Fuel Island 5300 Stockdale HWY Bakersfield, CA 93309 LOCATION: 01129 Ralph's 5300 Stockdale HWY 661-859-1 BaIœrs1ìeld, CA WORK ORDERWMØt:R: 109383 YOUR R!FERENCe NUM8ER: Dan DelaRosa [ U1~ _ ~ESCRJP11ON QUAN1T1'V "¡;œ AMOUNT TAX ) ....00 N TOTAL 011fER: --'00 TOTAL: _.00 SB-9B9 Testing ~£QlJEST~ S8~989 T@I'ting RESOI.UTION: WO 1109383 SS-989 Testing. Wete.. test 1'111 ~nd turbine containment 5ump-¡::oaSSed. ArmlA1ar test passed. #1.2.3.4.5.6.7.& 8 D1spenser containment fa11ed. Need to be repa1 red and ~ested. RECOMMENDATtON: Repair and retest. TQ:~ . /'~~ HfD F.....X FRQI\II:;:k,.,. ~ CA'TE:~ o~P'fI _ co:ßM~ FAX: :; to ..Goo ~¡{,( ~ "-I --- --... . 0'V£0 . d ¿9SZ v88 0'J£ 3J~N31NI~W lI~13~ SHdl~~ ZS:'Jt 2Ø0Z-ØG-~ON I"N' .a.u ~ 1IiW· .,;,."", ~ lOW.......... I '" I .... 4 Franzen-Hill System Design, 00MtMU0n & Malntenanc:e .~. -.I...... ~ ___~ ar. I . .~,.,.- Secondary Containment Testing Report Form 1. FACILnY INFORMATION F"1ICer. EBW a 147 Training by Manufacturer Çofn nt'$) Piøi and Testing Pi' Gnd Testing Piping and T eetin9 MenufecttJrer miron, AFT 0181 Containment. VeederRoot Piping and T eating 3. SUMMARY OF TEaT IŒ8ULTS 'f Nurnb8r at piping Runs Tested: Testêd; ~ Number d uDC Boxes Tested: Number of ~erfill Boxes or; Technician't SÎg/13ØJl8: Date: ,..... I f -O"'Z.. 1100 Nofth J Stl8et, Tulare, California 932141559-688--297718(10.65&034361559-688-1487 FAX www.franzen-trjfl.com.constnJotion@ft&nzen-hhl.com SWRœ 0T/Þ0 . d ¿9£Z Þæ 0t£: 3JNI:IN31N H:W lH:U3è1 SHdl~èI ZS:H æøZ-æ-f"'ION l-...,y .'-' .......... ............. e..--..... -.... , I." ..... e ......... ---.., '.."""'... , .-....-- ~. Page: 2 of: 1 o Professional engineer HyGrostatJc ConIm~include ínformation on repairs made prior to testing) AtvMJf,.~:' cvd~ ~ 1')1...,1\1(;. .s..*7/tJ'¡',~.,J f .LI --.;¡ SWRCB 01/S0'd ¿9SZ Þ8B 01£ 3JNtlN3LN I I::IW 1 I 1::I13èJ SHdlClèJ ZS: 11 æøZ-æ-()ON I~ ¡.a-CIrA:Io:. co· _ ~nQ ~..... '""'1101. I I e ......cr ......... --ow I ...........~ .~ Page: 3 at 7 C Prafessiona1 Engineer CJ Vacuum Hydrostatic i v.,~~ CwPn.ms-(indude Information on repairs made prior to testing) I w- SWRCB ØJ/gø'd ¿9S~ P8B øt~ 3JN1::JN31NltlW lIt;13è{ SHdltè{ ~s: t t GØ02-02-f'lON 1'tUV- .La--..-, I:IQ. ",.. ~n.:l ~. ""'11.:1. e ......r", ~ ~-.w I ........ IoIJ Page: 4 of: 1 o HydrostetJc ~ ..1;0 ~ ~ I '/"I/'tt) y.,,( ~ 'ð~ oS.... e,.... " ?:' $-I ~...~ '/~ \~ ~ CcdIIm~lnCIudB information on repairs made prior to testing) f1 51 ,¿s. ¡" c tv (p'I.J-tA,..¡ VV1t:\w.} 11f the taIIr1I methOd dCeS not trIIt1ha rire deøth of the sump. søedfy how much of the sump w.as mleCt. Methods no\ ~ lit &mire sump sI10úId otIIy .,. ùSØCllf f\e mo",~ IIy$tem provides fltlo5ave tultline shutdown. 2 WIIh Ute Mmersible PU"'P 1'\UIJ1itIg. place the eenscr in pradwt (cfiscrfrninaling sensors snoú1d do be plßced in W8t.Ir). ",. am. ~ pIa~ 118 sensor In product and the 1UrÞlne shutting doWn Is the response time. TN9 shOuld be done if ... øcond8ry contairIment !HUng method used does not test the en1ire ~IutnB of tne sump SWRCB ØJ/¿B'd ¿9Sè P88 øJ£ 3JNI:IN3lN H::JW 1 H::Jl3èl SHd1t:lèf £S:H GØBè-æ-()DN '-- ¡,c:r-CIUQ& -.-. rn.;, ~.... I·...'.... . .- Page: 5 ..,......~~ , .~.. y., .' of: 7 o Professional Engineer o Hydrastdç '2~'" y,S ý-(> )kS :> ..1cHI V1) l r.".s Y"f!':5. 'ý{! S 3 i 1WI,.-4' _,..~.ncIude information on ~~irs m~de prior to testing) ... O('::f~'Á -;~ ~O~.J -lØlINI1I\*1. of ~, L ~..atO 'Îe ~C! /&1)'/131%. , 1ft!he ....11I8Ihad dO. not test Ihe errIire depth of rhe UDC. soedfy how much of the UDC was te&r8d. M«hods not 1IStinQ "" enure UDC ~d only be u&ed if the moniltlf(~ ~ pnWIdBS raJI.øøve Mbine lhutdown. J WIt lie $llÞmenJibr. pump nIMinQ. place the senscr In prodUct (cfrSerirnina'dnQ sensors should also tie placed in water). hlme betWeen plaCIng 1M $811$Or in product and the turbln(! shuld"O dawn Is !he ftIC)OnIIe time. Thit shOUld be dðne if tw IIeOOndaJ'y COJd8lnmem testI~ memod r.I8Od does nor lest 1M entire volUme of tie UDC. r SWRCB 0J/8Ø'd ¿9SZ Þ88 0J£ 3~31NI~W 11~13~ SHdl~~ ££:J1 GØøZ-ee-~ON .~ .W ....... ....,.- ~II"'_"'. , . I"'..... .e w......~,........... . ....~&.#- , Page: e of: 7 Profwssional Engineer OHydrostetic 'iff VJP~ y~5: ç....~~nclude information on repairs made prior to ~) PI ~t:e~ ~ Of!\) c.~··bct"ß"J<,!,..ø~::f - SWRC8 01/6Ø"d ¿9Së P88 01£ 3J~N31NI~W lI~13~ SHdl~~ £S: T T æ0ë-æ-f\ON ·. . e 0J·d "}:IIDI , - Page: 1 of: 1 .. SPII.I.JOVEItAL CONTAINMENT IOXE$ est Method Developed By: Tank M8nufac:turer 0 Industry Standard C ProfesSional Engineer (] Other (5 ) est Method Uses: Pressure Vacuum Hydrosudic o Other ($p ~ I ,~~~~~_;~.:::~- =;':~";·~,::':=~~~~::~.~~'~~:::·Z::·-~;:¿\;~,,::~::=·;~.,~~:":_~':~,"~'._' ::....~:_~ ~~, ..:, ',' ~t.(jnclude information ?" repafrs made prior to testing) Customer Signature: ~.e-~ ---- ~: \0" \q.oV' SWRC8 I:\MY FILES\FORMS 01/01'd ¿9Sè P88 01t 3JNl:fN31NI~W lI~13è1 SHdl~èI TOTAL. P. 09 Þ£:H cø0è-æ-r"'tON 11/18/2082 17:04 e 9094773044 . cpr DEVELOPMENT INC PAGE 01/04 851~ Rochester Ave. Rani :!~o Cucamonga, CA. 91730 (909471-3200 (9os1ll$77-3044 fax CPI Development Fax To: Howard Wines Froma Susan Walt 'UI 661-32.6-0676 P_S88: 4 Pm: '''2 Dater. 11/1812002 R*i cc: AT 'N: Howald Wines C/O Steve Underwood o . Ilrgent x for Review c p.... Comment 0 Pl.... Reply .",11/18/2002 17:04 .... ..-..........""...-.... -- .' .., .. ... .......-,.. , .. 1 \ e 9094773044 . .::.... ...~:.~-~....:...n_.":.:r.;:. .... . ...,..... ......_Ç~I. .DEVELOPMENT INC PAGE 02/04 . ,··_.."'·..···~·~·7",:t;, ..._':..., ..._..~.._--~~'--~OÞ_·~::7' ...... .... . . ,-- . : .~. '.' .~. . ,.... " .' .f! ":J.~ ' :.:....." .. :-. .. . ..', ':-;'~~., .') l~l At""",S"""!:f. <:<1>II'1.IA,n¡ Sf..VI!:f.s :.:~#,; lbls Certifies That ~ d .:.t:~' . Reuben Aran a .~~:~ '. . '. I ::;r" , ',' I .... ~ ... .,..... ... B Hoar ~ RefreIMr ColIne ClMriIll.... "4I¡þd..IInqa ~ l1ae 8. 5192 ! Certification Expires February 5, 2003 ¡'nSINdOr. Freddy R. Alanis· (909) 532.1615 . ~.__1Pf ------- . .' '. i , ~,..~ " :;i,,' ,~f· 'i.,~~' . '\f.'7 ';;~:.: " to' ~l '".. "'.(i¡í;'." ' ií~:· :,~~" .~. . '::'*::',' ,:'1: '~I . "',,.; :::~:,~ .~::!~.' . ···1~· . , ". 11/18/2002 17:04 ¡. 8«3;25/2082 1e: 13 , ~ e 9094773044 7662442703 . CPI DEVELOPtvENT INC , ' n. 0::-" State of CoIiforl"'ÀO . aD ~ .. C:ON1V<CTORS frAY¡ UCEÑSé 80... ~ ACTIVE UCiNSE ... COl\P J . \I11III",",,716404 ~...~~)'~¿': x ~ ~ B Cl8 C20 JotAZ' r.;ø~12/31/2003 I i ( , 1 I \ I PAGE 04/04 rf'«&- ..,...'w.... fj A CO~ECTION NQJICE 04880 BAKERSFIELC FIRE CEPARTMENT Location S""2-00 S 'û:J~¡¿()Ä.L...£ ~ <I Name 'i2Ai..Rµ IS .a- 6 $"3 You are hereby required to make the following corrections at the above location: Cor. No. (]) r(...6t:3..se þ~y: CXJ(2. ~IU 06l. 3 '26. O~76 í2~SUc...T~ ex: $& C:¿$<1 '"'11:?;TI'''-G AND ,ÂLSò ~I)..ì<- A copy oF "i't'{E' COM.Pu='T8J APh'CA:,fuN ft>(2. Mc)r;H FICA"ïf~ PGRM I r FoR. RE-PAt,Q.5 rce Fv!2MéO P~IOV' ~ 'Sa c¡ 'fSGf ;<'é - ,és-r Completion Date for Corrections Date I (/'~ Ic>?- FD 1950 w{~¿=s Inspector 326-3951 _&2--- 14 : 50 I (/~1 ''''':/ ( RALPHS RETRIL MRIN1E~ .JJ.I;I ~ c......"'! f . "'-J,j' 1J...J . . P.tNCI,_ßJ:"'G~~& CITY OF BAKERSFÌltD OFFICE OF ENVIRONl\1ENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 / PERMIT APPUCATION TO CONSTRUCfIMODIFY UNDERGROUND STORAGE TANK TYPE OF' APPUCA TION (CHECK) [ }NEW FAC[lJl'Y [JMODtFICAT[ON OF FACILITY [)NEWTANK (NSTALJ..ATrON AT EXISTING fACD.ITY STAATINGDATE 11- II -OcL. PROPOSBVCOMJILETrON DAT~ //- 1l.{~ 0 "1...- PACILITY NAME ~aLnh;] . ~~ EXISTINq)"ACILJ1'Y PERMIT NO. FACIUIT ADDRES '\ ~æ> ~It>Ck-dt1 .~t!Ø CITY lb~rS¡;el¿? lIP CODE ' TYPE OP BUSINESS I e. (' ~ 6 Am # TANK-OWNER ~mç,(J..:S /J-Øot/é PHONE NO. AD~~ CITY ZIP CODE CONTRACTOR t. ~ z:. ~-4! ~-e../~~ nL~ CA t.lCENSE NO. ADDRESSfb .GO)( :J~ 3 7.9.3 ~l ~ ZlP CODE 9 ;} :3'1 tJ PHONE NO. c:¡ () t? - </7 ? ~ .3 ~ð crry BUSINESS LICENSE NO. WORKMAN COM? NO. INSt.1RFJl BRlEfLy DESCRIBE UŒ WORICTO BSDONE éßY? ð'J,!T,;i3#ÞZ- ~ß.-;t!6Jc.. 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Time {tl) Waler Level Waier Level Time (tl) Time (t1) Waler Level Water Level Time (t]) Time (t) Water Level Water Level Time (4) Water Level Pass Fail Pass Fail Pass Fail Pass Fail / ,/ - Turbine Sumps, Fill Sumps and Under Dispenser ContaInment ür.dcrgrour.d Stúrage Tank System Secondary Containmenl Cerlificalion Form !<,4LPI-/S iF Facility II: ~5:S City: I3f1K Cf!S ¡:-"; ELù Facility Addre.s!: 5:;..00 -Sf-óe. i::d.å 1< Page _ or Tt1t1ng Contractor: f? t: Uf3 [N tI fk í-/¡V /).4 (cp I) Test Dale: 1/(/~l.c¿2:- í?Edd¡' µ Tech. Name: ¡C).RANIJA u;, ~ Contractor Addren: 91 D 87 89 91 D 87 89 91 D 87 89 91 D / /' /. / / Pass Fail Pass Fail· Pass Fail I Pa.s.s Fail I . If UDC /0;) jÎ JD (In, 3/4, dC.) ...------ -- , .' -~ ManufactUrer , Start Time (t.) I Water Level / I Time (t.) \ I W:ster Level , I /' I TIme (tv /' / I Waler Level / /' . -:- / \ Time (I)) Water Level Time (4) 1/' 'Water Level Test R~ults / Pass Fail Pass Fail Pass fei! Pass Fail Signature I UDC ID (In, 3/4. tIC,) Ma nubcturer '/;2 -3 ~ Start Time (to) Water Level Tillie (II) W:iler Lenl I (0 j.:J./J ;},,}./7 J, ;)/3 ,;2. ,2/3 J. ::ua ,~ "> j /1 >" 1.)c570 5.(;)/5 3. DI7 tJ·5'10 5".(::,)/ 3,O/g ì.j,5b9,,)"-b,;:;/ Lj, 7{) 5, Q/ _~. D 5: b ::2/9 3.u/ Time (tl) Water uvd Time (tJ) W:ater Lcvd Time (t,) Water Level Te3t Röults I Signature I t I,U Y...'" ' ! 0 C í - 1. _~Z . \{{p) ~ /, '... "? .. ----- .I J 4 /.., 1'l: /' / /)" IN"rtJ ~l.Þu- Sikli1~ ' ~I(~ ","^;[ 66 ¡:1¡:-/~ 88"1 l-e~, SlJ/t¡p ~e~ ~~ l..i:ftJ( 1; , 1'~sr Sf b.._ ~ Rt r~1" 81"11 ""1(" t !t(JlI.18ìþ~']"tf) ....,.,1> IT 1.t,lIJ'r~ f!/! l¡l'1t~" eeJl: Ss Ltl\t' I.t~ fl. .,¡;.~ r~ THRJ;: 1iJfJ"IJIII;4 . RtS{h SHOI..o $. ¡;s.;28 Þ¡ .... r 8 r.<;¡ 9,2 .88.< IN J:fll/ 11'/ '-e"1> íùE:: . 1.4:¡lS4 e B.S.S.R. 'IHC· f".ø1 ~ ~ . FROM , SECONDA1lY SYS1'EM CE1l'fU'iCA 'f\ON f{)ro<l ðI ",...'" IÞ "I¿ f1Jr6 5 ¡( ../ " 'ODC tES1'lNG nl.S\"£NSE1l3 DI.SI.'ENSE1l4 I). -.4''t m J').:' n DiSPENSE1l1 DlS\'ENSE1l2 /1.;:, ~ I'M !5:". ? '7J Î ¿¡ t I fJl'Vf ST ART TIME UotlTtAL l1EJ.G111' or w t\ TØ- TIME W t\ T'ß'R llEJG'6T TIME WATER lIEIG"1' CER'tlF1CA TtON tS1GNA T\]1\'£.) 'l..~ .Ç.oq<i I': I ¿(I"~ S.Dcr1ï J; 114 f/¥to $". 5,{1·1,.) ~ . ê)71.f ( .01 $ t .01 G"'.07 I .f)], ,. .02-5 DlSPENS'Elt , 1(;']o/llNt D1SI'ENSEIl S /(;3011111 Dl.Sl'EN5E1l 5 DlS1'£NSE1l6 ~ I\~ßð It: 38> f(J'Yt '.1:> '(~'1.- 10 C('~ HNI START TIME iNITIAL 'tlEIGUT of WATER TRt'1ß W;\TER lIEIG1:\T TIME W;\TER 11£10111' CEkTlf'ICÂ 1'tON (S~çf:L\ TU}tE) (. , {;) 1.(7., 7.. 1(,LfÇA.;'II't ~-. 3 1 '2.- '1 II; 4~ ",,.. 5'.,7'}.. ..., 1/.'1Ç'A 6,.iS'tl $l( k.1::J l.{ ()I. 5 .3' ~l .l>l) t f .(/(;)11 ,,(1)"3 ,00"j b Page 3 of - .' . \~~ I OCT- 1-1'\~2 , . ~«(.U\r ,S 'P' ~ TUE . 14:34 FROM e :8. S. S. R. :INC. P. 01 0( ':Þ , . SECONDARY SYSTEM CERTIFICA TIQN FORM DATE ~-13'" Ð~ FACILITY ID, RI1-IPtLS- FACILITY ADDRESS G'.2ÐO .5T~CK,DI1(fj, *7 / ßtt1?¡ CP'?o '133 of¡ UDC TESTING tP ~~.~ UfU¿ fìJ-r6StfcIO DISPENSER 1 DISPENSER 2 DISPENSER 3 DISPENSER 4 START TIME /2--.. $"' PM t). ". S"Cf r77 INITIAL HEIGHT OF WATER $.oQ9ï 5. 0 c¡<¡ .:Ç. ? '87 ¿¡ TIME /;/I..( 111'\ /':'I¿(fh~ 1.:/ ~/~ WAtER HE.IGHT 5""'- 0 7 ( ;Ç. (þ'~ ( s· 77'2.) 5"". 't.~ TIME WATER ..025 ,,()2..' .0 I S I . () / / HEIGHT Ce:.R.TXFICA TION (SIGNATURE) DISPENSER 5 DISPENSER 6 DISPENSER 7 DISPENSER 8 START TIME ¡f.¡S 11:36 1(: 3 &P(P1 ¡{.:go 1/'*1 1(;30 "'''''t INITIAL HEIGHT OF <6.ð ~~'1.. WATER 5"'.;3 7 '2- -, ~-. .3 "] 2. '1 ~,<:> '-I,,~ TIME Ih"rÇ'A II; t.¡~ 11'" I (., i.¡ ~ ¿if ,..,. I(~ C('o$" If..., WATER HEIGHT 5..3' c;1 6.0¥()1. '.6> (,/ d) l.( TIME WATER "CD 3 .003 t -t/Ol' .D!> t 'f HEIGHT CERTIFICATION (SIGNATURE) Page 3 of _ OCT- l . ø . ,=," - I I. .. "- 3.-02 e 14:35 FROM TUE . .. ~.iiIl,:...,...\. ... ~""",.,. ...."..--.. J '~ OfSP' 1 t~ . RALPHS CAROLOCK IHTEl.LIGEHT CONTROLS IHC 5200 $,tOCl(I)ALE HWY aAKERSFIEU> CFt 93398 '''-661-859-1668 08/1312002 u~t PI'! SUMP LEAK TEST ~PORT SIJtIP :s TEST $TARTED 12'59 PM TEST STARTED ÐS/13/2002 BEGIN LEVEl. 5.0997 IH END TIME 1:14 PM EHO DATE 00/13.12002 END LEUEL 5.0741 IN LEAl< THRESHOLD tð.002 IN TEST RESULT FAILED Di~p. ~ J.~ ..¿.. RALPHS CARDL.OCI( INTELLIGENT 'CQNTROLS I!'IC ;200 stOCKOALF.: HWY BAKERSFIW> CA 933eS , 661...s~g-166e 00/1$12002 U31 PM S1J\'IP L.Ef'IK TEST REPORT SUMP 4 TEST STf\RTEI) 12= 59 PM TEST STARTED f)8.'1'3-'2E11J)2 BEGIN LEùEL 5.7874 IN END TIME 1:14 PM EJ.II) DATE 00/13/2002 £HI) LEVEL 5. i723 IN L.EAK TIiR£SHO/..D 8. a02 IN TEST RESI.I!..T FAILED .. e :8. s. $. R. :INC. P.02 '. . Rf\LPHS C~P.OlOC( INTEL.l.IGEtfT CONTROLS INC 5"~0 STOCKOAl~ ~y SAKERSFIELO CA 93308 661-859-16613 08/13/280.2 11'45 AM SUMP '-~flK TEST REPORT 6-6 T£8T STARTED 11:38 AM TEST sUtRTEI> 88"13"'213132 BEGIN LEVEL ~.3727 IN END TIME 11G45 AK r.N'D DATE øa....13,i'20132 END L.EVEl 5.3691 IN LEAK THR£SHOLD t.9B2 IN TEST RE:SUL T FlI I LED ?-S TEST STARTEO 11: 3EI AM TEST SrARTEJ) 08.'1 ~ØØ2 BEGIN LEVEL 6.04?.2 IN [ND tIM[ 11'45 AM EN!> DATE eS/1~002 END lEUEL 6.0404 IN LE"ItK ThRESHOLD ø.ÐÐ2 IN TEST RESULT FfIlU.'"O '.IIJHp,~ ~v I'. ·"1' '~, . .~.f-- è) (p /;}- CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TESTI .J SECONDARY CONTAINMENT TESTING FAC~Y /<A Lp As 0..../<.1) ((J(..JK.. ADDRESS ::S"'Ì4) 0 . J!.uGl<..OA(-e (-It,.w¡ 7Sk$-ft.,i{) &1 PERMIT TO OPERATE # J t q~ OPERATORS NAMEJ~ltD~ ~ OWNERSNAME~\r~~ NUMBER OF TANKS TO BE TESTED---L- IS PIPING GOING TO BE TESTED~ TANK # VOLUME CONTENTS I ( TANK TESTING COMPANY c:-z3S5 (L UJc..- MAILING ADDRESS ~63ò ~seDA/-e filAr¡ ~k~ff.D NAME & PHONE NUMBER OF CONTACT PERSON ~ -rJfc~-.{f.., TEST METHOD ~ ~ q ß 1 NAME OF TESTER OR SPECIAL INSPECTOR A1, k'c ElI\i It'.)h CERTIFICATION # OJ l> ~~ ì Ð g DATE & TIME TEST IS TO BE CONDUCTED IÎ // It rifñJrIfJ , ~ "5ff-~711 ~"~·OL ~ -t!>' 0 L- ~r¡? /. SIGNATURE OF APPliCANT APPROVED BY DATE FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "W Street Bakerstield, CA 93301 VOICE (661) 326·3941 FAJ( (661) 395-1349 SUPPRESSION SERVtCES 2101 "H. Street Bakersfield, CA 93301 VOICE (661) 326·3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFETY SERVICES' ENV1IIONII£NTAl SERVICES 1715 Chester Ave. Bakersfield; CA 93301 VOICE (661) 326-3979 FAJ( (661) 326-0576 PUBLIC EDUCATION 1715 Chester Avè. 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 (661) 399-4697 FAJ( (661) 399-5763 . . July 30, 2002 Ralphs Cardlock 5200 Stockdale Hwy Bakersfield 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 perfonn 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. SìÃ~ Steve Underwood Fire Inspector Environmental Code Enforcement Officer ~~7~ õfe W~ ß70P ~0P6.r~ .A W~" j. ... ,"'"," ¡. ~)J} ~ Franzen-Hill .1e:1 of: 7 .- ..~. ~ System Design, Construction & Maintenance Secondary Containment Testing Report Form 1. FACILITY INFORMATION Facility Name: Facility Address: Facility Contact: e Date Local Agency Was Notified ofTesting: J.:.~ - Cì;;).. Name of Local Agency Inspector Present: ~ =€v' Date ofTesting: Phone: 6 b '- Company Name: Franzen-Hill Corp. Tulare, Ca. Technician Conducting Test:-~ ({ II öì'\.lît2 ~. ~I cl Credentials: ./ CSLB Lidmsed Contractor 0 Licensed Tank Tester License Type and #: A,B, C-61/D40 HAZ Lic# 304147 Training by Manufacturer Manufacturer Component's) Date Training Expires Environ, APT Piping and Testing /0/0> '7 Smiths Filter, EBW Piping and Testing /?-/ Q3 Total Containment. VeederRoot Piping and Testing Econ, Gilbarco EMC, Monitor System Piping and Testing 2.TESTING CONTRACTOR INFORMATION Number ofTanks Tested: I <;;0 ft Number of Piping Runs Tested: <- Number of Submersible Pump Sumps Tested: '<- Number of UDC Boxes Tested: ..~ Number of Fill Sumps Tested: <- Number of Overfill Boxes Tested: - Component Pass Fall Comments ~NA.JIII Ai1 g- O ffì ¿ 'II (f'if! ? Vi'ì/)Ò --kOOO ~,Çc..( (j,..)::> ;~"-1 I!' 0 ~1 ,,¡ L., ¿í'- r i).~ ,.'>1/') "'''we' ~ 0 9 I ê-i t...- '-r:- ç'(I"",d 8- '0 ,- , ¥7 (..4<..- -, ~ - <,; il.....;., ~ 0 (71 ull OOe., 0 ~ I E."2- frO L 0 W 1. ¿-:.S j ¡,") <.. 0 I&' ")¿ <.( il ¡~ E 0 l!' cI ¿. (; t:-l /( Ç-..lNI) .8' 0 ~7 U/L ¡;:: I' ç", ~ /I ~ 0 4/ Íi)'~ ¡ 0 0 0 0 0 0 , 3. SUMMARY OF TEST RESULTS Technician's Signatu...; ~") ¡2,,-,~"¡JJ Date: b'-" l'ì -6 L 1100 North J Street, Tulare, California 93274/559-688-2977/800-655-3436/559-688-1467 FAX . www.franzen-hill.com/construction@franzen-hill.com SWRéB ,: ~ '''';.. . . Page: 2 of: 7 ~ est Method Developed By: 4. TANK ANNULAR TESTING ank Manufacturer ndustry Standard o Other (Specify) o Pressure ~acuum o Other (Specify) o Professional Engineer o Hydrostatic Tank Capacity: Tank Material: ank Manufacturer: Product Stored: Wait time applying pressure/ vacuum/water and starting test Test Start Test: Initial Reading (Ri): est End Time: Final Reading (Rt): est Duration: Change in Reading (Rf-Ri): ~ as sensor removed for testing? Was sensor properly replaced after testing? í ç"':$ Comments-{include information on repairs made prior to testing) AÀ)jJUL~\''¿ tv I~ ~ A hft.iNê Sc; /uf.öw , SWRCB .. '''\ -- I:: 3 of: 7 - est Method Developed By: 5. SECONDARY PIPE TESTING . Tank Manufacturer , Industry Standard D Other (Specify) &ressure D Vacuum D Other (Specify) , 0 D Professional Engineer D Hydrostatic Piping Material:: Piping Manufacturer: Piping Diameter: Length of Piping Run: Product Stored: Method and location of piping-run isolation: Wait time applying pressure/ vacuum/water and starting test est Start Test: Initial Reading (Ri): est End Time: Final Reading (Rf): est Duration: Change in Reading (Rf-Ri): Pass/Fail Threshold i , V\l}\~j Comments-(include information on repairs made prior to testing) SWRCB .. -, ...1 ., e") Page: 4 of: 7 .. 6. SUBMERSIBLE PUMP CONTAINMENT SUMP TESTING ";st Method Developed By: 0 Tank Manufacturer Industry Standard 0 Professional Engineer o Other (Specify) o Pressure RPther (Specify) t..... Sump # o Hydrostatic &.....1/7 Sump # ~ump', iameter: Sump Depth: Sump Material: Height from Tank Top to Highest Piping Penetration: Height from Tank Top to Highest Èlectrical Penetration: . Condition of sump prior to testing: Portion of Sump Tested (1) Does turbine shut down when sump sensor detects either product or water? urbine shutdown response time(2} Is system programmed for fail-safe shutdown? Was fail-safe verified to be operational? ait time applying pressure/ vacuum/water and starting test: est Start Test: , Initial Reading (Ri): est End Time: Final Reading (Rf): est Duration: Change in Reading (Rf-Ri): Pass/Fail Threshold ,ç( ~ & 1'\ Çù ,^l 0....0,.":' 4 f I 'I '7; S y~ ç' ~ Se. C/ .3> Se,., <...-- 'I't/ 5 v'ð....S> ~ \ { ..¢; ~ 30/"1IÞ1' 5, / () ./ t(j " l'~'V1 . ð I ú,' .> 0 fi )'11 60 /'1--1 ~i;,¡, ,oS' ~o /11'4':; Nc!. l? ¡?~$ (' as sensor removed for testing? as sensor replaced after testing? Comments-(include information on repairs made prior to testing) f¡ S c ~ :s. ~"ì 0 ( .-v) CON'1 A , ...t t'Y1tw.} 11f the testing method does not test the entire depth of the sump, specify how much of the sump was tested. Methods not testing the entire sump should only be used if the monitoring system provides fail-save turbine shutdown. 2 With the submersible pump running, place the sensor in product (discriminating sensors should also be placed in water). The time between placing the sensor in product and the turbine shutting down is the response time. This should be done if the secondary containment testing method used does not test the entire volume of the sump SWRCB '" -:) - e) , Page: 5 of: 7 -- ----~ _ _ _ _ _i~ __ ~_~~ _ 4__~ ~__ .~~~~ \: 1~: < ~~;: Measuring Equip. Used for Testing: 7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING est Method Developed By: 0 Tank Manufacturer . ndustry Standard 0 Professional Engineer o Other (Specify) o Pressure ~ther (Specify) 0'1- ',"'1,/ e..-t I UDC # ... G.- O tJ fó~ o Hydrostatic est Method Uses: UDC Manufacturer: UDC Material UDC Depth: Height ffom UDC Bottom to Highest Piping Penetration: l;1eiQ~t from UDC Bottom to Lowest Electriëal Penetration: CprigitJÒrl otUDC prior to testing: Póttipñ"'Q~UDCTested (1) Döesturbine shut down when UDC sensor detects either product or water? Turbine shutdown response time(2) Is system programmed for fail-safe shutdown? Was fail-safe verified to be operational? ait time applying pressure/ vacuum/water and starting tést est Start Test: Initial Reading (Ri): est End Time: Final Reading (Rf): est Duration: Change in Reading (Rf-Ri): Pass/Fail Threshold 2~JI "2- "2 "'I \'\ /6¡ c-( - ...;..~ 29" '2.. (... 2D'1 c..:c-ó £> - '-'/Jilt '~"d- \j'(> S Y-l5 y.¿s .. ~'.. ..e~> .) See ) , ·S .3 .so (., -e.l. '1-,;:5 \J-t: 5 \. rS i. ~s ·...¡"S y--e5 y~-;, YI!5 S. () j't/1¡ -'\-:$ '~o ""ltho 5 3 () n, ,¿-Ïf' Was sensor removed for testing? as sensor replaced after testing? Comments-(include information on repairs made prior to testing) 0/-('6>/1 ~; &Z... C ~¡.,.;; ~ AINI"\I\ ,nf ~I L ~~ IÓ -Ie! ~Q /& !}JGrz.- ; 11f the testing method does not test the entire depth of the UDC, specify how much of the UDC was tested. Methods not testing the entire UDC should only be used if the monitoring system provides fail-save turbine shutdown. 2 With the submersible pump running, place the sensor in product (discriminating sensors should also be placed in water). The time between placing the sensor in product and the turbine shutting down is the response time. This should be done if the secondary containment testing method used does not test the entire volume of the UDC. ( SWRCB '. .., . e) Page: 6 of: 7 est Method Uses: 8. FILL RISER CONTAINMENT SUMP TESTING o Tank Manufacturer ~ Industry Standard 0 Professional Engineer o Other (Specify) o Pressure 0 Hydrostatic «Other (Specify) L.r;> N.:YL..(. est Method Developed By: Sump· Diameter:: Sump Depth: J I '1 Height from Tank Top to Highest çyr/ Piping Penetration: Condition of sump prior to testing' -- PortiQ,p ofsump Te!?ted_ Sùoip;Material: -- , (/\.. Waittime applying pressure/ 30 jr1/}(J' .z ¿ Þ1lhr5 vacuum/water and starting test: est Start Test: I o Þ V"'\ I Initial Reading (Ri): , C I est End Time: I c ~O ~M ß}'tt Final Reading (Rt): () / est Duration: Change in Reading (Rf-Ri): Pass/Fail Thresholc{ Is there a sensor in the sump Does the sensor alarm when either product or water is 'It'S V~~ dectected? as sensor removed for testing? l Was sensor replaced after y t; 5: testing? ~5 Comments-{include information on repairs made prior to testing) p 1 0:;.[ e..s ~ Of Î\) CC)1"\i + Î'3 iN fVI'-P41 SWRCB ...;;-, '.. -'" fW '9~:7 of: 7 "" 9. SPILUOVERFILL CONTAINMENT BOXES est Method Developed By: 0 Tank Manufacturer 0 Industry Standard 0 Professional Engineer o Other (Specify) o Pressure 0 Vacuum 0 Hydrostatic o Other (Specify) 1--- Bucket Diameter: Bucket Depth: Wait time applying pressure/ vacuum/water and starting test Test Start Test: _ '_ _ Initial Reading (Ri): Test End Time: Final Reading (Rf): Test Duration: Change in Reading (Rf-Ri): Pass/Fail Threshold - -- -- ~ ~- ----, - --- - - . ---- - Comments-(include information on repairs made prior to testing) Customer Signature: ~\/.,,-~ Date: \0/ \C\ ( a'V SWRCB I:\MY FILES\FORMS e . ./ . ~~ D5111 7L (~z~~ CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST! SECONDARY CONTAINMENT TESTING I FACILITy~at pfls-¡±-~~~~ ~ -- ~--~ -- ~~-~-, -------~~-- _! ADDRESS ð300 Stn~lJ¿. HwLl PERMIT TO OPERATE # OlS - Od-.l-()CJ a (~-{ OPE~ATORS NAMEfuLph5 Gvn--e.r~t__9tNrr-, ~ IcS~ OWNERS NAME~h...~ &oClVV¡~<[./,:·'-Z, --,' NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED TANK # VOLUME CONTENTS 1 ~OJóbÒ 1Ln/~ d-. ~ . õ1Ji) f fðvm '<.Un . X ,oJ) \'.. :i-' 'Q'{xðJ0 ,- ~- ----=r~-~T;-¿;~~~A~.¿~~-:'~y\~~-- -~, --,--"--~,-~-_. - ,- MAILING ADDRESS~ ¡ no fiö. :J. SI-. oJ< -' ", :i-ï~ NAME & PHONE NUMBER OF CONTACT PERSON ~ - /¿, ~ g- ~ ;)Plî, C~ Z-ev1..{-\'( l) TEST METHOD 6esCf g c¡ NAME OF TESTER OR SPECIAL INSPECTOR ~ ~()<..LV..çl.e-td , CERTIFICATION #~l) DATE&TIMETESTISTOBECONDUCTED ~ t~) LmV ' ý'.~S3..rY\ ~J: ddJdO (ó~ 17- 0 L. Ju~ APPROVED BY DATE SIGNATURE OF APPliCANT ~---~-- -, ~--~.. - - FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 oH" Street Bakersfield, CA 93301 VOICE (661) 326·3941 FAJ( (661) 395·1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAJ( (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chesler Ave. Bakersfield, CA 93301 VOICE (661) 326·3979 FAJ( (661) 326-0576 TRAINING DIVISION 5642 Victor Ave, Bakersfield, CA 93308 VOICE (661) 399-4697 FAJ( (661) 399-5763 . . Ralphs Cardlock 5200 Stockdale Hwy Bkersfield, CA,93309 RE: Necessary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 5200 Stockdale Hwy REMINDER NOTICE Dear Tank Owner/ Operator: The purpose of this letter is to infonn 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 (Califonúa 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 pennit issued thru this office, and shall be perfonned 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 perfonn 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 pennit issued by this office. Should you have any questions, please feel free to contact me at (661) 326-3190. sinfierel i ~' ,... - ' ) G- . . ' SÛ:ve Underwood Fire Inspector/ Environmental Code Enforcement Officer SBU/kr enclosures ~~Y~de W~ ¥OP ~0Pe.r~ A W~" ./ 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 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 FAJ( (661) 399-5763 '. - April 17, 2002 Ralphs Card lock 5200 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. sinceleIY/, ' .. ." /I/Í /"' /', I,~I ./ Steve Underwood Fire InspectorÆnvironmental Code Enforcement Officer SB Uldm enclosures ~~7~ õfe W~ ~.A0Pe .r~ ..A W~" MAILBOXES ETC BFD BAZ MAT DIV . 01/15/2~02 105:24 80558~8 01/08/02 12:30 ft66~_8 0576 ,4 _ B^1tBR.BPIBLt} , CALIPORNIA PAGE 01 ~ ~ OO.!.- FAX Transmilttal . Cover She. ~t Bakersfield Fire Dept.~ Office of Environmental S~ces I 1715 Chester Ave. · Bakersfield. CA 93301 _ _ ., FAX No. (-6~1,.) 826-0376 · Bus Nö. ('6.1) 326-39'79 . -~V\ Vo...ve- ~ V ~ \ \ ~ '\ COMPANY:~~'~~'~"""., '-111.1}D: . $k.e;.¡e- \jnr\-«:~ ) '. FÁx NO.@alO) q/ () - ::;Q70 ~--,,- . . COMMENTS: (. ..2~!: J Seé: YOU' AI t ýff W ~ (..1{,. Y~\K ,. ¡ ,\ I \ '-... . .." 01/16/2002 05:24 01108102 12:31'1 80568.8 '6'6 _ 26 0576 MAILBOXES ET1a BFD RAZ )fAT DIV . PAGE 02 I4J 00 Z WRITrIN MONITORING PROCEDURES UNDERGROVND STORAGE TANK MONITORING PR RAM nø ØIODiIaria¡ prosrIIIIDIII be .. .. dID UST lGcIIioo . &II rima. 1111 hA. ......;00 aa tail pIOpU1 ani œDdtrfon- t1I b ....... pamlL 1'be panIIÌI bDIde:r IDIIII ~ die ()IBc:¡e of s..iczì wilbùa )Q ~ of., ..It....... CD the ~ p~ 1UIJeIJ mquUwf to ataiD bdn ØIItioø me ~ ~ tJy ~op 2632(d) aDd 2641(]1) CCR. Faålity Name Fac:iIit:Y Addraa A Describe tho i'equœcy ofpcrØ:nmiDg the momtoriøg: Tank \oJ Pipms B. Wbat mIÚDdI ad. cquip.meat. icl..wmld by œmo IDd ~ will be used pa~dh'e the momtoriDg: Tank: 3S'O PipÎDg - c. Dc:scribI: tåc locøicm(.) where the moDitoI'Ù18 will be priJrmecI (fådIlty plot 11m .h.-mld bo actacbcd): ~ _ gJ71f? or D. List m. namc(.} and dtlt(s) oft.he people responsibJo for pcriòmùng the m and/or maiDtaiDiDg the øquip~: .i . E. Rcponina Format tbr mcmhoriøg: Tank v Piping F. Describe the preventive mai4teuanœ sç~ for the monitoring eqtÚpmcm. MaiDteDa.acc IDU be lu accordaace wllb tbe ....ut.dUrer'. maiq..... but DQt leu tbaa eYBI'1I2 IDODtIIl. v. 01/16/2002 05:24 01/08/02 12:30 80568.18 tta . 26 05'18 MAILBOXES ET~ BFD HAZ MAT DIV . PAGE 03 141003 EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING J'ROG 'TbÏ$ JDDDitorlng proanm Ølust be kept at the UST loc:aågn at all times. The itdònnaúoJ1 ort this mo ol"in¡ pIOgJ'1tD rue 1ii9lid&lious of me oper:atin¡ penxút. 'The penDit b014er mUSt øoófy the omc:e of E . 5ervicø ,.¡thiD. 3D dayS of any changes to the II'IODitoring proœ1\IR$, unlcuø requited to obtain appro making tile c:b3øa-e. Rcquin:d by SCCIkms 1532(d.):md 2641(h) CCIl Fadlity Name Facility Address b 1. !fan unauthorized release o~urs, how u.i1I the hazardous substance be Gleaned up? Note; If released ha.zarðoùa Jubftll'lce5 reach the environment, increa.se the fire or e~ osion hazard, are DOt cleaned up ûom the secondary a>ntaimnent within 8 hours. or cccriørate the secondary toDr.aimnent. f:hen the Office: of Environmental SeMces must be øtißeö ~ilim24~. 2 1i'M o 2. Describe the proposed methods and equipment to be used for removing and pr i perly disposing of any hazardou.s substa.nœ, " ..s~ qo 3. 4. Describe the maintenance schedule for the ~leanup equipment: -- - o 5. LiSt the twne{s) and tiù8(s) ofthc! peflOn($) responsible for authoriz.íDg any w necessary under the response plan; ,..., - , ~' .c :þ t..J 01/16/2002 05:24 805588.' 8 01/08/02 12:31 tr66 6 0576 MAILBOXES ETC _ BFD HAZ ~IAT DIV e _ _ ( -- ( GUIDELINES FOR CARDLOCKlUNSUPERVISED DISPENSI G ( PAGE 04 IlJ 004 - - 01/16/2002 05:24 01/08/02 12:31 80568a,18 V6.26 0576 MAILBOXES ETC." BFD BAZ KAT DIV PAGE 05 ~005 , ·1 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SER CES . -- GUIDELINES FOR CARDLOCKlUNSUPERVISED DISP NSING I 1 I I Um;upervised dispensing is :!llowed when the owner or operator provides, and is accounmhle fì daily site v:ísìts. reguIa;r equipment inspec;tion an.~ mainteDan~ including any unauthorized release or $1' 15, posted Íl1S1JUctioDS for the safe operation of dispensing equipment, and posted telephone numbers for e owner or operator. Signs prohibiting smoking. prom."bitin8 dispensing into unapproved conw.ne~ ~d re uiring vehicles cm.eines to be 5toppoo during fueling shall be conspituously posted within sit~ of each dispense. In addition, a sign shaU be posted in a cou~pÌGuous location reading: ( In case of spill or release: 1. Use Etnqency Pump Shut-off 2. Report tho accident 3. Fìr~ Depamnmt telephonè n\lmber 4. F aci1ity adCÙ'ess During the höurS of operation, statiQns ha.ving \Ulsupc:rvised dispensing shall be provided with ~I alarm tr.msmitting device. A telephone hot requiring Ii coin to opm-ate is acceptable. The fuel leak d ction system mU5t have a rtmote or phone modem to inSUle off site monitoring during hours of unsuþervised ·spensÏllg. During hours of darkness. sufticitmt lighting m.ust be th8Ùltained So that all signs llSSociated wi fu~linB operation ðre conspicuous and readable. A 5 gallon contaìnet' of an absorbent material used for ills must be made available to the public during hours ofumupervised dispensing. A fJIe extinguisher with minimwn 2 A 20 BC rating, must 'be locøted on dispenser island duriJ;1g hours of tmSupervised dispc:ming. I In addltion to the above requirements, the follOWÍI1¡ infoonatíon is 1t:quired: 1. 2. :3. En1erget1Cy Response Procedures (Requirements 0 p.Z) Employee Procedures (R.cquiremen~ on p.3) Sample fotIIl on p. 4 shows all the necessary inti tion which must be provided to the City ofBakcnfield. Office' f Environmental Services. Yau may use any format Y1 \¡ wish, provided that all the inwmtation requested is suppli . (. Oec.21,2Q01 1:00PM P.O. Box 54143 tos Angeles CA 90220 .. Phone: (310) 900-3772 Fàx; (310) 900-5806 "' e No·2909 p. 1 \ Ra"phs Grocery Company - Risk Management Department Fax To: Inspector Steve Underwood From: Bonnie Franco Fax: (661)326-0576 PaIGS: 11 Phone: (661) 326-3190 Date: December 21. 2001 Re: Ralphs Fl,Jel Center eCI Dave Puglisi o Urgent 0 For Review 0 Please Comment 0 Pf..,e Repfy o Please Recycl. . Comments: Thank you for time explaining the required documents for the Ralphs fuel center in Bakersfield. I pulled the attached from the Kroger manual. Please let me know If these documents serve as the monitor and spill response plans. If not. do you have sample plans we can use as a template? ' Bonnie Franco 12/21/01H:\Dats\Word\1ax covers\fuel center fax.doc Oec,21. 2001 1 :OOPM Trplning Of KIO!EmPIOyeeS Training to take place prior to Opening day No.2909 p. 2 e Markings on fill spots (tanker unloading) I. Regular Unleaded gasoline (White with Black cross) II. PremIum Unleaded gasoline (Red with White cross) III. Diesel (Yellow) IV. Keep fill caps locked Fuel Delivery I. Print Veeder Root reading before fuel delivery II. Driver must have traffic cones In place III. Driver must have Vapor Recovery hose attached IV. Prtnt Veeder Root reading after fuel delivery Lights and Power 1. Lights end signs are on automatic system (where are the over ride buttons) II. Where Is the green emergency STOP button (this button cuts off all electrical power to dispensers). III. Where is the Green reset button IV. Where are the breakers located Veeder Root Operations \. Have vendor go over operation II. Print Button III. Autodial failure IV. Low Product Alarms V. High Product Alarms VI. PLLD Test VII. Where Is the Veeder Root Quick reference guide Dispenser Operation t. Have vendor go over operations II. Changing paper In card readers III. Cleaning dispensers, NEVER hose down IV. Wax dispensers 4 times a year V. Quick shut-off valve Fuel Spills I. II. III. IV. v. VI. Use oil absorbent or spills kit on any spill of 2 gallons or less NEVER hose down a fuel spill If $plllls large. hit red emergency stop button and use Intercom requesting all customers do not start their cars Where is spill kit Spills greater than 25 gallons require EPA notification within 24 hours Where do , dispose of the 011 dry Proper Fuel Dispensing I. Customers must use properly marked containers-NO milk jugs, glass jars, plastic bottles eCT... II. Container should be marked Flammable or with sImilar wording III. Metal or plastic (Polyethylene) should not be over 60 gallons IV. No smoking and shut off engines are regulations Operatlcn5 and Training Menusl Ver I R&v II Þage 26 Dec. 21 . 200 1 ~ 1: OOPMance~d Other Items I. Use oil ab~nt daily. II. MSDS filed III. Use of Intercom system IV. Emergency telephone numbers posted V. Where Is the 011 absorbent VI. Never give prices out over the phone VII. Where do we purchase our fuel-We purchase our fuel from local major refineries we are a unbranded operation VIII. Our gasoline Is performance guaranteed and quality assured No·2909 p, 3 e Operations and TrainIng Manual Ver J Rev II Page 21 Dec.21. 2001t 1 :OOPM~"a·lnMnanCe No,2909 P,4 . I....,....~ .....'w....II ... A 90rrectly installed dispenser, given proper preventative m.enance, will seldom require emergency service. Perform the following tasks on a regular basis: · Check the dispenser for internal and external leaks regularly. Check nozzles, swivels, hoses, filters and joints for leaks and wear. Have all defects repaired immediately. · Do not abuse the hose by trying to stretch it to reach an automobile. This will cause early failure at the couplings. · Keep the dispenser clean at all times. Use only mild soap and water with a soft cloth. Do not use gasoline or other petroleum-based products to clean the dispenser. Do not use abrasive cleaners on any part of the dispenser. · All stainless $teel surfaces require polishing with a non-abrasive silicone wax a minimum of three times per year to maintain a bright finish and prevent corrosion. Two cleaners in particular are very effective and practical to use: Zud Heavy Duty Cleaner and Bar Keeper's Friend. They can be found In most hardware/grocery stores. Follow the manufacturer's instructions and always rub In the direction of the brush finish to prevent scratching the stainless steel. · If it Is necessary to wipe off the dispenser, use a damp (not wet) cloth. Note: Do not direct pressurized water (even from a garden hose) at the dispenser. Under no circumstances should power washers be used to clean the dispensers. This can force water Into the electronic head and cause damage to the electronic components in the dispenser, rendering It inoperative. Operations and TrainIng Manual Ver I Rev II Page 41 Dec.21.2001 1:01PM H,ousekeeping · No.2909 P,5 e The equipment used in a fuel site, just like the appliances in your home, must be cared for to properly prevent breakdowns that could cost sales and result In costly repair bills. There are special rules for operation and maintenance of each piece of equipment. and you'll want to learn these procedures as soon as possible. Store Sanitation and Maintenance A clean and shining store Is important to customer relations and strong sales. Sweeping. mopping and cleaning are regular parts of the job of everyone who works at the fuel site. Of course. it's important that you perform major clean-up jobs on a regular schedule. but it's even more important that you train yourself to see what really needs to be done. Try to look at the store as a customer sees it. Are the shelves messy? Has someone made a dirty hand- print? Is the glass clean? If you train yourself to see such problems as they occur, you'll find it easy to keep the store sparkling. Daily: You should dust-mop the floors every shift, or even more often if needed. Spills should be cleaned up immediately before someone tracks up the rest of the floor or slips and falls. I Floors should be washed and rinsed thoroughly once a day. Parking Lot and Front Dock Care Dally: Pick up loose trash and sweep the driveway and dock area, including the ice..maker , if applicable. Clean gas islands, wipe down tops of gas pumps - Empty all trash receptacles, including the one on the gasoline Island. Empty and fill window wash buckets Window Care You may need to remove spots and fingerprints from the glass several times a day. All windows should be cleaned inside and out as needed. Shelf Care Dust daily. On a continuing cleaning routine, perhaps once a month, some of the shelves should be thoroughly cleaned, so that the entire store is covered at least once a quarter. Sales Counter Care You will need to clean the sales counter several times each day, Keep a spray bottle of cleaner under the counter for quick wipe..ups. Customer service is the basis for all cleaning jobs to be done. The customers demand to have a clean environment to do their shopping and we need to respect that demand. The following statement emphasizes the Importance of a clean store: Dec. 11.: .~ ~O ~(..! ~ O.1!.~9 caw' the customer...someone else tw" No. ¡go g P. 0 Tbe use of a daily 'work list is a great tool for any manager to ensure that all the work is being done, and also to hold the employees accountable for the work being done. Dec,21, 2001 1 :01PM e No,2909 P.7 e Windshield Wash Bug Bucket Solution . . In mild weather. dilute windshield wash at a 50% water, 50% wash solution . Use Unger pills, order from ANS . In sub-zero weather, DO NOT dilute windshield wash Floor Spills Clean up 011 and other automotive fluid spills from the concrete as soon as possible. 011 and other fluids can be dangerous to customers and will stain the concrete permanently. If proper care and maintenance procedures are followed, the life of your site's concrete will be lengthened. Operations and Tr81nlng Manual Ver I Rev II Pase 44 Oec·21,2001 1:01PM e P2yton Fuel Center Supplies MS 3751427 3764198 3729464 3729472 3717048 3713252 3772266 3763281 3766458· 3773165 3773140 3704095 3769403 3770161 3720133 3730397 3765286 3765294 3766441 3767423 3767407 3770310 3770328 3750460 -- Qtv 2 2 2 2 2 2 1 1 1 1 2 5 1 2 2 1 2 4 2 3 1 1 1 1 No·2909 P.8 Description Thermal Paper Roll (Recipe pump paper) Veeder Root TLS 350 Veriphone 250/500 Ribbon (For recipe inside printer) 2 Ply Carbonless Recipe paper Pump Card Reader Cleaner Fatigue Mat Step Stool First Aid Kit Goggles Face Shield Chemical Gloves Pen on Coil 50# Ice melt - Seasonal Feather Dusters Wastebasket Hand Sanitizer Squeegee Squeegee Blade Refills Heavy..duty Gloves Spray Bottles Lobby Pan w/handle Large Push broom Broom Handle So-Dri Blue Windshield Towels OperatIons and TrainIng Manual Ver I Rev" Page 45 Oec,21,2001 e Safety and Security 1 : 02PM e No.2909 p, 9 Personal Safety Your own common sense and precaution will go a long way toward preventing accidents and preventing bodily injury. Just by performing your duties in a businesslike manner and avoiding any "horseplay" on the job, you will be protecting both yourself and others. There are, however, some specltlc rules to follow that can help avoid Injury while performing some of the duties that could involve danger, Proper Lifting: When lifting a box or anything else that may be heavy, the use of a back support belt is recommended. You should squat down to pick up the object. then 11ft it by straightening your legs. thus not putting the straIn on your back. Your store should have a two- wheeled dolly to help you move heavy boxes. * * Check with Store Manaaement for søeeífies of your DivlslQns' Dollev " It Proper Use of Box Cutter: You should treat the box cutter with even more respect than you would gIve a very sharp knife. You want only to cut the case. nothing else. When opening cases, it's a good idea to cut at an angle across and to the side of your body, rather than pulling the cutter toward you. Proper Climbing: There is only one rule involved in climbíng safety - use a ladderl Never attempt to climb on boxes. crates, chairs, etc. Your store has been equipped with an eight-foot ladder and also a five-foot ladder. TO PREVENT ACCIDENTS, USE A LADDER! Proper Use Of Gasoline Container: ') Customer must use properly marked container 2) Gasoline may not, under any circumstances, be put into unapproved containers such as milk jugs, glass jars or plastic bottles. 3) Store clerk must ask customer to stop putting gasoline into unapproved container. 4) If customer refuses to stop clerk may (must) shut down dispenser. 5) How does clerk know what is proper, container. a) Container should be marked Flammable of similar wording. b) Metal or plastic (Polyethylene) should not be over 60 gallons. B) Customer should be made aware of sign on post. Operatlonø and Training Manual Vet I Rev \I Page 76 Oec.21.2001 \ : 02PM e e No,21j09 p, 1 0 No Smoking · Stop Engine Unlawful to dispense gasoline In any glass or unauthorized containers by order of the Fire Marshal Preventing Accidents To prevent injuries to others inside and outside your store. It is important to clean up broken glass Immediately. It's also Important to wipe up any spills immediately to prevent people from slipping and injuring themselves. Be sure the aisles in the store are always clear of any hazards that could cause someone to stumble. You should always be alert to this danger when stocking shelves. Displays and signs that protrude at eye level can be dangerous. Check to be sure any free-standing displays have a firm base, especially those that contain glass or heavy cans. In the event of serious injury to anyone in the store, utilize your Crisis Management Instructions. .. Check with Store Management for specIfics of your DIvision's policy ** In the event of an accident to an employee. you must send a workmen's compensation form to the office within three days (or as per your Division procedures). The Injured employee must see a doctor. AGAIN: If anyone is injured. be sure they receive medical attention immediately and then call your manager (or as per your Division procedures). Preventing Fires Good housekeeping is the key to fire prevention. You can reduce the risk of fire if your storage areas are clean and orderly. Know these thinas: Where the fire extinguisher is kept. How to use it The fire department telephone number Where the electrical emergency shut~off switches are Operations and Training Manual Ver I Rev 11 Page 77 Oec,21.2001 1:02PM . Emergency proced1!'Fes for Gas Spills . ! ,; " Sometimes a customer overfills a vehicle's fuel tank, which causes a small gas spill. The automatic shut-off should prevent this from happening, yet automatic shut-offs aren't fail-proof, Another accident can happen when a customer drives off with a nozzle in the car tank. Sometimes. this results in a gas spill and damage to the dispenser. It Is Important for you to know what to do to prevent further damage, 10$s or injury: e No.2909 p, 11 1. Shut off the emergency switch. This will stop the flow of gasoline from the underground storage tank through the pump and nozzle. 2. Use the Intercom to advise customers not to start theIr cars. A spark from their engine could start a fire if there is gasoline or fumes near the gas Island. 3. Offer medical ass/stance.if needed. Call 911 for medical assistance, If appropriate. and complete a Customer Injury Report. 4. /f it is a small spill· - 2 gallons or less: Use 011 dry or a spill sock to dry up the gasoline. When the oil dry appears to be dry, sweep It up and put It In the trash container. 5. If the spill is larger than 2 gal/ons: call the fire department immediately. The fire department will assist in the clean~up and ensure safety. 6. Don't sell any gasoline until the gasoline Island has been totally cleaned up. 7. Complete the incident report. 8. If you call the fire department: you must also call your point of contact (determined by your Division) to report the gas spill. A spill of 25 gallons or more must be reported to the EPA within 24 hours. CAUTION: NEVER WASH OFF A GASOLINE SPILL BY SPRAYING THE PARKING LOT WITH WATER (OSHA REGULATION) If a customer drives off with the gasoline nozzle still in their car, turn the pump off immediately. Check damages to the pump, hose and nozzle. Try to get a license plate number from the car If the customer does not stay at the store. You will need to complete an incident report. Operations and Training Manual Ver I Rev II PliIge 123 " " 01/08/02 12:30 tt661 326 057~ ~/~& . ~ BAKBRSPIBLD CALIFORNIA BFD HAZ MAT DIV - .- FAX"ransmittal Cover Sheet ~ 001- __ Bakersfield Fire Dept. Office of Environmental Semces - 1715 Chester Ave. · Bakersfield. cA 93801 " ~_ FAX No. (-6~~) 826-0576 · Bus No. (:661) 326·3979 . . -ølf7ÍoV"\ l)o..v¿ '{ \J ~ \ \ S '\ COMPANY: U~ç.._,_.~ f5f1RAlD I . ~~i'- \J~~~"):: FÁxNO.@(O) qOo -5"Q70 . - COMMENTS: . ;2~~ ) Seé yo UI Utvrr W~(,¡¿· YA-~ ~.. . :,I) \ '¡. 01108/02 12:30 ft661 326 0576 BFD HAZ MAT DIV ~EN MONITORING PRcf¡DURES UNDERGROUND STORAGE TANK MONITORING PROGRAM @002 .,-- ~ T1Ut moairori.a¡ P,OØlWo liliiii be kepi II dMt VST locatioa .II a1I tim-. Tbe ÌId:It'IIaIiOO aa CbiI ~ PftI8IUI are coadkioaa ottba apaaáaø pamiL The pcraût!lakler IIIUIt ~ dIø OfDœ ot'Euri.rnIl"'Oi1Oll SeIvku witlûøJO days olmy ~.... to the IÞOdit4riq p~ 1III1ea cequùed to obIaùt ~ bebw dI&Ir:iaø me cba,øe. R.equind by Secâ0Dl2632(d) a.ad 2641(h) CCR. Facility Name e Å-L..p~'f' ~ ~ç~JÆfL FlCility Address 5~C]o ~ïOù..Lbbr,.( 1~ 1~1 '"ß~iJ{ç(L";'PH;-LO , A Describe the fi'equcDcy ofpcrformiDg the monitoring; Tank ~ CD t::JT I J.J I..J 0 l.J -<" f'r\ ð t-J IT?> Il. 'u h . Pip.ing ê 0 IVT #oJ Y ø l'K YY\ 0 IJ 1Tt'{ ~, "-'6 Þ B. What methods aød equi.pmeut, idemified by uamc aud model. wm be used fur pertÞ.M~ thomcmitoriDg: Tank V Ç{Ç Q E;tL -.2. ~P"Ï ""L~ 3S'O - Piping \1. PEDE-It - ~ ðf)-¡- ""t"L~ 3SV c. Describe the locaIÏoD(s) where the moDitoñDg will be pedOrmed (tåcÜity plot plan sbøuld be attached): .::r o.J TEll I P IL D ~ ~ I ðSIL - ~ 1-";;: pt-or A-Tr A- ð J.+~ D. List the name(s) IDd title(s) ofthc people responsible for paforming the monitorin¡ and/or maimaiDiDs the equip~= "'J>ou ';Do.Dso/J 5f6d'U:: 'bifZ.F{'.:1fì')/Ir J !:>Af.I 'be- /..-A i20sA ":Þ-1n.p.{'~1t.. IN. n-.N2-~ì.. ANL1 1 ,f~ F=-V~ AîTE'NoAI\Ji\.. E. Reporting Format for monitoring: ~:s ~~~~ ~~~ = ~~U:~~ :~ ~~~;.~. : Describe the prevemive mainteøanc:c schedule (Qr the monitoring equip.meøt. Nate: MaiateDaace Ø1cut be ia ac:cotdaDce with the muuf'aeturer', maiøteaaDce sehedale but Dot leu tbo r:v0t'1 12 moadu. kOc..M- "" ÄJN:ret-J ¡4u(J;,{" \I F="-Að..-1,L CJO(V\f) Arvy ~ '3 (ha,\...'t1:> {... fI'IOU1\...).-;L A..Nn Y12A'I-')" F. - G. Describe the training necessa.ry for the operatiQn ofUST system. including pipiD& and the monitoring equipment: ¿"<""'A.S.SfZ...oOf"'\ AiJ..ý) 0 y- ~ /77= -r7l..A- fi...JJlA.lb ~ Q.u·ALIC1\F'J ~e?i<.SOtùUs:11 ., ,~ 01108/02 12:30 '5"661 326 0576 - BFD HAZ MAT DIV e ~003 i:. EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program Ø1USt be kept at the UST location at all times. The infonnaúon on this monitoring program are col1di.åons of the operating pemût. The pemùt hol4er must notify the Office ofEnvitonmeøta1 Services within 30 days of any changes to the m01Ùtoring procedures. unJess n:quired to obtain approval before making the c:baDge. Required by Sections 2632(d) and 2641(h) CCR Facility Name (l.þ,.Lj>"" '"Fu~ ( ê'~ JJrr:::- L FaciIity Address 5~t.O ~~e> ûL.1Y.>..tM l-4~ b~UBIL\ F1Gt..Ñl 1. If an unauthorized release occurs, how \Jtill the hazardous substance be cleaned up? Note; If released haza.rdous substances reach the environment. increase the fire or explosion hazard. are not cleaned up trom the secondwy containment within 8 hours, or deteriorate the secondary containment, then the Office of Environmental Services must be notifij within 24 hours. Les...s TUØt-/ ¿ b.4u...o IJ) - J fI'1 me Q I A;:"j'"'F( 'fAN up UJ I~ ~ß.~fl.AAV\ -~ puu~ IN ~~~Aí~ ;tJN./) LA'Pût:YJ 1)t¿ùr'O. (Y\OfU;; ~ 2. C:.~( ( Q ~~ - 04<..'- ql( - A-N,() c..t,.r.u.../ up tNJ~ LDc...M-.e:pA r-t{>flLol./l;;?r} V~ðn/L Imß\Pr\~Y 2. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substance. 5ptLU" l~(,. Ï1-lAN ~ ~ALLoí0\ 6-0 11Ui'D se ~o ~ LAß~J.:-:) '1::Ylu IV\ I ~ i-hc..u- 1'\ (11 ('I(UY\ (1t' ~v-e.(¿'1 qo 'Db.'f"\. Sy AN e-DI+ A:~/)I2Dl.J~ Loc...Ï;y( V~.l)r'1IZ.. (Y\ A./AJreu ~ptM'<:&e=:.Jelt.~~ I+Þ"2..Átl..DO~ IA.JM:~ C..JIU- ß<.jQ 7rl- I-tAN.:DLEO ß..y ~þ,. Af'Pl1.öv~ LöC'_vl 1-J4'2.AItD W.Æ'\~ ,c..o M,p Af.JY· Describe the location and availability of the required cleanup equipment in item 2 above. C)(o..j ~,ì?~ - (}cr''£' in t ¡"¿,;ö'<'//L <- l1-v.4--ILAn~ :l.. \.( J-k,. JM'" A- OAf. I 3. 4. Describe the maintenance schedule for the cleanup equipment: A~oA..B..t,\ ~ rY\ AD'IG; t=;i)/L Co. ~~ A~ 0 I L pfLo Due::::r"'\ WI LL ß~ [I ~~ I'b V'h A-/IV'T"""ÄfIV e.L't"4µ '~ E=r V )'(1~~IUT ·'PA-ìl..,... OIL. ¡Af O~ AÇ' v..s~. 5. List the name(s) and title(s) of the person{s) responsible for authorizing any work necessary under the response plan: ~€'.)...., be ß "-0 IJ :;ïi'? fl..1£ h l!"t.l;;;;;C-;ro/L J 'ì:)AN "t)1iî ~A Ro!:.A MAR.l.(.cJ\jub ':b¡fU;;,-c~I1., ANI) , Li=A..O ~ F/LS.;1:>1...J . .. ( 01/08/02 12:31 '5'661 326 0576 e BFD HAZ MAT DIV e -- ,i.. ( .' --- GUIDELINES FOR CARDLOCKlUNSUPERVISED DISPENSING c 141004 - --- 01108/02 12:31 'Zt661 326 0576 e BFD HAZ MAT DIV . I4J 005 .. CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES . -- GUIDELINES FOR CARDLOCKfUNSUPERVISED DISPENSING Unsupervised dispensing is allowed when the owner or operator provides, and is accountable for daily site visits, regular equipment inspection and maintenance, including any unauthorized release or spills, posted instructions for the safe operation of dispensing equipment, and posted telephone numbers for the owner or operator. Signs prohibiting smoking, prolu"biting dispensing into Wlapproved containers ~d requiring vehicles engines to be stopped during fueling shall be conspicuously posted within site of each dispenser. In addition, a sign shan be posted in a conspicuous location reading: ( In case of spill or release: 1. Use Emergency Pump Shut-off 2, Report the accident 3. Fire Depanment telephone number 4. Facility address During the hours of operation, stations having unsupervised dispensing shall be provided with a fire alatm transmitting device. A telephone not requiring a coin to operate is acceptable. The fuel leak detection system must have a remote or phone modem to insure off site monitoring during hours of unsupervised dispensing. During hours of darkness, sufficient lighting must be maintained so that all signs associated with fueling operation are conspicuous and readable. A 5 gallon container of an absorbent material used for spills must be made available to the public during hours of unsupervised dispensing. A fire extinguisher with a minimmn 2 A 20 BC rating, must 'be located on dispenser island during hours of UIlSUpervised dispensing. In addition to the above requ.irementst the following infonna.tion is required: 1. 2. 3. Emergency Response Procedures (Requirements on p.2) Employee Procedures (Requirements On p.3) Sample form on p. 4 shows all the necessary information which must be provided to the City of Bakersfield, Office of Environmental Services. You may use any format you wish, provided that all the inf'onnation requested is supplied. c .- l. 2. 3. 4, f ~. \ , .I. 01/08/02 12:32 U'661 326 0576 e BFD ÍÍAi MAT DIV , e I4J 006 , OPERATOR GUIDELINES EMERGENCY RESPONSE PROCEDURES CARDLOCK OR UNSUPERVISED DISPENSING Daily Inspection; -- 1. 2. 3. 4. 5, 6. 7. Check fot small sputs Place absorbent on the spill immediately Clean up absorbent within one hour Check for hoses lying on the ground Look for other tripping hazards and remove Ensure fire extinguishers are in place and inspect daily Check quantity of absorbent material daily Spill; ,- 7. 8. Detennine the source of $pill or release Stop the flow of product Hit emergency shut-off valve Stabilize the area Extinguish any smoking material Locate nearest fire extinguisher Use absorbent or spill pack to keep any product out of water source Or sewers Isolate the hazard area-deny entry to non~emergency personneL Contaimnent; I. Contain the spill totally with a spill pack and/or absorbent 2. Never use water 3. If larger than can be immediately contained, go to step #4- 4. Contact the local fire department. 9-1-1. 5. Notify company management personnel Fire: 1. Gasoline fire extinguishen; located on dispenser islands 2. Remove Pin 3. Point to the bottom. of the flame and squeeze handle 4. Call fire department even if fire is put out. (9-1-1) 5. Isolate and deny entry, except for emergency personnel 6. NotifY COmpany management personnel Earthquake Response: ( Make sure gasoline inventories are secure 2. If there are any signs of structural damage to the control moIl!. Qr island canopy, keep everyone away ftom the danger area. If danger is im:minent, shut down facility operntions until it has been deemed safe to continue. 01108/02 12: 32 "a'661 326 0576 e BFD HAZ MAT DIV " e ~007 .. CARDLOCKlUNSUPERVISED DISPENSING EMPLOYEE TRAINING GUIDELINES Employee Training: 3. Genttal . ..~ The Maintenance Supervisor/Health & Safety Director or designated person will train all new employees nn thp. ~fp. h~ntilinø' nfh~7~mnl1i1il m~tAn",J.: nrnnpr pmp...."'nf'v 1"PQnnn".. t'nnrñ;n..1'inn ..~,.¡ th.. ,,,,,,,. n~ .......-n~......., -- --' :"'--' ----0 -- ----- ------..-..., r......r-... -.........-...O-......-J ...-....y............,...... ............""1......"'1."'....".........., ,.......... \0&."" """'... "'. .........,...Q""..........) response equipment and supplies. Additionally, the manager will coordinate refresher training programs for all employees on an annual basis. 4. Procedures for Safe Handling of Hazardous Materials a. Employees will be ínfoIDled of the health and safety hazards involved with the handling of gasoline and diesel. b. Employees will be careful not to spill gasoline or diesel onto themselves or on the ground. c. Employees will not smoke, light matches, cause sparks, or take action which could ignite flammable liquids or vapors. C· ~. Procedures for Emergency Response Coordinator a. Employees will be familiar with the emergency response procedure outlined in company emergency response plan, b. Employees will know the location and operation of electrical shut-off switches dispenser shut-off valves. c. Employees will know the location of how and when to use dry chemical fire extinguishers that are located on the premises. d. Employees will know the location of the nearest storm drain(s) and the location of absorbent materials to be used to prevent spills reaching the storm drain(s). e. Employees will be familiar with the kinds of emergency situations, which will warrant imInediate evacuation of the premises. 1. Any gasoline, diesel or other type of ftre. 2. Any spill, leak or vapor leak that has the potential for igniting or exploding. 3. Any spill or leak when employees or customers notice gasoline vapors or spills. Employee Training Records: The manager or Health and Safety Supervisor will be responsible for documenting and retaining the types and dates of the "trÐining"for at least 5 years. c. 01/08/02 12: 32 "Zt661 326 0576 tit BFD HAZ MAT DIV e ¡g¡ 008 " , WRITTEN ROUTINE MONITORING PROCEDURE FOR CARDLOCKlUNSUPERVISED DISPENSING SAMPLE FORM Facility Name: R A-Lp I-h"" 'Fu~ t CeÞVT~1L ~ Facility Address: 52..00 t::>TO c..1,L.~ J~_ 'B>At,¿Ef'l..S.Ff~ Facility Telephone No.: b to I. c&: 5' q. , 6 ~ go Tank. Owner Name: ~ A-Lp~ htz-.o Cf fb.( I frL. Tank Owner Address: lJ D 19 We3? A ft,íe..s i A 6LV.f). Tank Owner Phone No.: ~;o. ~ ~\f.. '} ðOD IA) Identify all equipment used to monitor the underground storage tanks on site. Include make and model ( ofleak detection system. \ , Vee.oet't.... - r<OCtJT IL.~ :3 S'O GOfo..Jl/Nuöu~ V"\'\OlVtTO(l..IUJ. AN/) t\LAIttfV1 ~y6TE(y) .. m) Identify all equipment used to monitor the underground spill containment On site. Include leak detection system, type and placement of liquid sensors, type of leak detectors and.s does system have dispenser containment 2) \/ETeD6tl..-Ii.QQí' -r-L~ ~S'D - $eN~::>I'¿'f Lor ~~ ¡'''' E\J.E/{,1 $i!:CON'DAtV¡ C 0 f...rrA/~M-e.iV'T $urr-.'f- 1=1:;- Pef1l.o LJ u€ -LE Ä\L. U~Q oIL. ~~(T"E:,.v,. A-L\O (4A~ :Dl ~ ~It,. c, 0 U'\J4JUr'\-e.~ 0 fJl.V (\'\o.oél- . Identify the name(s) and title(s) of the person(s) responsible for performing the monitoring and/or maintenance of equipment. (.. -:t:>oN --:..t::x>~::;Ok.f 6"Jb~ -:[)1~-c;rOtL I ~l'-l ~ LA- ~Sl>r MA-a..L..{£;fltvb uia'C<:,:::¡-olL, A'^-IÐ Le-AO FUeL...pért...SoN' 01108/02 12:33 ft661 326 0576 e BFD HAZ MAT DIV ~ - 141 009 . \' 3) Identity the location of the monitoring equipment Include where remote monitoring will be conducted and name of company assigned to monitor and report name of company and phone nwnber if other than operator. v e-e: QElL- 2.004"" c... 0 t-.\ So Œ J N KI o<~- ~ Iv/.}{. Ov~ÞI(l ~~ A-N0 OUËlLALL A{Atl.ß'I1 LOC#f1!:D lus...iOFE. QtJIl.£. fV\ OIV 1'10 It.. rU'- tA.) I<..^- ß€ CH..)- S¡ n£ f!>y (2.4~wr--&aOC.<Ø7 Co. Identify how frequently the monitoring equipment ìs tested/checKed for operational status. Indiéate each piece of equipment separately. 17~ Me> ftJ \ 1"0 tl- ttùb ~9 VI,?> m~UT VJ(...\- ße ~ ':þA-Ìf'j. V~erL-Qoðí '\"":'~L 3ro ALAfl.VVl 1-44.1"" ~~"J bU~J...þ A 4) Identify how often the tank(s) are monitored on site (i.E:. daily. continuously). C QIV"IJ N V 0 llS-Ly. (, Describe the training needed to provide to the opèrator(s) of the underground storage tank for the proper operation of both the tank system and the monitoring equipment c..,~ 12..00 1""\ A-~ tJu- $; ,'TI5 '-¡-'¿A-t -I--.) j ~ ·b :{2a.-c Gf?.AfV\ ß.\../ ~uALIÞle:D ( p,= a...SO.IJ IJ 6' L 5) All equipment used in implementing the monitoring program shall be installed, calibrated, opernted and maintained in accordance with manufacturers instroctions, including routine maintenance and service checks. 8) You must develop a reporting fonnatllog that incorporates the following information: f) Verification of Equipment Testing g) ReportingtRecording when Alann is Indicated h) Maintenance Perfoxmed C. 9) 'These reports/logs must be submitted to the Bakersfield Fire Department on a annual basis. Written records of equipment calibration/maintenance shall be kept on site for at least 3 years. In the event of a release, emergency equipment is limited to fire extinguishers and absorbent material maintained on site. Please discuss contingency plans for additional cleanup personnel and or contractor/clean up consultants. S:\PIIOCEDURE MANUALIOUl.D2UH¡¡S FOP. CAJI.!)LOCK 1j004 01/10/02 12:31 tt661 326 OS76 8FD IIAZ HAT DIV fbe· CITY OF BAKERSFIELD , :.' , OFFICE OF ENVIRONMENTAL SERVICES' / , :L... 171S Chester Ave., Bakenßeld, CA 93301 (661) 32. -.___ .- UNDERGROUND STORAGE TANKS· TANK PAGE 1 .. rrPlQFACTOr ~ NCWsne......, c.....IIoIIIICIID~ ¡aoera-_..CW$f ~N a). ........ PÐUT ~,...... ..... MJf i1::,~~::~twllrf1lœA·o........At)C ~c.a..o c.c'4Af _0_ æ - -" a '- CtWIi3II~ ØJGWMnoN) CJ .. TÞf'OIII.M't SITI Q.Ca.A! C , PIMWIINn.'f' a.DaDCN.. ~tNr9f."I)Q",'" 0 I. T""~ , c:::JIfifIJJIID ~ " - ... I ' IID'I'CS!':wtlCLaF\6 I' ___,- ¡[:J.__ ¡O,__ I [:J. _*""'_ ....ao [:J..._ .....- ~_..: 0._ fIIIIIiIrIIUIIW&IiMBJ C I. ~ C_..xIWII~ C... CMØQ. c::tIIaUtMUilll""__~""""P*I o S. 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I'UMTloII:IWISItHo\TIHIISClfPINIMVJ.IJII: CiOHI'IMJCJJSI OISÆNIERPNftEl8QA.#UJaBNGVB.DU.M..t.Ar.d CONnMItJUI ~ ....IIIMCftJlItl.MnOatAII"QF1ffORCIIIfINRJII·N,gIIU oYiD YISUIoLALotAMI IX.~TDRIIGNAMtI I PwIIW'*-WfFOI"~_OIII11 .~ I ~~Þw,,",,__ UPCF 17199) "141""'~ØlletFot".....,__ ~ S:lCUPAI'ORM8\8'MIC&B,WPO '" ... I!' . ~ , . ... "' m 01110/02 12:50 fr661 326 0576 BFD HAZ MAT DIV a CITY OF BAKERSFIELD 17f:'FICE OF ENVIRONMENTAL _RVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 <ê UNDERGROUND STORAGE TANKS - UST FACILITY o 3, RÐreWAlI>eRM'T (] .... AM&rIOED PERMIT ~_Of_ o r. PERMI'NENTf.... CI.OS£O SIT!; o S, TANK FteMOV/ro 400, TYPe OF ACTION ~. NEW SITE PERMIT rc;1reØ one <11m DI!I)II 1"'" o S. CHANGE OF INf'()IUoIATION ~ dllIIIfI . - uw atVyJ o 8. 1t:MPQRARY SltÈ CI.~ I. FAClLrTV I SITE INFORMAT10N BuIII_ As) 3 FAOIJTY II) . r 653 1:1 4. LOCALAGEÞlCYIDISTRIC1"" [J 5. COUNN AGaIl:.Y" [:J 8. STIlTE AGEHC'I'" a 7. FEOeRAI.AGeNGV" 402. I o 1. FAIW LI $. CtJIIAMÉRCW. D 4.. PROc:eSSOR CJ 6. OnER 403- iii rPb an fmI¡p\ Rl!MMllfon 01' "It _ or lIST.. public ~ - ffllRI~ ffI II\OAIIIICB? ~ secIb'J Of ðIIIÐe wIIiCtIl!IIf\IIBS tile UST. [11IiS ill u.c:MIIet_ ~~-~ DVM No 4OS. '1:> C!Jc-l 'jJ -401. F UTYOWNeRTYPe I. COfUIOAAT1ON 2. INQIVIDtW. o 3. pARJ'1olERSHIP NEAReST I. GAS STATION [:J ~ DIS1RIÐUTOR 10TAlJ.l\JMBeAOHANKS ~INGATsrm BúSIHE TVPE -404. 406. 11 PROPERTY cw.'NER INFORIIA11Ot4 4U1, 0408. . Q 000 409. 4'0. 412- 02.~ [J ). PAHl'Nelt\iHIP t!.- D 4, L.OCALA~ I DISTRICT o 5. COUNTY AGE{IIC'I' '413. : II(.. TANK OWNER INFORMATION 4'4. PI-IOHS 4'$, '610. ggy- CX::JO 41B. D 2- INDMEIUAL o 3. PARTNER$H11> 417. STATE 41B, CIl: 04. LOCALAGe/CV/DIS1'RICT o S. CCItJNIY AGe4CY 419. Tt?N "'f'Zú. CIJRPOI'IA'MOtI Qo :J.20 0&. STATEAGENCV CJ 7. FEIJERAI..<ISiHC1' 420, 1 $El.F-!NSUReO Cl2.GUAAAtm!E o 3. ~R.AHCE IV. BOARD Of EQUAUZATIOIIf UST STORAGE Æ£ ACCOUNT NUMBER Call (918) 322.£1669 if quœtIons atiGê ':: Y. ~ETROlEuM lIST FÙtANcw. RESPONSIBIUfY o 4. SUfIeTY BOND 0 7, STATe: F\lHO (J s. 1.ErTER0FCREDn' 0 B. sr"11õFUNOaCFOLETI'ER o B. exa.\PtlO/II [:J $.. STA'Æ f'tJNO & CO 421, TV (TK) HQ INOICATE M!m«)D(S) [J 10. LO<:.oL GQV"T MeCHANISM D 99. OTHSt: 4h Y1. LEGAL NOTIFICATION ANÐ MAILING ADDRESS CllIIdt _1IG1C to iNk:alø ""*" _ ~ be "'*' COr /øIII ~;J/Id III8B1g. L.8p1 ~amI ~.IHt_t 10 Ihe~ _ ußI9I$_1 or 2 iSØ\IICIU!CI. C] 1. FAÇUJTV . ~0WNeR CJ 3. TANKCM1'!ER ~. VIL APPlICANT SIGNATURE ~Jc;adM: I awflI'y Iha1II18 ÏIIb'IIIIIIIaI IIVØdIId SIGNA OF DAre PHONE 42$, '.6/0. qeD.?>"') :.) 426, 421, ..... s LATE UST FACIIJTY NUhEER (Fwþ;¡q¡oJ 110!18 OII/yj UPCF (7199) 428J lees lJPGRAI]i: CERTIfICATE I'WMBeR (FM~ USII m, ..24. , S;\CUPAFORMS\swrco-a,wpd - " 01/10/02 12:50 "5'661 326 0576 BFD HAZ MAT DIV --:::- 141 003 --- -- --- CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 U~OERGRQUND STORAGE TANKS -INSTAU.A110N CERTIFICATE OF COMPLIANCE One form per tank ~ _ Of ..--.-----....--.. I. FACILITY IDENTIFICATION BI,J$I~ESS ~ (sam. a FAClÜiŸÑÑÆ ct08A . 0aIng IIUIIni!$t ~ ~' f FACILm'IO.!; ¡ [TANK 10 If ...---.- _..... ...___10_____···...... . _____ ~--------_.,_.. ........ .. --~......-_...-._-- ....--.-...- ..- ... ....--...---..-... -------.. ...,. -..-.- ---.. U. INSTALLATION ~ ~ o . o Check all ftJ8t 8PPIY The installer has beèn œrtIfled by the tank and piping manufacturers. The Installation has been inspectAd and certified by a registered professional engineer. Thé installation has been inspected and approved by the City of Bakersfield Office of Environmental Services. All work hsted on the manufacturer's installation checklist has been completed. The Installation contractor has been certified or ncensed by the Contractors State LlCènse Board. Another methOd was used as allowed by the City of Bakersfield Office of Environmental Services. Identify method,; III. TANK OWNER/AGENT SIGNATURE I CIIIIft II'1IIl1li 1IIbmIdøn~""1I1M "'__lit !I'd -.d"'1--' ~1Jdl4 - _~.~~~..YU C:øLI~ i ._ -tM ----- - ----- -- -L --:- 10 ,-0 1- _.___ ". __ ._. ,. 4IIS TI'I1.E OF TANK QWNÐVAGENT . .~Æ.f:~_/J?fik.JIJ.~Þ~_ __'''_'''_ -WI .-....-.....-- 4t1Ø, Fonn C ~~. _ __ -:-1 e . HAZARDOUS MATERIALS-EMERGENCY SPILL RESPONSE 1.0 Purpose: The purpose of this policy is to ensure compliance with State (Cal\OSHA) mandate for implementing a Hazardous Waste Operations (HAZWOPER) Program as detailed in the General Industry Safety Orders 5194. 2.0 Policy: All Ralphs Fuel Center members have the right to know the identity of the chemicals and materials to which they are potentially exposed and the specific health and safety hazards these materials represent. Additionally, in order to minimize the threat of personal injury as well as any adverse affects on the environment, all members need to be instructed as to the appropriate response in the event of a hazardous material release. 3.0 Responsibilities: 3.1 Risk Management has overall responsibility for ensuring program requirements meet applicable health and safety regulations. 3.2 Engineering/Purchasing is responsible for providing the resources necessary to establish and maintain the emergency spill response program. 3.3 Fuel Center Manager has been assigned the responsibility and authority for overall management and administration of the program at the local (station) level. These responsibilities include: 3.3.1 Implementation of the Hazardous Materials-Emergency Spill Response Program. 3.3.2 Workplace evaluation, that includes hazard identification and characterization. 3.3.3 Developing and updating the station's Hazardous Materials Spill Response Inventory. 3.3.4 Ensuring all members complete the appropriate training. 3.3.5 Securing the source of a hazardous spill should one exist. C:\TEMP\HAZWOPER.002.doc 1 ;) :.ç e . SUBJECT: HAZARDOUS MATERIALS-EMERGENCY SPILL RESPONSE January 10, 2002 3.3.6 Maintaining a "small spill" containment and clean-up kit at the fuel center. 3.4 Members are responsible for: 3.4.1 Members are expected to adhere to procedures and restrictions identified in this program. 3.4.2 Members will complete the required training. 4.0 Procedures: 4.1 Program Administration: The elements of the Hazardous Material-Spill Response Program is defined in this document and due to the changing environmental requirements, this document will be reviewed by the Risk Management and Environmental Affairs Department annually. In conjunction with the annual audit, a critical assessment of the hazardous materials used in the service stations will be conducted and an updated Hazardous Material Spill Response Inventory completed. 4.2 Training: All personnel required, as part of their normal duties, to use chemicals, cleaners, housekeeping agents, etc., will participate in the fuel center's Hazardous Material (HazMat) training program. 4.2.1 All personnel working at a service station are classified as "First Responder Technician Levels" and will receive annual instruction. The training will be in accordance with California's Right-to-Know Law (CCR, Title 8, Chapter 2.5, Article 1 through 4). This instruction will emphasize proper use and handling of hazardous materials, how to recognize and respond to an emergency situation, evacuation procedures and how to summon appropriate assistance. Additionally, the employee will be instructed on how to respond to both small (2 gallons or less) and large (greater than 2 gallons) spills. 5.0 Supervised Dispensing-Spill Response Procedures 5.1 All materials, as identified in the station's hazardous materials Inventory, are included in the scope of this plan. 5.2 The greatest potential spill concerns involves gasoline dispensing. The hazards include both exposures to gasoline vapor and the extreme fire C:\TEMP\HAZWOPER.002,doc 2 .. 'i' e . SUBJECT: HAZARDOUS MATERIALS-EMERGENCY SPILL RESPONSE January 10, 2002 hazards that gasoline spill represents. 5.3 Due to the potential health and fire hazard associated with gasoline spills, fuel center members will be restricted to spill cleanup activities addressing spills of two gallons or less. Gasoline spills exceeding a quantity of two gallons will be cleaned by a independent hazardous materials spill responder. 5.4 Due to the extreme volatility and fire hazard associated with gasoline products, always remain on the perimeter of the spill during containment and cleanup activities. 5.4 Large Spills (Spills greater than 2 gallons) 5.4.1 Shut off the emergency switch. This will stop the flow of gasoline from the underground storage tank through the pump and nozzle. 5.4.2 Use the intercom to advise customers not to start their cars. 5.4.3 Evacuate and restrict access to the area in which the spill has occurred. 5.4.4 Decontaminate fellow members or customers exposed to hazardous materials using potable water. If contaminants enter the eyes, flush eyes with potable water for at least 15 minutes and then seek medical assistance. 5.4.5 Immediately notify the Fire Department by dialing (911) and advise them of the nature of the spill and the station's location. 5.4.6 Notify the commercial hazardous materials response organization to initiate spill cleanup procedures. 5.4.7 When the fire department and emergency response organization arrives, all information pertaining to the incident should be immediately provided to ensure timely and appropriate corrective measures are initiated. 5.4.8 Do not sell any gasoline until the spill has been totally cleaned up. C:\TEMP\HAZWOPER.002.doc 3 !' .. e . SUBJECT: HAZARDOUS MATERIALS-EMERGENCY SPILL RESPONSE January 10, 2002 5.4.9 Do not reenter the area in which the spill has occurred until cleared to do so by the fire department. 5.5 Small Spills (2 gallons or less) Cleanup 5.5.1 Attend to injured and contaminated persons. Promptly remove contaminated clothing and thoroughly rinse contaminated skin and eyes with cool water for at least 15 minutes. 5.5.2 Call for medical assistance for any injured or contaminated person. 5.5.3 Identify the spilled chemical or hazardous material and its hazardous properties--refer to the Workplace Hazardous Materials Inventory for the required personal protective equipment and disposal protocol. 5.5.4 Contain the spill if it can be done without danger of personal injury. Emergency Spill Kits, equipped with absorbent materials, are available in all stations where a small hazardous material spill potential exists. 5.5.5 Restrict access to area around the spill and notify other workers of the spill. 5.5.6 If spilled material is flammable or combustible, remove all ignition and heat sources. Ensure motor vehicles are precluded from the area of the spill. 5.5.7 Avoid breathing vapors of spilled chemicals and gasoline. 5.5.8 Wear appropriate protective clothing and equipment during spill clean-up. The protective equipment is located with the spill clean-up kits. 5.5.9 When handling contaminated materials and debris such as broken bottles and glassware, use leather gloves over chemical resistant gloves designed to be used with the type of materials spilled. 6.0 Unsupervised Dispensing-Spill Response Procedures 6.1 A five-gallon container of chemical absorbent that can be used for minor spills by the customer will be provided for each service island during those C:\TEMP\HAZWOPER.002,doc 4 ·' ;' " e . SUBJECT: HAZARDOUS MATERIALS-EMERGENCY SPILL RESPONSE January 10, 2002 hours in which the fuel center is not staffed. 6.2 It will be posted on each island that during hours when the fuel center is not staffed, customers can register concerns or seek assistant from the "Key Person" within the Ralphs store. 6.3 The gasoline system is wired such that an alarm will sound within the Ralphs store during a major gasoline spill. 6.4 Should an alarm sound within the Ralphs store, the Key person will immediately investigate to determine the extent of the emergency. 6.5 If a large spill has occurred, the following procedures will be initiated: 6.5.1 Shut off the emergency switch. This will stop the flow of gasoline from the underground storage tank through the pump and nozzle. 6.5.2 Use the intercom to advise customers not to start their cars. 6.5.3 Evacuate and restrict access to the area in which the spill has occurred. 6.5.4 Decontaminate fellow members or customers exposed to hazardous materials using potable water. If contaminants enter the eyes, flush eyes with potable water for at least 15 minutes and then seek medical assistance. 6.5.5 Immediately notify the Fire Department by dialing (911) and advise them of the nature of the spill and the station's location. 6.5.6 Notify the commercial hazardous materials response organization to initiate spill cleanup procedures. 6.5.7 When the fire department and emergency response organization arrives, all information pertaining to the incident should be immediately provided to ensure timely and appropriate corrective measures are initiated. 6.5.8 Do not sell any gasoline until the spill has been totally cleaned up. 6.5.9 Do not reenter the area in which the spill has occurred until cleared to do so by the fire department. C:\TEMP\HAZWOPER. 002,doc 5 .. , .. e e SUBJECT: HAZARDOUS MATERIALS-EMERGENCY SPILL RESPONSE January 10, 2002 6.6.1 Small Spills (2 gallons or less) Cleanup 6.6.2 Attend to injured and contaminated persons. Promptly remove contaminated clothing and thoroughly rinse contaminated skin and eyes with cool water for at least 15 minutes. 6.6.3 Call for medical assistance for any injured or contaminated person. 6.6.4 Identify the spilled chemical or hazardous material and its hazardous properties--refer to the Workplace Hazardous Materials Inventory for the required personal protective equipment and disposal protocol. 6.6.5 Contain the spill if it can be done without danger of personal injury. Emergency Spill Kits, equipped with absorbent materials, are available in all stations where a small hazardous material spill potential exists. 6.6.6 Restrict access to area around the spill and notify other workers of the spill. 6.6.7 If spilled material is flammable or combustible, remove all ignition and heat sources. Ensure motor vehicles are precluded from the area of the spill. 6.6.8 Avoid breathing vapors of spilled chemicals and gasoline. 6.6.9 Wear appropriate protective clothing and equipment during spill clean-up. The protective equipment is located with the spill clean-up kits. 6.6.10 When handling contaminated materials and debris such as broken bottles and glassware, use leather gloves over chemicals resistant gloves designed to be used with the type of materials spilled. 7.0 Notification of Disposal Service: 7.1 The station member will notify the Environmental Affairs Department (310- 884-4082 for disposal of chemical spill waste. 7.2 Mandatory agencies to be notified as soon as possible (within 24 hour) C:\TEMP\HAZWOPER. 002.doc 6 ..' ..... > - . SUBJECT: HAZARDOUS MATERIALS-EMERGENCY SPILL RESPONSE January 10, 2002 are: 7.2.1 Bakersfield Fire Department Office of Environmental Services 661-326-3979 7.2.2 Office of Emergency Services-Sacramento 1-800-852-7552 (24 hours) 8.0 Hazardous Material Drills: 8.1 A minimum of one drill per year will be conducted by members of the Small Spill Response Team and fuel center manager. Actual occurrences will qualify as a drill. 8.2 A "drill completion" report will be submitted to the Safety Department by fuel center management. C:\TEMP\HAZWOPER,002.doc 7 · , ,~ e Safety and Security e Personal Safety Your own common sense and precaution will go a long way toward preventing accidents and preventing bodily injury. Just by performing your duties in a businesslike manner and avoiding any "horseplay" on the job, you will be protecting both yourself and others. There are, however, some specific rules to follow that can help avoid injury while performing some of the duties that could involve danger. Proper Lifting: When lifting a box or anything else that may be heavy, the use of a back support belt is recommended. You should squat down to pick up the object, then lift it by straightening your legs, thus not putting the strain on your back. Your store should have a two· wheeled dolly to help you move heavy boxes. * * Check with Store Manaaement for specifics of your Divisions' policv * * Proper Use of Box Cutter: You should treat the box cutter with even more respect than you would give a very sharp knife. You want only to cut the case, nothing else. When opening cases, it's a good idea to cut at an angle across and to the side of your body, rather than pulling the cutter toward you. Proper Climbing: There is only one rule involved in climbing safety - use a ladder! Never attempt to climb on boxes, crates, chairs, etc. Your store has been equipped with an eight-foot ladder and also a five·foot ladder. TO PREVENT ACCIDENTS, USE A LADDER! Proper Use Of Gasoline Container: 1) Customer must use properly marked container 2) Gasoline may not, under any circumstances, be put into unapproved containers such as milk jugs, glass jars or plastic bottles. 3) Store clerk must ask customer to stop putting gasoline into unapproved container. 4) If customer refuses to stop clerk may (must) shut down dispenser. 5) How does clerk know what is proper container. a) Container should be marked Flammable of similar wording. b) Metal or plastic (Polyethylene) should not be over 60 gallons. 6) Customer should be made aware of sign on post. Operations and Training Manual Ver I Rev" Page 76 · ~ - " !~ e _ Emergency Procedures for Gas Spills Sometimes a customer overfills a vehicle's fuel tank, which causes a small gas spill. The automatic shut-off should prevent this from happening, yet automatic shut-offs aren't fail-proof. Another accident can happen when a customer drives off with a nozzle in the car tank. Sometimes, this results in a gas spill and damage to the dispenser. It is important for you to know what to do to prevent further damage, loss or injury: 1. Shut off the emergency switch. This will stop the flow of gasoline from the underground storage tank through the pump and nozzle. 2. Use the intercom to advise customers not to start their cars. A spark from their engine could start a fire if there is gasoline or fumes near the gas island. 3. Offer medical assistance if needed. Call 911 for medical assistance, if appropriate, and complete a Customer Injury Report. 4. If it is a small spill· . 2 gallons or less: Use oil dry or a spill sock to dry up the gasoline. When the oil dry appears to be dry, sweep it up and put it in the trash container. 5. If the spill is larger than 2 gallons: call the fire department immediately. The fire department will assist in the clean-up and ensure safety. 6. Don't sell any gasoline until the gasoline island has been totally cleaned up. 7. Complete the incident report. 8. If you call the fire department: you must also call your point of contact (determined by your Division) to report the gas spill. A spill of 25 gallons or more must be reported to the EPA within 24 hours. CAUTION: NEVER WASH OFF A GASOLINE SPILL BY SPRAYING THE PARKING LOT WITH WATER (OSHA REGULATION) If a customer drives off with the gasoline nozzle still in their car, turn the pump off immediately. Check damages to the pump, hose and nozzle. Try to get a license plate number from the car if the customer does not stay at the store. You will need to complete an incident report. Operations and Training Manual Ver I Rev II Page 123 ...;¡ -, .~, ; - . No Smoking Stop Engine Unlawful to dispense gasoline in any glass or unauthorized containers by order of the Fire Marshal Preventing Accidents To prevent injuries to others inside and outside your store, it is important to clean up broken glass immediately. It's also important to wipe up any spills immediately to prevent people from slipping and injuring themselves. Be sure the aisles in the store are always clear of any hazards that could cause someone to stumble. You should always be alert to this danger when stocking shelves. Displays and signs that protrude at eye level can be dangerous. Check to be sure any free-standing displays have a firm base, especially those that contain glass or heavy cans. In the event of serious injury to anyone in the store, utilize your Crisis Management Instructions. ** Check with Store Management for specifics of your Division's policy ** In the event of an accident to an employee, you must send a workmen's compensation form to the office within three days (or as per your Division procedures). The injured employee must see a doctor. AGAIN: If anyone is injured, be sure they receive medical attention immediately and then call your manager (or as per your Division procedures). Preventing Fires Good housekeeping is the key to fire prevention. You can reduce the risk of fire if your storage areas are clean and orderly. Know these thinQs: Where the fire extinguisher is kept. How to use it The fire department telephone number Where the electrical emergency shut-off switches are Operations and Training Manual Ver I Rev II Page 77 e -- ~ "'--.. .......~ Store # Month Ralphs Daily Inspection Log Stage II Daily Inspection Log If there are any problems, with the items listed below immediately place equipment out of order. Log and contact maintenance. Dispensers 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Comments 1. Nozzle instructions & Oxygenated decals present & readable? 2, Weights & Measures number 800 # posted and readable? 3. Dispensers clean? 4, Are all lights lit & all displays readable? Nozzles 1. Are spouts tight with no play? 2, Are spouts damaged-worn-or bent? 3. Is the nozzle dipping gasoline? 4, Does the hold open latch work properly? Does the Trigger work properly? Moves freely when dispenser off & no fuel can be dispensed? Hoses 1. Are any hoses cut-crimped-torn-flattened- frayed or more than 6" dragging on the ground? 2, Breakaway? Is and fuel leaking from the connections? Underground Storage Tanks 1. Are spill buckets CLEAN & DRY? 2. Are the caps locked on securely? With gaskets in place? 4. Is the fill tube in good, condition? No dents/cracks? Gaskets between collar & drop tube? None torn or missing-out of place? 5, Are the fills labeled correctly by grade & Oxygenated type? Permits 1. Are permits and Licenses posted readable available to Regulators? 2, Inspection & Main. Logs CURRENT, COMPLETE & CORRECT? 3. Are through put records current? e ,~ .~ ~ '10 e 'j . o fj..{f ,., <Ð ~ ;! I ~ I I I . I I I I ,. Ie!] I I I I $ J. ~ y .'"'! ,., , I . I 10" I 18" S/S 9ÐF œtÐ IØIIRS 9f001II J-.' ~. ... .0 .~ 2'4 r 6'-4' ~ I 14'-o'O/O~ o -Ï-. I @ ~ I t--H--t I $ I :JJ 2" 2'-97/~ ~ flOOR PLAN set: 1/2" ., 1'~ ~ I ~ ¡ '"' ~ If T..{f EI.fI:IIIC PMEL (j) I ,$ æ @ @ ~¡ I i o. r EQUIPMENT LEGEND ~ S1WÆ RACK - BY G.C. CNÐY RACK- BY 01lŒRS OINR LOTIO IIAQIŒ SAfE p.os. REQSŒJI P.o.s. - BACK IffŒ lRIT IMIHAD aGARET1[ ~ y 0GARET1E CNlIOf ID:IWÐSÐI 10GARET1ECNlIIIIIIIICIINœR 46 cr. III IIROINOSER il.1JSPÐISIR . smA, IX9'EIfiR - BY \OO(J! . fŒ œtIQ.I!HR BY. G.C. iIJAImI:S . lOCA1IaIS iNsTlUfD!'ER I.OCIL can· Nm-FAlIQI: !lAt WI. lRAY - F\RI9I II IQOSK PANElIlONl) - RRI9I 'I JQOSK snn . AlWSTAII£ me (3) - 18" I fl AlWSTAIIIf me (3) - RiN9I ., JQOSK r PI'[ ØIlU.RD . IW£lJf IIOOiHOIfT 1J'JM. FEmIII£ IfIBiIn IIASIEi! STA11æ THI( II\Hlœ ' ÐIERŒNCY SIll' CIfIŒ CfDfIÐI .;. 'Jf' x 42 l/'l maQ¡ fNSII: II.OQ( cAsr \ŒER . AU. ~ 1!IŒ FRÐ:AST'" SECJioHS; aJSIII/IR YO 9'BFf , alœ ANDfIGI IF CAST \IDÐ. II01F.: gy BU'IINT LA'fWT I1H IamR 91£ !J'£IK Ðf/AIM)S . . ---_..._.--_.__..._'"'-~.,----"._.~~. ...._._- Jan ~1 02 05:21p " i" Fr,zen Hi 11 6851460 1467 e p. 1 facsimile TRANSMITTAL Franzen-Hill Corporation 1100 North J. Street 2080 S. Union Tulare, CA 93274 Bakersfield, CA 93307 Phone 559 688-2977 Phone 661834-1100 Fax 559 688-1467 Fax 661834-4216 1-800-655-3436 www.franzen-hill.com Name: Organization: Fax: Phone: From: Date: Subject: Pages: Steve Underwood Kern Co. Fire Department 661-326-0576 Amanda E. Hill E-Mail: amandahill@£ranzen-hi11.com 1-21-02 Ralph's 7 ._~ J .. Comments: A~ Jan 41 02 05:2110 Fr.zen Hi 11 6851460 1467 e 10.2 RICH ENVIROJSIMENTAL, 5643 BROOKS CT BAKERSF~ELD,CA.93308 OFFICE(661)392~86B7 & FAX(661) 392-B687 ALERT 1000 UNDERF~LL AND ALERT 1050x ULLAGE SYSTEM P,cecision Underground Sto~agê Tank $1st,e:rr. Leak Test TEST RESULTS .;'<:.,b# :.!.08891 ~es~ DaC~; 01/11/2002 DILLING~~~~~EN HILL 1100 N. J ST. TULARE, ~~. 93272 ~ I "': £ : RALPH'S 5200 STOCKDP~E B~V~ BAKERSFIELD, CA. PRODt1C~ V'OLtIME tFULL. (GAL) WE'I'7ED , PORTION NON-WE'I'TJtD PRODUCT I..EAK WA'1'ER IN PORTION LINE DETECTOR TANK PASS -.U05-PAS$ NO TEST 311 p]>.~S ··.OlO-PA.SS NO TEST 0" UNL-87 20000 85* ~.015-PAS& PRF~-91 8000 85~ +.019-~~$S WA'1.'11:R :BALANCE Measu.rert\~Hlt;:;; showed that water ir: th~ b¿¡ckfill a:ea at ':.h~ t.í:ne of t~::;t.ìng waoS below tank bottom, ðnd therefore not a factor in te~t determì,nòtion. A well point Wà$ driven in ch~ backfill a~~a to c.ece!'minc thi:it. there is no 'tJat.H at tank bòttom in th€< backfill. A precision test was performed on tanks at the above loçatio~ usi~g ~he Alert 100.0 underfill SY$tern and r.he Alert 1050 ullage syst;.<i:xn.l have reviewed 't:b;, da::a \=>roduce:d in conjunc1:ict), with this ce$t to·!: purpose 0:: verifying the resulcs and certi~yir.9 the tank systems. ~he testing was perfot'm<::d .itl acor:::-dal1cO! with 'Ale-xt protocol, ¡;md 't:herefore: $at.isfie.s $.11 r~quirem~n1:$ for such te$r.ing as set fo~th by NFPA 329-92 and U3EPA 4Q Cí:'.K part 280. 'the? results of test.ing' are shown on the following page, ëlnd i.ndica.te whethe:r th'e wetted s.nd non-wetted portion pa5!>~d or fail/!;d. In::::lud.:d ',vi·t',h the .repor~ e.re reproduC:'t:lon of data compiled èU1;j.ng ,-he test '"hich formed th+:! basis for these conclusion. This information is stored '11". a ·pëcmanent :Eil~ if future verification of test results is needed. A.L\NC 04Ú 'Tesí, ,::~f~~ /£~ ..Ii roes J. R~' . . tate cert#99-1072 ~'d lë9Ø+ë6S+S08 1~~N3WNO~I^N3 H8I~ WO~~ Wd9~:L ë:0G-St-t L, BI :J (Y) 0- N .... CJ I\) CJ U1 I\) .... " N CD (5;) + 8J (Y) + ~ <0 ..J <í f- Z W L Z o fY .... > Z W I o .... fY L o fY LL ¿ 0- lD N l"- N is) (\J I (Y) I " , ~ II) :J :I: ...' .... .... (1) e CD U1 .... .þ (1) CJ .... .þ (1) -.J ." w ALERT TECHNOLOGIES . PLOT OF ULLAGE TEST DA TA L. Q - ::J I - 'N úJ ... 1 I\) 0 IS) t\) I\) ..... 0 .. U1 IV CD .. \) I\) :s: w ." 'l ~ i3 ,e~ :s: ;Q .... N 0 ID I ::J ~ :r: < ...' .... .... XI .... * Z -i » r CD ß) U1 + w IS + !S) m I\) en - e~ ~ en 0 ... ~ en -J RALPH'S 5200 STOCKD^LE BLVD. BAKERSFIELD, CA 20000 GALLON UNL-87 TANK . : ~: .~ -. :. : 25KHz AMPLITUOE RÞ. TI 0 750+ 0.75 1.5 750+ ... M I N U T 3 E S , , 5 "u' 25KHz DETECTION RATIO = 1 .00 12KHz AMPLITUDE RATIO 0.75 1.5 M I N U T 3 E S , , 5 , , .. . ..'.{ .'. . . . . .. . , 12KHz DETECTION RATIO .999 TEST RESULT PASS DATE AND TIME OF TEST: 1/11/0211: 22AM BEGINNING BOJTLE PRESSURE'" 3000 ENDING BOTTÙ PRESSURE = 2200 BEGINNING TANK PRESSURE'" 1,5 PSIG ENDING 1ANK PRESSURE' =1.~ PSIG \J ." . ~ :~Ð:::\~::;,~:\f;!j ":r:,:' ,.: :.:::;~'~:u:,;;;) :¡¡o,';",>:H;:::::, ~:: , '::::~ '~~:·~\\::;::..~,;:·~·H_:~:;~\·:::;'H ~·~¡~~.~t:;~!,:!:~~~ ;:~:::::, ~~::¡>;~·;-·'¡:\'·:~t(~,~·:": <':\';:::-::")::;~~¡i¡~:~:::;'r;::; ::,", ~,:..:,.:}:\I.~~::.",,~: ".;::;:: .. .. ..,'"H... n.' "" ,:,:~" . ...,., ":~:::.:,,:" H" ',. ",' ',' ",,:.,:;-:,:.,. . :::'::H .~, ::, ' :. ,::,:,', ,..':' 'n:',',,":'"'' ""'. ::0;.:' " ': :.' ::,'.:":'.., . .. H¡:¡:::' '.''':''''''''':'' :,... H' :"C,"" ,:::; ;" ':',;...... ,,, H ... ,." -- --",:0:, ,..... ,.. 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':::¡:" '.... ,.. ,- ... c,.,.....;:::,;;;, no '\~1:~¡:=H:¡: ·....,::::::;l:.., ':;:: ..i;::::: ,,;:. ., ....·..:::c ~:::::;i::i :::,~",::.. :\:!:,:~,::;: ;~¡: : .;;; :;;,;; ~~~:::F::+~¡:Ut¡:, ;\;:;:¡:;F '¡:::'....;,: :',~ ,;::;C':: :;:: :;~j:¡:~:: :::,~:~ ':',~.::::. :':.:~.. ':... :::"::: ::":.::::":: ,'. ,n ...: ~':, ...;)H \r::U:;~l~~' ',' ~T>~::' ':~:u;;: ::¡:;~, ,::::,;;;:< .... ,: ,~:;;:~~~, : "'REM-91 ~,e 7 ' . 't019 " L. CII r :J I \) - W ... I I\) 0 IS) I\) I\) -. 0 .. Ul I\) ill 1) I\) 3: ~ " T 'T ;0 0 . 3: ;IJ ...... N 0 rD I :J fT1 J: ~ ...' ...... .... ;0 .... 0 ~ Z -i J> r CD IS) U1 + (¡J ill I\) ~ 0) I\) en e~ ~ en 0 ... ~ en ~ 1) I\) " Ul M I N U ~ 3 S 5: ALERT TECHNOLOGIES PLOT OFVLLAGE TEST DATA RALPH'S 5200 STOCKDALE BLVD. BAKERSFIELO. CA 8000 GALLON PREM-91 TANK 12KHz AMPL I TUDE RA TI 0 1.5 25KHz AMPLITUDE RATIO 1.5 750+ 0.75 .. M I N U ~ 3 S .. , . . 5 12KHZ DETECTION RATIO - 1.00 25KHz DETECTION RATIO 1.00 TEST RESULT = PASS DATE ,AND TIME OF TEST: 1/11/02 10: 36AM 8EGtNNING BOTTLE PRESSURE = 2200 ENDING BOTTLE PRESSURE = 1800 BEGINNING TANK PRESSURE = 1.5 PSIG ENDING TANK PRESSURE = 1.5 P5IG OU .. '.~,.' ..... _ 750~ . Lo CI.I - . ~ :J I !:\) W .... I I\) 0 IS) I'J I\) --.J 0 .. U1 W IS) .. 17 I\) ~ en " II "T1 ;Q 0 . 3:: ;Q .... N 0 ID I :J fT1 :J: ~ .... .... ..... ;Q ..... ~ Z -i » r (p IS) {J1 + W (D I\) + IS! (J) I\) en ~ e~ ..,. I en 0 .- ..,. en -J \J W " en Jan ~1 02 05:26p Fr.z@n Hi 11 6851460 1467 . p.7 RICH ,ENVIRONMENTAL 5643 BROOKS C~ BAKERSFIELD,CA.93306 OFF~CE(661)392-8687 & FAX (661)392-062~ ACi::iRI'l'E TM PIP~X.XNE 'l'ES'I'ER WORK SHEET DATE: /-11-01- w/o#: I09:~qf Facility Name: \< At- P -H,' ~ Facility Address: .52 ÇJ bS-f(:Jok":DAL..~ ßl.....uO- BAl.á?I/25'fí-ð't:.(f)-c§ Product Line Type (Pressure, Suct:.ion, i#:ravi ty) : p;epSSU K!E ~ Ha.nu£ac;:t:urer: rÇ-~ IsoJ..a.t:ion Meehanism: B¡ß,/.i... U..4l..l/i{' p~m]CT TEST PRESSURE (PSI) VOLUME RATE (GPH) ~ OOs- -: OJ 0 RESULT' PASS/ . FAIL ".-.--- --'.-..__.. I C:(~l:T;.ify that the above li:le t¡¡'$CS werè conducted ¿Iccc.r.:d;ing -:;0 the equipment manufacturer's ptocedur~g. The results ~$ li$ted are to ~y know~edge truê a~d correct. The' lest pass/fail is determined u3ing a threshold of 190 ml per hour (O.OS Ç;PH) ratE.! at. 1 1/2 times workÜ)ç pressure or SO psi' which ~ve:r i:~ g.ceat:er. ':'eC:,h; J~S J. f{!Cg Sigl1at,ure: ~ 4; /Z~ (7 I·' Sta~e Lic~n~e'# 99-1072 M~G.CERTIêICATION:# 601.LT '7'd 1G9Ø+G6E+S08 1~~N3~NO~I^N3 H8I~ WO~~ ~,::IlE: L G0ë;-E [-1 e e Permit No. CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERMIT APPLICATION TO CONSTRUCTIMODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICA nON (CHECK) [ ]NEW FACILITY []MODIFICATION OF FACILITY []NEW TANK INSTALLATION AT EXISTING FACILITY PROPOSED COMPLETION DATE EXISTING FACILITY PERMIT NO. CITY ZIP CODE APN# PHONE NO. CITY ZIP CODE CA LICENSE NO. CITY ZIP CODE BAKERSFIELD CITY BUSINESS LICENSE NO. INSURER ST ARTING DATE FACILITY NAME FACILITY ADDRESS TYPE OF BUSINESS TANK OWNER ADDRESS CONTRACTOR ADDRESS PHONE NO. WORKMAN COMP NO. BRIEFLY DESCRIBE THE WORK TO BE DONE WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO. OF TANKS to BE INSTALLED ARE THEY FOR MOTOR FUEL SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE NO NO YES YES SECTION FOR MOTOR FUEL TANK NO. VOLUME UNLEADED REGULAR PREMIUM DIESEL AVIATION SECTION FOR NON MOTOR FUEL STORAGE TANKS TANK NO. VOLUME CHEMICAL STORED (NO BRAND NAME) CAS NO. (IF KNOWN) CHEMICAL PREVIOUSLY STORED I APPUCATIONDATE FOR OFFICIAL USE ONLY . . .. .". .'.' ,', ",. -."'. . ··'··FACIùTYNO.···NÓ:OFTANKS ..' . . ../:.:: . -.",.' ··FEES $ , ,I THE APPLICANT HAS RECEIVED, UNDERST ANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER ST ATE, LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMP LETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. APPROVED BY: APPLICANT NAME (PRINT) APPLICANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED 1/13/01 16:0:1 '8'661' 05" ß']:- 02J:2- CITY OF BAKERSFIELD C~ ~--- 20'1 Bi3 OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 BFD HAZ MAT DIV . Permit No. @002 [ ]NEW TANK INSTALLATION AT EXISTING FACILITY ZOO '2, SOIL TYPE EXPECTED AT SITE x YES YES x NO NO SECTION FOR MOTOR FUEL I VOLUME f~:g 1 ÞO ~: íANI( #'2 1-t.Þr.5 TvJÒ (2,] COMPAerME:NíS. SECTION FOR NON MOTOR FUEL STORAGE TANKS UNLEADED X REGULAR PREMIUM DfESEL A VIA TION x x TANK NO. VOLUME CHEMICAL STORED (NO BRAND NAME) CAS NO. {IF KNOWN} CHEMICAL PREVIOUSLY STORED I APPUCATION DATE THE APPLICANT HAS RECEIVED, UNDERST ANDS, AND W ILL COMPLY WITH THE A IT ACHED CONDIT IONS OF THIS PERMIT AND ANY OT HER 5T ATE, LOCAL AND FEDERAL REGULATIONS. FOR OFFICIAL USE ONLY FACn.ItY NO. NO. OF TANKS FEES $ APPROVED BY: KA/2 L J.ltJof (% "~A'¡/~ eAJ"AJIfl!R.¡~ APPLICANT NAME (PRINT) , THIS APPLICATION BECOMES A PERMIT WHEN APPROVED ~ (d 'd"!' ~JS. ~ ".. ,.e;; " ' - n' . ... .... _ )' ct: :J ".a . ~: ~;~- ": ""'.- ... ' _.=--- .~ - " ¡-'-- " y / / " I '" t \ \\ "" '~, \' \ ,'(' ,i, .;'~ I .,....' ".;.; ~: I I / / / // I \ .........- '-'.' '",.-' ~ .""':J"V- . ~, ----- /': '^, ~ ~.., ,-- ;'-.....--.... , . . ~, ~1fI"~----:-----------------~U~ LL-- -9ì?~ " .' . - - (,! f/("" (:: . ", ,'.,' .,.,.", /' -- & ....., - '""" ~', \l-_~~ - t:;~-:;;c I· '-W ~~~ .11~ _ ,.'.....--- -. ~, ---------"! ,." ........,...~- ~ -, I .\~'¿..' :- . ~ r'&!r¡ .."-'þ r! ... ,.- --:... '" I ~ { ..:..::.;Jì 7'* J:J. ,. ~' ^' ,! -' ~~.,,_;, I /. ~I --~ ;".-../ *~~~l :ïlL.~ b.~ .J' fiiJ' ~'þ" -;-:".: --.ß.. " . /" ~.~~.> " ":'in~!i "'". _., .,'. .... . , ,¡'.<W' b '...-<11 - ' , :', ..... . ,..\fI .'. - , f;q>. :-~ ~r-' -'---"-' " I " .r\ AI "'" . ., _ ,;' ';01' à.'..i: I r! ;;; ~~ ' \ .._--y~ , 11.. 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'¿UO"- LEA): P,LP,RI"\ ALARI"1 '3:54 PI'1 ""R,'EC'C.'\ IOE LINE LH~K ALARI"1 r t:)~_1 - f'"~ Q . 2: PF~E\'ll UI"1 ,', ,'," PLLD SI-IU~12I~\01'~ ¡¿~~~I\.I"1 JAN 11. ¿UU¿ 0.J4 e __ C.'ENc;e:'R ALARI"1 --'.-- ~-8: D 1 SPE'~èEF: Pp,I"! 5-f, LiISPENSER pp,N FUEL ALARI"1 JAN 11. 2002 3:54 PM POOR OR~GI1iA~ L r '. -~ ~ -' . ~ Hr'tLPI-IS , " 4')00 f,rrOCKDP,L.:~ ~I::I\ - - KERSFIELD ~H.gJJU~ 1298634005001 ,]AN 11. 2002 3: 55, PI"1 e ,-,',/c'1'EI'1 C'1"H""TII'êi REne'RT ;:)'1~_1 ~_, _._ ...r J . - - - -. - - - - - - -- - ALL FUNC:TIONS NORt"lAL PHESt~UFŒ LINE LEAK AU\Rt"1 Q 1: UI\LEADED PLLD SI-IUTDO\.,IN fiLARI"1 JAN 11. 2002 3: 59 PI"1 e PRÐ3~3URE LINE LEAl': ALARr"1 o 2 : PREt"1 1 UI'" PLLD SHUTDOI",IN ALAR!"" JAN 11. 2002 3:59 ~1 ~ "\ ~.. SENSOR ALARM ----- L'9:DISPENSER Pp,N 7-8 - D I f:PEN~3ER PAN FUEL ÄLARI'1 JAN 11. 2002 3:59 PM 'e RALPHS / 5200 STOCKDALE HklV BAKERSFIELD CA.93308 B1298634005001 JP,~II. 2002 4:00 PM S","STEI"1 STATUE:; REPORT ------ ACL FUNCTION:'3 NOfJ"IAL .,,- e FRES::5l.1RE LI NE LEAK ALARI"l Q 1: UNLEADED - "'PLLD ,:3HLlTDOI",INc ALARI'" ~AN 11. 2002 4:01 PM ··e . ~ PRE:3SUHE LINE L.EAK f,LARI"l Q 2: PREI"l I Lit'" PLLIJ t;HUTDOI¡.JN ALARI"l JAN (I. 2002 4: 01 PI"1 ----- SENSOR ALARM ----- L 6:DISPENSER PAN 1-2 D I f:::F'ENf3ER PAN FUEL ALARt"1 JAN- 11., 2002 4: 01 FT'1 e -:-'-- . - - e HALPHf:; 5200 ~::;TOCKDALE HI,,)''i BAKERSFIELD CA.93308 B 12986:3400500 1 JAN 11. 2002 4:01 PM SYSTEI"l STATUS REPORT --.----.. ALL FUNCT I or"ls NORr"1AL POOR. ORl@O~¿ðJlL e PFŒ;=:;f:~UFŒ LINE LEAK ALAR!'" o 2: PREI"1 [ ur' F'LLD ~::;HUTDOI",IN ALARr"\ JAN 11. 2002 4:03 PM e ----- SENE;OR AU,Rf"1 L 4: 92-~3TP sur"lP E;TP ~::;ur'1P FUEL ALAR!'" JAN 11. 2002 4:03 PM PREBE;URE LINE LEAK ALAF:r"l I) 1: UNLEADED PLLD E,HUTI¡o:)kIN ALARr"1 ,JAN 11. 200:~ 4: 04 Pf"l e --,--- SENSOF: ALARt"1 L 2: B7-~3TP sur"1P EiTP ;::; Ut"U) FUEL ALARfV] JAN 11. 2002 4:04 PM f~'~'SUFŒ LINE LEAK ALARr", ( UNLEADED PL SHUTDOI"JN ALAR!"" JAN 11. 2002 4:04 PM PREE;SURE LINE LEAt: ALAF:r-'1 o 2: PREI"l I U!'" PH,D SHUTDG'L"JN ALAR!'" JAN 11. 2002 4:04 PM e E:ENE;OF: ALAF:n --,--- L 7:DISPENE:ER PAN:3-4 DISPENSER PAN FUEL' ALAR!'" .JAN 11., 2002 4: 04 PI"1 e ----- SENSOR ALARM ----- L 7:DISPENSER PAN 3-4 D 1 m'Ef,¡SEF: PAN SENS,:)R OUT ALARr'1 JAN 11. 2002 4:05 PM PRESE;URE LINE LEAK ALARr"l ø 1: ut~LEADED PLLD :3HUTDOI,.,)N ALARf"] JAN 11. 2002 4:06 PM e PRÐ3f3URE LINE LEf~K ALARl"'l ì::¡ 2: P F:E!"11 ur"l PLLD SHUTDOL,JN ALARI"l JAN 11. 2002 4:06 PM e ______ SENSOR ALAR!"1 L 1:87-92 ANNULAR ANNULAR ~3PACE FUEL ALAR!'" JAN 11. 2002 4:06 PM ptt¡::;U¡:';:E LINE LEAK {\LAPf"l ø 1: UNLEADED PLLD SHUTDOklN AU~Rt"l JAN 11. 2002 4:07 PM ~--- --- -~.,~.-.__.. PRESSURE LINE LEAK ALARM o 2: PREt"l I Ur"1 PLLD SHUTDOI;.JN ALARI"1 JAN 11. 2002 4:07 ~1 e ------ SEN¡::~(Œ ALARI'" L 1 :87-92 ANNULAR ANt'JULAF: ~3PACE FUEL f~LARr"1 JAN 11. 2002 4:07 PM ,__MA~ PREB~3URE LINE LEAK tiLAF:r"l o l: UNLEADED PI.~SHUTDOl"JN ALAF:r"l J.l. ~::002 4: 07 Ft'1 PRESSURE LINE LEAK ALARM o 2: PF:H'1 I Ut"l PLLD f;HUTDOl"IN ALAF:r"l JA.l. 2002 4: 07 Ft'1 \.,'..'¡ SENSOR (1LARt"1 L 1 :87-g2 ANNULAR Af'mULAF: ~3PACE FUEL ALARt"1 JAN 11. 2002 4:07 PM --. SENf:WF: ALARr"1 ---,"" L 7:DISPENSER-F'AN 3-4 DlfC'.':NSER PAN S R OUT ALARM JA 1. 2002 4:10 PM RALPH~::, 5200 STOCKDALE HI;./l BAKER~3F I ELD CA. SI:3:308 B 129SE,3400500 1 JAN 11. 2002 4:10 PM ~3'iSTH'1 ~3THTU¡::; REPORT - _ FU~CTIO~~::.;-r\JÕR~AL -- - ---- - --. ------ ----- SENSOR ALARM ----- L 7:DIBPENSER PAN 3-4 D I E:~P E NBER PA I'.j B~.i"'R OUT ALARr", .J~I. 2002 4: 11 PJ"1 j' "OR OIlGl~~l PREBSUF:E L [ NE J 1: UNLEADED PLL[I BHUTDOIAIN JAN 11. 2002 LEAK ALARr"l ALARr"l 4: 13 Pt"1 PRluF:E LINE o 2: PREt"! I ur"1 PLLD ~3HUTDOl.JN JAN 11. 2002 LEAK ALAR!"l ALAR!"1 4: 1 ~3 pr"1 \'<, -.---,- ~3ENEìOF: ALAR!"1 ------'- L 7:DISPENBER PAN 3-4 DIBF'EI~SER PF\N FUEL ALAR!"1 JAN 11. 2002 4:13 PM e Ri::"LPH~3 5200 STOCKPALE HII,I'y' BAŒF~~3F 1 ELD CA. '33:30E: B12'38634005001 JAN 11. 2002 4:14 PM , . 8'i81H'1 ~3TI::"TU~:;ì REPOF:T ----..-- -- - - - - L 7: FUEL PiLARI"1 (] 1: PLLD SHUTWklN AU~Rr"l _ : PLLD :3HUTDOl.,JN ALAR!"1 .'LPHS - 0 STOCKDALE HI,J'! 'EOCCI ELI\ r^ 91~~o ... ,P.t_',l . _,n. ~ ,_ 0\...: W B12'38634005001 JAN 11. 2002 4:17 PM BV~3TEt'1 :3TATUS REPORT -----.- - - - - L 7 :FUEL AUtHr"1 u 1: PLLD SHUTDO\"JN ALPiF:n o 2: PLLD BHUTDOI,\IN ALPiRt"1 'It CITY OF BA~SFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 Facility INSPECTION RECORD POST CARD AT JOB SITE Owner Address Address City, Zip City, Zip Phone No, Permit # INSTRUCTIONS: Please call for an inspector only when each group of inspections with the same number are ready, They will run in consecutive order beginning with number 1. DO NOT cover work for any numbered group until all items in that group are signed off by the Permitting Authority. Following these instructions will reduce the number of required inspection visits and therefore prevent assessment of additional fees. TANKS AND BACKFILL INSPECTION J Backfill ofTank(s) Spark Test Certification &:M~ufactures MethoÐ 51Jt.- N Cathodic Protection ofTank(s) Piping & Raceway w/Collection Sump Corrosion Protection of Piping, Joints, Fill Pipe Cathodic Protection System-Piping - :1- Dispenser Pan _ .;);). , 0 I SECONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETECTION Electrical Isolation of Piping From Tank(s) t II If) Liner Installation· Tank(s) N A Liner Installation· Piping /oj j¡ Vault With Product Compatible Sealer L2-.., Level Gauges or Sensors, Float Vent Valves :)... Product Compatible Fill Box(es) ~ Product Line Leak Detector(s) ~ Leak Detector(s) for Annual Space·D.W. Tank(s) \./ Monitoring Well(s)/Sump(s) - H20 Test NI,l)- Leak Detection Device(s) for Vadose/Groundwater .Q Spill Prevention Boxes II/{ 0 L fllt:J¿ I '(j 0 t. IJf{/ð'L . (1..' tl--() I t,~1 tJL ¡ /¡/f) I- r I 'll () L I 'l) L , I, ~ ¿ I 'f) () ;)... - FINAL ~ 3 '3 /' Monitoring Wells, Caps & Locks \ Fill Box Lock , Type 1/,)' r 1IttJ- T~· JS tJ ~'()nitoring Requirements Authorization for Fuel Drop , .¡ 'II. :J,.. CONTRACTOR --+ III , FJ\ \ll rfI 1'."'( 1\ .\a.. ( CONTAcrJL 11 A II IJ'1;.' /71. 1/"., u() r . I /1.. do,,/'. \'.. 'In. I J ~'~ 1(1. 't..J ~ I ì j HI. l/. 1fIr1f) 1J ~ (I J~ 4f) :\ ~L t /- t A.Lt) ~ "'I I ,~. ;,.;.Jt¡() ~ ~I /"" 1/ k:- If /.' . /, JJ it ( I ..{j ,k t14&LU~ A l-;//;,' J I!1O-,ü.,n - -- LlCENSE#J h"ß gÐ~g PHONE # ..1!.!j ~ 6to ,. ~J ð 0 · e 1'l o~c. '. To ç, \ (.. Th\~ ~,,\(.. \ ~ N()* F\ \<'Cl\ c.Å A ~ 4) {. ,,\c. -t · O\d S'\~~c"'~ t,.kdt f'"Ao.' ~fl~, qi,,". tb\U(.\1f.. do t4f)+ \~~~. ~fttWCf\" "'IOi î~ ~~~\ ~~f" !h~~~fd ~ - - - --- ---- l I I e Permit No. 13i:-D2-' 0 i CITY OF BAKERSFIELD -pJ {-;JJ:.lyt71 ~ i OFFICE OF ENVIRONMENTAL SERVICES C 1715 Chester Ave., Bakersfield, CA (661) 326-3979 - PERMIT APPLICATION TO CONSTRUCTIMODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATION (CHECK) (w1'FlEW FACILITY (]MODIFICATION OF FACILITY [JNEW TANK INSTALLATION AT EXISTING FACILITY ST ARTINO DATE 11... - t - 0 I PROPOSED COMPLETION DATE {- J} - 0 "L FACILITY NAME ftA"PM~ '"v.... r:AC.'L.tr'l EXISTING FACILITY PERMIT NO. FACIUTY ADDRESS§Z.OO .ToC.~A'" "WV. CITY BAIC.eIlL~"'&'-~ ZJPCODE 4o:a.m TYPE OF BUSINESS RIA.. ~TATlatJ APN ## TANK OWNER Q.A'-P" ~ PHONE NO. (~Ið) 8Sa4 - 'CðO ADDRESS IIOð "". "'~IA ...vi). CITY_c:..oM Prow ZIP CODE Qð2.t.ð CONTRAcrORTA.... I!:AlV'.~~~....L CALlCENSENO. Å 5'o(þ~o~ ~ ADDRESS 7D'· Y. .,....'UI.IJTÆfL. D~.. CITY ~ ANA ZlPCODE q~?ør PHONE NO. (.".,) ~W)-ø U)O BAKERSFIELD CITY BUSINESS LICENSE NO. WORKMAN COMPNO. INSURER BRIEFLYDESCRIBETH WORKTOBEDONE ~folS-r"~e.'"("~ oF== 6r"S-t..l~ þcsPco'JSrN"" r.Þ,&r v,-r. \oJ uA l.. ~t1 PA I<"l~ T U' ~. -('. - '2.e,oc::o -C--r b L.,,-- ~ - 4 'l €t4'5(~~ L.þ~1t> f> A TER T FACILITY PROVIDED BY DEPTH TO OROUND WATER ù r.tÞ- SOIL TYPE EXPECTED AT SITE NO. OF TANKS TO BE lNST ALLED' ARE THEY FOR MOTOR FUEL tI" SPILL PREVENTION CONTROL AND COUNT ER MEASURES PLAN ON FILE TANK NO. I VOLUME Zø. coo TANK NO. VOLUME l APPUCATrON I:>~TE .'.; . '. I.J.tol~ YES NO YES ~{A NO SECTION FOR MOTOR FUEL UNLEADED 2~Døo REGULAR PREMIUM ~ðCO DIESEL A VIA TION SECTION FOR NON MOTOR FUEL STORAGE TANKS CHEMICAL STORED (NO BRAND NAME) CAS NO. (IF KNOWN) CHEMICAL PREVIOUSLY STORED FOR OFFrClAL USE ONLY ·FACIurYNO. ,.. NO.OFTANKS FEES S :.', , .... THE APPLICANT HAS RECEIVED, UNDERST ANDS, AND WILL COMPLY WITH THE A IT ACHED CONDIT IONS OF THIS PERMIT AND ANY OTHER STATE. LOCAL AND FEDERAL REGULATIONS. HAS BEEN COMP LETED UNDER PENAL TV OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS DCO APPROVED BY: 'Dt! &'11:., ~ t:::L.Är4.c... APPLICANT NAME (PRINT) Jl -..Ð "A ~ APPLlCÀNT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED vc ( (, " .. (' e i - t.f'-f I e CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO INSTALL AND/OR REMOVE ABOVE GROUND STORAGE TANK(S) In confonnity with provisions of pertinent ordinances, codes and/or regulations, pennission is hereby granted to: (!/I Dßut!::lo¡:J fv1&vr¡;;- , Name of Company /7 <)()? ¿~¿íZCU/ 65Ù72. Address to display, store, install, use, operate, sell or handle materials or process involving or creating conditions deemed hazardous to life or property as follows: '%III)~ 5&'-11 ~&v&24fot¿ Tð ¡-Vq . I b-1 /J CY2 ~ a.~ ¡::JOt.;UL&Z -iv . / I' SZOù S r!vc¡¿c!/J I~ fI--t,v/4 .do b SI r/-ð I subject to the provisions and/or limitations as provided. Violation of pertinent ordinances, codes and/or regulations shall void this pennit. Issued j Pennit Denied " ~({J L Date ~ (t"Æf) Approved by: 14/ H 4-iZii u 62- Applicant Name (print) ¡p~ pp C 19nature THIS APPLICATION BECOMES A PERMIT WHEN APPROVED ,e - ..'iÞ .....\, .... \2AlPtts 61.-00 '5+~L¿(.dL? \~\ ~(L-l.1l5 h~t~ CA 1''3::'1..{ D --f ~\lr ~f\'ð o o o a D t 0 --- ------- ~. ,0 ~tv~M+OQ.. v;+~ s Jan.10. 2002 5:10PM e No.3261 fehere and typ~ address] p. 1 . . 'l;f!:ì!:+~t~rt~:jftt~¡;I'!':,i/!.>¡;;;;d1';'-'~'::!~~J:th ;!!,~j."!¡¡.i!' :¡ìl:,¡:;"¡;'¡,:3f!;¡r:"r :~IT*~~~1~1!:~1 '~;I'r:':;lb j:I\{;'!!it!·i¡~"I.'J.¿::ì;':1 !~i ¡f:jii@;;jmWt\:¡!I¡¡ñ¡;i¡!iif(I;H!I¡'~I;¡¡·;ft;[1!i¡:i[ "i~I':,!'i ~!, ~.;.~:,¡ };~:k~iifi~( ;¡~ ¡',¡j ¡"I¡IME,!I! l:ft:' ~ i}¡:I'~lï r~\ Irt'~: ::./ {'~~h~! I,'," '!(;H:;;-:;I, ~~:;; ~ \t'b, I II ,'; r; ; .~. ""1\ -; ::" I ¡ ~I'~, '~1 ~ \ 1 ;:~"~':: tl'~ ~'tl' .,,'j 1 ~ f IXI,¡ ~ ~ ¡j: þ'\"]~ ,: r:: ì 1fh: "j\ J);\ r:t:ttl:'r r~ 'J¡[,t ¡? \~ i J Lt,\ !I¡}. ,¡¡.t I ~~:r :J; ~} ~:~ .\~ t d,(¡\¡f ~ n~', .~\~}~i\' ~; : ~ U¡ 'f¡'\ ; ;J~I I . r ' , " \ \ ( . " I': ' .. .." II'. "~ \.... . . , ' I .1 r} . . " I I I I . .. .1 '01 If' , " I r 1 \ I ' r. I I; \ " , , To: STEVE UNDERWOOD Fax: 326.3190 From: DA VB PUGLISI Date: 1/10/02 Re: RALPHSFUELCENTBR Pages: 12 cc: DAN DE LA ROSA o Urgent X For ~8W o Please Comment r:J Pi.... Reply o PleMG Røqele . . . . . . . . nt Of ftnanclal responsibility for the Ralphs fuel center. .,..................... Jan.10. 2002 5:11PM No.3261 p. 2 e e '"' I-M3er ,.. , 11;11... VIM&; ST~"T . CII'IC'~NATI. OHIO "!nCI-IIOO Subject: The Kroger Co. Certificates of Insurance. After considerable review and discussion, The Kroger Co. has made the decision to discontinue the issuance of Certificates oflnsura.Ì1ce. They confer no real rights to the Certificate Holder and require significant resources and time of all parties to the transaction. As of March I, 2001, you may obtain evidence of Kroger's insurance coverage from the Memoranda of Insurance contained on the following website, utilizing the login, password and keycodes as follows (Please note, the following are case-sensitive and space-sensitive): VNlW.aonline-aon.com Login: KrogerMOI Password: memoranda Keycode: kro3697 The M.emoranda ofInsurance on this website will serve as evidence that The Kroger Co. is purchasing insurance protection from financially sound insUrers at prudent retention levels. Further, they confer additional status to Vendors and tò other parties to which The Kroger Co. has agreed contractually to include as Additional Insureds (Please note, Additional Insured status does not apply to Worker's Compensation coverages). The Kroger Co. has assets in excess of $17 billion, and is either fully insured or a qualified self insured for Workers Compensation in all states (in which it operates.) . Thank you for assisting The Kroger Co. in the elimination of the costly and time consuming process of issuing certificates of insurance. Sincerely, The Kroger Co. ( J. . _.__n________"..,... .. .. <.0.. .__. _~_ ,.__. __ ....~, ....., ,---,.- . ._. ....~~ . --. Ja~.10. 2002 5:11PM Memoranda of l&ran.Q~ No.3261 p. 3 e ,,. Welcome to the Memoranda of Insurance site for The Kroger Co. (Memoranda of Insurance). T c access evidence of coverage for this company, enter the Keycode that was provided to,you in the box to the left. Once you have entered a valid Keycode, links to the memoranda document(s) you requIre will appear under the left menu's "Memoranda" heading. ~~ Certificates of Insurance After considerable review and dIscussion, The Kroger Co. has made the decl.sion to discontinue the issuance of Certificates of Insurance. They confer no real rights to the Certificate Holder and require significant resources and tIme of all parties to the transaction. The Memoranda of Insurance on this webs/te will seNe as evidence that The Kroger Co. is purchasing Insurance protectIon from f\nanciaJly sound insurers at prudent retention levels. Further, they confer additional status to Vendors and to other parties to which The Kroger Co. ,has agreed contractually to [nclude as Additional Insureds. . WIth assets of over $17 billion, The Kroger Co. has sufficient financial resources to pay for Bny losses within our retentions, and as a responsible corporation, is either fully Insured or a qualified self insured for Wor-kers Compensation in all states. Thank you for assisting The Kroger Co in the elimination of the costly and time consuming process of issuing certIficates of Insurance, Copvrlght e2000 Aon Group. Inc, h ttps:llwww.aon1îne~aOll.comlmemorandalweI come.asp 3/20/2001 "--".---. ...._..,-,.....~ ..... .-.-. Jan.10, 2002 5:11PM No,3261 p. 4 , Memor~nda of Insurance e e . , .f Commercial General liability This memoranda verifies that the following coverage is in force and incltldes the following Items as outlined below: Covl¡arage: General Uability Named Insured: The Kroger Co. and it's subsidiaries including but not IItnited to Fred Meyer Stores, Inc., Dillon Real estate. Quality Food Centera, Ine.. Ralphs Grocery Co., Smith's Food & Drug, Kroger Limited Partnership I, Kroger LImited Pártnership II, Kf'19 Soopers, Fry's Food Stores of AZ. Inc::.. Dillon Companies, Ine I"'~ring Company: USF&G Policy Number: DRE 2389500 Policy Period: 1/112000 - 1/112003 Coverage Llmlœ Commercial General Uablllty Including Pel"8onallnjury, Pro,ducts/Completed Operations and Contractual Liabil~ty $4,500,000 each occurrence and aggregate where applicable . . Vendors Endorsement - provides aùtomatic addltlonallnsu,red status for the vendors Additional Insured endorsement prQvldes automatic additional insured status fer those entities for which The Kreger Co. or any of It'g subsidiaries heve contradually agreed to provIde such additional Insured status, subject to the terms end conditions of the contract. Sølf·lnaured Retention: $500,000 each occurrence Comment$!: This Memoranda serves as evidence of Commercial General Liability coverage. Should you have any questions please contact Karen MorrIson of Aon Risk ServIces at 503..224-9700 NOTE: This Memoranda Is furnished to you as B matter of information for your convenience. It only summarizes the listed policy and is not intended to reflect all the terms and conditions or exclusions of such policy. This summary is not an insurance policy and does not amend, alter or extend the coverage afforded by, the listed policy. The Insurance afforded by the listed pollcy;s subject to all the terms, exclusions and conditions of such policy, Copvrtght @ 2001 AQn GrQUp, Inc. https:/lwww.aonline~aon.com/memoranda/memorandal15 5 3kro _ cgen.asp 3/20/2001 ·........,....ø......."..ø..._..... Jan,1Q. 2QQ2 5:12PM ... e MernQræ:¡nd~ cf Ji1$UT3r4(:S No,3261 p. 5 e ~ 'V'J..:rkæi'3: Cem~$,41a¡¡ti(¡n ¡ids memcr'2r:åa v~rttTas thr¡t tha fcllcwir:g CC1l9roge Is In fcrca alid Includes iha rellcwing items :as otlClnad :s!;IPJ: C~v$Mi~e: Wcrker.¡' Compensation fer ~atas of CT, DE, FL, 10, IL,. L~, MD, MA, MN, MO. NJ, ~iY, NC, SC, SO, p~ V.i1., Sl1d WI Narn&d Insursd: The Kreger Ce. and It's ,utsldiartes ¡neuring Company: CNA PolI:y Numc$r. V~tiol¡a Policy Pened: 21312001 - 2J:S12002 C¢mment3: Umffa StatLItory , $1.000,000 each ac:cldent . $1,000,000 dIsease - policy limit $1,000,000 dIsease - eaçh employee The Memoranda sarves as evidenç~ ofWcr!œrs' Compensation and Employers Liability c:cvef'Qge. Shculd you have any questions please contact Rhcnda Mount of Aon RI¡¡k , SeMœs at ~03-22~91aQ .. ..... .' This Memoranda Is rurnlshed to You as a matter ct Informàtion fer your conyenieroce. It 'only summariz=s the listed pelley ~nd is ~ot Intended ,to. reflect aU ~e terms and conditions or excluslens of such polley. This summary Is not an In:surnnce pelIcy and deeS not amend, altar or extend the coverage. atrQr'dld by the lI$ted policy. The , insurance afforded by the listed poficy is sUbject to all the terms, exclusions and conditions of such policy. Wcrbl'$' Compensatlcn Coverage EmployeM! UabiJIty NOTE, C:ðpvriljllit =' 2001 Acn GfQI,P, Ine. . , -.... . t.. .~.. ........ . .... ~ _.....__._ ....... .......,. ~' ." https;//www.acnline-aon.c:om/memorandalmemcranda/l 5 53lao _ wkcomp.asp 3/20/2001 .. _.._...,~w......---_..,..__..._.'" ".,·M_., Jan.10. 2002 5:12PM No,3261 p. 6 e e " Memoranda of Insurance Excess Workers' Compensation Thi$ memoranda verifies that the following coverage Is in force and includes the followln9 items 8S outlined below: Coverage: ' Excess WQr1<ers' Compensatîon fer AL, AK, p.z, AR, CA, CO, GA,IN, fA: KS. KY, MI. MS. MO. MT, NE, NV, NM, OH, OK. OR. PA, TN. UT, WA. YoN. \NY . Named Insured: The Kroger Co. and it's subsidiaries tnsurlng Company: Continental Casualty Company Pellcy Number: W·,2S584230A Policy Pertod: 2/3/2001 ·21312002 Coverage Workers' CQmpenastion Employers Liability , Limits Self·lnsured: Statutory $1,000,000 each accident $1,000.000 disease - policy limit ~ 1,000,000 disease - each employee $ 250.000 Arizona, GeorgIa, New Mexico $ 300.000 Alabama, Kansas, Michigan. Nebraska $ 350,000 Montana . $ 500.000 Miss!sslþpl. Tennessee; Utah $ 1,000,000 All Other States NOTE: The Memoranda serveS as evIdence ofWor,k.ers· CClmpensatlon and Employers Liability coverage excass of the self-Insured retention. Should you have any questIons please contact Rhonda Mount of Aon RIsk Servlc:es, at 50~-224-9700. . This Memoranda is furnished to you as a matter of Information for your convenience. It only summarizes the listed polley and is not intended to ref1ect all the terms and conditions or exclusions of such policy. This summar¡ is not an insurance policy and does not amend, alter or extend the coverage afforded by the listed policy. The Insurance afforded by the listed policy Is subject to all the terms. exclusions and conditions of such polley. Comments: CODvr1ght It) 2001 Aon Group, Inc. https://www.a.online-aon.com/mernorandalmemoranda/15 3 3 kro _ excwkcomp.asp 3120/2001 ..._-,._,"-_....'".. Jan,10.2002 '~",,' MA RSF1°' 3261 .L. t' _~tompa"y , p, 7 ~ Terms and Conditions of Service Revised Novemb.er 14, 2000 PLEASE READ THESE TERM:S AND CONDITIONS OF SERVICE C'TERMS") BEFORE USING THIS SITE. By continuing to access or use this site, or any service on this site, you signify your acceptance of the TERMS. From time to time, Marsh Inc. ("Marsh") may modify the TERMS. Accordingly, please continue to review the TER.M:S whenever accessing or using this site. Your use of this sitet or any service on the site; after the posting of modifications to the TERMS wf1l constitute your acceptance of the' TEMIS, as modified. If, at any time, you do not wish to accept the TERMS, you may not use the site. Any terms or conditions proposed . by you that are in addition to or which conflict with the TERl\1S are expressly rejected by Marsh and shall be of no force or effect ' . . 1. Jl.&..e.r-.A.~~t to T~rm~d C..pl1ditions of Service. You represent that you bave read and agree to be bound by the TERMS for Marsh_com. You further agree: (i) to comply with U.S. law regarding the transmission of any data obtained from the Service (as defined herein) in accordance with the TERMS; (ii) not to use tbe Service for illegal purposes; and (iii) not to interfere or disrupt netw'orks connected to tbe Service. . 2. Il1~~ll~c:~_aUrºp.~rty. This Web site, including but not limited to text, content, photographs, video, audio and graphics (the "Service"). is protected by copyrightst trademarks, se1'Vice marks, international treaties and/or other proprietary rights and ,laws of the U.S. and other countries. The Service is also protected as a collective work or . compilation under U.S. cop)'Tight and other laws and treaties. All individual articles. columns and other elements making up the Service are a1s9 copyright~d works. You agree to abide by all applicable copyright and other laws, as well as any ad'ditional copyright notices or restrictions contained in the Service. 3. ß~ldction.&JL~LU§..e. You may not use the Service for any illegal purpose or in any manner inconsistent with the TERMS. You agree to use the Service solely for the use and benefit of your own organization, and not for resale or other transfer to, or use by or for the benefit of. any other person or entity. 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ADDITIONALLY, YOU MA Y NOT OFFER ANY PART OF THE SERVICE FOR SALE OR DISTRIBUTE IT OVER ANY OTHER .. .~..- . . ",-, , . ",~........",~,,,,..._. , CO!v.J a~ . 1 O. 2002v S: 13PM)R HYPERLINK FRAMING ON THE INTERNETWlTHCN 0 . 3261 E PP, 8K WRITTEN CONSENT OF MARA THE SERVICE AND THE INFOruaroN CONTAINED THEREIN MAY NOT BE USED TO CONSTRUC~ DAT.ABASE OF ANY KlND. NOR'A Y THE SERVICE BE STORED (m~ ITS ENTIRETY OR IN ANY PART) IN DATABASES FOR ACCESS BY YOU OR ANY THIRD PARTY OR TO DISTRIBUTE ANY DATABASE SERVICES CONTAINING ALL OR PART OF THE SERVICE. YOU MAY NOT USE THE SER'VICE IN ANY WAY TO IMPROVE THE QUALITY OF ANY DATA SOLD OR CONTRIBUTED BY YOU TO ANY THIRD PARTY. FURTHERMORE, YOU MAY NOT USE ANY OF MARSH'S NAMES OR MARKS IN ANY MANNER THAT CREATES THE IMPRESSION SUCH NA11ES OR MMKS BELONG TO OR ARE ASSOClA TED 'NlTH YOU OR Il\1PL Y ANY ENDORSEMENT BY MARSH, AND YOU ACKNOM..EDGE THAT YOU HA VB NO OWNERSHIP RIGHTS IN AND TO ANY OF THESE NAMES OR tv1ARKS. YOU WILL NOT USE THE SERVICE, TIlE INFORMA IrON CONT AlNED THEREIN OR ANY OF MARSH'S NAMES OR 'MARKS IN UNSOLICITED MAILINGS OR SP AM MA TERlAL AND WILL NOT SP AM OR SEND UNSOLICITED MAn..INGS TO ANY PERSON OR ENTITY USING THE SERVICE. 5. Liceng. You acquire no rights or licenses in or to the Service and materials contained therein other than the limited right to utilize the Service in accordance with the TERMS. 6. Rights Re~. All present and future rights in and to trade secrets, patents, copyrights, trade names, trademarks, service marks, databases, know-how and other proprietary rights of any type under the laws of any governrnenta1 authority, domestic or foreign, induding rights in and to all applications and registrations relating to the Service (tbe "IP Rights ") shall, as between you and Marsh, at all times be and remain the sole and exclusive property of Marsh. 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Marsb does not: (a) make any ,waITanty, express or implied~ with respect to the use of the links provided on, or to, the Service; (b) guara%1tee the accuracy, complete-.:<ess, usefulness or adequacy of any other Web sites, services, goods or advertisemerits}hat may be linked to the Service; or (c) make any endorsement, express or implied, of any other Web sites, services, goods or advertisements that may be linked to the Service. Marsh is also not responsible for the reliability or continued availability of the telephone lines and equipment you use to access the Service. You understand that Marsh and/or third-party contributors to the Service may choose at any time to inhibit or prohibit their content from being accessed under the TERMS. 8. Limitation of Liabi1ity. UNDER NO CIRCUMSTANCES, INCLUDIN'G BUT NOT LDvíITED TO NEGLIGENCE, SHALL MARSH, ITS SUPPLŒRS OR ITS THIRD..PARTY AGENTS BE LIABLE TO YOU OR ANY THIRD PARTY FOR DIRECT, INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIA.L, PUNITIVE OR EXEMPLARY DAMAGES EVEN IF AN AUTHORIZED REPRESENTATIVE OF MARSH HAS BEEN ADVISED SPECIFICALLY OF THE POSSIB1LITY OF SUCH DAIvrAGES: ARISING FROM USE OF OR INABILITY TO USE THE SERVICE OR ANY LINKS OR ITEMS ON THE SERVICE OR ANY PROVISION OF THE TERMS; SUCH AS; BUT NOT LIMITED TO, LOSS OF REVENUE OR ANTICIPATED PROFITS OR LOST BUSINESS. (Applicabie law may not allow the Iio:1itation or exdusion ofliability or incidental or ' ..... .-... ,,' .., Jan,10, 2002 5:14PM No.3261 P,9 9. ~es~~ntations and WarrantLaou represent, warrant and covenant .ou; (i) have !he power and authority to enter into this agreement; (ii) are at least eighteen (18) years old; (iii) shall not use any rights granted hereunder for j any unlawful purpose; and (iv) shall use the Service only as set forth in these TERMS. 10. Indemnification. You agree, at your own expense, tp indemnify, defend and hold hannless Marsh and its employees, representatives, Suppliers and agents, against any claim, suit, action or other proceeding, to the extent based on or arising in connection with your use of the Service, or any links on the Service, including, but not limited to: (i) your use or someone using your computer's use of the Servic;e; (ii) a violation of the TERMS by you or anyone using your computer; (Hi) a claim that any use of the Service by you or someone using your computer infringes any IP Right (as herein defined) of any third party, or any right ofpersonality or publicity, is libelous or defamatory, or otherwise results in injury or damage to any third party; (iv) any deletions, additions, insertions or alterations to, or any unauthorized use of, the Service by you or someone using your computer; or (v) any misrepresentation or breach of representation, warranty or covenant made by you contained herein. You agree to pay any and all costs, damages and expenses (including reasonable attorneys' fees) and costs awarded against or incurred by or in connection with or arising from any such claim, suit, action or proceeding. 11. :wmi¡l~ti~.n. 'Either ;ôuor Marsh maytenniriate this agr~ement with or without cause at any tim~ and effective immediately. You may tenninate by discontinuing use of the Se¡vice anq, destroying all materials obtained from the Service. This agreement will terminate immediately without notice from Marsh if Marsh determines, in its sole disçretion, that you have failed to comply with any provision of these TERMS. Upon tennination by you or upon notice of tennination by Marsh, you must promptly destroy all materials obtained from the Service and any copies thereof. Sections 2,3,6, 7, 8, la, 11 and 12 shall survive any tennination of this agreement. 12. Qo.Y..~mj.DgJ,&W. These TERMS shall be governed and construed in accordance with the laws of the United States of America and the StAte of New York, without giving effeot to conflicts-of-Iaw principles thereof. You agree to submit to the pernonal jurisdiction of the state and federal courts lo~ated' in New York County with respect to any , legal proceedings arising out of this agreement and waive any oojeGtiontothe propriety or convenience of venue in. such courts. 13. Access Ou..Wg,~e_t!ui!.e.Q..St:i!.tç§. If you choose to access'the Service from outside the United States, you are responsible for compliance with foreign and local laws., Software from the Service may be subject to UnÍted States export controls that prohibit downloading, exportation or re-exportation: (i) into (or to, a national or resident of) Cuba, Iraq, Libya; Nonh Korea, Iran, Syria, Sudan, or any other country to which the U.S. has embargoed goods; or (H) to anyone on the U.S. Treasury Department's Table of Deny Orders. By using the Service, you represent and warrant that you are not located in, controlled by or a national or resident of any such country or on any such list. 14. MiscellaneoYj. You acknowledge that Marsh has the right to change the content or technical specifications of any aspect of the Service at any time at Marsh's sole discretion. You further accept that such changes may r~§ult in your being unable to access the Service. . 15. Qfticial Cocresp.ondence. Official Correspondence mu'st be sent via postal mail to: Marsh Inc., 1166 Avenue of the Americas, New York. NY 10036, Attn.: Corporate CommUIÚcations. Dt¡~_1 . "'T~5:.0 . ~" : ME]~a 0_, .~ ~.' ,_ 2~_O 2.n. ~ : ~ ~ ~NSU-'·'··'-Ñ CÉ-~---_··_··---··-----"-'·----_·_~·-· .~ J:N 0 ' 3 2 6 1 ;;õi)p. 1 0 12/01/2000 This Memarandum IIIcI1114 IU à mattl!r Qt 'nrClrm Clol)' ta authorized viewers for thlllr lotllrnalllle only an . of en no rl¡hts ~pO!l 811)' vIewer of this I\'tem~r:ancfum. This Memorandum dou not amend, extend or titer the coverage described bQlow. Th\B Memorandum mo.)' ònly be çopled, printed and dlstrloutecf within an lIoutJIoTizod vIewer and ms¡y only be ù5.d and vi,weeS by an authorited vlowl\r for Itllnterlllll uso. Any lither use, dupl1ç:ulon or d¡'trlbutlon of 11111 M.morandum without tile consellt of ~fI-'$h USA. Inl:. is prahlbltod. "Authol'l:r;l!d vIewer" shall m..n an entity or person whlc:h II authorl:¡:ed by tho insured named hereIn to aecesl this MernOl'llndu.n:I via www.marsbwebJeUeDtsl0911....mQl.nsr. The InfClrmiitlan contained hereIn is as or the crate re~lTed to abo..... Mar¡h USA Inc. sll..n be undor DO obff¡:ltiCln to update 5uclt Inronnatioll. PRODIJCI:Q Marsh USA Inc. 500 W. Monroe Chicago, n.. 60661 .~ COMPANIES AFFOrmrNG COVERAGE Co. A Continental Casualty Co. INSURED The Kroger Co, " Co. B Co.C Co. D COVERAGES THIS IS TO CERTUi~Y:THA't THE POLICIES OF INSURANCE USTED BELOW HA vtr BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TAB POL,ICY rERIOD iNDICA TED. NOTWITHST ANDINO ANY REQUIREMENT. TERM..OR. COWDtTlOl'l Of ANY Com'MCT OR OTHER DOCUMENt' WI1'H RESPECT TO WHICH THIS M~MORANDUM MAYBE ISSUED 011.. MAY PERTAIN; THE INSURANCE AFFORDED BYTHEPOtlCtES DESCR.IBED HElŒlN IS SUBJECT TO ALL THE TERMS, eXCLUSIONS AND CONDmONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CL.ÅIMS. . CO lYPE OF INSURAo"CE POLICY NUMDItR E.FFECTIVE EXPIRATION LIMITS ~ 1'"- DATE DATE GENERAL LIABILITY OENERAL AGO¡œOATE. PRODUCTS· COMP/OP AGO PEkSONAL &. ACV , I1'lJURY EACH OCCURAENCE . FIRS DAMAOE! (Any one fini) MED EXP (Any ontS pe~n) .' AUTOMOBILE COMBINED SINGI.E '. LIABILITY LIMIT BODILY INJURY (per p.raon) BODILY INJURY (Per ¡¡ççiditntJ PROPaRrf DAMAGE GARAGE LIABILITY AUTO ONLY· SA ACCtD!1'O' <mœR THAN A1JI'O OI'lL Y: BACH ACCIDENT AOOR.EGATE EXCESS LIABILITY SAC» OCCUR.R.ENCE AOGItBGATB WORKERS' we STA11J1'ORY Excluded COI"PItNSAT10N LIMITS Qf' OTHER ANI) EMPLO'VERS' Et. BACH ACCIDEÞn' LIA81LITY THE PROPRJETOR I EL DISE.ASE . P ARiNERS I POLlCY LIMIT EXECtTTM OFFiCERS ARE: EL DISEASE· EA EMPLOY1:.E A J>ROPUTY 198794822 06/30/99 06/30/2002 $20,000,000 The Memorundum o( 1nsurance seMI SOlely to list ínsurunce policies, limits IInd dates of coverage, A¡¡y modifiClltions nc;rete Q11: not iluthQlÏ:zed. --.......... ,.,,' ".",,--"'.--'...' This Memorandum Is ISIIIcd lIS a matter of, ",form on only to authorized vloIYen 101' theIr Internal ust only atllnf'ers no r1a:hts upon a...y vlcnvlIl' of thl~ M,Illlorllndlllll. Tbls Memorandum dOIlJ not amend, osland or allor the ¢o\'t1'8ié de~r¡bed 1111101'. This Memorlmdum nl.Y only 11" çoph:d. prinl\!d And d!$",lbl/ted wltbln In aur~ørlzed lIiewer and IllY only b. used 8nd viewed by an authDrlzed vIewer ror 11$ Internal !.Ise. Any orher lise, duplicatloll or dlltrtl;Jurh~n of rhls Mllmorllndum wIthout the c:o".ent of Marlh USA Inc.1a prohibited. .....ulhorizad viewer" .hl! moan ..n antlty or person whf;h I' autlll.rh!ed by rtle iMùrcd named herein In Ilcc!'!n thl. Memorandum via www.mar:shweb/clllllltl/159ó1mol.nsr. The Infol'mørloß contained herein is as of the date l'IIferred to abDve. Mllrsh USA Ine. .ball be lindeI' no obllgatlón to updAte luch Intormatlon. P~ODUCE~ Marsh USA Inc. 500 W, Monroe Chicago. n.. 60661 ---- IN 0 . 3261;P, 1 ¡ I ! 11.012000 ·ME~.~[\~ ~~'_J~O ~i,~: ~ 5!M.ÏÑS ; COMPANIES AFFORDING COVrRAG£ Co. A Fireman's Fund Insurance Co. JI'ISVRED The Kroger Co. Co.B Co. C Co. D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OP INSURANCE LISTED BELOW tlA YE BEEN ISSUED TO THE INSURED NAME!) ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHST ANDINO ANY RP.QUIREMEN'r. ,.gRM OR CONDITION OF ANY CONTRACT OR OTHeR DOCUMENT Wmi RESPECT TO WHICH THIS MEMOM/IIDUM MAYBe ISSUED OR MAY PERTA.IN. THE INSURANCE AFFORDI;D BY THE POLICIES DESCItIBED HEREIN IS SUBJECT TO ALL TilE TERMS. eXCLtJ$IONS AND ÇONDITIONS OF SUCH ÞOLlCI£S. LIMITS SHOWN Mi\ '( HA VE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSUItANCE POLICY NUMDF.:R EFFECTIVE EXPI R,\ TlON LI~ITS I.TR DATE DATE C£:-;F..RAL UABIl,ITY OBNßRAL AOOREOATE PRODUCTS· cor.,mop ACiCi PERSONAL & ADV INJURY . EACH OCCURRENCE 0 FIRE DAMAGE (An)' one fi~) MED EX/' (Anyone person) ^UTO~08'I..E COMBINED SiNGLE LIABIU1''I' LIMIT BODI!. Y INJURY (Per pcrl¡on) BODILY INJURY O'er ac:c:idl;l'I¡) , PROPERTY DAMAGE GARAGE LI,\BIL1TY AUTO ONI. Y . SA ACCIDENT OTHER THAN AUTO ON!. V: EACH ACCIDENT AGGREQATE EXCESS LIABILITY EACH OCCURRENCE AOOREOATE WORI<:E1'($' we STATUTORY Excluded COMPENSATION LIMITS ár OTHER ,A.ND EMPLOYERS' EI.. EACH ACCIDeNT LIABILITY THE PROPRIETOR / E!. DIseASE - PARTNERS / POt..ICY I..IMIT EXECUTIVE OFFICERS ARE: EL DISEASE· EA EMPI.OVEE A pR.OPERTY MXl97902S97 07/31/2000 07/31/2001 $2,500,000 Tn.: M~mor;¡II<I\lm o( Instlrv.ncc scrvea solely to list insLlruBce polkîcs. limits 4cu1 dales of covc:rnge. Any m¢diticlllions hereto 4ft no! authorized. - - _.__.--_.----_._-~--_._--_._. . iMEJ.~~J2~..~~~ë.~~ ~~~ÏNS ____OIl No. 3 2 6 1 ;;¡;¡;P. 1 2 11/20/2000 ANCE Thl. Memorandum Is Issued a. , matter ~t'ln'or on only to But"orl~~d vIewers for th~lr Internelllse anI)' II confers DC ria"l. ..poQ ",..,. viewer of dds Memorllndum. This M.morllndum does not Dmend. e:dend or alter the covora¡¡1! described below. Tills Memorandum ma)' Qnly be copied, prln~d ~ncl dbrrlbuted wltllln In lutllorlzld viewer and may only be IIsed and viewed by In Iurltorlzod viewer fQr It. Internal US8.. Any othlll' UCè, dupll~14tloß or dl.trlburlCln of this Melllorandum ....¡thollt th. cOlIsent of Marsh USA tno!. Is prohlblt.d. .. Àllchorlzed vll!1"er" ¡Ita II mel&l1 an entit,)' or pør30n which Is authllrlzed by tI\e 1c"',Il'lld na",ec! herein to "ceSS thts Mcmonndllm via www.mll.rsllweb(cl1entsl.1S961mClI.ß5f. The InforltuUlon contaIned herein Is liS òf tht dlltll nlferrid CII abov.. Marsh USA. 1m;. .haU \Ie under no obUgatlon to update such Informadon. j PRODUC'f.R Marsh USA Inc. 500 W. Monroe Chicago, IT. 60661 INSVRED The Kroger Co. "\DDI1'IONAL INII'ORMA1'JON The named irisured includes: Merksamer Jewelers, Inc., Littman Jewelers, Fred Meyer Jewelers, Inc., Fox. Jewelers, Inc., Barclay Jewelers, Fred Meyer Stores, Inc., Roundup Co., Grand Central, Inc., and Fred Meyer Alaska, Inc. Jewelers Black; replacement cost; special fonn; includes furniture, fixtures, improvementslbetterments, '. Any party with which the named insured has a contractual requirement to be included as an additional insured, loss payee or mortgagee, is automatically given such status under the policy. The Mumomncluft'l at" 11\5111'111\cI: lIc:Nca 501-=1\1 to list ina\tt¡I\c~ polic:iu.lin\Ì1& tllld dRICS ofcoverqe. An.y madlnC4tions hCreto;.re !lot lI\uhorized. .. ,---.-.---.-,.--.-,,'-" , Jan.10, 2002- 5,: 16PM IvlE1YIV.KA1'UJu'!n Uj\ INS CE DN 0 . 3 2 6 1 ;;ÿP, 1 3 12io [12000 . This MemorrUidula is issued as II matter of,informatlon only ~ lI~thorl:zed vlàWets for their Inb!~I1BI USé IIl\ly lIad l:on'lIl'1 no rights lipon any "iOWèr of , till, MIIDn~lIn4Llm. Tbls l\'lèmorandUIII d04l' not mm.nd, e~talld ór alter tbe cDveral1 described below. ThlJ Memorandum lamy only b. <:o'ied, printed IInd dIstributed wltbln IIn 111Ithor!pd viewer IllId may ollly b. used and viewed by an authorized viewer for It.lntemal use. Any other uSe, dupllC:II.Uon or Cli.tr'IÞutlon of t1ùs MemOl'Dnd:llm without the cansent or Mush USA Inc. Is pronlbln=tS. .. Autho~zød viewer" shaU mlllln 11ft enett)' or penoft wn¡cl1 Is IllIthorl'ì:edby tile Inlured named heréln to IICCI'ISS this Memonandum vll1 www.mllrsbweb/ellentsl09841moLnsf. The Information contained lIereln Is III oUbe date referred to IIbøve.l\'lanb,USA. 11\1:, l~all be under no obl/gatløn to update such Inrormatløsr.. PRODUCER INStJRED . . Marsh USA Inc. 500 W. Monroe Chicago, It The Kroger Co.* 60661 , " . ~DDtTIONÁL INFORMATION All risk including boiler and machinery, business inter,rupûþn 'and extm expense; ap 9wned real and , personal property including leased property that the Named Insureçi hereon i,s contractually obligat~d to insure; replacemen(còst; co-insurance does not app!y.. ~ . '0 \'.,' " '.: \ ."'..... , . I!:~ . . . . \ . AIJ.y party with which the nam~d insured bas a contractual ~eq~ireent to be included as ,an addi\Íop~l insured, loss payee or mortgagee, is al;ltomatically given such sta..i&'S:under'the policy. Howèver;'~' / ' coverage under thê:þôlicY'ohly applies to the extent oftl1.e cov~~ required by such contractual ': '; requirement and for the limits of liability speci~d in suc~ cQn1la~~ requirement. but in no event, for insurance not afforded by the policy nor for limits ·òf lìabi1ity'l~' excess ofthe, applicable limitS. óf liability of the poHcy. . . ' ' ': !. 0 " . ~ The existence of more than one insured or additional insured or other interests shall not serve to " increase the limits of liability of the policy. $20,000,000, aggregate for earthquake/flood where req~ired,by contrac~. "'The named insured includes all'subsidiaries of The KrogerCo.t expect jewlery operaûons, including, but not limited to, the following: Dillon Real Estate ' Fred Meyer Stores, Inc. Quality Food Centers, Inc. Ralphs Grocery Co. Smith's Food and Drug Kroger Limited Partnership I Kroger Limited Partnership IT ' King Soopers, Inc. Fry's Food Stores of AZ, Inc. Dillon Companies~ Inc. The MØlonnciwn gf1n.\It!'IIIc~ $I'I"YCS Je!ely 10 list ¡nslll'/lPce pclIcles.limil:S and dates ofcaYCfnge. Any moditic$tians hereto art not authorind. ..."J '"'_'" """._.____..._-.