HomeMy WebLinkAboutUST-MONIT TEST 6/2/2004
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6630 RosedaJe Hwy., # B~akersfietd, CA 93308 Phone (661) 588-2-m Fax (661) 588-2786
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MONr~_ORING SYSTEM CERTIFICATION
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This form must be, used to document testing and servicing of mo~itoring eqÚipment. A separate "certificaÏio~ or re"port must be
prepaæd for each mqnitoring system control panel by the techilician who performs the w,ork. , A ~opy of this form must be provided to
the tank system owner/operator. 'The owner/operator must submit a ~opy of thi~ form to' theíócal agency'regulating UST systems,
within 30 days of test date. ' , , -. , '
A. General Information L/. "I A
Facility Name: ~ ~7æ'r/'7/lC- :,~.. " ' , Bldg. No.:
SiteA;idress: ~,r r£P)f9rl:JlU city;~k¿c¿)", ,'Zip:,
FacilityContact~~"' q,t'~.. ..' ConlactPh~eNò.:(· co')
Make/Model of Monitoring System:.f/¿ ,A~ LA -or( D~te ofT~!irig¡Servicing:
B. IIlventory ofEquip~~ntTeSt~øJCertµïed ..-.," '.' .':. - ';{{~!\".; !',-" , '
Cbeck tbe a ro rl te boxes to Indicate s ec:lfic: e ul meat Ins ected/servlc:ed:' . ' ¡' :,: :';'. ',,' : :",:,
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TaDk ID:
q 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: AJ.~., '..'
o Mec:hanical Line Leak Detector, ModeJ: ~ "
o Elec:tronicLine Leak Detector. Model:
a Tank O..mlll HigH~..1 S""",. Model: . ---. -
o Oth,:r s cif e ui ment and model in Stction E on Pa e 2 .
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~' ,- '0 'In- Tahk Gauging Probe. " Model:
.~ 0 Annular Space or Vàult Sensor. MÒdel: "", ,
o PipingSuinp I Trench Sensor(s). Model: ,
g ~~c:~:~a~~~~r~~k Detector. ~~::~>'~~. "~Þ~~9':::\~" :.~"~
o Elec;troniè Line Leak Detector. Model: .,~{.
o Tank Overfill I High-Level Sensor. Model: '
o Oth,:r' s ecif - ui ment e and model in Section E on Pa e 2 .
,.
TaDk ID:
o In-Tank Gauging Probe.- . Model: '
o Annular Space or Vault Sensor. ' : Model: '
o Piping Sump I Trench Sensor(s). " Model:
o FiIISumpSensor(s).' "".; " Model: '
Q, Mechanical 'Line Leak petectOr, ,ModeJ:
o Electronic Line Leak Detector;', . Model:
,0 TlÜ'lk Overfill I High-Level Sensor. ',Model:
o Othêr s eci ui ment and model in Section E on Pa e 2 .
Tank ID: " '"
o In-Tank Gauging Probe. ' Model:
o,;..:",.p, :^nnu~ar,.~pá~.~r~Y~~t§~SO(;::,:..J.\ ,M~~e.1:, '; ,
º piping ~ump I Trench' Sensor(s). Model: "'~'
O'f-iII Sump SensoJ:(s)", '. '. '-'" '.'. ,:.' Mod~k'~"
o Mechanical Line Leak Deteètoi,' . Modël:
a Electro~¡,c~.~iJJç Leak Detector: ' Model:
o Tank'Overfill / High-Level Sensór. Model:
o Other s if ui ment e and model in Section E on P e 2 .
Dispenser ID:
O'Dispenser"Containment Sensor(s). ' Model:
o Shear Valve(s).
o Dis enser Containment Float s and Chain s ,
Dispenser ID:
o Di~penser Containment Sensor(s). Model:
O· Shear Valve(s).
o Dis nser Containment Float s and Chain s . '
Dispenser ID:
o Dispenser Cont,ainment Sensor(s). Model:
o Shear Valve(s).
o Dis enser Containment Float s and Chain s .
[nclude information for every tank and dispenser at the façility.
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C. Certification - I certify that the equipment identified m this documeDt was iDspected/serviced in accordaDce with the
manufacturen' guidelines. Attached to this Certification Is information (e.g. manufacturen'checkllsts) Decessary to verify that this
information is correct and a Plot PlaD showing the layout of monitoring equIpment. For any equlpmeDt capable of generating sucb
. r,f:~,.·,rts, , " I b.veabo.tta'Z;¡Wl1~"""øppJy), 0 ~,et~ report
Technlcl¡u) Name (pnnt): ~ Signature:
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Cernfic~tion No.' f!2)-oS" -ðfrf . License, No.: 12--!1~'
Testing Company Name:' , ¿ ð JJ " , ' " ' Phone No.:(b6í) ð(f>¡>- ,271 ?
SileAddress: ~¡?ð Æø~/f£t!'~J/tr~/~ ' DateofTesting/Servicing:£¡ Z-/~'
Page 1 of 3
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Monitoring System Certification
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D; Results of Testing/Servicing
Software Version Installed:
Com Jete the followin checklist:
Yes 0 No'" Is the audible alann 0 erational?
Yes 0 No'" Is the visual alarm 0 erational?
Yes 0 No'" Were all sensors visuall ins ected functionall tested and confirmed 0 erational?
? Yes 0 No· Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will
not interfere with their ro er 0 eration?
DYes 0 No· If alanns are relayed to a remote monitoring station, is'all communications, equipment (e.g, modem)
N/A operational?'· ,
DYes 0 No·' For pressurized piping systems, does the turbine automatically shut doWn if the piping secondary containment
I;J NI A monitoring system detects a leak, fails to operate, or ,is electrically disconnected? If yes: which sensors initiate
positive shut-down? (Check all that apply) 0 Sumprrrench Sensors; D.Dispenser Containment Sensors.
Did ou confum sitive shut-down due to leaks sensor failure/disconnection? Q Yes' 0 No.
DYes 0 No· For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e, no
)!f N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank
fIll oin s and 0 eratin fO erl ? If so at what ercent of tank ca aci does the alarm tri er? %
DYes· JiI No Was any monitoring equipment replaced? If ye$, identify specific sensors, probes, or other equipment replaced
and list the manufacturer nanlC and model for alfr laccmei1t àrtsin Section E below.
Yes· 0 No Was liquid found inside any secondary containment systems desigiled as dry systems? (Check all that apply)
Q Product· ater. If es describe causes in Section E below.
Yes 0 No· Was monitorin stem set-u reviewed to ensure ro er settin 5? Attach set u
Yes 0 No· Is an monitorin ui ment 0 erational er manufacturer's s ecifications?
* In Section E below, describe how and when these deficiencies were or will be corrected.
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Page 2 of 3
03/01,
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E: In~l~a~k Gauging I SIR EqU¡p.nt:
o Check this box if tank .ing is used only for inventory control.
)a?Check this box if no tank gauging or SIR equipment is installed.
This section must be completed if in::-tank gauging equipment is used to perform leak detection monitoring.
ComDlett~ the followin2 checklist: ,
DYes o No· Has aU input wiring been inspected for proper entry and termination, including testing for ground faults?
DYes' Q No· Were a11 tank gauging probes visuaUy inspected for damage and residue buildup?
DYes o No· Was accuracy of system product level readings tested? ,
DYes o No· Was accuracy of system water level readings tested?
DYes Q No· Were all probes reinstalled properly?
DYes o No· Were all items on the equipment manufacturer's maintenance èhecklist completed?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
G. LiDE~ Leak Detectors (LLD):
~Check this box ifLLDs are not installed.
ComDletE~ the followin2 checldJst:
Q Yes a No· For equipment start-up or annua1:equipment certification, was a leak simulated to verify LLD perfonnance?
[J N/ A (Check all that. apply) Simulated leak rate: IJ 3 g.p.h.; a 0.1 g.p.h; 0 0.2 g.p.h.
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DYes a No· Were all LLDs confirmed operatio,J;Íal and accurate within regulatory requirements?
a Yes' a No· Was the testing apparatus properly ,calibrated? !
a Yes o No· For mechanical LLDs, does the LLD restrict product flow if it ~etects a leak?
o N/A '.. .'
DYes o No· For electronic LLDs, does the turbine auto~atical]y ~hut off i~ th~ ~~J? ~e~ct:l a leak?
o N/A .' '.'t,'.;:,,. ;, ',_' & ,
DYes > o No· For electronic LLDs, does the turbine automatically shut off if any portion of the monito~g system is disabled
o N/A or disconnected? -
DYes o No· For electronic LLDs, does the turbine automaticftlly shut off if any portion of the monitoring system
a N/A malfunctions or fails a test? '
DYes a No· For electronic LLDs, have all accessible wiring connections been visually in~pected?
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DYes o No· Were all items.on the equipment manufacturer's maintenance checklist completeq?'
* In the S,ection H, below, describe how and when these deficiencies were or will be corrected., _,
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H. Comments:
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Page 3 of 3
03/01
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. Monitorinl~ System Certification
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Site Addre"s'
UST Monitoring Site Plan,
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Date map was drawn: iL-12! J2!:{
Instructions
If you already have a diagram that. shows !,ll required information, you may include it, rather than this page, with your
Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify
locations of the following equipmen~)f installed: monitoring system control panels; sensors monitoring tank annular
spaces, Sllmps, d~spenser pans, spill eontainers, or other secondary containment areas; mechanical or electronic line leak
detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan
was prepared. ' .
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CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAME {}\C'k..'"f H~
INSPECTION DATE ail q(oJ
Section 2:
Underground Storage Tanks Program
o Routine BCombined 0 Joint Agency
Type of Tank (JuJR.. 'J
Type of Monitoring ~{.~\
o Multi-Agency 0 Complaint
Number of Tanks I
Type of Piping (WF
ORe-inspection
OPERA TION C V COMMENTS
Proper tank data on tile V "
Proper owner/operator data on tìle L/ ,-
Pennit fees current f/
Certification of Financial Responsibility l,../
Monitoring record adequate and current V
Maintenance records adequate and current t./
Failure to correct prior UST violations ./
Has there been an unauthorized release? Yes No L/
Section 3:
Aboveground Storage Tanks Program
TANK SIZE(S)
Type of Tank
AGGREGATE CAPACITY
Number of Tanks
OPERA nON Y N COMMENTS
SPCC available
SPCC on tile with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MYF?
If yes, Does tank have overtìll/overspill protection?
c~COmPI;""::_~ V~V;ol,¡;oo y"y"
¡",po.o, JJiB.J r ~
Office of Environmental Services (661) 326-3979
White· Fnv. Svcs,
N=NO
Pink· AlIsiness C()py
I · Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
I . Print your name and address on the rev~rse
I so that we can return the card to you.
. Attach this card to the back of the mailpiece,
or on the front if space permits.
\1. Article Addressed to:
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I 7002 3150 0004
I PS Form 3811, August 2001
MERCY HOSPITAL
2215 TRUXTUN AVE
BAKERSFIELD CA 93301
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D. 15 delivery address different from item 1? 0 Yes
, if YES, enter delivery address below: 0 No
3. Service Type
o Certified Mail 0 Express Mail
o Registered 0 Return Receipt for Merchandise
o Insured Mail 0 C.O.D.
4. Restricted Delivery? (Extra Fee)
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DYes
9985 3226
Domestic Return Receipt
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2ACPRJ.03.Z.0985
, UNITED ST'''' POSTAL SERVICE, <;' ,,,~,O' -::'''::'-:: ~ ,~V~, j
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Bakersfield Fire Department
Prevention Services
1715 Chester Avenue, Suite 300
8akersfíeld, CA 93301
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(D.. J)stic Mail Only; No Insurance Coverage Provided)
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Postage $
Certified Fee ¡ ~
Postmark
Return Reclept Fee Here
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
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:%ië£-Aj 2215 TR UXTUN A VB ,...-.--
~!.~.~ BAKERSFIELD CA 93301 ........
City, SIal
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FIRE CHIEF
RON FRAZE
ADMIMSTRATlVE SERVICES
2101 "H" Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395·1349
SUPF'RESSION SERVICES
2101 "H" Street
Bakersfield. CA 93301
VOICE (661) 326-3941
F¡U( (661) 395-1349
PREVENTION SERVICES
1715 Chester Ave.
Bal<ersfield. CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
ENVIR()NMENTAl SERVICES
1715 Chester Ave.
Bal¡ersfield. CA 93301
VOICE (661) 326-3979
FÞ')( (661) 326-0576
TRAINING DIVISION
!i642 Victor Ave.
Ba~:ersfield. CA 93308
VOICE (661) 399-4697
FAX (661) 399·5763
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April 11, 2003
Mercy Hospital
2215 Truxtun Ave
Bakersfield CA 93301
CERTIFIED MAIL
RE: Recent SB 989 Secondary Containment Testing
FOURTH REMINDER NOTICE
Dear Owner/Operator:
Our records indicate that you completed your secondary containment
testing on October 21,2002. Our records further show a failed test.
Therefore you are required to have your system repaired and re-tested
as soon as possible.
This office requests an update with regard to repairs of your system.
Please be advised that repairs involving the replacing of components
must be under permit from this office. The repairs of your system are
a condition of your pennit to operate. Failure to repair and re-test will
result in the revocation of your permit to operate.
Should you have any questions, please feel free to contact me at 661-
326-3190.
~
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
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I · Complete items 1, 2, and 3. Also Complete
item 4 if Restricted Delivery is desired.
I · Print Your name and address on the reverse
I so that We can return the card to you.
I · Attach this card to the back of the mailpiece,
' Or on the front if space permits,
I 1. Article Addressed to:
D. Is delivery address different from item 1?
If YES, enter delivery address below:
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MIKE WOOD
MERCY HOSPITAL
2215 TRUXTVN AVE
BAKERSF1ELD CA 93301
3. Service Type
o Certified Mail 0 Express Mail
o Registered 0 Return Receipt for Merchandise
o Insured Mail 0 C.O.D.
4. Restricted Delivery? (Extra Fee) 0 Yes-
7002 2410 0002 1974 9961
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I PS Form 3811, August 2001
Domestic Return Receipt
10259S.02-M_1S40 '
UNITED STATES POSTAL SERVICE
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First-Class Mail
Postage & Fees Paid
USPS
Permit No, G-10
· Sender: Please print your name, address, and ZIP+4 in this box ·
Bakersfield Fire Department
Prevention Services
1715 Chester Avenue, Suite 300
Bakersfield, CA 93301
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Postmark
Return Reclept Fee Here
(Endorsement Required)
Restrict"" DeliveN Fee
(Endoœ MIKE WOOD
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FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
:~101 "W Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FA)( (661) 395-1349
suppnESSION SERVICES
:!101 "H" Street
Bak,arsfield, CA 93301
VOICE (661) 326-3941
FA;( (661) 395·1349
PREVIENTION SERVICES
FIRE SAFm SEFMCES . EHVIIOHIlEHTAI. SERVICES
1715 Chester Ave.
Bak¡ rsf1eld. CA 93301
VOICE (661) 326-3979
FA)( (661) 326-0576
PUBLIC EDUCATION
1715 Chester Ave.
BakElrsfield, CA 93301
VOICE (661) 326-3696
FA)[ (661) 326-0576
FIRE INVESTIGATION
17'15 Chester Ave.
BakElrsfleld, CA 93301
VOICE (661) 326-3951
FA)C: (661) 326-0576
TRAINING DIVISION
5E~2 VIctor Ave.
Bakersfield, CA 93308
VOICE (661) 399-4697
FA)( (661) 399-5763
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March 12, 2003
Mike Wood
Mercy Hospital
2215 Truxtun Ave
Bakersfield, CA 93301
CERTIFIED MAn..
NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE
RE:
Failure to Perform/Submit Annual Maintenance on Leak Detection at
the Above Stated Address.
Dear Business Owner:
Our records indicate that your annual maintenance certification on your leak
detection system will be past due on March 13,2003.
You are currently in violation of Section 2641(J) of the California Code of
Regulations.
"Equipment and devices used to monitor underground storage tanks shall be
installed, calibrated, operated and maintained in accordance with
manufacturer's instructions, including routine maintenance and service checks
at least once per calendar year for operability and running condition. It
You are hereby notified that you have thirty (30) days, April 12, 2003 to either
perfonn or submit your annual certification to this office. Failure to comply
will result in revocation of your permit to operate your underground storage
system.
Should you have any questions, please feel free to contact me at 661-326-3190.
Sincerely,
Ralph Huey
Director of Prevention Services
bY:j¡ d£v
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
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I · Complete items 1 2 d
item 4 ., R . ',an 3. Also Complete
i · Print ydur ::~~te~ Delivery is desired.
I So that We an address On the reverse
· can return the card t
I Attach this card to the back of t~ You.. .
Or on the front if space Permits. e mal/PIece,
r 1. Article Addressed to:
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3. Sef1lice TyPe
o Certified Mail
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o Insured Mail 0 ReceiPt for MerChandise
C.O.D.
4. Restricted Deli~ery? r&tra Fee) _
,I MERCy lIüSPIT AL
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, 2215 TRUXTUN A VB
' BAKERSFIELD CA 93301
7DD~'315D DDD4 ~~ð5 3D11
r PS Form 3811, August 2001
Domestic Return Receipt
Q Yes
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. UN/TED STATES POSTAL SERVICE
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First-Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
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aACŒR~F82LD FORIE DËPAR1MËNY
C:CFt~r, 0'" Ei\JVi RCi'(.~;:E"J¡-I',!_ SERVICES
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&~~roùî~:Di, CA Ë~&JJ~
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MERCY HOSPITAL
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2215 TRUXTUN AVE
~= BAKERSFIELD CA 93301
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FIRE CHIEF
~ON FRAZE
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield. CA 93301
VOICE (661) 326·3941
FAX (661) 395·1349
SUPPRIESSION SERVICES
2' Q1 "H" Street
Bakersfield, CA 93301
VOICE (661) 326·3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFE'TY SER\!CES' EHV1RONIlENTAl SERVICES
1715 Chester Ave,
Bakersfield, CA 93301
VOICE (661) 326·3979
FAX (661) 326-0576
PUBI.IC EDUCATION
1715 Chester Avè.
Bake,l$field. CA 93301
VOICE (661) 326-3696
FAX (661) 326-Ð576
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield. CA 93301
VOICE (661) 326-3951
FAX (661) 326-Ð576
TRAINING DIVISION
5642 VIctor Ave.
Bakelsfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
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March 5, 2003
Mercy Hospital
2215 Truxtun Ave
Bakersfield CA 93301
CERTIFIED MAIL
RE: Recent SB 989 Secondary Containment Testing
THIRD REMINDER NOTICE
Dear Owner/Operator:
Our records indicate that you completed your secondary containment
testing on October 21,2002. Our records further show a failed test.
Therefore you are required to have your system repaired and re-tested
as soon as possible.
This office requests an update with regard to repairs of your system.
Please be advised that repairs involving the replacing of components
must be under permit from this office. The repairs of your system are
a condition of your permit to operate. Failure to repair and re-test will
result in the revocation of your permit to operate.
Should you have any questions, please feel free to contact me at 661-
326-3190.
sincere~ I j ¡J ~
}J/lu UJtliUl}L/
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services '
SBU/dc
""7~ ~ W~ çop ~0Pe!T~ ./6 W~"
· Complete itemS 1, 2. and 3. Also complete
~ item 4 if Restricted Delivery is desired.
I . Print your name and address on the reverse
so that we can return the card to you.
~ . Attach this card to the bac\< of the mailpiece. ,-
~ or on the front if space permits.
1. Article Addressed to:
I
I¡-
l
MERCY HOSPITAL
2215 TRUXTUN AVE
BAKERSFIELD CA 93301
,--
I
~ 2=
7002 24~0 0002
I PS Form 3811 . August 2001
o Agent
o Addressee
C. Date ot Delivery
D. 15 delivery addre ifferent trom item 17 0 '(es
it '(ES, enter delivery addresS below: 0 No
1
I
3. Service Type I
o certified Mail 0 Express Mail 1
o Registered 0 Return Receipt tor Merchandise ~
o Insured Mail 0 C.O.D. I
~~ Delivery? (Extra Fee) 0 '(es _1
1974 92b& I
I
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------_../
=
2ACPflH)3.z-09851
I
Domestic Return Receipt
UNITED STATES POSTAL SERVICE
· Sender. Please print your náme, address, and ZIP+4 in this box .
. 11111/
First-Class Mail
Postage & Fees Paid
USPS ,
Permit No. G-10
fBAtœ~3FgEUJ F¡~E DE¡PARTÞ,,1~N1
OFFIC!: OF EIIIV¡:-iCNMEiliTAi. S8'lVICES
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Sent To MER.CY lIOSPlT AL
&,......, 2215 TR. UXTUN A \IE
.'L~ BA.KER.SFlELD CA. 93301
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FIRE CHIEF
RON FRAZE
ADMINISlRATlVE SERVICES
2101 "H" Street
Baken.field, CA 93301
VOICE (661) 326·3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Baken.field. CA 93301
VOICE (661) 326·3941
FAX (661) 395-1349
PREVEUTlON SERVICES
FIRE SAFm SEIM:ES . ENVIROHIlENTAL SERVICES
1711i Chester Ave.
Baken.field, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBLIC EDUCATION
1711i Chester Ave.
Bakemfield, CA 93301
VOICE (661) 326-3696
FAX 1661) 326-0576
FIRE INVESTIGATION
17Hi Chester Ave.
Bakemlleld, CA 93301
VOICE (661) 326-3951
FAX ~661) 326-0576
TRAIUING DIVISION
564,2 VIctor Ave.
Bakemlleld, CA 93308
VOICE (661) 399-4697
FAX (661) 399·5763
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~
February 13,2003
Mercy Hospital
2215 Truxtun Ave
Bakersfield CA 93301
Certified Mail
I
'.
RE: Recent SB 989 Secondary Containment Testing
SECOND REMINDER NOTICE
Dear Owner/Operator:
Our records indicate that you completed your secondary containment
testing on October 21,2002. Our records further show a failed test.
Therefore you are required to have your system repaired and re-tested
as soon as possible.
This office requests an update with regard to repairs of your system.
Please be advised that repairs involving the replacing of components
must be under pennit from this office. The repairs of your system are
a condition of your pennit to operate. Failure to repair and re-test will
result in the revocation of your pennit to operate.
Should you have any questions, please feel free to contact me at 661-
326-3190.
Sin~cerel~' da£
,I. / ,: /
'," .~ I"" ,
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
"".7e/V~ õfe W~ §,op ~OPe ff~ .A W~'I'I
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakllrsfleld, CA 93301
VOICE (661) 326·3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "W Street
BakElrsfield, CA 93301
VOICE (661) 326·3941
FAX (661) 395·1349
PREVI:NTION SERVICES
FIRE SAFETY SERVICES. ENVIRONMENTAL SERVICES
1715 Chesler Ave.
BakElrsfield. CA 93301
VOICE (661) 326·3979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 Chester Ave.
BakElrsfieJd, CA 93301
VOICE (661) 326·3696
FA>: (661) 326-0576
FIRE INVESTIGATION
1715 Chesler Ave.
BakEtrsfleld. CA 93301
VOICE (661) 326-3951
FA>: (661) 326.0576
TRJUNING DIVISION
51>42 Vlclor Ave.
BakEtrsfleJd, CA 93308
VOICE (661) 399-4697
FA>: (661) 399·5763
.
_.
January 22, 2003
Mercy Hospital
2215 Truxtun Ave
Bakersfield CA 93301
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.
Si2;
Steve Underwood
Fire InspectorlEnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
--y~ de W~ ~ .A0P6 .r~ A We.n&uy"
·
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAME---Í\I\ (tc 'f
~+(l'
INSPECTION DATE I;;) -S "() L.
Section 2:
Underground Storage Tanks Program
o Routine ŒÝCombined 0 Joint Agency
Type of Tank DldFc..5
Type of Monitoring ¿'.C-l/V\
o Multi-Agency
Number of Tanks
Type of Piping
o Complaint
ORe-inspection
,
DOJF
OPERA TION C V COMMENTS
Proper tank data on tile /
V
Proper owner/operator data on file V
Pe¡mit fees current V
CeJiification of Financial Responsibility V
Monitoring record adequate and current l./
Maintenance records adequate and current v""
Failure to correct prior UST violations /'
Has there been an unauthorized release? Yes No L--/
Section 3:
Aboveground Storage Tanks Program
AGGREGA TE CAPACITY
Number of Tanks
TANK SIZE(S)
Type of Tank
OPERATION Y N COMMENTS
spec available
spec on file with OES
Adequate secondary protection
Proper tank p1acarding/labeling
Is tank used to dispense MVF?
If yes, Does tank have overfill/overspìll protection?
I:~~,:~:'J;'~:Æ V~{2~ff~ N~NO
Oftïce of Environmental Services (805) 326-3979
White· Env, Sves.
Pink· Business Copy
.-
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-
~J- -Ol¡ 7;,0
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CITY OF BAKERSFlET .D
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 326-397'
APPLICATION TO PERFORM A TANK TIGHTNESS TESTI
SECONDARY CONTAINMENT TESTING
FACILITY---.rnev7~~~1 .
ADDRESS tZ.\5/vu Y-~'" JJJ..e ~~(Ø
PERMIT TO OPERATE # f!) \ 5' - O~ I - DCDÚ:?-z:6
OPERATORSNAME_u'Y\fYCJ..J{ (~~l11v
OWNERS NAME \!V\WCA.A\ ~im I
NUMBER OF TANKS TO BE TESTED_ ,( ~ IS PIPING GoING TO BE TESTED+
TANK # VOLUME CONTENTS
, 5þt5D ~ìesiJ
TANK TESTING COMPANY§Q.N\E-.eV\ - H-i I ~ f.lJ V {)wah' tJV)
MAlllNG ADDRESS 1\ DD ~. J Stv ett I T u../ Q Ií!. i r;4. Cf 22 ïJ:L
NAME & PHONE NUMBER OF CONfAcr PERSON J«l,\ ~rV}\Q..V':'I ol(;LWL\ L\S44
TESTMETHOD~Rq~q TP~+ì()OJ -Iý\C-tm - CM we..U
NAMEOFTESTERORSPECIALINSPEcrOR~L{.CL1ó /ÍvV\.Q.r "J ELI;'/.. mwdes
CERTIFICATION # b~:¿/)~415) {/ D ~ oq~'1~ ~
DATE'~TBSTJSTOBECONDUCI'ED IOþ¡ /ôg, q:NJ 8IiL Ý Ð'?-
~ ,~ (0 ·~·O'-
'APPROVED BY DATE
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Hazardous Materials/Hazardous Waste Unified Permit
CO~NDITIONS OF _PERMIT ON REVERSE SIDE
Permit Ie #:: 015-o00..o~~0628
MERCY HOSPITAL
LOCATION: 2215 TRUXTUN AVE
this permit is r---'farthefallowi"9:
611 Huardoua IlateriaJs Pian
I:!I Underground Stcøage 0' Hazardòus MateriaJs
D Risk MaJI8II8I1'.MIId Program
D Hazudou. Waste O....SiteTN8tmeftt
ONITORING
Issued by:
Bakersjíield Fire Department
·OFFICE OF ENVIRONMENTAL SERVICES-
1715' Chester Ave., Jrd Floor
BakersJieJd, CA 93301
Voice- (661) 326-3979
FAX (6,61) 326-0576
Expiration Date:
4~JUIl2'-
~. . . œœ~
. OffiœofE . - cs
'''~ne ~, 2003
Approved by:
~
FIRE CHIEF
RON FRAZE
ADMINIS,.RATIVE 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
PREVErmoN SERVICES
FIRE SAFEl"I SEIM;ES' EIMROHMENTAl SEIMtES
17Hi Chester Ave.
Baker.¡fleld, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBLIIC EDUCATION
17Hi Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3696
FAX (661) 326.Q576
FIRE INVESTIGATION
171~; Chester Ave.
Bake~ifleld. CA 93301
VOICE (661) 326-3951
FAX(661)326.Q576
TRAINING DIVISION
5642 VIctor Ave.
Bakersfield. CA 93308
VOICE (661) 399-4691
FAX (1661) 399·5763
e
e
September 30, 2002
Mercy Hospital
2215 Truxtun Ave
Bakersfield CA 93301
REMINDER NOTICE
RE: Necessary secondary containment testing requirements by December 31, 2002 of
underground storage tank (s) located at the above stated address.
Dear Tank Owner / Operator,
If you are receiving this letter, you have not yet completed the necessary secondary
containment testing required for all secondary containment components for your underground
storage tank (s).
Senate Bill 989 became effective January 1,2002, section 25284.1 (California Health & Safety
Code) of the new law mandates testing of secondary containment components upon installation
and periodically thereafter, to insure that the systems are capable of containing releases from
the primary containment until they are detected and removed.
Of great concern is the current failure rate of these systems that have been tested to date.
Currently the average failure rate is 84%. These have been due to the penetration boots leaking
in the turbine sump area.
For the last five months, this office has continued to send you monthly reminders of this
necessary testing. This is a very specialized test and very few contractors are licensed to
perform this test. Contractors conducting this test are scheduling approximately 6-7 weeks out.
The purpose of this letter is to advise you that under code, failure to perform this test, by the
necessary deadline, December 31, 2002, will result in the revocation of your permit to operate.
This office does not want to be forced to take such action, which is why we continue to send
monthly reminders.
Should you have any questions, please feel free to call me at (661) 326~3190.
Si~ ctd£J
Steve Underwood
Fire Inspector/ Environmental Code Enforcement Officer
Office of Environmental Services
""7~de W~ ~.A~ §"'bt, A W~'I'I
F!RE CHIEF
RON FRAZE
ADMINI:;TRATIVE SERVICES
:1101 MHM Street
Bakersfield, CA 93301
VOICE (661) 326·3941
FA:( (661) 395·1349
SUPPfi:ESSION SERVICES
2:101 MHM Streel
Bakorsfield, CA 93301
VOICE (661) 326·3941
FAX (661) 395·1349
PREVE:NTION SERVICES
17'15 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326·3951
FAX (661) 326·0576
ENVIRONMENTAL SERVICES
1715 Chester Ave.
Bakel'sfield, CA 93301
VOIΠ(661) 326-3979
FAX (661) 326-Q576
TRAINING DIVISION
5642 Victor Ave.
Bakersfield, CA 93308
VOICE: (661) 399·4697
FAX (661) 399-5763
e
e
D August 30, 2002
Mercy Hospital
2215 Eye Street
Bakersfield, CA 93301
REMINDER NOTICE
RE: Necessary secondary containment testing requirements by December 31, 2002 of
underground storage tank (s) located at the above stated address.
Dear Tank Owner / Operator,
If you are receiving this letter, you have not yet completed the necessary secondary
containment testing required for all secondary containment components for your
underground storage tank (s).
Senate Bill 989 became effective January 1,2002, section 25284.1 (California Health
& Safety Code) of the new law mandates testing of secondary containment
components upon installation and periodically thereafter, to insure that the systems are
capable of containing releases ITom 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
pennit 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.
sin2 r£dv
Steve Underwood
Fire Inspector/ Environmental Code Enforcement Officer
Office of Environmental Services
"" y~ de t50//1/;uuu(? ~t:Y<' uØb~ ..o/~ A Wedu.P?~~
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
:2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326·3941
FAX (661) 395-1349
SUPPFIESSION SERVICES
~~101 "H" Street
Bakurslìeld, CA 93301
VOICE (661) 326·3941
FA)( (661) 395·1349
PREVE,NTION SERVICES
FIRE SAFETY SER'I1CES . EIMRONIotEHTAI. SERVICES
17'15 Chester Ave.
Bakersfield. CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBI.IC EDUCATION
1715 Chester Avè.
Bakersfield, CA 93301
VOICE (661) 326·3696
FAX (661) 326-0576
FIRE INVESTIGATION
171('; Chester Ave.
Baker..flekl, CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
TRAINING DIVISION
5642 Victor Ave.
Baker.;:tleld, CA 93308
VOICE (661) 399-4697
FAX ('561) 399-5763
.
e
July 30, 2002
Mercy Hospital
2215 Truxtun Ave
Bakersfield CA 93301
REMINDER NOTICE
RE: Necessary Secondary Containment Testing Requirements by December
31,2002 of Underground Storage Tank (s) Located at
the Above Stated Address.
Dear Tank Owner / Operator:
If you are receiving this letter, you have not 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 perfonn
this test, by the necessary deadline, December 31,2002, will result in the
revocation of your pennit 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.
~
Ste e nderwood
Fire Inspector Environmental Code Enforcement Officer
""7~~ 't?~.¥OP ~on? Y~..Æ W~"
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
Balcersfield, CA 93301
VOICE (661) 326·3941
FAX (661) 395·1349
PREVENTION SERVICES
H15 Chester Ave.
Bak,ersfield, CA 93301
VOICE (661) 326-3951
FAX (661) 326'()576
ENVIRONMENTAL SERVICES
j'15 Chester Ave.
Bak9rsfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
TRJIINING DIVISION
5'542 Victor Ave.
Bakorsfield, CA 93308
VOICE (661) 399-4697
FA>: (661) 399·5763
e
e
June 30, 2002
Mercy Hospital
2215 Truxtun Avenue
Bakersfield, CA 93301
REMINDER NOTICE
RE: Necessary Secondary Containment Testing Requirement by December 31,
2002 of Underground Storage Tank located at 2215 Truxtun Avenue.
Dear Tank Owner I 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 (California
Health & Safety Code) of the new law mandates testing of secondary
containment components upon installation and periodically thereafter, to et.lsure
that the systems are capable of containing releases from the primary
containment until they are detected and removed.
Secondary containment systems installed on or after January 1,2001 will be tested
upon installation, six months after installation, and every 36 months thereafter.
Secondary containment systems installed prior to January 1, 2001 will be tested by
January 1,2003 and every 36 months thereafter. REMEMBER! Any component
that is "double-wall" in your tank system must be tested.
Secondary containment testing shall require a pennit 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 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.
sJÆ~
Steve Underwood
Fire Inspector/ Environmental Code Enforcement Officer
Environmental Services
SUIkr
""7~ ~ W~ S?'op uØ6~ ybt, J'ß W~"
fIRE CHIEF
FtON FRAZE
ADMINISTRATIVE SERVICES
2101 MH" Street
Bakersfield. CA 93301
VOICE (661) 326·3941
FAX (661) 395·1349
SUPPRIESSION SERVICES
2101 MH" Street
Bakersfield. CA 93301
VOICE (661) 326·3941
FAX (661) 395·1349
PREVI:NTION SERVICES
1715 Chester Ave.
Bakorsfield. CA 93301
VOICE (661) 326·3951
FAX (661) 326-0576
ENVIRONMENTAL SERVICES
1715 Chester Ave.
Baklarsfield. CA 93301
VOICE (661) 326·3979
FAX (661) 326·0576
TR,"NING DIVISION
~;642 Victor Ave.
Bakersfield. CA 93308
VOICE (661) 399-4697
FAX (661) 399·5763
.
e
Mercy Hospital
2215 Truxtun Avenue
Bakersfield, CA,9330 1
RE: Necessary Secondary Containment Testing Requirement by December 31,
2002 of Underground Storage Tank located at 2215 Truxtun Avenue
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 Bi1l989 became effective January 1,2002. section 25284.1 (California
Health & Safety Code) of the new law mandates testing of secondary containment
components upon installation and periodically thereafter, to ensure that the systems
are capable of containing releases from the primary containment until they are
detected and removed.
Secondary containment systems installed on or after January 1,2001 shall be tested
upon installation, six months after installation, and every 36 months thereafter.
Secondary containment systems installed prior to January 1,2001 shall be tested by
January 1,2003 and every 36 months thereafter. REMEMBER!! Any component
that is "double-wall" in your tank system must be tested.
Secondary containment testing shall require a permit issued thru this office, and
shall be performed by either a licensed tank tester or licensed tank installer.
Please be advised that there are only a few contractors who specialize and have the
proper certifications to perform this necessary testing.
For your convenience, I am enclosing a copy of the code for you to refer to. Once
again, all testing must be done under a permit issued by this office.
Should you have any questions, please feel free to contact me at (661) 326-3190.
sm;¡ rfkc
Steve Underwood
Fire Inspector/ Environmental Code Enforcement Officer
SBU/kr
enclosures
~~y~ de W~ STop ~0P6 ..rkz, A W~"
FIRE CHIEF
RON FRAZE
ADMINI~;rRATIVE SERVICES
:! 1 01 oW Street
Bakersfield, CA 93301
VOIGE (661) 326·3941
FAX (661) 395-1349
SUPPBESSION SERVICES
:2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
1'715 Chester Ave.
Bal:ersfield, CA 93301
VOICE (661) 326-3951
FJlJ< (661) 326·0576
ENVIRONMENTAL SERVICES
1715 Chester Ave,
Baltersfield, CA 93301
VO::CE (661) 326-3979
FAX (661) 326-0576
TF;tAINING DIVISION
5642 Victor Ave.
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399·5763
-
.
April 17, 2002
Mercy Hospital
2215 Truxtun Ave
Bakersfield CA 93301
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 ànd 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.
Sincereï;,~
ߣrtkv
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
SBU/dm
enclosures
--7~ de W~.Ç~ ~eve .r~ ../6 W~"
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~, 6630 R9seda1e Hwy., # ~field, CA 93308 Phòne (661) 588-e Fax (661) 588-2186
,~
MONITORING SYSTEM CERTIFICATION-,
:--~3S'
J!;'
Testing Company Name: .ß "SS R \ ,.,J C .
Sit/~ Address: b6 ~a RO~ E D A l F
, '·Î
This f.orm must be used to document testing and servicing of moÌútoring equipnÌ~t.;;" separåte certffic~Q~n Qf rq>prt, mUst be
~ed for each monitorin¡ ax-stem control panel by the technician who peiformStbe wopc...Å cp:pY orthis, fo~must bêþìôvided·tQ,
the tar1k. system owner/operåtor. The owner/operator must submit a copy of this form to the toca' a.gency regulating UST systems
within, 30 days of test date.
A. General Information . í ~ :\
Faci1í1:yName: rv1(:;'(lC...¡ "'tD~?t."Tf't L.\.....Tf2v")l.-rùI'Vj . I Bldg. ~o.:
SìteAddress: dJl~ T~\}'\.{v,^ Cíty:.ßA\(ERSF.EL~ .~ Zip:
Facili'fY Contact Persop: Clot (.\-~ l ~ Contact Phone No.: ~l
MalœlMode! ofMonitoriDg ~ n .K &,\1.¡;ß'lMODH - A - aLL Date of~ .!0.ßJ.Q2,
B. InyentoJ:Y; of Eq\1i . t TestedlCertifle I ·1
Check,thea ro date boxes.to; cate s ectOc ment lu eetedlservlced:
!"~.:~=~¿;::::.' ~,~~ <S- I ~) g1;~=-~=sonsor. ~Z:
6Y'Pil)ing Sump I Trench Sensor(s). MOdel: t&"':> - , ,t~ a Piping Sump I Trenéh Sensor(s). ,M,~el:
o Fill Sump Sensor(s). Model:' 0 PiU Sump Sensor(s). M~el:
a MachanicaJ Line Leak Detector. Model: a Mechanical Line Leak Detector. MÐdel:
Q EJ;ectronic Line 'Leak Dèt~çtor.' Model: 0 Electronic Line Leak Detector. Mode):
Q T21nk Oyerfilll High-Level Sensor. Model:, a Tank Overfill I High-Level Sensor. Model:
tJ Other" s ""'; '" ui'" èïîf' e and model in Section B on Pa e 2 . a Other i ui t and mode) in 'Section Eon Pa e 2 .
TaD~: ID: Tank ID:
tJ In-Tank Gauging Probe. Model: Q IÌ1-Tank Gauging Probe. Model:
o Annular Space or Vault Sensor. Model: Q Annular Space or Vault Sensor. Model:
tJ Piping Sump I Trench Sensor(s). Model: Q Piping Sump I Trench Sensor(s). Model:
Q Fill Sump Sensor(s). Model: Q Fill Sump Sensor(s). Model:
Q Mechanical Line Leak Detector. Model: Q Mechanical Line Leak Detector. MOOel:
Q Bi/ectronic Line Leak Detector. Model: a Electronic Line Leak Detector. Model:
o T:ank Overfill I High-Level Sensor. Model: Q Tank Overfill I High-Level Sensor. Model:
Q Other eci ui ment e and model in Section B on Pa 2. Q Other s çi ui ent e and model in SeCtionB onP e2.
Dispenser ID: Dispenser ID:
Q Oispenser Containment Sensor(s). Model: Q Dispenser Containment Sensor(s). Model:
a Shear Valve(s). a Shear Valve(s).
a Dis eoser Containment Floa s and Chain s . 0 Di r Containment Flo s and Chain s .
Dlsplenser ID: Dispenser ID:
o Dispenser Containment Sensor(s). Model: Q Dispenser Containment Sensor(s). Model:
Q Shear Valve(s). Q Shear Valve(s).
Q Di er Containment Floa s and Chain s . 0 Dis nser Containment Float s and Chain s .
Disllcnser ID: Dispenser ID:
a Dispenser Containment Sensor(s). Model: Q Dispenser Containment Sensor(s), Model:
Q Shear Valve(s). a Shear Valve(s}. '
ODis nser Containment Float s and Chain s . 0 Dis ser Containment Float s and Chain s .
*rr the facility contains more t\1nks or dispensers, copy this form. Include information for every tank and dispenser at the facility.
C. Certification - I eertUy that the equipment identified in this document, was inspected/serviced in aeeordanee with the
DIanufactllrerst gulde1b1es. Attached to this, Certification is Information (e.g. manufacturers' ebedcJlsts) necessary to verify that this
information is eorrect and a Plot Plan showing the layout of monitoring equipment For' any equipment capable of generating such
repom, I bave mso attaehed a eopy of the report; (checlr.1lII that apply): 0 Smem ~t-up L Q AJ~ history rep?rt
Te<:hnicianName(print): (. DEL CAt<.T21 t ~D Signature:~lt__ Co CJ..Li'...l.,,.t. IS
Certification No.: License. No.: 6 -::¡ 2B , -;;L
,~,~:';.,::Phone No·:CU.Lt5.B8 - :l":] -; '1
H:N \j ~ ,t6 ""it" Date of Testing/Servicing: 3-/ ß/02-
" '>
Mf)nltorlng System Certification
Page t Of~
03/0t
\
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'f}. Reslldts ofTestingtServicing' e
Software V ers'i~ Installed:
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Com lefg the followin cheekltst:
a No· Is the audible almn 0 erational?
o No* Is the visual alarm 0 erational?
Q No'" Were aU sensors visual1' ected functionaU tested and confirmed 0 rational?
Q No· Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will
not interfere with their r ration?
If alarms are relayed to a remote monitoring station, is aU communications eqt,Jipment (e.g. modem)
operational?
For pressurized piping systems, does the turbine automaticaJly shut down if the piping secondary containment
monitoring system detects a leak, tàiJs to operate, or is electrically disconnected? If yes: which sensors initiate
positive shut-down? (Check all that apply) IJ SumplJ'reJich Sensors; (J Dispenser Containment Sensors.
Did ou contum itive shut-down due to leaks sensor failure/disconnection? (J Yes' CJ No.
eYes IJ No· For tanJt systems that utilize the monitoring system as the primary tank ovediJ] wáìni:rig device (i;~. 'no
Q N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and 'audible at thØ·tâDk
fill in s and o' erl ? If so at what of tank aei does the tri er? I '%
e Yes'" a No Was any monitoring eqµipment replaced? If yes, identify specific sens~,probes, or otherequipinent replaced
arid list the manufacturer name and model for all II lacement arts in Section B below. ," !'
a Yes* a No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)
(J Produc (J Water. If es describe causes in Section E below. '
es a No* Was I11Onito . stem set-u reviewed to ensure :to r se' s1 Attach set u 1icable . ,
Yes (J No·, Isa11monito' . mento erational ermanufacturer's ecitications?,
to In See1!ion E belowt desërlbe'how and when these deficlendeswere or will be correèted.
Q Yes
a No'"
I!I Nt A
a No·
a N/A
[J Yes
,(
E. C01mnents:
, ():
", ',."
..
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:, .'
"
Page 2 Off~
03/01
\
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·F.. In-1fank Gaugin~ I SIR Equi.t:
y
~./-Check this box if tanJ6ging is used only for inventory control.
ur Check this box if no tIP gauging or SIR equipment is installed.
This ~~~OO'~U~ be completed if in-tank gauging equipment is used to perform leak detection monitoring.
~ '
c
thiiUwin b kll
"."
omolete e 0 0 ISlC ee st: ' ,
a Yes a No* ,Has all 'input wiring been inspected for proper entry and termination, including testing for ground faults?
a Yes (J No'" Were an tánk gauging probes visually inspected for daJpage and residue buildup?
a Yes o No'" Was accuracy of system product level readings tested?
a Yes a No'" Was accuracy of system water level readings tested? , ¡
a Yes a No'" Were all probes reiustalled propèrly?
o Yes (J No'" Were an itemS on the equipment manufacturer's maintenance checklist completed?
* In the ;Section ~ below, describe how and when these deØclendes were or will be corrected.
G. Line Leak Detectors (LLD):
C 1 th f¡ nowl 'tJ¡ kIt
19"'Chec.k. this box if Lills are not installed.
OmÞle1:e e 0 n21, ee st:
IJ Yes CJ No'" Foi; equipment s1art-up or annual equipment certificatiou, was a leak simulated to verify LLD perfonnance?
(J N/A (CJleck all that apply) .S:imuJated leak rate: (J 3 g.p.h.; CJ 0.1 g.p.h; [J 0.2 g.p.h.
¡ "
(J Yes (J No'" Were all LIDs confirmed operational and accurate w:i1:hin regulatory requirements?
(J Yes· (J No· Was the testing appamtus properly calibrated?
Q Yes (J No* For mechanical LLDs. does the LLD restrict product flow if it detects a leak?
Q N/A
Q Yes (J No'" For electronic LLDs. does the turbine automatically shut off if the LID detecœ a leak?
o N/A .
a Yes (J No'" For electronic LLDs. does the turbine automatically shut off if any portion of the monitoring s~ is disabled
CJ N/A or disconnected?
Q Yes (J No'" . For electronic LLDs. does the turbine automatically shut off if any portion of the monitoring system
IJ NIA malfunctions or fails a test?
Q Yes o No'" For electronic LLDs. have all accessible wiring connectiöns been visually inspected?
aN/A
a Yes (J No'" Were all, items. on the equipment manufacturer's nlaintenanc,e checldist çoníp1.eted? ..
-- ,
* In the Section B, below, describe bow and when these deficleneies were or will be eorreeted.
H. Comments:
Page 3 of Vi
03/0 I
~
Monitòi'iing System Certifteation
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· . . -~ L5+ti . USl)r0nttOrlng Site Plan
Site Add1b1: LLy;t<.tN\ jO (\.v.~
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Date map was drawn: :JL! \ '3 / 0 ~
¡1I~tructions
If you already have a diagram ~t. shows all required information, you may include it, rather than this page, with your
MQnitoling System Certification. On your site plan, show the general layout of tanks and piping. 'Clearly identify
locatioIJ:S of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular
spaces, sumps, dispenser pans, spill containers, or other se~ndary containment areas; mechanical or electronic line leak
detectors; and ìn:tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan
was pre:pared. .
Page 1- of ~
OSlOO
Comp/~te ite~s 1, 2, and 3. Also ComPlete
It~m 4 If Restncted Delivery is desired.
o Pont YOu, na.." and add,." On the "".""
So that We Can return the card to you
o Attach th;s _ fo the baok of the ",,"Ip~
Or on the front if space permits. ,
I 1. Article Addressed to:
o Agent
o Addressee
o Yes
ONo
l{IT'l'Y~RINGER
IfERCf HOSPITAL
247'RltYTuN AVE
BAlCERSFIELD CA 93301
3. ~rvice Type
r!} Certified Mail 0 Express Mail
o A","_ 0 A",,", A_Of"" Moo,,",", '
o Insured Mail 0 C.O.D.
4. Restricted Delivery? (Extra Fee)
o Yes
2, Article Number (COpy from service label)
, 7000 1530 0006 3456 3355
' PS Form 3811, JUly 1999
Domestic Return Receipt
102595'99'M'1789
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Postage $ .34
Certified Fee 2.10
Postmark
Return Receipt Fee :L50 Here
(Endorsement ReqUired)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees $ 3.94
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U" Sent To
I r; KITTY RINGER.
I g Š;;ëëfÄ~~1~Õ~~"~;;~'~"""""""""""""""'"..........
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FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 oW Street
Baltersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395·1349
SUPPI~ESSION SERVICES
2101 MHn Street
Ba~:ersfield, CA 93301
VOICE (661) 326·3941
FAX (661) 395·1349
PREVENTION SERVICES
1.'15 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326·3951
FAK (661) 326-0576
ENVIRONMENTAL SERVICES
1715 Chester Ave.
Bakørsfield, CA 93301
VOICE (661) 326·3979
FAJ( (661) 326·0576
TR ,INING DIVISION
51542 Victor Ave.
BakElrsfield. CA 93308
VOICE (661) 399·4697
FAX (661) 399·5763
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February 20, 2002
Kitty Ringer
Mercy Hospital
2215 Truxtun Ave
Bakersfield, CA 93301
CERTIFIED MAIL
NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE
RE:
Failure to SubmitlPerform Annual Maintenance on Leak Detection
System at Mercy Hospital, 2215 Truxtun Ave
Dear Ms. Ringer:
Our records indicate that your annual maintenance certification on your leak
detection system is past due. December 29,2001.
You are currently in violation of Section 2641(J) of the California Code of
Regulations.
"Equipment and devices used to monitor underground storage tanks shall be
installed, calibrated, operated and maintained in accordance with manufacturer's
instructions, including routine maintenance and service checks at least once per
calendar year for operability and running condition."
You are hereby notified that you have thirty (30) days, March 22, 2002, 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.
Should you have any questions, please feel free to contact me at 661-326-3190.
Sincerely,
Ralph Huey
Director of Prevention Services
by' ~ riW
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
cc: Walter H. Porr Jr., Assistant City Attorney
··Y~ de W~ 370P ~0Pe .rbt- A W~"
·
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAME---11'\(t'(Y
tf(}!?~{
INSPECTION DATE
I ~/1l &,
I
Section 2:
Underground Storage Tanks Program
o Routine ¡:gfombined 0 Joint Agency
Type of Tank (\UH=C:S
Type of Monitoring é¡...UA.
o Multi-Agency 0 Complaint
Number of Tanks (
Type of Piping 1llv¡::
ORe-inspection
OPERA TION C V COMMENTS
Proper tank data on tile t.. /
Proper owner/operator data on file v /'
Pelmit fees current i/ /
Certification of Financial Responsibility L. 0
Monitoring record adequate and current /
V
Maintenance records adequate and current i/ /
/
Failure to correct prior UST violations /
V
Has there been an unauthorized release? Yes No \ /
Sedion 3:
Aboveground Storage Tanks Program
TANK SIZE(S)
Type of Tank
AGGREGATE 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 overfill/overspill protection?
Inspector:
Oftìce of Environmental Services (805) 326-3979
White· Env, Sves.
Pink - Business Copy
C=CompJiance
N=NO
JRN. 22. 2001 11 : 06RM ENGINEERING SERVICES NO. 636 P.l
,ì II II
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Cailiolic He~ilicare West
+CHW
Mercy Hosplbl
2215 TNxtun Avc:nue
P.O. Box 119
Bakersfield. CA 93302
(661) 632·5973 Telephone
(661) 326-0104 Façsimilc
cboyles@chw.cdll E-mail
Charlie Boyle5
Coordinator!
1?la1\1 Operations
IPacilities Manaceme
Fax
CHW Central
California - Mercy
Hospital Bakersfield
To: ~\\Z.Ù~ GJ\.IùE.Q..WOOC'\
f:'.: 3;2~ -OS ì ~
Phone: ~ ::lCo.. .3 q ( c¡
FfOM: C t-\AQ..(, ~ ~'l \..E';.
Date: \.. ~ :1 . a ,
Pages: ~
Re:t). F\ ~~ ~1 \.C\ c... Sfs eCI
o Urgont ~or Review 0 Please Comment D '....se Roply
o Please Recycle
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JRN.22.2ØØl 11:Ø6RM
ENGINEERING SERVICES
NO. 636
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Invoic(Ð
Invoice Number:
HU~ E:NTERPt{ I SI~S
2014 SOc UNION AVENUE
I'~ r'l j II~ "'ï
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BAKERSFIED, CA 933Ø7
USA
Invc;)içe Date:
Dl~C . ,1.4 ~ 2ØØØ
F'agl<? :
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V~ice: 661/834-11ØØ
Fax: 661/834-4216
r:ìolc:l '1"0:
MERCY HOSPITAL-ENGINEERINS
P.O" BOX 1J.9
BA~ERSFIELD, CA 93302-Ø119
USA
Ship 1:0:
TRUX'fLlN AVE
CustcHner IV
'1ERCY
Cl.lstc;)mer PO
¡<EN/CHARLIE
Payment "rerms
Net 15 Days
8al(jo~js Rap lD
Shi pping l'1ethod
None
Ship Dð'b?
Due Dat~
12/29/0Ø
Extl?ns,i.Ón
Quantity Item
.1 . I2!Ø WSC 4420
Dt:'l'r.;c: ri pt:i.Qn
INSTALLED PARTS .WI
CUSTOMER AUTHORIZATION
REPLACE LAL 81 SENSOR ON
LEAK ALERT MONITOR
1.0Ø USD LALS-l LIQUID SENSOR
1.0Ø VEE 05141ØØ-304SEALING PACK I VEEDER ROOT
1.0Ø MIS CLEAN ElECT/ MECH 12 KLEEN
1.ØØ MIS ØZ11ØØ-12 JET AIR
2.50 LABOR 7 ELEC. TECH/ALL CONTRACTS
- RATE tECH # 34 29 DEC øø
1.0Ø ZONE 2 MILEAGE/TRAVEL TIME DRIVER
.!f. THUCI<
TEST FOR PROPER OPERATION
TEST UNIT FOR PROPPER
OPPERATION, NOTE UNIT IS
IN COMPLIANCE FOR YEAR.
WILL SET UP RETEST FOR
NE:XY YEAR.
Ulií t PI'-ir.::e!
3ØØ.0Ø
_ 9.89
6.87
8..50
15Ø.ØØ
3Ø0..ØØ
9.89
6.S7
8.50
bf2\.ØØ
31l!.ØØ
::,0 . øø
1.ØØ WSC 443121
RECEIVED
JAW 19 ,at31
MeRCY HOSPfH\. _ _
l"I""f.RI~G SfRVIGI:. .
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Subtotal
Sales Tax
Total Invoice Amount
5Ø5.2b
22.77
528.03
Cheçk No:
Payment Re~~ived
TOTAL
528.Ø3
PAY FROM THIS INYOICE/ NO STATEMENT WILL BE SENT! ! ~ !
JRN. 22. 2001 11:06RM
ENGINEERING SERVICES
NO. 636
P.3
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I~~LW ENTEHPRI8ES
I 2014 SO~ UNION AVENUE
Inv(¡ice Number:
Ii" 1 ~r "
ì J ,'1 i
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BAKERSFIED, CA 93307
USA
111VC)ir.:e1 Pat.e=
Dee 1."1·, 20Ø\Zl
,
Voice: 6bl/834-11ØØ
Fax; 661/834-4216
F:lag~~=
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Sold To:
MERCY HOSPITAL-ENGINEERING
P"O. BOX 1J.9
BAKERSFIELD~ CA 93302-0119
USA
Ship t:o:
SOUTH WEST LOCATION
CHARILE OR ENG ON DUTY
6:~2
Cus'tome '" rD
MI:;:r.;:Cy
Custom~1'" PO
KEN/CHARLIE
Payment "fenns
NI::l't 15 Days
Sales Rep ID
Shipping '1ethocl
None
Ship D¡;\te
Quantity Item Dsscription
1.0Ø WSC 4420 INSTALLED PARTS WI
CUSTOMER AUTHORIZATION
F~EPLACEMENT BULBS IN DC
SYSTEM REPLACF.~
ANNUNCIATDR F'HE-:UI"IORCATm~
5Y5TE:I'1
1.00 PNE 553503-1 ANNUNCIATOR
1.ØØ MIS CLEAN ELECT/ MECH 12 KLEEN
1.00 VEE 05141ØØ-3Ø4SEALING PACK / VEEDER ROOT
2.0Ø LABOR 7 ELEC. TECH/ALL CONTRACTS
RATE #34 29 DEC øø
1.0Ø ZONE 2 MILEAGE/TRAVEL TIME DRIVER
& TRUCK
1.ØØ INFO EQUIPMENT PASSE ANNAUl
INSPECTION FOR CALENDAR
Yl~AF~ . WI U. SET UP Rt:;--'"EST
FOR NEXT YEAf~ 1
Unit Pr'ice
D~~ Date
12/29/øØ
E:xtel"~siQn
125"Øø
t..-..87
9.89
6IZJ.ØØ
125.Ø0
I,) . 87
9.89
,t2ø .øø
3:Ø . øø
~~ø . øø
,. Y', RECEßV!::D
~.PAN 1 9 21701
MERe : ,'m~':'I"! "
t:NGtNEE~Ij\''''' :: .: ~ . <.
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Subtotal
Sales Ta~\
Total Invoice Amount
291.76
9.92
301.68
Ct1(~d~ No:
Payment Received
TOTAL.
3Ø1.68
PAY FROM THIS INVOICEI NO S"rATEME:I\IT I...¡ILL BE SENT! ! ! !
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.
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAME (V\r.-rc. 'f l+~{
INSPECTION DATE i ,II ì /00
Sedion 2:
Underground Storage Tanks Program
o Routine ¡j Combined 0 Joint Agency
Type of Tank nwFc..s
Type of Monitoring tLM
o Multi-Agency
Number of Tanks
Type of Piping
o Complaint
I
()Ul ,-=
ORe-inspection
OPERA TION C V COMMENTS
Proper tank data on tile v'
Proper owner/operator data on tile V
Pennit fees current V
Certification of Financial Responsibility V
Monitoring record adequate and current V
Maintenance records adequate and current .¡ twA-OM¿,.r hllll -ht.j( ¡4,iJDV-fO o{4
. .
Failure to correct prior UST violations
Has there been an unauthorized release? Yes No
c(..
Section 3:
Aboveground Storage Tanks Program
TANK SIZE(S)
Type of Tank
AGGREGATE CAPACITY
Number of Tanks
OPERA TION Y N COMMENTS
spec available
spec on file with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?
¡fyes, Does tank have overfiJlloverspill protection?
C=Compliance V=Violation Y=Yes N=NO
I"'pcet"' _~, dJWJ()
Oftïce of Environmental Services (805) 326-3979
White· Env. Sves.
Pink - Business Copy
'"
CITY OF BAKERSFIELD
.ICE OF ENVIRONMENTA.RVICES
1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
e
UNDERGROUND STORAGE TANKS - UST FACILITY
TYPE OF ACTION
(Check one #em only)
s{'RENEWAL PERMIT
o 4, AMENDED PERMIT
o 1, NEW SITE PERMIT
o 5. CHANGE OF INFORMATION (Specify change,
local use only)
D 6, TEMPORARY SITE CLOSURE
I
i
I
BUSINESS NAME (Same as FACILITY NAME or DBA· Doing 8usiness As)
I rY\ ES- Q(.. i \-tOSP \ \A '-
I NEAREST CROSS STREET
II J.I;.. S\
BUSINESS D 1. GAS STATION
I TYPE
o 2, DISTRIBUTOR
I. FACILITY I SITE INFORMATION
3
FACILITY 10 II
401,
~~{\
FACILITY OWNER TYPE
~ 1. CORPORATION
IT2, INDIVIDUAL
D 3, PARTNERSHIP
o 3, FARM D 5, COMMERCIAL
o 4. PROCESSOR R.6, OTHER 403,
TOTAL NUM8ER OF TANKS
REMAINING AT SITE
\
'If owner of UST a public agency: name of supervisor 0'
dh¡jsion, sectioo or office which operates the UST.
(This is Ihe contact person for the tank records.)
Is facilily on Indian Reservation or
trust/ands?
404.
Dyes
No
405.
t=
PROPERTY OWNER NAME
\'~ <é-Qé; OS~'\\A.L
MAILING Of¡ STREET ADDRESS
I ,?'d::\S ~-y.\\.Jd\
~'J_ ~ ç\...C)
PROPERTY OWNER TYPE
t2í.1. CORPORATION
II. PROPERTY OWNER INFORMATION
Aùb.
410.
STATE
CA
D 4, LOCAL AGENCY I DISTRICT
o 5, COUNTY AGENCY
o 2, INDIVIDUAL
o 3, PARTNERSHIP
III. TANK OWNER INFORMATION
TANK OWNER NAME
SA('('...~
Lls
.
¡/160¡Jb
MAILING OFt STREET ADDRESS
CITY
417, I STATE
D 4, LOCAL AGENCY I DISTRICT
o 5. COUNTY AGENCY
TANK OWNER TYPE
o 2, INDIVIDUAL
o 3. PARTNERSHIP
o 1. CORPORATION
IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER
TY(TK)HQ
Call (916) 322-9669 if Questions arise
V. PETROLEUM UST FINANCIAL RESPONSIBILITY
INDICATE METHOO(S)
"þa 1. SELF·INSURED
o 2, GUARANTEE
o 3. INSURANCE
o 4. SURETY BOND
o 5. LETTER OF CREDIT
o 6. EXEMPTION
o 7, STATE FUND
D 8, STATE FUND & CFO lETTER
09. STATEFUND&CD
VI. LEGAL NOTIFICATION AND MAILING ADDRESS
Check one b')X to indicate which address should be used lor legal notifications and mailing.
Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked.
Page _ 01 _
o 7, PERMANENTLY CLOSED SITE
o 8, TANK REMOVED 400,
o 4. LOCAL AGENCY'DISTRICT'
o 5, COUNTY AGENCY'
o 6. STATE AGENCY·
o 7, FEDERAL AGENCY'
402,
406.
407,
PHONE 408.
(p J' G.5~ -5000
409,
411.
ZIP CODE 412,
Q330 I
o 6. STATE AGENCY 413,
D 7, FEDERAL AGENCY
414, I PHONE
415,
416,
418./
ZIP CODE
419,
D 6, STATE AGENCY
o 7. FEDERAL AGENCY
420,
421.
o 10, LOCAL GOVT MECHANISM
o 99, OTHER:
422,
o 1. FACILITY
1!!l2. PROPERTY OWNER
03, TANK OWNER 423,
VII. APPLICANT SIGNATURE
PHONE
b32- 597.2
LAr(\' O~~ìO/l
425.
427,
I STATE UST FACILITY NUMBER (Forlaea' USl/ only)
UPCF (7/99)
428,
429,
S:\CUP AFORMS\swrcb-a. wpd
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'_.:AIIII~ "--
. CITY OF BAKERSFIELD_
OFF!r:E OF ENVIRONMENTAL SeR'VICES
1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
UNDERGROUND STORAGE TANKS - TANK PAGE 1
(Specify change· for 'oca' use only)
Page of
o 6, TEMPORARY SITE CLOSURE
o 7, PERMANENTLY CLOSED ON SITE
o 8, TANK REMOVED
430
TYPE OF ACTION
(Check one item only)
o 1, NEW SITE PERMIT 0 4, AMENDED PERMIT
o 5, CHANGE OF INFORMATION)
(Specify reason· for loca' use only)
BUSINESS N'AME (Same as FACILITY NAME or DBA - Doing Business As)
S3, RENEWAL PERMIT
3
----------.---
~QC-
LOCATION WITHIN SIT
A.'-
431
,
!
I
I
i TANKID#
!
I. TANK DESCRIPTION
\
¡ DA TE INSTALLED (YEARlMO)
tC\8G\
432
TANK MANUFACTURER
~OO'R
TANKCAðœõ
433
COMPARTMENTALIZED TANK 0 Yes )(.NO 434
" ·Yes·, complete one page for each compartment.
NUMBER OF COMPARTMENTS 437
~
435
436
I
i
I ADDITIONAL DESCRIPTION (For local use on'y)
!
,
438
II. TANK CONTENTS
, TANK USE 439 PETROLEUM TYPE 440
i 0 1, MOTOR VEHICLEFUEL o 1a. REGULAR UNLEADED o 2, LEADED o 5, JET FUEL
i (If marl<ed, complete Petroleum Type) D 1b, PREMIUM UNLEADED ~3, DIESEL o 6, AVIATION FUEL ,
,
¡ 0 2, NON·FUEL PETROLEUM o 1c. MIDGRADE UNLEADED D 4, GASOHOL D 99. OTHER
D 3, CHEMICAL PRODUCT
104, COMMON NAME (from Hazardous Matenals 'nventory page) 441 CAS # (Irom Hazardous Malenals Inventory page) 442
HAZAHDOUS WASTE ('nc'udes 1*2 ~
i Used On) ~ L p.¡JÙ, «. DlbSG L
I 0 95. UNKNOWN
I III. TANK CONSTRUCTION
i TYPE OF TANI< D 1. SINGLE WALL D 3. SINGLE WALL WITH D 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443
I (Check one item on'y) ~, DOUBLE WALL EXTERIOR MEMBRANE LINER D 95. UNKNOWN
¡ D 4. SINGLE WALLIN A VAULT D 99, OTHER
I TANK MATERIAL· primary tank D 1. BARE STEEL ;&l3. FIBERGLASS I PLASTIC D 5. CONCRETE o 95. UNKNOWN 444/
(Check one item only) D 2, STAINLESS STEEL D 4, STEEL CLAD WIFIBERGLASS D 8. FRP COMPATIBLE W/100% METHANOL D 99, OTHER I
I
L
TANK MATERIAL· secondary lank D 1. BARE STEEL
(Check one item only) D 2. STAINLESS STEEL
D 1. RUBBER LINED
D 2. ALKYD LINING
REINFORCED PLASTIC FRP
·-8...3, FIBERGLASS I PLASTIC
o 4. STEEL CLAD W/FIBERGLASS
REINFORCED PLASTIC (FRP)
o 5. CONCRETE
D 3, EPOXY LINING
o 4. PHENOLIC LINING
D 8. FRP COMPATIBLE W/100% METHANOL
D 9, FRP NON-CORRODIBLE JACKET
D 10. COATED STEEL
D 95. UNKNOWN
o 99, OTHER
445
TANK INTERIOR LINING
OR COATING
D 5. GLASS LINING
o 6. UNLINED
18195, UNKNOWN
D 99, OTHER
446
DATE INSTALLED
447
SPILL AND OV!:RFILL
451
(For local use only)
OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED
095, UNKNOWN
o 99, OTHER
448
449
(Check one item on'y)
D 1. MANUFACTURED CATHODIC
PROTECTION
o 2. SACRIFICIAL ANODE
YEAR INSTALLED
o 3. FIBERGLASS REINFORCED PlASTIC
o 4, IMPRESSED CURRENT
450 TYPE (For 'oca' use only)
452
(Check all that apply)
b
I' IF SINGLE WALL TANK (CheCk all that app'y):
I' D 1. VISUAI_ (EXPOSED PORTION ONLY)
D 2, AUTOMATIC TANK GAUGING (ATG)
I 0 3, CONTINUOUS ATG
I 0 4. STATISTICAL INVENTORY RECONCILIATION (SIR) +
e/ENN,'AL TANK TESTING
\-----
-g¡.1.
02,
D 3.
DROP TUBE
D 2. BALL FLOAT
-
SPILL CONTAINMENT
D 1. ALARM
-
D 3, FILL TUBE SHUT OFF VALVE _
D 4. EXEMPT
STRIKER PLATE
·".:v·
lv~tÀNK LËAKÒE~òN'
453
IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): 454
D 1, VISUAL (SINGLE WALLIN VAULT ONLY)
2, CONTINUOUS INTERSTITIAL MONITORING
o 3. MANUAL MONITORING
, ,
D 5, MANUAL TANK GAUGING (MTG)
D 6. VADOSE ZONE
o 7, GROUNDWATER
o 8, TANK TESTING
o 99, OTHER
V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE
---"-'--~--'-----
ESTIMATED DATE LAST USED (YRIMO/DAY)
455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING
456 TANK FILLED WITH INERT MATERIAL?
457
gallons
Dyes
DNa
UPCF (7/99)
S:\CUPAFORMS\SWRCB-B.WPD
p
L
.........,...'......Qt"t::.~ .
, CITY OF BAKERSFIELD , ,
. OFFICE OF ENVIRONMENTAL SERVICES.
15 Chester Ave., Bakersfield, CA 93301 (661) 3~79
Page
UST· TANK PAGE 2
of
UNDERGROUND PIPING
VI. PIPING CONSTRUCTIoN (Check .n thet .pply)
ABOVEGROUND PIPING
, SYSTEM TYPE 0 1. PRESSURE ~, SUCTION 0 3, GRAVITY 458 0 1. PRESSURE
: CONSTRUC nON/ 0 1. SINGLE WALL 0 3. LINED TRENCH 0 99, OTHER 460 0 1. SINGLE WALL
; MANUFACTURER 0 2, DOUBLE WALL 0 95, UNKNOWN 0 2. DOUBLE WALL
i MANUFACTURER 461 MANUFACTURER
I 0 1, BARE STEEL 0 6. FRP COMPATIBLE W/1 00% METHANOL 0 1, BARE STEEL
I MATERIALS AND 0 2, STAINLESS STEEL 0 7, GALVANIZED STEEL 0 2, STAINLESS STEEL
CORROSlml
, PROTECTION 0 3, PLASTIC COMPATIBLE WITH CONTENTS 095, UNKNOWN 0 3. PLASTIC COMPATIBLE WITH CONTENTS
~ 4, FIBERGLASS 0 8. FLEXIBLE (HDPE) 099. OTHER 0 4. FIBERGLASS
05. STEEL WI COATING 09, CATHODIC PROTECTION 464 05, STEEL WI COATING
VII. PIPING LEAK DETECTION (ChBck a8 that apply)
o 16. ANNUAL INTEGRITY TEST (0.1 GPH)
o 17. DAILY VISUAL CHECK
"',f"" ,', ""·'i, ,,',i';)<'i(\i"'Iî.ÒIS~ENSER~AlNM.~~~:+( .,."
o 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE
o 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS
o 3, CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS
UNDERGROUND PIPING
I SINGLE WALL PIPING 466
I PRESSURIZED PIPING (Check all that apply):
o 1, ELECTRONIC LINE LEAK DETECTOR 3,0 GPH TEST ~ AUTO PUMP SHUT OFF FOR
LEA~:, SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL
ALAF:MS
o 2. MONTHLY 0.2 GPH TEST
I 0 3, ANNUAL INTEGRITY TEST (0,1 GPH)
CONVENTIONAL SUCTION SYSTEMS:
o 5, DAIL" VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY
TEST (0,1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING):
o 7, SELF MONITORING
GRAVITY FLOW:
o 9, BIENNIAL INTEGRITY TEST (0.1 GPH)
SECONDARJL Y CONTAINED PIPING
PRESSURIZED PIPING (Check all that apply):
10. CONllNUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND
(ChØ(x one) -
o a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
o b, AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM
DISCONNECTION
o c, NO AUTO PUMP SHUT OFF
o 11, AUTOMATIC LINE LEAK DETECTOR (3,0 GPH TEST) WITH FLOW SHUT OFF OR
RESTRICTION -
o 12, ANNUAL INTEGRITY TEST (0,1 GPH)
SUCTION/GR!\VITY SYSTEM:
o 13, CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS
EMERGENCY GENERATORS ONLY (Check all that app'Y)
o 14, CONTINUOUS SUMP SENSOR JCillI:!Q!.!I AUTO PUMP SHUT OFF + AUDIBLE AND
VISUAL ALARMS
o 15. AUTOMATIC LINE LEAK DETECTOR (3,0 GPH TEST) WITHOUT FLOW SHUT OFF OR
, RESTFUCTlON
1J)jt 16, ANNUAL INTEGRITY TEST (0,1 GPH)
17 , DAILY VISUAL CHECK
DISPENSER CDNTAINMENT
OA TE INST A'LLED
468
o 2. SUCTION
o 95, UNKNOWN
o 99. OTHER
o 3, GRAVITY
459
462
463
o 6, i=RP COMPATIBLE W'100% METHANOL
o 7, GALVANIZED STEEL
o 8, FLEXIBLE (HDPE) 0 99, OTHER
o 9. CATHODIC PROTECTION
o 95, UNKNOWN
465
ABOVEGROUND PIPING
SINGLE WALL PIPING 467
PRESSURIZED PIPING (Check all that app'Y):
o 1. ELECTRONIC LINE LEAK DETECTOR 3,0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,
SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS
o 2. MONTHLY 0.2 GPH TEST
o 3. ANNUAL INTEGRITY TEST (0,1 GPH)
o 4. DAILY VISUAL CHECK
CONVENTIONAL SUCTION SYSTEMS (Check all that app'Y):
o 5, DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM
o 6. TRIENNIAL INTEGRITY TEST (0,1 GPH)
SAi=E SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING):
o 7. SELF MONITORING '
GRAVITY FLOW (Check all that app'Y):
o 8. DAILY VISUAL MONITORING
o 9, BIENNIAL INTEGRITY TEST (0,1 GPH)
SECONDARILY CONTAINED PIPING
PRESSURIZED PIPING (Check all that apply):
10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (chedl one)
o a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
o b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM i=AILURE AND SYSTEM DISCONNECTION
o c. NO AUTO PUMP SHUT OFF
o 11. AUTOMATIC LEAK DETECTOR
o 12. ANNUALlNTEGRITY TEST (0,1 GPH)
SUCTION/GRAVITY SYSTEM:
o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS
EMERGENCY GENERATORS ONLY (Check all that app'Y)
o 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL
ALARMS
o 15, AUTOMATIC LINE LEAK DETECTOR (3,0 GPH TEST)
::./'.-'"
,',/,,'.:':
,,', ':.....
o 4. DAILY VISUAL CHECK
o 5, TRENCH LINER I MONITORING
o 6, NONE 469
IX. OWNER/OPERATOR SIGNATURE
I certify that the intormatlon provided herein is true and accurale 10 I e besl ot my knowtedge,
SIGNATURE OF 0 PE TOR "
Permit Numbe ' (For local use only)
473 Permit Approved (For local use only)
UPCF (7/99),
471
è))<=Q.t.\fi~
472
DATE
470
474 Permit Expiration Dale (For local use only) 475
S:\CUPAFORMS\SWRCB-B.WPD
'~
-
-
.~ .
RLW ENTERPRISES
2014 so UNION AVE #107
BAKERSFIELD. CA 93307-4154
Invoice Number: 52117
Invoice Date: Sep 13, 1999
Page: 1
Voice (805) 834-1100
FaXt (805) 834-4216
Sold To:
MERCY HOSPITAL-ENGINEERING
P.O. BOX 119
BAKERSFIELD, CA 93302-0119
USA
Customer ID
MERCY
Customer PO
KEN/CHARLIE
Payment Terms
Net 15 Days
Sales Rep ID
Shipping Method
None
Ship Date
Quantity Item
Description
Unit Price
Due Date
9/28/99
Extension
1. 00 WSC 4430
1.00 INFO
TEST FOR PROPER OPERATION
TANK MONITOR SYSTEM AT
BOTH HOSPITAL LOCATIONS
TEST DOWN TOWN FACILITY
FOR COMPLIANCE
MILEAGE/TRAVEL TIME
DRIVER/TRUCK TRAVEL TIME
TO DOWN TOWN FACILTY
TEST OF SYSTEM FOR
COMPLIANCE
MILEAGE/TRAVEL TIME DRIVER
& TRUCK TRAVEL TO OLD
RIVER FACILTY
NOTE BOTH SYSTEMS ARE
OPPERATING AS PER
SPECIFICATIONS
60.00 60.00
25.00 25.00
60.00 60.00
30.00 30.00
1.00 LABOR 2
1.00 ZONE 1
1.00 LABOR 2
1.00 ZONE 2
THIS IS TO CERTIFY THAT THE Subtotal 175.00
WORK WAS SATISFACTORILY Sales Tax
COMl)LETED. Total Invoice 175.00
ACCE:PTED
Payment 0.00
Check NOt TOTAL 175.00
PAY FROM THIS INVOICE/ NO STATEMENT WILL BE SF-NT 1 I I 1
'"
-
e
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAME.-1Ylct'c "/
H-OGf ,4J
INSPECTION DATE 8 - d3~ ,.1
Section 2:
Underground Storage Tanks Program
o Routine 0 Combined [](Joint Agency
Type of Tank t1.l1FCS
Type of Monitoring t-t..M
o Multi-Agency 0 Complaint
Number of Tanks I
Type of Piping (}().1 F
ORe-inspection
OPERA nON c v COMMENTS
Proper tank data on tìle if
Proper owner/operator data on file V "
Permit fees current vi
Certification of Financial Responsibility vi
Monitoring record adequate and current vi
Maintenance records adequate and current V (i upJe IN r l1li(1., ( ~II D \I
vi .
Failure to correct prior UST violations
Has there been an unauthorized release? Yes No /'iO
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 file with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?
If yes, Does tank have overfill/overspill protection?
C=Compliance V=Violation Y=Yes N=NO
Inspcoto,L (~
Oftìce of Environmental Services (805) 326-3979
White - Env. Svcs.
t
onsible Party
Pink - Business Copy
FIRE CHIEF
RON FRAZE
ADMINISTRAT1VE SERVICES
:l101 'W Street
Bakersfield, CA 93301
VOICE (805) 326-3941
FAX (805) 395-1349
SUPPFtESSION SERVICES
~~101 'H" Street
Bak.,rsfleld, CA 93301
VOICE (805) 326-3941
FAX (805) 395-1349
PREV1:N1l0N SERVICES
1715 Chester Ave,
BakEtrsfl8ld, CA 93301
VOIC:E (805) 326-3951
FA>: (805) 326-0576
ENVlROPlMENTAL SERVICES
17'15 Chester Ave.
Bakersfield, CA 93301
VOICE (805) 326-3979
FAX (805) 326-0576
TRAlINING DMSION
5642 Victor Ave,
Bakersfield, CA 93308
VOICI: (805) 399-4697
FAX (805) 399-5763
.
.
February 9, I 999
Mercy Hospital
2215 Truxtun Avenue
Bakersfield, Ca 9330 I
RE: Compliance Inspection
Dear Underground Storage Tank Owner:
The city will start compliance inspections on all fueling stations
within the city limits. This inspection will include business plans,
underground storage tanks and monitoring systems, and hazardous
materials inspection.
To assist you in preparing for this inspection, this office is
enclosing a checklist for your convenience. Please take time to read this
list, and verify that your facility has met all the necessary requirements to
be in compliance.
Should you have any questions, please feel free to contact me at
805-326-3979.
S2'~
Steve Underwood
Underground Storage Tank Inspector
Office of Environmental Services
SBU/dm
enclosure
"".9'~ ~ W~ ~ ~o/'e ~~ A W~?"
·
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAME---Î\\t't"cL( f/n~f,1tJ
INSPECTION DATE g ~(,~ ~8
Se(:tion 2:
Underground Storage Tanks Program
o Routine 0 Combined ~int Agency
Type of Tank Ft~
Type of Monitoring ¿ L M
o Multi-Agency
Number of Tanks
Type of Piping
o Complaint
ORe-inspection
J)wF
OPERA TION C V COMMENTS
Proper tank data on tile V
Proper owner/operator data on file V
Permit fees current V
Certification of Financial Responsibility V
Monitoring record adequate and current /
Maintenance records adequate and current V
Failure to correct prior UST violations /'
Has there been an unauthorized release? Yes No .r-
Section 3:
Aboveground Storage Tanks Program
TANK SIZE(S)
Type of Tank
AGGREGATE CAPACITY
Number of Tanks
OPERA nON Y N COMMENTS
SPCC available
SPCC on file with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?
If yes, Does tank have overfill/overspill protection?
Pink - Business Copy
c~comPI~ V~V;ol,tioo y~y"
Inspector:' d~0
Oftìce of Environmental Services (805) 326-3979
White - Env. Sves.
N=NO
F~PR. 24.1998 11: 38RM ENGINEERING SERVICES
. - '
",-
Mercy Healthcare Bakersfield
Å DlvI$loc or Catholic lkatthc:are "est
NO. 530
P.1/7
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FAGILITIESMANAGEMENT
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FAX
Date: 4 ,').L\. ~ (
Number ofpages including cover sheet: 7
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Fax þboM: (805)326-0104
REMARKS: 0 Urgent ~oryour review C) Reply ASAP 0 Please comment
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RLN EN'~ERPRISES
2014 SO UNION AVE #107
ÐAXERSFIELD, CA 93307-4154
e
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Invoicee
NO. 530 \P.2/7
-~
APF~. 24. 1998 11 : 39AM
ENGINEERING SERVICES
Invoice Number;
8470
Invo1~e Date~
Apr 22, 1998
Voice (805) 834-1100
OLD RIVER ROAD
MERCY SOUTHWilST
ENGINEERING
DEPT.
APR , 4 1998
Sold TOI
MERCY HOSPITAL-ENGINEERING
P.O. BOX 119
BAKERSFIELD, CA 93302-0119
USA
Ship tOr
Customer ID Customer PO Payment Terms
KEN/CHARLIE !fet 1'5 Days
Sales Rep ID Shipping Method Ship Date Due Date
None 4/22/98 5/7198
Quanti't.y I~em Description Unit Price Extension
1.00 INFO ANNUAL MONITORING SYSTEM
CERTIFICATION
1.00 WSC 4430 TEST FOR PROPER OPERATION
1.00 WSC 5500 TEST/TESTED GOOD-COMPLETE
1. 50 LABOR 3 TECHINICAN/MINIHUM 1.5 HR 40.00 60.00
1.00 ZONE 2 MILEAGE/TRAVEL TIME DRIVER 30.00 30.00
, . & TRUCK
1.00 WC 3000 TERMS NET 15 DAYS FROM
. .
..' INVOICE DATE. ANY
QUESTIONS CONTACT OUR
OFFICE WITHIN 5 WORKING
DAYS.
1.00 we 3001 THANK YOU.
Subtotal
Sales Tax
Total Invoice Amount
90.00
90.00
Check No.
Payment Received
TOTAL
0.00
90.00
Finance charges will be added to invoices after 15 days.
; I
-" APR.24.1998 11: 39AM ENGINEERING SERVICES
.,~.., .. a . NO. 530 \ _P..s:7
,'.-.... i 1.. '1; .. 'to .. _ ... . &...
)1 TANK FACILITY ANNUAL REPOR1'
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RL)l ENTERPRISES
2014 ~ci UNION AVE #107
BAKERSFIELD. CA 93307-4154
e
~
Invoicee
NO. 530 ^P.5/7
¿ ... r"(
APR.24.1998 11:40AM
ENGINEERING SERVICES
Invoice Numberl
8469
Invoice Date:
. Apr 22, 1998
Voice (805) 834-1100
Sold ~~o I
MERCY HO~PITAL-ENGINEERING
P., O. BOX 119
B ~KER6FIELD. CA 93302-0119
i:' USJA
Ship 'to:
ENr¡IN££RIM
4PII (J OfPr.
R " 199{j
Customer IO -Customer PO Paymen~ Terms
CHARLIE/KEN Net lS Pays
Sales Rep ID Shipping Method Ship Date Due Date
None 4/21/98 5/7/98
Quant.ity I1:.eJII Descript.ion Unit Price Extension
1.00 ;J:NFO ANNUAL MONITORING SYSTEM
VERIFICATON
1.00 wse 4430 TEST FOR PROPER OP~RATION
1.00 WSC 5~00 TEST/TESTED GOOD-COMPLETE
1.50 LABOR 3 TECHNICI~N 40.00 60.00
1.00 ZONE 2 MILEAGE/TRAVEL TIME DRIVER 30.00 30.00
& TRUCK
1.00 we 3000 TERMS NET 15 DAYS FROM
INVOICE DATE. ANY
QUESTIONS CONTACT OUR
OFFICE WITHIN 5 WORKING
D~YS.
1.00 WC,3001 THANK YOU.
Subtotal
Sa;Les Tax
~otal Invoice Amount
90.00
90.00
Check No;
Payment ~eceived
TOTAL
0.00
90.00
Finance charges will be added to invoices after 15 days.
rAPR.24.1998 11:40AM ENGINEERING SERVICES
.. _ NO.530 5.6/7
T~clLm'AÑNUAL REPOR_ . 2 - ,
Plnaltl:~ 1 J fl\D . ·Ù~ M~Period.PJOm:~ JiJ,
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, "AF'R. 24.1998 11: 40AM "I .... ENGINEERING SERVICES-
,~ 2. W.r. .a)' of au tou~ CIQI1d~ 11 ~ fKilit' 1
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1'10.530 P.7/7
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r./c.
sr~AItJ)IMOÐØ'IED INYEHTORY COHROL MON1TOJtlNG (puW.w... .....17 cOGWl ODIJ)
.
1 ha"$ aRI-~ lAY nponable Jimilll .. UIICd iD USe appropri&&ø iA~rDr)' coacrollllaAilØriq dlltÌDl Cbe WI
twelva ~tba.
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ST4'I'ISTICAL JNV£NTOaV RECONCD..IAnON (SIR) S'O'M1tIA&y ItEPOaT Ø'MiIiIIu ~ IIIt-'1>
(~_~~ ...-..~.... ¡au.
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CAD....., all. ____ lilt.. ... . . .... .. 6øiIiq _ ..... 6Ir.. ............ - ......
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-
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--
FIRE CHIEF
MICHAEL R. KellY
ADMINISTRAlIVE SERVICES
2101 ·w street
Bakem1eld. CA 93301
(805) 321>-3941
FAX (805) :195-1349
SUPPRESSlO.1 SERVICES
2101 ·w Street
Bakersfield. CA 93301
(805) 32«>-3941
FAX (805) :195-1349
PRMNOON SERVICES
1715 Chester Ave.
Bakersfield. CA 93301
(805) 326·3951
FAX (805) :126-0576
ENVIRONMENtM SERVICES
1715 Chesler Ave.
Bak8lSfleld. <CA 93301
(805) 32/1"3979
FAX (805) ~i26-0576
TRAINING [Þ!VISION
5642 V1ctc,r Street
Bakersfield. CA 93308
(805) 3CX'-4697
FAX (805) 399-5763
.
.'
~
BAKERSFIELD
FIRE DEPARTMENT
~
February 13, 1998
Mercy Hospital
2215 Truxtun Avenue
Bakersfield, CA 93301
RE: "Hold Open Devices" on Fuel Dispensers
Dear Underground Storage Tank Owner:
The Bakersfield City Fire Department will commence with our annual
Underground Storage Tank Inspection Program within the next 2 weeks.
The Bakersfield City Fire Department recently changed its City Ordinance
concerning "hold open devices" on fuel dispensers. The Bakersfield City Fire
Department now requires that "hold open devices" be installed on all fuel
dispensers. The new ordinance conforms to the State of California guidelines.
The Bakersfield Fire Department apologies for any inconvenience this
may cause you.
Should you have any questions, please feel free to contact me at 326-3979.
Sincerely,
:L ~ç;)
Steve Underwood
Underground Storage Tank Inspector
cc: Ralph Huey
'Y~de W~ ~P~~~.A W~"
NO. 389 P .1/2
JlL31.1997 3:17PM ENGII£¡NG SE~ICES. \
Mercy Health~~~~~~ +
- . ------- - -.- ..- .-.. ..... - .-- .-..... -.....---.........- ..--.. -- ---...- - -------
FACILITIES MANAGEMENT
,
FAX
Date: 1.- ð¡- 9,
Number afpqes hdudiD¡ covar Iheet ~ _
, ,
To:
SI-elle__ ) Jt'lde. r:/..ùOOJ
~~iãr
~aR~{Jeld Cjl-~ ,',
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From:
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Plume: (805) 326-1917
FI~ phone: (8O~326-0104
,.0 . " ' I
DMAJU(S: 0 Ursøt .' þ(,or yoqr ~r:w . O:a,p1y ASAP CI Þ1eaIe comment
A GoFf of our 1kder3röil~d ·Fue/70.l1~ fJ1'JnUq;/, f?(í),
\
\. JUL.31.1997 3: 17PM ENGINEERING SERVICES NO. 389 P.2/2 ! ¡
, __ MAIN DATA AREA
I e
Ipa~
1 Date: 07/30/97 ! I
SCHEDULED
WORK ORD:ER: 39810 PRIORITY: HIGH START DATB: 07/01/97 I,
CONTROL Nm! TYPE IUHF MoDEL SERIAL LOCATION DEPT
[ ) UFTOOl UNDBRGROUND FDiL TANK UNIVERSAL SENSORS. DEV. LA-04 83378 MERCY 16TH St. 8460
Next Scheduled Date for this Procedure 07/01/98
PROCBDURE: 285
UNDERGROUND FUEL TANK ANNUAL
~ 'fask ID Task Name
V 8 CLEAN UNIT
28 CHECK ALL ELECTRICAL CONNECTIONS FOR TIGHTNESS
~ 1151 CHECK OPERATION OF UN!T CONTROLS, INDICATOR LIGHTS & ALARMS
F J[ ELD
EMPLOYEE
W'"A-r~;~ Y\
REPORT
HOURS DATE
'IC 7-3D
MATERIAL ID
QUAN
DESCRIPTION
ACTION TAKEN:
~L~A lÎo! cÀ ?,,' (\ I _ , l
\ '-V\.'Ly, 'f~ (jft:('\\\¿(.\ "'- ~ ~ \J"""\ \ 5t n'O rs
,
UNDERGROUND STORAGE TANþSPECTION
.
Bakersfield Fire Dept.
Office of Environmental Services
Bakersfield, CA 93301
FACILITY NAME
FACILITY ADDRESS
fhl"fr' 'I ft.o5p d·al
ad \5 TN,,-hI\A Ave..,
BUSINESS I.D. No. 215-000 0J ~
CITY f\~..cJ. ZIP CODE q3?LJ1
FACILITY PHONE No. 101 101 101
INSPECTION DATE 7-.J3^?7 DI
Pð:,UCI Product Product
TIME. IN TIME OUT ~4.r;
Insl Dale Insl Dale Insl Dale
INSPECTION TYPE: It'/R9
ROUTINE V FOllOW-UP s~e. C~ f) Size Size
REQUIREMENTS yes no n/a yes no nIa yes no nIa
1a. Forms A & B Submitted 'v
1b. Form C Submitted ;/
1c, Operating Fees Paid ./
1d. State Surcharge Paid ./
1e. Statement of Financial Responsibility Submitted J
1f. Written Contract Exists between Owner & Operator to Operate UST ,/
2a. Valid Operating Permit ../
2b, Approved Written Routine Monitoring Procedure -if
2c. Unauthorized Release Response Plan V
3a. Tank Integrity Test in Last 12 Months if
3b. Pressurized Piping Integrity Test in Last 12 Months V
3c. Suction Piping Tightness Test in Last 3 Years V
3d. Gravity Flow Piping Tightness Test in Last 2 Years v'
3e. Test Results Submitted Within 30 Days ../
3f. Daily Visual Monitoring of Suction Product Piping ,/
4a. Manual Inventory Reconciliation Each Month V
4b. Annual Inventory Reconciliation Statement Submitted .,/
4c. Meters Calibrated Annually II
5. Weekly Manual Tank Gauging Records for Small Tanks V
6. Monthly Statistical Inventory Reconciliation Results 'Ii
7. Monthly Automatic Tank Gauging Results if
8. Ground Water Monitoring Ý
9. Vapor Monitoring V
10. Continuous Interstitial Monitoring for Double-Walled Tanks ./
11. Mechanical Line Leak Detectors /
12. Electronic Line Leak Detectors
13. Continuous Piping Monitoring in Sumps ,-I
14. Automatic Pump Shut-off Capability V
15. Annual Maintenance/Calibration of Leak Detection Equipment .",uÅ tCÐ" J ..
16. Leak Detection Equipment and Test Methods Listed in LG-113 Series ;/
17. Written Records Maintained on Site V
18. Reported Changes in Usage/Conditions to Operating/Monitoring
Procedures of UST System Within 30 Days J
19. Reported Unauthorized Release Within 24 Hours v'
20. Approved UST System Repairs and Upgrades 1/
21. Records Showing Cathodic Protection Inspection II
22. Secured Monitoring Wells -17
23. Drop Tube 1
~~ "-, '"' ~~~'-
RE-!INSPECTION ~E ¿~ RECEIVEDBT. ....~...... ~ ,~,'-..'~~ \
'''' ~'C' - ~ -
OFFICE TElEPHO~ N. ~t -.~~J79
INS¡:)ECTOR: J ~
FD 1669 (rev. 9/95)
·
-
At.erey Hospital
September 6, 1995
RECEIVED
SfP 1 2 199!i
HAl. MAT, DIV.
Bakersfield City Fire Department
Hazardous Material Division
Attn: Mark Turk
1715 Chester A v€:.
Bakersfield, CA 93301
Dear Mr, Turk:
Attached, please find the "Written Routine Monitoring Procedure" and the
"Unauthorized Release Response Plan".
The "Statement of Financial Responsibility" was sent to Ralph Huey, Hazardous
Materials Coordinator, on March 23~ 1995,
If you need any further information regarding the "Statement of Financial
Responsibility", Please call Teresa Ramos, Manager, Risk Management at 632-5633.
Sincerely,
£Pher
Supervisor Engineering Services
KAS:jab
cc: Teresa Ramos, Manager, Risk Management
2215 Truxtun Avenue
P.O. Box 119
Bakersfield, CA 93302
(805) 632-5000
+
A Division of Catholic Healthcare West
:;
'. COVECTION NOTIe¡
BÀKERSFIELD FIRE DEPARTMENT N~
0473
LocatioI1 /Jk;;C'r ~~/Jtf~.
Sub Div. ~LC::- /,Q (~Jo....Ji1Ik. . Lot
You are hereby required to make the following corrections
at the above location:
Cor. No
Completion Date for Corrections
Date ~/B/g--
326·3979
--~-
~NDERGROUND STORAGE TANI4tSPECTION
e Bakersfield Fire Dept.
Hazardous Materials Division
Bakersfield, CA 93301
FACILITY NAME IYk..,. / ~..{~(
FACIILITY ADDRESS fJ."J.'5- ~ ~IJe
BUSINESS I.D. No. 215-000 6 ~~
CITY ~1::dX ZIP CODE ð /
FACIILITY PHONE No. IDtI IDtI IDtI
J
INSPECTION DATE ')\'4 t::!<.e.l Product Product
TIME IN TIME OUT
In61 ~~ In61 Date In61 Date
INSPECTION TYPE: US!) lèÞr~ !Al ~ LA- -Ol{
~ Siz~ ) Size Size
ROUTINE FOLLOW-UP .~h
REQUIREMENTS yes no nla yes no nla yes no nla
1a. Forms A & B Submitted ,/
1b. Form C Submitted .,/
1c. Operating Fees Paid V"'"
1d. State Surcharge Paid ,r'
1e. Statement of Financial Responsibility Submitted ,/"
1'. Written Contract Exists between Owner & Operator to Operate UST ~ V
28. Valid Operating Permit V
2b. Approved Written Routine Monitoring Procedure ih+ (,.. P(,o V
2c. Unauthorized Release Response Plan ,/
38. Tank Integrity Test in Last 12 Months V'
3b, Pressurized Piping Integrity Test in Last 12 Months .,r
3c, Suction Piping Tightness Test in Last 3 Years /
3d, Gravity Flow Piping Tightness Test in Last 2 Years ,/
3e. Test Results Submitted Within 30 Days ..,...-
3f. Daily Visual Monitoring of Suction Product Piping ,/'
48. Manual Inventory Reconciliation Each Month ,,/
4b. Annual Inventory Reconciliation Statement Submitted .,/
4c. Meters Calibrated Annually /
5. Weekly Manual Tank Gauging Records for Small Tanks ,/
6. Monthly Statistical Inventory Reconciliation Results ,,/
7. Monthly Automatic Tank Gauging Results v"
8. Ground Water Monitoring ,,/
9. Vapor Monitoring ./
10. Continuous Interstitial Monitoring for Double-Walled Tanka .,/'
11. Mechanical Line Leak Detectors /
12. Electronic Line Leak Detectors ,/'
13. Continuous Piping Monitoring in Sumps ~
14. Automatic Pump Shut-off Capability ./
15. Annual Maintenance/Calibration of Leak Detection Equipment ~, Ý
16, Leak Detection Equipment and Test Methods Listed in LG-113 Series /(f- v
17. Written Records Maintained on Site . j<:. V
18, Reported Changes in Usage/Conditions to OperatingJMonitoring /
Procedures of UST System Within 30 Days
19, Reported Unauthorized Release Within 24 Hours ..,/
20. Approved UST System Repairs and Upgrades ,./'
21. Records Showing Cathodic Protection Inspection V
22. Secured Monitoring Wells v
23. Drop Tube ~ t/
RE-INSPECTION DATE ~ RECEIVED BY: X-~ /./-4
~~; , 3;££' ~?C{
INSPECTOR: ~~~ -- OFFICE TELE ONE No.
FD 1669
0,
\. WRITrEØMONITORING PROCED19æs
· UNDERGROUND STORAGE TANK MONITORING PROGRAM
" This monitoring program must be kept at the UST location at all timea. The information on tbi.a moni&oria¡ pro¡ram are
condítions of the operating pcmút. The permit holder must notify (the local uenc:v) wi1ùa 30 cia)" of
any chan¡ea to the monitoring proc:cdurca, unlcu required to obc.aiø approval before making thedaarap.
. Required by Sœtions 2632(d) and 264 1 (b) CCR.
Facility Name-Æ ~1t!..,y I-!<t¿AL THC-I9~jù f?,AK~e.SF J£Lf\
Facility Address '22)::; T!..UXTUN P,t/v
,~. Describe the frequency of performing the monitoring:
Tank L!.ðAJ TI AJUo C}s
Piping ê.ðl\JiINUðc)S
¡,
ß. What methods anå equipment, identified by name and model,
~ -~. -----w-i--l-l- -bs--:-u'se'd--- f·o-r-p·e'r·f·cr-m-i-n·g-the~---mon·tt·or'±n·g~:- - --- - -- ---- -
Tank Mi."'})' LeAK ALe f'r f'rIn Di L L {1-0 'I
Piping U,s.,)) L-€-A¡¿ A Le..R...T
/f)(} lJe L
Lf}-o¿¡
C:. Describe the location(s) where the monitoring will be
per~ormed (facility plot plan should be attached):
~:;;;:' IÞJA L¿ øF E /lJ6-¡Alef?L 11ll6- &/l e.te .J
D. List the name(s) and title(s) of the people responsible for
performing the monitoring and/or maintaining the equipment
EA1GJNe.e..~/NGSeR //)( ~S WðR- (e~S ,
~.. ~~~::~;¡j:l?~1t¿j~;~{-~~~~~-2e~
F. Describe the preventive maintenance schedule for the
monitoring equipment. Note: Maintenance must be in
accordance with the manufacturers' maintenance 8chedule but
not le8s than every 12 months. é!JNC_..J2.- £.,(/e..fi-y
o ///ð/llT/I,
G. Describe the training necessary for the operation of UST
s~ntem, including piping, and the monitoring eqUipment,:
fWUlb.f.J\ tdt.7R..lé~Ç ILlI-r-/I' 7?&//l11llfJ6- #JA-¡f)Oé!. L _ a
,~o ml;1), L/U.Çe..tÙ/tce I
'.
-,
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.
EMEeENCY RESPONSE PLA.
,UNDERGROUND STORAGE TANK MONITORING PROGRAM
;This'moaiIoriag program mU¡¡ be kept at the UST location at aU timca. The information on Uúa moniloria, propam are
eoadi&iona of the operating permit. The pcnni& bolder mU¡¡ notify (the local uen~v) ~ 30 clays of
any chanica to the IDOIÙtoria¡ proc:edura. unJcu required to obcaiø approval before makin¡ tho chaqc.
Required by Sections 2632(d) and 2641(h) CCR.
:Ei'acility Name 117-e£LY Jl..eA1.:¡#(!A1é€___ f)/fKeL5FI£L.D,
:Ei'acility Address ~ 2. /,ç Tf..l))( TU;V
, .
,__ .
:L. If an unauthorized release occurs, how will the hazardous
substance be cleaned up? Note: It released hazardous
suDstances reach the environment, increase the tire or
explosion hazard, are not cleaned up from the secondary
- -- -- --_. - ---C::òíitainment wítn:ín 8 ííours, or-ä'e-i:eriorai:-e- -tife-s-.condary-- ---------
containment, then (the local aaencv) must be
notified wi thin 24 hours. LðéA. L V.¿N.bOR (?] Je...
HII 2-- IY/A-T /~
.
2.
Describe the
removing and
glþh~
proposed methods and equipment to be used for
properly disposing of any hazardous substances.
11~ fl~-ue./ :# I
3.
Describe the location and availability of the requlred
cleanup equipment in item 2 above.
.5 ~m c€' /AS~ -/7,&2Z7~ ",-7!r I
1--- _ ______
--------
4,. Describe the maintenance schedule for the cleanup equipment.
S/9;n.e ~ .4~l/~ #"/
,
5. List the name(s) and title(s) of the person(s) responsible
for. authorizing any work necessary under the response plan:
C ~ ZI
. ,\
,
e
-
~--------------------------------
KBF'7!7!
e
COjRECTlON NOTl~
BAKERSFIELD FIRE DEPARTMENT
. ,,~~)
~ I.. '1-')
. ""', ()
~; .. j \:,;
Location. /Ji,.fIr:: L.. ¿¿'""T<)" Ý ~ L
- / ' ,
' '--::-..
Sub Div._~~ /4,. .\:Ib-ßllc _. LoL
You are hereby required to make the fo!Jowing corrections
at the above location:
~or. No
- {.J
----
-
Completion Da 1e for Corrections
--
Date-4/B/5'ç
"'2
326-3979
,,-
So:
~,
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UN[)ERGRÒUNQ STORAGE TAN.SPEQTION
i¡i¡i¡j¡··
j , ; ,Bakersfield Fire Dept.
Hazardous Materials Division
Bakersfield, CA 93301
FACILITY NAME ~ ~"':;,
F ACI LlTY ADDRESS f' , "It t:\ I J f¿
BUSINESS LD. No. 215-000 6.Þ.fð
CITY [t{¿¿,r;¡ ZIP CODE ñ /
~' ;
..
;,
FACILITY PHONE No. IDI IDI IDI
I
INSPECTION DATE P~uct Product Product
TIME IN TIME OUT ,1~eJ
Ins! ~~ Ins! Date Inst Date
INSPECTION TYPE: USD leA!J..IAI€~ LA -oLf.
~ Slz~ ,œ~ Size S~e
ROUTINE FOLLOW-UP
REQUIREMENTS yes no nla yes no nla yes no nla
1a. Forms A & B Submitted c/
1b. Form C Submitted r/"
1c. Operating Fees Paid ~
1d. State Surcharge Paid ~
1e. Statement of Financial Responsibility Submitted r
1f. Written Contract Exists between Owner & Operator to Operate UST ~ V
2a. Valid Operating Permit t/
2b. Approved Written Routine Monitoring Procedure rv,-'¡ , ., .r (p V
2c. Unauthorized Release Response Plan V
3a. Tank Integrity Test in Last 12 Months ¡/'
3b. Pressurized Piping Integrity Test in Last 12 Months V'
3c. Suction Piping Tightness Test in Last 3 Years ./
3d. Gravity Flow Piping Tightness Test in Last 2 Years V
3e. Test Results Submitted Within 30 Days r/"
31. Dally Visual Monitoring of Suction Product Piping t;/'
48. Manual Inventory Reconciliation Each Month 0/
4b. Annual Inventory Reconciliation Statement Submitted ¡;/
4<:. Meters Calibrated Annually ,/'
5. Weekly Manual Tank Gauging Records for Small Tanks r/
6. Monthly Statistical Inventory Reconciliation Results ,/
7. Monthly Automatic Tank Gauging Results ~
8. Ground Water Monitoring ,/
9. Vapor Monitoring ,/
10. Continuous Interstitial Monitoring for Double-Walled Tanks ./
,. 11. Mechanical Line Leak Detectors ./
12, Electronic Line Leak Detectors /"
13. Continuous Piping Monitoring in Sumps \r
14. Automatic Pump Shut-off Capability v"
15, Annual Maintenance/Calibration of Leak Detection Equipment ,\, V-
16. Leak Detection Equipment and Test Methods Listed in LG-113 Series 0/, .
"
17. Written Records Maintained on Site , V
18. Reported Changes in Usage/Conditions to OperatingJMonitorlng
Procedures of UST System Within 3ODa~ ./'
19, Reported Unauthorized Release Within 24 Hours ./' "
20. Approved UST System Repairs and'Upgrades e/
21. Records Showing Cathodic Protection Inspection t/
22. Secured Monitoring Wells t/
23. Drop Tube ~ V
X_~ '.4!-- /
RE-INSPECTION DATE /k~__- RECEIVED BY: ;'/- ~Z
INSPECTOR: ?/~~~. OFFICE TELÉ~ONE No. 3/;'Z - ?R71
J' .~
:¡~¡ ..-:( J
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FD 1669
Iii
· .
..' 'CITY of BAKERSFIELiJ
"WE CARE"
January 30, 1995
FIRI: DEPARTMENT
M. R. KELLY
FIRE CHIEF
WARNING!
1715 CHESTER AVENUE
BAKERSFIELD. 93301
326·3911
CERTIFICATION OF FINANCIAL RESPONSIBILITY REQUIRED
215-ØØØ-000&2B
!'I Ef~C\' HOSPITAL
;=:215 TRUXTUN A',)
BAKERSFIELD~ CA 93301
Dear Underground Storage Tank Owner:
Our records indicate that your business does not have a Certification of Financial Responsibility on file with this office.
Please forward either a copy of your existing State approved mechanism to show financial responsibility or else
complote the attached Certification of Financial Responsibility form.
An attached letter from the State Water Resources Control Board lists the approved financial responsibility mechanisms
required to pay for corrective actions resulting from leaking underground fuel tanks.
Remember, most tank owners only have to show financial responsibility for at least $10,000 of clean up liability. The
Under~Jround Storage Tank Clean Up Fund (USTCF) may be used as the mechanism to cover the remaining accidental release
liability.
The total amounts of financial responsibility required (check boxes from section A of form) are as follows:
If you don't sell product from you tanks, and you pump less than 10,000 gallons per month,
check "$500,000 per occurrence". Else, or if you are in the business of selling from your
tanks, check "1 million dollars per occurrence".
For owners of 101 or more petroleum underground storage tanks, check the "2 million dollar
annual aggregate" box. All others need only check the "1 million dollars annual aggregateD
box.
Please be aware that failure to provide the financial responsibility document to this office within 30 days will result in
your P.~rmit to Operate being revoked. (25285.1 (b) California Health & Safety Code).
If you have any questions, or would like help in completing the Certification of Financial Responsibility, please contact
Howard Wines, Hazardous Materials Technician, at 326-3979.
Ralph E. Huey
Hazardous Materials Coordinator
REH/dlm
j~
..Permit to Operate
.. Underground Hazardous Materials Storage Facility
(PZy
17000f ~
, S tat e I D IN 0 I 7 C) 60 , ..:,:::,:::.:{:{:?/::;::::?::?::;:;;i;::;;~:;;;;:;;;;~~~::::;;;:;~:::::;::::::;::::::::::::':';:::::::::::::::::::::::::,:... P e rmi t No
. .. · . ,,:::::(:!::::rr:[I~~:~::;::~;;::::":¡ ··::··::::::¡i;:~~:¡¡i~..;i~!;::\~¡¡!" ~I¡¡:f::::;:;~;ii:~;¡~i~:::;.¡j;;¡;~::;;~::::~;::::::::::\:::':¡:, ·
Cf)NDITI ONS\ '; :¡Ö'f';::::" BE'RM:I::I::::::·,":t;j::N::::·····REV ERSE
, .
"::::':'.,. ,,:::::!'::i:!!\:¡~:t:::::i:I:!::!':¡!:~:;';:;¡:",:"",
....... . . '-' ..
::::...... '.:; .:. ......... ::"':' .',:.'
Tank
Number
('
I
Issued By:
~_I
'-
Approved by:
SIDE
Hazardous
Subst¡~nce
,~~~t!t~~~~
Piping
Method
Piping
Monitoring
Þ l <!.-s e---(
.5vc:...~~
'-TT
,':..', ",:.:
',' ,', " ",. .::';', :.,,:::;:.,
"':::;;::,::::,. "\::\" .!:::!:~.::.::\¡:r:::;;;::::.i:::::;::.:!:.:·:i:"l..·, ::: ":.' :..,. .;::; 'r:: /:':/:.::::..:.:;',:::::::::::::> ..:::\.'<'::::;:'::'
Bakersfield Fire De:~~~~B~Ø~~~4ol.,,- Ikd.f4ccr"- Weà
HAZAlmous MATERIALS DIVISIO~ "':::':::::':::':;.:,;;:;:;;:::,:;,:,;:::::;;;~::{:;:¿:::~;::;::::;¿:;:((,::{/:./:,:::::,:::'::"'" Md'~<¡ 4~p,JC1 (I ß~kf:f~C~(c(
1715 C:hester Ave., 3rd Floor 2. L (S- Tì I A
Bakerllfleld, CA 93301 r VI. >< TV" v
(805) 326-3979
q 1 30 I
Ralph E. Huey, Hazardous Materials Coordinator
Valid from: JJy ( q 4 to: J... (ì- ( '1 c;
- .
Mlercy Healthcare Bakersfield
A Division of Catholic Healthcare West
«
+
....
~ l¿¡ ~ Îl~!j'"Te---::-'n
'- u ~ iS~!
r M/~R 2 7 1995 Ui'
By j
~._-~~ .. '-.
u. .~. , ,
._--.~- .
/
March 23, 1995
Ralph E. Huey
Hazardous Materials Coordinator
City of Bakersfield
1715 Chester Avenue
Bakersfield, CA 93301
RE: Underground Storage Tank
Dear Mr. Huey:
Mercy Hea1thcare Bakersfield participates in the Catholic Hea1thcare West Self-
Insurance Program which includes $1,000,000 protection for covered general
liability losses caused by Mercy Hea1thcare Bakersfield's negligence. This
program will protect Mercy Hea1thcare Bakersfield for operations at Mercy
Hospital, 2215 Truxtun Avenue, and Mercy Southwest Hospital, 400 Old River
Road, for the year June 1, 1994, through May 30, 1995.
Please do not hesitate to contact me at (805) 632-5633 if you have any questions.
Sincerely,
--I~~
Teresa Ramos, Manager
Internal Audit/Risk Management
TR:H:\WP\RISKMGMT\CITYBKFD.CRT
c. CHW Risk Management Dept.
Pat Jacobs, Facilities Management
Mercy Hospital
2215 Truxtun Avenue
Bakersfield, CA 93301
(805) 632-5000
Mercy Southwest HospitaJ!
400 Old River Road
Bakersfield, CA 93311
(805) 663-6000
Mercy Child Care ~rvices
2301 Ashe Road, ,-' - ,
Bakersfield, CA 93309
(805) 832-8300
Mercy Home Health Services
551 Shanley Court
Bakersfield, CA 93311
(805) 663-6400
"
0\\
rj>/ UNDERGROUND TANK QUES~I
1-' 4} í
;,. Bakersfield Fire Dept. .-
HAZARDOUS MATERIALS DIVI~ÒN
2130 G Street, Bakersfield, CA 93301
(805) 326-3970
J
j
~ ~if Ans'd.
...........
I. FACILITY/SITE No. OF TANKS ONE ,
~-
~-----
DBA OR FACILITY NAME NAME OF OPERA TOR
Þ;1ercy Hospital, Bakersfield Mercv Hospital. Bakersfield
I ADDRESS NEAREST CROSS STREET PARCEL No.(OPTlONAl)
2215 Truxtun Avenue A Street on West, D St on East
CITY NAME STA TE ZIP CODE
Bakersfield CA 93302
,/ EOX TO INDICATE ~ CORPORATION o INDIVIDUAL 0 PARTNERSHIP o LOCAL AGENCY DISTRICTS o COUNTY AGENCY 0 STATE AGENCY 0 FEDERAL AGENCY
TYPE OF BUSINESS 01 GAS STATION o 2 DISTRIBUTOR I KmN COUNTY PERMIT / / 70DO (
03 FARM 04 PROCESSOR è); 5 OTHER TO OPERATE No, 1'70DOIc..-
~
Resendez, Jack
NIGHTS: NAME (LAST. FIRST)
Resendez, Jack
805 327-3371
PHONE No. WITH AREA CODE
Jacobs, Pat
NIGHTS: NAME (lAST. FIRST)
(805) 327-3371
PHONE No. WITH AREA CODE
(805) 327-3371
Jacobs, Pat
(805) 327-3371
II. PROPERTY OWNER INFORMATION (MUST BE COMPLETED)
NAME CARE OF ADDRESS INFORMATION
Mercy Hospital, Bakersfield Jack Resendez
MAILING OR STREET ADDRESS ,/ BOX o INDIVIDUAL o lOCAL AGENCY o STA TE AGENCY
2215 Truxtun Ave TO INDICA TE o PARTNERSHIP o COUNTY AGENCY o FEDERAL AGENCY
CITY NAME STA TE \ ZIP CODE I PHONE No, WITH AREA CODE
Bakersfield CA 93302 (805) 327-3371
III. TANKOWNER INFORMATION (MUST BE COMPLETED)
NAME
CARE Of ADDRESS INFORMATION
~~
t...1AIUNG OR STREET ADDRESS
Jack Resendez
,¡ BOX 0 INDIVIDUAL
TO INDICA TE 0 PARTNERSHIP
o LOCAL AGENCY 0 STATE AGENCY
o COUNTY AGENCY 0 FEDERAL AGENCY
221:5 Truxtun AVenue
CITY NAME
STA TE ZIP CODE
PHONE No, WITH AREA CODE
Bakersfield
OWNER'S
TANK No.
U1#30918
CA 93302
DATE ~VOLU~
INSTALLED
11/4/89 8,000 gallons
(805) 327-3371
PRODUCT
STORED
IN
SERVICE
Diesel
Q/N
Y/N
Y/N
Y/N
Y/N
Y/N
DO YOU HA VE FINANCIAL RESPONSIBILITY? (YN TYPE YES
... Fill one segment 0& for each tank, unless all....anks and piping are
constructed of th~ame materials, style and..,pe, then only fill
one segment out. please identify tanks by owner ID #.
I. TANK DESCRIPTION COMPLETE ALL ITEMS.. SPECIFY IF UNKNOWN
I A, m~m~i~K 1.0,#
I C, DA IE INSTALLED (MO/DAY;EAR)
B. MANUFACTURED BY:
11 4 89
"-"---_.-..
III. TANK CONSTRUCTION
MARK ONE ITEM ONLY IN BOXES A B. AND C, AND ALL THAT APPLIES IN BOX 0
I A. TYPE OF XX] 1 DOUBLE WALL 0 3 SINGLE WAll WITH EXTERIOR LINER 0 95 UNKNOWN
SYSTEM [J 2 SINGLE WALL 0 4 SECONDARY CONTAINMENT (VAUL TEO TANK) 0 99 OTHER
0 1 BARE STEEL 0 2 STAINLESS STEEL 0 3 FIBERGlASS iXJ 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC
B. TANK
MATERIAL 0 5 CONCRETE 0 6 POLYVINYL CHLORIDE 0 7 AlUMINUM 08 100% METHANOL COMPATIBLE W,FRP
(Primar\, Tank) 0 9 BRONZE 0 to GALVANIZED STEEL 0 95 UNKNOWN 0 99 OTHER
01 RUBBER LINED 0 2 AlKYD LINING 0 3 EPOXY LINING 0 4 PHENOLIC LINING
C. INTEF:IOR 0 5 GLASS LINING XX] 6 UNLINED 0 95 UNKNOWN 0 99 OTHER
LINII~G
IS LINING MATERIAL COMPATIBLE WITH 100'Y. METHANOL? YES_ NO_
D. CORF:OSION 0 1 POLYETHYLENE WRAP ~ 2 COATING o 3 VINYL WRAP [:8:J14 FIBERGLASS REINFORCED PLASTIC
PROTECTION 0 5 CATHODIC PROTECTION 0 91 NONE o 95 UNKNOWN o 99 OTHER
IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE
A. SYSTEM TYPE ßI. U SUCTION A U 2 PRESSURE GRAVITY A U 99 OTHER
B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER
C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A@ 4 FIBERGlASS PIPE
COI:¡ROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100'Y. METHANOL COMPATIBLE WIFRP
PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER
D. LEAl< DETECTION 0 1 AUTOMATIC LINE LEAK DETECTOR ~ 2 LINE TIGHTNESS TESTING ~ J ~~~~~;~¿. 0 99 OTHER
V. TANK LEAK DETECTION
~ VISUAL CHECK 0
~¡ TANK TESTING ~
2 INVENTORY RECONCILIATION 0 3 VAPOR MONITORING 0 4 AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING
7 INTERSTITIAL MONITORING 0 91 NONE 0 95 UNKNOWN 0 99 OTHER
I. TANK DESCRIPTION COMPLETE ALL ITEMS·· SPECIFY IF UNKNOWN
~~ER'S TANK 1.0,#
EE INSTALLED (MO/DAYiYEAR)
B, MANUFACTURED BY:
0, TANK CAPACITY IN GAlLONS:
III TANK CONSTRUCTION
MARK ONE ITEM ONLY IN BOXES A, B, AND C. AND ALL THAT APPLIES IN BOX 0
0 1 DOUBLE WALL 0 3 SINGLE WALL WITH EXTERIOR LINER 0 95 UNKNOWN
A. TYPE OF
SYSTEM ~ 2 SINGLE WALL 0 4 SECONDARY CONTAINMENT (VAULTED TANK) D 99 OTHER
'-J
"--->
0 1 BARE STEEL 0 2 STAINLESS STEEL 03 FIBERGlASS 0 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC
8, TANK 0 0 6 POLYVINYL CHLORIDE 0 7 AlUMINUM US 100% METHANOL COMPATIBLE WIFRP
MAl!::RIAL 5 CONCRETE
(Primary Tank) 0 9 BRONZE 0 10 GALVANIZED STEEL 0 95 UNKNOWN 0 99 OTHER
0 1 RUBBER LINED 0 2 ALKYD LINING 0 3 EPOXY LINING 0 4 PHENOLIC LINING
C. INTERIOR 0 5 GLASS LINING 0 6 UNLINED 0 95 UNKNOWN 0 99 OTHER
LINING
IS LINING MATERIAL COMPATIBLE WITH 100'Y. METHANOL? YES_ NO_
D. CORROSION 0 1 POLYETHYLENE WRAP 0 2 COATING o 3 VINYL WRAP 0 4 FIBERGLASS REINFORCED PLASTIC
PROTECTION 0 5 CATHODIC PROTECTION 0 91 NONE o 95 UNKNOWN 0 99 OTHER
IV. PIPING INFORMATION
CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE
A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER
8. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER
A U t BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGLASS PIPE
C. MATERIAL AND
CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COA TING A U 8 100% METHANOL COMPATIBLE WIFRP
PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER
o 1 AUTOMATIC LINE LEAK DETECTOR o 2 LINE TIGHTNESS TESTING o J INTERSTITIAL o 99 OTHER
D. LEJI.K DETECTION MONITORING
V. TANK LEAK DETECTION
~.1. VISUAL CHECK I :_J
! : b TANK ~E:;T¡NG i
2 INVENTORY RECONCILIATION ï,'] 3 VAPOR MONITORING [_~ 4 AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING
7 INTERSTITIAL MONITORING ;-:1 91 NONE i-- 95 UNKNOWN G9 OTHER
. 'J .
.
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FILE COHTE~TS SUMMARY
FACILITy:J1Je('c.~~ '
ADDRESS : r.:l;;J.J5 TFux.Ji¡Y1-.A~.
PERMIT #: /7()()()/ ENV. SENSITIVITY: NE.S
Activity Date # Of Tanks Comments
.
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RESOURCE MANAGEMENT AGENCY
RANDALL L. ABBOIT
DIRECTOR
DAVID PRICE III
ASSISTANT DIRECTOR
Envirorunental Health Services Department
STEVE McCAU.EY, REHS, DIRECTOR
Air PoUution Control District
WIUJAM J. RODDY, APeO
Planning & Development Services Department
"ŒD JAMES. AlCP. DIRECTOR
ENVIRONMENTAL HEALTH SERVICES DEPARTMENT
February 20, 1991
Mercy Hospital
P. O. Box 119
Bakersfield, California 93302
CLOSURE OF 2 UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANKS LOCATED
AT 2215 TRUXTUN AVENUE IN BAKERSFIELD, CALIFORNIA.
PERMIT # A1275-17/170001
This is to advise you that this Department has reviewed the project
results for the preliminary assessment associated with the closure
of the tanks noted above.
Based upon the
satisfied that
requirements and
time.
sample results submitted, this Department is
the assessment is complete. Based on current
policies, no further action is indicated at this
It is important to note that this letter does not relieve you of
further responsibilities mandated under the California Health and
Safety Code and California Water Code if additional or previously
unidentified contamination at the subject site causes or threatens
to cause pollution or nuisance or is found to pose a significant
threat to public health.
Thánk you for your cooperation in this matter.
~~
BRIAN PITTS, HAZARDOUS MATERIALS SPECIALIST
cc: McNabb Construction
7808 Olcott Avenue
Bakersfield, CA 93308
2700 "M" STREET. SUITE 300
BAKERSFIELD, CALIFORNIA 93301
(805) 861·3636
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