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Home My WebLink AboutBUSINESS PLAN ...,.~.Q.i'.~_,6. J>(-"""-;~~ - II:> ~ 1'LAN. FACILITY DIAGRAM cz:5' H M.Vl P SITE DIAGRAM 1 Business Name: _k L !JV,'A't:OYl 8usiness Address: Q.~ 8 l,V\,:-a", iJ\Je For Office Use Only I \ ! i \ I I , I ! ' lVlAP '"" ~ ' FirST In Stetion: Area Meo .:; Inscec~ion Stetion: of NORTH 0 ~\l..E~¡:-'¡ELb RJ:RrÁJ\'(.. I >- "" I ' ~ RLW >< J IJ ~ ~~<J- o 5HbP \ x , ~f o I : -~ ~tk KL-~ Q "JAMES A. RHOADES 0 ·~rn County Auditor - Controller - County C'ièlKJ,' 1115 Truxtun Avenue, First Floor Bakersfield, California 93301 (661) 868-3588 FICTITIOUS BUSINESS NAME STATEMENT ;~i~t~§3~~~~~!rt¥:~t~~~;~~=í;~;t~~~;~~~~~~ij~:i~~:~~~~~:l·.. " ."; «'.': ..' .:: :...' :..:.:.......'.' .,,' ,........:..... ,.:...,.. . '.. .... . ..'.' '. . .,';' ..,..<..'..:..:--:-:-:.. ..,..,.....: ,',:. :::-......-:.......-:-:........ ::::::-:>..;:>:<;.-::::;';:;::;;:':;:;:::::::;:;:::::;'::::::;':::::::::.:....:.: :-:-:..;';':.:.;::-" >B\.1~iÍ1è~~<NªÍTlèt~).>.'" ">(ifii~ti~9' more th~n£~~Î>~;~;~ttI~ FŠNAdd~cid~~¡'~9'~.) ,»','," L AVIATIO,-..¡ .WOO-iJü,U4 #2 : street address of principal place of business: 2010 ~6uth Union dye. Hailing address of business: 2010 South Union aVd. City: !3aKt:.::L:';¡ t i~ ld state: CA Zip: ~jJ¡Jì City: State: Bd k&,C::> t hÜd Clì Zip: :.J307 . .... ... .. ....... ..... .. . .. ... ... .. . . '. . ..... . .. .. ,. . . . ... '., . " . .....'. ...,.... '... , last and' first namèseparat~iy,a,sd1ndt~åted;Husband state of1ncorpöration or " of 1ndividual, partner, or name of corporation, LLC, or LP: .... '.'10..,.... state of incorporation or organization: individual or partner: address: (P.O. Box not acceptable.) 1516 Ivau ave. city: (J.;i¡}\'c'H'sfi¿¡)ld state: CA Zip: 9JJiJ4 Last name of individual, partner, or name of Corporation, LLC, or LP: state of incorporation or organization: First name of individual or partner: address: (P.O. Box not acceptable.) City: State: Zip: , , Insert the one-letter code that best describes how the business is being conducted. (See reverse for table of codes.) +:++:+:+:+: j, the ,business commenced. (mm/dd/yyyy) not started, enter 00/00/0000. ' ö'l The filing of this statement does not of itself authorize the ,use in this state'ofa fiötitious business name 1n'v10lation of the rights of another under federal, state,or conunon law':(B\lS' & Prof 14400 etseq, This Fictitious Business Name statement expires five years from the datei,twas,filed'in>the,countY,Clerk's Office., A new fic'tit10usbusiness name statement must be filed before that tilne. ,', '" ", . .... ., . Individuals àndaÚôtheis Signature of Signature: / ./ / .---~-- Type name and title of Officer: Type name: ¡ ~ :)'; ....-..., ., F.<.::ílih,. UI \v Lç; ~ Daytime phone number: Daytime phone number: '1';,'. ., ,.., DO NOT WRITE BELOW THIS LINE * COUNTY CLERK This statement filed on: (rom/dd/yyyy) JAMES ~. RHOADES I Auditor-Controller ç :, .. '". ; l.. ~ ; 'r ,; ; ~ ¡i' ¥i y::' ( ,"'i.~__ j 01 / 13 / ¿oou ,t.; BY: ,;t".f / ....ûJ:'h AiM; _,:)"JI, \ PUBLICATION NOTICE '- . XÄ .. . .... " . . .' " ' .. . . In:itial<-stat"""rit must be pUbl1shed once a ""ek for four successive weeks (publicaU()~to~t~t"Úbin30d¡ an aff1davit of public aU on must,be fUed with the County Clerk within 30 days after publicaUon h.... bee,~cOl _. i ¡-t.. , , , . ... . ...,. ... .....",. ...'. .'. ..,' ......... , ...'.....,...... . -.. .... ..... ....,..',., . '..,.,,'.",..... " .. ..' ..... , ... ..' ..... .. . . ..,. '.' .... '., .. ','. ,..' ......... . , ",'.' ~~ew~1".· :~. P~.11c~tion '1. no't re~~reét', pÜrsua.nt' ·~o .lÙ1.s··, Prof Code Section 1791"7 (c)'~ ,!' ~n _:!, ***** BANK CERTIFICATION ***** I hereby certify that the foregoing is a correct copy of the original filed in my office on 01 , \" .. ,... - ..- JAMES A. RHOADES, Auditor-Controller-County Clerk By: , ' ' ' Distribution: White copy -County Clerk Pink copy - Bank Blue copy ~,Newspaper Yellow copy - Registrant DBA /11: ':'OUU-Ùv.d4 PJG/fbnform/5-98 AUOITOR 580 1110 FN·1 (2-99) Addendum(s) attached? K L Aviation Income Statment October 1,1999 thru December 31,1999 Sales Cost of Goods Sold Gross Profit 37,702 17. 177 20,525 Operating Expenses Salaries and Wages Insurance Sales Tax Bank Charges Utilities City of Bakersfield (gate fee I hazardous waste ) Total Operating Expenses 9,140 319 366 159 1104 345 11,433 Net Income $9,091 STATEMENT OF CITIZENSHIP ALIENAGE, AND IMMIGRATION STATUS FOR STATE PUBLIC BENEFITS Print Name of Applicant (the applicant is the person who wants the Date public benefit identified below) J-IJ.-:looò Relationship to Applicant PROGRAM UNDER WHICH PUBLIC BENEFiT IS SOUGHT o Direct Farm Loan 0 Old Growth Loan ~ RUST Loan 0 Fishing Fleet Loan STATE PUBLIC BENEFITS TO CITIZENS AND ALIENS Citizens and nationals of the United States who meet all eligibility requirements may receive the public benefit checked above and must fill out Sections A and 0, ....,...' .....,., .., Aliens who meet all eligibility requirements may also receive the public benefit checked above and must complete SECTIONS A, B or C, and 0 of this form. SECTION A: CITIZENSHIP/IMMIGRA TION STATUS DECLARATION 1. Is the applicant a citizen or national of the United States? No @ If the answer to the above question is yes, where was he/she born? J~~.1~ x. Az. I (City/State) 2. To establish citizenship or nationality, please submit one of the documents on List A (attached hereto) which is legible and unaltered to establish proof. IF YOU ARE A CITIZEN OR NATIONAL OF THE UNITED STATES, GO DIRECTLY TO SECTION D. IF YOU ARE AN ALIEN, PLEASE COMPLETE SECTION B, OR, IF APPLICABLE, SECTION C. SECTION B: ALIEN STATUS DECLARA TJON IMPORTANT: Please indicate the applicant's alien status below, and submit documents evidencing such status. The alien status documents listed for each categor¡ are the most commonly used documents that the United States Immigration and Naturalization Service (INS) provides to aliens in those IMPORTANT: Complete this section if the applicant, the applicant's child or the applicant child's parent has been battered or subjected to extreme cruelty in the United States. 1. Has the INS or the EOIR granted a petition or applic~tion filed by or on behalf of the applicant, the applicant's child, or the applicant's child's parent under the INA or found that a pending petition sets forth a prima facie case? Evidence includes one of the documents on List B (attached hereto). 2. Has the applicant. the applicant's child, or the applicant child's parent been battered or subjected to extreme cruelty in the United States by a spouse or parent, or by a spouse's or parent's family member living in the same house (where the spouse or parent consented to, or acquiesced in the battery or cruelty)? SECTION D: I DECLARE UNDER PENALTY OF PERJURY UNDER THE "LA'W5 OF THE STATE OF CALIFORNIA THAT THE ANSWERS I HAVE GIVEN ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. Applicant's s¡gnatur: i/_ J ., J µ~ 'tJ þ. Date: /~ J:J. -J.p"c> Signature of Person Acting For Applicant: Date: Statement of Citizenship Document - Form Number CTCA 046. Revised 6/17/98 ., AGREEMENT NO. , D 9 i~ 1 8: UNDERGROUND STORAGE TANK FEE AGREEMENT THIS UNDERGROUND STORAGE TANK FEE AGREEMENT is made and entered into on September 1, 1999, by and between the CITY OF BAKERSFIELD, a chartered municipal corporation ("CITY") and KENNETH W. LEWIS, dba K.L. AVIATION, a sole proprietorship ("KLA"). RECITALS WHEREAS, KLA owns property upon which is located two underground storage tanks; and WHEREAS, KLA is obligated by State Law to remove said underground storage tanks; and WHEREAS, KLA desires to obtain the necessary permit to remove the underground storage tanks; and WHEREAS, KLA has already made an $83.00 payment towards the $483.00 permit fee; and WHEREAS, KLA is delinquent in the amount of $428.00 in the payment of its annual underground storage tank fees; and WHEREAS, the parties hereto desire to provide for a payment schedule to bring these fees current; NOW, THEREFORE, incorporating the foregoing recitals herein, CITY and KLA mutually agree as follows: 1. PAYMENT OF OUTSTANDING FEES. The permitfee for the removal of the underground storage tanks has been determined by CITY's environmental services director to be $483.00, towards which KLA has already made an $83,00 deposit, leaving a balance of $400.00. KLA's outstanding underground storage tank fees are $428.00. The combined fees totaling $828.00 shall be due and payable as follows: $70.00 per month beginning on October 1, 1999 and continuing thereafter until and including August 1,2000, with a final payment of $58.00 due and payable on September 1, 1999. 2. LATE PAYMENTS. All payments are due on the first day of the month. A payment will be deemed late if not received by CITY by the 15th day of each month in which payment is due. Late payments will be subject to an Administrative Service Charge often percent (10%). Interest at the rate of one percent (1%) per month will be charged Permit Fee Agreement S:\LitIK L AviationlUST Fee Agr.wpd - September 3, t99page 1 of 2 Pages -- - on the unpaid balance, Such additional charges shall not be considered penalties, but are charged to cover the administrative expenses of CITY. 3. CORPORATE AUTHORITY. Each individual signing this Permit Fee Agreement on behalf of an entity represents and warrants that they are duly authorized to sign on behalf of and bind said entity to the obligations set forth in this Agreement. 4. TAX NUMBERS. "KLA's" Federal Tax Identification No, "KLA" is a corporation? Yes 770022470 No XX IN WITNESS WHEREOF, the parties hereto have caused this Permit Fee Agreement to be executed, the day and year first-above written. "CITY" CITY OF BAKERSFIELD By: BO~J2Y "KLA" K.L. AVIATION By: JI~{:¿;:L Title: C'J uJ ^-L c?f? APPROVED AS TO èONTENT: BAKERSFIELD FIRE DEPARTMENT By: ~~~ Environmental Se ices Director APPROVED AS TO FORM: BART J. THIL TGEN City A,rne~ By: f..,/L/(' WALTER H. P , JR. Assistant City Attorney COUNTERSIGNED: GORY J. KLlMKO nance Director Permit Fee Agreement S:\Lit\K L AviationlUST Fee Agr.wpd - September 3. t99f>age 2 of 2 Pages -- 4".. ~ BART J. THIL TGEN City Attorney 2 State Bar No. 131133 WALTER H. PORR, JR. 3 Deputy City Attorney State Bar No. 138100 4 City Hall 1501 Truxtun Avenue 5 Bakersfield, California 93301 6 Telephone: (661) 326-3721 7 Attorneys for Plaintiff, CITY OF BAKERSFIELD 8 9 SUPERIOR COURT OF THE STATE OF CALIFORNIA lOIN AND FOR THE COUNTY OF KERN 11 12 CITY OF BAKERSFIELD, ) CASE NO. 239380 NFT ) 13 Plaintiff, ) PLAINTIFF CITY OF BAKERSFIELD'S ) STATUS REPORT ON FURTHER 14 vs. ) HEARING RE: ORDER TO SHOW ) CAUSE 15 KENNETH WILLIAM LEWIS, ) individually and dba K.L. A VIA TION ) 16 and DOES 1 through 50, inclusive, ) DATE: September 23, 1999 ) TIME: 1 :30 p.m. 17 Defendants. ) DEPT: 1 ) 18 19 COMES NOW, plaintiff City of Bakersfield and hereby submits its status report on 20 further hearing re: order to show cause: 21 Since the previous hearing on this matter, K.L. Aviation has obtained the necessary 22 permit from the Office of Environmental Services to remove the underground storage tanks. 23 A true and correct copy of said permit is attached hereto as Exhibit "A." 24 In addition,K.L. Aviation has entered into an agreement with the City of Bakersfield to 25 pay for the cost of the permit, as well as to bring its past due underground storage tank fees 26 current. A true and correct copy of said agreement is attached hereto as Exhibit "B." 27 Finally, defendant Kenneth Lewis, the owner and operator of K.L. Aviation, has met with 28 Environmental Services Director, Ralph Huey, and has obtained and apparently submitted the Plf. City of Bakersfield's Status Report on Further Hearing Re: Order to Show Cause ~; ~ necessary paperwork to obtain a loan/grant from the State of California to remove the 2 underground storage tanks. The City has requested that Mr. Lewis bring copies of the 3 loanlgrant application paperwork to Court for the instant hearing. A true and correct copy of 4 the letter requesting his assistance in this regard is attached hereto as Exhibit "C." 5 The City continues to work with Mr. Lewis towards obtaining environmental compliance 6 by the removal of the underground storage tanks. The City understands that Mr, Lewis is 7 encountering some financial difficulty in this regard and is willing to work with him in any way 8 possible to accomplish the tank removal. 9 City requests a further continuance of ninety (90) days to enable Mr. Lewis' loan/grant 10 application be processed by the State of California andlor to enable Mr. Lewis to seek 11 alternate sources of funding. 12 DATED: September D999 13 14 15 16 17 18 19 20 21 22 WHP:alj 23 S:\Lit\K L Aviation\Pldgs\StatusReport,wpd 24 25 26 27 28 2 Plf. City of Bakerstìeld's Status Report on Further Hearing Re: Order to Show Cause Respectfully submitted. BART J. THIL TGEN City Attorney By: '" EXHIBIT A @ ... Q) Q. as a.. "t; .!! o >- o Q) II: a; q:; N N "4' Ò o IX) <J ¡:; r£ Æ ¡¡ o< (f w X t:I! 1:) c -æ c o ï:¡¡ <I) t:I! Õ It Permit No. ß It· 02S1. CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES t 7 t 5 Chester Ave., Bakersfield, CA (805) 326-3979 PER!\IIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK SITE IN FORMATION SITE ADDRESS .,.2010 5 t...lAJ.'ðN FACILITY NAME I< 1.. .4¡J:A-f..~Þ~( CROSS STREET TANK O\VNERJOPERATOR \1AILlNG ADDRESS ~f!)/~ ..s ~ tV.~ ~ Åu ~ ZIP CODE '(330 7 APN nO~f/10 -Jf:>OU-ï PHONE NO, S 3:l-.2S~ l CITY ~ ~K..~~6C,·dfc( ZIP ~ 3.3ø.7 CONTRACTOR INFORMATION COMPANY ~LJ. A ßeE::J~c-."~^' U!-<; ADDRESS fo~SI fttt'.D:".-t-t De. INSURANCE CARRIER PHONE NO, B3' - 9/~o LlCENSç NO, Sü.:~ i) CITY B Ar~~.·c5~ ZIP 9~313 WORKMENS COMP NO. PRELIMINARY ASSESSMENT INFORMATION COMPANY Q,.. u~Gq~ <~ at/''' PHONE NO. LICENSE NO, ADDRESS II CITY ZIP INSURANCE C ARRlER WORKMENS COMP NO. TANK CLEANING INFORMATION . COMPANY ~.a.-. c;..Q..~ f-Q ADDRESS WASTE TRANSPORTER IDENTrFlCA TION NUMBER NAME OF RINSATE DISPOSAL FACILITY ADDRESS FACILITY IDENTIFICATION NUMBER PHONE NO. CITY ZIP CITY ZIP TANK TRANSPORTER INFORMATION COMPANY ADDRESS TANK DESTINATION PHONE NO, CITY LICENSE NO. ZIP TANK INFORMATION TANK NO, AGE VOLUME CHEMICAL STORED DATES STORED CHEMICAL PREVlOUSL Y STORED --- ------- APPLICATION DATE For Ollicinl U!Ic: Onl .i F ACn.Ìn-NO}< .'.i<·,'N'O.'OFTANkSi . '.. '. '" ...', .... ,.. .. ... .... . ,·'FEES Till' ;\I'I'I,ICI\NT f (AS RFCElVED. UNDERSTANDS, AND WILL COMPI.Y Wfm TI IE AfT^CIII'D CON)fTIONS OF TIllS 'I'HMIT¡\N) ^NY (HilER STAlE. I.OCAL AND 1·ï.~DFRAL REGULATIONS, II liS H J/{M f 1M; ¡WEN COMI'IYTFD UNDER PENALTY OF PEIUURY. AND TO TIlE nEST OF MY KNOW!.I':IXiE IS TRlW ,\NI) ('<>1 -AC . KttN¡.¡6fl. v.~ L;;..J;) fJ p L /\1'1') BY APPLICANT N^ME (PRINT) , APPLlC^NT SI(¡NATURE THIS APPLICATION BECOME A PERMIT WHEN APPROVED ~ . @ CD a. as Q. 1:1 III Õ >- U III a: c;; q; N N ¿; o a:> Ó c: fIÎ () ü: oð In () X () 1:1 c: ëii c: o ,j¡ (j () õ ... Q. 'f,. Ii... EXHIBIT B J1 1" " AGREEMENT NO. , D 9 g-, 1 8 UNDERGROUND STORAGE TANK FEE AGREEMENT THIS UNDERGROUND STORAGE TANK FEE AGREEMENT is made and entered into on September 1, 1999, by and between the CITY OF BAKERSFIELD, a chartered municipal corporation ("CITY") and KENNETH W. LEWIS, dba K.L. AVIATION, a sole proprietorship ("KLA"). RECITALS WHEREAS, KLA owns property upon which is located two underground storage tanks; and . WHEREAS, KLA is obligated by State Law to remove said underground storage tanks; and WHEREAS, KLA desires to obtain the necessary permit to remove the underground storage tanks; and WHEREAS, KLA has already made an $83.00 payment towards the $483.00 permit fee; and WHEREAS, KLA is delinquent in the amount of $428.00 in the payment of its annual underground storage tank fees; and WHEREAS, the parties hereto desire to provide for a payment schedule to bring these fees current; NOW, THEREFORE, incorporating the foregoing recitals herein, CITY and KLA mutually agree as follows: 1. PAYMENT OF OUTSTANDING FEES. The permit fee for the removal of the underground storage tanks has been determined by CITY's environmental services director to be $483.00, towards which KLA has already made an $83.00 deposit, leaving a balance of $400,00. KLA's outstanding underground storage tank fees are $428.00. The combined fees totaling $828.00 shall be due and payable as follows: $70,00 per month beginning on October 1, 1999 and continuing thereafter until and including August 1, 2000, with a final payment of $58,00 due and payable on September 1, 1999. 2. LATE PAYMENTS. All payments are due on the first day of the month. A payment will be deemed late if not received by CITY by the 15th day of each month in which payment is due, Late payments will be subject to an Administrative Service Charge often percent (10%), Interest at the rate of one percent (1%) per month will be charged Permit Fee Agreement S:llit\K L Aviation\UST Fee Agr.wpd - September 3, t99page 1 of 2 Pages -- J~" .,'~ on the unpaid balance, Such additional charges shall not be considered penalties, but are charged to cover the administrative expenses of CITY. 3. CORPORATE AUTHORITY. Each individual signing this Permit Fee Agreement on behalf of an entity represents and warrants that they are duly authorized to sign on behalf of and bind said entity to the obligations set forth in this Agreement. 4. TAX NUMBERS. "KLA's" Federal Tax Identification No. "KLA" is a corporation? Yes 770022470 No XX IN WITNESS WHEREOF, the parties hereto have caused this Permit Fee Agreement to be executed, the day and year first-above written. "CITY" CITY OF BAKERSFIELD By ~111vvV BO P ICè', Mayor "KLAn K.L. AVIATION By: ~~~LJ ENNETH W. LEWIS Title: Q(J..j t>-J..(5L APPROVED AS TO CONTENT: BAKERSFIELD FIRE DEPARTMENT BY~~~/ RÄ PH Environmental S rvlces Director APPROVED AS TO FORM: BART J. THIL TGEN City Attocney WALTER H. PO , JR. Assistant City ttorney By: COUNTERSIGNED: GORY J. KLlMKO ance Director Permit Fee Agreement S:\Lit\K L AviationlUST Fee Agr.wpd - September 3, t99!?age 2 of 2 Pages -- EXHIBIT C @ ... Q) a. as D.. 1J Q) Õ >- u Q) II: ... 0> C; N N ~ 8 co ó r:: vi .!!! ü: oð rJ) () x Q 1J r:: ¡¡; r:: o ïñ rJ) Q Õ à: I ""'" 'i'-V'; i' ..L III) ~.. :. DEPUTY CITY ATI'ORI\ŒY Alan D, Daniel AUen M, Shaw Walter H. Porr, Jr, Michael G, AUford Carl Hernandez ill Janice Scanlan Virginia Gennaro Andrew C. Thomson ~{~'_~}i!::~:~}~~" " /''',',1, ~,1! , -",.\' { (.";- ~t~ ~ \!~~" \l;'\~,~' '~)~ ~:~~"þ~;; ~...::::::.:::---- CITY OF BAKERSFIELD CITY ATTOR.'lEY Bart J. Tbiltgen ASSISTANT CITY AITORIIŒY Roben M, Sherfy OFFICE OF THE CITY ATI'ORIIŒY 1501 TRUXTUN AVENUE BAKERSFIELD, CA 93301 ADMINISTRATIVE ASSISTANT Lori A, Aquilar TELEPHONE: 661-326·3721 FACSIMILE: 661·852·2020 September 17, 1999 Kenneth William Lewis dba K.L. Aviation 2014 S. Union Avenue Bakersfield, California 93307 RE: Underground Storage Tank Fees Dear Mr. Lewis: The purpose of this letter is to remind you of our September 23, 1999 hearing at 1:30 p.m. in Department 1 of the Kern County Superior Court located at 1415 Truxtun Avenue. I am enclosing herewith a status report for the Court to advise the Court of the progress we have made since our previous hearing. It is imperative that you bring with you and be prepared to discuss with the Court all of the efforts you have undertaken to obtain funding for removal of the underground storage tanks. In particular, copies of the applications you have made to the State Fund should be produced for the Court. Should you have any questions concerning the foregoing or the upcoming hearing, please do not hesitate to contact either myself or Mr. Ralph Huey of the Environmental Services Division. ¿;¡):y:urs, WALTER H. POR 4 Deputy City Attorney WHP:alj Enclosure cc: Ralph Huey, Director of Environmental Services S:\Lit\K l Aviation\CorrlLewis5,ltr.wpd i~ ..!.... PROOF OF SERVICE 3 2 I am over the age of eighteen years and not a party to the within action; my business address is 1501 Truxtun Avenue, Bakersfield, California 93301. On the date last written below, I served the attached PLAINTIFF CITY OF BAKERSFIELD'S 4 STATUS REPORT ON FURTHER HEARING RE: ORDER TO SHOW CAUSE on the party(ies) listed below, through their attorneys of record, if any, by facsimile transmission, by personal deliver¥ or by placing 5 true copies/originals thereof in sealed envelope(s)s addressed/designated as shown below: 6 A. 7 8 9 10 B., 11 C. 12 13 14 15 D. 16 TYPE OF 17 SERVICE 18 A 19 20 21 22 -X- 23 24 25 26 27 28 BY MAIL - I enclosed such document in sealed envelope(s) with the name(s) and address(s) of the person(s) served as shown on the envelope(s) and caused such envelope(s) to be deposited in the mail at Bakersfield, California. The envelope(s) was/were mailed with postage thereon fully prepaid. I am "readily familiar" with the firm's practice of collection and processing correspondence for mailing. It is deposited with the U.S. postal service on that same day in the ordinary course of business. I am aware that on motion of party, service is presumed invalid if postal cancellation date or postage meter date is more than one day after date of deposit for mailing in affidavit. BY OVERNIGHT SERVICE - I caused each such envelope to be delivered by overnight service to the addressee(s) noted below. BY FACSIMILE SERVICE - I placed such document in a facsimile machine (pursuant to California Rules of Court, Rule 2003(3» with the fax number of (661) 852-2022. Upon facsimile transmission of the document, I obtained a report from the transmitting facsimile machine stating that the facsimile transmission was complete and without error. A copy of the transmission report is attached to this Proof of Service pursuant to California Rules of Court, Rule 2008(e). BY PERSONAL SERVICE - I caused such envelope(s) to be delivered by hand to the office of the addressee(s). ADDRESSEE FAX NO. Kenneth William Lewis dba K. L. Aviation 2014 S. Union Bakersfield, California 93307 . (STATE) I declare under penalty of perjury under the laws of the State of California that the above is true and correct. . (FEDERAL) I declare that I am employed in the office of a member of the Bar of this Court at whose direction the service was made. \ Executed on September 17, 1999 at Bakersfield, alifornf¡' '. I JS¿ . ADREA L. JONES \ ,L....':) \ ) '-J FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave, Bakersfield. CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave, Bakersfield. CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399·5763 e e May 25, 2001 Mr. Kenneth Lewis K L Aviation 2014 S. Union Avenue Bakersfield, CA 93307 RE: Laboratory results from preliminary site assessment conducted at the K L Aviation Yard, 2014 S. Union Ave., Bakersfield, CA; Permit #BR-0259 Dear Mr. Lewis: Upon review of the recently submitted laboratory results from your facility, this office has determined that the extent of the contamination plume, associated with the north end of the former unleaded gasoline tank previously located on your property, has not been adequately defined. This office requires (in accordance with Chapter 6.7 of the California Health and Safety Code and Chapter 16, Title 23 of the California Code of Regulations) that further assessment be done to define the vertical and horizontal extent of the contamination plume. Please submit a work plan for further assessment, to this office, within 30 days from receipt of this letter. The workplan should follów guidelines found in: Appendix A -Reports. Tn - Regional Board Staff Recommendations for Preliminary evaluation and Investigation ,cjf UnderQround Tank Sites; July 6, 1990~ Additionally, be advised that oversight cost for this project will be billed to you at a rate of $80.00 per hour. If you have any questions, please call me at (661) 326-3979. Sincerely, =IL/=40~~ Howard H. Wines, III Hazardous Materials Specialist Office of Environmental Services HHW/db cc: M. Magargee, HFA S:\May 2001\kLewis 2014 S UnionUST,L2 HWlnes 1.1.7~ ~ ?!?O/~..%p ~ope y~ .A W~y" ~;~ ..-> " AGREEMENT NO. F D 0 0 ~ 2 2 PAYMENT AGREEMENT THIS PAYMENT AGREEMENT is made and entered into on November 1,2000, by and between the CITY OF BAKERSFIELD, a chartered municipal corporation ("CITY") and KENNETH W. lEWIS, dba K.L. AVIATION, a sole proprietorship ("KLA"). RECITALS WHEREAS, KLA owns property upon which is located two underground storage tanks which it is obligated by State Law to remove; and WHEREAS, KLA desires to have the work performed to cause the removal of the underground storage tanks and has already paid $83.00 of the $483.00 permit fee; and WHEREAS, KLA owes the CITY $428.00 in underground storage tank fees and does not have the resources to pay for the removal of the underground storage tanks; and WHEREAS, the parties hereto desire to provide for a payment schedule to bring these fees current and to pay for the removal of the underground storage tanks. NOW, THEREFORE, incorporating the foregoing recitals herein, CITY and KLA mutually agree as follows: 1. PERMIT AND REMOVAL FEE. The CITY's Environmental Services Director has determined that the unpaid underground storage tank fees, plus the remaining permit fees and the cost for the removal of the underground storage tanks equals Twelve Thousand Eight Hundred Twenty-seven Dollars ($12,827.00) which shall be due and payable as follows: $83.00 per month beginning on December 1, 2000 and continuing thereafter until concluding on November 1, 2015. 2. CANCELLATION OF UNDERGROUND STORAGE TANK FEE AGREEMENT NO. FD 99-18. Upon execution of this Agreement, the Permit Fee Agreement entered into on September 1, 1999, between these parties will be deemed terminated and of no force or effect. 3. LATE PAYMENTS. Payments are due on the first day of the month. A payment is late if not received by CITY by the 15th day of the month in which it is due. Late payments will be subject to an Administrative Service Charge of ten percent (10%) in addition to the specified monthly fee. Additionally, interest at the rate of one percent (1 %) per month will be charged on the unpaid balance. Such additional charges shall not be considered penalties, but are charged to cover the administrative expenses of CITY. Payment Agreement S:llitlK L AviationlPayment Agr,wpd -- Page 1 of 2 Pages -- ""'\~ .\~~ !AI / 4. CORPORATE AUTHORITY. Each individual signing this Permit Fee Agreement on behalf of an entity represents and warrants that they are duly authorized to sign on behalf of and bind said entity to the obligations set forth in this Agreement. 5. TAX NUMBERS. "KLA's" Federal Tax Identification No. "KLA" is a corporation? Yes r7oo2Â47ù No X (Please check one.) IN WITNESS WHEREOF, the parties hereto have caused this Permit Fee Agreement to be executed, the day and year first-above written. By: "KLA" K.L. AVIATION -£.J ¿:J L· KÉNNETH W. LEWIS "CITY" CITY OF BAKERSFIELD By: Title: 6c.A.J}....( elê APPROVED AS TO CONTENT: BAKERSFIELD FIRE DEPARTMENT By: ~ _______ By: Environmental Services Director APPROVED AS TO FORM: BART J. THIL TGEN City Attorney By: WALTER H. P RR, JR. Deputy City Attorney COUNTERSIGNED: ORY J. KLlMKO nance Director Payment Agreement S:\Lit\K L Aviation\Payment Agr,wpd -- Page 2 of 2 Pages -- =- ASSISTANT CITY ATTORNEY Robert M, Sherfy /;z:~j¡Ä*}~~~ It;l"'-,*~' ~:;;';'c fí'~;i p': ,\f' t ~''''\' (Ø' i-; "~, ~ ,Ii , ).,<W, .;:/: I : .' .'.:l':' .:..,p". . ,'. .' ',' X" <,,,..,~d "/ -:Z~~/ CITY ATTORNEY , Bart J. Thiltgeo DEPUTY CITY A'ITORNEY Alan D, Daniel Allen M. Shaw Walter H, POrT, Jr, Michael G, AIlford Carl Hernandez ill Janice Scanlan Virginia Gennaro Andrew C. Thomson CITY OF BAKERSFIELD OFFICE OF THE CITY A'ITORNEY 1501 TRUXTUN AVENUE BAKERSFIELD. CA 93301 ADMINISTRATIVE ASSISTANT Lori A, Aquilar TELEPHONE: 661·326·3721 FACSIMILE: 661-852-2020 September 17, 1999 Kenneth William Lewis dba K.L. Aviation 2014 S. Union Avenue Bakersfield, California 93307 RE: Underground Storage Tank Fees Dear Mr. Lewis: The purpose of this letter is to remind you of our September 23, 1999 hearing at 1 :30 p.m. in Department 1 of the Kern County Superior Court located at 1415 Truxtun Avenue. I am enclosing herewith a status report for the Court to advise the Court of the progress we have made since our previous hearing. It is imperative that you bring with you and be prepared to discuss with the Court all of the efforts you have undertaken to obtain funding for removal of the underground storage tanks. In particular, copies of the applications you have made to the State Fund should be produced for the Court. Should you have any questions concerning the foregoing or the upcoming hearing, please do not hesitate to contact either myself or Mr. Ralph Huey of the Environmental Services Division. WHP:alj Enclosure cc: Ralph Huey, Director of Environmental Services S:\Lit\K L Aviation\Corr\Lewis5,Ltr.wpd ~~ ~,.-/ . 1 BART J. THIL TGEN City Attorney 2 State Bar No. 131133 WAL TER H. PORR, JR. 3 Depu~ City Attorney State ar No. 138100 4 City Hall 1501 Truxtun Avenue 5 Bakersfield, California 93301 Telephone: (661) 326-3721 6 Facsimile: (661) 852-2020 7 Attorneys for Plaintiff, CITY OF BAKERSFIELD 8 9 10 11 12 CITY OF BAKERSFIELD, SUPERIOR COURT OF CALIFORNIA, COUNTY OF KERN METROPOLITAN DIVISION 17 18 19 IT IS HEREBY STIPULATED by and between plaintiff, City of Bakersfield, and Defendants. ) CASE NO. 239380 NFT ) ) STIPULATION FOR ENTRY OF ) JUDGMENT AND PAYMENT OF ) JUDGMENT IN INSTALLMENTS ) ) ) ) ) ) ) 13 Plaintiff, 14 vs. 15 KENNETH WILLIAM LEWIS, individually and dba K.L. AVIATION 16 and DOES 1 through 50, inclusive, 20 defendant, Kenneth William Lewis, individually and dba K.L. Aviation, that judgment on the 21 complaint on file herein shall be entered on behalf of plaintiff, City of Bakersfield, and against 22 defendant, Kenneth William Lewis, individually and dba K.L. Aviation. 23 IT IS FURTHER STIPULATED that said judgment shall include the sum of Twelve 24 Thousand Eight Hundred and Twenty-seven Dollars ($12,827.00), as the civil penalty and 25 costs recovered by plaintiff, City of Bakersfield, in this action, said sum to be payable at the 26 rate of Seventy-eight Dollars ($83.00) per month for a period of one hundred eighty (180) 27 months, the first payment to be made on December 1, 2000. 28 / / / Stipulation for Entry of Judgment and Payment of Judgment in Installments " ,,-, ',¡, ¡/. 1 IT IS FURTHER STIPULATED that execution on the judgment shall be stayed provided 2 that defendant, Kenneth William Lewis, individually and dba K.L. Aviation, regularly pays the 3 installments in the manner provided in that certain Payment Agreement entered into between 4 plaintiff, City of Bakersfield, and defendant, Kenneth William Lewis, individually and dba K.L. 5 Aviation, on November 1, 2000. 6 IT IS FURTHER STIPULATED that the parties request that the Court retain jurisdiction 7 over them to enforce this stipulated judgment until performance in full of its terms. : OATEo/ð¡j;r ( ,2000 BART J. THIL TGEN City Attorney BY.~ Deputy City Attorney Attorneys for Plaintiff CITY OF BAKERSFIELD 10 11 12 13 14 15 DATED: /D -Iro 16 17 18 19 20 21 22 23 24 ,2000 K.L. AVIATION By: ~.~~ individually and dba K.L. AVIATION 25 WHP:alj 26 S:ILitIK L AviationlPldgslStipEntryJudgment.wpd 27 28 Stipulation for Entry of Judgment and Payment 2 of Judgment in Installments ?' AGREEMENT NO. FDOO~22 PAYMENT AGREEMENT THIS PAYMENT AGREEMENT is made and entered into on November 1, 2000, by and between the CITY OF BAKERSFIELD, a chartered municipal corporation ("CITY") and KENNETH W. LEWIS, dba K.L. AVIATION, a sole proprietorship ("KLA"). RECITALS WHEREAS, KLA owns property upon which is located two underground storage tanks which it is obligated by State Law to remove; and WHEREAS, KLA desires to have the work performed to cause the removal of the underground storage tanks and has already paid $83.00 of the $483.00 permit fee; and WHEREAS, KLA owes the CITY $428.00 in underground storage tank fees and does not have the resources to pay for the removal of the underground storage tanks; and WHEREAS, the parties hereto desire to provide for a payment schedule to bring these fees current and to pay for the removal of the underground storage tanks. NOW, THEREFORE, incorporating the foregoing recitals herein, CITY and KLA mutually agree as follows: 1. PERMIT AND REMOVAL FEE. The CITY's Environmental Services Director has determined that the unpaid underground storage tank fees, plus the remaining permit fees and the cost for the removal of the underground storage tanks equals Twelve Thousand Eight Hundred Twenty-seven Dollars ($12,827.00) which shall be due and payable as follows: $83.00 per month beginning on December 1, 2000 and continuing thereafter until concluding on November 1, 2015. 2. CANCELLATION OF UNDERGROUND STORAGE TANK FEE AGREEMENT NO. FD 99-18. Upon execution of this Agreement, the Permit Fee Agreement entered into on September 1, 1999, between these parties will be deemed terminated and of no force or effect. 3. LATE PAYMENTS. Payments are due on the first day of the month. A payment is late if not received by CITY by the 15th day of the month in which it is due. Late payments will be subject to an Administrative Service Charge of ten percent (10%) in addition to the specified monthly fee. Additionally, interest at the rate of one percent (1 %) per month will be charged on the unpaid balance. Such additional charges shall not be considered penalties, but are charged to cover the administrative expenses of CITY. Payment Agreement S:\Lit\K L Aviation\Payment Agr.wpd -- Page 1 of 2 Pages -- , 4. CORPORATE AUTHORITY. Each individual signing this Permit Fee Agreement on behalf of an entity represents and warrants that they are duly authorized to sign on behalf of and bind said entity to the obligations set forth in this Agreement. 5. TAX NUMBERS. "KLA's" Federal Tax Identification No. "KLA" is a corporation? Yes 7700;2..,')470. No ;( (Please check one.) IN WITNESS WHEREOF, the parties hereto have caused this Permit Fee Agreement to be executed, the day and year first-above written. "CITY" CITY OF BAKERSFIELD By: Boß2~ "KLA" K.L. AVIATION By: ~JvL' ENNETH W. LEWIS Title: Ovû ¡Jefè...-. APPROVED AS TO CONTENT: BAKERSFIELD FIRE DEPARTMENT By: ~-=== By: Environmental Services Director APPROVED AS TO FORM: BART J. THIL TGEN City Attorney By: Deputy City A COUNTERSIGNED: GORY J. KLlMKO . ance Director Payment Agreement S:llitlK L AviationlPayment Agr.wpd -- Page 2 of 2 Pages -- SERVICES AGREEMENT NO. -, ~ FD 00";21 THIS AGREEMENT is made and entered into on October 25,2000, by and between the CITY OF BAKERSFIELD, referred to as "CITY," and BC ENTERPRISES, referred to as "PROVIDER." CITY AND PROVIDER MUTUAllY AGREE AS FOllOWS: 1. SCOPE OF WORK. The scope of work is described as: Evacuating, pressure washing, disposing of rinsate, furnishing crane and trucks to remove, haul and dispose of two (2) 10,000 gallon Underground Storage Tanks (UST's) and piping from the property located at K.L. Aviation, 2000 South Union Avenue and providing backhoe and operator to collect soils samples from said property in accordance with the City of Bakersfield Underground Storage tank Removal Guidelines as set forth on the Proposal attached hereto as Exhibit "A." This scope of work includes all goods and actions necessary to complete the task PROVIDER has been hired to perform, whether specifically included in the scope of work or "not. 2. COMPENSATION. PROVIDER shall be paid the sum of Eleven Thousand Nine Hundred Ninety-Nine Dollars ($11 ,999.00) for the services to be performed under this Agreement. This compensation shall be the total compensation for services, including out- of-pocket costs. CITY shall pay no other compensation to PROVIDER. 3. PAYMENT PROCEDURE. PROVIDER shall be paid for completed services after receipt of an itemized invoice approved by CITY. Payment shall be made within 30 days after approval of said invoice. 4. INSURANCE. PROVIDER shall procure and maintain a minimum $50,000.00 CGL insurance and workers' compensation insurance as required by statute. Additional insurance may be required by the CITY department ordering PROVIDER's services. 5. INDEPENDENT CONTRACTOR. This Agreement calls for the performance of the services of PROVIDER as an independent contractor. 6. INDEMNITY. PROVIDER shall indemnify, defend, and hold harmless CITY, its officers, agents and employees against any and all liability, claims, actions, causes of action or demands whatsoever against them, or any of them, before administrative or judicial tribunals of any kind whatsoever, arising out of, connected with, or caused PROVIDER, PROVIDER's employees, agents, independent contractors, companies, or subcontractors in the performance of, or in any way arising from, the terms and provisions of this Agreement whether or not caused in part by a party indemnified hereunder, except as limited by California Civil Code section 2782 or CITY's sole active negligence or willful misconduct. S:\Lit\K L Aviation\Svcs Agmnt.wpd Page 1 of 2 7. TERMINATION. Either party may terminate this Agreement with ten days' written notice. ' 8. COMPLIANCE WITH ALL LAWS. PROVIDER shall, at PROVIDER's sole cost, comply with all of the requirements of Municipal, State, and Federal authorities now in force, or which may hereafter be in force, pertaining to this Agreement, and shall faithfully observe in all activities relating to or growing out of this Agreement all Municipal ordinances and State and Federal statutes, rules or regulations, and permitting requirements now in force or which may hereafter be in force including, without limitation, obtaining a City of Bakersfield business tax certificate (Bakersfield Municipal Code Chapter 5.02) where required. 9. TAX NUMBERS. "PROVIDER's" Federal Tax Identification No. 11-£),/6 7.~ß "PROVIDER" is a corporation? Yes No _ . ' (please check one.) IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed the day and year first above-written. CITY OF BAKERSFIELD ("CITY") APPROVED AS TO CONTENT: By: ~~~tl Irec or, Ice 0 nVlfonmen a Services, Bakersfield Fire Dept. BC ENTERPRISES ("PROVID~, " , ~C) By:~4", " Ønh J¡pje£ u)pcd - RJi},l/e,¿. PRINT NAME AND TITLE COUNTERSIGNED: 7/CJ~ elk hORN 1314. 933/3 (Address) (;6 {- ~ 63 - 'T0..15';Z ~Q.A{~ (Phone Number) (Facsimile Number) By: ,. 4f ~ 736"- A, GORY J. KLlMKO inance Director Contractor's License Number By: Ron Fraze Fire Chief' Bakersfield Fire Department APPROVED AS TO FORM: BART J. THIL TGEN City Attorne By: :l.h5" -- ~ S:\Lit\K L Aviation\Svcs Agmnt.wpd Page 2 of 2 §nterQrises ........ 7104 Elkhorn Street Bakersfield, CA 93313 (661) 663-7052 CA Lic. #742735 PROPOS"AL October 12, 2000 Bakersfield Fire Department Environmental Services 1715 Chester Avenue Bakersfield, CA 93301 ATTENTION: Steve UnderwoodlRalph E. Huey RE: KL Aviation - Tank Removal BC Enterprises proposes to excavate, pressure wash, dispose of rinsate, furnish crane and trucks to remove, haul & dispose of two (2) 10,000 gallon USTs, dispensers and piping. We will collect a total of eight (8) soil samples with Holguin. Fahan & Associates, Inc. to perform the analyses and complete a closure report. We will furnish backfill material & backfill to surface grade. This proposal does not include the following: 1. Compaction report 2. Concrete and/or asphalt 3. Permits The above scope of work will be completed for the sum of: $ 11,999.00 'FØ/18/2000 11:06 ? 661-327-8397 STOCKDALE INSURANCE PAGE 82 - PRODUCER SKA/Stockdale Insurance Ag4ill'1cy License #0100644 PO BOX 10269 Bakersfield CA 93389-0269 Phone:661-637-2112 Fax:66 -327-3490 CERTIFIC ATE Of LIABILITY INSURANC~~~~?^ I DA~E~~~~O THIS CERTIFICATe IS ISSUED AS A MATTER OF INFORMATION ONL.Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERT1FICA TE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Y' : ACORD. INSURERS AFFORDING COVERAGE B. C. Enterprises 7104 Zlkhorn Street Bakersfield CA 93313 I COVERAGES INSURER A; INSURER B: INSURER C; INSURER D: INSURER E: Colony Insurance Ccmpany Financial Indemnitv INSURED " ,1 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TI'S INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, N01WlTHSTANDINO ANY REQUIREMENT, TERM OR. CONDITION OF ANY ONTRACT OR OTHI!,R DOCUMENT'I-JITH RE.SPECTTO 'M1ICH THIS CERTIFICATE MAY BE ISSUED OR r.tA Y PERTAIN, THE INSURANCE AFFORDED BY THE 'OLICIES DESCRlBEb HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDIíION8 OF SUCH POLICIES, AGGREGATE LIMITS SHO\NN MA,V HAVE B "EN REDUCEO BV P~ID CLAIMS, It.,~ TYPE OF INSURANCE pOL.ICY NU", ~SR. GENERAL LIÞ.IIIUTY - A X COMMERCIAL GENERAL LIABILITY GL 08698 X I CLAIMS ~e 0 OCCUR ~ATe"(M'M1b~· ~k}~~,¡xtA~~1 EACH OCCURRENCE 05/12/00 05/12/01 FIRe DAMAGE (Anyone lira) MED EXP {Any 0<"1.. p6f/lOl'l¡ PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCtS· CQMP/DP AGG LIMITS $ 1000000 , 50000 . 5000 $ 1000000 s 1000000 s 1000000 - GENL AGGR¡¡GATE LIMIT APPLIES PER: "I POLICY n ~~8r n LDC ,AUTOMOBILE LIABILITY - X ANY AUTO - C7~36147 10/01/00 10/01/01 COMBINeD SINGLE LIMIT (Ea accid9nt) s 1,000,000 B ALL OVVNED AUTOS - SCHEDULED AUTOS - HIRED AUTOS BODILY INJURY (Per pðteon) $ - NO~WNED AUTOS - - BODILY INJURY (Po, ..ccidènt) s PROPERTY DAMAGE (Pet acckl8ll1t) s GARAGE UABIIJ1Y ==1 ANY AUTO EXCESS UABtUTY =:J OCCUR 0 CLAIMS MADE I DEDUCTIBLE I RETENTfOr-l $ WORkERS cOIl'lPENSJlTION AND EMPL.OYSt$' LIABlUT'I' AUTO ONLY - EA ACCIDENT $ EA ACC S AGG $ OTH~ THAN AUTO ONLY; : EACH OCCURRENCE $ AGGREGATE $ $ $ S I TORY LIMrTs1 IOJ~' EL. EACH ACCIDENT S E.L, DISEASE· EA EMPLOyeE $ e,L, DISEASE· POLICY LIMIT $ OTHER DESCRlPTIOtI,OF (;IPERATlONSlLOCATIONSlVEHÇLESlEÄCLUSIONS AOI:I~D 8'!' ENDORSEMENT/SPECIAL PROVISIONS I , I ! i ( t ¡ ¡ I ~ ~" r _. - CEiRTIFICA ~ ¡'!OLDEr-t I N i AbOITlO~"L INSURED; INSUR£JUETTER: CANCELLATION " ., ,. - ¡ C'i.TX~"-~8HOUI.D ANY OF TIlE áBOVE DESCRIBED POLICIES B~ C~,'BE~ORI!''THE r,;¡~ ! DATE THEREOF. 'THE ISSUING INSURER WILL ':¡NþEA,VOR TO MAIL -1P_. ;':\Y!J WRlTTSII \ 1 ' NOTICE '(0 TH¡; Cl!R"nFICA TE HOLDER NAMELJ TO THE LEFT. IIUT FAlLURiò. "(0 DO $0 SHALL , Ci ty ,')1:: Bak4i:rsf'ie1 !' IMI'OSS.="O',OBuGA, 1IOrÙIIH.lA, BIIJr( OF ANY "..IID UPON '!'Hi! INSURER,ITS i\QElôT3 n~ ' :, \5Cil' 'Cr\.t'4ocun "'V8n.U" 'I ." - , =,aker:Jfielld, CA ~33)1; rŒPQ!SENTATlVES.· . ì. : ~QRlZEDREPRES¡NTAl1~~, ., / rh, -/~ - · _.,_.--J--,_,__- I::, _~Jc: £11;is' '7L~ ~ t ~.',';()RD ~6-S (7191) j4ç, ' " '..,., @ACORD \~C'RPOAATION 1V8 -'- ,- "~ OCT .18.2000 11: 26AM STATE FUND NO. 345 P.Ul I" .,/'t - --' STATE COMPENSATION INSUR.NCE F=U N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE OCTOÐER S8c¡ 2t!:100 P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 POI-I¢Y NUMBER: CERTIFICATE EXPIRES: 713-ØØ UNl1 000213g !Q-l-ø¡ !CITY OF' B~KËR;FIELD GTEVE UNDEfJ.JOOD æHiH [of STREET ÐAK~RSr-¡ELÐ CA 93301 JOB: CDNTR~ LIC. NO. 742735 L This Is to certify that we have Issued a valid Workers' Compensation Insurance polic:y in a form approved by the California Insurance Commlssion~r to the employer named below for the policy period indicated. This potic:y is not su~ject to cancellation by the Fund except upon ten days' advance writteln notice to the employer. We will also gIve you TEN days' advance notice should this policy be car\oelled prior to iW "ormal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be Issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditIons of such policies. ~~~a:~A~ TH\-", IS A 'FAXED' COpy THE ORIGINAL DOCUMENT WILL FOLLOW IN THE MAIL I(~ PRI!SIPENT EMPLOYER'S LIABILnv LIMn INClUDING ût:'Fi:iNSE COSTSa !i; 19 0Ø@~ 000 ÆR OCCURRENCE. STANDARD EXCLUSION: INDIVIDUAL EMf'lOYER~ AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE fOR BENEFITS AS EMPLOYEES UNDER THIS POllC'! EMPLOYER r Uf:JDF-RWOOD, OOB8Y j. AND UNœ:RWDOD, DBA: BC ENTERPRISES 7104 m_K HORN ST~~ET BAKEF:SrIELD CA 93Z¡~ C\./'j'\TiiIR A. 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I . : '1g'!:f: .. " ...... ':". ....¡ .,. t",', . .' ; .. '.:-:",':(:'/:¡·;':::..;.',:4~:¡¡:'~ :~:':," . {¡jNI}I[RWOOD ,,' 801.Yfy:~·<>J~:AND D~~ ~ F-NYfL~~IS~Š:" ~ '. ' 71'04 EW<. HORN STREET ' BAf<~SP.IÉ:LD ' éA 93313: - " . '..111: '. ..... ., ':',1 ,. , ,"'...' î' ~ '4 :.. ~ ~'.:- ", , " " " ... :~. ... - .. "' -- ..... "'4BÞ' f SERVICES AGREEMENT NO. FD OO~2~t THIS AGREEMENT is made and entered into on October 25, 2000, by and between the CITY OF BAKERSFIELD, referred to as "CITY," and BC ENTERPRISES, referred to as "PROVIDER." CITY AND PROVIDER MUTUALLY AGREE AS FOLLOWS: 1. SCOPE OF WORK. The scope of work is described as: Evacuating, pressure washing, disposing of rinsate, furnishing crane and trucks to remove, haul and dispose of two (2) 10,000 gallon Underground Storage Tanks (UST's) and piping from the property located at K.L. Aviation, 2000 South Union Avenue and providing backhoe and operator to collect soils samples from said property in accordance with the City of Bakersfield Underground Storage tank Removal Guidelines as set forth on the Proposal attached hereto as Exhibit "A.n This scope of work includes all goods and actions necessary to complete the task PROVIDER has been 'hired to perform, whether specifically included in the scope of work or not. 2. COMPENSATION. PROVIDER shall be paid the sum of Eleven Thousand Nine Hundred Ninety-Nine Dollars ($11 ,999.00) for the services to be performed under this Agreement. This compensation shall be the total compensation for services, including out- of-pocket costs. CITY shall pay no other compensation to PROVIDER. 3. PAYMENT PROCEDURE. PROVIDER shall be paid for completed services after receipt of an itemized invoice approved by CITY. Payment shall be made within 30 days after approval of said invoice. 4. INSURANCE. PROVIDER shall procure and maintain a minimum $50,000.00 CGL insurance and workers' compensation insurance as required by statute. Additional insurance may be required by the CITY department ordering PROVIDER's services. 5. INDEPENDENT CONTRACTOR. This Agreement calls for the performance of the services of PROVIDER as an independent contractor. 6. INDEMNITY. PROVIDER shall indemnify, defend, and hold harmless CITY, its officers, agents and employees against any and all liability, claims, actions, causes of action or demands whatsoever against them, or any of them, before administrative or judicial tribunals of any kind whatsoever, .arising out of, connected with, or caused PROVIDER, PROVIDER's employees, agents, independent contractors, companies, or subcontractors in the performance of, or in any way arising from, the terms and provisions of this Agreement whether or not caused in part by a party indemnified hereunder, except as limited by California Civil Code section 2782 or CITY's sole active negligence or willful misconduct. S:\Lit\K L Aviation\Svcs Agmnt.wpd Page 1 of 2 \~. 7 . TERMINATION. Either party may terminate this Agreement with ten days' written notice. 8. COMPLIANCE WITH ALL LAWS. PROVIDER shall, at PROVIDER's sole cost, comply with all of the requirements of Municipal, State, and Federal authorities now in force, or which may hereafter be in force, pertaining to this Agreement, and shall faithfully observe in all activities relating to or growing out of this Agreement all Municipal ordinances and State and Federal statutes, rules or regulations, and permitting requirements now in force or which may hereafter be in force including, without limitation, obtaining a City of Bakersfield business tax certificate (Bakersfield Municipal Code Chapter 5.02) where required. 9. TAX NUMBERS. "PROVIDER's" Federal Tax Identification No. 71...&>1/6-11 PP "PROVIDER" is a corporation? Yes No J>r. (Please check one.) IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed the day and year first above-written. CITY OF BAKERSFIELD ("CITY") APPROVED AS TO CONTENT: BY:~_ Director, Office of Environmental Services, Bakersfield Fire Dept. BC ENTERPRISES ("PROVIDER") By:J¿~ ~BI!> ,~ t//tJ'- :¡I¿J'I E)/(ho¡f¡V fí ßj(/Jþ f33/.ß PRINT NAME AND TITLE By: 6. /' (Addr~s~ 6 - 66g-7t(JJ ë (Phone Number) ~J9.A1e (Facsimile Number) COUNTERSIGNED: ORY J. KLlMKO nee Director 7?1¿7ð~# Contractor's License Number By: By: o content: APPROVED AS TO FORM: BART J. THIL TGEN City Attorney Ron Fraze Fire Chief Bakersfield Fire Department S:\Lit\K L Aviation\Svcs Agmnt.wpd Page 2 of 2 EXHIBIT A @ ... CD Q, :. '0 CD Õ >- u CD a:: ¿;; ~ <.'\I N <It 8 QO <> c: oð en q,¡ x @ -0 ¡;;; '¡ij ¡;;; o '¡¡; !;j) @ 15 d:' §nterQrises ........ 7104 Elkhorn Street Bakersfield, CA 93313 (661) 663-7052 CA Lie. #742735 PROPOS'AL October 12,2000 Bakersfield Fire Department Environmental Services 1715 Chester Avenue Bakersfield, CA 9330 I ATTENTION: Steve Underwood/Ralph E. Huey RE: KL Aviation - Tank Removal BC Enterprises proposes to excavate, pressure wash, dispose of rinsate, furnish crane and trucks to remove, haul & dispose of two (2) 10,000 gallon USTs, dispensers and piping. We will collect a total of eight (8) soil samples with Holguin, Fahan & Associates, Inc. to perfonn the analyses and complete a closure report. We will furnish backfill material & backfill to surface grade. This proposal does not include the following: 1. Compaction report 2. Concrete and/or asphalt 3. Pennits The above scope of work will be completed for the sum of: $ 11,999.00 lÐt'18/2000 11:06 ~ # I '" 661-327-8397 STOCKDALE INSURANCE PAGE 02 , ACORD... , CERTIFIC ATE Of LIABILITY INSURANCec~~~lRA ¡ DA~E~~~~ THIS CER.TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONI. Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTlFICA no DOES NOT AMJ:ND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PRODUceR SKA/Stockdale Insu~ance Agency License #0100644 PO BOX 10269 Bakersfield CA 93389-0269 Phone:661-637-2112 Fax:66 -327-3490 INSURERS AFFORDING COVERAGE INSURED B. C. Ent8rp~ises 7104 Zlkhorn Street Bakersfield CA 933J3 I COVERAGES INSuRER A; INSURER B: INSURER C: INSURER D: INSURER E: Colony Insurance Company Financial Indemnitv " , ~ THE POLICIES 01' INSURANCE LISTED aElOw HAVE BEEN ISSUED TO Tf;S INSURED NAMED ABovE FOR THE POLICY PERIOD INDICATED, N01WlTHSTANDINO ANY REQUIREMENT, TERM OR CONDITION OF AN'! ONTAACT OR OTHf,R DOCuMeNT WI'Tl-I ReSPECT TO Vl/HICH THIS CERTII'ICATE MAT BE ISSUED OR MAY PERTAIN, 1'HE INSURANCE AFFORDED BV THE ~lICIES DESCRlBEb HE:REIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS 01' SUCH POLICIES, AGGREGATE LIMITS SHO\NN MA,Y HAVE e EEN REDUCED 8'1 P~ID CI.Þ<IMS, 'tfR' TYPE OF INSURANCE pOLICY HUM aER GENERAL. UABIU1Y ~ A X COMMERCIAL GENERAl LIABILITY GL 09698 X I CLAJMS ~E 0 OCCUR 1>X~(1..MIDDi'M ' DA.TE i,gró~o LIMITS EACH OCCURRENCE $ 1000000 , 50000 $ 5000 $ 1000000 s 1000000 s 1000000 05/12/00 05/12/01 FIRE DAMAGE (Anyone lire) MEt> EXP (Any en" peo'son¡ PERSONAl & ADV INJURY GENERAl AGGREGATE PRODUCtS - CQMP/OP AGG - ~ GEN'L AGGReGATE LIMIT APPLIES PER: --=¡ POLICyn ~~8T n LOC AUTOMOBILE LIAB1UlY - X AtlY AUTO - C1 36147 10/01/00 10/01/01 COMBINED SINGLE UMIT (Eaa~t) $1,000,000 B - - ~ ALL OVVNEO AUTOS SCHEDULED AUTOS HIREO AUTOS BODILY INJURY (Per pèt'aon) $ - NO~WNeD AUTOS BODILY INJURY (P.... ..cci'*'n!) $ - PROPERTY DAMAGE (Per accldent) $ GARAGE LIABILITY ~ ANY AUTO EXCESS LIABlUTY :=J OCCUR 0 CLAIMS MADE I DEDUCTIBLE I RETENTION $ WORKERS COMPENSATION AND I;MPLOYEIt$' L.IABlLITY AUTO ONLY· EA ACCICENT $ EA ACC S AGG $ OiHlõR THAN AUTO ONLY; EACH OCCURRENCE $ AGGREGATE $ $ $ , I ffi'R~lðMh-sl IU~~' E,L EACH ACCIDENT S ' E.L, DISEASE· EA EMPLOYEE $ E,L, DISEASE - POLICy LIMIT S OTHER , ¡ ¡ ¡ ¡ ~" r ,CEiRTIFICATP":..,r!OLDEr<, .l!!J.~ON"-INSURED;INSU~RLETTEf!: . _ _~NCELLATION ¡", _ ..:.:...-=--- C%TYOI' SHO~L.P ANY OF THE 6Bove DeSCRIBED POLlCIIõ$ BI1. CAIICELL£O'9EFOAE THE J¡¡XPlRA11O,..( OAn 1'HE~EOl'. THE ISSUING INSURER WILL '=.NDEA,VOR TO, MAI~ ' 1 CL. ;:\,,~ WRITTeN ; NOTIc.:E 're THI;¡ CEA'nFIC',A TE HOLDER NAMEU TO THE L~. BUT FAlLURjO "(0 DO 50 StIAlL ; IMPOŠ¡:HO:!>Bu~ tlÒÞì ',)R, Ú~Ðlt.nY OF ANT 1ÇJ,I'Iþ UPON THE IIi/SURER, ITS ^GE":r.:ifj~ ' ;~, ~J!SENTATlVes. ,- i. I'~RIZ£D ItE~RfS&NTAll~~, .,./ ) /:;. _ /' ~ ... ' _ 141cJt 1:11,18' '7L~ ~ t AÇ' . ' '" ';'," @.\CORO ~~~C.·RPOAAT/ON 1~"ß DESCRIPTION ,OF OPEAAT10NSlLOCATiONSlVEHICLE~EÄCLUSIONS A.DQPO BY ENDORSEMENT/SPECIAL PROV\&lOI'IS I i ! j ¡ CH:y '"),t' Bak"iir8~ielt1 \SCU: 'C~W4~un ""venue ~aker~f~øld,CA ~3301 _.,_---1.-,_,.____ ,-':,,:ORD ~õ.S (7/~'() ,OCT.18.2000 11:26AM " STATE FUND NO. 345 P.Ul ¡' '"- .-' STATE COMPENSATION INSURANCE I=U N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE aCTQÐER r8~ ê090 P,O. BOX 420807, SAN FRANCISCO, CA 94142-0807 POI-I~V NUMBER: CEFtTlFICATE EXPIRES: 713-00 UNIT 0002139 tC-l-øl l"ënv OF' BMKËR~IELD STEVE UNDEfJ.JOOD ¡!HjH Ii STREET ~K~RSf¡ELD C~ 93301 JOB: CONTR. LIC. NO. 142735 L This Is to certify that we have issued a valid Workers' Compensation Insurance policy in a form approved by the California Insurance CommIssioner to the employer named below for the policy period indicated. This policy is nor su~ject to cancellatIon by the Fund except upon ten days' advance writtjn notice to the employer. We will also give you TEN days' advance notice should thIs policy be cancelled prior to Ît$ normal expiration. "This certificate of insurance is not an insurance policy and does not amend, extend or alter the cover'age afforded by the policies listed herein. Notwithstanding any requirement. term, or condition of any contract or other document with respect to which this certificate of insurance may be I&sued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. ¿:;.;~~-''''~ TH~ IS A IFAXED' COpy THE ORIGINAL DOCUMENT WILL FOLLOW IN THE MAIL I(~ pFeSIDENT ~PLDYER'S LiABIliTV LIMIT INCLUDING ~~~E COSTS3 ~190ØØ,000 PER OCCURRENCE. STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WlfC EMPLOYERS ARE NOT ELIGIBLE fOR B~NEFITS AS EMPLOYEES UNDER THIS POlIC" eMPLOYER r Uí:JDF-FìUDOD, 00.38'( J. AND UND::RklDOD, D>ÐA: OC ENTERPRISES 71Ø4 ~JJK HORN STr.EET 8AKEP.SFIELD CA 93Jl~ C,.rNTtiI f~ A. L ._.. SCIF 1Q2Ø:a ¡REV. 3-95) elf c: ""'0" OCT-19-2000 03:50 PM BC-ENTERPRISES 6616637052 P.02 .. -.-.- _.- ..-_..~,. ,.. , . .' "'" " " &TAft OOI\llP.....ATIOH 'N.U"'~Nce " " ". , ','. 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'...,. ,. ,'j' ~~~~~~~'.~~~t~$~:r; 71"1 EId<. HORN, STREET, BAf<~SP:1f¡:LQ , CA 933t3 " ".." ... '...'101: ., ,..... " .~ .' ., . ....... ':~ ~ .), . ' ".. ~', :- .' " '. . ~. ... î' ~ . -~ ..:.. ~," " ,,/ @ ... G) Q. aI Il. 'tJ G) Õ >- u G) a: ái ... O! N <.'II "t o á5 ó c:: <IÎ Æ:! ¡¡: oð II) G) )( OJ 'tJ c:: 7G c: o ïñ II) G) õ ... Q.. '. . EXHIBIT M ,. . :' :.. ' ", .. . , " , , ,t, ' · · · I' '.' " I ' '! ¡ ,',.. " , I , 4 ; I · , " FROM : CRWQC - Central Ua~' -y Region . ~ .. ............ ... , ~ , :.' TEL: 209 445 5910 JUL. 19. 1996 4:12PM P3 ,( - . .' .:~. ')~.:,::~.:~';::~~ " ", '\ " ; , "< I () o ..., ," ... ,,'. : CALIFORNIA REGIONAL WATER QUALITY CONTROL BOARD CENTRAL VALLEV REGION CLEANUP AND ABATEMENT ORDER NO. 90-716 fOR J.e. "JACK- GARRIOTT. JR. dba GARRIOTT CROP DUSTING CO. (FORMER OPERATOR), RICHARD R. "DJC"- GARRIOTT db. DICK GARRJ011 CROP DUSTING, (CURRENT OPERA10R). AND RICHARD R. "DICK- GARRIOTT AND KAREN l. GARRIOTT (LAND OWNERS) BAKERSFIELD., KERN COUNTY INC. . : I . :r . ",.!: .,',' The California Regional Water Quality Control Board, Central Valley Regtori, . (hereafter Board) finds that: .' ',. 1. Garriott Crop Dusting Co. was an aerial pesticide operator at 2010 1:, ., Union Avenue. Bakersfield, in T30S, R28E. t'D8&M. On 26 Mlrcb 1987 t Garri ot t Crop Dusting Co. fit ed for bankruptcy under Chapter 11 . A Regionil Board staff inspection conducted on 29 April 1987 revealed that Dick Garriott Crop Dusting, Inc. had begun operations at the facility. The property at 2010 S. Union Avenue, Bakersfield, was acquired by Richard R. Garriott and Karen l. Garriott on 28 'July 1977. 2. G~rriott Crop Dusting Co. was a CaHforn1a corpDration between 5 May 1953 ' , " ' and 1 November 1988. On 1 November 1988, the compan'y was suspended boY the franchise Tax Board and, thus, lost all corporate rights and privileges. Dick Garriott Crop Dusting, Inc. was incorporated on 30 October 1986. Its corporate status was suspended by the Franchise Tax Board on 1 December }988. " '. ~ 3. From 1969 until 1985. wash-down water frOll airplane exteriors and rins..:, " water from mixing tanks was disposed of in an unlined surface impoundment. The surface impoundment is an earthen. artificial excavation formerly used, as a drainage ditch that once continued an additional 190 feet to the eastern boundary of the property. The ditch was backfilled to hold an accumulation of liquids for disposal sometime before September 1986. The Qxisting impoundment is approximately 130 feet long (E-W), 8 feet wide (N- S), and 3 to' 5 feet deep. The impoundment has nearly vertical sides, and is enclosed by a 6-foot high, chain-link fence. 4. The vadose zone sediments beneath the Garriott site are typical of fluvi.r' , and alluvial depo$its, and consist of tan to brown. fine to very coarse- 9~·a1ned. poorly sorted, unconsolidated silty sands. Gravel deposits in a sandy matrix wore also encountered. The transition from the vadose lone to the zone of saturation is marked by an abundance of coarse sand and gravel, and cobbles were present in the zone of saturation. The sandy " loam so11s below the impoundment have moderately rapid permeability and belong to the Hesperh-Hanford series. : " ' ' .... " . , . , : ' ~ '.. ¡ . , TEL: 209 445 5910 JUL. 19. 1996 4:13 PM P 4 ~::~:: :: Î :t: :': . , i. FROM: CRWQC - Central Val"Y Region ,.' .' '" , ( ,t I I " , " I ':;" ': ' ','" ' , ' , .. , ' CLEANUP AND ABATEMENT ORDER NO. 90-71& J~C. 'JACK' GARRIOTT, JR. dba GARRIOTT CROP DUSTING CO., RICHARD R. ~DICK· GARRIOTT dba DICK GARRIOTT CROP DUSTING, INC., AND RICHARD R. "DICK- GARRIOTT AND KAREN L. GARRIOTT BAKERSFIELD. KERN COUNTY -2- Dfscharge of liquid hazardous wastes or hazardous wastes containing free liquids to surface impoundments after 1 January 1985 is regulated &1 the Toxic Pits Cleanup Act. Section 25208, et seq·f Health and Safety Cod. (HISe). ' The impoundment is not adequately covered and receives rainwater each ra1~ storm. The hazardous wastes within the impoundment have, therefore.. been in contact with 'free liquids after 1 January 1985, and'the impoundment at the facility is subject to the Toxic Pits Cleanup Act (TPCA'). 10. The legislature has found that discharges of liquid hazardous wastes or hazardous wastes containing free liquids into lined or unlined POndS; pits, and lagoons pose a serious threat to the quality of the waters 0 the state (H&SC, Section 25208.1(a)]. Hazardous wastes have been discharged into the former drainage ditch, which was closed at both ends to form a surface impoundment. , :1' , .¡" 11,. ,',' 12. , " , , " , " , ' , : ". 5. There are two aqui fers beneath the hel1 i ty. The depth to the ffrst ' encountered water zone is 157-158 feet. The upper, unconfined aquifer overlies the -300-foot clay·, a regional clay 1ayer, the base of which is found at a depth of about 300 fe~t. and which separates the unconfined zone from a deeper confined zon.. ' The beneftctal uses of ground wlter beneath and adjacent to the fl(111ty are agricultural, industrial, municipal and domestic supply. : :', :~ 6. 7. On 8 February 1995, staff from the Department of Health Services. Toxie " Substance Control Division. collected samples from the impoundment while . on an inspett ion with Regional Board staff. The sampl es reveahd hazardous levels of chlordane, DDE, and DOT in soils collected from the abandoned r1nseate impoundment. Other pesticides detected in samp1'$ co 11 ee ted from the impoundment f nc 1 ude: PCNB, Th t odan I , Th 1 od.n II, methoxychlor', carbofuran. carbaryl. buffencarb. Tedion, dtuh'lori, chorpyrtfos, ethyl parathion. DEF, Endosul'an I. Endosulfan II, and l1nuron. '. '. .,,' 8. . "..,' t.' .' :'," , " ' 'Surface 1mpoundmel1t- or -impoundment" means a waste management unit vh1ch is a natural topographic depresston. artificial excavation, or diked arel formed primarily of earthen materials. which is designed to hold an accumúl aHon of 1tquid hazardous wastes or hazardous wastes conh,intng free liquids, including evaporation ponds and percolation ponds [H&SC, Section 25208.2(x»). On 24 April 1985, Mr. Jack Garrtott, dba Garrfott Crop Dusting Co., was informed that the impoundment at the facility was subject to the TPCA, and was I"'cquested to submit a Hydrogeological Assessment Report (HAR), FRUM CRWQC - Central Val' 'Y Region TEL: 209 445 5910 JUL. 19. 1996 4:14 PM P 5 i-'. '- . o . ,~ ' . , CLEANUP AND ABATEMENT ORDER NO. 90-116 J.e. ·JACK" GARRIOTT, JR. dba GARRIOTT CROP DUSTING CO.. RICHARD R. "DICK- GARRIOTT dba DICK GARRIOTT CROP OUSTING, INC., AND RICHARD R. "DICK" GARRIOTT AND KAREN l. GARRIOTT BAKERSFIELD, KERN COUNTY -3~ pursuant to Section 25208.7(b) and Section 25208.8, H&Se; to submit fees to cover TPCA costs t pursuant to Sect ion 25208.3, H&SC; and to ceue discharge to the surface impoundment by 30 June 1988, pursuant to Sectton 25208.4, H&SC. 13. In conducttng an investigation of the quality of any waters of the state within its region, the Regional Board may require that any person discharging or proposing to discharge waste within its region or any citizen or domiciliary, or political agency or entity of this state discharging or proposing to discharye waste outside its region that cou1d affect the qual1ty of waters within its region shall furnish. under penalty of perjury, those technical or monitoring program reports IS the Board may specify. The burden. including costs. of those reports $h.11 bear a reasonable relationship to the need for the report and the benefits to be obtained from the reports [California Water Code. Section 13267(b»)~ 14. 8y letters dated 11 June 1987 and 11 Ju1y 1987, Hr. Dick Garriott. db. Dick Garrtott Crop Dusting. Inc., was informed of the requirements of the TPCA. The July letter informod Mr. Dick Garriott that a Hydrogeologfea1 Assessment Report (HAR) was due J December 1981. Dick Garriott Crop Dusting. Inc. was requested to cease discharge to tho surface impoundment prior to 30 June 1988. and Was notified of past due fees and pen.1tte$. 15. A HAR was submitted 17 April 1989. The .~R indicates that pesticides .r. present tn the $011s beneath the impoundment at hazardous concentrations. Although the concentrations of dlnoseb found at the s1te are not halardou5. the chemical was detected throughout the soil column to ¡ depth of 140 feet (within 18 feet of ground water beneath the site). 16. Although the HAR was deficient in mud of the work necessary to mIke the determ1nation of whether or not the discharge of hazardous waste to . surface impoundment had affected water quality, the work was sufficient to indicate that it is l1kely that the d1$posa1 operation has degraded ground water with, at least. the chemical d1noseb. 17. When the Reglon.l Board determines that a surface impoundment, 1. polluting, or threatens to pollute. the waters of the state. or that hazardous waste constituents are migrating from the surface impoundment 1nto the vadoso zone or the waters of the state, in concentrations which po11utc the vadose zone, or p01lute. or threaten to pollute, the waters of the state, the Regional Board shall order' the surface Inlpoundment to c1os. (HISt. Sect1pn 25208.6). 18. ·Close the impoundment· means the permanent termination of all hazardous waste discharge operations at a waste management unit and any operations necessary to preparo thAt waste managehlcnt unit for post-c10$ure 4:15PM P6 " '; :-::::, ,~: ':-':' ,::~: :. ::: ':'.." ';' ....¿,. FROM CRWQC - Central Val' 'Y Region TEL: 209 445 5910 JUL. 19. 1996 ( :: " " ,t , i / ( CLEANUP AND ABATEMENT ORDER NO. 90-716 J.t. ftJACK- GARRIOTT, JR. dba GARRIOTT CROP OUSTING CO., RICHARD R. -OICKw GARRIOTT dba DICK GARRIOTT CROP DUSTING. INC.. AND RICHARD R. "OICKft GARRIOTT AND KAREN l. GARRIOTT BAkERSFIELD. KERN COUNTY -4- !: maintenance which are conducted pursuant to the federal Resourçe Conservation and Recovery Act of 1976 (42 U.S.C. Section 6901, et seq.) and the regulations adopted by the State Water Resources Control Board and the Department of Health Services concerning the closure of surface impoundments (H&SC, Section Z520a.2(d»). 19. Sectton 13304(a) of the California Water Code states. ftAny person who has discharged or discharges waste into the waters of this state in violation of any waste discharge requirement or other order or prohibition issued by a regional board or the state board, or who has caused or penaitted, causes or permits, or threatens to cause or permit any waste to be discharged or deposited where it is. or probably will be, discharged fnto the waters of the state and creates, or threatens to create, a condition of pol1ut10n'or nuisance, shall upon order of the regional board clean up- , such waste or abate the effects thereof 'or, in the case of threatened pollution or nuisance. take other necessary remedial action. Upon fatlure of any person to comply with such clei\nup or abatement order, the Attorney General, at the request of the board, shall petition the superior court for that county for the issuance of an injunction requiring such persons to comply therewith. In any such suit, the court sha1l have jurisdiction to grant a prohibitory or "andatory injunction. either prel1minat'y or permanent, as the facts may warrant.· , 20. No waste discharge requirements have been issued for discharge of wastes to the impoundment. '21. All work necessary to dete~ine the effects of the disposal of wastewater containing pesticides to the impoundment Ðn the underlying ground water has not yet been completed; free liquids can come into contact with sOils in tho impoundment containing hazardous concentrations of pesticides, allowing haza...dou$ waste constituents to migrate from the surface impoundment .1nto the vadose lone or the waters of the State; and the impoundment ,has not yet been closed. Th is th.-eatens to result in a condition of pollution of ground water underlying the facility. . 22. Issuance of this Order is exempt from the provisions of the California Environmental Quality Act (Puhlic Resources Code. Section 21000. et seq.) in acc.ordance with Section 15321(a)(2), Title 14, California Code of Regulations. 23. Any persons affected adversely by thfs action of the Board may petitton the State Water Resources Control Board (State Board) to review this action. The petition must be received by the State Board within 30 days of the date on which the Board took act ion. Copies of the law and regulations applicable to filing petitions will be provided upon request. ' " ,',' . .' " ',' , ' , ' , " " ".", , ..' ;,:",'" . :;r · ~j' . :;' . ,',:'. . '1: .... !. " 'I" ,', ;: .. ,,' " 'j' ".' .' .. , ,~ ' ," , 'j, " " ", 'I'" ' " '" ¡ ..;,:: ,I: '" I. i. ¡ " !: .' " CLEANUP AND ABATEMENT ORDER NO. 90-71& J.C. -JACK· GARRIOTT, JR. dbl GARRIOTT CROP DUSTING CO., RICHARD R. "DICK" GARRIOTT db a DICK GARRIOlT CROP DUSTING, IN e., AND RICHARD R. "DICK- GARRIOTT AND KAREN l. GARRIOTT , BAKERSFIElD, KERN COUNTY FROM: CRWQC - Central Ual'~y Region TEL: 209 445 5910 I .' ( ( " JUL. 19. 1996 4:29 PM P 2 " .,' :.:', :,,: ::~.':'I,\::( , '.." , HV . r!':iit~tJ , '.,...: :.'.:' :: . ~ -5.. , ", " .-: . ,. ..' , : ~ J :,:':::"1 " ',,;:'i:r::: ; IT IS HEREBY ORDERED that, purSuint to Sections 13261 and 13304 of the Ca11fornU Water Code and Section 25208, at seq., of the California Health and Safety Code, J.e. -Jack- Garriott, Jr. dba Garriott Crop Dusting Co., Richard R. ·Oick- Garriott, dba Dick Garriott Crop Dusting, Inc., and Richard R. "Dick- Garriott and Karen L. Garriott (land owners), shall comply with the following tasks and time schedules. All work outlined below shall be performed under the dtreetion of a California regfstered civil engineer or certified eng1neering'geolog1st. Supporting data and rat10nale shaH be subllitted by the Discharger for e.c;h proposed plan. All plans and time schedules are subject to approval by the Executive Officer. Submitted time schedules become part of this order once appro~ed or revised by the Executive Officer. lu.k I. Complete Assessment discharge. A. Submit a tec"n1c.l report that contains . work plan and time schedul. to address the deficiencies in the 17 April 1989 HAR and to cease the discharge. the Hydrogeological Report and cease the , B. Inittate and complete the work approved '" Task I~A. above. and submit a completed HAR. II. Dete~1ne the extent of ground water degradat10n that has occurred as a' result of waste disposal It the s1te. A. Submit a technical report that contains a work plan and time $chedule to accomplish the fol10wing: 1. Identify the waste const i tuents 1n the plume of degraded ground water. , 2. Assess the 1 atera 1 and vert 1 ca 1 extent of groµnd water degradat i on that has occ:urred from constituents that have migrated from the ~mpound.ent. rnmJ.1.iDtt..lli1I ',' :' i~' . '. . ,:': . '. , 1 October ]990 . , , ". :. I ',:', <> :;~¡ff' . ,',....,. . ;', ';::, :. ~~r:r.; .":.'¡ .. .' '; ",.., . '. ; :'::,i . , ",:, ;:.,:; ~:r).:.' :':0 ':.':' , ' " " .', -:: :':~':: , ': . In accordance with thi' ,': ',.::) approved time schedu1e. ' :: ,;": ",' ¡:'.j¡~.J.~: ," ,!. ';;::'..' ,: ?:,} , , ,:.",; , ,'!-...,. Within 60 days of the Executive Off1ce~'. approval of Task I-B. ;'~.~ ':i' ..; ~:' ;:: ~ ::: ~, .. ,,¡";. ; .... ': :: :':~"H,I:', , ....." . ..,... ., " ' ,;,' :::.:':' ". '. ";: :::,,:':?,:;::' , ' ,:.':,.... ':: , 'i:"'!' !;~J: .. , ..: ,>~~~. , ' : ' .' I, :~:, I. . : ,,: ~: . " t ~:~, ':i ., ';.'.. . " , , ,':. :. :;:; :; :!¡ ~ :': ' ; !,' ' ',. . :( , ' " .. , !. ~ . ¡ : ...... .. , i ~ 'II: ' ~ . : ; '~.. " : ~" , ,I., !., .¡. ,,' ,", '.. '" .;' , ' ! " , "I, " .; , ' " il. , , ..L . ,:' , . " I' ' FROM : CRWQC - Central Val" '~ Region , ': TEL: 209 445 5910 ;' (~ " ( JUL. 19. 1996 4:30 PM P 3 CLEANUP AND ABATEMENT ORDER NO. 90-716 J.t. -JACK- GARRIOTT. JR. db. GARRIOTT CROP DUSTING CO., RICHARD R. "DICK" GARRIOTT dba DICK GARRIOTT CROP DUSTING. INC., AND RICHARD R. -DICK- GARRIOTT AND KAREN L. GARRIOTT BAKERSFIELD, KERN COUNTY Ink 8. Initiate and complete the work approved in Task II-A. above. and submit a report which describes the measures implemented to detèrmine the nature and extent of ground water degradation at. the site. III. Remediate ground water degradation that has occurred as a result of disposal operations at the site. A. Submit a technical report that contains a work plan and time schedule to accomplish the fo11owing: 1. Take correct he act 10n to açhieve tompl hnçe with water quality protection standards. 2. Establish and imp1ement a monttoring program to demonstrate the effectiveness of the corrective action program. The monitoring program shall be as effective as the verification monitoring program in determining compliance with water quality protection standards and in determining the success of a corrective action program. 8. Implement the work detaf1ed in the technical report in Task III-A and submit technical reports describing the design, construction. operations, and offect.iveness of tho$e features nec,ssary to cleanup ground water frø~ the impacts identified in Tas"- I I-B. t.QmR]ianc~ Q.ill In accordance with the approved t 1 me schedul e . ' . : ':. < :;¡~~j :' j:~: -6~ ; ',',: " .,.' .', ' ". ':" ~ i ' , . ~ . . :;; ~~~ ~:.~;; '. " ", ': t;:::,;!, ..: ' " :::, :. ,~ " ,. ".,\ : ,. ' ", .~ . . , ;':'.': : , ' '. ;: :~: {::',: . , ': ':"i:' , ': " :: :::~:F!': ,;;: >~iH: '.. .'. : , ,.:,,'1 ; , , ': ~ ~,,:' .. , :' ':,<: ,,·:drJ,( , , 'M .:~ To',; Within 60 days of the, '!";:":::' Executive Officer's ' approval of T~sk II-B. In accordance vith the'; approved time schedu1e. : ,:~,..'~: '¡; " " " '<:\~~~~-'::' " " ::~:t1 :';, ".'. ,I . ... ...';~¡J. ,'t,U::,: " .·;.,..'::'.1·.. " " ,;, :}T!: ',. ",,' '.', ::::.:!:..¡ , , ,:: I . " .'. " " ;' -: i -:: '.: , " ~. , . ~ " <,·:·,..1 ,,:... . :,.... ! '. : ',::,{H , ",....; '; :)::]' ,\: ;t ": :~'~".~' .; , ',;:,,' :,: ~¡~i; , ',:"::~'.' .., , '......... ';: r~,..:j·, . ,,:~. . ...., :' , ,: 1':' '. 1..'.- (i.' · "I:,,' , , '; '. ï' ' , ' I:: ", .j .,:' 'ii. " : ~ .. '., ' : ", ¡.,' ' '!, " ;:¡ :, '''::" ' ,:¡::'.." ' . 'f', ' ; " : . " , .. ',', . , , " , .. '.. ::!"> . .!' ,,', .1 " ..!: ~': , I: ;.' " .!"" '!", ':..' FROM : CRWQC - Central Val' "oj Region TEL: 209 445 5910 JUL. 19. 1996 4:30 PM P 4 ( ( J . .' , .. .< '1'{;!1 , ( .. ,~ " ',' , : CLEANUP AND ABATEMENT ORDER NO. 90-716 J.C. "JACK" GARRIOTT. JR. db a GARRIOTT CROP DUSTING CO., RICHARD R. "DICK" GARRIOTT dba DICK GARRIOTT CROP DUSTING, RICHARD R. "DICK" GARRlon AND KAREN l. GARRIOTT BAKERSfIELD. KERN COUNTY .' INC.. AND -7- , , ; ',¡,ff lu.k ~.Qf1Iplt~nçt! Oate tv. Close the impoundment. A. Submit a closure plan for the surface 1mpo~ndment. The closure plan must include a time schedule and the disposal methods proposed for the hazardous maleril1s. ,,', ,. , , ~ " :::~; ~::::!: Wi thi n 60 days of the, Executive Officer's, approval of Task I-B. , , ',' ':',: . \ ~' :>:').) "::' '.. ~; ,:,: !;:') , '~ B. Close the impoundment in accÓrdance wi th the apl)roved closure plan. In accordance with ttiè' approved time schedu1e~ , , ~ : " ,: ;, ",,;d¡¡:t; . ., ':~f'U W~~.U . .,' WiIlIAH~CROOKS. Executive Of'1cér R¢H:rch/cjs DATED: 24 July 1990 ....;:-l!: . ,'.' .: , :' :,:, ":: 't:~;~:'J'} ,', : .i.(.: '.~ , ',,:¡ !,! ::,:1 .'~ , "i,nl: . .'. " " :; '.:t':' : , ",. . . ' " ,', .' ~ : . ". ',::,.-::rfH , :' :,::' ,':n:¡-:]:< , ",'i: ::':'., ',···'·····!il'!, ", ;:"~ ~.f.{:,'.: ; '..,;¡?~)~..:,: ,," :;i~ T:: "' :', ~:: ; '. 'I' EXHIBIT H @ ... Q) a. 1\1 0.. 'C Q) Ü >- u Q) II: T'" en T'" q> N N '<f ~ Ó c: o:i ;!? ü: oð rn Q) x (\) 'C .: iG c: o ïii en (\) Õ ... 0.. .', . . ~'i::~~l\~;,:<"" : " , , .. 8 December, 1978 Date ...,. . ,,- . . '....' ' ' - BAKftSFIELD >FIRE ' DEPARTMENT BUREAU OFFill PREVENTION APPLICATION X7 Application No, In conformity with provisions of pertinent ordinances, codes and/or regulations, application is mode by: RIM Enterprises Name af Company 2014 So. Union Address to display, store, install, use, operate, sell or handle materials or processes involving or creating con- ditions deemed hazardous to life or property os follows: ~rad.sBioa to iutall three tanka., ODe diesel tank - 10,000 gal. Two gaB tanks - 12,000 ~1. RUl Equipment ia installing the tanka. Charles McCan is the permitee. ....:~~...Jl1..:~............................. 'Authorized Representative permri~f!d ~.~...Ç2'1-.t9.78........... ,: ,'~?_J¿..~.:..&~..............çg.~:........m......... Date " ',. ',c Fire Marshal " , ~: :" " " ,- ;"", "-. EXHIBIT E @ Q) C- as Q. "0 Q) Õ >- o Q) a:: ...... 0> ...... q; N N '<t" o o co d £: !JÎ .!! ¡¡: I>ð /I') IV X <IJ U c: ïïi c:: o ,:¡¡ (/) q¡ Õ ð: . . r' ¡ 'I ,( 1 , I I I I I 1 \ I 1 lf~ I , ; f I I , , I I I Drain~ge & ACC8SS EðS0m~n~ : i ~) , ---- J-'-- ,- , f t I I ! ; I . : II ! ! I I ' I ! I ¡ j I J t , ¡ : t t ! f I ¡ , , I I \ : ; r I I .( I $..... ~...e J::..,;>c~.,p~eAffi 1/, I / /' // // 2: t I ! . , I I I I I I /'_' [==r--'-'_ ~ ~~ Islanrl--- ¡ \;;;U¡I I4p".,."il ; (~{ F""t!-I f,...,I<5. I , I ~ PLATE 2 ~ DATE Shop Shop ,J BAKERSFIELD AIRPARK ¡ , ¡ I !n ' I I I I ¡ SITE PLAN ßakersfielct ^irpark J\PPIHWP,D REVISED A-n-~oII'ð""'" cfé. EXHIBIT D @ ... Q Co «I a.. "C Q Õ >. o Q II: ..... œ T" ~ N N "'" 6 o co Q C tf) ~ ¡¡: "" tf) () x Q) "0 c:: "@ c: '0 '00 rJ <) Õ à: ~ ". . . ^J f þ' Co!.. ~tÆ.. /r ~ .~_.._'--._-.......+.- .tí ......._.......__ ~ v 't '\.\ gi ~~ \.Ii I' ,_.. __u__, -:--,.__.. .. , CONe. - ~t_._ __,._ ;\ 'J 0 "' FlIlL if ~ ISI.AND I ]œ I I~ 1~ llNDfR(;R()(INO ' , ¡- t' j 0 0 eø..r ~ ~ FUf:1. STOI?ta ~.. :'" ~e.\ 10)(700'111/ -_...,---- AII'4A~ 10cLJ- ~t <..l-..I!::',1.JEf,) A""tÐ METAL t } I BLDG, ,.........---.. I ~I MISC£LLJ)NfOV5 ~ I · ~. - ~Jf',.,t::Nr f .... ~ SCRAP ~ STO~~G£ I I~ I ¡ ~ ,.,.5C_""",~"_':-; __ ~-'rrM:r'-.L __-_ _". .. ~ -'-I'-~- ,... --,'. f·....; I f I , i . . t y~'w 1 ,.' '._.. . ".'. ,-- .., . ~ ~ . .. . ~ > .' " .. 'l'¡h" ' O~};r;¡,:~, , , " .........'. , r~~Ít~,'· ,Bu; 1~'''1 '. '.:' . . :,: :~' . " ¡, ':. " .,' ,'.. '_ I, , " , :: ' ~~r#1t ;, ."/ " , , " . ., ... .. ....... <' . /..;; @ œ a. III a. 'C Q) Õ >- o Q) a:: 0; ,.. 0{ ~ "" ó o a:¡ Ó c: rñ () ¡¡: oð I/) Q) X Q) 'C c: ëa c: o ¡¡¡ m () - e a. ,('. -:~ EXHIBIT B . . ,- STATE OF CALIFORNIA - Environmental Protection Agency r PETE Vv1LSON, Govemol CALIFORNIA REGIONAL WATER QUALITY CONTROL BOARD CENTRAL VALLEY REGION 3614 East Ashlan Ave, Fresno, CA 93726 PHONE: (209) 445-5116 FAX: (209) 445-5910 14 February 1995 Mr. Michael D, Pilla Michaelis, Montanari, and Johnson 2829 Towngate Road, Suite 150 Westlake Village, CA 91631 GARRIOTT CROP DUSTING (GCI» FACII.'{TY, KERN COUNTY We have conducted an inspection of the site and reviewed a letter dated 30 November 1994 from Mr. Manning Puette and conclude that: I, Information provided indicates that GCD has not made an adequate effort to obtain access to install a downgradient monitoring well, which is needed to identify the outer boundaries of polluted ground water as required under Cleanup and Abatement (C&A) Order No. 90-716, 2, Repair work/maintenance of the cover needs to be implemented to prevent contact of rainwater with contaminated soils at the locations where rodents have burrowed through the cover. Prior to 15 March 1995, please provide us with a plan and time schedule for addressing the above issues, A copy of our inspection memorandum is enclosed. If you have any questions or would like to meet with us to discuss this matter, please telephone Les Obata at (209) 488-4390. 'r V, F. SCOTT NEVINS Senior Engineer RCE 14336 '''--., #0 ~/ LSO:lso/mlc Enclosure cc: Mr. Mark 1. Urban, Deputy Attorney General, Department of Justice, Sacramento Mr, Philip Wyels, Staff Counsel, SWRCB-OCC, Sacramento Mr. Alan D. Daniel, Assistant City Attorney, City of Bakersfield, Bakersfield Mr. Steve McCalley, Kern County Department of Environmental Health, Bakersfield ......... Mr. Manning Puette, Klein, Wegis, DeNatale, Hall, Goldner & Muir, Bakersfield "'Mr. Bill Lewis, KL Aviation, Bakersfield ! ~ ¿(II _ , ~ -¡ CENTRAL VALLEY REGIONAL WATER QUALITY CONTROL BOARD INSPECTION REPORT DISCHARGER: Garriott Crop Dusting (GCD) Facility LOCATION & COUNTY: 2010 South Union Avenue Bakersfield, CA Kern Coooty CONT ACT(S): Mr. Bill Lewis KL Aviation INSPECTION DATE: 8 November 1994 INSPECTED BY: Lester S. Obata ACCOMPANIED BY: Bill Lewis - KL Aviation Scott Nevins - CRWQCB, CVR On 8 November 1994, I conducted an inspection of (1) the GCD facility at 2010 South Union Avenue, and, (2) the area south of the GCD facility near Planz Road and Coy A venue, where construction of a new ground water monitoring well has been proposed. The construction of the monitoring well is part of the work that is needed to investigate the lateral extent of ground water that has been degraded from past wastewater discharges at the GCD facility. The location of the GCD facility and the proposed new well are shown on the attached map (Figure 2). A narrative of the observations made during my inspection of the two areas is provided in the following section. 1. Inspection of GCD Facility The GCD facility is adjacent to the City of Bakersfield on South Union Avenue. The facility has been shut down for several years, and there is currently no operation ongoing at the site. Mr. Bill Lewis (KL A viation) recently acquired the GCD property through foreclosure action and plans to move his aviation repair business to the GCD site. Mr. Lewis currently operates an aviation repair shop (KL Aviation) at a facility leased from the City of Bakersfield. The business is located north of the GCD site and at the City of Bakersfield Airpark. Although Mr. Lewis is planning to move his business onto the GCD site, he is aware that both soil and ground water has been affected from past operations and a significant amount of contamination assessment and remediation work remains to be completed. Site contamination assessment and [Approval idtdt-VV!) ~II~(~ \(' GARRIOTT CROP DUSTINO -2- 1 0 FEBRUARY 1995 remediation work for the OCD facility is required in accordance with Regional Board Cleanup and Abatement (C&A) Order No. 90-716, issued 24 July 1990. During OCD's past operations, wastewater was discharged to an unlined impoundment along the south side of the property. The impoundment was forn1erly a drainage ditch that was bermed at both ends to contain liquid wastes. Soils underlying the impoundment have been impacted with a variety of pesticides and herbicides. A ground water monitoring well (MW-l) was completed near the center of the impoundment in January 1992. Information developed from that work indicates that dinoseb, a cWorinated herbicide, has migrated through the soil profile into ground water. Interim measures have been taken to cover the impoundment and restrict further migration of contaminants to ground water. The impoundment was backfilled to original grade with native soil and covered with a 10 mil plastic liner. Additional soil was then placed over the area and followed with a second liner and more soil cover to hold the upper liner in place. The top of the backfilled area is about two feet higher than original grade and sloped to prevent rainwater from ponding on top of the fill. As I inspected the interim cover on the impoundment, I noticed that there were at least two areas on top of the backfill where rodents have burrowed vertically through the soil cover. If rodent activity has damaged the integrity of both liners in those areas, rainwater can infiltrate through the interim cover and cause additional migration of contaminants to ground water. Therefore, repair work on the interim cover, particularly in those areas where rodent holes exist, needs to be performed. Rainwater that falls on other areas of the property generally drains towards the north section of the property and is contained onsite in a drainage swale. In the past, rainwater that drained to the swale flowed east onto the City of Bakersfield property and to the City's storm water pond. However, after the soil contamination problem was discovered on the OCD site, the City took action to prevent rainwater from draining onto the City Airpark by constructing a berm between the City and OCD property. There was no rainwater ponded during my inspection. Mr. Lewis has expressed concern that rainwater could pond over contaminated soils following storm events and could cause further groundwater degradation problems. I collected a soil sample from the drainage swale to evaluate the potential impacts from rainwater ponding over the area. The sample was collected from a depth of about 6 inches, at a location approximately 40 feet west of the northeast comer of the OeD property. The soil sample was subsequently submitted to Appl Laboratory in Fresno to be analyzed for organochlorine pesticides (EP A Method 8080), organophosphorus pesticides (EP A Method 8140), and chlorinated herbicides (EP A Method 8150). The analytical results reported by Appl indicate that all constituents analyzed were determined to be below laboratory detection limits. The findings from the sampling event indicate that although corrective measures may be needed to prevent ponding of rainwater in the swale, work needed for this area can probably be conducted later as a lower priority. 2. Inspection of Location Selected by GCD for Proposed Ground Water Monitoring Well C&A Order No. 90-716 directs OCD to provide and implement a plan for defining the lateral and vertical extent of contaminants in ground water. During May 1994, a workplan for the construction of a new ground water monitoring well at a location south of the site was submitted by Mr. Michael Pilla, attorney for OCD. We reviewed the workplan and subsequently told oeD to implement the work necessary to construct the downgradient monitoring welL · GARRlOTT CROP DUSTING -3- 10 FEBRUARY 1995 The proposed work that was conceptually approved includes: (I) The construction of a downgradient monitoring well, approximately 1,400 feet south of the GCD site, and near the intersection of Planz Road and Coy Avenue (see Figure 2). (2) Development of the well; sampling and analytical testing for specific constituents of concern. (3) Preparation of a report covering this phase of work; to be submitted to the Regional Board by 1 October 1994. On 8 November 1994, I visited the area near Planz Road and Coy Avenue where GCD proposed to construct the monitoring well. The area surveyed consists of privately owned parcels that are either vacant or occupied by light industrial type businesses. After touring the area, I reviewed parcel maps and records at the Kern County Assessors Office. This review indicates that there are at least six different property owners in the area of the proposed well (including the City of Bakersfield). On 30 November 1994, we received correspondence indicating that GCD has: (a) contacted one of the six property owners in the area (City of Bakersfield), and (b) been unable to conduct the proposed work because the City has not allowed access to the property. Guidance from our legal staff indicates that the Regional Board may require land owners to provide ground water monitoring reports where ground water is polluted or threatened to be polluted. This authority is contained in Sections 13267, 13268, and 13304, of the California Water Code. Before deciding to proceed with action under this authority against the City of Bakersfield or any of the other five property owners in the area, it needs to be determined whether GCD has made an adequate attempt to access the property to complete work required under C&A Order No. 90-716. As indicated below, GCD's letter of 30 November 1994, does not provide information to indicate that an adequate effort has been made to gain access or that reasonable consideration has been offered to gain access. Information which has not yet been provided includes: (a) Documentation of contacts with the City representatives (including dates, names, type of contact, etc,); (b) correspondence documenting the nature of access requirements requested by GCD; (c) correspondence which documents consideration offered to the City by GCD for the access requested in Item (b) above'; (d) indication that requests for access, along with offers of reasonable consideration, have been made to other property owners in the area. lA letter to us dated 15 December 1994, from the City of Bakersfield indicates that OCD has refused' to indenmify the City for liability from work on the property. 'GARRIOTT CROP DUSTING -4- 1 0 FEBRUARY 1995 SUMMARY GCD has not provided sufficient information to indicate that an adequate attempt has been made to gain access to the City property or to indicate that reasonable consideration has been offered to the City. If GCD is still unable to negotiate an agreement to gain access to the City property even after an adequate attempt has been conducted, there are at least five other property owners in the area that can be approached. To demonstrate that an adequate attempt has been made to gain access to City or private property, a reasonable approach must be taken by GCD. All significant activity related to the request for access conducted between GCD and the property owner must be documented and should include, but not be limited to, the following: 1. A sW1lInary of contacts with property owners (including names, types of contact, d~tes, etc.). 2. Correspondence documenting the nature of access requirements requested by GCD. 3. Discussion of consideration offered to the property owner(s) by GCD, for the access requested, CONCLUSIONS I. Information has not been provided to indicate that GCD has made adequate efforts to obtain access to install a downgradient monitoring well. 2. Repair work/maintenance of the cover needs to be implemented to prevent contact of rainwater with contaminated soils at the locations where rodents have burrowed through the cover. Attachment \ \ Ä -f.6\ \ APPROXIMATE UfJCONFlfJED AOUIFER ~">-.. EDGE· OCTOOER 1993 "_ ...J1¿¡L ~ , , ' ~ ..Ll206. """" ~~ (_.on' ,_,_ :x \ '" ~ '" . ~ - ,I '" \, '" \ ~ \ ------ ...- l-) .............. /, '" '-' , -'1' -~.-=-- .- ,,",,\~,.4 J \ I "' ',\ ('\ '" I ,~PROPOSED LOCATION C r[R 'I" , 'I' ". I.... VA , ' 0- .............. MW·2 6358 -937 \ .............., ~ 3/16/.90 Q,R',',, " , JO--, '"::::ç - L- 655,dL-L -i- i>-L - \,!_,SS~ --l- r -PL-AN L - no. ----------,.-. r e " :,15 W I APPROXIMATE UNCONFINED AOUIFEn > 20 FOOT CONToun· OCTOOEn 1993 « >- 8 --1 ','" b 1 ~ W" 0- - - I ' ,F.~ r?\AA gi .~r 0viR ì ,- , ~. ~ ~ I I, OUR r ~ \Ao't<,~ 8 (',¡-: 90 \ \ Rr-'" ¡: 6 :;:¡ , ~~.:;! S --<. --L ~ -,--.-1 :8 IT -r-' / -7 , / I ,'89,25 - I I GARRIOTT CROP DUSTING SITE I ~ "4 '<> I £ G I :¡: 9/9.31 654,613 ® I I I - ~ ~ I I 1 I -<>- I I 8G.J ö :J ZJ ,\ r 1 /....... 32\ \:,/ 2/ 655,07 27 EL a,S7AC @\1R \,) ,,- + , ,45 3?Q' SCALE 1'1 fEE T REF: WZIINC" BN<ERSFELD, CALFORNIA. 1994 ('I '654,68 ' @MR æ 655,07 - - éB 5pO' ~ -.?ý- 1\ FIGURE ~ emcon {f#ì Associates GARRIOTT CROP DUSTING GROlHOWATER MONITOR1NG WELL INSTALLATION BAKERSFIELD. CAUFORNIA 2 PRO.lECT NO, 25ö&-200,01 LDCATION OF MONITQR1NG WELL MW-2 lJ~!t I _~. v ."'....¡¡¡.¡¡¡¡ lu~ulne lax Keturn IRS Use Only - Du nof write Of staple in this space, ,1!l97, cllding , 19 OMB No, 1545-0074 Your social security number .. For the Y."' Jan, 1.'lJec. 31, 1997, or other tax year beginning Do you want $3 to go to this fund? . . . . . . . . . . . , . . If a joint return, does your spouse want $3 to go to this fund? 1 Single 2 X Married filing jOint return (even if only one had income) Married tiling separate return. 3 fnfer spouse's social securiry no, above & full name here, .... _~_ __.__~_ Head of household (with qualifying person), (See page 10J If the qualifying person is a child but not your dependent, enter this child's name here, ~ 5 Qualifying widow(er) with dependent child (year spouse died ~ 19 ). (See page 10J 6 a IXl Yourself, If Your Parent (or someone else) can clatm you as a dependent on hts or } Nho, 0kf dboxes 1-,,1 c ec e on her tax return, do not check box 6a, , , . ., .. ............. 6a and 6b b xl Spouse . . . . . . . , . . . . . . . . . . , . . . . . No, of your c De endents' (4} No, 01 children on ,_.____ __________._____...__ ,___:P-._____,_:...__.____ m Oependent's (3) Dependenl's os, lIVed 6c who, (,! name social security number lelationship to you inhO~~r . lived with you I I 602-96-0715 DAUGHTER 12 .did not live ¡ with, you due to dtvorce or separatiQn (see page 111 Dependents on 6c not enter ed above Add numbers entered on lines above ~ ~ far right column for lines 7 througl1 21. This is ;~~-;;t~¡¡;;co~;--:-:-~'-'; lage 16) . . . . . . . . . , , , , . . 23 ,unt deduction, Attach Form 8853. 24 25 Moving expenses, Attach Form 3903 or 3903-F , 25 26 One-half of self-employment tax, Attach Schedule SE 26 If line 321$ under 27 Self -employed health insurance deduction (see page 17) 27 $29,290 lunder 28 Keogh and self-employed SEP and SIMPLE plans. . , . . 28 $9.770 jj a t;M~ t\~ ~{è;\ ¡~ 1f'ê'f'1tJ\\ÿt>n ~'11t\\( WI\\"Óf~llitl' ~ëN;m'9S' . , . . .. 29 live wìth you), 30 a Alimony paid, b Recipient's SSN '-'_d __,_ _ 30a see EIC on page 21. 31 Add lines 23 through 30a. . . . . . . . . . . , ' . . , . . , , , , 32 Subtract line 31 from line 22, This is your adjusted gross income. A87H For Privacy Act and Paperwork Reduction Act Notice, see page 38. Use the IRS label. Other - wise, please print or type, Presidential... Election ~ Cam ai n KENNETH W. & KELLY 1516 IVAN AVE BAKERSFIELD Filing Status Check only one box 4 Exemptions Wag...., tips, other camp, 14013.00 2 e era .ncome tax Wit e 1293.56 Social security tax withheld _~8,81 6 Medicare tax withheld 203.19 -a- Control Number Oap, -~;:l Emplover use on!v _Q501.QLPU,", ,_,_05~,-'-:,LA 98 c Employer'" name, addre...., and ZIP code Social security wage& 14013,00 5 Medicare 14~N3a."8òiPa SANBRA INC 1801 JULIAN AVENUE BAKERSFIELD CA 93304 b""""Employer's FEO ID number d Emplo~ee's SSA numbër 95·3875908 568-41·9608 7 Social security tips 8 Allocated tips vance payment 10 Dependent care benefits 12 Benefits included in box 1 3- See lnati-;-:'iör box 13 14 Other 70.07 CA SDI S-StlI emp, '¡jew.sed Pension plan , -Employee's name, address and ZIP code ELL Y LEWIS ..16 IVAN AVE l\KERSFIELD CA 93304 State EmplajÍé7;;staïe ID 17 Slate wages, lips, e¡c.- :A 30B-5370-9 14013.00 Slate income tax 19 Locality name 154.80 Local wages, típa, etc. 21 local income tax Federal Filing Copy -J-2 Wage and Tax 1997 Statement ClMB No, \54£0008 B To be filed..1IIt .mploy..', fad.rellneome To ReI.In. ' Income 51 D. LEWIS CA 93304-6649 ~m tions claimed. . . . . . . ¡ etc, Attach Form(s) W-2. I ~ch Schedule 8 if required. k. DO NOT include on line 8a , ;tach Schedule B if required, I pits. or offsets of state and local 8b income taxes (see page 12) . . . . . . . . . . . . . . . . . . . . <loss), Attach Schedule C or C -EZ ¡ Attach Schedule D. . (sL Attac~h Form 4797 . , , . . !s . .. 15a b Taxable ~nuities 16a b Taxable 'yalties. partnerships. S corporations. trusts, I !;), Attach Schedule F. ~nsation. . . . ¡its.. ~I and amount-see page 15 amount (see page 1 3) amount (see page 13) etc. Attach Schedule E . . . . . . . . . . . . . . . b Taxable amount (see page 14) 3 554-35-1795 Spouse's social secur ¡tv number 568-41-9608 For help in finding line instructionSi see pages 2 and 3 in the booklet. Note: Checkmg "Yes" w¡f/ not change your tax or reduce our refund. 2 1 7 14 013 8a 14 9 10 65 11 12 52 719 13 14 15b 16b 17 18 19 20b 725 566 66 811 ~ 31 4 2,9', 32 6 2 5 ':-' Form 1040 I ~, 74660 , fJlP I<IL ~ Tax' Compu - tation Form 10/10 (1997) 33 Arnount from line 32 (adjusted gross income) . . , . . . . . . . . . . . . . . . . . . 34 a Ct1eck If: [J You were 65 or older. D Blind; D Spouse was 65 or older. 0 Blind, Add the number of boxes checked above and enter the total here . . . . ~ 34a b If you are married filing separately and your spouse Itemizes deductions or you were a dual-status alien, see page 18 and check here. . , . . . . ~ 34b If you want the IRS to figure your tax, see page la, Credits Other Taxes Payments Attach 57 Forms W - 2, 58 W'2G, alld 1099-R 011 5~ page 1- 60 Refund 61 Have It 62 directly ~ depositedl See page 27 and fill In ~ 62b, 62c, and 62d, 63 64 Amount You Owe 65 Sign Here Keep a copy ~ of this return for your ~ records, Paid Preparer's Use Only 52 35 {Itemized deductions from Schedule A. line 28, OR } Enter Standard deduction shown below for your filing status But see the page 18 If you checked any box on line 34a or 34b or someone larger can claim you as a dependent of . Single - $4,150 . Married filing JOintly or QualifYing wldow(er) - $6,900 your: . Head of household - $6,050 . Married filing separately - $3,450 33 Page 2 62 520 9 280 36 53 240 37 7 950 38 45 290 39 7 321 45 ~ 46 47 48 49 50 51 52 53 ~ 294 o 7 321 7 449 14 770 1 294 d Account number Amount of line 61 you want APPLIED TO YOUR '98 ESTIMATED TAX~ If line 53 is more than line 60, subtract line 60 from line 53, This is the AMOUNT YOU OWE, For details on how to pay. see page 27, . . . , . . , . . , . . . . . . . . ~ 64 Eslrmated tax penalty, Also include on line 64 , . . . . . . .. 65 136 Under pena¡ies of perjury, I declare that I have examined this 'elu,u and accompanying schedules and statements, and to the best of my knowledge and beliet, they are true, correct, and complete. Declaration of prepare! (othel than taxpayed is. based on all information 01 which preparer has any \l.nowledge, 36 37 Subtract line 35 from line 33 . . . . . . . . . . . , , . . . . . . . . , . . . . . . . 38 39 40 41 42 43 44 If line 33 IS $90,900 or less, multiply $2,650 by the total number of exemptions claimed on line 6d, If line 33 is over $90,900, see the worksheet on page 19 for the amount to enter, . Taxable income. Subtract line 37 from line 36. If line 37 is more than line 36. enter -0- . Tax. See a e 19, Check if an tax from a Form(s) 8814 b Form 4972 ~ Credit for child and dependent care expenses. Attach Form 2441 40 Credit f or the elderly or the disabled, Attach Schedule R 41 Adoption credit Attach Form 8839 , , . . , , , , ' , . , 42 Foreign tax credit Attach Form 1 1 16· . . , . , , . , . . 43 Other. Check if from a 0 Form 3800 b 0 Form 8396 c 0 Form 8801 d D Form (specify) ~___,_ Add lines 40 through 44 . . . . . , . . . . , . , , ' . . . . , Subtract line 45 from line 39, If line 45 is more thall line 39, enter -0- Self -employment tax, Attach Schedule SE. , . . , . . , Alternative minimum tax, Attach Form 6251. . . . . . . 44 45 46 47 48 49 50 51 52 53 54 55 56 Social security and Medicare tax on tip income not reported to employer, Attach Form 4137. Tax on qualified retirement plans, (including IRAsl and MSAs, Attach Form 5329 if required. Advance earned income credit payments from Form(s) W - 2 . Household employment taxes, Attach Schedule H. . . . , Add lines 46 through 52, Total tax. . . . , . . . . , . , , . Federal income tax withheld from Forms W-2 and 1099 . . 1997 estimated tax payments and amount applied from 1996 return. Earned income credit. Attach Sch, EIC if you have a qualifying child b Nontaxable earned income: amount~ and type ~,_ ,____ 56a Amount paid with Form 4868 (request for extensIOn). . . .. 57 Excess social security and RRTA tax withheld (see page 27), 58 Other payments, Check if from a D Form 2439 b I I Form 4136 59 Add lines 54, 55, 56a, 57. 58. and 59. These are your total payments. . . . . . . ~ If line 60 is more than line 53. subtract line 53 from line 60, This is the amount you OVERPAID. a Amount of line 61 you want REFUNDED TO YOU. , . , . . . . . . . . . . . . . , . . ~ b 110uting number c Type: D Checking D Savings 54 55 1 60 61 62a SELF-EMPLOYED Your occupation RESTORATIVE AIDE Spouse's occupation Preparer's social security no, 545 68 7233 ¿, ,Z( JOYCE A. BEREND EN, J B ACCOUNTING PLUS 1801 HAST I-ACRES DR. STE.7 BAKERSFIELD CA. 93309 EIN ZIP code 93309 74660-15 FOflll 2210 Underpayment of Estimated Tax by Indivldualls, Estates, and Trusts ~ See separate instructions, ~ Attach to Form 1040, 1040A~)NR, 1040NR-EZ, or 1041. OMB No, 154:;'0140 ~®97 OeparlIJIt!rJl ul Ihe Trt.:~sury Internal Revellue Ser ;'Ice ~~I~~~~~ee"INO 06 Identifying number 554-35-1795 Name(s) shown on tax return KENNETH W. & KELLY D. LEWIS Note: In most cases, you do not need to file Form 2210., The IRS will figure any penalty you owe and send you a bill, File Form 2270 only if one or more boxes in Part I apply to you, If you do not need to file Form 2210., you still may use it to figure iuur pCIJalty. Enter the amount from line 20. or line 32 on tilt' penalty line of your return, but do not attach Form 2210. I:ilftiIï Reasons for Filing - If 1 a, b, or c below applies to you, you may be able to lower or eliminate your penalty, But you MUST check the boxes that apply and file Form 2210 with your tax return, If 1 d below applies to you, check that box and file Form 2210 with your tax return, Check wllIchever boxes apply (if none apply, see the Note above): a I YOll request a waiver, In certain Circumstances, the IRS vvill vv¡¡,ve ¡¡II 01 part of the penalty, See Waiver of Penalty on :;dge 1 of ttle Instructions, Yo,: ,Jse the annualized income installment method, If your Income varted during the year, this method may reduce the amount of one or more required installments, See page ,~ of the instructions, You had Federal income tax withheld from wages and, tor e:;tlmated tax purposes, you treat the withheld tax as paid on ttle dates it was actually withheld, instead of in equal amounts on the payment due dates, See the instructions for Ime 22 on page 3, d L: Your required annual payment Oine for either 1996 or 1997 but not b c i 13 below) is based on your 1996 tax and you filed or are filing a Joint return for both years. DmIlW Required Annual Payment 2 Enter your 1997 tax after credits (see page 2 of the instructions) Caution: Also see page 2 for a special rule if claiming the research credit . 2 3 Ottler taxes (see page 2 of the instructions) . 3 4 Add lines 2 and 3 . , 4 5 Earned ,ncome credit. 5 6 Credit f or Federal tax paid on fuels. 6 7 AcJd lines 5 and 6 . . 8 Current year tax, Subtract line 7 from line 4. 9 MUlt,ply 1'l1e 8 by 90% (90) . . . . , . . . 9 13 293 10 WllIlholcJll1Y taxes, Do not include any estimated tax payments on this line (see page 2 of the instr.). 11 Subtract IlIle 10 from line 8, If less than $500. stop here; do not complete or file this form, You do not owe the penalty. . , . . . . . . . . . .. . . . . . . . , . . , . . . . . . , , , . , . . . . . . . . 12 Enter the tax shown on your 1996 tax return (110% of th.,t amount if the adjusted gross income shown on that return IS more than $ 1 50,000, or if married fil,ng separately for 1997, more than $75,000) Caution: See page 2 of the instructions. . . , , . . . . . . . . 13 Required annual payment. Enter the smaller of line 9 or line 1 L . . . . . . . . Note: If Ime 10. is equal to or more than line 13. stop here; you do not owe the penalty, 00 not file Form 2210. unless you checked box ld above, Iil'r.IiTIIi1 Short Method (Caution: See page 2 of the instructions Co fmd out if you can use the short checked box Ib or c in Part I, skip this part and go 10 Part IV) 14 Enter the amount, if any, from line 10 above. . . . . . . . , , 15 Enter the total amount, if any, of estimated tax payments you made 16 Add llIles 14 and 15 , . . , . . . . . . . . . . . . . . . . . . 17 Total underpayment for year, Subtract line 16 from line 13, If zer no\ OWE: ¡he penalty, Do not file Form 2210 unless you checked b 18 l\i1"I\,ply 11I1e 17 by ,05CJ86 , . . . . . . . . . . . . . . . . . . , , 19 . ',1 the "l11ount 0'\ IlI1e 17 was paid on or after 4/15/98. tinter - . I i the arnount on line 1 7 was paid before 4/15/98, make the to ¿l11ount to enter on [lIle 19, 7 321 7 449 14 770 7 8 14 770 10 1 294 11 13 476 12 3 566 13 3 566 method, If you 20 Amount on line 17 PENAL TY, Subtract line 19 from line 18, Enter 1040A. I,ne 34; Form 1040NR, line 65; Form For Paperwork Reduction Act Notice, see page x Number of days before 4/15/9 the result here and 1040NR-EZ, line 2 1 of separate instructions, 1141 1,294 115 I 0 , 16 1,294 0 or less, stop here; you do ox 1d above ' 17 2,272 18 136 0- Ilowlng computation to find the paid ;" 8 x ,00025. 19 0 on Form 104O, line 65: Form 6' or Form 1041, line 27 ,~ 20 136 AB7B Form 2210 (1997) 53 74660-15 I' ...111 tU<+UI Oeµartrnec¡[ (II [flc I¡\~ð',LI(Y ¡nlf!rna! H¡~vf'nlll' ~;I'¡.. ICl~ ';»~lIeuule A - Itemized Deductions Name(s) SIWWI1 011 Form 1040 ~ Attach to Form 1040. ~ See Instructions for Schedule A (Form 1040), KENNETH W. & KELLY D. LEWIS Medical and Dental Expenses Taxes You Paid (See page A'21 Interest You Paid (See pagt A,) i Note: Personal interest is not deductible Gifts to Charity if you made a gift and got a bene fit t or It, see page A - 3, Casualty and Theft Losses 19 20 Job Expenses and Most Other Miscellaneous Deductions (See page A - 5 i or expenses to deduct hêre,¡ 23 24 25 26 Other 27 Miscellaneous Deductions Total Itemized Deduct,uns Caution: Do not include expenses reimbursed or paid by a/hers, Medical and dental expenses (see page A-1) SEE ATTACHED A-I ._--,--~ 2 3 4 5 6 7 8 2 62 520 .. .. .. .. .. .. .. . .. .. .. . .. .. .. .. .. .. . . .. . . . . . . . . . . . . . . . . Add lines 20 through 22 . . . . . . . . Enter amount from Form 1040. line 33 ~ 62 520 M\Jlliply line 24 above by 2% (.02L . . . . . , ' ,. ...,., 1 Subtract line 25 from line 23. if line 25 is more than line 23, enter -0- Other - from list on page A-5. list type and amount ~ 3 5 6 7 8 11 12 13 16 17 33 }07 Enter amount from Form 1040, line 33. Multiply line 2 above by 7,5% (.075). Subtract line 3 from line 1, If line 3 is more than line 1, enter - 0- State and local income taxes. . . Real estate taxes (see page A-2) Personal property taxes . . . . . . !"!\UTO LICENSE TAXES FROM BUS. EXPENSES __ _____-----125 98 _ _n_'_____" -~----_.- --- Is I'orm 1040, line 33, over $121.200 (over $60,600 if married filing separately)? NO, Your deduction is not limited. Add the arnourlts in the far right column for lines 4 through 27, Also, enter on Form 1040, line 35, the larger of this amount or your standard deduction, YES, Your deduction may be limited, See page A- 5 for the amount to enter. Paperwork Reduction Act Notice. see Form 1040 instructions, 9 Add lines 5 throu h 8. . . . . . . . . . . . . 10 Home mortgage interest and points reported to you on Form 1098 11 Home mortgage interest not reported to you 01\ Form 1098, If paid to the person from whom you bought the nome, see page A ':3 'Jfld S~)QW that person's name, identifying nu" and address .. ----~--- 12 13 14 15 POintS not reported to you on Form 1098, See page A- 3 for special rules Investment interest Attach Form 4952 if required, (See page A - 3,) Add lines 10 through 13 . . . . . . ' , . , . . . . . . . Gifts by cash or check, if you made any gift of $250 or more, see page A-3 ' . . . . . . . . . . . . . . . , . , , , . . . . . , , , Other than by cash or check. If any gift of $250 or more, see page A-3, You MUST attach Form 8283 if over $500. Carryover from prior year. Add lines 15 lhrou h 17 A878 For 54 16 17 18 Casualty or theft loss(es), Attach Form 4684, (See page A-4.J Unreimbursed employee expenses - job travel. union dues, Job education, etc, You MUST attach Form 2106 or 21 06-EZ If required, (See page A - 4.) II> p~OFESSIONAL SOCIETIES LAUNDR.¥ ,.~ UNJFORMS - ---,------ 21 Tax preparation fees. . . . . . . . . . . . . . . . , . . . . . 22 Other expenses - investment, safe deposit box, etc, List type and amount II> --~~ -~------ --_.._---- 28 OMU Nu ¡:,,¡,,-,)Q74 ~@97 ~~t:~:~~e:1No. 07 Your saCla\ secur>ty no, 4 4 27 }. 74660-15 \rUlm IU4U) . . _.... vT L.U~S r- rom DUSlness (Sole Proprietorship) þ> Partnerships, joint ventures, etc" must file Form 1065. ~ Attach to Form 1040 or Form 1041, þ> See Instructions for Schedule C (Form UMIJ Nu f ~,Jb-UU/4 ~~®97- Depanmerll oj lilt' TII~Jsury hH~'na' H~"'\'\\\\\' S\~¡\I\ce KENNETH W. LEWIS 1 0401. ~~l~~~~~~nlNC 09 'Social securiW 110, ISSN) 1554-35-1795 B Busil1ess code ~ 66191 D Employer 10 number (EIN) Name of proprre1Or A Busin~5S or pro fession, including product or service A I RCRAFT MA I NTENANCE C BUSll1coS name It no separate business name, leave blank. K L AVIATION E Busl"essacJdress~ 2010 SOUTH UNION AVE. (mcll,dlng ',dlle - - -, or room no.) BAKERSFIELD CA 93307 Accounl"'9 method: (1) lKI Cash (2) 0 Accrual Old 'IOU "materially participate" in the operation of this - ----- ._---~-~--- F G (3) i ¡ Ottler (specify) þ> business during 19977 It "No," ---~ see page C-2 for limll on losses . . . , , . , . . . . . . . . . . . . . . . . . . . . . , . ,IX Yes :-iNo ~ l__....-1 . . . . , . ~ ~J H If IOU ~;I;)rted or acqlJlred lhis business during 1997, check hero, , . Income 1 Gross receipts or sales, Caution; If this income was reported 10 you on Form W-2 and the "SliJiUlOr v employee" box on that form was check ed, see page C-2 and check here, ~ 0 1 149 891 2 HelCJI r1S df1d allow~nc es 2 3 SUlJtracl line 2 from line 1. 3 149 891 4 Cas I of goods sold (from line 42 on page 2) . 4 54 169 5 Gross profit. Subtract line 4 from line 3. 5 95 722 6 OU10: Income. including Federal and state gasoline or fuel tax credit or refund (see page C-2), 6 7 Gr(,ss income, Add 11r1es 5 and 6 þ> 7 95,722 . Expenses. Enter expenses for business use of your home onlv on line 30, 8 Adverllsl11g 8 25 Utilities 25 3,775 9 Bac debt;; from sales or services 9 26 Wages (less employment credits) 26 10 Cal Jlld 11,.r;k expenses (see page C-31, 10 8,925 27 Other expenses (from line 48 on page 21: 11 COi1mIISSlo"S and fees, 11 ~Ç,ÇOUNTING 1.638 12 Dep,etlon 12 BANK SERVICE CHARGES 548 '.' 13 Der:reclatlon and section 179. 13 1,519 ÇQLLECTION EXPENSES 120 14 Emµlovee benefit programs 14 ~Q!1IPMENT RENTAL 186 15 Insurance (other than health) , 15 FRE 1GB!, 2.054 . - -, - -~-~-"----,--- 16 Inte' est: </ FUEL 1,475 a Mo( ¡gage (paid to banks, etc.) . 16a LAUNDRY & CLEANING 554 b 01111:1'. 16b 2.090 ~I NTENANCE 414 17 LeUdl and professional services. 17 Q{jTSIDE SERVICES 15,121 18 Of 1.<.<; f~ / pense. 18 548 POSTA,GKr KTC_~" ,__,_______,,,__ 263 19 P(:fl:,lon i.J)d pro f ,\- S~1~r '''9 plans 19 PHI NTJNG___,____ 35 20 Rei'lI 0' lease (see page (-4): ..',.:'. §~ÇURITY_& SAFETY 360 a Ver,:cies. machinery. and equipment. 20a TAX~BUSI~ESS/PROPERTY 29 bOt"d bUSiness property. 120b ThÄ::-SALES 1,492 21 Repd!fS and maintenance. 21 142 TOOLS 1,170 22 Sl,pulles tnot included In Part III) . 22 366 ---_._---~- 23 T 2 y 0~~ d!H1 licenses, 23 179 1< ,,',', - ,~-. --------. ~ 24 Tr J (:'ì, II 1 1':<11 S, and elltertalnment: -- ---<--, -..-- a Tr d.i..-:ì 24a ,- ' ,~-. , , --,-.----,. b M,'",', ,IOJ ,'!\k! lain{fH~II¡ - ~~ ~---<----- C lntj'¡ 011% 01 line 24b .. - sUbJ!'!.! to ¡imitations. .' -..-- ." d SUI;[Cact line 24c from line 24b. 24d 27 25 459 28 Tot;.1 expenses before expenses for business use of home, Add lines 8 through 27 in columns. þ> 28 43,003 29 T CnlJllve pr 0 fí t (loss), Subtract line 28 from line 7. 29 52,719 30 EXiJenSeS for business use of your home, Attach Form 8829 30 31 Net pro t it or (loss), Subtract line 30 tram line 29. · I: d pi Ü fit, enter on Form 1040, line 12, and ALSO on Schedule SE, line 2 (statutory 31 52 719 32 ,,,,,plo/ees, see page C - 5), Estates and trusts, enter on ForrnllJ.11, line 3, · [' J loss, you MUST go on to line 32, 11 " 'os:., check the box that describes your investment in ¡[\IS dCI'\lIly (see page C- 5), } · " ~o" ;;r,ecked 32;;, enter the loss on Form 1040, line 12, ¡'f)J ;\LSO on Schedule SE, h..e 2. (statutory employees, see page (-5). Estates and trusts, enter on Form 1041. line 3, · if you checked 32b, you MUST attach Form 6198, For Paperwork Reduction Act Notice, see Form 1040 instructions, } A878 32a [J All Investment ,s at lIS" 32b 0 Some investment is not at risk, Schedule C (Form 1040) 1997 55 CUl .,. ., .... r I') 1 ¡:::, .'), Schpd"le C (lco1m 1040) 1997 IBIIII Cost of Goods Sold (see page C-5) 33 Method(s) used to value closing inventory: a IX] Cost b 0 Lower of cost or market c 0 Other (attach explanatlonl 34 Was there any change in determining quantities. costs. or valuations between opening and closing inventory? If "Yes," attach explanation. . . . . . . . . . . . . . . , . , . . . . . . . . 0 Yes [Xi No Page 2 35 Inventory at beginning of year, If different from last year's clOSing inventory, attach explanation. ,. 35 o 36 Purchases less cost of items withdrawn for personal use . . , ' , , . . . . . . . . . . . . . . . . ,. 36 50 130 37 Cost of labor, Do not include salary paid to yourself . . . . . . , . . . . . . . . . . . . . . . , . . . 37 4 039 38 MiJter,als dnd suppl,es . . . . . . . . . . . . . . . . . . . . . . . , , , . . . . . . . . . . . , . . . . . . 38 39 Other cas IS , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 40 Ada iIlH'S 35 througrl 39 . . . . . . . . . . . . . . . . . . . . . . , , . . . . . . . . . . . . . . . . . . . 40 54 169 41 Inventory at end of year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 o 42 Cost of goods sold, Subtract line 41 from line 40. Enter the result here and on page 1. line 4 . 42 54 169 Information on Your Vehicle. Complete this part ONLY if you are claiming car or truck expenses on line 10 and are not required to file Form 4562 for this business, See the instructions for line 13 on page C- 3 to find out if you must file, 43 When did you place your vehicle in service for business purposes? (month. day, year) ~ ------- .-- 44 Of lr\e 10lal number of miles you drove your vehicle during 1997, enter the number of miles you used your vehicle for: a Bus'rles~ b Commuting cather --.--- -----~ 45 Do you (or your spouse) have another vehicle available for personal use? . . . . . . . . . . . . . . . . . o Yes f- U No 46 Wa:; your "chic I", available for use during off-duty hours? 4 7 a Do It)(. l\dVe ev,dencc to support your deduction? [] Yes DYes ! No l=J No b if "Yes," IS the eVidence written? . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . , . . . . [J Yes ,- L J No - Other EXDenses. List below business expenses not included on lines 8- 2 6 or line 30, - --, .., --,- ..- ._--~- --~--~ ,-- '" ---,-_.- .-- ~ ---~- - - --' --------.--. ----- -- ---- ~~------- ----- ,.. ~--- - -----..., --.., -- , ---- ---- ---- - --~.- - -- ----------- --- ----,._- -- - --...-- -- --.- ---.------ -, ,-- ,-, - .. .. ~--- . -- ----- '- -- ~.. _.~-,- ~.~.- ---- --- --.-. -- .. - ----------~~-" -- -----,--- .., - --~---- -, --.- ..-- .. - -- ..--------- ------< ---, . ,,-- --- ~-- ..-.-- --- -'- -'--- --.-.-- -.------..----..-,-,-.------., -, " ---.---.- ---.- --.-~--_._- - ----------- --.-.---.-. ------, I 8 Total Uft,,;r expenses, Enter here and 011 page 1 line 2 7. 48 ,-~, 4 56 COl 74660-15 SCHEDULE SE (Form 1040) Self-Employment Tax OM¡ No, Ib45'0074 ------- -----.--- Deparlmenl ul !tit' Tr!'asuIY Inlernal Revl~III,' :\1'1 '/lCI! ~ See Instructions for Schedule SE (Form ~ Attach to Form 1040, income (as shown on Form 1040) 1040). ~@97 ~~I~~~~~eenlNO. 17 Name of Pt:rSUII Wllh self-employment KENNETH W. LEWIS Social security number of person with self- em 10 ment income ~ 554-35-1795 Who Must File Schedule SE You must ¡,I(: Schedule SE ,f: . You haU I\ul earn'ngs from self-employment from other than church employee ,ncome (line 4 of Short Schedule SE or line 4c of LOI1~J Schedule SE) of $400 or more, OR . You had church employee income of $108,28 or more, Income from services you performed as a minister or a member of a religious order is not church employee income, See page SE- 1, Note: Even If vDU had a loss or a small amount of income from self-employment, it may be to your benefit to file Scrledule SE and use 211ner "optIOnal method" in Part /I of Long Schedule SF See page SE-3, Exception, II your only self-employment income was from earnings as a minister, member of a religious order, or Chr'sllan Science pract,lroner and you filed Form 4361 and received IRS approval not to be taxed on those earnings, do not file Schedule SE, Instead, write "Exempt-Form 4361" on Form 1040, line 47, May I Use Short Schedule SE or MUST I Use Long Schedule SE? I DID YOU RECEIVE WAGES OR TIPS IN 19977 I I I No J Yes , Are you ;; ::\:I\lster, member of a religious order, Was the total of wages and tips Clmsllal\ SCience practitioner who received Yes ~ your sub jeCI Ye, ... or security railroad retirement IRS appr ova, not to be taxed on earnings from 10 social or tax these sour ces. but you owe sel f - employment plus your' net earnings from self-employment tax on other earnings? more than $65.400? No . Are you USII\g one of the optional methods to Yes ~ figure your net earnings (see page SE-3)? No ~ Old you receive tipS subject to social security Yes ... or Medicare tax that you did not report to No your employer? --- Did yo" receive church employee Income Yes reported or' ¡Corm W-2 of $108,28 or more? , - No YOU MA Y USE SHORT SCHEDULE SE BELOW ... YOU MUST USE LONG SCHEDULE SE ON PAGE 2 Section A - Short Schedule SE. Caution: Read above to see if you can use Short Schedule SE. Nel f ;;rm profit or (loss) from Schedule F. line 36. and farm partnerships, Schedule K - 1 (Form 1065), line 15a . , , . . , . . . . . . . . , . . . . . . . . . , . , , ' , . . . , , . , . . , . . 2 Net pi c I t or (loss) fr'orn Schedule C, line 31; Schedule C-EZ, line 3; and Schedule K - 1 (Form 1065), ¡,:Ie 15a (othel than farming), Ministers and members oj religious orders, see page SE- 1 for 3lfHJI,nls to repo'l on this line, See page SE- 2 for other Income to report. . . , . . . . . . 2 3 Comb,rlU IlIles 1 and 2 , . , , . . . . , . . . . . . . . . . . , . . . , ' , . . , . . . . 3 4 Net earnings from self-employment. Multiply line 3 by 92,35% (,9235), If less than $400, do not Illro [¡,is schedule: you do not owe self -employment tax. . . . , , . . " ~ 4 5 Self'er"ployment tax, If the amount on line 4 is: 52 719 52 719 48 686 . $i.: '., Fur,n . lViu'" Entel ,J(] or ie:;s,n"ltiply line 4 by 15,3% (.153), Enter the I (':,ult here and on 1040, line 47, .11<ln $6~),40U, multiply line 4 by 2,9% (,029), Then, add ~8, 109,60 to the tile total here and on Form 1040, line 47. ,,,,"} . . . . 449 6 Deduct",¡ for one-half of self-employment tax, Multiply line 5 by 50% (.5) 'i'lc' the :esdlt '¡ere and on Form 1040, line 26. . , , . A878 For P ,,¡:':, Nark Reduction Act Notice, see Form 1040 instructions, 6 - TAXPAYER 3 725 Schedule SE (Form 1040) 1997 74660-15 57 Form 4562 Depreciation and Amortization (Including Information on listed Property! ~ See separate instructions, ~ Attach this form to your return, Business or activity to which this form relates OMH Nu I '"I o'( I 72 -~ ----- Oepattmcnt ül :t1t, 11 t'asury Inlelnal Rt'lit'J1lJt' ~!'IVI({~ ~®97 Name(s) shown on return ~~(~~~:~e:ItN(J, 67 Identifving number KENNETH W. & KELLY D. LEWIS SCHEDULE C NO. 01 554-35-1795 Election To Expense Certain Tangible Property (Section 179) (Note: If you have any "listed property, H cumplete Part V before you complete Part I.) -.. 1 MiJ""":IIIHlIJ¡ dollar limitation, If an enterprise zone business, see pay" 2 of the ins truc tlOns 1 $18 000 2 Total co~; t of sect'on 179 property placed In serVice, See page 2 of the Instructions 2 3 ThresnoiLi cost of section 179 property before reduction in limitation 3 $200 000 4 Reduct,or, In limitatron, Subtract line 3 from line 2, If zero or less, enter -0- 4 5 Dollar limitation for tax year, Subtract line 4' from line 1. If zero or less, enter -0-, If marrred flllfl,J SC:¡)drately, ëee p<Jçje 2 of the Instructions 5 - --.---' 6 Cd IJt!scriplioll at plUlclly (!JI COSI (e1 {·eeled cost -~--- -, --~-_.,- 7 Llo,led pr operty, Enter amount from line 27. I 7 8 Total elélcted cost of section 179 property, Add amounts In COll.f))r! (C), lines 6 and 7 8 9 Tentative '¡eduction, Enter the smaller of line 5 or line 8. 9 10 Cé]r"r'lover of disallowed deduction from 1996. See page 3 of the ,nstructlons 10 11 BU~\!\e:,:, \Lcomc Ilf1mat,of\, Enter the smaller of business income (not less rl1an zero) or line 5 (see instructions). 11 12 Section 179 expense deduction, Add lines 9 and 10. but do not enter more than line 11 12 13 Carryove' of disallowed deduction to 1998, Add lines 9 and 1O, less line 12 ~ I 13 Note: 00 no: use Pari II or Part III below for listed property (automolJiles, certain other vehicles, cellular telephones, certain corlip,,:ers, or (.Jroperty used for entertaInment. recreation, Of amusement). Ins lead, use Part V for listed properly ~- MACRS Depreciation For Assets Placed in Service ONLY During Your 1997 Tax Year (Do Not Include Listed Property.! Section A - General Asset Account Election 14 If you dre making the election under section 168(i)(4) to group any assets placed In service during the t¡¡X year rnto one or mOl" ,j(-meral dsset accounts, check this box, See page 3 of 111e InSlr'uctrons ,.....'",.,.."., ~ Section B - General Depreciation System (GDS) (See page 3 of the instructions.) l , (bl Monlh and (c) Basis lor deprccialw/J Ie) COllvl!ioll (jj) LI""illl:aIJl}l: "I pI (pt~r! y year placed in (business/investmenr lJ.';1' \JJ Hecovel Y ill Method Iy) lJeprl~cjJliurl deduct,on 15 selvice only - see instructions} pel ¡ad .. -- --,._-- +--' -' ------- ----.-- ---._- ----~. -.-- 16 Section C - o (0 Alternative Depreciation I I N t I I d L" t d P System lADS) (See page 6 of the instructions,) L I I U1iIIWLOi'h 17 GDS anl 18 Proper l 19 Ac:ns ~__~,~mmarv (See page 7 of the instructions,) 20 Listéll1 ~J' ::Jperty, t:flter amount from line 26. . . , , . . , , , . . . . , . . . . , , 21 Total. ,;Jd deductions on line 12, lines 15 and 16 in column (9), and lines 17 through 20, Enter here af\(J on the appr opriate lines of your return. Partnerships and S corporations - see instructions. 22 Far assets shown above and placed in service during the current year, enter the I I por t,or' "t the bas's ;jltributable to section 263A costs . . . , , . 22 A878 For Pap<:rwork R",duction Act Notice, see the separate instructions, er eprecla Ion 0 0 nc u e IS e roper V. (See OaCle 6 of the instructions.! J ADS deduct,ons for assets placed in service in tax years beginning before 1997. 17 1,519 V subject to section 168(f)( 1) election 18 HI,(j, other depr ecratlon hO_ -.---- 19 -.-- t ) 20 21 1 519 58 PAGE 1 Form 4562 (1997) 74660-15 Forr1 .4:oc¿ í' 'j97) ~ S(,ction A, - Depreciation of MACRS property (placed in service before tax year beginning in 1997) ." (bl Oate (c) Ba~I~, I ¡¡: ,¡ I~ pi CC ¡allIIn id) Ht~co", \IJ) Ik¡Jll'IIJlIUI (íJ) LI;¡:,;, II! pi Opt!! [y placed in mus¡nt~":' ""t' onlY-5.ct! (el Lonvclllion (f) Method 1 sendee ill:;!! tll.! ¡ous) per ¡ad 1.1 t~ (]11 [[ I U II , ,-. 7 YEAR PROPERTY 25/90 ,- MACHINERY 4J 1 381 7 200 DB 62 TOOL BOX IJ 17/95 3 020 7 MQ 200 DB 462 - LEASEHOLD-HANGER DOOR 2J 01/95 6 500 7 MO 200 DB 995 ----_..- - -- --, -"_. - ._- - --...-.-..- - - '--.-- --.--.-.. -_. --..-..-- ----- -------.. .----. -~-+~--.-- ,- 2 MACH~ deCluct,on for assets placed In service prior to tax year beqinning 11\ 1997 (Enter here and on page 1, line 17) 1 519 Section B, - Depreciation of ACRS and Nonrecovery Property (bl Dale (c) Basis for depreciation idl lJeplcCiíJlion lei Method (f) life, ,ale Igl III!dllrlllHI ':II IJI".u 11111011 01 pi Ol!'1 ty (Business use ony-~el' !i lowed 'H allowal1lt' ot liyul inU or Recollt'r y acquired 10' [hi:. ,l'<lf 3 instructions) '" C31lit!r YI~¡H s ut!precialio/1 Period --~- _._--~'"--_. - u_, -_._-,--- - ---- --- ----- - .. '-'-' -,--- -, -..- .._--------. ----. ----'--- --.------ -- --- .- ------- --. -------.--- r- - - -------.--. r -,- -- --- ,- 4 Tot~i iJ()Jumn G Seeliol1 ß, (Enter here and on page 1, line 19) 59 PAGE 3 74660-15 . ~-,',-~'--l L-~ ATTACHMENT TO ITEMIZED DEDUCTIONS SCHEDULE A, FORM 1040 Name 0 f ì ax payer (s) I s~c;~ Secur i ty Number RENNE 'I' H W . & KE L L Y D . LEW I S - 3 5 - 1 7 9 5 ---- - -, . .. --- , .-,..-- - , ,,- ----- OTH E R ME D I CA L E X P EN S E S u__ , .-.---- - ---- , --- S E LF - EMP LO Y E D H EALTH I N SURANC E 8 5 0 . I N ~URA~,Ç~ 'pREM I UMS ---~ 3 , 2 1 7 . ~--- - - TOTAL TO L I NE 1 OF SCHE DULE A -~-- - -, -.-- ... ___________....J,L 0 67 -"- --- -,- --. __no ____ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - .. - . - -- ~---- u , . -- - -- --------~---- ,.. ---- -- -- - -- ------ ..--- .. -, u ,- .- .., -- - _._~ -,- U - ---- ---- -- - - ...-. -...----- ---_._-.. --.-.--- ,- '-- -.----- ,- u -_._~----_.- - ----- , ---- ----- -- --- .. - --~---- .. -" .------- -- -- -, -, ,- ,- -- --- -, -------- -- ----- -~-------_.- _._--~- - - .. ,-, --. ----- ..--- --- --,-----~--~ - _u_ u ---- ----- ,- - -- --- ---- '.-- ------ ---- ,- ,--- - ---- ---- - -, ---- .n'___ ._.n --- --, - -----.--- .. ---- ,.. , - --.- --- - - -, ----- - ,- ,- - -- - -, .. - - u .. - ---- --, -, .., -, ,-, ,- ---. ---~~~------ -.--- ----,. - ---- - ..- - --_._-----,--- -- ---- -, , ------.---- -- .. - -- u --- , --.--- - -- " .----- ~-----_._---_.~--- -----~--- .., .---- --, -- - -- --- _...u_ ,- --- -- -.-- '.-,~ --.,.--. -------- - - _..~.. - - .., -.--... -~---- ---..- -- --, __n~___' - --- -~--_._-.~. ------- - -- ~---~------~~ -, - ---- - --.. -, --, '- - -.----- ,-.- - -, -_._-----_._,-~------- ----.- ,- ---. , -_._~_.- -- --- , -, , .---.---- - ,--- ,- -~~--- ..- .. -- -,~--~--~--~ --~.~ -- - -- .. ,- - -_._.._-~-~_..~ ~._-------- ..- --- -' -----~--~--- .. , -.. - _n____ - ...~--_._-_.. -~--------- .. --- -,- - ,-- ---- -,- .. -- -.--~----- ---, ----.- -- -...-- - -.-.-, -~'-- --, -._-- -- -- ,- ------ -----.- -_._-------- ---- ,-- -...- - -- ,.. - , ,--.-- '- - -------- ~--_._---I-- -'- - -, , ---.-----.- -, ,-, --.--.- , .. ....- -.._----~_._- ..._--~-~._._-- _.~._- -- ---- ---- ------~--~~-- - ..--,.-.--.-,--- .__._--------~- -- .-~---- ----------.------.. _.---- ,- -.- ,-' .. ..' ,- ,- -- .--.------ --_.~- --.------- .. -----, -- ) 7 4 6 60- 1 5 6 _"". I . STATEMENT AUTO, TRAVEL, AND OTHER BUSINESS EXPENSES KENNETH W. & KELLY D. LEWIS SCHEDULE NO.01 AUTO EXPENSES DATE PLACED IN SERVICE PERCENT OF BUSINESS USE INSURANCE LEASE PAYMENTS INCLUSION AMOUNT REPAIRS LICENSE FEE - IN EXCESS OF REGISTRATION TIRES, BATTERIES TOTAL TOTAL X BUSINESS % TOTAL CAR/TRUCK EXP. (TO SCH C01 LINE 10) SlMTI 1554-35-1795 PAGE: 1 VEHICLE 1 VEHICLE 2 TOTAL 07/30/94 11/14/93 75.000 % 90.000 % 502 495 4,817 3,608 -68 -3 90 725 288 263 138 5,629 5,226 4,222 4,703 4,703 8,925 4,222 74660-15 '~California Resident T JncomeTaxReturn 1997 APE DO NOT ATTACH LABEL 540 FEDERAL RETURN ATTACHMENT REQUIRED: [X] YES 0 NO Step 1 Name and Addre~, 554-35-1795 KENNETH W. KELLY D. LEWI LEWIS LEWIS 568-41-9608 r------- 97 Do Not Write In These Spaces 1516 IVAN AVE BAKERSFIELD CA 93304 FOR COMPUTERIZED USE ONLY P AC A R RP 01 06 09 10 12 14 16 2 30 o 31 o 35 1 36 14013 37 65 38 o 39 o o o o 1716 155 200 o o o o 1361 o o .~..- -.. -.-------.--- ,-..- -. -- ------ - ---. _ -.----------.--....---.--------.---.. 3 -Wage;: tips. othërë~mp~-- 2Ff:derallñCome tax witiìi\eid 14013.00 1293.56 Social security wages 4 Social security tax withheld 14013.00 868.81 Medicare 14813 ~n36ipa 6 Medicare tax withheld 203.19 Control Number I Dept Corp. IlmPloyer use ~Ù OSO!07 PUH 052 Employer's name, addreða, and ZIP code ANBRA INC 801 JULIAN AVENUE AKERSFIELD CA 93304 ..,- ",.._,-- ----, EmPloler's FED ID number d EmPlo~ee's SSA number 5-3875908 68-41-9608 Social security tips 8 Allocated tips Advance EIC payment 10 Dependent Care benefits . Nonqualifie plans 12 Benefits included in box 1 14 Other 70.07 CA SDI . SI<I' emp,Dece.sed renSion plan legal rep'lHShld, emp'lDeferred camp, Employee's name, address and ZIP code ElL V LEWIS 16 IVAN AVE AKERSFIELD CA 93304 s¡aie~mp¡oYer's state ID 17 State wages, tips, etc. A 08-5370-9 14013.00 State -¡,icome tax 19 locality name 154.80 Local wages, tips, etc. 21 local income tax --CA.State Filing Copy - 2 Wage and Tax 1997 Statement , 2 to be filed with employ..·. Stote Income Tax RePu~ No, 1545'0008 . . . . . . . . . . 5 a :; 1 49 50 51 52 53 54 55 56 57 58 59 61 o o o o o o o o o o 1361 o 62 1 APE 0 3800 0 3803 0 CATMT 0 SCHG 1 0 5870A 0 5805 5805F 0 545687233 -~ turn (even if only one spouse i'i.ld Income) ! return, Enter spouse's social security number above and full name here -~~- vith qualifying person), If the quail tYing person IS a child but not your dependent. enter --~---- - .----.-,--"----.--.- .- ---..------.---. --~---- with dependent child, Enter year spouse died 19 u (or your spouse. if married) as a dependent on their tax return, check 11 13 15 ~:O , , î5 . . . . . . . . . . . . . . . . . . . . . . box 1, 3 or 4 above, enter 1 if you checked box 2 or 5. enter 2, If you 6, see instructions . , . . , . , , , . . . . . . . . . . . . . . . 7 your spouse) are visually impaired, èllter 1, I f both are visually impaired. enter 2,. 8 your spouse) are 65 or older. enter 1, If both are 65 or older. enter 2. . . . , . , . 9 and relationship. Do not include yourself, your spouse or the person listed I number of dependents. ,SEE ATTACHED, SCHEDULE. ED. 10 io'ns, Add line 7 through line 10, . . . . . . . 11 =orm(s) W-2, box 17.." ·.12 14,013.1 32; fa, III I040A, line 16; form 1040El, 11111' '; iJ/ Telchlc Tax HHord, line H . 13 tractions, Enter the amount from Schedule CA 1540), line 32. column B . . .14 Ie 13, If less than zero. enter tile result in parentheses. See instr. . 15 itions, Enter the amount from Schd-JIt, ~r\ 15401. line 32. column C . 16 :6 C 8 w income, Combine line 15 ana ,lIle 16 , ' , , , deduction OR your CA itemized deductions . . ne 17, This is your taxable income, If less than zero, enter -0- Step 5 20 Tax, Check If from U Tax Table IX] Tax Rate Schedule ¡ J FTB 3800 or 0 FTS 3803 . 21 Exernpt,un cr edits, Check one; [XI Flowchart 0 Federal AG: limil or CI CA TMT limit 22 Sublr<Jcl I"'e 2 1 from line 20, If less than zero. enter "lJ-, , ' , . 23 Tax Cr,cck If f"om 0 Schedule G-1 and 0 form (,':8 58701\, 24 Add I,,,,, 7. 2 <Jnd line 23 . . , . . . . . . . , . , , , , , For P"vacy Act NOlice, S8U instructions, Continue to Side 2 n_ Tax 62 .17 .18 . 19 (!)20 021 . . 22 C!)23 . .24 Form 540 . · 6 ,~ 2 1 3 62,520. 65. 62,455. 62,455. 8,855. 53,600. 1,920. 204. 1,716. o. 1. 716. c11997Side1 74660-15 c C T 25 I Step 6 Credits 28 29 30 31 33 34 Step 7 35 Other 36 Taxes 37 Step 8 38 Pay- ments 39 42 Step 9 43 Over - 44 paid Tax or 45 Tax Due 46 47 Step 1 0 Contri 4{j butions 49 50 51 52 53 54 56 57 58 Step 11 Refund :,9 or Amount You Owe Step 12 Intcre~;t LO and 6 Penal' ties G2 Sign Here It ,s Ufl' lawful 10 forge a spouse's signature, Amu"fl; Irom Side 1, line 24 1,716. . . . . . . . . . . . 25 iJnd dll'l~ 28 ,HI( ,'"'I~ 29 JII(J "lJIt~ 30 . 31 33 34 · 35 · 36 · 37 1,716. t IIh~! \'11'\1 il 11,11111' (: U dt~ II () -----~ ~-~ 1:/llel ,:r L'lJII !I.JJI)!' ColJe IIU trill'! U \'l!l¡ 1I.ln(' COUt'IIO -~-~~._~. -_._---~------ 41 To cl;,II" !110' e than three cr'edits, see instructions, . , , Add 1¡'He' L G thlough line 31. These are your total nedl! \ Subtr'act ¡II\8 33 from line 25, If less than zero, enter U-- Altelflallve Inlflirnum tax, Attach Schedule P (540) Other taxes and credit recapture, See instructions Add line 34 through line 36, This is your total tax CA "";UI)1(; t:JX withheld, Enter total from your 1997 101,)1(,;) VV'L, W-2Cì, 10:-)LJ-MISC and 1099-R. Also, attach Form{sl it; Side 1,,838 1997 CA estllnated tax and amount applied from your' 'I cJ96 return, Include lhe amount from' form FTB 3519 or Schedule K.. 1 (541). , .39 Oid either YOu or your spouse receive more than $31,767 in wages In 1997? Yes, See Instructions, No, Go to line 42 , , . , , , .41 Add 1111(; 38 tnrough line 41, These are your total payrneflls Overpaid tax, It I,ne 42 is larger than line 37, subtract ¡II1e 37 tram line 42. Arnoufll ul I"\e 43 you want applied to your 1998 eSl'lIldwd tax,." Overpa,d tax available this year, Subtract line 44 from I,ne 43, . . , , Tax due, If "fle 4 2 IS less than line 3 7, subtract line 4 L' frum line 37, Cünlr,iJul,ufl 10 California Seniors Special Fund, See 111Slt,:C[rOIlS, , , .47 Y0l1 ,,,;,. ,¡;,~ ,-' a contnbut'on ot $1 or more to: AILlwlI"':" :JI~ease/Relaled Disorders Fund, . , . . . 48 Calif or ill.3 I'urrd tal Senior Citizens. , . . . , . . . . . 49 Rare and Endangered Species Preservation Program . 50 State Ollldren's Trust Fund for the Prevention of Child Abuse, . 51 Caldol'll'" Breast Cancer Research Fund. . . . . 52 Caldol'\'" I'll e fighters' Memorial Fund, . . , . , . 53 Callfolllid l)lJollc School Library Protection Fund . 54 D,A.R.[ C,,11f orl)!a (Drug Abuse Resistance Education) I'urro . 55 Calrtornr<J Military Museum Fund. . . . . . . . . . . . . . . 56 Add IIIW ,17 through line 56, These are your total conlrlblJtions . . . . . . . . . . . 57 REFUND OR NO AMOUNT DUE, Subtract line 57 from IIIW 45, Mail your return to: IMAGE PROCESSING, FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0009. 58 $ AMOUNT YOU OWE. Add line 46 and line 57, Make d check/rnoney order payable to 1,716. o . 155. 200. 355. 42 43 · 44 · 45 · 46 1,361. 55 "1-, iJflcr,,~,c I,p: Board" tor the full amount. Write your s()cl<J1 secur'lty IllJlTlber and" 1997 Forrll :J4U" on it. Complete Form 540-V, Attach both to the tront of your Form 540 and ITlJII to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001, . 59 $ 1,361. Inl(;1 ij" "I,' ¡ ,,1111'1'1 penalties and late payment penaltlc'; , Unue'~" '¡:(;liI of estimated tax, If form FTB 5805 or :,dUSF IS atlached, check here. [J If VOl: ,)(J nut need Califor'nia income tax forms mailed to vou next year, check here 60 . 61 · 62 IX] IMPORTANT: See "Sign Your Return" in the Form 540 instructions to find out if you should attach a copy of your complete federal return, Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, iJnd to the best of my knowledge and belief. It IS true, correct and complete, 4 Daytime phone number ( I Preparer's SSN/FEIN 545-68-7233 ---..--.-.-.-. ¡ Irf Spouse's signaturt (I f 1IIIIg 10lnt, both must sign) 0 te" X C~ I(~V reparer is based on all info'flldll~7: of which preparer has any knowledge) ¿i JOYCE A. BERENDSEN, EA J B ACCOUNTING PLUS 1801 HAST I-ACRES DR. STE.7 BAKERSFIELD, CA. 93309 Side 2 Fc¡m 540 ,;' I~J97 63 74660-15 _ C T AXÁBLE YEAR 'C T 1997 California Adjustments - Residents Important: Attac/l this schedule directly behind Form 540, Side 2, Name s as shown on return KENNETH W. & KELLY D. LEWIS Part I Income Adjustment Schedule Section A -- Incorne 7 Vvages, salal,es I,PS, elc. See instructions before making an entry 111 COlt.l)II) 8 01 C Taxable Inter est If)CO['r1(~ Dlvlucnd IfIC()[lll Statv {JX rellHHl ¡, :t:r trlt' sullle amount In column A and column B Alimony reCeIV(';(, , ' Bus,ness InCOIf1l] 01 (loss), Cap'tal gain or (loss) , , Other gains or (losses)· IRA d,stnbuL,on Sue il1stl'ucllons, (a) Pens,ons and JliI\LJ,tleo" See instr, (a) Rental real estate, '()yiJltle~, partnerships, S corporations, trusts, etc, Fal'm Income 01 (loss)· , , . . , . . , , , . . Unemployment êompensation, Enter the same amount in column A and COltmln B, , Social seClJIIly 1"]I$J¡[~; (¡¡) (lthel' InCOll1U 8 9 10 11 12 13 14 15 16 17 18 19 20 21 ~~-~--~ a C¡¡(I!O!!\\;\ loU,·¡. ~·.q1 \\\\q", e Nlll l,ulII rTH :l805l, 3806 or 3807 Ollie, Idescr;"el b[)I',JSlt'J 105:> (.II:(!v\·: ¡I(¡I¡IITH JHUbV C I"ih'ral NOt. (lOIII! 11),1() lilt!, ¿I) d t~ I J1 I ,J[ r '10 v t~ r II ¡WI ) 1 1\ j d $ ~J V Tutal. COII'OIIIt: I:.,,, ' IllriJuyl, line 21 In column A. Add line 7 tllrOlJ(Jli III1t: ï ì I ,;; (:,,,,;11111 B and column C. Go to Section B, Section B - Adjustments to Income 23 IRA deduct, on , 24 Medical savings account deduction, 25 MovlI1g eXfJenses, , 26 Une--half of sf;lf "ernployment tax. 27 Self-employed r¡e~llIl insurance deduction 2 8 ~ GO'ln ana sel f' urnployed SEP and SIMPLE plans 29 h;l1iJll V on e¿¡1 I, Jv: IIlcj¡'awal of savings 30 a /\lllllony paid, IIJI Huc,plent's: SSN 22 ----- ~-,--- LdS( Nan)e ----- ---,~ 31 I\dci Illle '2.:3 th, ',),);11, line 30a in columns A. B, and C . 32 Total. SubtracI I,¡,e: 3 ì frorn line 22 in columns A, B, and C, Sèè tllè i¡¡Slluetin¡", '01 now to transfer the total to Form 540. Part II AdJustm(;nts To Federal Itemized Deductions A F(;deral Amounts ¡t""dble amounts frorn ',ûur lederal return) 7 8 9 10 11 12 13 14 (b) (bJ 17 18 14 013 14 .i B Subtractions See instructions. 65 65 SCHEDULE CA (540) Social security number 554-35-1795 C Additions See instructions, I ,'ap,,,¡ ill'IIII'l'd aeductions, Add the arnountsonfederal Schedule A (1'11111 IIJ,lUl.li,,,,, ,¡ 9,14,18,19,26, and 27 52 719 19 Ib) 21 22 66,811 23 24 25 26 27 28 29 3 725 566 {a b ci""': .. d e f " I t 'a I , :':':':'i:¡~ , 'd :e :- : f 65 ! - - 34 35 34 9,280. 30a 31 4 291 65 - i 11Il" IuLII of federal Schedule A. line 5 (stale and lu('iJl 111COlnc I¿¡A and State Disability 'II,;,,: ",fllç) dlld IlIle 8 (foreign taxes only). ;)ul):, "et I,ne 35 from line 34 . . . Otht:! ,,,iju,;t;nents includiny CA lottery losses, See instr, SPt:"¡\Y C:OI:lIJdle IlI1e 36 and line 37. . . . . . . . . Is the dmount on Form 540, line 13 more than the ¡,[J\ount shown below for your filing status? S,nylc: 01 married filing separate . S114, 152 lleat! 01 household. , . . . S171.228 - - - 36 37 38 39 - - - - - - - - - lVIarr,,,(J filing JOint or ~"JliÌ'Iillg wldow(er) . . S228,305 - - -- - - NO, :riillsfer tllc amount on line 38 to line 39, YI=~> '(''''1'1.:1<; the Itellllle,j Deductions Worksheet ILl! ,I)," celloll> lor Se\':, CA {54P., ;,ne 39, --~_.__..- NO to Form 540, line 18, [-¡(Ir;i you, :,Talldard deduction on ! d' ¡\, '.:¡¡C, \l(,l: \8. 64 32 62 520 . . . . . . Is thr, ,¡mount you entered on '}ne 39 more tlldn your standard deduction below? Slllyle ~r married flllllg separate . S2'583} Mall le(1 fllll'y JOint, head of household or qualifYing wldow(er) . . ,. S5,166 YES lransfer the amount on line 39 35 36 37 38 425. 8,855. 8,855. , '1f:' 39 8,855. Sch7qule CA (540) 1997 74660-15 C TAX",BU: YEAH C---- T 1997 Depreciation and Amortization Adjustments Business or activity to w lorm FTB 3885A relates H 1 CALIFORNIA FORM 388SA Name(s) as shown 0/1 return KENNETH W & KELLY 0 LEWI Part I Identify the activity as passive or nonpassive. See instructions, 1 i ' Th,s form ,~;, [)elng completed lor a passive activity, [X] '1'1,,:; form Part II Election to Expense Certain Tangible Property (lRC Section 179), 2 ['ntel the amount f['om line 11 01 the worksheet In the instruct'ons IS being completed for a nonpassive actIvity, . . . , . , . . . . . . . . , . . . 2 Part III Depreciation, (a) DescrIptIon 01 property placed (b) Date placed -(.;¡ Cali lorn,,, DaSIS (d) Method (e) Life or (f) 1997 California In service during 1997 In service for depreciation rate depreciation deduction 3 ---,--_.- -, -- --.,-----.- --~-_. I - '-~ ¡ 1 ---'I ,- I "-.- , I I 1. 4 ¡\iJd lile anlount~; on IIIW 3, column (I) . . . . . . . . . . . . , . , 5 Cali lamia deprecl~llon f or assets placed in service prior to 1997 6 '¡ ~Jlal Call1olnla c:upreciation Irom this activity, Add the amounts a: rille 2, line 4 and line 5 7 ;é!tai iedelðl de¡,reClatlon from this activity, Enter depreciation 11\,", -¡our federal Form 4562, line 21 8 a:1 1111" 6 10. 11101, than IlIle 7, enter the difference here and on ~,;( IlUdule CA (SL10 or 540NR), See instr, b I: III'" G Ie. It;',;~, II\an 111It; /, enter the di f fel'ence here and on SV\èl)ule CA (~L1 Ü or 540NR). See instr, 4 5 1,519 6 1,519 7 1,519 8£1 8b 0 Part IV 9 Amortizatic;n, (a) Description 01 costs amortizable (b) Date placed during 1997 In service (e) California basIs tor amortization (d) Code e)Period or (f) 1997 California section percentage amortization deduction -,- - - --, - - - - - ------ I , -I' I , r- - - - - -~_.- - - - - -- .------ 1- -,__ I I l- t H.! ',< - - - -~------------- " - - - - --, - - - - ---.. 10 rota, Calilorflla amortization from this activity, Add tl" dl110unts Ofl line 9, column (I)., 10 11 :::al,'" Ilia dlflürllzatior¡ 01 costs that began before 1')· ¡ . , , . . . . . , , 11 12 i ut:, :':alilü' fI,,, amOr'llZå!IOn from this activity, Add lIl, dl\l()UlllS C)ll I'fle 10 and line 11 12 13 rotJI !e'1erai "II\Ormation from this activity, Enter amortIZiiti¡" IUIIII yuur federal Form 4562, line 42 13 14 a It 1111l: 12 is more than line 13. enter the difference here and,,, Sclledule CA (~40 or 540NR). See instr . 14a b If III,,: 12 IS les~; than line 13, enter the difference here "'lIi 011 Schedule [1-\ 1:,40 or 540NR). See instr 14b FTS 3885A 1997 - - -- - 65 74660-15 c C 19')7 C;¡ll!orrll<.. Depreciation ¿Hld Amortization (Form 3885A) ;)' T Ibl (e) (el (f) Igl {al Idl Basis for Ihl Typ{~ of plopcny (lis! Date placed in Business/ CO$I 01 deplèciation Recovery Melhodl Oepl~ciatlofl vldlich~s lirst) service invest. other IJJ~i ~ (business/ investment period Convenlion deduction 1 NONPASSIVE use % use only) MACHINERY 4/25/90 100 ,1 381 1,381 7 200DB 62 . 1/17/95 TOOL BOX 100 3 020 3,020 7 200DB 462 LEASEHOLD-HANGER DOOR 2/01/95 100 6 500 6,500 7 200DB 995 .... --,. , ,-..- - ------ , ,- - -.--, .. -~-.' -.-. --., --....- --- nd ._ -- .. ------- 1---- ---.--.-. .. -.-- . -.--_.,-- 1---. ---_.-. --- ..,..-- 1--- -.---., - ,.- Page 3 2 Total C"I,torn!iJ dèpreciat,on for assets placed in service prior to í ;J~J7 ~ 1 519 Amortization laJ fJ e ~>l; rill I ì Oil Ib) Dale placed in serviu 3 ---- ----_.. ._, ----_._,-- .. ,- ---.. -_._~ ..-..--- '..- - ,.. '.--- ----.' .. ..-- -- .--.-.-.--. -.. , lei C 0 ~.I '" Idl Code Ie) Per lad 01 (II Amoftilillion ollwr Ua~J ~ section pelcefllage deduction .. -- -,-_. - -.-- ------- [=---.- 4 Total iJrl1ortll;¡~,On ~)f costs In;)t began before 1997. , , . , , , , , . . . . . . . . . . . . . . . . . . ~ 74660-15 , . STATEMENT SCHEDULE ED KENNETH W. " KELLY D. LEWIS 1554-35-1795 C::i HANNAH K. LEWIS DAUGHTER ,- ""'TI 7 4660:-15 ~ Wage., tipa, other compo 2 Federal income lax withheld "i7675.89 1672.20 3 Socialll8Curily wage" 4 Social "ecurity lax withheld 17675.89 1095.91 5 Medicare wa~e" and lip" 6 Medicare lax wilhheld 17 75.89 256.30 a Conlrol Number I Depl Corp. I Employer use only 050107 PUH 052 L 89 c Employer'" name. addresa, and ZIP code SANBRA INC 1801 JULIAN AVENUE BAKERSFIELD CA 93304 Batch #00846 bEñi'p'ger'" FED 10 number d EmPlo~ee'" SSA number _, 5-3875908 68-41·9608 7 ;I')Clelll8Curily lip" 8 Allocaled lips 9 Advance EIC psymenl 10 Dependenl care benefit" 11 Nonqualified plan" 12 Benefita included In box 1 13 See In"lr". for box 13 14 other 141 .41 CA SDI 15 Stal emp.Deceased ¡penSion plan legal re~hld, emp, feferred comPo elf Employee'" name, addre"" and ZIP code KELLY LEWIS 1516 IVAN AVE BAKERSFIELD CA 93304 16 Slale:EmPloyer'" "Iale 10 17 Slale wages, liIB. etc. CA 308-5370-9 17675.89 18 Stale income lax 19 Locality name 207.13 20 Local wages, lips. etc. 21 Local income lax Em20yee Reference COg W- Wage and Tax 1 96 Statement Copy C for Employee's ReconIa. OMB No, 154£>-0008 ---------------------------------------- -. 1996 W-2 and EARNINGS SUMMARY This blue Earnings Summary sect/on Is Included wI1h your W-2 to help describe portions In more data, The reverse side Includes general Information that you may also find helpful. 1, The following information reflects your final 199B paystub plus any adjustments submitted by your empoy~ Gross Pay 17675,89 Social Security 1095.91 CA. State Income Tax 207,13 Tax Withheld Box 18 of W-2 Box 4 of W-2 SUI/SDI Box 14 of W-'¿ 141,41 Fed, Income Tn Withheld Box 2 of W·2 Medicare Tax Withheld Box 6 of W-2 1672,20 256 , 30 2. Your Gross Pay Was Adjusted as follows to produce your W-2 Statement. Wages, Tips, other Social Security Medicare Compensation Wages Wage'!! Box 1 of W-2 Box 3 of W-2 Box 5 of W~2 CA, State Wages, Tips, Etc. Box 17 of W-2 Gross Pay Reported W-2 Wages 17.675,89 17,675.89 17,675,89 17,675.89 17,675,89 17,6'15.89 17,675,89 17,675.89 3. Employee W-4 Profile To change your Employee W-4 Profile Information, file a new W-4 with your payroll del KELLY LEWIS 1516 IVAN AVE BAKERSFIELD CA 93304 Social Security Number: 568·41-9608 Taxable Marital Status: MARRIED Exemptions/Allowances: FEDERAL: 0 STATE: 0 o 1996 AUTOMATIC DATA PROCESSING, INC, ----------- ---~-~~~~~~~~~~~------------------------------------------- j 1;)40 ü:se~t 10~dividü~ri~ë~r;¡r;eT ax Return Filing Status Check only one box. Exemptions Income , Attach Copy B of your Forms W-2, W-2G, and 1099-R here. If you did not get a W-2, see the instructions for line 7. ,1996, ending CA 93304-6649 Do you want $3 to go to this fundi'. . . . . . . . . . . . . . . If a joint return, does your spouse want $3 to go to this fund? 1 Single 2 X Married filing joint return (even if only one had income) 3 Married Wino separate return, Eoter spousel's social security no, above & lull name here, ~ ~®96 IRS Use Only - 00 not write ,or slaple in this space, OMB No. 1545-0074 Your social security number 554-35-1795 II use's social security number 68-41-9608 For help finding line in- structionshsee pages 2 and 3 in t e bookTet. Note: Checking "Yes" will not change your tax or reduce our refund CLIENT'S CO . 19 Head of household (with qualifying person). (See instructions.) If the qualifying person is a child but not your dependent. enter this child's name here.~ 5 Qualif in widow(er> with de endent child ( ear souse died ~ 19 ). !See instructions:) 6 a 00 Yourself. If your parent (or someone else) can claim you as a dependent on his or, } ~èc~~l~~efmes her tax return, do not check box 6a. . . . . . . . . . . . . . . . . . . . . .. 6a and 6b ~ b X Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., No. of your ( ) " (4) N I children on c Dependents: 2 Dependent s sOCIII (3) Dependent's 0,: °d II'ne 6c who' . security number, II born ,os, Ive ' 10 F,rst name last name In Dee, 199B, see insl. relationship to you In your . lived with you . did not live with you due to divorce or ~eparlation (see rnstr, Dependents on 6c not entered above Add numbers entered on Jines above ~ 4 8b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I b Taxable amount (see inst.). 22 Add the amounts in the far right column for lines 7 through 21. This is your total income. . . . ~ 23a Your IRA deduction (see instructions). . . . . . . . . b Spouse's IRA deduction (see instructions) . . . . . . . . 24 Moving expenses. Attach Form 3903 or 3903-F . . . 25 One-half of self-employment tax. Attach Schedule SE If line 31 is under 26 Self -employed health insurance deduction (see inst.). . $28 495 (under 0 $9,500 if a 27 Keogh & self-employed SEP plans. If SEP. check ~ child did not 28 Penalty on early withdrawal of savings. . . . . . . . . . . live with you), 29 Alimony paid, Recipient's SSN ~ see the instructions 30 Add lines 23a through 29. . . . . . . . . . . . . . . . . . . . . . for line 54, 31 Subtract line 30 from line 22. This is our ad 'usted ross income. A8'8 For Privacy Act and Paperwork Reduction Act Notice, see page 7. 30 For the year Jan, '-Dee, 31. 1996. or other tax year beginoing Use the IRS label. KENNETH W. & KELLY D. LEWIS Other- 1516 IVAN AVE wise, BAKERSF I ELD please print or type. Presidential ... Election ,.. Cam ai n d Total number of ex em tions claimed. . . . . . . . . . . . . 7 Wages. salaries. tips. etc. Attach Form(s) W-2. . . . . . . 8 a Taxable interest. Attach Schedule B if over $400 . b Tax-exempt interest. DO NOT include on line 8a . . . . . 9 Dividend income. Attach Schedule B jf over $400 . . . . . 10 Taxable refunds. credits, or offsets of state and local income taxes (see instructions) 11 Alimony received. . . . . . . . . . . . . . . . . . . . . . . 12 Business income or (loss). Attach Schedule C or C-EZ . 13 Capital gain or (loss). If required, attach Schedule D . . . 14 Other gains or (losses), Attach Form 4797 . . . . . . . . . . . . 15 a Total IRA ~istributions .,... ~ I b Taxable amount (see inst.). 16aTotal pensIons and annuities ~ . b Taxable amount (see inst.)· Enclose, but do 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E not attach, any payment. Also, 18 Farm income or (loss), Attach Schedule F. please enclose 19 Unemployment compensation. . . . . . Form 1040-V. 20 S . I 'b f't l~nJ20 (see the a oCla secunty ene IS. . ~ instructions 21 Other income, list Iype and amount-see Instr. for line 62). Adjusted Gross Income 23a 23b 24 25 26 27 28 29 '9 10 11 :12 13 '14 1Sb 16b 17 : 18 i 19 20b 818 .~ 17 676 9 11 571 29 256 818 28 438 Form 1040 ('996) 75044-07 Tax Compu- tation Form 1040 (1996) -, , 32 Amount from line 31 (adjusted gross income) . . . . . . . . . . . . . . . . . . . . . 33 a Check if: 0 You were 65 or older. 0 Blind; D Spouse was 65 or older. 0 Blind. Add the number of boxes checked above and enter the total here . . . . . 33a b If you are married filing separately and your spouse itemizes deductions or you were a dual-status alien, see instructions and check here. . . . . . 33b I f you want the IRS to figure your tax. see the instructions for line 37. Credits Other Taxes Payments Attach Forms W - 2, W-2G, and 1099-R on page 1. Refund Have it sent directly to your bank account! See inst. and fill in 60b, c, and d. Amount You Owe Sign Here Keep a copy of this return f or your records. Paid Preparer's Use Only 31 34 ¡Itemized deductions from Schedule A. line 28, OR ) Enter Standard deduction shown below for your filing status, But see the the instructions if you checked any box on line 33a or b or someone larger can claim you as a dependent. of . Single - $4,000 . Married filing jointly or Qualifying widow(erl - $6,700 your: . Head of household - $5,900 . Married filing separately - $3.350 35 Subtract line 34 from line 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 If line 32 is $88,475 or less, multiply $2,550 by the total number of exemptions claimed on line 6d, If line 32 is over $88.475, see the worksheet in the inst. for the amount to enter. . 37 Taxable income. Subtract line 36 from line 35. If line 36 is more than line 35, enter -0- . 38 Tax. See instructions. Check if total includes any tax from a 0 Form(s) 8814 b Form 4972. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Credit for child and dependent care expenses, Attach Form 2441 . 39 Credit for the elderly or the disabled, Attach Schedule R . 40 Foreign tax credit Attach Form 1 1 1 6. . . . . . . . . . . . 41 Other. Check if from a 0 Form 3800 b 0 Form 8396 c 0 Form 8801 d 0 Form (specify) Add lines 39 through 42 . . . . . . . . . . . . . . . . . . . . . Subtract line 43 from line 38. If line 43 is more than line 38, enter -0- Self-employment tax, Attach Schedule SE. . . . . . . . . . . . . . . . . . . . Alternative minimum tax. Attach Form 6251. . . . . . . . . . . . . . . . . . . Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 . Tax on qualified retirement plans, including IRAs. If required, attach Form ,5329. Advance earned income credit payments from Form(s) W-2 . Household employment taxes. Attach Schedule H. . . . . Add lines 44 throu h 50. Total tax . . . . . . . . . . . . . . Federal income tax withheld from Forms W-2 and 1099 . . 1996 estimated tax payments and amount applied from 1995 return. Earned income credit. Attach Sch. EIC if you have a qualifying child. Nontaxable earned income: amount . ~d~e. ~ 55 Amount paid with Form 4868 (request for extension). 55 56 Excess social security and RRTA tax withheld (see inst.) . .. 56 57 Other payments. Check if from a 0 Form 2439 b 0 Form 4136 57 58 Add lines 52 through 57. These are your total payments . . . . . . . . . . . . . 59 If line 58 is more than line 51. subtract line 51 from line 58. This is the amount you OVERPAID. 60 a Amount of line 59 you want REFUNDED TO YOU. . . . . . . . . . . . . . . . . . . . . . b Routing number c Type: D Checking 0 Savings 39 40 41 42 42 43 44 45 46 47 48 49 50 51 52 53 54 .. 1 672 Page 2 28 438 10 483 17 955 5 100 12 855 1 931 43 .. 44 45 46 47 48 49 50 51 1 931 1 635 3 566 1 672 . d Account number 61 Amount of line 59 au want APPLIED TO YOUR '97 ESTIMATED TAX. 61 62 If line 51 is more than line 58, subtract line 58 from line 51. This is the AMOUNT YOU OWE. For details on how to pay and use Form 1040-V, see instructions. . . . . . . . . . . . . . . 63 Estimated tax penalty. Also include on line 62 . . . . . . . .. 63 91 Under penlllies of perjury. I decl.,e Ihll I hove e..mlned Ihis relurn Ind Iccompenying schedules end slllemenls. Ind 10 Ihe besl 01 my knowledge end belief. Ihey .,e !rue, correcl, end complele, Decleralion of prep.,er (olher Ihen Iuplyerl is bued on III informllion of which prep.,er hu Iny knowledge, SELF-EMPLOYED Your occupation RESTORATIVE AIDE Spouse's occupation Preparer's social security no, 545-68-7233 ~ ~ Your signature Date Date Date Spouse's sign Preparer's III.. SIgnature r st sign. Firm's name (or yours if self- employed) and address JB ACCOUNTING PLUS JOYCE A. BERENDSEN EA 1801 HAST I-ACRES DR. STE.7 BAKERSFIELD CA. 93309 EIN ~ ZIP code 93309 75044-07 Form' 2210 Underpayment of Estimated Tax by Individuals, Estates, and Trusts ~ See separate instructions. ~ Attach to Form 1040, 1040A, 1040NR, 1040NR-EZ, or 1041. OMB No, 1545-0140 ~®96 Department of the Treasurv Inlernll Revenue Service Name s shown on tax return Enter your 1996 tax after credits (see page 2 of the instructions) . Other taxes (see page 2 of the instructions) . Add lines 2 and 3 . . . . . . . Earned income credit. . . . Credit for Federal tax paid on fuels. Add lines 5 and 6. . . . . . . Current year tax. Subtract line 7 from line 4. Multiply line 8 by 90% (.90) . . . . . . . . . . 9 2 Withholding taxes. Do not include any estimated tax payments on this line (see page 2 of the instr.). 10 Subtract line 10 from line 8. If less than $500. stop here; do not complete or file this form. You do not owe the penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11 12 Enter the tax shown on your 1995 tax return (110% of that amount if the adjusted gross income shown on that return is more than $150.000, or if married filing separately for 1996. more than $75.000). Caution: See page 2 of the instructions. . . . . . . . . . . . . . . . . . . . . . . 13 Required annual payment. Enter the smaller of line 9 or line 12. . . . . . . . . . . . . . . Note: If line 10 is equal to or more than line 13, stop here: you do not owe the penalty. Do not file Form 2210 unless you checked box 1d above. IDIIII Short Method (Caution: See page 2 of the instructions to find out if you can use the short method checked box 1b or c in Part l skip this part and go to Part IV,) Enter the amount, if any, from line 10 above. . . . . . . . . . 14 Enter the total amount. if any, of estimated tax payments you made. . . 15 Add lines 14 and 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total underpayment for rear. Subtract line 16 from line 13. If zero or less, stop here; you do not owe the penalty. Do not file Form 2210 unless you checked box 1 d above. . . . . . . . . 18 Multiply line 17 by .05914. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 . If the amount on line 17 was paid on or after 4/15/97. enter -0-. . If the amount on line 17 was paid before 4/15/97, make the following computation to find the amount to enter on line 1 9. 2 3 4 5 6 7 8 9 10 11 2 3 4 KENNETH W. & KELLY D. LEWIS Note: In most cases. you do not need to file Form 2210. The IRS will figure any penalty you owe and send you a bill. File Form 2210 only if one or more boxes in Part I apply to you, If you do not need to file Form 2210. you still may use it to figure your penalt. Enter the amount from line 20 or line 36 on the enalt line of our return, but do not attach Form 2210, Reasons For Filing - If 1 a. b, or c below applies to you, you may be able to lower or eliminate your penalty, But you MUST check the boxes that apply and file Form 2210 with your tax return. If 1 d below applies to you. check that box and file Form 2210 with your tax return. 1 Check whichever boxes apply (if none apply. see the Note above): a 0 You request a waiver. In certain circumstances, the IRS will waive all or part of the penalty. See Waiver of Penalty on page 2 of the instructions. b 0 You use the annualized income installment method. If your income varied during the year, this method may reduce the amount of one or more required installments. See page 4 of the instructions, c 0 You had Federal income tax withheld from wages and. for estimated tax purposes. you treat the withheld tax as paid on the dates it was actually withheld, instead of in equal amounts on the payment due dates. See the instructions for line 22 on page 3, d 0 Your required annual payment (line 13 below) is based on your 1995 tax and you filed or are filing a joint return for either 1995 or 1996 but not for both years. .m... Required Annual Payment 32 5 6 12 13 14 15 16 17 1 Amount on Number of days paid line 17 x before 4/15/97 x .00025........ 19 20 PENAL TV. Subtract line 19 from line 18. Enter the result here and on Form 1040, line 63; Form 1040A. line 34; Form 1040NR. line 63; 1040NR-EZ, line 26; or Form 1041, line 26. . . . . . ~ 20 A878 For Paperwork Reduction Act Notice, see page 1 of separate instructions. 1 931 1 635 3 566 3 566 1 672 1 894 7 921 3 209 If you 1 672 1 537 91 o 91 Form 2210 (1996) 75044-07 SCHEJULE A (Form 1040) Department of the Treasury Internal Revenue Service Schedule A - Itemized Deductions OMB No, '545-0074 ~ Attach to Form 1040. ~ See Instructions for Schedule A (Form 1040). ~®9& ~~la~::c~ntNo, 07 Your social security 110, Name(s) shown on Form 1040 KENNETH W. & KELLY D. LEWIS Medical and Dental Expenses Taxes You Paid (See page A-1.) Interest You Paid (See page A- 2.1 Note: Personal interest is not deductible, Gifts to Charity If you made a gi ft and got a benefit for it, see page A-3. Casualty and Theft Losses 19 Job Expenses 20 and Most Other Miscellaneous Deductions (See page A-4 for expenses to deduct here.) 23 24 25 26 Other 27 Miscellaneous Deductions 2 3 4 5 6 7 8 Caution: Do not include expenses reimbursed or paid by others. Medical and dental expenses (see page A - 1) SEE ATTACHED A-I Enter amount from Form 1040, line 32. 2 28 438 Multiply line 2 above by 7.5% (.075). . . . . . . . .. 3 Subtract line 3 from line 1. If line 3 is more than line 1. enter -0- State and local income taxes. . . Real estate taxes (see page A - 2) . . . . , . Personal property taxes . . . . . . . . . . . . ~TAXES FROM BUS. EXPENSES 100 1 2 9 Add lines 5 throu h 8. . . . . . . . . . . . . . . . . . . . . . . . . 10 Home mortgage interest and points reported to you on Form 1098 11 Home mortgage interest not reported to you on Form 1098, If paid to the person from whom you bought the home, see page A-2 and show that person's name. identifying no.. and address ~ 12 Points not reported to you on Form 1098, See page A-3 for special rules 13 Investment interest. If required. attach Form 4952, (See page A-3.J 14 Add lines 10 through 13 . . . . . . . . . . . . . . . . . . . . . . . 15 Gifts by cash or check, If you made any gift of $250 or more. see page A - 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Other than by cash or check. If any gift of $250 or more. see page A-3, If over $500. you MUST attach Form 8283. 17 Carryover from prior year. 18 Add lines 15 throu h 17 . . . . . . . . . . . . . . . . . . Casualty or theft loss(es), Attach Form 4684, (See page A-4.J Unreimbursed employee expenses - job travel. union dues. job education, etc. If required. you MUST attach Form 2106 or 2106-EZ. ~ LAUNDRY & UNIFORMS 242 21 22 Tax preparation fees. . . . . . . . . . . . . . . . . . . . . Other expenses - investment, safe deposit box, etc, List type and amount ~ . . . . . . . . . . . . . . . . . . Add lines 20 through 22 . . . . . . . . . . . . . . . Enter amount from Form 1040. line 32 24 28 438 Multiply line 24 above by 2% (,02). . . . . . . . . . . . . . . . ., 25 Subtract line 25 from line 23, If line 25 is more than line 23. enter -0- Other - from list on page A-4, List type and amount ~ 28 Is Form 1040, line 32. over $117.950 (over $58,975 if married filing separately)? NO. Your deduction is not limited, Add the amounts in the far right column for lines 4 through 27. Also. enter on Form 1040. line 34. the larger of this amount or your standard deduction. YES. Your deduction may be limited, See page A-5 for the amount to enter. For Paperwork Reduction Act Notice, see Form 1040 instructions. Total Itemized Deductions A8l8 33 }.. Schedule A (Form 10401 1996 75044-07 SCHEOULE C ro I or oss rom uSlness OMB Na, 1545-0074 (Form 1040) (Sole Proprietorship) ~®9& Oeparlmenl al Ihe Treasury ~ Partnerships, joint ventures, etc., must file Form 1065. Allachmenl 09 Inlernal Revenue Service ~ Attach to Form 1040 or Form 1041. ~ See Instructions for Schedule C (Form 1040). Sequence Na, Name of proprietor ISOCial securitv 110. ~SSN' KENNETH W. LEWIS 554-35-1795 A Business or profession, including product or service AIRCRAFT MAINTENANCE B Business code ~ 66191 C Business name. If no separate business name, leave blank.. K L AVIATION ID Employer ID number !EINI E Busine~s ad~ress ~ 2010 SOUTH UNION AVE (including sUite . or room no.) BAKER SF I ELD. CA 93307 p ft L F B . F Accounting method: (1) 00 Cash (2) 0 Accrual (3) 0 Other (specify) ~ G Did you "materially participate" in the operation of this business during 19967 If "No," see page C- 2 for limit on losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . H If you started or acquired this business during 1996, check here. . . . . . . . . . . . . . . . . In m 1 Gross receipts or sales. Caution: If this income was reported to you on Form W-2 and the "Statutory employee" box on that form was checked, see page C-2 and check here. . . . . ~ 0 1 2 Returns and allowances . . . . . . . . . . . . . . 2 3 Subtract line 2 from line 1. . . . . . . . . . . . 3 4 Cost of goods sold (from line 42 on page 2). 4 5 Gross profit. Subtract line 4 from line 3. . . . .. ..................... 5 6 Other income. including Federal and state gasoline or fuel tax credit or refund (see page C-2). 6 .~ Yes ONo ....··~O 120 828 84 120 744 40 918 79 826 79 826 2 187 Gross income, Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ 7 Ex eoses. Enter ex enses for business use of your home onion line 30, 8 Advertising.............. 8 600 25 Utilities............... 9 Bad debts from sales or services. 9 26 Wages (less employment credits) 10 Car and truck. expenses (see page C-3). 10 11 691 27 Other expenses (from I,i,".e 48, page 2): 11 Commissions and fees. . . . . 11 ACCOUNT I NG 12 Depletion............ 12 DUES AND PUBLICATIONS 13 Depreciation and section 179. 13 2 163 FREIGHT 2 14 Employee benefit programs . 14 FUEL 2 15 Insurance (other than health). . 15 1 073 OUTSIDE SERVICES 17 16 Interest: SECURITY & SAFETY a Mortgage (paid to bank.s. etc.). 16a TAX-BUS INESS PROPERTY bOther. . . . . . . . . . . . . . . 16b 2 508 TAX-SALES 2 17 Legal and professional services. 17 TELEPHONE 2 18 Office expense. . . . . . . . . . 18 1 702 TOOLS 19 Pension and profit-sharing plans. 19 20 Rent or lease (see page C-4): a Vehicles. machinery, and equipment. b Other business property. . . . . . 13 635 21 Repairs and maintenance. . . . . . . 2 492 22 Supplies (not included in Part II). 1 845 23 Taxes and licenses. . . . . . . . 32 24 Travel. meals, and entertainment: a Travel . . . . . . . . . . . . . . . b Meals and enlerla¡nmenl C Enler 50% af line 24b subject ta limilatians . d Subtract line 24c from line 24b. . 28 29 30 31 Total expenses before expenses for business use of home. Add lines 8 through 27 in columns. ~ Tentative profit (loss), Subtract line 28 from line 7 . . . . . . Expenses for business use of your home, Attach Form 8829 . . . . . . . . . . . . . . . Net profit or (loss). Subtract line 30 from line 29, · If a profit, enter on Form 1040, line 12, and ALSO on Schedule SE, line 2 (statutory employees. see page C-5). Estates and trusts, enter on Form 1041. line 3. · If a loss. you MUST go on to line 32. If you have a loss, check the box that describes your investment in this activity (see page C-5). } · If you checked 32a. enter the loss on Form 1040, line 12, and ALSO on Schedule SE, line 2 (statutory employees. see page C-5), Estates and trusts. enter on Form 1041. line 3, · If you checked 32b. you MUST attach Form 6198. For Paperwork Reduction Act Notice, see Form 1040 instructions. 27 28 327 28 68 255 29 11 571 30 31 11 571 }. 32 AB78 All investment is at risk, Some investment is not at risk, Schedule C (Form 10401 1996 32a 0 32b 0 34 COl 75044-07 Schedule C (Form 1040) 1996 Page 2 __ Cost of Goods Sold (see page C-5) 33 Method(s) used to value closing inventory: a IXJ Cost b 0 Lower of cost or market c 0 Other (attach explanation) 34 Was there any change in determining quantities. costs, or valuations between opening and closing inventory? If "Yes." attach explanation, . , . . . . . . . , , . . . . . . . . . , , . . . . . . . . . . , , . . . . . . 0 Yes [i] No 35 Inventory at beginning of year, If different from last year's closing inventory, attach explanation. ,. 35 o 36 Purchases less cost of items withdrawn for personal use . . . . . . . . , , . . , , . . . . . . . . .. 36 38 695 37 Cost of labor. Do not include salary paid to yourself . . . . . . . . . , . . . . . .. .. .. .. .. .. .. .. .. .. 37 2 223 38 Materials and supplies .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 38 39 Other costs. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 39 40 Add lines 35 through 39 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 40 40 918 41 Inventory at end of year, .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. I .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 41 o 42 Cost of goods sold, Subtract line 41 from line 40, Enter the result here and on page 1, line 4. 42 40 918 Information on Your Vehicle. Complete this part ONLY if you are claiming car or truck expenses on line 10 and are not required to file Form 4562 for this business. See the instructions for line 13 on page C-3 to find out if you must file. 43 When did you place your vehicle in service for business purposes? (month. day. year) ~ 44 Of the total number of miles you drove your vehicle during 1996. enter the number of miles you used your vehicle for: a Business b Commuting cather 45 Do you (or your spouse) have another vehicle available for personal use? . .. .. .. .. .. .. .. .. 0 Yes 0 No 46 Was your vehicle available for use during off-duty hours? . 0 Yes 0 No 47 a Do you have evidence to support your deduction? . 0 Yes 0 No b If "Yes." is the evidence written? . . . .. .. .. .. .. . . . . . . . . . . . . . . . . 0 Yes 0 No . Other EXDenses. List below business expenses not included on lines 8-26 or line 30. 48 Total other expenses. Enter here and on page 1, line 27,.."".,.,.....,........ /48 35 COl 75044-07 SCHEDULE SE (Furm 1040) Self-Employment Tax OMB No, 1545-0074 Oeparlment of the Treasury Inlernal Revenue Service ~ See Instructions for Schedule SE (Form ~ Attach to Form 1040. income as shown on Form 1040 1040). ~®96 Anachmenl 17 Sequence No, Name of person with self-employment KENNETH W. LEWIS Social security number of person with self- em 10 ment income ~ 554-35-1795 Who Must File Schedule SE You must file Schedule SE if: . You had net earnings from self-employment from other than church employee income (/ine 4 of Short Schedule SE or line 1 4c of Long Schedule SE) of $400 or more. OR I . You had church employee income of $108,28 or more. Income from services you performed as a, minister or a member of a religious order is not church employee income. See page SE- 1. 1 I Note: Even if you had a loss or a small amount of income from self-employment, it may be to your benefit to file Schedule SE and use either "optional method" in Part II of Long Schedule SE See page SE-3, : Exception. If your only self-employment income was from earnings as a minister. member of a religiqus order, or Christian Science practitioner and you filed Form 4361 and received IRS approval not to be taxed on those earnings. do not file Schedule SE. Instead. write "Exempt-Form 4361" on Form 1 040. line 45, I I j May I Use Short Schedule SE or MUST I Use Long Schedule SE? I DID YOU RECEIVE WAGES OR TIPS IN 1996? I I I No ~ Yes I , , I Are you a minister, member of a religious order. I or Christian Science practitioner who received Yes .. Was the total of your wages and tips subject Yes _ IRS approval not to be taxed on earnings from to social security or railroad retirement tax these sources. but you owe self-employment plus your net earnings from selt-employment more than $62.7007 , tax on other earnings? 1 1 I I No I I 1 Are you using one of the optional methods to Yes ... 1 figure your net earnings (see page SE-3>? No I ~ Did you receive tips subject to social security Yes ... or Medicare tax that you did n'ot report to , No your employer? I I Did you receive church employee income I Yes .. reported on Form W-2 of $108.28 or more? I No I I YOU MAY USE SHORT SCHEDULE SE BELOW YOU MUST USE LONG SCHEDULE SE ON PAGE 2 I Section A - Short Schedule SE. Caution: Read above to see if you can use Short Schedule SE 1 5 Net farm profit or (loss) from Schedule F, line 36. and farm partnerships. Schedule K-1 (Form 1065). line 15a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Net profit or (loss) from Schedule C. line 31; Schedule C-EZ. line 3; and Schedule K-1 (Form 1065). line 15a (other than farming), Ministers and members of religious orders see page SE-1 for amounts to report on this line. See page SE- 2 for other income to report. . . . . . . . . . Combine lines 1 and 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Net earnings from self-employment. Multiply line 3 by 92.35% ('9235), If less than $400. do not file this schedule; you do not owe self-employment tax. . . . . . . . . . . . . . . . . . . Self-employment tax. If the amount on line 4 is: . $62.700 or less. multiply line 4 by 15.3% (.153), Enter the result here and Form 1040, line 45. . More than $62,700. multiply line 4 by 2.9% <.029), Then. add $7.774.80 to Enter the total here and on Form 1040, line 45. 1 2 3 4 2 3 11 571 11 571 on } the result. 10 686 6 Deduction for one-half of self-employment tax. Multiply line 5 by 50% (.5). Enter the result here and on Form 1040, line 25. . . . . . . . 6 A8 For Paperwork Reduction Act Notice, see Form 1040 instructions. - TAXPAYER 36 I I 818 Schedule SE (Form 1040) 1996 75044-07 form, 4562 Depreciation and Amortization (Including Information on Listed Property) ~ See separate instructions, ~ Attach this form to your return. Business or activity to which this form relates OMB No, 1545-0172 Oepartment of the Treasury Internal Revenue Service (T) Name s shown on return ~@9& :~t:~:::'c~ntNo, 67 Identifying number KENNETH W. & KELLY D. LEWIS SCHEDULE C NO. 01 554-35-1795 Election To Expense Certain Tangible Property (Section 179) (Note: If you have any "listed property," complete Part V before you complete Part I.J 1 Maximum dollar limitation. If an enterprise zone business. see page 2 of the instructions . . . . .. 1 $17 500 2 Total cost of section 179 property placed in service during the tax year. See page 2 of the instr. 2 3 Threshold cost of section 179 property before reduction in limitation. . . . . . . . . . . . . . . . 3 $200 000 4 Reduction in limitation. Subtract line 3 from line 2, If zero or less. enter -0- . . . . . . . . . . . 4 5 Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less. enter -0-. If married filing separately. see page 2 of the instructions . . . . . . . . . . . . . . 5 6 (a\ Description 01 property (bl Cosl (eI Elecled cosl 7 Listed property. Enter amount from line 27. . . . . . . . . . . . . . . . . . . . .. 7 8 Total elected cost of section 179 property. Add amounts in column (c). lines 6 and 7 8 9 Tentative deduction, Enter the smaller of line 5 or line 8. . . . . . . . . . . . . . . . . . 9 10 Carryover of disallowed deduction from 1995. See page 2 of the instructions. . . . . 10 11 Business income limitation, Enter the smaller of business income (not less than zero) or line 5 (see instructions). 11 12 Section 179 expense deduction. Add lines 9 and 10. but do not enter more than line 11 . . . .. 12 13 Carryover of disallowed deduction to 1997. Add lines 9 and 10. less line 12 . ~ 13 Note: Do not use Part II or Part //I below for listed property (automobiles, certain other vehicles, cellular telephones. certain computers. or property used for entertainment. recreation, or amusement). Instead. use Part V for listed property, I11III MACRS Depreciation For Assets Placed in Service ONLY During Your 1996 Tax Year (Do Not Include Listed Property.) " " Section A - General Asset Account Election 14 If you are making the election under section 1680)(4) to group any assets placed in service during the tax year into one or more general asset accounts. check this box. See page 2 of the instructions . . . . . . . . . . . . . . . . . . . . . ~ n Section B - General Depreciation System (GDS) (See page 3 of the instructions.! (a) Classilication of property (b) Month and (c) Basis lor depreciation (d) Recovery (e) Convenlion (II Melhod (9) Depreciation deduction year placed in (business/inveslmenl use 15 service only - see inslructions) period 16 Section C - Alternative Depreciation System (ADS) (See page 4 of the instructions.! Other De reciation (Do Not Include Listed Pro ert .) (See a e 4 of the instructions.! GDS and ADS deductions for assets placed in service in tax years beginning before 1996. Property subject to section 168(1)( 1) election. . . ACRS and other de reciation . . . . . . . . . . . . . Summar (See a e 4 of the instructions.! 20 Listed property. Enter amount from line 26. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Total. Add deductions on line 12. lines 15 and 16 in column (g), and lines 17 through 20. Enter here and on the appropriate lines of your return. Partnerships and S corporations - see instructions. 22 For assets shown above and placed in service during the current year, enter the portion of the basis attributable to section 263A costs ........ . . . . . AB78 For Paperwork Reduction Act Notice, see page 1 of the separate instructions. 37 PAGE 1 17 2 163 18 19 20 21 Form 4562 (1996) 75044-07 For<ITI 4562 (1996) . . Section A. Depreciation of MACRS property (placed in service before tax year beginning in 1996) (b) Date (cl Basis lor depreciation (d) Recov, (g) Depreciation (a) Class of property placed In (Business use only-see (e) Convention m Method 1 service instructions) period deduction 7 YEAR PROPERTY LEASEHOLD-HANGER DOOR 2 01/95 6.500 7 MO 200 DB 1. 393 TOOL BOX 11 17/95 3.020 7 MQ 200 DB 647 MACHINERY 41 25/90 1 381 7 200 DB 123 2 MACRS deduction for assets ølaced in service ørior to tax year be!linnin!l in 1996 (Enter here and on øa!le 1, line 17) . 2 163 (b) Data !c) Basis lor depreciation (d) Depreciation (e) Method () life, rate (g) Deduction (a) Description of properly acquired (Business use only-see allowed or allowable 01 figuring or Recovery lor this year 3 instructions) in earlier years depreciation Period , , 4 Total column G. Section 8, !Enter here and on page 1. line 19) . Section B. - Depreciation of ACRS and Nonrecovery Property 38 PAGE 3 75044-07 AUTO, TRAVEL, AND OTHER BUSINESS EXPENSES 1554-35-1795 STATEMENT KENNETH W. & KELLY D. LEWIS SCHEDULE NO.01 AUTO EXPENSES DATE PLACED IN SERVICE PERCENT OF BUSINESS USE INSURANCE LEASE PAYMENTS 4,325 INCLUSION 48 REPAIRS LICENSE FEE - IN EXCESS OF REGISTRATION TIRES, BATTERIES TOTAL TOTAL X BUSINESS % TOTAL CAR/TRUCK EXP. (TO SCH C01 LINE 10) JITMT6 PAGE: 1 VEHICLE 1 VEHICLE 2 TOTAL 07/30/94 11/14/93 75.000 % 90.000 % 1,851 1,604 4,277 4,165 1,446 263 343 127 6,518 7,558 4,889 6,802 4,889 6,802 11,691 75044-07 A-1 A TT ACHMENT TO ITEMIZED DEDUCTIONS SCHEDULE A, FORM 1040 Name of Taxpayer(5) I Social Security Number KENNETH W. & KELLY D. LEWIS 554-35-1795 OTHER MEDICAL EXPENSES INSURANCE PREMIUMS 1.800. TOTAL TO LINE 1 OF SCHEDULE A 1.800. ---------------------------------------------------------------------- '..."'...... -07 4 ~ California Resident TlncomeTaxReturn 1996 APE DO NDT ATTACH 554-35-1795 LEWI 568-41-9608 LABEL KENNETH W. LEWIS Step 1 KELLY D. LEWIS Name and 1516 IVAN AVE Address BAKERSFIELD CA 93304 FOR COMPUTERIZED USE ONLY 01 2 30 0 49 06 0 31 0 50 09 0 35 0 51 10 0 36 0 52 12 17676 37 142 53 14 0 38 207 54 16 0 39 0 55 17 28438 41 0 56 18 9695 43 65 57 20 276 44 0 58 21 134 45 65 59 23 0 46 0 60 28 0 47 0 61 29 0 48 0 63 CLIENT'S COpy 540 FEDERAL RETURN ATTACHMENT REQUIRED: [i YES 0 NO 96 Do Not Write In These Spaces P AC A R RP o 64 0 o APE 0000 o 3800 0 o 3803 0 o CATMT 0 o SCHGl 0 o 5870A 0 o 5805 5805F 0 o 545687233 o o 65 o o Step 2 ~ 3 Filing Status Check 4 only one. S Step J 6 Exemp- tions 7 Do nol enler dollar 8 amounls 9 in Ihe boxes, 10 Attach check or money 11 r er e, o Single I.iJ Married filing joint return (even if only one spouse had income) o Married filing separate return. Enter spouse's social security number above and full name here o Head of household (with qualifying person). If the qualifying person is a child but not your dependent. child's name here. o Qualifying widow(ed with dependent child, Enter year spouse died 19 If someone can claim you (or your spouse. if married) as a dependent on their tax return. check the box here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 0 Personal: If you checked box 1. 3 or 4 above, enter 1. If you checked box 2 or 5, enter 2. If you checked the box on line 6. see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Blind: If you (or if married, your spouse) are visually impaired, enter 1. If both are visually impaired, enter 2. .. 8 Senior: If you (or if married, your spouse) are 65 or older, enter 1. If both are 65 or older, enter 2. 9 Dependents: Enter name and relationshiþ. Do not include yourself. your spouse or the person listed on line 4. Enter the total number of dependents. . . . . . Total number of exem tions. Add line 7 throu h line 10· enter 2 . . . . . . . . . 10 11 2 Step 4 I Taxable 12 State wages from your Form(s) W- 2, box 17. . . . . . . . .12 17 . 676. Income 13 Federal AGI from Form 1040, line 31; Form 1040A, line 16; Form 1040EZ, line 4; or TeleFile Tax Record, line H . . . . . . 13 28 . 438 . 14 California adjustments - subtractions. Enter the amount from Schedule CA (540), line 31. column B . . . 14 Attach copy of your 15 Subtract line 14 from line 13. If less than zero, enter the result in parentheses, See ¡nstr. . 15 28 . 438 . 'ormls) W-2, W-2G and 16 California adjustments - additions. Enter the amount from Schedule CA (540), line 31, column C . . .16 t099-R here, 17 California adjusted gross income, Combine line 15 and line 16 . . . . . . . . . . . . . . . . . 17 28 . 438 . 18 Enter your CA standard deduction OR your CA itemized deductions . . . . . . . . . . . . . . 18 9 . 695 . 19 Subtract line 18 from line 17, This is your taxable income, If less than zero, enter -0- . . 19 18.743. Step 5 20 Tax, Check if from [X Tax Table 0 Tax Rate Schedule 0 HB 3800 or 0 FTB 3803. . . .20 276 . 21 Exemption credits. Check one: /XI Flowchart 0 Federal AGI limit or 0 CA TMT limit fê\21 134 . Tax \:V 22 Subtract line 21 from line 20. If less than zero, enter -0- . . . . . . . . 22 142. 23 Tax. Check if from 0 Schedule G-1 and 0 form FTS 5870A. . .23 O. 24 Add line 22 and line 23 . . . . . . . . . . . . . . . . . . . . . . . . . . 24 142. For Privacy Act Notice, see instructions. Continue to Side 2 Form 540 c 1 1996 Side 1 41 75044-07 c C T Step 6 25 Credits 28 29 30 31 33 34 35 36 To claim more than three credits, see instructions. . . . . . . Add line 28 through line 31. These are your total credits . . Subtract line 33 from line 25. If less than zero, enter -0-. Alternative minimum tax. Attach Schedule P (540) . . . . . . . . . . . . . . . . . Other taxes and credit recapture from forms FTB 3501, FTB 3535, FTB 3805P, FTB 3805Z or FTB 3806. See instructions. . . . . . . . . . . . . . . . . . . . . . . . Add line 34 through line 36. This is your total tax. . . . . . . . . . . . . . . CA income tax withheld. Enter total from your 1996 Form(s) W-2, W-2G, 1099-MISC and 1099-A. Also. attach Form(s) to Side 1 . .38 39 1996 CA estimated tax and amount applied from your 1995 return. Include the amount from form FTB 3519 or Schedule K - 1 (541). . .39 41 Did either you or your spouse receive more than $31.767 in wages in 1996? Yes. See instructions. No. Go to line 42 . . . . . . . . . . . .41 42 Add line 38 through line 41, These are your total payments . . . . . . . . . . . . . .. 42 Step 9 43 If line 42 is larger than line 37. subtract line 37 from line 42. This is your overpaid Over- 44 Amount of line 43 you want applied to your 1997 estimated tax. . . . . . . . . . . . ~:~ or 45 Subtract line 44 from line 43. This is the amount of overpaid tax available this year. Tax Due 46 If line 42 is less than line 37, subtract line 42 from line 37. This is the tax due. . 47 Contribution to California Seniors Special Fund. See instructions. .47 Step 10 You may make a contribution of $1 or more to: Contri- 48 Alzheimer's Disease/Related Disorders Fund. . . . . butions 49 California Fund for Senior Citizens. . . . . . . . . . 50 Rare and Endangered Species Preservation Program 51 State Children's Trust Fund for the Prevention of Child Abuse· 52 California Breast Cancer Research Fund 53 Veterans Memorial Account. . . . . . . . . . . . 54 California Firefighters' Memorial Fund. . . . . . . 55 California Public School Library Protection Fund 56 DAR.E. California (Drug Abuse Resistance Education) Fund Calif, Election } 57 Your politicl' plrly 1m!. 1$25 mIX)' Campaign Fund 58 Spouse's politicll plrry 1m!, ($25 mIX). 59 Add line 47 through line 58. These are your total contributions. . Step 11 Refund 60 or Amount 61 You Owe Step 7 Other Taxes 37 Step 8 38 Pay- ments Amount from Side 1, line 24 . . . . . . . . . . . 142. . . . . . . . . . . . . . . . . . . . . . . . .. 25 Enler credil nlme Ind Iml~ 28 Ind Im!~ 29 Ind Iml~ 30 Enler credit name code no, code no. code no. Enlef credit nlme .31 33 34 142. 35 O. 36 37 142. 207. tax.. 43 ..44 ·.45 ., 46 207. 65. 65. .48 .49 .50 .51 .52 ·53 .54 ·55 .56 ~57 ~58 . . . . . . . . . . 59 Subtract line 59 from line 45. You have a REFUND or NO AMOUNT DUE. Mail your return to: IMAGE PROCESSING, FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0009. . 60 Add line 46 and line 59. This is the AMOUNT YOU OWE. Make a check or money order payable to "Franchise Tax Board" for the full amount you owe, Write your social security number and "1996 Form 540" on it. Attach it to the front of your Form 540 and mail to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001. . . . . . . . . . 61 65. Step 12 Interest 62 and 63 Penal- ties 64 Sign Here Interest and late return and late payment penalties . . . . . . . . . . . . . . . . . . . . . . . 62 Underpayment of estimated tax, If form FTB 5805 or 5805F is attached, check here .0 . 63 If you do not need California income tax forms mailed to you next year, check here . . . . 64 0 IMPORTANT: See "Sign Your Return" in the Form 540 instructions to find out if you should attach a copy of your complete federal return, Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. It is un- . lawful to Your signature forge ~ X X ~r::a~~rse. Signature of paid preparer (dec/aration of preparer is based on a/l information of which preparer has any knowledge) 4 Daytime phone number ( ) Preparer's SSN/FEIN 545-68-7233 ~ , signature lit tiling joint, both must sign) Date Firm's name (or yours if self-employed) JB ACCOUNTING PLUS JOYCE A. BERENDSEN, EA Firm's address 1801 HASTI-ACRES DR. STE.7 BAKERSFIELD, CA. 93309 Side 2 Form 540 c 1 1996 42 75044-07 43 C TAXABLE YEAR C T SCHEDULE CA (540) California Adjustments - Residents 1m ortant: Attach this schedule directl behind Form 540. Side 2. Name s as shown on return 1996 Social security number 554-35-1795 C KENNETH W. & KELLY D. LEWIS Part I Income Adjustment Schedule B A Federal Amounts /taxable amounts fro¡n your federal return) Additions See instructions. Subtractions See instructions. Section A - Income 7 Wages. salaries. tips. etc. See instructions before making an entry in column B or C Taxable interest income· . . . . . . . . . . . . . . . . . . Dividend income . . . . . . . . . . . . . . . . . . . . . . . State tax refund. Enter the same amount in column A and column B Alimony received. . . . . . Business income or (loss). Capital gain or (Joss) . . . . Other gains or (losses)· . . IRA distribution, See instructions. la) Pensions and annuities. See instr. (a) Rental real estate, royalties, partnerships, S corporations, trusts, etc, Farm income or (Joss) . . . . . . . . . . . . . . . . . . . . Unemployment compensation. Enter the same amount in column A and column B.· ............ Social security benefits la) Other income. (a b c..,..',...... ...... d e t I ..............'., ..........'..'... .,...,.......,.., ,................ .................. . . . . . , , , . . . . . . . . . ...........,...... '..,.,...........,.,.,'..,.,.,.,'.. .......,..,...,......,.,.....,. . . . . . , . , . , , ' . , , . . . . , . . , . . . '. ' .at::::::))::',:::::':':':"""""""',·," ~,(:/:"""""""""""", '<:i¡~:),.,.,.,."".".,.,.,." , :e:;::/::::::::,""::',",""""""'''''''' :t ! 17 676 9 7 8 9 10 11 12 13 14 Ib) Ib) 17 18 8 9 10 11 12 13 14 15 16 17 18 19 11 571 19 (b) 20 21 a C.Worni. IO!lery winnings b ois.ster loss carryover from fTO 3805V eNOL from fTB 3805Z, 3806 Dr 3807 t Other (describe) 21 C Federal NoL (Form 1040, line 21) d NOL carryover from fTO 3805V 22 Total. Combine line 7 through line 21 in column A. Add line 7 through line 211 in column B and column C. Go to Section B. Section B - Adjustments to Income 23 a Your IRA deduction . . . b Spouse's IRA deduction. . . . . 24 Moving expenses. . . . . . . . . 25 One-half of self-employment tax. 26 Self-employed health insurance deduction 27 Keogh and self-employed SEP plans . 28 Penalty on early withdrawal of savings . . 29 Alimony paid, Recipient's: SSN Last Name 29 30 Add line 23a through line 29 in columns A, B. and C. 30 31 Total. Subtract line 30 from line 22 in columns A, B, and C, See the instructions for how to transfer the total to Form 540. 31 Part II Adjustments To Federal Itemized Deductions 33 Federal itemized deductions. Add the amounts on federal Schedule A IForm 1040), lines 4, 9, 14. 18. 19, 26, and 27 34 Enter total of federal Schedule A. line 5 (state and local income tax and State Disability Insurance) and line 8 (foreign taxes only). . . . . . . . . . . . . . . . . . . . . . Subtract line 34 from line 33 . . . . . . . . . . . . . . . . . . . . . . Other adjustments including California lottery losses, See instructions. Specify Combine line 35 and line 36. . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . Is the amount on Form 540, line 13 more than Is the amount you entered on line 38 the amount shown below tor your tiling status? more than your standard deduction belOW?] Single or married filing separate $111.695 Single or married filing separate. $2,527 Head of household. . . . . . . . . . $167.542 Married filing joint, head of household or 38 Married filing joint or qualifying widow{er> . . . . . . $5.054 qualifying widow{er) . . . . . . . $223.390 YES. Transfer the amount on line 38 NO. Transfer the amount on line 37 to line 38. to Form 540, line 18, YES. Complete the Itemized Deductions Worksheet NO. Enter your standard deduction on in the instructions for Sch. CA (540). line 38. Form 540, line 18, 22 29.256 23a b 24 25 26 27 28 818 818 28 438 35 36 37 38 33 10,483. 34 788. 35 9.695. 36 37 9.695. 9.695. = Schedule CA (540) 1998 75044-07 CTAXABLE YEAR ¥ 1996 Depreciation and Amortization Ad·ustments CALIFORNIA FORM 388SA shown on return Identify the activity as passive or non passive. See instructions. This form is being completed for a passive activity. IX] This form is being completed for a nonpassive activity, Election to Expense Certain Tangible Property IIRC Section 179). Enter the amount from line 1 1 of the worksheet in the instructions , . . . . . , . , . . . . . . , , , . 2 Part III Depreciation. la) Description of property placed Ib) Date placed Ic) California basis Id) Method Ie) Life or If) 1996 California 3 in service during 1996 in service for depreciation rate depreciation deduction 4 Add the amounts on line 3. column (fl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 California depreciation for assets placed in service prior to 1996 ...........,." 5 6 Total California depreciation from this activity. Add the amounts on line 2, line 4 and line 5 6 7 Total federal depreciation from this activity. Enter depreciation from your federal Form 4562, line 21 7 8 a If line 6 is more than line 7, enter the difference here and on Schedule CA (540 or 540NR). See instr 8a b If line 6 is less than line 7, enter the difference here and on Schedule CA (540 or 540NR). See instr 8b 2,163 2,163 2,163 o Part IV Amortization. la) Description of costs amortizable Ib) Date placed Ic) California basis Id) Code e) Period or If) 1996 California 9 during 1996 in service for amortization section percentage amortization deduction 10 Total California amortization from this activity. Add the amounts on line 9. column (t). . , 10 11 California amortization of costs that began before 1996 . , , , , , . , . . , , . , . , . . . 11 12 Total California amortization from this activity. Add the amounts on line 10 and line 11 . 12 13 Total federal amortization from this activity. Enter amortization form your federal Form 4562, line 42 13 14 a If line 12 is more than line 13. enter the difference here and on Schedule CA (540 or 540NR), See instr 14a b If line 12 is less than line 13. enter the difference here and on Schedule CA 1540 or 540NR). See instr 14b FTB 3885A 1996 44 75044-07 t C t996 California Depreciation and Amortization (Form 3885A) Page 3 T (a) (b) (c) (d) (e) (I) (g) (hI Basis for Type of properly (list Date placed in Businessl Cost or depreciation Recovery Method/ Depreciation vehicles first) service invest other basis (business/investment period Convention deduction 1 NONPASSIVE use" use only) LEASEHOLD-HANGER DOOR 2 01/95 100 6.500 6.500 7 200DB 1,393 TOOL BOX 11 17/95 100 3,020 3 020 7 200DB 647 MACHINERY 41 25/90 100 1.381 1.381 7 200DB 123 2 TIC I'f 'd d . 1996 ~ 2 163 ota a I ornla epreclatlon or assets place In service prior to . Amortization (a) Description (b) Date placed Ic) Cost or (d) Code (e) Period or (I) AmOrlization in service other basis seclion percentage deduction 3 4 Total amortization of costs that began before 1996. . . . . . . . . . . . . . . . . . . . . . . . . . . . . " ~ 75044-07 ·- . G·) " {/¡ dfc¡ua¿~~ ::I:~~:~I::'I'" C,,"'~:: August 1 0, 1999 Mr. Bill Lewis K.L. Aviation 2010 South Union Avenue Bakersfield, California 93307 RE: Proposal to Remove Underground Storage Tanks at K.L. Aviation, 2010 South Union Ave, Bakersfield CA. 93307 Dear Mr. Lewis: AquaGeosciences, Inc. (AGI) is pleased to present the following bid proposal to you for the removal of two (2) underground storage tanks and any remaining associated piping. The underground storage tanks consist of two (2) 10,000 gallon tanks. The last known substance in the tanks was aviation fuel in one of the tanks and automotive fuel in the other. The tanks are assumed to be empty and have been out of service for approximately nine years. The following tasks will be conducted to complete the Scope of Services necessary to complete the tank removals. SCOPE OF SERVICES - Underground Storage Tank Removals AGI proposes to expedite the work in order to meet a reasonable deadline for the tank removal project. To accomplish this, we propose to provide the following services: · AGI will obtain all necessary permits required by local health and fire jurisdictions for tank removal prior to commencement of work; · Excavate tank and associated piping in accordance with the City of Bakersfield Fire Department Hazardous Materials Division Guidelines. Dispose of up to 2" of residual product remaining in tank. Decontaminate the tank and associated piping. Transport and dispose of rinseate and product at a permitted recycling facility. Transport steel tanks to a permitted facility for scrapping. Provide certification of final tank disposition; · Call for inspection by City Fire Site Inspector. Forty-eight (48) hours notice will be given; · Render the tank inert with the placement of dry ice at a minimum ratio of 2 pounds of dry ice for each 100 gallons of tank capacity, until the LEL level at 0% allowing four (4) hours of oxygen displacement; · Secure all bungs and openings tightly, leaving a 1/8 inch pressure relief hole at the top of the tank; · Collect and analyze approximately eight (8) soil samples (one at 2 and 6 feet below each end of the 10,000 gallon tanks). Soil samples will be analyzed for TPHg/BTEX/MTBE. , " , , 6X51 MeDl VIIt DriVe, Suite D . Bakersfield, California 93313 (g05) X36-8 100· FAX (80S) X36-8800 (ROO) 301-4244 i' · Soil which is not visibly contaminated will be replaced into the excavation. Due to the void created by removing the tank, AGI will scarify and transport on-site clean fill material or if suitable material is not available on site, AGI will purchase sufficient material. The site will be backfilled, compacted to 90% of maximum density and brought back to grade upon completion of sampling activities; · A written report with all documentation will be presented to you at the completion of this project. This report will then be submitted to the City for review and site closure. There are no provisions in the Scope of Work described above for any of the following items: · Additional tanks discovered during removal operations; · Cave-ins or over excavation due to unstable soil or site conditions; · Resurfacing of the excavated area; · Trucking in clean backfill material, in the event of contamination; · Compaction tests of the backfill; · Excess of groundwater, dewatering, pumping or drainage; · Unknown or unreported subsurface conditions such as electrical plumbing, piping, utilities, communications, sewers, septic system, or concrete anchors; · Structural conditions for adjacent buildings, structures and equipment; · State and federal taxes expressly associated with disposal of hazardous waste; · Shoring, sheeting, piling; · Security of excavation in the event contamination precludes timely backfill; · Delays or stoppage by owner, buyer or regulatory agencies; · Strikes, acts of God adverse weather conditions; · Removal and disposal of contaminated soil; · Removal and disposal of contaminated groundwater; · Disposal of materials other than described in above Scope of Work; · On-site treatment of contaminated soil and/or groundwater. FEE ESTIMATE for referenced SCOPE OF WORK TANK REMOVAL Professional Services Permitting 2 Hrs. @ $75/Hr. Project Manager/Site Supervisor 8 Hrs. @ $75/Hr Permit Fees Field Operations Mob/Demob Tank Rinsing and Rinseate Disposal Tank Removals and Disposal (transport) Dry Ice 400 Ibs. @ $1.1 O/Ib. Backfill and Compaction (Material & Equipment) Backhoe w/Operators 32 Hrs. @ $80/Hr. Laborers 64 Hrs. @ $35/Hr. Sub-Total Analytical Services 8 samples - TPHg/BTEX/MTBE @ $75/ea. Sub- Total Report of Findings Total - Tank Removal $ 150.00 N/C $ 966.00 $ 400.00 $ 1,800.00 $ 1,400.00 $ 440.00 $ 2,100.00 $ 2,560.00 $ 2,240.00 $ 12,056.00 $ 600.00 $ 600.00 $ 750.00 $ 13,406 .00 If contamination is discovered, then additional soil removal and hence additional backfill will be required. Additional soil excavation will be charged on a TIME and MATERIAL basis. Client Responsibilities To perform this investigation, Client will be responsible for the following: 1. Provide adequate access and workspace. 2. Locating all utilities and other subsurface structures that could interfere with or be damaged during excavation operations. Failure to locate such Jines or structures, and the the responsibility for any necessary corrective action or resulting damage, will be the responsibility of Client. AGI will contact USA/DIG prior to starting the excavation operations. .. 3. Client agrees to pay AGI the contracted amount as follows: $2,210.00 $9,330.00 $1,866.00 10% Down & Permit Fees due at time of contract 75% Upon completion of Field Work 15% Upon completion of Tank Closure Report Limitations This proposal is based upon information supplied to AGI by Client for a Underground Storage Tank Removals. Client will be kept abreast of developments as they occur, and jf significant changes to the scope of work, as described in this proposal, do occur, the Client will be notified in writing prior to implementation of work. The referenced fee estimate is based upon AGI mobilizing and working on the entire project during one (1) continual time period. Delays in the field due to Client schedule changes or contractual breaches will be billed on a time and material basis for the work performed at the time of delay or breach. These are fee estimates given for budgetary purposes and AGI will not exceed the total amount unless authorized in writing by Client due to scope changes. Agreement I have read, understand and agr~e t~ terms and conditions of the contract. SIGNED ß ~V ~ DATE q -;2 -9e¡ SUBMITT (. The cost estimate is od until 10/15/99. acquire written approval from AGI. TITLE AQUAGEOSCIENCES, INC. 6851 McDivitt Drive, Suite D BAKERSFIELD, CALIFORNIA 93313 (805) 836-8100 Business control 18150 Bu.in.sJ name & addre.. K L AVIATION 2000 S UNION AVE BAKERSFIELD CA 93301 Location, ID . . . Mai1in9 addre.. 2000 S UNION AVE BAKERSFIELD '--- 1/07/99 ,. 11:16:10 ~ 1 10356 '~ CA 933010000 OL100I01 CITY OF BAlŒRSFIBLD Busin.s. Ma.ter Inquiry Da te opened . . Federal tax ID Business phone Status . . . . · . 11/01/81 Contractor flag Type of ownership Emergency phone Status date . . . N . · . · · . · . t:1U5 A · · . 0/00/00 · . Owner Infor.matioD LEWIS, KENNETH W Phone ..... Social security Drivers license Date of birth . · · . 805 833-2510 . Pre.. Enter to continue. F3-Exit F5-Di~lay officer. r7~.oe11aneou. inrozmatioD F9-Di~1.y lieeD... F12=Cancel OL110I01 C:In OF BAlŒRSF:IBLD Licens. Master :Inquiry 1/01/99 11:16:48 Business control nbr .: 18150 Business name & address K L AVIATION 2000 S UNION AVE BAKERSFIELD CA 93301 License Number .: 99 20199 Mailing address 2000 S UNION AVE BAKERSFIELD CA 933010000 . Classification Exemption applied . . . . License status, date Appl, issue date . . . . Expiration date . . . Lic valid thru date . Gross receipts amount Date renewal printed . . . Date printed, reprinted .. 7/10/98 Prior license . . . .. . 98 20199 Municipal code reference Press Bn1~r to continue. F3-Exi t F5-Addi tional charge. F6aCharqes I'111Miacel1aneous F8-Bu.inta.. inquiry Pg-,.dcU tional requi~Dt. nO-lteoeipt. . . . 570 SERVICE OR MANUFACTURING MISCELLANEOUS ACTIVE 1/01/98 6/30/99 6/30/99 1/06/98 7/01/98 More. . . infor.mation F24-4fore key. '~ t 1-~~ '. ", .,.,~. ~!!!.A!~.X~,.:..;~:.:~..,:::X~··~:~~~::~J::2.~:r:J~1åt:.~! , ~ . S6-J9 '~/ 170-03 SWII4 OF SEee "T.30S.R.28E. SCHOOL.. DIST. 1-.1 170-03 " @ @ C> C> , ... ':' C> ... C> , C> ... ... ... 3 : ... 01 I III 8 01 01 ... ð e . to.: . .. c! >- .. '" t M e ~ . ,. , .. HI I ,... IO..p ...", ~;) ... . I ".. 8 , I I I I 1'3~\ I ,;;I I 2/ I !!!" - - N I I I \ I\. , ...8UL.~ '--\, ~ 'I VOlt. "1:", t, ~Mo~A:" '\ ...~...¡.' --- .. .. @MR @~ . ¡I--' 20 ~'- æ @ .M', ~' - r t~1 ,~ . =.'::.. ~ ';.....:=-:::=. ..... ____ . - If _ .. .... ., ..... . ........... .. . ASSESSORS MAP 1O..!I9:::º~.... COUNTY OF IEIII '......<.- ,--~.."-..........-.....:... '."~ :I, ;- '" '. ~ ~-(C) 1994 TRW REDI Property Data ------------------------------------------------------------ 242) Situs: 2014 S UNION AVE, BAKERSFIELD CA 93307 'Use: WAREHOUSB APN :170-030-36-00 County: Kern CA Census: Map Pg: 232-B2 New Pg: Owner : LEWIS BONITA J Mail :2000 S UNION AVB¡BAKBRSFIELD CA 93307 Tax Rate Area:000-1003 Property Tax :$364 Bxemption ABsd Land:$20,738 Assd Imp :$10,119 Total Val:$30,857 ABsd Year:95 'Improved: 32' Last Sale Transfer Date:02/25/94 Docœnent # :31283 Docwnent Type: TRUSTEB' S DBED Price :$30,400U First TO Prior Sale 01/31/78 50830584 $70,000U Bldg/Lvarea: Yrblt/Bff # Stories # Units : # Buildings: Junior TD Lender Seller : CHICAGO TIT CO (TE) , Title Company:CHICAGO TITLE INSURANCB CO County Use:3600 Bldg Class: Flood Panl: Flood ZOne: , Heat Air-Cond Lot Size Lot Area Zoning Park Type : Park Spaces: :A2.72 :118,483 Pool Condition . . Paved Pkg Legal :L1 PM4511/ TRW-RBDI (C) 1994 i The Page & Grid reference is copyrighted by Thomas Bros. Maps <'D!? ------------------------------------------------------------ » Reported data believed to be reliable but accuracy is not guaranteed « " . ,'.... ·i\. . . ,. James Maples.Assessor-Recorder Kern County Official Records DOCUMENT #:0198150291 1111111I IIII111 e01991S029H JASON Pages: 1 IØ/3Ø/1998 8:øø:ee 1\ECORD\NG REQUESTED BY AND WHEtt RECORDED MAlL THIS DEED AND, UNLESS OTl-iERWISE SHOWN BELOW. MAIL TAX STATEMENT TO: Name ~ ~\S =~ 610\0 ~U\)-\ U~\O~ ~:'IO¡ ~G:\tS~laJ) CA ~ ZIp Fees, " , Taxes, . . Other, , , TOTAL PAID, . 7,e8 7,eø TItle Order No. Escrow No. Stat. Types: I SPACE ABOVE THIS LINE FOR RECC.__. ___ T 355 Legal (2-94) Grant Deed THE UNDERSIGNED GRANTOR(s) DECLARE(s) en"", DOCUMENTARY TRANSFER TAX IS $ , I c I e 1 r QlII':'l :I~ 0_ unincorporated area 0 City of Bakersfield Parcel No. 170-030-36-00-4 n_ O computed on full value of interest or property conveyed, or o computed on full value less value oflicns or encwnbrances remaining at time of sale, and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Bonit~ J. Lewis hereby GRANT(S) to Kenneth William Lewis the following described real property in the county of Kern , state of California: Parcell in the City of Bakersfield, County of Kern, state of California, as shown on Parcel Map no. 4511, filed January 17, 1978 in the Book 20, Page 22 of Parcel Maps, in the office of the County Recorder of Kern County. Except all oil, gas and other minerals contained within said land, as reserved by Kern County Land Company, a Corporation, in Deeds of Record. APN 170-030-36-00-4 I STATE OF CAUFORNIA ¥. COUNTY OF ~~'('\ On \O~~ct-o..~ ~",\c. ~,\~~ a Notary ~ In ~ for said County and State. personally appeared '" ~. \-9"""~ } 8.8. Dated \ ~ .. ð.. 0... - ~ i .. before me, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(~ whose name(f) is/are subscribed to the within instrument and acknowledged to me that helshe/1hey"ex8Cuted !he same in hislherMeir authorized capac:Ity(iee)\ and that by IIIsIherNlelr slgnature(~ on the instrument the person(t'). or the entity upon behalf of which itie person(~ acted, executed the instrument. vmNE~~~~al seal ~ Signature, ~\ \.. '~~ ,~- ~ &~æ - ~ - ~ , -e ~~14330 J' _.....-~ I Kern County - ~ ~ .._~~~~~20.~! (ThIs area for ofIIc:faJ notarial sea/) MAIL TAX STATEMENTS TO PARTY SHOWN ON liOLLOWlNG LINE; IF NO PARTY SHOWN, MAIL AS DIR.ECI'ED ABOVE N~enneth Levis 2010 s. Uni~~_ ~~~9rafi81d, QA1~~iJ~7 . . .....,1.:- ", ~, This is a true certified copy of the record if it bears the seal, imprinted in purple ink, of the Recorder. JUL 1 3 m99 Deputy Permit No. ð R 0;2 d""l. , CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 PERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK SITE INFORMATION SITE ADDRESS ;20/0 5 c..lÅJ'~^' FACILITY NAME /(. 1. A"':A-#-'~ð~( CROSS STREET TANK OWNER/OPERATOR MAILING ADDRESS ~(1)IC> ..s c...l^-,."b"v AI.J~ ZIP CODE 9330 7 APN nO~p30 -S(>Ot;- PHONE NO, S g1.-..2.5~ l CITY ~ tt"-t&Il.&C.-dfd. ZIP '\ 3.!Ø7 CONTRACTOR INFORMATION COMPANY ~u A ße£J!'-c......çAJ e.Æ<; ADDRESS fo~S' (t11'.D:.;.-H D~ INSURANCE CARRIER PHONE NO, B3' - t¡¡/ðC) LlCENS~ NO, ~:~ i) CITY BÞr~~~.'c5!æL ZIP C¡~313 WORKMENS COMP NO, PRELIMINARY ASSESSMENT INFORMATION COMPANY PHONE NO, LICENSE NO, ADDRESS CITY ZIP INSURANCE CARRJER WORKMENS COMP NO, TANK CLEANING INFORMATION COMPANY ADDRESS WASTE TRANSPORTER IDENTIFICATION NUMBER NAME OF RINSATE DISPOSAL FACILITY ADDRESS FACILITY IDENTIFICATION NUMBER PHONE NO. CITY ZIP CITY ZIP TANK TRANSPORTER INFORMATION COMPANY ADDRESS TANK DESTINATION PHONE NO, CITY LICENSE NO, ZIP TANK INFORMATION TANK NO, AGE VOLUME CHEMICAL STORED DATES STORED CHEMICAL PREVIOUSL Y STORED ------- For Ot1icial U!Ic: Onl APPLICATION DATE '... ..:.<:...,...:.:'.'.:::,;. ,. , 0'" ...;;..'............'.'..,...............:... ,., '..........,.',., .......,. .'....;'.,...... ',.':.;:,<:':;:,.<::,::::.;.;:.;';;';':''':: , '\ ", ", ·,'··'·'·'YAêijSî1XNØ}:}<'i<><·::NQ.QFTANK$:> : ',,/ ·.F~ES22.:..: 'II II,: /\I'I'LlC^N'I fI^S RECEIVED, UNDERSTANDS. AND WILL COMPLY wrnl TIlE A1T^CIfJ'D CONDITIONS OF TIllS I'J-:RMI'I ^NI> ^NY Ollll:R STAll:. LOCAL AND FEDERAL REGULATIONS, TIllS H >RM 'I^S III':I:N COMI'[YIl·:n (INnER PENALTY OF PElUURY. AND TO TIlE BEST (W MY KNOWLEIXìE IS TRlJl·: ANI"'''' ){/' J/ -'-.., / · KttN¡..Jt!f~ úU U...J,-.J ~~ y L APPLICANT N^ME (PRINT) , APPLICANT SI(ìNA TURE THIS APPLICATION BECOME A PERMIT WHEN APPROVED ~ . " I ",¡ t~ I PERMIT STATEMENT Bakersfield Fire Dept. 1715 Chester Ave. Bakersfield, CA 93301 RECEIVED FROM KW1Itri., ¿ eW ~ DATE 9 - 2 - 99. : ,':"r,., .. -',' '. ,\' - '~.,': ': \ ~ ~ . " :"{;?:i ! . ~ ; " ~ ~i.: .. Ì'!'! ~;; .\ ,. d,., ,,. " AMOUNT :.1 ~ ~ ~)! ~ r ~:. ~: ì '; AMOUNT . ./h.;~~!(!~~U ìi 1 '<3 ~ .; ',"~ :'~~y~ .:~~~;t~:~~~o: o' UST/AST PERMIT Re.HovAL 82 TENTS, LPG 84 I "'::-.......-...(.,~~;,1"'_~ ".·.::·,£..-41,1 ,....;.:.. STATE SURCHARGE .. FIRMoRi<s~PoWDER. ,if'" 86 ... OTHER PERMITS C' , " , TANK TESTING 83 .. , . ,.i. OTHER :. . i:'};': ,.. COPIES/REPORTS 89 '.. .- bY~ TOTAL DUE J' (3 ,\ FD1595 - \. ........- '(. 'W{C .Y ... ~_ "~. .. ,,'" " '~'~'P?;. ..-, 2010 S. ~nion Ave. Description of Adiacent Properties The property is boardered on the north and east by the Bakersfield Municipal Airport. The remainder of the surrounding area consists of privately owned parcels that are either vacant or occupied by light industrial type businesses. ~ ___._ ~-....if_ -..-' . _......,.;,~- - '- ,--.- ~- , ". ~~- -. '';::-.-II'IÀ.\$j"~'~:,: ,;":'">~.~~"'. 1<_ -..~<"':~~~ , ., . --~'~'¡'¡1~~if:~;~~' to. _ "f~":;' :,......:- -- . . 'I "Jii!:, . . . . --~---_._- - &, Sanwa Bank California K L A vialÎon 20 I 0 So. Union Ave Bakersfield, Ca 93307 August 26, 1999 Ref No: 019622 Dear Applicant: Thank you for giving Sanwa Bank California the opportunity to review your request for a Business loan. Our goal is to meet the needs of our customers, On the basis of the infonnation available to us, we are unable to approve your credit request. ._--- -- --" - . Y our credit application was processed by using a credit scoring system that assigns a numerical value to the various items of infonnation we consider in evaluating a credit application. These numerical values are based upon the results of analyses of repayment histories of large numbers of customers, The infonnation you provided in your credit application did not score a sufficient number of points for approval of your credit application on the terms you requested. The principal reasons you did not score well compared with other applicants were: · Serious delinquency, public records, collections in owner/guarantor's consumer credit report · serious delinquency, derogatory public record, or collection filed · number of accounts with delinquency · Derogatory information is shown on the business credit report In evaluating your credit application, the consumer credit reporting agency listed below provided us with information that, in whole or in part, influenced our decision, The consumer-reporting agency played no part in our decision other than providing us with credit information about you and is unable to supply specific reasons why we have denied credit to you, Under the Fair Credit Reporting Act, you have the right to know the information contained in your file at the consumer-reporting agency. It can be obtained by contacting: Experian Consumer Assistance p,O, Box 949 Allen, TX 75013 Toll Free 1-800-422-4879 You also have a right to a free copy of your report from the consumer-reporting agency, if you request it no later than 60 days after you receive this notice. In addition, if you find that any information contained in the report you receive is inaccurate or incomplete; you have the right to dispute the matter with the reporting agency, If you have any questions regarding this letter you should contact us at: Bakersfield Office 5201 California Avenue Bakersfield, CA 93304 Telephone No: (661) 327-5345 Please read the last paragraph of this letter for important information about your rights under the federal Equal Credit Opportunity Act. NOTICE: The federal Equal Credit Opportunity Act prohibits creditors from, discriminating against credit appìicants ofi the basis of race, color, religion, national origin, sex, marital status, age (provided that"the applicant has the capacity to enter, into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this bank is: The Federal Deposit Insurance Corporation, 25 Ecker Street, Suite 2300, San Francisco, California 94105. 'f ; e e LITIGATION GUARANTEE Guarantee Number: 496090 Liability: $10,000.00 Fee: $300.00 SUBJECT TO LIMITATIONS CONTAINED HEREIN, THE EXCLUSIONS FROM COVERAGE, THE LIMITS OF LIABILITY AND OTHER PROVISIONS OF THE CONDITIONS AND STIPULATIONS HERETO ANNEXED AND MADE A PART OF THIS GUARANTEE, COMMONWEALTH LAND TITLE INSURANCE COMPANY a corporation, herein called the Company, GU ARANTEES the assured named in Schedule A against loss not exceeding the liability amount stated in Schedule A which the Assured shall sustain by reason o~any incorrectness in the assurance which the Company hereby gives that, according to the public records, as of Date of Guarantee shown in Schedule A: 1. The title to the herein described estate or interest is vested in the vestee named in Schedule A. 2. Except for the matters shown in Schedule B, there are no defects, liens, encumbrances or other matters affecting title to the estate or interest in the land shown in Schedule A, which matters are not necessarily shown in the order of their priority. 3. a) The current interest holders claiming some right, title or interest by reason of the matters shown in Part II of Schedule B are as shown therein. The vestee named in Schedule A and parties claiming to have some right, title or interest by reason of the matters shown in Part II of Schedule B may be necessary to name defendant in action, the nature of which is referred to in Schedule A. b) The current interest holders claiming some right, title or interest by reason of the matters shown in Part I of Schedule B may also be necessary to name defendant in an action, the nature of which is referred to in Schedule A. However, no assurance is given hereby as to those current interest holders. 4. The return addresses for mailing after recording, if any, as shown on each and every document referred to in Part II of Schedule B by specific recording information, and as shown on the document(s) vesting title as shown in Schedule A are as shown in Schedule C. THIS LITIGATION GUARANTEE IS FURNISHED SOLELY FOR THE PURPOSE OF F ACILIT A TING THE FILING OF THE ACTION REFERRED TO IN SCHEDULE A. IT SHALL NOT BE USED OR RELIED UPON FOR ANY OTHER PURPOSE. Commonwealth Land Title Insurance Company By: ·é%>~ CLTA Guarantee FOnTI No.1 Litigation Guarantee (Rev, 12-16-93) e e 496090 Page 2 SCHEDULE A 1. Name of Assured: City of Bakersfield 2. Date of Guarantee: February 22, 1999, at 7:30 a.m. 3. This Litigation Guarantee is furnished solely for the purpose of facilitating the filing of an action to: condemn 4. The estate or interest in the Land which is covered by this Guarantee is: A FEE 5. Title to the estate or interest in the Land is vested in: Kenneth William Lewis, by Grant Deed recorded October 30, 1998, as Instrument No. 0198150291, Official Records 6. The Land referred to in this Guarantee is described as follows: Parcell of Parcel Map 4511, in the City of Bakersfield, County of Kern, State of California, as per map recorded January 17, 1978 in Book 20, Page 22 of Parcel Maps, in the Office of the County Recorder of said County. EXCEPT all oil, gas, minerals and other hydrocarbon substances within or underlying said land, as reserved of record. CLTA Guarantee Fonn No, 1 Litigation Guarantee (Rev, 12-16-93) e e 496090 Page 3 SCHEDULE B PART I A. General and special taxes, including any assessments collected with taxes, to be levied for the fiscal year 1999-2000, which are a lien not yet payable. B. General and special taxes, including any personal property taxes, and assessments collected with taxes for the fiscal year 1998-1999. Total: First Installment: Delinquent Amount: Second Installment: $385.06 192.53 Delinquent 19.25 192.53 Unpaid Homeowners' Exemption: None Code: Parcel: 001-003 170-030-36-00-4 C. Said property has been declared tax defaulted for non-payment of delinquent taxes for the fiscal year 1987 to 1988 (and subsequent years, if any). Amount to redeem: Prior to: $17,190.09 March 31, 1999 Amount to redeem: Prior to: $17,303.64 April 30, 1999 Amount to redeem: Prior to: $17,417.19 May 31, 1999 D. The lien of supplemental taxes, if any, assessed pursuant to the provisions of Section 75, et seq. of the Revenue and Taxation Code of the State of California. 1. An easement for the purpose shown below and rights incidental thereto as set forth in document Granted to: Purpose: Recorded: Kern Island Canal Company for main and lateral canals January 25, 1928 in Book 128, Page 254, Official Records CL T A Guarantee Fonn No. 1 Litigation Guarantee (Rev. 12-16-93) e e 496090 Page 4 Affects: The exact location and extent of said easement is not disclosed of record. 2. An easement for the purpose shown below and rights incidental thereto as set forth in document Granted to: Purpose: Recorded: the present or future property owners for ingress and egress January 17, 1978 in Book 5083, Page 333, as Instrument No. 005061, Official Records Affects: the Northerly 15 feet of said land 3. An easement for the purposes shown below and rights incidental thereto as shown or as offered for dedication on the recorded map shown below Map of: Recorded: Parcel Map 4511 January 17, 1978 in Book 20, Page(s) 22, of Parcel Maps Purpose: Affects: for drainage purposes the North side of said land as shown on said Parcel Map 4. Any interest of the spouse of Bonita J. Lewis. 5. The requirement that the spouse of the vestee join in the execution of the deed andlor deed of trust. CLTA Guarantee FOnTI No, 1 Litigation Guarantee (Rev, 12-16-93) 496090 Page 5 e e P ART II 6. A lien for unsecured property taxes fIled by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1990 Kenneth W. Lewis, dba K L Aviation 14627-00-9 $576.08 December 12, 1990 in Book 6464, Page 1178, as Instrument No. 079919, Official Records 7. A lien for unsecured property taxes fIled by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1990 Kenneth W. Lewis, dba K L Aviation 50276-00-7 $647.78 December 18, 1990 in Book 6467, Page 337, as Instrument No. 084201, Official Records 8. A lien for unsecured property taxes fIled by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1990 Kenneth W. Lewis, dba K L Aviation 50277-00-0 $633.10 December 18, 1990 in Book 6467, Page 338, as Instrument No. 084202, Official Records 9. A lien for unsecured property taxes fIled by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1990 Kenneth W. Lewis, dba K L Aviation 50278-00-3 ' $578.31 December 18, 1990 in Book 6467, Page 339, as Instrument No. CL T A Guarantee Ponn No, 1 Litigation Guarantee (Rev. 12-16-93) 496090 Page 6 e e 084203, Official Records 10. A lien for unsecured property taxes fIled by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1981 Kenneth William Lewis, dba Pee Wee Golf 03130 $128.01 July 18, 1991 in Book 6546, Page 630, as Instrument No. 089520 Official Records 11. A lien for the amount shown and any other amounts due, in favor of the State of California. Amount: Filed by: Taxpayer: Cert. No: Recorded: $1,277.22 State of California, Board of Equalization Kenneth William Lewis doing business as K. L. Aviation BE-381247 February 16, 1993 in Book 6804, Page 705, as Instrument No. 023411, Official Records 12. A lien for the amount shown and any other amounts due, in favor of the State of California. Amount: Filed by: Taxpayer: Cert. No: Recorded: $2,457.69 State of California, Board of Equalization Kenneth William Lewis doing business as K. L. Aviation BE-421981 January 31, 1995, as Instrument No. 0195011726, Official Records 13. A lien for unsecured property taxes fIled by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1994 Kenneth W. Lewis, dba K L Aviation 03349-00-0 $55.49 February 16, 1995, as Instrument No. 0195020313, Official Records 14. A lien for the amount shown and any other amounts due, in favor of the State of California. CL T A Guarantee Fonn No, 1 Litigation Guarantee (Rev, 12-16-93) e e 496090 Page 7 Amount: Filed by: Taxpayer: Cert. No: Recorded: $1,378.78 State of California, Board of Equalization Kenneth William Lewis doing business as K. L. Aviation BE-428688 May 10, 1995, as Instrument No. 0195056759, Official Records 15. A lien for the amount shown and any other amounts due, in favor of the State of California. Amount: Filed by: Taxpayer: Cert. No: Recorded: $1,694.17 State of California, Board of Equalization Kenneth William Lewis doing business as K. L. Aviation BE-444725 February 27, 1996, as Instrument No. 0196024699, Official Records 16. A lien for the amount shown and any other amounts due, in favor of the State of California. Amount: Filed by: Taxpayer: Cert. No: Recorded: $566.41 State of California, Board of Equalization Kenneth William Lewis doing business as K. L. Aviation BE-450058 May 13, 1996, as Instrument No. 0196061585, Official Records 17. A lien for unsecured property taxes fIled by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1997 Kenneth W. Lewis 7007736-00-2 $216.68 December 5, 1997, as Instrument No. 0197161223, Official Records 18. A lien for the amount shown and any other amounts due, in favor of the State of California. Amount: Filed by: Taxpayer: Cert. No: Recorded: $2,102.16 State of California, Board of Equalization Kenneth W. Lewis, doing business as K. L. Aviation BE-1142444 February 23, 1998, as Instrument No. 0198021832, Official Records 19. A lien for unsecured property taxes fIled by the tax collector of the county shown, for the amount set forth, and any other amounts due. CLTA Guarantee POnTI No, 1 Litigation Guarantee (Rev, 12-16-93) 496090 Page 8 County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: e e Kern County 1998 Kenneth W. Lewis 7006956-00-0 $219.64 December 7, 1998, as Instrument No. 0198170505, Official Records CLTA Guarantee Ponn No.1 Litigation Guarantee (Rev. 12-16-93) e e 496090 Page 9 SCHEDULE C ADDRESSES 1. William Lewis 2010 South Union Avenue Bakersfield, CA 93307 -- As Owner 2. Bonita J. Lewis clo Bill Lewis 2000 South Union Avenue Bakersfield, CA 93307 -- Prior Owner 3. Kern County Treasurer / Tax Collector 1115 Truxtun Avenue Bakersfield, CA 93301 -- Lien Holder 4. State Board of Equalization P.O. Box 942879 Sacramento, CA 94279-0001 CLTA Guarantee POnTI No, 1 Litigation Guarantee (Rev. 12-16-93) IHle PLAT 18 PROVIDED FOR INFORMATION ONLY. ALTHOl.TGT'" me INfORMA110N ON THIS PLAT IS PART OF THE OFFICIAl iRECOFlP$. ,THt: ACCURACY OF THAT fNFORM/\rON IS NOT GUARANTEEI " BY :rn'iS, co'MPM1V. THIS PLAT IS NOT TO BE CON$IDERED M es:~~. .PARr_~ øP,'._1HE POUCY. REPORT, BINDER, 'GUARANTEr M:·4,:ORI!R .~ IIIIEO fJtI mls COMPANY, 1'0 WHICH r ---~;..; ~:~/: = -T;~"~'~-'-T'~-:;l'-;;~~~~;¡;¡;~~~r""~¡:;;J-~--f~80Ô:-ã¡5;j3~¡'¡D"I' ,. ,~.-- ..:...------. '--- ...... ,.,.. --..."'" ""_',"_U''''L.' ,-"...'..,,'"-,.,.,~.. "'-~', ........",- .".' \ "~'" .......... ,"- .. ~\". ,~ L" ,~, h1·, "~ '''7">'-~;....,'!'....~.~......¡I..,.......-..~;~C'''I:'... ~. , ,~. ,-.!,",.!>;'~!r.?,\~:;j:~...~:ü.'J·.-r·.;~~.~,~~~l.~~:~k~'~:"":',' .;.,:.... '. :";;.:.~.....'::.'.; .' . ::::.~; I I I ~ ~ I I I I 4- I I I ~ \ ì \1 t\ VAC, PER, 6358-937 \ 3116/.90 Q,R',.., .L- ~4L...t -+' 0-< 170-03 SW 1/4 OF SEC 8 -r. 30 s. R28 E. SCHOOL DIST. e ~79,JI ' , W6S4'6 a,; <> 23 ~ 1'..... 32\ \:./ 8 , El. 8.57 AC @WR e ".... 104\ '-/ 26 I/~,:,:, 1251,/7 , PL-.4N-Z ï ' ~ ::45 8 56-39 /-3 @ 2/ 6if. 07 27 170-03 L 654.68 @MR e 20 ~5.07 _ æ @ r Nott: This mop Is for asalMmlnl purpose. on~. It Is not to.bl conttrued a.s pot't'oyrn~ 'egol ownlrlhip or dlvi.ton. III tand for PWPO"I at lomng or aubd1v1l1on tow. ASSESSORS MAP NO..Fº..:-;º~.... COUNTY OF KERN ·.·.'..4...·.'.. ., .;..; c: () E " E o o 1# .4001 .,.. .... o .,.. () 01 æ C") c:i '" .,.. t:: o '- Ã 5 II) () a o '" Q) (0 .,.. o '0 ,0 '~ J:: '~ Uj i...: :~ ',0.;;. .....":,,,0. -~2985 - ..: ~-.~ ------ ~ ----..... --- - -- - -- - -.- - --_.- SCHEDULE OF EXCLUSION~ ~OM COVERA.OF TIllS GUARANTEE 1. Except to the extent that specific assurances are provided in Schedule A of this Guarantee, the Company assumes no liability for loss or damage by reason of the following: (a) Defects, liens, encumbrances, adverse claims or other matters against the title, whether or not shown by the public records, (b) (I) Taxes or assessments of any taxing authority that levies taxes or assessments on real property; or, (2) Proceedings by a public agency which may result in taxes or assessments, or notices of such proceedings, whether or not the matters excluded under (I) or (2) are shown by the records of the taxing authority or by the public records, (c) (I) Unpatented mining claims; (2) reservations or exceptions in latents or in Acts authorizing the issuance thereof; (3) water rights, claims or title to water, whether or not the matters excluded under (I), (2) or (3) are shown by the public records, 2. Notwithstanding any specific assurances which are provided in Schedule A of this Guarantee, the Company assumes no liability for loss or damage by reason of the following: (a) Defects, liens, encumbrances, adverse claims or other matters affecting the title to any property beyond the lines of the land expressly described in the description set forth in Schedule (A), (C) or in Part 2 of this Guarantee, or title to streets, roads, avenues, lanes, ways or waterways to which such land abuts, or the right to maintain therein vaults, tunnels, ramps or any structure or improvements; or any rights or easements therein, unless such property, rights or easements are expressly and specifically set forth in said description, (b) Defects, liens, encumbrances, adverse claims or other matters, whether or not shown by the public records; (I) which are created, suffered, assumed or agreed to by one or more of the Assureds; (2) which result in no loss to the Assured; or (3) which do not result in the invalidity or potential invalidity of any judicial or non-judicial proceeding which is within the scope and purpose of the assurances provided, (c) The identity of any party shown or referred to in Schedule A. (d) The validity, legal effect or priority of any matter shown or referred to in this Guarantee, GUARANTEE CONDITIONS AND STIPULATIONS 1. Definition of Terms. The following terms when used in the Guarantee mean: (a) the "Assured": the party or parties named as the Assured in this Guarantee, or on a supp]emental writing executed by the Company, (b) "land": the land described or referred to in Schedule (A)(C) or in Part 2, and improvements affixed thereto which by law constitute real property, The tenn "land" does not include any property beyond the lines of the area described or referred to in Schedule (A)(C) or in Part 2, nor any right, title, interest, estate or easement in abutting streets, roads, avenues, alleys, lanes, ways or waterways, (c) "mortgage": mortgage, deed of trust, trust deed, or other security instrument, (d) "public records": records established under state statutes at Date of Guarantee for the purpose of imparting constructive notice of matters relating to real property to purchasers for value and without knowledge, (e) "date": the effective date, 2, Notice of Claim to be Given by Assured Claimant. An Assured shall notify the Company promptly in writing in case knowledge shall come to an Assured hereunder of any claim of title or interest which is adverse to the title to the estate or interest, as stated herein, and which might cause loss or damage for which the Company may be liable by virtue of this Guarantee, If prompt notice shall not be given to the Company, then all liability of the Company shall tenninate with regard to the matter or matters for which prompt notice is required; provided, however, that failure to notify the Company shall in no case prejudice the rights of any Assured under this Guarantee unless the Company shall be prejudiced by the failure and then only to the extent of the prejudice, 3. No Duty to Defend or Prosecute, The Company shall have no duty to defend or prosecute any action or proceeding to which the Assured is a party, notwithstanding the nature of any allegation in such action or proceeding, 4. Company's Option to ~fend or Prosecute Actions; Duty of Assured Claimant to Cooperate. Even though the Company has no duty to defend or prosecute as set forth in Paragraph 3 above: (a) The Company shall have the right, at its sole option and cost, to institute and prosecute any action or proceeding, interpose a defense, as limited in (b), or to do any other act which in its opinion may be necessary or desirable to establish the title to the estate or interest as stated herein, or to establish the lien rights of the Assured, or to prevent or reduce loss or damage to the Assured, The Company may take any appropriate action under the tenns of this Guarantee, whether or not it shall be liable hereunder, and shall not thereby concede liability or waive any provision of this Guarantee, If the Company shall exercise its rights under this paragraph, it shall do so diligently, (b) If the Company elects to exercise its options as stated in Paragraph 4(a) the Company shall have the right to select counsel of its choice (subject to the right of such Assured to object for reasonable cause) to represent the Assured and shall not be liable for and will not pay the fees of any other counsel, nor will the Company pay any fees, costs or expenses incurred by an Assured in the defense of those causes of action which allege matters not covered by this Guarantee, (c) Whenever the Company shall have brought an action or interposed a defense as permitted by the provisions of this Guarantee, the Company may pursue any litigation to final detennination by a court of competent jurisdiction and expressly reserves the right, in its sole discretion. to appeal from an adverse judgment or order, (d) In all cases where this Guarantee pennits the Company to prosecute or provide for the defense of any action or proceeding, an Assured shall secure to the Company the right to so prosecute or provide for the defense of any action or proceeding, and,all appeals therein, and pennit the Company to use, at its option. the name of such Assured for this purpose, Whenever requested by the Company, an Assured, at the Company's expense, shall give the Company all reasonable aid in any action or proceeding. securing evidence, CLTA Guarantee Conditions and Stipulations Form 2015-1 (Rev, 12-15-95) ()RIr::IN41 . obtaining witnesses, pre_ng or defending the action or ]awful act which in the opinion of the Company may be necessary or desirable to establish the title to the estate or interest as stated herein, or to establish the lien rights of the Assured, If the Company is prejudiced by the failure of the Assured to furnish the required cooperation, the Company's obligations to the Assured under the Guarantee shall tenninate, ' S. Proof of Loss or Damage. In addition to and after the notices required under Section 2 of these Conditions and Stipulations have been provided to the Company, a proof of loss or damage signed and sworn to by the Assured shall be furnished to the Company within ninety (90) days after the Assured shall ascertain the facts giving rise to the loss or damage, The proof of loss or damage shall describe the matters covered by this Guarantee which constitute1be basis of loss or damage and shall state, to the extent possible, the basis of calculating the amount of the loss or damage, If the Company is prejudiced by the failure of the Assured to provide the required proof of loss or damage, the Company's obligation to such assured under the Guarantee shall tenninate, In addition, the Assured may reasonably be required to submit to examination under oath by any authorized representative of the Company and shall produce for examination, inspection and copying, at such reasonable times and places as may be designated by any authorized representative of the Company, all records, books, ledgers, checks, correspondence and,memoranda, whether bearing a date before or after Date of Guarantee, which reasonably pertain to the loss or damage, Further, if requested by any authorized representative of the Company, the Assured shall grant its pennission, in writing, for any authorized representative of the Company to examine. inspect and copy all records, books, ledgers, checks, correspondence and memoranda in the custody or control of a third party, which reasonably pertain to the loss or damage. All infonnation designated as confidential by the Assured provided to the Company pursuant to this Section shall not be disclosed to others unless, in the reasonable judgment of the Company, it is necessary in the administration of the claim, Failure of the Assured to submit for examination under oath, produce other reasonably requested infonnation or grant pennission to secure reasonably necessary information from third parties as required in the above paragraph, unless prohibited by law or governmental regulation, shall tenninate any liability of the Company under this Guarantee to the Assured for that claim, 6. Options to Payor Otherwise Settle Claims: Termination of Liability. In case of a claim under this Guarantee, the Company shall have the following additional options: (a) To Payor Tender Payment of the Amount of liability or to Purchase the Indebtedness, The Company shall have the option to payor settle or compromise for or in the name of the Assured any claim which could result in loss to the Assured within the coverage of this Guarantee, or to pay the full amount of this Guarantee or, if this Guarantee is issued for the benefit of a holder of a mortgage or a lienholder, the Company shall have the option to purchase the indebtedness secured by said mortgage or said lien for the amount owing thereon, together with any costs, reasonable attorneys' fees and expenses incurred by the Assured claimant which were authorized by the Company up to the time of purchase, Such purchase, payment or tender of payment of the full amount of the Guarantee shall tenninate all liability of the Company hereunder, In the event after notice of claim has been given to the Company by the Assured the Company offers to purchase said indebtedness, the owner of such indebtedness shall transfer and assign said indebtedness, together with any collateral security, to the Company upon payment of the purchase price, Upon the exercise by the Company of the option provided for in Paragraph (a) the Company's obligation to the Assured under this Guarantee for the claimed loss or damage, other than to make the payment required in that paragraph, shall tenninate, including any obligation to continue the defense or prosecution of any litigation for which the Company has exercised its options under Paragraph 4, and the Guarantee shall be surrendered to the Company for cancellation, (b) To Payor Otherwise Settle With Parties Other Than the Assured or With the Assured Claimant. To payor otherwise settle with other parties for or in the name of an Assured claimant any claim assured against under this Guarantee, together with any costs, attorneys' fees and expenses incurred by the Assured claimant which were authorized by the Company up to the time of payment and which the Company is obligated to pay, Upon the exercise by the Company of the option provided for in Paragraph (b) the Company's obligation to the Assured under this Guarantee for the claimed loss or damage, other than to make the payment required in that paragraph, shall terminate, including any obligation to continue the defense or prosecution of any litigation for which the Company has exercised its options under Paragraph 4, 7. Determination and Extent of Liability, This Guarantee is a contract of Indemnity against actual monetary loss or damage sustained or incurred by the Assured claimant who has suffered loss or damage by reason of reliance upon the assurances set forth in this Guarantee and only to the extent herein described, and subject to the Exclusions From Coverage of This Guarantee, The liability of the Company under this Guarantee to the Assured shall not exceed the least of: (a) the amount of liability stated in Schedule A or in Part 2; (b) the amount of the unpaid principal indebtedness secured by the mortgage of an Assured mortgagee, as limited or provided under Section 6 of these Conditions and Stipulations or as reduced under Section 9 of these Conditions and Stipulations, at the time the loss or damage assured against by this Guarantee occurs, together with interest thereon; or' (c) the difference between the value of the estate or interest covered hereby as stated herein and the value of the estate or interest subject to any defect, lien <>r encumbrance assured against by this Guarantee, 8. Limitation of Liability. (a) If the Company establishes the title, or removes the alleged defect, lien or encumbrance, or cures any other matter assured against by this Guarantee in a reasonably diligent manner by any method, including litigation and the completion of any appeals therefrom, it shall have fully perfonned its obligations with respect to that matter and shall not be liab]e for any loss or damage caused thereby, CONDITIONS AND STIPULATIONS CONTINUED ON BACK COVER ~- - -fo' ----------"-.-'"--.-,- ....- '1" ~. , e CONDITIONSANDSTWULATIONSCONTThmED (b) In the event of any litigation by the Company or with the Company's consent, the Company shall have no liability for loss or damage until there has been a final determination by a court of competent jurisdiction, and disposition of all appeals therefrom. adverse to the title. as stated herein, (c) The Company shall not be liable for loss or damage to any Assured for liability voluntarily assumed by the Assured in settling any claim or suit without the prior written consent of the Company. 9. Reduction of Liability or Termination of Liability. All payments under this Guarantee, except payments made for costs, attorneys' fees and expenses pursuant to Paragraph 4 shall reduce the amount of liability pro tanto, 10. Payment of Loss. (a) No payment shall be made without producing this Guarantee for endorsement of the payment unless the Guarantee has been lost or destroyed, in which case proof of loss or destruction shall be furnished to the satisfaction of the Company, (b) When liability and the extent of loss or damage has been definitely fixed in accordance with these Conditions and Stipulations, the loss or damage shall be payable within thirty (30) days thereafter, 11. Subrogation Upon Payment or Settlement. Whenever the Company shall have settled and paid a claim under this Guarantee, all right of subrogation shall vest in the Company unaffected by any act of the Assured claimant. The Company shall be subrogated to and be entitled to all rights and remedies which the Assured would have had against any person or property in respect to the claim had this Guarantee not been issued, If requested by the Company, the Assured shall transfer to the Company all rights and remedies against any person or property necessary in order to perfect this right of subrogation, The Assured shall pennit the Company to sue, compromise or settle in the name of the Assured and to use the name of the Assured in any transaction or litigation involving these rights or remedies, ' ' If a payment on account of a claim does not fully cover the loss of the Assured the Company shall be subrogated to all rights and remedies of the Assured after the Assured shall have recovered its principal, interest, and costs-of collection, 12. Arbitration. __~ .-~___n ,¡ -- -, '- ----- _ --";'_-=..õ._-=:'" ~ ~_-::~ . .~ -.. -- ¡;. Unless prohibited by applicable law, either the Company or the Assured may demand arbitration pursuant to the Title Insurance Arbitration Rules of the American Arbitration Association, Arbitrable matters may include, but are not limited to. any controversy or claim between the Company and the Assured arising out of or relating to this Guarantee, any service of the Company in connection with its issuance or the breach of a Guarantee provision or other obligation, All arbitrable matters when the Amount of Liability is $1.000,000 or less shall be arbitrated at the option of either the Company or the Assured, All arbitrable matters when the amount of liability is in excess of $1,000,000 shall be arbitrated only when agreed to by both the Company and the Assured, The Rules in effect at Date of Guarantee shall be , binding upon the parties, The award may include attorneys' fees only if the laws of the state in which the land is located permits a court to award attorneys' fees to a prevailing party. Judgment upon the award rendered by the Arbitrator(s) may be entered in any court having jurisdiction thereof. The law of the situs of the land shall apply to an arbitration under the Title Insurance Arbitration Rules. A copy of the Rules may be obtained from the Company upon request. 13. Liability Limited to This Guarantee; Guarantee Entire Contract. (a) This Guarantee together with all endorsements, if any, attached hereto by the Company is the entire Guarantee and contract between the Assured and the Company, In interpreting any provision of this Guarantee, this Guarantee shall be construed as a whole, (b) Any claim of loss or damage, whether or not based on negligence, or any action asserting such claim, shall be restricted to this Guarantee. ' (c) No amendment of or endorsement to this Guarantee can be made except by a writing endorsed hereon or attached hereto signed by either the President, a Vice President, the Secretary. an Assistant Secretary, or validating officer or authorized signatory of the Company, 14. Notices, Where Sent. All notices required to be given the Company and any statement in writing required to be furnished the Company shall include the number of this Guarantee and shall be addressed to COMMONWEALTH LAND TITLE INSURANCE COMPANY, 1700 Market Street. Philadelphia. PA 19103-3990. t:D ....::c ~ <I ~t;;' ~ ~ I\) ~o 0 '" ~ QIt ¡¡¡ ~ c I ~'" ~ ~ '" 0 ~ ;::. 0 0 0 ¡f~ ;: I o:J ~ n 0< C'-I .. '" ;:: d "," ~ C ~ '" a '"0 ~ ~. ~ = ~ a ~ t'rj .... 0 0 ~ 00 Cj ~ = ~ ~ p 0 ~ '" 0 ~ ž z z ~. I» ¡:;: '" en 0 ~ c =" ~ a .... z ::¡ (") 0 æ '" ~ z ~ 0 I,Q ~ en I,Q ~ Q ,;;' - ---- - To:' , (Lender) . . \ ~ ., ¡ 'it l'(.a 1\'1 e: Add.ress t. Kenneth W Lewis 1516 Ivan ave'Bakersfield CA. Date of Birth 1 1 /27 / 6 0 Zip Code 93304 CHECK AS APPLICABLE Applicant Is applying for this loan: 89 Individually, without a co-signer or guaranty of a relative or ~ther person(s} or entity. o Jointly, with the co-signature or guaranty of one or more persons or entities (including any existing guarantors), NAMES OF OTHER PERSON(S} AND ENTITY(IES} ". PLEASE INDrCA TE OR PROVtDE EXPLA.NA TION RELA. TING TO ANY ASSETS OWNED JOINTLY OR t.:IAB[UTIES OWED WITH OTHERS. fAIT ACH ADDITIONAL SCHEDULES AND EXPLANATORY NOTES IF NECESSARY.) STATEMENT OF FINANCIAL CONDITION OF Kenneth W Lewis AS OF 9/14 19-22- ASSETS AMOUNT LIABILITIES AMOUNT SCHEDULE A I Notes SCHEDULE G I - & Loans N/A Cash In this Institution Payable I'jotes Payable to Banks [Other Than J Notes & Loans Payable (Othe~} a/her Banks or Savings & Loans $2,000.00 Real Estate N/A SCHEDULE B I SCHEDULE C I -- Stocks ~ Insurance & Bonds Marketable Securities Loans ' .- Others N/A N/A Tax Tax Refund Due N/A Taxes Owed SCHEDULE C I SCHEDULEH I Insurance Cash Value g;1 000 00 Accounts Bankcharge C.uds <I: 700 or Accounts SCHEDULE D I & Bl11s $ 1,300.0C & Payable Open & Revolving Accounts Notes $6,000.00 N/A Receivable Other SCHEDULE E I SCHEDULEE I Residence(sl 1>75,000.00 Real Residencelsl $56,919.0C Real N/A Estate N/A Unimproved Land Notes & Unimproved Land Esta te N/A Contracts N/A Income Property(iesl Payable Income Property(ies Olher Business Prop. ~50,000.00 Other N/A SCHEDULE F I SCHEDULE I I Other ~46,200.00 Other Assets Other Assets & LIabilities N/A Personal Property TOTAL ASSETS $180 200 10 TOTALLlABIUTIES . $SA q1q O( HE·CAP OF INCOME AND EXPENSES I NET (DIFFERENCE BETWEEN TOTAL ' WORTH ASSETS Be TOTALLIABILmES) 5121 ?A1 . See notice below before complellng Other Income. ANNUAL INCOME FOR YEAR 19 ...9.ß...... ANNUAL EXPENSES FOR YEAR 199..8- CONTINGENT UABtLmES Salary or Wagn 25,00<100 Property Tax & Assessmenls 570.00 As Endorser on Notes/Contracts N/A DlllidendJ or Interest /. N/A Fed. & Slale Income Tax 3 500.00 As Guarantor on Notes/Contracts N/A Rentals (Grau Incomel N/A Real Estate Loan Payments 9,600.00 For Taxes 5,000.OC Business (Net Incomel 22,000.00 Paymenls on Contracts/NOles N/A Olher (Describel N/A Other Income (DesCrtbel· Esllmated Wiling Expenses 2U,OUU.UC Olher. TOTAL INCOME Sil,UUU.UU TOTAL EXPENSES ~,j,b/U.Uu TOTAL s:>,uuu.Ul ,II 1911 CFI flunk.... s.n.,;.,. Gm..ø. /"", AI.s'--- 1t..uJI.OOIOlallUV . Alimony, child support or maintenance payment income need not be revealed if you do nOllllish to have il considered as a basis lor repaying Ihis obligalion. ~ -' SCHEDULE A CASH LOCATION AND STATUS OF BANK ACCOUNTS ¿1<Nþ CD"S SVNG B.n..nd Br.nch Wh~r. C.m~d 8..I.I"CII Inc.rne R.ce o...c.o" I. This Accounl Bal..ncc /Oh""1Iy P.ld 10 Youl M.",rn PI.dg.d for. L....nl ofLo.n Dal.ollo.en X Sanw~ R;:m Ii- (/l5 0 3 ) 500 00 0 0 0 0 0 .x~ West AmericÇl. Bank 1,500.00 0 0 0 0 0 (" TOTAL 1:/000 00 TOTAL 1 n SCHEDULE B STOCKS AND BONDS' (Include Interests In Any Closely Held Business) Oncr1pnon No. Sh.r.. Reglsl.rod In 1'4..... of Source a/Valu.nan Oal. I Pr1.. P., Share Total Value ' Pu,ch...d on Margin or Ptodgod I I I I I , - I I I - TOTAL 1 SCHEDULE C LIFE INSURANCE TOTAL ,25,000. 11000.00 1 o SCHEDULE D ACCOUNTS AND NOTES RECEIVABLE Own.I1.1 Du. From Add.... CoU.,.ral M."'111y 0... I H_ Plyabw aalanc.Ou. Ted Kerzie 1/99 City N/A N/A 1 400. P., moun th 4 000.00 Tim Carey 6/99 City N/A N/A 1 :/00 Pft'mnl1nt-h I? oon nn 1 P., I, Per I 1 Pft' s Pft' II Per II Pit' 1 Pft' 1 P., TOTALS 1 600.00 mounth 16,000.0 SCHEDULE E REAL ESTATE P.re.1 No. D_pdon Addr..../L.oc.llon 0_";.1 I 0.,. ACQUU> 1 Residence 1516 Tv~n ~vp R;::¡kpr!':fipl" J( pn fl.. J( ø 1 1 'T' r.øúd... 1n/Q"'on z Business 2010 S TJninn ;::¡vp u .t-h r.ø,.,-; '" 1"1'2,,1,,, 3 4 S , 7 . I , 10 I . '...... .. . SCHEDULE F -- >' , ~-.a;'- ,. OTHER ASSETS AND PERSONAL PROPERTY "..,o",obll.. v.au. R.c. V.hlel....nd Boa.. V..I... P~non.1 Property V.Iu. To...'. Y;.: 91'M..k., Chev 10.000 Yr.: 6BM..kof.;:¡r!';er 4 000 F urnl"',. 2 000 00 S..b'o...1 _ ""101 110,000 Yr.: M..k., Yr.: M..k., J_.1ry 200.00 S..b'o...1 _ R IVO. I 4, [JOU Yr.: M..k., Yr.: M..k.: F'. Eq..lp","" 30,000.0 PS..btolal - Pono",1 Prop.ny l';l,) ?()() . o .h.r. '. Oth.R 5..1110...1 ""'0. 11 0 , 0 0 0 'S..b'o"'l R/V'. I 4,000 $..blo...1 P...OII..I Prop.ny 3i2,200.0 0 T.....'-"U Other A...u IA h ')nn SCHEDULE G NOTES AND lOANS PAYABLE TO BANKS AND OTHERS P,y..bl. To Addr... Coli. tor.' P'Ro,,1s I LI.ob'. M'NtI.., D.... H_ P.y..bl. B.yne« Due . I Por , I Por I PII' I Por I Por I PII' I Por I Por I Por TOTALS I I N/A SCHEDULE H ACCOUNTS AND BILLS PAYABLE (Including Bank Cards) P.y..ble To Accounl Numb... P...on. Llab~ H_ P.y..bla B..lane. D... Sears Kenneth Lewis - I 50. PII' mounth 1,000.00 Texaco 512311321871001 " .. I 50. Por .. .. 300.00 Bank Flrst 4/11'2.1 U t! 1 1 5464 b;¿ Kenneth Lew 1 s. I1UU. Por mounth 700.00 I Por I Por I Por I Por I Por I Por TOTALS S LUU. mounth 1.2 , 000. 00 SCHEDULE I OTHER LIABIlmES P.yabla To P,nolU Uabl. Colla,,"1 H_ Paya..1e aaLonc.O... I PIf I Por I Por I Por I Por I Por I Por I Por I '11' TOTALS I S N/A 69,_ - -~,~ I Mon".o,," or Wen Holdll' A"nu.j T ..... .....o"lId., ".com. MOIl"'''' P.y"'..... ......... V...... aaLaMI' Du. Ol>P. Midland Mortqaqe Canœnv 1 165.00 .NjA 799.00 75,000.00 56,919.00 " _1- - J I 1 ,1 ¡:;¡; 00 I N/A I 7qq 00 r¡¡; ,000 ,00 sS6,Q1Q,OO -. ----.--- I ~n~~';~;965 v:;;;;~~;;~~46462 r~~~~ ) - , 554-35-1795 833-2570 Occup._ I N.m. 01 Employ", I N010; V..n Is.I.,., , I Bulin... PIvNt. A Aircraft Mechanic K L Aviation S 2, O0Ûpe. mo 832-2521 p P Amount o{ alimony, child support and maintenance payment Income. NOTE;' Alimony, child support or maintenance payment L ~come need not be revealed If you do not wish to have II considered as a basis {or repaying this obligallon. S N/A I Name and address o{ payor o{ any alimony, child support or mN~J\nance payment Income disclosed above as source of repayment. C A N Alimony, child support, separate maintenance received under o court order o written agreement o oral T I Income (salary, pension, sodal security, dividends, Interest, etc.) N Source: K L Aviation S 2. 000 00 per month /F Have you ever borrowed from any a N/A R other branch o{ thls Inslilullon? Name Locallon N/A Date N/A M A Number of dependents 1 Ages 2 years T I Have you made a will? yeS Name o{ personal representative 0 Have you guaranteed or endorsed the notes of any other person? No Do you have any a/her contingentliabilllles? No N Have any actions or suits been filed against you or are there any unsatisfied judgements or decrees yes entered against you, or have you been adjudged bankrupt or made any assign men Is for creditors? Names o{ Re{erences: Addresses: Omaha Airolanp SlJp.p 1 Y - ~,~l.?_~~ring st. Lonq Beach CA. 90806 CQ..Aøøi.ac.an,', Fu¡'¡ Name lAg. Add.... N/A 50a01 50cunlY Mo, I Dnv",', Licon.. Mo. VIUI or M."c.clurgc No. I Home Phon. C 0 Occup.I1On I N.m. 01 Employer I Mo, oj v.... I:'~'" I au"",,, Phone . A per p Amount of alimony, child support and maintenance payment income. NOTE: Alimony, child support or maintenance payment p Income need not be revealed il you do not wish to have it considered as a basis for repaying this obligation. ' $ L I Name and address 01 payor of any alimony, child support or maintenance payment income disclosed above as source 01 repayment. C A Alimony, child support. separate maintenance received under o court order o wrinen agreement o oral N T Income (salary, pension, social security, dividends, Interest, etc.) I Source: $ per month N F Have you ever borrowed Irom any 0 other branch 01 this Institution? Name Location Date R M Number of dependents (not listed by applicant' Ages A T Have you made a will? Name o{ personal representative I Have you guaranteed or endors~d the notes 01 any other person? Do you have any other conllngent lIabililles?, 0 N Have any act10ns or suits been med against you or are there any unsaUs{led Judgements or decrees entered against you, or have you been adjudged bankrupt or made any assignments fer creditors? Names of Re{erences: Addresses: I {we} hereby affirm that the foregoing information contained In this financial statement is presented for the purpose of obtaining credit as of the date Indicated and Is true, complete and correct. I understand Lender is relying on this statement of my financial condition In making loan{s) to me. Lender Is authorized to make any Investigation of my credit or employment status either directly or through any agency ~ employed by Lender for that purpose. Lender may dIsclose to any other interested parties Lender's experience with this account. I agree to I inform the Lender Immediately of any matter which will cause any significant change in my financial condition. I understand that Lender will ,j ",'ain t~ itn.ndal "'''ment wheth~;?,f""dit" ",.nted. ,; ". ,j '.£.;.>../VO~ff P ~ q/14/qq , i J Applicant's Signature v- Date Co-Applicant's Signature Dale " Consent (If you are relying on income from a person who is not an applicant above, please have that person complete this ~ section so that we may verify their credit.) I authonze Lender to make any investigation of my credit either directly or through any agency employed by Lender for that purpose in connection with this credit application. . Date Signature Social Security Number - SCHEDULE OF CURRENT DEBT ..I"~ As of 9/14/99 . ~m application for: ancial informatio for' R.U.S.T. Loan .' AL n ' W T ~wi !'; CREDITOR ORIGIf~AL ORlGIfJAL PRESEIH INTEREST MATURITY MOIHHl Y P&I AfmUAL COLLATERAL CURREtH Name and address DATE AMOUNT BALANCE RATE DATE PAYMENT DEBT SERVICE OR DElItlOUEHT Midland Mortgage Company 11/87 $62,850. 56,919.00 11.5% 2017 799.00 , I . R:!nk,Fir~t 3/99 REV. 700.00 100.00 Sears 1/80 REV. 1,000.00 50.00 Texaco REV. 300.00 -- - - -- - --- -- I -, . ' I - I , , , " " I , --- I I , - - J " , - I PRESENT BALANCE"'" i< Same as interim financial statement. -- - ..58&11'1.00 "'" Total must agree with balance shown on ilJterim balance sheet. --- f e) .-::ertify that the above i1)l0rmation is correct and complete to tile best of my (ollr) knowledge. I & ~ l'CUUJLD P1c:uc prov\dc tbc below Iisc:d ~ IS ¡ppüa.blc to your "'KÍ~: Submit copies, II ori¡iDa1a will be rea.D:d wùh tbc Iœn appUcaâca md amoc bG l'CCW1Xd. L ~ Awtiacior\ approved by tb: S~ a{û1ifonü&. /' EnwœlilõiD1 ~&..uL ~i~ fix' ead1 UST =. prcMdc: _ CUJ'r'13 tTn.;b&J ~ Stcnae Taak Pcrmia. _ M08t n:c:at three TanJc IDœ¡rity TCItI. A Currœe )Jr Quality Pc:mit. ,~ Currc:U Haz:ardous Mau:ria1s Ston¡c Pcnnit. blA.. MOISt rcc:m three lwbni~ fix ~ oCal] ba.'a.rdoua awcria1s (to.: wuLc oil, &DtÍfi"CC:J:. tnnsmissiœ fluid. où fi1ten, bn.k: t1uid. parts cleaner, batteries, used tires. ¡rc:a.sc, Boor clcaocr). vEaviromr-,>·t~ ~. c/ Public A¡cxy EnviroomcntaJ ~. .,,( ûxrective Actiœ R.epoIU. ~viroomcmaI Citatioas. =z Faality Map. ~Fina~J StatcmeaI Ccni&atiœ. J:!1L Ccpy ofLeasc. if property is Jcascd. / Cœsttuaiœ Cœraà and coaà'ador1 ~. / Persœa1 rncaM,J Statcmc:m p~ widUu lase 6 mcahs. ~Srbedulc of Debts, iDdudiD¡ øøt¡a¡cs, low md qxz1 acdit card ~1nf1. _ BusÌDc:sS Fedcn1 ~ Tu Rmuas, it' partDcnhip or c:crpcnciaa. ~ The appt.icaD1s PenoaaI Fcdcnl aød StIt.c: ~ Tax si¡Dcd n::tums fur the molt =em tbrcc years. IDdudioa aD ~IJcs aDd DCCs. .v~ny, if ~11e B 1im ~ oc s~poo.~ also provide !r ead1 ~~ 1hc most I'CICCa& thn:c)'Qa sipd FcdcnJ 1Dccmc Tax rdUlDS, ~]Lo! ]C.¡ 's aDd ~tc aCDebcI. .1l..J!.. F.aitièus Trade Name 1t1t~ (dba) it a:amc œ 3ppüc:a:m is dii1i:n:::at than owœrs aamc. & IlPanœnlüp, tbcD provide Panncsship A¡r~ aDd list of aD p;utD:r1. ,J IY' Jfr~ tbca rcMdc A.rtidcs oClDcot ~ Auf.. List of SbareboIdcrs _ ---.......-OG, p ,rpor w ¡..WI, with pcí(~ d~r 0WDCd, üst of Officers aDd tb:ir tides. 1!.! Appraisal aDd 50 year chain-of-tidc report if n:a1 cstIœ Þ.k= as colbtcr.ù. , SUPPORTING DATA led and'dated nnanclal slalements not ,older thon ninety (90) do)'s _ wBusiness (Applicanl, affiliates, and subsidiaries) , flersonal (All owners, cosigners, and guarnntors) led,Jlld 'camplde cop let of the three (J) most recent federal tux returns .YB)sincss (Applicant, affiliates, and subsidinries) ~ersonal (All owners, cosigners, and guarantors) t schedules corresponding to the nnanelal statements .!Business (Appiicanl, ~ffi1iotcs, and subsidiarics)" " I ~ersonol (All O,\\11c,rs, cosigncrs, 8J!d guarontors).. :, " ~. . , . . , of Proceeds _ D9cription of how lJle proceeds from lJlis lonn will be used. Include lJle expected uscfullife of any equipment or fixtures. _v'éopics of supporting invoices nnd contracts. _ For construction loons, include copies of pions, specifications, ond a cost brcnkdown. 01 _ _ Copy of the legal description with the property owner's nome for: The real estate occupied by the business. All real estate offered as collateral. r...· ., r.· se . A copy of lJu: most current signed lease for the real estate occupied by the business. ironmental vSigncd and dated Envirorunental Assessment QuestiolU1aire with supporting docwnenlntion. GENERAL INFORMATION CONCERNING APPLICANT, OWNERS, COSIGNERS, AND GUARANTORS anv assets held in Trust? Yes No \/""" nny asselS pledged or debts secured except as shown? Yes~ No ~ .: you ever had a repossession? Ycs_, No : yoù ever had a bankruptcy or had a judgment against you? Yes? No.' , : you ever been a principal orgWlrnntor of a linn lJlot declared bankruptcy? Yc:s~ N02 yuü party to any claim or lawsuits? Yes"-z' No---,- been audited by the fiS in the past lJuee (3) years? Ycs_ No_ yes~ is the audit settled? ' Yes V' No_ -.€ ¡ndude an expllUtation on a separate page for each ·yes· answer. ¡Jü are married, complete all infonnntion for yourself and your spouse. You do not hove to list your spouse's sepnratc property unless your spouse is , .'!\;¡ or guarlUttor. You do nol have to list income from alimony, child support, or separate maintenance: unless you \\1Ulltlte Agency to consider it fOI :¡£.~3 of this application for credit. Your spouse is not required 10 be a borrower, cosigner, or gWlnUltor unless hc/she is all owner of the busincss. California RU,S.T loan application Date: 9/13/99 1, Chapter 13 Bankrupcy, filed January 8,1988, 100% Repayment of Creditors. ( case number 188-80068 ) 2, Pending Lawsuits I Judgments, City of Bakersfield vs Kenneth W Lewis, concerning Failure to remove Underground Storage Tanks, RUST I / The C4Hfornla Trade and Commerce Agency Office of Small Business Direct Loan Application * Plensc check C.¡} lhc loan progrnm for which you arc applying. CI.EAN I ENERGY I FISI'ill'la FLEET I BUSINESS DATA LON! Auou« S $13,406.00 ...css NN.MI TAX Lo. tü.IU" K L Aviation 77022470 . STIIUT AOOAUS TELUt<INI! No. (INC. MEA CODI) 2010 S. Union ave. 661) 832-2521 C(UaT STArr Bakersfield Kern California lJIt ~I 93307 00 20799 '"""" ~ E/oIPI.OYEU 0# SUsMs.s ~lI! Aircraft Maintenance Kenneth W Lewis ru.L·nw ' 1 CaßN:T ?f"~" OÐtt:II ~ CMooEII N¡A P""f·nw ;tQ~A '!~h addicionaJ p¡¡gcs /òr affiliatcs r.mJ subsidiaries.) PERSONAL DATA FOR All. OWNER(S), COSIGNERS, ¡nd GUARANTORS (Owner is defined as a solc-oranrielar. !Zcneml nartncr(s), ar any shnrcholdcr(s) wilh 10% ar more ofthc autstnndinll shures.) ~ FIIIsr NN.IIt I.IIOCL& INtIA&. Soc:u.c. SlCLMITY NO. auø.csa T'ELDK»C ~IA (IIC. .A4lEA I:CQI) Lewis Kenneth W STIIUT AOOAua 1516 Ivan ave. City STArr Bakersfield CA. HCI4 TÐ.IJIttON& IUoIUA (Ie. ""lEA CQØ£; (661) 833-2570 .....$ NIo.C I" CW'UrHJ 'Itwt ArPlIC:H« I K L AVl.ation Aooaua 2010 S. Union ave. Po$moN, Owner O:iW1'~ Lewis FtllST NNooI! K e 11 y MIOOl¡ "rw. socw. S(CUII/tY No. NJU 0' DOÐCQa$ 568-41-9608 2 years MIOOL. ..rw. HcwI! T'£UI'I<INI""""" (Ie......u. CQOf1 ..- FIIIsr......... SOI:IAI. SlCUU1Y NO. / "'!fT AOOAUI CI1'I' STArr iW1'~ MIDOI.a INTW. socw. SlCUIU1Y NO. .lG&S 0# DIPÐCIINI'a ....':1 tWoII! (II OII"fJlÐff-nwc~ I AOaIIUI Po.Imc::n ~~ additional pngc:s for olhcr O"l1crs, co-signers, and gW1nU1tOrs.) " , . .'.- , :.'~' '.. : ~ - - . , '.' ' J represent and dcclarc undcr penally of perjury undcr thc laws of thc State of California that this is u true and correct statement, ,current financial condition of thc prospective borrowcr nnd its owners, cosigncrs, and guarantors, Any existing or threalencd Ii\i claim or circumstance which might rcasonably bc cxpcctcd to affcct by condition in the future is fully described below or in an éJ stnlement. I will immediately notify )'ou in wriling if there is a material challgc in my financial condition. In thc abscnce of slIch IIO\ÌCC, till constitute both a new and continuing statement of my financial condition if I become obligated to you or you rely, to any extent \\ on this statement of my financial condition. J agrec that my present and future obligations to you may become immediately due and payable, at your sole discretion, if: (a) I, L cosigner or guarantor of any of my obligations, at any time fail in business, become insolvent, commit an act of bankruptcy, or di mil of allachment, garnishment, execution or olher legal process is issued against a material portion of my property; (c) any act J collection of delinquent taxes is taken against me; (d) any representation to you by me or a cosigner or guarantor of my obligatiO! be misleading or untrue; (e) I fail to nolify you of any malerial change in my financial condition or there is a materially adverse (' m)' condilion; (I) I sell or transfer any intcrest in my current business; or (g) any other action or condition containcd in the loan rt which is executed by me. I waive the right to notice of any action taken by you in cnforcing these rights. You may verify the Information contnined In this stntcment with nllY third Itarty, I am authorized to suhmit this nllllicl\tion on the pl\rt of the ßlllllicallt business. $'OI"J\JRf ~,,4- V SIOt"'URE [)All SlQ/lfD [)AI' SIOI(D PLEASE TELL US HOW YOU HEARD ABOUT THIS PROGRAM FINANCiAl DEVELOPMENT CORPORApON I SMAll BUSINESS DEVELOPMENT CENTER I CONTACTING TRADE AND COMMERCE ; .ùe:.S.S Ù News ARTICLE (WUA T PUBLICATION?) e.ù/ OTHER (PlEASE SPECIFY) tNFORMATION FOR GOVERNMENT MON/TORING PURPOSES The following infonnation is requestcd to monitor compliance with thc equal credit opportunity laws. You are not required to fUl informalion, but are encouraged to do so. The law provides Ihat a lender may neither discriminate on the basis of this inrormalioi whether you choose to furnish it. However, if you choose not to furnish iI, and you apply in person, this lender will nole race and basis of visual observation or surname. Uyou do nol wish to furnish the information, please check the box below. I I do not wish to furnish this information. RacelNatlonat Orlgtn: I American Indian I Black, not Hispanic origin I Other (specify) Gender: I Asian or Pacific Islander I Hispanic '1'White, nol Hispanic origin I Female I Male Please lee Part 2 for the type of loan for which you are applying. " REPAIR UNDERGROUND STORAGE TANK APPLICATION Part 2 1. List each underground storage lank (US1) owned or operated by the business applying for a loan from the Agency. The list shall include the address of each UST, the number of USTs at each location. and indicate which USTs will be included in the project u, the loan funds (project tanks), Also provide a copy of any correspondence between the applicant and public agencies concerning, UST owned or opernted by the applicant. 2. For each UST, include a copy oUhe current permit Evidence ofa current ptrnùt shall consist of one ofthc following: a.) A copy 'of a curTent pemlit issued by the county of city agency charged with responsibility for USTs (local agency); or b.) Both of the following: 1.) A compleled Stale Waler Resources Conlrol Board Form A &, B, signed by an authorized representative ot the local ager: and 2.) Evidence lhallhe permil fee has been paid for each UST for the currenl year, consisting of a canceled cbeck or a receipl the local agency. 3. A description of any unauthorized releases from a UST owned or operaled by tllC applicanl, including copies of correspondence " the local agency, and reports made 10 illSUlers. 4. lnfonnatlon regarding the project for which funds is being requested (project), including a description of the reasons why: a.) The project lanks either currently are not, or in the future will not be, in compliance wilh federnl, state, or local standards. b.) The project will result in project tanks which are in compliance with federnl , state; or local standards. 5. Describe the project in detail, including: a.) A list of the project components, with the cost and time line for the completion of each component. b.) The name and appliC<lble experience of the individual or firm preparing the cost estimates, and copies of any supporting inv() estimates or contracts, c.) A list of any permils necessal)' to carry out the project. 6. A project can consists of the upgrade, repair or removal of a UST used to store petroleum. The project can also includc correctin action. Corrective action caD' include any action laken to correct an unauthorized release from a UST used to store petroleum, including: evaluation and investigation of an unauthorized release, irútial corrective action measures, clean-up ofthe release, any actions necessary 10 investigate and remedy any residual effects remaining after the inWal corrective action and post clean-up monitoring. If lhe project Includes corrective açtion measures, pro\ide the rolJowing informaûon: a.) ,A description. budget, and time line for each segment or activity comprising the corrective action. and the identified source c funding for each segment or activity. b.) A copy of any corrective action plan filed \\;th a public agency. 7. Provide a copy of all monitoring reports conducted on any project tank during the last three years. ~ck; CALIFORNIA TRADE AND COMMI:RCI AGENCY ENVIRONMENTAL AssrssmNT UNDERGROUND STORAGE TANI< LOAN PROGRAM Wt1, an. A.pplicant: Kenneth W Lewis Applicant', ~dr=: 201 0 S _ [In i on ;:¡ vp Bakersfield CA. 93307 Addr~ of the Droperty (or whidt this ~c is beù1¡ c:anpkted (the ·Subjec:t Propa1Y-): Sé1me Ust the meet a.ddr~ ~ and ownct'S1úp interest in any oc:bcr propeny owned by the Applicant (e.g.: 100 Mmt Street.1As Angd~ ) yean rcnuJ u warebowe spa.ce). 1516 Tv~n ~VP R~k~rc~;Q1A ~n Q3304 R~~i~pnrø. .~nin~ Tønn~n~ 001 Qpn&9 If the list 0( other pr~ indudes additional propcrbes with pdn?kwn under¡round stonp tanb. ~ include I.S AtùclUncnt A I copy of the mo~ rec:cm imqrity ~ air ~ and underground st~ tank pcrt!IÎt. If the propcI1J' ìs foc:atcd in a state wfúclt does DO( require ODe Of more or these documentS, pfàse ~ - - N/A N2mC(s) ~~s) compIerins dú qu~oM&Íte, their position(s). respon.s¡òiIiti=. duties, &nd tenure with the ~øüant: Kenneth W Lewis, applicant ;:ñc foUo~ questions are ~~ to provide the c.aJifonlia TrJde and COfM)CfCe Ågf:r&J (the (J Ag~ W1t1i infocmatioa coæ .CJVitoM1CJUl ~ otthe Sub;ect ~. the ~i w1D rcquÎR the pcnoo(s) co . ¡ this sUtemc!t to ccrtifÿ that the statement IS true &nd coastinrtes at acante account af ¡ß wn envitonmeztuJ matters i'eJated to the S~ Prooertv and its vicinity. The Agenc:y wiD rei)' on these answen as bowing rcpresenu.rioos õl the SubjedwProperty's coõdmoa. The ~ sbould be answered by one or more penocs "tWo are most knowicdgeabfe about the Subject ~. Such ~ns 'i1rÌD be expected to conduct I -reasonabie iDqUiry'. The term -reaSonable Ú1QuÌtY' shan include a thorough e:arninat.ioo at che Subteå Property ana all property records IS welt u -aD au.tten into which the Appbnt bas ~ tór ~ ~ or do wtUd1 the Applicant hu had the rip 0( duty to anquire. WJleuOaable inqwry- snaa DOt require 111 'eawoM\enta.l audit or the hiring of I corisuJunt to respood to these questioGS. & set out more ÑDy iø the loan application and provam pt91~ the ~t:ÐC'j may coodua III '~ ÜM:stigaåçn of the It\SVI"C:CS ~ in thís stat~ . the Applicant's ~ If sucb an investiptioc riVeab problem areas not disclosed in this statement, the Joan de(ùioQ may be de1ayed. , 1 ~ ~~Á¡~7ri~1 t~u:O~~~~'~I~-;~~7tiš;t'i~~';të~ A¡;piïani's -Q~ prior"to i~ini alo~ COrM\ltmenC. - , The Awüanc should düdose aD known cx.isting or potenti¡J enwonmcnt¡J is.su~ when Il1swerins the ronowiJ1g ~ The A¡t:rCf is aware dW txJsin~ Ù\¡t apply under the lo.n pro¡rw will gencnte ~dous '-Jb$f.&~. When tUlly djsclo~. the wstenu of hu.ardOUJ ~bst~s on the Subject Pro~rty will not ne«$wiJy result in an autonutic loan <kniaJ, The Agency, in its sole discretion. sJWJ consider other (&C1on u tisted in th<: retJUlations when detemúnin¡ whether the proposed Io&n meets the program's goals and the Agencys acupLlble tiabilicy risk. It the spaa: pro...;&:¿ for your response is insuffidcnt. indude an uw:hment to the qu~onna.ire and label the atW:hment with the humber oftbe question you are continuing to &nSWa'. Exhibit A conu.ins denMions ot"the terms used in this SUttment tow the Appliant in determinin¡ the ~pe of each qu=cion. ' Exluòit B conuW a fist of atuclunenu to be included with this ccmpleted questionnaire. Á. SCOPE OF APPUCANTS "REASONABLE INQUIRY" I. Is this assessment being completed by someone familiar with the Subject Property and the business operations conducted at that property? " 2-Ya No It~ d~ why the ~ completing this ~ is knowiedgca1*: (e.g.: b«au5e that person owns and ~= the 6u~ toared on the prooertY). ~r because I own the property and business löca~ed on the subject property. ' B. PROPERTY INFORMA nON I. Current and Former Ownm and u~ o(~ Subject PrQ~ and Vicinî\Y (a) Give the name of the present owner and SUte the current u: ot the Subject , Propeny Kenneth W LeW1S. Alrcraft Malntenance Faclllty Year acquired: 1 9 9 8 (b) Do you know who owned the Subject Property prior to the current owner? x Yes No - 2 ------ ------. -.....-- - --- If yes.. ,ute the ~ or &.If such (o~ owners. the approxim¡te CÚIt1 o( heir ownership, and their u~ or the Subject Property, Note ~iaJJy any rNOOr¡cruM¡ or ~stNJ u.s=. and ury u~ which required the: use, Slon¡e. Of' diJoosaJ o( ~)cid~ l\I.z..udous subst~, or ~rolewn productJ Bonita Le~is, 10/93 to 10/98, Leased to present owner Garriott Crop Dustinq from 1977 to 1993 see attachment E. A. Bender. vacant land (c) Are there or Mve tMte been tenantJ or u.semenc holden on the Subjeç: , Property? " 2-Yes No - Do not know If yes, sute the names o(present and former tenanu. e!.Sement holders. etc. and their uses of the Subject Property. Note especi~ any manur.acturing or - industrW uses, and any uses ~ required the we, stonge. or.düpoSal of pesticides. hazardous subsunces. 0( petroleum products. K L Aviation. from 9/91 to prPRPnt fJRPcl for aircraft maintenance (d) What is the auTem zoning for the Subject Property? M1 (c) Do you know the. prior wning ofthc Subject Property? Yes --L No If yes, pa.,e is the ~ zoning and the d.ùes when the zenina Vt'1S clw1¡ed. (t) If the property is used IS a gas sutioa, to the best of your knowiedge bow long Iw the propaty bc:a1 used for this purpose? N/AyatS (g) Appro~ how w- below the surlàa: is ground water? .2..1..9.... ~ 3 (h) Are you awve of my ~s en";(oruncnt.aJ ~u. audits. Of ~ÌQtU o(û)e Subject Propcrt}' by any ¡o.Ymvn<nuJ entity, consultant, or othci p.atty' -LYes No Ifyc:s. pIa.se ~ Ind indude &oS Att~c~t B U1y ~portl, Jtudj~. pWu. or other rdated dOQJlnenU. 2. Curre!!t or Propo~ U~ of Su~ject Proper\)' (a) PI~ d~n'be aD current and proposed actMties that the Á{'Pliant conducu or intends to conduct on the Subject Property. If the property as used u. ps sution, l'1~ ~ any automotive ~ conducted on'the premises. If automotl've ~ wen: historiaUy ~ on the prerni~ bUt no( pr~tJy. d~òe the automotive repairs and when they ceu:d. Property is used for ~;r~rÂTr M~inron~n~o and to store disasRPmhlø~ wnn~on ~irO~7nrkc c~~n~i (b) In addiûon to storing gasoline and/or diesd fud inunder¡round sto~e W1b, pl~ list an hazzrdOUs materials and W'&.Ste on the prenuses. Examples at materials that should be listed are solvents and motor oil. Examples of wastes that sbouJd be listed ate spatt solvents, wasu ~ and où cowrid saw <bit. üst ofhazardous mataia1s: None List of hazardous wastes: None For each hazardous wute listed abo~ include u Attxhmenc C tbetwo (2) most recent manif=.s oòu.ined &om the ~ who picked up the hu.ardous waste. In the c:ue or wa.ste oiL the å'I.ßSI?Orter may haW ~"ided you with a reœåpt in lieu of a m.a.nifest. If the ha.z:arQow wute is oat Piáed up fly a licensed haž2tdous waste ha.uJer, please desa1"be disposal proc:edura. NIl>. 3. p~aI ~prion ofPmperty (a) P1eu: describe aD sauc:tur= OQ the Subjeà Proøertv (mc.i¡~ ~ lie) and include as A.ttJcluncm D ~ map" 1nclúcíe in that map the 100000n orany underground st~e tanks. iDduding a descripdoa oltbe size and use of the tank (e.&,: S,~ ~ ~ 60 x 70 meta~ office / hanqar buldinq 2U x 20 metal storage bulding Structures are approximately 30 years old The tanks were lnstalled new 12/78 andlast used 1988 (b) In addition to the tanb identified in the Attachrnctt C ~ map. are there DOW. or have t.bcre ever been any t&nb, sun1p; ~ lagoons, or ocher conuinmcnts (whether under or above ¡round, mside or ouuide of Ufj stnJàW'e) on the Subject Property? x Yes - No At If yes. pleue ancNdc -u Aruchmc:nt E . list de3Cnbìn¡ such cont~runentJ (&ndudtnj their size. ¡¡e. and Ioation) and. ~e powble. list all sub~~ known to be (or to ~ve bcen)~orcd Of' dCpQsiced therein. (c) Do any of eM stl'Ucrure:s, paved &IUS, and other work UUJ ccnujn ðoor dr¡Úu or other dircc1 conz1«tjon.s to dnin&¡e areu. JUmp. septic systems. Of' public sewer f&cili(i~? Yes x No 1f)'C':S¡ pkasc ~ the ~e system.. and the nunner in which it is currently ~n 111 the AppÜQnt's opention. ' (d) IW an asbestos expcn or indwtrial hy¡jerÜst inspected the Subject Property? Yes x No It~ inclu~ the report as Attalf~ F. (e) Is there '!1Y PCB equipment (tnnsfonnc:n, capacitors, or other dectricl equipment) U1 ~ or sicced on site? Yes x No Do not kDow Ifm p~ list. C. REGU1Â TORY INFORMA nON'" HISTORY 1. Retail ~ ~ &cillties ~ . &om the Ioallir ~ management distrid or air poDution coritrol =' Include IS A.tachment G a copy Olthe aøn:nt pemWt issued by the air district for the business Ioated at the Subject Property. ' , 2. Ownen of ~Icum und~ound stonge t.a.nb are required to obuiD a pcnnit for these t.1nb. This p;rmit IS iJsucd by the city or ~ in wbicl1 the Þ.nb are loated. Please inclúdc IS Att.acluneDI H a COØ' of ttie cUrrem UDder¡round storage tank permit (or the tanks loœcd oa the Subject Property. 5 - 3, Mo. åtjes requirc th&r 1&oS Jution.s obuin a permit (0( the stOf1¡C or 1u.urd~s rmterijJs PIuse indu<f~ u Atuc:hmctt [ a copy of the h&.uidooj fNCcri&ls st~ ~ fa the busin= ~ed &1 the Subject Propctty, l(no such permit is required in foot muNcipality, plUS( JUte this below. No permit avai]ab]e. tanks illeaallv abandoned and not properly closed in 1988 '... AJ' condition o( the u~erground $tOt'lic t1nJc ~rmit di3CU~ above under C.2,. wú: owners are ~ to monitor tt.c unk.s to detect feW. rn mo1t c.&.se1, tlnk o~s are required to CQnduct annu.al tW integrity t~ or all pennined ~m unb. P1use include u AnWuTw:nt J a ~.PY or the three most r~ Integrity t~ r()(~'tted unks located on the Subject Pr~. -integrity te,ts arc no< req' pluse provide ¡ copy or the instructions ûõm the JoaJ pennitting &ger.c¡ . .~'. ~ morùt.onng t~que other than. int~ te:u. I(the method seI~ u ~on and D'Wl1t~ oran uupedJOn log. ~ include IS Atbdvnc:I1t I copy o(t.he December. 1990 log. and the log fOC' the month ju.u concluded. ' S. fLu any go~nuJ a.g~ i~ed any letter, noti~ or verbal ~I1'UTIJJ'ÙQtjon indÎat1ng that it intended to investIgue or seà infomutiOQ ~ envirorunenuJ matters relating to the ~bjed Propetty? Yes ~No Itya, pl~ 5pcci1ÿ and include a copy IS Anacluncm Ie. 6. Have 1Ity hu:udous subSUnces, ~iddes, 0( petroleum producu ever been ~ ~ 1eaJced., I~ disposed o( or otherwise placed OQ or in the X Yes _No If p~ speCìÿ and deuiI respoose and ~ ~ \md.erukcn ~ any go~ktrtJJ agencies còataaed. Include u ~ L copia o( ~ sa~ ~ or other doaJments gcnented. RW CB current statis monitorin test well. The only par lon 0 e property a ec e lS a cover con alnmen1 area along south east propertyllne. ,. Is the,~ Property or any ac;tMty cxniJded thereon in violation of ~:~~ to pemltj under any taw I ocdiNnè:e. ~ or regulation relating to OW su~ or the protectJOn o( the enviroé1mauf" Yes x No It yes. please 5pcci1ÿ and cxpWn. 6 a. IUs tM Subic:å Pr~rty been d~gn.ated. ~ed. 0( idcrttiñc:1 in U1y m&Mcr by the Ul'Ûted Stat~ Environmenul ProcectÍ()(1 Agency (the eEP A 8) 0( any OCbcf &0\ mvnenul¡¡ency as . h.a.w-dow mat eriW di 'poW or removal SIte, supa1ÎJnd or cJeanup site. Of candid¡te (or remoV1J 0( cJosure pursu&l1t to &l1Y rcdcnJ, SUte, or local law1 ---1L Yes No rr~ plu.se d~òe. RW~CB clean up and abatement order gO-71h InòJde u Att3clunent M copies Or U1J wvning; ciatiOIU, aoûus or vioWion, enforcement actions, and administntJve and jud1<::JJ romp/Ainu or O(dtn. and COfTespondence related to any h.1.urdow subsunce or envirorwental IIw or -regulation. 9. Are you & ware or any litigation or thrwened titigJ.tion pertaining to the Subject Property? -1L-Yes No ----- Jf~"a~~leld is seakinq a Judampnt fnr f~ilure to rpmovp t~nk~ " 10. Are you aware of any litiption or tht=tened litiption pett.Iinina to the Subject Pro~ Yes No II ya, please descnòe and include IS A.ttxhmem P & copy or lIlY ~ 7 D. APPLICANT lNFOR.\tA T10N For ~~i Appü~c ~ ~cb enterpri~ o~~rin¡ on !be Suòject Property, &~ the rouo"";n.: I, EP.". identifiC4tion numben CAL000070145 2. Ongoing or thr~trned environmcntll clunup activities ror which the Appü~ i.s or !NY be ~bject to la~jt, dcmand., liability, or respon.slòilicy tOr the conduct o( de3.nup or p-ayment o( d~up costs. "fiJõne 3. ü5t 1lJ related bu~ o( ~ AppÜ~. A.s ~ ~ the term ereiattde ~ that the Appücant owm :t r~ 5 1 % or mother bu~, Of another bu~ own.s ~ lC;:1St S 1 % of the AppÜ~. None , ~ ~"'IC ~t owner of the AppliCJnt or h.a~ 111 intete::t therein, or u m offic= or 13 ~ ser~ pa.rtr.c' of tbe p~ owner of the .\pplÍcw (or the ~ ~ri%:d repr~urive of~, owner), t.be undersi~ and cacl1 o{ them, indMdwJ1 c:nm~ that hel3he Í3 &milW' with me Appüaat ~ and the Subjec: Pr~pc:tt)' U1d witb a.I1 of tbe o~~ ~~ucted OQ the Subjec: Property, his mad~ 1 diligent inquiry Into (be present and fonnet uses and xriviries con<iucic:1 on the Sub~ Pro~, the pr~ and former ~ and xtMÐes conduc:ed w;t1ùn the 'fi¿.nity ofiliat property, ani 2i other matten ~ to a full disc:osure oi ~ environmenul ca~ and ~ reW:ive to the ~ Property, 1nd that, 10 tbe best oftbe knowicdge, imènnacioa and beúcl or the und~i~ the intormacion cfudosed ~ IS ~ true and come:. The undersigned aclr.owiedge:s that tbe ~ency Ínteixis to rely upon the ti3cio~ made ~ve or 2tUc.ìed hereto in detennùung Whdber wi 00 wf1at tertn.1 it wùl make 2 Joan to the AppliQl1t. Appüom Kenneth W Lewis By: Kenneth W Lewis Title: Owner Date: 9/13/99 ~~¿ ~¿ - 8 - -, '. .,. .........." . 11hbi( A ", I. H 11' "dOUj S UÒ~ 1!1a 'The: tet"TN · Huudoos Subsu.nc.=" and "H.uudous, ~·.Üt C'f'ÙJs · sn~J ~ inte1'Ch4J"lge.1bly. 1l\Y hLUfdoos wlJte. toJcic subst~. or rel¡ted mate:Üb The term ,twl include without limitation. any subst~. INteriaJ or W&3te which ~'or ~md re¡uJ~ted by 1nY 10Q,j goyel'T\mentll ~thorilY, The term ·Ha...wdousM.uetiaJ· .sha U ~50 include without Umjt~tion, 1nY lNteri~ Of subsunc.e deñned as ·h&.wdous subst~", ·hu1rdous materials" 0( ·toxic "-Ib~· in the Comprehetuive E:wironmenul R~rue. Com~cion u.d Li~ty Act o( 1980, as amended (42 U,S,C. 0 9601 ~'(·CE.'CLA .~ the Huu-dow Materials TrllUporution Act, ¡.s amended (-49 U.S.C. \of 1801~. ·HMTA·h The R=ouru CofUCrVltion &nd R~very A.c::, is am:nded (42 U.S. . C 6901~.X·RaA·)i those subsunc= deñned 1S -&wrdow W a.ste· in $ec:X)a 25 1 17 of the Cilifcnu¡ Hahh 2nd S~~ Code Cf' U ·H.1.wdcw Su~· :n Sccrion 25316 o(tbe CJliforni¡ He.ùth and S~êty Code; 2nd in the ~~ru adoP(~ md publi~ promul~ed put'SWJtt to ~d ~\VS. 111< tenn "Hu.1rdow M.1te:-Ws· Wl11.l~ include ~ !ûTùution, any sub~ that, ~se o(!beir q,wntÎty, conc...-ntn.txìn or ci~mic:l, !'2di~ fb.mmable, aplo~ infectious., corrOSIVe, rw:-:ive, or other c.~eri~c:s ~nstiMe or may r~nãbty be e~~ to a>nstitutc or contrlòute to 1 danger 0( ha.z:1rd to tbe public he3lth, wet)' or weifJre} or to the enviro~t, ~ weiJ .u ~ petroleum producu and pc:tjQd~ w~.bet OÚ1etW1se iDduded within the ~vc deDnition or ~ 2. P~. 'The term .~. slWI ÌnC.ÌJde my ~ registnrion, c=tiñQtÍOQ or otbcr 6J.ú.1¡ or xrion wtúC.i mwt be oouincd trom. or ñ1ed with ury govunrnenw agency. or is otbe:wise ~ed in order for tbe App&=nt to ccndud opcnrions, or own or ~ UTf equipment or f2cility. ~ 9 [ll.ibif B ,. :.J The qUe3tionN.Ïre uJcJ ror scverll an¡'~ntJ. PI~ cfw1y identify a1J IttJchmenu IJ'Id circle the letters below th¡( c.orrespond 10 the ¡ctICh.mcnU encJo~ 'Iñe de~riptions ue merely (or rererenc:~ the full dcscnption or m¡teri~s to be ¡nached is (jsted in the qucstlo~re itsell Att.1chmeru tk~riptioa Integrity Test, Air Pennit a.nd Underground Storage Permit fur . ~ Property with Underground Storage Tanks Environmental A.ss.essment..S A B C D E F G H I J K L M Manife;su Facility Map Conu.inment üst Asbestos Report Air District Permit Underground Storage Tank Permit for the Subject Propcrt'y Iú.z:u'dous M1terU1s Sto~ Permit Tank Monitoring ReporulInspeàioa LDg Pubúc Agency Enviromnental ~ Corrective Action Reporu EJ1vironmcnul Ciutions 10 CALIFORNIA TRADE AND COMMERCE AGENCY OFFICE OF SMALL BUSINESS FINANCIAL STATEMENT CERTIFICATION r, Ar.y financial statements hereby furnished to you for the purpose of procuring and establishing credit from time to time with you are to be regarded as a complete and truthful statement of the undersigned's financial condition on the date indicated. The undersigned authorizes you to make wh.atever inquiries about the content of the attached financial statements, including contacting taxing authorities, creditors, and credit reporting agencies; and to provide credit ¡nfonnation about the obligations of the undersigned to credit reporting agencies or in response to other inquiries. /~ ¿ , Dated Q-,3·-Qr ~ Dated I LITIGATION GUARANTEE Guarantee Number: 496090 Liability: $10,000.00 Fee: $300.00 SUBJECT TO LIMIT A TIONS CONTAINED HEREIN, THE EXCLUSIONS FROM COVERAGE, THE LIMITS OF LIABILITY AND OTHER PROVISIONS OF THE CONDITIONS AND STIPULATIONS HERETO ANNEXED AND MADE A PART OF THIS GUARANTEE, COMMONWEALTH LAND TITLE INSURANCE COMPANY a corporation, herein called the Company, GU ARANTEES the assured named in Schedule A against loss not exceeding the liability amount stated in Schedule A which the Assured shall sustain by reason of any incorrectness in the assurance which the Company hereby gives that, according to the public records, as of Date of Guarantee shown in Schedule A: 1, The title to the herein described estate or interest is vested in the vestee named in Schedule A, 2. Except for the matters shown in Schedule B, there are no defects, liens, encumbrances or other matters affecting title to the estate or interest in the land shown in Schedule A, which matters are not necessarily shown in the order of their priority, 3. a) The current interest holders claiming some right, title or interest by reason of the matters shown in Part II of Schedule B are as shown therein. The vestee named in Schedule A and parties claiming to have some right, title or interest by reason of the matters shown in Part II of Schedule B may be necessary to name defendant in action, the nature of which is referred to in Schedule A, b) The current interest holders claiming some right, title or interest by reason of the matters shown in Part I of Schedule B may also be necessary to name defendant in an action, the nature of which is referred to in Schedule A. However, no assurance is given hereby as to those current interest holders. 4. The return addresses for mailing after recording, if any, as shown on each and every document referred to in Part II of Schedule B by specific recording information, and as shown on the document(s) vesting title as shown in Schedule A are as shown in Schedule C. THIS LITIGATION GUARANTEE IS FURNISHED SOLELY FOR THE PURPOSE OF FACILITATING THE FILING OF THE ACTION REFERRED TO IN SCHEDULE A. IT SHALL NOT BE USED OR RELIED UPON FOR ANY OTHER PURPOSE. Commonwealth Land Title Insurance Company By: 1!;t> ~- CLTA Guarantee Fonn No.1 Litigation Guarantee (Rev, 12-16-93) 496090 Page 2 SCHEDULE A 1. Name of Assured: City of Bakersfield 2. Date of Guarantee: February 22, 1999, at 7:30 a.m. 3. This Litigation Guarantee is furnished solely for the purpose of facilitating the filing of an action to: condemn 4, The estate or interest in the Land which is covered by this Guarantee is: A FEE 5. Title to the estate or interest in the Land is vested in: William Lewis, by Grant Deed recorded October 30, 1998, as Instrument No. 0198150291, Official Records 6. The Land referred to in this Guarantee is described as follows: Parcell of Parcel Map 4511, in the City of Bakersfield, County of Kern, State of California, as per map recorded January 17, 1978 in Book 20, Page 22 of Parcel Maps, in the Office of the County Recorder of said County. EXCEPT all oil, gas, minerals and other hydrocarbon substances within or underlying said land, as reserved of record. CLTA Guarantee Ponn No.1 Litigation Guarantee (Rev. 12-16-93) 496090 Page 3 SCHEDULE B P ART I A. General and special taxes, including any assessments collected with taxes, to be levied for the fiscal year 1999-2000, which are a lien not yet payable. B. General and special taxes, including any personal property taxes, and assessments collected with taxes for the fiscal year 1998-1999. Total: First Installment: Delinquent Amount: Second Installment: $385.06 192.53 19.25 192.53 Delinquent Unpaid Homeowners' Exemption: None Code: Parcel: 001-003 170-030-36-00-4 C. Said property has been declared tax defaulted for non-payment of delinquent taxes for the fiscal year 1987 to 1988 (and subsequent years, if any). Amount to redeem: Prior to: $17,190.09 March 31, 1999 Amount to redeem: Prior to: $17,303.64 April 30, 1999 Amount to redeem: Prior to: $17,417.19 May 31, 1999 D. The lien of supplemental taxes, if any, assessed pursuant to the provisions of Section 75, et seq. of the Revenue and Taxation Code of the State of California. 1. An easement for the purpose shown below and rights incidental thereto as set forth in document Granted to: Purpose: Recorded: Kern Island Canal Company for main and lateral canals January 25, 1928 in Book 128, Page 254, Official Records CLTA Guarantee Fonn No, 1 Litigation Guarantee (Rev, 12-16-93) 496090 Page 4 Affects: The exact location and extent of said easement is not disclosed of record. 2. An easement for the purpose shown below and rights incidental thereto as set forth in document Granted to: Purpose: Recorded: the present or future property owners for ingress and egress January 17, 1978 in Book 5083, Page 333, as Instrument No. 005061, Official Records Affects: the Northerly 15 feet of said land 3. An easement for the purposes shown below and rights incidental thereto as shown or as offered for dedication on the recorded map shown below Map of: Recorded: Parcel Map 4511 January 17, 1978 in Book 20, Page(s) 22, of Parcel Maps Purpose: Affects: for drainage purposes the North side of said land as shown on said Parcel Map 4. Any interest of the spouse of Bonita J. Lewis. 5. The requirement that the spouse of the vestee join in the execution of the deed and/ or deed of trust. CL T A Guarantee Fonn No, 1 Litigation Guarantee (Rev, 12-16-93) 496090 Page 5 PART II 6. A lien for unsecured property taxes fùed by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1990 Kenneth W. Lewis, dba K L Aviation 14627-00-9 $576.08 December 12, 1990 in Book 6464, Page 1178, as Instrument No. 079919, Official Records 7. A lien for unsecured property taxes fùed by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1990 Kenneth W. Lewis, dba K L Aviation 50276-00-7 $647.78 December 18, 1990 in Book 6467, Page 337, as Instrument No. 084201, Official Records 8. A lien for unsecured property taxes fùed by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1990 Kenneth W. Lewis, dba K L Aviation 50277-00-0 $633.10 December 18, 1990 in Book 6467, Page 338, as Instrument No. 084202, Official Records 9. A lien for unsecured property taxes fùed by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1990 Kenneth W. Lewis, dba K L Aviation 50278-00-3 $578.31 December 18, 1990 in Book 6467, Page 339, as Instrument No. p CL T A Guarantee Fonn No, 1 Litigation Guarantee (Rev, 12-16-93) 496090 Page 6 084203, Official Records 10. A lien for unsecured property taxes fIled by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1981 Kenneth William Lewis, dba Pee Wee Golf 03130 $128.01 July 18, 1991 in Book 6546, Page 630, as Instrument No. 089520 Official Records 11. A lien for the amount shown and any other amounts due, in favor of the State of California. Amount: Filed by: Taxpayer: Cert. No: Recorded: $1,277.22 State of California, Board of Equalization Kenneth William Lewis doing business as K. L. Aviation BE-381247 February 16, 1993 in Book 6804, Page 705, as Instrument No. 023411, Official Records 12. A lien for the amount shown and any other amounts due, in favor of the State of California. Amount: Filed by: Taxpayer: Cert. No: Recorded: $2,457.69 State of California, Board of Equalization Kenneth William Lewis doing business as K. L. Aviation BE-42l981 January 31, 1995, as Instrument No. 0195011726, Official Records 13. A lien for unsecured property taxes fIled by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1994 Kenneth W. Lewis, dba K L Aviation 03349-00-0 $55.49 February 16, 1995, as Instrument No. 0195020313, Official Records 14. A lien for the amount shown and any other amounts due, in favor of the State of California. CL T A Guarantee POnTI No, 1 Litigation Guarantee (Rev, 12-16-93) 496090 Page 7 Amount: Filed by: Taxpayer: Cert. No: Recorded: $1,378.78 State of California, Board of Equalization Kenneth William Lewis doing business as K. L. Aviation BE-428688 May 10, 1995, as Instrument No. 0195056759, Official Records 15. A lien for the amount shown and any other amounts due, in favor of the State of California. Amount: Filed by: Taxpayer: Cert. No: Recorded: $1,694.17 State of California, Board of Equalization Kenneth William Lewis doing business as K. L. Aviation BE-444 725 February 27, 1996, as Instrument No. 0196024699, Official Records 16. A lien for the amount shown and any other amounts due, in favor of the State of California. Amount: Filed by: Taxpayer: Cert. No: Recorded: $566.41 State of California, Board of Equalization Kenneth William Lewis doing business as K. L. Aviation BE-450058 May 13, 1996, as Instrument No. 0196061585, Official Records 17. A lien for unsecured property taxes filed by the tax collector of the county shown, for the amount set forth, and any other amounts due. County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1997 Kenneth W. Lewis 7007736-00-2 $216.68 December 5, 1997, as Instrument No. 0197161223, Official Records 18. A lien for the amount shown and any other amounts due, in favor of the State of California. Amount: Filed by: Taxpayer: Cert. No: Recorded: $2,102.16 State of California, Board of Equalization Kenneth W. Lewis, doing business as K. L. Aviation BE-1142444 February 23, 1998, as Instrument No. 0198021832, Official Records 19. A lien for unsecured property taxes filed by the tax collector of the county shown, for the amount set forth, and any other amounts due. CLTA Guarantee Fonn No, 1 Litigation Guarantee (Rev, 12-16-93) 496090 Page 8 County: Fiscal Year: Taxpayer: County ID No: Amount: Recorded: Kern County 1998 Kenneth W. Lewis 7006956-00-0 $219.64 December 7, 1998, as Instrument No. 0198170505, Official Records CLTA Guarantee Fonn No, 1 Litigation Guarantee (Rev. 12-16-93) 496090 Page 9 SCHEDULE C ADDRESSES 1. William Lewis 2010 South Union Avenue Bakersfield, CA 93307 -- As Owner 2. Bonita J. Lewis c/o Bill Lewis 2000 South Union Avenue Bakersfield, CA 93307 -- Prior Owner 3. Kern County Treasurer I Tax Collector 1115 Truxtun Avenue Bakersfield, CA 93301 -- Lien Holder 4. State Board of Equalization P.O. Box 942879 Sacramento, CA 94279-0001 CLTA Guarantee Fonn No, I Litigation Guarantee (Rev, 12-16-93) IHla PLAT IS PROVIDC[) --FOR INFORMATION ONLY. ALTHOUGI ,/ me INFORMA110N ON THIS PLAT IS PART OF THE OFFICIAl íRE~THË ACCURACV OF THAT INFORMATiON IS NOT GUARANTEEI ' BY ' :TH'í& . QO'MPAAIV. THIS PLAT IS NOT TO BE CON$IDERED Af BÇ(NG,' , II' ,PARI',.'_' ØP..,.. JHI! POUCY. REPORT, BINDER, 'GUARANTEr' œ~O'JIIR ~ IIIJED BY THIS OOMPANY, TO WHICH r \lfAY'BE A1TACtfE'D. ' ' , ' ,', " ". ~ '_'_"__""__"_'_'~~~_M,"~"~_"'"~''''~'~''''.''~'''..._..'''.''...'''''.,.,..'"..,,~ --..--~~;L~-IN 1/1'0 O;;'~~;H ~·'-·-r7;~'I~-~r-;~-':;~-,"l=n..~7·:~~~Î'~:;,~·;~'~f77~,'7 ;~;~~'~I·;~·, I, 1.'I,~6I" ,,1..80Q-~.4~~7,3,34i::,l~~tr " ",.." ""··':',c·-----' "-on JJ' ..,.." .__",n'.~'..-...'","" '".,.,"'":'.,' '"- ":.......~,... -"":' '.' 'i''''''' ':',..".. ':,.... < ,: ":'~ " ':'·':-'···7"'ë''';-·.'':·""~:"'':',':',~''' .,;~""'·"'·,'."';"':!''.::''m';:'N~f:,,·::':!/-?'::~~~~~f~~l~:;IT:'."~t{~::.ó:,: 56-J9';~ii SCHOOL DIST. / -3 170.:..03" @ I I I ~ ~ I I I I - I I I ~ \ ì \1 )\ VM:., PER, 6356-.937 \ 3116/.90 Q,R':'.! .L- ~4L..i -1-' µ 7 170-03 SW 1/4 OF SEC 8 -r. 30 s. R28 E. 8 1179,31 ' , . f®JT654'6 (ù u 23 ~ ".... 0~ 27 , ø.. 8.57 AC @WR ,.... 104\ '-./ .. "g.:.:, 12$3,17 , PL-ANZ ., . " ::45 8 2/ Off. 07 'I.. 654,/58 @MR @ 20 655,07_ æ @ r ":~5 Nol.: Thil mop I, 'or usalnmlnl purpos.. ontr II II nol to Þa COftltrlMld OS porttoylnQ legoi ownership 01 dlvil10na of kind for pulposlt 0" zonlno œ autulv1110n taw. ASSESSORS MAP NO.JIº.-:-;º~.... COUNTY OF KERN ....'._.~...,. .,. .;.; c:: ,<1> E 'E o (.) 1# - 4001 ~ ..... o ~ <1> Q æ C") c) I'-. ~ è:: o :<:; ,g- O II) <1> a o I'-. (J) (Q ~ o ,0 o ~ 'J:: '~ Uj l..: <1> ,-e ,.,,0. '-.--:- n2308 -"--, .------ SCHEDULE OF EXCLUSIONS FROM COVERAGE OF TIllS GUARANTEE 1. Except to the extent that specific assurances are provided in Schedule A of this Guarantee, the Company assumes no liability for loss or damage by reason of the following: (a) Defects, liens, encumbrances, adverse claims or other matters against the title, whether or not shown by the public records, (b) (I) Taxes or assessments of any taxing authority that levies taxes or assessments on real property; or, (2) Proceedings by a public agency which may result in taxes or assessments, or notices of such proceedings, whether or not the matters excluded under (I) or (2) are shown by the records of the taxing authority or by the public records, (c) (I) Unpatented mining claims; (2) reservations or exceptions in \atents or in Acts authorizing the issuance thereof; (3) water rights, claims or title to water, whether or not the matters excluded under (I), (2) or (3) are shown by the public records, 2. Notwithstanding any specific assurances which are provided in Schedule A of this Guarantee, the Company assumes no liability for loss or damage by reason of the following: (a) Defects, liens, encumbrances, adverse claims or other matters affecting the title to any property beyond the lines of the land expressly described in the description set forth in Schedule (A), (C) or in Part 2 of this Guarantee, or title to streets, roads, avenues, lanes, ways or waterways to which such land abuts, or the right to maintain therein vaults, tunnels, ramps or any structure or improvements; or any rights or easements therein, unless such property, rights or easements are expressly and specifically set forth in said description, (b) Defects, liens, encumbrances, adverse claims or other matters, whether or not shown by the public records; (I) which are created, suffered, assumed or agreed to by one or more of the Assureds; (2) which result in no loss to the Assured; or (3) which do not result in the invalidity or potentia] invalidity of any judicial or non·judicial proceeding which is within the scope and purpose of the assurances provided, (c) The identity of any party shown or referred to in Schedule A. (d) The validity, legal effect or priority of any matter shown or referred to in this Guarantee, GUARANTEE CONDITIONS AND STIPULATIONS 1. Definition of Terms. The following terms when used in the Guarantee mean: (a) the "Assured": 'the party or parties named as the Assured in this Guarantee, or on a supplemental writing executed by the Company, (b) "]and": the land described or referred to in Schedule (A)(C) or in Part 2, and improvements affixed thereto which by law constitute real property, The term "land" does not include any property beyond the lines of the area described or referred to in Schedule (A)(C) or in Part 2, nor any right, title, interest, estate or easement in abutting streets, roads, avenues, alleys, lanes, ways or waterways, (c) "mortgage": mortgage, deed of trust, trust deed, or other security instrument (d) "public records": records established under state statutes at Date of Guarantee for the purpose of imparting constructive notice of matters relating to real property to purchasers for value and without knowledge, (e) "date": the effective date. 2, Notice of Claim to be Given by Assured Claimant. An Assured shall notify the Company promptly in writing in case knowledge shall come to an Assured hereunder of any claim of title or interest which is adverse to the title to the estate or interest, as stated herein, and which might cause loss or damage for which the Company may be liable by virtue of this Guarantee, If prompt notice shall not be given to the Company, then all liability of the Company shall terminate with regard to the matter or matters for which prompt notice is required; provided, however, that failure to notify the Company shall in no case prejudice the rights of any Assured under this Guarantee unless the Company shall be prejudiced by the failure and then only to the extent of the prejudice, 3. No Duty to Defend or Prosecute, The Company shall have no duty to defend or prosecute any action or proceeding to which the Assured is a party, notwithstanding the nature of any allegation in such action or proceeding, 4. Company's Option to Defend or Prosecute Actions; Duty of Assured Claimant to Cooperate. Even though the Company has no duty to defend or prosecute as set forth in Paragraph 3 above: (a) The Company shall have the right, at its sole option and cost, to institute and prosecute any action or proceeding, interpose a defense, as limited in (b), or to do any other act which in its opinion may be necessary or desirable to establish the title to the estate or interest as stated herein, or to establish the lien rights of the Assured, or to prevent or reduce loss or damage to the Assured, The Company may take any appropriate action under the terms of this Guarantee, whether or not it shall be liable hereunder, and shall not thereby concede liability or waive any provision of this Guarantee, If the Company shall exercise its rights under this paragraph, it shall do so diligently, (b) If the Company elects to exercise its options as stated in Paragraph 4(a) the Company shall have the right to select counsel of its choice (subject to the right of such Assured to object for reasonable cause) to represent the Assured and shall not be liable for and will not pay the fees of any other counsel, nor will the Company pay any fees, costs or expenses incurred by an Assured in the defense of those causes of action which allege matters not covered by this Guarantee, (c) Whenever the Company shall have brought an action or interposed a defense as permitted by the provisions of this Guarantee, the Company may pursue any litigation to final determination by a court of competent jurisdiction and expressly reserves the right, in its sole discretion, to appeal from an adverse judgment or order, (d) In all cases where this Guarantee permits the Company to prosecute or provide for the defense of any action or proceeding, an Assured shall secure to the Company the right to so prosecute or provide for the defense of any action or proceeding, and,all appeals therein. and permit the Company to use, at its option, the name of such Assured for this purpose. Whenever requested by the Company, an Assured, at the Company's expense, shall give the Company all reasonable aid in any action or proceeding, securing evidence, CLTA Guarantee Conditions and Stipulations Form 2015-1 (Rev. 12-15-95) ()~I~IMAI f'" ------ ._----~---,----- - obtaining witnesses, prosecuting or defending the action or lawful act which in the opinion of the Company may be necessary or desirable to establish the title to the estate or interest as stated herein, or to establish the lien rights of the Assured, If the Company is prejudiced by the failure of the Assured to furnish the required cooperation, the Company's obligations to the Assured under the Guarantee shall terminate, S. Proof of Loss or Damage. In addition to and after the notices required under Section 2 of these Conditions and Stipulations have been provided to the Company, a proof of loss or damage signed and sworn to by the Assured shall be furnished to the Company within ninety (90) days after the Assured shall ascertain the facts giving rise to the loss or damage, The proof of loss or damage shall describe the matters covered by this Guarantee which constitute1he basis ofloss or damage and shall state, to the extent possible, the basis of calculating the amount of the loss or damage, If the Company is prejudiced by the failure of the Assured to provide the required proof of loss or damage, the Company's obligation to such assured under the Guarantee shall terminate, In addition, the Assured may reasonably be required to submit to examination under oath by any authorized representative of the Company and shall produce for examination, inspection and copying, at such reasonable times and places as may be designated by any authorized representative of the Company, all records, books, ledgers, checks, correspondence and ,memoranda, whether bearing a date before or after Date of Guarantee, which reasonably pertain to the loss or damage, Further, if requested by any authorized representative of the Company. the Assured shall grant its permission, in writing, for any authorized representative of the Company to examine, inspect and copy all records, books, ledgers, checks, correspondence and memoranda in the custody or control of a third party, which reasonably pertain to the loss or damage, All information designated as confidential by the Assured provided to the Company pursuant to this Section shall not be disclosed to others unless, in the reasonable judgment of the Company, it is necessary in the administration of the claim, Failure of the Assured to submit for examination under oath, produce other reasonably requested information or grant permission to secure reasonably necessary information from third parties as required in the above paragraph, unless prohibited by law or governmental regulation, shall terminate any liability of the Company under this Guarantee to the Assured for that claim, 6. Options to Payor Otherwise Settle Claims: Termination of Liability. In case of a claim under this Guarantee, the Company shall have the following additional options: (a) To Payor Tender Payment of the Amount of üability or to Purchase the Indebtedness, The Company shall have the option to payor settle or compromise for or in the name of the Assured any claim which could result in loss to the Assured within the coverage of this Guarantee, or to pay the full amount of this Guarantee or, if this Guarantee is issued for the benefit of a holder of a mortgage or a lienholder, the Company shall have the option to purchase the indebtedness secured by said mortgage or said lien for the amount owing thereon, together with any costs, reasonable attorneys' fees and expenses incurred by the Assured claimant which were authorized by the Company up to the time of purchase, Such purchase, payment or tender of payment of the full amount of the Guarantee shall terminate all liability of the Company hereunder, In the event after notice of claim has been given to the Company by the Assured the Company offers to purchase said indebtedness, the owner of such indebtedness shall transfer and assign said indebtedness, together with any collatera] security, to the Company upon payment of the purchase price, Upon the exercise by the Company of the option provided for in Paragraph (a) the Company's obligation to the Assured under this Guarantee for the claimed loss or damage, other than to make the payment required in that paragraph, shall terminate, including any obligation to continue the defense or prosecution of any litigation for which the Company has exercised its options under Paragraph 4, and the Guarantee shall be surrendered to the Company for cancellation, (b) To Payor Otherwise Settle With Parties Other Than the Assured or With the Assured Claimant. To payor otherwise settle with other parties for or in the name of an Assured claimant any claim assured against under this Guarantee, together with any costs, attorneys' fees and expenses incurred by the Assured claimant which were authorized by the Company up to the time of payment and which the Company is obligated to pay, Upon the exercise by the Company of the option provided for in Paragraph (b) the Company's obligation to the Assured under this Guarantee for the claimed loss or damage, other than to make the payment required in that paragraph, shall terminate, including any obligation to continue the defense or prosecution of any litigation for which the Company has exercised its options under Paragraph 4, 7. Determination and Extent of Liability, This Guarantee is a contract of Indemnity against actual monetary loss or damage sustained or incurred by the Assured claimant who has suffered loss or damage by reason of reliance upon the assurances set forth in this Guarantee and only to the extent herein described, and subject to the Exclusions From Coverage of This Guarantee, The liability of the Company under this Guarantee to the Assured shall not exceed the least of: (a) the amount of liability stated in Schedule A or in Part 2; (b) the amount of the unpaid principal indebtedness secured by the mortgage of an Assured mortgagee, as limited or provided under Section 6 of these Conditions and Stipulations or as reduced under Section 9 of these Conditions and Stipulations, at the time the loss or damage assured against by this Guarantee occurs, together with interest thereon; or' (c) the difference between the value of the estate or interest covered hereby as stated herein and the value of the estate or interest subject to any defect, lien I)r encumbrance assured against by this Guarantee, 8. Limitation of Liability. (a) If the Company establishes the title, or removes the alleged defect, lien or encumbrance, or cures any other matter assured against by this Guarantee in a reasonably diligent manner by any method, including litigation and the completion of any appeals therefrom, it shall have fully performed its obligations with respect to that matter and shall not be liable for any loss or damage caused thereby, CONDITIONS AND STIPULATIONS CONTINUED ON BACK COVER ·~, Vl'>l .~ ---=-~----=------............~-.=-~-,- - --- CONDITIONS AND STIPULATIONS CONTINUED (b) In the event of any litigation by the Company or with the Company's consent, the Company shall have no liability for loss or damage until there has been a final detentùnation by a court of competent jurisdiction, and disposition of all appeals therefrom. adverse to the title, as stated herein, (c) The Company shall not be liable for loss or damage to any Assured for liability voluntarily assumed by the Assured in settling any claim or suit without the prior written consent of the Company. 9, Reduction of Liability or Termination of Liability, All payments under this Guarantee, except payments made for costs, attorneys' fees and expenses pursuant to Paragraph 4 shall reduce the amount of liability pro tanto. 10. Payment of Loss. (a) No payment shall be made without producing this Guarantee for endorsement of the payment unless the Guarantee has been lost or destroyed, in which case proof of loss or destruction shall be fumished to the satisfaction of the Company, (b) When liability and the extent of loss or damage has been definitely fixed in accordance with these Conditions and Stipulations. the loss or damage shall be payable within thirty (30) days thereafter, 11. Subrogation Upon Payment or Settlement. Whenever the Company shall have settled and paid a claim under this Guarantee, all right of subrogation shall vest in the Company unaffected by any act of the Assured claimant. The Company shall be subrogated to and be entitled to all rights and remedies which the Assured would have had against any person or property in respect to the claim had this Guarantee not been issued, If requested by the Company, the Assured shall transfer to the Company all rights and remedies against any person or property necessary in order to perfect this right of subrogation, The Assured shall pentùt the Company to sue, compromise or settle in the name of the Assured and to use the name of the Assured in any transaction or litigation involving these rights or remedies, If a payment on account of a claim does not fully cover the loss of the Assured the Company shall be subrogated to all rights and remedies of the Assured after the Assured shall have recovered its principal, interest. and costs-of collection, 12. Arbitration. ~---' '!- - ~ '~----';";'-=---=--~-' ~~-";-""'"'=-'- '-I¡) """ ~ Unless prohibited by applicable law, either the Company or the Assured may demand arbitration pursuant to the Title Insurance Arbitration Rules of the American Arbitration Association. Arbitrable matters may include, but are not limited to, any controversy or claim between the Company and the Assured arising out of or relating to this Guarantee, any service of the Company in connection with its issuance or the breach of a Guarantee provision or other obligation. All arbitrable matters when the Amount of Liability is $1,000,000 or less shall be arbitrated at the option of either the Company or the Assured, All arbitrable matters when the amount of liability is in excess of $1.000,000 shall be arbitrated only when agreed to by both the Company and the Assured, The Rules in effect at Date of Guarantee shall be binding upon the parties. The award may include attorneys' fees only if the laws of the state in which the land is located pentùts a court to award attorneys' fees to a prevailing party, Judgment upon the award rendered by the Arbitrator(s) may be entered in any court having jurisdiction thereof, The law of the situs of the land shall apply to an arbitration under the Title Insurance Arbitration Rules, A copy of the Rules may be obtained from the Company upon request. 13. Liability Limited to This Guarantee; Guarantee Entire Contract, (a) This Guarantee together with all endorsements, if any, attached hereto by the Company is the entire Guarantee and contract between the Assured and the Company. In interpreting any provision of this Guarantee, this Guarantee shall be construed as a whole. . (b) Any claim of loss or damage, whether or not based on negligence, or any action asserting such claim, shall be restricted to this Guarantee. , , (c) No amendment of or endorsement to this Guarantee can be made except by a writing endorsed hereon or attached hereto signed by either the President, a Vice President, the Secretary, an Assistant Secretary, or validating officer or authorized signatory of the Company, ' , , 14. Notices, Where Sent. All notices required to be given the Company and any statement in writing required to be furnished the Company shall include the number of this Guarantee and shall be addressed to COMMONWEALTH LAND TITLE INSURANCE COMPANY, 1700 Market Street Philadelphia, PA 19103-3990, ' CD, "'X ~ <I C'1~ ~ Gj I\) ~o 0'" ~ Q;:: ;- ::: c: I ~'" ¡r ::: '" I::;j ~ ;. 0 j; i"~ ;:: þ (") C"'-) ... '" ;:s CI>" ¡;¡ e :j ... q ~ CI> a :c: "'0 ~ s' t: c::: ~ ¡;¡ a z ~ t'fj ... e 0 oc ~ '-1 = =' n 0'1 I ..; - 0 ~ .... 0 '" ;:ro ž z z ~' Da .. '" en I::;j ~ c: ... =- ~ a :: (') 0 63 '" C'1 Z ~ 0 '0 ::: en '0 ~ Q ~ i ·i - '~(Ç~' 1 05/08/96 K L AVIATION 215-000-001336 ¡age Overall Site with 1 Fac. Unit JUN 41996 ¡ , General Information By I . ..,~, Location: 20~0 S UNION AV Map:124 Haz:2 Type: 3 City . BAKERSFIELD Grid: 08C F/U: 1 AOV: 0.0 . ~ Contact Name Title - Contact Name Title KEN LEWIS / OWNER BILL LEWIS / Business Phone: (805) 832-2521x Business Phone: (805) 832-2521x 24-Hour Phone · (805) 833-2570x 24-Hour Phone · (805) 832-2687x · · Pager Phone · ( ) - x Pager Phone · ( ) - x · · ""'_1" Administrative Data ~-I- Mail Addrs: ~eo~s UNION AV D&B Number: 14-768-3718 City: BAKERSFIELD State: CA Zip: 93307- Comm Code: 215-005 BAKERSFIELD STATION 05 SIC Code: 4581 --- -----.. Owner: KEN LEWIS ~~~=:~á~O? ),~,~3:~,~57"0 - ) Address: 1516 IVAN AV City: BAKERSFIELD Zip: 93304- Summary I, lé.S,N LEw /' ~ Do hereby certify that! hav'ð (Type or print name) v reviewed the attached hazardQus rriaterials manage-- ment plan for It.. L I')v,'A-{.'DÑ and that it along with (NanJe Of Bualne88) any corrections constitute a complete and correct man~ agement plan for my facility. ,L.. Jr!_, Signature 5b.1'/'7~ , 0at6 e e 05/08/96 K L AVIATION 215-000-001336 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site PIn-Ref Name/Hazards Form Max Qty MCP 02-002 WASTE OIL Liquid 100 Low ~ Fire, Delay Hlth GAL 02-001 NITROGEN Gas 156 Minimal ~ Fire, Pressure, Immed Hlth FT3 e e 05/08/96 K L AVIATION 215-000-001336 02 - Fixed Containers on Site Page 3 Hazmat Inventory Detail in MCP Order 02-002 WASTE OIL ~ Fire, Delay Hlth L'iquid 100 Low GAL CAS #: 221 Trade Secret: No Form: Liquid Type: Waste Days: 365 Use: WASTE Daily Max GAL ~ Daily Average GAL --r-- Annual Amount GAL -- 100 I 100.00 I 100.00 ion HOP OUTSIDE ( ~ 5~LLt::D ~ MCP Low Storage r Press T Temp :l~ METAL CONTAINR-NONDRUM Ambient Ambient~ SIDE - Cone l Components 100.0% Waste Oil, Petroleum Based ----,-Guide I 27 02-001 NITROGEN ~ Fire, Pressure, Irnmed Hlth Gas 156 Minimal FT3 CAS #: 7727-37-9 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: HEATING Daily Max FT3 ~ Daily Average FT3 --r-- Annual Amount FT3 -- 156 I 156.00 I 312.00 Storage r Press T Temp ~ PORT. PRESS. CYLINDER Above Ambient Location - Cone l 100.0% Nitrogen Components ~ MCP ---rGuide Low I 12 ()~« CY\L IS 'D6Pðj. ~ 0 I Æ<rv Ct <TV ùJ'A?"f'ê 0 (L <ïfl'c"StL ~. cÆ ßL-OC9- ç 'Z-- ~ rJ't) t ~~ ØrJ' 'S. \ <rE , e e 05/08/96 K L AVIATION 215-000-001336 00 - Overall Site Page 4 <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation VERBAL <3> Public Notif./Evacuation PUBLIC ACCESS LIMITED, IF PRESENT WILL BE NOTIFIED VERBALLY. <4> Emergency Medical Plan SAN JOAQUIN COMMUNITY HOSPITAL - 2615 EYE ST. 05/08/96 e e K L AVIATION 215-000-001336 00 - Overall Site Page 5 <E> Mitigation/Prevent/Abatemt <1> Release Prevention APPROVED CONTAINERS. <2> Release Containment KITTY LITTER. <3> Clean Up CALL HOPPERS <4> Other Resource Activation " e e 05/08/96 K L AVIATION 215-000-001336 00 - Overall Site Page 6 <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs vi A) GAS - ~SIDE OF BLDG IN CORNER OF SHOP & STORAGE B) ELECTfICAL - INSIDE END OF W WALL OF SHOP C) WATER - A!l' CAIS £IIU'P QPf' l~"",T\ l~ ti ~(g S. oJ< r+~~ D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS FIRE HYDRANT - CORENR OF WATTS AND UNION 01\..( t\-¡ ~Ð~ E ~ p.~o?ðfi!-J--J <4> Building Occupancy Level ..., ~ e e 05/08/96 K L AVIATION 215-000-001336 00 - Overall Site Page 7 <G> Training <1> Employee Training WE HAVE NO EMPLOYEES AT THIS FACILITY - OWNER OPERATOR ONLY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: WE HAVE NO FORMAL TRAINING PROGRAM. <2> Page 2 <3> Held for Future Use <4> Held for Future Use ... Yo.~_~"-.""""<"'A\.' ~ .' \.J 2000 SOUTH UNION AVENUE KEN LEWIS BAKERSFIELD, CALIFORNIA 113307 OWNER 805 - 832-2521 BILL LEWIS ,''>~ ~,""~- //,'; ,""" '':'-., .b /~,. _.:..:.or.,j¡ .__ ., '-"""- ..,~"¡;"~~"""':-:"_'L_ -" ,.a ~ --"'- INSTRUCTIONS: ì. 2. ~ " e - BAKERSFIELD CITY FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE, 3RD FLOOR BAKERSFIELD, CA 93301 (805) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN , ,/1 \0 r'l. ~ \~1 "1 CO ø ?-lq~ Pr6~ iIš 70 avoid further action. reTurn ;t,¡s form within 30 days of receipt. 7YPE/PRINT ANSWERS IN ENGL.;Si-i. Answer ¡he questions below for ~he Dusiness as a whole. 3e brief and concise as pcs.sible, SECTION 1: BUSINESS 1DENTIFIC,.\TION DATA -, , I"" I'" ~" N ' 'vj r- I... L JL.;~¡¡\H::;.:) ! ';""'j r::: n L'::::C,;¡¡CN: ~\ J ~ lOt- ~"" ;).ÐfY) (~ ()¡II. 'Ln"" Ç1I'P- >.:1A;~~NG ~,= DR ESS: t' ,"'-"1-',/, -.:, , ~~WA- S~:~i=: -û:- Z!P: qß~7 PHONE: EtD ~J... ~l SIC ':::::JDS: i.tSB l ='~~~ 8:. S~,~.=SïKE=¡ NU¡Vl5E~: ::; i :/1 A;\ Y:,:::: ~¡\/ \ T'(: p.,:~~M ~f'?At~II<:;~'\j k1 ~ ;2\\,'N:K: .ke,V\ 4>~ "5 \/L~,;~:\JG ,.:.,= JR:::SS: ~'ÐO() s. t ) 1\. ~ 0/\ ti. Ie. S::C-:-10N 2: ~MERGENCY NOT¡~1CAT¡ON: ì , CC~ïACT BUS. P~ONE 24 HR. PHONE ,;, -- \(p>~ L-.~( ~ I .u V\Q...R.. 88~' ~~~I ') <\3 ~ II Le.t AI b; \ -.." .öaKerSneta .c l!'e DeDt. , tit Hazar¿ous Materials Division tit HAZARDOUS MATERIALS MANAGEMENT PLAN SECTtON 3: TRAINING: NUMBER OF EMPLOYEES: (D At/ t+ MATERIAL SAFEïY DATA SHEETS ON FILE: y.e£; BRIEF SUMMARY OF TRAINING PROGRAM: /Ý/ t\- SECTfON 4: :XEMPTION REQUEST: ! C:::~T¡FY UNCE~ s~NALiY OF ?~:<JURY ~:-i,;;"T :v1Y 3USiNESS IS EXEMPT FROM THE KE?ORT[NG :\=;:UlRE:víENTS OF C:-:APE~ 6.95 OF THE'CALlFORNIA HE.',\LTH & SAF=~Y C:JC::' =CR ThE ~CL'-CW!NG K=.~,SCi'iS: 11/= :0 ¡\jCT :~ANOL= :~I~L.':",RCCJS :\1Aïë~!ALS. .'/': :::C :-:,';NCL= HA,Z;:"RCCUS ~¡1Ai=~Ì,;;'.LS, 3UT iHE QUANTITiES AT NO -:\/==:<C:::=~ ¡:-iE ~\¡\\N\i'v1lJì\'1 ~=?CRTiNG QUANHTlES. :~:~=~ (~~='=:;:'ý !~E:~SC>~' SECTION 5: CE~ì¡F1CÂïION: !, j¿£¡(.),.ù(5-f~ w LE-W .~ C:::~T\FY THAT THE ,L\SOVE INFOR- MATION IS AC:JRATë. I UNOEi<STANC T~~J THlS INFORMATION WILL BE USED TO FULFill MY FiRM'S CBL!GATìONS UNOE~ ~~E'C.';UFCRNIA HEf\LTH AND SAFETY CODE" ON ""ZARnrl 'C: \ ,1'A-'--IALS 'DIV "'1'"1'--",' '""...-... , "5 ~--- 2~-OO E- AL) \ NO -HA- 'l :'1l""'\ I l,..,...........\.JOo,I:v I r::t~ \'. ~\..j (~~l'.--J..I! ::~~ 0.'1 ~C.\....... -.;.:J l . r.1 I 1 INACCURATE iNFORlv1A T ON CONSTiTUTES PERJURY. .- ?-r9-<U DATE c-Jµ&K.- TITLE SIGNATURE '" ~- ,'-' e BakersñeldFire Dept. e Hazaràous Materials Division ........_.,.~'r:' .,....,.. HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION ì: MITIGATION, PREVENTION AND ABATEMENT PLAN: .A.. RELEASE PREVENTION STEPS: prppPoVeJ c-oV\'+~ ,,-tv¿;, 3. RELE,-\SE'C8NTAINMENT AND/OR MINIMIZATION: K:*'1lj~~ >, " ·=~=,~.N-UP ?RCCEeJURES: SéCT¡CN 3: UTILITY SHUT-OFFS (LCC.;TiCN Cf= SHUT-OFFS AT YOUR FAC:LlTY): \JAïL!~,~,L:;,.:..s/?r~CPþ,j\JE: N ~~Q_ ~ b~ ~"" C'~'^-'P~¡t- ot;. ~~~ ~ s'te~'2- =~=C~~!C.':'.~: ~\J\.sìÁ~ 3"'7 e.vJ. o~ w .^.~ll ~ s"'-C)? ',\j ,0.i:::::: .p;\ ~-As. . -1A..~ 't ~ ...,,.... ~ ---. 'I ' ::; ï =;__ 11\ L.. : LCC:< :CX: '.'-~I!F ¡ - ~ , -~ .~ '{~~, _::·C,~¡jON: SEC710 N 9: PRIY ATE FIRE PROTECTIO N/W A TER A Y AlLABILlTY: A. ?RIVATE ¡:¡RE PROTECT[ON: ~~ ~J-~:?Le-~ B. WATER AVAILABlllTY (FIRE HYDRANT): eo~~ W¡4i1ýs~'ÐV\. i,- "_~ ~. ;~:....' -. .-, ..ûaz.ersn~lQ l"lIe lJept. e Hazaràous Materials Divisio~ HAZARDOUS. MATERIALS MANAGEMENT PLAN Facility Unit Name: \{ L-, At... ~ -I- J...-.V) SECTION 6: NOTIFICATION AND EV ACUATION PROCEDURES: A. AGeNCY NOTIFICATION PROCeDURES: ~M.L q/f 3. ::~;1PLCYE= NOTIFICATICi'1 ,j.,ND ::'./A,CUAJION: Ve-<ÙbA- ( ~ '-' . ?USl\C ::'./ ACUA ï¡ON: ~ '""\ =:v\E~G¡:~jC\( MEJ\C,::',L::I_.':"¡\j: 8~~ 'X'OA-LU ~ ~ ='""'c.' BAKERSFI~ CITY FIRE DEPARiA/1ENT HAZARD~US MATERIALS INVENTO~ : ~...;;.. :~ Page_of_ )\I:~,-~' Jsiness Name Address ". . ./ CHEMICAL DESCRIPTION ~'¡F' . ",. ":'. 1) INVENTORY STATUS: N_ (~ Addition ( ] Revision ( ] OeIeCion ( ] Check if chemical is . NON TRADE SECRET' V TRADE"~ ( ) 2) Common Nvne: (I'~f^. 3) DOT # (opCiona) Chemical Name: AHM I] CAS.. ~) PHYSICAL. & HEAlTH PHYSICAL [~ HEALTH HAZARO CA TEGORJES Fire [ I Reactive ( I Sudden Release of Pressure Immediate Health (Acute) I ] Oelayed Health (Chronic) I] I :) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE "2.2- 3) PHYSICAL STATE Solid ( ] uquid ( ] Gas (M' Pure I] Mixture [ ] Wast. I] RadIoectiw [ ) I ;;;EOCAti :1-fAT APPlr ì) AMOUNT ANO TIME AT FACIUTY UNITS OF MEASURE e{'" 8) STORAGE CODES ¡ I,1UJmum Daily Amount: tbh :bs [ ] ;aJ [1 1'!3 [ a) Container: 1OL.t ~verage Daily Amount: <'IS~ ;\Jnes [ ] b) Pressure: '4'J '1- I Annuai Amount: 3l!l ~J. c) Temperarure: '-I Largesl SizeConlamer: 31~ I * Days On Site Circle Which Months: F. M. A. M. J. J. A. S. 0, N. D I 3) MIXTURE: ust COMPONENT CAS # %wr AHM , :he Ihree most hazaraous 1) I] chemical components or ! any AHM components 2) I] I I 3' I I ! . 0) Loc~lIIon Yb~ ,I>é\D\,º- ~ I CHEMICAL DESCRIPTION I I < ) INVENTORY STATUS: ,',ew ( ] P-daitlon ( 1 Pevision { ] Deletion ( ] Check if chemical is a NON TRADE SECRET I ] TRACE SECRET [ ] I , , 2) Common Name: 3) DOT 11 (optional) i I i ChemlcaJ Name: AHM ( ] CAS # i ; ~) PHYSICAL & HEAL.Tri I PHYSICAL HEAlTH I I HAZARD C':'TEGORIES Fire r , "!eactlVe ¡ I Suoden Release oi P'~ssure [ ì Immediate Health (Acute) [J Delayed Health (Chronic) [ ] ! 3) WASTE CLASSIFIC':'¡¡CN ':3-<Jiglt coae from DHS Form 80221 USE CODE I ! :3) PHYSICAL STATE ~olid ( : 'Jould [ ] Gas [ ] Pure { ] Mixture [ J Waste [ ] Radioactive ( ] I ! ~'E''=X 4U. -..Ar.fPPlY , :-) ~MOUNT AND TIME Ai F~C:UTY :JNlTS ~F '-.-1EASURE 8) STORAGE CODES ! ,'.laxlmum Oally Amount: Ibs I ;aJ ( ] 13 [ 1 a) Container: ¡ Average DaJly Amount: ;~nes [ ¡ b) Pressure: I I Annuai Amount: c Tempenøure: I Largest Size ContaJner. , : .; Davs On Site Circle whicn Months: AJI Year. J, F, M. A. M. J, J. A. S. O. N. D I I 3) MIXTURE: Ust COMPONENT CAS¡! %wr AHM i i :he three most hezaraous n [ J : cnemlCal components or I any AHM components ;:¡ [ J i I \ 3) [ 1 ! 10) Locæion I '''f¥ una., ."""''YO< ,.W, au." n.... þ_......... """ am ,,,,,,,,u .,.. ... '''''''''''.z Þn -- __OIl Z I Oelleve tne ;mitted information is true. accurate, and campi.". Il ' '_', ~.. '_ . s-( 1:'~'Û' YEJV~ lJ L~t "" ,'7 ~ -""~ INT Name c!r Title of Aurhonzea Comøany R.presentative $ Signature Dam ~ .:;.. ....-;.~~ BAKERSFif:LD CITY FTFr~ DE:t-IArlTMENT-n . e _ OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE, 3RD FLOOR BAKERSFIELD, CA 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY ~ :/ :1 FAC:UTY DESCRIPTION CHECK IF BUSINESS IS A FARM [ BUSiNESS ~AME _~ l flv~~{.:-n~ , =AC'L'''7''''/ ~'AME 'i I ¡ ¡ , ,--; I" \. .' : SiTE ADDRESS ~to S. l '~~a1..-1 pde C:7Y B~p~~~..cJ-~ó.. """'-,-- ~ii"\I::: e.'A ZIP 9:S~()7 ; .'~A ïL:SE CF =USINESS A ~ A C. ~~ f't'L4,\.¿f-p-VI A T\£: l? , ç·C ""'""DE I '- I '-' ,_; I '1.5'(3 ( :;UN & 6PAOSïRE~ï NUMBER C'NNE:='¡CF=:=,A TC R ~Y\ I~..,u Š PHONE , \AAIL:"'G \""",r-~~c:: : :VI ¡¡'< .....L.......,'1c....'-J 'H!/f::)() c~ . (') IA..'-a "" Ave.... C:TY ß~~~oU -.--,,-- ~ i.......! ,= Cl\ ZiP S33D7 :=ME::1GENCY caNT ~CTS i ¡ I ¡ ,'J AM E _+<9v\ LQ-vv .LS i I CUC::'NE~C:: =wCNE ¡ .... '-J\ -..1'-" ¡ I I TITLE OL' ~~ R.3~· :lS~1 24-HGUR PHONE ¡ ! NAME ,\S~ \~ LP.I-1 ~5 :!SUS1NESS "HONE ~ - );\.5~1 T!TLE 24-HOUR PHONE s.a-:xl IS011Z AlGlCNY I.EPC STNiCAAD p:.: ;;,.~ ....-~~ (', .. C,","CM;)rICLOkJ \"'11, T t'in~ UI:.t"JL¿J=1 11V1t:.d~ a HAZAR.S MATERIALS INVENTO_ Page_of_ :usiness Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New ( ] Addition ( Revision ( Deletion ( ] Check if chemical is a NON TRADE SECRET [J TRACE SECRET [ ) 2) Common Name: (v\c~ f:>: l 3) DOT # (optional) Chemical Name: AHM ( ) CAS # 4) PHYSICAL & HEAlTH HAZARD CATEGORIES PHYSICAL Fire [] Reactive (] Sudden Release of Pressure ( ) 6) PHYSICAL STATE Solid [) Uquid (] Gas [ ] HEALTH Immediate Health (Acute) Delayed Health (Chronic) [ ) 5) WASTE CLASSIFICATlON (3-digit code from DHS Form 8022) Pure Waste [) RadioIICtive [ ) 7) AMOUNT AND TlME AT FACIUTY Maximum Daily Amount: Average Dally Amount: Annual Amount: Largest Size Container: # Days On Site ./ 8) STORAGE CODES a) Container. b) Pressure: c) Temperature: ~ Circle Which Months: All Year, J. F, M. A. M, J, J. A. S. O. N. D 9) MIXTURE: Ust the three most hazardous chemical components or any AHM components COMPONENT CAS # %WT AHM [ ] [ ) [ ) 1) 3) / CHEMICAL DESCRIPTION i) iNVENTORY STATUS: New ( ] Addition [ Revision [ ] Deletion ( j 2) Common Name: \{ViAst'e- 0 ~ \ Check if chemical is a NON TRADE SECRET [ TRADE SECRET [1 I 3) DOT # (optional) ChemlcaJ Name: AHM [ ] CAS # ~) PHYSICAL" HEALTH ~AZARD CATEGORIES PHYSICAL Fire [.1 Reactive [J Sudden Release of Pressure [ ] HEALTH Immediate Heaith (Acute) [] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATlON (3-digit cOde from DHS Form 8022) USE CODE l.{D 5) PHYSICAL STATE Solid [] Liquid [I Gas [ ] Pure [] Mixture [] Waste [ ] Radioactive ( ] ':;"£0; AlL j1.j.t.r AJ¥'lr ì)':-MOUNT AND TIME ,':-T FACIUTY Maximum OaJiy Amount: Average Daliy Amount: Annual Amount: Largest Size Container: # Days On Site ~ ¡~ UNITS OF MEASURE bs í j gal [4-" it3 [ ] cunes [ ] 8) STORAGE CODES a) Container: b) Pressure: c) Temperature: 1'3 I 'i Circle 'Nnich Months: " M, A, M, J, J, A, S, 0, N, 0 9) MIXTURE: Ust the three most hazaroous chemlcaJ components or any AHM components COMPONENT CAS # %WT AHM [ J [ ] [ ] 1) 2) 3) 10) Location 3-1';-'7( Date ~~11i82 AECIaN V L.£JIC STNilQ¡trlÐFQIIW .¡. t,-;:::::. ;J!I- ~~ BAKE.IELD CITY FIRE DE.RTMENT HAZARDOUS MATERIALS INVENTORY Page_of_ 3usiness Name K'L Dv,\"" '\-~~V\ Address ~DOO S. Ù,^~A"/~I''¡¿ '¡ CHEMICAL DESCRIPTION 4) PHYSICAL & HEALTH HAZARD CATEGORIES PHYSICA Fire [I Reactive [] ijden Release of Pressure [J TRADE SECRET [ I ',i 1) INVENTORY STATUS: New [/ Addition [ ] Revision [ ] Deletion [ ] 3) DOT # (optionaJ) , , " 2) Common Name: Chemical Name: AHM ( ] CAS # HEALTH Immediate Health (Acute) [] Delayed Health (Chronic) [ ] : 5) WASTE CLASSIFICATION USE CODE 6) PHYSICAL STATE Solid Pure ] Mixture ( Waste ( ] Radioactive [ ] (;).¡'fQ( AU. '),IAT APPtr 7) AMOUNT AND TIME AT FACIU Maximum Daily Am nt: Average Daily Aunt: AnnuaJ Amou : Largest Si Container: # Days n Site UNITS OF MEASURE !bs [ ] gal [] 1'13 [ ] curies [ ] 8) STORAGE CODES a) Container: b) Pressure: c) Temperature: Circle 'Miich Months: All Year, J. F, M, A. M, J. J. A. S, 0, N. D 9) MIXTURE: Ust the three ost hazardous chemical components or any AHM components COMPONENT CAS # %wr AHM [ ] [ ] [ 1) 2} 3) 10) Location Chemical Name: EMICAL DESCRIPTION 1) INVENTORY STATUS Check if chemical is a NON TRADE SECRET [] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) AHM [ CAS # 4) PHYSICAL & HEALiH HAZARD CATEGORIES PHYSICAL Reactive [J Sudden Release of Pressure [ ] HEALTH Immediate Health (Acute) [J Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022\ USE CODE 6) PHYSICAL STATE ~iquid (] Gas [ ] P'Jre [] Mixture [ Waste [J Radioactive ( ] -;",EQ( ALL ;>.Af A¡:q,-f 7) A,MOUNT AND TIM T FACIU,( Maximum Dallv Amount: Average Dally Amount: AnnuaJ Amount: Largest Size Contamer: # Days On Site :JNITS OF MEASURE !bs [ ] gaJ [ ] ft3 [ =:.mes [ ] 8) STORA(3E CODES a) Container: b) Pressure: c) Temperature: Circle 'Miich Months: All Year, J, F, M, A, M, J, J. A, S, 0, N, D 9) MIXTURE: Ust the three most hazaraous chemical components or any AHM components COMPONENT CAS # %wr AHM [ J [ ] [ ] ,) 2\ .31 10) Location PRINT Name & Title cr Authorizea Company Representative Signature Date