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MISCELLANEOUS RECEIVABLES ADJUSTMENT
DATE 3-~3-0 1
NEW ACCOUNT
ADDRESS CHANGE
CLOSE ACCT ¡
: FINANCE CHARGE I
; OTHER ADJ !
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MAILING ADDRESS 4- \ °l to PI (ì e.wood We
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SITE ADDRESS ';)~::L S Sc ~~ tW\ J.ve.
CUSTOMER NAME
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ZIP CODE q~ ~ J
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PARCEL NUMBER
(IF APPUCABLE)
ADJUSTMENT
ADJUSTMENT AMOUNT
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APPROVED BY,~ ;ÛA~·
FINANCE DEPARTMENT
CITY OF BAKERSFIELD
P.O. BOX 2057
BAKERSFIELD, CALIFORNIA 93303
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STATEMENT OF ACCOUNT
CITY OF BAKERSF!ELD
POBOx 2057
BÄKERSFIELD, CÂ 98808-2057
(661) 326-3658'
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DATE: 3/01/01
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TO: ALOHA RAINBOW BODY & PAINT
4176 PINEWOOD LAKE DR
BAKERSFIELD, CA 93309
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CUSTOMER NO:
30382 '
CUSTOMER TYPE: ESt
36911
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CHARGE DATE DESCRIPTION'" "REt=NtJMBER D,tJE'DATE' TOTAL AMOUNT
------ -------- -..:..~~-------~------..:..--------....:.. ~--i--j.-..,.¡~,--..~ --:l--_"':~~ --------------
I ,
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2/02/01 BE(HNNING BALANCE'
63.00
FOR GUESTIONS OR CHANGES TO YOUR ACCOUNT PLEASE
CALL THE NUMBER AT THE TOP OF THIS STATEMENT.
-------------- -------------- -------------- --------------
CURRENT OVER 30 OVER 60 OVER 90
-------------- -------------- -------------- --------------
63.00
DUE DATE: 4/02/01
PAYMENT DUE:
TOTÂL DUE:
63.00
$63.00
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CUSrE & NO. E5- 30 ~ "6 ~
MISCELLANEOUS RECEIVABLES ADJUSTMENT
DATE bd (-:00
NEW ACCOUNT i
ADDRESS CHANGE
CLOSE ACCT I
: FINANCE CHARGE I
'OTHER ADJ i \/
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CUSTOMER NAME A\D~o. 12:..; (\'oOlA'> 8x:J.y ¿ Po..ín t
MAILING ADDRESS Lr"\(b Pl 0ewoöd lR\c.~ Dr
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SITE ADDRESS d3'd-3 5 l h\õ\\ ~\f~ -#~
PARCEL NUMBER
(IF APPUCASLE)
'ADJUSTMENT
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STATEMENT OF ACCOUNT4It
CITY OF BAKERSFIELD
POBOX 2057
BAKERSFIELD, CA 93303-2057
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TO:
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ALOHA RAINBOW /~~ODY"t..;::PAIN~ "
2323 S UN I ON<J~'tE/;#3,j\ :", ~<5;, "
BAKERSFIELD) \'CA ~~39,g~>¿t/
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DATE:
6/01/00
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DATE pþSCRI8¡TION H, ,'REF-NUMBER DUE DATE
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CHARGE
TOTAL AMOUNT
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5/01/00 ,,~EGINN'ING BAt:A~~CE~
6/01/00$!"I~Q!JAI\!,..ITYI-ÍAzwASrEGEN
'THJ:ß FEE IS FOR'pMALL QUANTITY "GENERATORß: ,'OF HAZARDOUS
W~SrE. "
6/01/00 CASTATES!JRCHARGE~ 10.00
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c't
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50.00
HM018
SS001
CURRENT OVER 30 OVER 60 OVER ~o
-------------- -------------- -------------- --------------
60-:-(;o.Q
DUE DATE: 7/03/00
PAYMENT DUE:
TOTAL DUE:
60. 00
$60.00
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FINANCE DEPARTMENT
CITY OF BAKERSFIELD
p,o, BOX 2057
BAKERSFIELD, CALIFORNIA 93303
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BODY & PAINT
2323 # 3 SOUTH UNION AVE.
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CITY OF BAKER~ELD ~
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfiel 93301 (805) 326-3979
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V) \'1 FACILITY INFORMATION
~
7 Page Of '
e
I Year Beginning
100
101
- \SöDV
3 BUSINESS PHONE
102
SITE ADDRESS 23'23 ù~ (dyJ
5-
CITY
DUN&
BRADSTREET
COUNTY
OPERATOR NAME -JIIV\
103
106 SIC CODE
(4 Digit #)
105 !
107 i
I
104 CA ZIP
108 I
110 i
OWNER NAME
-J f ^'\ c....fLE6:l-l
OWNER PHONE 7 <47 - g--~3-b
i
112 I
I
I
113 I
OWNER MAILING
ADDRESS
417G
(~~'
Ut,,~
CONTACT MAILING
ADDRESS
NAME
~T
75l.ANCò
:~~;0~":¡~1j~;~i~gi~~!~~~ç~tç;@~[~çfu~jf)t
123 NAME .A:,...)6"éL ÁV ÂLÄ
125 TITLE ékJlÚé~
126 BUSINESS PHONE
ZIP
CITY
129
TITLE
CLJ>J'(,J't.......
130
BUSINESS PHONE
24-HOUR PHONE %"2 Î - () 5:.:< Cf
PAGER #
131
127 24-HOUR PHONE
:3 Z-~ - "?3;4~ I
132
133 ;
!
128 PAGER #
Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined
and am familiar with the information submitted in this inventory and believe the information is true, accurate, and complete.
SIGNATURE OF OWNER/OPERATOR DATE 134 NAME OF DOCUMENT PREPARER
NAMES OF OWNER/OPERATOR (print)
136 TITLE OF OWNER/OPERATOR
137
A}òDS (f~òPLt:¿-¡t(
P (5 fv5~L
c;t-J~&L .....\/I'V c.C2éC-ô-I IS. 6U3s?drJStalE ~L #.Aè_ ùJlA.s~
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OES FORM 2730 (7/9ð)
P;\OES2730,TV4,wpd
~ CITY OF BAKERSFIiLD
"FICE OF ENVIRONMENTAlPSERVICES
1715 Chester Ave., CA 93301 (805) 326-3979
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UNDERGROUND STORAGE TANK FACILITY
Page of
TYPE OF ACTION
(Check one item only)
o 1 NEW SITE PERMIT
o 3 RENEWAL PERMIT
o 4 AMENDED PERMIT
o 5 CHANGE OF INFORMATION (State Iype of change)
o 7 PERMANENTLY CLOSED SITE
o 8 TANK REMOVED
400
o 6 TEMPORARY SITE CLOSURE
I. FACILITY I SITE INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As)
3
FACILITY ID #
o 4 LOCAL AGENCY/DISTRICT'
o 5 COUNTY AGÈÑCY'
06 STATE AGENCY"
o 7 FEDERAL AGENCY'
402
NEAREST CROSS STREET
401
FACILITY OWNER TYPE
01 CORPORATION
o 2 INDIVIDUAL
o 3 PARTNERSHIP
BUSINESS
TYPE
o 3 FARM
o 4 PROCESSOR
o 5 OTHER 403
o 6 COMMERCIAL
01 GAS STATION
o 2 DISTRIBUTOR
TOTAL NUMBER OF TANKS
REMAINING AT SITE
Is facility on Indian Reservation or
trustlands?
'If owner of UST a public agency: name of supervisor of
division, section or office which operates the UST,
(ThiS is the contact person for the tank records,)
404
DYes
DNa
405
406
II. PROPERTY OWNER INFORMATION
PROPERTY OWNER NAME
407 PHONE
408
MAILING OR STREET ADDRESS
409
CITY
410 STATE
411 ZIP
412
PROPERTY OWNER TYPE
01 CORPORATION
o 2 INDIVIDUAL
o 3 PARTNERSHIP
o 4 LOCAL AGENCY I DISTRICT
o 5 COUNTY AGENCY
o 6 STATE AGENCY
o 7 FEDERAL AGENCY
413
'III.TÀNK O~ERINFORMATíON
PHONE
415
TANK OWNER NAME
MAILING OR STREET ADDRESS
416
CITY
417 STATE
418 ZIP
419
TANK OWNER TYPE
o 1 CORPORATION
o 2 INDIVIDUAL
o 3 PARTNERSHIP
o 4 LOCAL AGENCY I DISTRICT
o 5 COUNTY AGENCY
o 6 STATE AGENCY
o 7 FEDERAL AGENCY
420
TY(TK)HQ
IV. BOARD OF EQUALIZATIONUST STORAGE FEE ACCOÜNTNUMBER
Call (916) 322-9669 if questions arise
421
V. PETROLEUM UST FINANCIAL RESPONSIBILITY
INDICATE METHOD(S)
o 1 SELF-INSURED
o 2 GUARANTEE
o 3 INSURANCE
o 4 SURETY BOND
o 5 LETTER OF CREDIT
o 6 EXEMPTION
o 7 STATE FUND
o 8 STATE FUND & CFO LETTER
o g STATE FUND & CD
o 10 LOCAL GOVT MECHANISM
o 99 OTHER:
422
VI. LEGAL NOTIFICATION AND MAILING ADDRESS
Check one box 10 indicate which address should be used for legal notifications and mailing,
Legal notification and mailing will be sent to the tank owner unless box 1 or 2 is checked,
o 1 FACILITY
o 2 PROPERTY OWNER
o 3 TANK OWNER
423
VII. APPLICANT SIGNATURE
Certificalion: I certify Ihallhe informaliOll provided herein is true & accurale 10 Ihe besl of my knowledge
SIGNATURE OF APPLICANT DATE
424 PHONE
425
NAME OF APPLICANT (print)
426 TITLE OF APPLICANT
427
STATE UST FACILITY NUMBER (For local use only)
1998 UPGRADE CERTIFICATE NUMBER (For local use only)
(Formerly SWRCB Form A) July 1, 1998
P:\USTFAC-A,FM4,wpd
. CITY OF BAKER~ELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., CA 93301 (805) 326-3979
DADO
o DELETE
D REVISE
200
HAZARDOUS MATERIALS INVENTORY
Chemical Description Form
(one form per material per budding or area)
Page of
·'·"i. FÂêlUtv INFORMATlð~'~;
BUSINESS NAME (Same as FACILITY NAME or DBA· Doing Business As)
.. ....
.. ' .... .
,,'.' lI.ë~ËMICÁLlNFORMATlON
3 I
I
I
l.~~~~'~:~_~CA TlON
FACILITY 10 II
rIJ<;, If) E
C;ïCJYGf" f?CVVV1. ~'Ai 50 I DE oF
1 MAP II (optional)
DYes 0 No 202
204
CHEMICAL NAME
tJ L\;S TG:,
((A-,0T
(++'; I\//VC--L
o Yes 0 No 206
If Subject 10 EPCRA, refer to iinstrudions
207
COMMON NAME
EHS'
DYes DNa 208
CAS II
209
..:., EHS·~~~. aU ;u¡,Ooi1ts bei~ must ~¡,):'inV,
'lbs.', '.>. ;'.,:,¡
217
MAXIMUM ""7D
DAilY AMOUNT -->,
~GAl 0 å CUFT
. If EHS. amount must be in Ibs,
218 AVERAGE
DAilY AMOUNT
70
219
STATE WASTE CODE
210
213
215
216
220 .j.
222
223
TYPE
o p PURE
o m MIXTURE w WASTE 211 RADIOACTIVE DYes oNo 212 CURIES
~lIaUID D9GAS 214 lARGEST CONTAINER "30
o 2 REACTIVE o 3 PRESSURE RELEASE o 4 ACUTE HEALTH 05 CHRONIC HEALTH
PHYSICAL STATE
o s SOLID
FED HAZARD CATEGORIES
(Check alllhat apply)
ANNUAL WASTE
AMOUNT
~F'RE
UNITS'
o Ib LBS
o In TONS
221
DAYS ON SITE
STORAGE CONTAINER
(Check all that apply)
o a ABOVEGROUND TANK
o b UNDERGROUND TANK
o c TANK INSIDE BUilDING
~ STEEL DRUM
De PLASTICJNONMETALlIC DRUM
Of CAN
o 9 CARBOY
o h SilO
o i FIBER DRUM
OJ BAG
Ok BOX
o 1 CYLINDER
o m GLASS BOTTLE
o n PLASTIC BOTTLE
00 TOTE BIN
o P TANK WAGON
o q RAIL CAR
o r OTHER
STORAGE PRESSURE
;:(a AMBIENT
o aa ABOVE AMBIENT
o ba BELOW AMBIENT
224
STORAGE TEMPERATURE ~a AMBI~NT 0 aa ABOVE AMBIENT 0 ba BELOW AMBIENT
;',;. ',';, %Wr' '..:;'~;:"·¡i;#t~;ý·l;%:,···;·:r:¡;j;· '.t':::':1;0;~t~~99[~:~tlt~R9N§:NÍ.~;j~\~;;~:i(G(l"~E0?:1;*~~;~:r;:}jiÅ
o C CRYOGENIC
225
.'. " ,
'CASt#-
228
2 230
3 234
4 238
5 242
-...---.
227 o Yes 0 No 228
231 o Yes 0 No 232
235 o Yes 0 No 238
239 o Yes 0 No 240
229
233
237
241
243
DYes 0 No 244
245
SIGNATURE
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;;$IGNÄTURE
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DATE 246
OES FORM 2731 (7/98)
P:\OESZ731,TV4,wpd
. CITY OF BAKERSF.D
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., CA 93301 (805) 326-3979
"
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DADD
[] DELETE
D REVISE
200
HAZARDOUS MATERIALS INVENTORY
Chemical Description Form
(one form per material pe' building or area)
Page of
CHEMICAL LOCATION
1 MAP # (optional)
201 CHEMICAL LOCATION
CONFIDENTIAL (EPCRA)
203 GRID # (optional)
o Yes 0 No 202
204
~'~> ~;: ":'ê¿: i .
''''It&figM¡bÁtl~~6.R, MÀi,dN
"','<,';,
"
o Yes 0 No 206
If Subject to EPCRA, refer to iinstructions
CHEMICAL NAME
207
COMMON NAME
EHS'
o Yes 0 No 208
CAS #
209
FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief)
210
TYPE
o p PURE
o m MIXTURE
o w WASTE
211
RADIOACTIVE
o Yes 0 No
212
CURIES
213
PHYSICAL STATE
o s SOLID
o I LIQUID
o g GAS
214
LARGEST CONTAINER
215
FED HAZARD CATEGORIES
(Check all that apply)
ANNUAL WASTE
AMOUNT
o 1 FIRE 0 2 REACTIVE
o 3 PRESSURE RELEASE
o 4 ACUTE HEALTH
o 5 CHRONIC HEALTH
216
217 MAXIMUM
DAILY AMOUNT
218 AVERAGE
DAILY AMOUNT
219 STATE WASTE CODE
220
UNITS·
o ga GAL 0 cf CUFT
. If EHS, amount must be in Ibs,
o Ib LBS
o tn TONS
221
DAYS ON SITE
222
STORAGE CONTAINER
(Check all that apply)
o a ABOVEGROUND TANK
o b UNDERGROUND TANK
o c TANK INSIDE BUILDING
o d STEEL DRUM
o e PLASTIC/NONMETALLIC DRUM
Of CAN
o 9 CARBOY
o h SILO
o i FIBER DRUM
OJ BAG
Ok BOX
o I CYLINDER
o m GLASS BOTTLE
o n PLASTIC BOTTLE
o 0 TOTE BIN
o P TANK WAGON
o q RAIL CAR
o r OTHER
223
STORAGE PRESSURE
o a AMBIENT
o aa ABOVE AMBIENT
o ba BELOW AMBIENT
224
STORAGE TEMPERATURE
o a AMBIËNT
o aa ABOVE AMBIENT
o ba BELOW AMBIENT
o c CRYOGENIC
225
226
227 o Yes 0 No 228
231 o Yes 0 No 232
235 o Yes 0 No 236
239 o Yes 0 No 240
243 o Ye~ 0 No 244
229
2
230
233
234
237
4
238
241
5
242
245
OES FORM 2731 (7/98)
P;\OES2731,TV4,wpd