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Home My WebLink AboutUNDERGROUND TANK-C-11/03/92 ~ ø ,Jç&ft5 .¡~tI ~,~fÝ \ 13 ·"c - '30)("50 Ct?AI( ¡( G. TÞ /0, ()(X) ,,¡It£. TI<" 0 AJ,,1 Mfl~ - ".,t' . '.. i\ .f .~..~ . , .,-:.........; ... f~ ;.~ .~, . :ßVIL-Þ/Nj . ., . .- . . ,¡, .. . o l' 0111-' P-J £..1 Ñ K CøA~ 145'O<;~ UNIoN Þr'lf- UN\ON A\j£. ·'N f ~ Bal;.:ersfield Fire Dept. PERMIT No. $-C(J3:¡ ~ZARDOUS MATERIALS DIVISIOI "13_' UND~RCUND STORAGE TANK PRC AM , '", OOS, 32~-3CJ7~ ZJ30'G (/ PERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK SITE INFORMATION SITE 1'1 5"0 5. UNioN ADDRESS i3IJK~S¡:I&l.Þ ZIP CODE C¡3?0'7 APN FACILITY NAME D ð-- YY\ 'G N n: R P R f7fÇCROSS STREET rr¡ I tV.. '} TANKOWNER/OPERATOR De>NHEIAJ5 ' PHONE No. [505 "3ZZ Z227 MAILING ADDRESS -Y3<6Z TU~Col'Y/ CITY Æt1r6€S'fiELÞ ZIP CODE '?330g CONTRACTOR INFORMATION ' COMPANY f'(\ P £A.)V,RONmENrA¿ 5'£1/ PHONE No. ~$ $93 I/S/ LICENSE NO.~ ~'( 13 7CJ~ ADDRESS 3'1 (JI./ fY/A-N()({ CITY E~JrrE¡esr¡::rfEL.i> ZIP CODE 9330<lf INSURANCE CARRIER F.)(V\:QJe,l(!.ß\I\, b1·~MIQ. fis~()e~fl)~(WORKMENS COMP No. uJ(' 5/i'J - 73/.,5' PRELlMANARY ASSEMENT INFORMATION COMPANY '5Jtr/1"H .r14~SO C ADDRESS ~R..u IT va, 've. ç. ..¡. t"<e.-(l. TI 0 tIJ INSURANCE CARRIER ~1P':"--'€.A Fu f\) ù PHONE No. Cð'(5) 53q-791& ¡ LICENSE No. CITY ß¡¿s ç D ZIP CODE q.:3 3ó5? WORKMENS COMP No. TANK CLEANIN'G INFORMATION COMPANY (Y) f' £NÝtfCJAJMeNì19~ -:;teÝ PHONE No. 30Ç :>93" I,.S / ADDRESS š' '100 m 1P-v o~ CITY ðA,it:'~~ ZIP CODE 93:70 g WASTE TRANSPORTER IDENTIFICATION NUMBER 2G 95 C4'(()O() r;2~2.'¿¡7 NAME OF RINST A TE DISPOSAL FACILITY G'I 6S'ON G'V III Æ "AI ~t:/(/ 1'71- c... ADDRESS END OF'ComPlGRCI'¡q'L 4VG CITY Cl1ìŒRsFtE¿.DZIPCODE ~53C13 FACILITY INDENTlFICA TION NUMBER C /-1- D 9 go "<iJ"g3117 \ TANK TRANSPORTER INFORMATION COMPANY /Y} P 8NV I !<cH,JIYlf9VrJfL ADDRESS 3 '-10 0 m-Wð-R.. TANK DESTINATION (;OLD~N PHONE No. '5 9 y~ //~I LICENSE No. CAróW6'Z9'¿'"Y 7 CITY t'/II(13eSHE¿J.) ZIP CODE 7'33C?8 srr-rrG" I'YI £T4 L 5 TANK INFORMATION TANK No. AGE VOLUME CHEMICAL DA TES CHEMICAL / ~ STORED STORED PREVIOUSLY STORED I 1'1 10 000 GAS ~ 18-9/ 315 2 IIf t þ~ coo D, ESE L 71- 9/ D /(£5EL ¡1~lì!'~¡l~1ttt~1~~!'¡Î¡lìïl~~'i~rlf~i~~~~~"!;~~i~1.~ THE APPLICANT HAS RECEIVED. UNDERSTANDS. AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHEj( STATE. LOCAL AND FEDERAL REGULA nONS, THIS FORM HAS BEEN COMPLETED UNDER PENAL TV OF PERJURY. AND TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT. .t/l DON HE:/NS ~~ ~PPRÕV~ APPLICANT NAME (PRINT) APPLlCÂNT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED 1..-'--'·' ........#.-.....,.,...-,., ..,..,.,...,..._....~~-_.. 4IÞBAKERSFIELD FIRE DEPARTME~ HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 TANK REMOVAL INSPECTION FORM FACILITY D & M ENTERPRISES ADDRESS 1450 S. UNION AVE , OWNER DON HINES PERMIT TO OPERATE# 40466 CONTRACTOR M P ENVIRONMENTAL CONTACT PERSON MIKI LABORATORY #OFSAMPLES TEST METHODOLOGY 8020, 8015 - GAS & DIESEL, METHOD 5030 PRELlMANARY ASSESSMENT CO.D. SMITH ASS. CONTACT PERSONDUANE SMITH CO2 RECIEPT LEL% O2% PLOT PLAN 1 N 3t~INn c: C\J,' f.J. "') (OOQ'O 3-l~)I>~.:J oi,)C:Of. ~() o ;t OG>o'OJ @:¿l o~\. ~~. ç\J15~ 9 1",~H')I¿ )\ "', CONDITION OF TANKS CONDITION OF PIPING CONDITION OF SOIL COMMENTS 10/09/92 DATE JOE DUNWOODY INSPECTORS NAME SIGNATURE ø ,Jçe,tt5 i~t! 'i)\~(v 111 ·"oJ "30)("30 co.(¡(I(~rt: e e ,.," '!' ( ;0-. ~ .f , .~ .,"11, .. tþ~ /\ :,!, . . ~ . ' ~. ,t" A' : /(),fXX) jÆ£. TI<' 0 o ~L,1 Æ7PH 1'CNIl1r>JlrIÑIÁ . I (;,A1Í- iBvr"D'Nj /45'() ~, UNioN Pry€. UN \0 N A\j£. ·N ¥ Bakersfield Fire Dept. PERMIT No. ~ JikAZARDOUS MATERIALS DIVIS1c:w. ;:. ~ 'OO-~ - UN~GRCUND-STORAGE TANK PRGW1AM II '-''1- ~ ZIP CODE 93?Cí7 APN FACILITY NAME D ~ m ~ f\\ rE R P R I5f>CROSS STREET fYll N~ ~ TANKOWNER/OPERATOR f)oNHEIAJS PHONE No. g05 '$ZZ 2227 MAILING ADDRESS 7'3<62 TU~coñ1 CITY gl1KéØ'fiELð ZIP CODE 9'33C)<8' CONTRACTOR INFORMATION " ;/ COMPANY {YI P ENVIRoNmENTAL. S'R,V PHONE No. ~5 393 l/sl LICENSE No.1? (13 7(7b ADDRESS 3'1"0 rnA-I\Jo{( CITY ffA.I('rE¡esr¡:rfEl-V ZIP CODE 93307f INSURANCE CARRIER A{V\:~,\!!.IH'\J blð MIQ. AS~ltel4f\)~(WORKMENS COMP No. IÆJ(' 51i'1 - 7aC)ð' PRELlMANARY ASSEMENT INFORMATION COMPANY "'Sl1It.,..H .f-Æ~SO C ADDRESS ~R..U\Tu",,'ve f",r¿{~Î/o\4J INSURANCE CARRIER S1-P,:ì'~ Fu I\j ù PHONE No. Q'C5) 53Cf-781& r LICENSE No. CITY ß~s ç D ZIP CODE q 3 30)1 WORKMENS COMP No. TANK CLEANING INFORMATION COMPANY (Y) fJ £NV(feJl\JI'Y/6N77'1L.. ,>~ý PHONE No. 30Ç :5"93 11'5/ ADDRESS ~ LfC7f:'/ ¡;YI1f?v otC CITY óA£!7'S'FieL¿) ZIP CODE 9'3 Jo g WASTE TRANSPORTER IDENTIFICATION NUMBER 2G 95 C4'T~O() & 2~2A'7 NAME OF RINSTATE DISPOSAL FACILITY G t650N ErvVI'¡¿O/V.Þ1té-;'t,n'7r.c.... ADDREssE;y D 0 F Co /'Y1 /J1 G R C I~L 4V!Z CITY g/jìŒRsFIE¿'f) ZIP CODE '7"330?J FACILITY INDENTlFICA TION NUMBER C /-f D 9 go If<g 3/17 \ TANK TRANSPORTER INFORMATION COMPANY /Y} P ENV I R.OA./IY/Gv17Jr(.. ADDRESS 3 'fo 0 rl/t"V\)()-R.. TANK DESTINATION (;()L D ~N PHONE No. '39 Y-I/>7 LICENSE No. (A'í'ðW6'Z?,¿,cr 7 CITY ¡f/Jl(13e5FIE¿J> ZIP CODE 7'33C?8 S~G' m£T4L5 TANK INFORMATION TANK No. AGE VOLUME CHEMICAL DA TES CHEMICAL I STORED STORED PREVIOUSLY STORED 1'1 10 ()OO GA$ 78-9/ 3 A_5' 2 IIf I ð, 000 DI ESE L 11- 91 D/~5'EL ';~~!ª!~!;i~l~!{~~'~II.îilllf~Jj.1¡~~¡¡I~¡i~~ß~,;;~¡~~~,%~.~ THE APPliCANT HAS RECEIVED. UNDERSTANDS. AND Will COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE. lOCAL AND FEDERAL REGULA nONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY. AND TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT. ij)kJf~ DON H~INS ~~ ~PPROVED BY: APPLICANT NAME (PRINT) APPLlCÁNT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED _.,...._...u~.... . ........~~_........__.-. -----... . \ "1+ - ¡ l F I \ 'I I I t 1 ¡ l , - I 1 ¡ 1 1- 'I I I i I I I. 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('. l../j ( '.\ ';¡. . . - ',i .,' 1~ ~- -""--' ~-- --- . +- ~--- . ~ ---- -. - - .4¡ 7 J~IQe 1977 Dote BAKERSFIELD FIRE DEPARTMENT BUREAU OF FIRE PREVENTION APPLICATION ft. 016 Application No. In conformity with provisions of pertinent ordinances, codes and/or regulotions, application is made by: mol E<p.Jfpltleftt cn~IIGy Name of Company 1450 s. Un10a Aveaue Address to display, store, install, use, operate, sell or handle materials or processes involving or creating con- ditions deemed hazardous to life or property as follows: , _ , n, non 'v1 'nft ttnitp.rg,-m1nd g.aAnHn~ R~n1"agP- tank.~ 'Z~"'IJ-~ M~~~...................,...... Authorized Representative issued () t.JP /) . I Permit ~ .7"~t;.¡..tf..22.--- By____....,..C2...LU ~::£~)........---..---.....---... ?~. ~ - ---~- ---- ])6Il 111 lJIe 5_ b+rv\ U(t;1 t-¡ û~ "'.' . . ,~I' ;~ ~ ;~ , r \....;:~ ,: ..¡.=; . " i">:<::.r{'''_î~ 'v '';'J ~ j ~"!JZz-Z7Z7. ,j . T ,). '. 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V J ~~___ ~.:,~Jv'~!~'~~ t ~ ." e - 51 ATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM A COMPLETE THIS FORM FOR EACH FACILITYISITE MARK ONLY ONE ITEM o 1 NEW PERMIT o 2 INTERIM PERMIT o 3 RENEWAL PERMIT D 4 AMENDED PERMIT o 5 CHANGE OF INFORMATION J2J7 PERMANENTLY CLOSED SITE o 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS· (MUST BE COMPLETED) E OF OPERATO PARCEL 1/ (OPTIONAL) D PARTNERSHIP D LOCAL·AGENCY DISTRICTS D ./ IF INDIAN 1/ OF TANKS AT SITE E, P. A. I. 0.1/ (optional) RESERVATION ;;? OR TRUST LANDS D COUtiTY·AGENCY D STATE·AGENCY D FEDERAL-AGENCY TYPE OF BUSINESS D 1 GAS STATION D 2 DISTRIBUTOR o 3 FARM 0 4 PROCESSOR ø-Þ"0THER EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY)· optional DAYS; NAME (LAST, FIRST) . PHONE 1/ WITH AREA CODE DAYS: NAME (LAST, FIRST) PHONE 1/ WITH AREA CODE NIGHTS: NAME (LAST. FIRST) PHONE 1/ WITH AREA CODE NIGHTS: NAME (LAST. FIRST) PHONE 1/ WITH AREA CODE D lOCAL-AGENCY CARE OF ADDRESS INFORMATION CITY NAME ,/ box 10 indica1e D INDIVIDUAL D CORPORATION D PARTNERSHIP STATE ZIP CODE D LOCAL·AGENCY D STATE·AGENCY D COUtiTY-AGENCY D FEDERAL-AGENCY PHONE 1/ WITH AREA CODE IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER· Call (916) 739·2582 if questions arise. TY(TK) HQ 3EJ-ITIIIIJ V. LEGAL NOTIFICATION AND BILLING ADDRESS legal notification and billing will be sent to the tank owner unless box I or II is checked, CHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTIFICATIONS AND BILLING: I. D ~ III. 0 THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT ~ CENSUS TRACT 1/ . OPTIONAL FACILITY # ~ JURISDICTION # lOCATION CODE· OPTIONAL SUPVISOR - DISTRICT CODE ,OPTIONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION· FORM B, UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY. FOR0033A·R2 FORM A (9'90) --.« _---=¡--,-~ -0--_ __<;;.. ~-----'---:-~-"--¡r-::-- -;~'>"J."", ,¡:--". - - I!NSTRUCnONS !FOR COMPLEnNG FORM"N GENJERAL I!NSTRlJCi.'!ONS: 1. One FORM "A" shall be completed for ¡¡It NrnI'J 1PERMJlJS, 1F'::~i?.JVIJlT CBANGES or any ll'ACJ!Ull'V ¡SliTE iN1FORMA'fiON CHANGES. 2. SUBMO" ONLY ONE (1) ]<'ORM "A" for a Fa<:ílity/Site. regardless of the number of tanh Io<:ated at the site. 3, 1ñis form should be completed by either the PER:vllT All'!?UCi"Nr or the LOCA.L AGENCY UNù)ERGROUNIJ TANK INSPECTOR. 4. Please type or print dearly at! requested information. 5. Use a hard point writing instrument, YOII are making 3 topics, Tor OP FORM: "MARK ONLY ONE rDEM" :L Mark an (X) in the box n'èxfto the item that bestdèscribes the reason the form is being completed, I. I!IACnX,IYjSH¡¡ JlNI"ORMA'fiON &. ADDRJESS (MUST AnI COMJPJiJl~nJD) 1. Record name and address (physical location) of the underground tank(s). NO'!1'!: Address MUST have a valid physical location induding dty, r,tate, and zip code.. ¡>.O. BOX NUMBn,!JR ARE NO-I" ACCJ!WTAI!UJE, Include nearest cross street and name of the operator. 2. Phone number must have an area code. If the night number is the same, write "SAME" in proper location. 3. Check the appropriate box for TYPE OF BUSINESS OWNERSHIP (ex. CORPORATION, INDIVIDUAL, etc.) 4, Check the appropriate bòx- for 1YPE OF BUSINESS. 5, If Facility/Site is located on land within an indian reservation or other indian trust lands, check the box marked ";'ES'. Ú. Indicate the NUMBER of TANKS at this SITE- 7. Record the E.P.A. ID if or write "¡';ONE" in the space provided. H. R'ROi'EKiY OWNER INFORMAT!ON &. ADORE.')S (MUST BE COMPLEH,ìED) L Complete all items in this section, unless all items are the same as SECT10N 1; if the same, write "SAME AS S11!" across this section. Be sure to check PROPERTY OWNERSHIP TYPE box. m. TANK OWNER INFORMATiON &. A!mRFSS (MUS'r BE mMPIJETllID) I. Complete all items in this section, unless all items arc thc same as SECnON 1; If thc same, writc "SAME AS S'.TJE" across this section. Be sure to check TANK HWNER')¡Ur TYPE box. . ' xv IBOARD OF EQUAUZA110N US'!' s:roRAGE FEE Aœ.oUNT NUMBER (Musr !BE COf\lJJ"U:m:~D) Enter your Board of Equalizatkm (13013) usr stOC3gc fee account number which is required before your pcm1ìt applicatíÜn ean . be processed. Registration with the HOE will ensure that you will reçeive a quarterly storage fee return in ,reportinglhe SO,006 (6 mills) per'gallon fee due on the number of gallons placed in your USTs. The HOE will code persons exempt from paying the storage fee so returns will not be sent. If you do not have an account number with the HOE or if you have any questions regarding the fee or exemptions, please call the BOE at 916-739·2582 or write to the DOE at the following address: Board of Equalization, Environmental Fees Unit, P.O. Box 942879, Sacramento, CA 94279·0001. V. LfJ,GAL NŒWK'ATION AND BILLING ADD RES..'; 1. Check ONE BOX: for the address that will be used for 130Tìfn UìGAt AND mlJIJNG N011F¡CA110NS, APrUCA]\nr MUSJr SEON AND DATE 11m FORM AS JlNDlIC:A'ŒD, INSTliWCTñONIT'OR 11m LOCAJL AGENC!nBS The county and jurisdiction numbers are predetermined and can be obtained by calling the State Hoard (916)739·2421. The facility number may be assigned by the local agency; however, this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the facility number, please Icave it blank. . iT is THE )!U,ìSI"ONSmIUTY OF THE UK',AL AGIF.NCY TE.ii:AT INS?JHCì['S THE Ji'ACILliT'l 'ro VElRWY T! m AC£UJI"'A'CY OF THE INFOFMATiON. 'nus APPUC:AlIì!ON Ü\NNOT BE JPlROC1IìS..'mn IF 'Jlm mm ACCOJNT NUMBER is NOT FiLLED UN, THE UJCAL AGJENCY ¡¡S RI!1...<;n>ONsmu~ FOR T!m COMJ¡>urmON Oi'THE "U)CAL AGENCY USJ..~ ONLY' INFORMA110N BOX: ANJI)]j10R Ji'ORWARDING ONE FORM oN AND AS,.<;OOATIED ITIORM "B"(s) TO THE FOUl.OWING ADDRlìS..<;' , ·S'!'!!.1,]!! OF ¡CAJUl10RN11A STATll,Î WATER RESOURCES CON'mŒ,OOARD C/O S.W.E.EJ!',S. DATA PROLjE..')SING CENTER r,o. oox: 5Z7 PARAMOUNf, CA %723 ~, -~----~-~ --------=--~ -·_~_~-,w-_ .j". - - STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM A MARK ONLY ONE ITEM pij R O~I~~~/i\[bCOMPLETE THIS FORM FOR EACH FACILITYISITE D 1 NEW PERMIT D 3 RENEWAL ~ERMIT D 5 CHANGE OF INFORMATION J2r 7 PERMANENTLY CLOSED SITE D' 2 INTERIM PERMIT D' 4 AMENDED PERMIT D 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS· (MUST BE COMPLETED) D~A.oR FACILITY ~AME _ i NAME OF OPERATOR. / , ' '/' 1/ I C·"/fP.r >'/CçS- .~:.. "/'("; .'/./.... ADDRESS .. I NEAREST CROSS STREET / ~I ~: G ì _-" /l·} I 'II 1/ I (~.- CITY NAME ) ¡...., STATE ZIP CODE ~/r;(ì/'-.p¡,~ 't-1J¿ CA ~:;;; ~\)-/ ,/ BOX ~ TO INDICATE D CORPORATION ~ INDIVIDUAL D PARTNERSHIP D LOCAL·AGENCY D COUNTY-AGENCY DISTRICTS D ,/ IF INDIAN # OF TANKS AT SITE RESERVATION OR TRUST LANDS PARCEL # (OPTIONAL) SITE PHONE # WITH AREA CODE .";,,,' .') --, ")')':1'/ )-0 ,,~....- ¿;.= - _-,' C D FEDERAL-AGENCY D STATE·AGENCY TYPE OF BUSINESS D 1 GAS STATION D 2 DISTRIBUTOR D 3 FARM D 4 PROCESSOR ..I2I-!r OTHER E. P. A. I. D. # (opt/OIIsl) c -~-- EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY). optional DAYS: NAME (LAST, FIRST) PHONE # WITH AREA CODE DAYS: NAME (LAST, FIRST) PHONE # WITH AREA CODE NIGHTS: NAME (LAST, FIRST) PHONE # WITH AREA CODE NIGHTS: NAME (LAST, FIRST) PHONE # WITH AREA CODE II. PROPERTY OWNER INFORMATION· MUST BE COMPLETED NAMï ", " i. . / ,.- I. /.." Itk / 1/___ MAILING OR STREET ADDRESS- /'1/:; »;; //......../ t )¡"t .,/ '- . ¡/ (- '.' , CITY NAME /, I {' 1/; 7 if' (- I.S 1-1 (,,0( CARE OF ADDRESS INFORMATION L"J.' ../ ~_. r ;. ,r .þ.'~ ,/ box 10 indicate ..!ZnNDIVIDUAL D CORPORATiON D PARTNERSHIP STATE,' ZI":C,9Df .--. /..':¡¡/I. ..'/ " ,.) () V (.... ~. j_'. J D LOCAL·AGENCY D STATE·AGENCY D COUNTY·AGENCY D FEDERAL·AGENCY PHONE # WITH AREA CODE 'J: ~I' --, c' J J .. ':'.--, ~) --/ ._ ( j.../ . :~/40t:..... :" - "~:. / III. TANK OWNER INFORMATION· (MUST BE COMPLETED) NAME OF OWNER CARE OF ADDRESS INFORMATION ;; /://,1 ,/ "..:/ - <,),-£..,,::/ ¿>'--€--. MAILING OR STREET ADDRESS ,/ box to indicate D INDIVIDUAL D LOCAL·AGENCY D STATE·AGENCY D CORPORATION D PARTNERSHIP D COUNTY·AGENCY D FEDERAL·AGENCY CITY NAME STATE I ZIP CODE I PHONE II WiTH AREA CODE IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER· Call (916) 739·2582 if questions arise. TY(TK) HQ 03J-[mIIJ V. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked, CHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTIFICATIONS AND BILLING: I. D ~ III. D THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT /... .' APPLlCANrs TITLE -r / ''7 / /.. / """. /- , ' , /// r 'I' '1 _,/,,'/[ '-.. /. / .' , . JURISDICTION # ~ FACILITY # ~ LOCATION CODE· OPTIONAL I CENSUS TRACT # - OPTIONAL I SUPVISOR - DISTRICT CODE - OPTIONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION· FORM B, UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY. FO RM A (9.90) FOR0033A·R2 e e INSTRUCTIONS FOR COMU)UJI1NG FORM oN GENERAL INSTRUCnONS: L One FORM "A" shaH bc completed for all NIEW J¡>ERMnS, PERîv:IE';;' C Sl,N::j;ES or any 11àC!IIZû1f /SnE INFORMATION CHANGE.<), 2. SUHMn' ONLY ONE (1) FOR],'!'! "A" for a Facil¡tyJSIl(~, reg.mJkss "f ,he nclnlbcr of ê;;nks located at the sitc, 3. This form shoulcì be comp!c:teù by eIther the PERMIT APJ¡>U(::J\!\!T lIT ¡he LUCh,. AOEi'¡CY iUNDII.RGIROU!\::) TAN;;( HN~l>ECTOK 4. PJeasc type or print clearly all requested information, 5. Use a hard point "'/Titing instrument, you arc making 3 ('opies. TOP OF FOR!Vt "MARK ONLY ONE !TEMØ :L Mark an (X) in the box next to the Item that best deserihes the reason the fl,rm is belng completed, l R?AO¡XnfjSfm IN'i1()RMATmN & ADD RES,,) (j',¡mST BiE COMPLE'!lI.D) L Record name and address (physical location) of the underground tank(s). NO'n~: Address MUST have a valid physIca! !ocation incJudjng Ôty, :;tate, and lip code, P.O, BOX NUMBER ARE NOT Aea~J1rARlLR ¡¡¡dude nearest cross streeT and name of the. operaTor. 2. Phone number must have an an;a code. If ¡he night number Ì> the same, write "$/\;\'iC' in proper locatino. 3. Cheek the appropriate box for TYPE OF BUSINESS OWNERS!!!!' (ex. CORPORATION, INDIVIDUAL, cte,) 4. Check ¡he appropriate box for TYPE OF BUSINESS. 5. If FaÔJityjSI¡e is !oca1cd on land within an indi,1O reservation O[ other indian Ims! hinds, check the box ma"ked "YES". 6. Indicate the NUMBER of TA.NKS at this SITE, 7. Record the EP,A ID# or write "NONE" in the space provided, HI, PROPERTY OWNER TNFORMA'IlON & ADDRE.<;S (MUST HE COMPLEn¡rr)) L COl11pkte all items in this section, unless all items arc the same as SECnON I; if the same, write "SAME AS Sr"1~o across this section. Be sure to check PROPERTY OWNERSllIP TY PE box. m, TANK OWNER INFORMNnON &. ADDRFX" (MUST BE CO!\í1PUn:ED) 1. CompJete a11 items in this section, unless all ¡'ems ilre th.:: same as SECnO\; 1; If thc same, wrile "SI\I<i2E AS 5>1,:,~" across this see! ion. Be sure to checK TANK OWNER.<;]HI? 'IYR'E box. IV BOARD OF I'Á)UAUj"Al10N UST STORAGE FEI:!. AOCüUNr N[Jfv.mm<:. eMUST S1'\ Enter your Goard of Equa¡¡zati(jn (HOE) LST storage fce account number ·.,¡hieh is reqmrtd hefore your permit app¡¡~;!tton can be proccssed. Registration wl,h thc BOE wiH ensurc ¡hat yo," ",i]l rc(C¡ve a qUi\rtèrly storage fee return in reporting r~ $O.lYìö (Ü míifs) per ga!1on fee due on ,he number of gal!ons placcd in your LiSTs, The BOE witi code persons c"cmp¡ fr<)n~~aying the storage fee so returns wil! not be sent. If you do not have an acroum l1umber with the HOE or if you have any quest; )'\5 reg¡trding the fee or ex.::mptions, pka¡,c call the BOE at 91(j.. ì39·25R2 or write to the nOE at the fo!JowUJg address: dnrd of Equalization, Environmental Fees Unit, P.O. Box 942879, Sacrm11ento, CA 94279-000L V, U'.GAL NGTW¡CATlON AND mU..!NG ADDRE,<;"<;; 1. Check ONE BOX foj' the address that wiU be used for BOTlìJ U!G1\'. !,l'!ÐWUJNC¡ NGT~['!CATRONS. AR>PUCANf MUST SEiGN ¿"'ND DATE THE FORM AS TINIH<:::tnY!!}. INS'nmCT¡;ON ¡¡lOR Tn:<: ';.OCAL Am~NC'1iFS The county and jurisdiction numbers are predetermined and can be ohtained by caHing the State Board (916)739·2421. The facility number may be assigned by the local agency; however. This number must be numerical and cannot contain an a!"habet. If ¡he local agency prefers the State Board to assign the facility numb¡:r, please !eave it blank. n is ',fUn JR.E..'WONSmILITY OF THE LOf'AL AŒ,1NCY 'n U"T !í'Js:>j[!crs '~'HE ~lAC;::L!TY 'r:) VH!í'i{"ll',;( T! W, ACCùRAC'V OF TIBrE INFOFMA'U10N, Tms AJf'PUlC/\'flfON C/\Nf\JOT m,! PROC1L¡s..<;;~!~) IF TEE o.m! Ace!:, '1\'1' NUMBER lìS NOT FiLLED iN, THE HK'AL /\UlìiJ'JCY IS R[!...WONS¡BU~ FOR THF CŒVœLEIí1QN Œ' 'H m ,.~ .ÜC1'L AGENC.Y USE ONLY' INFORMA'nON BOX AND FOR FORWARDING ONE U'ORM oN AND ASSOOA'H¡;:~ ','mUJ1 "B"(s) '1'0 nIE POI.lLOWING ADDRES..'>. S1'ATJE OF CAUFORNli.A srA'm WA'1T1!R RESOURCIHS CONTiftGI. EûAIRD C/O S,W,ITULP,S. DATA pROCJ[....'*iING CENfiEIK P.O. OOX 5Z7 I?AAAMOUN:I', C¡\ %123 e ---- I I - STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ONE ITEM o 1 NEW PERMIT o 2 INTERIM PERMIT o 3 RENEWAL PERMIT o 4 AMENDED PERMIT DBA OR FACILITY NAME WHERE TANK IS INSTALLED: ~VV\ o 5 CHANGE OF INFORMATION 0 7 PERMANENTLY CLOSED ON SITE o 6 TEMPORARY TANK CLOSURE ,.;:a-8 TANK REMOVED Y'1 Se S I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK L D. # B. MANUFACTURED BY: 7 . D. TANK CAPACITY IN GALLONS: oC!:) ê) II. TANK CONTENTS IFA-1ISMARKED,COMPLETEITEMC. A. )2r1 MOTOR VEHICLE FUEL 0 4 OIL B. C. 1a REGULAR 0 3 DIESEL D 6 AVIATION GAS UNLEADED D 080 Q"1PRODUCT 4 GASAHOL o 7 METHANOL o 2 PETROLEUM EMPTY 0 1b PREMIUM UNLEADED D 5 JET FUEL o 3 CHEMICAL PRODUCT o 95 UNKNOWN D 2 WASTE D 2 LEADED D 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.# : III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC, AND ALL THAT APPLIES IN BOX DAND E A. TYPE OF 0 1 DOUBLE WALL D 3 SINGLE WALL WITH EXTERIOR LINER D 95 UNKNOWN SYSTEM ~ SINGLE WALL - D 4 SECONDARY CONTAINMENT (VAULTED TANK) D 99 OTHER ~ BARE STEEL D 2 STAINLESS STEEL 0 3 FIBERGLASS D 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC B. TANK MATERIAL o 5 CONCRETE D 6 POLYVINYL CHLORIDE 0 7 ALUMINUM D 8 100% METHANOL COMPATIBLE WIFRP (Primary Tank) 09 BRONZE D 10 GALVANIZED STEEL 0 95 UNKNOWN D 99 OTHER 01 RUBBER LINED 0 2 ALKYD LINING 0 3 EPOXY LINING D 4 PHENOLIC LINING C. INTERIOR D 5 GLASS LINING ~NlINED 0 95 UNKNOWN D 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO_ D. CORROSION 01 POLYETHYLENE WRAP o 2 COATING D 3 VINYL WRAP D 4 FIBERGLASS REINFORCED PLASTIC PROTECTION 05 CATHODIC PROTECTION ~ NONE D 95 UNKNOWN D 99 OTHER E. SPILL AND OVERFILL SPILL CONTA~NMENT INSTALLED (YEAR) -&-' OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) -ð-- IV. PIPING INFORMATION A. SYSTEM TYPE B. CONSTRUCTION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 99 OTHER A U 95 UNKNOWN A U 99 OTHER BARE STEEL A U 2 STAINLESS STEEL A U U 5 ALUMINUM A U 6 CONCRETE A U U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 o 1 AUTOMATIC LINE LEAK DETECTOR 0 2 LINE TIGHTNESS TESTING 4 FIBERGLASS PIPE 8 100% METHANOL COMPATIBLE WIFRP 99 OTHER V. TANK LEAK DETECTION o 1 VISUAL CHECK 0 2 INVENTORY RECONCILIATION 03 VAOOZEMONITORING 04 AUTOMATIC TANK GAUGING 0 5 GROUNDWATER MONITORING o 6 TANK TESTING 0 7 INTERSTITIAL MONITORING ~NONE 0 95 UNKNOWN D 99 OTHER 2. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 3. WAS TANK FILLED WITH INERT MATERIAL? YES D MPLETED UNDER PENAL TY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT Jrx!- STATE 1.0.# TANK # ~ PERMIT NUMBER FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION· FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOR0034 B-R5 ~~~."'-~"":7~ :- -- -:-v-- e e INsrRucnONS [lOR COMPLRTING ¡IQRM "ß0 GENERAL INSJrRUCTIONS: 1. One FORM "13" shall be completed for each tank for all NEW PERMITS, PERM]!T CHANŒ:ìS, JREMOVAI~<; and/or any other TANK INFORMA1l0N CJHlANGJB. 2. This form' should be completed by either the PERMIT APPUCANT or the U)('.AL AGENCY UNDERGROUND TANK INSPJF...croR . 3. Please type or print dearly all requested informatio~. 4. Use a hard point writing instrument, you are making' 3 copies. TOP 011 FORM: "MARK ONLY ONE fl1!M" 1. Mark an.(X) in the box next to the item that best describes the reason the form is being completed. 2. Indicate the DBA' or Facility name where the tank is installed. l TANK DIF.5CRIŒ"110N - COMJ.>IEJI1E JillL n'EMS - IF UNKNOWN - SO ~'PECIFY A. Indicate owners tank ID # - If there is a tank number that is used by the owner to identify the tank (ex. ABìOì89). B. Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG,). C. Indicate the year the tank was installed (ex. 1987), D. Indicate the tal1k capacity il1 gallol1s (ex. 25,000 or 10,000 etc.), II. TANK CON'ŒNTS A. 1. If MOTOR VEHICLE FUEL, check box 1 and complete items B & c. 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D. B. Check the appropriate box. C. Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in A), D. Print the chemical name of the hazardous substance stored in the tank al1d the c.A.S.#. (Chemical Abstract Ser'Vice number), if box 1 is NOT checked in A. m. TANK CONSTRUCTION - MARK ONE UEM ONLY IN BOX A. n, C & D 1. Check only one item in TYPE OF SYSTEM, TANK MATERIAL, INfERIOR LINING and CORROSION PROTECI10N. 2. If OTHER, print in the space provided. IV. PIPING IINIIQRMATION L Cirde A if above ground; circJe U if underground; and circle both if applicable. 2, If UNKNOWN, circle; or if OTHER, print in space provided, 3. Indicate the LEAK DEI'ECI10N system(s) used to comply ",ith the monitoring requirement for the piping. V. TANK U1AK DETECnON 1. Il1dicate the LEAK DEn:cnoN system(s) used to comply ",ith the monitoring requirements for the tank. Vl INIIQRMATION ON TANK PERMANIßN'I1,Y CJLOSJ!ID IN PlACJE 1. ES"I1MATED DATE LAST USED - MONITljYEAR (Jal1uary, 1988 or 01/88). 2. ESTIMATED QUANITIY of HAí'ARI)OUS SUBSTANCE remail1ing in the tank (in Gallons). 3. WAS TANK FILLED WITH INERT MATERIAL? Check 'Yes' or 'NO'. APPUCANI' MUSf SIGN AND DATE ~nrn FORM AS J!NDICATJEID. INSTRUCnON FOR nm LOCAJ!, AGENC1R<; The state underground storage tank identificatiol1 number is composed of the two digit county l1umbcr, the thrce digit jurisdiction number, the six digit facility number and the six digit tank number. . The county and jurisdiction numbcrs are predetermined al1d can be obtained by calling the State Board (916)739·2421. The facility number must bc the same as shown in form "N. l11e tank number may be assigned by the local agency; however, this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please Jeave it blank. IT IS nm RESPONsmruny Œl TIm JLOCAJL AGENCY TI1fAT INSPECTS TUE FACU,ITY TO VERIFY 111m ACC'URACY Œi nm INFORMATION. THE I.û(,.AI, AGENCY IS JRR<)J¡>ONSmU! ¡lOR TIm COMPLEnON OF TIm °VOCAJL AGENCY USE ONJLYw JIM"ORMAnON BOX AND JI"OR I?ORWARDING ONE lTlQJRM ON AND AS..<';o('1A·1'ED FORM "UO(s) TO TIlE FOULOWlTNG ADDJRR"i..<;, SI'ATE OF CAUlTlQRNJlA SJrATE W ATEJR JRR<;OURCES CON'I.Xo[, BOARD C/O S,W .E.E.p,s. DATA PRoœ..ssING CJEN1'ER P.O. BOX 5Z7 . PARAMOUNT, CA 90723 \ \ e . STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM 8 COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. DBA OR FACILITY NAME WHERE TANK IS INSTALLED: ¿; ¡ Vì 5 CHANGE OF INFORMATION 0 7 PERMANENTLY CLOSED ON SITE 6 TEMPORARY TANK CLOSURE ~8 TANK REMOVED 'r¡Jr/SPS MARK ONLY ONE ITEM o 1 NEW PERMIT o 2 INTERIM PERMIT o 3 RENEWAL PERMIT o 4 AMENDED PERMIT I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK L D. # / B. MANUFACTURED BY: 7 C. DATE INSTALLED (MO/DAYNEAR) 1'7 7 ~::;/ D. TANK CAPACITY IN GALLONS: J D 000 II. TANK CONTENTS IFA-1ISMARKED.COMPLETEITEMC, A. )2ri MOTOR VEHICLE FUEL 0 4 OIL B. C ~a REGULAR 0 3 DIESEL o 6 AVIATION GAS . UNLEADED 0 ~RODUCT 4 GASAHOL o 7 METHANOL 02 PETROLEUM 0 80 EMPTY o 1b PREMIUM 0 UNLEADED 5 JET FUEL 03 CHEMICAL PRODUCT 0 95 UNKNOWN o 2 WASTE o 2 LEADED 0 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF (A.1) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C. A. S.#: III. TANK CONSTRUCTION MARKONE ITEM ONLY IN BOXES A, B, AND C, AND ALL THAT APPLIES IN BOX DAND E A. TYPE OF 0 1 DOUBLE WALL 0 3 SINGLE WALL WITH EXTERIOR LINER 0 95 UNKNOWN SYSTEM )a-2 SINGLE WALL - 0 4 SECONDARY CONTAINMENT (VAULTED TANK) 0 99 OTHER J2r1 BARE STEEL 0 2 STAINLESS STEEL 0 3 FIBERGLASS 0 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC B. TANK MATERIAL o 5 CONCRETE 0 6 POLYVINYL CHLORIDE 0 7 ALUMINUM 0 8 100% METHANOL COMPATIBLE W/FRP (Primary Tank) 0 9 BRONZE 0 10 GALVANIZED STEEL 0 95 UNKNOWN 0 99 OTHER 01 RUBBER LINED o 2 ALKYD LINING 0 3 EPOXY LINING 0 4 PHENOLIC LINING C.INTERIOR 0 5 GLASS LINING ~UNlINED 0 95 UNKNOWN 0 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES - NO - D. CORROSION 01 POLYETHYLENE WRAP o 2 COATING o 3 VINYL WRAP 0 4 FIBERGLASS REINFORCED PLASTIC PROTECTION 05 CATHODIC PROTECTION.Ja"'91 NONE o 95 UNKNOWN 0 99 OTHER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) ~ OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) ~ IV. PIPING INFORMATION A. SYSTEM TYPE B. CONSTRUCTION C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH BARE STEEL A U 2 STAINLESS STEEL A U 3 5 ALUMINUM A U 6 CONCRETE A U 7 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION o 2 LINE TIGHTNESS TESTING A U 99 OTHER A U 95 UNKNOWN A U 99 OTHER o 1 AUTOMATIC LINE LEAK DETECTOR 4 FIBERGLASS PIPE 8 100% METHANOL COMPATIBLE W/FRP 99 OTHER V. TANK LEAK DETECTION o 1 VISUAL CHECK 0 2 INVENTORY RECONCILIATION 0 3 VADOZE MONITORING 0 4 AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING o 6 TANK TESTING 0 7 INTERSTITIAL MONITORING 2<NONE 0 95 UNKNOWN 0 99 OTHER 2. ESTIMATED QUANTITY OF /'.:J--- 3. WAS TANK FILLED WITH SUBSTANCE REMAINING ~ ~ GALLONS INERT MATERIAL? YES 0 STATE 1.0.# . JURISDICTION # [Ç2[AZJ TANK # ITIIJœJ PERMIT NUMBER PERMIT APPROVED BY/DATE FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION· FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOR0034 B-RS ", e e iN~TRUCnONS [lOR iL'OMJPJLIE'Ji'iINO [?ORlVJ "BO GENERAL JlNS.rRUCTiONS: 1. One FORM "8" shaH be ('ompJeted for each tank for all NEW jp>ERMnS, pmtM!ìJ[' CHANGES, !REMOVAlS and/or any other TANK KN!FORM/;;nON CiIJ1ANOKl 2. This form should be ('ompleted by either the PERMIT AJPJP[lCANT or the [DCA!. AGENCY UN!LUm.GROUND TANJ:{ J!NSPECTOR. 3. Please type or print clearly all requested information. 4, Use a hard point writing instrument, you are making 3 copies. TOP OF FORM: WMARK ONLY ONE fl1!M" 1. Mark an (X) in the box next to the item that best describes the reason the form is being completed. 2. Indicate the DBA or Fací1ity name where the tank is instalJed, JL TANK DIFXRWltlON - ICOMPK..EJlE AJLL ITEMS - II? UNKNOWN - SO SPECIFY A. Indicate owners tank ID #- . If there is a tank number that is used by the owner to the tank (ex. AI1707[,9:. B. Indicate the name of the company that manufactured ¡he tank (ex, ACME TANK MFG.). C. Indicate the year thc tank was instaHed (ex. 1987), D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 etc.). U. TANK (X)N1ìENfS A. L If MOTOR VEHICLE FUEL, check box I and complete items B & c. 2. If not MOTOR VEHICLE FUEL, check the appropriate box in seclion A and complete items B & D. B. Check the appropriate box. e. Check the type of MOTOR VEIHCLE FUEL (if box I is checked in A). D. Print the chemical name of the hazardous substance stored in the tank and the C.AS#. (Chemical Abstract Ser\.ice number), if box 1 is NOT checked in A. m. TANK CONSJrRU(.TION - MARK ONE lITEM ONILY JIN BOX A, B, C Ik D 1. Check only one item in TYPE OF SYSTEM, TANK MATERIAL, INfERIOR LINING and CORROSION PROTEC110N. 2. If OTHER, print in the space provided. IV. Jl"JrPJlNG J!NI"ORMATION 1. Circle A if above ground; circle U if underground; and circle Doth if appJicab!e. 2, If UNKNOWN, circle; or if OTHER, in provided. 3. Indicate the LEAK DETECnON system(s) to comply with the monitoring requirement for the piping. V, TANK U~ DETiECTION 1. Indicate the LEAK DEn~CI10N system(s) used to comply "ith the monitoring requirements for the tank. VI. INFORMATION ON TANK PERMANENrll.Y CJLOSED IN PlACE L ES'I1MATED DATE LAST USED· MONIII/yEAR (January, J9R8 or 01/88). 2. ESrIMATED QUANrITY of HAZARDOUS SUBSTANCE remaining in ¡he tank (in Gallons). 3. WAS TANK FILLED WITH INERT MATERiAL? Check 'Yes' or 'NO'. AIl>PUCANT MUSr SIGN ANI> DAlE urn IT"ORM AS JlNmCATJEiIl 1INSrRUCJ[1fON IFOR 'nm LOCAL AGENCiIR¢) The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facility number and the six digit tank number. 111e county and jurisdiction numbers arc predetermined and can be obtained by caIJing the State Board (916)739-2421. The facility number must be the same as sho",'I1 in form "A". The tank number may be assigned by the local agency; however, this number must be numerical and cannot contain an alph<:beL If the local agency prefers the State Board to assign the tank number, please leave it blank. IT ITS nm ~'1P'ONS!BJiJL1J'TY Œ? 11m JLOCAL AGENCY TiHIAT JINSPEClS 11m J[?ACHUTY TO VTIRJtI"Y THE ACCURACY OR? nm J!NFOJRMA'1i10N. nŒ I..oeAL A(¡JENL'Y ITS !RJFI~<;i?ONSHm.E ¡FOR TJ1m COMPLETJfON OIT? TIiJE °LOCAR, AŒli\rCY USE ON1LY" ITM"OR1\llATION OOX AND J[?OR IT?ORWAiUJíNG ONE n"ORM ON AND ASSOaA'l'ED Jf"ORM "B"(s) TO 11m JFOULOWITNG ADDRES,"\. SrATJE OF CAUITIORNJ1A Sll'A.'Œ WA1'JER!RJFI.-SOURCJßS ('JJiNiIlJWL HOARD C/O S.W.KlEJP',5, DATAPRO(.'1ESSJlNG CEN'TER ¡¡>,o. OOX 57:7 PARAMOUNT, f'A 9m23 e e STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM 8 COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY D 1 NEW PERMIT D 3 RENEWAL PERMIT ONE ITEM D 2 INTERIM PERMIT D 4 AMENDED PERMIT DBA OR FACILITY NAME WHERE TANK IS INSTALLED: 11/{ D 5 CHANGE OF INFORMATION D 6 TEMPORARY TANK CLOSURE D 7 PERMANENTLY CLOSED ON SITE ~ TANK REMOVED I. TANK DESCRIPTION COMPLETE ALL ITEMS .. SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. # ~ B. MANUFACTURED BY: 7 . C. DATE INSTALLED (MO/DAYIYEAR) D. TANK CAPACITY IN GALLONS: II. TANK CONTENTS IF A-1 IS MARKED, COMPLETE ITEM C. A. ~MOTOR VEHICLE FUEL D 4 OIL B. C. D 1a REGULAR ~ DIESEL D 6 AVIATION GAS UNLEADED D 2 PETROLEUM D 80 EMPTY ~DUCT D 1b PREMIUM D 4 GASAHOL D 7 METHANOL UNLEADED D 5 JET FUEL D 3 CHEMICAL PRODUCT D 95 UNKNOWN D 2 WASTE D 2 LEADED D 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C. A. S.#: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, AND C, AND ALL THAT APPLIES IN BOX DAND E A. TYPE OF D 1 DOUBLE WALL D 3 SINGLE WALL WITH EXTERIOR LINER D 95 UNKNOWN SYSTEM ~ SINGLE WALL - D 4 SECONDARY CONTAINMENT (VAULTED TANK) D 99 OTHER ~ BARE STEEL D 2 STAINLESS STEEL 0 3 FIBERGLASS D 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC B. TANK MATERIAL D 5 CONCRETE 0 6 POLYVINYL CHLORIDE 0 7 ALUMINUM 0 8 100"10 METHANOL COMPATIBLE W/FRP (Primary Tank) 0 9 BRONZE 0 10 GALVANIZED STEEL 0 95 UNKNOWN 0 99 OTHER 01 RUBBER LINED D 2 ALKYD LINING 0 3 EPOXY LINING 0 4 PHENOLIC LINING C. INTERIOR D 5 GLASS LINING ~LINED 0 95 UNKNOWN D 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100"10 METHANOL? YES_ NO_ D. CORROSION D 1 POLYETHYLENE WRAP D 2 COATING D 3 VINYL WRAP D 4 FIBERGLASS REINFORCED PLASTIC PROTECTION D 5 CATHODIC PROTECTION~NONE o 95 UNKNOWN 0 99 OTHER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) ~ ~, OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) ~ ,/ IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND,BOTH IF APPLICABLE A. SYSTEM TYPE 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A @/ 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGLASS PIPE A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEELW/COATING A U 8 100"10 METHANOL COMPATIBLEW/FRP A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D 1 AUTOMATIC LINE LEAK DETECTOR D 2 LINE TIGHTNESS TESTING D 3 INT S I IAL MONITORING V. TANK LEAK DETECTION o 1 VISUAL CHECK D 2 INVENTORY RECONCILIATION D 3 VAOOZE MONITORING 0 4 AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING o 6 TANK TESTING 0 7 INTERSTITIAL MONITORING ß91NONE 0 95 UNKNOWN 0 99 OTHER 2. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 3. WAS TANK FILLED WITH INERT MATERIAL? YES D STATE 1.0.# COUNTY # [Zm FACILITY # ~ TANK # ~ PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION· FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOR00348-RS ~"<"".~---"-'~~,___,-~.~":::::'T~-_.--~~.._"-.;;..., .,_ . .....->.~_....... ...~'~- ._r__~U"""'-~T--""':"-,,,_ e e IN~TRUCI10NS llOR COMPLJfITI!NG llORM "B' GENERAl. INS.i:RU(.1l10NS: 1. One FORM "D" shall be completed for each tank for all NEW PERM1TS, PERMiT CIJfANGI!S, REMOVAlS andior ¡¡ny other TANK INflORMAll0N CHANGE.. 2. This form should be completed by either the PERMIT APPUCANr or the ¡,OCAL AGENCY UNDERGROUND TANK INSPECTOR 3. Please type or print clearly all requested information. 4. Use a hard point writing instrument, you are making 3 copies, TOP 01' FORM: "MARK ONLY ONE flEM" 1. Mark an (X) in the box next to the item that best describes the reason the form is being completed. 2. Indicate the DBA or Facility name where the tank is installed. l l'ANK DR<;Cl\UYrJION - OOMPJf,El'E ALL ß'EMS - IF UNKNOWN - SO SPECIFY A Indicate owners tank JD # . If there is a tank number that is used by the owner to identify the tank (ex. AB7(789). B. Indicate the name of the company that manufactured the 'tank (ex. ACME TANK MFG,). C Indicate the year the tank W'dS installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 etc.). 11 TANK CONTENTS A 1. If MOTOR VEHICLE FUEL, check box 1 and compJete items B & c. 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items D & D. B. Check the appropriate box, C. Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in A), D. Print the chemical name of the hazardous substance stored in the tank and the C.A.s.#. (Chemical Abstract Ser"ice number), if box 1 is NOT checked in A m. TANK CONsrRUCl10N - MARK ONE ¡(TEM ONLY IN BOX A., n, C &. D 1. Check only one item in TYPE OF SY&TEM, TANK MATERIAL, INIERIOR LINING and CORROSION PROTECnON. 2, If OTHER, print in the space provided. IV. PIPING INHIORMATION 1. Cirde A if above ground; cìrc1e U if underground; and circ!e both if applicable. 2. If UNKNOWN, circle; or if OTHER, print in space provided. 3. Indicate the LEAK DEI'EC110N system(s) used to comply ",ith the monitoring requirement for the piping. V. TANK JLEAK DETF£rION 1. Indicate the LEAK DEIECTION system(s) used to comply with the monitoring requirements for the tank. VI. INllORMATION ON TANK PERMANENl1.Y L'I.OSJED IN PlACE 1. ES'I1MATED DATE LAST USED - MONTH/yEAR (January, 1988 or 01/88). 2. ESI'IMATED QUANITIY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). 3, WAS TANK FILLED WITH INERT MATERIAL? Check 'Yes' or 'NO'. APPUCANl'.M!US]1' SIGN AND DAlE um IIORM AS INmCATI~l INSTRUCl10N roR TIm LOCAl, AGENUP.5 The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facility number and the six digit tank number. 1ne county and jurisdiction numbers are predetermined and can be obtained by calJing the State Board (916)739-2421. The facility number must be the same as shown in form "A". 1ne tank number may be assigned by the loca! agency; however, this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please leave it blank. IT IS TIm RR<;pQNSI:BllXIY OF TIlE LOCAL AGENCY TJBIAT IN~"PECTS ']["HE I'AULITY TO VERIFY TIm AC(.'URACY OF 11m INFORMATION. um l'oC.I\L A(¡EN(.'Y IS JRF~<)roNsmu~ I?OR um COMPU1UON OF um 'LOCAL AGENCY USE ONLY' INJFORMATION!BOX AND IIOR 11ORWARDIN(¡ ONE ,FORM 'N AND ASSO<"''lAl,TID roRM "U"(s) TO TIJfE roíL1LOWING ADDRE..Ç.<). SI'ATE OF CAUI10RNIA STATE WATERJRF~<;OURCES CONTROL BOARD C/O S.W.E.HJP.s. DATAPRoœ.ssING CENTER P.O. !BOX SZl PARAMOUNT, CA'91Y723 ;;...,--=~-~..:------ . . STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM 8 COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY 0 1 NEW PERMIT 0 3 RENEWAL PERMIT ONE ITEM 0 2 INTERIM PERMIT 0 4 AMENDED PERMIT DBA OR FACILITY NAME WHERE TANK IS INSTALLED: 71 C / V'\ 5 CHANGE OF INFORMATION 0 7 PERMANENTLY CLOSED ON SITE 6 TEMPORARY TANK CLOSURE ~ TANK REMOVED / /)¡/ / -:;.~) I. TANK DESCRIPTION COMPLETE ALL ITEMS·· SPECIFY IF UNKNOWN A. OWNER'S TANK L D. # À- B. MANUFACTURED BY: C. DATE INSTALLED (MO/DAYiYEAR) D. TANK CAPACITY IN GALLONS: /0 CJ 00 II. TANK CONTENTS IFA-1ISMARKED.COMPLETEITEMC. A. Ja""1 MOTOR VEHICLE FUEL 0 4 OIL B. C. 0 1a REGULAR ~ DIESEL o 6 AVIATION GAS UNLEADED o 2 PETROLEUM 0 80 EMPTY Q-r'15ÃODUCT 0 1b PREMIUM o 4 GASAHOL o 7 METHANOL o 3 CHEMICAL PRODUCT o 2 WASTE UNLEADED o 5 JET FUEL 0 95 UNKNOWN 0 2 LEADED o 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF (A.1) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C. A. S. # : III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B, AND C, AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF 0 1 DOUBLE WALL 0 3 SINGLE WALL WITH EXTERIOR LINER 0 95 UNKNOWN SYSTEM ~ SINGLE WALL - 0 4 SECONDARY CONTAINMENT (VAULTED TANK) 0 99 OTHER ~ BARE STEEL 0 2 STAINLESS STEEL 0 3 FIBERGLASS 0 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC B. TANK MATERIAL o 5 CONCRETE 0 6 POLYVINYL CHLORIDE 0 7 ALUMINUM 0 8 100% METHANOL COMPATIBLE W/FRP (Primary Tank) 0 9 BRONZE 0 10 GALVANIZED STEEL 0 95 UNKNOWN 0 99 OTHER 01 RUBBER LINED o 2 ALKYD LINING 0 3 EPOXY LINING 0 4 PHENOLIC LINING C. INTERIOR 0 5 GLASS LINING ~LINED 0 95 UNKNOWN 0 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_. NO_ D. CORROSION 0 1 POLYETHYLENE WRAP o 2 COATING o 3 VINYL WRAP 0 4 FIBERGLASS REINFORCED PLASTIC PROTECTION 0 5 CATHODIC PROTECTION~ NONE o 95 UNKNOWN 0 99 OTHER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) ~ OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) ... .-' IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A &? 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/COATING 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 99 OTHER D. LEAK DETECTION o 1 AUTOMATIC LINE LEAK DETECTOR o 2 LINE TIGHTNESS TESTING V. TANK LEAK DETECTION D 1 VISUAL CHECK 0 2 INVENTORY RECONCILIATION 0 3 VADOZE MONITORING 0 4 AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING o 6 TANK TESTING 0 7 INTERSTITIAL MONITORING ~ NONE 0 95 UNKNOWN 0 99 OTHER 2. ESTIMATED QUANTITY OF SUBSTANCE REMAINING 3. WAS TANK FILLED WITH INERT MATERIAL? YES 0 THIS FORM HAS BEEN COMPLE.,TED UNDER PENAL TY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANT'S NAME J 0 b' / "1 (PRINTED & SIGNATURE) 0 (/ UIJ ¡ U,..; \ jr f) /p ;, ( I . . '-- (/ V'.-"~ 1/7'-4. / 7 _- - ¡ " .e.--'...- LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS'éOt;1POSED OFTHE FOlH! NUMBERS BELOW COUNTY # Jl!JRÍSDICTION # 'FACILITY # ~m1J~ STATE 1.0.# TANK # ~ PERMIT NUMBER I PERMIT APPROVED BY/DATE I PERMIT EXPIRATION DATE FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION· FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOR0034B-R5 e e J!NSTRUCnONS [lOR Cm,,~¡¡>Lm1!NG PORt\\!. °3° GENERAL J!NS]l'RUC1l10NS: 1. One FORM "B" shall be completed for each tank for all NEW J¡>ERMrrs, PERMKT CW\NGìI.!.':Ò, REMOVALS and/or any other TANK J!NFORMAnON CIHIANGJE. 2. This form should be completed by either the PHRMIT APlrUCANI' or the H)(,AL AGJIl..NCY UNDERGROUND TANK I!NSPBCmJR. 3. Please type or print clearly all requested information, 4. Use a hard point writing instrument, you are making 3 copies. TO]!, OF FORM: "MARK ONLY ONE RT¡¡!M" 1. Mark an (X) in the box next to the item that best describes the reason the form is being completed, 2. Indicate the DBA or Facility name where the tank is instaJied. l TANK DIfI'£cRI[JfTKON - COMPH.EIE AIL n'EMS - W UNKNOWN - SO SPECJ[ìI.1Y A. Indicate owners tank ID if . if there is a tank number that is used by the owner to identify the tank (e¡:, AB70ì89). B, Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG.), C. Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 etc,). U. TANK Cor...¡'JriENTS A 1. If MOTOR VEHICLE FUEL, check box 1 and complete items B & c. 2. If not MOTOR VEHICLE FUEL, check thc appropiÌate box in section A and complete items B & D. B. Check thc appropriate box. e. Check the type of MOTOR VEIUCLE FUEL (if box I is checked in A). D, I'rínt the chemical name of the hazardous substance stored in the tank and the C.A.s.#. (Chemical Abstract Service number), if box I is NOT checked in A Ill. TANK CONSrRU(''1.10N - MARK ONE [,l'EM ONILY IN BOX A, B, C & D 1. Check only one item in TYPE OF SY~TEM, TANK MATERIAL, INfERIOR LINING and CORROSION PROT12CnON. 2. If OT1·IER, print in the space provided. IV. !PIPìI.NG INll'ORMATION 1. Cirde A if above ground; circJe iJJ if underground; and circle both if applic¡¡ble, 2. If UNKNOWN, cirek; or if OTHER, print in provided. 3. Indicate thc LEAK DETECnON system(s) to comply \\1th the monitoring requirement [or the piping. V, TANK UW( DE111,CR10N 1. Indicate the LEAK DETECI10N system(s) used to comply with the monitoring requirements for thc tank. VìI.. iNFORMATION ON TANK JP'ERMANENril}1 (C]LOSJED EN PlACE 1. R'ì'I1MATED DATE L\ST USED· MONfHjYEAR (January, 1988 or 01/88). 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). 3. WAS TANK FILLED WITH INERT MATI~R[AL? Check 'Yes' or 'NO'. APJP'UCANT !\'illST SIGN AND DAlE TJIm H.IORM AS JINKnCATHil KNS.i.1RUCl.'![ON FOR 'nl.E LOCAL AGENUR<; The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facility number and the six digit tank number. 111e county and jurisdiction numbers are predetermined and can be obtained hy calling the State Board (916)739·2421. The facility number must be the same as shown in form "A", The tank number may be assigned by the loeal agency; however, this number must be numerical and cannot contain an alphabet. If the loea! agency prefers the State Board to assign the t¡¡ok number, please leave it blank. fiT IS TIllE RJE."WONSmnlTY Œ? '.lInE WCJ\JL AGlF..NCY 1'1lIA1' JfNSJP'JECTS nm FAOLUY 'JfO VERIFY THE ACCIURA(.'Y OF 'jmm I!NFOR!l.f,JA1'RON. TIIm l.fiX'AL AOJENC\{ IS 11{JIlSñ;ONS[]~U~ K?OR 'l.ll!Ì! COMJPJU,ínON 01F THE "I.)()('.A..[, AGENCY \USE ONJLY" JINJIIOIítTv:IATION ![lOX AND IT/OR [URWARDiING ONE [IORM ON AND ASSO{.,1[ATED FORM "BP(s) 1ro nmlflou..oWJING ADDIRJE.\b."i srATE O]F CAI1RIORNIIA SlATE WA'IER RIfI~<¡Q\UJRCF"§ CONìI.1ROL BOAIlID C/O S,W.JEJ!.JP''s, DATA JP'R(x'11SSJING iCENU~R ]ì>,O, BOX 5Z7 PARAMOUNT. CA !m723 e _ CITY of BAKERSFIELD "WE CARE" FIRE DEPARTMENT S. D. JOHNSON FIRE CHIEF November 3, 1992 2101 H STREET BAKERSFIELD, 93301 326-3911 D & M Enterprises 4382 Turcom Street Bakersfield, CA 93308 Attn: Don Heins CLOSURE OF 2 UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANKS LOCATED AT THE D & M ENTERPRISES FACILITY; 1450 SOUTH UNION, BAKERSFIELD, CALIFORNIA. PERMIT #BR0059 Dear Mr. Heins, This is to inform you that this department has reviewed the results for the preliminary ass~ssment associated with the closure of the tanks located at the above stated address. Based upon laboratory data submitted, this office is satisfied with the assessment performed and requires no further action at this time. This letter does not relieve you of any liability for past, present, or future operations. In addition, any future changes in site use may require further assessment or mitigation. It is the property owners responsibility to notify this department of any changes in site usage. If YOQ have any questions regarding this matter, please contact me at (805)-326-3979. S Inc~~e,~ y , ;/ i"-C /-I-.!A~IU¿'o_t,~Y . ¡,/J oe A. Dunwoodÿ If/Hazardous Material Specialist v Underground Tank Program cc: Greg Brandom M P Environmental 3400 Manor Street Bakersfield, CA 93308 Duane Smith Smith - Gutcher and Ass. 7201 Fruitvale Extension Bakersfield, Ca 93308 --- . ....... . '-,' , ~, e", , Environmental Services, Inc.' October 30; 1992' " Joe, Dunwoody Bakersfield Ci t'y Fire Depa:rtme,nt, ' Haza,rdous Matèrials Di,visidn ' 2~;jO ,G Street. .B~kersfield, Ca 93301' Re: Underg:r:ound tarik;removal, 'permit # BR~0059, ·D&M'Enterprise. Mr. DunwQody, Attached pl~as~ fi~d t~e closure report for ~he. abóve permitee~ Also enclosed is t,he copy of. 'th,e 'signed disposal, manifest.' The tank , t:r;ácking, do'cumënta'tion ·is not 'present due to 'the fact that the new property owner, E ó M . Tharpe; ha~assummèd contr'òlof the' two, tanks. This was done: with 'the consent', of Dòn Heins'" the exi,sting' , ,ówner. The, tanks a~e stored at' 145,0 S,. UniQn' Avenue, Bakersfield Ca: Also ¡' pleasé be advis'ed that ,this prop.erty is, in escrow and needs -' , . are great to have this tank closure 'to 'put rest. Anything you can 'odo to speed th'e final documentation will be greatly appreciated. Should yòu. have any. questions or need further data please caJ,.l me ',at 393-,1151. ~elY" Greg Brandbm . " -~, . 3400. '1'!ANOR STREET BAKERSFIELD, CA 93308 (805) 393·1151 (800) 45&3036 'FAX(8Q5)393~508 ¡:. __--ir e e SMITH - GUTCHER AND ASSOCIATES, INC. Consulting Geologists 7201 Fruitvale Extension Bakersfield, California 93308 (805) 589-7861 October 28, 1992 Mr. Greg Brandom MP Environmental Services, Inc. 3400 Manor Street Bakersfield, California 93308 Dear Mr. Brandom: Two underground fuel storage tanks were removed on October 9, 1992 at the D&M Enterprises property located at 1450 South Union Avenue, Bakersfield, California (see Attachment A). Each tank had a volume of 10,000 gallons and was used for the storage of gasoline and/or diesel. The tanks had been in place for about 14 years. There was minor evidence of soil contamination. The dispensers were located about 13 feet east of the tanks. The tanks abandonments were witnessed by Mr. Joseph A. Dunwoody, Hazardous Material Division Bakersfield city Fire Department. Two soil samples were collected by Smith-Gutcher and Associates as directed by Mr. Dunwoody. The samples were collected at 2 feet and 6 feet beneath the bottom of the tanks and at the dispensers locations shown on Attachment B. The samples from beneath the tanks were collected from a backhoe bucket using a 2 inch diameter sampler. The hand driven core sampler was driven into the soil. The core sampler contained two I' e e Mr. Greg Brandom MP Environmental Services, Inc. October 27, 1992 Page 2 2 inch diameter by 2 inch long brass liner. The sample was removed from the sampler and the brass liner immediately covered with Teflon seals and polyethylene caps. The samples from below the dispensers were collected using the 2 inch diameter hand driven core sampler. The test holes were hand augered to the appropriate depth and the soil sample was then collected using the core sampler. The samples were delivered to B.C. Laboratories in Bakersfield, California (see Attachment C). The samples were analyzed for T.P.H. (gasoline & diesel) using Modified EPA method 8015 and the individual constituents were analyzed by EPA method 5030/8020. No T.P.H. (gasoline or diesel) or B.T.X.& E. constituents, above the minimum reporting levels, were detected in the soil samples from Test Hole Nos. 1 through 5 or Test Hole No. 6 at a depth of 2 feet. The 6 foot soil sample from Test Hole No. 6 contained a T.P.H. (diesel) concentration of 90 ppm. No B.T.X.& E. constituents were detected in the sample above the minimum reporting levels. Based on the results of this investigation, no significant contamination exists beneath the tanks or dispensers locations. Due to the results of the soil sampling, further characterization or remedial action does not appears necessary at this location. SMITH - GUTCHER AND ASSOCIATES, INC. e e Mr. Greg Brandom MP Environmental Services, Inc. October 27, 1992 Page 3 If you have any questions regarding this report, please feel free to call. DRS/ds Yours truly, J. / ¡ 't(éhU ;(. ~ Duane R. smith Registered Geologist State of California No. 3584 MPEHIENS.PSA SMITH - GUTCHER AND ASSOCIATES, INC. ,'!IC~e..~' It <->It". Fo....51. r- _x .. . ," 'H \' '''e.' 't 11:!:IITgi ·t"t~II~';Wšë;'-¡ ¡ ;;;:;, ,., II "'i'" ~;; i,~tf ~iL:¡iT;,;, ~ --;~ u B h I ðIïi' è..... ì.. ' , ;;!.-! ~ m .. . z om ~H- '" - Vi - _ V';'NON . ~~.v PE"" I 51. · ¡v,i EO,h ~~--'\]:""';' (;",,1151 D'Wíl~851 I~ Ví~I' scu¡. if, j. tV) V} I Dr, 'cna SCHOOL SI. Þ" ~ ~ :::i z ~ CL ~T ~.~ i :=3. E 7th G~~I~i~H'. .I..I~t, S I~ - 1..,11... ... ~I. t I -' ; ..; ~ ST. c1'-~ Ikd~ t:! 6th (/) O. S~"lcn a z E 6111 . Umnn(r tI'!f)' :. MI:fI~':k~1 It UW.~ SI ~~ S, ~; ~I~ "1111~~: .. v: I P.llm ;:~:N;\~ . 51. !,a..:;;-. "'I 5 Ih to\: I . . ~., I..... ft.;;;;I ~; . Vlff1I1Ua v; .1 § -, ~ Av.: :ií' ~ 1[0 VH'lin.., --1,::: I ..t -~. 5 . p~...¿ f-"!:.I. J. ~~" Rd. '-.' '. q" ..... 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M:"A Mincn.. I,.t. j~; r-c'~ft.". ~~~~'t;Þ.IWO"d " ~ : ~ i ~ ~ g - ;;- . ,:o:;,~ . "..' ~' t W.F.1r.iMv ~."'" . rÏë.' ~. 0 I W Up"ANA"M- A j'~' I .r>. I~",\ ·~'II :~" \. A.A.Sp,U:~ ~: ~~~ J g -. j. ~n' ;;tto. ~~ [.i'l- ."'''' f~..Y.'n." Co. . ¡ ¿¡D~'\" Œ ~ I'AST lANE EAST :" . . PANAMA:... . ,I (~~~~~:~~n ·~~P) ~ 11 r9 .,~ I ~\I. !.~ ~LANE ~I ~ V; 1 l~ r 'Uj I I t~ ,\ ~ -2 .. ¡ ~u~~ I~, D&M ENTERPR ISES 1450 UN ION AVE. SO. LOCATION MAP Attachment A 'Ú LEGEND -: ¡;;. freeway' ~r Acc.u Rout.s Shown { 99 \ ~g~~". Sc~t. ",",ory ,,,..I. r ëiiYïiiñiii 1 r- CutOe·SacI c~c Secondary Str",." luildings 6'Q>ij~: r~J Go/ICtf~~~:TI.::::.~',~..\7ï.. ~ Res.rvollon loundoue. o hit' 2000' ~ M;I:-- V.m;-.·---· ;;:J'B o KilomeltHS 501<111 r- -. c=: @ ~ /J1ap5 :;,~~::.:~~:'~: ,~: . ::'~~ t~¿:;~ ::'~~;~~~t" AeøowIKhon (If t~,,,'g 01 '1'11, "'U In -'- 01' III ,.11, Þr '''Y manNIf. .. .eo.ok.I",p<""'b'led.llfIoI.l..nll...~· ""..kIt'oftltop"'OI\f~.....·~..· ..~ Inc. POlo. ._, W...ø"IO. CA ~,Ockl.O..".......lOfIotl". U"«I SI....COpl"II"ll...... LA e D&M ENTERPR ISES VICINITY MAP 60. t/N/éJA/ AVEA/t/€' )< ---J( GAT£' / F£NC€'~ )( -X-(-x-¡t-x -1<-)<-1( x-x I ,. I ~ ! £;(CA VAT'''''' ! ~ y 1 1~ ITH#/~-ì r--, ::Lt 1\ I . I I .~~ T.II. 3 I I I I PIÆT I I I I I I I I 11 I \. I I I I 7./1. H4 ~ I I I ...:-r )c -r:íI. Zï::--¡-. I I . I ~ J L ---l!::--~I ~ rANK LtJcA,/ðN5 "'I /0ðOO tiAL. Ú'As AN.o/tJR P/ESEL Ix ~I ~ II ~ 1 J\ P/¡(T I ~ I ASPHALT ~T.1I..{f5 \T.N. "6 (?/St'€NSEÆ. ú;Jt:Ar /0.11/'> ~ '4J -t \¡ ~ ~ ASPHALT I J :5CA L.E : / " == z.o I Attachment B ~ o ~ ~ ~ ~ ~ ~ I;) ~ ~ ~ " ~ ~ ~ =-- - - < e e -. LABORATORIES Petroleum Hydrocarbons SMITH-GUTCHER and ASSOCIATES, INC. 7201 FRUITVALE EXT. BAKERSFIELD, CA 93308 Attn.: DUANE R. SMITH 805-589-7861 Date of Report: Lab #: 10/26/92 9191-1 Sample Description: HEINS PROPERTY, 1450 SO. UNION AVE.-BAKERSFIELD, CA: T.H. 1 @ 21 (SOIL) 10-09-92 @ 1500 HRS COLLECTED BY DUANE SMITH TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Constituents Date Sample Date Analysis Received @ Lab: Completed: 10/12/92 . 10/22/92 Minimum Analysis Reporting Reporting Results Units Level None Detected mg/kg 0.005 None Detected mg/kg '.---. 0.005 None Detected mg/kg 0;005 None Detected mg/kg 0.01 None Detected mg/kg l. None Detected mg/kg 20. ..", . ~ "~ )' , Date Sample Collected: 10/09/92 Benzene Toluene Ethyl Benzene Total Xylenes Total Petroleum Hydrocarbons. (gas) Total Petroleum Hydrocarbons (diesel) California D.O.H.S. Cert. #1186 De~~=ir Attachment C 41CXJAtlasCt.· Bakersfield,CA 933:E. (El:E)327-4911 . FAX(EI:E)327-191B =-- e e lABORATORIES Petroleum Hydrocarbons SMITH-GUTCHER and ASSOCIATES, INC. 7201 FRUITVALE EXT. BAKERSFIELD, CA 93308 Attn.: DUANE R. SMITH 805-589-7861 Date of Report: Lab #: 10/26/92 9191-2 Sample Description: HEINS PROPERTY, 1450 SO. UNION AVE.-BAKERSFIELD, CA: T.H. 1 @ 6' (SOIL) 10-09-92 @ 1500 HRS COLLECTED BY DUANE SMITH TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Date Sample Collected: 10/09/92 Date Sample Date Analysis Received @ Lab: Completed: . - __..__.___. o. ,. 10/12/92 10/22/92 Minimum Analysis Reporting Reporting Results Units Level None Detected mg/kg 0~005 None Detected mg/kg 0.005 None Detected mg/kg 0.Ö05 None Detected mg/kg 0.01 None Detected mg/kg 1. None Detected mg/kg -'-2l1 ~ .. Constituents Benzene Toluene Ethyl Benzene Total Xylenes Total Petroleum Hydrocarbons (gas) Total Petroleum Hydrocarbons (diesel) -õ"-" -,-, ~ "~, California D.O.H.S. Cert. #1186 ~7 Department Superv~r Attachment C 41CXJAtJasCt.· Bakersfield,CA 933:E. (ED5)327-4911 . FAX(ED5)327-191B · lABORATORIES e e Petroleum Hydrocarbons SMITH-GUTCHER and ASSOCIATES, INC. 7201 FRUITVALE EXT. BAKERSFIELD, CA 93308 Attn.: DUANE R. SMITH 805-589-7861 Date of Report: Lab #: 10/26/92 9191-3 Sample Description: HEINS PROPERTY, 1450 SO. UNION AVE.-BAKERSFIELD, CA: T.H. 2 @ 2' (SOIL) 10-09-92 @ 1515 HRS COLLECTED BY DUANE SMITH TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Constituents Date Sample Date Analysis Received @ Lab: Completed: 10/12/92 10/22/92 Minimum Analysis Reporting Reporting Results Units Level None Detected mg/kg '"-'0; 005 None Detected mg/kg 0~O05 None Detected· mg/kg 0;005 None Detected mg/kg 0.01' None Detected mg/kg 1. None Detected mg/kg ~.~~...._- ".-" 2Õ~" Date Sample Collected: 10/09/92 Benzene Toluene Ethyl Benzene Total Xylenes Total Petroleum Hydrocarbons (gas) Total Petroleum Hydrocarbons (diesel) California D.O.H.S. Cert. #1186 ~~ Department Supervx or Attachment C 41 CD Atlas Ct. . Bakersfield, CA 933:B . (a:5) 327-4911 . FAX (a:6] 327-191 B .. e e lABORATORIES Petroleum Hydrocarbons SMITH-GUTCHER and ASSOCIATES, INC. 7201 FRUITVALE EXT. BAKERSFIELD, CA 93308 Attn.: DUANE R. SMITH 805-589-7861 Date of Report: Lab #: 10/26/92 9191-4 Sample Description: HEINS PROPERTY, 1450 SO. UNION AVE.-BAKERSFIELD, CA: T.H. 2 @ 6' (SOIL) 10-09-92 @ 1515 HRS COLLECTED BY DUANE SMITH TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Date Sample Collected: 10/09/92 Constituents Date Sample Date Analysis Received @ Lab: Completed: 10/12/92 10/22/92 Minimum Analysis Reporting Reporting Results Units Level None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg 0.01 None Detected mg/kg l. None Detected mg/kg .2Õ: Benzene Toluene Ethyl Benzene Total Xylenes Total Petroleum Hydrocarbons (gas) Total Petroleum Hydrocarbons (diesel) California D.O.H.S. Cert. #1186 Depa~r Attachment C 41CXJAtlasCt. . Bakersfield. CA 933:E. (ED3)327-4911 . FAX (BE) 327-1918 I. LABORATORIES e e Petroleum Hydrocarbons SMITH-GUTCHER and ASSOCIATES, INC. 7201 FRUITVALE EXT. BAKERSFIELD, CA 93308 Attn.: DUANE R. SMITH 805-589-7861 Date of Report: Lab #: 10/26/92 9191-5 Sample Description: HEINS PROPERTY, 1450 SO. UNION AVE.-BAKERSFIELD,CA: T.H. 3 @ 2' (SOIL) 10-09-92 @ 1530 HRS COLLECTED BY DUANE SMITH TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Constituents Date Sample Date Analysis Received @ Lab: Completed: 10/12/92 10/22/92 Minimum Analysis Reporting Reporting Results Units Level None Detected mg/kg . 0; 005 None Detected mg/kg CL 005 None Detected mg/kg 0.005 None Detected mg/kg 0.01 None Detected mg/kg 1. None Detected mg/kg ....,. ~'." o>~., ~.~~__... 26. Date Sample Collected: 10/09/92 Benzene Toluene Ethyl Benzene Total Xylenes Total Petroleum Hydrocarbons (gas) Total Petroleum Hydrocarbons (diesel) ~~ .",,-_. -, . -", California D.O.H.S. Cert. #1186 Dep~~r A.ttachment C 41 CD Atlas Ct. . Bakersfield, CA 933:JB . [B:E) 327-491 1 . FAX [B:E) 327-1 91 B =-- - e LABORATORIES Petroleum Hydrocarbons SMITH-GUTCHER and ASSOCIATES, INC. 7201 FRUITVALE EXT. BAKERSFIELD, CA 93308 Attn.: DUANE R. SMITH 805-589-7861 Date of Report: Lab #: 10/26/92 9191-6 Sample Description: HEINS PROPERTY, 1450 SO. UNION AVE.-BAKERSFIELD, CA: T.H. 3 @ 6' (SOIL) 10-09-92 @ 1530 HRS COLLECTED BY DUANE SMITH TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Constituents Date Sample Date Analysis Received @ Lab: Completed: 10/12/92 10/22/92 Minimum Analysis Reporting Reporting Results Units Level None Detected mg/kg ··..,0.005 . . None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg 0.01 None Detected mg/kg 1. None Detected mg/kg ~ --. >--'~"{")'~ .'< '20.- ., Date Sample Collected: 10/09/92 Benzene Toluene Ethyl Benzene Total Xy1enes Total Petroleum Hydrocarbons (gas) Total Petroleum Hydrocarbons (diesel) California D.O.H.S. Cert. #1186 /--4~¿ ,/ /~c:..- il) Department Supervis Attachment C. 41 CXJAt:Jas Ct. . Bakersfield,CA 933:E. (B:E)327-4911 . FAX(B:E)327-191B =-- e e LABORATORIES Petroleum Hydrocarbons SMITH-GUTCHER and ASSOCIATES, INC. 7201 FRUITVALE EXT. BAKERSFIELD, CA 93308 Attn.: DUANE R. SMITH 805-589-7861 Date of Report: Lab #: 10/26/92 9191-7 Sample Description: HEINS PROPERTY, 1450 SO. UNION AVE.-BAKERSFIELD, CA: T.H. 4 @ 2' (SOIL) 10-09-92 @ 1600 HRS COLLECTED BY DUANE SMITH TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Constituents Date Sample Date Analysis Received @ Lab: Completed: 10/12/92 10/22/92 Minimum Analysis Reporting Reporting Results Units Level None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg 0.01 None Detected mg/kg l. None Detected mg/kg 20. . , Date Sample Collected: 10/09/92 Benzene Toluene Ethyl Benzene Total Xylenes Total Petroleum Hydrocarbons (gas) Total Petroleum Hydrocarbons (diesel) California D.O.H.S. Cert. #1186 Dep~~r Attachment C· 41 CXJAtlas Ct. . Bakersfield. CÄ S33:E. (B:6)327-4911 . FAX~327-191B . e e LABORATORIES Petroleum Hydrocarbons SMITH-GUTCHER and ASSOCIATES, INC. 7201 FRUITVALE EXT. BAKERSFIELD, CA 93308 Attn.: DUANE R. SMITH 805-589-7861 Date of Report: Lab #: 10/26/92 9191-8 Sample Description: HEINS PROPERTY, 1450 SO. UNION AVE.-BAKERSFIELD, CA: T.H. 4 @ 6' (SOIL) 10-09-92 @ 1600 HRS COLLECTED BY DUANE SMITH TEST METHOD.: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Date Sample Collected: 10/09/92 Constituents Date Sample Date Analysis Received @ Lab: Completed: 10/12/92 10/22/92 Minimum Analysis Reporting Reporting Results Units Level None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg 0:005 None Detected mg/kg 0.01 None Detected mg/kg 1. None Detected mg/kg 2(). Benzene Toluene Ethyl Benzene Total Xylenes . Total Petroleum Hydrocarbons (gas) Total Petroleum Hydrocarbons (?iesel) California D.O.H.S. Cert. #1186 ~¿ - Department supervi~r Attachment C 41 CD Atlas Ct. . Bakersfield. CA 933:E . (B:E) 327-4811 . FAX (B:E) 327-181 B .. e e LABORATORIES Petroleum Hydrocarbons SMITH-GUTCHER and ASSOCIATES, INC. 7201 FRUITVALE EXT. BAKERSFIELD, CA93308 Attn.: DUANE R. SMITH 805-589-7861 Date of Report: Lab #: 10/26/92 9191-9 Sample Description: HEINS PROPERTY, 1450 SO. UNION AVE.-BAKERSFIELD, CA: T.H. 5 @ 2' (SOIL) 10-09-92 @ 1620 HRS COLLECTED BY DUANE SMITH TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Constituents Date Sample Date Analysis Received @ Lab: Completed: 10/12/92 10/22/92 Minimum Analysis Reporting Reporting Results Units Level None Detected mg/kg 9;005 None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected . mg /kg 0.01 None Detected mg/kg l. None Detected mg/kg 20~' Date Sample Collected: 10/09/92 Benzene Toluene Ethyl Benzene Total Xylenes Total Petroleum Hydrocarbons (gas) Total Petroleum Hydrocårbons (diesel) California D.O.H.S. Cert. #1186 ~~ Department Supervi or Attachment C 41 CXJ Atlas Ct. . Bakersfield. CA 933:E . (B:E) 327-4911 . FAX (B:E) 327-1 91 B · e e lABORATORIES Petroleum Hydrocarbons SMITH-GUTCHER and ASSOCIATES, INC. 7201 FRUITVALE EXT. BAKERSFIELD, CA 93308 Attn.: DUANE R. SMITH 805-589-7861 Date of Report: Lab #: 10/26/92 9191-10 Sample Description: HEINS PROPERTY, 1450 SO. UNION AVE.-BAKERSFIELD, CA: T.H. 5 @6' (SOIL) 10-09-92 @ 1620 HRS COLLECTED BY DUANE SMITH. TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Constituents Date Sample Date Analysis Received @ Lab: Completed: 10/12/92 10/22/92 Minimum Analysis Reporting Reporting Results Units Level None Detected mg/kg -.. 0 . 005 None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg 0.01 None Detected mg/kg 1. None Detected mg/kg 20. Date Sample Collected: 10/09/92 Benzene Toluene Ethyl Benzene Total'Xylenes Total Petroleum Hydrocarbons (gas) Total Petroleum Hydrocarbons (diesel) California D.O.H.S. Cert. #1186 ~~ Department Supervisor Attachment C 41 CXJAt:Jas Ct. . Bakersfield,CA 933:E. (B:E)327-4911 . FAX(B:E)327-1918 =-- e e lABORATORIES Petroleum Hydrocarbons SMITH-GUTCHER and ASSOCIATES, INC. 7201 FRUITVALE EXT. BAKERSFIELD, CA 93308 Attn.: DUANE R. SMITH 805-589-7861 Date of Report: Lab #: 10/26/92 9191-11 Sample Description: HEINS PROPERTY, 1450 SO. UNION AVE.-BAKERSFIELD, CA: T.H. 6 @ 2' (SOIL) 10-09-92 @ 1645 HRS COLLECTED BY DUANE SMITH TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Constituents Date Sample Date Analysis Received @ Lab: Completed: 10/12/92 10/22/92 Minimum Analysis Reporting Reporting Results Units Level None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg Ó:OOS None Detected mg/kg 0.01 None Detected mg/kg 1. None Detected mg/kg 20. Date Sample Collected: 10/09/92 Benzene Toluene Ethyl Benzene Total Xylenes Total Petroleum Hydrocarbons (gas) Total Petroleum Hydrocarbons (diesel) California D.O.H.S. Cert. #1186 ~ ~) Department Supervisor Attachment C 41 CXJAtlas Ct. . Bakersñeld,CA S33:E. (B:I5]327-4911 . FAX(B:I5]327-191B =- e e lABORATORIES Petroleum Hydrocarbons SMITH-GUTCHER and ASSOCIATES, INC. 7201 FRUITVALE EXT. BAKERSFIELD, CA 93308 Attn.: DUANE R. SMITH 805-589-7861 Date of Report: Lab #: 10/26/92 9191-12 Sample Description: HEINS PROPERTY, 1450 SO. UNION AVE.-BAKERSFIELD, CA: T.H. 6 @ 6' (SOIL) 10-09-92 @ 1645 HRS COLLECTED BY DUANE SMITH TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Constituents Date Sample Date Analysis Received @ Lab: Completed: 10/12/92 10/22/92 Minimum Analysis Reporting Reporting Results Units Level None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg 0.01 None Detected mg/kg 1. 90. mg/kg 20. Date Sample Collected: 10/09/92 Benzene Toluene Ethyl Benzene Total Xylenes Total Petroleum Hydrocarbons (gas) Total Petroleum Hydrocarbons (diesel) California D.O.H.S. Cert. #1186 ~¿ -7 Department Supervisdf Attachment C 41 CXJAtlas Ct. . Bakersfield,CA 933:E. (B:E)327-4911 . FAX(B:E]327-1918 N8IIIIt: Location of Samolina fle.1 ñ $ fro ~e ff'l . ./ C~: ......... f1 Cn j,~/.f/1) Telephone: ( ) o Lab Reports to property owner o Billing to property CMWr Sampling Method: f)y~"e. SC¡¡~ y Sample No. Date Time :Þ' T. ~( . I JO -q ~ eft I~()ù ~ rt rt T. II. Z. II If I) " III 0 [ 1. ..f. ~ II /~3~ I' (1) lí.J.I.4 II l~ðO II ::s rt II. J.I . /¿,2b II () S I, í.J4.t:... II /" V5''' :. '- CHAIN OF CUSTODY RECORD . Ave. Samole Collector H8IIIIt: 7JuaAc J mil/, Company: Smith-Gutcher and Associates. Inc. Address: 7201 Fruitvale Extension Bakersfield. California 93308 Telephone: (805) 589-7861 Qi!U!1 Millie: m p ~/W j rOi1!keAi..ç. / Company' = ~M Address ~ () y .$I. '1-r..,y'f).fie./d . fA. , Telephone: ( ) ~ Lab Reports to S8IIIple collector m Billing to S8IIIple collector Semple Type: S 0"/ o Lab Reports to client o Billing to client Preservation: Ját:..p Có td U,."¡'," Au~ t'f7..ed (C¡O( i) Sample Deacription Anelys.. Requnted Laboratory No. II to' ~ ~' 7. ',t(. (t;tn ~ctó~At) ~ 1,7 X E q¡ql-I . .2.' cw.Á " - II " '" -.Vtt nil - (~ 1,' a,.d ,,' " " I, '2: evr,.;{ 61 II " ~. 2.' tølA h' It I, ., '- ' L':H" PI hI It " ,... -- Relinquished by: tJJl LCV1v< ¡z Æ .:;J Received by: , "" _. ~ ,Y\1 ,"" Ûr!i::: ,., Relinquished by;C- ~ Received by: Company: Smith-Gutcher and Associates, Inc. Company: .AC L 1'1 L-,,...,vY'¡ L-, V' ' .ð <:' Company: Company: Date and Time: /~ k. /0-/1,- Date and Time: ít1t.:J/¡;"") ~..'\L__ . , . L Date and Time: Date and Time: Sheet / of / SMITH - GUTCHER AND ASSOCIATES, INC. /J"'" " .~;/}::':: ",",' ~ '.," I .. S~ol' ~Iilornic>-En"¡ronmental Protection Agency . . '''--Fo:~'Ap~fo~ OMB No. 2050-0039 (Expires 9-30-94) See Instructions on bailaf page 6. i Pleasep..nt or,ty.e· Form designlld lor use on elite (121" ) typewriter. . .... " f¡! UNIFORM HAZARDOUS 1. Generator's us EPA ID No. WASTE,MANIFEST Deportment 01 Toxic Substances Control Sacramento. California Inform orion in the shaded areas is not required by Federal law . .... .... -:5 r--< NU C\J~ (\J!::: O')~ N o CO co ...t N 'Ot 8 C9 - o 10 10 ,.... N 10 CO Ó o C9 -, '" W to- Z W U w V) Z o Q.. V) W ~ .... -< Z o ¡:: -< Z w J: to- .... .... -- U Z w C> .~ w ~ w T R A N S P o R u.. ~ OR w V) -< U ~ ï' <1ejr.¢or'fN.!'rY)ðPl!d ~j¡ngIAd~rØS$ í "}.~?;~~t~~~;'¿';"':' '4. Gene~ator's Pho~ ( 'iii)~.~' 5. TransPorter 1 Co~pany Nome ¡C/.;;:' ';! Ii .¡!~ ~ ::- .r. ; ./ ;?-'~? ~;¡._¿(' 6. US EPA 1D Number '-11" fNV InOr4t.1CNT At, :;rnVICrc., INC. 7 . Transporter 2 Com,:>any Nome, 9.",Qe~gnatlld FacilitY ~1)\,ond)Site,A.dd>;eJ.\(. !..,J. ~},.,$". '1,;'.' fh ,'''...U - }1J,,,J , filJ'~\" [ND or ((X,1t~(nGI;\t on BA~[RSrJ(lO,C^ 9JjOß 11. Nem,.)iCHA I IIUAf¡[X)!JG \rIA~;n/ L! (JU 1 fJ G E N E R A T o R b. c. !i(!¡(Ü)(JfI (ij~'~8~fiJl d. [J.1CHCL HCY PI K.iNJ: ",~ (.~ 16. GENERATOR'S CERTIFICATION: I hereby declare that the conten~ of the consignment are fully and accurately described above by proper shipping name and are classified. packed. marked, and labeled. and ore in all respects in proper condition for tronsport by highway occording to applicable feder(l, stote and intemationallaws. If I am a large quantity generator. I certify thot I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the procticøble method of treatment, slorage, or disposal currently ovailable to me which minimizes the present and future threol to humon health and the environment; OR, if I om a small quantify generator, I have mode a good faith effort to minimize my waste generation and select the best waste mana ement method that is avaUoble to me and that I can alford. Print!,d/Typed Nome ~','<'::"l/' " Signature ~.'l'~'~""?~~') .....~..)~ /<:l~(" ;/,!",f (!,~:;.~:..r /~'/.:,/,..~:' 17 . Trans orter 1 Acknowled ement of Rec;ei t of Materials Printed¡J'yped Name ..,~ Î" /'J , ',.,/ ,ß~- {. /1/1';;;" I' ,/.."l:" I (" J 18. Trans orter 2 Acknowle ment of Recei t of Materials , Printed/Typed Name 19. Discrepancy Indication Space . ......"".\..~ ~., . . ~~I(;>;; '~,' , ~.t._ .. ~, . " , .'. __ '>,/!J(,'" ".~." .I ,.', ¡.." .,.~.,." Ill' ~". ~. ~ ,r ,< F A C I L I T Y this manifest exce t as noled in Item 19. / ' i ' 6' , Ii" ,,;/ //(¿'" C- o /.rv" ,-~.."".,... ./.;J- '....-:> -' DO NOT WRITE BELOW THIS LINE. Drsc 8022A (12/91) EPA 8700-22 Green: HAULER RETAINS _.--:.-,----'- --,~- - - -)"'""--'- -"-- - - -- --- - - -- -,-,-' - - -- - -'- - - _...-.- 1, ~ e e .? ;'1' 0,' fr;'\[r;In~' " n 1'9,~¡(CJ)t);< \lJJi-" ~~",I;, .11.>111,-, "",:t:":':'-v·",ci;..... ."~ ;'·,;ir; "~~'\!" ," -;;'Ì1']:,j~';' ';'ç¡;: "·i·;'!~);¿/;". ,.'. ",¡;;;K .;;,;; :¡;";.;~i~7;G;;;'.1:;;\:.:::~~'::':;~:" ::;<~:::".::.'~;!~'.\,;:ç :;;:'~:;;~:Ji':'~r.:; i;'.('V.,.....,...<\\;;""1''''.~;l''·\'~!'·'q:;,;. ';;\;ij;;.,'''~:''~';~''k'''':' ; '";''¡'~';''''' ..... ....~ .. G · b'" .. WEIGHT TAG NUMBER ; I SOh . . Environniental /' í (.., (,./ ! c~wr,~"""'%t~tmw@r.~mr.m~t\· : . ."-~ 3300 TRUXTUN AVENUE, SUITE 200 DATE , , BAKERSFIELD, CA 93301 ~ .. ,....1' (805) 327-0413 : , .' n:i ORIGIN: " ;_.... .. MANIFEST# ., " ;'''t ¡) ;,t . ~. .., , ~j , t I~\/,';,O(''': 9 p5 . ,8 . I , ,~~ {.. :...;...¡ ~ " .. ;,,¡..(. .(,,¡ ¡ . ',. f,'! ,. it . ~ , DESTINATION: GIBSON ENVIRONMENTAL INVOICE TO: . \ END OF COMMERCIAL DRIVE BAKERSFIELD, CA 93308 PRICE: CARRIER # CARRRIER RELEASE# COMMODITY TDS PH GRAV. NET GALLONS fBBLS , , '1 , , .... ARRIVED TO UNLOAD START TO UNLOAD FINISH UNLOADING SOLIDS % AM AM AM PM PM PM WASHOUT LOADED FROM UNLOADED TO .-..........."..' GALLONS / .' DEDUCT LOADER'S SIGNATURE DRIVER'S SIGNATURE BS&W% ~',-: .J., "'/ ,--,~,/ ~~~~:~{'" .. ,/' ~/ NET ,./ BARRELS .. .~ _....11 ."'~..r:::.'.~ .- ./ l REMARKS RECEIPT TICKET <', B 5410 <> · Bakersfield Fire Dept. ~AZARDOUS MATERIALS DIVISI_ UNDERGROUND STORAGE TANK PROGRAM 32'-3lj7C¡ PERMIT No. ß¡¿ ~a:JS-'l PERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK SITE INFORMATION SITE / Ij 5"0 S. UNlolI! ADDRESS ß4KGI:?S;:"1 ~l..Þ ZIP CODE 93?Cr7 APN FACILITY NAME D ~ YY\ ~ f\I n: R P R f'5gCROSS STREET fYJ II\/. 9 TANK OWNER/OPERATOR DoN HE I A.JS PHONE No. goS ~'Z2 Z227 MAILING ADDRESS "13<62. TU~COnJ CITY tft1KO!!JfiE./..ZJ ZIP CODE 9330g CONTRACTOR INFORMATION " ,,/ COMPANY {y\ P £I\JV/P"Ol\JfYlE/JrAt. S'£v PHONE No. ~$ >93 lIS/LICENSE No.1? (1]70b ADDRESS 3'1 (JO /?'lA-AI oR CITY ß¡f/("€¡esr;::(fEL..j) ZIP CODE 933o<Çf INSURANCE CARRIER f-\{V\'O.!2.le.r\·vn W" I)'''' l'ì<:::'<~¡H~.AI\)~(WORKMENS COMP No. ¿(..If' 5li'J - 7?,C:;/f PRElIMANARY ASSEMENT INFORMATION COMPANY "S111't'H .¡..A~so C ADDRESS f/ f(~u IT v." l,{'. r:- 'f rt:',t. I/O t\,) INSURANCE CARRIER S1"f\·ìt. Fv 1\'1 Ù PHONE No. (~C$) "j-ð'('r-79ld LICENSE No. CITY ì::)I<~'~:J ç () ZIP CODE q.=1 3(})1 WORKMENS COMP No. TANI( CLEANING INFORMATION COMPANY (Y) ~ £tJIJ, fCJIII/11(ZyoJ'r71'- ~teÝ PHONE No. 30Ç ~9Y II S / ADDRESS ~ ~oC) m 1?v o~ CITY óA£Gt'5FrEEL.P ZIP CODE 9'3:70 g WASTE TRANSPORTER IDENTIFICATION NUMBER 2t; 9$ C4TtJoo (; 2:~2.4I7 NAME OFRINSTATE DISPOSAL FACILITY c;, ¡¡SON E/VII/~o/V;ne--"t//7?-¿ ADDRESS£ND OF Comfl1 GRC"'~'L .4VG CITY CI}i(£RsFlE¿f) ZIP CODE ~'330'8 FACILITY INDENTlFICATlON NUMBER . C4 D ÿ g (;) (f''i53 //7 \, TANI( TRANSPORTER INFORMATION COMPANY m (J E'NV II?(JA,J/YIG/\)r7fL ADDRESS 3,-/0 c. , rn~()I¿ TANK DESTINATION (;c:J¿ D f' N PHONE No. ~9Y-II-:;--/ LICENSE No.(ArlXO.çZÇ¿>~7 CITY ¡f~5FiE¿j> ZIP CODE 7'3308 S77-/'1'G'· m £T4 L5 TANK INFORMATION TANK No. AGE VOLUME CHEMICAL DATES CHEMICAL I 1'1 STORED STORED PREVIOUSLY STORED I ~ 000 G.AS 78-9/ 3A.s' 2 IIf I Þ,OOO D, E:SEL 7"6- 9/ DIE5EL w~f.&~~i~:b!~~-\<;''');~I THE APPliCANT HAS REC EIVED. UNDE RST ANDS. AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE.lOC,'\l AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY. AND TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT. APPROVED BY: DON HEl N S APPLICANT NAME (PRINT) ~4'~~ APPlICÃNT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED .........~._........... e e BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 CERTIFICATION STATEMENT OF TANK DECONTAMINATION I ~ Gd<EC j3f<1tN Dé>J'11 an authorized agent of name 1'Y\ f£N'\JI«ol\)mr7VT.41 S;?\IC5~ here by attest under penalty of contracting co. perjury that the tank(s) located ~t ¡.If S6 5". U/)IO/'J /9VE and address being removed under permi tit B r¿ -.: úO 59 has been cleaned/decontaminated properly and a LEL (lower explosive limit) reading of no greater than 5% was measured immediately following the cleaning/decontamination process. /0(09(92- date (;¡¿fC &11 N})ø11)l( name (print) ~s~ I - 'O/)C)O 3rtL ,- . .. e e CITY of BAKERSFIELD "WE CARE" FIRE DEPARTMENT . S. D. JOHNSON FIRE CHIEF BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 2101' H STREET BAKERSFIELD, 93301 326-3911 CERTIFICATION STATEMENT OF TANK DECONTAMINATION I, Gf?EG ¡sæ,4AJDo/YJ name an authorized agent of M P Environmental Service contracting co. here by attest under penalty of perjury that the tank (s) located at 1450 S. Union Ave. and address being removed under permit# BR - 0059 has been cleaned/decontaminated properly and a LEL (lower explosive limit) reading of no greater than 5% was measured immediately following the cleaning/decontamination process. 10/09/92 date GreeG ß;fA-AJ[X)Œ/ name (print) Jf;~ I - / 0 ! Of) 0 J r9L e e CITY of BAKERSFIELD "WE CARE" FIRE DEPARTMENT . S. D. JOHNSON FIRE CHIEF BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 2101 H STREET BAKERSFIELD, 93301 326-3911 CERTIFICATION STATEMENT OF TANK DECONTAMINATION I, G~£G ßR ANJ)OI11. name an authorized agent of M P Environmental Service contracting co. here by attest under penalty of perjury that the tank (s) located at 1450 S. Union Ave. and address being removed under permit# BR - 0059 has been cleaned/decontaminated properly and a LEL (lower explosive limit) reading of no greater than 5% was measured immediately following the cleaning/decontamination process. 10/09/92 date 6' «f"G ß¡f AN lxJ/y! name (print) 4J~ . signature ~i~is~~~n~~ ~~~i~g~-~~yn~~a u___ 1700 Flower Street I Bakersf ie/ CA 93305 \ . . --rç .LI~~-T~. -- -¿;::.:.:;zD---~- '-" '-, --.-J '---- --- Application .e .:::;....... APPLICATION FOR PERMIT TO OPERATE UNDERGROOND HAZARDOUS SUBSTANCES S'l'ORJIGE FACILITY !ïe:. of Application (check): ~ DNeW Facility DModification of Facility)'\._.istiN; Facility DTransfer of CMnership A. Emergency 24-lIour Contact (name. area ,code. ¡none : ~~ts ~ø:E'j'.3 ~?I- I 3,3 Facil i ty Name No. of Tanks Pl- Type of Busines(check): OGaso lne Statlon. er (describe) -fï-u~ k;"_.-, ,ç,.. Is Tank(s) Located on an Agricultural Farm? Dyes . .., Is Tank(s) Used Pr.i,~rily ~r hJ;icuitura~. rposes. Dyes ~No ~' /) Facility Address /~ ~. Uø..Lðø.J_. Nearest Cross St. ~ ~ T R' SEC (Rura Locations cnly) , OWner' onta t Person . Address V Telephone %3<;£.---/ ~'_ ':f Operator ~onta~t Person . _ Addres~ ~ I _~, ." .___- 3207 Telepho~'y~q- / is-.5~ B. Water to Facility Provided by Depth to Grourxlwater Soil Characteristics at Facility Basis for Soil Type and Grourxlwater Depth Detenninations C. Contractor Address Proposed StartiN; Date Worker's Compensation Certification t CA Contractor's License No. Zip Telephone proposed Completion Date Insurer () D. If This Permit Is For Modification Of An ExistiN; Facility I Briefly Describe fiØodifications proposed E. ~ank( s) Store (check all that apply): Tank t Waste Product Motor Vehicle Unleaded Regular Premium Diesel Wastg -- Fuel . Oii r "bu~e I . I D D D D 0 g 0 ,f D .;2 foI' D D D D D 0 0 0 0 0 0 B 0 8 B D 0 0 0 0 F. Chanical Canposi tion of Materials Stored (not necessary for motor vehicle fuels) Tank t Chemical Stored (non-comnercial name) CAS t (if known) Chemical Previously Stored (if different) G. Transfer of Ownership Date of Transfer Previous Facility Name I, Previous Owner accept full y all obligations of Permit No. issued to I understand that the PennittiN; Authority may review and modify or terminate the transfer of the Permit to Operate this underground storage facility upon receiviN; this completed form. - 'ftlis form has been canpleted under penalty of perjury and to the best of my knowledge 'is true and correct. Signature [){)IJß¡J IJ(tc d Title C/J1~iAf)/fl/L Date ~/;~/ðr6 -- ----.1 TANK I' (FILL C:-SEPARATE FORM '., ACHP::~ No...A .. uuQ,Ç - FÕR EACH SEcTÏÕÑ, CHECK ALL APPRõPRÏÃTE šõXEŠ-- 10. 1. Tank is: DVaulted DNon--uaulted DDouble-Wall ~single-Wall 2. Tank Material . ~Carbon Steel 0 Stainle!:s Steel 0 Polyvinyl Chloride 0 Fiber9lass~lad Steel B Fiberglass-Reinforced Plastic 0 Concrete [] Ahminum 0 Bronze DUnknown Other (describe) . Primary Containment Date Installed Thickness (Inches) ~" 4. Tank Secondary Contairunent o Doubl e-Wa 1 1 W Synthetic Liner DOther (describe): [] Ma ter ial 5. Tank Interior Lining DRubber 0 Alkyd DEpoxy DPhenolic DGlass DClay (])U1lined Dl1'1kno'-'1 OOther (describe): . Tank Corrosion Protection --crGalvanizedDFlberglass-Claci DPolyethylene Wrap DVinyl WrappiBj STar or Asphalt DUnknow DNone DOther (describe): Cathodic Protection: ~None Otmpressed CUrrent System LJSacrificial Anode System Descriœ System & Equipnent: 7. Leak Detection, Man! toring, and Interception . . a. Tank: OVisual (vaulted tanks only). LfGrourrlwater Manitorir13 Well(s) D Vadose Zone Moni taring Well ( s) [] U-Tube Without Liner []U-Tube with Compatible Liner Directin¡ Flow to Monitoring well(s)* o Vapor Detector* D Liquid Level Sensor 0 Conductivit~ Sensor* o Pressure Sensor in Annular Space of Double Wall Tank o Liquid Retrieval' & Inspection From U-Tube, Moni toring well or Annular Space a Daily Ga~in:} & Inventory Reconciliation 0 Periodic Tightness Testin:} o None 0 Unknown 0 Other b. Pipin:}: 0 Flow-Restrictirq Leak Detector (s) for Pressuri zed Pipirq- D Mani tor in:} Sump wi th Raceway D Sealed Concrete Raceway DHal f-CUt Compatible Pipe Raceway 0 Synthetic Liner Raceway [] None D Unknown D Other *Describe Make & Model: Tank Tightness Has nus Tank Been Tightness Tested? nYes DNa Dunknown Date of Last Tightness Test TIMET2bNIN'S"tAL~sul ts of Test OK Test Name AJ.r test . Testing Company RLW Equipment 9. Tank Repair Tank Repaired? DYes E8No DUnknown Date(s) of Repair(s) Describe Repairs Overfill Protection []Operator Fills, Controls, & Visually Monitors Level DTape Float Ga~e DFloat Vent Valves 0 Auto Shut- Off Controls DCapacitance Sensor DSealed Fill Box IClNone Dunknown DOther: List Make & Model For Above Devices 3. H. Capaci ty (Gallons) Manufacturer Unknot.JTl o Lined Vaul t i] None 0 ()ùmown Manufacturer: Capacity (Gals.) Thickness (Inches) -.- 6. 8. 11. Piping a. Underground Pipiog: IK]Yes []No Dti1kno...." Material Steel Thickness (inches) Diameter . 2" Manufacturer ~J e~cher coat È!]Pressure DSuction OGravity Approximate Length 0 Pipe RLr\ 30' b. Underground Piping Corrosion Protection : DGalvanized DFiberglass~lad DImpressed Olrrent DSacrificial Anode Dpolyethylene Wrap []Electrical Isolation DVinyl Wrap DTar or Asphalt DUnknown o None mOther (describe): Fletcher coat pipe w/10 mil wrap on c. Underground Piping, Secondary Containment: tJ.tt~ngs ODouble-Wall DSynthetic Liner System BNone Dunknown r1n~hn~ I~~~~~'hn\. e e F l L t:: C})NT t::NTS 1 N V t::N'l~OR '{ F de i lit Y ._ \J (') If K C.LJ m rY'\ er (1",; o...l. -p r ð P . ~ Pe no i t to Om d t e * Õ:)5 O~ DConstru(;tion Permit I o Permit to abandon~ o Amended Pe rm it Cond i t ions ~Permit Application Form, DApplication to Abandon OAnnual Report Forms . ) -- :::J",.A~_ :-0_ No. of Tanks Date Date Date Tank Sheets tanks(s) '9101 9IaY1S: Date ,,/ []Copy of Written Contract Between Owner & Operator OInspection Reports OCorrespond~.nce- Received " Date Date Date 5Z1Correspondence - Mailed rpC,ê,ip+ f).{ ncJ-,¡;;O-h~n ?1~ J/7ftnf .foremovePate 7-d-.;;J.. -as- Date Date o Unauthori zed Releas~ Reports [J Abandonment/Closure Reports [JSampling/Lab Reports . DMVF Com pI iance Check (New ConstructIon []STD Compliance Check (New Construction DMVF Plan Check (New Construction) [JSTD Plan Check (New Construction) []MVF Plan Check (Existing Facility) DSTD Plan Check (Existing Facility) O-Incomplete Application- Form DPermit Application Checklist . OPermit In~tructlons ODiscarded D Tightness Test Resul ts Checklist) Checklist) Date Date Date []Monitoring Well Construction Data/Permits ----------------------------------------------------------------- OEnvironmental Sensitivity Data: DGroundwater Drilling, Boring Logs DLocation of Water Wells [JStatement of Underground Conduits ~Plot Plan Featuring.AII Env~ronmentally Sensitive Data OPhotos ConstructIon DrawIngs Location DHalf sheet showing date received and tally of inspection time, ete DMiscellaneous e ft}e s !'... ;!:í--- c¡ 5 Ctfi 1700 Flower Street aaker.lleid, California 93305 Telaphone (80S) 861-3836 ,. . KtRN COUNTY HEALTH DEPARTMENT HEALTH OFFICER Leon M Hebertson. M.D. ENVIRONMENTAL HEALTH DIVISION DIRECTOR OF ENVIRONMENTAL HEALTH 'lemon S. Reichard May 22, 1985 Doretha Ward, Controller York Commercial Properties 1450 &:>. Union Avenue Bakersfield, CA 93309 t,; .'. Dear Ms. Ward: This is to acknowledge receipt of your application, notifying this department of your intention to remove the tank located 1450 &:>. Union Avenue, Bakersfield, CA. ~ern County Ordinance Code .G-3941 requires that all underground tanks be ·permi tte::J. Sinc~ you have notifie::J this department that you intend to abandon/close this facility/tank you must sutmit the enclosed documents within F10 days for review. The tank must either be properly abandoned, or be subject to all permit, inspection, and monitoring requirements of this Department. I have enclosed an abandonment permit application and our requirements regarding tank removal. A permit to abandon will be issued after the sutmitte<ì application has been approven. The permit will enable you to get necessary approval from the local Fire Department for tank abandonment. Shoul~ you have any further questions concerning the en~losed applications, please feel free to contact this office. Sincerel y, p~ {!~ Joe Canas Environmental Health Specialist I Hazardous Substances Management Program JC:aa Enclosure DISTRICT OFFICES De'eno Lemont. Leke I.ebelle Mojeve. Rldgec,e.t Shafter Taft e . ANNUAL TREND ANALYSIS SUMMARY TANK # J , (\. . 1 to ~_1fY! fl ~ n~ /Î C> }. ,-- TIME PERIOD: (..Ju.Þ-t 6' 7 to.-.~~.-¡L· r7 Total Mi nuses T~i s Per iod (L i ne 3) I ¿) Action Number for this Period (Line 4)~ ~c? Total Minuses This Period (Line 3) ¡I~ Action Number for this Period (Line 4) '37 /1 (Line 4) ~~ to;Qe0 ?1 ~ . Äl .s- tÝS .3 TIME PERIOD: QUARTER 3 TIME PERIOD: f1 to IY1W/ f f PERIOD 7: Total Minuses his Period (Line 3) ,~ Action Number for this Period (Line 4) / / 7 1/ /33 ..s' /~9 . to~ f~ PERIOD 10: Total Minuses Th s Period (Line 3) ~ I¿'S L/ IRo é/; I~¿' QUARTER 1 PERIOD 1: PERIOD 2: PERIOD 3: QUARTER 2 PERIOD 4: PERIOD 5: PERIOD 6: PERIOD 8: PERIOD 9: QUARTER 4 Total Minuses This Period (Line 3) Action Number for this Period TIME PERIOD: (bf f? 1 Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Total Minuses This Period (Line 3) Action Number for this Period (Line 4) TIME PERIOD: Action Number for this Period (Line 4) PERIOD 11: Total Minuses This Period (Line 3) Action Number for this Period (Line 4) PERIOD 12: Total Minuses This Period (Line 3) Action Number for this Period (Line 4) I report. ) ~g /0/ Date '7-1- P:P ) ,. - ANNUAL TREND ANALYSIS SUMMARY TANK # ·2 . QUARTER 1 PERIOD 1: PERIOD 2: PERIOD 3: QUARTER 2 PERIOD 4: PERIOD 5: PERIOD 6: QUARTER 3 PERIOD 7: PERIOD 8: ,- PERIOD 9: . - . ~.. , TIME PERIOD'~ PI to TIME PERIDD'~ g1 to k+ ,51 I I ¡ / Total Minuses This Period (Line 3) ~ Action Number for this Period (Line 4) ~L/ c:J /J~ ~-c~ 57 I ScJ f7 Action Number for this Period (Line 4) TIME PERIOD: f) tT P7 to' &.. Total Minuses This Period (Line 3) ~ Action Number for this Period (Line 4), ¿, 9 S- Action Number for this Period (Line 4) ~~ Total Minuses This Period (Line 3) ~ Action Number for this Period (Line 4) ¡I(ÎI TIME PERIOD~I~ 22 to /"?1CLA~ Total Minuses This Period (Line 3) '</ 1/7 .....3 133 Ó' /{/tj Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Total Minuses This Period (Line 3) Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Total Minuses Th~s Period (Line 3) Action Number for this Period (Line 4) P/ /' ú/4~~~ ~~ QUARTER 4 TIME PERIOD: ~ r¡'to if PERIOD 10: Total Minuses This Period (Liné 3) Action Number for this Period (Line 4) )0S- PERIOD 11: Total Minuses This Period (Line 3) <I Action Number for this Period (Line 4) IJCJ PERIOD 12: Total Minuses This Period (Line 3) -5 Action Number for this Period (Line 4 ) If' t¡, I hereby Signatur report. Date 1- ¿. It . 'I \. ¡,e~ 6 (¿') i'~ . \ r. . ./' . co" ' I I' ~ . , :(" \ -l::' (. .' )'" \ . -./: ~.. ...,; . . . .::> \ "" . .5/ .2f 5 fob w-/JÁ;4. (¡}~I s-b-kI .¡Iv-I- /10 uJ/ / ski b.~~ J-h ðllvr 'LIc~ ~~r;!;~ ~ ~cJø<' M~~h.sJ,J, .u.J J4 wJ/ ~ ~ ~¡~é. -/" <II.. ~hiJ¡u!~~5 M /-I.t ~ øow / "- (/-L.JL ~'- J q" æ1J'.,.J/U.-I.A-.J tv<ïJ Ju -~ -' ~ ~d Jy-.1~£. - 1 ,-}randum · KERN COUNTY DATE: L¡ - / L/ ï!J7 UfJ:;IT . ~~ (r2- .,- ~ :::J 17 '1 :0 Ú<> '" I~ ~ ~. J þ nsfv r, .c· ;z;:t:, (.}- ~ . ._ /1- '-1> (" /~"- I ; -L- ,.J. t .~, . 1700 Flower Street Bakerslleld, California 93305 Telephone (805) 861-3636 I:ERN COUNTY HEALTH DEPARTMI" HEALTH OFFICER Leon M Hebertson, M.D. ENVIRONMENTAL HEALTH DIVISION " INTERIM PERMIT TO OPERATE: DIRECTOR OF ENVIRONMENTAL HEALTH Vftmon S. Reichard .... - FERMI T#"2 5 Ò O'C; ~ 6':' ISSUED: EXPIRES: MARCH 1, 1987 MARCH 1, 1990 UNDERGROUND HAZARDOUS SUBSTANCES STORAGE. FACILITY NUMBER OF TANKS= 2 ' . . ---------------------------------------------------------------------- ." '-.' ~. . FACILITY: I OWNER: .. """"";"'~.:" YORK COMMERCIAL PROP. I SHEPHERD, ROBERT )c. .,"..... ",1450, SO. UNION AVENUE .1. 7604 DE COLORES '.;:;'.~':':¡":'" " i;¡f:.~~~~~~·~:~~~:.~~~:_~~;c~-~.-~~.~-~ë,~~'~~~~:----~:~~~~~:~~~:.-~~s4i.~~~!~i~~~~,,;,£i' . AGE (IN' YRS ). . SUBSTANCE CODE ..' PRESSURIZED PIPING? .~;;i:}::·<:;:'c.. ':;>;£;:~:';tD:~~ ~N usk'~';::;l!,t~:,~!i~;:*;;tf:j¡;~~~"i'\;;:',F .~ \. . ""., ~ . . ~: -.~ .... ... .,f..·. .., . " ..., , . NOTE: ALL INTERIM REQUIREMENTS ESTABLISHED BY THE PERMITTING AUTHORITY MUST BE MET DURING THE TERM OF THIS PERMIT :\ - . ~ .' . . .-,.,. ; ~. .. NON-TRANSFERABLE *** POST ON PREMISES "- ........ . . DATE PERMIT MAILED: MAR 1 7 1987 . . . .. DATE PEm1IT CHECK LIST RETURNED: '.1 . . . . . . -- KERN COUNTY HEALTH DEPARTMBNT TREND ANAL~SXS WORKSHBET ..... ..... . F A C I LIT ~ U~ &.~~..r:n efl" / ',~ /. /~./)....... r-P E R M:r T -.2L£xJOS c.. TANK t Z C~ACITY /~ lJòO t!2ð ~_ PRODUCT I ACð~ Â ) YEAR/PERIOD ~ - :rNSTRUCT:rON~: Pill in all infor.ation at top forll. In the space tor yel: period indicate the year and ~ consecutive perJod of analy~ being conducted (fro. 1 thro' 12 only). Transfer the date ~ the sign troll coluans 1 and 16 Reconciliation Shee~ to coluc at left. Use the table below determine the action nuaber t the period beinl analyzed. PART A : OVERAGE/SHORTAGE 1 DAY DATE DAY 1 ,-/,;;¡ DAY 2 i-I? DAY 3 J.~,~ DAY 4 i.,;Z·/ DAY 5 I·Z:; DAY 6 /- Zt.l DAY 7 1-7/ð DA Y . 8 1- Z ¿¡ DAY 9 ~- J.j- DAY 10 "ì-.') DA Y 11 ,.:J- (t:) DAY 12 ~-9 DAY 13 é)·17~ DAY 14 ~ I DAY 15 ..:J-.~ DAY 16 J...,-5 DAY 17 L-k DAY 18 <.../-- DAY 19 '+-Gt DAY 20 . 'l- J..{ 0 DAY 21 L.,-/~ DAY 22 L -IQ DAY 23 t..¡ Iw DAY 24 I..¡-/7 DAY 25 '-1-/<;< DAY 26 ~-I'1 DAY 27 L4 -';d- DAY 28 I-¡~d.è DAY 29 :d L DAY 30 ~;;;2.~ TOTAL MINUSES 16 (+/-) - -'- .- -+- -.,I- -I- -+- ~ .-/- -+ ';ACT:I ON NUMBER TABLE - - -+- ...... - - + -t- .4- - - -+- - +- + -+- -I- G - + +- 30-DAY I ('i ER IOD NUMBER II. J 1 ¡I J J ~', 2 S4;f 3 O~J 4 ¡f).o I. 3 illL c..,.¡ 6 ~7 8 9 10 11 12 - ACTION NUMBER 20 37 34 89 83 101 ~ 149 163 180 196 - .. .. .. .. - - .. "" '"' '"' Circle appropriate period an ac~ion number. A full cycle i made up of periods 1-12, afte which a new cycle bègins. Us information to cO.Dlete Part B PART B: Line 1 . Line 2. Line 8 . Line 4. Line 5. ACTION NUMBER CALCULATION Total minuses this period-Part A . . . . . . . . . . . . Cumulative .inuses from previous periods in this cycle. Total minuses (add lines 1 a 2) . . Action nu.be~ tor this period (from Is line 3 greater than line 4? 11 Yea, ~ have ~ reDortable . . . . . . table above) . . . . DYes ~o loss and must begin notification and investigation procedures as described in Kern County Health Department HANDBOOK JUT-I0 "STANDARD INVENTORY CONTROL MONITORING". £nv. Hqltll G80 4113 t018 (11/116) 10 c2 .:2J J~ /17 .... 8(· . er KERN COUNTY HEALTH DEPARTMENT TREND ANAL¥SIS WORKSHEET '. .... ., ~A~C/ L'þ-T~ cA~Q!(10)DOO , PERM:I T . d-SóWS PRODUCT ':.D--L~ P UYEAR/PERIOD I NSTRUCTI ON"S: Fill in all information at top form. In the space tor ye[ period indicate the year and t consecutive period of analyr being conducted (from 1 thro 12 ~). Transfer the date; the sign from columns 1 and 16 Reconciliation Sheet to coIu. at left. Use the table below deter.ine the action nu.ber . the period being analyzed. pART A : OVERAGE/SHORTAGE 1 16 DAY DATE (+/-) DAY 1 I..J-,;;) 7 + DAY 2 ¡:::;-;;;, - DAY 3 f-lLJ -+- DAY 4 -<=)-1 LI - DAY 5 5-11 - DAY 6 . ~_-'ì -:::-.. - DAY 7 '5- ~l /L -t- DAY 8 lLJ- -J.- DAY 9 (-y- ..:; - DAY 10 '---I - DAY 11 1...- R -;- DAY 12 ~-y -+ DAY 13 ~., 1::.L -.¿ DAY 14 (/'1- f7 /1 -I- . DAY 15 (,.....- ( ? - DAY 16 t: -;:). C) -I- DAY 17 h-:4----. -J- DAY 18 ..-.,.. Ò .'?;, - DAY 19. ;-.,- if ~ -f- DAY 20 DAY 21 DAY 22 DAY 23 DAY 24 DAY 25 DAY 26 DAY 27 DAY 28 DAY 29 DAY 30 TOTAL MINUSES PART B: Line 1. Line 2. Line 8 . Line 4 . Line 5. ACTION NUMBER TABLE 30-DAY I ACTION PERIOD NUMBER NUMBER '1 · 20 a · 3'1 3 :0 54 4 - 69 ~ · 85 6 · 101 '1 - 117 8 - 133 9 - 149 10 '" 185 11 '"' 180 12 .. 196 Circle appropriate period 8. ac~ion number. A full cycle made up of periods 1-12, aft. which a new cycle begins. U, information to coaDlete Part [ ACTION NUMB~R CALCULATION Total minuses this period-Part A q 32- <II 133 . . . . . . . . . . . . Cumulative .inuses from previous periods in this cycle. Total minuses (add lines. 1 & 2) . . . . . . . . . . . Action nu.be~ ror tbl. period (fro. table above) . .~ Is line 3 greater than line 47 (]Yes ~NO 11 Yes, you have ~ reportable loss and must begin notification and investigation procedures as described in Kern County Health Departaent HANDBOOK #UT-lO "STANDARD INVENTORY CONTROL MONITORING". -<\. En". Hulth 6804113 1018 (8186) Pacl11tx: _ -6*~ h, \~'2~.:s P~rlll1!! :l5Qaq 5C- -- Note: I. All .~ters .ust have calibration checks a minimum of twice .! year, which aay Include checks done by the Department of Wel&hts and Measures. ~. Before starting cal1bration runs. wet the, calibration can with product and return product to storage. 3. Run 5 gallons with nozzle wide open Into the can. Note gallons and cubic Inches drawn. and return product to storage. . ". Ru~ 5 ~al1ons with the nozzle one-half open tnto toe cân. NQte gallons and cubic Inches drawn. arid return produèt to storage. . 5. After all product for one calibration check Is returned to storage. remember to record the voluMe returned to storage in coluMn 9 of the Inventory Recording Sheet. 6. If' the volu.e ·.easured In a 5-gallon calibration CRn 19 more than 6 cubic Inches above or below the 5-ga11on .ark. the Meter requl res cal1bratloo by a registered device repairman. Date/Time Hose or Tank 'I Pump t Product 1- ~ I ~:3t> \ \)t~'S~' ~~ Past Plow Slow Plow Vo ru.e Returned Calibration Device Repalr.an Date of 5-Gallon Draft 5-0al100 Draft to Stora~e Required? Use~ for Calibration Gals Cu. Inches Gals Cu. Inches Gallons Yes No Calibration 5 (-'- ~) 0 5 (+ 7)-3 35.(:) X C,ClÂ-\-=' ~\ ~¿' '5 ~ 'A \ ,C\<6ì . \-e.s t c:::.R\ " . . " ~~~~ OWner or Operator Sllnature Calibrator's Signature ~. ~ ':8 ~tI.J\ SUBMIT A COPY or THIS PORM WITH ANNUAL REPORT.' Rellstrat10n . ~5-<::)(::)3ö . . . ~ .. RI.~ - Record of Computer Chenge, Meter Change, or Calibration } COMPUTER CHAN,OE ~ CALllIA"TION o WI" NOTIFIED ] METER CHANGE STATlOH NO. oapa~ -y FINI8H TOTALIZER "fADINGS STAAT ODUÇT e.-5e ] ~,"A( ANLJ ",OUt\, .-.--....-- TùT AlIlEH FINISH READINGS STAAT JOVCT ,.- ?\~o GALLO" - .$ '2 L<O~ GAl.LOH. 5 1 9 1 \...{ GAl.LON. IIETUIINED TO ITOIIAOE 2:> 5 .c~~ \ IIIONIT - ..- TOTAL IiEII'.... NUM8EII wÕÑf. UA'LÜN~-- . -- --- -, GALLONS TOTAL LL NS RfTUHNED TO ST~AGE . ----...---- .ïõÑiY--_.'" -.---.-. f..iA1LtIHŠ--· ...- 0·__ FINISH TOT ALIZER READINGS YONi' STAAT ~LH~' Pump * TOTAL ..... WAIIl ....t I 1IiIl.'Ua.... .-.:..__.. _n ll)' ALlZER FINISH READINl.ìS we,..., STAAT f )':·'~''':ï· ----. UAIIONIt GALLONS HE 1UANI'U 10 ~'dA.I.r lier.IAL NUMBI II :...:'~~.- -..--------..- r.Alll)HS hAil I_-¡---..·· --.. -... GAll UNfi ilL 'LIIINf U TO :ò' OIIAUL IoIONIY TOTALIZER READINGS FINISH ~ GALLONS STAAT ALLØNS liE TUIINEO TO STOIIAOE J"'" \!I4.--'l .,..(, MUO(L IiEH'A' HUWBk H ~, GALLU"IS ~.~ lùTAlIZER READINGS FINISH -.;y LL UN' START 'OuuC' Pump # TOTAL ., / DAn - .... 1-~-?J7 CALIBRATION -- CHECKED ADJUSTED TO fAST BLOW fAST SLOW +- "t" -¡ <:J -. 3 ....TI~ oNO 18 oNO CHECKED I~--- !iLOW lO'AI'lEMSEAL D DyES DNO I ¡"ii"i"-- ... .LüW JÚT.....'ltR St.....£D Om. 0 NO " CHfCKEU ':.~._~-r_~:· 101.0.1'1[" h'A' 1.11 0'1:8 D NO . fAST CHECKED BLOW 'UT Al.1lER SEALEO O'ES. oNO CHECKED fAST &LOW 'U . AUlEH :if AtEII 0't!S DNO MUtR SEALEO Dna ;.. ¡ t I T ' DNa CALI BRA TlON r ~ f"~T ADJUSt ED TO :iLOW ...nÃ -¡¡¡"¡Lr u o'fl -..--- 0"" CALIBRATION fAIT ADJUSTED TO BLOW METER _ED DYES o~ \.-". CALIBRATION ADJUSTED TO fAST SlOW .J MfTEII .EAI.iD Dvu oNO . - ._- . ..--. ~ -. . -" _. ~ - BAKERSP'IELD SERVICE STATION REPAIR Ino so UNION ....VE.. a....KERSfIELD. CA 93307 24 HOUR SERVICE {80S! 317-4659 Record Of Computer Or Meter Chenge i-- is:- 9ð o Meter Chenge o Compu ter Change o W/M Notified Contractor Location Station number Datø Product Sen..1 Number Taglled Tee- oAed DGreen Calibratíon: Fast Cheekad Slow PII. J Adjusted To Slow ",oduet Totali.er Sealed ~ter See led es oNo es DNo Serial Number Tagged Tag. DAed DGreen DBlue Fest :3 Calibration: Checked Adjusted To Fest -t 3 PrOduct Totalizer Sealed Meter Sealed Serial Number ~es Tagged DRed DNa AJ>Y.. Teg _ DNa DBlue Finish (gallons) Calib,ation; Checked Start ga/lons Adjusted To Return to Storage (gallonS ~ter S..lea DYe, DNo Meke end Model Serial Number Teg. Pump DBlue Fini'h (money I Finish (ga/lons/ SlOW T ot.lin, RNdinp Start (money I Checked Adjusted To Slow Make and Model Totalizer Sealed DVe, DNo T egged DRed oGreen DBlue Calib,ation: Fan Checke~_ Adjusted To Meter eled Ov.. ee- ONO Product Pump Slow Totaliaef R....i"" Stert (monev F_t Slow Pump Totalizer Sealed Met., S.al.d DYe. DNo Dves DNo Tee _ DBlu. Fa.. Slow Slow DY. DNa P,oduct .. if' ) KERN 4!OUNTV HEALTH 4kEPARTMENT ~ T~END ANALYSIS WORKSHEET ..~ ¡~ T <:.--":' o..J _ ·.Nl( # -.- LITY [ ) CAP NC I TV _ J1T A : Q.Y..E RAG E ISH 0 R TAG E .-- :)AY ....----- .- ;.!:\ Y Ji\Y "fA Y j.~Y d. . '11 '! ¡kY U:,.Y ,.;AY DAY ·:·ÁY -,. ;;AY .' · L~·1 JAY 1 2 3 4 5 6 7 8 9 10 11 1 DATE 'J;-I ~. Tì ...... I ;;;. '-"-, 16 (+/-) <n/é.~t(i; M I ~AR7p~~)~~;' I II 3D-DAY I ,PERIOD NUMBER 1..1 1 ~~ 2 ~3 {)i;J:' 4 1\)00 5 ~~6 l.-1.V 7 , :.L.b 8 ÌY)A.- <!2 ~~ 1'0 'ß.4-4.f 1 1 . ,,- 12 --.:.r__ ;(!¡\[ 14 ~::¿¡()-' .J. '! 15 ¡..Lj -~ ~,{:.y 161 L_'-q .. :}" Y 17 L..j - ",::;c; ;, \/ 18 ,...... :,." -' . I JAŸ 19 -?.1\ )/\'1 20 ;;-;/ t:.l 21 ~. 4- · ".Y 22 ì=;-x .:iY 2 ~~ .1=): rr ') " ,1\ Y ;2 4 '-- r,;- T c::::;;J.- -, .~¿. Y 2 5 ~"::I-') _?>Y 26 ..."1 -(7 :/. i 27 ". ::;21') :.lAY 2:.1! 'T,~Îí (.~i-? 9 r" CD-"1 ¡ÿ.' 3 0 j (/)- X ..2.TAL MINUSES INS T Rue T I 0 N'S : Fill in all info~mation at top form. In the space fo~ yea period indicate the yea~ and t consecutive period of analys being conducted (from 1 throl 12 Q.!!1y). . Transfer the date L ~ the sign from columns 1 and 16 Reconciliation Sheet to colu~ at left. Use the table below determine the action number f the pet'iod being analYZed.~ ACTION NUMBEFt' TABLE -tt -L- -r- ~~,Ll "::2. t:.. - .. ACTION NUMBER 20 37 54 69 85 101 117 133 C@"') 16'5 180 196 + ~ 4- -.;¡.-! r ~·.:Fr h- 0:;2. -14 7). -Jr7 r.;¿r ~. 12 .~dJ4- 13 .- -I- - -1-. -i- .. ::0 ::0 = .. .. ::0 = = = = Circle appropriate pe£Jod a action number. A full cycle made up of periods 1-12, aft, which a new cycl~ begins. u~ information to complete Pa~t f "'? .-- "'" IL- I - C7'- - ....J- - -+- .- ..... .- -+- - - - L -I- =t- - - · !~.RT-ª: ACTION NUMBER CALCULATION L1ile 1. Liü(-; 2.. LJ ne 3.· "-~ (19 4. .L~ne 5. Total minuses this period-Part A Cumulative minuses fro~ previous periods in this cycle. Total minuses (add lines 1 & 2) . Actioc number for this period (from table above) Is 1 ine 3 grea ter than Ii ne 4'/ 0 Ye s· . ~o li Ye.J!., ~ have -ª reportable loss and IIIUSt begin .notification and investigation procedures as describ~d in Kern County Health Departoent HANDBOOK #UT-IO ,i. H<w!th 58041131016 (6/86) "STANDARD INVENTORY CONTROL MONITORING". / ~~ ?~ /~9 .. - KERN COUNTY HEALTH DEPARTMENT '" TREND ANALYSIS WORKSHEET F A C I L J. T Y /.4177/ ¿j..n/ ~4J ,/ L~2 TANK # ~ CAPACITY .//J /Jr)O ~ j;J PRODUCT PART A : OVERAGE/SHORTAGE , A:æ p~~ ~ ~ ~AR~~f~DOtj~fF - INSTRUCTION'S: Fill in all inforœation at top of form. In the space for year/ period indicate th~ year artd the consecutive period of analysis being conducted (froa 1 through 12 only). Transfer the date and the sign froa coluans 1 and 16 of Reconciliation Sheet to coluans at left. Use the table below to determine the action number for the period being analyzed.' 1 16 DAY DATE (+/-) DAY 1 /--:J~ - DAY 2 1- 7_ t./ - DAY 3 / - ~ J_ ' -i- DAY 4 "/- "7'1 .~ DAY 5 /_ '7? ~ DAY 6 / 2~ - DAY 7 /- 5¿> -:-+- DAY 8 ~.~ ~ - . DAY 9 7..- <../ - DAY 10 Z. - ~ - DAY 11 ..¿ - L.ð - DAY 12 ,..;;) ... 7 -I- DAY 13 '7_ Y -I- DAY 14 ? - ~;;. - DAY 15 7 - /1;) - DAY 16 ?-/y - DAY 17 'L-/9 -t- DAY 18 L-¿Õ -J-- DAY 19 Z,-¿I ' -+- DAY 20 2- 2.7.- -!- DAY 21 ...:; . .;2 3 - DAY 22 Z-¿y -- DAY 23 ...2 -..:?.'" -r- DAY 24 2-Z/,. - DAY 25 '::::'-Z-; -I- . DAY 26 2 -757 - DAY 27 DAY 28 DAY 29 DAY 30 TOTAL MINUSES PART B: Line 1. Line 2. Line 8. Line 4. Line 5. ACTION NUMBER TABLE 30-DAY I ACTION .-P.ERIOD NUMBER NUMBER r:.- 7 .~ 1 :a 20 T 7 - a a 37 - 3 = 54 -4 = 69 ..5 = ~5 ==þ.- 6 = G~~ ~ J-'__ 7 .. ~8 .. 133 9 .. 149 10 = 165 11 = 180 12 = 196 Circle appropriate period and action number. A full cycle is made up of periods 1-12, after which a new cycle begins. Use information to complete Part B. ACTION NUMBr:'R CALCULATION Total minuses this period-Part A . . . . . . . . . . . . Cumulative minuses from previous periods in this cycle. Total minuses (add lines 1 & 2) . . . . . . . . Action nuabEnt fop this pertod (from table above) . Is line 3 greater than line 41 DYes ~o XL Yes. ~ have ~ reportable loss and must begin notification and investigation procedures as described in Kern County Health Department HANDBOOK #UT-10 "STANDARD INVENTORY CONTROL MONITORING". Env. Health 58041131018 (6J86) PER M X T .d6CJOO5(;, YEAR/PERIOD //·ð INS T Rue T I 0 N'S : Fill in all information at top form. In the space tor yea period indicate the year and t consecutive period of analys being conducted (froa 1 throu 12 only). Transfer the date a the sign froll coluans 1 and 16 Reconciliation Sheet to colu. at left. Use the table below determine the action nu.ber f the period being analyzed:· e(, e( KERN COUNTY "~LTH DEPARTMENT - .. ..=.,~._----~ TREND~ANALYSIS) WORKSHEET '~~~"-,-'" ..~ i t¡¡.---:..- . " ' FACILITY TANK , C PART .A OVERAGE/SHORTAGE DAY DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8 DAY 9 DAY 10 DAY 11 DAY 12 DAY 13 DAY 14 DAY 15 DAY 16 DAY 17 DAY 18 DAY 19 DAY 20 DAY 21 DAY 22 DAY 23 DAY 24 DAY 25 DAY 26 DAY 27 DAY 28 DAY 29 DAY 30 TOTAL MINUSES Circle appropriate period anc ac~ion number. A full cycle is made up of periods 1-12. after which a new cycle begins. Use information to co. lete Part B. PART B: I.i ne 1. Line 2. Line 8 . Line 4. Line 5. ACTION NUMBER TABLE - -r- ACTION NUMB~R CALCULATION Total minuses this period-Part A . . . . Cu.ulatlve .lnose9 from previous periods ln thls cycle. Total mlnuses (add lines 1 A 2) . . Action nu.be. for tbie period (from Is line 3 greater than line 41 11 Yes, ~ ~ ~ reportable . . . . . . . table above) . loss and %~o \lust begin DYes notification and investigation procedures as described In Kern County Health Department HANDBOOK #UT-10 ·STANDARD INVENTORY CONTROL MONITORING". En". Healt" 680 4113 1018 (11/86) . ACTION NUMBER 20 ." 37 .54 4.2- C~v:.? - . ~ " .- 117 133 149 16ð 180 196 II: c 1/ 413. S-</ g5 ... . .. 0 KERN COUNTY HEALTH DEPARTMENT TREND ANAL?SIS WORKSHEBT ...... ,.... PACJ: LJ: TV UJ)4~ £-.. -,/'/~d g.A2..l1rJPERMJ: T ~S1?t15c.. TANK. I CAPACITY If} I)()O /)A1.... PRODUCTI ÆU./P..-.~/, YBAR/PBRIOD&-YJ: INS T Rue T I 0 N"S : I PART A : OVERAGE/SHORTAGE Pill in all intoraation at top fora. In the space tor yec period indicate the year and t consecutive peiiod of analYf being conducted (fro. 1 throl 12 only). Transfer the date f the sign froa coluans 1 and 18 Reconciliation Sheet to colu~ at lett. Use the table below determine the action nu.ber f the period beina analyzed.' 16 (+/-\ 1 DATE //J - J /J /~ - / /0 /n - / -7 11:J' - /It¡ ~ -.h::> t:. -Z, Z &-?~ In - 7c1 DAY DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAy 8 DAY 9 DAY 10 DAY 11 DAY 12 DAY 13 DAY 14 DAY 15 DAY 16 DAY 17 DAY 18 DAY 19 DAY 20 DAY 21 DAY 22 DAY 23 DAY 24 DAY 25 DAY 26 DAY 27 DAY 28 DAY 29 DAY 30 TOTAL MINUSES +- - + +- - ~ - - ACTION NUMBER TABLE 30-DAY I PERIOD NUMBER 1 2 3 4 5 6 7 8 9 10 r-l&~~ ~ ~ ACTION NUMBER 20 37 54 69 85 101 117 133 149 165 180 196 - - ... .. .. .. .. .. .. '" .. .. Circle appropriate period an action number. A full cycle i made up of periods 1-12, afte which a new cycle begins. Us. information to coaolete Part B PART B: ACTION NUMBER CALCULATION Line 1 . Total minoses this period-Part A . . . . ~ Line 2. Cumulative .inoses frail previous periods in this cycle. ~ Line 8 . Total .inuses (add lines 1 at 2 ) . . . . . . . . Line 4 . Action nu.be'F tor tbis period (tram table above) /0/& Line 5. Is line 3 greater than line 41 DYes )tNO 11 Yes, ~ have A reportable loss and must begin notification and investigation procedures as described in Kern County Health Department HANDBOOK #UT-10 "STANDARD INVENTORY CONTROL MONITORING". ~ En.... .....Uh 0804113 1016 (8/116) -, ~-- --~ .~-- ~ INVENTORY RECONCILIATION SUMMARY - WEEK 11 A. Percent Variation: 31_ Amount Ove~r~cnl 16) Gals. 0 Total Metered Throughput (Col. 15) Gals. x 100 = % Variation ... B. Reporting: - ~ 'C --~- .- - ; ::'..~:} 1, Does the Amount Over or Short exceed 350 Gals? DNO - Continue routine monitoring DYES .'-' within 24 hours of discovery -- . . ~ ....:.~ 7_. 2. Does the Variation exceed 5%? ; DNO - Continue routine monitoring DYES - Report to Peraitting Autho within 24 hours of discovery. I WEEK 21 ~ ~ -- - -.. - . . -- , I .0._'___'__ . . --. --.,.. . ._~:t. i· - ., -------: -- --.' - ---;-:.- --: .." - -...... A. Percent-' Variation: - --- _.u _ _..~ _. --. .....-..,- "- --...'~ -- --..,. ..~ . --.....- ~- ~ .-,.- '" .~ - --- .." Amoun~~~~ (C~l. 16) ~-. . _.~. _ ._--- -..--.-. .~.- -~,.~-- --. ---~- . . - . .... - ... ILP3 . " -G~l~-. -;~~; }~_. , .-1- -. ~-~ariatíon-~ - :-~ :'~--~-(' ' . ' Gals . · Total Metered Throughput (Col. 15) T 8. Reporting: í DNO Continue routine monitoring DYES Report within 24 hours of discovery. 1~ Does the Amount Over or Short ex~~ed 350 Gals? - - 2. Does the Variation exceed 5%? DNO - Continue routine aonitoring DYES - Report to Permitting Authority within 24 hours of discovery, ~. .... . iation: {. I ~¿¡;- (Col. 16) Gals . · Total Metered Throughput (Col. 15) .:;; 'ð Gals. x 100 = % Variation B. Reporting: I 1. Does the Amount Over or Short exceed 350 Gals? DNO - Continue routine monitoring DYES - Report within 24 hours of discovery. ( DYES 2. Does the Variation exceed 5%? DNO - Continue routine monitoring - Report to Peraitting Authority within 24 hours of discovery, 1ßŒI[ 41 A. Percent./Variation: / \ 0J Gals. · Total Metered Throughput (Col. 15) 30"5 Gals. x 100 = / % Variation ( Amoun~ Over/Short (Col. 16) ~ ~. ./ B. Reporting: 1. Does the Amount Over or Short exceed 350 Gals? DNO - Continue routine monitoring DYES - Report within 24 hours of discovery. 2. Does the Variation exceed 5%? :0 NO - Continue routine monitoring DYES Report to Permitting Authority within 24 hours of discover - I JmImlI ¡ A. Percent Variation: Amount Over/Short (Col. 16) Gals. · Total Metered Throughput (Col. 15 Gals. x 100 = % Variation B. Reporting: - Does the Variation exceed 1.5%? DNO - Continue routine monitorin DYES Report to Permittin Authority within 24 hours of discover ,~ ( I HEREBY CERTIFY THAT THIS IS A TRUE AND ACCURATE REPORT SIGNATURE DATE En~H.ealth 5804113 1017 1f)!ß61J!33ck\ .. (----' (~)L;(__'S- --- -~;> --. C PERMIT # KERN COUNTY HEALTH DEPARTMENT INVENTORY RECQNCILIATION SHEETt ~ TANK # CAPACITY) () i 000 PRODUCT 'DLLS.~ J '. ¡- ii·! \.../.~,. 1\ ç' MONTH/YEAR FACILITY 16 AMOUNT OVER OR SHORT +GALS -GALS Z ~ T J::F 4 ¿¿ 7:J: - EQUATION 4 I 14 :c INVENTORY - REDUCTION = GALLONS IllllLLlllllllllLlllLlllllllLI LIIIII/ll[ILIILIILIIIILIIILLII I , \ I ~ TOTAL METERED THROUGHPUT GALLONS ¡ ¡ ( , , j' 15 TOTAL METERED THROUGHPUT GALLONS -:5l ~ ~ -c-r ~ ~ ê= ~ &-7 k5" ..c::r o :3 1 ~ l~ , 11111I1/IIILlLUlUIIIIIIIIILI \ ¡ ~ 7Nï f EQUATION !! = I 9 TOTAL METERED READING SALES ADJUSTMENT GALLONS GALLONS -:¿::¡ h - - L 14 INVENTORY - REDUCTION GALLONS W-. . I Þ ~ -g- ð ?J ~ ..J-í 3f5 -1:::L ~ ..£...- ) ,fð i EQUATION 2 12 1----2 = DELIVERED CLOSING INVENTORY INVENTORY GALLONS ~ 7rm- I~ì>;.. " L..If ":J7; ¡ r,,<, '. \' y ".'. j \ "I, " f !-, ~;.~ '\ ~\~~ ~ ~ \~ \ ~ ~"1u( J , , , " ~ Uµ , , tt L¿ \ LIL/ILlLIII/III/I///////////// ! Q.. L) I/////////////I//II/LI/L /l11//li... B n !Æ 4 OPENING INVENTORY p¿GA!3öS ,r·...,. . '. ì,..., . '-/·"-.r· f ~'.'-'~.' ~. .....: \.) . > ...~ . WEEK 4 TOTALS ~±ß_ R I + 2 1 DATE DAY/HOUR ({;-( <;'·c"} (0·~) . . '. .~~~-.t 1. ',-' . ~. ;.-'..r -r~ l,...,.- [ ;" .r'~)<. ~,_'_f ~ ,,.;-1_~ ;,_f i (:1/~ 0-/3 ?J-I'-J VJ-/~ / (':-11 f) f~'r ! I . i' V. -/ï, ""........) ¡:,u . '¡!/.-, '-bX.) .....: l~ &-~, ~ ¡~ ~ (ð.;J:5 G~.;y' /'! -. , 121 (,..,';;'-, (ry6)'1) ~% -- ..... I ILIIIIIVIIIIIILIIILILIIIL/LLII 11I11LlIII/llllll1 III I Lllll11llLl MONTHLY TOTALS ;: Env. Health 5804113 1017 (6/86)-¡¡;;;';; / .- - PERMIT # ' (' hr- - I C" _~. Y)t 1 L_:- : ~ !.. I- i r) r 9 MONTH/YEAR \. '! : " ..... '" --I '-¿" L.,.' þ' II i I KERN COUNTY HEALTH DEPARTMENT ",-;, ; ' ,~~i ,'r ./-: _, __~~ INVENTORY RECORDING SHEET I IO¡CCÛ /-" FACILITY ICX2.K 0rrJ)!( ':;1/1 1/ f1ry)(t, tT(éTANK # CAPACITY r"r' C PRODUCT L)leS2- .. '--\ __L ; EQUATION 1 I 1 2 3 4 5 6 7 I 8 9 10 ¡ 11 12 13 OPENING OPENING CLOSING CLOSING METER _ DAILY METER = TOTAL READING GAUGING : GAUGING DELIVERED WATER DATE GAUGING INVENTORY INVENTORY READING READING METERED ADJUSTMENT BEFORE i AFTER INVENTORY GAUGING SALES DELIVERY; DELIVERY DAY/HOUR INCHES GALLONS GALLONS GALLONS GALLONS GALLONS - GALLONS INCHES GALS INCHES GALS GALLONS INCHES /,' )(")" ('¡";;'/\ ':L" <'III I -::>~ ~/"I''/ J 4' ;'. I L...),_/. I(! I -:at'. I '"~-n:-! "'1 ';< Ii' '7".' \ :5()A)/ I i ~::):;! " , I /'¡ ¡ "),'-'y' ) ."~ ft'~~"f i :'.'-,/'\ _~:;/'F-';:· ; ~--:~:".~';' ; ~ . .J /.'~'" .' ì ' ........-~/.-.. ? r\;~ II I .-' -, ,.0 ¡' , ( .. " II,' ./ J/' J _-JC7,1"" -10./ (', - . ,~ J !"',y'(') /:.;? '\ \, 1 ~~I~I I . '::~~.i:- . :. ; ì I , I' 3d?'! ¡ I I:<;d-,ýl/, /~) ) " ( ) ~ - . ., "" <7.' )('1 I -, - .- - , " ~(. Ie '. 'Jd, ,-:~! . -þ}Ç,! ! , ! -)' I CfCr.::v ~J...!r. _ 3dXCr q . j 3,;i9;0Q: ¡ . ) ¡, - - ~ì--i::::J :"-k/' I 3'JQLlJ., I 3;)x':'¡:j I I < ì I ~ l./'-./ -j --cl~;' / ;::>~o:.J j. t ::::<';)--U.' j , I i ~ I,'¡r ( 'r\ .' -. -:::;,~' ..-:' "i -.;.,~~ ..._- ~~i:"· I -1~./' , 3;)1'7/. I ->'-'_I-.J: I ' , : ,= C-1c;)() I 10/) :::::: ')0' ¡: ; )/~ICj 'I i. i ' W' ,...:J:'Y '¡ i r~J( ) ! ¡ Q'Y) 2, d q '''/1 , I ::",;;'1 --1 '7,' . } _ ~ 1Ic:0) /I"" ) j)9' 1(, ~,;JC¡'-lf, il' ~ . l/ùfJ I() [) ~:<;[),9, I I ~_Jç~) í I ¡ ., , Ê'" Iii () '-1'LI () .;¡ -q !"l J I I Z)::<, /,,x, J ' J ~ I! ~, í ~ GfU!\ (..h'¡:) ~3j ;::;/, í ,~3/;=ji, f I V{LJr¡ ~ I 4- ~?d n:¡. J ;";;;;, j .;¡ ; . ¡ "'.. ; \ j ;"5 J rf5?¡ 33~;:'JS, j X¡¿fI7, í U i I rl~M ~?. ~\"3;¡)\. 33~3í5. J (, I F5';j (é!5-J ~,/;<:4'-1 ) I 333';)3' , I IOó.L. I (/)5/ .e:. 'd:Y J ~:?ç.::::. ) I / 3?V.J~l). I ?$C¡ I ~Lfl;:J,r F- ,y /) "J ~ Ff,:'I:J ' ~ -=3 F) J'Ì t I r'/ () 0)' n ;.(..¡() ~~7l I ==3~5K5, I//f) -:<.:,¡n ~qn'5~'7( I. J 337()/. (. ' - -~'1() , I?() 3;;¿r7(~ . /=<;--<;'7') I i )X! ) 7() 'I 'Ie} -')~7( . 33-'1"',)1' , i ' ¡-liD '--"''-' '""--'..-¡( /. -;;<?-rr-.I (, 'L fl,:) -'_)1'::' ¡)/()!, ) r-¡ 7n I f7r 3";(~()1 \ :)~7()1 \ ( j I r- ~ '-v.VJ ~ / l l i ~ I ., /1),/)1; l(.1 /1-I.Afl.Á(lJ'~'/~ DATE " ~ d ; Ii ¡ I I , ""'" .- .' Permit Questionnaire Normally, permits are sent to facility Owners but since lIany Owners live outside Kern County. they may choose to have the permits sent to the Operators of the facility where they are to be posted. Please fill in Permit # and check one of the following before returning this form with payment: For PERMIT # ~5Ló05G 1. Send all information to Owner at the address listed on invoice (if Owner is different than Operator. it will be Owner's responsibility to provide Operator with pertinent information) . 2. Send all information to Owner at the following corrected address: K- 3. Send all inform~tion to. Opera~nr:- Name: \.. .... L _ _ .....- -' -' Address: ¡¡¡Ø ¿)o· On i on Ave.., ßks-F, 'Co. _ 1,-3 3D J (Operator can make copy of permit fòr Owner) . Facility . 'i~ YOfK PERMIT CHECKLIST QOmmºfC~cJ. ?(O~(-nès Permi t t2:.50005~ This checklist: is provided to ensure that all necessary packet enclosures were received find that the Peraittee has obtained all necessary equipment to impleraent the first phase ot oonitoring requirements. Please complete this form and return to KCHD in the selt-addressed envelope provideà ~ithin 30 days of receipt. Check: Yes No i. A. : ~ - K ~ B. ~ Ä- The packet I received contained: 1) Cover Letter, Per.it Checklist, Interim Permit, Phase I Interia Permit Monitoring Requirements, Information Sheet (Agreement Between Owner and Operator), Chapter 15 (KCOC tG-3941), Explanation. of' Substance Codes, Equipment Lists and Return Envelope. 2) Standard Inventory Control Monitoring Handbook tUT-IO. 3) The Following Forms: a) Inventory Recording Sheet b) Inventory Reconciliation Sheet with summary on reverse c) Trend Analysis Worksheet 4) An Action Chart (to post at facility) I have examined the infor.ation on ay Interim Permit, Phase I Monitoring Requirements, and Information Sheet (Agreement between Owner and Operator), and find owner's name and address, facil i ty name and address, operator I s name and address, substance codes. and number of tanks to be accurately listed (if "no" is checked, note appropriate corrections on the back side of this sheet). C. I have the following required equipment 1) Acceptable gauging instrument 2) "Striker plate(s)" in tank(s) 3) Water-finding paste (as described on page 6 of Handbook): D. I have read the information on the enclosed "Information Sheet" pertaining to Agreements between Owner and Operator and hereby state that the owner of this facility is the operator (if "no" is checked, attach a copy of agreement between ~ and operator). IX: E. I ~~ve en losed a copy of Calibration Charts for all tanks at this facility (if ~ - tank,~/,arê' identical, one chart w~l.4 suffi91!:1I )abel chart(s) with corresponding -------tañk numbers listed on permit). r~ ~~~ k ~ F. As required on page 6 of Handbook 'UT-IO, all meters at this facility have had calibration checks within the last 30 days and were calibrated by a registered device repairman if out of tolerance (all meter calibrations aust be recorded on "Meter Calibration Check Form" found in the Appendix of Handbook). G. Standard In~entory Control Monitoring was started at this facility in accordance with procedures described in~book #UT-IO. Date Started ;- / - (S' I Si"nature of Person Compieting Checklist, 85W-$h.( çhQJ.-(~ Title: oaOÒUfl+() Date: /'-7r-F7