The URL can be used to link to this page

Home My WebLink AboutUNDERGROUND TANK Operate Waste Uilified Permit Ît to MaterialslHazardous Hazardous .PN REVERSE SID~ , , I CONDITIONS OF.<PEElMfI , . "'::' ~.:~; :;.j~~:~ .i,:' .:.., , );]~:~?~f;~}*~{~;\ : ;. . r,..... ItI Hazardous Materials Plan o Underground Storage of Hazardous Materials o Risk Management Program o Hazardous Waste On-Site Tre8tment Permit ID #::015-000-000701 HARRIS MARKET LOCATION: 1701 UNION AVE ONITORING : " : ., ~:i' "~:(~. , \ ,; Approved by: Date Issue -" ExpÏiation,Date: <f'.;~'~ ,~.~ t.. .? Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 , Voice (661) 326-3979 FAX (661) 326-0576 ,', Issued by: ~ . I i I I CA Cert. No. tT07713 . J City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (661) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below. The certificate number on'this facsimile matches the number on the certificate displayed at the facility. I Instructions to the issuing agency: Use the space below to enter the following infonnation in the fonnat of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facili&; facility identification number (from Fonn A); name of issuing agency; and date of issue. Other identifying infonnation may be added as deemed necessary by the local agency. This permit is issued on this 18th day of October, 2000 to: HARRIS MARKET Permit #015-021-000701 1701 Union Ave. Bakersfield, California 93305 __0__- Operftte to Ît Per Waste Unified Permit Materials/Hazardous Hazardous CONDITIONS OF PERMIT ON REVERSE SIDE This ermit is issued for the followin tI~~ardous Materials Plan .",'''' ~[øround Storage of Hazardous Materials "'~gagement Program "" Waste PIPIN ONIT ALD ALD ALD \' PERMIT ID# 015-021.Q00701 & UNION AVE MINI MART (HOW, UNION 1701 LOCATION PIPING METHOD PRESSURE PRESSURE PRESSURE UNK UNK UNK LPT LPT LPT CAPÀCt1Y~~ f;::C3l!'L i ~._-.:. .:~ :. ~~ '~i !~¡-:~:::'" .:~ \'\ :¡~. ' '-.J: :"", ,~.. ....... .',. '....., " , .~ ...- . ''''-. .,. ',-. 12,OOQ:ÖÖ GAL'r, 12,00d:¡PO''eAL 12,000.do"GApii: TAN HAZARDOUS SUBSTANCE - 01 SUPER UNLEADED i>02 LEAD PLUS 0003 REGULAR UNLEADED Approved by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326,0576 Jun Expiration Date: Issued by: e -- CA Cert. No. 007i3 1 City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (805) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to the issuing agency: Use, the space below to enter the following information in the format of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. This permit is issued on this 2nd day of November, 1998 to: UNION AVE MINI MART Permit #015-021-000701 1701 Union Ave Bakersfield, California 93305 , 0~ ~ DIAGRAM OF LICENSED PREMISES '. STATE OF CAliFORNIA OEPARTMENT OF AlCOHOliC BEVERAGE CONTROl 3, TYPE OF LICENSE Öff ~G.-~ ße.ctR,A1,~W"AA 2'PRE\~~DRÜM~~SlreeA~~) ß~(!~~8~~~9-Á ej\ qlJ>~os 4'1e:;~oSSSlreel The diagram below is a true and correct description of the entrances, exits, interior walls and exterior boundaries of the premises to be licensed, including dimensions. DIAGRAM . . . ' , . . ' , , , . . ' , ' . . ' , . , , 1. FULL NAME (Last First M1dd9) : , 7 :TH : : s :-r; : ~ ~'~·~~7-~.·~'~)-~~~"~'-~--~'~·~'-~'~~·~ ~ ~j ~ :Î:Jr: .. . ~ ~.!-~-~-~~-~ :> I : l-=~,T~'T: :r~=:I : :~ : ~i~~ 9~ ~~1:' : : : : : : ......... ·······w················· ::::::: +-~ i ~ J ~::::::::::: /:tL~T:i~--~;': >i1.Ui):.:::::::::; · . . . . . . . . . . . . " .~ íJ;. Ð.: . . . . . . . . . ./: : . . . . . . t . . . . , . . . . . , . . . . . . . . . . . .:::r:::: · . . . . . ---r-r . , . .~ U1 ~ . . . . . . "",.¡,' t',. . . "" ·(·r)· . . r . . . . : . . . . . . . . . . . . , . . , . . . . . ¡ . , . . . · . , . . . . J . . . . ~ . . ~ Ç(l . .* ~t) .r.\.1Mr.g" .0. . . . ; . . . . . . . . . . . . . . . . . . . . . . . . . . ¡ , . . . . : : : : : : : : : : : : ~ :g ~ l!i : : : :,: : : : : : : : : : : : : : : t : : : : : : : : : : : : : : : : : : : : : : : : : : ¡ : : : : : · òD l' '0 1-. . . . . . . . . . . . . . . i . . . . . · :-: or ~ .-. . . öi.: . ''$ -4"1 ô <¡. c;PI:¡2" . . . . . . · ~ . . i ~ ;i. : . 'w : .s:;\):i:cr·-:~ii:(NV.~. ' : :¡ : : · . . ill . . . .\ l .\f. ,-. ~ . . ~ : . . . . .. ...,.. . . , ; . "0' . . : : : ~ . . , . . : : S ~ : : ~ : : : : : : : : : . . : : : : :1. :: : : : : : : : : : : : : : : : : : : : : : [ :~: : : · . . '/. . . . . . . . .\.Y. ë:!.: : Å ÇI. . . . . . . . . . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . . ¡, . .'. . . : : : ~ :: ;::: ~ ~ ~ ~: : : : Õ : : : : Ù.ija,:"2:..,:.'5 ?¡~:!l<1ï¡~ô-'S- : : : ¡ : 2-: : : N . . . . Q9 ~ 7· . . . . . : 0 . . . . ~._....~Q'iL~.?'~~...fl1.-.. . : : ¡ ,: ~~. : : : z :: :""1:: t;: :-¿: :t ~1: : : . . 1," .. l.ìI I V '0 . a ' . . . ...... '0 oJ.: z: . 9' ' . ~ . . . ... ~. . . . .J W ::t. 'Q' .. ? .. .. :...J . , ..". ·.:",_'_')"ÿYG)~,¡~""r.::_·,,'.">· · . . Z . . ; . . . : -.:t -::J :;7- . . : . k-\ ~ -K_ : : : I : : ; : J;. C0 P ~ : : :r: . . . . . . : : . . ~ ~ ~:Q:~: ~ ~?: ' . . . :.' :.' :. :. :. :.' :.' I' :.' :.' ..::.' b: .:' .:' .:' :.' ..'. .:' .>.' ......: ~¿~: .. . .::::: ~V~:Q:~~~~::: ::: ~:. : Lc. :: . ~ : : : : ~-::'5:(~;fq~ ~ 'i .{ì-:-:-: .:::::: ..-=-. . j:~ : : : : : : : : : : : : : : : : : : : :: .:!: t~ : L~: ~-:--:'- :::--:-':-: -:--:-: -~~: . . :;: . l,~'\_. ........... ',14' '<!:::....~.-.../... l~~.__. . :-:-.",~~V-:,35).v; go.l-.0-.;.,'...... ; ¿j.<:f: " . . . . . . . . . . . . . . . ~ \ . . .. . . . ß~~ :ilJ:~~~': : .. .. . .. . . . . . . . . . . . . . .. · . . . . . . . . . . - .. - ······L· · . . . . .. .... . · . . . . .. ...... · . . . . .. ........... .. .. .. .. .. .... ............ · .. .. .. .. .. .. .. .. .. .. .j¡'!' . ' , . "" .. , ~:".:I'~ 9~ ~ ~~ : .. .. . .. . . .. .. .. .. .. l-:- . ...~. ~W: . .. . . . .. . . ---.-.-------- ._-. · . .. . .. .. .. .. . .. , ~-:-: : :f.¡j -r~t'Y< :3 <1.\ S · . . . . . .. .. .. . .. .. .. . .. .. . . . .. . . . . . . .. .. .. . . .. Please read carefully and sign below. It is hereby declared that the above,described boundaries, entrances and planned operation as indicated on the reverse side, will not be changed without first notifying and securing prior written approval of the Department of Alcoholic Beverage Control. I declare under penalty of perjury that the ore oin is true and correct. 5. APPlICANT SIGNATURE 6, DATE ,- , .,. ~7 (5IIM) I ,.,/ ./ e PERMIT APPLICATION FOR REMOVAL OF AN ~~ UNDERGROUND STORAGE TANK , ~.,jf~>;'; ~: ,,,.""-"<",:;:_'\{~;:n;u....<;;>~;,, d{;.i'· .,$~:~,~mÚ1Jm:,;>¡;_~;~~",!;~_~~;t.':::;~;¡¡;~j!~"ëI:óf;.~:.'tIf;w.r.IQJ~~:re$'4~.··¡l¡¡¡Þ¡Nm Page 1 of 1 ~tNO !~/ \ , . J i i:' SITE FACILITY NAME MAILING ADDRESS ( \ \J Bakersfield Fire Dept. Environmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 APN ~. CONTRACTOR INFORMATION CI COMPANY CITY ~ WORKMENS COMP NOA PRELIMINARY ASSESSMENT INFORMATION ~ INSURANCECARRI~ <.....0 ~ WORKMENSCOMPNO~ TANKCLEANING INFORMATION ADORES ~ INSURANCECARRIER~ ~ -.;;;;:>, '" 7"e WASTE TRANSPORTER 10ENTlFICATION NUMBER R.o. ~L) TANK TRANSPORTER INFORMATION COMPANY ADDRESS TANK No, VOLUME CHEMICAL STORED . TANK IN FORIVIA TION CHEMICAL PREVIOUSLY STORED AGE DATES STORED 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 PENAL TV OF PERJURY, AND TO THE BEST OF MY KNOWl..EDGE IS TRUE AND CO ECT, APPLICANT NAME (PRINT) N (D o N :E THIS APPLICATION WILL BECOME A PERMIT WHEN APPROVED ,""'- :aa. J~_ /'.~-' ' f -~~~ '" '." , ; CONTINUED (See 2nd File) £15/23/2£1£1£1 ~> ~~,,·t 'V)(: ~U ;'f~ £18:42 551393£1453 JACO OIL COMPANY Cont. :>tJs Monitoring Device C~.ication ,PAGE £12/£12 ?-1;/ ." >.\ " Í" , , . ...., . \., -.. 7 -...... ,..q- TE~ í DATe It - I ~ -9 9 rM;llllY Nb~·aE:!,. ~.~,~..__".., ..~."____.~. ___ ~~... -.._.__._..__.~..... I......... '._._ ,.....~.. ··''''__··.~I.·_....·_·____·_'''M''' ~ ~I (' \ \ " - I '. .' 1;).. Sf' ' . ) , T' __FA(~~': i...:~ O~_~~~!..,!!lA~_"!, ". .e:~~<:~) ,¡:~~~:~.,.::~~:._~-~~-,:.,_.,._,",., ....:'....-.. _...':.~- ,.{ ;¡ACDRE5$ r':f 01 UNION r¡:...v/ ¡ rs~"ep,~CNg ~~t - 6~6 :'.~n;;l.:!.i,_."....._ ':':'. , '[ê~n~eA~t:~'5r,ËLð. ~f\ -:--:, '·'·-~---·==.JZ;;·CO~E -'-~·ª?Q5· ~___~,:'"__. ' , 'MkE.ANÒ MOOl¡l..,þF MO~'HTORING SY~rEMö8't 16C¡O-O).~.. YNi; 16 S~ cn~ '1C?_?OO l ',,>, ;. . .-- ; -~:~: 1':~": · " tzooo \1..CCC ·\aooQ '. " 1 ::1: " '~" -.,.r- --_..___..__..__....__.__ Ii prlE'S.S "iZfSS . PRfS5 . .~ . ..' .. .. .... _; :; J. , "1 .NDic-\T~ iOCÅT~ON 'OF THf MoÑITORINc) SENSORS TESTEO BY ~tJ\CI";" A YES OR No IN A.PPl )CABL~ ~ox; ~ ~ ~- .- --, ~ :)t;l'In1;ihJ,~èns'X' '171 PIN-'-¡ I ~:' .~' , y o.:r .~. . ,- ~. :, Sump sensor. So' , r . Oi5penser COl1ta\nmelil Sensor ~ ..~_._-".-.,--,~-~--",' ','" -- -,-' , '';.. . Elc:tronic o Jt;rf¡;1I Levç[_--_"',..~.:1.9J:... __ "i ES ~E'S I ~E5 \ "'~: ." ''¡¡'1', '~'"..~ ~ '¡.' ~~h" . .,....,...', \ ':",!, ¥': '~~f)"··:'J .~ ,;;,0 ..~ .~ ,:~~ ~ ,~1 :?~. ':ï~:: - _...;._._-------------- ._..,--J-..~_ ,1 ~ 0 I ¡ NO NO ,......... NO i ~ü N C) ',_,"-' """'~ -- ,. .-..-,.,-!--~..,"-..,-.. "'1'-----'" t ¡ 'IE$. , ''iE'S ; íE S 'i .--..,^-~-". .,_......... ,.... ..~--,..... ......... .'.-.........' ,_..._~_..... ·-··;·······.._··'-·~...·....·t........_···,..- '~ .; EI~ct(on¡c In'Llne l¢i.1k Qelecto;, , ¡oJ 0 ~ () ,:t~ ,~... I' MechanIcal Line Leal< Detecto' --,-------- _ . ., ~r~El' ..¡€-", - -IoS';":fr - .....--..--.-------- i '.In Tank GaugIng Device '.____. .~,__.- ._-Yr::5.~ ý~,~___,J -( ~s~;':::Î' 1 t~OICATE THE FÖI.LOWING BY PLACING A YES OR NO N APHIC^!:IlE aox: ß~"':::~':' Il, poes the monl{Qr!f\g system h3....e ¡audible and \li~ual a~s? -. I "f?S ~~'r~¡:: ç:' ";5( ~~,~:. ! J Does the turbine automatic;1y ,Shut-dO;'~' the sys;¢m de.te:ts . r '-: . - ,::~"~'.:,~~ ' '. I f ,Z: a laak, rails tQ operate or is elec;!ronic8l!y disconnected? . , ,,~S: ..¡ ç ~ Y€ Ç.' /:~>;~., t iJ$ the mOflitoring syst.:m Installed to prevent u~~ tdn~per¡¡ig? ~'-·~;s,' ..¡€-> t;~'~· ... f:t fa the monitoring SY$tem op~rable as per the manu(¿ctiJr~r's sp~cin:;Ç1tí:)r1:S( r~G'ç : E ~ ..¡~ $ \ ~ø . ~. . - - , """ 1 i I Which 'conijnU~_oni:orin9 cI;~;.S :~:::~:ShU! ~~!~; ,,,;:".? ~,,---..g~_~ ;_ 'i:: 1~1 ~ I..,C~~~i~~IEO T~=~~~~~--'~,..~.~--·~·-·T'-'-' '-¡;"Š:-l 0 ~-~~-: ~""'~~--"-'''''-'--r C",T~ 11-11-qCl11 " - . ............... . - ,.' .--,.,.. .........._-_....~......~...... .-.......-- :SI(:tIArUR~O,:;C=~TlF;::.on;(~!-;!:::.~\, ~ í I d..t..( G ~.5L . ,l ' . " ....-_.,.._..____.-., '-'-"_I'''''~___~~_' .-.,---- ,.,_CA.l__~~ ,,,t...-, ....--..-..-,.-, ..'-----'-......... ~~ .. . .. , : 1 , .' I ' .', ...., '1 ~ r-;¡¡·.i:¡i~;Hi 'to',:. C," "";:,',;y;( ;,,, :..:":: '~ \ ~'" L CAR 'R' L lO J :'; .~; . ..:. _ ".. .,... ,.,~.:-::-_~-:::: ~-;------'-:-~--~.----'-.._. -"---.'--- ~':,'." 1 '. ;:, l,~.~~~~:~~:::; ':.~~2:\:~: _ _ . .._:J~t~"~J~.~_~:._6 6 \. :,.,5_eþ~..;J 1-;LI_.._ _..-.- ',: . 11 J . .~ '1% ~ ~. ....;¿,~~I·(:,::.~j(:,,\. /-';.¡·A . - '~,f , ':'/' -¿y~- .:::n " " ~...': ~~ 06/07/2000 17:18 06:0;/00 Oi:~9 6613'330453 '5'_326 05;6 JACO OIL COMPANY BfD H:\.Z ~-iT Drtl PAGE 02/05 CITY OF BAIŒRSFIELD OFFICE OF ENVIRON1\rIENTAL SERVICES 1715 Cbester Ave., Bakersfield, CA 93301 (661) 326-3979 l~ ~002 UNDERGROUND STORAGE TANKS - UST ¡:ACrLlTY e 1"rF'E CF ACTlON ja..r;. :me ~tI'" ð<f/YI o 1.:'I1!W sITe PI:I'I"'IT x..R~~"" P5RwIT ;: 1, .u.lEloICeD flE'U4IT o S. CPI......Gé OF '~Iia4I.TroN (~~.. . tlC<I/ LßO ooql a II, 1"'ENPc~$ITE~ ~ _ d_ Or, PES\MOO/ojENT1., 'r Q.OSI!D SITE o II, TN« RSNovElJ' 40:1, .. FAC2UTY I SITE INfOU4T1ON , EIU~"'ESS """"E ¡Sip. .. .õACl..1T'f' ;r caa. . I>:oog ~ ~¡ : f-I14-f+r.5 /.4Af2-~ , ~ST CRDSS ~er oIa!, F"CIUTY OWNeR Tr'?'!¡ : l?....f-Æ- 5/IlE-Z-t O~. CO~TIèN , ~~~ : ~1'ESo5 " CA3 S'TAT'1:)N a 3, F.u!M D 5, COI4ŒAc~ : 0 3. PART~p o :z. 1;iISTi'I:I~ 0 4.. PRtI<;ES.SCI:! 0 &. O~ 4Cr, JoL..-J1o!BER OJ: TANIIS IS....,.... _ ~ <:r ,,_:it UST'õI ~Iic:~ _<:I!III~" I R&þ¡4aI~4TSO'E ~1 lMù!ft......crdl!cl:o..nil:ll~~IJST. i ..3 ~. CT. rrNllllI>oI a;I'IQI:t pIfta1 v-1I'e 1iiI*_) J!~rI), i 4F[)-5Ï II I ,~ o 4, u::IOII. ,l,GENCl'1CI1$TRICT'" o 5. CI::ItWTT ~ o 6, STAT!;1oŒ1<'P" o 7, FeøEP..AL AGéNCr ~ GS, . a. PROPEIn'f OWNER IItR:IMIU.TION JPRC1+~N 1<-(1--1 + "Sðö/Ù ~fH ¡~rt7vµlð70 A-VZ-. : CITY R'Ú/Þ éTl n ( - .~3¿~ ÒJ;7 i <Iœ, t?3301 . 1:1 1, ~TIOIiI 2. IHDlVlCUol.L CJ~, p~ o 4. I,.QCÀI. JŒJCT I èIsnõocr o ~ o::um'~ o /I, STATE ÞrJðfCt o 7. ~AGENCr 413. m. TAHK oWNeR INRlRJU.'OOH .'4, ) Z"¿j -:37 3-7tJa-o~'s, 4111. I'.. ...1 40' . ~¿ _ .,IL '-F'. '" ¡ TA~ O...,....R T'I'Æ I I TY (TX) HQ ...g,. M)/WIOO~' ~P~ij> , IV. BQARD OF 1E~1 ~ T10Y lIST STORAGE Fa: ACCOUh7 NUIIBrR ~I , . ' '" v. pE'JROLEtj.. U8T FWAH<:LaL RESPONmBUTY Jl'i;(!.' ~ 0 I, !!l.lRET'1'1ØQ 0 " S1'ÁT\õFUIoI) o Z. ~. IJ!!., ~CFCIiEOIT Q II.. ST...re"WCIðCFO~ o 3. IN3IJIUHCE 0 5. ÐiEM'110111 0 i. ST...TE FlIN) It OJ Call (916) 322.-9669 it ql.lC31kJns ari:ge UI, D" C:C~TIOH a t, f.OCI¡.~'~ o ~ COI.IIIITT ÁGÐIC'r o e. S1'''~AoG8C'r' I:J 1. FCÐ8tAI.~ 4I2Ø, I I ¡ Ito!OCATE~S) I o lQ, LOCÀlGðVT~ Q !Ii. OTHER 4ZZo ~ LeGAL NOnFICAT10H AND MAlUNG ADDRESS , ~.no - to ~ ooI'IIa! ___lIh,~,IICH.. -1I:r '. ~:n: III....,. 0 1. .õJ.CuT'l' 0 2. ~ OwÞIER I ~~owo:Im-."I4I~""IID_~""""""'_1 r,rt2"~ I YR. APPLJCAHT SIGNA TUAE 3. T A.NI( OYH:R QJ, _11\1._ ~ ID 11M t.III.,...y~, I ~b 7 ~ð";ðö .24. , ÞZ£ /-.;393-?t.mcJ ~~. 421LJ TITlE 0," ~ ~ ,_ LJ 4.7:1, ~dZ/AJ£ urØr7tf7L}£;. Hé7', , rtAT,"U!iTt=..Clt.I''II'II.J~f"""'tuI_*, UPCF (7199) do ¡ IOI u~ CEA'I'1FICATE ICJ~ {~~"'IIII QriIjIJ ~, s:\CuP1\FORMS~.v.pd "i . CITY OF BAKERSFIELIJ. OFnCE OF ENVIRONMENTAL KRVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUNDSTORAGETANKS-TANKPAGE1 TYPE OF ACTION (Check one Ilem only) o 1. NEW SITE PERMIT ~. AMENDED PERMIT o 3, RENEWAL PERMIT {ìfl ~t TANK USE 439 g[ 1, MOTOR VEHICLE FUEL (ff;;'arlled, complete Pel70leum Type) o 2, NON-FUEL PETROLEUM o 3. CHEMiCAl PRODUCT o 4, HAZARDOUS WASTE (Includes Used Oil) o 95, UNKNOWN TYPE OF TANK (Check one item otIIy) TANK MATERIAl· pnmary tank (CheCk one item only) 432 435 (Ð o 5, CHANGE OF INFORMATION) Page of o 6, TEMPORARY SITE CLOSURE o 7, PERMANENTLY CLOSED ON SITE o 8, TANK REMOVED 430 3 (Specify chenge . for IØCaI use only) I. TANK DESCRIPTION f~ II. TANK CONTENTS 431 433 COMPARTMENTALIZED TANK 0 Yes 0 434 If "Yes", tOIIIple\e one page fer eac:n tOIIIpartmenl. NUMBER OF COMPARTMENTS 437 436 / 436 PETROLEUM TYPE o la. REGULAR UNlEADED 0 2. lEADED o lb. I'fŒMIUM UNlEADED 0 3. DIESEL J;1Gc. MlDGRAOE UNlEADED 0 4. GASOHOL COMMON NAME (from Hazsrdou$ Materials Inventory page) 1. SINGlE WALl o 2. DOUBlE WAlL o 1. BARE STEEL o 2. STAINLESS STEEL TANK MA TERIAl- sec:ondaty tank 0 1. BARE STEEL (CheCk one item only) 0 2. STAINLESS STEEL TANK INTERIOR LINING OR COATING (Check one item only) SPILL AND OVERFILL (Check all thel apply) o 1. RUBBER LINED o 2. AlKYD LINING III. TANK CONSTRUCTION o 3. SINGlE WALl WITH EXTERIOR MEMBRANE LINER 04. SINGLE WAlL IN A VAULT o 3, FIBERGLASS I PlASTIC 'r$-4. STEEL CLAD WIFIBERGLASS REINFORCED PlASTIC FRP o 3, FIBERGLASS I PlASTIC o 4. STEEL CLAD WIFIBERGLASS REINFORCED PlASTIC (FRP) o S. CONCRETE ' o 3. EPOXY LINING o 4. PHENOLIC LINING o t, MANUFACTURED CATHODIC PROTECTION o 2. SACRIFICIAl ANODE YEAR INSTALLED 01, 02. 03. SPILL CONTAINMENT DROP TUBE STRIKER PlATE 3. FIBERGLASS REINFORCED PlASTIC o 4. IMPRESSED CURRENT 450 TYPE (For local use only) ~~ ~5 <'(5" 440 o 5, JET FUEL o 6. AVIATION FUEL o 99, OTHER 441 CAS II (from Hazardous Materials Inventory page) 442 o 5. SINGlE WALl WITH INTERNAl BlADDER SYSTEM 095. UNKNOWN o 99, OTHER o 5. CONCRETe 095. UNKNOWN o 8. FRP COMPATIBLE WII00% METHANOL 099. OTHER 443 444 o 8. FRP COMPATIBLE WII00% METHANOL o 9. FRP NON-CORRODIBLE JACKET D 10. COATED STEEL 095. UNKNOWN 099. OTHER 445 D 5. GlASS LINING ~. UNlINED DATE INSTALlED 447 095. UNKNOWN o 99. OTHER 446 449 D 95. UNKNOWN D 99. OTHER 448 (ForJocal use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTAlLED 452 01. AlARM ~ 03. FILL TUBE SHUT OFF VALVE ~ o 2. BAlL FLOAT D 4. EXEMPT IF SINGLE WALL TANK (Check.. thaI apply): o V'SUAl (EXPOSED PORTION ONLY) Œr2, AUTOMATIC TANK GAUGING (ATG) o 3, CONTINUOUS ATG o 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + BIENNIAL TANK TESTING '~'... .!Ù····~ê·C{·\..,'Œir/~Òì~K·Lì!'AK· ò~ê;!Igtf.,V~fg~~'¥æ~f:j·.:r.(;.·"·:(Y.".':"· ' 453 IF DOUBlE WALL TANK OR TANK WITH BlADDER (Check ane item only): 454 . o 1. VISUAl (SINGLE WALLIN VAULT ONLY) o 2. CONTINUOUS INTERSTITIAL MONITORING o 3, MANUAl MONITORING ·:;,~:'}:;!l:n::; o 5, MANUAl TANK GAUGING (MfO) D 8. VADOSE ZONE o 7. GROUNDWATER D 8. TANK TESTING 099. OTHER V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED QUAHrITY OF SUBSTANCE REMAINING 45ð TANK FILLED WITH INERT MATERIAl? ESTIMATED DATE LAST UseD (YRlMOJDAY) UPCF (7/99) 455 457 gtflon. Dyes DNa S:\CUPAFORMS\SWRCB-B.WPD l' ~ ~ CITY OF BAKERSFIELD A OFFICE OF ENVIRONMENTAL SERVICE. 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UST· TANK PAGE 2 Page of UNDERGROUND PIPING ABOVEGROUND PIPING VI. PIPIt;JG CONSTRUCTiON (Check sn /hat apply) 1, PRESSURE 0 2, SUCTION 0 3. GRAVITY 458 0 1. PRESSURE CONSTRUCTIONI 1, SINGLE WALL 0 3, LINED TRENCH 0 99, OTHER 460 0 1, SINGLE WALL MANUFACTURER 0 2, DOUBLE WALL 0 95. UNKNOWN 0 2, DOUBLE WALL MANUFACTURER 461 MANUFACTURER o 1,BARESTEEL 06. FRP COMPATIBLE WI 1000/0 METHANOL 0 1. BARE STEEL o 2, STAINLESS STEEL 0 7. GALVANIZEO STEEL 0 2. STAINLESS STEEL o 3 PLASTIC COMPATIBLE WITH CONTENTS 095, UNKNOWN 0 3, PLASTIC COMPATIBLE WITH CONTENTS ~ FIBERGLASS 0 8. FLEXIBLE (HOPE) 0 99, OTHER 0 4, FIBERGLASS o 5, STEEL WI COATING 0 9, CATHODIC PROTECTION 464 0 5, STEEL WI COATING VII. P'PINGi:.~(RETECTlOfoJ(Chick all itrat apply) MATERIALS AND CORROSION PROTECTION UNDERGROUND PIPING SINGLE WALL PIPING 466 PRE§81JRIZED PIPING (Check al/ that apply): ~1, ELECTRONIC LINE LEAK DETECTOR 3,0 GPH TEST ~ AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS o 2, MONTHLY 0,2 GPH TEST o 3, ANNUAL INTEGRITY TEST (0,1 GPH) CONVENTIONAL SUCTION SYSTEMS: o 5, DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0,1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): o 7, SELF MONITORING GRAVITY FLOW: o 9, BIENNIAL INTEGRITY TEST (0,1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZEO PIPING (Check al/ that apply): 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) - o a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o b, AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION o c. NO AUTO PUMP SHUT OFF o 11 , AUTOMATIC LINE LEAK DETECTOR (3,0 GPH TEST) WITH FLOW SHUT OFF OR RESTRICTION - o 12, ANNUAL INTEGRITY TEST (0,1 GPH) SUCTION/GRAVITY SYSTEM: o 13, CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) o 14, CONTINUOUS SUMP SENSOR J!Y!I!:!QY! AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS o 15, AUTOMATIC LINE LEAK DETECTOR (3,0 GPH TEST) ~ FLOW SHUT OFF OR RESTRICTION o 16, ANNUAL INTEGRITY TEST (0,1 GPH) o 17, OAILYVISUALCHECK o 2, SUCTION o 95, UNKNOWN o 99, OTHER o 3, GRAVITY 459 462 463 o 6, FRP COMPATIBLE WI 1000/0 METHANOL o 7, GALVANIZED STEEL o 8, FLEXIBLE (HOPE) 0 99, OTHER o 9, CATHODIC PROTECTION o 95, UNKNOWN ABOVEGROUND PIPING SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): o 1, ELECTRONIC LINE LEAK DETECTOR 3,0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS o 2, MONTHLY 0,2 GPH TEST o 3, ANNUAL INTEGRITY TEST (0,1 GPH) o 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply): o 5, DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM o 6, TRIENNIALlNTEGRITY TEST (0,1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): o 7, SELF MONITORING GRAVITY FLOW (Check all that apply): o 8, DAILY VISUAL MONITORING o 9, BIENNIAL INTEGRITY TEST (0,1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check al/ that apply): 10, CONTINUOUS TURBINE SUMP SENSOR ït!I!:! AUDIBLE AND VISUAL ALARMS AND (check one) o a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o b, AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION o c, NO AUTO PUMP SHUT OFF o 11, AUTOMATIC LEAK DETECTOR o 12. ANNUALlNTEGRITY TEST (0,1 GPH) SUCTION/GRAVITY SYSTEM: o 13, CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) o 14, CONTINUOUS SUMP SENSOR J!Y!I!:!QY! AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS o 15, AUTOMATIC LINE LEAK DETECTOR (3,0 GPH TEST) o 16. ANNUAL INTÉGRITY TEST (0,1 GPH) o 17 , DAILY VISUAL CHECK DISPENSER CONTAINMENT o 1, FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE o 2, CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS o 3, CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS IX. OWNER/OPERATOR SIGNATURE I certify Ihat the information provided herein is true and accurate 10 the best of my knowtedge, SIGNATURE OF OWNER/OPERATOR DATE INSTALLED 468 NAME OF OWNER/OPERATOR (print) Permil Number (For local use only) 473 Permit Approved (For local use only) UPCF (7/99) o 4, DAILY VISUAL CHECK o 5. TRENCH LINER I MONITORING ~ 6, NONE 469 DATE 470 ' 471 TITLE OF OWNER/OPERATOR 472 474 Permit Expiration Date (For local use only) 475 S:\CUPAFORMS\SWRCB-B.WPD TYPe OF ACTION (Chec. 0". _ ~) .' CITY OF BAIŒRSFIEIA OFFICE OF ENVIRONMENT AL ~RVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS· TANK PAGE 1 (Ð o 1, NIW SIT!! PeAMIT s-<' AMI!NOt!D PeRMIT P-oe o e. TEMPORARY SITE CLOSURe o 7, PeRMANINTI. V CLOUD ON SITE CJ I. TANK ReMOVED 4J fII o S. CHANGI OF 1NF0RtAA noN) o 1. AlNeWAL PeAMIT (~....-. I'oIIOCM UN only) , BUSINESS NAME IS- _ FACILITY NAMI! 01 D8A. Oaing..... 0\8) ~{ð..('t't\ M~\~rt I LOCATION WITHIN SIT! (QIIIøM/) I ìû \ ANKI . (~ C/IMIII . If¡, IOCM .... only) 3 I FACILITY 10 · ~ 43' f 'd-h.. ~\ ß~Ur c-vr- q 3:?lJ( I. TANK DESCRIPTION COMPARTMENTALIZED TANI< 0 v. ~ 4J.< If -v.', camllele one pege far eedI COIIII*ImenL 437 IJt 438 .. TANK CCtnINTI ' TANK US! - ÆTAOU!UM TYPE 44C ~. MOTOR VI!HICU IIUI!L o 1L AEGU.M UN.EADEO o 2. LEADED o S. JET FUEL ( IN"*I. ~"....." T)pe) ~.. PR&tUU UN.EADEO o 1. DIESEL EJ I. AVIATION FUEL o 2. NciN.Fua PETROLEUM o 1c. YDORAœ UtI.EADED o 4. GASOHOl. 0.. OTHER o 3. OiEMICAL fIROOUCT o 4. HAZARDOUS WAST1! (1nt:IutIN COIoM)N fWot! IIGm HIørdøuI AIIIMIIII/MIIt:II)' t»It) 441 CAS' IIGm HuMIofII___ *'-by t»It} 442 /bed 01} CJ 95. UNKNOWN .. TANK CONSI'RUC1ION .. , TYPE Of' TANK I (C/IecIl_ 11m odyJ I ! TANI< MATERIAL . Ifinery 1M! 0 1. BAAl! STEEL i (C/IecIlone"" odyJ 0 2. STAIHLI!SI STEEL I TANK MATERIAL . øcandIIy 1M! 0 1. BAAl! STEEL (C/IecIl_ 11m odyJ 0 2. ITAIHLI!SI8TI!II. TANK INTERIOR LM«J OR COATINO (Clleck one .", only) SPILL AND OVERFILL I I I (Clleck" tNt .ppIy) .,. SINGLE WALL o 2. oouae WALL o 3. SINGLE WALL WITH EXTERIOR MØoØWE ~ 0.. SlNGLEWALL.UVAULT o S. SINGLE WALL WITH INTEANAL IILADOER S'tS1'EM o IS. UNKNOWN 0.. OTHER o So CONCR£TE 0 lIS. UNICNOWN 01. FRPOOMPATI8U!WI1001UETHANOL 0.. OTHER 443 o 1. AUIIIR UN!D C 2. ALK'I'O LM«J o 3. FI8EROLASS I PlASTIC "bf... STEa. a.AO WIFI8ERGtASS REINFORCED PlASTIC o 3. FI8ERGL4SS I PlASTIC o 4. STEEL a.AO WIFeERGLA8S REINFORCEO PLASTIC (FRP) o S. CONCAET1! o 3. EPOXY I.INItG C 4. PHENOLIC I.INItG 1øW_ D4T1! INSTALLEO 4411 444 o I. FRP OOMPATI8U! W/100% METHANOL o .. FRP NON-C:ORAOÒcøu: JACKET o 10. COATED STEEL OIlS. UNICNOWN 0.. OTHER .us ..... D4T1! INSTALLEO 441 o I. GlASS UNINO 0 IS. UNI<NOWN ~ IH.INED c.. OTHER o 1. MAMlf'ACTUR!D CATHOCIC . FI8EROI.ASS REJNIORŒD PLASTIC PROTeCTICH JlÞ. IMPRESSED CUAR£NT o 2. SACfUf'ICW. ANODe / YEARINSTALLED 450 TYPE(~IOUI""onIy} 451 .er)< SPIll. CONTAINMENT <¡\'ç é 2. DAOP TUIe ß ç er;: STAIICIR Pl.ATI ~ r:; o IS. UNI<NOWN 0.. OTHER 448 (For IøW _ only) OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLEO 452 o 1. AlARM 0 3. FILL ruBE SHUT OFF VALVE1~ o 2. BALL FlOAT 0 4. I!XÐP1' " SINOLa WALL TANK (CMM""" II/tIIY}: o I, y&fJAL (I!XPOIID PORTION ONl. V) ~ AUTOMATIC TANI< GAUGINQ(ATQ) o J. COHTINUOU8ATG o 4. STATlST1CA&.INIIÐITORY Rl!CONCIUATION(SIR). BIENNIAl. TANK TUTIHQ '.-,:..~"":" :~;~~~.:r.:~~... .~: t~ .:':-.:;'", ··.::fb~~·;· ., DOU8UI WALL TANK 0" TANK V'tmf ILADDIIt (CMt:II_ ..,., onIy1: ... o I, VlSUAI.(SINOl!WALLINVAULTONI.V) . o 2. CONTINUOUS INTEASTrrlAl. MONrrORINQ o 3, MANUAL MONrrORINQ 411 o S. MN«JAI. TANK QAUQINQ (MfQ) o I. vADOSE ZONE! 07. CJfIOUNDWATER o I. TANI< TESTINQ 0.. OTHER V, TANK CLOIUItIINPORMATION' PlltllANlNT CLOIUU IN PLACI UTlMATID QUANTITY ~ SUIITANCI RDWHNI 4H TANK FIU.l!D WITH INIRT MATIRIAI.? 461 I!STIMATI!O D4T' LAIT U8ID (VMotOIOAV) UPCF (7199) ...... o v. 0 No S:\CUPAFORMS\SWRCø.e.WPO ~ a CITY OF BAKERSFIELD ., OFFICE OF ENVIRONMENTAL SERVICHA 1715 Che.ter Ave., Bakersfield, CA 93301 (881)11r.3979 .!-' <' un . TANK PAGE 2 Page of UNDERGROUND PIPING ABOVEGROUND PIPING VI. PIPING CONSTRUCTION (Chedld tllet 'ppIy) SYSTEM TYPE 1. PRESSURE 0 2, SUCTION 0 J. GRAVITY 458 0 1. PRESSURE I CONSTRUCTION! " SINGLE WALL 0 J. LINED TRENCH 0 99, OTHER 460 0" SINGLE WALL MANUFACTURER 0 2, OOUBLE WALL 0 95. UNKNOWN 0 2, OOUBLE WALL MANUFACTURER 461 MANUFACTURER o 1. BARE STEEL 0 8. FRP COMPATIBLE WI 100% METHANOL 0 1, BARE STEEL MATERIALS AND 0 2, STAINLESS STEEL 0 7. GALVANIZED STEEL 0 2. STAINLESS STEEL CORROSION PROTECTION 0 3:J'-ASTIC COMPATIBLE WITH CONTENTS 095, UNKNOWN 0 3, PlASTIC COMPATIBLE WITH CONTENTS ¡¡¡.-4. FIBERGLASS 0 8. FLEXIBLE (HOPE) 0 99, OTHER 0 4. FIBERGLASS o 5, STEEL WI COATING 0 9, CATHODIC PROTECTION 464 0 S. STEEL WI COATING VlI.PlPI~ LEAK DETECTION (Checke, tMt apply) , :~~ ~~~~~~ .v ': ~. ¥~,~~,:"pJU~~)~~:t~rrt~~~~~¡t~~~~~}~~i~~~~:l11~&~t~r;fi.@~P?$lMj]Ji~t~jifl~{;~~~;i~ty\~~::¡;: ~~ ::>~h~t;~~ ;~ DISPENSER CONTAINMENT 0 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 0 4. CAlLY VISUAL CHECK DATE INSTALLED 468 0 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL AlARMS 0 5. TRENCH LINER 1 MONrrORlNG o J. CONTINUOUS DISPENSER PAN SENSOR ïmJ:t AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS ~E 489 IX. OWNER/OPERATOR SIGNATURE I certify thaI the information provided herein is true and accurate to the best of my knowledge. SIGNATURE OF OWNERIOPERATOR UNDERGROUND PIPING SINGLE WALL PIPING 466 PRE~ED PIPING (Check aU tllet apply): QlA. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST ï4II:1 AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAilURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL AlARMS o 2. MONTHLY 0.2 GPH TEST o 3: ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: o 5, CAlLY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0,1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): o 7, SELF MONrrORING GRAVITY FLOW: o 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONOAlUL Y CONTAINED PIPING PRESSURIZED PIPING (ChecIc 8/1 tllet apply): 10, CONTINUOUS TURBINE SUMP SENSOR ï4II:1 AUDIBLE AND VISUAL AlARMS AND (Check one) o a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION o c. NO AUTO PUMP SHUT OFF o 11, ~~~~~~f6~'NE LEAK DETECTOR (3.0 GPH TEST) mn1 FLOW SHUT OFF OR o 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Chedld fIIIt apply) o 14. CONTINUOUS SUMP SENSOR ~AUTO PUMP SHUT OFF + AUOIBLE AND VISUAL ALAfIMS o 15, AUTOMATIC LINE LEAK DETECTOR (3,0 GPH TEST) ~ FLOW SHUT OFF OR RESTRICTION o 16. ANNUAL INTEGRITY TEST (0,1 GPH) o 17. DAILY VISUAL CHECK NAME OF OWNER/OPERA TOR (print) 4 ,Iocll use only) UPCF (7/99) o 2. SUCTION 095, UNKNOWN o 99, OTHER o 3, GRAVITY 459 462 463 o 6, FRP COMPATIBLE WI 100% METHANOL o 7. GALVANIZED STEEL o 8. FLEXIBLE (HDPE) 0 99, OTHER o 9. CATHODIC PROTECTION o 95. UNKNOWN 465 ABOVEGROUND PIPING SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check an thet apply): o 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST mn1 AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS o 2. MONTHLY 0.2 GPH TEST o 3. ANNUAL INTEGRITY TEST (0.1 GPH) o 4. CAlLY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check an IIIst apply): o 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM o 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): o 7. SELF MONrrORING GRAVITY FLOW (Check aU tile! apply): o 8. CAlLY VISUAL MONrrORlNG o 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check aU tllet apply): 10. CONTINUOUS TURBINE SUMP SENSOR ïa!!:1 AUDIBLE AND VISUAL ALAfIMS AND (check one) o a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION o c. NO AUTO PUMP SHUT OFF o 11. AUTOMATIC LEAK DETECTOR o 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check eO tllet apply) o 14. CONTINUOUS SUMP SENSOR~ AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL AlARMS o 15. AUTOMATIC LINE LEAK DETECTOR (3,0 GPH TEST) 016. ANNUAL INTEGRITY TEST (0.1 GPH) o 17. DAILY VISUAL CHECK DATE 470 471 TrrLE OF OWNER/OPERATOR 472 S:\CUPAFORMS\SWRCB-B.WPD - 06(07/00 07:50 5513'3153 '5"681 J~6 05i6 JACO OIL COMPANY BFD EL-\Z ~~T DI\' e PAGE 03/05 05/07/2000 17:18 ~003 --- ~- ---_. -,- CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 171S Chester Ave., Bakersfield, CA 93301 (661) 326...3979 UNDERGROUND STORAGE TANKS· TANK PAGE' (Ð l:sosu,o -- . ",.. ~ IISOI ~",.J '9~~rø5;q¡sh~~ L-Oc..: ~ SITE ~ a 3. AI;/'IEWAL F'EFlIo1IT Page d o 6. rtl.l'lOAAR't' Srrs CLO$UAE o 7. ~T CI.CS¡¡c 0'" SIrE a ø. TA.'« R~Ò ~:¡¡;J 1'Y"" 00; ...ÇI'IO" {C/l8Ù on. ;/alll O"fY1 o I, Nl!!w:sma PERIMIT*Mõ,...,eo ~ER/oIIT o ~ OW"CEOF 'I"I'O~T'IQfoII (~CftI>IISII. 101","'" I4J/ ,,,,1,) ~ J ¡oAQl.J1"r (HI I i r4-2bi ¡ ¡ l. I : ,¡,;¡, UH~ 10 . 9 0132 rt...,.. ~"'I:1'1.JIòER ....., ¡ /-to P fYJ'i-Lþ(IÚtf-i 43.!j , 't IN GAIJ.ONS Qj ¡ J ~f O'?TÔ èOr.P,o..ImoU;NTALIl!;O T.w< LI Till ~~ If"',.", CllftPidÞ <no¡>aQ$ /d...." _~ 104I,~~QF'CQ,P~S 1 4:10" ~T¡; 1N$TAl.L.EO îi . /13'5) 16 ; Accmc~OeSCRlPT1C"'Pà"-lØeanl)( I I '-'57 Q a. TAMC CCIN'I'EKrS ~'NPE ~a. Rl!GíJUI.R ~ Dle.~~EÒ 01c:.~~EO ~ ''Lf T.u.tk use oiI:'I9 !~1. /'c)TOR \IÐIIQ.£ Ftlel. , 11I'-'--~T)08J : 0 2. IOONoFUE\.~"" : a ;), OoIE....CAL. F"RQOUCT : 0 &, ~wAST'E(1Iø.du , u...1 CIi, ; 0 95. UNJIMJ"'" 02.~ o 3. DIeSEL o ¿, Go\SOHOl o s, J€f fò\le¡, CJ L Avv..~ 1'lJ8.. a :1'9. OTÞIiJo1 +11 I c.as.¡m.......,.~~~~) i 80 -ore fc (7 ~ CC/'.øoCIiI IU)Æ ('boo ~t<¡:Ø "..,._ ~".¡;JfJ u.N q~P:-0·.·:,'~~/ ¡Jê TI'JIIK M'I'reF!W... ~ 12M a ,. ~ 5TEl!L {CIOlC"~""Dm~} 0 2. ST"'I""I£SS~T1;.e:. ,,,,,,,~:,,:,:~..'~, " ",.',-~..'~';',', "C'" :.'''Iß.,TANJ(~OIiI, _ ," ~' ' ,,"": ' ~";.~I~WAU. ~~.~'~~ ,-" . a S,~WIoLl~~L~~ 02. COUBl..ËWALL. ~Y""_n·ÞELH;,R O!lS. U~ a.t. SlHQ.£W~DItA,.....Lr..T OI1Q. O~ o 3. FI~(!:'I.A$Tl(: a s. CC~ D~, ~ )i{ ... stm. ~ WIF1~ 0 &. FIlIP CO~AT1ÐLE WflCI:I':Ió r.ETH.W:lL 0 \19. orMER RlõIJoR~ ~iC t=zP) o 3. I'1BERGIA$S I PI./IS'I\C o .. ST'E~ ~ WJI'IaE~ IE:IM"ORC:ë'Ø PutoSTIC IFRP'> o s. ccHCR.e:I'E o 1. RI.IB8El' UPEO D 3. E;I'IQrr 1.QIIoIG 0 $., GlASS IJpoING 0 8$. UNDIOWN 02. AI..IC'I1)I.MIiG 0 &. ~1JNIItG ~\I. ~ Q99- 0T\€!t o 1. t.wcJÇACTU~ CA'T11Oè~ ~3. õlBE~ ~þ IVSTIC 0 is. UIiiWolQ~ .wi! PR:TT1j:cnoN CJ 4. ~I!D~ 0 ¡I',. OTl'iet CJ :. $ACR.FlèW.-""OCe $R ,lCS'rJ,U,eD 4$C TYPfi. (Fór ÞciIJ - .w,J ~1 Cð;" SPILL C:CI'I'I":I.'I'ÆNT I Cj <;(~ - ~~ DAQP1\I8e ~S , /qgS ....-.. i ~OI'T.IH( i : IC/lock QIII! liliiii""") ~ , '¡'ANI( rA~RIAL . øNnarr ~ 0\, !\.I\I!!G5TæL o ~, STA¡.¡L,ES$ STEEL +oc , (CM".""iem=ðy) o B. I'RPCCr.4PATlBLS Wl1~ IoE'THUIOL o 9. FRPI'IO~oø.s ~ 010, COATEOsn¡s.. o g'j, ~~ICNC""'" Dse.O'1"Þ!¡;¡:t oÙ5 I T,ANI( II'IrERIOR LININ:> I O~ CQA T'iI'G ~odffilllllMlf OTI-IeR COfiIRC$IQfoI ! P~'T'!!cno"lF ~ 448 C¡I, TE II'IS1'IoU.eD 467 (R; 1cr.III.... "'"" 0ATt! JIotST.IU.EI:I ~ã ¡'JØI1œa1 _ Ø<'II1) OV£RF1U. ~TE?'C'N E(Ù~ TEAA IHST.-u..ED I q c¡ F o&S2 .a:r ~ -' Jjj1'.iç;. FII.L1\I8ESlVro""v~....e: J1j,J" ~ 8oW. FU!A T {9 ~¥' 0 &, E.J:EMP1' :f01/Blt:Jt"""e",_J , SPllJ.. ANIJ OIol1õRF1U. (Qr.¡ç> .;Ø /1Jdl aœlTJ . ~' q: IFDClWUi: T___ORT.ulKwrnt~(CJIdc2"",",""",ody): ..~ o !i, ~T_~..a(~ 01. YISJÁI.($lNGL.EIIW..LII'I......u..TONlT} o fl vADOS!; ZQIo¡E a z. r::-.òImN.JOIJS ~~ K1~'" , o 7, GRrWNOWAT1;R I' 0 J. ~ M:lr«TOI'!II<G o II. TAN!( reSTING O~O~~ I v. TAM( CL.OSURE: HF~T1(1¡ I ~ENT CI.O$IRE ~ PLACl: !;~'!EICIJ.o:<m'r OF SlJa3T.oi<E ~1«3 ~ TJ\N<.F!uEJ '1'1m11!'iEFlTW.reR~~ ".U ~ . ";. '....~. IF :!llIiIDLS WALL TAIOI: (OIod< ~ ~r ~ ! .9?' vL1lUAL ¡¡:ø>o$IED PORnON ONI. TJ ~ ;¡, ~T:1(:T.uo:.GAlJGlIIIG("=J i 0], COòlTUokJQuS ATe , 0 4. :JT...ris~Ih'\tfHT'O~FŒlXlfoICIj.i.T1O!oI(SIRI· 8Iii,.._L r...- ,..UTIH(; esT'....1"eD tlAT"E u.s.r I,ISEJ:I <y~T) 4S~ --- ......... OTGOt 0.... UPCF (7199) S :tCUP AFOR.MS\SI/v'RC6-6.'M't: 06/07/2000 17:18 6613930453 e '6"661 :126 05ï6 o ß " 0 i .' 00 Q i : 5 Q JACO OIL COMPANY BFD HAZ ~~T D1V4IÞ PAGE 04/05 III DO'"' CITY OF BAKERSFIELD OFFICE OF eJoMRC"MENTAL SERvICES , ,1 S CM.tlt Ava,. eak.'.field, CA 93.301 (61$1) ,12Q...3g19 UST· foUl" PAIO£ Z ~ -$ - - '- '1:: :~.~PNGc;oÑ8T1WCTlCIM~"_flIiD~'J , Ui'4rJ~~ :>!PING ~UND PI"ING '~::,µ';'~.:.J(::.~~u~,=~'-'6 ' SUCT1C'- ci-)~-c~--:;-~Çi"~PRESSU~ ~~.~~ a_2- ;u~~ _~. ~g.~~_G;~~ - ~9 CCP'lSTl:!..C;llQNf 0 " SlHG.E w...u. ~ ~II'EO ~ D.. OTHER 4&); 0 1, Sl~ w~ c:J~, uNKNOWN , MAl"lJ"A~RI!.R 0 ~. CQU81.£ w~ 0 95, UNIOC...... ' 0 2. CCUB¡,¡¡ w.t.U. a 99, O~5R IMNUF~illEAI 4111 I hIo\Nt;'.>CT\J~5F1 CI ,0 1. ß,l.Rf! ST1!1i:~, 0 6. FFtPCéY'''~1.E WI 1Œ1!1, ~I. ~ 1. EIARI:: ¡¡r¡¡¡¡¡~ 0 &. ¡;¡;cpQJ""AnaLEWl1~ ~L , I : MATE~IAL.S.-...c 'a 2. SUM.SSS!~" c:J 7, GALV~:m;E1. 0 2. 3T"JN~s.s:m;a c:J T. Gal"VANIZEC ~ , CORROSICIO : I I flROTECT;ON : CJ :3. F'IASi1C (XIooIPATl8I.5MTH œHT'2.'fTS C is. UMOoIQ""" 0 3. I'VoSnc a:lMPA TliIIJii: ~ CDNT'EI'nS 0 ð. 1'I.D:I8LJ;; CI«IPE) 0 9'9. O'T)eiI: :t' I , <I. F1~S 0 8. FT..EXISL2 \IG"E) 0 99. a'M!JQ D ... F1BER(;I.A.S$ Q $, CA'n'ItXHC l"RO~c:noN , '.. ST'e~ 'N/ ~"'1l~ 0 !to Cl~C,~:eCT1OH, .. _ 0 $. STœ.,~ QAl:'NG 0 Il$. u~~ ... . ",~' ,I ,4 '....¡.~, ':..:.Þ:~ ~ VlL.PI~J..!."J(~CTI~~,~tw..., . : .,: ~ , U,NŒ"'GIôJNO ~ r AOCN¡~ND PlPIHG , :---" SlNCU:; WAU. PlPlICi '-I SØlGr...E WALL i'IIOl"", ~7 ' ~~ PIPING (O>crr;k'" Nl M~ I'R!!SSURJZE!) rz,ANG (CII«k ¡¡ INr ~fIØJrl: A. el..E~Pj1C I.INE l£AI<. ~~ 3.0 .GPI1 'TEST" ~ AIiTt> F'U1oIP SHUT QI"I" ¡:OR 0 1. El.Ec:TROHIC I.ØIe I.E.AII. OETCCTOR 3..0 GPIi 'I'!!:rt ~ AIJTt) ~ 1SJoIU1' QIõF FOR LfAA. : LIW(. &Y$TEM "AI\.~ ~ S'fSTEM CIISC:C-'¡¡Ci'Ot - AUDIBLe ,u¡g W!IJA. I~ ST$iEM F¡WWRE. AIÐ srsT/!/II OISCQNoIECTIO,., ~ l,U)8U!i A~ VI$ùAI.....1.ARWS ~' ~. 0 2. KIN'IW.'" IU GPtt T1;S'' 2. ...:JNTH.1'IUGPHTE5T 0 --...--_ ..........) I "I J. ANPftJ,OJ. ,.. ........ OT ...... (tI.' -- ~ ; ). AI'II'UAI. INTEGIItJ'T'r 11!!ST (D.', GPH I CI 4. ~It. "1o'I~ OtEOC ,0 '5, ~NI.W.I¡om¡¡GRITYTEST(o. OPH¡ ! 0 1 r , CAlL"" 't'1SIJÁI. Ç!ECI( --. , '~E"" ):9HT. .~ ' 'ji!.1, ROoIIr ME~~ THAT sPouTs (FÕ SHI:AA V'AL"E 1 CJ :z. C".o/OlT'lool.JCUS ~ ¡o~ SE/iCSOR . jl!JoraLe ,ANti YlaJ..... AIJI,RI.G I LI II. ~uous ~NSUI PÞ,I Slii:N$CR 1MnI.AUTO SI-II,/T O~ FOR CISPEN$êR . ..o.utll6U! N'/O vlSUA.L ALAAM$ I IX. QWNERIOPER.tTQR SIGNATUJU¡ ra,.._tJl""1~ ; COfo\l!!Im:JHA!, suc;no.¡ S'rsrec;! . I : 0 5, c.:>«. '!' VtSUoi. ICI,.,ITOIU'IG CF PlJ,¡pIl>iQ STsr=:W . Tiô:IEM'oIIAI.. pjPNG 1NTEGiõU1"r ! TE.$T (0.' GPH) , i : we SUcnOH STSTE..-s IT'<' VALve.!; IN aEl.ow~uIC PlJ'NG~ : 0 7. S aU' IoCINITORJlolG . GRAvm' IOU:Iw. : : d 1, el~1AL 1NTEGRfn" TESi' (0:' GPI'é) i ' , I " 5eCI:I1CiIIõIIL l' !X1MT~ PIf'IHG ~SS~¡;¡~~ PIPING fC1**"!IW~ , I '0, COHT'I/>IÙClùS Tl,JRStNI': $t.J~ sa&SCM 'MT') .,UDIIòI.E ~ vISUAL~ AM) £""'8) 1- , ....l.uro pJ,4õO SHuT 0l"F1 ¥MEN.A I.SAA OCCURS 0, ..I.IJTQ PUW:> SHUT OFF1 FOR !..SAXS, STsre~ FoW'~ ANO STS'T1;, CISCON/>olEC;nON I o ~ IoIC AUTO PU.... SIoIUT' Of'!" ¡ 0 ", "uTOMATIC Urc'E l.E,AI( DETECTOR (3,0 GPI1 TE$1") IMT>I ~w SHUT OF" OR f!ES'1RICilOÞI : - o , z, NI"'JAl..INTÉCP:IT'f' TeST (Ct'I' ~) :suCTCON.<;RA\ITT'I'S'1'STa.c ~ 13. C~>U:lUS s~ ~R +AIJOSI.E ~D VISUooI. ~ I EJEIIIOElCT Gsr-roPli 0.... T (o.c. oil ~~) " 0 1.4. CO/olTlNlJOUS SUIo4' seNSOR, 'I'toIT11CJVT ...UTO P'IJM' 911.iT OfT< + AtJCISJ.e .ANI) V\SUA.L ~ ' io I I IS, J10UTCIMTIC UIŒ ~ ~crOA(U GPH TEST)wm<!J.!! FlC!wSl'tUT OFF' OR , REsnllCT1C1/11 : 0 1 &. AHNI.!AI. 11'IT!;¡GRm' reST (0, 11 ~) , ' : 0 17.C..ll",...ISUAI.C);eo< I : CISPeNS¡¡~ CClNT",I~ 0,/\ T'E I P<S'r A.U...EO 4a , I awIy \NIl :II.. In , -Š~éiN.t.ruflE OF I : -'W'.IÕ 0" (';) .;¡¡;: .o.&S CI:III/V&mo~ su=n:;IM S'lSTEa.tS ~ all/IIJt iiWTt o s. 0A1I.'1' V1$UAL ~~ ClI= PIPING AHO P'lI'Ð!NG S'I'$"/'EU a a. 'fREN"'IA~ iN'T'!¡;GI"ßT TE5T (tI.1 C¡¡>I'I) SAFE SuCT10/ll S'l"S~ ¡fie V4l \IES IN BELOW ûP.'OtJNO PlprNG¡: o 7, Sl:!1J' I>4:IN rrQRIoIG GF.t."""" F!..OW (Q':a:II'dØ _! ~F o B. ~.. YIIISlIAL IfCNIT~ o 9. iI~I.I;.m;;~ TEST (0.' ~ Se::olo.um, T CONT -'DI!!Þ PIP!HQ i PRESSlJREEQ "1PIIoIG t'OIø::k:¡ ØIIr ~J:' 10, çclffiMJOI./S nJR!!1NE SUI>iP' seN""..oR ~ AUOIEILE ..,No VGUAf.. AI.Am.os.4M:) (dUd CJ'18 Q ;,¡, ALI'1'é ÞI,M> SHUT ~ WHEN A I..ë». OCCURS o b. AIJTC ,;oup,p SHuT OI"F FQR LßI\IG, S't'STEJoI "Ao1WRS AND S'YSTE¡N CISCCi"HEC11ON I:J <=. ~.AU'TtI PU ,If> ~I.n' Off . 0 11, AIJ'TOMATIC lEAIC. DETEÇ'tOQ o 12. ANNtJALINTEGRlTTT1EST(C.' GPH) SlJCT1CNI~ \I1T'1' S"rS'T'e1lC o :l. çcNTlNlJOU$ 5U*.P ss.s:;JR . AIJOIll.E,AJIm V15UAi, ~ E.IlERGDeI' GÐlE"....r'tlRS CI!iI1.'T {~96_~ o 1.... Q;)NTlNUClU$ SfJ"'" ~ WITHOUT AIJ1'O PIJI¡.4> $Io(UTOI'F + ~8U::AHD VISUAl. AI..NWS ; 0 1~. AUTOW.TK:: UHG L£'J< C€TEcrnR (3.0 GPM Tii~ CJ 4. 0AIl v VISU.AL Q-tCQ( o 5, t'I'IaICHlJIo¡A/~rrcRJNCi DILNONE. 4119· 471 41<\ ¡CArE '70 i"ootn. ~ (t"à'_ ~ Q\IWJ') .73 , ,,_ "'-Ifa' II)à¡ /,WI 01\1)') 47 ¿ I p~ I:JprI'lDl DaJ.o (Fø/'.I:Ii::III.- 0I'fy) " UPCF (7i'39) $:\ClJPAFORM$ISWRCS-B. 'cWO 08.'07.'00 07:31 6613930453 '6'661_ 05i6 JACO OIL COMPANY PAGE 05/05 06/07/2000 17:18 :Bm EB.Z ~H D IV CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 14! 005 IJ"¡DERGROUfioID STORAGE TANKS .INSTÁLLAT10N CERTIFICATE OF COMPLIANCE One form per tank P«V't _ r;I ~-_....__._--_. -"- u__.........._ _._ .._..._..___.... .____._ 1__" I. FACILI1Y IOeNTlFICA TlON -- -----.. . '",,~PACaJTY""""'~_"J . IS' j-f/ff4<-z-T FACJ/JNID' ¡ ~¡ Frö- -...-...-.-----. .. -...... .. . ......... -...--.,,-. -----.- .... .--.-----.-.....--.... ...-.- -.... --. -- - -" --...... II. INST ALLA. 'nON Check EiI tbld. ¥f11y The installer has been c::ertifled by the tank and piping manufacturers. " þ ~ CJ The installation has been ins~P.d and certified by a registera<l professionQI engineer. ~ The il'lStallatJon has bean Jn~ and approved by the City of 8ak~field Office of Environmental Services. ~ All worX listed on the man1Jfact.Jn~ts installation cnec::kJist has been comp1eted. o The installation contractor has been certified or licensed by the Contractors State Lìcense Beard. o Mother f1U3D'1oc1 was used as alloWed by the City of 8a"e~field Office of Environmental Services. 1d.entifV me1tJpd: ilL TANK OWNeRlAG~NT SIGNATURE _ _..._I'_~_..... a.' '0_'__'__ "_&~ItJII'IoI_~~""'" ." .._----..._~'-- .; ~N!ø17~- '" I~ IJJi/m;;;..s ·;¿¡Gž ____a 1,............--...__.-.-.- _____.___.......... '. - .,... - -..----... "'- .. . "'. .,----:¡¡;- -.. .. . Bakersfield Fire DePta- ~AZARDOUS MATERIALS DI~ION 2130 G Street, Bakersfield, CA 93301 (805) 326-3970 ~l UNDERGROUND TANK QUESTIONNAIRE /J¡) /, ;;J'ð'. r' ~bO \ lbv I. FACILITY/SITE i) ReceiVED JAN 2 3 1992/ DBA OR FACILllY NAME U ,,1 , t!> ¡...., (\'\ M \( Q- T g vCL1 Pt-VlE c;4 . 0, '1> ð I HAZ MA T. 0 I NAME OF OPERATOR 0 ! #ftð-1<et+<d1¡J T) C" CS Ù I ( 14 / G- t Í- L NEAREST CROSS STREET PARCEL No.(OPTlONAL) 'UN (oN AlirE /}N i) (3 C-ó R.N d.:1t- STATE ZIP CODE Œ-A-, Ci -S30' No. OF TANKS . (V11 '\j 1 ADDRESS \'101- V/\I{öl\! CllY NAME 'ß A-tLØft <; .I BOX TO INDICATE 0 CORPORA TlON 0 INDIVIDUAL ~ARTNERSHIP 0 LOCAL AGENCY DISTRICTS 0 COUNlY AGENCY 0 STATE AGENCY 0 FEDERAL AGENCY EMERGENCY CONTACT PERSON (SECONDARY) optional DAYS: NAME (LAST, FIRST) PHONE No. WITH AREA CODE C.s. vµ,LLÞN (,8'C'S) j.Q7-7Sfb· NIGHTS: NAME (LAST, FIRST) PHONE No. WITH AREA CODE ¡}S f:}g oYó lYPE OF BUSINESS 02 DISTRIBUTOR KERN COUNlY PERMIT 04 PROCESSOR 05 OTHER TO OPERATE No, 1 GAS STATION 03FARM EMERGENCY CONTACT PERSON (PRIMARY) DAYS: NAME (LAST. FIRST) PHONE No. WITH AREA CODE ~ I j.t . ~ . G- j t. LC&'O')") ~ 2. 7' 13 L..Q NIGHTS: NAME (LAST, FIRST) PHONE No. WITH AREA CODE c.E'O Š) 672, c; <¿-CJ 7 II. PROPERTY OWNER INFORMATION (MUST BE COMPLETED) - \ S-~ NAME ¡.J(H~K¡/~kí Ç(NGH£.RM' N'j)~ ,~~ CARE OF ADDRESS INFORMATION I MAILING OR STREET ADDRESS .I BOX o INDIVIDUAL o LOCAL AGENCY o STATE AGENCY i 3l.tll- G:Lf21-J /2,1) (;.f£ S /-. TO INDICATE Œ!1'ARTNERSHIP o COUNlY AGENCY o FEDERAL AGENCY ! ! CllY NAME 'ì33"iJ ~A~ I ;C3D3 66 I PHONE No. WITH AREA CODE (l /J-( Œi<S' Fr lZ1, Ì) , C.Jl., J:)of('( 1< fJð c.v- III. TANKOWNER INFORMATION (MUST BE COMPLETED) NAME CARE OF ADDRESS INFORMATION I , I JT Company MAILING OR STREET ADDRESS .I BOX, o INDIVIDUAL o LOCAL AGENCY o STATE AGENCY ¡ P.O. Box 1307 TO INDICA TE ~ PARTNERSHIP o COUNlY AGENCY o FEDERAL AGENCY I i CllY NAME STA TE ZIP CODE PHONE No. WITH AREA CODE I Bakersfield Ca 93302 (805) 393-7000 I OWNER'S DATE VOLUME PRODUCT IN TANK No. INSTALLED STORED SERVICE 1985 12000 gasoline '\ á)N 1985 12000 gasoline ('9/ N 1985 12000 gasoline <;Þ'N Y/N Y/N Y/N DO YOU HAVE FINANCIAL RESPONSIBILITY? áJ;N TYPE Fill one segment out for each tank, unless all tanks and piping are , constructed of 1IÞ same materials, style an~ype, then only fill one segment out~ please identify tanks by ~er ID #. I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECiFY IF UNKNOWN =- 'i A. OWNER'S TANK I. D. # B. MANUFACTURED BY: Hodern ~velding c, DATE INSTALLED (MOIDAYIVEAR) 1985 D. TANK CAPACIIY ,IN GALLONS: 12000 -,- III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B. AND C. AND ALL THAT APPLIES IN BOX D A. TYPE OF 0 1 DOUBLE WALL 0 3 SINGLE WAll WITH EXTERIOR LINER 0 95 UNKNOWN SYSTEM fi] 2 SINGLE WALL 0 4 SECONDARY CONTAINMENT (VAULTED TANK) 0 99 OTHER 0 1 BARE STEEL 0 2 STAiNLESS STEEL 0 3 FIBERGlASS ~ 4 STEEL CLAD WI FIBERGLASS REiNFORCED PlASTIC B. TANK MATERiAl 0 S CONCRETE 0 6 POLYVINYL CHLORIDE 0 7 ALUM INUM 0 8 1000/. METHANOL COMPATIBLEWIFRP (Primary Tank) D \1 BRONZE 0 10 GALVANIZED STEEL 0 95 UNKNOWN 0 99 OTHER D I RUBBER LINED o 2 ALKYD LINING 0 3 EPOXY LINING 0 4 PHENOLIC LINING C. INTERIOR 0 I; GLASS LINING ~ 8 UNLINED 0 95 UNKNOWN 0 99 OTHER LINING is LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO_ D. CORROSION 0 1 POLYETHYLENE WRAP 0 2 COATING ".'0 3 VlNÝL WRAP.",D 4 FIBERGlASS REINFORCED PLASTIC PROTECTION 0 5 CATHODIC PROTECTION 0 91 NONE o 95 UNKNOWN \!J 99 OTHER trench lined IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH iF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION " A U 2 PRESSURE A U 3 GRAVIIY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WAll A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FiBERGlASS PiPE CORROSION A U 5 ALUMINUM A U 8 CONCRETE A U 7 STEEL WI COATING A U 8 1000/. METHANOL COMPATIBLEWIFRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~ 1 AUTOMATIC LINE LEAK DETECTOR o 2 LINE TIGHTNESS TESTING o 3 INTERSffilAL o 99 OTHER MONITORING V. TANK LEAK DETECTION o , VISUAL CHECK GJ [XJ 6 TANK TESTING D 2 INVENTORY RECONCILIATION 0 3 VAPOR MONITORING 0 4 AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING 7 INTERSTITIAL MONiTORING 0 91 NONE D 95 UNKNOWN 0 99 OTHER I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN A, OWNER'S TANK I. 0, # B, MANUFACTURED BY: C, DATE INSTALLED (MOIDAYIVEAR) D. TANK CAPACIIY IN GALLONS: III. TAN K CONSTRUCTION MARK ONE iTEM ONLY IN BOXES A. B. AND C. AND ALL THAT APPLIES IN BOX D A. TYPE OF 0 1 DOUBLE WALL 0 3 SINGLE WALL WiTH EXTERIOR LINER 0 95 UNKNOWN SYSTEM D 2 SINGLE WALL 0 4 SECONDARY CONTAINMENT (VAULTED TANK) 0 99 OTHER 0' BARE STEEL 0 2 STAINLESS STEEL 0 3 FIBERGlASS 0 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC B. TANK MATERIAL 0 5 CONCRETE 0 6 POLYVINYL CHLORIDE 0 7 ALUMINUM 0 8 1000/. METHANOL COMPATIBLE WIFRP (Primary Tank) 0 9 BRONZE 0 10 GALVANIZED STEEL 0 95 UNKNOWN 0 99 OTHER , 01 RUBBER LINED 0 2 ALKYD LINING 0 3 EPOXY LINING 0 4 PHENOLIC LINING C. INTERIOR 0 5 GLASS LINING 0 6 UNLINED 0 95 UNKNOWN 0 99 OTHER LINING is LINING MATERiAL COMPATIBLE WITH 100% METHANOL? YES _ NO_ D. CORROSION 0 1 POLYETHYLENE WRAP 0 2 COATING o 3 VINYL WRAP 0 4 FIBERGLASS REINFORCED PLASTIC PROTECTION 0 5 CATHODiC PROTECTION 0 91 NONE o 95 UNKNOWN 0 99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVIIY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGlASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100% METHANOL COMPATIBLE W/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODiC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION [J 1 AUTOMATIC LINE LEAK DETECTOR o 2 LINE TIGHTNESS TESTING o 3 INTERSTITIAL 099 OTHER MONITORING v. TANK LEAK DETECTION o D !~] 1 VISUAL CHECK :-1 6 TANK TESTING 2 INVENTORY RECONCiLIATION 0 3 VAPOR MONITORING 0 4 AUTÖMATlC TANK GAUGING 0 5 GROUND WATER MONITORING 7 INTERSTITIAL MONITORING 0 91 NONE 0 95 UNKNOWN 0 99 OTHER · ., - ~tñì Ûj0)þ March 29, 2000 Union Ave Mini Market 1701 Union Ave Bakersfield, CA 93305 Dear Underground Tank Owner: Your pennit to operate the above mentioned fueling facility will expire on June 30, 2000. However, in order for this office to renew your pennit, updated fonns A, B & C must be filled out and returned prior to the issuance of a new pennit. Please make arrangements to have the new fonns A, B & C completed and returned to this office by May 15, 2000. For your convenience, I am enclosing all three fonns which you may make copies of. Remember, fonns B & C need to be filled out for each tank at your facility. Should you have any questions, please feel free to contact me at (661) 326-3979. Sincerely, Steve Underwood, Inspector Office of Environmental Services SU/dlm Enclosure -- . SUNSET MECHANICAL __ 3812 PANORAMA DR BAKERSFIELD CA. {8œJ 322-0000 Continuous Monitoring Device Certification TEST DATE FACILITY NUMS!R ~~-r:¡ TELI!PHONE lIP CODE MAKe AND MOOEl OF MONITORING SYSTEM ~ I -: t..:5 . 35° . , Contents of Tank Capacity of Tank Type of Product Line: (Gravity, Suction, Pressure). INDICATE lOCATION OF THI; MONlrO"ING SENSORS TESTED BY PLACING A YES OR No IN APPL\CA8LE BOX: ~ Annuler Space Sensor ./ -.... /J!'!;Þ - - Sump Sensor #&!VI ..... . Dispenser Contat.nment Sensor ~, - Electronic Overfill / Level ?S% 1/ ~ /lts '7' Electronic In-Line Le~k Detector N4 - , #ß ...... MechanlcCilllne leak Detector -- In Tank Gauging Device y¿~ ~ , - It' , INDICATE THE fOLLOWING BY PlJI\CING A YES OR NO IN APPLICABLE BOX: poes the monitoring system have audible and visual alarms? y~ " , Does the turbine automatically shut-down if the system detects Yfh ...... a leak, fails to operate or is electrooically disconnected? , 15 the monitoring system Installed to prevent unauthorized tampering? Yb '-!!. -, Is the monitoring system op~rableas per the manufacturer's specincati~ns? ~S ~ . SIGÑATUR; OF CERTIFIED TEC¡"~l\CIA'N ~ Which continuous monl~oríng devIces Initiate posiU'Je shut-down of the turbine? CERTIFIED TESTER'S 10# r rtJ:·ïr~o r·t~,~,~:: c:= c: ~í':-:;~J -,:':~H";: :.:}..~: ~I - , 2E.~3 C0M;)~.:W t·.;.:.~; t·, ";':L=~':-i )~.:::;:: __.,__...._,_ FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 'W Street Bakersfield. CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'W Street Bakersfield. CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield. CA 93301 VOICE (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield. CA 93301 VOICE (805) 326-3979 FAX(805)32~576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 ~- - February 9, 1999 Union Ave Mini Mart (Howards #8) 1701 Union Ave Bakersfield, CA 93305 RE: Compliance Inspection Dear Underground Storage Tank Owner: The city will start compliance inspections on all fueling stations within the city limits. This inspection will include business plans, underground storage tanks and monitoring systems, and hazardous materials inspection. To assist you in preparing for this inspection, this office is enclosing a checklist for your convenience. Please take time to read this list, and verify that your facility has met all the necessary requirements to be in compliance. Should you have any questions, please feel free to contact me at 805-326-3979. Si1' r/I4J Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm enclosure .""..9'~ de W~ ~ .Æ6~.r~ A W~~.,., Aik\-âok<t-~RRECTION N0icE BAKERSFIELD FIRE DEPARTMENT N~ 644 Location Ùh.IOV'l All(, 01 i\1." \fM..,,~i1 . Sub Div. eWI Ùf\fôn A\.t.. Blk. . Lot (1).3(0 ... 0'1 ì ( You are hereby required to make the following corrections at the above location: Cor. No t5 (J-f 1- UVlttuf"~fl ¡Q/tJ. (Ot1)" fuJo f {II ý¿,tI ¡g( I/d Za.vJ ~~IJ.l"Ir\lCIL~,,- 'ß{g@~ fl1CJ-\-/.ICNJ t4( ('<:c:. !';hJ Completion Date for Corrections Date .,,/JJ!1 sL Inspector 326-3979 -- e CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME cJtllm\. Ave.. tk 1.\ \ ~t'r1 ADDRESS not ¡}tI\IÒ~ Ax.. F ACILlTY CONTACT INSPECTION TIME INSPECTION DATE~(H PHONE NO. ..3~7 ~ (3J~ BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES ? Section 1: Business Plan and Inventory Program &f Routine o Combined D Joint Agency o Multi-Agency D Complaint ORe-inspection OPERA TION C V COMMENTS Appropriate permit on hand J Business plan contact intormation accurate V Visible address J Herd ~4) t'c \1ldC.v AMIt~ S/ðh ,It 'f (g /1 Correct occupancy V Veri tication of inventory materials J Veritication of quantities v' Veritication of location \I Proper segregation of material V Veritication ofMSDS availability V Verification of Haz Mat training V Veritication of abatement supplies and procedures vi' Emergency procedures adequate V Containers properly labeled ..¡ Housekeeping V Fire Protection V Site Diagram Adequate & On Hand if C=Compliance V=Violation Any hazardous waste on site?: Explain: DYes DNo White - Env, Svcs, Yellow - Station Copy Pink - BlI~íness Copy ¿uQJi~ Sr'~ Bus\ness Site Respons\ e Party Inspector: d, cid/,Afff) Questions regarding this inspection? Please call us at (805) 326-3979 e, e CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ¡}t\tÒvt Aile ftit"V\i ß1tlt~d INSPECTION DATE~1(99 Section 2: Underground Storage Tanks Program o Routine 0 Combined 0 Joint Agency Type of Tank fe~ Type of Monitoring AT<o o Multi-Agency 0 Complaint Number of Tanks .3 Type of Piping ?. t?'I ORe-inspection OPERA TION C V COMMENTS Proper tank data on file V Proper owner/operator data on tìle \I Penn it fees current V Certification of Financial Responsibility ,(// 'If N(c¿ ~()PJ. t!) 1 FtI\4~1ð.1 A'!If(lttH h, My ~'I"t-~l Ita. Monitoring record adequate and current -Ii if" Ñad Maintenance records adequate and current V ~() 4/; ( Failure to correct prior UST violations V Has there been an unauthorized release? Yes No '('It) Section 3: Aboveground Storage Tanks Program AGGREGATE CAPACITY Number of Tanks TANK SIZE(S) Type of Tank OPERA TION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? c~comPIi'~ V~V¡ol"¡oo y~y e, 10,p"lo", ~ ' d{;"lW"J Oftìce of Environmental Services (805) 326-3979 White - Env, Svcs, N=NO Pink - Business Copy RRE CHIEF MICHAEL R. KEllY ADMlNISTRATM SERVICES 2101 ·w street Baketsfleld, CA 93301 (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 ·w street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 PREVENOON SERVICES 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor street Bakersfield, CA 93308 (805) 399-4m7 FAX (805) 399-5763 It ~ BAKERSFIELD FIRE DEPARTMENT . . ~ February 13, 1998 Union Avenue Mini Mart (Howards #8) 1701 Union Avenue Bakersfield, CA 93305 RE: "Hold Open Devices" on Fuel Dispensers Dear Underground Storage Tank Owner: The Bakersfield City Fire Department will commence with our annual Underground Storage Tank Inspection Program within the next 2 weeks. The Bakersfield City Fire Department recently changed its City Ordinance concerning "hold open devices" on fuel dispensers. The Bakersfield City Fire Department now requires that "hold open devices" be installed on all fuel dispensers. The new ordinance conforms to the State of California guidelines. The Bakersfield Fire Department apologies for any inconvenience this may cause you. Should you have any questions, please feel free to contact me at 326-3979. Sincerely, ~tiJwfJ Steve Underwood Underground Storage Tank Inspector , ! cc: Ralph Huey "Y~~ W~ ~vØ&0Pe ~ A W~" · e ----..--- - QIL ~r~1 ~< ,IJ I'll C, N 1''111,1 I \ \r~ F:T 17.'·'" '"UN \ ON p,\L., - - Bi "-"F 1 EL[' ,-,,' q'-;'-"U··~" r~':', " . '.,' ,I IA-\.·' ,-',,) OJ 8U_'-b,,)b-U,,,71 l"lAF: :3. 1 998 11: 51 An S\'~3TÐ'1 STATUS FŒPORT - - - - - - ALL FUNCT IONS NORI"lAL UN \ ')I' 1''11 N \ l'lAF:T 1701 UNIC/t, A\/. B~..,ESF 1 ELD CA. 9:3:305 8r~~,'36-0271 MAR '3. 1998 11 :51 AM S"fSTÐ'l ~3TATUE; F~EPC'RT _----- i ALL FUNCT I ON~3 NCH'\AL " RRE CHIEF MICHAEL R. KEllY ADMINISTRAtIVE SERVICES 2101 "W Street Bakerstlek:l. CA 93301 (805) 32~941 FAX (805) 395-1349 SUPPllESSlON SERVICES 2101 "W Street Bakersfield. CA 9330 1 (805) 32l>-3941 FAX (805) 395-1349 PREVEN1ION SERVICES 1715 Chester Ave. Bakersfield. CA 93301 (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield. CA 93301 (805) 32~979 FAX (805) 326-0576 TRAINING DIVISION 5642 VIctor Street Bakersfield. CA 93308 (805) 399-4tn7 FAX (805) 399-5763 It ~ BAKERSFIELD FIRE DEPARTMENT . e - January 29, 1998 John Kerley JACO Oil P.O. Box 1807 Bakersfield, CA 93303-1807 RE: Howards Mini Mart #8, 1701 Union Avenue UNDERGROUND STORAGE TANK UPDATE Dear Mr. Kerley: The City of Bakersfield wishes to congratulate those tank owners who have upgraded, removed or replaced their tanks in the month of January. During the month of January, our office had six sites (14 tanks) which are now in compliance. This is a very big "first step". For those who have not yet upgraded, I would like to share some thoughts on why it is so important to act right away: 1. Licensed contractors are booking up fast, in some cases, up to three months in advance. 2. Supplies (pumps, dispensers, leak detection equipment) may be scarce. 3. The cost for upgrading or removing could go up as demand Increases. 4. Assembly Bill 1491 will ban fuel deliveries after January 1999 to non-upgraded owners. The good news, is there is still time!!! If there is anything this office can do to assist you in your planning, do not hesitate to call. Sincerely, ActJJJ Steve Underwood Underground Storage Tank Inspector Office of Environmental Services cc: Ralph Huey, Director, Office of Environmental Services '7~~ W~ ~OP~~ ~.A W~" ARE CHIEF MICHAEL R. KEllY ADMINlstRAnVE SERVICES 2101 oW Street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 ·w Street Bakersfield. CA 93301 (805) 326-3941 FAX (805) 395-1349 PREVENnON SERVICES 1715 Chester Ave, Bakersfield. CA 93301 (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave, Bakersfield. CA 93301 (805) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Street Bakersfield. CA 93308 (805) 399-4697 FAX (805) 399,5763 ~ . . - BAKERSFIELD FIRE DEPARTMENT December 18, 1997 John Kerley JACO Oil Company P.O. Box 1807 Bakersfield, CA 93303-1807 RE: Howard Mini Mart #8, 1701 Union Avenue Dear Mr. Kerley: You will be receiving this letter on or about December 22, 1997. One year from today, December 22, 1998, your current underground storage tanks will become illegal to operate. Current law would require that your permit be revoked and, would make it illegal for any fuel distributer to deliver to any non upgraded tanks. However, in reviewing your file I see that you do plan to replace your tanks by December 1998. We congratulate you on your decision to replace your tanks and simply want to offer any assistance we can in meeting your target date. Please remember to contact this office for permits well in advance of yoùr anticipated start date. As we get closer to the December 22, 1998 date, I would expect construction lead times to become extended, as well as costs for tank replacements. Sincerely, REH/dm cc: Kirk Blair, Assistant Chief Harry Singh '7~de W~~~fYe~ A ~~" ..~- '7 COMPLETE THIS FORM FOR EACH FACIUTY~rrE ~:t, :7:'~ECFCAUFORNlA ~ I STATE WATER RESOURCES CONTROL BOARD .. UNDERGR ND STORAGE i ANK PERMIT APPLlCMoN . FORM A MARK ONLY [], NEW PERMIT ONE ITEM =:J 2 INTERIM PERMIT o 3 RENEWAL PERMIT ~ AMENDEO PERMIT o 5 CHANGE ~ INFORMATION 0 7 PERMANENTlY CLOSEO SITE r 6 TEMPORARY SITE CLOSURE I. FACIL/TYISITE INFORMA110N & ADDRESS· (MUST BE COMPLETED) - PARCel' (0P00NAl¡ ON Iclt/ III./é I=/i;..¡ c.'" :: CORPORATIOM STATE CA ¡ ZIP CCOE : tf ..3301 ~ lNOIVIOUAI. C PARTNERSHIP = LOCAL·AGEHCY DISTRICTS ï! ,/ IF INDIAN , OF TANKS AT SITE L-.: RESERVATION OR TRUST LANDS = COUNTY~Y SITE PHONE' WITH AREA CODE l80s \ b3b -0';1'-' \ o STATE-AGBICY 0 FEDERAl-AGENCY -:YPE OF BUSINESS ~ ' GAS STATION I 2 DISTRIBUTOR "i :I FARM c: "PROCESSOR E. P. A. L D. , (ØPIit1tIII/J 5 Oi"ER EMERGENCY CONTACT PERSON (PRIMARY) II. PROPERTY OWNER INFORMATION· MUST BE COMPLETED) ~ OF AODRESS , ð-o'-- ,/ ÞoIIllIncIiI:a ; ::tl CORPORATION :: PARTNERSHIP I S~TE : ZJPfJ!¿E, L ~ ~ I /.,3::?¿>Õ o LOCAI.-AQENCY 0 STATi-AGENCY o COUNTY-AGEICY 0 FEDERAl..\GENCY PHONE' WITH AREA CODE '. ~J37:?-7Þ~--Û III. TANK OWNER INFORMATION· (MUST BE COMPLETED) CARE OF AOORESS INFeRMA TICN i ,/ bOIllllIIdr:a ~ IIDVDJAl 0 LOCAI.-AGBa 0 STATi-AGEHCY Rt7 I C CORPORATION ::J PARTNERSHIP 0 COUNTY-AGEICY 0 FEDERAl..\GENCY , I ST? ZIP PHONElWlTHAREAcooe ,v1J r i Ci?1 or ' :?.7P.. ¡,ð ~ ~--?ðtÞÒ IV. BOARD OF EQUALlZA110N UST STORAGE FEE ACCOUNT NUMBER· Call (916) 739·2582 if questions arise. TY(TK) HQ í4T4l-¡ÓID~1 v. LEGAL NOTIFICATION AND BILUNG ADDRESS ~egal r.:::,:'carion and billing will be sent to the lank owner unless box I or II is checked. C¡..¡ëCK ONE BOX INDICATING WHiCH ABOVE ADDRESS SHOULD BE USéD ~OR L"G':'_ \OTIFICATIONS AND BILLWG: 1·0 11·0 111·0 UNDER PENAL TY OF PER.JIJ¡;Y, AND TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT JURISDlcr:ON II ~ FACILITY II ITITIIJ ..CCATlON COOE . cpnONAL CENSUS TRACT. . OPTIONAL SUPVISOR . DISTRICT COOE . OPTIONAL i THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION. FORM B, UNLESS THIS IS A CHANGE OFSrTE INFORMATION ONLY. FORCQI3A-A2 =ORM A (9-901 -~':fUli ---~------- .~ -- e Sf A Tt Of CALJIOfIU STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM B COMPlETE A SEPARATE FORM FOR EACH T AHK SYSTEM. MARK ONl Y ONE ITEM o 1 NEW PERI,IIT o 2 INTERIM PERMIT ~RENEWAl PERMIT ~ 4 AMENDED PERMIT o 5 CHANGE Of INFORMATION o ð TEIAPORARY TANK CLOSURE D 7 PEJ!UAHEHTly ClOSED ON SITE o 8 TAHK REIoIOVED DBA OR FACfUTY NAME WHERE TANK IS INSTAllED: I. TANK DESCRIPTION COMPlETE ALl ITEMS - SPECIFY IF UNKNOWN A. OWNER'S TANK I. 0.' // A ~ B. r.tANUFACT\JRED BY: ./ ./..n~ -'- ,~~ 1 C. DATE INSTALLED (MOIOA Y /YEAR}....... '. D. TANK C/lPAI:.fTY IN GAllONS: ~. II. TANK CONTENTS IFA·\lSMARKED.COUPLETEITEMC. A. I MOTOR VEHICLE FUEL 04 OIL o SO, EMPTY C 95 UNKNOWN B. ~ PRODUCT o 2 WASTE C. 8 3 DIESEL 4 GASAHOl 5 JET FUEL 911 OTW:R (Œ9CR1BE IN ITEU 0. 8ElOW 08 AVIATION GAS o 7 METHANOl ~ CJ 2 PETROLEUM ï: '---' 3 CHEMCALPROOUCT D, IF (1..1) IS NOT MARKED. ENTER, NAME Of SUBSTANCE STORED C.A.S..: III. TANK CONSTRUCTION MARK ONE ITEM ONt Y IN BOXES A. B. AND C. AND ALL THAT APPliES IN BOX D A. TYPE OF 0 1 DOUBLE WALL ~INGLE WALl WITH EXTERIOR LINER o SlS UNKNOWN SYSTEM D 2 SINGLE WAlL 0 4 SECONDARY CONTAIN~ENT (VAUlTED TANK) o 911 OTHER [] 1 BARE STEEL 0 2 STAINLESS STEEL 0 3 FIBERGlASS ~EEL ClAD WI FIBERGlASS REINfORCED PlASTIC B. TANK MATERIAL =:J 5 CONCRETE 0 6 POLYVINYL CHLORIDE D 7 AlUM INUI.t o 8 100% IAE'THANOL COMPAT18LEWIFRP :Primary rlnkl Il SI BRONZE 0 to GAlVANIZED STEEL 0 liS UNKNOWN 0 911 OTHER ---' =:J 1 RUBBER LINED o 2 AlK'(D LlNfjG 0 3 EPOXY LINING 0 4 PHENOLIC LINING C. INTERIOR ~ 5 GlASS LINING ~ UNLINED [J 115 UNKNOWN 0 gg O'THER UNING ~ IS LINING MATERIAl COUPATlBLE WI'TH 100% ME'THANOl ? YES_ NO_ --, POLYETHYLENE WRAP Ii 2 COATING ,---: 3 VINYL WRAP ~ FIBERGLASS REINFDAœD PlASTIC D, CORROSION , 1 - - pQOTECnON - 5 CATHODIC PROTECTION ¡- 91 NONE - 95 UNKNOWN 0 gg OTHER IV, PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION U 2 PRESSURE A U 3 GRAVity B. CONSTRUCTION A 1 SINGLE WALL A U 2 DOUBLE WALL U 3 LINED TRENCH A U ~ OTHER A U liS UNKNOWN A U 911 O'THER C. MATERIAL AND CORROSION PROTECTION D. lEAK DETECTION A U 1 QARESTEEL A U 2 STAINLESS STEEL AU 3 POLYVINYL CHLORIOE(Pvc)A U 4 FIBERGlASS PIPE A U 5 AlUMINUM A U 8 CONCRETE <iJ, STEEL WI COATING A U 8 100% IAETHANOL COMPATIBLEWIFRP A U 9 GALVANIZED STEEl A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U gg OTHER I AuTOI.IA TIC LINE LEAK DETECTOR :- 2 LINE TIGHTNESS TESTING !.IONfTORINO D gg OTHER V. TANK LEAK DETECTION I VISUAL CHECK ò TANK TESTING L- 2 'NVENTORY RECONCILIATION "7 INTERSTITIAL MONITORING - J '¡APOR MONITORING ~ 4 AUTOMATIC TANK GAUGING 0 5 GROUNDWATER MONITORING 91 NONE [J 95 UNKNOWN 0 go On-tER VI. TANK CLOSURE INFORMATION I, ESTlMAT¡¡O DATE LAST USED (MOIDAY/YR) 2, ESTIMATED OUANTlTY OF SUBSTANCE REMAINING I 3. WAS TANK FillED WITH GAllONS ' INERT MATERIAL ? YES 0 NO D LOCAL AGENCY USE MBERS BELOW STA TE 1.0.# FACILITY II = TANK. ITTIIIJ PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FOR'" B (9-QOI THIS FORM MUST BE ACCOWJANIEC BY A PERMIT APPUCAnON· FORM A. UNLESS A CURRENT FORM A HAS BEEN ALEC. FOIIOaM I-IM ·ÙH:!: ,,' .~ '" ~ e . '" ~ Sf A Tt Of CAL.IfOfNA STATE WATER RESOURŒS CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM B COMPlETE A SEPARATE FORIA FOR EACH T AHK SYSTEM. MARK ONLY ONE ITEM o ' NEW PERMIT o 2 INTERIM PERMIT o 3 RENEWAl PERMIT ~ AMENO€D P€RJ.\IT o S CHANGE Of INFORMATION o 0 T"ElAPOfWIY TANK CLOSURE o 7 P€JIIU.HÐm. y ClOSSD ON SITE o 8 TAl« REIoIOVED DBA OR FACILITY NAW: WHERE TANK IS INSTAl.1.fD: <S' I. TANK DESCRIPTION COMPLETE AU. ITÐ.IS - SPECIFY IF UNKNOWN A, OWNER"S TANK J. D. . //.. ,...... ..1 "} B. IoIANUFACnJRED BY: /./. .J, J..... .'.Þo~ C, DATE INSTALLED IMOIOAYIVEAA) D. TANK CAPACITY IN GALlONS:~ II. TANK CONTENTS IFA.IIS...ARIŒ:D.COUPLETEITEMC. :.~ MOTOR VEHICLE FUEL 0 . OIL A. ~ 2 PETROlEUI.I 0 90, EUP'IY n 3 CHEMICAL PROOUCT C gs UNKNOWN D. IF (A.I) IS NOT MARKED. ENTER NAJ.lE Of SUBSTANCE STORED B. ~"PRODUCT D 2, WASTE O taAEGUU.R C. UNLEADED o IbPREMIUM UNLEADED o 2 LEADED ~ 3 DIESEL 0 «AVIATION GAS ~ GASAHOl 0 7 IAETHANOl. o 5 ~ET FUEL ~ OTHER (Œ~18£ IN ITEU D. BElOW) C. A. S. . : III. TANK CONSTRUCTION MARK ONE ITEM ONt Y IN BOXES A. B. AND C. AND ALL THAT APPLIES IN BOX D A. TYPE OF CJ I DOUBLE WAll ~ 3 SINGLE WAll WITH EXTERIOR LINER o 95 UNKNOWN SYSTEM CJ 2 SINGLE WAlL 0 . SECONDARY CONTAIN~ENT (VAULTEDTANI<) o 911 OTHER 0 1 BARE STEEL 0 2 STAINLESS STEEL 0 J FIBE~ ~' STEEL CLAD WI FI6ERGlASS REINFORCED PlASTIC e. TANK MATERIAL CJ S CONCRETE 0 6 POL Y'JINYL CHLORIO€ C 7 ALUI.lINULI o 8 100'J1. IAETHANOL COUPAT18LE WIfRP :P,imary Tril 11 9 BRONZE 0 10 GAlVANIZED STEEl 0 95 UNKNOWN 0 911 OrneR '---' :=J 1 RUBBER LINED o 2 ALKYD lINNG 0 3 EPOXY LINING 0 ~ PHENOLC LINING C. INTERIOR CJ S GL4SS LINING ~ UNLINED C ~ UNKNOWN 0 GII OTHER UNING , IS LINING MATERIAl COMPATIBLE WITH 100% I.IE~ANOl1 YES_ NO_ ---. POL YETHYLENE WRAP Ii 2 COATING ,---: 3 VINYL WRAP ~ FIBERGLASS REINFORCED PlASTIC 0, CORROSION , 1 - - PI10TECnON 5 CATHODIC PROTECTION 1- 91 NONE ---. 9S UNKNOWN o 911 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A 2 PRESSURE A U 3 GRAVITY A U GII OTHER B; CONSTRUCTION I SINGLE WALL A U 2 OOUBLE WALL A 3 LlNEO TRENCH A U ~5 UNKNOWN A U 99 o~eR C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U J POL Y'JINYL CHLORIDE (P\I'C} A U ~ FIBERGlASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A(ji) 7 STEEL WI COA TINa A U 8 100% IÆTHANOL COIAPATlBLEWIfRP PROTECTION A U 9 GALVANIZED STEEl A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 911 OTHER D. lEAK DETECTION I AuTOMATIC LINE LEAK DETECTOR :: 2 LINE TIGHTNESS TESTlNG MOHrrORIHO o 911 OrneR ~ V. TANK LEAK DETECTION I VISUAL CHECK V; :NVENTORY RECONCILIATION ~ J '/APOR MONITORING 0' AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING õ TANK TESTING L i INTERSTlTIALI.IONITORING ---; 91 NONE [J 95 UNKNOWN 0 9Q OTHER VI. TANK CLOSURE INFORMATION I. ESTlMA rëD DATE LAST USED (MO,DAYIVR) 2, ESTIMATED QUANTITY OF SUBSTANCE REMAINING I J. WAS TANK FillED WITH GAllONS' INERHAATERIAl1 YES 0 NOD STATE 1.0.# OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT OATE /~/? -....._~ THIS FORM HAS BEEN COMPLETED UNDER PENA APPlICANrS NAME .P~N'fO I SIGNATURE) £ LOCAL AGENCY USE ONLY JURISDICTION II :~ FACILITY II = TANK' CIIIIIJ PERMIT NUMBER I PERMIT APPROVED BY/DATE , PERMIT EXPIRATION DATE FOR'" B !J.!( THIS FORM MUST BE ACCOIofJANIED BY A PERMIT APPUCATJON· FORM A. UNLESS A CURRENT FORM A HAS BEEN AlED. FOAOaMI.JM ....1" ... , e . , Sf Art Of CAUIOAIIA STA~ WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPlICA TtON . FORM B ,i COMPlETE A SEPARATE FOR" FOR EACH TANK SYSTEK. MARK ONL Y ONE ITEM o I NEW PERMIT o 2 iNTERIM PERMIT o ] RENEWAl PERMIT ~ AMENDED PEIUIIT o 5 CHAHOE OF INFORMATION o S TEl.lPOFWtY TANK CLOSURE o 7 ~Y ClOSED ON sriE o 8 T.we RE..ovED DBA OR FACIlITY HAW: WHERE TANK IS INSTAllED: I. TANK DESCRIPTION COMPlETE AllITÐAS - SPECIFY IF UNKNOWN A. OWNER'S TANK I. D.' B. I.IANUFAC1\JRED BY: C, DATE iNSTALLED (MOiOAYIYEAAI D. TANK CAPACITY IN GAllONS: II. TANK CONTENTS IF 1..1 is "'ARKED. CQLIPlETE ITE'" C. : Vi' MOTOR VEHICLE FUEL 0.4 Oil B. C. o I. REGULAR B 3 DIESel 0 8 AVlAnoNGAS A. UNlEADED CJ 2 PETROLEUM o 9O,EMPTY ~ PRODUCT ~PREMIUM .4 GASAHOI. 0 7 "'ETHANOl UNlEADED 8 S JETFUEl ' r-¡ ] CHEMCALPROOUCT C 95 UNKNOWN . D 2 WASTE o 2 LEADED ' 911 OTHER (ŒSCRIBE IN ITEU Do BElOW) 0, IF (A, I) is NOT MARKED. ENTER NAME OF SUBSTANCE STORED C. A. S. , : ! III. TANK CONSTRUCTION MAAK ONE ITEM ONlY IN BOXES A. B. AND C, AND ALL THAT APPliES IN BOX 0 A. TYPE OF CJ I DOUBLE WAll G"3 SINGLE WAll WITH EXTERIOR LINER o !IS UNKNOWN SYSTEM CJ 2 SINGLE WAlL o 4 SECONDARY CONTAIN~ENT (VAULTED TANK) o 911 OTHER CJ 1 BARE STEEL 0 2 STAINLESS STEel 0 ] FIBERGlASS ~ STEEL ClAD WI FIBEAGlASS REINFORCED PlASTlC e. TANK MATERIAl =::J S CONCRETE 0 8 POLYVINYL CHLORIDE D 7 AlUM INU&.I o 8 100'J1. "'ETHANOL COI.IPAT18lE WIFRP :Primary Twl 11 II BRONZE 0 10 GAlVANIZED STEel 0 Q5 UNKNOWN o 9Q OTHER '---' CJI RUBBER LINED o 2 AlKYD UNNG 0 3 EPOXY LINING 0 .4 PHENOLIC LINING C. INTERIOR c:::J 5 GlASS LINING [B'8 UNLINED [J 115 UNKNOWN 0 III! OTHER UNING IS LINING MATERIAL COIAPATlBLE WITH 100% "'ETHANOL ? VES_ NO_ --. POLYETHYLENE WRAP Ii 2 COATING ,----: ] VINYL WRAP ~. FIBERGlASS REINFOAœD PlASTIC D, CORROSION I 1 - --. pQOTECnON 5 CATHODIC PROTECTION 1- 91 NONE - 95 UNKNOWN 0 gg OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GRC}JND OR U IF UNDERGROUND. BOTH IF APPLICABlE A. SYSTEM TYPE A U I SUCTION A PRESSURE Å U ] GRAVITY A U gg OTHER B. CONSTRUCTION A I SINGLE WALL A U 2 DOUBLE WALL A LINED TRENCH A U !IS UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION A U 1 BARESTEEL A U 2 STAINLESS STEEL AU] POLYVINYL CHLORIDE (P\IC)A A U 5 ALUMINUM A U 6 CONCRETE A&J STEEL WI COATING A A U II GALVANIZED STEel A U 10 CATHODiC PROTECTION A U !IS UNKNOWN A I AUTOMATIC LINE LEAK DETECTOR . 2 LINE TIGHTNESS TESTING IAONITORINQ --' U .4 FIBERGU.SS PIPE U 8 100% UETHANOl COMPAT1BLE WIFRP U gg OTHER D 99 OTHER V. TANK LEAK DETECTION 1 VISUAL CHECK~2 :NVENTOAV RECONCILIATION , tì TANK TESTiNG L- '7 INTERSTITiAL MONITORiNG ] 'IAPOA MONITORING ~ 4 AUTOMATiC TANK GAUGING 0 5 GROUND WATER MÒNITORING , 91 NONE [J 95 UNKNOWN D 99 OTHER VI. TANK CLOSURE INFORMATION I, ESTlMA rï:O DATE LAST USED ¡MO/DAVIYRI , 2, ESTIMATED OUANTITY OF SUBSTANCE REMAINING I 3. WAS TANK FILLED WITH GALLONS' INERT MATERIAl? YES D NO 0 LOCAL AGENCY USE ONLY APPLlCANrs NAME ,PAlNTfO I SIGHATUf'£1 &. . OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS mUE AND CORRECT DATI: ~ ~ / .D/NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW STA TE 1.0.# JURISDICTION II ',lL ' , FACILITY II OIIIIJ TANK' CIIIIJJ PERMIT NUMBER I PERMIT APPROVED BV/DATE , PERMIT EXPIRATION CATE FOAl.! 9 (9-g( THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATlON, FORM A. UNLESS A CURRENT FORM A HAS BEEN ALEC. FCAoGMI-M ...-.. "--''-'~- - - - -~.. ..-~..........--------_.~---- ---......- --... "'-~---~.~ ... . ì I ¡ ! l-.LJ" c¡ '1 , (,lhd- ~ùt Ut~¿fr Ilcðt ~'t~~W\ . +0 /11 ~ pce f N("w it... ~,.. ~~-o "at ft ¿(., {«:{/(Ùt t I ; ! ! ¡ ~ ~- -------.~- ~ -- -- ¡ "I ! I '"," I¡ " , I II ¡ I I I I' ,I , I , I , I , II I' ,I ¡ , i : 1 I ·1 , , ·1 I , I , i , , , ¡ : I . ; , I I 'I : 1 , I , ¡ , , -~~-----~-----"""-~.;,.~_.._--=zr_w:::.9______""_.~"'___,,_-.~_,,~_,,-_._,,-_ , ! ¡ I : I ! , r~- I I \ \ ¡ ./ ., o i -1 I I , -,,' - - - ~=~EN:3ì)F: I-iLI-iF:r"l _h__ ~, L I: ~:::':)UTH f'] P] f'JG :3Ef'JSOR . PI F'I NG SUf"lF' FUEL ¡.;LHF:r"r JUL 2. 1997 10:53 AM - -,,- - - :3Er'-t:::>:)F: ALARI"1 hh_ L 2: r"V>F:TH PI F' I NG SENSOR F I PIN':; Surw ~I FUEL ~1LARr"l U JUL 2. 1997 10:53 AM i j j " ~ , \..c. ~ '" .~ . e- Emergency Response Plan What you do Complete this emergency response plan, making any additions necessary to adjust for your facility size or emergency procedures'. If you already have a plan Caution Table: of contents Submit the original to the HMD; keep a copy on site. Your facility may already have an emergency response document. You should verify try,ªl:""~t,..,provid~~,·,,,tJJ~,.. same information as the plan included h~f.e:~"t1::::$p,l;l:;submit Y6¥rçt9ëij(nef1J to the HMO in lieu of the enclo§e~f"'plan.:'::·¥:þ'µ:::.,maY"'als(r.¿6:~sg t9::::::(evi~e your document to inç.qfþd~,at~..,arìY' missing .:informatioíl""Š.ôtÞãf"".jt meets the plan J~~Ù¡f::erPe~~s." ':" ", ..' .. ......,.. . ... " , ," .......,................. ," ... . . .. ..". " ..... ... ...... .. ....... ... ........ . · ... .. . ..' .. . . ....... · . ....... .' " . . . ...... .. · . " - . . . . . . . . . . :::'<:,~hÎs, ~mergency,:,resPQriáé,:,':pfð~:., ptpyides the, rninirti~!Jl:ipformation neCessary }.9:nieet ,the,I~,w'~,~e,,~~~~è~::~r response :Plàfí,requirements. /,;~:~et~~þ~tmt~t 'a~\ portion Of.thi~\P!an:\vithout .., .. . ... . "This ~~ÞI~:: descriJ.~~::¡::i~;!,:::~~'d:h~t~:i~~:;åi!i,ihé:::~~~rgency ;~sÞdnse ~Ian. . ... ... . ..,.... .... ...... ..... . . .. . ...... ... . " , , To ':::";:';'::'..:: ..:..:.: Overview:::Emer .. .... " ',. . Gellerål:'Pacilì I nformati()n\{ " ",,/'9 10 11 12 13 14-15 .. ..... .. ". .... ... ....".... .... ... ......... .... .. ........ , , , .... . ... . ... Coordinåtä..- InfÒfmatioíÍ,/H ... Phone"'Nhfubers , , ' ,', ....-.. ......... ":"Ë;ag:å~tidh"':'P:rocø:dur~$'....:""":::::::·:"·"':"'::;::::::' "\ H' Emer Emer Employee Training I Overview: EmAency Response Plan ~ I Background An emergency response plan ensures prqper action in the event of emergencies involving hazardous material~ or hazardous wastes. '- ! \ The plan: . describes actions an operator must take in an emergency or I accident involving hazardous materi.als or wastes. . is developed in advance for irhplementation during an I emergency'~",;,;.,;.;""""" "'..;.;,',',','.'.'.......',.,',.,;,;,;,;,;'.."",,,. "..;,,;..';....' ,;,;.:". ";::;, :i:,,,; ;;:;\:; ..;:/;1 ,..;,;,;,;;,;;,: ";";"';"~'" .;;;,prô'vides;;pr§ç,édures"foi;:'fR:t&1~i~te ~m~:r"ap'propriate response to ·';;efr.,~,~gefJêles., '" ".. " "':, ';:;;" """ "", ... ,;" '...., " I'''''' "'", '::; "'" ,," , ., ';;:::::;;;;;,:::::::.·;;';h,inimizes haZard$;:.,~~:::¡~;~:~åÔ hèalth,iandthEf::ènVironment. " " , , .. " ',.. . .... ", ..... When i~;'~ required:::; .. : ::c~;;~~~¿~f~~i!~~~r~~~~~:C~:ì:~t~::~t:nd/or ......... ........... .... . ...... . ..... . ...................... . . ......... .... . .... ...,............... .... E~~~en~An :~:e~;!~!:~=:~a.~~~~êes in.it~use. . subri1il::ê.'ò.þies to agencies invohiedIiQ.:::~riJ~tgency r~spo~se. . .. . · ~;j·j~ul~hr~~~I~~J(~~~~f1gency.~bom~nents -.:. :..............:.:\:::;:::::.::......... "':"':!: ...:,:::::,:., I .~:' ":':':';" . .. ..:-... ..;.....:::....-=-- I . . Component~ Th!;~ Hs(describes the corqp'0r.!,W:;¡.~,~:::ôf;;the ¡emergen~y respónse plan: ',;;, ' ",};··,·,·':':-::.~V;;";;"·" ¡ ;', " ," . ..;...:.:.:-......:.. ;'.",,;,., ønjerge~cy coordinator" " ", .., ,;',;;;þ"1,~Í'gency;proc~9ures';", " "~~~~ii~~~~- . . emergency""phone:"'lumbers" . employee training " ii e - .] Emergency Response Plan General Facility Information Date of completion 3/ '3 I Ie¡ 7 I I , - _'/ \ ;;'" Date Facility information . .. ". Owner,::" ii"""""':::: informat/otf".' .. .., , , Hazardous" materials , description Records location DBA () f.J ( h N t1 (~,. fVLq1z.,~£-r D Address /701 U tV' ðtJ Ali£- City 13A1L¿¿.i.S( (~a C4 Zip Code 9530 / Busines. A>on:Jli1~~~~to Parcel NU,!"ber '" ,: "': ":-",:,, ,,::;::':-:,,:,,: ,,/ ',' ,"""'" .. . .... o . . . . 'St~~~ârd:!Cd~~rialCÕde(SIC) N~~ber ' ~ÊP.AIÖ'Nu~bEír ",..,..,........... .. ,.. .. .. , ..' . ....... ....... .. .., ,.. .. . . . .. .... ,', ," ..' ......" ,', .. - .......' ," ........ . ,',.,' '~ .'." '.'... ,",.,.. Na,~:~%t:~:;~~;l~~¡~>~~~5-r. ,. , , .. ., ...." ')t.' '"<rAt £" ..,.. ... z d~y ':-.'~~SriMl.~j,Sii.:::::::.,Jp:f,,:(' 2b '\, ",."""", ~¡i5it£IiA'ðh:;¿j9i'l/ .... .. .. :~i:::~~c¿~~~~~;,~~c .... :- .....;.:....;. ",: . ..... . ,- . . . . . .. . .., ..... . .., .. . -. .. , .., . '", ":':c , ' .. , ..... .".. ..... .',. . . . . . . . . .. . ... . .. .- . .. ...... n' . . , . , ..',.. Give a bri:~f"::'.d.êscription of hazarddÜ~',:;!P~~f.~.ialsandJor wastes .. use/proces~:,,:;:'\<:.":::>':;:::'::':> .. .. ,{e.g .',á4:i':t~Þ~r;';:J;1f1q méi~nt~nán6~; sale,~fp'êh()leum products for \.,"autómobitè's:; dry::'çJ,~,~njhg, etç.'d .. .:...:.....;.:...... ~~.øf Pz-;;;ltt:;;'PftJ1JVd-J;/Ót /lul,tfJtÞ¡¡z5 . q .. ....,'êta:te',,:::,:"'lt1é:,..' ,'Ioqation::,., "of ".. tecords,r..êlating ,../ to m$t~~.i~:!:~~häzar~,?,us',~~~~.~.~.~,,, .". ," :" hazardous ....... .... ..... " ....,........ .... .... .. ...'.... . ...... .. .. ....., ... ...... :::.:.:.:. .::: :::: :.::..:.:.' ," · State the 10'êiition",,6f..,V,Q:µr.::::M.$.,bS,arid"emergency response plan. OAl 5¡+Ž¡ Continued on ne.xJ page 1 General Facility I.rmation, Continued . Waste disposal information ----r e , , '.r,_. " 1 If you are a hazardous waste generator, identify your hazardous waste hauler(s) or recycler(s) here: HaIlIAr(s) . Name: Address: City: Zip code: Phone #: EPA ID #: Additional: RAcyclAr(s) . Additional: 2 , , þ> Emergency Coordin!r Information Emergency coordinator Alternates . Designate your primary emergency coordinator: This person must have the authority to: . make decisions regarding the classification of the release. and . determine the appropriate response. Name -:S-O~,.. ~~~ Address -31 0 51j 12..Ì) City1JAl¿~s.Ç,~;J) Çjb, QY¿ò1 Business Phone '1IJ5 ?fi3- 7 OOD Home Phone W'J' ~35" -30()é) Check whether on-site 0 or on-ca~ Designate alternate emergency coordinators in order that they would assume responsibility: · Alternate 1: Name 12.0L-( SAD-.JïJ7~(L5 Address '310 l 5-tfJrrzL ~ CityE>~s(l0-D {)kiP 0/"7'308 Business Phone i::O S-- ?713 ---j(X)[) Home Phone Check whether on-site 0 or on-c~ · Alternate 2: Name :Kofn~.,- 1-1 Au... Address 9101 "'5~. 7-D City ~~5//{~lð Zip Q130t Business Phone LfIJ) ¿Cf3- Î (X)Ò Home Phone CVtJ ~ ~ (P2 -3~1 Check whether on-site 0 or on-c~ 3 e e , . , ,. '" ~' e Emergency Procedures Internal response team Employee notification e · Designate your internal hazardous materials response team and their responsibilities. {. ~- - '. Names - - Responsibilities J (j¡ j) f) 11 ${ N€rff- / \, ' , "' VI - , '''" ,~ / · Describe procedures for notifying your team of an emergency: [ ] voice P<J phone , [ ] public address system [ ] alarm system [ ] other (describe): --\-\: \ ' · List procedures for notifying employees who could be exposed to hazardous conditions by a release. Ì>{I voice [ ] phone [ ] public address system [ ] alarm system (sirens, bells, etc...) · Designate an individual responsible for notification: HBe-fl~ 5/N6tI- ConJinued on next page 4 Emergency Pro.dures, Continued Technical advisors Neighbor notification procedures e ,: J . > List personnel who will provide technical advice to off-site emergency responders (fire, police) in case of an emergency incident. ~ Owner H~e..~ 5u:'bf-t [ ] Manager ~ Supervisor ~Í;£P-:1Í H4v- [ ] Other · List procedures for notifying neighboring residences, businesses, schools, etc, which could be affected by a release threatening off- site. ~ voice, personal visit [ ] phone [ ] public address system [ ] alarm system (sirens, bells, etc...) · Designate an individual who will perform the notification: Hft~~ 5íNtétf · Keep a list of those to be notified (see next page). Continued on MXt page 5 , ¡ \ ~ e e Emergency Procedures, Continued Neighbor notification list ...... ...... ......-" . . .......,- ... ...... .. ............... . ..... ,..........- ....... ". . . . ,.-.."' .......... .....- - -. ......--..."... . . . "". ...... d..... . . "'..,- ......... .. .<.~~!~~~O'r ~~'~~.,.Notification List ,'.',.',' '......,.",' ,'.' ,',',' "'.".,,' . .. - .. .._....."........ __..... ._.d. ... ."" ,d.,. ..... ",.. .... ................__ . .___ . .. . .............. " - .... ..--_...... . .. - ..... .-.....,',',',.......... .- -- ...................-.......... " ... ,'" ...,',',. . ,........... ,.. "" ". ............. .... - ". - .... , .,'" ,..,. , -' ......"".-. - ." .---.-". ... , - .........-......... - .., ... ..-. . - . ..... -, ........,,- ............. - -,....-...........--. - - -...- --. -- .....--._.. . " ........, --........, .' "...,..----, .... .... --, ,. .-". -- --. ...., ,-.--.-....'" ........, ,. ,.....- -.....,. .... ... . . . - ,... '--,- .-. .. ,'(o~ muSt'JJr~\Ïi.d.~#I~i~W'fhiCJ1...iti~~tifie".·.·all.ofth$businesses'and/or , . .. . ....... ,structuresbQrdenngC)Ï'¡¡djacerittoyour facilitY. , ... '..... ...... ..."'..'.'..............,. .' " '.. '. ", Business Name: Address: " Phone #: Contact Name: Business Name: Address: Phone #: Contact Name: Business Name: Address: Phone #: Contact Name: Business Name: Address: Phone #: Contact Name: , j Continued on next page 6 e e .. If Emergency Procedures, Continued Containment Describe procedures for containing spills, releases, fires or explosion's: procedures [ ] blocking drains 'fA diking with absorbent/other material [ ] berm in storage/work area [ ] other Clean-up procedures Describe your clean-up procedures: þ4 use absorbent [ ] evaporate [ ] dilute/flush (those chemicals acceptable to the sanitary sewer) [ ] equipment clean-up as described here: [ ] other (describe): ConJinued on next page 7 " . .. .....;~ e . Emergency Procedures, Continued Hazardous waste disposal Recycler List the name of the hazardous waste disposal company you will use should your emergency generate hazardous wastes: C~LP í List the name of the hazardous waste recycling company you will use should your emergency generate recyclable wastes: 8 .' . - Emergency Phone &bers e Emergency response phone numbers Agency notification numbers Other Enter information on your medical facility here: Name of medical facility: -521S- Fire 911 911 911 386-7681, or 366-2911 --24 hour number Sheriff CHP Sacramento County Hazardous Materials Division Ambulance 911 1-800-342-9293 Poison Control Center California Office of Emergency Services 1-800-852-7550 CA Dept of Health Services: Radiologic Health Branch CA Dept of Toxic Substances Control 445-0931 324-1826 CA Water Quality Control Board, Central Valle Region US Environmental Protection Agenc (US EPA) 255-3000 1-415-744-1500 National Response Center 1-800-424-8802 Other Important Numbers: :s- kD 0 it. (-6(Y1fA-00f 393-7eoð 9 ~ (!' e e , - " Emergency Equipment Equipment list Provide your equipment list here: " ,. ~, ,.'.',',', - - .., - - , - -- < - -",." , ' , , _ , _, , " , " .' " . > . - _- . .' .' , .' , " " , " , ._ , f " ," ,.' '.You/,,"~$tproýìdø8cÓn;~I~tê: list:<ihíll ~Giþn;tin{åv~iIâble: fø(u'sé'in" árÍen\erg~ricy: '/ ,'. VVh~n:8pplh~8ble., th~lis!r6ustspècifý,theêquip!Í'~t!sè8páb~lity,>, / '". ,.... ,.. "" .' ',,' .... ' , ..,...., ,". . ,. -".' '..' .,..~',..' '.. " ::><-~.,'-: , :~M~tES:·Uu·i';[:' ,':" ' '" . ~,~" "".,..;':: "," ['.[, >.,i!J;::~<::::..' .>;:.:,Pl:fONJ:::::~::t::~:::· ....:' . ,. '. _ _,__ _~.:~ ',.. .." . , ~"::::~·:L~::~::LÄFfì~:~::~ ,t '- ,·'..~..,;,..·,,'FIREEXIINGtJISHER;."·,. .'".., "...,,",'.'. ,;;;.···.·SH(j~~S;NOl\tH;vv~tb:;·..,.···.. , :", [" ,': .··;;;;:['..;;:<H.,;,;:.·'.....·;i.<',:..:, :::~R.,Jt\þ,~J:~I~~t:~W);Kì1'[,··,..... ........ --._--...-..-.-........................-._..-.-.---.....-....'. " _...-. ......'..........'_._"..-.'..'..- _.._..-.-.....-...-, ,,-..,-,..-.-.............'......... ...........:-:-........:-.....'.'.-:'...'....:-:-..':-,......_'...',._._-.---,-.-,-..,..,:-........:-.:-....-...-._._-.-.-..-.-..,.-.':-,-...............:-................'-_. .' ....'.'. .·.·.···'.·.··......<..........·.............ç...ÊCk..AL~..'1"H~-r~PPl.'\'~EI\I1'~â.tQCÂÍIºI\I.ÎÇÁPABlta1'XÂ~ÂpPåºêâIÁTê....··....',.,., ,N~ME<' ,',',' '" .', ." . "'LOCAIIQI\l< . ... ""'¢~I'\ElILITY PHONE OF-F(C~! ~rL€-f2- f-J/ A. (þ~ N~ ~rÞ~6'(~ c... NIl\- rJ/A- BROOM b( ~ b(' FIRE EXTINGUISHER(S) ABSORBENT (KITTY LITTER, RICE HULL, SAND, ASH) SHOVEL (M-q~ f<.ò-()f1 (lA-c1¿ f/.MH I:) DECONTAMINATION SHOWER ~ EYEWASH FOUNTAIN ~ WATER HOSE I:) PERSONAL PROTECTIVE EQUIPMENT I:) FACE SHIELDS, SAFETY GOGGLES, GLASSES f'J~ I:) RUBBER GLOVES Q RUBBER BOOTS Q RESPIRATOR Q PROTECTIVE CLOTHING I:) OTHER ~ 0 kJ'L rJ 10/~ t-J ) Â:- J\J/A- 10 , ..- f .., e e Evacuation Procedures Notification of evacuation Evacuation route Evacuation coordinator Emergency assembly area Other procedures . List your procedures for spreading the alarm to evacuate. þcf voice [ ] phone [ ] alarm system [ ] public address system [ ] other (describe): . The individual responsible for spreading the alarm is: H~~ S/~~rf Define your evacuation route on your site map and post copies for employees., I have posted the evacuation route. E;(Iyes Ono The individual responsible for accounting for all employees and visitors after evacuation: µM~ ?/HIPH Indicate on your map the emergency assembly area for evacuees; describe here: Describe additional evacuation procedures here: 1 1 ~ l .. ~ e e Emergency Services Description When required Describe any arrangements you have made for emergency services with: · local fire and pOlice departments · hospitals · contractors · other (describe): Advance arrangements for emergency services should be made ,as appropriate for potential need in an emergency. You may decide that such contingency planning arrangements are not necessary for your facility. 12 ¡ : e e Emergency Response Plan Use Record When required Procedure A record must be kept for each time the emergency response plan is utilized. In some cases, you are required to make specific agençy notifications as a result of the emergency. It is therefore important to keep adequate records of any incidents at your facility and to understand your reporting responsibilities. Follow this procedure anytime you must utilize your emergency response plan to ensure that you make proper agency notifications as necessary. Step Action 1 Record date, time and details of incident in operatina log. 2 Does the incident/emergency threaten human health or the environment off site? · If yes, go to step 3. · If no, go to step 5. 3 Emergency coordinator notifies the HMD and local emergency response agencies as appropriate (fire, police, etc...). 4 Emergency coordinator notifies the State Office of Emergency Services (OES) and reports: · date and time of incident · name and phone number of person reporting to OES · facility's name and address · type of incident occurrence · names and amounts of hazardous materials involved · description of any injuries · description of hazards to people or the environment off-site 5 Emergency coordinator verifies that prior to resuming operations: · no incompatible wastes are left in affected areas, and · emergency equipment is cleaned up and ready to use. If OES was not required to be notified, stop here. 6 Owner/operator notifies OES, prior to resuming operations, that requirements of step 5 have been met. 7 Owner/operator submits a written report to OES within 15 days confirming or revising emergency coordinator's initial report, and reporting the amount and disposition of recovered waste. 13 " \- ç. e e I.l~ Employee Training Law California Health and Safety Code Chapter 6.95 requires: · training for all employees on safety procedures and the emergency response plan · training for all new employees · an annual refresher course for all employees Suggestions We suggest that you: · review any Hazard Communication Training Program you currently have in place to be certain it meets the requirements described here. · use your Business Plan in conjunction with Material Safety Data Sheets for each chemical as the core of your training program. · include instruction on proper chemical handling, safety, and personal protection procedures. · incorporate the components of this emergency response plan into your training program. Proof of training required You are required to keep written documentation of your employee training sessions. A sign-off sheet stating dates, employee names and positions, and the training material covered will meet the requirements. A sample of an acceptable training log is included for your reference. Waste generator requirement In addition to the above requirements, training records at hazardous waste generator facilities must include a brief job description as well as the employees' names. Attach your training outline You must attach an outline or equivalent description of your training program for our review. What you must cover Frequency · MSDS familiarization, . within six months of hiring new employees, and · proper chemical handling & management, . annually for all other · emergency response procedures, and employees. · notification & reporting requirements. Remember that you must keep written documentation of your training sessions. 14 ý ~-. "";., e e ç,~. ,/ EMPLOYEE TRAINING LOG TOPICS DISCUSSED AT MONTHLY TRAINING MEETING: AUGUST 1. 1996 · REVIEWED MSDS (Material Safety Data Sheet) FOR NEW PRODUCT-- CHEMLAWN FERTILIZER · PROPER DISPOSAL OF PESTICIDE CONTAINERS & UNUSED PESTICIDES · EMERGENCY RESPONSE ACTIONS (SPILL CONTAINMENT, SPILL RESPONSE CREW MEMBERS & EVACUATION PROTOCOL) · FIRE EXTINGUISHER & FIRST AID KIT LOCATIONS · USE OF FIRE EXTINGUISHERS EMPLOYEES IN A lTENDANCE: Employee signatures below indicate completion of above-noted training session & understanding of topics covered. Name Job Title Signature Date Sue Black Office Manager Jeremy Dodds Landscape gardener Dominic Smith Landscape gardener . I 15 3 "", e . EXXON SUPREME CARB PHASE II ~E)j(ON COMPANY. USA A DIVISION OF EXXON CORPORATION DATE ISSUED: 01/24/97 SUPERSEDES DATE: 09/11/95 MATERIAL SAFETY DATA SHEET EXXON COMPANY, U.S.A. P.O. BOX 2180 HOUSTON, TX 77252-2180 A. IDENTIFICATION AND EMERGENCY INFORMA TION PRODUCT NAME EXXON SUPREME CARS PHASE II PRODUCT CODE 000015 - 62100 ThiS Material Safety Data Sheet is valid for all EXXON UNLEADED SUPREME and UNLEADED PREMIUM Reformulated Gasolines and CARS Phase II Gasolines. PRODUCT CATEGORY Reformulated Motor Gasoline - Certified under Simple Model Standards Contains minimum 1.5 weight % oxygen PRODUCT APPEARANCE AND ODOR Clear colored liquid (typically orange) Gasoline hydrocarbon odor MEDICAL EMERGENCY TELEPHONE NUMBER (713) 656-3424 B. COMPONENTS AND HAZARD INFORMATION I" r> COMPONENTS CAS NO. OF COMPONENTS APPROXIMATE CONCENTRATION Product is a variable complex mixture of components, principally hydrocarbons, blended to performance, rather than chemical specifications and typically contains the following: Naphtha (petroleum) , 1 i gh t catalytic 64741-55-5 cracked Naphtha (petroleum) , heavy catalytic 64741-54-4 cracked Naphtha (petroleum), fUll-range 68919-37-9 reformed Naphtha (petroleum) , full-range 64741-64-6 alkylate Naphtha (petroleum) , sweetened 64741-87-3 Butane 106-97-8 Proprietary additives Proprietary It may include varying amounts of the following identifiable components: Benzene Cumene Cyclohexane Ethylbenzene Naphthalene n-Hexane Toluene Xylene 71-43-2 98-82-8 110-82-7 100-41-4 91-20-3 110-54-3 108-88-3 1330-20-7 0- 1 . 3% 0-1% 0-1% 0-3% 0-1% 0-3% 0-20% 0-10% It may also include varying amounts of oxygenates SUCh as the fOllowing: Di-isopropyl ether Ethanol Ethyl-tertiary-butyl ether Methyl-tertiary-butyl ether Tertiary-amyl-methyl-ether 108-20-3 64-17-5 637-92-3 1634-04-4 994-05-8 0-18% 0-10% 0-18.5% 0-16% 0-18.5% 945 ,02 77(MWHOO 11 ThiS product. as manufactured by Exxon, does not contain POlychlorinated <' l' e EXXON SUPREME CARB4laASE II D. FIRE AND EXPLOSION HAZARD INFORMATION UNUSUAL FIRE AND EXPLOSION HAZARD EXTREMELY FLAMMABLE VAPORS CAN TRAVEL AND EXPLODE FLASH POINT (MINIMUM) FLAMMABLE - Per DOT 49 CFR 173.120 Approximately -38°C (-36°F) AUTOIGNITION TEMPERATURE Approximately 456°C (853°F) National Fire Protection Association's Guide on Hazardous Materials NATIONAL FIRE PROTECTION ASSOCIATION Health Flammability Reactivity 130 (NFPA) - HAZARD IDENTIFICATION BASIS Recommended by the National Protection Association Fire HANDLING PRECAUTIONS This liquid is volatile and gives off invisible vapors. Either the liqUid or vapor may settle in low areas or travel some distance along the ground or surface to ignition sources where they may ignite or explode. Keep product a~ay from ignition sources, such as heat, sparks, pilot lights, static electricity, and open flames. FLAMMABLE OR EXPLOSIVE LIMITS (APPROXIMATE PERCENT BY VOLUME IN AIR) Estimated values: Lower Flammable Limit 1.4% Upper Flammable Limit 7.6% EXTINGUISHING MEDIA AND FIRE FIGHTING PROCEDURES Foam, water spray (fog), dry chemical, carbon dioxide and vaporizing liquid type extinguishing agents may all be suitable for extinguishing fires involving this type of product, depending on size or potential size of fire and cìrcumstances related to the situation. Plan fire protection and response strategy through consultation with local fire protection authorities or appropriate specialists. The following procedures for this type of product are based on the recommendations in the National Fire Protection Association's "Fire Protection Guide on Hazardous Materials". Tenth Edition (1991): Use dry chemical. foam or carbon dioxide to extinguish the fire. "water may be ineffective". but water should be used to keep fire-exposed containers cool. If a leak or spill has ignited, use water spray to disperse the vapors and to protect persons attempting to stop a leak. Water spray may be used to flush spills away from exposures. Minimize breathing of gases, vapor, fumes or decomposition products. Use supplied-air breathing equipment for enclosed or confined spaces or as otherwise needed. NOTE: The inclusion of the phrase "water may be ineffective" is to indicate that although water can be used to cool and protect exposed material, water may not extinguish the fire unless used under favorable conditions by experienced fire fighters trained in fighting all types of flammable liquid fires. DECOMPOSITION PRODUCTS UNDER FIRE CONDITIONS Fumes. smoke. carbon monoxide, sulfur oxides. aldehydes and other decomposition products. in the case of incomplete combustion. "EMPTY" CONTAINER WARNING "Empty" containers retain residue (liquid and/or vapor) and can be dangerous. DO NOT PRESSURIZE. CUT. WELD, BRAZE. SOLDER. DRILL, GRIND OR EXPOSE SUCH CONTAINERS TO HEAT. FLAME. SPARKS. STATIC ELECTRICITY. OR OTHER SOURCES OF IGNITION; THEY MAY EXPLODE AND CAUSE INJURY OR DEATH. Do not attempt to clean since residue is difficult to remove. "Empty" drums should be completely drained. properly bunged and promptly returned to a drum reconditioner. All other containers should be disposed of in an environmentally safe manner and in accordance with governmental regulations. For work on tanks refer to Occupational Safety and Health Administration regulations, ANSI Z49.1, and other governmental and industrial references pertaining to cleaning, repairing, welding. or other contemplated operations. PAGE: 3 DATE ISSUED: 01/24/97 SUPERSEDES. DATE: 09/11/95 945' 02 771MWH0021 " ¡, e EXXON SUPREME CARB~ASE II body weight, and an acute dermal LD50 (rabbit) greater than 3.16 g/kg of body weight. Inhalation of components of exhaust from burning, SUCh as carbon monoxide, may cause death at high concentrations. Exposure to the exhaust of this fuel should be minimized. PRE-EXISTING MEDICAL CONDITIONS WHICH MAY BE AGGRAVATED BY EXPOSURE Benzene - Individuals with liver disease may be more susceptible to toxic effects. Hexane - Individuals with neurological disease should avoid exposure. Petroleum Solvents/Petroleum HYdroca~bons - Skin contact may aggravate an existing dermatitis. F. PHYSICAL DATA The following data are approximate or typical values and should not be used for precise design purposes. BOILING RANGE Approximately 21°C (70°F) IBP to 225°C (437°F) FBP VAPOR PRESSURE Varies seasonally from approximately 5 to 15 psi Reid Vapor Pressure SPECIFIC GRAVITY (15.6°C/15.6·C) Approximately 0.74 VAPOR DENSITY (AIR = 1) Approximately 5 MOLECULAR WEIGHT Complex mixture, components vary from approximately 45 to 185 PERCENT VOLATILE BY VOLUME 100 pH Essentially neutral EVAPORATION RATE ~ 1 ATM. AND 2S·C (77"F) (n-BUTYL ACETATE = 1) Approximately 10-11 POUR, CONGEALING OR MELTING POINT Less than -38°C (-36"F) Pour Point by ASTM 0 97 VISCOSITY Approximately 0.5 cSt @ 25°C SOLUBILITY IN WATER ~ 1 ATM. AND 2S·C (77·F) Negl igible; less than 0.1% G. REACTIVITY ThiS product is stable and will not react violently with water. Hazardous polymerization will not occur. Avoid contact with strong oxidants such as liquid chlorine, concentrated oxygen. sodium hypochlorite, calcium hypochlorite, etc., as this presents a serious explosion hazard. . H. ENVIRONMENTAL INFORMATION CLEAN WATER ACT / OIL POLLUTION ACT This product may be classified as an oil under Section 311 of the Clean Water Act, and under the Oil Pollution Act. Discharges or spills into or leading to surface waters that cause a sheen must be reported to the National Response Center (1-800-424-8802). STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED Shut off and eliminate all ignition sources. Keep people away. Recover free product. Add sand. earth or other suitable absorbent to spill area. Minimize breathing vapors. Minimize skin contact. Ventilate confined spaces. Open all windows and doors. Keep product out of sewers and watercourses by diking or impounding. Advise authorities if product has entered or may enter sewers, PAGE: 5 DATE ISSUED: 01/24/97 SUPERSEDES DATE: 09/11/95 945,02 n(MWH002J ~, " e EXXON SUPREME CARB4ItASE II For use as a motor fuel only. Do not use as a cleaning solvent, or thinner, or for other non-motor fuel uses. Do not siphon by mouth. Minute amounts of liquid gasoline aspirated into the lungs may cause potentially fatal chemical pneumonitis. In order to prevent fire or explosion hazards, use appropriate equipment. Information on electrical equipment appropriate for use with this product may be found in the latest edition of the National Electrical Code (NFPA-70). This document is available from the National Fire Protection Association, Batterymarch Park, Quincy, Massachusetts 02269. PERSONAL HYGIENE Minimize breathing vapor or mist. Avoid prolonged or repeated contact with skin. Remove contaminated clothing; launder or dry-clean before re-use. Remove contaminated shoes and thoroughly clean and dry before re-use. Cleanse skin thoroughly after contact, before breaks and meals, and at end of work period. Product is readily removed from skin by waterless hand cleaners followed by washing thoroughly with soap and water. J. TRANSPORT A TION AND OSHA RELATED LABEL INFORMATION TRANSPORTATION INCIOENT INFORMATION For further information relative to spills resulting from transportation incidents, refer to latest Department of Transportation Emergency Response Guidebook for Hazardous Materials Incidents. U.S. DOT HAZARDOUS MATERIALS SHIPPING DESCRIPTION Gasoline. 3, UN 1203. II OSHA REQUIRED LABEL INFORMATION In compliance with hazard and right-to-know requirements, where applicable OSHA Hazard Warnings may be found on the label, bill of lading or invoice accompanying this shipment. DANGER! EXTREMELY FLAMMABLE LONG-TERM, REPEATED EXPOSURE MAY CAUSE CANCER, BLOOD AND NERVOUS SYSTEM DAMAGE CONTAINS: BENZENE Note: Product label may contain non-OSHA related information also. The information and recommendations contained herein are. to the best of Exxon's knowledge and belief, accurate and reliable as of the date issued. Exxon does not warrant or guarantee their accuracy or reliability. and Exxon shall not be liable for any loss or damage arising out of the use thereof. The information and recommendations are offered for the user's consideration and examination. and it is the user's responsibility to satisfy itself that they are suitable and complete for its particular use. If buyer repackages this product. legal counsel should be consulted to insure proper health, safety and other necessary information is included on the container. The Environmental Information included under Section H hereof as well as the Hazardous Materials Identification System (HMIS) and National Fire Protection Association (NFPA) ratings have been included by Exxon Company. U.S.A. in order to provide additional health and hazard classification information. The ratings recommended are based upon the criteria supplied by the developers of these PAGE: 7 DATE ISSUED: 01/24/97 SUPERSEDES DATE: 09/11/95 945 ,02 771MWH0021 .. i' e e EXXON PLUS CARB PHASE II E)$(ON COMPANY USA A DIVISION OF EXXON CORPORATION DATE ISSUED: 01/24/97 SUPERSEDES DATE: 09/11/95 MATERIAL SAFETY DATA SHEET EXXON COMPANY, U.S.A. P.O. BOX 2180 HOUSTON, TX 77252-2180 A. IDENTIFICATION AND EMERGENCY INFORMATION PROOUCT NAME EXXON PLUS CARB PHASE II PRODUCT CODE 000017 - 62200 This Material Safety Data Sheet is valid for all EXXON UNLEADED PLUS and UNLEADED MIDGRADE Reformulated Gasolines and CARB Phase II Gasolines. PRODUCT CATEGORY Reformulated Motor Gasoline - Certified under Simple Model Standards Contains minimum 1.5 weight % oxygen PRODUCT APPEARANCE AND ODOR Clear colored liquid (typically orange) Gasoline hydrocarbon odor MEDICAL EMERGENCY TELEPHONE NUMBER (713) 656-3424 B. COMPONENTS AND HAZARD INFORMATION COMPONENTS CAS NO. OF COMPONENTS APPROXIMATE CONCENTRATION Product is a variable complex mixture of components, principally hydrocarbons, blended to performance, rather than chemical specifications and typically contains the following: Naphtha (petroleum), 1 ight catalytic cracked Naphtha (petroleum), heavy catalytic cracked Naphtha (petroleum), full-range reformed Naphtha (petroleum), full-range alkylate Naphtha (petroleum), sweetened Butane 64741-55-5 64741-54-4 68919-37-9 64741-64-6 64741-87-3 106-97-8 Proprietary additives Proprietary It may include varying amounts of the following identifiable components: Benzene Cumene Cyclohexane Ethylbenzene Naphthalene n-Hexane Toluene Xylene 71-43-2 98-82-8 110-82-7 100-41-4 91-20-3 110-54-3 108-88-3 1330-20-7 0- 1 . 3% 0-1% 0-1% 0-3% 0-1% 0-3% 0-20% 0-10% It may also include varying amounts of oxygenates suCh as the fOllowing: Di-isopropyl ether Ethanol Ethyl-tertiarY-butyl ether Methyl-tertiary-butyl ether Tertiary-amyl-methyl-ether 108-20-3 64-17-5 637-92-3 1634-04-4 994-05-8 0-18% 0-10% 0-18.5% 0-16% 0-18.5% 945,Q277CMWHQQ I} ThiS product. as manufactured by Exxon. does not contain polychlorinated · ,t - EXXON PLUS CARB PHJIt II D. FIRE AND EXPLOSION HAZARD INFORMATION UNUSUAL FIRE AND EXPLOSION HAZARD EXTREMELY FLAMMABLE VAPORS CAN TRAVEL AND EXPLODE FLASH POINT (MINIMUM) FLAMMABLE - Per DOT 49 CFR 173.120 Approximately -38°C (-36°F) AUTOIGNITION TEMPERATURE Approximately 456°C (853°F) National Fire Protection Association's Guide on Hazardous Materials NATIONAL FIRE PROTECTION ASSOCIATION Health Flammability Reactivity 1 3 0 (NFPA) - HAZARD IDENTIFICATION BASIS Recommended by the National Fire Protection Association HANDLING PRECAUTIONS This liquid is volatile and gives off invisible vapors. Either the liquid or vapor may settle in low areas or travel some distance along the ground or surface to ignition sources where they may ignite or explode. Keep product away from ignition sources, such as heat, sparks, pilot lights, static electricity, and open flames. FLAMMABLE OR EXPLOSIVE LIMITS (APPROXIMATE PERCENT BY VOLUME IN AIR) Estimated values: Lower Flammable Limit 1.4% Upper Flammable Limit 7.6% EXTINGUISHING MEDIA AND FIRE FIGHTING PROCEDURES Foam. water spray (fog), dry chemical, carbon dioxide and vaporizing liquid type extinguishing agents may all be suitable for extinguishing fires involving this type of product, depending on size or potential size of fire and circumstances related to the situation. Plan fire protection and response strategy through consultation with local fire protection authorities or appropriate specialists. The following procedures for this type of product are based on the recommendations in the National Fire Protection Association's "Fire Protection Guide on Hazardous Materials", Tenth Edition (1991): Use dry chemical. foam or carbon dioxide to extinguish the fire. "Water may be ineffective", but water Should be used to keep fire-exposed containers cool. If a leak or spill has ignited, use water spray to disperse the vapors and to protect persons attempting to stop a leak. Water spray may be used to flush spills away from exposures. Minimize breathing of gases, vapor, fumes or decomposition products. Use supplied-air breathing equipment for enclosed or confined spaces or as otherwise needed. NOTE: The inclusion of the phrase "water may be ineffective" is to indicate that although water can be used to cool and protect exposed material, water may not extinguish the fire unless used under favorable conditions by experienced fire fighters trained in fighting all types of flammable liquid fires. DECOMPOSITION PRODUCTS UNDER FIRE CONDITIONS Fumes, smoke, carbon monoxide, sulfur oxides, aldehydes and other decomposition products, in the case of incomplete combustion. "EMPTY" CONTAINER WARNING "Empty" containers retain residue (liqUid and/or vapor) and can be dangerous. DO NOT PRESSURIZE. CUT, WELD, BRAZE, SOLDER. DRILL, GRIND OR EXPOSE SUCH CONTAINERS TO HEAT. FLAME. SPARKS, STATIC ELECTRICITY, OR OTHER SOURCES OF IGNITION; THEY MAY EXPLODE AND CAUSE INJURY OR DEATH. Do not attempt to clean since residue is difficult to remove. "Empty" drums should be completely drained. properly bunged and promptly returned to a drum reconditioner. All other containers should be disposed of in an environmentally safe manner and in accordance with governmental regulations. For work on tanks refer to Occupational Safety and Health Administration regulations, ANSI Z49.1, and other governmental and industrial references pertaining to cleaning, repairing. welding. or other contemplated operations. PAGE: 3 DATE ISSUED: 01/24/97 SUPERSEDES DATE: 09/11/95 945 -0277/MWH0021 ·,i e e EXXON PLUS CARB PHASE II body weight, and an acute dermal LD50 (rabbit) greater than 3.16 g/kg of body weight. Inhalation of components of exhaust from burning, such as carbon monoxide, may cause death at high concentrations. Exposure to the exhaust of this fuel should be minimized. PRE-EXISTING MEDICAL CONDITIONS WHICH MAY BE AGGRAVATED BY EXPOSURE Benzene - Individuals with liver disease may be more susceptible to toxic effects. Hexane - Individuals with neurological disease should avoid exposure. Petroleum SOlvents/Petroleum Hydrocarbons - Skin contact may aggravate an existing dermatitis. F. PHYSICAL DATA The following data are approximate or typical values and should not be used for precise design purposes. BOILING RANGE Approximately 21°C (70°F) IBP to 225°C (437°F) FBP VAPOR PRESSURE Varies seasonally from approximately 5 to 15 psi Reid Vapor Pressure SPECIFIC GRAVITY (15.6·C/15.6·C) Approximately 0.74 VAPOR DENSITY (AIR = 1) Approximately 5 MOLECULAR WEIGHT Complex mixture, components vary from approximately 45 to 185 PERCENT VOLATILE BY VOLUME 100 pH Essentially neutral EVAPORATION RATE . 1 ATM. AND 25·C (77·F) (n-BUTYL ACETATE = 1) Approximately 10-11 POUR, CONGEALING OR MELTING POINT Less than -38°C (-36°F) Pour Point by ASTM 0 97 VISCOS !TY Approximately 0.5 cSt @ 25°C SOLUBILITY IN WATER . 1 ATM. AND 25°C (77·F) Negl igible; less than 0.1% G. REACTIVITY This product is stable and will not react violently with water. Hazardous polymerization will not occur. Avoid contact with strong oxidants such as liqUid chlorine, concentrated oxygen, sodium hypochlorite, calcium hypochlorite. etc.. as this presents a serious explosion hazard. H. ENVIRONMENTAL INFORMATION CLEAN WATER ACT / OIL POLLUTION ACT This product may be classified as an oil under Section 311 of the Clean Water Act. and under the Oil Pollution Act. Discharges or spills into or leading to surface waters that cause a sheen must be reported to the National Response Center (1-800-424-8802). STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED Shut off and eliminate all ignition sources. Keep people away. Recover free product. Add sand. earth or other suitable absorbent to spill area. Minimize breathing vapors. Minimize skin contact. Ventilate confined spaces. Open all windows and doors. Keep product out of sewers and watercourses by diking or impounding. Advise authorities if product has entered or may enter sewers, PAGE: 5 DATE ISSUED: 01/24/97 SUPERSEDES DATE: 09/11/95 945' 02 77(MWH002} e EXXON PLUS CARB PjlþE II For use as a motor fuel only. Do not use as a cleaning solvent, or thinner, or for other non-motor fuel uses. Do not siphon by mouth. Minute amounts of liquid gasoline aspirated into the lungs may cause potentially fatal chemical pneumonitis. In order to prevent fire or explosion hazards, use appropriate equipment. Information on electrical equipment appropriate for use with this product may be found in the latest edition of the National Electrical Code (NFPA-70). This document is available from the National Fire Protection Association, Batterymarch Park, Quincy, Massachusetts 02269. PERSONAL HYGIENE Minimize breathing vapor or mist. Avoid prolonged or repeated contact with skin. Remove contaminated clothing; launder or dry-clean before re-use. Remove contaminated shoes and thoroughly clean and dry before re-use. Cleanse skin thoroughly after contact, before breaks and meals, and at end of work period. Product is readily removed from skin by waterless hand cleaners followed by washing thoroughly with soap and water. J. TRANSPORT A TION AND OSHA RELATED LABEL INFORMATION TRANSPORTATION INCIOENT INFORMATION For further information relative to spills resulting from transportation incidents, refer to latest Department of Transportation Emergency Response Guidebook for Hazardous Materials Incidents. u.S. DOT HAZARDOUS MATERIALS SHIPPING DESCRIPTION Gasoline, 3, UN 1203, II OSHA REQUIRED LABEL INFORMATION In compliance with hazard and right-to-know requirements, where applicable OSHA Hazard Warnings may be found on the label, bill of lading or invoice accompanying this shipment. DANGER! EXTREMELY FLAMMABLE LONG-TERM, REPEATED EXPOSURE MAY CAUSE CANCER, BLOOD AND NERVOUS SYSTEM DAMAGE CONTAINS: BENZENE Note: Product label may contain non-OSHA related information also. The information and recommendations contained herein are, to the best of Exxon's knowledge and belief, accurate and reliable as of the date issued. Exxon does not warrant or guarantee their accuracy or reliability, and Exxon shall not be liable for any loss or damage arising out of the use thereof. The information and recommendations are offered for the user's consideration and examination, and it is the user's responsibility to satisfy itself that they are suitable and complete for its particular use. If buyer repackages this product, legal counsel should be consulted to insure proper health, safety and other necessary information is included on the container. The Environmental Information included under Section H hereof as well as the Hazardous Materials Identification System (HMIS) and National Fire Protection Association (NFPA) ratings have been included by Exxon Company, U.S.A. in order to provide additional health and hazard classification information. The ratings recommended are based upon the criteria supplied by the developers of these PAGE: 7 DATE ISSUED: 01/24/97 SUPERSEDES DATE: 09/11/95 945 ,02 77IMWH0021 · ,. e e " e e EXXON REGULAR CARB PHASE II E)$(ON COMPANY. USA A DIVISION OF EXXON CORPORATION DATE ISSUED: 01/24/97 SUPERSEDES DATE: 09/11/95 MATERIAL SAFETY DATA SHEET EXXON COMPANY, U.S.A. P.O. BOX 2180 HOUSTON, TX 77252-2180 A. IDENTIFICATION AND EMERGENCY INFORMATION PRODUCT NAME EXXON REGULAR CARB PHASE II PRODUCT CODE 000019 - 62300 This Material Safety Data Sheet is valid for all EXXON UNLEADED REGULAR and UNLEADED REGULAR Reformulated Gasolines and CARB Phase II Gasolines. PRODUCT CATEGORY Reformulated Motor Gasoline - Certified under Simple Model Standards Contains minimum 1.5 weight % oxygen PRODUCT APPEARANCE AND ODOR Clear colored liquid (typically orange) Gasoline hydrocarbon odor MEDICAL EMERGENCY TELEPHONE NUMBER (713) 656-3424 B. COMPONENTS AND HAZARD INFORMATION COMPONENTS CAS NO. OF COMPONENTS APPROXIMATE CONCENTRATION Product is a variable complex mixture of components, principally hydrocarbons, blended to performance, rather than chemical specifications and typically contains the following: Naphtha (petroleum), light catalytic cracked Naphtha (petroleum), heavy catalytic cracked Naphtha (petroleum), fUll-range reformed Naphtha (petroleum), fUll-range alkylate Naphtha (petroleum), sweetened Butane 64741-55-5 64741-54-4 68919-37-9 64741-64-6 64741-87-3 106-97-8 Proprietary additives Proprietary It may include varying amounts of the following identifiable components: Benzene Cumene Cyclohexane Ethylbenzene Naphthalene n-Hexane Toluene Xylene 71-43-2 98-82-8 110-82-7 100-41-4 91-20-3 110-54-3 108-88-3 1330-20-7 0- 1 . 3% 0-1% 0-1% 0-3% 0-1% 0-3% 0-20% 0-10% It may also include varying amounts of oxygenates SUCh as the following: Di-isopropyl ether Ethan01 Ethyl-tertiarY-butyl ether Methyl-tertiarY-butyl ether Tertiary-amyl-methyl-ether 108-20-3 64-17-5 637-92-3 1634-04-4 994-05-8 0-18% 0-10% 0-18.5% 0-16% 0-18.5% 945'0277IMWHOO I) This product. as manufactured by Exxon, does not contain polychlorinated ,i e e EXXON REGULAR CARB PHASE II D. FIRE AND EXPLOSION HAZARD INFORMA TION UNUSUAL FIRE AND EXPLDSION HAZARD EXTREMELY FLAMMABLE VAPORS CAN TRAVEL AND EXPLODE FLASH POINT (MINIMUM) FLAMMABLE - Per DOT 49 CFR 173.120 Approximately -3SoC (-36°F) AUTOIGNITION TEMPERATURE Approximately 456°C (853°F) National Fire Proteçtion Association's Guide on Hazardous Materials NATIONAL FIRE PROTECTION ASSOCIATION Health Flammability Reactivity 130 (NFPA) - HAZARD IDENTIFICATION BASIS Recommended by the National Protection Association Fire HANDLING PRECAUTIONS This liquid is volatile and gives off invisible vapors. Either the liqUid or vapor may settle in low areas or travel some distance along the ground or surface to ignition sources where they may ignite or explode. Keep product away from ignition sources, such as heat, sparks, pilot lights, static electricity. and open flames. FLAMMABLE OR EXPLOSIVE LIMITS (APPROXIMATE PERCENT BY VOLUME IN AIR) Estimated values: Lower Flammable Limit 1.4% Upper Flammable Limit 7.6% EXTINGUISHING MEDIA AND FIRE FIGHTING PROCEDURES Foam. water spray (fog), dry chemical, carbon dioxide and vaporizing liquid type extinguishing agents may all be suitable for extinguishing fires involving this type of product, depending on size or potential size of fire and circumstances related to the situation. Plan fire protection and response strategy through consultation with local fire protection authorities or appropriate specialists. The following procedures for this type of product are based on the recommendations in the National Fire Protection Association's "Fire Protection Guide on Hazardous Materials", Tenth Edition (1991): Use dry chemical. foam or carbon dioxide to extinguish the fire. "Water may be ineffective", but water should be used to keep fire-exposed containers cool. If a leak or spill has ignited, use water spray to disperse the vapors and to protect persons attempting to stop a leak. Water spray may be used to flush spills away from exposures. Minimize breathing of gases, vapor, fumes or decomposition products. Use supplied-air breathing equipment for enclosed or confined spaces or as otherwise needed. NOTE: The inclusion of the phrase "water may be ineffective" is to indicate that although water can be used to cool and protect exposed material, water may not extinguish the fire unless used under favorable conditions by experienced fire fighters trained in fighting all types of flammable liquid fires, DECOMPOSITION PRODUCTS UNDER FIRE CONDITIONS Fumes. smoke. carbon monoxide. SUlfur oxides. aldehydes and other decomposition products. in the case of incomplete combustion. "EMPTY" CONTAINER WARNING "Empty" containers retain residue (liqUid and/or vapor) and can be dangerous. DO NOT PRESSURIZE. CUT, WELD. BRAZE, SOLDER. DRILL, GRIND OR EXPOSE SUCH CONTAINERS TO HEAT. FLAME, SPARKS. STATIC ELECTRICITY. OR OTHER SOURCES OF IGNITION; THEY MAY EXPLODE AND CAUSE INJURY OR DEATH. Do not attempt to clean since residue is difficult to remove. "Empty" drums Should be completely drained. properly bunged and promptly returned to a drum reconditioner. All other containers should be disposed of in an environmentally safe manner and in accordance with governmental regulations. For work on tanks refer to Occupational Safety and Health Administration regulations. ANSI Z49.1, and other governmental and industrial references pertaining to cleaning. repairing. welding. or other contemplated operations. PAGE: 3 OATE ISSUED: 01/24/97 SUPERSEDES DATE: 09/11/95 945, 02 7 7(MWHOO 21 " e e EXXON REGULAR CARB PHASE II body weight, and an acute dermal LD50 (rabbit) greater than 3.16 g/kg of body wei ght. Inhalation of components of exhaust from burning, such as carbon monoxide, may cause death at high concentrations. Exposure to the exhaust of this fuel should be minimized. PRE-EXISTING MEDICAL CONDITIONS WHICH MAY BE AGGRAVATED BY EXPOSURE Benzene - Individuals with liver disease may be more susceptible to toxic effects. Hexane - Individuals with neurological disease should avoid exposure. Petroleum Solvents/Petroleum Hydrocarbons - Skin contact may aggravate an existing dermatitis. F. PHYSICAL OAT A The following data are approximate or typical values and should not be used for precise design purposes. BOILING RANGE Approximately 21°C (70°F) 18P to 225°C (437°F) FBP VAPOR PRESSURE Varies seasonally from approximately 5 to 15 psi Reid Vapor Pressure SPECIFIC GRAVITY (15.6°C/15.6·C) Approximately 0.74 VAPOR DENSITY (AIR = 1) Approximately 5 PERCENT VOLATILE BY VOLUME 100 MOLECULAR WEIGHT Complex mixture, components vary from approximately 45 to 185 pH Essentially neutral EVAPORATION RATE ~ 1 ATM. AND 2S·C (77°F) (n-BUTYL ACETATE = 1) Approximately 10-11 POUR, CONGEALING OR MELTING POINT Less than -38°C (-36°F) Pour Point by ASTM D 97 VISCOS ITY Approximately 0.5 cSt @ 25°C SOLUBILITY IN WATER . 1 ATM. AND 2SoC (77·F) Negl igible; less than O. lex. G. REACTIVITY ThiS product is stable and will not react violently with water. Hazardous polymerization will not occur. Avoid contact with strong oxidants such as liquid chlorine, concentrated oxygen, sodium hypochlorite, calcium hypochlorite. etc.. as this presents a serious explosion hazard. H. ENVIRONMENTAL INFORMATION CLEAN WATER ACT / OIL POLLUTION ACT This product may be classified as an oil under Section 311 of the Clean Water Act. and under the Oil Pollution Act. Discharges or spills into or leading to surface waters that cause a sheen must be reported to the National Response Center (1-800-424-8802). STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED Shut off and eliminate all ignition sources. Keep people away. Recover free product. Add sand. earth or other suitable absorbent to spill area. Minimize breathing vapors. Minimize skin contact. Ventilate confined spaces. Open all windows and doors. Keep product out of sewers and watercourses by diking or impounding. Advise authorities if product has entered or may enter sewers. PAGE: 5 DATE ISSUED: 01/24/97 SUPERSEDES DATE: 09/11/95 945,0277(MWH002: e e EXXON REGULAR CARB PHASE II For use as a motor fuel only. Do not use as a cleaning solvent, or thinner, or for other non-motor fuel uses. Do not siphon by mouth. Minute amounts of liquid gasoline aspirated into the lungs may cause potentially fatal chemical pneumonitis. In order to prevent fire or explosion hazards, use appropriate equipment. Information on electrical equipment appropriate for use with this product may be found in the latest edition of the National Electrical Code (NFPA-70). This document is available from the National Fire Protection Association, BatterymarCh Park, Quincy, Massachusetts 02269. PERSONAL HYGIENE Minimize breathing vapor or mist. Avoid prolonged or repeated contact with skin. Remove contaminated clothing; launder or dry-clean before re-use. Remove contaminated shoes and thoroughly clean and dry before re-use. Cleanse skin thoroughly after contact, before breaks and meals, and at end of work period. Product is readily removed from skin by waterless hand cleaners followed by washing thoroughly with soap and water. J. TRANSPORT A TION AND OSHA RELATED LABEL INFORMATION TRANSPORTATION INCIDENT INFORMATION For further information relative to spills resulting from transportation incidents, refer to latest Department of Transportation Emergency Response Guidebook for Hazardous Materials Incidents. u.S. DOT HAZARDOUS MATERIALS SHIPPING DESCRIPTION Gasoline, 3, UN 1203, II OSHA REQUIRED LABEL INFORMATION In compliance with hazard and right-tO-know requirements, where applicable OSHA Hazard Warnings may be found on the label, bill of lading or invoice accompanying this shipment. DANGER! EXTREMELY FLAMMABLE LONG-TERM, REPEATED EXPOSURE MAY CAUSE CANCER, BLOOD AND NERVOUS SYSTEM DAMAGE CONTAINS: BENZENE Note: Product label may contain non-OSHA related information also. The information and recommendations contained herein are. to the best of Exxon's knowledge and belief. accurate and reliable as of the date issued. Exxon does not warrant or guarantee their accuracy or reliability, and Exxon shall not be liable for any loss or damage arising out of the use thereof. The information and recommendations are offered for the user's consideration and examination, and it is the user's responsibility to satisfy itself that they are suitable and complete for its particular use. If buyer repackages this product, legal counsel should be consulted to insure proper health, safety and other necessary information is included on the container. The Environmental Information included under Section H hereof as well as the Hazardous Materials Identification System (HMIS) and National Fire Protection Association (NFPA) ratings have been included by Exxon Company. U.S.A. in order to provide additional health and hazard classification information. The ratings recommended are based upon the criteria supplied by the developers of these PAGE: 7 DATE ISSUED: 01/24/97 SUPERSEDES DATE: 09/11/95 945 -02 77(MWH002) e e EXXON CARB VEHICULAR NO. 2 DIESEL E)$(ON COMPANY. USA A DIVISION OF EXXON CORPORATION DATE ISSUED: 01/24/97 SUPERSEDES DATE: 02/15/96 MATERIAL SAFETY DATA SHEET EXXON COMPANY. U.S.A. P.O. BOX 2180 HOUSTON, TX 77252-2180 A. IDENTIFICATION AND EMERGENCY INFORMA TION PRODUCT NAME EXXON CARB VEHICULAR NO. 2 DIESEL PRODUCT CATEGORY Petroleum Distillate Fuel PRODUCT CODE 072714 - 00785 PRODUCT APPEARANCE AND ODOR Clear liqUid, yellow color Faint petroleum hydrocarbon odor MEDICAL EMERGENCY TELEPHONE NUMBER (713) 656-3424 B. COMPONENTS AND HAZARD INFORMATION Fuels. diesel. No.2 CAS NO. OF COMPONENTS 68476-34-6 APPROXIMATE CONCENTRATION 100% COMPONENTS ThiS product. as manufactured by Exxon. does not contain pOlychlorinated biphenyls (PCB's). All components of this product are listed on the U.S. TSCA inventory. See Section E for Health and Hazard Information. See Section H for additional Environmental Information. HAZARDOUS MATERIALS IDENTIFICATION SYSTEM (HMIS) Health Flammability Reactivity BASIS 1 2 0 Recommended by Exxon EXPOSURE LIMIT FOR TOTAL PRODUCT 100 ppm (900 mg/m3) for an a-hour workday BASIS Recommended by Exxon C. PRIMARY ROUTES OF ENTRY AND EMERGENCY AND FIRST AID PROCEDURES EVE CONTACT If splashed into the eyes, flush with clear water for 15 minutes or until irritation subsides. If irritation persists, call a physician. SKIN In case of skin contact, remove any contaminated clothing and wash skin with soap and water. Launder or dry-clean clothing before reuse. If product is injected into or under the skin, or into any part of the body, regardless of the appearance of the wound or its size. the individual should be evaluated immediately by a physician as a surgical emergency. Even though initial symptoms from high pressure injection may be minimal or absent. early surgical treatment within the first few hours may significantly reduce the ultimate extent of injury.' 945'0277IMWHOO I) e e EXXON CARB VEHICULAR NO. 2 DIESEL other containers should be disposed of in an environmentally safe manner and in accordance with governmental regulations. For work on tanks refer to Occupational Safety and Health Administration regulations, ANSI Z49.1, and other governmental and industrial references pertaining to cleaning, repairing, welding, or other contemplated operations. E. HEAL TH AND HAZARD INFORMATION VARIABILITY AMONG INDIVIDUALS Health studies have shown that many petroleum hydrocarbons and synthetic lubricants pose potential human health risks which may vary from person to person. As a precaution, exposure to liquids, vapors, mists or fumes should be minimized. EFFECTS OF OVEREXPOSURE (Signs and symptoms of exposure) Prolonged or repeated liquid contact with the skin will dry and defat the skin, leading to possible irritation and dermatitis. High vapor concentrations (greater than approximately 1000 ppm, attainable at temperatures well above ambient) are irritating to the eyes and the respiratory tract, and may cause headaches, dizziness, anesthesia, drowsiness, unconsciousness, and other central nervous system effects, including death. NATURE OF HAZARD AND TOXICITY INFORMATION Prolonged or repeated skin contact with this product tends to remove skin oils, possibly leading to irritation and dermatitis; however, based on human experience and available toxicological data, this product is judged to be neither a "corrosive" nor an "irritant" by OSHA criteria. Product contacting the eyes may cause eye irritation. Lifetime skin painting studies conducted by the American Petroleum Institute, Exxon and others have shown that similar products boiling between 175-370°C (350-700°F) usually produce skin tumors and/or skin cancer in laboratory mice. The degree of carcinogenic response was weak to moderate with a relatively long latent period. The implications of these results for humans have not been determined. Limited studies on oils that are very active carcinogens have shown that washing the animals' skin with soap and water between applications greatly reduces tumor formation. These studies demonstrate the effectiveness of cleansing the skin after contact. Potential risks to humans can be minimized by observing good work practices and personal hygiene procedures generally recommended for petroleum products. See Section I for recommended protection and precautions. Contains light hydrocarbon components. Lifetime studies by the American Petroleum Institute have shown that kidney damage and kidney cancer can occur in male rats after prolonged inhalation exposures at elevated concentrations of total gasoline. Kidneys of mice and female rats were unaffected. The U.S. EPA Risk Assessment Forum has concluded that the male rat kidney tumor results are not relevant for humans. Total gasoline exposure also produced liver tumors in female mice only. The implication of these data for humans has not been determined. Certain components. SUCh as normal hexane, may also affect the nervous system at high concentrations (e.g., 1000-1500 ppm). Product has a low order of acute oral and dermal toxicity, but minute amounts aspirated into the lungs during ingestion or vomiting may cause mild to severe pulmonary injury and poSSibly death. This product is judged to have an acute oral LD50 (rat) greater than 5 g/kg of bodY weight, and an acute dermal LD50 (rabbit) greater than 3.16 g/kg of body weight. Inhalation of components of exhaust from burning. such as carbon monoxide, may cause death at high concentrations. Long-term repeated exposure of laboratory animals to whole diesel exhaust has resulted in an increased incidence of lung cancer. Exposure to exhaust from burning and diesel exhaust should be minimized. PAGE: 3 DATE ISSUED: 01/24/97 SUPERSEDES DATE: 02/15/96 945, 02 7 71MWH002J ,. e e EXXON CARB VEHICULAR NO. 2 DIESEL HAZARDOUS CHEMICAL REPORTING, EPA REGULATION 40 CFR 370 (SARA Sections 311-312) EPA HAZARD CLASSIFICATION CODE: Acute Chronic Hazard Hazard XXX Fire Hazard XXX Pressure Hazard Reactive Hazard Not Applicable TOXIC SUBSTANCE CONTROL ACT This product may contain the following TSCA 12b reportable chemical substance( s) : 2-Ethylhexanol CAS # 104-76-7 I. PROTECTION AND PRECAUTIONS VENTILATION Use only with ventilation sufficient to prevent exceeding recornrnended exposure limit or buildup of explosive concentrations of vapor in air. RESPIRATORY PROTECTION Use supplied-air respiratory protection in confined or enclosed spaces, if needed. PROTECTIVE GLOVES Use chemical-resistant gloves, if needed, to avoid prolonged or repeated skin contact. EYE PROTECTION Use splash goggles or face shield when eye contact may occur. OTHER PROTECTIVE EQUIPMENT Use chemical-resistant apron or other impervious clothing, if needed, to avoid contaminating regular clothing, which could result in prolonged or repeated skin contact. WORK PRACTICES / ENGINEERING CONTROLS To minimize fire or explosion risk from static charge accumulation and discharge, effectively ground product transfer system in accordance with the National Fire Protection Association standard for petroleum products. Keep containers closed when not in use. Do not store near heat, sparks, flame or strong oxidants. In order to prevent fire or explosion hazards, use appropriate eqUipment. Information on electrical equipment appropriate for use with this product may be found in the latest edition of the National Electrical Code (NFPA-70). This document is available from the National Fire Protection Association, Batterymarch Park, Quincy. Massachusetts 02269. PERSONAL HYGIENE Minimize breathing vapor. mist or fumes. Avoid prolonged or repeated contact with skin. Remove contaminated clothing; launder or dry-clean before re-use. Remove contaminated shoes and thoroughly clean before re-use; discard if oil-soaked. Cleanse skin thoroughly after contact, before breaks and meals, and at end of work period. Product is readily removed from skin by waterless hand cleaners followed by washing thoroughly with soap and water. J. TRANSPORT A TION AND OSHA RELATED LABEL INFORMATION TRANSPORTATION INCIDENT INFORMATION For further information relative to spills resulting from transportation incidents. refer to latest Department of Transportation Emergency Response Guidebook for Hazardous Materials Incidents. U,S. DOT HAZARDOUS MATERIALS SHIPPING DESCRIPTION Transported by highway or rail: Bulk packagings (capacity greater than '19 gallons) Fuel Oil. Combustible Liquid, NA 1993, III PAGE: 5 DATE ISSUED: 01/24/97 SUPERSEDES DATE: 02/15/96 945 - 02 77(MWH0021 FROM TANKNOLOGY-SO.CAL - 915124591712 .c BAKERSFIELD FIRE DEPARTMENT HAZÞ.RDQUS MATERIAL DIVISION 1715 C~ESTER AVE., BAKERSFIELD. CA 93304 (805) 326-3979 TO 6T - oý ?:;C¡ APPLICATION TO PERFORM A TIG~SS TEST ' FACILITY Ut/11J11 mUll" J1}4fj" . ADDRESS 170/ IIIIrj)n 11-1 PERMIT TO OPERATE # OPERA'rORS NAME OWNERS NAME ~ · mJIIÍ!i:R OF TANKS TO BE TES~$- IS PIPING GOING TO BE TESTED-þ . TANK# J ~ J- VOLUME I az, I<.. I z,¡¿ /2/G CONTENTS /2IAIfI r/~ " _ d, S'uh' J , S4k ..21r7fo Co,w,..Ute" (~ ADDRESS T~û..!.tt:/ ØA- 9ZS-"è .' TANX TES'rING COMPANY T4#iN~. h'PE ~ TEST 'METHOD 1 L [;) / NAME or TESTER ehl,3 £I/~ 1n45 CERTIFICATION i STATE REGISTRATION t ¡r''f :JZS- ~,,{ii;;) ~'= DATE & TIME TJ::STIS TO BE CONDUCTED ~.~~ \, TOTAL P.0S ,_ ~_-"'.-'~";',_ ......-ri~ '-___~-, -__-.-----..-.- ~-.~~~~ ---~-~.-.---. - ~..----------~-~--- -- T>-,-- , . } '- " .Ç9jRECJION NOTI~ ¿1/3tf17 BAKERSFIELD "FIRE DEPARTMENT N~ 1840 5't?-7C¡3( LocatioIl t:J.a¡ ()(¡fldJ 0. Pl(~; ft14.tf- Sub Div. 170 I tJ"I/O'''' ~. Blk. . Lot You are hereby required to make the f~~~ng corrections at the above location: r" rl·, . ðcJ ("" tJ .{(( ~ ð.. c!'(J t) t fl¡~/f'rGS ðf.t((~ e(J¡c.kk(C-. t)t ffi!:Jl>~ /J.t ~ j)1J1t5t.- frda./urcc5 I ð>ð r (Cc.f.ro~-s ~() -S<.- hd VL S-.J ~r-r7 duý~ L ,01( tJf(u¿ (iJll~(t; ç ¿~(6 ,~ H<?r! ff) ~dtf¡ oJk.tf t.¡ ~ 1.(0 t1i!'~t .Completion Date for Corrections Date 3 .I t.f /1:l : Inspector 326-3951 "' ,;,~-.;.~, &.,~->.,~, o .. UNDERGROUND STORAGE TANK INSPECTION FACILITY NAME -=tJ FACILITY ADDRESS FACILITY PHONE No. INSPECTION DATE TIME IN INSPECTION TYPE: ROUTINE V -k Ih'l16~\. II1tt~, t41d..(í 170 I Vn'l"" Ai<_ ~~L-; 3 ;)~ TIME OUT lOt - Bakersfield Fire Dept. Hazardous Materials Division Bakersfield, CA 93301 BUSINESS I.D. No. 215-000 "'D I CITY Jj~..{d'. ZIP CODE 13.1tJs I ~ l1JJ !nit ~~ ,., Is SIa iJ 00c yes no nla V / V V RECEIVED BY: C ~, ~ OFFICE TELEPHONÈÑo. \13.2'" ~ 7/ FOLLOW-UP REQUIREMENTS 1 a. Forms A & B Submitted 1 b. Form C Submitted 1 c. operating Fees Paid 1 d. State Surcharge Paid 1e. Statement of Financial Responsibility Submitted 1 f. Written Contract Exists between OWner & Operator to Operate UST 2a. Valid Operating Permit 2b. Approved Written Routine Monitoring Procedure 2c. Unauthorized Release Response Plan 38. Tank Integrity Test in Last 12 Months 3b. Pressurized Piping Integrity Test in Last 12 Months 3c. Suction Piping Tightness Test in Last 3 Years 3d. Gravity Flow Piping Tightness Test in Last 2 Years 38. Test Resu"s Submitted Within 30 Days 3f. Dally Visual Monitoring of Suction Product Piping 4a. Manual Inventory Reconciliation Each Month 4b. Annual Inventory Reconciliation Statement Submitted 4c. Meters Calibrated Annually 5. Weekly Manual Tank Gauging Records for Small Tanks 6. Monthly Statistical Inventory Reconciliation Resu"s \\d e. ¡i)1c" 7. Monthly Automatic Tank Gauging Resu"s 8. Ground Water Monitoring 9. Vapor Monitoring 10. Continuous Interstitial Monitoring for Double-Walled Tanks 11. Mechanical Line leak Detectors 12. Electronic Line Leak Detectors 13. Continuous Piping Monitoring in Sumps 14. Automatic Pump Shut-off Capability 15. Annual Maintenance/Calibration of Leak Detection Equipment 16. Leak Detection Equipment and Test Methods listed in L~ 113 SerieS 17. Written Records Maintained on Site 18. Reported Changes in Usage/Conditions to OperatinglMonitoring Procedures of UST System Within 30 Days 19. Reported Unauthorized Release Within 24 Hours 20. Approved UST System Repairs and Upgrades 21. Records Showing Cathodic Protection Inspection 22. Secured Monitoring Wells 23. Drop Tube v' V V V V V V tf ,f , V ¡f if J RE-INSPECTION DA~_ INSPECTOR: 1Œ: ¿¡/'3! c; 7 /Ii /) - II» v l... Product IJH~ oJJ'J Inat Date )?fÇ Size I" .(Joo yes no nla y' if II II ¡/ V tI ¡,I V ¡J v V V \I if V \/ V \I ..¡ V ~ V \/ v' v' V t/ V VI '\¡ V V V V V i. 1/ I, V v' J V V V 11/ V ¡ v ¡ \/ V II» 3 Product D~¿, If N· lnsI~ç Size I J COt:;) yes no nla if v , 11 \I V Ii v' v: V V .¡ V 1/ V V V if \Í .. 1/ V V ~ 1/ v v V V ¡/ Ii V V V... V v: V V V, V , _, , -, ,J . . ': ,., v, .,' r':';:¡~;,.v'~~¡.f.,..r'.f~"\V"""I''''' ,.,r"'r~,Jf{.·~'~_ìA'I!M""';< I"'W" ..,,"¡ïV~·,'-~·~v·, ~,.<...,..., .."'*'¥"<,. '........~..,.o 'N' 'tf;.','i:1t .':',.' '.:~~ -"...;r".,,-:,,,:~~;~ i' :,:.' ...,,,i.,~¡ut<¡;"':o,,,,·-~~r"..,~'¡.y{~"r,,y,t:;(";·...rr"{'""¡;,t;'-w....."f'~ ~...'. -;'M" ". 'ø''''''''~'''-:''_':'; " . I,.."~ .','" ..,.r.;!.;,."..':"'..~'-<.¡.,.~...\'J,;.r-...~'l . _ t~"f'Y"! ;~"I' ~"II"''''', '".,,".' '" WI 1_ ," õ1' HAZARDOUS MATERIALS INSPECTION Akersfield Fire Dept. I I OFFIC'POF ENVIRONMENTAL SERVICES I 1715 Chester Ave. Bakersfield, CA 93301 Business Name: In IO~ . ~~..f~ nun; [I14rt Date Completed 3/ t¡ / t!J 7 Location: lìo I (J" ,,, tI\ AI/(., Business Identification No. 215-000 ')C I (Top of Business Plan) Inspector ~(ut. Uttdt'('wœ/ Station No. . Arrival Time: :J', t15 1"" Shift Departure Time: Inspection Time: Address Visable Ad~te Inadduate Emergency Procedures Posted Ade6ate Inad~te Correct Occupancy ¡gt .,4 a Containers Properly Labled cv/ 0 Verification of Inventory Materials ~ g Comments: Verification of Quantities ~ Verification of Location g¡ g Verification of Facility Diagram 0 Proper Segregation of Material Housekeeping a Fire Protection ~ a Comments: Electrical 0 cV Comments: Verification of MSDS Availablity a Number of Employees: ~ UST Monitoring Program 0 0 Comments: Verification of Haz Mat Training a aV ~ Permits 0 .comments: I Spill Control a Hold Open Device ~ 0 Verification of c:V Hazardous Waste EPA No. Abbatement Supplies and Procedures a ~ Proper Waste Disposal 0 Comments: Secondary Containment 0 Security ctÝ 0 Special Hazards Associated with this Facility: Violations: /'Irrl t3d5/ÞY~S (J/4f\, 1" 51k (J/tU/ftllt\ , lÝul Pl'JfJ~ ¡.fur! ¡;lW.r~HV pf6uJ.~ ~'s-Irl. \A A,~ \¿ " tl· AT $" N, <Sri I Business Owner/Manager PRINT NAME White-Haz Mat Div. Yellow-Station Copy íO ~ .... .... All Items O.K 0 ~ Correction Needed a e; fèj ~ Pink-Business Copy 0 I u. / FIRE CHIEF MICHAEL R, KELLY ADMINISTRAßVE SERVICES 2101 'W Street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'W Street Bakersfield. CA 93301 (805) 326-3941 FAX (805) 395-1349 PREVENßON SERVICES 1715 Chester Ave, Bakersfield, CA 93301 (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave, Bakersfield, CA 93301 (805) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Street Bakersfield, CA 93308 (805) 399-4697 FAX (805) 399-5763 ~ -- -.ii' . - BAKERSFIELD FIRE DEPARTMENT December 10, 1996 JACO Oil P.O. Box 1807 Bakersfield, CA 93303-1807 RE: Underground Storage Tanks located at Union Avenue Mini Mart (Howards #8), 1701 Union Avenue. Dear JACO Oil: As I am sure you are aware, all existing single walled steel tanks that do not meet the current code requirements must be removed, replaced or upgraded to meet the code by December 22, 1998. Your tanks do not currently meet the new code requirements and therefore fall into the remove, replace or upgrade category. Your current operating pennit expires on or before that date and of course will not be renewed until appropriate upgrade of your tank system is accomplished. In order to assist you and this office in meeting this fast approaching deadline, I have attached a brief questionnaire addressing your plans to upgrade these tanks. Please complete this questionnaire and return it to this office by Friday, December 27, 1996. If you have any questions concerning your tanks or if we can be of any assistance, please do not hesitate to contact this office. Sincerely, -<ÇfaPfl ~/ Ralph E. Huey Hazardous Materials Coordinator Office of Environmental Services REH/dlm attachment 'Y~d:e'W~~.A~~.A W~" · - USTMAN SIR SYSTEM Yearly Statistical Inventory Reconciliation (SIR) Report 1995 STATION NAME: UNION M.TNI MART STATION #: 2259 COMPANY NAME: JACO OIL ADDRESS: 1701 UNION AVE. CITY: BAKERSFIELD ZIP: 93305 STATE: CA PHONE: COUNTY: KERN DATE OF REPORT: 02/09/96 MONITORING THRESHOLD: 0.05 GPH LEGEND --> T - TIGHT/PASS *I* - INVESTIGATE/FAIL IP - IN PROCESS/INCONCLUSIVE ND - NO DATA SUBMITTED TANKID CAP JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 22591 12K T T T T T T T T T T T T 2259M 12K T T T T T T T T T T T T 2259P 12K T T T T T T T T T T T T SIR PROVIDER: USTMAN INDUSTRIES, INC. 12265 W. BAYAUD AVE. SUITE 110 LAKEWOOD, CO 80228 PH: 303/986-8011 FAX: 303/986-8227 SIR VERSION: 91.1 that all SIR results listed above ;).. - ;;J. 7 - 9 {¿, Date e e~ BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 ßT-o~s-o APPLICATION TO PERFORM A TIGHTNESS TEST FAÇILITY HOW/teJ,\C:; :f! 8 ADDRESS '101 ONION Av. PERMIT TO OPERATE # .!bsc..o 0, L OWNERS NAME :JÞr<.o bt L OPERATORS NAME NUMBER OF TANKS TO BE TESTED 3 IS PIPING GOING TO' BE TESTED~ . TANK # I Z 3 VOLUME CONTENTS eVN ~'l) .$ UN TANK TESTING COMPANY ÍÅAlKNOW"V ~oß!O ewAlri Cr2. ADDRESS "TEII'\EeULA. eA "Z~I TEST METHOD V~ NAME OF TESTERYA-r PF2.M6- CERTIFICATION # 18S' STATE REGISTRATION # 15'0 DATE & TIME TEST IS TO BE CONDUCTED~ ~r r I '''i, <tIJi¡fF c2 'liP '1(p DATE êÛ SIGNATURE OF APPLICANT - .\ t/ USTMAN SIR SYSTEM Monthly Statistical Inventory Reconciliation (SIR) Report STATION NAME: HOWARD'S MINI MARKET #8 STATION #: 259 COMPANY NAME: JACO OIL ADDRESS: 1701 UNION AVE. CITY: STATE: CA ZIP: PHONE: PERIOD ANALYZED: MARCH, 1995 DATE OF REPORT: 04/17/95 PART A: Tank ID: Tank and Lines Status: Product: 00 TIGHT OO-FS PRE 02 TIGHT 02-UNL #1 05 TIGHT 05-FS MID Data Quality: Dels: Sales: GOOD 10894 9025 GOOD 24462 24780 GOOD 8945 7651 USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. PART B: Tank ID: Comments and Recommendations: 00 No comments. 02 {3/23/1995: -142} 05 No comments. For regulatory compliance in California, a piping integrity test every 12 months and a tank integrity test every 24 months are required in association with SIR monthly monitoring. j VacuTectTM TEST REPORT KNOLOÕ .. ... '. ..:.~ -. . . TECHNOCOGY FOR TAN~S AND THEIR ENVIRONa.fENT . 146222 S.O.# 05/03/95 <800> 253-8054 BRUCE McDUFFY Date Phone Attn 259 Site # JACO OIL COMPANY Owner 80228 CO LAKEWOOD #110 BAYAND AVE w 12265 INC INDUSTRIES USTMAN Invoice Name/Address 93301 CA BAKERSFIELD UNION AVENUE 1701 MARKET UNION MINI JACO OIL COMPANY Site Name/Address leak Det ITANKS and LINES Tested to CFR-40 Parts 280-281 & NFPA 329 Spec's. NEW LD(s) T es ted & PASS Other: Exist LINE LD(s) . Pass/ Tight Fail/ or or Fail NONE Final Leak Rate . LINE TEST . END TIME LINES LINE TEST . START TIME Line Delivery Sysl. Type . Line Material . ST/ FRP TANK . Tight or Fail Ullage Air Ingress Detected . Bubble Ingress Detected . Water Ingress Detected . Probe Water Level . START END TANKS Dipped Product Level . START END Dipped Water Level . START END Tank Dìa, & Materia ST/ FRP/ Lined See Diag, For Lã' T_ Tank # Product GPH 14 PS/SS/GS Line # Yes/No Y¡Js/No . Yes/No Tank Capacity XLD Exist LD SN/MDL/MFG 2 9 4 9 3 - 18 5 9 Newl2nd LD SN/MDL/MFG: 50 P " OOO.IT . o 25 : 55 : 3 PS 1AIST Diameter PUN 1 X. Exist LO SN/MDLlMFG: 30292 - XXXX XL D New/2nd LO SN/MDL/MFG 00 LINE TEST PSI Dispenser Shear Valves Operate {yes/noL [nclínometer p~gr~eJi.: Pump Mtg,: I ~~~~~ al ereent om Time of Tes\: ~ T!rn PSI ~ End Time: Material 000 IT' I P o 30 - 14 00 4 t t f : : PS 2AIST Ulamete PLUS UNL 2 XLD 50.00 Y Exist LO SN/MDLlMFG 3 0 9 9 3 - 3 4 18 Nowl2od LO SN/MOL/MFG: CINE TEST PSI 5 0 00 CINE TEST PSI Dispenser Shear Valves Operate (yes/no) P OOO.'IT . o 15 : 45 115 4 PS 3AIST t Tnelínometer Q~Qree~r -PUmp Mflt,: TF>rõbe I ËntrY: 1'ereent oTFlif a I Time of Test: ~ T!1stPSI t at ereent oITf Time of Tesl: ~ Test PSt + ~: End Time: 1Jaterla Ulametel Malerlal REG UNL 3 Y Dispenser Shear Valves Operate (yesLno) lnclinometer Q!illr~s: ump Mfg,: ìl5f'õ"bë I Entry: ~ Emt Time: Exist LO SN/MOLlMFG: New/2nd LO SN/MOL/MFG t t al t fa meter LINE TEST PSI Oìspenser Shear Valves Operate (yes/no! Exist LD SN/MDLlMFG: New/2od LD SN/MDL/MFG: LINE TEST PSI t neJTnometer D~Qœes: ump Mfg,: ìl5f'õ"bë I EntrY: t 'ereent 01 Time of Test ~ T!rn PSI t ~: End nme~ lTateriaT Nameter Dispenser Shear Valves Qpefate !yes/no) ncfinometer OeQœes: ump Mfg,: TPr05e I Enjry: at Percent 01 Time of Test ~ Test f'~ ~ End Time: 1TatiÙ¡aJ Exist LD SN/MDLlMFG: New/2od LD SN/MDL/MFG: t ump Mfg,: f "ereent of Fill al Time of Tesl: ~ T~PSt t Nameter lTateriãr nternational CINE TEST PSI Dispenser Sheaf Valves ()Pefate ¡yes/no" Tanknology Corporation 5225 Hal I TnelTnometer D~Q(ees: TPrObe I Enlry: ~: En.!! Tim~ TX 77040 FAX (713) 690-2255 Houston St. . ister (800) 888-8563 CA State: #95-1525 tíle. State Lic. NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on TAK-O 023 # Unit WESTERN REGION ~ TANKNOLOGY Region: 50# Iy Þ~d.d-. OW . LJ r') :::I:.O rU óO) :r:rJ:t ~1(__ 5ite# d S C} ?" ~ON!TORWELLS Well Number 1 2 3 4 5 6 7 8 9 10 11 12\ Well Depth Depth to Water Product Detected AMOUNT in inches Standard Symbols for diagram below: ®Fi1J (J) Vapor Recovery S V.R. w / Ball Float ® Monitor Well ® Observation Well ® @ (Outside Tank Bed Area) o (Inside Tank Bed Area) B Ball Float G Tank Gauge Vent ~ Manway [!] Iron Cross [!] Turbine L9c.at~on l;)ic;tgran'1-:-ln~luçte ~he.Vapo~ RE!coyery Syst~m~ LJ V'I r 0 f\J A.ur;-. . . \ å\::: pvÑ q;lot-f :\~ ŒJ 1 '-~~~-~ 1 ~ .1d.-k.fV[...P8:~ 0.<::+ . .\®@® bÐ IL~~6.~~A '-; . U N1=' C\ y-J . " ~):: Av rJ . /S'?å c,'¡' . . . . .\~ ,[iJl Lr:,-JG: [I- .3rr. 0\ :I- r-.! :L .0\ f:: 1:' - ~ ~ .g..$ 9 (g: :@;J -t :t- . ~. J> ~: :~ c f!J ~II' . VEt! .y. 'Lç'6.s. . , . ~ .- ~ Vapor Recovery System & Vents were tested with which tank? Parts and Labor used General Comments I4U l'~oOu C---/- '--' vV~) ...¡....... LD:S- A R. (;; fl; (,.. w--f-. .. -. -. -- --.-- --- - - .. When OWNER or local regulations require immediate reports of system failure-Complete the following: REPORTED NAME DATE TIME TO: Phone# OWNER or Regulatory Agency FILE NUMBER Pnnt Certified Testers Name Vacu1ec(TMCertification Number S-H;UE".v £. J-JAcu ~ S :;:r:- () 08 3 ce~ Testers Signature Date Testing Completed ~/r1~ A 0-- ¿- H~ S~3 ,95 FCfI'II- Tanlal\...ne~ 4IÞBAKERSFIELD FIRE DEPARTME~ HAZARDOUS MATERIAL DIVISIQN 1715 CHESTER AVE., BAKERSFIElO, CA 93304 (805) 326-3979 " . APPLICATION TO PERFORM A TIGHTNESS - TEST ~O ¡-=Ii tA;;)J? ~-oder7 FACILITY ¡)A//Ó¡J /'1/I/J! M.er PERMIT TO OPERATE # OPERATORS NAME::JACO 0 l L ADDRESS !7D/ Ultl/ð/lj /l--vE NUMBER OF TANKS TO BE TESTED OWNERS NAME :rALO ot L IS PIPING GOI~G TO BE TESTED ýéS ! TANK # / 2 -~ VOLUME !ZK. / ZK.. IZK. CONTENTS tiNt.- n m I['¡ -:SUA ~ TANK TESTING COMPANY MNJ!./IjDLlXil .' :, TEST 'METHOD TL]) I J YA-LVIl::4-· NAME OF TESTER~rezk' H!jWt:i/r!.5 CERTIFICATION #: STATE: REGISTRATION * IS: d.-S:- ADDRESS i/tÆffO,6 Ú;ÚI7rr' tæ b~. 1ÉM~ CIf-,q;~1 œ3 ~t::::: 7-Z? )?J- DATE $' r.3·7 ~ SIG~PPLICANT DATE & TIME TEST IS TO BE CONDUCTED ........., 7! f IIS-S- - - /5008'2 USTMAN SIR SYSTEM Monthly Statistical Inventory Reconciliation (SIR) Report STATION NAME: HOWARD'S MINI MARKET #8 STATION #: 259 COMPANY NAME: JACO OIL ADDRESS: 1701 UNION AVE. CITY: BAKERSFIELD ZIP: 93305 STATE: CA PHONE: PERIOD ANALYZED: MAY, 1995 DATE OF REPORT: 06/14/95 PART A: , 02 TIGHT 05 TIGHT 00 TIGHT 02-UNL #1 05-FS MID OO-FS PRE Data Quality: Dels: Sales: POOR 22414 23404 GOOD 7834 7379 POOR 6579 7205 Tank ID: Tank and Lines Status: Product: USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. PART B: O/S listed below represent removals, additions or delivery discrepancies which were accounted for as part of the SIR analysis. Tank ID: Comments and Recommendations: 02 Slight gaining trend not in excess of parameter- watch tank os {S/11/199S: 143\ J {5/20/1995: -1497} {5/21/1995:DEL 1414} 00 No comments. . . USTMAN SIR SYSTEM Monthly Statistical Inventory Reconciliation (SIR) Report STATION NAME: HOWARD'S MINI MARKET #8 STATION #: 259 COMPANY NAME: JACO OIL ADDRESS: 1701 UNION AVE. CITY: BAKERSFIELD STATE: CA ZIP: 93305 PHONE: PERIOD ANALYZED: APRIL, 1995 DATE OF REPORT: 05/15/95 PART A: Tank ID: Tank and Lines Status: Product: 00 TIGHT OO-FS PRE 02 TIGHT 02-UNL #1 05 TIGHT 05-FS MID Data Quality: Dels: Sales: GOOD 7964 7785 GOOD 27901 23601 GOOD 8938 7906 USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. PART B: O/S listed below represent removals, additions or delivery discrepancies which were accounted for as part of the SIR analysis. Tank ID: Comments and Recommendations: 00 No comments. 02 {4/6/1995: 115} {4/26/1995: 112} 05 {4/30/1995:DEL -135} For regulatory compliance in California, a plplng integrity test every 12 months and a tank integrity test every 24 months are required in association with SIR monthly monitoring. '. ~ ... Certificate of Tightness ~~~' .~-t :.~ /,~- t.:f':: ;," '; ,..,~ ," ~, ~"',1 ~f ~ ~W:i . : -I ~ !f¡ i ~:1 ~~"> ';,j ~,, .' ; -.. '" ( ~: , ~~ .,;,W\; I/- " , t~ I ~ fI/--¡ . ; ~i ~ ?:, ; ~'...: ~ r: ~ ~?f ~'; ~: ~ I ."j ~;t Ii \\\\HIII/III .;'¡ ,\ cC~TION II. :-.: r;' ~ .......-. tsrJ:~" /'" ~',>"",',',', I , . e. , _~?., "".- .... ~, '1 .:::- ... Q1tl'O~'" ~ ,~ ! - . ..' . i ' , .... : v..A·· . ""~ _~: .._ V·~ ~. ," XLD- *: SEAL i t.... = i ¡ *'. .. ::. .\ . A. ¡ -'~ ." '. .- "/. ¡ ~ e. .... ~ ..'~ ....." -. .. ,.'. . . ///llrö~Z;;,~;~'\\",'" ~ II \' 1ff,:. '1I,'I~\ It,; ~ ~ ~~/! t.." .,; f~,};.i, ' ' \ii¡,;' ~ ~< "ft..: f':~ f;;;;' 'if; TANKNOLOGY CORPORATION INTERNATIONAL 5225 Hollister, Houston, Texas 77040-6294 Phone (800) 888-8563 FAX (713) 690-2255 Service Order #: 146222 Test Date: 05/0 3/ 95 Underground storage tank system(s) tested and found tight for: Tank Owner: Test Site No.: Test Site Address: Tank(s) only, ÚrJtuv0 170 I JACO OIL COMPANY 259 JACO OIL COMPANY UNION BAKERSFIELD, CA 93301 3 Line(s) only, MINI MARKET 3 Leak Detector(s) only. Tank sizes & products tested: Lines Tested: lA PUN, 2A PLU, U'ro~ /,~8 ~lC- l\ U 3A REG ---- l-- ~~ XLD 30292-XXXX XLD 30993-3418 Valid only with Corporate Seal Unit Mgr. Certificate Number & Name 083 STEVEN E. HAWKINS 06/96 95-1525 STEVEN E. HAWKINS 04/95 U,S, Patent #4462249, Canadian Patent # 1185693, European Patent Appl. # 169283 TANKNOLOGY & VacuTect are trademarks of TANKNOLOGY CORPORATION INTERNATIONAL Note: See VacuTect Report for tank identification & site location drawing. ...<: VacuTectTM TEST REPORT 146222 S.O.# 05/03/95 Date 253-8054 <800> Phone 259 Site # ) \ . IND~STRIES jt KNOLOÕ ...... ...... 1'ECHNOlOGV FOft tANKS A.ND '!"HfJR ENVIRONMENT ... JACO OIL COMPANY Owner BRUCE McDUFFY Attn 80228 CO LAKEWOOD #110 BAYAND AVE W 12265 INC USTMAN nvoice Name/Address 93301 CA BAKERSFIELD UNION AVENUE 1701 MARKET UNION MINI JACO OIL CQMPANY Site Name/Address Leak Det ITANKS and LINES Tested to CFR-40 Parts 280,281 & NFPA 329 Spec's, NEW LD(s) Tested & PASS Other Exist LINE LD(s) . Pass/ Tight Fail/ or or Fail NONE Final Leak Rate . LINE TEST . END TIME LINES LINE TEST . START TIME Line Delivery Sysl. Type . Line Material . ST/ FRP TANK . Tight or Fail Ullage Air Ingress Detected . Bubble Ingress Detected . Water Ingress Detected . Probe Water Level . START END TANKS Dipped Product Level . START END Dipped Water Level . START END Tank Dia, & Materia ST/ FRP/ Lined See Diag, For Loc, -- GPH 14 PS/SS/GS Line # Yes/No Yes/No Yes/No Tank Capacity Tank Product ! Tank # XLD Ex,,' cO SNIMDllMFG 2 94 93 - 1 8 5 9 NewNnd LD SN/MOL/MFG: 50 P T 000 o 25 : 55 3 PS 1AIST Dtameter PUN J . : ¡ Ex<S'lDSNIMDlIMFG 30292 - XXXX XLD New/2nd LD SN/MDLlMFG 00 LINE TEST PSI Dispenser Shear Valves Operate (ves/no 00lf4 1ñC1ìñometer Deo.tees: "Pümp M'g,: I~~~~ at l5ëi'eent oTrn Time of Test: "I'ãñJ("""- Tesl PSI:, P T 000 o 30 : : L4 PS 2AIST t t J5ëreent oTr.Jl"ãi Time 0' Test: ~ Tes' PSI 50.00 Y Dispenser Shear Valves Operate (ves/no) \ 15 lñëJìñometer DeQrees: ~mp Mfg,: TI5i'õbë'" I EntrY' XLD Ex<s.lO SNIMDl/MFG 3 0 9 9 3 - 3 418 Now/2nd LO SNIMOLlMFGc P 000 IT . o 15 : 45 : L4 PS ST 3A t ~mp Mtg,: t J5ëreenl'oTr.Jl"ãi Time of Test: ~ J!1~ I I .L I [ , ~: .End TjJne: Mãteroal Diameter PLUS UNL 2 / Start Time: Em:! Time: 1Ta'te"a Diameter 1Ta'leroa j;I~~~ 50.00 y LINE TEST PSI D'lspenser Shear Valves Operate Iyes/no nClrnomete Degrees: I Probe EntrY: ~ End Time: EJlist LD SN/MDL/MFG" Now/2nd LD SN/MOL/MFG t f "Breent 01 ~ill ai Time of Test: ~ Jest PSI' [ ¡- , t mameter 'e-¡ Dispenser Shear Valves Operate ¡yes/no) Inclinometer Dearees: ump Mtg,,; Probe EntrY; Start Time: EnJ1 Time: Materia t f 'ereent ot ~ ill ai Time of Test: ~ Tesl PSI: Uíameler EII"isl LD SN/MDlIMFG Nowl2nd LO SNIMOLIMFG ump M'g,; Materia LINE TEST PSI Dispenser Shear 'Valves Operate (yes/no t Inciinometer Dea.tees~ TPiOì>e I Entry: t 'i!reenf 01 ~ ìIr al Time ot Test: ~ Jest PSI: !t ; Start Time: En.d Time: Nameter EJlist LD SN/MDlIMFG" Now/2nd LD SN/MOL/MFG ump Mfg,,: -Materia LINE TEST PSI' Dispenser Shear Valves Operate (yes/no I Inclinometer Dearees~ TPrõ6e I EntrY: ~: End Jime: Tanknology Corporation International I WESTERN R~GION Houston. TX 77040 FAX (713) 690-2255 St. . 5225 Hollister (800) 888-8563 CA State State Lie. # 95 - 15 2 5 file, NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on I I TAK-01 023 # Unit TANKNOLOGY Region u r¡ lGrU Õ) i - rV:t. ð'f\ K __ Site# ;} '5 ~ . SO# I~ Þðd.~ MONITOR WEllS Well Number 1 Well Depth DeDth to Water Product Detected AMOUNT in inches Standard Symbols for diagram below: ®FiII @ V.R. w / Ball Float ® M >nitor Well (Ol tslde Tank Bed Area) ® Ball Float ® Tank Gauge Œ!] Manway [!] Ire n Cross LÇ>c,atjon pi~grarn-:-ln~luçje the,Vap< ~ R~coyery Syst~m: LJ '^ .1-0 f\J A,uÇ. . . Ow .- . - " 2 3 4 5 6 7 8 9 10 11 12 ø Vapor Recovery @ Observation Well O (Inside Tank Bed Area) Vent [!] Turbine u Nia ~ 0\ 3-. "-! :L .0\ k't W . 'J,.,S :1 1 it. pvÑ 9:lol-f :!~ ŒJ ] '-~~~-~ 1 ~ . IdJ::. {I/~p &:f? 0.£:+ . .\ ®@®, bÐ I L'I-.~ t: ,~ d., R ., , ~t AVrJ'£'7ðC-,f-' . , . .\~) [£]1 LCrJ€'''' .Jh. - ~. ~: ~: ~ :@;J :~ -:-.J -t- :J: 1> c (J) ~II' U ¡;rJ Ì'. ~es. ~ Vapor Recovery System & Vents were tested with wi ich tank? Parts and labor used General Comments IlU .,Pt<'OÜU c--.... (.J wG\ ~. L[) ~ Ai<.r::: 77::/'.. IJ-h ., ~- - - +.- , , -- ---. -- - ---- --- ~ ---- ,- . , - When OWNER or local regulations require immediat reports of system failure-Complete the following: REPORTED NAME DATE TO: Phone# OWNER or Regulatory Agency TIME FILE NUMBER Pnnt Certified Testers Name I S it~"u E ¡LJ ~. /-I Aev /::.:tAJ S Cer . 'ed Testers Signature , ~L'l~ ¿: H~ Vacu1ecf"d Certification Number ~()o8 3 Date Testing Completed 5-3 ·95 Form- T.nIatlN~ ~"'-- ~ B , e . , BAKERSFIELD FIRE DEPARTMEN HAZARDOUS MATERIAL DIVISION 1715 CHESTER AVE., BAKERSFIELD CA 93304 (805) 326-3979 ' . APPLICATION TO PERFORM A 'rIGHTNESS TEST "?d j *' 01;)7 ~- Od-67 FACILITY VA//OII) 1'1/11,// MkT ADDRESS /7DI UIl!Ié)/lJ It-vE PERMIT TO OPERATE * OPERATORS NAHE::JA:CO 0 l L OWNERS NAME :r-ALO, Ol L IS PIPING GOI~G TO BE TESTED Y£S NUMBER OF TANKS TO BE TESTED TAW:::' -I? / 2 _2¡ VOLUME /ZK. IZK IZK:. CONTENTS tiNt- ,-m/f) ,.:su/\ I TANK TESTING CaMP ANY Ti+/III!J\jDLCÞ'I :. TEST 'HETHOD TL,D / J JI/KUÎt::t.¡- NAME OF TESTER..$;re11: H/rtUt:-iN.5 CERTIFICATION ~ ADDRESS i/DffD,ð &ÚI7rr' Cæ b~. Tév7~ CIf- C¡;; J( I œ3 STATE REGISTRATION ~ IÇd-~ DATE & TIME TEST IS TO BE CONDUCTED $-3'9.5" ~/I!::::: 7- ¿ç 70- DATE SIG~PPLICANT -...... ~ --~ "'_! -I 7/ f !/,:ç ; ~rt~¡"t~,¡t"i':;"'it i¡"~ !r~<' ;~"'!!ii', , ...~.~:. I'\'~' ¡¡;i i~.~ f-"'~""~,~,\~ ,~F~" \:.;\,\~{(,¡~ ;'.. ~,~",:¡;,?< , ~~~¿..~ / ~ ~if~' >j!i"'''''' ''',"'-., ""'"'''''''''''' \,' TANKNOLOGY CORPORATION INTERNATIONAL t~i'¡; ~;:"",j, ;:.~I $~:' "r~; ;,&;1'1 ,....;'(~, I L1'1 ....." i ~ ~~,r,~,'~,: I //', ',' ~~:::' ~,~~~) I «"'~', " ~,:,':,!~;" ~ ~';r; 5225 Hollister, Houston, Texas 77040-6294 Phone (800) 888-8563 FAX (713) 690-2255 Certificate of Tightness Service Order #: 146222 05/03/95 Test Date: Underground storage tank system(s} testeçf and found tight for: Tank Owner: Test Site No.: Test Site Address: Tank(s) only, JACO OIL COMPANY 259 JACO OIL COMPANY UNION BAKERSFIELD, CA 93301 3 Line(s) only, MINI MARKET 3 Leak Detector(s) only. Tank sizes & products tested: Lines Tested: 1A PUN, 2A PLU, ~,~~"", ~ ~¥I I ~,;,:~e""..¡11 ¡f,¡":'.. ~,t,',',;c,~ i :~i \ \ \ U ! if f { ¡ f , ~,',1:~',J¡ I '\\cP~TIO.v 1/. ~: ~ -:sø ..........-....~~/ ~," I 2"~./.. ofJ?Ol? ~- .....~ :tIi"I¡ -~ : C -~(¢>.. ~~JI 30993 3418 XLD::~ i - ~ - \ ~~ - ª *\ SE~~ )*~! ~ " ... ~ 1\ ~ ..,.. ...... .:::"'1::' ,) I ./ I'c .......... ~ ...~' /// l:"LAWAf'-e:. \" (~,,;; ",~~II/¡,ql\\\\\ ,,:~J ,t;;I' / ~/- "<,~ ~#'. ~ ~', Valid Onl,Y, with ~'"";,f,,,:.:,:, -.,I'~ ., / ' ..',', ',' CoÌ'¡:ioratè'Seal :' /~ . '~'~;.. r~}' I , \1'-:. } ~ß" '. .' ...,' -' J::¡~c ß¿ . ~II/~D .11'14 Y I Q J..¡4;> " 199$ "'444 .,. . DIll: 3A REG 30292-XXXX XLD Unit Mgr. Certificate Number & Name 083 STEVEN E. HAWK INS 06/96 95-1525 STEVEN E. HAWKINS 04/95 U.S, Patent #4462249, Canadian Patent # 1185693, European Patent AppL #169283 TANKNOLOGY & VacuTect are trademarks of TANKNOLOGY CORPORATION INTERNATIONAL ., , >t..... ,_ r ,,' .' ..,', ./ ':/. ~., '" \'.'. ',~. Note: See VacuTect Report for tank'identificati~n'& site location drawing, "" ø" V' ~~ ì ~ ¡ 14622¡2 ! 05/03!195 S.o. -# Date ;1 TANKsTand LINES Tested to CFR'40 Parts 280-2~.1 & NFPA 329 Spec's. NEW II LD(s) !( Tested Other' ~. & . , PASS ) =- E'isIlDitNlMDLlMFG: 29493-1859 XLD N'Wl2nd;!LD SNiMDLlMFG: LINE TESI PSI 5 0 . 0 0 OlspensAt Shear Valves Y _ Operate \\·.~s/nol - E'isILO~'J/MDUMFG 30292 - XXX X XLD / New/2nJ,LD SN/MDL/MFG: LINE TEsir PSI 5 0 0 0 , ,I . OI::;pÇn$(~~' Shear Valves y _ Operøtè (ldSlnol - bisllD ~"IMDlIMFG 3 0 9 9 3 - 3 418 NItW/2nJILD SNiMDLlMFG: LINE TEST PSI 5 0 . 0 0 giS~:;:::t; ;~~~':;) Val..es y ExisllD ~N/MOL/MfG: I, New/2nd, LO SN/MDLlMFG LINE TEJ.\\ PSI I: Oispcns,;-:, Shear Valves Opcrølt: (~~s/no) Exist to tN/MDlIMfG: 1 Newl2nd LD SN/MDL/MFG l LINE TEST PSI: Oispenst!} Shear Valves Operal~ lyc5/no) Exist lD hN/MDLlMFG: NeW/2nJ LD SN/MDL/MFG l' l tNE TEsr PSI: [)iSpenSe~ Shear Valves Operale (yes/no) 253-8054 BRUCE¡ McDUFFY f::A . J~~~LOõ VacuTect™ TEST REPORT HC~1k0uX.¥ fOR TA,hI\.S .... __ _ ~~~ ~ "iJrH.hYl~Ct¡'wf"'T Owner JACO OIL CONPANY Site # 25 9 Invoice Name/Address U STMAN IN DU S'I'R I ES / INC 12265 W BAYAND AVE. #110 LAKEWOOD/ CO 80228 ,Site Name/Address JACO OIL COMPANY UNION MINI MARKET 1701 UNION AVENUE BAKERSFIELD CA 93301 - TANKS LINES <800> Phone AUn Leak Det Exist LINE I LD(s) . Pass/ Tight Fail! or or Fail NONE Final Leak Rate . GPH LINE TEST . END TIME LINE TEST . START TIME Line Delivery Sysl. Type . PS/SS/GS Line Material . ST/ FRP TANK . Tight or Fail Ullage Air Ingress Detected . Water Bubble Ingress Ingress Detected I Detected . . Yes/No Yes/No Probe Water Level . START END Dipped Product Level . START END Dipped Water Level . START END Tank Dia, & Materia ST/ FRP/ Lined See )13g. ¡:or it ¡ Tanknology Corporation ~ 5225 Hollister St. \ (800) 888-8563 · \ 1 I \ 1 XLD Line # 1A ST PS 3:55 114:25 0.000 T P 2A ST PS 4:00 14:30 0.000 T P 3A ST PS 11-4:45 15:15 0.000 T P Yes/No Pump 'ercent 01 ~ill at Mfg,: ~ Time of Test: Tankp'l - ~ I : - Pump Mfg,: ~ - - Pump ~ ~ - - Pump Mtg,: J Probe I Inclinometer _lliillrces: !;I!!fy, Diameter lVfaterial Slart Time: End Time: Start Time: End Tin,ª,- Tank C¡,pacity Tank Prodilct . PLUS UNL ;> fŒG UNL - -- - PUN Üt " 1 nternational Houston. TX 77040 3) 690-2255 (71 FAX CA State #95-1525 L, úriginal VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file, >\K'O State Lie 023 :# t Un WESTERN REGION ANKNOLOGY Region ,,:) U;' I'.' Ie ,- 0, _0\ Owner: I 1 n ~ "\ 0 ,,-, i-. \ ' Site# 'Î ç 0. 'J\J-..::;7-- ---' i~;~_r , ,; I -,- [v I ~\ f" t?'. J MONITOR WELLS 1J We1l Number 1 I 2 3 I 4 5 6 7 8 9 10 11 12 I Well Depth ¡ , ì " DeDth to Water Product Detected AMOUNT in inches Standard Symbols for diagram below: ®FiII ø Vapor Recovery S V.A. w / Ball Float @ Monitor Well @ Observation Well ® ® (Outside Tank Bed Area) o (Inside Tank Bed Area) B Ball Float G Tank Gauge Vent ~ Manway [!] Iron Cross IT] Turbine Location piC:1grarn-:-ln~luøe ~he.Vapo~ RE!coyery Syst~m: . . . . '--" 11\ .L 0 0-.1 A.uf? . \ åt.. p'-'Ñ '1~cl-f :Iœ'è ŒJ J '-~:v~-~ \ ~ . I ~K f\/~P 8.~ o.c+ . ·I~)@® [] I L.'L:,",6.~ ~?J " U Ñ¡:'\) ~ . )~t. RvrJ'!??òe--r' . . . .\~) 'wl L~,-JE. f1- .J/7. 0\ 3.- \\.}:L .0\ k ~ - ~ .tt .~.S9 ~: :@J -7- :¡: ~: 1> ~: .~ c @ (7') 'Ø,II . ·LfJ Vfr-'1'· ~e.s . . ~ l!J Vapor Recovery System & Vents were tested with which tank? Parts and labor used General Comments ;4 U .f1 fZ. () 0 L/ C_:-f- L J 1.A.l (;' '\ +- L[) 'S A R.. ç 72 ¡:. IJ-I~ - - - ~~- - ~,.-- ~-Wh-en OWNER orlocal regUlations require immediate reports of system failure-Complete the following: REPORTED NAME DATE TIME TO: Phone# OWNER or Regulatory Agency FILE NUMBER Print Certified Testers Name Vacutec(I1d Certiticatlon Number S-H:UE;V ~. /-/ A 0 J.::::tA; S t:¡t:- Q 0 8 3 Cen' 'ed Testers Signature H~ Date Testing Completed -'- 5-3 ·95 ~ ./1'"'\" 1 O--v-...- ¿: Form- T.nI<Jt'Lht~ .~:~ :: -. . . /i::: r.. ......... - - ":..; ;<:;~\ "'::;<ýo ~', ". --.:. --''v ~ _~ -\ " ,. .......-. ~ ~ \ ,: ,~};; ~~---)".:"";"",";/i} I ¡-.........2;;r, \ \ e E~ZRS?:E~ F:^Z DEPAR~~~ t.:,...Z',..,"'O·'S )"f"'T''':;''~''''''1' Dr·"~s,,01\.' .._~ J-\..t"~ U ..:~.._...""....r.,,-, _ y _ _ .I., :'//c~j~:"~·;~ :".-::, ~)~\ (:-..; .A'I'-,ii 'f.;\ '\ i ,..... . ':. 1 ''0\ !"-, ~'~" ,\ J ,I'UI~ ' , ~ ;--:1,__ I_)' \.~ '-'~--_: } \ '. ~ ' J '~~/; ~TF'õ?-~o ~ ¡, , t 1715 CHESTER AVE., BAKERSFIELD, CA 93304 (805) 326-3979 APPLICATION TO PERFORM A TIGHTNESS TEST ~d ¡ =#- og~7 £r- 0 d- err FACILITY ¿)It//¿)¡J 11/1'&'1 I I PERMIT TO OPERATE 1Þ I ::fWi) OPERATORS NA11E . I NUMBER OF TANKS TO BE )//¡¿í ADDRESS /7Ö¡ (j/\.I/Ô/l/ /lTV'E OlL OWNERS NAME ::r-ACO 01 L IS PIPING GOI~G TO BE TESTED Yé~ TESTED T A...~.r\ .#= I 2 -~ VOLUME /ZK !ZK IZK:. CONTENTS V/1/L ,.,/17/0 _)U/\ I TlùrL< TESTING COMP_~ T!+/l/J!./\jDf£Þ'I :' I, / ,TEST 'HETHOD rLb /) FfKUlèLl- I, 1/ ' NA..~ OF TESTER.-S7EU.: 1'!/ttJj:://I!-5 CERTIFICATION ~ STATE REGIST~TION ~ I~~~ ' I DATE & TIME TEST IS TO BE CONDUCTED I ~rl ADD RES S LlDj/fD,ô {ÖOI? rY Cæ b.e. TBV7~ C/f-CfyJf! OP3 S-3"C¡.s- 7- ¿~.ýj- DATE cAdi: SIGNATURE OF APPLIC.~T ........ 7/ f !ls-ç Ope Material~/Storage Facility rate to Permit Underground Hazardous "S~<{:rmit I,'::,,;N,:,:::,;:REVER SE SID E ... .._ ..". _n ::......::;::.:::::;. ..;:::::;:;::...::::.......;::;:.. .. .... ........ ,- '" "::::'. -..;:::::;::....;;:;....;:...............:;::.. .. . ............. ... .. . ....... ..... .. . .. ... .. ...... .. . . .. . . . .... .. . .". . . .. . ......... .. . ..... ... .... ...... .. . . ......". .. ~~1i'!~~\\~~~i ~T ""LPT L ,_.. .. .. .. ~,SIRrt~:;:,::,:;:::::':,::;:I, LPT ~""'''' . . .. . .. ,.:. ',: :L:::,,::j LPT ~," ,"," " ',', ',',', ... .. .. .. . . .. . . .. .. . .....H .. ... ... ... ... . .. . ... .':':':'.':",': :..;. .:.... ". :.:. """',"""'~'C\ ',," , ",' , ''"'''', ..... . .. .. . .. ":&:','" ',:;,:':::,::: "':;:'::'" :,::"',', "':::: '~,,"""""" . ... . . . . . \ ,,'i .':'" /:"':::::':: . . .. . ... . .... ...... :;'. '. ....;::: . . .. . . . . ", .. . .. . . - . .. "." ...-. , " . . .. .. . .. . . . . . . . . . . . . . . . .. ... . . .. "." . .',', ..... . .. . ... .. .... ~; ~~)" :.... Issued To: 701 No. 200009 No. D. I. State " Piping Monitoring Piping Method nk pe ALD ALD ALD PRESSURE PRESSURE PRESSURE .. Y ....",,, ' .. ..... . · . . . . . . . · . ...... . ",,~:ªr::::::::,:::;::;:::, :: ~~~~ ..... ............. . ............. 1985,::;:;;;;:;::;';';/:, " ...... 'n. . . . . n. . .... . 19t3.S,',·'·,)(}: ... .... .... · .. .. '"' .. . . .......". .. ..... 0" ..... .. .... ..... ....... ........ ... ....... ...- .... . .. . ............... . ....... .............. . ......... ............. . ........ ............-.. ........ ............... ...... .............. ...... .............. .... .............. Hazardous Substance " J. T. COMPANY UNION AVENUE MINI MARKET 1701 UNION AVE. BAKERSFIELD, CA 93307 " ; : 12-22-98 to: 12-22-93 from: Valid Coordinator Tank Number 01 02 03 Issued By: ~ ~ ..;0:0..... . :.:....; . :.:. of, , ' . , ..:':? ::.t· }. .: -: fti~ '.<". in ".<' ~ Approved by CONDITIONS:,:,:, ... . .. ... ... . . .... .. . .... .... ,.. ..... o . . . .. . . . . ...... .. . . . . .. . . . . -. . . . ,- . . .. ........ .. . ." ......... ~~;!tQ6.t:::::::::::: , C#:p:~ç!~Y':::=::,::: ... . ............... ... . .............. .... .. ... ......... ... .. ........ .. . -- ... .. . .... ...... .. . .... .... .. . .... .. . ... .... .. ... .... ..... .. .... ..... ',' """00'" "",', . . . .. . .. . . .. .. ...... . ... ..... .. .. .... "'1,2," Q""", .... ':0 ',,' ,", ::::". ·.of ....:.:.:.... ::..:: ,;::,~~ 000 :!::: V~j~~ ¡~¡, UNLEADED UNLEADED UNLEADED : .. .., '" : Bakersfield Fire Dept. HAZARDOUS MATERIALS DIVISION 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 (805) 326-3979 -- ~ - -- BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 1715 CHESTER AVE., BAKERSFIELD CA (805) 326-3979 ' 93304 APPLICATION TO PERFQRM A TIGHTNESS . TEST "?d ¡ -=#- tF};)'7 ~-()dB-r FACILITY f)A//ó/IJ I'1MJ/ M ~T ADDRESS /7DI UIt//ð/IJ /l-vE PERMIT TO OPERATE * OPERATORS NAME:JACO 01 L NUMBER OF TANKS TO BE TESTED OWNERS NAME :J1î{.O Of L IS PIPING GOING TO BE TESTEDÝ€S ,I . TANK # / 2 -~ VOLUME / z,K.. !Z¡¿ IZK:. CONTENTS tJ/l/L ""mID -SUA I TANK TESTING COMPANY TÆNJ!JVD~' ~~TEST 'METHOD TLD / J )/1KU1t::q- NAME Of' TESTERS~ HItWOA/..5 CERTIFICATION # STATE REGISTRATION #F / ~ d-~ ADDRESS 'IbffO ð ú;úl1rr' ~ De. TBv7~ or'~s(1 Œ3 DATE & TIME TEST IS TO BE CONDUCTED S-~3'9~ ~rt:::: ~-2e:-7J- DATE SIG~PLICANT ........ 7! f 1I'r ~ . . - ~- /1'" ' 1"'\' -" ~', -"', Jaco Oil Co~parïr 2i7 1994/ '. ¡, " ,t . 1/; - I 1 ,~ . 3101 Strte Road Bakersfield, California 93308 - P O. Box 180rBakersfield. Califo-mià'93303~ 1807 .'..~ . Phone: 805 393-7000 . Fax: 805 393-8738 -. -~<,.j -- Irq~({;~~ ~'NOV 11994 ~ By~ ".~! .~ August 1, 1994 LETTER FROM CHIEF FINANCIAL OFFICER I am the chief financial officer for Jaco Oil Company, general partner of,J. T. Company. This letter is in support of the Underground Storage Tank Cleanup Fund to demonstrate financial responsibility for taking corrective action and/or compensating third parties for bodily injury and property damage caused by an unauthorized release of petroleum in the amount of at least $10,000 per occurrence, and $10,000 annual aggregate coverage, Underground storage tanks at the following facilities are assured by this letter. /~I Howard's #8, 1701 Union Ave., Bakersfield, CA 93301 1. Amount of annual aggregate coverage being assured by this letter: $10,000 3. Total liabilities: $830,804 $118,276 $712,528 2. Total tangible assets: 4. Tangible net worth I hereby certify that the wording of this letter is identical to the wording specified by subsection 2801.1(d)(1), Chapter 18, Division 3, Title 23 of the California Code of Regulations. I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and belief. Executed at Bakersfield~fQmja on Date Signature Æ~ ~~- AUG 0 11994 ------ Name: Brian Busacca Title: Chief Financial Officer BB:jlc ) '" COR.RECT~N NOTICE .,_, '2; .~: -- BAKERSFIELD FIRE DEPARTMENT \10 ~ ~~"" 1 o ~,1 7 .~ .~ :~ '} ~;~\ J ~! '~ -; J ] . '~ 'J Locatiol1 thu",¡:¡¡eJ; j}J,'/),'/J}.¡R't- Sub Div. 1701 Vn /&-.>1'1 t9µ£..- . Blk. . Lot You are hereby required to make the following corrections at the above location: Cor. No ill! /-Íel}?? cA, I ï;/;'111M. VtJv, ., ,.'( .. :: ,,' " " I .,' ,;':~ ....:' Completion Date for Corrections Date ¡!,/Is-fir #J~,~' Inspector " ~ , .,~ <1 326-3979 .._u_ ____. :.-.."._",;";,--,--"___.~,,,_,",,,,"-,","~'--...''':-~C"''''''' _ c"'--~:~--'-'_~_____.....:-...,.~ . 7;,--- ~'¥'"'.....', ~--- ._",._ ~---..., -,---..,.---- ~'_r:"~ . , . . - ~ ..... "~..,:., ~ õ UN~ERGROUND STORAGE AK INSPECTION , =-- ... , , , ' Bal<èrsfield Fire Dept. Hazardous Materials Division Bakersfield, CA 93301 ¡ \.., }.... FACILITY NAME H6wPlød~ FACILITY ADDRESS J70' U",;ov'\ f:.)vP_ BUSINESS J.D. No. 215-000 70 I CITY ZIP CODE I I ! i I I, \ ¡ , I ( , ! ¡ ¡ I ! FACILITY PHONE No. II» II» II» , "2- j INSPECTION DATE 1011'?/'1«1 Product Product Product TIME IN " '. I> 5'" TIME OUT InBl Date InBl Date Inst Date :5 INSPECTION TYPE: fO¡~ ?? /7 ~,Ç I'H~, ,/ FOLLOW-UP Size Size Size ROUTINE , REQUIREMENTS nla nla nla í yes no yes no yes no t "'a. Forms A & B Submitted V v' V 1b. Form C Submitted V- I-- t,...-' 1c. Operating Fees Paid V ,/ v 1d. State Surcharge Paid v .... ........ 1e. Statement of Financial Responsibility Submitted -\ / V' - H. Written Contract Exists between OWner & Operator to Operate UST < V - ...- :2a. Valid Operating Permit ¡;, ",. ,/ .,/ 2b. Approved Written Routine Monitoring Procedure * ¡/ /' ¡./ 2c. Unauthorized Release Response Plan " V 'V' ~ 3a: Tank Integrity Test in Last 12 Months t/ II" ,/' 3b. Pressurized Piping Integrity Test in Last 12 Months .,.,. t' .r >,~. Suction Piping Tightness Test in Last 3 Years v ,/ 0/" 3d. Gravity Flow Piping Tightness Test in Last 2 Years V ./ ,/ 3e. Test Results Submitted Within 30 Days ./ {" .......... 3f. Daily Visual Monitoring of Suction Product Piping ¡/ (,/' ,,/ 48. Manual Inventory Reconciliation Each Month V' ,/ / 4b. Annual Inventory Reconciliation Statement Submitted .$... 4c. Meters Calibrated Annually ./ ./ ,,/ 5. Weekly Manual Tank Gauging Records for Small Tanks v v: --- 6. Monthly Statistical Inventory Reconciliation Results ¥ ./ ." V- I"! Ý .,r" 7. Monthly Automatic Tank Gauging Results ./ v1 ./ 8. Ground Water Monitoring V ......- v \ 9. Vapor Monitoring v' / ¿./ 10. Continuous Interstitial Monitoring for Double-Walled Tanks V' ,,/ V' 11. Mechanical Line Leak Detectors t/ I'" V' 12. Electronic Line leak Detectors ,/ .,/ / 13. Continuous Piping Monitoring in Sumps ......... v' c./' 14. Automatic Pump Shut-off Capability ¡/ ,/ "./ 15. Annual MaintenanceJCalibration of Leak Detection Equipment ./ V' ¡/' 16. Leak Detection Equipment and Test Methods Listed in LG-113 Series v ./ ........- 17. Written Records Maintained on Site .:s ACD ./ .... ,,/ 18. Reported Changes in Usage/Conditions to OperatinglMonitoring ./ ./ ,/ Procedures of U~T System Within 30 Days ... 19. Reported UnaUthorized Release Within 24 Hours ~ V' V 20. Approved US't ~ystem Repairs and Upgrades ¿ ./ ¡/ 21. Records Showing Cathodic Protection Inspection ./ t/ V 22. Secured Monitorlng Wells 1/ / tl ../ 23. Drop Tube ~þ ./ v vf!¡ Û. , I ! \-.~~ r\'~"'" 1;:11'f, cli.J. ) ~ct .,11.'1 ...~.",,~, ?~I(" ¿,\¡,I "",'HI tAV\ \" '\ RE-INSPECTION DATE ,I RECEIVED BY: INSPECTOR: 1iI1JP;( -ri:.?(¿, ~~~ -i.ÆOFFICE T~LEPHONE No;.' (loJ¡\c...e.1-e h,,~ t~Ir'\. \OK f: ji"'J r:&.~E;';" t ::;?-,,,,,"t -(,.,[~ ..'.1.::,."..... rµ ~.\'. \1- ;#'#J. '¡1Þ1'''#'''J'~If..Jo~,. . FD 16fìQ ~ -.---- -~ FOR M OF PHONE ~---'-- ,----~---.~----~ - ..--.~ ~___,,~F___~_~__~_~_ ,,- -- -~. - -,--- -- - - ~- v v- _~ or_J ( ,,".' '" . . ' :~æ~~<~,~,,-f7··~'~t~L_~._~ " 'I __ 11 ! ' ~ ~. ~ _ -_ ___~_ --r-..:.~ -- - . -.'-.'. " , ),..,..Ç ': . . , , , ,- ,- -.-~~--~---,.----------- - - - -.---.--- - ~ I , ¡~'\ ;"1 ~.~l ~I ,I " 1, .-. 122'523 07/28/94 < 80') > 2 53- 80 54 BRUGE McDUFFY S.O.# Date VacuTectTM TEST REPORT Site # 259 '- 12265 W BAYAND AVE. #110 LAKEWOOD, CO 8022~ HOWARDS #8 1701 UNION AVENUE BAKERSFIELD CA 93305 ~, I I I I TECHNOLOGY FOI ""'0 THEIR ENVIRC r Owner JACO OIL COMPANY INC Invoice Name/Address US TMAN INDUSTRIES, INC Phone ¡ I I , I I I I j /1 I Attn TANKS LINES Leak Det , See Ullage TANKS and LINES Tested to CFR-40 Parts Diag, Tank Dipped Dipped Probe Water Bubble Air Line Final Exist 280-281 & NFPA 329 Spec's. Dia.& Water Product Water Ingress Ingress Ingress TANK Line Delivery LINE LINE Leak LINE LD(s) NEW For Material Level Level Level Detected Detected Detected . Material Syst. Type TEST TEST Rate . Pass/ LD(s) Loc. ST/ . . . . . . Tight . . . . . Tight Fail/ Tested Other: - Tank Tank FRP/ START START START or ST/ START END or or & Product Capacity Lined END END END Yes/No Yes/No Yes/No Fail Line # FRP PS/SS/GS TIME TIME GPH Fail NONE PASS 1 SUPR 12000 ' u'ameter )0 . 000 060.00 00.160 N N N T lA 8T PS " $:42 (1'\2 ·O.GOO' tf.','" " P - Ex;sl LO SN/MOL/MFG. XL D ."'.... UNL 95 )0.000 060.00 00,160 New/2nd LO SN/MOL/MFG: . Matenal 7:44 Percent qf ~ìII at 63.0 ~~~p RED JACKET ." , 50.00 Start Time: Time of Test: LINE TEST PSI ST 10:08 1+~~rp~I:- 2. 00 m~~~ FI LL ß'~~~~~~teL.1 . 0 0 0 " gi~~r~~:~~~~~~ Valves Y End Time: 2 NO 12000 ' Diameter )0.000 1061.00 00.120 N N N T 2A 8T PS 9:18 9:48," 0,>000' rt" P - Exisl LO SN/MOL/MFG. 512 9 2 - 8 7 91 DLD 95 JO.OOO 1061.00 00.1201 · , '. h",.. "".., ,".., .., LEAD New/2nd LD SN/MDLlMFG· PLUS Matenal 7:44 I tIi.'.~e~l¥~s'i:1I at 64.0 ~~~p RED JACKET .. . , ", '., I 50.00 Start Time: LINE TEST PSI ST 10:08 If~~rpsl:- 2. 00 m~~~ FILL ß'~~~.?e~~teL .900 ' c g~~~7:~;~~~r ValvS5 End Time: y .j l{~G J.;¿UUU ulameter )U, IJUU /Ul;'::. ~ . J.bU/ N l~ N T 3A ST FS ,1:15 LJ.:~:a ~ .q<.ìQ ..~ ~....,' p - Ex;sl LO SN/MOL/MFG. 30 9 9 3 - 3 41 8 XLD UNL 95 JU. QUU IU/ 'L.::>O UU.lbU " ,,' ,.' New/2nd LO SN/MOLlMFG, Matenal Start Time: .lU:'L~ I 'iI':,~e~l¥est: at 76.0 f'.ump RED JACKET '. ,,','.. I,"" LINE TEST PSI 50.00 Mfg.: .'"" '. ", ST End Time: .l'L:4b 1+~~rp~I:- ¿ . üU IÞ~~~~ 'lLL f\'g~~2.~~ter l'1lli g~:.~:~;~~~' Valves y ulameter / ,', . .. ;i"> ;. ~; Exist LD SN/MOL/MFG: -<"~ , , ..' ' '., <.,.. I I " . New/2nd LO SN/MOLlMFG: Material I t~~e~l¥~s'i~1I at r,,~~p ." ,,"i ,i;' ;'.. I;,,'·,"··,,·· er Start Time: " .. LINE TEST PSI · t~~rp~l: I ~~~~~ ß'g~~~,,~~ter . g:~~:~~~~~) Valves End Time: Diameter " 1 , I :. Exist LD SN/MDL/MFG: '," , , , .;,., " "." f I New/2nd LO'SN/MOLlMFG: Material i ~%e~l f~s'i:1I at M~~P , " '," , ...;.n.,.... ,'" Start Time: . ." LINE TEST PSI. 1:¡::~rpSI: / ~~~~~ ß'~~~~~~ter · Dispenser Shear Valves End Tim": ODerate lves/no) ! ulameter " / . / I ",'.,', ." "",.,. .,,'.,·i· ."',,. ,J,. . Exisl LO SN/MOL/MFG. '''' I I New/2nd LD SN/MOLlMFG: . ,." ,. , , Matenal Start Time: Itriri~e~¡fest' at !".ump .. LINE TEST PSI. Mfg,: .. I· "., " End Time: 1:¡::~rpSI: I Þ~~~~ I f\'g~~2.~~ter gi~~~~:~~;~~~\ Valves INC JACO OIL COMPANY Site Name/Address t~ . :1'., .t :~,'..J I,' " 1; ~ I Tanknology Corporation International 5225 Hollister St., Houston; TX 77040 (800) 888-8563 · FAX (713) 690-2255 "'------"'--~~, ,.. TANKNOLOGY Region WESTERN REGION Unit # 023 State Lic. # State: CA NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. TAK'01 ~-~~--'----'-"-'--~-'''-' -~:-.:..-....-=-="--"".~ ~~ -~ -~,- .. '~~~~-~."--------~~- '~~~'~'-'"'-~-~-~' .,..-,';"":';' ".."""...,'",;:,:, '.....~~ "'J ,. ",,,,.;':;0- . , "" ,'f;. ';>,¡' ,'(':"¡¡ '..; ,T,; :"<" , '. ,<~:¡i:'; ri~~i~~ '¡..C' (:~, ~ ¿51;:';."": .'.:', ~ } ".... , ,.! . ~'{¡ : ~ i¡~~o#~~;1 Z~7t1.) .': ¡MONITOR WELLS' " '\i ¡ :\,;:1:,;""" ;~ ;,":~{,Well Number 1 23 4, 5 6 q 8 ,9¡ ~o 1-~1,. '·:'~1.21! 1,1,,: ,( ~; ,::).¡;Well Depth N ð : ; \ . I :,\ ' ~ ,,~, ~J:~f~J;1 '<~ ~¡ Deothf.to Water ~ LA "\ ~,..ii" ", ~~:1~!f~~1 ::. ?~~~~c.: ~e:== N A ". ~". ' ~ ¡ I·,,; ,'" .\',-:;:;,:; .' 'Standard Symbóls t¿ r diagram below: . , ,,{VFi11 .f!) j 'Vapor.Reêovery·,\',J:;?~;;,: %i ',if ..( ,@1~·~·Jwi.;Ba)'F'oat¡. ,.,' @ Monitor Well :@: Oa)sèht~ti~~ ,w~lí;~l:~:'\<y"', . \ ~ t''', ~~' , '~'~, " @(OutsldeTankBedArea)'O,¡(lnSldeTank Bed'Area),,:"\ ,::;'}, ~ ,: :B ,~!:Ia,II;,Float" :. .. G Tank ,Gauge ", Ve:nt: í'" hi' '¡',' I ~,."::", , ",,' 1 - "" 1 OJ " , [!]'" 1.', ,1';,;-'(')1/1.,: ~~){,f~~ ,'; ~ M LM~~è'vtay : ,: 1j ." .'.'. I Iron Cross., ' " :T \ TU'rbir;té; ,¡.r;, ~"J.; , 'l':.1'\·;) :'r;~ f --.~ .. .. . "., it"d l'·~J,;n:v},· ~:i '~ ;L:º~~~,o~" l;),i~gra~-:-ln~luøe·~he.Vapo~ Rec'overy Syst~rTl~,; "<"".-: L~:' ¿,' ' ",:: ',1 :'J~.l"-' t- d ',: > ~ ';. < ; [þ';':' ", : ,1 I '\I ï, ''1'''''' ";' ';''i''¡''',!~'',... ."" ... '",I.". .'", '::,·:+....':"'··'f"·\:~:1~+}<;.: ¡\ ¡;1: ì . ¡ f'" !.-, 1.,1. ,,¡...~ ,,: . ;': .! ,,:,.,' '. i '" ""'~:' ¿ :~; ." ".....: ,."Ii ¡;" , t I, 'I' (I I ,," ¡ \: :,: :t:." ,'j :'~ r~ " ' .t. ~. . ! ¡ t ) ~ ¡ : ? r ¡J '·Al " , {! ~~ . '.. ~ ~':'-'I ":';:,{~ ¡, ,¡ L ,í .j; I'. ',Ij. I t· · -:~' ,,' " " . . ',. .';;"<", ,!~~I " ~. ( " ~ ' '.' " ". . ."~":" ~~~~i'~)~1 j, ~ ¡ ;,~,; ¡ ; , ¡ ~ _..r -. t...~í:h'.}'V~.. {. " '. ..j ~ f~~..~.~¡ . í ~ : ; ¡. j ¡ 1 . \ j .~ R;· fj+-i· ' ' : " '. . , ""1 .~. ¡ .! ¡." .", ~ ~ (;) §"i. é0 'r,.~ ,h ! I ¡ ¡ ! ' ~ n-, ~..; . ..~~.......t_....~..._"{.."....~,,,.:..~ ;...... e'., "'-~..~..;..... '. ....}' .,.ct;>. .. - .-..¡;J :.:V:ì',~~" "~. ì \ ¡ ~ [ ¡ 1 \ ¡ 1 ' ~ . .., , ", " ' , ," 'I:: ' ¡ : ~ ¡ I' ¡ ..-/ ¿:;.. -.--J- '1'", ij. í .¡ ¡. ¡ .J ¡.;: . '¡?l.p' m' rP1 J' f~ß ì,""v~,·,t;~··~""~",,,;,·~,:·<·,:>, " ' '('" LLlIiJ' LfJ '" , :¡~'1' :. i 'I Ti '\" ',' 11<.>1\11' ft.t¡>:>,I^- : ¡;, '"I ¡..,;,' , '. ,,; ,¡ . H ~ / t ". \ \ 1 ( \ _, " ,"" 6".'",', ,'b-,", : ~. r ¡ " ¡.! : I " I 53 ' ITI. L~_J .. "., ."",,, : :; ,:,~, t¡1i,;I: i! lŒ¡ : ';" I .: ,'.:. .,,,.:. , I" , . '., ,: "'". : : j .: I ;¡--·I' \1.":"..\..,,. ,;",\ ~ ; " "J/7',..../ '"í"" ,,,,,,',,,,, ,11' :¡; to f!.";"" .'.... . .., 'I"/~ .-- .." . 11 ,I' ~. LA (1 ¡,1,1 ".:! i ,:;:,,"- '. . 1,'\" .' '.,'" ,: i <,,:,,~,!Vapor¡ ~ec9y:ery.~y~t~m & Vents,w~re tested ,with which tank?: ",',", "'.. "', ' .~ , Der: +L.AtC4 ..Jb8 :! Sit~# i \ : ¡ i. ~ , ~ ;l '.' .~ ' , ~ ~ . '" i'J " ¡ t-.'·"." ,'. " '" .'1 .';ï" , ") ..' ,,, " :~:'~~:¡ ~'" ,":' " '. <¡" .~,~ .',' ~ì';,"'~ . ,',' "':.Y: ';;''': :j:,¿;,:~~ ',C\":: '1:<,>" t'¡~ ",.,:.";:",\;\" .:' ,::,,'.';:LL: ""/".:,, " . "'\t{ '.' "i:~ } 'f /.''':: \" ," ,,' ,!, , :~ ., ':i ~,L . . . .,-" ',' '" ;¡ ".' '-,. ...... , ..' '.; r~\ .; ':'(!:!, -1' ; ih,.,",' li;:f' ;.'j: li..,·",¡¡ ~:1~~;/, i'. ,n:"Y:~:2;i':;·~; I . í ¡¡Ii ", 1';>,' "~(I ¡ ';,'"::"",~,;,'",,i,' .'....', . Î ' }, i;'>¡1..: ';'._:'.' fr f. ! ,'~ ~,~. ,. ,!:,I,i. \: ~~;: ~!, :~'", , . (~r;,,~ :, ; ,i . .~,. '\.~~; 'j ! t ! .,,/' ( ~ ~ j ~ J ¡ <. '«:. ~ : /J~ .~ 3· ¡ .1. .:, ;,,)~~ ~"~;~~t:1 ,Gèneral ! Comments, ¡ : ':, ¡ I" ":~".,',,:' :',,; t:.; ;~,;f ; t,~ ~~<~\!'1J,i-rf;,.. '¡¡{pi/!< f.s1".,IJðf:wkl;)J5~" t-ilÚ;:(~ i,hJ,7-£lih~,:"t:, ".,.",; ;.( ~!i)j:¡.~L, ¡ $,;'~".. ,/Aj ,7~zj;:"?J('¡¿I;ì¡;'ð/) - ;¡ZS' if, , ; >,:;:,jf."\!.,\,,;;,,, " 'I i ,; : " 1 :L,')-. """:""';'" ~ ,\ ì (j ~ í ~ : ! " "'~,~~" . ·:[{~...;.i'-Z-,\'.)...._"\"-<':';'~;;-~~"~::' :"< , ; Xv,l, l ¡; ') : :; . ".',;: ~.' \:', 1- i.,:-:-- ¡í;,,",j/"/:':';;:::);¡';L/ .':¡ ( II '~ Ii , ~ , ,,' I" ¡ / 1:,,". I¡, ,.;1.' ", /,:.: >, ;. ¡ I" .,1-' (.. " i ", ...v" . ¡. , : '.:¡',:.' ~ :':-' :/;~[: ;. <t' ¡ f ¡ .~'" ! ': ¡ ¡ { l.{>?~~h'"L~;· "......:. ,~~:;.{'~.: ',I, :.", ,,'. ,":'." ,,','.', "';", '., "',' , ,; ,,',"',' " >'V{"""""',,' :~,;,;:::;";!i~ :~hehOWNER òr I,oeal regulations' require immediate !reports o,f system failure-',Complete tt\~ foIlO~i~g:ir~ ..' '.·.¡v......."1 t~· ~,~ ! yo), "'J;'~ ~ .' 1. '. "'!,; , , '.' r, 1.. , ! , ; ,.~., . .1· ".1'.. ~,'."~::'~..'; ,,/;; ,REPORTED,"~"..~:'·"'~~~::I~ _=_,~H'_''''', _~" ~" .DAtE~::,_-",-~-,-",~",'+--T}ME~f~~ ......." " ~, ,,1 ~ 'T'O' . ~!'" ~~¡ ." " , . ',..... r l,~ í\ .,/':Ù.; .:. ,f " " u. 0 . :',,' .. ,. c; . ." .' '1 ,'" ì " 11. ...~~';.<;~... ., :\~; , :.! ;~:~'R~e#' " ,,-, OWNER or RegIJ1atory Agency FILE NUM~ER' ' it :i::~ r; ,,' .'.:.¡;"" , ~ ..' !:. ,", .. .,.:·;i ; 3:'~~ "~'i>~" ..j t- { .. {" ''':'' "'",;.~ " ", ¡ Pnnt Certi ed Testers Name , Vacu1ec. ,'__' cation .Num.. i }3' cjE;;;:'75()~~H¿i/l ' /, " .. ';ðL,} ,;¡ -,~~:'>,~;ri'~:: ~ .~' ~ce~ed7;,'S ,,,~:.si . tureç, " , ."Dàte,J~Sti~í';0'c~m,r··~~'·"'.~":j ',,~.,-,ê,,:" , :. ,"'~~ ? L) - , ~,í 7.~.;, " b ' . ',."", ,_) ~;, L/" '7 '- '~ f.J?-Q, , "V.""'" ,.'."""".,,,,,,,,,,.'.',,, ,'" ','." ",,'..,'"' ~,'i,: '., ,_..... . H" :'; Parts an'd+labor used··..:, ....J.. 1 , , \ . '~"", " j,," , i / ' " .'04'_'" " '~, .,'..¡ '.t', 'I;"~; c '" :", "';~~'; FROM TANKNOLOGY SOUTHERN CAL . TO 916022643068 P.12 e . .. BAKERSFIELD ~IRX DEPARTME~ RAZA1\DOUS MAnRlAL DIV¡SION 1715 CHESTER AVE.. BAKERSFIELD, èA 93304 (eos) J26-3979 ï , ßT~O~O l APPLICATION TO PERFORM A TIGHTNESS TEST 1ACILITY !hkJl1#JS :Jff ADDRESS (701 tJftl/)1t) ~II/tlé PERMIT '1'0 OPERATE t OPERATORS NJU« OWNERS NAME ::TkO t)IL . øER OF 'l'.Am<S TO Bt: TESTED~ IS PIPING GOING '1'0 BE nS'XED ~ . TANKI I OJ. J B~UME t,;) K . I~ CONTEm'S ;¿ TANK TESTING COMPANY fiM¡~;;(){:t)þl/ ADDRESS ~ TES'l' "METHOD 1Itrt~ NAME or TESTER\. }ij¡zl .Q,ærlr2, CERTIFICATION i 7 STATE REGISTRATION t (S~q éJ4 ~6 &vArYtw~~ 7Sn~ 64- '<?J11 33G ~~ -71- -""-- DATE & TIME TEST IS '1'0 BE CONDUCTED ~~ PRoJ!i . 7::/--- 'If DATE S~~APPLICANT . ' e BAKERSFIELD FIRE DEPAR&NT HAZARDOUS MATERLAL DIVISION 1715 CHESTER AVE.! BAKERSFIELD, CA 93304 (805) 326-3979 61-000 l APPLICATION TO PERFORM A TIGHTNESS TEST FACILITY fhkJ /I:ßI15 :tf f ADDRESS /701 VI) //J/lJ /ÎvE/\/¿J¿- PERMIT TO OPERATE * OPERATORS NAME OWNERS NAME::Jfk:D OIL NUMBER OF TANKS TO BE TESTED 3 IS PIPING GOING TO BE TESTED ~ . TANK # , / ç) ~ lJ~UME OK'. /d<Í CONTENTS eUA/ ~IV I/Y! I D TANK TESTING COMPANY ~/t:./JOWÞY ';. TEST 'METHOD ¡/1tZ~ ADDRESS 1/~6 d)J//lTY ~~y 7bn~ tA- '1<.5"11 NAME OF TESTER CERTIFICATION # STATE REGISTRATION # DATE & TIME TEST IS TO EE CONDUCTED ~J E-~ PRQV~ . 7-/~ 71 DATE ~~ 81 ATURE OF APPLICANT o , ,tI?~~. n ~~ e J.T. Company ,< 3101 State Road Bakersfield, California 93303 Telephone (805) 393-7000 Post Office Box 1807 Bakersfield, California 93303-1807 January 20, 1994 Mr. Ralph Huey CITY OF BAKERSFIELD UNDERGROUND TANK PROGRAM 2101 "H" STREET BAKERSFIELD, CA 93301 Subject: HOW ARDS MINI MART 1701 UNION AVENUE BAKERSFIELD, CA RECEIVED JAN 2 4 1994 HAZ. MAT. DIV. Dear Mr Huey: To comply with the mOlÙtoring program requirements outlined in the State Underground Storage Tank Regulations, J.T. Company utilizes Statistical Inventory Reconciliation (SIR) with tank integrity testing as a release detection method at the above referenced facility. Current regulations require IT. Company to (1) submit a sUßll11a1)' to the local agency which indicates the results from tile statistical inventory reconciliation reports for the previous 12 months, (2) perfonn tank integrity tests bi-annually and (3) perfonn integrity tests on the piping and line leak detectors annually. Attached for your review is the following: The annual summary of the SIR reports for this facility prepared by our SIR vendor, Ustman Industries Inc. / I Copies of the results of the line and leak detector tests which were perfonned December 1, 1993, by . Tanknology Corporatiòn International. Review of the results indicate the product lines are tight and the leak detectors are functiolÙng properly. IT. Company strives to maintain compliance with all state and local regulations at our facilities. Should you have any questions or require additional ilÛonnation. do not hesitate to contact me at (805) 393-7000. especlfully, K e.-\--Á \ (L\J) Kerley r Operations Manager ( JKJjk attachments .~ -~-~-- " :<.~. ~.. ·~~~~?-~{:~~j0·~~1~~~;~:;!f¡~i,~~~~?~::?~~t~,. -",,: " ',,"i ~,;,;:,,,>,'"Z.-!.;¿: ".i-'>':,,-,,"":U~SIR:iSYSTEM;:': I "-;,,,: :""}'<".:- .'.""., +~tf~ :¡.<'.i'~...,:- < "M~''''J- . _.... _. . -'., - .i"''' - "t ~ (., ~...--v+~""~~. ~ ~ ',. ",,¡:.-,~,~..~ ~.:h>-<-~: 'Monthly-;"Móñitormg::rRepo , .".;-. - '-:,.. ~. , . . ' ,,', ',T:::::' :: T;!: j;.~1 ,?;;~' ··~.T~~· ··T=~: T": ~,T ,~j' ,.... ,r, , ·:..,,,;~S::/:t- ~ ;:,;i:iëiJi.iuLAiÍjE:MONTBLY.::REPORT: " ;;ti;~~ACQ ~,oi:¡¡;~~ ,..19_9j.~ _ .,.,,-,. '·"~·~·_~~~?~~~~~£~i~~~i~~[~~~lii1!~~~;:~·, ." '""," j' ?,?...,:, ,'< INCONCLUSIVE_ '-Ji)" <,..~ND"" ,NO.., DATA..... ·,~(y:;;~:?:'~l;~~;:J~1;~i;~~:~;~*'~tir.~::A~:~~~:~~l~W;r~~~~t~:~,.:,Ù~;d:::~"!.', ~~~';f' ;FEB: MAR.::' APR- MAy::'j]JN;: JQL:,,:, AUG::: SEP'::;' OC . .í".';:' "''J-. ..:-:.,....,.<.','~.¡-':._,::,¡;.;~...~~:;.~.~-., ,.c;.'.';:--;:;'''"''-::'' ""( -'-:->'- ~ð- .',.,.~ 25'9-02'"' ~ '," . . '", ,.",' 25'9:;-05::, .' ":'<".'~':'~>, " " Tank'ID': Pr.oduct-:;" .,' . USTMAN INDÙSTRIES INC;' is:: acertified"Statiàtical<: Inventory. RecC;;íi""" ~,,,...,'.LO~4i::, (SIR)' release' detection vendor;' Tank~' status,·resul ts-", for'monthly ;.m~t'òriñg:< are . base~,' on~ paramet~rs:' sP!!cif~~dëby~·:the~,EP~' P,,,,rotoc:01:: for. SIR metliOêiã¥¿' '.,' ' "".' '.. '''~';", ,.,.: . ' "'~:~"~~:~,~~·;;{f:,-·:'/·" For"regulatory compliance'in California, ä·-.piping integrity.~,t'est'j::" . every 12:, 'months: and a -tank; integrity' test every" 24 months arei:~,í1;:.~';~'_"·<, required in" association with SIR monthly monitoring. " ,',,' :1-',- OO-FS,::PRE::" 02-UNL #1. 05,~FSMID ." ;~?:..,~ '~:"<'--í -1 00 02 05~ , . :zj> , .. .. " . -." " ~ ,.-- :>~/=.(.;..... '. .~ "~a :wTANKNOLOGY ORPORATION INTE 5225 Hollister, Houston, Texas 77040-6294 ~Certificate of'Tightness ServlceOrder# 030726 Underground storage tank system(s) tested and found tight for: TANK OWNER: Phone (800) 888-8563 . TestDate 12/01/93 Unit Mgr. Certificate Number & Name 083 STEVEN E. HAWKINS 06/94 Valid only with Corporate Seal ~'j"'i. ·~i~-;';:'··/ . - <;-.;:~ ¡ . !">~. . I i';'"'' I r~';~7r: ¡, I'" . I""" '".'. . I, I t~:;;;,;;'; ~¡..~",~.,,:,. I'"''·',''' r·':)~~ I"'-;¡i'f/; .I~,:';&;~J' " :'~:~;' I·";,,, ~~~::~: , " [' ] TANK(S) ONLY, TANK SIZES & PRODUCTSTESTED ,1 3 SUPR UNL REG UNL JACO OIL COMPANY INC. 8 JACO OIL COMPANY INC. 259 HOWARDS 1701[ UNjON AVENUE BAK~RSFIELD, CA :\\\,,'IIf""'I~ 3 LlNE(S) ONLY, L 3] LEAK DETECTOR(S) ONLY. S~~~~~"CORPOIl4~ ~ ~p ~~' ~OP 0.;1)' S~ FC) y ::*, ...... ~ 2 PLUS UNL ~. SPA: ~\~ \'ð~,-----/ ~,,/.qWARE) ""II;""",,\\\~ TEST SITE ADDRESS: LINES TESTED lA, 2A, 3A LEAK DETECTORS TESTED 20493-3856 XLP, 30292-8719 XLP, 30993-3418 XLD U.S. Patent #4462249"CanadIan Patent #1185693. European Patent Appl. #169283 . TANKNOLOGY lVacuTect are trademarks 01 TANKNOLOGY CORPORATION INTERNAOONAL :~{t~~· .. VacuTectTM TEST REPORT S.O.# 030726 r Date 12/01/93 ~~uwnel JACO OIL COMPA~Y INC Site4#: 8 ¡ 'í"j"t <800> 253-8054 I~it¡:'ij" '" Phone Invoice Name/Address USTMAN INDUSTRIE:S, INC 12265 W BAYAND AVE. #110 LAKEWOOD,' CO 80228 Aftn: BRUCE McDUFFY ;~ ~Slt~ Name/Address JACO OIL COMPANY tHC. 259 HOWARDS 1701 U~~ON AVENUE BAKERSFIELD, CA ~ TANKS LINES ; Leak Det " See Ullage TANKS and LINES Tested to CFR-40 Parts Dlao. Tank Dipped Dlþped 'Probe Water Bubble AIr Line Final Exist 280-281 & NFPA 329 Spec's. For ' DIa. & Water Product Water ingress Ingress Ingress TANK Line Delivery LINE LINE Leak LINE LO(s) NEW Loc. Material Level Level Level Detected Detected Detected . Material , Syst. Type . TEST TEST Rate . Passl LD(s) ffrl . . . . . . Tight . . . . . Tighl Faill Tested Other: I ,e· 1I!nk . Tank FRPI ffrART START START " or STI START END or or & Pfoduct Capacity Lined END END END Ves!No VeslNo Vea/No Fall Line # FRP PS/SS/GS TIME TIME GPH Fail NONE PASS. 1 SUPR I Ulamet8f ," ...., 1A ST P5 8:50 9:20 o :õ'OO T P N Exist LD SNiMDIJMFG: 20493 - 3 8 5 6 XLP UNL -- ,-- ,- ~>.-_. . _.".-->. --- -~ ~, '. Now/2nd LD SN/MDL/MFG: I Malenm \'r=f'es'i~" al D/:rr --.~-- ,.._,,_..~ -, .._,-- -- ---~~ -.............-~_. ~~-~~,. ~--- --, 50,00 S1art TIme: LINE TEST PSI 1:tkpsl: . 1= -~ .- ,.. ,.....~. ----- +"-- --".. -..-..-- . ...^- ~- . - ,,- . ~ . -~~.. , .. ~~;:= Valves y "nrl TI.....· Daamea: :2 PLUS I Ulameler . j"j'l "."" " 1 2A ST P5 9:30 10:00 o . 00,0 T P N Exis'LDSNiMDIJMFG: 30292 - 8719 XLP UNL I I -~_.--.- --------.-.- . ¡ Now/2nd LD SN/MDL/MFG: J I MalenaJ 1:es'i~1I a : ' Œr ~._---'-'-- -,- -~--.---' .' ---'~.-..__..- -----'- . ~.-------------. ~ ----------- - 50.00 t Start Time: ~ LINE TEST PSI ~ ---- .. '-- -_.---~.- _.-.,"-_.~_.' .~ -" --. --- -- ..-- :" _...-.. ". g=:r,::~~valves t::nrÌ'tI"",· y 3 REG ',' ',¡ " ~ ,: ",", :1':,,' ,fn '0' I 3A 5T , P5 .Q_;;L...?, [l,Q ~_~ß_ '" ,9.. 00,,0 T P' Y Exist LD SNiMDIJMFG: D L D UNL -----~--- -~_._~ , ,," æl181 P Nowl2nd LD SNIMDLIMGO 9 93 - 3 418 XL D I Malena! ttk'"r - ~--,,' -...- ~-'--" '.----- 1---.-- ,- ,.. ~-,,-- ------ - S1art TIme: " LINE TEST PSI 50.00 j 1= "~---~ ~--- ---"---~_. _.~..~._~._. _.-~_..-~-. ~.~____~n_" . - g=~:~valv.s y , "....11.....· ' D<IOreea: ..- ..- ',', :~:- ""Y<' I ',"4"""';:" ""';:';"\ "'. J ' , Exist LD SNiMDLlMFG: --,..~--_. ---~.. ._-~- --~-~'--'~ '-'~---'.- - ...- ,.~. .~ " Now/2nd LD SNIMDL/MFG: 'Mamnm nme ot 1'9$1: al Œf - -, -- -~-~ ",--,-- --...------- --..,. --' f---~--- ._~. lA Start TIme: LINE TEST PSI " ~:".., I~ ._..--..~-~ --~_.- ---.------.". - -.._..~.~---- ,_.h__.___ ,-~~_. ---~-,--- ..-. g=:r..= Valves ;, ::nd 11.....· DatJrAA,,, - --I ¡: ( ·.í~: IV-'-'- , ""ii:' " " ".. 1 Exist LD SNiMDIJMFG: " J I _~o_·· ----~ .-- ~ -.~--- "--~ ' ~- -- -'-. .~ Now/2nd LD SN/MDL/MFG: " I MalanaI .. E!:: CI:rf ~.- ---- -_._,.,,- - - --" -~- '-'------ 1--- -.~- - -I 1 S1art TIme: LINE TEST PSI: \ I~ --....,,- ,.._~- ----.- 1------ - ._-~ ,-- ~- g=~=1 Valves f I:nrl ,.",;.,. D.........., '-:- I ul8II1BIer " 1 ' - .. ~ 1 - - .. ., Exist LD SNiMDLlMFG: '~-' -'--'-~' ---~~~-- " ~ ._~'''T__ -- . , ! Now/2nd LD SN/MDLIMFG: I Malanm ~~"a fJI:rr -.-.,,---- ._--~ --'---.-- ~ 1---,-- -- --'-- -- -,- Start TIme: LINE TEST PSI: , I~ 1 -- .,--~,- ---:-- " ,.- --- -~--- g=:~:= Valves "...<1 Tlma' Tanknology Corporation International IANKNOLOGY Regìon: . WESTERN REGION Unit # 416 State Lie. :it State: CA 5225 Hollister St., Houston, TX 77040 , Nt>TE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. (800) 888-8563 . FAX (713) 690-2255 ''rAK-01 -, ~ ,- . 'SO#~"3~ '?~<o' MONITOR'WELLS ·,Well Number 1 ..~ "Wen Depth '2 DeDthto Water : ;PrDduct' DetectI!cI AMOUNT in inches StaiJdai'dSymbolS for diagram be1o.w: .:' " , . ®~I, Q V.R. w I Ball Roat, ". ® Monitor Well ~ ~ 'A' '. (Outside Tank Bed Ar.ea) .@, BãU .Fíoat ':XID Tánk Gauge ' i[!lManway . -[!JIron C~oss' L9C~t;Øp P¡,grarn7InçtuØe !h~.:Vapo~ R'E!Coyery'Syst,m~ , ". " . . . . . . . . U,", 1 0. N. A.C1 ~.. . . ., . .. rttner;'?-s tt .' ¡..J.fZa t..W A..RCl Sitd" ~~ . " "' ~ - 2, 3 5 6 '1 '.4/ 8 9 11 12 . 10 . . , , ,¡ - ® vapor~~fY} .{ Ii!' ..Observàtfon ;Well:, ¡ \!:!J,;. (Inside TankBed~iIa) ' 1 O.-vent ' ~ . 1, '. t ", . " II '. 1 ) [!J~TUrbln~~'-' !, é; : t'; t. '. ' " , ' (¡ I {J: ~ i"., · . . _\ . Ii'· ~. ..I.'; 1_ J-"'I :. - I,'" ~. ¡r .. '''~'; ·v",\ t ¡ c; t 'n .. ' . .:~ t-.. (1 \ · · · · . - . I " f· · · · · · · · · · · , · · ' . · · · ; , . · · , · , · · · · · · . · · · , · ¡ : ',\1' ¡ , , -' ¡r . , .. ".......,..- I · · . ·\).~SûP,q·Qt~:;;'. . .~ t . ~ ' ·r. ® ® œ lL'~¡; 'dt · (it ,vll~;:øe:t--" . · ,. '[® ® 'l!J'l L,t';ftr ' ~ .. . _" .. .. ",·..·1 .. 1 : """;' 1 . . · ·1~1'-f.~~~i4C.~ ~ ·1· " · '·I@(!f:·[rllif.:· .;\: ~ '~f! · .' -. . ¡. , ¡ '...( ~ . -, . : I: -r:. h~,' J .. . I,' ~..;'. ~~ 1. ~ ¡~ß l:~t· ~ < ~"'" ìh' :.t.: '. "'~ If, ~' r~~ . f~ ~~~ .cy.;] c;. .'i'I' t . 1--(;" .. . . !-n t,.\ ~ ~. .J .:., î :!il· . . ::Jl u~ ~ .... .J r~ -: ú . :.t;' '. . . ,; ,,_, I,."! .. d' · . . .....: ': .. i.~'þ , . .. .. ~ , . ¡ .'g ~.. 'j .~); ~ · .. · · · · · · · · · · · · · · · · · . , ." · · · · . . . , .j . ¡ .1 . 1 1 ! '1 . I .1 . ! ., . , · · · · · , . · · · · · · · · · · · · · · · · · · , . .. " , · 1, · · · · · · · · · · .' .. · , - · '. , ,,- 0 , · · · , , · · · · · · · · · · . .f , ¡ . ,_, '1"" ILl .' I, ,·.fl ·i~¿ .(; · · · · : · - " · ., · · · , ; · , · , · , · · · " · · '. ~ · · +\~w, f\~'O .¢.~ · · · · · fO' · ø· .~:c · ~. 's;ì _/ . 'U . :~,,' · · · . 1 · · ~ · , · · - :J · , · /" .: · i"1 · , ~ ~ · , · · · · f' p · · · · , , -~ · · · : .' ,ð~;<~, · ,.8, . · . jrJ, . . 1r' '¡r.J , . . c . l{ t ¡r; 1.;'-> . :,~ 'te ';,: ~ .,..... .. '. ~. ,--. - ~ ~; I : . · · · · · · · · -" · · · · · · · :~r: · .~'1) , " ...~...~ ' .. -..:''''"''' . t'" .~~ .....) · . ~ I' . .-: ,.. ¡ . " , · · · · · , · · · ~ , , · · · · · · · · · · · , ~, , · · · · · ~!. _;; 0 -. ,- !:J " ~ '~:-: . ',' , I · · , · · · · · · ¡ · · · · · . . · .. · · · · , .. · ' , · · · · · · · · · · · , . ;. ... .. .. . .. ~ .. · · · · · · " . · · · · · · ;.,; i ~ .' : i . . . 3" Vapor Recovery System & Vents were tested with which tank? ..... . I . Parts and~Labori used 'v yt...O ~GO 7frc.K.~T ~" ~¡¿..J Il :" :';fÎ' d' ,c..-h , , f AJ (i :"? A . r¿~p(fi C-(3;,O 6ih· . <,it. 17' I ", , !I"?, ,. I ' . ~.;>:; ~. Pl<ðlJU r.+- L, ,v (; + L 1') 7-~ ') I' ,; ,^ '-'.1:-: III ("'r . ~~' !~ , ¡' ¡ .., IF I , . " .. ....' ~ <- ~ ( ~- -- ~......; General Comments: r- 'V7V~ f.l+" I , , , . - . ..~ .~. . . , ~ ; .' " I,'.) I r ¡...- ! 'k, ,:- ) I .~ '..1 1,- .. r4~ . ~ " " When OWNER or local regulations require immediate reports of system failure-Complete the fdllowlng: · .". ~. ¡ :'. REPORTED NAME DATE TIMe -~' !U " ¡,,-.-', TO-. 'J ¡ 'J i. r·· - FILE NUMB~;c ;:~: i~ 1~~ fi!Š I ':,'.~' ¡O p t,.·.·" Vacu1eCfl'M Certification Number" ~ '4""~ -IF ' ~. ~~!:.::: H :,: k ~ !I",.,.' g , ,,' ~-" ~ ?!" .~ ~ ~~ 'ðC> ' ::1,'-,,1; ~:~ ? >I'~"" "',,;,: Date Testing comptetecl ~'~ ~ 1 l~ /¿:J. -/ -9 J .'} ~ i-r ~~ r ,,:--'~~ OWNER or Regulatory Agency Phone# " L , . .. "" ., ., ....i " Pnnt Certified Testers Name -, - :¿5',f~GN G 1f,Qu.J¿,rVS Certified Testers Signature "'~' :_--~-"S:-' J;: .A - , , -- , ~ ..... - '\ . e Jaco Oil Company O(()OCoC¡ '.' 3101 State Road Bakersfield, California 93308 Telephone: (805) 393-7000 Facsimile: (805) 393-8738 Post Office Box 1807 Bakersfield, California 93303-1807 June 27, 1990 <..~ , , .. --''!::)~ "y" t -'~:-:/ ~ .,; JUN zo {~ . 0 1990 H .~ ,RECEIVED J "-,"~'\/ ' . . ~ .. , ..' . .~ \ I ! r ! \ ~ '..~.</ '-..(' ,..' J-.---'"' Kern County Environmental Health Department 2700 "M" Street, Suite 300 Bakersfield, Ca. 93301 Ms. Amy Green: Please be advised that the attached forms are those forms that we have requested that all of our operators in Kern County utilize in completing underground tank monitoring. Please advise us if you have any problem with these forms. A. I~: ,I, ;f t;!! . I.t,\ r ~~ . " " ,;! ¡,f;' H! ' J~\; , ,~, '¡ii .: '.'1', "1 ~',L t~¡ '; 'fj !~;:"I i¡ ~ :!) .. '¡ :,~!~ V, ,i , LI ¡,: ~~ , I , 'I';'! : ' ! ~ ,.; I ,1 ¡ I : , ',' Gala. over/short TOTAL Gala. sold X 100' Variatioq ÞI _t. over/~t' exceed 350 gall' _ Ib - ODnU~ ttanitori,,? " _ Yes - Jlepor~ within 24 þra 0ai " ' ~ry Does the variattQn elœed 5'1 ~i' _Ib" ~tiW'f~Une -ri~.,,~ " .J.. ~ =-"pofF'~' "raitt~ AuttØltY~ ,.,' wit" 24 hra of dlllQOlNl~H . ,~ ~ TOTAL Gala. aold _. .' I 100' Variation I»U _to over/~r~ exceed 350 gala! .-,;. ~ - ~U~ ~~tor~ . Yeo - ~pott within 24 hI", a of1 .- - . ,-., ." ,- ð ~ry Dolls the variat.O'I exceed 5\1 '.- I ~ Ib - ~t.1n\le routine .onitocing I _ ~ :....pa(~·to IItraitting Au~Jty witl1~ a4 lira of 4iBCCMrytJ ' ~ ,- . , TOTAL Gala. Bold - . X 100' Variation - .,. Doea _to over/*rt exceed 350 gall'l. f _ Ib - Ç,Q!\t1f1\11 Manitoring ': . _ Yaa - aopor~ within 24 bra 0ði8QIMß Doe. the variatlœ ucee4 5\1 . ," 'Ib - CDltinue routine .onit.or!ßg ~ = ~es - pepor~ to Perattting Autho:1ty , withifi 2~ þca of ~ilCOW~': " ¡ ., ... 7~ , D. over/lhort-¡ TOTAL Gals. ao14 X 100' Variatio!' Þa eat. over/~rt elœed 350 gala?: , Ib - CDlUnlf Monitoring = Yes .: ~porf within 24 þra 0áiscove Does the variatiœ exceed 5'1 ç ry _ Ib - ODntinue routine .onitorill!i _ r.. - Jlepor~ to Perattting Autløtty , Withiil 24 hra of c1iBCCMry . Gala ov.ì/.hor~¡'~ B. B. n. ~ ) I I I ¡ ¡ \ J ¡ I ¡ 'I r ¡ I I I " ¡ \ I ': J \ I ) I I i Year PERMIT OVER/SHORTS CALCULATIONS Month ^ on OVER Locat PRODLJC'l':_ GALLONS SOLD 1 2 3 4 5 6 7 TOTALS 8 9 10 11 12 13 14 TOTALS 15 16 17 18 19 20 21 TOTALS 22 23 ) 24 25 I 26 27 28 j 'I'OTALS - 29 I 30 I 31 TOTALS MONTHLY GRAND TOTALS (TOTAL SHa ~TMJ~, I ; SHORT OVER PRODUCT: GALLONS SOLD DAYS 1 ovp.r/short ______ X 100' Variation D. [Qe¡¡ amt. over/short exceed 350 gals? _ NO - Continue /t:)¡jtoriO<) _ Yes - Rc~rt within 24 hrs 0åiscovery Does the variation ex~~ 5\1 _ NO - Continue routine lIOI'Iitoring _ Yes - Report to Permitting Authority within 24 hrs of discovery ~ - A. Gals B. sold over/short Gals. sold ___ 100' Variation Docs amt. over/short exceed 350 gals1 ___ NO - Continue Monitoring _ ¥es - Report within 24 hrs o~i:¡c;)V'!r Doe~ the variation exceed 5\1 NO - Continue routine lDni tor ing - Yes - Report to Fermitting Authority - within 24 brs of dillCOVery TOTAL Gals TOTAL X _Gal:; ---- --- I i 1 1 SHORT DAYS T 2 :3 4 5 6 '7 TOTALS 8 9 Iõ 11 12 13 14 : 1œt:(J A. __~___GalS over/short . TOTAL Gals. Bold 1 - X 100' Variation I B [kJe5 IUIt. over/5hort exceed 350 gala? , . - _ NO - Conlin.. It:InJtor ing - Yes - Report within 24 hrs of - discovery Doc~ the variation exce~d 5'1 - _ NO - Continue routine monitoring - _ Yea - Report to PerlQitting Authority - within 24 hrs cf di500Very WI'.~,K 4 ^. Gals over/short TOTAL Gals. sold - X 100\ Variation ~ : D Does amt. over/short exceed 350 gal~? 1 _. Ib - Continue Mooitorin<J Yes - RcJ))rt within 24 hes 0á' ! u_ I GCOvery lJoc~ the var iation exceed 5\1 _ tb - Ccntinue routine aonitoring _ ¥es - Report to Perlllitting Authority within 24 hrs of discovery 1'O'fA : X 1001 ,. ... . Dooa Variation ~ 1.5'? ~ _..It» t ~t1'" ~~ine tb\i~i..; ,; ___ ~s '"r:~~".,~!!r~~~~~~~\~, D. ì 6 I ( I ¡ I' amount? exceeded chart Have your shortages Yes No If Yëš, report~Kern County 1 f ,t%, con tinue mon t to_l'i no ,Gals over/ahort TOTAL Cala. sold X 100\ Varia/lo ty Docs Variation r.xceed 1.5\1 _ NO - ContinlX: Routine It:Initorlng Yes - lleport to Fen.ittifI<J Author - wi lhin 24 hrs oC di:;cnverv I:;NiJ "McJH'l'i A. B -, 'I'OTALS 29 30 31 -TOTALS MONTHLY GRAND [TOTAL--šRC.1RTAG ES ~ ·TOTALS Have your shortages exceeded chart amount? Yes No If Ÿëš, re~rt~Kern County If No, cC)I)tinue monito ' TOTALS 15 16 17 18 19 20 21 TOTALS 22 23 ,A...2! .., 25 ~ ---21 --28 TOTAL GALLONS Leaded Premium · - Regular · - No lead ~ UnleatJed Premium · - - - Qiesel · - - - TOTAL · - - - - - - - CIGARETTE SALES - - - 0.. PUNCH TOTAL OFF UNI - ) pJCf \ r I ,\ - II ¡ i _ - REMARKS: 4MOU~ t:J STATION NAME: I CITY: - I- ?III ~ ~îll G> jill - I Tolal Finish - TOlal Start - TOTAL - Pump Tests - TOTAL SALES If I I I . I : I ¡r , I ~ED PREMIUM iii l Gallons Monèv . -\ ' , I '( L.l \ : , \: _.1 I I ~ 1"T \ ~ n I I i , I i J .1 I I .L I I J.. I I J. , I I I I I I I I I I I I I 1 \ I :1 '1 I, ) i i ¡ 1 , i - -- -- -- -- - - - - - I . r· - - J - L Prem. - Reg. - . No Lead NIL Prem. - Diese' - Total l ~ ~ ,', - · ~, : " ...: · · · ¡ :~11 - " Beg, In" I REGULAR @ Gallons I I i I I I 1. I I I i I I I I I I I I ! I I I I I I Add Rcpls. " Monev . I I , ï I ..!. I I .1 I .1 I . .1 I I I T I I I I I I , I I , I I I Sub. Sales Gallons I I T I I I I I ì I I T I I i I . j , NO LEAD @ T I I T I I I I i I I Book In", I I J. I I I ï I ..1 I I J. I I I i I I Money . I J I I .1 I I I I ! I I Inctles Gallons UNLEADED PREMIUM @ - - Gallons Money I I I I T I I ï I I - I I J I I I I I I i I I I ! I I , I I I I I + or - - I I I i I J I I I , I I I I I I I I I I I i I I I I ì I I I , .L I PRODUCT . GallQns - t>· CASH SALES I r · , , · , I , , i I I I I i I J I I I , I I · I i I ! I I I 1 MoMy 1 ~ , -L- I , -1-. I I --L..... I .. , i.. I I I I , I I . - I I . ~ I I - "":. , I I ,I , -l JACO Oil COMPANY. P.O. 801 1807 . I BAKERSFIELD. CALIFORNIA 93303. (805) 393·7000 L " . Monlh _ _ Day _ DIESEL 0 .. . 19_ . - ,Jaco Oil e( Company ,-/\ - .-' '- / 3101 State Road Bakersfield, California 93308 Telephone: (805) 393-7000 Post Office Box 1807 Bakersfield, California 93303"" 18 May 26, 1987 ,CI Kern County Health Department 1700 Flower St. Bakersfield, Ca. ATTN: Ann Boyce Dear Ann: Enclosed please find a copy of our revised forms. These forms and procedures will be implemented system wide as of June 1, 1987. We will be holding meetings in our office on May 28, 1987 at 9:00 a.m. and 11:00 a.m. should you wish to send anyone from your office. Si~r;;;~~ Roy F. ,Saunders RFS:js encl \) e .( REPORTING PROCEDURES FOR INVENTORY SHORTS/OVERS Any loss that is reportable under the guidelines must be reported to the Health Department and Jaco's office. The guidelines for reporting are as follows: 1) ~ny shortage or overage on any tank over 200 gallons on a daily basis must be reported to the Health Deparmtent and our office. 2) Any shortage or overage over 350 gallons or above 5% by the weekly calculation must be reported to the Health Department and our office. 3) On a monthly basis~ any shortage or over~ge over l~% of monthly throughput must be reported to the Health Department and our office. 4) On a monthly basis, if your total number of shortages exceeds the action number chart it needs to be reported to the Health Department at once. The Health Department reporting number is: 805-861-3636, 24 hours a day Jaco Oil's office number is: 805-393-7000 The Health Department will need your location and permit number for reporting purposes. e eí Jaco Oil Company DAILY REPORT INSTRUCTIONS A) Fill in the month, day and year at the top as well as the location at the bottom of the page. B) In Area #1, write down the pump number, total gallons and total money reading from the console, or the dispenser as the case may be. C) Line #2, is the total of all pump readings. D) Line #17 is the start figure, or totals carried forward fro~ the previous day. . E) Line #8 is: Line 2 less Line 17 for a total sales figure. F) Line #9 is for deducting pump tests that were returned to the underground tanks. G) Line #15 is the net total sales after adjustments. II) Line #10 is the total sales in gallons for the day. This should be taken from Line #15. I) Line #11 is the total sales in money, by grade, less pu~p tests and credit cards, if any, to determine your deposit. J) Line #4 is the beginning inventory by the prior days gau~in~ (Line #5 of prior days report). K) Line #12, receipts are gross gallons received for inventory. These gallons are not to be temperature corrected. L) Line #14, these numbers are in section 10 which c~ne from Line 15 of the report. (Total gallons sold by grade of product). M) Line #5 is the sum of Line 4 plus Line 12 minus Line 14 to determine Book inventory. H) Line #3 is the inches you gauged the tank at the close of the report, 0) Line #15 is the gallons those inches represent from the tan~ chart. P) Line #16 is the difference between Line 5 and Line IS. Q) Line #15 is your beginning number for Line 4 for the next day. Line #2 becomes Line 17 for the next day. Special Notes: 1) Daily tank gauging must take place at the same time that the final shift is cut off for the day. It is imperative that this be done to have accurate paperwork. 2) It is reconunended that the gauging be performed by the same people as much as possible. 3101 State Road _ Bakersfield, California 93308 Telephone: (805) 393-7000 Post Office Box 1807 Bakersfield, California 93303 , . ,- I 'i r '" ~1'" n".c. TIO Y\ '\. \ ( '"\.' \ I / '" r:: i &.. JACO OI~_~OMPANY. PO BOX 1807, BAKERSFIELD, CALIFORNIA 93303. (805) 393,7000 Iì ~ Month" \ \ 1 Y ~ _ Day _ _.19___ " LEADED PREMIUM (II 9 /0 REGULAR ,1/ C>l10t NO LEAD it, C ,.,: _Lt UNLEADED PREMIUM \'s. -I' t C} ~. DIESEL .<l . , 1/ /I. X -, /I_ .:">V-~( 1/ .' "' 1/ _ ~ Gallons Money Gallr,ns Money Gallons Money Gallons Mqney' Gallons Money : I I I I.¡ I \ . J I ~I' ! 3?;C",X) fIh )C~ï t¡:) I 4S~C) :1/a'-it)4() 4\ ~5~~? ~)Z::2 12C 3J:) 4 D)Œí ~4-qu-~1 ~l~' .: : ¡;E t; I I t I I I I . I J ~~ r 5 (rJ~ S<:~ f/Jl1:h t5 7 ~Lj.q2~4 /-J4~ 6t2 ~ 7?-{+~ ó:>9 ~~~ :\'J. ,II IoQO ~7 L.)g~jO :\C¡, : : H II ~ 10 ilq I k2ç) ~ ~ 7 'l "6q.,,,>~ \ ~~ -:r' Ie.;¡ ) ~O q .$K 77 ~ -<t l \ J ~ i I :~, "} rrr €-c.\.1- : ~-gll fà I I 1/1 I ! I.J I I I I I ~:, I J:i(\ ~Tru.c..ì~ ~ ~ I:;t, \.~ (11 Œ 7{t')~:~2.. \'-1 /74 ~~ 'Sllo(;; :IK BI( 302 :174)<2/+~: \ :~\ : A ~ ~ ) : . . _.;. .,.* ","' ""'" -:c"'>""'4''''''&-''''='-~ ......'...,.' ,.~. '" ~\~,,,=..,,,d,.,,"., . ":~~ ." ""'t', t +~""':';J" ..,~: ~ I I I I I I \ I ¡,. I J I I 1 ¡ I I I I I I I I , I I I , I I í TOlal I I I 'I I \ I st t'DI\ Co- '" I Finish t:)4D¡¡ tnIIQI,,~7 m ~/2 ~~n gí .:L/L.l~(Æ :JJ 'À~fí bp, !1IJl, 7 m Z I:J!J.. 'R I /1,/ t·~ :B7 - ~i :~" ~ ~ Total I. I , I I I I I I I - t .f) I Starl 15307 ~~ !\S<~?B ~\óCP- ~ ')Ll ,~J-l:S" ~(V.:::J.(- t9' :2a'Xf rsx: ~qS- .j~ IIA-=W :10 ~ ~~~ Y\~~~~ ~ I ~~ I I I I I! IT"". Lo' ~ I TOTAL I I .¡... ....& ;-t'I.lCo ,,'0 s:;. I - I <gq 4J 11LJ-- l¿., '1{í.J,"ZL 9/)1 1P, \/l4q Sw I {)'i\(" 'l1 ;)?:Ø ,J5X J.ILfI i71 - ...1...... R H ' J:~+.....(adja... F:: ~l ~NC.t(O.. ~ I \ ~~,,-t.r~Ot ðr\ .: . L-~~Q.. ~'I : c.,"\i6.J\J: ?I~J~ \1. I : _""M ~~:tJ /a : '- ~ t ¡:-V\~ tv'~c.t{o,,: ~: ~1" l,\ "'~ '" 1 ./ Y\~'tV",c.t'tr\ ~ t\.1i~ 1 '"' ¡:f\&~"':r .Y L..'Y\~p5"" ' . L:-, V\¡¿ I c:- , I ~ I 'L_ 7f j; '- I ~ I\'f ð\:t ,~5'" í\' a..1~ . /i ¡ , I . TOTAL GALLONS I Beg, In~ Add Rcptso"" r Su {Sales I Booaktv. I I ~s Gall8ñS + or -. ~ .r~~"'';.ilj'" p ~ · qi~? \? r¿n ~-3~~ ?fi.1/v, 1(;R70 +-(j7 'I PR ðu'è q7~ · 7:J.- ~I 3Cf16 i= ~ ~ t 7(110/ -rlq&, \ LPrem. ~ · CX{) 31C1\ ¿±qJîB- \ . _ 7(P r l(; 5S..1h../77 I ,~' -c>C \ Reg. ~3 ~ 3lorO¡ _ f)?J ~4l .!)'" ?tJ L?;f:):r7 +-~µ \ No Lead · NIL Premo 905~ =-ëfr - ~ I I ¡-- I I :t ,.;:;\1 CASH SALE~ j::. ¿It /' "",\ · to 1.0 .~'b ·'1>7 ./7 · \JL1 ~O~ )ö ~ (" ~\L\. t=.-' · · · ·63 - i?6ž 7~ __ Diesel - - MAY 11 REC'nJ.q1l /1 = ~! I Less Cr. Cards _ ! Less Pump Test DEPOSIT Leaded Premíum Regular No Lead Unleaded ,P¡emium ~ c.. \"\ - -.s~Ed; ~ \0 - .\ f\~. TOTAL Pump Tests TOTAL SALES - L - ), t, t REMARKS: - "- - T"ITY~ - \9. -:tÞ . \~ - T A TlON NAME: ~, - AMOUNT - T , - ï I I - - CIGARETTE SALES ;; ï:~NITPRICE . TOTAL --- I -- I - ON I PURCH, L- , ' y:. ,.:,,:.~·.I:"': .. ';.'.. . .~; .~.- , , -",'e-",· . . '. ~. '... ;:~;':~:~-?;ŸjL;,:e:i~ . . . . , " . - ::~, r . .' . . , "';~~(j~\;~~,~~"g;;}:0~';'~j\~~,~e~~:~Þ:~:)\~~~i~~~}~10.ti~~~tfirf.jf.&i~~~#'~~k~~~~~~!,~~~~~·~~~)kÙ:i:~t~:;:~·,~~~;:)~~:~'~'~~':';}"~';""~'\'~;' :"_: :. ' ',:.,::':-:~'\'~~';;f ~:; , . ..... .' ·t··: -' '. :.' ~. M: ~ ~.;'. 1 ~ J I j ~~I FÜËLS INC. BULK PllINT 2200 E. BRUNDAGE BAKERSFIELD. CALIF. 93307 (805) 327-4eoO SOLD TO: DATE ---L.-1-, ACCT , P.O. , Truck /I F 0. b t-t'I'f ) c¡ 'i C{ O! SÐ CÅM (0" SHIPPED TO: ¡::. V\ J€ J1 tc 'f , , íy ,ßu ~e('&fíQI~ Cd.. SALESMAN' _ : ~ d (/0 V\ .s B/LI PART GROSS 1\ PRODUCT GAUGE UNITS PRICE 1UTAL BEFORE AFTER GAULBS PER UNlr PRICE 1 l.(é)CX F ~ular Gasoline· Aammable Liquid UN1203 ',~~,:"..,,:" " ~46) 01 j 02 ~OO'C ~ p Lead Gasoline· Flammable Liquid UN1203 "'¡~'ff I ¡ 0 \ ¡¡rem, ND Lead GasDline' Flammable liquid UN1203 ~ - ..,. 1 0 Premium Gasoline· Aammable Liquid UN1203 ~ - 1 ¡ 04 Diesel Fuel 112 . Combustible liquid NA1993 PC OTY PKG PART NUMBER PRODUCT DESCRIPTION 1 j / .. 0 Combustible liquid Sub TDtal , - Flammable Liquid 0 Net Drums Sales Tax 80 Drums Delivered ( ) Returned ( ) @ $20 80 Drums Delivered ( ) Returned ( ) ~ $25 I This Invoice Includes Call1ornla and laderal taxes II applicable. Terms: Net by the 10th 01 the follow· Freight/Delivery Differenllal Ing month, A In% Inlerest will ba assessed on past due amounts, which is an annual percentage ----_...- I 01 18%, In the event an action Is brought by wholesale luels Incorporated for the collection of sums Invoice Total I due. reasonable attorney's le8s and costs shall be peld In addition to the sum due, " :'(,', Charge--:...-CII.ck ....!-.;...-.,;... Cllec" , )<:1;_,;'. ~ Received by X C,Q,D. (Cash)_ WHITE OFFICE BLUE NUMERIC GREEN DEliVER' Delivered by , e ei Jaco Oil Company OVER/SHORT CALCULATIONS 1) Fill in Permit #, Location, Month and Year. 2) Identify each product you are keeping the recap on. 3) Enter the total sales by product from Line 10 of the Daily Report to the appropriate date line. 4) In the Plus and Minus columns enter the amount over or short for each day from Line 16 of your Daily Report. S) The weekly total on this form will be the figure you will use as your gallons over or short for the week you are working with. 6) To determine the gallons over or short, you take the gallons over, less the gallons short, to arrive at a net number. This number can be a negative number. 7) The monthly recap will be the total gallons over less the total gallons short. Again, this can be a negative number. This is the total amount over or short for the month. INVENTORY CALCULATION 1) To complete this portion, you need two numbers: a) The net amount over and short from recap of overs and shorts for the week; b) Total weekly sales by the meter reading also is on tne recap. 2) SECTION A: Enter the net gallons over or short for the week on the first line and total sales for the week on the second line. By dividing the gallons short or over by the gallons sold you will have a fraction. By multiplying this fraction by 100 you will have a percentage of variation. SECTION B: Simply answer the two questions based on the information you have gathered. At the end of the month a recap of the month (28-31 day period) shall be calculated usinß the same format. 3101 State Road Bakersfield, California 93308 Telephone: (805) 393-7000 Post Office Box 1807 Bakersfield, California 93303 I e e( Jaco Oil Company 3101 State Road Bakersfield, California 93308 Telephone: (805) 393·7000 Post Office Box 1807 Bakersfield, California 93303-1 ACTION NUMBER CHART In an effort to detect leaks, an "action number" has been d~veloped. ' For each month you will count the number of total shortages by product. If a product comes up short more than the action number, it indicates a possible leak and is to be reported at once. This recap will be totaled at the end of each month. At the bottom of the over/short calculation. ACTION NUMBERS JANUARY 17 FEBRUARY 15 MARCH 17 APRIL 16 MAY 16 JUNE 16 JULY 16 AUGUST 16 SEPTEMBER 16 OCTOBER 17 NOVEMBER 16 DECEMBER 17 I ¡ I I I I i i I ; '" U) / C.;¡l~. nvcr/z:::--.r l - .- , ,-- - - -.----- TOT.1\J, Gals. ::old -,--- X lOO~ V;¡riùtion Doe~ affit. over/~hort exceed 350 9ùl~? I _ No - Contwue /I.o:'litoring I _ Ye::; - r-cport within 24 hrs 0áü;cov¡;,ry Docs the variation exceed 5%? ; _ No - Continue routine ~nitoring _ Yes - Rc¡::crt to pc:mitting Authority \'li thin 24 hrs of dj ~coveT' } # ¡ ) /) -/ < -/-.. -7 ...- . \...- - -_.- -- --- --_._- Year ,. 7 :/ -- 'J' I ORTS C^LCULNf'T ONS Month_ J;~( L\Q....r-'t- ,_ :R1'¡ r /I µ V~:RI S _ IIi ~~ X 100' Variation Does amt. over/short exceed 350 gals? _ No - Continue ~itoring _ Yes - Report wit!1in 24 hrs 0åiscover Does the variation exceed 5%1 ' No - Continue routine =itoring - Yes - Report to Pe:mitting Authority - ~Ii thin 24 hrs of discovery Gals aver/short TOTAL Gals. sold , D, Wi:.~-r A. B ~ 1 ~ ,! SHORT R WEEK J A. Gals aver/short TOTAL Gals. sold X 100\ Variation -:" D:>eS amt. over/short exceed 350 gals? No - Continue r,mitoring - Yes - Report within 24 hrs of - di=ve DoeS the variation exceed 5\1 No - Continue routine =itoring - Yes .,. Report ta Permitting Authority - wi thin 24 hrs of discovery Does amt. over/short exceed 350 gals? No - Continue I'J:1!Iitoring - Yes - Report within 24 hrs of. _ O:LSCCIIIe DoeS the variation exceed 5'101 No - Continue routine =i taring - Yes - Reoort to pemitting Authority - ~Ii thin 24 hrs of discovery X 100% DOSS Variation exceed 1.5%? No - Continue Routine !'.onitaring - Yes - Report to Permitting Aut!1Ority - >Ii th." 24 hrt: of diccovery Gals over/short TOTAL Gals. sold X 100% Variation Gals over/short TOTAL Gals. sold Variatio MüH'!'!i END A. '-'J::.J:,t\ A. D. B B I ¡ 1 , 'I " , \ \ I amount? SHÒÍlTAGES) exceeded chart PRODUCT:__ D!\YS G¡d,LONS SOLD OVE ---r-- - - 2 --- - 3 ---,- 4 I - I => I 6 I 7 I TOTALS 8 9 10 11 12 13 14 TOTALS 15 16 17 18 19 . 20 ! 21 ¡ TOTALS I 22 \ 23 24 25 26 27 28 TOTALS 29 30 31 TOTALS MONTHLY GRAND TOTALS J I ! l~ 'i'" '1 " _' , ~ \ LOCi) t 1 011_ " l,r :"j T £.l.t ~ ~ - -} --- PRODUCT: -~~..ft-L\.ÌÇ...r::_ _, ' 1)1\ YS GALLONS .c;()J ') 'I' \1 ~H ;1., JI~ r -" , 1 I ' i5f~ -t- c;- ., __ - 2' Ci~-c... - ~s- -'-3 I L\J 4 4- ~ì -- :3. -'~ï II C "? 'T" ç-~ -'S ¡"') Î 'I - j/'.l. -6 j , (¡ ï -r, L 7 i') \1 ~ 4-- L¡ "2 6' T(j'I'Þ.LS C/.(.., 0 ;---(':\-1:: - I ~~' \ t; (:f-.z<7..¡... Cï "') ~ 9 I ¿ ~ ~ _ ~~ A. ~, 10 \7Ç~ _\~} - 11 (I \. L I +-- C\ f"I 12 "c:'7.' I _ «c;-"" B. 13 D7¡j -r'-1"Z 14 ) ~~ -;-~ ~\ TOTALS t;¡ - C ...-:>.(t., - 2C I U·~ T:> I~[C _~ 16 q -t- ~\( ~':¡ 17 ) c)2 +-1'2-'<" I A. 18 1')'17: _ 111'"1 19 ~'Î-';- ~ 20 I b'l - -1('") B. - 21 \1;7. 1-~ ! 0-( TOTALS ~TI \ -f-"3.2..~ -2\~ I 22 c¡-~ ~ ï 0 ; 2 3 'Cj 7 ~ ....... LI c:;- ) 24 121.f2 - 7h ,~ J~ 25 IDS' _?" ;} -- 26 Cf,7', ''-« ~ I 27 I ~ \4 ., T'"' \..\., . 2 8 \ 1 I _ '1t E ,TOTALS ì '''P- "'") '" e- n. 'f( I '-o:õ -2'9' "( ~ ' -:¡::-;; 3 0 i 0 b 2- .,.. ~) ~ ~ 31 "..." -81 vI TOTALS I '"2 'it ~ ""\.4 ' ~~~~~L y ~ \1 \. 3 t----. " . TOTALS ,·.1.'U%AL IRTAGESJ 11=;-4 .3 _U Have your shorta~s exceetled chart amount? ~ Yes___ No ~1 If Yes, report to Kern County If No, continue monitoring If:.],___ :,1 uv( 't), ~J~u_ ,_TC ,';,1, G:'1l:; --,I..L9..7..\<.__;: ],In V..riùUü,", LY~.:; ~l1t. '.J:·'::r/::;h~Jrt l!Xcced 350 gùl:;? -':1.- No - cc;¡tinue :'b:;lluring ___ Ye::; - ~'port withi" 24 hrs 0ðiscuvery Does the vùr iation exceed 5%? ~ No - Continue routine monitoring Yc::; - R:port to Permitting Authority --- within 24 hrs'of òiscoverv .L.l\ ¿ ~ --- " Gals over/short -i- <6\ 1 ~ TOTAL Gals. sold () X 100% Variation Does a.":tt. over/short exceed 350 gals? ~ !b - Continue Nonitoring .. ___ Yes - Report within 24 hrs 0åiscovery Does the variation exceed 5%? .$ !b - Continue routine ucnitaring Yes - Report to Penni tting Authori ty --- within 24 hrs of àiscovery ch: r l :3(·ld :.:, :+ '- F- , () Gals over/short ~J TOTAL Gals., sold ~/I(;~: X 100\ Variation "'j"'- .~ Have your shortages Yes No If YeS, report~Kern County If No, continue monitoring (TOTAL lbes amt. over/short exceed 350 gals? 4- !b - Continue M:mitoring Yes - Report within 24 hrs of --- discovery ~s the variatioo exceed 51? ..2 !b - Continue routine =i tor ing Yes - Report ta Permitting Author i ty --- within 24 hrs of discovery LLK 4 ~. -, () 1 Gals over/short , -:- ì 1 ~ 2TOTAL Gals. sold ,.3 t,,) X 100\ Variation lbes amt. over/short exceed 350 gals? ~!b - Continue Monitoring Yes - Report within 24 hrs of. , --- à:Lscovery¡ ~ the variati:on exceed 5%?" ...:J: No - Conti.,ue routine lIa1i taring Yes - Rerort to PeDllitting Authority --- I~iihin 24 hrs of discovery over/short ;:5"' I \..I "7. TOTAL Gals. sold 6 .., ~) X 100\ Var iatio~ ~s Variüticn exceed 1.5~? ~ !b - Continue Routine Monitoring - Yes - neport to PeDllitting Authority - wi thin 24 hrs of discovery Gals -ly7 . ¡uN1'!i I:;¡~D A. . p¡:rníJ'T' ;; Y c: ¿H uvrd~/ ~!1lJt('n; C/\LCLJL/\'I''J ONS f\~un t h ;, G:>l:,. ovc':'/.5hc.·:-t .-------.---- -1 ~ 1 -- ----.-------- PHODUC'l' :____ S GhLLONS .sOLD ---_. ---- ! t -.J ( , j j ) ! 1 :¡ :j õ¡ i , 1 ¡ ¡ 1 I I , , h:s 0ti:::::~J'~":::' ....O,L..,.......ve!"Y! i !:oes 2.o"7It. over/short cxceeå 350 c;als? :~ - continu2 ~~itoring - Yes - Re1:ort ~i thi... 24 ¡-.;os 0=, : -. å"~-\."e-~ DOeS the varia'=icr. exceed 5i.? ~-~ .o¡ - ~~s-_~~~~\~C~~t~~~~;~;rit...! - within 24 h=s of disoo.e:y " ~ TOTAL Gals. $clõ __ X 100% Va=i~tio~ ; D:>es amt. over/srort exceed 350 gills? I N::> - Continue !·~i :.=~ing " - Yes - Rei:Or"'" \...:+'-1';... ,,, h".s 0&_ - - <p .-............. -"'¡ ... lhscover"'JI Does the v-a=ië:tic:: exoeed 5~? i NO - Cb~tinuc r~~tir.~ ~nito~in9 j = Yes - Re?C=~ ~c :P~c.itti~9 h:ltro=ity: '·;i thin 2~ ::=:; 0= ¿:'~c:overy TCTA~ Gals. sold X lO~% variatiC':1 D:>es 2.o"I',t. over/short exceed 350 sals? ____ 110 - Co~tinue }~~it==ìng _ Yes - Report within 24 hrs .....F ~ "-_"', ~s the va~ietio~ exceed 5%7 tb - Co:'\tinue rOi.:tL~c r.cnit - Yes - Report to Pe:n-.itting it;( - \.¡it.hi.n 24 r.=s of disc Yes - RCi=Ort t.o Fc:=:-.i ~ting ;;:~t.h~:ity ,·;it"-;1:""\ 24 1".:s c·~ è1S~I"'"-~~n.. Gals over/short TOTAL Gals. sola X lOO~ variation Gal.s over/shc::t r .~ :: 10:';:" ':~rj.J~.i ovc::':~;-.:,:t cx=e::.å :;50 S~·?-...? C-':.õ1tir,l;2 !.~:1i t::):: i:19 ~~port ~it~in ~4 G¡;.ls ovc:ishort Does th~ vûri~t~c~ cx~eed 5%7 ~b - Cvntin~~ :c~tinc ~nitcríng ~, : c,\"cr 'To'.:" G<:lls ________(,.1 ---- ---- 1).);;;$ ~_:: N,) - 1·c::; - - ¡..¡r:1::i\ .j A E ::''::'1\ A n ----1 I t I 2 I I ; 3 I 4 I :; I 6 I 7 I I TOTALS I I 8 I I I 9 I 10 I I I 11 I I I ! I I I I 12 I 13 I I 14 I , TOTALS I 15 I 16 I ! 17 I I 18 I 19 ¡ 20 , I 21 I TOTALS I I 22 I I 23 I 24 I 25 ! 26 I I 27 \ J 28 I TOTALS 29' I I I 30 I ¡ I I 31 I I I TOTALS I I MONTHLY .1 GRAND , D Wt;.L:.h. A B SHORT PRODUCT :____ GÌlLLONS sor.n OVER UlIYS I ì ~ . -, - SJJ ii}::'I' I , TC'i'AI. Gùls. :;olð T 1----'--"---- ï - -_. -------- ;.: ID0~ V;;riiltil,...:) } ~ r·.x:~; ê..7It. uv('r /d1~rt px=ecd 3!:JO gal~? r _ t~~ - Cc:-,ti:.~~ H:r.:it.o!'i~9 I ___ Ye5 - R~fc:t within 24 hrs 0ðizcovary , Lo~~ ~~c v~riütion cxcecà 5~? i ___ ~b - Co~tj~ue =outi~e mo~itoring i _ Yes - R-:-;:o::t to Pc~.jttin9 Authc:ity '·,'1thi:-; 24 r.!'s ("..: r1Ü:~)\Ierv f T r T wt..::'l\ .: A. _Gals over/short -- , - - - TCTA¡, Gals. sold t ~ - - - X 100% Variation I D. Does ~~t. over/$ho~t ~x=~eõ 350 çals? { _ No - Cc:1ti::~e I'~nít~:ii1g j ___ Yes - Report within 24 hrs 0disc~very ~ Does the va:iati~, exceed 5~? j _ !b - Ccntinue routine monitoring I Yes - Report to l'en:itting Authority . - wit!Ü.'\ 24 h::s of disoo\'e:y -j j ¡-lEEK j r A. Gals over/short i TOTAL Gals. sold t - X 100\ Variation 1 B. !);)es amt. over/short exceeð 350 gals? J _ No - Ccntinue 11::::1itoring ¡ - Yes - Re=t within 24 hrs of -. disco·..ery 1 I)oð..s the variation exceed 5'? ___ NO - Continue rcutine monitoring 1 _ Yes - Report to Pem.itting Authorit-j' ~Ii thin 24 hrs of discovery "! ..·...t;t;h , ; 1.. Gals over/short . TOTAL Gals. sold , í >: lCO~ Variation i B D;)es ¡¡¡¡¡t. over/short exoeed 350 gals? 1 NO - Continue ~\onitoring . - Yes - Report within 24 hrs 0ð.' er J - 1SOOV ry Does the variation'exceeè 5%? I 1-b - CC:'l~inue routi."le m::mi wring , = Yes - Repo=t to Pe::ü.itting Authority I \'Ii thin 24 hrs of disoovery I --- OVJ'::R .- 1 1 I I I f 2~~~ ± 3 i - ~~ t ---g-- T __-2 _I T'''T' T S I I.) :., ~.J -8' T 9 >10 11 12 13 14 TOTALS 15 16 ':~ 18 19 20 21 TOTALS 22 23 _.,.~~ 26 27 28 TOTALS 29 30 31 TOTALS 01\ --T sold y. 100% Vt.::iatio V3ri~tic~ cx=~z.5 l.~~: t-b - CC:ltin\:~ !,:=o..:tine !'~::'1Ì to=i~g Ycs - Rep:;rt to p~r:::itt:'¡.; A~~1:==ity \-:i t:h.A.;¡ 24 ;'::."!; c!.: ãi::~:J\·..:r~; MONTHLY GRAND (TOTAL SH9RTAGES) - TOTALS Have your shortages exceeded chart Yes No If Yes, reportto Kern County If No, continue monitoring LND l I.'~-...J ,¡:.H.!J lit~}n'l1 ! , o,,"e= I sho! t Gäls Gals over/short TOTAL Gals. sold Gals TOTAL íY_~~ - :; ¡ \ I TOTALS I SHOETAGES Have your shortages exceedea-G Yes No If Yes, report to Kern County If No, continue monitoring TOTAL X 100% Variûtio Dc~s V~=iatic~ c~ceed 1.5~? _ 1b - CC':ìtinue r.outine l·:Cnitoring _ Yes - R~port to Permitting Authority IIi thin 24 hrs of dÜ::::overy ¡ ænount? B / ...'.. .... { , e' i Facility' FILE ,-"ONTENTS INV¡;:~fTORY t-b LL CO ' ,/ ::;" ';'1 L< s ..----- (. ) Ato OPermit to Operate t !S:aConstruction Permit t MDIJD9 o Perm it to abandon' No. OAmended Permit Conditions ~permit'Application Form, OAppl ication to Abandon [JAnnual Report Forms ~) Date Date Date of Tanks ....3 Tan k Shee ts, Pfo+ 'Plans: tanks(s) Date Fìlt<'>s DCopy of Written Contract Between Owner & Operator OInspectlon Reports []Correspondence - Received Date Date Date []Correspondence - Mailed Date Date Date [] Unauthorized Release Reports []Abandonment/Closure Reports [] Sampl ing/Lab Reports []M~F Compliance Check (New Construction ~D Compliance Check (New Construction []MVF Plan Check (New Construction) [] STD Plan Check (New Construction) []MVF Plan Check (Existing Facility) \ [] S TD P 1 an C hec k ( Ex i s t i n9 Fa c i li t y) \o-rncomPlete Applicat~on- Form ~ermit Application Checklist []Permi t Instructions []Discarded []Tightness Test Results Checkl! st) Checklist) Date Date Date Monitoring Well Construction Data/Permits ----------------------------------------------------------------- Environmental Sensitivity Data: []Groundwa ter Dei 11 i ng, Bor ing Logs []Location of Water Wells DStatement of Underground Conduits l œplot Plan Featuring All Environmentally Sensitiv~ Data r.hotos DConstruction Drawings Location: -::tr/ö ialf sheet showing date received and tally of inspection time, ptc Ii scellaneous -...-.- e ..; .\ Permits' Facility Name . ~i)nð7 ~ c'j 0 !-J.; I C,-.. Inspector Date 5L 4-/24-90 . PINAL INSPBCTION CHBCKLIST . I I I ' \ HZJwOACf S : )1;~ -}1~ I I I I I I I I I I I I I I I I I í1 I tJ ......oM- b.v.r t:ZM., c/ 'I 'Î a-~2.v2 ~k. ~ I~ I I J ./. -' "Z N ~ <J, ,.; [ '_'_ _ : J _ m /1J [ËJ -- ~ J.\.. ~ei tt&11 . C" ,1 : ,. _ _ _ ~ _ _:, @ A Ii') () , - - - - _ _ w-'_ _ __ _ ':' L "L h :J I -¡ "J.-~ C \ .J.- ·..,+·v -.-:7 :~ t --' -- Plot Diagram 1. All new and existing tanks located on plot plan? Yes No ~-" ~ - ,1;) v IJ I LI (!..,~...." - , ~ QI' \ 1:1 11..1 I~I I_I 2. Does tank product correspond to product labels on plot plan? '~'_ ,,', Ie "i' t- 'f('.~- 3. Any modifications identified which were not depicted on the plot plans? If "Yes" described ß')"I,,¡j;;i,':',>_,~ ¡/.r ¡-Î !)/ ~/·:'t. CI t'f':".,v,:,/ I -j;:~,\. ,.k , ,.. ,-~.' i 4. Are monitoring wells secure and free of water and product in sump? III I_I 5. Is piping system pressure, suction or gravity? Y f·? -:5 ~c.U'--:_ 6. Are Red Jacket subpumps and all line leak detector accessible? ____ ..-,; ! Type of line leak detector if any l:~ ,·-1- ..-," ,'T' - I_I IiI - e 7. Overfill containment box as specified on application? If "No", what type and model number: Of7/-0. ,Çi.L r::<tR:./ or e-5Ç (t,'~ C ,"'v Î> It f' ,~ f\ 0-/1 ~ ..., . I I.' ' a) Is fill box tightly sealed around fill Ye-7 I?Î b) Is access over water tight? tube? ~u/d nd-J=:I c...~L -j I_I I~I c) Is product present in fill box? µo I_I I_I I_I I_I " 8. Identify type of lIoni toring: J-.ec.L1- A-Lu-t- AÞ>-LIl(JÇ5 &77-er--()f(2 - Abdt7· ¿)íc¡fr~ I ' a) Are manual monitoring instruments, product and I_I I_I water finding paste on premises? b) Is the fluid level in Owens-Corning liquid level monitoring reservoir and alarm panel in proper operating condition? LI c) Does the annular space or secondary contain.ent liner leak detection system have self diagnostic capabll i ties? If "Yes". is it functional If "No", how is it tested for proper operating condition? I_I I_I 9. Notes on any abnormal conditions: ... I_I LI I_I . . KERN COUNTY HEALTH DEPARTMENT PERMIT TO CONSTRUCT UNDERGROUND STORAGE FACILITY PERMIT 42Do0098 FACILITY NAME AND ADDRESS: OWNER(S) NAME AND MAILING ADDRESS: Jaco Hill Company 1701 Union Avenue 8 a k e r 5 fie ld, CA Jaco Hill Company P.O. Box 1807 Bakersfield, CA 93303 I xxi 1-\ I-I I-I 1=1 NEW BUSINESS CHANGE OWNERSHIP RENEWAL MODIFICATICN OTftER PERMIT EXPIRES August 9, 1980 þU7r;;;:B5 Joe Canas APPROVAL DATE APPROVED BY POST THIS PERMIT ON PREMISES CONDITIONS AS FOLLOWS: 1. Note: All pertinent equipment and materials used in this construction are subject to identification and approval by. the Permitting Authority prior to construction. This permit is issued contingent upon guaranteed compliance with the guidelines as determined by the Permitting Authority. 2. All construction to be as per facility plans approved by this department and verified by inspection by Permitting Authority. 3. Permittee must contact Permitting Authority for on-site inspection(s) with 48 hours advance notice. 4. All underground metal product piping, fittings and connections must be wrapped to a minimum 20-mil thickness with corrosion-preventive, gasoline-resistant tape or otherwise protected from corrosion. 5. Construction inspection record is included with permit given to Permittee. This card must be posted at jobsite prior to initial inspection. Permittee must contact Permitting Authority and arrange for each group of required inspections numbered as per instructions on card. Generally, inspections will be made of: a. Tanks and backfill b. Piping system with secondary containment c. Overfill protection and leak detection/monitoring d. Any other inspection deemed necessary by Permitting Authority 6. Spark testing (35,000 volts) required at site prior to installation of tank(s). Test(s) must be certified by the manufacturer, and a copy of test certifications supplied to the Permitting Authority. 7. All equipment and materials in this construction must be installed in accordance with all manufacturers' specifications. 8. Liner shall be installed by a trained experienced liner contractor and installation at site approved by Permitting Authority prior to backfilling. 9. No product shall be stored in tank(s) until approval is granted by Permitting Authority 10. Monitoring requirements for this facility will be described on final, "Permit to Operate". ACCEPTED BY ;f:d-~Æ~ DATE I I Qi;li) APPLICATION FOR PERMIT TO OPERATE UNDERGROUND , ' HAZARDOUS SUBSTANCES STORAGE F'ACILITY\ '6':'; i ~ of Application (check): . IfJ-New Facil i ty 0 r-bdification of Facil ity 0 EKistirv:J Facility OTransfer of OWnership Emergency 24-Hour Contact (name, area code, phone): Days 1505"-~q3-7é)()O \ \ \ Nights ,2.,-\ h ," S Facility Name J--CA (0 No. of Tanks -3 Type of Business (check): Gaso me Statlon . Other (describe) Is Tank(s) Located on an Agricultural Farm'? Dyes BNo Is Tank(s) Used Primarily for Agricultural Purposes'? DYes gNo Facility Address \ ìQ I L\ 1'\,' 0\1\ C~ ~ e Nearest Cross St. ,171- I" T R SEC (Rura Locations cnly) Owner J(.A (,.0 14.\', \ (,0 Contact Person a ny SeA (, I... j ~ v'" ç Mdress "PIQ, lCï5ð7 ~C\/::~Y'~f"~JclZip C~ a2,50:~TelePtone 3C¡~-7c?c:Jð Operator ~:¡;:o :~'j~ (." ifnu./oV'l'}.... "1ï<:cd..o~contact Person . Address po, (~. I ~ Ò 'llìol AJ.: 01¡' CI/1 A-tl,~ Z P ~:s3ð z.. TelePtone jJ)"~,,,,,,, Q<: f..'ý ):raC'~, \. B. Water to Facility Provided by L CA' We). +-Q v Depth to GroW¥iwater "2..(\0 1-""..£) 'f Soil Characteristics at Facility £,ctl~ çl~ Basis for Soil Type and Grourowater Depth Detenninations 'L~ ,. '" ' L(')C U-1 i-y c. Contractor S-Q. I t- CA Contractor's License No. Address Zip Telephone proposed Startil'¥:J Date .,} 2. () ~ '6 ¿;, Proposed Canpletion Dtte q I } ) >r_~ Worker's Canpensation CertÍficatlon I 19 V\ ~I' \e. Insurer ' 93305 Permi t No. APPlication4IÞte .:--- '- - '. ~~- \\, County Health Depart.ment, Dj, '_sion of Envirorunental H~h 1700 Flower Street, Bakersf~, CA A. D. If This Permit Is For Modification Of An EXisting Facility, Briefly Describe Modifications proposed E. Tank (s) Store (check all that apply): Tank ! waste Product Motor Vehicle Unleaded Regular ' premium ,Diesel wast~ Fuel Oil D - \ EJ EtJ æ 0 0 0 0 2- 0 II] G1 0 Il1 ~ 0 D ~<, 0 EJ G] 0 B B B D 0 0 0 F. Chemical Composition of Materials Stored (not necessary for motor vehicle fuels) rank . Chemical Stored (non-coomercial name) CAS . (if knO'Wl1) Chemical previously Stored (if different) G. Transfer of OWnership Date of Transfer Previous OWner previous Facility Name T, accept fully all obligations of Permit N:>. issued to I understand that the Pennittil'¥j Authority may rev:ew and .000ify or terminate the transfer of the Permit to Operate this underground storage facility upon receiving this campleted form. !'his form has been canpleted under penalty of perjury and to the best of my knowledqe is :rue and correct. '3ignature t':J __:kdA ~l<x- Title tho VI, ('~ 5Q~ Date ~I ~5 - ~. ---:.:-~ pe nn i t No. "d~~ ,~ ~~~'5"=' N"tÎJI\~? I. j, .. 4. -----'.-- .-.". ------ -.---. ( L TANK. ~ A/..,--__ (FIL.!:. OU~ ~.t:PAHA_Tl-~ r'(~"~ l:J\CH TANK) FOI~CH SECTION, CHECK ALL AP~I:: BOXES -- ---.- ,- . Tank is: 0 Vaul ted ONon-Vaul ted ODouble-Wall C}Jsingle-:Wðll Tank. Mater ial -§ Carbon Steel 0 Stainless Steel 0 Polyvinyl Chloride G;lFiberglass-<lad Steel Fiberglass-Reinforced Plastic 0 Concrete 0 Al~im.ln, 0 Bronze [Jtk1known Other (describe) . Primary Containment Date Installed ThiCknjSS (Inches) "- "'/ Tank Secondary Containment ' DDouble-Wall---ml SyJ\thetic Liner Dother (describe): ' [JHat-erial 'l11ickness (Inches) Tank Interior Lining -nRubber CAlkyd [JEpoxy [JPhenolic [JGlass, DClay Dlblined [JlhkncNt COther (describe): IV é) 11\ €.. Tank Corrosion Protection -rrGalvanlzed ï¡anberglaas-Clad [JfO!}ethylene wrap [JVinyl Wrappll'¥) [JTar or Asphalt Dt)'\kJ¥M'\ [JNone DOther (describe): , ' Cathodic Protection: BNone [Jtmpr-eued OJrrent Sys~ CSacrlflclal Anode Syst_ Oeser lbe Syaa.'. Equipaent: Leak Detection, Monitoring, and Interception ¡:--Tank: r:JVi8UIIl (vaultedtãnks only) CfGrowdwater Monitoring' *11 (a) o Vido.. Zone Monitoring Well (s) [J u-1'ube Wi thout Liner [Ju-TUbe with Caœpatible Liner Directi~ Flow to Monitoring ~ll(.)* [J Vapor Dlttector* [) Liquid Level Sensor D Cond..x:tivit¥ Sen8or* 8 pr.uur. Sensor in Annular Space of Doubl~ Wall Tank Liquid RIItrIeval . Inspection FrCID U-Tube, Moni toriI'¥) *11 or Annular Space o Daily GaUIJ!D) . Inventory ~ncill_atlon ç Periodic T1gþ~ "..il'¥) ONone C~ IS]Other _ --2' ~~'.J;:;' ~.. ,'" 1(.1/1 ¿ -X . b. PlpinrJl mlrlOW-Restrictll'¥) Leak Detectór(s) for Pressurized Pi,ll'¥)- 8 Moni toriI'¥) SLIIp wi th Racewy iC Sealed Concrete ~y Half-cut Cœpatible Pipe RaceWIY [J Synthetic Liner RacM8y [J1IaM [J UnknCN1 n Other . . *Deacribe Make "Mode~ 1?~-;:m /1-' -(X) I Tank Tightness IIIIS 'mls 'rank Been Ti9htne.. ~8ted? DYes caNo Olt\knoW1 Date of LA8t. Tl9htn_ Teat Resul ts of Test Test Name ~stiRJ Canpany Tank Repair TãñIë Repal red? D Y.S ~ Dlk\knoWi Date(s) of Repair(s) Describe Repairs OVerfill Protection ~atorPills, Controls, , Visually Monitors Level OTape Ploat Ga~. DPloat Vent Valves 0 Auto Shut- Off Control. BCapacitance Sensor E¡aSealed Fill Box ONone Olk\knoW\ Othera' List Make . Model Por Atxw. c.vlces ~IM.(O cd kf)t1 ~ A 7JC Piping ð. l)}derground PlpiBJ: BYes DNa Dlk\known Material ~ S ~ / Thickness (inches) S,-h '-I U Diameter ':L) I Manufacturer ' tiSJPressure OSuctlon OGravlty 'Approx'imate Lerw:¡th of Pipe Am SD' b. Underground Pipirq Corrosion Protect ion : DGalvanized DFiberglass'-<lad DIm¡ressed OJrrent 05acrif1clal 1tnode MPolyethylene Wrap IZ}Electrical Isolation (]Vinyl Wrap DTar or Asphalt DUnknown DNone DOther (describe): . -c. Underground Pipin:], Secondary ~ontatrment-::-' --,,---,--. ODouble-wall Œ'J~/ 'metie L ....., ~ ::''yst~ ÙNont _ _nknown DOther (describe): /' - , 'j ~ __ L-:- ,L::L~__.. 3. Capaci ty (Gallons) Manufacturer 12 , C éJ eJ ~.J1od:e, (t).,,",, : P Lined Vaul t 0 None [J lk\knO'l\ ' . Manufacturer: - CapIK:lty (Gals.) _._ ... .., 6 -, , 8 9~ ..IO~ 11.,. ------ 'dC, I. 1- 2. Ly Nc1H\t: pe on i t No. -'-'~~~:-; 4Þ2...- (FILL OU~ ~.!:~P~_Tl-:t-~jkt.)R I::ACH ~) FOR EACH SECTION, CHECK ALL APP~Q!>RIATi-: BOXES 3. Tank is: 0 Vaul ted o Ncm-Vaul ted O[X)uble-Wa 11 ÇJsi~le-Wall Tank Mater ia 1 -§ Carbon Steel 0 Stainless Steel 0 Polyvinyl Ctùoride GlFiberglass~lad Steel Fiberglass-Reinforced Plastic 0 Concrete 0 Al~ìntin 0 Bronze []lhknown Other (describe) , primary Containment Dilte Installed ThiC~jSS (Inches) "- '--I Tank Secondary Containment DDouble-Wall--c:J Synthetic Liner DOther (describe): DMalerial Tank Interior Lining -rfRubber CAlkyd DEpoxy DPhenolic DGlass DClay DLbl1ned DLbkncMt []Other (describe): 11/ ð 11\ e.. Tank Corrosion Protection -Uealvaniz8èJ ~F1berglaaa-Clad []Po!)ethylene Wrap IJVinyl Wrappin¡ eTar or Asphalt (]tA'\kncM\ CHane DOther (deacribe): ' Cathodic Protection: BHone IJImpr-euedOlrrent Sys~ CSacrlflclel InocJe Syst.l DeacrltB Syst_ . Equi~nt: Leak Detection, Monitoring, and Interc~ion ' -¡:-"Tank: OŸi.....l (vault.fiinks only c:rGroWldWilter Monitorln¡Î Nl11 (a) D V.to.. Zone Mani toring Well (a) [] lJ-II"ube Wi thout Liner [JU-TUbe with Cam~tible Liner Directi~ Flow to Monitorin; ~11(.)* o Vapor Dlttector* IJ Liquid Level Sensor (] Conductivit~ Sen8or* 8 preuure seNIOr in Annular Space of Doubl~ wall Tank Liquid ~tri.,.l . Inspection Pran U-T\be, Moni toriI'M) Willl or Anrwlar Space 8~y ~~ Iõ'=~ ~~ncu~~~~~~~ Pel~J T)'::+ ~1n¡ b. Piping. Crlow-Restrictlng Leak Detector(s) for Pressurized Pl¡»ll11J- . 8 Moni tor II'M) a.p wi th RaCftlly 'C) Sealed Concrete ~y Half-<:ut Cœpatlb1. Pip. Race..-y [] Synthetic Liner RaCMlB)' CMone [] UnknoW\ Ii Other L~ 41ec'..- *Describe Make . Modell ". Tank T1ghtnesa Haa 'l'hla Dnk Been Ti9htne.. "sted? Date of Lalit. T19htnesa Teat Test Name Tank Repair T'ãñk Repaired? Dy.s ~ DU1kOOW'\ Date(s) of Repair(s) Describe Repaira OVerfill Protection ~ator Pilla, Controls, , Visually Monitors Level DTape Float Gauge Drloat Vent Valves 0 Auto Shut- Off Control. BCapacitance Sensor EaSealed F11l Box DNone OU1knoW\ Other I List Make , Model ror Above Dwices 4. CapacIty (Gallons) Manufacturer I "2 ¡ Co ( C) VI é) (' t --.Q VV1 0."- j4f c.s Ii P Lined Vaul t D None 0 U1kn01l«1 Manufacturer: Capacity (Gals.) _,_ 5. Thickness (Inches) 6. 7. 6, (] Yes ra No OU1kno'-" Resul ts of Test ~stir¥J Canpany 9~ 10 11 Piping. . a. U1derground Pipir¥J: BYes DNo OtA'\known Material ~ S ~ / Th,ic)tness (inches) C,ch \.( U Diameter -:L)/ Manufacturer . ~Pressure DSuctlon LJGravi ty . ~rox'imate Lerqth of Pipe IU\ b. Underground Piping Corrosion Protection : OGalvanized DFiberglass~lad DImpl:'essed CUrrent DSacrificial Anode mPolyethylene Wrap mE1ectrica1 Isolation ,~Oviny1 Wrap OTar or Asphalt DUnknown DNone OOther (describe): c. Underground Piping, Secondary Sontatrment-::-' ODouble-wall O~¡ ',chetlc L "\<:! :'yst~ ÙNont' _ _nknown OOther (describe):_ __ __ __,~I~t~~"" ____,____ Permit No. ________1 ._ ( ~ TANK ~.___u_, (FILL OUT S~PARAn~ FUkM_R EACH TANK) FOR EACH SECTION, CHECK ALL A.PP~_Q..PRIAT~ BOXES l"acil i ty Ndffie rI. 1. Tank is: O'Vaulted ONon-Vaulted ODouble-Wall ÇJsingle-wall 2. Tank Material ,-§ Carbon Steel .0 Stainless S~eel 0 Polyvinyl Ctùo~ide r&.Fiberglass-Clad Steel Fiberglass-ReInforced PlastIc 0 Concrete 0 AlLI1um.ll1 0 Bronze [JUnknown Other (describe) primary Containment Date Installed Thickness (Inches) Capacity (Gallons) 'll{ 1'2)()éJ() Tank Secondary Containment DDouble-Wall"l:]Synthetic Liner 'ßLined Vault OOther (describe): [JMaterial 5. Tank Interior Lining -rJRubber L1Alkyd DEpoxy DPhenolic [JGlass DClay Olblined DlbknoW1 COther (describe): IV ð 11\ €.. 6. Tank Corrosion Protection -UGalvanized ~P1berglass-Clad DFb!}ethylene Wrap DVinyl Wrapping eTar or Asphalt DtA'1kncM1 DNone DOther (describe): ' Cathodic Protection: BNone DImpcessed O1rrent System []Sacrlflclal Anode System Describe System' Equipaent: . Leak Detection, Monitoring, and Interception ¡:--Tank: [jVisual (vaultedtãnks only) [jGrouœwater Monitoril1iJ' *11(s) OVadose Zone Monitoring Well(s) [J~ube Without Liner OU-TUbe with Compatible Liner Directi~ Flow to Monitoril1iJ well(s)· [J Vapor Detector* 0 Liquid Level Sensor 0 Conductivit¥ Sensor* 8 Pressure Sensor in Annular Space of Doublt! Wall Tank Liquid Retrieval , Inspection Fran' U-Tlbe, Mooi toring Well or Arvwlar Space o Daily GallJlo¡ , Inventory Reconciliation [] Periodic T14htn- ~11'J) []None Ct)\~ Oather 5 ~-Q tJ¡ c\ "'" ~ ' b. Piping. []rlOW-Restr1ctlrq Leak Detector(s) for Pressurized Plplrq- o Moni toril'J) SLIIp wi th RaCewlY 'EJ Sealed Coocrete ~y [J Hal f-CUt Caapatib1e Pipe Racew.y [J Synthetic Liner Racewy [] Mane [J UnknoVl 0 Other *Describe Make 'Modell " Tank Tightness Has 'ibIs 'nInk Been Tightness Tested? Date of LA_. Tightness Teat Test NiDe 9. Tank Repair Tãñk Repai red? 0 Yes ~ Ol)\knoVl Date(s) of Repair(s) Describe Repairs Overfill Protection ~ator Pills, Controls, , Visually Monitors Level OTape Ploat GalWe DFloat Vent valves 0 Auto Shut-. Off Controls BCapacitance Sensor . 6')Sealed Fill Box o None Dl)\knoW1 Other:' List Make , Model Por Above Devices 3. 4. Manufacturer 1/1 é) cJ'-Q 1M 0 v I4t CIs ), . Thickness (Inches) D None 0 l)\knoW'\ Manufacturer: capacity (Gals.) -,- 7. 8. DYes ŒJNo Ol1'1knoVl Results of Test 'l'estiR) Canpany 10. 11. Piping. ' , a. tA'1derground PlpiB]: Byes DNa Dlk1known Material iJðfi5/t. S k...c¿ / Thickness (inches) Sc....h \.j U Dianeter ~ ) I Manufacturer . æfPressure DSuctlon OGravi ty 'Approximate Len::Jth of Pipe Am . b. ~e'rground Pipirg Corrosion Protect 101'1. : . DGalvanized DFiberglass-Clad OImpr-essed CUrrent D5acrificial Anode IDPolyethylene Wrap [JElectrical Isolation ~Vinyl Wrap OTar or Asphalt DUnknown o None OOther (describe): c. UndergrOlmd Pipi1"¥J, Secondary Çontairment-::-·· DDouble-Wall D~/ ',chetlc L ")':! Systel ûNone _ .nknown OOther (describe): ~:.:.~~~~c;.t-;:'.,__,L:I ~":.'__<':"_é'':::::-:'_" . . CITY of BAKERSFIELD "WE CARE" FIRE DEPARTMENT S. D JOHNSON FIRE CHIEF July 2, 1993 2101 H STREET BAKERSFIELD, 93301 326,3911 UNION AVE MINI MART 1701 UNION AVE. BAKERSFIELD, CA 93305 RE: Monitoring requirements for underground storage tanks. Dear Business Owner: Our records reveal that no precision tank testing has been performed on the three underground storage tanks located at 1701 Union Ave. Section 2643 2(A) of Article 4; Title 23, Div. 3, Chapter 16, CCR., requires that all underground tanks that do not utilize automated leak detection shall have a precision tank test annually. Additionally, pressurized piping shall be tested annually and non- pressurized piping shall be tested every three years. Pipeline leak detectors and automated leak detection systems also have to be certified to be in working order on an annual basis. Please make arrangements to bring the tanks into compliance with state law. ',' If you have any questions, please call me at (805) 326-3979. ..1 -"'::" . YlJaPy, ~ ¡ ~~hE.~ ~ Hazardous Materials Coordinator Underground Tank Program e . K ERN. C 0 U N T Y - - - - 0 F F ICE TO ACCOUNTING - BETTY MARION M E M 0 RAN DUM DATE: ~)ó( (PI 9/ FROM JANE WARREN SUB.1ECT: CHANGE OF INFORMATION FOR PERMIT # A ð OL?t::J <1 Change of Ownership: Previous Owner Mailing Address Current Owner Mailing Address Number of Tanks Changed: Reason: ( ) Removed ( ) Other From To ( ) Installed Comments (~ Change of Permi t Number: Frome:? ðft)ð 9 Reason, Gd.é?t1 (Á) (0 YJJ ~ T :i:!::. cha r:Je. . ( . Change of Anniversary Date: From To 1,5 ~{)¿JoZ.. ÝJet?&~ To \ I Reason: Date last invoice was prepared for the facility: Annual Fee $ State Surcharge $ Please delete Annual Fee $ , State Surcharge $ owing from your records for the following reason: DEPARTMENT HEAD DATE e e ¡ I,' PERMIT NUMBER B{)'')())C\ (' ./ TYPE OF INSTALLATION ( ) 1. In-Tank Level Sensor (-~ 2. Leak Detector (~3. Fill Box FACILITY NAME J:tot t 'Ü ~ i 11 ~ ~n ~ FACILITY ADDRESS 'l(~\ \ \r\\()"AiJf , fu&rcfl'€ 0\ ) (~B(~) ,_ CONTACT PERSON . JCJì h '0Lrt C j f-:.r- 1. IN TANK LEVEL SENSORS Number of Tanks List By Tank ID Name of System Manufacturer « Model Number Contractor/Installer 2. LEAK DETECTORS ) Number of Tanks ) List By Tank ID Name of systemÆ.ec/fL.f\Q + Manufacturer «Model umber IV /A Contractor/Installer ' 3. FILL BOXES Number of Tanks , -'-- ) List By Tank ID Name of system~mf(() Manufacturer « Model Number Contractor/Installer 11/ IVIA- I O~TOR~ /-?-/- c¡/ DATE . . .. "'~ -",' I¡ KERN COUATY RESOURCE ~NAGEMENT AGENC I' ENVIRON~TAL HEALTH SERVICES DEPAR'I!NT 2700 "M" STREST. SUITE 300. BAKERSFIELD. CA.33301 (305)861-3636 I) UNDERGROUND HAZARDOUS SU8STANCE STORAGE FACILITY * INSPECTION REPORT * , I I L .1 I ¡ ¡ , ¡ ! ¡ I I ¡ ! I í . I I ¡ ¡ t L , : ! , I PERMIT:!; GOC09SJ PERMIT POSTt::üt TYPE OF INSPECTION: ~ '5' ,.., , '''':' ( ., ('-' T I ¡VI E I N ~.~........./:' T =) E 0 U T ...d..~..2..!..ff.. "" ,\{ U M 8 E ¡;, 0 F TAN K S : ........_.......?~.F'...... yES..................... N O......~......... ' N S P E -: T ION DA T E : .L:~::::.L..~-::::...._..... ...... ROUT IN E..........~........._. RE INSPECT r ON .......................... COMPLAINT ...___..............__ ... ......___~~,,~u....,~.,....._.....h...n........n~.......................................... FA elL .r T Y N AM E : .tLº.'d:~.ß.º..:..?....M.~R.!S.g.T......~.ª......................................_.......................................,....,......................................................................................... F.A. C r LIT '( ADD R E 3 S ; .:LI.º..!......V!2!J..Q.(:!....::~y..g.!:-:!.~Ls.........................................................................................._..................._.................................................... BA}<ERSF I ELD. CA o INN E R S N AM E : .~..t&º.....I::Ll.!:-:.b.....9..º!~":..¡:_~.tfL..!n..~.~.........................._......................................................._...................._.........................._......__....__.._. OPE RAT 0 R S N AM E : ..¿.t&Q.__t!..L~b-.....,Ç..º-~J?AtiY..................._..._........._...._............~.._........_.............._...._._..._..._..._....___......__._......_..._..........._._ COMMENTS: ---..~.~~~.......~........~.._...-.................._......"-...............-._......-....."........-.............................."..................................--................................................................--.".........-............-...........-...............-.....................-.........-..........--...................... . ...._......_..... ......................_............................................................................................................_n.............................................................................................................~....""'n__ .._~_............................_........._........................_........_...._ ·,·..···_·_·I'T-¡~:-M----........··_·_.._·_···_·.._·.._..-_..-_......-..........----...........-................................................................-"V-ÏÕ'i'::ATÏ-()Ñs7õs'sËfRVA T I'ÕÑS 1. PRIMARY CONTAINMENT MONITORING: ~. Intercepting an direct1nc system ~- '¡ ~ '.' fO.~) ~tanaarj .r.ventcry ~ontro! c~ Moàifiad Inventcrï Control d. In-tank Levei Sensing Daviee a. Groundwater Monitoring f. Vadose Zone Monitoring t<.eco"¡Zd..S ~t1-V~lG.-Þ (€ .. ,<I' j;-~ V t e_ U ( e..u..r .:.3ECCNDARY ;:ç~m,;NMtNT :~o~mOR¡'~G: , ; WY'\.. ¡'¿"_v~-~'vJ-1-'" , ¡ a. Liner I I ~. Ooubla~ri<! i:eo ~ank . : ': . V 31.1 1 t I ' I ¡ ~. :)~PI~'~G ~~O:.:.7::;.Ei:r;: d. P¡"~s'~;;~ . ! I ¡ I I [ I I h ""Suet ~ ~ri . . Gravity :l~~F~~~ ;;C7E:~:)~:. , ; ,-' ¡ L"-'Y'~i'~~ -- pe;-$-:5f'Þ/j , L'" : . ."J.1".-~".~,..:..-""¡..~...-"~._~ , CD TrGHiNESS i;S!NG (~ NEW CON~3T,UCTI:·N/MODIF!C~TI·::~~:) .______.____________.__._.__..,.___________~_____.__.,0" '.~_ ___,____.....___._,.____~_.u___,__._..____.~.._.____.__ ._~_. _____.__."____..____________..__ i~) CLOSURE/ABANDONMENT ¡N° ; ..._--------------_..,-----;-~ / \, -'-- (V v ",..-, e) UNAUTHORiZED RELEASE 3. ~A:~¡TENANCË. 3ENEF~L 2AF~~~. A~2 OPERAiING CONO!T!O~ OF FACILE'! ! ¡ '~c¡;~/=rJ TS / R ECOiVlM Er'~Q~ T ¿ C N s,_..t;;~~,.....~2~.....,,E:,~~:4~hþ~,~þ....i,.1~,(lA;.~ :~~~':~$:;~'~,.~,.~,"'.:~'{).,..,.b-,~".,~:~~_~.r.,.,..',~.,,:',.:'.-"~:.".,',~..~ .. h· ......h......'...' ....."...... "'''''' ........."................ ........ ."....., ".n_, ...._ -'........... .._,.... __ ..... ""... ....,. ,.._ ......n.... ..... .,... ........ '_"'" ......_~"....._ ..,..... ..._ .......... ,_ .__...._ .."...... ,..~., _,,~ .......... ..n..........h_ _........ ....... __ .......... '~.~ ;~-;~ :~',~ '~~'~ =~:) ~:ì·.., s ~::'~'~Jt_ ',~ª=,~ ")(,::~'~ ~ ';",~..,?".../ / ......"....." ,.... .~. ...... .. ." __ . ", »" "0"··· " .... .'. ~~. C "~; .~:. q !~O'~< : :11.~, T 2 ? E: : :,J~:' c· ~,:.",!," L '.'){~¡ ..........--."......"........... ... ,- - .- .... - ':::: ::.: E ~ . / ': __ :i", "---." ~/ ~~í~:-~!?_;;·~=--~./ i ., -:: ---- ./ "'<! ¡ I I I I I I ¡ ¡, Stat i cr1 NaCIo.-Zl...Q..i.D..[y.r. Locati on .L2'O'.L_....~.L~.lJ..~..!.........._? /0 #._l9-ï_~.'-~'i...:I s-:~ \ 1 I I I I I I i I I I .I I I I i ! ! ~ ",. .{,/' . ~ KE+NTY AIR POLLUTICN cet.lTROL DI.CT '2700 "M"Street, Suite. 275 8akersfield, CA. 93301 (805) 861-3682 PHASE I VAPOR RECOVERY INSPECTICN FORM Company Mè!li' i ng Address.............__......_......_......___..__....___._............._...__~..._............. Ci ty -...8..J41J....__~....__.___._.._ Date ....._..I...:::...L$-.::::.:1..1-.._.... Phone ._._._.._.,........_.._......___.._..._.__........_._........_' System TY~: Sep. Ri se~ Coaxial A ,~~ì~ ~~ Inspector ,_._,:~:....c...._t......G.l~.º.L!~~t._._........._......_...._..... Notice Rec'd By _.t _l_..._ _.._.___.....__...;_..:.____.. ._._ " TANK #1 TAN~#f TANK #3 TANK #4 " 1. PRODUCT (UL. PUL, p. or R) --f.&L (J..L 2. TANK LOCATION REFERENCE ~ W 3. BROKEN OR MISSING VAPOR CAP 4. BROKEN OR MISSING FILL CAP 5. BROKEN CAM LOCK ON VAPOR CAP 6. FILL CAPS NOT PROPERLY SEATED 7. VAPOR CAPS NOT PROPERLY SEATED a. GASKET MISSING FROM FILL CAP 9. GASKET MISSING FROM VAPOR CAP 10. FILL ADAPTOR NOT TIGHT 11. VAPOR ADAPTOR NOT TIGHT 12. GASKET BETWEEN ADAPTOR & FILL TUBE ~ISSING / IMPROPERLY SEATED 13, DRY 8RÐ~K GASKETS CETE~IORATED 1":4:. EXCESSIVE VERTICAL PLAY IN COAXIAL FILL TUBE 15. COAXIAL FILL TUBE SPRING MECHANISM DEFECTIVE 16 . TANK DEPTH MEASURE.~ENT 17. TUBE LENGTH MEASUREMENT 18. DIFFERENCE (SHOULD BE 6" OR LESS) 19, OTHER 20, COMMENTS: ", ~ ¡l.t7 /, I '-I'fif~ ) s- () I. lL¡jh 14//1 f. II / '14 11 2/J j I¡z II Sl II /2 r * WARNING: SYSTEMS MARKED WITH A CHECK ABOVE ARE IN VIOLATICN OF KERN CCtJNTY AIR POLWTICN I **** CC'tIITROL DISTRICT RULE~S) 209. 412 AND/OR 412.1. THE CALIFORNIA HEALTH & SAFETY CODE , I == ~~!f:1~J~~~î~ ~IN~E ~M~Ú¥~&ogFP~ED¢íol]~I~~)v~~t.:.:nl~:k~~~~~.~:~) I I ¡ ; f .. . * yr .,," f; KE~.~~( A~R" ¡;~LLUTICN_ CCt-ITROL.. DISr.WCT .:; lOa 'II è.)trgec. .:õLnta 275 j ! I ¡ PHASE II VAPOR RECOVERY INSPECTIGJ' FORM : i . -ðt.tì on Loc..ti.oo...J..7/2/U(l!CJUl3v~_¡Jª!c¿(::'þ~Içj___ P /0 · B09(PlE.ý",j;[(P . [ Company fd¿~~ _.e~Lß-oU8º2-__.__.___..__.._____ C j ty .l:¿±_~¡=S2_._ z ; p _'.i¿~º_~_ ¡ contact\.DhO.........._~r.~....~.i........ Ptone .....ª,..53...:::...1.º.Q..º........... System Type: SA @ H 1" HE GH HA I I Insoector ......C:_.~..:~.~...... Datel:I!2..=..1L........._. Notice Rae' d 8Y.......J..~- ,,:.<_..~~~..;~:::.. /..-::~ I i I 2 s--! f ;' ¡ I LA, I IJ..L '" U II I ¡ fw 1f.;(¡J 6W (- I I I , I I 8¡3kers'f ~:~ ¡:~ ~ CÞ,. 9?3C: (805.1 861-3582 NOZZ LE 1+ , GAS GRADE " NOZZLE TYPE ~Ø'_t'~Dk'Uf.ttw':mt~ ¡. CERT. NCZZi...E 7, FLOW LIMITER (EWì ,BIll HOSE CONDIiION ¡ , i I I , , , , I , , I I I ~ ¡ I I I ¡ ! I I I I I j ì ! ! Vi V I ! , ; ! i , I ;- , , , I N o .., .. Z L '- 2. CHECK VALVE 3. FACE SEAL 4. RING. RIVEï 5. BELLOWS 6, SWIVEL(S; ., :\, ..; _ L:::~J() ï!-i :') o :3. CCNFIGURll.TICN R D.. PC)WEF:'\.;':J I ~:..;~~ C'N , , ¡ 1 ! .--1-__--1.---L-__ ~ ' , i,\.. ;:WI".iE:'" ,'~ '-' 5,_ ()Vl::RHf:::.AD RF~F:AC:-()¡:~ , . S TGJ\J~ P()S"TED ';£~rb'ft,fE.ttif:']F~Jè1'f.il'3I'>,t~~Ij~~r;'U ~~='l ':0 S'ýS'::8!T: ¡:\/P·&.3: ~ P,::",~,·~_·~."a,:._,,~,an,.',',.;,~""~:A,,-,,_-r- HE:!-iea ~e\¡ .:~ "_ -, ~~2 _ ;:.:.:,...",,::\- (3h.::"3u~ f ~~¿:sse¡fTI"''::'''~.:''¡ .;: :;irJ.\~iÈil~j4tt"htll::tl~;.î:f~~îï¡¡JÙ{r:::i;1~:;LtJ~tJ:'ÜkJà :<,EV ::c~ det:'c'''; l:nc-;" ss : '''It::: - fnissl,nq 1 . ~ TO= ~orn. .:~,;~.:::::: -JeeCL2 ·:~c:~ .".l.1S"t:ï:er '": . ...,; .-,/.....~ 'l~;~= ,:ì·fs.~ :..:;:':~..:~~ '¡('- .'1,...- ('¡O:: :er~·~·fiad. 8= br'cken f::::~~ .~t '_'=~1 c,;~~g : eO ',M .... -..... ~. ' '. ,..., '':;'''; , ~' -- C-:"",.?\/SC. Ir¡ ¡ï1 III "';1< INSPECTION RESULTS ;'!C+( ;j~~~ :!~g,~:~:2'~~~~~~c;:~~~~:~ : ~~$~~~~~í~:~~~~ r ~'J'\~;¿:':'~~~~~'~ ~.";I;~;:;:.~ C :~~~'9n , "\'/!f'r" . -,- -# -~) V ~D<.' ('" .,¿ .- , ~- f· '/ ~'i-1 ,. '7 ~¡J ,-;> ,I ~~,' n' '-~~,,-:~~,,_.:1~~r:;¿~;");;t,~~t~E¡;=::2~{;i-;¡~J.5:~:=~~?:~:='! .."......"-,..,.,, ..,................"...-"..-.--, . ," ," .,...... ., "",.v ......". ..... .'~' . .......".....__ _", ....."............... ._'"'..~.._d'. ',. I ! I ~ I :0: VIOUTrONS: SYSTEMS MARKED WITH A "T" CODE IN INSPECTICN RESULTS. ARE IN VIO~TICN OF ""'" KËW'C'CUNrf' AIR POLLUTION CO'JTROL DISTRICT RULË(S) 4:2 AND/OR i! 12 ~ 1. TI-IE CALIFORrHA ** HEALTH & SAFETY CODE SPECIFIES P8'JALTIES OF UP TO $1,000.00 PER DAY FOR EACH DAY OF ;+coo: V!OUTION. TEL2PHONE (805) .851-3682 CONCERNING FtNAL RESOWTION OF THE V!OLATICN. NOTE: CALIFORNIA HEALTH & SAFETY CODE SECTION 41960.2, REÇUIRES THAT THE .åBGVE LISTED 7-0AY SiEFICIE'JCIES aE CORRECTED WITHIN? DAYS. FAILURE TO\XMPLY MAY RE3lJL'7" IN LEGAL ACnCN ", e . TagNumM - -:: - Dat~/"':"/S-~/ TIme.30 S- ~ Station Name '3"" o...c:..o 0 ~( / ~, J' " Operator's Name ":':, .. ' '. , ,StatiOn AidreSs l?ð I ~ -=-- ~ Major Cross Street" I ., " '" TelephoneN~''''':Gq3- 70è> 0 ' ."', , o~~ ,_.. Inspector - ' ...;. - ~ Defect" -f1Þ-. '~ U ' ~ , ",:<:,:,,;, ':':':~::".. ,'-:.' ,,', " if~273 Totalizer Reading When Tagged WARNING .,.' " .. . Use of this device ~iS ~hibited by state law and ~. authorized removal of this tag or use of this equipment will constitute a violation of the law punishable by a , maximum civil fine of $1,000 per day or a maximum , criminal. fine of $500 per day and/or six months in jail ~ . "f:- I declare under penaJty of perjury that the device tagged was not used. nor was the tag removed. until the required repairs were effected and the distrtct notified. Repaired by TItle (Please print) f Signature Date TIme Totalizer Reading at TIme of Repair , Repairs made BEFORE USING TIiIS DEVI1f ~Iepho~ ~r~ air pollution control district at I 2 ' If repairs Were made to the nozzle bo y you must notify the County Department of Weights and Measures. Ser. # 0 8 2 0 9 2