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Home My WebLink AboutUNDERGROUND TANK #1 Per It t. Operate Prevention Services Unified Permit SUBJECT TO CONDITIONS OF PERMIT THIS PERMIT IS ISSUED FOR THE FOLLOWING: o Hazardous Materials Plan t8 Underground Storage of Hazardous Materials o California Accidental Release Program o Hazardous Waste GeneratQr and/or Treatment o Above ground Storage Storage of Petroleum o Paint Spray Booth o Industrial Hood Suppression System .\ ~ ;, ; ¡ ~~ ...~1~~·~!~r;:.I·~-:~~·:·;.~:~;;;'~~·t~¡~';7~;. PERMIT ID #015-021-001217 ",,;,~·".·.'·/.~¡,,:w;,;...,,,.,.. /.:q,,~> " VaN'S FUEL CENTER #2 ¡,I":2,:,f:,,' :~/:;~,',' "-t{';~l tf::~~ }~:f" '~,¡ '~~:," Stl. ."'. ~¡L ~"':::""" >. ::-.' "'I, ;.. 'k·, :'1-, i~~'·.\~-~'~·>·~::} :~;:;'¡:";:':'~~~;~~'~£~ ï~,; ~~~':{ ~:. .:'::~:::t~~, ~17i~;'::", '\. 2050 WHITE LANE I'·'·'·'<}'.;; ",;.." ",:,,-, "'J, ··'<i;~...:~,~,·'~_... BAKERSFIELD CA 93304 ;, '. 'j'\}. .',~' , ' "', ~J\.1":;'t:~ , ,'~\'. ':~~! .{'e'- ,.~':.a:.. I:'; ". ':. ..,~\!iP" . [\ '; ¡ ¡p- 'i'..<r f::~''';r~;;.. :.; .' :', '!', .,*'(~ ' ..... ..,- .!iTt~ ,f ,.' ,'- ,~"~j)fr.~~. ~ i ~ " ' ~~.;; ~,-,., ;.,' ,-/;~":i,r;:",~::,~,;: A('¡,l"- j)f,"';~'. :~.¡ regular unleaded, 20kt~ f¡h!f}fDWFcS:~~ pjpiit~:tiWF,...,.. . ¡~,~{ .' premium unleaded, 1'~+ tã'i1~ Dwt~·~;ÏJ.tR!tt9;I?\vF ': T f~":~'T't"" . : ;(;<:': midgrade unleaded, ~kr ta~i,( DWFP -.- :piþin'g .PW.F.. . , ' .. ' }>. ' í>'~ ' ,. ( , . " ..' P JFtr" .., " ..... '.', , \\\' \\,,,~~~,·~J?~~2:"i .,' ' \<:~~~~" Y;';:þ~"\:;j:;;{(::.. "/ ~. ~ "'" .¿: ~Y,.~'~?J f¡~ ~,¡~. ~~..¡ '§¡ "'....~ ;.l ~<::~',:::~~::~2::~,))o .,' 1. 2. 3. Approved by 1d1736 dune 30 Expiration Date: .~.',".' Bakersfield Fire Department OFFICE OF PREVENTION SERVICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 852-2171 Issued by: ':~~;~,~":':":". ~ B II S P I':. ;', "11';' ::' II."A" ,..", - .:;1~{~"Ð~~~"';' '1:'0.,.. (~ .cJ (\ GILBARCO' ~~. VEEDER-ROOT RETURN RECEIPT REQUESTED City of Bakersfield ,-- Certified Unified Program Agency _ ..~/"/ Ralph E. Huey- Director of the Office of Environmental Health ..;/ 1715 Chester Ave, Third Floor / Bakersfield, CA 93301 7300 W. Friendly Avenue Post Office Box 22087 Greensboro, NC. 27420-2087 (800) 997-7725 (860) 651-2842 Fax CERTIFIED MAIL Dear Sir: Iv e GILBARCO VEEDER ROOT Fuel Management Services WRITTEN FOLLOW-UP REPORT 3/29/2004 .- ~---. ----.- -~-'" I -', RELEASE NOTIFICATION) Safeway Vons Division# 2512 21 00 White Lane. Bakersfield CA 93304 , / / .... .~ In accordance with California reporting procedures, we herein provìäeUïërÕÏlowing follow-up information regarding the fuel spill reported at V ons service station #2512, in Bakersfield, CA on March 26th 2004. ;;. Facility Address: Substance Released: Source: Estimated Quantity: Time: Duration: Media: Health Risk: Action Taken: Precautions Required: Additional Measures: Mobil Contact Person: Agency Notification(s): City of Bakersfield OES 2100 White Lane, Bakersfield CA 93304 Gasoline Component Dispenser Half a gallon 7:30am 1 minute Concrete No immediate threat to human health of the environment. Spill Cleaned up Dispenser was turned off. Case closed no further actions are planned. Compliance Issues: Marcella Gelman 626-821-5608 Remediation Issues: Scott Miller 626-821-7781 . Contact Ralph E. Huey Time Notification # Caller D.Fera Joanne Phillips R. Shaw 1 :OOpm 04-1707 If you have any questions regarding this report, please call me (336) 315-2831. ~'ncerelY" ro/) () C- c..... ~ an A. Ellis Gilbarco Veeder-Root Fuel Management Services e e UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK I CONTAMINATION SITE REPORT []] N() NO 01 ':/ BY LOCt'..l AGEJ~CY D REGI('NAL GCFì.RD D ,T~E"" ......,., " Gílbarco V,Wd8r,-Roo: 01 31 H M Jan /\. EJis HE-PORTED üVV!\ERJOPCR.·':\ TOR 7300 \IV. Fr1end1y A v(~nue G!'censboro.! NC 2742G r:)Tf~[E'T :>, ":'IF' NAME Gafeway \fons Divfsion 626~821 ~ 7"78 'j RESPONSiBLE PARTY PO BOX 513:J8 Los Angeies CA 9005'1 STREET "..:'. ~,: ZIP ~':AG¡Lrry !'ü~,ME 2542 Saieway VOr1$ Cheryi Frye LQcatk)n Manar.p~r ")1"1E. ßßi·396,23'¡'¡ SITE LOCATiON 2100 \Nhite Lane :;CiDF~ES~.: Bake(siieid CiTY CA 93304 57 ZIP ~:"n-<'[ET AGENCIES A:':.íËNC\' ~,¡Ai\:JE PHCNE C;::>NT ÄC~' F'f.RSO¡..J I"H()NE GE1-32G-3~)ï9 CUPA Ralph E. Huey OES ,Jcanne Phi iip" 800~~52-7550 DUANT¡TY LC~;T (GALLGr-.J3'¡ Gasoline SUGSlANCL '''VOLVED Halia [3] QUP-NTI ¡Y LOST (G/\LLC",iS¡ CiA TS [)JSCHN,!?Ë 8EGA.¡-'! W UN}<,t~D'.:VN SU8SURF N:::E ~:10NITOrm~G ¡~UISt'·NCE COiKHTICt-jS D Seen Visuail'J '-·""~4.t<, EJ T,~~:'¡j< RE~-:10V,<\l. UNhNC\'iN rvIETM(;f.) USED r:"ì STOP O:8C:HARGE RS\:¡Oìi[ CCNT[NT:;:'; C.:"08E TANK ¿<. FiLL iN PLr.,CE D D ~~;¿:.PA¡R P¡P;r,,¡(; (,HANG[ P¡-.:.zOCEDU¡':¿E 0 OTHER 0 DiSCOVERV 0 RËP/,~R TMH..:.: & J\8A TEMENT UNf-NCWiJ D i)T1-iEF D Disoenser [lJ D OVER"ILL D CCRF~CS¡Ot~ D ¡:¿CPTU~;T j F.~:LU}'~E ONL\' ClTHE.R Concrete Surface f3R()UI'H) WATER U¡-.g.':r40v\r'!'J D SF-H.L D on-;;' i', [RI DRINKING WATER {V;,i;:?.i..!,.;3 ,:~fFECTËD'; D PCLtLJT¡(.:¡'¡ CHARP..CTEFi.!Z,':"T!CN 0 ecsr CL EA.NUP MC\,J(TCR1N(:: :r-J PRO(3RE~g3 D C!..E.q~UP UNDËPVVA'r 0 ONL'y' \'JO Þ..CT1CN T ~'\~:EN l.EJ,V 8E!!'J(~ CQNFRMËO o !::REl.!MINAP.'y SiTË ,^\S~¡ES8r,,~E.NT SUBMiTTED o PREl.!MINAPY SiTE .~S~,ES;:;MENT UNOERvVI:;Y m Ct\~;E C..08ED (CC\1PLËTED! U~"':NECF.~/~A¡::¿Yj RË\1ED!~\T!C~J? ,AN :(~: '; CAP ~2.n'E ~ CD: EYCAV:\TE E< 1.Y~;POSE{[D; F<:[f..'H)VE FREE (;r;;CDUCT{FP'; D D D [l CC!'FA~Nt,;)ENT S,ÄRRIER(~';B, V,ACUl.P..1 EXTRAGi ,,,;::, PUMP ,':it "};r.:A~' G¡':'\)Ui~DV\iÞ,TER(Cï; T?,,'f-:;,\ fHENT AT HCC';¡"~U?!HU} \/ENT ~:::OiU\iS) ;::::hHf'\J~CED E;!O DEGR,\D,-;\T!ONUTì has responded to ttÙ,! ¡~;Gue and aH necessary 3ction h3S been taken. No further actions are currenty planned. 3129/2004 2137 PM -- ¿~ GILBARCO V VEEDER-ROOT - 12265 West Bayaud Ave., Suite 300 · Lakewood, CO 80228 · (303) 986-8011 · www.veeder.com April 19, 2004 Inspector Rodriguez Bakersfield Fire Department Environmental Services 1715 Chester Avenue Suite 300 Bakersfield, CA 93301 RE: Vons Fuel Facility #2512 2100 White Lane Bakersfield, CA 93304 Dear Mr. Rodriguez: Please find enclosed Hazardous Materials Business Plan, Monitoring Procedure, and Emergency Response Plan for the subject Vons fuel facility. This information is being submitted solely to update the contact information for environmental matters and emergency situations. As you may know Safeway Stores, Inc. has retained Gilbarco/Veeder-Root to manage compliance activities at all Safeway owned fuel-dispensing facilities. As Safeway's authorized Compliance Service Provider, Gilbarco/Veeder-Root is responsible for coordinating and tracking the resolution of non-compliance issues and renewing and maintaining registrations, licenses and/or certificates associated with the operation of the underground storage tank systems (i.e. UST, Stage IIII, Weights and Measures, etc.). In order to facilitate streamlined communications, Safeway would like to change the owner address on the UST registrations/notification forms, for all Safewav Stores, Inc. owned facilities within your jurisdiction. I have attached a listing of these facilities for your reference. Please make the following changes to the existing UST system permits/registrations: NEW ADDRESS Safeway Stores, Inc. C/o GilbarcoNeeder-Root 12265 West Bayaud Avenue, Floor 300 Lakewood, CO 80228 Attn: Emily JoAnn Daigneau Upon receipt of this correspondence please update you database and being sending all correspondence to the new address indicated above. Please do not hesitate to contact me at (303) 986-8011 should you have any questions or require any further documentation. I greatly appreciate your assistance in this matter. Sincerely, 04 Cu.-t E~~ai~ ~;;a~ Manager Cþ REDJACKET· 'LMS .'~'Y 'í' . i e I' - RECEIVED APR 1 9 REC'O 'I\- BY: UNDERGROUND STORAGE TANK MONITORING PLAN VONS FUEL STATION #2512 BAKERSFIELD, CALIFORNIA " .. e e TABLE OF CONTENTS General Infonnation 1 Tank Monitoring 1 Pipeline Monitoring 1 Monitor Locations 1 Personnel Responsibilities 1 Reporting F onnat 1 Equipment Testing and Preventive Maintenance 1 Training 1 Spill Control and Clean up Method 2 Clean up Equipment and Disposal Method 2 Location of Clean up Equipment 2 Personnel Responsibilities 2 ',' ,. ,,' e UST MONITORING PROGRAM t WRITTEN MONITORING PROCEDURES i¡¡ :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::;:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~~: ¡~~ Page 1 of 1 ~¡¡ This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Environmental Services within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641 (h) CCR. Bakersfield Fire Dept. Environmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661 )326-3979 FACILITY NAME Vons Fuel Facility #2512 FACILITY ADDRESS 2100 White Lane, Bakersfield, CA 93304 DESCRIBE THE FREQUENCY OF PERFORMING THE MONITORING: TANK Continuous electronic monitoring of tank annular (interstitial) space. PIPING Continuous electronic monitoring of piping sumps and other secondary contaimnent. WHAT METHODS AND EQUIPMENT. IDENTIFIED BY NAME AND MODEL, WILL BE USED FOR PERFORMING THE MONITORING: Veeder Root TLS 350R TANK Veeder Root TLS 350R PIPING DESCRIBE THE LOCATION{S) WHERE THE MONITORING WILL BE PERFORMED (FACILITY PLOT PLAN SHOULD BE ATTACHED): LIST THE NAME{S) AND TITLE{S) OF THE PEOPLE RESPONSIBLE FOR PERFORMING THE MONITORING AND/OR MAINTAINING THE EQUIPMENT: NAME TITLE Veeder Root Fuel Management Services - Emily Daigneau Program Manager IDECO, Inc. Testing Vendor Cheryl Frye Facility Manager REPORTING FORMAT FOR MONITORING: TANK Monthly Compliance Report PIPING Monthly Compliance Report DESCRIBE THE PREVENTIVE MAINTENANCE SCHEDULE FOR THE MONITORING EQUIPMENT, NOTE: MAINTENANCE MUST BE IN ACCORDANCE WITH THE MANUFACTURER'S MAINTENANCE SCHEDULE BUT NOT LESS THAN EVERY 12 MONTHS. Monitoring equipment is serviced annually. DESCRIBE THE TRAINING NECESSARY FOR THE OPERATION OF UST SYSTEM, INCLUDING PIPING, AND THE MONITORING EQUIPMENT: Employee Training Subjects are as follows: (1) location of main electrical panel, (2) location of emergency shut off pump outside and the store, (3) location of emergency shut off of dispenser at the cashierregister (START/STOP) button on the cashier register, (4) loca emergency exit doors, (5) method of announcement of evacuation and assembly area, (6) hazard communication, (7) what is the Emer Response Plan, (8) what is MSDS and where is it located, (9) what to do in the event of drive off/top off, (10) what to do in the event earthquake & earthquake check list, (11) where is the location of fire extinguisher in the store, how to use is and when to use it, (12) do in the event of a spill, (13) posting of emergency contact phone numbers and how to notify maintenance, (14) spill cleanup materia . .. . . . inside tion of gency of what to Is and proper handlmg and dlsposal, (15) danger of carbon dlOxlde (C02) gas cylmder, (16) dangers of flammable hqwd such as gasolme, NO SMOKING RULES, sparks or smoking may cause fire or explosion, ¿ e e UST MONITORING PROGRAM :!i EMERGENCY RESPONSE PLAN ;¡¡ :~~~~::::::~~~::;:;:::::;:::::::::::::::;:::::::::::;:;:;:;:;:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::;:;:::::;:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::;:::::::::::::::::::::::::::::::::::::::::::::::::::l :~: Page 1 of 1 '!! This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Environmental Services within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641 (h) GGR. Bakersfield Fire Dept. Environmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661 )326-3979 FACILITY NAME Vons Fuel Facility #2512 FACILITY ADDRESS 2100 White Lane, Bakersfiled, CA 93304 IF AN UNAUTHORIZED RELEASE OCCURS, HOW WILL THE HAZARDOUS SUBSTANCE BE CLEANED UP? NOTE: IF RELEASED HAZARDOUS SUBSTANCES REACH THE ENVIRONMENT, INCREASE THE FIRE OR EXPLOSION HAZARD, ARE NOT CLEANED UP FROM THE SECONDARY CONTAINMENT WITHIN 8 HOURS, OR DETERIORATE THE SECONDARY CONTAINMENT, THEN THE OFFICE OF ENVIRONMENTAL SERVICES MUST BE NOTIFIED WITHIN 24 HOURS, In the event of a fuel spill, employees will take the following actions: (1) Locate the source of the spill and prevent more fuel from spilling. Use the emergency shut off switch to stop any more fuel ITom leaking. (2) Call 911 if there is a threat to public health and safety or if unable to contain the spill. (3) Immediately notifY the manager on duty. (4) Ensure there is no ignition source near the spilled fuel. (5) Evacuate all non-essential people ITom the immediate area and place safety cones areound the spill area. (6) Do not allow customers to start their vehicles if located within the spill area. (7) Contain the spill or prevent fuel from spreading into stonn, sewer or other drains or bodies of water. Use of protective goggles and gloves. Use socks or absorbent material to stop migration of the fuel and to block stonn drains. DESCRIBE THE PROPOSED METHODS AND EQUIPMENT TO BE USED FOR REMOVING AND PROPERLY DISPOSING OF ANY HAZARDOUS SUBSTANCE. In the event of a fuel spill, employees will take the following actions: (1) Locate the source of the spill and prevent more fuel ITom spilling. Use the emergency shut off switch to stop any more fuel ITom leaking. (2) Call 911 if there is a threat to public health and safety or if unable to contain the spill. (3) Immediately notifY the manager on duty. (4) Ensure there is no ignition source near the spilled fuel. (5) Evacuate all non-essential people fonn the immediate area and place safety cones areound the spill area. (6) Do not allow customers to start their vehicles if located within th espill area. (7) Contain the spill or prevent fuels fonn spreading into stonn drains. (8) If spill is manageable, clean up spill utilizing FM 186 (unless FM 186 is not approved by the local agency). If socks or booms have been used to block a spill, they must be treated as hazardous waste. (10) Document spill on Spill Log located in the Environmental Compliance Manual. 3,DESCRIBE THE LOCATION AND AVAILABILITY OF THE REQUIRED CLEANUP EQUIPMENT IN ITEM ABOVE. Equipment is located on site, at the fuel station. DESCRIBE THE MAINTENANCE SCHEDULE FOR THE CLEANUP EQUIPMENT: N/A LIST THE NAME{S) AND TITLE(S) OF THE PERSON{S) RESPONSIBLE FOR AUTHORIZING ANY WORK NECESSARY UNDER THE RESPONSE PLAN: NAME TITLE Cheryl Frye Facility Manager Loss Prevention Loss Prevention Manager Dresser Wayne Wayne Help Desk Environmental Incident Hotline Hotline Help Desk " .... o :E ~;y ~j \ e s'~ f\ GILBARCO- ' ~~ VEEDER-ROOT - GILBARCO VEEDER ROOT Fuel Management Services 7300 W. Friendly Avenue Post Office Box 22087 Greensboro, NC. 27420-2087 (800) 997-7725 (860) 651-2842 Fax WRITTEN FOLLOW-UP REPORT CERTIFIED MAIL 2/1 0/2004 City of Bakersfield Certified Unified Program Agency 1715 Chester Avenue, Third Floor Bakersfield, CA 93301 RELEASE NOTIFICATION Safewav # 2512 2100 White Lane Bakersfield. CA 93304 Dear Sir: In accordance with California reporting procedures, we herein provide the following follow-up information regarding the gasoline spill reported at Safeway service station 2512, in Bakersfield, CA on February 4 2004. Facility Address: Substance Released: Source: Estimated Quantity: Time: Duration: Media: Health Risk: Action Taken: Precautions Required: Additional Measures: Mobil Contact Person: 2100 White Lane, Bakersfield, CA 93304 Gasoline Component Customer Vehicle ' 0.3 of a gallon 1 :30pm Imins. Concrete No immediate threat to human health or the environment. Spill Cleaned up N/A Case closed. Remediation Issues: Scott Miller (626) 821"7781 04-0624 Caller R Shaw S.Gun Agency Notification(s): City of Bakersfield OES Contact Ralph E. Huey Bob McRae Time Notification # If you have any questions regarding this report, please call me (336) 315-2831. Sincerely, ~ CíL -ilL Ian A. Ellis Gilbarco Veeder-Root Fuel Management Services ....;0; ¡;_ì ...... .. e e LEAK I CONTAMINATION SITE REPORT UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE iNC FEPORT NO CA.. BY ()WNER'CPE¡:v\TU¡:~ Gilbarco Veeder Root 130D 'N, Friendly Ave STREET c;reef1sboro CiTY CONTACT PERSON NC $" 2/420-2081 7!P NAME S~:.1feway Vons Dìvisìon Scott Miller 626-255·6844 RESPONSIB PARTY SITE LOCATION Box 513338 Los Ange!es CA 900~) 1 STF<EET ZIP FACIUTYNAME Safeway - Vans PHONt: Sherrel Frye 661-396-2344 2512 2100 White Lane .AODRESS CROS~; STHEET Bakersfield CA 93304 CITY (~T ZIP LOCAL AGENCY AGENCY AGENCIES 5-3979 ()E3 OUANTJTY LOST (GALLONS) Gasoline SUBSTANCE 0.3 of a galion o INVOLVED UUAt'IT1TY LOST ,,) DISCOVERY D UNKNOWN 'tr, o TANK TEST o !NVENTORY CONTROL UNKNOWN OTANK REMOV,;L o SUBSURF¡\CE \.10NITOE!NG Seen tv1ETHOD USED TO ~¡TUP D!SCHAf~GE REMOVE C()NTENT~; "1"$"""'(")""1'1"""$ 0 ,,< )h t"\"h~t: ~,P....... h/Ph OTHER EJ REPA!R T};N}\ CLO:SE TANK" HLL iN PLACE 0 REP,;IR PiPiNG 0 8- ABATEMENT HEPL\CE TANK CLOSURE "f/\NK & REMQV/\L CH/\NC;E PHOGEDUFE 0 Custome, VetÛ;':¡B \\'8S iernD\!ed OTHER ~ UNt<NOWN D OTHER [8] Dispenser o OVERFILL D CORROS!ON o _REPTUHE i F¡;\ILURE , UNKNO'NN 0 SPILL D See Comments OTHER 0 CASE TYPE I ~ OTHER Concrete O!'·JLY NO r,CTION TMt:N OSOILONLY D C..."" 'N") "A'I'E'i" ,,1,,;,.; L 1.;'~h _ '( DFm<,JK!NC WATER (WELLS A¡:FECTED) 0 POLl,I.ITiON CHARACTERiZATlm" 0 FOST CLEANUP fAONrTORING iN PROGRESS 0 CLEANUP UNDER\VAY CURRENT STATUS LE,4K CF:!NC GONFIFÖ\;1f:.D hEMEDIAT!ON PLAN PRELIMINARY SiTt: AS:',f:SSMENT SUBMITTED PREUfll!INARY S¡TE ,';SSESSMf::NT UNDf::RWA'! CASE [~LOSED (COMPLETED,I UNNECES~'\eY) aEMEDIAL ACTION CÞ,p SITE (CD} 0 EXC/W/'..,TE,~ DjS?OSE:'!,EDj CONTA¡Nt~1ENT 81~HR¡En{CB) D EXCAVATE & THE!\T(ET) VACUU~"i EXTi0\CT (VE'¡ D NO ACTION HEOLHHED1Nt\) VENT SO!j..(VSj [8] OTHER. See Comments A hole in custorner vehicle gas tank on site cHused gasoline l"o fB3dl concreÜ-;; ßurface, fill Product was contained to concrete surface. SafelNay has responded to this issue and ail necessary action has been taken. No further actions are currently rkanne ;"¡EMOVE FREE FRODUCTZFPì o o o o PUMP & H~EAr Gf~OUNDWf\TERí GT} THEAfMEN"!' i\T HOGKUP[HU) ENHANCED BIO DEGRADATIONliTj COMMENTS 2110/2004 6:59 PM CORlRECTION NO.ICE 04916 BAKERSFIELO FIRE OEPARTMENT Z tOO IN'n, k L."vJE:- Location Name 'VDN"S 5Øy€ You are hereby required to make the following corrections at the above location: Cor. No. (4) I ) ()+I~+ Q(jv£v ?k. p¿.)¡J E: ~ L\ +- ~ ~ Completion Date for Corrections Date -±11 ~ /õ 4- FD 1950 e 152858 I,/ONS 2100 l¡,JHlTE LANE BAKERSFIELD CA. 661-3'36-0191 APR 13. 2004 9:43 AM SYSTEM STATUS REPORT - - - - - - - - - - - - ALL FUNCT I ON8 NORt"IAL I N'v'ENTORY REPORT T 1: REGULAR VO.IE = UL = 90:, LAGE= TC \/OLUr"lE HEIGHT WATER VOL l.>JAT-E-R--- TEI"IP T .'~ 'uc.· .. . t.J VO ULL' 'E 9œ" ULLAGE= TC VOL Ut'1E HEIGHT LJATER VOL l.>JA TER TEMP T 3: SUPRE!'1E VOLUt'IE ULLAGE 900; ULLAGE= Te I,jOLUr"lE HEIGHT l,JATER VOL WATER TE/iP 104:36 GALS 9615 GALS 7609 GAL~3 10309 C;ALS 61.42 INCHES o GALS 0-; 00 I r'ICHEB 77.2 DEG F 5294 GALS 4743 GALS 3739 GALS 5240 GALS 62. :35 INCHES o GALS 0.00 INCHES 74.6 DEG F 5636 GALS 4401 ';,iLf3 3397 ';i.! .' 5578 C"I : , 65.56 I Ni :~ o Gr,¡ :' 0.00 Hi"iI! 74.4 ])£1:; '" '" ¡;; ¡;; EN[, ,,: " '" '" '" . ...... ~J ~ UNìFIED PROGRAM IN.ECTION CHECKLIST 5Z::z.~~'a..~:i'L~~ijt£:~~~~"æ:;ßf~~'.\i."';,;r~Mi~~~.\ir~~" SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 ~ACILlTY :A~~~YO}j_'~__ __F~_~ 1_ _ D~~±f;-..C__ __ _ _ __ ______m_________ __, u_ 1-~~lßL~- INSP~CTION_:~:_____ ADDRE.Z10D ?£) ~B_____k\lJ~u±&___Lþ~Ü~____ ____________________~___ :~=_______ :~_E:~:~es____ FACILlTYCONTACT Business 10 Number 15-021- Section 1: .Business Plan and Inventory Program o Routine )( Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection C V ( c=comPliance) V=Violation OPERATION COMMENTS " 0 ApPROPRIATE PERMIT ON HAND f--------~-.----~~--,--,-------------------,------~--- ..-.--..--" - ---------- - ..---,--,---. ..-.--.- ~ 0 BUSINESS PLAN CONTACT INFORMATION ACCURATE . -.... - -..... -----------------.--.---.-.. ...---- -.- .__.__.__ ________~~_~_______.___.~____~~~.___.__.__ ______._...._________.... __....____ _____ ..__ _____.___.__.. _m . _._____u.. ....., __n_.. ..ou___. __. ou .__._n______.___.___ .__.__.___. j'1!( --~- VIS~~LE !DDRE~~_______________________ -------------- - ---t Jt!' 0 CORRECT OCCUPANCY i-~__,_..,________._____.___._._.__m__________.____._._h._________._...,______..____ _ __ - - - -_ - _ --- --- - --- __!t_~__~__~~~I~~TI~~~:_~~~~~~~~Y M~~:_~~~~_~_________ ,,-------------t- ________________________, vl 0 VERIFICATION OF QUANTITIES _____,._._ _______.,________________,_________._. __.__,___.__.,._____.~.____,__..___.,________,__ ,,________,_ ,._ ,.,____ ___._.,_ _ m_________ )( 0 VERIFICATION OF LOCATION ------------------------------------- ------ -- ------- ----- _ -, -.-...----- -, -------- ---~---- --- .,g 0 PROPER SEGREGATION OF MATERIAL . ..... .. ...- ---.---------....--..... ..--.... __. .._ .._...._..__n__._____________.._....n_u___.._ ~ ~--------'-- ....--------.---.----- ._. .._ ._._ _ .___ _ _._ _ O____"__n._. _n_ ---. -... .--.---. ..n. ._______ _.____n___________._ --.---.--.---..----------.-------.--------.------.-...--.....--..- -_..~._,. ._-~.._-_.__._.- -. - ..-... -_.-.- _. ..__ __ __._.__ _n___ ._____._._____. ....._..._ _.__ . _.____ _ ._..____._.u________ ð' 0 VERIFICATION OF MSDS AVAILABILlTYE I ______,.___________.______________________ _, __ .____..__ um ,_____~,_.__,_.__._ _______-¡, ___ _ ___ kf 0 VERIFICATION OF H~AT TRAINING __________.,___,_____________________________.._____,_____________u., ____,.____..._.____~,.-,-.---,---- _. _ _.___..._...., __, ______u___,__, . ~~--~~~~~~~Np~(,:~~:::N:~::~SANDPROCEDURES1---· _ _______ ._ _______.__.____,._____ ,_.__ _ ___ ___,_ ~____________,___,__._____._.__________._..______~__.__u . ________..._______________.__ _ _____'_m _.. ,'____.______ ____ __ _..__._.._.__...__._______ __..______,_. __,_.__ __. _.____ )l CJ CONTAINERS PROPERLY LABELED I -.------.-------,---.,------.-.-.- ------ _,__m u__m_ -,------- ---,--,---. --- ,-- '-'--i- --- un...._ .--- -- mm ------- )zt 0 HOUSEKEEPING l _________.__.____ _.___._.____.________..___n.______.______. .___.__.____~__~___~ __. _. __n_____. ___ _....__ __._.__ _ _._._____ +____ __ ... ____nu_.. ..... _.. ..... _n... _.____. _. _._ _ _ _.n__n___._u__~_.___~_____ .----_..~~---_-._---~------ ---,- ._---,_..--.._~-----_.- _._ __ _~_..~______._.___.__n_._.._._. ----.-----.---....-...-.-- .. ..--- -.--..------ ----.---,---_._----_.- -..- ---. -.- ------------..---.-.-------.- ):( 0 FIRE PROTECTION ---_._---_._----..~~.._--_._.~..__._-_.. _._.._._-_..._._-~ -----.----.--------.--. )I( 0 SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: DYES ~No EXPLAIN: THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 \ .~._-----------~-------------,-----_.- --. -- -0--'- --- Fire Prevention 1st-In/Shift of Site <----- Party (Please Print) ð £1 While - Environmental Services Yeliow - Station Copy Pink - Business Copy · CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave.. 3rd f'loor. Bakersfield. CA 93301 FACILITY NAME VQAJ '~ Ç-ÙE I ŒE~(' INSPECTION DATEAI'3/D4- Section 2: Underground Storage Tank~ Program o Routine ~ Combined 0 Joint Agency Type of Tank 1)\1\) F Type of Monitoring ~. L-~ o Multi-Agency 0 Complaint Number of Tanks 3 Type of Piping D \J\ J F" ORe-inspection OPERA TION C V COMMENTS Proper tank data on tile 1-. Proper owner/operator data on tile Ix Permit fees current X. Certification of Financial Responsibility ;( Monitoring record adequate and current X Maintenance records adequate and current ~ Failure to correct prior UST violations )( Has there been an unauthorized release? Yes No 'f... Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks / OPERA TION Y N COMMENTS SPCC available SPCC on tile with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MYF? If yes, Does tank have overfill/overspill protection? C=Compliance Y=Yiolation Y=Ycs N=NO x Q., \ Whitc - Fnv, Svcs. Pink - AlIsincss Cory '~ / 'i: - - ~r~ DJnknology CLIENT: VONS/SO. DIVISION OF SAFEWAY 618 MICHllLlNDA AVE. ARCADIA, CA 91007 TANKNOLOGY CERTIFICATE OF TESTING 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 TELEPHONE (512) 451-6334 FAX (512) 459-1459 TEST RESULT SUMMARY REPORT WORK ORDER NUMBER: 3131022 CUSTOMER PO: SITE: VONS/SAFEWAY 2100 WHITE lANE BAKERSFIELD, CA 93304 PURPOSE: COMPLIANCE TEST DATE: 09/25/03 FRANCES FERNANDEZ (626)821-3920 PHIL (661)396-2344 TEST TYPE: TlD-1 1 REGULAR 2 PLUS 3 SUPREME FIBERGLASS FIBERGLASS FIBERGLASS PRESSURE PRESSURE PRESSURE 1 VEEDERROOT 2 VEEDERROOT 3 VEEDERROOT ELECTRONI 176757 ELECTRONI 176750 ELECTRONI 176761 P P P For owner detailed report information, visit www.tanknology.com and select On-Line Reports-WRAP, or contact your local Tanknology office. Tester Name: RANDY JAQUEZ Technician Certification Number: 10039 c<-y~9"W Printed 10/07/2003 12:52 KOHLMEYER \ · i e e INDIVIDUAL TANK iNFORMATION AND TEST RESULTS ~ Ji II'DJnlcnology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 TEST DATE: 09/25/03 CLlENT:VONS/SO. DIVISION OF WORK ORDER NUMBER3131022 SITE:VONS/SAFEWAY TanklD: 1 Product: REGULAR Capacity in gallons: 20, 051 Diameter in inches: 120.00 Length in inches: 413 Material: DW STEEL COMMENTS ',:::1~~IØ.gl\1~1l~lìl~':····· Tank manifolded: NO Vent manifolded: YES Vapor recovery manifolded: YES Overfill protection: YES Overspill protection: YES Installed: ATG CP installed on: / / Bottom to top fill in inches: Bottom to grade in inches: Fill pipe length in inches: Fill pipe diameter in inches: Stage I vapor recovery: Stage II vapor recovery: 120.0 4.0 DUAL ASSIST Start (in) End (in) New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Water Level: Dipped Product Level: Probe Water Level: Ingress Detected: Water Test time: Inclinometer reading: VacuTect Test Type: VacuTect Probe Entry Point: Pressure Set Point: Tank water level in inches: Water table depth in inches: Determined by (method): Result: COMMENTS Bubble Make: Model: SIN: Open time in sec: Holding psi: Resiliency cc: Test leak rate ml/m: Metering psi: Calib. leak in gph: Results: 3.00 PASS Ullage VEEDERROOT ELECTRONIC 176757 NOT TESTED NOT TESTED 189.0 COMMENTS Material: Diameter (in): Length (ft): Test psi: Bleedback cc: Test time (min): Start time: End time: Final gph: Result: Pump type: Pump make: COMMENTS FIBERGLASS 2.0 243.0 NOT TESTED NOT TESTED NOT TESTED NOT TESTED PRESSURE FE PETRO Impact Valves Operational: UNKNOWN Printed 10/07/2003 12:52 i e e INDIVIDUAL TANK INFORMATION AND TEST RESULTS -~ Tånknology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 TEST DATE:09/25/03 CLlENT:VONS/SO. DIVISION OF WORK ORDER NUMBER3131022 SITE:VONS/SAFEWAY Tank ID: 2 Product: PLUS Capacity in gallons: 10,037 Diameter in inches: 120.00 Length in inches: 207 Material: DW STEEL COMMENTS Tank manifolded: NO Vent manifolded: YES Vapor recovery manifolded: YES Overfill protection: YES Overspill protection: YES Installed: ATG CP installed on: / / Bottom to top fill in inches: Bottom to grade in inches: Fill pipe length in inches: Fill pipe diameter in inches: Stage I vapor recovery: Stage II vapor recovery: 120.0 4.0 DUAL ASSIST Start (in) End (in) New/passed Failed/replaced New/passed Failed/replaced L.C. #1 L.C. #1 L.C. #2 L.C. #2 Dipped Water Level: Dipped Product Level: Probe Water Level: Ingress Detected: Water Test time: Inclinometer reading: VacuTect Test Type: VacuTect Probe Entry Point: Pressure Set Point: Tank water level in inches: Water table depth in inches: Determined by (method): Result: COMMENTS Bubble Make: Model: SIN: Open time in sec: Holding psi: Resiliency cc: Test leak rate ml/m: Metering psi: Calib. leak in gph: Results: 3.00 PASS Ullage VEEDERROOT ELECTRONIC 176750 NOT TESTED 189.0 NOT TESTED COMMENTS Material: Diameter (in): Length (ft): Test psi: Bleedback cc: Test time (min): Start time: End time: Final gph: Result: Pump type: Pump make: COMMENTS FIBERGLASS 2.0 274.0 NOT TESTED NOT TESTED NOT TESTED NOT TESTED PRESSURE FE PETRO Impact Valves Operational: UNKNOWN Printed 10/07/200312:52 e e INDIVIDUAL TANK INFORMATION AND TEST RESULTS J.t~ 7ånknology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 TEST DATE: 09/25/03 CLlENT:VONS/so. DIVISION OF WORK ORDER NUMBER3131022 SITE:VONS/SAFEWAY Tank ID: 3 Product: SUPREME Capacity in gallons: 10,037 Diameter in inches: 120.00 Length in inches: 207 Material: DW STEEL COMMENTS Tank manifolded: NO Vent manifolded: YES Vapor recovery manifolded: YES Overfill protection: YES Overspill protection: YES Installed: ATG CP installed on: 1 1 Bottom to top fill in inches: Bottom to grade in inches: Fill pipe length in inches: Fill pipe diameter in inches: Stage I vapor recovery: Stage II vapor recovery: 4.0 DUAL ASSIST 120.0 Start (in) End (in) New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Water Level: Dipped Product Level: Probe Water Level: Ingress Detected: Water Test time: Inçlinometer reading: VacuTect Test Type: VacuTect Probe Entry Point: Pressure Set Point: Tank water level in inches: Water table depth in inches: Determined by (method): Result: COMMENTS Bubble Make: Model: SIN: Open time in sec: Holding psi: Resiliency cc: Test leak rate ml/m: Metering psi: Calib. leak in gph: Results: 3.00 PASS Ullage VEEDERROOT ELECTRONIC 176761 NOT TESTED 189.0 NOT TESTED COMMENTS Material: Diameter (in): Length (ft): Test psi: Bleedback cc: Test time (min): Start time: End time: Final gph: Result: Pump type: Pump make: COMMENTS FIBERGLASS 2.0 291.0 NOT TESTED NOT TESTED NOT TESTED NOT TESTED PRESSURE FE PETRO Impact Valves Operational: UNKNOWN Printed 10/07/2003 12:52 ~,~... n.nknology A.~ONITORING SYSTEM CERTIFICATION e "'Ú~e By All Jurisdictions Within the State of California Authority Cited: Chapter 6. 7, Health and Safety Code; Chapter 16, Division 3 Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or report must be prepared for each monitorina svstem control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: VONS/SAFEWAY Site Address: 2100 WHITE LANE City: BAKERSFIELD Contact Phone No: 396-2344 CA Zip: 93304 Date otTesting/Service: 09/25/2003 Facility Contact Person: PHIL Make/Model of Monitoring System: VR TLS-350 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced Work Order Number: 3131022 Tank ID: 87 Tank ID: 89 X In-Tank Gauging Probe. Model: MAG1 ŒJ In-Tank Gauging Probe. Model: MAG1 X Annular Space or Vault Sensor. Modei: VR460 [X] Annular Space or Vault Sensor. Model: 460 X Piping Sump/Trench Sensor(s). Model: 208 ~ Piping Sump/Trench Sensor(s). Model: 208 X Fill Sump Sensor(s). Model: 208 Model: 208 Fill Sump Sensor(s). = Mechanical Line Leak Detector. Model: D Mechanical Line Leak Detector. Model: X Electronic Line Leak Detector. Model; VRPLLD ŒJ Electronic Line Leak Detector. Model: VRPLLD = Tank Overfill/High-Level Sensor. Model; D Tank Overfill/High-Level Sensor. Model: = Other (specify equipment type and model in Section E on page 2). D Other (specify equipment type and mgdel in Section E on page 2). Tank ID: 8' Tank ID: ŒJ In-Tank Gauging Probe. Model: MAG1 D In-Tank Gauging Probe. Model: X Annular Space or Vault Sensor. Model: 460 D Annular Space or Vault Sensor. Model: ~ Piping Sump/Trench Sensor(s). Model: 208 l Piping Sump/Trench Sensor(s). Model: == X Fill Sump Sensor(s). Model: 208 D Fill Sump Sensor(s). Model: == Mechanicai Line Leak Detector. Model: D Mechanical Line Leak Detector. Model: X Electronic Line Leak Detector. Model: VRPLLD D Electronic Line Leak Detector. Model: = Tank OverfililHigh-Level Sensor. Model: D Tank Overfill/High-Level Sensor. Model: = - Other (specify equipment type and model in Section E on page 2). D Other (specify equipment type and model in Section E on page 2). IUlspenser IU: 1/2 Dispenser ID: 7/8 QSJ Dispenser Containment Sensor(s) Model: 208 [K] Dispenser Containment Sensor(s) Model: 208 [K] Shear Valve(s). Œ] Shear Valve(s) o Dispenser Containment Float(s) and Chain(s). n Dispenser Containment Float(s) and Chaln(s). Dispenser ID: 3/4 Dispenser ID: [K] Dispenser Containment Sensor(s) Model: 208 [Xl Dispenser Containment Sensor(s). Model: 208 [8] Shear Valve(s), o Shear Valve(s). n Dispenser Containment Float(s) and Chain(s), D Dispenser Containment Float(s) and Chain(s). Dispenser ID: 5/6 Dispenser ID: ~ Dispenser Containment Sensor(s) Model: 208 0 Dispenser Containment Sensor(s). Model: ŒJ Shear Valve(s), D Shear Valve(s). 0 Dispenser Containment Float(s) and Chain(s). 0 Dispenser Containment Float(s) and Chain(s). * If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this certification is information (e.g manufacturers' checklists) necessary to verify that this information is correct. and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): System set-up report; 0 Alarm history report 0 Q~ M-·9~w PRINTED NAME:RANDY JAQUEZ COMPANY: Tanknoloç¡y SIGNATURE: PHONE NO: page 1 of 3 (800) 800-4633 Based on CA form dated 03/01 Aitoring System Certification e Site Address: 2100 WH ITE LAN E Date of Testing/Service: 09/25/2003 D. Results of Testing/Servicing Software Version Installed: 123.00 Complete the following checklist: xl Yes nNo' Is the audible alarm operational? [8] Yes DNo' Is the visual alarm operational? [8] Yes DNo' Were all sensors visually inspected, functionally tested, and confirmed operational? [8] Yes DNo' Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? [] Yes DNo' nN/A If alarms are relayed to a remote moniionng station, is all communications equipment (e.g. modem) operational? [] Yes DNo' DN/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (check all that apply) ŒJ Sumprrrench Sensors; ŒJ Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ŒJ Yes ONo DYes DNo' 0N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device (I.e.: no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? % DYes' []No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. DYes' []No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) o Product; D Water. If yes, describe causes in Section E, below. [] Yes DNo' Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. [] Yes DNo' Is all monitoring equipment operational per manufacturers' specifications? . In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: page 2 of 3 !itoring System Certification e Site Address: 2100 WHITE LANE Date otTesting/Service: 09/25/2003 F. In-Tank Gauging I SIR Equipment ~ Check this box if tank gauging is used only for inventory control. o Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to peñorm leak detection monitoring. Complete the following checklist: ŒJyes DNa' Has all input wiring been inspected for proper entry and termination, including testing for ground faults? o Yes DNa' Were all tank gauging probes visually inspected for damage and residue buildup? o Yes DNa' Was accuracy of system product level readings tested? 0Yes DNa' Was accuracy of system water level readings tested? ŒJyes DNa' Were all probes reinstalled properly? ŒJyes DNa' Were all items on the equipment manufacturers' maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line leak Detectors (llD) : D Check this box if LLDs are not installed. Complete the following checklist: o Yes DNa' DN/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: 0 3 g.p.h 0 0,1 g.p.h 00.2 g.p.h MYes DNa' Were all LLDs confirmed operational and accurate within regulatory requirements? o Yes DNa' Was the testing apparatus properly calibrated? DYes DNa' 0N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? o Yes DNa' DN/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? o Yes DNa' DN/A For electronic LLDs, does the turbine autcmatically shut off if any portion of the monitoring system is disabled or disconnected? o Yes DNa' DN/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? o Yes DNa' DN/A For electronic LLDs, have all accessible wiring connections been visually inspected? 0ves DNa' Were all items on the equipment manufacturers' maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: page 3 af 3 e TEST DATE: 09/25/03 CLlENT:VONS/SO. DIVISION OF SAFEWAY SITE DIAGRAM 1-~ DJnknology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 e WORK ORDER NUMBER3131022 SITE: VONS/SAFEWAY WHITLANE ~ t ~ C-STORE 1 \ VENT o PREM §@ 10K I HAS~TEC I UL I§ 20K @~ Printed 10/07/2003 12:52 KOHLMEYER e e Lr;L8L SBX;).L 'U!¡Snv OOZ: ¡JU!Pl!ns: ':>;);)1;) BollS 0068 3GN-Á¡JOou:>UB.L ~~on:n: Rcví\<'Ó.I.II~~!~ :1;)P10 :>10 M. Wark Order: - 3131022 S'iCin'I"l j3r;TUF SEP Th, Z(¡U:3 2: 28 ¡:'tl f~Ii,T£!1 UN! TS J 1"1£ fORI"lI-iT H\'1:t"R"t:Elp" ,;.Î't 1 ~5'2B.58 V~HfJ 2100 IdH!TE Li1NE ßi'\ÌŒ~:SF tELL' CA, ,661·,,39601 S¡ 8H1Fl' THI£ .! 3d 1FT T 11'1E2 SHiFT TlhE J mOrT T1r1E'1 5 :4G p,þ\ H ¡as rc'M D!i3AÐ\...En Dl::)ABLtn f;11 ¡ 1'T IHR FR l1HOUT~3 Ü J ~;¡:~fJL.RLi 1>\(L,/ 8lR ,FRtl'mJUTG l>¡SABL£D TICKETED DELIVER'; Dl SABLE(' mHK PER TST NEEVED WRN DISABLED Tf1NK (iNN T1'51' NEH4::Ü ¡;¡RN D 1 SF\FILEV RE-ENhbLE l"lEThOD L j NE TEfiT L ¡ l'jE Þæ· T~3T IŒCÚEI) I¡JRN [,¡SriÐ!.ED L! NE ;~t'm 1:';1 HEE8EL' WRN 818,;131.£1'1 \/;:)1 ,1.~'lE~:J TEli.· (:(¡I'iPENS{Y!' j , 'HiLUS (DEG F ¡: 6(1,0 E;'! ! CI( HE I ÇHT ÜfFSET DISABLED HFROTG(OL ÜiYff.' FORtiAT HE 1(;\-\T PHEC!'DtGIi T£\51' DURAlH1N HQURS ~ ~Jo.4 0,20 GPH UNE TEHT AUTÔ-COI~F ¡RH: 12N(,91..EO o. ¡[) (¡PH tiNE T£8T AUTo-cONn Rt'l: ENABLED DIWUGHT SAVING rmE ENABLED E:Tf\RT DI\'I'[ riPF. WEEK SUN ~3TAP'T n !~IE 2:0Q A!'1 Ei'¡[¡ MT£ <~(T WEn: (, HUN ENn l!HE 2 :00 Fil"l RE' Ü I kE\::T ¡ :Ol:r,r [iI:' ¡,,,,'r.J"" e e <..v,:0.~ SYSTEM SS'Jur;;JTY CODE : OOÚ(H'j[) CUST{¡f1 ALARM LHEELS 1\1,&18L£1) RECEIVER ,SETUP: D B:VEEDEB' ~qoT (HI;:;) L80D3?64255 ," k(:VR TyPE: C011FUT¡òR j)ORT i;¡0::2 RETRV NO: 5 RETRY PELH'/: 5 ÇONf'rp,t1ATlON REPORT: OFF (:()t'lt"lui;¡] (efiT ¡ ON~i ¡:¡ETUF Pt)'RT SETT¡ N¡·)S : (;()I"II'1 BQARD 8AUDRf,T£ PARI TV srøFìJTr , : DATA Lg~~GTH: '1 RS-::'<32 SEGUR ITY CODE : ¡:j! Sf\BLf:I) DIAL TYFE ¡TONE ANSWEFi' ON ;,[ R1NG MODEri SETUI' ciTRI NG : D!ALTüI'lE ¡ NTER\!AL; ~12 CÙI1li BOARu 5 (Kt)-485.) BAUD Rim: 2400 PNHl'! ' EVEN ST(}fi 811' : JSTOP ["\T0 LE!4GTH; ..7 Di\T" RS-<)3iì"'l:y-IjR! T" 'XmE : D.J ŠABLED COt'1I'iBDfiP.0 BAUj) RATE . PAR ITV . BTO;F BIT: Dt'iTA LENGTH: 7 RB-232SEClJRl tv CODE : DfSf.!HLED AUTO Gh\LTII'1Er;ETlW:, [, 8: VEEDgR ROOT \ FI1S¡ [J!PlLÜN DATE SEP '19. 't;'ù02 D I hI:. TH1E: 2:1 9 pri REc:E ¡.\.IERFi£PÜP'~¡3 : AUTO TRmSdT 8EH! N':.B: AUTOL&1KAÜ\f!H LINn D ¡BABLEr, AUTO Hr(,H U{.\TLf: LH'¡¡:r DISABLED AUTOO\ÌEFtF ¡ LL L HI! T n ¡ SABLE[), AU1:0, LÖì.d P2Gvu'::T f.1H3ABLED AUTOTHEFTLHiJ T DlOOBLED ' HUT!) fiEL! \lEk'/ DISAfiLED AUTÜ r¡ËLJ\lER~' EN[, DISABLED AUTO EXTERNFlL I ¡¡PUT QN DISABLED . AUTO EX:TEF:Nr\L1 tjpUTGFF lilSfìBÜ'tfi AUTOSEN$ÜR liLhFl1 DISABLED ,AUTD SEN8GRLI!+TEFi HLHFI'l DI5A!1!.:ED ' Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Wark Order: 3131022 OF ~'1ESßHC;E AUTO fi I At ALARi." SETUP _"".w--- D 8: V£ED¡;;F:; ROGT ( Fnb ¡ I N-'rt1I'J!( f1Lf\RNS ALL: LEAl( ALARt'1 ALt:H!GH I,~ATER ¡ì!.iìRn ALL: ÜVER!" ILLAtAR~1 ALL ;SuDnEN LOSB ilLARtl AIJ.: H ¡ GH PRODliGT ALRRt'1 ¡ìLt : J Nil!)!. ¡DrUE!. . LE'·ÆL "tL:PR08£ ÜUT ALL: 1'111>( PRO£JUCT f\LARM ALI.:GROSS TEST FAIL ALL :pEJWXí!C TEST PAIL f.l.l.L:ANr;UAL TEST FAIL ALL: PER NEE[>ED WRN ALL:PER NEEDEDALM ALL:NO caLD IDLE rIME ALL: CSLD J NCRRATE viAEN ALL: f1CC\.LCHHRT CAt tJARN ALL: REC{)N ~JARNJ N(~ ',. ALL:J?ECON ALARM ALL :t..0tJ TÐ1P ~~ARN¡I;j(. AU. : GRCïsS fA H. L! NETNK UGLJIlJ SENSOR ,AU'~S ALL: FUEL ¡,LARt1 ALL: SENSON ,OUT ,~LARì1 ALL; ;JiK'RT ALAR~1 ALL :WATER ALAí<~'j ALL:WATER OUT AU1RM ALL: H lGH L ¡ OU H> ALARM ALL: LOl,, LHJU m f.l.LARM ALL:L!QUW"IAF/NING , REGE ¡ \tER f\LARI'iS SERVICE REPORT WARN P>lARn ÇLEAR l~AR¡'¡¡ NG . PRE8~JUF:E L ¡ NE LEAK ALL:GROSB LINE FAIL ALL:ANNUAL LINE FATL !iLL :PER TST NEEDED At.I'1 ALL:}'LL!) ,0pENfìLARtI ALL:UNKtIDWN ALARM ALl. ;¡J~¡K I~OWN ALARM ALL: UN}; NO¡,lN ALARIi ALl.. : PERiOD IC LI NE fAl L ALL: ANN 'TST NEEPEr, 'ALa ~\LL : L01A PREæUREALARM Hí...L : UN¡;NOWN ALARM f\LL :ÇONT. HANDlE AU'1 ALL: LN EOU ¡ P FlWLT ftLl'1 e IN~Tf\NK SETUP ~, '"'" -- -- .- - T .l : REGl/LAR PRODtK'TC,ODE THERliAL, COEFF TANK, OJ A~1ETER TANK PROf I l.E FULLV9L 90.0 [NCH IJOL pCL 0 INCH VOl. 30.0) NCH VOL METER ,DATA J : .000700 1'20.00 4, prs 20051 16246 1013Z 3989 NÖ e 1 2:PUJS pROPUC1GOPE THERI1AL CÙEFF TANK,DlAI1ETER TANK, PROFILE· FULL VOL 'iiO,OINGH VOL tSo,ÜlNl.:H VOL 30.0 1 NtH vor. METERDFfTÀ <1 ,000700 lZ0,OO 4,PTS l003? 6098 S045 1985' NO FLOAT >1.0 HI, F!.OHT 81ZE: ,~.o IN. ~,¡>\TERI;,IAF:N ¡ N,G ,: fil GH ~IATER LH11T: f'1AX ,OR LABELVO!..' OVERFILL LIMIT ; HIGH PRODUCT DELJVElN LII'1IT ¡ '. .. . L~ATER WARN H<(J : HtGHi.ATER LH11T: HAx {¡RLH8EL IIOL: OVERFILL LINn H¡';:;H PRODUCT DELl VER'iL ¡ ~11T I ¡:: ..·.oJ '2.·5 , 20051 951, 190>1t¡ 9 or. 1 Ei046 15:, 300;/ [OWf>R0DUCT' LEAK ALARM,LIMIT; ~UDPENLOBSLH"IIT' TANK TILT" , ". . PROBE OfFSET ' '500 99 93 O,00 f:),00 W037 '951'< . SÙ:;35 90% 903:3 15:~ 1505 LOW,PRODUCT. :500 LEAI~ AI..A!ir'1 LIMIT: 59 SUDD!:N LOSS LIf'lU: 99 TANK TILT : 0,00 PRqBE OFFSET 0.00 SIPHONMAIHFQLDED TAI~I<:S 1'11: NONE LINE ~jANIFOLDErí TANKS Tµ: NONË ' ' LEAK hlN PERIODIC: tEAK HI N. ,ANNUAL PERIODIC TEST TYPE , , STAiiDARD ANNUA!..tESTFA ¡ L ALARN DIMBLED PERJOD!¡:TE$TFAIL ALARM DISABLED P.ROS$ TEST FAIL ALARHDISABLED ANN TEpr AVERAG! tiC> : OFF PER TEST A'JERAt;¡NG: OFF TANK NOT! PI: SIPHON MAN J fOL!>!W ·1'LiNK~· Ii: NONE . "Y LINE t1ANlfOLDED ri\l~vQ 111: NONE. .' "'" LEA¡{¡'UN PERIÜDW: [J>¡ o INK'TS! SIPHONBREAK:OFF DELIVER'Y DELA\' PUI4P THRESHOLD ,5 t11N teL 00:.. LEAK M J N ANNUf\L ,: ù'4 o Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 f>ER,!O[¡¡C TEpT TYPE STANDARD ANNUAL TEST FAIL ALARf'l lì!SABLED PE~!ô!;'¡(; TEST FAIl. ALARM D If3>\BLED GROSS T£STrAIL ALARI'I DlSA8LED ANN TE8i AVER'A1~·Nf'·QFf PI?R TE8TA\JERAGINÓ'~ OFF TANKTEP'T NOTlF'I; OFF TN}; TST SI¡>HONBR~K:OFr ~EUV!i:¡;¡VDELiW ::; r{r N F UMt· THRESHOIJ) : l[j.QQ~ U--*.,,· " o 0" o ,OFF Work Order: 3131022 TJ:SUFRf:1'1E PRDDUCT (;'ODE THER~1AL COEFF TAN!( DIAr1ETER TANK PROfILE fULL OOL 90.0 INCH VOL 60.0 INCH VOL 30.0 INCH llOL HETER DMTA FLO,,]' SI2E: : :3 ; .'(¡00700 : ¡ZO,GO 4 FrS 10037 8íJ9$ 5045 IS8,5 NO l~'ATER ¡4ARN J N(; : 1 .5 H[OK ¡,JATER UNIT: 2.5 ~.D IN. rlAX OR LABEL VOL: OVERFILL Llt"HT HIGH rRoDUCT DELIVER\' L HiLT 1 OIJ37 "3:5/& 9535 SO% 9033 15.~1 1505 LÖW PRODUCT : 5QO LEAK ALAR!4 L 111fT: 99 SUDDEN LOSs L It'll'': 99 TANK TILT (} .00 PROBE OFFSET 0.00 SINtON l'iMNIFOLDEn TAN~:S T¡¡: NONE UNE t1ANIFQLDED TAN}(Ë! ill: ¡'{{iNE LE{\j( 111 N H:RWDIG: OJ¡; o LEAi( ~1! Pi ANNUAL (f3j o PERiODIC TEST riPE STANDARD ANN1.JfIL TEST FAiL ALARM ri BEVBLED ¡'¡:R IOD! G TEST 1'1\1 L f!l..Al'il'1 D ¡ SAntE!:) GROß$ TEST FAIL {¡!.!',RM D!£;;;BLED AI~H AVERA\) I Nt): OFF PER AVERAGING: OFF H,NK TEST Non FY : OFf TNK TS1' SIPW}N BRE/V;;PFF DEL I VERY DELfw : 5 111 N PUl1P THRESHOLfJ ; W.ü()% e '~~=___'C~,. LEAK TEST !1ETHOD TEST öN [J#TE .IAN I; 1 996 START TIME TEST RATE DURATION, ALL TANK GO P¡'1 GAL/fiR ijOURS TST EARLY S1'OF:OlSAÐLED LEAK TEST REPORT FORrti4T NORMAL 162B58 VONS 2JOO WHITE LHNf: BAKERf;FIELD GA. ßf.!-395--019] SEP 2E>. 2008 2:28 PM FUEL MAt~>~tENT - - - - - - - - - - - DELIVER'IWARN l!.V¡S,: -0. () AUTO PR ¡ NT: bi SABUW T I: REGULAR AVGSAI.E$;,.SUN: AVG £;;;LES-MON: Ave SALES~TU¡;:: AVG SALES,..WED: Ave SALES"'rHR: F¡VGSALES-FRJ: AVG SALES-SAT: T 2,:?LUS AVO $ALES-SUN: AVO SALES-MVn: AIJO, SALEs;",TlIE: AVGBi'I!..£S,..WED: AVGSALES"'THR: Ave; SALEfH"RJ: AVGBÄLES-S!\T: T 3: SUPREME AVG SALES-BUN: Ave SALES-,,11ÓN; AVG SALE.S"TIIE: AVO SALEá~WED: AVGd$ALES-THR: AVGSALE£;--F!H.: AVG SALES-SAT: 3687 GAL 3ß.7'!iGAL 3657 GAL 3.987 GAL 3,624 GAL 4983 GAL 4381 GAL 479 GAL 462, GAL 46¡~L 400 GAL 4G6 ':;AL S13GAL 552. ¡:;AL 208 GAL 20~J GAL .! 92 G¡ìL 195,OAL 2 is (,At 224 GAL 2:~4 GAL e PRES'StlRE 1.. I NE G !: J?EGULAR TYP :WFG (>Q<'L>:2000 RIBBED LIt~E LENGTH: 243 FEET Q.2Q GF'HTEST: REPETlTlV o. ¡o, GPH rEST: AuTO SHuTDOWN RATE :3 _ Q (¡PH LOW PRESSURE BHIlTPFF:VES LOW PRESSURE : 10 PSI T I : REGULAR D I SpEM;;£ MODE: STANDARD SENSOR: HIGH PRESSURE PRESSURE OFFSET: tJ.(jr&1 ,G, ;?:PLU8 TV¡;- :,tJi"r.;, ('01"1.:<2000 RIBBED ~ ¡ NE LEN(HH: ,274. TE'ET 0.20 ,-?PH TEST: REPf.nnv - 0.10 GPH TEST: AUTO SHUTDOWN RATE: 8.0 (¡PH LO[.) ?RES-SURE SHUTOFF: YES LOW PRESSURE: 10 PSI T 2WLus DISPENSE MOD!;:: STANDARD 8Ertzo!?:, HI.GHPRESSlJRE PRESSURE OFFSET: O.OPSI {¡ 3: SURREÍ4E rVP:WfG (;ÜfLX20ÛO RIBBËl.ì Ll.NE LENGTH.: 291 FEET - 0.20 (.;Þ1I TEST: REPETlnV (}. 10 (¡PH TEST: AÙio 8HUi~NRATE :3. (I ç:PH 1.9'" PRESSURE, SHUTOFF: YES LoW PRESSURE: 1 () PSI i"3 :8lJPREME DISPENBEMODE: $TANDARD SENSOR: HIGHPRE8$URE f'RESBURE OFFSET:ü. ÒrBJ Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3131022 U';;Ui" SENSOr¡ LETUP ,~----- L ¡: REGUl.AR srI' TRj-STATF.Œ1!'IGU': fLOATì GATEGO,,"Y : 81'1' BtR'I!" ' L 2:,REGULAR FILL . ,',' TRJ -S'¡.;TE ([';1 NGLE FLOAT) e:¡WEGÚRV : OTHER SENSQRS L :J :REGUL!,R ANNULAR TRl -STATE (S INGLE FLOAT i ("JlTEGORV : ANNULAR SPACE L 4 :f'!.,liS STP TRI-Smn: i8JNfJLf. fLOAT) CA1EC;ORY : sTP 8U~IP L 5 :PUÆ FILL , nn-STi'(fE ;:;';JNGl.E FLOhn CATEGORY : OTH£RßENf.30RS L 6 :~:;¡IJPREHE ST? TRI-STATE (SI fiG!.£: FLOAn ctìTEGORY :STP BUMP L 7:ßUPREME FILL 1R 1 STATE ;:3 ¡ NOLE FLoAT> C¡'ITEGORY : öTíj£R SE}lf30RS L 8 ; sup H.US ANNULAR " ,. TRI "STATE t81.NGLS FLOAT) CATEGORV : ANNüLAASPACE, L 'j:DIBP 03-U4 , . TR¡ "-STATE (SINGLEFJ..QAT) CATEGORY : PISPENßER PAN Ll G :D1$P 01 "fJ:t TRI-STATE (::;1 N(¡LE fLOAT> CATEù{)RY : nISPENBERPAN LJ! :DISP 05-05 IFf! -STATE tS ¡ NGLE FLOAT)' CATEGORY: D!SPENSER pAN LJ 2: PISPO,?"ü8 TRI-BTATr:: (SINGLE FL01'iTÎ CATEGORY : DISPENSER PAN Ll3:Dr¡:¡p 1J9~ 0 TR I -STATE OJ NGLE FLOAT) CATEGORY ; D SPENBER PAN e OUTPUT' RELlW SETUI> - '- -.- .~ -- R 1 :OVERFILL-RE110TË TYPE: STANDfìt:¡:¡ r,¡oI1~IALL I{ OPEN I NcTANK ALARMS, ' ALL: QVERf' [L1.. ALnRI1 ALI.;HIGHPRODU(;T ALARt'j RZ:VON8 .,Lt ALAR~I T'iPS:" ,,' STÄNDARD NORI'IAU..Y 0!>m~ 1 N-TANKALARt'18 ALL: LEAK ALARM ArcL:HI~HW,TgR ALARM ALL:OVERFrLL'ALARM fiLL :LOW¡:'RODUCTA1AR11 ALL ;SUDDEN LOSfJA!j,RH ALL; H 1GB PRODUCTALAP.1i ALL: I NVAU DFUEL LE\!EL ",LL:PROBBOUT ALL:HWH L~ATER UhRNING ALL :PEU vERY NEE~'ED " ALL:MAX PRODUCT MLARf'l ALL : (¡R.ofi¡$ 1£:3T FA I I. L ¡ OU ID SENSOR A!J'lS RLL:F UBL f\LfiRt1 ALL:SENSOR OUT ALARI1 ALI..:SrlÖRT ALARM ALL:WATER ALARM ALL:WATËR OUr ALARl1 ALL:HIGH L¡GUIQALARÍ'I ALL: Low U QUID I'ILARM ALL :LIQUI I) WARN.JNG PRESSURE LINE LEAK ALt:.;J':ROSS LINE,FAIL ALL :ANNUAL LJ NEPAlL ALL:PER T8TNC121;EP HRN ALL: PER 1ST NEEDSDAL/1 ALL; PLLD OPEN ALARtI ALL:PLLD8HUTDOWN ALARl1 ALL:PER LOn! (;L ¡tiE FAIL ALL,:ANN TBT NF.EDED WRN ALL:ANN TST NEiWED RLM (,LL:LOWPRES$URE ALARI1 ALL:CONT HANDLSALH, ALL :,FUEL OUT e PLI..D LINE DJg.f\B.LE SEiUP _ .... :w "¥ '" . - - . -_.~~._- Q I :REGULAR IN-TANK ALARI1S T I: H IGrt, L<J,ATER f\LARt,! T l:LOW PRODUCT ,ALARl"l LIQUID SENSOR ALNS L I:FUEL ALARt1 L Z ;f'-UEL ÂLARtJ L8:FUEL ALÄRI1 L9:EuËl, ALARM L1 (J : FUEL A!..Á#r'l LII :FUEL ALAI<M U;?:PUEL ALARM LJ 3:FIJE1., ALfiFM o ::1 :ÞLU8 Hk1'f,NK flLARl1S T 2:Hll~H WATER ALARM T 2:LOW PRODUCT ALARM LItJUlD 6Efi.SOR ALMS L 4:FUEL ALA~!~1 L 5: FUEL ALAF!M L 8:FUEL ALAR!"I L ,9 :FUEL ALAF'M L ¡ 0 :YÛEL ALAPN LIt: FUSL ALAr~\1 l!2:F.UEL ALARM Ll:3 : F!jEL ALfìR~l 03 :.sURRENE I N~TANJÇ ALfiRkS T 8: HICH WATER.f1LARI"1 T 3:LOWPROPUCTALARM L!0u! D. SENSORALr"lS L 6: fUEL ALAR~1 L 7:fUELALARM L e:FUELALARt'1 L 9:FUELALARM L ¡ Q :FUEL ' ALARI"! Lit :FUEL ALARM U2,:FUEL ALARM LJ::J:PUEL ALARM LINE LOGKOUT8CHEDULE DAJl.Y START T!t1E: tHMBLEj) ST(ìP TI ME : D !SA8LE!) 8~Tljp Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Wark Order: 3131022 RECONCltIMT!{)N BETur .... .~ ... - - - NJTOHATiC f)í-IILV CLOStNG TINE; 2: 00 f\f1 AUTO 8HIFTn CLíJ81NG T!I"IE: 11:05 Pi"1 fU.JTO SHIFT it.? CLOSING T ¡¡iF. ;1) lSABLEO AUTO ßHIFT IÌG CLOSING TIME: DISABLED hUTa SHIFT II.;!, CLOSING TIME: 5:40 N1 PEk10!) Ie RECONCH,¡ AT !OI~ I'1()ÞE :~10NTHL ',;' ALA"'!'!: DISABLED lUfF> C;(kIPENSAT ION S'1'¡:\I~DARD NETER CALIBRATION OFFSET: n. ODD" BUS 8L(JT FUEL HETER fANY. ... ~ - -, -.. ~, TNJf: t'ti\P £r1ÞTY OOF11,JARE REVISION Lk.'VEL VERSION 123.00 SOF1'L4ARE;t 3,¡f,¡ 23- I DO'A CREATED - 02.05.D8.1'7.03 ¿¡-flODULE! 33t} 60-1 63-A SV8TEM FEATURES: PER WI) ¡ C IN-TANK TffiTB I~NNUAL I N~TANK' TE$TB PIR' FUEL HANAGER FUb , D. ¡ 0 AtJT{) (U,Æ} REPET !TIll WPUD D. JO AUTO 0.20 k£PET1TLV e e ALARM HISTORV REPORT c- - - If,. fANlCALi'\I0r1 f,LAR!"IHIBTQRV ·RJ::PÒ¡;¡T ---'- IN-TANKALARÞI T2:PLU$ i3ETtJÞ DATA WARNING "UG 13.2002 1-2: 26 PM T 1 : REGULAR SETUF JH'I'f'A WARN! AUG 13. 200212 P~I HIGH wrITER (;LARJ1 AUG 200212 :29 P~l OVERf ¡ LL ALAt'.'11 r"lAV 26. 200:3 10: 16 AM APR 28. 2003 4:J() PI1 StJDDENLOSS ALARM SEP 25; 2003 12:07'Pl1 Aua 14. 20029:,22 AM HUG 13; 20HZ [: 38 PM HIGH ~JATER ALARM AUGl3. 2002 12;29 tN HIGH PR'OlJUòT ALfŒ~1 NOV 30. 200.2 12;34 AM NOV 26. 20023 :45 P~l OCT n. 2002 5: 06 PM H!(¡HWATER t~AFmING rUA.i ! 3. 20m? ¡ ;2TPrl HIGH PROPUCT ALARf'1 SEP 17. ZOO:'] 1 J :54 Ai"! 8EP ro.~008 ,7:06 Pf1 JUL 20. 20Ò3 1i.):20A/4 PROB!üUT $J:;P~·5. 2003 12: 09 H"I SEP25. 2008 12:08 PM AU(; 13;20021:::)8 PM HIGH wATER WARN!NG flU(; '1 ;:). 2002 I :'27 Þ¡'1 M ¿ ) ¿ . END M . . . . DEL! VERy NEEDED SEÞ ~5. 2b03 12:08 PM JUN 22. ;£003 '2: 2,7 pr!1 f'lLARt'1 HISTOFN,REFORT ......- ¡N~tANK ALi:'RM T3:SUPRfJ1E SETUP!JATA WARNING HUG 18. 2002 1,2:26 PfI HIGH t4ATER ALARM AU(; 13. 2002 12:29 PM OVERFILL ALAR/1 AUG 31 ..2C102 5:80AM S,UDDEN·WS¡;¡ AI.,ARM" AU(; 13. 2D02 ,2:¡",jOM Ii !G,'" PRODUCTALARI'1 SE? 7;20D3 2:39PM JULIE), 2003 9:37 PM ,TAN HI. 2008 21 HJPM .. · . KVND'~ .. ~ . M ,PROBE '. OUT 8£1',23.2003 I!: 13 A~!I AUG13.2002 2: 1:3 PH HIGH wATER wARNING AUG 13.2002 [:27 PM Lm~TEi"¡PWARN¡NG "/'1 AUG 13. 2D022:;;:¡ r-' . d· 200 Austin Texas 78757 I NDE 8900 Shoal Creek, Bud mg , Tankno ogy- n Wark Order: 3131022 X: ,,~,)( .. :~ EN!} it( Ji w: ~,' '.':~' IJLMiM f! J SiORYREPORT __u_ SENSOR AMRM .,---- L J: REGULAR SiP tin-SUMP FUEL 1'\[.1'\1'&\ SEP 25. 2003 12:03 PH FUEL ALIJRf'1 AUG 16,2002 9::25 AM FUEL ALARM i)¡!JG 15, 2002 1ù:(Yl AM i: .~ ~ ,~ :... ENV 1/;. Ji,.' :*; ~- '1( 1,\l,J\¡;:H HISTORY REPORT --~-- SENSOR,ALARM L 2:REGULA.R FILL OnfER ,SENSORS FUEL ALARM SEP 25, 2003 12:1'1 PH FUEL ALARf1 AUG 15. 2,002 lù:12 AI"! FUEL AUG ¡ 1 :51 PM ~ " e e jfMj('-¡ot ,. END ';'; :oi :oi 1<')<' (\LARM HISTORY REPORT .- - u ,- SErJSORALlW¡!'1- ---- L, :3;REÇòULAR'ANNULAR ÀNNULAR, SPACE' ' FUELAL.ARM SEP25 ,2003 ¡:2; 17 Hi FUELALf\RN AW(;, HL2ü02 1O:4 M1 FUEL ALARM AUG 13, 2ùD2 1; 58 PI1 ALARM HISTORY"REPORT :,h__ BEMJOR ALARN-~';-~ ... 5:PLUSfILL OTHER,13ENSORS ¡;'UELALARH BEÞ 25, ;?OO:J'1.2n6 f'M FUEL ALARM AUG 15; 2002 10: 1(.) AM fUEL ALARM AUGI3, 2082 2:001>M ;;¡ .;;¡ ;o¡ >ti(F.;NP" i(,;{ ~ ~ ;;¡ ¡,¡" '" .. END " .. .: ,.,.. AI.ARtI HISTOFNF/EP0RT ----- EEißORÄLRF/J'1 L 4: PLUS SU- sT;> ßU"1Þ FUEL ALARM SEP 25. 20QS 12:03ÞN FUEL ALARM AWG j:5, ZG02' lO;aB~¡ FUtt. ALARM AUG ! 3, 2002 1:59 pM ALMI1 HISTORY REPORT --.:--' SENSOR ALARM L b:SlmREI"IE STP STf>SUMP FUEL Al;ARt1 SEP 25.2003 ! :58 AI'1 FUEL ALARM fEE 12. 200a b: 08 Pl't FuEL ALARM JAN:lL 2003 10:03 PM '" 'J<, " .. :oi END ... . ,.. " ". 'Z~. Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Wark Order: 3131022 '.i( ";' < -;;:- ;.t' W~__o·, ,?jLARI"! H ¡BTGR..' REPORT --~-- SENSOR ALARM L7:SUÞREf1EFiLL OTHER SENSOR£! FUEL AtARf"1 SEP 25. 2003 12:27 P1'1 FUEL.. ALAR!'! BEP 25. 200;} 12: 16 PN F UEt ALAR!'! AIJe; lb.2ûû2 8n~;;¡ AM " ;< ", .¡(. ," END .)oJ )oi¡" JIi' :'< ALAP'~1 HISTORY REPORT ,",.--- BENSOR ALARN ----- L 8 :SIJP PLUS ANNULAR ANNULAR SPACE FUEL ALARM SEF' 25. 2003 12:j6 PM FuEL ALf1Rl'1 AL)(; 15. 2002 lÜ:16 AM fliEL ALARM AUG 15. 2002 10:1.5AI"1 ~' 1t' ~ j¡\, ~* ~,;, ~ ~ ¡w: e AtARt'1 HISTORY REPOi'l't -'---- SENSOR. ALARM --,-- L 9:DlSf> 0:)-04 DISPENSER. PAN EWE);. ALARM BE? 2':>'. 2008 ¡ ¡ :56nfl fUEL ALARM AUG. 15.:2002· 9:57AM FIJEL RLARH AUG 1.3.20132 4:09Þ¡. " ¡.¡ ',¡ x "END", ".J\-" " ALARN 'HISTORY P.Ef{}RT ----,- SEN!30R A!.;AR' L1 O:DIB? 01-0" H DISPENSER PAN" FUELALARM . . 8EP 25. 2003 11 :55 AM FUEl, ALARN AUG 15.2002. 9:59 AH FUEL ALARM AUç¡-15.;;>Oü2 9:58 AH ;i;')()( ".. END "'of .;, J;¥ e ALARM HISTORy REPORT L!!;r;' NBoR /:ìLAfi'M -___ DISPE fUBL AI..AJ;¡¡; $EÞ25. 2003 U:55 AM f'UEt AI.J.¡Rf1 AUCn)>> 2äû2 ¡ 0: aQ AI'! FUEL ALARt1 AUGJ3..iOQ2. q'O'" ." PM ,*- ..,: .~ ~ ~-- .. . . .ENtì.....J;)( Jo:,. ALA~ HISfORYREPQRT ë - ---S£N"'OR " t.J2, :D.·l"n'.. ·uS'" ALA~ ----..- D .,w"'08 ¡SPENSER .'':;'''1 FUEL ALARM BEP 25. 2003 11:55 AM FUEL. AlARM Ayû 15. 20(}2 10:04A11 FUEL ALARM Aua 18·2002 4:10 PM .. .j,! !Ii. -"11 END.). 'f." .i(" Tanknalagy-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3131022 AÙ,f;H HISTORY REPORT .. , ,,~,. SENSOR ¡\r..ARI1 LÌ3;fji8P 09-10 !)ISPENSF;.RPAN FUEL I-iLARt1 SE? 25, 2003 ¡!: 55 Af'1 FOEL AOG I lû:05 AM FUEL ALAR!'1 AUG 18,2002 4:11 P!1 ¡¡ .~ ¡¡ ".. <:'t¡f)".k *j¡¡ Ii e '"' :!':' ALARM HIS'rOFN REPORT _____.SENSOR (,LARM --~.'" 01 :REGULAR ." ..... PLLD SHUTDO~N' A~t~1 '.' . BEt' 25. 20031. kPtl GROSS LANE fAIL " SÈP 25, 2003 1:12 PM PI LDSHUTDOWN ALARN. SÊP 25, 200G ¡2:I'lt11 PLLD $HUTfiOWN ~I:A¡:¡f1 '.. 8f.P 25, 2D08 1¿.08 pM PLLD. SHUTDQWN 0LJ\Rt1 SEV '25, 2003 11 :55 Î41'! P'LLD SHUTDOWN ALARM AP~I, 2003 <1 : J 0 PM GROSS LINEFAIL " APR 1.2003 4;.1 0 PI4 PLLD '. SHUTDOWNALARll.. AUG 18,20029: 25f\l'l . FLL[¡ßiiUTDOWNALARtl .~UO 15. 2002 10: 14 A!'1 P LLPSHU1Tio.~J N AI..,11R11 AUG JS. 200210:12 AM e . )€-~: ît( HLARMHlSTo.RVREPORT ..."...... SENSOR ALARM ___.u Q2:1>lUS . . '.' PLLD SHUTDOWN ALÁRM SEP :25, 20031: 07 PM GROSS UN!': FAIL BE? Z5. 2003 1: 07 J41 PLLD SHUTOOHNALARl1 SEP ;15 .200:3 ¡ 2: 6PM PttD SHUTDOWI~ALARH BEl' 25.. 2003 12: 031='1"1 ELLD SHlITOOlJN·· ALARM SEP 2!L 2003 ¡ 1:55.AI1 PLLD 8HUTDO¡'N ALARI"I 8EP 27,. :!0025:09. PI"! GRif,j£¡ UNE FAIL SEP 27. 2002 5:09A1 PLLD SHUTI)01.4N ALARM AUO 1!5. 2002 W:. ¡ 6 AM PLLD SHUTDOWN ALARl1 AOO IS, 2002 10: 16 AM PLLD. SHUTPOWN ALARM Al~¡5, 2002 10:\0 AM if Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 ð ~ Work Order: 3131022 "'LliRf1 H ISTf)RY REPORT :. . SE¡'It:ÜR (\LAAM . V ;;: SURREr1E ~LLD SHUTDOWN ALA~M SEP 25. 2008 ¡2:53PM G¡;;OSS L ¡ NE F/) ¡ L SEP 25. 20Ü'4 12 :53 Pf'! H.LÜ SHUTttOWNALARM SSP 25. 2008 12:27 PM E~LD~HLlTD01'JN ALARM .o_P <::5, 2003 ¡ 2: 16 )j'l ~:LLD8fIUT[¡()j,~N ALARM ;:;121' ;:5, 20.03 11: 58 A!1 ELLD. SHUTVOWNALARM wEJ> ;::5. :?Ocn 1 I : 55 AM PLLD SHUTDOWN A1JiRM FEg 12.2003 6:08Pr'1 PLLD SHUTDOWN ALARM JHN 81, 2003 ¡O:D3PM PU..D . SHUTDOldN ALARf"! AUG 16.. 20020: 23 AM PLLD Bf¡UTt\OWN ALARM AUG ¡ 5 , 2002, 1.0: 16 Atl ~ ~ * · . END * ~ . . . _. . 152.958 vaNs 2100 WHITE, LME 8AKERSFIELD CA. ¡;&1-396~OJ9¡ SEP 2003 2:31 )J1 SYSTEM STATUS REPÒRT _ M _- __ _ _ - - - - - ~ L) a:ALAFiiMGL£r1R 4;Jt'lRNlNG INVENTVRY REPORT T 1: REGULAR .VOLUME· ¡ 4681 GAW ULLAGE .. 5370 GALS ~Q% ULLAGE'" 3364 GALS TC VOLUME" 14422 GALS HEiGHT .. 8[.84 INCHES Wt\TER VOL .. 0 OALS ~JATER . 0.00 INOHES TEMP . 95.1 DEG F SEP 25, :2003 .2:30 PM T2 : PLUS vOLUME ULLAGE 90% ULLAGE" TO I/OLtft1E .. HEIGHT WATER VOL .. l~A1'ER ' TÐiP SYSTEM $TATIlBREPORT --....,----- ---- b a:ÃLARM CLEAR .. 8156 GAl.$ I 8 '/9 GAl..£; 875 GAl.$ 7990 GAl.$ 9.0 '. 65 INCHES o GALS ' 0.00 INCHES .. g"L3 DEG F T ::¡:8upREI1E VOLUME' .. 7204.GALÐ ÙLLAGE .. 2833 ÇAtE 90%, ULLAGE- 1829 GALS, UM'" 7052 GALS ¡G, VOL ,1¡;; .. 80.12 INCHES HEIGHT .. Ò GALS "ATER VOL: G.OO rNGKE!') rJt? ' ' " 90,·¡íl!:'G F ~. ,~'... *- .. END ",,,It. Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 j ~~- !~ ~' -\ OCT-08-03 08:40 FROM-Ustman~ "' ;. ~ 3039868227 o ~~ROOt . T-002 P.OI/14 F-430 1226!5 west 6<lyaud Ave.. Suite 300 . LakewooC1, CO 80228 . (303) 986-801 1 · wwwveeder.com October 8, 2003 Steve Underwood Bakersfield Fire Department Environmental Services ] 715 Chester Avenue Suite 300 Bakersfield. CA 93301 RE; V ODS Fuel FaciUty #2512 (~i<', 2100 White Lane ) í.f' '-), "'". .J Bakersfield, CA 93304 , , Dear Mr. Unde¡wood: Please see attached testing for the subject VOn5 fuel facility. Testing was completed 9/25/2003 by TanknoJogy and everything passed. Please do not hesitate to contact me at (303) 986-8011 should you have any questions or req ¡¡ire any further documentation. 1 greatly appreciate yoU! assistance in this matter. -- -- tIP o REDJACKET· .- IfMS ",,-,.. 3039868227 . T-002 P.02/14 F-430 OCT-08-03 08:40 e FROM-Ustllan Inc yo .. .~ 'låI"IIcnOIøgy MONITORING SYSTEM CERTIFICATION .¿~ FOI USð 81 All Jurisdia#Ot1$ WJt1llll me $1818 of Ca/dcrtlJa Aurhority C;QØ: Ctlsprer 6. 7, ~altn and SafÐty Code; Chapœf 16. Dltlision 3 Title 23. Ca/lfornla CoCk/ at R(JguJiitions TillS form "''''''I Dð uS80 10 ooeumDnl 14£11no Snd 6Øf'lI&U19 01 mon1roring &qulpmønl. It more IIWI D/IØ monItoring aysœm COIII/'OI p¡¡naI,s inslallad alllle faQ~IY. a sep1111118 œn.fo"""/ln /Ie p!!DO/I muBl os Dr"MI':.d ror eaen monilOOoo:<V!\UIm COntrol llllnel 111 Ulm IOCnnlC:oa/\ woo psr1onm; tIU: wOfl\. ^ QOpy Qft/18 form m¡,&¡ lIB pro'tlOr:d II¡ 1110 I/WL s)'Støm ownar/oper:lUOf. Tne awner/oper3lOf musl &uoma a COP1 vf Irna tDlllllO tItB IDciII ¡¡gcnc;y reg.¡¡aQng UST 5ylitOml MUlln 30 Clays of I88t 0818. A. General Information FaclUly Name VONSISAF¡;WAY She Address. 2100 WHITE LANE CIty: BAKERSfIEl-O ConlaCl Prlone No; 3e6-ii!344 CA ;Zip' 93304 Paw of Tesling/SalVlce: 09I25l2OO3 Facility Conliict Person: PHIL Make/Model of Monitoring Syslem: vR TLS·S50 p. In...ontory of EqYipmllnt TestedJCemfia~ C/IeCI< me approprial$ þQ(8S to indicate &pecifiC equipment IlISpeCWdl¡;fiIIV~( Wot( Order Number: 3131022 TanklD: 87 Tan( ID: 89 'X In·Tan~ Gaugong Probe. Model: MAG1 In·Tan. GlI{lng ProÞø. MØCIeI' MAG1 IX MnLllSr Spscs or Vault Sc:mOI'. Moael: VR.60 AnnIII:or space or Vaull Sefl&O!'. ~& 460 X PIping SumpfTren&ll Stn;¡Or(SI· MDQaI 208 f'tplng SumplTrÐl1C.'l\ SeNor(S). MOQ8~ 208 X fill SumP SBII&Or(Ii). MoIIeI 208 1"111 Sump Sen6Of'(s. MoQøI: 208 :<!! = Møcr1I1/11CSI Linø Leilll OCII;¢IQ(. MDdBt MecnanlCllJ I.J/1S Lsall ~gr. MOCISI: ~ E~~c~L8e~~~~ t.!QQe1· VRPu.o X Elc:arOnIC una LallI( PSlsCIOr. Mellal: VRPI.LO TÐnk o.erldVNIQO-Level Sanmr. Moael: TIIOII <MsrliIUN'9h"LcveI $enaor. MoQeI: :.: Octter (¡peclr, cquopmOl'Il ¡ype IIIIQ model In Scclton e 01\ page 2). 01Mt (QP8~ cqUlpmønt!We Ind _In Saœon ~ D/1 page 2). TanKID \oJ Tank 10: ~ III- Tsnll Gsuging Probe. Mo4BI' MAG1 In-TanJ¡ G8119lng PfOD8. Modell. MnulElr Spec8 or vaun S2nIDr. Moc(ð¡: 460 Annlllør SpillõO gr V¡',fJ S«\aQr. MoØøI ~ PIPI/1g $ul't\llTrenen $811&Q1'(S). MoWI; 208 P'P</19 S~renØ1 Sc.n1lØf1$). MøQeI: & 1"111 Sump SeO&Or(il Moa4\I: 208 f,~ Sump Scn:ior(S), MDc!1I1: Mecnan,cal woe L88K OllUlClDr. Model; Mllc/1¡¡noc;¡¡ LInD Lt:ak DIMe!or Moa8I: ':X ÕðCtronlC wne LSS~ Døœc;¡gr. MOClBI; VRPLL.D EIÐc:tnxbc Lone L.ea. DeIðaOr. MeUsI' ~ = '(ElM Over1ilVl1IgtH.cvCl ~. MoQel: Tank OvorfllVHlQIri.&vSI Ssn&or. t.toat:l: Omsr (¡p~ cqu'pmem \'1pe allQ moøaI ./1 ScIõloGn Iii on page 21. ~ Oll1cr (speCIIy &q'llp¡nBm typØ and mooCl In Sc~n Ii gn P"ij<l 2). - - IJlSpenser 11.1: 1/2 Cìspenser 10: 7/8 ~ QISpen&8r ConI;¡""n1Cnl $ensor(S) MOII8I 208 v OlipllltiC:r Cgn~lnmenJ SensorlS) MxIeI. 208 = S/lur VilWO(S) ~ 9neør VaI.Ø(I). :ä Ol8pl106llr Conlilonmønl FJoaI(SJ enQ CoIIln(I). Plsp8NisrConlaonmanl FlcJ¡t(~) and cnalnle). Dlspenser'D: 3/4 Dlspemi/ilr ID. Œ1 Dispenser CoIIIallltne/U gensoI'(S) Model: 208 'X Do;;pOI\SO( ¢onraIIImeot SenlOl(l). Maclel.20S ŒJ Snsar va¡.c(.s). ~ SlIøar ViIIYD\:i). Ff D,span&8r Comalnmcnl fQ~I(') sn" Cnllln{s) :::: OlllpElnlillJ Canlainmcl11 l"lOOI(S) 1In<! Cnllan(s). Di~en&ér 10: 5/6 D~pømier 10; ~ o,spllnscr CoIlIUInl11<lnl San!lOr(B) Moœc 208 o o,spønsor Conlalnrnc:nl S.en~QftS). MQQ8I: ŒJ SlIear Val~$). o snear \/al\'o\$). o Dlsp&l\&8r Contillnmcnl FIOeI($ &nQ Cnlllnls). D Piapsn&ør Cof11iinmonl 1"10111($/ ~ Cna&n(s). . If me facility contain¡; more lankS or <lispenars, copy Ihi$ torm. InClllde intolTnallon for eve/}' tank ëlmI Ql&penær il Iha facllay. C. Cenification I centf)' Itlall/'le eqlllpmeOlIQenbfiad In ml5 ¡¡OOlman¡ wæ Il1specte<1lserviced in ¡¡çQQ!'Óanca wil/'llhe mllOlJ!actUrers' glljØeJlnlilll. AUllchøc:l1O this c:ertifiCillloO Is I/1fom1a~on (e.1, man¡¡faOlur~rs- checkltsls) neclIS8l1ry 10 \'erify InëIt lhiS infOCYl'latiools correel and a Site Plan atlowiOQ the (ayOlll of monitoring equipment. Far ëlny equlpmenl capaÞIe of generating &\ICh reportS. I have also attacl\e<1 a COP)' of me tensc$ all thilt ilppl)'): $)'$U!m $Øt.....p I'@port; 0 AJatm I\IsTQry (epon ~ Q~ ~J:;~~ PRINTED NAME' RANDY JAQUEZ COMPANY: TllnknoloQy faDOI800-4833 SIGNATURE: PHONE NO: p;1Ige 1 of3 Based on CA form <lata!! 03101 OCT-OB-03 OB:40 FROM-Ustman' y'\ .. 3039B6B221 . T-002 P.03/14 F-430 Monitoring System Certifioation Site AdClress: 2100 WHITe LANE Dëne otTmnglServloo; 09/25/2003 D. Results of Testlng/Serviçing Sotlw<lra VfflK>n Insœlled: 123.00 Complete the following checkli~: X 'VeG r- Is the alláible alarm operational? \¡Q . x Yes r- No' Is lI'1e vISUal alarm opatalÍOnal? x 'filii r- No" Were all sen50~ vISually lospecle<l, fIInc;tionall~ té&Jécl, anel confirmed opel<ltionðl? ŒI YeG ONo' waro all sensors inslalJed at lOwest point of seconailJy containment and posl1ianeá $0 trial other equipment will not interfere with thelt proper operation? I KJ ye. nNo' nNlA If alam1& are f0la\,eeI 10 a remole monnonng _on. is a~ c:ommllnlca1lol1S equIpment l~. mOáem) opQlildon<ll? (] YeG ONo' DN/A For preS5url%èl1 tlløino systems. dOØ!i I~ Ii.Irþne automatically snlll do..,n ,f the ~ping secondary conlliirunenl monilOnng B)'mm C~ a leak. falls to operate. or 16 e!éCUtCall\' áiscoMected. If )'IEI&: whiah senscrs in¡Uate posllIVe 5hLlt-Qown? (cneCk aU thai applJ') 00 SumpITrenc:h 5emon;¡ 00 DISpenser con~~ment Si¡nliOl'$. I Did ~oL.ponfirm positive snl.lt-down due \0 IéalCç aøa sensor failure/di&coMtlCliOn? ŒJ Yet. No FA..:I":t 111_... ~""" .. &~àiIft 8!1 me onmarv t8IIIC overf~1 \o\/iImirX aevlce (I.e.: no meCl\8ruc:1I -' ~ T .À Sep-19-03 09:0SA TANKtMLOGY MAY 12 2003 13:37 BKSFLD FIN~ ~N~Y~nllun 909~a 1239 ,go...'u""'.... ~..,~ P.Ol .. - - II '., II 1\ , CITY OF BAKERSFlEI..D OmCE OF ENVIRONMENTAL SEKVICFS 1715 Chester A ve.t Bakersfteldþ CA (661) 326·3979 APPLICATION TO PERFORM FUEL MONITORING CERTIFICA nON PACILlI'Y: ~~wr-YI ¡/MS AJ)Dm!SS ZIO~ Nr/;:¿;:;:' OPBRATORS NAMB_.~J-v,--I/P o~ N/t.VR - .s/bnE -- NAME OF MONlI'OR MANtJPACTURBR. , DOBS PAQLlfY HA VBDISPBNSBIl P~S? YEs v/ NO_ ( TANK. \ '7 '?::> VOWMB CON'l13NTS NAME OPTPSTING COMPANY Itj:n Jt,nL)l-D~ Y CONTRAcroRS lJCBNSB. NAMBAPHONBNUMBBR.OPCONTACI'PERSON M~ A~ DATE & T1MB TBST IS TOBBCONDUCTBD ? kr/() 3 ~ /"" rr; ~lt~v APPROVED BY l' . L L -0 S DAm 4/P: SIONATURE OF APPUCANT ( (JII S (5,· TNE' FI£~r T/rr>!E 11-'$ H!þ1: 7t;V1:lJ pitS ~ ({C. Wi: /fV(U- ,Hf/Ýt=" Ifz..(... In~ J11:7ë';1l ð ¡/£ Ft~1 VI$//; ,- bFJPJTf /a~-ßlJ~- &" . UNIFIED PROGRA~SPECTION CHECKLIST. ~SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave :.. Bakersfield, CA 93301 Tel: (661)326-3979 ¡;{ :?~5¡..,J.. INSPECTION DATE INSPECTION TIME é;¡¿-c;,.) PHONE No. No. of Employees - -- - r' --.? Ó») . {'..JLI I,' ~~____ Business 10 ïU5~Õ21_ ~ 1} 02- FACILITY NAME VOIÎ..$ ADDRESS ------~" UJt;Et¡¡¡- ~~o (' j h" !(' (, 1. . "..I~...U FACILlTYCONTACT Il~, t /' L ..~ ,_ ('1:) t'l-e(-' " ., , Section 1 : Businêss Plan and InvèntoryProgram " /..' . o Combined 0 Joint Agency 0 Multi-Agency (j Complaint (j Re-inspection ~ Routine C V .-t"- ( C=Compliance ) V=Violation COMMENTS OPERATION }If (j ApPROPRIATE PERMIT ON HAND ..-----.-----.--- _._----~-----------------------_._---_._-----------------.------.--.---- o 0 BUSINESS PLAN CONTACT INFORMATION ACCURATE 't! 0 JLD r;f, (j ---_._-_.~---_._---_._-- ------------_._-------_._-~.-. ----~-~_.._-_._---.__._._._._--------- ..--.--- VISIBLE ADDRESS --.--------------.--- --- _.._--------------_.__._------~------~.~_._.~.._----_.._._----~~..~ CORRECT OCCUPANCY --~..._--~._--_._--_._.~---_._.-.._-_._.._------_._._---_._~..._- VERIFICATION OF INVENTORY MATERIALS -----------.-- ~.__._---------_._.._----------_._-------~-_._----~_.-....- 'CiI (j VERIFICATION OF QUANTITIES ~-------------------------------------- ---------_._.~-_._--------------_._---------------_._-~----_._-_._--- '9J. (j VERIFICATION OF LOCATION I -------~_._------_. ---.-------. @ (j PROPER SEGREGATION OF MATERIAL I ~ /' ._---~-------------------- --------_._-------- _._._._._---~--------- -------.--.---....--.---- rd 0 VERIFICATION OF MSDS AVAILABILlTYE ., --~- -a 0 '~ (j r '. 9 0 ------".-------.------- ----.-------.--.-------.----------------------------- VERIFICATION OF HAT MAT TRAINING ---..--,--.--.--- ---------_.-----------------------------_._~-~------- VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES .----------.-- ---- ------_._----_..__._-----------_...__.._~._----------._- EMERGENCY PROCEDURES ADEQUATE b . ~----_._---------------------_.- ---------_._---~-----------------_._-,._------~--_.__.-- .~ (j CONTAINERS PROPERLY LABELED ..-'-_.:L.~_____.____._.__.___._________._____________.. , -~-~----_.._-----_._-----_._._.__. , . .~ (j HOUSEKEEPING \- > ---~~~--- ANY HAZARDOUS WASTE ON SITE?: ~ 0 9: 0 EXPLAIN: ----.---------- --------------.---------- -.-.---- FIRE PROTECTION ----. --.------- ----.------.----.-----.----------.--....----- SITE DIAGRAM ADEQUATE & ON HAND (j YES )(NO $:fct- V 56éD aut(J cfìarClc-s '0 '1- QUES~~~NS ?~.·~~0~~~~;~j~·IS INSPECTION? PLEASE C,..ALL US ~T (661) 326-3979 J- ..../1 ~~~.1!.- ._.___ ./ / I ¡~~··lj . / ) ~..J' 1i1l51~/¡('~ .. Inspeétórf----------·---- Badge No:----· . Business Site Responsible Party Pð j Y1 ¿ , (' White - Environmental Services ~ß Yellow - Station Copy Pink - Business Copy i ,... i ~ /\\.;1 , \(,,'S?~ ',' ." 1.i, / ~ __.Þ' .,1""1. ~", ' - . r '¡. , , , \¡. ,"", , 1 " -. '. I i' , . . . . . .' S£êÓND"~;$\'STEM CERTIIICA TlON FOaM, ' . . .'. , " ':' .' . : -. ~,'" ' ,.,' .. · DÁTEa-I~~ö3"':; ~:" ", ..,',...'. '. . :' ~~~~D=~05Q 1.¡)f;Hf:W !4.'<ØS~ff1j)(Il.·, , , '7 ,." ,". UST ADpn~pSp8ce " I 'I I' ' !, l' :" ',' . , " , "ask 4 '.' . , . '.' ...... " " . ,'. . ".... ~.' =. ~ > ,-~'.: : .. ...~ . ;: if \' ',,' ~ r ., ¡ "';, Secoadøy PIphaa " .' " " start 1üøe , Inlda.l PreI8ure' ' Eød TIme ,,' ßDaJ Preaure " CertifiCIdOU (Sfv..~,roe) . ' './. .; I , ¡ . ,¡ ;1 " , , . . .~ P~gC 1 of ~ J. '" " I :1 ' I , ' . 1 ' , ;l' 'I I i . , I 1. ¡ - I . ¡ r ì ¡ . . I SECONDA;&¥ SYSTEM .CERTlFlCA TION FORM', OA TE:). ~\ ':1-D 3 ' FACILITV ID Von ~ FACILITY ADDRUS ·:;2..D~O \Nt+\~ en} ~tJ;~FIËLÖ leA , " . , Turbine Sumps Start 'nme lDbIaIlWPt of Water Time Water ßeiabt Tame Water Het¡bt Time Wúer øtipc OvetIW BuckeU . Start TIme IDIúal Height of Water ' Time Waœr He!¡Ia& , , TIme Water JWPt CertiftcatloA (Slpalure) .! J z Sump 4 I I v 'OVerfUJ 4 P.2of~ ,I -- í ¡ e i . ,t' .1 \ , ¡ ¡ í ¡ ,I ro " . ," SECOND.u~y SYSTEM CERTIFICA nON FORM DA TE ~ ~ \ ~- 0 ~; , F AClUTY m \l (;)1\ os FACn.ITY ADDaESs... ""2:.D ~ 0 \À) m\C LY\ ) 'ßftw. €'\2.Ä "fIELD CI4 UDC TESTING START TIME INITIA.L ØElGBT OF WATER TIME W ATEB. HEIGHT TIME W Å 1'ER BE1GØT CF..ItTU'ICA TION <.S1GNA TURE) i ' i>lsPENSD 3 ' DJSft:NSEK 4 DisPaN$S J)lSPENSER IS DISPENSER , DISPENSER 8 ST AJtI'TIME 10: t/5'AffI , lJIlII'IAL '. !1JIGHT 011' - - -- - -t WATER I , ^n;r' TIME I J ~/JOµ,týÎ " WATER ( .1{jJ;~ ; HEIGHT I· " TIME I t l<)tA rIJ , .. , W ATEa ) .too,',) i HEIGHT , ' ' CD11Ji1c..t.11ON ' '"Y'1-/t.: r '4~ ~¿;A (SIGNA TUU) ^ '~ '~ " f .., j , Page 3 of 3. :) 'I ..i i ; i I ,',>1 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "W Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "W Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFm SERVICES' ENVIRONIlEHTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Avè. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 . ..... .. January 22, 2003 V òns Fuel Center 2050 White Lane. Bakersfield CA 93304 RE: Upgrade Certificate & Fill Tags Dear Owner/Operator: Effective January 1,2003 Assembly Bill 2481 went into effect. This Bill deletes the requirement for an upgrade certificate of compliance (the blue sticker in your window) and the blue fill tag on your fill. You may, if you wish, have them posted or remove them. Fuel vendors have been notified of this change and will not deny fuel delivery for missing tags or certificates. Should you have any questions, please feel free to call me at 661- 326-3190. Sin::! Steve Underwood Fire InspectorÆnvironmental Code Enforcement Officer Office of Environmental Services SBU/dc ""7~ de W~.¥OP ~0P6 y~ A W~" ~y I lit . &:I--òf/() CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICA TION TO PERFORM A TANK TIGHTNESS TESTI SECONDARY CONTAINMENT TESTING FACll..ITYV DAJ ~ ADDRESS c1:D,C;C' Lù""T~ LAIJ6 ~A K-GI(SFtCU)) CA PERMIT TO OPERATE # OPERATORS NAME OWNERS NAME NUMBER OF TANKS TO BE TESTED .3 TANK # VOLUME ) ~ D I DO ð c1 /ó .Oðð t -.3 Ib)O{)() IS P~ING GOING TO BE TESTEDk CONTENTS ~ 1 II rVLJ) ~~ UNLf) tf<£rf\. TANKTESTINOCOMPANY RGDIJJI1J6Tt.sÎ/~ J Rlc..H Ek)OIROlÙtn~íAL MAll.lNO ADDRESS P.D. Box J SiP 1 6A¿es F'f:.Lb) {!A '1336;2 NAME & PHONE NUMBER OF CONT ACf PERSON 'ùUßAtù \u~ (plJ, ~g34'(i~¡q3 TEST METHOD .]:f\)corJ ÍtJ(o 1- ß % --st 77 (to-.¿) NAME OF TESTER OR SPECIAL INSPECfOR ~1+wIe:) :I. R,c..H CERTIFICATION # CD- J()'1~ ß~TDR~ L'c.I?f\J~a:: ~3;)r71? A AAz.. DATE & TIME TEST IS TOBECONDUCfED WE{'}, ':;-/7~().1 P;Oð I4w1 ,.1 äD -1-~3-o3 ~~ _. APPROVED BY DATE SI ATURE OF APPUCANT · ( t:' -( RECORD OF TELEPHONE CONVERSATION Location: 0 E ,~ Business Name: tJ ÚL\-~ . ~0.c!rnv~ ~t! e1ø · Contact Name: 1\A~\l.(., Al~O- Business Phone: t ~ c~ ~e p Cß~) ~ Ç> J eg,~ FAX: Inspector's Name: ~+tUl? () ~dc.\c.ò~d Time of Call: Date:~:} ~ I fJ '3 TIme: ? \d {) r \k # Mln: 6 Type of Call: Incoming [ ] Outgoing M Returned [ ] ID# Content of Call: _~t.tLIl{¡tI(n[ ~tA t ~ L ~+- ,-~R q t? ~ tll-ftlqt'f Ut~ a\t~l- 1N1.~ o1VuJl~ {iÍtl)~~J(( Hh,tlt Q.JuhrAl -1-t5~lty +0 ~ f)tAdth.\- 4-t'.h~. "3 wu.~ aIÀ ~'~\!t'u\.~ Actions Required: ; f'I(ðN t J Time Required to Complete Activity # Mln: 1 52858 \.lONf~ 2 J 00 (i,IH IrE LANE BAKERf;F I ELD Cri. 661-::::96-01'31 ~v~----- DEC 6. 2002 9:08 AM :::;'iSTEI'1 ::nMTU:'::~ REPOF:T .- -' - - .- - ALL FUI"JCT IONS NORI". I N\/ENTC'R'i F:EPC,RT T 1: RECULAF: 'I/O L Uf"IE ULLA,:;E '30:\: ULLM(:;E~ TC "JOUJr"lE HEIGHT l,JATER \/OL [¡,lATER TUlP T 2:PLU:::; VOLU~'JE ULLAGE 9Q:!t ULLA(;E~ TC \.le'LUt"JE HEIGHT I",JATER I,/OL I,JrlTEF: TEr"lP T :3: ~3UPREI'IE \/OLUI"IE ULLAGE 90j:; ULLAGE~ TC \/OLUt"IE HEIGHT WATER VOL l"JATER TEt"IP 140'31 GALS 5%0 GAU3 ~]954 GALB 14002 GALS 78.89 INCHEB o GMU::; o . 00 I NCHE~3 69.0 DEG F 7452 2585 15:õn 7::::71 E~:3 . 22 o 0.00 r/i=: ç:: I ....J.....J 8140 1897 8'3:3 E1IJ48 90.46 o 0.00 76.0 GALS GALS GALS GALB !J'~C HE~3 (~ ~Ef3 DEe: F GALS GALS G~~L~3 GAL:3 I NCHŒ GALS INCHES DEG F M M M M MEND M M M M M e - CITY OF BAKERSFIEl..D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd ¡''Ioor, Bakersfield, CA 93301 FACILITY NAME ()O~5 'r~j &CA-k,- ADDRESS d()ÇO W~ /...N FACILITY CONTACT INSPECTION TIME INSPECTION DA TE-----t,.¡ , (0 ' é) L- PHONE NO. BUSINESS tD NO. 15-210- NUMBER OF EMPLOYEES~ Section J: Business Plan and Inventory Program o Routine I3"Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERA nON C v COMMENTS l/ ~ " Appropriate pennit on hand l Business plan contact infonnation accurate c... ,r , ,/ Visible address Correct occupancy ..... /' Verification of inventory materials - ,./ Verification of quantities ./ ,,/ Verification of location c/ /' Proper segregation of material ./ Verification of MSDS availability v , Verification of Haz Mat training u'" ./ , / Verification of abatement supplies and procedures , " ...-" Emergency procedures adequate ./ Containers properly labeled ./ / .,." /' Housekeeping Fire Protection l"'" ,.-" c Site Diagram Adequate & On Hand / C=Compliance V=Violation Any hazardous waste on site?: Explain: CJ Yes ~No Pink - Business Copy Questions regarding this inspection? Please call us at (661) 326-3979 While· Env. Svcs. Yellow· Station Copy Inspector: e . ~/ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME {h.~ FÙrI (Í'oxkr INSPECTION DATE ¡.l' ~. (9 L..- Section 2: Underground Storage Tanks Program o Routine C!¥éombined 0 Joint Agency Type of Tank -lI11Jp Type of Monitoring ¿Lw\ o Multi-Agency 0 Complaint Number of Tanks 3 Type of Piping JJt,dF ORe-inspection OPERA TION C V COMMENTS Proper tank data on tile V r- Proper owner/operator data on tile V ;' Permit fees current r V Certification of Financial Responsibility v ~ Monitoring record adequate and current ./ ~ Maintenance records adequate and current "'" ,/ Failure to correct prior UST violations ~ ".- Has there been an unauthorized release? Yes No \/ - Section 3: Aboveground Storage Tanks Program AGGREGA TE CAPACITY Number of Tanks TANK SIZE(S) Type of Tank OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling . Is tank used to dispense MVF? I f yes, Does tank have overfìll/overspill protection? :~~~~~Ii::t V;¿ã:;;' Office of Environmental Services (805) 326-3979 White - Env. Sves. N=NO Pink - Business Copy · en UJ tJ > a: UJ ~ o en ~ -I I- '" ~Z<t~OJ u..UJI-Z:=!: en~Z~Z a:I-UJ<C§ ~a:~~~ ««ZI-~ mQ.oæü UJa:J: . u..O_üg OUJ>~¡¡: >-a:~l'cn I-Û: ~~ - u.. :.: tJ 0 <C CD UJ tJ u.. u.. o --~-~ ~; ~' ~ ph~+~ s ~ , uOV\ s t- tlc.(rt) í ~OSD uJI\\ ~t LK m .\.-~mr' '~"",.,.m;";t' ~ r;,:; ~ ~.. ~ .,; (,1" I' 'J" ',' ~1~jj " I __11', \\.:I~ \' ':¡1¡'\.;(:~lt' ,I, f¡i ¡ '~',-'~. : -T} t¡.I·~,¡,·'-}"f .,: ,.-"L ~, ~ ,.~ en . ø ".. ~¡~.. ~.,-I J . -.- L. ""'-'..:~ ~- t' / -....,..... , . .:' : . ,.' . ~: -~) ~::: r·· :,....k-: -', (,' .' ..~ '.. i;, . ", -. ~ . -, ~. . .' ~ ,0;' r '_ _;~ ,:'; . . .~;. '~:. po'.. .' .... ::,'1'", "." ...'.'~ '. ,'Ù' '". '.- ". ..-.",. M'_. " q- ....... ~:-,~/ .~ '1'f1!'~ ~_-/' I ::,-: .~, .... ..;~,; ~ .#"",. ~~ "l!!!~ ~._. - . ............... \... t t ~ U to tl.-\ iU.ìC> to 1 t. L l.) _FICE OF ENVIRONMENT.' SERVICES 1715 Chester Ave., Bakersfield, CA 9J!O 1 (661) 326-3979 UNDERGROUND STORAGE TANKS· TANK PAGE 1 ......~ OF 4CTION C.'«> J'" ._ OIIII) ]if'1. I'4f:W SITe P!MIIT 0 4. AMENOeD Pl!RMlT o S. CHANGe OF INFORMA noN) "-oe o ð. Tl!MPORAAV "T! CLOSURe o 7. PER~HTl or ClOSÆ!O ON SITe o ð. TANK R1!MOVED o J. RI!NEWA&. PI!IUMT 01 (SIHdy _ . lOr 'OeM ~. 0I'Iy) (SIHdy ~ . lOr 'OeM~. OI'IyJ 3lJSlNESS ~ Is-.. ~AClUTV ~ or 08A . 0cIn0 ~ Aal J VoDS F0e::L- CENí€e.~ BAKEESFJEL.D #-25/2- LOCI< rlON WITHIN SITe~) ao50 WH-,í€ L.4Nt:: / OA I ) .1ùL 2002- : ADOfTIONAL CESCItPT10N (F« 1OaI_ Ody) I , TN« use 431 ~1. IoIOTOR VØCU! AJ8. , ("",.'*«1. ~~ Type) I 0 2. NOH-F\JE1.I'ETAOU\JfoI : 0 J. OiEMICAL PROOUCT . 0 4. HAZAAOOUS WASTE (ktdWN U.w 01) i 0 95. uNOolO'Mf I : TY?E OF TAl« I ! (C/IKJe ~ ..." odyJ , . TANK MATERIAL.· pMWy ** , (C/IKJe OM _ Ody) LTANKDESCRIPTIOH COJ.4PAAnENTA&.1ZEO TANK 0 v. No /I -v.'. camplel. OM ø-ve'or uctI can~ !1ðf)é£IJ tVe.t.J)/1J6 é}O) 00 0 / .. TANK CONTBn'I ~TYPe )lttL ~ UfUAOEO 0 2. LI!AOED o '''' PReWUoIUfUAOEO 0 J. 0ESa o Ie. Io«)OfW)E I.H.EAOEO 0 4. GASOHOl COYoOtNAIE (IIam~....,. ~~) o I, UIOI..! WALL Já 2. DOtaE WALL o 1. BAAl! sn:e. o 2. STAMUS sn:e. : TANK WoTERW" ~ ** 0 1. BAAl! S11!B. I (C/IKJe OM ..." odyJ 0 2. STAN..9S STœ. I o S. JET FUEL EJ 8. AVlATIOH FUEL 098. OTHER CAS" (llÐmHuatrlwS~~~) 4- 441 .. TANK CONSTRUCTION o J. SNJU! WALL WITH EX1ÐtIOR.øeAAHE LIER o 4. SINQU! WALL .. A VAUlT o So SH3l.E WALL. WITH IHTERNÃL IUOOER S't'STEM OM. UN<NOYotI Oft. cmtER o 5. CX)NCÆTE 0 Is. ~ o 8. FRP COM'ATI8LE 'M100% MEnWIOl 0 ft. O'niER '-'3. FI8EROtASS I PlASTJC % 4. STEEL ClAD Wo1=IBERGLA.SS ReINFORœO PlASTJC (FRP) JZ! J. FIBERGlASS I PlASTIC o 4. STEEL ClAD WIF1IERGLASS RElNFOAœD PlASTJC (FRP) o 5. CONatET! o J. EPOXY L.M.a J( So GtASS L.M.a 0 Is. UN<NOYtt4 o 4. fIH!NDUC L.M.a CJ L UN.JNED 0 It. OTHER }if J. FIIIEROLASS R!HOfICEt) f'tASTIC 0 M. UN<NOWN 448 o 4. IIoIPRESSED CUAR£NT 0 ft. OTHeR ...... r AI« IHTEAIOR L...o OR COAT1NO (C/tWI_ "'" OIIM i OniER CORROSION : PROTECTION IF APfIUCA8t.! (Ch.ø: OM ...,. odyJ SPILL AND OV!:RFILL (ClI«/( ., eNt 1þpIy} o 1. fUlleR IJN!D o 2. AUCYD LN«I o 8. FRP COM'ATI8le WI100% IoETHAHOl o .. FRP~JACKET o 10. COATED STEEL o 115. UNKNOWN 0l1li. OnER 445 44e MTE INSTAU.£D 447 (F« IOaIIIM onM MTE INSTAU.£D 4019 o t. .wurACTUft!Ø CATHODIC PROTECTIOH o 2. SACRI'ICW. AHOOf! YEAR INSTAlLED ~ 1. SPIlL COHTAINfwENT d () ð~ Çir 2. CROP T1JtII! ;). ðô;2. .;JððJ UTlMATeD CATI LAaT UIID ~Y) " SINOU WAU. TAM( (Chedt"1Ief IIJtIIY): o I. VISUAL (1IXF'Otm POfmON ON. Y) o 2. AUTOMATIC TAN< QAUOINQ (ATO) o J. COHTINUOUtATO 04. STATISTlCALINVIHfORYA!COHCIUATIOH(SIA). I!NHW. TN« TBaTIHO .... (For /oQI_ Ody) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLfO 452 /l!f,. ALARM dtJðZ 0 J. FlU. TUBE SHUT OFF VAL V!: _ rid 2. BAU.. FlOAT 2C<) Z. 0 4. EXaIPT 4SO T'fPE (ForIOCMUM Ody) .,.:.~::r~LIAK ·~i.: ~~~~·~~,;'··~1.:·~<~· ". .' >.;..'...,. ;~?~~ ":. .~;.. ,':-' ;";' .:.:,:.....::~.::)t¿.; . "oOue... wÄú. TANK DR TANK v.mf ~ (~_.... Of## 4&4 .. 1. VISUAL(SINQU!WALLINVAULTON.Y) );( 2. CONTINUOUS tNTI!RSTlTIAL IoIONrTOAINQ o J. MAH\JAL MONITORING o So MANUAl. TAN< QAUQtNQ (WO) o 8. VADOse ZONe o 7. OROUNDWATER CJ .. TN« TUTINO 011. OTH2R V. TANK CLOIUU IN'OItIlATION' PllUlANlHT CLOIUU IN PLAC8 IJT'IW, T1D QUAHTI'TV 01' SUNTAHCI ~...a .... TAN( ,IU.IO WITH INMT MA nAlAL7 - 461 GIllaN -- o v. 0 No :JCF (7m) S;\CUPAFORMS\SWRcs.s·wPD I I. . ~ .,¡< ~ ~ e CITY OF BAKERSfiELD ~ 0fII'1C10' !NVIRONMENTAL 5ER 1115 Chnter Ave., Bakersfield, CA i3301 (M :3%W919 -- - uNOeAOAOUNO PlPINO VI. NIINO CONatRUCTIOH (CMdI" IN, ."." AeovEGROUNO PIPING un. TAMe ~~~ ~ - fJI'l '~ ~ o J. GAAvrrr I -J J SYSTEM r'l'pt; og[ I PRESSURI! 0 2. SUCTION 0 J. GfVMTY ~ 0 I. PRESSURE CONSTRUCnONl'O I "NQ,I! WAI.I. 0 J. uNl!O TRfHCN 0 iI. OTHER .eo 0 I. SINGLE WALL o.MNUFACTURER'¡g' 2. OOU8I.£ WALL CJ lIS. uNI<HOYofiI -,1 0 2. OOUBLE WALL , MANUFACTURI!R ff-O 5fIIJ lírr .el MANUFACTURER ,0 ,. BAA! STEEL 0 I. FA> COWATa! WlI~ METHANOL 0 ,. BAAE STEEL : 1M TERIAl.S AHO 0 2. STAINUSS STEEL 0 7. GALVANIZED m.a 0 2. STAINLESS STEEL , CORROSION , PROTECTION 0 J. PI..AST1C COMPAT18LE wrrw CONTEHTS 0 II. IJNICNC)V,IN 0 J. PlASTIC COMPATIBlS wrrw CONTENTS ]it 4. FIBERGlASS 0 I. ~BI.! (HCPE) 0 iI. Oni!R 0 4. FI8€RGlASS o 5. STEEL WI COATING 0 t. CATHOOIC PROTECTION 4&4 0 5. STEEL WI COATING VI. PPING L!AK D!1ECTIOH (Chd" thIIt~) \JNDERGROI.H) PIPING PRESSURIZED PIPING (C/I«If .. "..,."",,): o ,. ELECTROHIC LIfE LEAl< DETECTOR 3.0 QPH TEST mIH AUTO PUWP SHUT OFF FOR LEAl<. SYSTEM FAIlURe. NÐ SYSTEM OISCQIKCfIOH · AUD&I! N#O VISUAL AI.AAMS o 2. MOHTK. y IU OPH TEST o J. ANNUAl. INTEGRfTY TEST (0. 1 GPH) I COHIIENTIOHAI. SUCTION SYSTEMS: I I 0 5. DAII. Y VISUAL. MOHrTORI'fG OF .......-..G SYS'TEM · TRIÐHAL Pf'INO NnGAnY TEST (0.1 GPH) : SAFE SUCTION SYSTEMS (NO VAl YES IN BB.OW GROUND PIPING): ¡ 0 7. SELF MONITORING I GRAVITY FLOW: o 9. Bl9NA/.. INTEGRITY TEST (0.1 GPH) SI!CONDARIL Y CONTAIN!D PI'ING PRESSURIZED PIPING (Ch«:Ic .. ".., I/PPIyJ: 10. CONTNJOUS 1'VR8IM: SUW SENSOR rdI11 AUOIBlE NÐ VISUAL ALARMS NÐ (C/IecIc OM) . ø a. AUTO PUW SHUT OFF WHeN A LEAl< OCCURS dr Þ. AUTO PU.... SHUT OFF FOR LEAKS. SYS'TEM FAII.JJR£ NÐ SYSTBof DISCONNECTION o c. NO AUTO PUMP SHUT OFF a( 11. AUTOMATIC LINE LEAl< DETECTOR CU QPH TEST) mns ROW SHUT OFÏ: OR RESTRICTION ti( 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTlOI'roRAVITY SYSTEM: o 13. CONTNJOUS SUa.tP SEHSOR. ~ NÐ YØ.W.A1..Af18 1!IWtG!HCY O!NI!JtA~ ONLY {CIIe«" lilt IIJPIY o 1<4. CONTINUOUS SUt.P seNSOR WITHOUT AUTO PUMP SNJTOR.AUOIØLE NÐ VISUAl. ~ o 15. AUTOMATIC LINE LEAl< DETECTOR (3.0 QPH TEST)~F\.OWSHUT OFF OR RESTRICTION o 18. ANNUAl INTEGRITY TEST (0.1 GPH) :J 17. OAlL Y VISUAl. CHECK o 2. SUCTION O~, uNXNOWN o 99. OTHER . o 8. FRPCOMPATlSU:WIIOO%~ o 7. GAlVANIZED STEEL o I. FLÐU8LE (HOPE) 0 911. OTtER o 9. CATHOOIC PROTECTION o 95. uNKNOWN 4i ".:.;µ::. <4M ASOVEGROUND PIPING NO WALL PIPING 4( PRESSURIZED PIPING (Chedt .. IN, ."",,): o I. a!:CTRONIC LIfE LEAl< DETECTOR 3.0 GPH TEST mIt1 AUTO PUWP SHUT OFF FOR LEAK. SYSTEM FAIlUÆ. N#O SYSTEM DISCONECTION . ALOBLE AHO VISUAL ALNUoCS ' o z. MONTHLY 0.2 0f'H TEST o 1 NHJAl Hm3RfTY TEST (0. 1 GPH) o <4. DAIlY VISUAL ClEO< COM/EHT1OHAl SUCTION SYSTEMS (ChecIc .. IN, apply): o 5. CAllY VISUAL MOHfTOAING OF PIPING ÞMO PUMPING SYSTEM o I. TRIENNIAl. INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VAlVES IN BELOW GROUND PIPING): o 7. SELF MONITORING GRAVITY FLOW (CMdI" /Nt~): o I. DAIlY VISUAl MONITOftING o II. SIENNIAL INTEGRITY TEST (0.1 GPH) ,II!CONDARIL Y CONTAINED PFINO PRESSURIZED PIPING (Ch«:Ic .. /Nt ."",,): 10. CONTINUOUS T\JR8INE SUMP SENSORr4IJ:1AU018LEAHO VISUAlALARMSNÐ (dledtØle) : o a. AUTO PU.... SHUT OFF WHEN It. LEAl< OCCURS ' o Þ. AUTO PUMP SHUT' OFF FOR LEAKS. SYSTEM FAlWRE. AHO SYSTBof 0tSC0NNECTJ0N o c. NO AUTO PUMP SHUT OFF o 11. AUTOMATIC LEAK DETECTOR o 12. NNJAlINTEGRITYTEST(0.1 GPH) SUCT1Of4'GRAVITY SYSTEM: o 11 CONTHJOUS sua.P SENSOR . AUDIBLE NÐ VISUAl ALARW8 !llØGENCY OINERATORS ONt.Y (Chect ..".., pIlI)) o 1<4. COHT1NUOUS SUM" SENSOR WITHOUT AUTO PUMP SHUT OFF . AUOI8LE AHO V1SUAl ALARMS o 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) JI$PENseR CONTAINMENT DATE INST~.2 481 ~Do~Mq '. .:,; ~""'!;' o 1. FlOAT MECHANISM THAT SHUTS Off' !HEAR VAlVE o Z. CONTNJOUS DISP£NSER PAN seNSOR . AUDC8U! AHO VISUAl ALARMS $if 3. COHTINUOUS OISPI!NSI!R PAN SI!NSOR rdI11 AUTO SHUT OFF FOR OISPENSER + AUOISU: AND VISUAl AI..ARMS IX. OWN!RIOP!RATOR SIOHA11JR! .. !rUe 8IICI 8CCIUrIIe to IN !MIl 01 trr'f 1rnCMIedge. <471 CATE &f·C¡.2 Tm.e;¡ ;;;il;;;ž Ef) rib €¡Jr <410 <412 ..73 I PwmUwowd iF« 100II... 0IIIy} <47.. I Penftj EIq)irIIIon DIM {For ØØt II'U'~} ..~ ' 'wmot ~_IFor lOCAl UN 0IIIy) 'CF (7/99) S:\CUPAFORMS\SWRC8-B.WPO ~ CITY OF BAKERSFIELD .FICE OF ENVIRONMENT.SE,RVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 (Ð UNDERGROUND STORAGE TANKS - UST FACILITY TYPE OF ACTION (Check one Ilern only) }!!f 1, NEW SITE PERMIT o 3. RENEWAL PERMIT o 4, AMENDED PERMIT o 5. CHANGE OF INFORMATION (Speedy change· local use only) o 8. TEMPORARY SITE CLOSURE Page _ of _ o 7 _ PERMANENTLY CLOSED SITE o 8, TANK REMOVED 400, I. FACILITY I SITE INFORMATION í BUSINESS NAME (Same as FACILITY NAME or DBA . Doing Business As) -#: 3 FACILITY 10 # ! VONS ru€L C.€"t0TfEe.. - ~KEe.SF1EL.-D 2512 , - NEAREST CROSS STREET la050 wHIr£. LAN£ 401. FACILITY OWNER TYPE g 1. CORPORATION o 2. INDIVIDUAL o 3. PARTNERSHIP BUSINESS TYPE o 3. FARM 0 5. COMMERCIAL o 4. PROCESSOR 0 8. OTHER 403. o 4. LOCAL AGENCYIOISTRICT' o 5. COUNTY AGENCY" o 8, STATE AGENCY" o 7. FEDERAL AGENCY" 402. ;g.. 1. GAS STATION o 2. DISTRIBUTOR TOTAL NUMBER OF TANKS REMAINING AT SITE Is facility on Indian Reservation or truSllands? 8 404. o Yes .D( No 405. II. PROPERTY OWNER INFORMATION ·If owner 01 UST a publiC agency: name 01 SlJpeMsor 01 0 division. section or office which operates the UST. A / , A (This is the contact petson lor the tank records.) ;' V" ;¡ 406. PR0V'o;;;W:E¡Š/J,c€W/fý eOM¡?AAJj I MAILING OR STREET ADDRESS , A / , /. {PIe I1/CIf/LLI/vtlA /lvre./(}£ CITY ItIZ. CA¡;;; / A PROPERTY OWNER TYPE W1. CORPORATION o 2. INDIVIDUAl o 3. PARTNERSHIP 407. PHONE 408. (P2~. 8Z/, 778/ 409. 410. STATE 411. ZIP CODE 412. CA 9/0CJ7 o 4. LOCAL AGENCY I DISTRICT o 6. STATE AGENCY 413. o 5. COUNTY AGENCY o 7. FEDERAl AGENCY III. TANK OWNER INFORMATION I TA~WNER NAME 414. PHONE 415. i oN5· A 5A,c'éwIJý coM;?AlJý øz~. 82/.178/ MAILING OR STREET ADDRESS " V€:N Ii F£ 418. (0/£3 M IC,H/LL/NVA CITY 417. STATE 418. ZIP CODE 419. ¡llzeA-P/1) cA 9/ðð7 TANK OWNER TYPE ~. CORPORATION o 2. INDIVIDUAl o 4. LOCAL AGENCY I DISTRICT o 6. STATE AGENCY 420. o 3. PARTNERSHIP o 5, COUNTY AGENCY o 7. FEDERAl AGENCY TY(TK)HQ IV. BOARD OF EQUALIZATlONUST STORAGE FEE ACCOl.!tlT!'4UMBER Call (916) 322-9669 if questions arise .-. 421. V. PETROLEUM UST FINANCIAL RESPONSIBILrrv INDICATE METHOO(S) 1. SELF-INSURED o 2. GUARANTEE o 3. INSURANCE o 4. SURETY BOND o 5. LETTER OF CREDIT o 8. EXEMPTION o 7. STATE FUND o 8. STATE FUND & CFO LETTER 09. STATEFUND&CD o 10. LOCAL GOV'T MECHANISM o 99. OTHER: 422. VI. LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank OINner unless box 1 or 2 is checked. 1. FACILITY o 2. PROPERTY OWNER o 3. TANK OWNER 423. VII. APPLICANT SIGNATURE herein is true and accurate to the best 01 my knOWledge. DATE q. &f. Z 424. PH7/1. 77(). 0C}1 / 426. TITLE OF APPLICANT AtJ'ÍHð/?/2& A¿;t!!.IJr 425. 427. I 428. 429. UPCF (7/99) S:\CUPAFORMS\swrcb-a.wpd __ __ ____-----'r: OW' ;-~~ 'Git -- -- .-. '-1 t .. U i' b.-\. !U.K.S r Ui..Lü _FICE OF ENVIRONMENT. SERVICES 1715 è'Tíester Ave., Bakersfield, CA 9!fO 1 (661) 326-3979 UNDERGROUND STORAGE TANKS· TANK PAGE t (I '"-ve f1I ,""ø<: OF 4CTION C.'«. JM ,,.,,, 0I'I'f) ]if" ~ SlTI! ~T 0 .. ~D Pl!!RWT o S. n!MPORAAV SIT!! CI.OSURI! o , Pl!!RtoW4!HT\. v CLOSED ON SITe o S. T ANt( REMOVED o 3. RI!NEW"'- I>!IUMT o S, CHAHGI! OF INFORM.-. noN) (~__ . Ibt' 'OaI u.. onr,J (~~ . Ibt' IOCM.... onr,) 3 FACIUT"I' 10 . ~uSJNESS ,~Is.... _ jOACJUTV NAMe or oeA . OolIte eo--'AI VO~ F0~L- CENí€e.~ BA¡(EBA€LD *ZS/2.. LOCA TiON WfTIoiIH SIT! {OtÞa>MI} ¿;!o50 wH-,í€ LANt::: !1ðfJ£,eAJ We.LP/N4 IN .1U1- 200 l /O¡t)é)() : AOOfTIONAI. OESCRPTION lFo' 1XaI_ only}.... ð . \ I rANi( d fI/t5 ~ Coñ1fAttrt\A&JI.$ - é.Ac¡.J, I ¡ßOò (;l"tl.LÒf\J5 ¡ I rANK! · cPA OAr I ( : TANK use G "'1::;(',. MOTOR VI!HCU! AJB. .;¡;",.",. ~PiIIaIIum Type) I 0 2. N()H.ÇUEL~ : 0 3. OiEMICAL PROOUCT : 0 .. HAZAIUX)US WASTE (1ttdudN U.-d 01) i 0 95. UN!<NOYM ; m>e OF TANK ¡ (Ch«Jt OM .." onIy , , T ANI< W. TERIAL . IM\Iry ** , (Ch«Jt OM ....., only) L TANI< DESCRIPT10H NU COp,ø>AAnEHT"'-IZED TANK V_ 0 No If -V.', com.. one ø-ve (or Ud'I QQII'I~ z ,,J 5/2£. .. TANK CON1"ÐfT'I ~'M't! o tL R!<UNt UN.I!AOEO 0 2. U!ADED ~... PA!MUU IHJ!AOED 0 3. 0Esa. o teo ..xJfW)I! IØ.EAOED 0 4. GASOHOl COfoM:)H NAIll! 1tam HIønbø....... ~~) o t. ~WALL p( 2. ooc.ae WALL o t. &W! STEEL o 2. STAINLESS STEEL ; T ANI< W.TERIAL· ~ IBM 0 t. &W! ST1!B. ¡ (Ch«Jt OM .." onIy 0 2. STAINLESS STœ. I I I rANK INTERIOR L...o OR COATIHO (Ch«Jt OM .... onIy ! OTIiER COAAOSIOH PROTECTION IF ~ o S. Ær FUEL EJ .. AVIATION FUEL o 911. OTIiER CAS'~HuM»ua~~P9) .. 441 .. TANK CONSTRUC11ON o 1. SINOU! WALL v.mt EXTERJOR IoÐIIIPNE lH:R o 4. SINQU! WALL'U VAiA,T o So SN:U WALL v.mt IHTERNÄL IIlACOER SYSTEM OM. UNI<NOWN 0l1li. cmtER D s. CONCRETE 0 115. UNICNO'Mf D .. FRP COY'ATIBl£"",OO% METHANOt. 0911. 0'niER "1. FI8EROlASS I PI.ASTIC % 4. STEEL CW) Wß<1ØERGtASS REH"ORCED PI.ASTIC IFRP) !l! 3. F1BERGlASS I PI.ASTIC o 4. STEEL CW) WIF&RGLASS REN<0Rœ0 PI.ASTIC (FRP) o s. CONCRETE o 1. EPOXY L.MG "So 0tASS LM«J 0 115. UN<NO\"tW o 4. PH!HDUC L...o 0 L UNLINED 0 II. cmtER Jt 1. ~ RÞ*ORŒD P\ASTJC 0 M. UNO«MtI 448 D 4. M"AESSEO CUMEHT 0 l1li. OTH£R ..... (CIt.cJt ..... ifMI only) SPIll AND OVERFIlL (CII«Æ ~l NIIIJPIY) o t. RUIIII!R &..NO o 2. AI.K'tD LNG OM. UNKNOWN 0.. 0'niER D L FRP COAØ>AT18I.e ""'00% METHANOt. o .. FRP NC)H.(X)RR()()Ø JACKET o 10. COATED STEEL 44.5 ..... 0.\ Te INSTALLED 441! iF« 1XaI_ ØtWI o.\TE INSTALLED 449 o t. r.wurACT\R!Ó CATHODe PROTECTION o 2. SACAI'ICW. AHOOI! VENt INSTAlLED J1( I. SPILL COHTAINfoEHT d 0 ð~ Çir2. DROPTUIe ;J.(JÕ;/. 3. STRItœJIt P\.ATe ~ OD ;). (For local 11M only) 451 OVERFIlL PROTECTION EQUIPt.EHT: YE4R INSTAllEO 452 ! Þ!f,. AlARM 2ððZ D 3. FILL TUBE SHUT OFF VALVE _ ¢ 2. BAU..Fl.OAT zc.oz. 0 4, exEMPT 4SO TYPE (For JocaI .... only) ::'r';~",; ~~~"';\~~': ,..;.':.~,~' '.':, '::,¡,i¡'~"~:~ .;:"'~}': ~~ ,:':'~:':r~ LIAK " SINOLI WAU. TANK (a......., ~ o 1. VlSUAI.(IJØIOI8)POfmC)HOtI-Y) o 2. AUTOMATIC TAN< CIAUOINO (ATO) o J. CONTIHUOUI A TO o 4. STATISTICAL ItNINTORY MCOHCLIATIOH (SIA) · IIIEHHIAL TANK T'lSTIHG :~~: ~~4iti~,it.;,··~~.?~··:!· "'. .' >.:..v·",. ;~~'!~.:l:.:~~' ."; Y .:.:,:.....:·~·:~ft~~ 4IS . OOUIIUI WALL TANK 0" TANK MrH IILADOeIt (a-. _..", od'# 464 .. t. VlSUAL(SIHOL!WALLINVAULTON..Y) r:t 2. CONTINUOUS IHT!RSTlTIAL MONrTORIHG o 3. MANUAL MONITORING fSTIMATI!D OATlI..4IT UIID ~Y) ::JCF (7m) o So MANUAl. TANK QAUG/NO (Mfa) D .. VAOOII! ZONe D 7. QROUN)WATeA o L TANK TUT1HO o II. OTHeR Y. TANK CLOIUIUIIH'ORMATIOH I PllUlANlHT CLOIUItIIH PLACII IITM'TIC QUNITITV 0' SU88TAHCI /Wo.4AM.a 4M TAN< n.LIO WITH IHMT W. T!RIAL? 411 467 aIIIaN o VII DNo I S;\CUPAFORMS\SWRCB-8·wPD , w_ .~ .. e CITY OF BAKERSfiELD Of'1'1C1 ~ I!NVIRONMENT AL 'ERVrA 1715 C,,"1er Ave., Ilak.,,"'.ld. CA 13.101 (~79 ~_ ~_ _____ _ ____·4_ .. p ~ ,... ueT. TAMe ~AQ( fIII~ . -;"'" UNOeAOAOuNO PlPINO VI. "PING CONSTRUCT1OH (CI/«:II" "-'.,pyJ - AaovEGAOUNO PlPI..o Sy~¡rEM r-..pt; -g[ 1 ~ESSURI! 0 2. SUCTION 0 3. QN.\IfTV ~ 0 I. ~ESSURE CONSTRUCTlONl'O 1 'INQ,! WALL 0 3. UNI!D TRfHCH 0 III. O~ 4ðO 0 I. SINGLE WALL "IANUFACTURERI18' 2. DOU8I..E WALL CJ M. UNKNOWN 0 2. OOUBLE WALL. ! IAANUFACTUR!R fJ-D SM ríll ~1 MANUFACTURER .0 1. BAR!! STEEL 0 e. FAP COMP4Ta.! WII~ ~l 0 1. BARE STEEL : MATERIAlSANOO 2. STAINLESS STEel 07. GALVAHlZEDSTUl 02. STAINlESSSreEL , CORROSION . PROTECTION .0 1. PlASTIC COW4T1111..e 'It'I'n4 CONTEHT'S 015. UNCNOYotoI 0 1. PlASTIC CO""ATIBlS WITH CONTENTS Jil4. FIBERGlASS 0 a. FlEXIBU! (HOÆ) 0 it. O~ER 0 4. FI8éRGlASS o 5. STEEL"" COA TlNO a t. CATHOOIC PAOT£CT1OH o4ð4 0 5. sreEL WI COA Tl..o VI. ....0 LeAK DeTECT10H (CI/«:II"""~) UNOERGROUHD PIPING PRESSURIZED "'PlNO (CMdl" tNll/I1PIyJ: o 1. ELECTRONIC UN! I£A( œTECTOR 3.0 OPH TEST mD1 AUTO PUoP SHUT OFF FOR LEAl<. SYSTEM FAIlURe. NÐ SYSTEM OISCOfKCTJON · AI.Ca.! NIO VISUAL ALARMS o 2. MONTHlYCU GPH TEST o 3. ANNUAL INTEGRITY TEST (0.1 QPH) CONIIEHTlOHAl SUCTION SYSTEMS: I 0 5. DAIlY VISUAL MONITORING OF PUIoIPING SYSTÐI. TRIÐHAL PFING M'EGRt1'Y TEST (O.' GPH) : SAFE SUCTION SYSTEMS (NO VAL YES IN Ba.OW GROUfC) PIPNì): j 0 7. SELF MONITORING I GRAVITY FlOW: o 9. BIENNW. INTEGRITY TEST (0.1 QPH) secoNDARILY COHrAINI!D ...... PRESSURIZED PFING (CMdc .. "1/PPIyJ: 10. CONTlMJOUS T1.JR8N: SUW SENSOR MI!1 AUDIa.E N«J VISUAl AlARMS NÐ (Chedc one) . iZf' a. AUTO PUIo4P SHUT OFF WHEN A LJ:N( OCCURS ãr II. AUTO PUIo4P SHUT OFF FOR LEAKS. SYSTÐI FAIWRE NÐ SYS'TEM OISCON'ECTIOH ¡ 0 c. NO AUTO PUfoIP SHUT OFF I QI[ 1,. AUTOMATIC lINE LJ:N( DETECTOR (3.0 OPH TEST) rdItf FlOW SHUT OFF OR RESTRICTION ~ 12. ANNUAL INTEGRITY TEST (0.1 QPH) SUCTlONlGRAVITY SYSTEM: o 13. CONTNJOUS SUWP seNSOR . AUDB.e NG VlSUALN.JIWIj !lll!JtQ1!NCY QPI!JtA~ ONLY (CItec*..,.",."" o 14. CONTINUOUS SUMP SENSOR wmtOUT AUTO PUMP SHUT OR' · AUDIIIU! NÐ VISUAl. AlAAMS o , 5. AUTOMATIC LINE lEAK DETECTOR (3.0 GPH TEST) mnø4 FlOW SHUT OFF OR RESTRICTION o 18. ANNUAl. INTEGRITY TEST (0.1 GPH) CJ 17. OAlL Y VISUAl. CliECK o 3. GR.A\IrTY o 2. SUCTION o 95. UNKNOYotoI o 99. OTHER , - _ 4 o 8. FRPCOlo4P4TI8U!WlI~~- o 7. GALVAHIZED STEel . o 8. FlÐCJ8LE (MOPE) 0 98. OTIiER o 9. CATHODIC PROTECTIOH o 95. UNKNOWN 4E ....;:¡,:;.. 4M ABOVEGROUND PIPING NO WALL PIPING 46 PRESSURIZED PIPING (CMdl ~ /Nt 1IIJØIy): o 1. ELECTRONIC UN! I£A( DETECTOR 3.0 GPH TEST mn1 AUTO PU&F SHUT OFF FOR lEAK. SYSTEM FAIlURe. AND SYST'EM DISCONNECTION. AUDIIILe NÐ VISUAL ALARMS o 2. MOHTHl Y 0.2 0fIH TEST o 1 NNJALINTEGAITY TEST (0. t QPH) o 4. DAIlY VISUAl. CHECK COH\t'ENTIONAI. SUCTION SYSTEMS (Chedc .. /IIa, IIJPIy): o 5. 0AIl Y VISUAl MONITORING OF PIPING AHO PUMPING SYSTEM o 8. TRJÐ.fIIAI. INTEGRITY TEST (0. t GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BElOW GROUND PIPING): o 7. SElF IoIOHITORING GRAVITY FlOW (CI/«:II"/Nt 1IIJØIy): o a. DAIlY VISUAl. MONITORING o 8. BIEHNIAlINTEGRITY TEST (0. t GPH) II~YCONTAlHEO I9INO PRESSURIZED PIPING (CMdc.ø /Nt 1/I1PIyJ: 10. CONTINUOUS ruRIIIPE SUMP SENSOR mIHAUOISlE NÐ VISUAl At.ARMS NÐ (ctIedt ØIe) o .. AUTO PUIo4P SHUT OFF WHEN A LJ:N( OCCURS o II. AUTO PUIo4P SHUT OFF FOR LEAKS. SYSTEM FAIlURe NÐ SYST'EM DISCOHNECT1ON o c. NO AUTO PUIotP SHUT OFF o 11. AUTOMATIC L.EAK DETECTOR o 12. AAMJALINTEGAITYTEST(O.1 GPH) St.ICTJ()NGRAVITY SYSTBot. o 11 CONTINUOUS StN> SENSOR . AUDIBLE NG VISUAl. ALARMS I!III!ROENCY QI!HERATQg ONLY (ChedI.ø /Nt wr'>'I o 14. CONTINUOUS SUIo4P SENSOR wmtOUT AUTO PUIo4P SHUT OFF . AUOI8l.E AHO VISUAL ALAAMS o 15. AUTOMATIC LINE LEAl< DeTECTOR (3.0 GPH TEST) o 111. ANNUAl. INTEGRITY TEST (0.1 GPH) o 17. DAllYVlSUALCliECK o 1. FlOAT a.ECHAHISM THAT SHUTS ~ SHEAR VALVE o 2. CONTNJOUI OISÆHS!R PAN S!N8OR . AUDI8U! AND VISUAl. ALAAMS ß! 3. COHTINUOUS OISÆNSI!R PAN S!N8OR mI!1 AUTO SHUT OFF FOR DISPENSER · AUDIBlE ANa VISUAL AlARMS IX. OWNI!RJOPI!RA TOR SIONA TURI! WI Ia INe InCI 8CQItIIe 10 l1li belt fII my III 1CMIedge. R JISPENSER CONTAINoENT DATE INST~,!> 4M ~DO().MV/ ·:"i~i:'~~"· . o 4. DAIlY VISUAl CHECK o 5. TIWDt \IN£RI MONITORING o a. NONE Ae8 471 DAre 0/. C¡. 2 Trru:;¡;;;¡;;;Z Ef) rib~¡Jr 470 .72 'enn,1 MImI!« (Fot IOUI III 0IIIy) .73 I PwrnM. ~ (R)lIOctI... ØIIIyJ '74' PttmIl!¡rprlàonOlle(For"'''''odY) 'J 'CF (7/99) S;\CUPAFORMS\SWRCS-B.wPD , -~" ~ . ,}- "'~. ".. .. A.'. "'""'- --.. -" --- .-' '- ~ 1 1: U r ð.-\~~i' U~..LU _FICE OF ENVIRONMENT. SERVICES 1715 è'líester Ave., Bakersfield, CA 9lio 1 (661) 326-3979 UNDERGROUND STORAGE TANKS" TANK PAGE 1 I t ,""~ 'JF 4CTION ,c.,''', J'" ,_ onIrl ]iZt't, ~ "T!! ~T 0 t. AMeNOl!O PERMIT . 0 J. ReNewAL PEIUMT '". fII o s, C~ OF I.....ORMA noN) o 8, T!!MPORAAY "T! CLOSIJRe o 7 PERMANENT\. v CLOSED ON SlTe o 8. TANK RfMOVED (~-- . ItN 'OeM II.. """'I ~o50 wHITE: L.AtJ6 , TAHK US! 431 , "f;:(',. MOTOR VI!HICL! IIUEL ';¡;fMtbd, ~~ 7'pJ I 0 2. NQN.f\JEL PETAIOI.EUM : 0 J. CHEMICAl. PAOOUCT : 0 t. HAZAAOOUS WAST!! (1ndtIdN U~ OI i 0 95. uN<NO'Mf I ; 'M'E OF T AHK I ! (C/IKk _ AIm ody (~~ ' ItN 'OeM.... """'J J FACILITY 10 . ~uSINESS ,'IOIWII!! Is.- a ~o4ClUrr NAMe or oe.A . 0a0nIJ ...... Aa '/oDS Fú~L.. CENíEI2.~ BAKEesA€L.D #-25/2.. LOCA nON Vt'ffii1H SITI! ~) L TANK DESCRIPT10N 004 I ) .1ÙL 2002- : ADOfTIOI'W. ~ (F«1ocaI- OdyJ I TAtJK FF ~ t+Þr5 T~è) l1ðIJé£IJ We.w/Al6 IN 10/ ð{)o c.. òMi?~¡L\M6tJT3 .4-+- . T ANI< MATERIAL.· pftnIry I8N ~ (C/IKk _ .., ør/f) COMPAAnEHTALIZfD TANK Va 0 No II "Va-, can.. one!leve for UØI CIOmI*lnlent. NU . GA·GH Iò¡òöà 6ALl()tJ5 ItJ SIz&, .. TANK CONSTRUCTION o 1 SNJU! WALL 'MTH EXTERIOR wa.eRh'E LH:R 04. SlNGU!WALL"AVAtA.T .. TANK CON1'!NT'I NTRCUUM TYPI! o 1L R!OIANt UN.!AŒD 0 2. IDOED o '''' PRSMJU UN..fAOED 0 J. OIESEL ~c. ..xJAAOI! UN.EADEO 0 4, GASOHOl COAM:)H NAAE(ItM~~~f*le} o 1. SNJU! WALL þ( 2. 00taJ! WALL o 1. BAAl! STEEL o 2. STAH.!SS STEEL : T ANI< MATERIAL· ~ ** 0 1. BAAl! STEEL I (C/IKk - AIm odyJ 0 2. STANZSS STœ. I I .1 FI8EROlASS I PlASTJC % 4. STEEL ClAD W618ERG1.ASS REN"ORœO PlASTJC 1FRf'J Jl! 1 FISEROtASS I PlAST1C o 4. STEEl. ClAD WF18ERGLASS REINFORCED PlASTJC (FRP) o I. COHC:ÆTE o 1 EPOXY LJhWoIO "50 GI.AI8 UNMJ 0 15. UN<NOYttI CJ 4. PH!NOUC L»IN) CJ .. UN.JNED 0 II. OTHER Ji 1 FIIEROlASa ROoI'OAC!D P\AST1C 0 85. UN<NOWN 448 o 4. tIM'ÆSSED CURR£NT 0 at. OTMER o 1. rowurACTURI!Ø Co\THC)CC fIAOTECT1OH o 2. SACRR:IAL AHOoe 'tENt INSTALL£D ~ ,. SPILL COHTAINMI!NT d 0 Ò~ Çil' 2. DROP ruBe ;J. tJÕ;J. 3. STRIIœft PlAT! ;¡ 00 ;; UTIMATI!D OATlI.4IT UIIO ~Y) o 1. IUIII!R LMD o 2. AIJM) LIINQ ., SIHOLI WAU. TAMe (CItedr., lief WIYJ: o I, VISUAl. (IXPOIIO POfmOH ON. Y) o 2. AUTOMATIC TAHK GAUOINO IATG) o J. COHT1NUOUIATQ o t. Sf A TISTICAL INIIIHTORY Rl!COHCLIA TIOH (SIA) . IIII!NHIAL TAHK Tl.-r1HO ... 450 TYPE (FM /oQ/ .... ør/f) CJ 5. MANUAl. TANI( GAUGINO (MfG) o .. VADOR ZONe 07. OROUHDWAT!R o .. TAHK T!STJHO 011, OnteR Y. TANK CLOIUU lH'OItMA TIOH , PlltllAHlHT a.oIUR11H PLACII IITN'TID QUAHrITY Of' SUUTAHCC ~INWO 4M TAN( rUII) WITH IH!ItT MA T!ItIAL? '*" o 5. JEr FUÐ. EJ .. AW.TION FUEL o ge. 011iER CAS' ~~~"-*'Yf*le} ~ 441 o 50 SINGLE WALL 'MTH INTERNAL IILADOER S't'S1'EW 085. UN<NOWN Oat. antER o I. CONCÆTE 015. UN<NOWN o .. FRP COM'A TlBLE ""'00% AETHANO\. 0 ge. OTMER ..... rANK' · c:Jß r,4H( INTVIIOR L..-.o OR COATING I (CMdI_1IMI OIM OTliER CORROSION PROTECTION IF APPt.JCA8l.e (Ch.ø _ ìIMI ør/f) SPILL ANO OVERFIlL (CII..,. ~, INt 1PtJ/y) o .. FRP COM'AT18U! ""'00% AETHANO\. o .. FRP HOH<:ORROOeU! JACKET o 10. COATeD STEa. 085. UN<NOWN 011. OTMER 404S 448 ~TE INSTAU.ED 447 (FM 1ocaI_ omJ ~TE INSTAU.£O 449 (For 1ocaI_ Ody) 451 OVERFIlL PROTECTION EQUIPMENT: ~ INSTAllED 452 J1{ 1. ALARM ;?ðO Z. 0 3. FILL ruBE SHUT OFF VAlvt: _ ri(f 2. BALL. F1..OA T zc.o Z. 0 4, exaFT :~: ~~""~·,~.r-·~i;:·"~··:~· ", .' >.;.."". ';;?'!~.:/:.~~~' ,.; y .:.:,:.~..:;~·ift:¿~ 4ð3 . DOUIIU WALl. TANK 0" TANK IMTH 8LADOeII (CMt:IrON"'" od1J: 4ðo4 .. 1. VISUAL (SINOl! WAlLIN VAULT ONLY) è! 2. CONTINUOUS IHTI!ASTlTIAl MOHfTORIHQ o 3. MANUAl MONlTORINO 467 OVa 0 No ~CF (719G) S;\CUPAFORMS\SWRCB-8·wPD 1___ <::'\ " -""'" ~> f' .- -- - e CITY Of 8AKERSFIELD etrfl1Cl ~ !NVIRONMENTAL SER~JIà:I 1115 Chester Ave., Bakerafl.ld, CA 13301 ("W2e-Jt19 ~ UIT. TAHI( ~AQ -' - fJ/ I .~ UNOt!ROAOuNO PlPlNO W. IIIPINO CONI1'RUCTION (CIIM:It .. ",., ~ SYSTEM 1'"1''''' -g[ I i>AUSUAt! 0 2. SUCTION a 3. 0AA1In"\' ~ a I. ~ESSUAE CONSTRUCTlON!'O , SINGl! WALL 0 3. WHED TREHOi a III. OTHER 4ðO a I. SiNGlE WALL ,IMNUFACTURERIj;!( 2. OOUBLe WALL 0 1115. U~ '.J 0 2. OOUBLE WALL , r.4ANtJFACT\JRt!R fl· 0 'SJIIJ /í rr 4411 MAHlIFACTtJRER o I. BAR!! ST££L 0 I. FRP COMPATaI! ~ lomI. r..t!"OW«)L 0 1. BARE STEEL : w. TERIALS ANO '0 2. STAINU!SS STEEL 0 7. QALVAHIZED ST!fL 0 2. STAIHLESS STEEL ¡ CORROSION , i>AOTECTION 0 3. PlASTIC COWAT1IU! WrTW COHTEHTS 01115. UN<NOWN 0 3. PlASTIC COMPATIBLE WITH CONTENTS ]it.. FISERGI.ASS 0 .. FlÐ08L! (HOPe) 0 ft. OT)ER 0 4. FIBERGlASS o 5. STEEL WI COA TlNO 0 t. CA THOOIC PAOTECTIOH 4&4 0 5. STEEL WI COATING VI. ftIIING L2AK DeTECTION (CIIM:It../hat 1IIJØIy) UNDERGAOUND PIPING i>AESSURIZED PIPING (CheQr ., /11M ~): o I. ELEcmoHIC UI'E LEAl< OETECTOR 3.0 QPH TEST mnf AUTO fII..Ut SHUT OI'F FOR LEAl<. SYSTEM FAIlURe. AKJ SYSTEM DISCONNECTION · ~ AK) VI8UAL AlARMS o 2. MOHTK. y 0.2 GPH TEST o 3. ANNUAL INTEGRITY TEST (0. t GfIH) CONVENTIONAl. SUCTION SYSTEMS: I 0 5. DAILY VISUAl ~ OF F't.U'ING SYSTEM · TRIBNAL PfIINQ NTEGAfTY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): o 7. SELF MONIToRING GRAVITY FlOW: o t. BIÐNAL INTEGRITY TEST (0. t GfIH) tecONDAIIIL Y CONrAINI!D I'M'INQ PRESSURIZED PFING (Ch«:It ., ",., ~ 10. COHTJM.lOUS T\JR8INE su..P SEHSOft mIt1 AUDIIIlE AHD \/ISUAL ALARMS AND (Checllone) . i¡J a. AUTO PUMP SHUT OFF WHEN A LeAK OCCURS ~ Þ. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAIWRE AHD SYSTEM DISCONNECTION o c. NO AUTO PUMP SHUT OFF '~ 1,. AUTOMAT1C LINE LEAl< DETECTOR (3.0 QPH TEST) mnf FlOW SHUT OFF OR RESTRICTIOH r( 12. ANNUAL INTEGRITY TEST (0.1 GfIH) SUCTlONlGRAVTTY SYSTÐot o 13. COHTNJOUS sua.f" SENSOR . AUDBJ! AND VISUAL ALNIMI 9IØ01NCY GIENUATORa ONLY (CIIect" MIIJPIY o 14. CONTINUOUS SUMP SEHSOft wmtOUT AUTO PUMP SHUT OFF. AUDIIIl£ AND VISUAl AI..ARMS I 0 15. AUTO'"" TIC LINE LEAK DETECTOR (3.0 QPH TEST) mD:Q!.!I FlOW SHUT OFF OR RESTRICTION o 18. ANNUAl INTEGRITY TEST (0. I GPH) o 17 . CAlLY VISUAL CHECK " . 4aovECROUNO PIPING --l o 3. ORA"",, - - o 2. SUCTION o 95. UNKNOWN 099. OTHER o 8. FRP COMPATIBLE WI IomI. ~- o 7. GAlVANIZED STEEL o 8. FlEXIBLE (HOPE) 0 Ie. OTIiER I o t. CATHODlCPROTECTIOH 095. UHKHDWN 4ðð 40¡ ,~~~, I 4{1 ABOVEGROUND PIPING NO WALL PIPING PRESSURIZED PIPING (CheQr "IN, ~): o I. ELECTRONIC UI'E LeAK œTECTOR 3.0 GI'H TEST mnf AUTO PI.JY' SHUT OFF FOR LEAK; SYSTaI FAIlURe. AK) SYSTEM DISCONNECTION. AUDI8LE AHlJ VISUAl AI..AAfo&S o Z. MONTHLY 0.2 QPH TEST o 1 AHNJAl WT!GRfTY TUT (0.1 GfIH) o 4. OAIlY~ CHECK COH\IENTIOHAl SUCTION SYSTEMS (Chedr ., IN'~): o 5. CAllY VISUAl MONrTORING OF PIPING AND PUMPING SYSTEM o I. TRlENNIAlINTEGAtTY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VAlVES IN BS.OW GROUND PIPING): o 7. SELF MONITORING GRAVITY FlOW {Ch«:It"/Nt epp/yJ; o .. 0AIl Y VISUAL MONrTOAINQ o 8. BIEHNIAlINTEGRtTY TEST (0.1 GPH) III!CONDARIL Y CONTAINED I9'INQ PRESSURIZED PIPING (Ch«It.,/Nt~): 10. CONTINUOUS 11JR8INE SUMP SENSOR mD:1 AUDIBLE AHlJ VISUAl AI.AAMS AHlJ (dIedt eN) o a. AUTO PUMP SHUT OFF WHEN A LEAl< OCCURS o Þ. AUTO PUMP SHUT OFF FOR L.EAI<S. SYSTEM FAILURE AHlJ SYSTEM DISCONECT1ON o c. NO AUTO PUW SHUT OFF o 11. AUTOMATIC LEAl< œTECTOR o 12. NNJAlINTEGAtTY TEST (0.1 GI'H) ~VTTYSYSTEM: o 11 CONfN)()US SUfoP SENSOR . AUOI8U! AND VISUAL ALARMS !ll!RGENCY OI!NERATORa ONLY (CMdt..".., eppIyt o 14. CONTINUOUS SUMP SENSOR wmtOIJT AUTO PUMP SHUT OFF . AUOI8I..£ NIO VISUAL AI.AAMS o IS. AUTO,"" TIC LINE LEAl< œTECTOR (3.0 GI'H TEST) o 18. ANNUAl INTEGRITY TEST (0.1 GPH) o 17. CAlLYVISUAlCHECK .. .." '~~:4.~\~.ã;i~£, JISPENSER COHTANoENT OATE INST~.2 481 ~()O().Mr:¡ o ,. FLOAT a.ECHAHISM THAT SHUTSOFP SHI!AR VALV1! o Z. CON'rN.OUI DISÆHSI!R PAH SI!NIIOA . AUDI8U! AND VISUAl AI.AAMS øzr 3. COHTINUOUI DISPEN8!R PAN SI!NIIOA mniNJrO SHUT OFF FOR DISPENSER · AUDIBLE AND VISUAL AI.AAMS IX. OWN!RIOPI!RATOR SIGNATURE .. Ie true -'CI-.rIIe 10 !lie IIeII øt my lInoo "11",. o 4. OAIlY\IISUAL CHECK o 5. TRENCH UNER I MONITOftING o 4. NONE 4Ø 471 DATE C¡. '1. Z T~'(diíð7í2Et> ribê¡Jr 470 472 473 PetmM.~{FotIotM_OdyJ 474 I Pwmll &ønIIon o.(ForAøc*lINøtI)1 4t:] }wm~ ~oer (For IOCM uø ØttIy) 'CF (7/99) S:\CUPAFORMS\SWRC8-ø.wPD -... '\) e e EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The infonnation on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Environmental Services within 30 days of any changes to the monitoring procedures. unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR Facility Name 'IoNS rvÐ- é.étJít:e.. - BAKee5 fi EL.[) *25 rl. Facility Address ~D'SO wHITE:: LÞtNE., e,AK€BF"JE:L.D . CA 93'301__ . 1. If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion hazard, are not cleaned up £rom the secondary containment within 8 hours, or deteriorate the secondary containment, then the Office of Environmental Services must be notified within 24 hours. Each Vons fuel center site is provided with an emergency spill clean up kit. In the event a spill occurs the attendant will secure the facility and prohibit any pedestrian or vehicular traffic. All clean up activity will be through the use of DRY materials. All waste clean up materials will be stored and disposed of by a certified hazardous waste hauler. The attendant, once the spill area has been secured and cleaned to the point of no immediate danger, will contact the local Vons approved hazardous waste clean up and maintenance contractor to visit the site and complete the clean up operations. 2. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substance. 5£t! ArrltCl-/Ev. 3. Describe the location and availability of the required cleanup equipment in item 2 above. CL64¡J vI' é'c;;u/p¡11eAlJ 15 K~ OIJ 5/TE W ¡rill;'; íil~ -rRA5t1 [:3¡JGL05UIl€ AJ264. APtJl/Íò,J1}v ITéM5 AI{£ MI7IAfllJ/NéO /N5/PG íHE: K/ÒsK ST{2.VcTJ¡Z.. 4. Describe the maintenance schedule for the cleanup equipment: If LL- ON 51 ré. (!LéAN u¡J £ oiJ/PÆEtJr /5 /N5P£ c:Tt:lP. Ré,A¿t..£¿J o,e R.En/iCI3'O Ò,.J Ir W6:¡¿:L'Ý ßAS/S. " 5. List the name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan: , J, .5/'rlE MA¡JA6€R.. ;l. J1/l. 7c"rr MIL¿t£!2 ' VONS rueL- Pi06t2AM MIJNA6€/2 3. PI". jI'//;q; AL8¡t} - ¡/()N.5 STo¡¿6 J)£3/6/(/ ~ . International Chemical Ams, Inc. ENVIRONMENT AL CHEMICAL SOLUTIONS, INC. MATERIÄ SAFETY DATA SHEET HYDROCARBON MITIGATION AGENT "Delivering Solutions to the Customer" FM 186-2 Emergency: 1-877-253-2665 SECTION I - GENERAL INFORMATION Name: Manufacturer P.O. Box 2029 Gig Harbor, W A 98335 Tel: (877) 253-2665 Generic Description HMIS Code HMIS Key D.O.T. Class Formula: FM 186-2, Hydrocarbon Mitigation Agent Environmental Chemical Solutions, Inc. Water Based, Biodegradable, Wetting Agents & Surfactants Health 0, Fire 0, Reactivity 0 4 = Extreme, 3 = High, 2 = Moderate, 1 = Slight, 0 = Insignificant Not regulated; not hazardous Proprietary SECTION II - HAZARDOUS INGREDIENTS This product does not contain any hazardous ingredients as defined by CERCLA and California's Prop. 65 SECTION III - PHYSICAL & CHEMICAL CHARACTERISTICS Boiling Point: <264F Melting Point: 32F Specific Gravity: 1.00 ±.01 Vapor Pressuremrn/Hg: NA Percent Volatile by Vo\.: NA Vapor Density Air 1: NA Solubility in Water Complete Reactivity with Water: No Viscosity 15 Centipoise Surface Tension: 29.1 Dyne/em at 25°C Evaporation Rate: > 1 as compared to Water pH: 7.0 to 7.6 ±.5 Appearance: Light Violet Liquid Fire Extinguisher Media: NA Odor: No Fragrance - Unopened Fire Fighting Procedures: NA SECTION IV - Fire and Explosion Data Special Fire Fighting Procedures Unusual Fire and Explosion Hazards Solvent for Clean-Up Flash Point NA None Water NA Percent Volatile by Volume Flammable Limit Auto Ignite Temperature Fire Extinguisher Media NA NA NA NA Copyright 1998, International Chemical Systems, Inc. All rights reserved 3/23/98 FM186-2 ';; . e SECTION V - SPECIAL PRECAUTIONS AND SPILL/LEAK PROCEDURES Precautions to be taken in Handling and Storage: Use good normal hygiene. Precautions to be taken in case of Spill or Leak - Small spills. Soak up with absorbent materials. Large spills: dike and contain. Remove with vacuum truck or pump to storage/salvage vessel. Soak up residue with absorbent materials. Waste Disposal Procedures: Dispose in an approved disposal area or in a manner that complies with all local, state, and federal regulations. SECTION VI - HEALTH HAZARDS Threshold Limit Values: NA Signs and Symptoms of Over Exposure- Acute: Moderate eye irritation. Skin: Causes redness, edema, drying of skin. Chronic: Pre-existing skin and eye disorders may be aggravated by contact with this product. Medical Conditions Generally Aggravated by Exposure: Unknown Carcinogen: No Emergency First Aid Procedures - Eyes: Flush thoroughly with water for 15 minutes. Get medical attention. Skin: Remove contaminated clothing. Wash exposed areas with soap and water. Wash clothing before reuse. Get attention if irritation develops. Ingestion: Get medical attention. Inhalation: None considered necessary. SECTION VII - SPECIAL PROTECTION INFORMATION Respiratory Protection: Local Exhaust Required: Not necessary No Ventilation Required: Protective Clothing: Normal Gloves, safety glasses, wash lothing before reuse. SECTION VIII - PHYSICAL HAZARDS Stability: Polymerization: Stable No Incompatible Substances: Hazardous Decomposition Products: None known NA SECTION IX - TRANSPORT & STORAGE DOT Class Storage Shelf Life : Not RegulatedINon Hazardous : 35°F-120°F : Approximately one year unopened Freeze Temperature Freeze Harm : 28°F : None SECTION X - REGULATORY INFORMATION The Information on this Material Safety Data Sheet reflects the latest information and data that we have on hazards, properties, and handling ofthis product under the recommended conditions of use. Any use of this product or method of application, which is not described on the Product label or in this Material Safety Data Sheet is the sole responsibility of the user. This Material Safety Data Sheet was prepared to comply with the OSHA Hazardous Communication Regulation. Copyright 1998, International Chemical Systems, Inc. All rights reserved 3/23/98 FM186-2 e e :, FM 186-2 Spill Response & Cleanup Program The Problem The environmental and safety problems facing the automobile refueling industry are enonnous. Today's refueling facilities are faced with volumes of regulatory compliance guidelines and mandates. One of the toughest to deal with is spilt fuel. State and Federal law requires spills to be cleaned up and, in many states, regulation goes on to state that it has to be cleaned up in such a way as to minimize, if not eliminate, the release ofVOC's (Volatile Organic Compounds) in to the atmosphere. In addition to environmental issues, there are concems for customer and employee safety. Risk of fIre resulting from fuel spills and exposure to physical contact with hazardous waste are both signifIcant issues. Traditional Methods Of Clean-up Traditional spill response methods to clean up gasoline & diesel spills require the use of sorbent material to soak up the spill and then be disposed of as hazardous waste. This method creates several new safety, training and environmental issues for the station operator to deal with. In some states the requirement of a manifest means that the operator may own the hazardous waste even after it has been picked up. This method is costly and completely out dated. The ECS Program The ECS Program is simple and straightforward. The ECS program eliminates the safety; training and environmental issues created by traditional spill response methods. Simply put the ECS Spill Response Program uses the best available methods combined with the best available technology to solve your spill response problem. What's more this program is less costly and more effective than traditional methods. ~ ~ e '\; e Comparison of the ECS Program to Traditional Methods 1. Utilize sorbent material to soak u fuel. 2. Move clean up materia sealed hazardous waste contai 3. Open the container inside. 4. Close the co ner. 5. When co mer is full or has been on site for the imum allowable days, call for al. out manifest and remove from site. aterials are either incinerated or landfilled. This type of program does nothing to reduce the explosiveness of gasoline vapors. Dur' spill response, customers and employees are ~ected to the potential explosiveness of the fue he proximity of the hazardous waste containe fuel islands and buildings usually does not sufficient protection from fire or explosion. ith benzene from the spilled gasoline evapo g into the air and being inhaled by customers a employees. This type of program does reduce VOC's at the island or at the hazar s waste container during disposal. Customers and employees are subjected to the dangers of the Benzene these VOC's produce. 1. Spray Fm 186 onto spill. 2. Mix with stiff bristle brush. 3. Utilize universal sorbent to soak up the spilled fuel. 4. Dispose of materials as solid waste. 5. Materials are landfilled and the hydrocarbon biodegrades readily. This program immediately addresses all of the safety concerns. First, as soon as the fuel and the FM186 product are combined all vapors are immediately suppressed. This results in reducing the lower explosion limit of the spilled fuel. The spilt fuel clean up materials are no longer ignitable. This results in a safer environment for customers and employees around the entire facility. Due to the reduction of the VOC's the health issue with the inhalation of benzene is dramatically reduced or eliminated. ~ r . ~ ~ . ... e This type of program reduces the impact ofpilt fuel becoming non-point source pollution. e act of responding to the spill and depositin e clean up materials into a sealed container re es evaporation of the fuel that contributes to pollution. In addition, cleaning up the spilt fì reduces but does not eliminate the amount of fì that can potentially wash into storm drains. may be disposed of in hazardous waste landfi s. Biodegradation will not occur and the rbon is simply relocated to another area. There is no training associated with this type of program. Owners and operators are ~esponsible for designing the contingency plan a:a the training program. Spill clean up equ'A ent is usually insufficient or non-existent. e This,program out distance's current practices by further reducing the spilt fuel's impact on non-point source pollution. The VOC's contributing to air pollution are eliminated while cleaning up the spill, whereas current practices do not stop the VOC release u'ltil sealed in the hazardous waste container. When this program is used to clean up a hydrocarbon spill the FM 186 product further removes the residual spilt fuel from the concrete. This results in even less of an opportunity for spilt fuel to enter a storm drain. Disposed materials will biodegrade like any other solid waste in the landfill. In wet weather climates this program reduces or eliminates the potential risk of falls by returning the hard surface immediately to a non-slippery condition. Training is very important to reducing the risks associated with fuel spill clean up. To protect the environment it is essential that the response be swift and properly done. The ECS program provides written and video training along with a written contingency plan on how to safely and properly deal with the spill. The contingency plan is not only included in the training materials but also in the spill response kit. Either our representatives or corporate assigned trainers train all onsite personnel on proper spill response methods. ~~. ",e ':t e e i ~ To accomplish the goals associated with each customer's spill response program, ECS monitors the use of spill response equipment and conducts continuous training at each site. This is done by representatives in the field and by customer service representatives in our home office. Each site is contacted on a regular basis to identify the needs of each facility. These needs may be in the fonn of replacement of spill response equipment or the training of new personnel. Per location: Start up Cost $235 Based on Training requirements . er month Summary In the comparison of these two programs, it becomes evident that one is strictly the selling of a product or delivery of a service - that is the drop off and pick up of a drum. This does nothing to reduce health and safety risks to customers and employees nor the liability of storing hazardous materials on site and may, in fact, increase the risk of an accident due to improper handling of the drum and/or waste materials. The ECS approach is the only true program available today that is geared to address the problems associated with service stations. The ECS Spill Response Program utilizes the FM 186 technology, the development of contingency plans, training of personnel and customer service and support. Hazardous materials are all but eliminated, health and safety concerns are mitigated and overall liability is significantly reduced. All at a lower cost! . ill Wipe up petroleum spills with our water-based spray, FM 186-2. Then dispose of as solid waste! Including gasoline, diesel, motor oil, heavy grease, antifreeze. e 1 spray by hand / / - ,~ 3 wipe up and throwaway . . . after a spill ---... ~' 2 brush until petroleum odor disappears Inc SOLUTIONS, If you have any questions or would like to reorder please call us toll free at 1-877-253-2665 ENVIRONMENTAL CHEMICAL FM 186-2 can also be used for variety of maintenance purposes: * Cleaning entry I exit areas * Floor areas prone to being slippe!"'{ * Cleaning pump dispen=ïers and islands c. D. E. F. G. ~EN MONITORING PR.EDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM ThillDOnitorin, proøram tDUII be kept II the UST locaâoa II aU lima. The åIdbnIWioa OD thiJ IIIOIIÌIariIII propam are coadilioDl at the opcrariq permiL The permit bolder IDUII ~ the OðIœ at Enviro,ul'~.,..1 Services within 30 days at any ch""ptI to the moaitoriD, procedun:s. WÛCSI required to obCai.D apprcwa1 before 1lUl1ri"8 the cJwI¡e. R.equirat by Sec:åoøs 2632(d) aad 2641(h) CCR. Facility Name VONS Ñ£l.. CeJréR.. - f;A¡<éJ2.SFi£L.O #2.:51'2.- Facility Address &90:30 WillI€. LAAlE., !J4K'ð!SFI£L.{;) J CFI Q3'3o/ . A Describe the ftequeucy of performing the monitoring: Tank ÚN'Kj A£é l'1ðNlro£ét) ON A coAJ7íNU,4~ /3AjIS (Z+fhJJIl..5 -7149'15 A- WE.æ:) , ' . Pi ing tJM ê]!..6.£o¡JAlf) ßl'wr; /5 MONdoee:; DV ~ co)../7ÏAltlA-L- S I Z 4 flo,j~s - .PðYS./f WfEf3K. B. What methods and equipment, identified by name and model, wiD be used for peãomiøa ~~~~: ) Tank V~éPæ¡¿007 7L:5 350;( (J.I)()/Jét- #\jR.8482'1Õ,/ZZ Piping v'étPf3lV2oar ¡LS;Sö)?. (11()J1£L#"VRB4BZ~O-/~) fiNO êl£GæiJMC uAfé. L.é/TK l?~íé.C.'1ÍOAl Describe the location(s) where the monitoring will be performed (tàciJity plot pIan should be attached): l1ðNITOIt/¡Jq wllL-'% P€UiìtÞI~[)/¡JIJt.¿' Tl1JJ~ ,p/5/e'1.l5~¡;AI# hi1A/6 Ll~+tS . J' List the name(s) and title(s) oCthe people responsible for performing the monitoring andlor maintaining the equipmeu : (\ AÑ¡¿NOl,O'Ý lCo,V1íVtCro)!, .106 J2ttDVß, Jl}4J~TéNANc:E tCONítZltcToQ) 'A/lJ( 1. t)./""'éfl.PI2.I~ CòN1'IlA6To¡¿ 5/re= /+7Í~AlPt'r r Reporting Fonnat for monitoring: Tank VAIL'! LD~S Piping VA I LY L06P Describe the preventive maintenance schedule for the monitoring equipment. Note: Maiateaaace mutt be ia accordaace with the manufacturer'. maiateaance sebedule but Dot leu than every 12 moaths. Au... Mð;¡Jffòe!lJ~ fJev'cB AI2é /JJ5/€c7Ð:J IMJ£) 1£51éP £¡J62ý ~/X /V/òAl11f5 . k'oAlS )1IJIAlTf3)JftNC£ œ¡JíeltCToi!. /11.50 P£ef02JV!7 ArJO MAIt.Jí""AltJ.s Mo,.jrr01tltJl:t e:oû ,PM6J'J oN It l2.E6ùuri !31T5fS. Describe the training necessary for the operation ofUST system, including piping, and the monitoring equipment: All fuel site atten.dants must attend a manufacture's training course prior to working in the fuel kiosk. All ~ttendants are trained on ~II fuel sy~tem devices and .the steps necessary to stop and restart the system at any - time. All attendants are trained and Informed as to which manufacture's and contractors they must contact in the event of a shut down, defective equipment or a spill. SEP 10 '02 15:35 FR e 9254673990 TO 917147500990 e P.02/06 '\, A CO ROT" CERTIFICATE OF LIABILITY INSURANCE Pagê 1 of 2 I OATE 06/29/2001 O~ODUCER 877-559-6769 THIS CERTIFICATE IS ISSUED A.S A MATTI;R OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE W~lli~ Nor~~ Amer~c~, Inc. -, RegiQnal cer~ ,c:'..nt~JC' HO~CER. THIS CERTIACATE DOES NOT AMEND. EXTEND OR 11201 N. T~ç~ Boulevard AL íER THE COVERAGE A.FFORDED BY THE POl.ICIE:S BEI.OW. Suite 300 E>hofni~, AZ 85028 INSURERS AFFORDING COVERAGE INsuReD $afeway, Inc::. INSU~R k Indian Harhor In:¡n:ranC:e c:'om'Danv (36940-000) ~9:S Stò;r..<iI:-idge )loa::'::' !tQ....; INSUf'!ER B: i'leasa.nton. <:A 94SaS--322 INSURE~ C: INI¡;UR€R 0: I NSU~eA E; COVERAGES THE ~Ol.IC!e$ OF INSURANCe I.I$TEO BELOW HAVE SEEN ISSUEO TO THE INSUREO NAMeD ABOVE ~OR THE ~CI.ICY PERIOD INOICATEû. NOTWITHS"rANOING ANY REQUIREMENT. TeFtM OR CONDITION OF ANY CONTR~CT OR OTHER. OOCUMENT WITH RESPECT iO WHICH T¡.iIS CERTIFICATE MAY Be;: ISSUED OR MAY ¡oe;F¡TAIN. THE INSURANCé AFFORDED BY THe POI..IC/ES DESCR/seD HEREIN J$ SU8JECT TO AI..L THE TE~$. EXCLUSIONS AND CONOITIONS OF SUCH pot,,!cres, AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCE;O BY PAID CLAIMS. 't';: [ T'rPE OF INSURANCE POLICY NUMBIOR ~¡T~¡'¡~f~Æv~,e Og¡!fEY,~J:lft';::¡"C;;N ~I!.IJTS ~~ERAL UABILrT'Y I I eACH OCCURRENCE is , COMMERCIAL GIONeR.AL LIABILITY FIRE OAMAGE (Any one ~"') s I I CLAIMSMAOE 0 OCCUR MED EXP iAnv one "e~on} Is PERSONAL & AOV INJURY Is )-- s r-- . G=NE~ALAGGRE~A~e ~N'LAGGREGATE LIMI'I" APPLIES PER: ~ODuC"'S. COM"'IOP AG~ Is -- I POLICy n ~:s n LOe I ~TOM06IlE lIAB\LIT'r I CCMBINEO SING.." LIMIT I (~ .JeCidentl S § ~,.~ ALL OWNED AliiOS SOOILYIN.JuI'tY $ SCHEOUl.eO AUTOS (P..- pe,son) , HIRED AUTOS i eCOILY IN.JUI'{Y $ ¡ NON-OWNeO "UTOS ¡"~ SGCiCenl) H I ! I PROPEI'{TY DAMAGE S ~ !Pe-r .3cCldç.nt) i GARAG£L.IA!lIUTY I ¡AUTO ONLY· so. ACCIOe:NT Is R ANY AliTO ! E_ACC S OTHEH 1'HAN I AUTO ONLY: AGG! S pl<SS LlAB¡UiY ¡ I EACI'! OCCURRENCE Is ¡ OCCUR 0 CLAIMS MADE J A(¡C¡::¡EGATE $ I ! s H I O¡;OUCl1!RE s ! RETENTION $ I ¡ Is WORKERS COMPENSA TlCN AND I ¡ T~~~T¡'JUs i IOJ~-1 eMPLOY!!I'!S' UAB'~ITY ...~. EAC).! ACCIOENT Is I !:.I.. OISEASE· SA eM"~OYE5: s ¡ S.L. OI$EASE . POLICY l.IMIT S A , OTMER PECOOOO95ó4 07/01/2001 07/01/.2004¡ I t.T$'t' Vinancial ! s::.. 000 . 000 Each Occurrence Re"pon~i1;>~lity !:;2.000,000 Aggreg;a.t;e I OESCRIP'I10H OF OPIORA TIO"S'LOC"'TlONSNe~ICL.E$/EXCLUSlON3 AOOEO 8'1' !NOO~e."'¡¡"I'I'JSP!!C'.AL PROVISIONS See A!;!;acheå Certificate of Insurance CERTIFICATE HOLDER i Aoomo"...L INSURED: INSURER Le"I"TER' CANCELLA TION ACORD 25-5 (7/97) Col1:13547~ Tpl,22~S2 SHOULO ANY Ol'l'HeAsOVE DESCRIBED JOOI.ICleS!lE CANCELL.EC AEFORE THE EXPIRATION c.o,rs THEI'!EOF. TliE ISSUING INSURER WILl. eNOEAVOR 'ro MAIl,. ~ CAYS WRrTTõ:N "QTlC~ TQ THe Ct:RTlFlCATE t10LCI!R NA~(¡() TO Tke I..E:~. aUT FAILURE TO 00 $0 SMALL IMPOSE 1'10 OBl.lCõATlON OR LIABIL.ITY OF ANY KINO UPON THE INSURER. ITS AGEH'I"S OR R£PRE;seNTATIVES. A ORIZED "'L:'ESI!.NYA1We D"C)~ 19 @ACORO CORPORATION 1988 St&t~ Water Re~our¢es Control BO~~~ ~ Div. of Clean W~ter Prgrmð ~~de:-groun¿ Storage ~~~k Program 1001 I st~eet, 11tb FloQr saeramentQ~ CA ~sa~4 , SEP 10 '02 15:36 FR e 9254673990 TO 917147500990 e P.03/06 ';; Page 2 at :2 IMPORTANT If the certificate holder is an ADDITIONAL INSURED. the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder i!l lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain pOlicies may reql:iìre an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend. extend or alter the coverage afforded by the policies listed thereon. ~CORC 25-S (7/97) Col1:235471 Xpl:22~52 Ce~t:483l19 .. e 9254673990 TO 917147500990 e P.04/06 SEP 10 '02 15:36 FR '. FINANCIAL RESPONSIBILITY - CERTIFICA TE OF INSURANCE FEDERALUNDERGROUNDSTORAGETANK(US~ NAME: ADDRESS: Safew,,-y, Inc. and all subsidiaries 2100 White Lan~ Bakersfield. CA POLICY NUMBER: PERIOD OF COVEAAGE:. PEC0009564 July I, 2001 to July I, 2004 NAME OF INSURER: ADDRESS: Indian Harbor Insurance: Company c/o ECS Underwriting. Inc. 520 Eagleview Blvd. P. O. Box 636 Exton. PA 19341-0636 NAME OF INSURED: ADDRESS OF INSURED: Safeway, Inc. and all subsidiaries 5918 Stoneridge Mall Road Pleasanton. CA 94588-3229 I. Indian Harbor Insurnnc: Company, the Insurer, as identified above, hen:by certifies that it has issued liability insur<U\ce covering, the following underground storage tanks(s): # of Tanks Facilitv Name Facility Location 3 Safcway, Inc. 21 00 White Lane Bakersfield. Ca (2512) for taking corrective action andlor compensating third parties for bodily injury atld property damage caused by either sudden accidental reJeases or non sudden accidentaJ releases or accidental releases; in accordance with and subject to the limits of liability, ~xclusions. conditions, and other terms of the policy; arising from operating the underground storage tank(s) identified above. The limits of liability arc $ ¡ .000,000 each occurrence, $2,000,000aggregate exclusive of legal def~ns¢ costs. which are subject to a separate limit under th~ policy. This coverage is provided under PEC0009564. The effective date of said policy is Juiy I, 200 t. ENSTE243 (7/99) FEDlJST-CERT Page lof2 SEP 10 '02 15:36 FR e 9254673990 TO 917147500990 e P.05/06 'i 2. The Insure:: further certifies the following with respect to the insurance described in Paragraph \: a) Bankruptcyor insolvency of the insured shall not relieve the Insurer ofits obligations under the policy to which this certificate applies. b) The Insurer Î:i liabl<: for the payment of amounts within any deductible applicable to the policy to the provider of com:cnve action Or a damaged third-party. with a right of reimbursement by the insured for any such payment made by the [nsurer. This provision does not apply with respect to that amount of any deductible for which coverage is demonstr:1ted under another mechanism or combination of mechanisms as specified in 40 CFR 280.95-280.102. c) Whenever requested by the Director of an implementing agency, the Insurer agrees to fumish to the Director a signed duplicate original of the policy and all endorsements. d) Cancellation or any other termination of the insurance by the [nsurer. except for non-payment of premium or misrepresentation by the insured, will be effective only upon written notice and only after the expiration of 60 days after a copy of such written notice is received by the Insured. Cancellation for non-payment of premium or misrepresentation by the insurcd will be effective only upon written noticl: and only after th~ expiration of a minimum of 10 days after a copy of such notice is receivc:d by the insured. e) The insurance covers claims otherwise covered by the policy that are reported to the Insurer within six months of the effective date of cancellarion or non·renewal of the policy except where the ncw of renewed policy has the same retroactivE: date or a retroactive date earlier than that of the prior pçlicy, and which arise out of any covered occurrence that commenced after the policy rl:troaçtivc: date, if applicable, and prior to such policy renewal or termination atc. Claims rl:ported during sueh c;¡ctc:nded reporting period are subject to the terms, conditions. limits, including limits ofliabiliry, and exclusions of the policy. I hereby certitÿ that the wording of this instroment is identical to the wording in 40 CFR 280.97(b )(2) and that the Insurer is licensed to transact the business of insura.'1c¢, or eligible to provide insurance as an excess or surplus lines insure:, in one or mate states. Signature of I Lyn Bowers Type Name Underwriter, Authorized Representative of (Insurance Company) ECS, Inc. 520 Eagleview Boulevard P.O. Box 636 Exton. P A 19341-0636 ENSTE243 (7/99) FEDUST-CERT Page 2 of2 SEP 10 '02 15:36 FR 9254673990 TO 917147500990 P.06/06 ~ e e II') ~ðf~~-t\!~NC. . \..:tJ PLEASANTON. CA 94SòS-3229 Certification of Financial Responsibility Safeway Inc. hereby certifies that it is in compliance with the requirements of subpart H of 40 ÇFR part 280. The financial assurance mechanism used to demonstrate financial responsibility under subpart H of 40 CFR part 280 is as follows: Mechanism: Issuer: Amount of Coverage: Insurance Policy Indian Harbor Insurance Company $1,000,000 each claim $2,000,000 aggregate Effective Period ofCoverage:711/01-7/1/04 Type of Coverage: Taking corrective action and compensating third parties for bodily injury and property damage caused by accidental releases. STEW ~YINC. JÏ: 'L ¡ "'Ga~l::- yomura., '(:PCU ~ Director of Insurance Corporate Risk Management ignature of wi mess) ~lvì"- Hi I]u (N me of wItness) 7/1/01 ~P.eçyçled ,="Pape, ** TOTHL PHGE.06 ** l"",~____ PRESSURE LINE LEAK ALAR!'" Q 1: REGULAR PLLD SHUTDOI,..JN ALARt"1 / AUG 15, 2002 9:57 F~ PRESSURE LINE LEAK ALAR!v' Q 2:PLUS PLLD SHUTDOLm ALARlv, AUG 15, 2002 9:57 AM o PRESSURE LINE LEAK ALARI"l Q 3: SURREt1E PLLD SHUTDOiJ,JN ALAR~'1 AUG 15, 2002 9:57 AM ----- SENSOR ALARt"1 L 9:DISP 03-04 DISPENSER PAN FUEL ALARt"1 ~ ~ AUG 15, 2002 9:57 A~ PRESSURE LINE LEAK ALARt"1 Q 1: REGULAR PLLD SHUTDOklN ALAR!v' AUG 15, 2002 9:58 At"1 G PRESSURE LINE LEAK ALAR!"1 Q 2 :PLUS PLLD SHUTDOiJJI'J AUG 15, 2002 ALARt'" 9 : 58 Alv ------...' - --.... P 1"1 ~ ALARt"1 9 : 58 Atv1 PRESSURE LINE LEAK Q 3 :SURREt"1E PLLD SHUTDOWN AUG 15, 2002 _u__ SENSOR ALARrv, L1 0 :DISP 01-02 DISPENSER PAN FUEL ALARM AUG 15, 2002 9:58 At"1 u PRESSURE LINE LEAK ALARI'1 Q 1: REGULAR PLLD SHUTDO\¡,IN ALAR!v' AUG 15, 2002 9:59 At"1 \J PRESSURE LINE LEAK ALARt"1 Q 2:PLUS PLLD SHUTDOWN ALARrv' AUG 15, 2002 9:59 At"1 PRESSURE LINE LEAK ALAR~" Q 3: S URREtvlE PLLD SHUTDOI,JN ALARt,·, AUG 15, 2002 9:59 At"1 v ----- SENSOR ALAR!v' L1 0: D I SP 01-02 DISPENSER PAN FUEL ALAR¡V¡ AUG 15, 2002 9:59 At"1 PRESSURE LINE LEAK ALARt"1 Q 1: REGULAR PLLD SHUTDOWN ALARr1 AUG 15, 2002 10: 00 AI'1 PRESSURE LINE LEAK ALARr"1 Q 2:PLUS PLLD SHUTDOWN ALARt"1 AUG 15, 2002 10: 00 AtL \J PRESSURE Ll fJE LEAK ALARrv1 Q 3: SURREfvlE PLLD SHUTDOl,.JN ALARt'" AUG 15, 2002 10:00 At"1 -.....J -- - - - SE NSO R ALAR!1 Lll :DISP 05-06 DISPENSER PAN FUEL ALARr1 AUG 15, 2002 10:00 At"1 PRESSURE Ll NE LEAK ALARr"1 Q 1: REGULAR PLLD SHUTDOl.JN ALARrv, '0 AUG 15, 2002 10:04 AM PRESSURE LINE LEAK ALAR!v1 f Q 2:PLUS PLLD SHUTDOWN ALARM AUG 15. 2002 10:04 AM \..",) ... PRESSURE LINE LEAK ALA! ~ 3: S URREt"lE ÞLLD SHUTDOWN ALAR~" AUG 15. 2002 10:04 AM --.--- ~3Ert30R ALAR!1 -,,'.- Ll2 :DISP 07-08 . DISPENSER PAN FUEL ALAR¡Vl AUG 15, 2002 10:04 At"1 PRES:3URE Ll NE LEAK ALARI"1 Q 1: REGULAR PLLD SHUTDOkll' ALARrV] I AUG 15. 2002 10:05 AiIÞ PRESSURE LI NE LEAK ALARr"1 Q 2 :PLUS PLLD SHUTDOLm ALARr'1 AUG 15, 2002 10:05 AM PRESSURE LINE LEAK A_vI Q 3 :SURRErvlE PLLD SHUTDOl,m ALARrvl AUG 15, 2002 10:05 AM t - - -- - :::;Ert30P. HI " p.r'·) LI?;DISP O'3-ln·M. -\-.- I DIc;PHJBER PAN- ., FUEL ALAP'I"I AUG 15. 2nn? 10-'U-5 . - - - " Arv¡ ~'EE:~;:::;UkE ¡ I NE "., «I 1: RE;UL "F:' - LEi-ìL ALARI'" PLLD C.·HI.JrL",·: . AUG I;;;' ", :",:'I~IN AU'tRr"1 J. ~UU2 10:07 AM ---- ~,U___I :::ÆNSOF: Hl.HI~I'1 L I: kE,;;ULAF: blT' ::::'1'1 r'l)["1F' ¡ ï ';: riU,F:r"l '. l~. 20U~ 10:07 AM PRESSURE L ¡ NE LEP,l: ¡.:;\DifÙ"l o 2:PLUS PLLD SHUTDOl,JN i~LAJ.::I"l AUG 15. 2002 10:08 AM ----- ~::;EI'~E~OR ALAR!'" _uu L 4: PLíX:; srp STF' ::òUf"!P FUEL !,U~Ef"l AUG 1 ':~,. 2002 1 [I : 08 A!"l v PRESSURE LINE LEAK ALARM ø :3: SURF:Er"IE PLLD SHUTDO~,N f1LARr"f AUG 15. 2002 10:09 AM --.... G ----- SEf'.JSOF: ALAF:~'1 L 6: E:UPREME STP STP S ur·w FUEL ALAEr"¡ AUG 15. 2002 10:09 AM PRESSUF:E LINE LEAK ALARf"1 Q 2 :PLUS PLLD SHUTDO/¡,JN ALARr"J AUG 15. 2002 10:10 AM ""'~-. v ----- SENSOR ALARM L 5:PLUS FILL OTHER SENSORS FUEL ALAR!"1 AUG 15. 2002 10:10 AM \ \.../ PRESSURE LINE LEAK ALARr"l o 3: SURREr"lE PLLD SHUTDOl"JN ALARr"1 AUG 15. 2002 10: 11 AI'" _____ SENSOR ALARf'1 L 7: SUPREI"1E FILL OTHER SENSORS ~ FUEL ALARr"1 AUG 15. 2002 10:11 AM PRESSURE LINE LEMK ALARr", o 1: REGULAF: PLLD SHUTDOl,JN ALAR!"1 AUG 15. 2002 10:12 AM v _____ SENSOR ALARM L 2:REGULAR FILL O'1'HER SENSORS fLlEL ALAR!'" ..UG 15. 2002 10: 12 At'1 / PRESSURE LINE LEAK AWt'" (d 1: REGULAR PLLD SHUTDO~'JN ALAR!"' AUG 15. 2002 10:14 AM to. ----- SENSOR ALARM ----- L 3:REGULAR ANNULAR _ ANNULAR SPACE .., fUEL ALARr1 AUG 15. 2002 10:14 AM ~ ~---...... .I'~-- --------~ ----- -- --- PRESSURE LINE LEAK ALARM Q 2:PLUS PLLD SHUTrJi)WN ALAR!"l AUG 15. 2002 10:15 AM \....../ PRESSURE LINE LEAk ALARM Q 3 :SURRH'lE PLLD SHUTDOWN ALARr"1 AUG 15. 2002 10:15 AM __u_ SENS(iR ALARI'" -'-1- L 8:SUP PLUS ANNULAR ANNULAR SPACE FUEL ALARr"1 AUG 15. 2002 10:15 AM \ ¡ PRESSURE LINE LEAK ALAR!"! Q 2 :PLUS PLLD SHUTDOI,JN ALARr"¡ AUG 15. 2002 10:16 AM o PRESSURE LINE LEAK ALARr"l o 3 :::'=;URREr"lE PLLD SHUTDOl,JN ALAR!"1 j AUG 15..2002 10:16 At"1 o \ ___u SENSOR ALARr"l L 8:SUP PLUS ANNULAR ANNULAR SPACE FUEL ALAR!"1 AUG 15. 2002 10:16 AM VONS 21 00 ~,JH IrE LANE BAKERSFIELD CA. 661 -3%-[11 91 AUG 15, 2002 10:35 ~ S'lSTEf"1 :::TATUS REPORT ------ ALL FUNCTIONS NORMAL · CITY OF BA~SFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 Facility INSPECTION RECORD POST CARD AT JOB SITE Owner Address Address City, 'Zip --- City, Zip Phone No. Pennit # INSTRUCTIONS: Please call for an inspector only when each group of inspections with the same number are ready. They will run in consecutive order beginning with number I. DO NOT cover work for any numbered group until all items in that group are signed off by the Pennitting Authority. Following these instructions will reduce the number of required inspection visits and therefore prevent assessment of additional fees. TANKS AND BACKFILL Backfill ofTank(s) Spark Test Certification or Piping & Raceway w/Collection Sump f't Corrosion Protection of Piping, Joints, Fill Pipe Electrical Isolation of Piping From Tank(s) Dispenser Pan Cathodic Protection System-Piping Liner Installation - Tank(s) Liner Installation - Piping Vault With Product Compatible Sealer 11} Level Gauges or Sensors, Float Vent Valves ~,., ç. () L ~! Product Compatible Fill Box(es) g"lS"(]l. -I\. Product Line leak Detector(s) <t. ...., t;. t/l ~ i leak Detector(s) for Annual Space-D. W. Tank(s) 9S ... (Ç~ (\ 'I N I Monitoring Well(s)/Sump(s) - H20 Test ~ "'{Ç" ( 'l. ~ Leak Detection Device(s) forVadoselGroundwater t,,\s, at ~ Spill Prevention Boxes ~,,( S'" «) 1. ~ ~O FINAL Monitoring Wells, Caps & lOfks '8r\ç·C'l- W Fill Box Lock \ ~ "(5 .() '- ~ /I /..4 Monitoring Requirements Type ~,., IS"t3 '- .l-1 g ~ Authorization for Fuel Drop ~ßu -~95 'L. CONTRACTOR f\ ð-"T ð01.L~IVc..fc()~ ÒC-\ t--I ll-alL , LICENSE 1# 712J.{ qc{ CONTACT PHONE 1# ~ 1/13/01 \ ..' 'l~ I! ~- 16: 03' '8'661 326 0576 trJ BFD HAZ MAT DIV .~ -" termit No. @002 /,:. , ,- . 1:>1: - ù;L(-?J CITY OF BAKERSFIELD 74 ¡~qßl;~LflZ2 OFFICE OF ENVIRONMENTAL SERVICES J.. 1715 Chester A~e., Bakersfield, CA (661) 326-3979 Lftp PERMIT APPLICATION TO CONSTRUCTIMODIFY UNDERGROUND STORAGE TANK TYPE OF APPUCA nON (CHECK) Þ<]NEW FACILITY, [ ]MODlFlCATION OF FACILITY [JNEW TANK INSTALLATION AT EXISTING FACILITY STARTING DATE reS. DI/2.001.. PROPOSED COMPLETION DATE /'1MGH ~/1200-¿ FACILITY NAME ~~f\J':'t. c¿:t.)re:12.. EXISTING FACILITY PERMIT NO. FACILITY ADDRESS 2100 wHrÆ c..AtJe: CITY ðAK~F=.c..o ZIP CODE "':J'o/ TYPE-OF BUSINE$S ¡¿,e.1'AIl- GASOl..lNG. Sln£5 APN # 10S0/0!JIOcµ¡. TANK OWNER VotJs- A 5Af€WAý CO~f'AN>' PHONE NO. (,U..82.1.178/ ADDRESS 4>/8 MIC.HIWtJPA AlléN/Je ' CITY /lI2CA{)IA ZIP CODE 'f/()()7 CONTRACTOR D/IIJ CD/J5íRùcnDIJ,INe.. CA LICENSE NO. ADDRESS ~1-~O-A 6,ll.MolZ.é Ave-Nile CITY ØII"~S¡:'E.t..P ZrP CODE if1~ðß PHONE NO. (,(,1. e64. 1D23 BAKERSFIELD CITY BUSINESS UCENSE NO. CW ¡:'iLl: WORKMAN COMP NO. ()JJ F't.G INSURER oN FILG , BRlEFL Y DESCRIBE THE WORK TO BE DONE cOjJsr~rJc.r A r;~ K/~~}J~ ~vel- CeNrell. wrr;¡ FoUl!. McJLí/PL£ P¿oPVc.í P/sl'éAljas AN. WO U fl Ut)tJ. rp 5To/!./f6G "'AN~ WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO. OF TANKS TO BE INSTALLED 2. ARE THEY FOR MOTOR FUEL SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE Ý YES YES NO NO SECTION FOR MOTOR FUEL TANK NO. I 2.1# 1JJ V:JL:~ iLEADED ~ ono ~". uv' I ð (1I1¡J~ ,/ / I ,()ò() (sJl6t.) V REGULAR PREMIUM DIESEL AVIATION SECTION FOR NON MOTOR FUEL STORAGE TANKS TANK NO. VOLUME CHEMICAL STORED (NO BRAND NAME) CAS NO. (IF KNOWN) CHEMICAL PREVIOUSLY STORED I APPUCATION DATE , FOR OFFICIAL USE ONLY FACllJTY NO. NO. OF TANKS FEES $ I THE APPLICANT HAS RECEIVED, UNDERST ANDS, AND W ILL COMPLY WITH THE A IT ACHED CONDIT IONS OF THIS PERMIT AND ANY OT HER STATE, LOCAL AND FEDERAL REGULATIONS. OMP LETED UNDER PENALTY OF PERJURY, AND TO THE BEST 0 MY KN KÆL!& APPLI ANT NAME (PRINT) THIS APPLICATION BECOMES A PERMIT WHEN APPROVED >~~:f' eT · raVIS E· .- ngIneerIng 12453 Lewis Street, Suite #291 Garden Grove, California 92840 714/750-0991, (fax) 714/750-0990 ~; Transmittal To: Mr. Steve Underwood Fire Inspector/Petroleum Fire Department City of Bakersfield 1715 Chester Avenue, 3rd Floor Bakersfield, California 93301 Phone #: (661) 326-3979 Date: Proj. Name: Proj. #: Sent By: Total # Items: Fax Number: cc: 3-Jan-02 Vons - Bakersfield 02.061.004 KH 1 proj. file Distribution: D Regular Mail ŒJ UPS D Federal Express D DHL Type of Materials: D Contracts 0 Estimates ŒJ Plans 0 Proposal D Hand Delivery D Courier D Fax (# of pages including cover) o Other (Golden State Overnight) o Letter D Report o Memorandum D Specifications o Originals ŒJ Other Description: Copies Date Plan Sheet Description 1 1/3/02 Permit Application To ConstrucUModify Underground Storage Tank ......--..........·..·4-.....................-----··...··......·...·..·.............s·ëi...........................Í3I ueïiñ·ë....p¡¡ñi"sëis...õrtïië...ëõmpïëië....FÚëï..·s·ÿšiëïñ...ï"m·p·¡:õvëme·ñCPlañs......··............··... ::::::::::::::::::::::5:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::Ë:~~::::ªh:~:~~:::(~I;:~:ª:ª:::q:qI:::::::::::::::::::::=:~::::::::::::::::::::::::::::::::::::::::::::::::::::::::~::::::::::::::::::::::::::::::::::::::::::~=~:::~~:::::::::=:::::::::::::::::::::::::::::= .........."",,,"',,,,,,........,,,,,....,,.........................,,................................................".............................................................,,"'.......................................".................-.........."'........................................-..............................................................,......................................."..........._,,".......................-...............""...........""" ...."'.."""'....".............".................................,,......................................................................................................--.........................................".....................-........""..."................................-..........................................................."'...."..............."......".."...............................-......""........-....,...........""............".. ......,.............,.......................................................-...........................................................................................,,"...,"....................................."".......................-......."'."....................................""............................................................""""......................"..........".....,....-,..."-".".................-...............,,"........,,....... .."..'''.."......."......''''''......"........................--.........................................................................................."_................................................................-....''''',''.................................''"...."............................................,..."......,..,....,......,.......",.......,...............".......",,,..............................-...........'''''..,...........".... 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For: ŒJ Approval D Return o As Requested o Review o Distribution D Signature D Files D Your Use D Information D Other Remarks: Steve: '''pië'ãsë'''tiñ<i"ãiiãëï1ë<j''''ã'''ëõpy'''õf'the-''ã'p'pï'iëãiiõ·ñ·fõ·¡:ïñ·;..·ihë-fëë·..ëï1ë·ck..·ãñd..·tõU'¡:·(4j..·šëis....õfpiãñš-that...ã·¡:ë-·bëing......·...........··.........· ..šut,·ïñ'iÜëa·..iõ..·ÿõu..'fõï:..y·õ·u·¡:·..¡:ëviëw...·ã·ñ·a....ã·p·p¡õvãr-fï1ëšë-..p¡ã·ñï3...·ã·¡:ë·tõ¡..iïië..võ·ñ·š.....p¡:õjëëf..p¡:õ..po·šë...ë{ãì·2·1..ÖÕ..wiïitë....··..·......· ·Lã·ñ·ë:...·Ã·š...ÿõ'U....wii'ï..·¡:ë·ëãïï...t¡:õïñ..·õ·urcõñvë¡šãiiõ·ns·..iïië·së....p..iã·ñš...ãñ'd..ìïi·ë...·ã·ppï¡ê·ãt'iõñ..ãrë....ã·ïso....beiñ·g..·süi)ñi..¡Üed iñ..·.......·-...........· ..ã·ñ...·ëïfõ¡t·iõ·-öbiã'i'ñ...ã....ñ·ëw..·ã·ñ·a...·lipcfãfëd..·p·ë¡ïñit~·_..pfëãšë...ãëëëpi"ã·ñ'd....p¡õ·ëë·š·s..·iïi..ës·ë..·ñi·ãië¡iãiš..·ã·š..·¡ëq·ui¡èëf.....Th·ë·¡:ë....·.............. ..w'iïi"bë....Ñ'O..·ëh'ã·ñ·gë..iñ...ih'ë...ëõñi¡:ã·ëiõ·¡:·:...·piëã·se..ê·õ'ñtã'ëCïñë"'šhõuï,(j'''ÿ'õ'U'''hã"ë'''ãñÿ'''q'U'ësÜõ'ñš'''õ¡''whë·ñ..·tïi·ë·...përniiC.......-........·... :):~:::~~~ª:ÿ:::f9.:~:P.:!.ª:~·'Up:..·TB~:~~:~::::~~:~!.~::::!.?:~::y.~~:~::h:~:!:p.::::::::::::::::~:::::::::::::::::::::.::::::::::::~::::::::::::::::::::::::::::::::::::~:=:::::~::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::=:::::::::::::::::::::::::::::::: ~:g~~.._--- SENDER: COMPLETE THIS SECTION · qalete items 1, 2, and 3. Also complete i~ if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: JIM DOmED· DIRK POESCHEL LAND DEVELOPMENT SERVICES 2310 'fUÍ.ARE STREET SUITE 105 FRESNO CA 93721 2. Article Number (Copy (rom service /abeO 7000 0520 0021 9610 7974 3811, July 1999 Domestic Return Receipt + D. Is delivery address different from item 1 . If YES, enter delivery address below: 3. Service Type ~ Certified Mail o Registered o Insured Mail o Express Mail o Return Receipt for Merchandise o C.O.D. 4. Restricted Delivery? (Extra Fee) DYes 102595-99-M-1789 r 1--- First-Class Mail Postage & Fee.aid USPS' Permit No. G-1 UNITED STATES POSTAL SERVICE · Sender: Please print your name, address, and ZIP+4 in this box · 'I I I I I I I I I I J BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1115 Chester Avenue, Suite 300 Gakersiietd, CA 93301 . . - I J.I , .:r :1"- IT" l"- e ,...: ..D D"" I,..:¡ nJ e , e \e , ru LO Rec!p../ent's Name J!>1sass Print Clsarly) (To bil' compIÐtÐd,.ÞY mallsr) ~ I:J JIM DONABED " 'Postage $ .34 Certified Fee 2.10 PosImiuk" Retum Receipt Fee 1.50 Here (Endorsement Require<!) Restricted Delivery Fee ~~ .\ : (Endorsement Required) ..... ~ .; -. Total Postage & Fees $ 3.94 ...-.....-...................-.......;.............................................................................._...._.._........_..._.._.._..__....~---_..._......... g str~'1fbNTûíMx rTREET STE 105 ~ ëi,;mšia4ër··-93·72T-"-·-'·_·_-_·--·__·_~·---~·_······ I Certified MairProvides: · A mailing receipt · A unique identifier for your mail piece · A signature upon delivery · A record of delivery kept by the Postal Service for two years Important RemInders: · Certified Mail may ONLY be combined with First-Class Mail or Priority Mall. · Certified Mail is not available for any class of international mail. · NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider Insured or Registered Mail. · For an additional fee, a Return Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS Form 3811) to the article and add applicable postage to cover the fee. Endorse mailpieœ "Return Receipt Requested". To receive a fee waiver for a duplicate return receipt. a USPS postmark on your Certified Mail receipt is required. · For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement "Restricted Delivery". · If a postmark on the Certified M.,all reoeipfls desired, please present the artI- cle at the post office for postlflarking. If a postmark on the Certified Mail receipt is.eed,ad. detach and affix label' with postage and mail. IMPORTAN e Ihis receipt and present it when making an inquiry. PS Form 3800, Februarý"2000 (Reverse) 102595-00-M-1489 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "HO Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661)395-1349 SUPPRESSION SERVICES 2101 "W Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield. CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield. CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 . . ;jj\, ".;¡' " "c..' _ 7, '- ... September 6, 2001 Jim Donabed Dirk Poeschel Land Development Services Inc. 2310 Tulare Street Suite 105 Fresno Ca 93721 CERTIFIED MAIL RE: Unsupervised Dispensing at Vons Fueling Facility 2050 White Lane, Bakersfield Thank you for your rapid response to my inquiry regarding fueling operations at your proposed site. I am enclosing a copy of the Unifonn Fire Code and Bakersfield Municipal Code outlining the requirements for unsupervised dispensing. You will be required to have off site monitoring of your fuel monitoring system during the hours that the facility does not have an attendant onsite. I am also enclosing a copy of procedures which must be followed for unsupervised dispensing. Please be advised that prior to any final, you must demonstrate to this Office that your off site monitoring and procedures follow the code. If! can be of any further assistance, please feel rree to call me at 661-326- 3190. Sincerely, y:~~ 'Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dm enclosures cc: Jerry Hale, D&J Construction ""sP~ d~ c¡j~ ~p ./~60Pe .r~ A W~'I'I ~'\. <> \ e eermit No. :6T - 0 18~ CITY OF BAKERSFIELD 7)...' -tÞ 3~t.f~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 3.26-3979 PERMIT APPLICATION TO CONSTRUCTIMODIFY UNDERGROUND STORAGE TANK NrPE OF APPLICATION (CHECK) NEW FACILITY []MODIFICATION OF FACILITY []NEW TANK INSTALLATION AT EXISTING FACILITY STARTINGDATE~~IIO ðl PROPOSEDCOMPLETIONDATE ^hV 7-0 cJ( FACILITY NAME VOM~ ¡:::¿I¿¿" (~Œ""~ EXISTING FACILITY PERMIT NO. ,.- FACILITY ADDRESS 2Ð 5& Wf/frE hAI· CITY IbJet:4FP ZIP CODE ?,Æ;;i!.o I TYPE OF BUSINES~ .z2'~..4k H/?L... ~~s. APN # TANKOWNER to,.vs o:-~ c:;.~~~r·~ ('0. PHONENo(¿,æ~/'-S-~Oð ADDRESS I' MI(!¡-fIUINÞ;9- ~ CITY A¡!¿'A.o/t9 (~ ZIPcbDE /'7 CONTRACTOR I 'e)¡((~r: ,,~(!:. CA LICENSE NO. ADDRESS Ç'f;ze;:- ;2'¿:,.çr/J? ¡;;;: ~ r CITY ¡¿e:;t-7~ ZIP CODE 97;. ?C)f3 PHONE NO. 2; 9t:SJ ·-0700 BAKERSFIELD CITY BUSINESS LICENSE NO. oAf p..-/¿:= WORKMAN COMP NO. INSURER ~írrFE Fâ.I.J'::;::> BRIEFLYDESCRI ETHEW~TOBE ONE /Ar~P?¿¿' ~ ( ¿JJF ~;~ (,~/~ 1M??.! 5' /11yt?~ (Z U ':;9".(I¿¿~ - ~.k 1',;:2 )tJ ~. WATER TO FACILITY PROVIDED BY (k K/À-j~ ~(....../ C!c.-- DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE 'lZ?9.<:J@::1. NO. OF TANKS TO BE INSTALLED ~ ARE THEY FOR MOTOR FUEL ~ YES SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ---..¡ YES ¿-¿:¡:,~ NO NO SECTION FOR MOTOR FUEL TANK NO. VOLUME UNLEADED REGULAR PREMIUM DIESEL AVIATION SECTION FOR NON MOTOR FUEL STORAGE TANKS I t!- VOLUME CHEMICAL STORED "7 1/ (NO BRAND NAME) þO r-- J 'f!;:/7 ¿)C', /6/10 t:?¡?'-II-Ž ~1' CJe!- ,- I ðCr. CAS NO. (IF KNOWN) CHEMICAL PREVIOUSLY STORED TANK NO. FOR OFFICIAL USE ONt y I APPUCATION DATE 'FAClLlTY NO. ' 'NO. QFTANKS FEES $ >1 THE APPLICANT HAS RECEIVED, UNDERST ANDS, AND WILL COMPLY WITH THE ATTACHED CONDIT IONS OF THIS PERMIT AND ANY OT HER ST ATE, LOCAL AND FEDERAL REGULATIONS. P LETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS LJ~,-,o ç ¡)~ APPLICANT NAME (PRINT) TillS APPLICATION BECOMES A PERMIT WHEN APPROVED ;" .~ -,' \ - e - Permit No. ~- 0 rB; CITY OF BAKERSFIELD 7). '..tf-- ~~t-{4 OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 PERMIT APPLICATION TO CONSTRUCTIMODIFY UNDERGROUND STORAGE TANK ~ WATER TO FACILITY PROVIDED BY DEP1H TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO. OF TANKS TO BE INSTALLED.2. ARE THEY FOR MOTOR FUEL " ;( YES SPILL PREVENI10N CONTROL AND COUNfER MEASURES PLAN ON FILE X YES SECTION FOR MOTOR FUEL NO NO TANK NO. t 2. VOLQME UNLEAI)ED ,20, 000 e€~· . v/ ¡Ø;«JO /lj10 ¡/ . ¡Ç,ð()O I~ ,/ , REGULAR PREMIUM DIESEL AVIATION TANK NO. VOLUME SECTION FOR NON MOTOR FUEL STORAGE TANKS CHEMICAL STORED CAS NO. CHEMICAL PREVIOUSLY STORED (NO BRAND NAME) (IF KNOWN) FOR OFFICIAL USE ONLY TIlE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY Wl1H lHE ATIACHED CONDmONS OF THIS PERMIT AND,ANY OlHER STATE, LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO lHE BEST 0 TRUE AND CORRECT. ~ ¡:j¡£l- Æ,ý APPLICANT NAME (PRINT) E,IS THIS APPLICATION BECOMES A PERMIT WHEN APPROVED , - tit Permit No. ~- 0 IE; CITY OF BAKERSFIELD '"VJ i..¡,. ~J.{t-{4 OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (80S) 326-3979 PERMIT APPLICATION TO CONSTRUCTIMODIFY UNDERGROUND STORAGE TANK ~"Ol ~ WATER TO FACILITY PROVIDED BY DEP1H TO GROUND WATER son. TYPE EXPECTED AT SITE NO. OF TANKS TO BE INSTALLED;l. ARE TImY FOR MOTOR FUEL ",;( YES SPll.L PREVENTION CON1ROL AND COUNTER. MEASURES PLAN ON FILE X YES NO NO SECTION FOR MOTOR FUEL TANK NO. 1 2. VOLQME UNLEAOOD ;¡Oloooe£~. v/ /0;«)0 MIO vi' . /~C()o fAf./tI V" , REGULAR PREMIUM DIESEL AVIATION -- -- SECTION FOR NON MOTOR FUEL STORAGE TANKS TANK NO. VOLUME CHEMICAL STORED (NO BRAND NAME) CAS NO. CHEMICAL PREVIOUSLY STORED (IF KNOWN) FOR OFFICIAL USE ONLY TIlE APPLICANT HAS RECEIVED, UNDERSTANDS, AND wn.L COMPLY WITH TIlE ATTACHED CONDmONS OF THIS PERMIT AND ,ANY OTIŒR STATE, LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY. AND TO TIm BEST 0 TRUE AND CORRECT. ~ 1:Á£1.. ;i;ý APPUCANT NAME (PRINT) E,IS THIS APPLICATION BECOMES A PERMIT WHEN APPROVED v ~ Travis Engine.ng . A Division of Travis Companies. Inc. October 3, 2000 - Mr. Steve Underwood Fire Department City of Bakersfield 1715 Chester Avenue 3rd Floor Bakersfield, California 93301 RECE8VED Ocr 042000 ENVIRON. SERVICES RE:· PROPOSED VONS FUEL CENTER PROJECT, 2050 WHITE LANE, BAKERSFIELD, CA. Dear Steve: As a follow up to our conversation from Monday, please find attached the completed "A" and "Boo forms for the Vons fuel center proposed at 2050 White Lane. This fuel center project is proposed within the existing V ons shopping center located at 2100 White lane (White Lane @ Hughes). As we discussed, you requested a Form A for the entire fuel system and a Form B for each of the u/g tanks. Based on your instructions these forms have been completed and are attached for your processing. I have also attached a reduced copy of the fuel system improvement plans for your files. Please accept and process these materials as required. I thank you in advance for your assistance and cooperation in this matter. Please do not hesitate to contact me should you have any questions regarding this matter. KH:en Bakers fi e I dO 7 -I etter. doc 12453 Lewis Street. Suite 201 . Garden Grove. California 92840 . 714/750-0991 . (Fax) 714/750-0990 CITY OF BAKERSFIELJL _FlCE OF ENVIRONMENTA.ERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - UST FACILITY BUSINESS NAME (Same as FACILITY NAME or DBA - DoIng Business As) 'IONS Fuel- CéA1rel!.. ~Œ~RW;;~€ LAN£. (e ¡.It/GHB ~~NESS ¡g 1. GAS STATION 0 3. FARM 0 5. COMMERCIAL o 2. DISTRIBUTOR 0 4. PROCESSOR 0 6. OTHER 403. TOTAL NUMBER OF TANKS Is facility on Indian Reservation or ·If owner dUST a public agency: name of supervisor of REt.MINING tySITE trustiands? division. section or office which operates the UST. N;'If 404. 0 Yes 405. (ThIs Is the contact person for the tank records.) o 3. RENEWAL PERMIT o 4. AMENDED PERMIT o 5. CHANGE OF INFORt.MTION (Specify change - local use only) o 6. TEMPORARY SITE CLOSURE Page _ of _ o 7 . PERMANENTLY CLOSED SITE o 8. TANK REMOVED 400. TYPE OF ACTION ""'/1. NEW SITE PERMIT (Check one Item only) ¡q FACILITY OWNER TYPE ,S"1. CORPORATION o 2. INDIVIDUAL o 3. PARTNERSHIP o 4. LOCAL AGENCYIDISTRICr- o 5. COUNTY AGENCY· o 6. STATE AGENCY" o 7. FEDERAL AGENCY· 402. '\'\: n.PRØpËRttºWN~R !Nï=þR"'~1'IØt4:' 409. CA- 410. STATE CA 411. ZIP CODE 412. pt 1. CORPORATION o 2. INDIVIDUAL o 3. PARTNERSHIP o 4. LOCAL AGENCY I DISTRICT o 5. COUNTY AGENCY C¡00/7 o 6. STATE AGENCY o 7. FEDERAL AGENCY 413 i . i ! 'OWNËR'I"NFORMAUO" ""«__''- .h _,u.n.: ::-"''',:1':::::''',''.-; ""...,--,:;.......-. '"' ""i:"""'''; 416. TANK OWNER NAME 'IONS" If 5lJfe.wtrý COM?/ttJ MAIUNj 8 SM7ZHR~:1 rJPA A veJJv~ CITY ft/ZOrtJ/A TANK OWNER TYPE 417. STATE 418. ZIP CODE CA qool1 419. I 156 1. CORPORATION o 2. INDIVIDUAL o 3. PARTNERSHIP o 4. LOCAL AGENCY I DISTRICT o 5. COUNTY AGENCY o 6. STATE AGENCY o 7. FEDERAL AGENCY 420. :,,:,~,~g~ijq,êiF,Ê,RH~~,*JJ9~::ý!f:iiªM~~;f~~:~ÇÇ9,Y~l~ij,ij~~ ' Call (916) 322-9669 if questions arise , "::p~IiÄ~~u""º$f'f:I~~ÇiÂb::R~$", o 7. STATE FUND o 8. STATE FUND & CFO LETTER o 9. STATE FUND & CD 'V¡.:LE~Ak:ijº'¡"~içÁTIºt-4~~~M.o.í[INq~~~~~$S"J o 2. PROPERTY OWNER 421. o 10. LOCAL GOV'T MECHANISM o 99. OTHER: 422. o 3. TANK OWNER 423. DATE 424. OGT: 02.{)O . TITLE OF APPLICANT /ltJíllolZ/Ze PHONE 71- .~o.~/ &,éJJr 425. 426. 4ZT. STATE UST FACILITY NUMBER (For local use only) 428. 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 429. UPCF (7/99) S:\CUPAFORMS\swrcb-a.wpd e e Complete the UST - Facility page for all new permits, permit changes or any facility information changes. This page must be submitted within 30 days of permit or facility information changes, unless approval is required before making any changes. Submit one UST - Facility page per facility, regardless of the number of tanks located at the site. This form is completed by either the permit applicant or the local agency underground tank inspector. As part of the application, the tank owner must submit a scaled facility plot plan to the local agency showing the location ofthe USTs with respect to buildings and landmarks [23 CCR 32711. (a)(8)J, a description of the tank and piping leak detection monitoring program [23 CCR 32711 (a)(9)J. and, for tanks containing p~troleum, documentation showing compliance with state financial responsibility requirements [23 CCR 32711 (a)(11 )J. . Refer to 23 CCR 32711 for state UST information and permit application requirements. (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.) . , ., Please number all pages of your submittal. This helps your CUPA or local agency identify whether the'submittal is complete'ánd ¡fany' pages are separated. ' ,. . .". '" . , .' 1. FACILITY 10 NUMBER - Leave this blank. This number is assigned' by the CUPA.. ·T.his is t/:Ie ulÍiqu$'! numDëf~/1iè!:l:íc!ent(fiès your facility. ' 3. BUSINESS NAME - Enter the full legal name of the business. 400. TYPE OF ACTION - Check the reason the page is being completed. CHECK ONE ITEM ONLY. 401. NEAREST CROSS STREET. - Enter the name of the cross street nearest to the site of the tank. 402. FACILITY OWNER TYPE.: Check the type of business ownership. 403, BUSINESS TYPE - Check the type of business. 404. TOTAL NUMBER OF TANKS REMAINING AT SITE -Indicate the number of tanks remaining on the site after the requested action. 405. INDIAN OR T.RUST LAND - Check whether or not the facility is located on an Indian reservati,on ,or oth~r ~ru~t lanp~.. " 406. PUBLIC- AGENCY' SUPERVISOR NAME - If the facility owner is a public agency, enter. the nam'e of tne;superVisor for the division,', . . section or office which operates the UST. This person must have access to the tar;lk.records. 407. PROPERTY OWNER NAME - Complete items 407- 412 fortlie'property oWner.':unless.åltitems.are·:·. . 408. PROPERTY OWNER PHONE the same as the Owner Information (items 111-116) on the Business . 409. PROPERTY. OWNER MAILING OR'STREET ADDRESS Owner/Operator Identification page (OES Form 27,30). If th~ sal11e, 410. PROPERTY OWNER CITY write "SAME AS SITE" in this section. 411. PROPERTY OWNER STATE 412, PROPERTY OWNER ZIP CODE 413. PROPERTY OWNER TYPE - Check the type of property ownership. 414. TANK OWNER NAME - Complete items 414- 419 for the tank owner.. unless all items are the 415. TANK OWNER pHONE same as the Owner Information (items 111-116) on the Business 416. TANK OWNER MAILING OR STREET ADDRESS Owner/Operator Identification·þag~(O!:S Form 2730),:,.If the'. same, . 417. TANK OWNER CITY write "SAME AS SITE" in this sectio,n. 418. TANK OWNER STATE . '.~ : ' .' ;;.. ." 419. TANK OWNER ZIP CODE 420. TANK OWNE~ TY.PE - Check the. type of tank ownership. .'. ...' ,: .:\ 421. BOE NUMBER - Enter your Board of Equalization (BOE) UST storage fee account number. This fee applies to regulatedUSTs ". storing petroleum products. This is required before your permit application can be processed. If you do not have an account number with the BOE or if you have any questions regarding the fee or exemptions, please call the BOE at (916) 322-9669 or write to the BOE at: Board of Equalization, Fuel Taxes Division, P.O. Box 942879, Sacramento, CA 94279-0030. 422. PETROLEUM UST FINANCIAL RESPONSIBILITY CODE - Check the methodes) used by the owner and/or operator in meeting the Federal and State financial responsibility requirements. CHECK ALL THAT APPLY. If the method is not listed, check Aother: and enter the methodes). USTs owned by any Federal or State agency and non-petroleum USTs are exempt from this requirement. 423. LEGAL NOTIFICATION AND MAILING ADDRESS -Indicate the address to which legal notifications and mailings should be sent. The legal notifications and mailings will be sent to the tank owner unless the facility (box 1) or the pró.p~rty owner (box 2) is checked. SIGNATURE OF APPLICANT - The business owner/operator of the tank facility, or officially designated representative of the owner/operator, shall sign in the space provided. This signature certifies that the signer believes that all the information submitted is accurate and complete. 424. DATE CERTIFIED - Enter the date that the page was signed. 425. APPLICANT PHONE - Enter the phone number of the applicant (person certifying). 426. APPLICANT NAME - Enter the full printed name of the person signing the page. 427. APPLICANT TITLE - Enter the title of the person signing the page. 428. STATE UST FACILITY NUMBER - Leave this blank. This number is assigned by the CUPA as follows: the number is composed of the two digit county number, the three digit jurisdiction number, and a six digit facility number. The facility number must be.the same as shown in item 1, 429. 1998'UPGRÂÒE CERTIFICATE NUMBER ~ Leave this blank. This number is assigned by the CUPA. ..,., , . ":., t "', . '1," .,:."', :.... '.. " . .' ... . '.' ," . r_... . . . 1\ . CITY OF BAKERSFIELD 'fAîùK # J OFaE OF ENVIRONMENTAL SeVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS· TANK PAGE 1 TYPE OF ACTION (Check one it8m only) ~. NEW SITE PERMIT 0 4. AMENDED PERMIT o 3. RENEWAL PERMIT o 5. CHANGE OF INFORMATION) Page of o 6. TEMPORARY SITE CLOSURE o 7. PERMANENTLY CLOSED ON SITE o 8. TANK REMOVED 430 (Specify reason· for /oc81 use only) BUSINESS NAME (Same as FACILITY NAME or DBA . Doing Business As) 3 VpA/S Fu€.L. c.eJr~¡¿ LOCATION WITHIN SITE (Optional) (Specify change· for local use only) TANK 10 # 14: I DATE INSTALLED (YEARIMO) Ú NOI/ ZCXjO /kol'oSGp ADDmONAL DESCRIPTION (For /oc81 use only) 35 't T ANK:[)ESCRIf»TIQN TANK CAPACITY IN GALLONS ó1 0, 000 . TANK USE 439 )'i!{ 1. MOTOR VEHICLE FUEL (" marked, complete PetlO/eum Type) o 2. NON-FUEL PETROLEUM o 3. CHEMICAL PRODUCT o 4. HAZARDOUS WASTE (Includes Used aD) o 95. UNKNOWN PETROLEUM TYPE N1a. REGULAR UNLEADED o 1b. PREMIUM UNLEADED o 1c. MIDGRADE UNLEADED o 2. LEADED o 3. DIESEL o 4. GASOHOL COMMON NAME (hom HazslÙous Materials InventDry pege) ~ 434 ! 436 NUMBER OF COMPARTMENTS ONé 437 438 o 5. JET FUEL o 6. AVIATION FUEL o 99. OTHER 441 CAS # (ftom Hazatdous Mater/s1s InvenlDry page) 442 ..--- TYPE OF TANK 443 (Check one it8m only) TANK MATERIAL· primary tank (Check one it8m only) o 1. SINGLE WALL 1i! 2. DOUBLE WALL o 1. BARE STEEL o 2. STAI~LESS STEEL TANK MATERIAL - secondary tank 0 1. BARE STEEL (Check one it8m only) 0 2. STAINLESS STEEL o 1. MANUFACTURED CATHODIC PROTECTION , 0 2. SACRIFICIAL ANODE YEAR INSTALLED 450 TYPE (For local use only) ø 1. SPILL CONTAINMENT )/411 ex;' . ø 2. DROP TUBE Alðtl Of)' ¡Jot Oð' TANK INTERIOR LINING OR COATING (Check one it8m only) SPILL AND OVERFILL (Check al/ll1al apply) o 1. RUBBER LINED o 2. AlKYD LINING o 3. SINGLE WALL WITH EXTERIOR MEMBRANE LINER 04. SINGLE WALL IN A VAULT o 3. FIBERGLASS I PLASTIC þ( 4. STEEL CLAD WIFIBERGLASS REINFORCED PLASTIC FRP o 3. FIBERGLASS I PLASTIC pi' 4. STEEL CLAD WIFIBERGLASS REINFORCED PLASTIC (FRP) o 5. CONCRETE o 3. EPOXY LINING o 4. PHENOLIC LINING 3. FIBERGLASS REINFORCED PLASTIC o 4. IMPRESSED CURRENT o 5. SINGLE WALL WITH INTERNAL BLADDER SVSTEM 095. UNKNOWN 099. OTHER o 5. CONCRETE 095. UNKNOWN o 8. FRP COMPATIBLE W/100% METHANOL 099. OTHER 444 o 8. FRP COMPATIBLE W/100% METHANOL o 9. FRP NON-CORRODIBLE JACKET 010. COATED STEEL o 95. UNKNOWN 099. OTHER 445 o 5. GLASS LINING o 6. UNLINED IX 95. UNKNOWN 099. OTHER 447 i I ¡ I 446 DATE INSTALLED 448 095. UNKNOWN 099. OTHER (For /oc81 use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 i ø 1. AL.ARM¡Jð,¡ 00 ø 3. FILL TUBESHUTO~FVALVE N6Û tb ø 2. BALl FLOAT NdV IJO 0 4. EXEMPT ! IF SINGLE WALL TANK (Check aI/that apply): o 1, VISUAL (EXPOSED PORTION ONLY) o 2. AUTOMATIC TANK GAUGING (ATG) o 3. CONTINUOUS ATG \ o 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + BIENNIAL TANK TESTING -.,.. "'''''', -".:' '" '.,."., ...-..... ',,':'-' ..-.'.",-.', ,. ·.,"t", ,'":,,,.' ... ,... -..".--............". ,::·',,-/;.::'.::;;·;,.;':;i ....,",..,..'::.::,..;:::,..,'J. ESTIMATED DATE LAST USED (YRIMOIDAY) .......-..".." ',,,..... .......::: ':....,.",..". ...........'.........',., ...................". . UPCF (7/99) ,,,.,,,,,.,:, o 5. MANUAL TANK GAUGING (MTG) 06. VADOSE ZONE 07. GROUNDWATER o 8. TANK TESTING o 99. OTHER '''''''''., , ':y.TAN~ç4~lJ~1~FO'~~!Jº~rPf:R~~~:t¢~øs9~f:ltlP~~E::'T, '., ...... . . 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one it8m only): o 1. VISUAL (SINGlE WALL IN VAULT ONLY) Þ§ 2. CONTINUOUS INTERSTITIAL MONITORING CK 3. MANUAL MONITORING 457 aallons oVes DNa S:\CUPAFORMS\SWRCB-B.WPD 1.\ ;. - t \. ~ e UST - Tank Page 1 . ~ < Complete the UST - Tank pages for each tank for all new permits, permit changes, closures and/or any other tank information change. This page must be submitted within 30 days of permit or facility information changes, unless approval is required before making any chan!~es. For compartmentalized tanks, each compartment is considered a separate tank and requires completion of separate tank pages. '...~4 ,,"', Refer to 23 CCR 32711 for state UST information and permit application requirements. (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary. ) ... : :- ~-~)' ~ '.~ ;:....~.. ~ . . .,...... ~~..~\.".,~ Please number all pages of your submittal. This helps your CUPA or local agency identify whether the submittal is complete and if any pages are separated. " , 1. ,FACILITY 10 NUMBER - Leave this blank. This number is assigned by the CUPA. This is the unique number which identifies / . . your . ~. ~~cility. 3. BUSINESS NAME - Enter the full legal name of the business~ '.'.' ,. . ..... ... : 430. TYPE OF AÇTlpN - Check the reason the page is being completed. For amended permits and change of information, indude a short " statement to direct the inspector to the amendment or changed'information. ' ,... 431. .LOCATION\ÑmiIN~SITE-Enterthelocationofthetankwithinthesite.· . . ., 0'.: .' 432. TANK 10 NUMBER - Enter the owner=s tank 10 number. This is a unique number used to identify the tank. It may be assigned by the owner or by the CUPA. 433. TANK MANUFACTURER - Enter the name of the éomþany that manufactured thetànk. 434. COMPARTMENTALIZED TANK - Check whether or not the tank is compartmentalized. Each compartment is considered a separate tank and requires the completion of separate tank pages. 435. DATE TANK INSTALLED - Enter the year and month the tank was installed. 436. TANK CAPACITY - Enter the tank capacity in gallons. 437. NUMBER OF TANK COMPARTMENTS - If the tank is compartmentalized, enter the number of compartments. 438. ADDITIONAL DESCRIPTION - Use this space for additional tank or location description. 439. TANK USE - Check the substance stored. If MOTOR VEHICLE FUEL, check box 1 and complete item 440, PETROLEUM TYPE. 440. PETROLEUM·TYPE - If box 1 is checked in item 439, check the type of fuel. 441. COMMON NAME - For substances that are not motor vehicle fuels (box 1 is NOT checked in item 439), enter the common name of the substance stored in the tank. 442. CAS # - For substances that are not motor vehide fuels (box 1 is NOT checked in item 439), enter the CAS (Chemical Abstract Service) number. This is the same as the CAS # in item 209 on the Hazardous Materials Inventory - Chemical Description page. 443. TYPE OF TANK - Check the type of tank construction. If type of tank is not listed, check Aotheræ and enter type. '. 444. TANK MATERIAL (PRIMARY TANK) - Check the construction material of the tank that comes into immediate contact órì its inner surface with the hazardous substance being contained. If the tank is lined do not reference the lining material in this item. Indicate the type of lining material in item 446. If type of tank material is not listed, check Aothe~ and enter material. 445. TANK MATERIAL (SECONDARY TANK) - Check the construction material of the tank,th~t provides the level of containment extemal to, and separate from, the primary containment. If type of tank material is not listed, check Aotheræ and enter material. 446. TANK INTERIOR LINING OR COATING - If applicable, check the construction material of the interior lining or coating of the tank. If type of interior lining or coating is not listed, check Aotheræ and enter type. : 447. DATE TANK INTERIOR LINING INSTALLED - If applicable, enter the date the tank interior lining was installed. This is to assist the CUPA to develop an inspection schedule. 448. OTHER TANK CORROSION PROT,ECTION - If applicable, check the other tank corrosion protection method used. If other corrosion protection method is not listed, check Aotheræ and enter method. 449. DATE TANK CORROSION PROTECTION INSTALLED -If applicable, enter the date the tank corrosion protection method was installed. This is to assist the CUPA to develop an inspection schedule. . 450. YEAR SPILL AND OVERFILL INSTALLED - Check the appropriate box and enter the yêar in which spill containment, drop tube, and/or striker plate was installed. CHECK ALL THAT APPLY. 451. TYPE OF SPILL PROTECTION - Enter the type of spill containment, drop tube, and/or striker plate. FOR CUPA USE ONLY. 452. YEAR OVERFILL PROTECTION. EQUIPMENT INSTALLED - Check the appropriate box and enter the year in which overfill protection .' ". was installed or whåthår there is an exemption from overfill protection. CHECI~ ALL THAT APPLY, unless tank is exempt . 453. TANK LEAK DETECTION (SIN~LE WALL) - For single walled tanks, check the leak detection.system(s) used to comply with the monitoring req'uirenÍents for the tank. CHECK ALL THAT APPLY. If leak ~e~ecti.ón system is not listed, check Aotheræ and enter system. " . . 454. TANK LEAK DETECTION (DOUBLE WALL) - For double walled tanks or tanks with bladder, check the leak detection system(s) used to comply with the monitoring requirements fòr the tank. CHECK ONE ITEM ONLY. 455. ESTIMATED DATE LAST USED - For dosure in place, enter the date the tank was last used. 456. ESTIMATED QUANTITY OF SUBSTANCE REMAINING IN TANK - For dosure in place, enter the estimated quantity of hazardous substance remaining in the tank (in gallons). 457. TANK FILLED WITH INÈRT MATERIAL - For closure in place, check whether or not the tank was filled with an inert material prior to closure. '. . . . AlTACHMENTS- 1. Provide a scaled plot plan with the location of the UST system, induding buildings and landmarks. 2. Provide a description of the monitoring program. 4 " . CITY OF BAKERSFIELD . OFFICE OF ENVIRONMENTAL SERVICES_ 15 Chester Ave., Bakersfield, CA 93301 (661) 3~79 .. UST . TANK PAGE 2 UNDERGROUND PIPING SYSTEM TYPE eg 1. PR~SSURE 0 2. SUCTION CONSTRUCTION/ 0 1. SINGLE WALL 0 3. LINED TRENCH MANUFACTURER ~ 2. DOUBLE WALL 0 95. UNKNOWN MANUFACTURER éíJvlltUJr~1 o 1. BARE STEEL .06. FRP COMPATIBLE WI 100% METHANOL MATERIALS AND 0 2. STAINLESS STEEL 0 7. GALVANIZED STEEL CORROSION PROTECTION 0 3. PLASTIC COMPATIBLE WITH CONTENTS 095. UNKNOWN o 4. FIBERGLASS ø 8. FLEXIBLE (HOPE) 0 99. OTHER o 5. STEEL WI COATING 0 9. CATHODIC PROTECTION 464 ;;,Vii~t, UNDERGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check aU 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 ¢ 3. ANNUAL INTEGRITY TEST (0.1 GPH) o 3. GRAVITY 458 o 99. OTHER 460 ABOVEGROUND PIPING o 1. PRESSURE o 1. SINGLE WALL o 2. DOUBLE WALL MANUFACTURER o 1. BARE STEEL o 2. STAINLESS STEEL o 3. PLASTIC COMPATIBLE WITH CONTENTS o 4. FIBERGLASS o 5. STEEL WI COATING o 3. GRAVITY 459, 462 o 2. SUCTION o 95. UNKNOWN o 99. OTHER 463 o 6. FRP COMPATIBLE WI 100% METHANOL o 7. GALVANIZED STEEL o 8. FLEXIBLE (HOPE) 0 99. OTHER o 9. CATHODIC PROTECTION o 95. UNKNOWN 465 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 PRESSURIZED PIPING (Check all that apply): -- 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) - ø: 8. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ~ b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION o c. NO AUTO PUMP SHUT OFF ~ 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR RESTRICTION - ~ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check aU that apply) o 14. CONTINUOUS SUMP SENSOR~ 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. DAILY VISUAL CHECK ABOVEGROUND PIPING SINGLE WALL PIPING PRESSURIZED PIPING (Check a/l that apply): o 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST ~ AUTO PUMP SHUT OFF. SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL A o 2. MONTHLY 0.2 GPH TEST o 3. ANNUAL INTEGRITY TEST (0.1 GPH) o 4. DAILY VISUAL CHECK 467 CONVENTIONAL SUCTION SYSTEMS (Check all that apply): o 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTE o 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIP o 7. SELF MONITORING GRAVITY FLOW (Check an that apply): o 8. DAILY VISUAL MONITORING o 9. BIENNIAL INTEGRITY TEST (0.1 GPH) 10. CONTINUOUS TURBINE SUMP SEN R WITH AUDIBLE AND VISUAL AlARMS AND (check one) o 8. AUTO PUMP SHUT OFF N A LEAK OCCURS o b. AUTO PUMP SHUT OFF R LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION o c. NO AUTO PUMP SH OFF o 11. AUTOMATICLEAKDETE o 12. ANNUAL INTEGRITY SENSOR + AUDIBLE AND VISUAL AlARMS EMERGENCY GENERATORS ONLY (Check an that applý) o 14. CONTINUO S SUMP SENSOR~ AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS o 15. AUTO TIC LINE LEAK DETECTOR (3.0 GPH TEST) DISPENSER CONTAINMENT 468 o 16. ANNUAL INTEGRITY TEST (0.1 GPH) o 17. DAILY VISUAL CHECK AJðvSTõóD g 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE o 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL AlARMS ~ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OfF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS o 4. DAILY VISUAL CHECK Œ! 5. TRENCH LINER I MONITORING o 6. NONE 469 Perml! Number (For Ioesl usa only) 473 Panni! Approved (For Ioesl usa only) UPCF (7/99) DATE lb· 3·0() 471 TITLE OF OWNERIOPERATOR Urlfo¿¡Z£[J Æ68J-r 470 472 474 Pennlt ExplraUon Date (Forloesl usa only) 475 S:\CUPAFORMS\SWRCB-B.WPD - UST - Tank Page 2 . , ··â (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.) .', " ~ ! Please number all pages of your submittal. This helps your CUPA or local agency identify whether the submittal is complete and if any pages are separated.. \.... . ". .. ~ " . , 458. PIPING SYSTEM TYPE (UNDERGROUND) - For items 458 and 459, check the tank=s piping system 459. PIPING SYSTEM TYPE (ABOVEGROUND) information. CHECK ALL THAT APPLY. 460. PIPING CONSTRUCTION (UNDERGROUND) - Check the tank=s piping construction information. CHECK ALL THAT APPLY. 461. PIPING MANUFACTURER (UNDERGROUND) - Enter the name of the piping manufacturer. 462. PIPING CONSTRUCTION (ABOVEGROUND) - Check the tank=s piping construction information. CHECK ALL THAT APPLY. . - -~'. 463. PIPING MANUFACTURER (ABOVEGROUND) - Enter the name of the piping manufacturer. 464. PIPING MATERIAL AND CORROSION PROTECTION (UNDERGROUND) - For items 464 and 465, check the 465. PIPING MATERIAL AND CORROSION PROTECTION (ABOVEGROUND) tank=s piping material and corrosion protection. 466. PIPING LEAK DETECTION (UNDERGROUND) - For items 466 and 467, check the leak detection system(s) used 467. PIPING LEAK DETECTION (ABOVEGROUND) to comply with the monitoring requirements for the piping. 468. DATE DISPENSER CONTAINMENT INSTALLED - If applicable, enter the date that dispenser containment was installed. 469. DISPENSER CONTAINMENT TYPE ~-Check-thë týpe of dispenser containmènt monitoring system. SIGNATURE OF OWNER/OPERATOR - The owner or agent of the owner shall sign in the space provided. This signature certifies that the signer believes that all the information submitted is true and accurate. 470. DATE CERTIFIED - Enter the date the page was signed. 471. OWNER/ OPERATOR NAME - Print the name of signatory. 472. OWNER/ OPERATOR TITLE - Enter the title of the person signing the page. 473. PERMIT NUMBER - Leave this blank, this number is assigned by the CUPA. 474. PERMIT APPROVED BY - Leave this blank, this is the name of the person approving the permit. 475. PERMIT EXPIRATION DATE - Leave this blank, this is completed by the CUPA. . j.". . . . I' . .~ )".... ... . >. 11 - --- CITY OF BAKERSFIELD lfiAJKfF2/C0I1f/Ai!.TftlGuT (Ð OFe:E OF ENVIRONMENTAL se.VICES #- / . ~.' . 1715 Chester'Ave., Bakersfield, CA 93301 (661) 326-3979 ~\$" UNDERGROUND STORAGE TANKS . TANK PAGE 1 TYPE OF ACTION (Check one item only) þÍ,. NEW SITE PERMIT D 4. AMENDED PERMIT D 3. RENEWAL PERMIT D 5. CHANGE OF INFORMATION) Page of D 6. TEMPORARY SITE CLOSURE D 7. PERMANENTLY CLOSED ON SITE D 8. TANK REMOVED 430 - ON:> rù G"L I LOCATION WITHIN SITE (OptJonel) I BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) , 3 ce:tJíEJ2. (Specify chenge - for local USfl only) (Specify _$On - for local USfI only) .. .....- , . . ,. TANK USE 439 JiI. 1. MOTOR VEHICLE FUEL (ff marl<ed, complete Petroleum Type) D 2. NON-FUEL PETROLEUM D 3. CHEMICAL PRODUCT D 4. HAZARDOUS WASTE (Includes Used OD) D 95. UNKNOWN I TYPE OF TANK (Check one item only) TANK MATERIAL - primary tank (Check one item only) .... ...... .....-... . -'..- p" ..--- ... . .,..,..,.....;,.,:--.'.'.. ,..-.----..,.::...., ':":-:":"::õ:-:::'~' '-', _,~:¡i,'.<':~':?=.::: ..... ... >I"TANK DESCRIPTION' ..... .. ···"<;¡;II;',T~KCÓN'l'ENTS·········'· PETROLEUM TYPE ~la. REGULAR UNLEADED D 1 b. PREMIUM UNLEADED D Ie. MIDGRADE UNLEADED D 2. LEADED D 3. DIESEL D 4. GASOHOL COMMON NAME (from Hazardous Matetla/s InllØntDry page) ~ D 1. SINGLE WALl Ji!f 2. DOUBLE WALL D 1. BARE STEEL D 2. STAINLESS STEEL TANK MATERIAL - secondary tank D 1. BARE STEEL (Check one item only) D 2. STAINLESS STEEL TANK INTERIOR LINING OR COATING (Check one item only) SPILL AND OVERFILL (Check all that apply) D 1. MANUFACTURED CATHODIC JK 3. FIBERGLASS REINFORCED PlASTIC PROTECTION D 4. IMPRESSED CURRENT D 2. SACRIFICIAL ANODE YEAR INSTAlLED 450 TYPE (Forlocsl use only) 451 f,2!f 1. SPILL CONTAINMENT tJð~ OÖ og 2. DROP TUBE NO~ (;t) ~ 3. STRIKER PLATE NO" (j) D 1. RUBBER LINED o 2. ALKYD LINING o 3. SINGLE WALL WITH EXTERIOR MEMBRANE LINER D 4. SINGLE WALL IN A VAULT D 3. FIBERGLASS / PLASTIC ø 4. STEEL CLAD WIABERGLASS REINFORCED PlASTIC D 3. ABERGLASS / PLASTIC ø 4. STEEL CLAD WIABERGLASS REINFORCED PlASTIC (FRP) o 5. CONCRETE o 3. EPOXY LINING o 4. PHENOLIC LINING 431 433 COMPARTMENTALIZED TANK Yes It "Ves", complete one page for each compartment. NUMBEROFCOMPARTM~ fWD 437 ï4 ðòò) 436 438 'P'-' , ,. . .... ---. .. .. ,.-, -.-.. ...... ........ ·n·....""· . .. 440 D 5. JET FUEL D 6. AVIATION FUEL o 99. OTHER 441 CAS # (from HaZJJtrious MatetIaJs Inventory page) ,,--- 442 D 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM D 95. UNKNOWN o 99. OTHER o 5. CONCRETE D 95. UNKNOWN D 8. FRP COMPATIBLE W/I00% METHANOL D 99. OTHER 443 444 o 8. FRP COMPATIBLE W/I00% METHANOL o 9. FRP NON-CORRODIBLE JACKET o 10. COATED STEEL 095. UNKNOWN o 99. OTHER 445 D 5. GLASS LINING o 6. UNLINED P(95. UNKNOWN D 99. OTHER DATE INSTAlLED 447 446 449 D 95. UNKNOWN D 99. OTHER 446 (For local use only) OVERFILL PROTECTION EQUIPMENT: YEAR INSTAlLED 452 ç& ,. ALARM rJÒV ðo p( 3. FILL TUBE SHUT OFF VALVE /lAW'to rj. 2. BALL FLOAT tJ~V 00 D 4. EXEMPT 0" D 2. D 3. D 4. IF SINGLE WALl.. TANK (Check sH that apply): VISUAL (EXPOSED PORTION ONLY) AUTOMATIC TANK GAUGING (ATG) \ CONTINUOUS ATG STATISTICAL INVENTORY RECONCILIATION (SIR) + BIENNIAL TANK TESTING o 5. MANUAL TANK GAUGING (MTG) D 6. VADOSE ZONE 07. GROUNDWATER D 8. TANK TESTING D 99. OTHER TANK CLOSURE INFORMATlONJ PEIWANENT. CLOSURE INP~CE .... " ~.. IF DOUBLE WALl TANK OR TANK WITH BLADDER (Check one item only): 454 D 1. VISUAL(SINGLEWALLINVAULTONLY) ~ 2. CONTINUOUS INTERSTITIAL MONITORING oø 3. MANUAL MONITORING 456 TANK FILLED WITH INERT MATERIAL? 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING Dyes ESTIMATED DATE LAST USED (YRIMOIDAY) UPCF (7/99) aallons DNa S:\CUPAFORMS\SWRCB-B.WPD e t e .,~ j :1 -, ., CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES e15 Chester Ave., Bakersfield, CA93301 (661) 3.9 1. , UST . TANK PAGE 2 Page of . ~~,~:~~" ^'._~~CTI~.:(~~~~~Ji~1?~~~~~;:;~~~~~&}~1~~f#~5~~::·;~-í.~;;~~~~·¿~~'~;>1~1i:~~~.;~~~~;~}~1~~'~ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE I if 1. PRESSURE 0 2. SUCTION 0 3. GRAVITY 458 0 1. PRESSURE 0 2. SUCTION CONSTRUCTION/O 1. SINGLE WALL 03. LINED TRENCH 099. OTHER 460 01. SINGLE WALL 095. UNKNOWN MANUFACTURER ~ 2. DOUBLE WALL 095. UNKNOWN 0 2. DOUBLE WALL 099. OTHER MANUFACTURER ~N \J 12. öl\}f L.Ð<. 461 MANUFACTURER 463 o 1. BARE STEEL .08. FRPCOMPATlBLEW/100%MET1iANOL 01. BARE STEEL 06. FRP COMPATIBLE WI 100% METHANOL MATERIALS AND 0 2. STAINLESS STEEL 07. GALVANIZED STEEL 02. STAINLESS STEEL 07. GALVANIZED STEEL CORROSION PROTECTION 0 3. PLASTIC COMPATIBLE WITH CONTENTS 0 95. UNKNOWN 0 3. PLASTIC COMPATIBLE WITH CONTENTS 0 8. FLEXIBLE (HOPE) 0 99. OTHER o 4. FIBERGLASS 'p( 8. FLEXIBLE (HOPE) 099. OTHER 0 4. FIBERGlASS 0 9. CATHODIC PROTECTION o 5. STEEL WI COATING 0 9. CATHODIC PROTECTION 464 0 5.. STEEL WI COATING 095. UNKNOWN 465: ~~~~~~iýltEftf~r'~ ~~~çjJ~l~~~íti#t áPPiA.~~ft!ÄH5~~Ji~;~~\~i~f;t~2};~~¡çl}!~}t_:~~;}~~~;(:!:~:Z~~iN?~~iw~~i!rf~>~{~~!k~i~~~d':' UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING PRESSURIZED PIPING (Check aU that apply): PRESSURIZED PIPING (CheCk aU that apply): 18' 1. ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST:!ill!:! AUTO PUMP SHUT OFF FOR 0 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAl AlARMS ALARMS 0 2. MONTHLY 0.2 GPH TEST o 2. MONTHLY 0.2 GPH TEST 0 3. ANNUAl INTEGRITY TEST (0.1 GPH) t'2!I 3. ANNUAl INTEGRITY TEST (0.1 GPH) 0 4. DAILY VISUAl CHECK \, 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 PRESSURIZED PIPING (CheCk a/l that apply): ! 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL AlARMS AND (Check one) - ¡ 0 a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS " 0 b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION I 0 c. NO AUTO PUMP SHUT OFF )XI 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR I RESTRICTION - (i 12. ANNUAl INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check a8 that apply) o 14. CONTINUOUS SUMP SENSOR~ AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL AlARMS o 1 5. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION o 16. ANNUAL INTEGRITY TEST (0.1 GPH) o 17. DAILY VISUAL CHECK o 3. GRAVITY 459 462, 467 : GRAVITY FLOW (Check aU that apply): o 8. DAILY VISUAL MONITORING o 9. BIENNIAL INTEGRITY TEST (0.1 GPH) CONVENTIONAl SUCTION SYSTEMS (Check aU that 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 MONITORING SECONDARILY CONT PRESSURIZED PIPING (Check a/l that apply): 10. CONTINUOUS TURBINE SUMP SENSOR AUDIBLE AND VISUAL AlARMS AND (check one) o 8. AUTO PUMP SHUT OFF WHEN A OCCURS I o b. AUTO PUMP SHUT OFF FOR S. SYSTEM FAILURE AND SYSTEM DISCONNECTION o c. NO AUTO PUMP SHUT OFF. o 11. AUTOMATlCLEAKDETECTO o 12. ANNUAl INTEGRITY TEST .1 GPH) SUCTION/GRAVITY SYSTEM: o 13. CONTINUOUS SU SENSOR + AUDIBLE AND VISUAL AlARMS ERGENCY GENERATORS ONLY (Check a/l that apply) o 14. CONTINUO SUMP SENSOR ~ AUTO PUMP SHUT OFF + AUDIBLE AND VISUAl ALARMS o 15. AUTO TIC LINE LEAK DETECTOR (3.0 GPH TEST) DISPENSER CONTAINMENT o 16. ANNUALlNTEGRITYTEST(0.1 GPH) o 17. DAILY VISUAL CHECK jJ1\J5TAW ., 'IS 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE o 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS ~ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS IX,OWNERlOPERATOR SIGNATURE o 4. DAILY VISUAL CHECK þf-.5. TRENCH LINER I MONITORING o 6. NONE 469 466 Permit Number (For local USð only) 473 Permit Approved (For IocaJ USð only) UPCF (7/99) DATE 470 471 I d· '3. tJÒ TITLE OF ~ilId.ëïž5¿;? /t6GU¡ 472 474 Pennit Explrauon Date (For local USð only) 475 S:\CUPAFORMS\SWRCB-B.WPD e ~, ~ e v r ~ ( ¿ CITY OF BAKERSFIELD 1I/¡JKtft/CðJl4fJJJt.rH6JT e OF.E OF ENVIRONMENTAL SeVICES tI-;!. 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 · f!;. UNDERGROUND STORAGE TANKS-TANK PAGE 1 TYPE OF ACTION (Check one item only) ~1. NEW SITE PERMIT 0 4. AMENDED PERMIT o 3. RENEWAL PERMIT 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 cheng/l - for local use only) (Specify reason - for local use only) 'kTANKI)ESCRIPTION' .",......... .... . ,............."..:.. TAHðPffljER W6uJ¡N6 TANK CAPACITY IN GALLONS ) ~() OòQ (")P!.IT 10 òòt) f¡f) DOt) TANK USE 439 J!! 1. MOTOR VEHICLE FUEL (ff marked, complete PetlOleum Type) o 2. NON-FUEL PETROLEUM o 3. CHEMICAL PRODUCT o 4. HAZARDOUS WASTE (Includes Used OD) 095. UNKNOWN PETROLEUM TYPE ø 18. REGULAR UNLEADED o 1b. PREMIUM UNLEADED o 1c. MIDGRADE UNLEADED o 2. LEADED o 3. DIESEL o 4. GASOHOL COMMON NAME (ftom Hszstdous Materials InvenlDry page) ~ TYPE OF TANK 443 (Check one item only) TANK MATERIAl- pr1mary lank (Check one item only) o 1. SINGLE WALL ~ 2. DOUBLE WALL o 1. BARE STEEL o 2. STAINLESS STEEL TANK MA TERIAl- secondary lank 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 thaI apply) o 1. RUBBER LINED o 2. ALKYD LINING o 3. SINGLE WALL WITH EXTERIOR MEMBRANE LINER 04. SINGLE WALL IN A VAULT o 3. FIBERGLASS I PLAST1C C1( 4. STEEL CLAD WIABERGLASS REINFORCED PLASTIC FRP o 3. FIBERGLASS I PLAST1C ¡;r 4. STEEL CLAD WIABERGLASS REINFORCED PLASTIC (FRP) o 5. CONCRETE o 3. EPOXY LINING o 4. PHENOLIC LINING ~ 3. FIBERGLASS REINFORCED PLASTIC o 4. IMPRESSED CURRENT o 1. MANUFACTURED CATHODIC PROTECTION o 2. SACRIFICIAl ANODE YEAR INS~D 450 TYPE (For local US8 only) ø 1. SPILL CONTAINMENT N6V Oò X 2. DROP TUBE ~ O!I 3. STRIKER PLATE NO V (J.::, 436 COMPARTMENTALIZED TANK Yes 0 No If -Ves", complete one page for each compal1menl. NUMBER OF COMPARTMENTS 437 ! I ¡ Twò 438 o 5. JET FUEL o 6. AVIATION FUEL 099. OTHER ~I 441 CAS # (ftom Hazstdous Materials InvenlDry page) 442 ---- o 5. SINGLE WALL WITH INTERNAl BLADDER SYSTEM 095. UNKNOWN o 99. OTHER o 5. CONCRETE 095. UNKNOWN o 8. FRP COMPATIBLE W/100% METHANOL 099. OTHER 444 o 8. FRP COMPATIBLE W/100% METHANOL o 9. FRP NON-CORRODIBLE JACKET o 10. COATED STEEL 095. UNKNOWN o 99. OTHER 445 , ! o 5. GLASS LINING o 6. UNLINED Ið 95. UNKNOWN 099. OTHER 446 DATE INSTALLED 447 095. UNKNOWN o 99. OTHER For local use 0 DATE INSTALLED 449 448 (For local use only) 451 OVERFILL PROTECTION1EQUIPMENT: YEAR INSTALLED I IA,I 452 ~ 1. ALARM ~ ~ 3. FILL TUBESHUTOFFVALVE~ r::¡..2. BALL FLOAT ~ 0 4. EXEMPT 01, 02. 03. 04. IF SINGLE WALL TANK (Check an thaI apply): VISUAL (EXPOSED PORTION ONLY) AUTOMATIC TANK GAUGING (ATG) \ CONTINUOUS ATG STATISTICAl INVENTORY RECONCILIATION (SIR) + BIENNIAL TANK TESTING o 5. MANUAL TANK GAUGING (MTG) o 6. VADOSE ZONE 07. GROUNDWATER o 8. TANK TESTING o 99. OTHER ;'LY'V.fANK'CLÓSlJR~I"FpijNi~!Iº~lPJ~:~~~t:ÇLOSIJ~E'f04.PµCE·¡'.. ." ',- , -,.. - -.... .-........'..... """.' ............. .... ..---. - ..... ..,.."....-,.,..',,, .,',"..""',:,':','''."-,, ......q...........,........... :"i," ;. .;: ,J:;;: ~ ESTIMATED DATE LAST USED (YRIMOIDAY) .'.. "',,,,. UPCF (7/99) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): 454 o 1. VISUAL (SINGLE WALL IN VAULT ONLY) .Pt 2. CONTINUOUS INTERSTITIAl MONITORING r¡ 3. MANUAL MONITORING 456 TANK FILLED WITH INERT MATERIAL? 457 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING DYes callons DNa S:\CUPAFORMS\SWRCB-B.WPD " J. . UST - Tank Page 1 . -. '1 - Complete the UST - Tank pages for each tank for all new permits, permit changes, closures and/or any other tank information change. This page must be submitted within 30 days of permit or facility information changes, unless approval is required before making any changl~s. For compartmentalized tanks, each compartment is considered a separate tank and requires completion of separate tank pages. .~ . I" {I' Refer to 23 CCR 32711 for state UST information and permit application requirements. (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or local agency identify whether the submittal is complete and if any pages are separated. 1. FACILITY ID NUMBER - Leave this blank. This number is assigned by the CUPA. This is the unique number which identifies your f~cility. 3. BUSINESS NAME - Enter the full legal name of the business. ' 430. TYPE OF ACTION - Check the reason the page is being completed. For amended permits and change of infôrmation, include a short statement to direct the inspector to the amendment or changed information. 431. LOCATION WITHIN SITE - Enter the location of the tank within the site. " . 432. TANK 10 NUMBER - Enter the owner=s tank 10 number. This is a unique number used to identify the tank. It may be assigned by the owner or by the CUPA. 433. TANK MANUFACTURER - Enter the name of the company that manufactured the tank. 434. COMPARTMENTALIZED TANK - Check whether or not the tank is compartmentalized. Each compartment is considered a separate tank and requires the completion of separate tank pages. 435. DATE TANK INSTALLED - Enter the year and month the tank was installed. 436. TANK CAPACITY - Enter the tank capacity in gallons. 437. NUMBER OF TANK COMPARTMENTS - If the tank is compartmentalized, enter the number of compartments. 438. ADDITIONAL DESCRIPTION - Use this space for additional tank or location description. 439. TANK USE - Check the substance stored. If MOTOR VEHICLE FUEL, check box 1 and complete item 440, PETROLEUM TYPE. 440. PETROLEUM TYPE - If box 1 is checked in item 439, check the type of fuel. 441. COMMON NAME - For substances that are not motor vehicle fuels (box 1 is NOT checked in item 439), enter the common name of the substance stored in the tank. 442. CAS # - For substances that are not motor vehicle fuels (box 1 is NOT checked in item 439). enter the CAS (Chemical Abstract Service) number. This is the same as the CAS # in item 209 on the Hazardous Materials Inventory - Chemical Description page. 443. TYPE OF TANK - Check the type of tank construction. If type of tank is not listed, check Aother:: and enter type. 444. TANK MATERIAL (PRIMARY TANK) - Check the construction material of the tank that comes into immediate contact on its inner surface with the hazardous substance being contained. If the tank is lined do not reference the lining material in this item. Indicate the type of lining material in item 446. If type of tank material is not listed, check Aother:: and enter material. 445. TANK MATERIAL (SECONDARY TANK) - Check the construction material of the tank that provides the level of containment extemal to, and separate from, the primary containment. If type of tank material is not listed, check Aother:: and enter material. 446. TANK INTERIOR LINING OR COATING - If applicable, check the construction material of the interior lining or coating of the tank. If type of interior lining or coating is not listed, check Aother:: and enter type. 447. DATE TANK INTERIOR LINING INSTALLED -If applicable. enter the date the tank interior lining was installed. This is to assist the CUPA to develop an inspection schedule. 448. OTHER TANK CORROSION PROTECTION - If applicable, check the other tank corrosion protection method used. If other corrosion protection method is not listed, check Aother:: and enter method. 449. DATE TANK CORROSION PROTECTION INSTALLED -If applicable, enter the date the tank corrosion protection method was installed. This is to assist the CUPA to develop an inspection schedule. 450. YEAR SPILL AND OVERFILL INSTALLED - Check the appropriate box and enter the year in which spill containment, drop tube. and/or striker plate was installed. CHECK ALL THAT APPLY. 451. TYPE OF SPILL PROTECTION - Enter the type of spill containment, drop tube, and/or striker plate. FOR CUPA USE ONLY. 452. YEAR OVERFILL PROTECTION EQUIPMENT INSTALLED - Check the appropriate box and enter the year in which overfill protection was installed or whether there is an exemption from overfill protection. CHECK ALL THAT APPLY, unless tank is exempt. 453. TANK LEAK DETECTION (SINGLE WALL) - For single walled tanks, check the leak detection system(s) used to comply with the monitoring requirements for the tank. CHECK ALL THAT APPLY. If leak detectiqn system is not listed, check Aother:: and enter system. 454. TANK LEAK DETECTION (DOUBLE WALL) - For double walled tanks or tanks with bladder, check the leak detection system(s) used to comply with the monitoring requirements for the tank. CHECK ONE ITEM ONLY. 455. ESTIMATED DATE LAST USED - For closure in place, enter the date the tank was last used. 456. ESTIMATED QUANTITY OF SUBSTANCE REMAINING IN TANK - For closure in place, enter the estimated quantity of hazardous substance remaining in the tank (in gallons). 457 . TANK FILLED WITH INÈRT MATERIAL - For closure in place, check whether or not the tank was filled with an inert material prior to closure. ATTACHMENTS - 1. Provide a scaled plot plan with the location of the UST system, including buildings and landmarks. 2. Provide a description of the monitoring program. f- CITY OF BAKERSFIELD _ OFFICE OF ENVIRONMENTAL SERVICES. _15 Chester Ave., Bakersfield, CA 93301 (661) 3 9 UST. TANK PAGE 2 Page of ",~, ~,~myçjli!!::{~)tt~~!~jif!~~rJ~~~~~~ij~}~1~?'.;~~~~~!~~t ~:tf~~~~,~~?-:~~?~:!;}j:;¿~î~l~;~~~~a~-~·· ABOVEGROUND PIPING UNDERGROUND PIPING SYSTEM TYPE G'J 1. PRESSURE 0 2. SUCTION CONSTRUCTION/ 0 1. SINGLE WALL 0 3. LINED TRENCH I MANUFACTURER 12' 2. DOUBLE WALL J:: Q 95. UtlKNOWN I MANUFACTURER rjJ'JllloNrt.£'" 461 I 0 1. BARE STEEL . 0 6. FRP COMPATIBLE WI 100% METHANOL MATERIALS AND 0 2. STAINLESS STEEL 07. GALVANIZED STEEL CORROSION PROTECTION 0 3. PLASTIC COMPATIBLE WITH CONTENTS 095. UNKNOWN o 4. FIBERGLASS ~ 8. FLEXIBLE (HOPE) 0 99. OTHER 05. STEEL WI COATING 09. CATHODIC PROTECTION o 3. GRAVITY 458 o 99. OTHER 460 UNDERGROUND PIPING I SINGLE WALL PIPING 466 I ~SURIZED PIPING (Check aU that apply): I pg. 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST !£ill!:! AUTO PUMP SHUT OFF FOR I LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS o 2. MONTHLYO.2GPHTEST . -- .. - -. . II/8f 3. ANNUAl INTEGRITY TEST (0.1 GPH) ¡ I , 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. BIENNIALlNTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all 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 ~ 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR RESTRICTION - ¡;'1( 12. ANNUAl INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL AlARMS EMERGENCY GENERATORS ONLY (Check an that apply) o 14. CONTINUOUS SUMP SENSOR!£!!!!:!Q!!! 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. ANNUALlNTEGRITY TEST (0.1 GPH) o 17. DAILY VISUAL CHECK o 2. SUCTION o 95. UNKNOWN o 99. OTHER o 3. GRAVITY 459, 462 o 1. PRESSURE o 1. SINGLE WALL o 2. DOUBLE WALL MANUFACTURER o 1. BARE STEEL o 2. STAINLESS STEEL o 3. PLASTIC COMPATIBLE WITH CONTENTS o 4. FIBERGLASS o 5. _ STEEL WI COATING 463 o 6. FRP COMPATIBLE WI 100% METHANOL I o 7. GALVANIZED STEEL ' o 8. FLEXIBLE (HOPE) 0 99. OTHER o 9. CATHODIC PROTECTION 095. UNKNOWN ABOVEGROUND PIPING : SINGLE WALL PIPING 4671 PRESSURIZED PIPING (Check aU that apply): I o 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST !£ill!:! AUTO PUMP STOFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND V Al 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 aU that apply): o 5. DAILY VISUAL MONITORING OF PIPING AND PUMA o 8. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW o 7. SELF MONITORING UNO PIPING): GRAVITY FLOW (Check all that apply): o 8. DAILY VISUAL MONITORING o 9. BIENNIAL INTEGRITY TEST (0.1 SEC NDARlL Y CONTAINED PIPING PRESSURIZED PIPING (Check all th apply): MP SENSOR !£ill!:! AUDIBLE AND VISUAL ALARMS AND (check one) o a. AUTO PUMP SH OFF WHEN A LEAK OCCURS o b. AUTO PUMP S UT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION o c. NO AUTO P SHUT OFF o 11. AUTOMATIC DETECTOR 012. ANNUAlINTE ITYTEST(O.1 GPH) SUCTION/GRAVITY STEM: o 13. CONTINU S SUMP SENSOR + AUDIBLE AND VISUAL ALARMS .~ EMERGENCY GENERATORS ONLY (CheCk all that apply' o 14. CONTINUOUS SUMP SENSOR:£ill!:JQ!!! AUTO PUMP SHUT OFF + AUDIBLE AND VISUAl ALARMS o 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) o 16. ANNUAl INTEGRITY TEST (0.1 GPH) o 17. DAILY VISUAL CHECK D~oJNS~ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE o 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS J;ì!!I 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAl ALARMS .·,:.':.-,o,¡;;;.;':,,:<.¡:';::¡:!".;::':"'.¡--.· :;:::;i;:¡;i:[¡i~':~.~IY,O~~~!~·~i.~~~RÉ Permit Number (For local use only) UPCF (7/99) 470 471 472 474 Permit ExplraUon Date (For local use only) 475 S:\CUPAFORMS\SWRCB-B.WPD . UST - Tank Page 2 . .{ . ,.. ". " . . ç,," (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.) f. Z. Please number all pages of your submittal. This helps your CUPA or local agency identify whether the submittal is complete and if any pages are separated. 458. PIPING SYSTEM TYPE (UNDERGROUND) - For items 458 and 459, check the tank=s piping system 459. PIPING SYSTEM TYPE (ABOVEGROUND) information. CHECK ALL THAT APPLY. 460. PIPING CONSTRUCTION (UNDERGROUND) - Check the tank=s piping construction information. CHECK ALL THAT APPLY. 461. PIPING MANUFACTURER (UNDERGROUND) - Enter the name of the piping manufacturer. 462. PIPING CONSTRUCTION (ABOVEGROUND) - Check the tank=s piping construction information. CHECK ALL THAT APPL Y. 463. PIPING MANUFACTURER (ABOVEGROUND) - Enter the name of the piping manufacturer. 464. PIPING MATERIAL AND CORROSION PROTECTION (UNDERGROUND) - For items 464 and 465, check the 465. PIPING MATERIAL AND CORROSION PROTECTION (ABOVEGROUND) tank=s piping material and corrosion protection. 466. PIPING LEAK DETECTION (UNDERGROUND) - For items 466 and 467, check the leak detection system(s) used 467. PIPING LEAK DETECTION (ABOVEGROUND) to comply with the monitoring requirements for the piping. 468. DATE DISPENSER CONTAINMENT INSTALLED -If applicable, enter the date that dispenser containment was installed. 469. DISPËNSER cONtAINMENT TYPE'" ChecK the' type of dispenser containment mOriitoring system.-· u_. _ . .. _. SIGNATURE OF OWNER/OPERATOR - The owner or agent of the owner shall sign in the space provided. This signature certifies that the signer believes that all the information submitted is true and accurate. 470. DATE CERTIFIED - Enter the date the page was signed. .. 471. OWNER/ OPERATOR NAME - Print the name of signatory. 472. OWNER! OPERATOR TITLE - Enter the title of the person signing the page. 473. PERMIT NUMBER - Leave this blank, this number is assigned by the CUPA. 474. PERMIT APPROVED BY - Leave this blank, this is the name of the person approving the permit. 475. PERMIT EXPIRATION DATE - Leave this blank, this is completed by the CUPA.