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Home My WebLink AboutUST REPORT 9/2003 · CITY OF BAKERSFIE.: '()FFICE OF ENVIRONlVlENT ~SERYICÉS 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 ~ UNDERGROUND STORAGE TANKS - UST FACILITY TYPE OF ACTION (Check one 11em only) ~1. NEW SITE PERMIT o 3, RENEWAL PERMIT o 4, AMENDED PERMIT o 5, CHANGE OF INFORMATION (Specify change· local use only) o 6, TEMPORARY SITE CLOSURE Page _ of _ o 1 PERMANENTLY CLOSED SITE o 8. TANK REMOVED 400. BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) I, FACILITY I SITE INFORMATION 3 FACILITY 10 1# 401, FACILITY OWNER TYPE o 1. CORPORATION ~ 2. INDIVIDUAL tJ 3. PARTNERSHIP o 4, LOCAL AGENCYIDISTRICT' o 5. COUNTY AGENCV- o 6. STATE AGENCY' o 7, FEDERAL AGENCV- 402, - L GAS STATION o 2, DISTRIBUTOR TOTAL NUMBER OF TANKS REMAINING AT SITE ( 404. o 3, FARM 0 5. COMMERCIAL o 4. PROCESSOR 0 6, OTHER 403, DYes ,,0 No 405. II, PROPERTY OWNER INFORMATION 'If owner 01 UST a public agency: name 01 supervisor of division. section or offlœ which oøerates the UST. (This is the cantacl person for the lank records.) Is facility on Indian Reservation or trusIIands? 406. 407, 3 .~..3 t" 5ßg, 7L/<f""'" 408, Ave....., 409, CITY 410, STATE éJt 41 L ZIP CODE 412, '] 31 1 "ijš 2, INDIVIDUAl o 3, PARTNERSHIP o 4, lOCAl AGENCY I DISTRICT o 5. COUNTY AGENCY o 6, STATE AGENCY o 7. FEDERAl AGENCY 413. III, TANK OWNER INFORMATION TANK OWNER NAME 414. PHONE 415, MAILING 0 STREET ADDRESS 416, o 1. CORPORATION o 2, INDIVIDUAl o 3, PARTNERSHIP 417, I STATE o 4, LOCAl AGENCY I DISTRICT o 5, COUNTY AGENCY 418, I ZIP CODE 419, CITY TANK OWNER TYPE o 6, STATE AGENCY o 7, FEDERAl AGENCY 420, TY(TK)HQ IV, BOARD OF. EQUALlZATlON.UST STORAGE FEE ACCO~NI.NUMBER Call (916) 322-9669 if questions arise V. PETROLEUM LIST FINANCIAL RESPONSIBILITY>:· 421, INDICATE METHOD(S) o 1. SElF·INSURED o 2. GUARANTEE o 3. INSURANCE o 4, SURETY BOND o 5, LETTER OF CREDIT o 6, EXEMPTION o 7, STATE FUND o 8. STATE FUND & CFO LETTER 09, STATE FUND & 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 owner unless box 1 or 2 is checked. o 1, FACiliTY o 2. PROPERTY OWNER o 3, TANK OWNER 423. VII, APPLICANT SIGNATURE Certification: I cer1ify that the information provided herein is true and accurate to the best 01 my knowfedge. SIGNATURE OF APPliCANT DATE 424, I PHONE 425. NAME OF APPliCANT (print) 428. TITLE OF APPliCANT 427. ( or local use only) 428. 429. UPCF (7/99) S:\CUPAFORMS\swrcb-a,wpd t1t . . ,. ".. r ..,. Â.. ...... -. --- .-' _ CITY OF BAKERSFIELD OIlPlCE OF ENVIRONMENTAL~RVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS· TANK PAGE 1 (! a J. At!NEWA4. PERMIT I~ _ ' IfN /oeM ".. 0lIIy) 8USINESS ~ (Same. 'AClLlTY NAME at 08A. 0aIn9 "*- All J P-ve ot o S, TEMPORARV SITE CLOSURE a 7. PERMANEHTI. v ClOSeO ON SITe o 8, T ANI( REMOvEO rYp@ OF .4CTI()H ~ t, HEW SITI! Pl!I'tMIT a 4, ~O PERMIT 0 " CMAHGI! OF INFORMA TlOH) , C¡'.CI ~... '/em OIIi'I} ~ln~\ TANK I . (I\~\l{ /....1'1.. (1'fN 1DeaI_ Ody) ~1~U ~ IA- q-:SJor I, TANK DESCRIPTION 433 COMPARTMENTAlIZEO TANK Vel a No " 'V.'. CXllllplete one ø-ve'or eIIdI axnøartmenc. 4. Nt) 4: 43i .. TANK COtt'JÐIft i TANK use 431 : bl., MOTOR VÐ4ICU! FUa. : 1i ";'tItMJ, ~ PMaMuIt 7)pe} i 0 2. NOH-FUEJ. PETROlEUM i 0 J. CHEMICAL PAOOUCT ! 0 4, HAZNUJOUS WASTe (1ndudN ¡ UMI 01) ¡ 0 95. UNlOiOWN TYPe Of' TANK ! I (CItedt 0lIl AIm odyJ I i P!TROU!UM TYPE o 1L REGULAR UM.EACED 0 2. U!AŒO 'Ø-,I1. PREMIUM UN..EADEO 0 J. DIESEL o Ie. ...:IGAAœ UN.EAOEO 0 .. GASOHOL CO...oN I'Wo4I! /!him HløldlulMI....ltMntlKy ¡»ge) o t, SINCU WALL ~2. DOUBU! WALL : TANK MATeRIAL . øm-y link "¢J. 1. BARE STeEL. ! (CltedtonettemOdyJ 02. STAINlESS STEEL i , TANK MATERIAL· -*Y link 0 1. BAR!! srea (Cltedt one ,.", odyJ 0 2. STAINLESS STEEL TANK INTERIOR l.-.G OR COATING (Cltedt one ttem Ody SPILL ANO OVERFIlL , i (CJleclI II INt oppIy i I ¡-- o t, RUeIER LN!D o 2. AIJM) LINWCJ I!STIMA TlO OA TI WT UIIO (VRIMOIOAV) o 1. a.w«JFACTUA!D CATHODIC PROTECT1ON o 2. SACRIFICIAL ANOOE YEAR IHSTAU£O 450 TYPE (~/OQI 11M onIy D-1. SPIlL CONTAINMENT <:)C 0 ~ C3-1. OROPTUIII! ~l1C)':J ß-1: STRII<I!A PlAn! Q nt'l 3 :: f·,~·:t:f, . ~~t{~j:..::f~ r ',;:,;~~:Q~~'~:~ r~;~'~}': ;;~~ :'f~( LBAK ., SlNOLI WALL TANK (CIIecIt" INt 1I/tIIY): o t. VISUAI.(IXPOIeOPOfmONONLV) a 2. AUTOMATIC TANK CIAUGIHO (ATO) o J. COHT1N1JOUt ATO o 4, Sf A TlSTICAL IN\/IHTOAV RECONCIlIATION (SIR) · lJ,eNHw, TANK TBaTINQ UPCF (7199) [J s. MANUAL TANK QAUQINQ (Mfa) [J .. VACOSE ZONe [J 7. GROUNDWATER [J .. TANK TESTING [J 8IJ, OnleA y, TAN( CLOIUU IN'ORMATION I PIRIIANINT CLOIURIIN PLACI UTlMATIO QUAHTITY Of' SUI8TAHCI RIMAINNI ... TANK'ILLIO WITH INeRT MATeRIAL? ... 4<- o 5. JET FUB. EJ .. AVIATION FUEL o 99. OniER ...., CAS' (frrJtn ~ MlIMII:s 1nvent:Ny ~ ~: .. TANK CONSTRUCTION o 3. SINGLE WALL WITH EXTERIOR MBØWE LINER a ... SINOU! WALLIN A VAUlT . a J. F18EROLASSI ~ o ... STEEL Q.AD WIFIBERGtASS REINFORCED ~ (FRP) [J J. Fl8EROlASSI ~ ø:.. STEEL Q.AD WJFI8ERGI.ASS REINFORCED P\ASTIC (FRP) [J 5. CONCRETE o 3. EPOXY UNNJ [J ... PHEHOUC JJNNJ o 5. SINGLE WALL WITH INTERNAL BlADOER SYSTEM o 115. UNCNCWotf o SIll. ontER [J 5. CONCAETE [J 95. UNKNOWN [J .. FRP COIo4PATI8LE WI100% METHANOL 099. OTtER 444 4(3 o .. FRP COIoPATI8LE WI100% METHANOL o II, FRP NC)N.C()M()OØ.e JACKET o 10. COATED STEEL o 95. UNtcNOWN a 118, ontER 445 o So GlASS UNJNCJ 'S".. UMJHED 448 DATE INSTALLED ~7 0115. ~ o SIll. OTHER /oQI- DATE INSTALLED ~9 3. FIIEROlASS REIHf'()ftŒO PlASTIC [J .. ø.tPRESSEO CURRfNT D 115, UNI<NOWN D SIll, OniER 448 (For /oeM use Ody 451 OVERFIlL PROTECTION EQUIPMENT: YEAR INSTAllED 452 a 1. AlARM ~ILLTUBESHlITOFFVA4.~()3 o 2. BAU.FLOAT a .. exEMPT :.~(Jl$~~~i~;:·~~i.;:~~··.~·!:.· '.". ::::.." ..... ;~?~~·~'r.~~;;·:.·" .;:: . Y .:.:,:.....:::~:::;;t~~ 413 II' DOUllLI WALL TANK OR TANK WITH ILADOIR (CltedtOlll""'ødYJ: 4$4 a " VISUAL (SINOI.a WALL IN VAULTONLV) [J 2. CONTIHUOUS/HTERSTITIAL MONITORING o J, MANUAL MONITORING - 467 IIIIaIII [Jy. aNo - S;\CUPAFORMS\SWRC&-8, '//PC ,'t¡. / c a CITY OF BAKERSFIELD . _ O"lel! 0' ENVIRONMENTAL SERVICE~ 1115 Chnter Ave., Bake,.".ld. CA 93301 (ee1) ~119 VI. ..... CONSTRUCTION (CII«*" tltet ~ UNCEROROUNO PlPINO I SYSTEM TYPE 'tá- I. PRESSURE 0 2, SUCTION 0 ], GAAVlTY 451 I 0 I. PRESSURE I CONSTRUCTION!'O 1. SINGl.e WAl.l. 0 ], l.INED TRENCH 0.. OTHER 480' 0 I, SINGl.E WALL MANUFACTURER~2. OOUBl.E WAl.l. 095. UNKNOWN 0 2. DOUBLE WALl. i MANUFACTURER 461 MANUFACTURER ,0 " BARE STEEl. 0 e. FRP COMPATI8Le WlIOQ1I, METHANOl. 0" BARE STEEL : MA TERIAl.S ANO '0 2. STAiNlESS STEEL 0 7, GALVAHIZEO STEEL 0 2. STAINLESS STEEL I CORROSION : , PROTECTION : 0 ]. PlASTIC COMPATI8LE WITH CONTeNTS 0 M. UNtcNOWN 0]. PlASTIC COMPATIBLE WITH CONTENTS ~ 4. FIBERGLASS 0 e. FLSXI8l.E (HOPE) D.. OTHER 0 4. FIBERGlASS o 5, STEEl. WI COA TINO 0 i, CATHOCIC PAOTECTION 4ð4 0 5, STEEl. WI COA TlNO W. PPING LEAK DETECTION (CII«*"1Mt ~ '..;.i>'Ao'!~ o 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE o 2. cyNl'lNUOUS DISPENSER PAN SENSOR . AUOI8U! AND VISUAL AlARMS ~ CONTINUOUS DISPENSER PAN SENSOR mIt1 AUTO SHUT OFF FOR DISPENSeR · AUDIBLE AND VISUAL ALARMS IX. OWNI!RIOPERA TOR SIONA TORE . to !lie bell d my knowIecIge. PRESSURIZED PlPlNO (Ch«k " /llet 1t/IIIIy): o I, ELECTRONIC UNE LEAK DETECTOR 3.0 GPH TEST mI!1 AUTO PUlP SHUT OFF FOR LEAK. SYSTEM FAILURe. AND SYSTEM OISCOHNECTION · AUCIIII.2 AND VISUAl. ALARMS o 2. MOHTHL Y G.2 GPH TEST o 3. AHNUAI.INTEGAfTY TEST (0.1 GPH) CONVENTIONAl SUCTION SYSTEMS: o 5. DAILY VISUAl. MONrrORlNG OF PUMPING SYSTEM . TRIÐØAL PIPING INTEGRITY TEST (0,1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): o 7, SELF MOHfTORJNO GRAVITY FLOW: o 9, BIENNIAL INTEGRITY TEST (0.1 GPH) I secONDARILY CONTAINED PIPINQ PRESSURIZED PIPING (Check "lNt ~ I 10, CONTlMJOUS TURBINE SUMP SENSOR mItt AUOI8l.E AND VISUAL AlARMS AND : (Chedt !lie) . ! 0 a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o þ, AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAIUJR£ AND SYSTEM DISCONNECTION o c. NO AUTO PUMP SHUT OFF 11, AUTOMATIC LINE LEAK DeTECTOR (3.0 GPH TEST) XtI!11 F1.OW SHUT OFF OR RESTRICTION o 12. ANNUAlINTEGfUTY TEST (0.1 GPH) SUCTIO~VITY SYSTEM: o 1], CONTlNJOUS SUMP SENSOR . AUOI8U! AND VISUAL AI.NIMB DlI!RO!NCY OENIRATORI ONLY (CMdt",.., ¥IJI1) o 14. CONTINUOUS SUMP SENSOR m:tI:I2ilIAUTO PUMP SHUT OFF · AUDIBlE AND VISUAL AlARMS ~ 15, AUTOMAT1C UNE LEAK DeTECTOR (3.0 GPH TEST) mng¡¡ F1.OW SHUT OFF OR RESTRICTION o 18, ANNUAL INTEGRITY TEST (0.1 GPH) '0 17 , DAILY VISUAl CHECK " DISPENSER CONTAINMENT DATE IN ALLED 4fIS ?:. I P8ge UIT, TANK "AGe ~ _ d _ ABOVEGROUND P'PINO o 2, SUCTION o 95, UNKNOWN o 99, OTHER o ], GRAvITY 45 46. 46: o e, FRP COMPATIBLE W/IOQ11, METHANoL o 7, GALVANIZED STEEL o 8, FLEXI8l.E (HOPE) 0 99. OTHER o 9. CATHODIC PROTECTION 095. UNKNOWN 465 488 ABOVEGROUND PIPlNO SING WALL PIPING 467 PRESSURIZED PlPlNO (Ch«k "lNt~): o 1, ELéCTRONIC UNE LEAK DETECTOR 3.0 GPH TEST mIt1 AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE. AND SYSTEM DISCONNECTION. AUOI8I.E NÐ \IISUAI. ALARt.tS o 2. MONTHLY 0.2 GPH TEST o 3. NNJAL INTEGRITY TEST (0.1 GPH) o 4. CAlLY VISUAl. CHECK CONl/ENTlONAl SUCTION SYSTEMS (CMck "lNt ~): o 5. CAlLY VISUAl MONITORING OF PIPING AND PUMPING SYSTEM o e. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): o 7. SElF MONrTORJNO GRAVITY FLOW (CII«k "lNt 1t/IIIIy): o 8. CAlLY VISUAl. MONITORING o i. BIENNIAL INTEGRITY TEST (0.1 GPH) 8ECONDARIL Y CONTAINED PIPING PRESSURIZED PlPINO (CMck ..lNt ~); 10. CONTINUOUS TURBINE SUMP SENSOR mn1 AUOtBLE NlO VISUAL ALARMS AND (check one) o a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o þ, AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION o c. NO AUTO PUMP SHUT OFF o 11. AUTOMATIC lEAK DeTECTOR o 12. ANNUALINTEGRfTY TEST (0,1 GPH) SUCT1O~VITY SYSTEIot o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL AlARMS EMERGENCY OI!!Nl!RATORI ONLY (CII«* ..lNt Itþp/y) o 14. CONTINUOUS SUMP SENSOR ~ AUTO PUMP SHUTOFF. AUDIBLE AND VISUAL AlARMS a 15, AUTOMATIC lINE lEAl< DETECTOR (3,0 GPH TEST) 471 DATE c¡- /;2-03 TITLE)Jf OWNERIOPERA TOR U6<.//1 e...- 410 "72 Perm,. Numller (~ /oeM 11M only) ..73 I Pwmll AItOWd (fOr'" 11M od)'J 474 Pwmlt !xIIrIIIon 0IIe (For IDeM uø onlY) "7J UPCF (7/99) S:\CUPAFORMS\SWRCB-B.WPD 89/10/213£13 J9:51 E513273745 SCEALES & ASSOC INS FAGE 02 CERTIFICeE OF LIABILITY INSUR O~;~:~~:~~~I FAX (661)327-374"5 THI RTIFICATE I SUf; AS A MA ¡ ER OF INFORMATION . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance Serv1C:es HOLDER. nus CERTIFICATE DOeS NoT~!V'END. EXTEND OR AL;TER THE COVEFtAGE AFFORDED BY.¡TI1E POLICIES BEL-OW. ACORD ·--TM PROOUCER (661)JZ7-3533 Seeal~s & Assoc;at@s licênse * 0411Z17 P.O. Box 3099 - 719 Niles Bak~rsfield, CA 93385 IN$l!RI!O Bashaare Najdawi D8A: Gas-N-Go 2601 White Lane Bakersfield, CA 93304 St. INSURERS AFFORDING COVERAGE INSUAF.AA; ^'1 ied Insurance INSUAe~ e· INSURER c: INSURER 0: INSU~E" E' NAIC# [00035 -I COVeRAGES lTR NSRa TYPE OF INSURANCE i GENI!III"'ll,IABu..ITV , fTj COIl4MERCIM. aENERAlLI,llBll;TV ----¡ ÇLMMSMAOE [Xl OCCUR __-.J _ _. ---- GEN'l Ac;GFlF.GATE LIMIT' APPLIES I'E"-: ~ POlICV n )~j n LOC AuTOMOBilE lIABiliTY - A,.,., 1\1.11'0 -- ALL OVIINED AUTOS -- SOHEDULED AUTOS I AI I THE POLICIES OF INSURANCE LISTED BELOW I-tAV!: eeEN ISSUF.tl TO THE INSI,JRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWliHSTANOIN A/oN ~eOUIREMF.NT TERM OR CONOITION OF ANY CONTRACT Oft OTHER DOCUMENT IMTH RESPECT TO WHiCH THIS CERTIF'ldATË MAy at! ISSUED OR MAY PERTAIN, THE iNSURANCE AFFORDED 8Y THE POLlcrES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCI.USIONS AND CONDITIONS OF SUCH ¡>OI.ICII;S. AGGRF.GATF. LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PA1D CLAIMS,j .... ~ POLICY NUMBE~ 'ðtfe~MMI¡;;DrYYì DA 1'E fMM/DDrvv ¡ LIMITS ACP780138Z74Z 09101/2003 09/01/2004 EAÇH OÇCURI<F,~ÇF. 3 ~.~~~~~ ';'E~~r;J;~ncQ\ $ MED EXP (I.nV 'n~ p&,=en} $ FE R~ONAI. 1\ Af)V INJU'\Y $ , Gl!NEMtAGGRE¡JATE S PRODUCTS, CO~.FIOP AGO $ 1.000,000 300.000 5,000 1 000,000 Z,OOO,OOO 2,000,000 -. COMBINED SINC'.LE LIMIT (E8 8ccider1t) $ - ~~~;~~I),RY f ! 1 - - HIRED AUTOS NON-OV-'NeO r,UTO:; ~ODILY II'JJURY I (rw scCidtr1\) ! 1-. "I PROPEP,TV DAMA~F. . (pry .ccI~~n()1 AlITO ONLY -EA":CCIIJF.NT '$ OTHGR 71-1J\N! fA ACe $ AUTO ONI,y: ,I AGG $ --- $ s "-- GAAAGI! "1¡I,D1\.ITV R ANV AUrO ~QtsSlUMeRl!llA llABll.lrY i=J OCCUR 0 CI.AIMS MADE R°F."UCTI5lE AenNT'CN $ WOItKtRS COMPENSATION AND ~ I <;rT EMPlOV(/\S' ~'^BllITY ~fLíM'T$1 _I ER· ANY I"RO"III¡¡¡ORI~AAT;'¡1:RIEXeCUTlV¡¡ I', E.l, [!ACH ACC)Dt;~r $ OFF'CI!R/MEM!lER EXCLUOED? Ilye8, deSCribe ""do, I ' F.,I., DISEASE, EA,~MPI,OYEE $ ~FECIAL i>ROVI$ION& bslOW U OISEASE, P0410V LIMIT $ OTHER , A Þ·"Opert)' I ACP780B8274l 09;01/Z003 I' 09/01/2004 I I I De$I;RIf'nON OF OPl;;f(A TlONS IlOCA TIONS I VEHICLES II!~CI.V$IONS ADDED 11'f ENDORSEMENT I S,.eCIAl PIIO·"'SIOO$ F.ACH OCCURRENC¡¡ $ A~GREG^TE $ $ ¡ $ -- Builiding $175,000 Contents $60,000 I 'I i I I CERTFrCA TE H01.DER CANCELLATION ,~ Bashaare N~jdawi DBA: Gas-N-Co 2601 White Lane Bakersfi@ld, CA 91~04 $HOULD ANY OF THF. At/OVE DESC~IØ~O POLICIES B! bAtCflLEO BEFORe THE 'I E·P~ATiON OAn Tlif~EOF, Tift ISSIJII'IG INSURER wil~ ENDI!AVOR 10 M"'" ...lQ.... DAYS WRITTEN /IJOnC;:E TO TH! Q¡¡lrI1FJCAT! ~OI.DER NAMED TO 'tHE LEn. BUT FAilURE TO MAil SUCH NOTICE GIIALllMPOS! Nd OBLIGATiON OR LIABILITY OF ANy KIND UI'ON T'fE I URCR,ITS ^GE~ 0" A"P~ESEI>ITATIV"S, AUTHORIZED" EPRESE E ©ACFRD CORPORATION 1988 I I I I I I I 'i I ACORO l6 (2001/~ ú"JQ/ .-JNet..^/ T )c)/1 T Lj t¡ 01 ( I c..¡ h . CITY OF BAKERSFIEL..Q.. . OPPlCE OF ENVIRONMENTAL.RVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUNDSTORAGETANKS·TANKPAGE1 (S fYPE OF ACTION $1, NEW SITe PeRMIT CJ 4, AMENCED PERMIT , 0 5. CHANGe OF INFOR", TION) (Check one ,/em oIII)t) PIge d CJ IS, TEMPORAAV SITE CLOSURE o 7. PERMANENTL V CLOseD ON SITE o IS, TANK REMOVED a 3, RENEWAL PERMIT (~ -- . fOr lOcal ... oIII)t) 8USINESS NAAE (sam.. FACILITY NAME ot D8A . DaIng I!uIIneII AI) d<ncl ttJt\\.~ LN ! TANK 10. 4: auJ, hA: q 13{J<f L TANK DESCRIPTION ,433 COMPARTMENTALIZED TANK Vel a No 1t'V.-. comllele one PIge lot NCII compartment. 43- \l NU 43: \L '2- 438 .. TANK CON18frI ¡ TAHKUSE, 43t i 'f/-,. MOTOR V!HICU! FUEL ¡ (If_rted, ~~ 7)J») I 0 2. HON-FUEL PETROLeUM I 0 3. CHEMICAL PRODUCT I 0 4, HAZAROOUS WASTE (1ncAIdN I URd 01) I 0 95, UN!<NOWN PETROLEUM TYPe ~ II. REGUlAR UN..EAœO 0 2. LEADED o 111. PREMIUM UNLEADED 0 3. 0tESEl o Ie:. IoC)GAADE UNLEAœO 0 4. GASOHOL COMMON NAME (IhIm HeDI'dI:Iw ....lnvenlDty f»fe) 44C o 5. JET FUEL EJ 8. AVIATION FUEL a 99. O~ER 441 CAS' (from ~rdoI4 AII,.,.1tJwntrNy f»fe) 442 ! TYPE DF TANK ¡ (C/IeCJC _ *'" ody) i ¡ TANK MATERIAL· ørIn*Y link CJ 1. SINGlE WALL '\19 2. DOU8LE WALL ~ 1. BARE STEEl CJ 2. STAINLESS STEEL I (C/IeCIt _ ".", only) I I I TANK MATERIAL· -*Y link 0 ,. BARf! STEEl (C/IeCIt - ifeIJI ody) CJ 2. STAINLESS STEEL TANK INTERIOR UNINO OR COATING CJ 1. RUIIIER LN!O CJ 2. ALJM) L.MG (Ch«k _ ifeIJI ody) SPiLL AND OVERFILL (Check.U INI~) If' SlNQLa WAU. TANK (CIIecII....t II/PIYJ: o " V1SUALlIXPOIeOPORTIOHONLV) o 2. AUTOMATIC TANK GAUGING IATO) o ), CONTtNUOUIATG 04, STATISTICAlINWNTOAYRI!CONCIUATIONISIR)· BIeNNIAL TANK T8n1HO -,,,---.,'-" ~... .»-"" ~ ,~,~.. < > , eSTIMATeD OATI LAST UUO (VRIaDOAV) UPCF (7199) 411 .. TANK CONSTRUCTION o 3. SINGLE WALL WITH EXTERIOR MEMBRANE LINER a 4. SINOlfWALLINAVAUlT o 5. SINGlE WN.,L WITH INTERNAL BLADDER SYSTÐ4 005. UNI<NOWN o est. OTHER o 5. CONCRETE 095. UNKNOWN o 8. FRP COWATI8lE WlI00% METHANOL 099. OTHER 443 ~ 3. FI8ERGlASS I PlASTIC o 4, STEEl. CLAD WIF/BERGlASS REINFORCED PI..ASTIC lFRP) ".", FI8EAGlASS I PlASTIC Ii!f 4; STEEl. CLAD WIFI8ERGLASS REINFORCED PlASTIC (FRP) a 5. CONCRETE o 3. EPOXY UNI«] 0 5, GLA88 UNINQ 0 05, UNKNOWN o 4. PHENOLIC UNINO l2I='e. UNLINED 0 est. OTHeR J9. 3. FI8ERGLASS REINFORCED I'tASTIC 0 05. UNKNOWN 448 (] 4. ra.tPAeSSEO CURRENT 0 est. OTHER 444 o 8. FRP COWATI8LE Wl100% METHANOl. o II. FRP NON-CORROOI8LE JACKET o 10. COATED STEEl. 095. UNKNOWN o est. OTHER 445 448 DATE INSTAI.l£D 441 'Forlocal_ DATE INSTAI.l£D 449 450 TYPe (For IouJ '* only) (For 1ocaIC/N only) 451 OVERFill PROTECTION EQUIPMENT: YEAR INSTALLED 452 01. ALNIM 0 3, FILLTUBESHUTOFFVALve~ 02. BALLFLOAT 04. EXEMPT ::;Mi!". urAK, :.~~:' ~~~~~~;,i·~~t?r.~·::::··· . :::::.~"".: :~\$t~····~.:.·~~;4~." '::' ~;. .:.:,:.....~;:~:::}t\~~~·· I . "oOUIIU w~ TANK OR TANK ~ ~ (~_IemødrJ: 454 o " VlSUAL(SINOU!WALLINVAULTONLV) 1iØ. 2. CONTINUOUS INTERSTITIAL MONITORING o 3. MANUAL MONITORING o 5. MANUAL TANKOAUOINOIMTO) o 8. VADOse ZONE o 7, GROUNDWATER o .. TANK TESTING (]... OTHER 'Yo TANlc'CLOIUU 'N'ORMATION I PIRIlANINT CLOSURI'N PLAa!. .. ISTIIMTIO QUAHTJTY OF SUlSTANCI RlMAlNIHO .... TAN( FILLID WITH INEAT MATEAIAI.? 451 gIIIanI o V. 0 No S:\CUPAFORMs\sWRCs-a.WPO ~ ~b ~ Ò A CITY OF BAKERSFIELD .. OFFICI! OF ENVIRONMENTAL SERVICE. 1715 Cheste, Ave., 8ak.~fI.ld, CA 93301 (H1) ~879 J UST, TANI( PAGI! 2 - .. . P8ge d - UNDERGAOUNO PIPING VI. PIlING CONSTRUCTION (CMcIt "".t IPtJ/rJ A80VEGAOUND PIPING SYSTEM TYPE ,. PRESSURE 0 2. SUCTION 0 3, GRAVITY 458 0" PRESSURE , CONSTRUCTlON/'O 1. SINGLE WALL 0 3, LINED TRENCH 0.. OTHER 4ðO 0 1. SINGLE WAlL : MANUFACTURER!¥,2, DOUBLE WALL 095, UNKNOWN 0 2. DOUBLE WALL I I MANUFACTURER 481 MANUFACTURER f 0 L BARE STEEL 0 8. FRP COMPATIBLE W/I00% METHANOL 0 L BARE STEEL MATERIALS AND !O 2. STAINLESS STEEL 0 7. GAlVANIZEDSTEEL 0 2. STAINLESS STEEL CORROSION : PROTECTION i 0 3, PLASTIC COMPATIBLE WITH CONTENTS 095. UNKNOWN 0 3. PLASTIC COMPATIBLE WITH CONTENTS ~ 4. FIBERGLASS 0 8. FLEXIBLE lHOPE) 0.. OTHER 0 4, FIBERGlASS : 0 5, STEEL WI COATING 0 9. CATHODIC PROTECTION 484 0 5. STEEL WI COATING VI. PIllING LEAK DETECT10N (CMcIt" th8t.ç¡ply) PRESSURIZED PIPING (Check '" ".t ~J: o 1, ELECTRONIC UNE LEAK DETECTOR 3.0 GAt TEST mI!1 AUTO PUMP SHUT OFF FOR lEAK. SYSTEM FAILURE. AND SYSTEM DISCONNECTION · AUDIBLE NÐ VISUAL ALARMS o 2. MONTHL V 0.2 GPH TEST o 3. ANNUAlINTt:GRIT'f TEST (0,1 GPH) CONVENTIONAL SUCTION SYSTEMS: . 0 5, DAlL V VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY I TEST (O, 1 GPH) i SAFE SUCTION SYSTEMS (NO VAlVES IN BELOW GAOUND PIPING): o 7, SELF MONITORING GRAVITY FLOW: o 9. BIENNIAlINTEGRIT'f TEST (0.1 GAt) SECONOARlL Y CONTAINED PIPING PRESSURIZED PIPING (Check ., ".t .ç¡pIyJ: 10. CONTINUOUS TURBINE SUMP SENSORïdIl:1AUDIBLE AND VISUAL ALARMS AND (Check one) o a, AUTO PUMP SHUT OFF WHEN A L.EAI( OCCURS o þ, AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION o c. NO AUTO PUMP SHUT OFF i§. 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GAt TEST) mn1 FLOW SHUT 0Fi: OR RESTRICTION o 12, ANNUAL INTt:GRITY TEST (0,1 GAt) SUCTIONlGRAVITY SYSTEM: o 13. CONTINUOUS SUMP SENSOR . AUOI8lE NÐ VISUAL AI.AAMS EMERGENCY GENERATORS ONLY (Check "'",., 1tJIIIy) o 14. CONTINUOUS SUMP SENSOR~AUTO PUMP SHUTOFF + AUDIBLE AND VISUAl ALARMS ~ 15, AUTOMATIC LINE LEAK DETECTOR (3.0 GAt TEST) ~ FlOW SHUT OFF OR RESTRICTION . o 18, ANNUAlINTt:GRITY TEST (0.1 GAt) o 17. DAilY VISUAl CHECK o 2, SUCTION o 95, UNKNOWN o 99. OTHER o 3, GRAVITY 45S 46= 463 o 8. FRP COMPATIBLE WI 100% METHANOL o 7. GAlVANIZED STEEL o 8, FLEXIBLE (HOPE) 0 99. OTHER o 9, CATHODIC PROTECTION 095. UNKNOWN 465 4ð8 ABOVEGROUND PIPING SING WALL PIPING 467 PRESSURIZED PIPING (Check '" III.t apply): o 1, ELECTRONIC LINE LEAK DETECTOR 3.0 GAt TEST mIH AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE. NÐ SYSTEM DISCONNECTION + AUOI8LE AND VISUAL ALARMS o 2. MONTHLV 0.2 GAt TEST o 3. ANNUAL INTEGRIT'f TEST (0.1 GAt) o 4. OAIL V VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check"".t ~): o 5. CAlL V VISUAl MONITORING OF PIPING AND PUMPING SYSTEM o 8. TRIENNIAlINTt:GRIT'f TEST (0.1 GAt) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): o 7. SELF MONITORING GRAVITY FLOW (Check ",,,.t apply): o 8, CAlL V VISUAL MONITORING o 9. BIENNIAL INTEGRIT'f TEST (0.1 GAt) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check III ".t apply): 10, CONTINUOUS TURBINE SUMP SENSOR rim:! AUDIBLE AND VISUAL ALARMS AND (dIeck one) o a, AUTO PUMP SHUT OFF WHEN A L.EAI( OCCURS o þ, AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION o c. NO AUTO PUMP SHUT OFF o 11. AUTOMATIC LEAK DETECTOR o 12. ANNUAL INTt:GRIT'f TEST (0.1 GAt) SUCTION/GRAVITY SYSTEM: o 13. CONTINUOUS SU".. SÐISOR . AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check" ".t.""", o 14. CONTINUOUS SUMP SENSOR ~ AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS o 15. AUTOMATIC LINE lEAK DETECTOR (3,0 GAt TEST) o 1, FlOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 4ð8 0 2, CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS t,: 3. CONTINUOUS DISPENSER PAN SENSOR mItt AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS DC. OWNERIOPERATOR SIGNATURE I ~ty lIIelltle i"tormallon pnMded .,.." Ie IMI 8IICI accu"'. to !lie Ileal d my knowledge, SIGNAT OF RlQf!:RATO :" ".< I Perm,t NumÞer I~ IOaJ uae only} 473 Pumlt Ap/oIIed (~b:at uae CIIIIy) UPCF (7/99) DATE Q-leJ-03 470 471 TITLEOFOWNE~PERATOR D (.,vI Yt -e...,.,.-- 472 474 Permll ExpirIIIon Date (For IOt»I UN only) 4t~ I S:\CUPAFORMS\SWRCB-S.WPD .' Š_W.__~C4a~8011'd I " ;';;1::"'·':~;''"'''~''''':.~.:",:~v~,,·';'~'~>,>,. ;,-- ~I a ' " ";';"""S ,,~, '",""''''':,: ", ',~ ~".,:,: . . ., _·..··:~::·.·..··;t:··~·-~····~:<:···~~·;~:~,~·~iC;:<:. ,¡.". :', .~.~..:~~. n"'JIÎ... _......., ., ,',:' :':'<:';:'~__ "~;~..;T'.,.,, , , , ~~,., CERTIFICATION OF FINANCIAL RESPONSIBILITY fICA UNDI!RCRXJND STORA_ TMkS CONTAlMNCI PtI.rftoILSJlf \.. (aa....... .. 'n T AI - . .. .. I r 11 . .... ~ __. ",. mi. I! ia s..a.. ~ a..- &I. ow. J.. 1'IdI n a:a. 0......,... I. 1::....- 0 1 .~ .................t. ~...... ~ pe,....... AND 0 % .ilioa 4;;;............... ""'by~ttiIIa that it ø in compl~ with thtJ ~ of S«:tIon 2807, - s~ Ath(ð. £~StJt~ , I O~() ¡ÐO 0 ( I 00t9.00t) q-l~" 0 '3 ~ \o.\-L k}hJ ,~: If)Ou are ..Jnøthe SIIIte Fund.. any ptIItøfyour demoMtratJan ofl/nllnCiat,.ponsiblity, yourewcutkJn MId ~ of thå cøttlflctllJon .., cøttJflø that you .reln compliance with all conditio,. for /NII1/CIPtIIIOn ;, thtI Fund. ~~~H_ - --- -------- - --- - ,...,~ ',,;11- 7"- . ,...,~ I I ~H..- 1'IIi1I.~ i"- .,~ ~~~~- /¿:¿~ -.ø:- . _.1M......., -- I ~ _11.. CII'I'IiM 0... o,a. f'~ShaCotfa 'j'~' ..... elYrI.._....., c/C-VJ'1 t? .r ~ PILla Crt..... - te.t ~ c.,NI- ....,.11(.) .. UST MONITORING PROGRA. WRITTEN MONITORING PROCEDURES Page 1 of 1 Bakersfield Fire Dept, Environmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661 )326-3979 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 SeNices 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 FACILITY ADDRESS f..M. DESCRIBE THE FREQUENCY OF PERFORMING THE MONITORING: TANK tt\~.\(\t\IIV6(Y l\. It PIPING 'M-iAT METHODS AND EQUIPMENT, IDENTIFIED BY NAME AND MODEL, IJIIIlL BE USED FOR PERFORMING THE MONITORING: TANK Ut(l((~' ¡(fI"+- TLS - 3S'O PIPING t<.. I, DESCRIBE THE LOCATlON(S) 'M-iERE THE MONITORING IJIIILL BE PERFORMED (FACILITY PLOT PLAN SHOULD BE ATTACHED): 1'1A~~IJ4)r ~()(lL(..t¿ Jlrc.(J~ ht.(V\.1 Lð.~"- h~ (st<r t- .A-rJ,Ja.J LIST THE NAME(S) AND TlTLE(S) OF THE PEOPLE RESPONSIBLE FOR PERFORMING THE MONITORING AND/OR MAINTAINING THE EQUIPMENT: NAM n I.. fJC{5n~ A/a ,'daL//' v TITLE Û,^-" /1 e,..- REPORTING FORMAT FOR MONITORING: TANK f UtA.. L L.OI\. PIPING 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. A'.... ....l 1 . f .. l ( A l 1I\.II\",v.. C( t-~l.(\{ð.-t10 "'l I t lc"llt \.\.t- "'-lU!; t- '1 U. ,"It DESCRIBE THE TRAINING NECESSARY FOR THE OPERATION OF UST SYSTEM, INCLUDING PIPING. AND THE MONITORING EQUIPMENT: P ( r It\. .!.1· (2(. ~CJ #ttLt.¡Jð.,1t f) 1(j It) ~ UST MONITORING PROGRAAt EMERGENCY RESPONSE PLAN Page 1 of 1 Bakersfield Fire Dept. Environmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 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 FACILITY NAME IF AN UNAUTHORIZED RELEASE OCCURS, HOW 'MLL 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 'MTHIN 8 HOURS, OR DETERIORATE THE SECONDARY CONTAINMENT, THEN THE OFFICE OF ENVIRONMENTAL SERVICES MUST BE NOTIFIED 'MTHIN 24 HOURS, h~ $~Ll 6p(l(~ tk (}Ç;,(. a-t ~dl'f 11l+(( ~ 0./01 ð~~Cf~tl,..t lkc.d-{f(aÍ. ¡:Ör l Í\t~L ~fd(t, tÖV\.{nJ (3ç:(\ \"- tt,L£l q{, DESCRIBE THE PROPOSED METHODS AND EQUIPMENT TO BE USED FOR REMOVING AND PROPERLY DISPOSING OF ANY HAZARDOUS SUBSTANCE, ~{{(y l-.1:~Cf w((( ltJc <JfJ({ tlb al~ c&,6ÐtbdJ- ~+-tt£t,d .y &rorci iN c-. lllN dtSl1hU( -Ç.CV'" Wo.~~ ~1L~(.((lt( W\.+k. ð.. drlJ",^, 3,DESCRIBE THE LOCATION AND AVAILABiliTY OF THE REQUIRÉD CLEANUP EQUIPMENT IN ITEM ABOVE, \LlH-... ~ t'\ '- t.u-a.b~ S~tJ l,^ +k ~o.d,- Ot- ~{()1rL DESCRIBE THE MAINTENANCE SCHEDULE FOR THE CLEANUP EQUIPMENT: tit. c.Jul:. tLkuJ'{ -\-C (:~~d t~ prOpc.\ Otk~,r..f- (;IN fM.1'\[ LIST THE NAME(S) AND TlTLE(S) OF THE PERSON(S) RESPONSIBLE FOR AUTHORIZING ANY WORK NECESSARY UNDER THE RESPONSE PLAN: NAME ì30S~í Ala ~cP~; v TITLE (!)G-v'/l c~ ... ... o '" :E e CITY OF BAKERSFIEL. OFFICE OF ENVIRON~IENTAL~ERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - UST FACILITY (Ð TYPE OF ACTION í Check on" ,t"m only) '1& I. NEW SITE PERMIT o J, RENEWAL PERMIT o 4, AMENDED PERMIT o 5, CHANGE OF INFORMATION (Specify cnange . local use only) o 8, TEMPORARY SITE CLOSURE Page _ 01 _ o 7 PERMANENTLY CLOSED SITE o 8, TANK REMOVED 400. BUSINESS NAME (Same as FACILITY NAME ot DBA . Doing Business As) I, FACILITY I SITE INFORMATION 3 FACilITY 10 . 401. FACiliTY OWNER TYPE o 1. CORPORATION \;i 2. INDIVIDUAL Ó 3. pARTNERSHIP I I , - \ o 3, FARM 0 5, COMMERCIAL o 4. PROCESSOR 0 8. OTHER 403. Is facility on indian ReIIeIvaticn ot 'If _ of UST a public agency. name of SIIIeNisor of tnJsIIanda? division, section ot oI!Iœ which operates !lie UST. (This is !he oantac:l peISOI1 lot !he tank recordS.) o 4. LOCAL AGENCVIDISTRICT' o 5, COUNTY AGENCY" o 8. STATE AGENCY" o 7, FEDERAL AGENCY" 402, BUSINESS TYPE 1. GAS STATION o 2, DisTRIBUTOR TOTAL NUMBER OF TANKS REMAINING AT SITE 404. OVes '6tNo 405, 406, II, PROPERTY OWNER INFORMATION ! PROPERTY OWNER NAME MAILING OR STREET ADDRESS 407, I PHONE 408, 409, o ,. CORPORATION o 2. INDIVIDUAL o 3. PARTNERSHIP 410, I STATE o 4. lOCAl AGENCY I DISTRICT o 5, COUNTY AGENCY 411, I Zip CODE 412. CITY PROPERTY OWNER TYPE 06, STATE AGENCY o 7, FEDERAL AGENCY 413. III, TANK OWNER INFORMATION TANK OWNER NAME ßCl~u" \ MAILING OR STREET ADDRESS 414. I C;~ l ~ 5 ~ ~ r 7C{1.{Ç 415, 418, CITY 417, ZIP CODE 1'f31 L 419. o " CORPORATION 2. INDIVIDUAL o 3. pARTNERSHIP o 4, lOCAl AGENCY I DISTRICT o 5. COUNTY AGENCY o 8, STATE AGENCY o 7, FEDERAL AGENCY 420, TY(TK)HQ rv, BOARD OF EQUALlZATlON.UST STORAGE FEE AC.COUNT"UM.BER Call (916) 322-9669 if questions arise 421. . '. V. PETROLEUM UST FINANCIAL RESPONSIBIÙTY', INDICATE MEniOO(S) ~ ,. 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 o 9, STATE FUND & co o 10. LOCAL GOV"T MECHANISM o 99, OTHER: 422, VI. LEGAL NOTIFICATION AND MAILING ADDRESS CIIed< one box 10 indk:ale which address should be used lot legal noüftcations and mailing. Legal nOliflcations and maiUngs wiU be senl to !he tank own~ unless box 1 ot 2 is checked. ~ 1, FACILITY o 2. PROPERTY OWNER o 3. TANK OWNER 423, VII, APPLICANT SIGNATURE CertiftcaUon: I certify !hat !he information prOVided herein is lNe and accurate 10 !he besl 01 my knOWledge, /Í/a. . cfcLCA./· DATE 1- ¡ ';¿-û '3 428, TITLE OF APPliCANT OUJ/1 e-- 424. HONE 425, 66/J 703-76 7G 427. I ST A TE UST FACiliTY NUMBER (Few /oeM use only) 42$, 1'998 UPGRADE CERTIFICATE NUMBER (For Ioc,,¡ US" only) 429. UPCF (7/99) S:\CUPAFORMS\swrcb-a.wpd ( .~. cr~"y OF BA~FIELI)'" , '--'", OFFICE" OF'ENVIRONMENT AL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326~3979 INSPECTION RECORD POST CARD AT JOB SITE Facilily Address City,Zip Phone No, Owner Address Cily, Zip Pennit # INSTRUCTIONS: Please call for an inspector only when each group of inspections with lhe same number are ready, They will run in conseculive order beginning Wilh number I, DO NOT cover work for any numbered group until all items in lhat group are signed off by lhe Pennitting Authorily, Following lhese instructions will reduce the number of required inspeclion visilS and lherefore prevent assessment of additional fees. TANKS AND BACKFILL Backfill of Tank(s) Spark Tesl Certification or Manufactures Method l!o..tl.1J.A..; Cathodic Protection of Tank(s) Piping & Raceway w/Collection Sump ~03 Corrosion Protection of Piping, Joinls, Fill Pipe Electrical Isolation of Piping From Tank(s) Dispenser Pan Cathodic Protection System-Piping 'û-3~ 0 3 SECONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETECTION Liner Installation - Tank(s) Liner Installation - Piping Vault With Product Compatible Sealer Level Gauges or Sensors, Float Vent Valves Product Compatible Fill Box(es) ~ Product Line Leak Deleclor( s) fG--"3--C~ .JI It. Leak Detector(s) for Annual Space-D.W, Tank(s) 1()-~-()3 ()j , Monitoring Well(s)/Sump(s) - H20 Test q -J)-O S Jt Leak Detection Device(s) for Vadose/Groundwater /1 Spill Prevenlion Boxes JO- '3'0 '.7 .~ FINAL /J Monitoring Wells, Caps & Locks I () '~ ...{) ~ M'J Fill Box Lock IO':~-()~ \.J '1 Monitoring Requirements Type tJlu/r If' Ooo+:Tu, 3.s0 I()"'~"'IJ~ L1 '.J , Authorization for Fuel Drop OiL Q,...'j,""-l) .~ q--è). ì-~ ~ ~~ CONTRACTOR 'he 1'(/\ ~'" CONTACT ß(''fii N Me.. Na.~~ t()L\ ~~I~lI~ LICENSE # '('7433/ PHONE # 'fì1 .. 8 ((('0 , - ~:; -- ~t~·~-- --~~~.~ . 91- D~5b CITY OF BAKERš;ÏË~~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 . PERMIT APPLICATION TO CONSTRUCTIMODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATION (CHECK) [ ]NEW F ACll..ITY []MODIFICA TION OF F ACll..ITY []NEW TANK INSTALLATION AT EXISTING F ACll..ITY ~ f)6 fOB PROPOSED COMPLETION DATE 8 \ I \ ~ EXISIDj.g F .i\ClLIIY. ~~RMIT NO. CITY~ illcoœ q~~ APN# PHONE NO, ').. - $i aD ill CODE CA LICENSE NO, ill CODE aUSINESS LICENSE NO. ÔI'-.. tb , - !iD lID WATER OFACILITYPROVIDED Y DEPTII TO GROUND WATER :f: SOIL TYPE EXPECTED AT SITE NO. OF TANKS TO BE INSTALLED -.--J ~ ARE THEY FOR MOTOR FUEL SPILL PREVENTION CONTROL AND CO R MEASURES PLAN ON FILE 7 TANK NO. --L- ')..-- VOJ..UME f'J-:6.'D fSao TANK NO. VOLUME 1.····~~~m~mm:*8~......··..:...·: NO NO SECTION FOR MOTOR FUEL UNL~ED PREMIUM AVIATION REGULAR DIESEL \L SECTION FOR NON MOTOR FUEL STORAGE TANKS CHEMICAL STORED (NO BRAND NAME) CAS NO. CHEMICAL PREVIOUSLY STORED (IF KNOWN) .. FOR OFFICIAL USE ONLY ..."...... THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY wrm THE AITACHED CONDmONS OF TIllS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. TIllS FO HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO TRUE' CO C, ~ ,~,I I. , - ~ jAJv~ APPROVED BY; APP CANT NAME (pRINT) THIS APPLICATION BECOMES A PERMIT WHEN APPROVED ~.¡ ~ ,,·113/313/213133 15: 46 66139213. . ,~ 5643 BROOKS CT BAX2RSPXBLD,CA.93308 OFFXCE(661)392-86B7 & FAX (661)392-0621 EAX TRANSM~TTAL COVER SH~RT Datez ID/30/~ TiIne: B:Yc:)ph4 NO.~f pages: / Attention: 5 -n::- VE UnD£,RfA.JOOD Couapa:c.y ~ 6IH<FRS'FJELD -¡'lIZ-£' 7)epr, <Ö5~ -- ~ \~~ Fax:# ~ Front: Jl!'iIl"U!!t1l J. iiQh R.i:= G--A~ ¢. G-o -r:E~\ KF.5U.lT"S I ~ . If you have guestions please contact me at my office, ThaPk you I PAGE 81/8S ~. ! 10/30/2003 15:46 6613920_ e PAGE 02/08 RICH ENVIRONMEN'1!AL , 5643 BROOKS CT BAKERSFIELD,CA,9330B OFFICE(661)392-S6S7 & FAX(661)392-0621 ALERT 1000 UNDERFILL AND ALERT l050x ULLAGE SYSTEM P.recision Undet:ground storage Tank System L,~ak Test 'X'EST RESC'L'I'S Test Date:1C,'13/03 BILLING:MC NABB CONSTRUCTION 2122 WEGIS AVE BAKERS~IEL~,CA 93312 SITE/GAS AND GO 2601 WHITE LANE BAKt~SFIELD, CA PRODUCT VOLUME 'FULL (GAL) WETTED PORTION NON-WETTED J?il.ODUCT LEAK WA'l'ER IN pORTION LINE DE'1'EC''I'OR 'rAm: '¡'ASS +,OOQ-P.ASS NO TEST 0" PAS ~ì +,OOO~PA:;S NO TEST 0" UNL-87 12000 72~ -, 017'''PAS3 PREM'-91 8000 78't -, OOl-PASS WA'I'EF. BALANCE MeaSUJ:ern(!:nts shot.'ed that water in the backfill area at the time of testing was below tank bottom, and therefore not a !acter in test deterroJ.nliltion. A moni,toring well or a well point W6J.S driven in the backfill arr~ to determine that there is no watet in the backfill at tank bottom- A precision teat was performed on tanks at th~ above location u~1ng the Alert 1000 underfill sy~tem and the Alert 1050 ullage ~ystem. I have revi~w@d the data pr.oduced in conjunction with this test for purpos~ of verifying the results ~nd certifyingche tank systems. The testing was þEl:t:f:ormed in acor.rdance with Alert protocol, and therefore satis fj,es all requirements ~or such testing as set forth by NFPA 329-92 and USEPA 40 eFR part 260. Th~ results of testing are shown on the following page, and indicate whethe~ the wetted and non-wetted portion passed or fail~d, Included with the report: are reproduction at data compiled during the te$t whtcl1 formed the basis for these conclusion, Thi~ information is scored in a permanent file if future verification of test results is needed. X declare unde~ penal~y of pe~juxy tha~ I &rn a 1~cense4 ~&nk teste~ ~n the a~ate of Cal~fornia and that tha in~or.mation oon~ained in this repor~ is true an~ eorreot to the þea~ o~ my knowledge.