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HomeMy WebLinkAboutMITIGATION 9/29/2004 / :\".c. .,. '\ '\ t· .. OCT- 4-04 MON 14:40 FROM B.S.S.R. INC. P.06 ; , BSSR, Inc. 6630 Rosedale Hwy., # St Bakersfield, CA 93308 Phone (66 t) 5S8~2777 f'ax (66 t) 588·2186 ·M,ONITORING SYSTEM CERTIFICATION " ,', - " '~!~~ ,;', f~~~~ :t:o,rrl:'. must be used to do<:u¡nent testing and s~"Vic.iIlg of monitoring cqtl1pment. ~ ,?a(nl!L~œOtt U1llSt ~. i\r~t;ffi~Hd12r each rnonito.rinø lyst~ çg}i!~W b~ the tcchllician who perfOl'm5 the work. A copy or this fonn m.ust be p.rovidcd to, '!:!}~~t];!j¡'~.:~stêrn owner/operator. . ,':1'he'~,o\Í(ne~/ope,r~t9r must submit a copy of this fann tò the 10QI\1 agency regulating UST BYS~;~ ' :' ' ~\~J~¡i/30, <lays ofteat date. ' ' , "/, . .,~:: 'I ·.·If\I,:- . ,'of', ~ r'· . "\ . . ',', !,:;:~t/G:enera'lln(orIDation ,., . ,:'; :.:;,¡:,:~.::,[..1t~"~~~nc;" ,:; t2Al~ &~¿ ......~~~No· ' ,/," :,~¡;}¡'~t ,,',"f':,', ~~è;o ,~". .c">r-;- - --. "c¡¡~'- '''d~/~J~.e'2Z1~í :':,~~ I '):,' ¡:F" "~¡lð:,1t.1, ~f.Wts'j'" ,V-r~ ,~Ud:_", .__..'.. 'I .--..iQ~._:!~ - ---' p .þ;i''':- , r:~";~'¡*i,tH~~,'B~n~~ Pets~n:, ~ ð1. , ~, _,,_'A .---~ Contact Phone No.: t!~.:î2? ~.øo , ¡ '~"~i;~~~W~~ÿ4e1 !>~M?mto¡;~~;.~'Istem: æ~d~ ZZl.-:.-3£c.ì... Date ofTestU1g1Sexv1Cing: -1.JkfJ12.)t' , . ,¡'~¡~:U~ \'~1~!1:~,ry ~f,~q~ipin~~t, 1:~~~~~/Certiped , , , .':1'" ,f;f."t ro rlat" 'bOXCl to Indlcatt I ocUlc ",I IIcnt Ilia teeVscrvle I . .' ~~ . ' .. , ,," ~~~'~ "'" 'I :MI < ~',r:' ....'~~;:'~... ,j;'}:" If.;·" i .; ,:"',:f¡ ''(1;>.:':1' T:wk 10:' ~ (../... ' ," <ii! ~i.'í¡~¡,O/ .~~¡ng Pipbe. ':' ';~, . M~dcli ,'Z/YfI.--.::uz ... t1ln-TaltkÓao.sging Probe. odc1= i!Yp'5h;,-7i'.7'~ :-:,1' '~~l~r.Space or Vault S~\?r, ~~el: _' : . Q ~nular Space or Vault Sensor. Model: .> '," . , : ::~:'ffi: !31~~)8:~~mp lTJf!1\~ S~n$o~~~)~: M94el: "Rz""ff:lJ'J1Õ=;giZ. ~i'Plng Sump f Trencb SCt'lSo ~s). M9~.~!: ~5I'.3:"?:?--ZI!lJ>.. :;!Jjj]~ '; ",EU;,'$~~~~$Or(:¡)· .. J.:,,,:::,,t4?dcJ: :.. _ a FiI1S"mpSe~sor($), Modef: . '" .' ,i. :' :~!¡~; ~,:M '~.al),~,~1 LlI1e Lc,ak Detector. M~491: I, _ tJ MecblU\lcal ~lI1e LOll ( DClt:ctor. ,Model: - , ~---:. ' : ':', "'I~ ',: ttiF,~(Q,~j:~, ~r~o ~~ t?et,~t~~, ,Mod!:,l: Æ~- ~Iectton¡c Lme l.ealc Detector. Mod.lll\ 53?~ J.f.7'(l,,-(X)'Z-: ; . ,,:' ~, " J\i:~OvcrtiU J H1el\.Lcvcl Sensor'. M'odd: '" . ,,' Q Tønk OVerfill I High-Level Sensor. Modth ¡, l' ,,: 1 ,!';;:::: ~: ~. ';~f š' '~ ., . '01' merit f' 'and !nodel in 'Section S' on Lh e 2 . ,otJ'lC1' fspeçib ~~~2u\en~}, model in Section B on Pa c 2 : ,,;.' , ,I :';:~; , J.tF~V ~:;..:; ::;: ". " T:tnk ID: '..'!nl,;',;: ; :, .::. ~¡ ::ç.:{:,~t~~~J~~u8ing Probe., M04c1: 0 h)-Tank Ga7;¡¡ñgProbc, ·-Model: .- . ',',,'t,;: if; ,:d"..: ;¡«;ii~,µ!.,.3J'.~" pác,4! 9f Vault Scn~pr. Modd: 0 A"nular Space or Vault Sensor. Model: :,¡i, ~~ ;·:9;f;~j¡h~ ~.uit1P I TreJ1eh Sensor(s). Möd~(: Q P~píng Sump f Trench Sensor(s). Model: ':; ji~ ~ 'J~U:;l1.t§!,mlp ~cnsor(~). Mod.cl: CJ Fill Sump ScnSQr(¡), Modd: : il;:;¡¡¡! ::p¡.'., ,: :~,~¡¡al,~ìnc Lëak Detector. Mod'el: Q Mcchani~a1 ~ino Leak Dc\~l.Or, Model: .', I~: ':;~:.. 9.,,,.~ç¡:'l~e LCOIk D¢tCCtor, Model: a Eleçtromc Line Leak Detector. Model: .: Ij;: ::'~: '.9<~~mll !.~i~~-Lcvel S,en£or, Mode}:, _ a Taltk OvCf~" I Hi~h.Lcvcl Sçl\sor. Mode}1 , "'I~ "'~'".", .,' ~~, "c UI ean~mQdelmScct'onEonPa 02. .~RP;Ç.r s /XI ~ mtltf, ~ndmodclu\SecIlOnB~ Pa ~2. t, ,i~¡ ;jJ,t~;?...~,.,~r.m.:: ,,,' 1- z. '¡'. . , - _ DI~JtÞ$cdD' .~'.'" y.- j" !~; }';O;~~~,~er çontaanmcnt S~spr(s); Moder: 0 Qiwcnscr Contllinment Sensor(s). Model: ¡:: :"':[:¡; ¡~~\~~r.Y3Iv,e(s). ~car Val\'e(s). . : ,¡:~~~¡ ;:~~¡U~~~.~cn$Cr C~ntair\~ent ~Io~ s and Chain s . ._ C Dis nBCI' Cont~í!ln.7o:a?l~d Chl,1i'2.(s~. ¡ :,¡,~'il¡;~ ,p.?~1~~~!~1r,ln: ", '¡'-' DlslJCnSCr ID:",:2-'· --- ~ :::\Ai: ¡;i ,:p',H;j~¡~p~~ Conlainmont Stnsor(s)~ Model: _ :, 0 ~se:r (;onllllnlnonl Sen$or(~). Mod~l: ,..,'ii' :;f; ':G;r ":Val~*). erShcar Valve(s). " :,' ~cnscr COn alnment Flail! s and Chain $ . ,. .'. Q Displ:lISer COht!inment PIQ~t~s) ~<I Chain<'l' J , " :~~~HD: ..', ,'......' _ Db:penscr ID; ..._ .,2£_"2:: 2 ' ¡ "~ ".' : ' ~s,pçIlJ;er Contalnmcnt S~nSor(s); . MO<Iel: ,_ C ~<:n:Jcr COl'\utlmntnl š'énsor(s). Model:_ . ,!:,¡ :~~t~': Vtlv<:(s).'·, ~hear Va/vo(s). , . ': ¡~L ;: Ci,ttir.pcoscr ÇontD~mcnt Floaf~s) I1.9d Çhoon(s). ....._ 0 Di~ enm Cuntalnl1Umt Plolù s ¡¡nd Chaln~$). ,') ,~'~~ (~~~I.~~~':,i.l\tY'eonta!nS morc'tanks ôr'öi5pc:i'iácrlþ ~p>, t~Ì$ form. Include infòrrl"lotion for every t,lnk find dlspCln~r at the facility. ¡~:; ,¡ç~lÇ~i,tiqcation . I certify tJ.~t the cqalpl,*ent Identified In this document WAS In$pC!ded/$~rv&éed in aCcordalu:e w.lt~· the ¡, ' I ~t'UIAI~"ráétl1rers' &utd~nt$. J\Ui',cþt4..to th~ C4~cad4)n I, Information (e.g. IDaU\JfactuTèr8' checkJisC$) nl.~esltBry to VtrUy Ulat this ; " . !~r..fl(~nnatlon Is eorrcct ,and &,:Plot, PIIµ1 s,b~wblïl ,the layout ot mÒJ\ltorhlg cqUIP~cnt. ~or I\D)' ~1.I pmtnt capable 'or &èneratJl)g such , j' ~~ort9. I bavo also atü.cbJ'f4 )f;J>'11 tbe174êm ø.U t(.at IIJ Ply)~ a SY' Z,Jct.gÇ --Q ~~;)' report ,·,·rINN~W~IlName(p'in~):_U . ~ S{gl\nturc; _ . ~:L~ ~~~.£. , , ~~llji<=,atÎon No.: ø.Þ.:::Of:"712~· , ~__ License, No,: . ' ..~ilÆ&Z -- """ "'1tt.~V18'COmpanYN:~e:'T-~SÆ .. _¥'" ..". Phone NO.:(4?JP-L>~(q<f~7:;, Sfr4: ^d.dms: ø6Ø~£«ß#~4~ ¿ Dote oCTesling/SclVìc:in3: 4-/~i~ ......~ I ." ,~ Page t of ;, 03lQ t , ¡:.', Ø5t~nl,~~,~lnl.SY~tem Certißça(ion ',/<:: : :: ~.1,~ .;-" " " íì ~ OCT- 4-04 MON ~4:41 FROM B.S.S.R. J:NC. P.07 :Q~f>~g,I.~,s, afTesting/Servicing , i!\J:~'r'1/"f'ìon 1....lIed: I L9....ø~ --___...,~ j .~Ç.~~\~~~\}:~.lhe CQUowin çhecklM: "'._~. ----==--=-=,_'"'~~=.._ ..~. ,.,....=~.._==_''''''''''"...--==---'== ,'_ : ': . .. :!l ~'Q 'No' ts the audible alarm 0 lratlonal? · 'I'j~! 0: . No" Is the visual alaL"m 0 e~ational? ,-....----,.-,--- ';:::.' ,:¡,':~,j;~ ~'O' No' Wert. a11 scnsors vÎsuaqy jns~ccted, tùnctionall~ tð8'c¡r~1tirmc:d~~~;ration~___ · '; 'v j¡ :~,f'!~ ,j a: No" Wert. all sensors inståJJcd at lowcst point of secondary containIn!nr and positioned so that other equipJ'ncot will ¡. ~, ' ':. .: not interfere wítJ's t))cir ro er 0 eration? , 1~"'1-"'!"'?~ ,---- ,.-----......-..' .....-.- - ¡ :n~;v.~ :: ; q No'" If alarms are ~laycd to a rðmote monitoL'Ìng statiou. is aJl COITImulljc:ations equipm~nt. (e.g. modem) , '::':, ': :', ;~~.. N/A operational? : ~.'~¡~~l\; :;'9: ,'NO* Pbr ~..e5;Sl.U'Izod piping systems, does the turbine ãù&>maticaJ1y-šiiüï dow:a if the pipi.ug sccoiídåry containment ; ,I: .. !:' : .' :,;,¡ 9' ,N/A mODltOrlng systtm detects a leak, fails to operate. or is eleCtrically discolmected? 1f yes: which sensors initiate , ., '. positive shut-down? (Check all that appl'Y) ß1 Sump/Trench Sensors; 0 Dispenser Containment Sensors. ::.1.. i"!', ~ ' Did ou confirm ositivc shut·down due to feaks '). sens r failureldiscon.nectïon? Yes' 0 No, : ;,f:y:i/VFt: ': ::·9: :No·' Por tank systems that utiUze the mOnitOring system as tbe primary tank ove in warning device (i,e. 1\0 · !\; ~:~ .',: ~ ';!¡ ~ NI A mcoh'anical overfi1t prevention valve is Lnstalled). i8 the overfitl warning al3Tm visible and audible at the tank , .,' f111 oint s and 0 elating ~crly? If 90-, at what pf:Jcent or tank capacity does the ,darrn tri or? % Was any LUonitofint equipment replaced? Iry~. identify specific $eMora, probes, Of other equípmeL\t replaocd .¡ . , , , a):1d list the manufacturer )IU)\C and model Cot aU lac¢Inent arty in Section E below, ;: ~:Ffüf.fr~, J! Ñ()" Wd liquid found Inside any 3c¢ondaxy contai~ment .systems designed as dry systems? (Chack allthar apply) :'..1 " ,;, , ' . a Product' CJ Water. If os describo CI\USCS in S¢ction E below. :'I~ ~~ikr~: 0' :No', W,as monitorin' .8 st~m set-u review 0 ensure ro er settin ,? A~b set u. re 011$ It' 8 ¡¡cable . , ' ~'", i 0, No! Is aU mo:nítor!.n e W n1ent 0 rational er manufacturer's s ~Clf¡caaons? ':or' . ~ -- .... ...._._~UI\4'.czM;~~,,'I;tUØIL.J.:.aI.:~~J.C , " òw. describe how and wben tbcse dtt1dcncies were or will be correctcd. : ';~¡h ,(;t{~»in).cnu: · . I ' . ...._.. .M....___ .." ..... '._...~, .__...... ··M _.__. ..-r....."':~....--- _."..,.........__---.. H ,.. ..,... ...,..........- ~._.~-.,.. , ..... ..........-..,. .._~..... ,,-...... --..-............-'.....-. ..-.-.,-......., ..-....-.. . -~r··'i·..~.......-- . .' .-.'''.--'-'---.--'''-', .,._...~...,t··....·f ......,..._,~ '........, ,.._...._.. '4' .......__..." , ~.~~~.~.. . --,-,--' . ..-.....,.."....... ...,._,--- , " ........._.., .u~''II' .,.-___...--.--- .~.;~...~... "_H .. ." ,.,... ...... -'__1_"" ..'..··.1'--..'··...,..-··-' . '.... .._ I...... ........ ._..I......".~ '._..' I,' .....,.. "...--_....~-_._... -.-.....---- .,-~~........., ~-- .....-...-.- ...-." , '.' , . ',' . ...... . ..-----...-....----- ,.....,-¡_:._.y..- ,. ,,,....,....' .. , ,... ".....__.'., ......-.........--.............--.-.--- ...........¡...._.. ......--..'..- .. ,.'. ,...-...,.--.---..,-.- ..~~....I'" "...--"..............-...--... ,-~....._--........-..... .- -, .~ ,-_. ...."... .............--- "-T~""~'''--.. .._,.-...~..." ---""", ,'. ..... ..- ....------..---..... ...--.--- ---.....~...!...._- ,'., ,. ..' ..-.------.. '~..h'.."~OJ..~ , ....._--,- -.--- Par:e 1 of 3 03/01 " õ> OCT- 4-04 MON 14:42 FROM B.S.S.R. INC. P.08 F¡.. ~~tf,ßJ,I,t. C~,~giog I SIR Equip'J1Wnt: '. ' tJ Chec1c rh.is box if Lank gauging is used only for inventory control. [J Check this bOlt if no tank gauging or SIR. equIpment 1s iD,$tallod. This $.~il~ij9n,must be comp'Jeted ifin-~k ga,uging equipment ís used to perHmu leak detection monitoring. C~~~J~t~ th~ folJow1n checklist: , --=_:..........:..~____,."è;n~-"=.' .·_~·_.~~~.....~w=_.~¡ ..:.'~.<C..' " ' ,. ;': ,; ,1:-lo·' Has aU Input wlrin '\:¡een Inspccted for proper entry and termination, including testing fol' ground faults? ,: ......! ,!.: ,Nci*· Were an ~nk gauging prøbes v~aJ1y inspected fQr damage and resi<fue buildup? , ,.fi.'f.;~; ,.. ':':", " :.: 1:'10'" Was accuracy of s)'sten:i prpduct )QvQl readings tested? ",~~;. ."..,' : :N.o"'· Was acc:µ~cy of sys~n¡. wat~~ levcl readings tested? "-'--'--"" -.,., -- . ,~':~, ,,;,!~ ,¡RJ, ,No· Were all probeS rcÎD~talIod, ropérly? .,---.-..."." ...-. :!\'.......~.. . . -.....-.-.,,-,--.. ... - ", ",:~'X:, ,;, ~ " , ;No·: Were aU ite~ on the, equipméøt manufacturcr'6 ¡naíntcnaIlce cbeckli$t completed? -", 't~f~4.., "1" ßp. 'H~ belowt describe how and wben these deßdèiiciêš-w-:;õr:\vml;~r-~" . q., ,~lp',~,~E!a1{ Detectors (LLD): C'iM~~ wi h ~.~..:t",.~ t ':~~:;t4~:i p Check this bo't if LIDs are nt)t installed. " të th~ CoUo níl c ccldlst: ~;,:;O' No· ; ~,.r-'ñ~·~·-'~ ...--._......~S'.::.:a-III I ~¡; ~~,.t"';l.:'~~__~_·ro....._rtt:cr.-.;¡;~~ ','9' For eqUipinònt Stan-Ü.li:'ò:rå.nin~al e<¡uipmcnt certaicatioo, was a Icalc simulated to ve.ri{y [JJ) perfonnancd ¡~' ,:,NIA (Check tùl,tnat apply) Simulated It;ak rate: "3 B.p.h.; a 0.1 g.p,h: CJ 0.2 g.p.h. , :'M ' , i~-';ªV -. -- .....--. ~ ::"'" .,o:~' Were all µ..D,s conf'mn¢ Oþ~8ti0na1 and accurare within l'egulatory requirements? '~Q::'No=" WaJi the testing appa~atU.s pi'()))crly ca1ibxt\tcd? . ~ '." . "..' . , ;, ~'Q' 'No*" For ~cal LLDà. døes the LLD restrict product flow if it detcc~'â leak? If 11.. ,', ' ;' ;'C¡i-N/A ;, (g': No· Por electronic LLDs, docs the turbino automa.tica.l1y shut off if'the LLD detccts a leak? i>~.tii "N/ A . ;"-:'Jg' No· For electronic L~DSt docs the tur\line autQmaûcaUy .sh~iõffiTa:;"ÿ'¡;ö;:ïion of the monitoring system is di~bled ~',ø N/A or wsco.tW.CCtcd7 .- doC$ the tuIbine automatical1Ÿ" hut off Tfãny POrtiOD otthe m.onitoring system :;~~'~j~ For electronic LLDs, mnlfunctio~ or 1\i1s a tost? h :,~L:... Por eleç\t'Qµic LLPa, have aU accessible wiring connectiõñSbCë;;[Šuâfiý inspected? .,..,~ No· !\f..,. ' fA ";" Nt, Were alt items.on the equipment manufacturer'. mainteJ1anê'êÕheékïist completed? ¡~ ',ª No· ~."~ . " , ' :. ::', "" -,.-v- -w- .1~"Q~"d~~J....-.,.,..,.~~~It>.._.."U: '-~î'~~ " :.:" :tf:;; , "" :f~~J]'\r~>'1~µ9Îl Bt.below, dcse,lbe M~.~ij w~en these defide~cles 'Were or wiJI be Clørrcdcd. ;; , .~.. ,(:~1.~¡};~~:nts; . 'I'.~:'~" ,.;rr'I'~.r ". : I . ~.-.6."""~";".J:I -.......-. "'.--" ...-....-"..".. ,..-....-, -. "...-.,,------.... .. '. '>', ~: ;:'.;~ ' , ._..,. ...M._...... - ...._..._.,_ o. .", ,..,..-.--... -...-.---............ --.-..--:..........- ----:-t"".~'~ . ~ ~~¡::!~f:~ --..'" .,'- ...... -. ....-....-.-.. -- " ~ . ' -....-.....-'..1ye _., _.. ......___ ..,.. ,I" ..-.. .--...-.......---....... - ,....-......,.-...,... "',"',,,."'" ..- ..........~.._......." " . 11 " .::.. ,_......"..-... .,--..---.--- ",. I . ~ _...__......_..,~ .' J. -.---...- ... --. . ..; " ;;.;" ._--"..~ , " __.. A...... , ._.., ," ,'. ...._...._...__ .. ,~' " . Page 3 of 3 03101 ';' ¡, , ~ OCT- 4-1134 MaN 14:43 FROM B.S.S.R. INC. p.a9 " ~.¡)¡~~t,:pr.Jn,g System CertUic:atlon :~i~ ,A.ddress: , . .: I"~:'" I , , 3.;tOO 'f . UST Monitoring Site Plan s:t12~E'T ., _... .._-~_.,_._". . ---~ , : : . ,'\. ~' . , , , , .. I , ~'\ol~' : ",:rt"Ml: .,' ::·····N·· ,..', ~ I; : ~.. . -.::s" E, " '''::~I~:::: , , :0' . : PI~ N(': : ,:$: .. . , . , .; 1\11~P,.. , . .. :SE;W~O(\ , . ...., f . .. . . . t . . . . . . , 'e t6 , , '!.\o. . . , . . ::' , , , . . " S t:j: : ' , ' ð.'i . -. , . . . , . . '~r')1'~ . ¡'~r{'I , ; ¡, . , t't.. · . . . , . . .. . I ..;..~..; ,¡"f',~ib , · . . . , . . I , . . . . :~, , . ; : Ej'~" . " , , " \I~' ~ , ..,!' . .,.' , , , I . , I .. ....., . . . .. . . . , ¿f ~ð, , . . . . , , ·e~·' ..¿~.." .' .. ~t-q....., . , :,'0:. :: di'~": .. .... . .. . . '~' ' , , ' , , , 'V-~ 0 S1q' , . 0 : : ~~:\'1): g: t. ~ 'P' .. 40 . . · , : 5 rOQ:E: 40 , . , , . . . . . . . . . . . , I , , <I . . .. . . . . . '" .. .... I . · . : . .. ~~. I . .. . , 'S'" ~...~...\.. : ~ :: o~' ... .., I I .. . . . . . . . . . òoP·t.O . ' . Or . .' ~'( ~ , : :: .,. ~Vlt\.() , . . . . . Da~c: mJiP was draWIl: ..9...JJ9./-ºf. Instructions . ':#:*øµ,:~ltC:\3dy have a diagram that. shows all required infonnation, you may Include it, rathe.r than this page. with )'our : ': :~t~\~9.ri~~ Syste,m ce:n~cati?n,: On .)'~ur site plan, s~0v.: the general layout of tanks and pipin~, ,Clearly identify j09~\f.jß~s of the fol1o~~$.eq~l~~~nt, .f ~nstalled: momtonng system ~ontrol panels; sen$Qr~ momtonng tank .annula.r . ,,~!~.w.~i#.% sumpSt d~sp~ser p\U}s, $}>.111 contamers, or otbè1' socondaty contaU\ment areas; mechanioal or electronic ¡me leak , ,,!dt;:~~~-òrsi and in.tank liquid level probes (if ustd for leak detection). In the space provided, no~ the date this Site Plan ;~~ ~r.epared.· . , ' Page _of_. 115100 ~¿} 1~ /'OCi I PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK Bakersfield Fire Dept. Environmental Service 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 PERMIT NO, I to T m - 0 37 ~ TYPE OF APPLICATION (CHECK) o NEW FACILITY ODIFICATION OF FACILITY o NEW TANK INSTALLATION AT EXISTING FACILITY EXISTING FAClUTY PERMIT NO, BRIEFLY DESCRIBE THE WORK TO aE DONE ' /~~¿n77¡t;AJ tJ~PW IJ¡Rg-cT!?U£'Y pV~ /drJJ¿- ro _ ~ Cð/l/ c:æ-,-- I' NO OF TANKS TO BE INSTALLED SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE DYES 0 NO THIS SECTION IS FOR MOTOR FUEL. TANK NO. VOLUME UNLEADED ~g: 5/< <.PI;' REGULAR PREMIUM DIESEL AVIATION -/ .:Jrf3 x ~ ?\. THIS SECTION IS FOR NON MOTOR FUEL. STORAGE TANKS TANK NO. VOLUME CHEMICAL STORED (NO BRAND NAME) CAS NO (IF KNO,^",) CHEMICAL PREV10USL Y STORED FOR OFFICIAL USE ONLY I APPLICATION OÞ.TE I FAClUTY NO, I NO. Of TANKS I FEES $ The applicant has received. understands, and wi" comply with the aI/ached conditions of the permit and a /olhe slate, local and federal regulations, This form has been completed under penalty of per), and t th est of my knowledge, is true and correct, M II) ~ THIS APPLICATION BECOMES A PERMIT WHEN APPROVED ~ -<~,' . -..... , t -~,.' ---,---.-- ---------,. - ----...-.----- _ _ __ ."_U__ -_.---_._--~-- -- _.- --' --- ----_.."--- -. ._.~ - -- - --------- -0 _ __ __ _ __ 0---' _.______ Ñ¿L...,.........- . --- --------- - _. --. -- .-- -- --- ,.-". - -- --" --. - . . J M I J{E.. S...., ----'.-- ,- Eoo.l> ANJ),I-UlrJ.0R.- -,..-.-.- ~.Q.~. ,... .... ._ __..f?/iNAmtL-kN........ .... ----,---- .- .. . -' ............-.::>- ~ .. ï/}j. 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'.---......,2 c'tll''::I'lO 86-0Z-.:::>O 10/07/2004 08:45 6618363177 REDWINE TESTING '2NCS PAGE 02/02 '-""" CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester A ve., Bakersfield, CA (661) 326-3979 APPLICA TION TO PERFORM FUEL MONITORING CERTIFICATION FACn.JTY --... YOÞ\s 3tJ...u... ~moh,l ADDRESS_~ÖO ~#... ;5+r ~-t ~' 'Rea. \c.~r-s.Ç I~ ì CA 9"330 I OPERATORS NAME ' L~A. OWNERS NAME ' Mr Yf'JfJ NAMBOF MONITOR MANUFACTURER Gd~rr.1l DOes FACILITY HA VB DISPENSER PANS? YES_ NO_ TANK it VOLUME , ~o r:... '----'" ..2 10,,"- -3 ... SI( CONTENTS 11. U" \rJ 'ß'q Pi \.L~ q l... P"-ffl' NAME OF TESTINO COMPANY 1<dw tr\f... Te.~t ''j , ~«ú 'l' l..S} II\L . CONTRACTÇ>RS UCENSE# 5"3~31í' A H4+-z.. NAME &. PHONE NUMBER OF CO NT ACT PERSON b~(lh -r u..t"I\f'r ~~l... ~.34... "q'!.S DATE & TIME TEST IS TO BE CONDUCTED IO~ t~ wo'-l, J{}l(J{J ¡::)M .J, dt/lM£) APPROVED BY IOr1-o1 DATE ~7~ IONA TURE OF AP~UCANT J -