HomeMy WebLinkAboutUNDERGROUND TANK #2
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LUCKV 7 19
:330 1 ~'J I BLE RD
BAKERSF I ELD CA 9:3309
661-397-4553
AUG 3. 2004 10:41 AM
I
8'iST£rvl STATU~3 REPORT
- - - - - - - - -,-
PAPER OUT
PRII'HER ERROR
INVENTORV REPORT
T 1: UNLEADED
VOLU~'1E 4084 GALS
ULLAGE 6287 GALS
90~~ ULLAGE= 5249 GALS
TC VOLUME = 4001 GALS
HEIGHT 39.51 INCHES
'-ÞJA~E~\10¡:----:=~Ö~-;At3-
WATER 0.00 INCHES
TEMP 88.9 DEG F
T 2: PREI" I ur'1
VOLur1E
ULLAGE
90% ULLAGE=
TC VOLUME
HEIGHT
WATER VOL
WATER
TEt"ll:>
T 3:PLUS
VO LUr"IE
ULLAGE
90% ULLAGE=
TC VOLUI"1E
HEIGHT
WATER VOL
vJA TER
TEMP
3'388 GALS
6383 GALS
5345 GALS
3905 GALS
38.81 INCHES
o GALS
O. 00 I NCHE~3
89.7 DEG F
4472 GALS
5899 GALS
4861 GALS
4:372 GALS
42.34 INCHES
o GALS
0.00 INCHES
91.8 DEG F
~ ~ ~ ~ ~ END ~ ~ ~ ~ ~
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CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave.. 3rd }<'Ioor, Bakersfield. CA 93301
FACILITY NAME l ..J.Aé,J-~..17 :¡t ''1
I
Section 2: Underground Storage Tanks Program
o Routine iJ Combined 0 Joint Agency
Type of Tank 5> V\) ~ (ß. R.)
Type of Monitoring AT CJ"f
INSPECTION DATE <fJ/~lo4-
o Multi-Agency 0 Complaint
Number of Tanks ~
Type of Piping $\Aj 5 (C.. P,)
ORe-inspection
OPERA TION C V COMMENTS
Proper tank data on tile .J
Proper owner/operator data on tile X
,
Pennit fees current ~
Certification of Financial Responsibility i
Monitoring record adequate and current ,k'
Maintenance records adequate and current X
Failure to correct prior UST violations X
Has there been an unauthorized release? Yes No -X
Section 3:
Aboveground Storage Tanks Program
AGGREGATE CAPACITY
Number of Tanks
TANK SIZE(S)
Type of Tank
OPERA TION Y N COMMENTS
SPCC available
SPCC on tile with OES
.
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?
If yes, Does tank have overfill/overspill protection?
C=Compliance
V=Violation
Y=Yes
N=NO
Inspector:
Office of E
i-~ÀJ'S~ '
Business Site Respon ibIle Party
Whitc - Fnv. Svcs.
PinK' Busincss Cory
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UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1 Business Plan and Inventory Program
.. Bakersfield Fire Dept.
~ Enironmental Services
,-/
1715 Chester Ave
Bakersfield, CA 93301
Tel: (661)326-3979
~,:::=~~~~J~-~x==~_--=_-==~-_~=~~~~!~~~~_~::~~~~-
.
Section 1: Business Plan and Inventory Program
.
LI Routine
~ Combined
CJ Joint Agency
CJ Multi-Agency
CJ Complaint
CJ Re-inspection
C V ( C=Compliance )
V=Violation
OPERATION
COMMENTS
,fy 0 ApPROPRIATE PERMIT ON HAND
-~_._._-~--.-~---------_.__._---_._---_._--, ------------.--.-..----.-------..
fM LJ BUSINESS PLAN CONTACT INFORMATION ACCURATE
-~~ ~------ ----.----.-------- -- ..- -.---...--. ...----.. .-----
CJ VISIBLE ADDRESS
...._._ _.__._____+. ·__.__._.n.___..____
'-'---'-'--' .....
....... ...-,----...--,.--...
. - -....-..--.--.---- ...--------,-.--.-
...-.. -....---....-----..
- ...n........_..
·--·--_·____·___···"_____·__________·____·...__·______d
. _ ._..."_____________."___"__ m" ~__. ____~ __.. n_"__..".".._____ "_~_~._._
XI 0 CORRECT OCCUPANCY
.+-----------~-------------~--_._._-"._------~-
o VERIFICATION OF INVENTORY MATERIALS
..-__...__.."__..__._.."_._"____..._.. __..._____"____..._.______~..__ ._.______."."_. m____.._.____~___" .__.."."_ __...."_
~~ -----------_______._________.__..___n_____.______ .. ____"__"_ _"U_ __" ----" " _" _____.__". ~. h_______._.__ _. _________...."_."____. ...~_. ____..___. ..__..._ u.."
CJ VERIFICATION OF QUANTITIES
-"~. --..--...-.-~-.----_.------..--~-".-.--.- ..--..----------....--.."..-.---------. -----.-~-___._____ ___" _..___...__. ________m_._.~__.____.____" "__ _. __"....n..__ "__
~ 0 VERIFICATION OF LOCATION
-¡\fa~R~~~~GRE-;:,O':~;;.:;;~:---~-~--- 1--- ~-- -. ..=~~-~=~m _
~__ CJ ~_~~~~~~TION OF ~_~~~ AV~L~~~~~_~________________n _ _______________ _____________ ____ _ _n___ __ _ _ ________
~__~_~_RIFICATION OF ~~~~ TRAIN~~~__________.____n_____.________________________ _______________ n______._ m__ ___
_ t~- VE~'F'CATI~N O~_ ABAT':~~T SUP~=':~~~~!~C~~~~':..S__.____________.___________________ _____n__ ____________ _.. ________
bt CI EMERGENCY PROCEDURES ADEQUATE
-~-,-------------------.------ .--..-.-.----.....-. --.----- ------------- ---------.. __.__+..._m___ n__._ . ... _. _. .___ .._.__..n.._ ..__.____m_.... __ _ _ .... _.... _. .___ ._. _.n _~ '._ ____
Ii 0 CONTAINERS PROPERLY LABELED I
tD~~ous;~;~;'"~.-==-=-=-_-==u= ·~j~-=~=-u=_=-===~=-=__ _. ._........ ....
~~~-~--~I~~~?~:CT~~~--~----~---------------- ____________ _____________ -_______________________n__ ________n___ _ _ _ ....._n ___
)( 0 SITE DIAGRAM ADEQUATE & ON HAND I
ANY HAZARDOUS WASTE ON SITE?:
CJ YES
þo
:1 (~ /5/vt/D4--
/
EXPLAIN: '"PV\A~~ 1/'-:1... duE. ...dfc.r
ß
NG THIS INSPECTION? PLEASE CALL US AT (661) 326-3979
~~ss~..
While .. Environmental Services
Yellow .. Station Copy
Pink.. Business Copy
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MONITORING SYSTEM CERTD~ICATION
For Use 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 A seoarate certification or report must be oreoared
for each monitorin2 ¡¡ystem 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: htJC,¡( y 7 ¡IF /?
Site Address: .33 0/ ú//ß¿¿r A-.tJ
Facility Contact Person: ~}., ba'L.
MalœIModel of Monitoring System: t/#.. 7Z:s. -.3SO
Bldg. No.:
City: ß4~e-AS'F£~ Zip: 95309
Contact Phone No.: (~/ ).397 -ý'~'::"
Date of Testing/Servicing: ~'(¡ø
B. Inventory of Equipment Tested/Certified
Check the a boxes to iDdicate .
~ UN(... Tank ID:
" n- Tank Gauging Probe. Model: .Á"JIN# . ~ank Gauging Probel ·s MModel:
... Annular Space or Vault Sensoi'. Mòdel: ./- I;;L~DJlularSpaceorVau tensor. odel:
~pingSump/TrenchSensor(s). Model: "'..A <"y ~pingSump/TrenchSensor(s). Model: ~ ~ .
1:1 Fill Sump Sensor(s). Model: 1:1 Fill Sump Sensor(s). Model:
1:1 Mechanical Line Leak Detector. Model: 1:1 Mechanical Line Leak Detector. Model:
1:1 Electronic Line Leak Detector. Model: 1:1 Electronic Line Leak Detector. Model:
1:1 Tank Overfill I High-Level Sensor. Model: 1:1 Tank Overfill I High-Level Sensor. Model:
1:1 Other . . t and model in Section E on P e 2 . 1:1 Other . ui t and model in Section E on Pa e 2).
T-.ID: S ' Tank ID:
e:fIn-TankGaugingProbe. Model: ~ 1:1 In-T
1:1 Annular Space or Vault Sensor. Model: 1:1 Annul81'S Vault Sensor.
..a1\Iping Sump I Trench Sensor(s). Model: ~ L""", 1:1 Piping Sump I Tren
1:1 Fill Sump Sensor(s). Model: 1:1 Fill Sump Sensor(s).
1:1 Mechanical Line Leak Detector. Model: 1:1 Mechanical Line Leak Detector.
1:1 Electronic Line Leak Detector. Model: 1:1 Electronic Line Leak Detector. M
1:1 Tank 0verfiJJ I High-Level Sensor. Model: 1:1 Tank Overfill I High-Level Sensor. Model:
1:1 Other (s . ui t and model in Section E on Pa e 2 . 1:1 Other s . ui ment and model in Section E on Pa e 2).
~ ID: 'z.- Dispenser ID:
IiiI'15ispenser Containment Sensor(s). Model: 1:1 Dispe
~œarVæv~~. I:ISœarVæ
1:1 Di Containment FIoat(s) and Chain(s . 1:1' Con .
a; ID Dispenser ID:
'spenser~ntainment Sensor(s). Model: 1:1 DispenserContainmen
Shear Væve(s). 1:1 Sœar Væve(s).
1:1 Dis Containment Float(s) and Chain s). 1:1 Di Containment Fl
Dispeoser ID: Dispenser ID:
1:1 Dispenser Containmen 1:1 Dispenser Containment Sensor(s).
1:1 Sœar Væve(s). 1:1 Shear Valve(s).
1:1' serContainmentFloat(s) s. --I:IDi ContaìnmentFloat(s)andChains.
·If the facility contains more tanks or dispensers, copy this form- Include infonnation for every tank and dispenser at the facility.
C. Certification - I certifY that the equipment identified In this document was Inspected/serviœd in aceordanœ with the manufacturers'
guidelines. Attached to this CeI1ific:ation is Infonuation (e.g. manofadurers' daeddists) necessary to verify that this Information is
eorred aod a Plot Plan showing the layout of IDOIIitorûJg equipment. For 8DJ equipment capable of generating such reports, I have also
attached a copy of the I"epOÂ) (check IIll thøt~l: a'S'ystem set-up ~ bqlbry~"",,-
Technician Name (print): troJJA-t..Q ~.es- Signature: ~ ~ ~ ~ 7.11
Certification No.: 'l~6 License. No.: 81 ;;¡ 6/ ¿,. .
Testing Company Name: Acé J7e-720Lé'c..w1 .s8~GSS PhoneNo.:(¿6¡) ..387·-~S-2-'Z-
Site Address: /SS-i'o ~¡-t¿GßðL þ¿."vd Date of Testing/Servicing: 5í2.Y¡OY
Monitoring System Certification
Page 1 of3
03101
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D. Results of TestingIServicing
Software Version Installed: /6 ".Õ'/ -S'~6:?/~-/oÐ--6"
checklist:
Is the audible alarm 0
Is the visual alarm 0 tional?
Were all sensors visuall ins functionall tested. and confirmed rational?
Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will
not interfere with their ration?
H alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem)
operational?
For pressurized piping systeJns. does the turbine automatically shut down if the piping secondary containment
monitoring system detects a leak, fails to operate, or is electrically disconnected? H yes: which sensors initiate
positive shut-down? (Check all that apply) a1;umpffrench Sensors; et"'Dišpenser Containment Sensors.
Did ou confirm itive shut-down due to leaks and sensor failure/disconnection? a1'es; Q No.
a Yes a!iP* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no
B"'N/A mechanical overfill prevention valve is installed). is the overfill warning alarm visible and audible at the tank
fill int sando ratio rl ? H so, at what rcent of tank ca ci does the aJarm tri er? %
Was any monitoring equipment replaced? H yes., identify specific sensors. probes, or other equipment replaced
and list the manufacturer name and model for all lacement in Section E. below.
Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Q
Product; a Water. H es, describe causes in Section E, below.
Yes a No· Was monitorin s tern set- reviewed to ensure r settin ? Attach set u
Yes a No· Is all monitorin ui ment 0 rational manufacturer's s ifications?
... In Section E below, describe bow and when these deticiendes were or will be corrected.
a Yes
a,No·
a"N/A
a No·
aN/A
Yes
Q Yes·
Q Yes·
E. Comments:
Page2of3
03101
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F. In-Tank Gauging I SIR Equipment:
l3'Check this box if tank gauging is used only for inventory control.
Q 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 perform leak detection monitoring.
checklist:
Q No· Has all input wiring been inspected for proper entry and termination. including testing for ground faults?
Q No· Were all tank gauging probes visually inspected for damage and residue buildup?
Q No· Was accuracy of system product level readings tested?
Q No· Was accuracy of system water level readings tested?
1:1 No· Were all probes reinstalled properly?
1:1 No· Were all items on the equipment manufacturer's maintenance checklist completed?
... In the Section B, below, describe how and when these deficiencies were or wÐI be corrected.
G. Line Leak Detectors (LLD):
~k this box if UDs are not installed.
Co the f; n . checklist
mplete 00 IVÙI2 I :
Q Yes Q No· For equipment start-up or annual equipment certification. was a leak simulated to verify u..D perfonnance?
Q N/A (Check all that apply) Simulated leak rate: Q 3 g.p.h.; Q 0.1 g.p.h; Q 0.2 g.p.h.
[J Yes [J No· Were all U..Ds confirmed operational and accurate within regulatory requirements?
Q Yes Q No· Was the testing apparatus properly calibrated?
Q Yes Q No· For mechanical U..Ds, does the U..D restrict product flow if it detects a leak?
1:1 N/A
1:1 Yes [J No· For electronic lLDs, does the turbine automatically shut off if the U..D detects a leak?
1:1 N/A
1:1 Yes Q No· For electronic lLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
[J NlA or disconnected?
1:1 Yes [J No· For electronic lLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions
Q N/A or fails a test?
1:1 Yes [J No· For electronic UDs. have all accessible wiring connections been visually inspected?
1:1 N/A
1:1 Yes Q No· Were all items on the equipment manufacturer's maintenance checklist completed?
... In the Section B, below, descn'be how and when these deficiencies were or wÐI be corrected.
H. Comments:
Page30f3
03101
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, Monitoring System Certification
Site Address:
¿:t/c..~ 7fF UST Monito~~Site Plan ~ )"
r '/9 I S:w¡ I.~)?Þ I - , h~¡C+-- 933-Yj
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Date map was drawn: Sf z'/¡ 0'1.
Instructions
If you already have a diagram that shows all required information, you may include it. rather than this page, with your
Monitoring System Certification. On your site plan. show the general layout of tanks and piping. Clearly identify
locations of the following equipment. if installed: monitoring system control panels; sensors monitoring tank annular
spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak
detectors; and in-tank liquid level probes (if used for leak detection). In the space provided. note the date this Site Plan
was prepared.
Page 1- of X-
05100
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SYSTEM SETUP
- - - - - - - - - - - -
MAY 24. 2004 2:21 PM
SYSTEM UNITS
U.S.
SYSTEM LANGUAGE
ENGLISH
SYSTEM DATE/TIME FORMAT
MaN DD 'IY'N HH:MM:SS >eM
LUCKY 7 19
3301 WIBLE RD
BAJŒRSPIELD CA 93309
66J-397-4553
SHIFT TIME 1 6:00 AM
SHIFT TIME 2 DISABLED
SHIFT TIME 3 DISABLED
SHIFT TIME 4 DISABLED
TANK PERIODIC WARNINGS
DISABLED
TANK ANNUAL WARN I NGS
DISABLED
LINE PERIODIC WARNINGS
DISABLED
LINE ANNUAL WARN I NGS
DISABLED
PRINT TC VOLUMES
ENABLED
TEMP COMPENSAT ION
VALUE <DEe F ): 60.0
ST ICI< HEIGHT OFFSET
DISABLED
DAYLIGHT SAVING TIME
ENABLED
START DATE
APR WEEK SUN
START TIME
2:00 AM
END DATE
OCT WEEK 6 SUN
END TIME
2: 00 AM
SYSTEM SECUR I TV
CODE : 000000
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IN-TANK SETUP
------
T J: UNLEADED
PRODUCT CODE
THERMAL COEPF
TANK DIAMETER
TANK PROF I LE
FULL VOL
71.3 INCH VOL
47.5 INCH VOL
23.9 INCH VOL
. Jl:.QßT SIZE: 4.0 IN.
WATER WARNING :
HIGH WATER LIMIT:
MAX OR LABEL VOL:
OVERFILL LIMIT :
HIGH PRODUCT
DELIVERY LIMIT
LOW PRODUCT .
LEAK ALARM LIMIT;
SUDDEN LOSS LIMIT:
TANK TILT :
MAN I FOLDED TANKS
Tit: NONE
LEAK HIN PERIODIC:
LEAK HIN ANNUAL :
: 1
: .000700
: 95.00
4PTS
1 0371
9227
5196
2034
9496
2.0
3.0
1 0371
90%
9333
95%
9952
10%
1037
215
99
50
7.25
.,
lœ~
1037
10%
1037
~~"""""~"~~"'-'''''~..~~.
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TÈST FAIL
ALARM DISABLED
ANN TEST AVERAGI NG: OFF
PER TEST AVERAGI NG: OFF
TANK TEST NOT I PY: OFF
TNK TST S I PHON BREAK: OFF
DELIVERY DELAY : 15 MI N
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T 2:PREMIUM
PRODUCT CODE
THERMAL COEPF
TANK DIAMETER
TANK PROFILE
FULL VOL
71.3 INCH VOL
47.5 INCH VOL
23.8 INCH VOL
: 2
: .000700
: 95.00
: 4PTS
1 037 J
8227
5186
2034
FLOAT SIZE: 4.0 IN. 8496
WATER WARN I NG :
HIGH WATER LIMIT:
MAX OR LABEL VOL:
OVERFILL LIMIT :
HIGH PRODUCT
DELIVERY LIMIT
LôW"PROI>tJcT :
LEAK ALARM LIMIT:
SUDDEN LOSS LIMIT:
TANK TILT
MAl'll FOLDED TANKS
Tit: NONE
LEAK HIN PERIODIC:
.
LEAK MIN ANNUAL :
2.0
3.0
10371
9œ"
9333
95%
9852
10%
1037
275
99
50
5.45
1 0-"
1037
10%
1037
PER IOD I C TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARt1 DISABLED
ANN TEST AVERAG 1 NG: OFF
PER TEST AVERAG I NG: OFF
TANK TEST NOT [F'f : OFF
TNK 1ST S I PHON BREAK: OFF
DELIVERY DELAY : 15 MIN
r..
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T 3:PLUS
PRODUCT CODE
THERMAL COEFf
TANK DIAMETER
TAN)( PROP I L£
FULL VOL
71.3 INCH VOL
47.5 INCH VOL
23.8 INCH VOL
: 3
: .000700
: 95.00
4 PTS
: 10311
8221
5186
2034
FLOAT SIZE: 4.0 IN. B496
WATER WARNING :
HIGH WATER LIMIT:
MAX OR lABEL VOL:
OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
2.0
3.0
10311
90%
9333
95%
9852
10%
1037
275
99
50
6.25
LOW PRODUCT :
LEAK ALARM LIMIT:
SUDDEN Lass LIMIT:
TANK TILT :
MANIfOLDED TANKS
Tit: NONE
LEAK MIN PERIODIC:
10%
1037
10%
ID37
LEAK MIN ANNUAL
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM D I SABl.ED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAG I NG : OFF
PER TEST AVERAG I NG: OFF
TANK TEST NOTIFY.: OFF
TNK TST S I PHON BREAK: OFF
DELIVERY DELAY : 15 MIN
LEAK TEST METHOD
- - - - - - - - - - - -
TEST ON DATE: ALL TANK
JAN 1. 1996
START TIME : DISABLED
TEST RATE : 0 . 20 GAL/HR
DURAT ION : 2 HOURS
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LIQUID SENSOR SETUP
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L 1 :DISP 1-2
TRI-8TATE <SINGLE FLOAT>
CATEGORY: DISPENSER PAN
L 2:DISP 3-4
TRI-STATE <SINGLE FLOAT}
CATEGORY : DISPENSER PAN
L 3:81 STP
TRI-sTATE <SINGLE FLOAT>
CATEGORY: STP SUMP
L 4:91 STP
TRI-sTATE <SINGLE FLOAT}
CATEGORY : STP SUMP
L 5:89 STP
TR I -STATE <SI NGLE FLOAT>
CATEGORY : STP SUMP
or¡
OlITPlIT RElAY SETUP
- - - - - - - -
R 1: P<>S I T I VE SHlITDOWN
TYPE:
STANDARD
NORMALLY CLOSED
LIQUID SENSOR ALMS
ALL : FUEL ALARM
ALL: SENSOR OlIT ALARM
ALL:SHORT AI..ARt1
I~ ~
,~
'..
SOFTWARE REVISION LEVEL
VERSION 16.04
SOFTWARE~ 346016-100-E
CREATED - 98.08.03.18.43
S~DULE. 330160-010oA
S\'STÐ1 FEATURES:,
PERIODIC IN-TANK TESTS
ANNUAL 1 N-TANK TESTS
PLLD
O. 10 CONT&O. 20 CONT
WPLLD
O. 10 MANUAL&O. 20 CONT
ALARM HISTORY REPORT
----- SYSTÐ1 ALARM -----
PAPER mrr
APR 8. 2004 6:21 AM
PRINTER ERROR
APR 8. 2004 6:21 AM
BATTERY IS OFF
JAN 1. 1996 9:00 AM
* * * * * END * * * * *
ALARM HISTORV REPORT
----- SENSOR ALARM -----
L l:DISP 1-2
DISPENSER PAN
FUEL ALARM
MAV 24. 2004 3:06 PM
FUEL ALARM
MAR 22. 2004 2:13 PM
FUEL ALARM
MAR 22. 2004 10:28 AM
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ALARM H I STORY REPORT
----- SENSOR ALARM
L 2:DISP 3-4
DISPENSER PAN
FUEL ALARM
MAV 24. 2004 3:13 PM
FUEL ALARM
MAY 24. 2004 3:07 PM
FUEL ALARM
MAR 22. 2004 2:14 PM
* * * * * END * * * * *
AlARM HI STORY REPORT ..,
----- SENSOR ALARM
L 3:97 STP
STP SlIMP
FUEL ALARM
MAY 24. 2004 3:07 PM
FUEL ALARM
MAR 22. 2004 2:14 PM
FUEL AlARM
MAR 20~ 2004 10:28 AM
* * * * * END * * * * *
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ALARM HISTORY REPORT
----- SENSOR ALARM
L 4:91 STP
STP SlIMP
FUEL ALARM
MAY 24. 2004 3:0B PH
FUEL ALARM
MAR 22. 20D4 2:15 PM
FUEL ALARM
MAR 20. 2004 10:33 AM
* * * * * END * * * * *
AI..AAt1 H I STORY REPORT
----- SENSOR ALARM -----
L 5:99 STP
STP SlIMP
FUEL ALARM
MAY 24. 2004 3:08 PM
FUEL ALARM
MAR 22. 2004 2: 12 PM
FUEL ALARM
MAR 20. 2004 10:27 AM
* * * * * END * * * * *
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OCT 03 2003 12:27
BKSFLD FIRE PREVENTION
(661)852-2172
. CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 326-3979
APPLICATION TO PERFORM
FUEL MONITORING CERTIFICATION
FACILITY Ll..lc, Ky '1 II- 17
ADDRESS 2¿oJ uJl.ßt$ f.1D. ~I/Á~
.H ". "'. . .. ,.
OPERATORS NAME RD't-J
OWNERS NAME ~y a~
NAME OF MONITOR MANUFACTURER
DOES FACRlTY HA VB DISPENSER PANS?
93.)07
.
¡//¡¿ T1-S 3óO
YEs " NO_
( TANK# VOLUME CONTENTS
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NAME OF TESTING COMPANY A-<:Æ ~617Wi.:€c.J.41 2SG1W1~
CONTRACfORS UCENSE # 8" / 3 ~ tr? A ~2- ~.o ~4b
NAME & PHONE NUMBER OF CONTACf PERSON ~(, /- SJ' '7-662:2-
DATE & TIME TEST IS TO BE CONDUCfED ð- Z'I-o'f
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SIONATURB~~UCANr
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APPROVED BY
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:'iRE CHiEF
:·:U':i'J I-:F~A'::::E
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFETY SERVICES· ENVIRONMENTAL SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 Chester Ave.
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
.
.
Apri I 22. 2004
Lucky 7
3301 Wible Road
Bakersfield, CA 93309
NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE
RE:
Failure to Perfonn/Submit Annual Maintenance on Leak Detection at
the Above Stated Address.
Dear Business Owner:
Our records indicate that your annual maintenance certification on your leak
detection system will be past due on March 4, 2004.
You are currently in violation of Section 2641 (J) of the California Code of
Regulations.
"Equipment and devices used to monitor underground storage tanks shall be
installed, calibrated, operated and maintained in accordance with
manufacturer's instructions, including routine maintenance and service checks
at least once per calendar year for operability and running condition."
You are hereby notified that you have thirty (30) days, May 22, 2004 to either
'perform or submit your annual certification to this office. Failurè to comply
will result in revocation of your permit to opèrate your underground storage
system.
Should you have any questions, please feel free to contact me at 661-326-3190.
Sincerely,
Ralph Huey
Director of Prevention Services
b)f~
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/db
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Law Offices of _
ELIAS Z. SHAMIEH
A Professional Corporation
703 Market Street, Suite 1700
San Francisco, CA 94103
Elias Z. Shamieh *
*Not admitted to practice in California
Practice limited only to Immigration and Federal Courts
Telephone: (415) 777-0700
Facsimile: (415) 543-0891
March 24, 2004
To Whom It May Concern:
~ -:. .:::- ----
I
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This is to inform you that this certain property has been sold and the new owners are:
Pitho Enterprises, Inc.
5640 District Boulevard, Suite 132
Bakersfield, CA 93313
Please forward any and all correspondences to this address.
~.~~,L) \.
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STATEMENT OF ACCOUNT 4IÞ
PAGE
1
CITY OF BAKERSFIELD
POBOX 2057
BAKERSFIELD. CA 93303-2057
( : I . "
CO.l. :
32b-3658
DATE: 3/15/04
TO: LUCj.{'ÿ 7 #19
ELIAS SHAMEIH
703 MAR~ET ST STE 170ü.
SAN FRANCISCO. CA 94103
CUSTOMER NO: 35382/43173 TYPE: ES - ENVIRONMENTAL SERVICES
----------------------------------------------------------------------------
DA TEDESC RI Pi I ON
REF-NUMBER DUE DATE
TOTAL AMOUNT
------ -------- ------------------------- ,---------- -------- --------------
HM007
HMOi7
S8001
S8002
UI001
3/01/04 BEGINNING BALANCE
3ii5i04 HAZ MAT FEE GROUP 7
3/15/04 HAl MAT ANNUAL INSPECTION
3/15/04 CA 8TATE SURCHARGE
3/15/04 UST~STATE SURCHARGE
THIS FEE IS A STATE SURCHARGE OF $10.00 FOR EACH
UNDERGROUND STORAGE TANK.
3/15/04 UNDERGROUND TANK ANNUAL
OPERATiNG PERMIT FEE OF $81.00 FOR EACH TANK.
THIS UNIFIED BILL REPLACES SEPERATE BILLS RECEIVED
¡¡-'j THE PAST FOR THESE PROf~RÅMS.
.00
376.00
58. 00
24.00
60. 00
324.00
'----
ANNUAL HAZ-MAT BILLING FOR FISCAL YEAR 7/01/03
THROUGH 6/30/04-IF RECEIVED IN ERROR CALL 326-3658
-------------- -------------- -------------- --------------
CURRENT OVER 30 OVER 60 OVER 90
-------------- -------------- -------------- --------------
842.00
m'!= DATE: 4í14í04
P A Yi"1ENT DUE:
TOTAL DUE:
842.00
$842. 00
DATE: 3/15/04 DUE DATE: 4/14/04
CUSTOMER NO: '85882/48178
NAME: LUCKY 7 #19
TVPE: E8 - ENVIRONMENTAL
!~~",O-Y -"
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PLEASE DETACH AND SEND THIS COPYWI1H REMITTANCE
, .
0',,'.0.
',1(",',/'\/',,,';;0.",,
REMIT AND MAKE CHECK PAYABLE TO:
CITY OF BAKERSFIELD
PO BOX 2051
BAKERSFIELD CA 93303-2057
(66i) 326-3658
TOTAL DUE:
$842.00
.. . . ... .
U.S. Postal ServiceTM
CERTIFIED MAILM RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
.- . . . , -, , ,
I OFEICIAl USE
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Certified Mail Provides:
· A mailing receipt (_91161:/) <:00<: 9Unr '008f: WJO'¡ Sd
· A unique Identifier for your mailpiece
· A record of delivery kept by the Postal Service for two years I
Important RemInders: I
· Certified Mail may ONLY be combined with First-Class Maile or Priority Mail<ll>. I
· Certified Maills not available for any class of inteníàtional mail.
· NO INSURANCE COVERAGE IS PROVIDED ~ith Certified Mail. For I
valuables, please consider Insured or Registered Mai~. I
I . For an additional fee, a Retum Receipt may be requåsted to provide proof of I
delivery. To obtain Retum Receipt service, prease complete and attach a Retum
Receipt (PS Form 3811), to the article and add applicable postage to cover the I
fee. Endorse mailpiece 'Retum Receipt Requested". To receive a fee waiver for I
a duplicate return receipt, a USPSQ¡¡ 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 I
endorsement uRestrictedDeliveryu.
· If a postmark on the Certified Mail receipt is desired, please present the arti- I
cle at the post office for postmarking. If a postmark on the Certified Mail I
receipt is not needed, detach and affix label with postage and mail. I
IMPORTANT: Save this receipt and present it when making an inquiry. I
Internet access to delivery information is not available on mail
addressed to APOs and FPOs.
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
21 01 "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 SERVI,¡ES
FIRE SAFETY SERVICES' ENYIRONIIE~ITAl SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-~979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 Chester Ave.
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
it
.
October 15,2003
CERTIFIED MAIL
Mr. Elias Shamich
703 Market Street, Suite 1700
San Francisco, CA 94103
REMINDER NOTICE
Re: Deadline for Dispenser Pan Requirements December 31,2003
For Lucky 7,3301 Wible Road, Bakersfield, CA 93313
Dear Underground Storage Tank Owner/Operator:
A review of our files, indicate that you have not completed the retrofit of your
underground storage tank system. Current code requires that you install under
dispenser containment pans prior to December 31,2003.
Further file review, indicates that you have been receiving Reminder Notices
since April of 2002. With time growing short (2.5 months) this office is very
concerned that insufficient time is left for you to hire a licensed contractor and
complete the necessary retrofit.
Currently, contractors are scheduling 8-10 weeks out. I strongly urge you to
complete the repairs as soon as possible. Failure to comply with the state
requirement could result in revocation of your permit to operate your
underground storage tank system.
If I can be of any further assistance, please feel free to contact me at
661-326-3190.
Si~O~
Steve Underwood
Fire InspectorlEnvirohmental Code Enforcement Officer
Office of Environmental Services
SBU/db
""Y~ de ??~ ~p ~OPß y~ A ??enh~"
SENDER: COMPLETE THIS SECTION
· Complete items 1, 2, and 3. Also complete
item 4 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 mallpiece,
, or on the front if space permits.
I 1. Article Addressed to:
I
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~~- --~~~~--
LUCKY 7
3301 WIBLE ROAD
BAKERSFIELD CA 93309
COMPLETE THIS SECTION ON DELIVERY
A. Signature
,ì
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o Agent
o Addressee
B. Received by (Printed Name) Cr::9ate of Delivery
7'ló-v'
D. Is delivery address different from item 1? 0 Yes I
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)s Certified Mail
o Registered
o Insured Mail
o Express Mail I
o Return Receipt for Merchandise I
o C.O.D.
4. Restricted Delivery? (Extra Fee) 0 Yes
2. Article Number
(Transfer from service label)
PS Form 3811, August 2001
7002 3150 0004 9985 4407 j I
Domestic Return Receipt 102595:02.M'11
UNITED STATES POSTAL SERVICE
IIIIII
First-Class Mail
Postage & Fees Paid
USPS '
Permit No. G-10
. Sender: Please print your name, address, and ZIP+4 in this box ·
Bakersfield Fire Department
Prevention Services'
1715 Chester Avenue, Suite 300
Bakersfield, CA 93301
IIIII'IIIIIIIIIIIIIIIIIIIIIIIIIII\IIIIIIIIIIIIII,UIIII,illlll
- ----
u.s. Postal ServiceTM
CERTIFIED MAIL", RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
o 0" 0 " 0 0 '0 0 0 .
I OF Fie I A l USE I
,Postage $
Certified Fee
Retum Reclept Fee Postmark
(Endorsement Required) Here
Restricted Delivery Fee
(Endorsement Required)
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"Sitiië£AP£}
or PO Box N,
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LUCKY 7
3301 WffiLEROAD
BAKERSFIELD CA 93309
A
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I Certified Mail Provides:
· A mailing receipt
· A unique Identifier for your mailpiece
· A record of delivery kept by the Postal Service for two years
Important Reminders:
· Certified Mail may ONLY be combined with First-Class Mliil@ or Priority Mail@.
· Certified Mail is not available for any class of intemational !,nail.
· NO INSURANCE COVERAGE IS PROVIDED with Certified Mall. For
valuables, please consider Insured or Registered Mail. _
· For an additional feel a Return Receipt may be requested iò provide proof of
delivery. To obtain Relurn Receipt service, please complete and attach a Retum
Receipt (PS Form 3811) to the article and add applicable postage to cover the
fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for
a duplicate return receipt, a USPSe 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 "RestrictedTJelivery".
· If a postmark on the Certified Mail receipt is desired, please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed, detach and affix label with postage and mail.
IMPORTANT: Save this receipt and present It when making an inquiry.
Internet access to delivery information is not available on mail
addressed to APOs and FPOs.
(SSJaASI:J) ¡:oo¡: sunr 'OOBB WJO;: Sol
i>
FIRE CHIEF
RCI'j F"Rr\ZE
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 SAFETY SERtICES . EHVIRONIlEHTAl SERVICES
1115 Chester Ave.
Bakersfield, CA 93301
~ICE (661) 326-3979
FAX (661) 326-0576
PUBLIC EDUCATlÓN
1715 Chester Avê.
Bakersfield, CA 93301
VOICE (661) 326-:'Ì696
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
-
.',
.,
September 8, 2003
CERTIFIED MAIL
Lucky 7
3301 Wible Road
Bakersfield, CA 93309
REMINDER NOTICE
Re:
Deadline for Dispenser Pan Requirements December 31,2003
Dear Underground Storage Tank Owner/Operator:
A review of our files indicate that you have been receiving quarterly reminders
from April of 2002 to December 2002. Our files further show that since January
of this year you have been receiving monthly reminders.
The purpose of this letter is to remind you of the necessary retrofit of your
fueling system. Current code requires that you install under dispenser
containment pans prior to December 3 L 2003. You will not be allowed to pump
fuel after December 31, 2003 unless you have completed the upgrade
requirements.
Contractors are already scheduling 8-10 weeks in advance. I urge you to retrofit
your facility as soon as possible.
Should you have any questions, please feel free to contact me at 661-326-3190.
Si)Æ, cere I yours, :'/
. ~¡1 /l /\
/"~
Steve Underwood
Fire Inspector/Environmental Code Enforcement Officer
Office of Environmental Services
SBU/db
~"Y~ de ??o,,;vnu~ ~/" ,---~6ope .9'Z,/b A ~/lb/.P?""
· . Complete items 1, 2, and 3. Also complete
:item 4 if Restricted Délivery is desired.
I . Print your name and address on the reverse
I so that we can return the card to you.
I · Attach this card to the back of the mail piece,
or on the front if space permits.
11. Article Addressed to:
I
KAR FAR SINGH
LUCKY 7 #19
3301 WIBLE ROAD
BAKERSFIELD CA 93309·-
,"-
-- --~--=-~--=-=-~
I~! 7b022410
PS' Form 3811 ,August 2001
o Agent
o Addressee
b. Date of Delivery
'(-'1. .--6)
D. ,Is delivery address different from item.17 0 Yes
if YES, enter delivery address below:' 0 No
~
;3. Service Type
" 0 Certified Mail 0 Express Mail
o Registered 0 Return Receipt for Merchandise
o Insured Mail 0 C.O.D.
4. Restricted Delivery? (Extra Fee)
0002 1974 9534
Domestic Return Receipt
DYes
f
I
2ACPRI-b3-Z-()985I
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,
Ie UNITED STATES POSTAL SERVICE
I
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First-Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
."
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· Sender: Please print }'Ður name, address, and ZIP+4 in this box.
BAKERSFIELD FIRE DEPARTMENT
C~FéCE OF ENV!RONiv~ENTAL SERVICES
~ 7íi [; C;lesîer Avenue, Suite 300
Bakersfield, CA 0030~·
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1.-:1 (Endo (
~ TO~ KARFARSINGH
ru I LUCKY 7 #19
§: se~t; 3301 WIBLE ROAD
I"'- ~~ BAKERSFIELD CA 93309
ëitÿ,,_-
U.S. Postal ServiceTM
(?'~'~TIFIEÓ MAILTM RECEIPT
(L . astic Mail Only; No Insurance Coverage Provided)
Postage $
Certified Fee
Postmark
,Here
..--.......-----
.. -. . . .
Certified Mail Provides: ¡¡69~·V\I-¡¡0-969¡¡0~
· A mailing receipt (8SJ8MII:/) ¡¡00c: eunr _ WJO, Sd
· A unique identifier for your mailpiece -
· A record of delivery kept by the Postal Service for two years I
Im1'ortant Reminders: -, '
· Certified Mail may ONLy-,be corñbîñed with First-Class Mail® or Priority Mail(! I
· Certified Mail Is not available for any class of international mail. I
· NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables, please consider Insured or Registered Mall.
· For an additional fee, a Return Receipt may be requested to provide proof of 1
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 I
fee. Endorse mailpiece "Retum Receipt Requested". To receive a fee waiverfor '
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 I
addressee's authorized agent. Advise the clerk or mark the mailpiece with the I
endorsement "RestrictedlJelivery".
. If a postmark on the Certified Mail receipt is desired. please present the arti- ,
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed. detach and affix label with postage and mail.
IMPORTANT: Save this receipt and present It when making an inquiry.
Internet access to delivery information is not available on mail
addressed to APOs and FPOs.
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 SAfETY SERVICES· EHVIROIIIlENTAL 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'()576
TRAINING DIVISION
5642 Victor Ave.
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
e
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9'
March 1, 2003
Kar Far Singh
Lucky 7 #19
3301 Wible Road
Bakersfield, CA 93309
CERTIFIED MAIL
NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE
RE: Failure to Perform/Submit Annual Maintenance on Leak Detection
System
Dear Business Owner:
Our records indicate that your annual maintenance certification on your leak
detection system was past due on February 28, 2003.
You are currently in violation of Section 2641 (J) of the California Code of
Regulations.
"Equipment and devices used to monitor underground storage tanks shall be
installed, calibrated, operated and maintained in accordance with
manufacturer's instructions, including routine maintenance and service checks
at least once per calendar year for operability and running condition."
You are hereby notified that you have thirty (30) days, April 1, 2003 to either
perform or submit your annual certification to this office. Failure to comply
will result in revocation of your permit to operate your underground storage
system.
Should you have any questions, please feel free to contact me at 661-326-3190.
Sincerely,
Ralph Huey
Director of Prevention Services
bY~~.
Steve Underwood
Fire InspectorlEnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
""7~ de ~~n~ ..¥OP uØ60Pß ..r~ A We.n.h...;?""
I
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 SAFETY SERVICES' EHV1IIONIŒHTAI. SERVICES
1715 Chesler Ave.
Bakersfield, CA93301
VOICE (661) 326-3979
FAX (661) 32EH0576
PUBLIC EDUCATION
1715 Chester Avè.
Bakersfield, CA 93301
VOICE (661) 326-3696
FAX (661) 32EH0576
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
-
--
March 5, 2003
Lucky 7
3301 Wible Road
Bakersfield CA 93309
REMINDER NOTICE
RE: Deadline for Dispenser Pan Requirements December 31,2003
Dear Underground Storage Tank Owner:
A Review of our files indicate that you have been receiving quarterly
reminder notices since April of 2002. Effective January 2003, you can
expect them monthly.
The purpose of this letter is to remind you of the necessary retrofit of
your fueling system. Current code requires that you install dispenser
pans prior to December 31,2003. You will not be allowed to remain
open after December 31, 2003 unless you have completed the upgrade
requirement. Contractors are already scheduling work 6-8 weeks out.
I urge you to start planning to retrofit your facility as soon as possible.
Sincerely,
, ;; /'1/ / /0
JIf£~
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
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6630 Ros.odale Hwy.. # B~ Bakersfield. CA 93308 Phon!) (661) 588·2777 fax (661) 588-2786
FROM
B.S.S.R.
INC.
I
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. MONITORING SYSTEM CERTIFiCATION
,
Th\& [.,rm must be u&ed to dQcument testing and servicing of cnonitoritlg equipment. ~q.r¡tt~ cc:rlific..~ion~
,)i'\r,~,tj~~~1 fQr t~"I,Cb·n\O\'Ù.19rinpys~.ìrnl..n1~j by the tccbnièia.n who perform.s the work. A copy of this rorm m~stb~provid~4,'to
. ..; .Ÿ~~;ft~~.srstem owner/operator. The owner/operator must submit D. Cl)PY of thIs form lO the local agency regulatmg US! syst~S
, : ,:., r4'~1,~W~}O. çays of tçst date.
·l~~;}~c.~eraJ .InforD,).ati.oD .
:1':' "'1' ...1' >, J I }C 11 d ~ Bid No'
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!~~!14¡<,,'~0' 1,)\ ß.~.I"ID __ cì'Y,~ili z;p:'l~",o9
; :r.~:ib:¡ty Q>...., ¡>eno.: ~ f JH 'f¡ .- -.- Contact Phone No.: tULJ.!ß.1.,:.. '-I5·1~ .
! ::M-~¥f.~94e~ :ofMonit~~g .~ystem: :rL'5"'~. ()8~.J..Q..qp -~:2. _ Oate ofTeslÙJ,glServicin¡: ..3.-/~ ~
. .; . t~;~X~,,~~t9ry ~f Eq~ip~'~.t.,~~~~~tÇertified
. ::; ::Fl~6k~.tÞe.. n rbtcboICCsliolJldlcatts eelnc pi mcptl ç~cdJ6ervlc:e4: _=--..........,....0, ~~- ..,
,::H~ j~M: ;~ÞJ' :ft"j.: : t>Ü, 5' . .' ' '. .. Tank (D: ..:.tL~ vi? ~ oJ \ \. 'h"'"
. ;'.:;:'~\!;T)~~ a~ugi~g Prpbe. '.' M.~cl: B~'3qÖ ~O1-- I9'ín·Tank Gaugmg Probe. Model; ß.i.'" 31:\Õ -- '0; .
.,:; :~q:l~,il~~~;µ; Space or Vault S~~or. Model: 0 A.nnular Space or Vault Sc:nsor. Model: -
,:~ "9.: ~f:1PI~$~urnp 'Trench Scn~r(s). ~odel: 0 p~plng Sump I Trench Scnsor(s). Model:
. ':~ J ':9.if:l!~.$,~~p Sensor(s). . Model: _ 0 FIll Su~p Scn.sor(s). Model: - .'
.:.j ::~.¡.M~~~a~'h::al LI~e:.Leak Detector. Model: __ a MeclIaßlC31 Lme Lçak. Detector. Mod(;l: ,
.1 ,~j1i~¿t¡'o~jç,Linc: Leak Dcteptbr, M~~cI:ai.q~~o ~ºº.ß_ VElcctronic Line Leak Detector. Modr:I;~~í.:t.90"" 003~
¡~ ':~ : :P..f§\th~.Q~é!~II' ~11çh.~~vel. ~~c;)r. . MO~~: _. . . ___ 1:1 Tank Ovcr~l1l Hi~.L~vel Sensor. Mode~: .' " ~.
. : ["~~9\herl elf e \11 tt fand model In SectIOn n Pa e 2 . 0 O..!~~ (s~cJ{x..~U!~~ e and mod!:1 In Sc<:tlon e.()~..Pa e 2. ::""
.!: >J¿W..~:..({)j... ~ Tank JD: -
( . ~dr~T~k Oàl1ging Probe. . M~del:~~'" lO~ a In·Tank Gauging Probe. Mode!:
'¡ ; drÄ'li\'ìu)ai' Space 'or Vault Sensor. Modd: _ 0 Annular Space or Vaul! Sensor. Model:
¡: ; :q~:P'ipJ¡'¡iSuÍ'i1p / Trcnch So~or(s). Model: a Piping Sump / T~nQh ScnsoT(s). Model: . I
:.. ¡ .g;:fi!..~\I~ Scn~or{s).' Model: 0 Fill Sump Scnsor(s). Model:
, ; :qiÍ1pg~~¡c,-:1 Line LCllk Dct~et~r. Mo~e: a Mechanical L.ine Lcak Detector. Modd:
ç .~;19~~r~nicLine ~ Detector. Mo~et:a~t:¡4~fqO · roa...... 0 electronic Line L~.ak Detector. Model:
.,' ¡qtf¡ml~ .qvç~fíll ~Hlgh.LevcJ Sensor. Model: a Tank Overfill' Hlgh·Level Sensor. Model:.
'.t} ..!ì':Oth<il $ ecir . ui mt .. and mode1 in Section E on Pa e 2 . a Other sJ;!teif . . uí n~nt c and model in Section B ori Pa ., 2 .
r<Pi¥}j{n~t¡:;iD:j ~~ :flt>.I~ ~u.61"~C:O DI¡¡pclIserlD: ...:Q-~ A~l:~. 0,. .
.¡ :.giQ¡~p~/'1~cr Containment Scnsor(s). odel: 0 Di5penscr Contninment Sensor(s).
i! .:.~.~~~r.vaIVC($). . ~~car Valve(s). .
~..;":~I¡¡ .~~cr .Contalnment FI~a s and Chain s . 0 qlspcnssr Conullnmc:pt F!£!1~~s~ and Chain s .
::; . O}fP~~~,r 10.:'. . Dispenser (0: - . .
;~:.'.gP!¡p~~r Conl.mmcnt Sensor(S). . Model: C Dispen:¡er Contalntncnt SeI1&Or(s). Model:
:::P;LSM~~Va1vc(s). a Shear Valve(s).
r '. a,p¡~ t;,s~TContainment FIb s and Chain s . Q Dls nser Containment Float s and ChaIn s .
nPr~t!.:n,s'ii~ tD: . . , Dispeuser (D: -- --
: :,~. JPi~~~:serContainment Sensor(5). MQdcl: __ C Oispcnsc:r Containment Scnsor(s). M.odel: .
:;. ~~!(~~rYilve~s). a Shear Valvc(s).
¡,j :~i~p~¡\$(.'1' Cònlainmcnt float(s) and Chaines). .... ,...Q.J2!!~lInScr Containment FloaID» and Chain s . 0 ;., .
.: ,. Up~~, f!Wilitÿ contains mC)~ 'ønks Qr dišpcnS(:'s, copy this form, Include information fòr ever)' tank and dispenser at ~e facility.
. ¡ 'qi{}:'~.~µncatioD : I eertify U\I\t the cqulpmcDt Ideøtinc:d In thi$ dotument was in$pccted/s~rv1Céd ID lIc:cor~ån~e with the
o":i'}:r)a.n~ra,c:tDrers' &lude1~es. Atta~bèd to this CertlDcatioll Is IDformation (e.g. maDvraeturen' tbe~kU$ts) l1c:tC$sary to ~¢f)' tbat :tbls
;:-:'.'}~rorm~tlon Is c;orrect and. a PloC p\an showing the '-yout of mooJtol'!ng equipment. For uyequlpment capable o( g'~:crat1og ~ui:h
:" rèp,~~ I b.ve al~ .~ed . ,copy of the report; (cJ.ecA Ill' ihat apply): 0 S~rn !.5t~~8 ~ _A~.~rn h~~rYr:ëp'ort· .
~~~~19",nName(pn.nt}: ,.....t~EL~..CL-.- Signature:~L~jS"
~~r~ific.tion No.: ~_~6 - ~5..... I "þ l3 license. No,: _.. ._.J>:J..:Lß, 1;¿
1~~~~¡'I~ COl)\pany Na~nc: ßþ.~~ (..J('. _._w___.,- OH ,,_ Phone No.;<-~M_J-5ffi.:2 7:¡-:; 1
~I~c;::^ddres$: ~6 '3ò ~~ if ß ~__.._. Daœ QfTc~tin$!Scrviçi.ng: £ì ~I JJ3
Page 1 or 3 .
03/0 .
.. . ~g~~HQrlng System CcrtlOcation
..
;.
e
MAR- 7-0~ FRI 10:06
e
FROM B.S.S.R. INC.
P.02
,....
o¡ ;J.\esults ofTestlog/Serviciug
$Qn~¡tre Version Ins~lIcd: --1&._~----T
,ÇQfD. I¡:te the CoJ1owbi êheckUst:
, .~. _ :v.::::a:...___......:.-=- ",_".:,:;~~""~~I"_"""'W::rl..!llT.l~*",,,.f~~.':';'':J'.::w:;.M':~....:=t4'a1L1;
, õ" rJ'ii·: ·IJ No.' IS the audIble atann 0 rational?
; I:;" Grfàs, 0 N. Is th. vi~ual alarm 0 eratlonal1 -'-
,; fi -:ïr~:1~ ~ 0 N· Were al1 seUsors visuany inspected. fUnotiQ.Qally t'Cstcd..!!Id co"ñfiñned opc~ational? ~
, ' ;: :.g,ny,~f·· 0 No· We~ aU sensors ix\$tal1ed åt lowcst point of secondary containment and position~ so that other equipment wi1l
: ,," :' , not mtctfct4 with their co 0 ~ratiQn?-- '
, ¡; ...~Yêà ". 1£ 'àlanns are' relayed to a remote monitoring station.' is all communication~ eq\lipm~nt (c.g. m04em)
, . I. .' operatio~? " .
'.. i'· ;,~,~~~~~ ',' Foi',p~jzcd pipin¡ BY$tems, docs the Qu1)fne ';utomatlcaUÝšhLlt dow.D ift11C pipin, ¡¡ccondary oontainment
f; ,,; ',.'; , . ~S system detects a leak, faits to op¢1'ate, or is electricalJy disconnected? If yes:' whicb ~ors initiate
positive shut·down? (Clleck a~ that· QPPly) [J Sump/fTench Sensors; IJ Dispenser Çon~ainJnent.Se)1:¡on.
Did ou conflml ositivc shut-down due to lcà'b ~ sensor failurcldiS(:~.!!~lßrtí:0'9t 0 Nò.
~: :'iii"~ 0 No· For tank syst_ that utUize tM monitoring aY$tem as the primary ümk ovomU warning d~i<:e (i.e. no
a N/A mecha~c,al overl'iU pr;evention valve is installed). is the overfill warning a1ann visible- and ~ud{ble'at the·tauk
. . . fill óln s and 0 rot·' to éd ? If so at what ercent of tank ac:i d es thø ala..m,tri a1" %
, : :'~T¥¡F QJI No' Wú ariY'n:lOlÚtòrlog equipment rep1a.<:ed? U'ye~ Identify specific sensors. probes, or other equfpineut replaced
:, ; i ' ,'~.=- and list themaD.utaçturer BlUDe and, model for al1 rwlaccment 'Parts b1 s.cctiÇ>Q ~ 'below.
:. :·.~,ß;~~* G1 No Was liquid toubd inside any secondary containment systems designed as thy systems? (Check a.l1 tñat apply)
. . ,: ' \ . C Pioduc:t· 0 Water: It describe causcs in Section B below. '
, ..': ~fi...;. 0' No~ Was' nior:iitorin s tern set::u rcvièwc:d tb C11S11l"t ~roÇ!cr ~~tI? Attach set up re orts if a ticabJe .
..: t,! >~py'¢$' a No· Ia aU m.oJ:üt " ut roento erational er I11anuf'e.c:t"....··s !loe¢ifications? . .
. I', alli:1ftîlll'/il ~..~ ~~J;:'::-~~_1XI:ø::ø.:~"""~J:·~~-c..a::r.:r~-Zd8
,..,' ,.::tí($ec:d.oD E below, descrlbe ;bow åncJ 'Wb. thëse defidende¡ were or will be eorrec::ted. '
.,.,:"f·J: .; .
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Paee 2 of :\
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R.
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10:07
FROM
MAR
7-0::3
FRJ:
B. S. S.
J:NC.
·,M.øl1it~ring System Certification
S:i~:~9;~'~SS: J 15?)O ,
f~ ~ßL'E..
UST Monitoring Site Plan
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~r.~('W~;!1,~,~ac;ly ~ve a dia~ ~at. shows 1111 required information, you may include it. ra.ther than this. påg~,::vy'(ih yo.ut
. ~?ì~a?l~ig .s)l~~e~, Ce~µç~,t~p~,., ~ 'y~ur site plan. S?o,,": the general layout of tanks and pipi~~. :. .C!.~~ly i~~ti~
lø.<;~t~on,$ .øf the (olloWIng equip1'!:1~~t,. Jf Installed: mon1tonng system control panels¡ sensor~rp.C)nJtQnng tank annu~ar : :
~1~~: :Š!I#.i#tps; d!~~sèr ~$,·sPmcQn.ta~ners, or other second:uy containment areas; n'~ech.~#~o~~· ør c~~c~~ic Un~:.lea~. .,
ð.~~~: ,s.;'::~~d, i*.t~'i1k liquid lcvêl pt'obés (if used for leak deteotion). In the space provided, hc?t~ th¢ ~ate}h,is Sit¢ rlar,¡
W'~$;p.r#P'a,ted. . . .' ;;' ';', ,;
, I' ~.~.
Page
or
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MAR-
7'-03
e
FRI 10 :08
FROM
e
B. S. S. R. INC.
P.04
~--
Ii'. I.n--Taol< Gauging I SIR Equipment:
o Check thís bo,," If tank gaugins Í8used only fOf inventory control.
o Check this bo,," if M tank gauging or SlIt equipmtnt is in$tal1ed.
l'hi~J~(;cû.on mu~ be completed ifin-~.gauging equipment is used to perfonn leak detect,ion monitorin¡.
, II . ,f.~~te the follow Dil checklist: __ _.~.....~r.=_"'''=__:=UO:o::=J''==''-:==:¡=~=''''=_''"''''.'''''''~''-=~~
" . Qi",y'~~ {, Q No' a.,s aU input wiring been inspected for proper entry aud terrnina.t~cludhtg testing f,or groun,d f'aµ1ts'1
;;:'~i4f:' . 9 ~o'" Were all tank .sa1.lgtnB pr,obes visually insJ>ccted for da~á8c and residue buildllp?
¡' .~~~:; 9 ,N.o'" Was accu,racy of system product level rC:ildings ~ted? --
. .:: ,~~;; .0 No'" Was a~uJ:acy of system water 1evol rcadb'lgs tc$ted?·"·-~·_··--···"·---
'; jE.;~F.) a No. Wbte an prøbcs rçm$~aUed.pIopèdy? v --.'
..,; 'ii'yæ ,C No. ,Wec~aU,itemS Qn the cquipxn~t manufactuter's maintenance checklíst colnplcted?
:<" ;,ii'~;'¡;:', __'C.2:_......r.."_<"'...........,..~J:...,,,...".II..
[; 'iI!' ~~~f:¿¡~,S~ti~n 11, below. dêSUibe hów and WhCD these detidendes were or "ill be corrected. '
,~
-
--
t
;, .!Q~t'~e Le~k Detectors (LLD): 0 Check this box. ifLLDs are not instaUed.
, :i' :~~glf.re tbe foJlowln2 eb~ckll$t% , . . .._~="",=-=".....¡..~'""T'--
1iKY¡~.': a No. Por èquipmet\t Start~up ò1' annual equipment ~tifica1ion, was a leak sùnu1a.ted to verify UJ) "p~omJaó~1
<:;;;:;:'. '"'" 0 N/A (Checkal1tllatapply) Simulaœdlc:akrate: 91g.p.h.; CJO:lg.p.b¡ CJ0.2 g.p.h.
i,~r!' ' a Nø-
1: ':~~;~:~ ' ~ ~::
" ~.' . ' ~ NlA
:: .~¥~S:.; 0 No' FOI: electxonic U:D;'-does the lÙrbinc automaücally shut off if the LLD detects a tcllk?
:: ..~..~'. ~::~: Ò N/A
oj: '~~j~::' 0 No·
r<' tJN/A
.,; ~¡~:~, ON9·
'. 0 NlA
'7',~ a No'
þ'p, ,
'. ·á N/A
.;;. :~¥ry . a No' Were aU iteøs.o~:...th~!qUit~~c.m<n:~~~~~~~T~~~~!¥~
:"::jII'Jq;.~,þ:~ S~tion H, belo"rt. d~~jbe bow and when these deficiencies were or will be corredcd.
, Were aU LLPs confin:Þe;d ope.ra.tional and accu.mt;' withfn regulatÒxy requirements?
. Was the testing appat.tns property ca1ib.œted? -
For meéhanical LLDs, does tho LLD restrict product flow it it dctec~ a lc"ñk?
.
, ,
,
For e1cctronic LLDs, does the turbine automAûcally ~~any portíOD of the z.nonitoring systc:.lµ is di8a~led
or di8conn~ced? '
Foi el~~niç Lt.D.. doca tht: tw:blne. autom2\tic;ñÿ"-liliütõif'if any pO'rlion of tbe monitoring IYs~
[1'.al~~l)ns or fails a test? .
POt electronic LLDs. b¡\vt all acces.sibte wing connections bðen visua~pccte:d?
. '
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Page 3 of 3
03/0 J I
, ~
~o.,."
---.' "ENSOR ALAF:f" -----
L 5. ~ STP
STP Em"lP
FUEL ALARr"l
MAR 22. 2004 2:12 PM
----- SENSOR ALARM
L 1 :DI;3F' 1-2
D I f3PENSEF: PAN
FUEL ALAF:r"l
MAR 22. 2004 2:13 PM
.
----- SENSOR ALARM
--L2..;..IlI SP 3.::.1
D I F3FH'JE;-EF: PAN
FUEL ALAF:r"l
MAR 22. 2004 2:14 PM
.
SENSOR ALARM -----
L :3: 87 STP
STI> ~3LJr'lP
FUEL ALARr"l
MAR 22. 2004 2:14 PM
SENSOR ALARM -----
L 4: 91 E;n'
Em:., ,~ f"lP
FU LARr"l
MAR L¿. 2004 2:15 PM
'--.......
INSPECTION RECOW
~
Bakersfield Fire Dept.
1715 Chester Ave.
Bakersfield, CA 93301
DATE: FACILITY ADDRESS:
'J. '2-1.. 04- '330\ WiI'SL£
FACILITY NAME: LI.Jc..-¡¿ Y 7
MANAGER NAME: 1)1 L.LIO~ KIW:!)(:;é
BUSINESS OWNER NAME, ADDRESS, ZIP CODE
BILL TO: (IF DIFFERENT FROM ABOVE)---NAME, ADDRESS, ZIP CODE, PHONE No.
ZIP:
FEE:
FACILITY PHONE
OCC TYPE
OCC LOAD
No. OF FLOORS
HI RISE BLDG.
YES 0 NO 0
DATE ÒF REINSPECTION
RISER DATE
VIOLATION NOTICE CORRECTION:
1.
¡.Jo..\... V'S( ¡NSf()..tl.1'Lr(.,.,..) ,JSPC;¿<í1o...J fQtL 'j)IS(7&v5~ Ç)A9JS
2. "\
3. "PE..v<::>,N6-:
,
Svc<..G-sSKJt.. ~Lq(oN t>.? rRdOUc.'i"" v~ lNTr:::6RIt"Y-res,
fbs"- ,.v,"AuA7't'~
,É:;LeïR¡c.AL {,}&
~ntT()tt.€ ~ .jvf'.JC...'i1~ 10}(. ç.~ (.lcL...vCðQ €é.éCï(lx::,~
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
NOTES $C.¡..t-C'OJ\"I..J& if þ.t.L ~TI~ if. (Z.C-PAtR.$ t.A,),<ty,"\) "7'-~.s.
CUSTOMER:
INSPECTOR: tP No. 3.
FIRE PREVENTION SERVICES
(661) 326-3979
WHITE ORIGINAL·OWNER YELLOW-INSPECTOR'S COPY
PINK-FILE
FD1952
e CITY OF BA~SFI~LD
OFFICE OF ENVIRONi\'IENTAL SERVICES
1115 Chester Ave., Bakersfield, CA (661) 326-3919
FJ~ili(y
INSPECTION RECORD
POST CARD..\r JOB SITE
Owner
I:hL..
Address
Address
City. Zip
City, Zip
Phone :-.10.
Permit #
Ii'lSTRliCTIONS: 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 otTby the Permiuing Authority. Following these instructions will reduce the
number of required inspection visits and theretore prevent assessment of additional fees.
TANKS AND BACKFILL
INSPECTION DATE INSPECTOR
Backtill of Tank(s)
Spark Test Certifieation or Manufactures Method
Cathodic Protection of Tank(s)
PIPING SYSTEM
Piping & Raceway w/Collection Sump
Corrosion Protection of Piping. Joints. Fill Pipe
( Electrical Isolation of Piping From Tank(s)
Cathodic Protection System-Piping
Dispenser Pan
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 Detector{s)
Leak Detector(s) for Annual Space-D. W. Tank(s) J7
Monitoring Well(s)/Sump(s) - H20 Test /.. ø..'" r --hA\- ~l ~~/(,"'Olf >IlP-
Leak Detection Device(s) for Vadose/Groundwater
Spill Prevention Boxes
CEU/}\ L 0"-\ 3.11..'1-/1')4-
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Monitoring Wells, Caps & Locks
Fill Box Lock
Monitoring Requirements Type ',L.S - '"3. s.--6 3 /Z- '-104- ~
I Authorization tor Fuel Drop
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2700 Stagecoach Street
Bakersfield, Ca. 93314
ENVIRO CONSTRUCTION
Phone (661) 588-0108
Fax (661) 588-0108
Dec. 24, 2003
Bakersfield Fire Dept. Environmental Service
1715 Chester Ave.
Bakersfield, Ca. 93301
Tel: (661) 326-3979
Mr. Steve Underwood
We have been contracted to install dispenser containment sumps, double wall
product piping and turbine tank sumps at Lucky 7 #19,3301 Wible Rd., Bakersfield, Ca.
We have applied for the permit on this project today.
The plan is to have the project completed by 2/27/04.
We would like to request an extension to operate at this location.
If you have any questions or there are any problems please give me a call at (661)
472-1858.
Thanks,
Terry Cannady
~~
Enviro Construction
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PERMIT APPLICATION T~STRUCT/MODIFY
UNDERGROUND STORAGE TANK
I
Bakersfield Fire Dept.
Environmental Service
1715 Chester Ave
Bakersfield, CA 93301
Tel: (661)326-3979
PERMITNO. ßL- 0135
TYPE OF APPLICATION (CHECK)
o NEW FACILITY ~ODlFICATION OF FACILITY
o NEW TANK INSTALLATION AT EXISTING FACILITY
PROPOSED OOMP\..ETION DATE //
.-2-¿7-0..,..
EXISJ1rG FACIUIY PERMIT t«).
ZIP CODE
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WATER TO FACIUTY PROVIDED BY
QEPTHTO I SOIl1YÆ EXPECfED AT SITE
GROUNDWATER
NO. OF TANKS <I I ARE THEY FOR NOTOR FUEL I SPILL PREVENTION CONrROLAND COUNTER MEASURES PI.AH ON AlE
TO lIE INSTAU.ED o YES at«) aYES ONO
THIS SECTION IS FOR MOroR FUEL
TANK NO. \IOWIIE
UNLEADED
REGUlAR
PRaIIUII
DIESEL
AVlA1ION
THIS SECTION IS FOR NON MOTOR FUEL SIORAGE TANKS
TANK t«)_ VOUJIIE CHBIICAL sroRED lNO BRAND NAME)
CAS NO (IF IQICJV'M
QtEIIICAL PREVIOUSLY STORED
FOR OFFICIAL USE ONLY
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The applicant has received. understands. and will comply with the attached conditions ofJhe permit'
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per' ' 0 e best of my knowledge. is true and correct.
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APPUCANT NAME ( NT)
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THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
Bakersfield Fire Dept.
, Environmental Service
1715 Chester Ave
Bakersfield. CA 93301
Tel: (661)326-3979
PERMIT APPLICATION TaSTRUèTIMODIFY
UNDERGROUND STORAGE TANK
PERMIT NO·1 ~~b '3 3l{
TYPE OF APPLICATION (CHECK)
a NEW FACILITY a MODIFICATION OF FACILITY
a NEW TANK INSTALLATION AT,EXISTING FACILITY
I'ftOPOSEO COMPLETION DATE ,,¿,
Z-27-0~
EXISTING FAQUTY PERMIT NO.
ZIP CODE
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GROUNDWATER
NO. OF TANKS 01 ARE THEY FOR MOTOR FUB.. I SPIlL PREVENTION CONmOL AND COUNTER MEASURES RAN ON FIlE
TOIlE INSTALLED elves elNO aves elNO
THIS SECTION IS FOR MOTOR FUEL
TANK NO. VCWIIE
UNlEADED
REGUlAR
PREMIUM
DIESEL
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THIS SECTION IS FOR NOH IIOroR FUEL S10RAGE TANKS
TANK NO. VCWIIE CHEIIICAl srOREDtNO IIRANOHAME)
CAS NO (IF KNDVIIf)
QtEIIICAL PREVIOUSlY STORED
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The applicant has received. understands, and will comply with the attached conditions of the permit'
and an olhe Slale, local and federal regulations. This form has been completed under pe'halty of
perj . and to th est of my knowledge. is true and correct.
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THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
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Randeep S. Dhillon
1615 South H Street
Bakersfield, CA 93304
Phone: (661) 835-8044
Fax: (661) 835-0279
Date: December 29,2003
Subject: Ownership Disclosure on the Properties.
To Whom It May Concern:
Below infonnation is for the Fire Dept of Kern County requirements.
(A)
Lucky-7 Food Store.
3301 Wible Road
Bakersfield, CA 93304
Phone: (661) 397-4553.
Property Owners Cherry Enterprises Inc., Owned by Shivreet Dhillon and Dhillon Randeep Singh.
(B)
La Barata Food Store
430 E-California Ave
Bakersfield, CA 93307
Phone: (661) 861-8505
Property Owners Pedro Martinez and Rosa Martinez and Reyna, Amarjeet Kaur and Dhillon Randeep
will be new owners any time, open Escrow.
Sincerely,
D~ph
Date: d -'iiJ-ð J
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· A unique Identifier for your mailplece
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Important Reminders:
· Certified Mall may ONLY be combined With Arst-Glass Maile or Priority Mail@.
· Certified Mall Is not available for any class of international mall.
· NO- INSURANCE COVERAGE IS PROVIDED With Certified Mail. For
valuables, P/t1åse consider InSUred or Registered Mail. ,
· For an additional f~l, a Return Race/Of may be requested to provide Proof of '
delivery. To obtain RtfIUm Receipt service, prease complete and attach a Retum \
Receipt (PS Fonn 38"1. to the article and add applicable postage to COVer the
fee. Endorse mai/plece 'Retum Receipt Requested". To receive a fee waiver for
a duplicate return receipt, a USPSe postmark on your Certified Mail receipt is I
reqUIred.
· For an additional fee, delivery may be restricted to the addressee or I
I addressee's authOrized ~ent. Advise the clerk or mark the mallpiece with the
endorsement 'RestrlcteàVellvery~
· If a postmark on the Certified Mail receipt is desired, please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt Is not needed, detach and affix label with postage and mail.
IMPORTANT: Save this receipt and presenl if when making an inquiry. "
Inlernel access to delivery information is not available on mail
addressed to APOs and FPOs. .,
· Complete items 1, 2, and 3. Also complete
Item 4 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 mail piece,
or on the front if space permits.
1. Article Addressed to:
- "
Lucky 7
3301 Wible Road
Bakersfield, CA 93309
2. Article Number
(Transfer from service label)
I PS Form 3811, August 2001
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D. Is delivery address different from Item 11
If YES, enter delivery address below:
3. Service lÿpe
\III Certified Mall 0 Express Mall
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o Insured Mail 0 C.O.D.
4. Restricted Delivery? (Extra Fee) 0 Yes
7003 2260 0004 7652 3140
Domestic Return Receipt
102595-02-M-1540 I
UNITED STATES POSTAL SERVICE
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First-Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
. Sender: Please print your name, address, and ZIP+4 in this box ·
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Bakersfield Fire Department
Prevention Services
1715 Chester Avenue, suite 300
Bakersfield, CA 93301
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FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVfCES
FIRE SAFETY SERVICES. ENVIRONMENTAl SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 Chester Ave.
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
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December 12, 2003
CERTIFIED MAIL
Lucky 7
3301 Wible Road
Bakersfield, CA 93309
RE: Propane Exchange Program
Dear Owner/Operator:
The purpose of this letter is to advise you of current code requirements for
propane exchange systems, such as "Blue Rhino" or "Amerigas." This does not
apply to large propane tanks, only propane exchange systems.
Over the past two years this office has noted a dramatic increase in the propane
exchange system in the city of Bakersfield. It has also been noted, with great
concern, that many of these installations are a clear violation of the UFC
(Uniform Fire Code) and represent a danger to public health and safety.
Accordingly, procedures for storage of propane cylinders awaiting use, resale or
exchange, have been adopted through BMC (Bakersfield Municipal Code) and
adoption of the 2001 UFC. The procedures are as follows:
Storage öutside of building for propane cylinders (1,000 pounds
or less) awaiting use, re-sale, or part of a cylinder exchange point
shall be located at least 10 feet from any doorways or openings in
a building frequented by the public, or property line that can be
built upon, and 20 feet from any automotive service station fuel
dispenser. (Note distance from doorways increases when
cylinders are over 1,000 pounds cumulatively.)
Cylinders in storage shall be located in a manner which
minimizes exposure to excessive temperature rise, physical
damage or tampering (Section 8212, California Fire Code, 2001
Edition).
When exposed to probable vehicular damage due to proximity to
alleys, driveways or parking areas, protective crash posts will be
required as follows (Section 8001.11.3 and 8210, California Fire
Code, 2001 Edition):
1) Constructed of steel, not less than 4 inches in diameter,
and concrete filled.
2) Spaced not more than 4 feet between posts, on center.
··.?;;q,ú,? d~ CCrwl/N.///l4? $7;.,,, . I¿r',,'r' .o/~/l' v~6 '&r:/lh~/r~~
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Letter to To: Owner/Operators of Propane Exchange Systems
Re: Propane Exchange Program
Dated: December 12.2003
Page 20f2
3) Set not less than 3 feet deep in a concrete footing of not
less than a 15 inch diameter.
4) Set with the top of the posts not less than 3 feet
aboveground.
5) Located not less than 5 feet from the cylinder storage
area.
Exceptions: Cylinders storage areas located on a
sidewalk which is elevated not less than 6 inches above
the alley, driveway or parking area, with not less than
10 feet of separation between the curb and the cylinder
storage area.
"No Smoking" signs shall be posted and clearly visible
(Section 8208, California Fire Code, 2001 Edition).
- Re&ale and exchange facilities must be under permit to verify compliance. .All
existing facilities will be checked and when compliance is confirmed, a permit
will be issued. All new propane exchange systems must be permitted prior to
installation.
You will have 90 days (March 4, 2004) to comply with the procedures outlined.
Once compliance has been confirmed, each exchange system will be issued a
permit, which will be placed on the exchange system.
Sites not conforming to CUITent code, will be "red tagged" and must be taken out
of service immediately. '
You should contact your Blue Rhino representative, Mr. Taylor Noland, or your
local Amerigas representative. They are aware of current code requirements. If
you do not have a propane exchange system, please disregard this letter.
Should you have any questions, please feel free to contact me at (661) 326-3190.
Sincerely,
(: rl/ /'
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Steve Underwood
Fire Inspector/Petroleuml
Environmental Code Enforcement Officer
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MR RANJIT KAUR
LUCKY 7
3301 WIBLE ROAD
BAKERSFIELD CA 93309
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Certified Mail Provides: I
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· A unique Identifier for your mal/piece
· A record of delivery kept by the Postal Service for two years
ImfJortant Reminders: ,~,
· Certified Mall may O/ljL Y be combined with First-Class Mal/@!òr Priority Mail@.
· Certified Maills not avål/able for any class of internatioJ.al mail: I
· NO INSURANCE COVERAGE IS PROVIDED with Certifi,~d Mail. For I
valuables, please consider Insured or Registered Mail.. .~
· For an additional fee, a Return Receipt may be requeste'it to provide proof of
delivery. To obtain Return Receipt service, prease complete and attach a Return
Receipt (PS Form 3811) to the article and add applicable postage to cover the
fee. Endorse mal/piece "Return Receipt Requested". To receive a fee waiver for I
a duplicate return receipt, a USPS@ postmark on your Certified Mail receipt Is I
required. I
· For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent. Advise the clerk or mark the mal/piece with the I
endorsement "RestrictedDelivery".
· If a postmark on the Certified Mail receipt is desired, please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mall
receipt is not needed, detach and affix label with postage and mail.
IMPORTANT: Save this receipt and present it when making an inquiry.
Internet access to delivery information is not available on mail
addressed to APOs and FPOs.
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so that we can return the card to you,..
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I or on the front if space permits.
I 1. Article Addressed to:
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SENDER: COMPLETE THIS SECTION
MR RANJIT KAUR
LUCKY 7
3301 WIBLE ROAD
BAKERSFIELD CA 93309
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2. Article Number
(Transfer from service labeQ
PS Form3811, August 2001
COMPLETE THIS SECTION ON DELIVERY
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UNITED STATES POSTAL SERVICE
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1715 Chester Avenue, Suite 300
Bakersfield, CA 93301
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FIRE CHIEF
RON FRAZE
ADMltjSTRATIVE SERVICES
- 2101 "W Street
Bakersfield, CA 93301
VPICE (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 SAFETY SERVICES' EHVIROHIlENTAI. SERVICES
1715 Chester Ave.
Bakersfield. CA 93301
VOICE (661) 326-3979
FAJ«661)32~576
PUBLIC EDUCATION
1715 Chester Avè.
Bakersfield, CA 93301
VOICE (661) 326-3696
FAJ< (661) 32~576
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield. CA 93301
VOICE (661) 326-3951
FAJ< (661) 326-0576
TRAINING DIVISION
5642 VIctor Ave.
Bakersfield. CA 93308
VOICE (661) 399-4697
FAJ< (661) 399-5763
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December 4, 2003
CERTIFIED MAIL
Mr. Ranjit Kaur
Lucky 7
3301 Wible Road
Bakersfield, CA 93309
FINAL REMINDER NOTICE
Re: Deadline for Dispenser Pan Upgrade - December 31, 2003
\
\
Dear Underground Storage Tank Owner/Operator:
I
One month from today, this office will be forced to revoke your Permit to Operate your
Underground Storage Tank System, effectively shutting down your fueling operation.
Section 2636(H)(l) California Code of Regulations Title 23, Div. 3 Chapter 16 reads as follows:
"Owners or operators of an UST System shall have the system fitted with under-dispenser
containment by December 31, 2003."
It is noted in your file that you have been receiving "Reminder Notices" since May of 2002.
As of this writing, no permit has been pulled nor have you conveyed your plans for compliance to
this office.
If we find it necessary to revoke your permit for non-compliance, you will have limited options as
stated in the following:
After 90 days of closure, your tanks will be considered illegally abandoned and we will
take action to properly close these tanks. If you do not comply with our tank closure
requirements, we will find it necessary to take legal action, including but not limited to
citation and/or injunctive relief.
Prior to the 90 days inactive, you hire a contractor and complete the upgrade per code.
This office has extended you every courtesy with regard to timely reminders and support over the
last 18 months. If we can be offurther assistance, please feel free to contact me at 661-326-3190.
Sincerely yours,
Ju rkLo
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
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~' postage $
Certified Fee
Postmark
Return Reciept Fee Here
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total postaor ì
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, Certified Mail Provides:
· A mailing receipt (8SJ8A8/:i) ¡:0Oë: 8unr '008£ WJ0.:l Sd
· A unique identifier for your mailpiece
· A record Of_delivery ~.e.pt by the Postal Service for two years
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Im1ortanf Reminders: I
· Certified Mail may ONLY be combined with First-Class Mai\æ¡'èr Priority Mail<!l>. I
· Certified Mail is nof available for any class of Intemational mail. "'-.- !
· NO INSURANCE COVERAGE IS PROVIDED with Certified Màil. 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 Retum Receipt service, please com)lete and attach a Return
Receipt (PS Form 3811) to the article and add applicable postage to cover the
fee. Endorse mailpiece "Retum Receipt Requested". To receive a fee waiver for
a duplicate return receipt, a USPS0 postmark on your Certified Mail receipt is
required.
. For an additional fee, delivery may be restricted to the addressee or
addressee's authorized a@nt. Advise the clerk or mark the mailpiece with the
endorsement uRestrictedDefiveryu.
. If a postmark on the Certified Mail receipt Is desired, please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed, detach and affix label with postage and mail.
IMPORTANT: Save this receipt and presentit when making an inquiry.
Internet access to delivery information is not available on mail
addressed to APOs and FPOs.
Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
I Ii Print your name and address on the reverse
I so that we can return the card to you.
. Attach this car~ to the back ?f the mail piece,
or on the front If space permits.
I 1. Article Addressed to:
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RANJITKAUR
Lucky 7
3301 WIBLE ROAD
Bakersfield, CA 93309
I 2. Article Number
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I PS Form 3811, August 2001
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4. Restricted Delivery? (Extra Fee)
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7002 3150 0004 9985 4933
Domestic Return Receipt
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Bakersfield Fire Department
Prevention Services
1715 Chester Avenue. Suite 300
Bakersfield. CA 93301
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November 5, 2003
CERTIFIED MAIL
FIRE CHIEF
RON FRAZE
Ranjit Kaur
Lucky 7
3301 Wible Road
Bakersfield, CA 93309
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
REMINDER NOTICE
Re: Deadline for Dispenser Pan Requirements December 31, 2003
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
c4
PREVÈNTION SERVICES
FIRE SAFe'l-Ÿ SERVICES· ENVIRONMENTAl SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
Dear Underground Storage Tank Owner/Operator:
A review of our files, indicate that you have not completed the retrofit of
your underground storage tank system. Current code requires that you install
under dispenser containment pans prior to December 31,2003.
PUBLIC EDUCATION
1715 Chester AV8.
Bakersfield, CA 93301
VOICE (661) 326-3696
FAX (661) 326-0576
Further file review, indicates that you have been receiving Reminder Notices
since April of 2002. With time growing short (2 months) this office is very
concerned that insufficient time is left for you to hire a licensed contractor
and complete the necessary retrofit.
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
Currently, contractors are scheduling 8-10 weeks out. I strongly urge you to
complete the repairs as soon as possible. Failure to comply with the state
requirement could result in revocation of your permit to operate your
underground storage tank system.
TRAINING DIVISION
5642 Victor Ave:
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
If I can be of any further assistance, please feel free to contact me at
661-326-3190.
Sincerely yours,
~~
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/db
""Y~ a; WonlDuuu(? ~ vØboPe .r~ .A W~"
0þ,
.
-
Law Offices of
ELIAS Z. SHAMIEH
A Professional Corporation
703 Market Street, Suite 1700
San Francisco, CA 94103
e.
Elias Z. Shamieh *
Telephone: (415) 777-0700
Facsimile: (415) 543-0891
*Not admitted to practice in California
Practic~ limited only ~o Immigration and Federal Courts
-' -
.". ' ".. .' .' ~ \
October 22, 2003
I-
I
Bakersfield Fire Department
Mr. Steve Underwood
2101 "H" Street
-- - Bakersfield, CA 93301
Dear Mr. Underwood,
This is to inform you that effective October 17,2003 we are no longer the owners of the property
on 3301 Wible Road in Bakersfield. Any correspondence please mail directly to that address.
cooperation in this matter.
-<.,~. - ' '.; ( ~:.' ",,'; .1- '; ;', {~ :
¡"! ':. '" '. ... ~.),~.,:~ . (; ,;!. d
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield, CA 93301
VOICE (661}326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFm SERVICES' ENVIRONMENTAl SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBUC EDUCATION
1715 Chester Ave.
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.
, Bakersfie!d,C~330ª- _ ..~
VOICE (661) 399-4697
FAX (661) 399-5763
-
l
I
...
-
October 15, 2003
.'
CERTIFIED MAIL
Mr. Elias Shamich
703 Market Street, Suite 1700
San Francisco, CA 94103
REMINDER NOTICE
Re: Deadline for Dispenser Pan Requirements December 31,2003
For Lucky 7, 3301 Wible Road~ Bakersfield, CA 93313
Dear Underground Storage Tank Owner/Operator:
A review of our files, indicate that you have not completed the/etrofit of your
underground storage tank system. CUlTent code requires that you install under
dispenser containment pans prior to December 31, 2003.
Further file review, indicates that you have been receiving Reminder Notices
since April of 2002. With time growing short (2.5 months) this office is very
concerned that insufficient time is left for you to hire a licensed contractor and
complete the necessary retrofit.
CUlTently, contractors are scheduling 8-10 weeks out. I strongly urge you to
complete the repairs as soon as possible. Failure to comply with the state
requirement could result in revocation of your permit to operate your
underground storage tank system.
If I can be of any further assistance, ple~sefeel f!ee to contact me at
-. 661-326-3190. --
si;1ncer.el, ~ yours" . !
"'d£o: "
. , .,
, . ..
, ,. ,
. ,
.. "
Steve Underwood
Fire Inspector/Environmental Code Enforcement Officer
Office of Environmental Servicès
SBU/db
""Y~ ~ W~ ~ vØbOPe .o/~ A W~"
'I
'.I
LUCK'l 7 19
3:30 1 ~\J I BLE F:D
BAKERSFIELD CA,93309
661-:397-455:3
OCT 21. 2003 9:59 AM
o
SYSTEM STATUS REPORT
- - - - - - - - - - - -
ALL FUNCT IONS NORt"1AL
I r'JI./ENTOR'y' REPORT
T 1 :PLUS
1./0 L Ut"1E
ULLAGE
9U\ ULLAGE=
TC \/OLIJI"1E
HEIGHT
~~ATER I/OL
l¡JATER
TEt"1P
T 2: PREr"1 I ur"!
VOLUJ"1E
ULLAGE
90% ULLAGE=
TC 1/0LUt"1E
HEIGHT
l.-JATER I/OL
~\IATER
TEI"!P
T :3: REGULAR
IjOLUI1E
ULLAGE
9œ~ ULLAGE=
TC I/OLUr"1E
HEIGHT
[¡JA TER I/O L
l¡JATER
TEt"1P
4000 GAL3
6371 GALS
53:3:3 GALS
:3992 GALS
:38.90 I NCHEf3
o GALS
0.00 INCHE3
85.4 DEG F
1648 CW' S
8723 ( ~
7685 C, .J
1617 GALS
20.46 INCHES
o GALS
o . 00 I NCHEf3
86.2 DEG F
5804 GALS
4567 GALS
:3529 GALS
5795 GALS
52.21 I NCHE3
o GALS
0.00 INCHES
82.1 DEG F
M M M M MEND M M M M M
e e
-UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1 Business Plan and Inventory Program
Bakersfield Fire Dept.
Enironmental Services
1715 Chester Ave
Bakersfield, CA 9330 I
Tel: (661)326-3979
FACILITY NAME . ! INSPECTION DATE INSPECTION TIME
ADDREs~-vd~'l-ì~~~_~----------~----------~~ -,- ~-~ ---- -- __U___~___n__ ----~~ ,----- -mg-ßE·-~t-~º2 NQ-ofT-IOyees---
""uii¿~~9 (...... !lli~---- . -- ..------ - ..-..---..r'lkj~~~; ..'-1-
"
Section 1: Business Plan and Inventory Program
o Routine
11 Combined
o Joint Agency
(] Multi-Agency
(] Complaint
(] Re-inspection
C V ( C=Compliance )
- / V=Violation
~ 0 ApPROPRIATE PERMIT ON HAND
--~D - B~~;~~~-;;LAN-~~~~~~~~~;~:;;~~~~:~~:~~---~---- ____~______~_______.~____u ~ U --~----~ ~_~___~___U___U
--;¡ ~---~~~~~~SS~-------~---~----- -- -~---"--, ----~-"----
~~" CORRECT OC~~~~:~~--'------~-------~---"'-----~----~--
I----~-~,-~--~~------------------.-----------~,-_______._.._ _,. __, ~__~_____..______~__, _",_~_,_,_, ~_,_hm_'___~~_, .._,__,__.__.____h,_______ __h_~'__h ..,___, ,_
g/" 0 VERIFICATION OF INVENTORY MATERIALS
~70-h- VERI~~~~~ON OF ~~~NTI~;~~---------h-- n~____ ---- -----~ -------- -- n_h____h___ u___~u__ -- ______d_u ---~--
OPERATION
COMMENTS
~-------
. .....- --..-..---.-+..--
....___.'_.n__..._.n..
. ._---_...._-.__..-.-.-..<.........-..
..--_.. ,.- -..---.--..-...--
m. _____ __...__.
n._ __ ... n__._... .__.__n._... .__.."
- -,-~----
__·_·_____·_~..._____·_"___________u___._._____.___.__.____.____....._ ....__._____u ____~_._____.._______.__.. ~__.__.__" ____.___m___......____.._ u. __ ___. _.".._._~..__.__ ."__. ._._
~ 0 VERIFICATION OF LOCATION
-~---r--~----------------u,------------------------------ - - I- --- __n______,____u__ __,___ -, _~ _________~,__ ~_u,__,__ __. ~_ _ ____H_h___'___,_ __ m_ ,___
D" 0 PROPER SEGREGATION OF MATERIAL
r;7~- VERI~~~~TION ~;~'-;~S AV~;:ABIU~-~------h-------~---~ ---------~------~.--...~-.. -~~---------~----------~ --------
~ 0 --V~~;;I~~TION OF -H~~MAT ~~~~~~--h---------nn--n - ------------------- - ---.----- n__m__u______~ ..--- _m__
C7;-~~,FICATI~N OF -:B:TE~;NT ;U-~~~;~~-~~D-;~~~~~~~~~-+-------- h ----------~ ,. - .--------- ____n_~
- -~--- E~~RGENC~__;;~CED~;~~uADEQ~~TE----- __n___~m____ - ______________________________u______u _._~_u_~_______~_____ ~" __m_____ -
---T--------~~---~---~----------~ ,----- "n____~__,________n___ ------------ ~_n_____.. ----~--,---- ~------~--.. - - - -- ---- ----------- ,---, ------~ --- -. -- - -
I!J 0 CONTAINERS PROPERLY LABELED 1
_~---~O~~~K-E:~~~--~ ~u~~--n_~---~~_ _-~~--.=u~~~_ ___-_~~-~~~- ~~~--~ _~-__~-- =--~~- -n ~___-~~~_-~~~_:~-_n____h_::-~~-_~_~
C':'J 0 FIRE PROTECTION
- -- - --- - - ------ -- -- -- -- - -- - ----- -- - - - - - -- - - - --- -------- - ------ --- --- ________ _ ___ __ __ __ _ _ _ __ _ ..._ .. _...__.u_____
c;r" 0 SITE DIAGRAM ADEQUATE & ON HAND
I
-.-.---.-....-..--.--
ANY HAZARDOUS WASTE ON SITE?:
(] YES
~
EXPLAIN:
Inspector
ECTION? PLEASE CALL US AT {661} 326-3979
: ___n______t{_h____~____
Badge No,.
o " ê------" (J
---~-~~SiteR~~~h-
White - Environmental Services
Yellow - Station Copy
Pink· Business Copy
(;
--
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave.. 3rd Floor. Bakersfield. CA 93301
FACILITY NAME (H){ k~ ì
INSPECTION DATE
(O"J(-OS
Section 2:
Underground Storage Tanks Program
o Routine œ Combined 0 Joint Agency
Type of Tank !,h.JL CC-,P. ')
Type of Monitoring --ATC,
o Multi-Agency 0 Complaint
Number of Tanks 3
Type of Piping !JW ~ ( ~ . P. ,
ORe-inspection
OPERA nON c v COMMENTS
Proper tank data on tile l V
m , V
Proper owner/operator data on tile \..
Pennit fees cun-ent ... V
Certification of Financial Responsibility ;I
Monitoring record adequate and current ;I
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
TANK SIZE(S)
Type of Tank
AGGREGATE CAPACITY
Number of Tanks
OPERA TION Y N COMMENTS
spec available
SPCC on tile with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?
[f yes, Does tank have overfìll/overspill protection?
C=Compliance
N=NO
Inspector:
Office of Environmenral Services (661) 326-
Whitc - Env, Svcs.
Pink - Busincss Copy
-- -- ---
u.s. P,ostal ServiceTM
CERTIFIED MAILM RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
'[]""'
I~
U1
J:[)
[]""'
[]""'
3'
D
D
D
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U1
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rn
~ ::~£Ñõ.;n._...- _......._mmm _,.Lnnn.ýÿ........--7t---...-
~~~-~."!~:_----_._~.~.g._[..~.~-~..._._-
City, State. ZJP+4 ~ '13 3ð
o O' 0 0 0 ., , 0
I OFFICIAL USE I
Postage $
irtlfled Fee Postmark
Retum,Reclept Fee Here
(Endorsement Required)
Restri~ Delivery Fee
(Endorsement Required)
Total Postage & Fees $
Certified Mail Provides:
· A mailing receipt (9SJ9119/:i) ;:00;: 9unr '008& WJO~ Sd
· A unique Identifier for your mailpiece
· A record of delivery kept by the Postal Service for two years
Important RemInders:
· Certified Mail may ONLY be combined with First-Class Mail(¡þ or Priority Mail(@. I
· Certified Mail is not available for any class of intemational mail. '
· NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For j
vaiuables, 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, pfease complete andlattach a Return
Receipt (PS Form 3811) to the article and add applicable postage to cover the
fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for
a duplicate retum receipt, a USP~ postmark on your Certified".¡Mail receipt is
~~ .,
· For an additional fee, delivery may be restricted to the addressee or I
addressee's authorized aQ.ent. Advise the clerk or mark the mailpiece with the I
endorsement "Restricted Delivery". i
· If a postmark on the Certified Mail receipt Is desired, please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed, detach and affix label with postage and mail.
IMPORTANT: Save this receipt and prese'!t it when making an inquiry.
Internet access to delivery information is not available on mail
addressed to APOs and FPOs.
1 ....,'
SENDER: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
I
I
I . Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
I . Print your name and address on the reverse
I so that we can return the card to you.
I . Attach this card to the back of the mailpiece,
I or on the front if space permits.
I
I
If
Ii
II
II
¡i
¡'
I
1. Article Addressed to:
LUCKY 7
3301 WffiLE ROAD
BAKERSFIELD CA 93309
2. Article Number
(rransfer from service label)
PS Form 3811, August 2001
D. Is delivery address different from item 1 .
If YES, enter delivery address below:
1
J
3.Seìvice Type
Q..Certified Mail
o Registered
o Insured Mail
o Express Mail
o Return Receipt for Merchandise
o C.O.D.
4. Restricted Delivery? (Extra Fee) 0 Yes
7002 3150 0004 998~ 3479
Domestic Return Receill~
~
I
I
I
I
I
I
I-
I
UNITED STATES POSTAL SERVICE
First-Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
· Sender: Please print your name, address, and ZIP+4 in this box ·
4fJ\
Bakersfield Fire Department
Prevention Services
1715 Chester Avenue, Suite 300
Bakersfield. CA 93301
\. ~ 11.1 II II 1111 ,III" I "'""" 1111.1111 fll/lI fill fill ,I,ll" 11,1
-! ;'1~
FIRE CHIEF
RON F?f\ZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "HO Street
Ba~ersfield. CA 93301
VOICE (661) 326-3941
~ (661) 395-1349
i
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
.
.
July 8, 2003
CERTIFIED MAIL
Lucky 7
3301 Wible Road
Bakersfield, CA 93309
REMINDER NOTICE
Re: Deadline for Dispenser Pan Requirements December 31, 2003
Dear Underground Storage Tank Owner/Operator:
A review of our files indicate that you have been receiving quarterly reminders
from April of 2002 to December 2002. Our files further show that since January
of this year you have been receiving monthly reminders.
The purpose of this letter is to remind you of the necessary retrofit of your fueling
system. Current code requires that you install under dispenser containment pans
prior to December 31. 2003. You will not be allowed to pump fuel after
December 31, 2003 unless you have completed the upgrade requirements.
Contractors are already scheduling 8-10 weeks in advance. I urge you to retrofit
your facility as soon as possible.
Should you have any questions, please feel free to call me at (661) 326-3190.
Sincerely,
Ralph Huey
Director 02prev,.' tion se,~vices
i tibùl ,
/' -' ,/
. .
By: Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SU:db
""~~ de WCY~ ~ ~0Pe y~ A WeAbu;?"
'~.
.
FIRE CHiEF
;"mJ :=,qA¿E
ADMINISTRATIVE SERVICES
21 01 "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 SAfETY SERVICES' ENVIRONMENTAL SERVICES
1715 Chester Ave.
Bakersfield. CA 93301
VOICE (661) 326-3979
FAJ«661)326~576
PUBLIC EDUCATION
1715 Chester Ave.
Bakersfield. CA 93301
VOICE (661) 326-3696
FAJ«661)326~576
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield. CA 93301
,VOICE (661) 326-3951'
FAJ< (661) 326~576
TRAINING DIVISION
5642 Victor Ave.
Bakersfield. CA 93308
VOICE (661) 399-4697
FAJ< (661) 399-5763
-
.
June 5, 2003
Lucky 7
3301 Wible Road
Bakersfield CA 93309
REMINDER NOTICE
RE:
Deadline for Dispenser Pan Requirements December 31, 2003
Dear Underground Storage Tank Owner:
A review of our files indicate that you have been receiving quarterly
reminder notices since April of 2002. Effective January 2003, you can
expect them monthly.
The purpose of this letter is to remind you of the necessary retrofit of
your fueling system. Current code requires that you install dispenser
pans prior to December 31,2003. You will not be allowed to remain
open after December 31,2003 unless you have completed the upgrade
requirement. Contractors are already scheduling work 6-8 weeks out.
I urge you to start planning to retrofit your facility as soon as possible.
Sincerel1, ¡f j í ~
jt~...
Steve Underwood
Fire InspectorÆnvironmental Services
Office of Environmental Services
SBU/rs
(,(,.7~ ~ ~~n/Ju~ .%p </øgOPe .7~ .A W~"
FIRE CHIEF
RON "'<AZE
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 SAFETY SERVICES· ENVIRONMENTAl SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 Chester Ave.
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
-
-
May 7, 2003
Lucky 7
3301 Wible Road
Bakersfield CA 93309
REMINDER NOTICE
RE:
Deadline for Dispenser Pan Requirements December 31, 2003
Dear Underground Storage Tank Owner:
A Review of our files indicate that you have been receiving quarterly
reminder notices since April of 2002. Effective January 2003, you can
expect them monthly.
The purpose of this letter is to remind you of the necessary retrofit of
your fueling system. Current code requires that you install dispenser
pans prior to December 31,2003. You will not be allowed to remain
open after December 31, 2003 unless you have completed the upgrade
requirement. Contractors are already scheduling work 6-8 weeks out.
I urge you to start planning to retrofit your facility as soon as possible.
Sincerely,
.~~
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
"".%~ de WCWl/nN~ .%/e .~ope .9IZz.n .A t?~?"
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 SAFETY SERVICES. ENVIRONMENTAL SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 ChesterAvÈl.
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
-'
e
-
February 3, 2003
Lucky 7
3301 Wible Rd
Bakersfield CA 93309
REMINDER NOTICE
RE: Deadline for Dispenser Pan Requirements December 31, 2003
Dear Underground Storage Tank Owner:
.~
A Review of our files indicate that you have been receiving quarterly
reminder notices since April of 2002. Effective January~003, you can
expect them monthly.
The purpose of this letter is to remind you of the necessary retrofit of
your fueling system. CUITent code requires that you install dispenser
pans prior to December 31,2003. You will not be allowed to remain
open after December 31, 2003 unless you have completed the upgrade
requirement. Contractors are already scheduling work 6-8 weeks out. I
urge you to start planning to retrofit your facility as soon as possible.
Sincerely,
yi/: ~.'
. . .' ~..-
/... !
Steve Underwood
Fire Inspector/Environmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
··7~ áe' W~ §",op uØbOPe y~ A W~'I'
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. ENYIROHIIENTAL 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 DIVlSfON
5642 Victor Ave.
Bakersfield. CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
e.
--
January 22, 2003
Lucky 7
3301 Wible Rd
Bakersfield CA 93309
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.
Si7! rIk
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
"".7~ bfe WonlD~ ~ .A0P6 .r~ .A W~"
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 SAFETY SERVICES. ENVIRONIIëIIfAl. 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)326~76
TRAINING DIVISION
5642 Victor Ave.
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
.e
.
January 13, 2003
Lucky 7
3301 Wible Rd
Bakersfield CA 93309
RE: Deadline for Dispenser Pan Requirements December 31,2003
REMINDER NOTICE
Dear Underground Storage Tank Owner:
A review of our files indicates that you have been receiving quarterly
reminder notices since April of 2002.
. ,..,.;...;
The purpose of this letter is to remind you of the necessary retrofit of
your fueling system. Current code requires that you install dispenser
pans prior to December 31,2003. I urge you to start planning to retrofit
your facility as soon as possible.
Should you have any questions, please feel free to contact me at 661-
326-3190.
Si2~
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
"7~ ~ W~ ~,.A0Pe' ~bt, .Æ .W~"
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CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 326-3979
APPLICA TION TO PERFORM A TANK TIGHTNESS TEST/
SECONDARY CONTAINMENT TESTING
FACILITY Lu.r./kf '1
ADDRESS 330i itJd)\e_ RDru:Å ßOvkQ,('sCleJ~) tA
PERMIT TO OPERATE # C\ \
OPERATORS NAME G: I It{,:) Qh.(~f)'\;e~+
OWNERS NAME £II~~ ~kt1jrn~e..+
NUMBER OF TANKS TO BE TESTED d. IS PIPING GOING TO BE TESTEDk
TANK # VOLUME CONTENTS
\
I
. I
I !
TANK TESTING COMPANY Rf(1uJ/n~ Iës~I"~ ~e.nJ\t~ :t:t\c.) R If h. ËnVlrt>''\()\!-~\
MAILING ADDRESS PÐ ßö;< I ~lD 1 ACv~:e. lP~ J LA Cl 3 .~O~
NAME & PHONE NUMBER OFCONTACf PERSON DL~'Lt,-rL\.r-f')&- &(¡/- P3<-í-f...,e¡Q3
TEST METHOD cJ: () t.D f""\
NAl'vIE OF TESTER OR SPECIAL INSPECfOR -:::r~e, -::r. ~
CERTIFICATION # qo- ID'1à- r~,,--tÎt\~-hN-~ L\c-~Y\ Se_ S-3:> P'7 ~ A f4~:z...
DATE & TIME TEST IS TO BE CONDUCfED /... /cJ -J..()Q '1 I: Ò() ,;0/11
.~(4W
APPROVED BY
( ~'Io --0 d...
DATE
~ì~
SI NATURE OF J\PPUCANT
";/~:')"V"':"
:":-,<.0 ' , :., ' .
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CAl VAllEY EQUIPMENT
,3500 Gilmore Ave
Bakersfield, Ca 93308
661-327-9341 Fax 661-325-2529
IMPRESSED CURRENT CA THODIC PROTECnON CERnFICA nON
PATE:
<Ö-;l.j-O 2
SITE: LUcKfj 7 '#/1
3301 Wí'b/e U
ß¿¿~erf¡:''tl¡(c~- 9i>juq
cf.,4 ß/tctfUtflCl /HMflr. r"". .
, Model # sS-:t ' Serial #: 98'1'3J
. "':'·"::'CONTACT: '
, ,',PHONE:
," ." ,'Instailatlon pate:--1 qq g-
Hours: 2 S- ~ ß'l
AdjlJ~ment: CÞV(S~ +-1
Voltage: 32
Course: C-
Amps: _ G
Fine: I
,',
" "StrlIcture to Soil Potential Readings For Previously Installed Systems (System Off )
: . ,
"
" ,,': '. :. , I: . '.
: 'I hentl)y ,~rtifY that the minlrn~m IISysterÞ potential ~~I~f'ents. for Impressed Current Cathodic
"ProJecuc)O. , I",
, . ,,', ;', : '. " J;::::=-=:::::f Ha~e Been Met. . ' " '
- 'I' ,
I' I ,
: I' Have Not Been Met.' .
" I I
' I' . ",
, fqr the systems referenced above': take~ In accordance with the minimum standards of the National
~ci~tI~n of Çorrosion Engineers. 'and as done to' comply with EPA and State Directives
,'., '", ., ' ;, ¡
ßrtæt'fI/Vz.c;/~lA" 'I,' I
Technicl,n Perlonnil'!gTest ' 'i
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, "
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;,/',
"
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LUCK\' 7 19
3301 WIBLE RD
BAKERSFIELD CA.93309
661-397-455:3
OCT 21. 2002 8:40 AM
S\'STEM STATUS REPORT
. FU~CTIO~:3 -N¿Rr~AL -
INVENTORY REPORT
T 1 :PLU:=:;
\/0 L UI"1E
ULLAGE
90% ULLAGE=
TC VOLUI"lE
HEIGHT
[...IATER VOL
WATER
TEI"IP
T 2: PREt"1 I ur"1
VOLUI"IE
ULLAGE
9œ. ULLAGE=
TCfI- LUI"1E
HE
('JA . 'v'OL
WATER
TEI"1P
T 3:REGULAR
VOLUI"1E
ULLAGE
9œ. ULLAGE=
TC VOL ur"1E
HEIGHT
('JATER VOL
WATER
TEt"1P
2333 GALS
8038 GALS
7000 GALS
2328 GALS
26.20 INCHEB
o GALS
0.00 INCHES
88.9 DEG F
1513 GALS
8858 GALS
7820 GALS
1482 GALS
19.27 INCHES
o GALS
0.00 INCHE:3
88. 1 DEG F
:3844 GALS
6527 GALS
5489 GALS
:3836 GALS
37.75 INCHES
o GALS
o . 00 I NCHEE;
87.2 DEG F
~ ~ ~ ~ ~ END ~ ~ ~ ~ ~
ee
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
F ACILITY NAME~Ù' ,b.., 7
INSPECTION DATE (0 ";). (~ () "(
Section 2:
Underground Storage Tanks Program
o Routine ~ Combined 0 JoiVt Agency
Type of Tank ,t::j.ù~ C,C P../
Type of Monitoring -1tT6
o Multi-Agency 0 Complaint
Number of Tanks 3
Type of Piping EúJ S (, é . P. )
ORe-inspection
OPERA TION C V COMMENTS
Proper tank data on tile \... j
Proper owner/operator data on tile í....- /
Pemit fees current C...... I
Certification of Financial Responsibility l j
Monitoring record adequate and current \..JJ
I
Maintenance records adequate and current ./
Failure to correct prior UST violations ./
Has there been an unauthorized release? Yes No 1/
-
Section 3:
Aboveground Storage Tanks Program
TANK SIZE(S)
Type of Tank
OPERA nON Y N COMMENTS
SPCC available
SPCC on file with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?
If yes, Does tank have overfill/overspill protection?
AGGREGATE CAPACITY
Number of Tanks
C=Compliance
Y=Yes
N=NO
Inspector:
Office of Environmental Services (805) 326-3979
White - Env. Svcs.
JvJ~ ~~r
Business Site Responsible Party
Pink - Business Copy
ee
ee
CITY OF BAKERSFIEIJD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd F'loor, Bakersfield, CA 9330J
FACILITY NAME ~ !l"~,! ì
ADDRESS 33ú (1 .'Jt(
FACILITY CONTACT
INSPECTION TIME
~J
INSPECTION DATE ì () . ~ l ' () L
PHONE NO. 317" l{s:.~ 3
BUSINESS ID NO. 15-210-
NUMBER OF EMPLOYEES ~
Section 1:
Business Plan and Inventory Program
o Routine Y:Ö Combined
o Joint Agency
o Multi-Agency
o Complaint
ORe-inspection
OPERA TION C V COMMENTS
Appropriate pennit on hand \ V
Business plan contact infonnation accurate 1I
Visible address v V
Correct occupancy L- '/
Verification of inventory materials l -/
Verification of quantities '-' /
Verification of location L /
Proper segregation of material '-" /
V çrification of MSDS availability \... ~
Verification of Haz Mat training 1"""-
/
Veri fication of abatement supplies and procedures ./
Emergency procedures adequate \... V
Containers properly labeled \..... V
Housekeeping v ,G,g
#
Fire Protection ~ / /rrc -,)<Y CVJ'VtI'IIt.<h.Pf'_'- NC'l'A -StNt'
- v V '1ffi 3
.
Site Diagram Adequate & On Hand t,....'" )
L7 d,c.. (l.c.t ( I IK
~
C=Compliance
V=Violation
N c ct>c(; C(.l.{( Ð (./S- f
Wc.c" ~UJI(tJ
£'~f.
Any hazardous waste on site?:
Explain:
DYes qNo
White - Env. Svcs.
Yellow - Station Copy
Pink - Business Copy
f¡J "'-- ~
Business SJ'ponsible Party
Inspector: _ ¡£~/()
Questions regarding this inspection? Please call us at (661) 326-3979
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 SAFETY SERVICES' ENVIRONIlENTAl SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 Chester Ave.
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
.
.
September 30, 2002
Lucky 7
3301 Wible Rd
Bakersfield CA 93309
REMINDER NOTICE
RE: Necessary secondary containment testing requirements by December 31,2002 of
underground storage tank (s) located at the above stated address.
Dear Tank Owner / Operator,
If you are receiving this letter, you have not yet completed the necessary secondary
containment testing required for all secondary containment components for your underground
storage tank (s).
Senate Bill 989 became effective January 1,2002, section 25284.1 (California Health & Safety
Code) of the new law mandates testing of secondary containment components upon installation
and periodically thereafter, to insure that the systems are capable of containing releases from
the primary containment until they are detected and removed.
Of great concern is the CUlTent failure rate of these systems that have been tested to date.
CUlTently the average failure rate is 84%. These have been due to the penetration boots leaking
in the turbine sump area.
For the last five months, this office has continued to send you monthly reminders of this
necessary testing. This is a very specialized test and very few contractors are licensed to
perform this test. Contractors conducting this test are scheduling approximately 6-7 weeks out.
The purpose of this letter is to advise you that under code, failure to perform this test, by the
necessary deadline, December 31, 2002, will result in the revocation of your permit to operate.
This office does not want to be forced to take such action, which is why we continue to send
monthly reminders.
Should you have any questions, please feel free to call me at (661) 326-3190.
Si;i dûuv
Steve Underwood
Fire Inspector/ Environmental Code Enforcement Officer
Office of Environmental Services
"7~~ W~ Y"'op ~~ y~ A W~'.,
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 oW Street
Bakerslield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 oW Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFETY SERVICES' EIMROIIIlEHTAL SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3696
FAJ< (661) 326H0576
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAJ< (661) 326-0576
TRAINING DIVISION
5642 Victor Ave.
Bakersfield, CA 93308
VOICE (661) 399-4697
FAJ< (661) 399-5763
'.
.
September 30, 2002
Lucky 7
3301 Wible Road
Bakersfield CA 93309
RE: Deadline for Dispenser Pan Requirement December 31, 2003
REMINDER NOTICE
Dear Underground Storage Tank Owner:
You will be receiving updates from this office with regard to Senate Bill
989 which went into effect January 1,2002.
This bill requires dispenser pans under fuel pump dispensers. On
December 31, 2003 which is the deadline for compliance, this office will
be forced to revoke your Permit to Operate, for failure to comply with the
regulations.
It is the hope of this office that we do not have to pursue such action,
which is why this office plans to update you. I urge you to start planning
to retro-fit your facilities.
If your facility has been upgraded already, please disregard this notice.
Should you have any questions, please feel free to contact me at 661-326-
3190.
Sin::¡ rU4J
Steve Underwood
Fire Inspector/ Environmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
""sP~de W~ ~.AO/¥Þ.r~.A W~"
L\u
'7
9-19-20029:17AM
-- .
FROM CALVALLEY EQUIP 16613252529
CAl VALLEY EQUIPMENT
3500 Gllmöre Ave
Bakersfield, C8 93308
661"327..9341 Fax 661"325-2529
IMPRESSED CURRENT CA T''''()I)IC PROTECTION CS"TlP,CATJON
OATE:
·<j)~2-3·-O 2
SITE: Luct.. '1 7 '#1 '1
3301 lví' bit! t¡,f
ß¡.t:.c(/A'c/¡(,Ç¿¡,.- '!..?},e¡
ú.A fdltä (I)",'cl /H(oiI('v:, I¡"c· .
Modell# J $.~.r ' Serial .,.38'13 J
CONTACT:
PHONE:
InstaUaUon Date: I tf'J ß"
'-fours; 2 S- c;r 51
Adjuslrn(fnt:...Q.~v(S~, ..¡- J
Voltage: 32
/'..
Course: !...-
Amps:
6'
t
F¡ne~
I: ~ I·~~¡
I t:~;~ ~tfl ~ . ~:~~+~Jt:~ j'
. I
I'
I:
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; !
: i
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i ¡
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.~
I hereby certify that the mlnlmunlsysterh potential requirements for Impressed CUlT8nt Cathodic
ProtectIon: ' '
~ Have Been Met
.
~: ¡ Ha~e Not EJeen Met
I' !
for the systems rererenced eböve: .teke~ 1/1 accordance with the minimum standards of the Nationsl
Assocl8t~n of CoO'osloo Engineehi. and as done to oomply with EPA and State Directives
ßYú';Cl /ilk!. <ï/e.M.
Technician Peñorrning Test
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P.4.
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i}:;.
"I:
"t:
..!.
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.;
:i
,
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
21 01 "H" Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" 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
-
-
o August 30, 2002
Lucky 7
3301 Wible Road
Bakersfield, CA 93309
REMINDER NOTICE
RE: Necessary secondary containment testing requirements by December 31, 2002 of
underground storage tank (s) located at the above stated address.
Dear Tank Owner / Operator,
If you are receiving this letter, you have not yet completed the necessary secondary
containment testing required for all secondary containment components for your
underground storage tank (s).
Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health
& Safety Code) of the new law mandates testing of secondary containment
components upon installation and periodically thereafter, to insure that the systems are
capable of containing releases from the primary containment until they are detected
and removed.
Of great concern is the current failure rate of these systems that have been tested to
date. Currently the average failure rate is 84%. These have been due to the
penetration boots leaking in the turbine sump area.
For the last four months, this office has continued to send you monthly reminders of
this necessary testing. This is a very specialized test and very few contractors are
licensed to perform this test. Contractors conducting this test are scheduling
approximately 6- 7 weeks out.
The purpose of this letter is to advise you that under code, failure to perform this test,
by the necessary deadline, December 31, 2002, will result in the revocation of your
permit to operate.
This office does not want to be forced to take such action, which is why we continue to
send monthly reminders.
Should you have any questions, please feel free to call me at (661) 326-3190.
Si::¡ C~O
Steve Underwood
Fire Inspector/ Environmental Code Enforcement Officer
Office of Environmental Services
""~~ de W~;vnu~ ~ ~0Pe .r~ A We.náuy""
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 oW Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 aH" 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
-
-
August 30, 2002
Lucky 7
3301 Wible Road
Bakersfield, CA 93309
RE: Deadline for Dispenser Pan Requirement December 31,2003
I
REMINDER NOTICE
Dear Underground Storage Tank Owner:
You will be receiving updates from this offices with regard to Senate
Bill 989 which went into effect January 1, 2002.
This bill requires dispenser pans under fuel pump dispensers. On
December 31, 2003 which is the deadline for compliance, this office
will be forced to revoke your Pennit to Operate, for failure to comply
with the regulations.
It is the hope of this office that we do not have to pursue such action,
which is why this office plans to update you. I urge you to start
planning to retro-fit your facilities.
If your facility has been upgraded already, please disregard this notice.
Should you have any questions, please feel free to contact me at 661-
326-3190.
Sinc:¡ dMJ
Steve Underwood
Fire Inspector/ Environmental Code Enforcement Officer
Office of Environmental Services
SBU/kr
~"Y~ de, ~0Hl/~ .97'0P .A0Pe ff~ A ~~"
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U.S. Postal Service
CERT!-EI~D MAIL RECEIPT
(Dome: '(Aes Only; No Insurance Coverage Provided)
\ _ / 'U),
Postage $
Certified Fee
Postmark
Retum Receipt Fee 1. 0 Here
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees $ 3.94
,...:¡
.1:]
a City, State, ZIP+ 4
I"'-
Sent To
umu.u.'....n..m···§gg;Q··~...................m..................n
Street, Apt. No.;
~:.~~.~~~.~~~nm.u~}º!...w!~~~..~n............u....m.n.n.mn'm
:.,
Certified Mail Provides:
· 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 Mail.
· 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 I
fee. Endorse mail piece "Return Receipt Requested". To receive a fee waiver for I
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 I
addressee's authorized agent. Advise the clerk or mark the mail piece with the '
endorsement "Restricted Delivery""... . --"" I
· If a postmark on the Certified Mail receipt is desired, please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is naeded, detach and affix label with postage and mail.
IMPORTANTWI this receipt and present it when making an inquiry.
PS Form 3800, January 2001 (Reverse)
1n?~q~_n1_M_1nA7
· Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
· Print your name and address on the revèrse
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:
SAEED ALAZj\S
1
LUCKY 7
3301 WIBLE ~lID
BAKERSFIELD CA 93309
~.
7001 0360 0002 5244 7049
PS Form 3811, August 2D01
COMPLETE THIS SECTION ON DELIVERY "
A. Signature
o Agent
o Addressee
D. Is delivery address different from item 1?
If YES, enter delivery address below:
3. Service Type
IX 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
Domestic Return Receipt
102595-01-M-2509
I
I POSTAL SERVICE
I UNITED STATES
I
I
,
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~::::::::Üi +:s:;,:~ i C
111111
First-Class Mail Paid
Postage & Fees
USPS
Permit No. G-10
d ZIP+4 in this box ·
name address, an
' der' Please print your ,
· Sen .
!
II
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BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Avenue, Suite 300
B~karsff.ald.. CA 93301
)'
e
I 11 I I') 1I1,llIi,I,1
II,IIIII,"II,IIIIII"fh'::lIliiIUIIII, III I III/II ,
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Slreet
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFETY SERVICES' ENVIRONMENTAL SERVICES
1715 Chesler Ave.
Bakersfield, CA 93301
VOICE (661) 326·3979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 Chester Ave.
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-D576
TRAINING DIVISION
5642 Victor Ave.
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
e
e
~ ~._~
.'
. ~ -.
August 1, 2002
Saeed Alazas
Lucky 7
3301 Wible Rd
Bakersfield, CA 93309
CERTIFIED MAIL
Re:
Failure to Perform or Submit
Three Year Cathodic Protection Certification
NOTICE OF VIOLATION &
SCHEDULE FOR COMPLIANCE
Dear Customer:
According to our records, your three year Cathodic Protection Certification is due on
August 10,2002. Failure to comply is a violation of section 2635 2(a) Failure to
Perform/Submit Cathodic Protection Testing results.
Section 2635 2(a) is as follows:
"Field-installed cathodic protection systems shall be designed and certified as adequate
by a corrosion specialist. The cathodic protection systems shall be tested by a cathodic
protection tester within six months of installation and at least every three years
thereafter. "
The cathodic protection is part of your leak detection system and is a condition of your
Permit to Operate. Therefore, prior to August 30, 2002, you shall either perform or
submit evidence of cathodic protection testing. Failure to comply will result in
revocation of your Permit to Operate.
Should you have any questions, please feel free to contact me at 661-326-3190.
Sincerely,
Ralph E. Huey
Director of Prevention Services
BYÂ~
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
Cc: Elias Shameih
~~.?~ ~ W~ yO/<' .A~ §'"'kz, A W~"
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 SAfETY SERVICES' ENVIRONMENTAl. SERVICES
1715 Chester Ave.
Bakersfield. CA 93301
VOICE (661) 326-3979
FAX(661)32~576
PUBLIC EDUCATION
1715 Chester Avè.
Bakersfield, CA 93301
VOICE (661) 326-3696
FAX (661) 32~576
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
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July 31,2002
Lucky 7
3301 Wible Road
Bakersfield CA 93309
RE: Deadline for Dispenser Pan Requirement December 31,2003
REMINDER NOTICE
Dear Underground Storage Tank Owner:
You will be receiving updates from this office with regard to Senate
Bill 989 which went into effect January 1,2002.
This bill requires dispenser pans under fuel pump dispensers. On
December 31,2003, which is the deadline for compliance, this office
will be forced to revoke your Pennit to Operate, for failure to comply
with the regulations.
It is the hope of this office that we do not have to purse such action,
which is why this office plans to update you. I urge you to start
planning to retro-fit your facilities.
If your facility has been upgraded already, please disregard this notice.
Should you have any questions, please feel free to contact me at 661-
326-3190.
sincer",~. el.Y." '..........
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Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
""~~S¡¿R~-O~L~~P~N~~"
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "W Street
, Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H. Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFETY SERVICES' EIMAOHIIEIfTAI. SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (66~) 326-0576
PUBLIC EDUCATION
1715 Chester Ave.
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 DIVlStON
5642 VIctor Ave.
Bakersfield, CA 93306
VOICE (661) 399-4697
FAX (661) 399-5763
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August 1. 2002
Saeed Alazas
Lucky 7
3301 Wible Rd
Bakersfield. CA 93309
CERTIFIED MAIL
Re:
Failure to Perform or Submit
Three Year Cathodic Protection Certification
NOTICE OF VIOLATION &
SCHEDULE FOR COMPLIANCE
Dear Customer:
According to our records. your three year Cathodic Protection Certification is due on
August 10. 2002. Failure to comply is a violation of section 2635 2(a) Failure to
Perform/Submit Cathodic Protection Testing results.
Section 2635 2(a) is as follows:
"Field-installed cathodic protection systems shall be designed and certified as adequate
by a corrosion specialist. The cathodic protection systems shaH be tested by a cathodic
protection tester within six months of installation and at least every three years
thereafter. "
The cathodic protection is part of your leak detection system and is a condition of your
Permit to Operate. Therefore, prior to August 30, 2002, you shall either perform or
submit evidence of cathodic protection testing. Failure to comply will result in
revocation of your Permit to Operate.
Should you have any questions, please feel free to contact me at 661-326-3190.
Sincerely,
Ralph E. Huey
Director of Prevention Services
BY~~
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
Cc: Elias Shameih
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LEASE
TIllS LEASE is entered into between Jamal Shamieh, aka Shambro, hereinafter
referred to as "Land/orc!' and Kartar Singh, hereinafter referred to as "Tenant'.
NOW, THEREFORE, in consideration of the mutual covenants and agreements
herein contained, the parties hereto agree as follows:
ARTICLE I
PREMISES -
Section 1.01. Landlord hereby leases to Tenant, and Tenant hereby hires and takes
from Landlord, for the, term, at the rental and upon the conditions hereinafter set forth, those
certain Premises and personal property, hereinafter collectively referred to as 3301 Wible Road,
Bakersfield, California, 93309.
Section 1.02.' The Landlord covenants and agrees that the Tenant on paying the rent
and performing the covenants contained herein shall and may peaceably and quietly hold and
enjoy the Premises for the term of this lease.
Section 1.03. This lease shall be subordinate and subject at all times to any
,mortgage or deed of trust covering the Premises or which ,at any time hereafter shall be made, and
to all advances made, or hereafter to be made, upon the security hereof.
ARTICLE II
USE
Section 2.01. The Premises are to be used solely for the purpose of a branded
service station convenience store and for no other purpose without the written consent of Landlòrd.
Section 2.02. Tenant shall not do or permit anything to be done in or about the
Premises, nor bring,' nor keep anything therein which will in any way affect fire or other insurance
upon the building" or any of its contents, or which shall in any way conflict with any law,
ordinance, rule, or regulation affecting the occupancy and use of the Premises, which are or may
hereafter be enacted or promulgated by any public authority, nor allow the Premises to be used, for
any improper, immoral, or unlawful, or objectionable purpose.
Section 2.03. Tenant shall not assign, mortgage, or hypothecate this Lease, or any
interest therein, or permit the use of the Premises by any person or persons other than the Tenant,
or sublet the Premises, or any part thereof, without prior written consent of landlord. Consent to
any such assigrÌÍnent or subletting shall not operate as a waiver of the necessity for consent to any
subsequent assignment or subletting, and the terms of such consent shall be binding upon any
person holding by, under, or through Tenant. Landlord's consent shall not be wrreasonably
withheld. Any such assignment or subletting without such consent shall be void, and shall, at the
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option of Landlord, tenninate this Lease. This Lease shall not, nor shall any interest therein be
assignable, as to the interest of Tenant, by operatìon of law, without the written consent of
Landlord.
Section 2.04. Tenant will not pennit or suffer any awning, shade, sign,
advertisement or notìce to be displayed, inscribed upon or affixed on any part of the outside or
inside of the Premises, or in the building of which they are a part, except on the prior written
consent of Landlord, and then only of such size, color, and style as Landlord may approve.
Section 2.05 Tenant agrees to observe faithfully, and comply strictly with, such
rules and regulations, promulgated from tìme to time by the Landlord, as in the Landlord's
judgment are necessary for the safety, care, and cleanliness of the building or for the preservation
of good order therein.
ARTICLE ill
TERM AND RIGHT OF FIRST REFUSAL
Section 3.01. The tenn of this Lease shall be five (5) years, commencing on
to
, Section 3.02.
(a) Tenant agrees to surrender the Premises at the tennination of the tenancy
herein created, in the same condition as herein agreed they have been
received, reasonable use and wear thereof and damage by the act of God
or by the elements excepted.
(b) Tenant shall, at least thirty (30) days before the last day of the tenn
hereof, give the landlord a written notìce of intention to surrender the
Premises on that date, but nothing contained herein shall be construed as
an extension of the tenn hereof or as consent of Landlord to any holding
over by Tenant.
Section 3.03. Upon the expiratìon or early tennination of this Lease, Tenant agrees
to deliver a quitclaim deed in favor of Landlord releasing its interest in the Premises.
Section 3.04.
(a) If Landlord detennines to sell the premises, Landlord shall notify
tenant of the tenns on which Landlord will be willing to sell. If
Tenant, within 15days after receipt of Landlord's notice, indicates in
writing its agreement to purchase the premises on the tenns stated in
Landlord's notice, Landlord shall convey and sell the premises to
Tenant on the tenns stated in the notice. If Tenant does not indicate
its agreement within 15 days, Landlord thereafter shall have the right
to sell, and convey the premises to a third party on the same tenns
stated in the notice. If Landlord does not sell and convey the
premises within 180 days, any further transaction shall be deemed a
new detennination by Landlord to sell and convey the premises and
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the provisions of this paragraph shall be applicable. If Tenant
purchases the premises, this lease shall terminate on the date title
vests in Tenant and Landlord shall remit to tenant all prepaid and
unearned rent. Tenant's right of first refusal shall not apply to a new
transfer between any of those persons who constitute Landlord and
the blood relatives of any of those persons, either outright or in trust,
or to a legal entity (i.e., partnership, corporation, trust, or like entity)
when majority interest is owned by all or some of the per.sons who
constitute Landlord.
(b) If Tenant determines to sell the business and its assets, Tenant shall
notify Landlord of the terms on which Tenant will be willing to sell.
If Landlord, within 15 days after receipt of Tenant's notice, indicates
in writing its agreement to purchase the business and its assets on the
terms stated in Tenant's notice, Tenant shall convey and sell the
business and its assets to Landlord on the terms stated in the notice.
If Landlord does not indiéate its agreement within 15 days, Tenant
thereafter shall have the right to sell and convey the business and its
assets to a third party on the same terms stated in the notice. If
Tenant does not sell and convey the business and its assets within
180 days, any further transaction shall be deemed a new
determination by Tenant to· sell and convey the business and its
assets and the provisions of this paragraph shall be applicable. If
Landlord purchases the business and its assets, this lease shall
terminate on the date title vests in Landlord and Tenant shall remit to
Landlord all prepaid and unearned tent. Landlord's right of first
refusal shall not apply to a transfer between any of those persons
who constitute Tenant and the blood relatives of any of those
persons, either outright or in trust, or to a legal entity (Le.,
partnership; corporation, trust, or like entity) when majority interest
is owned by all or some of the persons who constitute Tenant.
Section 3.05. OPTION TO RENEW LEASE. Provided that tenant is not in
breach of any tèrms or provisions of this lease, tenant shall have the option to extend the terms of
this lease for an additional two (2), five (5) year term under the same terms and conditions with the
exception of the rent. The rent for the first option term shall be as follows:
Effective the 60th month and through the 120th month, the rent shall be $3850.00
Effective the 121st month and through the 1 80th month, the rent shall be $4850.00.
Tenant shall by registered mail notify the landlord of his intent to exercise the option no later than
six (6) months prior to the expiration of the le~e terms.
ARTICLE IV
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Section 4.01. Tenant agrees to and shall pay to Landlord as basic rent for the
demised premises the sum of Three Thousand Two Hundred and Fifty Dollars ($ 3,250.00) per
month on the first day of each month commencing on the beginning of the term herein for Sixty
(60) months, and Three Thousand Eight Hundred Fifty Dollars ($ 3,850.00) per month
commencing on Month Sixty First (61st) and ending on the One Hundred Twentieth (120th) month;
thereafter on the frrst day of each and every month during the within term.
If the Rent is not received on the fifth day of each month a late payment of 10% shall become due
and payable in addition to the Rent.
In addition to the rent tenant shall pay all real estate property tax, fire, liability and
damage insurance in addition to 11.01, 11.02, and 11.03. This is a triple net lease
ARTICLE V
TAXES AND UTILITIES
DEPOSIT: Tenant shall pay the following deposit:
1 st month rent:
Security Deposit:
Last month rent:
Total:
$ 3,250.00
$ 400.00
$ 3.850.00 .
$ 7,500.00
Last month and Security Deposit shall not be deposited in an interest bearing account.
Section 5.01. Landlord shall pay all taxes and assessments levied upon the
Premises including all Real Estate Tax Assessed.
Tenant shall pay all taxes and assessments levied against any personal property,
trade fixtures, or other improvements on the Premises belonging to the Tenant.
Section 5.02. Tenant shall pay for all electricity, garbage service, water and all
other utilities or services.
ARTICLE VI
IMPROVEMENTS AND REPAIRS
Section 6.01.
(a) Tenant shall make no installations, additions, or improvements in or to
,the Premises, except as otherwise authorized in this Lease, or· structural
alterations or changes either to the interipr or exterior of the building
initially constructed on the Premises, or in the bearing walls, supporters,
beams, or foundations, without the written consent of Landlord.
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(b) Plans and specifications showing such proposed inst~lations, additions,
or improvements, and alterations and changes, shall be submitted to
Landlord for approval upon the application for such consent.
(c) All installations, additions, or improvements, and alterations and
changes made, with the written consent of Landlord, shall be made at the
sole cost and expense of Tenant, under supervision of an architect or
engineer satisfactory to Landlord. .
, (d) If during the term of this Lease any additions, alterations, or
improvements in or to the Premises, as distinguished from repairs, are
required by any governmental authority or any law, ordinance, or
governmental regulation because of the use to which the Premises are
put by Tenant and not by reason of the character or structure of the
building, they shall be made and paid for by Tenant. .
(e) It is understood and agreed between the parties that all installations,
additions, or improvements erected or installed at any time upon the
Premises during the term of this Lease, shall revert to and become the
property of the Landlord upon termination of this Lease, and the erection
of same shall be deemed to additional rent payable by the Tenant
hereunder to be prorated over the then remaining term of said lease and
Landlord shall be entitled to any and all depreciation, which may be
available under the Internal Revenue Code of 1954. Such additional
(f) Rent shall not offset or otherwise reduce the rental payable under Article
IV.
Section 6.02. Tenant shall, at its sole cost, keep and maintain the demised
Premises, buildings, appurtenances and all furniture, furnishings and equipment, and every part
thereof, now or hereafter constructed or located on the demised premises in good and sanitary
order, condition and repair, ordinary wear and tear excepted.
Section 6.03.
(a) Tenant agrees to pay promptly for all labor done or materials furnished
for any work of repair, maintenance, improvement, alteration, or
addition done by Tenant in connection with the Premises free, clear, and
harmless from all liens that could arise by reason of any such work. If
any such lien shall at any time be filed against the Premises, Tenant
shall either cause the same to be discharged of record within fifteen (15)
days after the date of filing the same. Or if Tenant, in its discretion and
in good faith, determines that such lien should be contested, Tenant
shall furnish such security as may be necessary or required to prevent
any foreclosure proceedings against the Premises during the tenancy of
such contest. If Tenant shall fail to discharge such lien within such
period or fail to furnish such security, then in addition to any other right
or remedy, Landlord may but shall not be obligated to discharge the
same, either by paying the amount claimed to be due or by procuring
the discharge of such lien by deposits in court or by giving security or in .
such other manner as is or may be prescribed by law. Tenant shall repay
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to Landlord on demand all sums disbursed or deposited by Landlord on
demand all sums disbursed or deposited by Landlord's costs, expenses,
and reasonable attorney's fees incurred by Landlord in connection
therewith. Nothing contain~d herein shall imply· any consent or
agreement on the part of Landlord to subject landlord's interest in the
real property, of which the Premises are a part, to liability under any
mechanic's lien law.
(b) Landlord shall at all times have the right to post and to keep posted on
the demised Premises such notices provided for under the laws of the
State of California for the protection of the Premises form mechanic's
liens or liens of a similar nature.
(c) In the events any underground facilities, including tanks or fuel lines
(except the hoist, water and sewer lines which Tenant agrees to pay for
any repairs or replacement) develop leaks or are in need of repair,
Tenant agrees to pay 50% of the cost of any repair or replacement to
Landlord immediately upon demand and Landlord agrees to pay the
balance of any costs of any necessary repairs or replacement of such
facilities provided that the repairs are not covered by the State Insurance
Program.
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ARTICLE VII
DESTRUCTION AND CONDEMNATION
Section 7.01. If the Premises or the building wherein the same are situated shall be
destroyèd by fire or other cause, or be so damaged thereby that they are untenable and cannot be
rendered tenantable within ninety (90) days from the date of such destruction or damage, this lease
may be terminated by Landlord or Tenant by written notice. In case the damages or destruction is
not such as to permit a termination of the Lease as above provided, then a proportionate reduction
shall be m~de in the rent herein reserved corresponding to the time during which and to the portion
of the Premises of which Tenant shall be deprived of possession. The provisions of Subdivision 2
of section 1932 of the California Civil Code, and of Subdivision 4 of Section 1933 of that Code,
shall not apply to this Lease, and Tenant hereby waives the benefit of such provisions.
Section 7.02. If the whole or any part of the Premises shall be takes or condemned
by any competent authority under power of eminent domain for a public or quasi - public use or
purpose, then, at Landlord's option to be exercised by written notice to be given by Landlord to
T enant,the term hereby granted shall cease from the time when possession of the part so taken
shall be required for such public or quasi - public use or purpose, and the award shall belong to
and be paid to Landlord, except that Tenant shall receive from the award the following: Any sum
attributable to Tenant's improvements or alterations made to the premises by Tenant in accordance
with this lease, which improvements or alterations Tenant has the right to remove from the
premises pursuant to the provisions of this lease, but elects not to remove or' any sum paid to
Tenant form cO'Ïldemnor for loss of goodwill.
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ARTICLE VIII
INDEMNITY
Section 8.01. Landlord shall not be liable to Tenant for any injury or damage that
may result to any person or property by or from any cause whatsoever, and without limiting the
generality of the foregoing, whether caused by water leakage of any character form the room,
walls, basement, or other portion of the Premises, or caused by gas, fire, oil, electricity, or any
cause whatsoever, in, on, or about the Premises or any part thereof.
Section 8.02. Tenant agrees to hold Landlord harmless form and defend Landlord
ag~st any and all claims or liability for any injury or damage to any person or property
whatsoever occurring in, on, or about the Premises or any part thereof, when such injury or
. damage shall be caused in part or in whole by the act, negligence or fault of, or omission of any
duty with respect to the same by Tenant, his agents, sen:ants, or employees.
ARTICLE IX
DEFAULT
Section 9.01. Any and all of the following actions shall constitute default of this
lease:
(a) Use of the Premises for any purpose other than as authorized in this Lease;
or
(b) Default in the payment of rent or any other sums owing due; or
(c) Abandonment or vacation from the Premises; or
(d) Assignment of the Premises by Tenant, either voluntarily or by operation of
law, whether by judgment, executions, death, or any other means; or
(e) The filing by Tenant or any other person of a voluntary or involuntary
petition in bankruptcy or an arrangement by or against Tenant; the
adjudication of Tenant as a bankrupt or insolvent; the appointment of a
receiver of the business or of the· assets of Tenant, except a receiver
appointed at the instance or request of Landlord; the general or any other
, assignment by Tenant for the benefit of its creditors; or
(f) A default in the performance of any of the terms, covenants, and conditions
herein contained; or
(g) The inability of Tenant to pay the rent herein specified or tö perform any of
the terms, covenants, or conditions herein by it to be kept or performed.
Section 9.02. In the event of default of this Lease, and in addition to all other rights and
remedies Landlord may have at law, Landlord shall have the option to do any or all of the
following:
(a) Reentry: Immediately reenter and remove all persons and property from the
Premises, storing said personal property in a public warehouse or elsewhere at
the cost of, and for the account of the Tenant. No such reentry or taking
possession of the Premises by Landlord shall be construed as an election on its
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part to terminate this Lease unless Landlord gives a written notice of such
intention to Tenant.
(b) Collection of Rent: To collect by suit or otherwise, pursuant to the provisions
of Section 1951. 4 of the Civil Code, each installment or rent or other sum as it
becomes due hereunder, or to enforce, by suit or otherwise, an other term or
provision hereof on the part of Tenant required to be kept or performed, it
being specifically agreed that all unpaid installments of rent or other sums
shall bear installments of rent or other sums shall bear interest at the highest
legal rate from the date thereof until paid.
(c) Termination of Lease: Terminate of this Lease, in which event Tenant agrees
to immediately surrender possession of the Premises, and to pay Landlord, in
addition to any other remedy Landlord may have, all damages Landlord may
incur by reason of its default including the cost of recovering the Premises,
and including:
(1) The worth at the time of award of the unpaid rent
which had been earned at the time of the termination:
(2) The worth at the time of award of the amount by
which the unpaid rent would have been earned after
termination until the time of award exceeds the
amount of such rental loss that the Tenant proves
could have been reasonably avoided:
(3) The worth at the time of award of the amount by
which the unpaid rent for the balance of the term
after the time of award exceeds the
(4) a mount of such rental loss that the Tenant proves
could be reasonably avoided: and
(5) Any other amount necessary to compensate the
Landlord for all the detriment proximately caused by .
the Tenant's failure to perform its obligations under
this Lease or which in the ordinary course of things
would be likely to result therefrom.
(d) Re letting: Should Landlord elect to reenter, as herein provided, or
should it take possession pursuant to legal proceedings or as otherwise
provided for by law, it may either terminate this Lease or it may from
time to time, without terminating this Lease, re lette the Premises, or
any part thereof, as the agent and for the account of Tenant, either in
landlord's name or otherwise, upon such terms and conditions and for.
'" such a period (whether longer than the balance of the term hereof or
not) as Landlord may deem advisable, either with or without any
. equipment or fixtures that may be situated thereon or therein, in which
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event the rents received on any such re letting during the balance of
the term of this Lease, or any part thereof, shall be applied first to the
~xpenses of re letting and collecting, including necessary renovation
and alteration of the Premises and reasonable attorney's fees, and any
real estate commission actUally paid and, thereafter, toward payment
of all sums due to Landlord hereunder, and if a sufficient sum shall
not be thus realized to pay such rent and other charges, Tenant shall
pay to landlord monthly any deficiency shall arise: such monthly
deficiencies shall be paid punctually when due. If Landlord should
take possession of the Premises under the provisions of this paragraph
or at the end of the term, landlord may remove to any place of
storage, or any dumping ground, at Tenant's risk and expense and
without incurring any responsibility to Tenant for loss, damage, or
theft, all property in or about the leasehold belonging to, or in the
custody of Ten ant.
(e) Waiver or Breach: Landlord's failure to take advantage of any default
or breach of covenant on the part of Tenant shall not be, or be
construed as a waiver thereof, nor shall any custom or practice which
may, grow up between the parties in the course of administering this
instrument be construed to waive or to lessen the right of Landlord to
insist upon _ the performance by Tenant of any term, covenant, or
condition hereof, or to exercise aný rights given it on account of any
such default. A waiver of a particular breach or default, shall not be,
or be construed to be, a waiver of any term, covenant, or condition of
this Lease.
(f) Demand for Rent: In the event that Tenant shall be in default in the
payment of any rents provided for in this Lease, Tenant waives the
making by Landlord of any demand fòr rent prior to the
commencement of any action in ejectment or to obtain possession of
the Premises.
(g) Cumulative Remedies: The foregoing remedies of Landlord shall not
be exclusive, but shall be cumulative and in addition to all remedies
now or hereafter allowed by law or elsewhere provided.
(h) Landlord Curing: Default: Upon ten (10) days prior written notice to
the Tenant by the Landlord, it is agreed that the landlord may cure any
default by the Tenant hereunder and, if necessary, may enter upon the
Premises for such purpose, and in such event and the cost thereof to
landlord shall be deemed additional rent payable by Tenant, which
shall become immediately due and payable.
ARTICLE X
INSPECTION AND NOTICES
Section-ïo.Ol. Tenant will permit Landlord and its agents to enter into and upon
the Premises. at all reasonable times for the purpose of inspection the same, for the
purpose of protecting owners' reversions, or to make alterations or additions to the
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Premises or to any other portion of the building in which the Premises are situated or for
maintaining any service provided by Landlord to Tenant hereunder, without any rebate of
rent to Tenant for any loss of occupancy or quiet enjoyment of the Premises, or damage,
injury, or inconvenience thereby occasioned, and will permit Landlord at any time within
thirty days prior to the expiration of this Lease to bring upon the Premises, for the
purposes of inspection or display, prospective tenants thereof.
Section 10.02 Any notice, demand, or communication under, or in connection
with, this Lease may be served upon Landlord by personal service or by mailing the same
addresses to Landlord at: 703 Market St., Suite 1700, San Francisco, California 94103,
and upon Tenant by personal service or by' mailing the same addressed to Tenant at:
33 ~ \ ¿w /iJp R~! ~~¡:.Je,~J ' California, or at such other place or
places as the parties hereto may designate in writing by mailing such notice to the other
party certified mail, postage prepaid.
ARTICLE XI
INSURANCE
Section 11.01 The Tenant shall carry and maintain, during the entire term hereof,
at Tenant's sole cost ánd expense, the following types of insurance, in the amounts
specified and in the form provided for ,in this section:
(a) Broad form comprehensive public liability insurance with limits of
not less than one lnillion dollars ($1,000.000.00) each occurrence,
insuring against any an ~lliability of the Tenant with respect to the
Premises or arising out of the maintenance, use, or occupancy thereof, ,
and property damage liability insurance with a limit of not less than
(1,000.000.00) each accident.
(b) A policy or policies of fire insurance with standard form extended
, coverage endorsement, to the extent ,of at least ninety percent(90%) of
the full insurable value of Tenant's improvements, fixtures, equipment,
and merchandise, which may from time to time be located in the
Premises, and trade fixtures and equipment of others which are in
Tenant's possession and which are located within said Premises. The
proceeds from any such policy shall be used for the repair or
replacement of said improvements, fixtures, equipment, and
merchandise.
(c) Coverage endorsement, to the extent of at least ninety percent (90%) of
the full insurable value of Tenant's improvements, fixtures, equipment,
and merchandise, which are in Tenant's possession and which are
located within said premises. The proceeds from any such policy shall
be used for the repair or replacement of said improvements, fixtures,
...' equipment, and merchandise.
Section 11.02
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(a) All policies of insurance to be provided for herein by Tenant shall be
issued by companies having not less than' Best's A;AAA rating and
except for the policies Under Section 11.0 1 (b) above shall be issued
in the names of the Tenant and the Landlord and for the mutual and
joint benefit and protection of the parties. All public liability and
property damage policies shall contain a provision that the Lap.dlord,
although names as an insured, shall nevertheless be entitled to
recovery under said policies for any loss, injury, or damage to
landlord, its servants, agents, and employees by reason of the
negligence of the Tenant.
(b) Tenant shall deliver to landlord policies evidencing the insurance
procured by Tenant, or to deliver in lieu thereof certificates of
coverage trom the insurance company or companies writing the policy
or policies of insurance, which certificates shall, among other things,
designate the company writing the same, the number, amount and
provisions thereof. Upon Landlord's written request, duplicate copies
of such certificates of insurance shall be delivered to Landlord's
mortgagees.
(c) All insurance policies shall contain a provision that such policies shall
not be cancelled or· terminated without thirty (30) days' prior notice
trom the insurance company to Landlord. Tenant agrees that on or
before ten (10) days prior to expiration of any insurance policy,
Tenant will deliver to Landlord written notification in the form of a
receipt or other similar document trom the iiisurance company that
said policy or policies have been renewed, or deliver certificates of
coverage trom another good and solvent insurance company for such
coverage;
(d) Tenant shall procure an appropriate clause in, or an endorsement on,
an policy of fire or extended coverage insurance covering the personal
property, fixtures, and equipment located in or on the Premises,
pursuant to which the insurance companies waive subrogation or
consent to waiver of right of recovery against Landlord, and Tenant
does hereby agree that it shall not make any claim against or seek to
recover trom landlord any loss or damage to its property or the
property of others, resulting trom fire or other hazards covered by
such fire and extended coverage insurance.
(e) Tenant shall, upon Landlord's written request, procure a mortgagee
loss payable endorsement to the policies; provided, however, it is
expressly understood
(f) That any policy proceeds paid to such mortgagee shall be available for
reconstruction in accordance with the¡ terms of this lease.
Section 11.03 Tenant shall procure and maintain in force an effect a policy or .
policies of starldard fire and extended coverage insurance covering the Premises in an
amount equal .to not less than ninety (90) percent of the full insurable value thereof, the
11
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proceeds of which shall be payable to landlord or any encumbrance of Landlord, or in
accordance with its respective interests therein.
ARTICLE XII
GENERAL PROVISIONS
Section 12.01 It is mutually agreed that the letting hereunder is made upon and
subject to the terms, covenants, and conditions of this Lease and that Tenant covenants as
a material part of the consideration for this lease, to keep and perform each and all of said
terms, covenants, and conditions by it to be kept or performed, and that this Lease is
made upon the condition by it to be kept or performed, and that this Lease is made upon
the conditiòn of such performance.
Section 12.02 The parties hereto agree that all the provisions thereof are to be
construed as covenants and conditions as thought the words importing such covenants
and conditions were used in each instance and that all of the provisions hereof shall bind
and inure to the benefit of the parties hereto and its respective' heirs, legal representatives,
successors, and assigns.
Section 12.03 Time' is of the essence in the performance of each provision of this
lease.
Section 12.04 The specified remedies to which Landlord or Tenant may, resort
under the terms of this Lease are cumulative and not intended to be exclusive of any other"
remedies afforded by law. The waiver of the performance of any covenant, term, or
condition of this Lease by Landlord and Tenant shall not be construed as a waiver of any
subsequent breach of the same covenant, term, or condition.
Section 12.05 Should either party hereto institute any legal action to enforce any
provision hereof, the prevailing party in such action shall be entitled to receive from the
losing party such amount as the court may adjudge to be reasonable attorney's fees.
Sèction 12.06 Any such accruing to Landlord or Tenant under the provisions of
this Lease which shall not be paid when due shall bear interest at the rate of then (10%)
percent per annum from the date written notice specifying such nonpayment is served
upon the defaulting party until paid.
Section 12.07 If any term, covenant, condition, or provision of this Lease is held
by a court of competent jurisdiction to be invalid, void, or unenforceable, the remainder
of the provisions hereof shall remain in full force an effect and shall in no way be
affected, impaired, or invalidated thereby.
Section 12.08 Nothing contained in this Lease shall be deemed or construed by
the parties or by"any third person to create the relationship of joint venture or of any other
association otl).er than Landlord and Tenant.
12
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Section 12.09 All reference to the tenn of Lease shall include any extensions of
such tenn.
Section 12.10 The captions of Articles of this Lease are for reference only and are
not to be construed in any way as a part of this Lease.
Section 12.11 This lease shall not be binding and in effect until a counterpart
hereof has been executed and delivered by the parties each to the other.
Section 12.12 The parties have executed this Lease at the place and on the dates
specified immediately above their respective signatures.
Executed at: 703 Market St. #1700, San Francisco, California 94103, on
¿j -10 - ,200l--- .
l1ë.J.þ ~ 03-9&-2a02
Katar Singh
Tenant
13
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_0"."
Policy No. LRA585044
Effective a e.
o Supplemental Dee ar
BUSINESS DESCRIPTION* ,
GAS STATION I MINI MART
DESCRIPTION OF PREMISES
PREM. NO. BLDG. NO. LOCATION, CONSTRUCTION AND OCCUPANCY
1 1 3301 WIBLE ROAD, BAKERSFIELD, CA 93309
FRAME - GASOLINE SERVICE STATIONS
COVERAGES PROVIDED - INSURANCE AT THE DESCRIBED PREMISES APPLIES ONLY FOR COVERAGES FOR WHICH A UMIT OF INSURANCE IS SHOWN.
PREM. NO. BLDG. NO. COVERAGE LIMIT OF INSURANCE COVERED CAUSES OF LOSS COINSURANCEt RATES
1 1 BUILDING 200,000 SPECIAL FORM 90% 0.209
1 1 BPP 50,000 SPECIAL FORM 90% 0.435
OPTIONAL COVERAGES - APPLICABLE ONLY WHEN ENTRIES ARE MADE IN THE SCHEDULE BelOW I tlF EXTRA EXPENSE COVERAGE. LIMITS ON LOSS PAYMENT
AGREED VAlUE REPlACEMENT COST (X)
PREM. NO. BLDG. NO. EXPIRATION DATE COVERAGE AMOUNT BUILDING PERSONAl PROPERTY INCLUDING "STOCK"
1 1 BUILDING X
1 1 I BPP X
INFLATION GUARD (Perœnlage) ttMONTI-Il Y LIMIT OF ttMAXlMUM PERIOD ttEXTENDED PERIOD
PREM. NO. BLDG. NO. BUILDING PERSONAl PROPERTY INDEMNITY OF INDEMNITY(X) OF INDEMNITY (~)
MORTGAGE HOLDER(S) I ttAPPt..IES TO BUSINESS INCOME ONLY
PREM. NO. BLDG. NO. MORTGAGE HOLDER NAME AND MAILING ADDRESS
N/A
DEDUCTIBLE'
$250. EXCEPTIONS: BUILDINGS: $1,000, BPP: $1,000.
FORMS AND ENDORSEMENTS (other than applicable Forms and Endorsements shown elsewhere in the policy)
Forms and Endorsements applying to this Coverage Part and made part of this policy at time of issue:
APPliCABLE TO All COVERAGES: PER SCHEDULE OF FORMS AND ENDORSEMENTS
APPLICABLE TO SPECIFIC PREM. NO. BLDG. NO. COVERAGES FORM NUMBERS
PREMISESICOVERAGES: 1 1 BUILDING CP0010 CP0090 CP1030
1 1 BPP CP0010 CP0090 CP1030
PREMIUM
Premium for this Coverage Part $
"Information omitted If shown elsewhere In the policy.
THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD.
CF 150 (CONT.) (11.85) Includes copyrighted material of ISO COlTYT1erdal Risk Services, Inc., with its permssion. Copyright, ISO Corrrnercial Risk SeMces. Inc.. 1983, 1984
[] RELIANT AMERICAN INSURANCE COMPANY
[ ] STATE NATIONAL INSURANCE COMPANY
00 LINCOLN GENERAL INSURANCE COMPANY
[ ]
Coverage is provided in the Company designated by [X] above.
Administrative Office: 777 Main Street, Ste. 900 Fort Worth, TX 76102
Agency Information
_MMON POLICY DECLARATION.
.
No. LRA585044
NEW POLICY
Renewal of
Named Insured and Mailing Address
KARTAR SINGH
DBA: LUCKY 7 #19
3301 WIBLE ROAD
BAKERSFIELD, CA 93309
Policy Period:
To 05/24/2003
12:01 A.M. Standard Time at your mailing address shown above.
From 05/24/2002
Business Description: GAS STATION 1 MINI MART
I
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r
~
l'
~
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In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the
insurance as stated in this policy.
This policy consists of the following coverage parts for which a premium is indicated. This premium may be subject to
adjustment.
Commercial Auto Coverage Part
$
$
$
$
$
$
$
TOTAL $
Commercial Crime Coverage Part
Commercial General Liability Coverage Part
Commercial Inland Marine Coverage Part
Commercial Property Coverage Part
Premium shown is payable: $
at inception.
Forms applicable to all Coverage Parts: (Show numbers)
SEE SCHEDULE OF FORMS AND ENDORSEMENTS
Premium
NOT COVD
NOT COVD
1,543.00
NOT COVD
637.00 .
2,180.00
·Omits applicable Forms and Endorsements if shown in specific Coverage Part/Coverage Form Declarations.
I' Countersigned: 06/05/2002/MAS By
(Date)
BURNS & WILCOX INSURANCE SERVICES, INC.
2650 CAMINO DEL RIO NORTH, SUITE 308
SAN DIEGO, CA 92108
04-0005
THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART DECLARATIONS, COVERAGE PART COVERAGE FORM(S)
AND FORMS AND ENDORSEMENTS. IF ANY. ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY.
Copyright, Insurance Services Office, Inc,. 1983. 1984
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 oW Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 oW Street
Bakersfield, CA 93301
VOICE (661) 326·3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFETY SERVICES· ENVIROHIlEHTAL SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 32€H0576
PUBLIC EDUCATION
1715 Chester Avè.
Bakersfield, CA 93301
VOICE (661) 326-3696
FAX (661) 32€H0576
FIRE INVESTIGATION
1715 Chester Ave.
BakersfJeld. 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
.
.
July 30, 2002
Lucky 7
3301 Wible Rd
Bakersfield CA 93309
REMINDER NOTICE
RE: Necessary Secondary Containment Testing Requirements by December
31,2002 of Underground Storage Tank (s) Located at
the Above Stated Address.
Dear Tank Owner I Operator:
If you are receiving this letter, you have not yet completed the necessary
secondary containment testing required for all secondary containment
components for your underground storage tank (s).
Senate Bill 989 became effective January 1,2002, section 25284.1 (California
Health & Safety Code) of the new law mandates testing of secondary
containment components upon installation and periodically thereafter, to insure
that the systems are capable of containing releases from the primary
containment until they are detected and removed.
Of great concern is the current failure rate of these systems that have been
tested to date. Currently the average failure rate is 84%. These have been due
to the penetration boots leaking in the turbine sump area.
For the last four months, this office has continued to send you monthly
reminders of this necessary testing. This is a very specialized test and very few
contractors are licensed to perform this test. Contractors conducting this test
are scheduling approximately 6-7 weeks out.
The purpose of this letter is to advise you that under code, failure to perform
this test, by the necessary deadline, December 31, 2002, will result in the
revocation of your permit to operate.
This office does not want to be forced to take such action, which is why we
continue to send monthly reminders.
Should you have any questions, please feel free to call me at (661) 326-3190.
Sinc~~
Steve Underwood
Fire Inspector Environmental Code Enforcement Officer
··Y~ de??~.¥OP.A~ .r~ A ??~"
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" 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
.. - '.~""1",.,,' ~"' . .. .' . .,. 't:"' .. ..
-
.
June 30, 2002
Lucky 7
3301 Wible Road
Bakersfield, CA 93309
REMINDER NOTICE
RE: Necessary Secondary Containment Testing Requirement by December 31,
2002 of Underground Storage Tank located at 3301 Wible Road.
Dear Tank Owner / Operator:
The purpose of this letter is to inform you about the new provisions in
California Law requiring periodic testing of the secondary containment of
underground storage tank systems.
Senate Bill 989 became effective January 1,2002, section 25284.1 (California
Health & Safety Code) of the new law mandates testing of secondary
containment components upon installation and periodically thereafter, to ensure
that the systems are capable of containing releases from the primary
containment until they are detected and removed.
Secondary containment systems installed on or after January 1,2001 will be tested
upon installation, six months after installation, and every 36 months thereafter.
Secondary containment systems installed prior to January 1, 2001 will be tested by
January 1,2003 and every 36 months thereafter. REMEMBER! Any component
that is "double-wall" in your tank system must be tested.
Secondary containment testing shall require a permit issued thru this office and
shall be performed by either a licensed tank tester or licensed tank installer.
Please be advised that there are only a few contractors who specialize and have
the proper certifications to perform this necessary testing.
For your convenience, I am enclosing a copy of the code for you to refer to. Once
again, all testing must be done under a permit issued by this office.
Should you have any questions, please feel free to contact me at (661)326-3190.
Si:;!~
Steve Underwood
Fire Inspector/ Environmental Code Enforcement Officer
Environmental Services
SUIkr
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FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 MH" Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 MH" 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
.
.
July 1,2002
Lucky 7
3301 Wible Road
Bakersfield, CA, 93309
RE: Deadline for Dispenser Pan Requirement December 31,2003 for Site
Location at 3301 Wible Road, Bakersfield.
REMINDER NOTICE
Dear Underground Storage Tank Owner,
You will be receiving updates from this office with regard to Senate Bill 989
which went into effect January 1,2000.
This bill requires dispenser pans under fuel pump dispensers. On December
31,2003, which is the deadline for compliance, this office will be forced to
revoke your Pennit to Operate, for failure to comply with the regulations.
It is the hope of this office, that we do not have to pursue such action, which
is why this office plans to update you. I urge you to start planning to retro-fit
your facilities.
If your facility has been upgraded already, please disregard this notice.
Should you have any questions, please feel free to contact me at (661)326-
3190.
Si7lt tJ£v
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
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FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" 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
e
-
May 30, 2002
Lucky 7
3301 Wible Road
Bakersfield, CA 93309
RE: Deadline for Dispenser Pan Requirement December 31,2003 on
Underground Storage Tank(s) located at 3301 Wible Road, Bakersfield.
Dear Underground Storage Tank Owner:
You will be receiving updates from this office with regard to Senate Bill 989
which went into effect January 1,2000.
This bill requires dispenser pans under fuel pump dispensers. On December
31,2003, which is the deadline for compliance, this office will be forced to
revoke your Permit to Operate, for failure to comply with the regulations.
It is the hope of this office, that we do not have to pursue such action, which
is why this office plans to update you. I urge you to start planning to retro-fit
your facilities. .
If your facility has been upgraded already, please disregard this notice.
Should you have any questions, please feel free to contact me at (661)326-
3190.
sinceLZ', ' II /
;lkv lLuiWJo~{)
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBUIkr
~~.9~ de W~ ~.A0Pe.r~ A W~"
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326·3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" 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
-
..\
April 12, 2002
LUCKY 7
3301 WIBLE RD
BAKERSFIELD, CA 93309
Re: Enhanced Leak Detection Requirements
REMINDER NOTICE
Dear Owner/ Operator,
The purpose of this letter is to remind you about the new provision in California
law requiring periodic testing of the secondary containment of underground
storage tanks.
Your facility has been identified as not having secondary containment on at least
one of your underground storage tank components and as such falls under section
2637.(1) of the California Code of Regulations, Title 23, Division 3, Chapter 16;
As an alternative, the owner or operator may submit a proposal and
workplan for enhanced leak detection to the local agency, by July 1, 2002;
complete the program of enhanced leak detection by December 31, 2002;
and replace the secondary containment system with a system that can be
tested in accordance with this section by July 1, 2005. The local agency
shall review the proposed program of enhanced leak detection within 45
days of submittal or re-submittal."
Please be advised that there are only a few qualified testers available to perform
"Enhanced Leak Testing". All testing must be under-permit through this office.
For your convenience, I am enclosing a copy of the code as a reference. Should
you have any additional questions or concerns, please feel ftee to call me at
(661 )326-3190.
Sincerely,
Ralph Huey
Director of Prevention Services
by: ~ cI!k/J
Steve Underwood
Fire Inspector/Environmental Code Enforcement Officer
Office of Environmental Services
SU/kr
Enclosures
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~~~
~~f¡,'\J MONIneING SYSTEM CERTlFI.TION
For Use 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 servicíng of monitoring equipment. A separate certification or report must be
prepared for each monitoring system 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.
Á. General Information
Facility Name: ~y
Site Address: '3:3v / ú..rt r'5 <.;£
Facility Contact Person: 5/-w.w.J JJ
MakeIModel of Monitoring System: V~U ~ ~ - ~
B. Inventory of Equipment Tested/Certified
Check the appropriate boxes to indicate specific equipment inspected/serviced:
?
fZ()
Bldg. No.:
City: ~1i~ Zip:.
Contact Phone No.: (,"Co ( ) '3C;'7-tr S S":$
Date of Testing/Servicing: -2..-1.< «- /.E.L
Tank ID: fA J.) J... - r.¡r .., Tank ID: p~...,IV't - q f
O!f In-Tank Gauging Probe. Model: MM--1 ,:v In-Tank Gauging Probe. Model: M .A,.G... - I
o Annular Space or Vault Sensor. Model: o Annular Space or Vault Sensor. Model:
o Piping Sump / Trench Sensor(s). Model: o Piping Sump / Trench Sensor(s). Model:
o Fill Sump Sensor(s). Model: o Fill Sump Sensor(s). Model:
o Mechanical Line Leak Detector. Model: o Mechanical Line Leak Detector. Model:
~ Electronic Line Leak Detector. Model: WJ..I...P ¢ Electronic Line Leak Detector. Model: W (..'-- P
o Tank OvertìJl/ High-Level Sensor. Model: o Tank Overfill/ High-Level Sensor. Model:
o Other (specify equipment type and model in Section E on Page 2). o Other (specify equipment type and model in Section E on Page 2).
Tank ill: (¡(JJ L.. ~ 8"'1 Tank ID:
~ In-Tank Gauging Probe. Model: .MAfr- I o In-Tank Gauging Probe. Model:
o Annular Space or Vault Sensor. Model: o Annular Space or Vault Sensor. Model:
o Piping Sump / Trench Sensor(s). Model: o Piping Sump / Trench Sensor(s). Model:
o Fill Sump Sensor(s). Model: o Fill Sump Sensor(s). Model:
o Mechanical Line Leak Detector. Model: o Mechanical Line Leak Detector. Model:
1¡if' Electronic Line Leak Detector. Model: W t.,.(.. Þ o Electronic Line Leak Detector. Model:
o Tank Overfill / High-Level Sensor. Model: o Tank Overfill/ High-Level Sensor. Model:
o Other (specify equipment type and model in Section E on Page 2). o Other (specify equipment type and model in Section E on Page 2).
Dispenser ID: I of 1- Dispenser ID:
o Dispenser Containment Sensor(s). Model: o Dispenser Containment Sensor(s). Model:
~Shear Valve(s). o Shear Valve(s).
o Dispenser Containment Float(s) and Chain(s). o Dispenser Containment Float(s) and Chain(s).
Dispenser ID: 3'1 I..{ Dispenser ID:
o Dispenser Containment Sensor(s). Model: o Dispenser Containment Sensor(s). Model:
'¡i!C Shear Valve(s). o Shear Valve(s).
o Dispenser Containment Float(s) and Chain(s). o Dispenser Containment Float(s) and Chain(s).
Dispenser ID: Dispenser ID:
o Dispenser Containment Sensor(s). Model: o Dispenser Containment Sensor(s). Model:
o Shear Valve(s). o Shear Valve(s).
ODispenser Containment Float(s) and Chain(s). o Dispenser Containment Float(s) and Chaines).
"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 Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such
reports, I have also attached a copy of the report; (check all that appLy): 0 Syste set-up Al rm istory report
Technician Name (print): .:::sJ:\.N1'~ S CS-/Q.t. CA+ Signature:
Certification No.:
(c 2.. -, 'r) ---9 'io6
License. No.:
Cjo- (ù~2
PhoneNo.:(~G.( ) 3C¡;Á-8'(,i'"7
Date of Testing/Servicing: ~ .:t.r--o~
.
Testing Company Name: ~Cb4- ~,J()lteðA/ /l1F~
Site Address: :3:>0 I WI ß 1.., &- 'RD - ~"t...O --:- op'
Page 1 of3
Monitoring System Certification
03/01
~
~
D. Results of Testing/Servicing
e
e
Software Version Installed:
/'JO¿'¡
Complete the following checklist:
~Yes D No* Is the audible alarm operational?
~'Yes D No* Is the visual alann operational? ,
¡g. Yes D No* Were all sensors visually inspected, functionally tested, and confirmed operational?
)ã. Yes D No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will
not interfere with their proper operation?
D Yes D No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem)
~N/A operational?
D Yes D No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
,;g N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate
positive shut-down? (Check all that apply) 0 Sump/Trench Sensors; D Dispenser Containment Sensors.
Did you confirm positive shut-down due to leaks and sensor failure/disconnection? DYes; D No.
DYes D No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (Le. no
1lq NI A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank
fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? %
D Yes* 'jQ 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.
D Yes* ¡:( No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)
D Product; D Water. If yes, describe causes in Section E, below.
~Yes D No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable
'%f, Yes D 'No* Is all monitoring equipment 'operational per manufacturer's specifications?
* In Section E below, describe how and when these deficiencies were or wiII be corrected.
E. Comments:
Page 2 of 3
03/01
'~
; In-Tank Gauging / SIR EqUiP.nt:
~ Check this box if tankeging 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-tarik gauging equipment is used to perform leak detection monitoring.
Complete the following checklist:
~Yes 0 No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
~ Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup?
9'( Yes 0 No* Was accuracy of system product level readings tested?
~Yes 0 No* Was accuracy of system water level readings tested?
;¡¡ç Yes 0 No* Were all probes reinstalled properly?
;ïìCYes 0 No* Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD):
o Check this box if LLDs are not installed.
Complete the following checklist:
o Yes o No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance?
1l N/A (Check all that apply) Simulated leak rate: 0 3 g.p.h.; 0 0.1 g.p.h; 0 0.2 g.p.h.
DYes 0 No* Were all LLDs confirmed operational and accurate within regulatory requirements?
0 Yes 0 No* Was the testing apparatus properly calibrated?
DYes 0 No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak?
)g N/A
~Yes o No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak?
o N/A
)i! Yes o No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
o N/A or disconnected?
DYes o No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system
o N/A malfunctions or fails a test?
~Yes o No* For electronic LLDs, have all accessible wiring connections been visually inspected?
o N/A
I '91. Yes o No* Were all items on the equipment manufacturer's maintenance checklist completed?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
H. Comments:
Page 3 of3
03/01
:ç
$
e
e
Monitoring System Certification
UST Monitoring Site Plan
Site Address:
:A
o·
.~..
~.
-t.
· ..
· .Q
· ..
:0:
: ~vt~K:Y : ì:
. . . .
11,,,,,<:,,, .
t:s:j. . .
. Pt· .
.. .. .
~ . . . . . .
Date map was drawn: ~ _/_.
Instructions
If you already have a diagram that shows all required information, you may include it, rather than this page, with your
Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify
locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular
spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak
detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan
was prepared.
Page ~ of --,-
05/00
·"':
-\.~
SOFTWARE REVISION LEVEL
VERSION 16.04
SOFTWARE~ 346016-100-E
CREATED - 98.08.03.18.43
S-MODULE~ 330160-010-A
SVSTEI- FEATURES:
PERIODIC I N-TANK TESTS
ANNUAL IN-TANK TESTS
PLLD
0.10 CONT&0.20 CONT
WPLLD
0.10 tvIANUAL&O. 20 CONT
I
I
ISVSTEI-1 SETUP
~E~ 28. 2002 ~O~O~ ~M- -
!
I
VSTEI1 UN ITS
U.S.
"'VSTEtvl LANGUAGE
ENGLISH
VSTEI1 DATE/T I r-lE FORtvlAT
ON DD WYY HH :r-Itvl :SS xlvI
IBLE EXXON
301 WIBLE RD
AKERSFIELD CA.93309
:'61-397-4553
,
SHIFT TH1E
SHIFT TltvlE 2
SHIFT TII1E 3
SHIFT TIr-1E 4
6:00 Atvl
DISABLED
DISABLED
DISABLED
ìANK PERIODIC WARNINGS
.) I SABLED
~ANK ANNUAL WARNINGS
) I SABLED
INE PERIODIC WARNINGS
ISABLED
INE ANNUAL WARNINGS
ISABLED
,R I NT TC VOLUtvlES
fNABLED
tEMP Cor-1PENSAT I ON
ALUE (DEG F): 60.0
ITI CK HE I GHT OFFSET
ISABLED
REC I S I ON TEST DURATI ON
OURS: 1 2
AVLIGHT SAVING TIME
I SABLED '
VSTErvl SECUR I T'1'
ODE : 000000
IN-TANK SETUP
~ ~ ::L:S-
PRODUCT CODE
THERMAL COEFF
TANK D I AtvlETER
TANK PROFILE
FULL VOL
71.3 INCH VOL
47.5 INCH VOL
23.8 INCH VOL
: 3
: .000070
95.00
4 PTS
10371
8227
5186
2034
FLOAT SIZE: 4.0 IN. 8496
WATER WARNING
HIGH WATER LIMIT:
tvlAX OR LABEL VOL:
OVERFILL LIMIT :
HIGH PRODUCT
DELI VERY LI Ivl IT
LOW PRODUCT
LEAK ALARM LIMIT:
SUDDEN LOSS LIMIT:
TANK TILT .
MANIFOLDED TANKS
H: NONE
LEAK MIN PERIODI?:
LEAK tvl I N ANNUAL
2.0
3.0
10371
90%
9333
95%
9852
1 O~.
1037
275
99
50
0.00
PERIODIC TEST TVPE
STANDARD
ANNUAL TEST FAIL
ALARr-1 DISABLED
PERIODIC TEST FAIL
ALARtvl DISABLED
GROSS TEST FAIL
ALARr1 DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFV: OFF
TNK TST SIPHON BREAK:OFF
DELI VERY DELAV : 1 5 fv1I N
T 2: PRErv1 I Ur"1
PRODUCT CODE
THERt"IAL COEFF
TANK D I Ar1ETER
TANK PROFILE
FULL VOL
71.3 INCH VOL
47.5 INCH VOL
23.8 INCH VOL
. 1
.000700
.' 95.00
4 PTS
10371
8227
5186
2034
FLOAT SIZE: 4.0 IN. 8496
WATER WARNING
HIGH WATER LIMIT:
MAX OR LABEL VOL:
OVERFILL LII1IT :
HIGH PRODUCT
DELI VERY LI r1 IT
LOW PRODUCT
LEAK ALARM LIMIT:
SUDDEN LOSS LIMIT:
TANK TILT
r1ANIFOLDED TANKS
TIi: NONE
LEAK tvl1 N PERIODIC:
D·'
'Ý
o
LEAK MIN ANNUAL
D·'
'.
2.0
3.0
10371
90%
9333
95%
9852
1m..
1037
275
99
50
0.00
PERIODIC TEST TVPE
STANDARD
ANNUAL TEST FAIL
ALARr-l DISABLED
PERIODIC TEST FAIL
ALARr1 DISABLED
GROSS TEST FAIL
ALARtvl DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFV: OFF
TNK TST SIPHON BREAK:OFF
DELI VERY DELAY : 15 tvl IN
o
T 3:REGULAR
PRODUCT CODE
THERtvlAL COEFF
TANK DIAlvlETER
TANK PROFILE
FULL VOL
71 .3 I NCH VOL
47.5 INCH VOL
23.8 INCH VOL
: 2
: .000070 I
95.00
4 PTS I
10371
8227
5186
2034 I
FLOAT SIZE: 4.0 IN. 8496 I
2.0 I
3.0
WATER WARNING :
HIGH WATER LIMIT:
MAX OR LABEL VOL:
OVERFILL LIMIT :
HIGH PRODUCT
DELI VERY L It1 I T
10371 I
90% I
9333 '
95% 'I
9852
1 O~.
1037 'I
275
99
50
0.00
LOW PRODUCT
LEAK ALARM LIMIT:
SUDDEN LOSS LIMIT:
TANK TILT
MANIFOLDED TANKS
TIi: NONE
0%
o
LEAK MIN PERIODIC:
0·,
'0
o
D·''
'Ý
o
LEAK MIN ANNUAL 0%
o
PERIODIC TEST TVPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARtv1 DISABLED
GROSS TEST FAIL
ALARtv! DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFV: OFF
TNK TST SIPHON BREAK:OFF
DEL I VERY DELAV : 1 5 tvl IN
I LEAK TEST~THOD
- - -~-' -' - - - - - - -
TEST ON DATE : ALL TANK
JAN 1. 1996
START TIt'lE : DISABLED
TEST RATE :0.20 GAL/HR
DURATION : 2 HOURS
LEAK TEST REPORT FORMAT
NORr'1AL
WPLLD LINE LEAK SETUP
------
-----
¡"J 1 :PLUS
PIPE TYPE: FIBERGLASS
LINE LENGTH: 75 FEET
0.20 GPH TEST: DISABLED
0.10 GPH TEST: ENABLED
SHUTDOWN RATE: 3.0 GPH
TANK: NONE
I
I
W 2: PREt'1 I Ut'1
PIPE TYPE: FIBERGLASS
ILINE LENGTH: 75 FEET
0.20 GPH TEST: DISABLED
10 10 GPH TEST: ENABLED
SHUTDOWN RATE: 3.0 GPH
TANK: NONE
I
I W 3: REGULAR
I PIPE TYPE: FIBERGLASS
I LINE LENGTH: 75 FEET
I O. 20 GPH TEST: DISABLED
10 10 GPH TEST: ENABLED
, SHUTDOWN RATE: 3.0 GPH
, TANK: NONE
J I BLE EX>A
1301 WIBL_D
jAKERSFIELD CA.93309
;61 -397-4553
'EB 28. 2002 11 :41 AM
JPLLD LINE LEAK
'EST RESULTS
J 1 :PLUS
3.0 GAL/HR RESULTS:
,AST TEST:
'EB 28.2002 10:14AM PASS
IUt'lBER OF TESTS PASSED
PREV 24 HOURS: . 8
SINCE MIDNIGHT : 3
),20 GAL/HR RESULTS:
'EB 28.2002 11 :18AM PASS
'EB 18,.2002 1 : 49Pf'1 PASS
'EB 18.2002 9:28AM PASS
'EB 18.2002 12:22AM rASS
'EB 17.2002 10:08AM PASS
'EB 16.2002 7:22PM PASS
'EB 16. 2002 1 2 : 1 3PI-1 PASS
'EB 15.2002 11 :08PM PASS
'EB 15.2002 4:13PM FAIL
'EB 15.2002 1 : 22PM FAIL
) . 1 0 GAL/ HR
iEB 28.2002
'EB 18.2002
'EB 18.2002
'EB 17.2002
'EB 16.2002
'EB 1 6.2002
'EB 16.2002
'EB 4.2002
fAN 20. 2002
IAN 1 7.2002
RESULTS:
11 : 34Ar'1 PASS
10: 00At'1 FAIL
1:10AM FAIL
12:01PM PASS
7:55PM FAIL
1 : 1 8Pt'1 FA I L
12: 13At'1 FA I L
11: 37Pt1 FAIL
8: 38Pt'l FAIL
8:37PM FAIL
J 2: PREI'1 I Ur-1
-
3.0 GAL/HR RESULTS:
AST TEST:
;EB 28.2002 10:25AM PASS
~UMBER OF TESTS PASSED
PREV 24 HOURS : 3
SINCE MIDNIGHT : 3
).20 GAL/HR RESULTS:
~EB 28.2002 11 :13AM PASS
~EB 5.2002 12:54AM PASS
~EB 4.2002 7:55PM PASS
JAN 14.2002 7:52PM PASS
0.10 GAL/HR RESULTS:
FEB 5.2002 2:31AM PASS
FEB 4.2002 8:43PM FAIL
JAN 14.2002 8:41PM PASS
W 3: REGULAR
3.0 GAL/HR RESULTS:
LAST TEST: _ _
FEB 28.2002 10:26AM PASS
NUMBER OF TESTS PASSED
PREV 24 HOURS: 26
SINCE MIDNIGHT : 6
0.20 GAL/HR RESULTS:
JUN 23.2001 1:50PM PASS
JUN 23.2001 . 9:08AM PASS
FEB 6.2001 10:48PM PASS
JAN 29.2001 10:10PM PASS
JAN 29.2001 8:36PM PASS
0.10 GAL/HR RESULTS:
JUN 23.2001 2:22PM PASS
FEB 7.2001 12:56AM PASS
JAN 29.2001 10:43PM PASS
~ ~ ~ ~ ~ END ~ ~ ~ ~ ~
LINE LEAK LOCKOUT SETUP
------
- - - -
LOCKOUT SCHEDULE
DAILY
START TIME: DISABLED
STOP TIME : DISABLED
WPLLD LINE DISABLE SETUP
-----
- --
- - - -
W 1 :PLUS
IN-TANK ALARt'lS
T l:HIGH WATER ALARM
T 1 :LOW PRODUCT ALARM
I 2: PREt'1 I Ut'I
N-TANK ALARr-1S
T 2:HIGH WATER ALARM
T 2:LOW PRODUCT ALARM
3 : REGULAR
N-TANK ALARr-1S
T 3:HIGH WATER ALARM
T 3:LOW PRODUCT ALARM
I
"
."."'
SENDER: COMPLETE THIS SECTION
· Complete items 1, 2, and 3. Also complete
item 4 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 mail piece,
or on the front!fspacepe~rnits.
D. Is delivery address different from item 1?
If YES, enter delivery address below:
D Agent
D Addressee
DYes
D No
. . ~ - . "~,
1. Article Ad~sse.d,to:.
r
"
SAEED AtAzAs
/¡
LUCKY 7r,
3:8 WIBLE RD
BAKERSFIELD CA 93309
3. Service Type
aD Certified Mail
D Registered
D Insured Mail
D Express Mail
D Return Receipt for Merchandise
DC.C.D.
4, Restricted Delivery? (Extra Fee)
DYes
2. ArtiCle~Ö'õ~r (£~3ð°7>tf6'~e ~tz.e~6 3317
PS Form 3811; duly 1999
Domestic Return Receipt
102595-99-M-1789
i
'..
UNITED STATES POSTAL ~ERVICE
IT
First-Class Mail P 'd
Postage & Fees al
USPS
Permit No. G-10
I
ddress and ZIP+4 in this,box ·
· Sender: Please print your name, a , ' , ~
.
l
BAKERSFiELD FIRE DEPARTIIIENT .
OFFICE OF ENVIRONMENTAL SERVICES
17~5 Chester Avenúe, Suite 300
Bakersfield, CA 93301
-
U.S. Postal Service
CERTll::lEp MAIL RECEIPT
(Ðomes\ ~/ail Only; No Insurance Coverage Provided)
I
II"-
I ,..:¡
l::ri
Postmark
Here
, ...a
I U")
.::r
/T Certified Fee
, ...a Return Receipt Fee
I e (Endorsement Required)
I e Restricted Delivery Fee
I e (Endorsement Required)
'e
I /T
U")
,..:¡
Total Postage & Fees $
3.94
Sent To
SAEEDALAZAS
Si~~¡iNt:~Ÿ~tlš~¡,¡ö.·'·--·'·"-'-"-""-""--"'--""-....-..----.---..-.-..
Ie
e
, e
I"- ëiftž{il~--'~---'933-Ö9--'---'''''---''''----'''---''----''----'-_.
PS Form 3800, May 2000
. -
Certified Mail Provides:
· 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 Mail.
· 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 mail piece "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 mai/piece with the ,
endorsement "Restricted Delivery".
· If a postmark on the Certified Mail !(}ceipt js_dßsired, please present the arti-
cle at the pO~Coffice for postmarking. lfãpòstmark on the Certified Mail
receipt is nO*ed, detach and affix label with postage and mail.
IMPORTANT: ~his receipt and present it when making an inquiry.
PS Form 3800. Mav 2000 IRRVAI'!:R\
1 n"~Q~.nn.M..,nnA
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "HO 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
--
-
-........t
r-,~,~.
~",,:/.J'~
February 20, 2002
Saeed Alazas
Lucky 7
3301 Wible Rd
Bakersfield, CA 93309
CERTIFIED MAIL
NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE
RE:
Failure to Submit/Perfonn Annual Maintenance on Leak Detection
System at Lucky 7,3301 Wible Rd
Dear Mr. Alazas:
Our records indicate that your annual maintenance certification on your leak
detection system is past due. December 28, 200 1.
You are currently in violation of Section 2641 (1) of the California Code of
Regulations.
"Equipment and devices used to monitor underground storage tanks shall be
installed, calibrated, operated and maintained in accordance with manufacturer's
instructions, including routine maintenance and service checks at least once per
calendar year for operability and running condition. "
You are hereby notified that you have thirty (30) days, March 22, 2002, to either
perfonn or submit your annual certification to this office. Failure to comply will
result in revocation of your permit to operate your underground storage system.
Should you have any questions, please feel free to contact me at 661-326-3190.
Sincerely,
Ralph Huey
Director of Prevention Services
bY:~. dW
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
cc: Walter H. Porr Jr., Assistant City Attorney
~~y~ ~ W~ S7'~ ~0Pe.r~ A W~"
FIRE CHIEF
RON FRAZE·
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" 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
:.
-
'ï
February 11, 2002
~, -----.....
Lucky 7
3301 Wible
Bakersfield CA 93309
RE: Deadline for Dispenser Pan Requirement December 31, 2003
REMINDER' NOTICE
Dear Underground Storage Tank Owner:
You will be receiving updates from this office with regard to Senate Bill
989 which went into effect January 1, 2000.
This bill requires dispenser pans under fuel pump dispensers. On
December 31, 2003, which is the deadline for compliance, this office will
be forced to revöke yöur Pennit to Operate; for failun~ to comply with- the
regulations.
~ . - - --.. .
It is the hope of this office, that we do not have to pursue such action,
which is why this office plans to update you. I urge you to start.planning
to retro-fit your facilities. ..... --- - --
If your facility has been upgraded-already, please disregard this notice.
Should you have any questions, please feel free to contact me at 661-326-
3190.
Sinc_AL.1, ereIY"
~~
Steve Underwood
Fire Inspector/Environmental Code Enforcement Officer
Office of Environmental Services
SBU/dm
""Y~ de W~,~ ~0Pe ykt- .A W~"
CiRRECTION NOTtfE
BAKERSFIELD FIRE DEPARTMENT N~ 688
LocatioJ\)f k 'f ì
Sub Div. 330 (tlh~~L ~lnk.
. Lot
You are hereby required to make the following corrections
at the above location:
Cor. No
L{
v-J.
llt .... S' 1\
Completion Date for Corrections
Date ItJ{ {ì!Q I
Inspector
326·3979
--..,.----~-~.,.-- -----~-
CiRRECTION NOT~E
BAKERSFIELD FIRE DEPARTMENT N~ 688
LocatioJ\)tlr\.{ f
Sub Div. 33ü ( Llh~\L ~dUk.
. Lot
You are hereby required to make the following corrections
at the above location:
Cor. No
;[
L{
v-J.
Completion Date for Corrections
Date I tJ I ["1 / Q I
Inspector
326-3979
·
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAME "va,,! ì
INSPECTION DATE 101' '1/0'
Section 2:
Underground Storage Tanks Program
o Routine C3 Combined
Type of Tank 5wt...
Type of Monitoring
o Joint Agency
(~Ç)J
AT~
o Multi-Agency 0 Complaint
Number of Tanks 3
Type of Piping 5wtJ (. é P
ORe-inspection
OPERA TION
c V
COMMENTS
Proper owner/operator data on file
Proper tank data on tile
Penn it fees current
Certification of Financial Responsibility
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
TANK SIZE(S)
Type of Tank
AGGREGATE CAPACITY·
Number of Tanks
OPERA nON Y N COMMENTS
SPCC available
SPCC on file with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?
If yes, Does tank have overfill/overspill protection?
C=Compliance V=Violation Y=Yes N=NO
In,p"to, ,It cMuffi
Office of Environmental Services (805) 326-3979
White - Env, Svcs.
Pink - Business Copy
e
.
CITY OF BAK}:RSFIEI..D FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd 1;'loor, Bakersfield, CA 9330 I
FACILITY NAME ~v'"'~~~
ADDRESS 33() l
F ACILITY CONTACT
INSPECTION TIME
æJ
INSPECTION DATE 10(' ì(flJI
PHONE NO. 3q~ - tfs-s3
BUSINESS ID NO. 15-210-
NUMBER OF EMPLOYEES ~
Section 1:
Business Plan and Inventory Program
o Routine
r:¡) Combined
o Joint Agency
o Multi-Agency
o Complaint
ORe-inspection
OPERA TION C V COMMENTS
Appropriate pennit on hand \, V
L- V
Business plan contact infonnation accurate
Visible address \.. 'k(..~ It cui -tQ \t)c. I It v.,t:; tl
Correct occupancy t- V
Veri fication of inventory materials \... V
Verification of quantities \,. F
V /'
Verification of location
Proper segregation of material V
Verification of MSDS availability (à \;/ NrtÁ ~ INtc.O ~ ~L c\. ~
r
Verification of Haz Mat training V
;-
Verification of abatement supplies and procedures V
Emergency procedures adequate V ...
r
Containers properly labeled \.I
Housekeeping L-
Fire Protection l If NreÁ S "
~C('{ he. t.
Site Diagram Adequate & On Hand
C=Compliance
V=Violation
Pink - Business Copy
Any hazardous waste on site?:
Explain:
DYes DNo
Questions regarding this inspection? Please call us at (661) 326-3979
White - Env. Svcs.
Yellow - Station Copy
Inspector: ' '
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" 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
:-
e
August 3, 2001
Lucky 7
3301 Wible Rd
Bakersfield Ca 93309
RE: Deadline for Dispenser Pan Requirement December 31, 2003
REMINDER NOTICE
Dear Underground Storage Tank Owner:
You will be receiving updates trom this office with regard to Senate Bill
989 which went into effect January 1, 2000.
This bill requires dispenser pans under fuel pump dispensers. On
December 31,2003, which is the deadline for compliance, this office will
be forced to revoke your Permit to Operate, for failure to comply with the
regulations.
It is the hope of this office, that we do not have to pursue such action,
which is why this office plans to update you. I urge you to start planning
to retro-fit your facilities.
If your facility has been upgraded already, please disregard this notice.
Should you have any questions, please feel free to contact me at 661-326-
3190.
sincer;t" '
;ffhu ~
Steve Underwood·
Fire Inspector/Environmental Code Enforcement Officer
Office of Environmental Services
SBU/dm
~~ .~;"uú1~ ~ ~//l//lN/u(~ .,¥o/" ._/#6o/~e ~Ub ../6 tSr'.yl/u/'~ '1'1
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
. VOICE (661) 326·3941
FAX (661) 395-1349
PREVENTION SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FA~ (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
,
\
'-
\
\
\
\
\
\
\
\.".,.,..
\
.
-
May 3,2001
Lucky 7 #19
3301 Wible Road
Bakersfield, CA 93309
Dear Business Owner:
I Enclosed, please find the Site and Facility Diagram Instructions packet. Wþen your
Hazardous Materials Management Plan and Inventory were submitted it was lacking
the diagram portion. Please draw and submit the diagram(s) of your facility by
June 8, 2001.
The diagram should include the following:
1)
2)
3)
4)
5)
6)
7)
8)
name of your business;
business address;
indicate which direction is North;
the cross streets neighboring business addresses (within 300 feet)
entrances and exits
location of utility shut-offs;
location of the nearest fire hydrant;
portions of the building protected by automatic sprinkler system; and most
importantly
the location of the hazardous material(s).
9)
If you have any questions, please feel rree to call me at (661) 326-3658.
Thank you for your assistance.
Sincerely,
RALPH E. HUEY, DIRECTOR
OFFICE OF ENVIRONMENT AL SERVICES
~~
Esther Duran, Accounting Clerk II
Office of Environmental Services
ED\db
Enclosures
\ ".%u~ ~ Z'~/n/.IU'''4'?' .¥"... J;6~ STk.. A g;¡;nD'~"
\
~
. FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
21 01 "H" 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
.
.'
January 22,2001
Lucky 7
3301 Wible
Bakersfield Ca 93309
RE: Dispenser Pan Requirement December 31, 2003
Underground Storage Tank Dispenser Pan Update
Dear Underground Storage Tank Owner:
You will be receiving updates from this office now, and in the future with
regard to the Senate Bill 989, which went into effect January 1, 2000.
This bill requires dispenser pans under fuel pump dispensers. On
. December 31,2003, which is the deadline for compliance, this office will
be forced to revoke your pennit to operate, effectively shutting down your
fueling operation.
It is the hope ofthis office, that we do not have to pursue such action,
which is why this office plans to update you. I urge youto start planning
now to retro-fit your facilities.
If your facility has upgraded already, please disregard this notice. Should
you have any questions, please feel free to contact me at 661-326-3190.
Sincerely,
~~
Steve Underwood, Inspector
Office of Environmental Services
SBU/dm
"'7~ de W~ ~ ~0Pe .977uu¿, A W~"
I~\u/ ~- .'
)ì CERTIFICATION OF UN~GROUND STORAGE TANK McttrORING SYSTEMS
DO NOT USE THIS FORM FOR AN ALARM RESPONSE. .
SITE Lucky 7.,.,",..
- ~-~-'-~.
TANK SIZE' UNL , .·.DSL OTHER
1 10K X
:-,~...
2 10K X
3 10K X
AQDRESS 3301 Wible Road
CITY Bakersfield, CA 93309
TANK/LINE MATERIAL:
[X] STEEL Tanks
OD FIBERGLASS
PRODUCT TANKS:
IJD SINGLE WALL
o DOUBLE WALL
PRODUCT TANK MONITORING SYSTEM
PRODUCT LINES:
ŒJ SINGLE WALL
o DOUBLE WAL~
MANUFACTURER
MODEL
Veeder-Root
PROBE MODEL
TLS-350
80850579305001
Maq.
CHANNEL DESCRIPTION
1 4
... 5
0:;
3 6
QTY 0 VADOSE ZONE MONITOR QTY 0
QTY 0 TANK LEVEL MONITOR QTY 3
- ..-- ··SER!f.\L-NU~..1B~R
WET INTERSTITIAL MONITOR
DRY INTERSTITIAL MONITOR
STATUS @ ARRIVAL ..
CORRECTIVE ACTION
STATUS @ DEPARTURE
I OPERA TIONAL NON-OPERATIONAL I PERFORMED REQUIRED
I' x !
I I
I x ·-,1"'-' . '. I
. :'0,....·",,,;"-, < """\ ~~." ~". .
,J . <'__ ..;'. ":, .;','\"" .. ,i,~ '."';;';'_'.' ',,:. ~_ '.
. .,
PRODUCT LINE MONITORING SYSTEM
. ..... ~
. ,"" - ," .'.
...t"i'", "~
{')._J
',' 1........, ,"" ....;
ElECTRONIC'LlNE PRESSURE MoNITOR'
INTERSTITIAL MONITOR (SUMP MONITOR)
MANUFACTURER IF APPLICABLE
- .. t" ~ ¡
QTY
QTY.,
3
..,_". ~."'''- D--·,,·C~t1:~:!..._._---,_._-_...._.-
NONE
:·:"¡-"::<:i~t~L~!
. ,
r; .,-: ,. .
, \ .'
STATUS @ ARRIVAL
CORRECTIVE ACTION
STATUS @ DEPARTURE
OPERA TIONAL NON-OPERA TIONAL PERFORMED REQUIRED
x
x
-- MECHANICAL LEAK DETECTOR;
NONE 0
Yes m No 0
.',
MANUFACTURER
MODEL
DID YOU PLACE COMPANY COMPLIANCE STICKER ON BOX?
I, :Bruce Hinsley" CERJI.FY ,THt:·ABOVE INFORMATION AND OPERATING P.~I.\TUS IS REPRESENTATIVE
. ~~!.~~~ ~u~:~~~~g~J~~~~'~È~~::~~~·{TORI~~.fYSTEM.-..
-, 'r' ~~V~h.t:q":'f~~ :"::1\ ....-.---.-......,.,... "-'-'1:2-28-2000
Signature '..----' Date ,____......._ .~"
<..0; ._.. ~ ';0""'" ~.¡. _,...~~.,__.. ,...~,.,......~.... ......... .........__.,...O~.~ . ...".-.."...-.... :-'-" ..:-:..:.,:.:~:-.~~~.~.,..~_ ..:~.;_; ~.7-::-"',::'-:-:-:-~"'''.~,'~~ :;';.. ,:--',~'''~''.:.,- : : .:: .._~._- ".- ""..'_'~'" ~ ,.--,_........~- ........,......... --
.. _..,REDWINE. TESTING.SERVIGESnN'(6~':'i~:p·:Ó:.'BÒX,Yš67:'::~· sAkER'SFiELD', 'CA' 93302...*...·~66·1) 32~0446~" ~._-
·,····CONTRACTORS LICENSE #532878' .. ...... "... "" -"" ..> "" ... ...... - '.
;. '. \ .
t..· l"~" _. ~.: 1" , ,--' ,
..~.., q~'_ .._"_''0- ,~.H.. 0'- .....,,_. ....,. ~~.,
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i---------.-..---:--&~~~(----. ...______ .1
.--~_:::=:~~_:___._I_tç___~t-~--0- '3 ~:g:~3--:~.:~_~=-~~=~~==~~~.:i
I
,-----..----------------------.-------------------.--------~----..-------~_..-.._--_.._----
,------- ----'~Tl5>\9I)tZ;~--------¡
I -:;It:-u u t- J-{OtR -Leq0B I
I i
- I
/~' 12/ /2000 14: 27 5513250453 . REDWINE TESTING PAGE 02
~;\U . ~
,\. CERTIFICATION OF UNDERGROUND STORAGE TANK MOrlORING SYSTEMS
DO NOT use THIS FORM FOR AN ALARM RESPONSE. .
, . l '
SITE Lucky 7 . 'I'
AqORESS 3301 Wible Road
. '
CITY Bakersfield, CA 93309,
TANK SIZE .' . UNL:, , .DSL ' OTHER
1 lOK x
2 lOR 'X
3 10K X
T ANKlllNE MATERIAL:
W STEEL Tanks
m FIBERGLASS
, PRODUCT TANKS:
ŒJ SINGLE WALL
o DOUBLE WAll
PRODUCT TANK MONITORING SYSTEM
PROPUCT LINES:
[]], SINGLE WALL
D DOUBLE WALL
MANUFACTURER veeder-Root CHANNEL DESCRIPTION
.
MOOEL TLS-350 1 4
SERIAL NUMBER 80850579305001 2 5
PROBE MODEL Maq. 3 6
WeT INTERSTITIAL MONITOR aTY 0 VADOSE ZONE MONITOR QTY 0
DRY INTERSTITIAL MONITOR QTY 0 TANK lEVEL MONIT9R QTY 3
STATUS @ ARRIVAL
CORRECTIVE ACTION
STATUS ~ DEPARTURE
OPERATIONAL NON-OPERATIONAL PERFORMED REQUIRED
x
:x:
, ..
, PRODUCT UNE MONITORING SYSTEM
ELECTRONIC LINE PRESSURE MONITOR,
INTERSTITIAL MONITOR (SUMP MONITOR)
MA~UFACTURER IF APPLICABLE
QTY
QTY
3
NONE D
STATUS @ ARRIVAL
CORRECTIVE ACTION
STATUS @ DEPARTURE
MECHANICAL LEAK DETECTOR:
MANUFACTURER
OPERA TIONAL NON-OPERATIONAL PERFORMED ' REQUIRED
, x
x:
MODEL
NONE 0
Yes ŒJ No 0
DID YOU PLACE COMPANY COMPLIANCE STICKER ON BOX?
I, :Bruce Hinsley" CERTIFY THE.ABOVE·I~FORMATION AND OPERATING STATUS IS REPRESENTATiVe
OF THE ~UAL CONDITION OF TH~ MONITORING SYSTEM.
~~ ~ -1-ð~'P
Signature
12-28-2000,
Date
RE,DWINE TESTING SERVIC.ES, INC. .. P.O. BOX 1567 · BAKERSFIELD, CA 93302 · ~66') 326-0«6
CONTRACTORS LICENSE #532878
~·.f.
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.......---
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, -----
.
----
/
Allied
Insurance
.
.
a member of Nationwide Insurance
ALLIED COM-PAl( SUMMARY
PRINTED, 02/24/2000
701 5TH AVE
DES HOINES, IA 50391-2000
Number:
Named Insured:
ACP
7820164562
Effective from 03/31/2000
to 03/31/2001
Mailing Address:
Agency Name:
Agency Address:
T NN COMPANY, INC.
BAKERSFIELD CA 93306-3055
84 06197
(661) 873-2200
78
Division Program
Total Premium
A SPECIAL RETAIL AND SERVICE
$1,524.00
, .
'--
THIS IS NOT A BILL, SEE YOUR BILLING STATEMENT
Estimated Total Premium:
$
1,524.00
trhis ALLIED Com-Pak is 8 portfolio of individual policies which combines various
insurance coverages written in the ALLIED Group Companies. It is not a single
policy, but a group of separate contracts of insurance for the various coverages
or which. premium ii shown
\....-
EMOO10
780K
2000055
INSURED COpy
ACP 7820164562
78 0023788
PAKSUM (01-97)
c
Allied
Insurance
e
e
a member of Nationwide Insurance
AGENCY - 84 - 06197
THE ROBERT LYNN COMPANY, INC.
BAKERSFIELD CA 933063055
661-873-2200
POLICY NUMBER
ACP RAS 78 2 0164562
LUCKY PARTNERS, INC. - DBA
LUCKY 7 FOOD STORE
3301 WIBLE ROAD
BAKERSFIELD, CA 93309
We are pleased to serve your business insurance needs. Our company is committed to providing you high quality
insurance protection and superior service.
Allied is a growing organization with more than sixty years of experience in providing insurance services. We are
rated" A +" (Superior) for our financial soundness by the A.M. Best Company, an independent insurance rating or-
ganization. We provide protection for a full range of personal and commercial insurance needs.
If you should have any questions about your insurance plan or if you wish to make a change to your policy, please
contact your Allied agent.
IMPORTANT INFORMATION ABOUT YOUR POLICY. . . .
( Please spend a few minutes to read and understand your policy. Some items to which you should pay special at-
tention are as follows:
· Special Required State Notices. These notices, when included, point out specific items concerning your policy.
We urge you to read them.
· Declarations Page. This shows such information as your name, address, the coverages provided, the policy term,
policy limits, list of coverage forms, premium amounts, and other individualized information.
· Coverage and Endorsement Forms. This is the section of your policy which provides policy and coverage infor-
m·ation. Please read it carefully. . .
JL7001 (04-98)
DIRECT BILL 780K
00055
MO
INSURED COPY
825350567
78
23789
c
AMCOINSURANCEC~ANY
701 5TH AVE DES MOINES IA 50391-2000
DECLARATIONS
-
RENEWAL
Policy Number:
Named Insured:
ACP RAS 7820164562
LUCKY PARTNERS, INC. - DBA
LUCKY 7 FOOD STORE
3301 WIBLE ROAD
BAKERSFIELD, CA 93309
THE ROBERT LYNN COMPANY, INC.
BAKERSFIELD CA 933063055
ALLIED SERIES
SPECIAL RETAIL AND SERVICE POLICY
Mailing Address:
Agent:
Address:
84 06197
Policy Period: This policy is effective from 03-31-00 to 03-31-0112:01 AM Standard time
at the above mailing address.
The Named Insured is: CORPORATION
Business of the Insured is: CONVENIENCE STORE
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY,
WE AGREE TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
This policy contains a $ 500 deductible unless otherwise stated.
1803
SEE SCHEDULE (BP8010)
I \~
SCHEDULE - SECTION "
BUSINESS LIABILITY
PROD/COMPLETED QPER
ALL OTHER
E MEDICAL EXPENSES
2,000,000 Aggregat
2,000,000 Aggregat
Annual Premium
16.00
INCLUDED
INCLUDED
INCLUDED
1,524.00
ALL
5,000 Per Occurrence
...
~ PREVIOUS POLICY NUMBER
'"
g ACP RAS 7810164562
0..
m
DIRECT BILL 780K 00055
MO
INSURED COPY
1,52 .00
?J/qI2OVV
~
825350567 78 23790
e
-
AMCOINSURANCECOMPANY
IN WITNESS WHEREOF the Company has caused this policy to be signed by its president and secretary and
countersigned on the declarations page by a duly authorized representative of the company.
~uJ&t
J)+~
SECRETARY
I
I
It
~ ....
SPOOO2 (10-98)
ACP RAS 7820164562
INSURED ,COPY
PRESIDENT
78 23791
AMCO INSURANCE COMPANY .
701 5TH AVE DES MOINES IA 50391-2000
SPECIAL RETAIL AND SERVICE POLICY
7820164562 SCHEDULE
.
Policy Number: ACP RAS
SCHEDULE - SECTION I
~~~.,..,..,'
0101
, Policy Period:
From 03-31-00 To 03-31-01
0102
3301 WIBLE ROAD, BAKERSFIELD, CA
ONVENIENCE STORE WI GAS SALES
BUILDING
PERSONAL PROPERTY
BUSINESS INCOME AND EXTRA EXPENSE
PTION - OUTSIDE SIGNS
PTION - EXTERIOR GLASS DEDUCTIBLE BUYBACK
135,000 $ INCLUDED
50,000 $ INCLUDED
ACTUAL LOSS $ INCLUDED
5,000 $ 80.00
$ 26.00
$ 22.00
10,000 $ INCLUDED
ACTUAL LOSS $ INCLUDED
3301 WIBLE ROAD, BAKERSFIELD, CA
PUMS, NOZZLES & CANOPY
UILDING
USINESS INCOME AND EXTRA EXPENSE
SCHEDULE - SECTION "
0101
0101
FIRE LEGAL LIABILITY
LIQUOR-LIABILITY
FIRE LEGAL LIABILITY
100,000 Per Occurrence
1,000,000 Per qccurrence
1,000,000 Aggregate
100,000 Per Occurrence
$
$
$
INCLUDED
240.00
0102
INCLUDED
(
I
~
co
co
¡¡
...
51RECT BILL 780K 00055
INSURED COPY
82~7 78 23792
AMCO INSURANCE COMPANY . e
701 5TH AVE DES MOINES IA 50391-2000
. RETAIL AND SERVICE POLICY
Policy Number: ACP RAS 7820164562SCHEDULE OF LOSS PAYEES
Policy Period:
From 03-31-00 To 03-31-01
EMIL DABBAS AND LEILA DAB BAS
P.O. BOX 118
GORMAN, CA 93243
INTEREST : 3301 WIBLE ROAD
SLUSH PUPPY
3224 NO. WEBER AVE.
FRESNO, CA 93722
,
{
, .
~
g
.,
¡¡¡
¡:Ii
DIRECT BILL 780K 00055
INSURED COPY
825350567 78 23793
AMCO INSURANCE COMPANY . _
701 5TH AVE DES MOINES IA 50391.2000
, . RETAIL AND SERVICE POLICY
FORMS AND ENDORSEMENTS SUMMARY
Number: ACP RAS 7820164562
Period:
From 03·31·00 To 03·31.01
BP8013 0194 SCHEDULE OF LOSS PAYEES $ INCLUDED
BPOO04 0498 CALIFORNIA AMENDATORY ENDORSEMENT $ INCLUDED
BP1502 0498 LIQUOR LIABILITY INSURANCE $ INCLUDED
BP5013 0498 OUTDOOR SIGNS AND SATELLITE DISHES $ INCLUDED
RSOOOl 0498 SPECIAL RETAIL AND SERVICE - SECTION I - PROP $ INCLUDED
RSOO02 0498 SPECIAL RETAIL AND SERVICE - SECTION II - LIA $ INCLUDED
I
10940 0789 CA INSURANCE GUARANTEE ASSN $ INCLUDED
13614 1185 SPECIAL CONTINUATION PROVISION $ INCLUDED
BPOOOl 0498 COMMON POLICY CONDITIONS $ INCLUDED
BP5005 0498 EXTERIOR GLASS (DED. BUYBACK) $ INCLUDED
TOTAL FORMS AND ENDORSEMENTS PREMIUM $ .00
(
"
, .
,
;
§
~
a.
III DIRECT BILL 780K 00055
INSURED COPY
825350567 7B 23794
.
.
....;;.....JJ.!.QJ..I.....I .,-;:!.[lX[!"........ .;¡.t..ªt,ªtn~[!~'Æ..P.r.º.Ç.\;'1~.g...;............;;.............,.....t..................;.:.........;......,.Q.P.I.............................. QP.l.............I............
1 0101100 $;tmrn Statement$; Proce$;$;ed . .00 . 342.00
9,101100 stmm Statements Procened .00 342.00
6101100 $;tmrn Statement$; Proce$;sed .00 342.00
6101100 stmrn StatementsProce$;sed .00 342.00
6101100 UTOOl UNDERGROUND TANK ,liNN 138.00 342.00 þ,
6101100 %002 LIST STATE SURCHÞ.RGE 24.00 144.00 A
6101100 SS001 CiI. 5T A TE SURCHARGE 10.00 120.00 ,6,
6101100 HM005 H.6.Z MM HANDLING FEE 110.00 11 0.00 ,6,
!fJ@(fJR
ORIGIN184
i '
CITY OF BAKERSFIELD
<if1CE OF ENVIRONMENT~RVICES
1715 ðÍester Ave., Bakersfield, CA 93Jíl (661) 326-3979
UNDERGROUND STORAGE TANKS - UST FACILITY
(Ð
TYPE OF ACTION
(Cheç/( one /Nm only)
o ,. NEW SITE PERMIT
o 3. RENEWAL PERMIT
o 4. AAENOEO PERMIT
~ 5. CHANGE OF INFORMATION (SpeçIy~.
1OCaI_ only) Dû.)..Æ7Z.!i "-12
o 8. TEW'ORARY SITE CLOSURE
P8ge _ at _
o 7. PERMANENTLY CLOSED SITE
o 8. TANK REMOveD
400.
,
....,
'.
I ~
I. FACILITY I SITE INFORMATION
BUSINESS NAME (s.me .. FAClUTY NAME or DBA - DoIng BuI!r*a Aa)
/£.Lc,j¿
NEAREST CROSS STREET
3
FACIUTY ID .
401.
FACILI1Y O'NNER TYPE
o 1. CORPORATION
Jä:z. INDIVIDUAL
o 3. PARTNERSHIP
o 4. LOCAL AGENCY/DISTRICT"
o 5. COUNTY AGENCY"
o 8. STATE AGENCY"
o 7. FEDERAL AGENCY"
402.
I BUSINESS
I ,TYPE .
I
~ ,. GAS STATION
o 2. DISTRIBUTOR
'TOTAL NUMBER OF TANKS
'\, . REM4INING AT SITE
I.
o 3. FARM 0 5. COMMERCIAL
o 4. PROCESSOR 0 8. OTHER 403.
fa fKØIIy on Incbn ~ or ·If _ at UST . pubic 88I1Cy. ß8IIIe at supeMsor at
1ruIII8ndI? dvIsIon, sec:IIon or aIIIce whk:II ~ the UST.
(ThiI1II the con\8CI pet.uI for Ihe I8nk reconIa.)
404.
- D...... . _ QU.No u. 405.
'. IL PROPERTY .OWNER ~F.9~'Ï1Ö.,;\
408.
. ",' .,. :. "-.- :',' '. ," :~/.~:: .".. .;.,:... ,. : :' :;.:.~>:,~ ï :<";F~'~;::,' ':"".;;
I ". ,. , '.n ':;:";':¡¡:/;~:¡;'::;:/;:~'~~~~;~fi';:O·
I ~~~ 5~~:AM/~'
I MAJUNG OR STREET ADDRESS
70 ..3 fV\ A«- \<. ë-,
I CITY
i ~ AI
PROPERTY OWNER
",_.. -.... . .
.. .... ... .
'.':'~'." -:; ~..;-;.::
. .. .. '";'.', ~¡~:'::~:,>¡:y;:
:·:'.':~.~:·:~i;;: (. ',.'
n","',' .,-..._ ",
. ". ':~~~;J~~~~i"
..
. -... ... -.
407'/7/;-771- 07 0 0
408.
Sf
.sVv~+e. ~ /700
409.
410.
TATE
CIr
411.
412.
o 1. OORPORATION
-AJ~C-D
J{ 2. INDIVIDUAL
o 3. PARTNERSHIP
o 4. LOCAL AGE.NCY I DISTRICT
o 5. COUNTY AGENCf
09
08. STATE AGENCY
o 7. FEDERAlAGENCY
413.
Sh~rv\\e1-t
sr
?HONE
ýlJ-- 7 7'7- CJ 7 (TO
418.
S~~
1700
417. STATE 418.
GA
41f1.
-..
.r'ht) cÞ"J (..,¿)
IB.2.1NDMDUAl
o 3. PARTNERSHIP
o 4. lOCAL AGEHC:f I DISTRICT
o 5. COUNTY ACÆHCY
03
o 8. STATEAGE.NCY
o 7. FEDERAl AGENCf
420. .
o 1. CORPORATION
"·"·!:!·~':;:::jiJj9~;R~:~9H~~:'?"W~·IP.!!:~~,ª~"~~";~~§ijrf:r:iti~~~·.::~J::,:':';· .
Call (916) 322-9669 If questions arise
~..,.~~. ". ,; I.;:
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PETROLEUM LIST FINANCIAL ReSPONSIB,tLitv
...
.J
o 1. SELF-INSURED
o 2. GUARANTEE
o 3. INSURANCE
o 4. SURETY BONO
o 5. lETTER OF CREDIT
o 8. EXEMPTION
7. STATE FUND
o 8. STATE FUND & CFO lETTER
09. STATEFUND&CO
o 10. lOCAL GOVT MECHANISM
o 99. OTHER:
422. :
Check one bax to IndIc:eIe which IICIdresII/IouId be UNCI ror Ieg8I noIIfIc:8IJona end 111811Jng.
Legal noIIIIc8IJont IInd mdngl will be MI1I to Ihe I8nk _ unIesa bax 1 or 2 III CfIeCkeèI.
01. FACIlITY
f!l2. PROPERTY OWNER
o 3. TANK OWNER 423.
'\ÌI.LEGAL NånFlCATlONAND MAtUNGADDRESS.
... ..... .... ..... ..,:,~,."... ..' ,.,...,.......'.. .. ..... .
. 'VifÄPPtlC~NT SIGNA1YRË ,,,,,.';.
424. PHONE 425. i
Y/~---7"} ') .... olo-c> i
4%1. !
2'
ð-z..v f\.,
428. 1'988 UPGRADE CERTIFICATE NUMBER (For Ioc:M 11M only) , 428./
S:\CUPAFORMS\8wrcb-a.wpd
I STATE UST FACIUTY NUMBER (Forloc:Muaeonly)
UPCF (7/99)
I
e
.
Complete the UST - Facility page for all new pannits, pannit changes or any facility infonnatlon changes. This page must be submitted
within 30 days of pannit or facility infonnatlon changes, unless approval is required before making any changes. .
Submit one UST - Facility page par facility, regardless of the number of tanks located at the site. This tonn is completed by either the
pennit 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 of the USTs with resReCt to buildings and landmarks [23 CCR 32711 (aX8)], a
description of the tank and piping leak deJeçtlon ,!!Qnitoring program [23 CCR )2711 (a)(9)], and, for tanks containing petroleum,
documentation showing compliance with state financial responsibility requirements [23 CCR 32711 (aX11-)]. ' ' ,
Refer to 23 CCR 32711' for state UST infonnatlön and pennit application rØquirements. ' ,
(Note: the numbering of the instructions follows·the data elemenfnumbers that are on the UPCF pages. These dâta element numbers are
used 'for electrOniè'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 facility.
3. BUSINESS NAME - Enter the tulllegal 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. 'J
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 TRUST LAND - Check whether or not the facility is located on an Indian reservation or pther trust/aOOs.
406. PUBLIC AGENCY SUPERVISOR NAME -.If the facility owner is a public agency, enter the name òf the supelvisor tor the division,
section or office which operates the UST. This person must have access to the tank ~rds.
407. PROPERTY OWNER NAME - Complete items 407-412 tortne property owner, unless all items are
408. PROPERfY OWNER PHONE the same as the Owner Infonnation (items 111-116) on the BusinesS
409. PROPERTY OWNER MAILING OR STREET ADDRESS Owner/Operator Identification page (OES Fonn 2730). If the same,
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; Ì'ÀNK OWNER PHONE same as the Owner Intonnation (items 111-116)on the Business
416. TANK OWNER MAILING OR STREET ADDRESS Owner/Operator Identification page (OES Fonn 2730). If the same,
417 . TANK OWNER CITY " '- write -SAME AS SITE- in this section.
418. TANK OWNER STATE
419. TANK OWNER ZIP·CODE
420. TANK OWNER TYPE - Check the type of tank ownership.
421. BOE NUMBER - Enter your Board of Equalization (BOE) UST storage fee account number. This fee applies to regulated USTs
storing petroleum products. This is required before your pennit 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
, _~, __tf1e E.~~~_aJ~ ~tt!rte financiaL~~ibllitY. @CIui~o.æ~.. CHECK.~L THAT A~PL Y. _lfthe,meth~,1s not 11s.ted,
check Aotheræ 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) Qr the property 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 ¡nfonnatlon
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 We 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 UPGRADE CERTIFICATE NUMBER" Leave this blank. This number is assigned by the CUPA.
. .".. .~. - -- .'
. A ... "___
-
,
BAKERSFIELD FIRE DEPARTMENT
HAZARDOUS MATERIAL DIVISION
2130 G Street, Bakersfield, CA 93301
( 805 ,) 32 6 - 3 9 7 9
)
~.
f
APPLICATION TO OPERATE.AN'UNDERGROUND STORAGE TANK
APPLICATION IS BEING SUBMITTED FOR THE FOLLOWING REASON:
)
/
I
)
TO OPERATE A NEW FACILITY
~ TO TRANSFER ow:œRSHIP
TO' OPERATE AN EXISTING FACILITY
PREVIOUS TANK OWNER (if applicable)
NAME ~ IY1 I c... D ,Q·h t., tl ç . PHONE
_,__AD--E~~~~ '_'~:!~_ Ilg L[ih~c ~ 932-f3
--=--" -~-- ___...-.,.....",._-r--.
-- - - -~-..--- -- --,.- - --....
NEW TANK OWNER
NAME ,J~ (+L oShA 1'\1\; p,^ PHONE 4/,r-"J 7') - D 70 D
ADDRESS 70 ~ /¥IÂ72.IC.~T .çr#' i '] crO .5A ,v-r,¿AN i.:'~ L<:) , LA· ~ }//~
BILLING ADDRESS .S'.4-.-vt tr
TANK OPERATOR (if different from owner)
NAME I-i ISh A-i'VI A /-I FYI A--n PHONE t' 6 1- 3 f' 7 - ~js~
ADDRESS, <301 t..ulillt'-.£d AA-lax-.s~j¡l elL '?ij0C¡
APPLICANTS NAME (if different from .owner)
NAME PHONE
~-~-- _.- - - .~------
ADDRESS
TANK LOCATION
FACILIrr:y NAME /~J:.f '7
PHONE ¿,t;/- ,~'17- c.lS-..)-~
ADDRESS 3.5.:;0 ( W//·IJIe.. ¡eel. ·I5Aþgt..s};dJ (~
OPERATORS NAME #1.5hA7v7 A#~A-ð 93s''f
EMERGENCY CONTACT ,
NAME {£( ¡ ,q.:<? 5 h 4. M. I e. ~
ADDRE S S ? 0 '<. ¡IV.. A-d../<;.:l:ót ~7
PHONE ï.j.1 J-- "7 ? ?- 07 ~ a
S ~ i'Jc3-0 _ç .. J::- C-A- 9 .".'/ 03
T ANI< INFO R..M,A T I ON
tank# v.olume date installed substance stored previous substance
~
"
ì
\
,
D.o Y.ou Have a HAZARDOUS MATERIAL RESPONSE PLAN?
D.o Y.ou Have an OWNER ~ OPERATOR AGREEMENT?
Have You Filled Out a HAZARDOUS MATERIAL BUSINESS PLAN?
YES NO
~NO
YES . NO
, )
~
date
name (print)
signature
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
21 01 oW Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 oW 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
-,a
-.
.
" ,..,~.,.,
October 17, 2000
Elias Shameih
703 Market Street, Suite 1700
San Francisco, Ca 94103
NOTICE OF VIOLATION
SCHEDULE FOR COMPLIANCE
RE: Lucky 7 #19,3301 Wible Road in Bakersfield, Ca 93309
Dear Mr. Shameih:
This letter will recap our phone conversation of Friday, October 13, 2000.
As you were made aware, you are in violation of the following:
Section 25284(c) of the Health & Safety Code
"Any person assuming ownership of an underground
storage tank used for the storage of hazardous substance for
which a valid operating permit has been issued shall have 30
days form date of assumption of ownership to apply for an
operating permit."
In addition to failing to obtain a underground storage tank permit (at the
time of purchase, July 1 0, 2000), the following violations are also noted:
Section 25292.2
"F ailure to provide evidence of financial responsibility. All
owners and operators of an underground tank system shall
maintain evidence of financial responsibility for taking
corrective action and for compensating third parties for
bodily injury and property damage caused by a release from
underground tank system.
~~7~de W~ ~,~0Pe Y~.Æ W~'I'I
;.
--
.
\¡;
1
Failure to provide Form "A" showing owner operator data.
Therefore. prior to November 15. 2000, you shall bring the above
referenced facility into compliance with all applicable underground storage
tank codes administered by this office. Failure to comply with the
provisions of the code may necessitate legal action, including, but not
limited to citation and/or injunctive relief
For your convenience, I am enclosing the necessary forms. Thank you in
advance for your anticipated cooperation and, should you have questions
concerning this Notice of Violation action or require further information,
please feel ftee to contact me at (661) 326-3979.
Sincerely,
Ralph E. Huey, Director
Office of Environmental Services
by:
jL dL{)
Steve Underwood, Inspector
Office of Environmental Services
,
SBU/dm
enclosures
~~
klJ ELE E':::e'N
3:301 ,1,,1 I BLE HI,
BAKERSFIELDS.CA93309
805 -. :397 -·4 5 5:3
OCT 13. 2000 I :23 F~
-------
:=::\':::::,r£[-,] :~;THTU;~~ F:EPC'F:T
- -- .- - - -
T I 'PERIO[!/C TE:3T ALAF:r'
T ~. : PEF: 1 ':)[1 I C: TE::3T ALriF:r"l
T ,', : PEF: I ':)[111:; TE;~;T riLAF:r"
'-)
W 2:PERIODIC LINE FAIL
I"",
J ¡',"'./t. 'n':':'I?,- PEPCRT
T I:UF/::p UI"jLEHDEfi
\/'..'1.1 Jill: 12.8..9_ C;¡:~LB
Ul....l.i-·il~..;E =~ ,:i]B~"2 GML~:;
I 90\,: ULlj.,C;E': ;::1]'14 GALS
TC ~)LUME 1261 GALS
HEIGHT 17.23 INCHES
WATER VOL 0 GALS
IT"',JE~r1.", 0 ,00 I NCHE:=:;
'. 91 . 1 DEG F
T 2: REGLJLAF:
VOLUr"lE
ULLAGE
90:\; ULLAGE;
TC VOLur"IE
HEIGHT
LJATER \/OL
l.JATER
TEf"IP
T :3: F'll1:;
\/OLUI"lE
ULL.ACÆ
90\ ULLAGE;
TC \/OLUI"lE
HEIGHT
, VJAiI'T' \/OL
v,j"
TEr"1 '
UNLEADED
14:36 GAL.;::;
813:35 GALS
78':)7 GALS
140:, GALS
18.58 I NCHE:~:
Û GALS
[1.00 1 NCHE:~;
91.0 DEG F
Ur'JLEADED
1914
8457
7419
1871
GALf~
GALS
GALE
GALB
22, '7':, INCHES
o GALS
0.00 INCHES
91 . '3 DEG F
~ ~ ~ ~ ~ END ~ ~ ~ ~ ~
e
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAME---hdGt" 7
INSPECTION DATE 10 1t,1 () 0
Section 2:
Underground Storage Tanks Program
o Routine 0 Combined
Type of Tank !)'{11C)
Type of Monitoring
o Joint Agency
~11II~cf
ATCo
o Multi-Agency 0 Complaint
Number of Tanks ..3
Type of Piping .~6 ~ P
ORe-inspection
OPERA TION
C V
COMMENTS
Penn it fees current
Proper tank data on tìle
Proper owner/operator data on file
Certification of Financial Responsibility
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
TANK SIZE(S)
Type of Tank
AGGREGATE CAPACITY
Number of Tanks
OPERATION Y N COMMENTS
SPCC available
SPCC on file with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?
If yes, Does tank have overfill/overspill protection?
c~comPI~ V~V¡ol"¡oo y~y e,
lo'peolo" .., t.i~
Office of Environmental Services (805) 326-3979
White - Env. Sves.
N=NO
Pink - Business Copy
·
..
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITYNAME-"VC.~ )
ADDRESS 3. 'JfJ j w~ bl<..
FACILITY CONTACT
INSPECTION TIME
I
flt:/
INSPECTION DATE I O/ff/{) 0
PHONE NO. 31 ì- "'IS" E 3
BUSINESS ID NO. 15-210-
NUMBER OF EMPLOYEES ~
Section 1:
Business Plan and Inventory Program
o Routine
D Combined
D Joint Agency
o Multi-Agency
D Complaint
D Re-inspection
OPERATION C Y COMMENTS
Appropriate permit on hand· V ,
Business plan contact information accurate IV
l(aJ 1\:5 n _L - 1 I /d.h 1- rC
Visible address \) I "'l5:>
r ,
Correct occupancy V
Verification of inventory materials / ~ - 1rkD
Verification of quantities ~
Verification of location ./
Proper segregation of material vi
/ , ... {
Verification of MSDS availability V ?oJnMI
Verification of Haz Mat training Iv NnNI (I-
I.. ~v;¡
Verification of abatement supplies and procedures V Nt,t'f( ~
Emergency procedures adequate I, LI'" t;"t ~
1.1 NI1NI .
Containers properly labeled Iv
Housekeeping Iv
Fire Protection .J
Site Diagram Adequate & On Hand
C=Compliance
V=Violation
White - Env. Svcs.
Pink - Business Copy
Any hazardous waste on site?:
Explain:
DYes ONo
Questions regarding this inspection? Please call us at (661) 326-3979
Yellow - Station Copy
Inspector:
- CITY OF BAKERSFIELD
¿aICE OF ENVIRONMENT~ERVICES
1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
UNDERGROUND STORAGE TANKS - UST FACILITY
(Ð
TYPE OF ACTION
I Ch«k one Item only)
o 1. NEW sm: PERMIT
"3. ReNEWAl PERMIT
o 4. AMENDED PERMIT
o 5. CHANGE OF INFORMATION (Spedy cIMnge .
Ioc8I ... only)
o 8. TEMPORARV SITE CLOSURE
PIIge_oI_
o 7, PERMANENTl V CLOSED sm:
o 8. TAN!( REMOVED
400,
I. FACIUTY I SITE INFORMATION
3 FACILITY ID .
401.
FACILITY OWNER TYPE
50 1. CORPORATION
o 2. INDIVIDUAl
o 3. PARTNERSHIP
3
o 3. FARM 0 5. COMM:RCIAL
o 4. PROCESSOR 0 8. OTHER 403.
Is flldllly on Incbn R8HMIIIon 01 ·If _ 01 UST a puÞIIc: agency: name 01 SUpeMsor 01
1nJSIIanda? cIIIIsIon. MdIon 01 cIIIoe whlàl opendeI!he UST.
(11W ia tile oanlaà person for !he tank reocnIs.)
o 4. LOCAl AGENCVIDISTRICT'
o 5. COUNTY AGENCY"
o 8. STATE AGENCY"
o 7: FEDERAl. AGENCY"
402.
CO\~
~~IrESS r41. GAS STATION
o 2. DISTRIBUTOR
TOTAL NUMBER OF TANKS
REMAINING AT SITE
404.
Dv_
~
405.
406.
PROPERTY OWNER NME [. M' \
MAILING . ô~1!O~ ( <6
0oVVV)~
IL PROPERTY OWNER INFORMATION -
.: ~ ..
..... ..
407.
1;J<t (oDq 0
406.
409.
CITY
410.
ZIPq3~ <I .3
o 8. STATE AGENCY
o 7. FEDERAl. AGE.NCf
412.
PROPERTY OWNER TYPE
JJ 1. CORPORATION
o 2. INDMDUAl
o 3. PARTNERSHIP
o 4. LOCAL AGENCY' DISTRICT
o 5. COUNTY AGENCY
413.
f,~~,:;:'~
bt.,c...
I I
.. ..y~,BOARQo.F EQ~~(~~~1JP~;IJ~iST()RAGE FEEACCºQ~'I',~y'II~BE:~ ':r .,_,
Call (916) 322-9669 If questions arise
416.
419.
420.
ï
I
i
421.
CITY
417. STATE
416.
I ZIP CODE
o 6. STATE AGENCY
o 7. FEDERAl. AGENCY
TANK OWNER TYPE
o 1. CORPORATION
o 2. INDIVIOUAl
o 3. PARTNERSHIP
o 4. LOCAL AGENCY' DISTRICT
o 5. COUNTY AGENCY
o 4. SURETY BOND
o 5. LETTER OF CREDIT
o 8. EXEt.f'TION
o 7. STATE FUND
o 8. STATE FUND & CFO LETTER
09. STATEFUND&CO
o 10. LOCAL GOVT toECHANISM
o 99. OTHER:
V.PETROLEUM UST FINANCIAL RESPONSIBILITY,,;, '
422.
, ' ,
VI. LEGAL NOTIFICATION AND MAJUNG ADDRESS
1. FACILITY
Chedt one box to Indcale whk:II acIcIr-. should be UMd rOIl. noCIftc8tIons IIId mlllllng.
Legal noIIfIaItIona IIId m8lllnge will be lent to tile ... _ urn... box 1 01 2 is cIIec:ked.
o 3. TANK OWNER 423.
I
i Cer1JflcalJon: I certify tNllhe InformaIIon ptOIItded herein Is true IIId 8CCUtIIle to !he ~ 01 my knowtedge.
r-SiGNATURE OF APPUCANT
1_ "" 'I'PUCN<T_
1-
;:,1,
, ,",:. ,."....... "..;i!"'t'··", '.
VII. APPLICANT SIGNATURE
:. ~'. . '. .
···:'"i;·... .....
..... .'
DATE
424. PHONE
425.
428.
TITLE OF APPLICANT
4'0.
428. IIK18 UPGRADE CERTIFICATE NUMBeR (For toe., u.. only)
'428.,
I STATE UST FACILITY NUMBER (For /oQJUH only)
UPCF (7/99)
S:\CUPAFORMS\swrcb-a.wpd
--
e
STATE OF CALIFORNIA
STATE WATER RESOURCES CONTROL BOARD
UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B
COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM.
MARK ONLY
ONE ITEM
o 1 NEW PERMIT
o 2 INTERIM PERMIT
o 3 RENEWAL PERMIT
o 4 AMENDED PERMIT
~ CHANGE OF INFORMATION
o 6 TEMPORARY TANK CLOSURE
o 7 PERMANENTLY CLOSED ON SITE
o 8 TANK REMOVED
A. OWNER'S TANK I. D. #
B. MANUFACTURED BY:
DBA OR FACILITY NAME WHERE TANK IS INSTALLED:
I. TANK DESCRIPTION
II. TANK CONTENTS
IF A-1 IS MARKED, COMPLETE ITEM C.
A. ~1 MOTOR VEHICLE FUEL 0 4 OIL B. C. ~ 1a REGULAR UNLEADED o 3 DIESEL o 6 AVIATION GAS
c:J1 1 b PREMIUM UNLEADED o 4 GASAHOL D 7 METHANOL
02 PETROLEUM D 80 EMPTY PRODUCT o 1c MIOORADE UNLEADED 0 5 JET FUEL 0 8 M85
03 CHEMICAl PRODUCT D 95 UNKNOWN D 2 WASTE o 2 LEADED D 99 OTHER (DESCRIBE IN ITEM D. BELOW)
D. IF (A. 1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.#:
III. TANK CONSTRUCTION
MARK ONE ITEM ONLY IN BOXES A, B, AND C, AND ALL THAT APPLIES IN BOX D AND E
A. TYPE OF D 1 DOUBLE WALL 0 3 SINGLE WALL WITH EXTERIOR LINER D 5 INTERNAL BlADDER SYSTEM D 95 UNKNOWN
SYSTEM ~2 SINGLE WALL D 4 SINGLE WALL IN A VAULT D 99 OTHER
B. TANK ~1 BARE STEEL 0 2 STAINLESS STEEL 0 3 FIBERGLASS D 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC
MATERIAL D 5 CONCRETE 0 6 POLYVINYL CHLORIDE 0 7 ALUMINUM D B 100% METHANOL COMPATIBLE WIFRP
(Primary Tank) 0 9 BRONZE 0 10 GALVANIZED STEEL 0 95 UNKNOWN 0 99 OTHER
C. iNTERIOR 01 RUBBER LINED 0 2 ALKYD LINING ~ 3 EPOXY LINING 0 4 PHENOLIC LINING
LINING OR 0 5 GLASS LINING 0 6 UNLINED D 95 UNKNOWN D 99 OTHER
COATING IS LINING MATERIAL COMPATIBLE WITH 100"4 METHANOL? YES _ NO_
D. EXTERIOR 01 POLYETHYLENE WRAP o 2 COATING o 3 VINYL WRAP D 4 FIBERGLASS REINFORCED PLASTIC
CORROSION ~ 5 CATHODIC PROTECTION 0 91 NONE D 95 UNKNOWN D 99 OTHER
PROTECTION
E. SPILL AND OVERFILL, etc. ~~~ ~~~~A~~EN~A~~ED (YEAR) I ~W! OVER~NTION EQUIPMENT INSTALLED (YEAR)
STRIKER PLATE YES NO DISPENSER CONTAINMENT YES NO
IV. PIPING INFORMATION
CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE
A. SYSTEM TYPE A(ÎJ J SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER
B. CONSTRUCTION A@1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED mENCH A U 95 UNKNOWN A U 99 OTHER
C. MATERIAL AND A@1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGLASS PIPE
CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100% METHANOL COMPATIBLE WIFRP
PROTECTION A U 9 GALVANIZED STEEL A@ 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER
D. LEAK DETECTION D 1 MECHANICAL UNE LEAK ~ 2 UNE TIGHTNESS D 3 CONTINUOUS INTERSTITIAl 0 4, ELECTRONIC UNE D 5 ~~: PUMP D 99 OTHER
DETECTOR TESTING MONlTORIIIG tEAK DETECTOR
V. TANK LEAK DETECTION
~ 1 VISUAl CHECK 0 2 ~~~~~I~:T~~ORY 0 3 ~~,zgRING 0 4 ~~0~~NAJ'C TANK D 5 ~~~\!r~I~~TER ~ 6 ~~~~~TANK
o 7 CONTINUOUS INTERSTITIAl ~ 8 SIR 09 WEEKLY MANUAl 010 MONTHLY TANK D 95 UNKNOWN 099 OTHER
MONITORING TANK GAUGING TESTING
VI. TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN-PLACE)
1. ESTIMATED DATE LAST USED (MOIDAYIYR)
2. ESTIMATED QUANTITY OF
SUBSTANCE REMAINING
3. WAS TANK FILLED WITH
GALLONS INERT MATERIAL?
YES 0 NOD
LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW
STATE I.D~#
COUNTY #
IT]
JURISDICTION #
ITIJ
FACILITY #
ITIIIIJ
TANK #
ITIIIIJ
PERMIT NUMBER
I PERMIT APPROVED BYIDATE
I PERMIT EXPIRATION DATE
THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION· FORM A, UNLESS A CURRENT FORM A HAS BEEN ALED. FORM C MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM
SHOULD BE ACCOMPANIED BY A PLOT PLAN. ALE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS
FORM B (6-95)
-
e
STATE OF CALIFORNIA
STATE WATER RESOURCES CONTROL BOARD
UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B
COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM.
MARK ONLY
ONE ITEM
o 1 NEW PERMIT
o 2 INTERIM PERMIT
o 3 RENEWAL PERMIT
o 4 AMENDED PERMIT
~ 5 CHANGE OF INFORMATION
o 6 TEMPORARY TANK CLOSURE
o 7 PERMANENTLY CLOSED ON SITE
o 6 TANK REMOVED
DBA OR FACILITY NAME WHERE TANK IS INSTALLED:
I. TANK DESCRIPTION
I
COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN
A. OWNER'S TANK I. 0.11
B. MANUFACTURED BY:
C. DATE INSTALLED (MOIDAYNEAR)
II. TANK CONTENTS
IF A-1 IS MARKED, COMPLETE ITEM ,C.
A. ~1 MOTOR VEHICLE FUEL 0 4 OIL B. C. o la REGULAR UNLEADED 0 3 DIESEL 0 6 AVIATION GAS
02 PETROLEUM D EMPTY D 1 PRODUCT o Ib PREMIUM UNLEADED 0 4 GASAHOL 0 7 METHANOL
60 ~ Ic MIDGRADE UNLEADED 0 o 6M65
5 JET FUEL
03 CHEMICAL PRODUCT 0 95 UNKNOWN 0 2 WASTE o 2 LEADED 0 99 OTHER (DESCRI6E IN ITEM D. BELOW)
D. IF (A. 1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.II:
III. TANK CONSTRUCTION
MARK ONE ITEM ONLY IN BOXES A. B, AND C, AND ALL THAT APPLIES IN BOX 0 AND E
A. TYPE OF 0 1 DOUBLE WALL 0 3 SINGLE WALL WITH EXTERIOR LINER 0 5 INTERNAL BlADDER SYSTEM o 95 UNKNOWN
SYSTEM ~2 SINGLE WALL 0 4 SINGLE WALL IN A VAULT 0 99 OTHER
B. TANK g 1 BARE STEEL D 2 STAINLESS STEEL 0 3 FIBERGLASS 0 4 STEEL CLAD WI FIBERGLASS REINFORCED pLAsTIC
MATERIAL o 5 CONCRETE D 6 POLYVINYL CHLORIDE 0 7 ALUMINUM 0 6 100% METHANOL COMPATIBLE WIFRP
(Primary Tank) 0 9 BRONZE D 10 GALVANIZED STEEL 0 95 UNKNOWN 0 99 OTHER
C. INTERIOR 0 1 RUBBER LINED D 2 ALKYD LINING [25:l 3 EPOXY LINING 0 4 PHENOLIC LINING
LINING OR 0 5 GLASS LINING D 6 UNLINED o 95 UNKNOWN 0 99 OTHER
COATING IS LINING MATERIAL COMPATIBLE WITH 100"4 METHANOL? YES_ NO_
D. EXTERIOR 01 POLYETHYLENE WRAP D 2 COATING o 3 VINYL WRAP o 4 FIBERGLASS REINFORCED PLASTIC
CORROSION S 5 CATHODIC PROTECTION D 91 NONE o 95 UNKNOWN o 99 OTHER
PROTECTION
E SPILL AND OVERFILL SPILL CONTAINMENT~ALLED (YEAR) I Q\.4 -. OVERFIL~~TION EQUIPMENT INSTALLED (YEAR) 1'1Y'I'"'>
. ,etc. DROP TUBE YES L NO STRIKER PLATE YES NO DISPENSER CONTAINMENT YES NO
IV. PIPING INFORMATION
CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE
A. SYSTEM TYPE A ® 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER
B. CONSTRUCTION A(!L) SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER
C. MATERIAL AND ~ 1. BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGLASS PIPE
CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 6 100% METHANOL COMPATIBLE WIFRP
PROTECTION A U 9 GALVANIZED STEEL A @ 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER
D. LEAK DETECTION D 1 MECHANiCAl UNE lEAK ~ 2 UNE TIGKTNESS D 3 CONTINUOUS INTERSTITIAl 0 4 ELECTRONIC UNE D 5 =~ PUMP D 99 OTHER
DETECTOR TESTING MONITORING lõAK DETECTOR
V. TANK LEAK DETECTION
I"J! 1 VISUAL CHECK 0 2 MANUAL INVENTORY '0 3 VADOZE 0 4 AUTOMATIC TANK 0 5 GROUND WATER ~ 6 ANNUAL TANK
~ RECONCILIATION MONITORING GAUGING MONITORING Jið.I- TESTING
o 7 CONTINUOUS INTERSTITIAL ~ 6 SIR 0 9 WEEKLY MANUAL D 10 MONTHLY TANK 0 95 UNKNOWN 0 99 OTHER
MONITORING ¡t,6L TANK GAUGING TESTING
VI. TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN-PLACE)
1. ESTIMATED DATE LAST USED (MOIDAYNR)
2. ESTIMATED QUANTITY OF
SUBSTANCE REMAINING
3. WAS TANK FILLED WITH
GALLONS INERT MATERIAL?
YES 0 NOD
LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OFTHE FOUR NUMBERS BELOW
STATE 1.0:#
COUNTY #
CD
JURISDICTION #
ITIJ
FACILITY #
DIIIIJ
TANK #
ITIIllJ
PERMIT NUMBER
I PERMIT APPROVED BYIDATE
I PERMIT EXPIRATION DATE
THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATlON - FORM A, UNLESS A CURRENT FORM A HAS BEEN ALED. FORM C MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM
SHOULD BE ACCOMPANIED BY A PLOT PLAN. ALE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS
FORM B (6-95)
';,~......c:;-,-,--=~._--,-\:_~,_"",--,___..",:;_¿,,'-~_·7'''-~~__ -~-",,_:- ,,"'-
.
e
STATE OF CALIFORNIA
STATE WATER RESOURCES CONTROL BOARD
UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B
COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM.
MARK ONLY
ONE ITEM
,
o I NEW PERMIT
o 2 INTERIM PERMIT
o 3 RENEWAL PERMIT
o 4 AMENDED PERMIT
~ 5 CHANGE OF INFORMATION
'0 6 TEMPORARY TANK CLOSURE
o 7 PERMANENTLY CLOSED ON SITE
o 8 TANK REMOVED
DBA OR FACILITY NAME WHERE TANK IS INSTALLED:
I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN
A OWNER'S TANK I. D. # B. MANUFACTURED BY:
II. TANK CONTENTS IF A-liS MARKED, COMPLETE ITEMC.
A /&.' MOTOR VEHICLE FUEL 0 4 OIL B. C. 0 I a REGUlAR UNLEADED D 3 DIESEL 0 6 AVIATION GAS
02 PETROLEUM 0 EMPTY 0 I PRODUCT ~ I b PREMIUM UNLEADED 0 4 GASAHOL 0 7 METHANOL
80
Ie MIOORADE UNLEADED 0 5 JET FUEL 0 8 M85
0 3 CHEMICAL PRODUCT 0 95 UNKNOWN 0 2 WASTE 0 2 LEADED D 99 OTHER (DESCRIBE IN ITEM D. BELOW)
D. IF (A 1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A. S.#:
III. TANK CONSTRUCTION
MARK ONE ITEM ONLY IN BOXES A, B, AND C, AND ALL THAT APPLIES IN BOX 0 AND E
A. TYPE OF 0 1 DOUBLE WALL D 3 SINGLE WALL WITH EXTERIOR LINER 0 5 INTERNAL BlADDER SYSTEM o 95 UNKNOWN
SYSTEM JZf2 SINGLE WALL D 4 SINGLE WALL IN A VAULT 0 99 OTHER
B. TANK l}a1 BARE STEEL D 2 STAINLESS STEEL 0 3 FIBERGLASS 0 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC
MATERIAL 0 5 CONCRETE 0 6 POLYVINYL CHLORIDE 0 7 ALUMINUM 0 8 100% METHANOL COMPATIBLE WIFRP
(Primary Tank) 0 9 BRONZE D 10 GALVANIZED STEEL 0 95 UNKNOWN 0 99 OTHER
C. INTERIOR 0' RUBBER LINED D 2 ALKYD LINING ~ 3 EPOXY LINING 0 4 PHENOLIC LINING
LINING OR 0 5 GLASS LINING D 6 UNLINED 0 95 UNKNOWN 0 99 OTHER
COATING IS LINING MATERIAL COMPATIBLE WITH 100"'{' METHANOL? YES)( NO_
D. EXTERIOR 0 1 POLYETHYLENE WRAP D 2 COATING o 3 VINYL WRAP o 4 FIBERGLASS REINFORCED PLASTIC
CORROSION g 5 CATHODIC PROTECTION D 91 NONE o 95 UNKNOWN o 99 OTHER
PROTECTION
E. SPILL AND OVERFILL, etc. ~~\3'p ~~~~ A~~E~ ~~g:D (YEAR) 1'"1'"1'1-\ OVERF~;NTION EQUIPMENT INSTALLED (YEAR) \''''''1' ~
STRIKER PLATE YES NO DISPENSER CONTAINMENT YES NO
IV. PIPING INFORMATION
CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE
A. SYSTEM TYPE A@1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER
B. CONSTRUCTION A(ý.ï, SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER
C. MATERIAL AND AI€)I BARE STEEL '2 A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGLASS PIPE
CORROSION A U 5 ALUMINUM . A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100% METHANOL COMPATIBLE WIFRP
PROTECTION A U 9 GALVANIZED STEEL A{J!; 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER
D. LEAK DETECTION o 1 :ii~~ UNE LEAK 123-2 ~~~~HTNESS 0 3 ~~~~~ INTERSTITIAL 0 4 ~~~~~E o 5 ~~~ PUMP 0 99 OTHER
V. TANK LEAK DETECTION
18:11 VISUAL CHECK D 2 MANUAL INVENTORY 0 3 VADOZE D 4 AUTOMATIC TANK D 5 GROUND WATER ~ 6 ANNUAL TANK
RECONCILIATION MONITORING GAUGING MONITORING }Z!:>o.J TESTING
o 7 CONTINUOUS INTERSTITIAL ~ 8 SIR 0 9 WEEKLY MANUAL 0'0 MONTHLY TANK D 95 UNKNOWN 0 99 OTHER
MONITORING IAJ TANK GAUGING TESTING
VI. TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN-PLACE)
1. ESTIMATED DATE LAST USED (MOIDAYNR)
2. ESTIMATED QUANTITY OF
SUBSTANCE REMAINING
3. WAS TANK FILLED WITH
GALLONS INERT MATERIAL?
YES D NOO
THIS FO~~ COMPLETED UNDER PENAL TY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT
I ~~..~~"'" Ak.n.-L~/ !J¡."j1?M- I /õ-Zb-9e, I
LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW
STATE 1.0;#
COUNTY #
rn
JURISDICTION #
[ll]
FACILITY #
ITIIIIJ
TANK #
CIIIITJ
PERMIT NUMBER
I PERMIT APPROVED BYIDATE
I PERMIT EXPIRATION DATE
THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATlON· FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM
SHOULD BE ACCOMPANIED BY A PLOT PLAN. RLE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS
FORM B (6-95)
'-"":;-:-'-.';;:;"'--~¿:;O~~~""'Ci --:-r_· -0- . '-_~.:......_~'_,..Lc-'-'''__:_..::.;;;_;::¡~,,:;,....,i..~'__.-~'~''''_'_'_'........"=_'_~~,;....¡_,,~,..<._~'_'__''___~