HomeMy WebLinkAboutUNDERGROUND TANK FILE #2
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(See 3rd File)
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CITY OF BAKERSFIELD
.ICE OF ENVIRONl\'IENTAI""ERVICES
1715 Chester Ave., Bakersfield, CA 93 1 (661) 326-3979
UNDERGROUND STORAGE TANKS - UST FACILITY
(9
TYPE OF ACTION
¡Cheek one ,18m only)
o 1. NEW SITE PERMIT
o 3. RENEWAL PERMIT
. 4. AMENDED PERMIT
o $. CHANGE OF INFORMATION (Specify ClI8f198 .
local use only)
o 6. TEMPORARY SITE CLOSURE
Page 1.. of ..!..
o 7. PERMANENTLY CLOSED SITE
o 6. TANK REMOVED
400.
BUSINESS NAME ($¡¡me as FACILITY NAME IX DBA· Doing Business As)
I. FACILITY I SITE INFORMATION
3 FACILITY 10 1#
1="~tt-'
77')
77'-
')
o 4. LOCAL AGENCYiDlSTRICr
o 5. COUNTY AGENCY"
o 6. STATE AGENCY'
o 7. FEDERAl. AGENCY'
402.
NEAREST CROSS STREET
401.
FACILITY OWNER TYPE
o 1. CORPORATION
k!è 2. INDIVIDUAL
o 3. PARTNERSHIP
\J µ iO i'-)
BUSINESS
TYPE
1& 1. GAS STATION
o 2. DISTRIBUTOR
TOTAL NUMBER OF TANKS
REMAINING AT SITE
D 3. FARM 0 5. COMMERCIAL
D 4. PROCESSOR 0 6. OTHER 403.
IS facility on Indian R--.ation IX
trusUanés1
"If owner of UST a public agency: name of supeMsot of
diviSion, sectJon or ofIk:e whict1 operates !he UST.
(This Is !he contac:l person fIX !he lank records.)
7 404.
Dves
DNa
405.
406.
IL PROPERTY OWNER INFORMATION
ITY
407. PHONE 408.
(6/- '-,y¡ ~~ 7000
! PROPERTY OWNER NAME
MAILING OR STREET AOORESS
409.
410.
ATE 411.
Clt
ZIP DE
c¡ 3 3ð~
412.
PROPERTY OWNER TYPE
o 1. CORPORATION
o 2. INOMOUAL
~ 3. PARTNERSHIP
o 4. LOCAL AGENCY I DISTRICT
D 5. COUNTY AGENCY
o 6. STATE AGENCY
D 7. FEDERAl. AGENCY
413.
! :
III. TANK OWNER INFORMATION
TANK OWNER NAME
T Cl.", l ~ c;.CJ...;
414.
415.
ITY
Hl II
t
416.
MAILING OR STREET ADDRESS
417. STATE 418. ZIP CODE
(.A '1 ~?:O~
419.
TANK OWNER TYPE
D 1. CORPORATION
o 2. INDMOUAL
.2il3. PARTNERSHIP
D 4. LOCAL AGENCY I DISTRICT
D 5. COUNTY AGENCY
D 8. STATE AGENCV
D 7. FEDERAl. AGENCY
420.
í
I
ì
I
ì TV (TK) HQ
IV. BOARD OF EQUAlIZATION UST STORAGE FEE ACCOUNT NUMBER
Call (916) 322-9669 if questions arise
421.
V. PETROLEUM UST FINANCIAL RESPONSIBIUTY
'-.
INDICATE METHQO(S)
D 1. SELF·INSURED
D 2. GUARAHTEE
o 3. INSURANCE
o 4. SURETY BOND
o $. LETTER OF CREDIT
o ð. EXEMPTION
D 7. STATE FUND
o 8. STATE FUND & CFO LETTER
o 9. STATE FUND & CD
o 10. LOCAL GOV"T MECHANISM
o 99. OTHER:
422.
VI. LEGAL NOTIFICATION AND MAILING ADDRESS
Ched< one box 10 indlcat. whict1 address should be used for aI nOllftcations and mailing.
Legal nOlltk:aUons and mailln will be sent to the tank unless box I or 2 is ched<ed.
D 1. FACILITY
o 2. PROPERTY OWNER
o 3. TANK OWNER 423.
VII. APPLICANT SIGNATURE
CertJflcallon: I
SIGNATURE
DATE
424. PHONE
425.
NAME OF APPliCANT (prillt)
JC~N
k..!\i L·..
Lf - 2<;-- 00 66; - 313 -7ooÔ
426. TITLE OF APPliCANT
\J-P G-c..Scli I'.o~ 0 v
4V
4 .
( or ~I use Only)
429.
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CITY OF BAKERSFIELD
O.E OF ENVIRONMENTAL.RVICES
1715 Chester A ve., Bakersfield, CA 93JOT(661) 326-3979
UNDERGROUND STORAGE TANKS· TANK PAGE 1
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~ L «7
o s. T£MPOAAAV SITe o.OS\JfU!
o 1. PERMAHEHTt. y o.oseo ON SITe
o s. TANKR.E~O
rYPE OF ACTION CJ ,. HeW SIT! ~ ,þ!... AoIoIINCeO PeRMT 0 S. OW«JI Q t INFOftMA TION)
, C/I«- oJ'" ,,.,,, ",.,."
CJ 1. IWieWAL P!IUMT
($p«iy __ . ~ IOcM UN OItIyJ
suSINESS NAAe (s-... '''ClUTY NMII! 01 oaA . 0c0IIe ~ Aa)
F",,-
lOCA TION 'MTHIH SITI (QIItDMO
77
ANK I .
L TANK DESCRIPTION
.
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TNoIC use
)i. t. UOTOft VЫU I'UeL
{l/fNtbd. ___......... 7)pe}
:J 2. N()N.I'\JEL I'£T'AiCU\AI
CJ 3. CH6IICAI. PAOOUCT
:J .. HAlAAOOUS WASTI! (1IwåIdN
Uwd 01)
"] 95. ~
.'Pf: OF TNoIC
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; ANK 1M TERIAL . pmwy 111*
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438
o 1. IN3L! WAU.
iii 2. DOUIU! WAU.
0,. &w!STUL
o 2. STANDS STœ.
<NK 1M TERW. . ~ 111* 0 ,. BAAl! ST!8.
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.v.< IHTEIOOR ~
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o 5. JET FUEL
EJ e. AVIATION FUEL
o gg. OnER
CAS' (II'om~ WINMIØ ~¡w¡e)
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441
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.. TANK CONSTRUCTION
o ¡, SINOU! WAU. ænt
~TeRIOR r.e.IIfWe LMR
o 4. SINQU! WAU. If A VAU.T
8()o6"~ó'-1
o 5. SINGU! WALL ænt INTERNAL IIUDOER SYSTEM
OM. UNOC)WN
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05. CONCæT! OM. ~
0.. FRPCOU'ATl8l.EWI100'HETlWO. Ow.OTIER
44:
o 3. FeEROlASS I PlASTIC
Qi( 4. S'T'EEl ~ w.'FIB!RGlASS
R£N=OAœD PlASTIC (FRP)
o 3. FIIERGlASS I PlASTIC
k\ 4. STEa. ~ 'NFeERGlASS
REIN'OACm PlASTIC (1'RP)
o 5. CONC:ÆT!
o ¡, EPOXY LNNQ 0 50 0lASS I..NNO 0 M. I.JN<NO'Mf
o t. PH!HOUC ~ a.. UN.N5D 0 W. OTHER
(&¡, FeÐØASS It!H'ORœ) P\.MTIC 0 M. UN<NOVt'N 448
o 4. M'Af!SSI!O CUAMHT 0 W. cmÆR
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o .. FRPCOU'ATIBU!W1100% ~
o .. FRP~JAO<ET
o 10. COATED STEEl.
~
44ð D4TE INSTAUEO
447
{FfK 1OœI_ odYJ
D4TE INSTALLED
449
o 1. ~ACT\IN!D CATHOOIC
PAOTICT1OH
o 2. SACIWICIAL ANOOe
Y!AA INSTAlLED 4.SO TYPt! (For /oeM UN orIy1
18l1. SPIU. COHTAHoeHT ~ 6' .
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3. 2. DAOP T1J8I ~ ._
o ¡, STRIIŒIt fltAn
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(F1K 1oøI_ ody)
451 0'ÆIU'1l.L PROTECTION EQUIPMeNT: Y!!AA INSTAllED 452
ø I. AI.AAM q ( 0 3. FIlL ruBE SHUT OFF VALve _
fð. 2. 8AU. F1.OA T '1 , 0 4. I!XÐAPT
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01. VlSUAL(SINOl!WALLINVAUlTON.Y)
o 2. CONTINUOUS INT!RSTTTW. UONfTORINQ
o 3. MAHUAL r.tONlTORINQ
o 50 IoWAJAL TANI( OAIJOINQ (MfO)
o .. VADOse ZONe
07. OIIOUNOWATeR
0.. TAl« ~TlNO
O. OTMtR
V. TANK Ct.OIUJIU! IH10ftMA T10H I PllU&ANIHT CLOIUQ IN PlACI!
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_ CITY Of BAKERSFIELD ~
. Of"1C8 Oft I!NVIRONMENTAL SERVIC
1115 Chn.., A~.. e.ke,..fteld, CA 13301 (N1) 1-3111
VI.,... caNITRUCT10H (a.." fie,."
UNCI!AQIIOUNO PIPING I
SYSTEM rYPE - 0 0 I 0
110 I. PRESSURe 2. SUCTION 3. GAAVITY 458 I. PRESSURE
CONSTRUCTION!'O f. SINGLE WALL 0 J. LINI!O TRfHCH 0 it. OTHER 4ðO 0 I. SINGLE WALl.
MANUFACTURER! lit 2. OOUBlE WALl. 0 is. U~ 0 2. OOUBlE WALl.
, f MAMiFACTURI!R 481 IoWIUFACTlJRER
,0 1. SARE STEEL CJ .. FRP COWA1'IIIU WlI~ METHANOL 0 I. BAAE STEEL
: MATERIALS ANO '0 2. STAINU!SS STEEL 0 7. QALVAHIZEO STEfL 0 2. STAINLESS STEEL
: CORROSION ;
, PAOTECTION :0 J. PlASTIC COWAT18U! wmt CONTENTS 0 is. UNICNQ'MI 0 3. PlASTIC COMPATIBLE WITH CONTENTS
:Ø' .. FIBERGlASS 0 .. F\.!XIIU! (HOPE) 0 it. OTHER 0 4. FiBeRGlASS
: 0 5. STEel WI COATING 0 t. CATHOOIC PROTECTION 4t4 0 5. STEEL WI COATING
VI. PPING L2AK DETECT10N (CMdIII""~)
UHOERGROUNO PIPING
PRESSURIZED PIPING (CMcIr " filii' ~):
Øi ,. ELECTRONIC UNE LEAK OET1!CTOA 3.0 GfIH TEST mIt1 AUTO fI\M» SHUr OFF FOR
LEN<. SYSTEIoI FAA.URI!. AND SYST£M DISCOfKCTION · AUOIIU! AND VISUAl.
AI.NUoIS
o 2. MOHniL Y 0.2 GPH TEST ~
o 3. NHJÞL INT£GRf1'Y TEST (0.1 QPH)
CO~~SYSTaIS:
. 0 5. 0AJl Y VISUAL WONfTORING Of' f'tAFINO SYST£M . TRIÐHAI. PIPING INT'EGRITY
TEST (0. I GAi)
I
Ii SAFE SUCTION SYSTaCS (NO VAlVES IN øaow GAOUND PI'N»:
o 7. SElF MONITORING
GRAVITY flOW:
o t. BIÐHAl HTEGRfTY TEST (0.1 QPH)
SECONDARILY CONTAINI!D PIPING
PRESSURIZED PIPING (CMcIr " IIIat IIPIJ/y):
10. COHTlNJOUS 'T1.IR8H SU.... seNSOR ~ AUOI8lE AIÐ VISUAl AlARMS AND
(0Ied< one)
PI a. AUTO PUMP SHUT OFF 'MiEN A lVJ( OCCURS
i1C II. AUTO PU.... SHUT OFF FOR LJW(S, SYST£M FAI.URf AIÐ SYSTEM
OISCONECTION
o Co NO AUTO PU.... SHUT OFF
o 1,. AUTOMATIC LIE LEAK OET1!CTOR (3.0 OPH TEST) rstII:1FltJWSHUroFF OR
RESTRICTION
o 12. ANHIJAL iNTEGRITY TEST (0.1 OPH)
SUCTIOWGRAVYTY SYSTEM:
.tx 13. COHTNJOUS SUIM' SEN80A . AI.IOIILe NIO VISUAl N.»U!S
IJII!ftQI!HCY CJÐlØATOfW ONLY (Check""''''
o 14. COmNJOUS SUMP SEHSOA ~AUTÖP\.W StM' OfF. AUOI8U! AND
VISUAL AI.AAMS
o 15. AUTOMATIC UNE LEAK DETECTOR (3.0 QPH TEST) mnœI FltJW SHUT OFF OR
RESTRICTION
- 0 18. ANNUAL IHTCGRrrY TEST (o-:-ï GPH)
o 17. DAll'l' VISUAL CHECK
,..
un ,TANk ~AQ(
..l...- Clf11
A80V10A0UNO PlPlNO
o 2. SUCTION
o 95. UNKNOWN
o it. OTHER
o 3. GAAvnv
o 8. FRs> COfoM>ATI8U! W/I~ ~
o 7. GALVANIZED STEEl
o a. FlÐCJ8LE (JC)P£) 0 it. OnER
o t. CA n100IC PAOTECTION
o 95. UNKNO'MI
4
4M
.~'':'...
4-
PRESSURIZED PIPING (CMdt " filii' IIJP/y):
o 1. ELECTRONIC UNE LEN< DETeCTOR 3.0 GPH TEST mIt1 AUTO PIAP SHUT OFF FOR lEAl<
SYSTEM FAILURE. AIÐ SYSTEM 0ISC0NNECT10N. AUCI8LE AND VISUAL ALAAMS
o 2. MONTK.Y U GPH TEST
o 3. NHJN..INT'EGRITY TEST (0.1 OPH)
o 4. CWlYV1SUAlOECK
CON\lENTlONAL SUCTION SYSTEMS (Chttdl.. "".wy):
o 5. OAII. Y VISUAL MONfTORING Of' PIPING NIO PIJM'tNG SYSTEW
o 8. TRJENNIAlINTEGRITY TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VAlVES IN BELOW GROUND PIPING):
o 1. SELF 1wIONIT000NG
GRAvrTY FlOW (CMdt"!Nt~):
o a. DAIlY VISUAl r.tOMTOft NQ
o t. BIEMML INTEGRITY TEST (0.1 OPH)
..
SECONDNIIf. Y CONTA/HI!D PII'INQ
PRESSURIZED PIPING (C/I«k II tN, IIJP/y):
10. COHTlNUOUS T\JRBINE SU.... SEHSOR~AUOI8lEANDVlSUALAI.ARMS AND (c:hIIck~
o a. AUTO PVJ.f> SH1JT OFF WHEN A LEN< OCCVRS -..
o Þ. AUTO PVJ.f> SHUT OFF FOR L£AI<S. SYSTEM FAl.URe AND SYSTEM DISCONNECT1O~·
o Co NO AUTO PIJt.4P SH1JT OFF
o 11. AUTOMATIC LEN< DETECTOR
o 12. ANNUAL INTEGRITY TEST (0.1 GPH)
SUCTIONlGRAVYTY SYSTEM:
o 13. CONT1NUOUS SUMP SENSOR . AUOI8U! AND VISUAL AI.AAt.tS
ÐII!ROEHCY CJI!HØATOfW OHL Y (Check II /11M Wt)-
o 14. CONT1NUOUS SlJJ.f> SENSOR wrrHOUT AUTO PU.... SHUr OFF . AUOI8L£ AND VISUAL
ALARMS
o 15. AUTOMATIC UNE LEAl< DETECTOR (3.0 GPH TEST)
o 18. ANNUAL INTEGRITY TEST (0.1 GPH)
o 17. DAILY VISUAL CHECK
.".. :fpg~MEf[:~~\,.'t\;;:~~t~;
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o .. DAIlY VISUAL CHecK
o S. TR2NCH UN£R I MONrTORHJ
o .. NON! ~
OISPeNSER CONTAINMeNT
OA TE INST ALL!D
't('
o 1. FlOAT MECHANISM ~T SKITS OR' SHeAA VALve
o 2. COHrNJOUS OISP!HS!A P~ S!NSOA . AUDIIU! AND VISUAL AlAIWS
. COHTNJOUI OIIP!NSEA PAN SENSOR ïdIt1 AUTO SHUT OFF FOR DISPENSER· AUDIBLE ANO VISUAl ALAAMS
IX. OWNI!RIOPI!RATOR SIGNAT\JRI!
to IN !MIl II my 1U1CMIedge.
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CITYOF BAKERSFIELD
O.E OF ENVIRONMENTALMRVICES
1715 Chester Ave., Bakersfield, CA 93J~(661) 326-3979
UNDERGROUND STORAGE TANKS· TANK PAGE 1
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o 8, TEMPORARY SITe ClOS\JR8
o ,. PEAAW4EHTt. Y ClOseO ON Srre
o 8. TANK A£~O . '
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o 3. CHÐACAl PROOUCT
o 4. 'HAZAA!:JOUS WAS'T1! (hdWN
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o 95. UH<NOWN
.. TANK CONTDITI
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o 1.. RI!<X.tNt ~ 0 2. L!AOED
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o S. CONCÆT!
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o S. TRJENNIAI. IHTEGRITY TEST (0.1 GPH)
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o 1 ð. ANNUAL INTEGRITY TEST (0.1 <>PH)
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0IttCE OF ENVIRONMENTAf..M:RVICES
1715 Chester Ave., Bakersfield, CA 933m'" (661) 326-3979
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o PO. O~
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CITY 0' BAKERSFIELD
a ()fI lICB 0' INVIRONMENTAL SERVICa
.1715 Chester Ave., Sake"fteld, CA 93301 (se1~179
UNOEROROUNO P1P1NO
VI. ~ CONITRUC'nOH {C1I«II" IIW/-wrl
AðOV!!GROUNO PlPlNO
SYSTEM TYPE ¡g I. PRESSURE 0 2. SUCTION 0 ]. OIV.VITY 454 0 ,. PRESSURE
CONSTRUCTIONI'O I SINGlI! WALL 0 J. LINED TRfNCH 099. OTHER 4ðO 0 I. SINGlE WALL
MANUFACTURER~~ 2. COuell! WALL o~. U~ 0 2. COueu! WALL
! ~FACTURI!R 401 MANUFACTURER
i ,0I.aAAESTE!L 0 a. FRPCO....ATI8U!'Nt001H4ETH...NOL 0 1. aAAESTEEL
: MATERIALS ANO . 0 2. STAlNU!SS STEEL 0 7. GALVANIZ!D STI!EI. 0 2. STAI~SS STEEL
, COMOSION ¡
I PROTECTION :0 J. PI.AST1C COMPAT18U! WITH CONTEHTS O~. UNI<NO'M4 0 J. PlASTIC COMPATIBlE WITH CONTEHTS
:JR 4. FIURGlASS 0 e. FlÐCI8U! (HOPE) 0 99. OTHER 0 4. FIBERGlASS
: 0 5. STEEL WI COATING 0 9. CA THOOIC PROTECTION 4ð4 0 5. STEEL WI COATING
VI. PIPtNO L2AK DETECT10N (C/I«Jf" hI~)
UNO£RG,qQUNO P1P1NG
PRESSURIZED PIPING (Ch«Jc ., IN/ ~):
Pi 1. ELECTROMC UN£ LEAK DETECT~ 3.0 OPH TEST :txm1 wro PVfo4P SHlÍT OFF FOR
LEAK. SYSTEM FAIlURe. ÞHJ SYSTEM CCSCONECT1ON . AUOII!U! ÞHJ VISUAl.
AURMS
o 2. MOHTK Y 0.2 oPH T!ST
o 3. NHJAJ.. INTEGRrTY TEST (0.1 OPH)
CONVEHTlONAL. SUCTION SYSTEMS:
o 5. 0AJl Y VISUAl.. UONrTORJNO OF P\JI.Af>1HG SYSTEM . TRIÐHAL Pf>INO INTEOOI'TY
TEST (0.1 OPH)
SAFr: SUCTION SYSTÐ.CS (NO VAL YES IN BElOW GAOUNO P1P!NG):
o 7. SElF MONITORING
GRA V1TY FlOW:
o II. 81ÐHAJ.. M"EGRfTY TEST (0.1 OPH)
secOHDARlL Y COHT AIHI!!D I'U'IHO
PRESSURIZED ~ (CMd< ., INt ¥PiT):
10. CON1'NJOVS nJR8INE SUMP SEHSOA i'J:ID1 AUDIBlE ÞK} W>UAL AlAAMS ÞHJ
(o-Ico.-..)
,&g. &. AUTO PUMP SHUT OFF v.+I£N A LEAJ< OCCURS
. '£R' Þ. AUTO PUMP SHUT OFF F~ L.£AKS. SYSTEM F~ ÞK} SYSTEM
OISCONNECT1ON
o Co NO AUTO PUMP SHUT OFF
o 11. ~~~ UNE LEAK D€TECT~ (3.0 OPH rEST) mlli FlOW SIVT OFF OR
o 12..a.NNUAL HrEGRfTY TEST (0.1 GPH)
SUCTIOWGRAVTTY S'YSTÐ.t
.Pi: 13. COHTNJOOS SlJ904P SfNSOR . AUOC8U! NÐ VISUAl. ÞUM.fS
ÐŒJItQ Ы::Y OI!N!M TOftS Of&. Y (Chodc ., II« IfIIIIrl
o 14. CO/mNUOOS so.... ~ ~AUTO PUf,f> StIJT on:. AIJOIÐU! ÞHJ
VISUAL ALAAMS'- ,
o 15. AUTO 1M T1C UNE LEAl< OETt:CTOR (3.0 OPH TEST) ÏJID!Q!JI FlOW SHUT OFF OR
RESTRICT10N
I 0 15. ANNUAL INTEGRIiY TEST (0.1 OPH)
i 0 17. OAIL Y VISUAL CHECK
I
'. "
o 2. SUCTION
o 95. UNI<NO'M4
o 99. OTHER
o ,. OAAVITY
. ¡
o e. FRPCOMPATlBU!W/1~~
o 7. GALVAAIZS) STEEL. . ,
o a. FlÐCI8lI: (HOPE) 0 98. OTHER
o I. CATHOOICPROTEC11ON . '
095.U~ ':1 .
.
40ð
.~''';..:.
...
PRESSURIZED PIPING (CMcIc" INI~): .' '.'
o 1. ELECTRONIC UNE LEAl< DETECTOA 3.0 GPti TEST :tdIH AUTO PU.... SHUT OFF FOR U!AJ<
SYSTEM FAILURE. NÐ SYSTÐ.C 04SC0NECTI0N . AUOII!U! NÐ V1SUAL AlARMs . . i
o 2. MONTK. Y 0.2 OPH TEST
o 3. ~ M1!GRITY T!ST (0.1 OPH)
o .. DAJl Y VISUAL CHEO<
CONVEHTlONAL SUCT10N SYSTa4S (CIIet:k ~ /llet ~):
o 5. DAJl Y VISUAL MONrT'OAING OF PIPN) AK) PVI.FING SYSTBI
o 5. TRJENNIAL IHTEGfUTY TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALV1:S IN Ba.OWGf1OUNO PIPING):
o 7. SélF MONITOOJNG
GAAVTTY FlOW (Ch«k" INt 61JP1y):
o a. DAJl Y VISUAl. MONrTOOING
o II. 9IEHIIAL IHTEGRfTY TEST (0.1 GPH)
aecoNDAIaL Y COHTAnœD PIPIHCl
PRESSUFUZEO PIPING (CMcIc ., IN/ apply):
10. CO/mNUO\J5 TUR8lPE SUMP SENSOR:tdIl1 AUOI8U! ÞHJ VISUAl ALARMs ~ (ctMIdi: ~ i
o a. AUTO PUMP SHUT OFF WHÐI A LEAX OCCURS
o Þ. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURe NÐ SYSTEM OISCÓNNEC'T1O~ I
o Co NO AUTO PUMP SHUT OFF
o 11. AUTOMATIC LEAl< DETECTOR
o 12. mNUAL INTEGfUTY TEST (0.1 GPti)
SUCTlOWGRAVTTY SYSTEM:
o 13. COI'mM.lOU3 SUY> SENSOR . AUOI8t..e ÞHJ VISUAL ÞUJ!;US
0IVt01!HCY QÐÆRATOftS OM. Y (C/t«* .. ,.., ~ . .
o 14. CONT1h\JOUS $V.... SENSOR wrrnour AUTO PU.... SHUT OFF. AUDI8lE AK) VIsuAL.
ALAAMS .
o 15. AUTOIMTIC LINE LEAK DETECTOR (3.0 OPH TEST)
o 15. ANNUAL INTEGRITY TEST (0. I OPH)
o 17. OAlL Y VISUAL CHECK
~~!JHWOO::<\ ,If'~;ì:.1~t~;
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o .. D.U. Y VISUAL 0i1!CK '
o S. TÆHCH LINER I J.4ONrf,oIUNO
o .. ~. 4ð9
I OISPeNSER CONTAJNJ.ENT
I OA TI! INST ALJ.fO 40ð
¡ ft{¡
!
o 1. FlOAT ~ THAT SHUTS OR SHf!AA VAlvt!
o 2. COHT1NUOIJS ~ PAN SÐðOR . AUO/8U! N«J VISUAL ALAAMS
'pst 3. CONTNJOUS ~ PAN SfHSOA :äIIH AUTO SHUT OFF FOR OISPENSER 'AUOIBlE ANO VISUAL. ALAAMS
IX. OWNI!RJOPI!RATOO SIOHAruRI!
IN *I 01 my~.
OATE
ATO
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471 TITLE OF O'fwt¡ENOP€RA TOR
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472
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473 I P«rnIi Aw<Md (kt JocoI_ only)
4741 PerrNè~o.IFor.bølUHOtIYJ 475
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o 8. TAH(RJ:~O
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"'~-'~~'''''''''''-'~.''''''ot~,t''t't-'~ì4~'='I'' ?, ,,,. ,-
, , /tþ~,~.t O.CE ¿~~~~¡:O~~:~~.ERVICES
__:.ÿ.: ._. 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
UNDERGROUND STORAGE TANKS· TANK PAGE 1
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448
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o .. VI>OO~ ZONe
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ðII!NN\AL T A/'.t( TUT1N() 0 911. OTHl!R
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o i. VtSU~(SINOU!W~INVA1JlT~Y)
o 2. CONTINUOUS INT!R3TTTIAl MONlTORlNo
o 3. MANV~ MONITORINO
,.rv.:T~K LIAK
443
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VI. I'PtHO COHI'mUCT1OH ra..œ ~ INt ~
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CITY OF BAKERSFIELD
. Of'¡r1C1 0' !NVIRONMENTAL SERVlGa
. 1715 Chest., A.,.., Bak'''''''d, CA 93301 (1SeWJ-3'79
SYSTEM T"YP1; 18' I. ~ESSUR!! 0 2. SUCTION 0 J. GRAVITY .54 0 I. ~ESSURE
CONSTRUCTiON/'O I. SINGle WALL 0 J. LINED TRENCH 0 99. OTHeR 4ðO 0 I. SiNGlE WALL
MANUFAC1"URER~~ 2. OOUBti! WALL 0 \ IS. U~ 0 2. DOUBtE WALL
I MAH.;FACTURI!R ~I MANUFACTURER
: 0 1. I!.AAE STeeL 0 S. FRP CO&.FAT18l! 'M 100% METHANOL 0 1. I!.AAE mEL
: MA TERIAlS ANO : 0 2. STAINU!S3 STeEL 0 7. GALVANIZED 3TUI.. 0 2. STAJNLESS STEEL
' CORROSION ;
I PROTECTION : 0 J. PlAST1C COMPA T18U! WI11i COffl'£HT3 O~. UNKNO'MI 0 J. PlASTIC COMPA TlBLE 'MTH CONTENTS
:J2' .. F/eERGlASS 0 I. FU!XJ8U! (to'E 090. OT>iER 0 .. FIB€RGlASS
: 0 S. STEEL WI COA TIN() 0 ,. CA THOOIC PROTECTION oCð4 0 S. STEEL WI COATING
VI. PIPING LUX DETEC1lON (Ch«Ic ~ fIIM~)
o 1. Fl.OAT MI!CHAMSM THAT SHVT3 OFP ~ VALV1!
o 2. COHT1NUOUS ~ PAH ~ . AUOC8U! AKJ VISUAL ALVWS
~. CON'TINUOUS ~ PAH ~:i4W AUTO ~UT OFF FOR OISPENSER . AUDIBLE ANO VISUAL ALARMS
IX. OWN!!RIOP!RATOR SIONATURJ!
MIIrJtny~.
m I PwmJC ~ lFoI iXM..... orIy)
0~CF (7m) S:\CUPAFORMS\SWRc8-8.'IY1'C
UNOERGRQUNO PlPlNO
¡ , ~
PRESSURIZEO PlPINO (Ch«i;., INt.wyJ:
1& I. ELECTROHIC LH: l.EAK OET!!CTOA 3.0 OPH TEST :txm1 AUTO PI..U> SH.iT OFF FOR
!..EM SYSTEM FAA.UR!!. AKJ SYSTëM 0CSC0NNECT10H . AUOI8l.E ÞHJ VISUAL
ALAAMS
o 2. MONTHlY 0.2 OPH T!ST
o 3. AJoIH,JI.L ~ TEST (0.1 OPH)
CONV1:NT1ONAl SUC'TJON SYSTÐAS:
o 5. OM.. Y VISUAL UONrTORJNO OF P\.JU>'HQ SYSTEM + TReHAL. PIP1HO HT"EOOITY
TEST (0.1 GPH)
I
Ii SAF¡: SUCTION SYSTEMS (NO VAL YES IN BElOW OAOUNO P/P!NG):
o 7. SElF MONrTQRJNG
I GRAVITY FLOW:
o ,. 8JÐH.tJ.. ffTEGRm' TEST (0.1 OPH)
Sl!COfCWtIl. Y COHT AJNI!D P1PIHQ
PRESStJRIZEO PP1NO (Ch«Jc ., INl~):
10. CONmAJQUS ~ SUMP SENSOR:oD11 AUOI6l.E JH) V1SUAL AlAAMS ÞHJ
(CNdc ~)
.~ ~ AUTO PUMP SHUT OFF 'M-ÆH A L.eAI< OCCURS
,Ç!( o. AUTO PU"" SHUT OFF FOR ~ SYSTEM FAJl.1)Rf JH) SYSTEM
O4SCONt>ECnON
o c:. NO AUTO PUMP SHUT OFF
o 11. Al/'TOMA TIC LINE l.EAK DETECTOR (3.0 OPH TEST) :txm1 FlOW StM OFF OR
RESTRX:T1ON
o 12. ANNUAL INTEGRITY TEST (0.1 GPH)
SUCTIO~VITY SYSTEM:
.£X 1 J. COHTN..()US SUt.IP SENSOR . ALiOIIIU! NÐ VISUAl}UJllJ¡fJ
UlftO!HCY O!HI!AA TOttI OM. y (Ctt«t II ,., IIppIy1
II 0 14. CONTlI'O:)()S SUMP ~ ~ AUTO PUMP SWT OFF. AUOIBl.! ÞHJ
10 15. :::: l.EAK DETECTOR (3.0 GPH TE~ ~ FlOW SHUT OFF OR
, RESTRICTION
f 0 1 ð. ANNUAL INTEGRIiY TEST (0.1 OPH
i 0 17. OA/LYVlSUAlCHECK
I I
I
I
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';"" .;, ~'.;":; .."ì;1 1!:rS-':.·¡·.t.·o.;:-_~-.-:-,.. '."-:- ",,:.0.:" :';
o 2. SUCTION
o 95. UNI<NOWN
o 99. OTHeR
o J. GRAVITY
o e. FRP COMPATI8U! W".OO1Io ~
01. GAl.VAHIZEOSTt!EL ii .,~,.~'-:
o .. FlÐCI8lE (IØ'E) .. 0 98. . OntER
o i. CATHOOICPROTECTION
D~. UNKNO'Mf
.
·r'::
..
PRESSURIZEO PIPING (CMcJr ., INt ~): : '.
o I. ELECTRONIC LN: LEAK DETECTOR 3.0 OPH TEST mntAUTO P\JW SHUT OFF FOR LEA¡r
SYST'EM FAa.URE. ÞHJ SYS1"EM 0CSC0HNECT10H + AI.IOI8U! NÐ VISUAl ~
o 2. MONnil Y 0.2 GPH TEST
o 3. NHJAL IHreGAtTY ~ (0.1 OPH)
o 4. 0AJl Y V\SUAL CHECK
CONVEHTlONAL. SUCTION SYSTEMS (Chedl .. INl."çJly):
o 5. OM. Y VISUAL MONITORING OF PIPING NÐ PUMPING SYSTÐI
o ð. TRJENNW. IHTEGRrTY TEST (0.1 GPH)
SAFE SUCTIOH SYSTEMS (NO VALVES IN BelOW GROUND PIPING):
o 7. SElF I.4ONrTORlNG
GRAVITY FLOW (CMcJr" IfYt ~):
o S. CAlLY VISUAl MONITORING
o i. 8IENN1AL MEORrTY TEST (0.1 GPH)
SECONOARIl. Y COHTAmED PIPINQ
PRESSURIZE[) P1P1NO (Ch«Jr ~ INt ~):
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o II. AUTO PU~ SHUT OFF FOR LEAKS. SYSTEM FAa.UÆ AKJ SYSTEM D scONNECTIO~
o c:. NO AUTO PU~ SHIJT OFF
o I I. AUTOMATIC LEAK OETECTOR
o 12. ANNUAl.. INTEGRrTY TEST (0. I GPH)
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o 1 J. CONTlMJOUS SUf.IP SENSOR . AOOI8U! NÐ VISUAl ALAP.US
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o i. VtaUAl (SINOt.! WAll. IN VAIJl TOM. Y)
o Z. COHTlNUOUS INT!R3TIT\Al. MONlTO'ÜNO
o 3. MANUAl. MONITOAINQ
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CITY OF BAKERSFIELD
.. 0fI'1C1 0' !NVIRONMENTAL SERVIC~_
_1715 Chester Ave., Bake"tleld, CA 93301 (1S81~t1t
UNOEROROUNO PIPING
'^ I'I'tNO CON'~UCT1OH (Ot.å ., tN, .wn
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SYSTEM TY"€ !8' I. PRESSURt! 0 2. SUCTION 0 1. OAAVITY .5t 0 I. PRESSURE
CONSTRUCTiON!'O I. siNGle WALL 0 1. LINEO TRfHCH 099. OTHER ~ 0 I. SiNGlE WAll
MANUFACTURER~t!5t 2. COU (.! WAll O~. UNKNOWN 0 2. DOUBle WAll
I MANUFACTURER 481 MANUFACTURER
¡ ,0 I.BAAE STEEL 0 S. FR?CO"'AT18l!'M 100"UETHN~l 0 t. BAAE STEEL
: MATERIAlS ANO '0 2. STAII'.U!~ STEEL 0 1. GALVANIZED ma 0 2. STAINLESS STEEL
I CORROSiON ;
I PROTECTiON :0 3. I'tAST1C COMPAT18U! WITH CON1CNTS O~. UNKNOWN 0 3. PlASTIC COMPATIBLE 'NITH CONTENTS
:~ .. FlIlERGlAS3 0 a. FU!XI8U! (HOPE) 0 99. OTHER 0 .. FIBERGlASS
:0 5. STEELWfCOATlNG 09. CATHOOICPAOTECTJON ~ 0 S. STEELwfCOATING
VI. PP1NQ LUK DETECTION (CMdt., ffl.UppIy)
UNO£RGROUNO PIPING
PRESSURIZED PIPING (CMcJt AI IN, ~):
Pi 1. ELECTROMC UNE lEAK OETEC'TOA 3.0 GPti TEST ïxm1..urO P\.U' SHUT OFF FOR
LEAl<. SYSTEM FAJlURf:, ÞHJ SYSTEM DCSCOHNECTX)N · AUOØ.J! ÞHJ vtSUAL
AL.ARM5
o 2. MOHTa. Y O.l GPH TEST
o 3. ANNUAL M'EGRITY TEST (0. I 0f'H)
CONlÆNT1ONAi.. SUCTION SYSTEMS:
. 0 S. OM. Y VISUAl. LIONITORING OF P\AIPIN(] SYSTEM · TRÐHAl PI>ING HTEGRrTY
TEST (0.1 GPH)
I
i SAF¡: SUCTION SYS'T'EMS (~VAlVES IN 8aOW OROUNO P1PN>):
! 0 7. SElF MONITORJNG
I GRAVITY FlOW:
o SI. BIÐ-NAl flT'E<>R!TY TEST (0.1 GPH)
I
I
Si!C~ Y COHTAINI!O PII'IHQ
ffiESSURIZED P'PIHQ (CNck AllNt apply):
to. CONTlMJOUS TUR8IfoE SUMP SENSOR ÏIfi11 AUOI8LE }K) V1SUAI. A1ARMS ÞH:i
(CMdt croe)
j& a. AUTO PUI,f> SHUT OFF 'MiEN A LE.AK OCCURS
~ Þ. AUTO PUIoP SHUT OFF FOR LEM.S. SYSTEM FAJlI.JRe}K) SYSTEM
OISCO/'4'IECT1ON
o Co ~ AUTO PUMP $HUT OFF
o t ,. AUTOUA TIC LNE lEAK DETECTOR (3.0 GPti TEST) ÏIID1 Fl(1N SHUT OFF OR
RfSTRX:TION
o t 2. ANNIJAJ. IHTEGRfTY TEST (0.1 GPH)
SUCTIO~VITY SYSTEM:
.PI 13. CONTN.XXIS SlJ9A> SENSOR . AIJOI8U! ÞHJ VISlW. ÞUtOIIS
vœtOl!HCY OeHeAATOftI OM. Y (Ch«* ., ,. '"""
o 1.. CONTIMJOUS SUMP SENSOR ~ AUTO I"UMP StM OFF. AUOIÐU! AKJ
VISUAl ALARMS .
o 1$. AUTOMATIC UNE LéAK OETECTOR (3.0 OPH TEST) ïxmJQ!JI FV:JW $HUT OFF OR
RESTRICTION
Old. ANNUAl INTEGRITY TEST (0. I GPH)
o 1 7. DAI~ '( VISUAl.. CHECK
o 2. SUCTION
o 95. UNI<NOWN
o 99. OTH~
.
o ,. OAAVITY ,. _,
o a. FRP COWATlIIU! W/lOO'!I. r.EniAHOl
o 1. GALVANIZED STEEL: . , .-,
o a. F1.ÐC18l.E (HOPe) O~. o'THÎ!R
o 9. CATHOOICPROTECTION
O~. UNI<NCMfl ! I
·
48S
~'-' .
4.
PRESSURIZED PIPING (Ch«Jc AI tN'~): ., ¡
o 1. ELECTRONIC LINE LéAK 0ETëCT'OA 3.0 GPti TEST ÏI1Il1 AUTO P\Jr.tP SHUT OFF FOR lEAl<
SYSTEU FAJlUR!. NÐ SYSTEM DISCONECTIOH . AUCI8U! NÐ VISlW. AI.AÀMS
o 2. MOHTHl Y 0.2 QPH TEST
o 3. NHJAL IHTEGMY TUT (0.1 QPH)
o 4. DAJl Y V'SlIAl CHECK
,;,-
CONl/ENTlONAI. SUCT10H SYSTEMS (CItedl.. ".t apply):
o S. OM. Y VISUAl.. MONrTORING OF PIPN) NC) PIJY'ING SYSTÐI
o S. TRJENNIAI. IHTEGRITY TEST (0.1 GPH)
SAFE SUCT10H SYSTEMS (NO VAl YES .. Ba.OW GROONO PIPING):
o 1. SélF MONITORING
.'
. >
GRAVITY FlOW (CMck AI tN' 1IJPIy):
o a. [)AJl Y VISUAl.. MONITORING
o 9. 8IENNIAL INTEGRITY TEST (0.1 GPH)
SI!CONDAItIt. Y CONTAINED PIPtNQ
PRESSURIZED PIPING (CMck AI IN, ~):
10. CONTIMJOUS TURBINE SUMP SEHSOR mItt AUOI8lEÞH:i ~ A1ARMS AND (d-k ~
o a. AUTO PUMP SHIJT OFF 'MiEN A I.EAX OCCURS
o Þ. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURe ÞH:i SYSTEM OISCONNECTlO"
o Co ~ AUTO PUMP SHUT OFF
o t 1. AUTO"" TIC L£IJ< DETECTOR
o 12. ANNUAL INTEGRITY TEST (0. I GPti)
"
SUCT1QWGAAVITY SYSTEM:
o 13. COh'TNJOUS SUr.tP SENSOR . AUOI8t.E NC) VISUAL ÞUS!US
EM!RO!HeY 0 I!HI!RA TOftI OM. y (Chedr .. rIM I/IP')')
o 1.. COIffiNUOOS SUMP SENSOR WITHOUT AUTO PUr.tP SHUT OFF . AUOI8li: AKJ VISUAL .
~ ' .
o 1 $. AUTOMATIC liNE LEAK O€TECTOR (3.0 GPti TEST)
.: "
Old. ANNUAl INTEGRITY TEST (0.1 GPH)
o 17. DAll,( VISUAl CHECK
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o .... [)AJl Y VISUAL CHI!CK 1
o S. TR!NCH UNER I MONtTOAØJ
o a. NON!! 4ðG
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OA TE INST Azt~l ~
o I. FI.OAT~THAT~Of'P~VAlII!!
o 2. COHT1NUOUS ~ p~ S&.soA . AUOaIU! I>H) VISUAl ~
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CITY OF BAKERSFIELD
o.e OF ENVIRONMENTAL ~VICES
1715 Chester Ave., Bakersfield, ~ 93301
(661) 326-3979
UNDERGROUND STORAGE TANKS . INSTALLATION
CERTIFICATE OF COMPLIANCE
..._--. ---.- ----- . .-.---.
..----.--.---
One form per tank
Pege J... 01 ï
--- ....-----------...---.--.------.
I, FACILITY IDENTIFICATION
--....--..---- .--- - ... .. -.... .. -..
.... ....... -- ..... ----..---
BUSINESS NAME (S- as FAëii.iTY NAME fI' 08A . DoIng euu.. AI)
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FA~~' rTII.lLLLLLLl ~.
---_._--- -
.. - .. -.----- ------
th \
\.:i N\_Æ(~C~
--------.--. --.---
II. INSTALLATION
Check BlI that apply
.
B The Installer has been certffled by the tank and piping manufacturers.
o The installation has been inspect~ and certified by a registered professional engineer.
JrJt The Installation has been Inspected and approved by the. City of Bakersfield Office of Environmental Services,
~ All work listed on the manufacturer's installation checklist has been completed,
ðØ The installation contractor has been certified or licensed by the Contractors State License Board,
o Another method was used as allowed by the City of Bakersfield Office of Environmental Services.
Identify method:
III. TANK OWNER/AGENT SIGNATURE
I c;ettIty INIItIe iM)nN1Ioft ptOYiIMd
I SIGNA ruRe ÕF i ANIÙ¡WÑÊÃlAGë-
.. .... -------:¡¡:¡---
._---~
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. ~ .
CITY OF BAKERSFIELD
OFtÞcE OF ENVIRONMENTAL ~VICES
1715 Chester Ave., Bakersfield, ~A 93301
(661) 326-3979
. 3:~;'~111f":~
;',; .
~~.j.
UNDERGROUND STORAGE TANKS . INSTALLATION
CERTIFICATE OF COMPLIANCE
...--..--..---...-.. .-...----.
..----.-- ._----
One form per tank
_u_ _.____________...___._ .____. Page. ..2- of "2
I. FACILITY IDENTIFICATION
BUSINESS AAME (SMne as FAëiüTY NAMe 01 OØA . DoIng ~ AI)
FA7'7S' rrUIIllìln'f '>Ir;;¡¡¡¡-;-õ~ 2-
.---.--..- .--- - -. .. ...... .. ..
- . .-.... -. .-- ...------
~. --.--... -
.. - .. ..._---- ----..-,
f\.-\ '(~¥.c..cl <.
..-.-----.--- --.---
II, INSTALLATION
..
Check 8/1 that apply
~ . The Installer has been certlfled by the tank and piping manufacturers.
o The installation has been inspec4Ad and certified by a registered professional engineer.
.
~ The Installation has been Inspocted and approved by the City of Bakersfield OffIce of Environmental Services,
~ All work listed on the manufacturer's Installation checklist has been completed.
¡:¡¡r The installation contractor has been certlfled or licensed by the Contractors State License Board.
o Another method was used as allowed by the City of Bakersfield Office of Environmental Services.
Identify method:
III. TANK OWNER/AGENT SIGNATURE
I uttHy ItuII It>e inJonNlIon pt'OYIded 1'IereIn~1Ne & 10 It>e bM cI "'1 knowIedoe
šÏGNAruRe õi: TANK-···· . '-GËÑT-' ----- -.------ - ---TõATË
'-c-Ø =1 Ll'"" 2S--00
------.-.- -- ..-- ._._.~ .--.-.------.-.-.-.--- -. .-- .-.
NAME 0,. TANK RiAGI!NT (prinI) 445 TITle Of' TANK OWNER/AGENT
_ .._~.:_... ...~. . ~~":'__ V-o·_\~ ~_.-_-----. ____.___..\) r .i:~~ \If':,_~._._.-º.ð__...... _..__
--------.--- - .-.._~--..
. . - . ... ----:¡:¡:¡---
._._-~
'omIC
CITY OF BAKERSFIELD
OFfttE OF ENVIRONMENTAL SiiVICES
1715 Chester Ave., Bakersfield, ~ 93301
(661) 326-3979
-_._--_.__...~.._---_... .. ........
.......... -....-----..--..
I
I
,I
I
¡
¡
UNDERGROUND STORAGE TANKS . INSTALLATION
CERTIFICATE OF COMPLIANCE
One form per tank
p.~ of
..-------.-----
--... --------------...---.- .-..--.-..
..-..-.. ---.- --.--. .-.-----..
I, FACILITY IDENTIFICATION
BüšiÑËss ÑAMe (S- IS FAÕI.ITY ÑÃMe 01 06A. 00Ir<Q s...u- AI)
~"'n~
FACIUTY ,o,--r:-II: r~'
7íl) !!.L I . il °3
-...--.---' -
..- .. ......-.....----..-..
V,e \i\^_\ .....~
.-------.--- ----.._.....-
:
1I,INSTALLATlON
Chðck all that apply
..tBI The Installer has been certffled by the tank and piping manufacturers.
o The installation has been inspecf~ and certified by a registered professional engineer.
.
]i( The Installation has been Inspocted and approved by the City of Bakersfield OffIce of Environmental Services,
eq All work listed on the manufacturer's Installation checklist has been completed.
Cï1 The installation contractor has been certlfled or licensed by the Contractors State License Board.
o Another method was used as allowed by the City of Bakersfield Office of Environmental Services.
Identify method:
Ill. TANK OWNER/AGENT SIGNATURE
I c:e<tIfy !t\alll"l inJo"".o1Ion ~ hetWIn Ie true & ~ b
šiGÑAri)Ãeõi: TANx--"--' AGeN'f-' ------ ------- - ---TõAfe ----- -----.-- n.._"· . . - -. ..----:¡¡¡-
-;W.<eo"....- ,..;.::,- . -1 mi.... ,m<~:'.::;~~-- ---- - -- -- --...
__ __,_ _ __ : :Jo\''''__ v-,~_\, ~_____~__ __uu __\J r _1:""", \, >c_ ~__.Qf?--- ___-
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CITY OF BAKERSFIELD
O.E OF ENVIRONMENTAL ~VICES
1715 Chester Ave., Bakersfield, ~ 93301
(661) 326-3979
. ...............,.. u-,,>
." ' ..:..,
I
UNDERGROUND STORAGE TANKS . INSTALLATION
CERTIFICATE OF COMPLIANCE
...__..__0.______·· ._._____
..----.-- ._----
One form per tank
__._ _._.__________...___.. .____. PIQe. .::í of :::!.
I, FACILITY IDENTIFICATION
. 8USINešSÑ.we (SAme as FAëilITY NAM!! 01 08A . [)o ng auu- AI)
:cifl:ill:J '-7';
FACIUTYIO'/TII I ~. JI
77') ;...L I . -= t..\
------.----. .---- - -. ... ..... .. ... .... -..... -. ..- -------.
--.--.--..- .. - .. ..._---. ------.
\) \ c: :?~l
--------.--- -----.
1I,INSTALLATlON
CMck 811 that apply
..£!9 The Installer has been certified by the tank and piping manufacturers.
o The installation has been ins~+'Kf and certified by a registered professional engineer.
.
~ The Installation has been Inspocted and approved by the City of Bakersfield OffIce of Environmental Services.
~ All work listed on the manufacturer's Installation checklist has been completed.
~ The installation contractor has been certJfled or licensed by the Contractors State License Board.
o Another method was used as allowed by the City of Bakersfield Office of Environmental Services.
Identify method:
III. TANK OWNER/AGENT SIGNATURE
'-"~.._......_._~.,-
SIGÑAruRe ÕF TANK' n... -¡:----. ------ ..----- - ---TõAfe ----- ----.-. - - -_..- - -- -
£A- =1 Ll- 2t)-OO
------.-.- --. -.----.-. .-- -----....... --.-.------.-...-.---. -- .-. .-.
NAMe 0,. TANK AGI!NT (prinI) .~ T11le Of' TANK OWNERJAGENT
_ ..__.J._.._ _. .../. ~~~__ V-(Y._~_.________ ____ ._n..\) r .~~~ \, ":-_<;._._.~___.......__
. ._...._--~
._._-~
'CIIftIC
CITY OF BAKERSFIELD
O$E OF ENVIRONMENTAL ~VICES
1715 Chester Ave., Bakersfield, ~A 93301
(661) 326-3979
r-7~~~"~T;'¡ :. ; -:-'
UNDERGROUND STORAGE TANKS . INSTALLATION
CERTIFICATE OF COMPLIANCE
One form per,tank
PIge '5""' oi
...--.. --..- .-.--. .-.-----...
..----.-- ._----
--.", .-----...-------...--...- .-------
2.
I. FACILITY IDENTIFICATION
__.___0__._._---- _. ... ....... ...
.. .. ....... -- ...- .."'--.--...
BUSINESS ÑAME (SMne IS FAcn.iTYÑÃMe Of 08A. 00ir'Q 8'*- A.)
, ~ -
:c:ÏîÌJ.Ìo T7 "
FACI-T1I~'lTII ¡ Fó' ~ 5.
..--.---. -
.. - .. ....--..... -----_.
1J1\J~E:~D
--______0_.- _____.....
II,INSTALLATJON
:
CMck all that apply
.2J The Installer has been certtfled by the tank and piping manufacturers.
o The installation has been Insp0c4Ad and certified by a registered professional engineer.
.
~ The Installation has been Inspocted and approved by the City of Bakersfield OffIce of Environmental Services..
~ All work listed on the manufacturer's Installation checklist has been completed.
!5l' The installation contractor has been certlfled or licensed by the Contractors State LIcense Board,
o Another method was used as allowed by the City of Bakersfield Office of Environmental Services.
Identify method:
Ill. TANK OWNER/AGENT SIGNATURE
I certify INt It>e in.IotrNIdoft prooAdec IIetwIn Ia !rUe & IOCUI1ICe 10, It>e IMtI 01 my ~
,,,,,,,ruÃ, ãd",,-- --- AG-"'-- --~------- - ---,,,,, ---- -~--- - -. -- u. -
-¡¡¡¡¡.ö,,""- -.- ;G¡¡¡¡-_I----~mi' ""'¡¡¡¡-~~~G~:'~-----·- -- u. ---
___.__ ._. . :Jõl,,":'__ \L{':.\, '1-------.--1.------\) f'..G:",,,,,, \. "'_<__..2I?__
. . - . ..----:¡¡¡-
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'-.
CITY OF BAKERSFIELD
O~E OF ENVIRONMENTAL ~VICES
17f!' Chester Ave., Bakersfield, ~ 93301
(661) 326-3979
-- ¡ ~f-T';~r~,"!~/;¡ ':t~
: ~, . ~
UNDERGROUND STORAGE TANKS . INSTALLATION
CERTIFICATE OF COMPLIANCE
-....-.. ---.- .-...-. .-.----.
..----.-- .-----
One form per tank
p. 6- 01 '7
__._ _._.__.....______a...._...._ .____.._.
I. FACILITY IDENTIFICATION
--.----.--.......-----. ... ....... ..
- . ...... -. ... --__._ _. i
. 8uslNešSÑ.t.Me (SMne as FAëit.rfY NAMt! Of 08A . 00r0Q ~ AI)
~ -
:c.ïJÌTITI 7ì."
FACIUTYIO·--r-:U-: r' b
7Î') I! ¡I· -:4:þ
, -
.. --.--.. -
.. - ..... ..-.-. -----_.
't) r- e J/'^~ \J ¡,\.-
--------.-.- ----...--..-
II, INSTALLATION
:
ChfIck all that apply
ÆJ The Installer has been certffled by the tank and piping manufacturers.
o The installation has been inspecfAd and certified by a registered professional engineer.
.
~ The Installation has been Ins~ed and approved by the City of Bakersfield OffIce of Environmental Services.
.eQ All work listed on the manufacturer's Installation checklist has been completed.
~ The installation contractor has been certified or licensed by the Contractors State License Board.
o Another method was used as allowed by the City of Bakersfield Office of Environmental Services.
Identify method:
Ill. TANK OWNER/AGENT SIGNATURE
I c.rtJfy INt IN i'IIonNlIon ~ herein " INe & ac:co..nW 10 IN bat 01 my ~
,,,,,,,,;JR' "i"",;;;;"",,-¡¡¡- --- ~----- - ---,"'iE ----- ~--.--- - ---- --- -
4"- ¥?: =1 Ll~ 2.5""-00
-iW4ëoI'TÅÑiC '.. - ËÑT(ptInC -' . - ~ me OF r;v¡j(ëSWNERiAãËÑT--'-'-' -.--- ... - - .-.
_ ..__..._m'. ._. ._c~~__ ¥-{~\~ ~_.-_--_.-. ____ ___..\J P ..k~~ \, 1v_<:._._...9l?__..
. ._._._--~
._._--~
.........--
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." ........~~.,...
CITY OF BAKERSFIELD
o.e OF ENVIRONMENTAL .VICES
1715 Chester Ave., Bakersfield, ~ 93301
(661) 326-3979
.. ..'~;¡;J ~""11"1"'¡' #"
. "'·'f';'¡r.¡:';;:,!,~" I
.', ¡i. ·~·-\~:i-;r\·;"¡ ,if~;:'
"'... '.' .
UNDERGROUND STORAGE TANKS ,INSTALLATION
CERTIFICATE OF COMPLIANCE
-.__·___0'- ._....... .______.
..-------.-----
One form per tank
__._ ..____________....__._ ._____ Pege. ::z.. of "2
J. FACILITY IDENTIFICATION
BuslNeššÑAMe (SMne II FAëiLiTY NAMe 01' OOA . DoiroQ auu-a AI)
:cIJÌill:J T1':;
FAc77~'lTII ¡ rò,
--...--.--..... ---- - -. .. ..... .. ..
.. . -..... -. ...- ...--.---...
.....-.---. -
... .. ..·.._4_...____.._..
~7
~.L~~ e. \
..-..----.-.-
----....
1I,INSTAlLATlON
Chock all that apply
j'g} The Installer has been certtfled by the tank and piping manufacturers.
o The installatJon has been ins~Ad and certified by a registered professional engineer.
.
]ït The Installation has been Inspected and approved by the City of Bakersfield Office of Environmental Services.'
.eq All work listed on the manufacturer's Installation checklist has been completed.
rs;g The installation contractor has been cert1fled or licensed by the Contractors State License Board.
o Another method was used as allowed by the City of Bakersfield Office of Environmental Services.
Identify method:
Ill. TANK OWNER/AGENT SIGNATURE
I CMtJfy INt Ihe ~110<1 ~ '-win" INe .. aocurwCe 10 Ihe _ 01 "'Y ~
SIGNArUR'ÈÕi: TANKöWÑÈri.iAë;ËÑT-· -------.------ - ---TõAiE ----- ---.---- _m - -- . . . -. -----~
.....ö"ÀiiKO';;¡~.<Gi"'i.... -·-· _.~- -.~Jiñi.'Õ> ,=~~:-~~.- -.-.-.. .... .-. . u --.,.
..___ .. ::Jc,\.-"'__ \L{':.\' ~~--_--.--I.-.- ___\J f'..G:""" \, ~_ <._.2Ï?.u .__
,
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~
.
-
-
BAKERSFIELD
FIRE DEPARTMENT
ENVIRONMENTAL SERVICES
1715 Chester Ave, · Bakersfield, CA 93301
Business Phone (661) 326-3979 · FAX (661) 326-0576
FAX Transmittal
TO: Ç(-t-f¿( S ßUI26C./L
COMPANY: ¡.(<-6rJ cs-.. A:-L--
FAX No. ~ 'Z..~ 0 4- ('i!
FROM: ~ W,,v:=s
COMMENTS: :3 tp~ <1"ö Fô-L LùL-J
~E "f1.!.tS p..':) Dl2.BS8 ~Q. C-u C~T 's c~u::...vV s: _
\
.
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-D576
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
fa
--
May 19,2000
Wennilyn Fua, Technical Reviewer
UST Cleanup Fund Program
State Water Resources Control Board
P.O. Box 944212
Sacramento, CA 94244-2120
RE:
Claim No 014194
Fastrip Store #19 at 4901 S. Union Avenue, Bakersfield, CA
Dear Ms. Fua:
I have been contacted by the claimant and asked to explain that the corrective
action work of overexcavation was performed under the direct oversight and
approval of this office.
The overexcavation was performed on a qualitative basis during the several day
window of opportunity between removal of the old and installation of the new
UST's. I personally verbally approved and visually witnessed the
overexcavation.
Confirmation sampling, also conducted under my supervision, verified the
overexcavation as successfully removing the contaminated soil prior to the
reinstallation of the new UST's.
By allowing Fastrip to proceed with their Registered Engineer's proposal to
overexcavate "on the fly" prior to reinstalling the new UST's, this office
effectively saved the claimant, and ultimately the Cleanup Fund, the potentially
more costly alternative of performing a full site assessment after the excavation
had been filled.
Please approve the claimant's reimbursement on this basis. Thank you.
Sincerely,
4b-fd W~_~
Howard H. Wines, III
Hazardous Materials Specialist
Office of Environmental Services
cc: C. Burger, Klein, et al
B. Busacca, Jamieson Hill
""Y~ de W~.97op ~0Pe y~ A We/lh/?'"
.- .UŒRSFIELD FIRE DEPAR~·:.
ENVIRONMBHTAL SERVICES
1715 Chester Ave.,
Bakersfield, CA 93301
(805) 326-3979
TAHK REMOVAL INSPECTION FORM
FACILITY FA~""'RI\.c> ADDRESS J.¡C) 191 <\. UV\ '~bt'\ i C)d~
OWNER ":S'A~ 't:?ï Ct"). PERMIT TO OPERATE'
CONTRACTOR Cl\I~: CONTACT PERSON .I...¡c\IZ~
LABORATORY srnc # OF SAMPLES
TEST METHODOLOGY ~"" ßhH;:- ..
PRELIMANARY ASSESSMENT CO. ;"Ç'~ CONTACT PERSON
CO2 RECIEPT ,/" LEL% 0
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CONDITION OF TANKS 1. ~1 ~. ~j 0. ~ ~ ) All 114....</::..<. ),J<.e. ,..ec..J
CONDITION OF PIPING
CONDITION OF.SOIL ~t>(Y\f'(." ~m~llu( <!' ~l' tJ....A
COMMENTS 7f,,~ -1. ~t" ¡; c:.t\""'~\O>'7 ~\AJ"QV\ ..~\-. nÇ ~ '1 ,;]1/ ..e,.p-\... ~ ...\:~rn ~ q,
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INSPECTORS NAME
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SIGNATURE
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RECORD OP TELEPHONE CONVERSATION
Location: 4 ora f ~. U"'-'V-^--
Business Name: h') -I.tt.p
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Contact Name:
Business Phone:
InspeCtor's Name:
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FAX:
Time of Call: Date: t ~ ç>- q {:; Time: I ç ~ ~C) # Min:
Type of Call: Incoming [~
Outgoing [ ]
Retumed [ ]
Content of Call: Wt:..Þ\.-ffJ. ~ O\Iqe.-)(C~v'...·.J·e.- /.... ~.r~ðt... w 4.R...{'-e....
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Actions Required: CJ..·a:.-ka£ wi M~Jk...Tt..>/('- 4 h~ s;;:;J ,+ (óalc-s
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Time Required to Complete Activity # Mln: :) 0
~
Winston H. Hickox.
Secretary for
Environmental
Protection
Division of Clean Water Programs
·2014 T Street' Sacramento, California 95814.' (916) 227-4411
Mailing Address: P.O. Box 944212, Sacramento, California' 94244-2120
FAX (916) 227-4530.' Internet Address: http://www.swrcb.ca.gov/-cwphorne/ustcf
,1
s
State~ter Resources·Contr.Board
...
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Gray Qavis
Governor
C·(Ò:-f
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Brian Busacca
Jámieson-HiIlCo.
POBox 82515
Bakersfield, CA 93380-2515 .'
-.-
,-
UNDERGROUND STORAGE TANK CLEANUP FUND, CLAIM NO. 014194, FOR SITE
ADDRESS: 4901 UNION AVE S, BAKþRSFIELD
. TneState Water Reso.urces 'Control Boàrd (State Board) is able to issÜe, pUrsuãllt to äpplíc'able'
regulations, the enclosed Letter of Commitment (LOC) in an amount not to exceed $15,000.
This LOC is based upon our review of the corrective action costs you reported to have incurred
to date. The LOC may be modified by the State Board.
It is very important that you read the terms and conditions listed in the enclosed LOC. Claims
filed with the Underground Storage Tank Cleanup Fund far. exceed the funding available and it is
very important that you make use of the funding thathas been committed to your cleanup in a
timely manner.
110_
Y 011 are reminded that you must comply with all regulatory agency time schedules and
requirements an~you must ob~ain ti1!ee bid~ for 8J.1Y required corrective action. Only corrective
action costs requiredby.the regulatory agency to protect human health, safety and the
. environment can be claimed for reimbursement. Unless waived in writing, you are required to
obtain preapproval of costs for all future corrective action work (form enclosed), If you
have any questions on obtaining preapproval of your costs or the three bid requirement, please
call Wennilyn Fua, our Technical Reviewer assigned to claims in your Region, at (916) 227-
4518. Failure to obtain pre approval of your future costs may result in the costs not being
reimbursed.
The following documents needed to submit your reimbursement request are enclosed:
"Reimbursement Request Instnictions" package. Retain this package for future
reimbursement requests. These instructions must be followed when seeking reimbursemept for
corrective action costs incurred after January 1, 1988. Included in the instruction package are
samples of completed reimbursement request forms and spreadsheets.
. .
"Bid Summary Sheet" to list information on bids received which must be completed and
returned. . .
"Reimbursement Request" forms which you must use to request reimbursement of costs
incurred.
CalifornÍa EnvÍronmental ProtectÍon Agency
Iro
~~ Recycled Paper
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Jamieson-Hill Co;
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"Spreadsheet" forms which you must use in conjunction with your reimbursement request.
. .
* THIS IS IMPORTANT TO YOU. PLEASE NOTE:
You have 90 calendar days from the dàte of this letter to subp1Ìt your first reimbursement request
for incurred corrective action costs. NO EXTENSIONS CAN BE GRANTED. If you fail to
do so, your LOC funds will àutomatically be reduced to zero (deobligated). Once this occurs,
any future funds for this site are subject to availability when you submit your first reimbursement
request. We continuously review the status of all active claims. You mùst continue to remain in
compliance and submit a reimbursement request every 6 months. Failure to do so will result in
the Fund taking steps to withdraw your LOC;;:.
I ,_ If you have any.questiçms r.egarding the enclosed documents, please contact Jesus Genera at
(916) 227-4514.
/ W~
Dave De~ner anager - 11::r\
UST Cleanup Fund proJ£.;;;
Enclosures
cc: Mr. John Noonan
RWQCB, Reg. 5 - Fresno
3614 E. Ashlan Ave.
Fresno, CA 93726
Mr. Howard Wines
City of Bakersfield Fire Dept.
1715 Chester Ave, 3 rd Floor
Bakersfield, CA 93301
Caüfornia EnvÍronmental Protection Agency
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FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 'W Streel
Bakersfield, CA 93301
VOICE (805) 326-3941
FAX (805) 395-1349
SUPPRESSION SERVICES
2101 ow Streel
Bakersfield. CA 93301
VOICE (805) 3~941
FAX (805) 395-1349
PREVENTION SERVICES
1715 Chesler Ave.
Bakersfl8ld. CA 93301
VOICE (805) 326-3951
FAX (805) 326-0578
ENVIRONMENTAL SERVICES
1715 Chesler Ave.
Bakersfield, CA 93301
VOICE (805) 326-3979
FAX (805) 326-0576
TRAINING DMSION
5642 Victor Ave.
Bakersfield. CA 93308
VOICE (805) 399-4897
FAX (805) 399-5763
~.-.
.
April 4, 2000
Jaco Oil
Mr. John Kerley
POBox 1807
Bakersfield CA 93303 1807
Dear Mr. Kerley:
You have been identified as the compliance coordinator for the
facility/facilities referenced in the attachment.
The permits to operate this facility/facilities will expire on June 30, 2000.
However, in order for this office to renew your pennit, updated fonns A,
B, & C must be filled out and returned prior to the issuance of a new
permit.
Please make sure that you are sending the updated foqns which are
indicated by the date 7/99 in the lower left hand comer. Please complete
and return to this office by May 15,2000. Failure to comply, will result in
a delay of issuance of your new permit to operate.
Should you have any questions, please feel free to-call me at
661-326-3979.
Sincerely,
siddv
Steve Underwood, Inspector
Office of Environmental Services
SU/dam
attachment
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Facility
Address
Farrells Fastrip
6401 White Lane, Bakersfield, Ca 93309
Fastrip
800' 1 White Lane, Bakersfield, Ca 93309
Fastrip
120'0' Coffee Road, Bakersfield, Ca 93308
F astrip
~Or-S:lJIfiOllAVë1., Bakersfield, Ca 9330'7
Fastrip
2698 Oswell Street, Bakersfield, Ca 9330'6
Fastrip
1640' S. Chester Ave., Bakersfield, Ca 9330'4
Fastrip
80'S 34th Street, Bakersfield, Ca 93301
Fastrip
12851 Rosedale Hwy, Bakersfield, Ca 93312
F astrip
4013 S. "H" Street, Bakersfield, Ca 9330'4
Fastrip
6401 S. "H" Street, Bakersfield, Ca 9330'4
Wholesale Fuels
220'0' E. Bnuidage Ln., Bakersfield, Ca 9330'7
Chris Liquors .
2732 Brundage Ln" Bakersfield, Ca 9330'4
Howards
320'0 Panama Lane, Bakersfield, Ca 93312
Howards
420'1 Belle Terrace, Bakersfield, Ca 9330'9
Howards
330'0 Planz Rd., Bakersfield, Ca 9330'9
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UNDERGROUND STORAGE TANK PERMIT APPLlCATlON,¡,,·FORM'A "". <,;1;:" '4", '
'.~", ,'¡:' " . . . '. ",' COMPLETE~: FORM FOR E~ FAa~~rre.. ",(·,·::/·~:},~ý¿!l;:'~,~/il~;~:~~~·~' ~.
MARK ONLY
ONE ITEM
~1' NEW' PERMIT.,··'
0' 2 IN1ÈRiM PERMIT' ,
0, 3. RENEWAL! PERMIT .
o . 4 AMENDED PERMIT
....
. 0 6 CHANGEOF~INFORMATiöN'¡r{:f¡¡'l~ÆRMANeimY"CLOSÉtUITE'" .
o 8 TEMPORARV'SITE"C..oSÙRE{;~·¡"::::.:,:~~~~.,::;:"',.·' ,¡" .... ;-',,;;.
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I. FACILITYISITE INFORMATION & ADDRESS· (MUST BE COMPLETED)
I ~ 7 .s-- NAME OF OPERATOR·
~. VNIt)~
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D LOCAl-AGENCY D STATE-AGENCY
D COUNTY-AGENCY D FEDERAL-AGENCY
PHONE' WITH AREA CODE
1..3 ~ r-3 3-::;t>ð
IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER· Call (916) 739-2582 if questions arise.
TY(TK) HQ @E]-~
V. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked.
CHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTIFICATIONS AND BILLING: I. 0 II.~ III, 0
,/ BOX
TO INDICATE
D CORPORATION
D INDIVIDUAL
ARTNERSHlP
TYPE OF BUSINESS
1 GAS STATION 0 2 DISTRIBUTOR
D 3 FARM D 4 PROCESSOR D 5 OTHER
EMERGENCY CONTACT PERSON (PRIMARY)
PHONE /I WITH AREA COQF
y. ??g. ?OtJ ()
PHONE /I WITH AREA CODE
¡¡;;:-
CITY NAME
III. TANK OWNER INFORMATION· (MUST BE COMPLETED
NAME OF OWNER . /
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D LOCAL·AGENCY
DISTRICTS
D ,/ IF INDIAN , OF TANKS AT SITE
RESERVATION
OR TRUST LANDS
o COUNTY-AGENCY
D STATE-AGENCY
o FEDERAl-AGENCY
E. P. A.. I. D.' (op/iøIaIJ
EMERGENCY CONTACT PERSON (SECONDARY), optional
DAY . NAME (LAST, FIRST) PHONE /I WITH AREA CODE
AI G5 ,r-.-37) ?ðlJ'C
NIGHTS: NAME (LAST, FIRST) ~N~TH AREA CODE
CARE OF ADDRESS INFORMA nON
,/ box Ii) indicate 0 INDIVIDUAl
D CORPORATION ~ PARTNERSHIP
S~ ZIP:rE330 3
o LOCAl·AGENCY 0 STATE·AGENCY
D COUNTY-AGENCY D FEDERAL-AGENCY
PHONE' WITH AREA CODE
S-~ 37 3-7ððO
CARE OF ADDRESS INFORMATION
-----
,/ box Ii) indicate
PENAL TY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT
COUN7Y #
CD
JURISDICTION #
ITIJ
FACILrTY #
ITIIIIJ
LOCATION CODe - OPTIONAL
I CENSUS TRACT' - OPTIONAL
I SUPVISOR . DISTRICT CODe . OPTIONAL
THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION· FORM B, UNLESS THIS IS A CHANGE OF srre INFORMATION ONLY.
FO RM A (9-90) FOROCXI3A-R2
__ ___u_._ _
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COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM.
STATE OFCAUFORNA
STATE WATER RESOURCES CONTROL BOARD
UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM B'·
....
MARK ONLY
ONE ITEM
~ 1 NEW PERMIT
o 2 INTERIM PERMIT
D 3 RENEWAL PERMIT
D 4 AMENDED PERMIT
D 5 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. MANUFAC11JRED BY: #0.L)&!!iJ2.A.) w G?..L/ " ~ '"
D. TANK CAPACllY IN GALLONS: ;;;)..- 0 c> 0
DBA OR FACILITY NAME WHERE TANK IS INSTALLED:
I. TANK DESCRIPTION
C. DATE INSTALLED (MOIDAYNEAR)
II. TANK CONTENTS
IF A-1 IS MARKED. COMPLETE ITEM C.
;:
3 CHEMICAL PRODUCT
o
o
1 PRODUCT
2 WASTE
o
o
EGULAR
UNLEADED
1b PREMIUM
UNLEADED
2 LEADED
o 3 DIESEL 0 6 AVIATION GAS
o 4 GASAHOL 0 7 METHANOL
o 5 JET FUEL . .
o 99 OTHER (DESCRIBE IN ITEM D. BELOW)
C.A.S..:
A.
MOTOR VEHICLE FUEL
2 PETROLEUM
D 4 OIL
o 80 EMPlY
D 95 UNKNOWN
B.
C.
--
D. IF (A 1) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED
III. TANK CONSTRUCTION
MARK ONE ITEM ONLY IN BOXES A BAND C AND ALL THAT APPLIES IN BOX 0
A. TYPE OF ~1 DOUBLE WALL [J 3 SINGLE WALL WITH EXTERIOR LINER o 95 UNKNOWN I
~ YSTE ~~ ? SINGLE WALL 0 4 SECONDARY CONTAINMENT (VAULTED TANK) o 99 OTHER
-
¡ , 1 BARE STEEL D 2 STAINLESS STEEL LJ 3 FIBERGlASS ~ STEEL CLAD WI FIBERGlASS REINFORCED PlASTIC
B. TANK .----, D 0 o 8 100% METHANOL COMPATIBLE WIFRP
MATERIAL ' , 5 CONCRETE 6 POLYVINYL CHLORIDE 7 ALUMINUM
-
(Primary Tank) , , 9 BRONZE 0 10 GALVANIZED STEEL [J 95 UNKNOWN 0 99 OTHER
I I
¡ 1 RUBBER LINED D 2 ALKYD LINING [J 3 EPOXY LINING 0 4 PHENOLIC LINING
C. INTERIOR - 5 GLASS LINING ~ UNLINED 0 95 UNKNOWN 0 99 OTHER
LINING ---.J
is LINING MATERIAL COMPATIBLE WITH 100'Y. METHANOL? YES - NO -
D, CORROSION ~---..: 1 POLYETHYLENE WRAP 0 2 COATING ~ VINYL WRAP 0 4 FIBERGlASS REINFORCED PLASTIC
PROTECTION Ii 5 CATHODIC PROTECTION 0 91 NONE o 95 UNKNOWN 0 99 OTHER
IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE
A. SYSTEM TYPE A U 1 SUCTION PRESSURE A U 3 GRAVllY A U 99 OTHER
B. CONSTRUCTION A U 95 UNKNOWN
A U 1 SINGLE WALL DOUBLE WALL A U 3 LINED TRENCH
A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3
A U 5 ALUMINUM A U 6 CONCRETE A U 7
A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION
AUTOMATIC LINE LEAK DETECTOR 2 LINE TIGHTNESS TESTING
A U 99 OTHER
C. MATERIAL AND
CORROSION
PROTECTION
------
D. LEAK DETECTION
FIBERGlASS PIPE
8 100% METHANOL COMPATIBLE WIFRP
99 OTHER
o 99 OTHER
V. TANK LEAK DETECTION
I VISUAL CHECK
----: 6 TANK TESTING
2 INVENTORY RECONCILIATION LJ 3 VAPOR MONITORI~ AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING
~INTERSTITIAL MONITORING 0 91 NONE 0 95 UNKNOWN 0 99 OTHER
I 2. ESTIMATED QUANTITY OF
SUBSTANCE REMAINING
3. WAS TANK FillED WITH
INERT MATERIAL?
YES 0 NO~
APPLICANT'S NAME
(PRINTED" SIGNATURE)
..
LOCAL AGENCY USE ONLY THE STATE J.D. NUMBER IS COMPOSED OFTHE FOUR NUMBERS BELOW
STATE 1.0.#
COUNTY #
i i
JURISD!CTION #
¡'-J-
~-- ---
FACILITY #
ITIIIJJ
TANK #
LUlJL[J
I PERMIT EXPIRA TION DATE
I
PERMiT NUMBER
! PERMIT APPROVED BY/DATE
FORM B ,9·gol
THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION· FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED.
FOIIO(X)48-!i4
- .-.--- -+
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COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM.
STATE OFCAURJRNA
STATE WATER RESOURCES CONTROL BOARD
UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM B'
MARK ONLY
ONE ITEM
1 NEW PERMIT
D 2 INTERIM PERMIT
,
o 3 RENEWAl ?ERMIT
o 4 AMENDED PERMIT
D 5 CHANGE OF INFORMATION
D 6 TEMPORARY TANK CLOSURE
o 7 PERUANENTl Y CLOSED ON SITë
D 8 TANK REMOVED
DBA OR FACILITY NAME WHERE TANK IS INSTALLED:
7S-
I. TANK DESCRIPTION
MPLETE ALL ITEMS - S?ECIFY IF UNKNOWN
A. OWNER'S TANK I. D_.
B. MANUFACTURED BY:
C. CA TE iNSTALLED (MOIOAYIVEARj
:.s-
D. TANK CAPACITY IN GAlLONS:
II. TANK CONTENTS
IF A·1IS MARi<ED. COMPLETE ITEM C.
A.
-
: MOTOR VEHICLE FUEL
2 PETROLEUM
LJ 4 OIL
D 80 EMPTY
, 3.
!
Ii 1 PRODUCT
1- 2 WASTE
'---
D 13 REGULAR
C. UNLEADED
~b PREMIUM
UNLEADED
o 2 LEADED
o 3 DIESEL
U 4 GA$AHOL
D 5 JET FUEL
LJ 99 OTHER ¡DESCRIBE IN ITEM D. BELOW)
D 6 AVIATION GAS
D 7 METHANOL
-
.--
'---
--
3 CHEMICAL PRODUCT
[J 95 UNKNOWN i
'--
O. iF iA I) is NOT MARKED. ENTER NAME OF SUBSTANCE STORED
C.A. S..:
III. ïANK CONSTRUCTION
.'JARK ONE ITëM ONLY IN SOXES A. B. AND C, AND ALL THAT APPLIES IN BOX D
I ~. TYPC :)f
1 DOUBLE WALL
l....J 3 SINGLE WALL WITH EXTERIOR LINER
!I 95 UNKNOWN
.- 0 99 OTHER I
SYSTEM 2 SINGLE WALL , 4 SECONDARY CONTAINMENT (VAULTED TANK)
~ STEEL CLAD WI FIBEi1GLASS REINFORCED PLAS"C I
- 2 STAINLESS STEEL - 3 FIBERGLASS
1 BARE STEEL , I , i
B. TANK '-
- 5 CONCRETE U 6 POLYVINYL CHLORIDE n 7 ALUMINUM 0 8 1000/, METHANOL ~MPATIBLE W/FRP
MATERIAL '- -
:Primary TanK) 9 BRONZE :: 10 GALVANIZED STEEL U 95 UNKNOWN 0 99 OTHER
1 RUBBER LINED ' , 2 ALKYD LINING LJ 3 EPOXY LINING 0 4 PHENOLIC LINING
- ---.J
C. INTERIOR - 5 GLASS LINING ~ UNLINED II 95 UNKNOWN 0 99 OTHER
UNING -
is LINING MATERIAL COMPATIBLE WITH 1000/, METHANOL? YES_ NO_
'- POLYETHYLENE WRAP 0 2 COATING ~ VINYL WRAP 0 4 FIBERGLASS REINFORCED PLASTIC
D. CORROSION 1
-
PGOTECT10N 5 CATHODIC P<;OTECTION II 91 NONE o 95 UNKNOWN 0 99 OTHER
IV. PIPING INFORMA TJON CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE
A. SYSTEM TYPE . AU' SUCTION 2 PRESSURE A U 3 GRAVITY
a. CONSTRUCTION A U 1 SINGLE WALL DOUBLE WALL AU:) LINED TRENCH
A U 99 OTHER
A U 95 UNKNOWN
A U 99 OTI1ER
C. MATERIAL AND A u 1 BARE STEEL A U 2 STAINLESS STEEL A U :)
CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U
PROTECTION A U 9 GALVANIZED STEëL A U 10 CATHODIC PROTECTION
D. LEAK DETECTION 1 AUTOMATIC LINE LEAK DETECTOR ~ UNE TiGHTNESS TESTING
Ii FIBERGLASS PIPE
8 100% METHANOL COMPATIBLE WiFRP
99 OTHER
CJ 99 OTHER
V. TANK LEAK DETECTION
1 VISUAL CHECK 2 INVENTORY RECONCILIATION LJ 3 VAPOR MONITORIN
~TANK TESTING z:7 INTERSTITIAL MONITORING i I 91 NONE
4 AUTOMATIC TANK GAUGING U 5 GROUND WATER MONITORING
c::: 95 UNKNOWN D 99 OTI1ER
I 3. WAS TANK FILLED WITH
GALLONS INERT MA TERIAL ?
YES C
PERJURY, AND TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT
LOCAL AGENCY USE ONLY THE STATE LD, NUMBE;; IS COMPOSED CFTHE :=OUR NUMBERS BELOW
CCt;~HY II JURISDICTiON :t
STATe !.O.#
FAC:LlTY II
TMJK II
¡,
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--
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¡i-iiS ;:{JRM MUST 2= ~C~MP .!."'iED ::'1 ~ ï:EiiW¡ :"P?L'C:. r;C~¡ . FCR~ A. L:~¡L:SS A C::RRENi FCRI,4 ~ HAS 3EE:-I FiLEù.
:".-"< .
-- '-."--.- ..
--
... -. ----, '-.
------ -----e
- --- -.-------.--
(..,
Sf ATE OF CAUFORNlA
STATE WATER RESOURCES CONTROL BOARD
UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM B'
COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM.
MARK ONL Y
ONE ITEM
o 3 RENEWAL PERMIT
o 4 AMENDED PERMIT
o 5 CHANGE OF INFORMATION
o 6 TEMPORARY TANK CLOSURE
o 7 PERMANENTlY CLOSED ON Srr=
o 8 TANK REMOVED
1 NEW PERMIT
C 2 INTERIM PERMIT
DBA OR FACILITY NAME WHERE TANK IS INSTALLED:
I. TANK DESCRIPTION
A. OWNER'S TANK I. D. .
B. MANUFACTURED BY:
II. TANK CONTENTS
A. ~, MOTOR VEHICLE FUEL
IF A·IIS MARKED. COMPLETE ITEM C.
B. C.
Ii 1 PROOUCT
L 2 WASTE
[J 3 DIESEL
U 4 GASAHOL
5 JEHUEL
99 OTHER (DESCRIBE IN ITEM D. BELOW)
U 4 OIL
[J 80 EMPTY
o 95 UNKNOWN
.--
2 PETROLEUM
3 CHEMICAL PRODUCT
O. :¡: iA I) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED
o
o
6 AVIAnON GAS
7 METHANOL
C. A. S..:
III. TANK CONSTRUCTION :.tARK ONE ITEM ONLY IN BOXES A. B. ANDC, AND ALL THAT APPLIES IN BOX 0
! :.. TYPE OF ~ DOUBLE WALL i I 3 SINGLE WALL WITH EXTERIOR LINER n 95 UNKNOWN
i ' 4 SECONDARY CONTAINMENT (VAULTED TANK) II 99 OTHER
SYSTEM 2 SINGLE WALL
1 BARE STEEL
B. TANK '-
---,
MATERIAL 5 CONCRETE
-
~Primary Tank) , 9 BRONZE
[J 2 STAINLESS STEE:L
i : 3 FIBERGLASS
¡ I 6 POLYVINYL CHLORIDE 0 7 ALUMINUM
II 10 GALVANIZED STE"L n 95 UNKNOWN
C. INTERIOR
LINING
_ 1 RUBBER LINED [J 2 ALKYD LINING
= 5 GLASS LINING 8"6 UNLINED
IS LINING MATERIAL COMPATIBLE WITH 1~, METHANOL?
LJ 3 EPOXY LINING
n 95 UNKNOWN
YES _ NO_
~ 3 VINYL WRAP
o 95 UNKNOWN
D. CORROSION
PROTECTION
1 POLYETHYLENE WRAP 0 2 COATING
5 CATHOOIC PROTECTION!I 91 NONE
-
IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUNO. BOTH IF APPLICABLE
A. SYSTEM TYPE . A U 1 SUCTION 2 PRESSURE A U 3 GRAVITY
B. CONSTRUCTION A U 1 SINGLE WALL DOUBLE WALL A U 3 LINED TRENCH
a-:r STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC
o 8 1~, METHANOL COMPATIBLE WtFRP
o 99 OrnER
o 4 PHENOLIC LINING
o 99 OTHER
o 4 FIBERGLASS REINFORCED PLASTIC
o 99 OrnER
A U 99 OTHER
A I) 95 UNKNOWN
A U 99 OTHER
C. MATERIAL AND A'U 1 BARE STEEL A U 2 STAINLESS STE"L A U 3
CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U
PROTECTION A U 9 GALVANIZED STE"L A U 10 CATHODIC PROTECTION UNKNOWN
D. LEAK DETECTION UTOMA TIC LINE LEAK DETECTOR : 2 LINE TiGHTNESS TESTING
U 4 FIBERGLASS PIPE
8 100% MErnANOL COMPATIBLE WtFRP
99 OrnER
o 99 OrnER
V. TANK LEAK DETECTION
1 VISUAL CHECK
~NK TESTiNG
2 INVENTORY RECONCILIATION U 3 VAPOR MONITORIN
~NTERSTITIAL MONITORING [I 91 NONE
4 AUTOMATIC TANK GAUGING 0 5 GROUND WAT!.:R MONITORiNG
o 95 UNKNOWN 0 99 OTHER
2. ESTIMATED QUANTITY OF
SUBSTANCE REMAINING
. I 3. WAS TANK FILLED wlrn
GALLO~S iNERT YA TERIAL ?
YES 0 N~
APPLlCAN rs NAME
(P~ ~HEO" SIGNATURE!
JURY. AND TO TJ./E BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT
LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED CF THE FOUR NUMBERS BELOW
STATE 1.0.#
CCLJNTY iI JURISDICTICN It
---¡
FACiliTY It
TANK It
;:>E.~'-1I¡ ""LM8t:~
PE.:::¡MIi' ~pPqOVE£:) öY,s~~=
?EñMI¡ EX?IRA¡¡CN CA7¡:
THIS FORM MUST 8:: AC~MP ANtED aT' A r::::i1WT AFP~C':' T:C~¡ . FORM A. L:NLESS A C:';RRE~1' FCR~ A HAS SEEN FlLEJ.
;:C~'..A ~ ,.ì ~)
". "____u h
--
·--0__- ,__
-- - --- -+----_.
----- --" -~"-.. .-.
,.
---_e
STATE DFCAUFORNA
STATE WATER RESOURCES CONTROL BOARD
UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM B'
COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM.
MARK ONL Y
ONE ITEM
~1 NEW PERMIT
o 2 INTERIM PERMIT
o 3 RENEWAL ?ERMIT
o 4 AMENDED PERMIT
o 5 CHANGE OF INFORMATION
o 6 TEMPORARY TANK CLOSURE
o 7 PERUANENTlY CLOSED ON SITE
o 8 TANK REMOVED
DBA OR FACILITY NAME WHERE TANK IS INSTALLED:
I. TANK DESCRIPTION
A. OWNER'S TANK L D. ,
B. MANUFACTURED BY:
C. DATE iNSTALLED (MOIOAYIYE
r
" TANK CONTENTS
IF A-liS MARKED COMPLETE ITEM C
s-
.-- MOTOR VEHICLE FUEL LJ OIL I C. 0 la REGULAR Õ3' DIESEL 0
A. 1 4 B. t;NLEADED 6 AVIAT'oC)N GAS
'-
.-- 2 PETROLEUM [J 80 EMPTY Ii 1 PRODUCT 0 Ib PREMIUM U 4 GASAHOL 0 7 METHANOL
.-- UNLEADED 0 5 JET FUEL
- ,--, D
J CHEMICAL PRODUCT ~ 95 UNKNOWN 2 WASTE 0 2 LEADED n 99 OTIiER (DESCRIBE IN ITEM D. BELOW)
'--
D. IF iA 1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C. A. S.':
III. TANK CONSTRUCTION
~.IARK ONE ITEM ONLY IN BOXES A. B. AND C. AND ALL THAT APPLIES IN BOX D
i :... TYPE OF 1 DOUBLE WALL
SYSTEM 2 SINGLE WALL
1 BARE STEEL
B. TANK
MATERIAL 5 CONCRETE
-
;Primary Tank) 9 BRONZE
1 RUBBER LINED
C. INTERIOR '-
LINING - 5 GLASS LINING
i I 3 SINGLE WALL Win; EXTERIOR LINER
. ,
4 SECONDARY CCNTAINMENT (VAULTED TANK)
o 2 STAINLESS STEEL , J FIBERGlASS
U 6 POLYVINYL CHLORIDE [J 7 ALUMINUM
[J 10 GALVANIZED STEEL Ii 95 UNKNOWN
[J 2 ALKYD LINING
~ UNLINED
IS LINING MATERIAL COMPATIBLE WITH 1~, METHANOL?
U 3 EPOXY LINING
II 95 UNKNOWN
YES_ NO_
~. VINYL WRAP
o 95 UNKNOWN
O. CORROSION
PROTECTION
1 POLYETHYLENE WRAP 0 2 COATING
. , CATHODIC PROTECTION it 91 NONE
.---,
o 4 FIBERGlASS REINFORCED PLASTIC
o 99 OTIiER
IV. P!PING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE
A. SYSTEM TYPE . A U 1 SUCTION 2 PRESSURE A U 3 GRAVITY
8. CONSTRUCTION A U 1 SINGLE WALL 2 DOUBLE WALL A U 3 LINED TRENCH
II 95 UNKN!1WN
[] 99 OTIiER
I
8""':!' STEEL CLAD WI FIBERGLASS REINFORCED PlASTIC
[] a 1~. METIiANOL COMPATIBLE WIFRP
o 99 OTHER
o 4 PHENOLIC LINING
o 99 OTHER
A U 99 OTHER
A U 95 UNKNOWN
A U 99 ornER
C. MATERIAL AND
CORROSION
PROTECTION
O. LEAK DETECTION
A U 1 BARE STEEL
A U 5 ALUMINUM
A U 9 GALVANIZED STEEL
A U 2 STAINLESS ST"EL A U 3
A U 6 CONCRETE A U
A U 10 CATHODIC PROTECTION
U 4 ¡:IBERGlASS PIPE
8 100% METIiANOL COMPATIBLE WiFRP
99 OTHER
o 99 OTIiER
AUTCMA TIC LINE LEAK DETECTOR
" E TiGHTNESS TESTING
V. TANK LEAK DETECTION
VISUAL CHECK ~VENTORY RECONCILIATION
~. TANK TESTING ~ INTERSTITIAL MONITORING
U J VAPOR MONITOR~AUTCMATIC TANK GAUGiNG 0 5 GROUND WATER MONITORING
o 91 NCNE 0 95 UNKNOWN 0 99 OTIiER
'I 2. ESTIMATED QUANTITY OF --e- . I 3. WAS TANK FILLED WITH
; SUBSTANCE REMAINING GALLONS INERT MATERIAL?
,),PPlICAN rs NAME
¡pq ilrHEO" $IGNATUAE)
LOCAL AGENCY USE ONLY THE STATE 1.0. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW
YES 0 Nt>fS:t
STATE 1.0.#
CCLJNTY II JURISDICTICN II
~
F ¡'C:lITY II
TANK II
;J;::::~qr '''''L\td¿~
PE~MIT J.?PCìOVEJ 3Y,S..\~::
fJ£RU¡i SXP:RA 7':CN CATê
¡filS FORM MUST 2:: AC~MP .I.~HED 2V A PERMIT APPL;C:' T10N . FORM A. l:NL:=SS A C:';RRENT FCRM A H..I.$ SE::~ FiLED.
;':(~::I'" ~ ).~\
e . STATE OFCAUFORNlA .
STATE WATER RESOURCES CONTROL BOARD
CERTIFICATION OF COMPLIANCE
FOR UNDERGROUND STORAGE TANK INSTALLATION
FORM C
COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM
CITY
~774~ ? )J--
#P'/ ~. 1/A.//tJA.J
.
~~
COUNTY
K~
I. SITE LOCATION
STREET
II. INSTALLATION (mark all that apply):
The installer has been certified by the tank and piping manufacturers.
The installation has been inspected and certified by a registered professional engineer.
~ The installation has been inspected and approved by the implementing agency.
~II work listed on the manufacturer's installation checklist has been completed.
The installation Contractor has been certified or licensed by the Contractors State License Board.
Another method was used as allowed by the implementing agency. (Please specify.)
Tank Owner/Agent
Print Name
Phone
) 3 '.).
7" 330 J
III. OATH I certify that the information provided i tru
Address
LOCAL AGENCY USE ONLY
STATE
TANK 1.0. It
COUNTY It
[IJ
JURISDICTION If
rrr=
FACILITY If
-LLI 1-
TANK #
[UJTTl
FORM C (7,'91)
THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FORMS A & B UNLESS THEY HAVE BEEN FILED PREVIOUSLY
~
e STATE OF CAUFORNlA e
STATE WATER RESOURCES CONTROL BOARD
CERTIFICATION OF COMPLIANCE
FOR UNDERGROUND STORAGE TANK INSTALLATION
FORM C
COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM
I
I'
I
CITY
¡;;;-~ /'
~fb/ ~.
(.
~~
-
STREET
77.J
t/ AI/ (.),J
I. SITE LOCATION
CO U NTY
~~
II. INSTALLATION (mark all that apply):
The installer has been certified by the tank and piping manufacturers.
The installation has been inspected and certified by a registered professional engineer.
The installation has been inspected and approved by the implementing agency.
~AII work listed on the manufacturer's installation checklist has been completed.
~e installation Contractor has been certified or licensed by the Contractors State License Board.
= Another method was used as allowed by the implementing agency. (Please specify.)
III. OATH I certify that the infor
Tank owner/Ag~~-ð'A/r¡l¿ c...-:
Print Name ~CG" ~--AJ~
Address ~ P ~ /' g'lJ I
.
of my belief and knowledge,
Date /O~ð/?J
Phone ( ) 373-70 òò
/f$~f ~~". ð' fie.~
LOCAL AGENCY USE ONLY
;.........
STATE
TANK I.D. :i
COUNTY It
ITJ
JURISDICTION It
ITL
FACILITY It
~
TANK"
=
FORM C (7;91)
THIS FORM MUST BE ACCCMPANIED BY PERMIT APPLICATION FORMS A & B UNLESS THEY HAVE BEEN FILED PREVIOUSLY
~æ003SC7
e STATE OFCAUFOFHA e
ST ATE WATER RESOURCES CONTROL BOARD
CERTIFICATION OF COMPLIANCE
FOR UNDERGROUND STORAGE TANK INSTALLATION
FORM C
COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM
CITY
FitS~r:' 77r.
Vro/ ~ . c/ AJ/ Ò A.J
~17~C-O
CO U NTY
~~
I. SITE LOCATION
STREET
11. INSTALLATION (mark all that apply):
The installer has been certified by the tank and piping manufacturers.
The installation has been inspected and certified by a registered professional engineer.
The installation has been inspected and approved by the implementing agency.
~ All work listed on the manufacturer's installation checklist has been completed.
>--me installation Contractor has been certified or licensed by the Contractors State License Board.
- Another method was used as allowed by the implementing agency. (Please specify.)
III. OATH I certify that the information y belief and knowledge,
TankOwner/Agen~~~J.k¿L- Date IO~d/9J-
Print Name ~~c.¿;. /./~ ";Sø Phone ( ) 39~ ;?òdð
t-
Address ¡::?.- () /~ I" n '7 ~~T7'---6'"C.Æ;J
LOCAL AGENCY USE ONLY
STATE
TANK 1.0. Ii
COUNTY 1#
LL
JURISDICTION 1#
co=
FACILITY It
~
TANK 1#
=
FOR'" C (7;91)
THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FORMS A & B UNLESS THEY HAVE BEEN FILED PREVIOUSLY
><JAOO35C7
e STATEOFCAUFORNlA e
STATE WATER RESOURCES CONTROL BOARD
CERTIFICATION OF COMPLIANCE
FOR UNDERGROUND STORAGE TANK INSTALLATION
FORM C
COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM
CITY
~~~ 77r-
V7ò/ ~. t/ »1 ~
~~--Z.¿;J COUNTY
.
~/~
I
I
I
I
I
I
I. SITE LOCATION
STREET
II. INSTALLATION (mark all that apply):
The installer has been certified by the tank and piping manufacturers.
The installation has been inspected and certified by a registered professional engineer.
The installation has been inspected and approved by the implementing agency.
~ All work listed on the manufacturer's installation checklist has been completed.
~ installation Contractor has been certified or licensed by the Contractors State License Board.
= Another method was used as allowed by the implementing agency. (Please specify.)
III. OATH I certify that the information pr v:
Print Name
Address
LOCAL AGENCY USE ONLY
STATE
TANK I.D. ::
COUNTY II
W
JURISDICTION :I
OI
FACiLITY :I
=
TANK #
=
. .'
FORM C (7;91)
THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FORMS A & B UNLESS THEY HAVE BEEN FILED PREVIOUSLY
on "_._._ h
--e
. ---- .~,.- .--- '-..
~. -. -- - ---- ---.-.-- ..
"
--------- -- ------
STATE OFCAUFORNA
STATE WATER RESOURCES CONTROL BOARD
UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM 8 .
COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM.
MARK OIlL Y
ONE ITEM
U t NEW PERMIT
C 2 INTERIM PERMIT
o 3 RENEWAl PERMIT
o 4 AMENDED PERMIT
DBA OR FACILITY NAME WHERE TANK IS INSTALLED:
I. TANK DESCRIPTION
COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN
A. OWNER'S TANK L D. .
II. TANK CONTENTS
C. DATE iNSTALLED (MOIDAYNEAR)
[] 5 CHANGE OF INFORMATION D 7 PERMANENTlY CLOSED ONSm:
[] 6 TEMPORARY TANK CLOSURE ~ TANK REMOVED
B. MANUFACTURED BY:
1a REGULAR " 3 DIESEL 0
A. MOTOR VEHICLE FUEL U 4 OIL B. C. lJNLEADED 0 6 AVIATlCN GAS
[J EMPTY Ii 1 PRODUCT 0 1b PREMIUM 4 GASAHOL 0 7 METHANOL
2 PETROLEUM 80 0
UNLEADED 5 JET FUEL
3 CHEMICAL PRODUCT ,--, 95 UNKNOWN L 2 WASTE 0 2 LEADED 0
L.! 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
.·~ARK ONE ITEM ONLY IN BOXES A. B. AND C, AND ALL THAT APPLIES IN BOX 0
A. TYPE OF
SYSTEM
1 DOUBLE WALL
~ SINGLE WALL
U 3 SINGLE WALL WIT,.; EXTERIOR LINER 0 95 !JNKNOWN
n 4 SECONDARY CONTAINMENT (VAULTED TANK) U 99 OTl-lER
I
-
o 2 STAINLESS STEa
U 6 POLYVINYL CHLORIDE
~O GALVANIZED STEEL
B. TAIIK
MATERIAL
~Primary Tank)
I BARE STEEL
'-
.-
5 CONCRETE
9 BRONZE
-
C. IIITERIOR
LINING
._ ' RUBBER LINED [J 2 ALKYD LINING
- 5 GLASS LINING ~ UNLINED
- '--"
;S LINING MATERIAL COMPATIBLE WITH 100'1', METl-IANOL?
D. CORROSION
PROTECTION
_ 1 POLYETHYLENE WRAP 0 2 COATING
5 CATHODIC PROTECTIO~ NONE
a. CONSTRUCTION
IV. PIPING INFORMA TJON CIRCLE A IF ABOVE GR UND OR U IF UNDERGROUND. BOTH IF APPLICABLE
A. SYSTEM TYPE . A U 1 SUCTION PRESSURE A U 3 GRAVITY
A U 99 OTl-lER
U
SINGLE WALL
A U 2 DOUBLE WALL
C. MATERIAL AND
CORROSION
PROTECTION
D. LEAK DETECTION
U t BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGLASS PIPE
5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COA TlNG A U 8 100% METl-IANOL COMPATIBLE W/FRP
9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER
AUTOMA TIC LINE LEAK DETECTOR : 2 L::'>iE TIGHTNESS TESTING ,---' J ¡NT 5 I IAL i=:J 99 OTl-lER
I I MONITORING
V. TANK LEAK DETECTION
; 3 FIBERGLASS
o 4 STEEL CLAD WI FIBERGlASS REINFORCED PLAS"C
[] 8 100'1'. METHANOL CDMPA TlBLE WIFRP
[] 99 OTl-lER
o 4 PHENOLIC LINING
o 99 OTl-lER
-
n 7 ALUMINUM
Ii 95 UNKNOWN
U 3 EPOXY LINING
I i 95 UNKNOWN
YES _ NO_
LJ 3 VINYL WRAP
o 95 UNKNOWN
o 4 FIBERGLASS REINFORCED PLASTIC
o 99 OTl-lER
A U 3 LINED TRENCH
A U 95 UNKNOWN
A U 99 OTI;ER
ì--! 2 INVENTORY RECONCiLIATION LJ J VAPOR MONITORING n 4 AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING
o 7 INTERSTITIAL MONITORING n 91 NONE 0 95 UNKNOWN 0 99 OTl-lER
1. ~STlMA TED DATE LAST USED (
..-- I 2. ESTIMATED QUANTITY OF ~- I 3. WAS TANK FILLED WITl-I
: SUBSTANCE REMAINING ---c;;r GALLONS INERT MATERIAL?
YES 0 ~
THIS FORM HAS SEEN COMPLETED UNDER PENAL TY OF P
AfJPUCAN rs .'AME
p~INrED" $IGNATUAE)
LOCAL AGENCY USE ONLY
STATE 1.0.#
CCUNTY:l JURISOICTICN :;
---¡-
~
";;:~VI r ."LV , ¿ "
"EFì~lr APPqOVE:: 3Y c::.:. 7":
THS FORM MUSi 8E AC~M.PA.' iED BY ~ PERWi AFFL;C:.T:C:¡ - FCRM A. L:~ILESS ~ :~RRENT rCMM A HAS ë::=~ FILED.
"E."MIT ~XPIRA ':0.'1 CATE
:~;:.'A ..; "·~~1
FACiLITY :l
TANK II
"',-..:..:-,:: r'.':~~"""'·-
n~ __,___ h
... -,,-- ----.---,--
-e
.--.---. .------
~
COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM.
STATE OFCAUFORNlA
STATE WATER RESOURCES CONTROL BOARD
UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM 8 . .
MARK ONLY
ONE ITEM
o 1 NEW PERMIT
C 2 INTERIM PERMIT
o :) RENEWAl PERMIT
o 4 AMENDED PERMIT
o 5 CHANGE OF INFORMATION _~RMANENTlY CLOSED ON SITE
o 6 TEMPORARY TANK CLOSURE ~8 TANK REMOVED
DBA OR FACILITY NAME WHERE TANK IS INSTALLED:
I. TANK DESCRIPTION
COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN
A. OWNER'S TANK L D.' B. MANUFACiURED BY: ml>'p
C. CATE iNSTALLED (MOIOAYIVEAR) D. TANK CAPACITY IN GAlLONS: I
II. TANKCDNTENTS IF A·IIS MARKED. COMPLETE ITEM C.
A.AI MOTOR VEHICLE FUEL 0 4 OIL i S. C. o 1a REGULAR 8 :) DIESEL 0 6 AVIATION GAS
i L;NLEADED 4 GASAHOL
2 PETROLEUM [J 80 EMPTY ! Ii : PRODUCT ~PREMIUM 0 7 METHANOL
'-- UNLEADED 0 5 JET FUEL
- r--1 I [J 2 WASTE 0
J CHEMICAL PRODUCT L; 95 UNKNOWN 2 LEADED 0 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 MARKONE ITEM ONLY IN SOXES A. S.ANDC. AND ALL THATAPPlIESINBOXD
A. TYPE OF 1 DOUBLE WALL LJ :) SINGLE WALL WITH EXTERIOR LINER n 95 UNKNOWN I
'---'
SYSTEM ~2 SINGLE WALL ì I 4 SECONDARY CONTAINMENT (VAULTED TANK) 0 99 OTHER I
- BARE STEEL D 2 STAINLESS STEEL i I :) FIBERGlASS 0 4 STEEL CLAD WI FIBERGlASS REINFORCED PlASTIC
I
B. TANK '-
MATERIAL 5 CONCRETE :-- 6 POLYVINYL CHLORIDE 0 7 AlUMINUM 0 8 1000/. METHANOL COMPATIBLE WIFRP
- ;H-70 GALVANIZED STEEL
:Primary Tank) Jj 9 BRONZE Ii 95 UNKNOWN 0 99 OTHER
, 1 RUBBER LINED o 2 ALKYD LINING LJ :) EPOXY LINING 0 4 PHENOLIC LINING
.-
C. iNTERIOR - ~ UNLINED 0 95 UNKNOWN U 99 OTHER
5 GLASS LINING
LINING - '---'
is LINING MATERIAL COMPATIBLE WITH 1000/, METHANOL? YES _ NO_
.- POLYETHYLENE WRAP D 2 COATING U :) VINYL WRAP 0 4 FIBERGlASS REINFORCED PLASTIC
D. CORROSION '--- I
PROTECTION :-¡ 5 CATHODIC PROTECTIO~91 NONE o 95 UNKNOWN D 99 OTHER
IV. PIPING INFORMATION CIRCLE A IFABOVEGR UNO OR U IF UNDERGROUND. BOTH IF APPLICABLE
A. SYSTEM TYPE . A U 1 SUCTION A PRESSURE AU:) GRAVITY
B. CONSTRUCTION A U SINGLE WALL A U 2 DOUBLE WALL AU:) LINED TRENCH
C. MATERIAL AND
CORROSION
PROTECTION
D. LEAK DETECTI
A U 99 OTHER
A U 95 UNKNOWN
A U 99 OTHER
U , BARE STEEL A U 2 STAINLESS STEEL AU:) POLYVINYL CHLORIDE (PVC A U 4 FIBERGlASS PIPE
ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100% METHANOL COMPATIBLE WIFRP
GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER
AUTOMA TIC LINE LEAK DETECTOR ' 2 LINE TIGHTNESS TESTING n 3 ~NIÏ~~I: 0 99 OTHER
V. TANK LEAK DETECTION
l~ 2 INVENTORY RECONCiliATION LJ 3 VAPOR MONITORING n 4 AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING
o 7 INTERSTITIAL MONITORING 0 91 NONE [J 95 UNKNOWN 0 99 OTHER
2. ESTIMATED QUANTITY OF
SUBSTANCE REMAINING
~... I :).WASTANKFILlEDWITH
-c.....-' GALLONS. INERT MATERIAL?
YES 0
~4BJŒ
LOCAL AGENCY USE ONLY THE STATE I.D. NU'-1BER is COMPOSED OF THE FOUR NUMBERS BELOW
STA TE 1.0.#
COUNTY;; JURISDICTICN ;;
I
._._----~
PEF;tvtl r NL'.~tdf M
í'E.õ1Mti ~?P~C\'E;:) 3Y,:~ 7"::
FAC:LlTY ;;
I
I
TANK II
;>!;RMIT EXPIRA r:CN CA TE
:.:c..:~I..A:1 ;.~~,
THIS FORM MUST 8: '\C~~IPANiED BY ,\ PER\.ifT :';PL!C:'¡;C~J· FC¡:;!A A. UNLESS A C:JRRENT FCRM A HAS 2EE!, FILED.
·_ ._._._ h
~..- ----- --------.--
¡,
.,
--
.---- ... ".--. '-..
.. 'A .i' ',', ,: ~
-------- -------
STATE OF CAUFORMA
STATE WATER RESOURCES CONTROL BOARD
UNDERGROUND STORAGE TANK PERMIT APPLICATION· FORM 8 . .
MARK ONL Y
ONE ITEM
U t NEW PERMIT
D 2 INTERIM PERMIT
COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM.
o 3 RENEWAl PERMIT
o 4 AMENDED PERMIT
o 5 CHANGE OF INFORMATION __~RMANENTlY CLOSED ONS~I
o 6 TEMPORARY TANK CLOSURE ~ 8 TANK REMOVED
I. TANK DESCRIPTION
DBA OR FACILITY NAME WHERE TANK IS INSTALLED:
A. OWNER'S TANK L D. .
COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN
C. CA TE INSTALLED (MOiDAYIYEAR)
II. TANK CONTENTS
IF A·' IS MARKED. COMPLETE ITEM C.
B. MANUFACì1JRED BY:
D. TANK CAPACllY IN GAlLONS:
/??o
A. '---- MOTOR VEHICLE FUEL U 4 OIL B. C. 0
2 PETROLEUM [J 80 EMPTY ~ 1 PRODUCT 0
~
J CHEMICAL PRODUCT 0 95 UNKNOWN LJ 2 WASTE
-'
3 DIESEL
4 GASAI-IOL
5 JET FUEL
99 OTHER (DESCRIBE IN ITEM D. BELO.,."
III. TANK CONSTRUCTION
D. IF (A. I) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED
o 6 AVIAT10N GAS
o 7 ',IET};ANOL
C.A.S..:
~JARK ONE ITEM ONLY IN BOXES A. B. AND C. AND ALL THAT APPLIES IN BOX D
A. TYPE OF 1 DOUBLE WALL
-
SYSTEM ~NGLE WALL
1 BARE STEel
B. TANK '-
-
MATERIAL 5 CONCRETE
-
(Primary Tank) 9 BRONZE
1 RUBBER LINED
C. iNTERIOR -
- 5 GLASS LINING
LINING -
LJ 3 SINGLE WALL WITH EXTERIOR LINER
il 4 SECONDARY CONTAINMENT (VAULTED TANK)
'-
1 POLYETHYLENE WRAP k COATING
5 CATHODIC PROTECTION, 91 NONE
n 2 STAINLESS STEEL
:1 6 POLYVINYL CHLORIDE
~ GALVANIZED STEEL
[J 2 ALKYD LINING
~UNLINED
IS LINING MATERIAL COMPATIBLE WITH 1~, METHANOL?
D. CORROSION
PROTECTION
. ,
IV. PIPING INFORMATION
A. SYSTEM TYPE . A U
B. CONSTRUCTION U
1 SUCTION
CIRCLE A IF ABOVE G
A
D OR U IF UNDERGROUND. BOTH IF APPLICABLE
PRESSURE A U 3 GRAVllY
A U 99 OTHER
A U 95 UNKNOWN
99 OTHER
SINGLE WALL
C. MATERIAL AND
CORROSION
PROTECTION
, D. LEAK DETECTION
U 1 BARE STEEL
A U 2 DOUBLE WALL
¡ I 3 FIBERGlASS
o 7 ALUMINUM
LJ 95 UNKNOWN
U 3 EPOXY LINING
II 95 UNKNOWN
YES_ NO_
U 3 VINYL WRAP
o 95 UNKNOWN
A U 3 LINED TRENCH
n 95 UNKNOWN
-
U 99 OTHER
LJ 4 STEEL CLAD WI FIBERGLASS REINFORCED PlASTiC
0 8 100% METHANOL COMPATIBLE WIFRP
0 99 OTHER
0 4 PHENOLIC LINING
0 99 OTHER I
I
0 4 FIBERGlASS REINFORCED PLASTIC
0 99 OTHER
A U
A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGlASS PIPE
A U 6 CONCRETE A U 7 STEEL WI COA TlNG A U 8 100% METHANOL COMPATIBLE WIFRP
A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER
V. TANK LEAK DETECTION
TOMA TIC LINE LEAK DETECTOR
, 2 LINE TiGHTNESS TESTING
1 VISUAL CHECK
TANK TESTING
~~ENTORY RECONCILIATION
U 7 INTERSTITIAL MONITORING
U J VAPOR MONITORING 0 4 AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING
n 91 NONE 0 95 UNKNOWN 0 99 OTHER
o J ~6NfT~~I: 0 99 OTHER
I 2. ESTIMATED OUANTlTY OF ~ I 3. WAS TANK FILLED WITH
: SUBSTANCE REMAINING ~ U GALLONS. INERT MATERIAL?
YES 0 ~.
EST OF MY KNOWLEDGE. IS TRUE AND CORRECT
DATE ,,/.
rO/IO/9,J
LOCAL AGENCY USE ONLY THE STATE 1.0. NUMBER is COMPOSED OF THE FOUR NUMBERS BELOW
STATE 1.0.#
COUNTY;: JURISDICTION ;:
---
--'--
;:I~~'..4 ·r ,'4l..:Mdl:: ~
P:::;'MIT ~PPc.CVE: 3Y.S.J.7~
FAC:lITY If
TANK II
:JERYIT EXP1RAT;ON CATE
;:n~"" ~ ,;.~-,:\
THIS F<JRM MUST BE: AC:X:MP4NIED BY A ?::!1WT AFPL. C':'T;O~· FORM A. U~LESS A C:':RRENT FCRM A HAS BE=~ FILED.
------.----
-e
.. ----- .~... .-.. -_.
......
~
~¡;.-;,n'Þ-~ ..,~.
-------- ----_e_
Sf ATE OF CAUFOIHA
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
D 2 INTERIM PERMIT
o 3 RENEWAl PERMIT
o 4 AMENDED PERMIT
o 5 CHANGE OF INFORMATION
o 6 TEMPORARY TANK CLOSURE
...O~RMANENTLY CLOSED ON SITE
{S: 8 TANK REMOVED
DBA OR FACILITY NAME WHERE TANK IS INSTALLED:
I. TANK DESCRIPTION
COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN
A. OWNER'S TANK L D. .
C. DATE INSTALLED (MOiOAYtfEAR)
ts.
I
B. MANUFACTURED BY:
D_ TANK CAPACITY IN GAlLONS:
NTS IF A-tiS MARKED. COMPLETE ITEM C.
Jl 4 OIL B. C. 0 la REGULAR
A. L-.J UNLEADED
2 PETROLEUM 0 80 EMPTY Ii , PRODUCT 0 Ib PREMIUM 0
UNLEADED
3 CHEMICAL PRODUCT D 95 UNKNOWN L 2 WASTE D 2 LEADED D
-'
D. IF (A.1) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED
III. TANK CONSTRUCTION
3 DIESEL
4 GA$AHOL
5 JET FUEL
99 OTI-lER (DESCRIBE IN ITEM D_ BELOW)
D
D
7 YETHANOL
6 AVIAT1CNGAS
.·~ARK ONE ITEM ONLY IN BOXES A. B. AND C. AND ALL THAT APPLIES IN BOX D
C.A_ S..:
A. TYPE OF . ¡ t DOUBLE WALL
SYSTEM ~NGLE WALL
- BARE STEEL
1
B. TANK -
.---,
MATERIAL 5 CONCRETE
-
~Primary Tank) .~ 9 BRONZE
L-: 3 SINGLE WALL WITH EXTERIOR LINER
i 4 SECONDARY CCNTAINMENT (VAULTED TANK)
C. INTERIOR
LINING
I : 2 STAINLESS STEi:L
:-¡ 6 POLYVINYL CHLORIDE
~ GALVANIZED STEEL
---' ' RUBBER LINED LJ 2 ALKYD LINING
¡ 5 GLASS LINING ~UNlINED
;S LINING MATERIAL COMPATIBLE WITH 100'\', METHANOL?
.-
1 POLYETHYLENE WRAP 0 2 COATING
5 CATHODIC PROTECTION~ NONE
D. CORROSION
PROTECTION
-
;~
IV. PIPING INFORMATION
A. SYSTEM TYPE . A U 1 SUCTION
a. CONSTRUCTION A U I SINGLE WALL
ì 3 FIBERGLASS
o 7 ALUMINUM
n 95 UNKNOWN
U 3 EPOXY LINING
II 95 UNKNOWN
. YES_ NO_
U 3 VINYL WRAP
o 95 UNKNOWN
n 95 UNKNOWN
o 99 OTHER
D 4 STEEL CLAD WI FIBERGlASS REINFORCED PLASTIC
o 8 100'Y. METI-lANOL COMPATIBLE W/FRP
o 99 OTI-lER
D 4 PHENOLIC LINING
o 99 OTHER
o 4 FIBERGLASS REINFORCED PLASTIC
o 99 OTI-lER
PRESSURE
NO OR U IF UNDERGROUND. BOTH IF APPLICABLE
A U 99 OTHER
A U 2 DOUBLE WALL
A U 3 GRAVITY
A U 3 LINED TRENCH
A U 95 UNKNOWN
A U 99 OTHER
C. MATERIAL AND U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGLASS PIPE
CORROSION 5 AlUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100% METI-lANOL COMPATIBLEWIFRP
PROTECTION 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTI-lER
D. LEAK DETECTION TOMA TIC LINE LEAK DETECTOR . 2 cINE TiGf1TNESS TESTING o J INT S I IAL o 99 OTI-lER
YONIiORING
V. TANK LEAK DETECTION
-
2 INVENTORY RECONCILIATION U 3 VAPOR MONITORING U 4 AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING
7 INTERSTITIAL MONITORING 0 91 NONE 0 95 UNKNOWN 0 99 OTHER
.--,
LJ
2. ESTIMATED OUANTlTY OF
SUBSTANCE REMAINING
THIS FORM HAS SEEN COMPLETED UNDER PENAL TV OF PEPJ
~kl)N
YES 0 N
COUNTY :I JURISDICTiON :I
LOCAL AGENCY USE ONLY THE STATE 1.0. NUMBER IS COMPOSED OFTHE FOUR NUMBERS BELOW
TANK 1#
STATE 1.0.#
I
il
FACILITY :t
~
----.
",,:;Mlr .';\.,.\1",,:;
?E;:1MIT AP;JqOVED 3...· 2~ 7E
P"",...IT ¡;XPIRA710N CA7E
THIS FORM MUST 8E AC~~.tp AN:E~ 3Y A PE;;',\!T AFPUCA T¡C~ . FOR'" A. UNLESS A C:';RRE~'T FCRM A HAS BEEN FILED.
;:r;;:;:y ..; . ,. .....~\
~~--~~-----..,....-----------~--- ~- ---
~r·
ceRRE'CTION NOT~E
BAKERSFIELD FIRE DEPARTMENT N~ ' 023 '1
Locatiol1 ~sfr~ # Ie¡
Sub Div. l{f(() ( 9. tJ?(D'1 MBlk.
. Lot
You are hereby required to make the following corrections
at the above location:
Cor. No
t
fb(c~ of
~PI\\~\(4. 'V
<'&('
Completion Date for COITectV!i!!~
Date l 2/ tg /99
I . ~
nspector
326-3979
f'1:;f.rn~ I P J Si
4901 S. UNION AVE.
BKFLD. (~. 93307
661 -3'37 -'3:387
DEC 8. 1999 2:00 PM
S\"thH'l SmTLJS REPOF':T
.~
,:~
.L
fUNCTIONS NORMAL
-_._-~.-
----..
~@OR OR'GINA~
FASTRIP 19
4901 S. UNION AVE.
BKFLD. CA. 93307
651-39(7--93:::7
DEC 8. 1999 2:01 PM
S\:'STF:t-'l ~3TiHUf.:; F:EF'ORT
- - - -- -- - -. - - - -. -
ALL FUJ'K;T IONf.:; 1', ()F:I"IAL
IINTORi REPORT
T 1: UNL. 775
VOLUr"1E
ULU~GE
90~'~ ULLJiGE= 5372
TC VOL UJ"lE
HEIGHT
iAIATEF: VOL
~\IATER
THIP
54~)6
6576
:;4~!0
'+'1.49
o
0.00
t,':1 . ~:::
T 2: UNL. PLi.13 77~}'
VOLUME - 6209
.Ut..L,;;:'GE--::-c ""_ ,5ß.Z;:¡
9CJ;\, I..ILL.I'\GE= :h; I ':¡
TC 'v'OLlJr"n:: 61 1 :'
HEIGHT Q9.2:
~\IATER \/Ç)L U
I,IATER 0 . 00
TEI"IP :3? . ¿:
T 3: PREJ'" .IJ!'~L.. 77~i
VOLUME 4487
ULLAGE '7545
90% ULLAGE= 6341
TC 'v'OLUI"1E 4443
HI·;HT = :3:::. :J'5
~ F.1 VOL = 0
~Jf ~R = iJ . 00
TEMP 73.9
T 4: D] Ef=~EL 7'7:;
VOLUME 5296
ULLAGE ~736
90~\ IJLLAGE> 553~:
TC VOLUr"lE '5249
HEIGHT 43.48
WATER VOL 0
WATER 0.00
THIP '79. '?
T 5: UI~L . 725
VOLUME 4288
ULLAGE 7712
90?-; ULU4(;E= 6':; 12
TC VOLUME 4268
HEIGHT 37.]5
I"IATER \/C'L = [I
iAlATER LJ . Uti
~lpFi'EJ"l. U:L.. t,~~:
\/OLUJ"lE 4~:;94
ULLAGE 7406
90~'; UU.ACE= b20C
TC VOLUf"lE 4564
HEIGHT :39.12
WATER VOL 0
WATER 0.00
TEMP 69.4
Gt~L~3
GALS
GALS
G~1L:::~
II'·¡CHEf:;
Gr~L:3
: ,t:HG:;
L1EC:; F
GfiLß
(;,0.1 ::.;
(;P, L~~
G{~I..S
II'~,;HE::::
cr,u::
( I''¡'::;HE::,
DEG F
Gf'iLS
GAL:3
(;,",U:::
G~1L~~
I J'.JC HEf3
':;;:,L8
¡ NCHEf.::
DEG F
GAL.~3
CAL::::
GAL.f~
GAL:::~
T I"¡CHE;~;
GnlB
1 NCHE~
DEG F
CALS
GAL:',
GP,LS
GALS
J rK: HE;ê-;
GI4LS
J NC HÐ:::
DEG F
(~ALE:~
G{1L~;
Gi~I.:::~
r.;HL.:::\
1 NCfJEfé:
GALS
r NC HE:;::
DEG F
T '7: D f E::::EL. '725
\lOLUI"IE 331 ':' C;:,U3
ULLP,GE :36:::: 1 Gf'iU:.:
90\; ULLACE> '/4Bl CALE;
TC \/OLUI"lE 3297 GAU3
HE I C.~HT ::::[1. n:: ] I~CHEE:
1"IATEf.? VOl. [I (;¡-:¡L:3
Ih.IATEF: 0 . OU I NCHEf3
TEMP 74.~ DEG F
M ¥ * M ¥ END ¥ ¥ ¥ ¥ M
..
.,
-
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave" 3rd Floor, Bakersfield, CA 93301
FACILITY NAME FO~t:)it',f'1 if- {1
INSPECTION DATE 12'" ~ "19
Section 2:
Underground Storage Tanks Program
o Routine Œrtombined 0 Joint Agency
Type of Tank f\l1J\'::.c.s
Type of Monitoring é l..M.
o Multi-Agency 0 Complaint
Number of Tanks 7
Type of Piping GJJF
ORe-inspection
OPERA TION C V COMMENTS
Proper tank data on file V .;,
Proper owner/operator data on tile V
Pemit fees current V
V f
Certification of Financial Responsibility . .
Monitoring record adequate and current r/
Maintenance records adequate and current V Id(dr\' ~f Ð1 ~N\C<¡ t1I./ct9
Failure to correct prior UST violations I~
Has there been an unauthorized release? Yes No V
Section 3:
Aboveground Storage Tanks Program
,-. ,,~,
I' .,
:\<.., ,. .
,'I
OPERATION Y N COMMENTS
.. ,
SPCC available ,.
,
SPCC on tile with OES .. I~
Adequate secondary protection .:.:
Proper tank placarding/labeling ; , ,
".,...
Is tank used to dispense MVF? ~i: (
,<If:":'
If yes, Does tank have overfill/overspill protection? '-
AGGREGATE CAPACITY
Number of Tanks
,.
\
TANK SIZE(S)
Type of Tank
'. ,',
C=Compliance V=Violation Y=Yes N=NO
10,p<oIo" ~ "LhI:O
Oftìce of Environmental Services (805) 326-3979
White - Env. Svcs.
il'-'
,
~;,~~,;.
.'..... . ".....
~.Y·~
Business Site Responsiblé~arty
Pink - Business Copy
-
.
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave" 3rd Floor, Bakersfield, CA 93301
F ACIL~TY NAME ~~+r-'D 'It ( c¡
ADDRESS '1q(J( . r/\/Of/\.
FACILITY CONTACT
INSPECTION TIME
M.
.
INSPECTION DATE I;).'~ ~ f'
PHONE NO. 39)' 93g"/
. BUSINESS ID NO. 15-210-
NUMBER OF EMPLOYEES 10
Section 1:
Business Plan and Inventory Program
D Routine
~ombined
D Joint Agency
D Multi-Agency
D Complaint
ORe-inspection
OPERA nON C v COMMENTS
Appropriate permit on hand tI
Business plan contact information accurate V
Visible address V
Correct occupancy V
Verification of inventory materials V
Verification of quantities V
Verification of location V
Proper segregation of material v'
Verification of MSDS availability V
Verification of Haz Mat training V
Verification of abatement supplies and procedures V
Emergency procedures adequate V
Containers properly labeled \/
Housekeeping V
ñ'K (2"hV\c ll\.!.~<.r NeedS 11\{9tJ"\l~(. oorh e .
Fire Protection \J
Site Diagram Adequate & On Hand v
s.{
C=Compliance
V=Violation
Any hazardous waste on site?:
Explain:
DYes DNo
White - Env. Svcs.
Yellow - Station Copy
Pink - Business Copy
~.~
~ ...rj. -
Business 2esponsib1e Party
Inspector: ~ ~.
Questions regarding this inspection? Please call us at (805) 326-3979
.... CITY OF BAKERSFIELD.· ,
OF~E OF ENVIRONMENTAL S VICES
1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
UNDERGROUND STORAGE TANKS· TANK PAGE 1
e
TYPE OF ACTION 0 1. NEW SITE PERMIT
(Check one Item only)
Page of
o 6. TEMPORARV SITE CLOSURE
o 7. PERMANENTL V CLOSED ON SITE
o 8. TANK REMOVED
430
TANK USE 439
b1. MOTOR VEHICLE FUEL
I!!?>arlced, comp/ete Pøltoleum Type)
I 0 2. NON-FUEL PETROLEUM
o 3. CHEMICAL PRODUCT
o 4. HAZARDOUS WASTE (Includes
Used Oil)
095. UNKNOWN
TYPE OF TANK
431
I. TANK DESCRIPTION
433
COMPAiUMENTALIZED TANK 0 Ves
" 'Ves', complete one page for eaCh
436' NUMBER OF COMPARTMENTS
(
No 434
partmenl.
437
436
II. TANK CONTENTS
PETROLEUM TYPE
o 1a. REGULAR UNLEADED
o 1 b. PREMIUM UNLEADED
o 1c. MlDGRADE UNLEADED
440
o 2. LEADED'
~. DIESEL
o 4. GASOHOL
Materials Inventory page)
441
'". TANK CONSTRUCTION
o 3. SINGLE WAll WITH
EXTERIOR MEMBRANE LINER
o 4. SINGLE WAll IN A VAULT
o 1. SINGLE WAll
~ DOUBLE WAll
(Check one item only)
I
TANK MA TERrAL - primary tank
(Check one item only)
o 3. FIBERGLASS I PlASTIC
o 4. STEEL ClAD WIFIBERGlASS
REINFORCED PlASTIC FRP
. FIBERGLASS I PlASTIC
o 4. STEEL CLAD WIFIBERGlASS
REINFORCED PLASTIC (FRP)
o 5. CONCRETE
o 3. EPOXY LINING
D 4. PHENOLIC LINING
D . 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM
'095. UNKNOWN
o 99. OTHER
o 5. CONCRETE D 95. UNKNOWN
D 8. FRP COMPATIBLE WI100% METHANOL D 99. OTHER'
444
443
1. BARE STEEL
D 2. STAINLESS STEEL
TANK MA TERrAL - secondary tank 0 1. BARE STEEL
(Check one item only) 0 2. STAINLESS STEEL
TANK INTERIOR LINING
OR COATING
D 8. FRP COMPATIBLE W/100% METHANOL
o 9. FRP NON-CORRODIBLE JACKET
D 10. COATED STEEL
D 95. UNKNOWN
o 99. OTHER
445
D ,. RUBBER LINED
D 2. ALKYD LINING
'For local use 0
DATE INSTAllED
449
D ,. MANUFACTURED CATHODIC 0 3. FIBERGlASS REINFORCED PlASTIC 095. UNKNOWN
PROTECTION 0 4. IMPRESSED CURRENT D 99. OTHER
D 2. SACRIFICIAL ANODE
YEAR~NS ED 450 TYPE (~~' use only) 451
rð ,. SPILL CONTAINMENT ~~
~2. DROP ruBE ~~~
. STRIKER PlATE .#feJ¡ O~~ )
;';:i\)i)¡Wi!: ~¡L;»<:';·'Ø~i7o/l.;·t~~'LEAKl)m~i;L~:~"%;,æ:~f;:;¡;;; .'. ..... :'::;i:'?:;¡:W~~::j:Y';" ; .
IF SINGLE WALL TANK (Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): 454 .
o I, VISUAL (EXPOSED PORTION ONLY) D 5. ~UAL TANK GAUGING (MTG) 0 1. VISUAL(SINGLEWALLINVAULTONLy)
o 2. AUTOMATIC TANK GAUGING (ATG) D 6. VADOSE ZONE CONTINUOUS INTERSTITIAL MONITORING
o 3. CONTINUOUS ATG 0 7. GROUNDWATER MANUAL MONITORING
o 4. STATISTIcAL INVENTORV RECONCILIATION (SIR) + 0 8. TANK TESTING
BIENNIAL TANK TESTING D 99. OTHER
-~>-----
V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE
(Check one item only)
SPILL AND OVERFILL
(Check alllhat apply)
ESTIMATED DATE LAST USED (YRlMO/OAV)
UPCF (7/99)
D 5. GlASS LINING
D 6. UNLINED
DATE INSTALLED
447
095. UNKNOWN
D 99. OTHER
446
446
(For local use only)
OVERFILL PROTECTION EQUIPMENT: VEAR INSTAllED 452
f,· ALARM q Î p1J3. FILL TUBE SHUTOFF VALVE ~/
píh. BALL FLOAT 7 t:t d 4. EXEMPT
455. ESTIMATED QUANTITY OF SUBSTANCE REMAINING
98ß0na
458 TANK FILLED WITH INERT MATERIAL?
457
Dves
DNa
S:\CUPAFORMS\SWRCS-S. WPD
J:t'i//
1"
_ CITY OF BAKERSFIELD _
. OFFICE OF ENVIRONMENTAL SERVICES ,.,
1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
UST· TANK PAGE 2
Page
of
UNDERGROUND PIPING
ABOVEGROUND PIPING
. .'. (;,:VtjP.JPI~ø ê9t4S~UCTlON(C~ck ènthet epÞtYJ
SYSTEM TYPE . PRESSURE 0 2. SUCTION 0 3. GRAVITY 458 0 1. PRESSURE
CONSTRUCTION/ 0 1. SINGLE WALL 0 3. LINED TRENCH 0 99. OTHER 460 0 1. SINGLE WALL
MANUFACTURER 0 2. DOUBLE WALL 0 95. UNKNOWN 0 2. DOUBLE WALL
MANUFACTURER 461 MANUFACTURER
o 1. BARE STEEL 0 6. FRP COMPATIBLE WI 100% METHANOL 0 1. BARE STEEL
o 2. STAINLESS STEEL 0 7. GALVANIZED STEEL 0 2. STAINLESS STEEL
o 3. PLASTIC COMPATIBLE WITH CONTENTS 095. UNKNOWN 0 3. PLASTIC COMPATIBLE WITH CONTENTS
o 8. FLEXIBLE (HOPE) 0 99. OTHER 0 .4. FIBERGLASS
o 5. STEEL WI COATING 0 9. CATHODIC PROTECTION 464 0 5. STEEL WI COATING
: .(~ ~·:t: .'.: .:>~::}~' <. ;)~~~~~)~~I.~.q:,ç,~~:J~,~~CTI.~,J¢h~è~,.~! ,~a!_~~i· ,<' ',",,~
MATERIALS AND
CORROSION
PROTECTION
UNDERGROUND PIPING
SINGLE WALL PIPING
PRESSURIZED PIPING (Check all that apply):
o 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST :tl!I!i AUTO PUMP SHUT OFF FOR
LEAK, SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL
ALARMS
2. MONTHLY 0.2 GPH TEST
o
o 3. ANNUAL INTEGRITY TEST (0.1 GPH)
CONVENTIONAL SUCTION SYSTEMS:
o 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY
TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING):
o 7. SELF MONITORING
GRAVITY FLOW:
o 9. BIENNIAL INTEGRITY TEST (0.1 GPH)
SECONDARILY CONTAINED PIPING
PRESSURIZED PIPING (Check all that apply):
10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND
(Check one) -
f. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM
DISCONNECTION
c. NO AUTO PUMP SHUT OFF
o 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR
RESTRICTION -
o 12. ANNUALlNTEGRITY TEST (0.1 GPH)
SUCTION/GRAVITY SYSTEM:
o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAl ALARMS
, EMERGENCY GENERATORS ONLY (Check all that apply)
~4 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND
VISUAL ALARMS
15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR
RESTRICTION
o 16. ANNUALlNTEGRITY TEST (0.1 GPH)
o 17 . DAILY VISUAL CHECK
o 2. SUCTION
o 95. UNKNOWN
o 99. OTHER
o 3. GRAVITY
459
462
463
o 6. FRP COMPATIBLE WI 100% METHANOL
o 7. GALVANIZED STEEL
o 8. FLEXIBLE (HOPE) 0 99. OTHER
o 9. CATHODIC PROTECTION
o 95. UNKNOWN
466
ABOVEGROUND PIPING
SINGLE WALL PIPING 467
PRESSURIZED PIPING (Check all that apply):
o 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,
SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS
o 2. MONTHLY 0.2 GPH TEST
o 3. ANNUAL INTEGRITY TEST (0.1 GPH)
o 4. DAILY VISUAl CHECK
CONVENTIONAL SUCTION SYSTEMS (Check all that apply):
o 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM
o 6. TRIENNIAL INTEGRITY TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING):
o 7. SELF MONITORING
GRAVITY FLOW (Check all that apply):
o 8. DAILY VISUAL MONITORING
o 9. BIENNIAL INTEGRITY TEST (0.1 GPH)
SECONDARILY CONTAINED PIPING
PRESSURIZED PIPING (Check all that apply):
10. CONTINUOUS TURBINE SUMP SENSOR :tl!I!i AUDIBLE AND VISUAL ALARMS AND (check one)
_,~ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
~b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION
o c. NO AUTO PUMP SHUT OFF
o 11. AUTOMATIC LEAK DETECTOR
o 12. ANNUALlNTEGRITY TEST (0.1 GPH)
SUCTION/GRAVITY SYSTEM:
o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS
EMERGENCY GENERATORS ONLY (Check all that apply)
o 14. CONTINUOUS SUMP SENSOR ~ AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL
ALARMS
o 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST)
16. ANNUAL INTEGRITY TEST (0.1 GPH)
17 . DAILY VISUAL CHECK
DISPENSER CONTAINMENT~' FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE
DATE INST L 0 468 . CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS
€;. 3. CONTINUOUS DISPENSER PAN SENSOR WiTH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS
ix. OWNER/OPERATOR SIGNATURE
o 4. DAILY VISUAL CHECK
o 5. TRENCH LINER I MONITORING
o 6. NONE 469
UPCF (7/99)
471
472
DATE
470
Permit expiration Date (For local use only) 475
S:\CUPAFORMS\SWRCB-B.WPD
.. CITY OF BAKERSFIELD.
OF~E OF ENVIRONMENTAL S~VICES
1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
UNDERGROUND STORAGE TANKS - TANK PAGE 1
TYPE OF ACTION 0 1. NEW SITE PERMIT
(Ch8ck one ,Iem only)
o 3. RENEWAL PERMIT
U·
~
I. TANK DESCRIPTION
e
Page
d
o 6. TEMPORARY SITE CLOSURE
o 7. PERMANENTLY CLOSED ON SITE
o 8. TANK REMOVED
430
431
433
437
I
I
1
[/1:' TANK USE 439
I ',1. MOTOR VEHIClE FUEL
. i. (If marlced, complelB Pel10leum Type)
o 2. NON-FUEL PETROLEUM
o 3. CHEMICAL PRODUCT
o 4. HAZARDOUS WASTE (Includes
Used Oil
o 95. UNKNOWN
432
435
COMPARTMENTALIZED TANK 0 Yes
If ·Yes·, complele one page for each
NUMBER OF COMPARTMENTS
1
434
436
436
II. TANK CONTENTS
~ PETROLEUM TYPE
1a, REGUlAR UNLEADED
1b. PREMIUM UNLEADED
D 1e. MJDGRADE UNLEADED
D 2. LEADED
D 3. DIESEL
o 4. GASOHOL
COMMON NAME (from Hazardous MalBrials InvenfDry page)
440
D 5. JET FUEL
o 6. AVIATION FUEL
D 99. OTHER
441 CAS /I (from HaZardous MalBrials InvenfDry page)
442
, TYPE OF TANK
I
I (Check one ilam only)
1
!
i TANK MATERIAL· ptimary tank
i (Check one item only)
1
I
TANK MATERIAL· secondary tank 0 1. BARE STEEL
I (Check one ilam only) D 2. STAINLESS STEEL
TANK INTERIOR LINING
OR COATING
~1. SINGLEWAU.
r.?' DOUBLE WALL
, 1. BARE STEEL
D 2. STAINLESS STEEL
D 1. RUBBER LINED
o 2. AlKYD LINING
D 3, SINGLE WALL WITH
EXTERIOR MEMBRANE LINER
D 4. SINGLE WAlL IN A VAULT
D 3. FIBERGLASS I PLASTIC
~4. STEEL CLAD WIFIBERGLASS
':fI". REINFORCED PlASTIC FRP
, 3. FIBERGlASS I PlASTIC
4. STEEL CLAD WIFIBERGlASS
REINFORCED PlASTIC (FRP)
D 5. CONCRETE
D 3. EPOXY LINING
D 4. PHENOLIC LINING
D 5. 'SINGLE WALL WITH INTERNAL BLADDER SYSTEM
D 95. UNKNOWN
D 99. OTHER
o 5. CONCRETE D 95. UNKNOWN
o 8. FRP COMPATIBLE W/100% METHANOL 099. OTHER
443
444
o 8. FRP COMPATIBLE W/1 00% METHANOL
o 9. FRP NON-CORRODIBLE JACKET
D 10. COATED STEEL
D 95. UNKNOWN
099. OTHER
445
D 5. GLASS LINING
D 8. UNLINED
DATE INSTALLED
447
D 95. UNKNOWN
D 99. OTHER
446
(Check one ilam only)
SPILL AND OVERFILL
I (Check all that apply)
i
I
D 1. MANUFACTURED CATHODIC D 3. FIBERGlASS REINFORCED PLASTIC D 95. UNKNOWN
PROTECTION D 4. IMPRESSED CURRENT D 99. OTHER
D 2. SACRIFICIAL ANODE
YEAR~N D 450 TYPE (For local use only) 451
D 1. SPILL CONTAINMENT ð~tJ
o 2. DROPTUBE n ~
D 3.' STRIKER PlATE (!)
~\r':'~;:;¡ />;: ':.f;~r.'[2JW~;):ì~¡Ü.lW(Qm~:¡i.~:Ç:,:!¥:;~!;~~ n\~;:EJ/>·: ....~.
453 IF DOUBLe WALL TANK OR TANK WITH BLADDER (Check one item only): 454 .
o . VISUAl (SINGLE WAlL IN VAULT ONLY)
2. CONTINUOUS INTERSTITIAL MONITORING
D 3. MANUAL MONITORING
01.
D 2.
03.
04.
IF SINGLE WALL TANK (CIIeck eU fllsl apply):
VISUAL (EXPOSED PORTION ONLY)
AUTOMATIC TANK GAUGING (ATG)
CONTINUOUS ATG
STATISTICAL INVENTORY RECONCILIATION (SIR) +
BIENNIAL TANK TESTING
o 5. MANUAl TANK GAUGING (MTG)
D 8. VADOSE ZONE
o 7. GROUNDWATER
D 8. TANK TESTING
o 99. OTHER
V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE
ESTIMATED DATE LAST USED (YAlMOIOAY)
UPCF (7/99)
446
449
(For local use only)
OVERFILL PROTECTI~E~IPMENT: YEAR INSTALLED . ~
~ AlARM -=++ t¡t2. FILL TUBE SHUT OFF VALVE ~ .
'E(2. BAlL FLOAT q ~ 0 4. EXEMPT .
455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING
ONo
458 TANK FILLED WITH INERT MATERIAL?
457
98110111
DYes
S:\CUPAFORMS\SWRCB-B.WPD
I~
/",
. A CITY OF BAKERSFIELD A
_ OFFICE OF ENVIRONMENTAL SERVICES .
1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
,
/-'
UST· TANK PAGE 2
. ,;>.
VltP,IPIt4ØCONS~UCTl~(~Ck ånthat.afJPIYX·
ABOVEGROUND PIPING
1. PRESSURE 0 2. SUCTION 0 3. GRAVITY 458 0 1. PRESSURE
1. SINGLE WALL 0 3. LINED TRENCH 0 99. OTHER 460 ,W1. SINGLE WALL
2. DOUBLE WALL 0 95. UNKNOWN 0 2. DOUBLE WALL
MANUFACTURER 461 MANUFACTURER
o 1: BARE STEEL 0 6.\ FRP COMPATIBLE W/1 00% METHANOL 0 1. BARE STEEL
o 2. STAINLESS STEEL 0 7. GALVANIZED STEEL 0 2. STAINLESS STEEL
o 3. PLASTIC COMPATIBLE WITH CONTENTS 095. UNKNOWN 0 3. PLASTIC COMPATIBLE WITH CONTENTS
4. FIBERGLASS 0 8. FLEXIBLE (HDPE) 0 99. OTHER 0 4. FIBERGLASS
5. STEEL WI COATING. 0 9. CATHODIC PROTECTION 464 0 5. STEEL WI COATING
;~:~t~~r0;:?~/-. . ::;:rV}Çp~rl.~(~f~~~·:.D:,;!~¢tJ9~.:(9i~#.f~Þ: ~,át~p¡;i;i:??<.·~::~: .:
UNDERGROUND PIPING
MATERIALS AND
CORROSION
PROTECTION
UNDERGROUND PIPING
. SINGLE WALL PIPING
PRESSURIZED PIPING (Check all that apply):
o 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST J!Y!I!:! AUTO PUMP SHUT OFF FOR
LEAK. SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL
ALARMS
2. MONTHLY 0.2 GPH TEST
o
o 3. ANNUALlNTEGRITY TEST (0.1 GPH)
CONVENTIONAL SUCTION SYSTEMS;
o 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY
TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING);
o 7. SELF MONITORING
GRAVITY FLOW:
o 9. BIENNIAL INTEGRITY TEST (0.1 GPH)
SECONDARJL Y CONTAINED PIPING
PRESSURIZED PIPING (Check all that apply):
1 O~. CONTI~~~)US TURBINE SUMP SENSOR J!Y!I!:! AUDIBLE AND VISUAL ALARMS AND
la. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
. b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM
DISCONNECTION
c. NO AUTO PUMP SHUT OFF
o 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) J!Y!I!:! FLOW SHUT OFF OR
RESTRICTION .
o 12. ANNUALlNTEGRITY TEST (0.1 GPH)
SUCTION/GRAVITY SYSTEM;
o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS
;
1 EMERGENCY GENERATORS ONLY (Check all that apply)
o 4. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND
VISUAL ALARMS .
. 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) ~ FLOW SHUT OFF OR
RESTRICTION
o 16. ANNUAL INTEGRITY TEST (0.1 GPH)
o
o 2. SUCTION
o 95. UNKNOWN
o 99. OTHER
o 3. GRAVITY
459
462
463
o 6. FRP COMPATIBLE WI 100% METHANOL
o 7. GALVANIZED STEEL
o 8. FLEXIBLE (HDPE) 0 99. OTHER
o 9. CATHODIC PROTECTION
o 95. UNKNOWN
465
466
ABOVEGROUND PIPING
SINGLE WALL PIPING
PRESSURIZED PIPING (Check all that apply):
o
467
1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST J!Y!I!:! AUTO PUMP SHUT OFF FOR LEAK.
SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS
o 2. MONTHLY 0.2 GPH TEST
o
o
3. ANNUAL INTEGRITY TEST (0.1 GPH)
4. DAILY VISUAL CHECK
CONVENTIONAL SUCTION SYSTEMS (Check all that apply):
o 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM
o 6. TRIENNIAL INTEGRITY TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING):
o 7. SELF MONITORING
GRAVITY FLOW (Check all that apply):
o 8. DAILY VISUAL MONITORING
o 9. BIENNIAL INTEGRIlY TEST (0.1 GPH)
SECONDARILY CONTAINED PIPING
PRESfRIZED PIPING (Check all that apply):
10. INUOUS TURBINE SUMP SENSOR Y:illJ::! AUDIBLE AND VISUAL ALARMS AND (check one) i.:
. a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ~
. ,
b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION'
i
, c. NO AUTO PUMP SHUT OFF '
o 11. AUTOMATIC LEAK DETECTOR
o 12. ANNUAL INTEGRITY TEST (0.1 GPH)
SUCTION/GRAVITY SYSTEM;
o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS
EMERGENCY GENERATORS ONLY (Check all that apply)
o 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL
ALARMS
o 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST)
16. ANNUALlNTEGRITY TEST (0.1 GPH)
17. DAILY VISUAL CHECK
DISPENSER CONTAINMENT 0 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE
468 0 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS
o 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS
IX. OWNER/OPERATOR SIGNATURE
~4, DAILY VISUAL CHECK
o 5. TRENCH LINER I MONITORING
o 6. NONE 469
UPCF (7/99)
471
Permit expiration Date (For local usa only) 475
DATE
470
472
S:\CUPAFORMS\SWRCB-B.WPD
.. CITY OF BAKERSFIELD.
OFFW:E OF ENVIRONMENTAL S VICES
1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
UNDERGROUND STORAGE TANKS· TANK PAGE 1
(Ð
Page of
o 6. TEMPORARY SITE CLOSURE
o 7. PERMANENTLY CLOSED ON SITE
o 6. TANK REMOVED
430
II. TANK CONTENTS
PETROlEUM TYPE
o 1a. REGUlAR UNLEADED
~Þ. PREMIUM UNlEADED
o 1c. MIOGRAOE UNLEADED
TANK USE 439
1~1. MOTOR VEHiClE. FUEL
I 'f;;,.arlced. complete Petroleum Type)
o 2. NON-FUEL PETROLEUM
o 3. CHEMICAL PRODUCT
o 4. HAZARDOUS WASTE (Includes
Useø 01)
o 95. UNKNOWN
I. TANK DESCRIPTION
432
435 TANK
o 2. LEADED
o 3. DIESEL
o 4. GASOHOL
"'" 0' ""'0' 0 L ,.,,,,,, """" \4. "'I'OfO """" _ nO">""""" on"o,,,,,,,,,,,
(Check one Item only) P' aM ~'=s ()u.;.) ~
o 3. RENEWAL PERMIT ($pacdy 18a$On . lor local use only) (Specdy change - lor local use only)
I BUSINESS NAME (Same as FACILITY NAME ex DBA - Doing Busin_ As) 3 FACILITY 10"
i ~ ~OCJ ~~
, LOCA nON WITHIN SITE ( /Ional)
!
i
431
433
437
COMPARTMENTALIZED TANK 0 Yes
If 'Yes', complete one page fex eacn
436 NUMBER OF COMPARTMENTS
¡
434
436
TYPE OF TANK
(Check one ít8m only)
! TANK MA TERIAl- primary tank
(Cheèk one ít8m only)
m. TANK CONSTRUCTION
o 3. SINGLE WALl WITH
EXTERIOR MEMBRANE LINER
04. SINGLE WALl IN A VAULT
o 1. RUBBER UNED
o 2. AlKYD LINING
o 3. FIBERGlASS I PlAST1C
~4. STEEL CLAD WIFIBERGlASS
f'U REINFORCED PlASTIC FRP
3. FIBERGlASS I PlAST1C
o 4. STEEL CLAD WIFIBERGlASS
REINFORCED PlASTIC (FRP)
o 5. CONCRETE
o 3. EPOXY UNING
o 4. PHENOLIC LINING
TANK MATERIAL - secondaty tank 0 1. BARE STEEL
(Check one ít8m only) 0 2. STAINLESS STEEL
TANK INTERIOR LINING
OR COATING
(Check one ít8m only)
SPILL AND OVERFILL
(Check all the! apply)
0'1> MANUFACTURED CATHODIC 0 3. FIBERGlASS REINFORCED PLASTIC 095, UNKNOWN
PROTECTION 0 4. IMPRESSED CURRENT 0 99. OTHER
o 2. SACRIFICIAl ANODE
YEAR IN~D 450 TYPE (For local use only)
~ 1. SPILL CONTAINMENT ~ 0V>tJ
'lIq 2. DROP TUBE 99 IJ flJ
. 3. STRIKER PlATE . ð r Ít J
',' :':'T?), ~: ;.~ ~~HP7iOl:~~:r:~!~E~7~~~N~?iT~Î(-~~: Q~¢:rn:!I~f~~~t~:;;f~#W~i~1f¡.r·~~¥:{:~~~y~t'[i; ,':.. ,j>::-.';,':;' :~',~..::," "~:t(j~t{U/:Y~~~:;}:::"'·-:'i:~'," :;", "
453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): 454 :
S¿. VISUAL (SINGLE WALL IN VAULT ONL V)
1:. 2. CONTINUOUS INTERSTITIAL MONITORING .
o 3. MANUAL MONITORING
0"
02.
03.
04.
IF SINGLE WALL TANK (CIIecIc aU 1M! apply):
VISUAL (EXPOSED PORTION ONL V)
AUTOMATIC TANK GAUGING (ATG)
CONTINUOUS ATG
440
o 5. JET FUEL
o 6. AVIATION FUEL
o 99. OTHER
441 CAS 1# (from Hazanious Materials Inventory page)
442
o 5. SINGLE WALl WITH INTERNAL BLADDER SYSTEM
. 095. UNKNOWN
099. OTHER
o 5. CONCRETE 0 95. UNKNOWN
o 8. FRP COMPATlBLEW/100% METHANOL 099. OTHER
443
444
o 8. FRP COMPATIBLE W/100% METHANOL
o 9. FRP NON-CORRODIBLE JACKET
o 10. COATED STEEL
o 95. UNKNOWN
099. OTHER
445
o 5. GlASS UNING
o 8. UNlINED
095. UNKNOWN
o 99. OTHER
DATE INSTALlED
447
446
For local use
DATE INSTALLED
449
446
(For local use only)
..' """"'LL """""'~"""""''''''''''''-ED ~'
Æ 1. AlARM (a:1. FILL TUBE SHUT OFF VALVE ¡! .
pv 2. BALL FLOAT 0 4. EXEMPT .
o 5. MANUAL TANK GAUGING (MTG)
o 8. VADOSE ZONE
07. GROUNDWATER
STATISTICAL INVENTORY RECONCILIATION (SIR) + 0 8. TANK TESTING
BIENNIAL TANK TESTING 099. OTHER
V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE
ESTIMATED DATE LAST USED (YRlMOIOAY)
455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING
UPCF (7/99)
458 TANK FILLED WITH INERT MATERIAl?
457
gll'ona
DYes
DNa
S:\CUPAFORMS\SWRCB-B.WPD
,~
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
1. PRESSURE
1. SINGLE WALL
D 2. SUCTION
D 3. LINED TRENCH
D 95. UNKNOWN
D 3. GRAVITY 458
D 99. OTHER 460
MATERIALS AND
CORROSION
PROTECTION
461
D 6. FRP COMPATIBLE W/100% METHANOL
STAINLESS STEEL D 7. GALVANIZED STEEL
. PLASTIC COMPATIBLE WITH CONTENTS D 95. UNKNOWN
4. FIBERGLASS D 8. FLEXIBLE (HDPE) D 99. OTHER
5. STEEL W/ COATING D 9. CATHODIC PROTECTION
UNDERGROUND PIPING
SINGLE WALL PIPING 466
PRESSURIZED PIPING (Check al/ that apply):
D 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR
LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL
ALARMS
D 2. MONTHLY 0.2 GPH TEST
D 3. ANNUAL INTEGRITY TEST (0.1 GPH)
CONVENTIONAL SUCTION SYSTEMS:
D 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY
TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING):
D 7. SELF MONITORING
GRAVITY FLOW:
D 9. BIENNIAL INTEGRITY TEST (0.1 GPH)
SECONDARILY CONTAINED PIPING
PRESSURIZED PIPING (Check all that apply):
10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND
(Check one) -
D a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
~. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM
r- U DISCONNECTION
D c. NO AUTO PUMP SHUT OFF
D 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR
RESTRICTION
~12. ANNUAL INTEGRITY TEST (0.1 GPH)
SUCTION/GRAVITY SYSTEM:
D 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS
EMERGENCY GENERATORS ONLY (Check all that apply)
D 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND
VISUAL ALARMS
D 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) Jtill!::!Q!Jl FLOW SHUT OFF OR
RESTRICTION
&. ANNUAL INTEGRITY TEST (0.1 GPH)
~ 7. DAILY VISUAL CHECK
UPCF (7/99)
UST· TANK PAGE 2
of
D 1. PRESSURE
D 1. SINGLE WALL
D 2. DOUBLE WALL
MANUFACTURER
ABOVEGROUND PIPING
D 2. SUCTION
D 95. UNKNOWN
D 99. OTHER
459
462
D 3. GRAVITY
463
BARE STEEL D 6. FRP COMPATIBLE W/100% METHANOL
STAINLESS STEEL D 7. GALVANIZED STEEL
PLASTIC COMPATIBLE WITH CONTENTS D 8. FLEXIBLE (HDPE) D 99. OTHER
FIBERGLASS D 9. CATHODIC PROTECTION
D 95. UNKNOWN
ABOVEGROUND PIPING
SINGLE WALL PIPING 467
PRESSURIZED PIPING (Check all that apply):
D 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK,
SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS
D 2. MONTHLY 0.2 GPH TEST
D 3. ANNUAL INTEGRITY TEST (0.1 GPH)
D 4. DAILY VISUAL CHECK
CONVENTIONAL SUCTION SYSTEMS (Check al/ that apply):
D 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM
D 6. TRIENNIAL INTEGRITY TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING):
D 7. SELF MONITORING
GRAVITY FLOW (Check al/ that apply):
D 8. DAILY VISUAL MONITORING
D 9. BIENNIAL INTEGRITY TEST (0.1 GPH)
SECONDARILY CONTAINED PIPING
PRESSURIZED PIPING (Check al/ that apply):
NTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (check one)
. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
b. UTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION
D 11. AUTOMATIC LEAK DETECTOR
D 12. ANNUAL INTEGRITY TEST (0.1 GPH)
SUCTION/GRAVITY SYSTEM:
D 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS
EMERGENCY GENERATORS ONLY (Check al/ that apply)
D 14. CONTINUOUS SUMP SENSOR Jtill!::!Q!Jl AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL
ALARMS
D 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST)
D 1 . ANNUAL INTEGRITY TEST (0.1 GPH)
7. DAILY VISUAL CHECK
470
472
Permit Expiration Date (For local use only) 475
S:\CUPAFORMS\SWRCB-B.WPD
.. CITY OF BAKERSFIELD
OFF~ OF ENVIRONMENTAL SE.ICES
1715 Chester Ave., Bakersfield, CA 93301
(661) 326·3979
UNDERGROUND STORAGE TANKS . INSTALLATION
CERTIFICATE OF COMPLIANCE
One form per tank
Page _ of
---.. --..- --.--.....------..
..----.-- .---------- --~- ._-----------_._- - --.--..-...-.---.--
I, FACILITY IDENTIFICATION
BiJsiÑ~ME( meašFAëiL;~'ŠI~~----- ______.___..n______ - ___n_· .. - .-.---. --..---------.
FACILlTYIOØ ¡ IIIWlJ] ~óø M 45 ~ Lt~_~___-_-_~_~_=.=._ '~~~_'_=~~.- ---..---.
II. INSTALLATION
Check all that apply
~ The installer has been certified by the tank and piping manufacturers.
o The installation has been inspec~ed and certified by a registered professional engineer.
.
p The installation has been inspected and approved by the City of Bakersfield Office of Environmental Services.
o All work listed on the manufacturer's installation checklist has been completed.
o The installation contractor has been certified or licensed by the Contractors State License Board.
o Another method was used as allowed by the City of Bakersfield Office of Environmental Services.
Identify method:
III, TANK OWNERlAG~NT SIGNATURE
I certify tI1atlhe Inronnatlon PftIVIded henIIn Is INe & accurate 10 tI1a best of my knowtedge
,-:~~ -~-----~ ~l::fj~Ð ---~~----- --_::_~~~~:
: __ ...~~_~ .__._êLLl..~º-,----------- ___~~__c2;L_(2ÇJ-Æ--- --. -. --.. ---.
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. CITY OF BAKERSFIELD .
OFFIeE OF ENVIRONMENTAL SEJ\lrICES
1715 Chester Ave., Bakersfield, CA 93301
(661) 326-3979
UNDERGROUND STORAGE TANKS ,INSTALLATION
CERTIFICATE OF COMPLIANCE
One form per tank
..----.-- ._----
Page _ of
_____·_.____________._.0.__ __.._. .___ __._.____.
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8uSINess,ÑAMe(SameåiFAëiL~NAM~:;r~1. DBA" . --~ -~
.'ACMY~D'
I, FACILITY IDENTIFICATION
._____.______._.._______ _ _. _ .___." . ... _.... ....n. ___.._...______...___
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II. INSTALLATION
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Check all that apply
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The installer has been certified by the tank and piping manufacturers.
The installation has been inspaded and certified by a registered professional engineer.
The installation has been inspacted and approved by the City of Bakersfield Office of Environmental Services.
All work listed on the manufacturer's installation checklist has been completed.
The installation contractor has been certified or licensed by the Contractors State License Board.
Another method was used as allowed by the City of Bakersfield Office of Environmental Services.
IdentifY method:
III, TANK OWNERlAG~NT SIGNATURE
I c;ertIfy thaI the Infotmallon provided herein Is true & accurate 10 the best 01 my knowledge
SIGNATUÃe ôi: TANK öWÑËRJï\'-NÏ'-' -----.------------ - ---- TÕÃie --.--- -----.---- - .-.. -. .. -------484
. :-NAME~;l~ --.J ~,JI¿¡JJ-L____- .... --..---...
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Form C
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-
.. CITY OF BAKERSFIELD .
OFFIeE'OF ENVIRONMENTAL SE ICES
1715 Chester Ave., Bakersfield, CA 93301
(661) 326·3979
UNDERGROUND STORAGE TANKS ,INSTALLATION
CERTIFICATE OF COMPLIANCE
One lorm per tank
Page _ of
______.__ .______________~_ ·_._____4__·_____· - -----.-.--.-----+---__
_____. __.._ 4____ .... ._____..
I, FACILITY IDENTIFICATION
-------..---.----...-.--------.. .---"-."" ... .-.--.'""-... ..-.......--.--....-.--
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FACILlTYID':: : ~'
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II, INSTALLATION
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The installer has been certified by the tank and piping manufacturers.
The installation has been inspe~ed and certified by a registered professional engineer.
The installation has been inspected and approved by the City of Bakersfield Office of Environmental Services.
All work listed on the manufacturer's installation checklist has been completed.
The installation contractor has been certified or licensed by the Contractors State License Board.
Ano~her method was used as allowed by the City of Bakersfield Office of Environmental Services.
Identify method:
III, TANK OWNERlAGi:NT SIGNATURE
I certify that the inlonnatlon IfOYIded henIIn 18 true & accurate 10 the best of my knowtedge
SlGNATUReÕFTANKÖWÑËR1AGËÑÏ'- -----------.-----------uTõÃie -------.-----. - -. --
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CONFID8JCE UST SERVICE', INC.
417 Montclair Street, Bakersfield, CA 93309 , 800-339-9930 or 805-631-3870
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CUSTOMER ADDRESS:
Jaco Oil Company
P.O. Box 82515
Bakersfield, CA 93380-2515
SITE CONTACT: Debbie
TECHNICIAN: Doug Young
WATER IN BACKFILL: 0.00"
WORK ¡ ORDER: 4155
TEST DATE: 09-27-1999
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I AES SYSTEM j ;i~ î SiEP 3D! /999
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SITE ADDRESS':· ' "- ---------
Fastrip -._~____
4901 South Union Avenue
Bakersfield, CA
: FINAL TEST RESULTS:
ALERT 1000 / ALERT ULLAGE 10S0X / AES PLT-100R
PHONE NUMBER:661-633-7540
PHONE NUMBER:800-339-9930 LICENSE: 99-1076
DATE & TIME OF LAST FUEL DELIVERY:24+ hours
TANK INFORMATION:
(WETTED)
TANK 1
TANK 2
TANK 3
TANK 4
PRODUCT TYPE: " Diesel Regular Supreme
TOTAL GALLONS: 12000 gallons 12000 gällons - - 12000 gallons
PRODUCT LEVEL: 59 inches 66 inches 66.5 inches I~'¡.!¡""
PERCENT FULL: 65% 74% 75% '-'<"~~'t~~;~t.~J :
,.
TEST METHOD: Alert 1000 Alert 1000 Alert 1000 Ii j"" "
.......'f..JJj. fJ
0.00" 0.00" 3.00" '-' f) 19c,
WATER IN TANK:
TANK MATERIAL: Plasteel Plasteel Plasteel -"'t-' I'" ~/:-.;':. ';f./~,~.!/
."
P~S.I.@ BOTTOM: 2.124 psi 1. 65 psi 1.6625 psi '. _i;þ."..
/' c:-I'f
TEST DURATION: 2.1 hours 2.0 hours 2.1 hours ~.. '
FINAL LEAK RATE: +0.037 gph -0.012 gph -0.001 gph
TEST RESULT: PASS PASS PASS
TANK INFORMATION: ALERT lO50X ALERT lO50X ALERT lO50X ALERT lO50X
(ULLAGE)U/F ONLY
ULLAGE GALLONS: . 4174 gall oIls , 3097 gallons 3026 gallons
START PRESSURE : 1. 5 psi 1.5 psi 1. 5 psi
END PRESSURE: 1. 5 psi 1. 5 psi 1.5 psi
TEST RESULT: PASS PASS PASS
PRODUCT LINES: AES PLT-IOOR AES PLT-IOOR AES PLT-IOOR AES PLT-IOOR
LINE TYPE: Pressure Pressure Pressure
START TIME: 7:10a 7:20a 7:25a
END TIME: 7:40a 7:50a 7:55A
-- n -50 psi - 50 psi- - - - 50 psi_
TEST PRESSURE : - - .
FINAL LEAK RATE: -0.002 gph -0.001 gph -0.002 gph
TEST RESULT: PASS PASS PASS
MECHANICAL
LEAK DETECTORS: Red Jacket FTA Red Jacket FTA Red Jacket FTA Red Jacket FTA
MODEL: Electronic Electronic Electronic
SERIAL NUMBER: Shut Down Shut Down Shut Down
CHECK VALVE PSI:
BLEED OFF ml:
LEAK RATE TESTED:
TEST RESULT:
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A) These systems and methods meet or exceed the criteria in USEPA 40CFR parts 280, NFPA 329-87 and all
applicable state codes.
B) Any fa' re listed above may require further action, check with all regulatory agencies.
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T2 : 12999 GAL. REGULAR
T3 : 12999 GALa SUPREME
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SOUTH UNION AVENUE
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PLOT OF ULLAGE TEST DA TA
Fastrip
4901 So. Uno in Ave.
. Bakersfield. CA
12000 GALLON Diesel TANK
12KHz AMPLITUDE RATIO
1.5
750+
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12KHz DETECTION RATIO
.871
25KHz AMPLITUDE RATIO
1.5
5
25KHZ DETECTION RATIO
1. 08
TEST RESULT = PASS
DATE AND TIME OF TEST: 09/27/99 8: 16AM
BEGINNING BOTTLE PRESSURE = 1000 ENDING BOTTLE PRESSURE = 900
BEGINNING TANK PRESSURE = 1.5 PSIG ENDING TANK PRESSURE = 1.5 PSIG
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ALERT TECHNOLOGIES
PLOT OF ULLAGE TEST DA TA
Fastrip
4901 SO.Unoin Ave.
. Bakersfield. CA
12000 GALLON Regular TANK
12KHz AMPLITUDE RATIO
1.5
25KHZ AMPLITUDE RATIO
1.5
750+
M
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12KHz DETECTION RATIO
1. 03
25KHZ DETECTION RATIO
1 .01
TEST RESULT = PASS
DA TE AND TIME OF TEST: 09/27/99 8: 22AM
BEGINNING BOTTLE PRESSURE = 1000 ENDING BOTTLE PRESSURE = 800
BEGINNING TANK PRESSURE = 1.5 PSIG ENDING TANK PRESSURE = 1.5 PSIG
..
750+
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ALERT TECHNOLOGIES
PLOT OF ULLAGE TEST DA TA
Fastrip
4901 SO.Unoin Ave.
, Bakersfield. CA
12000 GALLON Supreme TANK
12KHz AMPLITUDE RATIO
1.5
25KHz AMPLITUDE RATIO
1.5
750+
M
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12KHZ DETECTION RATIO
1. 04
25KHz DETECTION RATIO
1.14
TEST RESULT = PASS
DA TE AND TIME OF TEST: 09/27/99 8: 29AM
BEGINNING BOTTLE PRESSURE = 1000 ENDING BOTTLE PRESSURE = 700
BEGINNING TANK PRESSURE = 1.5 PSIG ENDING TANK PRESSURE = 1.5 PSIG
.
750+
----- ::::EN::XiR ¡::'¡LpIR~'l
L 9: LlNL. EWf"IP '125
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F_ ALARt"1
SEP 29. 1999 12:00 PM
----- SENSOR ALARM
LIO:UNL.ANN. 725
ANNULAF: Sf ACE
FUEL ALARP'I
SEP 29. 1999 12:01 PM
e
f3ENE;OF: AIJ\Rr"l ------._
LI2:PREM LlNL.ANN. 725
ANNULAR E;Pf~CE
F LlEL AU\RJ"l
SEP 29, 1999 12:05 PM
::3ENSO/? ALARr"'1
L 13: DIESEL :3Ui'lP 7::0'5
srp SUI"IP
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L14:DIESEL ANN. 725
ANNULHR SFt:;CE
FUEL AU~Rf"l
SEP 29. 1999 12:06 F~
uA SENE;OE' AU~Rr'l ------
L I_REI"l LlNL. :;:;UI"lP 725
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FUEL AU-ìRr"1
SEP 29. 1999 12:09 PM
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SEP 29. 1999 12:10 PM
-'I'EI"1 e'T"··I·¡·J'·' F.'E~¡:"-"R'r
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- -- -. -. "- - - -- - -- -- -
ALL FUNI:::n ON:::: NORI"IAL
I N\lENTORV FŒPOF!T
T 4 :DIÐ3EL. '/75
\lOLU¡",E '-1:::':::'/
ULLAGE 7795
9œ. ULLACE=' é>=:9]
'\1'0 \lOLUI"IE = 4180
H~IGHT = 36.75
WATER \lOL = 0
1.IF\TER iJ. 00
TE.' = :::9.5
T CJ. JNLE(ìDELi '7;~~:i
\lOLUME 8967
ULLAGE 3033
9œ~ ULUK':;E= 18::::3
Te \lOLUI"IE t1822
HEIGHT 67.16
WYrER \lOL 107
~JATER :~. 92
TEMP 82.9
T 6: PREi"I. UNL . 7:~:;
T I: UNLEPiDED
'v'OLU~'lE
ULLAGE
9œ~ ULLHCE=
Te \/OLUr"lE
HEIGHT
vJATER \lOL
I¡JA TER
T H'U>
T ~:J:PLU;::; 7'lt5
\lOLUt'lE
ULLliCE
9œ. ULLAGE=
Te \/0 L ur"IE
HE.- T =
W ~' . \lOL =
L\/M. '"
TH'1P
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\/0 L Ut"IE
ULU¡GE
90\ ULU\GE=
TC \/OLUP'lE
HEIGHT
~\IATER \/OL
ç",,~\IATER - .
TE~'IP
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91]:;. ULLHGE'~
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HEIGHT
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L..IATER
TH'H>
rl'?:;
(i'?4:='1
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~2085
8567
65.48
o
0.00
88.7
GAL~3
GALS
GAU3
GALS
I NCHE~;
G¡:.)LS
INCHES
LIEG F
~:50f~
1::3527
7:]2:::
C¡:.)L::;
G¡:.)LS
G/iLS
GALE:
INCHES
(';ALS
I NCHEf:
DEG F
:3421
:31.96
o
0.00
9~::. 7
UNL. 77!::ì
~j4'-1 [ GAL:::;
859 I C;HLS
7387 GALS
3374 GALS
~ll .54 I NCHE:3
. 0 GALf.;
",-' CI. CIll J NCHE:3
87.5 DEG F
GALS
GALS
G(~LS
CALS
INCHES
GALS
1 NC HES
[lEG F
G¡!~I..E;
GALS
CALS
GALS
I NC HE:=:;
GALS
I NC HES
DEG F
90:39 GALS
2'361 GALS
1761 GtiL:=:;
8900 GfìL~;
67,66 INCHES
2:::: GALS
I ,[I '7 I NC HES
8i.8 [lEG F
T ?:DIE:3EL 725
I"W' Ur"IE = 71 '/5 Gi:\U:;
I. GE = 4825 C¡:'\LS
~ . ULLAGE= 3625 GALS
TC VOLUME 7101 GALS
HE 1 GHT f:'.i5. '-II I NCHE:=::
(,JATER V()L 0 GALS
~JATER Ci . 00 I NCHE8
TEMP 82.6 DEG F
M * ~ * ~ END ~ ~ ~ ~ *
~,-,:.~
CONFIDfNCE UST SERVICEI, INC.
417 Montclair Street, Bakersfield, CA 93309 , 800-339-9930 or 805-631-3870
:FINAL TEST RESULTS:
ALERT 1000 / ALERT ULLAGE 1050X / AES PLT-100R / AES SYSTEM II
CUSTOMER ADDRESS:
. Jaco Oil Company
P.O. Box 82515
Bakersfield, CA 93380-2515
SITE CONTACT: Debbie
TECHNICIAN: Doug Young
WATER IN BACKFILL: 0 . 00"
WORK ORDER: 4155
SITE ADDRESS:
Fastrip
4901 South Union Avenue
Bakersfield, CA
TEST DATE: 09-27-1999
PHONE NUMBER:6 61- 6 3 3 -7540
PHONE NUMBER:800-339-9930 LICENSE: 99-1076
DATE & TIME OF LAST FUEL DELIVERY:24+ hours
TANK INFORMATION:
(WETTED)
TANK 1
TANK 2
TANK 3
TANK 4
PRODUCT TYPE: Diesel Regular Supreme
TOTAL GALLONS: 12000 gallons 12000 gallons 12000 gallons
PRODUCT LEVEL: 59 inches 66 inches 66.5 inches
PERCENT FULL: 65% 74% 75%
TEST METHOD: Alert 1000 Alert 1000 Alert 1000
WATER IN TANK: 0.00" 0.00" 3.00"
TANK MATERIAL: Plasteel Plasteel Plasteel
P.S.I.@ BOTTOM: 2.124 psi 1. 65 psi 1.6625 psi
TEST DURATION: 2.1 hours 2.0 hours 2.1 hours
FINAL LEAK RATE: +0.037 gph -0.012 gph -0.001 gph
TEST RESULT: PASS PASS PASS
TANK INFORMATION: ALERT lO50X ALERT lO50X ALERT lO50X ALERT lO50X
(ULLAGE) UfF ONLY
ULLAGE GALLONS: 4174 gallons 3097 gallons 3026 gallons
START PRESSURE: 1. 5 psi 1. 5 psi 1. 5 psi
END PRESSURE: 1. 5 psi 1. 5 psi 1. 5 psi
TEST RESULT: PASS . PASS PASS
PRODUCT LINES: AES PLT-1OOR AES PLT-1OOR AES PLT-1OOR AES PLT-1OOR
LINE TYPE: Pressure Pressure Pressure
START TIME: 7:10a 7:20a 7:25a
END TIME: 7:40a 7:50a 7:55A
TEST PRESSURE: 50 psi 50 psi 50 psi
FINAL LEAK RATE: -0.002 gph -0.001 gph -0.002 gph
TEST RESULT: PASS PASS PASS
MECHANICAL Red Jacket Red Jacket Red Jacket
LEAK DETECTORS: Red Jacket FTA FTA FTA FTA
MODEL: Electronic Electronic Electronic
SERIAL NUMBER: Shut Down Shut Down Shut Down
.
CHECK VALVE PSI:
BLEED OFF ml:
LEAK RATE TESTED:
TEST RESULT:
A) These systems and methods meet or exceed the criteria in USEPA 40CFR parts 280, NFPA 329-87 and all
applicable state codes. .
B) Any failure listed above may require further action, check with all regulatory agencies.
-..,-~------...---._.................8t"''''~-'_IID;'''-'____ca.~...__-.__~...--.~____~__-.--.:__.._...ctItIL__.._-.-....~_~~
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13 : 12999 GAL. SUPREME
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Site Layout For: 4991 SOUTH UNION AVENUE , BAKERSFIELD, CA
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ALERT TECHNOLOGIES
PLOT OF ULLAGE TEST DA TA
Fastrip
4901 SO.Unoin Ave.
. Bakersfield. CA
12000 GALLON Diesel TANK
12KHz AMPLITUDE RATIO
1.5
750+
25KHz AMPLITUDE RATIO
1.5
5
25KHz DETECTION RATIO
1. OB
M
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12KHz DETECTION RATIO
.B71
TEST RESULT = PASS
DA TE AND T I ME OF TEST: 09/27/99 B: 16AM
BEGINNING BOTTLE PRESSURE = 1000 ENDING BOTTLE PRESSURE = 900
BEGINNING TANK PRESSURE = 1.5 PSIG ENDING TANK PRESSURE = 1.5 PSIG
..
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750+
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ALERT TECHNOLOGIES
PLOT OF ULLAGE TEST DA TA
Fastrip
4901 So. Uno in Ave.
. Bakersfield. CA
12000 GALLON Regular TANK
12KHz AMPLITUDE RATIO
1.5
25KHz AMPLITUDE RATIO
1.5
750+
M
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5
12KHz DETECTION RATIO
.871
25KHz DETECTION RATIO
1. 08
TEST RESULT = PASS
DATE AND TIME OF TEST: 09/27/99 8: 16AM
BEGINNING BOTTLE PRESSURE = 1000 ENDING BOTTLE PRESSURE = 900
BEGINNING TANK PRESSURE = 1.5 PSIG ENDING TANK PRESSURE = 1.5 PSIG
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..
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ALERT TECHNOLOGIES
PLOT OF ULLAGE TEST DA TA
Fastrip
4901 SO.Unoin Ave.
Bakersf ield. CA
12000 GALLON Supreme TANK
0.75
12KHz AMPLITUDE RATIO
1.5
750+
M
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12KHz DETECTION RATIO
1. 03
0.75
25KHz AMPLITUDE RATIO
1.5
5
25KHz DETECTION RATIO
1. 01
TEST RESULT = PASS
DA TE AND T I ME OF TEST: 09/27/99 8: 22AM
BEGINNING BOTTLE PRESSURE = 1000 ENDING BOTTLE PRESSURE = 800
BEGINNING TANK PRESSURE = 1.5 PSIG ENDING TANK PRESSURE = 1.5 PSIG
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750+
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8-19-1999 3:34PM
FROM JACO OIL CO 8053938738
P.l
Today's D.te ~
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Numberofpag~ ,Jr
Including COver page
lACO OIL COMPANY
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3101 State Road, Baket$field, Ca 93308
Fax 661~393-8738 Office 661-393-7000
Fastrip Food StOres
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Phone: 3';"t:, - J9?9
FaxJ-" tJ5"?ftI
CC:
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Phone:
(661) 393-7000
(661) 393-8738
Fax;
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REMARKS
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URGENT t!&t.. 0/ ß~(J./àl ~'~~E6/h'7
FOR YOUR REVIEW &-ttq-. pr~ n~CtAà( QFrloer-
J
REPLY ASAP
PLEASE COMMENT
If you have any ¡rouble receiving the abolJe specified pages, plea~"e call 661-393-7000
..~
~
','
Confidentiality Notice: This message is intended only for the use of Úle individual of entity designated
above, is confidential and may contain irûonnation that is legally privileged or exempt from di$Glosure under
law. You are hereby notified that any dissemination, distribution, copying or use of or reliance upon the
informatioa c:oøtaîned in an transmitted with this fa.l;simite by or to anyone other than the recipient
designazed above by the sender is Not authOri7ed and striçtly' ørohibited. If you have received thi~
communi(:ation in erTor. please immediately notify the sender by telephone and return it to the sender by
Dhone or destroy if it authorization is wanted bv the: sender. Thank You. Jaco Oil Comnanv
~\ .',
8-19-1999 3:35PM
,:-z=;
FROM JACO OIL CO 8053938738
e
P.2
e
State ofCalífomia
State of Water Resources Control Board
Division of Clean Water Programs
P.o. Sox 944212
Sacramento, CA 94244-2120
For Stale USe: Only
(Instructions on reverse side)
CERTIFICATION OF FINANCIAL RESPONSIBILITY
FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM
A. I am required to demonstrate financial Responsibility in the Required amounts as specified in Seclion 2807, Chapter 18, Div. 3, Tide 23, CCR:
o 500,000 dollars per occurrence
[i] \ million dollars annual aggregate
o I million dollan per occurrence
or
AND
or
o 2 million dollars annual aggregate
8. Jamieson Hi 11 COmpanY herebycettifies that it is in compliance with the requirements of Section 2807,
(Na.718 of Tank Ownel 0/ O~~rato/)
Article 3, Chapter 18, Division 3, TiVe 23, California Code of Regulations.
The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows:
C. Mechanism
T e
Name and Address ot Issuer
Mechanism
Number
Coverage
Amount
Coverage Corrective Third Party
Period Action Com
state Fund
state of Calif.
$ 990,000
Cont
Yes
Yes
elf Insuranc Jamieson Hill Co
P.o. Box 82515
Bakersfield, CA
93380-2515
$ 10,000
Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and $ubmission of
this certificaiion also cf3rtifies that you are in compliance with all conditions for participation in the Fund. . .
D. Facility Name Facility Address
Fastrip #12 692 s. San Jacinto, San Jacinto
Facili!y Name Fac:îlity Address
Fastrip #19 4901 s. Union Ave. , Bakersfield
Faâlity Name Facility Address
Date ' Name and Title of Tank Owner or Operator
6/1/99
Date
T.J. Jantieson
Name of Witness or Not3ry
General Partner
6/1/99
Brian Busacca
f"lLE: Original. Loc.1 Agenq
Copies - Fací\ieylSire(s)
8-19-1999 3:35PM
)~
FROM JACO OIL CO 8053938738
e e
Jaco Oil Company
P.3
:r:, , /'Ie ^
...
3101 State Road Bakersfield, California 93308 *.. P O. Box 1807 Bakersfield, California 93303-1807
Phone; 80S 393-7000 . Fax: 80539J..8738
June 1, 1999
LETTER FROM CHIEF FINANCIAL OFFICER
I am the Chief Financial Officer for Jamieson Hill Company. This letter is in support of the
Underground Storage Tank Cleanup Fund to demonstrate financial responsibility for taking corrective
action and/or compensating third parties for bodily injury and property damage caused by an
unauthorized release of petroleum in the amount of at least $10,000 per occurrence, and $10,000
annual aggregate coverage. Underground storage tanks at the following facilities are assured by this
letter.
Fastrip #18,2199 Hwy 95, Bullhead City, AZ. 86442
1. Amount of annual aggregate coverage being assured by this letter: $ 10,000
2. Total tangible assets: 6,146,124
3. Total liabilities: 2,081,494
4. Tangible net worth: 4,064,630
I hereby certify that the wording of this letter is identical to the wording specified by subsectiòn
2801.1 (d)(1), Chapter 18, Division 3. TItle 23 of the California Code of Regulations.
I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge
and beliet
Executed at ~Ié-o~ 1999
Signature ~ ~ -- - - ?
Name: Brian Busacc;:a
Title: Chief Financial Officer
08/16/99 10:51
a
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-
NO. 484 [;101
Ii I
I
v
Gray Davis
Gf1IlerrfQT
State Water Resources Control Board
WlDstQIl R Hickox
Særèlflrj for
Er¡vjl'01/Ttl1!lllol
PrtJlcclton
Division of Clean Water Programs
2014 T Street . S~ramento. California 958]4' (916) 227-44] I
Mailing Address; P.O. Box 944212 . S!lCrumc:nto, California' 94244-2120
FAX (916) 227·4530· IT1ternet Address: bttp:llwww.swrc.b.C8.gav/-c~\¡Qrneluslcf
FAX MEMORANDUM
TO: Howard Wines
City of Bakersfield Fire Department
Fax Number: (661) 326-0576
FROM: Sandy Gill~ (916) 227-4411, FAX (916) 227-4530
Claim Review Unit
USTCLEANUPFUNDPROG~
DIVISION OF CLEAN WATER PROGRAMS
2014 T Street, Sacramento, CA 95814
DATE: August 16, 1999
SUBJECT: Detailed Reviews
. i
Here is a listing of the files I wìll be reviewing at your office 011 Wednesda.y, August 25, 1999 at
1 :00 p.m. I will be accompanied by a co-worker, Shad Knieriem. We will be lookìng for
compliance confirmation, including current Certification of Financial Responsibility and 1998
Upgrade. Thanks!
Iamieson·Hill Co
RL Ragsdale Ine
4901 Union S, Bakersfield.
726 Union S, Bakersfield
Clll1forl110 ElIf'ironmelJtll1 ProœctílJl1 Ageßcy
'-AC&JTY OWNER
AUJ>I . I ~ . -',
CITY.ZIP CITY. ZIP
PHONE NO. ....... II
8AKF~SFIELD CITY FIRE DEPARDENT
O~ OF ENVIRONMENTAL Sftl'llCES
INSPECTION RECORD
POST CARD AT JOBSITE
~ ........ tar.. i...... ,..,.... -.:II groupcl i~I6...............,...... n.,..IUIt. ... I f III.. arder ..~....", :
.... IU'I'IÞW 1. DO NOT oawr... tar.., nurne..d group...... 1Inw.. II1II graup.. ........... FII......~. r-~It. L. __ inIa'UaIøM.'" i
reduCe .. ~ of NqUINd ....... ... .., 1Io...Â4. ~ II J 1 J J _II of ........ .... .
TANKS AND BACKFILL
11M _.WIft
a.- of T-*(S)
C~) <83QV93 '~IL 10" <lQ(~1tA
PIPING SYSTEM
PIping .. ~ wJColedian Sump ~(Z{M~ ð K. <Y'11· (<i<¡ /JA
Conaeion F........... of ~ JointI. AI Ptpe5etÐeJau.} IJfL f.J1::i- q-Il/-r¡1 J/f
~k* IIoIdan of ""*'v F10m Tame(I'
Cd10dIc p,~, SVstIQ..-PIping
I
I
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Liner n° ~ - :''1 . TIIM I)
Liner Ir'- ~ . -.,-/I . ""*'v
Vault WIIt'I Product ComøâCIe SNIet I
:
l..8YeI Gaugee Of SeneorI. Float Vent Vafvee
I q ~ ]1f / ï j
Product CotnødÞte AI Box(_, II
: t¡J~dq, f 7 ¿þ
Product Line LaM on.ctDr(l)
I tf-J1~ q i -rJ I,i
LaM DetKtrM(l) tor Annular Spece.O.W. Tanlc(I' " ....,
MonIlOmg w.l(1)/8Umø(I'; ~O Test 9-/£/- 1'1 ~/¡¡¡I /}
.....
LaM ~ o.va(l) for V~roundw'"
SECONDARY CONTAINMENT. OVERFILL PROTECTION. LEAK DETECTION
ANAL
Monrtomg w..... C&o. & l.odœ
F. Sax l.odc
~~
CONTAACTOR 4Uf15d- /h('dtaVllC J
,....,...,.ar,. /tt\fJ.f't {3/tJ.ct6cJnt\ or
~,
PHON& , ~ j- >a,O
~ a ~ \ ~'D~ l/ f
." "PermitNo, ~- 'to\-!
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (805) 326-3979
PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK
TYPE OF APPLICATION (CHECK)
[ ]NEW FACILITY ~MODIFICATION OF FACILITY []NEW TANK INSTALLATION AT EXISTING FACILITY
~....,vve. qß
ZIP CODE ~=5Bo ?
APN#
PHONE NO. m:.a-7"ðO
ZIP CODE '?3So R
CA LICENSE NO.
CITY",.. ZIP CODE 9 ð3 ¿;) e
BAKERSFIELD CITY BUSINESS LICENSE NO. t:M/ ,h'>-_
INSURER ð '"V'" A "c.- v:;.. .
;:¡::;';>:srp>.vi- nielð* /..2 c:vo ~H¿vl¿:.s
WATER TO FACILITY p,ROVIDEDBY - ¿ Wl4nL~
DEPTII TO GROUND WÁTER /'#0 -f- SOIL TYPE EXPECTED AT SITE }4 "'-L c.l
NO. OF TANKS TO BE INSTALLED ,3 ARE TIlEY FOR MOTOR FlÆL ")¿J YES NO
SPILL PREVENTION CÒNTROL AL'\¡1) COUNTER MEASURES PLAN ON FILE )ð YES NO
SECTION FOR MOTOR FUEL
+
...~
VOLUME
/,9pCJO
/o,.pc?()
/;;Jr c:J(!:;)
TANK NO.
VOLUME
UNLEADED
&.---
DIESEL
AVIATION
REGULAR
PREMIUM
~
¡..-
SECTION FOR NON MOTOR FUEL STORAGE TANKS
CHEMICAL STORED CAS NO.
(NO BRAND NAME) r- ; (IF KNOWN)
CH;~MICAL PREVIOUSLY STORED
TIlE APPLICANT HAS RECEIVED, UNDERSTANDS, AND ~L COMPLY WITH rim ATrACHED co~~tNfö~~·~
TIllS PERMIT AND ANY OTIlER STATE, LOCAL AND FEDERAL REGULATIONS.
TIllS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO TIlE BEST OF
~
_// /IØI¡¿/é &~,~gV/eo/
. APPLICANT NAME (PRINT)
THIS APPLICA nON BECOMES A PERMIT W
/
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State 'aterResources Contt!PBoard
Winston H. Hickox
Secretary for
Environmental
Protection
Division of Clean Water Programs
2014 T Street' Sacramento. California 95814' (916) 227-4411
Mailing Address: P.O. Box 944212' Sacramento. California' 94244-2120
FAX (916) 227-4530' Internet Address: http://www.swrcb.ca.gov/-cwphome/ustcf
Gray Davis
Governor
June 9, 1999
¡.
I ~ -.-.
- --
Brian Busacca
J amieson- Hill
POBox 82515
Bakersfield, CA 93380
. -:-- ~TJÑDERGRÕfffi1)-STORAGE-T-kNR·eLEMrnP-FUND-PROGR.A..:.l\1,.NOTICE OF__ELIGIDILITY. .
DETERMINATION: CLAIM NUMBER 014194; FOR SITE ADDRESS: 4901 UNION Á VE S,· .-. ~---' - -~~ -.-
BAKERSFIELD
Your claim has been accepted for placement on the Priority List in Priority Class "C" with a deductible
of $5,000.
I
I
I
Compliance Review: After adoption of the Priority List, staff will review, verify, and process
applications based on their priority and rank within a priority class. During this Compliance Review,
staff may request additional information needed to verify eligibility. Once review of the application is
complete and the claim is determined to be valid, a Letter of Commitment will be issued Qbligating funds
toward the cleanup. After the compliance review, your claim maybe rejected if Division staff determine
that you have not complied with regulations governing site cleanup, you have not supplied necessary
information or documentation, or your claim application contains a material error. In such event, you will
be issued a Notice of Intended Removal from the Priority List, informed of the basis for the proposed
removal of your claim, and provided an opportunity to correct the condition that is the basis for the
proposed removal. Your claim will be barred from further participation in the Fund, however, if the
claim application contains a material error resulting from fraud or intentional or negligent
misrepresentation.
-
Record keeping: During your cleanup project you should keep complete and well organized records of
all corrective action activity and payment transactions. If you are eventually issued a Letter of
C6rimìitmerit;:you will be -rêqüîred-tõ suhmit:- (1) copies of detailed invoices -forall corrective- açtion- -
activity performed (including subcontractor invoices), (2) copies of canceled checks used to pay for work
shown on the invoices, (3) copies of technical documents (bids, narrative work description, reports), and
(4) evidence that the claimant paid for the work performed (not paid by another party). These documents
are necessary for reimbursement and failure to submit them could impact the amount of reimbursement
made by the Fund. It is not necessary to submit these documents at this time; however, they will
definitely be required prior to reimbursement,
Compliance with Corrective Action Requirements: In order to be reimbursed for your eligible costs of
e1~anup incurred after December 2, 199), you must have complied with corrective action requirements of
Article 11, Chapter 16, Division 3,Title 23, California Code of Regulations. Article 11. categorized the
cor.rective action process into phases. In addition, Article 11 requires the responsible party to submit an
investigative work plan/Corrective Action Plan (CAP) before performing any work. This phasing
process and the workplan/CAP requirements were intended to:
California Environmental Protection Agency
o Recycled Paper
/
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-
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J amieson- Hill
-2-
June 9, 1999
1. help the responsible party undertake the necessary corrective action in a cost-etTective, efficient and
timely manner;
2. enable the regulatory agency to review and approve the proposed cost-effective corrective action
alternative before any corrective action work was performed; and
3. ensure the Fund will only reimburse the most cost-effective corrective action alternative required by
the regulatory agency to achieve the minimum cleanup necessary to protect human health, safety and
the environment. . .
In some limited situations interim cleanup will be necessary to mitigate a demonstrated immediate
'hazardto'publichea1th,.or-the,-enyironmenkJ~rogram regul~tions allow the responsible party to undertake
interim remedial action after: (1) notifying the regulatoÏyâgenc-y of the propôseê[ ãctiöi1, ariâ;' (2)--'-'- -.~-"-~~-
complying with any requirements that the regulatory agency may set. Interim remedial action should
only be proposed when necessary to mitigate an immediate demonstrated hazard. Implementing interim
remedial action does not eliminate the requirement for a CAP and an evaluation of the most cost-
effective corrective action alternative.
Three bids and Cost PreapDfoval: Only corrective action costs required by the regulatory agency to
protect human health, safety and the environment can be claimed for reimbursement. You must comply
with all regulatory agency time schedules and requirements and you must obtain three bids for any
required corrective action. Unless waived in writing, you are required to obtain preapproval of costs for
all future corrective action work. If you do not obtain three bids and cóst preapproval, reimbursement
is not assured and costs may be rejected as ineligible,
If you have any questions, please contact me at (916) 227-4411.
Sincerely,
~~
Sandy Gill
"'.- ClaÍInsReviewUnit _ ._._ _ .__._
Underground Storage Tank Cleanup Fund
.-. . -"-.-
- . ~---. - .-
cc: Mr. John Noonan
RWQCB, Reg. 5- Fresno
3614 E. Ashlan Ave.
Fresno, CA 93726
Mr. Howard Wines
City of Bakersfield Fire Dept.
1715 Chester Ave., 3rd Floor
Bakersfield, CA 93301
California Environmental Protection Agency
o Recycled Paper
AI
-'
SUNSET MECHANICAL .-
3612 PANORAMA DR. BAKERSFIELD CA.
(8œ 322-0600
Continuous Monitoring DevJcè Certification
FACILItY NUMS/!R
7S'
CONTACT PIiRSONd-o~^-f
ADDRESS
CITY t9-~.
MAKe AND MOOeL OF MONITORING SYSTEM
-r2S
~Y-CJ
,
Contents of Tank
Capacity of Tank
Type of Product line: (Gravity, Suction, Pressure).
INDICATE lOCATION OF THE MONITORING SENSORS TESTED BY PLACING A YES OR No IN APPLICABLE 80X:
Annular Space Sensor G.o': --
1~.5 "7
Sump Sensor YéS ........
. .....
Dispenser Contal.nment Sensor .~ -
'iiifIØ""
Electronic O'Jerfilll Level ,~~ ..,I ---
/Ø - ~
Electronic In-LIne Leak Detector -
~, --
, r~~ ......
Mechanical LIne Leak Detector --
In Tank Gauging bevice , If'" - ~
.
INDICATE THE fOLLOWING BY PLACING A YES OR NO IN APPLICABLE BOX:
~ .L
poes the monitoring system have audible and vi5uaJ alarms? -
Does the turbine automatically shut-down if the system detects v - - -..".
a leak, fails to operate or is electronically disconnected? I/~~
Is the monitoring system Installed to prevent unauthorized tampering? ~~ - ,
Is the monitoring system op~rab'eas per the manufacturer's sp~cificélti:Jns? Ir~~ -....
.
S,GNArUR:! OF CERTIFIED TECt'I~IICIA'N ~
~/t....
Which continuous moni~orin9 devices Initlat~ positive shut-down of the turbIne?
CERTIFIED TESTER'S I[}#
DAT~_
P RI:-rr:o f.i-~,~.~= C~ C~ ~i"J~;~:) -r::~H'~: :4:.:~.~:
,
ïESTln3 C0~,P~.:-f( t'.':'.:.~: e·. "~LE?;-i )~.:: (:
- -..:-.-
.
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---
BAKERSFIBLD
PIRB DBPARTMBNT
FAX Transmittal
TO: Cµr(t S ~c.J r2.Gc~
COMPANY: - KGþ 'é7 -A<-
FROM: -==¡{~f.V!D W (~5
Office of Environmental Services
FAX No, (805) 326-0576 · Bus No. (805) 326-3979
1715 Chester Ave, · Bakersfield, CA 93301
FAX No: '5 '26 . o¿¡ (fT
COMMENTS: ......f.:1./::!?::.~.........1s.......~?.T.~......~......q.~~~.E~.~~~~.~.~.....J.~........ç~.~.~~~.......?~.~.~~
...........................................................................................................................................................................................................................................~.
................................................................................................................................................................................................................................................................
..............-....................................................................................................................................................................................................................................................
.........................................................................................................-.........................................~~........................._.......................................................-.-...............-.............;....
.....................................................................................................................................................................................................................................................................................
--
.................................................................................................................................................................................................................................................................
....................................................................................................................................................................................................................................................................
............................................................................................~....................................................................................................................................................................-....................................
..................................................................................................................................................................................................................................................................................
........................................................................................................................................................................................................................................................................
...........................................................................................................................................................................................................................................................................
....................................................................................................................................................................................................................................................................................
.............................................................................u.......n.........u..........u.........................................................................u........n.......................................................................................
..................................................................................................................................................................................................................................................................
............................................................................................................................................................................................................................................................................................
.......................................................................................................................................................................................................................................................................................................
,
........................................................................................................................................................................................................................................................................................................
..................................................................................................................................................................................................................................................................
. ..............................................................................................................................................................................................................................................................................
................................................................................................................................................................................................................................................................................................
.........................................................................................................................................................................................................................................................................
..................................................................................................................................................................................................................................................................
Ie
.
UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) I CONTAMINATION SITE REPORT
EMERGENCY
DYES
HAS STATE OFFICE OF EMERGENCY SERVICES
REPORT BEEN FILED?
o YES NO
NO
>-
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cr:
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9
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I- DATE DISCOVERED
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HOW DISCOVERED 0
. 0 TANK TEST ~:
;::1..
~~t ~.
UNKNOWN
,... ..'
~w
a:UJ
ðJ
UJð
'. .
ftJ - UNKNOWN'; ':.
b.... OTHER .. .
Ww
~a.
o~
CHECK ONE ONLY
D UNDETERMINED
CHECK ONE ONLY
o NO ACTION TAKEN
D LEAK BEING CONFIRMED
D REMEOIATION PlAN
CHECK APPROPRIATE ACTION(S)
___œrAU!
o ~SITE(CO
o CONTAINMENT BARRIER (CB)
o VACUUM EXTRACT (VE)
~XCAVATE & DISPOSE (ED)
o EXCAVATE & TREAT (E1)
o NO ACTION RECUIRED (HA)
o OTHER (OT)
NAME
0 UNKNOWN
0 UNKNOWN
INVENTORY CONTROL. 0 S~URFACE MONITORING 0 NUISANCE CONDITIONS
TANK REMOVAL . ::DOTHE~
METHOD USED TO STOP DISCHARGe (CHECK ALL THAT APPLY) .
o REMOvÉ CÇ>~NTsd!0LÓsE !ANK & REMOVE " 0 REP~'R ~IPI~~ 5
o REPAIR TANK .'~ OJ ClOSE TANK & FILL IN PLACE 0 CHANGE PROCE£>.URE
,. 0 REPl.AΠTANK"; : G OTHER' : :. '.:
D 'R~PTUÁEiFAILURE
UNKNOWN
o SPILL
D OTHER
SOIL ONLY
o GROUNDWATER 0 DRINKING WATER· (CHECK ONLY IF WATER WELLS HAVE ACruALLY BEEN AFFECTED)
I-UJ
z~
II! <
cr:1-
5UJ
D
D
PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED
PRELIMINARY SITE ASSESSMENT UNDERWAY
CASE CLOSED (ClEANUP COMPLETED OR UNNECESSARY)
~~
@I-
::10
II! <
D
D
W
POLLUTION CHARACTERIZATION
POST CLEANUP MONITORING IN PROGRESS
CLEANUP UNDERWAY
D
D
o
REMOVE FREE PRODUCT (FP) D
PUMP & TREAT OROUNDWATER (OT) 0
TREATMENT AT HOOKUP (HU) 0
ENHANCED BIO DEGRADATION (IT)
REPLACE SUPPLY (RS)
VENT SOIL (VS)
~ ¡JÖ-rC:. {?BvrG/:;)(AL-. CVC-<.éXC~vA-1iOllJ W4.$ P&efÖrV1"tc50 UNí)&e-, -mE
~ 1> R..EC'toN oP {4E LOCAL AGc'-.JcY Co-Jcuel2c-ur¡-. w t-n+-~ f<é-wrClvAL ~
~ ~~-IN~rA'-(.4r1c1l\J oF NEW US'(s, ÞU«',J~ "T~c T'I'V'Iè oç oPC-r-J EXCAJI.\.1íO~. W
HSC 05 C8I8OI
05/11/99
13:16
'B805 326 0576
TRANSMISSION OK
TX/RX NO.
CONNECTION TEL
CONNECTION ID
START TIME
USAGE TIME
PAGES
RESULT
BFD HAZ ~IAT DIV
***************************
*** ACTIVITY REPORT ***
***************************
1466
3260418
05/11 13: 14
01'21
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State .ter Resources Contr.oard
Winston H. Hickox
Secretary for
Environmental
Protection
Division of Clean Water Programs
2014 T Street· Sacramento, California 95814' (916) 227-4411
Mailing Address: P.O. Box 944212' Sacramento, Calitornia' 94244-2120
FAX (916) 227-4530' Internet'Address: http://www.swrcb.ca.gov/-cwphome/ustcf
Gray Davis
Qoyernor
Brian Busacca
Jamieson-Hill
POBox 82515
Bakersfield, CA 93380
April 22, 1999
UNDERGROUND STORAGE TANK CLEANUP FUND PROGRAM, REQUEST FOR
. 'FURTHER~D0CUM:ENTATION DURING·INITIALREVIEW-:-GLAIM· }"TUMBER'014194;
FOR SITE ADDRESS: 4901 UNION AVE S, BAKERSFIELD
After reviewing your claim application to the Cleanup Fund, we find that the following
additional information is needed to determine your eligibility for placement on the Priority List:
Verification from the local agency that an unauthorized release of petroleum from the UST was
discovered on a specified date. You submitted an Unauthorized Release Form (URF) that was
not signed by the Bakersfield Fire Department. This is not acceptable.
C9PY of a letter from the local regulatory agency naming J amieson- Hill a responsible party aµd
directing Jamieson-Hill to clean up the contamination at the subject site. You provided a copy of
the "No Further Action" letter addressed to JACO Oil. This is not acceptable. The'claimant
must be named a responsible party and must be directed to cleanup by the regulatory agency.
Please provide the'claimant status for Jamieson-Hill (partnership or corporation). Provide a
listing of the owners or majority shareholders of the corporation or the general partners of the
partnership. Provide the same information for all affiliates (JACO Oil, IT. Company, etc.) and
explain their relationship.
To quality for príöiit'iClass' C,prõvidé" p"roofofthè ¡lUmber of full-tinIe ahd part-time
employees for Jamieson-Hill and all affiliates (e.g., latest DE3 Form submitted to Employment
Development Department quarterly).
You are required to demonstrate financial responsibility. The "Letter from Chief Financial
Officer" that you submitted is dated August 1, 1994. You did not submit a copy of the
"Certification of Financial Responsibility". Enclosed are forms and instructions. Please submit
(l!coPy ofthe:up~ated forms, keep·.acopy at each facility, and mail the original to the local
agency.- Questions regarging ·financial respònsibility should be d.irected to Judi 'Nash at (916)
227;4527.; .... . . ...'~' . ~ ~..' . . .. . . - '" '. . .
i'
Califomia Ell virollmelltal Protectioll Agellcy
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Jamieson-Hill
-2-
April 22, 1999
NOTE: Failure to respond to this request within thirty (30) calendar days from the date of this
letter may result in an ineligibility determination of your claim.'
If you have any questions, please contact me at (916) 227-4411.
Sincerely,
~t~
Sandy Gill
Clàims' ReviewUnit·- ~
Underground Storage Tank Cleanup Fund
--.. -~ ,. ~-
cc: Mr. John Noonan
RWQCB, Reg. 5 - Fresno
3614 E. Ashlan Ave.
Fresno, CA 93726
Mr. Howard Wines
City of Bakersfield Fire Dept.
1715 Chester Ave., 3rd Floor
Bakersfield, CA 93301
..- - - - -. - -
California Environmental Protection Agency
o Recycled Paper
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 'W Street
Bakersfield. CA 93301
VOICE (805) 326-3941
FAX (805) 395-1349
SUPPRESSION SERVICES
2101 'W Street
Bakersfield. CA 93301
VOICE (805) 326-3941
FAX (805) 395-1349
PREVENTION SERVICES
1715 Chester Ave.
Bakersfield. CA 93301
VOICE (805) 326-3951
FAX (805) 326-0576
ENVIRONMENTAL SERVICES
1715 Chester Ave.
Bakersfield. CA 93301
VOICE (805) 326-3979
FAX (805) 326-0576
TRAINING DMSION
5642 Victor Ave.
Bakersfield. CA 93308
VOICE (805) 399-4697
FAX(805)3~5763
--
Fastrip Food Store # 19
490 I S. Union Avenue
Bakersfield, CA 93307
e~'
February 9, 1999
RE: Compliance Inspection
Dear Underground Storage Tank Owner:
The city will start compliance inspections on all fueling stations
within the city limits. This inspection will include business plans,
underground storage tanks and monitoring systems, and hazardous
materials inspection.
To assist you in preparing for this inspection, this office is
enclosing a checklist for your convenience. Please take time to read this
list, and verify that your facility has met all the necessary requirements to
be in compliance.
Should you have any questions, please feel rree to contact me at
805-326-3979.
SBU/dm
enclosure
S), tI4wv
Steve Underwood
Underground Storage Tank Inspector
Office of Environmental Services
""..9'~ de Won~ ~ .§6~ ff~ .A We.nm~'I'I
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.
.
KLEIN, DENATALE, GOLDNER,
COOPER,. ROSENLIEB & KIMBALL, LLP
Anthony J. Klein
Thomas V. DeNatale, Jr.
Barry L. Goldner
J. L. Rosenlieb
David J. Cooper
Claude P. Kimball
William A. Bruce
Leonard K. Welsh
Christopher P. Burger
Ned E. Dunphy
Mel Ehrlich
Kevin C. Findley
Krystyna L. Jamieson
Barry E. Rosenberg
LAWYERS
T. Scott Belden
Catherine E. Bennett
David D. Blaine
Nancy L. Oehler
Timothy G. Scanlon
Andrea Selvidge
4550 CALIFORNIA AVENUE
SECOND FLOOR
BAKERSFIELD, CA 93309
MAILING ADDRESS:
P.O. BOX 11172 '
; BAKERSFIELD, CA 93389-1172
(80S) 395-1000
FAX (805) 326-0418
E-MAIL kleinlaw@kleinlaw.com
OF COUNSEL
Bruce F. Bunker
Thomas C. Fa1lgatter
Craig D. Braun
Mr. Howard Wines, III
Hazardous Materials Technician
Bakersfield Fire Department
Environmental Services
1715 Chester Avenue
Bakersfield, California 93301
I
I
0-';'
I
,February 2, 1999
Re: Fastrip Food Store
4901 So. Union,Avenue
Bakersfield, CA
Dear Mr. Wines:
Enclosed please find a completed "Underground Storage Tank
Unauthorized Release (Le~k)/Contamination Site Report" completed
for the above-referenced' facility. Please execute and distribute
copies of the form as sh?wn on the instruction sheet on the back
page of the form.
Thank you for your cooperation in this matter. Should you
have questions or concerns regarding the enclosure or any other
aspect of this matter, please feel free to contact me.
C
CPB : j m
Ene. as noted
cc: Mr. Brian Busacca
Jamieson-Hill
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.....'/
UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) I CONTAMINATION SITE REPORT
EMERGENCY
DYES
HAS STATE OFFICE OJ: EMERGENCY SERVICES
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D YES NO
NO
REPORT DATE
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HOW DISCOVERED
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TANK REMOVAL D OTHER
METHOD USED TO STOP DISCHARGE (CHECK ALL "Il-IAT APPLY)
D REMOVE CONTENTS.~LOSE TANK & REMOVE D REPAIR PIPING
D REPAIR TANK D CLOSE TANK & FILL IN PLACE D CHANGE PROCEDURE
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CAUSE(S)
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DATE DISCOVERED
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D NO ACTION TAKEN
D LEAK BEING CONFIRMED
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CHECK APPROPRIATE ACTION(S)
(SEE BACK FOR DETALS
D CAP SITE (CD)
D CONTAINMENT BARRIER (CB)
D VACUUM EXTRACT (VE)
ENHANCED BIO DEGRADATION (IT)
REPLACE SUPPLY (RS)
VENT SOIL (VS)
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D PRELIMINARY SITE ASSESSMENT WORKPLAN SUBMITTED
D PRELIMINARY SITE ASSESSMENT UNDERWAY
, CASE CLOSED (CLEANUP COMPLETED OR UNNECESSARY)
POLLUTION CHARACTERIZATION
POST CLEANUP MONITORING IN PROGRESS
CLEANUP UNDERWAY
~XCAVATE & DISPOSE (EO)
D EXCAVATE&TREAT(ET)
D NO ACTION REQUIRED (NA)
D OTHER (OT)
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PUMP & TREAT GROUNDWATER (GT) D
TREATMENT AT HOOKUP (HU) D
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