HomeMy WebLinkAboutUNDERGROUND TANK FILE #2
UNIFIED PROGRAM INtECTION CHECKLIST
SECTION 1 Business Plan and Inventory Program
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_~__~__JJ1_~ß1_____d____~___________________________~ _~__,_~____ __,
FACILlTYCONTACT Business ID Number
Bakersfield Fire Dept.
Enironmental Services
1715 Chester Ave
Bakersfield. CA 9330 I
Tel: (661)326-3979
INS~EfTI~ŽDATE INSPECTION TIME
'S/Z1/04-
PHONE-Ño.-' ----'¡;¡O-öTËrÏipïë,ý'ees - ---,
15-021-
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Section 1: Business Plan and Inventory Program
o Routine
Combined
o Joint Agency
o Multi-Agency
o Complaint
ORe-inspection
C V
( C=Compliance )
V=Violation
OPERATION
COMMENTS
_~_~_ Ap~RO~~~~E, PE~~~~~~~~~____, ____m________________
_ . _._._ _._.______.. ._____u.._.____.__"____..
n...._____ ____n.....
__'__ ____._.._...u_...._
---,---
~ 0 BUSINESS PLAN CONTACT INFORMATION ACCURATE
-þ(-~'---~~SIBLE AD~RESS----------------------'---------~------- -- - -,-,---,---- ___u_,____ -- -- '________n
f-=-'-------,----,-~,---~------~-----~---------,----,--,---,--___,_ ___
W 0 CORRECT OCCUPANCY
~,----,-----------------,-----,-,--,~--~--,----------- __, _,___ ______,,_____,__'u,_______ __,__m_ _m_______n'_____'_u__ __ ,__,____ ______,_
_~~~__uVERI~~~~ON OF ~~NT~~~_ MATE_~~~:_____________
þ( 0 VE~IFICATION OF QUANTITIES
f----,--~---- _'_______,__________"___,n'____"",___,____",_
~ 0 VERIFICATION OF LOCATION
----_.__.~-~---------------------_._------------_._----.----.--....---- ---_._----_._._-----~---_._..- ..._._._..._--~-_..._--~_...._- --.-...........--.-
li___O _~RO:ER ~EG~EG~~~~~~~~TE~~~__'_n_____u__u_,__ ____________,_,_",___, __ _________,_______________, _,____,,___
1- : --~~:~::: ~~~~A:V::~~E -. _u_ m - -- -. ----- -- .- - - -- -.-- --- _u_ -- - -- -. -. - -.-.
..:,~-----,-------,-~-----,----,-,-,---,-----, ------ , -- -'n'n't-'__________, __, _________,__,______,__ _ ____,_______", """ _____ "
~ 0 VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES - ___n_,..
, ~~~'----------- ______,_,___"__n__'_________________ ----'_'_____,______,_______..___,___,,__'___..'n' ____ _,______,_____ ,________,___,__ _" _'__n_____ __,
..;( l] EMERGENCY PROCEDURES ADEQUATE
-D---___~__u___'uu,___'u_________,__________,__________,_____u______u,__ ______n__'..'_____+,,__,__________,_, ,___,,__,_ 'u",_, "__ __,_____ _ ,____ _ _ , ___'u,_,
'M LI CONTAINERS PROPERLY LABELED I
,ß--,--,--~,____,_________"_,___ __~,__,______,_,___ _______ _'n____'__ ,__, --,-L,----, ___,_____, __ _, ,_____'u_______,_ __nu__" ____", ______ ___ ,__
'rfl'f 0 HOUSEKEEPING, 1
-~---,--,-,--"-----u------'--'-n~-------,--------,--,~,--_____ ___ __~__,__,_,_u____,_____________ '_,___,_,__,___,________ _, _,___,~___
t.,¡ 0 FIRE PROTECTION
-_.1._______.___~_____________.__ -_______.__.._..___.______.______._ .________ _._______..~__.__ ____________._._ ______n'____ :____.__._________...__ ._._ ._.____._ ______+__.._____n_.._... _ .. __.n ____..
~ LI SITE DIAGRAM ADEQUATE & ON HAND ,
. .._._... h__..___.._..__..__
m ____ _.___ _____ __..__"..._.____._._ .__.___._." __.. ~
..n__.. _. .__...._
___._ ,,____.. _. _ ._~______.n ___ ._. .___.____.__ __ ____._____....._. ___._ ... ___ __ __..__
---_._._----_._--~ -_.- --.--..-.
..._...._.___.___.__...__ __.. _.......n..__ .__
,---,
.-.-----......-.---.
ANY HAZARDOUS WASTE ON SITE?: ~YES
560"1
EXPLAIN:
o No
J4',) V\I'--.J
L., jY I ¡¿ \AJk>fc
ING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979
-~n____,____u___ ' Y!.. -- I ~~
U Badge NO',~~SsSite R'ãspoñsibie Partyn-_-
White - Environmental Services
Yellow . Slalion Copy
Pink . Business Copy
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CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave.~ 3rd Floor~ Bakersfield~ CA 93301
FACILITY NAME~ ~+ý 'bIbL!~15M,Of''¡''f
Section 2: Underground Storage Tanks Program
INSPECTION DATE fS/z7JM
,
o Routine I)t Combined 0 Joint Agency
TypeOfTank~
Type of Monitoring vY1
o Multi-Agency
Number of Tanks
Type of Piping
o Complaint
I
Pit\.) F
ORe-inspection
OPERA TION C V COMMENTS
Proper tank data on tile 1)\
Proper owner/operator data on tilc IK
, ~\
Pennit fees current
Certitìcalion of Financial Responsibility J(
Monitoring record adequate and current Ix
Maintenance records adequate and current I~(
Failure to correct prior UST violations X
Has there been an unauthorized release? Yes No )<
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Section 3:
Aboveground Storage Tanks Program
TANK SIZE(S)
Type of Tank
AGGREGA TE CAPACITY
Number of Tanks
OPERA TION Y N COMMENTS
.
SPCC available
spec on tile with OES
Adequate secondary protection
Propcr tank placarding/labeling
Is tank used to dispcnsc MVF?
[fyes, Does tank have overfill/overspill protection?
C=Compliance
V=Violation
y = Y es
N=NO
~.Ô~?1~
Busl ss Site Responslble Party
White - fnv, Sves,
Pink - AlIsiness Copy
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II · Complete items 1, 2, and 3. Also complete
. item 4 if Restricted Delivery is desired.
. Print your name and address on the reverse
I so that we can return the card to you.
. Attach this card to the back of the mail piece.
or on the front if space permits.
1. Article Addressed to:
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Ms. Mary Alice Lopez
Kern County Housing Authority
Æ 3015 Wilson Road
.f Bakersfield, CA 93304
2. Article,Number
t (rransfer from sefVicelabel)
i PS Form 3811, August 2001
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COMPLETE THIS SECTION ON DELIVERY
3. _ Sprvice Type
~Certifjed Mail
D Registered
D Insured Mall
D Express Mail
D Return Receipt for Merchandise
D C.O.D.
4. Restricted Delivery? (Extra Fee)
Domestic Return Receipt
7003 1680 0007 4658
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9138·/L1
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DYes
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I UNITED STATES POSTAL SERVICE
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: Bakersfield Fire Department
Prevention Services
1715 Chester Avenue, Suite 300
Bakersfield, CA 93301
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'cERilFIED MAìL~' FfEËë'ÉtIPT" ,
(Domestic Mail Only; No Insurance Coverage Provided)
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FICIAl
Postage
I ~ Certified Fee
!I CI Retum Reelept Fee
I CI (Endorsement Required) IFr 1<.. '1'1
CI ReStricted Delivery Fee
'I:() (Endorsement Required)
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I g Sent To ! Kern C~unty Housing Authority
I ><=-~,---''''--_! 3015 WIlson Road
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I ~!..::?_~~-~~ Bakersfield, CA 93304
City. State, Z/.
Postmark
Here
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Certified Mail Provides:
I!iI A mailing receipt (8SJ8A8I:JJ GOOG aunr '008& WJo, Sd
II A unique identifier for your mailpiece
II A record of delivery kept by the Postal SelVice for two years
Important Reminders:
II Certified Mail may ONLY be combined with First-Class Mail@ or Priority Mail@.
¡ II Certified Mail is not available for any class of international mail.
. NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables, please consider Insured or Registered Mail.
II For an additional fee, a Retum Receipt may be requested to provide proof of
delivery. To obtain Retum Receipt selVlce, prease complete and attach a Return
Receipt (PS Form 3811) to the article and add applicable postage to cover the
fee, Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for
a duplicate return receipt, a USPS@ postmark on your Certified Mail receipt is
reqUired.
ŒI For an additional fee, delivery may- be restricted to the addressee or
addressee's authorized a@nt. Advise Ìhe clerk or mark the mailpiece with the
I endorsement "Restricted Delivery", <;:.-
1/1 If a postmark on the Certified Mail receipt is desired, please present the arti-
cle at the post office for postmarking, If a postmark on the Certified Mail
receipt is not needed, detach and affix label with postage and mail.
I¡IMPORTANT: Save this receipt and present it when making an inquiry.
Internet access to delivery information is not available on mail
>addressed to APOs and FPOs.
, e BSSR, Inc. __
6630 Rosedale Hwy" # B, Bakersfield, CA 93308 Phone (661) 588-2777 Fàx (661) 588-2786
MONITORING SYSTEM CERTIFICATION
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This forfu must be used to document testing and servicing of monitoring equipment. A separate certification or report must be
prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to .
the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems
within 30 days of test date. '
A. General Information
Facility Name: ¡(ERN CÚÙt-JI,/ HOÙ'SIN~
Site Address:" -:>() I C) (Å \ I L "S 0 N
Facility Contact Person:
Make/Model of Monitoring System: -rAN Ii.... h 0 A R D
J). Inventory of Equipment Tested/Certified
Check the a ro riate boxes to indicate 5 eclßc e ul ment Ins ected/servlced:
f-
f\uí\"{OR.''( Bldg. No.:
City: ~t1 11.E i<'SF \ E LÌ~ Zip:
Contact Phone No.: ( Db \ ) 6'2.. I - 8 '500
Date of Testing/Servicing: \ '- /3\ /03
, ,
Tª~k JP: ~
o In-Tank Gauging Probe, Modël:
0' Annular Space or Vault Sensor, Model:
o Piping Sump / Trench Sensor(s), Model:
o Fill Sump Sensor(s), - Model:
o Mechanical Line Leak Detector. Model:
o Electronic Line Leak Detector. Model:
o Tank Overfill / High-Level Sensor, Model:
o Other s ecif e ui ment e and model ¡nSection Eon Pa e 2 '
Tank ID:
o In-Tank Gauging Probe. Model:
.' ,O-AnnularSpaceor-Vault, Sensor,..". .¥()del:
: ..PPÚ>Î.'1.g?ump / Trench Sensor(sf" J Model: ': ;". . --
o Fill Sump'Señsor(s). ;'.' :,'):,':(--\:;;~:'Mõdel: -':--c'-""~"':::::-":-'-"'-:-'-
O!v.fechanicaJ Li~~eak p'~tecior,' , Mode!:" ~,,"' . ,:' .:,' "
o Electt'onic'Line Leak Detécto¡'~'-" --: MöåeE-- ....... -----.,-..,---
o Tank Overfill / High-Level S~nsòL ,Mod~l:
o Other s ecif e ui ment e and model in Section Eon Pa e-2 .-
TankID: -t>+~S EI
> 0 In-Tank Gauging Probe. Model:
Gr"'Annular Space or VauJt Sensor. Model: M ,A
Œ(Piping Sump / Trench Sensor(s). Model: fÝI SA
o Fill Sump Sensor(s), Model:
o Mechanical Line Leak Detector. Model:
o Electronic Line Leak Detector, Model:
o Tank Overfill / High-Level Sensor. Model:
o Other s ecif e ui ment e and model in Section E on Pa e 2 .
Tank ID:
O,ln-Tank Gauging Probe.,. Model:
0: 'ÁnnJiaI' Space or VauJt;Senso-¡":::::Modil:"
O,'~iping Surnp/1re!1ch,Sensor(s)'j,':Model:, ,. --.','..--
o Fill Sump Sensor(s): '" !:,'..' "':Model:
o Mechanical Li,ne [;eak-Detector,----Model:----·--·------·- ."--, ,---,
o Electronic Line Leak Detector, Model:
o Tank Ovelf!lI / High-Level Sensor: , Model: --'..' ....,
o Other s ecif e ui ment eand'model in Section,E onPa e 2,
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Dispenser ID:
o Dispenser Containment Sensor(s), Model:
o Shear Valve(s),
o Dis enser Containment Float 5 and Chain s ,
Dispenser ID:
o Dispenser Containment Sensor(s), Model:
o Shear Valve(s);
o Dis nser Containment Float s ,and Chain s .
Dispenser ID:- ',- ,
'0 Dispenser Containment Sensor(s),, Model:
o Shear Valve(s),
o Dis enser Containment Float s and Chain s '
Include information for every tank and dispenser at the facility,
Dispenser ID:
o Dispenser Containment Sensor(s), Model:
o Shear Valve(s),
o Dis enser Containment Float s and Chain s ,
Dispenser ID:
o Dispenser Containment Sensor(s), Model:
o Shear Valve(s), ' ,
o Dis enser Containment Float s 'and Chain s .
Dlšpenser ID:
o Dispenser Containment Sensor(s). Model:
o Shear Valve(s),
ODis enser Containment Float s and Chain s ,
*' f the facility contains more tanks or dispensers, copy this form,
C. Certification _ I certify that the equipment identified in this document was inspected/serviced In accordance with the
manufacturers' guideJines. Attached to this Certification Is information (e.g. manufacturers' checklists) necessary to verify that this
information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment ,capable of generating such
, re~~rts, ~\þaveal~o attached}! copy of the report; (che(:k all that apply!: , " 0 ~tern.J', tern set-1Æp 0 Alarm history re,port
Techmq¡m:Name (pnnt): -:F,DFL· ' CA í(Q d I 0 ;;lgµature:~.£.! ' C a<l.9v\...Å!~/c :
'ëertifi~~tion No,:o:. ¡;',.,::':':~:~,:;¡, ",; '. ,oo_u,._q__~_. , ri¡è¡~ris¿'~:'~'~':" -'·;:(~-:t?2;I':?- ;¡. .' q -.. -~~':.::~'-' .: - . --
, ,Te~i1;'gC~r11P~~'~,¡~'~Ipe:,,-ß-S ~'R':: -,-\~\C~·~---oo·- ,------- ' :~, >,;",:",: '~;;:~Ph~~e ~~;~;(I:j) \.r(:j'~~5ffi-~'i1i-i' , .'
Sit:(~.~dré~~:1"'; ':6,l-)~O':'" Kc:);?E f?A: I~E:. ,'M~ \{:.; W,~:'~:¡:..'" ':,: /ß~te¡~f::f~sting{~~~-i~~g~-\2]3\'-/ 0'3
._ _ ._______...____.... u . .. ..... ;-'::';:1 ;.1'1~;' ,,¡' -- n_.
Page 1 of 3
03/01
Monitoring System Certification i
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0; Results of Testing/Servicing
Software Version Installed:
Com lete the followin checklist:
Yes '0 No· Is the audible alarm 0 erational?
Yes 0 No· Is the visual alarm 0 erational?
Yes 0 No· Were all sensors visuall ins ected, functionall tested, and confirmed 0 erationaJ?
Yes 0 No· Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will
not interfere with their ro er 0 eration?
DYes 0 No· If alarms are relayed to a remote monitoring station, is all communications equipment (e,g, modem)
~ N/ A operational?
DYes 0 No· For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
\XI N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate
positive shut-down? (Check all that apply) 0 Sump/Trench Sensors; 0 Dispenser Containment Sensors.
Did ou confmn ositive shut-down due to leaks ~ sensor failure/disconnection? 0 Yes; 0 No,
q Yes 0 No· For tank systems that utilize the monitoring system as the primary tank overfill warning device (i,e, no
jiI N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank
. filI- oint s :and 0 eratin ro erI ? If so, at what- ercent of tank ca aci, does the alarm tri er? - %
'Q Yes· Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced
and list the manufacturer name and model for all re lacement" arts' in Section E, below. '
DYes· (g"No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)
o Product; 0 Water. If es descnoe causes in Section E below. '
úY Yes 0 No· Was monitorin s stem set-u reviewed to ensure ro er settin s? Attach set u
Yes 0 No· Is all monitorin e ui ment 0 erational er manufacturer's s ecifications?
* In Section E below, describe how and when these deficiencies were or will be corrected.
E. Comments:
Page 2 of 3
03/01
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F. In-Tank Gauging / SIR Equipment:
o Check this box if tank gaUglis used only for inventory control.
~heck this box if no tank gauging or SIR equipment is installed,
This section ~ust be completed if in-tank gauging equipment is used to perform leak detection monitoring.
ø
omp ete the followine: checklist:
DYes o No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
DYes o No* Were all tank gauging probes visually inspected for damage and residue buildup?
DYes' o No* Was accuracy of system product level readings tested?
DYes o No* Was accuracy of system water level readings tested?
DYes o No* Were all probes reinstalled properly?
DYes o No* Were all items on the equipment manufacturer's maintenance checklist completed?
c
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD):
'.
B"Check this box if LLDs are not installed.
Complete the followine: checklist:
p Yes o No· For equipment start-up or anriUai equipment certiñcation, was a leak simulated to verify LLD perfonnance?
o N/A (Check all that apply) Simulated leak rate: 0 3 g.p.h.; 0 0.1 g.p.h; 0 0.2 g.p.h.
DYes 0 No· Were all LLDs confirmed operational and accurate within regulatory requirements?
DYes' 0 No* Was the testing apparatus properly calibrated?
DYes o No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak?
o N/A
\10 Yes o No· For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak?
o N/A
0 Yes o No· For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
CJ N/A or disconnected?
o Yes o No· For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system
o N/A malfunctions or fails a test?
DYes o No· For electronic LLDs, have all accessible wiring connections been visually inspected?
o N/A ,
DYes o No· Were all items.on the equipment manufacturer's maintenance checklist completed?
* In the Section H, below, describe how and when these deficiencies were or will be corrected.
H. Comments:
03/01
Page 3 of 3
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Monitoring System Certification
UST Monitoring Site Plan
Site Addr;J:- ~\ ~ (A) \ L "'50,,\ ~D
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Date map was drawn: \"'2.. /3l../ ill
Instructions
If you already' have a diagram that shows all required infonnation, you may include it, rather than this page, with your
Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify
locations-of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular'
spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak
detectors; and in~tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan
was prepared.
Page _of_
05/00
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:INC. P.01
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DEC-31-03 WED 14:19' FROM B.S.S.R.
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SKSF~D FIRE PREVENTION
l661JB5Z-217Z
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CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakel·st1eld, CA (661) 326..3979
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APPLICA TION TO PERFORM
FUEL MONITORING CERTIFICATION
PACJLlTY K€i'W ~,~ {J/fli/Ñc AV\.~ .:.,~.___
ADDRESS 3ó (S' W./'5éN t< ð .
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OPEMTORS NAMa ~' ~c.VNf'1
OWNERS NAMB__~ ~~11
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N~OF' MÇ>NlT()B. MANUPAC'I'lTRER ' lANt:.. Cu./Yl P
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DOES FAClI.4TY HAve DISPENSBR. PANS? ¥BS__
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NAME Oft TBST1N<J COMPANY_ .. "BS"5(l.... +- r¡;v ~
CONTRAC",rQRS UCENSE tt C.7 Z, 'fl V .
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NAMa &: PHQl'œ NOM,ÐER OF CONTAcr PERSON ~~
, ~A~ &, ~ TEST IS TO BE CONDUC'fBD-.J ¿,131 / ():~
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APPROVED BY
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,~IGNATU.RE OP APPLICANT
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DATE
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OCT ~5 2002 9:39
MON 1JÞ47 FROM B.S.S.R. tiC.
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SKSFLD FIRE PREVENTION (561)852-2172
P. 01
DEC-22-03
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CITY OF BAKERSFIEI..,D
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 326..3979
FACILITY (:::EM _ COVN *t
ADDRESS 3<:) ()- (,;,¡¡ ('S,¡.J
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OPERATORS NAME (\: .-c
OWNERS NAMB_ (\..-S'- . ._' .
NAME OP MONITOR, MANuFAcrt.nœR.-1AÑ (\ Gf.\{?-.D /
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DOES F^CII.1TY HAVE DISPENSER PANS? YES_~
APPLICA 1'ION TO PERFORM
FUEL MONITORING CERTIFICATION
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TANK #
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CONTENTS
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NAMEOPTBSTINOCOMPANY 13'S.:5(( .fÑ c
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CONTRACTORS UCBNSE # t; 7 z.. i"1 v
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NAME &: PJiONB NUMBER OF CONTACT PERSON 8f1A,tf- 7« -1-1") 1
, ~A 'IE & TIME TEST IS TO BE CONDUCTBD_ (). J". <''>5 .-._ q AM
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APPROVED BY
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DATE SIGNATURE OF APPUCAN"f
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CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAME ~ff'l ('1)I\t" H'hJ~I"'~ A1I4~(Jt I~
INSPECTION DA TE41 7/0 '1
Section 2:
Underground Storage Tanks Program
o Routine Q) Combined 0 Joint Agency
Type of Tank OlJJf
Type of Monitoring ¿l-tJ\I\
o Multi-Agency 0 Complaint
Number of Tanks I
Type of Piping ØwF
ORe-inspection
G
OPERA TION C V COMMENTS
Proper tank data on tile L- V
Proper owner/operator data on tile l. V
Pennit fees current ../
/
Certification of Financial Responsibility j
Monitoring record adequate and current '"" V
Maintenance records adequate and current ~ l/
Failure to correct prior UST violations '"
Has there been an unauthorized release? Yes No /
Section 3:
Aboveground Storage Tanks Program
TANK SIZE(S)
Type of Tank
AGGREGATE CAPACITY
Number of Tanks
OPERATION Y N COMMENTS
SPCC available
SPCC on file with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?
If yes, Does tank have overfill!overspill protection?
C=Compliance
N=NO
Inspector:
Oftïce of Environmental Services (805) 326-3979
White - Env, Svcs,
Business Site Responsible Party
Pink - Business Copy
UNIFIED PROGRAM I&PECTION CHECKLIST
--------_""",i_~<!":'._,"M!.."¡¡W"'4t'_':t<_,
SECTION 1 Business Plan and Inventory Program
Bakersfield Fire Dept.
EnironmentaJ Services
1715 Chester Ave
Bakersfield. CA 93301 '
Tel: (661)326-3979
~.;::~-~~'~L_Jlo_ÙSlLtlL__._.Aolift\_~'t______...__,_____. "_...."_..,._._____ .. ..... ,___...._ ..__I'(jl~;I_~~_ ~NS:=tON.TI::___~
::,:,:~,~ --Ú11ls~- RL~n_ .-'-___ ___ u. u._ u _ ~~~~!;l- 'OM""":_ .
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Seçtion 1: ,Busin(i)ss Plan and Inyentory Progr~m
LJ Routine
~ Combined
o Joint Agency
o Multi-Agency
LJ Complaint
LJ Re-inspection
C V
c./6
( C=Compliance )
V=Violation
OPERATION
COMMENTS
ApPROPRIATE PERMIT ON HAND
------~---_._._"----_._..._--~----_._~-~---------------~-
. . .--,-.-.----.......------..-----
--- '.-..-...-..-...-.-
__ _ _____·_·__________.___.____u~__._.____'"___
~ BUSINESS PLAN CONTACT INFORMATION ACCURATE
'~--~ISIB::-:~DR~~_;-·-·--'------,·-----·--·-····-'-----,-
-/'-'-'-'--'---'------------'---~'---"-'---'-'--'-'-' --,.,,- ----,------- ,-,.---,-- ,- ,-, ---, ,---------,-, . ". -, - --,---- ---------
~' CORRECT OCCUPANCY
f----c-,-----------,---,- --'__,,______~_____,_,__'_______'m___ -.------------,---,---- ----,------ .:, c--- _______,_,___,__, '_____ ____'_____,_,_,
LJ ' VERIFICATION OF INVENTORY MATERIALS
.._'__n____....___...~ ..
.__ ___~_______·_·_·_·~._,_._u_ .__,___~
...... . ~..··_·_··_______,_.._....__u...
-" --.---.-- -_.-------_.._._-~--~
. __.._.___'u~ ...._____. _______.__._...___......_
~LJ VERIFICATION OF QUANTITIES
---=--_._,---------"~---,-------------'''-,--,-----,--''--, -- ---'-'------,._-----._----,-,- -------, _ , ",--".,- -'----,--,-,------,
[j/'LJ VERIFICATION OF LOCATION
~---- ---'-----,-,-------------- -- --,--,----- ..----------..--,------,---.--- -------,
~LJ PROPER SEGREGATION OF MATERIAL
C:7D--~~-~~~~IO~-~;-MS~S~~~~~ILI~~-- ----------,-- '------ ,-- __un___ m --..".------ -------------------------------------...
-~-------------------------'---- ____ __________ _ n_~,--------
~ -~:~~:: :~~:~~~;:~;;~A;;;~~;~~~ES I---n ----.- ... u_ .. -
-~--E~~~~~~'~~;~~~~~~~; AD~QU~~~-'------'·" -- ,.".---. '..,--------- -. ---'---------- .---- ,---- . ,.---------~~---,----
7D-C~~~~'~'~~;;~~;~~L~-~~;~~----' '--------------------,--- .. ------,----,--.- -,-- . .-----,-- ,.- -,------ ,--------
~~~H~~SE~~~~~--=~~=-= .~J~-n-..... .u_ ..._ ..- .. . ...--=~~~_--=
C1 LJ FIRE PROTECTION I
-----,---, -----,-,-.- -- -,--..---,-,- -,---------,---,. '-,' ----------r---- ----,--,------..,,-- ,-., ------, ,-------, ,,,,---,
e( LJ SITE DIAGRAM ADEQUATE & ON HAND I
...-----.....-...
_. ___·~_·_.__.__.u
,--~---_._-_..~----_......._--~. -
---- -.-..--'-"'.-
.-.-.-.,------
. ._."._--~.__.._.---~--_._-----_..-
- -_" ..._ ·_~~__··____.._·~~____._n___'._",..__..
ANY HAZARDOUS WASTE ON SITE?:
LJ YES
LJ..N~
EXPLAIN:
S I~~PECTION? PLEASE CALL US AT (661) 326-3979
/
Fire Prevention 1 51-In/Shift of Site
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._-----"---~-----_._----~~._._-.~-~_._-----_._.__.
White - Environmental Services
Yellow - Station Copy
Pink - Business Copy
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B"AKERSFIELD
F~ Transmittal
C~VER SHEET
I' fe,
FIRE DEPARTMENT
PREVENTION SERVICES
1715 Chester Avenue. Bakersfield, CA 93301
Business Phone (661)-326-3979 . FAX (661) 326-0576
TO: rvìánù~ b~ó..:?-
COMPANY: Kerh .Co. ++DU~'/)j
FROM: A-u... -+Y1 or ~ T-L \
FAX NO.:
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COMMENTS:
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FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "H" Street
- - ----- - BåKersfield~CA9330r----
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFETY SERVICES. ENVIRONMENTAL SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3696
FAX (661) 326'()576
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAX (661) 326'()576
TRAINING DIVISION
,-,_.-~ -5642 VictõfAve.--
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
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May 8, 2003
Manual Diaz
525 Roberts Lane
Bakersfield, CA 93308
CERTIFIED MAIL
RE: Failure to Complete SB 989 Secondary Containment
Repairs & Retest at Kern County Housing Authority, 3015
Wilson Rd
FINAL REMINDER NOTICE
~ ---- -~--~~ " - .' -- -"_. - .' ~ . ~ ----.
--' -_.-..--- --._-----~ -
- - ~---- ."
--- --- *-
Dear Underground Storage Tank Owner & Operator:
Since January 1,2003, this office has sent you monthly reminders
advising you of a failed SB 989 test. In that letter, this office also
requested an update with regard to repairs of your system.
This office further explained that repairs of your system are a
condition of your permit to operate. Please be advised that you must
have your system repaired and retested by June 15, 2003. Failure to
comply may result in further enforcement action up to, and including
revocation of your permino operate.
This office has extended every courtesy with regard to sending
contractor information as well as one on one visit's
Should you have any questions, please feel free to call me at 661-326-
3190.
Sincerely,
-~---- _. -. ----- -'- -------
Ralph E. Huey
Director of Prevention Services
by: b
yJÍtu rßIlu£;
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
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UNITED STATES POSTAL SERVICE
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First-Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
· Sender: Please print your name, address, and ZIP+4 in this box .
Bakersfield Fire Department
Prevention Services
1715 Chester Avenue, Suite 300
Bakersfield, CA 93301
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SENDER: COMPLETE THIS SECTION
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. ' Complete'items 1, 2, and 3. Also complete
item 4 If Restricted Déljveryis desired.
. Print your name and address on the reverse
so that we can return the card to you.
. Attach this card to the back of the mailpiece,
or on the front if space permits. _ '
1. Article Addressed to:
,-
\ MANUAL DIAZ
¡ 525 ROBERTS LANE
I \ BAKERSFIELD CA 93308
."
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121
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PS Form 3811,~ugust 2001
.
o Agent
o Addressee
B. Received by ( Printed Name) ,\ C. Date of Delivery I
D.ls delivery address different from item,1? 0 Yes I
if YES, enter delivery address below:' 0 No I
. .
A. Signature
x
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-3. Service Type
o Certified Mail
o Registered
o Insured Mail
. . .
o Express Mail
o Return Receipt for Merchandise--
o C.O,D.
1002 3150 0004 9985 3905
4. Restricted Delivery? (Extra Fee)
DYes
Domestic Return Receipt
2ACPRI-03-Z-09B5
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OFF i c 'rÄ 1:7' USE
Postage $
Certified Fee
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Retum Reclept, Fee
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Restricted Delivery Fee
(Endorsement Required)
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I MANUALDIAZ
enti 525 ROBERTS LANE
~ BAKERSFIELD CA 93308
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Certified Mail Provides: _
· A mailing receipt (9SJ91\9/;J) ê':0Wr '008£ WJo: Sd
· A unique Identifier for your mailp/ece
· A record of delivery kept by the Postal Service for two years
Important RemInders: 'ò"'-¡
· Certified Mall may ONLY be combined with First-Class Mai~ or Priority Mailc¡p.l¡
· Certified Mail is not available for any class of Intemational mail. .
· NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For I
valuables, please consider insured or Registered Mail. ~
· For an additional fee, a Return Receipt may be requested to provide proof of I
delivery. To obtain Return Receipt servIce, prease complete and attach a Return I
Receipt (PS Form 3811) to the article and add applicable postage to coverthe I
fee. Endorse maiJplece "Retum Receipt Requested". To receive a fee waiver for I
a duplicate return receipt, a USP8e postmark on your Certified Mail receipt is
required.
· For an additional fee, delivery may be restricted to the addressee or
addressee's authorized ag,ent. Advise the clerk or mark the maiJpiece with the I
endorsement uRestrictedDeliveryu. ,
· If a postmark on the Certified Mail receipt is desired, please present the art;- ,
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed, detach and affix label with postage and mail.
IMPORTANT: Save this receipt and present it when making an inquiry.
Internet access to delivery information is not available on mail
addressed fo APOs and FPOs.
FiRE CHIEF
RO~ FR.".ZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "W Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFETY SERVICES· ENVlRONIlENTAI. SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3696
FAX (661) 326-0576
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
TRAINING DIVISION
5642 Victor Ave.
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
....
t.
-
~.- ~
May 8, 2003
Manual Diaz
525 Roberts Lane
Bakersfield, CA 93308
CERTIFIED MAIL
RE: Failure to Complete SB 989 Secondary Containment
Repairs & Retest at Kern County Housing Authority, 3015
Wilson Rd
FINAL REMINDER NOTICE
Dear Underground Storage Tank Owner & Operator:
Since January 1, 2003, this office has sent you monthly reminders
advising you of a failed SB 989 test. In that letter, this office also
requested an update with regard to repairs of your system.
This office further explained that repairs of your system are a
condition of your permit to operate. Please be advised that you must
have your system repaired and retested by June 15,2003. Failure to
comply may result in further enforcement action up to, and including
revocation of your permit to operate.
This office has extended every courtesy with regard to sending
contractor information as well as one on one visit's
Should you have any questions, please feel free to call me at 661-326-
3190.
Sincerely,
Ralph E. Huey
Director of Prevention Services
bYjL ~£
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
1010 y~ ~ Ý5onV/lN/lo// .¥OP ~oPe !Y%U/b A Ý5~?"
II Complete items 1; 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
,I] _Print your name and address on the reverse
so that we can return the card to you.
I] Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addrêssed to:
. KERN COUNTY HOUSING
AUTHORITY
3015 WILSONRD
BAKERSFIELD CA 93304
""-
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;3. Service Type
-I 0 Certified Mail 0 Express Mail I
I D Registered D Return Receipt for Merchandise
,¡ 0 Insured Mail 0 C.O,D,
4. Restricted Delivery? (Extra Fee) DYes'
{ .~..- ·'7ÔÕ2 2410 0002 ;1974 9244
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PS_Form 3811_, August 2001. ,LJUIII!;;~LI"', IW._...
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2ACPRI-03-Z-098S
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BAKERSFIELD FIRE DEPARTIAENT
OFFICE OF E~N!RON¡\¡~ENTAt. SERVICES
1715 Chester Avenue, Suite 300
Bakersfield, CA 93301
+4 in this box ·
",U. .l..}.1 ;1;J"i,.1
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Return Reciept Fee
(Endorsement Required)
Restricted Delivery, Fee
(Endo
TJ KERN COUNTy HOUSING
senti I A VTHOR/Ty
3015 WILsON RD
~:~1 BAKERSFIELD CA 93304
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Certified Mail Provides: .¡-r,¡-¡m-969¡:O¡ I
13 A mailing receipt (S8J9A9/:J) ~0Oë: 08& WJ0:l Sd
iii A unique identifier for your mailpiece
III A record of delivery kept by the Postal Service for two years
Im{Jortant Reminders: I
11/ Certified Mail may ONLY b~ combined with First-Class Mailæ> or Priority MailQ
III Certified Mail is not available fõr any.ilass of international mail. .
/I NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For I
valuables, please consider Insured or Registered Mail. .
.. For an additional fee, a Return Receipt may be requested to provide proof of .
delivery. To obtain Return Receipt service, pfease complete and attach a Return
Receipt (PS Form 3811) to the article and add applicable postage to cover the
fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for '
a duplicate return receipt, a USP~ postmark on your Certified Mail receipt is
required. I
.. For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent. Advise the clerk or mark the mailpiece with the '
endorsement "RestrictedDeliveryu. .
III If a postmark on the Certified Mail receipt is desired, please present the arti. !
cle at the post office for postmarking. If a postmark on the Certified Mail I
receipt is not needed, detach and affix label with postage and mail.
IMPORTANT: Save this receipt and present It when making an inquiry. I
Internet access to delivery informal/on Is not available on mail
addressed 10 APOs and FPOs.
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFETY SERVICES' EHVIROHIlENTAL SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 Chester AvÈt.
Bakersfield. CA 93301
VOICE (661) 326-3696
FAX (661) 32EH>576
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAX (661)326-0576
TRAINING DIVISION
5642 Victor Ave.
Bakersfield. CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
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February 13,2003
Kern County Housing Authority
3015 Wilson Rd
Bakersfield CA 93304
Certified Mail
RE: Recent SB 989 Secondary Containment Testing
SECOND REMINDER NOTICE
Dear Owner/Operator:
Our records indicate that you completed your secondary containment
testing on October 4, 2002. Our records further show a failed test.
Therefore you are required to have your system repaired and re-tested
as soon as possible.
This office requests an update with regard to repairs of your system.
Please be advised that repairs involving the replacing of components
must be under pennit from this office. The repairs of your system are
a condition of your pennit to operate. Failure to repair and re-test will
result in the revocation of your pennit to operate.
Should you have any questions, please feel free to contact me at 661-
326-3190.
Si2~
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
~~7~ ~ W~ ..¥OP ~£JP6 !Y~ A W~~?"
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield, CA 93301
VOICE (661) 326·3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "W Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFETY SEIMCES . EHVIRONIIEIITAL SEIMCES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979 r".',:
FAX (661) 326-0576
PUBLIC EDUCATION
1715 Chester Avè.
, Bakersfield, CA 93301
VOICE (661) 326-3696
FAX (661) 326-0576
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
TRAINING DIVISION
5642 VIctor Ave.
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
.
..
~
January 22,2003
Kern County Housing Authority
3015 Wilson Road
Bakersfield CA 93304
RE: Upgrade Certificate & Fill Tags
Dear Owner/Operator:
Effective January 1,2003 Assembly Bill 2481 went into effect. This
Bill deletes the requirement for an upgrade certificate of compliance
(the blue sticker in your window) and the blue fill tag on your fill.
You may, if you wish, have them posted or remove them. Fuel
vendors have been notified of this change and will not deny fuel
delivery for missing tags or certificates.
Should you have any questions, please feel free to call me at 661-
326-3190.
Si2
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
~-7~dé W~ ß70P ~0Pe ~ ./6 W~"
, . Complete items 1, 2, and 3, Also complete
item 4 if Restricted Delivery is desired.
. Print your name and address on the reverse
so that we can return the card to you.
. Attach this card to the back of the mailpiece,
or on the front if space permits.
1, Article Addressed to:
KERN COUNTY HOUSING
AUTHORITY
3015W1LSON RD
~~IELD CA 93304
"} A...· I ".
\ --.
7002 0860 0000
1 02595-02-M-0835 !
PS Form 3811, August 2001
0, Is delivery address different from item 1? 0 Yes
If YES, enter delivery address below: 0 No
'3, Service Type
/ 0 Certified Mail 0 Express Mail
o Registered 0 Return Receipt for Merchandise
I 0 Insured Mail 0 C,Q,D. .
Restricted Delivery? (Extra Fee)
-==--~r 4.
1641 ,5837
DYes
Domestic Return Receipt
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BAKERSFIELD AAE DEPARTIJlENT
OFFICE OF ENVfRONPlf1ENTAl SERVICES
1715 Chester Avenue, SLUts 300
Bakersfield. CA 93301
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Return Receipt Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total
Postmark
Here
I
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i
I········
I
.J
. II :r.t. ~-. I I
i Certified Mail Provides:
· A mailing receipt
· A unique identifier for your mail piece
· A signature upon delivery
· A record of delivery kept by the Postal Service for two years
Important Reminders:
· Certified Mail may ONLY be combined with First-Class Mail or Priority Mail.
· Certified Mail is not available for any class of international mail.
· NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables, please consider Insured or Registered Mail.
· For an additional fee, a Return Receipt may be requested to provide proof of
delivery. To obtain Return Receipt service, please complete and attach a Return
Receipt (PS Form 3811) to the article and add applicable postage to cover the
fee, Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for
a duplicate return receipt, a USPS postmark on your Certified Mail receipt is
required.
· For an additional fee, delivery may be restm:Ü3d to the addressee or
addressee's authorized agent. Advise the clerk or mark the mailpiece with the
endorsement "Restricted Delivery".
· If a postmark on the Certified Mail receipt is desired, please present the arti-
cle at the post office for postmarking. If a postmark on the Certified ,Mail
receipt is not .0 .ed, detach-and affix label with postage and mail.
IMPORTANT: S is receipt and present it when making an inquiry.
PS Form 3800, April 2002 (Reverse)
102595-o2-M-1132
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield. CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326·3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFETY SERVICES. ENVIROH/lEHTAI. SERVICES
1715 Chester Ave.
Bakersfield. CA 93301
VOICE (661) 326·3979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 ChesterAvè.
Bakersfield, CA 93301
VOICE (661) 326-3696
FAX (661) 326-0576
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
TRAINING DIVISION
5642 VIctor Ave.
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
e
.
. .?".
, '\
~~,....<:" ,...-....'
January 13, 2003
Kern County Housing Authority
3015 Wilson Rd
Bakersfield CA 93304
Certified Mail
RE: Recent SB 989 Secondary Containment Testing
REMINDER NOTICE
Dear Owner/Operator:
Our records indicate that you completed your secondary containment
testing on October 4, 2002. Our records further show a failed test.
Therefore you are required to have your system repaired and re-tested
as soon as possible.
This office requests an update with regard to repairs of your system.
Please be advised that repairs involving the replacing of components
must be under pennit from this office. The repairs of your system are
a condition of your pennit to operate.
Should you have any questions, please feel free to contact me at 661-
326-3190.
Sincer~
Ji1£ dauo
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
SBU/dc
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~ NOV-11-02 MON 10:05 FROM B.S.S.R.
.~/0/'; JJ ' '. - - BSSR, In'c.
'" '( \: 6630 RosedaJe Hwy., # B, Bake~Sfiel~. CA ~330S'Phono (661 ) 5~U!·:!777 fax (661) 588·2186
MONITORING SYSTEM CERTIFICATION
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P.02
" ' '~?~i,~JQ,tm 'must be used to document testing and servicing ~Î. monitoring equlplnonl Ä-l.C'paratc ¡:;eroJlcati9n or r~)~rt must ~
, ~¡ . ¡,;~:if~i~~r~.d (9,[ ~;a.!fQ monitorin,e ~yslcrn con'I$1.~ by the tecb.xUC1~ who pel'forros the work. A copy of this Conn x:n~st be j)rov¡de~.to
· '~ï.~.'~~}* sy,stcm ~"Y,ø.er/0l'e~~~9r. }'he OW11er/operator must submn a copy or this forro to the local aGency rogulating 'UST syst~µ\S
; ',~~!tl~:~;~,~,~r\9.fccst date.
: . : :,.A~iî8-M:~i'a1 I~formati,op. ,
': Y'~<!f,~~o/.~Namc: ~.~G.......t:lU1rl.Qj2, T~ ..___,.... Bldg. No.:.817 'I: 1.;}Ll ¡,
. ¡'+~.i~:ijMres" 2>D\'S~~~~ -- CiIy,~KFgçfœ.l.!:L- Zip: 2r~Þ'?-
.£;¡~.tyConø.ct l'etaon: .' I ~J!b ':1..!;:t_c~ Co_t Phone No.: U,IILJ~-~ 0 f, ,
" ;~it~~!¥9d~l,~f~oJ::IÎ~~~ing ~~'tern:-A>') t.:; , If"ið1:f1:!J:J.. .,.. Date o£Testi.nglS~rvi¢ing: .u..JJv.Q..2
. ~ :t:;,:,:~~~.~,~~ye.t9Q' ~fEquli)Jp.~n~ ~es,t~Çertified' ' "
'.: is, -CaiMik'tbl)" ' 'r'ó ,,'-tit bOXN to 'adJute: $ eclßc: tal ment Ins cccodJ$(\rvlccd! _' '-, .. ''''r-
,: L t:it'~'ki'ii' "':';:, " ~"'", TaDI( 10:
': ';,\~,:q;Wt#~~ºa~.ins Probe. '" ModeM' ,C In-Tank Oauging Probe. Modcil:
, .,~Q"lf;¡,~n\J,I~r ~p'~e or Vàutt Scns9f. . Môdel: _.',' .' -'--= I3rÃnnular Space or Vautl Scn$Or. Muc.l~J: ~IQ:i
; ;»Q¡(.J~¡J~ìi\¡, ~Wnþl Trench $,er¡$~i(s). ,Mod~t: ~ i b 0 .~ Q p~ping Sump I Trench Sensor(I). M9det: ",
f :~,P:',ßi1I' Slimp S,en$or($). ' ,. ' .. Modch ,,' Q FIll Sump Scnsor(s). Modet:
:: i.9Jvi~~.þ'81'1',cal L,inc Leak Detcçtor. Model: Q Mechanical Une Lellk Detector. Mo~cl:
,/~~;."t;l ~~f'ônic Line LtaIc Detector. ' ,Model: Q Electronic Line Leak Detector. Model:
~;:l!.',;! ëJ/r.dn~~Ôverf'jlì I Higb.Levèf'SêinSor. M'odcl: ' , C Tank Overfilll High-Level Sensor. Model: :,: ,
:"r{:i) '~''','whêt;''cÇjf' 'ui : nt ,.,,,.1 '~d'modci in šCêiion Bon Pa e 2. 0 Othcr (specifv C \.Ii m.en! ond model in 'Section E! on pa It 2. '..,
:I'....~..~. .".. 11 ~ _ ¡,&"
',V,:.f ;fììp) Itit::' ,- " Tank ID:' I ",
,;!: 'i ~,q:1~i;, f~!\~ ,GaUging Probe. Model: a In. TMk Oaugin¡ Probe. Model:
, : '~ ,Q:,~i.!~!II.àr Sp~c or Vault Scn/i~r. Model: 0 Annular SPIICC Ot Vault Sensor. Model:
, :'; ,ë ,¢i'~ipihg $i,rriP I Trench Sensoi($). Modd: -- 0 PÎpins Sump I Trench Sensor(s). Model:
. :;': ,Çf~i~:,~~~ ~c~or(s). , ,M9d.el: C Fill Sump Sc~sor(s). Model:
,,'L:;'~¡;i ,ø.,M.~çÞ~lcal.~!ne ~cak Det~tor. Model: [J Mechani~aJ ~lne ~ak Detector. Model:
Ú :;~:iJq .~,!çç~ro~J~,~I~ µ8k Detcc;~or. Model: C Electronic; Line ~,Qk Detector. Mod~l:
::¡/}~J::,i ,,0;, t~~,9~~!11 ~ifh7~cIS~n~or. Mode.l: . C Tank Over~1I1 HI~-Level Sensor. Model:. ' ,
";',';:¿":': d, Other s 01 UI ment e and model an Section Ii onP.. e 2. 0 Other s çc;lf, UI ment e and model in Section E! on Pa e 2." :
: ~ ~',;~~$~i,~~¡'i'b(' ".' :' , Dlsp~J$er ID: ", .. ," ,,', .'
: ' :t '.ÇLQ.¡~,~;."scr ContaInment $ensor(s). Model: Q OispcnsCf' Contolnmcnt SèJ\Sor(s). Model: --
, q(~þ'~är:VDlvc(s). 0 Shear Valvc(s),
,,:,d.,,!¡;;~sCr Containment FloalÍS} and Chain(s). .,. ,. a Dìs nser Containment Float Ii and Chain :¡; .
"',Q¡~p~¡~~éf rni: " Dispenser 10:
, ..' f., O;,]?l~ijÍ$er Containment Sensor(s). Model: 0 Dispenser Containment Scnsor($). Model:
,; : , 'Q,'S1i~~l,~,Qtv~($). 0 Shear Valva(s).
:.', ;:' '. Î$'~nscr Containment Floa sand Cba,;'1 $ . 0 Dis nçcr Containment Ploat sand
" : .D.1~i~~'i~~dD::' . ' ", , " DIspcn$CrlD: -
, ;.Q ::p'¡,l'ipcn~ Containment Sensor(s). Model: a Dispcn5cr Containment Setlsor(s). Model:
, ::qI :S..ht~¡' Valvc:ls). [J Shear VDlvc(s).
~, ,tidi!.~Ii'it.'I' r.ontalnmen\ flQatíà~d Ch.aiLn~s~. _,",' '._. , a Dis nsCf Containment float s and Chuin s .
· . rt~ql!~ racii\)"contalns irlon: tanks or dispèns¢ra; oopy rbi. form. Include infotn'latlon for every tank and dlspen:>cr at tho £ltl;iliIY·
, "I
..(t:.~:;~~~atioD . I certify tbat the equipment IdentißccI ID this doc'lIncø\ was iD$pc:ctw/scrvlced ID aècol'da~c6 wltb tII~
. 't:~~~,~~açturers~ gu.lde1lD~. Attached to this Certification Is lufornt:utotl (e.g. mQDUracturust chec~U$ts) necessary to v~fy tlast ~~
,~C,!n~or!-!,atlo.D Is correct ~d a Plot "laD s.bøwbag the layout of O1onltorlns equipment-For all)' equlpmeot ~pable of e~ctatlll8 such
, ';'~p¥órtsll b."e also atta.~ed a tOPY of the report; (check all q,flt apply): CJ System set-up a Alarm history report '.
i1'~~~~,~(;i_n Name (print): _ Signature: --.
(Ñttifica,tion No.: _ Liçense. No,: ,...~...J.:;3'l ð ,~
'r~~Hr~~O,~anYName:~J<. \Ní'!' ....__._., ,..,. Phone NO.:( 66' ) ~ß8·';r:"13.-
· ,";~!*~~¿b:C$S: bb:3tÖ ~ ð~EJ") eL, 'E ..I::iJbJ.'i ,__."'_ Date of Te;tinglServicing: ll/ j..J M-.
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NOV-11-02 MaN
~ \!~.' 1J),,.Tal1k Gauging I SIR Equipment:
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This $~ction must be completed if in·ta$ gauging equipment is used tQ perfonn leak detection monitoring.
!.
.Q Check thill box if lank gauging is used only for inventory control.
~check thill box jf no tank gauging or SIR equipment is i,nstallcd.
C m~le~tt tbe roUowin checklist:
. . ·~..IJ'" ....-- ..-....1:.__ 'i -.: g¡ro....... - -. .~- - ..- - ~
j~:,:yß't§. J~ No· Has allíßput WAMS b~~ lospccted for propct entry and termination, including testing for Itou.nd Caµts?
':tR':~~:ï;¡' : q' No'" Were all tank gauging probes visually inspcctçd Cor damage and residue buildup?'
;4:,' ",' ~~i : 0' ~9.~ Was a~acy 'ófsy~t'ein product level readings tested? '
ç.:, ' :~' ~ º ::No. ,Was aCQu,acy qf sy~te~ water level readings tested?
:9,,;,,"... {, q No· Wcrëal1 prob~,:reÌJ,~~1Jc¡d,plopcr1y'1
,:g~:'X~ .,;-", '; 0 ND* Were aU..itc'~ ~Q tI;1c equipment manufacturer's maintenance checkli$t c:omp1cted? ,
1'~~~~.~~)¡~ ~ below. de&c:rlb.è bow ahd when tbese defi.cienclëšwU;-;;;ïDb; ;~eeteci. -~_.._-_.......
:i'(~¡;, qJi~ ~e~ Ðetectors (LLD): GÝCheck this box itLLDs ate not installed.
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" '." on'U>!tft e 01 owint7 checklist:
;:~~......_ ~..... ,...~. --"'-r~--'~.-e~:;p
[;) Y..·" 0 N · FOr equipment start-up or annual equipment certi1tc:atiOD, was a leak simWatcd to verity LLD perfonnanco?
' ",;..:>..,~t::"'" ,0
, ;-;':1'1: . '~~1 :'q-NIA (Check all that apply)Sixnu1ated I~k rate: C 3 g.p.b.; ['J 0.1 8·p.h; 0 0.2 g.p.b.
~... ' "
, 'm:.Ÿ~~fI 'q NQ' ,We:re.all LLDs ,çonf'~d operational and accurate wi1bin regulatory requiicments?
fµ' : ~~i':r¡, ; 0 No· Was the tcstius app~tul properly ca1ib.tated?
': ....:' ....... .."
d:;;t:Y~iP;'¡ ,'1:1 No· Por mechanical LLDs~' dOcs the LLD restrict product flow if It detects a leak? f .,
. _.', f..' ,,", .
· t:,fL¡; ,ïj N/A
'a);yq> Q N'· Por electronìc LLDs, 4oe.s tbe turbine automatically shut off if the LLD detects a leak?
' , .. <, '9
;": ' ',~Jt.. N/A . "
~-<:<"aN
' !,a,;)r~::i ': " o' For elccC;foAiC. LLDa. ~eš the turbine automatically shut off if any, portiQn ot the moGitoring system is disabled
, ~.~: »<, çf NiA or discoœeotcd?
: tD:,:Y~~ ;:0, No. For e1eCtr~è LLDs~ does the turbine automatically shut off jf &.Dy portion of the moDitorin¡ syst=
. ..~. . t-. , " ", ~ . . I
,¡", !,'::O N/A malfuncti9Ds or fails a teat?
~a-vai; :0' N' .' For electromc LLD.. have aU accessible wiring connections been vi$uaUy inspected?
,:': ,',P " Q,
i',: ,:'1'0 N/A ,
~"O ~i~' C: N· Were all itCms.QR theequlpm.cnt mnnufaCNrIl:J:"a maintena1\¢c c:heck1itr completed?
:";"':·~"'I.·~;~ ..:....:. 9:.
'...., '" .'::('d. ... "
;'.:,~~:J'r~.~~~,~o"'~, below, des¢be how ~d w.hen tbese deficiencies were or will be corrcc:tecL
',fll~ eq,~eø.ts;
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03/01
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P.05
r' NOV-11-02 MaN
, ~~QJ,I~t:~ng System CertificatioD
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UST Monitoring Site Plan
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.'" NOV- 6-l12li2 WED 11:15 FROM B.S.S.R. J:NC.
P.1I2II3
O~T ~S 2002 9:39
ÐKSFLD FIRE PREVENTION
(661J852-2172
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CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester AveÞt Bakersfield, CA (661) 326-3979
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APPLICA TION TO PERFORM
FUEL MONITORING CERTD"1CA TION
F'AÇJLlTY_ ~ ~ ,(js~ ßu:ffts.,..ùl1,.. .',.,.....
ADDRESS :;JOt S WII$4V I!-p
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OPBRATOR~ NAME C&Nl1 t.r 14>fi-vJ
OWNERS N~ c 4 _ ',' _
NAME OF MONITOR MANuFACTURBll Gt·16~.u
DOES FAcu.ny HA VB DrsftENSBR PANS? YBS_
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TANK.
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VOLUME
$"'1 <..
CONTENTS
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NAME OF TESTING COMPANY 7]5".$/1- -:I."fvt...
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CONTRACI'ORS UCENSE # b 72,.. ~I v ,
NAME It PHONBNUMBER OF CONTACT PERSON _75n~ if
QATE" TIME TEST IS TO BE CONDUCTED-L (p r:¡- ó l./
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S<lf .. ~ 771
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APPROVED BY
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SIGNATURE OF APPUCANT
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· Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
· Print your name and address on the reverse
so that we can return the card to you.
· Attach this card to the back of the mailpiece,
or on the front if space permits.
1, Article Addressed to:
D, Is delivery address different from item 17
If YES, enter delivery address below:
K C HOUSING AUTHORITY
3015 WILSON RD
BAKERSFIELD CA 93304
L~u--c~
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3, Service Type
JC Certified Mail
o Registered
o Insured Mail
o Express Mail
o Return Receipt for Merchandise
o C.O.D,
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102595-02-M.08351
DYes
4, Restricted Delivery? (Extra Fee)
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I PS Form 3811, August 2001
7002 0860 0000 1641 7398 j
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Domestic Return Receipt
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Postage & .Fees-Paid
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BAKERSFIELD FIR&: DEPAR11V1ENT
OFFICE ÚF ENVIRONMENTAL SERVICES
1715 Ches~r Avenue, Suite 300
Bakersfield, CA 93301
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IL 'III ,1/" ,II 111,11 11/ ,1"11111 '1,1111/ 11111111111 I, 11111'
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1111
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Postage $
Certified Fee
Postmark
Return Receipt Fee Here
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees $
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š;i-BërÄPt.·Ñõ:¡···············_·_····_·_···__............._..._......_....................
or PO Box No. 3015 WILSON ROAD
ëitŸ.·Š;å;ë:·ž1¡;;-4·-··~m;~;~~~···~_····;;·;~~_···_·····_.._..._.
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'I Certified Mail Provides:
· A mailing receipt
· A unique identifier for your mail piece
· A signature upon delivery ,
· A record of delivery kept by the Postal Service for two years
Important Reminders:
· Certified Mail may ONLY be combined with First-Class Mail or Priority Mail.
¡ . Certified Mail is not available for any class of international mail.
· NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For ,
valuables, please consider Insured or Registered Mail.
· For an additional fee, a Return Receipt may be requested to provide proof of
delivery. To obtain Return Receipt service, please complete and attach a Return
Receipt (PS Form 3611) to the article and add applicable postage to cover the
fee. Endorse mail piece "Return Receipt Requested". To receive a fee waiver for
a duplicate return receipt, a USPS postmark on your Certified Mail receipt is
required.
, . For an additional fee, delivery may be restricted to the addressee or'
addressee's authorized agent. Advise the clerk or mark the mailpiece with the
endorsement "Restricted Delivery".
. If a postmark on the Certified Mail receipt is desired, 'p\êase present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is no~ded, detach and affix label with postage and mail.
IMPORTANT: . this receipt and present it when making an inquiry.
PS Form 3800, April 2002 (Reverse) 102595·02·M-1132
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 oW Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFm SERVICES' ENYIROHIlENTAL SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 32EHJ576
PUBLIC EDUCATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3696
FAX (661) 32EHJ576
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield. CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
TRAINING DIVISION
5642 VIctor Ave.
Bakersfield, CA 93308
VOICE (661) 399-4691
FAX (661) 399-5763
.
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October 21, 2002
K.C. Housing Authority
3015 Wilson Rd
Bakersfield, CA 93304
CERTIFIED MAIL
NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE
RE:
Failure to SubmitlPerfonn Annual Maintenance on Leak Detection System
Dear Underground Storage Tank Owner:
Our records indicate that your annual maintenance certification on your leak detection
system was past due on September 26, 2002.
You are currently in violation of Section 2641 (J) of the California Code of
Regulations.
"Equipment and devices used to monitor underground storage tanks shall be installed,
calibrated, operated and maintained in accordance with manufacturer's instructions,
including routine maintenance and service checks at least once per calendar year for
operability and running condition."
You are hereby notified that you have thirty (30) days, November 21,2002, to either
perfonn or submit your annual certification to this office. Failure to comply will result
in revocation of your permit to operate your underground storage system.
Should you have any questions, please feel free to contact me at 661-326-3190.
Sincerely,
Ralph Huey
Director of Prevention Services
bY~~
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
cc: Walter H. Porr Jr., Assistant City Attorney
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CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 326-3979
~._~,-~ ...~
. APPLICATION TO PERFORM A TANK TIGHTNESS TEST!
SECONDARY CONTAINMENT TESTING
~¡CILITY ~ Oli~;-ð}· ~
~DRESS ',,~/ß 'rl~'--1ZL, L-fu)w~.LLl.pL
PERMIT TO OPERATE #. ,,-
OPERATORSN
OWNERS NAME
NUMBER OF TANKS TO BE TESTED
TANK # VOLUME
J-. :5õ1J
-~""-"="'.
G GOING TO BE TESTED
CONTENTS .
fL¡PNIJ' .
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TANK TESTING COMPANY ~ '11ùv .
MAllJNG ADDRESS " / ( 00, ' µ- ~LOJLß-J_
NAME & PHONE NUMBER OF CONTACT PERSON-k£¿ ~
TEST METHOD 3f3 9 N .
NAME OF TESTER OR SPECIAL INSPECTOR qu¡ fb ~
CERTIFICATION # o:Jl)f~-¡57
, I Q~~ J ~ to/'/..
DATE~=ECONDUCTED . I 1. _
~~~
MffiO~BY DAre
fJ 3,0
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FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFETY SERVICES' ENVIRONIlEHTAL SERVICES
1715 CheSler Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
PUBLIC EDUCATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3696
FAX (661) 326-0576
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
TRAINING DIVISION
5642 Victor Ave.
Bakersfield. CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
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September 30, 2002
Kern County Housing Authority
3015 Wilson Road
Bakersfield CA 93304
REMINDER NOTICE
RE: Necessary secondary containment testing requirements by December 31,2002 of
underground storage tank (s) located at the above stated address.
Dear Tank Owner / Operator,
If you are receiving this letter, you have not yet completed the necessary secondary
containment testing required for all secondary containment components for your underground
storage tank (s).
Senate Bill 989 became effective January 1,2002, section 25284.1 (California Health & Safety
Code) of the new law mandates testing of secondary containment components upon installation
and periodically thereafter, to insure that the systems are capableof containing releases from
the primary containment until they are detected and removed.
Of great concern is the current failure rate of these systems that have been tested to date.
Currently the average failure rate is 84%. These have been due to the penetration boots leaking
in the turbine sump area.
For the last five months, this office has continued to send you monthly reminders of this
necessary testing. This is a very specialized test and very few contractors are licensed to
perfonn this test. Contractors conducting this test are scheduling approximately 6-7 weeks out.
The purpose of this letter is to advise you that under code, failure to perfonn this test, by the
necessary deadline, December 31, 2002, will result in the revocation of your pennit to operate.
This office does not want to be forced to take such action, which is why we continue to send
monthly reminders.
Should you have any questions, please feel free to call me at (661) 326-3190.
Si2~
Steve Underwood
Fire Inspector/ Environmental Code Enforcement Officer
Office of Environmental Services
"7~ õfe W~ ~.A0Pe jT~ .A W~"
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UNITED STATES POSTAL SERVICE', :::-.-:_,~
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First-Class MaW-- -- --, I
Postage & Fees Paid 'I
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· Sender: Please print youEnal!1e, address, a~d ZIP'+4 in this bmr·-<
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BAKERSF!ELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Avenue, Suit,s aoo
Bßt{Or3Y1G·~d" C,A b3"8J1
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· Complete items 1, 2; and 3. Also complete
item 4 if Restricted Delivery is desired.
· Print your name and address on the reverse
-136 thatWe èan return'thecardto you.' ,
· Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
¡
Kern Co&nty Housing Authority
3015 Wiil'son Road
Bakersfield CA
93304
7001 0~6~,0002'5~~~
PS Form 3811, July 1999
3. Service Type
o Certified Mail
o Registered
o Insured Mail
o Express Mail "I
o Return Receipt for Merchandise ....,
OC,Q,D.
4, Restricted Delivery? (Extra Fee)
DYes
7445
1
Domestic Return Receipt
102595'OO-M-0952
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' ,..:¡ Street, Apt. No.;
I:J Or PO Box No. 3 0 IS . _W.g~.?~...g~.................................._.........
I ::2 ë¡fŸ,·S¡';ië:-Ži¡;~~k~~·~field CA 93304
Postage $
Certified Fee
Retum Receipt Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees $
:II
./34
2.10
1.50
Postmark
Here
3.94
II
... -. .. .. .
Certified Mail Provides:
Ell A mailing receipt
II A unique identifier for your mail piece
II A signature upon delivery
II A record of delivery kept by the Postal Service for two years
Important Reminders:
II Certified Mail may ONLY be combined with First-Class Mail or Priority Mail.
.. Certified Mail is not available for any class of international mail.
II NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables, please consider Insured or Registered Mail. I
.. For an additional fee, a Return Receipt may be requested to provide proof of I
delivery, To obtain Return Receipt service, please complete and attach a Return
Receipt (PS Form 3811) to the article and add applicable postage to cover the
fee, Endorse mailpiece "Return Receipt Requested"..To receive a fee waiver for
a duplicate return receipt, a USPS postmark on your Certified Mail receipt is I
required. '
. For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent. Advise the cle~~or mar~e mailpiece with the
endorsement "Restricted Delivery". ~ ,/' '-
II If a postmark on the Certified Mail receipt is desired, please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receiptjs not needed, detach and affix label with postage and mail.
IMPOR_ Save this receipt and present it when making an inquiry.
\.: -,'
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D~ ~"'..... "3onn I~........... I')nn1 Ir't_..____\
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
21 01 "W Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFE1Y SERVICES. ENVIRONMENTAL SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 32s-D576
PUBUC EDUCATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326·3696
FAX (661) 32s-D576
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAX (661) 326.()576
TRAINING DIVISION
5642 Victor Ave.
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
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Septem~er 13, 2002
Kern County Housing Authority
3015 Wilson Road
Bakersfield CA 93304
CERTIFIED MAIL
NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE
RE:
Failure to Submit/Perfonn Annual Maintenance on Leak Detection System
Dear Underground Storage Tank Owner:
Our records indicate that your annual maintenance certification on your leak detection
system is past due on September 26, 2002.
You are currently in violation of Section 2641(J) of the California Code of
Regulations.
"Equipment and devices used to monitor underground storage tanks shall be installed,
calibrated, operated and maintained in accordance with manufacturer's instructions,
including routine maintenance and service checks at least once per calendar year for
operability and running condition."
You are hereby notified that you have thirty (30) days, October 13, 2002, to either
perfonn or submit your annual certification to this office. Failure to comply will result
in revocation of your pennit to operate your underground storage system.
Should you have any questions, please feel free to contact me at 661-326-3190.
Sincerely,
Ralph Huey
Director of Prevention Services
bY~~
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
Office of Environmental Services
cc: Walter H. Porr Jr., Assistant City Attorney
~~.Y~ ~ W~ ~.A0Pe ff~ .Æ W~"
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, FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1'349
SUPPRESSION SERVICES
2101 "W Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
FIRE SAFETY SERVICES· EIMROHIlEHTAl SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX(661)32~576
PUBLIC EDUCATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3696
FAX (661) 32~576
FIRE INVESTIGATION
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
TRAINING DIVISION
5642 VIctor Ave.
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
~'..
.'
July 30. 2002
Kern County Housing Authority
3015 Wilson Rd
Bakersfield CA 93304
REMINDER NOTICE
RE: Necessary Secondary Containment Testing Requirements by December
31,2002 of Underground Storage Tank (s) Located at
the Above Stated Address.
Dear Tank Owner I Operator:
If you are receiving this letter, you have not vet completed the necessary
secondary containment testing required for all secondary containment
components for your underground storage tank (s).
Senate Bill 989 became effective January 1,2002, section 25284.1 (California
Health & Safety Code) of the new law mandates testing of secondary
containment components upon installation and periodically thereafter, to insure
that the systems are capable of containing releases from the primary
containment until they are detected and removed.
Of great concern is the current failure rate of these systems that have been
tested to date. Currently the average failure rate is 84%. These have been due
to the penetration boots leaking in the turbine sump area.
For the last four months, this office has continued to send you monthly
reminders of this necessary testing. This is a very specialized test and very few
contractors are licensed to perform this test. Contractors conducting this test
are scheduling approximately 6-7 weeks out.
The purpose of this letter is to advise you that under code, failure to perform
this test, by the necessary deadline, December 31,2002, will result in the
revocation of your permit to operate.
This office does not want to be forced to take such action, which is why we
continue to send monthly reminders.
Should you have any questions, please feel free to call me at (661) 326-3190.
sin;lzr£k
Steve Underwood
Fire Inspector Environmental Code Enforcement Officer
""Y~ de W~ ~ vØ6OPe.o/~ A W~"
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
ENVIRONMENTAL SERVICES
1715 Chester Ave,
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
TRAINING DIVISION
5642 Vielor Ave.
Bakersfield. CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
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June 30, 2002
Kern County Housing Authority
3015 Wilson Road
Bakersfield, CA 93304
REMINDER NOTICE
RE: Necessary Secondary Containment Testing Requirement by December 31,
2002 of Underground Storage Tank located at 3015 Wilson Road.
Dear Tank Owner! Operator:
The purpose of this letter is to infonn you about the new provisions in
California Law requiring periodic testing of the secondary containment of
underground storage tank systems.
Senate Bill 989 became effective January 1,2002, section 25284.1 (California
Health & Safety Code) of the new law mandates testing of secondary
containment components upon installation and periodically thereafter, to ensure
that the systems are capable of containing releases from the primary
containment until they are detected and removed.
Secondary containment systems installed on or after January 1,2001 will be tested
upon installation, six months after installation, and every 36 months thereafter.
Secondary containment systems installed prior to January 1, 2001 will be tested by
January 1,2003 and every 36 months thereafter. REMEMBER! Any component
that is "double-wall" in your tank system must be tested.
Secondary containment testing shall require a pennit issued thru this office and
shall be perfonned by either a licensed tank tester or licensed tank installer.
Please be advised that there are only a few contractors who sPecialize and have
the proper certifications to perfonn this necessary testing.
For your convenience, I am enclosing a copy of the code for you to refer to. Once
again, all testing must be done under a pennit issued by this office.
Should you have any questions, please feel free to contact me at (661)326-3190.
Sincere. /'// ~
,()J ()24IJPA:lC/
Steve Underwood
Fire Inspector! Environmental Code Enforcement Officer
Environmental Services
SUIkr
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FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "W Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
ENVIRONMENTAL SERVICES
1715 Chester Ave,
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
TRAINING DIVISION
5642 Victor Ave,
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
.
.
Kern County Housing Authority
3015 Wilson Road
Bakersfield, CA,93304
RE: Necessary Secondary Containment Testing Requirement by December 31,
2002 of Underground Storage Tank located at 3015 Wilson Road
REMINDER NOTICE
Dear Tank Owner/ Operator:
The purpose of this letter is to inform you about the new provisions in California
Law requiring periodic testing of the secondary containment of underground storage
tank systems.
Senate Bill 989 became effective January 1, 2002. section 25284.1 (California
Health & Safety Code) of the new law mandates testing of secondary containment
components upon installation and periodically thereafter, to ensure that the syst~ms
are capable of containing releases from the primary containment until they are '
detected and removed.
Secondary containment systems installed on or after January 1, 2001 shall be tested
upon installation, six months after installation, and every 36 months thereafter.
Secondary containment systems installed prior to January 1, 2001 shall be tested by
January 1, 2003 and every 36 months thereafter. REMEMBER!! Any component
that is "double-wall" in your tank system must be tested.
Secondary containment testing shall require a permit issued thru this office, and
shall be performed by either a licensed tank tester or licensed tank installer.
Please be advised that there are only a few contractors who specialize and have the
proper certifications to perform this necessary testing. '
For your convenience, I am enclosing a copy of the code for you to refer to. Once
again, all testing must be done under a permit issued by this office.
Should you have any questions, please feel free to contact me at (661) 326-3190.
Sincer¡1 "/ / __
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Steve Underwood
Fire Inspector/ Environmental Code Enforcement Officer
SBU/kr
enclosures
~~y~ de W~ ~ vØ60Pe y~ A W~"
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326·3941
FAX (661) 395-1349
PREVENTION SERVICES
1715 Chester Ave.
Bakersfield. CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
ENVIRONMENTAL SERVICES
1715 Chester Ave,
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
TRAINING DIVISION
5642 Victor Ave,
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
-
.-
April 17, 2002
K C Housing Authority
3015 Wilson Rd
Bakersfield CA 93304
RE:
Necessary Secondary Containment Testing Required by December 31,2002
REMINDER NOTICE
Dear Tank Owner/Operator:
The purpose of this letter is to inform you about the new provisions in California law
requiring periodic testing of the secondary containment of underground storage tank
systems.
Senate Bill 989 became effective January 1,2002. Section 25284.1 (California Health &
Safety Code) of the new law mandates testing of secondary containment components
upon installation and periodically thereafter, to ensure that the systems are capable of
containing releases from the primary containment until they are detected and removed.
Secondary containment systems installed on or after January 1,2001 shall be tested upon
installation, six months after installation, and every 36 months thereafter. Secondary
containment systems installed prior to January 1,2001 shall be tested by January 1,2003
and every 36 months thereafter.
Secondary containment testing shall require a permit issued thru this office, and shall be
performed by either a licensed tank tester or licensed tank installer.
Please be advised that there are only a few contractors who specialize and have the proper
certifications to perform this necessary testing.
For your convenience, I am enclosing a copy of the code for you to refer to. Once again,
all testing must be done under a permit issued by this office.
Should you have any questions, please feel free to contact me at 661-326-3190.
Sin¡¡erel .
-&£;:. ,
' ,
, ,
Steve Underwood
Fire InspectorÆnvironmental Code Enforcement Officer
SBU/dm
enclosures
"7~ de W~ ~.A0Pe.r~ A W~''
-'
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAMK_Jlnrl^ ~OUIA.~ tk>ùt,(tÀ( Mf)~i..l
INSPECTION DATE ìJII~(J1
Section 2:
Underground Storage Tanks Program
o Routine ~ Combined 0 Joint Agency
Type of Tank IÀJJF
Type of Monitoring é 1..«A.
o Multi-Agency 0 Complaint
Number of Tanks J
Type of Piping ffk.I1F
ORe-inspection
OPERA TION C V COMMENTS
Proper tank data on tile Iv V
Proper owner/operator data on file t v:
Pel1Tlit fees current V /
/
Certification of Financial Responsibility V
Monitoring record adequate and current V ~
Maintenance records adequate and current ../ /
Failure to correct prior UST violations ...,/
Has there been an unauthorized release? Yes No (/
Section 3:
Aboveground Storage Tanks Program
TANK SIZE(S)
Type of Tank
OPERA TION Y N COMMENTS
SPCC available
SPCC on file with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?
If yes, Does tank have overfill/overspiIl protection?
AGGREGATE CAPACITY
Number of Tanks
C=Compliance
Y=Yes
N=NO
Inspector:
Office of Environmental Services (8 326-3979
White - Env, Svcs,
Pink - Business Copy
~ "-......
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RICH ENVIRONMENTAL
5643 BROOKS CT BAKERSFIELD,CA.93308
OFFICE~J392-86_8::::m & FAX (661) 392-0621
AES MODEL PLT-100R HYDROSTATIC PRODUCT LINE TEST
Precision Product Line Test
TEST RESULTS
JOB#:
Test Date:09-26-2001
BILLING:E.L.G.ENVIRONMENTAL
6701 CHEWACAN
BAKERSFIELD, CA 93309
SITE:KERN Co PLAZA TOWER
3015 WILSON RD
BAKESFIELD, CA
PRODUCT
PRODUCTS
PRODUCT
LINE TEST
MECHANICAL
LEAK DETECTOR
MONITOR
LEAK DETECTOR
DIESEL
NO TEST
Nip
ANNULAR & SUMP
PASS PASS
COMMENTS
A precision test was performed on product lines at the above location
using the AES MODEL PLT-100R HYDROSTATIC PRODUCT LINE TEST. I have
reviewed the data produced in conjunction with this test for purpose of
verifying the results and certifying the product line test systems.
The testing was performed in acorrdance with AES protocol, and
therefore satisfies all requirements for such testing as set forth by
NFPA 329-92 and USEPA 40 CFR part 280.
The results of testing are shown on the following page. Included with
the report are reproduction of data compiled during the test which
formed the basis for these conclusion. This information is stored in a
permanent file if future verification of test results is needed.
AL\NC 040
T~ti~ ~
l(m:s J.'L~'
State cert#99-1072
2-25-1995 2:49AM
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FROM RICH ENVIRONMENTAL 805+392+0621
1--'. I
RI~RNOMENTAlI
56~3 »~OO~s CT 2AKERSFIELD,C^.~3308
OFFICE(661)392-8687 ~ FAX(661)392.0621
Monitor Cel·titic¡,)lion In'\pection
Califo.mia Code' of R=gu1arjo~ Chapter 16, requires that equipment which monitors ~ and.! or piping systems COtltaining ha.zardOU3
D;1àterials be testedlSEm'icedannua.l1y or on a schedule specified by the m;muf~c:r, whic:hever is more frequent. This fonu, or a service
report with equivalent information, must be used to document testing and set'Vicing of lIIonitoring equiPD1àlt. If more than one monitoring
systml (e.g. V ceder-Root TLS-350, RomilIl X76S, etc.) is insulled at the facility, a separate certification or report must be prepared for
each monitoring system.
hcility Name: j(~ R.,J [; o. ?l....!r Z A It) vB R..
Site Address: 30 I=:;- (,..J / L2>cMJ fZ. I:::>
Facility, Conœ.ct Person: .J Ð 1f.AJ A- v0/lto,.J '1
'.M.ake/Model of Monitoring System: J11:f If 7 AMI{ &1/-£ P
MakelModcl ofLino L,ak Deteçtor (LLD): Ald..v-¿
City:
Dilte of Te~Servicing: c¡ -:- ;< (p -0 (
(34-f<~FIßP I ~
Contaèt Phone No.:
Location of COM'oI Panel: N ¡:::)(}
LLD L~ak Threwold
Tò '¡.fIVk
t·p·h.
Complete die following checklist:
x Yes No· Monifl)rln. S)':nem is operable per manllf!cbJrer's .speeifit:aliOIlS1
>< Ya No- A,jlfibl~ alarm is opm1iollal?
X ,'Yes ' No· Vi$UIII alarm is opemtional?
X Y¢s No· Moniroring $)'S1I:m is secured ftom the WWllhorized tampering?
Yes NO'" For pæsJUfized pipÜlg syaems"do rhe turbines au~ca!ly sbut down if the moDirDñng system deucù a leak, wI, to opcnzo,
or is elecaically diseonnecll:d? If yÇs, wbid1 moallOrin,g ckviça inilialo posirivc SJu¡l dowu?
,', _ Sump S~Qr$? PR$$un: Liøc Leak Dc~rs 1
~
Yes No" Fot moniroriog sysœ~ wJlÎçh servc IS tank O"t'CtfiU wMDÏøg dcviccs,. do... the ovcriill W11roÍ8g ñ1l\çtion ope-roll/: properly? If su.
~ . wlw. pen:aIf of. ÞrIk c:apacìt)' doe.s die alarm Iri&¡¡cr?
,
Cb
b
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dI:
- d
-
eck the appropnate oJtes to lD eate speel Ii! eq1UpmeDt mspec:te semce :
TimkID: P/c5EL Tank ill: Tank lD: Tank ID:
-X Allnular S)KC ScmOl A.nnWm' Spaçe Sensor AnnuJar Space: Sensor Annular Space Sero:œ
'X ~pìnl5 $umpSCJI5Qr PipÍÐ8 Sump Sensor Pipìl1$ $UQ1P $Çn:¡01 Piping SlImp Sensor
In.T~ ,Gt!ugins .I'It1bc In-Tan1: Gausing Probe In-TanIc Oaugi.nS .Probe In- Tank Gauging Probe
, Dispenser Containment $ensor(s) Dispenk1 CQI\Wrunent Sensor(s) Di$p~Nçr ContaiU!Jlc.at Sçmor(s) Dispensu ColUainlN:nL Scnsor(s)
McçlJll¡¡ical Line Leak DeteCIOr MechaQical Une LeU; Detceu>r Meclwtícal Líne Leak ÐefleCtl;¡r MedJlIDìcallinc Leak Deo:dDt
I 'EJ~Diç Line Lc:å DctcclOr Elc:c:tronic Line Leak Detl:cœr EleClrOnic Line Leak DeœclOt EleCÐl)nic Line Lcalc Octc;CU)f
Àn: an imp"", valm operational pr::r marnllac:II.IlCr'S specíticadOl1S? IV I tA YES NO .
·In ~ conuneT.!tS section below, describe bow and when rbe$e deficiencies were or will be corrccted.
Comments:
1 eert'ily th'at t.bè equipment identified above WIIf io$pectedlserviced ¡a accordanee with manut'atttuwß guidelines;.
N_ofQ,Wñ~~.._~QN
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(over)
J< ~. T"""aC",,,,,,y, RlLH ¡:;;Uut,e<Mlfl11F,vì4L
, Phone' L.e>c..ol- -^¡ù~ - '?(¿. ~"1 ,
, ~~UN\"""'OCUM¡''''F,,",,'\hAZMÂ I ICUPÄMSKP"" ·'4-A,,",,0
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I 525 Rob~rts Lane
¡BakerSfield CA 93308
I
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II 2, Article Number (Copy from service label)
~OO 1530 0006 3456 3065
:~3811;\JuIY 1999· .,',." Domestic Return Receipt
lete items<1, 2, and 3. Also complete
ite '4 if Restricted Delivery is desired.
III Print your name and address on the reverse
so that we can return the card to you.
III Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Manuel Diaz
t>
K C Housing Authority
3, Service Type
XXCertified Mail
o Registered
o Insured Mail
o Agent
o Addressee
DYes
o No
o Express Mail
o Return Receipt for Merchandise
o C,Q,D,
4. Restricted Delivery? (Extra Fee)
DYes
102595-00-M·0952
II I post~d
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· Sender: Please print yol)T~~~,\açk1ress, and~æJ:~(¡,O:.!m~:'~9:i:~: ~-" '''-:-1
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UNITED STATES POSTAL SERVICE
BA!(!ERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Avenue, Suite 300
Bakersfield, CA 93301
'~'~
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U.S. ~ost;:tl Seryl.c¡,~."."" "''''''" , ,~;,,' ~ ' "., {,'i'è' ,~" : .
',CEB:J:IFIEÐ'MÄIE:'RECEIPT ': " ,
(D< )tiC Mail Only; No Insurance Coverage Provided)
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Postage $ .34
Certified Fee 2.10
Postmark
Return Receipt Fee 1.50 Here
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees $ 3.94
Sent To
Manuel Diaz
Si;ëëi;ÊmCÑõ:';õr-pöËiõx.Ñö...--...mm.......m...m.....m....__..m..mm.._
52 Roberts Lane
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Certified Mail Provides:
m A mailing receipt
II A unique Identifier for your mail piece
II A signat\lre upon delivery
II A record of delivery kept by the Postal Service for two years
Important RemInders:
II Certified Mail may ONLY be combined with First-Class Mail or Priority Mail.
· Certified Mail is not available for any class of international mail.
II NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables, please consider Insured or Registered Mail.
II For an additional fee, a Return Receipt may be requested to provide proof of
delivery. To obtain Return Receipt service, please complete and attach a Retum
Receipt (PS Fonn 3811) to the article and add applicable postage to cover the
fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for
a duplicate return receipt, a USPS postmark on your Certified Mail receipt is
required.
· For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent. Advise the clerk or mark the mailpiece with the
endorsement "Restricted Delivery". ~"., -""
If If a postmark on the Certified Màil receipt is desired, please present the arti-
' cle at th.ø post office for postmarking, If a postmark on the Certified Mail
receipt_t needed, detach and affix label with postage and mail.
IMPORTJW!;ave this receipt and present it when making an inquiry.
PS Form 3800, May 2000 (Reverse)
FIRE CHIEF '
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
EN~RONMENTALSER~CES
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
--
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October 18, 2001
Manuel Diaz
K C Housing Authority
525 Roberts Lane
Bakersfield Ca 93308
CERTIFIED MAIL
RE: Failure to Submit/Perform Annual Maintenance on Leak Detection
System for Underground Storage Tank at 3015 Wilson Road
NOTICE OF VIOLATION &
SCHEDULE FOR COMPLIANCE
Dear Mr. Diaz:
Our records indicate that your annual maintenance certification on your leak
detection system is seriously past due, March 16, 2001. This office has made
attempts to contact you and Mary Alice Lopez, advising you of this necessary
testing.
You are currently in violation of Section 2641 (J) of the California Code of
Regulations:
"Equipment and devices used to monitor underground storage
tanks shall be inst~lled, calibrated, operated, and maintained in
accordance with manufacturer's instructions, including routine
maintenance and service checks at least once per calendar year for
operability and running condition."
You are hereby notified that you have 10 days, October 28,2001, to either
perform or submit your annual certification to this office. Failure to comply will
result in revocation of your permit to operate your underground storagé system.
Should you have any questions, please feel free to contact me at 661-326-3190.
Sincerely,
Ralph E. Huey
Director of Prevention Services
by:
/£~
Steve Underwood
Fire Inspector/Envirorunental Code Enforcement Officer
cc: Mary Alice, Lopez
Walt Porr, Assistant City Attorney
""7~ ~ ~~.~ ~OPe, y~ ..A ~e.rth~"
'-
. CITY OF BAKERSFIELQ
." .FICE OF ENVIRONMENT.SERVICES
1715 Chester Ave.~ Bakersfield, CA 93301 (661) 326-3979
UNDERGROUND STORAGE TANKS - UST FACILITY
(9:
TYPE OF ACTION
(Check OM t/em only)
o 1. NEW SITE PERMIT
o 3, ReNEWAL PERMIT
o 4, AMENOED PERMIT
o 5, CHANGE ?F INFORMATION (Spedy eNnge .
/oQ1 use only)
o 8. TEMPORARY SITE CLOSURE
Pege _ of _
o 7. PERMANENTlY CLOSED SITE
o 8. TANK REMOVED
400,
i BUSINESS NAME (s.m... FACILITY NAME or DBA· 0aIn9 ~ AI)
4+Du$( Y\
I NEAREST CROSS STReET
. W. b(~
~~~NESS 0 1, GAS STATION
o 2. DISTRIBUTOR
TOTAL NUMBER OF TANKS
REMAINING AT SITE
I. FACIUTY I SITE INFORMATION
3 FACIUTY 10.
+
FACILITY OINNER TYPE
o 1, CORPORATION
o 2. INDIVIDUAL
o 3. PARTNERSHIP
o 3, FARM 0 5. COMMERCIAL
o 4. PROCESSOR 0 8, OTHER 403.
18 fàdtlty on Indan ReseMtIon or 'If _ of UST a puÞ8c agency: name of sul«Yisor of
trusIIands? division. MCIIon or oIIIce wIIictÌ oøontea !he UST,
(ThIs is !he conlKl person for !he tank 11ICOIós.)
o 4, LOCAL AGENCYlDlSTRlcr
o 5. COUNTY AGENCr
08. STATEAGENCr
o 7. FEDERALAGENCr
402.
404.
DYes 0 No 405.
408,
PROPERTY OWNER NAME ~lA~' ?Pi -3 -~l![;"ò
MAILING OR STREET ADDRESS c? b ¿.V"~ ~ L.~ 409.
CITY 410, I STATE 411'1 ZIPCODE '1~ ~D 8' 412.
PROPERTY OWNER TYPE o 2. INOMDUAI. o 4. LOCAl AGENCY I DISTRICT o 8. STATE AGENCY 413.
o 1. CORPORATION o 3. PARTNERSHIP o 5. COUNTY AGENCY o 7. FEDERAL AGENCY
IL PROPERTY OWNER INFORMATION
S~
._."j~~i.j:i.¡ç¡{:~t;~,i;'Jj',~"i;'iJ"i¡,~~i0,'-'-.~:']::,t.";i1Jâ~~~~~..~:"i~!~,'!1í&~~~ijij̺~î1ó"-'i~t~1i\;Jj,"·" ',",¡,;,:",;f
MAILING OR STREET ADDRESS
416.
I ! CITY
I .
I
I I TANK OWNER TYPE
I
I
o 1. CORPORATION
o 2. INOMOUAL
o 3. PARTNERSHIP
417. I STATE
o 4, LOCAL AGENCY I DISTRICT
o 5. COUNTY AGENCY
418.
I ZIP CODE
08. STATE AGENCY
o 7. FEDERAL AGENCY
419.
420.
"" ",';ji'ri'r. ,,/,,:';" , ;, .Ïy.BOARqO.~ EQIJ~(~~~1JP~IJ~i,~dRAG~~~~Cçº~~ J~~II~B~~ . .
, I
I
i
Call (916) 322-9669 If quesllons atfse
421.
o 1. SELF~NSUREO
o 2. GUARANTEE
o 3. INSURANCE
... . ..'"..
. ,. .
<' V; ,PETROLEUM UST FINANCIAL RESPONSIBIIJTY
o 4. SURETY BOND ,¡g 7. STATE FUND
o 5. LETTER OF CREDIT b 8. STATE FUND & CFO lETTER
o 8. EXEt.f>TION 0 9. STATE FUNO & CO
o 10. LOCAL GOVT MECHANISM
o 99. OTHER:
422.
" ,
' -
, ,', VI. LEGAL NcmFICATION AND MAlUNG ADDRESS "
Check on. box to Indlcat. wI1IdI addrea IhoukI be UNCI for IegeI notItIatllonllllCl m8lllng.
legal notifICIIlIonIlIICI meillngs will be 1«1110 tile r.nk _ unleea box 1 01 2 Is checked.
o 1. FACILITY
o 2. PROPERTY OWNER
o 3. TANK OWNER 423.
. . ,..;: ::=, ~ :.... - ,::.,I!'¡~'; . -"'. .. ,.-
VII. APPUCANT SIGNATURE
Certlflcallon: I oer1IIy I!IIt tile Inform8tIon pI'OIItded herein IlINe Ind ICCUI1Ite 10 tile bell of my knowledge.
SIGNATURE OF APPlICANT DATE
424. PHONE
42S.
NAME OF APPlICANT ~oll\ Y\
AV\~V\
428. TITlE OF APPliCANT
4'ZT,
428.
18118 UPGRADe ceRTIFICATE NUMSeR (For/oÇ./ UH only) 42, I
S:\CUPAFORMS\swrcb-a.wpd I
I STATE UST FACILITY NUMBER (Ft¡, /oQI UH only)
UPCF (7/99)
f\LY'
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.
RICH ENVIRNOMENTAL
5643 BROOKS CT BAKERSFIELD,CA.93308
OFFICE(661)392-8687 & FAX(661)392-0621
Monitor Certification Inspection
Facility Name:_P/..~'2 Å. /tJ(AJrt1-
Facility Address ::30 I~ WJJ...SO,{J - ßAk£~A~l..O- CfÂ
Monitoring system make and model: ~Ms tA -r.1AJK ~IGO
4
3.5-0
Produc
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Di
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El
automatically Annu Annu
s,ensor is þu t Sump Sump
in Di i
When signed by an authorized techician, this certifies that the
monitor panel alarm and the sensors are in the correct position, and
the system is operating according to manufacturer's specifications.
r
system have
In-Tan
Device
I,
CERTIFIED BY: a Ii U
TECHNICIAN SIGNATURE: ""1
f/ ~
DATE: 3- /~...- 06