HomeMy WebLinkAboutUNDERGROUND TANK FILE #1 (2)
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BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfie1d,"'CA 93301
(805) 326-3979
APPLICATION TO OPERATE AN UNDERGROUND STORAGE TANK
APPLICATION IS BEING SUBMITTED FOR THE FOLLOWING REASON:
_TO OPERATE A NEW FACILITY _TO TRAHSFER OWNERSHIP .KTO OPERATE AN EXISTING FACILITY
PREVIOUS TANK OWNER (1f app11càble)
NAME PHONE
ADDRESS
NEW TANK OWNER
NAME C Hue K ¡2. u "f'1-1
ADDRESS 3700 F<....Ar-/v~ f2.O
BILLING ADDRESS '3bO 1 W 1<... S ()N
PHONE
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(U)
'1'7<£$ - SL'L<Í
TANK OPERATOR (if different from owner)
NAME PHONE
ADDRESS
APPLICANTS NAME (if different from owner)
NAME PHONE
ADDRESS
TANK LOCATION
FACILITY NAME (.-....IIL.ScJ--.) XPC-'?'{ Lù-3.é ADDRESS s6c> 1 ¿,..)'f..-S,ðY'J ~
PHONE OPERATORS NAME Cµ,..x:..t< ¡~U n-l
EMERGENCY CONTACT
NAME
ADDRESS
PHONE
TANK INFORMATION
tank# volume date installed substance stored previous substance
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Date"
Name (print)
@ NO
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CØš NO
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Signature
Do You Have a HAZARDOUS MATERIAL RESPONSE PLAN? ~
Do You Have an OWNER - OPERATOR AGREEMENT? )/~
Have You Filled Out a HAZARDOUS MATERIAL BUSINESS PLAN?
l '!~::::~:F·FiÑÃNèIA~!!!!!!!;~;
FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM
A. 1_........ to ¡f,., ........ Pi . .J I. ] ]i. ia......... _.... ulplCÜieci ia Secåoa ZI07. aaa,.18. Div. 3. 'Ii'" 23. CCR:
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01' AND or '
D 1 aiIÎcIIa cloIIan per oa:ureace D 2 miDioa cloUan aaaul qpep&e
8. C;+u C-/..( gu 1:1-\ hereby certifies that it is in compliance with the requirements of Section 2807,
IN-arn.to....crq.r.-)
Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations.
The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows:
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II Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your exeøJlion snd submission
of this certification also certifies that you are in compliance with all conditions for participation in the Fund.
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Fac. Unit: Fixed Contain~rs
7
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CONY 01/07/90 =
CAS/Waste Code ~
221
MOP: Low
F X PERT. LUBE
I
r= Hazma~ Inventory
i= Inventory Details
[Name
WASTE OIL
Hazards: Fire, Dela~ Hlth
Form: Liquid Type: Waste
Days: 365 Use: WASTE
Daily Max GAL
500.00
I [Daily Average GAL ~ [ Annual, Amo~nt GAL ~
. __ 250.00 'I ' 2,500.00~
Press Temp Location
Ambient Ambient REAR OF BLDG CENTER
Storage
UNDER GROUND TANK
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<S> S.P.T.L.
<I> Inventory List
<C> Components <N> Notes
<P> Print <F1> Help <Ese> Exit
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. . Bakersfield Fire Dep~
"'-AZARDOUS MATERIALS DI~ION
2130 GStreet, Bakersfield, CA 93301
(805) 326-3970
/
I
UNDERGROUND TANK QUESTIONNAIRE
I. FACILITY/SITE
No. OF TANKS
J
RECEIVED,
JUN ~ 1991
53ð '1
,/ BOX TO INDICATE 0 CORPORATION 0 INDIVIDUAL ~ERSHIP 0 LOCAL AGENCY DISTRICTS 0 COUNTY AGENCY 0 STATE AGENCY 0 FEDE~L AGENCY
TYPE OF BUSINESS
01 GAS ST~nON
03 FARM
02 DISTRIBUTOR KERN COUNTY PERMIT
'04'PROCESSOR ~R TO OPERATE No,
NIGHTS: NAME (LAST. FIRS1)
PHONE No, WITH AREA CODE
II. PROPERTY OWNER INFORMATION (MUST BE COMPLETED)
CARE OF ADDRESS INFORMATION
,/ BOX
TO INDICATE
DIVIDUAL 0 LOCAL AGENCY OSTATE AGENCY
o PARTNERSHIP 0 COUNTY AGENCY 0 FEDERAL AGENCY
PHONE No, WITH AREA CODE
'")05'~3Z 30/2
III. TANKOWNER INFORMATION (MUST BE COMPLETED)
CARE OF ADDRESS INFORMATION
,j
,/ BOX
TO INDICATE
o INDIVIDUAL
o PARTNERSHIP
o LOCAL AGENCY 0 STA TE AGENCY
o COUNTY AGE~ÇY OF~ERAL AGH'!CY
STA TE ZIP CODE
¡h/J- 9g?O 7
PHONE No, WITH AREA CODE
'oS- ~3 z, '30) 'L
/
DATE
INSTALLED
/2-/1-77"
VOLUME
PRODUCT
STORED
LJ.ç'ed (Ð,.')
IN
SERVICE
OWNER'S
TANK No.
;¿;CJG! )
(Ÿ)/N
V/N
V/N
V/N
V/N
V/N
"
::.
DO YOU HAVE FINANCIAL RESPONSIBllITV? Vt!§ TVPE
~~,,-~:.
/
Fill one segment out for each tan~, unless all tanks and piping are
constructed Of4 same materials', style ancAype,' then only fill
one segment out.- please identify tanks by o~er ID t.
I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN
/
C, DATE INSTALLED (MO/DAYIYEAR)
A, OWNER'S TANK L D. # 7
I
B, MANUFACTURED BY:
.<
III. TANK CONSTRUCTION
MARK ONE ITEM ONLY IN BOXES A. B. AND C. AND ALL THAT APPLIES IN BOX D
A. TYPE OF o 1 DOUBLE WALL 0 3 SINGLE WAll WITH EXTERIOR LINER 0 95 UNKNOWN
SYSTEM ~ SINGLE WALL 0 4 SECONDARY CONTAINMENT (VAULTED TANK) 0 99 OTHER
~ARE STEEL ,0 2 STAINLESS STEEL 0 3 FIBERGLASS 0 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC
B. TANK
MATERIAL 0 5 CONCRETE 0 6 POLYVINYL CHLORIDE 0 7 ALUMINUM 08 100% METHANOL COMPATIBLE WIFRP
(Primary Tank) 0 9 BRONZE 0 10 GALVANIZED STEEL 0 95 UNKNOWN 0 99 OTHER
01 RUBBER LINED o 2 ALKYD LININGJ 0 3 EPOXY LINING 0 4 PHENOLIC LINING
C. INTERIOR 0 5 GLASS LINING ~NLINED 0 95 UNKNÖWN 0 99 OTHER
LINING
IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES _ NO_
D 1 POLYETHYLENE WRAP o 2 COATING ',' 03 VINYL WRf>¡> ,.,0 4 FIBERGLASS REINFORCED PLASTIC
D. CORROSION o 5 CATHODIC PROTECTION ~E h~_.
PROTECTION o 95 UNKNOWN ..·0 99 OTHER
IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE
A. SYSTEM TYPE . Á u 1 SUCTION ,'A U 2 PRESSURE A. U 3 GRAVI1Y A U 99 OTHER
B. CONSTRUCTION U 1 SINGLE WALL A U 2 DOUBLE ,WALL, A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER
C. MATERIAL AND C9 U 1 BARE STEEL A U 2 STAINLESS STEEL A U ,3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGLASS PIPE
CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 1000/. METHANOL COMPATIBLE WIFRP
PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER
D. LEAK DETECTION D 1 AUTOMATIC LlNELEAK DETECTOR D 2 LINE TIGHTNESS TESTING 0 3 ~~~~~~J
V. TANK LEAK DETECTION
o
o
~ISUAL CHECK
o 6 TANK TESTING
2 INVENTORY RECONCILIATION 0 3 VAPOR MONITORING 0 4 AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING
7 INTERSTITIAL MONITORING 0 91 NONE 0 95 UNKNOWN 0 99 OTHER
I. TANK DESCRIPTION
COMPLETE ALL ITEMS.. SPECIFY IF UNKNOWN
/
A, OWNER'S TANK L D. #
B, MANUFACTURED BY:
III. TANK CONSTRUCTION
MARK ONE ITEM ONLY IN BOXES A. B. AND C. AND ALL THAT APPLIES IN BOX D
A. TYPE OF o 1 DOUBLE WALL 0 3 SINGLE WALL WITH EXTERIOR LINER 0 95 UNKNOWN
SYSTEM ~~INGLE WALL 0 4 'SECONDARY CONTAINMENT (VAULTED TANK) 0 99 OTHER
~ BARE STEEL 0 2 STAINLESS STEEL 0 3 FIBERGLASS 0 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC
B. TANK
MATERIAL o 5 CONCRETE 0 6 POLYVINYL CHLORIDE 0 7 ALUMINUM 0 8 100% METHANOL COMPATIBLE WIFRP
(Primary Tank) 0 9 BRONZE 0 10 GALVANIZED STEEL 0 95 UNKNOWN 0 99 OTHER
01 RUBBER LINED o 2 ALKYD LINING 0 3 EPOXY LINING 0 4 PHENOLIC LINING
C. INTERIOR 0 5 GLASS LINING ~~NLlNED 0 95 UNKNOWN 0 99 OTHER
LINING
IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES_ NO_
D. CORROSION D 1 POLYETHYLENE WRAP ~TING o 3 VINYL WRf>¡> 0 4 FIBERGLASS REINFORCED PLASTIC
PROTECTION D 5 CATHODIC PROTECTION . 91 NONE 095 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 A U 2 PRESSURE A U 3 GRAVI1Y A U 99 OTHER
B. CONSTRUCTION U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER
G U 1 BARE STEEL A U 2 , STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGLASS PIPE
A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100% METHANOL COMPATIBLE W/FRP
A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER
D ' AUTOMATIC LINE LEAK DETECTOR D 2 LINE TIGHTNESS TESTING 0 3 ~~~~~¡~J, ~HER
C. MATERIAL AND
CORROSION
PROTECTION
D. LEAK DETECTION
V. TANK LEAK DETECTION
I-~ D
I ,'.i 1 VISUAL CHECK
i 6 TANK TESTING D
'~
2' INVENTORY RECONCILIATION D 3 VAPOR MONITORING 0 4 AUTOMATIC TANK GAUGING D 5 GROUND WATER MONITORING
7 INTERSTITIAL MONITORING [J 91 NONE 0 95 UNKNOWN D 99 OTHER
.. Bakersfield Fire DePA
~AZARDOUS MATERIALS DmSION
2130 G Street, Bakersfield,CA 93301
(805) 326-3970
~
DEe
Ansí/.
....
.......
I. FACILITY/SITE
UNDERGROUND TANK QUESTIONNAIRE
ðßdVlr cõ!SeJiJ UO
I
No. OF TANKS
h1 g '-;
,/ BOX TO INDICATE 0 CORPORA T10N
o PARTNERSHIP a LOCAL AGENCY DISTRICTS 0 COUNlY AGENCY 0 STATE AGENCY 0 FEDERAL AGENCY
<¡II,'.
I':. '",
,- TYPE OF BUSINESS -, 01 GAnTATION
03FARM
{¡,i/
1.
02 DISTRIBÙTOR -- . -KERN COUNTY PERMIT, - -. / 2. J 0 . .
04 PROCESSOR ~ TO OPERAT~~, 'J.. £-00 ð -- 00
-II ~ 8
"3" 1"-/13 ð---
'I
I ,
II. PROPERTY OWNER INFORMATION (MUST BE COMPLETED)
() f ~
CARE OF ADDRESS INFORMATION
STATE
~q
r"·
R¿
./ BOX
,TO INDICATE
o LOCAr'AGENCY 0 STA TE AGENCY
o COUNTY AGENCY 0 ~EDERAL AGENCY
, PHONE No, WITH AREA CODE
III. TANKOWNER INFORMATION (MUST BE COMPLETED)
CARE OF ADDRESS INFORMATION
---:--' -
./ BOX
. Tq INDICATE
NDIVIDUAL 0 LOCAL AGENCY 0 STA TE AGENCY
o PARTNERSHIP. 0 COUNTY AGENCY '0 FEDERAL AGENCY
STATE ZIP CODE
PHONE No, WITH AREA CODE
c· r33&9
OWNER'S
TANK No.
'I
DATE
INSTALLED
/2,/ lJ.. 71
VOLUME
PRODUCT
S~RED
L)5~ Oì I
IN
SERVICÈ
J.50~r¡J
<ÐN
Y/N
Y/N
,
Y/N
Y/N
Y/N
. DO YOU HAVE FINANCIAL RESPONSIBILITY? Y ~ TYPE
"~': ' Fill one segment out' for each tank, unless a-ä tanks and
't¢"~(¡ constructed of e same materials, style anw.ype, then
i~,- one segment out. please identi fy tanks by owner ID #.
,Joe.
I. TANK DESCRIPTION
piping are
only fill
A. OWNER'S TANK I. D, #
COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN
B. MANUFACTURED BY:
/i
;t:,- / 'í - 7
D. TANK CAPACI1Y IN GAlLONS:
-'$"[)
---
-----_.~-
,~-_._----
III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B.ANDC. AND ALL THAT APPLlESINBOXD
A. TYPE OF 0 1 DOUB E WALL 0 3 SINGLE WAll WITH EXTERIOR LINER
SYSTEM SINGLE WALL 0 4 SECONDARY CONTAINMENT (VAULTED TANK)
~ BARE STEEL 0 2 STAINLESS STEEL 0 3 FIBERGLASS
o 5 CONCRETED 6 POLYVINYL CHLORIDE 0 7 AlUMINUM
o 9 BRONZE 0 10 GALVANIZED STEEL 0 95 UNKNOWN
o 1 RUBBER LINED 0 2 AlKYD LINING 0 3 EPOXY LINING
o 5 GLASS LINING ~NLlNED 0 95 UNKNOWN
IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES _ NO_
C.INTERIOR
LINING
o
o
o
o
o
o
o
4 STEEL CLAD· WI FIBERGLASS REINFORCED PLASTIC
8 100% METHANOL COMPATIBLEWIFRP
99 OTHER
95 UNKNOWN
99 OTHER
B. TANK
MATERIAL
(Primary Tank)
4 PHENOLIC LINING
99 OTHER
D. CORROSION
PROTECTION
o 1 POLYETHYLENE WRAP 0 2 COATING
05 CATHODIC PROTECTION ~NE
'~,:,.O 3 V1NÝL WRAP",~ 0 4 FIBERGLASS REINFORCED PLASTIC
",0 95 UNKNOWN -- 0 99 OTHER
--ïv -PIP¡'ÑGlÑFÓRMATION
- A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE Wu 3 GRAVI1Y A U 99 OTHER
{i.)u .-
B. CONSTRUCTION 1 S~GLE WALL A U 2 DOUBLE WALL 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 A U 5 AlUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100'Y. METHANOL COMPATIBLEWIFRP
PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER
D. LEAK DETECTION D 1 AUTOMATIC LINE LEAK DETECTOR [;1 2 LINE TGHTNESS TESTING o 3 INTERSmlAL ~ OTHER
MONITORING
CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND BOTH IF APPLICABLE
V. TANK LEAK DETECTION
o
o
I~ VISUAL CHECK
o 6 TANK TESTING
2 INVENTORY RECONCILIATION 0 3 VAPOR MONITORING 0 4 AUTOMATIC TANK GAUGING 0 5 GROUND WATER MONITORING
7 INTERSTITIAL MONITORING 0 91, NONE 0 95 UNKNOWN 0 99 OTHER
I. TANK DESCRIPTION
COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN
A, OWNER'S, TANK I. D, #
B, MANUFACTURED BY:
C. DATE INSTALLED (MO/DAYIVEAR)
D. TANK CAPACI1Y IN GAlLONS:
-.-------
III TANK CONSTRUCTION
MARK ONE ITEM ONLY IN BOXES A. B. AND C. AND ALL THAT APPLIES IN BOX D
A. TYPE OF 0 1 DOUBLE WALL 0 3 SINGLE WAll WITH EXTERIOR LINER 0 95 UNKNOWN
SYSTEM 0 2 SINGLE WALL 0 4 SECONDARY CONTAINMENT (VAULTED TANK) 0 99 OTHER
," 0 0 0
0 1 BARE STEEL 2' STAINLESS STEEL 3_ FIBERGLASS 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC
B. T~NK ~,- .-- - 0 0
MATERIAL '0 5 CONCRETE 0 6 POLYVINYL CHLORIDE 7 AlUMINUM 8 100'Y. METHANOL COMPATIBLEWIFRP
(Primary Tank) 0 9 BRONZE 0 10 GALVANIZED STEEL 0 95 UNKNOWN 0 99 OTHER
01 RUBBER LINED 0 2 AlKYD LINING 0 3 EPOXY LINING 0 4 PHENOLIC LINING
C. INTERIOR 0 5 GLASS LINING O-~ UNLINED 0 95 UNKNOWN 0 99 OTHER
LINING
IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES _ NO_
D. CORROSION 0 1 POLYETHYLENE WRAP 0 2 COATING o 3 VINYL WRAP 0 4 FIBERGLASS REINFORCED PLASTIC
PROTECTION 0 5 CATHODIC PROTECTION 0 91 NONE o 95 UNKNOWN 0 99 OTHER
-I
IV. PIPING INFORMATION
CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE
A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVI1Y A U 99 OTHER
B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER
C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) A U 4 FIBERGLASS PIPE
CORROSION A U 5 AlUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100"10 METHANOL COMPATIBLEW/FRP
PROTECTION A U 9 GALVANIZED STEEL AU 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER
D. LEAK DETECTION D 1 AUTOMATIC LINE LEAK DETECTOR D 2 LINE TIGHTNESS TESTING o 3 INTERSTITIAL D 99 OTHER
MONITORING
V. TANK LEAK DETECTION
::::J 1 VISUAL CHECK 0
__ J 6 TANK TESTING 0
2 INVENTORY RECONCILIATION 0 3 ,VAPOR MONITORING 0 4 AUTOMATIC TANK GAUGING D 5 GROUND WATER MONITORING
7 INTERSTITIAL MONITORING D 91 NONE D 95 UNKNOWN . D 99 OTHER ,