Loading...
HomeMy WebLinkAboutUNDERGROUND TANK MAY 12 2004 10:32 BKSFLD FIRE PREVENTION P~RMIT A~PLlCA TION T~ONSTRUCTIMODIFY UNDERGROUND STORAGE TANK (661)852-2172 e p. 1 PERMITNO. ~T - ()Öì~ . /-:-'r:~",__",..,_~ TYPE OF APPLICATION (CHECK) a NEW FACILITY XMODIFICATION OF FAC~LlTY ----- -~- Bakersfield Fire Dept. Environmental Service 1715 Chester Ave Bakersfield) CA 93301 Tel: (661}326-3979 L1 NEW TANK INSTAlLATIO'N AT EXISTING FACILITY PROPOSED COMPLETION ~TE EXISTING FACiliTY PERMIT NO. em eo \Pv5f1 eld lJcr3 3fff5 TANK O~ER ZIPCOOE q.4 6~ 'ò CAUCENSENO, 241005 fJö<olO ~.L~œSCRIBeTHeWORKToseCON£ \ 1-.-: -h ~ + j:VKJSG: \ E.ve.. UQ.~vVd() - \Í1-Slúl\\Cì tv\ 0 h~ E\ltL# \ vefY'o:ç.i-\- L Z+:=:-, and Cldct,.-h"()V1C1 { -F CJ ~,Úpm . W'.TER TO FACILITY PROviDED BY LurYìe..., EIlENTJOt CONTROL AND CO\Jt-ITER MEASURES PlAN ON FILE c:J YES (j NO ~6'0N~WATEA \ 11 NO. OF TANKS TO BE INSTAU.ED THIS SEC'I1ON IS FOR MOTOR FUEL TANK NO. VOLUME UNLEADED REGU1J\R PREMIUM DIESEL A\I1ATION TIiIS SECTION IS FOR NON MOTOR FUEL STORAGE T ÀNI<S TANK NO. VOLUME OiEIo41CAL STORED ¡NO 8RAND NAME) CAS NO (IF I<NOW>lJ CHEMICAL PRE\I10USl.V STORED FOR OFFICIAL. USE ONL.Y 'APPLICATION DATE ! ~"::.: I NO. OF TANKS I FEES$ The applicant has received, understands, and will comply with the attached conditions of the permit and anJj the state, local ami federal regulations. This form has been completed under penalty of ,¡mju and to fJ a/my kmw/,dg,c" ßr¡7};,o"jtla¿:?b .......¡J¡tli< '0 ¡ij t40 ~NT NA!.IE (PRINT) APPUCANT 5IGWITURE THIS APPliC.<\'nO~~ BECOMES A PERMIT WHEN APPROVED <'J If o N :E · -~ '- .~" ~--"':~ _....~.~ - ..~ f .?o 0 203.00' ~o -=- _ ..J _"T-'4t- -w''"j(lt 0 II 0 II ~==t-l..-l ~o o [tJ o (3) 12.000 Co\L OBL g WALL F/G XERXES TANKS ~I I I ! [ 0 000 "'" 0 I: I I ~ I I I ----~-"" .,====-......... [ 0 000 UNLEADED 0 """-'-----" ~======-o.. [ 0 000 SUPREME 0 I I I ""'====-===="'" I I I I I I I L- g ~ 183.00' \\,h ~µ N n...rï o 5 10 20 GRAPHIC SCALE SCOPE OF WORK 1. INSTALL NEW EVR (VR-101-0) EQUIPMENT AT EACH TANK: A. BREAK CONCRETE AT FILL & VAPOR, INSTALL NEW SPILL BUCKETS (PHIL- mE 85000-GS FILL & 85001-NV-GS VAPOR) B. TOP SEAL CAP (MORRISON BROS. 323C) C. TOP SEAL ADAPTOR (PHIL-mE SWF -1 OO-B) D. VAPOR CAP (MORRISON BROS. 305C) E. VAPOR ADAPTOR (PHIL-mE SWV-101-B) F. POSITIVE SHUT-OFF DROP TUBES. IN FILL (PHIL-mE 61S0-PT) G. RISER ADAPTORS AT FILL, VAPOR & TLM (PHIL-mE MjF4X4) H. TLM CAP & ADAPTOR (EVER-mE 4097AGBR & 4097MBR) I. P jv VENT VALVES (HUSKY 4885) -MANIFOLD VENT RISERS J. EXTRACTOR FITTING (UNIVERSAL V421) K. DROP TUBE AT VAPOR (OPW 61-T) A -::r: o 0:: ....:¡ ....:¡ -::r: ::r:: ~ ...... 0:: ¡::c¡ 10(1. [101"( PII. ...YI¡II[ 1 08/11/04S1.X EVRUPCRAII(PROPOSAI, _ GROUND & GRADE PLAN SERVICE STATION #20-3576 1125 COffEE ROÄO k BRIMHÄLL ROÄD BAKERSFIELD. CALIFORNIA S Chevron ~TE: 02/11/94 DAAWN BY: EJI,I SCALE: '-=10'-0" F1L[N~ME: 203578 A '~Q",,- ~ ·a;:~.;¡...;L~ '. ¡f'o -:.- NEW.." TOP SEAL ADAPITR AND CAP (MORRISON BROS. JZ.x: &: ÞHIl-mE SWF-l00-B) t:EW SPill CONTAlNIoIQJT (PHIL-TlTES500Q-GS) NEW VAPOR RECOVERY ADAPTER AND CM' (MORRISON BROS. JOSC &: PHIL-TITE SWF-101-B) NEW SPill CONTAINMENT (PHil-TIT( BSOOI-NV-GS) 4 1 I')"~ FROM TOP OF SPIll BUCKET T IQE....Q£....Sl Silly ; NEW RISER ACAPTOR (PHIL-TITE "'/f4X4) (XTRACTORrlrnNG (UNI\lC:RSALV4Z1) eXISTING 2" f.R.P. PHASE II VAPOR RElURN NEW PQsrrlVE SHUT -Ofr FILL TUBE SET AT 95% or TANK CAP".>.C11'1 (PHIL-TlfE t>IS0-PT) FILL & VAPOR RISERS ~ I I I 7 1 ¡ ~ 2 TANK LEVEL MONITOR RISER NEW Tl.M PROBE RISER ADAPTER 01< C1\P (EYER-TITE 4097AG &: EVER-TITE 40971.18R) NEW RISER AÐAPTOR {PHll-TITE M/f4X4} R(VISIONS EVR UPGRADE DETAILS ii Chevron ~:;NO:Ç,1~'~4 SCA.L£, NONE FJLWAA4E,(VRUÞGRAOENOSUIA A-2 -* h Material - Equipment List F'Scílity N""umber: BAKERSFIELD 203576 Address: State: Surveyor Name: 1125,COFFEE ROAD California -.1' .. Petro Builders Inc. EVR Package Require QTY of Packaae Addition Equipment: 1 2 3 4 5 6 7 8 9 10 11 12 3 QTY DEBRI BUCKETS FILL DEBRI BUCKETS VAPOR HUSKY VENT VALVES PHIL-TITE EVR. OVER FILL DROP TUBES FLAPPER 3" BALL FLOAT FOR UNIVERSAL HOUSING IF REQUIRED BY AGENCY PHIL-TITE TANK BOTTOM PROTECTOR 3. 3 3 3 3 3 Seo e of Work: Cost 1 INSTALLATION OF THREE EVR #1 RETRO FIT KITS. AND ADDITIONAL EQUIPMENT 2 FOR DIRECT BURIAL 3 TLM RISERS IN SEPARATE MANWAY CENTER OF TANKS 4 5 6 7 8 9 10 PHIL TITE DIRECT BURY TO DIRECT BURY 11 EXCAVATION 12 Safety Fence 13 PaintinQ 14 TestinQs 15 Permit Process 16 General Conditions! SURVEY 17 Fee & Profit Number of Dates to Perform Work 5' ~ ~g~aIf Total Cost $ 7,885.00 $ 3,888.00 $ 75.00 $ 262.00 $ 112.00 $ 2,612.00 $ 1,483.00 $ 16,317.00 Signture I Date: ;'\,., "" 203576 BAKERSFIEL Address: 1125.COFFEE State: California Surveyor Name: Sco ~ .¡' Contractor: Generallnfonnation: Total No. of Tanks Tank No. (example: 1 of 5) Tank Manufacturer Tank T Petro B ilders Inc. NO HIGH LEVEL ALARM 3 JOOR STEEL FIBREGLASS COATED DW. FiliI Vapor Configuration i. Sump 2. Direct BUI)' 2 Equipment List VR-101-C (Phil-Tite) existing VR-102-C (OPW) Mfg Model Number Mfg Model Number Mfg Model Number Spill Bucket - Fill Phil- Tite 85100-F OPW ? OPW 1 SC-21 OO-DEVR 85000-S 8500O-GS 85000-EXT 85100-15 Spill Bucket - Vapor Phil-Tite 85101-NV PHIL TITE ? OPW 1 SC-2100-PEVR 85001-NV-S 85001-NV-GS 85001-NV-EXT Replacement Drain Vlv Kit nla OPW 1DK-2100 Debris Bucket - fill Phil-Tite PP 1005 TB None Debris Bucket - vapor Phil- Tite PP 1005 TBP (optional) None Rotatable Adaptor - fill Phil- Tite SWF-100-B Dover ? OPW 61SALP-EVR Rotatable Adaptor - vapor Phil- Tite SV\N-101-B Dover ? OPW 61VSA-EVR Vapor Riser Offset Phil- Tite M-6050 (optional) None nfa Riser Adaptor Phil- Tite MfF4x4 None nfa Face SeaiAdaptor nfa None OPW FSA-400 or FSA-400-S Spill Container Cast Lid Phil- Tite 85011 OPW ? Dust Cap - fill Morrision 305C OPW 634T OPW 634TT-EVR or 634LPC Bros. Dust Cap - vapor Morrision 323C OPW 1711T OPW 1711T-EVR or 1711LPC Bros. Tank Gage Port Ever-Tite 4097 AGBR Evertite ? Morrision 305XPA1100AKEVR (threaded adaptor) Brothers (cap & adapt) 305-0200AAEVR (repl adapt) 305XP-110ACEVR (repl cap) Ever- Tite 4097MBR (double handle Evertite ? Ever-Tite 4097 AGBR (adaptor) cap) 4097GMBRNL (adaptor) 4097MBR (cap) Veeder Root 312020-952 (cap & adapt) PN Vent Valve Husky 4885 ? See Photo Husky 4885 or OPW 623V Extractor Fitting Universal Univ. V-421 or OPW 233 Universal ? OPW OPW 233 Ball Float Vent Valve Universal Univ. 37 or OPW 53VML Universal 2" OPW OPW 53VML or OPW 30MV Drop Tube OPW 61-T (straight tube) or OPW 61S0-PT OPW 61-T (straight tube) or 61S0-PT 61 SO-xxxC-EVR Tank Bottom Protector Phil Tite TBP-3516 OPW OPWf 6111-1400-EVR Pomeco Jack Screw Kit nfa OPW 61 JSK-4400-EVR Tool kit for Rotatable Phil- Tite T-7043 nla Adaptors I Additional "!I.lpone.. Not LI.... Ab.."" 'F. J_~. g:; J . e e Phase 1\ Equipment Facility Number 203576 Address 1125,COFFEE ROAD City BAKERSFIELD State California Contractor: Petro Builders Inc. Survevor Name: Scotty General Information: NO HIGH LEVEL ALARM Dispenser Number 1 2 3 4 5 6 7 8 No. of dispensers 1&2 3&4 5&6 7&8 9&10 11&12 Serial number 660714 660717 660715 660713 660716 660718 Type of dispenser 1. Balance 1 1 1 1 1 1 2. Vac Assist Manufacturer 1. Dresser Wayne 1 1 1 1 1 1 2. Gilbarco 3. Other No. of hoses/dispenser 6 6 6 6 6 6 Hose length 12' 12' 12' 12' 12' 12' Nozzle Mfg. 1. Husky 2. Emco Wheaton 2&4 2&4 2&4 2&4 2&4 2&4 3. VST 4. Other Nozzle Model No. Breakaway ALL HUSKY Probe Type 1. Veeder Root 2. Beaudreau 3. Other 2 2 2 2 2 2 Monitoring System 1. Veeder Root TLS 350 2. API Ronan 1 1 1 1 1 1 3. Other e rt~... x: .....,M\<,<t;.tH:i':".:.''>1.'--'-·~'~;.<' ",,~ '>( .~~~.", Pw ~- t~";";:' ""- ,k x.;~ '" ,\4 ." .JtJ'~'l~~ :L """,,?,,,y1lJt{'):{"'-I~~*t;i""~~ '<;r ;'ljJ:f""' . ~r~"';z- it}.;;'!>.;1)..." ~ If c:rit<'*"'.o:1>~'!t~,.", ~.,.& ".< = ,~..~~~ ,'* ,;:. '" ,,~- '" """~':-'I'"'.;"," ~ ')"'f"~ ~. ~ '> . ¥ -;:4' ~ c." .~ ~~lm!;.I!![~~( ~()~.)~~~6:~.28~~~. : EÆ~';~J 5.~~X ,9.. ~6:::qßJH~' t;~. "c"~~¿:.'ilJ :,¡f~"\ ¿"".~j,:; ~1.'n' <r4,':-,.;t·:::!':'",1if: if..,';, 'Ii!~ .'tii Jiii'FyP~1 !WVY~1,:? Em~JD,~}!fI tj)~EBS;ÇOry1f.::-î"~ ~ .-., .:. May 12, 2004 To Whom It May Concern: The following people are authorized to obtain permits on behalf of Petro Builders, Inc, for various Chevron locations for the EVR Upgrade Program. * * Monica Velasco, Petroleum Business Systems George Johns, Petroleum Business Systems If you have any questions regarding this information, please do not hesitate to contact the undersigned. Sincerely, PETRO BUILDERS, INC. þ)¿4 R. L. Girard President '- . 0 II ""~,'-.-'"~'-:h_?-~;.,.;;~ -i!::;'" ::~' {;.:... _~* "I - ~""J- 9L:-- State of California <:::::.:..... CONTRACTORS STAT:: LICENSE BOARD ~ ACil'jE UCENSE .':, " li=N,mber241 905 E!Jli~ CORP ßusin...Nam. PETRO- BUILDERS INC CIa"ili..tlon('jA 8 C61/D40 HAZ C21 ~ te ExpiraüOI1DaIe 09 13 0 /2 004 .:.~ -- --.--------- I> ""... ~~-~.........--_--- 241905 OFFICE: (562) 946-2285 FAX: (562) 946·5395 10609 PAINTER AVENUE, SANTA FE SPRINGS, CA 90670 HTTP://WWW.PETROBUILDERS.COM BOB GIRARD e ACORD CERTIFICAT TM OF LIABILITY INSURA PRODUCER (949)622-5517 FAX GSM Insurance Services Lic. #OD15612 19200 Van Karman Ave. #400 Irvine, CA 92612 INSURED Petro Buil ders, Inc. 10609 Painter Ave. Santa,Fe Springs, CA 90670 622-551& DATE (MMIDDNYYY) 01/05/2004 THIS CERTIFICATE 'SUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE NAIC# 26&&3 19410 INSURER A: Ameri can Int' 1 Speci a 1 ty Lines INSURER B: Commerce & Industry Ins. CO. INSURER c: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ~~~ . TYPE OF INSURANCE ' POLICY NUMBER P~.k+~~~~~gg,W\E PgÄ!fl(~~~~N LIMITS LTR GENERAL LIABILITY PROP 417 77 94 01/01/2004 01/01/2005 . EACH OCCURRENCE $ 1,000,000 - UAIVIA",~ ~ (r~N II::U X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence\ $ 100,000 I CLAIMS MADE. 0 OCCUR . MED EXP (Anyone person) $ 10,000 A PERSONAL & ADV INJURY $ 1,000,000 '--- GENERAL AGGREGATE $ 3,000,000 '--- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.. COMP/OP AGG $ 3,000,000 h ·nPRO. nLOC POLICY JECT AUTOMOBILE LIABILITY CA &0& 71 43 01/01/2004 01/01/2005 COMBINED SINGLE LIMIT I-- (Ea accident) $ X ANY AUTO 1,000,000 I-- ALL OWNED AUTOS I-- BODILY INJURY $ SCHEDULED AUTOS .. (Per person) B- e--- -'. - - -. . ~ '. .. "~---.'~---"- -_.-~-_.~'- ~ __n_ ._~ __ __~_ . HIRED AUTOS BODILY INJURY I-- (Per accident) $ NON-OWNED AUTOS I-- PROPERTY DAMAGE $ I-- (Per accident) GARAG E LIABILITY AUTO ONLY, EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ tJ OCCUR o CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC 32& 22 92 01/01/2004 01/01/2005 X I TORY LIMITS I lü~t ER EMPLOYERS' LIABILITY E.l. EACH ACCIDENT $ 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE.. EA EMPLOYEE $ 1,000,000 If yes, describe under E.L. DISEASE.. POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below OTHER . PROP 417 77 94 01/01/2004 01/01/2005 $1,000,000 each loss {ontractor's Poll uti on A Liability $3,000,000 total all losses DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS :'Except 10 days notice for nonpayment of premium, CERTIFICATE HOLDER Sample Certificate For Bid Purposes Only CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE v EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) 'Õo e e ór' \ , I . I SITE SAFETY PLAN JOB LOCATION: Chevron #20-3576 1125 Coffee Rd. Bakersfield, CA PETRO BUILDERS, INC. 10609 Painter Ave. Santa Fe Springs, CA 90670 PREPARED BY: Michael eltz . Petro Builders, Inc. Health & Safety Officer DATE PREPARED: May 7,2004 ~. .. e SITE' DESCRIPTION JOB TITLE: Chevron #20-3576 SITE DESCRIPTION: x Operation Non-Operating Undeveloped Remediation Gas Station Terminal Refinery Landfill Building Factory Lot Field Oil/Gas Product x PROJECT INFORMATION: EVR- Repairs ACTIVITIES AND DURATION: x e U.S.T. Former U,S,T. MWs Hoists Borings Soil Samples Drums Pits Oil/Gas Wells Upon arrival Petro Builders, Inc. personnel will perform an initial site reconnaissance with air monitoring equipment and observe any physical hazards that may be present. The air monitoring results and physical hazards must be recorded in this document. After a safe work environment has been established, Petro Builders, Inc. will conduct a site screemng survey. If at this time a member of the Petro Builders, Inc. field team considers personal health and sàfety to be at risk, operations on the site will cease and the safety concern will be addressed. If the safety concern requires consultation, contact the Petro Builders, Inc. Health and Safety Department for further instructions. In the event the work plan becomes altered the Petro Builders, Inc, Health and Safety Officer must be notified immediately and appraised of the alterations so that an addendum to this plan can be prepared. .. e e SITE SAFETY PLAN SIGN OFF SHEET The following persons have read, understand and will comply with this Site Safety Plan. This plan was established for Petro Builders, Inc. personnel who are trained in the compliance with OSHA 29 CRF 1910.120 (Waste Site Worker Protection) exclusively for the work performed on the site listed above. This plan is provided to others solely for information purposes or contractual requirements. Any other use of this document is done without the authorization of Petro Builders, Inc. NAME COMPANY SIGNATURE (See attached additional signature sheet if required) All site personnel have read the Site Safety Plan and are familiar with its provisions. . Health & Safety Officer Michael W. Peltz TITLE NAME Project H & S Officer Bill Day Site Safety Officer Michael W, Peltz e e SITE HEALTH AND SAFETY RISK HAZARD LEVEL A ( ) B ( ) c ( ) D (X) (Requested by site environmental personnel) AIR MONITORING ACTION LEVELS Level D < 100 PPM sustained readings Level C > 100 PPM sustained readiµgs If at any time air monitoring levels read over lQO PPM or a member of the Petro Builders, Inc. Field Team considers personal health and safety to be a risk, operations on the site will cease and the safety concern will be addressed. If the safety concern requires consultation, contact the Petro Builders, Inc. Health and Safety Department for further instructions. In the event the work plan becomes altered the Petro Builders, Inc. Health and Safety Officer must be notified immediately and appraised of the alterations so that an addendum to this plan can be prepared. Please note: Air monitoring will take place continuously every 15 minutes during excavation and at any time deemed required by the Site Safety Officer and Consultant. POTENTIAL HAZARDS CHEMICAL HAZARDS: TYPE: PHYSICAL HAZARDS: DESCRIPTION: Temperature Noise Equipment (x) (x) (x) Heat or cold exposure Topography Confined Spaces Other ( ) ( ) ( ) Excavation e - WHEN VEHICULAR TRAFFIC POSES A POTENTIAL PHYSICAL HAZARD, SAFETY VESTS AND SAFETY CONES ARE REQillRED ON-SITE. BIOLOGICAL HAZARDS: RADIATION HAZARDS: MONITORING EQUIPMENT: EQUIPMENT Hnu (PID) 1 L7ev bulb ( ) . OV A (FID) (x) LEL/02 Meter ( ) Line Finder ( ) Colometric Tubes ( ) HCN Detector ( ) H2S Detector ( ) . Other ( ) PERSONAL PROTECTIVE EQUIP. DECONTAMINATION EQUIP. Eye Protection Ear Protection Protective Gloves Steel Toe Shoes Protective Footwear Hard Hat Chemical Suit Type: PVClNylon Other: (x) ( ) (x) ( ) (x) (x) ( ) ( ) ( ) Plastic Trays Plastic Bags Sprayers Contrad Wash Solution Rinse Water Scrub Brush Waste Solution Holder ( ) ( ) ( ) ( ) ( ) ( ) () ON SITE EMERGENCY EQUIPMENT WILL INCLUDE: (2) ABC Rated Fire Extinguishers Visquin to place soil on and cover stockpiles Water hose and water availability for vapor suppression All emergency exists posted , ,. e EMERGENCY CARE e THE NEAREST EMERGENCY MEDICAL FACILITY: San Joaquin Hospital ADDRESS: 2615 Eye St., Bakersfield TELEPHONE NUMBER: 661-385-3000 DIRECTIONS FROM SITE: See attached map and directions. LOCATION OF PRIMARY TELEPHONE: 562-946-2285 LOCATION OF ALTERNATE TELEPHONE: 562-946-2285 EMERGENCY TELEPHONE NUMBERS: 562-946-2285 POLICE: 661-327-7111 FIRE: 661-324-6551 . AMBULANCE: 911 PETRO BUILDERS, INC: (562) 946-2285 HAZ MAT UNIT: 911/661-324-'6551 · e PURPOSE STATEMENT This Site Safety Plan has been established to comply with Occupational $afety and Health Administration (OSHA) and the Environmental Protection Agency (EP A) standards and regulations. The main focus of this plan is to protect the hea.lth and safety of our personnel and the community. The plan also assigns duties and responsibilities, along with establishing safety procedures and contingency plans for those involved with this project. RESPONSIBILITIES PROJECT HEALTH AND SAFETY OFFICER Design, implement and maintain project Site Safety Plan(s) to comply with Federal standards and regulations, Instructs Site Safety Officer (SSO) on potential site hazards. Checks conformity, consults on changes, develops alternative procedures to the plan and resolves safety issues. SITE SAFETY OFFICER Has knowledge and authority to carry out specifications of the Site Safety Plan. Coordinates on-site activities regarding health and safety and has authority to stop work if significant safety hazards arise. Supervises air monitoring, decontamination, and documentation requirements. Oversees usage of personal protective equipment and maintains compliance with the Site Safety Plan, SITE WORKERS To use knowledge obtained through 40-hour Waste Sit Worker Protections course, Stàndard Operating Procedures, and common sense, to safely perform site duties. TRAINING All Petro Builders, Inc. field members receive corporation 40 hour Waste Site Worker Protection training that meets or exceeds the requirements of OSHA 29 CFR 1910.120. This training is supplemented annually with an 8-hour update course. e e MEDICAL SURVEILLANCE All Petro Builders, Inc. field team members are enrolled in a medical surveillance program, which includes: initial employment physical, annual physical and termination physical. Petro Builders, Inc. also maintains a personal exposure field that documents air-monitoring results and sampling results from each site that employee works. All Petro Builders, Inc. field team members will establish on site medical surveillance (performed by trained Petro Builders, Inc. personnel) when the temperature exceeds 80 degrees F. along with establishing cold weather working procedures. e - PERSONAL PROTECTION EQillPMENT LEVEL D: Coveralls Hard Hat Inner Gloves Outer Gloves Safety Glasses . (Optional) (Site specific) (Optional) (Optional) (Site Specific) LEVEL C: Full face air purifying respirator Hooded chemical resistant coveralls Hard hat (site specific) Inner gloves Outer gloves Chemical resistant outer boots Steel toe boots LEVEL B: SCBA' Hooded chemical resistant coveralls Hard hat (site specific) Inner gloves Outer gloves Chemical resistant outer boots Steel toe boots LEVEL A: SCBA Encapsulated chemical resistant suit Inner gloves Outer gloves Chemical resistant boots Steel toe boots e e SITE CONTROL ' The Petro Builders, Inc. field team shall locate any areas that contain elevated air. monitoring results, or confined spaces, and record these areas on the map, All exclusion zones shall be marked off and secured. Only authorized personnel who have read and , signed this Site Safety Plan shall be allowed in the exclusion zone. These people must also be able to demonstrate that they have the proper medical and training requirements. All site work shall employ the buddy system, Do not lose visual contact with the decontamination area wi~h a line of site person. Site decontamination problems and emergency response must be addressed prior to daily operations during the tailgate meetings. Any entrance into unidentified confined spaces without prior consent of the Project Health and Safety Officer is prohibited. DEFINITION OF A CONFINED SPACE According to NIOSH, a confined space "refers to a space that by design has limited openings for entry and exists: unfavorable natural ventilation, which could contain or produce dangerous air, contaminates, fuîd which is not intended for continuous employee occupancy" . DECONTAMINATION Decontamination personnel shall wear personal protective equipment at most one level lower than the workers entering the exclusion zone. All persons leaving the site must complete a decontamination process, which includes at least the following stations: 1. Equipment drop 2. Outer glove removal 3. Inner glove removal Upon completion of site personnel decontamination, an site personnel should wash hands and face prior to leaving the site. e e EMERGENCY PROCEDURES On-site personnel will use the following emergency procedures. The Project Safety Officer shall be notified of anyon-site emergencies and will be responsible for ensuring that the appropriate procedures are followed: PERSONAL INJURY IN THE EXCLUSION ZONE: Upon notification of any injury in the Exclusion Zone, the designated emergency signal (a continuous vehicle horn blast) shall be sounded. All site personnel shall assemble at the decontamination line. The rescue team will enter the Exclusion Zone (if required) to remove the injured person to the hot line. The Site Safety Officer and Project Team Leader should be decontaminated to the extent possible prior to movement to the Support Zone, The on- site EMP shall initiate the appropriate first aid, and contact should be made for an ambulance and with the designated medial facility (if required). No person shall re-enter the Exclusion Zone until the cause ofthe injury or symptoms are determined. PERSONAL INJURY IN THE SUPPORT ZONE: Upon notification of an injury in -the Support Zone, the Project Team Leader and Site Safety Officer will assess the nature of the injury. If the cause of the injury or loss of the injured person does not affect the performance of the site personnel, operations may continue. The.on-site EMP shall initiate the appropriate first aid and follow up as stated above. If the injury increases the risk to others, the designated emergency signal (a continuous vehicle horn blast) shall be sounded and all site personnel shall move to the decontamination line for further instructions, Activities'on site will stop until the added risk is removed or minimized. FIREIEXPLOSIQN: Upon notification of fire or explosion on site, the designated emergency signal (a continuous vehicle horn blast) shall be sounded and all site personnel moved to a safe distance from the involved area. FIRST AID: Ifthe site ofthe accident is safe to enter, field crew members should perform first aid if trained in RED CROSS STANDARD FIRST AID AND ADULT CPR, .. e e PERSONAL PROTECTION EQUIPMENT FAILURE: If any site worker experiences a failure or alteration of protective equipment that affectsthe protection sector, that person and his/her buddy shall immediately leave the Exclusion Zone. Reentry shall not be permitted until the equipment has been repaired or replaced. OTHER EQUIPMENT FAILURE: If any other equipment on site fails to operate properly, the Project Team Leader and Project Safety Officer shall be notified and then determine the effect of the failure on the continuing operations on site. If the failure affects the safety of personnel or prevents completion of the Work Plan Tasks, all personnel shall leave the Exclusion zone until the situation is evaluated an appropriate actions taken. EMERGENCY ESCAPE ROUTES: The following emergency escape routes are designated for use in those situations where egress from the Exclusion Zone cannot occur through the contamination lines: IN ALL SITUATIONS, WHEN AN ON-SITE EMERGENCY RESULTS IN THE EVACUATION OF THE EXCLUSION ZONE PERSONNEL SHALL NOT RE- ENTER UNTIL: 1. Petro Builders, Inc. Health and Safety officer allows. 2. The conditions resulting in the emergency have been corrected. 3. The hazards have been reassessed. 4. The Site Safety Plan has been reviewed. 5. Site personnel have been briefed on any changes in the Site Safety Plan. , .. e e APPENDIX I - SITE SAFETY PRACTICES 1. Any activities such as making, eating, drinking, chewing gum or tobacco, or any activity that increases the risk of hand to mouth contact shall be prohibited within the contamination zones. 2. Field crewmembers are encouraged to shower 'as soon as possible upon leaving . the site. 3.' Check all personal protective equipment prior to use to identify any faulty equipment. Report defects to the Site Safety Officer. 4. Avoid contact with any unknown sources on the site. Avoid kneeling, walking in puddles, leaning or sitting on drums or containers, and do not pick anything up and smell it. 5. Levels of protection that have been set in the he Site Safety Plan must be followed unless the project health and Safety Officer have granted permission. . 6. 'If unexpected hazardous situations occur work shall be halted until the information is discussed and remedied by the Project Health and Safety Officer. <, ~. ~ e e PLEASE RETURN TO THE PET,RO BUILDERS, INC. HEALTH & SAFETY OFFICER PLAN FEED BACK FORM JOB NAME: Chevron #20-3576 DATE: May 7,2004 CLIENT: Chevron Products Company PROBLEMS WITH PLAN REQUIREMENTS: UNEXPECTED SITUATIONS: ::, 1125 Coffee Rd, Bakersfield, CA 93308 to San Joaquin Community Hospital ,. Omi 0.5 1.5 2 e Copyright © 1988-2003 Microsoft Corp. and/or its suppliers. All rights reserved. http://www.microsoft.com/streets © Copyright 2002 by Geographic Data Technology, Inc. All rights reserved. © 2002 Navigation Technologies. All rights reserved. This data includes information taken with permission from Canadian authorities © 1991·2002 Government of Canada (Statistics Canada and/or Geomatics Canada), all rights reserved. ..' ,~ ;. c,: :.'9:00 AM O.Omi 9:01 AM 0.3 mi 9:04 AM 1.8 mi 9:09 AM 4.4 mi 9: 1 0 AM 4.6mi 9:12 AM 5.5 mi 9:13 AM 6.0mi 9:14 AM 6.2mi .. . e I Depart 1125 ~ffee Rd, Bakersfield, CA 93308 [1125 Coffee Rd, Bakersfield, CA 93308] on Coffee Rd (South) for 0.3 mi Turn LEFT (East) onto Truxtun Ave, then immediately turn LEFT (North) onto Coffee Rd for 1.5 mi Turn RIGHT (East) onto SR-58 [Rased ale Hwy] for 2.6 mi Road name changes to SR-178 [SR-58] for 0.2 mi Keep STRAIGHT onto SR-178 [24th St] for 0.9 mi Keep STRAIGHT onto SR-178 [23rd St] for 0.5 mi- Turn LEFT (North) onto Eye St for 0.2 mi I Arrive San Joaquin Community Hospital Copyright © 1988-2003 Microsoft Corp. and/or its suppliers. All rights reserved. http://www.microsoft.com/streets © Copyright 2002 by Geographic Data Technology. Inc. All rights reserved. © 2002 Navigation Technologies. All rights reserved. This data includes information taken with permission from Page 2 Canadian authorities © 1991-2002 Govemment of C"mada (Statistics Canada and/or Geomatics Canada), all rights reserved. e e fJ " L.¡~ WAYNE PERRY, INC. Environmental Remediation, Construction and Consulting March 2, 2004 Inspector Steve Underwood City of Bakersfield Fire Dept. 1715 Chester Ave. Third Floor Bakersfield, CA. 93301 SUBJECT: SB 989 COMPLIANCE TESTING AT CHEVRON STATION # 20-3576 LOCATED AT 1125 COFFEE RD. & BRIMHALL RD. IN THE CITY OF BAKERSFIELD, CA. 93306 Dear Inspector Underwood, Below please find the secondary containment testing results for the above-referenced site. These results are being sent to you per the requirement of SB 989. Included with this submittal are the following: CONTRACTOR: Wayne Perry, Inc.; License No: 300345 TECHNICIAN: Jose M. Dethier . SB 989 Testing Results & Procedures Components Tested Component Date Tested Type of Test Pass I Fail Manufacturer Performed Regular (87') Fill Bucket OPW- Pomeco 02/04/04 Hvdrostatic Pass If you have any questions regarding the attached results please contact the undersigned at (714) 826-0352. Attachments - SB 989 Testing Results & Procedures CC: Judy Bowe- Chevron Products Company Sam Stevenson- Chevron Products Company Dea1er- Station Manager 8281 Commonwealth Ave. Buena Park, California 90621 Phone (714) 826-0352 Fax (714) 523-7880 ~ e e SWRCB, January 2002 Page LofL Secondary Containment Testing Report Form This form is intended for use by contractors peiforming periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. . The completed form, written test procedures, and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. Facility Name: C;- Facility Address: // 2S Facility Contact: /\Jet Date Local Agency Was Notified of Testing : Name of Local Agency Inspector (ifpresent during testing): o Z -~ _.-..:?"Y ~ 3 3-01. Company Name: V\} A . Technician Conducting Test: Credentials: CSLB Licensed Contractor License Type: A'''O (, (c; I D' D 2. . TESTING CONTRACTOR INFORMATION .:::; rZ-".¿ '-I.. J f\1 (. - é7'T~0.H..--- o SWRCB Licensed Tank Tester License Number: ß DO:3 £f'Ç "::?'':.''''''':''~'''~..''''~; Manufacturer Date Trainin Ex ires 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Repairs Component Pass Fail Not Repairs Tested Made Tested Made ø 7 n~t- /3G/~..;;:.-r-- ~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 If hydrostatic testing was perfonned. describe what was done with the water after completion of tests: ?.t.L CL ttiLclu (1 -k/Jll ¡It:) '--pro ~ (ÍU)'LU) - CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING TIDS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Toehn;,;",', Signa""" tØ ~ Ða"" 02 -=¥- o~ e e SWRCB, January 2002 Page -2- of 'G,. 9, SPILL/OVERFILL CONTAINMENT BOXES Facility is Not Equi ped With SpilVOverfill Containment Boxes 0 SpiWOverfill Containment Boxes are Present, but were Not Tested 0 Test Method Developed By: 0 Spill Bucket Manufacturer ¥industry Standard o Other (Specify) Test Method Used: 0 Pressure 0 Vacuum. o Professional Engineer ydrostatic Equipment Resolution: Spill Box # Spill Box # Bucket Depth: Wait time between applying pressure/vacuum/water and startin test: Test Start Time: Initial Reading (Rr): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-R1): PasslFail Threshold or Criteria: !;Î~~f;Rés~it:/ " . r 60 m\11 II,' 3ß 15· l'j,,01.. II; S,ç;> 15_C¡s~ç;. \\ L\ /) '2... o ,<3SL o - Oò 2- o~ \)02- Comments - (include infonnation on repairs made prior to testing, and recommended follow-up for failed tests) - ----~---- Secondary Containl9t Test Panel e Test Parameters Test Status Function Menu Test Site Status Pass/Fail I Restart I I "~'I Chevron jSaving.. . L~~~o,~ 1125 Coffee Rd. Change . PASS I Save I I Return I Bakersfield, CA 99999 10.000.72 Product )87 Fill Bucket Test Results Type 15.9604 ITank Sump Fill 15.9602 15.9600 Test Start Time 15.9598 ¡Wed, Feb 04, 2004 11 :38 AM 15.9596 Test End Time _ 15.9594 G.I Wed, Feb 04, 2004 11 :50 AM > 15.9592 G.I ..J 15.9590 Length (min) Limit (in) ~ c 15.9588 \12 JO.0020 II ~ 15.9586 Test Result 15.9584 ¡Test passed. 15.9582 15.9580 Comments 15.9578 I 15.9576 1\ I I I ï 11 :38:54 AM 11 :42:00 AM 11 :45:00 AM 11 :48:00 AM 11 :50:54 AM 02/04/2004 02/04/2004 02/04/2004 02104/2004 02/04/2004 Test Time ---.--------~- _. --~'-------_.._-----,._._-------------_._--------_."._-,----,_._~~ iN ~8 2004 9:20 BKSFLD FIRE PREVENTION . N. 'l5 2004 ~:49 BI<.D FIRE PREVENIIUN ~eRMIT APPLJCA TION TO CONSTRUCT/MOOIFY UNOERGROUND STORAGE TANK (661)852-2172 lb.~5~-t!.l/~ p. 1 p.~ Bakeratlelc1 Fire Dept. ICD.vironmenta1 Senrlcc 1715 Chester Ave Bakersfield. CA 9330 1 Tel: (661)326-3979 P~WT NO. I ~ -:t: - D?4 sf TYPE OF APPL.ICA TlON (CHECK) o NEW ¡::ACILfTV )(IIAODIFIC\TlON OF FACIL.ITY a NEW TANK INS.TAL.L.ATION AT !)ClSTING FACIUTY S1NmNG ¡) I.fE N QAT!: FACIUT... 1WI4¡ . '\ C\té\.J~ 0 N 'ST""A--'11 0 I'..J F'A!.l AOQR6SS \ \ Z,5"Co PFEE ~o A-- i) TVPII 0" Ã~O 'F uet.A EXISTING p.oUTV P&RMIT I0IO. T - OVwWIA c.. Irt-~ v ¿"q ¡J ¡oQCIII! ss ÇI.o, ad' CIT"r~ g~sA~ð CQNrIW:TCA "OOItIIS ~z.,. 8' \ IN&I.Ø'Ii t S~c"",.~ t~. hi",..tJ BAlEF!.V œ5CIIlH TJoIt V'IQRII¡ TO II 0CHii 12 L '1r ..., ":So P L L;o(.... 'ò (I c...~ - (J.e,~ {f'fw aJ.N ~ l t!..,.,uoø ~- tJr-NtJ tZ. E (1, f.W".e C!t!:N.JLr~ P..r-~A--* 0 l.I'í C!tJ AJc.,rr;:'f7F' (2e-,..c/\.Ir -S-P\!.A- ~uL~l) 12t:;'-~ ~u~ ,w,TeR TO ¡:AClLIT'I' FIAOoIICIRI.... (V\ P. V¡'JICl *'- CEPntT~ f15 I SOl\, TYPIII!XP!Cn:D AT lirE GROJNC WI\. eft $~ 10l"Io...1 C-I' A.o-' NO on NOeS 0 I ...... TME'f FQR IICTOR PUlL /þ, I IPL, PREIISM11QN CCNTROL AND COUNI'I!IIIÆASUIES PINI C»I F1L~ TO IE !HST A"ID C 't&5 C PolO IJ ~&S a"O THIS SlCT1QH 18 POR MðTCR FUlL TAMe NO. VOLUMe I ~2-. DO 0 2 L2...~OO -3 12,. OliO CII&sEI. AIIIA TIOH THtS SIiCTlCN ,. FeR NON 1101'0" 'UIL STOItAGE TANICI t'~lnIQ. 1iO.UM! CkEMICA!. STOfue (NO BRAND i'Wi1!) CAS NO I. i<NC'llH1 CI-1I!IIICAL PRS!\/IOUSI. '" STCAeo FOR OfFIQAL USE ONLY ' APPUc:AT1Q\1 OI'TI! I FAaU'rY NO. I NO, 0# TNéM& I FUSS The applicant has rec.iv.d, wnder,/and8. and will comply with tJr. al/ach.d ctmdltions aflhø permit and an a/he .state local œrd federal regu/alÍofU. Thi:J form has been completed under peM(lJI of p.r1:J and ~ e st of my lrnuw/edge, i.r trUII and corr·ecl. '5 'Tl!JvbJ (!. IV, A A/ÞfIIJCNlT ..wIE (PIIINJ) THIS APPLICATIONBECOME8 A PERMIT WHEN APPROVED N 3Z UST Agency Name City of Bakersfield Office of Emergency Services .. e e . ~. Chevron Products Company Facility List: Co-Op 3 Party Stations Facility Number NAME ADDRESS 98109 201527 203576 206561 CHEVRON STATIONS INC#1920 CHEVRON STATIONS INC.1830 CHEVRON STATIONS INC#1842 CHEVRON STATIONS INC 1849 D ~ \ () ~t ~i \ A eÐr'1~-f MltJ ~ ~O ~O 1131 ÒAK ST I 6601 ,~ING AVE 1 ~.25ÇOFFEE RD ,~ , 33,60 \~~NAMA LN ,¡ t ' ~ . 'i¡ ',i , 'i, " !; 1l . ': ~ ~ :. ~. , "', :p , ~;. ~ ~_! ' :j,' ~i! . . "1 \ £ \(\,~ ¡i>-'~-¡ ('Hl V~ ~r~ r-Ç\q!\. hqd (£ .\ .t' . '~ . ·'1:;' !I, " 'I, r\ V\d \tX.. (It \ {N 'Tha.~~~ "', 1'" ;,' , I;:!;. l t . ~. 0' r . , . ~ I :;! i' (',. ¡; . .~. ..' I '" , CITY 4/26/2004 STATE ZIP BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD CA 93304-1 06~ CA 93309-344é. CA 93308.-5747 CA 93313-3695 ~~<D~ . , , I Chevron Prodllct~ Company . -- Marketing HES Permits' PO Box 6004, L2375-B3. San Ramon, CA 94583 Tel 925-842-9002 Fax 925-842-9585 chi nle@chevrontexaco.com Charles Bittle --HES-Permits- .-- Chevron III April 30, 2004 City of Bakersfield Office of Emergency Services-UST 1715 Chester Ave" Third Floor Bakersfield CA 9330 I RE: FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS Please find the following documents enclosed: __ __ ..-1) Proof of Financial Respon~ibility__ 2) Certificate of Financial R~spÖnsibility 3) Chevron Facility List under your jurisdiction . .. These documents meet the financial responsibility requirements for all UST's owned by Chevron and have previously been submitted directly to the State. If you have any questions feel frèe to contact me. Sincerely, ~~~ Charles Bittle HES Permits Enclosure e e ~ (:hcvr()nTcxaco Corporation (iOO I ßulling<.:r Canyon Road San Ramon, Ca ()45X3-2J24 Tel ')25 X'¡2 3232 Fax 925 X'¡2 60'¡7 ,John Wats()n Vice President and- Chid' r-ínancíal Ortiœr - ----~ -'".., ---- - -'- . - April 30, 2004 ChevronTexaco UST FINANCIAL ASSURANCE To Whom It May Concern: I am the Chief Financial Officer of ChevronTexaco Corporation, 6001 Bollinger Canyon Road, San Ramon, CA. This letter is in support of the use of the financial test of self-insurance and guarantee to demonstrate financial responsibility for taking corrective action and compensating third parties for bodily injury and property damage caused by sudden accidental releases and/or nonsudden accidental releases in the amount of at least $1,000,000.00 per occurrence and $2,000,000.00 annual aggregate arising from operating underground storage tanks. Underground storage tanks at the following facilities are assured by this financial test or a financial test under an authorized State prograiriHbÿ -this-gÜarantor: alluñâergroundstoiage~tanks owned bYHChevrori -. U,S.A. rnc, are assured by this financial test. A financial test and guarantee are also used by this guarantor to demonstrate evidence of financial responsibility in the following amounts under other EPA regulations or state programs authorized by EPA under 40 CFR parts 271 and 145: EP A REGULATIONS AMOUNT Closure (§§264.143 and 265.143) Post-Closure Care (§§264.l45 and 265.145) Liability Coverage (§§264.147 and 265.147) Corrective Action (§264.101(b» Plugging and Abandonment (§ 144.63) 104,080,132 80,555,940 8,000,000 25,849,286 5,130,800 California State Program Closure Post-Closure Care Liability Coverage Corrective Action Plugging and Abandonment 212,996 755,681 66,000,000 o o e e April 30, 2004 . .Page 2 ._ __ . - .. ". __ ..... - .-,... -0 ~. ..=- . _ _, _. .-~_ >_.- ,,- ... --.---. . ->"" . -- . --." "-' ",---<. -,., _._-_.~ .--- ,~.....- Louisiana State Program Closure Post-closure Care Liability Coverage Corrective Action Plugging and Abandonment 3,577,265 867,643 1,000,000 o o Total 296,029,743 This guarantor has not received an adverse opinion, a disclaimer of opinion, or a "going concern" qualification from an independent auditor on his financial statements for the latest completed fiscal year. e e April 3D, 2004 Page J .' .". .",~_."," '" .... ". -~- - - ~...-.~ -~ . . ,--...,. . '-.-. AL TERNA nVE II 1. Amount of annual UST aggregate coverage being assured by a test and guarantee 2. Amount of corrective action, closure and post-closure care costs, liability coverage, and plugging and abandonment costs covered by a financial test and guarantee 3. Sum of lines I and 2 4. Total tangible assets 5. Total liabilities 6. Tangible net worth 7, Total assets in the U,S. 8, Is line 6 at least $10 million? 9, Is line 6 at least 6 times line 3? 10. Are least 90% of assets located in the u.S,? (If "No", complete line 11.) II. Is line 7 at least 6 times line 3? 12. Current assets 13. Current liabilities 14. Net working capital (subtract line 13 from line 12). 15. Is line 14 at least 6 times line 3? 16. Current bond rating of most recent bond issue 17. Name of rating service 18. Date of maturity of bond - ~._~ ",,-.-~. ...... --- $ 2,000,000.00 $ 296,029,743.00 $ 298,029,743.00 $ 81 ,218,000,000.00 $ 45,175,000,000,00 . $ 36,043,000,000.00 $ 30,523,000,000.00 Yes No X' X X X $ N/A $ N/A $ N/A $ N/A AA Standard & Poors February 15,2008 - April 30. 2(J()4 .PageA '~--..~.- - -- -- -~.'.- -, - - _. - ~~ _ u.~_ - -~. - -- Yes No 19. Have financial statements for the latest fiscal year been filed with X the SEC, the Energy Information Administration, or the Rural Electrification Administration? I hereby certify that the wording of this letter is identical to the wording specified in 40 CFR part 280.95(d) as such regulations were constituted on the date shown immediately below, except that information concerning California and Louisiana was added to make disclosure more complete. ~1vç~ ~ Watson Ice President, Finance April 30,2004 - - --- -- -.. e e ¡) -April 30, 2004 Page 5 - ~--'- ,-- ."-" ~ GUARANTEE Guarantee made this April 30, 2004, by CHEVRONTEXACO CORPORATION, a business entity organized under the laws of the State of Delaware, herein referred to as guarantor, to EPA Regional Administrators and/or state agencies implementing underground storage tank regulation for the states listed in Paragraph 2 (hereinafter collectively referred to as the "implementing agencies"), and to any and all third parties, and obligees, on behalf of CHEVRON U.S.A. fNC. ("CUSA"), of 6001 Bollinger Canyon Road, San Ramon, CA. RECITALS I. Guarantor meets or exceeds the financial test criteria of 40 CFR 280.95(b) or (c) and (d) and agrees to comply with the requirements for guarantors as specified in 40 CFR 280.96(b). 2, Guarantor owns or operates the following underground storage tanks covered by this guarantee--all underground storage tanks owned by Chevron U.S.A. Inc. in the following states: Alaska Arizona California Florida Georgia Hawaii Oregon Texas Washington This guarantee satisfies 40 CFR part 280, subpart H requirements for assuring funding for taking corrective action and compensating third parties for bodily injury and property damage caused by either. sudden accidental releases or nonsudden accidental releases or accidental releases arising from operating the above-identified underground storage tanks in the amount of $1,000,000.00 per occurrence and $2,000,000.00 annual aggregate. 3. On behalf of our subsidiary, CUSA, guarantor guarantees to implementing agencies and to any and all third parties that: In the event that CUSA fails to provide alternative coverage within 60 days after receipt of a notice of cancellation of this guarantee and the Director of the implementing agency has determined or suspects that a release has occurred at an underground storage tank covered by this guarantee, the guarantor, upon instructions from the Director, shall fund a standby trust fund in accordance with the provisions of 40 CFR 280,108, in an amount not to exceed the coverage limits specified above. In the event that the Director determines that CUSA has failed to perform corrective action for releases arising out of the operation of the above-identified tanks in accordance with 40 CFR 280, subpart 'F, the gÚarantor upon writtenlrÏstruëtions from theUOirectorshall fund a stäridby trust in e e April ]0, 2004 Page 6 I .. accordance with the provisions of 40 CFR 280.108, in an amoLlnt not to exceed the 'coverage limits specified above. If CUSA fails to satisfy ajudgement or award based on a determination of liability for bodily injury or property damage to third parties caused by sudden and/or non sudden accidental releases arising from the operation of the above-identified tanks, or fails to pay an amount agreed to in settlement of a claim arising from or alleged to arise from such injury or damage, the guarantor, upon written instructions from the Director, shall fund a standby trust in accordance with the provisions of 40 CFR 280.108 to satisfy such judgement(s), award(s), or settlement agreement(s) up to the limits of coverage specified above. 4, Guarantor agrees that if, at the end of any fiscal year before cancellation of this guarantee, the guarantor fails to meet the financial test criteria of 40 CFR 280,95(b) or (c) and (d), guarantor shall send within 120 days of such failure, by certified mail, notice to CUSA. The guarantee will terminate 120 days from the date of receipt of the notice by CUSA, as evidenced by the return receipt. 5. Guarantor agrees to notify CUSA by certified mail of a voluntary or involuntary proceeding under Title 11 (Bankruptcy), U.S. Code naming guarantor as debtor, within 10 days after commencement of the proceeding. 6. Guarantor agrees to remain bound under this guarantee notwithstanding any modification or alteration of any obligation of CUSA pursuant to 40 CFR part 280. 7. Guarantor agrees to remain bound under this guarantee for so long as CUSA must comply with the applicable financial responsibility requirements of 40 CFR part 280, subpart H for the above- identified tanks, except that guarantor may cancel this guarantee by sending notice by certified mail to CUSA, such cancellation to become effective no earlier than 120 days after receipt of such notice by CUSA, as evidenced by the return receipt. 8. The guarantor's obligation does not apply to any of the following: (a) Any obligation ofCUSA under workers' compensation, disability benefits, or unemployment compensation law or other similar law; (b) Bodily injury to an employee of CUSA arising from, and in the course of, employment by CUSA; (c) Bodily injury or property damage ansmg from the ownership, maintenance, use, or entrustment to others of any aircraft, motor vehicle, or watercraft; (d) Property damage to any property owned, rented, loaned to, in the care, custody, or control of, or occupied by CUSA that is not the direct result of a release from a petroleum underground storage tank; e e ,) · --^pril 30, 2004 Page 7 (e) Bodily damage or property damage for which CUSA is obligated to pay damages by reason of the assumption of liability in a contract or agreement other than a contract or agreement entered into to meet the requirements of 40 CFR 280.93. 9. Guarantor expressly waives notice of acceptance of this guarantee by the implementing agency, by any or all third parties, or by CUSA. I hereby certify that the wording of this guarantee is identical to the wording specified in 40 CFR 280.96(c) as such regulations were constituted on the effective date shown immediately below. Effective date: April 30, 2004 CHEVRONTEXACO CORPORATION By øÆ-~- Wq~ Jo~atson Vi~~:~ent, Fin~ B(/~~~~ 'f-.._~ _ Assistant Secretary 11· , ~ \.V\ .- - - --- -- -_. " e e .~ fiRE CHIEf RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Sfreet Bakersfield, CA 93301 VOICE (661) 326-3911 FAX (661) 852-2170 SUPPRESSION SERVICES 2101 "H" Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 852-2170 PREVENTION SERVICES fiRE SAfETY SERVICES. ENVIRONMENTAl SERVICES 900 Truxtun Ave.. Suite 210 Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 852-2171 fiRE INVESTIGATION 1715 Chester Ave.. 3'd Floor Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 852-2172 TRAINING DIVISION 5642 Victor Ave. Bakersfield. CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 December 10, 2004 Chevron Station 1125 Coffee Road Bakersfield, CA 93308 REMINDER NOTICE Re: Necessary Compliance Deadlines for UST Owners/Operators Dear Valued Customer: The purpose of this letter is to remind you about three compliance deadlines for UST Owners/Operators. These are as follows: 1) January 1,2005 deadline for submitting declaration statement designating: (a) Owner/Operator understands and is in compliance with all applicable UST requirements, and (b) Owner identifies the designated UST Operator for each facility owned. (c) Owner/Operator passes and submits proof of International Code Council Test. 2) EVR upgrade requirements on spill buckets are due April 1, 2005. 3) Secondary Containment Testing on all secondary systems. Code requires re-testing 36 months from date of last test which was in 2002. Should you have questions regarding these compliance deadlines, please feel free to call me at 661 - 326-3190, SincerelYj ~~ Steve Underwood Fire Prevention Officer SU:db :1 II _CIl C6' -..//.~ .-IC/::' /I Q/ryrIIÙI/J lie T(:MINIU¡,m!;y (ì,,/í(l'jI. º l{(Nle C}:J/U/'II Qr;ý T(:P#Ii.M¿j " - -:-;;"pril 30. 2ü(),! Page 8 CERTIFICATION OF FINANCIAL RESPONSIBILITY CHEVRON U.S.A. INC. hereby certifies that it is in compliance with the requirements of subpart H of 40 CFR part 280. The financial assurance mechanisms used to demonstrate financial responsibility under subpart H of 40 CFR part 280 are as follows: Financial test and corporate guarantee of Chevron Texaco Corporation in the amount of$l million per occurrence, $2 million annual aggregate, for the period commencing April 30, 2004 and which is anticipated to be renewed annually, with the next renewal scheduled to occur during the first 120 days of 2005. Said guarantee covers taking corrective action and compensating third parties for bodily injury and property damage caused by either sudden accidental releases or nonsudden accidental releases or accidental releases, April 30, 2004 CHEVRON U.S.A, INC. By' By c;J4./?'t/~¿ Z .L;}¿vJ'~ Judith L. Geisler Legal Analyst e e ;¡. ~~ràB CARD POST CARD AT JOB SITE Bakersfield Fire Dept. Prevention Services 900 Truxtun Ave #201 Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME Ül/IEv'VON .5Ti>1roAJ 203570 A_DDREss'1 ~S GoJ'Pee _ CITY BAKERSFIELD PHONE No. ::::S-~·\t\D-Ç ~~~ w~~~t~--~~f ~ . cv~&vv-r ~_ _u J133D0 - . :~~-_\:?~~~;~-_~~:~_~~:-.-~]~~~_~~_ PERMITNÓT - 037'Z. INSTRUCTIONS: PLEASE CALL FOR AN INSPECTOR ONLY WHEN EACH GROUP OF INSPECTIONS WITH THE SAME NUMBER ARE READY. THEY WILL RUN IN CONSECUTIVE ORDER BEGINNING WITH NUMBER ONE. DO NOT COVER WORK FOR ANY NUMBERED GROUP UNTIL ALL ITEMS IN THAT GROUP ARE SIGNED OFF BY THE PERMITTING AUTHORITY. FOLLOWING THESE INSTRUCTIONS WILL REDUCE THE NUMBER OF REQUIRED INSPECTION VISITS AND THEREFORE PREVENT ASSESSMENT OF ADDITIONAL FEES. INSPECTION PRIMARY PIPING .- - ----.--------.---- -~._--.-.-._--------_.._---_._------ SECONDARY PIPING -'---~ TYPE OF PIPING o FLEX 0 FIBERGLASS CATHODIC PROTECTION SYSTEM-PIPING -...----_._-----~--------~_._~--------- -----~----- ._-_._-~.__._----------- DISPENSER PAN CONTINUOUS VAPOR MONITORING --.- - ----.-----------------..--- --_._---------~-------- --_._-.---..-_._~-- --------- ------ --_.-- --~. ENHANCHED LEAK DETECTOR TEST --.- ---."-------.-.--.-------------. --------^--~--~._---------~- ----------- ---- LEVEL GAUGES OR SENSORS, FLOAT VENT VALVES -_.---- ------------------_._------~._--------._-----_._----<-~-- ------ ----~-------<-- -~~--------------- FILL TIGHT FILL BOX(ES) ---- --~--~._----------------------------------- ------- ----- --------- ------- PRODUCT LINE LEAK DETECTOR(S) ---- ----~._----------~-------------_.~ ------~------- ---_.---------~- --------~----- LEAK DETECTOR(S) FOR ANNUAL SPACE-D.W. TANK(S) . --- --------- ------~_.----------~-,------_.~ -----~---- -----. -_.~------------- -- -- -- -.---------.----- ------------------.- i;.~t~~, -:~~:1;~~~*¡¡t{~~~~~ii:Æ~::~:~~~~:¿:~:~~j;~~~:i~~~~·,':~;f~:¡~;~~..ft~~&;~f;.::f;r;~~~f;:~;1:k~if(~;~~?{~ ~:. _ -'--.-.. ~---,------~---_.._- ._-----<---+--_. ----.------ ----..--.- ....~_._._------------ -<---------- -<------ <._-~------_..---------- FILL BOX LOCK _.____..___________,__ ___.___._ ___________. _..___.~_____________. '__··~n_____.________ __.__ .__._______________ _______________________._~ MONITORING REQUIREMENTS TYPE ____________ -_.- --.---".-- ------ ----.. -------- --'- ,---- -.-.- -~------ '--- --_.-. ----.--------- ,--- ,'- - ----- -- --,._--~ ~~~--_.- --,-- -.--- -- -- ----_.~-- -.------- AUTHORIZATION FOR FUEL DROP CONTRACTOR ---g.±(~--J3vJ.JdE{'~t-~~~--~--------------------------- LICENSE No. __~lj~___ CONTACT _________________________________________ ___________________________________________________ PH ON E N o. (~?L_r:t~_~?!_f35 fd1743 j "ì¡ 08/27/2004 06:05 5629469893 PBS JTE RUG 28 2004 11:10 BKSFLD FIRE PREVENTIDN (661)852-2172 PAGE 02 p.~ . PERMIT APPLICATION TO CONSTRUCT/MODIFY AN UST UNDERGROUND $TORAGE TANK fit BakOlde1d Pin Dept. Environmental Service ".. 900 TruxtunAve., Sœ.210 'A.'. Balœrsfield. CA 93301 ~ Tel: (661~826-3979 Pf.RWUIQ. La.T-057i I TYPE OF APPLICATION (ChOCK one item only) C N~ FAClUTV J(MODIFI~TlON OF FAClUTY D NEW TANK INSTALLATION AT EXISTING FACIUTY ED COUPtS'lDN IIA'Œ CODE '3 þ ~ TO I'M:1UTY I'IIDVI:IEP BY ¿.,.\ Wþt-~ IIa"TH TO ,.0. *- ~ FOIt MOTOR F\ÆL DYES CNO 'THIS SiCT1Cfi 11\ FO~ MOTQR FUãL Ti\Nll:NO. ~U"'E ~NLlõAœD RIOGI,I,AA ~..... þIaa. [MtrATlCN m=_~=~~~T~ .. _ _ r _ - E _L-=r J r =--1 FOR OFFICIAL USe. Oþ, LV [API'IJCA1\OH D >78 l' FACILITY NO. I NO. OF TANKS I FB;SS 77N appliœnt has receiw.d, lIntiersfßnds. and will comply with tht!! tUtlIch«l condlIion.s of the pemrit iPJd tIJIy ødwr _~ l~ œulftdltraJ ",Wœlons, '!hi, førm Juu been eømpÙUd u,.u.,. ~by t;J/~rjury. ØNl tD'" Jj¡7J;Å~~-: -ft/L~~. \BCtifW, 0zd¿{~ .. ~ ~ --~,~ --- 6 TH APPUCATION BI!COMESA PERMIT WHEN APPROVED Ð