The URL can be used to link to this page

Home My WebLink AboutAST APPL 11/9/2004 (COPY) 1', A,PPLlCATION FOR ABOVEGROUND ·$TORAGE TANK(S) . )( INSTALL 0 REMOVE I PERMIT: # ft-TI - '-f 7 '7 FACILITY -r:: <'.. / d ror~er JUnIaI') Oil ~elii?e. DDRESS 2/52 Coffee. -¡;road 73èJkeí6lield PERATORSNAME Vodd G( Q OWNERS NAME ,. 1 world Oil. Cor. CA PERMIT TO OPERATE NO, NUMBER OF TANKS TO BE INSTAllED ~ I REMOVED TANK No. CONTENTS 1 COl1detróafe (úJafer ~d oil) NAME OF COMPANY INSTAlliNG & I OR REMOVING TANK(S) C/evel1 'ef COI7"S MAILING ADDRESS /232 .:S. I NAME & PHONE NUMBER OF CONTACT PERSON Kelt DATE & TIME TEST IS TO BE IN SIGNATURE OF APPLICANT Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave,. Ste. 210 Bakersfield. CA 93301 Tel: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 VOLUME J.t OW }1a/Jo/ls fd2058 $ 0 $ 0 . 64HID C , B C D 18" 18" 18" 18" I 572." I 21" L 16 J 5" 2 r~251"!251"~1" h b Its 8 8 ane or 0 BASEPLATE DETAIL AIR TEST AT NDT LESS THAN 3 PSI NDR MDRE THAN 5 PSI. PRIMARY TANI< m BE TESTED I\LDN£. SECDNDARY T ANI( m BE PRESSURE TESTED VlTH PRESSURE IN PRIMARY T ANI<. THIS SHALL BE ACCIIM- PUSHED BY BLEEDING AIR F"RDM THE PRIMARY TANI< INi1J THE SECCNDARY TANI<. AT NO TIME SHALL PRESSURE IN SECONDARY TANK EXDCEED PRESSURE IN PRIMARY TANK. SHELL THKI PER UL HEAD THKI PER UL INTERIOR, BARE, CLEAN OF DEBRIS. EXTERIOR' 'WHITE EPOXY MATERIAL AND CCNSTRUCTIDN CDNFIJRM TD UNDER1o/RITERS LAIIIJRATDRIES STI\NIIARJ UL142. - ~ $0009- 12'-0" 10'-11 " 10t-11 " NO. REQD. ONE (1) IlEII NO.: H 1 81 FNPT SEC. E-VENT ~ - wålÎDgcœI(IIIY of WiD, Œ G 1 41 FNPT F 1 41 FNPT 4141 N. BRAWLBY AVB lIBJIIINO,CA9372Z æ.~ PAX~I E 1 81 FNPT PRI. E-VENT D 1 41 FNPT WORLD OIL C 3 21 FNPT 4000 GALLON DOUBLB WALL ABOVEGROUND TANK B 1 41 FNPT JJ ~'Œ 11/03/04 A 1 21 FNPT MONITOR DWN. BY SCALE: NONE MARl< REIl n SIZE TYPE RATING REMARKS CHI<. BY oIDB NO. 1M. NO. 7604 &. SCHEDULE OF OPENINGS APR. BY P.D. NO. SHT. NO. 1 OF 1 SIZE DIA. LENGTH WEIGHT 4 000 65' 24'-6' 9 000# ~ ~~ e e 4700 Coffee Rd. Brookside Mkt. 07/08/04 Diesel Dispenser Hose Leak ~~ .-. _:---~~~.~ ~ .... -;:; - - ==--. ~~-.-1 \.. /~0 'r---- (,\ l~. r!!J'C) t. c;~--\/ \\..- ,- _H___ _yP '«': __.____ . ___ __.___ I"-~""" . ~" e EnVIronmental Manageme8 West Region po. 80x 5095 Room 3EOOO San Ramon, CA 94583-0995 .- ~ -, --~ .~-~.- ~,.~--. -- ~- ~_. -'--- .. _.~- -'. -~ _..- -' -~_. ---- """ . ._-.~¥. --. --- 877.8219833 Phone 925.973:0584 925,867.0241 ~_. -~. ...- ..,. --' -- .- - _...~_..._- . -- --- ---- ~- r/ June 8, 2004 City of Bakersfield - CUP A Attn: Ralph E. Huey, Director Fire Department 1715 Chester Ave, Third Floor Bakersfield, CA 93301 RE: Certification of Financial Responsibility - Underground Storage Tanks Please find the enclosed copy of the annual State of Cali fomi a Water Resources Control Board's Certification of Financial Responsibility form to demonstrate financial responsibility for SBC/Pacific Bell and its affiliate's underground storage tanks. Also enclosed is a list, Exhibit A, of SBC/Pacific Bell sites that have underground storage tanks on the premises in your area of jurisdiction. I can be reached at (925) 823-6161 if you have questions regarding this correspondence. -c4~/'1~~ Andrew Taylor Senior Environmental Manager SBC Environmental Management Attachment: Certification of Financial Responsibility Exhibit "A" 2004 Financial Test of Self Insurance (Certificate of Insurance) . . - - '0' ______ ..~_..- ,-" ~. EXHIBIT A . . -- Bakersfield Fire Dept Bakersfield Fire Dept Bakersfield Fire Dept Bakersfield Fire Dept Kern County Health Dept Kern County Health Dept Kern County Health Dept e e ---.- -~-- - - - - -~ --_. .~~~o_______ _~_~___ --~_.....--~.~- .- ----.. ---- _ .-----'. ~.~- .~~-~ -"--'- -- ------ -"'-. -,,_.'~- .--__ _ T. _-.., ._.~ .~_._...... 2004 UST FI~A.NÇIAL R._§.~P9tJSIBILlTY --- - . KERÑ COUNTY . ~_-.." 3221 So. Street 1918 "M" Street 3501 Columbus Ave 11609 Rosedale Hwy 925 Jefferson St 8313 E Segrue Road 1021 California St Bakersfield . Bakersfield Bakersfield Delano Lamont Oildale Porter Linda Porter Linda Porter Linda Porter Linda Porter Linda Porter Linda Porter - - -"- . - -~ . -,.---- -- n .. .. . - . CERTIFICATE OF INSURANC issue Date: 06-09-2004 , - .. c:e_rtificate N um.ber: 20208. -- - - -'- -~ -- o' .. . ..INSURED: . -- '" - -- - .- - -._~."~.--'~~---.' This i,\> _\0 çeljlfyJt)at p.olicies-OUnsurance listed.below.have been. issued-to- the-Darned· insurecHor the _ v___· policy period indicated, Notwithstanding any requirement. term or condition of any contract or other SSC COMMUNICATIONS INC, - .. document with respect to which this certificate may be issued or may pertain, ttîéinsû¡'àriêë âffo'rded by PACIFIC BELL TELEPHONE COMPANY the po~cie~ dE:}scribed herein is suþjes;t to .allthe terms, exclusions. and cOnditions of such policies. 175 E. HOUSTON .. . - . . . --' SAN ANTONIO. TX 78205 This certificate is issued 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 described below. TYPE OF INSURANCE . .POLlCY EFFECTIVE EXPIRA TJON LIMITS OF LIABILITY COMPANY AFFORDING COVERAGE NUMBER DATE DATE OTHER Gateway Rivers Insurance Co. 409-1 UST001 12/31/2003 12/31/2004 PER OCCURRENCE $ 500,000 Environmental Impairment ANNUAL AGGREGATE $1,000,000 liability for Underground and Above Ground Storage Tanks DESCRIPTIONOFOPERf-TI0/'JS;,':' .<".._:~{:"; ,; . .. . SEE ATTACHMENT FOR CERTIFICATION LANGUAGE. CANCELLATION .. .. . . .; .. Should any of the above described policies be cancelled before the expiration date thereof, the insurance company will endeavor to mail 30 days written notice to the certificate holder named below. Failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. CERTIFICATE HOLDER . PRODUCER CONTACT STATE OF CALIFORNIA American Risk Management Requested By STATE WATER RESOURCES CONTROL BOARD P,O. Box 1530 ANDREW TAYLOR DIVISION OF CLEAN WATER PROGRAMS 8ur1ington, VT 05402-1530 Requestor's Phone P.O. BOX 944212 925-823-6161 SACRAMENTO, CA 94244-2120 Issued By DJ AUTHORIZED REPRESENTATIVE ~ø~ ...." ". ...,' .. - e -e For State Use Only State ofCalitòmia~ - . State Water-Resources-Contror Board·· Divisil.1n of Clean Watc::r Programs P.O. 81.1x 944212 Sacramento, CA 94244-2120- --- -_._~~- -- -.--.-- -~~--_. ~ --.. CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM - -- -- - A. I am required to demonstrate Financial Responsibility in the required amUU/1ts as specified in Sectiun 2807, Chapter 18, Div, 3, Title 23. CCR: ~ 500,000 dollars per occurrence ~ I million dollars annual aggr:,egate or AND or o I million dollars per occurrence 0 2 million dollars annual aggregate B. Pacitìc Bell Telephone Company (Name of (Jnk OwnCf or Opcrutor) hereby certities that it is in compliance with the requirements of Section 2807, Article 3. Cbapter 18, Division 3; Title 23, California Code of Regulations. The mechanisms used to demonstrate financial res onsibili as re C. Mechanism Name and Address of Issuer Mechanism T e Number Certificate of Ga teway Ri vers Insurance 409- Insurance Compan y 1 USTOO 1 76 St. Paul St., Ste. 500 Burlington, VT 05401-4477 uired b Section 2807 are as follows: Coverage Coverage Corrective Amount Period Action $500,000 Per 12/31/2003- Yes Occurrence & 12/3 1/2004 $1,000,000 Annual Aggregate Third Party Compensation Yes . Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certifies that you are in com liance with all conditions for artici ation in the Fund. D. F3Ciliry Namc Faeiliry Addrw Pacific Bell Tele F3Cility Name See Attachment Facility Address Faci1iry Name Facility Address Facility Name F3Ciliry Adùrc.u Facility Name Facility Address Faciliry Namc E:acility Address rl1ci¡iry Namc Facili~y Address Name and Title orTank Owner or Operator Paul W. Stephens, Director & Executive Vice President Name of Witness or Notary Barbara L. Hohman (Instructions on Reverse) UN-049 - 1/2 www.unídocs.org 01/29/02 " 40 CFR. 280.91 [b)(2) e e Pacific Bell Internet Svcs.lnc. " Ceni(icatö of Insurance Name: [name of each covered location: See attached schedule Address: (address of each covered location) See attached schedule Policy Number: 409-1 USTOOl Endorsement (if applicable): Not Applicable perio? of Coverage: 12/31/2003-12/31/2004 Name of Insurer: Gateway Rivers Insurance Company Address of Insurer: 76 St. Paul Street, Suite 500, Burlington VT 05401-4477 Name of Insured: Per Certiticate of Insurance Address of Insured: Per Certificate of Insurance Certitication: 1. Gateway Rivers Insurance Co., the "Insurer" as identified above, hereby certifies that ithas issued liability insurance covering the following underground storage tank(s): See Attached for "taking corrective action" and/or "compensating third parties for bodily injury and property damage caused by" either "sudden accidental releases" or "nonsudden accidental releases" or "accidental releases"; in accordance with and subject to the limits ofliability, exclusions, conditions, and other terms of the policy; if coverage is different for different tanks or locations, indicate the type of coverage applicable to each tank or location] arising from operating the underground storage tank(s) identified above. The limits of liability are $500,000 for "each occurrence" and $1,000,000 "annual aggregate", limits of the insurer's liability; exclusive oflegal defense costs, which are subject to a separate limit under the polic . This coverage is provided under 409-1 US TOO 1. The effective date of said policy is 12/3112003- 12/31 2004. 2) The insurer further certifies the following with respect to the insurance described in Paragraph I: a. Bankruptcy or insolvency of the insured shall not relieve the insurer of its obligations under the policy to which this certificate applies. b. The insurer is liable for the payment of amounts within any deductible applicable to the policy to the provider of corrective action or a damaged third-party, with a right of reimbursement by the insured for any such payment made by the insurer. This provision does not apply with respect to that amount of any deductible for which coverage is demonstrated under another mechanism or combination of mechanisms as specified in 40 CFR 280.95-280.102. c. Whenever requested by a Director of an implementing agency, the insurer agrees to furnish to ~e Director a signed duplicate original Qf the policy and all endorsements. __ d. Cancellation or any other termination of the insurance by the insurer, except for non-payment of premium or misrepresentation by the insured, will be effective only upon written notice and e -- only after the expiration of 60 days after a copy of such written notice is received by the insured, Cancellation for non-payment of premium or misrepresentation by the insured will be effective only upon written notice and only after expiration of a minimum of 10 days after a copy of such written notice is received by the insured. e. The insurance covers claims otherwise covered by the policy that are reported to the insurer within six months of the effective date of cancellation or non-renewal of the policy except where the new or renewed policy has the same retroactive date or a retroactive date earlier than that of the prior policy, and which arise out of any covered occurrence that commenced after the policy retroactive date, if applicable, and prior to such policy renewal or termination date. Claims reported during such extended reporting period are subject to the terms, conditions, limits, including limits ofliability, and exclusions of the policy. I hereby certify that the wording of this instrument is identical to the wording in 40 CFR 280.97(b)(2) and that the insurer" is "licensed to transact the business of insurance," or "eligible to provide insurance as an excess or surplus lines insurer, in one or more states". c~~~ Signature of authorized representative of Insurer: Type Name: Paul W. Stephens Title, Authorized Representative of Insurer: Director & Executive Vice President Address of Representative: Gateway Rivers Insurance Co. 175 E: Houston, 7-P-60 San Antonio, Texas 78205