HomeMy WebLinkAboutBUSINESS PLAN
~~GROUNDSTORAGETANK
PERMIT APPLICATION TO
CONSTRUCT I MODIFY I MINOR ~
MODIFICATION OF AN UST ~
PERMIT NO. Þ ~-D.2) -OD l~ ~ N\T f'V) - Q3 B G
TYPE OF APPLICATION: (Check one item only)
o NEW FACILITY 0 NEW TANK INSTALLATION AT EXISTING FACILITY
o MODIFICATION OF FACILITY MINOR MODIFICATION OF FACILITY
Bakersfield Fire Dept.
Environmental Service
900 Truxtun Ave.. Ste. 210
Bakersfield. CA 93301
Tel: (661)326-3979
Fax: (661) 852-2171
Page 1 of 1
EXISTING FACILITY PERMIT NO.
IP CODE
Q g3v'f
BAKERSFIELD CITY BUSINESS LICENSE NO.
ITY
lu.lú.r¢.
ORKMANS COMP NO.
1* JDIO ð"O~
IP CODE
q 311¥
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BRIEFL V DESCRIBE THE WORK TO BE DONE
-6~~~ C5h C'?) l!~I-~TIO<>-
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W ~ pn ~1..1'\ \1(", sn.u..+ do (..a)Y'\.
LO Ot) Ò tL&-~
DI'b~~ . ~So'Y>
WATER TO FACILITY PROVIDED BV
DEPTH TO GROUND WATER
SOil TYPE EXPECTED AT SITE
NO. OF TANKS TO BE INSTAllED
ARE THEV FOR MOTOR FUEL
DVES DNO
SPill PREVENTiON CONTROL AND COUNTER MEASURES PLAN ON FilE
DVES DNO
THIS SECTION is FOR MOTOR FUEL
TANK NO. tv°lUME ¡JNlEADED REGULAR !PREMIUM DIESEL [AVIATION
THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS
TANK NO. ~OlUME UNLEADED REGULAR PREMIUM DIESEL AVIATION
,
FOR OFFICIAL USE ONLY
APPLICATION DATE
FACILITY NO.
NO. OF TANKS
FEES $
The applicalll has received, understands, and will comply with t~¡e attached conditions of the permit and any other state'g:;(ocal and ederal 2 ~
regulations. Thí.l"form has bee ¡ com leted under penalty afperJury, and 10 the best of my knowledge, 1.1" true and correct r
SA, f\)f\fV) ~lNc.-\1 wt~ I
APPR APP ANT NAME PRINT APP I ANT I NAT R
PLICATION BECOMES A PERMIT WHEN APPROVED
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U~DËRGROUNDSTORAGETANK
~:.
Bakersfield Fire Dept.
Environmental Service
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel: (661)326-3979
Fax: (661) 852-2171
PERMIT APPLICATION TO
CONSTRUCT I MODIFY I MINOR ~
MODIFICATION OF AN UST ~
PERMIT NO. Þ "-"~J-4019J~ N\TtV')... Q30b
TYPE OF APPLICATION: (Check one item only)
o NEW FACILITY 0 NEW TANK INSTALLATION AT EXISTING FACILITY
o MODIFICATION OF FACILITY MINOR MODIFICATION OF FACILITY
Page 1 of 1
EXISTING FACILITY PERMIT NO.
ITY
13(.LJu.r~ -{l ~
IP CODE
q g'30'1
PN#
ITY
'li..t.1cv4.-
ORKMANS COMP NO.
1* ,;?DID 60'~
BRIEFLY DESCRIBE THE WORK TO BE DONE
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~~ 1. .. ~l~D-\- S nt'.Å ~e.
W1. L r-'n~"\.,.-tl\JL. S .doc..c)Y"\ "
BAKERSFIELD CITY BUSINESS LICENSE NO.
to ot) Ò u..&---~-.
DI'C;:~~.- .n.Ç Sen'òO'YS
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
NO. OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEL
DYES DNO
SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE
DYES DNO
THIS SECTION IS FOR MOTOR FUEL
TANK NO. VOLUME UNLEADED REGULAR PREMIUM DIESEL AVIATION
. _. --~
.
THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS
TANK NO. fvOLUME UNLEADED REGULAR PREMIUM DIESEL VIA TION
FOR OFFICIAL USE ONLY
APPLICATION DATE
FACILITY NO.
NO. OF TANKS
FEES $
The applicant has received, understands, and will comply with the attached conditions of the permit and any other state'gJocal and ederal 2 ~
regulations. 771isform has bee com leted under penalty of perjury, and to the best of my knowledge, is true and correct
. Sft,~~T"\ ~\Nc...~ .. ~~ J .
APPR ED BY: APPLI ANT NAME PRINT APPLI ANT SIGNAT RE
PLICATION BECOMES A PERMIT WHEN APPROVED ',,- ,
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FRANZEN-HILL CORPORATION
1100 North J Street
Tulare, California 93274
(559) 688-2977 / FAX (559) 688-1467
LETTER OF TRANSMITTAL
TO:
Thiara Food Mart
3401 South Chester
Bakersfield, CA 93304
Date:
Quote#:
Regarding:
11/19/04
Permits
Attn: Satman
FAX# : 51ncluding Cover Sheet
P'hone=~~- _.~-~~---~~-- ~---'~
WE ARE SENDING YOU A TT ACHED VIA: .fU.s. Mail: --'=ax
o Letter 0 Literature ""'Permits Application 0 Specifications 0 Drawings DSub-Contract DTest Results
THESE ARE TRANSMITTED as checked below:
.fFor approval 0 Return
corrected prints
Page5 Date De5cription
3 11/19/04 Permit APCD
1 11/19/04 Permit City of Bakersfield
.fFor your use
DAs requested
o For review --~
o FOR BIDS DUE 2004
o PRINTS RETURNED AFTER LOAN TO US
o Signature and Return
COMMENTS:
The following are the permit applications we spoke about, please call me when you receive them so I can reviewthem
with you.
SIGNED: ¡va Tucker Ext: 3002,LQns~ruction Secretary
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San Joaquin Valley Air Pollution Control District
www.valleyair.org
Permit Application For:
o AUTHORITY TO CONSTRUCT (A TC) - New Emission Unit.
£:] AUTHORITY TO CONSTRUCT (A TC) - Modification Of Emission Unit With Valid PTONalid ATC.
o AUTHORITY TO CONSTRUCT (A TC) - Renewal of Valid Authority to Construct.
o PERMIT TO OPERATE (PTO) - Existing Emission Unit Now Requiring a Pennit to Operate.
1. PERMIT TO BE ISSUED TO: Thiara Food Mart
2. MAILING ADDRESS: 3401 South Chester Ave.
S1REET/P.O. BOX:
CITY: Bakersfield STATE: CA
9-DIGIT
ZIP CODE: 93304
3. LOCATION WHERE THE EQUIPMENT WILL BE OPERATED:
S1REET: 3401 South Chester Ave
CITY: Bakersfield
WITHIN 1,000 FT OF A
SCHOOL? DYES rn¡NO
S.LC. CODE(S) OF FACILITY
(If known): S-240-2-2
INSTALL DATE:
/4 SECTION
TOWNSHIP
RANGE
4. GENERAL NATURE OF BUSINESS: Convenience Store/Fueling Site
5. TITLE V PERMIT HOLDERS ONLY: Do you request a COC (EPA Review) prior to receiving your ATC?
DYES DNO
6. DESCRIPTION OF EQUIPMENT OR MODIFICATION FOR WHICH APPLICATION IS MADE (include Permit #'s if known, and use
additional sheets ifnccessary)
Gasoline dispensing operation with two 10.000 gallon UGT served by two-point Phase I vapor recovery system (G-70-97), and 8
Fueling points with 8 gasoline dispensing nozzles served by Gilbarco Vaporvac assist Phase II Vapor Recovery System (G-70-
150). Replace the existing Phase I Vapor Recovery System with OPW Phase I Vapor Recovery System (VR-102-E)
7. PERMIT REVIEW PERIOD: Do you request a three- or ten-day period to review the draft Authority to Construct
permit? Please note that checking "YES" will delay issuance of your final permit by a corresponding number of
workin da s. See instructions for more infonnation on this review rocess.
8. HAVE YOU EVER APPLIED FOR AN ATC OR I!JYES 0 NO Optional Section
PTO IN THE PAST? 1 L CHECK WHETIIER YOU ARE A IPA L
If yes, A TC/PTO #: 8-240-2-2 PARTICIPANT IN ErIHER OF !:;:::...
9. HAVE ALL NECESSARY LAND-USE TIIESE VOLUNTARY PROGRAMS: ~
AUTHORIZATIONS BEEN OBTAINED? 0 YES DNO "SPARE TIlE AIR"
(If "No" is checked, please attach explanation.) rnv es []No Dend info ~C~
.~·~ml\ ~:~fl~i}~~~_~~T~~~¿~~o~~=-ÇJye~:OV1N'fe_#'--º.~_O _,_c_ _-, _r:JYes_.~:=E~end-info~~~~
- OR A NOTICE TO COMPLY? - ,.
12. TYPE OR PRINT NAME OF APPLICANT: TITLE OF APPLICANT:
. tv\ ~,~~
APPLICANT: DATE:
FOR APCD USE ONLY:
DATE STAMP:
FILING FEE
RECEIVED: $
CHECK #:
DA IE PAID:
PROJECT #:
FACILITY ID:
Northern Regional Office * 4230 Kiernan Avenue, Suite 130 * Modesto, California 95356-9321 * (209) 557-6400 * FAX (209) 557-6475
Central Regional Office * 1990 East Gettysburg Avenue * Fresno, California 93726-0244 * (559) 230-5900 * FAX (559) 230-6061
C',......~........... D.........:....._...1 nç.&;.......... * ...."'7IV\.... C'................... <'....:....... .....,..c * D....1,......._...4::.....1.-1 "...1:.,:-............:... O']']{\1<'0'1"'J{\ 21;: 1&:./:.1'\ .,....¡;;, J::fVY\ * 'I::' A V 1¿:¿;'1\ .,"t¡;;: ¿;:noc
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San Joaquin Valley Unified Air Pollution Control District
Supplemental Application Form
GASOLINE DISPENSING
This form must be accomøanied by a comøleted Aøølication for Authority to Construct and Permit to Oøerate form.
Permit to be issued to: 'Thl()f~ r? f1A-f¿:f
r-öcx:1
Location where the equipment will be operated: CJ;1-e..~ k.r ~ Ö~~--Çdd
340 I So
Current Permit to Operate number (if applicable):
S - 2 Lf()~- ;). - d-
Complete a separate form for each tank and dispensing system which has a different type of Phase I or
Phase II vapor recovery system with as much information as possible.
2 Attach a copy of the site plan showing underground fuel and vapor lines and location of dispenser islands. You
may submit the drawings in electronic format.
1
Note: Information on Vapor Recovery Executive Orders is available online at: www.arb.ca~ç ov/vapor/vapor.htm
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-:-,~:.~<~,;;;:<.-.-::,c'· :':-"'-f;;-~t;·-" . ~_" \::~.:~ '.';'~ :':' -.','y:_::·.:,~.,.:,.:·" ':,_: \ ': ::,;,/~:,::'_;.:':', -:-,.-..;:~_ ". _~')''';;'~_~;_-:_ "' ,-.,.,.;:>;:'.:' __'/-~'~;<-::':_-";:".\'. ':' -'1"';:-'" _:".:,_:<¡.._:;-.~'._~_,>\:_'_,.,-:-\. ',_,,,. y_ '_ .':: -;; ~,:;,::.,¡'..i,>_.>;~.,\,.- ,_\;",,,:-,\:_; . ,:', :';~r' ,<.~::,,~'~:\:'j,,~.-;:'~";-'-',~}' ~,--,
:;:'.'> '" .' ,~, ,-, -'. " ' ""'\" .;.. ",- ';~Y')''-'',,\:> " .-'
';;,;,;';;,. ~~1~~~êi.;i'> ,~~¡t~,.~~~~~~[¥:~:;;,.;,;;
III' Underground 0 Aboveground*
tJ Underground 0 Aboveground*
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L>'-',',>-;: :';'<';:'
'-';'\ ~:, :'/ 'c:- co::, '
\--:,~'- r~'; \:~ y::;-::_
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Type 'ànd Gfadé . ...,>
.. òf Fuel
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¡ 0 I OC> Ù
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GJI
,
,
L o} DOO
o Underground 0 Aboveground*
o Underground 0 Aboveground*
'>.~>.~.··:i~;":~~:,;i':{:;¥ô~r~Un,~~~~fGa~ºiin~~Risp~~~~~~:; .- 04
'¡;';;'", .. T~tal Number of Gasoli~eFu'8Iing Points: f
;±j,Ni,':}jo.tal,N~"R1'~.f"qf~~~§I¡n,ê,[)i#~ItÌ1~i~~·~~#!;~:,; <6
:;:':'i!~:~"i':;;~'i~~~t¡,~~'~þ!: ~,~~~'li~~D,¡#~~,~·.~-'~·..·~;r~~~'I~::'· ~
T~~~~~rnb~r:~fY~~Õr'~!~€"jry',I~it~~,~tiÓr,f~i~~~:" (Should be clearly readable from eve/}' fueling point)
:,F,f¡:~:::gt:;j~~¡~~'~~~~tt1.~m:¡f~~,ií¡~'~ã~~í'i~~:il1ro~~hp,~f ;L y ~ 0 0 Gallons per Month (;).. ~ 7 ~ 0 Ö Gallons per year'
t' :'.·:,;i,\:;~;';';.c .'J<. W Retail 0 Non-Retail
;0;.;. '.'Ci;"·',,. .;<'.",;:. '<."... I¡A
- ':);{"·"';;;','.i'1j,,~,;1j'~F:Ót'~~§~~g~Òli~~;-r~º~~"(i·~¿IY~ês··ßn;ks:;i·~:,~~~·~fgt~u~d ·yául~)··· ...', '. ..,.~.;.,',.,;"
,.c,:-:¿<," ....'...., ;;C"}.';.Iî'O;:;' . "c,;, (iF
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- --,- ~' "----- -" --
-- -- - -
..
-
(Maximum number of vehicles which can be fueled at one time,
normally two vehicles per dispenser)
(Do not include Diesel)
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PLEASE CONTINUE ON REVERSE SIDE
12/02
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1-2100-DEVR
1-2100-PEVR
OPW':
OPW
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OPW
OPW
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12/06/2004 14:31 6613252529
CAL VALLEY
PAGE 01
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CITY OF BAKERSFŒLD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester A vei~ Bakersfield, CA (661) 326-3979
APPLICA TION TO PERFORM
FUEL MONITORtNG CERTIFICATION
FAcn.rrY~KwÞ¡:'d/tf City rAt'''· V4id
ADDRESS '1/0/ 1Y£<.XTfA..IA Av-t:.. . ;
OPERATORS NAME C¡'tlfr tJl~ 1J~e.rs~/'f/d'.
OWNERS NAME I' .
NAME OF MONITOR MANUFACTURER. ' t.ked'ey -Rwt
DOES FACILITY HAVE DISPENSER PANS? "YES V
NO_
TANK #
I
2...
VOLuME
CONTENTS
~7 u.1.
P¡efel
NAME OFTESTlNQ COMPANY CA../-V4/1ey. .E~/jtJ~hr
CONI'RAcroRSUCENSB# 7~ijI7(} A H/lz
NAME & PHONE NUMBER OF CONTACT PERSON~Y~ ~hHS/~ G~/- :1Z.7-1;11(1
DATE & TIME TEST IS TO BE CONDUCTED 12.-/3-0'( @ 09:00
IJ
:J¡;;j~£J.
APPROVED BY
/2.-6-tJ'(
DATE
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SIGNATURE OF APPUCANT