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HomeMy WebLinkAboutUST-REPORT 4/15/2004~-'J': .............................................. UNIFIED PROGRAM CONSOL~--~DATED FORM TANKS TYPE OF ACTION ~ 1 NEW SITE PERMIT ~ 3. R~NEWAL PERMIT ~ 5,CHANGE OF INFORMATION ~ 7 PERMANENTLY CLOSED (Checl~ one item only) ~ 4. AMENDED PERMIT speci~ change local use o~ly ~ 8. TANK REMOVED [] 6TEMPORARY SITE CLOSURE 400 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 7-Eleven #16329 NEAREST CROSS STREET 3USINESS [] 1. GAS STATION [] 3. FARM [] 5. COMMERCIAL TYPE [] 2. DISTRIBUTOR [-[ 4. PROCESSOR [] 6. OTHER 403 TOTAL NUMBER OF TANKS I Is facility on Indian Reservation or REMAINING AT SITE I trustlands? 3 404 [] Yes [] No 405 FACILITY OWNER TYPE [] 4. LOCAL GENCY/DISTRICT* [] 1. CORPORATION [] 5, COUNTY AGENCY* [] 2. INDIVIDUAL [] 6. STATE AGENCY* [] 3. PARTNERSHIP [] 7. FEDERAL AGENCY* 402 *If owner of UST is a public agency: name of supervisor of division, section or office which operates the UST (This is the contact person for the tank records.) 406 PROPERTY OWNER NAME Bobble Stokes MAILING OR STREET ADDRESS 1348 Mentone Ave. # C 407 PHONE 408 CITY 410 ] STATE 4~1 ] ZIP CODE Grover Beach CA 93433 PROPERTY OWNER TYPE [] 1. CORPORATION [] 2. INDIVIDUAL [] 4. LOCAL AGENCY / DISTRICT [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 6. STATE AGENCY [] 7. FEDERAL 409 412 413 TANKOWNER NAME 414 ] PHONE 7-Eleven, Inc. I 253-796-7170 MAILING OR STREET ADDRESS P.O. Box 711 Attn: Gasoline Acctg CITY 417 ] STATE 4~8 IZIPCODE Dallas TX 75221-0711 415 416 419 TANK OWNER TYPE [] 1. CORPORATION [] 2. INDIVIDUAL [] 4. LOCAL AGENCY / DISTRICT [] 6. STATE AGENCY 420 [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 7. FEDERAL AGENCY TY (TK) HQ 44- 3 I 1 8 9 6 Call (916) 32~9669 if questions arise ~2~ INDICATE ~ 1. SELF-INSURED ~ 4. SURETY BOND D 7. STATE FUND ~ 10. LOCAL GO~ MECHANISM METHOD(s) ~ 2. GUA~NTEE ~ 5. LE~ER OF CREDIT ~ 8. STATE FUND & CFO LE~ER ~ 99. OTHER:~ ~ 3. INSURANCE ~ 6. EXEMPTION ~ 9. STATE FUND & CD 422 Check one box to indicate which address should be used for legal notifications and mailing. Legal notifi~tions and mailings will be sent to the tank owner unless ~x 1 or 2 is chewed. ~ 1. FACILITY ~ 2. PROPER~ OWNER ~ 3 TANK OWNER 423 UPCF f1/99 revised~ c ..... ~,, C~^/D~ ~.~ ^ UNIFIED PROGRAM CONSOLIDATED FORIV[' TANKS (two pa~es per tank) Page of TYPE OF ACTION [] 1 NEW SITE PERMIT [] 4 AMENDED PERMIT [] 5 CHANGE OF INFORMATION [] 6 TEMPORARY SITE CLOSURE (Cneckonedemonly) [] 7 PERMANENTLY CLOSED ON SiTE [] 3 RENEWAL PERMIT (Specify reason - for local use only) (Specify reason - for local use only) [] 8 TANK REMOVED 430 BUSINESS NAME (Same as FACIUTY NAME °r DBA- D°ing Business As) 3 I FACILITY [D:7-Eleven #16329 LOCATION WITHIN SITE (optional) 431 1701 Pacheco Rd., Bakersfield, CA I. TANK DESCRIPTION (A scaled plOtPlanWith the location of the UST system inc!uding bUildings and landmarks shall be submitted to the local agenCy.) TANK ID fl 432 TANK MANUFACTURER 433 cOMPARTMENTALIZED TANK [] Yes [] No 434 1 Joor if "Yes". complete one page for each comparlment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF cOMPARTMENTS 437 4/1 985 10,000 ADDITIONAL DESCRIPTION (For local use only) 438 TANK USE 439 PETROLEUM TYPE 440 [] 1. MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL (If marked complete Petroleum Type) [] lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4. GASOHOL [] 99. OTHER__ [] 3, CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS# (from Hazardous Materials Inventory page ) 442 [] 4. HAZARDOUS WASTE Gasoline (Includes Used Oil) [] 95. UNKNOWN ~ ' !Il: TANK: CONSTRUCTION TYPE OF TANK '[] 1. sINGLE WALL [] 3. SINGLE WALL WITH [] 5, SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER [] 95. UNKNOWN [] 2. DOUBLE WALL [] 4. SIGNLE WALL IN VAULT [] 99. OTHER __ TANK MATERIAL - primary tank [] 1. BARE STEEL [] 3. FIBERGLASS / PLASTIC [] 5, CONCRETE [] 95, UNKNOWN 444 (Check one item only) [] 2. STAINLESS STEEL [] 4, STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE W/ [] 99. OTHER REINFORCED PLASTIC (FRP) 100% METHANOL TANK MATERIAL -secondaytank [] 1. BARE STEEL [] 3. FIBERGLASS / PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 445 (Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE [] 99. OTHER REINFORCED PLASTIC (FRP) W/100% METHANOL [] 5. CONCRETE [] 10. COATED STEEL DATE INSTALLED 447 TANK INTERIOR LINING [] 1, RUBBER LINED [] 3. EPOXY LINING [] 5. GLASS LINING [] 95. UNKNOWN 446 OR COATING [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 6 UNLINED [] 9g OTHER (Check one item only) (For local use only) 448 DATE INSTALLED 449 OTHER CORROSION [] 1 MANUFACTURED CATHODIC [] 3 FIBERGLASS REINFORCED PLASTIC [] 95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION [] 4 IMPRESSED CURRENT [] 99 OTHER (Check one item only) [] 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check ali [] I SPILL CONTAINMENT thal apply) 2004 [] 1 ALARM [] 3 FILL TUBE SHUT OFF VALVE [] 2 DROP TUBE 2004 [] 2 BALL FLOAT [] 4 EXEMPT [] 3 STRIKER PLATE 1997 2004 :1~! TANK: BEAK,DETECT ON: (A d~cr Pi on °f;thi~'~0n tedn~ ~og'~'~ ~ '6~ Sub~i'jied io{he d~ A~en~:y ) - IF SINGLE WALL TANK (Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 45,i (Check one item only) [] 1 VISUAL (EXPOSED PORTION ONLy) [] 5 MANUAL TANK GAUGING (MTG) [] 1 VISUAL (SINGLE WALL IN VAULT ONLY) [] 2 AUTOMATIC TANK GAUGING (ATG) [] 6 VADOSE ZONE [] 2 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG [] 7 GROUNDWATER [] 3 MANUAL MONITORING [] 4 STATISTICAL INVENTORY RECONCILIATION [] 8 TANK TESTING + (SIR) BIENNIAL TANK TESTING [] 99 OTHER 'IV, TANK.¢CEOSIJRE NFORMATION/PERMANENT CI:OSURE N:PI..ACE 455 ESTIMATED QUANTITY OF SUBSTANCE 456 457 ESTIMATED DATE LAST USED (YPJMO/DAY) REMAINING TANK FILLED WITH INERT MATERIAL? gallons [] Yes [] No UPCF (1/99 revised) Formerly SWRCB Form B UNIFIED PROGRAM CONSOLIDATED FORM TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI. PIPING CONSTRUCTION Check all that apply) Page __ of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [] 1 PRESSURE [] 2 SUCTION [] 3 GRAVITY 458 [] 1. PRESSURE [] 2. SUCTION [] 3 GRAVITY 459 CONSTRUCTION / [] 1. SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 46O [] 1. SINGLE WALL [] 95. UNKNOWN 462 MANUFACTURER [] 2. DOUBLE WALL [] 95. UNKNOWN [] 2 DOUBLE WALL [] 99. OTHER MANUFACTURER 461 MANUFACTURER 463 [] 1, BARE STEEL [] 6. FRP COMPATIBLE w/100% METHANOL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] UKNOWN [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 99. OTHER [] 4. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 5. STEEL W/COATING [] 9. CATHODIC PROTECTION 464 VII; BIP!NG :EE~,DE~ECTIQN ;(Check ~il that apply)(A description of the moditorin¢:program shall be subm!ti~d;t0 i~e.loc~i;~g~ncy.) [] 1. BARE STEEL [] 2. STAINLESS STEEL [] 3 PLASTIC COMPATIBLE W/CONTENTS [] 4. FIBERGLASS [] 5. STEEL W/COATING [] 6. FRP COMPATIBLE W/t00% METHANOL [] 7. GALVANIZED STEEL [] 8, FLEXIBLE (HDPE) [] 99, OTHER [] 9. CATHODIC PROTECTION [] 95. UNKNOWN 465 UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Checkall that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1GPH) CONVENTIONAL SUCTION SYSTEMS [] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS {NO VALUES IN BELOW GROUNDPIPING): [] 7. SELF MONITORING GRAVITY FLOW [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION L-lc. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUTOFF OR RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMPSENSOR +AUDIBLEANDVISUALALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17, DAILY VISUAL CHECK SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST(0.1GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply) I--I 5. DAILY VISUAL MONITORING OF PiPiNG AND PUMPING SYSTEM [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION []c NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS r'q 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) I-I 17. DAILY VISUAL CHECK DISPENSER ...................................... .............. ' ' [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 468 [] ~. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS CONTAINMENT DATE INSTALLED 1 Qq7 ,,, ' [] 3. CONTINUOU~DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + rm .... ./ .... AUDIBJ. E'/~ND ~ISUAL ALARMS -- u 6. NONE NAME OF OWNER/OPRATOR (print) ] TITLE 0F~ oWNER/OPERATOR Randy Martin I Environmental Mana§er Permit Number (For local use only) 473 [] 4. DALLY VISUAL CHECK [] 5. TRENCH LINER/MONITORING 469 Permit Approved (For local use only) Permit Expiration Date (For local use only) 475 47O 472 UPCF (1/99 revised) Formerlv SWRCB Fr~rm R UNIFIED PROGRAM CONSOLIDATED FORM TANK UNDERGROUND STORAGE TANKS -. TANK PAGE 2 VI. PIPING CONSTRUCTION (Check al~ that appty) Page _ of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM-I YPE [] 1. PRESSURE [] 2 SUCTION [] 3. GRAVITY 458 [] t PRESSURE [] 2 SUCTION [] 3 GRAVITY 459 CONSTRUCTION / [] 1 SINGLE WALL [] 3 LINED TRENCH [] 99. OTHER 46o MANUFACTURER [] 2 DOUBLE WALL [] 95. UNKNOWN MANUFACTURER 461 [] 1 BARE STEEL [] 6. FRP COMPATIBLE w/100% METHANOL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] UKNOWN [] 3 PLASTIC COMPATIBLE W/CONTENTS [] 99. OTHER [] 4. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 5. STEEL W/COA~ING [] 9. CATHODIC PROTECTION 464 [] 1 SINGLE WALL [] 95. UNKNOWN 462 [] 2 DOUBLE WALL [] 99. OTHER MANUFACTURER 463 [] 1. BARF STEEL [] 2. STAINLESS STEEL [] 3 PLASTIC COMPATIBLE W/CONTENTS [] 4 FIBERGLASS [] 5, STEEL W/COATING [] 6. FRP COMPATIBLE W/t00%METHANOL [] 7. GALVANIZED STEEL [] 8. FLEXIBLE (HDPE) [] 99. OTHER [] 9. CATHODIC PROTECTION [] 95. UNKNOWN 465 VII. PIPING I,EAK DETECTION (chec~ a!~ that apply) (A description of the monitoring program shall be submitted to i~e local agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST(0.1GPH) CONVENTIONAL SUCTION SYSTEMS [] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): [] 7. SELF MONITORING GRAVITY FLOW [] 9. BIENNI~,L INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION []c. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUTOFF OR RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUSSUMPSENSOR+AUDIBLEANDVISUALALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WiTH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply) [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION []c NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF +AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17~ DAILY VISUAL CHECK DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK DATE INSTALLED 468 [].2, CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER I MONITORING · '[]/3. CONTINUOUS DISPENSER PAN SENSOR WlTH AUTO SHUT OFF FOR DISPENSER + 1997 AUDI,.BL'b~'D VISUAL ALARMS [] 6. NONE //" //' .? ..... ::'. ' i;.!X:':O~NER/O~ERATORSIGNATU~E 469 I cerhfy that the ~n~ormat~on provided here~r~true anC. a~curate to the best of my knowledge. ,,/ // SIG NAT U R E/O F'~"~~T~' DATE NAME OF-QWNE~OPRATOR (print) TITLE OF OWNE~OPERATOR Randy Martin Environmental Manager Permil Number (For Io~1 use only) 473 Permit Approved (For local use on[y) Permil Expiration Date (For Io~1 use only) 475 47O 472 UPCF (1/99 revised) Formerly SWRCB Form B UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TAN < PAGE 1 (two pages per tank) Page _ of TYPE OF ACTION [] 1 NEW SITE PERMIT [] 4 AMENDED PERMIT b~ 5 CHANGE OF INFORMATION [] 6 TEMPORARY SITE CLOSURE tChec!~ o~e item on~¥) [] 7 PERMANENTLY CLOSED ON SITE [] 3 RENEWAL PERMIT (Specify reason - for local use only) (Specify reason - forlocal use only) [] 8 TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) FACILITY ID: 3 7-Eleven #16329 LOCATION WITHIN SITE (Optional) 431 1701 Pacheco Rd., Bakersfield, CA I. TANK DESCRIPTION (A scaled plbt Plan With the location of the UST system including buildings and landmarks shall:be submitted to'the local agency.) ':::; ' TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes [] No 43.4 2 J oor If "Yes". complete one page for each compartment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 4/1 985 1 0,000 ADDITIONAL DESCRIPTION (For local use only) 438 TANK USE 439 PETROLEUM TYPE 440 [] 1. MOTOR VEHICLE FuEL [] la. REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL (If marked complete Petroleum Type) [] lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2 NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4. GASOHOL [] 99. OTHER__ [] 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS# (from Hazardous Materials Inventory page ) 442 [] 4. HAZARDOUS WASTE Gasoline (includes Used Oil) [] 95. UNKNOWN "..: ~.',.: :,' ': · "lie ~ANKCONS~R~C~I~N' i' :::~ '., : ' ,' TYPE OF TANK [] 1. sINGLE WALL [] 3. SINGLE WALL WITH [] 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM : 443 (Check one item only) EXTERIOR MEMBRANE LINER [] 95. UNKNOWN [] 2. DOUBLE WALL [] 4. SIGNLE WALL IN VAULT [] 99. OTHER __ TANK MATERIAL -primary tank [] 1. BARE STEEL [] 3. FIBERGLASS / PLASTIC E] 5. CONCRETE [] 95. UNKNOWN 444 (Cheek one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE W/ [] 99. OTHER REINFORCED PLASTIC (FRP) 100% METHANOL TANK MATERIAL ~sec0ndan/tank [] 1. BARE STEEL [] 3. FIBERGLASS / PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 445 (Check one item only) [] 2. STAINLESS STEEL [] 4, STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE [] 99. OTHER REINFORCED PLASTIC (FRP) W/100% METHANOL [] 5. CONCRETE [] 10. COATED STEEL DATE INSTALLED 447 TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5, GLASS LINING [] 95. UNKNOWN 446 OR COATING [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 6 UNLINED [] 99 OTHER (Check one item only) (For local use only) 448 DATE INSTALLED 449 OTHER CORROSION [] I MANUFACTURED CATHODIC [] 3 FIBERGLASS REINFORCED PLASTIC [] 95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION [] 4 IMPRESSED CURRENT [] 99 OTHER (Check one item only) [] 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all [] I SPILL CONTAINMENT that apply) 2004 [] I ALARM [] 3 FILL TUBE SHUT OFF VALVE [] 2 DROP TUBE 2004 [] 2 BALL FLOAT [] 4 EXEMPT [] 3 STRIKER PLATE 1 997 2004 IF SINGLE WALL TANK (Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) [] 1 VISUAL (EXPOSED PORTION ONLY) [] 5 MANUAL TANK GAUGING (MTG) [] 1 VISUAL (SINGLE WALL IN VAULT ONLY) [] 2 AUTOMATIC TANK GAUGING (ATG) [] 6 VADOSE ZONE [] 2 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG [] 7 GROUNDWATER [] 3 MANUAL MONITORING [] 4 STATISTICAL INVENTORY RECONCILIATION [] 8 TANK TESTING + (SIR) BIENNIAL TANK TESTING [] 99 OTHER IV. TANK CLOSURE INFORMAT ON/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MO/DAY) 455 I ESTIMATED QUANTITY OF SUBSTANCE 456 457 REMAINING TANK FILLED WITH INERT MATERIAL? gallons [] Yes [] No UPCF fl/99 revised~ c ..... ~,, q~^¢c,r,o ~,~ c, UNIFIED PROGRAM CONSOLIDATED FORM TANKS (~wo pages per tank) Page TYPE OF ACTION ~ ~ NEW SITE PERMIT ~ 4 AMENDED PERMIT ~ 5 CHANGE OF INFORMATION ~ 6 TEMPORARY SITE CLOSURE (Check one item oniy) [~ 7 PERMANENTLY CLOSED ON SITE ~ 3 RENEWAL PERMIT (Specify reason - for lo~l use only) (Specify reason - for lo~l use oniy) ~ 8 TANK REMOVED 430 7-ElevenBUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As)~ FAC{LITY ID:¢16329 3 II I LOCATION WITHIN SITE (optional) 431 1701 Pacheco Rd., Bakersfield, CA I. TANK DESCRIPTION (A scaled plot plan with the location of the UST system including buildings and landmarks shall be submitted to the local agency.) TANK ID fl 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ~ Yes ~ No 434 3 Joor if "Yes", complete one page for each compartment. DATE INSTALLED (YEA~MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 4/1985 10,000 ADDITIONAL DESCRIPTION (For local use only) 438 ~ 1. MOTOR VEHICLE FUEL ~ la. REGU~R UNLEADED ~ 2. LEADED ~ 5. JET FUEL (tf ~rked complete Petroleum Type) ~ lb. PREMIUM UNLEADED ~ 3. DIESEL ~ 6. AVIATION FUEL ~ 2. NON-FUEL PETROLEUM ~ lc. MIDGRADE UNLEADED ~ 4. GASOHOL ~ 99. OTHER ~ 3, CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventow page) 441 CAS~ (from Hazardous Materials Invento~ page ) 442 ~ 4. HA~RDOUS WASTE Gasoline (includes Used Oil) ~ 95. UNKNOWN ~PE OF TANK ~ 1. SINGLE WALL ~ 3. SINGLE WALL WITH ~ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 Check one item only) EXTERIOR MEMBRANE LINER ~ 95. UNKNOWN ~ 2. DOUBLE WALL ~ 4. SIGNLE WALL IN VAULT B 99. OTHER TANK MATERIAL -palm, tank ~ 1. BARE STEEL ~ 3. FIBERGLASS/P~STIC ~ 5. CONCRETE ~ 95. UNKNOWN 444 Cheek one item only) B 2. STAINLESS STEEL ~ 4. STEEL C~D W/FIBERG~SS ~ 8. FPP COMPATIBLE W/ ~ 99. OTHER REINFORCED P~STIC (FPP) 100% METHANOL TANK MATERIAL -s~,d~ ~ 1. BARE STEEL ~ 3. FIBERGLASS / P~STIC ~ 5. CONCRETE ~ 95, UNKNOWN 445 (Check one item only) ~ 2. STAINLESS STEEL ~ 4. STEEL CLAD W/FIBERGLASS ~ 8. FPP COMPATIBLE B 99. OTHER REINFORCED PLASTIC (FPP) W/100% METHANOL ~ 5. CONCRETE ~ 10. COATED STEEL TANK INTERIOR LINING ~ 1. RUBBER LINED ~ 3. EPOXY LINING ~ 5. G~SS LINING ~ 95. UNKNOWN 446 DATE INSTALLED 447. OR COATING ~ 2 ALKYD LINING ~ 4 PHENOLIC LINING ~ 6 UNLINED ~ 99 OTHER (Check one item only) -- (For Io~1 use only) OTHER CORROSION ~ 1 MANUFACTURED CATHODIC ~ 3 FIBERGLASS REINFORCED PLASTIC ~ 95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ~ 4 IMPRESSED CURRENT ~ 99 OTHER (Check one item only) ~ 2 SACRIFICIAL ANODE (For lo~1 use onty) SPILL AND OVERFILL YEAR INSTALLED 450 ~PE (1o~1 use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all ~ 1 SPILL CONTAINMENT that apply) 2004 B I A~RM ~ 3 FILL TUBE SHUT OFF VALVE ~ 2 DROP TUBE 2004 ~ 2 BALL FLOAT ~ 4 EXEMPT ~ 3 STRIKER PLATE 1 997 2004 ' IV, TAN.K LEAK:DETECT ON (A des~iptiOn of the:monit0dn~ ~ ~ij:6~ ~U~ t~Sd,~O the °~ agency ) IF SINGLE WALL TANK (Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) ~ 1 VISUAL (EXPOSED PORTION ONLY) ~ 5 MANUAL TANK GAUGING (MTG) ~ 1 VISUAL (SINGLE WALL IN VAULT ONLY) ~ 2 AUTOMATIC TANK GAUGING (ATG) ~ 6 VADOSE ZONE ~ 2 CONTINUOUS INTERSTITIAL MONITORING ~ 3 CONTINUOUS ATG ~ 7 GROUNDWATER ~ 3 MANUAL MONITORING ~ 4 STATISTICAL INVENTORY RECONCILIATION ~ 8 TANK TESTING + (SIR) BIENNIAL TANK TESTING ~ 99 OTHER IV. TANK CLOSURE INFORMATION/PERMANENTOLOSURE N:PbACE ESTIMATED DATE LAST USED (Y~MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 456 } 457 REMAINING TANK FILLED WITH INERT MATERIAL? gallons~ ~ Yes ~ No UPCF (1/99 revised) ~ ..... ~,, q~^¢pc-,R c,-,,m ~ UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS - TANK PAGE VI. PIPING CONSTRUCTION i Check all that apply) UNDERGROUND PIPING SYSTEM TYPE [] 1 PRESSURE [] 2 SUCTION [] 3. GRAVITY 458 [] 1. PRESSURE CONSTRUCTION / [] 1. SINGLE WALL [] 3. LINED TRENCH [] 99 OTHER 460 [] 1, SINGLE WALL MANUFACTURER [] 2. DOUBLE WALL [] 95. UNKNOWN [] 2. DOUBLE WALL MANUFACTURER __ 461 MANUFACTURER [] 1. BARE STEEL [] 6. FRP COMPATIBLE w/t00% METHANOL [] 1. BARE STEEL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] UKNOWN [] 2. STAINLESS STEEL [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 99, OTHER [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 4. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 4, FIBERGLASS [] 5. STEEL W/COATING [] 9. CATHODIC PROTECTION 464 [] 5, STEEL W/COATING TANK Page __ of ABOVEGROUND PIPING [] 2 SUCTION [] 3. GRAVIIY 459 [] 95. UNKNOWN 462 [] 99 OTHER 463 [] 6. FRP COMPATIBLE w/100% METHANOL [] 7. GALVANIZED STEEL [] 8. FLEXIBLE(HDPE) [] 99. OTHER [] 9. CATHODIC PROTECTION [] 95. UNKNOWN 465 VII: PIB!NG: LEAK DETECT ON (Checka[ th:~t app y (A d~di~tio~'m{he monior~g ~r0~m sh~ be subm tied 0the oCa a~]ency ) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 =PRESSURIZED PIPING (Check all that apply): [] 1, ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2, MONTHLY 0.2 GPH TEST ~[] 3. ANNUAL INTEGRITY TEST (0.1GPH) CONVENTIONAL SUCTION SYSTEMS .[] 5. DALLY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES tN BELOW GROUNDPIPING): [] 7. SELF MONITORING GRAVITY FLOW [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND [Check one) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION I-~c. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUTOFF OR RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION [] 16. ANNUAL INTEGRITY TEST (Q1 GPH) [] 17. DAILY VISUAL CHECK SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply) [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST(O] GPN) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION []c NO AUTO PUMP SHUT OFF [] 11, AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEGRITY TEST (0,1 GPH) SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST [] 16. ANNUAL INTEGRITY TEST (0,1 GPH) [] 17. DAILY VISUAL CHECK ' Villi DiSpENSER " . CONTAINMENT [] 1. FLOAT MECHANISM THAT S~UTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK DATE INSTALLED 468 ~ 2, CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING 1 c¢~7 ~.-~ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + r'~ · ~ o ~// AUDIBLE/~.,ylSUAL ALARMS u o. I cedify that the inf~on~ded herein is ~and/re to the best of my kno~edge. / / O .~NE~OPRATOR (prmt) TITLE OF OWNE~OPE~TOR Randy Martin I Environmental Manager Petit Number (For Io~1 use only) 473 Permil Approved (For local use only) Permit Expiration Date (For Io~1 use only) 475 469 470 472 UPCF (1/99 revised) Formerly SWRCB Form B .................. - ..... ~ ~u~ otu.t rt U I~:NVlRO~Nq~_ENTAL FILTII [~006 6-10 Vendors 11-15 Vendors 16 or more Vendors Water Systems - Transient Non-Community $112.50 $150.00 $187.50 $150.00 HAZARDOUS MATERIALS MANAGEMENT PROGRAM Underground Storage Tank Facility Permit: Perm'K to CloseJAt~ndon (per facility) $1100.00 Permit to Construct (per facility) $1500.0O Permit to Modify (per facility) $650.00 Underground Tank T~ghtness Test Authorization: Well Appl~: F~ng and Processing Fees Per cathodic protection well $225,00 Per monitoring well $335.00 Per vadose zone well Test ho~e app~i~m (d~ied & destroyed) Test hole appt~ (ddUed & cornHeted) $335.0O Wells pemrtitted within the hazardous materials management program shall be charged at the above ~a~es for theflmt well. Each addilional well applied foe, ~ and inspected concurrently at the same location with vadose zone v,'ells d~lled as a requirement of the local ove~ight program for the remediation of shall pay the following annual administrative fee. 7 7 ELEVEN FOOD STORE #2125-16329 Manager : Location: 1701 PACHECO RD City : BAKERSFIELD CommCode: BAKERSFIELD STATION 05 EPA Numb: SiteID: 015-021-000807 BusPhone: (661) 834-1350 Map : 124 CommHaz : Low Grid: 19A FacUnits: t AOV: SIC Code:5541 DunnBrad:00-734-7602 Emergency Contact / Title SHINDA UPPLE / FRANCHISEE BusineSs Phone: (661) 834-1350x, 24-Hour Phone : (800) 845-0031x Pager Phone : ( ~ ¢~) ~O~-~7//x-~~'~il ) Hazmat Hazards: Emergency Contact / Title B~WT~R~Z~eo~a~-c / FIELD CONSULT Business Phone: (~m~-~6x3719 24-Hour Phone : (~lx--~&~ Pager Phone : ( ) - x ImmHlth' DelHlth Contact : RANDY MARTIN MailAddr: PO BOX 711 City : DALLAS Phone: (253) 796-7170x State: TX Zip : 75221 Owner 7 ELEVEN, INC. Address : PO BOX 711 City : DALLAS Phone: (253) 796-7170x State: TX Zip : 75221 Period : preparer: Certif'd: ParcelNo: to TotalASTs: = Gal TotalUSTs: = Gal Res: No Emergency Directives: Fire Press ~ement plan for my facility. 1 04/06/2004 7 ELEVEN FOOD STORE #2125-16329 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7 ELEVEN FOOD STORE #2125-16329 Cross Street : Business Type: Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact:, PROPERTY OWNER INFORMATION Name : BRENT CRUZ Phone: Address: City : Type : Name : BRENT CRUZ Address: City : Type : State: Zip: TANK OWNER INFORMATION Phone: State: Zip: SiteID: 015-021-000807 (888) 711-4876x3719 (888) 711-4876x3719 BOE UST Fee# : 002251 Financ'l Resp: INSURANCE Legal Notif : Tank Owner Mailing Address Date:04/ll/2000 Name:RANDY MARTIN State UST # : Phone: (253) 796-7170x Ttl:ENVIRON. MGR. 1998 Upg Cert#: 00779 -2- 04/06/2004 ELEVEN FOOD STORE #2125-16329 Hazmat Inventory -- MCP+DailyMax Order Hazmat Common Name... UNLEADED GASOLINE MIDGRADE UNLEADED GASOLINE SUPER UNLEADED GASOLINE CARBON DIOXIDE SiteID: 015-021-000807 By Facility Unit Fixed Containers on Site Frm I DailyMax ]UnitlMcP F IH DH F IH DH F IH DH F P IH L 10000.00 GAL Mod L 10000.00 GAL Mod L 10000.00 GAL Mod G 1275.00 FT3 Min 3 04/06/2004 7 ELEVEN FOOD STORE #2125-16329 = Inventory Item 0001 -- COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Location within this Facility Unit UNDERGROUND FRONT PARKING SiteID: 015-021-000807 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 STATE --TYPE PRESSURE Ambient Pure Liquid TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 7500.00 GAL I%Wt. I 100.00 Gasoline HAZARDOUS COMPONENTS N 8006619 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA /// USDOT# I MCP Mod Ag.Definedl: Ag.Defined5: Ag. Defined8: -- Ag.Definell MISC. LOCAL AGENCY DATA Ag. Defined2: Ag. Defined3: Ag. Defined6: Ag.Definedg: Ag.Defined4: Ag.Defined7: Ag. Definel0: -4- 04/06/2004 7 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 ~- Inventory Item 0001 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: UNDERGROUND FRONT PARKING TANK DESCRIPTION Tank ID#: 1 Mfr: JOOR Installed: 04/1985 Capacity: Additional Info: Tank Use: MOTOR VEHICLE FUEL Matl Name:UNLEADED GASOLINE TANK CONSTRUCTION Type : DOUBLE WALL Material(p): STEEL CLAD W/FIBERGLASS R. P. Material(s): STEEL CLAD W/FIBERGLASS R. P. Lining : UNLINED Corr Prot: FIBERGLASS REINFORCED PLASTIC Spill Cnt : 1997 Alarm Drop Tube : 1997 Ball Float Striker Plate: 1997 Wall: 10000 Gals TANK CONTENTS Petrol Type: REGULAR UNLEADED cas #: compart Tank: N No. Of Comparts: Installed: Installed: : : Fill Tube S/O: 1997 TANK LEAK DETECTION 8006-61-9 Exempt: No Dbl Wall: INTERSTITIAL MONITORING Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Qty Remaining: Was Filled: No -5- 04/06/2004 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 Inventory Item 000t Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping Type : PRESSURE Const: DOUBLE WALL Mfgr : UNKNOWN Mtl : FIBERGLASS & : Corr : FIBERGLASS Prot : PIPING LEAK DETECTION UnderGround Piping AUTOMATIC LEAK DETECTORS AboveGround Piping AboveGround Piping Installed: 02/20/1997 Date: 04/11/2000 Name:RANDY MARTIN Prmt Number: 0807 TANK/LINE TEST :02/09/2004 CP CERT. : MANWAY INSP. :07/01/1999 UST MONIT. CERT:02/09/2004 DISPENSER CONTAINMENT Type: DISP. PAN LIQUID SENSOR & ALARM OWNER/OPERATOR SIGNATURE Ttl:ENVIRON. MGR. Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED PASSED STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: No Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: Yes Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 04/11/2000 Name:RANDY MARTIN Ttl:ENVIRON. MGR. -6- 04/06/2004 ELEVEN FOOD STORE #2125-16329 Inventory Item 0002 -- COMMON NAME / CHEMICAL NAME MIDGRADE UNLEADED GASOLINE Location within this Facility Unit UNDERGROUND FRONT PARKING SiteID: 015-021-000807 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9  STATE ~ TYPE , PRESSURE Liquid /Pure Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average I 7500.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS N 8006619 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA/// I USDOT# MCP Mod Ag.Definedl: Ag.Defined5: Ag. Defined8: -- Ag.Definell MISC. LOCAL AGENCY DATA Ag. Defined2: Ag.Defined3: Ag. Defined6: Ag.Definedg: Ag.Defined4: Ag.Defined7: Ag.Definel0: -7- 04/06/2004 7 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: UNDERGROUND FRONT PARKING TANK DESCRIPTION Tank ID#: 2 Mfr: JOOR Compart Tank: N Installed: 04/1985 Capacity: No. Of Comparts: Additional Info: Tank Use: MOTOR VEHICLE FUEL Matl Name:MIDGRADE UNLEADED GASOLINE TANK CONSTRUCTION Type : DOUBLE WALL Material(p): STEEL CLAD W/FIBERGLASS R. P. Material(s): STEEL CLAD W/FIBERGLASS R. P. Lining : UNLINED Corr Prot: FIBERGLASS REINFORCED PLASTIC Spill Cnt : 1997 Alarm Drop Tube : 1007 Striker Plate: 1997 10000 Gals TANK CONTENTS Petrol Type: PREMIUM UNLEADED Cas #: Sgl Wall: Installed: Installed: : Ball Float : Fill Tube S/O: 1997 TANK LEAK DETECTION 8006-61-9 Exempt: No Dbl Wall: INTERSTITIAL MONITORING Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE~IN PLACE Qty Remaining: Was Filled: No 8 04/06/2004 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 Inventory Item 0002 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping Type : PRESSURE Const: SINGLE WALL Mfgr : Mtl : FIBERGLASS & : Corr : FIBERGLASS Prot : PIPING LEAK DETECTION UnderGround Piping AUTOMATIC LEAK DETECTORS AboveGround Piping AboveGround Piping Installed: 02/20/1997 Date: 04/10/2000 Name:RANDY MARTIN Prmt Number: 0807 TANK/LINE TEST :02/09/2004 CP CERT. :' MANWAY INSP. :07/01/1999 UST MONIT. CERT:02/09/2004 DISPENSER CONTAINMENT Type: DISP. PAN LIQUID SENSOR & ALARM OWNER/OPERATOR SIGNATURE Ttl:ENVIRON. MGR. Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED PASSED STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: No Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: Yes Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 04/10/2000 Name:RANDY MARTIN Ttl:ENVIRON. MGR. 9 04/06/2004 7 ELEVEN FOOD STORE #2125-16329 ~ Inventory Item 0003 -- COMMON NAME / CHEMICAL NAME SUPER UNLEADED GASOLINE Location within this Facility Unit UNDERGROUND FRONT PARKING SiteID: 015-021-000807 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 STATE -- TYPE PRESSURE Ambient Pure TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION I Daily Maximum I 10000.00 GAL Daily Average 7500.00 GAL 100.00 Gasoline HAZARDOUS COMPONENTS N 8006619 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA /// USDOT# I MCP Mod Ag. Definedl: Ag.Defined5: Ag.Defined8: -- Ag.Definell MISC. LOCAL AGENCY DATA Ag. Defined2: Ag.Defined3: Ag. Defined6: Ag.Definedg: Ag.Defined4: Ag.Defined7: Ag. Definel0: -10- 04/06/2004 7 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: UNDERGROUND FRONT PARKING TANK DESCRIPTION Tank ID#: 3 Mfr: JOOR Compart Tank: N Installed: 04/1985 Capacity: '10000 Gals No. Of Comparts: Additional Info: TANK CONTENTS Tank Use: MOTOR VEHICLE FUEL Petrol Type: UNLEADED PLUS/MIDGRADE Matl Name:SUPER UNLEADED GASOLINE Cas #: 8006-61-9 TANK CONSTRUCTION Type : DOUBLE WALL Material(p): STEEL CLAD W/FIBERGLASS R. P. Material(s): STEEL CLAD W/FIBERGLASS R. P. Lining : UNLINED Corr Prot: CATHODIC PROTECTION Spill Cnt : 1997 Alarm Drop Tube : 1997 Ball Float Striker Plate: 1997 Sgl Wall: Installed: Installed: : : Fill Tube S/O: 1997 TANK LEAK DETECTION Exempt: No Dbl Wall: INTERSTITIAL MONITORING Last Used: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Qty Remaining: Was Filled: No -11- 04/06/2004 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 Inventory Item 0003 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping Type : PRESSURE Const: SINGLE WALL Mfgr : Mtl : FIBERGLASS & : Corr : FIBERGLASS Prot : PIPING LEAK DETECTION UnderGround Piping AUTOMATIC LEAK DETECTORS AboveGround Piping AboveGround Piping Installed: 02/20/2097 Date: 04/11/2000 Name:R3kNDY MARTIN Prmt Number: 0807 TAi~K/LINE TEST :02/09/2004 CP CERT. : MANWAY INSP. :07/01/1999 UST MONIT. CERT:02/09/2004 DISPENSER CONTAINMENT Type: DISP. PAN LIQUID SENSOR & ALARM OWNER/OPERATOR SIGNATURE Ttl:ENVIRON. MGR. Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: No Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: Yes Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 04/11/2000 Name:RANDY MARTIN Ttl:ENVIRON. MGR. -12- 04/06/2004 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 Inventory Item 0004 Facility Unit: 'Fixed Containers on Site ~U~U~ ~vl~ / ~£~ ~vl~ CARBON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 124-38-9 E STATE TYPE Gas I Pure PRES SURE TEMPERATURE I Above Ambient { Cryogenic CONTAINER TYPE INSUL.TANK / CRYOGENIC Largest Container I 425.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 1275.00 FT3 Daily Average { 638.00 FT3 %Wt. 100.00 Carbon Dioxide HAZARDOUS COMPONENTS 124389 TSecret No HAZARD ASSESSMENTS RS,BioHaz, Radioactive/Amount EPA Hazards N° IINo · No/ Curies F P IH NFPA/// { USDOT# Min Ag. Definedl: Ag.Defined5: Ag.Defined8: -- Ag.Definell MISC. LOCAL AGENCY DATA Ag. Defined2: Ag. Defined3: Ag.Defined6: Ag. Definedg: Ag. Defined4: Ag.Defined7: Ag.Definel0: -13- 04/06/2004 7 ,ELEVEN FOOD STORE #21~-16329 Manager : Location: 1701 PACHECO RD City : BAKERSFIELD CommCode: BAKERSFIELD STATION 05 EPA Numb: SiteID: 015-021-000807 BusPhone: Map : 124 Grid: 19A (661) 834-1350 CommHaz : Low FacUnits: 1 AOV: SIC Code:5541 DunnBrad:00-734-7602 Emergency Contact / Title SHINDA UPPLE / FRANCHISEE Business Phone: (661) 834-1350x 24-Hour Phone : (800) 845-0031x Pager Phone : ( ) x Emergency Contact / Title BRENT CRUZ / FIELD CONSULT Business Phone: (888) 711-4876x3719 24-Hour Phone : (800) 845-0031x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : MailAddr: City : Owner Address : PO BOX 711 City : DALLAS HOE PO BOX 711 DALLAS Zip : 75221 ~"-State: TX g±p : 75221 Period : Preparer: Certif'd: ParcelNo: to TotalASTs: = Gal TotalUSTs: = Gal RSs: No Emergency Directives: I,_/Randy Martin ~ ~r~..,~,.,=~) Do hereby certify that I haVe reviewed the attached hazardous materials manage- ment plan for?-,~ /~.~,.~9' and that it along with (;,;e,.eo!aueheu) -- any corrections constitute a complete and correct man- 1 06/16/2003 7 ELEVEN FOOD STORE # .16329 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7 ELEVEN FOOD STORE f6~-125-16329 Cross Street : Business Type: TotaI Tanks : Name :~ Address: City : Type : Name ~ Address: City : Type : SiteID: 015-021-000807 Org Type: 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION 7~Eleven, Inc. Phone: ~8~oj 711-~o,6X3-7-19  Gasoline Acctg. P. O. Box 711 State: Zip: Dallas, TX 75221-0711, ........ ~'~u~ 'uw~R INFORMATION 7-Eleven, Inc. Phone: Gasoline Acctg. P. O. Box 711 State: Zip: Dallas,_ TX _75221-0711 o,<5-5- 7q3- '7/7D BOE UST Fee# : 002251 Financ'l Resp: INSURANCE Legal Notif : Tank Owner Mailing Address Date:04/ll/2000 Name:B~ State UST # : Randy Martin Phone: (503) 977-7713x Ttl:ENVIRON. MGR. ~D-~- 79~-gzT~ 1998 Upg Cert#: 00779 -2- 06/16/2003 ELEVEN FOOD STORE #2 329 SiteID: 015-021-000807 Inventory Item 0002 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping Type : PRESSURE Const: SINGLE WALL Mfgr : Mtl : FIBERGLASS & : Corr : FIBERGLASS Prot : PIPING LEAK DETECTION UnderGround Piping AUTOMATIC LEAK DETECTORS AboveGround Piping AboveGround Piping DI SPENSER CONTAINMENT /~ype: DISP. PAN LIQUID SENSOR & ALARM Installed: 02/20/1997 OWNER/JD~P ERATOR S I GNATURE Date: ~4~/10/2000 ;/~ ar~--~ · Tt 1 - ENVIRON MGR I~.('~'1~ n ]~","KT T l~rl~T/'"'~./?~...~,~/_~/ . Name: ............ ~ .... ~ · · Prmt Number: 0807 Approved: Yes Expiration Date: 06/30/2003 AGENCY DEFINED TANK/LINE TEST :08/24/1995 CP CERT. : MANWAY INSP. :07/01/1999 UST MONIT. CERT:02/10/2003 STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: No Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: Yes Installer Certified by Contractors' State Li. cense'Board: Yes Approved Alternate methods: // Date: 0~00 ~~j Name:~-BENI~O~,~ Ttl:ENVIRON. MGR. -9- 06/16/2003 D August 27, 2001 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) 395-1 349 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 Shinda Upple 7-11 1701 Pacheco Road Bakersfield Ca 93304 CERTIFIED MAIL NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE Failure to Submit/Perform Annual Maintenance on Leak Detection System Dear Shinda Upple Our records indicate that your annual maintenance certification on your leak detection system is past due. (August 11, 2001.) You are currently in violation of Section 2641(J) of the California Code of Regulations. "Equipment and devices used to monitor tmderground 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, September 26, 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 tmderground storage system. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Ralph Huey Director of Prevention Services Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services cc: Walt Porr, Assistant City Attorney D January 22, 2001 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) 395-1 349 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 7-11 1701 Pacheco Road Bakersfield, Ca 93304 RE: Dispenser Pan Requirement December 31, 2003 Underground Storage Tank Dispenser Pan Update Dear Underground Storage Tank Owner: You will be receiving updates from this office now, and in the furore with regard to the Senate Bill 989, which went into effect January 1, 2000. This bill requires dispenser pans under fuel pump dispensers. On · December 3 l, 2003, which is the deadline for compliance, this office will be forced to revoke your permit to operate, effectively shutting down your fueling operation. It is the hope of this office, that we do not have to pursue such action, which is why this office plans to update you. I urge you-to' Start planning now to retro-fit your facilities. If your facility has upgraded already, please disregard this notice. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Steve Underwood, Inspector Office of Environmental Services SBU/dm · 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 s,pace permits. 1. Article Addressed to: BOll DE~III~II~IO 7-11 z~]c GASOL~iE ACCOUN~LNG P O BOX 711 DALLAS II~XAS 75221-0177 7-11, 1701PACHECO RD B. Date of Delivery X t [] Addressee D. Is del 'te! ,ddress different from item 17 If YE; .~r d~ress below: 3. Se~,oe ~. ~ / [] Registered~urn Receipt for Merchandise ~ Insured Mail ~ C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 2. Article Number (Copy from service label) a'~/~lO 286 926 PS F;~I~ 3811, July 1999 Domestic Return Receipt 102595-99-M-1789 UNITED STATES POSTAL SERVICE Permit No. G-10 · Sender: Please print your name, address, and ZIP+4 in this box · ~AKERSF~ELD F~RE DEPARTMENT C~TICE OF ENVIRONMENTAL SERVICES '~'r 15 Chester Avenue, Suite 300 E;~.~ersfie~d, CA 93301 Ihh,,,Ih,,Ihll,,,,,,ihhh,,l,h,,llii,,,,,,ihl,hil,,,I Z 410 286 US Postal Service Receipt for _~rtif!ed Mail No Insurance Cov~{le~ro~ided. Do not use for International Mail (See reverse) s~B DENINNO ' Street & Number P.O.~BOX 711 Post Office, State, & ZiP Code ])_.~t,l~a~S TEXAS 7.5221 0711 Postage $ .32 i Certified Fee 1 o 10 Spedal Delivery Fee Restricted Deliver/Fee Return Receipt Showing to 1.1(3 Whom & Date Delivered Return Receipt Showing to Whom Date, & Addressee's Address TOTAL Postage & Fees I $ 2.52! Postma~ or Date Stick postage stamps to article to cover First-Class postage, certified mail fee, and charges for any selected optional services (See front), 1. it you want this receipt postmarked, stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post off ce sen/ce window or hand ~t to your rural camer (no extra charge). 2. If you do not want this receipt postmarked, stick the gummed stub to the right of the return address of the article date detach, and retain the receipt, and mai the article,. 3, If you want a return receipt, ~rite the certified mail number and your name and ~addrass or) a return receipt card, Form 3811, and attach it to the lront of the article by means of the gummed ends if space permits. OthenNise, affix to back of article. Endorse front of,~article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delive~ rest~cted to the addressee, or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article~ 5 Enter fees for the services requested in the appropi'iate spaces on the front of this r~ceipt. If return receipt is requested, check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present it if you make an inquiry. 102595-98-M-0~48 D August 8, 2000 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 Bob DeNinno 7-1 l, Inc. Gasoline Accounting P.O. Box 711 Dallas, Texas 75221-0711 cERTIFmD ~L RE: Inaccurate Form "B" for 7-11, 1701 Pacheco ROad, Bakersfield, Ca Dear Mr. DeNinno: A recent modification inspection at the 7-11 located at 1701 Pacheco Road reveals that you have single wall fiberglass lines at this facility. Documentation (Form "B") received by this office on May 11, 2000 shows that you indicated Double Wall Fiberglass (D.W.F.). Please submit corrected Form "B's" to our office A.S.A.P. Should you have any questions, please feel free to call me at 661-326-3190. Sincerely, Steve Underwood, Inspector Office of Environmental Services SBU/dm D April 4, 2000 FIRE CHIEF RON FRAZE ADMIN~TRATIVE 8ERVICE8 2101 'H' Street Bakemfleld, CA 63301 VOICE (8O5) 326-3941 FAX (805) 395-1349 8UPPRE881ON 8ERVICF.8 2101 "H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 PREVENTION SERVICE8 1715 Chester Ave. Bakemfleld, CA 93301 VOICE (805) 326-3951 FAX (805) 326-0576' ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3979 FAX (805) 326-0576 TRAINING DIWSION 5642 Victor Ave. Bakemfleld, CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 7-11 Mr. Bob Deninno 10220 SW Greenberg Rd//470 Portland OR 97223 Dear Mr. Deninno: You have been identified as the compliance coordinator for the facility/facilities referenced in the attachment. The permits to operate this facility/facilities will expire on June 30, 2000. However, in order for this office to renew your permit, updated forms A, B, & C must be filled out and returned prior to the issuance ora new permit. Please make sure that you are sending the updated forms which are indicated by the date 7/99 in the lower left hand comer. Please complete and return to this office by May 15, 2000. Failure to comply, will result in a delay of issuance of your new permit to operate. Should you have any questions, please feel free to call me at 661-326-3979. Sincerely, Steve Underwood, Inspector Office of Environmental Services SU/dam attachment 7 ELEVEN FOOD STORE #2125-16329 Manager : Location: 1701 PACHECO RD City : BAKERSFIELD. CommCode: BAKERSFIELD STATION 05 EPA Numb: SiteID: 015-021-000807 BusPhone: (661) 834'-1350 Map : 124 CommHaz : Low Grid: 1gA FacUnits: 1 AOV: SIC Code:5541 DunnBrad:00-734-7602 Emergency Contact / Title SHINDA UPPLE / FRANCHISEE Business Phone: (661) 834-1350x 24-Hour Phone : (800) 845-0031x Pager Phone : ( ) - x Emergency Contact / Title BRENT CRUZ / FIELD CONSULT Business Phone: (888) 711-4876x3719 24-Hour Phone : (800) 845-0031x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : MailAddr: PO BOX 711 City : DALLAS Phone: (214) 841-6718x State: TX Zip : 75221 Owner THE SOUTHLAND CORPORATION Address : PO BOX 711 City : DALLAS Phone: (214) 841-6718x State: TX Zip : 75221 Period : Preparer: Certif'd: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency Directives: Bob DeNinno " Fnvironmental Manager I, 'Do hereby certify that i have (Type or'pdnt name) reviewed the attached hazardous materials manage- ment plan for 7'-~.~.4~;~"'/%.~Z? and that it along 'with (Name of Bu~ine~) any corrections co,,~itute a complete and correct man- // I SignOre Date -1- 10/31/2000 7 ELEVEN FOOD STORE #2125-16329 -- STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7 ELEVEN FOOD STORE #2125-16329 Cross Street : Business Type: Total Tanks : Name · ~' 7-Eleven, Inc. Address: Gasoline Acctg. City : Type : P.O. Box 711 Name · ~ 7-Eleven, Inc. Address:, Gasoline Acctg. City : Type : P.O. Box 711 SiteID: 015-021-000807 Org Type: 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION ~ Phone': (~8~_) ~9 State ~ Dallas, TX 75221-0711 TANK .-O-~ER INFORMATION Phone: (~1~8) ~19 State: Dallas, TX 75221-0711 BOE UST Fee# : 002251 Financ'l Resp: INSURANCE Legal Notif : Tank Owner Mailing Address Date:04/ll/2000 Name:BOB DENINNO State UST # : Phone: (.-5-9--~) Ttl:ENVIRON. MGR. 1998 Upg Cert#: 00779 ~ Hazmat Inventory -- As Designated Order EPA HazardsI Frm Hazmat Common Name... ISpecHazI UNLEADED GASOLINE MIDGRADE UNLEADED GASOLINE SUPER UNLEADED GASOLINE CARBON DIOXIDE F IH DH L F IH DH L F IH DH L F P IH G One Unified List Ail Materials at Site I DailyMax IUnitlMcP 10000.00 GAL Mod 10000.00 GAL Mod 10000 00 GAL Mod 1275.00 FT3 Min 2 10/31/2000 7 ELEVEN FOOD STORE #2125-16329 ~ Inventory Item 0001 -- COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Location within this Facility Unit UNDERGROUND FRONT PARKING SiteID: 015-021-000807 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 rSTATE ~ TYPE Liquid /Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION I Daily Maximum I 10000.00 GAL Daily Average 7500.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS N 8006619 ITSecret N~SIBioHaz No No HAZARD ASSESSMENTS I Radioactive/Amount I EPA Hazards I NFPA No/ Curies F IH DH / / / USDOT# I MCP Mod Inventory Item 0002 COMMON NAME / CHEMICAL NAME MIDGRADE UNLEADED GASOLINE Location within this Facility Unit UNDERGROUND FRONT PARKING Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 STATE ~ TYPE Liquid/Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum I 10000.00 GAL Daily Average 7500.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS N 8006619 TSecretINo NoRSIBi°HaZNo HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA/// I USDOT# MCP Mod -3- 10/31/2000 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 Inventory Item 0003 Facility Unit: Fixed Containers on Site SUPER UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9  STATE TYPE PRESSURE Liquid [ Pure I Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 7500.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS I CAS# N 8006619 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA /// USDOT# MCP Mod = Inventory Item 0004 -- COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Location within this Facility Unit Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 124-38-9 FSTATE [ TYPE Gas Pure PRESSURE -- . TEMPERATURE I Above Ambient I Cryogenic CONTAINER TYPE INSUL.TANK / CRYOGENIC Largest Container 425.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum I 1275.00 FT3 Daily Average 638.00 FT3 %Wt. 100.00 Carbon Dioxide HAZARDOUS COMPONENTS I CAS# N 124389 HAZARD ASSESSMENTS Radioactive/AmountNo/ Curies I FEPAp HazardsiH NFPA /// USDOT# Min -4- 10/31/2000 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 Fast Format ~ Notif./Evacuation/Medical --Agency Notification CALL 911. Overall Site 10/21/1998 -- Employee Notif./Evacuation NOTIFICATION WILL BE MADE VERBALLY AND 911 WILL BE CALLED. HAZARDOUS MATERIALS NOTIFY THE FIRE DEPT AND STATE OES. 10/21/1998 FOR RELEASE OF Public Notif./Evacuation POLICE AND FIRE DEPT. 10/21/1998 Emergency Medical Plan POLICE AND FIRE DEPT OR NEAREST ER IS 10/21/1998 TO BE USED IN THE EVENT OF INJURY. -5- 10/31/2000 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 Fast Format Mitigation/Prevent/Abatemt Release Prevention Overall Site 10/21/1998 STANDARD GASOLINE STATION SAFETY FEATURES FOR GAS PUMPS, AUTO SHUT OFFS, VAPOR SHIELDS, COMPRESSED GASES PROPERLY STORED IN SMALL CONTAINERS. -- Release Containment DAILY INVENTORY RECONCILLIATION TO INDICATE LEAKAGE ABOVE GROUND. 10/21/1998 -- Clean Up USE ABSORBENT MATERIALS, KITTY LITTER. ENVIRONMENTAL SERVICES. FOR BIGGER SPILLS CONTACT 10/21/1998 Other Resource Activation 6 10/31/2000 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 Fast Format Site Emergency Factors Special Hazards Overall Site 05/09/1995 --Utility Shut-Offs A) GAS - NE SIDE OUTSIDE OF BLDG B) ELCTRICAL - NE CORNER OF THE OFFICE C) WATER - STORE FRONT SIDE D) SPECIAL - NONE E) LOCK BOX - NO 10/21/1998 Fire Protec./Avail. Water 10/21/1998 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS LOCATED IN STORE PER FIRE CODE. FIRE HYDRANT - NE CORNER OF LOT ON PACHECO AND H ST. Building Occupancy Level 7 10/31/2000 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 Fast Format Training -- Employee Training Overall Site 10/21/1998 WE HAVE 6 EMPLOYEES AT THIS FACILITY. WE DO HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: THE EMPLOYEE TRAINING IS DONE WHEN HIRED AND CONSISTS OF READING THE HMMP WITH SPECIAL ATTENTION TO THE EMERGENCY RESPONSE PLAN PROCEDURES. REFRESHER TRAINING IS DONE EVERY SIX MONTHS. -- Page 2 Held for Future Use Held for Future Use 8 10/31/2000 7 ELEVEN FOOD STORE #2125-16329 Manager : Location: 1701 PACHECO RD City : BAKERSFIELD CommCode: BAKERSFIELD STATION 05 EPA Numb: SiteID: 015-021-000807 BusPhone: (661) 834-1350 Map : 124 CommHaz : Low Grid: 19A FacUnits: 1 AOV: SIC Code:5541 DunnBrad:00-734-7602 Emergency Contact / Title SHINDA UPPLE / FRANCHISEE Business Phone: (661) 834-1350x 24-Hour Phone : (800) 845-0031x Pager Phone : ( ) - x Eme_r_G_e n c_v Contact. / Title Business Phone: 24-Hour Phone : Pager Phone : ( ) - x Hazmat Hazards: Contact : Bob DeNinn0 MailAddr: PO BOX '711 City : DALLAS Owner ; 7-Eleven Inc. Address : PO BOX 711 City : DALLAS Press ImmHlth DelHlth ~Ph0n¢-(503)977-7713 Phone: State: TX Zip : 75221 Phone: ~'.'~0'~'~' ~77-77/3 1 State: TX Zip : 75221 Period : Preparer: Certif'd: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency Directives: I, /~o~ ,~c ~/~'~'-'~Do hereby certify that I have (Type or print name) reviewed the attached hazardous materials manage- ment plan for '1- (_.)_,~..u~.,,,3 and that it along with (Name of Brininess) any corrections constitute a complete and correct man- agement plan for my facility. ~&ture i 10/31/2000 7 ELEVEN FOOD STORE #2125-16329 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7 ELEVEN FOOD STORE #2125-16329 Cross Street : Business Type: Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: Name : ! ~o~b ~-e_~ ~TO~ROPERTY~ OWNER INFORMATION Phone Address: ~ ~/~. ~.~t.~k~ ~ ~ City : ~%.Z~o~t ~ State:~ Zip: Type : ~ ~/~ER INFORMAT I ON Name : Y-Eleven, Inc. Phone Address: Gasoline Acctg. City : P.O. BOX 711 State: Zip: T~e : Dallas, TX 75221-0711 SiteID: 015-021-000807 BOE UST Fee# : 002251 Financ'l Reap: INSURANCE Legal Notif : Tank Owner Mailing Address Date:04/ll/2000 Name:BOB DENINNO State UST # : Phone: (503) 977-7713x Ttl:ENVIRON. MGR. 1998 Upg Cert#: 00779 = Hazmat Inventory --As Designated Order Hazmat Common Name... UNLEADED GASOLINE MIDGRADE UNLEADED GASOLINE SUPER UNLEADED GASOLINE CARBON DIOXIDE One Unified List Ail Materials at Site ISpecHazlEPA HazardsI Frm F IH DH L F IH DH L F IH DH L F P IH G DailyMax Unit MCP 10000.00 GAL Mod 10000.00 GAL Mod 10000.00 GAL Mod 1275.00 FT3 Mi~ -2- 10/31/2000 7 ELEVEN FOOD STORE #2125-16329 ~ Inventory Item 0001 -- COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Location within this Facility Unit UNDERGROUND FRONT PARKING SiteID: 015-021-000807 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 r STATE I TYPE PRESSURE Liquid Pure Ambient -- TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 7500.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS No 8006619 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA/// I USDOT# MCP Mod Inventory Item 0002 COMMON NAME / CHEMICAL NAME MIDGRADE UNLEADED GASOLINE Location within this Facility Unit UNDERGROUND FRONT PARKING Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 r STATE I TYPE PRESSURE Liquid Pure Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average I 7500.00 GAL %Wt. I 100.00 Gasoline HAZARDOUS COMPONENTS HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ -Curies F IH DH NFPA /// USDOT# MCP Mod -3- 10/31/2000 7 ELEVEN FOOD STORE #2125-16329 ~ Inventory Item 0003 -- COMMON NAME / CHEMICAL NAME SUPER UNLEADED GASOLINE Location within this Facility Unit I/NDERGROUND FRONT PARKING SiteID: 015-021-000807 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 V STATE ~ TYPE Liquid /Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 7500.00 GAL %Wt. I 100.00 Gasoline HAZARDOUS COMPONENTS IRSI CAS# No 8006619 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA /// USDOT# I MCP Mod = Inventory Item 0004 -- COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Location within this Facility Unit Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 124-38-9 STATE -- TYPE Gas Pure PRESSURE --,TEMPERATUREr Above Ambient ! Cryogenic CONTAINER TYPE INSUL.TANK / CRYOGENIC Largest Container 425.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 1275.00 FT3 Daily Average 638.00 FT3 %Wt. I 100.00 Carbon Dioxide HAZARDOUS COMPONENTS I No SI CAS# 124389 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ .- Curies F P IH NFPA /// IUSDOT# Min -4- 10/31/2000 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 Fast Format ~ Notif./Evacuation/Medical --Agency Notification CALL 911. Overall Site 10/21/1998 Employee Notif./Evacuation NOTIFICATION WILL BE MADE VERBALLY AND 911 WILL BE CALLED. HAZARDOUS MATERIALS~NOTIFY THE FIRE DEPT AND STATE OES. 10/21/1998 FOR RELEASE OF Public Notif./Evacuation POLICE AND FIRE DEPT. 10/21/1998 Emergency Medical Plan 10/21/1998 POLICE AND FIRE DEPT OR NEAREST ER IS TO BE USED IN THE EVENT OF INJURY. -5- 10/31/2000 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 Fast Format = Mitigation/Prevent/Abatemt --Release Prevention Overall Site 10/21/1998 STANDARD GASOLINE STATION SAFETY FEATURES FOR GAS PUMPS, AUTO SHUT OFFS, VAPOR SHIELDS, COMPRESSED GASES PROPERLY STORED IN SMALL CONTAINERS. --Release Containment 10/21/1998 DAILY INVENTORY RECONCILLIATION TO INDICATE LEAKAGE ABOVE GROUND. -- Clean Up USE ABSORBENT MATERIALS, KITTY LITTER. ENVIRONMENTAL SERVICES. FOR BIGGER SPILLS CONTACT 10/21/1998 Other Resource Activation -6- 10/31/2000 F 7 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 Fast Format Site Emergency Factors -- Special Hazards Overall Site 05/09/1995 --Utility Shut-Offs A) GAS - NE SIDE OUTSIDE OF BLDG B) ELCTRICAL - NE CORNER OF THE OFFICE C) WATER - STORE FRONT SIDE D) SPECIAL - NONE E) LOCK BOX - NO 10/21/1998 -- Fire Protec./Avail. Water 10/21/1998 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS LOCATED IN STORE PER FIRE CODE. FIRE HYDRANT - NE CORNER OF LOT ON PACHECO AND H ST. Building Occupancy Level 7 10/31/2000 ELEVEN FOOD STORE #2125-16329 SiteID: 015-021-000807 Fast Format Training -- Employee Training WE HAVE 6 EMPLOYEES AT THIS FACILITY. WE DO HAVE MATERIAL SAFETY DATA SHEETS ON FILE. Overall Site 10/21/1998 BRIEF SUMMARY OF TRAINING PROGRAM: THE EMPLOYEE TRAINING IS DONE WHEN HIRED AND CONSISTS OF READING THE HMMP WITH SPECIAL ATTENTION TO THE EMERGENCY RESPONSE PLAN PROCEDURES. REFRESHER TRAINING IS DONE EVERY SIX MONTHS. -- Page 2 --Held for Future Use Held for Future Use -8- 10/31/2000 7 ELEVEN FOOD STORE #2125-16329 Manager : Location: 1701 PACHECO RD City : BAKERSFIELD CommCode: BAKERSFIELD STATION 05 EPA Numb: SiteID: 215-000-000807 BusPhone: (805) 834-1350 Map : 124 CommHaz : Low Grid: 19A FacUnits: 1 AOV: SIC Code:5541 DunnBrad:00-734-7602 Emergency Contact / Title SHINDA UDPLE ~g// FRANCHISEE Business Phone: ~3~r5-~) 834-1350x 24-Hour Phone : Pager Phone : ( ) - x Emereency C~ntact / Title BRENT CRUZDh~nn~-~ / FIELD CONSULT Business Phone: (605) 2Gi~4~3~x 24-Hour Phone : (Rom) ~y~_ ODl/x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : MailAddr: 3_7_0! PACHECO RD ~O ~ ~ ~// City : Address : ~ VTT,T,AG~ PL ~2~ ______~0 ~ ~// City : Phone: (805) 834-1350x State: Zip : ~,~.~/~. Phone: (~) ~-'-5-~ State: ~-7-~ Zip : 98055 Period : Preparer: Certif'd: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency Directives: ~ Hazmat Inventory --Alphabetical Order Hazmat Common Name... CARBON DIOXIDE MIDGRADE UNLEADED GASOLINE SUPER UNLEADED GASOLINE UNLEADED GASOLINE ISpecHazlEPA HazardsI Frm F P IH G F IH DH L F IH DH L F IH DH L I, ~,*C ~..~ . DO hereby cedi% that , have reviewed"" ~ .... "-~ ,n,., at...::,.,,~d hazardous materials manage- that it along with any corrections constitut~ a complete aGd correct man- One Unified List Ail Materials at Site DailyMax Uhit MCP 1275 FT3 Mit 10000 GAL Mod 10000 GAL Mod 10000 GAL Mod agement plan for my facility. 04/20/1999 ELEVEN FOOD STORE #2125-16329 SiteID: 215-000-000807 Inventory Item 0004 Facility Unit: Fixed Containers on Site CARBON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 124-38-9 FSTATE -- TYPE Gas Pure PRESSURE TEMPERATURE Above Ambient I Cryogenic CONTAINER TYPE I INSUL.TB/NK / CRYOGENICI Largest Container 425.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 1275.00 FT3 Daily Average 638.00 FT3 %Wt. 100.00 Carbon Dioxide HAZARDOUS COMPONENTS RNo~ CAS# 124389 HAZARD ASSESSMENTS TSecretI oRSIBioHazI Radioactive/Amount I EPA HazardsI NFPA No N No No/ Curies F P IH / / / USDOT# I MCP Min Inventory Item 0002 Facility Unit: Fixed Containers on Site ~UUVL~ ~vL~ / ~IVli ~-'~.L~ ~Vl~ MIDGRADE UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 FSTATE ~ TYPE Liquid /Pure PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROLrND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum I 10000.00 GAL Daily Average 7500.00 GAL I%Wt. I 100.00 Gasoline HAZARDOUS COMPONENTS INoRS CAS# 8006619 HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies F IH DH NFPA/// I USDOT# Mod 2 04/20/1999 7 ELEVEN FOOD STORE #2125-16329 ~ Inventory Item 0003 -- COMMON NAME / CHEMICAL NAME SUPER UNLEADED GASOLINE Location within this Facility Unit UNDERGROUND FRONT PARKING SiteID: 215-000-000807 Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 TYPE - PRESSURE FSTATE 1 Liquid ! Pure Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 7500.00 GAL %Wt. 100.00 Gasoline HAZARDOUS COMPONENTS No CAS#80066191 HAZARD ASSESSMENTS ITSecret NoRS BioHaz] Radioactive/Amount EPA Hazards No No No/ Curies F IH DH NFPA /// USDOT# Mod ~ InVentory Item 0001 -- COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Location within this Facility Unit UNDERGROUND FRONT PARKING Facility Unit: Fixed Containers on Site Map: Grid: Days On Site 365 CAS# 8006-61-9 STATE -- TYPE PRESSURE Ambient Pure lLiquid TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 10000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10000.00 GAL Daily Average 7500.00 GAL I%Wt. I 100.00 Gasoline HAZARDOUS COMPONENTS I CAS# 8006619 HAZARD ASSESSMENTS TSecretl RSlBioHaz Radioactive/Amount I EPA Hazards No No No , No/ Curies F IH DH NFPA /// USDOT# MCP Mod 3 04/20/1999 ELEVEN FOOD STORE #2125-16329 SiteID: 215-000-000807 Fast Format ] ~ Notif./Evacuation/Medical --Agency Notification CALL 911. Overall Site 10/21/1998 -- Employee Notif./Evacuation NOTIFICATION WILL BE MADE VERBALLY AND 911 WILL BE CALLED. HAZARDOUS MATERIALS NOTIFY THE FIRE DEPT AND STATE OES. 10/21/1998 FOR RELEASE OF -- Public Notif./Evacuation POLICE AND FIRE DEPT. 10/21/1998 Emergency Medical Plan 10/21/1998 POLICE AND FIRE DEPT OR NEAREST ER IS TO BE USED IN THE EVENT OF INJURY. -4- 04/20/1999 ELEVEN FOOD STORE #2125-16329 SiteID: 215-000-000807 Fast Format Mitigation/Prevent/Abatemt Release Prevention Overall Site 10/21/1998 STANDARD GASOLINE STATION SAFETY FEATURES FOR GAS PUMPS, AUTO SHUT OFFS, VAPOR SHIELDS, COMPRESSED GASES PROPERLY STORED IN SMALL CONTAINERS. -- Release Containment DAILY INVENTORY RECONCILLIATION TO INDICATE LEAKAGE ABOVE GROUND. 10/21/1998 -- Clean Up USE ABSORBENT MATERIALS, KITTY LITTER. ENVIRONMENTAL SERVICES. FOR BIGGER SPILLS CONTACT 10/21/1998 Other Resource Activation -5- 04/20/1999 ELEVEN FOOD STORE #2125-16329 SiteID: 215-000-000807 Fast Format Site Emergency Factors -- Special Hazards Overall Site 05/09/1995 --Utility Shut-Offs A) GAS - NE SIDE OUTSIDE OF BLDG B) ELCTRICAL - NE CORNER OF THE OFFICE C) WATER - STORE FRONT SIDE D) SPECIAL - NONE E) LOCK BOX - NO 10/21/1998 -- Fire Protec./Avail. Water 10/21/1998 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS LOCATED IN STORE PER FIRE CODE. FIRE HYDRANT - NE CORNER OF LOT ON PACHECO AND H ST. Building Occupancy Level 6 04/20/1999 ELEVEN FOOD STORE #2125-16329 SiteID: 215-000-000807 Fast Format ~ Training -- Employee Training WE HAVE 6 EMPLOYEES AT THIS FACILITY. WE DO HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: THE EMPLOYEE TRAINING IS DONE WHEN HIRED AND CONSISTS OF READING THE HMMP WITH SPECIAL ATTENTION TO THE EMERGENCY RESPONSE PLAN PROCEDURES. REFRESHER TRAINING IS DONE EVERY SIX MONTHS. Overall Site 10/21/1998 Page 2 Held for Future Use Held for Future Use -7- 04/20/1999 BAKERSFIELD FIRE DEPARTMENT February 13, 1998 FIRE CHIEF MICHAEL r~. KELLY ADMINISlg. A11VE 2101 "H' Street Bakersfield. CA 93301 (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'H' Street Bakersfield, CA 93,301 (805) 326-3941 FAX (805) 395-1349 FRE1/~NTION $EI~VlCF~ 1715 Cl'~'ter Ave. Bakersfield, CA 93301 (805) 326-3951 FAX (805) 326-0576 ENVlILK)NMENTAL SEI~flCF.$ 1715 Chester Ave. Bakersfield, CA 9,3301 (805) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Street Bakersfield, CA 93,308 (805) 3994697 FAX (80~) 399-576,3 7 Eleven Food Store 1701 Pacheco Road Bakersfield, Ca 93304 RE: "Hold Open Devices" on Fuel Dispensers Dear Underground Storage Tank Owner: The Bakersfield City Fire Department will commence with our annual Underground Storage Tank Inspection Program within the next 2 weeks. The Bakersfield City Fire Department recently changed its City Ordinance conceming "hold open devices" on fuel dispensers. The Bakersfield City Fire Department now requires that "hold open devices" be installed on all fuel dispensers. The new ordinance conforms to the State of California guidelines. The Bakersfield Fire Department apologies for any inconvenience this may cause you. Should you have any questions, please feel free to contact me at 326-3979. Sincerely, Steve Underwood Underground Storage Tank Inspector cc: Ralph Huey 03/02/98 08:.4~ ~805 326 0576 BFD tIAZ MAT DIV ~007 INSTRUCTIONS: 2. 3. 4. CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) $26-3979 To avoid further action, return this form within 30 days of receipt. TYP~PRINT ANSWERS IN ENGLISH. Answer the questions below for the business as a whole. Be as brief and concise as possible. * SECTION 1: BUSINESS IDENTIFICATION DATA DL~ & B~ST~ET ~ER: ~ -7~ 7~ ~ 02 SIC:CODE: SECTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 I-IR. PHONE 03/02/98 08:48 '~805 326 0576 BFD HAZ MAT 008 HAZARDOUS MATERIALS MANAGEMENT PLAN S_E~TION 3: TRAINI~_ G. NUMBER OF EMPLOYEES: MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION REQUEST I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXE'i~iPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION INFORMATION IS ACCURATE USED TO FULFILL AND SAFETY COD~ ET AL.) AND~ Slfi~NATURE CERTIFY THAT THE ABOVE i mM'S OBLIGATIONS ~EK ~~OUS reTElLS (DIV. 20 C~TER 6.95 SEC. 25500 cossm s v my. TITLE DA'I 0.3/02/98 08:49 8805 ~ 0576 BFD IIAZ BlAT DIV [~009 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES AGENCY NOTIFICATION PROCEDURES: Cc&J EMPLOYEE NOTIFICATION AND EVACUATION: PUBLIC EVACUATION: EMERGENCY MEDICAL PLAN: 0~/02/98 08:49 '~805 j~0576 BFD IIAZ MAT DIV ~010 BAZARDOUS MATERIALS MANAGEM~ENT PLAN SECTION 7: MIT.!GATION, PKEVENTION AND ABATEMENT PLAN A. RELEASE PREVENTION STEPS: B. ~AS~ CONTENT ~/OR ~ATION: SECTION 8: UTILITY SHLFT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FAC]I'ITY),, NATURAL GAS/~ROPANF.: hO{'~-,ecl~ ~l& OU~<J~O~' WATER: O~r SPECIAL: LOCK BOX: YES~ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: B. WATER AVAILABH_,ITY (FIRE HYDRANT): 4 03/02/98 08:51 9805 326 0576 BFD IIAZ MAT DIV ~012 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA ($05)326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ] zn, q bo'7 , DUN & BRADSTREET NUMBER (DC) - '7 3M - -2 ~ cD ~ OWNER/OPERATOR "~.._)b ~ ~/I',31,,.)O PHONE(~;2~) CITY ~ggh 3cOY'x STATE EMERGENCY CONTACTS BUSrNESS m,IO~ (~C~) .2~q - \ BUSINESS PHONE 03/02/98 08:58 ~'805 0576 BFD IIAZ MAT DIV [~017 HAZARDOUS MATERIALS INVENTORY Page ..o£ . CI~MICAL DESCRIPTION I ) INVENTORY STATUS: New [ ] Addition [ ] Res4sion.~Deletiou [ ] Check if chemical is a NON Trade Secret [ ] Trade Secret [ 2) Common Name: &~.r~ tr'p~_.. 3) DOT # (optio6al) Ch,,mi¢~ N~¢: aHM [ I CAS # o~2<X:, -G k-c~ 4) Physical & Health MRcactivc [ PHYSICAL HEAL~ Ilazard Categories Fire ] Sudden Release ofPressure [ ] Immediat~ Health (Acute) 5) WASTE CLASSWICATION (3-digit ¢od¢ from DHS Form 8022) USE CODE STATE Solid [ ] Liquid ~ Cras [ 1 Pure [ ] Mixture~ Wast~ [ ] Radioactive { ] 6) PItYSICAL rants o~ MZaStma ~) sto~n CODFS 7) AMOUNT AND 'IIME AT FACILITY Maximum Daily Amount ~ Lbs [ l C-al.~?t3 [ ] a) Contains. Average Daily Amount r-Q-[ COO Curies [ Annual Ammmt ~O'70~ ~' c) Tempmmtum Largest Size Container [O COC.% ~J, F, M, A, M, J, J, A, S. O, N, D # Days on Site 9) MIXTURE: List thc three most haT.'trdous chemical components or any AHM components Circle Which Months: CAS# % WT 2) ~~--~ [ [ [ I I 0)[,OCATION t ) INVENTORY STATUS: New ( ] Addition [ ] Re~ision ])<].Delefion [ ] Chemical Name: C%r-~t,. __ 4) Physical & Health Ilazard Categories Fire [ ] Reactive [ PHYSICAL of Pressure ~l immediate Heatlh (Acute) [ Sudden Release Check if chemical is a NON Trade Secret [ ] Trade Seeret [ ] 3) DOT # (optional) ] O ~ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION 6) PIiYS~CAL STATE Solid [ ] Liquid [ 7) AMOUNT AND TIME AT FACIL1TY Maximum Daily Ammmt Average Daily Amount Annual Amount Largest Size Containcr # Days o~ Site 9) MIXTURE: List the tkree most tu~ardous 1 ) chemical components or 2) uny AHM components 3) (3-digit codc from DIIS Form 8o22) USE CODE ~S OF ~SU~ S) STOOGE CODES I.bs ~1 Gal [ ] fi3 [ I a) Con~: O~ ~ Crees [ ] b) ~essme: ~ c ) Tcm~a~e ~ Ckcle %~ch Monks: ~, F, M. A. M, J. J. & S. O, N, D CO~ONE~ C~, % ~ [ I [ ] 10 )LOCATION ~ . [~;:,feY~ds~bP~al~ed~ Ofinf2a2;t~t~aoaont :?atr~;.pfc. c~2;:elY2~l c~m~.d am familiar with th~./y~/n this and al~l atlached d,,.5' ~TenJs/.~i I 03/02/98 ~805 0576' BFD IIAZ MAT DIV ~018 Business Namc ~OUS MATERIALS INVENTORY Addr~s Page CI~I~ICAL DESCRIPTION 1 ) INVENTORY STATUS: New [ ] AddRion [ 2) Core. ton Na~e: Chemical Name: ] Revision [ ] D~tction [ } Ch~k ifch~xir~l is a NON Trad~ Secret [ ] Trsd~ ~ [ ] 3) DOT # (op6onsl) ARM[ I c~# .4) Physical & Health PHYSICAL HEALTH Hazard Categories Fi~e[ ]Reactive[ ]SuddenReleaseofPresame{ 1 lmmediateHealth(Acute)[ ]DelayadHealth(Chroni¢)[ ] 5) WASTE CLASSIFICATION . (3.digit code from DH8 Form $022) 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] 7) AMOUNT AND ~ AT FACILITY Maximum Daily Amount Average Daily Amount Ammal Amount Largest Size Container # Days on Site 9) MIXTURE: Li~ the three most hazardous I) chemical components or 2) any AHM components 3) USE CODE Pu~[ ] Mix. et ] W~[ ] R~tioa~five[ ] UNITS OF MEASURE 8) STORAGE CODES Lbs [ ] C.,al [ ] fi3 [ ] a) Container: Curies [ ] b) Press-are: c) Temperatur~ Cimle Which Months: All Year, J, F. M, A, M, J. J, Ct. S, O, N, D COMPONENT CAS# % WT [ 1 [ 10)LOCATION l) INVENTORY STATUS: New [ 2) Coramon Name: Chemical1 Name: 4) Physical & Health Hazaxd Categories FLre [ 5) WASTE CLASSIF[CATION ] Addition [ ] Revision [ ] Deletion [ ] PHYSICAL Reactive [ ] Sudden Releas~ of Pressure [ (3-digit code from DHS Form 8022) Check if chemical is a NON Trade Secret [ 3) DOT # (optional) AHM[ ] CaS# : ] Immediate tteadth (Acute) [ USE CODE ] Trade Secret [ ] ] Delay~l Health (chxonic) [ ] 6) PItYSICAL STATE Solid[ ] Liquid[ ] Gas[ ] Pure[ ] Mixt~¢[ } Waste[ ] thaio~ve[ ] 7) AMOUNT AND ~ AT FACILITY Maximum Daily Amount Average Daily Amount Armual Amount Largest Size Container # Days on Site UNITS OF MEAS~ g) STORAGE CODES Lbs[ ]Gall ]ft3[ ] a) Container: Curies [ ] b) Pressure: c) Temperature Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D 9) M[X~: List the three most hazardous 1 ) chermcal components or 2) any AHM components 3) COMPONENT CAS# % WT I 0 )LOC AT[ON [ l [ 1 [ I I ce~fy under penalty of law. that I have personally examined and am familiar with the information on tMs and all attached documonm I believe the submitted information is true, accurate and complete. PRINT Name & Title of Authorized Company Relxcsentative Signature Date ./ 03/02/98 08:56 0805 0576 BFD IIAZ MAT 016 Business Name ItAZARDOUS MATERIALS INVENTORY Ad&ess Page__ CHEPdICAL DESCRIPTION 1) INVENTORY STATUS: New [ 2) Common Name: Chemical Name: Addition [ ] Revision [ ] Deletion [ ] Check if chcm~ical is a NON Trad~ Secret [ ~) DOT # (o~ion~) AUM[ I CAS# ] Trade Secret [ 4) Physical & Health }lazard Categories Fire [ 5) WASTE CLASSIFICATION 6) PHYSICAL STATE Solid [ ] l,iqu/d [ 7) AMOUNT AND TIME AT FACILrI'Y Maximum Daily Amount Average Daily Amount Annual Amount Largest Size Container # Days on Sile 9) MIXTURE: List the three most hazardous 1) chcrnical componcmts or 2) any AHM components 3) __ PHYSICAL ] Reactive [ ] Sudden Release of Pressure [ O-digit code from DHS Form 8022) ] Oas[ ] UNITS OF MEASUR~ Lbs[ lC_ad[ ]fO[ ] Curies [ Circle Which Montlu: COMPONENT HEALTH ] Immediate Health (Acute) [ ] Delayed Health (Clmmic) [ USE CODE Mixture'[ ] Waste [ ] Radioactive [ 8) STORAGE CODES a) Conlainer: b) Pressure: o) Temperature AIl Year, $, F, M, A, M, J, J, A, S, O, N, D { 0)LOCATION [ [ I ] I ) IN-VF. lxrrORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion I { Check il'chemical is a NON Tnut~ Secret [ 2) Common Name: 3~ LX)T # (optional) Chemical Marne: AHM [ [ CAS # ] Trade Secret [ 4) Physical & 1 lealth PHYSICAl. HF. ALTH Hazard Categories Fire [ ] Reactive [ ] Sudden Release of Pressure [ } Immediate Health (Acute) [ ] Delayed Health (Chronic) 5) WASTE CLASSIFICATION 6) PHYSICAL STATE Solid [ ] Liquid [ 7) AMOUNT AND 'lIME AT FACII.ITY Maximum Daily Amount Average 1 )ally Amount Annual Amount Largest Size Container # Days on Site 9) MIX'lURE: List the fl~ree most lmzardous 1 ) .... chemical components or 2) m~y AHM components 3) _ . (3-digit code from DHS Form 8022) USE CODE ] Gas[ } Pure[ ] Mixture[ I Waste[ I Radioactive[ ] UNITS OF MEASURE 8) STORAGE CODES Lbs[ JGal[ ]RS[ ] a) Container: Curies[ ] b) Pressure: c) Temperature Circle Which Months: COMI~ONENI AIl Year, J, F, M, Ph M, J, J, A, S, O, N, D CAS# %WT 10)LOCATION [ 1 [ 1 l ] I certify mtder penalty of law, that I have personally examined and am familiar with thc information on this and all attached documents. I believe lhe submitted/afformation is true, accurate and complete. PRINT Name & Title of Au~orized Company Representative Signature Date PACHECO ROAD _JAIBICIDIEIFIGIHI'I IJIKILIM 4 5 7 8 9 0 11 MW-7 k ,.. .. ',,,' "~,, FACILITY NO. 19,329 r MW-Sz ",. 'o~ 7 I SVE- 1 I Mw-4 1 ~ 12 P'l TREATMENT coMPou. D P~E. ' MW-3~rl I 14 B STREET FLUOR DANIEL GTI ~ 16329-HM EXPLANATION +-~+-4--~ WE,.,. ,OCAT, O, FIRE HYDRANT FIRE ALARM PANEL ELECTRICAL SHUT-OFF GAS SHUT-OFF WATER SHUT-OFF UST SHUT-OFF SANITARY SEWER STORM DRAIN  EMERGENCY INFO, BUSINESS PLAN, CHEMICAL INVENTORY, AND MAPS SPILL CONTROL EQUIPMENT KITI'Y LITTER ~ FIRST AID KIT ~ EVACU.~TION/STAGING AREA -- E --." EVACUATION ROUTE E EMERGENCY EXIT --X --X-- FENCING, { } UNDERGROUND STORAGE TANK ~ CO2 TANK 50 60 APPROX. SCALE IN FEET SOUTHLAND CORPORATION 1-ELEVEN FACILITY NO. 16392 1701 F~ACHECO ROAD BAKERSFIELD, CALIFORNIA O20700420 DRAWN BY: CRAIG NEFF DATE: 04-12-98 DRAFTED BY: CHUCK GRIJALVA DATE: 04-12-98 CHECKED BY: DATE:__ BAKERSFIELD CITY FIRE DEPARTMENT HAZARDOUS MATERIALS DIVISION 1715-CHESTER A,V_E.~ BAKERSFIELD, CA. 93301 .... HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: · To ovoid further action, return_ this form w_ithin 30 days.of receipt. _ TYPE/PRINT ANSWERS tN ENGLISH. Answer the questions below for the business as <3 wtsole. Be brief and concise as possible. SECTION 1' BUSINESS IDENTIFICATION DATA BUSINESS NAME' '~- ~,\q:5)Q~ ~2.~ '~i LOCATION: ~'~O\ ~¢~0 ~. ~~%~l~ MAILING ADDRESS:.~ ~- 0~O~~ CITY: DUN & BRADSTREET NUMBER: PRIMARY ACTIVITY' STATE:O~'qr ZIP: q~'~ ~,\ PHONE: ~-c~,,~.-\ ""0'~'~, ~\ coo : SECTION 2: EMERGENCY NOTIFICATION' CONTACT TITLE BUS. PHONE 24 HR. PHONE . '_Bakersi~_eld Fire Dept. ' ~zardous 1V~aterials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: MATERIAL SAFETY DATA SHEETS ON FILE: 8~iEF SUMMARY OF T~AINING SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT'MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIAl_S, BUT THE QIJANTITIES AT NO _TiMEEX.CEED THE MI.NIMUM REPORTING-QUANTIT.!ES SECTION 5: OTHER (SPECIFY REASON) C ERTIFt CATI O N: I, CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. i UNDERSTAND THAT THIS INFORMATION WILL-BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE!' ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET 'AL.) AND'~H,~,T INACCURATE iNFORMATION.CONSTiTUTES PERJURY. SIGNATURE TITLE DATE. Bakersf~:eicl F~re Dept. Hazardous Materials Divisio~ HAZARDOUS MATERIALS MANAGEMENT PLAN Facilih/Unit Name: 'c~-~\Ck~(LY~ ~'O'T~>~ /~~' SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: Ao AGENCY NOTIFICATION PROCEDURES: ~-..-~ ~:)~--~-~q B, EMPLOYEE NOTIFICATION AND EVACUATION: C. PUBLIC EVACUATION' EMERGENCY MEDICAL PLAN: · B~kersfield. Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: B. REL=AScCON'TAINMENT AND/OR MI~MIZATIO~ .... CLEAN-UP PROCEDURES' tr, c-bd, 8,0%- SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY)' ~C!AL: :OX. LOCK '~ · !F YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: Ao PRIVATE FIRE PROTECTION: WATER AVAILABILITY (FIRE HYDRANT): BAKi~i~SFIELD CITY FIRE,D~. ARTMENt HAZARDOUS MATERIALS DIVISION - .. " 1715 CHESTER AVE.' · BAKERSFIELD, CA. 93301 (805) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF =~USINESS IS A FARM BUSINESS NAM E-'~'Y~ SiTE ADDRESS CITY NATURE CF ..E,~SINESS STATE DUN & B~DSTREET NUMBER MAILING ADDRESS \'""~('")\ ~"~CJc'~'~(._O PHONE ~(~-;~-5¢0 '~i0 ~'¢{~ ~----'~~ EMERGENCY CONTACTS BUSINESS PHONE ~0~-~'~'3~G-~(-..~ 24-HOUR PHONE ~~-~- nOS 1 TITLE 24-HOUR PHONE 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: Shinda~Upple 7-11 1701P~checo Road Bakersfield CA 93304 Date of Delivery [] Agent [] Addressee s different from item 17 [] Yes If YES, enter delivery address below: [] No 3. Service Type ~ Certified Mail [] Registered [] Insured Mail [] Express Mail [] Return Receipt for Merchandise [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 2. Arti, cJi~lumber (Copy from service label) ____~__0.0520 0021 9610 7745 PS Form 381 ~ 1'~ Domestic Return Receipt 102595-99-M-1789 UNITED STATES POSTAL SERVICE First-Class Postage & USPS Permit No. G-10 · Sender: Please print your name, address, and ZIP+4 in this box ° E~AKERSFIELD FIRE DEPARTMENT OFF~CE OF ENVIRONMENTAL SERVICES 1715 Chester Avenue, Suite 300 Bakersfield, CA 93.301 ~ .~l Oel"t~l'md Fee, e*,Um ~ece~Pt' Fee ~ ~.n~c~ment p, ec~uimct~ OJ p, estVtcteCl Oe~N_e~Y .~ee~ ' ~ ~ndo~sement Certified Mail Provides: . A mailing receipt · A unique identifier for your mai)piece · A signature upon delivery II A record of delivery kept by the Postal Service for two years Important Reminders: · Certified Mail may ONLY be combined with First-Class Mall or Pdority Mail. · Certified Mail is not available for any class of international mail. e 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 add tional fee delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the ma Ipiece with the endorsement "Restricted Delivery". ~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 n,~eded, detach .a~ affix la~el with postage and mail. IMPORTANTI~e this receipt and present it when making an inquiry. PS Form 3800, February 2000 (Reverse) 1025§5-00-M-1489 FLUOR DANIEL GTI August31,1998 City of Bakersfield Office of Environmental Services 1715 Chester Avenue Bakersfield, CA 93301 Dear Sir/Madam: Enclosed is a 1998 HAZARDOUS MATERIALS MANAGEMENT PLAN (HMMP)for Southland Site #16322 for Bakersfield County, as required by law. Please contact me at (602) 966-0808 if you have questions regarding this material. Sincerely, Fluor Daniel GTI ~ladjan~' Larson Project Manager Assistant 1100 East University Drive, Suite 116 / Tempe, AZ 85281 USA (602) 966-0808 FAX (602) 894-0955 Announcing a New Office Location June 15, 1998, Bob DeNinno, Environmental Services Manager is moving to a new address. Please note the change of address, phone and fax numbers. Address: The South/and Corporation ~0220 S. FY. Greenhurg Rd Suite 470 Portland, OR 97223 Phone: 505/977-77~3 Fax: 503/245-3438 Pager: ~-800-38 ~- ~209 BAKERSFIF D CITY FIRE DEPARTa .ENT HAZARDOUS MATERIALS INVENTOH r/ ..... Addre~ ~0~ CHEMICAL DESCRI~ION AHM [ 1 3) DOT · (olXionaJ) CAS # 4) PHYSICAL & HEALTH HAZARD CATEGORIES PHYSICAL / Fire [V~ Reactive [ ] Sudden Releaseof Pressure [ ] HEALTH Immediate Healtl~ (Acute) [ ] Delayed HeaRh (Chronic) WASTE CLASSIFICATION '-------- (3-digit code from DHS Form 80221 USE CODE PHYSICAL STATE Solid [ ] liquid [/Gas [ ] Pure [ ] MLxture [ ] Waste [ ] Raclioa~Jve [ ] Average Oally Arno Annual Amount: LaJ'gest ~ize'Conta.ner: # Oa~ On Site UNITS C~F MEAS/'URE 8) STORAGE CODES lbs [] =a~ [VT ~t3 [] a) Cont"'nen cunes [] b) Pressure: c) Temperature: CircteW~ichMonths:~J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: Dst the three most haz~cious ct~emlcal components or any AHM components COMPONENT 3) [] [] [] CHEMICAL DESCRIPTION 1) INMENTORYSTATUS: New..[..] Addition[ ] Revision[ ] Deletion[ ] Check if chemical is a NON TRADE SECRET [ ] 'T'FLaOE SECRET [ ] Common Nm'ne: Chemical Name: · 4) PHYSICAL & HEALTH HAZARD CATEGORIES Fire 5) WASTE CLASSIFICATION PHYSICAL STATE Solid [ ] 7) AMOUNT AND TIME AT FACI[JTY Maximum Omly Amount: Average Oaly Amount: Annual Amount: Largest Size Contmner: ~* Days On Site 11 2) 31 MIXTURE: Ust the three most he. zm'dous cnemlcat componems or any AHM comDonents 3) COT # (opt~n~ AHM [ ] CAS # HEALTH immediate HealU~ (Acute) [ ] Delayed Health (Chronic) [ ] AHM [} [I P H Y S:C A~ Reactive [ ] Suc~den Rete~s~of Pressure [ ] (3-digit code from OHS Form 80~ USE CODE LiQuid [ ] Gas [ ] '"~a4~[ ] Mixture [ ] Waste [ ] Radioactive [ ] UNITS CF MEASURE ~ 8) STORAGE CODES lbs [ t ~a [ ] ft3 [ ]~ a) Contalner: · tunes [ ] ~ b) Pressure: ".~perature: Circle W~icn Months: All Yea', J. F, M, A, M, J. '~,~, S, O, N, O COMPONENT CAS'~.~ % WT [1 RINT Name & Title of Autt~onzeo Company i~epresenta~ve Signature Date Business Name: Bakersfield Fire DepOt. ' HAZARDOUS MATERIALS DIVISIOI~' Date Completed Location: ~"701 Business Identification No. 215-000 000~0 ,'7 (Top of Business Plan) StationNo. ~' Shift .,, ~ Inspector "J'J'J'~.L~/~Jc'~(.I'~ ~ Adequate Verification of Inventory Materials ~ Verification of Quantities J~ Verification of Location I~' Proper Segregation of Material~/ Inadequate Comments: Number of Employees Comments: Verification of MSDS Availablity ./ ~'/ ~] Verification of Abatement Supplies & Procedures Comments: Emergency Procedures Posted Containers Properly Labeled Comments: Verification of Facility Diagram Special Hazards Associated with this Facility: Violations: ~ss Ow~/'~an-a~er ~ All Items O.K. J~ Correction Needed J~ White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy 06/25/93 7 ELEVEN FOOD STORE #2125-16329 215-000-000807 Overall Site with 1 Fac. Unit Page General Information Location: 1701PACHECO RD Map: 124 Hazard: Low Community: BAKERSFIELD STATION 05 Grid: 19A F/U: 1AOV: 0.0 1 Contact. Name~_ ,~ Title Administrative Data Mail Addrs: 1701PACHECO RD City: BAKERSFIELD Comm Code: 215-00! 05 .Owner: ~HE SOUTHLAND CORPOP~TION ,~dress: 31""~v WILLOW AV SU--394 Business Phone 24-Hour Phone- (805) 834-1350 x ~( ) - ~+~ ( ) - D&B Number: 00-734-7602 State: CA Zip: 93307- SIC Code: 5541 Phone: (J,~) ~! State: CA Zip: ~3612 ~~'~. ~ ~ .. ~ ~~' , _ ~ I, T~ 5;~ ~ ~_ Do hereby codi~ thru I have RECEIVED reviewed the a~ched h~a~ous materials manage- JUL forg-E~ ~ and that along with ment plan W 1~3 it HAZ, MAT. DIV. any corrections constitut~ s complete and ~rm~ man- agement plan'for my facility, 06/25/93 Pln-Ref 02-002 7' ELEVEN FOOD STORE #2125-16329 Name/Hazards 215-000-000807 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site ~R~FeW~At~ GASOLINE /Y),'d~c~td..e · Fire, Immed Hlth, Delay Hlth Form Max Qty Page MCP 2 Liquid 10000 Moderate GAL 02-003 SUPER UNLEADED GASOLINE · Fire, Immed Hlth, Delay Hlth Liquid 10000 Moderate GAL 02-001 UNLEADED GASOLINE · Fire, Immed Hlth, Delay Hlth Liquid 10000 Moderate GAL 06/25/93 7 ELEVEN FOOD STORE %2125-16329 215-000-000807 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order Page 3 02-002 ~ GASOLINE /~;~Jg~ · Fire, Immed Hlth, Delay Hlth Liquid 10000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL 10,000 I Daily Average GAL 7,500.00 Annual Amount GAL 359,054.00 Storage UNDER GROUND TANK Press T Temp Location Ambient|AmbientlUNDERGROUND FRONT PARKING -- Conc 100.0% IGasoline Components iMCP ---TGuide ModerateI 27 02-003 SUPER UNLEADED GASOLINE · Fire, Immed Hlth, Delay Hlth Liquid 10000 Moderate GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL 10,000 I Daily Average GAL Annual Amount GAL 7,500.00 ~ 104,666.00 Storage UNDER GROUND TANK Press T Temp Location Ambient~AmbientlUNDERGROUND FRONT PARKING -- Conc 100.0% IGasoline Components MCP -~Guide IModeratel 27 02-001 UNLEADED GASOLINE · Fire, Immed Hlth, Delay Hlth Liquid 10000 GAL Moderate CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL 10,000 I Daily Average GAL 7,500.00 Annual Amount GAL 228,741.00 Storage UNDER GROUND TANK Press T Temp Location IAmbientlAmbientlUNDERGROUND FRONT PARKING -- Conc 100.0% IGasoline Components ~ MCP ---FGuide IModeratel 27 06/25/93 7 ELEVEN FOOD STORE #2125-16329 215-000-000807 00 - Overall Site <D> Notif./Evacuation/Medical Page 4 <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation VERBAL AND CALL 911. FOR RELEASE OF HAZ MAT NOTIFY BFD HAZ MAT DIV AND STATE O.E.S. <3> Public Notif./Evacuation VERBAL AND DIAL 911 <4> Emergency Medical Plan FIRE DEPT/POLICE DEPT 911. NEAREST EMERGENCY ROOM TO THE LOCATION IS TO BE USED IN THE EVENT OF INJURY. 06/25/93 7 ELEVEN FOOD STORE #2125-16329 215-000-000807 00 - Overall Site <E> Mitigation/Prevent/Abatemt Page 5 <1> Release Prevention STANDARD GASOLINE STATION SAFETY FEATURES 'FOR GAS PUMPS, AUTO SHUT OFFS, VAPOR SHIELDS AND SHEER OFF VALVE. COMPRESSED GASSES PROPERLY STORED IN SMALL SAFETY CONTAINERS AND WITH PROPER FITTINGS. BUSINESS EMERGENCY PLAN 'ON FILE AT EACH STORE. <2> Release Containment <3> Clean Up <4> Other Resource Activation 06/25/93 7 ELEVEN FOOD STORE #2125-16329 215-000-000807 00 - Overall Site <F> Site Emergency Factors Page 6 <1> Special Hazards CALL 911 <2> Utility Shut-Offs A) GAS - NONE B) ELCTRICAL - BACK ROOM HALLWAY C) WATER - STORE FRONT SIDE D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS LOCATED IN STORE PER FIRE CODE FIRE HYDRANT - NORTHEAST CORNER OF LOT ON PACHECO AND H STREETS <4> Building Occupancy Level 06/25/93 7 ELEVEN FOOD STORE #2125-16329 215-000-000807 Page 00 - Overall Site <G> Training <1> Page 1 WE HAVE 9 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE SEE HAZARDOUS MATERIALS HANDLING PROCEDURES POSTING AND EMPLOYEE AWARENESS FORM <2> Page 2 as needed <3> Held for FutUre Use <4> Held for Future Use BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 BUSINESS N~ME: OFFiCiAL USE ONLY ID# BUSI NESS PLAN SINGLE FACILITY UNIT FORM SA INSTRUCTIONS · 1. To avoid further action, this form must be returned by: . . 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACILITY UNIT LISTED BELOW -~-. 4. Be as BRIEF and CONCISE as .possible.' .... ~ ........ . ................ FACILITY UNIT~ FACILITY UNIT N~E: SECTION 1: MIT!GATION, PREVENTIONT ABATEMEN'r PROCEDURES SECTION 2: NOTIFICATION ~\~ EVACUATION PROCED5~ES AT THIS 5%'IT 05%Y t:'t''~" '=HAZARDOUS MATERIALS DI~I~ION 2130 G Street,· Bakersfield, CA 93301 · (805) 326-3970·  J4N 0 5 1992 I, FACILI~/SITE No. OF TANKS ~ " DBA OR FACILITY NAME AODRES~ 17ol Po~ck e~o ~'INDIVIDUAL Q PARTNERSHIP ~LOCALAGENCYDISIl~ICTS Q COUNW AGENCY {~ STATE AGENCY ~FEDERAL AGENCY · WPEOF BUSINES3 Q ~ GAS S~AnON Q 2 DIST.ISUrO. Q3PARM Q4 P.OCESSOR ~S OTHE. EMERGENCY CONTACT PERSON iP RIMARY~ DAYS: NAME (LAST, FIRST) PHONE No. WITH AREA CODE 55'm~qs~ d-~ ~,~ NIGHTS: NAME (LAST. FIRST) PHONE NO. WITH AREA CODE KERN COUNI'Y PERMIT S EMERGENCY CONTACT PERSON (SECONDAR~ ootlonal OAYS; NAME (~ST. FI~ PHONE ~. WITH AR~ CODE NIGHTS: NAME (LAST, FIRST) PHONE No. WITH AREA CODE II. PROPERTY OWNER INFORMATION (MUST BE COMPLETED) NAME MAILING OR STREET ADDRESS ClW NAME CARE OF ADDRESS INFORMATION ~ BOX ~,t'~IVIDUA L TO INDICATE Q PARTNERSHIP STATE ZiP CODE LOCAL AGENCY C~ STATE AGENCY ~ COUNTY AGENCY {~ FEDERAL AGENCY PHONE No. WITH AREA CODE Ill. TANKOWNER INFORMATION (MUST BE COMPLETED) NAME MAILING OR STREET ADDRESS ClW NAME CARE OF ADDRESS INFORMATION ~/' 80X J~ INDIVIDUAL TO INDICATE [~ARTNERSHIP STATE ZIP CODE J LOCAL AGENCY ~ STATE AGENCY [~ COUNTY AGENCY ~ FED. ERAL AGENCY PHONE No. WITH AREA CODE OWNER'S . DATE VOLUME TANK No. INSTALLED j {,:,3 2q -~ q/~'cj' I0, 0'~0 1(~.~?~__= 7_- 4 /"~ g I01 PRODUCT IN STORED SERVICE Y/N YIN DO YOU HAVE FINANCIAL RESPONSIBILITY? ~)/N TYPE YIN CITY og~ B.,4 A"£R SFIEL D "~'£' ( ~y~e or u,r!n% name) Do he.=b.v~ . cert~fv_ . that I have reviewed the RECEIVED attached Hazardous for name MaUerials business HAE. MAT. DIV. of business) and that it along with the attached additions or corrections constitute a complete and correct Business Plan for my facility. BUSINESS NAME '7 ELEVEN FOOD STORE ~Z1ZS-1G3Z9 LOCATION I701 PACHECO RD I0 NUMBER 2 tS--000-000807 HIGH HAZARD RATING 1. OVERVIEW JURIS CODE MAP PAGE 124 LAST CHANGE 07/t5/88 BY ESTER Z15-0¢)5 SURIS BAKERSFIELD STATION 05 GRID 19R FACILITY UNITS I HAZARD RATING Z RESPONSE SUMMARY 2R SEC 4) EMERGENCY COOROINRTOR SHALL NOTIFY ALL AGENCIES AND !NTER..-COHPANY PERSONS IN THE EVENT OF INCIDENT. EMERGENCY COOROtNRTOR SHALL IMPLEMENT ALL NECESSARY MEASURES IN REGARD TO EMPLOYEE ANO ENVIRONMENTAL SAFETY RS INSTRUCTED BY TRAINING RECEIVED, EMERGENCY CONTACTS ZA SEC Z) AUSTIN & ELEANOR BIGELOW - 834-1350 ~ ~iq~g~RB~ Steve Jones - 834-27tl '-'- UTILITY SHUTOFFS 2A SEC 3) R) GAS - NONE 8) ELCTRICRL - 8ACK ROOM HALLWAY D) SPECIAL - NONE E) LOCK 80X - NO C) WATER - STORE FRONT S10E Z, NOTIFICATION / PUBt_IC EVACUATION Verbal and dial 911. LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > PAGE I 01119/89 t6:39 MATERIAL SAFETY DATA SYSTEMS, INC. (80S) G48-6800 BUSINESS NAME ? ELEVEN FO00 STORE ~ZtZS-163Z9 LOCATION t701 PACHECO RD ID NUMBER Z1S,-00~-~807 HIGH HAZARD RATING 2 3. HAZ MAT TRAINING SUMMARY LAST CHSNGE /~ i BY See Hazardous Materials Handling Procedures Posting and Employee Awareness form (attached). < NO INFORMATION RECORDED FOR THIS SECTION > 4. LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 07/15/88 BY ESTER SEC S) FIRE DEPT/POLICE DEPT 911. NEAREST EMERGENCY ROOM TO I'HE LOCATION IS TO BE USED IN THE EVENT OF INJURY, PAGE Z Ol/iB189 1G:3B MATERIAL SAFETY DATA SYSI'EMS, INC. (80S> B48-G8(~ BUSINESS NAME '7 ELEVEN FOOD STORE ~ZtZS--IG32B LOCATION 170t P~CHECO RD FACILITY UNIT 01 ID NUMBER Z1S.-OOO-~Y~807 HIGH HAZARD RATING 2 R, OVERALL HAZARDOUS MATERIALS INVENTORY LAST CHANGE 0'7/15/88 BY ESTER ID TYPE NAME MAX fiMT UNIT HAZARD LOCATION CONTAINMENT USE 1 MIXTURE UNLEADED GASOLINE 10000 GAL S H ST SIDE UNDERGROUND TANKS FUEL I0 PERCENT COMPONENTS 1t82.00 100,0 GASOLINE HIGH HAZARD LIST HIGH Z PURE REGULAR GASOLINE 10000 GAL S H ST S10E UNDERGROUND TANI(S FUEL I0 PERCENT COMPONENTS 1t8Z.00 I~D.O GASOLINE HIGH HAZARD LIST HIGH PURE SUPER UNLEADED GASOLINE 10000 GAL S H ST SIDE UNDERGROUND TANKS FUEL ID PERCENT COMPONENTS 118Z.(~ 100,0 ORSOLINE HIGH HI:~Z ~RD LIST HIGH M~xxxxRMMM~x~l~R~Rxx NE~b~kEBx~N~x ~B~k~x~xx~x OTHER x~SWx B. FIRE PROTECTION / WATER SUPPLIES I_RST CHANGE / / BY Fire extinguishers located in store per fire code. Fire hydrant located at northeast corner of lot (Pacheco & "H" Streets). < NO INFORMATION RECORDED FOR THIS SECTION > PRGE 3 01/19/88 1G:39 MATERIEL S~FETY DATA SYSTEMS, INC. (80S) G48-G800 BUSINESS NAME ? ELEVEN FOOD STORE ~Z12S-1G3Z9 LOCATION )701 PACHECO RD ID NUMBER Z 15-000-000807 HIGH HAZARD RATING Z O. EMPLOYEE NOTIFICATION ~ EVACUATION L.~ST"CHANGE '07/15/88 BY ESTER 3~ SEC 2) VERBAL AND CALL 911. FOR RELEASE OF HAZ MAT NOTIFY BFO HAZ MAT AND STATE O.E.S. Call Tom Carmichael, Development Manager at 1-800-541-1334 for removal of cleanup materials. E. MITIGATION / PREVENTION / ABATEMENT LAST'CHANGE 07/15/88 BY ESTER SEC 1) STANDARD GASOLINE STATION SAFETY FEATURES FOR GAS PUMPS, AUTO SHUT OFFS, VAPOR SHIELOS AND SHEER OFF VALVE. COMPRESSED GASSES PROPERLY STORED IN SMALL SAFETY CONTAINERS AND WITH PROPER FITTINGS. BUSINESS EMERGENCY PLAN ON FILE AT EACH STORE. See Hazardous Materials Handling Procedures Posting and Employee Awareness form (attached). PAGE 4 0t/19/89 1G:39 MATERIAL SAFETY DATA SYSTEMS, INC. (805) G48-G800 CITY of BAKERSFIELD NON--TRADE SEC i2ETS , BUSINESS I,OCATIOF: CITY, ZIP: PHONE a: 7-Eleven Store 2720r16329 1701Pacheco. Road Bakersfield 834-1350 OW~En W^~g: 7-Eleven Mar~e~.27~O ADDRESS: 4008 White Lane il?.l..~,.oo~.I ~, [~.__[ ~,~>.l~~:f~-~ iX 1 ~rgrounj/Front mkg ~it;l ~ ~lth ~z~ &I.L ~ 8006619 .... l..iI ........... ii .............. Austin Bigelow ~ii~': ................................... N~E OF T[[i~ FAClLIT_Y: 7-Eleveil_~.t.~re 16329 $?,,?:~)A~P IND.--C~,$~ CO~g 54 11 55 4i 29Jll ular Gasoline 8006~19 Unleaded Gasoline 8006619 Unleaded Franchisee 805/834-1~0 .l~Steven S. Jones Market Man.a~g.e_K_ 805/664r_i~.L~ :ertlticat,o. [Read and Sil~n after Co=pletJn£ all sections) P&gt :]- of 2 pages F~m Ai;~'o~ld O~ I~k3. 2050-0072 Faclllty..!dentlficatlon' ' ::.:.! :... : .:: Owner/Operator Name . 'i....: :'..'" Tier Tw0 -~ 7-~L~VEN STORE NO: 10329 A Nm The Southland Corporation p~. (214~ 522-4790 EMERGENCY StreetA~d S~)C P/~CHSCH0 @ SO H t-- ..,~.,, 2828 N. H~kell-.~las, ~ 75204 AND BAKERSFIELD CA ~330? . , HAZARDOUS COU~TY: KE~N Emergency Conla~t ..... ' CHEMICAL ~ I C: 5341 Sto~e M~age~ S T 0 R E N 0: 1 b 3 INVENTORY Na~ N A ~: E : ~,~/~ s,c~ .~ ~ I ~ ( ~ TITLE: ~CA~m~¢~I '.:::' :FOR .1~ I Linde C~t~iqht ~-MOUR: (;~05) 834-1350 · ' ~':: OFFICIA~ I -- :::.:::~?~.ONLY .... Oat..~l~ ~ (214) 522-4790 portent: Read all instructions before con ~leting form Repo, rting Period From January ! to Decemba' 31. 19 C~I De'~:~riptiO-n:: :: .:i i: ::i:.ii~' ~;iii::::: ~dazHa~c~h..' "": ': : Chemi ! T :: ii:. -'a MaX.Dally ' ::Dally:' .!Avg..-....::..: NO.DaysOf .::!.":. !.:.':':?.:: ::,L-i.'"' .¥' (N°n-c°nfidential)"::::::':L:'::".. ." :.': "' ' :'":' · Amount Amount' On-site ..:: .......~F... · ..... .: .. · ::: .":-:'.:! !;:..-' i': .' :': . - :'' .:::':'.::i '.' ? "i:: .,:' (ch~ ell that &~31y}. code) - (code) (days) ' Storage Code · .... ·Storage Locat]o~ :...'- :'. ..... c,sl'1 I I I I I~~ ~'~ X,,,. . ' ~ p~n0 lot ne~ D~ isl~. S~et I I S~ Re.ese -. : Chem. N~e of ~lalo (~le) '. :'.'.- .' ' ' ' ' ;!: ~ ~la~ {~) :. ' .... t~at a~ply: ~e Mia ~M ~ Gas ' ' ' ' ' ":'" ; cAsl I I I I I I ~ ~~,r"'~ ~-- ~,,. 3 1 4 P~ng lot ne~ D~. S~ Re.ese Chem. Name __ of ~s~o ,,, Pre~ Unlead~ ~oline .~,,.,,~ ~ ~ [3J6 ~ ~lay~ (~) '-. : ~ ~1~: ~e ~ ~ ~id Gas S~en Reloa~ Chem. N~e ~ of Prei~o ~iale {~ute: that apply: ~e ~ ~ Lh,,id Gas Certification "(g,ad ~nd li~n nft~r ~om~ltIing ~1~ lectionl} .. Optional ~ttachments (CheCi one} I c~Ii~ ~ ~1~ of [a~ ~ I ha~ ~s~a~l~ ~x~in~ a~ am familiar wi~ ~ inf~mati~ ~iti~ ~ ~s a~ all aliac~ O~umenls, a~ thai bas~ ~ my ~ui~ o~ ~* ~als r~s~Bl~ f~ oMainl~ lhe inf~mali~, I ~li~ l~a~ su~ilt~ l~f~m~ is ~*~. ~cc~ra~, a~ c~p~ete. ~ I have ~Hach~ ~nda ~iqht- ~e ~1~ ~n. ..... ~:~ ~,--~, ~ ~,. 01-30-89 ~,....' "~" '"~ F~m Ai3Cxoved O~8 No. 2050'-007:~ Tier Two .am- see page 1 .~ The. Southland Cormoration ~o~ i 214, 522-4790 EMERGENCY StreetAddres= MailAddress 2828 N. Haskell -.Dallas, Texas 75204 AND C,ty Stat. -- Z,p ..... :.' ' HAZARDOUS Emergency Contact ..... , :' ' · i.' "..' · INVENTORY Name Title. Information Number by Chemical ' .:..: : FOR . [ ] ':'::i:..OFPICIALI ~ '- :' N,m. Linde Gathriqht. Title Code Compliance :~i-ONLY ::.[oateReceivedl ~1 (214) 522--4790 24H~.Pt~e ( I Important: Read ali instructions before completin/~ form neporllng Period F,om January t to I:)e<:em~e~ at. t9 · ':'' ' ''' : Physical.. InventorY ~ '' . :.. : :. -, :;:':.. torage Codes' and Locations ':i.:. ChemiCal DeScription.':: i: :::i i .::i;.,::: andHazardsHealth·.::.. MaX.Daily ' DallyAVg' NO.DaysOf . :" ;:' '. : .~'.. ..:.'.:. i::" : (Non,C°nfidentiai)':I::'::'? '' ·. ..- ..... · Amount. Amount .. On-site : ':.".: ": ::" ' '. :'::: ' ' · .... · (check. all that al:~dy) ' (code) · (code) (days) Storage COde . ...Storage Locations' ". ':-: .' i:.: '"-:'-:' '::' -:'--'.' { ili::i .: CA$I I I I I I I I-'T'-]r~ T'a~'l--"] X n,a ' £ 1 4 P~]~Lnq lot ne~-Durr~ isl~nc~ Such:len Release ': .. · Chem. Name of P~essu~e ~*d'ate (.cmo: ': .'.'-. :" i I ' ': .: i that apply: Pu,e Mix ~o1~1 Liquid Gal ' · cAs l I I I I I I~~ TraO. Se~-ot ~1 Chem. N~e of ~ess~e ~iate (a~te ~a~ (c~) I that apply: ~e M~a ~1~ Li~ Gas CAS~ ~ ~~.etTra~ Fire S~den Release Chem. N~e at Press~e I ~iate (acute) Delay~ (c~ic) thai appI~: ~e M~ ~lld U~ Gas Certification (Read and Mgn afttr gompleting all ~ectiont) Optional Attachments SEE FRONT PAGE~ ,,a~. ~,,ac.~ · ,~,, £14 HAZARDOUS MATERIALS HANDLING PROCEDURES FUEL SPILLAGE EMERGENCIES 1) In case of large fuel spill, (50 square feet or larger or any- thing that looks potentially hazardous) CALL THE FIRE DEPARTMENT. 2) In case of small fuel spill 50 square feet or smaller, determine potential hazard. Use absorbent material (kitty litter or sand), absorbent pad, or for very small spills, let evaporate. UNDER NO CIRCUMSTANCES HOSE OFF WITH WATER. THIS WOULD CAUSE UNDER- GROUND CONTAMINATION AND WE COULD BE FACED WITH A VERY LARGE CLEAN-UP BILL. Keep used clean-up material in a metal container with metal lid. 3) For removal of clean-up material for ~1 or ~2, call Tom Carmichael at 1-800-541-0334. 4) Know where the fire extinguisher is and how and when to use it. If you have to use a fire extinguisher, ALWAYS CALL THE FIRE DEPARTMENT FIRST. In our store the fire extinguishers are located: 5) Know where and how to shut off power to gasoline equipment. Every store is different; have someone show you. In our store the gaso- line power shut-off is located: CO2 TANK HANDLING 1) All COz tanks are to be stored with metal cap in place (except ~hen in use). Replace metal cap on tank after use (empty). 2) All CO2 tanks are to be chained up tightly 3/4 way up at all times. Signed: Witness: Employee Franchisee/Store Massager Complete and file in each employee file. ~qZARDOUS ~TERIALS HANDLING PROCEDURES FUEL SPILLAGE EMERGENCIES 1) In case of large fuel spill, (50 square feet or larger or any- thing that looks potentially hazardous) CALL THE FIRE DEPARTMENT. 2) In case of small fuel spill 50 square feet or smaller, determine potential hazard. Use absorbent material (kitty litter or sand), absorbent pad, or for very small spills, let evaporate. UNDER NO CIRCLE~STANCES HOSE OFF WITH WATER. THIS WOULD CAUSE UNDER- GROUND CONTAMINATION ~ND WE COULD BE FACED WITH A VERY LARGE CLEAN-UP BILL. Keep used clean-up material in a meca! container with metal lid. 3) For removal of clean-up material for ~1 or #2, call Tom Carmichael at 1-800-541-0334. 4) Know where the fire extinguisher is and how and when to use it, If you have to use a fire extinguisher, ALWAYS CALL THE FIRE DEPARTMENT FIRST. In our store the fire extinguishers are locat=d: 5) Know where and how ~o shut off power to gasoline equipment. Every store is different; have someone show you. In our store the gaso- line power shut-off is located: CO2 TANK HANDLING 1) Ail CO~ tanks are to be stored with metal cap in place (except when in use). Replace metal cap on tank after use (empty). 2) ~1.! CO= tanks are to be chained up tightly 3/4 way up at all times. PLEASE POST IN STORE f~. OWNER'S TANK I.D.# I (Z:) '~;:~.."~r - J s. MANUFACTURED ......~(:::)0~(.~ C. DATE INSTALLED (MO/DAY/YEAR) /'~ / <~'~' O. TANK C~ACI~ IN G~LONS: I O O I ~ III. TANK CONSTRUCTION MARK ONE I~M ONLY IN BOXES ~ B, AND C. AND ALL THAT APPLIES IN BOX D A. TYPE OF [~ DOUBLE WALL SYSTEM [] 2 SINGLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANIO [] 99 OTHER [] 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS B. TANK MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM (PrimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC [] 8 100% METHANOL COMPAT'IBLEW,'FRP ] 99 OTHER [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING C. INTERIOR [] 5 GLASS LINING [~ UNLINED [] 95 UNKNOWN UNING IS UNING MATERIAL COMPATIBLE WITH 100% METHANQL ? YES ~ NO__ ] 4 PHENOLIC LINING [] 99 OTHER D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING PROTECTION, [] S CATHODIC PROTECTION [] 91 NONE [] 3 VINYL WRAP [::~' FIBERGLASS REINFORCED PLASTIC [] g~ UNKNOW. [] 99 OTHER IV. PIPING INFORMATION CIRCLE .&. IFABOVEGROUNDOR U IF UNDERGROUND, BOTHIFAPPLICABLE A. SYSTEM TYPE .~ u i SUCTION A ~)2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL Co MATERIAL AND CORROSION PROTECTION BARE STEEL ALUMINUM GALVANIZED STEEL A U 2 DOUBLE WALL A~ 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A U~)4 FIBERGLASS PIPE A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~ AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING [] 3 INTERSITriAL MONITORING [] 99 OTHER V. TANK LEAK DETECTION I[] 1 VISUAL CHECK ~ INVENTORY RECONCILIATION []3 VAPOR MONITORING ~ AUTOMATIC TANK GAUGING [~] 5 GROUND WATER MONITORING [] 6 TANK TESTING [] 7 INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN C. DATE INSTALLED (MO/DAY/YEAR) s. MANUPACTURED BY: D. TANK CAPACITY IN GALLONS: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, S, ANDC, ANDALLTHATAPPLIESINBOXD A. TYPE OF ~ DOUBLE WALL SYSTEM [] 2 SINGLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B. TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM (PrimaryTank) [] 9 BRO. NZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [~,'~4 sTEEL CLAD W/FIBERGLASS REINFORCED PLASTIC [] 8 100% METHANOL COMPATIBLEW/FRP ] 99 OTHER ~ 1 RUBBER LINED r-~ 2 ALKYD LINING ~ 3 EPOXY LINING [~ 4 PHENOLIC LINING C. INTERIOR LINING [] 5 GLASS LINING [~6 UNLINED [] 95 UNKNOWN [] 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ NO__ D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 "VINYL WRAP PROTECTION ~ 5 CATHODIC PROTECTION [] 91 NONE [] 95 UNKNOWN FIBERGLASS REINFORCED PLASTIC ] 99 OTHER IV. PIPING INFORMATION C~RCLE A IFABOVEGROUNDOR U IF UNDERGROUND. SOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A 2 PRESSURE A U 3 GRAVITY A U 99 OTHER CONSTRUCTION A U 1 SINGLE WALL A U ~ DOUBLE WALL A(~ 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER Co MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION V. TANK LEAK DETECTION BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)At~)4 FIBERGLASS PIPE ALUMINUM A U 6 CONCRETE J[ U 7 STEEL W/ COATING A U 8 100=/o METHANOL COMPATIBLEW/FRP GALVANIZED STEEL A IJ 10 cATHoDIC PROTECTION A U 95 UNKNOWN A U. 99 OTHER [:~ AUTOMATIC LINE LEAK DETECTOR - [] 2 LINE TIGHTNESS TESTING [] 3 INTERSTITIAL [] 99 OTHER MONITORING I[], viSUAL CHECK IN, NTORY RECONCILIATION []3 VAPOR MON,TOR,NG AUTOMATIC TANK GA_ ,NG GROUNDWATER ON,TOR,NG I [] 6 TANK TESTING [] 7 INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER I ~US IXESS BAKERSFIELD CITY FIRE DEPARTMENT 2130 "G" STREET BAKERSFIELD, CA 93301 (805) 326-3979 OFFICIAL USE ONLY ID# HAZARDOUS IVlATERI ALS BUSINESS PLAN AS A WHOLE FORM 2A INSTRUCTIONS: 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA A. BUSINESS NAMe: 7-Eleven Food Store #2125-1632~ B. LOCATION / STREET ADDRESS: 1701Pacheco Rd. CITY: Bakersfield ZIP: 93307 BUS.PHONE: (805) 834-1350 SECTION 2: EMERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local fire department and the State Office of Emergency Services as required by law. EMPLOYEES TO NOTIIm/ IN CASE OF EMERGENCY: NAME AND TITLE DURING BUS. HRS. A. Austin & Eleanor Bi~elow~ French. Ph~ (805)834-1350 Ph~ B. ~X, ati,~. District Xanager 2125 Phi ~805~834-2711 Ph~ AFTER BUS. HRS. Same same SECTION 3: LOCATION OF UTILITY S{IUT-0FPS P0R BUSlNE88 AS A M{i0LE A. NAT. OAS/PROPANE: None B. ELECTRICAL: Back room (hallwa~; C. WATER: Store front/side D. SPECIAL: E. LOCK BOX: YES /(N~ IF YES~ LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? (YES y NO FLOOR PL~S? YES / NO MSDSS? (YES)./ NO KEYS? YES / NO - 2A - SECTION 4: PRIVATE RESPONSE TEA~ FOR BUSINESS AS A i/HOLE Emergency Coordinator shall notify all agencies and inter-company persons in the' e~ent:of:inCident. Emergency Coordinator shall implement all necessary ~:~measures in regard to employee and~envirorn~ental safety as instructed by training received. SECTION 5: LOCAL ENERGENCY ,~EDICAL ASSISTANCE FOR YOUR BUSINESS AS A i/HOLE Fire Department/Police Department: 911 Nearest E.R. to the location is to be used in the event of injury. SECTION 8: EI~PLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRA~ WHICH PROVIDES EMPLOYEES NITH INITIAL A~ REFRESHER TRAINING ~N THE FOLLO¥~NG AREAS. CIRCLE YES OR NO A. ~4ETHODS FOR SAFE HANDLING OF HAZARDOUS .~fATERIALS: ....................................... YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES ~0 C. PROPER USE OF SAFETY EQUIPNENT: .................. YES NO D. E,'~ERGENCY EVACUATION PROCEDURES: ................. YES NO E. DO YOU NAINTAIN E~PLOYEE TRAINING RECORDS: ....... YES NO INITIAL REFRESHER YES ~0 YES NO YES NO YES NO YES NO SECTION 7: HAZARDOUS I~TERIAL CIRCLE YES OR NO DOES YOUR BUSINESS HANDLE HAZARDOUS MATERIAL IN QUanTITIES LESS THAN 500 POL~DS OF A' SOLID, $5 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A cor~PRESSED GAS: ...... YES NO I, Austin Bigelow , certify that the above information is accurate. I understand that this lnfor=ation ~ill be used to fulfill my firm's obliiations under the ne~ California Health and Safet~ code on Hazardous Materials (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaccurate information constitutes perjury. SIGNATURE TITLE Franchisee. - 2B - F'TANK DESCRIPTION COMPLETE &m~TEMS" SPECIFY IF UNKNOWN I~. OWNER'S TANK I. 0.. I g .3~"r--._~ B. MANUFACTURED III. TANK CONSTRUCTION MARK ONE I~M ONLY IN BOXES ~ B, ANOC,~DALLTHATAPPLIESINBOXD A. TYPE OF ~ DOUBLE WALL SYSTEM [] 2 SINGLE WALL ] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER ] 1 BARE STEEL · B. TANK MATERIAL [] 5 CONCRETE (PrimaryTank) [] 9 BRONZE ] 2 STAINLESS STEEL [] 3 FIBERGLASS [] ~ POLW,NYL CHLOR,DE [] 7 ALUM,~UM [] ~o GALVANiZED STEEL [] ~ UNKNOWN E~"~ STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLEW/FRP [] 99 OTHER [] 1 RUBBER LINED [] 2 ALKYD L~ING [] 3 EPOXY LINING C. INTERIOR [] 5 GLASS LINING ~ UNLINED [] g5 UNKNOWN UNING - IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES ~ NO__ ] 4 PHENOLIC LINING ] 99 OTHER D. CORROSION [] I POLYETHYLENE WRAP [] 2 COATING PROTECTION, [] 5 CATHODIC PROTECTION [] 91 NONE [] 3 .~'L ~ I~t~- F,BE,G~SS RE,NFORCED ~STIC [] ~ UNKNOW.[] 99 OTHER IV. PIPING INFORMATION C~RCLE ,&. IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPUCABLE A. SYSTEM TYPE A U 1 SUCTION A~) 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION C. MATERIAL AND CORROSION PROTECTION A U '1 SINGLE WALL A U 2 DOUBLE WALL A 0(,~3 LINED TRENCH A U 95 UNKNOWN A U OTHER A U I BARE STEEL A U 2 STAINLESS STEEL A I.I 3 POLYVINYL CHLORIDE (PVC)A ~..~4 FIBERGLASS PIPE A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100% METHANOL COMPAT]BLEW/FRP A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION [~ AUTOMATIC LINE LEAK DETECTOR [] 2 LINETIGHTNESSTESTING [] 3 INTERSTITIAL MONITORING [] 99 OTHER V. TANK LEAK DETECTION [] , v,SUAL CHECK ~ ,NWNTORY RECONC,L,ATIO" ©3 VAPOR MON,TOR,.G G~'~'~TOMATIC'TANKGAUG,NG [~S GROUND WATER MO.,TOR,NG [] ~ TANK TESTING [] , ,.TERSTmA. MON,TOR,NG [] ,, ,ONE [] ~ U.KNOW, [] 99 OTHER I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN 8. MANUFACTURED BY: A. OWNER'S TANK L D. # C. DATE INSTALLED (MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: II1. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B, ANDC, ANDALLTHATAPPLIESINBOXD A. TYPE OF [] 1 DOUBLE WALL SYSTEM [] 2 SINGLE WALL B. TANK [] I BARE STEEL MATERIAL I~ 5 CONCRETE (PrimaryTank) [] 9 BR.ONZE [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 9g OTHER [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 6 POLYVlNYL CHLORIDE [] 7 ALUMINUM [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 4 sTEEL CLAD WI FIBERGLASS REINFORCED PLASTIC [] 8 100% METHANOL COMPATIBLEW/FRP ] 99 OTHER r~ i RUBBER LINED ~ 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR [] 5 GLASS LINING [] 6 UNLINED [] 95 UNKNOWN [] 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100°/. METHANOL ? YES_ NO__ D. CORROSION [] I POLYETHYLENE WRAP [] 2 coATING PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 3 v,.~L w, AP [] 4 F,BERGLASS REINFORCED PLASTIC [] ,S UNKNOWN [] 990THE, IV. PIPING INFORMATION C~RCLE A IFABOVEGROUNDOR U IFUNDERGROUNO, BOTHIF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U ~ DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN ~, U 99 OTHER C. MATERIAL AND CORROSION PROTECTION A 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 W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 9 GALVANIZED STEEL A U 10 cATHoDIC PROTECTION A tJ 95 UNKNOWN A U. 99 OTHER D. LEAK DETECTION [] I AUTOMATIC LINE LEAK DETECTOR · r-~ 2 LINE T~GHTNESS TESTING [] 3 INTERSTITIAL MONITORING [] 99 OTHER V. TANK LEAK DETECTION [] 1 VISUAL CHECK [] 2 INVENTORY RECONCILIATION [] 3 VAP_~RMONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUNDWATER MONITORING [] ~ TANK TESTING [] , ,NTERST,T,ALMON,TOR'"G [] ~, NONE [] ~ UNKNOWN [] ~ O~ER Monitoring Flan: Monitoring shall be performed through Standard Daily Inventory Reconciliation. This shall be done by the store operator~ An annual tank and product line integrity test shall be done by a licensed tank tester~ Product line leak detectors shall be inspected and tested semi-annually by a trained service technician. Meters shall be checked by a trained service tech31ician registered with the Department of Wcights and Measures semi- annually. Annular space will be monitored by trained service tec~ician by manual dipping of int~ro~,~al space. This space should be found dry at all times. If any moisture, 'water or fuel is found it will be immediately reported to Gasoline Supervisor for determination of course of action~ "~is will be done monthly. Trench liner shall be monitored by trained service technician by manual dipping and observation of trench liner monitoring well. Well should be found free of any gasoline vapors and/or free floating product. If vapors or product is found it will be in~ediately reported to Gasoline Supervisor for determination of course of action, This will be done monthly. Spill Response Plan: Above ground spills will be dealt with by store personnel according to severity. Smaller spills will be absorbed with available material. Larger spills will be dispatched to appropriate'~' ~ xlr~ departmen't~ Underground spills (potential, suspected or actual) will be assessed by the Gasoline Supervisor, Potential spills will be remedied by repair of potential problem. Suspected leaks shall be inspected for actual problem or problem with paperwork error. Actual releases will be handed over to our Environmental Services Department for site assessment and remediation. BAffERSFIELD CITY FIRE DEPARTMENT FORM 4A-1 Page NON--TRADE SECRETS HAZARDOUS I~IATER I ALS INVENTORY ~ of .,l BUSINESS NAME: 7-Eleven Store #2125-16329 OWNER NAME: The Southland Corporation FACILITY UNIT #: ADDRESS: 1701 Pacheco Rd. @ S. "H" Street ADDRESS: 1240 S. State College BI. FACILITY UNIT NAME: Ste. 100 CITY, ZIP: Bakersfield, CA 93307 CITY,ZIP: Anaheim, CA 92806 PHONE ~: (805)834-1350 PHONE #: (714)635-7711 ~OF'FICIA'L USE CFIRS CODE I ONLY ! 2 3 4 5 6 7 8 g 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS ~ BY HAZARD !D.O.T CODE, AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMIC,AL OR COMMON NAME CODE 6.U, IDE ./M 10,000 228,741 GAL 01 19 S."H" Street side 100 Gasoli. ne/Unleaded FLLO. 1203 9!M 10~0Q0 3592054 GAL 01 .1.9. " 100 Gasoline/Regular . / / .~. ?~.. FLLO 1203-- ._?M 1.0,000 104,666 GAL 01 19 " 100 .Gas. oline/Super .Unleaded //~L~ FLLQ ~20~ .... ~"i~M ~ Ft3 04 99 Nr. Sales Counter 100 CO?/Carbon Dioxide / N~LC ~ O~ 3 NAME Jack Doolittle TITLE:Div. Gas Manager SIGNATURE: ~, ~ DATE: 6/8./87 EMERGENCY CONTACT: Austin Bi~elow TITLE: Franchisee ~Y PHONE # BUS NOURS: ~805)834-1350 AFTER BUS MRS: ~805)834-1350 EMERGENCY CONTACT: Kathy Mejia TITLE: District Manager, 212.,5. .PHONE. # BUS HOURS: (8055834-2711 PRINCIPAL BUSINESS ACTIVITY: Convenience Store with self-serve ~asoline AFTER BUS HRS: (805)834-2711 7-Eleven Food Store ~2125-16329 1 701 Pacheco R6ad Bakers£ield, CA 93305 %11 F'ood 7-Eleven Food Store #2125-16329