The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLAN O to ICI s ,- ~~ O .-~ } N ~ N ~ W ~' Prevention Services l1NIFIED PROGRAM INSPECTION CHECKLIST ~ff -_D 9ooTruxtun Ave.; Suite 210 __..If B E R_3_F I ~.~_ _ _ _~-:_ - _ .__ _ _ - , F/RE Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program ~ ARTM T Tel.: (661) 326-3979 ,~ ~ Fax: (661) $72-2171 FACILITY NAME ~ ~~ ~ l INSPE ION ATE INSPECTION TIME ADDRESS HON NO. O OF LOYEES ' ~ 5T~ ~.3~ -10 y f c~ FACILITY CONTACT USINESS ID NUMBER ~ ~~~ 15-021- Section 1: Business Plan and Inventory Program ^ ROUTINE OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (C=Compliance OPERATION V=Violation COMMENTS - ,_., / AY ^ APPROPRIATE PERMIT ON HAND m~ ^ BUSIIIeSS PLAN CONTACT INFORMATION ACCURATE ~^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES C c ~~^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ~ NO EXPLAIN: nnr-nuu QUESTI~'FJS REGAj2DI~G THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Print) Fire Prevention / 1s` In /Shift of Site/Station # ~~-.. Busin e I Responsi a Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 ~. - ~. INSPECTIONS BUSINESS PLAN & INVENTORY PROGRAM ---- UNIFIED PROGRAM INSPECTION CHECKLIST J'~ B E R S F I L D F/IirE ~RrM r Page 1 of 1 FACILITY NAME: ~•--Z ` `~ Q~~j Section 2: Underground Storage Tanks Program INSPECTION DATE: ~UII/ IU ~ ^ Routine ~ Combined ^ Joint Agenc ^ Multi-Agency Complaint ^ Re-Inspection Type of Tank S C,Q~ Number of Tanks Type of Monitoring Type of Piping -~~1 C C OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations /' Has there been an unauthorized release? ^ Yes ^ No Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill /overspill protection? C =Compliance V =Violation Y =Yes N = No Inspector: Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services Aggregate Capacity Number of Tanks BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 s Business Site Respons a arty Pink -Business Copy KBF-7335 FD 2156 (Rev. 09/05) ~- ~ CO ~ ECTION NC~TI -~ ~, :, BAKERSFfELD FIRE DEPARTMENT ~~' 0544 r --~~-- ~~ t Location_~~ ~~~~ .'r W ~C.e.- Sub Div. /~ ~ /g ~ S ~ - Blk. .Lot You are hereby required to make the following corrections at the above location: Cor: ?to ~i ` ~ ~ , e` i~ ~ r~ `'~ 1~ ~ N. l ~ ~ '. 1 c.~(~ ~~ ~- Completion Date for Corrections .3 S--S Date ~~~~ ~~ Inspector 326-3979 v EZ STOP MOBIL Manager VANG YAMM Location: 101 19TH ST City BAKERSFIELD CommCode: BFD STA O1 EPA Numb: SiteZD: 015-021-001856 BusPhone: (661) 631-1049 Map 103 CommHaz Moderate Grid: 30B FacUnits: 1 AOV: SIC Code:5541 DunnBrad: Emergency Contact / Title Emergency Contact / Title BOUN CHI LY / OWNER YANG YAMM / MANAGER Business Phone: (661) 631-1049x Business Phone: (661) 631-1049x 24-Hour Phone (661) 472-4058x 24-Hour Phone (661) 472-4058x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Contact BOUN CHI LY Phone: (661) 631-1049x MailAddr: 101 19TH ST State: CA City BAKERSFIELD Zip 93301 Owner BOUN CHI LY Phone: (661) 631-1049x Address 101 19TH ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT- ENT~D A U G ®1 ~Q07 PROG U - UST , Eased on my inquiry of those individuals responsible for obt i i a n ng the information, i certify under penalty of ia~~r that l hav e personally examined and am familiar with the information submitted and beli eve the information is true, acc ~~•• , nd complete. ~~ ® ignatur® - ~/ / gate -1- 07/11/2007 ?, F EZ STOP MOBIL SitelD: 015-021-001856 ~ ----• STORAGE CONTAINER DATA (UST FORM A) - Last Action Type: -•~ FACILITY/SITE INFORMATION Business Name: EZ STOP MOBIL Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper ICC Nbr: PROPERTY OWNER INFORMATION Name YANG YAMM Phone: (661) 631-1049x Address: City State: Zip: Type INDIVIDUAL TANK OWNER INFORMATION Name VANG YAMM Phone: (661) 631-1049x Address: City State: Zip: Type INDIVIDUAL BOE UST Fee# Financ'1 Resp: SELF INSURED Legal Notif : Business Mailing Address Date:02/12/2002 Phone: (6 6) 649- x Name:BOUN CHI LY Ttl:OWNER State UST # 1998 Upg Cert#: 00869 -2- 07/11/2007 F EZ STOP MOBIL 3itelD: 015-021-401856 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP GASOLINE L 6000.00 GAL Mod GASOLINE L 6000.00 GAL Mod GASOLINE L 4000.00 GAL Mod -3- 07/11/2007 -4- 07/11/2007 1~ F EZ STOP MOBIL SiteID: 015-021-001856 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 8006619 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 6000.00 GAL 6000.00 GAL 6000.00 GAL ----~ HAZARDOUS COMPONENTS gWt. RS CAS# 100.00 Gasoline No 8006619 ru~~tu~t~ r~~ar:~~rir:iv'1~5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: STATE TYPE PRESSURE Liquid TMixtur~-Ambient CAS# 8006619 TEMPERATURE ~~ CONTAINER TYPE Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 6000.00 GAL 6000.00 GAL 6000.00 GAL riti~~u~uu~ ~uMrc~N~N't'S ~Wt. RS CAS# 100.00 Gasoline No 8006619 tiE~GHKIJ A55~55M~1V'1'S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod -5- 07/11/2007 1 ~ F TsZ STOP MOBIL SiteID: 015-021-001856 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 8006619 Liquid TMixture ~ Ambient ~ T~PeRATURE ~EROGROUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 4000.00 GAL 4000.00 GAL 4000.00 GAL tiAG1iKLVU~ 1:V1~lYV1VL'i1V'1'S gWt. RS CAS# 100.00 Gasoline No 8006619 rlti~xtcl~ tia51;~51n~1v-1-a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod -6- 07/11/2007 f EZ STOP MOBIL SiteID: 015-021-001856 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 07/07/2006 ~ EMERGENCY, CALL 911; MAJOR LEAK, CALL FIRE DEPT 326-3979. Employee Notif./Evacuation 07/07/2006 SHUT OFF ALL ELECTRICITY AND LEAVE BLDG. Public Notif./Evacuation 02/23/1998 LEAVE BLDG. Emergency Medical Plan 02/23/1998 CALL 911. -7- 07/11/2007 F EZ STOP MOBIL SiteID: 015-021-001856 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 07/07/2006 ~ AUTOMATIC SHUT-OFFS, OVER-FILL PROTECTION, MANUAL SHUT-OFF ON THE OUTSIDE OF THE BLDG FOR AN EMERGENCY. Release Containment Clean Up 04/04/2006 BEYOND MINOR NOZZLE SPILLS, WE USE CERTIFIED CLEAN-UP COMPANY. Other Resource Activation -8- 07/11/2007 F EZ STOP MOBIL SiteID: 015-021-001856 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ -'~~lCl:1G1 nac~aiu~ Utility Shut-Offs 03/02/2007 ELECTRICAL - W SIDE OF BLDG WATER - BEH BLDG Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - 2 FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - 50FT FRONT OF SITE ON 19TH & UNION. 01/31/2007 Building Occupancy Level 04/04/2006 4 EMPLOYEES -9- 07/11/2007 _• ~,; F EZ STOP MOBIL SiteID: 015-021-001856 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 01/31/2007 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: EACH EMPLOYEE RECEIVED TWO WEEKS TRAINING ON KNOWLEDGE OF: KEY ON THE REGISTER THAT SHUTS DOWN ALL PUMPS; OUTSIDE EMERGENCY CUT-OFF SWITCH; AND CLEANING UP MINOR NOZZLE SPILLS. rayc a Held for Future Use Held for Future Use -10- 07/11/2007 f.. ,P,~. EZ S.'1'OP MOBIL Manager YANG YAMM Location: 101 19TH ST City BAKERSFIELD CommCode: BFD STA O1 EPA Numb: SiteID: 015-021-001856 BusPhone: (661) 631-1049 Map 103 CommHaz Moderate Grid: 30B FacUnits: 1 AOV: SIC Code:5541 DunnBrad: Emergency Contact / Title Emergency Contact / Title BOUN CHI LY / OWNER VANG YAMM / MANAGER Business Phone: (661) 631-1049x Business Phone: (661) 631-1049x 24-Hour Phone (661) 472-4058x 24-Hour Phone (661} 472-4058x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Contact BOUN CHI LY Phone: (661) 631-1049x MailAddr: 101 19TH ST .State: CA City BAKERSFIELD -Zip 93301 Owner BOUN CHI LY Phone: (661) 631-1049x Address 101 19TH ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST C~~ A ,, 'r/,~~ Based on my inquiry of those individuals I certify n ti 9 ~G ~O 0 , o responsible for obtaining the informa f law that I have personally , under penalty o examined and am familiar with the information submitted and believe the information is true, accurate, and complete. 2 ~ 'G ~ 0 ® Date o ignature -1- 01/31/2007 F EZ STOP MOBIL SiteID: 015-021-001856 ~ STORAGE CONTAINER DATA (UST FORMA) Last Action Type: FACILITY/SITE INFORMATION Business Name: EZ STOP MOBIL Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper ICC Nbr: PROPERTY OWNER INFORMATION Name VANG YAMM Phone: (661) 631-1049x Address: City State: Zip: Type INDIVIDUAL .TANK OWNER INFORMATION Name YANG YAMM Phone: (661) 631-1049x Address: City State: Zip: Type INDIVIDUAL BOE UST Fee# Financ'1 Resp: SELF INSURED Legal Notif Business Mailing Address Date:02/12/2002 Phone: (6 6) 649- x Name:BOUN CHI LY Tt1:OWNER State UST ## 1998 Upg Cert#: 00869 -2- 01/31/2007 F EZ STOP MOBIL SiteID: 015-021-001856 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP GASOLINE L 6000.00 GAL Mod GASOLINE L 6000.00 GAL Mod GASOLINE L 4000.00 GAL Mod -3- 01/31/2007 -4- 01/31/2007 F EZ STOP MOBIL ~ Inventory Item 0001 ~ COMMON NAME / CHEMICAL NAME I GASOLINE Location within this Facility Unit SiteID: 015-021-001856 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 8006619 Liquid TMixture ~ Ambient~E ~ AmbientT~E ~ UNDER GROIUNDRTANKE AMOUNTS AT THIS LOCATION Largest_Container Daily Maximum Daily Average 6000.00 GAL 6000.00 GAL 6000.00 GAL r1t~~r~tu~VU~ ~Vl~irvivl,lv_l~ oWt. RS CAS# 100.00 Gasoline No 8006619 tit~Gt~tCll lj5 ~L; 5 ~1~1L' 1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME GASOLINE Location within this Facility Unit Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 8006619 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~Ambient ~ Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 6000.00 GAL 6000.00 GAL 6000.00 GAL l1HGHiCLVUiJ l.Vl"lYV1VP~1Vl^7 oWt. RS CAS# 100.00 Gasoline No 8006619 t1HGEiKL 1~ J~tS5~1~1r,1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod -5- 01/31/2007 F EZ STOP MOBIL SiteID: 015-021-001856 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 8006619 Liquid TMixture~mbRe~~URE TEMPERATURE CONTAINER TYPE Ambient ~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 4000.00 GAL 4000.00 GAL 4000.00 GAL I1HGE~tCL V U .7 1. V1~lY V1V L" 1V 1.7 sWt. RS CAS# 100.00 Gasoline No 8006619 t1tiGKKL L-~.7J~.7A1~1r,1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod -6- 01/31/2007 F EZ STOP MOBIL SiteID: 015-021-001856 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 07/07/2006 ~ EMERGENCY, CALL 911; MAJOR LEAK, CALL FIRE DEPT 326-3979. Employee Notif./Evacuation 07/07/2006 SHUT OFF ALL ELECTRICITY AND LEAVE BLDG. Public Notif./Evacuation 02/23/1998 LEAVE BLDG. Emergency Medical Plan 02/23/1998 CALL 911. -7- 01/31/2007 P EZ STOP MOBIL SiteID: 015-021-001856 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 07/07/2006 ~ AUTOMATIC SHUT-OFFS, OVER-FILL PROTECTION, MANUAL SHUT-OFF ON THE OUTSIDE OF THE BLDG FOR AN EMERGENCY. AGIGGL7G L.Ull l.d 111L11C 111 Clean Up BEYOND MINOR NOZZLE SPILLS, WE USE CERTIFIED CLEAN-UP COMPANY. 04/04/2006 vl.,llcl. 1CC5vu1.l:C t1C:l.1Vdl.1Ui1 -8- 01/31/2007 ~ b t~ F EZ STOP MOBIL SiteID: 015-021-001856 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .7~JCC:ld1 ildGdIU~7' Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - W SIDE OF BLDG C) WATER - BEH BLDG D) SPECIAL - NONE E) LOCK BOX - NO 01/31/2007 Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - 2 FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - 50FT FRONT OF SITE ON 19TH & UNION. 01/31/2007 Building Occupancy Level 4 EMPLOYEES 04/04/2006 -9- 01/31/2007 .a .+ ~~ F EZ STOP MOBIL SiteID: 015-021-001856 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 01/31/2007 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: EACH EMPLOYEE RECEIVED TWO WEEKS TRAINING ON KNOWLEDGE OF: KEY ON THE REGISTER THAT SHUTS DOWN ALL PUMPS; OUTSIDE EMERGENCY CUT-OFF SWITCH; AND CLEANING UP MINOR NOZZLE SPILLS. rayc ~ Held for Future Use Held for Future Use -10- 01/31/2007 ,=.- UNIFIED PROGRAM INSPECTION CHECKLIST' .SECTION 1: Business Plan and inventory Program HAKERSFIELD FIRE DEPT Prevention Services ~It~ 900 Truxtun Ave., Suite 210 ~Rr~ r Bakersfield. CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME NSPEC ION DATE INSPECTION-TIME .~i~ V ADDRESS HONE NO. O OF EM OYEES FACILITY CONTACT ~ USINESS ID NUMBER 15-021- ~~ l - ----- - / ~-~} 4 . Section 1: Business Plan and Inventory Program - ^ ROUTINE OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-I CTION C V ~ C=Compliance O P E R AT I O N v=violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSltlt?SS PLAN CONTACT INFORMATION ACCURATE ,~, / LIV ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL ---------------------------------------__ VERIFICATION OF MSDS AVAILABILITY .------ - --- ---------- ---EN~'D-A-U~--Q-~--20D~___ --------- ^ VERIFICATION OF HAZ MAT TRAINING ~^ VERIFICATION OF ABATEMENT SUPPLIES AND P OC DURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINEHS PROPERLY LABELED HOUSEKEEPING ^- ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES LV/NU EXPLAIN: - _- QUESTIO REGA IN THIS INSPECTION? PLEASE CALL US AT (881) 328-3979 ~_ i Inspector (Please Print) Fire Prevention / 1°' In /Shift of Site/Station # Buslne ; White -Prevention Services Yellow - Stetlon Copy Pink - 8uaineae Copy FD2048 (Rw. 02/05) `'4~. .r~' \\ i~ ~ ~ ~~ ~ y'1 ~~ , , ~~ FACILITY NAME_~,~_ CITY OF BAKERSFIEL,D FIRE DEPARTMENT OFFICE OF >N:NVIRONIYIENTAL SERVICES UNIFIED PROGItANt INSPECTION CHF,CK1,[ST 1715 Chester Ave., 3~`' Floor, I3akersBeld, CA 93301 ~t~~l4t ~ INSPECTION DATE Section 2: tinderground Storage Tanks Program ^ Routine ^ Combined Join Agency ^ Multi-Agenc Complaint ^ Re-inspection Type of Tank e~~iL ~~~'t ~ Number of Tanks Type of Monitoring _ #~C4 Type of Piping aC OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data on the Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes NO ~, Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OGS Adequate secondary protection Proper tank placarding/labeling is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection'? C=Compliance =Violation Y=Yes N-NO Inspector: Office of Environmental Services (661) 326-3979 white - I?nv. Svcs. Pink -Business Ci~ry ... Business Site Responsible Party ;,, + EZ STOP MOBIL _______________________________________ SiteID: 015-021-001856 + Manager BOUN CHI LY BusPhone: (661) 631-1049 Location: 101 19TH ST Map 103 CommHaz Moderate City BAKERSFIELD Grid: 30B FacUnits: 1 AOV: CommCode: BFD STA Ol SIC Code:5541 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title BOUN CHI LY / OWNER VANG YAMM / MANAGER Business Phone: (661) 633.-1049x Business Phone: (661) 631-1049x 24-Hour Phone (~~/) y~~ _ yo,5~x 24-Hour Phone (~,~~) yea -yo~x Pager PhoneN'A- : ( ) - x Pager Phon~l~~ ( ) - x Hazmat Hazards: Contact BOUN CHI LY Phone: (661) 631-1049x MailAddr: 101 19TH ST State: CA City BAKERSFIELD Zip 93301 Owner BOUN CHI LY Phone: (661) 631-1049x Address 101 19TH ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST Based on y of those individuals responsible for obta~nrng the information, I certif under penalty of law that f examined and am familiar witr"atf1e ntormnall~ submitted and believe the infprrnation is accurate, and co anon mplet~, true, ignature ® ~~~©~,' Date ENrp ~~~ 0 7 2pps uo~ 1~55p0~~,~ ~~ ~5 ~~~ v~ -1- 06/08/2006 Z~ ' :S + EZ STOP MOBIL _______________________________________ SiteID: 015-021-001856 + Manager BOUN CHI LY Location: ,101 19TH ST City BAKERSFIELD BusPhone: (661) 631-1049 Map 103 CommHaz Moderate Grid: 30B FacUnits: 1 AOV: 1 CommCode: BFD STA O1 EPA Numb: SIC Code :.5541 , C ! ~~~ ` DunnBrad: ~J ------------- ----- ------ ------ -- - - -- Emergency Contact / Title Emergency Contact / Title BOUN CHI LY / OWNER VANG YAMM / MANAGER Business Phone: (661) 631-1049x Business Phone: (661) 631-1049x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Contact BOUN CHI LY Phone: (661) 631-1049x MailAddr: 101 19TH ST State: CA City BAKERSFIELD Zip 93301 Owner BOUN CHI LY Phone: (661) 631-1049x Address 101 19TH ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers. TotalUSTs: = Gal. Certif'd: RSs: No ParcelNo: ~ Emergency Directives: ~ PROG A - HAZMAT PROG U - UST ENT'D q UG 1®200 6 0~ ~n~~ ~ ~ ~~ ~~ `~ ~~ Based on my inquiry of those individuals ~ ~, responsible for obtaining the information, I certify ~~ O under penalty of law that l have personally O examined and am familiar with the information submitted and' believe the information is 4rue, ac e, and complete. ~, ~ ~ ~_ Sig a Date -1- 04/04/2006 --.. UNIFIED PROGRAM INSPECTION CHECKLIST .SECTION 1: Business Plan and Inventory Program ~ ~~ BASERSFIELD FIRE DEPT Prevention Services 900 Trtixtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAM NSPECTION DATE INSPECTION TIME E ` 1 ~-~ I- ' t o aa . ADDRESS HONE NO. O OF EMPLOYEES ® ~ ~ 2~ FACILITY CONTACT USINESS ID NUMBER 15-021- Section 1: Business Plan end Inventory Program ^ ROUTINE BINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS APPROPRIATE PERMIT ON HAND BUSIIlt3SS PLAN CONTACT INFORMATION ACCURATE /{~ ^ (/ VISIBLE ADDRESS ^ CORRECT OCCUPANCY J~. ^ (J VERIFICATION OF INVENTORY MATERIALS R ^ ~/ VERIFICATION OF QUANTITIES ~ ^ VERIFICATION OF LOCATION ~~~~ ^ ^ PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY ~^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND R CEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ~^ HOUSEKEEPING ~~ FIRE PROTECTION ~ 7~~ t ~~ S7 ti cfd~d ~ ~--.~f1~__~~_b ^ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ~DIO EXPLAIN: - _ - s~ OU STIONS REGARDING THIS INSPECTION? PLEASE CALL U8 AT (887) 328-3979 Inspector (Please Print) Fire Prevention / 1" In ! Shift of Site/Station 8 usiness ite/Sc ool SNe Responsi a Party (Please Print) White -Prevention Services Yellow - Sletion Copy Pink -Business Copy FD2049 (Rev. OZI05) 4 - - -,- -------- - t <~Y -- v ~, ~~.~ ->. E i 1 i iJ 1 `NTH ;T'}?EFT ___r_!~TLT-:.i=' J ELr., c:f f ~; rill. i'!,.ij.j, "; ,. I'!~ il. 4 I' I :ii(il... ~ i Lti_I_r+~ ;i. ' ,_rl~. , - T f•Jr-;1'FJ I T. IF;"1 L } '1'1:!°Il 1 .. - , I J ! r ;l tdli _ i~ •.ra I~ -~I.. ' HE 1 ~ ~FI~J~ I r~~~': ;[::.: l- ! r.. ;r-1i .... I,Jr iTcT°: _ [I ,III] ~ J I`J~'HE': ~`' k - - - ----- - - - - - - ~ ~ A~l i j°~^. ~ 'tea d~+w~~` ~~~ CITY OF BAKERSFIELD FIRE DEPAR'I'MF.NT ~~ ~ ~ M~ OFFICE OF ENVIRONMENTAL SERVICES ~~' y.` UNIFIED PROGRAM INSPECTION Ci)ECKL.IST `_w ~gtip'~ 1715 Chester Ave., 3r`' Floor, Bakersfield, CA 93301 FACILITY NAME ~ ~ /'J'l~h,` I INSPECTION DATE i~-,~ 1 ~_~_ Section 2: Underground Storage Tanks Program ^ Routine ~rnbined ^ Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection Type of Tank SsN~~isdl( ~.vz Gl~umber of "Tanks .~ Type of Monitoring ~..~ Type of Piping irk ~fs_, ~~~ OPERATION C V COMMENTS Proper tank data.on the Proper owner/operator data on talc Permit tees current Certification of Financial Responsibility Monitoring record adequate and current ~~ ti ~ Maintenance records adequate and current r Failure to correct prior UST violations v. Has there been an unauthorized release? Yes ~~o Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file ti~ith OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overlill/overspill protection'? C=Compliance V=Violation Y=Yes N=NO Inspector: I'_~~- N ~ 2 ~'' ,~~~~ Office of Environmental Services (661) 326-3979 G Business Site Res onsible Party White - f-nv. Svcs. Pink -Business CnPy ;_ ~ ~~~~ ~~. MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the Stare of California Authority Cite& Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulQtions This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepare for each monitorin~system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: ~ Z S~'t~ !'~O~~L-- Bldg. No.: Site Address: /Q1 t 9~ ST _ City: ~X~'.-~S,F,1 r<'~,b Zip 9~8 Facility Contact Person: Contact Phone No.: (~) Make/Model of Monitoring System: ! LS ~ S~ Date of Testing/Servicing: ~l o~Zl Gl~ B. Inventory of Equipment Tested/Certified n~. ,.,.i..r.- ., a >,....a~ r nd:..~m ~ ~14:~ a nr i Prr>A/crrvirod~ Tank ID: / NL Tank ID: ~~l ~ / ® In-Tank Gauging Probe. Model: ,~.ln-Tank Gauging Probe. Model: _~ ^ Annular Space or Vault Sensor. Model: -~-~- ® Piping Sump J Trench Sensor(s). Model: i~y p ^ Annular. Space or Vault Sensor. Model: ~-Piping Sump /Trench Sensor(s). Model: ^ ~ b' ®. vlj FAR 131a~T 5!~/ro~ Model: tid ~ ~ il1~ -~'2 ~UCx ~r ~u.~P Model: ,vo t71C ® Mechattica! Line Leak Detector. Model: ~. E ~ ~ ~ ~ Mechanical Line Leak Detector, Model: f~ ~?E7~ ^ Electronic Line Leak Detector. Model: ^,-Electronic Line Leak Detector. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Other s eci a ui ment t e and model in Section E on Pa e 2 , ^ Other {s eci e i rnent a and model in Section E on Pa e 2). Tank Ip: ~~tC~S~L Tank ID: -~t- ~iQ in-Tank Gauging Probe. Model: _, fT t/'t[~ ^ In-Tank Gauging Probe. Model: ^ Annular Space or Vault Sensor. Model: ^ Annular Space or Vault Sensor. Model: ~ Pipine Sumo /Trench Sensors}. Model: $ ^ Piping Sump /Trench Sensor(s). Model: ® Vf{~~ ~(~ki:T SUtyeF Model: ~~ ~S -t.~2 L7 Fill Sump Sensor(s). Model: ® Mechanical Line Leak Detector. Model: f£ AF T ICC~ ^ Mechanical Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: ~ ^ Electronic Line Leak Detector. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Other (specify equipment e and model in Section B on Page 2}. ^ Other (specify equipment type and model in Section E on Page 2). Dispenser !D: ~~ oZ __ Dispenser ID: 3~ ~/ 1~4 Dispenser Containment Sensor(s). Model: ,NO ~riF,..y~o+~ ~ Dispenser Containment Sensor(s). Model; w~ SE~/ti!SorC ~ Shear Valve(s). !~. 5hear Valve(s). ^ Dis eraser Containment Floats and Chains . ^Dis eraser Containment Floats and Chains . Dispenser ID: ,S ~~ Dispenser ID: 7~,~ ,~. Dispenser Containment Sensor(s). Model: i(.C7 sE.U~ ~ Dispenser Containment Sensor(s), Model: if_~"NSdIC ® Shear Valve(s): ~ 5hear Valve(s). ^ Dispenser Containment Float(s) and Chains}. ^Dis eraser Containment Floats and Chains . tispenser 1D; ~ Dispenser ID: _ ,~frl oZ ~ Dispenser Containment Sensor(s). Model: ti~ ,~,~~_ Dispenser Containment Sensor(s). Model: ~t/G ~~~s2 ® Shear Valve(s), ~ Sheaz Valves}. ^Dispenser Containment Ploat s) and Chain{s). ^Dis eraser Containment Float s and Chains . *If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. CertifiCatlOri - I certify that the equipment ldentilied ip this document was inspected/serviced In accordance with the manufacturers' guidelines. Attached to this Certification [s information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the report; (ci:eck all [hat apply): ~ System set-up rm history report Technician Name (print): f((~~,t/ ~~ G~J Signature: CertificationNo.: ~Q[y-qS'- 1}~'~ ICG#s~{o ]~~~~ License. No.: p ~1 ~f,S Testing Company Name: RICH ENVIRONMENTAL Phone No.: 661 }_ 392-8687 Site Address: ~~y ~~ Qt~K~?24F1~~,t~, ~ ~~b ~ Dale of Testing/Servicing: ~/~/~ Page I of 3 03101 Monitoring System Certification 13~~ q D. Results of Testing/Servicing Software Version Installed: / S. D ~ lam..... ..1.. a.. •L.. f.. 11 .....i...- .. 1. en41.n~. !~ Yes ^ o Is the audible alarrn o erational? ~ Yes ^ o Is the visual alarm o erational? ~ Yes ^ o Were all sensors visual! ins ected, functional! tested, and confin-ned o erational? ~] Yes ^ o Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their ro er operation? ^ Yes ^ o If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) ~ N/A operational? ~ Yes O o For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment O N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? Ifyes: which sensors initiate positive shut-down? (Check all that apply) ~ Sump/Trench Sensors; ^ Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ~ Yes; ^ No. ^ Yes D o For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e, no ® N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm tri ger? ^ es ~, No Was any monitoring equipment replaced? Ifyes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re lacement arts in Section E, below, ^ es ~. No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ^ Product; ^ Water. If es describe causes in Section E below. ® Yes 0 o Was monitorin s stem set-u reviewed to ensure ro er settin s? Attach set u re orts, if a livable 1~. Yes ^ o Is all monitoring equipment operational per manufacturer's specifications? In Sectiun N~ below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of3 0310] .~ 139' F. In-Tank Gauging /SIR Equipment: ~ Check this box if tank gauging is used only for inventory control. ~ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. ...,.•• ~1 Yes ^ o Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ~ Yes ^ ° Were ail tank gauging probes visually inspected for damage and residue buildup? ~ Yes ^ o Was accuracy of system product level readings tested? I,$ Yes ^ o Was accuracy of system water level readings tested? Yes ^ ° Were all probes reinstalled properly? ~ Yes ^ ° Were all items on the equ%pment manufacturer's maintenance checklist completed? !b the JCCiIOn !1, DeIOW, (leSCrIDC OVW AOa W[IC++ 11+C5C UG+II'lCU1:1CJ WG1c VI mu vc a.w,ca. a..u. G. Line Leak Detectors (LLD): O Check this box if LLDs are not installed. /'•r.,, ..loco •6n f~lln.,....., nhon41: c1• ~ Yes ^ No` For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ^ N/A (Check all that apply) Simulated leak rate: 1~ 3 g.p.h., ^ 0. 1 g.p.h , D 0.2 g.p.h. ~ Yes ^ o Were all LLDs confirmed operational and accurate within regulatory requirements? J~. Yes ^ o Was the testing apparatus properly calibrated? .® Yes ^ o For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^ N/A ^ Yes ^ o does the turbine automatically shut off if the LLD detects a leak? For electronic LLDs ~ N/A , ^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if any portion ofthe monitoring system is disabled CK N/A, or disconnected? ^ Yes ^ o Far electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ~. N/A or fails a test? ^ Yes ^ o For electronic LLDs, have all accessible wiring connections been visually inspected? ~ N/A ~ .Yes ^ o Were all items on the equipment manufacturer's maintenance checklist completed? >n Ine ~ecuun n, oeww, aescnoe uow ana wneu tnese aencrenetes were or wut ne correctea. H. Comments: Page 3 of 3 03101 .; Monitoring System Certification ~~`~ UST Monitoring Site Plan Site Address: ~~ l /q Th ~ Tf~f1k ~Y~S f~ ~~~., ,_~. g ~ ~o~ ------------ =---~g~-~ ~=I=- -------_-__-=--------------- - - - - - - - 1fw - - - - - - Q- - - - - - - ~ - ~ - ~ - - - - - - - - - - - - - - - - S~~ 1 a ~ ______~__~=== ----= ----= ----__~__--- - - --- ------------- ------ ---- ~ `;<----7 g--------------- - ZS3So------- ------ ----- ------------------------- -- Datc map was drawn; 7 /~/~ Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks.and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection}. In the space provided, note the date this Site Plan was prepared. Page ~ of~ os~oo ,~, ~~ ~, RAN E1V~TI.I~ONMEN?`A r 4 5643 BROOKS CT BAKERSF'IELD,CA.93308 OFFICE (661)392-8687 & FAX (661)392-0621 rIECIin??ICAL•;j,EAK DSTSCTOR •4 W/0#: Facility Name: ~ Z ~' ~o~z (-- Facility Address: fc71 /`1"~F~ 5T C3t~k~/tSFI~C.~~c~4 g33o2~ Product Lille Type (Pressure, Suction, Gravity) ,~CFS6~R~ PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS sFRIAL NUMBER BELOW PSI OR L/D TYPE ~a T YE PASS SERIAL # /V I,~Lt NO / ~ FAIL "y Uri 87 L/D TYPE I'~ ~,~TiQu YES PA88 SERIAL #,1L!~AUaRLE /a FAIL 1`~E+K9 I ' L/D TYPE FE PJ5"1RO ~ PA3 SERIAL # U./~QE1q~,~RLE NO /(, FAIL ~S EL L/D TYPE YES PASS SERIAL # NO FAIL I certify the above tests were conducted on this date according to Red Jacket Pumps field test apparatus testing procedure an limitations. The Mechanical Leak Detector Test pass / fail .is determined by using a low flow threshold trip rate of 3 gallon per hour or less at 20. PSI. I acknowledge that all data collected is. true and correct to the best of my knowledge. ' Tech: !~~ .I~I~So.,c/ Signature : Date : 7- ~ 7`c..y u•• SOFTWARE REVIS[OIV LEVEL VERSION 15.01 SOFTWAREp 346U15-1U0-H CREATED - 97.10.23.0&.56 NO SOFTWARE MODULE SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS SYSTEM SETUP JUL 27~ 2006 3:35 PM SYSTEM UNITS U.s. SYSTEM LANGUAGE ENGLISH SYSTEM DATEiTIi°lE FORhIAT hiON DD YYYY HH : Mhl : SS xf°I 19TH STREET MOBIL 101 19TH STREET BAKERSFIELD CA 805-631-1049 SHIFT TIME 1 11:00 Phi SHIFT TIh1E 2 DISABLED SHIFT TIME 3 DISABLED SHIFT TIh1E 4 DISABLED TANK PERIODIC WARNINGS DISABLED TANK ANNUAL WARN 1 IVGS DISABLED L 1 NE PER I OD I C WAR N I lVGS DISHBLED LINE ANfVUAL WARNINGS DISABLED PR 1 NT TC VOL UN1ES ENABLED TEMP COh1PENSATION VALUE (DEG F ): 60.0 STICK HEIGfiT OFFSET DISHBLED DAYLIGHT SAV 1 NG T I hIE ENABLED START DATE APR WEEK 1 SUN START TIME 2:00 AM END DATE OCT WEEK 6 SUN END TIME '3:00 AM C:UhIMUNICHTIONS SETUP FORT SETTINGS: NONE FOUND RS-23'2 ~uECURITY CODE : 000000 RS-232 END OF MESSAGE DISABLED 13~ IN-TANK SETUP T 1:UNLEADED PRODUCT CODE 1 THERMAL COEFF :.000700 TANK DJAh1ETER 96.00 TANK PROFILE 1 PT FULL VOL 6000 FLOAT SIZE: 2.0 1N.•8496 WATER WARNING 2.0 HIGH WATER LIi~1IT: 3.0 h1AX OR LABEL VOL: 6000 OVERFILL LIh1IT 90% 5400 HIGH PRODUCT 95% 5700 DELIVERY LIMIT l0i 600 LOW PRODUCT 500 LEAK ALARM LIhIIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 3.00 MANIFOLDED TANKS Tit: NONE LEAK f°iIN PERIODIC: 0% 0 LEAK MIN ANNUAL Oi 0 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARhI DISABLED ANN TEST AVERAGING: OFF PER TEST HVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY : 15 MIN SYSTEM SECURITY CODE OOD000 Q, T 3:DIESEL 3 T 2:SUPER PkODUc:T CODE 000450 PRODUCT CODE 2 THERh1AL COEFF 82 OU THEkI•IAL COEFF :.000700 . TANK UTAMETEk ! PT TANK UiAhIETER 96.00 TA{~K pkOFILE 4000 TAiVK PROFILE 1 PT FULL VOL FULL VOL 6000 FLOAT SIZE: 2.0 IN. 8496 FLOAT SIZE: 2.0 IN. 8496 r, 0 i.JATER WARNING 2.G , WATER WARNING HIGH WATER LIMIT 3.0 HIGH WATER LIhIIT: 3.0 4000 GR LABEL VOL: MA~t Ok LABEL VOL: 6000 MAX 90i OVERFILL' LIMIT g6G0 OVERFILL L I1~1 I T 90i ~ 95% 5400 HIGH PRODUCT x800 HIGH PRODUCT 95 0 10 e 5700 DELIVERY LIhI1T 400 DELIVERY LIMIT 10%b ' 600 325 LOW PRODUCT : 500 LOW PRODUCT 99 LEAK ALARM LIMIT: LEAK ALARI°1 L 1 h1 I T: 99 SUDD):N LOSS L I M I T: 1 .20 StJUUEN LOSS LIMIT: 50 TANK T1LT ' TANK TILT 2.50 rIAIVIFOLDEU TANKS f°1AiVIFOLDED TANKS TI3; NONE Tq: NONE LEAK M I IV PERIOD 1 C: O O LEAK MIN PEkIOUIC: 0% • 0 Oio LEAK MiN ANNUAL : 0 LEAK. MIN ANNUAL : 0%b ' 0 PERIODIC TEST TY~TANDARU PERIODIC: TEST TYPE STAIVDARU ANNUAL TEST FHIL HTJIVUAL TEST FAIL ALARI"1 DISABLED ALAkI°1 U [ SABLED PERIODIC TEST FAIL PERIODIC TEST FAIL ALHRhi U15ABLED ALARM DISABLED . GROSS TEST FAIL RM DISABLED GROSS TEST FAIL ALA ALARM DISHBLEU ANN TEST HVERAGING: OFF ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF PER TEST AVERAGING: OFF NOTIFY; OFF TANK TEST TANK TEST NOTIFY: OFF HON BREAK :OFF TNK TST SIP TfVK TST S1F'HON BkEA K:OFF ; !5 MIIV DELIVERY DELAY DELIVERY DELAY : 1 5 I°1 I N 3 ~p~ ! LEAK`TEST h1ETHOD - - - - TEST DAILY ALL TANK START TJhIE : 12:00 AM TEST RATE : 0.20 GAL: HR UURATIUN 2 HOURS LEAK TEST REPORT FORh1AT NORMAL LIGUID_SENSOR-SETUP- - - L 1 : UtVLEAUED STP TRI-STATE (SINGLE FLOAT) CHTEGOkY STP SUMP L 2:SUPER STP TRI-STATE (SINGLE FLOAT) CATEGORY STP a~UMP L 3:DIESEL STP TRI-STATE (SINGLE FLOAT) CATEGORY STP SUMP d OUTPUT RELAY SETUP R I:UNLEHDED TYPE: STANDARD NORhIHLLY CLOSED L 18U I D SEfVSOR ALl°IS L 1:FUEL ALARM L 2:FUEL ALARM L 1:SENSOR OUT ALARM L 2:SENSOR OUT ALARI°I L 1:SHORT ALARM L 2:SHORT ALARM R 2:SUPER TYPE: STANDARD FORMALLY CLOSED L i 0 U I D :]E PJSOR ALf°IS L I:FUEL ALARM L 2:FUEL ALARM L 1:SENSUR OUT ALARM L 2:SENSOR OUT ALARM L 1:SHORT ALARM L 2:SHORT ALARM R 3:DIESEL TYPE: STANDARD FORMALLY CLOSED L I 8U i D SEfVSOR ALf°iS L 3:FUEL ALARM L 3:SENSOR OUT ALARI°1 L 3:SHORT ALARM R 4:SONITROL ALARhI TYPE: STANDARD NORMALLY OPEN LIQUID SENSOR ALMS ALL:FUEL ALARM ALARM HISTORY REPORT ---- IIV-TANK ALARM - T 1 : UIVLEADED HIGH WATER ALAkhI MAY 4. 1998 7:11 PI'1 N1AY 4. 1998 7:01 PNI UVERFlLL ALARM JUL 26. 2006 1U:08 PM JUL 23. 2006 7:27 Phi JUL 19. 2006 6:59 Phl LOW PRODUCT ALARI°I MAY- 5. 2006 4:30 PM MAY 3. 2006 11:53 AM JAN 20, 2006 12:08 PM SUDDEN LOSS ALARM JUL 23. 2006 1:51 AM JUL 22. 2006 1:27 AM JUL 16. 2006 1:45 AI°i NIGH PRODUCT ALARM JUL ~19, 200G 7:01 PM JUL 17. 20D6 11:15 PM JUL 6. 2006 8:33 FM INVALID FUEL LEVEL MAY 5. 2006 4:31 Phl h1AY 3. 2006 11:53 Af°I JAN 20. 200E 12:06 PM PROBE OUT JAIV 24. 2005 1:12 Phl DEr_. 3. 20D4 9:12 Ahl DEC 22. 2003 11:36 RM HIGH WATER WARNING MAY 4. 1998 7:11 PM 1HAY 4. 1998 7:01 PM DELIVERY NEEDED 1~1AY 25, 2006 1 :40 PM N1AY 5. 20Db 4:12 Phl MAY 3. 2006 11:15 AM hIAX PRODUCT ALARM DEC 30, 2005 7:57 Phl AUG 14. 2005 3:15 Ahl JU1V 8, 2005 2:2Q Plh LOW TEh1P WARIVIfVG DEC 3. 2004 9:23 ANl OCT 16. 1999 3:15 AM MAY 4 . 1 998 ? : 52 Phl t ~ ~ =t-9 ALARhI H I STOR1` REPORT ---- !N-TANK ALARM - T 2:SUPER HIGH WATER ALARM OCT 27. 1999 6:19 PM OVERFILL ALARM JUL 20, 2006 6:16 PM JUIV 29, 2006 10:25 Phi OCT 10.. 2005 12:23 PM SUDDEN LOSS ALARM FEB 12. 2006 1:43 AM NIGH PRODUCT ALARM AUG ]9, 2002 2:18 AM FEB 8. 2000 12:17 PM HPR 27, 1999 2:00 AM INVALID FUEL LEVEL OCT 27. 1999 6:Q0 PM MAR 2B. 1499 1:41 AM PROBE OUT DEC 3. 2004 9:05 ANI HIGH WATER WHRNJNG OCT 27. 1999 b:19 PN1 DELIVERY NEEDED OCT 27. 1999 B:49 PM OCT 27. 1999 5:59 PNI MAR 27. 1999 4:08 PM LOW TEMP WARNING DEC 3. 2004 9:10 AM . ;, . _ ~~~ ALARf°I HISTORY REPORT ALARM HISTORY REPORT ---- IN-TANK ALHRM - T 3:UIESEL HIGH WATER ALARM AUG 1. 2000 8:37 PNI hIAR 26. 1999 1 :26 Phi OVERFILL ALARh1 APR 28. 200b 8:16 PP7 APR 9, 2006 12:16 ANI OCT 22. 2005 1:03 PM SUDDEN LOSS ALAkhI UCT 15. 2005 1 :19 Al°1 HIGH PRODUCT ALARhI SEP 29, 2003 8:23 ANI SEP 1. 2003 9:33 ANI FEH 17. 2003 10:54 HNI IfVVALID FUEL LEVEL AUG 1. 2000 5:27 PM APR 12, 1999 2:48 PM MAR 26. 1999 12:5b PM HIGH WATER WARNING auG 1 , 2oDO e : D7 Pr~l MAR 26. 1999 1:26 PNI DELIVERY NEEDED SEP 5, 2000 5:58 PI°I AUG 2. 2000 11:06 Ahl AUG 1. 2000 3:01 Phl ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 1:UNLEADEU STP STP SUMP FUEL ALARI°I JUL 27, 2006 .1:53 PM FUEL ALARM DEC 29. 2004 11:05 AM FUEL ALARM DEC 29, 2004 10:59 AN1 ----- SENSOR ALARI`1 ----- L 2:SUF'Ek STP STP SUhIF FUEL ALHRM JUL 27. 2006 1:5q PM FUEL ALARM AUG 25. 2005 7:34 AM FUEL ALARM AUG 25, 2005 7:19 AM x * ~ * ENU * ~ ~ * x ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 3:UIESEL STP STP SUMF FUEL ALARM JUL ~7. 2006 1:51 PM FUEL ALARM DEC 29. 2004 10:54 AM FUEL ALARM DEC 29. 2003 2:47 PM v ~3~~~ MONITOR CERT. FAILURE REPORT SITE NAME • ~ 2 ~"~v P ~a 3 ...~. L DATE: 7 - a.7 -O(o Tit THE FOLLOWING COMPONENTS WERE REPLACED/REP~hItED ~ COMPLETE TESTING. REPAIRS: NC) ..UG LABOR: il/p.ii C PARTS INTALLED: ~cJ c~,u ~ NAME: TITLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENYIItONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIIZONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON-COMPLIANCE. A COPY OF TffiS DOCUMENT HAS BEEN LEFT ON-SITE FOR YOUR CONVIENENCE. SWRCB, January 200,6( Spill Bucket Testing Report Form This form rs intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from.tests (if applicable), should be provided to the facility.owner/operator for submittal to the local regulatory agency. ~. r•Tr r~rr<, n~r~nnnre~nN Facility Name; F'2 ,5 -31 J-- ~ - _ - - ~ - - - Date of Testing: 7- ~ 7 ° o G Facility Address: ~Q 1 T~ 5] E `-EL~D G to c Facility Contact: Phone: Date Local Agency Was Notified of Testing Name of Local Agency Inspector (ifpresent during testing: ~ r~c~r~rr_ f,nNTU a ('"TnR 1NFnRTN'ATTnN Company Name: ,~'1-.=Ff ~.c~+a ~-12ew r''1 ,,,.• '` . Technician Conducting Test: ,Q tf ,.ti ;~' .v Credentials: CSLB Contractor . ICC Service Tech. CB Tank Tester Other (S ec~) License Number(s)`. 't CPlT.i . R7T~ KFT TF.~TTN(; TTTRf1RMATInN Test Method Used: drostatlc Vacuum Other Test Equipment Used: Equipment Resolution: Identify Spill Bucket (By Tank Number, Stored Product, etc. I VN~7 ~~~ 2 Ci"^ 9 ~ F'L~- 3 .1-FSEL 4 Bucket Installation Type: Direct Contained in Sum Duect Contained in Sum u~ect B Contained in Sum Direct Bury Contained in Sum Bucket Diameter: / a a, Bucket Depth: -~ [n /(,p Wait time between applying vacuum/water and start of test: O /'~~N 3 3U A~£N 3U N~ Z iU Test Start Time (T~: /: ap ~-~ I'1 ~; ~~ ~j~ Initial Reading (R~:. /Ut ~ ~• / ~ ~ Test End Time (TF): a: (~G Pl+~, a; 00 /-t : dip Final Reading (Rr): a 1 ~~ r ~~ , Test Duration (TF - Til: / H j2 /NR % N j2 Change in Reading (RF - R~: ~~ ~ ~ ~ a I ~ Pass/Fttil Threshold or Criteria: ~~ Q ~~ ComineDts ' (include information on repairs made prior to testing and recomme ~~ ~ nded~ollow-up or~ailed tests) CERTIFICATION OF TECIINICLAN RESPONSIBLE FOR CONDUCTING THIS TESTING Yhereby certify that all the information contained in this report is trut, accurate; and in full compliance with legal requirements. Tec}mician's Signature: ~ Date: 7~~~"~~ ' State laws and regulations d0 nOt Currently require testing to be peSfDrmed by a qualified contractor, However, local requirements m8y be more stringent. 1~~~~ SB.989 TESTING FAILURE REPORT SITE NAMET~'2`~7U P 1nD~ ~ L DATE : 7 ~~-OCp ADDRESS : O \ " T ~, TECFINICIAN: ~ ~( ,c1 ~ ,~/ CITY: ~A IE SIGNATCTRE: SITE CONTACT: THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE THE 38989 TESTING. LIST OF PARTS REPLACED/REPAIRED: REPAIRS : /1/D/t! Lc LABOR : /VOA E FARTS INSTALLED : ./{/O/~ C ' ~~ ~a~79 UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD 1 LINE TESTING ! SB969 SECONDARY CONTAINMENT TESTING !TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION BAKERSFiELD FYRE DEPT. ~-~i~ Prevenfiion Services A1~l1/ ! 900 Trtixtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 PERMIT N0. ^ ENHANCEb LEAK DETECTION ^ LINE TESTI ^ 56.88 SECONDARY CONTAINMENT TESTING I-I rrt r~cocnDl~ ~~ ~cl ~~l~~IIT/~DIUP_ !`C DTICMA71(1A1 FACILITY { NAME b PHONE NUMBER Of CONTACT PERSON ADDRESS OWNERS NAME OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED P N T 7 7 Q~ Q 10 U~ ,_ `:,fiANK,TES7ING COMPANY r' . NAME OF T1N0 COM l 1 NAM ~ PHONE NUMB OF C TACT PERSON .MAILING D ESS /} ~ O . C/i/ NAME 3 ONE NUMBER OF ESTER OR SPECIAL INSPECTOR CERTIFt TION #: DATE & TIME EST TO BE CONDUCTED D ICC #: stn to-(3-v TEST METHOD SIGNATURE 0 APPLICANT `- DATE 1 ~.. Q -APPROVED BY DATE FD 2095 (Rev. 09105) a' BILLING & PERMIT STATEMENT PERM(T NO.: ~iRr ARlN T BA.KERSFIELD FIRE ~~ Prevention Services 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 PROlEC7 r -_., ~~. STARTWG GATE DATE 2.`l - l ~ 00 1 v~ NAAAE PROJECTNANIE ~ ~, a ~ ~ ~ ADDRESS PHQNENO. ti a- o s PRQIECTADDRESS y7 cm ~2Y ~ i 1 A~ ' ~ ~"0DE R 330 $ C NAME ,~ r~ CA LICENSE N0. , (mil TYPE OF LICENSE OfPWkTION DATE PHON ~ CONTRAGrOR C ANY NAME PAX N0. 2 "Q ADDRESS' ~ ~ ~, • ~ r $262 i Ch 50 ti i M ifi ^ • • ~ arge) mum n ons - (M Alarms -New & ca od . 98 FL 000 S O 0 FL x 013125 = Pennlt fee S ~ ^ q. ver 2 , . q. 88 ^ Mi i dific ti Ch ri kl s N ~ M S $210 00 ~ n mum arge) n a ons - ( er - ew o p . 98 ^ Ft Over 5 000 S FL x 042 =Permit fee S ~ , q. . q. 98 ^ Minor S rinkler Modifications (< 10 heads) 00 [inspection Only) ; 93 ~ p . 98 ^ Commertaa! Hoods -New & Modifications 26 $398 ~ . 98 ^ Additional Hoods 00 S 38 ~ . 98 ^ Spray Booths -New & Modifications 00 $458 ~ . 88 O Aboveground Story a Tanks (Insta/latlavrnnsp,-1'rTime) $165.00 82 ^ Addlt/onal Tanks E 28.00 82 ^ Aboveground Storage Tanks (RemovaUlnspedion) $108.00 82 ^ Underground Storage Tanks (lnstallatbnAnspectbnj $878.00 (pertank) 82 ^ Underground Storage Tanks (Modification) $878.00 (persite) 82 ^ Underground Storage Tanks (Minor Modificatbn) $155.00 82 ^ Underground Storage Tanks {Removap $675.00 (pertank) 84 ^ Oilwell (installation) $ 72.00 ~ 84 Mandated Leak Detection (Te /Fuel Montt Cert. $ 81.00 (persiteJ t32 ^ Tents $93.00 (percent) 84 ^ After hours lnspect3on fee 512200 84 O Pyrotechnic - {per everrt, plus Insp. Fee ~ 590 per hour) ; 80A0 + (5 tvs. rNn. stand -by tee Mspection) _ $510.80 84 ^ R~INSPECT/ON(S) /FOLLOW-UP INSPECTION(S) ; 93.00 (per hour) 84 ^ Portable LPG (Propane): NO.OF CAGES? $66.00 84 ^ Explosive Storage $249.00 84 ^ Copying & Fite Researrtl (File Research Fee 533.00 per hrj 25¢ per page 84 ^ Miscellaneous ~ 84 FD 2021 (Rev. 09/05) t -ORIGINAL 1NNITE (to Treasury) 1•YELLOw (to Ppe) '1-PINK (to Customer) UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING ! SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMff NO. ~ ~ ~ a l a b BAKERSFIELD FIRE DEPT. B ~,~~~ n Prevention Services ARlI/ T 900 Truxtun Ave:, Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANKTIGHTNESS TEST ^ TO PERFORM FUEL MONffORING CERTIFICATION )~ Cathodic Protection Testing SITE INFORMATION FACILITY E-Z Mobil NAME 8 PHONE NUMBER OF CONTACT PERSON . ADDRESS 101 19t" St. OWNERS NAME Same OPERATORS NAME Same PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES ^ NO TANK# VOLUME CONTENTS 1 87 UL 2 91 UL TANK TESTING COMPANY NAME OF TESTING COMPANY Cal-Valley Equipment Bruce W. Hinsley 661-327-9341 MAILING ADDRESS 3500 Gilmore Ave. Bakersfield, Ca: 93308 Bruce W. Hinsley 661-327-9341 cERTIFICATION #: NACE 8882 DATE 8 TIME TEST TO BE CONDUCTED AUgU8t 2, 2006 13:00 ICC #: SIGNATURE OF APPLIC T ~_ ~~ DATE July 31, 2006 APPROVED BY DATE ~ ~' FD 2095 (Rev. 09/05) } ~.-~~ UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / S8989 SECONDARY CONTAINMENT TESTING !TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMff NO. ~~-~ ~`~ I BAKERSFIELD FIRE DEPT. p~R~ Prevention Services ART~I T 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING n TANK TI(:HTNFSS TFRT _ T(l PERFORM FI IFI MnNITl1RWR CFRTIFIRATI(1` , FACILITY _ ~ NAME 8 PHONE NUMBER OF CONTACT PERSON ADDRESS OWNERS NAME ~ " OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES ^ NO # V L ME CO TENT . D O ~ - `~ ~ r D C~~ r TANK TE$TWG COMPANY .. ..:.... NAME OF TING COM N NAM 8 PHONE NUMB OF C TACT PERSON MAILING DRESS _ /~ !~ ~O v` J NAME 8 ONE NUMBER OF ESTER OR SPECIAL INSPECTOR CERTIFI TION #: DATE & TIME EST TO BE CONDUCTED ~ ~ O ICC #: ~ ~ t _ v, ~ ~ ~ ~ ~ U TEST METHOD SIGNATURE OF APPLIC T ~ ~ DATE 1 - Q ~j APPROVED BY DATE fD 2095 (Rev. 09105) E~ILLING & PERMIT STATEMENT PERMIT NO,: BAKERSFIELD FIRE DEPT. a 3 Prevention Ser-vices P/R6 900 Truxtun Avenue, Suite 210 ARTY T Bakersfield, CA 93301 _Tel.: (6611 526-3979 S Fax: (6611 852-2171 • - ~ • LOCATION OF PROJECT PROPERTY 0 ~ ~ STARTING DATE OMPLETION DATE NAME PROJECT NAME n unL.Q. a c -~-1. ~ c ADDRESS n PHONE NO. y oZ - o S PROJECT ADDRESS CfTY ~ ~~ATE _ n (~ ZIPCODE ~ 33~$ Y • ~- •- • CONTRALTO NAME CA LICENSE NO. TYPE OF LICENSE EXPIRATION DATE PHONE N0. CONTRACTOR C PANY NAME FAX NO. 2~ ADDRESS C ZIP C DE 6 V J • • • ^ Alarms -New & Modifications - (Minimum Charge) $262 50 ~ ~ • . 98 000 Sq Over 20 FL 013125 = Pennit fee FL x Sq ~ 0 . , . . 98 ^ Sprinklers -New & Modifications - (Minimum Charge) $210 00 ~ . 98 ^ Over 5 000 Sq Ft 042 =Permit fee Sq FL x ~ . , . . . 98 ^ Minor Sprinkler Modifications (< 10 heads) $ 93 00 [Inspection Only] ~ . 98 ^ Commercial Hoods -New & Modifications $ 398 26 ~ . 98 ^ Additional Hoods $ 36 00 ~ . 98 ^ Spray Booths -New & Mod cations $458 00 ~ . 98 ^ Aboveground Storage Tanks (InstallaGon/Insp: 1" Time) $165.00 82 ^ Additional Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Removal/Inspection) $109.00 82 ^ Underground Storage Tanks (InstallationJlnspedion) $878.00 (per tank) 82 ^ Underground Storage Tanks (Modfication) $878.00 (persite) 82 ^ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Underground Storage Tanks (Removan $675.00 (per tank) 84 ^ Oilwell (Installation) $ 72.00 84 Mandated Leak Detection (Testin I Fuel Monit. Cert. $ 81.00 (persite) 82 ^ Tents $93.00 (per tent) 84 ^ After I-ours inspection .fee $122.00 84 ^ Pyrotechnic - (Per event, Plus insp. Fee @ $90 per hour) $ 60.00 + (5 hrs. mtn. stand -by fee Mspec6on) _ $510.00 84 ^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) 84 ^ Portable LPG (Propane): NO: OF CAGES? $66.00 ~ ^ Explosive Storage $249.00 ' 84 ^ Copying & File Research (File Research Fee $33.00 per hr) 25¢_ per page ; 84 ^ Miscellaneous : ~ FD 2021 (Rev. 09/05) 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to Flle) 1-PINK (to Customer) E R S F I D F/RE A R TM T April 10, Zoos Mr. Boun Chi Ly EZ Mobile 101 19th Street Bakersfield, CA 93301 RONALD J. FRAZE REMINDER NOTICE FIRE CHIEF Re: Guidelines for Unsupervised Dispensing Gary Hutton, Senior Deputy Chief Deaf Mr. Ly: Administration 326-3650 It has come to our attention that many convenience stores who sell gasoline, like yourselves, are closing late at night. If you are using card readers and leaving Deputy Chief Dean Clason your fuel pumps on, this is defined in the California Fire Code as: "Unsupervised Operations/Training Dispensing." 326-3652 Unsupervised dispensing is allowed when the owner or operator provides, and is Deputy Chief Kirk Blair accountable for daily site visits, regular equipment inspection and maintenance, Fire safety/Prevention services including any unauthorized release or.spills, posted instructions for safe operation 326-3653 of dispensing equipment, and posted telephone numbers for the owner or operator. Signs prohibiting smoking, prohibiting dispensing into unapproved 2101 "x° Street containers and requiring vehicle engines to be stopped during fueling shall be Bakersfield, cA 93301 conspicuously posted within site of each dispenser. OFFICE: (661) 326-3941 FAX: (661) 852-2170 In addition, a sign shall be posted in a conspicuous location reading: In case of spill or release: RALPH E. HUEY, DIRECTOR 1) Use Emergency Pump shut-off PREVENTION SERVICES 2} Report the accident FIRE SAFETY SERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 3) Fire Department Telephone Bakersfield, CA 93301 4) Facility address OFFICE: (661) 326-3979 FAX: (661) 852-2171 During the hours of operation, stations having unsupervised dispensing shall be provided vVith a fire alarm transmitting device. A telephone not requiring a coin to David Weirather operate is acceptable. The fuel leak detection system must have a remote or Fire Plans Examiner phone modem to insure off-site monitoring during hours of unsupervised 326-3706 dispensing. During hours of darkness, sufficient lighting must be maintained so Howard H. Wines Ill that all signs associated with fueling operation are conspicuous and readable. A , Hazardous Materials Specialist gallon container of an absorbent material used for spills must be made available 326-3649 to the public during hours of unsupervised dispensing. Afire extinguisher with a minimum 2A, 2B, and 2C rating must be located on dispenser island during hours of unsupervised dispensing: ..~ax.~in~ die ~ ~ ~ C~~~ ~~.~ ~~~% C~en~~ To: Mailing List of Valued Customers Reminder Notice Re: Guidance for Unsupervised Dispensing April 10, 2006 Page 2 If you are currently having hours of unsupervised dispensing, you must comply with the above-mentioned requirements. . Starting April 15, 2006, this office will conduct random checks of afl fueling stations within the city limits for compliance. If you shut your station down after normal business hours and are not pumping fuel, please disregard this reminder notice. Should you have any questions, please feel free to call meat 661-326-3190. Sincerely, Ralph E. Huey, Director of Prevention Services By: Steve Underwood, Fire Prevention Officer REHJdb E R S F I D F/RE ARTM T RONALD J. FRAZE ~ May 15, 2006 FIRE CHIEF ~ Gary Hutton, ~ Mr. Boon Chi Ly Senior Deputy Chief ' E-Z Stop Market Administration ~ 101 19th Street 326-3650 ~ Bakersfield, CA 93301 Deputy Chief Dean Clason Operations/Training • 326-3652 F~MINDER NOTICE Deputy Chief Kirk Blair ~ Re: Deadline for Three 'Y.ear Cathodic Protection Certification Fire Safety/Prevention Services 326-3653 ~ Dear Mr. Chi Ly: 2101 "H" Street Our records indicate that yvUr three year cathodic protection certification is due on Bakersfield, CA 93301 08-26-06. This test is part ~t your leak detection system as stated in Section 2635 OFFICE: (661) 326-3941 2(a) of the California Code of Regulations, Title 23, Division 3, Chapter 16 FAX: (661) 852-2170 Underground Tank Regulations. Please make every effort to Have this completed by the above-mentioned date. RALPH E. HLTEY, DIRECTOR Failure to comply may result in further enforcement action. PREVENTION SERVICES ~ Should ou have an FlRE SAFETVSERVICES•ENVIRONMENrAI SERVICES i Y y questltills, please feel free to call me at 661-326-3190. 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 Sincerely, OFFICE: (661) 326-3979 FAX: (661) 852-2171 ~ Ralph E. Huey, David Weirather ~ Director of Prevention Servioes Fire Plans Examiner 326-3706 ; f Howard H. Wines, III ~ By: Steve Underwood, Hazardous Materials Specialist ~ Fire Prevention Officer 326-3649 REH/SU/db ~~ u~~~ ~. F/RE ARTM RONALD J. FRAZE FIRE CHIEF Gary Hutton, Senior Deputy Chief Administration 326-3650 Deputy Chief Dean Clason Operations/Training 326-3652 Deputy Chief Kirk Blair Fire Safety/Prevention Services 326-3653 2101 "H" Street Bakersfield, CA 93301 OFFICE: (661) 326-3941 FAX: {661) 852-2170 RALPH E. HLTEY, DIRECTOR PREVENTION SERVICES FlRE SAFETY SERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 OFFICE: (661) 326-3979 FAX: (661) 852-2171 David Weirather Fire Plans Examiner 326-3706 Howard H. Wines, III Hazardous Materials Specialist 326-3649 December 1, 2005 EZ Mobile 101 19th Street Bakersfield, CA 93301 FINAL REMINDER NOTICE RE: Necessary Secondary Containment Testing Requirements by December 31, 2005 of Underground Storage Tank (s) located at the Above Stated Address Dear Valued Customer, Over the last six months this office has continued to send reminder notices regarding secondary containment testing. Code requires that all secondary containment systems must be tested 6 months post construction and every 36 months there after. Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and every 36 months, thereafter, to insure that the systems are capable of containing releases from the primary containment until they are detected and removed. Our records indicate that your facility is due prior to December 31, 2005. Those sites that have not been tested and have not pulled a permit prior to December 31, 2005, will have their permit to operate revoked. This office does not wish to take such action, which is why we will continue to send monthly reminders. Contractors are already booked several weeks in advance. I urge you to schedule your testing date as soon as possible to avoid possible revocation of your permit to operate. Should you have any questions, please feel free to caN me at (661) 326-3190. Sincerely, RALPH . I-IIJEY, Director of Prevention Services ~' Steve Undervvood Fire Prevention Officer SU:db wV~ ~ IC~ 1~~ t/vs~ a.~~~WK/ ~/7K~Ni' t. `k~C~~ C~~~1GW/~ a t' .~ 12/13/2005 09:17 6613920621 i~...x ~' , , . ~ ~~, ~~ ~~; +;. •; ;~~ ~!.;{ ~~ 'fs, •'I ~',~{ ~+' f r~• ~ ~ Y Y A i `Y~ M~'C .d .`',.. r 1 i~;, .~ ~~~; r ZIT- r '~ ~ i w;'~~; ~:~~~ ~~<~~ ~~~ ~.aa ,~r ~' . ~~:: prrr J, agp~a . . ~d Th~a ~ . ~'.~~~ ~:~. * . rte. ~~ ~r~:; ~~:.~ ~~, ,,:. ; ~. ~.: k-:. ;~~ .:, ~~~~ ,~... ~~ :~~~ R~ `y~~:! ~'~~'. PAGE 02104 )1f~S ---_~. 12!13!2005 09:17 '`' t~ ,~ , ~~~ . ~: !4' ~ ~., , tr., f Q ~ ~ Q~~ ~~ . . _ '~~''' FA~~;~TY AID,] ~1y.. 1':~' <-y ~ ~'„~To Y.^s.. ~.. k' ~ i,~ 'i, '~ . ~••• i _ , ~. ~: ;~t .- n., ;: . 6613920621 ~~. s,~,p~ s~,~ a ~~.~ :, a ~ ~ ~ D~,~ :old r~'r ~~ ~. A~~ ~ ~ ~ 'y. ~7~ a ~Y` ..'~ ~y F ~+~ ~~ ` A V I'~' } ~r • • f ~~/ ~ ~ ~~ fff ~ V .f r O ~ ~ ~~~ ~ ~S .~~ ~ - ~~ ~~ ~~ ~ ~.. ~~~: ~--~er Ham. ,.toa'91:~ :, ' ',~ :~ ~~ ~ ' .'4 ~ 'DO ~tlae •` K, + j~ ~ ~ . ~r 2~3 ~ PAGE 03/04 {~~1~ :~l_ 12/13!2005 09:17 6613920621 PAGE 04/04} .;.~. ,t. ,~. r ~:;h . . 4x r:~: r.; f ~.. - . -~~~ t ~ ;r~~..~ i;; ~~,~;, ~M .. •~~7~iL1r7~iis J/ ` ~~ r~y ~9 ~r y~~ 7T ~ ~ JIYiR ~„~ ~ r~ ' + ~~ i ~~R{.r 111 ~ ~ ~ ~.~ fff 1' f~ f ~ ~S/I '~ ~1~ a ~~.• ~~ ~.~J~/fl ~ r/IJ ~~~ ,. ~~ . ~' •~: ' Laid ~ 1i i~~aN ~ O~ : ~~ ,1 ~ ~~ 1 ~; ~ATf~L ~ .~ '~ ~ ~~ ~ J ,: ~ - .~~ ~ .~' +~ ."' GAT ! 1 ~ ;,.~ ~ . ri ~ J • • ..~ 'r~=• , Cx ~, 11~~ ~~yy'~- e {~; [ K}i '' ~ ~ iA' ` . . ~~~ ? =.:- MONITORING SYSTEM CERTIFICATION For Use By.4ll.lurisdictions Within the State of California Authority Cite& Chapter 6 7, Health and Safety Coa'e; Chapter 16, Division 3, Title 23, California Code ofRegulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must,~repare for each rnonitorine system control panel_by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: t/"z-_ STt~p /YlUB~ ~-- Bldg. No.: Site Address: 1d J /9TN ST City: ~ lc-Et~ti ~T~L~1 Zip: Facility Contact Person: lrE.~ Contact Phone No.: { (D/__~ ___l )-_ ~l 7a -`~DS $ Make/Model. of Monitoring System: Tl~,j-~ ;C~ Date of Testing/Servicing: ~ / ~S/~ I3. Ll~~entory of equipment Tested/Certified INSPECTOR ON-SITE: YES/NAME: Check chc anorppriate boxes to indicate specific equipment inspected/serviced: .c Tank II): (J NC.- &~ Tank ID,: ~{~-~(Y~ ~ (~ In-"tank Gauging Probe. Model: r~G`z ~-ln-Tank Gauging Probe. Model: ~[ r9 C-) ^ Anmilar Space or Vault Sensor. Model: ^ Annular Space or Vault Sensor. Model: ~ Yiping Sump /Trench Sensor(s). Model: ~ 7~ Piping Sump /Trench Sensor(s). Model: ~.D $ U Fill Sump Sensor(s). Model: ^ Fill Sump Sensor(s). Model: ~ Mechanical Line Leak Detector. Model: >2-E17 JR~ k--+/T j~-Mechanical Lihe Leak Detector. Model: ~'E /~[r f ICU ^ Electronic Line Leak Detector. Model: ^ EEectronic Line Leak Detector. 1,4odel: ^ Tank Overfill !High-Level Sensor. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Other (s ecif e ui ment t e and model in Section E on Paoe 2 . ^ Other (s ecif e ui ment a and model in Section E on Pa e 2). 'rank IU: ~~~EL ___ Tank ID: ^ in-Tank Gauging Probe. Model: l1'J~C] ^ In-1`ank Gauging Probe. Model: ^ Annular Space or Vault Sensor. Mode]: _ ~ ^ Annular Space or Vault Sensor. Model: ^ Piping Sump /Trench Sensor(s). Model: ~US ^ Piping Sump /Trench Sensor{s). Model: ^ Fill Sump Sensor(s). Model: D Fill Sump Sensor(s). Model: ^ 1\~techanical Line Leak Detector. Model: FE ~ ~ ~ O Mechanical C,ine Leak petector. Model: Cl 8lcctronic Line Leak Detector. Model: ~ Electronic Line Leak Detector, Model ^ Tank Overt711 /High-Level Sensa•. Model: O Tank Overfill /High-Level Sensor. Model: - ^ Othe+- (specify equipment type and model in Section E on Page 2). t] Other (specify equipment type and model in Section E on Page 2). Uispenser ID: ~_ -~ Dispenser ID: ~`1 ^ Dispenser Containment Sensor(s). Model: _ /~U ~t/i.1,~UgS ^ Dispenser Containment Sensor(s). Model: AI'U }~j(i\ ($ Shear Valve(s). i~.Shear Valve(s). ' ^ Dis enser Containment Floats and Chains . D Dis enser Containment Floats and Chains . Uispenser tD: ~(o Dispenser ID: ~-8 ^ Dispenser Containment Sensor(s). Mode(: ~U v~ i:~^ SOK _ ^ Dispenser Containment Sensor(s), Model; /~.loj SE.nJ3~~ l~ShcaY Valve(S). .~ $heaC ValVe(S). ~Dispensor_Containme.nt Float(s) and Chain(s). D Dis enser Containment Floats and Chain s}. Dispenser !D: 9-/Q Dispenser ID: // - /~, ~ O Dispenser Containment Sensor(s). Model: ~D ~ G.~~j(L D Dispenser Containment Sensor(s). Model: ~~~E~/,~, ~ ~-Shear Valve{s}. f2~Shear Valve(s). ^Dispcnser Containment Float(s) and Chain(s). ^Dis enser Containment Floats and Chain(s). "If the facility contains more tanks or dispensers, copy this form. Include in formation for every tank and dispenser at the far.llirv C. CCrti~Citt1022 - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is Information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, t have also athtchcrt :i copy of the repa-t; (check al! char apply~r -System set-up f2~ Alarm history report 'T'echnician Name (print): ,~a~-tJ l~U "-5 /1~A~.1_'~ Signature: ~_....~ 1 Ce:ri.itication l~'o.: _f3~~ 3~~ License. No.: ~$~-t~$G-~ ~ 't'esting Company Nanre: RICH ENVIRONMENTAL Phone No.: ~ 661 ) 3,~ 2-868] Site Address: /U~ / g j t{ ~ l ~~__~ ~~1, ~;~ E~ t L~ Date of Testing/Servicing: ~/ ~/ r17 Page 1 of 3 031U1 Monitoring System Certification D, Results of TestinglServicing Software Version Installed: ~~.U C~mm~lata fha rnllnwina rhP~klict! Yes D o Is the audible alarrn o erational? ®- Yes O o Is the visual alarm o erational? E;~-Yes D o Were all sensors visually ins ected, functionally tested, and confin-ned o erational? Yes O o Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? O Yes D o Ifalarlns are I•elayed to a remote monitoring station, is all communications equipment (e.g. modem) ~ N/A operational? ~- ~'es ~7 o For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment O N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? Ifyes: winch sensors initiate positive shut-down? (Check all that apply) 1~-Sump/Trerich Sensors; ^ Dispenser Containment Sensors. Did you confirm positive shut-down duexo leaks and sensor failure/disconnection? $Yes; ^No. ^ Yes ^ ~ o For tank. systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no ~`N/A mechanical overfill prevention valve is installed), is the ove~ll warning alarm visible and audible at the tank fit! point(s) and operating properly? if so, at what ercenT of tank capacity does the alarm tri ger? Q Yes ~No Was any monitoring equipment replaced? Ifyes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re iacement arts in Section E, below. O es No Was liquid found inside any secondary.containment systems designed as dry systems? (Check all that apply) O Product; O Water. If es, describe causes ili Section E below. Yes D o Was monitorin s stem set-u reviewed to ensure ro er settin s? Attach set u re orts, if a licable j ~_ Yes ^ o is all monitoring equipment operational per manufacturer's specifications? * In Scction G below, describe Ilow and when these deficiencies were or. will be corrected. E. Comments: /1~C~ ~~~~ ,J~~~ ~ ~ 12E .Tn~~ 11~~ .~..^J ~~ ~ P ~ t~sot2-LS ~5 -s-~ T zo ~S ~J ~ ~ ~~~ i a r~ ~~ J ~ ~s ~,~ ,z~ T~s ~ A ~ r~ . Page 2 of 3 03101 I-'. In-Tank Gauging /SIR Equipment: ^ Check this box if tank gauging is used only for inventory control. ^ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform 1ei31c detection monitoring. (`r. nlafv f6w rnllnwino nh nrt[lict• ,~'~Yes O o Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ~. Yes O o Were all tank gauging probes visually inspected for damage and residue buildup? ~ Yes ^ o Was accuracy of system product level readings tested? E~ Yes ^ ° Was accuracy of system water level readings tested? ~ Ycs O o Were all probes reinstalled properly? ~- Yes ^ o Were all items on the equipment manufacturer's maintenance checklist completed? * ]n the Section H, below, describe how and when these deficiencies.were or will be corrected. G. Line Leak Detectors (LLD): Complete the followiue checklist: O Check this box if LLDs are not installed. ~- Yes ^ Not For equipment start-up or annual equipment certification, was a leak simulated to verify I,LD performance? ^ N/A (Check a!! that apply) Sil~~ulated leak rate: ~-;; g.p.h,, O 0. I g,p.h , O 4.2 g.p.h. Yes O o Were all LLDs confirmed operational and accurate within regulatory requirements? .Yes ^ o Was the testing apparahis properly calibrated? ~ Ycs ^ o For mechanical LLDs, does the LLD restrict product flow if it detects a leak? O N/A O Yes ^ o For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ~ N/A O Ycs ^ o .For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ~ N/A or disconnected? ^ Yes ^ o 'For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions .I'~.N/A or fails a test? O Yes O o ~'or electronic LLDs, have all accessible wiring connections been visually inspected? .1~NlA Yes ^ o Were all items on tl~e equipment manufacturer's maintenance checklist completed? m me ~ectron tt, detow, describe how and when these deficiencies fvere or will be corrected. SET. Comments: Page 3 of 3 a31o1 " LG 163-1, Enc. II Monitarlrig System Cerkiflcation Forra: Addendtun for VacunmlPressure Interstitial Sensors Y. Results of VacuumlPressure IVlonitoring Equipment Testing This page should be used to document testing and servicing of vacuum atxd piessure interstitial sensors. A copy of this form must be included with the Monitoring 'System Certification Form, which must bc'~providcd to. the tank system owner/operator. The owner/operator must,submit a copy of tlic Monitoring Systems Certification Form to the local agency regulating UST systems within 30 days of test date: . Model; System Type: Pressure; ^Vacuum Manufacturer; •Sensor TD Component(s) Monitored by this Senror: Sensor Functionality Tcst Result: ^ Pass; II Fail Interstitial Communication Teat Result: ^ Pass; ^ Fail Component(s) Monitored by this Sensor: ~ ' Sensor Functionality Test Result: II Pass;' ! ~] Fail Interstitial Communication Test Result: ^ Pass; ^ Fail' Component(s)Monltored by this Sensor: Sensor Functionality Test Result: II Pass; ~^ Fail Tntcrstitial Communication Test Result: ^ Pass; ^ Fail Component(s) Monitored by this Sensor: • SensorFunctionslity Test Result: ^ Pass; ^ .Fail Interstitial Communication TestRcsult: ^ Pass; ^ FaiI ' ' Component(r) Monitored by thlr Sensor: S ensor Functionality Test Result: ^ Pass; ~ ^ Fail ]Cntrsstitial Communication Test Result: []Pass; D Fail Components} Monitored by thls.Sensor: ~ ' Sensor Functionality Test Result: ^ Pass; ^ Fail Interstitial Communication Test Result: ^ Pass; ^ Fail Component(s) Monitored by•this Sensor: ~ ' Stusor Functionality Test Result: ^ Pass; ^ Fail Interstitial Communication Test Result: ^ Pass; ^ Fail Component(s) Monitored by this Sensor: Scissor Funptionality Test Result: ^ Pass; ^ .Fait • Interstitial Conimunication'Test Result: [] Pass; ^ Fail Component(s) Monitored by this Sensor: Sensor Functionality Tort Result: ^ Pass; ^ Fail ~ Interstitial Communicatioti Test Result: ^ Pass; ^ Fail Cgmponeat(c) Monitored by this Sensor: ' ScusorFunctionality Test Result: ^ Pass; ~ Fail Interstitial Communication Test Result: ^ Pass; ^ Fail IIow was lntercfitial communication verified? • .^ I.cslc Iniroduccd •at Far End of Interstitial Space; ^ Gau e; ^ Visual Inspection; .^ Other (Describe in Sec. J, below) Vacuum was restored to operatin~leveIs In all interstitial spACes: ^ Yes. ^ No (jfno, describe in Sec. J, below) J. Comments: Pale of ~ If the sensor successfully detects a simulated. vacuumJpressure leak introduced in the interstitial space at the furthest paint frpm thG scsasor, v:iCUtuu~pressurc has been demonstrated t0 be communicating thtOttghout the interstice. Monitoring System Certification UST Monitoring Site Plan Site Address: J01 1 ~ N ~`~'~ t. ~~ 1~-~ ~'__ t T c _ _ _--- ---- ---~----------~-- 1---------- - -H - - - - - - - - - - - _ - .. - _ _ _ _ ~ ~ .. - - ~ - - - - _ - - - - _ 4o ~ _ --------- --- `a' ---------- ~ ---------- - - -------------- - ---L~.rJ-----------------:~. - -. ---- ----y-------------~j----------- - -a :===:== ==- =========:-.-=================== Date map was drawn: ~/aj/~ Ins'-actions If you already have a diagram that shows alI required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment; if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes {if used for leak detection). In the space provided, note the date this Site Plan was prepared. Page ~ of ~-( ostoo ?` 56~k3 HR.O(?KS 0<,t' ~RSFxF~.ia,C.A.933Q8 oFFTCE (661.) 392&~87 & FAX (fi61,) 392^0621 I rac7~u ~N~~m . W/0#: Faa :1.1 ~. ~y Name ~ ~ Z ~~TO~. /~7U~s ~. FaG:I.~.~.~~ .Addx~ss: ~ / T+t 4-r ~. ,~A k~~~,F~~-~~.~~. .~;:. Pr4e;lue~C L,~,rze T~a~ (Pressuxe, Buctiazt, ~3xav~.ty} ~F.~~2C=•----~----- PRClpUC~' LEAK DE'1?ECTO~ TX~E 'T'EST TFxTP PARS; s~i~ ~avz~aa~z~ a~x,ow Psz o~ I.fA 'Z'"7fQ~ !"-~ s1..~C-K•~'T` Cj P.A,s .3~k2Z.A.~, # t~~~cNA~c.A~L D14 /a FA,ZI.~ 9 / I S~Ft.T.A.~ #,,.L?~Fd N R~r~A(_ ~(j I S FATLI ~~. T.~n 2Y'pE_ r~~ ~-O ~ ~z.~ s~xx.R.z, # m~~A.vz~~ xo ~~ sazz~ ~, /~~ T''.~P~ SC~S PASS' S~I2~1'~, ~-..- NQ FAXL X ::extify tlae abo~~e tests were conducted on tkxis Batts aoaaxdzng to fed ~:faa3cet Puxn~s ficlrl Lest a•ppa.rar_us test~,ng pro.cedux~a an lirnitat~.ans, Tki~sr Meck~anir.al. z,eak ~Ptect.or. Te~St ,pass / fa~.Z is determined by using a la~,r flaw thresk~ald trip rate cif 3 gallon per kzour ox' less at 10 k~ST. I •s~cknowledce t~Zat a1.1. data co].leceed ie h.xue and aorraat to tk~e best a£ rsf~ knowledgge . xe CkT, : ~F-A~/ ~O •~~_~1 HAS U ^-~ s igzi:~ Cure : _~ -~ _ Date : ,2ot.5 -U 7 •. i SWRCB, Jan 20~ . SpiIl~Bucket Testing Report Form This form Ls intended jot use by contractors perforrr~ing annual testing, of 1'IS"1'spill containment structures. •The completed form at; printoutrfromsests (fapplicable), should beprovided to the facility:owner/operatorforsubmittal to the local regulatory agency. • , ~erTr.Ti'V TNFCIRMATION ` `. • FacilityNatnc: ~Z- T P t --~-- Date of`Tcstin,g: 7-~5--0 7• Facility Address: /o / T -r t~ ~~ GfA Facility Contact ~,~ Phone: (~/ •- LI - ~-( U Date Local Agency Was Notified of Testing :: ~ ' Name of Local Agency Inspector (rfpresent during testing}: ~ Np iV ~~ •..• 2. TESTING CONTRACTOR INFORMATION. • Company Name:~x-'--t-c-.++ ~~~s{Lr~nJ ~~~Qt_~ :• .. . Tcohnician Conducting TcsG g lz tl ~ ~ .•~ /'Il ~ x~ Credentials: CSLB Contractor.. SWRCB Tank Tester. Other (S ec~) License Number(s): ~-s Q a - v ~ . . 3. SPI7,L BUCKET TESTING INFORMA.TYON Test Method Used: c Vacuum ~ Other Test Equipment Used: 1/S~ tS A L Equipmeu~ Resolution: Identify Spill Bucket (ByTank Number, Stored Product, etc. 1 ,g' ~ 2 ~ 1 3 ~~~~ ~ ~ 4 Bucket I~ostallation Type: uect B Contained in Sum acct Contained in Sum ir•ect B Direct Bury Contained in Sum Contained in Sum BuckctDiamcicr. /a'~ la~' /''' Bucket Depth: /(~~ ~ /!~ ~ ` . !~ Wait tuna between applying vacuum water and start of test: c30 Y>?,F"^f ~ 1"~ . • Ln1 Test Start Time (T~: 9.'~j rrl r-'1 • Initial Reading (R,); ' . ~ ~ i r 9. , . . Test End Timc (Tp): ~ ~~; ,q,~ l0.- / : . Final Reading (Rn}: ti • 9 ~ ~ •~ Test Duration (TF - Til: !/ 2 !z- / K~ • Change in Reading (Rp - R~: p ~ ~ p : ~ ~ 0 ~ , PasslFaIl Threshold or Criteria: C~ `~ ~ " . • Q' ,, . • Comments - (utclude'tnformallon on repairs made prior to testing, anti recommended follow~up fo>~ailed tests') • CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTIIVG I hereby certrfy.that all the information contained u: this report is true, accurate; and in full compliance with legal requirements. Tecllniciaq's Signature:,'~~~' ~~~----_-.--- ~ Date: ~~ -b 7 ~ State laws and regulations do not currently require testing to be pCt'fOlt3lCd by a qualified contractor- However, local requiretnezsts maybe mnrt stringent, SOFTWARE REVISION LEVEL VERSION ]5.0.1 SOFTWHREti 346015-100-H CREATED - 97,10.23.08.56 NO SOFTWARE MODULE S'lSTE1~1 FEATURES : PERIODIC IN-TANK TESTS ANNUAL I N-TAIVY, TESTS SYSTEM SETUP JUL t5, 2007 12:14 PM- r SYSTEM UNITS U.S. SYSTEM LANGUAGE E rdGL I SH SYSTEI~i GATEiT I h9E FORMAT t°IO IV DD Y'!Y'! HH : MM : SS xl'1 19TH STREET MOBIL 101 19TH STREET BAKERSFIELD CA 805-631-1049 SHIFT T I hlE 1 1 1:00 PM SHIFT .TIME 2 : DISABLED SH I F'f T I h1E 3 n I'SABLED - SHIFT TIME 4 : pISAHLED TANK PERIODIC WARNINGS DISABLED TANK ANNUAL WARNINGS DISABLED LINE PERIODIC WARNINGS DISABLED LINE ANNUAL WARNINGS DISABLED PR[NT TC VOLUMES ENABLED TEMA COMPENSATION VALUE (DEG F >: 60.0 STICK HEIGHT OFFSET DISABLED DAYLiu^HT SAVING TTME ENABLED START DATE APR WEEK 1 SUN START TIME 2:00 AM END DATE OGT WEEK .6 SUN EIVD T 1 ME 2:00 AM SYSTEM SECURITY CODE OOQ000 COhIMUN I CAT I OIVS SETUP PORT SETTINGS: NONE FOUND RS-232 SIrCUR I TY CODE 000000 RS-232 END OF MESSAGE DISABLED IN-TANK SETUP T 1:UNLEADED PRODUCT CODE 1 THERMAL COEFF :.000700 TANK DIAMETER 96.00 TANK PROFILE 1 PT FULL VOL 6000 FLOAT SIZE: 2.0 IN. 8496 WATER WARNING 2.0 H[GH WATER LIMIT: 3.0 MAX OR LABEL VOL: 6000 OVERFILL LIMIT 90% 5400 HIGH PRODUCT 95% 5700 DELIVERY LIMIT 10% . 600 LEAK MIN PERIODIC: 0% . 0 LEAK MIN ANNUAL : 0% . D PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST S I PHOIV 9REAK :OFF DELIVERY DELA`! l 5 N1 I IV T 2:SUPER PRODUCT CODE 2 THERMAL COEFF :.G00700 TANK DIAMETER 96.00 TAfVK PROFILE 1 PT FULL VOL : 6000 FLOAT S12E: 2.0 IN. 8496 WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 6000 LOW PRODUCT 500 OVERFILL LIMIT 90% LEAK ALARM LIMIT: 99 5400 SUDDEN LOSS LIMIT: 50 HIGH PRODUCT 95% TANK TILT 3,00 5700 DELIVERY LIMIT 10% MANIFOLDED TANKS 600 Tat: NONE LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 2.50 I°1AIV I FOLDED TANKS T~: NONE LEAK MIN PERIODIC: 0% a LEAK MIN ArJNUAL O% . 0 PERIODIC TEST TYPE STANDARD AIVIJUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM D I SAI3LED HNN TEST AVERAGINr,; OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TIVK TST SIPHON BREAK:OFF DELIVERY DELAY 15 MJN PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 15 MIN T 3:DI£SEL PRODUCT CODE THERMAL COEFF : 3 LEAK TEST METHOD . 000450 - - - - - - - - - - - - TANK DIAh1ETER TANK PROFILE 82.00 TEST DAILY ALL TANK 1 PT FULL VOL 4000 START TIhIE 12:00 AM TEST RATE :0.20 GALiHR FLOAT SIZE: 2. 0 IN . 8496 DURATION 2 HOURS WATER WARNING 2.0 HIGH,WATER LIMIT: 3.0 LEAK TEST REPORT FORNIAT h1AX OR LABEL VOL: 4000 NORMAL OVERFILL LIMIT 9pi HIGH PRODUCT • 3600 95i DELIVERY LIMIT ~ • 3800' 100 • 400 LOW PRODUCT 325 LEAK ALARM LIMIT: 9g SUDDEN LOSS LIMIT: 50 TANK TILT l.20 LIQUID SENSOR SETUP f°1ANIFOLDED TANKS _ - ~ - - ~ - - - - - Tu: NONE I, 1:UNLEADED STP TRI-STATE (SINGLE FLOAT) LEAK MIN PERIODIC: pa CATEGORY STP SUNIP . 0 LEAK MIN ANNUAL 0% L 2:SUPER STP TRI-STATE <SINGLE FLOAT) ~ CATEGORY STP SUMP OUTPUT RELAY S);TUP R I:UNLEADED TYPE; STANDARD NORMALLY CLOSED I N-TArVK ALARMS T 1:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 1:FUEL ALARM L 2:FUEL HLARM L i:SENSOR OUT ALARM L 2:SENSOR OUT ALARM L 1 :SHORT ALARf°1 L 2:SHORT ALARh1 R 2:SUPER TYPE : STANDARD NORMALLY1 CLOSED IN-TANK ALARMS T 2:LOW PRODUCT ALARfh LIQUID SENSOR ALh1S L 1:FUEL ALARM L 2:FUEL ALARM L 1:SENSOR OUT ALARM L 2:SENSOR OUT ALARM L 1:SHORT ALARM L 2:SHORT ALARM R 3:DIESEL TYPE: STANDARD NORMALLY CLOSED IN-TANK ALARMS T 3 :LOW PRODUCT ALAkf~1 LIQUID SENSOR ALMS L 3:FUEL ALARM L 3:SENSOR OUT ALARM L 3:SHORT ALARf~I R 4:SONITROL ALARM TYPE: STANDARD NORMALLY OPEN LIQUID SENSOR ALMS ALL:FUEL ALARM L 3:DIESEL STP TRI-STATE (SINGLE FLOAT) CATEGORY : STP SUMP ALARM HISTORY REPORT ---- 1 N-TANK ALARI°1 ------ T (:UNLEADED HIGH WATER ALARf°I f°1AY 4• 1998 7: 1 1 PM MAY 4. 1998 7:01 PM OVERFILL ALARM JUN 19. 2007 7:46 PM JUN 17. 2007 11:4b PM JUN 15. 2007 9:02 PM LOW PRODUCT ALARM ' FEB 2. 2007 5:12 PM ` JAN 2. 2007 5:57 PM OCT 23. 2006 6:52 PI°1 SUDDEN LOSS ALARf°1 JUL 22. 2007 1:28. AM JUL 15. 2007 1:22 Ah9 JUN 24. 2007 1:04 AM HIGH PRODUGT ALARM FEB 24. 2007 2:35 AM JAN 5. 2007 9:13 PM D£C: 29. 200E 12:15 AM INVA LID FUEL LEVEL SEP 5. 2006 5:34 PM MAY 5. 2006 4:31 PM MAY 3. 2006 11:53 AM PROBE OUT JAN 24. 2005 1:12 PM DEC 3. 2004 9:12 AM DEC 22. 2003 11:36 AM HIGH WATER WARNING MAY .4. 2998 7:11 PM MAY 4. 1998 7:01 PM DELIVERY NEEDED FEB 2. 2007 4:44 PM JAN 2. 2007 5:36 PM OCT 23. 2006 5:37 PM MAX PRODUCT ALARf~I DEC 29. 2006 12:21 AM DEG 30. 2005 7:57 PM AUG 14. 2005 3:15 AM LOW TEMP WARNING DEC 3. 2004 9:23 AM OCT 16. 1999 3:15 AM MAY 4. 19913 7:52 PM ALARM HISTORY REPORT ---- IN-TANK ALARIH --'_- T 2:SUPER H 1 GH WATER ALARIH OCT 27. 1999 6:19 PM OVERFILL ALARM MAR 7. 200? 8:20 PN1 JUL 20. 2006 6:16 PM JUN 29. 2006 10:29 PM SUDDEN LOSS ALARM FEB 12. 2006 1:43 AM HIGH PRODUCT ALARI~f AUG 19. 2002 2:18 A~'1 APR 27• ?999 12:00 AM INVALID FUEL LEVEL OCT 27. 1999 6:00 PM MAR 28. 1999 1:41 AM PROBE OUT DEC 3. 2004 9:05 AM HIGH WATER WARNING OGT 27. 1999 6:19 PM DELIVERY NEEDED 4CT 27. 1999 6:49 PM OCT 27. 1999 5:59 PM MAR 27. 1999 4:08 PM LOW TEMP WARNING DEC 3. 2004 9:10 AM ~ ~ 3~ * x END ~ ~ x ~ x x * * ~ END ~ x ~ ~ ~ - ALARM HISTURY REPURT ALARM HISTURY REPORT ---~ I!V-TANK ALARM ----- ----- S1=NSUR A LARM ----' L 2:SUPER STP T 3:DIES£L STP SUMP FUEL ALARM HIU^H WATEk ALARM JUL 25, 2007 9:40 AM AUG 1 , 2000 8:37 PI°I hiAR 26, 1999 1:26 PM FUEL ALARM JUL 27, 2006 1:54 PM UVERFILL ALARM JUL 5. 2007 12:41 AM. FUEL ALARM JUL 3, 2007 8:41 PM ~ AUG 25, 2005 7:34 Aly JUN 26, 2007 11:07 Pty SUDDEN LUSS ALARM OGT 15, 2005 1:19 AM ` HIGH PRODUCT ALARly _... SEP 29, 2003 8:23 Afy SEP 1 , 2GG3 9 : 93 AM FEB 17, 2003 10:54 Ahl INVALID FUEL LEVEL * * * x ~ ENU ~ AUG 1. 2000 5:27 PM APR 12. 1999 2:48 PM MAR 26. 1999 12:56 PM HIGH WATER WARNING AUG 1, 2000 8:37 PM N1AR 26, 1999 1:26 PM DELIVERY NEEDED SEP 5, 2000 5:58 FM AUG 2, 2000 II:06 AM AUG 1, 2000 3:01 PM, ~ x x ~ END ~ ~ x ~ ~ ALARM HISTURY REPURT S£NSi7R ALARM L !:UNLEADED STA STP SUMP FUEL ALARM JUL 25, 2007 9:40 AM FUEL ALARM JUL 27. 200b 1:53 Ply FUEL ALARM DEC 29, 2004 11:05 HM ALARM HISTURY REPURT SENSOR ALARM L 3:DIEBEL STP STF SUMP FUEL ALARM JUL 25. 2007 9:43 AM FUEL ALARM JUL 27. 2006 1:51 FM FUEL ALARM AEC 29, 2004 10:54 AM ~*x*~EraD**~~* MONITOR CER.T: ~'AIL~;rRE REPORT ATE i~TAME• ~a hrnP h?~~itr DATE: 7-~ - ~~ ADDRESS' /UI ~ 9TH 5s ~ TECH1yICIAN: ~~ ~~~•( iYJr9:~ ~ , CTTY::, v~ ..z- ~ S GNATURE: ~--- . THE FOLLOWING CODH'ONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. . REPAIRS ~ 1 ft Z" ~ ~ tt ,~ ~ ~ ~ SSP ~-nl~a (Z pig n1 S~~(ZS yTArS~,r> ~ G ~ 7 i Q ~ H AJ ~ ~ ~ ~~~ ~ ~T - ~nlS PEc,TcXZ l~ r~ L2 i ~3 ~.~ rffi ~~ Tv CrJ (~1 P1.- `~ _______. LABOR: ~U ~ E PARTS:INTALLED: ~ a ~~ NAME: TITLE; SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO RAVE CORRECTIVE ACTION TAKEN TO REPAIR TIIE ABOVE LISTED PROBLEMS AND NOT.C~'YING RICH ENVIItONMANTAL FOR ANY NEEDED RETESTIlV'G. TffiS AL5O RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON-COMPLIAI~ICE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON-BYTE FOR YOUR CO t' I~IENCE. UNDERGROUND570RAGETANKB APPLICATfON TO PERFORM ELD /LINE TESTING ! SB989 SEGONDARY CONTAINMENT TESTING !TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMrf N0. BAKERSFIELD FIRE DEPT. ~~~~ Prevention Services AR.lrr' T 900 TrLlxtun Ave., Ste. 210 Bakersfield; CA 93301 Tel.: (661) 326-3979 /;,~ Rax: (661) $52-21711 Pagelofl ~'~~ q •, c~U~w ^ ENHANCED LEAK DETECTION ^ LINE TESTING _ _._. ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ;~`~~ TO PERFORM FUEL MONITORING CERTIFICATIO FACILITY ~• NAM ~ PHONE NUMB OF CONTACT P SON ADDRESS ' O ~ ~~~ ~ r ~~ ~~ ^~ ~ ^ ' OWNERS NAME ~ OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED I PIPIN OIN T 7 7ED7 Y ^ ~ 10 o Oc~ l.;c-~C_ - 2-- O _ r...~ ,- ,_ TANff:;TESTING COMPANY NAME OF TESTING OMP Y ~ ~ `~~Y-~/ ~ NAME b PHONE NUMBE OF GQNTACT~,QN~(- C~ ~ ,C? MAILING AD E5 ~.r ~ NA 8 PHON NUMBER O TESTER OR SPEC AL INSPECTOR ~ CERT1FiCATION ii: DATE $~IM.E TE~T T BE U t~000TEO ~ i ICC ft;~~ ~ (J TEST METHOD SIGNATURE OF APPLICANT '' DATE __ ~..-~ / ~-7 DATE FD 2095 (Rev. 09/05) ~ff~LING ~ PERMIT STATEMENT BAKERSFIELD FIRE DEPT. Prevention Services ,_,,,,,,,T_ MfRii 900 Truxtun Avenue, Suite 210 PERMiT NO.: A~rM r Bakersfield, CA 93301 LOCATION OF PROJECT ~ -~ sTARrwcOATe coM ATE D~ PROJECT NAME ~OP~TM ° ~ _ _._ Nt~e ~'l~~„ n ADDRESS ~~ PHONE N0. ~~ PROJECT ADDRESS ~ ~ C • CRY ` STATE ~~ i aY °~ ""~ . J • • ' • - • l~_-.11- ..CONTRACTOR NAME ~,* CA t]CENSE NO. , TYPE OF LICENSE EXPIRATION DATE Z1P CODE ~ r~•~ °.~yl~ . Via. PHONE N~n '~ 7 CONTRACTOR COMPANY NAME - FAX NO• C ADDRESS ~~ ~ ~ 1 .^'+~ CfrY Z1P COD ~ O ~'^ ' i $262 50 Mi h l ti • 4 _, ~ ons - ( n arge) A mum C arms -New & Modifica . 98 Ft O 20 000 S 013125 =Permit fee FL x S ~ ^ ver g. . , . q. 98 ^ r ation Mi Ch dif i S ri kl N & M $210 00 ~ ge) a ic s - ( mum p n ers - ew n o . 98 __ _ ^ Ft O 000 S 5 042 =Permit fee F>~ x S ~ q. . ver , . q. 98 ^ Minar S rinkler Modifications (< 10 heads) 00 [Inspection OnIyJ $ 93 ~ p . 98 ^ Commeraa! Hoods -New & Modifications $ 398 26 ~ . 98 ^ Addltiona! Hoods $ 36 00 ~ . 98 _ ^ ~ Spray Booths -New & Modifications $458 00 ~ . 98 ^ Aboveground Storage Tanks (lnslallationllnsp.-1 Time) $165.00 82 ^ Additional Tanks $ 26.00 82 ^ Aboveground Storage Tanks (RemovaUtnspedion) $109.00 _ 82 ^ Underground Siorage Tanks (lnstallationJlnspedion) $878.00 (per tank) 82 ^ Underground Storage Tanks (Modification) $878.00 (persite) 82 ^ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Underground Storage Tanks (Removan $675.00 (per tank} 84 ^ Oilwell (Installation) $ 72.00 ~ 84 Mandated Leak Detection (Testin } /Fuel MoniL Cert. $ 81.00 (per site) 82 ^ Tents $ 93.00 (pertent) 84 ^ After hours inspection fee $122.00 ~ 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour) $ 60.00 + (5 hrs. min. stand -by tea nnspedion) _ $510.00 t34 ^ RE-1NSPECTION(S) /FOLLOW-UP 1NSPECTiON(S} $ 93.00 (per hour) 84 ^ Portable LPG (Propane): NO. OF CAGES? $66.00 84 p Explosive Storage $249.00 84 ^ Copying $ File Research (File Research Fee $33.00 per hr) 25¢ per page , ~ ^ Miscellaneous s 84 FD 2021 (Rev. 09VD5) 1 -ORIGINAL WHITE fto Treaaurvl 1-YELLOW tto Flle1 i-PttJK Ito Customer)