Loading...
HomeMy WebLinkAboutBUSINESS PLAN (2)~ N ~ ~ d C d a ,, ~~ ~~ ~ ~ C ~. PANAMA-BUENA VISTA UN SCH DIST Manager KAY LACKEY Location: 4200 ASHE RD City BAKERSFIELD SiteID: 015-021-001196 BusPhone: (661) 831-8331 Map 123 CommHaz Moderate Grid: 15C FacUnits: 5 AOV: CommCode: BFD STA 09 SIC Code:8211 EPA Numb: DunnBrad: _G IF fAl 1 Emergency Contact. / Title Emergency Contact / Title BRENDA LOWE / SAFETY COORD / ASST SUPT Business Phone: (661) 831-8331x Business Phone: (661) 831-8331x132 24-Hour Phone (661) 978-9099x 24-Hour Phone (661) '_'~~x~5$- Pager Phone (661) 978-9099x Pager Phone ( ) - x Hazmat Hazards: Fire React ImmHlth DelHlth Contact FRED RECLUSADO Phone: (661) 831-8331x MailAddr: 4200 ASHE RD State: CA City BAKERSFIELD Zip 93313 Owner PANAMA-BUENA VISTA UN SCH DIST Phone: (661) 831-8331x Address 4200 ASHE RD State: CA City BAKERSFIELD Zip 93313 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A HAZMAT EN ' = PROG H - HAZ WASTE GEN p ~~~ ® ~ T PROG T ABOVEGROUND STORAGE TANK 007 PROG U - UST C3ased on my inquiry of those individuals responsir~le- fr~r oktaining the information, !certify under penalty of lake that I have personally examined and am familiar with the information Su~amifiter and s,alieve the information is true, accurate, and complete, ~1~7 _ Si n t g a ur Date >e I -1- 07/13/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: PANAMA-BUENA VISTA UN SCH DIST Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper AARON KOOP {RICH ENVIRN} ICC Nbr: 5246167-UC PROPERTY OWNER INFORMATION Name Phone: Address : ~EIZ~IE rCI~LQCA-iD City State: Zip: Type LOCAL AGENCY DISTRICTS TANK OWNER INFORMATION Name 6~tE ~~~~~ Phone: Address: City State: Zip: Type LOCAL AGENCY DISTRICTS (661) 831-8331x132 (661) 831-8331x132 BOE UST Fee# 031874 Financ'1 Resp: SELF INSURED Legal Notif Date:05/30/2006 Phone: (266) 183-3136x0 Name:VICKI STALNAKER Ttl:TRANSPORTATION MANAGER State UST # 1998 Upg Cert#: -2- 07/13/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 q ~ Hazmat.Inventory By Facility Unit ~ ~ MCP+DailyMax Order GARAGE ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE ANTIFREEZE DH L 90.00 GAL Mod FUEL CONDITIONER F DH L 55.00 GAL Mod ANTIFREEZE DH L 220.00 GAL Low MOTOR OIL F DH L 110.00 GAL Min -3- 07/13/2007 ~' , F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order SERVICE CENTER ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED GASOLINE F DH L 12000.00 GAL Mod RUBBER CEMENT F DH L 63.00 GAL Mod DIESEL F DH L 12000.00 GAL Low WASTE OIL F DH L 500.00 GAL Low MOTOR OIL F DH L 350.00 GAL Min -4- 07/13/2007 F PANAMA-BUENA VISTA UN SCH DIST ~ Hazmat Inventory ~ MCP+DailyMax Order SiteID: 015-021-001196 ~ By Facility Unit ~ WAREHOUSE ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP CLEANER E DH L 900.00 GAL Mod ALLSTAR EXTRACTOR F DH L 300.00 GAL Mod INNOVATION DH L 600.00 GAL Min STRIPPER F IH DH L 400.00 GAL UnR -5- 07/13/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax-Order TRANSPORTATION ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP GEAR LUBE F R IH L 100.00 GAL Min MOTOR OIL F R IH L 100.00 GAL Min -6- 07/13/2007 -7- 07/13/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Inventory Item 0004 Facility Unit: GARAGE ~ COMMON NAME / CHEMICAL NAME WASTE ANTIFREEZE Days On Site 365 Location within this Facility Unit Map: Grid: GARAGE NW CRNR OF BLDG CAS# 107-21-1 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste ~ Ambient ~ Ambient DRUM/BARREL-NONMETAL AMOUNTS AT THIS LOCATION Largest Con55~00rGAL Daily M90ioom GAL I Daily A90r00e GAL tiHGlittLVUJ 1;V1~lYV1VJ;1V1J oWt. RS CAS# Ethylene Glycol No 107211 Sodium Hydroxide No 1310732 Diethylene Glycol No 111466 t1HGYitCL L~JJJ;JJ1~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME FUEL CONDITIONER Location within this Facility Unit NW CRNR GARAGE Facility Unit: GARAGE ~ Days On Site 365 Map: Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixtur~mbient ~ Ambient DRUM/BARREL-METALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 30.00 GAL I1HGt1ttLVUJ I.VP'lYV1VL'1V1S %Wt. RS CAS# 50.00 Mineral Oil No 8020835 50.00 Naphtha Solvent No 8030306 IlEiGL•itCL HJ JP~JJ1~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod -8- 07/13/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Inventory Item 0003 Facility Unit: GARAGE ~ COMMON NAME / CHEMICAL NAME ANTIFREEZE Days On Site 365 Location within this Facility Unit Map: Grid: GARAGE NW CRNR OF BLDG CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Liquid TMixture ~ Ambient ~ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION , Largest Container Daily Maximum Daily Average 55.00 GAL 220.00 GAL 220.00 GAL rit~Gt1KLVUJ ~vl~irvlvlJlV l~ owt. Rs cAS# Ethylene Glycol No 107211 Sodium Hydroxide No 1310732 Diethylene Glycol No 111466 ti1~GHtCL E~~7 w7 L' .7.71~11"i1V l J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Low ~ Inventory Item 0001 COMMON NAME j CHEMICAL NAME MOTOR OIL Location within this Facility Unit NW CRNR GARAGE Facility Unit: GARAGE ~ Days On Site 365 Map: Grid: CAS# Liquid TMixture~Ambient~E ~ AmbientT~E DRUM/BNARRELEMETALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 110.00 GAL ~ 60.00 GAL t11~G1~i1'CLV U.7 1:U1~lYV1V~1V 1 J oWt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 riHGEitCL 1~J~1;.7.71~1L"1V1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min -9- 07/13/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Inventory Item 0002 Facility Unit: SERVICE CENTER ~ COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: E EDGE OF PROP CAS# 1634-04-4 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~Ambient ~ Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL 5000.00 GAL HAZARDOUS COMPONENTS °sWt. RS CAS# 100.00 Gasoline No 8006619 rlri[~tuCL tiJ JP~J Jl"1P~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod ~ Inventory Item 0006 Facility Unit: SERVICE CENTER ~ COMMON NAME / CHEMICAL NAME RUBBER CEMENT Days On Site 365 Location within this Facility Unit Map: Grid: SECOND ROW BINS N END CAS# 110-54-3 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture T Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 63.00 GAL 30.00 GAL HAZARDOUS COMPONENTS oWt. RS CAS# 85.00 Hexane No 110543 rlti4tiiCL L'iJ JL' JJ1"1rJ1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod -10- 07/13/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Inventory Item 0001 Facility Unit: SERVICE CENTER ~ COMMON NAME / CHEMICAL NAME DIESEL Days On Site 365 Location within this Facility Unit Map: Grid: E EDGE OF PROPERTY CAS# 68476-34-6 Liquid TMixtur~ AmbRent~E ~ AmbientT~E -~EROGROIINDRTANKE AMOUNTS AT THIS .LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00_ GAL 5000.00 GAL nt~~tucLVUa wi~ir~lv~tvla oWt. RS CAS# 100.00 Diesel Fuel No. 2 No 68476302 riAGHKL AS~L'~JJ1~1L1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME WASTE OIL Location within this Facility Unit E OF GARAGE = Facility Unit: SERVICE CENTER ~ Days On Site 365 Map: Grid: CAS# f 1 221 ~iquia Twaste ~ Ambient~E ~ A~PeRATURE ~DEROGROIINDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 500.00 GAL 500.00 GAL 250.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Waste Oil, Petroleum Based No 0 ntiat-~rcL r-~~ a~~ai~i~lyt~ TSecret RS BioHaz RadioactivejAmount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low -11- 07/13/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Inventory Item 0004 Facility Unit: SERVICE CENTER ~ COMMON NAME / CHEMICAL NAME MOTOR OIL Days On Site 365 Location within this Facility Unit Map: Grid: N END OF GARAGE CAS# 64741-88-4 Liquid TMixture ~mbient~E ~ AmbientT~E ABOVEOGROIUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 350.00 GAL 350.00 GAL 200.00 GAL rlr-~~~xLUUS c:uriruiVl~;iV"1"~ %Wt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 riAGHhCL AS~L'~~~1~1i51V"15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / f / Min -12- 07/13/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Inventory Item 0006 Facility Unit: WAREHOUSE ~ COMMON NAME / CHEMICAL NAME CLEANER Days On Site DMQ SPARTAN 365 Location within this Facility Unit Map: Grid: E WALL CAS# 141-43-5 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 900.00 GAL 250.00 GAL HAZARDOUS COMPONENTS %Wt• RS CAS# 1.50 Monoethylamine Yes 75047 . 3.00 Tetrasodium EDTA No 67401507 5.00 Xylene Sulfonic Acid No 1300727 rlti4tiRL liJ JP~J J1"1P~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod ~ Inventory Item 0003 Facility Unit: WAREHOUSE ~ COMMON NAME / CHEMICAL NAME ALLSTAR EXTRACTOR Days On Site 365 Location within this Facility Unit Map: Grid: E WALL CAS# 107-98-2 STATE TYPE PRESSURE TEMPERATURE ~~ CONTAINER TYPE Liquid TMixture ~mbient ~ Ambient I PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 300.00 GAL 150.00 GAL HAZAR DOUS COMPONENTS oWt. RS CAS# 5.00 1-Methoxy-2-propanol No 107982 3.00 Nonoxynol No 26027383 nti[~tiRL H JJI;J J1~11;1V 1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod -13- 07/13/2007 F PANAMA-BUENA VISTA UN SCH DIST ~ Inventory Item 0005 COMMON NAME / CHEMICAL NAME INNOVATION CVS NIGHTLINE Location within this Facility Unit E WALL Map: STATE TYPE PRESSURE TEMPERATURE Liquid TMixture ~mbient ~ Ambient = SiteID: 015-021-001196 ~ Facility Unit: WAREHOUSE ~ Days On Site 365 Grid: CAS# 111-77-3 CONTAINER TYPE PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 600.00 GAL 200.00 GAL I1HG1-iCCLVU~J 1.V1~lYV1Vt',1V1w7 owt. Rs cAS# 7.00 Glycol Ether PM Acetate No 0 16.00 Acrylic Copolymer No 0 ns~at~u~L r~. ~aaa~ri~lvt~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Min ~ Inventory Item 0004 Facility Unit: WAREHOUSE ~ COMMON NAME / CHEMICAL NAME STRIPPER Days On Site L.O.E. 365 Location within this Facility Unit Map: Grid: E WALL CAS# 112-34-5 Liquid Mixture PRESSURE ~ TAE~MPeRATURE CONTAINER TYPE T -~ Ambient -I PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 1.00 GAL 400.00 GAL 200.00 GAL - ruaur-iru~v~a ~.vrirvivr~ilTS - %Wt• RS CAS# 32.00 2-(2-n-Butoxyethoxy)ethanol No 112345 7.00 Monoethanolamine No 141435 rlt'1G~t]2CL tiw 7 w7 P~~7 J1.1L'1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / UnR -14- 07/13/2007 ~ . F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Inventory Item 0001 Facility Unit: TRANSPORTATION ~ COMMON NAME / CHEMICAL NAME GEAR LUBE Days On Site 365 Location within this Facility Unit Map: Grid: NW CRNR OF SHOP CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Liquid TMixture ~mbient ~ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 100.00 GAL 60.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 t11~GHttL E~55~~51~1J;1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F R IH / j / Min ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME MOTOR OIL Location within this Facility Unit NW CRNR OF SHOP STATE TYPE PRESSURE Liquid TMixture ~mbient = Facility Unit: TRANSPORTATION ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE CONTAINER TYPE _ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 100.00 GAL 60.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 t1tiGEittL L~Jar,JJ1~1L"~1V 1 7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F R IH / / / Min -15- 07/13/2007 ` { F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 12/06/1999 ~ CALL 911. Employee Notif./Evacuation 02/23/1990 CALL CITY FIRE DEPT AT 324-4542 OR 911. EVACUATION WOULD BE BY PERSONAL CONTACT OF EMPLOYEES. Public Notif./Evacuation 08/13/1997 NOTIFY EMPLOYEES BY PERSONAL CONTACT WITHIN THE SERVICE CENTER AREA/ALSO ANY VISITORS THAT MAY BE ON PROPERTY. Emergency Medical Plan 05/09/2007 MERCY SOUTHWEST HOSPITAL, 400 OLD RIVER RD, 663-6000, OR HALL AMBULANCE SERVICE, 6201-A SCHIRRA CT, 327-4111. -16- 07/13/2007 t rr F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 08/13/1997 ~ MATERIALS AND FUEL STORED IN APPROVED TANKS AND CARTONS IN METAL CABINETS CLEANUP OF SPILLS WOULD BE DONE BY APPROVED AGENCIES. MATERIALS STORED IN BOXES ON PALLETS. MATERIAL IS IN SMALL CONTAINERS AND COULD BE CONTAINED BY OUR EMPLOYEES ON SITE. Release Containment L..L CGL11 V~J V 1.11G.L itG.7V UJ. l.:C 1"~V LIVCLL1V11 -17- 07/13/200? e T F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards Utility Shut-Offs 05/09/2007 GAS - NW CRNR OF UNIT A PARKING LOT NEAR DRIVEWAY ELECTRICAL - SE CRNR OF UNIT A BLOCK WALL ENCL WATER - SIDEWALK S OF UNIT A W OF DRIVEWAY SPECIAL - FIRE SPINKLER RISER SE OF UNIT C Fire Protec./Avail. Water 02/05/2007 PRIVATE FIRE PROTECTION - FIRE ALARM AND FIRE EXTINGUISHERS. FIRE HYDRANT.- FIRE PLUG SE CRNR ASHE RD & SCHIRRA CT 60FT S OF BLDG. Building Occupancy Level 11/29/2006 70 EMPLOYEES -18- 07/13/2007 t -. 1 :',i F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 06/26/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: MATERIAL SAFETY DATA SHEETS AT ALL WORK LOCATIONS AND TRAINING OF PERSONNEL IN THE USE OF PRODUCTS. rc~yC ~ Held for Future Use nciu ivi ru~.utc vac -19- 07/13/2007 _ __ _ _ _ _ . I+ ( 'n + ~' ~- ~j t r 4Q !/ F PANAMA-BUENA VISTA UN SCH DIST J SiteID: 015-021-001196 Manager KAY LACKEY Location: 4200 ASHE RD City BAKERSFIELD CommCode: BFD STA 09 EPA Numb: BusPhone: (661) 831-8331 Map 123 CommHaz Moderate Grid: 15C FacUnits: 5 AOV: SIC Code:8211 i DunnBrad: Emergency__Contact_ / Title Emergency Contact / Title E J~ ~~{~ _ . LL 1,t ~ ~ ; / SAFETY COORD KIP HEARRON / ASSISTANT SUPT Business Phone: (661) 831-8331x ~ Business Phone: (661) 831-8331x132 24-Hour Phone (661) 978-9099x 24-Hour Phone (661) 619-1494x Pager Phone (661) 978-9099x Pager Phone ( ) - x Hazmat Hazards: Fire React ImmHlth DelHlth Contact KE~T~s Fi2~ fLECLV5~p1p~j Phone: (661) 831-8331x 1~3 MailAddr: 4200 ASHE RD State: CA City BAKERSFIELD Zip 93313 Owner PANAMA-BUENA VISTA UN SCH DIST Phone: (661) 831-8331x Address 4200 ASHE RD State: CA City BAKERSFIELD Zip 93313 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG T - ABOVEGROUND STORAGE TANK PROG U - UST t3ased on my inquiry of those individuals responsible for obtaining the informati I on. c~;rtify under penalty of lavr that I have personaii y examined and am familiar with the information submitted and believe the information is t ~N~°D MAC" ~® rue, accurate, and complete. g ZpQ~ k_._7 ignatu ~~ D Dat e -1- 02/05/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: PANAMA-BUENA VISTA UN SCH DIST Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper AARON KOOP {RICH ENVIRN} ICC Nbr: 5246167-UC PROPERTY OWNER INFORMATION Name KIP HEARRON Phone: (661) 831-8331x132 Address: City State: Zip: Type LOCAL AGENCY DISTRICTS TANK OWNER INFORMATION Name KIP HEARRON Phone: (661) 831-8331x132 Address: City State: Zip: Type LOCAL AGENCY DISTRICTS BOE UST Fee# 031874 Financ'1 Resp: SELF INSURED Legal Notif r.~., , ~.,.~, , , r,, , Date:05/30/2006 Phone: ~166T~8.'~~~0 Name:VICKI STALNAKER Ttl:TRANSPORTATION MANAGER State UST # 1998 Upg Cert#: -2- 02/05/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order GARAGE ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE ANTIFREEZE DH L 90.00 GAL Mod FUEL CONDITIONER F DH L 55.00 GAL Mod ANTIFREEZE DH L 220.00 GAL Low MOTOR OIL F DH L 110.00 GAL Min -3- 02f05f2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order SERVICE CENTER ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED GASOLINE F DH L 12000.00 GAL Mod RUBBER CEMENT F DH L 63.00 GAL Mod DIESEL F DH L 12000.00 GAL Low WASTE OIL F DH L 500.00 GAL Low MOTOR OIL F DH L 350.00 GAL Min -4- 02/05/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order WAREHOUSE ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP CLEANER E DH L 900.00 GAL Mod ALLSTAR EXTRACTOR F DH L 300.00 GAL Mod INNOVATION DH L 600.00 GAL Min STRIPPER F IH DH L 400.00 GAL UnR -5- - 02/05/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order TRANSPORTATION ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP GEAR LUBE MOTOR OIL F F R IH R IH L L 100.00 100.00 GAL GAL Min Min -6- 02/05/2007 -7- 02/05/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Inventory Item 0004 Facility Unit: GARAGE ~ COMMON NAME / CHEMICAL NAME WASTE ANTIFREEZE Days On Site P 365 Location within this Facility Unit Map: Grid: GARAGE NW CRNR OF BLDG CAS# 107-21-1 Liquid TWaste ~ Ambient~E ~ AmbientT~E DRUM/BNARRELENONMETAL~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 90.00 GAL 90.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# Ethylene Glycol No 107211 Sodium Hydroxide No 1310732 Diethylene Glycol No 111466 17riGtiiCL tiJ JL~JJI•IP~IVIJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod ~ Inventory Item 0002 Facility Unit: GARAGE ~ COMMON NAME / CHEMICAL NAME FUEL CONDITIONER ~~ Days On Site 365 Location within this Facility Unit Map: Grid: NW CRNR GARAGE CAS# Liquid TMixtur~ AmbRent~E ~ AmbientT~E DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 55.00 GAL 55.00 GAL 30.00 GAL c~urucLV V a `.vrirvlvr~ly 1 S %Wt. RS CAS# 50.00 Mineral Oil No 8020835 50.00 Naphtha Solvent No 8030306 17C1l~tiCtL tiJ JP~J J1.1L~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod -8- 02/05/2007 F PANAMA-BUENA VISTA UN SCH DIST ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME ANTIFREEZE Location within this Facility Unit GARAGE NW CRNR OF BLDG STATE TYPE PRESSURE Liquid TMixture ~mbient SiteID: 015-021-001196 ~ Facility Unit: GARAGE ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE CONTAINER TYPE _ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 220.00 GAL 220.00 GAL t~1H~tirc.uvu~ ~vl~lrvlvlily 15 %Wt. RS CAS# Ethylene Glycol No 107211 Sodium Hydroxide No 1310732 Diethylene Glycol No 111466 riAGHKL AJJL"~7~1~1L'~1V'1'~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Low ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME MOTOR OIL Location within this Facility Unit NW CRNR GARAGE Facility Unit: GARAGE ~ Days On Site 365 Map: Grid: CAS# Liquid TMixture ~mbient~E ~ AmbientT~E DRUMjBNARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 55.00 GAL 110.00 GAL 60.00 GAL riAGEitCLVU~ 1:V1~lYV1ViS1Vlb ~Wt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 t3tiGH1CL LiJ 51;.7.71~11;1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min -9- 02/05/2007 r F PANAMA-BUENA VISTA UN SCH DI$T SitelD: 015-021-001196 ~ ~ Inventory Item 0002 Facility Unit: SERVICE CENTER ~ COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit 'f Map: Grid: E EDGE OF PROP CAS# 1634-04-4 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~mbierit ~ Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL 5000.00 GAL rir~~t~,tcLV~S ~vi~irviv~lvl~ %Wt. RS CAS# 100.00 Gasoline No 8006619 tll'~GHKL 1j~J~~51~1J'!i1V l5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod ~ Inventory Item 0006 Facility Unit: SERVICE CENTER ~ COMMON NAME / CHEMICAL NAME RUBBER CEMENT ,(C,, Days On Site III/' 365 Location within this Facility Unit Map: Grid: SECOND ROW BINS N END CAS# 110-54-3 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture 7 Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 63.00 GAL 30.00 GAL ntiGlittuVU.7 ~..vrirvlyL'1v17 %Wt. RS CAS# 85.00 Hexane No 110543 tltiGtlttL 1-~J 7r,~al~l~lv17 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod -10- 02/05/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Inventory Item 0001 Facility Unit: SERVICE CENTER ~ COMMON NAME / CHEMICAL NAME DIESEL ~ Days On Site 365 Location within this Facility Unit /Map: Grid: E EDGE OF PROPERTY CAS# 68476-34-6 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~mbient ~ Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL 5000.00 GAL HAZARDOUS COMPONENTS $Wt. RS CAS# 100.00 Diesel Fuel No. 2 No 68476302 i1tiL~riCCL tiJ ~7 L' J ~J1.1L' 1V 1 iJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low ~ Inventory Item 0003 Facility Unit: SERVICE CENTER ~ COMMON NAME / CHEMICAL NAME WASTE OIL Days On Site 365 Location within this Facility Unit / Map: Grid: E OF GARAGE CAS# 221 Liquid TWaste ~ Ambient~E ~ AmbientT~E ~ UNDER GROIUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 500.00 GAL 500.00 GAL 250.00 GAL - HAZARDOUS COMPONENTS °sWt. RS CAS# 100.00 Waste Oil, Petroleum Based No 0 HAZARD A SSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low -11- 02/05/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Inventory Item 0004 Facility Unit: SERVICE CENTER ~ COMMON NAME / CHEMICAL NAME MOTOR OIL Days On Site 365 Location within this Facility Unit ~ Map: Grid: N END OF GARAGE CAS# 64741-88-4 Liquid Mixture PRESSURE ~ TAEmbMPeRATURE CONTAINER TYPE T ~ Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 350.00 GAL 350.00 GAL 200.00 GAL nHG1ixLV U.7 ~.vrirvlv~ly t a oWt. RS CAS# 100.00 Motor Oil, Petroleum Based No 802-0835 ISLiGtiCCL LiJ .7~.7.71~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min -12- 02/05/2007 F PANAMA-BUENA VISTA UN SCH DIST ~ Inventory Item 0006 COMMON NAME / CHEMICAL NAME CLEANER DMQ SPARTAN Location within this Facility Unit E WALL STATE TYPE PRESSURE Liquid TMixture ~ Ambient Map: TEMPERATURE Ambient = SiteID: 015-021-001196 ~ Facility Unit: WAREHOUSE ~ Days On Site 365 Grid: CAS# 141-43-5 CONTAINER TYPE PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum ` Daily Average c~~1~T~'~~nes~SiZts"~~.o~ GAL 900.00 GAL I 250.00 GAL r1ti~~cl~VUa ~:Vl~lr~lv~lvl~ %Wt. RS CAS# 1.50 Monoethylamine Yes 75047 3.00 Tetrasodium EDTA ~ No 67401507 5.00 Xylene Sulfonic Acid No 1300727 riAGE1KL A~SL"~~a1~1L"~1V'1'~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod ~ Inventory Item 0003 Facility Unit: WAREHOUSE ~ COMMON NAME / CHEMICAL NAME ALLSTAR EXTRACTOR Days On Site 365 Location within this Facility Unit Map: Grid: E WALL CAS# 107-98-2 Liquid TMixture T Ambient~E ~ AmbientT~E ~PLASTOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average ~~~~{-~-~-n'~ ~ i2~ 3 0 0. 0 0 GAL 3 0 0. 0 0 GAL 15 0. 0 0 GAL t3 E' E riHGtitCLVUA 1:V1~lYV1V1;1Vlb %Wt. RS CAS# 5.00 1-Methoxy-2-propanol No 107982 3.00 Nonoxynol No 26027383 t1E~GEiKL H. 7.7 L" .7 J1~1L' 1V l J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod -13- 02/05/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Inventory Item 0005 Facility Unit: WAREHOUSE ~ COMMON NAME / CHEMICAL NAME INNOVATION Days On Site CVS NIGHTLINE 365 Location within this Facility Unit Map: -Grid: E WALL CAS# 111-77-3 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient ~STIC CONTAINER AMOUNTS AT THIS LOCATION ~~+~La~ Ss?~Co4tainerG~ Daily 600100m GAL Daily 200r00e GAL TTT ATTlT1/1TTA lT/~TRTI/11~TTTTTTA ruiur~Rl~vv~ ~.vrlrvlvalvlJ %Wt. RS CAS# 7.00 Glycol Ether PM Acetate No 0 16.00 Acrylic Copolymer No 0 IILiGL-iLCL HJ JP~JJP7P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Min ~ Inventory Item 0004 Facility Unit: WAREHOUSE ~ COMMON NAME / CHEMICAL NAME STRIPPER Days On Site L.O.E. 365 Location within this Facility Unit 'Map: Grid: E WALL CAS# 112-34-5 Liquid Mixture AmbRentURE TEMPERATURE ~STOCTCONTAINERE T ~- ~ Ambient ,.A-NIOUN'TS AT THIS LOCATION a Lamest Containe Daily Maximum Daily Average ~'~'r ~ Z'e 5 0 GAL 4 0 0. 0 0 GAL 2 0 0. 0 0 GAL ,~ 1,.c~us~rtLV V.7 L.Vl•lr VlV rtv 1 J - - %Wt. RS CAS# 32.00 2-(2-n-Butoxyethoxy)ethanol No 112345 7.00 Monoethanolamine No 141435 rLCiL~riRL tiJ Jl~J J1.11j1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / UnR -14- 02/05/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ ~ Inventory Item 0001 Facility Unit: TRANSPORTATION ~ COMMON NAME / CHEMICAL NAME GEAR LUBE Days On Site 365 .Location within this Facility Unit Map: Grid: NW CRNR OF SHOP CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient DRUM/BARREL-METALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 100.00 GAL 60.00 GAL riAGHKLVU~ l.:Vi~lYV1VL'1V1"J %Wt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 r1~~tucL ta~,~~aal~i~iv_1.~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F R IH / / / Min ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME V MOTOR OIL Location within this Facility Unit NW CRNR OF SHOP STATE TYPE PRESSURE Liquid Mixture ~ Ambient Facility Unit: TRANSPORTATION ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE CONTAINER TYPE _ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 100.00 GAL 60.00 GAL nriGt-LrcLV V ~ ~.V1Y1rv1V r,1V l ~ %Wt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 tiHGtiCCL ti. 7~J1:,~77P71.S1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F R IH / / / Min -15- 02/05/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 12/06/1999 ~ CALL 911. Employee Notif./Evacuation 02/23/1990 CALL CITY FIRE DEPT AT 324-4542 OR 911. EVACUATION WOULD BE BY PERSONAL CONTACT OF EMPLOYEES. Public Notif./Evacuation 08/13/1997 NOTIFY EMPLOYEES BY PERSONAL CONTACT WITHIN THE SERVICE CENTER AREA/ALSO ANY VISITORS THAT MAY BE ON PROPERTY. Emergency Medical Plan 06/26/2006 W~iI-~E-i-n~3d~-M~rD~`-~~-~CE;v3-E~.Z ~ s'4b3-Wi~~i~~; -~63~-=-2.O.DIZ , OR HALL AMBULANCE SERVICE, 6201-A SCHIRRA CT, 327-4111. ~ ~ e~ Souk-~, ~~ i ~~P~-~.-- ~ pt~ dL~ ~t~ P~(' ~ D ~<03 -!a~® -16- 02/05/2007 F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 08/13/1997 ~ MATERIALS AND FUEL STORED IN APPROVED TANKS AND CARTONS IN METAL CABINETS CLEANUP OF SPILLS WOULD BE DONE BY APPROVED AGENCIES. MATERIALS STORED IN BOXES ON PALLETS. MATERIAL IS IN SMALL CONTAINERS AND COULD BE CONTAINED BY OUR EMPLOYEES ON SITE. Release Containment, :; dean up V1.11C1 iCC .~V UI CLC Lytr l.lVdl.l Vll -17- 02/05/2007 a~ ~ ~~ F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ aNCC:1d1 rid'GdLUS Utility Shut-Offs 11/29/2006 A) GAS - NW CRNR OF UNIT A PARKING LOT BY~DRIVEWAY B) ELECTRICAL - SE CRNR OF UNIT A BLOCK WALL ENCL C) WATER - SIDEWALK S OF UNIT A W OF DRIVEWAY D) SPECIAL - FIRE SPINKLER RISER SE OF UNIT C E) LOCK BOX - NO Fire Protec./Avail. Water 02/05/2007 PRIVATE FIRE PROTECTION - FIRE ALARM AND FIRE EXTINGUISHERS. FIRE HYDRANT - FIRE PLUG SE CRNR ASHE RD & SCHIRRA CT 60FT S OF BLDG. Building Occupancy Level 11/29/2006 70 EMPLOYEES -18- 02/05/2007 t w -. ', 4 t ~ F PANAMA-BUENA VISTA UN SCH DIST SiteID: 015-021-001196 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 06/26/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: MATERIAL SAFETY DATA SHEETS AT ALL WORK LOCATIONS AND TRAINING OF PERSONNEL IN THE USE OF PRODUCTS. rciyC G nciu tvt ru~.utc vac ~ ~ r _ •aciu i.vi i~u~..uic vac -19- 02/05/2007 '~ ~- ~ x ~. Prevention Services UNIFhEC~ PROGRAM INSPECTION CHECKLIST ' B E R s F . _D 900 Truxtun Ave., suite 210 - --- -------- ____.~__ ~. ~ ~___m_~ _._ __ _ _ ___ Fief Bakersfield, CA 93301 SECTFON 1: Business Plan and Inventory Program ~' ABTM ~ Tel.: (661) 326-3979 li ~ Fax: (661) 872-2171 -~\ I FACI^LI~TY NAME ~l {~M A ~''~` N~ t . 4 ~ -'-l d~n SC~OD 6 S'Ir~ G ~ INSPE (f~I TI~D/AT~Ej ~ t Cep INSPEC~1QN TIME {je' ADDRESS Z~ A~~- PHONE NO. ~3, -~.3 - O OFEMPLOYEES `7c7 ~5~ FACILITY CONTACT _. BUSINESS ID NUMBER 15-021- l' 6 / Vi Section 1: Business_F~lan and Iinvenfory Program ^ ROUTINE ~ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=Comprance~ OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE ~ ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ~-c..A,~ ~ - -'r ~Z.~,~ fn, ~'~~'~~ ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~~O ^ EMERGENCY PROCEDURES ADEQUATE ~j 5 QQ ~[ / _ ^ CONTAINERS PROPERLY LABELED I ~/ t l~ ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: 1 ~ I„~ ` n YES ~JO ner-Dula QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 .~~1~~y Inspector (Please Print) Fire Preventio / 1~` In /Shift of Site/Station # Business Site I Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 ,°~,~ ~OQ~T- -~~ ~ CITY OF BAKERSFIELD FIRE DEPARTMENT w yk'~' CA4 /~' FACILITY NAME~I~n~ Arm A Na ~' es~a t~h+~oa S~ INSPECTION DATE ~ ~ Section 4: Ilazardous Waste Generator Program EPA ID # G~ ~ ~A ~~ ^ Routine l~j Combined ^ Joint Agency ^MultI-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ]D Number Authorized for waste treatment an or storage Reported release, fire, or explosion within 15 days of occurrence ~~ may-,,, Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal ~=~ompuance v=vto+anon Inspector: =~~---- Office of Environmental Services (661) 326- 979 White -Env. Svcs. ~ OFFICE OF ENVIRONMENTAL SERVICES b •y UNIFIED PROGRAM INSPECTION CHECKLIST y'' ti ~ 1715 Chester Ave., 3'd Floor, Bakersfield, CA 93301 Pink -Business Copy i~~ Business Site Responsible Party • - -'~, INSPECTIONS ~~ ~~ - B E R S F I L D BUSINESS PLAN 8~ ~ TM r INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: ~-n~Pa~A ~wA ISM u^~ua sG1,W1 a~:~-~G~i Section 2: Underground Storage Tanks Program INSPECTION DATE:~~ ^ Routine Q1`p Combined ^ Joint Agency ^ Multi-Agency ^ Complaint ^ Re-Inspection Type of Tank ~ `~ 5~~.. Cfc~ -F,C~, Number of Tanks Type of Monitoring Type of Piping_:~?2EssLL~~ .~ OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current V 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 ~tJo 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 OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill I overspill protection? C =Compliance V =Violation Y =Yes N"= No Inspector: ~'°~'~~~-^---- ~' G"~ Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 Business Site Responsible Party Pink -Business Copy KBF-7335 FD 2156 (Rev. 09/05) ,. ~;: + PANAMA BUENA VISTA UN SCH DIST ______________________ SiteID: 015-021-001196 Manager i "n T~~+~- K-~~ (~C.IC~ BusPhone: (661) 8 33~-~6-! ~~Z.~ Location: 4200 ASHE RD Map 123 CommHaz High City BAKERSFIELD Grid: 15C FacUnits: 5 AOV: CommCode: BFD STA 09 EPA Numb: SIC Code:8211 DunnBrad: Emergency Co tact / Title Emergency Contact / Title ~0w ~fl / SAFETY COORD K~ ~ µ~fl2~n ~ fls~si, 5t~~ E~tn'tE1l I Business Phone: 661) 831-8331x@',29 Business Phone: (bbl ) $31 -8331 x 13~ 24-Hour Phone (661) 832-7458xg7$-4d`~ 24-Hour Phone (bbl )6~i~{ - /~g~x Pager Phone (661) 3~9~2x 17$-969 Pager Phone (bpi ) - x Hazmat Hazards: Fire Press React ImmHlth DelHlth Contact MailAddr: 4200 ASHE RD City BAKERSFIELD Phone: (,661) 831-8331x State: CA Zip 93313 Owner PANAMA BUENA VISTA UN SCH DIST Phone: (661) 831-7700x Address 4200 ASHE RD State: CA City BAKERSFIELD Zip 93313 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG T - ABOVEGROUND STORAGE TANK PROG U - UST THIS SITE CONTAINS UNDERGROUND STORAGE TANKS. A JOINT INSPECTION IS REQUIRED. PLEASE GIVE THIS OFFICE AT LEAST 5 DAYS NOTICE PRIOR TO SCHEDULING THIS INSPECTION. Based on my inquiry of those individuals responsible for obtaining the information; I oertlfy under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ~~~ Date ignature ENT'D JUN 2 6 2006 ~~ -1- 04f03f2006 ~~ ~S .: UNIFIE® PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Aept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY N E _. INSP~TICyN DATE INSPECTION TIME ADDRESS PHONE No. No. of Employees -----~-'~~~ -- ~-------.~-- -- ~3 (~ $x.31. __ _ _ S'c~ _ _ Business ID Number FACILITYCONTACT I 15-021- 6 Section 1: Business Plan and Inventory Program ^ Routine t~Combined O Joint Agency ^Mnlti-Agency ^ Complaint ^ Re-inspection C V \V=Vioatlonncel OPERATION J COMMENTS L~'Ll PERMIT ON HAND APPROPRIATE O L~ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE L~/ C^ VISIBLE ADDRESS CY ^ CORRECT OCCUPANCY ~ ^ V L~ ERIFICATION OF INVENTORY MATERIALS E-~~ ^ VERIFICATION OF QUANTITIES _ ^ V _ ' ~ ERIFICATION OF LOCATION ° " ~ J S ~ ~ [" ~~ ^ PROPER SEGREGATION OF MATERIAL " ^ V MSDS ERIFICATION OF AVAILABILITYE LT ^ VERIFICATION OF HAT MAT TRAINING ~^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED Li U ("IOUSEKEEPING ^ F P ^ IRE ROTECTION S . ITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE: ^ YES ^ NO EXPLAIN: QUESTION REGARDING THIS INSPECTION? PLEASE CALL US AT ~G6'I~ 326-3979 - ~`~ Inspector Badge No., White -Environmental Services Yellow - Statbn copy Business Site Responsible Party Pink -Business Copy -~ .~ ~+'~~` `~'~~>~ CITY OF BAKERSFIELU FIRE DEPARTMENT d ~ • b~ OFFICE OF ENVIRONNIF.NTAL SERVICES `° y~' UNIFIED PROGRAM INSPECTION CI~ECKL.IST _wF'' gti,,!';~ 1715 Chester Ave., 3r`' Floor, Bakersfield, CA 93301 FACILITY NAME 1'ri4v~~,¢.~~.~ ~L~IrS~ Sl'~[-~~ INSPECTION DATE Section 2: Underground Storage Tanks Program ^ Routine Combined ^ Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection Type of Tank ' ^ ' S Number of Tanks ~ _ Type of Monitoring ._ ~. ~Fl~ Type of Piping ~C,'t,." OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data un the Permit fees current Certitication 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 the with OF,S Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overtill/overspill protection'? C=Compliance n V=Violation Y=Yes N=NO Inspector: v '' L.~ J Office of Environmental Services (661) 326-3979 white - Finv. Svcs. i ~~ Business Site Responsible Party Pink -Business CoPv UNIFIED PROGRAM INSPECTION CHECKLIST; ;. i°~':.as~".k u'~~'S~~: ~+~~~^°a.`;nv~_ ~.a...ie...+./~~.t_. Y"S- ~ ,., -i~.^./NG~ .i-..... aw+.,':'...4. .'.. .x:ed .,: S. ,r.4 ..:'.'T.~.. .,r ~. ,. t:.ir ....: SECTION 1: Business Plan and Inventory Program BAKERSFIELD FIRE DEPT a Prevention Services ~~t~ 900 Truxtun Ave., Suite 210 ~wrr s Bakersfield, CA 93301 '~ Tel.: (661) 326-3979 Fax: (661) 872-2171 FACIL AME (~ ~ ~ ~t NSPECTION DATE -r~s~ 0 zC INSPECTION TIME 1; /mil r.~ vt,L,a„L ~Ina~wt..9- v~, ~ ADDRESS ~~ ~ ~ ~ F~O~ ~NO.~ ~ ~ ~ B O OF EMPLOYEES FACILITY CONTACT /-~ ~ri ~ ~ ~T ~~iZ_-- USINESS ID NUMBER 15-021- ~ j ~j Section 1: Business Plan and Inventory Program ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION r 1 C V ~ C=Compliance OPERATION V=Violation COMMENTS (~ ^ APPROPRIATE PERMIT ON HAND I~ ^ BUSInt3SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ..,,/ LR ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION C3~ ^ PROPER SEGREGATION OF MATERIAL I~` ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND OCEDURES P R + / Lrf ^ EMERGENCY PROCEDURES ADEQUATE l~ ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION I~ ^ SITE DIAGRAM ADEQUATE ~ ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: ~ ~ T ~- ~~ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 16' In /Shift of Site/Station # GVPES ^ NO White -Prevention Services Yellow -Station Copy Pink - Bueinesa Copy FD2049 (Rev. 02/05) ~. ~ - ~ MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of Cali ornia Rttthority Cite& Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Tit e 23, California Code ofRegulations This form trust be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepare for each monitoring 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: ~ '1,. U'C.ti]I'4VS~?-A Bldg. No.: Site Address: t{a@7Q) rA~",F}r City: 3a\C.>/2.£~~'~~ Zip: Facility Contact Aerson: Contact Phone No.: (_,__.} Make/Mode! of Monitoring System: T_S._S Date of Testing/Servicing: a / 1 ®~• B. Inventory of equipment Tested/Certified INSPECTOR ON-SITE. YES/ O NAME: ~ICERs, F~Z~ ('herb the unnrnnriafe hnvec rn Ill ftlf. efe ST)BCItIC [Olnnril ent 7nSDCCICd/SCrVICed: * if the f[ciliry contains more tanks or dispensers, copy this form, include information for every tank and dispenser at the facility. Q~.P•,rLCI~{Z g`} Txnk ID: Txnk 1D: ~i~-S~.l.- __ _ ~-in-Tank Gauging Probe. Model: t11AC~ '~In-Tank Gauging Probe. Model. ~~Prt.~ ~iAnnular Spacc or Vattlt Sensor. Model: a ~-Annular Space or Vault Sensor. Model: ____ ~-{>iping Sump / "3"tench Sensor(s). Model: -Piping Sump /Trench Sensor(s). Modal: ^ Fill Sump Sensor(s}. Model: ^ Fill Sump Sensor(s). Model: 'Mechanical Lint Leak Detector. Model: Ctt£T ~-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 (s ecif a ui ment t e and model in Section E on Pa e 2 . ^ Other (s ecif a ui men[ a and model in Section E on Pa a 2). Tank lD: ("~~~~- OZZ_ Tank 1D: ~hl-Tank Gauging Probe. Model: ~gCo ^ In-Tank Gauging Probe. Model: ~ Annular Space or Vault Sensor. Model: ~~ ^ Amlular Space or Vault Sensor. Model: (] Piping Sump /Trench Sensor{s). ModeL• ^ Piping Sump /Trench Sensor{s). Model: Q Fill Sump Sensor(s). Model: ^ Fill Sump Sensor(s). Model: (~ Mechanical Line Leak Detector. Model: ^ Mechanical Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: ^ Tattk Overfill /High-Level Sensor. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Other (specify equiptnettt type and model in Section E on Page 2). ^ Other (specify equipment type and model in Section E on Page 2). Dispeuser ID; ` !!~ Dispenser ID: 3 j Dispenser Containment Sensor(s). Model: - ~DispenserContainment Sensor(s). Model: _ `'Shear Valve{s). t~-Shear Valve(s). ' ^ Dis enser Containment Floats and Chain s). ^Dis enser Containment Floats and Chains . Dispenser ID: Dispenser ID: ^ Dispenser Containment Sensor(s). Model: ^ pispenser Containment Sensor{s). Model: ^ Shear Valve(s). ^ Shear Valve(s). ^ Dispenser Containment Float(s) and Chain(s). O Dis enser Containment Floats and Chains . Dispenser ID: Dispenser ID: ~ ^ Dispenser Containment Sensor{s). ModeL ^ Dispenser Containment Sensor(s). Modef: ^ Shear Valve(s). ^ Shear Valve(s). ^Dispenser Containment filoat(s) and Chain(s). ^Dis enser Containment Floats and Chain(s). C. CeTttflCat1011 - 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 attd a Plot Plan showing the layout o! monitoring equipment. For any equi ment capable of generating such reports, i'have also attached a copy of the report; (check all that apply): ~-&ystem set-up ~larm history report Technician Natne (print): S-~r~ ~ 2T Signature: CertiticationNo.: rtc~•~J~,~ License. No. Testing Company Name: RICH ENVIRONMENTAL 5~ to ra~-c ca - uT r7 _ Phone No.: ~ 66 ~ 392.8687 Site Address: ~~ ~~I.}'~, (ZD, t~A~C~~r~"6-~~ Date of Testing/Servicing: off/ ~ /~ ~~_ Page I of 3 03101 Monitoring System Certification - -- . _ ~S~lg7 D. Results of Testing/Servicing Software Version Instafted: ~•~ Com lete the followin checklist: Yes ^ o Is the audible alarrn o erational? Yes ^ o Is the visual alarm operational? '~ Yes ^ ° Were all sensors visually 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 proper operation? ^ Yes ^ o if alarms are relayed to a remote monitoring station, is all communications equipment (e.g, modem) '~-.N/A operational? `FK-Yes O o For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ^ N/A monitoring system detects a leak, faits to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) lamp/Trench Sensors; ~-Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? 'Yes; ^ No. ^ Yes ^ ~ 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 overf Il warning alarm visible and audible at the tank fill point(s) and o erating ro erly? If so, at what ercent of tank capacity does the alarm tri get'? es ©No Was any monitoring equipment replaced? if yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re lacement arts in Section E, below. Q es •~No Was liquid found inside any secondary containment systems designed as dry systems? (Check al! that apply) ^ Product; ^ Water. If es describe causes in Section E, below. Yes ^ o Was monitorin s stem set-u reviewed to ensure ro er settin s? Attach set u re orts, if a liable '®`-Yes ^ o Is all monitoring equipment operational per manufacturer's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: ~~t-13-tb ~!~ t•.~ : SE~Sd2_ ~Q~ ~YF S~ -r~1N.lL ~.,~1~ at~L'L ~~1 ~ ~t-tARM ~c~T 1,.~~~~ N~'~- GOM'"c_s~~~ Q~ Ac..A2M ~ 2.~.PtACJ~-~ SrNSo2~y~2Y-Tt-t~NC~ z=S otL Page 2 of 3 03101 3 ~ 5~g `7 F. 7n-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. (`n...nlnFn thn fnnnwina rhnr4licf• ^ Yes ^ o Has all input wiring been inspected for proper entry and termination, including testing for ground faults? O Yes ^ ° Were all tank gauging probes visually inspected for damage and residue buildup? ^ Yes ^ o Was accuracy of system product.level readings testt;d? ^ Yes ^ o Was accuracy of system water level readings tested? ^ Yes ^ o Were all probes reinstalled properly? O Yes ^ o Were all items on the equipment manufacturer's maintenance checklist completed? ' In the Jecpon H, below, desenbe now ana when these aencienc~es were or ww oe correctea. G. Lille Leak Detectors (LLD}: ^ Check this box if LLDs are not installed. ('nrnnlata fha fn)Inwino rh arlrlict• --Yes 0 No` For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ^ NIA (Check all that apply) Simulated leak rate: ~ g.p.h„ O 0. I g.p.h , ^ 0.2 g.p.h. ~ Yes ^ o Were all LLDs confirmed operational and accurate within regulatory requirements? `'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 For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? "@f"N!A O Yes ^ o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled -~. NIA 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? ^ 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? ,,, ,,,r aec,w„ n, oe,uw, aescrioe uow ana when these aenciencies were or ww oe correctea. H. Comments: -~ Me,t,p F~.~~ CZ~ Pc,eCE-l~ 'g ~-'~S^`~.+~, ~C-LZ~ OtC._ Page 3 of 3 03101 S~~ 7 Monitoring System Certification Site Address: UST Site Plan --~~~-----?~t------------------------------ -~- - - - -_ - -_ - - - - - - - ' - - - - - tr,ar~-to Pit ,f~E - - ~®- - - - - - - - -~ ~ - - - - - - - - - - - - - - - - - - -c.T.w-~i.~A1LDET~Ct9~ F_ ~il~ $~ae -- --- S ~----- -- ---- ------------------ ~rr'IONZ.~-o2_- Date map was drawn: oZ / I / m ~- 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 osioo `s~~ ~ MonitorlnY System Certification Form: Addendum for Vacuum/Pressure IntersStiai Sensors LG 163-1, Enc. II I. Results of Vactlulm/Pressure Monitoring Equipment Testing • This page should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy of this form must be included with the MoniWring System Certificafion Form, which must be•~providcd to the tank system owner/operator. The owner/operator must submit a copy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date. Model: System Type: Pressure; []Vacuum Manufacturer: Sensor ID. Component(s) Monitored by this Sensor. Seaasor Functionality Test Result: Q Pass; L] Fail Intesatitial Commiurication Tort Result: []Pass: 1] Fail Campoz;eat(s) Monitored by this $ensor:~ . Sensor Fuactionsiity Test Result: II Pass;' ~ ~] Fail Interstitial Communication Test Result: ^ Pass; ^ Fain. Component(s).Monitored by this Sensor: Sensor Functionality Tcst Result: ^ Pass; ^ Fail Interstitial Communication Test Result: [] Pass; j] Fail Component(s) Monitored by thin Sensor: Senor Functionality Test Result: ^ Pass; ^ Fats Iasrrstitisl Commuaisatinn Test Result: ^ Pass; ^ Fail Component(s) Monitored by this Sensor. • Sensor Functionality Test Result: ^ Pass; .D Pall Interstitial Comtnutrication Test Result: [] Pans; ^ Fail Component(s) Monitored by this.Seasbr: ' Salsor Functionality Test Result: ~ Pass; ^ Fail Interstitial Comm .,,; -~tion Test Result: ^ Pass; ^ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ^ Pass; ^ Fail Intcrstitial Communication Test Result: ^ Pass; ^ Fail Component(s) Monitored by this Sensor; Sensor Functionality Test Result: ~ Pass: ^ .Fat[ .Interstitial Commuaication'Test Result: ^ Pane; ^ Pail Component(s) Monitored by this Sensor: SFnaor finnctionality Test Rrsull: ^ Pass: ^ Fail ~ ~ Interstitial Cotnmunicatimilest Result: ^ Pass; ^ Fail Component(s) Monitored by thts Sensor: ' ' Sensor Functionality Test Result: ^ Pass; ^ Fail Interstitial Communication Tesi Result: ^ Pass; ^ Fail How was lnterstitlal communication verified? ' .^ I.eaY Ina~oduced atFar End of Interstitial S ;~ ^ Gau c; ^ Visual ection; .^ Other (Describe In Sec. J, below Vacuum was restored to operating Ievels is all interstitial spaces: ^ Yea ^ No (~f~ro, describe in Sec. J, below) J. ~'ominents: ~~„ ~rc~t~iSo~~.~~ -.s~~'T~ ._..~ Page of r ~ If the sensor succcssfiilly detects a simulated vacuumlpc leak introduced in the inttrrtitisl spACa at tho furthest point from the soasor, vacat~p has been dcu~natrated to be communicating throughout the interstice. ~ Sy~7 5643 BI20QKS C'T S~C~R9FxR7.,2).OA.93308 OF'k'ICP(661)392-s687 & F.A~ (561)392.0621 M~'.c`SL4xrTr^xAgL T+3~*~ IZ'6iT,~3:TSlR mow: '~Q~K SR'F!t~ M W/0#s Fae:i.23t~,r 1Qanne;~~~~c F~N~ U.i S't74 PZ'vr',~uCC L,irre ~`~rpe {pressure, BuCtiaz~, l3ravi~y) QRl:1DVCT LEAK DETE~CTC]k2 TYPE T TEST 7.'RIk' PARS' sz~ixzax~ ~at]x~e~R 87~x,OW P82 OR ~._ ~~xz.~ #1~-8-~ x~o ~ ~ ~~.zs~ _. L/I? TYps D PtCltET" S Asa C'lL~~CL saz~ar.~. # ~s~ ;~..._ , .ato. ((~ BAr~ s~z~z.at #~ era ~ax~ L /11 1'YPF XRS $A59 SRRTAT+ # bT0 FAxL . I ::ertify tl~e alaoue tests were conducter3 on tkiis date aoeoxding to Hed ~,rackat Puu~pa .field Lear. apparatus testj.ng procedure an limitatiana. TY~~e: Mechanics]. Leak Detector Test. pass / fa.i1 is determined by using a la•fr £Iqw threskzold trip rate of 3 gallon Baer hour ar le9s at 10 P9I. T a~eknowledga L'bat a]. ]. data r_olleeted ie true as~d 4oxx•eaC to the .beat o£ r~•4r knowledge . Tech : ~p~_ b' 5 igi~..rtuxe : ~v~~9'\ Date : r~ ~ 1 ~ m~- k~. ~sl~~ swxca, ranuary Zoa Spill Buckef Testing Reporf Form This farm rs intended for use by contractors performing annual testing of ilST'spill containment structures. ?Yie completed form and. printouts from.tests (Ff applicable), should be provided to the facility.owner/operator jor submittal to the local regulatory agency. FAC"II,I'I'Y INFORMATION Facility Name: A-N~{MA t~.£1~1A ---s Tfl - --- Date ofTesting: a 1 '~- Facility Address: y tq 2eJ. ~A IC,~2S~ s~-~ Facility Contact: Phone: Date Local Agency Was Notified of TESting : ; 1 ! t m (®~ Name of Local Agency Inspector (ifpresent during testing): ~PIK~Z$F CS'T~ Tr.Li~- 2_ Trrc~rnvr C`ONTRAC.`TOR INFORMATION Company Name: (~s 1 s M ~t.~T1R" L . .Technician Conducting Test: ~~}~ Q'3~~T" Credentials': CSLB Contractor C Service SWRCB Tank Tester Other (S ec~) License Number(s): mot"-. ' t c..( ~"• 3. SPIiLL BUCKET TESTING INFORMATION Test Method Used: Vacuum Other Test Equipment Used: ~S(..t..+P~rL. Equipment Resolution Identify Spill Bucket (By Tank Number, SYoredProduct, etc. i 2~t'_.A2$~ 2 p~~ 3 wgs'TE 4 Bucket Installation Typc: t B Captained in S Cantaitteci in Sum irect Bury Contained in Sum Direct Bury Contained in Sum Bucket Diameter. (a ~ ~ { a • • 1 of Bucket Depth: I a ~ ~ ' ' I aZ Wait time between applying vacuum/water and start of test: ~ ~ Z ~ ~ ~~~ ~ M~tJ Test Start Time (T~: 'Q~1Qj ~' ~j (m. Initial Reading {R~: ~ r • ~ . Test End Time (TF): ~ : ~• fDC2~ - Final Readin8 l"F~~ ~ • , ~ • • , , Test Durafion (TF - T~: (. ~..{ ~(~•CZ Change in Reading (RF - R~: (~ (~` PassJFail Threshold or Criteria: ~- ~ ~ ~ C OZYI[aCAfS - (include information on repairs made prior to teshng. and recomme + nded follow-un for failed recto] . CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby cert{fy that ap the infor~natiow contained rn this report is true, accurate; and in full compliance with legd requirements Technician's Signature: ~~~ a. ~ 1' (~, • - Date: ut1.1._, ' Statc laws and regulations do not currently require testing to he performed by a qualified contractor. However, local rGquircmcntt may b8 morG stringent. f uv ~ ~.. ... .... •~-- - -- IN-TANK ALARM 1:DIESEL lERFILL ALARM ~N 22. 2004 2:04 PM aN 22, 2004 1:54 PM aN 22, 2004 1:24 PM IGN PRODUCT ALARM ~N 1, 1995 8:35 AM ~OHE OUT ?B 3. 2004 2:46 PM 3C 22, 2003 12:25 PM ~C 22. 2003 12:23 FM SLIVERY NEEDED 4N 12. 2007 9:48 AM EP 30. 2005 8:37 AM PR 15. 2005 6:54 AM qX PRODUCT ALARM ~N 1. 1995 8:35 AM UTPUT RELAY SETUP - 1:87POSITIVESHUTDOWN YPE: STANDARD 3RMALLY CLOSED N-TANK ALARMS t 1:LEAK ALARM T 1:HIGH WATER ALARM f 1:OVERFILL ALARM t 1:LOW PRODUCT ALARM f 1:SUDDEN LOSS ALARM T 1:HIGH PRODUCT ALARM I~dUID SENSOR ALMS 1:FUEL ALARM 2:FUEL ALARM 6:FUEL ALARM 3:DIESELPOSITIVESHUTDN !PE STANDARD )RMALLY CLOSED J-TANK ALARMS C 2:LEAK ALARM 2:HIGH WATER ALARM 2:OVERFILL ALARM 2:LOW PRODUCT ALARM 2:SUDDEN LOSS ALARM 2:HIGH.PRODUCT ALARM 'fdUID SENSOR ALMS . 3:FUEL ALARM . 4:FUEL ALARM . S:FUEL ALARM 4:ALARM 'PE STANDARD >RMALLY CLOSED !-TANK ALARMS ~LL:OVERFILL ALARM ~LL:HIGH PRODUCT ALARM ---- IN-TANK ALARM T 2:UNLEADED OVERFILL ALARM NOV 19. 2004 5:23 PM AUG 10. 2004 2:02 PM OCT 15. 2003 3:08 PM HIGH PRODUCT ALARM AUG 30, 2004 2:05 PM JAN 1. 1995 8:34 AM JAN 1. 1995 8:31 AM PROBE OUT FEB 3, 2004 2:43 PM JAN 27. 2004 12:38 PM JUL 30, 2003 9:47 AM HIGH WATER WARNING JAN 1. 1995 8:31 AM JAN 1, 1995 8:30 AM DELIVERY NEEDED APR 20, 2004 11:05 AM OCT 15. 2003 8:07 AM MAX PRODUCT ALARM JAN I, 1995 8:34 AM JAN 1. 1995 8:31 AM JAN 1, 1995 6:30 AM 1 :i:WHtillr fJtL PRODUCT CODE 3 THERMAL COEFF :.000470 TANK DIAMETER 46.00 TANK PROFILE 1 PT FULL VOL 550 FLOAT SIZE: 4.0 INCHES WATER WARNING 5.0 HIGH WATER LIMIT: 5.0 MAX OR LAHEL VOL: 550 OVERFILL LIMIT 95s: . 522 HIGH PRODUCT 90y 495 DELIVERY LIMIT 1~ 5 LOW PRODUCT : 1 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 MANIFOLDED TANKS T~: NONE LEAK MIN ANNUAL 0 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLEII 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 I MIN L 1:UNLEADED ANNULAR TRI-STATE tSINGLE FLO, CATEGORY ANNULAR SPA L 2:UNLEADED STP SUMP TR1-STATE (SINGLE FLOC GATEGORY STP SUMP L 3:DIESEL ANNULAR TRI-STATE (SINGLE FLOC CATEGORY ANNULAR SPA L 4:DIESEL STF SUMP TRI-STATE (SINGLE FLOE CATEGORY : STP SUMP L 5:DISPENSOR PAN 1-2 TRI-STATE (SINGLE FLOE CATEGORY DISPENSER I L 6:DISPENSOR PAN 3-4 TRI-STATE (SINGLE FLOF CATEGORY DISFENSER F L 7:WASTE OIL TRI-STATE (SINGLE FLOE CATEGORY MONITOR WEI --- IN-TANK ALARM ----- 3:WASTE OIL ETUP DATA WARNING 4N 1. 1995 8:04 AM IGH WATER ALARM 4N 1. 1995 8:04 AM ~W PRODUCT ALARM aN 1. 1995 8:04 AM IGH PRODUCT ALARM JN 9, 2005 12:15 PM IGH WATER WARNING ~N 1, 1995 8:04 AM :ARM HISTORY REPORT - -- SENSOR ALARM ----- I:UNLEADED ANNULAR NNULAR SPACE UEL ALARM EH 3, 2006 10:38 AM UEL ALARM EB 3. 2005 3:53 PM UEL ALARM EB 3. 2004 2:10 PM ALARM H I STORY REPORT - - - - - - - - PRODUCT C01~~~'T -- SENSOR ALARM ----- T I:DIESEL 1 THERMAL COEFF .. TANK DIAMETER 000 95. L 6:DISPENSOR PAN 3-4 DISPENSER PAN PRODUCT THERMAL CODE COEFF :. 000?00 TANK PROFILE 20 F FUEL ALARM TRNK DI AMETER 95.00 FULL VOL 121 FEB 3. 2006 10:42 AM TANK PR OFILE 20 PTS 90.3 85 5 INCH INCH VOL VOL 11~ 11E SETUP DATA WARNING 90.3 FULL INCH VOL VOL 12!53 11928 . 8D.8 INCH VOL 11C FEB 15. 2005 1:19 PM 85.5 80.8 INCH INCH VOL VOL 11520 11016 76.0 71.2 INCH INCH VOL VOL lOt 9i SETUP DATA WARNING 76.0 INCH VOL 10423 66.5 7 I INCH INCH VOL VOL 9C 8~ FEB 15. 2005 1:12 PM 71.2 INCH VOL 9770 . 6 66.5 INCH VOL 9087 57.0 INCH VOL 7E 61.7 INCH VOL 8355 52.2 INCH VOL bE 57.0 INCH VOL 7614 47.5 7 42 INCH INCH VOL VOL 6C 52.2 INCH VOL 6841 . ALARM HISTORY REFORT 47.5 42,7 INCH INCH VOL VOL : 6076 5295 38.0 33,2 INCH INCH VOL VOL 4E 3i ----- SENSOR ALARM ----- 38.0 33.2 INCH INCH VOL VOL 4539 3782 28.5 23.7 INCH INCH VOL VOL : 3C 2~ L 7:WASTE OiL TOR WELL O 28.5 INGH VOL 3066 19.0 14 2 INCH INCH VOL VOL : li 11 NI M 23.7 INCH VOL 2368 . FUEL ALARM FEB 3, 2006 10:51 AM 19.0 14.2 INCH INCH VOL VOL 1730 1136 9.5 4.7 INCH INCH VOL VOL E FUEL ALARM :35 PM g•5 4.7 1NCH INCH VOL VOL 633 224 FEB 3. 2005 5 FLOAT S IZE: 4.0 INCF FUEL ALARM FEB 3, 2004 2:39 PM FEB 1, 2007 10:08 AM LARM HISTORY REPORT SYSTEM UNITS ---- SENSOR ALARM ------ U.S. 2:UNLEADED STP SUMP SYSTEM LANGUAGE I'P SUMP ENGLISH UEL ALARM EB 3. 2006 10:36 AM A UNION SCHOOL DST UEL ALARM 4200=ASHE EB 3. 2005 3:54 PM HAKERSFIELD CA UEL ALARM SHIFT TIME 1 : 1:00 AM EB 3. 2004 2:10 PM SHIFT TIM£ 2 12:00 AM . _ ____ .. ~ _... _ _ _ 'SHIFT T I ME 3 D I SAHLED . _ , . _ LARM HISTORY REPORT ~ SHIFT TIME 4 DISABLED - -- SENSOR ALARM ----- FERIODIC TEST WARNINGS 3:DIESEL ANNULAR DISABLED NNULAR SPACE ANNUAL TEST WARNINGS UEL ALARM DISABLED EH 3, 2006 10:38 AM SYSTEM SECURITY UEL ALARM ~ CODE OOOOOD EB 3. 2005 4:29 PM ~ PRINT TC VOLUMES UEL ALARM ENABLED EB 3. 2004 2:15 PM LARM HISTORY REPORT - -- SENSOR ALARM ----- 4:DIESEL STP SUMP TP SUMP UEL ALARM EB 3. 2006 10:37 AM UEL ALARM EB 3. 2005 4:30 PM UEL f~LARM ~nn~ 2.i 14 PM .LARM HISTORY REPORT - -- SEN50R ALARM ----- 5:DISPENSOR PAN 1-2 DISPENSER PAN 'UEL ALARM 'EB 3. 2006 10:43 AM 'U£L ALARM' 'EB 3. 2005 4 ~ 41 I'M TEMF COMPENSATION VALUE CDEG F ): 60.0 COMMUNICATIONS SETUP- _~~ PORT SETTJNGS: NONE FOUND RS-232 SECURITY CODE 000000 RS-23P END OF MESSAGE DISABLED FLOAT SIZE: 4.0 INCHES WATER WARNING ~ HIGH WATER LIMIT: WATER WARNING 2.0 HIGH WATER LIMIT: 3.D MAX OR LABEL VOL: 12~ OVERFILL LIMIT MAX OR LABEL VOL: 12153 10~ OVERFILL LIMIT 903. .HIGH PRODUCT 10937 I1' HIGH PRODUCT 95% DELIVERY LIMIT 11545 1~ DELIVERY LIMIT l0i 1215 LOW PRODUCT 1C LEAK ALARM LIMIT: LOW PRODUCT 1000 SUDDEN LOSS LIMIT: LEAK ALARM LIMIT: 99 TANK TILT 1. SUDDEN LOSS LIMIT: 99 TANK TILT 0.25 MANIFOLDED TANKS Ttt:. NONE MANSFOLDED TANKS Ta: NONE LEAK MIN ANNUAL LEAK MIN ANNUAL D PERIODIC TEST TYPE STANDf PERIODIG TEST TYPE STA NDARD ANNUAL TEST FAIL ALARM DISABI ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABI PERIODJC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABI GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: C PER TEST AVERAGING: C ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:( TNK TST SIPHON BREAK:OFF DELIVERY DELAY 1 P ......DELIVERY DELAY 1 MIN ~~ ` -' -- ---•- - _ LEAK TEST METHOD _ SOFTWARE REVISION LEVEL TEST- ON DATE : ALL TAN} SOFTWARE#9 OD CREATED 346009-100-A ' JAN 1. •1995 START TIME DISABLED - 95.OEi,QB,II 25 TEST RATE :0.20 GALiHJ , NO SOF T~^rARE DURAT ION 2 HOURS MODULE SYSTEM FEATURES : PERIODIC IN-TAN]C TESTS ANNUA ' L IN-TANK TEST LEAK TEST REPORT FORMA S NORMAL 'UEL ALARM 'EH 3. 2D04 2:15 PM ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 3:DIESEL ANNULAR ANNULAR SPACE FUEL ALARM FE8 1, 2007 11:24 AM SENSOR OUT ALARM FEH 1, 2009 11:14 AM FUEL ALARM ~ FE8 1, 2009 10:56 AM gLARM HISTORY REPORT ---- SENSOR ALARM ----- L 4:DIESEL STP SUMP STP SUMP FUEL ALARM FEB 1. 2007 10:37 AM FUEL ALRRM FE8 3, 2006 10:37 AM F~IEL ALARM -...STAB.. 005 .4:30 PM . ALARM HISTORY REPORT • -- SENSOR ALARM -- L-5:DISPE1d8OR PAN 1-2 DISPENSER PAN FUEL ALARM . FE8 1, 2007 11:56 AM FUEL ALARM FE8 3, 2006 10:43 AM FUEL ALARM FE8 3. 2005 4:41 PM ALARM H IBTORY R#?FOJtZ' L 6:DI~EI~VBORR P3-d~- FD,~EpAN FEB ! . 2007 11 :'.f6 AM FUEL ALRRM . FE8 3. 2006 10:42 AM ~~B~i 5~2oal jg pM ALARM HISTORY REPORT ---- IN-TANK ALARM - T 2:UNLEADED OVERFILL ALARM NOV 19, 2004 5:23 PM AUG 10, 2004 2:02 PM OCT 15, 20g3 3:08 PM HIGH PRODUCT ALARM AUG 1D, 2004 2:06 PM JAN 1, 1995 8:34 AM JAN 1. 1995 8:31 AM PROBE OUT FE8 3, 2004 2:43 PM JAN 27, 2004 12:38 PM JUL 30 2003 9.47 AM 15~~' 7 LI~dUTD SENSOR SETUP L 1:UNLEADED ANNULAR TRI-STATE (SINGLE FLOAT: CATEGORY ANNULAR SpACI L 2:UNLEADED STP SUMP CATEGORYE:(STPGSUMP OAT: L 3:DIESEL ANNULAR. TRI-STATE (SINGLE FLOAT CATEGORY ANNULAR SpACI HIGH WATER WARNING L 4:D1ES£L STP 6UMP JAN 1, 1995 9:31 AM TRI-STATE (SINGLE FLOAT JAN 1, 1995 9:30 AM CATEGOIRY 6TP SUMP ' DELIVERY NEEDED L g:DI9PENSOR PAN'1-2 APR 20, 2004 11:05 AM TRI-FATE cSiNGLE FLOAT OC'f 15. 2003 8:07 AM pATEGORY DISPENSER PA MAK PRODUCT ALARM JAN 1. 1946 8:34 AM JAN 1, 1993 8:31 AM ± L 6:DIgPENSOR PAN 3-4 JAN 1, 1996 8:30 AM' i TRI-STATE (SINGLE FLOAT CATEGORY DISPENSER PA ^, ALARM HI81^ORY RETORT _:_ I IMp~tl6.AR- F10~ 1. 2007 12:26 PM F~ 1 2007 I2:26 P+~1 r FUQ. AII1iM .,,,`F88 ! . 200'! i 0 : ~, AM ~_~ ~~~ ,4i{~~ 87'p g - -.. +`RH ~ ~+ 1 • il00? ! 0:36 AM 0 ~'OOi J0:36 Af7 3 ~ 3:34 ~ AIAAM NI1'1!bOiR1f itEPORT I ---~-- 8E!l90R ALARM ----- L 7:WASTE OIL , ' MONITOR WELL FUEL ALARM FEH 1, 2007 11:3b AM FUEL ALARM FE8 3, 2006 10:51 AM ~ uEL ALARM -FE8 3, 2005 5.35 PM L 7: WFIBTE O I L C~A~R1f : (MON I TOR~b(ELL ALARM HISTORY REPORT ---- IN-TANK ALARM - 7 1 :DIEBEI. OVERFILL ALARM JAN 22, 2004 2:04 PM JAN 22. 2004 1:54 PM JAN 22. 2004 1:24 PM RICH PRODUCT ALARM JAN i. 1995 8:35 AM. PR+OHE OUT FE8 3, 2004 2:46 PM DEC 22. 2003 12:25 PM DDC 22. 2003 12:23 PM D81.IVERY NEEDED JAN 12, 2007 9:49 AM 35, 2005 6:54 AM MAX PRODUCT ALARM JAN t, 1995 8:35 AM '~. l s~l~ 7 MONITOR CERT: FAILURE REPORT S~„ITE NAME• QA~ frt~l ~ 1'. ~r~A l.l~S i f~ DATE' oZ ~, l ~ ~"~- ~DRESS: ~! a F1 S ~.• 2[J . TECHNICIAN: 5 - ~W ~.N '- ~ CITY• d~. ~1 'Q~S~ t'F.~-~ SIGNATURE• ~ _ _ -~1 THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS• 1~ AN Nc~.c-PrC2 ~tr_t.JS~ Ffl2 ~~~~L-"~~ReJ1C_ mc~ ~~~a cTx~~ wc~s 2~ P s~~ ~ ~ Irl rr~,.a+~w~*-~c-A Cx n~~,.~A ~ +f~~-rFcro 2 ~ 2 ~"~ -t~+~ i L ~ ~1~sL~c.0 • s`r ~J AS C~ Pt,ACE~ g ~E. -`1'~SrEA • , LABOR• N ©N ~ PARTS INTALLED: I -yam t9~ ~-- S~jG~•~2 l- 2ED~r~c~c~,T . Mt~,D . NAME: T[TLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBII.ITY OF NOTIFYIl~IG THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIItONMANTAL FOR ANY NEEDED RETESTING. TffiS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON COMPLIANCE. A COPY OF TffiS DOCTJMENT HAS BEEN LEFT ON-SITE FOR YOUR CONVIENENCE. UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. ~~ ^ ENFWNCED LEAK DETECTION ~-HNE'tESTWG' I'1 IC} Tn oCOCftO\A FI IFI ~ ~ ~sy~ ~ BAKERSFIELD FIRE DEPT. . ~»r prevention Services ~RfU f 900 T`ruxtun Ave., Ste. 210 Bakersfield, CA 93301 TeI.: (661) 326-3979 Fax: (b61) 852-2171 Pape 10(1 (:FRTIFIC.AI~Ifld ^ S&889 SECONDARY CONTAINMENT TESTING u ~n~n .wn~..cva .mss . ... ~. .. ~...... ..__...~.-.. _._... _ _._ _... .. _ FACILITY l ~~Q, NAME b PHONE NUMBER OF CONTACT PERSON ADDRESS oo ~ -Q OWNERS NAME OPERATORS NAME PERMIT TO OPERATE N0. NUMBER OF TANKS TO BE TESTED I IN IN T 2 l~ ~. ~'~ . ... TANK~TE371NG COMPANY .. _ . NAME OF TES 0 CO PANY V NAME b PHONE NUMBER OF CONTACT PERSON '3 2- MAILING ADDRESS NAM a PHONE NUMBER OF TE TER OR SPECIAL INSPECTOR alp.-tip- ~ - g i ~ o CERTIFICAT N #: DATE b TIME TEST TO 8E CONDUCTED , O ~, . ICC #: ~ ~ ~ l ~ U ~ ~ (~ T METHOD SIGNATURE OF APPLICANT a DATE ~ - r ~ .- O~ APPRpVED 8Y OATE FD 2095 (Rev. 09/05} BILLING & PERMIT STATEMENT ftlR! ~;Rrr r PERMIT NO.: ~5~~ 7 BAKERSFIELD FIRE DEPT. Prevention Services 900 '1Yuxtun Avenue, Suite 210 Bakersfield, GA 93301 .. rcc~ti ccn_nt~T t -- ~- - • LOCATION OF PRDJEC7 ~ • • PROPERTY OWNER STARTwG OATS , ~~ COMPLETION 447E ~ ^` ~~ ~~~ NAME V PROJECTADORESS ~~ .. COR CA LICENSE NO. , RESS ~~,n ~ Y~ CITY STATE ^~ - .- . TYPE OF LX~NSE DCPWNTION DATE . PHONE NO. ZIPCOOE~ PHONE NO. _ / 10 COH'TRAC'70R.COMP NAME* . C~p1S V ~ v~ FAX NO. 3 a. - o ~ ~ ADDRESS l`'"1 ' /~~ ~ CnY i`--(~ ~~ ^. ~/ LPCODE^~~Q~ ... - ~ ^ Alarms -New & Modifications - (MinimLlm Charge) $26250 98 mit fe 013125 =P F x ~ ^ Over 20, 000 Sq. FL er e . Sq. t 98 00 10 ~ ^ Sprinklers- New & Modifications - (Minimum Charge) $2 . 98 F 0 S 042 =Penult fee Ft S ~ O t q. Over 5,00 x, q. 98 ds} difi ti < 10 h Mi kl S M i ection Onl $ 93 00 jlns ] ~ ^ ca nor pr ons ( ea o n er p y . 98 D N dif & M tio C d t H d $39826 ~ ica o ns ommer oo ew a s - sa ^ al Hoods Additi a3t%00 ~ on 98 ^ Modifications S ra Booths -New 8 $458 00 ~ p y ~ . 98 ^ Abov round Storage Tanks (/nstadaboNlnsp.-1` Time) $165:00 ~ ^ Additional Tanks S 26.00 ~ D Aboveground Storage Tanks (Rernova4lnspedion) $109.00 82 D Underground Storage Tanks (/nstallatanJlnspection) $878.00 {pertank) 82 ^ Underground Storage Tanks (Modefication) $878.00 {Qersife) t32 ^ Underground Storage Tanks (r,Ru,or Modrficafion) $155.00 ~ ^ Underground Storage Tanks (RemovaQ $875.00 (pertank) 84 ^ Oilwell pnstadation) $ 72. ~ 84 Mandated Leak Detection {Tes ' Fuel Mond. Ce $ 81.00 (persite) 82 ^ Tents enfj 84 ^ .4iterhoursinspec6on fee 6122.00. 84 ^ Pyrotechnic - {Per event, Plus Insp. Fee (~ $90 per hour) $ 60.00 + (5 hra min. stars ~y tee Anspection) _ $510.00 84 ~ REdNSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) 84 ^ Portable LPG (Propane): NO. OF CAGES? $66.00 84 ^ i~Jbsive Storage $249.00 64 ^ Copying & File Research (Fite Research Fee $33.00 per hr) 25¢ per page 84 ^ Miscellaneous ~ ` 84 FD 2021 (Rev. 09!05) 1 - ORlGlNAL WFirTE (to Treasury) 1-YELLOW (to Ftle) 1?INK Ito Cuatomarl :. _ ~ :.' - UNDERGROUND STORAGE TANKS BAKERSFIELD FIRE DEPT. . PIRA Prevention Services ARTr r 900 Tnixtun Ave., Ste. 210 APPLICATION ~' Bakersfield, CA 93301 TO PERFORM ELD /LINE TESTING ~a Tel.: (661) 326-3979 / SB989 SECONDARY CONTAINMENT TESTING ~'il !TANK TIGHTNESS TEST AND TO PERFORM FaX: (661) 852-2171 FUEL MONITORING CERTIFICATION Page 1 of 1 PERMIT N0. ~ ~ 1 ^ ENHANCED LEAK DETECTION ESTING ^ SB-989 SECONDARY CONTAINMENT TESTING n TANK TIf:HTNFRS TEAT ®' TO PERFORM FUEL MONITORING CERTIFICATf6N FACILITY ..j. S\ ~- NAME 8 PHONE NUMBER OF CONTACT PERSON . ADDRESS 00 -- ----- - Q - I d OWNERS NAME - OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING OIN TO BETE TED? YES ^ NO TA # VO U E ONTENTS I 1 2 1< ~~-.~- - ~' ~ ~ .~ 2 ~~ __ ~ U o, TANK,TESTING COMPANY ' ' NAME OF TES G CO PANY v NAME 8 PHONE NUMBER OF CONTACT PERSON 3 2-8'(0 MAILING ADDRESS S 3 G c~. C~ ~ G- NAM~B PHONE NUMBAAER OF TE TER OR SnPECIAL INSpP~ECTQOR/y V / ~ O' I V CERTIFICATI N #: 2~J~ " ``S - - DATE 8 TIME TEST TO BE CONDUCTED - _ -' - - ,. ICC #: ~ T METHOD SIGNATURE OF APPLICANT C DATE ~ .- t ~ ^ Q-, AP-PROVED-BY-a ~ DATE ' S r ' FD 2095 (Rev. 09/05) BILLING & PERMIT STATEMENT BAKERSFIELD FIRE DEPT. r _ D Prevention Services FIRS 900 Truxtun Avenue, Suite 210 PERMIT NO.: ARTM T Bakersfield, CA 93301 . - LOCATION OF PROJECT ~~!!2~.,,,,,, `,, , ^ C PROPERTY OWNER STARTING DATE COMPLETION DATE /^~`` PROJECT NAME ADDRESS PHONE NO. PROJECT ADDRESS ~~ V ~~ ~~ lJ ' CITY ~ STATE ^~ ~• ZIP CODE • •- •- • CONTRACTOR E CA LICENSE NO. TYPE OF LICENSE. EXPIRATION DATE PHONE NO. a ~~ CONTRACTOR COMP NAM ~, v^ FAX NO. 3q ~--0 (o ~- ADDRESS ~ ~ ~ ~ ^ f - ~ CrrY ~~ ~ ~ ^ . ZIP CODE ^ ~ ~Q • • ~ ^ Alarms -New & Modifications - (Minimum Charge) $262 50 ~ • . 98 Over 20 000 Sq Ft 013125 =Permit fee Sq FL x ~ ~ . , . . 98 ^ Sprinklers -New & Modifications - (Minimum Charge) $210 00 ~ . 98 ^ 000 Sq Over 5 Ft Sq FL x 042 =Permit fee ~ . . , . . 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 & Modifications $458 00 ~ . 98 ^ Aboveground Storage Tanks (Installation/lnsp: 1~' Time) $165.00 82 ^ Additional Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Removal/Inspection) $109.00 82 ^ Underground Storage Tanks (/nstallabbn./lnspedion) $878.00 (pertank) 82 ^ Underground Storage Tanks (Modfication) $878.00 (per site) 82 ^ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Underground Storage Tanks (Removap $675.00 (pertank) 84 ^ Oilwell (Installation) $ 72.00 ~ 84 Mandated Leak Detection (fesfin Fuel Monit. Ce $ 81.00 (persite) 82 ^ Tents $ ent) 84 ^ After hours inspection .fee $122.00 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour) $ 60.00 + (5 hrs. min. stand -by tee nnspec6on) _ $510.00 84 ^ RE-JNSPECTION(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 ; 84 FD 2021 (Rev. 09/05) 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to Flle) 1-PINK (to Customer) ~' UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING I S6989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION BAKERSFIELD FIRE DEPT. ~~~~ Prevention Services wRfr T 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Pie 1 of 1 ' PERMIT NO. ~~- ~ 3 ^ TAHANCED NEA SDETTCTION /~RF(~RM FI IFI MnNITORING CFRTIFICATIt7N ^ SB-989 SECONDARY CONTAINMENT TESTING IT INFO MA I N FACILITY ~ S ~ ~ NAME & PHONE NUMBER OF CONTACT PERSON i - 8 3 i C>, 3 ADDRESS ~ ~~ OWNERS NAME OPERATORS NAME PERMIT Tp OPERATE N0. NUMBER OF TANKS TO BE TESTED IS PIPING GOING T T TED? YE5 ^ NO TANK# V L E CON NTS ~ 2 OOU - h S ~l ~ a 6' TANKTESTING COMPANY NAME TEST NG COMPANY NA E 8 PHONE NU R OF CONTACT PERSO~~ °:~ MAILING ADDRESS _ ~ ~ /~ „ ~ ~ O NAME 8 PH NE NUMBER OF TESTER OR SPECIAL INSPECTOR _ (~ CERTIFICATION #: DATE $ TIME TEST TO BE CONDUCTED ~~ ICC #: TEST METHOD SIGNATURE OF APPLICANT ~ _ ~~_ DATE ,~ ~ O APPROVED BY DATE ~ ~',.-~ 6 `'~///~ ~/ r t FD 2095 (Rev. 09/05) Ri~l:a`~eiG & PERMIT ST~-TEMENT ' PERMIT NO.: 'T"T , 0 3 i P/RB ~Rrr r BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 Tel. (6611 326-3979 S Fax' (6611 A52-?.l 1 • LOCATION OF PROJECT ~ /~ 1 l • ~ • PROPERTY OWNER STARTING DATE coMPLETION DATE 2 - ~- o : o oam NAME ' ~ PROJECT NAME , O AD~ ~OO ~~ r j d PHONE ND. ~ti~~'33~ PROJECT ADDRESS ~( CffY STATE rS ~ ZIP CODE t3 ` (off .- CONTRACTOR NAME CA LICENSE NO. ' S ~ `' .- . TYPE Of LICENSE. EXPIRATION DATE PHONE NO. to t- 9 -8(0 CONTRACT R COMPANY NAME ~/~ ~~ C.. tU 1~ ~ 12th JU 1~~. L. fAX NO. ty .O ~G ~ ADDRESS 5(.~~ oo~S ~~ - ~ CITY - ZIP CODE ! ~i ~ i J ~ ~ ~ ^ Alarms -New & Modifications - (Minimum Charge) $262 50 . ~ 9t 3 Over 20 000 Sq. Ft. Sq. F>~ x .013125 =Permit fee ^ , 9 8 ^ Sprinklers -New & Modifications - (Minimum Charge) 00 $210 . 9 ^ Over 5 000 Sq. Ft Sq Ft x .042 =Permit fee ~ , . 9 ^ Minor Sprinkler Modifications (< 10 heads) $ 93.00 -[Inspection Only] 9 $ ^ Commercial Hoods -New & Modifications 26 $ 398 ~ . 9 $ ^ Additional Hoods $ 36 00 ~ . i g ^ Spray Booths -New & Modifications 00 $458 ~ . 9 ^ Aboveground Storage Tanks (Installation/Insp.-1~ Time) $165.00 ~ 8 ^ Additional Tanks $ 26.00 j 8 ^ Aboveground Storage Tariks (Removal/Inspection) $109.00. 8 ^ Underground Storage Tanks (/nsta/l~tion./Inspection) $878.00 (pertank) ! 8 ^ Underground Storage Tanks (Modific;ation) $878.00 (persite) j ^ Underground Storage Tanks (Minor Modfication) $155.00 ^ Underground Storage Tanks (Remoyan $675.00 (pertank) ' j ^ Oilwell (Installation) ~ $ 72.00 ~ Mandated Leak Detection (Testing)/Fuel Monit. Cert. ~ $ 81.00 (persite) 8 ^ Tents $ 93.00 (per tent) ^ After hours inspection fee $122.00 ~ ~ ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour} $ 60.00 + (5 hrs. min. stand -by fee /Inspection) _ $510.00 ^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) ': 8 ~ ^ Portable LPG (P,ropane): NO.OF CAGES? _ $66.00 ^ Explosive Storage $249.00 ' ' ^ Copying & Fife Research (File Research Fee $33.00 per hr) 25¢ per page ; 3 ¢ ^ Miscellaneous : & } - FD 2021 (Rev. Q9/05)I ~II ...,...~.~.~ ..,~ ~~~.- ~._ r~__.._.~ ~ vo r rnti a., rn~~ ~..owrr r~., r.~os...,oer~ ~ l _ __ _ °,,- ~, - - .. - -- - tz4~.~ 1V10NITQRI.NG SYSTElVi CERTIFICATION ~~77~ For Use Bv;lll Jurisdictions YYithin the State of Calrfornia . [ utirorirn Cirzd: Chcrprer b.7, h+ealth anclSafety Cade; Chapter 16, Division 3, Tlrle 23, California Code of Regulations "Chic turrn must be used to document testing and servicing of monitoring equipment. Ass Harare certification Qr report must be ureuat~e~ tor_~,ch ntunirorinE sy~em contro(panel by the technician who performs the work. A copy of this form must be provided to the rant. slltcm ,nvnerloperator. The owner/operator ,T,ust submit n copy of ttus form to the local agency regulating UST systems within 3t) ~izi\:> uP rrst dace. .~.. tyeneral Y formation I aciliiy !Verne: ~AnlAtulA~~~J~~,)~5 i P~ ~C~~l~ Bldg. No.: ___- . - Sit. _,~~~~>c»: ~ a~~~1-ff r~ ~ City: g~~-~.~._ zip: a33c~._..... t~:i~iliq CuntaetPerson: PAM _ Contact PhoneNo.: (~fgl , ' ~1-331 F.~rr._te~3 ,\l:il:~:!\1ud~1 of ivlonitoring System: 'R,~j Date of Testing/Servicing: ~l__~__l~Cr~ ~. tt>~-'r.ntory of Equipment Tested/Certified ~:i~~, t: rLr :~ , )ru riate buses to iodicarc s ecitic a ui menr ius ectedhervieed: ~~. _, l 4 i:;uI,1D: ~~ L ~~ _ _ TanklD: ~T"~6'<~ 1 _•_- ~i ' - u 1 utl 1, w yin Probt. Model: (.fl "®-In-Tank Gau in Probe. A4odtk V'llP1C~ 5 i~-lunutar Space or Vault Sensor. Modti: I-i 3m -Annular Space or Vault Sensor. Model: tom, ~, _ a' p?'t'ipin` Sump i'I'rdnt:h Sensor(s). Model: ~(~~ Piping Sump /Trench Sensor(s). Modal: ~.-.._._ ,- .-- __ l~ U fill Stunp Sensor(s). lviodt{: ^ Fill Sump Sensors}. Modal; ,_~ ~' i ~8-t~ lc~.l):utiru! Line 1.aak Detector. Mod21: yf}(IDR.(. FMS ~-Mechanical Line Leak Deteemr. _ Model: c.'~Fx i¢_ . ;~ Lt.:ru•oni~ l.ina l.t,il: Detacta•. Model: O Electronic Line Leal: Detector. lvlodel: .__...__ ••, . C.nik O~•trtill i High-Level Sensor. Model: ^ Tank Overfill /High-Level Sensor. A4ode1; _,_.. O ~~di;•t- , acif • t ui menr r • e and mudaE in Sacrian E on Pa e 2 . ^ Other s eci - e ui menr a and model in Seerion E on Pa c ?). I';,nl: iD: 1.3t~ST~ OIL- TanlcID: -~ ~'iu-i'a„k Gauging Probe. ~ Model: MACS ^ In Tani: Gauging Probe. _ Model; ___ -__•. ~:t,u,ular Space or Vuulr Sensor. Model: (-(faQ~p f] Annular Space or Vault Sensor. Model: _T___ O 1'tpin~ Sump 1 "french Sensor(s). Mode]: 0 Piping Sump l Trench Sensor(s). Model: ,___ ~- i~~ ~l Fill Sump Sensor(s). Model: ^ Fill Sump Sensor(s). Model: _ _ ~{~ ~.l t\ l.c~lt:u,ical Line Laak Detector. Model: ^ Mechanical Line Leak Detector. Model: ••^ _.__ _ _ _ '~ J l:l~~truuii; Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: _ .,.. ,~ i.l l :u,l: v~ertill ! Hi h-Level Stnsor. la Model: ^ Tank Overfill ! Him -Level Sensor. ~ Model: ----~ it -~_' I° ~] e ~dtr< <~ «;>;• cc ui mznr r e and model in Section E on Pa e ? . ^ Other s eci a ui menr a and mode] in Stction E on Pn z ? ). _ 1 Uispcnser ID: ~ ~~ ,•,!_ Dispenser 1D: ~~ _^ ..yy J~-1?i;pc,tstr Containment S211SOf(S). Mod21: err '-Dispenser Containment Sensor(s). Modal: -------- .. r .._ ~~SJtcar Val~~e(,). >t~3hearVaEve(s}. j _~} Li,~ user Conrainn,entFloat(s) and Cl,ain(s , O Dis enserContainmentFloai s s,td Chains . _~, 1}ispeuser ill: Dispenser ID: ____ '~ O i)i:pen~er Containment Senior(s). Model: D Dispenser Containment Sensor(s). Model: ~~~ :.) 3hc:,r ~'alti~e(s). !~ Shear Valve(s). ~ _.__. .,_ l ~a Cii~ xns~r Containment Float s and Chaia s . ^ Dis eraser Contoinment Floats and Chain s). j'i lli~peuser ill: Dispenser ID: `+ L?i;pcn;zr Containment Sensu,•(s). ModeL• ^ Dispenser Containment Sensor(s). Model: ~~ __...... .. -' ~~, Sftc:ir V,ih'e(s). D Shear ValYe(S). ~i ;.7i)i~ ~ens~ r Coitainment Flout s and Chau~(s . ^ DiS eraser Containment Floa s and Chain s). A ~1P tl,. r:t;:ility contains more tanks or dispensers, copy this form. Include information fnr every tank and dispenser at the facility. ~1~. ~i'rtt~iCBtiUt1 - i certify that the equipment identified in this document was inspected/serviced in accordance with the manafacun-ers' guideli,tes. rirtached to this Certification is information (e.g. manufacturers' checklists} necessary to verify that this infarntatiu„ is cOCrect and a Plot Plan showinE the tayuut oi' monitoring equipment. Bor any equipment capable of Eenerating such reports, 1 have also arruahed a copy of the report; (check rrll that apply}: System set-up !arm history report l «{tt,ician Name (print}:.4TF,~Fj,J ~T~F~7- Signature: _--___-_ . Czrtizleation Na:~~6=QS(sJ~ fs~~l~¢._._. f- r' License. No.: C61/D40- # 809850 _~_.__ ._ . t'estin~ Co,t,panyN,irue: RICH ENVIRONMENTAL PhoneNo.:~661 392-8687 Sits .~lddress: ~~~_~ a3A(~(.~,5~%s1~.e~~ ~ CA, 331 3 Date of TestinglServicing: l 3~ i~(,p --- Page 1 of3 U3;tit ;~l,r,,,~tUrit,b System certification iy. iZrSUir~ of Testing/Servicing »fn~ a« ti'dr91J11 Inslalled: ~ . tG.~l~ C.'a,,,,;irtc cLr fullowine chzclaist: t 208' . II~~~ ~ ~ ^ No" Is the audible alarm o erational? ~i ~ ~d. `~ ~~ ^ No* is dte visual alarm o erational? ~ ~;'~-1'::~ ~ t7 No* __ ~ Were ail sensors visual! ins ectad, fimctionall tested and confirmed o erational? ~~ ~- -- Y~~ ^ No* __ - Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will ~~. ~i not interfere with their ro per o oration? i i__._ __.._-_..- Ii ~l 1" ~ C:I Nu* i if alarms are relayed to a remote monitories station, is all conununications equipment (e-g. mrdrru) I ~ ~ ~-NiA operational? ! i ~~ ~L'i:; ^ No* -._ For pressurized piping systems, does the turbine automatically shut down if the piping secondary cuntainniznr ~I l7 N;'A monitoring system detects a leak, fails to operate, or is electrically disconnected? if yes: which sensors uihiair ,`~ positive shut-down? (Check all that apply) ~' Sump/T'rench Sensors; 'II~Dispenser Contai~uttanr Sensors. ~I _ _ _ I I Did ou confirm ositive shut-dov/n due to leaks sensor fai.lure/disconnection? ~es• ^ No. __I, _ i J ~~ ' ^ No* For rank systems [hat utilize the monitoring system as the prinary tank overfill warning device (i-a- nu ~ J ~ N.%A mechanical overfill prevention valve is installed), is die overfill warning alarm visible and audible at the lank '.~ ' till oin s) and o e.ratinJ ~ru erl ? if so at what ercent of tank ca aci does dte alarm n•i qtr? '• n -~i ; ----- - u ~~.~'~ Nu identify specifc sensors, probes, or other equipment relal~icr~i ;~ Was any monitoring egtipment replaced? If yes , '' and list the manufacturer name and tnodel for all re lacement arts in Section E, belotiv. J ~'~,* ~- No Was liquid found inside any secondary containment systems designed as dry systelns? (Check all dtat Lrppl)•! ^ ! i?roducr, O Water, If es, describe causes in Section E, below. _ ~' ~ _ ~r-e~ 1'~~ ^ Nu" Was munitorin s stmt set-u reviewed to ensw•e ro er settin s? Attach set u re orts, if a licable _W._~ ~~jt'~1'~~ ^ No* Is all monitorin a ui. merit u erational er manltfacnlrer's s ecifications? ~~ 1~, ~rctiun E below, describe how and when these deficiencies were or will be corrected. fJ. ~:unttl]elitS: .Page 2 of 3 !I~ X111 ;~ ~ r~ ~~'. iu-~1':iiul: ~i;iu~lYl~' / SIl[2 ~+ quipment: +~Chzck this box if tank gauging is used only for inventory ~unte~~t. D Check this Uox if no tank gauging or SIR equipment is insia.llyd. ~l-his s~ctiun must bz completed if in-tank gauging equipment is used to perform leak detection monitoring. l~,~~n.•.Irrr the i'ntlOwinu' Checklisfc I~::l 1 ~ s ^ No* Has all input wiring beau inspected for proper entry and termination, including testing for ground faults'? ~~ ,~ t_3TY.~s ^ No* Were all tank gauging probes visually inspected for damage and residue buildup? __~ U ~',~ O No* Was accuracy of system product level readings tested? j I ^ 1~cs~ ^ No* Was accuracy of systeni water level readings tested? i I! u 1 ~s O No* Were a]] probes reinstalled properly? 'mss 1' ~~ IL= _ _ _ __- ©No* Wert all items on the ec;uipmznt manufacturer's maintenance checklist completed? ~~ _.~ " 1u Cllr )eCriUrr )~, below, describe how and when these deficiencies were or will be corrected. ~1. .l_irre Leal: lleceetors {LLD): O Check this box if LLDs are not instal]ed. f'n~~,r~INr[• rhr 1'nllnwina eheclaist~ ~-b.~ 1 ~s ^ No* For equipment start-up or a~uiuai equipment certification, was a teal: simulated to verify LLD performa+ur^ ^ N.lA (Check all thar apply~J Simulated leak rate: ~ 3 o.p.h.; D 0.1 g.p.h ; ^ 0.2 g.p.h. ~, 'Y e~ 7~ ^ No* Were all LLDs confirmed operational and accurate within regulatory requirements? ~ ~ (~-1 zs FF-- ^ No* ~_ Was the testing apparats properly calibrated? i ~4-Y c:s ^ Noy` For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ~~ U 1 ~s ^ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak'? I i ~• NIA _ i l:J l es ^ No* For electroruc LLDs, d~~es thz turbine automatically shut off if any portion of the monitoring system is dis:+hl~d ~! j ~! N!A or disconnected? ;I ~ ~J 1, ~, ^ No* Fur electronic LLDs, deer the turbine automatically shut off if any portion of the monitoring system malfuncric>+r~ ij ~ NiA or fails a tesr? '! i U '1"~s ^ No* -- j For electronic LLDs, have all accessible wiring connections been visually inspected? ~; __ •~ N!A 1~zs ^ No* _ Wire all items on the ecluipmeni manufacturer's maintenance checklist completed? ~' ~__ i+ In tlir Section 11. below. describe how an3. when these deficiencies were nr will be cnrrected_ Y-~. L'ornynents: Page 3 of 3 o?.t~+ ~o ~~ iYtiiniruriub System Certification US'][' lV~onitoring Site Plan s~ii:.~,d~,-~»: 4 a~ AS ~~ SOU. ~AIC.EFZ~-~F,c..~ , Gfl . q 3 3l 3 ~. :~SN~: ~. ---. ! -. +. ~~~~ ~t ~. .. 'ti-5.. . . l ~p~.. p .. .. ~3: :a :........... .... 1 .....................................w~is~........ oa. S 1 .~ . ~. i ~ •O Date neap was drawn: ~~~~®foe Instructions lf' ~ ~7ti already have a diagram that shows all required information, you maY include it, rather Phan this page, ~~~ith ~ ~~ur i~~l~~nitorind System Certification. On your site plan, show the general layout of tams and piping. Clearly i~icn.til~ tu~arions of the following equipment, if installed: monitoring system control panels; sensors monitoring tank ttnnui:,r ~pa::~s, sumps, dispenser paJis, spill containers, or other secaudary eoutainment areas; mechanical or electronic fins Ital. detectors; and in-tank liquid level probes (if used for leak detecfion). in the space provided, note the date this Sitr; flan .~:i; ~r~pared. Page cf o~ioti j.~~--_~ ~~'~ ~r.RONMEN'~'~c I i 5643 BROOKS CT BAKER9~IELD,CA.93308 dFFTCE(661)392-8687 & FAX (661)392-0621 Mg[~un*trCAj~.~~.)?$iTRCTdR 'j;fyST W/0#: i Facility Name: ~A{a~31.1C`-n~A V3~S`f1R ~c~DoL... Facility Address: yaPSC1s A~~ 6A~~rt~l . ~ • g~a~t3 Product Lime Type (Prossur~ $uction, Gravity) PRODUCT LEAK DETECTOR TYP$ TEST TRI$ PA83 sBRIAL rttnassR BRLOW PST OR L/D TYP ~ _ SS L/D TXPE_ V ~}PFXZ~S PAaB SERIAL #~S/~~b ~'7X?3 HO I ~ FAIL L/D TYPE YSS PAS$ SERIAL # NO FAIL L/D TYPS YSS PASS SSRIAI+ # NO FAIL z certify the above testa were conducted on this date according to Red Jack®t pins field test apparatus testing procedure an limitations. The Mechanical Leak Detector Tast gals / fail is determined by using a low flow threshold trip rate of 3 gallon per hour or lass at 10 PSI. I acknowledge that all data collected is. true and correct to the best of my knowledge. Tech• cs~k`~~ Signature: Date:~~~~~ 6- z ~. SYSTEM SETUP FEB 3. 2006 10:21 AM SYSTEM UNITS U,S. 5YSTEM LANGUAGE ENGLISH PANAMA-S-V UNION SL^HOOL DST 4200-ABBE BAKERSFIELD CA SHIFT TIME 1 1:00 AM SHIFT TIME 2 12:00 AM SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED PERIODIC TEST WARNINGS DISABLED ANNUAL TEST WARNINGS DISABLED SYSTEM SECURITY CODE 000000 FRINT TC VOLUMES ENABLED ALUE`~pEGNFA}ION 60.0 OUTPUT RELAY SETUP ' R 1:87FOSITIVESHUTDOWN TYPE: STANDARD NORMALLY CLOSED IN-TANK ALARNIS T 1:LEAK ALARM T 1:HIGH WATER ALARM T I:dVERFILL ALARM T 1:LOW PRODUCT ALARM T 1:SUDDEN LOSS ALARM T I:HFGH PRODUCT ALARM LIBUID SENSOR ALMS L 1:FUEL ALARM L 2:FUEL ALARM L 6:FUEL ALARM R 3:DIESELPOSITIVESHUTDN TYPE: STANDARD NORMALLY CLOSED IN-TANK ALARMS T '? :LEAK ALARM T 2:HIGH WATER ALARM T 2:dVERFILL ALARM T 2:LdW PRODUCT ALARM T 2:SUDDEN LOSS ALARM T 2:HIGH PRODUCT ALARM LIfdUID SENSOR ALMS L 3:FUEL ALARM L 4:FUEL ALARM L 5:FUEL ALARM R 4 : ALARhI TYPE: STAND~IRD NORMALLY CLOSED I N-TANK ALARMS AI-L : dVERF i LL ALARM ALL:HIGH PRODUCT ALARM T 2 : UNLEHUtu D Q RMAL OEFF THE :.00045 TANK DIAMETER 95.00 TANK PROFILE 20 PTS FULL VOL 12153 90.3 INCH VOL 11928 85.5 INCH VOL 11520 80.8 INCH VOL 11016 76.0 INCH VOL 10423 71.2 INCH VOL 9770 66.5 INCH VOL 9087 61.7 INCH VOL 8355 5?.0 INCH VOL 7614 52.2 INCH VOL 6841 47.5 [NCH VOL 6076 42.7 INCH VOL 5295 36.0 INCH VOL 4539 33.2 INCH VOL 3782 28.5 INCH VOL 306fi 23.7 INCH VOL 2368 19.0 INCH VOL 1730 14.2 INCH VOL 1136 9,5 INCH VOL 633 4.7 INCH VOL 224 FLOAT SIZE: 4.0 INCHES WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX dR LABEL VOL: 12153 OVERFILL LIMIT 9096 10937 HIGH PRODUCT 95ss 11545 DELIVERY LIMIT 109c 1215 LOW PRODUCT 1000 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 1,25 MANIFOLDED TANKS Tit: NONE LEAK MIN ANNUAL 0 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TE5T AVERAGING: dFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY I MIN T 3:WAS'fE OIL THERMAL COIrFF :.000470 TANK DIAMETER 46.00 TANK PROFILE 1 PT FULL VOL 550 FLOAT SIZE: 4.0 INCHES WATER WARNING 5.0 HIGH WATER LIMIT: 5.0 MAX OR LABEL VOL: 550 OVERFILL LIMIT 9566 522 HIGH PRODUCT 909e 495 DELIVERY LIMIT 15 P T ~ L I M I T : AK LE ALA~ 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 MANIFOLDED TANKS Tit: NONE LEAK MIN ANNUAL 0 FERIODIC TEST TYPE STA NDARD 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 HREAK:OFF DELIVERY DELAY 1 MIN LEAK TEST METHOD TEST ON DATE ALL TANK JAN 1. 1995 START TIME : D I S+t1HLED DURATI4NE :0220~G~HR LEAK TEST REPORT N dORM~AI.T $~ a`$ r~~ ~ ~ NQa v$Q`' ~~ ~ ~ ¢w°R ~E4~ ~icn ~ ~ qua. l~ww w~ ~ ~ za~ `~ a~tn ~ ~ ~w5 ~ ~ zi~. a w ° wE°- ~ ~ ~ z z ~~n¢ q - i a ~m~n z z z-~z aws • a a, cncn r~n v ~~ aim u:a v azu ~i ~ mA (~] y a a m O" m ~ ~ ¢ wH7. ¢ CK ~~~- Q0. ~~ Q~ , dH~ ~¢PK a "~~ OQ d C K . p~w,~u ~ iJ] L ~ ww.. ¢ ~ ~ > ~ . >U1C7 + ~~~ I _ q~ ~ A~C~.7 ~ -. p AiJ]C 7 t p A~C7 p ~C9 ~ I a 1 7 r. ~ aFCai ,-. N 3F$ ~ 11 C3! F F ~ ~'..H F$ ~ I 117! [-+ ~ g ~0..[W+ ~ d L..,-i(,+ . . a t a a c i a c i a~$ ~o$~/ HLHKI"I M 1 ~ 1 VK~ lCLYVic 1 ----- SENSOR ALARM -- L 1:UNLEADED RNNULAR r- ANNULAR SPACE FUEL ALARM FEH 3, 2006 10:3$ AM FUEL ALARM FEB 3, 2005 3:53 FM FUEL ALARM FEB 3, 2004 2:10 PM ALARM HISTORY REPORT -- SENSOR ALARM ---- L 2:UNLEAIIED STP SUMP STP SUMP FUEL ALARM FEB 3.. 2006 10:36 AM FUEL ALARhI FEB 3. 2005 3:54 PM FUEL ALARM FEB 3, 2004 2:10 PM ALARM HISTORY REPORT -- SENSOR ALARM -- L-3:DIESEL ANNULAR ANNULAR SPACE FUEL ALARM FEB 3. 2006 10:38 AM •FUEL ALARM FEB 3.. 2005 4:29 PM FUEL ALARP1 FEH 3, 2004 2:15 PM ALARh1 HISTORY REPORT SENSOR ALARM L 4:DIESEL STP SUMP STP SUMP FUEL ALARM FEB 3. 2006 10:37 AM FUEL ALARM FEB 3. 2005 4:30 FM FUEL ALARM FE8 3. 2004 2:14 PM ALARFI HISTORY REPORT -- -- SENSOR ALARM ----- L 5:DISPENSOR PAN 1-2 DISPENSER FAN FUEL ALARM FEH 3, 2006 10:43 AM FUEL ALARM FEH 3. 2005 4:41 PM FUEL ALARM FEB 3. 2004 2:15 PM ALARM HISTORY REPORT ----- SENSOR ALARM -- L 6:DISPENSOR PAN 3-4 DISPENSER PAN FUEL ALARM FEB 3, 2006 10:42 AM SETUF DATA WARNING FEB 15. 2005 1:19 PM SETUP DATA WARNING FEB 15. 2005 1:12 PM ALARM HISTORY klrl-'vx t -- SENSOR ALARM ----• L 7:WASTE OIL MONITOR WELL FUEL ALARM FEH 3, 2006 10:51 AM FUEL ALARM FEB 3, 2005 5:35 PM FUEL ALARM FEB 3. 2004 2:39 PM INCOli INTELLIGENT CONTROLS ING P. 0. 60k 63$ SRCO ME 04072 1-$00-984-6266 8,'Tr02.2006 10:20 SUMP LEAK TEST REPORT ~~r~SUP1P 1 TEST STARTED 10:05 TEST STARTED 03r92r2005 BEGIN LEVEL 2.5934 IN END TIME 10:29 END DRTE 03r02r2096 END LEVEL 2.5932 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED 1,1.1~J (r SLUMP 2 ~.. TEST STARTED 10:05 TEST STARTED 03r02r2086 BEGIN LEVEL 2.4221 IN END TI1ME 10:28 END DATE 03r82r END LEVEL 2.4205 IN LERK THRESHOLD 0.802 IN TEST RESULT PASSED INCON INTELLIGENT CONTROLS INC P. 0. BOk fs3$ SAGO ME 04a~ 1-800-984-6266 03r02r2686 10:50 ~y.,~S,U.MP LEAK TEST REPORT k,;AJC~~C- SUi9P 1 TEST STARTED 10:35 TEST STARTED 63r01r2006 BEGIN LEVEL .2.5930 IN: ENO TIME 10:50 END DATE 93r02r2006 END LEVEL 2.5929 IN LEAK THRESHOLD 0.802 IN TEST RESULT PASSEDi t~lN (~ suMP 2 ~ TEST STARTED 10:35+` TEST sTARTED 03r02r2~6 BEGIN LEVEL 2.4207 iN END TINE 18:58 END DATE 03r02r20i06 END LEVEL 2.4283 IN LEAK THRESHOLD 6.@02 IN TEST RESULT PASSED HLHK1'I lyl.']1V7ti J[Grvna ---- IN-TANK ALARM - T 1:DIESEL OVERFILL ALARM JAN 22, 2004 2:04 PM JAN 22, 2004 l:5d PM JAN 22, 2004 1:24 PM HIGH FRODUCT ALARM JAN 1. 1995 8:35 AM PRONE OUT FEH 3. 2004 2:46 PM DEC 22, 2003 12:25 PM DEC 22. 2003 12:23 PM DELIVERY NEEDED SEP 30. 2005 8:37 AM APR 15, 2005 6:54 AM MAR 18. 2005 9:52 AM MAX PRODUCT ALARM JAN 1. 1995 8:35 AM COrMUNICATIONS SETUPS 2 0 PORT SETTINGS: NONE FOUND RS-232 SECURITY CODE 000000 DISA2H32~DENII OF MESSAGE I IN-TANK SETUP :Di 1 :.000700 95.00 20 PTS 1?153 ALAIN'9 H [STORY REPORT ---- IN-TANK ALARM ----- T 2:UNLEADED OVERFILL ALARM NOV 19. 2004 5:23 PM AUG 10, 2004 2:02 PM OCT 15, 2003 3:08 PM HIGH PRODUCT ALARM AUG 10, 2004 2:06 PM JAN 1. 1995 8:34 AM JAN 1. 1995 8:31 AM PRONE OUT FEB 3, 2004 2:43 PM JAN 27, 2004 12:38 PM JUL 30, 2003 9:47 AM HIGH WATER WARNING JAN 1. 1995 8:31 AM JAN 1. 1995 8:30 AM DELIVERY NEEDED AFR 20, 2004 11:05 AM OCT 15. 2003 8:07 AM MAX PRODUCT ALARM JAN 1, 1995 8:34 AM JAN 1. 1995 8:31 AM JAN 1, 1995 8:30 AM ALARM HISTORY REPORT ---- IN-TANK ALARM ----- T 3:WASTE OIL SETUP DATA WARNING JAN 1, 1995 8:04 AM HIGH WATER ALARM JAN 1. 1995 8:04 AM LOW PRODUCT ALARM JAN 1. 1995 8:04 AM HIGH PRODUCT ALARM JUN 9, 2005 12:15 PM HIGH WATER WARMING JAN 1, 1995 8:04 AM ~O1-'TWARE REVISION LEVEL VERSION 9.00 SOFItiJRRE;t 346009-100-R CREATED - 95.08.28.11.25 NO SOFTWARE MODULE SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS 90.3 INCH VOL 1 928 85.5 INCH VOL 1 520 80.8 INCH VOL 1 016 76.0 INCH VOL 1423 71.2 INCH VOL 66.5 INCH VOL 61.7 INCH VOL : 57.0 INCH VOL : 52.2 INCH VOL 4?.5 INCH VOL 42.7 INCH VOL 38.0 INCH VOL 33.2 INCH VOL 28.5 INCH VOL 23.7 INCH VOL 19.0 INCH VOL 14.2 INCH VOL 9.5 INCH VOL 4.7 INCH VOL FLOAT SIZE: 4.0 I WATER WARNING HIGH WATER LIMIT: MAX OR LABEL VOL: OVERFILL LIMIT HIGH PRODUCT DELIVERY LIMIT LOW PRODUCT : LEAK ALARM LIMIT: SUDDEN LOSS LIMIT: TANK TILT MANIFOLDEII TANKS Ttl: NONE LZ+AK MI N ANNUAL PERIODIC TEST TYPE ANNUAL TEST FAIL ALARM DISABLED PERIODIC TAELARMADISA$LED GROSS TEST F~AI~L DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING; 4FF TANK TEST NOTIFY ~ OFF TNK TST SIPHON BREI~K:OFF DELIVERY DELAY ~! MIN l~ y MONITOR CERT. FAILURE REPORT sxTE NAb~ : PAM A ~uF.fy~ L ,i~'T,~~S~:~%bi~AT~ : a 1 ~ /~-~ xanR~ss:4a~ AsN.E i?~U, TECaNZCIAN: Si~~Ee.3 ~~ CITx • [~~(.~ S~,y~~(~ sxGNATVR~ SITE CONTACT: THE FOLI,OWiNG COM.DONENTS WERE RE$LACLD/REPAIRED TO COMPLETE THE L~ONITOR CERTIFICATION TESTING. LIST OF PARTS REPLACED/REPAIRED; REPAIRS:IJ LABOR: ~ ('~(J PARTS INSTALLED: ~ Q ~~L -~.t, y SWRCA, January 2002 Page ~_ of ~_ Secondary Contain>gaient Testing Report Form This form is intendedfor use by contractors performingperlodle testing of rIS'T'secondary contafnmentsysrama. Use tha appropriate pages of this form to report results for all components tested The completed form, written test procedures, and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agenry. 1. FACILITY 1i•NFOItMATION Facility Name:~kt~1AM1~ ~.~}Q~ VTR, (`lt'b'1r1~LGT Date of Tes ' 3 [~C.a FaciliryAddress: +~al~ {~, { i ~~lJ~ ~3 ~ Facility Contact: Phone: Date Local Agency Was Notified of Testing : ~ ~~ ~ ¢~(p Name of Local Agency Insuector ~fpresent during testing}: tJ f Ac TFC7'iN[;.' t`CINTRA['TnR INRtIRMATI(1N Compan Name: Rd CH ENVIRONMENTAL Tecluiician Conducting Test: Credentials: t~ CSLB Licensed Contractor ^ SWRCB Licensed Tank Tester License Type. C611D40 ~ LiceaseNumber. 809850 Manufacturer Maaufaer rsinia¢ e s ~ Date Trainin E fires INCON INCQN TS-STS 8/04 3. SUMMARY OF TEST RESY]LTS Component Pass Fail Not Tested Repots Made Component Pn88 Fail Not Tested Repairs Made t] .~: D ^ ^ ^ ^ ^ ^ 0 ^ 0 ^ ^ 0 0 0 0 ^ 0 ^~ ^ 0 0 ^ ^ ^ 0 D D ^ ^ D ^ D ^ ^ D 0 'ZT ^ ^ D D ^ ^ 0 ^ D ^ ^ ^ ^ ^ ^ ^ D ~ ^ ^ ^ ^ D ^ D ^ 0 ^ ^ D ^ 0 ^ ^ ^ ^ ^ ^ ^ ^ ^ if Hydrostatic testing was performed, describe what was dgne with the water after completion of tests: RECYCLE AND REUSED ~~ CERTIiFiCATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To t/ie best of my knowledge, the facts stated In this document are acettrate and In frill compUance wlth legal requirements Technician's 3ignature:~~ Date: ~?J3/~.Y~ SWRCB, January 2002 9. SPILL/OVERFILL CONTAIl~iMENT BOXES Zd~_ Pia a- o~ ~ Facilit is Not E ui ed With S illlOverfill Containment Boxes p j Spill/Overfill Containment Boxes ere Present, but were Not Tested Test Method Developed By: ^ Spill Bucket Manttfscturer Sd industry Standard C Professional Faigineer ^ ~tY:er (Speci ) Test Method Used: D Pressure ^ Vacuum ~ Hydrostatic Q Other (Specify} Test Equipment Used: INCO N TS-STS ui mentResolution:.oooin. T ~~ Spilt Box # spill Boa # Spilt Boa # Spill Box # Bucket Diameter: Bucket Depth: Wait time between applying pressure/vacuum/water and startin test: 3~ (~.Sf~-~ ~ ~S,T] Test Start Tune: ~~ '' tm'. ~Q;i Initial Reading (R~: a , y ~ , a ~ Test End Time: ~ ; 9m l : ~ ~ •,a ~Jj Final Reading (RF): . N at - eta 3 . sg 32 Test Duration: ~ ~ ~j t~~T`1 Chattge in Reading (R~R~: ('~j '; 050 Pass/Fail Threshold or Criteria: ,r -~ ~ ~ ~ • ~~ a Test Result: ~-Pass 0 Fail Pass Q Fail q Pass q Fail ^ Prss ^ FAit Comments - (include tnfor-natton on rcpatrs made prtor to testing and recommended follow-up jor~atled tests) T /2G SB 9 8 9 TESTING FAILURE REPORT' ' I TE t~t~ : PAN P~1~ ~• _6uE,tJAc l~b"tA- S~~t~-- n ATE : a ~ ~.(¢~~ ~D~~.s~JS - ~A~ Asi~~.~~ TrcxNxcxAN • ~~~y_}~~n.3 <T CITY: ~~TTj[,~'fj~,~~[~f~~ SIGNATLTNES - - - SITE CONTACT: 'THE FOLLOYIING COMPONENTS FIERE REPLACEDIREI'AT.RED TO COMPLETE THE 3B969 TES'TII3G . LIST OF PARTS REPLACED/REPAIRED: REPAIRS: /`~j~~ LABOR : ~ ©(~ Fes-- _ . PARTS INSTALLED : [`j~ ~ ~