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Home My WebLink AboutBUSINESS PLAN (3)~ - I. 7-Eleven 32376 9600 Brimhall Rd `w - ~ - UNIFIED~ PROGRAM INSPECTION CHECKLIST ,~ ._~ _._ SECTION 1-: Business Plan and Inventory Program ~!~- Prevention Services A > R s F t _ 0 900 Truxtun Ave., Suite 210 FIRE Bakersfield, CA 93301 v aerA- Tel.:. (661) 326-3979 Fax: (661) 872-21.71 " FACILITY NAME - INSPE TIO DATE INSPECTION TIME ADDRESS ~~ ~ ~ c PH NE O. s~ ~~o NO OF MPLOYEES ~ ~ FACILITY CONTACT - BUSINESS ID NUMBER ~/ 15-021- r gZ5 Section 1: Eusiness Plan and inventory Program -° -- ^ ROUTINE OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V__-~ C=Compliance OPERATION- V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIf1@SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS - ' ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ,> . ~~ ^ PROPER SEGREGATION OF MATERIAL . ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^- ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE - ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: -QUESTI REGAR THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please P t) Fire ention / 1~' In /Shift of Site/Station # Bu nes Sitl - White -Prevention Services - - Yellow -Station Copy Pink =Business Copy ^ YES ^ id6 FD 2155 (Rev. 09/05 S .~ INSPECTIONS BUSINESS PLAN & INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: ~ - I B ~ E R S F I L D F/RE A/PTM T 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 INSPECTION DATE: `~ ~ I Section 2: Underground Storage Tanks Program ^ Routine Combined ^ Joint Agency ^ Multi-Agency ^ Complaint ^ Re-Inspection Type of Tank in(,0(~~ Number of Tanks Type of Monitoring (! Lyj,~ Type of Piping (,~~ OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? ^ Yes ^ No ~" ~ Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank 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: Questions regarding this inspection? Please call us at (661) 326-3979 o • Busi ss ite Respo sible 0 White -Prevention Services Pink -Business Copy KeFaa3s FD 2156 (Rev. 09/05) ~- ~. T, ~~ F 7-ELEVEN 32376 (BRIMHALL) Manager SHASH KAMBOJ Location: 9600 BRIMHALL RD City BAKERSFIELD CommCode: KCFD STA 65 EPA Numb: CAL000274268 SiteID: 015-021-001885 BusPhone: (661) 588-4059 Map 102 CommHaz Moderate Grid: 29C FacUnits: 1 AOV: SIC Code:5541 DunnBrad:00-734-7602 Emergency Contact / Title Emergency Contact / Title SHASH&VEENA KAMBOJ / FRANCHISEE DISPATCH I / Business Phone: (661) 588-4059x Business Phone: (800) 828-0711x 24-Hour Phone (661) 872-3238x 24-Hour Phone (800) 828-0711x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact RANDY MARTIN Phone: (253) 796-7170x MailAddr: PO BOX 711 State: TX City DALLAS Zip 75221-0711 Owner 7-ELEVEN INC Phone: (253) 796-7170x Address PO BOX 711 State: TX City DALLAS Zip 75221-0711 Period to TotalASTs: = Gal Preparer : TotalUSTs : o~ _ /~~uo~ Gal Certif'd: Rss: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG U - UST Based on my inquiry of those individuals responsible for obtaining the information, 1 certify under penalty of law that I have personally examined and am f ' ~ r with the information submitted and _ lave . e infc~~~ a 'on is true, accurate, and . mpl . . Q~jS-~ ~ Signatur Date N~,® p,UG ~ p E ~,QO7 -1- 06/29/2007 F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-001885 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7-ELEVEN 32376 (BRIMHALL) Cross Street Business. Type: Org Type: Total Tanks 2 IndnRes/Trust: No PA Contact: Dsg Own/Oper IAN MOOREHEAD ICC Nbr: 5250115-UC PROPERTY OWNER INFORMATION Name : ~I-S-P3~'TC-H-~ ~ ~~~,-1 ~C . Phone: (-8fr6~ 82~x Address : ~ ~ . ~j rJ1L `7 //' G~,p d Lvr`~ 4.~e--f-~' ~ ~ 3 '~ R ~ ~ ~7 ~ ~ C7 City : `~~~~ State :7"~ Zip : ~5~~ ~ v old Type CORPORATION TANK OWNER INFORMATION Name ~BATC-F~--I- `~~G/~~~-e.,~ , ~,-lc . Phone : 828'= 0?~lx Address : ~6,,(~~ ~~/ ~~~~ Q-~~ o~~~ - 24~ ~ ~7! ~Z] City State~yL Zip : ~~~a-/-d -~~~ Type CORPORATION BOE UST Fee# 31896 Financ' 1 Resp : EI3----~~ ~~~ Legal Notif ~ ~ - ~7li ~o• -7/ 7 Z~ Date : 0 3 / 2 8 / 2 0 0 6 ~~ ` Phone : (~'~-1-7_0.-x ,~ Name:RANDY MARTIN Tt1:GASOLINE & ENVIRON COMPLAINCE MGR State UST # 1998 Upg Cert#: -2- 06/29/2007 F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-001885 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP GASOLINE L 10000.00 GAL Mod GASOLINE L 10000.00 GAL Mod CARBON DIOXIDE F P IH G 1275.00 FT3 Min WASTE FLAMMABLE LIQUIDS/SOLVENT F DH L 55.00 GAL UnR WASTE ABSORBANT F IH S 55.00 GAL UnR -3- 06/29/2007 -4- 06/29/2007 F 7-ELEVEN 32376 (BRIMHALL) ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME GASOLINE Location within this Facility Unit SW OF BLDG IN PARKING LOT STATE TYPE PRESSURE Liquid TMixture ~ Ambient SitelD: 015-021-001885 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 8006619 TEMPERATURE CONTAINER TYPE Ambient -~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 5000.00 GAL t1AG1-1ttLVUJ 1:v1~1rv1vL' 1v 1 $Wt. RS CAS# 100.00 Gasoline No 8006619 nta~r~ttL .ya a.G~~in~lvl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: SW OF BLDG IN PARKING LOT CAS# 8006619 Liquid TMixture ~mbRient~E ~ AmbientT~E UNDEROGROIINDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 100.00.00 GAL 5000.00 GAL nr~c~r~t~cLVUa ~.ui~irv~.v~lvi~ cwt. Rs cAS# 100.00 Gasoline No 8006619 nt~atucL r~~ a~~~ln~lvl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod -5- 06/29/2007 F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-001885 ~ ~ Inventory Item 0.006 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 124-38-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE ..Gas(,~.~~ Pure Above Ambient Cryogenic INSUL.TANK / CRYOGENIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average ~0~ ~ S ~ '-r° ?-5-8 o-FT3 ~ /.bS 3 0204 /~J S ,.~--v °v= FT3 - HAZARDOUS COMPONENTS °sWt. RS CAS# 100.00 Carbon Dioxide No 124389 t1HG1~itCL H.7~Jr,.7J1~1J;1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FLAMMABLE LIQUIDS/SOLVENT Days On Site 365 Location within this Facility Unit Map: Grid: NEAR TRASH ENCLOSURE CAS# Liquid TWaste =mbient~E ~ AmbientT~E DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GAL I3HGtitCLVUJ 1.V1~lYV1VJ;1Vl.'~ oWt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No riEiG1jlCL L-1, 7J~JJ1~1J~J1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / UnR -6- 06/29/2007 F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-001885 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE ABSORBANT Days On Site 365 Location within this Facility Unit Map: Grid: NEAR TRASH ENCLOSURE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Solid TWaste Ambient ~ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GAL riAGAtC1JVU~ 1:V1~lYV1Vl";1V15 °sWt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No ru~~tix1J s-~~ a.~~~ln~lvl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / UnR -7- 06/29/2007 F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-001885 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 04/04/2006 AFTER CALL 911, THE BAKERSFIELD CITY FIRE DEPT WILL BE NOTIFIED ALONG WITH THE CALIFORNIA STATE OFFICE OF EMERGENCY SERVICES 800-852-7550. 9 Employee Notif./Evacuation 07/17/1998 THE STORE ATTENDANT WILL NOTIFY OTHER EMPLOYEES AND CUSTOMERS BY A SHOUT THAT THE BLDG MUST BE EVACUATED. ALL PERSONS MUST EVACUATE THROUGH THE FRONT DOORS TO THE EVACUATION STAGING AREA SHOWN ON THE FACILITY DIAGRAM. Public Notif./Evacuation 07/17/1998 THE STORE ATTENDANT WILL NOTIFY OTHER EMPLOYEES AND CUSTOMERS BY A SHOUT THAT THE BLDG MUST BE EVACUATED. ALL PERSONS MUST EVACUATE THROUGH THE FRONT DOORS TO THE EVACUATION STAGING AREA SHOWN ON THE FACILITY DIAGRAM. Emergency Medical Plan 04/25/2006 MINOR INJURIES WILL BE TREATED USING THE FIRST AID KIT LOCATED INSIDE THE STORE. THE CLOSEST MECIAL FACILITY IS BAKERSFIELD MEMORIAL HOSPITAL, 420 34TH ST, 327-1792. -8- 06/29/2007 F 7-ELEVEN 32376 (BRIMHALL) SitelD: 015-021-001885 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 02/28/2007 EMERGENCY FUEL SHUT-OFF SWITCHES ARE LOCATED IN THE FRONT OF THE STORE AND NEAR THE STORE COUNTER. THE UNDERGROUND STORAGE TANKS ARE EQUIPPED WITH OVERFILL/OVERSPILL PROTECTION. TANK FLUID LEVELS AND INTERSTITIAL SPACE ARE MONITORED BY A VEEDER-ROOT TLS350 MONITORING SYSTEM. TANK TURBINES ARE EQUIPPED WITH LEAK DETECTORS WHICH RESTRICT FLOW IF A LEAK IS DETECTED BENEATH DISPENSERS OR ALONG PIPING RUNS. 9 Release Containment KITTY LITTER, LOCATED INSIDE THE STORE AT THE DIAGRAM, IS TO BE USED FOR SMALL FUEL SPILLS BAKERSFIELD FIRE DEPT WILL RESPOND TO LARGER OR ABSORBENT ON THE SPILL. 04/25/2006 LOCATION SHOWN ON THE FACILITY (LESS THAN 5 GAL). THE FUEL RELEASES BY PLACING SAND Clean Up 04/25/2006 ONCE A SPILL HAS BEEN CONTAINED, THE SAND OR ABSORBENT WILL BE CHARACTERIZED AND DISPOSED OF AT A PROPER DISPOSAL FACILITY. Other Resource Activation -9- 06/29/2007 F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-001885 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ aj~cc.;lai nac,aiu~ Utility Shut-Offs A) GAS - N/A B) ELECTRICAL - OUTSIDE NE CRNR BLDG C) WATER - OUTSIDE E SIDE BLDG AND IN PLANTER NW CRNR OF PROP D) SPECIAL - NONE E) LOCK BOX - NO 04/25/2006 Fire Protec./Avail. Water NEAREST FIRE HYDRANT - PLANTER ON NW CRNR OF PROP. 07/17/2006 Building Occupancy Level 8 EMPLOYEES 04/04/2006 -10- 06/29/2007 F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-001885 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 04/25/2006 ~ MSDS SHEETS ON FILE BEHIND STORE COUNTER. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED ON THE OPERATION OF THE UST IN A MANNER CONSISTENT WITH BEST MANAGEMENT PRACTICES, EMERGENCY CONTACT INFORMATION, SPILL/OVERFILL RESPONSE PROCEDURES, HAZ WASTE PROCEDURES, MONITORING EQUIPMENT OPERATION AND ALARM RESPONSE PROCEDURES. TRAINING IS CONDUCTED ANNUALLY, OR WITHIN 30 DAYS FOR NEW EMPLOYEES, BY THE DESIGNATED OPERATOR. rayc c. RG1~A ivl r. ut. uic vac Held for Future Use -11- 06/29/2007 UNDERGROUND STORAGE TANKS . .\ BAKERSFIELD FIRE DEPT. » B/%>i<! I n Prevention Services wRf'Af T 1600 Truxtun Ave., Ste. 401 APPLICATION ~ Bakersfield, CA 93301 TO PERFORM ELD /LINE TESTING Tel.: (661) 326-3979 \~~ 1 S8989 SECONDARY CONTAINMENT TESTING Fax: (661) 852-2171 (TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION Page 1 of 1 PERMIT NO. ~~~3 ^7 ENHANCED LEAK DETECTION IA~LINE TESTING ^SB-989 SECONDARY CONTAINMENT TESTING it I 1 TGNK TII:NTAIFSC TFCT Iv ITC1 PFRFf1RM FI IFI MCINITC1RINh CFRTIFICATIhN ~I SITE INFORMATION FACILITY '~_ll # 32376 NAME 8 PHONE NUMBER OF CONTACT PERSON 661-5884059 ADDRESS 9600 Brimhall Rd., Bakersfield, CA 93312 _OWNERS_NAME --SOUthland.. .~. _ _ __ _. _.. ._ OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED 3 IS PIPING GOING TO BE TESTED? ^ YES xO NO TANK# VOLUME CONTENTS 1 15,000 87 Octane 2 10,000 87 Octane 3 10,000 91 Octane TANK TESTING COMPANY NAME OF TESTING COMPANY Tanknolo InC. gyp NAME s PHONE NUMBER OF Mark Lindsey 800-666-2176_ ~ CONTACT PERSON @Xt.1B MAILING ADDRESS -41785 Enterprise Circle S. Suite D Temecula, CA 92590 NAME & PHONE NUMBER OF Will Rogers 909-772-9853 TESTER OR SPECIAL INSPECTOR: CERTIFICATION #: DATE 8 TIME TEST TO BE 7/13/07 at 9:OOAM CONDUCTED: '~~ #~ 5251926-UT Tesr TLD-1, FTA METHOD SIGNATURE OF APPLICANT _ ~ DATE: 6/22/07 ,- rr' ~E 0 E A ~ All '~'' V,U~'1 ~ A ~~Q,~~ APPROVED BY DATE a Q CJ FD 2095 (Rev. 09/05) T'T- o ~~ BAKERSFIED FIRE DEPARTMENT OFFICE OF ENVIIZONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA 93301 Test Date: 7/30/07 Order Number: 3153961 Dear Regulator: Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32376, MKT 2237 9600 BRIMHALL RD BAKERSFIELD, CA 93312 Services performed: Healy Volume to Liquid tests Sincerely, ~~ ~~ Dawn Kohlmeyer Manager, Field Reporting ~, M M i 'v ~. O 0 -17- ~1~~ ~• s A d a Testing Firm tJame and Address: res d nd GE?F Name Sh t :i t ld D ~~'~ --~ •-- ----- -- ~- ee a a e Hea! V!L i ft3 ti E 1 S `1??-'t~'t k `~' `~ ~,~ ° on ec , j,,,,. Tee Connection Test Result (Sea s.:: ~ ~{~~ - ~~~~ ~ SFi trGJ) ~} ~ I]ate of fast Gas Volume Meter Calihrakion Correction factor for Gas Volume Meter pressure Measurement Device Calibration Date t a ~ Phone No. (g`'°) 6 ~~ • ~~ ~~ ~~ a ~ ~ ~ ~ f~ Test DateiTime: ~ '3 ~ ' Pre-Test Leak Check: InltiallFlnal Pressures, in. Hz0 ~~5 / Post-Test Leak Check: !-~ InitiaiiFinal Pressures, in. H d ~ •~ ! 9 t .." D~ 261 A!C # P10 # f Test Performed b ./mow . , District Test Wetness Applicable ARB EQ # VFt-201-A Allowable VJL Range fl.95 -1.15 7.7.3 7.7.6 7.7.7 7.7,8 7'7'1 7.7.2 NouJe Mgde1 & Initial Final ~ Total Gas .Dispensing FUel ~ 01s eraser Dis eraser Pum ed, 7 Timm Rate. Pump I 5eria{ # ~ P P P # Grade i Totalizer, 7atalizer, Cations Seconds 9Pm ~ Gallons Gallons - ~ - .. ~t.~`t ...~. __~'_ t.b-~~- x.26 4 ! --__._._..._.__._ -- ~~ ~ Q y~ ~L L SOP .. .. .._ - .O ~ - ~'~~ I- ~{ ~-- -.-•.. .............---' 4•_17 - 1 ~°~~ J t~ ~• S ~5 too 2.~~ Q.~"f .,-, _ ., .._ ._ -- -- C. .p~6 . s;2 Heaiy Phase II EVR System, Exhibit 5 - VR•2171 •A °-- 7,7,4 7.7,6 ~^. _. Initial Final~7.t3 7.9 7,9, 7.9 Meter I Meter or 7_id VJL VJL Average Pass or Re ft3 rag, Re h3 rag, {ir necessary} Fais ... ~ ~- --aSS _~ t - ~ _ a ~ S5 ' _ O.`i 5 I _ ~ tom. ~ - +-~` • • --- _ Piss . - {- ~~ ..._ ..-QaSS _ f G2~ ~ 5 ~ -- , .._ _~- ~.~.+D~ ~sS I_ i 2 _.. .._ ~ ~hSS .~.. I { -O_ ~r~.._ ~~s5 - ._ --- -~- _... __ .._ i o~ E~ .~ d 0 0 v a~ ~. w 0 z 0 0 E~ ~, .~l 3 ~, M M i; b ~, 0 -~ ~- ~2~F~~ GbF Name and Address Testing Firm blame and Address: -.----.-.----~.........._--.------._.---..__.._ Heal V!L Field Data Sheet y - Tee Connection Test Result {See Section 6.1} ft' ___ _ Date of Last Gas Volume fvieter Galibration __ Correction Factor for Gas Volume Meter Pressure Measurement pevice C2ilibration bate Phone No. ( ) Test Data?Time; 30 v'~- Test Performed b Pre-Test Leek Gt+eCk: initial?Final Pressures, in, HzO ! Post-Test Leak Cheek: InitialrFinal Pressures, In, N O ? AJC # PJQ # Qistrict Test Witness Applicable ARB EO # VR-201-A Allowable V/L Range 0.95 - 1.15 7,7.3---- --~~7.7.5.~r - 7.7,7 ~~-~~ ~~ 7.7.4 7.T.6 .. 7.7.1 7.7.2 Y 7.7.8 T ~ Nozzle Model & Initial Final Tota! Gas J3ispensing Initial Final i 7.8 7.9 7.8, 7.9 or T.10 Pump ' FueE $erial # Dispenser Dispenser Pumped, Time. Rate, Meter Meter V?L VIL Average Pass or ~ Grade Tatallzer, Totalizer, Seconds Gallons gpm Reading, Reading, (if neressary} Fail _ Gallons Ga Ions n3 ft3 ~-_.-.- , ~- ._~~ 2 . o~.g ._.. _ i ~ • ~ 3 1- x..: X55 5~' ~- ..... _ ._ _, . - ~ ~ _ ~`.t..._ . M ~ aSox ~ ~ ..., r] ~ 'lrDC~ loco :,.... .~_..Gc_a~'t ~_._. .---~~- ---±'-°~~--..._. ,-~}'~ -- ~ Q.Z Z .os6 --- ~. >~2 _ .. ...._.._...... ----~~__a, ~q : X155-- . . ._ .._ .. .. ' ~•~2. ~ .~t )' ass ~ ~----..Z. ~~ .. _ _.1 ---'- -.... .._._ I -- Healy Phase It EVR System, Exhibit 5 - VR•2D1•A 00 x a~ [-•~ s~ .~ d 0 0 v a~ rn 3 a w U O z 0 ~, 0 H ti~ .:f 3 I - - I ~, M ul M i-i a~ ~. 0 GDF Name and Address Testing Firm Name and Address: l V Hea y 1L Field Data Sheet Tee Connection Test Result (See Section fi.1 } ft3 ___ __ _ ___ ~~~~ date of Last Gas Volume Meter Calibration Cgrrection Factor for Gas Volume Meter Pressure Measurement Device C8lipratign pate Phone No. { ) Test aateiTime: ~ 3~ a Test Performed b Pre-Test Leak Check: lnitiaUFinal Pressures, in. H2O f Post-Test Leak Cheek: lnitiallFinal Pressures, in. H D f AIC # _ P10 # District Test Witness Applicable ARB EO # VR-209-A Allowable V!L flange 0.95 - 1,15 7-7.3 '. 7.7,5 7.7.7 7.7.4 ~ 7.7.& 7.7.1 7.7.2 7,7.8 7.8 7.8 _ 7.8, 7.9 Nozzle Model & i Inltlsl Final Total Gas Dispensing Initial Final or 7.16 Pumfl Fuel Serial # dispenser pispenser Pumped. ~ Tma, Rate, Mater Mater Vtl. V!L Average Pess or # Grade i Totalizer, 7obiizer, ~ Gallons Seconds gpm Reading, Reading, (il ne~essary~ Pail Gallons Gattons ft3 k3 ._.._.~.~_..r „ , -... Y!'C-'fit 40~ Z.,~S ~~2 _.... .i ~• t2 _~ ~+~ S ..i-• ~ -- 2 _~~'.. l~9 LK C~pb 2.0 ~ ( `s1i,'}-"2-... . _ - f,v `t T -- ~-5~ ... r 4~ __ .__ ....- --- I Z.~sq ~.~-t-- --[..off. ~~I kS1 -.~~- : -- -= -- --~-------T Healy Phase tl EVR System; Exhibit 5 - VR-201-A a~ H s~ .y d 0 0 v 3 ti f: ~. w U 0 z 0 v7 ao ~, oq 0 H -~, ITE DIAGRAM "j ~_ Tanlv'to1o9Y 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 07/30/07 CLIENT:7-ELEVEN, INC. VENTS Af Ri #12 H2O #10 #11 #9 #8 #6 #7 #5 #4 #2 #3 #1 O O O REG 10K ~1 O O O PREM 10K O ~o c ~~ WORK ORDER NUMBER3153961 SITE:7-ELEVEN #32376, MKT 2237 W S N Printed 08/23/2007 15:17 ACRAMER ~~~~' ~ 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 07/13/2007 Order Number: 3153656 Dear Regulator, Date Printed and Mailed: 07/30/2007 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32376, MKT 2237 9600 BRIMHALL RD. BAKERSFIELD, CA. 93312 Testing performed: Leak detector tests Line tests Monitor Certification Sincerely, ...~ Oar~'r ~a~~m~t.~s~ Dawn Kohlmeyer Manager, Field Reporting ., i 7san PURPOSE: COMPLIANCE TEST DATE: 07/13/07 CLIENT: 7-ELEVEN, INC. P.O. BOX 711 DALLAS, TX 75221 (972)828-7908 MANAGER (661)588-4059 TEST TYPE: TLD-1 Product Pi a Tic htness Test Results LINE LINE LINE DELIVERY TEST RESULT FINAL LEAK RATE (gph) ID PRODUCT MATERIAL TYPE A B C D A B C D lOk 2 REGIILAR ENVIROFLEX PRESSIIRE P P 0.000 0.000 lOk 3 PREMIIIM ENVIROFLEX PRESSIIRE P P 0.000 0.000 IMPACT VALVE Y Y EYistina Line Leak Detector Test EXISTITG LEAK DETECTOR #1 EXIST ING LEAK DETECTOR #2 LINE ID MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # RESULT __ lOk 2 VAPORLESS LD2000 NO TAG P lOk 3 VAPORLESS LD2000 NO TAG P Npw Ranlarpmanf 1 ina 1 ~aak r)ptprtnr Tact REP IACED`LEAK DETECTOR #1 REPLACED LEAK`DET EGT R #2 LINE MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # RESUL ID rur uwnrr ueuaneu ropun mrormanun, visa www.ranxnoiogy.com anu seiecr vn-Lme xeporrs-wicnr, or comic[ your ~oca~ ianimoiogy omce. Tester Name: WILLIAM ROGERS ~~s~~ Technician Certification Number:1647 TANKNOLOGY CERTIFICATE OF TESTING 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 TELEPHONE (512) 451-6334 FAX (512) 459-1459 TEST RESULT SUMMARY REPORT WORK ORDER NUMBER: 3153656 CUSTOMER PO: SITE: 7-ELEVEN #32376, MKT 2237 9600 BRIMHALL RD. BAKERSFIELD, CA 93312 Printed 07/30/2007 08:20 ACRAMER INDIVIDUAL TANK INFORMATION AND TEST RESULTS i Tankr~ology TEST DATE:07/13/07 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3153656 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512)451-6334 SITE:7-ELEVEN #32376, MKT 2237 TANK INFORMATION Tank ID: iok 2 Tank manifolded: No Bottom to top fill in inches: 144.0 Product: REGULAR Vent manifolded: No Bottom to grade in inches: 147. o Capacity in gallons: l0, 028 Vapor recovery manifolded: YES Fill pipe length in inches: 4s. o Diameter in inches: 96 . oo Overfill protection: YES Fill pipe diameter in inches: 4 • o Length in inches: 324 Overspill protection: YES Stage I vapor recovery: DUAL Material: TOTAL corm Installed: ATG Stage II vapor recovery: AssxsT CP installed on: / / COMMENTS TANK TEST RESULTS Test Method:VacuTect LEAK DETECTOR TEST RESULTS Test method: FTA Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: vAPORLESs Ingress Detected: Water Bubble Ullage Model: LDZOOo Test time: S/N: xo TAB Open time in sec: 7.00 Inclinometer reading: Holding psi: 3 0 VacuTect Test Type: NoT ReSlllenCy CC: 330 NOT T VacuTect Probe Entry Point: ESTED Test leak rate mUm: 1s9. o TESTED Pressure Set Point: Metering psi: z4 Tank water level in inches: Calib. leak in gph: s . 00 Water table depth in inches: Results: Pass Determined by (method): Result: COMMENTS COMMENTS LINE TEST RES ULTS Test type: TLS-i LINE A B C D Mat@rl2l: ENVIROFLEX Diameter (in): 1.5 Length (ft): 260. o Test psi: 50 50 Bleedback cc: 0 0 Test time (min): 60 6o NoT NoT Start time: os :12 08:12 TESTED TESTED End time: 09 :12 04 :12 Final gph: o.ooo o.ooo ReSUIt: PASS PASS PUmp type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: YES Printed 07/30/2007 08:20 F INDIVIDUAL TANK INFORMATION AND TEST RESULTS - ~ Tan TEST DATE:07/13/07 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3153656 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512)451-6334 SITE:7-ELEVEN #32376, i~T 2237 TANK INFORMATION Tank ID: iok 3 Tank manifolded: No Bottom to top fill in inches: 146. o Product: PREMIUr> Vent manifolded: No Bottom to grade in inches: 150.0 Capacity in gallons: 9, 975 Vapor recovery manifolded: YES Fill pipe length in inches: 50. o Diameter in inches: 96. oo Overfill protection: YES Fill pipe diameter in inches: 4 • o Length in inches: 324 Overspill protection: YES Stage I vapor recovery: DUAL Material: TOTAL eoNT Installed: ATC Stage II vapor recovery: AsslsT CP installed on: / / COMMENTS TANK TEST RESULTS Test Method:vacuTect LEAK DETECTOR TEST RESULTS Test method: FTA Start (in) End (in) Dipped Water Level: New/passed Failedlreplaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: VAPORasss Ingress Detected: Water Bubble Ullage Model: LD2ooo Test time: SAN: rro xAc Open time in sec: s.oo Inclinometer reading: Holding psi: 31 VacuTect Test Type: NoT ReS111enCy CC: 340 NOT T VacuTect Probe Entry Point: ESTED Test leak rate mUm: 1s9. o TESTED Pressure Set Point: Metering psi: 24 Tank water level in inches: Calib. leak in gph: a. 00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type: T~-1 LINE A B C D Materlal: ENVIROFLEX Diameter (in): i. 5 Length (ft): 2 s o . o Test psi: 50 50 Bleedback cc: o 0 Test time (min): 60 6o NOT NOT Start time: 08:12 08:12 TESTED TESTED End time: 09:12 09:12 Final gph: 0.000 0.000 ReSUIt: PASS PASS Pump type: PRSSSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: YES Printed 07/30/2007 08:20 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of Califomia Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3 Title 23, Califomia Code of Regulations This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or report must be oregared for each monitoring svstem 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: 7-ELEVEN #32376, MKT 2237 Site Address: 9600 BRIMHALL RD. Faciiity Contact Person: MANAGER Make/Model of Monitoring System:TLS350R B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced TanklD: 87 TanklD: 91 X In-Tank Gauging Probe. Model: MAG 2 X In-Tank Gauging Probe. Model: MAG 2 X Annular Space or Vault Sensor. Model: 420 Annular Space or Vault Sensor. Model: 420 X Piping Sump/Trench Sensor(s). Model: 352 Piping SumplTrench Sensor(s). Model: 352 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: ~( Mechanical Line Leak Detector. Model: LD2000 X Mechanical Line Leak Detector. Model: LD2000 Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill/High-Level Sensor. Model: Tank Overfill/High-Level Sensor. Model: Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). TanklD: TanklD: In-Tank Gauging Probe. Model: In-Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: Piping Sump/Trench Sensor(s). Model: Piping Sumplfrench Sensor(s). Model: 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: Tank Overfill/High-Level Sensor. Model: Tank Overfill/High-Level Sensor. Model: Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). ispenser 1-12 DispenserlD: Dispenser Containment Sensor(s) Model: 352 Dispenser Containment Sensor(s) Model: X^ Shear Valve(s). Shear Valve(s) Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). * If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this certification is information (e.g manufacturers' checklists) necessary to verify that this information is correct. and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): ~ System set-up X^ Alarm history report Technician Name (print): WILLIAM ROGERS Signature: ~" " ~~~~~~ Certification No.: 8520 License. No.: Testing Company Name: Tanknology Phone No.: (800) 800-4633 Site Address: 8501 N. MoPac Expressway, suite 400, Austin, TX 78759 Date of Testing/Servicing: 07/13/2007 Page 1 of 3 Based on CA form dated 03/01 Monitoring System Certification City: BAKERSFIELD CA Zip: 93312 Contact Phone No: 588-4059 Date of Testing/Service: 07/13/2007 Work Order Number: 3153656 Monitoring System Certification Site Address: g600 BRIMHALL RD. Date of Testing/Service: 07/13/2007 D. Results of Testing/Servicing Software Version Installed: 326.00 Complete the following checklist: ^x Yes ^ No " Is the audible alarm operational? 0 Yes ^ No' Is the visual alarm operational? 0 Yes No' Were all sensors visually inspected, functionally tested, and confirmed operational? Q Yes ^ No' Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes No' X NiA If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? ^x Yes ^ No * ^ N/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (check all that apply) ^X Sump/Trench Sensors; ^x Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ^x Yes ^ No ^ Yes ^ No' ^x N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e.: no mechanical overfill prevention valve is insta-led), is the overfill warning alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? ^ Yes' ^x 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 replacement parts in Section E, below. ^ Yes' x^ No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) ^ Product; ^ Water. If yes, describe causes in Section E, below. ^x Yes ^ No' Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. ^x Yes ^ No * Is all monitoring equipment operational per manufacturers' specifications? * In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: Page 2 of 3 Based on CA form dated 03/01 r Site Address: g600 BRIMHALL RD. Monitoring System Certification F. In-Tank Gauging /SIR Equipment Date of Testing/Service: 07/13/2007 ^ 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. Complete the following checklist: 0 Yes ^No • Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes ^No' Were all tank gauging probes visually inspected for damage and residue buildup? Yes ^ No • Was accuracy of system product level readings tested? QYes ^No' Was accuracy of system water level readings tested? Yes ^No' Were all probes reinstalled properly? ^x Yes ^No • Were all items on the equipment manufacturers' maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD) : ^ Check this box if LLDs are not installed. Complete the following checklist: Yes ^ No • ^ N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? Check all that apply) Simulated leak rate: x^ 3 g.p.h ^ 0.1 g.p.h ^0.2 g.p.h x Yes ^ No' Were all LLDs confirmed operational and accurate within regulatory requirements? x Yes ^ No • Was the testing apparatus properly calibrated? ^X Yes ^ No * ^ N/A For mechanical LLDs, does the LLD restrict product flow if it detects a Teak? ^ Yes ^No' ^x N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ^ Yes ^No' ^x N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ^ Yes ^No • ^x N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ^ Yes ^No • 0 N/A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes ^No' Were all items on the equipment manufacturers' maintenance checklist completed? ' In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 Based on CA form dated 03/01 ~`~-._ SWRCB, January 2002 Page 1. '~ Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests (tf applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN #32376, MKT 2237 Date of Testing: 07/13/2007 Facility Address: 9600 BRIMHALL RD. BAKERSFIELD, CA, 93312 Facility Contact: MANAGER Phone: (6 61) 5 8 8- 4 0 5 9 Date Local Agency Was Notified of Testing : / / Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC . Technician Conducting Test: WILLIAM ROGERS Credentials: ~ CSLB Licensed Contractor ~ SWRCB Licensed Tank Tester License Type: TANK TESTER License Number: 3-1647 Manufacturer Training Manufacturer Component(s) Date Training Expires / / J / / / / / 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repair Spill Box 2 REG FILL ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 2 REG FILL ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 3 PRE FILL ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 3 PRE FILL ~ ^ ^ ^ ^ ^ ^ ^ If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician s Signature: ~~ S Date: 0 7/ 13 / 2 0 0 7 SWRCB, January 2006 . 9. Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN #32376, MKT 2237 Date of Testing: 07/13/2007 Facility Address: 9600 BRIMHALL RD. BAKERSFIELD, CA, 93312 Facility Contact: MANAGER Phone: (6 61) 5 8 8- 4 0 5 9 Date Local Agency Was Notified of Testing : 1 1 Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY , INC . Technician Conducting Test: WILLIAM ROGERS Credentials 1: ^ CSLB Contractor ^ ICC Service Tech. a SWRCB Tank Tester ~ Other (Specify) TANK TESTER License Number: 3 -164 7 3. SPILL BUCKET TESTING INFORMATION Test Method Used: ~ Hydrostatic ^ Vacuum ^ Other Test Equipment Used: Equipment Resolution: Identify Spill Bucket(By Tank Number, Stored Product, etc.) 1 2 REG FILL 2 2 REG FILL 3 3 PRE FILL 4 3 PRE FILL Bucket Installation Type: ^ Direct Bury ^ Contained in Sump ^ Direct Bury ^ Contained in Sump ^ Direct Bury ^ Contained in Sump ^ Direct Bury ^ Contained in Sump Bucket Diameter: 11 1l 11 11 Bucket Depth: 10 10 14 14 Wait time between applying vacuumJwater and starting test: 15 MINS 15 MINS 15 MINS 15 MINS Test Start Time (TI ): 8: 2 8 8: 4 5 8: 3 0 8: 4 7 Initial Reading (RI ): 6 6 9 9 Test End Time (TF ): 8: 4 3 9: 0 0 8: 4 5 9: 0 2 Final Reading (Rp ): 6 6 9 9 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading (R F - RI ): - • 00004 - .00004 - .00000 .00000 Pass/Fail Threshold or Criteria: . 0 0 2 0 0 .0 0 2 0 0 .0 0 2 0 0 .0 0 2 0 0 'l'est Result: ~ Pass ~ Fail [~ Pass ~ I~'ail ~ Pass ~ Wail ~ Pass ~ Fail CommeIIts - (include information on repairs made prior to testing, and recommended follow-up for failed tests) CERTIFICATION OF TECIINICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: ~~~~s~~ Date: 0 7/ 13 / 2 0 0 7 t State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements ITE DIAGRAM ~ Tanlvtobgy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 07/13/07 WORK ORDER NUMBER3153656 CLIENT:7-BL]3VSN, INC. SITE:7-BLSVLN #32376, MKT 2237 ~ , ~. AIR/ VENTS ~ CAS H2O ~ ~ ~ ~ ~ m~ ~~ OF ~F ICE . OV O REG PREM 10K 10K O O ~ w v .~ ^~ STP STP V11 S .; ` N Printed 07/30/2007 08:20 ACRAMER ~. ~_ Work Order: o, _.- a: ~~ E _ ; ~- _ - >~~ _ . ~ ~ -~ , .._ a. ~ .~~;. z, a~~, ~ _ _` ~~ .~~ ~~° - - ,..- a ,. ., 7 ~4 _ _ , ', ~ i s ,~ . ~, .. .. rc 3 ,~, , ~ 3{L sfi ! . ...k. k r ,9fi'. _ -~ - .. .i .+ x fi ~.~ t ~ ., ~ r r ~f r~-~ ,. -S -~ a» t ,i E •4 e o r ._ r! ~ ~ .r .~ c.v i' t r~.: .,,k dry>. ~ ~_ 4. ~ ~ t ~ ... .. ~. ~ ; . .. ^'i .. ... ^~y q' ~~ ~. n ~ ; r.q auk ied• e '.. ~'.~ ?fir. .. ... ~ atiw. s . ~ .. ~ ~ ,. ~ ~ ~-... f . ... ~ < yew ' $ F .. ... .., .., ? , ~i .~~ . S. {*~j.~bfib ~ ~ ~ i bd'~I __ ~ s ~`~ _ _ ~ ~ M P ~-) .. - - ., 1~f ... n tt Y .. ~ w ~ ..: Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 3153656 ' : .. 7-ELEVEN 32376 (BRIMHALL) _ Manager ~ ~ ~N- ~X}mbnJ Location: 9600 BRIMHALL RD City BAKERSFIELD CommCode: KCFD STA 65 EPA Numb : ~ ~I LD(~~~'~~~-COF~ SitelD: 015-021-001885 BusPhone: (661) 588-4059 Map 102 CommHaz Moderate Grid: 29C FacUnits: 1 AOV: SIC Code:5541 DunriBrad:00-734-7602 Emergency Contact / Title Emergency Contact / Title SHASI&VEENA KAMBOJ / FRANCHISEE D~SO9~~.L~/ Business Phone: (661) 588-4059x Business Phone: (8-8.8) fix{ 24-Hour Phone (661} 872-3238x 24-Hour Phone (800) 828-0711x~ Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact ~~'~ m~ ~"' N Phone: Ox MailAddr: PO BOX 711 State: TX City DALLAS Zip 75221-0711 7 ~ Owner 7 -ELEVEN INC Phone : (-.-^~ 2"~ '" ~ nX: Address PO BOX 711 State: TX City DALLAS Zip 75221-0711 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif ' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG U - UST ssaeed cn my inquiry of those individuals respansible for obtaining the information, f certify under pena of !aw that I have personally examined nd am fa ' ' r with the information submitt an bell e t e information is true, ' EIVr accur e a com ete p ~E , 2 6 ~~ 2 6 2007 . ignature Date -1- 01/24/2007 ,_ s F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-001885 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7-ELEVEN 32376 (BRIMHALL) Cross Street Business Type: Org Type: Total Tanks 2 IndnRes/Trust: No PA Contact: Dsg Own/Oper S~ ~9 rJ rndo~ ~ q-c~ ~~~ ~~~ u~ ICC ,Nbr : 5~~2-F-~~~~ Name D 7-Eleven, Inc. ~ Phone: (-8.8~-'33~-~-7-2~9~ Address : Gasoline Acctg. ~'"3- 7q~_ 7! 7 p City P. O. Box 711 .ate: zip: Type CORPORATION ~ Dalla s, TX 75221-0711 - _ TANK OWNER INFORMATION Name „T~'Tr 7-Eleven, Inc. Phone: {~s~-7~-37~-0~_ Address : Gasoline Acctg. X53- 79(x- 7 / 70 City P. O. Box 711 e : zip Type / CORPORATION Dallas, TX 75221-0711 BOE UST Fee# 31896 Financ'1 Resp: INSURED Legal Notif Date: 03/28/2006 F Phone: - x Name : ,~aJcl~( i'I'JQil,~-i N Ttl :GASOLINE & ENVIRON COMPLAINCE MGR State UST # 1998 Upg Cert#: -2- 01/24/2007 T' r F 7-ELEVEN 32376 (BRIMHALL) ~ Hazmat Inventory ~ MCP+DailyMax Order = SiteID: 015-021-001885 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP GASOLINE L 10000.00 GAL Mod GASOLINE L 10000.00 GAL MOd CARBON DIOXIDE F P IH G 1275.00 FT3 Min WASTE FLANIlKABLE LIQUIDS/SOLVENT F DH L 55.00 GAL UnR WASTE ABSORBANT F IH S 55.00 GAL UnR -3- 01/24/2007 ~} _` ~f -4- O1j24j2007 F 7-ELEVEN 32376 (BRIMHALL) ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME GASOLINE Location within this Facility Unit SW OF BLDG IN PARKING LOT STATE TYPE PRESSURE Liquid TMixtur~ Ambient SiteID: 015-021-001885 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 8006619 TEMPERATURE ~~~ CONTAINER TYPE Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 10000.00 GAL 10000.00 GAL 5000.00 GAL ntic~.ytcLUUJ ~vrirvl~nlV1S %Wt. RS CAS# 100.00 Gasoline No 8006619 t11~G.HtCL Ei. 7w'~L",.7.71~1L'1V1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: SW OF BLDG IN PARKING LOT CAS# 8006619 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~Ambient ~ Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL I 5000.00 GAL a1t~c~nlcs~vvJ L.vrlrvt~JJty t S %Wt• RS CAS# 100.00 Gasoline No 8006619 r1tiL~tiitL ti~ 7 w7 P~w7 J1"1G1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod -5- 01/24/2007 F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-0018$5 ~ ~ Inventory Item 0006 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Days On Site 365 .Location within this Facility Unit Map: Grid: CAS# 124-38-9 STATE T TYPE PRESSURE ~ TEMPERATURE ~ CONTAINER TYPE ~ ~GaS I Pure Above Ambient I Crvoaenic I INSUL_TANK / CRYOGENIC I AMOUNTS AT THIS LOCATION Largest Container_ Daily Maximum Daily Average 1275.00 FT3 1275.00 FT3 1275.00 FT3 HAZARDOUS COMPONENTS oWt. RS CAS# 100.00 Carbon Dioxide No 124389 IltiUtilC.L tiJ Jl~JJI.IP~IVIJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FLAMMABLE LIQUIDS/SOLVENT Days On Site 365 Location within this Facility Unit Map: Grid: NEAR TRASH ENCLOSURE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste ~ Ambient ~ Ambient DRUM/BARREL-METALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GAL •• HAZARDOUS COMPONENTS oWt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No i1PiUP].CCL 1•iJ JLiJ JP1P~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / UnR -6- 01/24/2007 -,,~ F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-001885 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE ABSORBANT Days On Site 365 Location within this Facility Unit Map: Grid: NEAR TRASH ENCLOSURE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Solid TWaste ~ Ambient ~ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GAL t1AGA1[llV U 5 1.:V1~lY V1V r;1V'1' S %Wt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No tiAGF~.KL A~SJJS~1~11;1V'1~~ TSecret RS BioHaz RadioactivefAmount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / UnR -7- 01/24/2007 F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-001885 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 04/04/2006 ~ AFTER CALL 911, THE BAKERSFIELD CITY FIRE DEPT WILL BE NOTIFIED ALONG WITH THE CALIFORNIA STATE OFFICE OF EMERGENCY SERVICES 800-852-7550. Employee Notif./Evacuation 07/17/1998 THE STORE ATTENDANT WILL NOTIFY OTHER EMPLOYEES AND CUSTOMERS BY A SHOUT THAT THE BLDG MUST BE EVACUATED. ALL PERSONS MUST EVACUATE THROUGH THE FRONT DOORS TO THE EVACUATION STAGING AREA SHOWN ON THE FACILITY DIAGRAM. Public Notif./Evacuation 07/17/1998 THE STORE ATTENDANT WILL NOTIFY OTHER EMPLOYEES AND CUSTOMERS BY A SHOUT THAT THE BLDG MUST BE EVACUATED. ALL PERSONS MUST EVACUATE THROUGH THE FRONT DOORS TO THE EVACUATION STAGING AREA SHOWN ON THE FACILITY DIAGRAM. Emergency Medical Plan 04/25/2006 MINOR INJURIES WILL BE TREATED USING THE FIRST AID KIT LOCATED INSIDE THE STORE. THE CLOSEST MECIAL FACILITY IS BAKERSFIELD MEMORIAL HOSPITAL, 420 34TH ST, 327-1792. -8- 01/24/2007 F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-001885 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 04/04/2006 ~ EMERGENCY FUEL SHUT-OFF SWITCHES ARE LOCATED IN THE FRONT OF THE STORE AND NEAR THE STORE COUNTER. THE UNDERGROUND STORAGE TANKS ARE EQUIPPED WITH OVERFILL/OVERSPILL PROTECTION. TANK FLUID LEVELS AND INTERSTITIAL SPACE ARE MONITORED BY A L EMS 3500 MONITORING SYSTEM. TANK TURBINES ARE EQUIPPED WITH LEAK DETECTORS WHICH RESTRICT FLOW IF A LEAK IS DETECTED BENEATH DISPENSERS OR ALONG PIPING RUNS. ~~-'T~- s ~SC~ Release Containment 04/25/2006 KITTY LITTER, LOCATED INSIDE THE STORE AT THE LOCATION SHOWN ON THE FACILITY DIAGRAM, IS TO BE USED FOR SMALL FUEL SPILLS (LESS THAN 5 GAL). THE BAKERSFIELD FIRE DEPT WILL RESPOND TO LARGER FUEL RELEASES BY PLACING SAND OR ABSORBENT ON THE SPILL. Clean Up 04/25/2006 ONCE A SPILL HAS BEEN CONTAINED, THE SAND OR ABSORBENT WILL BE CHARACTERIZED AND DISPOSED OF AT A PROPER DISPOSAL FACILITY. v~.lic~. ncavuii.c L"]l.:l..1VGLl.1V11 -9- 01/24/2007 F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-001885 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .7.IJ~C:1c11 lYclGcLiU~S' Utility Shut-Offs 04/25/2006 A) GAS - N/A B) ELECTRICAL - OUTSIDE NE CRNR BLDG C) WATER - OUTSIDE E SIDE BLDG AND IN PLANTER NW CRNR OF PROP D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water NEAREST FIRE HYDRANT - PLANTER ON NW CRNR OF PROP. 07/17/2006 Building Occupancy Level 04/04/2006 8 EMPLOYEES -10- 01/24/2007 ,; ~„ ; F 7-ELEVEN 32376 (BRIMHALL) SiteID: 015-021-001885 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 04/25/2006 ~ MSDS SHEETS ON FILE BEHIND STORE COUNTER. BRIEF SiTPMRARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED ON THE OPERATION OF THE UST IN A MANNER CONSISTENT WITH BEST MANAGEMENT PRACTICES, EMERGENCY CONTACT INFORMATION, SPILL/OVERFILL RESPONSE PROCEDURES, HAZ WASTE PROCEDURES, MONITORING EQUIPMENT OPERATION AND ALARM RESPONSE PROCEDURES. TRAINING IS CONDUCTED ANNUALLY, OR WITHIN 30 DAYS FOR NEW EMPLOYEES, BY THE DESIGNATED OPERATOR: rayC ~ Laciu. ivi L•u~..uic Vac 17C1V. 1V1 1'l.L t~u1C VAC -11- 01/24/2007 February 15, 2007 BAKERSFIELD FIRE DEPARTMENT 900 TRUXTUN AVENUE, SUITE 210 BAKERSFIELD, CA 93301 RE: Statement of Compliance and Designated Operator Dear Sir or Madam: Gilbarco/Veeder-Root, acting as the authorized agent of Safeway/Vons is submitting on behalf of the company, the attached Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of Compliance with UST Regulations for the subject fuel facility to register this site and Designated Operators with the county. The owner understands that with the submission of this document, Gilbarco/Veeder-Root is stating, on behalf of Safeway/Vons that each location is in compliance with all applicable UST regulations. Further, as specified in regulations Title 23, Section 2715 (c)-(f), the individuals listed as designated operators for the location will complete and document a monthly inspection to be maintained in accordance with the applicable requirements. Each statement of compliance being submitted herein is based on: (1) Gilbarco/Veeder- Root reasonable and good faith review of facility operations to evaluate compliance with applicable UST regulations, as well as information provided by facility operations as of the date the statement of compliance is made, and (2) Gilbarco/Veeder-Root's understanding of the applicable UST regulations and requirements as of the date the statement of compliance is made. Should you have any questions or require further information please do not hesitate to contact me at (303) 986-8011. Sincer , Sherry Peczka Designated Operator Program Manager Gilb arco/V eeder-Root Enclosures Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: 7-ELEVEN #32376 Facility ID #: 235431 Facility Address: 9600 BRIMHALL ROAD. BAKERSFIELD, CA 93312 Reason for Submitting this Form (Check One) O Change of Designated Operator Facility Phone #: 661-588-4059 ^ Update ICC # and/or Expiration Date Desi~n.ated UST Operator(s) for this Facility Primorv lnni/nnn/1 Designated Operator's Name: John Ablakat Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician ~ Third-Party International Code Council Certification #: 5279288-UC Expiration Date: 03/09/2008 ALTERNATE 1 (Ontionall Designated Operator's Name: Tony Mansour Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician © Third-Party International Code Council Certification #: 5269136-UC Expiration Date: 11/17/2007 ALTERNATE 2 (Ontionad) Designated Operator's Name: Sarkiss Zoumalan Relation to UST Facility (Check One) Business Name (If di, fferent from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician ©Third-Party International Code Council Certification #: 5238439-UC Expiration Date: 07/09/2008 I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 2~3, section 2715(c) - (f). Furthermore, I .understand and am in compli ce' with the t' ' ements (statutes, regulations, and local ordinances) applicab tou>~der ro torage tanks. ./ NAME OF TANK OWNER (Please Print): 7- C. DY MARTIN SIGNATURE OF TANK OWNER: ~ DATE: 2/15/2007 OWNER'S PHONE #: (253) 796-7170 November 2004 "W ' "Owner Statements of Designated Underground Storage Tank (UST) Ope~~ator and Understanding of and Compliance with UST Requirements -continued ALTERNATE 3 (Optional) Designated Operator's Name: Kevin Watermolen Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 916-212-7973 ^ Service Technician ~ Third-Party International Code Council Certification #: 5250470-UC Expiration Date: 12-21-2008 ALTERNATE 4 lOntionall Designated Operator's Name: Jessica Tuttle Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 831-537-7663 ^ Service Technician ~ Third-Party International Code Council Certification #: 5286530-UC Expiration Date: 07-03-2008 ALTERNATE 5 (Optional) Designated Operator's Name: Jim Palmer Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 831-840-5235 ^ Service Technician ^O Third-Party International Code Council Certification #: 5254109-UC Expiration Date: 2-21-2007 ALTERNATE 6 (Optional) Designated Operator's Name: Brian Ellsworth Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 707-815-2511 ^ Service Technician ~ Third-Party International Code Council Certification #: 5263224-UC Expiration Date: 7-7-2007 ALTERNATE 7 (Optional) Designated Operator's Name: Aaron Celaya Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 510-364-0385 ^ Service Technician ^D Third-Party International Code Council Certification #: 5246905-UC Expiration Date: 01-20-2007 ALTERNATE 8 (Optional) Designated Operator's Name: Darrell Riley Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 619-206-8379 ^ Service Technician (] Third-Party International Code Council Certification #: 5248975-UC Expiration Date: 11-29-2008 ALTERNATE 9 (Optional) Designated Operator's Name: Darren Austin Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 858-699-2751 ^ Service Technician D Third-Party International Code Council Certification #: 5250436-UC Expiration Date: 1 I-I 1-2008 ALTERNATE 10 (Optional) Designated Operator's Name: Eric Banghart Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 310-467-2529 ^ Service Technician ~ Third-Party International Code Council Certification #: 5250118-UC Expiration Date: 11-9-2008 ALTERNATE 11 (Optional) Designated Operator's Name: Blake Herness Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 951-288-1519 ^ Service Technician ~ Third-Party International Code Council Certification #: 5249180-UC Expiration Date: 12-12-2008 _ ,, ` '~ 8501 N. Mopac Expressway Suite 400 Austin, TX 78759 Telephone (512) 451-6334 Fax (512)459-1459 BAKERSFIELD FII2E DEPARTMENT OFFICE OF ENVIlZONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTON AVE., STE. 210 BAKERSFIELD, CA 93301 Test Date: 3/15/07 Order Number: 3151474 Dear Regulator: Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32376 9600 BRIMHALL RD MARKET #2237 BAKERSFIELD, CA 93312 Services performed: Healy Exhibit 9 Veeder Root A/L Sensor Test Sincerely, ~~ ti Dawn Kohlmeyer Manager, Field Reporting -. '-" Work Order: 3151474 Veetier-Root Irl~Station vapor Flow ~4leter Uper SERVICE COMPANY NAME - j . ~est_c SERVICE TEGHIVICIAN~ ' STATION NAME ~-1~ #- ~'L'S~ j STATIC3N ADQRESS QQ ,~, STEP 1. STEP 2. STEfl 3. STEP 4. STEP 5. STEP 6. 6~~~ --•'STA1'E Z1P---- ~L~~3~2 -, DISPENSER FUELINGPaNTNUlY1BERS FP..,~. -_ ~P -7- pstics (tSD~ Test PI-acedura -•- -- DATE OP TEST .. ~ ~ , 0'3' . -- SERYIgC.t~COMPANY'S TELEPHt]NE VI;acDER-ROOTTECii CERTIFICJkTIDN # ~"L~ ~,ZZ I ~... .... _ DfSTRICT PEItMrf # -...---~ •--- - CITY - ~ . . VAF't3R FLOW METER SERIAL NUM9FR f~ ISD aAFLY REPOftT GRf?SS A!L VAI.ifES p ~ `~ ~ I ~ Lt]W G12ADE FUEL H06 E 'VIt_ 12ESULT #! +. ..._ - •-- .- -- (OiIE FP ONLY] ! ' _ 5T1=P 1. VALUE lltJl'JUS STEP 2. VALUE /~ DIFF, ~ +~~~ 7 i DII"F. i PA55IF DIFFERENCE i,S YUITHBJ+Ifi.15, GONflNU ~ CONTINUE IF LARGE7t DIFFERENCE, THEN CONTINUE TO STEP d (CIIZC~E tlNEf PASS TO STEP 4 PRSS ~ TO STEP d . . - .`-' -! ..-- .--1 L4W GRADE FUEL HOSE Vftr R1;SUl.T d2 t,~ - ~ ( ii I LbW GRADE Ft3EL HOSE V!L RESULT 31Ki ' r7 j ~ O - I - { ! AVERAGE QF 3 VIL RESULTS AVG. ~. ~~ AVG. I STEP 7, i/ALUE MINUS STEP 4, AVG- DIFF. . j;) ~ 1 ~ DIFF_ 1pASS FF DIFF~ENCE I5 WITJiIN +1-0.t5, f IF LARGER DIFFERENCE, THEN ~ AS CONTINUE 5 ~ PASS CONTINUE CONTINUE Tt) STS 6 OFt 7 (CIRCLIE TO STEP B ~ FJ? STEP 7 ONE] IF CONTINUE, REPF_gT AT STEP 2. fOR 2ND FP USIPiG 2ND FP COLIJJYIN, AI3bVE. - ~ • ..-.~ Healy Phase II EVR System Including V6edP.r-Root ISD, [xhitsit 8 - VR-2U2-A Tanlrnology Inc. 8900 Shoal Creek, Building 200 Austin, Texas 78757 ;~ '~ TanlQ~ology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:03/15/07 WORK ORDER NUMBER3151474 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32376 COMMENTS Retest ISD on dispenser 9 only. Dispenser passed. PARTS REPLACED ~- QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 03/20/2007 11:40 ACRAMER ;. SITE DIAGRAM ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 03/15/07 CLIENT:7-ELEVEN, INC. WORK ORDER NUMBER3151474 SITE:7-ELEVEN #32376 • ~ ~ AIR/ VENTS CO CAS W H2O S :.= N 0 ~ O O m~ ~~ OF OF 1CE OV OV REG PREM 10K 10K ~ ~ o o w~ ~~ N ~ STP STP w rn Printed 03/20/2007 11:40 ACRAMER -_ ELEYEII ®~ Letter of Transmittal Date: May, 2006 Attention: Hazardous Materials Division Company: City of Bakersfield Fire Dept. Address: 900 Truton Ave., Suite 210 Bakersfield, CA 93301 RE: 7-Eleven #163299, 1701 Pacheco Rd. 7-Eleven #16549, 4647 Wilson Rd. 7-Eleven #17721, 3601 Stockdale Hwy 7-Eleven #32241, 4101 Calloway Dr. C7=Eleuen #32379600=Bri hm alrR~d? Enclosed are: ^ Business Plan ^ Business Activities ^ Business Owner/Operator Identification ^ Hazardous Materials Chemical Inventory ® Underground Storage Tank -Facility ^ Underground Storage Tank -Tank ^ Emergency Response Plan ^ Written Monitoring Procedures ^ Site Map ^ Owner/Operator Agreement ^ Test Results - ® Other: Financial Responsibility Comments: Shane Partridge Gasoline & Environmental Compliance Manager 702-270-7160 Rachel Rodriguez Sr. Administrative Assist t 503-977-7745 E~` ` ~~, State of California 4 f Foi State Use Only State of Water Resources Control Board Division of Clean Water Programs P.O. Box 944212 ~,,,,,w„ . Sacramento, CA 94244-2120 (Instructions on reverse side) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: SOO,000 dollars per occurrence ~ 1 million dollars annual aggregate or AND or ® 2 million dollars per occurrence ® 2 million dollars annual aggregate B. 7-Eleven. 1nC. hereby certifies that it is in compliance with fhe requirements of Section 2807, (Name of Tank Owner or Operator) Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: C. Mechanism Mechanism Coverage Coverage Corrective Third Party T e Name and Address of Issuer . Number Amount Period Action Com Liability Insurance Illinois Union Insurance Co. $2,000,000 per c/o ACE Environmental Risk UST G2379486A Occurrence & 4/30/2006 436 Walnut Street 001 $2,000,000 to Yes Yes Philadelphia, PA 19106 Annual 4/30/2007 Aggregate Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certites that you are in compliance with all conditions far participation in the Fund. D. Facility Name Facility Address 7-Eleven #16329 1701 Pacheco Rd., Bakersfield, CA Facility Name Facility Address 7-Eleven #16549 4647 Wilson Rd., Bakersfield, CA Facility Name Facility Address 7-Eleven #17721 3601 Stockdale Hwy, Bakersfield, CA E. ign ture of Tan 0 er or Operator Date Name and Title of Tank Owner or Operator -- ~-/~ /off Shane Partridge-Gasoline & Environmental Compliance Manager ' nature of Witnes r Notary Date Name of Witness or Notary 5'~ D(o Rachel Rodri uez CFR (Revised 04/95) U ~ FILE: Original -Local Agency Copies - Facility(5ite(s) .E~„°' r„ State of California For State Use Only Q; .E ^ State of Water Resources Control Board . w Division of Clean Water Programs ~~' P.O. Box 944212 ~,~,.ow~ • Sacramento, CA 94244-2120 (Instructions on reverse side) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: 500,000 dollars per occurrence ~ 1 million dollars annual aggregate or AND or ® 1 million dollars per occurrence ® 2 million dollars annual aggregate B. 7-Eleven, InC. hereby certi>,es that it is in compliance with the requirements of Section 2807, (Name of Tank Owner or Operator) Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: C. Mechanism Mechanism Coverage Coverage Corrective Third Party T e Name and Address of Issuer . Number Amount Period Action Com Liability Insurance Illinois Union Insurance Co. $2,000,000 per c/o ACE Environmental Risk UST G2379486A Occurrence & 4/30/2006 436 Walnut Street 001 $2,000,000 to Yes Yes Philadelphia, PA 19106 Annual 4/30/2007 Aggregate Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certifies that you are in compliance with all conditions for participation in the Fund. D. Facility Name Facility Address 7-Eleven #32241 4101 Calloway Dr., Bakersfield, CA Facility Name Facility Address 7-Eleven #32376 ~ 9600 Brimhall Rd., Bakersfield, CA Facility Name Facility Address E. ign ture of T nk O ner or Operator Date Name and Title of Tank Owner or Operator ~/~ /~~ Shane Partridge-Gasoline & Environmental li C l omp ance Manager . ignature of Witn or Notary Date Name of Witness or Notary c~v 5=~~~ Rachel Rodri uez CFR (Revised 04/95) `~ ~J FILE: Original -Local Agency Copies -Facility/Site(s) CERTIFICATION OF FINANCIAL RESPONSIBILITY 7-Eleven, Inc. (formerly known as The Southland Corporation) hereby certifies that it is in compliance with the requirements of Subpart H of 40 CFR part 280. The financial assurance mechanisms used to demonstrate financial responsibility under 40 CFR part 280 are as follows: Storage Tank Liability Insurance Policy No. UST G2379486A 001 issued by Illinois Union Insurance Company, effective Apri130, 2006, through Apri130, 2007, with a retroactive date of November 24, 2005, and covering underground storage tanks for taking corrective action and/or compensating third parties for bodily injury and property damage caused by accidental releases in the amount of TWO MILLION DOLLARS ($2,000,000) "per occurrence" and TWO MILLION DOLLARS ($2,000,000) "annual aggregate" as specified by 40 CFR §280.93; and To the extent of its eligibility, participation in various State fimds and State assurance programs as set forth in 40 CFR §280.101. 7-ELEV C. r By: ~ .~i Name:~~i.t'ie ~r/i/~/I~.~~' Title: Vice Phesident Date: ~ v0 STATE OF TEXAS COUNTY OF DALLAS SUBSCRIBED AND SWORN TO BEFORE ME this ~~~ day of _ , 2006. _ L ~ 7 ~. Mary B. Gamero No ary P is In and For Said County and Notary Pubflc, state of raxas State My Comm. Exp~rea Ofl20/10 My Commission Expires: 516202.2/SP2/76086/0209/04280G UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page ~ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®S.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 ., . ~ I. .FACILITY /SITE INFORMATION ... y BUSINESSNAME(Same as FACILITY NAME or DBA-Doing Business AS) 3 FACILITY"ID# 7-Eleven #16329 1 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT' ® i. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aoa ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* ao2 TOTAL NUMBER OF TANKS Is facility on Indian Reservation or •If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa Yes No aos aos ,., ` '' 11. PROPERTY OWNER':INFORMATION. PROPERTY OWNER NAME 407 PHONE aoa Bobbie Stokes MAILING OR STREET ADDRESS aas 1348 Mentone Ave. # C CITY 410 STATE att ZIP CODE atz Grover Beach CA 93433 PROPERTY OWNER TYPE ^ 1. CORPORATION ®2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL 413 III. TANK OWNER INFORMATION, TANK OWNER NAME ata PHONE ats 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS 41s P.O. Box 711 Attn: Gasoline Acct CITY ate STATE ats ZIP CODE ats Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY `IV: BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER- TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD az2 ' ' ' VI. LEGAL'NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 V1L APPLICANT SIGNATURE Certi Icatl - I certify t at t information provided herein is true and accurate to the best of my knowledge. SIG AT E OF AP CAT DATE 424 PHONE azs 2.6 0 ~0 702-270-7160 NAME OF APPLICAN print) azs TITLE OF APPLICANT az7 Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) a28 1998 UPGRADE CERTIFICATE NUMBER (FOrlocal use only) azs UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ t. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®S.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 L fACILITY /SITE INFORMATION BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business AS) 3 FACILITYID# 7-Eleven #16549 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT' 4647 Wilson Rd., Bakersfield ® 1. CORPORATION ^ 5. COUNTYAGENCY~ BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY' TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER 403 ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY' aoz TOTAL NUMBER OF TANKS IS facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos ~ aos II. PROPERTY.0INNER INFORMATION ., PROPERTY OWNER NAME 407 PHONE aoe 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS aos P.O. Box 711 Attn: Gasoline Acct CITY ato STATE att ZIP CODE atz Dallas TX 75221-0711 PROPERTY OWNER TYPE ^ 1. CORPORATION ®2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL at3 tll. TANK OWNER'INFQRMATION TANK OWNER NAME ata PHONE 415 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY 417 STATE ate ZIP CODE ats Dailas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ago ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY iV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER`:..' TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise 42+ V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(S) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD a22 ..: VI. LEGAL NOTIFICATION AND MAILING`ADDRESS <: Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 VII. APPLICANT SIGNATURE Certifi do - certify th t the i formation provided herein is true and accurate to the best of my knowledge. SIGN T E OF AP L NT DATE a2a PHONE az5 ~ ~i6 n (~ 702-270-7160 NAM F APPLICANT rint azs TITLE OF APPLICANT az~ Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (FOrlocal use only) 428 1998 UPGRADE CERTIFICATE NUMBER (FOrlocal use onty) a2s UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED O 6.TEMPORARY SITE CLOSURE 400 ,. ' h °FACILITY /SITE INFORMATION _, , -,. _ .., BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business AS) 3 °-.FACILITYID# 7-Eleven #17721 1 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT' ® 1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aos ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY' aoz TOTAL NUMBER OF TANKS Is facility on Indian Reservation or *If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos .~ ~ ;: II: PROPERTY ODU.NERrINFOR~MATION PROPERTY OWNER NAME aos PHONE aoe 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS aos P.O. Box 711 Attn: Gasoline Acct CITY ato STATE a>> ZIP CODE atz Dallas TX 75221-0711 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL ats ,." . . ., IIL TANK OWNER INFORMATION TANK OWNER NAME ata PHONE ats 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY a» STATE ats ZIP CODE ats Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY N.BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER ,_ TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise azt V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE ^ 1.SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(S) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD 4zz ,_ VI. LEGAL NOTIFICATION AND MAILING ADbRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box t or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER az3 '." VIL APPLICANT'SIGNATURE _" Certifica on I rtify that t e inf rmation provided herein is true and accurate to the best of my knowledge. SIGNA OF APPLI T - DATE aza PHONE a25 S ~Z6 ~ ~ 702-270-7160 NAME OF APPLICANT (p ' ) az6 TITLE OF APPLICANT az~ Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) a28 1998 UPGRADE CERTIFICATE NUMBER (For ~oca~ use only) i 42s UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ ~. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 ;,' L FACILITY /SITE .INFORMATION ,. BU$INE$$ NAME (Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID# 7-Eleven #32241 1 NEAREST CROSS STREET aof FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 4101 Callowa Dr ® 1. CORPORATION ^ 5. COUNTY AGENCY' BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5: COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR [] 6. OTHER aoa ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* aoz TOTAL NUMBER OF TANKS Is facility on Indian Reservation or •If owner of UST is a public agency: name of supervisor of division, section or office REMAINING A7 SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos II. PROPERTY OVIlNER NFORMATION PROPERTY OWNER NAME 407 PHONE aoa W EC I - 99 -3LLC 972-361-5000 MAILING OR STREET ADDRESS aos 15601 Dallas Parkwa ,Suite 40 CITY 41Q STATE 411 ZIP CODE aft Dallas TX 75001 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL at3 III. TANK OWNER INFORMATION _: . TANK OWNER NAME aoa PHONE ats 7-Eleven lnc. 702-270-7160 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY af~ STATE ate ZIP CODE ats Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY N BOARD OF EQUALIZATION UST`STORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise azf V. PETROLEUM UST FINANCIAL RESPONSIBILITY °_ ..: INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(S) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ~ ^ 9. STATE FUND & CD a22 VI. LEGAL IJOTIFICATION AND MAILING ADDRESS s._ _.._ _ ~.: ~, . Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 VII. APPLICANT SIGNATURE Certifcat' n - I ertify that the inf rmation provided herein is true and accurate to the best of my knowledge. SIGNA RE APPL C aza DAT PHONE a25 ~/~ ~ 702-270-7160 NAME PPLICANT (p ' t) azs TITLE OF AP (CANT az~ Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) 428 1998 UPGRADE CERTIFICATE NUMBER (For local use only) azs UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®S.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 I. FACILITY /SITE INFORMATION ". BUSINESSNAME(SameasFACiLmNAMEor0a,4-Doing Business AS) 3 FACILITYID# t 7-Eleven #32376 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 9600 Brimhall Rd. ®1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2• DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aoa ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* ao2 TOTAL NUMBER OF TANKS Is faoility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 2 ~ aoa ^ Yes ®No aos aos .. II. PROPERTY OWNER INFORMATION PROPERTY OWNER NAME aos PHONE aoa American West Lands Co. MAILING OR STREET ADDRESS aos P.O. Box 524 CITY ato STATE att ZIP CODE ail Bakersfield CA 93302 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL at3 IIL TANK OWNER INFORMATION TANK OWNER NAME ata PHONE ats 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS ais P.O. Box 711 Attn: Gasoline Acct CITY ate STATE ata ZIP CODE ats Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY - IV BOARD OF EQUALIZATION UST STORAGE fEE ACCOUNT NUMBER' ; TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, ,. V. PETROLEUM UST FINANCIAL RESPONSIBILITY ' INDICATE ^ 1.SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD az2 " VI. LEGAL NOTIFICATION AND MAILING ADDRESS _. ~ . , , Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 VII. APPLICANT SIGNATURE Certificaf n - certify that th info ation provided herein is true and accurate to the best of my knowledge. SIGNA UR F APPLI " azo DATE PHONE azs , .tom 26 0~, 702-270-7160 NAME APPLICANT (prl ) azs TITLE OF APPL CANT azs Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) a2a 1998 UPGRADE CERTIFICATE NUMBER (Forlocal use only) azs UPCF (1/99 revised) Formerly SWRCB Form A r-r ., + 7-ELEVEN 2125-32376 _________________________________ SiteID: 015-021-001885 + Manager SHASHI VEENA KAMBOJ Location: 9600 BRIMHALL RD City BAKERSFIELD CommCode: KCFD STA 65 EPA Numb: BusPhone: (661) 588-4059 Map 102 CommHaz Moderate Grid: 29C FacUnits: 1 AOV: SIC Code:5541 DunnBrad: t______________________________________________________________________________+ Emergency Contact / Title Emergency Contact / Title SHASHI KAMBOJ / FRANCHISEE DAVID LISUK / FIELD REP Business Phone: (661) 588-4059x Business Phone: (888) 711-3720x 24-Hour Phone (661) 872-3238x 24-Hour Phone (800) 828-0711x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Contact Phone: (877) 711-4422x MailAddr: PO BOX 7~( State: TX City DALLAS Zip 75221 Owner 7-ELEVEN INC Phone: (877) 711-4422x Address PO BOX ?~@~7 ? ~ ~ State : TX City DALLAS Zip 75221 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT n PR//~~O~G U - UdJST r///~//) ~~ ~-{~ 0~ ~ ~. 5®~ ~~~" 5 ~~ 5 ~ ~~ Based on my inquiry of those individuals 1 responsible for obtaining the information, i certify \ ~„\ under penalty of law that I have personally v_ examined and am familiar with the information submitted and believe the information is true, accurate, nd complete. ~~ d Sign ture ~ ate ENr~ ~U C l ~ 20 06 -1- 04/04/2006 + 7-ELEVEN 2125-32376 _________________________________ SiteID: 015-021-001885 + Manager SHASHId,~VEENA KAMBOJ Location: 9600 BRIMHALL RD City BAKERSFIELD CommCode: KCFD STA 65 EPA Numb: BusPhone: (661) 588-4059 Map 102 CommHaz Moderate Grid: 29C FacUnits: 1 AOV: SIC Code:5541 DunnBrad: Emergency Contact / Title Emergency Contact / Title SHASHI KAMBOJ / FRANCHISEE DAVID LISUK / FIELD REP Business Phone: (661) 588-4059x Business Phone: (888) 711-3720x 24-Hour Phone (661) 872-3238x 24-Hour Phone (800) 828-0711x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: "Contact Shane Partridge ~ Phone : - MailAddr: PO BOX 7// State: TX 76a- ~?O ~~~CO D City; DALLAS Zip 75221 T Owner 7-ELEVEN INC = G.~-sQ4 "~{ ~-c~-+-cg Phone: ( - Address PO BOX 2=T~'7 `7~ ~ State : TX ~0~~ a ~O ~~ ~ ~° ~ City DALLAS ~ Zip 75221 Period to Preparers Certif'd: ParcelNo: TotalASTs: _ TotalUSTs: _ RSs: No Gal Gal Emergency Directives: PROG A - HAZMAT PROG U - UST ~, Based on my inquiry of those individuals responsible for obtaining the information, (certify under penalty of law that f have personally examined and am familiar with the information submitted and believe the information is true, rate, and te. y~g~~P natur Date c~N~~ ~~ ~~~~0 p6 -1- 04/04/2006 UNIFIED PROGRAM INSPECTION CHECKLIST 3'rt'~...,. :g+6'F'.a?;iP^s'.f'A"S: 'sD'.V+'.J+ ,a ~. '~' ~.": r. '~' .:,: ... ..i:e. _.. .SECTION 1: Business Plan and~lnventory Program BASERSFIELD FIRE DEPT a Prevention Services I~~~ 9001Yuxtun Ave., Suite 210 ~w>rr Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME NSPECTION DATE NSPECTION TIME --~ 9 '~ ADDRESS ~ a ~ ~ ~ HONE NO. ~f sue- O OF EIJu pLOYEES s FACILITY CONTACT ~ USINESS ID NUMBER 15-021- Section 1: Business Plsn and Inventory Program ^ ROUTINE COMBINED ^ JOINT AGENCY D MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND Q - / lid'. ^ BUSIt1QSS PLAN CONTACT INFORMATION ACCURATE 0/^ VISIBLE ADDRESS Q/ ^ CORRECT OCCUPANCY Q~ ^ VERIFICATION OF INVENTORY MATERIALS I~~ ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ~/ ^ PROPER SEGREGATION OF MATERIAL ~/ ^ VERIFICATION OF MSDS AVAILABILITY (~^ VERIFICATION OF HAZ MAT TRAINING ^/ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE Ig/ ^ CONTAINENS PROPERLY LABELED ~ ^ HOUSEKEEPING ^ FIRE PROTECTION SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ~O EXPLAIN: - _ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (881) 328-3879 ~~CYA~RZA- ~ f Inspector (Please Pnnt) Fire Prevention / 1 In / Shit of Site/Station # White -Prevention Services Yellow -Station Copy Pink - 8uainesa Copy FD2049 (Rev. x/05) ?~ z ? - ' - - ~'~ ~T~~ C['I'Y OF BAKERSFIELD FIRE DEPAR'I'MF.NT ro OFFICE OF ENVIRON>\1ENTAL SF,RVICES y~~, UN[F[EI) PROCRAIVi INSPECTION CHECKLIST ;w ~g~,~!`A 1715 Chester Ave., 3r`' Floor, Bakersfield, CA 93301 FACILITY NAME_~-/~ ,t'~.~~ a~~v ~/ INSPECTION DATE~(_/~~~_ Section 2: Underground Storage Tanks Program ^ Routine ^ Combined ^ Joint Agency ^Mulfi-Agency ^ C'omplaint ^ Re-inspection Type of Tank pa'~.61~ rri~J l Number of Tanks 3 Type of Monitoring 'T'ype of Piping !.~ lC OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Y Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank OPERATION Y N COMMENTS SPCC available SPCC nn file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection'? C=Compliance V=Violation Y=Yes N==NO Inspector: .I~ Office of Environmental rvices (661) 326-3979 white- fnv. Svcs. AGGREGATE CAPACITY Number of Tanks Burin Site Responsible Party Pink - Business C npy l 9~,1111 FF'If"IHr;L.L. ,~r'r:, EIHI:E}-c':3F' I ELLS _. ~ r, '_±.'~: ~ l ;_ ' y E. LI t, r_,,,,~,- 551~~1IIIl SY^TEf°l riI'IJ~~ ~ HL.L FII(+1t'"CIC.~P!~~ P•J•; I<P9F;1.. - ' ~ ril._ y0'~ ULLhGE= 5~.:,94 ~~r-;1_:. HTK~~HE I G - `t~ . 5'~' 1 1'JCI•iL'r ` UJtiTER - LI , Oi i l Pd~;HES i T :~ : F'UL I tt;>LUt^9E - 1910 i=;r~1_~_ I ULLtii;E 5'05? _.-,L.-: I ~~' `- `~IJ%t• ULLr;GE= ?059 i;hL TG tit,LUN1E = 1910 ~~r-BLS HEIGHT =L'~:~.3? It'dL'HE:9 ~T} HE 1 GHT= '3.3? I fJi'HE l:JriTER 1..+i 1L it i :;=;L:~ ~,IryTEk = 0.00 I fdC'I-IE~ ~ a-* x e I'P~JD Q 7 i 4' UNIFIED PROGRAM CONSOLIDATED FORM _ ~ TANKS UNDERGROUND STORAGE TANKS -FACILITY ~~ (one page per site) Page of TYPE OF ACTION ^ t. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®S.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 I. FACILITY /SITE INFORMATION BUSINESSNAME(SameasFACILITYNAMEorDBA-DOingBusinessAs) g FACILITYID# ': 1 7-Eleven #32376 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 9600 Brimhall Rd. ®1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER ao3 ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* aoz TOTAL NUMBER OF TANKS Is facility on Indian Reservation or "If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 2 aoa ^ Yes ®No aos aos II: PROPERTY OWNER INFORMATION PROPERTY OWNER NAME ao% PHONE aoa American West Lands Co. MAILING OR STREET ADDRESS aos P.O. Box 524 CITY afo STATE afi ZIP CODE ail Bakersfield CA 93302 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL a~3 III. TANK OWNER INFORMATION TANK OWNER NAME a~a PHONE ass 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS ~ 2o0G ais 'R ® V P.O. Box 711 Attn: Gasoline Acct CITY ate STATE afa ZIP CODE afs Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST`STORAGE FEE ACCOUNT NUMBER "' TY TK HQ 44- 3 1 8~~ 6~ Call (916) 322-9669 if questions arise 4z1 V. PETROLEUM UST FINANCIAL RESPONSIBILITY. INDICATE ®1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ^ 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz VL=LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifcations and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 VII. APPLICANT SIGNATURE ert ication - I certi th t the information provided herein is true and accurate to the best of my knowledge. S ATURE OF ANT D E aza T?~' ' - ~ PHONE azs 702 270 7160 ~© Q - - N OF APPLICANT ( ) azs TITLE OF APPLICANT _ azs Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) azs 1998 UPGRADE CERTIFICATE NUMBER (For local use only) azs UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMAT ION BUSINESS OWNER/OPERATOR IDENTIFICATION Page of - - -. - I. IDENTIFICATION ~ FACILITY ID# O O A _ r ~ BEGINNING DATE ~~~ ENDINV DATE fof O F ~ - 3/1 /2006 3/31 /2007 ROSINESSNAME(SameasFACILITYNAMEorDBA-DoingBusinessAs) 3 BUSINESS PHONE X02 7-Eleven 32376 661-588-4059 BUSINESS SITE ADDRESS X03 9600 Brimhall Rd. CITY 104 ZIP CODE fos CA Bakersfield 93312 DUN & BRADSTREET cos SIC CODE (4 digit #) fo7 00-734-7602 5541 COUNTY f os Kern BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE ffo Shashi Kank Kamboj and Veena Kamboj 661-588-4059 _ II. BUSINESS`OWNER OWNER NAME ~~~ OWNER PHONE ~~~ 7-Eleven, Inc. 702-270-7160 OWNER MAILING ADDRESS 113 P.O. Box 711 Attn: Gasoline Acctg CITY 114 STATE ff5 ZIP CODE ffs Dallas TX 75221-0711 III. -- -- - ENVIRONMENTAL CONTACT - CONTACT NAME 117 -- --- CONTACT PHONE 118 Shane Partridge 702-270-7160 CONTACT MAILING ADDRESS 119 P.O. Box 711 Attn: Gasoline Acctg CITY ~2o STATE 121 ZIP CODE f22 Dallas TX 75221-0711 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- __-- -_ - - _I NAME ~2`s -_ __ - NAME ~2n Shasi Kamboj 7-Eleven Emergency Dispatch I TITLE 124 TITLE f2s Franchisee Emergency Service BUSINESS PHONE 125 BUSINESS PHONE f3o 1800-828-0711 800-828-0711 24-HOUR PHONE f2s 24-HOUR PHONE t31 1-800-828-0711 800-828-0711 PAGER # 127 PAGER # 132 ADDITIONAL LOCALLY COLLECTED INFORMATION: Ce ation: Bas on y inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally ex mi ed and am ami ' r with the information submitted and believe the information is true, accurate, and complete. SIG A E OF O R/OP RATO IGNATED REPRESENTATIVE DA E 134 NAME OF DOCUMENT PREPARER 135 ~ 2~ '?,~y (~ Rachel Rodriguez NAM F SIGNER (prin 136 TITLE O SIGNER 137 i Shane Partridge Environmental Manager UPCF (1/99 revised) HMP 2 (Back) Instructions OES FORM 2730 (1/99) UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) ^ MATERIAL(NON-WASTE) ® WASTE one a e er material er buildin or area ®ADD ^DELETE ^REVISE REPORTING YEAR 2005 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 7-Eleven #32376 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL zoz (EPCRA) ^ YES ® NO ENCLOSURE NEAR FACILITY TRAS H _ _ MAP# (optional) 203 GRID# (optional) 2oa FACILITY ID # 1 of 1 11. CHEMICAL INFORMATION CHEMICAL NAME zos TRADE SECRET ^Yes ®No zos WASTE FLAMMABLE LIQUID If Subject to EPCI2A, refer to instructions COMMON NAME GAS-WATER MIXTURE 207 EHS" ^Yes ®No zos CAS# N/A 209 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES {Complete if required by CuPA) 2to HAZARDOUS MATERIAL TYPE (Check one item only) ^ a. PURE ^b. MIXTURE ®c. WASTE 211 RADIOACTIVE ^Yes ®No 212 CURIES 213 PHYSICAL STATE (Check one item only) ^ a. SOLID ®b. LIQUID ^ c. GAS 214 LARGEST CONTAINER 55 Zt5 FED FfAZARD CATEGORIES 216 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH 181 e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 2t7 MAXIMUM DAILY AMOUNT 2t8 ANNUAL WASTE AMOUNT 2~s STATE WASTE CODE 2zo 25 55 55 134 zzt DAYS ON SITE: zz2 UNITS' ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 Check one item onl ' If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ®e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ®r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ® d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON z23 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 22a STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # MIXTURE OF GASOLINE & WATER OR ~ 89-90 zzs 227 ^Yes ®No zza N/A, MIXTURE zzs OTHER CONTAMINATION IN GASOLINE 2 230 231 ^Yes ^ NO 232 233 3 234 235 ^Yes ^ NO 236 237 4 z3s 23s ^Yes ^ No zao tai 5 za2 2a3 ^Yes ^No zaa gas If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION gas UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) ^ MATERIAL(NON-WASTE) ® WASTE one a e er material er buildin or area ®ADD ^DELETE ^REVISE REPORTING YEAR 2006 zoo Page of I. FACILITY INFORMATION BUSINESS NAME (same as FACILITY NAME or DBA -Doing Business As) 3 7-Eleven #32376 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 (EPCRA) ^ YES ® NO NEAR FACILITY TRASH ENCLOSURE MAP# (optional) zo3 GRID# (optional) 204 FACILITY ID # I ' 1 of 1 II. CHEMICAL INFORMATION CHEMICAL NAME zos TRADE SECRET ^Yes ®No 2os WASTE ABSORBENT & DISPENSER FUEL FILTER If Subject to EPCR4, refer to instructions COMMON NAME WASTE ABSORBENT & DISPENSER FUEL FILTER 207 EHS* ^Yes ®No zoa CAS# N/A 209 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) ^ a. PURE ^b. MIXTURE ®c. WASTE 211 RADIOACTIVE ^Yes ®No 212 CURIES 213 PHYSICAL STATE (Check one item only) ®a. SOLID ^b. LIQUID ^ c. GAS 214 LARGEST CONTAINER 55 215 FED HAZARD CATEGORIES 2t6 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT z1s ANNUAL WASTE AMOUNT z1s STATE WASTE CODE 220 25 55 55 352 zz1 DAYS ON SITE: 22z UNITS' ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS ' 365 Check one item onl If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ® d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # MIXTURE OF SILCATE & HYDROCARBONS 1 89-90 zzs zzz ^Yes ®No zze N/A, MIXTURE zzs & SPENT FUEL FILTERS 2 230 231 ^Yes ^ NO 232 233 3 234 235 ^Yes ^ NO 236 237 4 238 z3s ^Yes ^ No zao za1 5 242 243 ^Yes ^NO 244 245 If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION zos ~ r ~~ `ter , UNDERGROUND STORAGE TANK MONITORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 23 CCR, Sections 2632(d)(1), 2634(d)(2), and 2641 (h) TYPE OF ACTION ^ 1. NEW PLAN ^ 2. CHANGE OF INFORMATION Mot. PLAN TYPE ®MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. Moz. (Check one item only) ^ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): _ __ _ _ _ _ .._ " I. FACILITY INFORMATION _...._.... FACILITY ID # (Agency Use Only) FACILITY NAME 7-Eleven #32376 M03. FACILITY SITE ADDRESS 9600 Bflnhall Rd M04' CITY BBICefSfleld MOS. II. EQUIPMENT TESTING AND PREVENTIVE iVIAINTENANCE State ]aw requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in M06. accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED ® 1. ANNUALLY ^ 99.OTHER (Specify): Mop. __._ _ _ __ .__ 'III. MONITORING' LOCATIONS __ _ This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., location of each sensor, line leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring System Certification form, Hazardous Materials Business Plan ma ,etc.) which shows all re uired information, include it with this lan. __ IV. TANK MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) Mlo. ® 1. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM Mt t. PANEL MANUFACTURER: VeederROOt Mtz. MODEL #: TLS35O M13. LEAK SENSOR MANUFACTURER: VeedefROOt Mta. MODEL #(S): 847390-420 Mts. ^ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S) PANEL MANUFACTURER: Mt6. MODEL #: Mtz [N-TANK PROBE MANUFACTURER: Mts. MODEL #(S): Mtg. LEAK TEST FREQUENCY: ^ a. CONTINUOUS ^ b. DAILY/NIGHTLY ^ c. WEEKLY Mz°. ^ d. MONTHLY ^ e. OTHER (Specify): Mzt ' PROGRAMMED TESTS: ^ a. 0.2 h. ^ b. 0.2 h. ^ c. OTHER S ecif Mzz g•P• g•P• ( P Y)~ . Mz3. ^ 3. INVENTORY RECONCILIATION ^ a. MANUAL PER 23 CCR §2646 ^ b. STATISTICAL PER 23 CCR §2646.1 Mza. ^ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645 TESTING PERIOD: ^ a. 36 HOURS ^ b. 60 HOURS Mzs. ^ 5. INTEGRITY TESTING PER 23 CCR §2643.1 TEST FREQUENCY: ^ a. ANNUALLY ^ b. BIENNIALLY ^ c. OTHER (Specify): Mz6. Mn. ^ 6.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approval) ^ 99. OTHER (Specify): Mzs. _, V. PIPE' MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mao. ® 1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ a UNDER PRESSURE ^ d. UNDER VACUUM M3 t. PANEL MANUFACTURER: VeederROOt M32 MODEL #: TLS350 M33. LEAK SENSOR MANUFACTURER: VeederROOt M3a. MODEL #(S): 794380-352 M35. WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? ®a. YES ^ b. NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M37. ® 2. MECHANICAL LINE LEAK DETECTOR (MELD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED MLLDMANUFACTURER(s): VBnOfIeSS M3s. MODEL#(S): X2000 M39. ^ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS ELLD MANUFACTURER: ~ Mao. MODEL#: Mat. PROGRAMMED LINE INTEGRITY TESTS: ^ a. MINIMUM MONTHLY 0.2 g.p.h. ^ b. MINIMUM ANNUAL 0.1 g.p.h. Maz. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO M43. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Maa. ® 4. INTEGRITY TESTING TEST FREQUENCY: ®a. ANNUALLY ^ b. EVERY 3 YEARS ^ c. OTHER (Specify) M45. M46. ^ 5. VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY* ^ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED** M47. * Requires agency approval ** Allowed for monitoring of unburied emergency generator Cuel piping only per HSC §2528 1.5(b)(3) ^ 6. PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) ^ 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ^ 99.OTHER (Specify) Mas. UN-022A - 1/3 www.unidocs.org Rev. 10/14/03 t. - ~~ ~ , Underground Storage Tank Monitoring Plan -Page 2 of 2 VI: DISPENSER-MONITORING __ MONITORING OF AREAS BENEATH DISPENSER(S) IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mso. ® 1. CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT (UDC) PANEL MANUFACTURER: VeederROOt Mst. MODEL #: TLS350 M52. LEAK SENSOR MANUFACTURER: VeederROOt Mss. MODEL #(s>:794380-352 Msa. WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? ®a. YES ^ b. NO Mss. W[LL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M56. WILL FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO Msz ^ 2. MECHANICAL ASSEMBLY (e.g., FLOAT AND CHAIN ASSEMBLY) IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK ASSEMBLY MANUFACTURER: Mss. MODEL #(S): Msg. ^ 3.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approvaq M60. ^ 4. NO DISPENSERS ^ 99.OTHER (Specify) M61. . , ;. VII. ENHANCED LEAK DETECTION ' __ _ _ ^ 1. WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK Mso. DETECTION (ELD) FOR THE UST(S) COVERED BY THIS PLAN. PER 23 CCR §2644.1, ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED ;. VIII. TRAINING REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) Mso. 1. ® "fHIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 2. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 3. ® THE FACILITY'S BEST MANAGEMENT PRACTICES (Required as of January 1, 2005} 4. ^ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. ^ CALIFORNIA UNDERGROUND STORAGE TANK LAW 6. ^ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS -MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 7. ^ SWRCB PUBLICATION: "WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" ^ OTHER (Specify): Msi. 99 , Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and can access those documents when needed. By January 1, 2005, this facility will have a "Designated UST Operator" who has passed the California UST Sytem Operator Exam administered by the International Code Council ([CC). By July 1, 2005, and annually thereafter, the "Designated UST Operator" will train facility employees in the proper operation and maintenance of the UST systems. This training will include, but is not limited to, the following: - Operation of the UST systems in a manner consistent with the facility's best management practices. - The facility employee's role with regard to the leak detection equipment. - The facility employee's role with regard to spills and overfills. - Whom to contact for emergencies and leak detection alarms. For facility employees hired on or after July 1, 2005, the ini6a] training will be conducted within 30 days of the date of hire. IX. COIVIMENTS/ADDITIQNAL INFORMATION ___ _. Please use this section to include any additional UST system monitoring-related information (e.g., additional information required by your local agency): Mss. Note regarding Section X. Pending certification of a Designated UST Operator, the following person has authority for performing the monitoring activities and maintaining leak detection equipment covered by this plan. NAME: JOB TITLE: __ _ _ __ X. PERSONNEL RESPONSIBILITIES AS OF JANUARY 1, 2005, THE "DESIGNATED UST OPERATOR" IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT APPLICATION -FACILITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION EQUIPMENT COVERED BY THIS PLAN, AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS OF THE FACILITY'S UST SYSTEMS IN ACCORDANCE WITH 23 CCR § 2715 ). XI. OWNER/OPERATOR SIGNATURE _. E TIFICAT N: certify that the information provided herein is true and accurate to the best of my knowledge. ER/OPERA SIGNATU RE eSNTIN G M91. DATE o O ~Z~ ~~ ~ 33 perator OWNER/OPERATO NA E (print): Mvz. OWNER/OPERATOR TITLE: Ms3. Shane Partridge Gasoline & Environmental Compliance Mgr (Agency Use On/~) This plan has been reviewed and: ^ Approved ^ Approved With Conditions ^ Disapproved Local Agency Signature: Date: Comments/Special Conditions: UN-022A - 2/3 www.unidocs.org Rev. 10/14/03 ^L ~~n WRITTEN MONITORING PROCEDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at a-I times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify local agency within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name: 7-Eleven Store #32376 Facility Address: 600 Brimhall Rd, Bakersfield, CA Date: March 1.2006 A. Describe the frequency of performing the monitoring: Tank The site consists of two double walled jacketed steel tanks (1-Regular 10k gallon, and 1-Premium 10K aallonl and are monitored continuously with a VeederRoot TLS350. Piping Product lines are double wall Enviroflex and are monitored continuously with a VeederRoot TLS350. The turbine sump sensor activated audio/visual alarms and provides positive shutdown of the turbines. B. What methods and equipment, identified by name and model, will be used for performing the monitoring: Tank The method of leak detection for the tanks is Interstitial Monitoring of the double wall tanks using the Veeder-Root TLS350 Tank Gauge programmed for a threshold of .2gph. VeederRoot model #847390-420 probes are used for the monitoring. High level alarms activate audio/visual and external alarms. Piping The piping is monitored continuously by VeederRoot liquid sensors model #794380-352 located in the turbine sump of each tank. The turbine sump sensors provide positive shutoff and activate audio/visual alarms. Vaporless LD2000 line leak detectors are located on the turbine and programmed for a leak threshold of 3gph. The piping is precision tested annually At a threshold of .1gph. Dispensers are equipped with under-dispenser containment with VeederRoot liquid sensors model #794380-352 that provide positive shut down of the turbines. C. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: The individual responsible for the monitoring equipment is the store operator. The operator will contact 7-Eleven Dispatch 1 800-828-0711 for any alarm conditions on the VeederRoot. The local maintenance contractor will be dispatched. 7-Eleven, Inc. is responsible for maintaining the equipment. The Environmental Manager is Shane Partridge D. Reporting format for monitoring: Tank Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Monitoring records will be kept at the location and at a central office location. Piping Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Third party annual test results will be submitted to the agency. ,' ,~.~; Written Monitor Procedures 7-Eleven #32376 Page 2, March 2006 E. Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturer's maintenance schedule but not less than every 12 months. Tanks and product lines are continuously monitored and alarmed. Alarm histories are printed each month and investigated for corrective actions by the Designated Operator. Equipment repairs; replacement are performed as needed. F. Describe the training necessary for the operation of UST system, including piping, and the monitoring equipment: Employees are trained on the Operation of the UST in a manner consistent with Best Management Practices, Emergenc~r contact information, Spill/Overfill response procedures, Hazardous Waste Procedures, and monitoring equipment operation and alarm response procedures. Training is conducted annually, or within 30 days for new employees, by the Designated Operator. EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify LOCAL AGENCY within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641 (h) CCR. Facility Name: 7- Eleven Store #32376 Facility Address 9600 Brimhall Rd. Bakersfield If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion hazard, are not cleaned up from the secondary containment within 8 hours, or deteriorate the secondary containment, then LOCAL AGENCY must be notified within 24 hours. In case of a gasoline spill- Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. Employees will be notified to evacuate if deemed necessary. A contractor will be contacted to remove the spill as necessary. In case of a small carbon dioxide release- the tank will be visually inspected for obvious signs of the release point. If possible the control valve will be shut off. In the case of a large release of carbon dioxide, employees will be notified to evacuate and Contact 911 and 7-Eleven Dispatch. In case of fire- the alarm will be sounded by shouting "Fire" and the building will be evacuated. Employees will contact 911 and assemble at the designated assembly area as depicted on the site map. If safe, employees will shut off power and control fire using fire extinguishers. 2. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substances. Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. A contractor will be contacted to remove the spill as necessary. 3. Describe the location and availability of the required cleanup equipment in item 2 above. Absorbent is located inside the store in the backroom. 4. Describe the maintenance schedule for the cleanup equipment. Inventory of absorbent is periodically checked. 5. List the name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan. Shane Partridge, Gasoline & Environmental Compliance Manager 702-270-7160 Date 11/21/2005 17:22 5123807215 PAGE 02f 05 SB-989 SECONDARY CONTAI~iMENT SUMMARY RESUf*TS TEST ~ATE:oe/o9/zUU~ WORK ORDER NO.: 31a2o99 CLIEM-: 7-FS.EV~x, nQC. SITE: 7-LI,SVLN 832574 p,p, gp~( 711 94d0 xu~~hr.T. RD. t~T A2133 rj}~yA$ TX 73221 F'x19LD OA X3312 21d-961-6714 Tank Interstital Tests ;. •• • ..:.'.. STAN .. ;;":Ipi~ry"f'.:"":- .lutAtiu~itCTl'JREFt:.~..•. ~'RES~I.TS;: ~. ~. .. .. .~: , I;i' :' REGULAR PREMIUM Piping Interstital Tests ,.. _ .... ~ r.., ,... ..,,., .,:, r . .., • . yyy.~ .. j .'L'~IF~EIZ~^~ •ZJi]UGT '~'MAI~~,tFA . • +,.: ~ '. ::.: :' .:• ,~: .... ~ .. .. .... .. ......1 ~.. Sulm 8~ Under~Dis enser Containment Testa .„ .,.: ; ,.:;:.:b19P11~:'i;' :,.:.:... • ,~.. .,:. :.. ;: s.' :.' A'N,IaIFACI~JEt~R . ... M .... =;r: ~-RUL oPw pass 2-Pl1L OPVII Pass Tankn0logy representative: JERRY BELt,OLI Services conducted by: ALUERT J. QUEIRpS ~~~ m m m w c~ u7 N f~ m N ti Ln N CV r~ LL7 m m CV N e-i o-. <: ~~ i T~nkn~olv~Y SECQNDARY CONTAINMENT TEST RESl1~ i s SITE NAME: 7~LEVEN #32376 3237fi QATE: 081a9120Q5 WORK CIRdt3t 3142099 SITE AQDRESS: 96130 BRIMHALL Rb. MARKET #2`33 BAICERSFIELC CA 933'2 REASflI~l FOR TEST: CompSanoe Groundwater Level " fl~am rad9: Tan NK I RMATl0 Produa t1 I T Tank Sine L T ~;°' #:6TS Material Manufacturer De {,~ 'fc-stMeihod S[art r~ Initial ~ Finish rme Final Result 'asst Faif ~ p REGUTAR PREMIUhd 90029 10022 96 96 TOTAL C{7NT Ti4FAL OONI' 3 0 0 5 B 7 e Conmente: Tan HEINrVKMA~~V Product n nnumrrs Dia. Rar ~raL.r Len. feel w~~ Mat~lel Hanufac4urer Volume ions Test Method 5farf Time Irdliaf Level Finish ?ime Final Result Passl Fail 7 2 3 4 tf 6 7 8 CatnmenLs: m t V m • '` Tell Oats: OBdUg12005 ~`:': ~~ J~ yyp~ qty- 3142888 SECONDARY CONTAINMENT TEST ~tESEJLTS SUMP TE&T'S Type TankorD'esp Manutach~rer 1Sodetor Diam.NJidthfLen3lh ~~ DES ' i'estMettwd S1at1 Initial Level Finish Frial PasrJ Fail ~ Matariat } ~ ( ) TimE Gavel Charge Time Result SpellGontatner f-RUL OPVJ plastic 17' SGAL 22:46 r'FROM HOPE 29:f0 7"FROM Pass SpitlCuntainer 2~PUL OPW Plastic 17' 5 G4L 22:44 i' FROM HOVE 23:10 7"FROM Pass u~ N N m N ei lfI N N r to m m N N r-1 ~i 11/21!2005 17:22 5123807215 • ~~ PAGE 05!05 Work Order: 3142099 9. SF~LLiO~RF~~. C`D~'c~IN~irr ~ox.~s Facility Ss I3ot laquipped with SXriilk7vcrti~l Cotttaitnnertt $oxea S 1!lOverf~ll Contairit:ncttt Boxes are Present, bui were Not Tested Test Method Developed $r 5pii1 Htickcc Ma»ufaet~srar in~nstry S~si~ Professional F:n~it-e~' Ocher CspBafj'1 ~ - Test Methu+l Used: Fressta+e VaC~,mn Hydrostaae ~~ O Lt1CT {.SpCCt~{y) Test ~p~ctlcUSed; Fquipntent R,esolutian: Spill Boa it 9pii1 Box #'~f Sg1Tl Box 4F $pi1I Box i~ Bucket Dlame+ber. ~ ~ ~ _ 8neloet Dept~i: S ~~••~ SG~it7ti-;+•,~ ~ .- - ait time Uetween appiyis>lt pressure/ucurur-lwata ~ ~ 'T'est Start Time: .~.~ ~ a~sZ~-k D -. .... -- ! lniti:al Rcxding (lt~): '] ~ ~ ~ "' ~- -w Tasi End Time: 3 i e a n d .. .,~ _ Fine.! Rsadi~g )= 7 ' ... lest ~a: D .,~ 3 ~~~ ~ ..----R ngr. tin ~Rp- ~: C9 ~'r' ..^ Psss/Fail T}a+eshold or d ~ ~rit~`1'IR' -- ~.•~ ..~:. ~;*,z~ .,~ ,,R•fl.p, ~;. ~:~-~,; elf;;, -•.:~ ••~ u 1~'att ^ paw ~ Fan (:OmttnRel:L9 •- {IxcAtdr irsfvr~aution ore repairs r~tudr rfar ro tesaFr~; and ~•ernawnP.mdPd fa!!nw- far-Jailrr+ tesrsJ _, . _.. - - - - -- --~- ~ J' ~~ .. ~_ Tanknnlney-NDE 8904 Shoal G5-eek. Building Z00 Austin. Texas 75757 11!21/2005 17:39 5123807215 NK.; •n ~~tl~ -,. a. ._ b;AC:S1ML11E CdYER SxiEE7' SENDER'S NAME: _ _ Kevin Keegan (Senior Regional Vicc President) _ Jared Beavers {~_lps Ms+nAger) Lynn Rich (Ops Manager) Kevin Callaway (Account Manager) Chris MCDe[inand {Ac:WUlAI Manager) Ken Slane (Quality Assurance/Quality Control Manager) nATi~: ~~' ~ l ~ ml~ PAGE 01/04 REPFR.E3VCE: _ ._ ~_ RECIPiET1T'SNAMP::_ -• ]~Pv`e ~r~~Wo~i~ T - ----- RECII?IENT RECIPIENT FAX #: l~ ~O i z~ECI>'I>tNT plioriE ~: - NUM$LR OF l'ACxES (Including Cover Sheet): ~65~f~ If you should experience any difficulty in receiving this transmission, please contact us at ($00) 964-0150 or (512)3R0-7220 Thank-you_ CV1YF'IDENTLALITX 11tOTICE This message 9s intended for the use ofthe individual or entity for which it is addressed and may contain informatiozt that is legally privileged, canfadential, and exempt cram disclc~sure_ If th.e reader of this message is not the intended recipient. you are hereby notified. that any dissemination, distribution, or copying of this communication is strictly f+mhihited. if you received ti,is communication iu errar, please notify us immediately by telephone to arrartge for, the retvm of the originak material. Thank yau. &SQ1 N. 'MpAac Expwy, SuitC X00, Austin, TX 78759= FII 80{1-964-01..50 •PAX 512.384.7215 11121/2005 17:39 5123807215 PAGE 02/04 SB-989 SECQNDARY CONTAIFJMENT SUMMARY RESULTS ~. LaATE:na/oz/2005 WORK ORDER NO.: 3139217 VT: ~-Exsvsa~, z~+rC. SITE; ~-szt>~ia B169a9 Y. V . !li.7X 711 ~fR1G82 $2133 4647 TiSLt301~- ROAD nwrr.nc TX 75221 SAP~RSSSSLL+ CA 93309 219-84:1-6714 Tank Interstital Tests Piping Interstital Tests . ` ~ ~ ' RED'. G~°I1J AN~~•• A ti '. ilr~ ~ ,' r, ;,,•,: ~~ •i~:~ ~. ... .:~i•:~~1'i .. . „ .r;: .~, n: . I rlr irr p , it t a ;;:r .. - '; :~i: 'CT1~~rt'° ` ~'r` . ~ a ~..~, ,..1::. a..1 >~ ~ a"r .'~~:::- url'~ i'S!. I; t, ~aP9^b r iti~imn R I lnrir±r_r]iannn~E±r Cnntairtrnent T~t~ .. ,... ~..: .. , ~. ua, yy~~ .,d'ra•.• ~~~ l~: ''.1' ~~~fr ~•~ ~~ :rn,. . ~:.!'.. .'~~~:!i '. 7-REG OPW Pass 2-SUP OPW P2ss r representative: JERRY BELLOLI Services conducted try: ALBERT J. QUEIR05 ~~~ m M m w c~ SECONDARY CC)NTAINMENT TEST RESULTS SATE NANEE: 7~LEVEN #16549 76549 DATE: o3fazlzoa~ +NORKORO>FR 3139217 SITE ADDRESS: MARKET~2133 4647 ti1fILSON GOAD BAKERSFIELC° CA 93309 RFJ43UN FOR TEST: C4rnp6anoe Groundwater Levei "from tads ; ru~~ ~. •un I~I7cAQT~T~A1 mare Tan ~ rv Produrd n nn~ ~q ~~ Tank Size rwnn D~3 - Materiel Mar+ufarturer D {~ 'fes164a1E~°d Start Time initial Level Finish Time Final Result Paeai Fail 1 101$ 1U4 DtNSTrEEL 2 10018 1[}9 DW STEEL 3 4 0 4 5 7 8 Commems: [NE fNF RMATifl 1 STITUL TESTS N r- ca N l17 T M l17 w9 [~ _ N a--I e-i Tan Product Dia. ~n_ Fee Vlalerial ~dan~facturer Voume lions TesiMe>hod Start Time nitiel Level Finish Time Flna1 Result Past Fail 1 2 3 d 5 8 7 Cwnrnents: v m m u~ N m ao M N i-i If) 0'~ i*l II7 m N ._ .--i N .--i .1 ''' Test Dale: OOJ6212J)OS ~~•° ~ ~~~~~~ 3'39117 Wp~lcOrder SECONDARY CONTAINMEAIT TEST RESULTS SUMP TESTS Typs Tan[cas Disp htami'acturer hfodel oP Diam.IWtdthlt-e~fh 0~ ' Tit ~~ Star, lnifial Let+el Finish Fiia! Pass! Fail ~ Male+ial (°T } ( Time Level Ohm9e Time Result Spit Conlaine- 1-IiEG OPW PJastie 12" 5 GftiL 10:27 b` FROM tdONE 10:56 5" FRAM Pass SpiiGbnlalne• 2-SUP OPYd Plastic 12" Ss;At t0:27 5'FROM NONE 1o:5a 5"FRQ1ul ~~ C(7011fi1afQ5: m V m u~ N f~ m m N u~ m m N N UMP TESTS Tankorf)lsp Type ~ Spil cvnlefnet 2-REG Sfl. SpEI canlainEt' S-REG NO. - ~anuf2Clurer DPW DPW -:'.`.w ~ ~ ~ ~I~~ SECONDARY CONTAINMENT TEST RESULTS Illodelor DIemlNdth7.er~gth ~Pth Testy~teUiod !8>t Time Ualetial ("I ('1 Plastic 92" 5 L-AL f2-05 Plastic 12" 5 GAL t 2:0.5 nitial Level i" FROA4 6.b" Teat DaEe: 1Nmk Otiier. L~xel Ch a NONE NOTIE OSNf112005 $142087 Finish Time 12:35 12:35 iwl Result 5' FRDM 5.fi" FROP~I assf Fail Pass Pass Spil Cnntainsr 3•PREMIIfM DPW ?IasUc 12" 6 GAL f 2:05 5.5" NONE 12:23 fi.fi"FROM Paea Carnmenls: - 11/21/2005 17:18 5123807215 Wo~c C)rdcr• 31Q2[1g7 PAGE 05105 9. SPtU.S.±(1'4'~;RF'FL3': CQ~T.a-[ti~SEti's' kSU_~{I:.S i ~rCt;:rt• ue Not f:auipp~d with ~p~l'i.!f3ve-ftli C`ontai:urta~4 Btrx~ _ __ ~ I 'SST'pill ;it_e•: i Ali C:asu>:inni4`;st &sxes arc 'P'C~SC~ti, but .3~ere ~'~at ?~stcd ~ ~- -- - _ _ _ ~.~ i .,CCK: A4<Yh;s:4C.lrvcl4tptd 13v: Spilt $uck~t Muna:f::et~rnr ]ndi-sny 5t3:nc!a,rsl~ 4~-:~`cs~:::r.~i ~e~r.^^.' t S?titer f,5l~E•cifif a .. _ ~ .. . --~- ~ - -~ Sr'eauum ~..Y__..-~~~•~~~-_R`F.l1:i:: '1 .l.z,. E;.giirilt;~rri L'~Cd: ~~~~ - .. .-. r ><cl•~ipmanE ii~~lu~nfirt~_-~.__..._._ -• 4p~91i 334!t ~ ~~ Splii Hox r,/'i 5pt11 lfo~ ~~ 5hi11 Sux ~ 13uic~tp{pth: ___ '~GR2u•.J i _.~~~Lrr+.~ ~_~ -• -- ._! .,...,--_. .^ --- ..~ ail anti ik•L~.ccra ~~ ~ _ i ~pFw:!1 _r ~ i anti K:M^.:np; 4C9Y. •t _ ~ , .. _ .__ . _.__ ._.._,. -._ -; x: Ott:::': in~r:•----•- •~d~s~t_ ~ _ i 7~+ ~ - r -.. I Zv ~ _ ,. ~ ~° ~ l~:.ui ltea:liikt;_(R;•.y'- ~... ~- y 1f ~ ~ .5; ~~.,. ~-~Sh -_~.._-, ...._ ..-- !-C'hnn~,: u1 tZt:falinC i~; ~: .. r- ~ ~ d i Pnss?E~EUI 'Pllrrsiterli3 ers ~ '-' __~_ __...~~ ~ ~ . i 'iCeat Itc:rult: -.. -- ..~y~ ' 7 Fail )l'BSS ' t°t Fs~l' j 9s Ce Fait .~ 4:txs~~: I~'all , - Cor+ttneai~ - f+rsr•l~udR: ritr~ariu.,rrn~r nuf rr~~ri~x llitrcle~ripr ro letiira~, and rec~imn:~~~adari jtliiUS~~ .+¢~ ~'4~+_ *arl~cl;~~sr.,•, Tanknolo~j•-NDE 8404 Shoal Creek, Building 2d0 Austin, Texss 78757 11/21/2005 17:22 5123807215 ~.gai,,,:.. ~~~~ a. ~'ACSIMiLIC CUV ~;kc SH>C>E~C SFNnRR'S NAIvI1;:: Kevin Keegan {Senior Re~,i.onal Vice President) 3arcd $cuvcr' {Ops Manager) Lyt~ti Rich {Ops Manager) ~_ Kevin, Cafiaway (Account Manager) _ Chr[s McDermand {recount Manager) r ICen Slane (Quality AssurancelQuality Gpntral Manager) PAGE 01!05 REFERENCE: _, - - R1rCiPIEN~"5NAMlr; ~~tE'~ ~Anc~~i-~dt~ RECIPIENT Ca.: itIJCl~PiENT I^AX #:_ ~ ~~ $ ~~ -~ lzEC.[PIENT PCdoNE ~: _T -_ ~ - NUIVI[3CR.OF PAGES (ilIncludin, Gpver Sheet): ? ~_ _ ___,,, COMMENTS: ~~r t ~ 1? "'- Fe ~ {'C3 h ~ S 4r'~ ~ C~ S~ ~~ ~ ~ ~ a. -- ~~~~ b lfyou should experience any d.itrculty in receiving this transmission, please contact us at (Rp0) 9154-0150 or (512) 380-7224 "J'hAnk-yrni. CONFLDEN?IAL1<Tk NO'I:'itCl; This message is intended for fhe use of the individual or entity 'i'qr which it is addressed and may contain information that is legally privileged, confidential, artd exempt from disclosure- if the reader of this message is not the intended recipient. you are hereby noti.~ied that any dissemination, distribution, or copying of this communication is strictly prohibited. If year received this communication in error, please notify us immediately by telephone to arrange for the return, of the original material. Thank you. 85U] IV, MoYac :Gxpwy, Suite 400, Austin, Tx 75759'" ]P1-k 804^9G4-~O1~0 'T'AX 512-380^7215 ~.~; "`1JNIFIED PROGRAM INSPECTION CHECKLIST-? r~R~ .SECTION 1: Business Plan and Inventory Program y BAKERSFIELD FIRE DEPT Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 ~ ~ ~ Tel.: (661) 326-3979 ~. Fax: (661) 872-2171 ~~ FACILITY ME NSP TION ATE INSPECTION TIME -r c~ ~ ADDRESS HON NO. O OF E P YEES © ~' r FACILITY CONTACT SINE SID NUMBER n 15-021- `U b Section 1_ Business Plan and Inventory Program ^ ROUTINE OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ^ (c=Compliance` OPERATION V=Violation J APPROPRIATE PERMIT ON HAND COMMENTS ^ BUSIfi@SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF fNVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY ~~~ _. ,~ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED HOUSEKEEPING ~ /' ~' l ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES LY~VU EXPLAIN: - _ -- - THIS INSPECTION? PLEASE`CALL US AT (861) 326-3979 Inspector (Please Print) Fire Paevention / 1°1 In /Shift of Site/Station # Btfsinjss`~ White -Prevention Services Yellow -Station Copy Pink - Business Copy FD2048 (Rw.02/OS) ~~ ,~~iw4~' T~~ CITY OF BAKERSFIELD FIRE DEPARTMENT ~e ~ ~ ro; OFFICE OF ENVIRONMENTAL SERVICES ~~ yP UNIFIED PROGRAM INSPECTION CHECKLIST \~~_;w ~gti,,~'~~ 1715 Chester Ave., 3~d Floor, Bakersfield, CA 93301 ~~~~~ FACILITY NAME ~" ~ ~ INSPECTION DATE Section 2: Underground Storage Tanks Program ^ Routine ~mbined ^ Joint Agency ^Multf-Agency ^ Complaint ^ Re-inspection Type of Tank ~VJ~C S Number of Tanks Type of Monitoring C{ G, ~ Type of Piping ~pts,}~ OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data on the Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? YeS No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? [f yes, Does tank have overfill/overspill protection? ' C=Compliance V=Violation Y=Yes N=NO Inspector: ''` ..' Oft7ce of Environmental Services (805) 326-3979 Vdhite - S=nv. Svcs. y ~ i usines ~S to Responsible Party Pink -Business Copy UNDERGROUND STORAGE TANK PERMIT APPLICATION TO » $F/AE n CONSTRUCT /MODIFY /MINOR aAtll r MODIFICATION OF AN UST PERMIT NO. ~ ~( i'~~~ ~{ ~. TYPE OF APPLICATION: (Check one item only) ^ NEW FACILITY n Mt'11lIFlt'.ATICIN nF FOCII ITT Bakersfield Fire Dept. Environmental Service 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ NEW TANK INSTALLATION AT EXISTING FACILITY IxMINl7R MnIIIFICATInN OF FACILITY TARTING DATE PROPOSE COMPLETION DATE AGILITY NAME ISTING FACILITY PERMIT NO. FACILITY~DRESSD ~/ // ~ ITT ~ /~ j~ IP COD PE OF B INESS _ ~d/ v PN # ANK OWNER ~~~ PHONE NO DDRESS^~ ~~ /YL/ ~// ~ j~~~ / ~r IP CODE ~~ ONTRACTO ~~~/ tiG.ro.~s-~~~L' A LICENSE NO. ICC NO. .~3yS Z v o~ss ,/ ~ r~ ~::~ ITY~~C ~ ~ IPCO~~/~ HONE NO. -, Gad BAKER FIELD CITY BUSINESS LICENSE NO. l ~ ORKMANS COMP NO. INSURER ~ J BRIEFLY DESCRI HE WORK TO BE DO ~ WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO.OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL ^ YES ^ NO SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ^ YES ^ NO TANK NO. PHIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. OLUME NLEADED EGULAR REMIUM IESEL VIATION USE ONLY APPLICATION DATE The applicant !w~ re,~eived, under/Stands, and will comply with the attached conditioru of the permit and any other state, local regulations. 7hjs,Rirm has 6;~eys!conylTkted under penalty of perjury, and to jhe~e~t of myknowledge, is true and correct./ BY: APPLICANT N~KAE (PRINT) .THIS APPLICATION BECOMES A PERMIT WHEN APPROVED ~ 0 n UNDERGROUND STORAGE TANKS A~~~`CA~~®~ TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION c-^ A { ~AKERSFYELI) FIRE--DEP~T,~..., ~. ~ ~~~~ ~ER~ 'rte -`' Prevention Services `'~~ ~I~'+R'ARTM ~` 900 Truxtun Ave., Sire. 210 q ~~'-,',, . ~` . Bakersfield, CA 93301 ~' Tel.: (661) 326-3979 Fax: (661) 852-2171 Paged of 1 PERMIT NO, ~- ~ - ~:J ^ ENHANCED LEAK DETECTION I^-1 LINE TESTING ~SB-989 SECONDARY CONTAINMENT TESTING I-I TANK Tlfa-ITNFCC TFAT I 1 TC~ PFRF(lRM FI1FI Mf1NIT(IRINC, CFRTIFICATInN °SITE INFORMATION FACILITY T ~~ eV~N # ~ 2?~'7(o NAME & PHONE NUMBER OF ON I t~L/ MANA ~ - fo ADDRESS ~~o~ BriVY1~G~ll ~d ~ BakerS~i~tol C~ ~3?,12 ACT PERSON 58 ~05R ~ OWNERS NAME ~ A ~ C3PERA'I'ORS NAtv7E PERMIT TO OpERAl'E NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES NO TANK# VOLUME CONTENTS ~t 6500 ~~~ ude C~as --- ~ -~ 3 °l~~s °t t -~ .fir Gas c--- TANK TESTING COMPANY NAME OF TESTING COMPANY Tanknolo InC. gYs NAME t>< PRONE NUMBER Os= CON'(ACT PERSON Anthony Cheeks {951) 676-4060 MAIL-INGADDRESS 4'9785 Enterprise Circle S. Suite D Temecula, CA 92590 NAME & PHONE NUMBER OF S1ev~. Gyul ~.R ~ I TESTER OR SPECIAL INSPECTOR: ~ 8 5 CERTIFICATION #: -DATE & TIME TEST TO BE {~ ~ ry~ CONDUCTED: O~ B / ICC #: '" e+~-~- ~~TEST 525~75~a-' lA i METHOD SIGNATURE OF NT DATE: ~ /~ n !/ T S. AP :-L CATIO ' BEGO ES A P I ~ ~ !APP 0:1G D APPROVED BY DATE (~ !~ ~+ b FD 2095 (Rev. 09/05) FROM :BSSR,INC FAX N0. :6615882786 UNDERGROUND STORACy>r TANK PERMIT ~4PPLICATION TO ~~ CONSTRUCT I MODIFY !MINOR MO~1fICA`CiQ~Nyy~O1r AiN( UST PERMIT NO. ~1 1 f 1 l '~ ~ `Y~ TYPE OF APPLICATION: (Check one item only) t~ NEW FACI(,l1Y Sep. 27 2@@6 @8:57AM P1 B~CCRS~BLC~ l+`1~1' UC~L. Eav~ronm.ental Service 900 'IYuxtun Ave.. Ste. 214 Bakersfield, CA 93301 Tel: 1661}326-3979 Fax: (66X} 852-2171 Page 1 01 1 p NEW TANK INSTALLATION A7 EXISTING >=AGILITY PHIS SECT1pN I5 FOR MO70R FUEL rAWC N0. I.UME ~ NLEAD6D E~aLILAR lUM FSFl vIATION i PHIS SE TION IS F li NON MOTOR FUEL STORAGE TgNKS TANK NO. OLUtdE tlUtAR MIUM 69EL vw'aol+ F4a OFRICIA.L USE ONLY APPLICJ,TION GATE FACp.ITY NO. NO, OF TANKS FEES S 77te applicant has elved, rs , Artd wlt{ comply with the anached conditions of the parmll and any other state, local rind federal regulations. This c ted under puwlty of perj , andt~o t bast o~ !ed , is true and correct. ~ ~, APPROVED Y; APPLICANT NAME (PRINT) APPUCAtiT SIGNATURE THIS APNI.ICATION BEGOMIES A PERMIT WHEN AphF2QVEb ~ O n ~ M IIRr ,~ r . E r m N N CU 0. N Lq lD ymN W 0 z VJ al ;~~ ~1 I .~ "---~ ~~._~~ i ~ --r-"- ---~..---~.._..__s _ ._ i._.-- __f_--~_.._ f_~_t--r._~-:-. i __ _._~._T__i._~l--- } i ~ _..._ ~__. r __ 1 _T ------- ~- ~. ~~ . 11 ~: 44 { t! _. .. _: _.fi ~ I . ~ ~ _ '... '.. i ~ .. , r . _-. ..j _ !. i ~ ~ ~ ~ -~- ~ . .:.. , . - - i ~ i i _ ,.. _t _. .. r .. .__. _. .. , ..7.. _._ . .. ;.. _. ._, ~ + .. ' .~ . . .. .. ~ •, __•i~ . ~ 1 ' i .....~. .. .. ~~I n t _. .. .. _: . _ ' i ~ .. ~". t ~ ~ ~ ~ t ..~ -.._. .. ~ . _ ' ' . UNDERGROUND STORAGE TANK _- f'i PERMIT APPLICATION TO ~`~ a '~ ~ ~ p L F/~'!f CONSTRUCT /MODIFY /MINOR `~> ~Rrr r MODIFICATION OF AN UST` PERMIT NO. ~y\~ .J 'r ~~© TYPE OF APPLICATION: (Check one item only) ^ NEW FACILITY n MAI~IFICATIAN OF FACILITY Bakersfield Fire Dept. Environmental Service 900 ZYuxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ NEW TANK INSTALLATION AT EXISTING FACILITY fYMINOR MODIFICATION OF FACILITY TARTING DATE ROPOSE COMPLETION DATE AGILITY NAME ~~~ ~ Z ~w 7{..f/ ISTING FACILITY PERMIT NO. FACILITY DRESS /~~DD ~. ~i .~ 17Y / ~ %ii/ IP COD PE OF B INESS F ~/~~ ~ _ ~~\./ PN # ANK OWNER HONE NO DDRE~(/ / ~C/~ ~~~ ~I~j/~s / IP ~DJ ONTRACTO ~~/ .rrG.ro~~.~-C LICENSE NO. ICC NNO. ~35'.S" Z v D~ss ,/ ~ ~~ ::~ ITY /~~C ~ IP coy/~ HONE NO. AKER FIELD CITY BUSINESS LICENSE NO. ORKMANS COMP NO. INSURER / BRIEFLY DESCRI HE WORK TO BE DO ~ c ~ i~ r i// WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO. OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL ^ YES ^ NO SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ^ YES ^ NO THIS SECTION IS FOR MOTOR FUEL TANK NO. OLUME NLEADED REGULAR REMIUM DIESEL VIATION THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. OLUME NLEADED REGULAR REMIUM IESEL VIATION FOR OFFICIAL USE ONLY The applicant lui~r ' eived, under~~ss~ands, and will comply will: the attached conditions of the permit and any other state, local regulations. Thjs~ has b~ey>rc~Oir~ted under penalty of perjury, and to jhe~~ of m~-knowledge, is true and correct BY: APPLICANT N~jKAE (PRINT) ~/ L ,THIS APPLICATION BECOMES A PERMIT WHEN APPROVED i 0 n i. r~ ~' ' j ENVIRD,'VMENTAL Scope of Work ((( SERVICES, !N~ Facility: 7-11 32376 Date: 6/19/2006 Job Number: 3221 9600 Brimhall Rd. BAKERSFIELD, CA Estimate No: 394 Contact: Location: General Work to be performed: Location: FiII Sump -'87 Master Work to be performed: Replace 87 master direct bury fill bucket like for like •' i • •' ' , • • -,,. i i •~ .. .. y ~ ~ ~ ~ - Y~ . - "State Of:'California ~a ~ti CONTRACTORS:.ST~4TE.LICENSE'BOARD .~ '' ' ::~ :• :Con'su'mr~ ~A_CTIVE.LICENSE ' a-'•••' :.V - - Affairs', RR ,i . r ~ lkmaaPLmber•~+-U.831~~;3 ~ ~~ - EMS CO:RP ~ a^,~.~~m..BELSHCRE`:EN~/~IRONMENTAL ~ {• • , „ ;~ERViC~S INC ~ • .I ' ~ ,. ~' ` ci.:slrna~~oncsl A k{qZ. • ~ . ~~~~~^~°~• 05/31/2008 ~ . ~, i ~ `~! . V i . l ~ 1 CERTHOLDER COPY ST~4TE . P.o. sox 420807, SAN FRANCISCO,CA 94142-0807 -COMPENSATION FPI=S lIFtAN-EE U ~ ~ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE `+ ISSUE DATE: 04-01-2006 PROOF OF EVIDENCE ONLY SG 2597,1 TOWNE CENTRE DRIVE LAKE FOREST CA 92610 , GROUP: 000426 POLICY NUMBER: 0000276-2006 CERTIFICATE ID: 304 CERTIFICATE EXPIRES: 04-01-2007 04-01-2006/04-01-2007 JOB: 41AIVER OF SUBROGATION AVAILABLE UPON REQUEST This is to certify that we have issued a valid 1Norkers'.Compensation insurance policy in a fgrm approved by the California Insurance Commissioner 'to the employer named below for the policy period indicated,.;• This policy is not subject to cancellation by the Fund except upon 30 days advance written notice #o the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may •be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, .of such policy. THORIZED REPRESENTATI PRESIDENT • "EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. i ENDORSEMENT #1600 - KAREN CASS, PRES - EXCLUDED. ENDORSEMENT #1600 - LARRY MOOTHART, SEC, TRES - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER ~ BELSHIRE.ENVIRONMENTAL SERVICES, INC. SG • ~ 25971 7041[VE CENTRE DR ,J FflflTHI LL RANCH ~CA ~ 82810 M0408 SG '.2-05} ~ - .PRINTED' 03-18-2006 k _ , f _ .. INSR ' TYPEOFTNSURANCE ~~ POUCYNU[xBER POGGY ER~L-{7~/E DATE POLICY E7CPlE2AT[ON -GATE M$D ~_ LltG[TS - FR i. L .. ! GENERAL LIF(SICtSY EACH CF S I ~ OQQ ~ dOQ X CoC~au6zc(ALGEtiERAt UASIL[iY 916038-d3 06/Y4/ZOQ~ 06~14/~006 FIRE Wt&lAGE [Rny owe 6rej s IO(), 000 ctninas MADE X~ occuR I4~D EXP (Anv «,a ~~,) s 5 , 000 A PERSONnt c Aov wauRY s 1, 000, 000 G8IERALAt;~RECATE s I.OO0,004 ES PEK GENI.AGGRE&ATE UM[TAPPLI PROOULTS-COhTPIOP AGG S ~ ~ (jQQ ~ dQ _ pOLK'( ~~ LOC AUTOMOHII.E LIA81iSCY GOiN81TJED SlNGiE LIt UT s JC ArrtAUro 9I604Z-03: Ob/I4/ZOOS 06/I4f200b ~~«aa"p 1000 00 > , AII.OWNEOAUTOS @ODILYttJJVRY i . ~ SC[-~~[1LEp AUTOS (Px p«mr~ X HIRED AfIC05 BOQICY W.IURY !!ON-OWHF~ AI.tT~OS S IPcf a¢idad) PROPERTY DAMAGE S (Pei a¢ide~',} GARAGE IJABttITY ~ - - AUTD ONLY- EAACCIDENT S ANY AUfO OTHER TFItW EAACC S A(ITO ONLY' AGG S gCC65 UAHY_I'CY ~ ~ EACf1 OCCURREFlCE i ~ ~ QQQ, QI~a X occuR ~ cIAIMS uwDE EQ 533767&-07. • 06/1Q/Z005 06/14/ZOOb AGCUt=carE S 5, 000, 000 i B S OEEx1CTt8LE i • RETFMION S ~ S lF[OAKERS DON'IPENS0.TION AND TORY U0.t1T5 '~;R ER FJNPLDYERS tfASll_ilY F L ~cx-t acctoErrr i E.LDISFI~SE-EAEMPL a 1=L OlSEASE -POLICY UMtT S $I:000,000 Littrit Ontractors Pollution g L iability 926039-03 06/I4/Z005 06/I4f2dOb EDESCRTPix)N OF DI'EHAJIQN$!l.O~A710NS'IYEFt1CLt5/F~4-wSIOFiS~OtU 137 ttrvuVtcsuartv~r-rt~:uu. rtcvY~xura.~ . t -. - _ - RE. Proof Etridance Only - =10 day notice of cancellatioc~ in tE>:e event of non-payment of ~irenliclm. CERT(F(CA'fE HOLDEf2 . ( AooliioNALtNSVem:INSUtz~ztFi•rE>z; ~ C~CELLATIOK ' • --=-=ProoffE~r-idence IIiYIy'F~==:= D Z~.S (71371 -- SHOULD AHY DF THE ABOVE IIESCRIHED POLlaFS SE CQNCFt t Ffs EEFORE THE p~{KATTON RATE THERtAF. 7KE [SStt&~iG COH[PANYt'4II.L EBFDEAVOIt TQ 1GfAIL QAYS YYRlFTF~t ?Z073Ci=TDTKE GEKTFTGlTE HOI.}?l~2 NAFfHDTO'FKE LFrT. OUTFAILURETOThIilLSUCH N617CESHALL IIxIPOSE HO OBLIGATION ~OR LIA:~I+-BY OFANY KRtFI UPON THE COSdPA iL6ENT3 OR FCFPRESEFlTATNES ~ A[lTEfQkZfF1=D REPIFESEri1TA l..lJ Y Gl'C/'~~~-.a . 7HE PDUClES OF JNSfFRAIQCE LiSTEn B[10VY HAVE BEEN ISSUED TOTHE INSURI=D N/i~fED RBOVE FOF2lliE POLICY PERIOD 1KD(CATED_ No7W(iHST,~D~G i~,gNY IZEgUIR13vTENT, TERM OR CONDICION DE ANY CONTRACTOR OTHER DOGUtNFKC1ISIFCH RESPECTTO WFitCH THtS CERTIF1C11TE MAYBE [SSUID OR •°ls4AY PERTAIN, TFiE Q~ISURANCE AFFD(iDED I~THE POLICIES DESCRIBED HERIIN IS SUBJECTTO ACL THE TERMS, IXCLUSIONS AND CQNDii70NS OF SUCH .-' G[)I ICII=S_"Af3G1ZEGATE L1MlTS SHOWN MAY HAVE BEEF! REDUCED BY PAID CLAIMS_ _ BEtSHIRF ~~ ~ j ENVIRONMENTAL l sERVrcES, iNe. Scope of Work Facility: 7-11 32376 Date: 6/19/2006 Job Number: 3221 9600 Brimhall Rd. BAKERSFIELD, CA Estimate No: 394 Contact: Location: General Work to be performed: Location: Fill Sump -. 87 Master Work to be performed: Replace 87 master direct bury. fill bucket-like for like f .- ~ ~ - 4 - ~ ' . .. ~ ~ ~ -- "State ~rGalifornia ~ .. •rr..,,, ~,;,M,; CONTRACTORS:.STgTE.LICENSE BOARD ~,.,_ _- ~°'~"~"" ~.ACl'IVE.LICENSE ' m _ .. :Consumer - '~ . Affairs'. - ~ ,~~,.~,m,.~'80831:3 E~~m CORP ' ., . ~ ate,.„gym. $ELSHLREENV~IRONMENTAL • ~. ~. ~ ~ ;~E~ViC~S INC ~ - .j. ' ~ ~ ~' f ~. . ~ CxpLs4on Dalo~ ~JfJ1,2000 YrY c •\ W • t _ .~ fir, c `r { 3 ~ 1 • ~ _ _ __ t CERTHOLDER COPY 5G t, ~; S~~T~ . P.O. BOX 420807, SAN FRANC(SCO,CA 94142-0807 -COMPEiVSAT10N t AF~ S Ll R~ A N -C E U i~ D CERTIFICATE OF .WORKERS' COMPENSATION INSURANCE ~•ISSUE DATE: 04-01-2006 GROUP: 000426 • POLICY NUMBER: 0000276-2006 CERT{FICATE ID: 304 • CERTIFICATE EXPIRES: 04-01-2007 04-01-2006/04-01-2007 PROOF OF EVIDENCE ONLY SC.,. JOB: [~IAIVER OF SUBROGATION AVAILABLE 25971 TOWNE CENTRE DRIVE UPON REQUEST LAKE FOREST CA 92610 - • This is to certify that we have issued a valid V1/orkers',Compensation insurance policy .in a form approved by the California Insurance Commissioner 'to the employer named below for the policy period indicated..; This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded ' by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may .be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. THORIZED REPRESENTATI PRESIDENT - :•EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 -KAREN CASS, PRES - EXCLUDED. ENDORSEMENT #1600 - LARRY MOOTHART, SEC, TRES - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2004 I5 ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER - BELSHIRE.ENVIRONMENTAL SERVICES, INC. SG ~ " X25971 T_OF1NE CENTRE DR J FOOTHILL RANCH GA 92610 - M0408 '.z-o5} ~ - - PRENTED- : 03-18-2006 . a < - . f i PRODt)CER (449~85i''-454Q -4800 Mil7enniririi IZisfc Managa`neat & 3DSUrartce S>'rvices License ~ QC1348Q 5530 Trabuca Raad _ ~rvirte, CA °Z620 - IusutzED SeTsbi re Envi rontr~ertta7 Services , Inc _ ZS37I TD~me Centre Drive FaD~hi17 Ranch, C~ 9Z6I0 ~p e a e a y ~ q.e• n ca ac e <o s. Q6~~.6 f2E} TH[S CERTIFICATE ISM ISSCIEB AS l~ ~l-CER QF IP1FQRt~.:47T(1!H f3NLYAND Cf?t~EFERS I~EO RIGHTS UPOfi THE eE127TFICATE FIOLF~ER_ TF[IS CERTIFICATE DOES CidTAE~gEh'D,1=XFEAID pR ALTER THE CCJVERA~E AFFORL)E13 BY THE POLICIES BEL4~( . It~ESURERS RFFORI]IHG CL3YERAGE tNSUR~A:. ZUI:'"(Cft AFSfer7C~T[ ~ - -• tusU~te_ Steadf~as~ Insurance tusuaez c " utssuizaz e CQVEtzAeES - THE POLICIES OF INSURANCE Lt51 to Ba-1.DVV Havt= Bt~t [ssutu 1 u ~ Ht 1NSVtttu Hatvit-~ atsvrrt rurc t rsr= ruut:Y rttttuu tNUttat tu_ No7VVtT1iSTP,21Dllas; ~E i4!~IY REQUIRHSIEENT, TERM OR CONDf170N OE ANY COtdTf2AGT DR DTHER DOCUMERIT WFIH RESPECTTO WHICH THtS CERTIFICATE kiAY BE lSSUID OR < •-iJ'.AY PERTAIN. THE ttQSURANCE AFFORDED HYTHE POLICIES QESCRISED HERETN t5 SUB.tECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH -:' POLiC(ES_•AGGREGATI= LIMITS SHAWN M.4Y HAVE BEEN REDUCED BY PAID CIJUMS_ t ~~ <' ~ . ~TYPEOFiNSf7ttANCE~ ~ ~~ POLlC-YNUSSBHt .. PO[J~fE~7YE DATE PaL[CYIXPlRA7iON .DATE tNDD _ LlSG[TS I GENE=FtFIL (Jfi81UTY EACH oCCURAENCE S ~ e QQi7 i QQQ X cot~eatcIALGENtTZAt. UA$R.ttY 916038-03 06/14/2005 06/14/2006 flR1= t)AF64GE (MY a,a Gre} s IQO 000 ctAlrns thaDe Q occtttt tin ocP (~ a,a v~~+l S , 5 , 000 f A rt_RSON.at +; Aov tNn1RY s Z, 000, 000 - G@~t-3~ALAi~GREGATE ~ S ~:. aaa, ooa GEN'L AGGRE$ATE Uk(tTAPPUES PER' PRODUCTS- COMPIOP AGG S I Y OQQ ~ OQ POUGY j ~ LOC ~. AUTOMOSttE L1ASfLITI! - ' CO$,IBHJID S1NGtF UbNT S X AtyYAttt"O 9I6042-03, 05/I4/2005 06/I4/Z006 ~` ~~"d I, 000,00 Afi ONRtED AUTOS • 6oDtLY tN.1URY SCHEOULF~ALITOS ~ ~O~P°~~ S X HIRm AUTOS ' K Y X NON-ON7NE.D AUTOS - s (p~ ? PROPE3ZIYDAMAGE ' 3 (Pei axide~'} GARAGE llAettlTY ~ ~ AUTi7 ONLY- EAACClDEtJT S ANYAUfO OTHER?}IRtA1 EAACC S AUTO ONLY: AGG S EXCESS UAHtUTY EACEt OCCFJRRENCE I ~ ~ ~ OQQ ~ QQQ X occuR ~ ctAmnsanAne EQ 5337678-QI •06/1~/ZOOS 05/I4/2006 AccRSCATe r 5,000,000• B a - DEF3UCTl8[F S RETENTION S S IFlOtiKETZS COAtPE1tSATiON AND TDR~(f~RtITS Tafie ER EkfPtrnl=RS ilASttl'TY F.t_tltCfi ACCtoENf S . ELI7iSEASE-FAEMPLO S E"L OtSEASE - POLICY LRNff S $I,U00,OOtt Litrii-L onfracto>~s Pollution B L iability 916039-03 06/14/2005 06/I4/2006 E DESCRii 7'p~( OF OQERE~TIQN$20~Ji7I0ElSlYSiICLE_S/OCCLUS[ONS ADOm $Y ENOQRSE7dElV'TTSPEt'IAL PKOYiStOKS , t ... - -~ RI=: Pr-oof Evidz~ce Only _ . f =1a day notice of canceilatibac in the event of Hoer-payt>'tent of pres~lium. CERTIF(CATEHt]LdER. ADDtr[at~tALrNSVREn;tNSU[znzt~tz •~ CAI~CELIAT[~ht - ~ ~ SHOUTAANYOFIHEABOYEDESCRSHEDPOL1CtESSECANcFltFnl3EFORE-fFFE k7lY{RAT[ON DATE THEREOF. TKE ISSUfEtG COtIIPANYVVI[.L ETFDEAWR TD EfQ2L • DAYSWRLFiENNOTICETD7HEC82TFfCJ1TEHOLb62NA6[ED70'IHE~ - 6UTFK[LURETO'RfAlLSUCti NOTtCESHALLQetPOSENOOBLIGATIONDRt3A3l:-t1~C - ~ OFEVtY IiAlt} UPOi~! THE CotCSPA~S~tCvEt1 FS OR F~PRESENTAT'tttE=-S --=--=Proof/Evidence OtTly~=-_-- rAtiTKORT£EDt2f:rPRESEt'ICATIV~" t / - -j / _ /~~-- _~ ~- .ice' ~Y~i.6?-t34-~3t`~ti~.~.~ ~t-ttf-s-t+-- ~~--~-~'~~ 'ATM ---_ _ ~~ j BELSHIRE _ IJ ENVfRONMENTAt r SERVICES, (NC. Scope of Work Facility: 7-11 32376 Date: 611 912 0 0 6 Job Number: 3221 9600 Brimhall Rd. BAKERSFIELD, CA Estimate No: 394 Contact: Location: General Work to be performed: Location: FiIlSump - 87 Master Work to be performed: Replace 87 master direct bury fill bucket like for like ~ ~ ; t .~ ~ \• ~ w • ` q , • ~~ ~ - "State Of:'California ~,~, CONTRACTORS:.STpTE.L`ICENS~ BOARD ;' ~~" ~°'""""" ~.ACT'IYE.L`ICENSE ` ° m ~ ,r ` `I ' :Consumer - r .. Affsurs', RR }~1~~~/.~( ~~{1 1 ~ LbmesWmbsrM0831:3 E^,,, CO:RP .~ •• . ~ ~ a^,~,.,~m. $ELSHLRE`~.EN~/~IF~ONMENTAL • - ~. , ~ `~ERViC~S .INC ~ - .~. • ~ •' l a..~r m~~c.~ A k{qZ. - a '~ • ~~~~^~~• 05/3Y/2008 ~ , • • ', - ' - • 1 .~ S~ . r.,.. ~~~.;7. . „ ~ a • .~. CERTHOLDER COPY SG S~~T~ - P.O. BOX 420807, SAN FRANCfSCO;CA 94742-0807 -COMPENSATION ~ '. FAh S Li F2-A N-G E CERTIFICATE OF WORKERS` COMPENSATION INSURANCE `+ •ISSUE DATE: 04-Ot-2006 GROUP: 000426 - POLICY NUMBER: 0000276-2006 CERTIFICATE ID: 304 - CERTIFICATE EXPIRES: 04-01-2007 04-01-2006/04-01-2007 PROOF OF EVIDENCE ONLY SG JOB: WAIVER OF SUBROGATrON AVAILABLE 2597,1 TOWNE CENTRE DRIVE UPON REQUEST ' LAKE FOREST CA 92610. - This is to certify that we have issued a valid Workers' ,Compensation insurance policy in , a farm approved by the California Insurance Commissioner 'to the employer named below for the policy period indicated..; This policy is not subject to cancellation by the Fund except upon 30 days advance written notice #o the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may .be issued or to which' it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, .of such policy. THORIZED REPRESENTATI PRESIDENT • '.EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 -KAREN CASS, PRES - EXCLUDED. , ENDORSEMENT #1600 - LARRY MOOTHART, SEC, TRES - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER -_BELSHIRE.ENVIRONMENTAL SERVICES, INC. SG , _25971 T.OWNE CENTRE DR 1F043THILL RANCH GA -82510 ' ~ - Moos ',2-os} - - - PRINTEB' : 03-18-2006 . PRODUCER {949&sx-4~aa ~ -4g0o Miiterlniuai IZiste Manage;nent & Insur`artce Services _ Li cen.se ~ ~J.3480 5530 T`rabacn Raad _ 3=ruin!', cA s2-ELa ,r~suREa SeTshire Enviror~Ir~...cffal Set-vices, Inc. 25873. Tarme Centre Drive Footi~i37 Ranch, C.A 92610 TIf[S CERTIFICATE IS ISSUED AS A fe:ATTER OF I21FQRri1I.4TIpH QNLYAND COI~FFERS PIO RIGHTS UPOF! THE CERTIFICATE I-FOLI3EEZTHIS CERTIFICATE DOES Ft(?TAI~9EIhLT, E?QEi(D.pR ALTER THE COVERAGE dFFORDE€7 6Y THE P(zLICIES BEL'OVY_ • IttSURERS AFFORE)INEx CL)YERAGE WsUR~A:. Zurich Azs~l~zcan tntsut~xs: Sfeadfasf Insurance rasuRez ~ Wst~t o- ulsuFxsz e GQVERAGES THE POLICIES OF INSURANCE LF51ED BELOVtI HAVE BEEN ISSUE[] TO THE INSURED NAMID AB01fE FORTHE POLICY PERIOD INDICATED_ NOTWITtiSTAI~pING i ~~gNYREQUIR~MEMTFJ~h{ORCONDff70NOFA7~FYCONTRAGTOROTHERDOCUMEK>-WETHRESPECTTDVYFIICH7HtSCERTI!-~(:ATEktAYBEISSUIDOR .=TtdAY PERTAIN, THE QdSL[RANCE AFFORDED $yTHE POLICIES pESCRl81rD HEREIN tS 506JECTTO ACC THE TERMS, IXCLUSIONS AND CEiNDlTiONS OF SUCFI . ^= POLic(ES_•itGGREGATE LA1A[TS SHAWN MAY HAVE BEEN REDUCED SY PAID CWMS_ lflS ~_ LT'A R ~ ~1YPE OFINSItRItNCE ~ POUGYNUfd'8SZ .. .. !p U~ EFE~CIIYE PATE ~f3t o 170N _ 11ZC[TS _ j GFNERAt_t.Yieic,R'Y EACHOI;CURRENCE S I,aOO,000 X COhi1SdY3tCIALGE}tERALUA$1117Y 916038-a~ a6/Y6r/2Qa5 Q6/~4J~a~6 FIREDAFAAGE(MyoRe6re) 3 ~Qa,a(]~ clatnns wrADe X^ occuR t~D EXP Ia~y «,a a~«i) s 5 , 000 s ~ PERSOtyaL c Aov IruuRY s 7- s 000, 000 GBIERAL AZ;GREG4TE S _ Y ~ a0a, 000 GENLAGGREtiATEUMfTAPPUESPER: PRODUCTS-COMPIOPAGG S ~~QI}l1,QQ POUGY ~ LOC A[JT06SOB7LE UASfUTY - CO€IH WED SJNGLE tJM1T s }( AryYAUro 9I604Z-03, 05/14/2005 06/i4J 1006 ~~aa"U I, 000 00 AIIOWNEOAUTOS ' 6oBILYk4.1VRY SCHEDULEp AUTOS IPer P'~V S X f{IREBAUTOS BOptLYW.lURY X NON-OWNEn AUTOS ~°~ I s PROPERTY DAMAGE S ' IPeC accda~j GARAGE UAB[LTfY ~ ~ AUTO ONLY-EAACCIDEN7' S ANY AUTO OTHER-H.~ F1lACC S AUTO ONLY' AGG S IXC65 LlAHiLRY ~ EAC[-! DCCURREPlCE S ~', aQQ ~ OQQ X occuR ~ tXA1MSMADE Ea 5337678-QI •06/14/ZOaS 06/z¢/z0a6 AGGREGATE s 'S, 000, 000 B s 6F13UCTt(iLE 5 RE1Fl~RlON S .~ S 4V0{tKERS COIItPEHSAT[ON AND TORY UA/STS ;~'`• FJ2 1=MPi~'[ERSIIA[3ICIiY EL_EACfi ACCIDENT S E_L.DtSEaSE-FAEM1APtoY S EL D[SFJtSE ~ POLICY LANIT S o ~I,QOo,00a Limit ntt~actQrs Pol7u#ion 6 L iability 916039-(t3 06/14/2005 06/I4/200F E DFSCRlP770jV OF D~F~iq]IQtysrLOCa~1o2JSnlatteLESroccLUS[oels A ~bEn SY ENDOtzst7aQVTrsPECllu_ PROHtsiohcs . ~ _. - RE: Pr-oaf Ev~Hanee Un7y - ~10 day notice of cancel7atioR in the eitent of nax-I-payment of premium. RTIFfCATE HQLDEE2 . tcuut~R =--tPraaf/Ev-icfen~e tl~€1~==.-' 2~5 CIIS7- - ~ - - - cArdCELtATIdK SFiOULB ANY OF THE A80YE DESCR18Ed PO[1ctES BE CA!lCFt i cn BEFORE TFfE p~{RAT[OK BATE THEREOF, TKE fSSF1~lG f7DhtPANytn11LL ET~EDEAVO~ZTa 1LfA2L. ~' ~ BAYS iYftCFTEN AIOTICE TO THE CERTFiC1tTE HOLhER WiF[EDTO TXE LF"T, BUi'FAlLURE TB 7dR1LSUCH NOTICE SHALL Qe1POSE FFO OBLIGATION aR RSR3SLITY oEANY KfiA! UPON'ItiH COi41PA /LGETIT& OR FtFP'RE9ENTAT[YES AuTHaRfLED RI:PIFFSEMA ~ /I ~ _ - -~' _ _ l ~F1sH~RE s° -! - j ENVIRONMENTAL - sERVicES,1NC. Scope of Work Facility: 7-11 32376 Date: 6/19/2006 Job Number: 3221 9600 Brimhall Rd. BAKERSFIELD, CA Estimate No: 394 Contact: Location: General JI/ork to be performed: Location: Fill Sump; 87 Master JIlork to be performed: Rep{ace 87 master direct bury fill bucket like for like' • .. a.., ' •J,~a) _ .. c f • .y i .. J ~~ , .. 'State OirCalifornia ~ ~~aa CONTRACTORS:STATE.L'ICENSE BOARD :' "~"` : ,I ;• :con`su'me~W~~ •ACl'IVE:L'1CENSE ` ° m~ y • nct~r~•, ~ y • ~ ~~,.wm~~80831;3 E.,,Y co R P II C • ~ a~.,..~~m. BELSHCRE:ENV~IRONMENTAL ~ a- • •. , ~ ;~ERVIC~S .INC ~ • :i . ~ •~ .. ~ ~_.i , CxpL.Gon Dala 05/31 /2008 ~~~~ ~ .. ~•ec _ ` . [~. ' t ~, • i ~ r CERTHOLDER COPY SG _. ST~4TE P.O. BOX 420807, SAN FRANCISCO;CA 94142-0807 --COMPENSATION- - -. FNF S l.i FZ- A N -G E CERT[FICATE OF WORKERS' COMPENSATION {NSURANCE `' •ISSUE DATE: 04-Ot-2006 GROUP: 000426 " POLICY NUMBER: 0000276-2006 CERTIFICATE ID: 304 " CERTIFICATE EXPIRES: 04-01-2007 04-01-2006/04-01-2007 PROOF OF EVIDENCE ONLY SG JOB: WAIVER OF SUBROGATION AVAILABLE 25971 TOWNE CENTRE DRIVE UPON REQUEST LAKE FOREST CA 92610. - This is to certify that we -have issued a valid Workers`.Compensation insurance policy in a farm approved by the California Insurance Commissioner 'to the employer named below for the policy period indicated.,;• This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you S0 days advance notice should this policy be cancelled prior to its normal expiration: This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded ' by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may .be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. THORIZED REPRESENTATI .PRESIDENT - -.EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 -KAREN LASS, PRES - EXCLUDED. - , ENDORSEMENT #1600 -LARRY MOOTHART, SEC, TRES - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER - BELSHIRE,ENVIRONMENTAL SERVICES, INC. SG -X25971 70WNE CENTRE DR J FOOTHILL RANCH CA 82610 `.2-05} • M_0408 PRINTED'; 03-18-2006 ~. _ _ • f • y PRODUCER ~g'¢9~85X-45QQ -4gU0 Millenn'~I~E~i RisK l~ianaga~nent & Insurance Services L.i cerise ~ pQ348d 5534 T•rabuca Road 2=wine, CA °Zfi20 fusuRED SeTshi re Envi rDnEr~erstal Serv'i ces, Ittc . Z5g7I Tarme Centre Drzve Faathil7 Ranch, GA 926Id I s (~ "~~ ~ - ~ fFtSURER E F-C.QVERAGES THE POLICIES OF INSE7RANCE LISTID BF10W HAVE BEEN ISSUE[] TO THE R~lSURED NAIV1i=D Rt1UVt FUt~ 1 Fit POLICY PEf210O !N[)tCAT>=D_ NOTVii[THSTgplp~G +~:CtdY KEQEIlFiHuT1=N1, TF~tltd OR CDNDI[TOIV OF ANY COPiTEtACT OR OTHF.~Z DOCt1lSdFJ!Lf VtttTH RESPECT TD WHICH THES CERT)!-ZCATE MAYBE ISSUID OR • R4AY PER7AlN, THE Q~iSURANCE AFFORDED BYTHE POLICIES OESCt2It3ED HEREIN {S SU(3JECTTO ALL THE TERMS, LXCLUSEONS AND C011DITiONS OF SUCH ..' Poi1CFES_•A~C=REGAT(= LIMITS SHOWN MAY HAVE BEEI•E REDUCED 6Y PAID CIJUMS_ ,. iNS R "FYPEOFiFSSUE2ANCE ~ ~ .. 1'O(.IGYNiItdHEIi POUCY Ei~Cf7YE DATE PDUCY EXPIRATION -DATE ktIDD LM[75 ~ lTF1 . . j GFJdEWttIJABiUTY EACH oCCURREkCE s I, ddQ, ddd • X coC~H4I62crALGEFFEAALLIA[3LLfiY 9I6Q38-d3 06f14/2UQ5 06%14/ZOU6 FIRE DAMAGE{Rnyaie6re) a IOO,QUO CIAIIdLS NIAfSE Q OCCUR - [v1EQ EXP (Alnr one person) S S . UQd s q PErtsoFlAL ~ Aov EH.IURY s ]•, QQQ, UQQ GEFlEFAL AZ:GREGATE s I. Udd, Odd GENIAG6REf~ATE UM1firrAPPUES PFSt PROI.~UGfS-COMPlOP AGG S ~ ~ X11, Qd POLICY ~~ LOC AUTOMOBSIE LIABI!]TY ~ ' COMS WEB SINGLE LIkLT S X Aµr~ui-o 9I6042-03:. d6/I4~20OS ds/I4/ 2dd5 t~'~~"4 I,f>dO,EId Al10WkEDgUTOS ' HODIf..YWJVEZY S SCNEbUI.Ep AUTOS (Pa p«sonj A X HIRE]) pUT05 BO¢KY d`LIURY X kON-OWNED AUr05 ~~ ~ S PRO~TYDAMAGE S • ' [PeT accide~) GARAGE L1ABttSiY ~ AUFD ONLY- EJIACCI()ENT S ANY AUTD OTHER T}IMI FA ACC S AUTTS ONLY: AGG S IXCESS LIAB¢IrY FJtCE! OCCVRREkCE S ~, ~QQ, QQQ X occuR ~cLAmnsawDE EO 5337678-DI •06/I.4/ZOUS d6/I4/Zd06 AGC,~zscaTE r 5, Odd,ddd~ F B a DET3UCTBLE S RETEkT10N S ~ S • rvoRtt>:xxs exlluPexsAnDN AND T'otzY Lmvrs ~'`_ F3t . EMPLDYF32SLWHIUiY Ei.EACHACCttJEftT s EL DISFJLSE-Fli EAAPL S €t DtsEASe- POLICY uuttr s $I,QdO,oI}Q Litmifi ontractors Po77ution B L iability 916U39-43 d6/I4/Z445 d6/3.4/20d6 DESCTLIPT)Ok OF DEF,RgTi4N$!LD~ATICrtlslVS_ tICLEStoCCLUS[oks AnbED BY ENDORSEU[E1v'T7SPECIAL PfLD'41{SFDtds_ F _. - R1=: Proat; Evidznce Only =1U day notice of cance73ation in the event of nan-~Sayrstent o'F premir~ln. CERTIF[CATEHOLDER, t ADDITx>xatulsvaED;INSIIREIZLETTEK ~ CA1~CEl-LATIOK --=°-=Praaf/E~r-idente ~l~t1y'~~==_~ aCI~Rn zs-s {~ts7} . SHaFlLD RHY OF THE AHOYE I)ESCAIHED POL~tFS BE fJiFICEI t Fn BEFORE THE E7CPfKAT(ON BATETHEREDF THE ISSU@1G COFRPAAfYtRtlcL EkDEAVOR7D F+fAIL DAYS YIHCETE11kDTfCET'DTHECH2TF{CATEHOt~H2uAFhEDTO'FKEL~T, BUTFASLURE TO MAlLSUCH NQTiCESE{A!~ IMPOSE XO OBL[GATIOFf DR l.3AT3li.ETY otaL~NY 1fRtg UPDt1 THE c~SdPA ~iGENTS OS2 FtEPRESENTAT2VEs A[FTtiORf£ED REPFEE.SEIYFA • F - ....+..~ . _ ~..-~.~ _ - i•x..r..:e-sii~s-ccailK.E ~ -`~'s?~: ~*-r r c= 3'Y^ 1~`f_ - -r.r`.r3_.~.>-r ~a a c >aasav~r,~cr ar~e~s_. (76f16f2Q TEf[S CERTIEICEiTE IS IS5UE13 AS l~ BATTER OF II1FORnEIAAllC1N c)NLY At~dI7 CQI~IFERS KO RIGHTS UPt3T~F THE CIrR7IFiCATE IfC3i~ER_ THIS CF~2TIFICATE QOES Ft{3TAME1~, EXTERtD 0I~ ALTER TE11= CQVERA,t`sE AFFaRDE€7 6Y THE PCLtCIES BEL4Vy_ . • INSURERS AFFORDINf3 CL?YERAGE • INS[k2~A. zUr'TCh f~F;I°_ricarr FNSUizr~za_ Ste~cifasf Insurance IlzsuRez ~ . ltrsuR~t o- f, ~L 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 09/18/2006 Order Number: 3148605 Dear Regulator, Date Printed and Mailed: 09/29/2006 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32376 9600 BRIMHALL RD. ~ r~ MARKET #2237 ~T- ~ ~ '~C S~ BAKERSFIELD, CA. 93312 Testing performed: Secondary Containment-Dispenser Pan\Sump Secondary Containment-Line Interstitial Secondary Containment-Spill Container Secondary Containment-Sumps\Under Dispenser Secondary Containment-Tank Interstitial Sincerely, Dawn Kohlmeyer Manager, Field Reporting SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS ~ Tanknology TEST DATE:o9/18/2006 WORK ORDER NO.: 3148605 CLIENT: 7-ELEVEN. INC. BITE; 7-ELEVEN #32376 P.O. BOX 711 9600 BRIMHALL RD. MARKET #2237 DALLAS TX 75221 BAKERSFIELD CA 214-841-6714 Tank Interstital Tests TAN K PRODUCT MANUFACTURER RESULTS REGULAR Total Containment PASS PREMIUM Total Containment PASS Piping Interstital Tests 93312 LINE PRODUCT MANUFACTURER RESULTS Regular "A" Environ PASS Regular"B" Environ Premium "A" Environ PASS Premium "B" Environ PASS Sumn & Under-DisnPnspr Cnntainman+ Tac+c Sump! DISP.# MANUFACTURER -' P/F 2 REG Total Containment Pass 2 REG Total Containment Pass 3 PREMIUM Total Containment Pass 3 PREMIUM Total Containment Pass 1-2 Environ Pass 1-2 Environ Pass 3-4 Environ Pass 3-4 Environ Pass 5-6 Environ Pass 5-6 Environ Pass 7-8 Environ Pass 7-8 Environ Pass 9-10 Environ Pass 9-10 Environ Pass 11-12 Environ Pass 11-12 Environ Pass 2 REG FILL OPW Pass 2 REG FILL OPW Pass 2 REG VAPO OPW Pass 2 REG VAPO OPW Pass Tanknology representative: BRIAN DERGE Services conducted by: STEPHEN COULTER ~_ _ C~ SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS Tankno%gy TEST DATE:09/18/2006 WORK ORDER NO.: 3148605 CLIENT: 7-sLSVEN, INC. SITE: 7-ELEVEN #32376 P.O. BOX 711 9600 BRIMHALL RD. MARKET #2237 DALLAS TX 75221 BAKERSFIELD CA 214-841-6714 Sump &Under-Dispenser Containment Tests Continued Sump! DISP.# - MANUFACTURER P/F 2 REG Total Containment Pass 2 REG Total Containment Pass 3 Total Containment Pass 3 Total Containment Pass 1-2 Environ Pass 1-2 Environ Pass 3-4 Environ Pass 3-4 Environ Pass 5-6 Environ Pass 5-6 Environ Pass 7-8 Environ Pass 7-8 Environ Pass 9-10 Environ Pass 9-10 Environ Pass 11-12 Environ Pass 11-12 Environ Pass 2 REG OPW Pass 2 REG OPW Pass 2 REG OPW Pass 2 REG OPW Pass 3 PREM OPW Pass 3 PREM OPW Pass 3 PREM OPW Pass 3 PREM OPW Pass 93312 ~ ~ ~ ~~~ SFCnNnARY CnNTAINMENT TEST RESULTS SITE NAME: 7-ELEVEN #32376 32376 DATE: 09/18/2006 WORK ORDER 3148605 SITE ADDRESS: 9600 BRIMHALL RD. MARKET #2237 BAKERSFIELD CA 93312 REASON FOR TEST: Groundwater Level "from rade TA\IV I\ICAD\wwT1A\I A\1111\ITC~CTITIAI TGCTC Tan AI~1\ 111 Vf11Y1M 11V Product 1• I11\V 11\ I \ Tank Size .1\V 1111/1 Dia. 1 V Material Manufacturer Depth ~ ~~ Test Method Start Time Initial Level Finish Time Final Result Pass/ Fail 1 REGULAR 10028 96 TOTAL CONT Total Containment 5g Vacuum 820 -10 ..Hg 920 -10 ..Hg PASS 2 PREMIUM 9975 96 TOTAL CONT Total Containment 54 Vacuum 845 -10 ..H9 945 -10 ~~Hg PASS 3 0 0 4 5 6 7 8 Comments: 1 wo IucA~\AATIAAI nlln u Tan 1 v11m.1.. Product Dia. Len. feet Material Manufacturer Volume allons Test Method Start Time Initial Level Finish Time Final Result Pass/ Fail 1 Regular"A" 1.50 150 D.W. Flex Environ 1g Pressure 850 5 psi 950 5 psi PASS 2 Pressure - -- psi - psi 3 Premium "A" 1.50 15p D.W Flex Environ 18 Pressure 850 5 psi 950 5 psi PASS 4 Premium "B" 1.50 150 D.W. Flex Environ 18 Pressure 850 5 psi 950 5 psi PASS 5 6 7 8 Comments: _ Test Date: 09/18/2006 ~~~~~~~~~~ Work Order: 3148605 ii w . SECONDARY CONTAINMENT TEST RESULTS SUMP TESTS Type Tank or Disp # Manufacturer Model or Material Diam./Width/Length (") Depth (") Test Method Start Time Initial Level Level Change Finish Time Final Result Pass/ Fail STP Sump 2 REG Total Containment Plastic 48 56 VPLT 858 16 -.00001 913 16 Pass STP Sump 2 REG Total Containment Plastic 48 56 VPLT 914 16 -.00001 929 16 Pass STP Sump 3 PREMIUM Total Containment Plastic 48 54 VPLT 858 14.5 -.00002 913 14.5 Pass STP Sump 3 PREMIUM Total Containment Plastic 48 54 VPLT 914 14.5 +.00000 929 14.5 Pass Dispenser Sump 1-2 Environ Plastic 37x23 28 VPLT 1132 11 +.00001 1147 11 Pass Dispenser Sump 1-2 Environ Plastic 37x23 28 VPLT 1148 11 -.00003 1203 11 Pass Dispenser Sump 3-4 Environ Plastic 37x23 28 VPLT 1132 15.5 -.00001 1147 15.5 Pass Dispenser Sump 3-4 Environ Plastic 37x23 28 VPLT 1148 15.5 +.00001 1203 15.5 Pass Dispenser Sump 5-6 Environ Plastic 37X23 28 VPLT 1132 12 +.00000 1147 12 Pass Dispenser Sump 5-6 Environ Plastic 37X23 28 VPLT 1148 12 +.00001 1203 12 Pass Dispenser Sump 7-8 Environ Plastic 37X23 28 VPLT 1050 15 -.00036 1105 15 Pass Dispenser Sump 7-8 Environ Plastic 37X23 28 VPLT 1106 15 +.00005 1124 15 Pass Dispenser Sump 9-10 Environ Plastic 37X23 28 VPLT 1050 15.5 +.00001 1105 15.5 Pass Dispenser Sump 9-10 Environ Plastic 37X23 28 VPLT 1106 15.5 -.00050 1124 15.5 Pass Dispenser Sump 11-12 Environ Plastic 37X23 28 VPLT 1050 17 +.00001 1105 17 Pass Dispenser Sump 11-12 Environ Plastic 37X23 28 VPLT 1106 17 +.00000 1124 17 Pass Spill Container 2 REG FILL OPW Plastic 13 13 VPLT 858 7 +.00003 913 7 Pass Spill Container 2 REG FILL OPW Plastic 13 13 VPLT 914 7 -.00058 929 7 Pass Spill Container 2 REG OPW Plastic 13 13 VPLT 944 7 -.00005 959 7 Pass Spill Container 2 REG OPW Plastic 13 13 VPLT 1000 7 -.00001 1021 7 Pass Spill Container 3 PREM FIL OPW Plastic 13 13 VPLT 944 7 -.00002 959 7 Pass Spill Container 3 PREM FIL OPW Plastic 13 13 VPLT 1000 7 +.00129 1021 7 Pass Spill Container 3 PREM VAP OPW Plastic 13 13 VPLT 944 6 +.00038 959 6 Pass Spill Container 3 PREM VAP OPW Plastic 13 13 VPLT 1000 6 -.00001 1021 6 Pass Comments: ~ Tanlv~o/ogy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:09/18/06 WORK ORDER NUMBER3148605 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32376 COMMENTS Performed secondary containment testing as follows: Tested two tank interstitials; all passed; Tested three piping secondaries; all passed. Unable to test Reg. "B" Tested two STP sumps; all passed; Tested six dispenser pans; all passed; Tested four spill containers; all passed. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 09/29/2006 08:36 ACRAMER = r SITE DIAGRAM ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 09/18/06 WORK ORDER NUMBER3148605 CLIENT:7-ELEVEN, INC. SITE:7-ELSVSN #32376 ~ ~ ~- AIR/ H2O VENTS OO CAS W O S N o O m~ O ~~ O ICE O OV REG 10K O PREM 10K O ~~ STP ~ N v STP Printed 09/29/2006 08:36 ACRAMER -- -- -~ BELSH/RE ~ ~~~-°_ __ €NVtRQNMEN'fAL ____ = SERVICES, INC..: 25971 Towne Centre Drive Lake Forest, CA 92610 (949) 460-5200 Fax (949) 460-5210 Date: September 11, 2006 TO: Steve Underwood City of Bakersfield Fire Dept. 900 Truxton Ave., Ste. 210 Bakersfield, CA 93301 FROM: Jim Brown Sent Via: FedEx Ground Ref# 358673110011200 RE: Spill Bucket Test 7-Eleven Site# 32376 9600 Brimhall Rd. Bakersfield, CA 93312 rn--riY1-- 0 ~S ~j Transmittal ^ As Requested ^ For Review ^ Sign & Return ^ For Your Use ®ForYourFiles Quantity Description 1 Spill Bucket test performed on 9/6/2006. Comments: Please do not hesitate to call me at (949) 460-5200 if you have any questions or concerns regarding this work. Jim Brown Project Manager ~ SWRCB, January 2006 u "~ ` ~~' Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACTT,TTY TNFORMATTnN Facility Name: // 3 2 3 7 Date of Testing: r O (~ Facility Address: GOO ~ ~ ~ ire ~' ~ dQ e~~f T1 ~t.-lo) ~ ,~-- Facility Contact: Phone: Date Local Agency Was Notified of Testing Name of Local Agency Inspector (if present during testing): 2. TF,STTNG CONTRACTOR.TNFORMATION Company Name: „`~~$'~y1~.. ~iZ„/, Technician Conducting Test: Q,~fc,l CSGfCe Credentialsi: CSLB Contractor ICC Service Tech. SWRCB Tank Tester Other (Sped) License Number(s): 3: SPILL BUCKET TESTING INFORMATION Test Method Used: ydros Vacuum Other Test Equipment Used: ~ Equipment Resolution: € -__-_ Identify Spill Bucket (By Tank Number, Stored Product, etc.) _ 1 ~' 7 ~,t, f%jj - - Z - _ - 3 - - 4 _ - Bucket Installation Type: Direct Bury Contained in Sum Direct Bury Contained in Sum Direct Bury Contained in Sum Direct Bury Contained in Sum Bucket Diameter: ~y`' Bucket Depth: ~ `~ Wait time between applying vacuum water and start of test: ~Q it,,;,~ Test Start Time (T~: ~~ . 3,S'¢'k Initial Reading (RI): 3 , ash) 3 . tad' Test End Time (TF): g:3y9% nj; ~a4M Final Reading (RF): 3 „ OB i~'I 3 . ~ Test Duration (TF - Tr): / ~, b !~~ ~k Change in Reading (RF - RI): Pass/Fail Threshold or Criteria: ~~., ~ _ p O'Z rtiC KctiulL: t'a5 I`ail t`ns l:ul t',iti~ I~atl f'atiti' tail ~i ComlixentS - (include information on repairs made prior to testing, and recommended follow-up for failed tests). CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements.. .Technician's Signature: ~~"` ~~~"'~'~- Date: ~'~ .~ t State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements ~T lag maybe more stringent: ~ __ ~- ~~~ _~.. Bakersfield Fire Department Office of Environmental Services Inspector Steve Underwood 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Test Date: 07/26/06 Order Number: 3147770 Dear Regulator: Enclosed are the results of recent testing performed at the following facility: 7-11 32376 9600 Brimhall Rd Bakersfield, CA 93312 Services performed: Healy Quarterly Inspection STII A/L Testing Exhibit 9 Sincerely, ~~ ~~ Dawn Kohlmeyer Manager, Field Reporting ._ .,_a,._. 31A7770 -~- Use these forms to thet:k off and record the results from the 1SD Operability Tasting Procedure steps. Vapor Pressure Sensor Ambient Reference Test _ - _ DALE OF TEST ~~ °~__ 9ERVICE COMPANY NAME ~ ~ SI_RVICE COMPANY'S TELEPHONE SERVICE YECHNICIAN 'VEP~IER-Fi00T TECH C£RTtF'ICA710N #~ STATION NAME 015TRICT PER811T' tt STATION ADT3RESS CrrY 5TATE ZIP ~ (,DC7 ~r~~r~ti~c.L A1~~S~~t3Z fl ~' PRESSURE'SENSOR ..- ~- .- I LOCATtQN: CC PRESSURE SENSOR 2 F STEP 1. nPt7~NT NSIEMBERS OyG r P~ IF r' 1~ SERIAL NUMBER D D o G P o t Z- J 2 REFERENCE PORT GAP REMOVE07 ~ STEP 2. I VALVE SET TO REFERENCE PORT (PER FIG. 4-1 }? STEP 3. $ZEP 4_ STEP 5_ NON~ALIRRATEfl SENSOR VALUE " ~' ~ Z f INCLfES OF WATER COLUMN I (OBTAtI`I VALUE USING TLS 4~ONSOLf 14EYPA0 SEt2UENCE SI~OWN !N FIG. A-2, STER 7} PRESSURE BETWEEN ~0.2a A -D.211 {Y)N)? r ~ ~~ 1F NO: REPLACE PRESSURE SEN50R: N~1N SF-1~ISOR SERIAL NUMBER NEW 5ENSOR VALUE FNCHES OF WATER COLtlINN NEW SENSOR RRES$URE BETWEEN +0.20 8 -0.20 {Y!N)7 REFERENCE PORT CAP REI'LAGSD? +-~~ VALVE SET TO VAPOR SPACE PORT (PER FiG 41j? ~i ~' STEP t3. kiODE tCEY PRI=SSEb TO EXfT CALIBRATE SMArrrSENSOr! IItENU? Healy Phase It EVR System In~kuding Veeder-Root ISE], Exhibit 9-VIZ-2D'2-A Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, texas , a , ~ , Work Order: 3147770 -7- Veeder.Root In-Station Diagnostics {iSD) Vapor Flow Meter Uperahility Test Procedure SERVICE GOIIIPANY NAIAE ., i SERVICE TECHNICIAN I SYATION NAMI= ~ ---- -- •- - I STA;IdN ADDRESS IL _ _ __.. _ GATE OF TEST ~~ ~ SERVICE COMPANY'S TEf.EPHflNE ~ ~- VEEDER-ROOT TECH CERTIFIGATION # DISi'RlCT PERMIT # x.11 i ...-.. STATE 2IP I I VAPOR FLO1N METER SERFAL hUhABER ~ `rj~j ~ ` DISPENSER FUELfNG POINT NUMBa:R5 ~~J ~ FP 2 ~STEi* 1. ISr) DAILY REPORT GROSS AIL YALUI:S ~ ~ , ~~ ~If ! ~ ~ ~ S f , ~ $TEP 2. EL H05E `VIL RESULT #1 ~~~ ~ ~ G ~ ~ ~ ~ ` ONkY} r ` ~ I ..-. -_-.-_. .~ ..-._ ~ ,. .--..- ~...~...J STEP 1. VALUE MINUS STEP 2. VALUE DIFF. _- ~, i ~ bIFF. ~(] p 2 `STEP 3. ~ - - .- ._ ..-, -.. I PASS IF DIFFERENCE 1S WITHIN +J-0.75, IF LARGER DIFFFJ;tENCE, THEM \, CONTINUE PASS TO STEP 4 PASS CONTINUE TO STE 4 CONTINUE TO STEP 4 (CIRCLE flNEj i P i LOW GRADE FUEL HOSE YIL RESULT #2 5TEP 4. I L4W GRAdE FUEL HDBrE V!L RESULT #3• ` -. -- .. I --_~ -- .~ „ -, ,-~ 1 ~ ~ ~ AYERAG7_ OF 3 Y1L RESULTS . AVG. _ -- ~ - II AYCy_ .1 - - .~ .. I i STEP 1, VALUE MfIVUS STEP d. AVG. DIFf. i DEr=F_ i STEP 5. PASS iF OIFfERENCE IS WITHitd +l-b.15, IF LARGER DIFFERENCE, TFFEN CQN7INUE I PASS Pa`s CONTINUE CONTINUE T4 STEp S OR 7 ICRRCLE Tp STEP 8 TO 57EP T DNE} STEP 6. IF CONTINUE, REPEAT AT STEP 2. FOR 2"O FP USING 2N° FP COLtlMN, ABOVE. Healy Phase fi EVR System Including Vender-Roof ISO, Exhibit 9 - VR-202-A Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147770 -7- Veeder-Roclt in~tation Diagnostics (iSD) Vapor Flaw Meter Operability test Procedure SERVIGE COMPANY NAME SERVICE TECHI111CfAN STATION T+IAME STATION ADDRESS S7J=P ~. STEP 2. ~._ I STEP 3. DATE OF FESI' ~ "~_ ~~" SERVICE COAiIPANY'S Tt"LEPHONE Y££DER~itQOT TECH CERTIFICATION IK DISTRICT PERMIT >t CITY STATE ZIP VAPOR FLOW MIE'TER SERUU_ NUNl13ER ~~ l L~ - i DISPENSER FUELING POJNT NuINBERS ~~ ~ ~~7_y ~- ISD DAILY REPORT GRgSS AIL VALUES a ~ ~ ~w C7 LQVIf GRA[IE FtIEL HOSE'Vt1 RESULT t11 F (ONE FP ONLY) U c ~ ~ t ~ - ~ ~ i STEP 1. VALUE MINUS STEP 2. VALUE PASS 1F DIFFERENCE IS VMfTFtIN +I-0.f5, IF LARGER DIFFERENCE, THEN CONTINUE Tq 9TEP 4 {CIRCLE ONE) I LOW GRADE FUEL IfOSE Vf L RESULT t12 I STEP a. LOW GRADE FDEI HOSE V!L RESULT #3 STEP 5. I.. ~ STEP 8. DIFF_ ~ ~ , O ~ `DIFF. - ~, i ~ ~ .~ CQNTiNUE .. . CDNTINUE ~. ~I r0 STEP A PASS 70 STEP 4 ii 1 Ii _. .. ~ ..~.. •---1 i AVERAGE OF 3 V!L RESULTS AVG. ~ AVS",. STEI> 1. VALUE MINUS STEP d, AVG. DIFF. DIFF_ PASS tF LIFFERENCE IS WTTftIN +!-0.15 , 1F LARGER DIFFERENCE, THEN ~ PASS CONTINUE 1 P ASS CONTINUE CONTINUE TQ STEP 8 QR 7 (CIRCLE TO STEP 6 ~ TO $TEP 7 i DNfj IF CONTINUE, R£PEAT AT 57EP 2. FQR 2°D FP USING 2"~ FP COLUMN, A$OVE. tieely Phase II EVR System Including Veedsr-Root ISQ, Exhibit 9 - VR-2Q~-A Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147770 -7- Veeder•iZaot tn-Station Diagnostics [1SD) Vapor Flow Meter Operability ~es# Procedure SERVICE COMPANY NAME SEItViCE 3ECHiU1C1AN STATION NAME SERVICE COMPANY'S _.... ~ .. _._._ .. __ 1 VEEOER~tOQT TECH CERTIFICAT10fi ~ ~~~~~ ~~~ DkSTRICT PERIlIIT # ~ - 1 STATION ADDRESS CITY STATE ZIP C- ... ...__ ___... _._ _.. VAPOR FLOW DIETER SERIAL IuUMBER ~~'"~~ DISPENSER FUELING PgINT NUMBERS -. _ ~.... _. FP Fi' r -, I ~~' ~ STEP 1_ iSD DAILY REPDRT GROSS Ali. VALUES ~ r' ~ ~` UI Q _._. ._ _... _ , 1 .. STEP 2. LOW GRADE FUEL HOSE 'VfL RESULT #J7 ~ ~ i ~ U C LONE FP ONLY) ~ - ~ I` STEP 3. STEP 4. . STEP 5. I STEP 6. STEP 1. VALUE MINUS 5TEP 2. VALUE DIFF. ~ + ~ ,DIFF_ --C~. PASS IF DIFFERENCE IS WITHIN +1-0.15, CpNT1NUl: CONTINUE IF LARGEfi DIFFERENCE, TMEN PASS T4 STEP 4 PASS Tp STEP 4 GONTiHUE TO STEP d CIRCLE OI•IE) LOW GRADE FUEL HOSE VIL RESULT #2 LOW GRADE FUEL HQSE VfL RESULT#3 1 AVERAGE OF 3 VfL RESULTS AVG. ~ AVG_ .. __ .. ~ .. .. ... ._ .._J STEP 1. VALUE MINU5 STEP a. AVG. DIFF. DIFF. ` PASS 1F DIFFERENCE i`S WIT11iY1 +(-0,16, IF LARGER D]F`FERENCE, THEN CONTINUE CONTINUE QN~TINUE TO STEP fi OR 7 {CIRCLE PAS'' TO STEP $ PASS 7d STEP 7 _ _.. .. _. _ .__....~. _. .._. . _~J IF CONTINUE, REPEAT AT STEP Z. FOR 2Mp FP USINQ 2NO FP COLUINN, ABOVE. i Healy Phase N EVFt System It~cludirig veedel-Root ISD, Exhihlt 9 - VR-2ty2-A Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147770 .~_ Veeder-Roo# in-Station Uiagnosties (151]) Vapor i=iaw Meter Operability Test Procedure .. STATlOFi NAME j 5ERYICE C06lPANY NAliAE SERVICE TECHNLCFAN STATIUN ADDRESS t STEP 7. STEP 2. STEP 3. STATE ZIP ~- VAPOR FLOW METER SERfAL F{UNF9ER ~ ~ ~~ , . DISPENSER FUELING PQINF NUMB>:RS Fr" ~_ FP ~ __ ISD DAILY REPORT GROSS All YAt.ULs LOW GRADE FUEL HOSE'V!L RESULT #1 (ONE FP ONLY) STEP 7. VALUE A31NU5 STEP 2. VALUE PASS IF DIFFERENCE IS WITHIN +/~l_15, IF LARGER DIFFERENCE, TFIEN CONTINUE TO STEP 4 (CIRCLE OHE} COMPANY'S TELEfyHpNE VEEDER-RpOT' 7ECF! CERTIFfCAT10N ~F DISTRICT PERMIT # CrfY ~-~'~ f`~I~- v ~ _ .... I ...._ ' . ` I Q OIFF. ' ~. Q~ DIFF. ~ CS. CONTINUE CONTINUE ' PASS TO STI~P 4 f ASS 1 TO STEP 4 r ~ LOW GRADE FUEL HOSE Vli RESULT fiZ ! STEP 4. ~. ~ __ .. ._. _.. _.. LOW C+RADE FUEL 310SE YIL fiESULT #3 AVERAGE OF 3 V/l RESULTS AVG. AVG. STEP 1. VALUE MINUS STEP 4. AVG. DIFF_ DfFF_ STEP 5. PASS IF DIFFERENCE FS WITHIN f1-0.15, IF LANCER DIFFERENCE, THEFT CONTINUE CflNTiNUE TD STEP 6 OR 7 (CIRCLE PASS T fl STEP g PASS OHE) . . STEP b. IF CONTINUE, REPEAT AT STEP 2. FUR 7"0 FP USING 2NO FP COLUMN, ASOVE. Healy i'hase Il EVR System frtciuding Veeder-t2cpt ISU, Exhihil B -- vR Z02-A i ,_. •- CONTINUE Tfl STEP 7 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147770 -7- Veeder-Root in-Station Diagnostics (iSDf Vapor Flaw Meter Operability Test Procedure _ _ DATE OF TEST _ ~ ~{°'a~4 ~ERVICE COMPANY NAME SF.1iViCE COMPANY'S TELEPHONE •_-~- SEJRVICf TECHNICIAN VEEDER-ROOT T1ECH CERTIFICATION # -~I f STA7iON NAME ~ ~~_ ~~~--~ DISTRICT PERlY11T# ~ , ~~ STATION ADDRESS T CITY - STATE ZIP i STEP 2 STEP 3. f STEP 4. ~ STEP 5. VAPOR FLOW METER SERIAL N11M BER ~~ OI$PENSER FUELING POJN7 NUMBERS ~'~7 ~ F P ~ C.~ ISD DAILY REPORT GROSS AIL VALUES I ~~ ~, t'`~ ~ [~ ~ Q S i LOW GRADE FUEL HOSE `VIL RESULT #1 J ~ ~~ ~{ cl (OHIE FP ONLY) STEP 1. VALUP MINUS STEP 2. YAk.UE PASS IF DIFJFERENCE IS WITHIN +)-0.15, IF LARGER OIFFERENCE, THEN CONTINUE TO STEP d {CIRCLE ONEy LO'W GRADE FUEL HOSE V)!. RESULT #2 Low GRADE FUEL JiOSE V)L RESULT#3 AVERAGE OF 3 VIL RESULTS STEP 1. VALUE MINU$ STEP 4. AVG. PASS IF pIFFERENCE IS WITHIN +)-0.15, IE JJ~RGER [11FFERENCE, THEN CONTINUE 70 STEP 6 OR 7 (CIttCLE UNE) DIFF.. ~, t f DIFF. L, C3 ~ ~ AVG. DIFF PASS GONTJNUE CONTINUE i"b STEP d PASS TD STEP 4 I AVG. DIFF. i CONTINUE PASS CONTINUE TO STEP 6 TO STEP 7 - ~ STEP $. IF CONTINUE, REPEAT AT STEP 2. FOR ZMD FP USING 2"° FP COLUMN, ABOVE. Healy Phase JI EVR System Including Veeder-Rapt ISD, Exhibit 9 ~ VR 2U2-A Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 . Work Order: 3147770 -7- veeder-Roa# !n-Sta#ion Diagnostics (15D) Vapor flaw Meter Qperability Test Procedure I SERVpC£ COMPANY NAMI= SERVICE TECHNICIAN STATION NAME STATIOIiI ADDRESS STEP i. STEP 2. STEP 3. STEP 4. STEP 5. _ DATE OF TEST ~ ~'6 SERVICE C0INPANY'S TELEPHOl~IE YEEDER-ROdT TEC31 CERTIFICATION # OISTRIGT PERMIT # ~- - "^ _ ....~ CriY ~ ~ ~ STATE ZIP ~ ~~~-' i -. _. ... .. _ _._J VAPOR FLtiNf METER SERIAL HUMBER I ~3~ H DISP>:NSER FUELING PAINT NUMBERS FP_ t t _ FP..._ r'i-- ___ ISD DAILY REPORT GROSS AIL VALUES ~ ~ ~ C7 t'a i {~ ~ ~ ~' LOW C„RADE FUEL HOSE'V1L RESUL7 #1 {ONE FP ONir) STEP 1. VALUE MINUS STEA 2. VAf.UIE DIFF, c3 . C+ o DlFF. - C~, G:.> ~ ~ -~~- ... PASS iF DIFFERENCE I$ WITFIIN +1-0.75, IF LARGEf2 DIFFERENCE, THEN CONTINUE PASS TO 57EP 4 C4NTINLiE 1 PASS ~ TO STEP 4 CONTINUE TO S7EI' 4 {CIRCLE ONEI - .. .. _. ... I, ... .. -- i LOW GRADE FUEL HOSE VJL RESULT Id2 LDW GRADE FUEL NOSE yll RESULT #3 I AVERAGE OF 3 VIL RESULTS AVG. `AVG. - STEP 7. VALUE MINUS STEP 4. AVG. bIFF. i DiFF_ PASS iF DIFFERENCE IS WITHIN +1~.t5, 1F LARGER OIFi=ERENCE, THEN CONTINUE YA35 CONTINUE Pp`~ CONTINUE YO STEP $ OR 7 (CIRCLE TO S?EP 6 Tp STEP 7 ONE) ~ 5TEIs B. IF CONTINUE, REPEAT AT 57EP 2 FQR 2MD FP USING 2ND fP COLUIiEN, ABOVE. fiealy Phase fl EVR System Including Veeder-Root ISQ, Exhibit 9 - VR•202-A Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147770 8- VeederaZoot frnStation DiagnastiGS {ISD) Vapor Flow lYteter Operability Test Procedure ~-__., ..__. -._........ ,darn= ol= rl:sT ~ 2a6 ~ _ .. _.. ~ REPLACE FLOW MAR t S'fEP 7. NEYY VAPOR FLOW METER SERIAL NUMBER --- --- --._.. _~_ -- ..__ PERFORMED "CLEAR TEST AFTER REPAIR" AT TLS FOR BOTH FP'S7 ~----- . DISPEIVSERFUELING POINT NUM6ERS ~P F~! LOYY GRADE FUEL I•FOSE VJL RESULT #t 1 (ONE FP ONLYI STEP B. LOW GRADE FUEL HQ$E V/L RESULT tt2 _ .. _ ... ...... .I __ .. .. i ~ LOW GRADE FUEL HOSE Y!L RESULT ~3 ` i f ~ AVERAGE OF 3 YfL RBSt1L7S AVG_ AVG. IMPORtANT: WAIT FqR AIEXT ISI} DAILY REPORT GRASS AIL RESULTS FOR NEW METER SAT LEAST ONE DAYj. SERVICE TECHNICIAN DgTE OF TEST DISPENSER FUELING POINT ItUMBER 15D DAILY REPOt3T GRASS A1L VALUE '~ ~ STf P 9. STEM $. VALU E MINUS $TEP 8. AVG. L~IFF, ~ PASS !F D1FfERENCE I$ UYITlIIN +19,15, OTHERWISE FALL (CIRCLE ONE) PASS FAIL - ... - _ _I "h~feasun= V!L using test procedure In Exhibit 5 of YR-202-A. Healy Phase 11 t_VR Sys~m Including Veeder-Root 1SD, Exhibit 9- Vii•2U2-A Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147770 -9- Veeder-Root lnSta#ian Diagnvsticss (!SD) SRte Shutdown Test __ _ __ DATE OF TEST ~'~~_ _ ~"_ __ SERVICE COMPANY NAME _ - SERVICE CDMPANY'S TEIEPF~I NE _ SERVICE TECHNICIAN : YEEDER-7tp0T TECH CERTIFICATFON # I STATIpN NAME DISTRFCT PER1NITit i -- --~---..... .. .-- ---- --'-.I I STATIgN AOflRESS CITY STATE 21P • STEP 1. I P01NER REMQVED FRAM TLS CONSOLE? STEP ? POWER TO SUF3MERSIF3LE PIfMPS REMOVED BY TL57 (VERIFY GASOLINE FUELINfi OISAI3LED1 --•- ~ -- i STEP 3. :POWER RESTORED TO TLS CflNSDLE? ' I CQMFIIENTS ~INCLURE DESCRIPTION OF REF'A1R5lNAOE) .. ..._~ I I 'L .._ I I _J Healy Phase II EVR System Inr,!edinp Veeder-RcyGt ISD, Exhibit ~3 - VR•2(f7-A Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 i.: a~ -o ~. O ~. 0 AFB Approved I dM - HealyNeeder-Root Phase Il EVR SystQm - VR•202-A {5cheduleci Maintenance) Page S HealyNeeder-Root E~ VR-242-A -Weekly Inspection and Testing Checklist Check list results may be used to assis t with filling out GbF maintenance log. Date; ~ ~ o Page ~_ of Dispenser Numher Unihose or Fuel Grade (circle one) Noale Inspection (eircle one) Hose Inspection (circle one] Breakavray Inspection (circle one) VP16UQ VaCUUm Pump Normal Qperation {circle one) t U a 87 89 B1 Olhar _ Pass F '1 pas ~~ it Pass ail Na 2 I ~ 7 89 91 Olhsr _ ass i1 ass ail as Fail es No U " 0 7 89 9t t?lher ~ ass ail ass i! Pasa it es ho Unih 7 89 91 pther Pass ii a ail ass Fail Nu 'j Unih 7 89 91 Other Pass aii Pass it ass ail k No Uni 7 89 91 Other ass afl a s it l~s ail No UAi 87 89 91 Other _ all ass Fall Pas Fai! No Uhihose 7 89 91 Other ass ail 2sa ail Pa all Yes No ~1 nihose 7 89 91 QI17er_ Pass aii Pas'~s ii Pass ail C~ No I ~ Unihos 89 91 Other Pas ail ss Fail ass ail Yes Na t ~ Uni ~ 7 89 91 Other_ Pass aiE Pa ail Pass it i~ No l2 Unlhase 89 91 Other Pass all Pass ' sil ss al! No Unihoaa 87 89 91 Other Pass Fall Pass Fail Pass i:tlul Yes No Unihose 87 89 91 plher Pass Fail Pass Fail Pass Faii Yes No Unihose B7 $9 91 t?lher Pass Fall Pass Fail Pess Fail Yes No Unihose 87 89 91 Qther Pass Fail Pess Fail Pass Fail Yes No ~n X v [-~ .~ Q 0 0 N .~ -C3 .~ ~: U 0 0 rn W Q z oA 0 0 H 3 I I ARB Approved JQhA - HealyNeeder-Root Phase II FVf2 System - VR~202-A (Scheduled Maintenance) P2ye 7 t` v', t` x a~ f~ .~ Q 0 0 N bA Q .b .~ N N U 0 0 0 rn W Q z 0 0 >~ H ~; b ~, 0 ~, a 3 l ' 0 r ~r M i b ~, O .~ 0 3 .> -- 7.7.1 7.7.2 Pump Fuel {~ ~ Grade 7.7.3 Nozzle Mode18. 5erial# 7.7.5-~~ Initial Dispenser Totalizer, Gallons ...1 7.7.7 l Final Total Gas Dispenser pumped, Totalizer, Gattons Gafions -- 7,7.8 Time: Seconds ~- Dispensing : Rate, gpm 7.7.4 7.T.fi Initial Final Meter Meter Raading, Reading, Eta ~ ft3 7.8 VIL ~ 7.9 VJL AVeB9s {if naea5sary) ~- 7,8, 7.9 i or 7.19 Pass or Fail _ ~ ~ 2rG~~i " ' ' ' ~• 1~ ~ r1 ~~ 2 "~ ' 4~ ~,~ ~~-mss ~ y : ~t•~1~~' qp~ 3 _ /1~,~~ ~ L.J~iI:P ~~_ ~~~~f o (, -----Ill- _ ~_ I p .~ S_ ' ~~E~S (JAS -. I lJ Tv L (~( ~=L~ `~----~ ~ - `b~' _ 1fi~~L7 ~v~ - .~..vG`b ~.o'} - - - -r~.Stt - _ Frr<r~ -- _ - r. Healy Phase II ~VR System, Exhibit 5 - VR-24i-A ao .y 0 0 N bA .~ 'C .~ a'~i ins 0 0 0 A O 0 F~ .~, i ar 3 •17- - q.~ ,~ 3 of r r r r~ i~ .b ~. O 0 3 ~.. _„_ taDF Name and Address - ~~ --•- Healy 1111 Field Data Sheet '~~~-~- - Tee Conrteotian Test Result (See Section 6.t)T fty _,•,. .. _ Date of Last Gas Vaiume Meter Cafibratian Correction Factor for Gas Volume Meter Pressure Measurement Device Calibration Date lest DatelTime: Pre•Test Leak Check: InitlaVi:inal Pressures, in. HzO 1,• Post-Test Leak Check: WC # PfO # initiaUFina1 Pressures, in. H O 1 Testing Firm Name and Address_ Phone No. ( ) Test Performed b District Test Witness Applicable ARB EO # VR-2U~A Allowable V!L Range 0.95 - 4.95 ~.r.3 I.~-5 1.7.7 ~ 7.7.4 7.7-8 1.7.9 ~,i'.z 7,7.ES ~.a Nozzle Model 8 Initial Final ~ Total Gas Dispensing Initial Final Pump Fuel Serial # Dispenser Dispenser pumped ~ Time, Rale, Ivteter I Metar V1L i ~ Grade ~ Totalizer. Totalizer, I Seco+tds Gallons gpm ~ Readin8, Read+ng, _ Gallons Gallons ~ ft3 ft3 _ •--~ L ,~,,_ ~~ - ~~_ ....1.~.. .. .rL,~^S3 _, 1. `l r" -1 _~^ 4 -t~~'' I.s 7.s, 7.B or 7,10 V/L Average Pess or (iF necessriry) Faii _,r~l~ ~ $~ t tell ~ 5 t, - ~ ~--- -- a'~' t-+-k>k~Y quo 12,a~~ ~}~`'~5 ~ U.`(2 . _ ... _. ._.. --•- - _ ~ ..... ~ ~ ~ .b J~ Healy Phase ll EVR System, 1=xhibit 5 - VR-201-A ~S ~c, SS ~s5 (L _,. _.. X55 - _--~- x E~ s; .y Q 0 0 N b .~ a~ U 0 0 0 rn Q own 0 0 H 0 r m ;~ a~ -ti ~, O ~. 0 <.~ -17- GbF Name and Address ---"-~ Heaiy VIL Fieid Data Shee# ~" -~' lee Connection Tesf Result {See Section 6.1) ft' Date of Last Gas Volume Meter Calibration Correction Factor 1'or Gas Volume Meter Pressure JVieasurement Device CaJibratian Date Test DatefTJtne: Pre-Test Leak Check: ittJtial~Flnal Pressures, in, Hz0 f _ Post-Test Leak Cheek: A!C # Pio #F JnitiallFinal Pressures, in. H a / -~ Testing Firm Name ancf Address: Phpne No. ( y Test Perfoml8d h QistrtCt Test Witness Applicable ARB EO # VR-2~Oxq Allowable V!L Range 0,95 - 1.15 7,7.1 Pump ` ~ 7.7.2 Fuel 7.7.3 NnvJa Model & S i l # 7.7.5 Initial Dispenser 7.7.7 ~._~.... Final Total Gas - Dis e 7.7.8 Dispensing 7.7.4 7.7.x ~~ Jndlat Final ^ 7.6 7.E 7.8, 7.9 # Grade er a Totalizer, nser p Pumped, Totalizer, Gallons Time, SeCO~tds Fiate. gpm Meter Mater Reading, Readin g ~ !I. VI! Average or 7.10 Pass or ~ f +i~~li ~°~' ~Y~~ Gallons - Gallons .-mss`! ~, - ~ ~ R3 (ifnacessary) Fail ~ ~~. ~,` _ ~ _.._. ~• RCS I ' i~ vl .. ~~~ ~'~~` - -.. -. ~-• fJ~'{G~~ . .•pt,) r r~ cam, f -i f 2 .. .. ~~ Cam' ..._ - .. -_ ..--- ~ --~- ~ -- - I-teealy Phase 11 EVR System, Exhibit 5 - VR-201-A v, x v H >; .~ Q 0 0 N bA A U 0 0 a, Q o~'A 0 H 3 I I ~~ ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:07/26/06 WORK ORDER NUMBER3147770 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32376 COMMENTS Conf.#06-6775, all tests passed. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 08/07/2006 17:37 CLEACH ITE DIAGRAM ~ Tanlv~ology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 07/26/06 WORK ORDER NUMBER3147770 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32376 • ~- AIR/ VENTS OO CAS H2O m~ ~ ~ ° ~ o ~° ~~ OF ~F ICE . O ~ `~ REG PREM 10K 10K ~ ~ O O ~. N ~ I ST ST W S N Printed 08/07/2006 17:37 CLEACH { o Work Order: 3197770 SITF SAFETY CHECKLIST, SERVICE AGREEMENT' 8r aPERA~OR VERIFICATION FORA9 Sue Name: Address: W.d. +x: $iie p' CityrST!Zip: date: scope of wo~r: 1 Parts & Materials Provided- Arrival ?ime ai $rte: Depa•ture Trme from Site,: Total Travel Trme: f t,n ~ 13`1 s ~~~5 .F PRE-TEST' PRDCEDf1RES 1. ,d Discuss safety procedures with site personnel. 2. ,d Prior to fuel deliveries, the complete tank system must be placed hack into working order. 3. ~ All pumps, dispensers, and electrical breakers of the produCt(s} 1a be tested must be disabled during the tesl(sj. d. ~ Secure entire work area with Z8" canes. !lags, and caution cape. 5. ;d Place fire extinguishers and "No Smoking" signs in the work area. 6. ^ Turn off and secure the circuit breaker(sj of the product to 6e tested with tockou! devices and lags, 7. U PIaCe "tJut ai Service' bags On the dispenser nozzles of the products} to be tested. $. ~ Verify proper LockouUTagaut procedure is complete by trying io operate pumps. 9. ~ Close ball valves or Check valves on the product piping to be tested. 1fl. ^ Aemvve the electrical "bayonet- conneetor from the STP(sj. ,~ POST TEST PR4CED~fRES 1. U Fernwe all "LoCkou~Tagout- devioe_s. 2. U Run at! pumps and verify there are no IeakS under dispensers or in STP sumps. Must he witnessed by site representative- G Impact Valve Test Por! ^ Leak Detector Tliruads ^ Furtctional Elen}ent & Relief Screw 3. ^ Install a lead wire seal on all last plugs & leak detectors that were servrced. Count LD thrr;ads: Lt _ L2 _ L3 _ L4 _ L5 ,. 4. ~O Ensure that al! tank system Components are restored to their original state (including}: - ATG probes, sensors, 8 Caps - Ba{I floats, dry breaks 8 caps - Cathodic protection system is operational • Containment sumps are dry - Dispensers & POS system ~ Dispens[tr panels are replaced r Drop lutes, fill adapters & Caps - Leak de1eClors & copper vent tubes Manhole covP.rs and sump Gds ! Monitoring System is operational • Shear valves at the dispensers - Siphon tines and manifold valves - Spill containers & drain valves - STP fittings and bayonet connectors 5. }dr Remove cones, flags. and caution tape. Tanknnlogy ~„ f ~ Pre-Test Signature Signature below eordlrmg chat the Hems listed In the Site esentative Name Pre Tesl Signature --'~. -Test ]S7TE$T,Pror.~edures have been visually Post;Test Signalu by the location representative. i `y- -- rt-_: _---- - Tanknology-NDB 8900 Shoal Creek, Building 200 Austin, Texas 78757 Txnknnlogy-NDE.Inrcmuional Revised lJJlt3li12 .~ • e Work Order: 3147770 1:Vk, i SETUP ISD DHIL:~ REPORT 9e00 HRIMHt,~L BAKERSFIELD.CA 9:331? B0667E75505D01 .TuL 26. 20Dt l t1: l l AM 8VR 73 pE : VACUUI' haS I ST I~l:~ vERBIGra ct.aD REPORT GATE: JUL 25 1SI. vERSION Gl,uu tiV1;RHLL EZHTUS I:'HSS EVR ~~C>'rTHI LAMENT F•na3 E±l.~c COLLECT I UF; PASs aTHGEI 1 ~i 1 FASS SELF TEST pµS3 ISI: !•IuNITOR UF-TII•IE 100% COWTa i Nh1ENT TE$?5 GROSS y5R 0. ] '~~t: pGRI~ 75% - G' , a "WC vHPJR LEAK 2 l`•FH MHX 1.0 "1•..; MIN -~.~ "WC •:vLLECTIGN TESTS GROSS DGRp H~LIa, AiL'a~ FP 1: BL'cND'3 FP 2: HLENIr~S 0.951 25~ 0.95t]OF; FF 3: 9LI;ND3 0.96( 18) J.94( 53) FP 4: i3LEND3 D.Sct 29) 0,5[(141) FP 5: 13LEttG3 1.13i 25) 1.02!.yd) FF d: aLENns 0.991 3~; D.901245; FF- 7: HLF:ND3 1.021 ?3: ~.y9( 94i FF 8: BLENDS i,u3( 41) O.y9t?45) Fp y: HI,En,D3 D, ?4( 30> 0.91:174) FP10: ]3LEWI;; 0.981 35~ 1.03l~9p! FF t t : )]LENDS 1.OD( 171 0.9711041 FP12: B1-ENL3 G.95t 26) L. 3.i, ~04) SELF TEST '1.•R TYPE: ~r,._UUM ASS1::T Vr:'UUM ASS1S7 T',•'PE HEr,~': VAS; IVGZZLE ~• L RANGE MAX: 1..~ MIN: D.65 VHFDR Pk!i~_£3~•iJR TYPE NO VAPOR FR='.'ESSOR H 1~1~:.:'S I S T I MEw T11•,E: 8:59 Ar5 H~CI;P7 r : ~; H ORUR D 1 ~AHLEI. IS1'1 H05E T-iBLE ID FP Fl. HL AA ki< t: 171 0] ~? 171 uU 02 02 :? O1 UU 4~ 03 D3 Gi ^2 UU i.°+ D4 D4 L:: D2 UU U°_ 05 D5 i.• 03 UU ut u6 D6 U~ 03 UU U~ ~]7 07 D~ 0a UU U6 ~]8 U8 ^e Oa UU D5 ]y 09 u~ t]5 UU 10 :.. 10 Dc •]5 UU 11 11 D~ ]o UU 12 ._ 12 D~ ]G UU I SIB r i RF(_OW METER r'InP 1D v£R[AL N - - • ~ UM LrFiEL --- j~ -1 t - L1SP. 1-2 3 cii~.= L1~? 5-6 4 t?'2 I~1~F. 7-e 5 65.19 D15P. 9-1U E E~'-l D15P. 11-1 ISL FUEL GRApE h~3E MAP ' '? 3 ~ FF !'•'^f, hIHH MHht '-'HH AA O1 ~~: 3D1 901 .. U 1 02 ~L: 3D2 902 ;. U 1 U3 'c~7 303 9D3 ~ U 2 04 c~7:1 30~} 9Da ~ U 2 D5 05 3U5 9D5 u U 3 UE .176 3G6 9GE ~ U 3 U! _'07 3U7 yD7 u U 4 DE 3D6 3DB 546 u u 4 D5 _179 3D5 yG5 u U 5 1~e1031091uUU 5 1: 211 311 51] U U 6 .~ 212 312 51_' U U 6 SETUF TEST PASS SENSGR CuT TEST PASS LHBEL TA}3L£ 1: UNASSI•;'iEL 2: 13L&ND~ 3: REGULAk a: MID GRHL•£ 5: FRBMIUM 5: ~70LU ?; BkGNZE 5: SILVER •3: HLENU=' Tanknology-LADE 8900 Shoal Creek, Building 200 Austin, Texas 78757 '"~- 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 07/13/2006 Order Number: 3147501 Dear Regulator, Date Printed and Mailed: 07/26/2006 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32376 9600 BRIMHALL RD. MARKET #2237 BAKERSFIELD, CA. 93312 Testing performed: Leak detector tests Line tests Monitor Certification Secondary Containment-Spill Container Sincerely, ...~ Oarr'-~ f~b~nX~y~,. Dawn Kohlmeyer Manager, Field Reporting t ~n~Q70~0 TANKNOLOGY CERTIFICATE OF TESTING 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 TELEPHONE (512) 451-6334 FAX (512) 459-1459 PURPOSE: COMPLIANCE TEST RESULT SUMMARY REPORT TEST DATE: 07/13/06 WORK ORDER NUMBER: 3147501 CUSTOMER PO: CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32376 P.O. BOX 711 9600 BRIMHALL RD. DALLAS, TX 75221 MARKET #2237 BAKERSFIELD, CA 93312 • MANAGER (214)841-6714 (661)588-4059 TEST TYPE: TLD-1 Drn~l~~r+ Dino Tinti+nncc Tec4 Cec~~14c LINE -LINE LINE DELIVERY IMPACT ID PRODUCT MATERIAL TYPE TEST RESULT FINAL LEAK RATE (yph) VALVE A B C D A B C D FUNCTION lOk 2 REGULAR ENVIROFLEX PRESSURE P P 0.000 0.000 Y lOk 3 PREMIUM ENVIROFLEX PRESSURE P P 0.000 0.000 Y Fxic*inn 1 ino 1 oalr flo4nr4nr Tnc+ EXi - STING LEAK DET ECTOR #1' -- ---- --- EXIST ING LEAK DETE CTOR'#2 LINE ID MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER :...MODEL # SERIAL # RESULT lOk 2 FE PETRO MLD CAN'T READ P lOk 3 VAPORLESS LD2000 CAN'T READ P Now Rnnl~rmm~n4 1 inn 1 saL Ile.~..wL..v Ti.c4 REP LACED LEAK DET EGTOR #1 REPL "CED LEA DET C OR #2 LIRE MANUFACTURER _ ~L # SERIAL # RESULT MANUFACTURER MODEL RIAL # RESUL .,~ ., W ~,.,~ .,,,,a..,.,, ~~N,,, < <,,.,,,~~~a,~~~,, V IJR W W W.LdnKI1VIVb'y.GUIII GIIU SCICGL IJII-UI1C ICCpUl'[S- W 1CE\Y, or contact your local IanKnology ottlce. Tester Name: WILLIAM ROGERS ~~s~~ Technician Certification Number:1647 Printed 07/26/2006 07:23 SBOWERS INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tanlv~o/ogy TEST DATE:07/13/06 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3147501 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #32376 TANK INFORMATION Tank ID: lOk 2 Tank manifolded: No Bottom to top fill in inches: 144.0 Product: REGULAR Vent manifolded: No Bottom to grade in inches: 147. o Capacity in gallons: l0, 02s Vapor recovery manifolded: YES Fill pipe length in inches: 48. o Diameter in inches: 96. oo Overfill protection: YES Fill pipe diameter in inches: 4 • o Length in inches: 324 Overspill protection: YES Stage I vapor recovery: DUAL Material: TOTAL corm Installed: ATC Stage II vapor recovery: ASSIST CP installed on: / / COMMENTS TANKTEST RESULTS Test Method:VacuTect LEAK DETECTOR-TEST RESULTS Test method: FTA Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: FE PETRO Ingress Detected: water Bubble Ullage MOdel: MLD Test time: S/N' ~x~T ~ Open time in sec: s.oo Inclinometer reading: Holding psi: 29 VacuTect Test Type: NoT Resiliency cc: 3eo NOT T VacuTect Probe Entry Point: ESTED Test leak rate ml/m: 1s9. o TESTED Pressure Set Point: Metering psi: 23 Tank water level in inches: Calib. leak in gph: 3.00 Water table depth in inches: Results: Pass Determined by (method}: Result: COMMENTS COMMENTS LINE TESTRESULTS Test type: Ti,n-i ~ LINE _ h E? C _ D Material: ENVIROFLEX Diameter (in): 1.5 Length (ft}: 260.0 Test psi: 50 50 Bleedback cc: 0 0 Test time (rnin): 60 6o NoT NoT Start time: 08:26 08:26 TESTED TESTED End time: 09:26 09:26 Final gph: 0.000 0.000 ReSUIt: PASS PASS PUmp type: PRESSURE PUmp make: FE PETRO COMMENTS Impact Valves Operational: YES Printed 07/26/2006 07:23 INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Taniatology TEST DATE:07/13/06 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3147501 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #32376 TANK"INFQRMATION Tank ID: iok 3 Tank manifolded: No Bottom to top fill in inches: 146. o Product: PREMIUM Vent manifolded: No Bottom to grade in inches: 150. o Capacity in gallons: 9, 975 Vapor recovery manifolded: YES Fill pipe length in inches: 50. o Diameter in inches: 96 . oo Overfill protection: YES Fill pipe diameter in inches: 4 - o Length in inches: 324 Overspi{I protection: YES Stage I vapor recovery: DUAL Material: TOTAL coNT Installed: ATC Stage II vapor recovery: ASSIST CP installed on: / / COMMENTS TANK TEST- RESULTS'Test Method:VacuTect LEAK.DETECTOR TEST RESULTS Test method: FTA `' Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: VAPORLESs Ingress Detected: Water Bubble Ullage Model: Lnzooo Test time: S~N• cu: z xsan Open time in sec: 6.00 Inclinometer reading: Holding psi: 30 VacuTect Test Type: NoT Resiliency cc: 400 NoT VacuTect Probe Entry Paint: T ESTED Test leak rate ml/m: is 9 . o TESTED Pressure Set Point: Metering psi: 23 Tank water level in inches: Calib. leak in gph: s . 00 Water table depth in inches: Results: PASs Determined by (method}: Result: COMMENTS COMMENTS LINE TEST RES ULTS Test type: zLn= LINE A B C D Material: ENVIROFLEX Diameter (in): 1.5 Length (ft): 2 s o . o Test psi: 50 50 Bleedback cc: 0 0 Test time (min): 60 60 NOT NOT Start time: 08:26 08:26 TESTED TESTED End time: 09:26 09:26 Final gph: 0.000 0.000 R2SUIt: PASS PASS Pump type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: YE5 Printed 07/26/2006 07:23 MONITORING SYSTEM CERTIFICATION For tJse By All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3 Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or reoort must be Dreoared for each monitoring svstem control oanel 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: 7-ELEVEN #32376 Site Address: 9600 BRIMHALL RD. MARKET #2237 Facility Contact Person: MANAGER Make/Model of Monitoring System:TLS350 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced Date of Testing/Service: 07/13/2006 Work Order Number: 3147501 TanklD: 87 TanklD: 91 X In-Tank Gauging Probe. Model: MAG 2 X In-Tank Gauging Probe. Model: MAG 2 X Annular Space or Vault Sensor. Model: 420 a Annular Space or Vault Sensor. Model: 420 X Piping Sump/Trench Sensor(s). Model: 352 Piping SumplTrench Sensor(s). .Model: 352 Fill Sump Sensor(s). Model: ^ Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: MLD X Mechanical Line Leak Detector. Model: LD2000 Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill/High-Level Sensor. Model: ATG X Tank Ove~ll/High-Level Sensor. Model: ATG Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). TanklD: TanklD: Ih-Tank Gauging Probe. Model: In-Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: Piping SumplTrench Sensor(s). Model: Piping SumplTrench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Mode{: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill/High-Level Sensor. Model: Tank Overfill/High-Level Sensor. Model: Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). ispenser 1/2 Dispenser ID: 3/4 Dispenser Containment Sensor(s) Model: 322 ~( Dispenser Containment Sensor(s) Model: 322 X^ Shear Valve(s). X Shear Valve(s) Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: 5/6 Dispenser ID: 7/8 X^ Dispenser Containment Sensor(s) Model: 322 Dispenser Containment Sensor(s). Model: 322 X^ Shear Valve(s). ®Shear Valve(s). Dispenser Containment Float(s) and Chain(s). ~ Dispenser Containment Float(s) and Chain(s). Dispenser 1D: 9110 Dispenser ID: 11/12 Dispenser Containment Sensor(s) Model: 322 ~ Dispenser Containment Sensor(s). Model: 322 Shear Valve(s). X Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). * If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this certification is information (e.g manufacturers' checklists) necessary to verify that this information is correct. and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): ~ System set-up X^ Alarm history report Technician Name (print): WILLIAM ROGERS Certification No.: 8520 Signature: _ License. No.: Testing Company Name: Tanknology Phone No.: (800) 800-4633 Site Address: 8501 N. MoPac Expressway, suite 400, Austin, TX 78759 Date of Testing/Servicing: 07/13/2006 City: BAKERSFIELD CA Zip: 93312 Contact Phone No: 588-4059 ~,r~~~ Page 1 of 3 Based on CA form dated 03/01 Monitoring System Certification Monitoring System Certification Site Address: g600 BRIMHALL RD. Date of Testing/Service: 07/13/2006 MARKET #2237 D. Results of Testing/Servicing Software Version Installed: 326.00 Complete the following checklist: 0 Yes ^ No * Is the audible alarm operational? Q Yes ~ No * Is the visual alarm operational? Q Yes ~ No " Were all sensors visually inspected, functionally tested, and confirmed operational? Yes ^ No " Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes ~ No * X NtA If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? Q Yes ~ No " ~ NIA For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (check all that apply) ~ Sump/Trench Sensors; ^x Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ^x Yes ^ No ^X Yes ~ No * ~ N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e.: no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? so Yes` ^X 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 replacement parts in Section E, below. Yes" xQ No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) ^ Product; ^ Water. If yes, describe causes in Section E, below. ~X Yes ~ No " Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. QX Yes ~ No ` Is all monitoring equipment operational per manufacturers' specifications? * In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: Page 2 of 3 Based on CA form dated 03/01 Monitoring System Certification Site Address: g600 BRIMHALL RD. Date of Testing/Service: 07/13/2006 MARKET #2237 F. In-Tank Gauging /SIR Equipment ^ Check this box if tank gauging is used only for inventory control. ^ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: ^ Yes ^ No * Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Q Yes ^ No * Were all tank gauging probes visually inspected for damage and residue buildup? 0 Yes ^No" Was accuracy of system product level readings tested? ^Yes ^No * Was accuracy of system water level readings tested? x^ ves ^ No " Were all probes reinstalled properly? ^x Yes ^ No * Were all items on the equipment manufacturers' maintenance checklist completed? " In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD) : ^ Check this box if LLDs are not installed. Complete the following checklist: a Yes ^ No * ^N(A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: x^ 3 g.p.h ^ 0.1 g.p.h ^0.2 g.p.h ^X Yes ^ No * Were all LLDs confirmed operational and accurate within regulatory requirements? ^x Yes ^ No * Was the testing apparatus properly calibrated? Yes ^ No * ^ NIA For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^Yes ^No " ~ NIA For electronic LLDs, does the turbine automatically shut off if the .LLD detects a leak? ^Yes ^No * Q N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ^ Yes ^No * Q N(A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ^Yes ^No * Q NrA For electronic LLDs, have all accessible wiring connections been visually inspected? Yes ^NO " Were all items on the equipment manufacturers' maintenance checklist completed? In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 Based on CA form dated 03/01 SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS i.~ ~~ ~ TEST DATE:07/13/2006 CLIENT: 7-ELEVEN, INC. P.O. BOX 711 DALLAS TX 75221 214-841-6714 Tank Interstital Tests WORK ORDER NO.: 3147501 SITE: 7-ELEVEN #32376 9600 BRIMHALL RD. MARRET #2237 BARERSFIELD CA 93312 Piping Interstital Tests ~ TANK LIN~ PRODUCT MANUFACTURER RESULTS PRODUCT PANUFACTURER RESULTS REGULAR PREMIUM Sump &Under-Dispenser Containment Tests Sump/ DfSP:# MANUFACTURER P/F 2 87 FILL OPW Pass 2 87 FILL OPW Pass 3 91 FILL OPW Pass 3 91 FILL OPW Pass Tanknology representative: BRIAN DERGE Services conducted by: WILLIAM ROGERS v ~~j~~ UMP TESTS SECONDARY CONTAINMENT TEST RESULTS Test Date: Work Order: 0 7 /1 3120 0 6 3147501 Type Tank or Disp # Manufacturer Model or Material Diam./Width/Length (") Depth (") Test Method Start Time Initial Level Level Change Finish Time Final Result Pass/ Fail Spill Container 2 37 FILL OPW Plastic 11 12 VPLT 7:20 7 .00005 7:35 7 Pass Spill Container 2 87 FILL OPW Plastic 11 12 VPLT 7:37 7 .00001 7:52 7 Pass Spill Container 3 91 FILL OPW Plastic 11 12 VPLT 7:21 7 .00007 7:36 7 Pass Spill Container 391 FILL OPW Plastic 11 12 VPLT 7:38 7 .00002 7:53 7 Pass Comments: ~ 7anla~ology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:07/13/06 WORK ORDER NUMBER3147501 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32376 COMMENTS Lines, lds, monitor, spill buckets, and eso passed. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK'TEST RESULTS' Printed 07/26/2006 07:23 SBOWERS ITE DIAGRAM ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 07/13/06 WORK ORDER NUMBER3147501 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32376 ~ ~. AIR/ VENTS ~ CAS H2O ~'J m~ ~v ~F ~F ICE O ~ e REG PREM 10K 10K ~~ ~ ~ o o W V .. N ~ ST ST w rn W S N Printed 07/26/2006 07:23 SBOWERS ..- Work Order: 3147501 _ .. ' .. - __ -- ~ _ ~ ~~ ., y~:: ~k ~ > Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 Work Order: 3147 5 01 Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 ~ _ G Work Order: 3147501 Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 UNDERGROUND STORAGE TANKS ' >~ sxsPi~~.n FiR/ Alf TAi T APPLICATION '.-z'`~ TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. ' I L --- J~ 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 ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ~, TO PERFORM FUEL MONITORING CERTIFICATION SITE INFORM .,~ _ ,.. , , _, FACILITY 7_Eleven #32376 NAME & PWONE NUMBER OF CONTACT PERSON Manager - (661) 588-4059 ADDRESS 9600 Brimhall Rd., Bakersfield, Ca 93312 OWNERS NAME OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? YES ^ NO TANK# VOLUME CONTENTS TANK'TESTING COMPANY -- - NAME OF TESTING COMPANY Tanknolo Inc. NAME & PHONE NUMBER OF Anthony Cheeks (951) 676-4060 9Y~ CONTACT PERSON MAILING ADDRESS 41785 Enterprise Circle S. Suite D Temecula, CA 92590 NAME & PHONE NUMBER OF WIII Rogers (909) 772-9853 TESTER OR SPECIAL INSPECTOR: CERTIFICATION #: DATE & TIME TEST TO BE 7/13/06 -TAM CONDUCTED: I~~ #~ 5251926 - UT TEST METHOD SIGNATURE OF APPLICANT - ~~ DATE: ~ /~/D~ APPROVED BY DATE ~~ FD 2095 (Rev. 09/05) l~~ ~~ ~~ UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 = L FACILITY /SITE INFORMATION BUSINESSNAME(SameasFACILITVNAMEorDBA-DoingBUSinessAS) 3 ,FACILITYID# 7-Eleven #32376 1 NEAREST CROSS STREET aos FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 9600 Brimhall Rd. ®1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aoa ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* 402 TOTAL NUMBER OF TANKS IS facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 2 aoa ^ Yes ®No aos aos • ` IL PROPERTY OWNER1NFORMATION PROPERTY OWNER NAME aos PHONE aoa American West Lands Co. MAILING OR STREET ADDRESS aos P.O. Box 524 CITY ago STATE a>> ZIP CODE aiz Bakersfield CA 93302 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL at3 ;. fll. TANK OWNER iNFORMATION _.. TANK OWNER NAME aia PHONE ass 7-Eleven Inc. 253-796-7170 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY air STATE atB ZIP CODE ass Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER: TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise azi a ° °V. PETROLEUM USTfINANCIAL RESPONSIBILITY INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz _, VI. LEGAL NOTIFICATION AND MAILING ADDRESS ", ,+ , ` .. Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings w'll be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER 423 . ~ ~~ ~ VII. APPLICANT SIGNATURE Certification - certif ,that the i ormati rovided herein is true and accurate to the best of my knowledge. SIGNAT E DATE aza PHONE azs 7/28/06 253-796-7170 NAME APPLICANT (print) azs TITLE OF APPLICANT a2~ Randy Martin Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (Foriocal use only) 4ze 1998 UPGRADE CERTIFICATE NUMBER (For local use only) azs UPCF (1/99 revised) Formerly SWRCB Form A - _ UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page _ of L IDEN TIFICATI ON FACILITY ID# _ _- 1 - - - BEGINNING DATE 100 ENDING DATE t01 F A O O ~ , L~ 8/1 /2006 12/31 /2007 BUSINESS NAME (Same as FACILITY NAnnE or DBA -Doing Business As) 3 BUSINESS PHONE toe 7-Eleven 32376 661-588-4059 BUSINESS SITE ADDRESS to3 9600 Brimhall Rd. CITY taa ZIP CODE tos CA Bakersfield 93312 DUN & BRADSTREET 106 SIC CODE (4 digit #) to7 00-734-7602 5541 COUNTY toa Kern BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 Shashi Kank Kamboj and Veena Kamboj 661-588-4059 IL BUSINESS OWNER -- OWNER NAME 111 OWNER PHONE ttz 7-Eleven, Inc. 253-796-7170 OWNER MAILING ADDRESS 113 P.O. Box 711 Attn: Gasoline Acctg CITY 114 STATE 115 ZIP CODE t1s Dallas TX 75221-0711 NL `ENVIRONMENTAL CONTACT. CONTACT NAME 117 CONTACT PHONE 110 Randy Martin 253-796-7170 CONTACT MAILING ADDRESS Its P.O. Box 711 Attn: Gasoline Acctg CITY tzo STATE tzt ZIP CODE 1zz Dallas TX 75221-0711 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- --.. - - - --- NAME --- 123 NAME 128 Shasi Kamboj 7-Eleven Emergency Dispatch I TITLE 124 TITLE tzs Franchisee Emergency Service BUSINESS PHONE 125 BUSINESS PHONE t3o 1800-828-0711 800-828-0711 24-HOUR PHONE 126 24-HOUR PHONE 131 1-800-828-0711 800-828-0711 PAGER # 127 PAGER # 132 ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify 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. SIGN RE OF OWNER/OPERATOR R D SIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER t35 7 a~ ~~ Rachel Rodriguez NAME OF SIGNER print) 136 TITLE OF SIGNER 137 Randy Martin Gasoline & Environmental Compliance Manager UPCF (1/99 revised) HMP 2 (Back) Instructions OES FORM 2730 (1 /99) EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify LOCAL AGENCY within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name: 7- Eleven Store #32376 Facility Address 9600 Brimhall Rd. Bakersfield If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion hazard, are not cleaned up from the secondary containment within 8 hours, or deteriorate the secondary containment, then LOCAL AGENCY must be notified within 24 hours. In case of a gasoline spill- Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. Employees will be notified to evacuate if deemed necessary. A contractor will be contacted to remove the spill as necessary. In case of a small carbon dioxide release- the tank will be visually inspected for obvious signs of the release point. If possible the control valve will be shut off. In the case of a large release of carbon dioxide, employees will be notified to evacuate and Contact 911 and 7-Eleven Dispatch. In case of fire- the alarm will be sounded by shouting "Fire" and the building will be evacuated. Employees will contact 911 and assemble at the designated assembly area as depicted on the site map. If safe, employees will shut off power and control fire using fire extinguishers. 2. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substances. Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. A contractor will be contacted to remove the spill as necessary. Describe the location and availability of the required cleanup equipment in item 2 above. Absorbent is located inside the store in the backroom. 4. Describe the maintenance schedule for the cleanup equipment. Inventory of absorbent is periodically checked. 5. List the name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan. Randy Martin, Gasoline & Environmental Compliance Manager 253-796-7170 Date 7/2R/~fi r _ _ __ _ __._ __._.._ _ `i w r , Gam= ~- ~_ UNDERGROUND STORAGE TANK MONITORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited.• Title 23 CCR, Sections 2632(d)(1), 2634(d)(2), and 2641 (h) . TYPE OF ACTION ^ 1. NEW PLAN ®2. CHANGE OF INFORMATION Mot. PLAN TYPE ®MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. Moz. (Check one item only) ^ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): L FACILITY INFORMATION FACILITY ID # (Agency Use Only) _ FACILITY NAME 7-Eleven #32376 Mo3. FACILITY S[TE ADDRESS 9600 Brinhall Rd M04' CITY Bakersfield Mos. IL EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in M06. accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED ® 1. ANNUALLY ^ 99. OTHER (Specify): Mop. III. MONITORING LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., location of each sensor, line leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring System Certification form, Hazardous Materials Business Plan ma ,etc.) which shows all re uired information, include it with this lan. __ IV. TA K MONITORING - MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) Mto. ® 1. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM MI1. PANEL MANUFACTURER: VeederROOt Mlz. MODEL #: TL$35O M13. LEAK SENSOR MANUFACTURER: VeederROOt M'a MODEL #(S): 847390-420 MIS. ^ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(Sl PANEL MANUFACTURER: MI6. MODEL #: Mtg. IN-TANK PROBE MANUFACTURER: M18. MODEL #(S): Mtg. LEAK TEST FREQUENCY: ^ a. CONTINUOUS ^ b. DAILY/NIGHTLY ^ c. WEEKLY Mzo. M2I ^ d. MONTHLY ^ e. OTHER (Specify): . PROGRAMMED TESTS: ^ a. 0.1 h. ^ b. 0.2 h. ^ c. OTHER S ecif M22 g•P• g•P (P Y)~ . M23. ^ 3. INVENTORY RECONCILIATION ^ a. MANUAL PER 23 CCR §2646 ^ b. STATISTICAL PER 23 CCR §2646.1 Mza. ^ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645 TESTING PERIOD: ^ a. 36 HOURS ^ b. 60 HOURS Mzs. ^ 5. INTEGRITY TESTING PER 23 CCR §2643.1 TEST FREQUENCY: ^ a. ANNUALLY ^ b. BIENNIALLY ^ c. OTHER (Specify): Mz6. Mza. ^ 6.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approval) ^ 99.OTHER (Specify): Mza. V. PIPE MONITORING MONITORING [S PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mao. ® 1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM M31. PANEL MANUFACTURER: VeederROOt M3z. MODEL #: TLS350 M33. LEAK SENSOR MANUFACTURER: VeederROOt M3a. MODEL #(S): 7943RD-352 M36. WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? ®a. YES ^ b. NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M37. ® 2. MECHANICAL LINE LEAK DETECTOR (MELD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED MELD MANUFACTURER(S): VagOrIeSS M3a. MODEL #(S): LD2000 M39. i ^ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS ELLD MANUFACTURER: M40 MODEL #: Mat. PROGRAMMED LINE INTEGRITY TESTS: ^ a. MINIMUM MONTHLY 0.2 g.p.h. ^ b. MINIMUM ANNUAL 0.1 g.p.h. Maz. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Mai. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Maa. ® 4. INTEGRITY TESTING mnnm ror.~r ~rwrw. ~ _ r'l L r-i _ M4 6. M46. ~ iv a ~ .u:~vi.~v~, i . ~ a. e~ivi~ vr+LL r U u. is v it\ r ~ r nni`o <J v. v i nnic ~opcc~iYl ^ S.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY* ^ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED"" Mai. " Requires agency approval "" Allowed for monitoring of unburied emergency generator fuel piping only per HSC §25281.5(6)(3) ^ 6. PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) ^ 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) 99. OTHER UN-022A - 1/3 M4S. www.unidocs.org Rev. 10/14/03 ~~ 11 ~' i/~ Underground Storage Tank Monitoring Plan -Page 2 of 2 VL DISPENSER MONITORING MONITORING OF AREAS BENEATH DISPENSER(S) IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mso. ® 1. CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT (UDC) PANEL MANUFACTURER: V@@d@CROOt Msr. MODEL #: TLS35O Msz. LEAK SENSOR MANUFACTURER: V@t?d@rROOt Ms3. MODEL #(S): 79438U-352 Msa. WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? ®a. YES ^ b. NO MsS. WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO Ms6. WILL FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO Msg. ^ 2. MECHANICAL ASSEMBLY (e.g., FLOAT AND CHAIN ASSEMBLY) IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK ASSEMBLY MANUFACTURER: Mss. MODEL#(S): Msg. ^ 3.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approval) M60. ^ 4. NO DISPENSERS ^ 99. OTHER (Specify) M61. VII. -ENHANCED LEAK DETECTION.. ^ 1. WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK M7o. DETECTION (ELD) FOR THE UST(S) COVERED BY THIS PLAN. PER 23 CCR §2644.1, ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED VIII. TRAINING REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) Mso. 1. ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 2. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 3. ® THE FACILITY'S BEST MANAGEMENT PRACTICES (Required as of January 1, 2005) 4. ^ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. ^ CALIFORNIA UNDERGROUND STORAGE TANK LAW 6. ^ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS -MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 7. ^ SWRCB PUBLICATION: "WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" 99. ^ OTHER (Specify): Msg. Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and can access those documents when needed. By January 1, 2005, this facility will have a "Designated UST Operator" who has passed the California UST Sytem Operator Exam administered by the International Code Council (ICC). By July I, 2005, and annually thereafter, the "Designated UST Operator" will train facility employees in the proper operation and maintenance of the UST systems. This training will include, but is not limited to, the following: - Operation of the UST systems in a manner consistent with the facility's best management practices. - The facility employee's role with regard to the leak detection equipment. - The facility employee's role with regard to spills and overfills. - Whom to contact for emergencies and leak detection alarms. For facility employees hired on or after July 1, 2005, the initial [raining will be conducted within 30 days of the date of hire. IX. COMMENTS/ADDITIONAL INFORMATION Please use this section to include any additional UST system monitoring-related information (e.g., additional information required by your local agency): Mss. Note regarding Section X. Pending certification of a Designated UST Operator, the following person has authority for performing the monitoring activities and maintaining leak detection equipment covered by this plan. NAME: JOB TITLE: X. PERSONNEL RESPONSIBILITIES AS OF JANUARY 1, 2005, THE "DESIGNATED UST OPERATOR" IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT APPLICATION - FAC[LITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION EQUIPMENT COVERED BY THIS PLAN, AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS OF THE FACILITY'S US SYS/TEMS IN t~CCORDANCE WITH 23 CCR § 2715 XL OWNER/OPERATOR SIGNATURE CERTIFICAT N: I certify at the ' formation provided herein is true and accurate to the best of my knowledge. OWNER/OP TOR SIGN REPRESENTING DATE: M9~ ® Owner M90. ® Operator Jul 28, 2006 OWNER/ PERATOR NAME (print): M9z. OWNER/OPERATOR TITLE: M93. Randy Martin Gasoline & Environmental Compliance Mgr (Agency Use Only) This plan has been reviewed and: ^ Approved ^ Approved With Conditions ^ Disapproved Local Agency Signature: Date: Comments/Special Conditions: UN-022A - 2/3 www.unidocs.org Rev. 10/14/03 N ~ /~3 WRITTEN MONITORING PROCEDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify local agency within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name: 7-Eleven Store #32376 Facility Address: 600 Brimhall Rd, Bakersfield, CA Date: July 28, 2006 A. Describe the frequency of performing the monitoring: Tank The site consists of two double walled jacketed steel tanks (1-Regular 10k gallon, and 1-Premium 10K gallon) and are monitored continuously with a VeederRoot TLS350. Piping Product lines are double wall Enviroflex and are monitored continuously with a VeederRoot TLS350. The turbine sump sensor activated audio/visual alarms and provides positive shutdown of the turbines. B. What methods and equipment, identified by name and model, will be used for performing the monitoring: Tank The method of leak detection for the tanks is Interstitial Monitorina of the double wall tanks using the Veeder-Root TLS350 Tank Gauge programmed for a threshold of .2gph. VeederRoot model #847390-420 probes are used for the monitoring. High level alarms activate audio/visual and external alarms. Piping The piping is monitored continuously by VeederRoot liquid sensors model #794380-352 located in the turbine sump of each tank. The turbine sump sensors provide positive shutoff and activate audio/visual alarms. Vaporless LD2000 line leak detectors are located on the turbine and programmed for a leak threshold of 3gph. The piping is precision tested annually At a threshold of .1gph. Dispensers are equipped with under-dispenser containment with VeederRoot liquid sensors model #794380-352 that provide positive shut down of the turbines. C. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: The individual responsible for the monitoring equipment is the store operator. The operator will contact 7-Eleven Dispatch 1 800-828-0711 for any alarm conditions on the VeederRoot. The local maintenance contractor will be dispatched. 7-Eleven, Inc. is responsible for maintaining the equipment. The Environmental Manager is Randy Martin D. Reporting format for monitoring: Tank Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Monitoring records will be kept at the location and at a central office location. Piping Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Third party annual test results will be submitted to the agency. ,~ " ,- Written Monitor Procedures 7-Eleven #32376 Page 2, July 2006 E. Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturer's maintenance schedule but not less than every 12 months. Tanks and product lines are continuously monitored and alarmed. Alarm histories are printed each month and investigated for corrective actions by the Designated Operator. Equipment repairs; replacement are performed as needed. F. Describe the training necessary for the operation of UST system, including piping, and the monitoring equipment: Employees are trained on the Operation of the UST in a manner consistent with Best Management Practices, Emergenc~r contact information, Spill/Overfill response procedures, Hazardous Waste Procedures, and monitoring equipment operation and alarm response procedures. Training is conducted annually, or~within 30 days for new employees, by the Designated Operator.