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HomeMy WebLinkAboutBUSINESS PLAN--_- J~ ~ ~l ~~ - -- -- - - -- 7 Eleven 26599. _ _ ~-- ~- r,-, ~ 6529 E Brundage Ln Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: 7-ELEVEN #26599 Facility ID #: 235304 Facility Address: 6529 EAST BRUNDAGE LN. BAKERSFIELD, CA 93307 Reason for Submitting this Form (Check One) ©Change of Designated Operator Facility Phone #: 661-366-4788 ^ Update ICC # and/or Expiration Date Designated UST Ouerator(sZfor this Facility Prima O liana!) 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 (Optional) Designated Operator's Name: Tony Mansour Relation to UST Facility (Check One) $usiness Name (If di„~`erent from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 O Service Technician D Third-Parry International Code Council Certification #: 5269136-UC Expiration Date: 11/17/200? ALTERNATE 2 (Optional) Designated Operator's Name: Sarkis Zoumalan Relation to UST Facility (Check One) Business Name (If d~erent from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician ® Third-Party Intemational 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 23, section 2715(c) - (f). Furthermore, I understand and am in compli ce vf~ith th~ifec~irements (statutes, regulations, and local ordinances) applicab t9~derg un storage tanks. NAME OF TANK OWNER (Please Print): 7- ~ ~DY MARTIN SIGNATURE OF TANK OWNER: DATE: 2/15/2007 OwNER's PHONE #: (253) 796-7170 November 2004 ?-~ Owr, r Statements of Designated Underground Storage Tank (UST) Operator 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 ^O Third-Party International Code Council Certification #: 5250470-UC Expiration Date: 12-21-2008 Ai,TF.RNATF, 4 t()ntinnall 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 ^D 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 D 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 O 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-11-2008 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 ^D Third-Party International Code Council Certification #: 5250118-UC Expitation 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 . .~~ 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. Sincerel ~C~~„ Sherry Peczka Designated Operator Program Manager Gilbarco/Veeder-Root Enclosures ,~ r _ ~' ~- `' ~ / 11 r; t 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: 02/19/2007 Order Number: 3151150 Dear Regulator, Date Printed and Mailed: 03/08/2007 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #26599 MARKET 2133 6529 EAST BRUNDAGE LANE BAKERSFIELD, CA. 93307 Testing performed: Line Interstitial Secondary Containment Line Interstitial Sincerely, Dawn Kohlmeyer Manager, Field Reporting SWRCl~, January 2002 Page 1. J 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 (rf applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN #26599 Date of Testing: 02/19/2007 Facility Address: MARKET 2133 6529 EAST BRUNDAGE LANE, BAKERSFIELD, CA, 93307 Facility Contact: Manager Phone: (6 61) 3 6 6- 4 7 8 8 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 / / / / / / / / 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repair Secondary Pipe 1 REG SIPHON ~ ^ ^ ^ ^ ^ ^ ^ 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 2/ 19 / 2 0 0 7 ;.SWRC1~, January 2002 5. SECONDARY PIPE TESTING Page 2 - Test Method Developed By: ~ Tank Manufacturer ^X Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: X^ pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: ~ - 1 REG Piping Run # _ Piping Run # __._ Piping Run # __ Piping Run # Piping Material: _,~_~ __.~__~s DWFRP Piping Manufacturer: SMITH Piping Diameter: 3 Length of Piping Run: 10 Product Stored: REG UNLEAD Method and location of piping-run isolation: REG UNLEAD Wait time between applying pressure/vacuum/water and starting test: 15 MINS Test Start Time: 11:55 Initial Reading (Rt ): 5 Test End Time: 12:55 Final Reading (RF ): 5 Test Duration: 1 HOUR Change in Reading (Rg - RI ): 0 Pass/Fail Threshold or Criteria: 0 Test Result:.......... ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail COmmentS - (include information on repairs made prior to testing, and recommended follow-up for failed tests) - Tanknology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:02/19/07 WORK ORDER NUMBER3151150 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #26599 COMMENTS Triennial SB-989 Retest - 87 Siphon Line Secondary Only. Passed. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 03/08/2007 08:18 ACRAMER - SITE DIAGRAM ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 02/19/07 WORK ORDER NUMBER3151150 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #26599 ~~ L8 4 L2 L4 3 STP ~ OV O I REG L7 L5 P/S ~ O O I REG/ • SLV L3 L6 ~ v . 2 STP ~ O O I PREM ~ 1 ~ L1 N E AIR/ Q~Q VENTS H2O 58 Printed 03/08/2007 08:18 ACRAMER