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HomeMy WebLinkAboutBUSINESS PLAN i~~~ '~"~.~~ ~ ji t. BROTHER'S MINI-MART ~~ ~~ - ~',- ~~6_~~L-801 E.-CAL-IFORNIA A-VENUE L r, -_ _ - - - - --- - - __ .. - ~/' - ~. .~ i P:..~ ~~ SAMS LIQUOR & GAS Manager SAMRITH VONG Location: 801 E CALIFORNIA AVE City BAKERSFIELD CommCode: BFD STA 02 EPA Numb: SiteID: 015-021-002468 BusPhone: (661} 861-1614 Map 103 CommHaz Moderate Grid: 32A FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title SAMRITH VONG / OWNER / Business Phone: (661) 861-1614x Business Phone: ( ) - x 24-Hour Phone (562) 965-0724x 24-Hour Phone ( ) - x Pager Phone (661) 872-9986x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact SAMRITH VONG Phone: (661) 872-9986x MailAddr: 2806 WENATCHEE AVE State: CA City BAKERSFIELD Zip 93313 Owner SAMRITH VONG Phone: {661) 872-9986x Address 2806 WENATCHEE AVE State: CA City BAKERSFIELD Zip 93313 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST ENT oc r ~ s Zoos ~. . Vii'` ~ .tr ~;1t a (lr ~ i:~~i r!-• ;:r P!~c :.. :ndi~~ i._".' , .: u;i ri,a"'IIiiYG'~~F f~iiOPli~xi,'l^„ ~ (-,rt;`/ E~l'J-,. ~...+,~~t\I G. icV',' :~~84 ; (tai/~' ~?i,r~'PJ?~r~,t~l~l nvn,il;';c^C? ".i,f+ °i7i i"8 `Y'.I~IaP Wltll trl~ i'1'iq Pfil ~tlO it su` ~!'i'sd ~ ,-~,; ~~'!ie'i2 2ha infarrr~a!ion a Y;u2, accuiate; any col~~~lpte. ~~ ~~~ r~. ~~~ ~~ SignattAre Date -1- 10/10/2007 r F SAMS LIQUOR & GAS SiteID: 015-021-002468 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: SAMS LIQUOR & GAS Cross Street Business Type: GAS STATION Org Type: INDIVIDUAL Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper SAMRITH VONG ICC Nbr: 5248787-UC PROPERTY OWNER INFORMATION Name S ~/~~ ~`T l~ ~O7VG Phone : (,~C'2) y~S/- ~~ Address: City State: Zip: Type INDIVIDUAL TANK OWNER INFORMATION Name cz~/~''-'G~ '- Phone : ( ) - x Address: City State: Zip: Type INDIVIDUAL BOE UST Fee# 44-044807 FinanC'1 Resp: SELF INSURED Legal Notif Business Mailing Address Date:03/03j2003 Phone: (616) 6 - x Name:SAMRITH VONG Tt1:OWNER State UST # 2468 1998 Upg Cert#: -2- 10/10/2007 F SAMS LIQUOR & GAS = ~ Hazmat Inventory = ~ MCP+DailyMax Order = SiteID: 015-021-002468 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED GASOLINE F IH DH L 12000.00 GAL Mod PREMIUM UNLEADED F IH DH L 12000.00 GAL Mod PLUS UNLEADED GASOLINE F IH DH L 12000.00 GAL Mod -3- 10/10/2007 -4- 10/10/2007 F SAMS LIQUOR & GAS SiteID: 015-021-002468 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 STATE .TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~mbient ~ Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL 12000.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Gasoline No 8006619 riLil~tiRL HJ ~J L..7 ~71.1P~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient -~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL I 12000.00 GAL r~c~ruu~vv.7 l..Vl•lt'V1Vriv t S %Wt• RS CAS# 100.00 Gasoline No 8006619 ruyc~t-ucL ri ~~~~arlrlvl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 10/10/2007 ~ Y F SAMS LIQUOR & GAS SiteID: 015-021-002468 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PLUS UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture~mbient ~ Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL 12000.00 GAL HAZARDOUS COMPONENTS oWt. RS CAS# Gasoline No 8006619 L3HGL-ifCL H. 7~P~.7~71°1P~1V1iJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -6- 10/10/2007 F SAMS LIQUOR & GAS SiteID: 015-021-002468 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 02/21/2007 ~ CALL 911 AND CLOSE DOWN STATION UNTIL EVERYTHING IS SAFE. Employee Notif./Evacuation 02/21/2007 EVERYBODY LEAVES THE STORE. Public Notif./Evacuation 02/21/2007 WE WOULD PUT YELLOW CAUTION TAPE AROUND THE STATION. THEREFORE, NO PEOPLE COULD GET IN WHILE THE DANGER IS STILL PRESENT. Emergency Medical Plan 02/21/2007 CALL 911. -7- 10/10/2007 F SAMS LIQUOR & GAS SiteID: 015-021-002468 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 02/21/2007 ~ CHECK EQUIPMENT TO MAKE SURE EVERYTHING IS SAFE EVERY MORNING BEFORE STORE OPENS. Release Containment 02/21/2007 THERE WOULD BE A LITTLE VAPOR RELEASE EVERY TIME PEOPLE PUMP. Clean Up I WOULD USE KITTY LITTER IF THERE WERE A MINOR SPILL. 02/21/2007 V1.11CL 1CC r5VULUC L'il.L1VCL l.1 V11 -8- 10/10/2007 1, ~ F SAMS LIQUOR & GAS SiteID: 015-021-002468 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ay~~:lai nu~.aiua Utility Shut-Offs 02/21/2007 WE HAVE EMERGENCY SHUT-OFF IN FRONT OF STORE. Fire Protec./Avail. Water WE HAVE SHUT-OFF AND FIRE EXTINGUISHER BY THE DOOR. 02/21/2007 Building Occupancy Level 02/21/2007 2 EMPLOYEES. -9- 10/10/2007 ~. F SAMS LIQUOR & GAS SiteID: 015-021-002468 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/21/2007 ~ WE TRAIN ALL STAFF ONCE A MONTH ON HOW TO DEAL WITH EMERGENCY SITUATIONS, IE, CALL 911 OR SHUT OFF THE EMERGENCY. rayc ~ aiciu ivi r u~.u.~c vac _~ ~ r_ aiciu iv.L. ru~..utc vac -10- 10/10/2007 ~~~~~ Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST ( e__ E R_S__F , D 9oo'IYuxtun-Ave., suite 210 ~~ ___..._._.______. _____ w_..___.r_________ ____ ' FIRE Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program "RTM ~ Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME INSP CTIO DATE . INSPECTION TIME S asv~s t ~- r S ~ ADDRESS PHO ENO. O OFEMPLOYEES FACILITY CONTACT - USINESS ID NUMBER 15-021- a ~~~ S~ ., Section 1: Business- Plan and Inventory Program ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (C=Compliance OPERATION V=Violation COMMENTS ^ ^ APPROPRIATE PERMIT ON HAND Lt d' ^ BUSIfteSS PLAN CONTACT INFORMATION ACCURATE - / L ~Y ^ VISIBLE ADDRESS - / L ~ ' ^ CORRECT OCCUPANCY ~ , / ~d ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION CSY ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY .,L ~~ ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ,~ / L-i~ ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING Li' ^ FIRE PROTECTION ^ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: ^ YES Lf NO QUEST~fgNS REGARD~JG THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Ins(~ector (Please Print) Fire Prevention / 1s' In /Shift of Site/Station # White -Prevention Services Yellow -Station Copy Business Site esponsibl arty (Please Print) Pink -Business Copy FD 2155 (Rev. 09/05 _~ r '~ INSPECTIONS B I E R S F I L D BUSINESS PLAN & ~RrM r INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: ,S(t,W~s ~t Cacl~r r 6Qs Section 2: Underground Storage Tanks Program INSPECTION DATE: ~~~! '1 / V f ^ Routine ~ ombined ^ Joint Agency ^ Multi-Agency ^ Complaint ^ Re-Inspection Type of Tank ~W ~S Number of Tanks _ Type of Monitoring ~t,Uyl Type of Piping OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file J Q 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 /overspill protection? C =Compliance V =Violation Y =Yes N = No Inspector: Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services 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 V Business Site Responsible Party Pink -Business Copy KBF-7335 FD 2156 (ReV. 09/05) ~. ~ a 1 SAMS LIQUOR & GAS Manager SAMRITH VONG Location: 801 E CALIFORNIA AVE City BAKERSFIELD CommCode: BFD STA 02 EPA Numb: SiteID: 015-021-002468 BusPhone: (661) 861-1614 Map 103 CommHaz Moderate Grid: 32A FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title SAMRITH VONG / OWNER ~~rl,LlTy ~/Dl1/~ / pat//V~n Business Phone: (661) 861-161.4x Business Phone: ( ) - x 24-Hour Phone (562) 965-0724x 24-Hour Phone (~j"(o2)96.5"-~~~ Pager Phone ((~(~() 8~2- 99'S~'c Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact SAMRITH VONG Phone: (661) 872-9986x MailAddr: 2806 WENATCHEE AVE State: CA City BAKERSFIELD Zip 93313 Owner SAMRITH VONG Phone: (661) 872-9986x Address 2806 WENATCHEE AVE State: CA City BAKERSFIELD Zip 93313 Period Q3 /Qp017 to ,O2 1 ~~,~J' ~ TotalASTs : _ ~~ f~ ~~ Gal Preparers / ' j~~~~~ ~~~~ TotalUSTs: _ ~ ~ QO Gal Certif d: , RSs : No i ParcelNo: Emergency Directives: PROG A - HAZMAT PROG 'U - UST ENT'D F E s 21 ~ao~ Based on my inquiry of those individuals responsible for obtaining the information, i certify under penalt}~ of law that I have personally examined and am familiar with the informAtion submitted and believe the information is true, accuraie, and complete. ____~~~ G~~ 2 - 1 - O~ Signature Date -1- 02/06/2007 ~~ , ;: F SAMS LIQUOR & GAS Last Action Type: SiteID: 015-021-002468 ~ STORAGE CONTAINER DATA (UST FORM A) FACILITY/SITE INFORMATION Business Name: SAMS LIQUOR & GAS Cross Street Business Type: GAS STATION Org Type: INDIVIDUAL Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper SAMRITH VONG ICC Nbr: 5248787-UC PROPERTY OWNER INFORMATION ~1 Name ~'~/7~~~~ .~O/v~ Phone : ( 6~0~) ~s v ~ - ~~ ~i~ Address : ' ~ ~~ ~C,rj~ j~ ~.~~ The gIIVID AL ~ State: ~,L~-Zip: ~?3D~Z YP Name Address City Type ,/ TANK OWNER INFORMATION ~j'~/7~~ v~~"/~ Phone : ( ) o~>Q/Yn~ State: Zip: INDIVIDUAL x BOE UST Fee# 44-044807 Financ'1 Resp: SELF INSURED Legal Notif Date:03/03/2003 Phone: (166) 1 - x Name:SAMRITH VONG Tt1:OWNER State UST # 2468 1998 Upg Cert#: -2- 02/06/2007 ~~ ~ P SAMS LIQUOR & GAS SiteID: 015-021-002468 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... ISpecHazIEPA Hazards) Frm I DailyMax IUnitIMCPI UNLEADED GASOLINE F IH DH L 12000.00 GAL Mod PREMIUM UNLEADED F IH DH L 12000.00 GAL Mod PLUS UNLEADED GASOLINE F IH DH L 12000.00 GAL Mod -3- 02/06/2007 OOZ/90/ZO _~,_ ~~~ r 0 I~ Q D ~ g ~ ~1N 1 ~fi -~ F SAMS LIQUOR & GAS ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Location within this Facility Unit UST STATE TYPE PRESSURE Liquid TMixture ~mbient SiteID: 015-021-002468 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 12000.00 GAL 12000.00 GAL 12000.00 GAL r1t~~x~cL~uS c.:~l~ir~lvrlvla ~Wt. ~ RS CAS# 100.00 Gasoline No 8006619 t1HGHKL I~J~J~;~J1~1L'1V15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No Noj Curies F IH DH j / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED Location within this Facility Unit UST STATE TYPE PRESSURE Liquid TMixtur~mbient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient -~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL 12000.00 GAL riHGt1tCLVU.7 1;V1~lYV1V1;1V 1.7 ~Wt. RS CAS# 100.00 Gasoline No 8006619 t11~GHtCL E'~. 7.7L" .7.71~1L" 1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 02/06/2007 F SAMS LIQUOR & GAS SiteID: 015-021-002468 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME PLUS UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE ~~ CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 12000.00 GAL 12000.00 GAL I 12000.00 GAL r1ti~r~tcL~u~ ~ulnr~iv~lv"1"5 oWt. RS CAS# Gasoline No 8006619 t1E1GAttL H55~551~1~1V"1"~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -6- 02/06/2007 . ~, F SAMS LIQUOR & GAS SiteID: 015-021-002468 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ tit~Clll:y 1VV1.111C:d1.1Vi1 five PivO~L1~ ~~Z L ai!/ ,~rv~ etosc ~o~n~ T~~ s T~-~v~ r~r~r~yz ~~~Ry ~ rry~ > ~ sir P~LLl~.J1VyCC 1VV 1.11 ~ L' VdU Udl.1V11 t l~~2~ P 0 r~,Y ~ ~/~l/c' T ~ TOR ~ :emergency Nieaical Plan c ~-~ ~ 9l l -~- 02/06/200 ~. .., F SAMS LIQUOR & GAS SiteID: 015-021-002468 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention ~~1 c~'~ ~ ~ ~ p~~ ~~ ~~~ ~ s~~ ~ ~ ~~~~ i ~~ sTOR~ 1~ ~I~~nr Release-Containment ~CZ ~~"S'~ ~~~~ ~~~ ~~O~L~ J~~I7~ clean up ~~~~1~ ~~ r Lz vl.tiCL 1<CSVUIC:C 1"11: 1.1Vdl,lCJil c~rL~ 9i~ r~~y ~~ry ~ MAY ~~y ~ -8- 02/06/2007 %• . .~• F SAMS LIQUOR & GAS SiteID: 015-021-002468 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ aNc~.iai naaaiua ~~.iii~.y ollu~-vl_1_a IrU~ ~f~v~ ~~"7~R~~n~c~ 3~~rTO~F 9n~}~RO~ Fire Protec./Avail. Water--= g~ T2~E J~~oK ~~~t~G~~r~s~r DU111A 1111. VC:L U~Jd11C: ~/ LCVC1 -9- 02/06/2007 11. ~ J F SAMS LIQUOR & GAS SiteID: 015-021-002468 ~ Fast Format ~ ~ Training Overall Site ~ Employee - Training , ~ o~ ~~ ~~~~ ~~ ~~~~~~~~ s ~ ~~ ~ 10' rage ~ Held for Future Use nciu ivi r u~..utc ~~c -10- 02/06/2007 UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING 1 SB989 SECONDARY CONTAINMENT TESTING !TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMR NO. T ~-' U ~ ~ T BAKERSFIELD FIRE DEPT. F/Rt Prevention Services wRTr r 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661j 326-3979 Fax: (661) 852-2171 Page 7 of Z ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING f l TANK Tll;HTNFSS 7FST Tn PFRFnRM FUFI IuIANITnRINr CFRTIFI(].4Ttnhf- `t SITE INFO RMATION ,, . FACILITY Q ~ • ~ Gvrx. ~A Le-e'L. ~~ NAME 8 PkIONE NUMBER O~f~j NT(CT PERSON ~qiy,~ d ADDRESS 8b ~ ~ ~ n ( - ~ n ~ n ~ ~ O l.X~ "l OWNERS NAME ~ OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED I PIPING GOIN TO BE TESTED? ^ ES ^ NO TANK # V LU E CONTENTS 3 TANK TESTING COMPANY ": NAME OFT TING CO ANY NAME PHONE NU BER OF CONTACT PERSON a- ~ MAILING A S(o ~S 2 ~~y ~{ J G4 ~t 33a ~ i NAME 8 PH~ON?E~/NUMBER~ ~ OF ~ TER OR SPECIAL INSPECTOR . ~ ~ CERTIFICATION #: DATE & TIME TEST TO BE CON DUCTED 1-v -b9 9 ~ ~ ICC #: S~(o is ~~ - t~T TEST METHOD SIGNATURE OF APPLICANT DATE ~_ ~ 7 _ 0 . i1PPROVED B ~ DATE /~ -a~...O'~ FD 2095 (Rev. 09/05) 5''~ Ll ~ a o .._. ~..i, j ~~~~ ° S JOB CARD POST CARD AT JOB SITE INSPECTION RECORD-USTs 8 B R 8 P 1 D ~~~a ~1~ 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 FACILITY NAME ~ ` /~ ( IJ O ` ~ ~O OWNER C~^,1,, VU.~v, ~ Oh - ADDRESS ~~ ~ ~ ~`~~, ~~ /v ADDRESS Q' ~ f ~`t~ l ~~ t CITY BAKERSFIELD STATE CA ZIP 307 CITY (r k~a ~ S T Z ~ PHONE NO. p i `' 4~l-' y PERMIT NO. INSTRUCTIONS: PLEASE CALL FOR AN INSPECTOR ONLY WHEN EACH GROUP OF INSPECTIONS WITH THE SAME NUMBER ARE READY. THEY WILL RUN IN CONSECUTIVE ORDER BEGINNING WITH NUMBER 1. D N T COVER WORK FOR ANY NUMBERED GROUP UNTIL ALL ITEMS IN THAT GROUP ARE SIGNED OFF BY THE PERMITTING AUTHORITY. FOLLOWING THESE INSTRUCTIONS WILL REDUCE THE NUMBER OF REQUIRED INSPECTION VISITS AND THEREFORE PREVENT ASSESSMENT OF ADDITIONAL FEES. , ` INSPECTION DATE INSPECTOR TANKS AND BACKFILL _ BACKFILL OF TANK(S) SPARK TEST CERTIFICATION OR MANUFACTURES METHOD CATHODIC PROTECTION OF TANK(S) P ING SYSTEM PIPING 8~ RACEWAY W/COLLECTION SUMP I ~ l Q CORROSION PROTECTION OF PIPING, JOINTS, FILL PE ELECTRICAL ISOLATION OF PIPING FROM TANK(S) CATHODIC PROTECTION SYSTEM-PIPING ' - DISPENSER PAN __ -- SEGONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETECTION.; . .. LINER INSTALLATION -TANK(S) LINER INSTALLATION -PIPING VAULT WITH PRODUCT COMPATIBLE SEALER LEVEL GAUGES OR SENSORS, FLOAT VENT VALVES ~ Q / PRODUCT COMPATIBLE FILL BOX(ES) ~ PRODUCT LINE LEAK DETECTOR(S) f LEAK DETECTOR(S) FOR ANNUAL SPACE-D.W. TANK(S) r ( 3 , O~ / MONITORING WELL(S)/SUMP(S) - H2O TEST LEAK DETECTION DEVICE(S) FOR VADOSE/GROUNDWATER SPILL PREVENTION BOXES 3 Q -, .FINAL i MONITORING WELLS, CAPS & LOCKS FILL BOX LOCK MONITORING REQUIREMENTS TYPE Jc ~ / AUTHORIZATION FOR FUEL DROP ~" ~ _ 1 1 _._ . ~ v..--- - -- CONTRACTOR ~ d' J ~<~]]Ul.~"~T1~'~ ~Tl ©1~1 LICENSE NO. ~~~1 ~ ~ ('~1i7_ CONTACT ~, ~' ~ ~ ~ Ct'~_~ C_ PHONE NO. ~D I _ ~J1O FD 2097 (Rev. 09/05) UNDERGROUND STORAGE TANK MONITORING PROGRAM EMERGENCY RESPONSE PLAN (FORM) Page 1 of 1 B E R 5 F 1 D r~Rr ARTM T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661)326-3979 Fax.: (661) 852-2171 This monitoring program must be kept at the UST location at a/ times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Prevention Services 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 V®~ ~d: FACILITY ADDRESS ,~ 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 THE OFFICE OF PREVENTION SERVICES MUST BE NOTIFIED WITHIN 24 HOURS. f~-Q~ Sw~,C~ s~~C( c.~cG( c1sL ~c~Y G~~~{c.r oc~ act ~.~sbc~f~a.~,~f -~G,~.~f c ~ S ~ ~d~ d f1~.s (y' G~,~ , ~o c~ ~ ~~ ~ ~ c1 ~~ C~ 4 C l o ~ ~ ~~f DESCRIBE THE PROPOSED METHODS AND EQUIPMENT TO BE USED FOR REMOVING AND PROPERLY DISPOSING OF ANY HAZARDOUS SUBSTANCE. (?~1.c~ct-~~~c~ '~.~0 ~ ~c~ C Ce ~ EQC~•~`a f Hr~ S ~ ~ ~ -~-o~ ~lt~~ ~rc~~~~~, ~- 0~~ ~o~ ta.1~s~-c. ~(c~s toc~f Vic. S~c~r~~- fp cC~~ I~'ul~~'% `~ 4t.S~as~~ ~~ ~P DESCRIBE THE LOCAT(I~ON AND AVAILABILITY OF THE REOUIRyE~D CLEANUP EQUIPMENT IN ITEM ABOVE. ~J Gc~L S"t-0 ~~~ ~ ~ d NIP DESCRIBE 7HE MAINTrENANCEhS,CHEDULE FOR THE CLEANUP EQUIPMENT: ~.1~ `C-fig-~lJ ~~L LIST THE NAME(S) AND TITLE(S) OF THE PERSON(S) RESPONSIBLE FOR AUTHORIZfNG ANY WORK NECESSARY UNDER THE RESPONSE PLAN: NAME ~ f TITLE NAME TITLE NAME TITLE NAME ~- --------------- TITLE --- -------~ NAME TITLE FD2074b (Rev. 02/05) UNDERGROUND STORAGE TANK BAKERSFIELD FIRE DEPT. MONITORING PROGRAM (FORM) ~ a E x ~ ~ I D Prevention Services f/gt 900 Truxtun Ave., Suite 210 WRITTEN MONITORING PROCEDURES ARTM T Bakersfield, CA 93301 Tel.: (661) 326-3979 Page t of 1 Fax.: (661) 872-2171 This monitoring program must be kept at The UST location at al Times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Prevention Services 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 2641fh) CCR. FACILITY NAME r t'r~aS FACILITY ADDRE SDI ~~ t~~ o ~ 933©~ DESCRIBE THE FREQUENCY OF PERFORMING THE MONITORING: TANK 9 PIPING ~i - ' WHAT METHODS AND EQUIPMENT, IDENTIFIED BY NAME AND MODEL, WILL BE USED FOR PERFORMING THE MONITORING: TANK PIPING f T DESCRIBE THE LOCATION(S) WHERE THE MONITORING W ILL BE PERFORMED (FACILITY PLOT PLAN SHOULD BE ATTACHED): ' LIST THE NAME(S) AND TITLE(S) OF THE PEOPLE RESPONSIBLE FOR PERFORMING THE MONITORING AND/OR MAINTAINING THE EQUIPMENT: NAME TITLE V NAME TITLE NAME TITLE NAME TITLE NAME TITLE REPORTING FORMAT FOR MONITORING: TANK c '~ i~ L' , PIPING t1 i ~q.~ i~l L~ 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. ~C~' Wt 'T~, q t}cc~.~ f~c.S DESCRIBE THE TRAINING NECESSARY FOR THE OPERATION OF UST SYSTEM, INCLUDING PIPING, AND THE MONITORING EQUIPMENT: ~ ~'ac~c~ ~Y jJ *-~ ~~~~~cc~ FD 2074C (aev. Duos) State of California For State Use Only State of Water Resources Control Board Division of Financial Assistance P.O. Box 944212 Sacramento, CA 94244-2120 (Instructions on roverse side) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. [ am required to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: ^ 500,000 dollat5 per occurrence ^ I million dollars annual aggregate or AND or I million dollars er occurrence ^ 2 million dollars annual a re ate p gg g B. ~ hereby certifies that it is in compliance with the requirements of Section 2807, (Name o/ Tank Owner or Operatod 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 Pally T e Name and Address of Issuer Number Amount Period Action Com ~ C~t~r~ ~ N ~ 33 N ~~~ ~ ~o v^ 93? ~ °~©- 07 Note: if you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certifrcation also certifies that you are in compliance with all conditions for participation in the Fund. D. Facility Name Facility Address t ~ ~ ~ ~S Facility Name Facility Address Facility Name Facility Address E. Signature of Tank Owner or Operator Date Name and Title of Tank Owner or Operator ~ % Signature of Witn ss or Notary Date Name of Witness or Notary CFR (Revised 04/95) FILE: Original - LJcal Agency Copks - FaNllty/Slte(s) ~;:. ; _. ,. ~: ">ieaz •~.t:ThcrCo nsurar:e FaxID: To:L'~m;iih',/ony ~~ `` .~CDRL THIS Bi.1'_:~::3 li :'E li'~J~.J~it-;~J~C F3~~1D~6~ ~Ph: --: `' oe`i o12 6 INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORIA. Thom::u ~L~ulluce .~soc. Inc. Lice;_~P ~:~7~'.2ea 4333 N West Ava E'zesao CA 93705 Jay c: ~s~z __ _ 559-225-1000...----- --,~:,:c r; :, 559-x26-1800-- fac, No a*;• CODE: I SJd CCLc: 902 ~, f::~li.fo.^'.:.a .A:Te. aakersfield ~,A 93307 COVERAGES COFiPANY 9INDERi 1067 Markel insurance Company I ------DATE EFFcC'I'/E Tg~ - -__.._.._._--'-------r---.--~'--..---ATE ---- -r~ -- ~~x ; ~.r,, I ; ~ I :::~ I ,~~ 06/30/C6 12:01 ! r-~,.; 07/30/06 1 I:,_'n a::on; LIDAITS ?YYE OF iNSUkANCf9 j CUVcRAv2•r:R!aS ER•Pr' ___ __,_,~.L-,; ~ Buii.:ang/itepiacP-ment r;ost~~+- ;::,,;,.; _-~ `r;,:,~ !` x ;' :;F.=~_ ~ Persc•aal L'ropertyiEtep C:as t * x Business Incomte DcuU~i.f3Lc i CUiWS'6, ~ a.HDUFT i i30G 90 Si0,D00 1000 i 50 56500 I 100,000 s'~1Pr1ERC!~,L ~: Ei'dES~'t L1.4Ef~ 1T ~~IH':. .2 i Y i ~__... L;ie~:~r T~.i Z'-•i.lity =rrr .~iaT~ , .-1.L ~ ~H~uEC~ ~.U?~: SCHECI-lED a.~r.~ ril=~.._ 4.1i:. fJiJh-: Yd~it:~ r._... 'ETFC:'G:•'c ..: 'C. CIF, '.~ri~E: F-_-_~_--__._ ..~__ __ ~ r..__ -__._ -_.'~--_' -- :' c4E I!dcG °-; rr_,LE Ural' 13 ------ --- -r•------- -- ------"--- --- -1-'---'------ ... . If ~ .:. .;~. ' ~. . , ~'GEGj'v :~4w!P ':E ~ : -- -.._ .- ---------- :-.- ----~-----~--'----- i -~..v----_.--_._. ._ r-_. ..._ -_ I„ ~..__ __.: i ~_ L-- -i - -- I ~ _ ~prJ _ i :.._ .. I j , ~_U it -~ :. ... ~ l~Tl-EF ,Hn.^i i-~' I~I `_' - GARAGE'.IABIUTY ^U~'.:li'~'_1...:•~.•':~:IDEri' s1,DD0,CD0 I - ~ x '- ' rr P: ._-.__-.-...._-.___-_._ i ._._-__._--.-.____- '. C ; i1 ~ x J! J ) Other than ~ I ' _f ~.tiN .: ~ ! M1L t _''_.._..--....-----•-- - -- ---. e,-.ria'.:cloEr,; ,1,000,C00 __-___~__ E%CESS LIABILITY i ~--- _ - - -^~ _ ,- - = n_ c ! ' I. .. ---r ------ ._ - -- WORKER SCGMPENSATION . =CEP- E~:":• :, ~ EMPLGYER'S LtA81LIT' j ' ,. r ~ ,' - -'. ~+ ~!~:~VL':`; EE I -` SPECIAL ~ ..... -`- i '~ CONU11 IUNDi OTHER ,:..• c . I .: COVERAGES ...------- ----------~- ----'.__-' ~AA4E 8 AOORFSS s:, ,. .. ,,, ... .:. : -~_s~~:~-c ~ X'. Insured ~ Li t- - samrith vonq raUTFIOR4EC REPRESENTATIVE - 801 L*. California Ave. Bakersfield CA 93307 i ~~~ /~ /7~~Q~' ACORD 75 IZ004/09) NOTE: IMIPORTANT STATE INFO ATION ON REVERSE SI^uE ©ACORD CORPORATION 1993-2004 8 E R S P I D P/RL ABTM T -. 4'.-y M. ~ . A Yfny-.• CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301(661) 326-3979 UNDERGROUND STORAGE TANK FACILITY ^ t NEW SITE 3 RENEWAL PERMIT ^ 5 CHANGE OF INFORMATION (State type of change) ^ 7 PERMANENTLY CLOSED SITE TYPE OF ACTION PERMIT ^ 4 AMENDED PERMIT ^ 8 TANK REMOVED (Check one item onry) ^ 8 TEMPORARY SITE CLOSURE 400 ~ 1. FACILITY /SITE INFORMATION j BUSINF,~SS NAME (Same ea F CILITY NAME or DBA -Doing Business As) 3 FACILITY ID p 1 NEAREST CROSS STREET 401 FACILITY OWNER TYPE ^ 4 LOCAL AGENCY/DISTRICT' 1 ^ 1 CORPORATION ^ 5 COUNTY AGENCY' i , S ESS L7t.Z INDIVIDUAL BU IN GAS STATIO ^ 3 FARM ^ 5 OTHER 403 ^ 6 STATE AGENCY' TYPE i ^ 2 DISTRIBUTOR ^ 4 PROCESSOR ^ 8 COMMERCIAL ^ 3 PARTNERSHIP ^ 7 FEDERAL AGENCY' 402 TOTAL NUMBER OF TANKS Is facility on Indian Reservation or 'If owner of UST a public agency: name of supervisor of REMAINING AT SITE frusttands7 dlvisbn, sectron or office which operates the UST. (This is the contact person for the tank records.) 404 T ~~ ^ Yes LlYrvo 405 406 . tl. PROPERTY OWNER INFORMATION OWNER NAM 407 PROPE` PHONE 408 ~/ v i.C ~ ~Jl Q ~ ~ 7 ~ 0 I MAILING OR STREET ADDRESS 409 _ I CITY 410 ~ STATE 411 ZIP 412 ~ _ 3 0~ ' PROPERTY OWNER TYPE INDIVIDUAL ^ 4 LOCAL AGENCY /DISTRICT ^ 8 STATE AGENCY 413 ^ 1 CORPORATION ^ 3 PARTNERSHIP ^ 5 COUNTY AGENCY ^ 7 FEDERAL AGENCY III. TANK OWNER INFORMATION TANK OW R NAME 414 PHONE 415 ~ _ 7' ~ Q MAILING OR STREET AD SS '-. 416 CITY 417 STAT 418 ZIP 33 d.~ 419 TANK OWNER TYPE INDMDUAL ^ 4 LOCAL AGENCY /DISTRICT ^ 6 STATE AGENCY 420 ^ 1 CORPORATION ^ 3 PARTNERSHIP ^ 5 COUNTY AGENCY ^ 7 FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY (TK) HQ 4 4 - O ~ ~ ~ Q ~ Call (916) 322-9669 if questions arise 421 V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE METHOD(S) ^ 1SELF-INSURED ^ 4 SURETY BOND ^ 7 STATE FUND ^ 10 LOCAL GOVT MECHANISM ^ 2 GUARANTEE ^ 5 LETTER OF CREDIT ^ 8 STATE FUND & CFO LETTER ^ 99 OTHER: ^ 3 INSURANCE ^ 8 EXEMPTION ^ 9 STATE FUND 8 CD 422 VI. LEGAL NOTIFICATION AND MAILING ADDRESS Check one boz to Indicate which address should be used for legal nofificatlons and mailing. FACILITY ^ 2 PROPERTY OWNER ^ 3 TANK OWNER 423 Legal no0flcatbn and mailing will be sent to the tank owner unless box 1 or 2 is checked. VII. APPLICANT SIGNATURE Certllkation: I cer8fy that the information provkled herein la true 8 accurate to the best of my knowledge SIGNATURE OF APPLICANT DATE 424 PHONE 4~` j _ ~~''~ ~ ~ . 2 / - o ~ ~6//] fr ~2 - 995. NAME OF APPLICANT (pdnq 428 TITLE OF APPLICANT 427 `, STATE UST FA ILITY NUMBER (For k1ce1 use only) 1998 UPGRADE CERTIFICATE NUMBER ( or local uee only) Form A C[T~" OF B~KERSFiELD ~ ' OFF[CE OF EiYVIRO~Yi1/1EiYTAL SERVICES `~ ~ I11S Che9ter Ave., Bakersfield, CA 93301 (661) 32b-3979 `••'• UNDERGROUND STORAGE TANKS -TANK PAGE 1 - p~ d ,_c'Oi ACTION ^ t. NEW $TE vEWiAIT ^ a. AMENDED P£RA4T ^ S. CNANC',E Of iNfCRMATION) ^ d, iEA1PORAAV 91TE CLOSURE ^ >'. PERMANENTLY CLOSED ON gRE ^ ). RENEWAL PZRA4R (~~, mason • 1Ur bcal va. J A7r bcal w. o ! M') (swd)' ~+anP • M' ^ S. TANK REMOVED 9US~NES9 .WAE (gam. i FAGLITY NAA4$ ar Od- • OoutQ 6uarwa N) ] fACAlTY t0I --1'~-- "7iyGe ~ ~ttf~(1~~• `~' l~ ~ ~ounoN wm•IIN griE fG~4Lxtiq _ - _ ---`---- ~~ f ~ t ~c~ ~ ~- ~ ~ ~~• ~ ~~-- X33® ~ i. TANK DESCRIPTION LANK , ~ A a]J ~ CAMPARTMENTAL3ZED TANK ^ vs. r' ~ r tt'Ye.-. c«na«. ons ewa I« e.a, cvmoartmeru, . OA i iN ALL ( ) A IN n N NV ~ j V ADOfTIONAL (Faw ADtL wa only) M. TANK COItTE)fT'f TANK USE +~ PETROLeuM TYP1a - _ - - - _ - - _ - 4. MOTOR YEFIICLE fUEL ^ to REt><JLAR UFLEADED , ^ 2 LEADED ^ S. JET FUEL ' (Mnfaiiard, oompNM PgoA~trn Type) ^ 10. PRf~lUM Ut41.EA0ED ^ 1. DIESEL ^ 6. AVVITIOM FUEL O z. NoN+vF~. PETROLEUM ~,,~,DCI+zADe tXi.EADEO ^ .. ciA„SOFIOL ^ ~. OTHER ^ ~. cHEMIGU PRODUCT COMMC)f4 NAME (hWn M.nlt~us 44MrfiLt lrrHnWYD.p'.) Oat GS ~ (liovn NazarCtwa AtaAtniW l^++^wYD+pr1 4'- ^ a. HAZIRDOU3 WASTE (1'>cAdu Uaad Oh i ^ 9d. Uh1CN01A?J Ip. TANK COItS'iRUCTiOf! ~ TYPE OF TANK ^ t • 31NC~E y~l ^ g. 91NOLE WALL wRH ^ 3. garGLE WAl1 wRH uJTERNAI. Bt.ADOER SYSTEM saJ rc,~+ut a+. ~+ ary~ ~ioueLa WALL ExTERIOR AF.F~RANE LINER ^ 95. Ur6D40VUN ^ 4. $WOL,E WALL, PL A YAULT ^ ~. OT1tER TANK MATER{AL • pYtfaty talk .RARE STEEL ^ 3. FIBEROLA53 /PLASTIC ^ S. CONCRETE ^ 9S. UNKNOWN Fu (CnstX °M '~ ~Y) ^ 2 STAINt.E3$ STEEL ^ 4. STEEL, CLAD YYJFIBERGI./L53 ^ 6. FRP C0114PATiBLE W1100% A4ETFtANOL ^ 9D. OTHER ' REINFORCFA PLASTIC (FRP) ~ TANK MATERIAL • !Noonday tatic ^ t. BARE sTgFi ^ 3. F~~(;USg / PlA$TIC ^ e. FRP COMPATIBLE W1100% 1~T}WIOL ^ 95. UNKN04'M µ.`• (C>•atX ona 4Nn oNy) ^ 2 STAIfiE33 STEEL , ,, LIJ~ STEEL cL~D w/F'IBERGUSS ^ Y. FRP NON~CORR0018LE JAGCET ^ 9a. OTHER REINFORCED PLAS'T)C (FRF~ ^ 7Q COATED STEEL ^ S. CONCRETE TANK INTERIOR L1NN~KT OR COATING ^ t. RUd6ER LIED ^ 3. EPOXY LM6/K3 ^ S. CllABB LJr11NCi ^ 96. lN6CNOMM 446 GATE NtSTALLED 447 ^ 2 ALKYD LMlf3 ^ .. PrlEyaol,IC LJNRq C~uNL.uaED ^ ~. OTHER etlaex ona >tne Forba/.a. _ PROTECTION APPLIG6LE ^ 1. MANUFACTl1REA GTfgO1C 3. FIEEROL/~SS REIt4fOkCED PLASTIC ^ 96, UMCI'IONM 446 DATE INSTALLED aa9 PROTECTION ^ 4, u4PREgSED CIIRRENf ^ >76. OTHER (Cnatk oaa 4Wn o+ry) ^ t SACRIFICIAL ANODE (Forbcal usa oNyl SPILL ANO OVERFILL YEAR INSTALLED a50 TYPE (For bca! usa oNy) 431 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED a32 'CMck Aw mat apply) ,..~9PILL CONTAINMENT - ~ ^ t. ALARM ^ ], FILL TUBE SHLiT OFF VALVE _,~._.- ,L~~ 2~OROP TUDE ~ ~ ~^,,. 2~BALL FLOAT ^ 4. EXEMPT L'~'3. STRNfFR PLATE ~ ~r ~ lLl~ F- V ice. ~~ t~'-' ; ' ~? t ! u': -~ If SINOL6 YY/-LL rAA1K (CAaur aI en.l ~'~ ... a63: ~- 1/ DOUbI! WALL TANK oR TANK WRH aLADOeR (CJ»ck oM ,tam oNyx a3•+ t, VISUAL (EXP06l0 PORTION ONLY) ^ 3. MANUAL TANK OAUOINO (ALTO) ^ 1. VISUAL (SI-40LE WALL iN VAULT ONLY) 2. AUTOMATIC TANK 4AUOUrO (ATO) ^ 6. VADOSE ZONE ~02. CONTINUOUS INTERSTRIAL MONRORINO J J. CONTINUOUS ATO ^ 7. OROUNOWATER 1. ANNUAL MONRORINO ~ 4. STATISTICAL INVEMORY RECONCIL41TgN (SIR) • ^ 6, TANK TESTING Ir .~ 61ENNIAL PANIC TQ6TW0 L~- I (C ~1 l ~ •3 0 -=: 5 CC Dr,. 0 +' r y..~ ~R t);..., C.. (t G( _ O oo. OTNER ~~ V. TANK CLOaURE IN~ORMIATK>•1 I PERWINENT CL03URE IH PLACE 1- lTIMATEO OA7/ lJL9T UA[0 (YWMOIDAY) 486 4STIMATQD lyUAllTRY OF SUESTANCd REA4AYaM/0 abb TANK FILL60 WRH INERT MATEAW.) ~7 adorn ^ YM ^ Np _~-- :F (7/99) 9:1CUPAFna-yctcware-B•W~~ F, CITY OF BAKER3FIELD ~ OfftCE Of ENVIRONMENTAL SERVICES h t713 CMsN~ Aw., Bak~rsMld, CA 9JJ01 (6Et) JZ~7sa79 ' u3T • TANI( ~AOe ~ ~ K f'~Ilt?O CONSTRUCTION (Cn.ea r otar.pp+y) . UNOEROROUHtO PtPItVO ABOVEGROUND PIPING SYSTEM 'Y PE ~ PRESSURE ^ Z. SUCTION ^ ~, GRAVITY AS/! ~ ^ I PRESSURE ^ 2. SUCTION ^ ~. GRAVITY +~_ ^ 1 SINGLE WALL ONSTR CT~Ow' ^ ). LINED 7RENCN ^ 9ti. OTHER 460 ~ ^ t. SINGLE WALL ^ AS. UNKNOWN +c U C MANUFACTURERI ~OOUBIE WALL ^ 93. UNKNOWM I ^ 2. OOUBIc"'HALL ^ 99. OTHER MANUFACTURER 46t I MANUFACTURER 46 -- - - ^ t, BARE STEEL ^ 6. FRP t.;OAPATIOLE W! t00% (.ETHANOL ^ t. BARE STEEL ^ 6. FRP COMPATIBLE W/ t00x IAET}tAN01 MATERIALS ANO ^ 2. gTAINLE33 STEEL ^ 7. GALVANIZED STEEL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL CORROSION PROTECTION ^ J. PLASTIC COMPATIBLE WITH CONTENTS ^ 96. UNKNOWN ^ ~. PLASTIC COMPATIBLE WITH CONTENTS ^ 6. FLEXIBLE (HOPE) ^ 99. OTHER FIBERGLASS ^ 6. FLEXIBLE (HOPE) ^ 99. OTl•tER ^ 4. FIBERGLASS ^ 9. CATHOOK: PROTECTION ^ S. STEEL W/ COATING ^ 9. UTHOOIC PROTECTION 464 ^ S. STEEL W/ COATING ^ 95. UNKNOWN <6` VR. PlMtKi LEAK DETECTION (C>tack r a+.r,Pdr) _ UNDERGROUND PIPING ( ABOVEGROUND PIPING SINOI.E WALL PIPING 466 PRESSURIZED PIPING (CAacA r dwt apply): ^ I . ELECTRONIC UIUE LEAK DETECTOR 0.0 GPH TEST ~ AU7'0 PUMP Si#!T OFF FOR LEAK SYSTEM FAILURE, MD SYSTEM DL4~iECTION • ALJD~LE AID VTBI)AL ALARMS ' ^ 2. MONTHLY 02 GPH TEST ^ 3. ANNUAL R~ITEGRITY TEST (0.1 OPH) CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONRORING OF PUMPING SYSTEM • TR1E?iaAL PIPING NTE('~R)'TY TEST (O.t GP}I) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING); i ^ 7. SELF MONRORING GRAVITY FLOW: ~ ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) I SECONDARILY CONTAINED PIP1N0 PRESSURIZED PW}tdCi (C7wok r Cwt apply): t 0. C.ONTiN0003 TURBINE SUMP SENSOR ~ AUDIBLE AhD VISUAL AWiAf$ ANO (Cneoc ma) ~Al)TO PUMP SHUT OFF WHEN A LEAK OCCURS b. AUTO PUMP SHUT OFF FOR LE/1KS. SYSTEM FAILURE AND SYSTEM ~/ DtSC.ONNECTION LS c NO AUTO PUMP SHUT OFF ^ t t, AUTOMATIC UNE LEAK DETECTOR (3.0 GPH TEST) ~ FLOW SHIT OFF OR RESTRICTION) 0.iz. ANNUAL INTEGRTTI' TEST (0.1 GPM) SUCTIOWGRAVTTY SYSTEAk ^ t ~. CONTINLKx13 SUMP SENSOR • AJ10181E AND VISUAL ALARMS EMERG ENCY O ENERATORS ONLY (CAack r /tN appdyJ ^ t 4. CONTINUOUS SUMP SENSOR AUTO PUMP SHUT OFF • AL1D18LE Al•D VISUAL ALARMS ^ t S. AUTOMATIC LINE LEAK OET£CTOR (3.0 GPH TEST) ~ FLOW SHUT OFF OR RESTRICTION ` ^ t 8. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 17. DAILY VISUAL CHECK . ,.. .' 311'IU t.C wwLt_ nnnc; 4b. PRESSURIZED PIPING {GwGr r Cwt apply): ^ t. ELECTRONIC UNE LEAK DETECTOR ].0 GPH TEST ~ AUTO PUMP SHUT OFF FOR LEAK SYSTEM FAILURE. AtD SYSTEM DLSC;ON4ECTION • AUDIBLE /WD VISUAL AL1R1N3 ^ t AgKTHLY 02 GPH TEST ^ 1. ANNUAL INTEGRITY TEST (0.1 GPH) . ^ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (CAsek r tMt apply): ^ S. DAILY VISUAL MONtiORING OF PIPING AND PUMPING SYSTEM ^ 6. TRIENNLIL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING}: ^ 7. SELF hAONRORING GRAVITY FLOW (C/wok r Cwt apply): ^ ~ 8. OA11Y VISUAL MONRORIA10 ^ 9. BIENNUL INTEGRITY TEST (O.1 GPH) SECONDARJLY CONTAINED PIPING PRESSi1Rl7FD PIPING (CAeck r Cwt apply): 10. CONTINUOUS TURBINE SUMP SENSOR VN TFj AUDIBLE AND VISUAL ALARMS AND (dtetlc one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c tJ0 AUTO PUMP SHUT OFF ^ t 1. AUTOMATIC LEAK DETECTOR ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCigNIGRAVRY 5YSTFJ~k ^ 17. CONTINUOUS SUMP SENSOR • AUDIBLE ANO VISUAL ALARMS EMERGENCY Q)ENERATOR8 ONLY (Chock r that apply) ^ 14. C.ONTtNIX)US SUMP SENSOR ~ AUTO PUMP SHUT OFF • AUDIBLE AND VISUAL ALARMS 15. AUTOMATIC LINE LEAX DETECTOR (~.0 GPH TEST) ^ 16. ANNUAL INTEGRITY TEST (O.t GPH) 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT ^/~ FLOAT MECI4WLSM THAT SHUTS QFF SHE/1R VALVE ^ s, DAILY NSUAL CHECK 1 DATE IN TALLEO 463 ^ 2. CONTINUOUS DISPENSER PAN SENSOR • AUDIBLE ANO VISUAL ALARMS ^ S, ~ ~:: r' - •.~ ;i^~ ~ a-'-`-` i.:.,~ ~ . ^ S. C.ONTVJUOl19 DISPENSER PAN SENSOR ~ AUTO SHUT OFF FOR DISPENSER • AUDIBLE AND VISUAL ALARMS 489 0(. OWNERlOPERATOR SIGNATURE I only Inat tM mhamalbn p~o+ndad MraM U true anC aowrata to Uw baN d my krtaMadpa. (~ /+ SIGNATURE OF OWNER/OPE~ OR/~ DATE O~ _ .C ~ ~ ~ (~ 470 S~J'I~Z9~"r~ OrY~ Ow~Y uaa PCF (7/99) S:1CU PAFOR MSISVYRC&B. ~ D C[T'~' OF BAKERSF[ELD ; :;~ ~ OFFICE OE ENVIRONi1l1ENTA1, SERVICES ~, ~- ^ ~ 1715 Chester Ave., Bakersflefd, CA 93301 (661) 326-3979 - ';"' UNDERGROUND STORAGE TANKS -TANK PAGE t Pt>~ ~. 01 t:c`OF ACTION ^ I. NEW SITE PlRMIT ~. ~. AMENDED PEAMIT ^ ~. CNANG2 OF iNFCRMAr10N) ^ a. TEMPOAAAY 917E CL09URE tr.u on. ,t«n onhl ^ 7 PERMANENTLY CLOSED ON BITE ^ ). RENEWAL RlAINfT (fin, ~~ • ,~ ~~ ut. o br bCN W~ o M'! (SOKh~+9- • M'/ ^ 9. TANK REMOvE0 9USINES9 NAME ($,4rnt- a+1JFAGUTY NAME ar ObA • Oarq ewr+w Asl ] I fAGUTY 10 ~ I ~ , ` ~ ~ ~ ~ I I I I ~M h l ed 1~ ~ ~~ l./1 ~ ~ ~.,w ~r II) 1 Rdl C. ~a~L.~arUcr~ ~~ Q •~ ~'L~- ~ 33 ~ 7 I. TANK DESCRIPTION ""'~ "' - ~ ~"• I ,"'°•~~ ~~~ "` ""' ~ COMPARTMENTALfZEO TANK U Y4y ° L~No M'Ye~', camdel~ ons Oaq. !« esu+ oa„par9tlplq, kuN uM 4;; M. TANK COIiTEtfT= ~~ ~ TANK USE 439 H' t. MOTOR vRUCLE fUEL A ~ PETlgIPUAt TYPE !~ a REOUTAR U~LF,ADP~ ^ 2 LEADED 4.: ^ S..lET FuEt (n n+.rkw. oorro+•~ PwroAKrn ryp) ^ 1e. PREMIUM LIPIfADED ^ ]. DIESEL. ^ e. AVIATION FUEL O z. NoN-FUEL PuM ^ ,o r~oo~Ane I»aFAOEO ^ .. oA.soNOL ^ s9. on,>:R ^ ]. CHEMIGL PRODUCT i ^ 4. -tAZAROOUS WASTE (4+WO~a CO49~gH NAAE (110tH Haaerabus AIal~rf~Q lrntnp7DW0J 44 i CAS / (Ilom fJazarWut 444/iali mm~bryplpf/ H . UaM OQ i ^ %. UNKNOWN Ip. TAI~AC CO1~t9'TRUCTKaN TYPE OF TANK ^ ~. 994(I<f VrALL ^ 3. SMXIIE wALL 1NITH ^ s. SINGLE WALL WSTH lNTEFeliAL BLADDER SYSTEM 4~IJ rcn•G* ona ;~,~ oNy) LlVZ DOUBLE wAtL EXTERIOR MEMBRANE LwER ^ %. UNIO~I01M1 i ^ 4. $IN(11.E WALL, N A VAULT ^ ~• ~~ TANK MATERUL • prYnary tWt B,~E 9TEEL ^ ]. FIBEROIASB !PLASTIC ^ S. C.ONCFt>=7E ^ %. UNKNOWN tyu (Cnscr on• M+n orvy) ^ 2. 3TAHiE$$ STEEL ^ 4. S7EF1 CLAD vwFIBERGLA33 D e. FRP COAPAT78LE wnoox MET1,Ar,oL ^ ~. On,ER RewwRCEn PLASTIC (FRPI TANK MAT ERtA1- MAY tiNt ^ 1. BARE STEEL ^ 3 . FIBERGL/~3 /PLASTIC ^ 0. FRP CO6PATiBL.E W/100% A9:TMMlOt ^ %. UNKNOVi?1 u-` (CMNc orw .Mn aYr1 ^ L STANiFSS STEEL ,,~ / L{Y4. STEEL CLAD WfF18fRGU133 ^ 9. FRP NION-ODRRO018LP JACXET ^ 9D. OTNFR REINFORCED PLASTIC (FRP) ^ IQ COATED STEEL ^ 5. OON(xtEfE TANK INTERKM LNd0 ^ 1 RUEBER LJrEO ^ 3. EADXY LM/INO ^ S. ti1J188 L]lIINCi ^ 9e. IX~AQrOWN 148 DATE INSTALLED 447 OR COATWG ^ a ALKYD u~INO ^ •. P-IENOUC UPIINO Ia~UNLINED ^ 99. oTNER (cn.dc «» It«n oNr) rFar~.+w+ oral oT1,EA coRROSaN ^ I MANUFAGTLXilD CAT}10DIC ~ FIGERGLAS$ AEr•FDRCED PLASTIC D %. uNKNDWN s4e DATE INSTALlE0 4+9 . PROTECTION IF AAPUA~BLE PROTECTION ^ 4, IMPRE$SEO CURR£Ni ^ fl9. OTHER (Cn~ck one +tNn oM'1 ^ 2 3ACRIFIClAI. ANODE (For bu/ wa oNy) SP+LL ANO OVERFILL YEAR iN97ALLED aso TYPE (For bcal ut4 ony) 45, OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 ,,~~ L 1. SPILL CONTAINMEf~/T K Cn.ck ,r m.l spp/y) t ~4 ~ ^ t. ALARM ^ ]. FILL TUBE SNOT OFF VALVE _,r ~- ,, ~~ , . L"`1'2. DROP TUB E LD/. BAIT FLOAT ^ t. EXEMPT SLY,. $TRMEA PlA?E ~_ O6 ~.". V t-•. ~.~ tA! .....i~ I y~. ~ f'~~:!',~. ,a:: . k- ~i~~~ a wr: :.Nk:fiANKLQAfC ... ~ trdt' .it,.:'~.t. ~!i' ~: ~;4;,:,. : '% 1/ SINOL.! WALL TANK (CMdt I/ iMI AtfOfy): 4a3 II OOUat6 WALL TANK OR TANK vV1Tri 6LADOCR (G»c!c ono Rvn uM'X 45•~ ^ 1, VISUAL (E)tA09[O PORTK)N ONLY) ^ S. MANUAL TANK OAUC]INO (A(TG) ^ 1 • VISUAL (SWOLE WALL IN VAULT ONLY) ]. AUTOMATIC TANK QAUGINO (ATG) ^ e. VAOOSE ZONQ ~ 2 G]NTINUOU$ INTERSTRIAL MONRORtNG ]. CONTtN0003 ATO ^ 7. OROUNOWATER ^ ]. MANUAL MONRORINO . a. STATI$TK'/1L IM/E!lTORY RECONCILIATION (SIN) • ^ !. TANK TESTING (~ `{ Cc,~ -~ (~, v p a 5 Ct r:~:tu ~~ ~ ''•: !~ ~' ~• '' t 1r eteNNVU, TANK TnsTUro ^ ~ OTHER Y. TANK CLO>3URII INFORMATION I PtRMANlNT C LO3URQ IN PLACa ~ ._ STIMATEO OAT! LAST Udl0 (YRt1.lOfOAY) 4ee IISTiMATIIO QUANTTN Of SUEBTANC! REMAIlMNO 4ee TANK FILLQO WITH INERT MATERIAL? ~~ ~~ ^ Y« ^ No JJ---- :F (7199) s:ICUPAF~IRUC~ew17CB-A•~~ CITY OF BAKER9ftEL0 ~;~, OfFiCE Of ENVIRONMENTAL SERVICES 'ti 1719 ChtstK Aw., Bak~TSANd, CA 9JJ01 (641) J2d.~o79 (JlT 'TANK /AO! - - - ~ d v~ t•~t~w coNaneucTtoN (cA.al r N.I.Pp/y) . - uNOEROROUNO Ptp1N0 ABOVEGROUND PIPING SYSTEM ryPE , PRESSURE ^ 2. SUCTION ^ ~, GRAVITY 4S6 ~ ^ t PRESSURE ^ 2. SUCTION ^ ~, GRAVITY ~<_ ^ I sINGLe WALL ^ ~. uNEO rRENt:H ^ ~. oTHER 4eo ' ^ t SINGLE WALL ^ ~s. uNKNOtNN CONSTRUCTIOw'~` i a8 MANUFACTURER: ~`• DOUBLE WALL ^ %. UNKNOWN ^ 2. OOUBLE'NALL ^ 99. OTHER ' MANUFACTURER Oat I IuANUFACTURER ,~ ^ t. BARE STEEL ^ 4. FRP COMPATIBLE W1 1007E I~THANOL ^ t. BARE STEEL ^ 6. FRP COMPATIBLE W/ t00% METHANOL MATERULS aN0 ^ 2. STAINLESS STEEL ^ 7, GALVANIZED STEEL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL CORROSION PROTECTION ^ 7• PLASTIC COMPATIBLE WITH CONTENTS ^ 94. UNKNOWN ^ 7. PLASTIC COMPA718LE WITH CONTENTS ^ 8. FLEJ(18LE (HOPE} ^ gg, OTHER ' LU/i. FIBERGLASS ^ e. FLEXIBLE (HOPE) ^ 9p.. OTHER ^ 4. FlBERCLASS ^ 9. CATHODIC PROTECTION ^ S. STEEL W/ COATING ^ 9. CATHODIC PROTECTION 444 ^ S. STEEL W/ COATING ^ 9S. UNKNOWN a6 VIL PrMO LlAiC DETECTION (Gloat w' ~t+pPt)'1 UNDERGROUND PIPING I A80VEGROUNO PIPING - 31140LL WKL P1PINt3 464 ~ PRESSURIZED PIPING (C/t~Gt a/ Nwt atpply): ~ ^ t . ELECTRONIC UNE LEAK DETECTOR 7.0 GPN TEST ~ AUTO PUM+ Si1UT OFF FOR ~ LEAK SYSTEM FAILURE. MO 9YSTE1~1 CCTKk! +AlA6LE At~D VISUAL ALARMS ^ 2. MONTHLY 02 GPM TEST ^ 3. ANNUAL PITEGRITY TEST (0.1 QPH) CONVENTIONAL SUCTION SYSTEMS: ' ^ 5. OA1LY ViSt1AL MONITORING OF PUMPING SYSTEM + TR1EJliA1 PIPWG 1rITE(3RJTY TEST(O.t GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PO'WG): ^ 7. SELF MONRORING i GRAVITY FLOW: i ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) I ~ SECONDARILY CONTAINED %PtNO PRESSURIZED PIPMXi (Clwct a/ Itbaf tpplyf: ' t 0. CONTiNVOU3 TURBINE SUMP 9Ep190R ~1 AUDIBLE AND VISUAL ALARMS ANO (C,rpUc any) C3• /a. AUTO PUMP SHUT OFF 41MEN A LEAK OCCURS ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AAD SYSTFJd DISCONNECTION j ^ c' TIO AUTO PUMP SHUT OFF ~ 17. AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TEST) ~ FLOW SHUT OFF OR RESTRICTION ^ t 2. ANNUAL INTEGRITY TEST (0.1 GPH) SUC710WGRAVRY SY$TE/rt ^ 17. CONTINUOUS SUMP SENSOR + AUOfBLE ANO VISUAL ALAItMB PRESSURIZED PIPING (CASC,t a/ Nuf apply): ^ t. ELECTRONIC UNE LEAK DETECTOR ~.0 GPH TEST SIT}! AUTO Pt;1GP SHUT OFF FOR LEAK, SYSTEM FAILURE. AND SYSTEM DISCONJECT1pN + AUDIBLE AW VISUAL ALARMS ^ I. MONTHLY 02 GPH TEST ^ J. ANNUAL INTEGRITY TEST (0. t GPH) ^ s. GAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Cltsdr M Wl •pPN): ^ S. DAILY VISUAL MONRORING OF PIPING AND PUMPING SYSTEM ^ 6. TRIENNLII INTEGRITY TEST (0.t GpH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONRORING GRAVITY FLOW (CAsch d dt~t appyJ: ^ B. DAILY VISUAL AgNITORING ^ 9. BIENNUl1 INTEGRITY TEST (O.t GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (CAecka'ltltrtt+PNY): t 0. CONTINUOUS TURBINE SUMP SENSOR W~Ttj AUDIBLE ANO VISUAL ALARMS ANO (UteGc One) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c nl0 AUTO PULP SHUT OFF ^ t 1. AUTOMMTIC LEAK DETECTOR ^ 72. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTIOWGRAVRY SYSTEM: ^ t J. CONTIIJl10U3 SUMP SEld30R + AUDIBLE AND VISUAL ALARMS 1!MERGEIVCY OENERATORB ONLY (CAwt Y /fM agbry) EMERGENCY OENERATORB ONLY (CMclc alOtat iPPli9 ^ 14. CONTINUOUS SUMP SENSOR AUTO PUMP SHUT OFF +A1101BLE AND ^ t4. CONTINUOUS SUMP SENSOR AU70 PUMP SHUT OFF + AUDIBLE ANO VISUAL 41$UAL ALAR/.t3 ~~ ^ t 5. AUTOAl1TiC LINE LEAK DETECTOR (J.0 GPH TEST) FLOW SItIIT OFF OPR ^ 1 S. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST} RESTRICTION t,`~Ll~ h0`~.yi:~.oJli~ 1`~tf.5~,•.~rGtiCa ^ t 8. ANNUAL INTEGRITY TEST (0.1 GPH) L a t ^ iB. ANNUAL INTEGRITY TEST (0.7 GPH) ^ t7. DAILY VISUAI. CHECK ^ t7. DAILY VISUAL CHECK .«~.:Y 'itw' ~~ JICd~TAIlIYENT`:'e ~`s,s;i-..I'!'w{,':~ ''Y '~4A,: r...,~'.~~,i''v~3n~,,c~ii .~:.iiU"~:, DISPENSER CONTAINMENT fit. FLOAT MECHANISM THAT SHUTS OFF 9FIEJIR VALVE ^ 4. DAILY VISUAL CHECK i DATE 97ALLE0 464 ^ 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS ^ 9. ' ~~;, ~ ;: ~ ~ ~ ~ ;; z ~;, • i.. t ~ ~,. ^ 7. C.ONTIMIOU9 DISPENSER PAN SENSOR ~ AUTO SHUT OFF FOR DISPENSER + AUDIBLE ANO VISUAL ALARMS 469 DC. CWNER/OPERATOR SI(3NA7URE I CKUIy Ih41 tM mformalbn prov~dW hw4in It Irw l1nA KpXN~ to tM OMI d my kllpr{flQ~, SIGNATURE OF OWNER/OPEFjATf)R/r Q/d/ Q~ DATE ^ ~ ~ ~ D ~ 470 NAME Of OWNEWOPEFU70R (pMq ](fy,( •''/•i/,K' 47t T TREE OF OWNER/OPERATIO/R/ _ 472 (/ / K / PCF (7199) (~~/Vil~,,.e 1r- S:\CUPAF ORMSISWRCB'8 •~ C C1Z'~' OF B~-KERSFIELD OFFICE OF ENVIRONi1t1ENTAL SERVICES ~- , ~' 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 `"-' UNDERGROUND STORAGE TANKS -TANK PAGE t --` ~ ,,,,, ~ ~ P~ --- d ' ,:e'OF aCTtON ^ t. NEW 31T~ P!.'RAAT L~Ya. AJNINOfD PERMIT ^ !. CHANGE OF iNFCRMATtON) ^ e), rEMPORAR~ 41TE CL09URE ~~ ;CMCt ur» ~nm oM'1 O ). RENEW/LL. PlAINIT ^ 7. PERMANENTLv CLOSED ON SITE (SpK/}' iMJOn • .pr ~ocat ua~ ovy) (Softly cMnq~ • +br lxM ut~ Orvy) ^ ~. TANK REMOVED 9USINES9 VAAE (Saen~ at FAGUTY NAME ar OdA • Oaq euaMnaa NI ] FACAlTY 10 t ~ ^~- ~c~t~s ~r ~~~ +- C~~S ~ Loc~.noN w~'rQT-//a~~N SITE (q~a/la^rwJ tt r 1. TANK DESCR1PT10N tl.nn iN• ya I/WR hMfNrA~,IUKtFt •.>J --~~ g~'~ ` GJA,PARTAAENTALIZED TANK ^ Yea No Il 1 ~ C 1 ~~1 T I H'Yes'. oompiM~ ons paq~ for OaU+ catnDartrnMt (far btal raa aM'1 ~:: N. TANK ~tRf TANK USE a3Y PETAOL,PUM TYPE L: -MOTOR VEHICLE PLIEL ^^ is. R£GUTAR uia,EADED O 2 t.eAOED ^ s. rET Fva. ' (NmaMd, tonpN/a PWOMtAr Tom) L!/ti0. P~Al1M UIiFJ1DE0 ^ 3. DIESEL ^ 6. AV1AT10N FUEL ^ i. NoNruEL P£TROL,EUM ^ ,~ MOGRADE uKfADED ^ a. GASOHOL ^ ~. OTHER cor,•~oN tvAl~le (hwn Na>7rtl~ warts rm.~wrafl•J 4.i CAS 1t (hom tuntvblcl,Wtari.is 4,ti.,~ayc+9.~ a. _ ^ a. NAZARDOU9 WASTE (r<rs„osa u~.c oq ^ ~. uNKNOW?l ~ ip. TANK GON3TRU~'liQN TYPE Of TANK ^ 1. SHOIF YNALl ^ 3. $INOLB WALL WITH ^ S. SJNIC'sLE WALL WITH INTERTIAL BL.AOOER SYSTEM ia3 (Ctiack on. +Y.n oNy) ~OOUt9LE WALL EXTERIOR AEMBFAt~ LINER ^ %. UMUgwN ^ •. su~GLe wAU w A vAUT ^ yq, OT}iER TANK MATERIAL - pttmary Olrrt g~,R£ STE0. ^ 1. FtBERGlA33 /PLASTIC ^ S. CONCRETE ^ 4S. UNKNOWN Aa+ (Cnsrx one Rim only) ^ Z. STAINIE$$ STEEL ^ 4. STEEL CLAD W1FtBERGLASS ^ 0. FttP COMPATIBLE wltoox MET}iANOI ^ 99. OTHER ' REINFORCED PLASTIC (FRt~ TANK MATERIAL • Jwoond~ty tank ^ t. BARE STEEL ^ 3. FIBERGLASS! PL/L9T1C ^ !!. FRP COAPATIBLE Yg10p% METHMIOL ^ 95. UNKNOWN 4aS ~i (CMtk °^a 'twn aMyJ ^ L STAM4,F33 STEEL STEEL CLAD W/FIBERGLA33 ^ 4. FRP NqN-CORRpOtgL,E JACi(ET ^ 9D. OTHER REINFORCED PLA3TIC (FRP) ^ 1Q COATED STEEL ^ S. CONCRETE rAwc INTERIOR t.InaNG ^ i. RUBBER LIED ^ > EPOXY L1t+IN0 UNKNOWN 4aE DATE WSTALLED ULrt38 UNItrG ^ 93 ^ s 14T OR COATWG ^ x ALKYD Lf~WO , O •. PHENOLIC LRIR10 . . / ((1.tS. UNUt~D O ~. OTHER G»tIt a,. ~ Far buJ ~. OTHER coRROSaN ^ i. MAruRACTtx~-o anioolc s. FIBERGLASS RENFORCED PLASTIC ^ 9a. trtacl+ovvN uli DATE INSTALLED PROTECTION IF APPLIGISLE .aB PROTECTX)N ^ a. aYwRESSEO a>aRErYT ^ Qo. OTHER (~~ a,. ~ ~r~ ^ ~, sACRrFicIA1 ANOOe (~. kxat ~. onry) SPILL ANO OVERFILL YEAR IN 9 TALLED a50 TYPE (For kxal usa otVy) a3 t OvF3tfB.1 PROTECT1pN EQUIPMENT: YEAR INSTALLED ~2 ,~, / / ; T. 9WU. CONTAINMEt1T -l~_ Cn~ck JM Mgt ippryJ l j ~/ ^ t. ALARM ^ 3. FILL TUBE SHUT OFF VALVE - ., ~ , , L7 2. DROP TUBE ~4 Y [ ^ 2. B ALL FLOAT ^ t. EXEMPT STRp(ER PLATE ~ t~I(~ / ` A ~ 1. ~' F'+. , V' (~ ~ ~_. li 1 4'; ~i V ! ' .~• t 4 • :~x;. ., . :,11k: fi~1NK l.tiAK ,. ..ar': ~. ..t:. ;' ~:.:. •:.. : 'i IF 7JNOI.E MGLL.L TANK (CAaat a/ tMt a00A'1: a63 IF OOUBLQ WALL TANK OR TANK v4TTH BLAnDeR (CMCk or» Rarn onyx as•~ I, VISUAL (EXPOSlD PORTION OId.Y) ^ !. ANNUAL TANK GAUGING (MTO) ^ I. VISUAL (SWOLE WALL IN VAULT ONLY) 2. AUTOMATIC TANK GAUGING (A70) ^ d. VADOSd 7ANE ~+2 CONTINWUS INTERSTfTIAL MONRORINO ], CONTiMIOU>! ATO ^ 7. OROUNOWATF.R LSJ• 3• iWWUA1 MONITORING ~. 7TATISTICAL IM~ENTOtR7 RECONCILIATION (Slfl) + ^ >!. TANK TES71N0 J ` ~ (~, I CC ,1 * t n ~ Q ~ S : CC C:~;~o ~ r '~.-• ~ V ~.., ~ [ Ir t)IENNIAL T.W<TIIO'TINQ ^yq. OTHER V. TANK CLO>3URlI INFORIAATKkJ / PaRW1NlNT CLOSURQ IH PLACII _~ _ lTIMATlO OAT/ LAST US[C (YWItAO/OAY) Ida Q3TiMATEO C~(1AT11'TTY Of SUBSTANCa REAAAINI!!0 ~ TANK FN.LQO WITH INERT MATCRUII ~T ^ YN Q NO :F (7/99) 8:\CUPAFnauetewarB-g•W~~ CITY OF BAKER9f1ELO Of RICE Of ENVIRONMENTAL 9ERVICE9 t71~ CMshlr Aw., Bak~nMld, CA 9)301 (0a1) J2~979 LJtT . TANI( rAOe : ~ P.v. ~, er K !•I/INO CONSTRUCTION (coral r ITtar apply) . uNOEROROUNO P+PINO f ABOVEGROUND PIPING $~SiEM'YP£ t "RESSURE RY ^ 2. SUCTION ^ ]. GRAVITY 4SA i ^ t PRESSURE ^ 2. SUCTION ^ ]. GRAVITY ~: CONSTRUC'tOw'^ I SINGLE WALL ^ 3. LINED TRENCH ^ 90. OTHER 460 ^ + SINGIE'NALL ^ %. UNKNOwN y~ MANUFACTURERI~OOUBIE WAIL ^ 96. UNKNOWN I ^ 2. OOUBLE'NALL ^~49. OTHER ' MANUFACTURER 467 I MANUFACTURER ~ ~ ^ t. BARE 9TEEL ^ B. FRP COMPAT1StF Wl 100lL I~ETFUNOL ^ t. BARE STEEL ^ d. FRP COMPATIBLE WJ 700% METIIANOL ', MATERIALS AND ^ 2. STAINLE93 STEEL ^ 7. OALVANREO STEEL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL j CORROSION PROTECTION ^ ]. PLASTIC COMPATIBLE WITH CONTENTS ^ 96. UNKNOWN ^ ]. PLASTIC COMPATIBLE WITH CONTENTS ^ B. FLEXIBLE (HOPE) ^ 99. OT}iER ~FlBERGLAS9 ^ ti. FLEXIBLE (HOPE) ^ 9D. OTHER ^ 4. FlBERGIaSS ^ 9. GTHOOK; PROTECTON ^ S. STEEL W/ COATING ^ 9. GTHOOtC PROTECTION 464 ^ S. STEEL W/ COATING ^ 93. UNKNOWN 46„ ' VIL P~MIO LE/1K DETECTION (ChacirN anuaoWy) UNOER(s/tOUNO PIPING i ABOVEGROUND PIPING - PRESSURIZED PIPING (Chock a/ dtat apply): ._~_ .....-_ ^ t . ELECTRONIC LINE LEAK DETECTOR ].0 GPH TEST ~ AUTO PUAp SFIIlT OFF FOR LEAK SYSTEM FAILURE. AND SYSTEM DISCONNECTKkI • AL106LE AND VISUAL ALARMS ^ 2. MONTHLY 02 GPM TEST ^ 7. ANNUAL INTEGRRY TEST (0.1 OPFI) CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONRORING OF PUMPING SYSTEM + TR1FlaiA1 PIPWG NTEGRITY TEST(O.t GPfI) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPINGX ^ 7. SELF MONRORING i CRANKY FLOW: 1 ^ 9. BIENNIAL IMEGRRY TEST (0.1 GPH) I I SECOMQARIIY CO~ITALNEO PIPI}q PRESSURIZED PIPING (Clack a/ Ithatapply): t 0. ~CO~N71M1pU3 TURBINE SUMP SENSOR tf~(AUOIBLE /V~D V1,SUA1 /LL~1ftJ~t$ ANp W/' ono) AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ D. AUTO PU-.p SHUT OFF FOR Lf.AlSS. SYSTEM FAN.URE AND SYSTEJ,1 OISCONNECTK)N ' ^ c NO AUTO PUAP SHUT OFF t t. AUTOMATIC LINE LEAK DETECTOR (1.0 GF1i TEST) ~ FLOW SHUT OFF OR RESTRICTION ^ 7 2. ANNUAL INTEGRTTY TEST (0. t GPH) SUCTIOWGRAVITY SYSTEM: ^ 17. CONTINt10U3 SUMP SENSOR • AUDIBLE ANO VISUAL ALARMB E11ER0 ENCI' O ENERATORS ONLY (Cheat aI fW aAdY) ^ 14. CONTINUOUS SUMP SENSOR `~ jj AUTO PUMP SHUL OFF + AU018LE Mp VISUAL ALARMS ^ t 5. AUTOMATIC LINE LEAK DETECTOR (0.0 GPH TEST) FLOW SF1UT OFF OR RESTRICTION , ; ; ~~ ~ ;L ( 1~? C'S`;'. Y ^ t 8. ANNUAL INTEGRTY TEST (0.1 GPH) ^ t 7. GAILY VISUAL CHECK , PRESSURIZED PIPING (CJtsck a/ Mat appy)._ _ ..T_ .....-_ ^ t, ELECTRONIC LINE LEAK DETECTOR ].0 GPH TEST NRT1 AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AAD SYSTEM DISCONNECTION + AU018LE ANO VISUAL ALARIN$ ^ Z MONTHLY 01 GFi1 TEST ^ 3. ANM/AL INTEGRITY TEST (0.1 GPfq ^ 4. OAII.Y VISUAL. CHECK CONVENTIONAL SUCTION SYSTEMS (Chsac alf Mat sppy): ^ 5. DAILY VISUAL MONRORING OF PIPING AND PUMPING SYSTEM ^ 6. TRIENNIAL INTEGRTTY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONRORING CRANKY Flow (cnsck ar lytlr ~1: ^ 8. ONLY VtSL1AL MONRORING ^ 9. BIENNIAL OdTEGRlTY TEST (O.t GFfi) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Clack N tltat apply): t 0. CONTINUOUS TURBINE SUM? SENSOR N!~T j} AUDIBLE AND VISUAL ALARMS AND (cnedc one) ^ a. AUiO PUMP SHUT OFF VJF/EN A LEAK OCCURS ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c NO AUTO PUMP SHUT OFF ^ t t. AUTOMATIC LE/UC DETECTOR ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCT1pNK,RAVRY SYSTEM: ^ 10. CONTINUOV9 SUMP SENSOR + ALIpIBL.E AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (CMCk a/ that apply) ^ 74. CONTINUOUS SUMP SENSOR ~ AlJTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS ^ t5. AUTOMATIC LINE LEAK DETECTOR (].0 GPH TEST) ttl. ANNUAL INTEGRITY TEST (0.1 GPH) 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT 1. FLOAT MECHANISM THAT SHUTS OFF SFIEAR VALVE ^ 1. DAILY VISUAL CHECK I GATE IN TALLEO 4b$ ^ Z. CONTINUOU9 01$PENSER PAN SENSOR+AUQiBLE ANO VISUAL ALARMS ^ S, %-~,~ ~,; ,'. r.:~ :;_~~ z ~.~~° i.: i~~ ~, ® ^ 7. CONTtN0009 DISPENSER PAN SENSOR ~ AUTO SHUT OFF FOR DISPENSER + AUDIBLE ANO VISUAL ALARMS 489 D(. OMVNER/OPERATOR 91ONATURE I urtdy Ihal IM ~nlarmallan WOHdad MraM Is ttua and aaXUata to tM boat of my Iulw74adpa, GATE ~~_2>-~G ?lD PCF (7/99) 471 r sue' Y S:\CUPAFORMSISVVRC&8.~ 0 CITY QF BAKER9FIEL0 OlRFICE Of ENVIRONMENTAL SERVICES ti 1713 CI7Mt~~ Aw., Bak~nANd, CA 9)301 (t3a7) JZ~7979 _r.r. , WT .TANK -AO! Ptlprr ~ 7n, -Iruw coNSTleucTloN rC+~•a r m.r.pply~ . uNDEROROUNO PtPINO ABOVEGROUND PIPING SYSTEM rvPE (J t PRESSURE ^ 2. SUCTION ^ ]. GRAVITY 4$•! ~ ^ I PRESSURE ^ 2. SUCTION ^ ~. GRAytry ~< CONSTRUCTIOw' ^ t SINGL2 WALL ^ 1. LINED TRENCH ^ 9Y. OTHER 160 I ^ t. SINGLE WALL ^ 95. UNKNOWN a~ AMNUFACTURERi^ 2. OOUBLE'+VALL ^ %. UNKNOWN ~ ^ 2. OOUBLE'NALL ^'49. OTHER MANUFACTURER 467 ! MANUFACTURER ~ ^ t. BARE STEEL ^ 6. FRP CAMPATISLE W/ 70071 tvET1•U1NOL MATERULS ANO ^ 2, gTAINLESS STEEL ^ 1. GALVANIZED STEEL CORROSION PROTECTION ^ 7. PLASTIC COMPATIBLE WITH CONTENTS ^ %. UNKNOWN ^ 4. FIBERGLASS ^ 6. FLEXIBLE (HOPE) ^ 99. OTHER ^ S. STEEL W/ COATING ^ 9. CATHODIC PROTECTION 464 ^ t. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100% METlIANOL ^ 2. STAINLESS STEEL ^ 1. GALVANIZED STEEL ^ ~. P(.4STIC COINPATIBI.E WITH CONTENTS ^ 8. FLEXIBLE (HOPE) ^ 99. OTHER ^ •. FIBERGLASS ^ 9. CATHODIC PROTECTION ^ S. STEEL W/ COATING ^ %. UNKNOWN 45; VM, PN~NG L!A!C DETECTION lCJwctr ar tMt apply) _ UNDERGROUND PIPING WALL P1W 466 ~ PRESSURIZED PIPING (C1tuJt a/ mat apply): ~ ^ t . ELECTRONIC LINE LEAK DETECTOR 7.0 GPH TEST ~{ AUTO PU6P 3NlIT OFF FOR LEAK SYSTEM FAILURE, ANO SYSTEM OLlECT10N • AU06LP AHp VtStIAL ALARMS ^ 2. MONTHLY 02 GPH TEST ^ 3. ANNUAL rNTEGRITY TEST (0.7 GPH) CONVENTIONAL SUCTION SYSTEMS: ^ 5. ONLY VISUAL MONRORING OF PUMPING SYSTEM + TRIENNIAL PTPV4G RdTEGRRY TEST(O.t GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPWG): i ^ 7. SELF MONRORING i GRAVm FLOW: ~ ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) I SECONDARILY CONTAINED PtP7N0 PRESSURIZED PIPfN(' (CINCk a/ mat apply): t 0. CONTINUOUS TURBINE SUMP SENSOR X1),1 AUDIBLE AND VISWL ALARfrt3 ANO (Ct~eoc ono) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTFJd DISCONNECTION ^ c NO AUTO PUMP SHUT OFF ^ t t, AUTOMATIC LINE LEAK DETECTOR (1.0 GPH TEST) '~ FLOW SHUT OFF OR RESTRICTION ^ t 2. ANNUAL INTEGRITY TEST (0. t GP}I) SUCTK)WGRAVITY SYSTEM: ^ t J. C,ONTiMIOUS SUMP SENSOR • AUOIBL.E ANO VISUAL ALAtiA/8 EMERO ENCY 0 ENlRATORS ONLY {CMat a/ 1Mt apply) ^ t 4. CONTINUOUS SUMP SENSOR AUTO PUMP SHUT OFF • AU018LE AND VISUAL ALARMS ^ t 5. AUTOMATIC LINE LEAK DETECTOR (7.0 GPH TEST) ~ FLOW SF1lIT OFF OR RESTRICTON ~• ~O VI'~i:`. 011(11 i•`. ('.t\`. ,r 4ti .. ^ t8. ANNUAL iNTEGRTTY TEST (O.t GPH) ^ 17. DAILY VISUAL CHECK PRESSURIZED PIPING (CAeca a/ Mar apply): ~~ ..~~ .., ..._ .,, l ^ 1. ELECTRONIC LINE LEAK DETECTOR J.0 GPH TEST ~ AUTO PUMP SHUT OFF FOR LFJJC SYSTEM FAILURE. AND SYSTEM DLSCONNECTTON • AUDIBLE AND VLSUAL ALARMS ^ t MONTHLY 02 GPH TEST ^ a. ANNULI. INTEGRITY TEST (a t GPH) ^ 4. DAILY VISUAL CHECK WNVEM1pNA1 SUCTION SYSTEMS (Cltsdrt a/ mat sppy): ^ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING ^ 7. SELF MONRORING GRAVrTY FLOW (CAxX a1 mar aPWi~l: ^ B. DAILY VISUAL MOMTORING ^ 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTA)NED PIPING PRESSURQEO PIPING (CAeck d mat apply): 70. CONTINUOUS TURBINE SUMP SENSOR ITT AUDIBLE ANO VISUAL ALARMS AND (O11eCIC One) ^ a. AUTO PUMP SHUT OFF WHEN A LFJUC OCCURS ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c NO AUTO PUMP SHUT OFF ^ t t. AUTOMATIC LEAK DETECTOR ^ 72. ANNUALINTEGRRYTE$T(O.iGPH) SUCT70N/GRAVITY SYSTEM ^ 11. CONTINl10U3 SUMP SENSOR • AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (CAack a/ mat apply) ^ 14. CONTINUOUS SUMP SENSOR ~ AUTO PUMP SHUT OFF + AUDIBLE ANO VISUAL ALARMS ^ t5. AUTOMATIC LINE LEAK DETECTOR (~.0 GPH TEST) t B. ANNUAL INTEGRITY TEST (0.7 GPH) t 7. DAILY VISUAL CHECK DISPENSER CONTAINMENT ^ 1. FLOAT MECHANL7IM THAT SHUTS OFF St1fJ1R VALVE ^ 4. DAILY VI$ilA1 CHECK i DATE INSTALLED 466 ^ 2. CAN71NUW9 D19P£NSER PAN SENBOR • ALIDI8IE AND VISUAL ALARMS ^ S, ~: ~~;~ rj r ^_~ :,~ :ice :; ~ ~~+.;' , i.: L ~ C,. ^ ~. C.ONTOVUOUS DISPENSER PAN SENSOR ]~ AUTO SHUT OFF FOR DISPENSER • AUDIBLE ANO VISUAL ALARMS 469 DL dWNER/OPERATOR SIGNATURE t only th4t IM ~nhxmallbn proHOaO hudrt la Ina an6 acturHa to tM DaH d my IutpwM1Wpa, SIGNATURE OF OWNER/OPERATOR DATE 470 (per/) ut PCF (7/99) ABOVEGROUND PIPING 472 S:\CUPAFORMSISWRCB-B.~ C \~~ ~ ' + R~~-~ ' -_-- ""ART =__- ~y J/~ _____________ SiteID: 015-021-002468 + Manager RA ~~~/~~n ~~~ BusPhone: (661) 861-1614 Location: 801 E CALIFORNIA AVE Map 103 CommHaz Moderate City BAKERSFIELD ~ Grid: 32A FacUnits: 1 AOV: CommCode: BFD STA 02 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title R.~r.Tti,T,~r~T -' / OWNER S,~~Z%'~f/ ~.~~ / ~~~ Business Phone: (661) 861-1614x Business Phone: (~pl~ ~/- ~G'~~fx 24 -Hour Phone (~6-63-~ - 24 -Hour Phone (,S'~~2) ~~'S ~-O Pager Phone ( ) - x Pager Phone ( ) - 'x Hazmat Hazards: Fire ImmHlth DelHlth +------------------ ~ t &AwFT nt C ---------- -------------------------------------- ------ Iy (~c'1r ~ ~ ~~_ TNr~a- j yt-'t ~1 Ph ( 6 61) ~=-3~--- , o ac Mai lAddr : a o ~ 5 L r .. ~ " z-~~T Z,~O 6 V~u°!r~ ~il'~ `~ one : ~~ ~~.~° • State : CA ~'7~ QQ ~~ City B~'K R~SF~IELD I/~~ ~~1 ~ ~ ~~ r ~G Zip 93313 +------------------ TT•TL'T C~ a Cev T +e ------ t------------------------------------------+ TTTl~v f'Gf h~ ri~~ ~~y Owner ~ - ~` Phone : ( 6 61) 8.3~•-8~x ~`~ Address T 2g6(o (,fl+ev~a G~t~°~ State: CA ~''S`72-Qa~tio City -E~~~` TELD _~`,' ~ ~ ~ ~ Zip 93313 +----------=------- ------ Gt ~- -v ` -------- Period to Preparers Certif'd: ParcelNo: TotalASTs: _ TotalUSTs: _ Gal Gal RSs: No Emergency Directives: PROG A - HAZMAT PROG U - UST ~3a~~d ~n my inquirs~ hf thr...~e in~lvlduals respon~ibl~ fir Qbtalnln~ :H~ 3n~rtfl~tlt~n> I e~artlfy und€~r ppnaity ~f I~wr t~~i ( h~v~ per~Qrt~lly examined and am f~rr1111~r Yalth 4h1~ informmti0n submitted aid b~lleve the inferr~atien is true, accurate, and cempl e, ,~i/f7 Signature Da e ~ ~oo~ -1- 04/03/2006 }` UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program -, ~~ .~ r i,.... ~ ~,,, „ ~~~oc l~~ w _~cltr__ _.-~~-~ -- _------- ~ ?30~-------- FAC Bakersfield Fire Dept. Enironmentai Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 PHONE No. No. of Employees Business ID Number t 15-~21- Section 1: Business Plan and Inventory Pn~gram ^ Routine ombined ^ Joint Agency ^Mnlti-Agency ^ Complaint ^ Re-inspection C ~ lV=Voatlonnce~ OPERATION COMMENTS / ^ A M PPROPRIATE PERMIT ON HAND ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE LY ^ VISIBLE ADDRESS ~d ^ CORRECT OCCUPANCY ~ ^ ~ VERIFICATION OF INVENTORY MATERIALS ENS-M A-R--a-'~ -x-88 --_ _ .. ----_ _ __ _ _- _ _ _ ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ ~ VERIFICATION OF MSDS AVAILABILITYE ~n ~5~- C ^ L~l/ V ERIFIGATION OF HAT MAT TRAINING - ,1 ~~~ ~~5 l -- --- ^ ^ - ----- ----- ---- -_- ----- _._ .-- . --- -- - - VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES _ "'------- -..._.._. _ __ .. _..--- -... - --- ..... __... --- - -~y~ -~. ""r ~ ~®~ ------ ^ ^ -------------------------- ---------- -- EMERGENCY PROCEDURES ADEQUATE -~ _- - --.. - - - --- t~ 4J" CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ LW FIRE PROTECTION - - pp,, ~~y, - l ` _ -I~t15Y~~~'~~ 1~___~1t~-. -- - _ _. _. _ --- _ . .. _ -- ---- ^ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE: ^ YES ^ NO EXPLAIN: QUESTIO REGARDIN THIS INSPECTIONS PLEASE CALL US AT (661) 328-3979 t Inspec or Badge No., White -Environmental Services Yellow -Stettin Copy --_------~ ~Basirtess esponsibleParty-_- Pink -Business Copy .a.LD ~; ,',~w~~'. T~d~~ ~ ~ CITY OF BAKERSFIELD FIRE DEPARTMENT `d ~~ OFFICE OF ENVIRONMENTAL SERVICES ~`A \ , .y~~ ~ UNIFIED PROGRAM INSPECTION CHECKLIST ~=_wE` ~~~,d~ 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~fj ~~~~5 ~,~ ~ INSPECTION DATE Section 2: Underground Storage Tanks Program ^ Routine f~'Combined ^ Joint Agency Type of Tank ~a}~eS Type of Monitoring C~ LPn. ^ Multi-Agency ^ Complaint ^ Re-inspection Number of Tanks Type of Piping D0.?l= OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data on file Permit tees current Certification of Financial Responsibility Monitoring record adequate and current ~t #Qr ~ ' Maintenance records adequate and current J5~ ' Failure to correct prior UST violations 'U 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 lRs OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance ;~/=Violation Y=Yes N=NO ;' Inspector: Office of Environmental Services (805) 326-3979 White - Fnv. Svcs. Pink -Business Copy Business Site Responsible Party