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Home My WebLink AboutBUSINESS PLAN_~` - ~7-ELEVEN 32241 c i ~-4101-GALLOWAY DR °° City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (805) 326-3979 An upgrade compliance certificate " has been issued in connection with the operating permit for the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to the issuing agency: Use the space below to enter the following information inthe format of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. This permit is issued on this 2na day of November, 1998 to: 7 ELEVEN #32241 Permit #0][5-021-001884 4101 Calloway Dr Bakersfield, California 93312 _- '` - - Prevention Services r"'i1NIFIED PROGRAM INSPECTION CHECKLIST R r R S F , ,; 900'IYuxtun Ave., suite 210 _ - _ F~Re - Bakersfield, CA 93301_ SECTION 1; BuSin@SS Plan 1110 InV@11t01'~/ Program aRrM Tel.: (661) 326-3979 " Fax: (661) 872-2171 FACILITY NAME /~ ^ INSP TE INSPECTION TIME ~ ~ ~ ~ ~ ~~ C,hJ /(/J`' ~ ~~ A C! ^(' ADDRESS PHONE NO. NO OF EMPLOYEES ( 58?~~~a6 '-- FACILITY CONTACT - USINESS ID NUMBER - 15-021- (~~ Section 1: Business Plan and Inventory Program ^ ROUTINE OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ( C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ~ -; ~~ ~ `~~~ f~ ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL I~ ^ 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: QUESTIQ~~fS REGA~IN~a THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ^ YES ~' NO (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # ite /Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 ;`~.,,,~ INSPECTIONS BUSINESS PLAN & INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: ~_[ H i E R S F 1 L D F/IPE A li< TM T Section 2: Underground Storage Tanks Program 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: ~~ ^ Routine mbined ^- Joint Agency ^ Multi-Agency omplaint ^ Re-Inspection Type of Tank Number of Tanks Type of Monitoring C,GY~. Type of Piping b~W~ 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 /overspill protection? C =Compliance V = Violat'on Y =Yes N = No i~ Inspector: Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services e esponsible Party Pink -Business Copy KBF-7335 FD 2156 (Rev. 09/05) :~ ~yf. , F 7-ELEVEN 32241 (GALLOWAY) Manager S Jwr,~~- Ec Pnl~ Location: 4101 GALLOWAY DR City BAKERSFIELD CommCode: KCFD STA 65 EPA Numb : ~ /.~. L, ~0~,7 SiteID: 015-021-001884 BusPhone: (661) 587-8826 Map 102 CommHaz Moderate Grid: 19B FacUnits: 1 AOV: SIC Code:5541 DunnBrad:00-734-7602 Emergency Contact / Title Emergency Contact / Title SHINDA UPPLE / FRANCHISEE 7-ELEVEN EMERGENCY / DISPATCH I Business Phone: (661) 587-8826x Business Phone: (800) 828-0711x 24-Hour Phone (800) 828-0711x 24-Hour Phone (800) 828-0711x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact " "` T "~ Randy Martin Phone ~ ~ - '~i70 MailAddr: PO BOX 711 State: TX City DALLAS Zip 75221-0711 Owner 7 -ELEVEN INC X33"~g~'~~hone : ( 7 ^'' ` '''' ^ '" ~,Qx 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 r'~ased on my inquiry of those individuals responsible for obtaining the information, I certify ~ under pena o law t t I have personally examined nd fa ' iar with the information ~~$ 2 Zpp' submit a beli a th ,information is true, accu~ e, d com~ai'ete z 6 0,~ gnature Date -1- 01/24/2007 ..~ i . ~ .. -. F 7-ELEVEN 32241 (GALLOWAY) SiteID: 015-021-001884 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: Total Tanks 3 IndnRes/Trust : No PA Contact : raj-lj//S-UC- Dsg Own/Oper cuTrmn rTr„~IrE ~-A~ n~06 ~ ~~~ ICC Nbr •-~~~~~ FACILITY/SITE INFORMATION Business Name: 7-ELEVEN 32241 (GALLOWAY) Cross Street Business Type: Org Type: - PROPERTY OWNER INFORMATION Name 7-Eleven, Inc. •-~zC.~ Phone: Address: City Type Name Address: City Type Gasoline Acctg. P. O. Box 711 ~ state: zip: Dallas, TX 75221-0711 ~ ~' - TANK OWNER INFORMATION 7-ELEVEN ~~PFC~ 7-Eleven, InC. Phone: Gasoline Acctg. P. O. Box 711 zip: CORPORATION Dallas, TX 75221-0711 BOE UST Fee# 31896 Financ'1 Resp: INSURANCE Legal Notif Property Owner Mailing Address Date:03/28/2006 ~~~~ ~7~- %i~ a Phone : (~) -8-6-6- _--~ Name : 5-x~~-~R~-~GEiRandy Martin Ttl :GASOLINE & ENVIRON COMPLIANCE MGR State UST # - 1998 Upg Cert#: as3- -7R[~-~i7v ~~ 2'8~~x_ X53- X4(0• -7~ 70 -2- 01/24/2007 ;~ , F 7-ELEVEN 32241 (GALLOWAY) SiteID: 015-021-001884 ~ ~ 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 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- 01/24/2007 -4- 01/24/2007 J F 7-ELEVEN 32241 (GALLOWAY) SiteID: 015-021-001884 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: NE CRNR PARKING LOT CAS# 8006619 STATE T TYPE '~ PRESSURE TEMPERATURE ~~ CONTAINER TYPE Liquid I Mixture I Ambient ~ Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000..00 GAL 10000.00 GAL 10000.00 GAL nt~~ritcLUU~ ~ul~irulvl;iv~l~ °sWt . RS CAS# 100.00 Gasoline No 8006619 tlHGHKL L-~7aL' S51~11=,1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: NE CRNR PARKING LOT CAS# 8006619 Liquid TMixture ~AmbRient~E ~ AmbientT~E I UNDEROGROIUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL I 10000.00 GAL riEiGl-1ttLUU~J ~.ulnrulvr~lyl~ °sWt . RS CAS# 100.00 Gasoline No 8006619 ti1~GE~1[L 1-~7.7L" J:u1~1L" 1V 1 TSecret RS BioHaz Radioactive/Amount EPA. Hazards NFPA USDOT#, MCP No No No No/ Curies / / / Mod -5- 01/24/2007 F 7-ELEVEN 32241 (GALLOWAY) SiteID: 015-021-001884 ~ ~ 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: NE CRNR PARKING LOT CAS# 8006619 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient ~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 10000.00 GAL nr,ZARDOU5 COMPONENTS %Wt• RS CAS# 100.00 Gasoline No 8006619 I31iGt1RL ti~7 J L' JJ1"1L'1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod ~ Inventory Item 0006 COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Location within this Facility Unit STATE TYPE PRESSURE _ Gas Pure_ ~-Above Ambient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 124-38-9 TEMPERATURE CONTAINER TYPE Cryogenic INSUL.TANK / CRYOGENIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1275.00 FT3 1275.00 FT3 1275.00 FT3 HAZARDOUS COMPONENTS - %Wt. 100.00 Carbon Dioxide HA RS) CAS# No 124389 ZARD AS SESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -6- 01/24/2007 F 7-ELEVEN 32241 (GALLOWAY) SiteID: 015-021-001884 ~ ~ 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 Waste Ambient Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GAL riEiGHKLV U.7 1.V1~lYUlV I;1V 1 b %Wt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No riAGt1KL H5 5L' ~ 51~1L' 1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH ~ / / / UnR ~ 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 -~mbient ~ Ambient DRUM/BARREL-METALLIC AMOUNTS P.T THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GAL ntiG[itcLVUJ ~vlnrvl.VrJiv1~ %Wt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No t11~G1'~1CL H~5J;J51~1J;1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / UnR -7- 01/24/2007 F 7-ELEVEN 32241 (GALLOWAY) SiteID: 015-021-001884 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 04/26/2006 AFTER CALLING 911, THE BAKERSFIELD FIRE DEPT WILL BE NOTIFIED ALONG WITH THE CALIFORNIA STATE OFFICE OF EMERGENCY SERVICES 800-852-7550. Employee Notif./Evacuation THE STORE ATTENDANT WILL NOTIFY OTHER THAT THE BUILDING MUST BE EVACUATED. FRONT DOORS TO THE EVACUATION STAGING 07/17/1998 EMPLOYEES AND CUSTOMERS BY A SHOUT ALL PERSONS MUST EVACUATE THROUGH THE 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 04/26/2006 MINOR INJURIES WILL BE TREATED USING THE FIRST AID KIT LOCATED INSIDE THE STORE. THE CLOSEST MEDICAL FACILITY IS BAKERSFIELD MEMORIAL HOSPITAL, 420 34TH ST, 327-1792. -8- 01/24/2007 F 7-ELEVEN 32241 (GALLOWAY) SiteID: 015-021-001884 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 04/26/2006 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 EMS3500 MONITORNING SYSTEM. TANK TURBINES ARE EQUIPPED WITH LEAK DETECTORS WHICH RESTRICT FLOW IF A LEAK IS DETECTED BENEATH FUEL DISPENSERS OR ALONG PIPING RUNS. ~~.ea~~d~~GS '36~ 9 9 Release Containment 04/26/2006 KITTY LITTER, LOCATED INSIDE THE STORE AT THE LOCATION SHOWN ON THE FACILITY DIAGRAM, IS TO BE USED FOR SMALL FUEL SPILLS (LESS THAT 5 GAL). THE BAKERSFIELD FIRE DEPT WILL RESPOND TO LARGER FUEL SPILLS BY PLACING SAND OR ABSORBENT ON THE SPILL. Clean Up 04/26/2006 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- 01/24/2007 -. F 7-ELEVEN 32241 (GALLOWAY) SiteID: 015-021-001884 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ a~JCC~ 1d1 11dGdl U5 Utility Shut-Offs 04/26/2006 A) GAS - N/A B) ELECTRICAL - OUTSIDE SW CRNR OF BLDG C) WATER - NW CRNR OF PROP IN PLANTER NEAR DRIVEWAY APPROACH D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 04/26/2006 NEAREST FIRE HYDRANT - NE CRNR OF PROP IN PLANTER. Building Occupancy Level 04/04/2006 6 EMPLOYEES -1.0- 01/24/2007 i . ~. F 7-ELEVEN 32241 (GALLOWAY) SiteID: 015-021-001884 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 04%26/2006 ~ MSDS SHEETS ON FILE. 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, HAZARDOUS WASTE PROCEDURES, MONITORING EQUIPMENT OPERATION-AND ALARM RESPONSE PROCEDURES. TRAINING IS CONDUCTED ANNUALLY; OR WITHIN 30 DAYS FOR NEW EMPLOYEES, BY THE DESIGNATED OPERATOR. rage nciu tvi. r u~uiC use nciu i~.L r u~uic u~c -11- 01/24/2007 7-ELEVEN 32241 (GALLOWAY) SiteID: 015-021-001884 Manager SHINDA UPPLE BusPhone: (661) 587-8826 Location: 4101 GALLOWAY DR Map 102 CommHaz Moderate City BAKERSFIELD Grid: 19B FacUnits: 1 AOV: CommCode: KCFD STA 65 SIC Code:5541 EPA Numb: CAL000274247 DunnBrad:00-734-7602 Emergency Contact / Title Emergency Contact / Title SHINDA UP PLE / FRANCHISEE DISPATCH I / Business Phone: (661) 587-8826x Business Phone: (800) 828-0711x 24-Hour Phone (800) 828-0711x 24-Hour Phone (800) 828-0711x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact RANDY MARTIN Phone: (253) 769-7170x MailAddr: PO BOX 711 State: TX City DALLAS Zip 75221-0711 Owner 7-ELEVEN INC Phone: (253) 769-7170x 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 sased on my inquiry of those individuals PROG U - UST respon; ible 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, an :, ~ lete. S' r .~ - a.~~. ~/ ENT'D A U G 2 0 2007 -1- 06/29/2007 F 7-ELEVEN 32241 (GALLOWAY) SiteID: 015-021-001884 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7-ELEVEN 32241 (GALLOWAY) Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper IAN MOOREHEAD ICC Nbr: 5250115-UC PROPERTY OWNER INFORMATION Name ~-G ~irr-e-r, ~lC, Phone : ( 8~6-Q ) $~ 8 =~73-i-X Address : ,D. b ~ ~ dyG `7 // - ~ ~v ~%n.~ G:c=~~ ~ 3 '7~'~ ~ ~ ~ 7 (~ City (~~,Q~,Qv State: ~ y~ Zip: ~~~~/-0 7 /1 Type CORPORATION / TANK OWNER INFORMATION Name -B-I-S-P~A~ `~- ~~,-~ /~,r~ . Phone : (-8-0.8-} -8.28-(~-7~1-x-~ Address : ~Q . ,~ja-)L ~//- C Ada Cvna C~,~`~ °Z~~ ~~1 Co- `7i 7~ City ~ju,~~~ State~~ Zip: ~,~.~~/, o ~~J Type CORPORATION BOE UST Fee# 31896 Financ~l Resp: INSURANCE Legal Notif _ _ ~„ , _ _ Date:03/28f 2006 Phone: (~-2~•) ~-7~ 7-8- x Name:RANDY MARTIN Ttl:GASOLINE & ENVIRON COMPLIANCE MGR State UST # 1998 Upg Cert#: -2- 06/29/2007 ,. F 7-ELEVEN 32241 (GALLOWAY) SiteTD: 015-021-001884 ~ ~ 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 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 32241 (GALLOWAY) ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME GASOLINE Location within this Facility Unit NE CRNR PARKING LOT STATE TYPE PRESSURE Liquid TMixture ~ Ambient AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 10000.00 GAL HAZARDOUS COMPONENTS °sWt. RS CAS# 100.00 Gasoline No 8006619 r~~t~ttL rya a G ~ ai~i~iv 1 a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME GASOLINE Location within this Facility Unit NE CRNR PARKING LOT STATE TYPE T PRESSURE Liquid Mixture Ambient SiteID: 015-021-001884 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 8006619 TEMPERATURE CONTAINER TYPE Ambient ~ UNDER GROUND TANK Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 8006619 TEMPERATURE CONTAINER TYPE Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum l Daily Average 10000.00 GAL 10000.00 GAL 10000.00 GAL nl"l~ll"~J.~JUU1~ `..UlY~rULV LJIV l 1.~. %Wt. RS CAS# 100.00 Gasoline No 8006619 riHGEitCL 1~. 7.7~.7.71~1L" 1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod -5- 06/29/2007 F 7-ELEVEN 32241 (GALLOWAY) ~ Inventory Item 0003 ~ COMMON NAME / CHEMICAL NAME I GASOLINE Location within this Facility Unit NE CRNR PARKING LOT SiteID: 015-021-001884 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 8006619 STATE TYPE PRESSURE TEMPERATURE ~~ CONTAINER TYPE Liquid TMixtur~ Ambient Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 10000.00 GAL ntiGtitCLVU~J l..Vl"lYV1VP~1V1.7 %Wt. RS CAS# 100.00 Gasoline No 8006619 I1HG1itCL tiJ .7Law7J1"1P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod ~ 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# ~~ ~ ~-e~/C /1_.d 0~'-'1 12 4 - 3 8 - 9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE .~e-(~~~ Pure Above Ambient Cryogenic INSUL.TANK / CRYOGENIC AMOUNTS AT THIS LOCATION La~/rgest Container Daily Maximum Daily Average T ~V ~ bs ~ -~ ~ ~ ~ n n ~m3 Ada l bs .1~~-~ . ^-v"v--~L'z"'-.z- Lb ~ ~5 l 7'~ ~ . n n ~~ HAZARDOUS COMPONENTS oWt. 100.00 Carbon Dioxide RSI CAS# No 124389 i'1tiGtil.CL ti~ 7.71',J Jl`7L' 1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -6- 06/29/2007 F 7-ELEVEN 32241 (GALLOWAY) SiteID: 015-021-001884 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FLANIMABLE LIQUIDS/SOLVENT Days On Site 365 Location within this Facility Unit Map: Grid: NEAR TRASH ENCLOSURE CAS# Liquid TWaste ~AmbRient~E ~ AmbientT~E DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum ~ Daily Average 55.00 GAL 55.00 GAL 25.00 GAL t1AGHKLU U.7 1..U1~1rUlV J;1V 1 D %Wt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No nti~r~l<.1~ rj~alJa~ri~ivla TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / UnR ~ Inventory Item 0005 COMMON NAME / CHEMICAL NAME WASTE ABSORBANT Location within this Facility Unit NEAR TRASH ENCLOSURE Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# ~SolidE TWaste ~Ambient~E T AmbientT~E DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION - Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GAL n[iGtutUVU.7 ~.U1~1rUlv~ly 1 ~ %Wt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No IIHGHYGL 1-~~ .71;J.7P71:S1V-l.~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / UriR -7- 06/29/2007 F 7-ELEVEN 32241 (GALLOWAY) SitelD: 015-021-001884 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 04/26/2006 AFTER CALLING 911, THE BAKERSFIELD FIRE DEPT WILL BE NOTIFIED ALONG WITH THE CALIFORNIA STATE OFFICE OF EMERGENCY SERVICES 800-852-7550. 9 9 Employee Notif./Evacuation 07/17/1998 THE STORE ATTENDANT WILL NOTIFY OTHER EMPLOYEES AND CUSTOMERS BY A SHOUT THAT THE BUILDING 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 04/26/2006 MINOR INJURIES WILL BE TREATED USING THE FIRST AID KIT LOCATED INSIDE THE STORE. THE CLOSEST MEDICAL FACILITY IS BAKERSFIELD MEMORIAL HOSPITAL, 420 34TH ST, 32'7-1792. -8- 06/29/2007 F 7-ELEVEN 32241 (GALLOWAY) SitelD: 015-021-001884 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 MONITORNING SYSTEM. TANK TURBINES ARE EQUIPPED WITH LEAK DETECTORS WHICH RESTRICT FLOW IF A LEAK IS DETECTED BENEATH FUEL DISPENSERS OR ALONG PIPING RUNS. 9 9 = Release Containment 04/26/2006 KITTY LITTER, LOCATED INSIDE THE STORE AT THE LOCATION SHOWN ON THE FACILITY DIAGRAM, IS TO BE USED FOR SMALL FUEL SPILLS (LESS THAT 5 GAL). THE BAKERSFIELD FIRE DEPT WILL RESPOND TO LARGER FUEL SPILLS BY PLACING SAND OR ABSORBENT ON THE SPILL. Clean Up 04/26/2006 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 32241 (GALLOWAY) SiteID: 015-021-001884 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ apecldl nciGcLLUS Utility Shut-Offs 04/26/2006 A) GAS .- N/A B) ELECTRICAL - OUTSIDE SW CRNR OF BLDG C) WATER - NW CRNR OF PROP IN PLANTER NEAR DRIVEWAY APPROACH D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water NEAREST FIRE HYDRANT - NE CRNR OF PROP IN PLANTER. 04/26/2006 Building Occupancy Level 04/04/2006 6 EMPLOYEES -10- 06/29/2007 a• F 7-ELEVEN 32241 (GALLOWAY) SiteID: 015-021-001884 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 04/26/2006 ~ MSDS SHEETS ON FILE. 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, HAZARDOUS WASTE PROCEDURES, MONITORING EQUIPMENT OPERATION AND ALARM RESPONSE PROCEDURES. TRAINING IS CONDUCTED ANNUALLY, OR WITHIN 30 DAYS FOR NEW EMPLOYEES, BY THE DESIGNATED OPERATOR. YdC~C L Held for Future Use Held for Future Use -11- 06/29/2007 ' BAHERSFIELD FIRE DEPT ~ , ~ -° _°~ ~; ~., . p Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST ~ ~~t~ 90oTruxtunAve., Sulte210 .~~ ~.<~~,. ,~~,~.,.M .~ . x,.: ,~ . ,, ... ,. _: ....,.::. ~ ~Rrr Bakersfield. CA 93301 j _ .SECTION 1: Business~Plan and Inventory Program y Tel.: (661) 326-3979 4,l ' Fax: (661) 872-2171 l~ (~' t FACILITY NAME -CC NSP TION ATE NSPEC710N 71ME ADDRESS HO ENO. O OF EMPLOY ~ 1 ~~ FACILITY CONTACT USINESS ID NUMBER Section 1: Business Plan and Inventory Program ^~ ROUTINE OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT O RE-INSPECTION C V (C=Compliance OPERATION V_Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND BUSIneSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION C 7 ~y J( C PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY __ ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PRO DURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE S ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES C?.~KIO EXPLAIN: - _ - -- -- O EGAR IN THIS INSPECTION? PLEASE CALL US AT (881) 328-3979 (Please Print) Fire Prevention / 1" In /Shift of Sfte/Station fF Hess Site/Sc a es siWe Parry (Please Print) White -Prevention Sorvices Yellow -Station Copy Pink - Buainese Copy FD2049 (Rw. 02/t?5) rq i. ~ ~ ~i ~ ~a ~ ~ rn ~ W y,1 ~e ~~ i~ w ~R~i~ FACILITY NAME ~ " ~ CITY OF RAI~ERSFIE[.U F IRE DEPARTMENT OFFICE OF I;NVIRONMEN'I'AL SF,RV[C:ES UNIFIED PROGRAM INSPECTION CHF,CKLIST 1715 Chester Ave., 3r`' Floor, Bakersfield, CA 93301 INSPEC"TION DATE ~ ~ 1 Section 2: underground Storage Tanks Program ^ Routine ~ombined ^ Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection Type of Tank --#~~ ~ Number of "Tanks Type of Monitoring ~, L 6V~ Type of Piping _~. OPERAT'lON C V COMMENTS Proper tank data on file Proper owner/operator data un 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 c 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 OF,S Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection'? C=Compliance =Violation Y=Yes N=NO Inspector: Office of Environmental Services (661) 326-3979 white -Env. Svcs. ..~'' tness Site Respons• e Party Pink -Business Copy ~'t - .4 + 7-ELEVEN 2125-32241 _________________________________ SiteID: 015-021-001884 + Manager BusPhone: (661) 587-8826 Location: 4101 GALLOWAY DR Map 102 CommHaz Moderate City BAKERSFIELD Grid: 19B FacUnits: 1 AOV: CommCode: KCFD STA 65 SIC Code:5541 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title / STORE MANAGER DISPATCH I / EMERGENCY SERV Business Phone: (661) 587-8826x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone (800) 828-0711x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Contact ~ Phone: (877) 711-4422x MailAddr: PO BOX ~Y~077 7~ State: TX /~ City DALLAS Zip / fo 75221 ~d~7~ 7 +- ---------------------------------- ---- - - l1iQ --+ Owner 7-ELEVEN INC Phone: (877) 711-4422x Address PO BOX 2 ~~) State: TX City DALLAS Zip 75221 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ PROG A - HAZMAT PROG U - UST /'~,~~~ ~~~ ~ ' U . ENT'D ~~~ z ~ 2 006 0~ ~d C$ 0 Based on my inquiry of those individuals (~ responsible for obtaining the information, I certify ~V under penalty of law that I have personally / ~ ~~-- examined and am familiar with the information ` J ~ ~~ submitted and believe the information is true, ~~ 1 accurate, and complete. ~~~ -~ ig tune Date -1- 04/04/2006 ELEYEIf ~Y 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 =~Eleven_#32241,-41,01-Calloway-Dry 7-Eleven #32376, 9600 Brimhall Rd. Enclosed are: ^ Business Plan ^ Business Activities ^ Business Owner/Operator Identification ^ Hazardous Materials Chemical Inventory ® Underground Storage Tank -Facility ^ Underground Storage Tank -Tank Comments: Shane Partridge Gasoline & Environmental Compliance Manager 702-270-7160 ^ Emergency Response Plan ^ Written Monitoring Procedures ^ Site Map ^ Owner/Operator Agreement ^ Test Results - ® Other: Financial Responsibility Rachel Rodriguez Sr. Administrative Assist t 503-977-7745 ~.E~,; °. r~,n State of California For State Use Only n"'% State of Water Resources Control Board Division of Clean Water Programs P.O. Box 944212 ~•~,.owN • 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 ® 2 million dollars per occurrence ` ® 2 million dollars annual aggregate B. 7-Eleven. lnC. hereby certifies 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 #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 O er or Operator Date Name and Title of Tank Owner or Operator /~ /off Shane Partridge-Gasoline & Environmental ( Compliance Manager ' nature of Witnes r No tary Date Name of Witness or Notary f ~ 5~ l~(O Rachel Rodri uez CFR (Revised 04/95) U ~ FILE: Original -Local Agency Copies -Facility/Site(s) f °° .,, State of California 4 ' F ~~~~~~ For State Use Only e: State of Water Resources Control Board ° ;may' Division of Clean Water Programs ~, P.O. Box 944212 ~,~,,,wN,• 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 e. 7-Eleven, InC. hereby certifies that it is in compliance with the requirements of Section 2807, (Name of Tank Owner or Operator) Article 3, Chapter 78, 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 lure of T nk O ner or Operator Date Name and Title of Tank Owner or Operator 26 ~~ Shane Partridge-Gasoline & Environmental l Compliance Manager ignature of Witn or Notary Date Name of Witness or Notary c~v 5-~~ -z1 Rachel Rodri uez CFR (Revised 04/95) `~ ~~ FILE: Original -Local Agency Copies -Facility/Site(s) CERTIFICATION OF FINANCIAL RESPONSIBILITY 7-Eleven, Inc. (formerly lcno~xm 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, tlu-ough 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, paa-ticipation in various State funds and State assurance programs as set forth in 40 CFR §280.101. 7-ELEV C. 1 BY~ ~'~ • / Name: Title: / Vice • -esident Date: ~~~~ ~~ZVO ~ STATE OF TEXAS COUNTY OF DALLAS SUBSCRIBED AND SWORN TO BEFORE ME this `~~~ day of ___~/ , 2006. ~ L 7 r Mary B. Gamero No ary P is In and For Said County and Notary t'Ub{Ic, state of Texas State My Comm. Expires 01/20/10 My Commission Expires 51 G202.2/SP2/7G088/0209/04280G 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 ®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' ," . .. BUSINESS NAME (Same as FACILITY NAME OrDBA-Doing Business AS) 3 FACILITY ID# t 7-Eleven #16329 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 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.) 3 aoa ^ Yes ®No aos aos II. RROPERTY OWNER INFORMATION PROPERTY OWNER NAME aos PHONE aoa Bobbie Stokes MAILING OR STREET ADDRESS aos 1348 Mentone Ave. # C CITY ato STATE a>> 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 ats II(. TANK' OWNER INFORMATION, TANK OWNER NAME a1a PHONE ats 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY an 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`: BQARD OF EQUALIZATION USTSTORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, V. PETROLEUM,UST.FINANGIAL"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 Vf. 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 .. VIL'.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 aza PHONE azs 26 0 ~0 702-270-7160 NAM OF APPLICAN print) azs TITLE OF APPLICANT azz Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) aza 1998 UPGRADE CERTIFICATE NUMBER (Forloraluseoniy) 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 1. ` FACILITY /SITE INFORMATION: BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) g FACILITY ID# 7-Eleven #16549 NEAREST CROSS STREET ao1 FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 4647 Wilson Rd., Bakersfield ® 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 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 OWNER INFORMATION PROPERTY OWNER NAME aos PHONE aoa 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS aos P.O. Box 711 Attn: Gasoline Acct CITY a1o STATE all ZIP CODE a1z 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 111,TANKDWNER INFORMATION" -- ~ ~,. TANK OWNER NAME ata PHONE ats 7-Eleven, Inc. ~ 702-270-7160 MAILING OR STREET ADDRESS a1s P.O. Box 711 Attn: Gasoline Acct CITY a1~ STATE a1a 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'FINANC.IAL 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 AN,D .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 APL NT DATE aza PHONE azs ~ /Z~o n ~ 702-270-7160 NAM F APPLICANT rint azs TITLE OF APPLICANT azs Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) aza 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 ®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 '' BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITY I D#' 7-Eleven #17721 1 NEAREST CROSS STREET aof 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 ao3 ^ 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 II. PROR;ERTY Q1NNE.R''INFORMATION ~ , PROPERTY OWNER NAME aos PHONE aos 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS aos P.O. Box 711 Attn: Gasoline Acct CITY afo STATE aff ZIP CODE aft Dallas TX 75221-0711 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY J DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL af3 "~ IIL TANK OWNER INFORMATION TANK OWNER NAME a~a PHONE ais 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS ass P.O. Box 711 Attn: Gasoline Acct CITY af~ STATE afa ZIP CODE afs Dallas TX 75221-07 1 1 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 Nl1MBER TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, w ,..,,. 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 VI. LEGAL NOTIFJCATION 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 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 a2a PHONE azs S ~z6 o b 702-270-7160 NAME OF APPLICANT (p ~ ) a2s TITLE OF APPLICANT az~ Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) a28 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 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 ^ 6.TEMPORARY SITE CLOSURE 400 ' i. FACILITY /SITE INFORMATION ,, , BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 FACILITY I D# 7-Eleven #32241 1 NEAREST CROSS STREET aot 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 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 QINNER LNFORMATION ,: . PROPERTY OWNER NAME aos PHONE aoe WECI - 99 -3LLC 972-361-5000 MAILING OR STREET ADDRESS aos 15601 Dallas Parkwa ,Suite 40 CITY ato STATE apt ZIP CODE ate Dallas TX 75001 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL ats _ III: TANK OWNER INFORMATION ' , < - ,. TANK OWNER NAME ata PHONE at5 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY a» 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 USTBTORAGE 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 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 wilt be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER az3 " " VII. APPLICANT SIGNATURE " ., _ . Certificaf n - I ertify that the inf rmation provided herein is true and accurate to the best of my knowledge. SIGNA RE APPL C - DATE aza PHONE azs ~ ~ ~ b ~ 702-270-7160 NAME PPLICANT (p ' t) azs TITLE OF APP (CANT azs 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(SameasFACILITYNAMEOrDBA-Doing Business AS) 3 `'FACILITY ID#:. 7-Eleven #32376 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT' 9600 Srimhall 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 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 ,, , ,. 11. PROPERTY OWNER INFORMATION <.. PROPERTY OWNER NAME aos PHONE aoa American West Lands Co. MAILING OR STREET ADDRESS aos P.O. Box 524 CITY 410 STATE att ZIP CODE atz 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 III: 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 an STATE afs 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. BQARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise ~ az, R V. PETROLEUM UST FINANCIAL RESPON,SIBILITY,. 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 ANp 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 t or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 VII. APPLICANT SIGNATURE Certificat' n - certify that th info ation provided herein is true and accurate to the best of my knowledge. SIGNA UR F APPLI - DATE azo PHONE azs ~ 26 0~ 702-270-7160 NAME APPLICANT (prl ) azs TITLE OF APPL CANT a2~ Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (Foriocai useonry) 428 1998 UPGRADE CERTIFICATE NUMBER (Forioca~ use oniy) azs UPCF (1/99 revised) Formerly SWRCB Form A ~, 4 ~ N~ + 7-ELEVEN 2125-32241 _________________________________ SiteID: 015-021-001884 + Manager :S~rvdv ~ P'~`¢`~ ~t'i°~ BusPhone: (661} 587-8826 Location: 4101 GALLOWAY DR Map 102 CommHaz Moderate City BAKERSFIELD Grid: 19B FacUnits: 1 AOV: CommCode: KCFD STA 65 SIC Code:5541 EPA Numb: DunnBrad: +______________________________________________________________________________t Emergency Contact / ~ Titl e Emergency Contact / Title ~S'Iwrvd~tJ L[pj~l~ / -R DISPATCH I / EMERGENCY SERV Business Phone: (661) 587-8826x Business Phone: ( ) - x 24-Hour Phone (QQr/) 8'a-8'-U7~/ x 24-Hour Phone (800) 828-0711x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Contact _Shane Partridge Phone: ( 3~~=~ ~~ ~~ MailAddr: PO BOX 7 7~/ _ State : TX ?~~~ ~"~~ City DALLAS Zip 75221 Owner 7 -ELEVEN INC Phone : ( X13--r4ZZ~ ~ D Address PO BOX --7/J State: TX ~Da' ~?° "~~ ° City DALLAS Zip 75221 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST E3ased an 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, irate, and ete, ~~~ / at Date ~N`~~Q A P R ~ ~ X006 -1- 04/04/2006 __ _ :~~ UNIFIED PROGRAM INSPECTION CHECKLIST:' a p I/Il .. ,.:. ,; .. ~~sr A~*f- -::~~w_ sh~?Sd9PA.4,!1'..:a?.. ~T := w sr.'; .-;. .:: , -ate .~ :-I¢-...: _. ;_ .-. .. ... ,; :: ::-w.. ....._.. _.. ... .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 NAME NSPECTION DATE NSPECTION TIME / I y b -OG~ a ADDRESS HONE NO. OOF EMPLOYEES ~ // '7 / U FACILITY CONTACT USINESS ID NUMBER 15-021- --- -~~ Section 1: Business Plan and Inventory Program RO INE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ~I _ ^ BUSIfIi?SS PLAN CONTACT INFORMATION ACCURATE / ^ VISIBLE ADDRESS I~ ^ CORRECT OCCUPANCY ~I ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES NI D 'T' ^ VERIFICATION OF LOCATION DO~ ^ ^ PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND ROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE _ ~1 ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ~I. ( ^ FIRE PROTECTION ~ ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES (~DIO EXPLAIN: - QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (867) 328-3879 Inspector (Please Print) Fire Prevention / 7 In / Shlft of Site/Station q B its/ oo He Responsible Party (Please Pr White -Prevention Services Yeilow -Station Copy Pink -Business Copy FD2049 (Rev. o2/OS) .. - ,~ '~t~,Q~' 'rc~ ~ CITY OF I3AKERSFIEI.U FIRE DEPARTMENT I~ ~ ~ M~ OFFICE OF ENVIRONMENTAL. SERVICES `~ y.` UNIFIED PROGRAM INSPECTION CI~F,CKLIST \~w ~~ti,,~'~~ 1715 Chester Ave., 3~`' Ftoor, 13akerslield, CA 93301 ,.,~~ FACILITY NAME ~ // ~,~ Ljw.fpL~~ INSPECT-ION DATE ~"/D "(~~_ Section 2: Underground Storage Tanks Program Routine ^ Combined ^ Joint Agency ^Mul~i-Agency ^ Complaint ^ Re-inspection Type of Tank ~~ub(~ i~ri~l[ Number oI'Tanks 3 Type of Monitoring Type of Piping I~a~rbl£ Grisz/( OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Perrnit fees current Certification of Financial Responsibility Y Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations ' / Has there been an unauthorized release? Yes NO V 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: ~~ Office of Environme Services (661) 326-3979 whirs-Env. sues. Pink -Business Copy Business S to Responsible Party - - ~- 4101 ~r~l_I_>i:,Ifi: . ' Bh1,:Er: ~F= I L~I_C~ . ~'~ '!:~:; J BIJ3~_41 1 ~3lP.~i-1ii] ,I. F; I'd lli. ~'Ij~_Ib 1CJ:i~~ r;l'1 I.! i= : HL r7Fa"1 i:'Lk.r,}';' I,.1H}^:I'1I I`J~_~ T 1 :FiIIL I,Jr;'1'E:R = 0 . i ti i ! I'•li-'I-IF:;-:• T :P9LJ1.. TL' ,+':3LI_If''lE = r~:'I ICJ i;riL NF~IGHT = `.~7.;ii II'•Jr;}-ii= I;.h'I'ER - U . rnl I PJC'HFa-. 1' I iL III F ~ ~ '.1.•`=i i;r7L`, .J ,' ~ i.;riL. = IJ.ill. r~ r ~ F ._~ir' E:I`If.~ - UNIFIED PROGRAM CONSOLIDATED FORM ? -TANKS r - UNDERGROUND STORAGE TANKS -FACILITY ~~ (one page per site} Page _ of TYPE OF ACTION ^ t. 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 ^ s.TEMPORARY SITE CLOSURE 400 I. FACILITY /SITE INFORMATION T- - - -- - - BUSINESSNAME(Sameas FACILITY NAME orDBA-Doing Business As) 3 :FACILITY<ID# 1 7-Eleven #32241 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 4101 CallOWay 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* 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 II. PROPERTY OWNER INFORMATION - - - PROPERTY OWNER NAME aos PHONE aoa WECI - 99 -3LLC 972-361-5000 MAILING OR STREET ADDRESS aos 15601 Dallas Parkwa ,Suite 40 CITY ato STATE att ZIP CODE ate 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 ata PHONE ats 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS 206 ats 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 a2, ~V. PETROLEUMUSTFINANCIALRESPONSIBILITY -- 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 ^ 8. EXEMPTION ^ 9. STATE FUND & CD a22 Vt. 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 423 VI1. APPLICANT SIGNATURE Ce ficati n - I certif tha a information provided herein is true and accurate to the best of my knowledge. j SI AT E OF P NT DATE a2a PHONE a2s ~j ~ ~ d 702-270-7160 NA F APPLICA ( a2s TITLE OF A PLICANT a2~ Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) 428 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 42s UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page of L IDENTIFICATION'" FACILITY ID# F T i, A C ~ BEGINNING DATE 1ou ENDING DATE 101 II- I ~ 3/1 /2006 3/31 /2007 BUSINESS NAME (Same asFACI~ITYNAMEorDBA-Doing Business As) 3 BUSINESS PHONE 102 7-Eleven #32241 661-587-8826 BUSINESS SITE ADDRESS 103 4101 Calloway Dr. CITY 1oa ZIP CODE 1os CA Bakersfield 93312 DUN & BRADSTREET 106 SIC CODE (4 digit #} 10~ 00-734-7602 5541 COUNTY toe Kern BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 Shinda & Paramjeet Upple _ 661-587-882.6 _____ II . B USINESS OWNER _ __ _ OWNER NAME i _ 111 - -- OWNER PHONE 112 7-Eleven, inc. 702-270-7160 OWNER MAILING ADDRESS 113 P.O. Box 711 Attn: Gasoline Acctg CITY 11a STATE 115 ZIP CODE 116 Dallas TX 75221-0711 ENVIRONMENTAL_CONTACT CONTACT NAME 11~ CONTACT PHONE 116 Shane Partridge 702-270-7160 CONTACT MAILING ADDRESS 119 P.O. Box 711 Attn: Gasoline Acctg CITY 1za STATE 121 ZIP CODE 122 Dallas TX 75221-0711 -PRIMARY- IV. EMERGENCY CONTACTS -SEC~NDARY- NAME 1zs NAME 1Ztl Shinda Upple 7-Eleven Emergency Dispatch I TITLE 12a TITLE 129 Franchisee Emergency Service BUSINESS PHONE 125 BUSINESS PHONE 1ao 1800-828-0711 800-828-0711 24-HOUR PHONE 1zs 24-HOUR PHONE 131 1-800-828-0711 800-828-0711 PAGER # 127 PAGER # 132 ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Base o y inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally ex i ed and am ~amili r with the information submitted and believe the information is true, accurate, and complete. SIG T RE OF OW RATOR IGNATED REPRESENTATIVE DATE 134 3~Zg'/Z o-~ ` NAME OF DOCUMENT PREPARER 135 , Rachel Rodriguez NAME OF SIGNER (prin 136 TITLE OF SIGNER 137 Shane Partridge Gasoline & Environmental Compliance Manager UPCF (1/99 revised) HMP 2 (Back) Instructions OES FORM 2730 (1199} 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 Z00 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 7-Eleven #32241 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 (EPCRA) ^ YES ® NO NEAR FACILITY TRASH ENCLOSURE MAP# (optionaq 203 GRID# (optional) 204 FACILITY ID # 1 of 1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No zos WASTE FLAMMABLE LIQUID If Subject to EPCRP,, refer to instructions COMMON NAME GAS-WATER MIXTURE 207 EHS* ^Yes ®No 2oa 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 z1z CURIES 213 PHYSICAL STATE (Check one item only) ^ a. SOLID ®b. LIQUID ^ c. GAS 214 LARGEST CONTAINER 55 215 FED HAZARD CATEGORIES 216 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 21e ANNUAL WASTE AMOUNT z1s STATE WASTE CODE 2zo 25 55 55 134 221 DAYS ON SITE: 222 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 2z3 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 # ~ 89-90 22s MIXTURE OF GASOLINE & WATER OR 227 ^Yes ®No 22a N/A MIXTURE 22s OTHER CONTAMINATION IN GASOLINE , 2 230 231 ^Yes ^ NO 232 233 3 234 235 ^Yes ^ NO 236 237 4 23a 23s ^Yes ^ No zao za1 5 2a2 2a3 ^Yes ^No zaa zas 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. ADDITfONAL LOCALLY COLLECTED INFORMATION zas 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 #32241 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL zo2 (EPCRA) ^ YES ® NO NEAR FACILITY TRASH ENCLOSURE MAP# (optional) 203 GRID# (optional) zoa FACILITY ID # 1 of 1 -_ II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No zos WASTE ABSORBENT & DISPENSER FUEL FILTER If Subject to EPCRA, refer toinstrudions COMMON NAME WASTE ABSORBENT & DISPENSER FUEL FILTER 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) 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 216 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 21e ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 25 55 55 352 221 DAYS ON SITE: zzz 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 22a STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # ~ gg-gp 226 MIXTURE OF SILCATE & HYDROCARBONS 227 ^Yes ®No zza N/A, MIXTURE zzs & SPENT FUEL FILTERS 2 230 231 ^Yes ^ NO 232 233 3 234 235 ^Yes ^ NO 236 237 q 238 239 ^Yes ^ NO 240 241 5 2az 2a3 ^Yes ^No zaa zas 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 '` ~ 1 >, 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- I=ACILITY ID # (Agency Use Only) _ FACILITY NAME 7-Eleven #32241 M03. FACILITY SITE ADDRESS 41 O1 CaIIOWay Dr. M°a. 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 al] re wired information, include it with this ]an. _: , ' 'IV. TANK 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 mtt t' PANEL MANUFACTURER: VeederROOt M12 MODEL #: TLS35O M13. LEAK SENSOR MANUFACTURER: VeederROOt Mta. MODEL #(S): $47390-420 Mts. ^ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S) PANEL MANUFACTURER: M16 MODEL#: Mtz IN-TANK PROBE MANUFACTURER: Mtg' MODEL #(S): Mtg. LEAK TEST FREQUENCY: ^ a. CONTINUOUS ^ b. DAILY/NIGHTLY ^ c. WEEKLY M2o. Mgt ^ d. MONTHLY ^ e. OTHER (Specify): . PROGRAMMED TESTS: ^ a. 0.1 g.p.h. ^ b. 0.2 g.p.h. ^ c. OTHER (Specify): Mzz. 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) M30. ® 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 M32 MODEL #: TLS35O M33. LEAK SENSOR MANUFACTURER: VeederROOt M34 MODEL #(S): 7943$0-352 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 M3z ® 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): ~13.Or~eSS M38 MODEL #(S): LD2000 & FX1 V M39. ^ 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 M43. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Maa. ® 4. INTEGRITY TESTING ~ TEST FRE UENCY: ®a. ANNUALLY M4 Q ^ b. EVERY 3 YEARS ^ c. OTHER (Specify) S. M46. ^ 5. VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY* ^ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED** Ma7. • Requires agency approval *• Allowed for monitoring of unburied emergency generator fuel piping only per HSC §25281.5(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. liN-022A - I/3 www.unidocs.org Rev. 10/14/03 . ~~. 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 nasi' MODEL #: TLS35O Msz. 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 M55. WILL 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 approval) Mho. ^ 4. NO DISPENSERS ^ 99.OTHER (Specify) M61. VIL ENHANCED LEAK DETECTION ^ I . 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 _. VIIL 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, 200 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): Mst. 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 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 initial training will be conducted within 30 days of the date of hire. IX. COMIVIENTS/ADDITIONAL INFORIYIATION; ; . Please use this section to include any additional UST system monitoring-related information (e g., additional information required by your local agency): Mas. 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. PERSONNELRESPONSIBILITIES 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 CE IFICATIO : I ertify that the information provided herein is ue and accurate to the best of my knowledge. O E PERATO ATURE R ESENTING DATE: M91. }}~~ M90. [~ f e t ~ ~ .~ . p ra or OWNER/OPERATOR NAM rint): Msz. OWNER/OPERATOR TITLE: Mv:s. Shane Partridge 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 _.9,.r 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 #32241 Facility Address: 4101 Calloway Dr., Bakersfield, CA Date: March 1, 2006 A. Describe the frequency of performing the monitoring: Tank The site consists of three 10,000 gallon double walled fiberglass clad steel tanks (1-Regular Unleaded, 1-Midgrade, 1-Premium) and are monitored monthly with a VeederRoot TLS350 Piping Product lines are double wall Enviroflex and are monitored continuously with a VeederRoot TLS350. The turbine sump sensors activates audio/visual alarms and provided 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 using the Veeder-Root TLS350 Tank Gauge. VeederRoot model 794380-420 probes are used for the monitoring. Hiah 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. The piping is precision tested annually at a threshold of .1gph. Vaporless Mechancial Line Leak Detectors (LD2000) are used to detect 3 gph release. 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 VeedeRoot. 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. ;i> r'~ . ~~~, r'~~ J~ Written Monitor Procedures 7-Eleven #32241 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; replacements 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", Emergency 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. ;,=- .ti 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 #32241 Facility Address 4101 Calloway 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. 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 'i I X354'? I 7- I 1 :i'~':'41 B~;}EI'z':•;F I F'L.L'~ .!_ ~, 9:?31,-, BL13341 t ~~30FOiJ1 _ h9HY 1 9. ~i iiJS y : 5l ~I^9 r~ ,.'~~TEf°l .'_.Tfi1'IJ_ }:'F~l''+:`I;''I" HLL. FUPJ~::'fl~:?fd; hJCrRI^9~L ~ T I:kUL I 'sii:+LUP9E - 6525 GF,Lti IILLH~aE = 35G4 Gr'iL.S ', 9U~% UI.1.i7E= '?51J1 ~:ahL=_~ HEIGHT = 5~i . 46 11VC11E: InTER ',+~~rl_. ~ In Q arL. . 4+1~TER = 0.00 1I'~d~::'HE~~ i TEI°1P = I 63.5 L~E~ ~ F ' T '~:rv1UL ~.: 11{~LIJt~9E _ ?,J~~_ ~=f?1LS ULLi~GE _ ' 1 '=a2 (riLL TC VULUf°lE _ '~'?~~~ !ter=;L,_ . HEIGHT = ? D . 0'~ I h~dG HE_ WATER '~JtrL = 0 i i~iL:-` 6Jr";TER = O , i iCJ I fJC'HI~:_~ TEMI/ - r1 ) L!Er ~ F ~ ~ ~ ` i L - T'ULUdhE '~'5i17 GAL, ULLHGE _ ~P~'~1 ~F~LJ Guy ULL~t~aE= ~ i 51 a ~~r;L I~C~LUh9E _ j TC. ^•456 ~.t~LE HEIGHT r'_, i' . 2 ;' It'd!"' HE. } Wi~.TER 1~t_rI~ 1 U i_;HL ' R ~,;H T ER = 0 . f.:!G I h1CHEC~ "~ ~ TEt°1F = I r I . 1 1?EG :~ - - ' ~ 1. ~ s ~ a ?E E ~1 PdD < ,. ~ .r I ~ \_ P~w~~' T~ `; CITY OF BAKERSFiEi.U FIRE DEPAR'T'MENT • ~~ ~ ~ ~~ OFFICE OF ENVIRONMENTAL SERVICES yp`1 UNIFIED PROGRAM 1NSPECTION CHF,CKLIST ~_wE-~R~,~ii 1715 Chester Ave., 3n`t Floor, Bakersfield, CA 93301 FACILITY NAME ~"' ~ ~ ~~G~ (NSPCC"1•ION DATE .3~ 9 Section 2: Underground Storage Tanks Program ^ Routine f~.Combined ^ Joint Agency ^Minti-Agency ^ Complaint ^ Re-inspection Type of Tank nbtJFC ~ Number of Tanks 3 Type of Monitoring _Cl.~ Type of Piping ~'U F(>c->G OPERATION C V COMMENTS Proper tank data on the •~M ~-~- -~-~. g '~ Proper ownerioperator 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 the with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? Ifyes, Does tank have overtill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: Office of nvir nmental Servic (6 I) 3979 white - P.nv. Svcs. } Business •te Responsible Party Pink -Business Copy UNIFIED PROGRAM INSPECTION CHECKLIST -~, SECTION 1 Business ,Plan and Inventory Program Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel: (661_) 326-3979 FACILITY NAME INSPE TION ATE INSPECTION TIME 1 ~~ ~~~~~ ~~~~~a~ ADDRESS ~ ~ PHONE No. No. of Employees FACILITYCONTACT Business ID Number is-ozl- Section 1: Business Plan and Inventory Program O Routine Combined ^ Joint Agency OMulti-Agency ^ Complaint ^ Re-inspection ^ FIRE PROTECTION ~ ^ SITE DIAGRAM ADEQUATE Ei ON PIANO ANY HAZARDOUS WASTE ON SITE?: ^ YES ~NO EXPLAIN: QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT ~G6') ~ 326-3979 In ctor (Please Print) ~ Fire Prevention 1st-In/Shift of Site White - Environmental Services Ye1klW - 9tatgn Copy rn Pink -Business Copy R ~'__ -Site Re sible Party (Please Print) ~F_7 ELEVEN #32241 Manager Location: 4102 GALLOWAY DR City BAKERSFIELD CommCode: KCFD STA 65 EPA Numb: SiteID: 015-021-001884 BusPhone: (661) 587-8826 Map 102 CommHaz Low Grid: 19B FacUnits: 1 AOV: SIC Code:5541 DunnBrad: Emergency Contact / Title Emergency Contact / Title / STORE MANAGER DISPATCH I / EMERGENCY SERV. Business Phone: (661) 587-8826x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone (800) 828-0711x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Contact GASOLINE ACCOUNTING Phone: (972) 361-5000x MailAddr: 15601 DALLAS PARKWAY 40 State: TX City DALLAS Zip 75001 Owner 7-ELEVEN, INC./GASOLINE ACCTG. Phone: (253) 796-7170x Address PO BOX 711 State: TX City DALLAS Zip 75221-0711 Period t o TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~® herel?y Certify that I haute I R) or printna^z01 mateC~als rrlanaf~~` re~~ie~~ed ti1e attached hazardous t it along with and tha _ 1 me ~~t plan for AMA ~, ~ugt~~~ man- tionsconstitute a complete and correct any Corr®c aggment plan for my facility. : .. -L~;~:.~~ r 6 gnacure -1- 05/03/2005 ~F 7 ELEVEN #32241 SiteID: 015-021-001884 ~ STORAGE CONTAINER DATA (UST FORM A) - Last Action 'T'ype: FACILITY/SITE INFORMATION Business Name: 7 ELEVEN #32241 Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper ICC Nbr: PROPERTY OWNER INFORMATION Name DISPATCH I Phone: ( ) - x Address: City State: Zip: Type TANK OWNER INFORMATION Name DISPATCH I Phone: ( ) - x Address: City State: Zip: Type BOE UST Fee# 002251 Financ'1 Resp: INSURANCE Legal Notif Tank Owner Mailing Address Date:02/25/2005 Phone: (858) 715-2772x Name:JUDY SOPER Ttl:ENVIRON. MGR. State UST # 1998 Upg Cert#: 00871 -2- 05/03/2005 ~F 7 ELEVEN #32241 SiteID: 015-021-001884 ~ ~ 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 GASOLINE L 10000.00 GAL Mod -3- 05/03/2005 ~F 7 ELEVEN #32241 SiteID: 015-021-001884 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: LOCATED IN NE CORNER OF STORE PARKING LOT CAS# 8006619 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TPure ~ Ambient ~ Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 10000.00 GAL nt~~HtcL~ua ~viYirviv~ivl~ %Wt. RS CAS# 100.00 Gasoline No 8006619 tiHGHKL A~Sr;aa1~1L'lv1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod Ag.Definedl: Ag.Defined5: Ag.Defined8: Ag.Definell MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined6: Ag.Defined7: Ag.Defined9: Ag.Definel0: -4- 05/03/2005 ~F 7 ELEVEN #32241 SitelD: 015-021-001884 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: LOCATED IN NE CORNER OF STORE PARKING LOT TANK DESCRIPTION Tank ID#: 1 Mfr: Total Containment Compart Tank: Installed: 04/1998 Capacity: 10000 Gals No. Of Comparts: Fill Sumps: N EVR Compliant: N Dbl wall Sumps: N Installed: Additional Info: Tank Use: MOTOR VEHICLE FUEL Matl Name:GASOLINE TANK CONTENTS Petrol Type: UNLEADED PLUS/MIDGRADE Cas #: 8006619 TANK CONSTRUCTION Type DOUBLE WALL Material(p): STEEL CLAD W/FIBERGLASS R. P. Material(s): STEEL CLAD W/FIBERGLASS R. P. Lining UNLINED Corr Prot: FIBERGLASS REINFORCED PLASTIC Spill Cnt 1998 Alarm Drop Tube 1998 Ball Float Striker Plate: 1998 Fill Tube S/O: TANK LEAK DETECTION Installed: Installed: Exempt: No 1998 Sgl Wall: Dbl Wall: INTERSTITIAL MONITORING N TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Last Used: Qty Remaining: Was Filled: No -5- 05/03/2005 ~F 7 ELEVEN #32241 SiteID: 015-021-001884 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type PRESSURE Const: DOUBLE WALL Mfgr TOTAL CONTAINMENT Mtl "FLEX" Corr "FLEX" Prot PIPING UnderGround Piping AUTOMATIC LEAK DETECTORS ` Installed: 04/16/1998 Date: 02/25/2005 Name:JUDY SOPER Prmt Number: 1884 TANK/LINE TEST :08/06/2004 CP CERT. . MANWAY INSP. . UST MONIT. CERT:04/26/2004 Ttl:ENVIRON. MGR. Approved: Yes Expiration AGENCY DEFINED PASS STORAGE. CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: Installation ,Inspected & Certified by Registered Installation Inspected by Unified Program Agency: Manufacturer's Checklist Completed: Installer Certified by Contractors' State License Approved Alternate methods: Date: 02/25/2005 Name:JUDY SOPER LEAK DETECTION 9 AboveGround Piping DISPENSER CONTAINMENT Type: DISP. PAN OWNER/OPERATOR SIGNATURE - Date: 06/30/2006 No Engineer: No Yes Yes Board: Yes Ttl:ENVIRON. MGR. LIQUID SENSOR & ALARM -6- 05/03/2005 F 7 ELEVEN #32241 SiteID: 015-021-001884 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: LOCATED IN NE CORNER OF STORE PARKING LOT CAS# 8006619 E ~E P RATURE R E Liquid T Pure ~ Ambient ~ e A~ TER GROIIND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 10000.00 GAL -- tiAGAl[LVU~ 1:V1~lYV1VL'1V1~ %Wt. RS CAS# 100.00 Gasoline No 8006619 t1E~GEitCL H5J1;5J1~1L"1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod MISC. LOCAL AGENCY DATA Ag.Definedl: Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defined8: Ag.Defined9: Ag.Definel0: Ag.Definell -7- 05/03/2005 'F 7 ELEVEN #32241 SiteID: 015-021-001884 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: LOCATED IN NE CORNER OF STORE PARKING LOT TANK DESCRIPTION Tank ID#: 2 Mfr: Total Containment Compact Tank: N Installed: 04/1998 Capacity: 10000 Gals No. Of Compacts: Fill Sumps: N EVR Compliant: N Dbl Wall Sumps: N Installed: Additional Info: TANK CONTENTS Tank Use: MOTOR VEHICLE FUEL Petrol Type: UNLEADED PLUS/MIDGRADE Matl Name:GASOLINE Cas #: 8006619 TANK CONSTRUCTION Type DOUBLE WALL Material(p): STEEL CLAD W/FIBERGLASS R. P. Material(s): STEEL CLAD W/FIBERGLASS R. P. Lining UNLINED Installed: Corr Prot: FIBERGLASS REINFORCED PLASTIC Installed: Spill Cnt 1998 Alarm Exempt: No Drop Tube 1998 Ball Float Striker Plate: 1998 ~ Fill Tube S/0: 1998 TANK LEAK DETECTION Sgl Wall: Dbl Wall: INTERSTITIAL MONITORING TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Last Used: Qty Remaining: Was Filled: No -8- 05/03/2005 ~F 7 ELEVEN #32241 SiteID: 015-021-001884 ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type PRESSURE Const: DOUBLE WALL Mfgr TOTAL CONTAINMENT Mtl "FLEX" Corr "FLEX" Prot Installed: 04/16/1998 Date: 02/25/2005 Name:JUDY SOPER Prmt Number: 1884 TANK/LINE TEST :08/06/2004 CP CERT. MANWAY INSP. . UST MONIT. GERT:04/26/2004 Ttl:ENVIRON. MGR. Approved: No Expiration AGENCY DEFINED PASS PASS STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: Installation Inspected & Certified by Registered Installation Inspected by Unified Program Agency: Manufacturer's Checklist Completed: Installer Cdrtified by Contractors' State License Approved Alternate methods: Date: 02/25/2005 Name:JUDY SOPER PIPING UnderGround Piping AUTOMATIC LEAK DETECTORS LEAK DETECTION 9 AboveGround Piping DISPENSER CONTAINMENT Type: DISP. PAN OWNER/OPERATOR SIGNATURE - LIQUID SENSOR & ALARM No Engineer: No Yes Yes Board: Yes Ttl:ENVIRON. MGR. Date: 06/30/2006 -9- 05/03/2005 F 7 ELEVEN #32241 SiteID: 015-021-001884 ~ ~ 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: LOCATED IN NE CORNER OF STORE PARKING LOT CAS# 8006619 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 10000.00 GAL HAZARDOUS COMPONENTS °sWt. RS CAS# 100.00 Gasoline No 8006619 nr~~tircL r~aa~~~i~i~ivt~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod Ag.Definedl: Ag.Defined5: Ag.Defined8: Ag.Definell MISC. LOCAL AGENCY DATA Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined6: Ag.Defined7: Ag . Def ined9 : Ag . Def ine10 -10- 05/03/2005 'F 7 ELEVEN #32241 SitelD: 015-021-001884 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: LOCATED IN NE CORNER OF STORE PARKING LOT TANK DESCRIPTION Tank ID#: 3 Mfr: Total Containment Compart Tank: Installed: 04/1998 Capacity: 10000 Gals No. Of Comparts: Fill Sumps: N EVR Compliant: N Dbl Wall Sumps: N Installed: Additional Info: Tank Use: MOTOR VEHICLE FUEL Matl Name:GASOLINE N TANK CONTENTS Petrol Type: PREMIUM UNLEADED Cas #: 8006619 TANK CONSTRUCTION Type DOUBLE WALL Material(p): STEEL CLAD W/FIBERGLASS R. P. Material(s): STEEL CLAD W/FIBERGLASS R. P. Lining UNLINED Corr Prot: FIBERGLASS REINFORCED PLASTIC Spill Cnt 1998 Alarm Drop Tube 1998 Ball Float Striker Plate: 1998 Fill Tube S/O: TANK LEAK DETECTION Installed: Installed: Exempt: No 1998 Sgl Wall: Dbl Wall: INTERSTITIAL MONITORING TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Last Used: Qty Remaining: was Filled: No -11- 05/03/2005 `F 7 ELEVEN #32241 SiteID: 015-021-001884 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type PRESSURE Const: DOUBLE WALL Mfgr TOTAL CONTAINMENT Mtl "FLEX" Corr "FLEX" Prot PIPING LEAK DETECTION UnderGround Piping AUTOMATIC LEAK DETECTORS Installed: 04/16/1998 Date: 02/25/2005 Name:JUDY SOPER Prmt Number: 1884 AboveGround Piping DISPENSER CONTAINMENT Type: DISP. PAN LIQUID SENSOR & ALARM OWNER/OPERATOR SIGNATURE TANK/LINE TEST :03/10/2003 CP CERT. MANWAY INSP. UST MONIT. CERT:08/06/2004 Tt1:EMVIRON. MGR. Approved: Yes Expiration Date: AGENCY DEFINED PASS STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: No Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: Yes Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 02/25/2005 Name:JUDY SOPER Ttl:EMVIRON. MGR. 06/30/2006 -12- 05/03/2005 INTERSTITIAL MONITORING CALLS Date Store MKT Store Called Contact Interstitial Probe Status as Reported by Store 2133 32241 12/18/00 sunny rul, mul, pul -- normal. Mh 2133 32241 11/21/00 SUNNY IM PROBES-RUL,MUL,PUL-NORMAL. JH 2133 32241 10/24/00 SUNNY IM PROBES-RUL,MUL,PUL-NORMAL. JH 2133 32241 9/14/00 Ishy rul, mul, pul im probes are normal td 2133 ~32241 8/8/00 Connie ' rul, mul, pul im probes are normal td 2133 32241 7/19/00 Norwinda rul, mul, pul im probes are normal td 2133 32241 6/20/00 norwinda rul, mul, pul im probes are normal td 2133 32241 5/26/00 Ishi rul, mul, pul im probes are normal td gtm is still out of paper, same excuse as 5/22 2133 32241 5/25/00 clerk he asked me to call him back later td 2133 32241 5/22/00 clerk gtm is out of paper please call back td 2133 32241 4/24/00 ~am rul, mul, pul im probes read normal td 2133 32241 3/22/00 Sunny rul, mul, pul im probes read normal td 2133 32241 2/15/00 sunny rul, mul pul im probes read normal td 2133 32241 1/28/00 Connie rul, mul pul im probes read normal td 32241 IMLOG.xls 7 ELEVEN #32241 SiteID: 015-021-001884 Manager : BusPhone: (661) 587-8826 Location: 4101 CALLOWAY DR Map : 102 CommHaz : Low City : BAKERSFIELD Grid: 19B FacUnits: 1 AOV: CommCode: COUNTY STATION 65 SIC Code:5541 EPA Numb: DunnBrad: Emergency COntact / Title Emergency Contact / Title / STORE MANAGER DISPATCH I / EMERGENCY SERV. Business Phone: (661) 587-8826x Business Phone: ( ) x 24-Hour Phone : ( ) - x 24-Hour Phone : (800) 828-0711x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Contact : GASOLINE ACCOUNTING Phone: (972) 361-5000x MailAddr: 15601 DALLAS PARKWAY 40 State: TX City : DALLAS Zip : 75001 Owner 7-ELEVEN, INC./GASOLINE ACCTG. Phone: (253) 796-7170x Address : PO BOX 711 State: TX City : DALLAS Zip : 75221-0711 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~,~u~~o hereb~ certify that i have re¥~¥~ ~h~ ~ched hgza~oou~ materials manag~ merit plan for ~--~ ~ snd t~t it along wi~h - (Na~e of 8~ine~) any corre~ions constitute a complets a~d corre~ man- agement plan for my facility. . 1 05/10/2004 7 ELEVEN #32241 SiteID: 015-021-001884 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7 ELEVEN #32241 Cross Street : Business Type: Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : DISPATCH I Phone: ( ) - x Address: City : State: Zip: Type : TANK OWNER INFORMATION Name : DISPATCH I Phone: ( ) - x Address: City : State: Zip: Type : BOE UST Fee# : 002251 Financ'l Resp: INSURANCE Legal Notif : Tank Owner Mailing Address Date:04/ll/2000 Phone: (253) 796-7170x Name:RANDY MARTIN Ttl:ENVIRON. MGR. State UST # : 1998 Upg Cert#: 00871 -2- 05/10/2004 7 ELEVEN #32241 SiteID: 015-021-001884 ~ Hazmat Inventory By Facility Unit -- MCP+DailyMax Order Fixed Containers at Site Hazmat Common Name... ISpeoHazlEPA Hazardsl Frm DailyMax IUnitlMcP GASOLINE L 10000.00 GAL Mod GASOLINE L 10000.00 GAL Mod GASOLINE L 10000.00 GAL Mod -3- 05/10/2004 7 ELEVEN #32241 SiteID: 015-021-001884 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: LOCATED IN NE CORNER OF STORE PARKING LOT CAS# 8006619 F STATE ~ TYPE PRESSURE --~ TEMPERATURE I .CONTAINER TYPE Liquid ~PureIi Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container [ Daily Maximum [ Daily Average 10000.00 GALI 10000.00 GALI 10000.00 GAL HAZARDOUS COMPONENTS %Wt. R~NoRS~ CAS# 100.00 Gasoline 8006619 HAZARD ASSESSMENTS TSecretI ~SIBioHazI Radioactive/Amount EPA Hazards [ NFPA USDOT# I MCP No N No No/ Curies / / / Mod MISC. LOCAL AGENCY DATA Ag.Definedl: Ag.Defined2: Ag. Defined3: Ag.Defined4: Ag. DefinedL: Ag.Defined6: Ag.Defined7: Ag.Defined8: Ag.Defined9: Ag. Definel0: -- Ag.Definell -4- 05/10/2004 7 ELEVEN #32241 SiteID: 015-021-001884 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: LOCATED IN NE CORNER OF STORE PARKING LOT TANK DESCRIPTION Tank ID#: 1 Mfr: Total Containment Compart Tank: N Installed: 04/1998 Capacity: 10000 Gals No. Of Comparts: Additional Info: TANK CONTENTS Tank Use: MOTOR VEHICLE FUEL Petrol Type: UNLEADED PLUS/MIDGRADE M~tl Name:GASOLINE Cas #: 8006619 TANK CONSTRUCTION Type : DOUBLE WALL Material(p) : STEEL CLAD W/FIBERGLASS R. P. Material(s): STEEL CLAD W/FIBERGLASS R. P. Lining : UNLINED Installed: Corr Prot: FIBERGLASS REINFORCED PLASTIC Installed: Spill Cnt : 1998 Alarm : Exempt: No Drop Tube : 1998 Ball Float : Striker Plate: 1998 Fill Tube S/O: 1998 TANK LEAK DETECTION Sgl Wall: Dbl Wall: INTERSTITIAL MONITORING TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Last Used: Qty Remaining: Was Filled: No -5- 05/10/2004 7 ELEVEN #32241 SiteID: 015-021-001884 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type : PRESSURE Const: DOUBLE WALL Mfgr : TOTAL CONTAINMENT Mtl : "FLEX" & : Corr : "FLEX" Prot : PIPING LEAK DETECTION UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS DISPENSER CONTAINMENT Installed: 04/16/1998 Type: DISP. PAN LIQUID SENSOR & ALARM OWNER/OPERATOR SIGNATURE Date: 04/11/2000 Name:BOB DENINNO Ttl:ENVIRON. MGR. Prmt Number: 1884 Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED TANK/LINE TEST :03/10/2003 PASS CP CERT. : MANWAY INSP. : UST MONIT. CERT:03/10/2003 STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: No Installation Inspected & Certified by Registered Engineer: No - Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: Yes Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 04/11/2000 Name:BOB DENINNO Ttl:ENVIRON. MGR. 6 05/10/2004 7 ELEVEN #32241 SiteID: 015-021-001884 ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: LOCATED IN NE CORNER OF STORE PARKING LOT CAS# 8006619 F STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Pure AmbientIi Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container t Daily Maximum Daily Average 10000.00 GALI 10000.00 GAL 10000.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS TSecretl~slBioHazNo N No Radioactive/AmountNo/ Curies EPAHazards NFPA/// IUsDOT# MCP MISC. LOCAL AGENCY DATA Ag. Definedl: Ag. Defined2: Ag.Defined3: Ag.Defined4: Ag. Defined5: Ag.Defined6: Ag. Defined7: Ag.Defined8: Ag.Defined9: Ag.Definel0: -- Ag.Definell 7 05/~0/2004 7 ELEVEN #32241 SiteID: 015-021-001884 ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: LOCATED IN NE CORNER OF STORE PARKING LOT TANK DESCRIPTION Tank ID#: 2 Mfr: Total Containment Compart Tank: N Installed: 04/1998 Capacity: 10000 Gals No. Of Comparts: Additional Info: TANK CONTENTS Tank Use: MOTOR VEHICLE FUEL Petrol Type: UNLEADED PLUS/MIDGRADE Marl Name:GASOLINE Cas #: 8006619 TANK CONSTRUCTION Type : DOUBLE WALL Material(p): STEEL CLAD W/FIBERGLASS R. P. Material(s): STEEL CLAD W/FIBERGLASS R. P. Lining : UNLINED Installed: Corr Prot: FIBERGLASS REINFORCED PLASTIC Installed: Spill Cnt : 1998 Alarm : Exempt: No Drop Tube : 1998 Ball Float : Striker Plate: 1998 Fill Tube S/O: 1998 TANK LEAK DETECTION Sgl Wall: Dbl Wall: INTERSTITIAL MONITORING TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Last Used: Qty Remaining: Was Filled: No -8- 05/10/2004 7 ELEVEN #32241 SiteID: 015-021-001884 ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 ~ PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type : PRESSURE Const: DOUBLE WALL Mfgr : TOTAL CONTAINMENT Mtl : "FLEX" & : Corr : "FLEX" Prot : PIPING LEAK DETECTION UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS DISPENSER CONTAINMENT Installed: 04/16/1998 Type: DISP. PAN LIQUID SENSOR & ALARM OWNER/OPERATOR SIGNATURE Date: 04/11/2000 Name:BOB DENINNO Ttl:ENVIRON. MGR. Prmt Number: 1884 Approved: No Expiration Date: 06/30/2006 AGENCY DEFINED TANK/LINE TEST :03/10/2003 PASS CP CERT. : MANWAY INSP. : UST MONIT. CERT:03/10/2003 PASS STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: No Installation Inspected & Certified by Registered Engineer: No Installation Inspected by Unified Program Agency: Yes Manufacturer's Checklist Completed: Yes Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 04/11/2000 Name:BOB DENINNO Ttl:ENVIRON. MGR. -9- 05/10/2004 7 ELEVEN #32241 SiteID: 015-021-001884 ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~U~U~ ~v~ / ~£~ ~vl~ GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: LOCATED IN NE CORNER OF STORE PARKING LOT CAS# 8006619 Liquid /Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 10000.00 GALI 10000.00 GAL 10000.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS TSecretl ~S BioHaz Radioactive/Amount I EPA Hazards NFPA I USDOT# MCP No N No No/ Curies / / / Mod MISC. LOCAL AGENCY DATA Ag. Definedl: Ag. Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag.Defined8: Ag.Defined9: Ag.Definel0: -- Ag.Definell -10- 05/10/2004 7 ELEVEN #32241 SiteID: 015-021-001884 ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site STOP~AGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: LOCATED IN NE CORNER OF STORE PARKING LOT TANK DESCRIPTION Tank ID#: 3 Mfr: Total Containment Compart Tank: N Installed: 04/1998 Capacity: 10000 Gals No. Of Comparts: Additional Info: TANK CONTENTS Tank Use: MOTOR VEHICLE FUEL Petrol Type: PREMIUM UNLEADED Marl Name:GASOLINE Cas #: 8006619 TANK CONSTRUCTION Type : DOUBLE WALL Material(p): STEEL CLAD W/FIBERGLASS R. P. Material(s): STEEL CLAD W/FIBERGLASS R. P. Lining : UNLINED Installed: ~' Corr Prot: FIBERGLASS REINFORCED PLASTIC Installed: Spill Cnt : 1998 Alarm : Exempt: No Drop Tube : 1998 Ball Float : Striker Plate: 1998 Fill Tube S/O: 1998 TANK LEAK DETECTION Sgl Wall: Dbl Wall: INTERSTITIAL MONITORING TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Last Used: Qty Remaining: Was Filled: No -11- 05/10/2004 7 ELEVEN #32241 SiteID: 015-021-001884 ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type : PRESSURE Const: DOUBLE WALL Mfgr : TOTAL CONTAINMENT Mtl : "FLEX" & : Corr : "FLEX" Prot : PIPING LEAK DETECTION UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS DISPENSER CONTAINMENT Installed: 04/16/1998 Type: DISP. PAN LIQUID SENSOR & ALARM OWNER/OPERATOR SIGNATURE Date: 04/11/2000 Name:BOB DENINNO Ttl:EMVIRON. MGR. Prmt Number: 1884 Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED TANK/LINE TEST :03/10/2003 PASS CP CERT. : MANWAY INSP. : UST MONIT. CERT:03/10/2003 STORAGE CONTAINER DATA (UST FORM C) Installer Certified by tank/piping manufacturer: No Installation Inspected & Certified by Registered Engineer: tNo Installation Inspected by Unified Program Agency: Yes Manufacturer's CheckliSt Completed: Yes Installer Certified by Contractors' State License Board: Yes Approved Alternate methods: Date: 04/11/2000 Name:BOB DENINNO Ttl:EMVIRON. MGR. -12- 05/10/2004 Bakersfield Fire Dept. UNIFIED PROGRAM INSPECTION CHECKLIST Enironmental Services 1715 Chester Ave SECTION 1 Business Plan and Inventory Program Bakersfield, CA 93301 Tel: (661)326-3979 ~4 FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS PHONE No. No. of loyees FACILITYCONTACT t3usiness ID Number 15-2 I - Section 1: Business Plan and Uventory Pn~gram ^ Routine C~ Combined ~ Joint Agency ^Mutti-Agency ^ Complaint ^ Re-inspection ~C /V \V=VioaPOnncel OPERATION COMMENTS L~l/' ^ APPROPRIATE JPERMIT ON HAND L5V ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS LY" ^ CORRECT OCCUPANCY ~ ^ VERIFICATION OF INVENTORY`MATERIALS ^ VERIFICATION OF QUANTITIES L~^ VERIFICATION OF LOCATION Q,Y" ^ PROPER SEGREGATION OF MATERIAL Ll!^ VERIFICATION OF MSDS AVAILABILITYE ^ VERIFICATION OF HAT MAT TRAINING VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ~^ CONTAINERS PROPERLY LABELED ~ -- - - HOUSEKEEPING ^ L9/ 1-IRE PROTECTION `~ _ t 1 a`~~ ^/ ^ SITE DIAGRAM ADEQUATE 8c ON HAND i ANY HAZARDOUS WASTE ON SITE: ^ YES ~NO EXPLAIN: QUESTIO EGARDIN THI 7TVSPECTION~ PLEASE CALL US AT (66~) 326-3979 Inspector Badge No., Business ite esponsible Party White -Environmental Services Yellow -Station Copy Pink -Business Copy UNIFIED PROGRAM ~ECTION CHECKLIST SECTION 1 Business Plan and Inventory Program ~~~ ~ Bakersfield Fire Dept. ~ Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FA(:II.ITY' NAME INSPECTION GATE INSPECTION TIME ~=~.~3'~='- --- - ~ _-~_(C_~~~r__ --- --------- ----- ---- - ----- - _ ._ ._ --------- --.. - - -- - -~ - PHONE No. - No. of ploYees ~ - - ADCRESS ~ ~~' -~--- ~`a t{cc~ ~ ~ ------- - -------- ----- -- --------- -------- - 5S~ - ~5~~ - -- ~- - - - .- -- - - - --- - - _ - - - - --- Business ID Number FACIUTYCONTACT 15-021- Section 1: Business Plan and Inventory Pn~gram ^ Routine l~ Combined ^ Joint Agency ^Mnlti-Agency ^ Complaint ^ Re-inspection `C /V ~~-Voatonncel OPERATION COMMENTS LTV ^ APPROPRIATE JPERMIT ON HAND [.IV ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE LAY 1^ VISIBLE ADDRESS LY ^ CORRECT OCCUPANCY I d' ^ VERIFICATION OF INV~TURY MATERIALS ^ VERIFICATION OF QUANTITIES ~^ VERIFICATION OF LOCATION ~Y ^ PROPER SEGREGATION OF MATERIAL LJ./' ^ VERIFICATION OF MSDS AVAILABILITYE - W ^ VERIFICATION OF HAT MAT TRAINING 'C/ ^ VERIFICATION OF ABATEMENT SUPPLIES ANO PROCEDURES CI ^ EMERGENCY PROCEDURES ADEQUATE tL!/ ^ CONTAINERS PROPERLY LABELED HOUSEKEEPING ^ LV/ rIRE PROTECTION Q/ ^ SITE DIAGRAM ADEQUATE St ON HAND ~a _--4~,t~r=_~__ E SG.-- ---514_!x. ~--E-~"~~~ C1t~cl1 ANY HAZARDOUS WASTE ON SITE: ^ YES ~NO EXPLAIN: QUESTIO EGARDIN THI SPECTION? PLEASE CALL US AT ~66'I ~ 3ZB-3979 Inspector Badge No., Business ite esponsible arty White -Environmental Services Yellow - Stetbn Copy Pink -Business Copy - M r I''~G/~~tiLD AI~~ ~~ CITY OF BAKERSFIELD F IRE DEPARTMENT d ~ ~ b~ OFFICE OF ENVIRONMENTAL SERVICES ~' y~` UNIFIED PROGRAM INSPECTION CHECKLIST A'w ~gti,,!'~~ 1715 Chester Ave., 3~`' Floor, Bakersfield, CA 93301 • FACILITY NAME 1 1" LCUCN INSPECTION DATE ~n • L 3' ~ Section 2: Underground Storage Tanks Program ^ Routine ~ Combined ^ Joint~Agency Type of Tank I'~till=C S Type of Monitoring ~ L Et/t ^ Multi-Agency ^ Complaint ^ Re-inspection Number of Tanks "Cype of Piping DI,U F OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data on the Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No ~ l Section 3: Aboveground Storage Tanks Program TANK SIZE(S) _ Tvpe 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 [s tank used to dispense MVF? If yes, Does tank have overtill/overspill protection'? C=Compliance V=Violatic n Y=Yes N=NO 1' Inspector: Office of Environmental Services (661) 32 - 979 white - Pnv. Svcs. ~ ~ Business ite Responsible Party Pink -Business Ci~ry - M ....___ o 4`ti1.D Fl~c~ . CITY OF BAKERSFIEI,D FIRE DEPAR'I'M . ~°~~ OFFICE OF E:NVIRONNiEN`I'AL SERVICES .y~~~ UNIFIED PROGRAM INSPECTION CItECKL[ST ;w ~g~;,~!~~ 1715 Chester Ave., 3~~ Floor, Bakerstield, CA 93301 FACIL[TY NAME 1 ~ ICUtN L~(~ ~ ~~ INSPECTION DATE ~' ~ ~ ~ 0 Section 2: Underground Storage Tanks Program ^ Routine l~ Combined ^ Joint Agency Type of Tank null=C S Type of Monitoring ~ Llt.~ ^ Multi-Agency3 Number of Tanks - ^ Complaint ^ Re-inspection Type of Piping D~,eJ F OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data un tilt 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 t i Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling fs tank used to dispense MVF? !Eyes, Dues tank have overtilUoverspill protection'? C=Compliance ~~' V=Violati~ n Y=Yes N=NO Inspector: Office of Environmental Services (661) 32 - 979 AGGREGATE CAPACITY Business ite Responsible Party White -Env. Svcs. Pink - t3usiness C'~~py 7 ELEVEN #32241 SiteID: 015-021-001884 Manager : SHIVA & PARAMJEET UPPLE BusPhone: (661) 587-8826 Location: 4101 CALLOWAY DR Map : 102 Com~az : Low City : BA~RSFIELD Grid: 19B FacUnits: 1 AOV: CommCode: CO~TY STATION 65 SIC Code:5541 EPA Nu~: DunnBrad: Emergency Contact / Title Emergency Contact / Title~-- D~)NITA COCDILL / STORE MANAGER ~kR~--~R~D~/~A~- / ~-E~--R~P~ Business Phone: (805) 587-8826x Business Phone: 24-Hour Phone : ( ) - x 24-Hour Phone : (8~0~828-0711x Pager Phone : ( ) - x Pager Phone /~ ) - Hazmat Hazards: ~ 7-EleVen, Inc. Contact : , Gasoline Acctg. Phone: (-z~) ~-z~84o6x ~ , State:j~'T~ MailAddr: P.O. Box 711 Zip : -9-7-233- City : Dallas, TX 75221-0711 Owner 7-Eleven, Inc. '/ Phone: ~~x Address : Gasoline A¢ctg. State: City : P.O. Box 711 Zip : Period : Dallas, TX 75221-0711 TotalASTs: Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: Randy Martin , Environmental Manager "r~,',~,..~-- .: ~ hereby certify that I haYe review~l the attach~ hazardous materials manage- merit plan for ?--~f~ ~'~,%~Y/and that it along with any corrections constitute a complete and correct man- 1 06/12/2003 7 ELEVEN #32241 SiteID: 015-021-001884 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7 ELEVEN #32241 Cross Street : Business Type: Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name :t 7-Eleven, Inc. Phone: (209~~?19x Address: ~ Gasoline Acctg. 7 7 City : P.O. Box 711 State: Zip: Type : / __Dallas' TX '_____75221-0711TANK OWNER INFORMATIO ~~ Name . : 7-Eleven, Inc.-~---- -~ .... '~tY~phone: Address "~, Gasoline: Acctg. ~ ~=,'~,5'~- ~tate: Zip City P.O. Box 711 ' : ' : Type Dallas, TX 7,5221-0711 BOE UST Fee# : 002251 Financ' 1 Resp: INSURANCE Legal Notif : Tank owner M~iling Address Date: 04/11/2000 Phone: Name :~B--D~NTNNfF r Randy Matin ~ Ttl :ENVIRON. MGR ~--2~- 7/769 State UST # : ~-' 1998 Upg Cert#: 00871 2 06/12/2003 7 ELEVEN #32241 SiteID: 015-021-0018B4 Manager : '~~ BusPhone: (805) 587-8826 Location: 4101 CALLOWAY DR Map : 102 CommHaz : Low City : BAKERSFIELD Grid: 19B FacUnits: 1 AOV: CommCode: COUNTY STATION 65 SIC Code:5541 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title /~~ U~!~_. '/ STORE MANAGER BRENT CRUZ / FIELD REP Business Phone: (805) 587-8826x Business Phone: (209) 243-3719x 24-Hour Phone : ( ) - x 24-Hour Phone : ~cO)~ -0~1! x Pager Phone : ( ) - x Pager Phone : ( ) - x Hanmar Hazards: Contact : Phone: (~)~,~-7~x~ MailAddr: 10220 SW GREENBuRG RD 470 State: OR City : PORTLAND Zip : 97233 Owner THE SOUTHLAND CORP Phone: (503) 977-7713x Address : 10220 SW GREENBURG RD 470 State: OR City : PORTLAND Zip : 97233 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ~ Bob DeNin-no -- r~ Environmental Manager ~, Do hereby certify that I have (Type or print name) reviewed the attached hazardous materials manage- ment plan for"~-~'¢I ~7''~'~{ ~ and that it along with (Name of Business) any corrections constitute a complete and correct man- agement plan ~. z~('~ ~.. Signature Date -1- 10/31/2000 7 ELEVEN #32241 SiteID: 015-021-001884 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7 ELEVEN #32241 Cross Street : Business Type: Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name -~ 7-Eleven, Inc. ~ Phone: (~1~9) -2~3 27!9x Address: Gasoline Acctg. State: Dallas, TX 75221~0711 City : P.O. Box 711 Type : TANK OWNER INFORMATION Name . r 7-Elevenl Inc. ~ Phone:~Tz~'~9z~- Address: Gasoline Acctg. State: Dallas, TX 75221-0711 City : P.O. BoX 711 Type : BOE UST Fee# : 002251 Financ' 1 Reap: INSURANCE Legal Notif : Tank owner Mailing Address Date: 04/11/2000 Phone: Name :BOB DENINNO Ttl: ENVIRON. MGR. State UST # : 1998 Upg Cert#: 00871 ---- Hazmat Inventory One Unified List -- As Designated Order Ail Materials at Site Hazmat Common Name... ISpocHazlEPA HazardsI Frm DailyMax lUnitlMCP GASOLINE L 10000.00 GAL Mod GASOLINE L 10000.00 GAL Mod GASOLINE L 10000.00 GAL Mod -2- 10/31/2000 7 ELEVEN #32241 SiteID: 015-021-001884 9 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ -- COMMON NAME / CHEMICAL NAME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: LOCATED IN NE CORNER OF STORE PARKING LOT CAS# 8006619 r STATE -T- TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid /Pure I Ambient I Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average · 10000.00 GALI 10000.00 GAL 10000.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS TSecretl RS,BioHazl RadiOactive~Amount I EPA Hazards NFPA USDOT# MOP NoIllIN° No No/ Curies / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ -- COMMON NAME / CHEMICAL NAME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: LOCATED IN NE CORNER oF STORE PARKING LOT CAS# 8006619 STATE ~ TYPE PRESSURE--TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 10000.00 GALI 10000.00 GAL 10000.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS ITSecretI RSIBioHazI Radioactive/Amount I EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod -3- 10/31/2000 7 ELEVEN #32241 SiteID: 015-021-001884 ~ ~ 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: LOCATED IN NE CORNER OF STORE PARKING LOT CAS# 8006619 Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 10000.00 GAL 10000.00 GALJ 10000.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS ~ TSecret N~SIBioHazl Radioactive/Amount I EPA HazardsI NFPA USDOT# I MCP No No No/ Curies / / / Mod -4- 10/31/2000 F 7 ELEVEN #32241 SiteID: 015-021-001884 Fast Format ~ Notif./Evacuation/Medical Overall Site --Agency Notification 07/17/1998 AFTER CALLING 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 BUILDING 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 07/17/1998 MINOR INJURIES WILL BE TREATED USING THE FIRST AID KIT LOCATED INSIDE THE STORE. THE CLOSEST MEDICAL FACILITY IS BAKERSFIELD MEMORIAL HOSPITAL LOCATED AT 420 34TH ST, 327-1792. 5 10/31/2000 7 ELEVEN #32241 SiteID: 015-021-001884 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 07/17/1998 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. THANK FLUID LEVELS AND INTERSTITIAL SPACE ARE MONITORED BY A TIDEL EMS 3500 MONITORNING SYSTEM. TANK TURBINES ARE EQUIPPED WITH LEAK DETECTORS WHICH RESTRICT FLOW IF A LEAK IS DETECTED BENEATH FUEL DISPENSERS OR ALONG PIPING RUNS. -- Release Containment 07/17/1998 KITT LITTER, LOCATED INSIDE THE STORE AT THE LOCATION SHOWN ON THE FACILITY DIAGRAM IS TO BE USED FOR SMALL FUEL SPILLS (LESS THAT 5 GAL). THE BAKERSFIELD CITY FIRE DEPT WILL RESPOND TO LARGER FUEL SPILLS BY PLACING SAND OR ABSORBANT ON THE SPILL. ~ Clean Up 07/17/1998 ONCE A SPILL HAS BEEN CONTAINED, THE SAND OR ABSORBANT WILL BE CHARACTERIZED AND DISPOSED OF AT A PROPER DISPOSAL FACILITY. Other Resource Activation -6- 10/31/2000 ELEVEN #32241 SiteID: 015-021-001884 Fast Format Site Emergency Factors Overall Site -- Special Hazards -- Utility Shut-Offs 07/17/1998 A) GAS - N/A B) ELECTRICAL - SW CORNE~ OF BLDG, OUTSIDE C) WATER - NW CORNER OF PROPERTY IN PLANTER NEAR DRIVEWAY APPROACH D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 07/17/1998 PRIVATE FIRE PROTECTION - N/A NEAREST FIRE HYDRANT - NE CORNER OF PROPERTY IN PLANTER. Building Occupancy Level 7 10/31/2000 7 ELEVEN//32241 ~~~~~~ SiteID: 015-021-001884 Training ~~~~~~~~ Overall Site i i~ Employee Training ~~/~/~/~/~~/~/~~~ 07/17/1998 o WE HAVE 6 EMPLOYEES AT THIS FACILITY. o o WE DO HAVE MSDS SHEETS ON FILE. ° O BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED IN A HAZARDOUS o MATERIALS COMMUNICATION PROGRAM. eACH EMPLOYEE IS INSTRUCTED ON HOW TO USE o AND UNDERSTAND THE MATERIAL SAFETY DATA SHEETS. THE EMPLOYEES ARE INFORMED o OF THE HAZARDOUS MATERIALS STORED AT THE SITE AND THE PROPER RESPONSE o PROCEEDURES, INCLUDING WHO TO CALL, IF A SPILL SHOULD OCCUR. o o O O i~/~ Held for Fumre Use O o i~8~ Held for Future Use O O 7 ELEVEN #32241 ,f ~ , SiteID: 015-021-001884 Manager : ........ -__ ~p)~_ BusPhone: (805) 587-8826 Location: 4101 CALLOWAY DR ----L Map : 102 CommHaz : Low City : BAKERSFIELD Grid: 19B FacUnits: 1 AOV: CommCode: COUNTY STATION 65 SIC Code:5541 EPA Numb: DunnBrad: Emergency Contact / Title _5___ Emergency Contact / Title - S~/4~A~J~J~''' / ~--i~%5-)~ BRENT CRUZ / FIELD REP Business Phone: (805) 587-8826x Business Phone: (209) 243-3719x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x. Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Contact : Phone: (503) 977-7713x MailAddr: 10220 SW GREENBURG RD 470 State: OR City : PORTLAND Zip : 97233 Owner THE SOUTHLAND CORP Phone: (503) 977-7713x Address : 10220 SW GREENBURG RD 470 State: OR City : PORTLAND Zip : 97233 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: ', '~ "~-~ l,~V',4 DO hereby certify tha~: ~ have ~y~ Or p~nt name) reviewed the a~ached h~ardous removals manage- ment plan forq-~~~/and ~hm it along with (Na~ of Busine~) any corre~ions constiJute a complete and corre~ man- agement plan for my facili~. ., / ~to 1 10/31/2000 7 ELEVEN #32241 SiteID: 015-021-001884 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7 ELEVEN #32241 Cross Street : Business Type: Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : BRENT CRUZ Phone: (209) 243-3719x Address: City : State: Zip: Type : TANK OWNER INFORMATION Name : BRENT CRUZ Phone: (209) 243-3719x Address: City : State: Zip: Type : BOE UST Fee# : 002251 Financ'l Reap: INSURANCE Legal Notif : Tank OWner Mailing Address Date:04/ll/2000 Phone: (503) 977-7713x Name:BOB DENINNO Ttl:ENVIRON. MGR. State UST # : 1998 Upg Cert#: 00871 = Hazmat Inventory One Unified List -- As Designated Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax IUnit MCP GASOLINE L 10000.00 GAL Mod GASOLINE L 10000.00 GAL Mod GASOLINE L 10000.00 GAL Mod 2 10/31/2000 7 ELEVEN #32241 SiteID: 015-021-001884 ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~lV~Vl~ ~Vl~ / ~ ~ ~.I~ ~Vl~ GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: LOCATED IN NE CORNER OF STORE PARKING LOT CAS# 8006619 Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 10000.00 GALI 10000.00 GAL 10000.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 TSecret I RS IBi°Haz HAZARD ASSESSMENTS RadiOactive/Amount EPA Hazards NFPA USDOT# MCP No INo I No No/ Curies / / / Mod ---- Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ -- COMMON NAME / CHEMICAL NAME GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: LOCATED IN NE CORNER oF STORE PARKING LOT CAS# 8006619 Liquid ]Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 10000.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 , HAZARD ASSESSMENTS TSecretI oRS[BioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# MCP No N No No/ Curies / / / Mod -3- 10/31/2000 7 ELEVEN #32241 SiteID: 015-021-001884 ~ 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: LOCATED IN NE CORNER OF STORE PARKING LOT CAS#~ 8006619 FSTATE TYPE , PRESSURE I TEMPERATURE I CONTAINER TYPE /Liquid Pure I Ambient Ambient fINDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 10000.00 GAL 10000.00 GALI 10000.00 GAL HAZARDOUS COMPONENTS Wt. I CAS# 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS MCP TSecret N~SIBioHazl Radioactive/Amount I EPA Hazards NFPA USDOT#I No No No/ Curies / / / Mod -4- 10/31/2000 7 ELEVEN #32241 SiteID: 015-021-001884 Fast Format ~ Notif./Evacuation/Medical Overall Site -- Agency Notification 07/17/1998 AFTER CALLING 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 BUILDING 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 07/17/1998 MINOR INJURIES WILL BE TREATED USING THE FIRST AID KIT LOCATED INSIDE THE STORE. THE CLOSEST MEDICAL FACILITY IS BAKERSFIELD MEMORIAL HOSPITAL LOCATED AT 420 34TH ST, 327-1792. -5- 10/31/2000 F 7 ELEVEN #32241 SiteID: 015-021-001884 Fast Format = Mitigation/Prevent/Abatemt Overall Site --Release Prevention 07/17/1998 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. THANK FLUID LEVELS AND INTERSTITIAL SPACE ARE MONITORED BY A TIDEL EMS 3500 MONITORNING SYSTEM. TANK TURBINES ARE EQUIPPED WITH LEAK DETECTORS WHICH RESTRICT FLOW IF A LEAK IS DETECTED BENEATH FUEL DISPENSERS OR ALONG PIPING RUNS. --Release Containment 07/17/1998 KITT LITTER, LOCATED INSIDE THE STORE AT THE LOCATION SHOWN ON THE FACILITY DIAGRAM IS TO BE USED FOR SMALL FUEL SPILLS (LESS THAT 5 GAL). THE BAKERSFIELD CITY FIRE DEPT WILL RESPOND TO LARGER FUEL SPILLS BY PLACING SAND OR ABSORBANT ON THE SPILL. -- Clean Up 07/17/1998 ONCE A SPILL HAS BEEN CONTAINED, THE SAND OR ABSORBANT WILL BE CHARACTERIZED AND DISPOSED OF AT A PROPER DISPOSAL FACILITY. Other Resource Activation -6- 10/31/2000 F 7 ELEVEN #32241 SiteID: 015-021-001884 Fast Format ~ Site Emergency Factors Overall Site Special Hazards -- --Utility Shut-Offs 07/17/1998 A) GAS - N/A B) ELECTRICAL - SW CORNER OF BLDG, OUTSIDE C) WATER - NW CORNER OF PROPERTY IN PLANTER NEAR DRIVEWAY APPROACH D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 07/17/1998 PRIVATE FIRE PROTECTION - N/A NEAREST FIRE HYDRANT - NE CORNER OF PROPERTY IN PLANTER. Building Occupancy Level 7 10/31/2000 STATEMENT OF ACCOUNT in o[ DATE' 5/al/aa ~~_P, ~g33i2 7-ELEVEN STORE P.O. BOX 711 ~: DAL~, TE~S 7~1~7~1 CU~Y'C)M~R Nd' ~31 CUSTOMER TYPE ES/ .... C,~ *"=~"= ....... DATm~ ~*=o¢'=~.o~,,iPTiON REF-'NUMBER DUE DATE TOTAL AMOUNT ~, ~ ~.~1 ~'~ O0 ~/n!/O0 BEOINNINO ~ ..... ,~- . HMO05 6/0i/00 HAZ MAT HANDLiNg FEE E ii0.00 HMOi7 6i0i/00 HAZ MA'[' ANNUAL iNSPECTiON 50.00 SSOOi ~i~ /nn ~' ~T'T= ~-ii~P~'-m i0.00 SSO02 6/0!/00 UST STATE SURCHARGE 24. O0 THiS YEE iS A STATE SURCHARGE OF '.$8.00 FOR EACH UNDERQROUND ~uRAOE TA~K. UTO0i 6/0i/00 UNDEROROUND TANK ANNUAL' 198.00 OPERATIN~ PERMIT FEE OF $6&.00 FOR EACH TANK. THIS UNiFiED BILL REPLACES SEPERATE BILLS RECEIVED iN THE PAST FOR THESE PROGRAMS. , ......... CH~N~=o TO YOUR ACCOUNT PLEASE FOR =w=o,l~No OR ...... CALL 'THE NUMBER AT THE TOP OF THiS STATEMENT. CH~P=k,~ n~,=~ 30 OVER aO OVER 90 CITY OF BAKERSFIELD CLAIM VOUCHER IVendor No. I I certify that this claim is correct and valid, and isa proper charge against the City Agency and account indicated. CLAIMANT'S NAME AND ADDRESS: Seven Eleven #32241 (AUTHORIZED SIGNATURE OF CITY AGENCY) 4101 Calloway Dr Bakersfield, CA 93312 Date: 04-01-99 Initials of Preparer: CITY DEPARTMENT: FINANCE PLEASE PROVIDE SHORT EXPLANATION OF PAYME (Including Contract Number if Applicable) This customer made a duplicate payment of this years Haz Mat bill in the amount of $400.50. We have since made an adjustment to the California State surcharge in the amount of $8.50 leaving them with a credit of $409.00. Dept. El / Objt Project # Invoice # Amount Date of Invoice 0000 7900 $409.00 VOUCHER TOTAL $409.00 SECTION 72, PENAL CODE FINANCE DEPT. USE ONLY Section 72, Presenting False Claims. Every person who with intent to defraud, presents for allowance or for payment to any state board or officer, or any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, Examined & Approved for Payment Amount or writing, is guilty of a felony. 7 ELEVEN #32241 ~~~~~~ SiteID: 015-021-001884 Training ~~~~~~~~ Overall Site i~ Employee Training ~i~i~/~~~~~ 07/17/1998 i o WE HAVE 6 EMPLOYEES AT THIS FACILITY. o o WE DO HAVE MSDS SHEETS ON FILE. o O BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED IN A HAZARDOUS ° MATERIALS COMMUNICATION PROGRAM. eACH EMPLOYEE IS INSTRUCTED ON HOW TO USE o AND UNDERSTAND THE MATERIAL SAFETY DATA SHEETS. THE EMPLOYEES ARE INFORMED o OF THE HAZARDOUS MATERIALS STORED AT THE SITE AND THE PROPER RESPONSE o PROCEEDURES, INCLUDING WHO TO CALL, IF A SPILL SHOULD OCCUR. ° o o o i/~/~ Held for Future Use O O i/~i~ Held for Future Use 0 o STATEMENT OF ACCOUNT CITY OF BAKERSFIELD 1501TRUXTUN AVE BAKERSFIELD, CA 93301-5201 DATE: 4/01/c~c~ TO: SEVEN ELEVEN 4iOi BAKERE CUSTOMER NO: ?~, CUS~OMER~-.~YPE: ES/ ~3~33 .......... ,L ] ~ :~'EEF-NUMB ER~, DUE E TOTAL AMOUNT CHARGE DATE 2/1&/9~ ,~:~::~-.~:,: ~ 400. 50- SSO01 3/31/9~ 'Qe 8. 50-- ~,,'~ F~R GUEST[ONS fir CNAN~ES-'TO YOUR AC~flUNT PLEASE gALL THE NUMBER AT THE TflP ~ TH[~ ~TATE~ENT. CURRENT OVER 30 OVER 80 OVER 90 8. 50- DUE DATE' 5103199 PAYMENT DUE: 409.00-- TOTAL DUE: $409.00- MISCELLANEOUS RECEIVABLES ADJUSTMENT ,/"' DATE ~ [ I -~c~ '~GECLosENEWACCOUNTAcCT , OTHER ADJ CUSTOMER NAME ~-----~P--A~ ~.~ ~ ~ -~~L'-~ I MAILING ADDRESS ~, ~ \, ("~_~/~ uOo.~ ~ ('. ZIP CODE q"~\"~,. SITE ADDRESS PARCEL NUMBER (~ APPUCAeI.E) ADJUSTMENT I CHG DATE I CHARGE CODE ADJUSTMENT AMOUNT APPROVED BY ,~.~~~ .~- CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: :O ~'~/d~. (~- / DUN & BRAI)STREET NUMBER: SIC CODE:~ PRIMARY ACTIVITy: SECTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS'. PHONE 24 HR. PHONE SECTION 3: TRAINING NUMBER OF EMPLOYEES: 6 B~F S~Y OF x~a PROOf: SECTION 4: E~TION ~O~ST I CERT~Y ~ER PEN~TY OF PE~Y ~T ~ BUS,SS IS E~T ~OM ~ ~PORT~G ~Q~~S OF C~R 6.95 OF & S~TY CODE" FoR~ FOLLO~O ~ASONS: ~ DO NOT ~LE ~~OUS ~~S. ~ DO ~LE ~~OUS ~~S, B~ ~ QU~IT~S AT NO T~ EXCEED ~ ~ ~POKT~G QU~IT~S. OTHER (SPECIFY REASON) SECTION 5' CERTIFICATION I, CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE 2 ' 'HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES EMPLOYEE NOTIFICATION AND EVACUATION: -~. C. PUBLIC EVACUATION: D. EMERGENCY MEDICAL PLAN: t ' H~7,ARDOUS MATERIALS MANAGEMENT PLAN _. SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN B. RELEASE CONTA1NM~"-N¥/~D/OR MINIk~ATIO~: /~ c~/,,~/.~ SECTION 8: UTII.!TY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: //~~ SPECIAL: //-"' LOCK BOX: YE~ ll~ YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: B. WATER. AVAIl.ABILITY (FIRE HYDRANT): 4 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ] j SITE ADDRESS ~7~//0/ t~,a.. ~£,c,'-~ CITY ,~c~-~ ~(-.~./~Cdd STATE ~ Z~ ~ ~ ~/~ NAT~ OF BUS.SS SIC CODE ~/ D~ & B~S~ET ~ER CITY ~Or///~r.~~' STATE EMERGENCY CONTACTS / BUSINESS PHONE (c~.: ~ ~ 70- Z '~:/~ 24 HOUR PHONE I Cl~MICAL DESCRXPTION I)INVENTORYSTATUS:Ncw[/V~Addition[ ]Re~si0n[ ]~le~[ ] Ch~ch~isaNONTm~S~[ ]T~t[ ] 4) Physi~ & H~ P~SIC~ ~ H~dCategod~s Fke~R~ctive[ ]Sud~Rel~of~s~e[ ] ~ateH~(Aeu~)[ ]~Iav~H~(C~) 5) WAS~ C~S~CA~ON/' (3~t ~ from D~ Fo~ 8022) USE CODE 6) P~SIC~ STA~ Solid[] 7) ~O~ ~ ~ AT FAC~ ~S OF ~~ 8) STOOGE COD~ Av~e D~ly ~o~t / ~ O~O C~] b) ~es~e: ~ ~o~t c) T~~ ~ Days on Site '3 l' ~ C~le ~ch Mon~: ~I, F, ~ ~ ~ J, J, ~ S, O, N, D 9) ~: List CO~~ C~g · e ~ mo~ bn~nrdo~ 1) [ ] ch~ ~m~nm~ or 2) [ ))L~A~ON~ o~f- 1) ~ORY STA~S: New [ ] Addition [ ] Re,sion [ ] Dele~on [ ] Ch~k d ch~ is a NON T~ S~ [ ] T~ Stat [ ] 2) Co--on N~e: 3) ~T ~ (op~o~) Ch~lNme: ~[ ] C~g 4) Physi~ & H~ P~SIC~ ~dCategodes F~e[ ]R~cave[ ]Su~Rel~of~es~[ ] ~a~H~a(Acu~)[ ]~y~H~(~c)[ ] 5) WAS~ C~SS~CA~ON (3~i~t c~ ~om D~ Fora 8022) USE CODE 6) P~SIC~STA~ Solidi ] Liq~d[ ] ~a[ ] ~e[ ] ~e[ ] W~[ ] 7) ~O~ ~ ~ AT FACK~ ~S OF ~~ 8) STOOGE CODES' M~m Daily ~o~t Lbs [ ] G~ [ ] R3 [ ] a) Con~: Av~ge Daily ~o~t C~es [ ] b) ~e~: ~ ~o~t c) T~e L~gem S~e Conm~er g Days on Site C~le ~ch Monks: ~1 Y~, J, F, ~ A, M, J, J, ~ S, O, N, D 9) ~: List CO~O~ C~g % · e ~ee most h~do~ 1) [ ] ch~ ~m~nents or 2) [ ] ~y ~ ~m~n~m 3) [ ] )L~A~ON I cemi~ ~d~ ~1~ of law, ~at I have ~lly e~ ~d ~ t~li~ ~ ~e ~o~ah~n on ~s ~d M1 a~h~ ~~. I ~lieve ~e su~tt~ ~o~aaon is ~e a~t~d c~let~ ~ ~/ ~ ~ .... J_ .~ ~ N~ & Title of Auto.ed Comply R~re~ve 8i~e Da~ CITY OF BAKERSFIELD · OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, C~k (805) ~26-3979 SITE AND FACILITY DIAGRAM INSTRUCTIONS FOR HAZARDOUS MATERIALS MANAGEMENT PLANS These instructions explain the use of the site diagram and the facility diagram. Normally, small and medium size businesses will only have to submit a site diagram. If you have subdivided your business into smaller areas because of the complexity or size, then you will be completing and additional detail map, facility diagram, for each of these areas. Include instructions that show the route to your business it it is in a remote location. SITE DIAGRAM INSTRUCTIONS The site diagram is used to show your business and to indicate the businesses that immediately surround your property, usually within 300 feet. If you will be showing specific area detail on facility diagrams, use the site diagram to show an overall layout of the plant. If you will not be submitting facility diagrams, the site map must include all of the following information: 1. Check the box on the top lei~ corner of the form provided that indicated "Site Diagram". 2. Print the name of your business, as shown in your MP, on the top of the diagram. 3. Label the location of the hazardous materials and identify them by name and type of hazard (ie. Flammable liquid, corrosive solid). 4. Label the location of utility shutoff points for gas, electric and water services. 5. Label the location of fire hydrants. 6. Label portions of the building protected by automatic sprinkler systems. ~ 7. Label the direction representing north on the diagram,. (The diagram form provided includes a north arrow). Map labeling must be legi d easily understandable. Try to avoid the use of abbreviations or · symbols. If you must use them, provide a legend explaining your system. Maps may be returned for correction if you fail to follow these instruction. . FACILITY~ DIAGRAM INSTRUCTION,S, Facility diagrams are supplements to the site diagram. Use them to show the subdivision details of a large business. 1. Check the box in the upper right hand comer of the form provided that indicated "Facility Diagram". 2. Print the name of your business as shown on your HMMP. Print the name of the area that this map represents. This name should be the same name that you used on this area's inventory report. 3. Indicate which area the diagram represents and the total number of facility diagrams that you are including. If a map represented the first of four areas, it would be labeled #1 of 4. 4. Follow instruction (3 -7) for site diagrams regarding the specific details to be included on each facility diagram. 2 usiness Address: 7101 ~,~l/'~,.c.,z,/ D~,~,, I~r~u.~< f,~/~,~ ~ ? CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRl2~ ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. SECTION 1' BUSINESS IDENTIFICATION DATA DUN & BRADSTREET NUMBER: SIC CODE: MAmma ADDRESS: /02.2,0 ' SECTION 2: EMERGENCY NOTIFICATION CONTACT TITLE BUS~ PHONE 24 HR. PHONE ! HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING NUMBER OF EMPLOYEES: ~ BRIEF SUMMARY OF TRAINING PR~OGRAM: SECTION 4: E~TION ~Q~ST I CERT~Y ~ER PEN~TY OF PE~Y ~T ~ BUS.SS IS E~T ~OM ~ ~PORT~G ~Q~~S OF C~R 6.95 OF & S~TY CODE" FOR ~ FOLLO~G ~ASONS: ~ DO NOT ~LE ~~OUS ~~S. ~ DO ~LE ~~OUS ~~S, BUT ~ QU~IT~S AT NO T~ EXCEED ~ ~ ~PORT~G QU~IT~S. O~R (SPEC~Y ~ASO~ SECTION 5: CERTIFICATION I, CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. SIGNATURE TITLE DATE 2 ' ' US MATERIAI~ MANAGEME PLAN SECTION 6; NOTIFICATION AND EVACUATION' PROCEDURES A. AGENCY NOT~ICATION PROCED~S: ~ %'"./~r e:~/~ ~//,t ~4L ,~f,,~ ,..fie .-f-A- ~/,~,-~, ~ :TJ~ o~ 'o 4 ~-,,,.,.,...,.] ~2g" B. EMPLOYEE NOTIFICATION AND EVACUATION: -T~ _~'~r'< ,::~'~~~ C. PUBLIC EVACUATION: D. EMERGENCY MEDICAL PLAN: 3 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES,, A. AGENCY NOTIFICATION PROCEDURES: B. EMPLOYEE NOTIFICATION AND EVACUATION: C. PUBLIC EVACUATION: D. EMERGENCY MEDICAL PLAN: 3 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN A. ~bEASEP~WNTION Sm'S: ~,..~.~,, -C---/ZL,do~C ~,,.,;Z,J.~ ~ y' '' - ' ~" r '' ~ ~ ~ // g SECTION 8: UTILITY SHUT-OFFS (~OCATION OF SHUT-OFFS AT YOUR FACILITY). NATURAL GAS/PROPANE: SPECIAL: rS./ LOCK BOX: YE~ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: ~,'~//~ B. WATER AVAILABILITY (FIRE HYDRANT):///~ r/'~--~4 4 c CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 715 Chester Ave., Bakersfield, CA (805) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ] BUSINESS NAME /~x~ ~o~/~t~[6r/Y,~r~~ ·STATE ~ZIP 73"~/~ NATURE OF BUSINESS SIC CODE ~/ D~ & B~S~ET ~ER CITY ~Or' ~//~/~r STATE Or.-z q'aa ~ ZIP ~ 7.2-2 "~ EMERGENCY CONTACTS BUSINESS PHONEQ~. ~ BUS'SS PHO~2 ~ X TV- X eVV 24 HO~ PHO~ 1 ,~ I , I~4~b. RDOUS MATERIALS INVENTORY ' { 22. Page. __~ of/- .' , -~ J ' ~ / '- 1) ~ORY STA~S: New~ Ad~tiou [ ] Re~si~-[ ] ~le~ [ ] Ch~k ifch~ is a NON Tr~ S~ [ ] T~ S~t [ ] 4) Physi~ & H~kK P~SIC~ ~ H~d Categories Fke [~1 R~tive [ ] Su~ Rel~ of~s~e [ ] ~ate H~ (Acu~) [ ] ~lay~ H~ (C~c) s) WAS~ C~S~CAUON/' (3~t ~ ~m D~ Fora 8022) USE CODE Liq~d~ O~[ ] ~c~ ~[ ] W~[ ] ~w[ ] 6) P~SIC~ STA~ Solid[] 7) ~O~ ~ ~ AT FAC~ ~S OF ~~ 8) STOOGE COD~ ~ D~Iy ~o~t ~O O~ Lbs[ ]~~[ ] a) C~ Av~e D~ly ~o~t / ~ O ~ C~] b) ~s~e: ~ ~o=t ~) Tm~ ~ge~ S~e Con~ / O~ ~ ~ t Days on Site '~ g ~ C~le ~ch Mon~: ~1, F, ~ & ~ ~, ~, & S, O, N, D 9) ~: Li~ CO~~ C~t · e ~ moa ~do~ 1) [ ] ch~ ~m~ or 2) [ ] ~y ~ ~n~ 3) [ ] ~)L~A~ON~ o~~ _ ' 1) ~ORY STA~S: New [ ] Ad~fion [ ] Re, sion [ ] ~lefion [ ] Ch~k ffch~ is aNONT~ S~ [ ] T~ ~t [ ] 2) Comon Nme: 3) ~T ~ (option) Ch~lNme: ~[ ] C~ 4) Physi~ & H~ P~SIC~ ~dCategofies Fke[ ]R~cfiw[ ]S~Rel~of~es~[ ] ~~H~(Acu~)[ ]~hy~H~(C~)[ ] 5) WAS~ C~8S~CA~O~ (3~i~t c~ ~om D~ Fora 8022) HSE CODE 6) P~SIC~SIA~ Solid[ ] Liq~d[ I O~[ I ~e[ ] ~[ I W~[ ] ~w[ ] 7) ~O~ ~ ~ AT FAC~ ~S OF ~~ 8) STOOGE CODES M~ Daily ~omt Lbs [ ] O~ [ ] ~3 [ ] a) Con~ Av~ge Daily ~omt Crees [ ] b) ~ ~o~t c) T~~ L~ge~ S~e Conm~ ~ Day~ on Site C~I~ ~ch Monks: ~1 Y~, J, F, ~ & M, J, J, & S, O, N, D 9) ~~: List CO~O~ C~ · e ~ee most b~ardom 1) [ ] ch~ mm~n~ts or 2) [ ] ~y ~ ~m~n~ 3) [ ] )L~A~ON I ce~i~ ~ ~1~ of law, ~t I ~ve ~ly e~ ~d ~ t~ ~ ~e ~omfion on ~s ~d ~1 a~ ~~. I ~lieve ~e su~ ~omfion is ~e, ~a~ ~d ~mple~. PRINT Name & Title of Authorized Company Representative Si~aature Date 0CT-1~-1998 11:S0 SOUTHLAND CORP NW DIU. 503 977 7711 P.01×02 The Southland Corporation Environmental Services 10220 S.W. Greenburg Rd. #470 Portland, OR 97223 FAX COVER SHEET = · Please note our new address and phone and fax ~mbev~lll F~ NO: .(5031 2t~8 PHONE NO: 003)977-m3 Numar of pa~s ~clud~g ~is cover sh~