Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
BUSINESS PLA 12/19/2006
~- -- - ~ - - j (UNDERGROUND STORAGE TANKS) FILE # `~ 31M'S MOBiL 3200 F STREET _ l~ ~` ~. ~- .- Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST; e_ E R_5_F_, _D 90oTruxtun Ave., suite 210 ~_ ,~ ~= - _ -_~~. _- __._ .._ __ _ ~_ _ _ _ - ~ ~ F~R6 Bakersfield, CA 93301 _ -- - SECTION ~ : BUSIIIeSS Plan a11C1 inv@tltOf'~/ Program j ~ese- r Tel.: (661) 326-3979 I. ~ Fax: (661) 872-2171 FACILITY NAME ~~ .~... S jV~c~~~ ~ INSPECT ON D TE I / oG INSPEC TIME ~.... ADDRESS ~ ~~~ c , r ` ~ ~ ~ HONEi 0~~~,T NO OF EgMPLOYEES 1 FACILITY CONTACT BUSINESS ID NUMBER 15-021- ~/a-- Section 1: Business Pfan and Inventory Program ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=compliance OPERATION V=Violation COMMENTS ^ ^ APPROPRIATE PERMIT ON HAND ^ BUSItIeSS PLAN CONTACT INFORMATION ACCURATE r, ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES \,.,,, YJ ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ('1O VV \,~ ~+J ^ VERIFICATION OF HAZ MAT TRAINING ~( r ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES / ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ~~ ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ~ NO EXPLAIN: rcer-euis QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (667) 326-3979 Inspector (Please Print) Fire Prevention / 1s' In /Shift of Site/Station # Business / Resp nsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 ,~..~. _ ~. _ --- . ___ . _ - ~i L~ JIrt.:~ rICiBIL 3L'00 F ST . BH}:Ek F I ELLi C'r=~ 93301 6G 1-3"~-'250 DEC' 19. '2006 9:11 Hf°1 S`i`STEf°1 ~Ti=tTU:.i kEF'C'rkT - - - - i - - HLL FUPdCT I - - - - - - ti1N19 P~lC1Rr1tiL I fVt.~EtJTt+k'! kE P4RT r ' f '' 4 ^T 1; ~LEtiDED ~'~L~LI.~t°lE = 4989 iai~LS ' I:~L LHiaE = ~ 5i ~ 1 1 i. riL 90u" ULLtGE= X011 GALS ' TC.','U'ULUP'tE _ ~190~i GHLti HEIGHT = 47.9 ItVi~HES ' WH'T;~~k Vt?L = 15 GNLS I,tiItiTE>~t._' = 0.91 I tVt'_'HEti ~*'TEP'1F = 61 .3 DEC: F .;~`~ ~ ~ T 2 : P REri I Ut°I IttiLUr1E = 5'23 GhLS ULL~GE _ ~3777~ i;~LS 90%5 ULLr~C~E= 3?77 GHL:~ TC 'SIG+L Uf°lE = 5'~' 19 i;HL HEIGHT = 49.68 I fVi~HE , Wr~TEk IItiL = 0 GHLS lh1HTEk = 0.00 I N~ ~HES TEMP = 68.6 DEG F E ND ~ ~ :* _ „ .r-r INSPECTIONS BUSINESS PLAN & INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: ~ I "I^'`'S ~~~ i L, B E R S F I L D F/lit E AIPTM T Section 2: Underground Storage Tanks Program INSPECTION DATE: IZ 1 ~la 6 ^ Routine ,lid Combined ^ Joint Agenc ^ Multi-Agency ^ Complaint ^ Re-Inspection Type of Tank ~I "' ~IQ ~`lt ~ I"`°' Number of Tanks Type of Monitoring V~-•- Type of Piping ~1~as.~.~c S~=~1G >; t i't4_~ 12 - n OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current o,ar-.- . a.~ ~. ey ~ e ~ ,~ X73 ~~~~-Q, 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 ~1 No Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank 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: ~ / C,''~iL'~-+~s J' 1"~ Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services Pink -Business Copy Aggregate Capacity Number of Tanks 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 KBF-7335 FD 2156 (Rev. 09/05) UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ElD I UNE TESTING / S6989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION BAKERSFIELD FIRE DEPT. f,,R~ Prevention Services ART~I ! 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 PERMR NO. I ~~ r^-1 ENHANCED LEAK DETECTION t^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING 1 I TA AII[ Tir:HTNFCR TEAT V V T(1 PFRF(~RIW FI IFI IU(1NIT(1RIN(: CFRTIFI(:4TI(1N • . FACILITY NAME K PHONE U~~A=~BE1LaOF CONTACT PERSC+" ~ + ~ ;~rn~ , , . 5~,~,,I- ~~ 322 Zz, v ADDRESS 3~~ ~ ~~~~ OWNERS NAME ~~ ~ ~~~ ~~ In ~^ :'t~~ ~ ~~ OPERATORS NAME .-~` i _ ~~u~~~ C ~ G ~, / PERMIT TO OPERATE N0. NUMBER OF TANKS TO B E T ES T EO I I YE N ~ ~ ~~-c~ m ... ' '" ~ -TANK TESTING..COMPANY ,.. „ • ,. .. NAME OF TESTING COMPANY 55 ~ U • ME & P v.~ NE NUM ER O CONTACT PER ON • Z- ~ MAILING ADDRESS ~ ~ ~~ _ ~~ ~~ ,(~ ~~~~/„ , N 8~ PHONE UMBE E ER OR SP~EC~ INS~~I~ /'ZS O { ~ CERTIFICATION #: DATE B,TIM TEST T BE CONDUCTS ICC #: _ ~ TEST METHOD SIGNATURE OF APP NT DATE ~i ~ APPROVED BY DATE FD 2095 (Rev. 09/05) ~~ . ~ FROM :13SSR,INC FAX N0. :6615882786 Oct. 18 2006 09:11AM P2 ' ~ • USSR, Inc. • 6630 Rosedale Hwy., # B, Bakersfield; C1~ 9330$ Phone (661} 588=2777 Pax (661)`588-27$6" .. ;,.. .. M[~NITU.R~NG S~S~'ENx C~RTIF~CA,'~'~~N ~ • • . ' •This form ratter be used !o dpetitneAt testing. :and servicing of monitoring equipnnent.•S,_sSjlsrate~certificatiQ~. •qr ieport mu5t•b'e ' nrel,ared for ea~i rnoaito~g.~ystem rrontro! vestal by the technician who pcrforms'tht work. A copy of~.this fortxi must be provided to'• the tank, system owner/operator:. The ownerloperatar must sttbtnit. a copy of this ;farm io ttzc • local. agency regulating UST sysoems within 30 days of test date. ~ .~ A. ~Ge>aerai Iaform / •.. • . . ~ ~ : ~. "'' Facility Name: ~~/~'1~.~fl~ • : .. ~ ldg. Ne.- _ Site Add_ less: ' c~~QC~ ~ cs% ~ . -- Cam': ~ . Z~: ... . 'Facility Contact Person: ! ~~~ .:: - _ Contact.Photie No.c ( ~ )_.,. • Make/Model'of Nionitotiag System:. 'pate of Testing/Serviciag ,~~ I r~ l T~,d ...,._. .:. .. ~ . ..... r.,....._...:.. .. ... .. _ .. ... .... , . B. )Lnvent~ory of Eq->Efipment'~estedlCeirtlfed ._ ... • l:t1eCR the a ro ri&iR OpSes w [DOtC+iC a ecu,~ u, q~cuc n,s swrw....~u.. Tank •iD: • ; Ta~ak ID: • • in-'ra,tk tsuging Prober . Ivlodel,:: ~ ~ ~1ta-Tank C~iatiging.Piebc. ltkioad• ' ' ^ Annular Space or Vaul! 5egbor. •. Model:, • nsor: 'Model: _ e ^ Annular Space of Vault S ' ~ivlodeli ~f _ .t~ Piping Sump /"Itench Scnsor(s} ~ . , Model: . 'Q •l'iping Sump / Tre,ich S~isor{s). • ' 4 ~' •. .. D Fill Sump Stnsot{s). ' ' Model: • ~- . ¢ F!!T Sump 5ensoi•(s}. Model: O Methanical LineLroalt Detector. Model: .Q Mechanical Line Leak,>7etector.• :..Mode[:. - lrlectronie Line Leak )Retector. ~ ~ Model: " ~tecuostic.Line Leak• Detector.. , Modelb~ sor lti( d t: ~' l 1 Le e fil i h ' O Overfill !High-Cruel Sensor. Model: • Tanfc . Sen o e . ve v } r l ig - ~ • Fank ' D 'Others i ui meat' end model in Section B on Pa ~ . Soctiote >~ ob Pa a •Z . ^ Other' s csi ' 'ai ' nt t and mode! in Tank IDs 'rank IAt - ^ In-Tank Gauging Probe. Model' ^ In-Tank Gauging Pro6c: Model:. - -- --, Q Annular Space or Vault Sensor. Model: ~ ^ Annular Spaee or Va<tlt•Sensor. Model: _ ^ Piping Sump ! Trenoh Sensor(s). Model: ^ Piping Sump ! Tr~encls Scissor(s). Model: - _ _„ , ^. Fill Sump Sensor(s). Model:. _ ^ Fill Sump 5tnsot(s}. Model: _ - p :Mechanical Liar I:eak ietector. Model: Q Mechanical Line Leak, Detector. MvdeT: Q Electronic Line C:.eak Detector. Model: ~ D Electronic Line l';.cak Detector.. Model: D .Tank Overfill /High-Leyei Sensor. Model: ' n Tank Overfill /High-Level Sensor..MQdel: __ • •^ Other s eci ui rttertt and model in'$ection Eon Pa e 2 •. . ^ Other s eci ~ iii t Band modetlti Section S oa P s 2 iapepser XD: ~ ~ I)ispenstlr lb: Dispenser Con sinment Sensor(s): Modal: Dispenser Centainment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dis ser Containmen Floats and Chains _ ~ O Dis eraser Containment Flo sand Chai s . Dispenser ID: Dispenser FD: r • ,' '.%~tsRe~tscr Containm t Sensor(s). Model: f(! Dispenser Containment Sensor(s)., Model: $fiear Vslue(s). . ' Shear Valve(s). ~ ser Caritainm Flo sand Chains . I3is Dis scrCoi-talnrttchLFloat s and Chains , Dispenser [D: Dispenser iA:. tjdP Dispenser t;onta~nment Sensor(s), Modal: t~l Dispenser Containment 5ensar(s): MaleI: ' 5hearValve(s)-. ~ 5hear valve(s): ~~ ~DCS near Contairtraeht Plos s sad Chains . ^ Dis naer.Contalriment Floats end Chain s . ~Ifnc~ r•„eility eon~ins mere tarilts or disoc,isers. coov this form. Include infotrtiation for'every'ta»Ic and dispenser at'the facility. 'd C. Ce1-i~Ca>lf0>a - I certify that ilea equipment identified in 'this' doeumeut .w'as inspectedlserviaed iii accordance with ,the tnanafacturtrs'• guidelines. Attached-to this Certification !s infarmatiaa (e.g. mantttat:turers' chetkllsts} necessary co verify that this information is correct and a Piot )'tan showing the layout of itlonitoring equipnieYit. For • ay eq pmeat capable of geperating such reports, I have also atla~d a f the re ' d• rat s pplY): ste -alp Ala port Technician Name (print) ~~ Signatur ' Cerfif:!cation 1Jo. ~ License. No. ~~ ~~~ Testing Catttpany Na Phone' No.-~} w "o Site Address: V r ~ Date• of Testing/Se:rvieing: ' ~ Page ! of 3 03/8l Monitoring System Certiltcation FROM :BSSR,ING FAX N0. :6615882786 Oct. 18 2006 09:12AM P3 ~: Results of'~'t;sting/Servicing Software Version Irtstalled: „f~g- G~~ Comotete fhe fotlowinn checklist: .., Yes ^ No* is the sudlble alarm o eratiorsal? Yes ©No" Is the visual alarm o erational? Yes d No" Were al] sensors visual] ins ected functional] tested and confirmed o eratianal? Ycs ^ No" Were all sensors installCd at lowest~point of secondary containment and positioned so that other equipment will not interfere with thew ro r o eratian? Yes ^ No• I.f alarms aze relayed to a remote monitoring station, is all communications equipment (c.g. modem) ^ N/A operational? Yes D No's Fox pressurized piping systems, does the turbine autolnatically shut down if the piping secondary containment ^ NIA monitoring system detects a leak, fails to operate, or is electrioally disconnected? If yes: which sensors initiate positive shut-down? (Check a111ha1 apply) ~ Sump/Il'ench Sensors; ^ Dispenser Containment Sensors. Did ou cpnfirnl sitive shut-down due to cake sensor failure/disconnectian? 'Yes; ©Na, ^ Yes ^ No* For tank systems that tltilizo the nfvnitorirxg system as the primary teak over sl! warning device (i.e. no Nl~h mechanical overfill preveaciom valve is ianstalied), is the overfi3l warning alarm vissbie and sudibtc at the tank f131' in s and o ratio so ! If sa at wiaat ercent of tank ca aei does the alarm tri er? © Ycs' ~ No Was any monitoring equipment replaced? rf yes, identify specific sensors, probes, or other equipment replaced and list the ulanufat:turer name and model for all r lacemeat arts is Scctlon E below: ^ Yes" No Was liquid found inside any secondary containment systems designed as dry systems? (Check X11 that apply) a ]?raduct ^'Water, Yf es descrt'be causes in Section l3 below. `Yes D Noy` Was trlonitxyrin stem set-u reviewed to ensure ro ar settin s? Attach set u re orts if a lieable , Yes ^ No" Is a13 asonitorist ui ment erationaI er manuf'acturer's ificadons? " in ~eCtien ~ be10w, riG.4Crtt/e ht)w.81]Ct `VYge17 these tZeIiClCrleies were vi Wll1 4C COrreciea. E. Comments• Page 2 of 3 D3I0 t FROM :BSSR,INC FAX N0. :6615882786 Oct. 18 2006 09:13AM P4 IF. Xn-Tank Gauging /Silt ~.quipment: 1~ Check this box if'tank gauging is used only for inventory control." d Check this box if no tank gavgixtg or 5iR equipment is installed. This section must be cam leted if is-tank au ku ~i meet is,used to erform leak detection motutorin , . .. `d~ P g g $ .~1 P • 1'.. ~ Com fete the i'ollowln checklist: ' ' '. .Yes ' O No* Flas all input vviric:g been inspected for proper entry and termination, includfrag testing for ground faults? Yes D Nv* Wese, all tamlc gauging probes visually inspected for damage and residue buildup? Yes ^ No* Was accuracy of system product level readings tested? ~D Yes ^ No* .Was accuracy of system water level readings tested? ~lJYes ~ ©No"' ~ vVere all items' oa the equipment aiaaufaaturet''s mai~atnnanca checklist completed? ~®e:anw~s ~ , ire=~s s~u~rr,~y~ y Ye the Section g, below, describe bow aatd wizen these dellclencies were or will be corrected.. . ~vr G.. Lf3.ie Leak Detectors (I.L~): D Check this box if I..LDs are not installed. . Co late the follows ahecktist: ~ ~~ ~ • Yes Q No* F~ equiigment.start-up or amnual eciuipmaat cexh~cakion, was a leak simulated to vexify L7 D pcrfassnanee?. • R NIA (CJieck all that apP1YJ Simulated leak rate: ~' 3 g.p.h.; Q R.1 gp.h ; D D.2 g.ph. • Yes D No's ~Nere all Y:IADs aa~itrmed apetatiiamal alai acctuste witiaiin regulatory require~ments7 Yes ~ 4 No* Was the destin$ apperatvs properly Calibrated? ^ Yes ©No* For mechanical LLDs, does file LLD testtict product flow .if it detects a leak? NIA . Yes No* 1?or electronic LLUs, does the turbine automatically shut off if the LL17 detects a leak? q NIA . Yes ^ Na* Por elecizonie LLl]s, does the turbine suto:natically shut off if any portion of the monitoring system ig disabled D N/A or disoonaected? . .Yes ^ No" ltor electronic LLDs, does tl~ turttiine automatically sltttt ofF if any portion of the monitoring system ~ I F~ N/A 1 malfunctions or fails a test? Yes ^ Noy For electronic LLDs, h&ve all accessible wuing coxinections been visually inspectedY ,~ ^ NIA 'Yea Q Noy Were all iterns.ore the equipment manufactnrez's maintenance checklist completed? .. " Yn the Section H, t-elavr, describe bow alto when these de>icfencles were or will be corrected. • ~, ~QID111+rIIt3: ~ . ~~:• • I~ege 3 of 3 ~ ~ ~, o3~at ~~~ ROM :BSSR,INC Monitoring System Certification FAX NO. :6615882786 Oct. 18 2006 O9:13AM P5 ~. • .rr IJST Moin~toring Sits k'~an ~ Site Acidrr;ss: _~,'~~ f ~-('Q~ ~ "[" ~'~ ._ ~... . .. ryw~c~ .. t,. . ... L.. .. m., Date map was drawn: ~ /, `~~~ Yu:s etl~ns If you already have a diagram that. shows all required 'information, you may it,clude it, rather than this page, with yo+~r Ivtonitorin$'Systetn Certification. an your site plan, show tha general layout of tanks and piping, Clearly identify locations of the following equi~ment, if installed: monitoriztg system aantrol panals; sensors monitoring tank~annuiar spaces, sumps, dispenser pates, spi11 containers, ox Other secondary containment areas; mocharical or electronic lint leak derectprs; and in-tank liquid level probes {if used for leak dettctipn). Iia the space provided, note the date this Site Plan was prepared. 6~. Age ,_~ 4~ OS/08 FROM :BSSR,INC FA}S N0. :6615882786 Oct. 18 2006 09:14AM P6 ' ~ ~ SWRCi3, 7anuaty 2006 Spfll Becket Testiiug Report dorm - This form is intended fat use b3' coirtractors pe-forraing annual letting of UST sptll Contaurraent structures. The completed fora a,ad printouts from tests (f applicable), should be provided to the facility owner/operator for submtttal to the loco! regulatory agency- • 1. FACILITY INFnRMATif)N ~ • FaciHry Name: "'~ ~f Date of Testing: •~ Facility Address: Facility Contact: ~ ~ p ~ Date Local Agee Was atiiied of Testing : ' Name of Local Agency Inspector (lfpresertt during tecttn~; r (~~ ' 2_ TF.STIIVG C[INTRAt'"i'C1R iNFfIRMATTt'1N , .>.:'~•. ' Com an Name: ~ ~ ' Techtiiciaa Conducting Test: /~/ ' CredentiaLS': ^ CSLB Contractor C Service Tech. t~ 3WRC$ Tank Testa C7 Other (5' i License Nurnber(s}; 3. SPILI, RI7[".Ki~:T TFSTiNA iNFt)Y2MATi[]N Test Method Used: drostatic ^ Vacuwn ^ Other ' Test Equipmem Used: - Equipment Resolution: Identify Spill Bucket (p1' Tarok Number. Shred Praduc~ eta 1 ~L ~/~i ~'~'~` ` 2 ~ 3 4 Bucket Installatiaa Type: ~n t"-" ~ Bvr~` I~ Caattained " S ~9 Direct Bury Contain m S.um ^ Direct Bury ^ Contained in Sum Q birect gory C Contained in S Bucket Diameter: ' Z ~ ~a ! ,~- 13ucket.Depth: Wait time, between applying vaauum/wator~:ariii start of test: Test Start Time (T~:, ~ (] lt>litial. Reading (Rr}: . 'Y'est~F.n~dTinie.~{Tp}: ~ ~ ~,. . Fins1 Reading (Rr); ' 'rest Duration (TF _ Tt}: / / Change in heading (RF - Its: Pass/Fail Threshold or Criteria: ~ - . Test Result: ~ s , , ^ Fail Pass ' .^ Fail ^ Pass 0 )G"ail ^ Pass ^ Fail C:omlments - (include itifornration on repairs made~rior'ta t¢Stfrr~ and recommended follow-up fare failed tests) CYtII'i~'ICATION OF TEC)C~TIC)<AN RESPOI~TSIBI.E FOR CONDUCTING TIIiS TESTING . I hereby certify that all the ittformatipe cp>;tained lit this report is trae, accurate, and in~irtU cotnpllance wltle legal nequtrenzents. T tan's Si store: . ~ Date: / t/ ~~'~~ ' State taws and reQ , rA**ons do not currently reciuax~e testimg to be perfot~:ned by a, qualified contractor. However, local requirements mac inn mAYP OM';IS~++Ylt ~ ~ ~ ~ ~ - ~ ' ~, FRDM : ]3SSR, INC FAX h10, :6615i~2786 Oct. 18 2006 09:14AM P7 '~ .. iViouitarirtg Syseeta Certiiiteffo$FAr1n7c Atlde~nnu for Va~cntuture. ~teystitia! Sensors. ~ L(; 163.2, Enc. II, T, Rcsu}ts of '(~aaia>ttlxrlPte~sure 1l~aaikaring ~gtatipm~ent Te~ptn~ . 'This page Should be used to document tespng and servicing of vacuum. and pressure interstitial stnsors. A copy of this form most be inclttdsd with the Monitoring System Certification Form, whit!: must be providaci to the tank system owner/operator. Tire UwperJoperator must submit a copy of the Monitoring System Certification Form to the local agency regulating U5T systems within 30 days of fast date. 11+Iunufacdtrer: Mtadel: System Type: ^' Pressure; ^ Vacuum Setesor JI3 Camgwnent(s) ltn(anttored by this Sensor: ' $ettsar Functionality Teat RissulC [,~ Pass; ^ Fail Interstitial Communication Test Frsult: [] Pies; . ^• Fail Cat(s) Moapitx-red ~ aria Season.. . ' ,' Sensor Functtionality Test Result; ^ Pass; ^ Fail . Interstitial Communication Test Resu1C: ^ Pass;, [] Fail ~ompoaent(s) MonlWred by this Sensor: --~ Sensor Ftinctie~nslity Tcst Res'uli: ^ Pass; Fail inlcrstitisl Communication Test Result; ^ Pass; ^ Fail'' Compoaexet(s) Monitored by t!t!s Ser+sors Seatsar 1'•'tttctnatit5! T~ Reaultr ^ Pass: ^ 1?ait 'tncea~GCtal Cactnttctaisatciiam Tyr 1i,~sult: ^ Pass: ©Fait Coatpo»ie+at(B) Monitoreri by this Sensor: Sensor FunctionaEity Test Ttesult: ^ Pass; Q l?ail Interstitial Communication Test Result ^Fass; ^ Fall Component(s) Manitnred by this Sensor: Sensor Functionality Test Itnsult: •^ Pass; ^ Fail Interstitial Communication Test Result. i] Fass; ^ FaiE Cao~oRRetlt:(s) IOCCd ItY tl+~ Sear: • . x>:::::: . Seriao'r Eouceioreallty Test Result: ^ Pess; ^ Fail Interstitia7.Cogtc~tlwry Tzst Rc=xult: ^ Pass: ^ p'ail Owmponent(s)1tlonttorert by this Sensor: ~ ;_ Season Functionality Test Result: ^ Pass; ^ Fai] Interstitial Ciimmiinicaiior,_T'~;i:.Result: ^ Pass; ^ Fail Compotteat(s) Monitored b5' Ibis Sensor: `'~ ~~..` '~ . 5erisor PuwCticu~iityTest:R~tttC ^ Pass: ©Fait 1<ntarstltlat Caetuttttttisatian TesiResulc: ^ Pass; ^ Faii Component(s) Monita~red by thfs Sensor; ~ :. ~ , Sensor Functionality Test Result: [] Pass; ^ Pail Interstitial Communication `test Resrtlt:; ^ Pass; Q Pail: J ~QW RIBS iip~tetslitie! Ct1A3CAtlllin OCrYYi<Ed~: beak IIIttbdured at Far 16nd of Interstitial Space; ^ ~teuge; ks .- • ~ ^ Visual Inspection; ^ .Other (DerCribe tit 5~c. J bet0 Vacvmn wits resEOt^o[I to oPet~stiug llcv°e!s in al! fnt+e['stiiisl spaces: ' ^ lies ^ No {Ef ruj, deser. the ire Srt.'J, Gclow} ~ . .., _~ ~;; . ~. : . ~• . ommt~tS: ~ ,~. ~. ,. ;' t -- - •- - _..._...__.. _.... -- ,~`~ .. :;,, , '•; ~ ~; . •. ~ .. .. . ~ ,, . ~, page tiP_...___ ; ..t If tha sensor suiyoessfaily.,~eiec#s:'a:sitnul vacuma/`peessttraleak'ittEtod;rCed in the intersti#ial•.spsce_at:the'furtha~t point from itee ' 'd'e~xu>cl to be coramuni thmu bout , ': ~ ./ ' Scns4, vacuum/pi~ure iiav~¢e~. cittie~ g . Fhe ?~4,~rx~.t.'~c~s, , • .... ... ... ~ .:~n:.c:y .~: ~v;ahv7i ,gry.,r!tr. ~' Y id.•~. ' ~'~• ,` FROM :HSSR,INC SGiO RoLed9ie HWy # B Bakersfield, California 93308 PhOnQ: 867 688 2777 Fax 864 888'17'8 F2uc FAX NO. :66158$2786 Oct. 18 2006 O9:15AM P8 ~!~'~,I I~• ,'r Tar: BHicersftetd Fir$ DBQOrt-rient Flom: Kristine Bowman Fss~ 662 2171 Dates 1~18J~6 Phanee Pages: 7 . 11>Eee 1]e! Taao Mobil {Stuarts Peh'ateum) ~ ~aa ca3irforn~a Ave. .- ~.__ , _....: _~... Fuel Manibring Certification Q' kirge~ifl ~'or Rev:ew i~ Freese Cemme..t ~? r0epry E~ ~ea~ ise¢y~cle •Camenerr~s: ~. + JIMS MOBIL _______________________________ ~ ________= SiteID: 015-021-000512 + Manager BusPhone: (661) 322-2250 Location: 3200 F ST Map 102 CommHaz Moderate City BAKERSFIELD Grid: 24D FacUnits: 1 AOV: CommCode: BFD STA Ol SIC Code: EPA Numb: DunnBrad:77-016-4041 +______________________________________________________________________________t Emergency Contact / Title Emergency Contact / Title JEHAD HADDADIEN / OWNER HUDA HADDADIEN / Business Phone: (661) 32.2-2250x Business Phone: (661) 322-2250x 24-Hour Phone (661) 834-8610x 24-Hour Phone (661) 834-8610x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact Phone: (661) 322-2250x MailAddr: 3200 F ST State: CA City BAKERSFIELD Zip 93301 K owner .w is ~~a o~~sar Phone • (~~ ti_~ ~ 3 z ~ ~~ ~ Address ,7005 ArTAtTT~ =K-;-m- io3Z eA.Sia~lo Raab State: l. CA d''~C~~3~ 1 City COs ~NG'~, Co goo~5`.~~ ~ 93309 3~~ 't Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No. ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST ,~;t on my inquiry of those individuals ~sponaibl® for abtaming the informatioe~rsonally sander penalty of law that I have p ?xamined and am familiar with the information .submitted and beli1e~e the information is true, urate d comp ~-/y_o6 Date Signature l~t'`~~~ w~' 5~~p`~ ys~~~ ~Nfi"~ Mir ~ ,~ z®~ 6 -1- 03/30/2006 E R S F I D May 15, 2006 F/ICE ~1 R TM T Mr. Jehad Haddudien Jim's Mobil 3200 F Street Bakersfield, CA 93301 RONALD J. FRAZE NO"~`ICE OF VIOLATION FIRE cxiEF & SCH~C~ULE FOR COMPLIANCE Gary Hutton, Re: Failure to Perform d~.C....l;ubmit Three Year Cathodic Protection Certification Senior Deputy Chief Administration Dear Mr. Haddudien: 326-3650 Our records indicate that yoUl° three year cathodic protection certification is past Deputy Chief Dean Clason due. If you have pertormed tFiis test, please forward those results to my attention Operations/Training ~ immediately. If you haven't performed this test you are in violation of Section 326-3652 ~ 2635 2(a) of the California Cade of Regulations, Title 23, Division 3, Chapter 16 Deputy Chief Kirk Blair j Underground Tank Regulatit~lls. Fire Safety/Prevention Services i "Field-installed catht~dic protection systems shall be designed 326-3653 ! and certified as ade~Uate by a corrosion specialist. The cathodic protection system sHi~ll be tested by a cathodic protection tester 2101 "H" Street within 6 months of installation and at least every 3-years Bakersfield, CA 93301 ~ thereafter." OFFICE: (661) 326-3941 Therefore, prior to June 12, 20)06 you will perform the necessary testing as FAX: (661) 852-2170 required by Code. Failure t+~ Comply may result in revocation of your Permit to Operate. RALPH E. HLTEY, DIRECTOR '~~ Again, if you have recently performed this certification test, please forward the PREVENTION SERVICES results to my attention and disregard this notice. FlRE SAFETY SERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 Should you have any questit~lls, please feel free to call me at 661-326-3190. OFFICE: (661) 326-3979 FAX: (661) 852-2171 Sincerely, David Weirather Ralph E. Huey, Fire Plans Examiner Director of Prevention Services 326-3706 ., Howard H. Wines, 111 Hazardous Materials Specialist 326-3649 By: Steve Underwood, Fire Prevention Officer REH/SU/db T ~• ~ ~_ Friday, July 14, 2006 8:48 AM Juliana Sessions 661-396-0569 p,02 SESSIQNS 9521 W. Frig Lane Bakersfield, CA 93307 (6~1~ 833-9SUl Fax ~661~ 3~r~5C9 License #84432~l~IAZ May z~, zoos Stuarts' Petroleum 13. East 4~' Street Bakersfield, CA. 93307 Re: 32U0 F Street Bakersfileld7 CA A Cathodic Protection System test was performed at the above location on May 23, 2006. A vist~l, inspection was performed at the site ~d the Cathodic Protection test box was located but the anode well was not. It appears that the site had. been repaved and the pavia~g rtompany bad paved over the road box. We Heart inspected the rectifier. It was noted that the rectifier was set an A-3 and was oper~ing ax the maxirnu~rn voltage of 50 volts and 24 amps- During the test the rectifier was adjusted downward and the following reading w~ taken: Fuel Tank #1 Fuel Tank #2 do (mv) off (mv) -951 -Q•42 -454 -44Z Tl>~ above structure-to-sod pvte~tials were measured with a digital volt meter connected between the underground storage tank cad a saturalbed Dapper-coppear sulfate referen,oe electrode in oonta,ct with the earth. Structime-ta-soil potentials measurements for each tank exceed the recog~ed DACE 'The Con~osion Society criteria of -850 millivolts and 300 my shift for full cathodic protection T T w Juliana Sessions 661-396-0569 R•~ Friday, July 14, 2006 8:48 AM Shucture-to-sail potentials measurements far each tank exceed the recognized NACE The Corrosion Society criteria of -850 millivolts and 300 my shift far full cathodic protection. The rec~i~pr sings and outputs are as follows: Settings Coarse D dine 3 Output Vohs 47 Amps 3.2 Hour Meter 17500 This survey was conducted iin accordance with the procedures described in the NACE The Corrosion Society Standard ~eeona~ended l'ractYCe RP0285- 95, Corrosion Control of Undargrotsnd Storage Tank .S~sterias by Cathodic Protection and American Petroleum Institute (AFI) Reconnuzended Practit~e 1632, Cathodic Protection of Undergrotcind Petraleamt Storage Tanks mtd Piping Systems. Professional Engineer: Robert Pau] P.E. Add<+ess: 2243 Aspen Mirror Way, Ste. 204 ~~t~~ Laughlin, NV 89029 ~~o°~`ftT ~~~r tio. 11i ~ O ~' Sig~ture: ~r.~~'`~ ~~~ OF GP1. Registered Professional Engineer No Coarosi;oa~ 111 Expiration. Dame: 3/31./OS B~ E R S F I D >f~RE ARTM r April 10, 2006 Mr. Jehad Haddadien Jim's Mobil 3200 F Street Bakersfield, CA 93301 RONALD J. FRAZE REMINDER NOTICE FIRE CHIEF Re: Guidelines for Unsupervised Dispensing Gary Hutton, Senior Deputy Chief Dear Mr. Haddadien: Administration 326-3650 It has come to our attention that many convenience stores who sell gasoline, like yourselves, are closing late at night. If you are using card readers and leaving Deputy Chief Dean Clason your fuel pumps on, this is defined in the California Fire Code as: "Unsupervised Operations/Training Dispensing." 326-3652 Unsupervised dispensing is allowed when the owner or operator provides, and is Deputy Chief Kirk Blair accountable for daily site visits, regular equipment inspection and maintenance, Fire Safety/Prevention Services including any unauthorized release or spills, posted instructions for safe operation 326-3653 of dispensing equipment, and posted telephone numbers for the owner or operator. Signs prohibiting smoking, prohibiting dispensing into unapproved 2101 "H" street containers and requiring vehicle engines to be stopped during fueling shall be Bakersfield, CA 93301 conspicuously posted within site of each dispenser. OFFICE: (661) 326-3941 In addition, a sign shall be posted in a conspicuous location reading: FAX: (661) 852-2170 Incase of spill or release: RALPH E. HUEY, DIRECTOR 1) Use Emergency Pump shut-off PREVENTION SERVICES 2) Report the accident FIRE SAFETY SERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 ' 3) Fire Department Telephone Bakersfield, CA 93301 4) Facility address OFFICE: (661) 326-3979 FAX: (661) 852-2171 During the hours of operation, stations having unsupervised dispensing shall be provided with a fire alarm transmitting device. A telephone not requiring a coin to David Weirather operate is acceptable. The fuel leak detection system must have a remote or Fire Plans Examiner phone modem to insure off-site monitoring during hours of unsupervised 326-3706 dispensing. During hours of darkness, sufficient lighting must be maintained so Howard H. Wines, III that all signs associated with fueling operation are conspicuous and readable. A Hazardous Materials Specialist gallon container of an absorbent material used for spills must be made available 326-3649 to the public during hours of unsupervised dispensing. Afire extinguisher with a minimum 2A, ZB, and 2C rating must be located on dispenser island during hours of unsupervised dispensing: To: Mailing List of Valued Customers Reminder Notice Re: Guidance for Unsupervised Dispensing April 10, 2006 Page 2 If you are currently having hours of unsupervised dispensing, you must comply with the above-mentioned requirements. . Starting April 15, 2006, this office will conduct random checks of all fueling stations within the city limits for compliance. If you shut your station down after normal business hours and are not pumping fuel, please disregard this reminder notice. Should you have any questions, please feel free to call meat 661-326-3190. Sincerely, Ralph E. Huey, Director of Prevention Services ~i~l., 1.1,A.~1~~ By: Steve Underwood, Fire Prevention Officer REH/db UNIFIED PROGRAM INSPECTION CHECKLIST ~~' ~~~~ ~t^,.,-.:,:''.",-F. c~Pne:vY.."'4: a.:.:.._r.:._.f+tc+.. ;.,. „r r, ...'70._...._n: :-',~:_, `~. :.~.: .'..r:.;,: ..,x... ,. -.... ~rxrr .SECTION ~ : Business Plan and inventory Program ~ 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 ~m'S b i _9 ~~- ADDRESS HONE NO. O OF EMPLOYEES FACILITY CONTACT USINESS ID NUMBER 15-021- ~~ ~-- Section 1: Business Plan and Inventory Program ~i ~-~ ^ ROUTINE COM6INED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RTION C V (c=compliance OPERATION V=Violation _ COMMENTS ®~ APPROPRIATE PERMIT ON HAND m/~ BUSIt18SS PLAN CONTACT INFORMATION ACCURATE 61i~ VISIBLE ADDRESS (1~0' CORRECT OCCUPANCY l7/^ VERIFICATION OF INVENTORY MATERIALS ~~ VERIFICATION OF QUANTITIES Q~ VERIFICATION OF LOCATION I~^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY :, - ~^ VERIFICATION OF HAZ MAT TRAINING I~^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~1/^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED 7f{~E) HOUSEKEEPING FIRE PROTECTION ~^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: - _- ^ YES ^ NO QUESTIONS REGARDING THIS INSPECTION4 PLEASE CALL US AT (861) S2a-3979 In pector (Please Print) Fire Prevention / 1p In / Shift of Site/Station # l White -Prevention Sarvicea Yellow -Station Copy pink - 8uaineae Copy FD2049 (Rw. (12/05) ~~~w~~`. `~~~\ CITY OF BAKERSFIELD FIRE DEPARTMENT ~~ ~ ~ M~ OFFICE OF ENVIRONR'iF.NTAL SERVICES ~~ ~~~1 UNIFIED PROGRAM INSPECTION CHECKLIST `'wE"~ge,~i~~ 1715 Chester Ave., 3~`' Floor, Bakersfield, CA 93301 FACILITY NAME V 1~ /Y1~~7,c~ INSPECTION DATE o~ ~ ~ Y~i~ Section 2: Underground Storage Tanks Program ^ Routine ~mbined ^ Joint Agency ~ ^Muhi-Agency ^ Complaint ^ Re-inspection Type of Tank Sf^~~ w,%wi l{~Ts/I ~`~umber of Tanks Type of Monitoring ['i~j~ Type of Piping ~~~f~ ,Q/~ 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 __T(/~ 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 overtill/overspill protection'? C=Compliance V=Violation 1'=Yes N=NO Inspector: /YIeA.) U''j~~ Office of Environmental Services (661) 326-3979 ~~'hitc - inv. Svcs. Pink -Business Cody /~ ~ r' B sines Site Responsible Party .. 4 ~ ~- a ~ '- '1111 i t'1 ,III h;i,l .,. . ~'".il ~ ~:I~ ! - ril_{~ Y I {I'•U I. :' i UI_L.~;E t r. - I:,li-iTE}:; _~I. _ il[i 1P1i=1{~:=~ il LJ~TE::F' - . 'l' .' : k V-a:f'1 I I II' 1 1 ~ri L.cS x 1 { i ; - IIL_L.~~~-~F~ - ' ,. _ - .'~'~ I r;til.~, <,, i ! I I ~ ,. ':f I I i .:ri 1. '~:i " i ~ NL:1 i.~l i ~;L:3 _ '1'i;f ii' ~, ~ J . UNDERGROUND STORAGE TANKS BAKERSFIELD FIRE DEPT. =f "...:.>.,...,..~_._,.. ,. ..~...~,. _ ........,~.,.~,,..._,...Y__., . ~~ws Prevention Services AI~TIII ~ 90U Tillxtl~n l1ve~., Stc, 210 APPLICATION ~- t3~zkerSt~iCici, c;A y~:~c~ 1 TO PERFORM ELD /~~~LINE TESTING Tel.: (f3611 ;32Ea-;34~7~1 / 56989 SECONDARY CONTAINMENT TESTING {~ ~~x: (661) f352-2 17 1 /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION Paye ~ 011 PERMIT NO. ~, ~" a ^ ENHANCED LEAK, DE'I ECfION ^ LINE TESTING ~ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TES'(' ^ TO FEFtFORM FIJEI. MONITORING CERTIFIGAT IGfI I SITE INFORMATION ______~ .~.___ . _ .--- _ .... -- ----------~_.._~.-,T----._ --_ _ __ FACILITY ~ r I~ I~ ~ ;NAME & PHONE NUMBER OF CONTACT PERSON ~. _---___.____~.m_.,__ ___.__.______.________ . - DDRESS 1, 1~--~ . 3 n F _ ____~._~---,c~--.-- ____ ____~ C~ _____----_----_ ~____ _----_._____._.__._______T.__ WNERS NAME PERATORS NAME' I iPERMIT TO OPERATE NO. -- __~. 1MBER OF TAN TANK N TrsTED IS `IF ING GOING ~V.OLUME T____,__~___.__-____~_____ _~~___ -- __- __ ___ I CONTENTS -..._._______.._..-,..._--_ ~ .. -._-.. _ ' ' TEO?, ~ YES Q NO < <~ ~~ i oC. i - ____._.,L--__.____. ___--~_____-. ~ b K.. ____-...._._.~ _.__.__._ ._._______----_.__-_. I I TANK TESTING~COMPANY ._ __ _. _ OF TESTING COMPANY NAME PHONE NUM ER OF CONTACT PERSON IL NG ADDRESS`c~ ~-- ~-~~ ~__ ~a_-k°,~°_ ~ ,_ ~A__ ~ 330 _ _ __ __ _ __ _ __ __ ME & PHO E NUMBER OF TESTER OR 9D'ECIAI. INSPECTOR I~CERTIFICATION tr~~ ~ T ~ ~ ^'-Y~ `~ ~~~c_ -- ~~ L-_~q.~~~91--_____ _._~._._! 05 ens ~ a 9_-- b So 3S ~ 32 __~ TE TIME TEST TO BE CONDUCTED dCC k: - _____ ~,~ DES METHOD iNATURE OF dPLICANT DATE 1 O -- ~ "~ __, 1 APPI,~~AT.~ N @~GQ~ES ~A P~~i1~(11T H P~iQVEt? PROVED'BY'DAT'E _.r_ _. .. _ _-_ _._-----.-__~_ ._ l0 !y S _-__~__ .. FD21U6 ~r i ~ { ",) . ~ ~ Ba&~rsffield Fife'°Dept.` BILLING & PERMIT STATEMENT px~EVErrTiow ~~RVicEs Fire Saffety .Services o Environmental Services -. " 1715 Chester Ave Bakersfield; CA 93301 ( Tel: (661)326 3979 DATE ~ ~ ~ i ) r` ~ C --..,. ; ~ ~ , ,~ ~ i 82 UST/AST PERMIT, TANK TESTING ~ "' STATE SURCHARGE 88 . ~ 1 i . TENTS, LPG; FIREWORKS, POWDER/OTHER PERMITS 84 COPIES/REPORTS 89 `. FOLLOW-UP INSPECTION INSPECTOR:. ... ~ ~ : - ~ ~ ., .DATE .. TIME SPENT -' CHARGES ` CHARGES CODE: REASON and DATE ~: ~. ~~ i:i~ . . FOR INSPECTION j ~ LOCATION OF INSPECTION. _ BUSINESS NAME ...- r '~. - ~ . , ~ '~ - f_~ b ~ .,..!-.. X., . t , \ .. .. .. -. TELEPHONE NUMBER(S) - ~ . ..~ ~. l ~r T J~ BILCTO ~-' PAY.BY:.. :. _a...,. •` ,t: y _ .; .;~ r f r i t ,:~ ~ , ~ s~ I j,` ` ±( NOTES . -. ~ ~ ~ -r"' - _ . t + { I CUSTOMER SIGNATURE WSPEC TORlRECEIVERSLGNATURE: •y ~ ~ --° ----_ ~, _ . ORIGINAL WHITE FINANCE CUSTOMER: PINK -rOFRCE YELLON/ FD1734(feV X12103) B E R S F I D P/RE ARTM T RONALD J. FRAZE FIRE CHIEF Gary Hutton, Senior Deputy Chief Administration 326-3650 Deputy Chief Dean Clason Operations/Training 326-3652 Deputy Chief Kirk Blair Fire Safety/I'revention Services 326-3653 2101 "H" Street Bakersfield, CA 93301 OFFICE: (661) 326-3941 FAX: (661) 852-2170 RALPH E. HUEY, DIRECTOR PREVENTION SERVICES FlRE SAFETY SERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 OFFICE: (661) 326-3979 FAX: (661) 852-2171 David Weirather Fire Plans Examiner 326-3706 Howard H. Wines, III Hazardous Materials Specialist 326-3649 December 1, 2005 Jim's Mobil 3200 F Street Bakersfield, CA 93301 FINAL REMINDER NOTICE RE: Necessary Secondary Containment Testing Requirements by December 31, 2005 of Underground Storage Tank (s) Located at the Above Stated Address Dear Valued Customer, Over the last six months this office has continued to send reminder notices regarding secondary containment testing. Code requires that all secondary containment systems must be tested 6 months post construction and every 36 months there after. Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and every 36 months, thereafter, to insure that the systems are capable of containing releases from the primary containment until they are detected and removed. Our records indicate that your facility is due prior to December 31, 2005. Those sites that have not been tested and have not pulled a permit prior to December 31, 2005, will have their permit to operate revoked. This office does not wish to take such action, which is why we will continue to send monthly reminders. Contractors are already booked several weeks in advance. I urge you to schedule your testing date as soon as possible to avoid possible revocation of your permit to operate. Should you have any questions, please feel free to call me at (661) 326-3190. Sincerely, RALPH E. HU/ELY, Director of Prevention Services Cxu~~~ Steve Underwood Fire Prevention Officer SU:db Jisr.~is~ f~e ~~ ss~r~eiG~ ~ ...I~late ~I!'iast ~~~~ ti~eis ,~ j~. ; ~~~~ ~. ~ SEIf~UNOA~'~~3XSTEM CERTIFICATION FORM ~n' ; DATE ~•:~° ~ F~CIIIT ~ ~ - ~~;.. , FACILITY ADARF.SS Fyt F ::. S ~;~•' . ' ~ `. ~. i~iT Annular Spsce ... ' ~'. ~`~`" a ~~ f'~ '~~ 1'addk I. Tank x Tank 3 ` ~ '~ ~ ` Mart Time . .• ~~,~,~. , Itniti~t Prteaure , ~ ~:: ~ ~,~~ {m{TT,~ ~, i ~'~! i . .~ ~. ~~' ~~.. .. ~ ~~~ - -~,,, .~~ ~ ~ ~ ! ~~~:~; ~ Skoadsry Plping _ ' ,; ~ . x ~,t _ ;~s;~~. ~.Ine 1.: ~ :... ' Line 2 Lint 3 5~4 Lii~ l z~8 ~' J., L ~ ~ ~ ~ / `T•.. ~ ~~' r ~~i~~ ~ _ .'gam ~ 4~ . " ~ y~Q. ..\ ~ ~ .. ' ~~` • ~}^i . ~ \ ~T~ ~~ - d~~/ . :] :. _A'.~ . 1•~~ 'Csnk 4 :~.~...- ,~lne.4 ~l~S 1(~SN SECOND3~ SYSTEM CERT[F1CATIUN FURM A DATE ~ ~ ° ~' FACIY,TT IU Y/~ n ~ r ~ ~ - '~' Fl1CYL17'Y A17DR.F:9S ~ ~~Q-..~...._.~.~IC~.~,~ `. n-~-vS~ri~- ~. 1 C c._. -~ ~~ ,. z:. • T Surtrps 1'~ASi~Ict~1S~~~~ .~.. , ::~ ~. ;. T ' ~: ~ , ~. .3 .': ,, ~.: :~. ;: .;.; .: . ,~:.. ~f. ,~,, . uJ .. Y' 5u~ ~ ~ ~ 5usnp 2 Sunup 3 Swap 4 Sturt'Teme ~ , G`~/=1 nr1. ~atldsi Hit dt Wster "~'VVaty Heiglert ~ ,, war H~ht ~ •7 C 1; .=; ~ . ~:'. ~Vat~ He~igltt I -70 1:.1. ~rtiRcsElaa ~3lgnatnre) . dverElli BuCltets ~ ' Or~irllg 1:,.~ ,; ~.~ .:. ~}vertl[# 2 ~ Ov~arf1113 t)verllll 4 ~tsrt Time g• ; ~ ~ : a(`j~ ~nftlal Height at water . , . , ~t~1 ' ,~- .. . ~~ wab~r Height .. ~ ~ ~ ~~,~~: ~ 1; ..~ i` !VVst~er Height j.: ~~ ~ , .-~ . ~ . h/ (/, .~ iCert3lic~tion rSig~ture) ~~~ . , . ,; -~ , ~, 17 ; ~ . ~ / Page 2 of ,_ t:: ~ , 9~ vim- ~' i k" ~ ' ~~;:,, ~' ~. ~:~; ;. ,~ ,. ,; . ~; ~ . ;;:... ~;' . :~; :~. ,, .;: ~~~ t~ STsCUNDI~RY SYSTEM CERTIFICA'I'iON FORM DA 1 ~~ aS ~ FACILITY c FACILITY ADDRESS 3,~,G4 : '~ S~'r'e~-~ " ~a~X'S ~P_..`~ ~. C_.c-~ iJDC TE,S'F'ING ' DISPENSC ~1• ~ :DtSP'ENSEIt ~ DISPENSER 3 DISPENSER 4 START TII~IE ~ ; ~j ; i iNt'L'IAL HEIGHT OF WATER 'I't1NE ~: ~ . ~SG'~ ~'•' ~f QJ 'GI S 'WATER EIEIGRT % . ..:;,! .~ p,~ I . c~v~ i~ q • /~j%,.i f ..~°l ~.,r ~eTrFlc~-rioa~ ~GNATUR~ ~ ~ y - - ' ~ ~~~ r~1~ D15P~ .Nr'~lf." ' I1~[$P'ENSLR 6 DISPENSER 7 Il-IS~NSER S START TIME `~~ /may ~,'/ INITIAL ~rGIIT O~ WATER ' • ++. ~ . 1 •. ~~ ) t' ,:, ~. , U 1 i J ~CIMT'. q ~ /; G~. WA'Ct+,R HSIGRT ~.~ 1 ~~ ~ ~~-~ y~ ~ 9~ ~~~~ ~NATER r~T~~ ~~~~, ~casy 7 `~~ ~\` FROM :BSSR,INC FAX N0. :6615882786 Oct. 11 2007 18:35AM P2 . BSSR, inc. . 6630 Rosedale Hwy., # B, Bakersfield, CA 93308 phone (661) 5$$-2777 P'ax (661 } 5$8-2786 1V~ONZ'x'ORING SYS'~'~M CERTZ~`XCATION • • "Phis form must bt: used to documenf testing and servicing of motutoring equipment. A se atz.ratc Fortification or re~orc must be r ed f r eac i e by the technician who performs the wprk. A copy of this Farm must be }~ro~idcd to the tank system owner/operator. ;The ownerloperator must submit a copy of this form to the least agency regulating UST systems within 30 days of test date. A. Generalllnformation LFacility Name: `orj~~'!1'l~f~ Bldg, No. _ Site Address: ~.. ,~ rS~ ~ ~~ City; ~~~ Zip: - Facility Cortcaci Person; Contact Phone No.: ~ ~~ .~ Make/Model ofMoaitoring System: ~L.~ .a.~t~ Date of Testing/Setvicing: ~~1~10~ B. In~vet~to>r~y of Equipment'Y'ested/Cert>1Aed Check the a ro riate boxes co ladlcate a eelAe ul mept Ina ected/servicedt Wank C1a: 'C'a4k CID: In-Tank Gauging Probe. Model: ^ in-Tank Gauging Probe. Model: ^ Annular Space or Vault Sensor. Model: Q Annular Space or'Vault 5ensar. Model: . Piping Sump /Trench Sensor(s), Model: ~ D Piping Sump / Trench Sensor(s), ' Model: T ' ~` O Fill Sump Sensor(s). Model: ^ Piil Sump Sensor(s). Model: ,_,,,, ,,,~ ^ Mechanical Line Leak Detector. J~' Electronic Line Leak Dtttctor. Model: Mo¢e1: prl y Y ~ C3 Meehar{ea! Line Leak Detector. (Electronic Line Ltah Detector. Model: _ Model:l~f1 ~ ~ ^ Tank Overfill !High-LeveE Senior. Model: ~ ___~__._ _.. ~j Tank bverFill / I-Iigh-Level Sensor, Model: ,,, D Other s cci ui rtient a and madtl in Section E on Pa e 2 . ^ Other s ci a ui ment a and model in Section E on Pa e 2 , Tank Ib: Tank IIa: !n-Tank Gaugi Probe. ModeL• ~ ^ Cn-Tank Crauging Probe. Model: Annular Space or Vault Sensor. Modtl: D Annular Space or Vault Sensor. Model: __ Q Piping Sump !Trench Sensor(s). Model; ^ Piping Sump / Trtneh Scissor(s). Model: ^ Piil Sump Sensor(s). Model: ^ Fill Sump Sensor(s}. Model: ^ Mechanical Lint Ltak I7ettctor. . Model: Ca Mtchanical I.lne beak Detector, Model:.._ ,~,,_-„~ O Electronic Linc Leak Detector. .Model: ^ EItctronic Lint Ltak Detector. _ Model: ^ Tank Overfill !High-Level Sensor. Model: O Tank Overfill !High-Level Sensor. Model; -__.___...____. _ ._ . . ^ Other s ecif a ui mt:nt and model in Station E on Pa e 2 . ^ Other s eel ul ment a and model in Section'E on Pa e 2 . Dispenser ID: !7 pettser fD: -` Dispenser Containment Sensors}. Model: Dispenser Containment Sensors}. Model: ~7Shcar Valve(s). ~ Shear Valve(s). O Dis cnser Containment Fl t s and Chains .. ^Dis nser Containrlient Floats and Chains . i)ispe~:ser ID: blspenser II): Dispenser Containment ensor(s). Model: ©Dispcnscr Containment Sensor(s), Model; Shear Valve(s). D Shear Valve(s). D Dis nser Containment Floats and Chains . ^ Di nser Containment );lost s and Chains . Disprnstr ID: Dispenser ED: Dispenser Containment Sensor(s). Model: ^ Dispenser Contammeni Scissor(s). Model: Shear valve(s). ^ Shtar Valve(s). QDis cnser Containment Floats and Chains . ^Dis enserCanteinment Pleats and Chains . •lf the facility contains more tanks or dispensers, copy this form. include information for every tank and dispenser ac the facility. C. CertlfieatlAA - I eertity that we egplptnent ldeadited In this document was IuBpeeted/servleed In accordance with the misnufacturera' guidel4aes. Attached to Ibis Certitle~dou is lnformatlon (e.g. maatefaeturers' checklists) necessary to verify titer this information Es correct and ti Plpt Plan showing the layout of monitoring ey C ant. or any ul ment capablt of geaeratliig such reports, I have also attac d coy there ort;,(ch ck a Thad apply): y et- y report Tcchnieian Name (print): Signs re: Certification No.r ~~-"o~ ~~~~ __. License. No.: ~,~~~~ Testing Company Name: Phone No.:~~~~~~~~ Site Address: - Aate oi°Tcsting/Servicing:~/~/~ Page 1 of ~ ~ , -•• 07~Ot •~ Monitoring System Certlflcation FROM :13SSR, INC FA?C N0. :6615882786 Oct. 11 2007 10:37RM P3 • f D. Results ~f Testing/Servicing ~ i Sotinvare Version lnstailed: . ~ C'ornnlete the fnltnwi~a eheelrliet~ Yes ^ No" Is the audible alarm o erational? Ycs ^ No" Is the visual alarm o erational? Yes ^ No". _ _____ Were all sensors visuall ins ected funetionalt tested and confirmed o erational? ~ ~ ~••• • Yes Q No" __ _ Were alt sensors installed at lowest point of secondary containment and positioned so thtit other equ;pm<<n wiU not interfere with their ro er o ration? Yes ^' No'" _ _ If alarms are relayed to a remote monitoring station, is all communications cquipnlent (e.g. sriudetnt j ^ N/A operational? lip Yes ^ No' For pressurized piping systems, dues the turbine automatioally shut down if the piping secondtuy cuntuinrnrn: O N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which g~~ssi,rs :n,li:uc positive shutdown? (Check ah lhal apply}~SumplTrench Sensors; ~ Dispenser Contai,unent Sei~surs. +! ~ Did ou confirm ositive shut-down due toleaks and sensor failureldiscattnection? 'des; C] No. I Yes ^ No' For tank systems that utilize the monitoring system as the primary tank .overfill warning device (~ ~~ ~«, O N(A :, mechanical overfill prevention valve is installed), is the ovtrfill warning alarms visible and attdibic at th~• t.,~sk ~ fill oint s .and o cretin ro crl ? If so, at what ercent of tank ca acit does the alern•, ~n Lei :' ^ Yes" ~ No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other cyuipment rcpla~rti ~; ~ and fist the manufacturer name and model for all re ]accmcnt arts in Section E, below. ^ Yes" No __ Was liquid found inside any secondary containment systems designed as dry systems? (C'hec.~k rrll rhui up/,ltd Ij Q Product• ©Water. If es describe causes in Section E betow. ~~ ---- -;; Yes ^ No' Was rnonitorin s stem set~u reviewed to ensure ro cr stttin s? Attach set u ~ re Sorts, if a ~ficttbir _____ _ ~! 1'as ^ No" Is all monitorin a ui merit o erational er manufacturer's s eciiications'? ~! o r.. ~.....t ,... c? ,..., ...., a......_,.... ti..........~ ..,ti ,.., ae......, a.. C,.t .... ................ .......d1, 4.., ..., ..men fe,A Page z or FROM :BSSR,INC FAX N0. :6615882786 Oct. 11 2007 10:38AM P4 - .• F'. ,)<n-Ta>xk Gauging /SIR Equipment: ' • ~ b Chegk this box if tank gauging is used only for inventory control. D Check this box if no tanlrgaugin$ or SIR equipment is installed. This. sLction rriust be completed~if in-tariZc gauging equipment is asst! to perfor'txt leak detection monitoring. Comolefe the fn]]ewinv cheekti.ct~' ' Yes ^ No* ]~las all input wiring been inspected for proper entry and termination, including testing for ground fau[rs? Yes ^ No' Wcrc all tank gauging probes visually inspected For damage and residue buildup? Yes O No* Was accuracy of system produt;t level readings tested? 'Yes O -No's Was accuracy ofsystem water level readings tested? Yes q No* Were all probes reinstalled properly? Yes O No* Were al] items ou tha equipment inaitufaeturer's maintenance checklist completed? ` in rile Section i3, neiow, describe now and when these deficiencies were or wvfE[ be corrected, G. Liue Leak Detectors (LLb): ^ Check this box ifLLDs arc pot installed, ('mm~lrtp fhe frtllnwlno rharkli.af! Yes . ^ No* For equipment start up or annual equipment ceztification, was a leak simulated to verify LLD performance'? ^ NJA (Check all that apply) Simulated leak rate: ~3 g.p.h.; Q 0.1 g.p.h ; O 0:2 g.p.h• Ycs ~ Q No'' Wtre all i..L17s confnmed operational aztd accurato withim regulatory requirements? Yes • Q Nv" Was the testing apparatus properly calibrattd? C? Yes ^ No* Far mechanical LLDs, does the LLD restrict product flow if it detects a leak? NIA Yes C3 No* For electronic F LDs; does the turbine automatically shuC off if the LLD detects a leak? © NIA Yes ^ No* 1~or electrotrie LLDs, does the turbine sutomaticaily shut off if any portion of the monitoring system is disabled ^ NIA or disconnected?. Yes ^ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monicoruig system ^ N1A malfunctions qr fails a test? . Yes ^ No* For electronic L'LDs, have all accessible wiring connections baen visually inspected? ^ N1A Yes D No* Were all items,on the equipment mauufacturcr's maintenance checklist completed? * In the Section H, below, describe hoyw and when theca de2YCienciesYv~ere or wt4 4e corrected. ~. COIIIiriBI]1;S: Page 3 of 4 o3r~i ROM :BSSR,INC FAX N0. :6615882786 Oct. 11 2007 10:39AM P5 _ • , .. • . ~ ,,, ' ,iwring System Cert)fleat[on . ,, ~ , ` 3 o f ~ ~S~ Monitoring Site Plan to A ddr~ss: ~~ ` ' 'i `~~: . . ~vm p . - . ,. . . . . . . . . . . . . . . . . . . . ~ ~ , , ~ ~ . . . . '+k i . ~ ' . . . .~ . . . . . . . . . .~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ . ~ r~T t5 L~opn~ . -----I-'-~-~-y. 4-~wJt~ I O . ~ . Z. ~~ m' R. . :.,, . A gate ~p pitta drarva: ~ ~, ' l~ l ~? Cv . ~~xis • !f you already have a diagram that:shows alt required information, you may ineludt it, rather than this page, with your Monitoring System Certification. Ott your site plan, show the general layout of tanks and piping, Clearly identify locations of the following equi~`ment, if installed: monitoring system control panels; sensors monitoring tank ~~annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection}, In the space provided, note the date this Site Plan wasprcparcd. Page of ~„ os~au FROM :BSSR,INC FRX N0. :6615882786 Oct. 11 2007 10:40RM P6 . • 4' I . i _. SWlZCl3, January 2UU6 Spill Bucket 'Testing Report Form This form is intended for use by contractors performing annual testing of LIST spill containment structures. The completed fvrnr u~~~! printouts from tests (f applicQk~g), should be provided io the facility owner/operator for submittal tv the local re~trlptvr~! ugcnc.~y. 7 Ti A ~!Tf .iTV r1~TG'ADAiT A TTl~hY Facility Name:, bate of Testing: -~ Facility Address: PaciEiry Contact: Phone: Dare Local Agency Was Notified ofTssting ; Q --~.~'j ` Name of Local Agency Inspector (rf present during testing): , 2_ _TT;ST)<iV[: rnxTRAP'TnR TxFnulute"r>tnt~E Company Name: • Technician Conducting Test;. f Credentials: D CSLB Contractor CC Service Tech. 0 SWRCB Tank Tester D ether (Spec~J License Number(s): ~ ~._. 3_ SPILL RiI['1KFT TFSTTxt'~ Yx~'C)t2MAT1'(1N Test Method lased: drostatic D Vacuurri D Other Test Equipment Used: Equipment Resolution; Identify Spill Bucket (By Tank Number, Stored Product, etc, Y ~ ~~/~~ l~~f/ 2~~ 3 4 Buc3cet Installation .Type; D>reCt $ury ontaine in Sum ~birect bury ontained i Su ^ Direct Bury Contained in Sum D Direct Bury O Contained in Swn Bucket Diameter: _ Bucket Depth: Wait time between applying vacuum/water and start of test: Test Start Time {Tt}: Initial Reading (R,): Test Bnd Time (TF): ' Finai Reading (RF): Test Duration (Tf - T,): ~ ' Change in Reading (IZF - R,): PasslFail Ttveshotd or Criteria: ~~~ Test Result: Pass • D Fail ss ^ Fail ^ Pass D Fail D pass ^ Fail C:ommerltS_- (include information on repairs made priof to testln~ and recommended follow-up for a!!ed tests) CERTIFICA''I'TON OF TECHNICIAN RESPON$II3LIr FOR CONDUCTING THIS TEST'1NG I hereby certify that ail the irtforntatlOn cantatned !n this report is true, accuratx, and in full compliance with legs! requlremetrt~. pate: „~~~''~~ State taws and regutattons do not currently rec{uue testing to be perforTned by a qualified contractor. However, Iocal requirements mou }+a mnrn cTrin~ant ' FROM :BSSR,INC FAX N0. :6615882786 Oct. 11 2007 10:41AM P7 . $SS.~I, ~1~C. 6630 Rosedale i'iwy,, ~ ~, Bakarsfreld, CA 93308 Phone (661) 58.8-2777 Fax (661) 58~-2786 IV.~ONITQItING, SYSTEM C~R.'Z'Z~'ICATI~N ~w .. .. This form muss be used to doctunenf 'testing and servicing of monitoring equipment. A separate gertification pr Jeoort trust ,r e acrd f r ea by the teehuician who performs the work. A copy of this form must be provided to the tank system owner/aptrator. The awaer/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. Geuerail Info a#io Facility Natrte: ~~/J /l~~T~ ~Q~~I~ r~ Bldg. No.: Site Address:1,f zS"C~~.~CT- •,~~~• Ciry: /~ Zip: _ Facility Contact Person; ~~~5 _ _ Contact Phone No.: b~,~/~~ 41X~ Make/Model of Monitoring System; ~...~~ Date of Testing/Servicing: ~~/;~' ,rO,,,,~` ~. Xnventory of Eguiplmeut Tested/Certified l'heeti tAn ino*onriats hossa to inAEr~ts msell5n se~ln~nent In~nsnlQA/~a,..,inwfe 1'ay~tc T17: ~ G T ay~1~ ID: ~ ~ r - Q'~r Tank Gauging Probe. Model: ¢J ~ ~' Iy-Tank Cyauging pro e, _ tvlodel: L~J ~ ?'~~nnular Space or Vault Stnsor. F Model: L , Fd'~nular Space or Vault Sensor. Model: ,O f..G- ~ Td'Piping Sump / Trcneh Sensor(s). Model: 't~'Piping Sump/'French Sensor(s). "Model: __ © Fill Sump Sensor(s). Model: ~ A Fill Sump Sensor(s). Model: __ O Mechanical Lina Laak Detector. Model: _ ___ __ ^ Mechanical Line Leak Detector. _ Model: _ O' Elcctronie Line Leak 17eteetor. Model: ^ L'leetronic Line Leak Detector. ModeL• © Tank Overfill !High-Level Sensor. Model: __ __.,_, ___ ^ Tank Overfill /High-Level Sensor. Model: Q Other s ecif a ui mart t e and modal in Section E on Aa e 2 . ^ Other ei t ui mart a and model. in Section E on Pa e 2 . Tank 1'D: Tank IA: ^ ]n-Tank Gauging probe. Model: ^ In-Tank Gauging Probe. Model: -~_ O annular Space or Vault Sensor. Model: ^ Annular Space or Vault 5tnsor~ Model: ___ ^ Piping Sump /Trench Sensor(s). 'ModeL• ^ Piping Sump /Trench Sensor(s). Model: O Fill Sump Sensor(s}, Model:. ^ Filt Sump Sensor(s), Model: ^ Mechanical Lint Leak Detector. Modal: O Mechanical Line Leak Detector. Model: ,,,-,,,_,,,,,-,- . ^ Electronic Line Leak Aetector. 'Model: ©Eleetronle Line Leak Detector. Model: _ d Tams Overfill /High-Level Sensor. Model: ^ Tank Overfill /High-Level Sensor. Model: Q Other s ecif ui mart a and model in Section Eon Pa c 2 . A Other s ei a ui'menr a and model in Section E on Pa c 2 . Dispenser ID: Dispenser ID: _. ^ Dispenser Containment Sensor(s). Model: ^" C9ispensar Containment Sensor(s). Model: ~••„ D Shear Valve(s). Q Shear Valve(s), Q Dis enser Containment Floats and Chafn s . ^Dis 6nser Containment Floats and Chains , Dispenser ID: Dispenser ID: ^ Dispenser Containment Stnsot(s). Model: ^ Dispenser Containment Sensor(s). Model: D Shear Yalve(s), q Shear Valve(s). O Di enser Containment Floats and Chains . ^ Di aser Containment Flosit s and Chains . pisptnser ID: Dispenser ID: _.. __ O Dispenser Containment Sensor(s). Model: Q AispenserContainmcnt Sensor{s). Model: n Shear Valve(s). ^ Shear Volvo(s). ^Dis enser Containment Floats and Chaia s . O Di enser Containment Floats and Chains . •If the facility contains more tanks or dispensers, copy tuts roan. include tnrotmatton roc every ranee ana atspenscr at tnc tacmry. C. CertiflC8t10L1 - X cet•tlfy that the equipment ldentltled [u this document was Enspected/serviced is accordance with the maoufaetucets' guidelines. Attached to thla Certitlcatlon to Information (e.g. manufacturers' checklists) necessary to verify that this lnformatlon is cort'eCt and 8 Plot Platt ahowkag the layout of tnonitorlna equlptnent. or ap equipment capable of geacrating such reports, I have also attach a copy of the re ort• (check al! chat apply): ~ $ set- ory report Technician Name (print): ~~ ,~ ~ Signatttre:' Certification No.: S •-~,~-~ ~ Lieense. No.: ~7~ ~/~ r -7 Testing Company Name: ~ Phone No.:~ ~~/ }4 4~ r~ Site Address: ~ - ~ - ~/~ etc oFTcsting/Servicing: ~I_IQ Page I of~ ~ U7lUI ~ Monitoring System Certifcat[on FROM :BSSR,INC FAX N0. :6615882786 • D. Results of Testing/Servicing • Software Version Installed: .~~ ~ Q~ Complete the [a[lowinv checktist~ 1 Oct. 11 2007 10:42AM P8 s ©No* Is the audible alarm o eratienal? i s ^ No* ____ Is the visual alarm, o erational? ~ - ~~ ~ O Na* ~ __ _ __ ____ _ __ _ _ Were all sensors visuall ins ccted functionah tested and confirmed o crarional? ~ ~ es © No" _ Were all sensors installed at lowest point of secondary containment and positioned so that other cqui}m~e~u wlli not interfere with their ro er o erasion? _ . ~ O Yes ©• No* _ ___ _ • It' alarms are relayed to a remote monitoring station, is all corruniuiications equipment (r.k ~ru,drrn+ NIA optrational? ^ Yes ^ No* For pressurized piping systems, does the [ttrbinc automatically shut down if the piping secondary cu~u~u~urn:~u ' N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? if yes: which senso~~ ~nniaa III positivt Shut-down? (Check all that apply t~ Sump/Trench Sensors; ^ Dispenser Co,riaizunenl Scusurs. fi Did ou confirm ositive shut-down due to leaks sensor faiiureJdisconnection? ^ Yes; ^ No. _ __ _ •~ • O Yes ^ No' nu ~. r For Cank systems that utilize the monitoring system as the primary tank overfill warning devie~~ (~ N!A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible ;u ~h~ w3~1•. it fill oint s sud o eratin ro erl ? If so at what ereent of tank ca acit does the alarm tri ~cr'? ' ~:, D Yes" No _ Was any monitoring equipment rtplaeed? Tf yes, identify specific sensors, probes, or other equiprr>cnl ~'Cpla~•cJ ll and list the manufacturer name and model far all re lacement arts in Section )/ below, _ __._ i ` 0 Yts" No Was liquid found inside any secondary containment systems designed as dry syslcros? (Check r'f!l rhr„ ul,l,~'.', t • I ^ Product• ^ Water. If as descrbe causts in Section E, below, _ • •„•,,.,, • „_ „~~ Y ^ No* Was monitorin s stem set-u reviewed to ensure ro ar satin s? Attach se[ u rc orts, if t~licabic •.___..••_•._ ~! • es G7 No* _~~ Is all.manitorin a ui ment o erational er manufacturer's s eeifieations? ___ _ * In Section E below, describe how and when these deficiencies were or wtll be corrected. !r. Comments: Rage 2 of !.~ u.~,ui FROM :BSSR~INC FRX N0. :6615882786 Oct. 11 2007 10:43RM P9 ,. ~ F. In-Tank Gauging / SXR Equipmelot: ' ~ D Check this box if tank gauging is used on~y far inventory control. ^ Check this box if no tankgauging or STR equipment is installed. This s,:ction must be completed•if in-tank gaugit}g equipment is used to perfot~rl leak detection monitoring. -,~,.• . Complete the following checklists ' ' ' Y s ©No" Has all input wiring been inspected for proper entry and termination, including testing for greuad faults? Yts O No" Wtrt all tank gauging probes visually inspected for damage and residue buildup? s Q No" Was accuracy of system product level readings tcstcd7 s ^ • No" Was accuracy of system water level readings tcst~d7 es ^ No" Wera all probes roinstalled properly? Yes Q No" Were all items on the er~uipment manufacturer's maintenance checklist completed? ` in the Sectt0rx Id, below, describe how and w~he~n these deliclencies were or will be corrected. G. Liae Leak Detectot's•{r,>l.~}: ~` Check this box if LLDs are pot installed. f"„mnlo+o +S,n fnlln...;"b nl,an4lia+. ^ Yes ^ No" iron equipmeiiiG~atart-up or annual equipme>t certification, was. a Teak simulated to verify LLD performance? O N/.A (Check all that apply) Simulated Leak rate: ^ 3 g,p,b~.; ~ 0.1 g.p.h ; CI 0:2 g.p.h. ^ Yes ^ No" Were all LLDS confirmed operatiozial and accur~to within regulatory requirements? ' ^ Yes • ^ No• Was the testing apparatus properly calibrated? Q Ycs ^ No* Fos mechanical LLAs, dots the LLD restrict product flow if it detects a leak? ^ N!A ^ Yes O No" )~or eleetroaic LLDs, dons the turbine automatically shut off if the LLD dataets a leak? ^ NIA U Ycs ©No+ 1~or elecaonic LY,bs, does the turbine sutomaticalIy shut off if any portion of the monitoring system is disabled ^ NIA or disconnected? ^ Ycs 0 No" . For electronic LLDs, does. the turbine automatically shut off if any portion of the rraoriitori,~g sysrtrn ^ N/A rlxalfunctians or fails•a test? D Ycs O No' For electronic 1rLDs, have all accessible Wiring connections been visually inspected? O NIA O Yes O No" Were alt itetms.on the equipment manufacturer's maintenance checklist completed? * In the 5ectioA J~, below, describe how and waen these deiicienc[es„vYere or wiu ne correc[elx. H. Comments: page 3 of ~ o3ro~ ROM :BSSR,INC FAX N0. :6615882786 . ,. Moaitoria~ System Certit~catlon Oct. 11 2007 10:44AM P10 I • . 'C7ST ~onitor~ng Site ~~~n Sate Address• ..'. ~/ll~ ~~ ~. .. . ._x~ . ~.~,. . .. .,~ . IJata map was cizzawn: ~l d~ l Instrncti~s If you already have a diagram Yhat shows alI required information, you may include it, rather than this page, with your Monitoring System Certification. Qn your site plan, show tlu geaeral°layaut of tanks and piping. Clearly identify locations of the following equipment. if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill eoatainera, or other stxondary containment areas; mechanical or electronic line leak detectors;' and in•tank liquid Level probes (if~used for leak dctectiori}, In tbt spaac provided, note the date this Site Plan was prepared. ' Pa~e.~o[~ osroo i ~ ~ .~. FROM :BSSR,INC FAX N0. :6615882786 Oct. 11 2007 10:45AM P11 SWRCI3, January 2000 Spill Bucket Testing deport Form This forrrr is intended for use by contractors performing annual testing of UST spill cpnlainment struClures, The c•onrplered fvrn, ~„r~! prrnrours from tests (if applieQe), should be provided to the facfllry owner/operator for su6mlrtal to the local regyu/nto,y GgenG;v. 1 Y"i d ('T7 .T7`V 'fl\l'G'!1T? M A'riY/l)V' Facility Name: ~^ Data of Testing: G7-- - Facifity Address: ~ ,;~ ~~ ' . _ 1"aeifity Contact: "~ Phone: Dace Local :tlgancy Was Notified of Testing : /~ ~,~ ~CJ ~ ' Name of Local Agency inspector (f present during testing: ~'jf~ Qit/~+' ,.~/ ~ , 2_ TFSTIN(~ ~CftV~TRAi'TC1R INFOI21VrA't'Tf1TV Company Name; Technician Conducting Test; CredentiaEs~: 0 CSGl3 Contractor C Service Tech. 0 SWRCB Tank Tester ^ Other (Specify) License•Number(s): (~(~ --.... ~ as-p -~ _ - 3. SPILL $IICI~F,^i' T'F:fiTING INFORMATION Test Method Used: ^ li droststic Q Vacuurri ^ Other _ Test Equipment Used: Equipment Resolution: Identify Spill Bucket (By Tank Nu~rrber, Stored Product, etc. It •~,~~~~/, `'' 2 • ~ fi '"-`.~- 3 a Bueket•Instailation Type: ~irect Bury a Contained in Sum J~Dlrect i3tuy ^ Contained in Sum Cl Direct 13ury L7 Contained in Sum 0 Direct Bury Q Contained in Sum Bucket Diameter: ~ ' ~?' Bucket Depth: ~' ' Wait time between applying vaeuumlwater and start of test: ,mil ~""• • Test Start Time (T,): ~ ~Q Initial Reading (Ri): ~ , Test 1~nd Time (TF): O ~ ___. Final Reading {RF): Test Duration (TF - Tt): ff Change in Reading (ItF - Ri): -(~r-• Pass/Fai1 Threshold or Criteria: ~d r ~ ,, „fir ~ Gfi~•..~ ~© `' ~~~j+~ ~!~- x'estResult: pass ~ Q I'8i1 ass •D 1~'all 0 Pass 0 Fai! 0 Pass ^ Fail (~O1;g1I1817C9 - (include information on repatrs made prior 1o testing, and recPmmended_follow-up for farted tests) CERTIFICATION pl? T1aCIiNICIAN RESPON5113I.E FOR CdNDUCTING THIS TESTING 1 hereby cert~ that al! the fnjormation contained ta this report ds true, accurate, anal in full compltance with legal regtrire-ne~rrs. Tschniciar ' Sign~e: ~~~~/ _ Date; ~© .• "'~ ~ -,_____ -~--a State'(a~ and regulations do np1 c~rently require testing to be performed by a; qualified contractor. However, focal requiremems m o~, Fw n~AYP C1'MIf1lYPnt 1 ~:.' JTMS MOBIL SiteID: 015-021-000512 Manager JIM HADDADIEN Location: 3200 F ST City BAKERSFIELD CommCode: BFD STA O1 EPA Numb: BusPhone: (661) 322-2250 Map 102 CommHaz Moderate Grid: 24D FacUnits: 1 AOV: SIC Code: DunnBrad:77-016-4041 Emergency Contact JEHAD HADDADIEN Business Phone: 24-Hour Phone Pager Phone Hazmat Hazards: / Title / OWNER/MANAGER (661) 322-2250x (661) 834-8610x ( ) - x Emergency Contact HUDA HADDADIEN Business Phone: 24-Hour Phone Pager Phone / Title / OWNER/MANAGER (661) 322-2250x (661) 834-8610x ( ) - X Fire ImmHlth DelHlth Contact JIM HADDADIEN Phone: (661) 322-2250x MailAddr: 3200 F ST State: CA City BAKERSFIELD Zip 93301 Owner WILFRED KOMBISH Phone: (310) 471-1314x Address 1032 CASIANO RD State: CA City LOS ANGELES Zip 90049-1610 Period to Preparers Certif'd: ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST TotalASTs: = Gal TotalUSTs: = Gal • RSs: No ~N~°~ ~,,~ ~ •~ . ~ h t?4l~/ f~a==^~nd an my inquiry of those individuals rkf~~r~nri~lo fur obtaining the information, !certify u~jd~%r porlalty of law that I have personally exarnine~i artd am famili~r with the information subr~ittstt~~ fjf lieve + e information is true, accurate, ~,7 o tpla ~'-~'-~ ~ Sig .ure Date -1- 07/12/2007 F JIMS MOBIL SiteID: 015-021-000512 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: DIMS MOBIL Cross Street Business Type: Org Type: Total Tanks 2 IndnResjTrust: No PA Contact: Dsg Own/Oper AARON KOOP ICC Nbr: 5243167-UC , PROPERTY OWNER INFORMATION Name HUDA HADDADIEN Phone: (661) 322-2250x Address: City State: Zip: Type INDIVIDUAL TANK OWNER INFORMATION Name HUDA HADDADIEN Phone: (661) 322-2250x Address: City State: Zip: Type INDIVIDUAL BOE UST Fee# 006217 Financ'1 Resp: STATE FUND Legal Notif Business Mailing Address Date:04/20/2000 Phone: (326) 620- x Name:JOHN STEWART JR Ttl:OWNER State UST # 1998 Upg Cert#: 00743 -2- 07/12/2007 ~ S F DIMS MOBIL SiteID: 015-021-000512 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod SUPER UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod MOTOR OIL F DH L 120.00 GAL Min -3- 0~/12/200~ -4- 07/12/2007 -. F JIMS MOBIL SiteID: 015-021-000512 ~ ~ Inventory Item 0001 Facility Unit: .Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: W OF BLDG CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient --~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 3500.00 GAL rit~~titcLUUS ~vrirvlv~;ly 15 %Wt. RS CAS# 100.00 Gasoline No 8006619 riE~L,HKL AJSr;551~1.C;1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No, No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME SUPER UNLEADED GASOLINE Location within this Facility Unit W OF BLDG STATE TYPE PRESSURE Liquid Mixture Ambient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# ' 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 3500.00 GAL nt~~,tjrcLUU~ ~:ui~irvlvr~ivt~ °sWt. RS CAS# 100.00 Gasoline No 8006619 I1HG1-iCCL H~J .7r,.7.7P7r,1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 07/12/2007 F JIMS MOBIL SitelD: 015-021-000512 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME MOTOR OIL Days On Site 365 Location within this Facility Unit Map: Grid: S WALL LUBE RM CAS# 8020835 ~Liquid~Mixture I Ambient~E ~ AmbientT~E I PLASTOICTCONTAINER~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 120.00 GAL 60.00 GAL ru-~~titcliw~ cr~inruiv~i~~1~5 %Wt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 riHGHKL HJJL'~J1~1L'1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min -6- 07/12/2007 F JIMS MOBIL SiteID: 015-021-000512 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/04/2006 ~ CALL 911. CALIFORNIA OFFICE OF EMERGENCY SERVICES 800-852-7550 AND/OR HAZMAT OFFICE 326-3979. Employee Notif./Evacuation VERBAL. 02/17/2000 Public Notif./Evacuation VERBAL. 02/17/2000 Emergency Medical Plan 05/04/2006 SAN JOAQUIN HOSPITAL, 2615 EYE ST, 327-1711 ,OR HALL AMBULANCE, 327-4111. -7- 07/12/2007 r. F JIMS MOBIL SiteID: 015-021-000512 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 05/04/2006 GAS: DEPRESSED DOUBLE-CONTAINMENT - EMERGENCY SHUT-OFF SWITCH - SW WALL OUTSIDE. OIL: DEPRESSED DOUBLE-CONTAINMENT. Release Containment 05/04/2006 SAWDUST: MIDDLE W CABINETS. Clean Up 05/04/2006 LCI GASOLINES 800-333-9011 OR COLES WASTE OIL SERVICE, 322-8258. V1.11CL .RC.7-V ULC;C tic:~lvcdLlon -8- 07/12/2007 F JIMS MOBIL SiteID: 015-021-000512 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~NC~:.Lai na~aiu~ Utility Shut-Offs. 05/16/2007 ELECTRICAL - W OF SINK ON N LUBE RM WALL WATER - SW CRNR LOT NEXT TO F ST SIDEWALK SPECIAL - GAS PUMP EMER SHUT-OFF W OUTSIDE WALL Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - SW CRNR 30TH & F ST. 05/04/2006 Building Occupancy Level 03/30/2006 3 EMPLOYEES -9- 07/12/2007 .-~~ F JIMS MOBIL SitelD: 015-021-000512 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/04/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: VERBAL WHEN HIRED. MSDS AVAILABLE IN WORK AREA. rayC a aaclu iVt r ul. UlC Vw7-C nclu lvi 1' Ul.u1.C UDC -10- 07/12/2007 JIMS MOBIL .Manager Location: City s;r,;, U.~aa~a. 3200 F ST BAKERSFIELD CommCode: BFD STA O1 EPA Numb: ~~~a SiteID: 015-021-000512 BusPhone: (661) 322-2250 Map 102 CommHaz Moderate Grid: 24D FacUnits: 1 AOV: SIC Code: DunnBrad:77-016-4041 Emergency Contact / Title JEHAD HADDADIEN / s . _ . '~~'!~ ~lMw~~,,i Emergency Contact / HUDA HADDADIEN / .Title ~".r~MG.,~~ Business Phone: (661) 322-2250x Business Phone: (661) 322-2250x 24-Hour Phone (661) 834-8610x 24-Hour Phone (661) 834-8610x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact ~ "~`~ Phone: (661) 322-2250x MailAddr: 3200 F ST State: CA City BAKERSFIELD Zip 93301 Owner WILFRED KOMBISH Phone: (310) 471-1314x Address 1032 CASIANO RD State: CA City LOS ANGELES Zip 90049-1610 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT (~~ ~(1" \O PROG U - UST l` ANY°D MAY 1 s z~a~ ~.-used on my inquiry of these individuals rPSf:onsil~le far obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ~~~ 3 / O i Dat -1- 05/02/2007 .F F DIMS MOBIL SitelD: 015-021-000512 ~ - STORAGE CONTAINER DATA (UST FORM A) - Last Action Type: FACILITY/SITE INFORMATION Business Name: JIMS MOBIL Cross Street Business Type: Org Type: Total Tanks 2 IndnRes/Trust: No PA Contact: Dsg Own/Oper AARON KOOP ICC Nbr: 5243167-UC PROPERTY OWNER INFORMATION Name HUDA HADDADIEN Phone: (661) 322-2250x Address: City Type INDIVIDUAL State: Zip: TANK OWNER INFORMATION Name HUDA HADDADIEN Phone: (661) 322-2250x Address: City State: Zip: Type INDIVIDUAL BOE UST Fee# 006217 Financ'1 Resp: STATE FUND Legal Notif Business Mailing Address Date:04/20/2000 Phone: (326) 620- x Name:JOHN STEWART JR Ttl:OWNER State UST # 1998 Upg Cert#: 00743 -2- 05/02/2007 F JIMS MOBIL SiteID: 015-021-000512 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod SUPER UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod MOTOR OIL F DH L 120.00 GAL Min -3- 05/02/2007 -4- 05/02/2007 F JIMS MOBIL SiteID: 015-021-000512 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: W OF BLDG CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 3500.00 GAL I11~GHtCLV V.7 1.V1~lYV1VL,1V 1 ~ °sWt. RS CAS# 100.00 Gasoline No 8006619 r~~tatcl.~ ti~ ~~5ai~i~ly 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME SUPER UNLEADED GASOLINE Location within this Facility Unit W OF BLDG Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 Liquid TMixtur~ Ambient~E ~ AmbientT~E I UNDER GROUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 3500.00 GAL L1HGH1C11VU,7 LV1~lYV1V~1V1J %Wt. RS CAS# 100.00 Gasoline No 8006619 ri[~iGtjxL ti~ alJ~arilJlvla TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 05/02/2007 F DIMS MOBIL ~ Inventory Item 0004 COMMON NAME / CHEMICAL NAME MOTOR OIL Location within this Facility Unit S WALL LUBE RM STATE TYPE PRESSURE Liquid TMixture i Ambient SiteID: 015-021-000512 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8020835 TEMPERATURE CONTAINER TYPE Ambient `~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 1.00 GAL 120.00 GAL 60.00 GAL - r1ti~r~tcLVUS ~ulnrviv~;iv1'S %Wt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 t1AL,LittL A5~1;~~1~11'~1V'1'a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min -6- 05/02/2007 F DIMS MOBIL SiteID: 015-021-000512 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/04/2006 ~ CALL 911. CALIFORNIA OFFICE OF EMERGENCY SERVICES 800-852-7550 AND/OR HAZMAT OFFICE 326-3979. Employee Notif./Evacuation 02/17/2000 VERBAL. Public Notif./Evacuation 02/17/2000 VERBAL. Emergency Medical Plan 05/04/2006 SAN JOAQUIN HOSPITAL, 2615 EYE ST, 327-1711 ,OR HALL AMBULANCE, 327-4111. -7- 05/02/2007 F DIMS MOBIL SiteID: 015-021-000512 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/04/2006 ~ GAS: DEPRESSED DOUBLE-CONTAINMENT - EMERGENCY SHUT-OFF SWITCH - SW WALL OUTSIDE. OIL: DEPRESSED DOUBLE-CONTAINMENT. Release Containment 05/04/2006 SAWDUST: MIDDLE W CABINETS. Clean Up 05/04/2006 LCI GASOLINES 800-333-9011 OR COLES WASTE OIL SERVICE, 322-8258. Other Resource Activation -8- 05/02/2007 F JIMS MOBIL SiteID: 015-021-000512 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ _, ,_ oNc~iai raaaaiu~ Utility Shut-Offs 05/04/2006 A) GAS - NONE B) ELECTRICAL - W OF SINK ON N LUBE RM WALL C) WATER - SW CRNR LOT NEXT TO F ST SIDEWALK D) SPECIAL - GAS PUMP EMER SHUT-OFF W OUTSIDE WALL E) LOCK BOX - NO Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - SW CRNR 30TH & F ST. 05/04/2006 Building Occupancy Level 3 EMPLOYEES 03/30/2006 -9- 05/02/2007 F JIMS MOBIL SiteID: 015-021-000512 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/04/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: VERBAL WHEN HIRED. MSDS AVAILABLE IN WORK AREA. rayc ~ raciu ivi ru~.uic u~c nclu ttJi r uI.UIC U5C -10- 05/02/2007 .` ,; UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING !TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION BAKERSFIELD FIRE DEPT. ~~R~ Prevention Services Al~l~I t 900 Truxtun Ave., Ste. 210 ~-. Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 P~e1of1 PERMR N0. •~' O ~S ^ ENHANCED LEAK DETECTION ^ ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST TO PERFORM FUEL MONITORING CERTIFICATI N I s :INFO FACILITY NAME 8 PHONE NUMBER OF CONTACT PERSON ADDRESS ~~ c J I~ OWNERS NAME OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES ^ NO TA K # VOLUME CONTENTS lC~ VO C~ © 0 TANK,;TE$TING COMPANY NAME OF TESTING OMPA Y NAME PHONE NUMBER OF CONTACT PERSON MAILING ADDRESS 5co X13 ~d~ s c~ NAME 8 P NE NUMBER OF TESTER OR SPECIAL INSPECTOR CERTIFICATION #: DATE & T ME TE T TO BE CONDUCTED ICC #: TEST METHOD SIGNATURE OF APPLICA ~ ~ ~ DATE "'APPROVED BY DATE .~ ' FD 2095 (Rev. 09/05) ~IL~LING & PERMIT STATEMENT BAKERSFIELD FIRE DEPT. _ ~ Prevention Services ~'~ P1R~ 900 Tnixtun Avenue, Suite 210 -~ PERMIT NO.: ~Rfr r Bakersfield, CA 93301 . - ~ • LOCATION OF PROJECT PROPERTY OWNER STARTWG DATE ~ J ~ ~ _o PLETION DATE ~ - O O NAME ' PROJECT NAME ADDRE PHONE NO. ~ O • PROJECT ADDRESS ~ . CITY ~ r STATE ~~ V,l ZIP CODE • •' •' • CONTRACTOR NAME CA LICENSE NO. TYPE OF LICENSE EXPIRATION DATE PHONE NO~~ ' CONTRACTOR COMPANY NAME ~ '^ FAX NO. -6( ~ ~=-V ~ r ~ 0 . ADDRESS ~~ CffY ~ ZIP CODE ~ ~~~ J • • ~ ^ Alarms -New & Modifications - (Minimum Charge) $262 50 • ~ • . 98 Over 20 Ft 000 Sq Ft x 013125 =Permit fee Sq ~ ~ , . . . 98 ^ Sprinklers -New & Modfications - (Minimum Charge) 00 $210 ~ . 98 ^ Over 5 000 Sq Ft. Ft x 042 =Permit fee Sq ~ , . . . 98 ^ Minor Sprinkler Modifications (< 10 heads) $ 93 00 [Inspection Only] ~ . 98 ^ Commercial Hoods -New & Modifigtions $ 398 26 ~ . 98 ^ Additional Hoods $ 36 00 ~ . 98 ^ Spray Booths -New & Modifications 00 $458 ~ . 98 ^ Aboveground Storage Tanks (InstallatioNlnsp.-1 ~ Time) $165.00 82 ^ Additional Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Removal/Inspection) $109.00 82 ^ Underground Storage Tanks (Installation./Inspection) $878.00 (per tank) 82 ^ Underground Storage Tanks (Modfication) $878.00 (persite), 82 ^ Underground Storage Tanks (Minor Modification) $155.00. 82 ^ Underground Storage Tanks (RemovaQ $675.00 (per tank) 84 ^ Oilwell (Installation) $ 72.00 ~ 84 Mandated Leak Detection (Testin /Fuel Monit. Cert. $ 81.00 (per site) 82 ^ Tents $ 93.00 (per tent) 84 ^ ~ After hours inspection fee $122.00 ~ 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour) $ 60.00 + (5 hrs. min. stand -by fee /lnspectlon) _ $510.00 t 84 ^ .. RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) 84 ^ Portable LPG (Propane): NO.OF CAGES? $66.00 84 ^ Explosive Storage $249.00 ~ ^ Copying & File Research (File Research Fee $33.00 per hr) 25¢ per page 84 ^ Miscellaneous : ~ FD 2021 (Rev. 09/05) 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to Flle) 1-PINK (to Customer)