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HomeMy WebLinkAboutBUSINESS PLAN 3/15/200402t09f200~ 83:83 213-382-5~05 BEE INSURANCE PA~E 0!/B3 3600 Wilshlre BIvcI,, Suite 406 Los Angeles, CA 90010 Tel: (21.%) 582-6200. Fax; (21.3) 382-6005 Emall: amylee~BeeFlnanclal.com Fox DAY & MIGHT MARK~'r Ilrom~ Amy Lo~ Fa~ 661.322,2181 Pl'tmm: this [] Urg~mt. [] For REview CC: [] Please Comment i'I PleaM IMply [] INMSe RecYcle CERTIFICA ]E OF PROPERTY ZNSURANCF_. CERTIFT.¢ATE OF LIABILITY INSURANCE FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield. CA 93301 VOICE (661) 326-3911 FAX (661) 852-2170 SUPPRESSION SERVICES 2101 "H" Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 852-2170 PREVENTION SERVICES fiRE SAfETY SERVICes· ENVIRONMENTAl SERVICES 900 Trvxtun Ave.. Suite 210 Bakersfield. CA 93301 VOICE (661) 326-3979 FAX (661) 852-2171 FIRE INVESTIGATION 1715 Chester Ave.. 3'd Floor Bakersfield. CA 93301 VOICE (661) 326-3951 FAX (661) 852-2172 TRAINING DIVISION 5642 Victor Ave. Bakersfield. CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 December 10, 2004 Mr. Agmail Sangha A-I Foodstore 1200 H Street Bakersfield, CA 93301 REMINDER NOTICE Re: Necessary Compliance Deadlines for UST Owners/Operators Dear Mr. Sangha: The purpose of this letter is to remind you about three compliance deadlines for UST Owners/Operators. These are as follows: 1) January 1,2005 deadline for submitting declaration statement designating: (a) Owner/Operator understands and is in compliance with all applicable UST requirements, and (b) Owner identifies the designated UST Operator for each facility owned. (c) Owner/Operator passes and submits proof of International Code Council Test. 2) EVR upgrade requirements on spill buckets are due April 1, 2005. 3) Secondary Containment Testing on all secondary systems. Code requires re-testing 36 months from date of last test which was in 2002. Should you have questions regarding these compliance deadlines, please feel free to call me at 661 - 326-3190. Sincerel)', ~') ., . . ..~. rf:J1litO Steve Underwood Fire Prevention Officer SU:db fEr:f};;;r.tll;H// IIIf! Yii:.J/IINIUNtll;y O//r¡,j.' Q l/o'Fe Q'ý"/UUI Oyl Y¡;;'WÛI/PU /J (f Postage $ ...-/- Certified Fee Postmark  Ret~m Reclept Fee (Endorsement Required) , Here Restricted Delivery Fee ,J3 (Endorsement Required) ru Total Post~'~ ~ A~I roodstore ' '~ ,...'~. ~ [~r~'~?2'~ 0 H Street I ~Bakersfield, CA 93301 · Complete items 1,2, and 3. Also compJete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space ~ermits. 1. Article Addressed to: A- ! Foodstore 1200 Iq Street }-.Bakersfield, CA 93301 21 Article Number (transfer from service label) PS Form 3811, August 2001 A. Signature x B. Received by (Printed Name) [] Agent r'-I Addressee D. Is delivery address different from item 17 f'3 Yes ,ltCCES, enter delivery address below: [] No 3. Service Type ~1~ Certified Mail Express Mail F"I Registered I'-1 Return Receipt for Merchandise [] insured Mail [] C.O.D. 4, Restricted Delivery? (Extra Fee) [] Yes 7003 2260 0004 7652 2563 Domestic Return Receipt 102595-02-M. 1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage & Fees Paid USPS Permit No. G-10 · Sender: Please print your name)?ddress, and ZIP+4 in this box · Bakersfield Fire Department Prevention Services 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 FIRE CHIEF RON F P,.Z.,Z. E AOMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-394 1 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFETY SERVICES. ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 3260576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 3260576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 VL-tor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 D December 12, 2003 CERTIFIED MAIL A-1 Foodstore 1200 H Street Bakersfield, CA 93301 RE: Propane Exchange Program Dear Owner/Operator: The purpose of this letter is to advise you of current code requirements for propane exchange systems, such as "Blue Rhino" or "Amerigas." This does not apply to large propane tanks, only propane exchange systems. Over the past two years this office has noted a dramatic increase in the propane exchange system in the city of Bakersfield. It has also been noted, with great concern, that many of these installations are a clear violation of the UFC (Uniform Fire Code) and represent a danger to public health and safety. Accordingly, procedures for storage of propane cylinders awaiting use, resale or exchange, have been adopted through BMC (Bakersfield Municipal Code) and adoption of the 2001 UFC. The procedures are as follows: Storage outside of building for propane cylinders (1,000 pounds or less) awaiting use, re-sale, or part of a cylinder exchange point shall be located at least 10 feet from any doorways or openings in a building frequented by the public, or property line that can be built upon, and 20 feet from any automotive service station fuel dispenser. (Note distance from doorways increases when cylinders are over 1,000 pounds cumulatively.) Cylinders in storage shall be located in a manner which minimizes exposure to excessive temperature rise, physical damage or tampering (Section 8212, Califomia Fire Code, 2001 Edition). When exposed to probable vehicular damage due to proximity to alleys, driveways or parking areas, protective crash posts will be required as follows (Section 8001.11.3 and 8210, California Fire Code, 2001 Edition): 1) 2) Constructed of steel, not less than 4 inches in diameter, and concrete filled. Spaced not more than 4 feet between posts, on center. ~ttl~J 'to: Re: Dated: Page Owner/Operators of Propane Exchange ~l~ems Propane Exchange Program December 12. :2003 2 of 2 3) 4) 5) Set not less than 3 feet deep in a concrete footing of not less than a 15 inch diameter. Set with the top of the posts not less than 3 feet aboveground. Located not less than 5 feet from the cylinder storage area. Exceptions: Cylinders storage areas located on a sidewalk which is elevated not less than 6 inches above the alley, driveway or parking area, with not less than I0 feet of separation between the curb and the cylinder storage area. "No Smoking" signs shall be posted and clearly visible (Section 8208, California Fire Code, 2001 Edition). Resale and exchange facilities must be under permit to verify compliance. All existing facilities will be checked and when compliance is confirmed, a permit will be issued. All new propane exchange systems must be permitted prior to installation. You will have 90 days (March 4, 2004) to comply with the procedures outlined. Once compliance has been confirmed, each exchange system will be issued a permit, which will be placed on the exchange system. Sites not conforming to current code, will be "red tagged" and must be taken out of service immediately. You should contact your Blue Rhino representative, Mr. Taylor Noland, or your local Amefigas representative. They are aware of current code requirements. If you do not have a propane exchange system, please disregard this letter. Should you have any questions, please feel free to contact me at (661) 326-3190. Sincerely, Steve Underwood Fire Inspector/Petroleum/ Environmental Code Enforcement Officer IT' ~ Postage .:3- Certified Fee / Postmark ~ Return Reclept Fee / (Endorsement Required) ~_. Here r"'l Restricted Delivery Fee ! l.r) (Endorsement R~~ · ro~Pos~ A-1 FOOD STORE Sent To 1200 ~ H STREET l'~['~'~ BAKERSFIELD, CA 93301 [ o..rPO'~o~ No, ..,.:, ...... ~... ~ .... · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. A-1 FOOD STORE 1200 H STREET BAKERSFIELD, CA 93301 1 A. Sig ' II ~.~.,ved by l~'r~nte, o5 Na-'~e) lC. Date of ~,lv.~ If YES, enter delive~ address below: ~ No 3. Service T};pe ]~"Certified Mail ' [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 2. Article Number (Transfer from service/abe/) PS Form 3811, August 2001 7002 3150 0004 9985 5008 Domestic Return Receipt 102595-02.M.1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage & Fees Paid usPs Permit No. G-10 · Sender: Please p~'int your name, address, and ZIP+4 in this box · Bakersfield Fire Department Prevention Services 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 D November 4, 2003 FIRE CHIEF ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFE~' SERVICES, ENV1RONMEI~'AL SERV1CES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC ED. ,~,,,CATION 171;~ Chester Av~. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 A-I Food Store 1200 H Street Bakersfield, CA 93301 CERTIFIED MAIL NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE Dear Sir or Madam, Our records indicate that your annual maintenance certification on your leak detection system was past due 10-11-03. You are currently in violation of Section 2641(J) of the California Code of Regulations. "Equipment and devices used to monitor underground storage tanks shall be installed, calibrated, operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks at least once per calendar year for operability and running condition." You are hereby notified that you have fifteen (15) days, November 19, 2003, to either perform or submit your annual certification to this office. Failure to comply will result in revocation of your permit to operate your underground storage system. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely yours, Ralph E. Huey Director of Prevention Services Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/db BaKersfield Fire Department Prevention Services 715 Chester Avenue, Suite 300 Bakersfield, CA 93301 · Complete items 1,2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: A-1 FOOD STORE 1200 H STREET BAKERSFIELD CA 93301 ,al A. Signature X,,.~'~ ~ ~,, ~ I-I Agent /t/~/J~ ~// ~~_._..~ Addressee B~/.~eceived~; (Printe'd Name) 1 Ci ~Dat[~,of~Deliv, ff~j3/ D. Is delivery address different from item 1'~ [] ~es if YES, enter delivery address below: [] No [] Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise. -- -- -- [] Insured Mail [] C.O.D. Restricted Delivery? (Extra Fee) [] Yes 7002 3150 0004 9985 3110 PS Form 3811, August 2001 Domestic Return Receipt 2ACPRI-03-Z-09S5 Certified Fee Po,,~llark g Return Reciept Fee (Endorsement Required) Hem ~ Restricted Deliven/Fee i LO (Endorsement Required), m Total Pc~-~ ~ ~ A-1 FOOD STORE I.,1200 H STREET ~ April 11, 2003 A-1 Food Store 1200 H Street Bakersfield CA 93301 FIRE CHIEF RON FRAZE . ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 'H' Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. 'Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 CERTIFIED MAIL Recent SB 989 Secondary Containment Testing REMINDER NOTICE Dear Owner/Operator: Our records indicate that you completed your secondary containment testing on October 29, 2002. Our records further show a failed test. Therefore you are required to have your system repaired and re-tested as soon as possible. This office requests an update with regard to repairs of your system. Please be advised that repairs involving the replacing of components must be under permit from this office. The repairs of your system are a condition of your permit to operate. Failure to repair and re-test will result in the revocation of your permit to operate. Should you have any questions, please feel free to contact me at 661- 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc L D September 30, 2002 A-I Foodstore 1200 H Street Bakersfield CA 93301 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 ~H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES F~E SAFETY SERVICES. ENVI~OflMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93.'.~1 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Av~. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 REMINDER NOTICE RE: Necessary secondary containment testing requirements by December 31, 2002 of underground storage tank (s) located at the above stated address. Dear Tank Owner / Operator, If you are receiving this letter, you have not yet completed the necessary secondary containment testing required for all secondary containment components for your underground storage tank (s). 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 periodically thereafter, to insure that the systems are capable of containing releases from the primary containment until they are detected and removed. Of great concern is the current failure rate of these systems that have been tested to date. Currently the average failure rate is 84%. These have been due to the penetration boots leaking in the turbine sump area. For the last five months, this office has continued to send you monthly reminders of this necessary testing. This is a very specialized test and very few contractors are licensed to perform this test. Contractors conducting this test are scheduling approximately 6-7 weeks out. The purpose of this letter is to advise you that under code, failure to perform this test, by the necessary deadline, December 31, 2002, will result in the revocation of your permit to operate. This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services UNITED STATES POSTAL SERVICE First-Class Mail Postage & Fees Paid USPS Permit No. G-10 · Sender: Please print your name, address, and ZIP+4 in this box ° C??IC~ OF ENVIRONI~,ENTAL SERVIC~,S 1715 Chester Avenue, ~Ym 300 · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, '~ or on the front if space permits. 1. Article Addressed to: A1 obi 1200 H Street Bakersfield CA 93301 If YES, enter delivery address below: [] No 3. Service Type L3{] Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 7001 0360 0002 5244 7339 PS Form 3811, July 1999 Domestic Return Receipt 102595-00-U-0952 ,..-I' Postage I.~ Certified Fee Return Receipt Fee ~ (Endorsement Required) r"3 Restricted Delivery Fee I'-t (Endorsement Required) I--1 Total Postage & Fees Postmark Here Sent To A1 Mobil .............. / ~ F~[,'t;',~'~: ',~'&7 .............................................................. /.oL f.°...".?.x..".%.2.9...o...~....s...~.~~~ ................................................. ~[¢ttY'Stat°'Zt~a~ersfield CA 93301 September 13, 2002 Al Mobile 1200 H Street Bakersfield, CA 93301 CERTIFIED MAIL FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFETY SERVICES · ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93,..'.'.'.'..'~ VOICE (661) 399-4697 FAX (661) 399-5763 NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RE: Failure to Submit/Perform Annual Maintenance on Leak Detection System Dear Underground Storage Tank Owner: Our records indicate that your annual maintenance certification on your leak detection system is past due on September 20, 2002. You are currently in violation of Section 2641(J) of the California Code of Regulations. "Equipment and devices used to monitor underground storage tanks shall be installed, calibrated, operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks at least once per calendar year for operability and running condition." You are hereby notified that you have thirty (30) days, October 13, 2002, to either perform or submit your annual certification to this office. Failure to comply will result in revocation of your permit to operate your underground storage system. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Ralph Huey Director of Prevention Services by: Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services cc: Walter H. Porr Jr., Assistant City Attorney August 30, 2002 A-1 Foodstore 1200 "H" Street Bakersfield, CA 93301 REMINDER NOTICE FIRE CHIEF R©N FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICE~ 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 RE: Necessary secondary containment testing requirements by December 31, 2002 of underground storage tank (s) located at the above stated address. Dear Tank Owner / Operator, If you are receiving this letter, you have not yet completed the necessary secondary containment testing required for all secondary containment components for your underground storage tank (s). 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 periodically thereafter, to insure that the systems are capable of containing releases from the primary containment until they are detected and removed.' Of great concern is the current failure rate of these systems that have been tested to date. Currently the average failure rate is 84%. These have been due to the penetration boots leaking in the turbine sump area. For the last four months, this office has continued to send you monthly reminders of this necessary testing. This is a very specialized test and very few contractors are licensed to perform this test. Contractors conducting this test are scheduling approximately 6-7 weeks out. The purpose of this letter is to advise you that under code, failure to perform this test, by the necessary deadline, December 31, 2002, will result in the revocation of your permit to operate. This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services July 30, 2002 A-I Foodstore 1200 "H" Street Bakersfield CA 93301 FIRE CHIEF RGN FRAZE ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 ~H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFEI~f SER91CE$ · ENVIRONIJ~HTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA ~8 VOICE (661) 3994697 FAX (661) 399-5763 REMINDER NOTICE RE: Necessary Secondary Containment Testing Requirements by December 31, 2002 of Underground Storage Tank (s) Located at the Above Stated Address. Dear Tank Owner / Operator: If you are receiving this letter, you have not ',/et completed the necessary secondary containment testing required for all secondary containment components for your underground storage tank (s). 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 periodically thereafter, to insure that the systems are capable of containing releases from the primary containment until they are detected and removed. Of great concern is the current failure rate of these systems that have been tested to date. Currently the average failure rate is 84%. These have been due to the penetration boots leaking in the turbine sump area. For the last four months, this office has continued to send you monthly reminders of this necessary testing. This is a very specialized test and very few contractors are licensed to perform this test. Contractors conducting this test are scheduling approximately 6-7 weeks out. The purpose of this letter is to advise you that under code, failure to perform this test, by the necessary deadline, December 31, 2002, will result in the revocation of your permit to operate. This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Steve Underwood Fire Inspector Environmental Code Enforcement Officer D June 30,2002 A-I Food Store 1200 "H" Street Bakersfield, CA 93301 REMINDER NOTICE FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 'H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 RE: Necessary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 1200 "H" Street. Dear Tank Owner / Operator: The purpose of this letter is to inform you about the new provisions in California Law requiring periodic testing of the secondary containment of underground storage tank systems. Senate Bill 989 became effective January 1, 2002, section 25284.1 (Califomia Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, to ensure that the systems are capable of containing releases from the primary containment until they are detected and removed. Secondary containment systems installed on or after January 1, 2001 will be tested upon installation, six months after installation, and every 36 months thereafter. Secondary containment systems installed prior to January I, 2001 will be tested by January 1, 2003 and every 36 months thereafter. REMEMBER! Any component that is "double-wall" in your tank system must be tested. Secondary containment testing shall require a permit issued thru this office and shall be performed by either a licensed tank tester or licensed tank installer. Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at (661)326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Environmental Services SU/kr B D May 29, 2002 A-I Food Stores 1200 "H" Street Bakersfield, CA ,93301 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 RE: Necessary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 1200 "H" Street REMINDER NOTICE Dear Tank Owner/Operator: The purpose of this letter is to inform you about the new provisions in California Law requiring periodic testing of the secondary containment of underground storage tank systems. 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 periodically thereafter, to ensure that the systems are capable of containing releases from the primary containment until they are' detected and removed. Secondary containment systems installed on or after January 1,2001 shall be tested upon installation, six months after installation, and every 36 months thereafter. Secondary containment systems installed prior to January 1, 2001 shall be tested by January 1, 2003 and every 36 months thereafter. REMEMBER!! Any component that is "double-wall" in your tank system must be tested. Secondary containment testing shall require a permit issued thru this office, and shall be performed by either a licensed tank tester or licensed tank installer. Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at (661) 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer SBU/kr enclosures ~ R D FII E April 17, 2002 FiRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 ~H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326°0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 A- [ Foodstore 1200 "H" Street Bakersfield CA 93301 RE: Necessary Secondary Containment Testing Required by December 31, 2002 REMINDER NOTICE Dear Tank Owner/Operator: The purpose of this letter is to inform you about the new provisions in California law requiring periodic testing of the secondary containment of underground storage tank systems. 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 periodically thereafter, to ensure that the systems are capable of containing releases from the primary containment until they are detected and removed. Secondary containment systems installed on or after January 1, 2001 shall be tested upon installation, six months after installation, and every 36 months thereafter. Secondary containment systems installed prior to January 1, 2001 shall be tested by January 1, 2003 and every 36 months thereafter. Secondary containment testing shall require a permit issued thru this office, and shall be performed by either a licensed tank tester or licensed tank installer. Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at 661-326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer SBU/dm enclosures RECORD OF TELEPHONE CONVERSATION Loc~on: ~ (~ ~ ID# Busines~ N~me: d.O. I~ Business Phone: InspeCtor's N~ne: Time of C~ll: D~te: ~R-~-~) ( Time: ~L~,~' # Min: ~ Type of Call: Incoming Outgoing [ ] Returned [ ] Content of Call: Time Required to Complete Activity # Min: STATE OF CALIFORNIA STATE BOARD OF EQUALIZATION FUEL TAXES DIVISION MIC: 30 450 N STREET, SACRAMENTO, CALIFORNIA (P.O. BOX 942879, SACRAMENTO, CA 94279-0030) TELEPHONE: (916) 445-1873 FAX: (916) 323-9352 www.boe.ca.gov A-One Food Store Ajmail Singh Sangha 1200 H Street Bakersfield, CA 93301 May 15,2001 'I"K MT 44-040962 Site Address: 1200 H Street - Bakersfield CA 93301 JOHAN KLEHS DEAN ANDAL CLAUDE~ PARRtSH Third District, To~'rance JOHN CHIANG Fourth Distrrct. Los A~geles KATHLEEN CONNELL JAMES E. SPEED Execubve Director Dear Ajmail S Sangha: We received your Application for all UndergrouHd Slot;u:(: Tank Maintenance Fee Account and have assigned you the account number referenced above. Please ret'er to this account number when corresponding with the Board of Equalization (BOard) re[;arding your responsibilities under the Underground Storage Tank Program. The local agency lhat issues your underground storage tank permit may require you to provide this account number in order to ensure that you have properly registered with the Board. You are required to pay a fee to the Board for each gallon of petroleum product placed into your underground storage tank during the reporting periodi You will receive quarterly returns to report and pay your fee. However, you are responsible for reporting and paying the fee even if you do not receive the return. The return and payment are due on the 25th day of the month following the period for ~vhich you are reporting. Enclosed with this letter are returns for any past due periods. Please complete the returns and send them to us, with any payment due, within thirty (30) days from the date of this letter. If you have any questions, please contact me at the telephone number or address provided at the top of this letter. Sincerely,/~/) ,~ Erin Olivas Tax Technician Fuel Industry Section May 4, 2001 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Mr. Asmail S. Sangha A-1 Food Store. 1200 H Street Bakersfield, CA 93301 Re: Requirements for Final on New Fueling System Dear Mr. Sangha: Despite numerous attempts, this office has been unable to contact Mr. ¥ito DiMaggio, your contractor of record. Mr. DiMaggio' s phone has been disconnected and he is not at the address on his permit. This office has noted activity with regard to continued work on your station. However, we do not know who is working on it. Therefore, prior to any final, by this Department the office will need documentation of the following: 1) Mr. DiMaggio must come in to our office and update his permit application (working phone number and current mailing address). 2) We will need 3rd party certification from a Qualified Tank Tester that the tank and lines have passed an integrity test. 3) We will.need to see documentation from the Building Department that canopy and electrical has been signed off. 4) We will need documentation that the APCD (Air Pollution Control District) has signed off. on your vapor testing. 5) We will need documentation of 3rd party liability insurance prior to final. Should you have any questions, please do not hesitate to call me at (661) 326-3979. Steve Underwood, Fire Inspector Office of Environmental Services SU/db S:LMAY 2001 ~aSanglmReq' ~FinalonNew FuelSys SUunderwd Lb'.wpd ,,~~ ~~ ~ ~ A-1 FOOD STORE ,. 'i "~ 1200 H STREET -- ~ _ ~v~ ~,o~F S~ ~~o m ^ ,~~~., - ~ Prevention Services :~ ~dJNIFIED PROGRAM INSPECTION CHECKLIST R F R s e , . „ 900'IYuxtun Ave., suite 2io FARE Bakersfield, CA 93301 SECTION 1: Eusiness Plan and Inventory Program "RT"' Tel.:- (661) 326-3979 - ~ Fax: (661) 872-2171 FACILITY NAME ~ - INSP TION A~ INSPECTION TIME ~- ~~ ~ a~ o ADDRESS t~ t t P ~~ NO. NO OF EMPLOYEES ~ ~ ~ ~ ~ FACILITY CONTACT BUSINESS ID NUMBER 15-021- 1~~ ~, Section 1: Business Plan and Inventory Program.- ^ ROUTINE OMBINED- ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ( C=Compliance OPERATION - V=Violation COMMENTS L~^ APPROPRIATE PERMIT ON HAND ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE Cj ~/ ~ / L Y ^ VISIBLE ADDRESS , / CL/ ^ CORRECT OCCUPANCY (fl~^ VERIFICATION OF INVENTORY MATERIALS ~/ ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION , ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ~ ENT~D I L/ V ~/ ^ VERIFICATION OF HAZ MAT TRAINING 1~^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES L LLY ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION i SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: ^ YES `~. NO REGAFjpINf~ THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Fire Prevention / 1~` In /Shift of Site/Station # White -Prevention Services Yellow -Station Copy Business Site I po a Part lease Print) Pink -Business Capy FD 2155 (Rev. 09/05 ~, :• INSPECTIONS BUSINESS PLAN & INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST B E R S F I D F/IPE ARTM T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 FACILITY NAME: ~h~ ~ ~~©C1 ,~~(~. Section 2: Underground Storage Tanks Program INSPECTION DATE: ~ t d ^ Routine Combined ^ Joint Agency ^ Multi-Agency ^ Complaint ^ Re-Inspection Type of Tank 9 Number of Tanks Type of Monitoring Type of Piping OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? ^ Yes ^ No Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank Aggregate Capacity Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill /overspill protection? C =Compliance V =Violation Y =Yes N = No Inspector: '4C,~ Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services n Business Sit sponsible P Pink -Business Copy KBF-7335 FD 2156 (Rev. 09/05) ~- .~ A-1~FOOD STORE SiteID: 015-021-002203 Manager BusPhone: (661) 324-4138 Location: 1200 H ST Map 103 CommHaz Moderate City BAKERSFIELD Grid: 30C FacUnits: 1 AOV: CommCode: BFD STA O1 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title AJMAIL SANGHA / OWNER JASVIR SINGH / OWNERS BROTHER Business Phone: (661) 324-4138x Business Phone: (661) 324-4138x 24-Hour Phone (661) 747-3202x 24-Hour Phone (661) 322-7756x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Contact Phone: (661) 324-4138x MailAddr: 1200 H ST State: CA City BAKERSFIELD Zip 93301 Owner AJMAIL SANGHA Phone: (661) 322-7756x Address 1200 H ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ANT°~ J U ~ ~ 4 C QD/ PROG C - COMM HOOD ~ PROG U - UST cased on my inquiry of those individua{s responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. Si nature °r- t 9 D a e -1- 06/29/2007 F A-1 FOOD STORE Last Action Type: SiteID: 015-021-002203 ~ STORAGE CONTAINER DATA (UST FORM A) FACILITY/SITE INFORMATION Business Name: A-1 FOOD STORE Cross Street Business Type: Org Type: Total Tanks 2 IndnRes/Trust: No PA Contact: Dsg Own/Oper RONALD W ROGERS ICC Nbr: 5246001-UC PROPERTY OWNER INFORMATION Name ~~~"~~L ~` ~~I v ~ ~~ Phone Address: City State: Zip: Type INDIVIDUAL TA,pNK OWNER INFORMATION Name iTA~tTT77-~3~T~'"" ~~~r~~~L S~ ~'~~~1N~ Phone: .. Address: City State: Zip: Type INDIVIDUAL (661) 324-4138x (661) 324-4138x BOE UST Fee# 44-040962 Financ'1 Resp: SELF INSURED Legal Notif Date:04/06/2001 Name:AJMAIL S SANGHA State UST # Phone : (131) 6 - Tt1:OWNER 1998 Upg Cert#: 28502 x -2- 06/29/2007 F A-1 FOOD STORE SiteID: 015-021-002203 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ I Hazmat Common Name... ISpecHazIEPA Hazards) Frm I DailyMax IUnitIMCPI UNLEADED GASOLINE PREMIUM UNLEADED GASOLINE L L 15000.00 GAL Modl 7000.00 GAL Mod -3- 06/29/2007 _4_ 06/29/2007 ~~ F A-1 FOOD STORE SiteID: 015-021-002203 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 Liquid TMixture ~Ambient~E ~ AmbientT~E ~ UNDER GROIUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 15000.00 GAL 15000.00 GAL 15000.00 GAL tiAGAtCLV U ~ 1=vl~truivL' 1v 1 °sWt. RS CAS# 100.00 Gasoline No 8006619 riA7LHKL A5~J1";~~1Y1t;1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED GASOLINE Location within this Facility Unit UST STATE TYPE PRESSURE Liquid TMixture ~ Ambient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 7000.00 GAL 7000.00 GAL 7000.00 GAL nr~LtircLVU~ ~.vl~lrvlvr,lvt~ oWt. RS CAS# 100.00 Gasoline No 8006619 t1f~Gt~ttL r~5an~~1~1~1v 1 a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod -5- 06/29/2007 F A-1 FOOD STORE SiteID: 015-021-002203 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 04/27/2001 ~ SHUT OFF EQUIPMENT, CALL FIRE DEPT, NOTIFY OWNER AND ACCOUNT FOR ALL EMPLOYEES. Employee Notif./Evacuation CALL FIRE DEPT AND ACCOUNT FOR ALL EMPLOYEES. 04/27/2001 Public Notif./Evacuation 04/27/2001 SHUT OFF ALL EQUIPMENT, CALL FIRE DEPT, NOTIFY OWNER AND ACCOUNT FOR ALL EMPLOYEES. Emergency Medical Plan 04/18/2006 TELL ALL EMPLOYEES WHERE FIRST AID KIT IS LOCATED. KEEP IF FULLY STOCKED. HAVE THE FIRST AID KIT ACCESSIBLE. -6- 06/29/2007 F A-1 FOOD STORE SiteID: 015-021-002203 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 04/27/2001 ~ WAIT FOR INSTRUCTIONS FROM FIRE DEPT. 1CC1Cd~C l.Vill.dlil[RCI1L Clean Up CALL PROPER AGENCY AND SERVICES TO CLEAN UP AREA. 04/27/2001 V1.11C1_ rcCSC~uic:C r-~cLivaLion -7- 06/29/2007 F A-1 FOOD STORE SiteID: 015-021-002203 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards Utility Shut-Offs 04/18/2006 A) GAS - E SIDE OF BLDG BY BACK DOOR B) ELECTRICAL - E SIDE OF BLDG BY BACK DOOR C) WATER - SE CRNR OF BLDG BY FENCE D) SPECIAL - NONE E) LOCK BOX - NO ,_ ritc rtvt.c~../s-~vaii. vvai.ct Building Occupancy Level 2 EMPLOYEES 04/03/2006 -8- 06/29/2007 .~ F A-1 FOOD STORE SiteID: 015-021-002203 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 04/03/2006 ~ WE HAVE MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: TALK TO EMPLOYEES ABOUT WORKING SAFELY AND WHAT TO DO IN AN EMERGENCY. rays ~ Held for Future Use Held for Future Use -9- 06/29/2007 ,, °e UNIFIED PROGRAM INSPECTION CHECKLIST ; .SECTION 1: Business Plan and Inventory Program BAgERSFIELD FIRE DEPT Prevention Services ~~ts 900 Truxtun Ave., Suite 210 ARiN Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY ME f NSP TION ATE INSPECTION TIME ` 1 ADDRESS ~ ~ t ( S HO ENO. 3d~ -~{r~~' O OF LOYEES FACILITY CONTACT USINESS ID NUMBER 15-021- Section 1: Business Plan and Inventory Program ~~ ~~p~ ^ ROUTINE OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ REJ-DI.SPE IOCT N C V (c=Compliance` OPERATION V=Violation J COMMENTS ^ APPROPRIATE PERMIT ON HAND BUSIt113SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES VERIFICATION OF LOCATION PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY VC ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PRO DUPES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE $ ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ^ NO EXPLAIN: - _ - S REGA I THIS INSPECTION? PLEASE CALL U8 AT (881) 528-3979 (Please Pnnt) Fire Prevention / 1" In /Shift of Site/Stetion # B iness ool a Responsible rty (Please Print) White -Prevention Services Yellow -Station Copy pink - Buainese Copy FD2049 tRw. 02105) ~~ ~i~~' '`~ ~v CITY OF BAKERSFIELD FIRE DEPARTMENT ~ ~ . ~ ~~ OFFICE OF I1:NVIRONIi'tENTAL SERVICES y~'~ UNIFIED PROGRAM INSPECTION CHECKLIST \~_w ~~t~,A~~' 1715 Chester Ave., 3r`' Floor, 13akerstield, CA 93301 ,.,~~ FACILITY NAME ~ ~ lQ~ ~ INSPECTION DATE--~~ r ~~~, Section 2: Underground Storage Tanks Program ^ Routine ~~bined _ ^ Joint Agency ^ Multi-Agenc Complaint ^ Re-inspection Type of Tank ~(=(' ~~ Number of Tanks _ Type of Monitoring ~'~t-/tom Type of Piping OPERATION C V COMMENTS Proper tank data on tiie Proper ownerloperator 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 Section 3: Aboveground Storage Tanks Program TANK SIZ,E(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 =Violati< Y=Yes N=NO Inspector: Office of Environmental Services (661) 326-3979 r Business Site Responsible arty White - inv. Svcs. Pink - Nosiness Ci~ry 4~~ ~~, A-1 FOOD STORE ______________________________________ SiteID: 015-021-002203 + Manager Location: 1200 H ST City BAKERSFIELD BusPhone: (661) 324-4138 Map 103 CommHaz Moderate Grid: 30C FacUnits: 1 AOV: CommCode: BFD STA Ol SIC Code: I EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title AJMAIL SANGHA / OWNER JASVIR SINGH / OWNERS BROTHER Business Phone: (661) 324-4138x Business Phone: (661) 324-4138x 24-Hour Phone (661) 747-3202x 24-Hour Phone (661) 322-7756x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Contact Phone: (661) 324-4138x MailAddr: 1200 H ST State: CA City BAKERSFIELD Zip 93301 Owner AJMAIL SANGHA Phone: (661) 322-7756x Address 1200 H ST State: CA City BAKERSFIELD Zip 93301 Period to p TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG C - COMM HOOD PROG U - UST Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. i ~ ~~"~ ~ S' OG Signature Date ENro ~ip~ ~ 8 20os t__________________________--___________________________________________________+ -1- 04/03/2006 Cs3~~~~ UNIFIED PROGRAM INSPECTION CHECKLIST ~EG`~'t`ION 1 Business Pian and Inventory Program ~a~~ Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILRV NAME INSP Ti DAT INSPECTION TIME ~Q~~---=~~--=---- ------ ADDRESS PHO N No. of Employees ~~ ~~((~~ ,~,~--t{t{.. ~SL~~11rt-~ -- --'------- ------• ~ 0 --------~-------- FACILITYCONTACT Business ID Number IS-021- Section 1: Business Plan and Inventory Program ^ Routine f1~Combined ^ Joint Agency ^Mutti-Agency O Complaint ^ Re-inspection C V \V=VioaNlonnCel OPERATION J COMMENTS Q~^ APPROPRIATE PERMIT ON HAND ~/^ BUSINESS PLAN CONTACT INFORMATION ACCURATE - LV' ^ VISIBLE ADDRESS - -----._...- .-- ------- - Q -------_.-__------------ ~^ CORRECT OCCUPANCY - - ^ VERIFICATION OF INVENTORY MATERIALS ---- --- --- `-- - ------- -- -- -- y ~ l_Y' ^ VERIFICATION OF QUANTITIES ---_ -- - -- --- --^ - - - lt;f/ ^ VERIFICATION OF LOCATION - ~ -- - Ll/ ^ PROPER SEGREGATION OF MATERIAL ~IFICATIQN OF MSDS AVAILABILITYE - r J CSd !.J VERIFICATION OF HAT MAT TRAINING - - ~^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES - - ~^ EMERGENCY PROCEDURES ADEQUATE -' - - - ` LY L^ CONTAINERS PROPERLY LABELED LJ LJ r10USEKEEPING -- ------ -- -- ----------- ------------ ~ - `- F --_ _. L 1 LJ IRE PROTECTION (~ ^ SITE DIAGRAM ADEQUATE S~ ON HAND ANY HAZARDOUS WASTE ON SITE: ^ YES ~jIQO EXPLAIN: QUESTION ~ EGARDING THIS NSPECTION? PLEASE CALL US AT (881 ~ 328-3979 Inspector Badge No. Business Site Responsible Party White -Environmental Services Yellow • Sletbn Copy Pink • Business Copy ~ ~~~54,GyY rl~E' ~ ' ~ CITY OF BAKERSFiELD FIRE DEPARTMENT `I~ ~ b~ OFFICE OF ENVIRONMENTAL SERVICES ~`~ .y~~ UNIFIED PROGRAM INSPECTION CHECKLIST ,~? w ~gti,,~'~~ 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 ~~~i~ FACILITY NAME~I' ~ ~Am~ S`tof~ INSPECTION DATE ~ 3 Section 2: Underground Storage Tanks Program ^ Routine ~ Combined ^ Joint Agency ^Mnlti-Agency ^ Complaint ^ Re-inspection Type of Tank OWFC S Number of Tanks ~ Type of Monitoring C LGv~ Type of Piping [)u) t`~tiC OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data on the Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes NO 1~ f 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 placardingllabeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: 1 '= J Office of Environmental Services (305) 326-3979 Business Site esponsible Party White - F.nv. Svcs. Pink -Business Copy I. UNIFIED PROGRAM INSPECTION CHECKLIST` a rrlR/ mot. ~ ~;~..;::-,,:<..:~. ~~ , _.., ..;, ..., , wRTr SECTION 1: Business Plan and Inventory Program ~ BAKERSFIELD FIRE DEPT Prevention Services 900 Tru2ctun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME T ~' ors NSPECTION DATE l~~ _p(o NSPECTION TIME s ADDRESS HONE NO. O OF EMPLOYEES FACILITY CONTACT / ~ ~ USINESS ID NUMBER 15-021- a.,~ 3 7 --- --- -,---- ~ 1 ~,~ ta% ~"p Section 1: Business Plan and Inventory Program '.. '~~'~ ~ / ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c.compfiance~ OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ Business PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ~- ^ ~'^ ^ VERIFICATION OF INVENTORY MATERIALS VERIFICATION OF QUANTITIES JT~A N 2 ^ VERIFICATION OF LOCATION ,F}1- ^ V ^ PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ~"' ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ~f~'~ ^ T~ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ~^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ^ NO EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (861) 328-3979 N GA~za ~~ Inspector (Please Print) Fire Prevention / 1" In / Shift of Sfte/Station # White -Prevention Services Yellow - Station Copy Pink - Busineae Copy FD2049 (Rev. ~/OS) :a.LD r~ 114°'` 'r8' ~~ i ~ ~ ~ ~+~~ \W y1 -~ .~~1: ~I • -~ ,.wE CAR~i~ - ~ ~.~~i FACILITY NAME~~~~aa~L CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM iNSPECT'ION Ci~F.CKLIST 1715 Chester Ave., 3r`' Floor, Bakersfield, CA 93301 :`zatQ,f _ INSPECTION DATE f ` ,~3 z~b Section 2: Underground Storage Tanks Program ^ Routine ~ombined ^ Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection Type of Tank ~d~<<~l~ w,.Ql ~ Number of Tanks Type of Monitoring ~~.a~2 Aon'! Type of Piping ,8a ~ ~•~,~~/ T/ ~ ~~n OPERATION C V COMMENTS Proper tank data on the Proper owner'operator data on the (/' Permit fees current ~~ Certitication of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current V' Failure to correct prior UST violations - Has there been an unauthorized release? YeS o Section 3: Aboveground Storage Tanks Program TANK SIZE(S) _ Type of Tank AGGREGATE CAPAC[TY 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? If yes, Does tank have overtill/overspill protection'? C=Compliance V=Violation Y=Yes N=NO Inspector: ~ nN (ji4/LZ•¢ Office of Environmental Services (661) 326-3979 white- fnv. Svcs. Pink -Business C~~py Bu. • ess Site Responsible Party ,_,._ . - A '. e ., ti-Uf~JE _~'1't:RF 1 '~ Cu_I H ~T' t,61 -_ '~!-4 1 - _ f~t...l_ i'I-II'.Ji_"~'J.;ii:;_; !`Jc-i t''I"Jr-iI_. I Pd'~.: t: (i`[' _: F:''r' h i::1= ~_; t;,. 1. I IL.I.H~.~a ~ 1 :' 1 ELI i ,_:;iL; ~~ r, li III"tL. - ~.{I_I'c ~._;riL.:- _~ i . ?i i 1 I'~Jf_ HEh ~__ T~ : F'F:I~I`9 I i_if9 _ ~;1L1_II°IE = 1 ~ is=' l 'r[1 'tiirjL.l_il"iL _: 11-iJ'~ :.riL.i=, , 'TEP'ID -= i ~:_ . `i i.~E'~ F 1=1'JI-~ - - i T~ -, _~" T-T~-~-~ - -- `~lS~ MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions.Wilhin the State of California Authority Cite& Chapter 6 7, Health and Sufety Cvde,~ Chapter 16, Division 3, Title 23, Califarnia Code ofRegulations This form must be used to document testing and servicing of Inonitot`ing equipment. A separate certification or report must be prepare for each tnonitorin~ system control pane( by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General In ormation Facility Name: ~ ~ (~ n~E ft7C)~ S~(~~C Bldg. No.: Site Address: /~JO ~j ~l ~E_~l'. Clry: <f~ C(~Jl-`lr~,FL~ Zip: - Make/Model of Monitoring System: T"L --~~U Date of TestinglServicing: ~J,~l ~'7 B. Inventory of Equipment Testetl/Certified INSPECTOR ON-SITE: YE Y~NNCT~IAME: f`L.PrL ,1... .. a I~n~.n.• r nt•irn1P c ririr P(1111 nIT(?ITI InCnP.C IP. fI/CPfV ICP.lI' Facility Contact Person: v.•--.. ...- .. -- .....- ......-.. .- .._-.-~.- - __..._ _.. ._ _ _. Tanl< ID: UN~ ~ Z ~<,~=T~ Tank IA: P~/1`1 4 I C~PL~T~ ~ In-Tank Gauging Probe. Model: r~L-~ 1~ ln-Tank Gaugmg Probe. Model- Jul/tom Annular Space or Vault Sensor. Model: ~t~t'S(~I~'? ~ Annular Space or Vault Sensor. Mode(: ~~U CSnt,.TT Piping Sump /Trench Sensor(s). Model: ~~ Piping Sump /Trench Sensor(s). Model: a0 g ^ Fill Sump Sensor(s). Model: ^ Fill Sump Sensor(s}. Model: Mechanical Line Leak Detector. Model: t~ .~(u-k-ET $~~echanical Line Leak Detector. Model: Q t:t~ J jtsk~ ^ Electronic Linc Leak Detector. Model: ^ Electronic Line Leak Detector. Model: ^ Tank Overfill /High-Level Sensor. ModeL• ^ "Tank Overfill /High-Level Sensor. "Model: - ^ Oilier s ecif e ui men( t e and mode[ in Section E on Pa e 2 . ^ Other s ecif a ui rnent a and model in Section E on Pa e 2 . Tank ID: Tank tD: ^ In-Tank Gauging Probe. Model: [] 'In-Tank Gauging Probe. Model: O Annular Space or Vault Sensor. Model: ^ Annular Space or Vault Sensor. Model: ^ Piping Sump/Trench Sensor(s). Model: ^ Piping Sump /Trench Sensor(s). Model: ^ Fill Sump Sensor(s). Model: ^ Fill Sump Sensor(s). Made(: p Mechanical Line Leak Detector. Model: ^ Mechanical Line Leak Detector. Model: O Electronic Line Leak Detector. Model: p Electronic'Line Leak Detector. Model. ^ Tank Over61! /High-Level Sensor. Model: ^ Tank Overfill /High-Levee Sensor. Model: ^ Other (specify equipment type and model in Section L' on Page 2). O Other (specify equipment type and model in Section E on Page 2), Dispenser ID: ~~~ Dispenser (D: ~ ~-\ Dispenser Contammen[ Sensor(s). Model: ~~$ T ,Dispenser Containment Sensor(s). Model: [y g hear Valve(s). .>~Shear Valve(s). ' O Dis eraser Containment Floats and Chin s}. O Dis eraser Containment Floats and Chain "s . Dispenser ID:~~ Dispenser ID; ~.pispenser Containment Sensor(s). Model: 13t'AuDREfly Dispenser Containment Sensor(s). ModeL' f) v ~'~hear valve(s}. Shear Valve{s). D Dispenser Containment Float(s) and Chain(s). ^Dis eraser Containment Floats and Chain s). Dispenser ID: Dispenser ID: O Dispenser Contaimnent Sensor(s). Model: ^ Dispenser Containment Sensor(s). Model: O Shear Valve{s). O Shear Valve{s). ^D7S enscr Containment Float(s) and Chain(s). ^Dis eraser Containment Floats and Chain s). Contact Phone No.: {it cne nicuity contains more tanks or dispensers, copy this form, Include information for every tank and dispenser at the facility. C. CrertlfiCatiOri - 1 certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Pian showing the layout of monitoring equipment: For any eq~uitpm'ent capable of generating such reports, !have also attached a copy of the report; (check all that apply): .~iSystem set-up ~uvalarm history report 'T'echnician Name (print): ~N v~ /~b~~1 ~~ Signature: ~'~ /~"-_`- Cenitication No.: ~_~3L( ~~_ License, No.: ;Yy'~`~-t ~'~G Testing Company Name: RICH ENVIRONMEN-CAL Phone No.:.{ 661 ~ 392-8487 Site Address: /~[y~ fJ ~-}-~E,~ ,~,tq~~~~ L~ ~~ Date of Testing/Servicing: ~(/ 5 /U~ Monitoring System Certification Page 1 of 3 03101 ~c~~s~/ D. Results of Testing/Servicning Software Version Installed: ~~ ~ l -U 5 I.,i.. A1. .. C,.IIn...inrt n1.enLnC1~ Mil 1{iIV IIIV IV IIV.r 1 11 Yes ^ o Is the audible alarrn o erational? Yes ^ o Is the visual alarm o erational? Yes ^ o Were all sensors visually inspected, functionally tested, and confin-ned o erational? Yes ^ o Were al! sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? ^ Yes ^ o If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) ~N/A operational? '-Yes ^ o For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ^ N/A monitoring systeir detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) ~ Sump/Treneh Sensors;.Dispenser Containment Sensors. Did you confirm positive shutdown due to leaks and sensor failure/disconnection? Yes; ^ No. O Yes ^ o For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no ~ N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so,~at what ercent of tank ca acity does the alarm trig er? p es ~, No Was any monitoring equipment replaced? Ifyes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and mode! for all re lacement arts in Section E, below. ^ es o Was liquid found inside a~iy secondary containment systems designed as dry systems? (Check all that apply) O Product; ^ Water. tf es describe•causes in Section E below. ,.Yes O o Was monito~•in s stem set-u reviewed to ensure ro er settin s? Attach set u re oris, if a licable ~ Yes ^ o )s a!1 monitoring equipment operational per manufacturer's specifications? * In Section Ii below, describe how and when these deficiencies. were or will be corrected. E. Comments: Page 2 of 3 03101 ~~~SY F. In-Tank Gauging /SIR Equipment: ~-Check this box if tank gauging is used only for inventory control. ^ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tant< gauging egttipment is used to perform Leak detection monitoring. l.V~w ~c~c ^ Yes u~c wuv r O ° nu ~u~..ni.o.. Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ^ Yes O o Were all tank gauging probes visually inspected for damage and residue buildup? ^ Yes ^ o Was accuracy of system product level readings tested? Q Yes Q o Was accuracy of system water level readings tested? O Yes ^ o Were all probes reinstalled properly? O Yes ^ o Were all items on the equipment manufacturer's maintenance checklist completed? In the Jeetion ti, below, aesertue now ana when tnese uene~eucles were ur wu~ ur cur rec~cu. G. Line Lealc Detectors (LLD): O Check this box if LLDs are not installed. C'mm~tatn thn fnllnwina rhnnlrlict• Yes ^ No'` For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ^ N/A (Check all /hat apply) Simulated leak rate: ~ g.p.h., O 0. I g.p.h , D 0.2 g.p.h. es ^ o Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ^ o Was the testing apparatus properly calibrated? 4 Yes ^ o For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^ N/A O Yes O ° For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? N/A O Yes ^ o For electronic LLDs, does the turbine automatically shut off if any portion ofthe monitoring system is disabled ~„ N/A or disconnected? O Yes [~ o For electronic LLDs, does the turbine autommatically shut off if any portion of the monitoring system malfunctions ~. N/A or fails a test? O Yes ~O `Io J~/A For electronic LLDs, have all accessible tiviring connections been visually inspected? Yes ^ o Were all items on the equipment manufacturer's maintenance checklist completed? ui anc.~ccuu~~ r.y uciuw, ucsc~ iuc nuw auu Wucn u+ese QCnCICllrle5 WCre Or Wlll pC COrr'CCTEQ. H. Comments: Page 3 of 3 0310! ~~sY Monitoring System Certification Site Address: UST Monitoring Site Plan ---------- ~~-~~R-/*.l~-~~~--- -------- -----------w r - ~ ---~--------------------- -- - --- - -- -------- ----- --------------- ------------------------ - - ~ ire!- -~. -- ~'~ -------- ---c-~------------------=- - ------ --_ ----~---------- ---3-------------------- - - rL- - --------------- ------------------------ - - -~e~,~.-- - ---- --- ---- ---------------------- --- ---------- - Date map was drawn: ~( /~/~ In~'~actions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout 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 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 was prepared. Page ~ of~ osioo 5643 Bxi.OQIfS ~I' BAKERBF~FLT.~,+~.A.9330$ aPFZC~f651)392-a587 & FA:f (661~3A~r0621 M3+S~'I3.8I`I.G.~ T~$K D'E'i'E~L''~OR TEAT w/o#: Fac :I. ~. i ~~r Name ; ~Or-` ~. f~C~ rvl$t2. t ~, I Fac:i.l~.~~r Addxess : /~,.,~}i ~,r ~, 3A k.~tz. r TEt. ,~ S'~ ~~_ Pz'4c;lue~ ~3..ne ~'~'pe {Pressure, Suc~.iazs, ~raviCy) ~K,i/S~~IJt~ C -;~- kRl:>I3iICx' L~,~K L~x.'I'ECTQJ~ TkP~ T ~,`E8T TFt,T~ PASS` s~z~zAZ. ~zu~sa~R a~r~aw psx o~ L/L T3CPFi~~y~(«;.T -7 .3ER,z.A.T.+ # rn~f!'~ AN~cA C..- fits ~a Fli,zi, i L/A TifFE.QF.~ cJ CT . PASS - SFkt~.A.F~ #/f1~:.-4RN~CAI.._ M4 /a FAIL --^ L/D ~7CPF., _.~.._. .^ .._.. YES .~ PA88 _ SER2AZ, #.._. ~ ~ttiTQ FAIL . ~+/F3 ~'~fP~ ~ YFS PASS' SERIAZ, #.~.__._._ ..._ bi4 FAIL; I ::ertify the abovF~ teats were conducted on this dace aaaoxding ~o R®d ~:~aal~et Pumt~s .f.~.e1~~ rest appa.rat_ua testing px'oceduxe an limitat~,ans. Th~sr Meehan i.c+a). Leak netect'.or. `.Cast. pass / fa.i1 is detez^rnined by using a lour flow thresl~o3.r3 r..rzp rate cif 3 gallon per k~our or ~.esa at 10 PSI. T swknowledg~a Lliat aa].7. data co7.leae~d ie true a.xxd coxraat to the 7aeat of rr~~ knowledge . S].~IL?~CuX'E:~ _ ~~~-~ UAte; ~-~~~~ a•. i ~~~ 5y SWRCB, January 2006 Spill~Bucket Testing Report Form '?his form tr intended for use by contractors perfotrtting annual testing of UST'spill containment structures. The completed form and printouts from.tests (ijapplicable}, should be provided to the facility;owner/operatorfar submittal to the local regulatory agenry. 1. FACII.,I'TI' INFORMATION FacilityNatne• r~ fl r~'`P+ ~~ ~ Date ofTcsting• -07 . Facility Address: }{ `~ >~ Facility Contact: Phone: Date Local Agency Was Notified of Testing : , ' Name ofLocal Agency Inspector Cfpresent during testing: /~(j~y/ E 2. TESTING CONTRACTOR INFORMATION. Company Name: ~ N i, N uS~Rvn.? ~ ~ ~ , Teclmiciaa Conducting Test: B Q q ,~ -XyJ ~,~. Credentials : CSLB Contractor ICC S SWRCB Tank Tester Other ( ec~} License Number(s): ~~ J CERTIFICATION OR TECHNICIAN RESPONSIBLE FOR CONDUCTIlVG THiS TESTING I hereby certify that aU the information contained in this report is true, accurate; and In full comlrlianee with legal requirement Technician's SigAature; ~"Jr Date: L/"L~ / a ~ State law8 SAd rCeulation3 do not currently require testing to tae performed by a quaiifiad contractor. How~evcr, local rcquirammu may be more stringent ~.viuuients - mctuae to ormatton on re airs made rior to testin ,and recommended ollow-u or ailed tests' ~ ' (o l 5 y SOFTWARE REVISION LE1lEL VERSION 419.05 SOFTWARE# 346419-100-F CREATED - 00.02.25.12.40 S-MODULEti 33016]°001-~ SY'STEhI FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS SYS'!'EM SETUP - - HPk 5. 2007 -4:35 PM SYSTEIM UNITS U.S. SYSTEM LANGIJHGE ENGL I SI1 SYSTEM DHTEiTIIHE FORMAT MON DD YY'YY HH : MNI : SS xM A-ONE STORE 1200 H ST BAKERSFCELD CH 93301 661-314-4138 SHIFT TIME 1 5:45 AM SHIFT TIME 2 DISABLED SHIFT TIME 3 DISABLED SHIFT TIME 4 DISHBLED TANK PER TST NEEDED WRN DISABLED TANK ANN TST NEEDED WRN DISABLED LINE PEk TST NEEDED WRN DISABLED L I PJE ANN TST NEEDED WRIV DISABLED PRINT TC VOLUMES ENABLED TEh1P COMPENSHTION VALUE (DEG F ): 60.0 STICK HEIGHT OFFSET DISABLED H-PROTOCOL DATA FORMAT HEIGHT DAYLIGHT SAVING TIME ENABLED START DATE APR WEEK ! SUN START TIME 2:00 AM END DATE OGT WEEK 6 SUN END TIME 2:00 AM RE-DIRECT LOCAL PRINTOUT DISABLED EURO PROTOCOL PREFIX S __._„~~,..:~++v+v~ ~E'I'UP _ _ IN_THNK. SETUP- - - - - - PORT SETTINGS: T t:REG UIVL 1 PRODUi:T CODE COMhI BOARD 2 (kS-232) u0070G THERMHL COEFF 128.00 DIAMETER BAUD RATE 3200 TANK 1 PT TANK PROFILE PARITY ODD FULL VOL 15055 STOP BIT 1 STOP DATA LEPJr,TH: 7 DATA FLOAT SIZE: 4.0 IN. 8456 HUTO TRANSMIT SETTINGS: 2s0- WATER WARN I NG • AUTO LEAK ALARM LIMIT HIGH WATER LIMIT: 3.0 DISABLED HUTO HIGH WATER LIMIT P1A;;~ OR LABEL VOL : 15055 q0i DISABLED OVERFILL LIMIT 13549 AUTO OVERFILL LIMIT HIGH PRODUCT 55> DISABLED 14302 AUTG LOW PRODUCT 9i DELIVERY LIMIT DISABLED 1500 AUTO THEFT LIMIT DISABLED ~ AUTG DELIVERY START 500 LOW PRODUCT 99 ALARM LIMIT: DISABLED AUTO DEL 1 VER`f END LEAK SUDDEI'J LOSS L I M I T: 0 00 DISABLED TANK TILT • AUTO EXTERNAL INPUT ON MANlFOLDED TAfdKS DISABLED HUTO EXTERNAL INPUT OFF T#: NONE DISABLED DISABLEDSOk FUEL ALARM LEAK, hIIN PERIODIC: 9i 1500 AU'I'O SENSOR WATER ALARhI DISABLED HUTO aENSOR OUT ALARh1 LEAK MIN ANIVUAt 9i 1500 DISABLED PERIODIC TEST TY~TANUARD RS-232 SECURITY HIVNUAL TESALARMLDISABLEI'+ CODE xx*x*~ PERIODIC TALHRMHDISABLED GROSS TESTALARM DISABLED RS-'232 END OF h1ESSAGE DISABLED PER TEST HVERHGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVER`! DELAY 15 hl I N SYSTEM FJECURITY CODE Gd000U -- -- ALARM HISTORY REPORT LIQUID SENSOR SETUP T 2:PREMIUM •- - - - - - - - _ - - - _--- IN-TANK ALARt~1 ----- PRODUCT CODE 2 THERhIAL COEFF :.000700 L, t : D I SP 1 -'~ T l : REG U1VL TANK DIAMETER 128.00 TR[-STATE (S1IVGLE FLOAT) TANK PROFILE 1 PT' CATEGORY DISPENSER PAN OVERFILL ALARM FULL VOL 7026 , DEC 27. 2006 1:11 PN1 DEC 15. 2006 2:12 Pln DEC B. 2006 4:22 PM FLOAT SIZE: 4.D IIV. 8496 L 2:DISP 3-4 TRI-STATE (SINGLE FLOAT) LOW PRODUCT ALARM WATER WARNING 2.0 CATEGORY DISPENSER PAN MAR 5. 20U? 9:02 PM HIGH WATER LIMIT: 3.0 FEB 24. 2007 6:29 PM FEB 20. 2007 12:03 PM MAX OR LABEL VOL: 7026 OVERFILL LIhIIT 90r L '3:67 STP' HIGH PRODUCT ALARM 6323 TRI-STATE {SINGLE FLOATI DEC '27. 2006 1:13 Phl HIGH PRODUCT 95% CATEGORY STP SUMP DEC 15. 2006 2:16 PIH 6674 DEC 8. 2006 4:25 PM DELIVERY L I NI I T 93b 700 L 4:52 5TP JNVALID FUEL LEVEL TRI-STATE (SINGLE FLOAT) PIAR 5. 2007 9:42 PM LOW PRODUCT 50D CATEGORY : STP SUMP FEB 24. 2007 6:41 PiH LEHK RLARM LIMIT: 99 FEB 20. 2007 12:59 PM .SUDDEN LOSS LIMIT: 50 TANK TILT 0.00 L 5:ANNULAR PROBE OUT NORhiALL`f CLOSED MAR 21. 2005 11:06 AM NIANIFOLDED TANF;S CATEGORY ANNULAR SPACE __.. _ _ ._ NIAR 10. 2005 I1 :43 AM T#: NONE . . ... _. SEP 4. 2003 3:1E PM LEAK MIN PERIODIC: 9i . 700 LEAK hl I N ANNUAL 9% . 7D0 PERIGDIC TEST TYPE STANDARD ANNUHL TEST FAIL ALHRM DISABLED PERIODIC TEST FAIL ALHRM DISABLED uROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK T5T SIFHOtV BREAK:OFF DELIVERY DELAY 15 MIN LEHK TEST METHOD TEST OIV DATE ALL TANK APR 25. 2001 START T I ME 2 : 30 AI°1 TEST RATE :0.20 GALiHR DURATFOIV 2 HOURS DELIVERY NEEDED MAR 26. 2007 5:30 PM hIAR 16. 2007 2:32 PM NIAR 12. 2007 6:24 Pt°1 EXTERNAL INPUT SETUP NONE x x ~ * ~ END x ~ * ~ x OUTPUT RELAY SETUP k 1:B7 ALARM HISTORY REPORT TYPE: STANDARD ---- IN-TANK ALARh1 ----- PJORMALLY f_:LOSED T 2:PREMIUM LIQUID SENSOR ALMS LOW PRODUCT ALARM ALL:FUEL ALARhI FEB 20. 2007 2:01 PI°1 FEB 2. 2007 9:31 ANl R 2192 OCT 2. 2006 4:25 Phl TYPE: STANDARD PROBE OUT NORIhALL'f CLOSED MAR 21. 2005 11:06 HM MAR 10. 2005 11:22 Ahl L14~U1D SENSOR ALMS SEP 4. 2003 2:53 PM ALL:FUEL ALARM DELIVERY fJEEDED MAR 5. 2L~07 2:32 PiH FEB 19. 2007 3:20 PN1 FEB 13. 2007. 3141 PM LEAK TEST REPORT FORMAT ENHr1NCED ALARIN HISTORY REPORT ALARM HISTCR'Y REPORT ------ SENSOR ALARhI -- --- ---- - SEfVSOR ALARM _----- L 1:DISP 1-2 L A: 92 STP DISPENSEk PAN STP SUMP FUEL ALARM FUEL ALARM AF'R 5. 2007 3:17 'PM APR 5. 2007 2:58 PM FUEL ALARM FUEL ALARM APR 12. 200E 1:05 P1°I APR 12. 200E 12:52 PN1 FUEL ALARM FUEL ALARM NUV 12. 2003 1:08 Pf°! ~ MAR 4. 2005 5:11 PM * ~ ~ ~. ~ EIVD ~ ~ ~ ~ * ~ x * ~ * END ~ ~ ~ ALARh1 HISTORY REPORT ALARM HISTORY REPORT ----- SEIdSUk ALARM ----- ----- SENSOR ALARPI ----- L '2:DISP 3-4 L 5:ANNULAR DISPENSER PAN AIVIdULAk SPACE FUEL ALARM FUEL ALARM APR 5. 2007 3:15 PM APR 5. 2007 3:09 P!°1 FUEL ALARM FUEL ALARM APR 1'?. 2006 1:04 PM APR 12. 2006 1:21 PM FUEL ALARM SENSOR CUT ALARM NCV 12. 2003 1:07 PN1 APR 12. 2006 1:20 PM * ~ ~ END x ~ ~ ALARhI H I aT'OR'! REPORT ----- SENSC>R HLARM ---••- L 3:87 STP STP SUMP FUEL ALARM APR 5. 2UC7 2:54 PM FUEL ALARh1 FEH 13. 2007 2:58 AM FUEL ALARM APk 12. 2006 l'2:51 PI°I ~~~sY ~~~s~ MONITOR CERT:.FA.~LURE REPORT SITE NAME• A-O~IJE F~~-rA 12.E ~ DATE: ~1-S -~~ ADDRESS. /aoU /~ S i ~ E£- ~ TECHNICIAN• ~~A.~~c~~1 ~~y/ ~ITY• .ai4l~,~GrE~~ SIGNAT ~ ~`~ THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS• ~~ti~ LABOR: ~yt~ 1'J ~ PARTS INTALLED: it!'C~ /1/~ NAME: TITLE: SIGNATURE; THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTNE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFY2I~TG RICH ENVIIZONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURIIVG FROM NON-COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON-SITE FOR YOUR coNVnENENCE. . ~~lS'~ UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ElD / UNE TESTING / S8869 SECONDARY CONTAINMENT TESTING /TANK TiGHTNES3 TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMff N0. BAKERSFIELD FIRE DEPT. ~~R~ Prevention Services ,/tlll r 900 T'ruxtun Ave., Ste. 210 ~---~ ~- Bakersfield, CA 93301 ,~/ 'Tel.: (b61) 326-3979 r~~ Fax: (661) 852-2171 C - I PaQelotl ~ ('~d~ ~ ~ -~- 0'-7 ^ ENHANCED LEAK DETECf10N ^ LkV ~^ SB-98a SECONDARY CONTAINMENT TESTING r~ _...._._~..~..~~~~~-~ •w .~~.~.~~~.. ~. ~~~ •V...RA~I.II+f.COTICV•~T1A11 . :..' . M1 ~~ . FACILITY i ~~ NAME 3 PHONE NUMBER OF CONTACT PERSON . ADDRESS t 1 ~ O ~"" ~ (~ ~ 1~' ~ ~ A~ OWNERS NAME OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED b ~. Yl.Q~1'1rl- - t :, .: ,:. ..:~: :; , '_Y'fANKTES:TING COMPANY. , - NAME OF TES NG COMPANY ~ Y" NAM 1R PHO E NUMBER OF CONTACT PERSON MAILINI3 ADDRESS ~ 1~ iL ^ J4 NAME 3 P NE NUMBER OF TESTER OR SPECUU. INSPECTOR 7U ~(v~ CERTiFICA ' ON is DATE & TIME TEST TO BE CONDU ED a o w- ICC #: TEST METHOD SIGNATURE OF APPLICANT C~'F--~~ DA `_~"] ''APPROVED BY DATE FD 2085 (Rev. 08105) . - B1i~L1NG ~ PERMIT STATEMENT >rrxr ~~~~~Y BAKERSFIELD FIRE DEPT. preveat3on Services nnn •r•_...`.... e..,..~n~ Spite 21(1 PERMIT NO.: ~ l~~tRir~r Bakersfield, CA 93302 - •- • LOCATION OF PROJECT, PROPERl'Y 01NNER STARTWG OATS TpN ~~ ~~ ~~ -p m PRO.1ECr NAME ~cDRESS ~ PHONE No. ~ - 20 ~ ( U PROJECT ADDRESS CfTY STATE • ~ ~ ZP CODE by ~~~e~ ~ .- .- ~ ~~ CA LICENSE NO. , TYPE OF LICENSE EXPRATION GATE PHONE NO. a-~ ~ CONTAACTOR.COMPANYNAME FAX ~a'co~,l ADDRESS ~ CnY ~ CODE • ~ r r a ~ D Alarms -New & Modifications - (Mnimum Charge) .$262.50 ~ 98 it l 013125 = P FL x S ~ [7 Over 20,000 Sq. h erm ee q. . G i 00 $210 ~ Q nimum Charge) fications - (N Sprinklers- New 8 Mod . 9a it ft 042 =Per f e S ~ D Over 5; 000 Sq. FL m . e q. x . 98 < 10 heads ti M difi Mi i S kl ection Onty] 00 [Ins $ 93 ~ D ) ca ons ( nor pr n er o p . 8 9 ^ ti N dif n C 8 M i H d $38826 ~ ew o ica o oo ~ s ommerc s - al 9t3 L7 Additiona/Hoods ; 3&00 ~ 98 D S ra Modificatons Booths -New 8 $458 00 ~ p y ~ . 98 D . round St a Tanks (Irrsta!latlovYlruip.-~~ Tme) $165.00 ~ ^ AddrBogal Tanks ; 2&.00 82 ^ Aboveground Storage Tanks (RSmoveYlnspedia~ $109.00 ~ D Underground Storage Tanks pnstauetion.nnspection) $878.00 (pertank) ~ [] Underground Storage Tanks (Modification) $878.00 (persite) ~ ^ Urldergnotlnd Storage Tanks (Axrwr Modification) $155.00 82 ^ Under>~nourld St a Tanks (Removal} $675.00 (pert'arrk) 84 D OiM~ell (Installation) $72.00 ~ 84 Marxiated Leak Detection (TesB FG@I Monit S 81.00 (persite) 82 ^ Tents $93.00 (per fend 84 O Aft+ar hours Inspection ,fee 512200 84 ^ Pyrotechnic -(Per event, Phis Insp. Fee ~ S90 per hour) ;110.00 + (5 hrs. min. stand -ry tee nrlapedion} _ $6i 0.00 84 D RC--INSPECTION(S) / f'OLLOWdJP INSPECTION{S) ;93.00 (per f~our~ 84 ^ Portable LPG (Propane): NO.OF. GAGES? ;86.00 84 ^ E1glkuive Storage $249.00 84 O Copying & File Researchl(File Research Fee 533.00 per hr) 25¢ per page 84 ^ Misoellaneotls ~ ~ gy FD 2621 (Rev. ooro5) 1 - ORlG1NAL WHITE (to Tnaury) 1 •YELI.OW (to Fils) 1-PIHK (to Customer} UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD I LINE TESTING 1 SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMR N0. ~ r LJ~d~- I-/R/ AR1'/ T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DETECTION ^ LIN ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST TO PERFORM FUEL MONITORING CERTIFICATION SITE I FO FACILITY OG~+ ~ Y'~ NAME & PHONE NUMBER OF CONTACT PERSON ADDRESS 1 00 -- ~~-~ C o,_.. OWNERS NAME OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED I PIPIN IN T BETE TED? ^ YES ^ NO T K V L ME CONTENTS TANK TESTING COMPANY ` NAME OF TES NG COMPANY i ~. NAME 8 PHO E NUMBER OF CONTACT PERSON MAILING ADDRESS NAME 8 P NE NUMBER OF TESTER OR SPECIAL INSPECTOR r~ 7C~(0' ~4$~ 1 CERTIFICA ION #: DATE 8 TIME TEST TO BE CONDUC ED O O Mv1 ICC #: TEST METHOD SIGNATURE OF APPLICA T ~ C ~'s DAT `_O'7 APPROVED BY DATE FD 2095 (Rev. 09/05) -- -- :~;:,: E R S F L ~,',;'. '~ ~ AR r~r r • d ~ 4 ~A~.. 1,w Y:..q...:M~ ~ FIRE CHIEF RQN FRAZE ADMINISTRATIVE SERVICES 2101 "H' Street t3akers8eld, CA 93301 VOICE (861) 328.3941 FAX (681)395.1349 SUPPRESSION SERVICES 2t01 "H' Street Bakersflekl, CA 93301 VOICE (661)328.3941 FAX (681)3951349 . PREVENTION SERVICES FIpE EAFETI' BENVICEB • ENYd1~1Q:NtAI iE11VCE! 1715 Chester Ave. Bakerslieki, CA 93301 VOICE (681)328.3979 FAX (881)328-0578 PUBLIC EDUCATION 7715 Chester Ave. Bakersfield, CA 93301 VOICE (681) 328.3898 FAX (681)326-0578 FIRE INVESTIdAT10N 1715 ChesletAve. 9akerslkdfd, CA 93301 VOICE (881)328.3951 FAX (881)328-0578 TRAw1NO DIVISION 5642 VfctorAve. Bakersfield, CA 93306 VOICE (661)399.4897 FAX (881)399-5783, t~T , ~ September 13, 2002 Al Mobile 1200 H Street Bakersfield, CA 93301 ::., . NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RE: Failure to Submit/Perform Annual Maintenance on Leak Detection System Dear Underground Storage Tank Owner. Our records indicate that your annual maintenance certification on your leak detection system is past due on September 20, 2002. You are currently in violation of Section 2641(J) of the California Code of Regulations. "Equipment and devices used to monitor underground storage tanks shall be installed, j calibrated, operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks at least once per calendar year for operability and running condition." You are hereby notified that you have thirty (30) days, October 13, 2002, to either perform or submit your annual certification to this office. Failure to comply will result in revocation of your permit to operate your underground storage system. Should you have any questions, please feel free to contact me at 661-326-3190. sincerely, Ralph Huey Director of Prevention Services by: Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services cc: Walter H. Porr Jr., Assistant City Attorney November 4, 2003 CERTIFIED MAIL A-1 Food Store 1200 H Street Bakersfield, CA 93301 FIRE CHIEF I ~CtJ ;:Rt1ZE E ~ NOTICE OF VIOLATION ADMINISTRATIVE SERVICES & SCHEDULE FOR COMPLIANCE 2101 •~• slreel ~ Bakersfield, CA 93301 ~ VOICE (68t) 328.3941 i Dear Sir or Madarn, FAX (681) 395-1349 SUPPRESSION SERVICES ' Our records indicate that your annual maintenance certification on your leak 2101 •H' Street Bakersflekl, cA 93301 detection system was past due 10-11-03. VOICE (661)326.3941 FAX (661)395.1348 You are currently in violation of Section 2641(J) of the California Code of PREVENTION SERVICES RegUlatlOn$. Fsa s~enr acances • ~ ssxvses ' 1715 Chester Ave. 8akerslield, CA 93301 ~ " ui: ment and devices used to monitor under round story a tanks shall be F9 .P g S VOICE (681)326-s979 FAx (861) 328-0576 installed, calibrated, operated and maintained in accordance with manufacturer's ' instructions, including routine maintenance and service checks at least once per PU ~t~ii~iA~ N ~ calendar year for operability and running condition." Bak9tsfleld, CA 93301 i l VOICE (681)328-3698 FAX (661) 3~e-u5r6 ~ ~ You are hereby notified that you have fifteen (15) days, November 19, 2003, to ~ either perfonm or submit your annual certification to this office. Failure to FIRE INVEST1ciAATION i 1715 Ches~terAve. comply will result in revocation of your permit to operate your underground eakersneld. cA 93301 i storage system, VOICE (881)328.3951 FAX (881)328-0578 Should you have any questions, please feel free to contact me at 661-326-3190. TRAINING aVISION 5842 Vk20fAV6. t3akersflea. cA 93308 Sincerely yours, ' VOICE (681)399.4897 FAX (681)399-5783 ' Ralph E. Huey Director of Prevention Services sy: Steve Underwood Fire InspectorlEnvironmental Code Enforcement Officer Office of Environmental Services SBUldb cc cp~/~ l~ (~ifl7ilZLliZI~ .~oss .~G~(~osa9 /1t~lL~ Jp C~e/t~~e%ll~~~ FZ~'- tZ.lca~, /' MONITORING S'XSTEM CERTIFICATION For Use By All Jurirdietiona Wttltin the State ojCa11/ornta Authority Clted.• Chapter 6.7, Health and Safety Code; Chapter 16, Dlvlslon 3, 7Ytle Z3, Califortria Code ojRegulations This Ivr1n must bC used to document tesYutg and servicing ofmonlborittg equipntcnt. Q`so>?argu ocrtifi~t,~n or,~ust be,~ggarad rvr each monitorir~ svstsnt Control panel by the technician who porforms the work. A copy of this form must be provided to the tank ~~stern owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. ~. C:enera) I ormatiou ~ 3~'aciiiry Name: ~~ l-t~(~ S-TC~1GL Bldg. No.: Sitr riddress: ~ o~f~C~ J~ . ~ City:.t,7..~!!~-ys~- Zip: i=aciliry Contact Person: Contact Phone No.: (___~ iviake/Model of Monitoring System: "'j-L..S ~ -~ Date of TestinglServicing: ~/~/_~p _.__.--- b. Inventory of Equipment Tested/Certified ..~-~ • ~r ~~~~t~ t"nrrk the ~nnrnnriate Ames to tnrlirate sneciftc enuipment iasuecftd/srrvlced: T~To JL.'~-+ ~P ~.4~T~ (C._-~ it the tealr[y contains more tanks or dispensers, copy this form. Include intbrmadon For every tank and dispenser at the facility. C:. C:ertitlcatit}n - I certify that the equipment identitIed is this document was Inspeeted/setwlced la accordance with the tnaaufacturess' guidelines. Attached to this Certification is Information (ag. manufacturers' eheekllsto) accessary to verify Hatt this information is correct and a Plot Plan showing the layout of monitoring eQuipment For any equipment capable of geueratiog loch reports, I have also attached a copy of the report; (checIt aU that appty)• ~ystem get-1tp arm Llstory report 7'eclutician Name (print): ~'~~~'~ Sigoatttre: ~~ Tani: lD:.~~j~Q j Tarok TA: f5~- n-TwtkCauging Probe. Model: ~{z,~ $ !n-Tank Gauging Probe. Model: ~~ttnular Space or Vault Sensor. Model: t{s~~ ~Q~ _ •6wKP,nnttlar Space or Ysult Sensor, Model: ~-1 -~.{>iping Sump I Trench Sensor(s). Model:.~,@~ '~K-Piping Sump I Trench Sensors}. Model: ^ Fill Sump Sensor(s). Model: D Fill Stunp Sensor(s). Model: :~l4echanicat Lint Leak Detector Model: Q'FF)<t~A~C.i ~ ~-Mocttanic~l Litta Leak ietector. Model: ~~T C1 Electronic Line Leak Detector. Model: D Electronic Line Leak Detector. Model: ^ Tank OverFll /High-Level Sensor, Model: ^ Tank Ove~ll /High-Level Sensor. Model; D Other (s i e ui meet and model in Section E on P e 2 . ^ Other ci ui meet a and model in Section E on Pa C 2 '!'ank ID: Tank ID: l7 ln-1'artk Gauging Probe. Model: D Lt-Tank Gauging Probe. Model: Q Annular Space or Vault Sensor Model: ^ Annular Space or Vault Sensor. Model: Piping Sump /Trench Sensor(s). Model: O Piping Sump /Trench Sensor(s). Model: I U Fill Sutnp Sensor(s), Model: O Fill Sump Sensor(s). Model: C~ tv3ccltanical Line Leak Detector. Model: ^ Mechanigl Line Leak Detector. Model: Q @lectronic Line Leak Detector. Model: ^ Electronic Line leak Beteclor. Model: D Tank Overlitl /High-Level Sensor. Model; D Tank Overfill / HighLevel Sensor. Modrl: J n:her (s CCI' C ui meet a and model in Section l; on Pa 2 . ^ Other s i ui ent and model in Section E on A ). Dispenser iD: Dispenser TD: ~~~ ; ispenacr Containment Sensors}. Model; -Dispenser Containment Sensor{s). Model: ~~ ~ 4hear Valve(s), ~ Shear Valve(s), G Uis enser Containment Floats and Chain(s). ^ Dis cosec Containment Float s and Chains . lispenser iD: 4~(p Dispenser ID: `,i ~ D ispenser Containment Sensor(s). Model: ~~~QEL•tZC •D ~ - ispenser Containment Sensor(s~ Model: ,,~ yy (~ , ~YY?rtL'aC Va)YC($). ~ ~ _ ~ ra-D11ear V81VC(S). G Drs enser Containment Floats and Chains . D pis enser Containment Floats and Chains . Dispenser ID; Disperser IID: ^ Dispenser Cvntainment Sensor(s). Model: A ^ Dispenser Containment Sensor(s). Model: ' u shear Valve(s). O Sheet Valve(s), ^ Drs enser Con[•Ainment Floa s and Chains . D Di enser Containmert Fio s} and Chain s). Cc:nificativn No.: ~-~(~-(~~ Licease.No,• Testing Company Name: QTl1J- • tom)-y~~1M~~~~ Phone No.'~ Sire Address: I~~FJ ~Cr ~~~ S ~~7~~ pate of Testing/Servicing: ,~/13-/~ Page 1 of 3 p~pl lirlonitorillg System Certification a ~~~ ~, Zesults of TestingiServ[i~cing ~ottrMarz Version lnstaited: ~,~`{ ~S _ r_u__..: _._ ..a.....1.1:s. 1'as O No' Is the audible alarm o stational? -66~ Yes ^ No' Is the visual alarm o erationai? Yes ^ No* Were alt sensors visuals ins ted fttnctionall tested, and confittrted o rational? ~~e'LYes ^ No* Were alt sensors installed at lowest point of secondary containment and positioned so that other equipment wilt not interfere with their ro er o eration? O Yes O No' if alarms are relayed to a remote tnonitaring station, is all communications equipment (e.g. modem) '1~'N/A operational? t~. (Yes O No" For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment !1 ^ N!A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate ~~ positive shut-down:' (Check all that apply)-f~Sump/'1'rench Sensars;^f~flispenser Contaitunent Sensors. J; Did ou confirm csitive shut-down due to leaks and sensor failure/disconttection? i~--Yes• 0 No. _ .:1 Ycs ^ No* For tank systems that utilize the monitoring system as the primary tank ovc~ll warning device (i.e. no it '~. N/fA mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank 1f fill oin s and o ratin ro rl If so at what rcent of tank ca does the alarm !ri er't ^ Yes' ~. No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced ' ~ and list the manufacturer Warne and model for aU re lacement in Section E below. j ^ Yes* `~ No Was liquid found inside any secondary containment systems designed as dry systems? (C'heclt all that apply} Q 1'roduct• D Water. If es, describe ceases in Section E below. i~ Yes ^ No* Was monitosin s stem set-u reviewed to ensure ro er settin ?Attach set u , if liable O Yes $-No* Is all monitorin a ui ment o rational manufacturer's s cifications? * In Section E below, describe bow and when these deficiepcies were or will be corrected. i. Cotnmetnts• ~~.,.1C[~2 ~~ (]TS~'~-(~~f~~'" t~CjC~t[Z?~~ -,_ Ch~t~ t~ti,~'t'ta~3 C~ Pty t..~ct2 -1~ ~~ (~~ ~~~lr aS : 3--/4-0 ~ Psge 2 of 3 p3/pt i ~~ 'r'. l:n-Tank Gauging /SIR Equipment: '~-~heeJc this box if tank gauging is used only for inveotpry control. ^ Check this bax if no tank gauging or SiR equipment is installed. "1 his section must be completed if in-tank gauging egtvpment is used to perform leak detection monitoring. ,_„_._ ^ Yes` V ^-No* Has ail input wiring been inspected for proper entry aad termination, including besting for ground faults? q Yes D No* Were al] tank gauging probes visually inspected far damage and residue buikdup? O Yes >, No' Was accuracy of system product level readings tested? j ^ Yes D No* Was accuracy of system water level readings tested? U Yes ^ No* Were all probes reinstalled properly? '~ Yes O No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the section H, below, describe how and when these aene~n¢ies Were or wtu De Correcrea. iir. Line Leak Detectors (LLD}: ^ Check this box if LLDs are not installed. f :un nlrlN ~6a fnilnwina rhenl[lici- 1 Yes ^ No* 1=or equipment start-up or annual equipment certification, was a leak simulated to verity LLD patformlµtce2 i ~~ ^ N/A (Check all that apply) Simulated leak rate: ~ g.p.h.; D Q.1 g.p.tt ; ^ 0.2 g.p.h. Yes O No* Were all LLDs confirmed operational and accurate within regulatory requirements? ~--Yes 0 No* Was the testing apparatus properly calibrated? ~ $.Yes ^ No* For mechanical LLDs, does the LLD restrict product flaw if it detects a leak? ^ N/A ^ Yes ^ Noy` For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ~N/A ^ Yes ^ No* For electronic LLDs, does the turbine automatically shut off if any portion of the tnonitoting system is disabled ~, NIA or disconnected? ^ Yes O No* For electronic LLDs, does the tutbine automatically shut off if any port'son of the monitoring system malfunGdons 'y~`-N1A or faits a test? D Yes ^ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ~' NIA 'Yes ^ No* Were all items on the equipment manufacturer'sruaintenance Checklist completed? - ul one aecuon n, oe~ow, aescrtae now anti when tuera oepeteacies were or wtu be corrected. l-1. Cowments: Page 3 ot3 03161 ~~ t~tonitariug System CertiIIcattou ~~p,,-~ UST Monitoring Site Plaa tiitc Address: JrcJ'exL/ ~ S% '~$ L~1L'ic.,2~F2'~r~tll. C.~ ~ . . ~ ~ . 1 ~ . a . ~ . . . t _ . . , y . :: ::::: ~ ::: ~r.'1..~.,UP~F~Z : ::::: ' ' :::::::::::::...: £:: ::::::::: ::::;~ ~~::: :;: .... :::::: .I.. ::::: ......... .... ...... ... L.~--.~? ...... ~ .. . . ~:: ::::::::: ::: ~.c~~*.'^~: ...: :::':~::~::::::~:?~::::: ~.: :...:.... .... ..... .:::..::::::.::::5:::...: .. .....::::~-~.:: ' O-- ~ ~Po~- . ... .~ . ::::::: ... :::: ~~~ :::::::~: .....fl``.~`"..: :::. ..:::::::~::~:: a .. . Datc map was drawn: ~ /fa /~ l~8tl"11Ct10r1S if you already have a diagram that shows all required inforn~ation, you may include it, rather than this page, with your I~lonitoring System Certification, On your site plan, show the general layout of tanks and piping. Clearly identify tocatio,ts of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic tine leak detectar~; and in-tank liquid level probes {if used for leak detection), In the space provided, note the date this Site Plan was prepared. ' Page of p~pp a > ~~y ~~~r,~r,~nnrhr~~rlr~- r, 5643 BROOKS CT BAKERSFI$LD,CA.93308 OFFICE (661)392-8687 & FAX (661}392-0621 W/0#z Facility Name: a ~!~ ~~ ~'CUf~ facility Address: lo~~ !-~ ~• ~1 ~ fR ProcLuct Line Type (Pressure. uction, Gravity) PRC-DUCT LEAK DETECTOR TYPP TEST TRSP PASS s~ztzAr. rrcJnasr~x BELOW PSI OR L/D TYP ~~- ss12IAL # ~4a ~ rro (S aa~i L/D TYPE~ ~~G~T'r PAS , SERIAL # ~~ ! S N0 1 ~ FAIL L/D TYBfi YSS $A88 SEItI.A.L # NO FAIL L/A 'H'YPE _ Yfl3 PASS SERIAL ~ NO FAIT, z certify the above tests were conducted on this date according to Red ~~ack®t Bumps field test apparatus testing procedure an limitations. The: Mechanical. Leak Detector Test pass /fait is d$termined by using a lo4r flow threshold trip rate of 3 gallon per hour or leas at 10 PSI. z e:ckmowledge that all data collected is true and correct to the best of my knowledge. Tech :.5~1 D:3~.lZ~ s ign~aure : ~~1 Date : N IIZh~ :.. i y Zt.~g ~ -~._ SYSTEM SETUP APR 12. 2006 12:39 PM SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATEiTIME FORMAT ~ . NION DD YYYY HH:MM:SS xM A-ONE STORE r 1200 H ST BAKERSFIELD CA 93301 661-32A-4138 SHIFT TIME d 5:q5 AM SHIFT TIME 2 :'DISHBLSD SHIFT 'LIME 3 DISABLED • • SHIFT TIME Q DISABLED TANK PER TST NEEDED WRN DISABLED TANK ANN TST NEEDED WRN DISABLED LINE PER TST NEEDED WRN DISABLED LINE ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED ' TEMP COMPENSATION VALUE (DEG F >: 60.U STICK HEIGHT OFFSET DISABLED N-PROTOCOL DATA FORMAT HEIGHT ' DAYLIGHT SAVING TIME ENABLED START DATE APR WEEK 1 SUN START TIME 2:00 AM END DATE OCT WEEK 6 SUN END TIME 2:00 AM '• RE-DIRECT LOCAL PRINTOUT DISABLED EURO PROTOCOL PREFIX S ~ SYSTEh1 SECURITY CQDE Onnn''- S.LS3,L YNH,L-N I ?bf1NNH S,LS3,L xNH.L-NI aIQ01~t3d ~- rQQ=i9 ioeebtt~Q'~ ~` .ZI.Sd'd0'00 - d-OOI-6lb9bl; #Ha~1.L30$ 'I NOIS~/432Ib NOIb773/1 , 3~r1L30s ; I Q3']HHS I Q 3JHSS3W 30 QN3 ZEZ-S2[ i ~*~~:~* 3QOa ~ ~Z I2Ina3S ZEZ-S~i T 2:PREMIUM PRODUCT COBS 2 THERMAL COEFF :.000700 TANK DIAMETER 128.00 TANK PROFILE 1 PT FULL VOL 7D26 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING 2.0 HLGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 702b OVERFILL LIMIT 9092 , 6323 HIGk PRODUCT 959: ' N I W 5 I hH'73Q J~c~3/1 I T3Q 330: NH3YIH NOHdIS .LS.L 7IN.L _ 330 : A3I .LON .LS3,L 51NHZ 330 : JN I QH~[3nH .LS3.L 2I3d 3,30 : JN I JH2I3nH .LS3.L NNH Q3'IHHS i Q W2{H'Id 'f I H3 .LS3.t sso~~ Q3'IHHS I Q W2IH'2H 'I I H3 .LS3.L a 1 QO I tl3d Q3'IHHS I Q W~[H'IH 'IiH3 ,LS3.L 'IHnNNH - - - _ ~~ btTUP 81;87 ----_ TYPE STANI?gR,p NORhrAAL,LY CLOSED L~ FUG NSOR p~ . ALARM R 2:92 TYPE: sT ~~RD NOR~q CLggED J L1euID sE , ALL :FUEL A~LARR~S r , Q3JNHHN3 .LHW2t03 .L~10d32t 1S3.L }[b3•I Q~INH.LS 3d~.L ,LS3.L aiQ0I2t3d ' ~ 6674 DELIVERY LIMIT 9% 0051 Q3'IHHSIQ W2iH'IH Sn0 ~[OSN3S O,Il1H 700 >e6 'IHnNNH NIW XH3'I Q3'IHHSIQ LOW PRODUCT ~ 500 0091 W2IH'IH ti3SHM i!lOSN3S O.LIIb' LEAK ALARM LIMIT : 99 y„6 ; a I QO I Had N I W 5IH3'I ~ Q3'IHHBIQ SUDDEN LOSS LIMIT: 50 W2lH'IH 'I3(I3 i!fOSN3S O.LlIH TANK TILT 0,00 Q3'IHHS i Q ~ r 3NON ' # Z d30 .LndN i "IHN2i31.X3 O.LfIH MANIFOLDED TANKS S?INH.L CC3Q703INHW Q3'IHHS I Q ! T# : NONE , No .LndN 1 'IHN2i3.LX3 O.Il1H ' 00' 0 J:7 [Z 7[NH,L Q3'IHHSIQ QN 3 h213/1 I'I3Q O.Ln H LEAK MIN PERIODIC : ~ pg 6 6 :.LIWI'I SSO'I N3CIQfIS : Z I W I'I W~[H'IH :[H3'I Q3'IHkiSIQ 700 009 .LafiQO~[d ~i0'I ,LZ[H,LS ~H3/tI'I3Q O.LnH Q3'IHHSIQ LEAK MIN ANNUAL 9% OOSI ' ZIW[Z ,L33H,L O.LnH 700 %6 ZIWI'I h?l3nl'[3q a3'IHHSIQ dOEbi : ,LanQ02Id f10'I O.Lnb ~ 9,96 J.anQO~fd HOIH Q3'IHyS1D ~ PERIODIC TEST TYFE 6b9Ei .LIWI'I TII3K3n0 O.LnH STANDARD %06 .LiWi'I 'I'II32f3n0 Q3'IHHS I Q ,LIWI'I ~[3.Lt11'1 HJiH 0.1f1H ANNUAL TEST FAIL 9905 I : "IOn 'I3HH'I 2!O XHW t13'IHHS I Q ALARM DISABLED 0' E :.L I W I'i 2I3,LdM H J I H ' ,L i W I'! W2[H'Id 7IH3'I O.I.liH 0 ' z 9N I N2IHM 2I3.LHM . PERIODIC TEST FAIL i :SQNI,L.L3S .LIWS~IH3.L O.LnH ALARM DISA BLED 96b8 ' NI 0'b :3ZIS ,LHO'I3 GROSS TEST FAlL H.LHO L : H.LON3'I H,LHQ ALARM DISA BLED 9905 I zon zzn3 d0.L5 I Z I S dO.LS Ld i 3T 13O2fd xNHd. QQO h,L I aHd ANN TEST AVERFIG I NG : OFF' . 00 ' 8Z 1 33,L3WN I Q xN H.L ' 00?,I 3.Lb3 OnHH PER TEST AVERAGING: OFF OOL000 ': 3330) '7HWH3H.L ' {~BZ-S2!) Z Q21HOH WWOa 1 3~s0a ,L'J{1QO3d TANK TEST NOTIFY : OFF 'IPIn D33: I Z S ~N I .L,L3S ,L21Od TNK TST SIPHON BREHK :OFF _ _ _ _ _ _ _ _ _ _ _ _ dn,L3S ~{N H.L-N I _ _ _ _ _ _ _ - _ - - - DELIVERY DELAY 15 MIN df1,L3S SNOI.LHaINnWWOa S21fI0Ff Z NOI,LH2if1Q 2IHi"[HD Oz' 0: 3,LH?~ ,LS3.L WH DE : Z 3W I1 .L2[Hd.S IQOZ •5z 2IdH ~ -NNH.L 'I'!H _ B.LHQ NO-.LS3,L QOH.L3W 1S3.L }[H3'I ~ LI9UID SENSOR SETUP ' L 1:DISP 1-2 TRI-STATE {SINGLE FLOAT) CATEGORY DISPENSER PAN L 2:DISP 3-4 TRI-STATE (SINGLE FLOAT? CATEGORY DISPENSER PAN L 3:87 STP TRI-STATE (SINGLE FLOAT) CATEGORY STP SUMP L 4:92 STP TRI-STATE (SINGLE FLOAT) CATEGORY :STP SUMP L 5:ANNULAR NORFIALLY CLOSED CATEGORY ANNULAR SPACE Wd 68 : E SOOZ ' b 2[t+W w~dzd -Ian3 Wd t t :5 5002 `b 2iHW W~iy'Ib 'I3f13 Wd Z9:Zt 9002 'ZI 2ldH W~[H"1H "i3f13 awns ais dJ,S Z6: b Z ----- W~[H'Ib ?lOSN3S _____ ,LdOd32I A~[O.LS I H W21H'IH Wd 9ZW~H'1H inOr 2108N35 Wd OZ : t 9002 ' Z T 2[dH W~Id'I4i .LnO 34SN3S Wd [Z:[ 9002 'Z[ add W?iH'TH 'I3f13 3~ddS 3tf-InNAIH 2iFi'If1NNd:9 'I ____- WgH'IH 2lOSN3S ----- 1.2IOd321 h2S0,L5I H Wdd'IH ALARM HISTORY REPORT ---- IN-TANK ALARM - T 2:pREMIUM LOW PRODUCT ALARM MAR e, 2006 1:32 PM pE0 27. 2006 Azle PM PROBE OUT MAR 21. 2005 11:06 AM SEP 14. 2003 ~ 2:53 PM DELIVERY NEEDED MAR 7, 2006 4:26 PM AN 13, 2006 1:07 AM Wt~ isE:6 ZOWdH'iti['I3 3 Wd 80: i EOWda~y['I3f13 Wd SO:I 900~a'IHt'13n3 Ntid 2[3SN3dS1Q Z-[ dSIQ:t Z ----- W2ia'Id ?10SN3S ----- ,L7i0d3?~ A7i0.LS I H W3ti'IH WH 6E: [ l ~'OW3y0y['I3R3 !. Wd Zg : Z 9002 ' S 2[dH ~ w~~-Id -I3na Wd .[9:Z[ 9002 `Z[ 2ldd W2(t114i 'T3fid dWItS d.I.S d.LB L8 : E '1 .L?10d321 AxO.LS I H W2iFl"IH ALARM HISTORY REPORT' ---- IN-TANK ALARM - T 1:REG UNL 4VERFiLL ALARM APR 6, 2006 8:51 PM APR 2. 2006 2:19 PM AEC 13, 2005 10:59 AM LOW PRODUCT ALARM MAR 29, 2006 2:50 ~M FEH 24. 2006 7:32 AM JAN 26. 2006 9:26 PM NIGH PRODUCT ALARM DEC 13, 2005 11:08 AM APR 30. 2005 12:30 PM MAR 22. 2005 B:25fAM INVALID FUEL LEVEL MRR 29, 2006 2:53 PM FEB 24, 2006 7:53 AM JAN 26. 2006 9:44 PM PROBE OUT MAR 21, 2005 11:06 AM MAR i0. 2005 11:43 :AM SEP 4, 2003 3:16 PM DELIVERY NEEDED APR 1. 2006 12:18 AM MAR 29. 2006 11:25'AM FEB 28, 2006 ,4:59 PM Wtf E~ ~ 6 ZO Wgt!'I~['I3~d Wd L0: [ E04~y^Iy[^I3~~ Wd b0' [ 90~H'la[ 13113 NbaE3dSIQ ZI'1 ,L2tOd32t ~ ~?i{?].S i H Wd~'IE ;~,; ~ ~Z-~~ MONITOR CERT. FAILURE REPORT aIT:E NAME: ~ F,~?~ ];~~1„ ~~~ I.1ATE: ~ ~ j'~ (C~(y Al7l)RESS: Ii3QS~ ~~!-~`~ ~r TECHNICIAN: ~'~~~ 'L~~~~'T 'I'Hl: FOLLOWING COMPONENTS WERE REPLACED/REPAIItED TO COMPLETE Ti~S~TING. ?t.t:.I'AIRS: s~1.a ~-~p ~. ~ ~.S . ~ ~- 13 ~ C . j~EA D1„ _A2~A~Fr+~ N~JF,.,~AS ~ ~~ ~"2?C~ AND ~~ c7~~ u~ ir~uQ5 `r~~~ i E~-t~A ~ ~~? LAItOR• N ~iV ~ PAF:TS INTALLED: /~} HIV ~ NA11~IE _ f1'I,~M .L~'G ~ ~ ~ TITLE: CA3~ THF: ABOVE NAMED PERSON'i1~ES Fi3LL RESPONSIBILI'T'Y OF NOTIFYING THI: APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THF: ABOVE LISTED PROBLEMS AND NOTII~'YING RICH ENVIItONMANTAL FOR ANS' NEEDED RETESTING. THIS ALSO + + ES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM•NON-COMPLIANCE. ~. COPY OF THLS DOCUIVIEN~(' HAS BEEN LEFT ON-SITE FOR YOUR Cori VIENENCE. _...... ._.~..-. ~y 2DU2 -Z l~3 Bad ox ~- Secondary Canta~.eaT Testing Report Form _ .,.,~_,~,:-;r~ r, ~rsrendac'Tor we by contracso:~s perjor»sl~ng periodic tasting of LST.cecondarY aantatnmv~t syrttr~os. Uso !hs :: •u,re pagas• of this form to report results for a1! carr:paonenzs tested The cnx~leted farm, written teBXproCedterr,~ and .. :.:~ )i•orr: tests (if applicable), should be provided to the facility owner/aperalorfpr stthmitAa! to the local regulatory agtu~cy. _ 1. 1<ACILITY i,A~`QATIpN ,.._ _. - _ . iy aAl~': A• ©/~ t`1, Date of T ~( C~ - ___-.: 1_~:,:~:1.~gzt~cy W as Notlfiad of Tesrir-g : '-~ m(y _ ,_. ,. ci 1_ecai ~~ency lnspectnr ~fpresent ahrring testingJ: ~1Q~y~ ~. :: ~~::,~_«i}~ i~am~: R•TCH ENVIRONMENSEAL _:^_~_::ia31 ConducUn~ Test: S~~ ~~ ~ ..::c:'+.<:~t:int~: f~ CSL13 Licensed Contractor ...~:~,~ Ty~c. C611 D4 d _.,, _T,,:; ::~.~ ' itiianuiacturer ------ Tr~ICON ~ SWRCB Tacensed Tank Tester i.iceszse Nwmber•. 8 0 9 8 5 4 -STS _ 3. S~J1V rMA~2~' O F TES T RESIULTS Catapo+xeut Fes; Tail TAIot~ Ytapai@ ~ Component Face i?Ail ~ Rep ~'~rs --~~. S~-..fix ~. ^ ^ ^ D .^ Q D . . Rl _SP=~..~ ^ o ^ ~ ^ ^ ^ ^ ~. .____ ~~ ^ ^ ^ o o ^ ~, ': -____-- J CJ 0 ~ 0 ^ ^: 0: -- --- --. ------ i7 D Q ^ ^ D I] CJ _ ~ D ^ D D 0 D Q ^ _ ~ D ^ ^ a a o Q' ^ _ ...~__~ ;a ^ ^ o ^ ^ a. ^ _. ______ ~ o o ^ ^ o p -- n ^ o 0 o a a o: t7 ^ D D ^ ^ Q ~7. :; yur~,taeic tzsting vas pEU'f4rtne@, describe wi~at was done widt the water after completion of tests: -- ~::i:I'CLE ANT P~EsJ$P~D ~„ _ - - - C,EiITiFICATION OI< TE~_HNICIAN 7dTfi~3NS1RLE FOR CONDUCTING TITS T$STING • '~ :;~.- nest iij'~ty ktln~y/edge, thefircis st:~ted in this ti~,~rt e;rseaeCl[rrtte turd ln,frcll cnmpllance with legal >egxirsr~rur~v .'c.:~uciin's Signaitut:: ~ ~ Date' ~1~~~ )ZC~g ~- ~ t' ~ {:~, J~rauar}' 2002 Page vi' -_-.. __ 9. SPlO[,IJ®VE C4NTA.INA~CNT BOXES t r ai iis:y is Not E nipped With SpiiUOverfitl Containmeztt Bodes ^ _ _ _ _ _ .._,r__._~ ~. _........._ S{sili;"~;ivezfill Contfrinment $a~ces are Present, but were Not ~esied ^ __ _ ,I .._-_.~. '~ psi i~i.ethod Developed By: ^ Spill Bucket Maawfseturer ^ Industry Standard ^ Pmfessiana! Engiaeer '~ d Other (Specify} ~' _ _ ~ Est i~-iethod Used: 0 Pressure f7 Vacuum D Hydrostatic r, ^ other tSpecifv) f t ~ s" t r:1uipment Us:~d: Equipment Resoiutiom• f'.... ' ~ ~~- Spill Box #~~ ~ Spilt Soz Spit[ Box # SpillBax # . ~LCkt~tJiameter. /r ~a" - iic%c:r depth: r ~ ~~ I, i'~~ a.;t time between $PPiY~g s ~~st.reivuc:uturJwater and ;al~i~cest: ?~ /~•Z~ ~!J ' ~M~ N _ ~ _ °, ' ~,tT~ta~l ~ritrte: ~a: t~: f : ~ flttti;•allteading{Ri); ~ fol 3.3 3•~~ ti x ~~ ~ ~:;~~ ruttz: 1a• i a: 3 ~. c p ~: 4 P ~i1~:2i heading (RF); ~ ~. 3• .~ • 3~•~.a,. F _ `I'~~c L+uratit~n: (~ r+~l~ J`1 l Z tJ ~_____ ~p p _~ y l.•11~I1~t SII kea{l1Ilg, l+~F'~yl: t.~ -,. ~• ,q-yr)ti tsiay ~ ,}. _ ':~sss:`Fail Threshaid or ~~i:~~i1: ~ - .o©a . f- ~ ~~~ ~~ rsi Jie51[iiY9 ~ Pass ^ P+sil ~.-Pa~ CJ r+aii ^ PaSa ^ Faif 4 Pa9s. C1 Fail ~: u;ini;[CieTlrs (inclYde information on repairs mode prior to telstitr,~ and reenmme»dadfollow-ug for ailed tests) l~~gy ---~ SB989 TESTING FA-,.ILURE REPORT SIT1: NAME: Q E~~ r~`g„Sc_ S~~ DATE: ~~ l ~ ~Co ADx-RESS: ram ~5 ~ , ~ ~CHNICIAN: ~~ ~~~~ ~~~,&~ CITY: t~AtC~•~'~~:d~ SIGNATURE: ,,,, ~_ THk; FOLLOWING COMPONENTS WERE REPLACED/REPAI[2ED TO COMPLETE TESTING. REP'AIItS: N©~_ I.AE~OR• iV~~~ ' PA~tTS INTALLEll: N~~ NAP~IE: TITLE: y SIG:KA,TURE: THI: ABOVE NAMED PERSON T~ESFIJLL RESPONSIBILITY OF NOTIFYING THIS APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKFI~T TO REPAIR THIS ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMAkVTAL FOR ANIt NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ' AN~t FINES OR PEN_'~LTIES OC~URIN.G FROM NON-COMPLIANCE. A C~DPY OF THIS Dt3CUMENT HAS BEEN LEFT' ON-SITE FOR YOUR. COPdVIENENCE. r ~34F' 12.~2rt~t~ 1:43 Pt~l .~UP1P LEHK TE 5T REPORT ~ Sdd 1lR$3d 1531 ' NI b65~eZ ~7lOHS321y1 31F13~ 31FI LL 500Z~Zx: bQ 73ff31 aN3 TEST ~TARTEU 1:28 PM Wd b T : Z I HI £i9~•Z 3.Lya aN3 3~I1 QM3 TEST •_TARTEG 04.12/2006 9~~~~Ii{,9 13~ NI93$ FE~3IN LEUEL 3.;:,070 IN Wd bO:Zt 4=1121b1S 1S3L ENC7 TIME 1:43 Phi ~~-dd1S 1g31 ~~;n ~ArE Q~f12~20e~ ENL~ LEUEL 3.307T IN ~~ I~a^ 1_LRF`. THRESHOLD 0.042 IN TF~T RERI ILT Pr1SSEf? ~?•+: 1212006 i : l k+ Pi^ i"1fiS321 ~ SUMP LERK TEST r~PORT p35S~yd 3~ ZC~'Q Q-}0}153~i dN3 ' ' 91FIL L NI 0 1 13113 31~ ~~ 1 b6 90 3WIi ©N3 p 5 I p 9L~~ 't3t13`1 hill TEST STARTE r,E 04~12 2a0E• N ~ZT~tiO 900 (131~d1S 1531 ~;IN LEUEL 3.3080 IN ,. ZT ~ t73i21~l1S ENC~ TIME 1:10 PPt ' Wd 0 END LzRTE ~94~12r2B06 -~~I~~~; EhlC~ LEVEL 3.3x75 IN LEnK. THRESHOLD 0.662 IN TEST RESULT pHS•SEp 1--~ ~y i ~, ~11~L..1i1VC~`r & PERMIT STATEMENT ~~ Pl`t2NtIT HO.: i LOCATION OF PROJECT ~i~r r 12Ce9 BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Avenue, Suite 210 Bakersfiekt, CA 93301 'JI+U(IIIVIRfRIC ~umr~~ i (G91'' ._ r -___.. ~ j ~ItUJEC7N~+ME '~ A°°isa~ o PNONENO. NROJL-Cl'AOORESS )~j}i CIiY ST TE ~~~~ J CONTRACTOR NAMC CA LICENSE No. ~~.. TYPE OF LICENSE EXPIRA71pN DATE ANO ENO _ n r - c7 a lrJ i CONI'RACI~OFi CUMP ~ } n - i FAX NQ - ~ y,uioHGss ~., „ ~+ S -; t crn ~ - zIPC°o~, , ~ a J ^ Alarms -New & Modifications - (Minimum Char e) $262 50 ~ g . 98 __ Over 20 Ft: 000 Sq Ft x 013125 = Permit fee Sq ~ i ~_-.._. , . I . . i ^ S rinklers -New 8 Modifications - Minimum Char e) $210 00 ~ i p g ( . 98 _ _ ^ ~ Over 5 000 Sq Ft F~ x 04Z = Permit fee Sq ~ l , . . . r CI Minor Sprinkler Modifications (< 10 heads) ; 93 00 [inspection OntyJ ~ , 98 ^ Commercial Hoods -New & Modifications $ 39826 ~~_ ___ i ~ ~ ^ ~ Additional Hoods $ 36 00 ~ V _ ; . 98 _ ~` u I Spray Booths -New & Modifigtions $458 00 ~ ;_ __ . 96 I L~ ,__-.~. Abov round Stora a Tanks (InstapaUonnnsp.-1'~ Tune) $165.00 82 i. ^ Additional Tanks 3 26.00 82 ^ ~ Aboveground Storage Tanks (Removai/Inspec#ion) $109.00 82 Underground Storage Tanks (tnstaAa7onllnspedion) $878.Op (pertankJ 8'1 ^_ Underground Storage Tanks (Maiirication) $878.00 (perslfe) 82 ~ ^ r• Underground Storage Tanks (Minor Modfication) $155.00 ~ ^ ,~ Under round Storage Tanks (Removaq $875.00 (perlank) 84 ^ Oifweit (Installation) $ 72.00 ~ ~ a----- '~ _~ r- Mandated Leak Detection (testing) I Fuel Monk. Cert. $ 81.00 r site 82 ^ Tents $ 93.00 (pertent? ~ I__ ^ Afterhours/nspectlion fee $922,00 84 ~ ^ ~ Pyrotechnic -(Per event, Plus Insp. Fee Q $90 per hour) $ 60.00 + (5 his. rrdn. stand -by ree nnspectioo) _ $59 0.00 84 C1 L RE'-INSPECTION(S) /FOLLOW-UP tNSPECTION(S} ; 83.00 (per hour) 84 ~ ^ ~_ Portable LPG (Propane): NO. OF CAGES? $66.00 sa ^ ~--- Explosive Storage $249.00 t# ~ L7 Copyin & Fils Research (File Resea;~ Fee $33.00 per hr) 25~ per page a ~ Miscellaneous ea 1 FD 2021 (Rev. OQ1051 X24 ~ y fi tII,IDERGROUND STORAGE TANKS ;,, ,HPIPLICATION ~~ i~:i 70 PERFORM ELP / UNE TESTING ?:~ i 58959 SECONDARY CONTAINMENT TESTING ~, /TANK TIGHTNESS TEST AND TO PERFORM ;=UEL tulON170RING CERTIFICATION BAKERSFIELD FIRE DEPT. ,wiw~ Prevention Sexvices A'te' 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (b61) 326-3979 F'ax: (bb 1) 852-2171 Pape 1 of 1 PERIvi+r No. ~_ ^ ENHANCED LEAK DETECTION ^ NFr ^ SB-988 SECONDARY CONTAINMENT TESTING CJ 7AtJK TIGHTNESS TEST ~~ TO PERFORM FUEL MONITORING CERTIFICATION ' i~--r~,GL17Y ~ ~ '~ ;tDDRESS ' ( ~ `~' • ~ NAME 8 PHONE NUMBER OF CONTACT PERSON - OWNERS NAME ~ J:'ERkTORS NAME PERMIT 70 OPERATE NO. IJUMBER OF TANKS TO BE TESTED P ~ T -- . r- • I ~ _. - __ _ __..__ ;_ __. - . ~ ~~ TANK;•TE$TINO COMPANY I NHME OF TES tNG COMPANY ~_ - NAME d PHONE NUMBER OF CONTACT PERSON i WUiILING ADDRESS L - ~ tJAME 8 PHONE NUMBER OF TESTER OR SPECIAL INSPECTOR 5~ ~ - o Q CERTIFICATION iF: DATE 8. TIME TEST TO BE CONDUCTED r ~-Gt~ O , ICC ~: TEST METFIOD SIGNATURE OF APPLICANT - ~~ L^ - DATE I APPROVED BY DATE ` FD 2095 (Rev. 09105} _ .: ~~'1NDERGROUND STORAGE TANKS .,~~, ..~ ~ 4~ .:'::,T`.':: i:;.s:~.:_.:i e'1!.tii:.X.';J.'::.~n:~L'N'f.~.i1tl?:'nKYfif:lYed~l&IOUANFY.IY9~Dl.'iGW` 0'a:~Y:GYikAf6lYRia'M"~tYil<114J.~ e,~ ~ ~l~` APPLICATION ~~~ A~ r ~': TO PERFORM ELD I LINE TESTING ~: I SB989 SECONDARY CONTAINMENT TESTING '~ RANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. `T~'-U ~ (~ BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DEFECTION ^ ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ~ TO PERFORM FUEL MONITORING CERTIFICATION SIT IN . FACILITY NAME 8 PHONE NUMBER OF CONTACT PERSON ADDRESS `_ ~" OWNERS NAME OPERATORS NAME PERMIT TO OPERATE NO.. NUMBER OF TANKS TO BE TESTED I PIPING GOING T BE TES ED? ^ YES ^ NO TANK # V ME CONT NTS l ~ ~ V'~e.VVt,-r'l ~ :TANK,TESTING COMPANY NAME OF TES ING COMPANY NAME 8 PHONE NUMBER OF CONTACT PERSON 7 MAILING ADDRESS - G NAME & PHONE NUMBER OF TESTER OR SPECIAL INSPECTOR S - i o CERTIFICATION #: DATE & T{ME TEST TO BE CONDUCTED - a -0 0 ICC #: TEST METHOD SIGNATURE OF APPLIC NT Y~ C ~ DATE APPROVED BY DATE ~ ~ ~ 6 FD 2095 (Rev. 09/05) 181 :LING & PERMiT STATEMENT BAKERSFIELD FIRE DEPT. Prevention Services ARf11T 900 Truxtun Avenue, Suite 210 PERMIT NO.: Bakersfield, CA 93301 - ~ LOCATION OF PROJECT - ~ PROPERTY O ~ bb STARTING DATE COMPLETION DATE ~ 1~ V NAME PROJECT NAME ~ _ - 1 _, ~ ~( O V \ twT1V1 ADOR' S~~-O ~ PHONE NO. PROJECT ADDRESS ~ ~ CnY ST TE LP CODE • ~ CONTRAC NAME CA LICENSE NO. •' ~ ~ TYPE OF LICENSE. EXPIRATION DATE PHO~NO. CONTRACT R COMPA NAM FAX NO. .~ccam'~ O`' ADDRESS ~ ~ ~ ~ s CnY ~ 21P COD J • • ^ Alarms -New & Modifications - (Min'I mum Charge) $262 50 • ~ • . . . 98 Over 20 000 Sq Ft. 013125 =Permit fee Sq Ft z ~ ^ , . . . 98 ^ Sprinklers -New & Modifications - (Minimum Charge) $210 00 ~ . 98 ^ Over 5 000 Sq Ft FL x 042 =Permit fee Sq ~ , . . . . 98 ^ Minor Sprinkler Modifications (< 10 heads) 00 [Inspection Onlyj $ 93 ~ , . 98 ^ Commercial Hoods -New & Modifications $ 398 26 ~ . 98 ^ - Addifional Hoods 00 $ 36 ~ . 98 ^ Spray Booths -New & Modification; $458 00 ~ . 98 ^ Aboveground Storage Tanks (Installation/lnsp.-1 ~' Time) $165.00 82 ^ Additional Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Remo~ralllnspedion) $109.00 82 ^ Underground Storage Tanks (Instali~:`ion.llnspedion) $878.00 (per tank) 82 ^ Underground Storage Tanks (Modification) $878.00 (persite) 82 ^ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Underground Storage Tanks (Removan $675.00 (per tank) 84 ^ Oilwell (Installation) $ 72.00 8'} Mandated Leak Detection (testing) / F uel Monit. Cert. $ 81.00 er site 82 ^ _ Tents $ 93.00 (per tent) 84 ^ After hours inspection `ee $122.00 ~ 84 ^ Pyrotechnic - (Per event, Plus Insp. Fer. @ $90 per hour) $ 60.00 + (5 hrs. min. stand -by fee /Inspection) _ $510.00 84 ^ RE-INSPECTION(S) /FOLLOW-U!~ INSPECTION(S) $ 93.00 (per hour) ~ ^ Portable LPG (Propane): NO.OF CF:GE$? $66.00 ~ ^ Explosive Storage $249.00 ~ ^ Copying & File Research (File Resea; ch Fee $33.00 per hr) 25¢ per page ; 84 ^ Miscellaneous ; ~ FD 2021 (Rev. 09/05) 1 _ f1Rtf:INA1 V~i>.IITF Ifn Troaa~~ru1 ~_VFI I AW /fn Filol ~_DINK ffn !`~~afmm~rl E R S F I /~'/RE it R TR RONALD J. FRAZE FIRE CHIEF Gary Hutton, Senior Deputy Chief Administration 326-3650 D Deputy Chief Dean Clason Operations/Training 326-3652 Deputy Chief Kirk Blair Fire Safety/Prevention Services 326-3653 2101 "H" Street Bakersfield, CA 93301 OFFICE: (661) 326-3941 FAX: (661) 852-2170 RALPH E. HLTEY, DIRECTOR PREVENTION SERVICES flRE SAFETY3ERVICES • 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 A-1 Food Store 1200 H 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 . HUE~Y,Director of Prevention Services Steve Underwood Fire Prevention Officer SU:db r `12/06/2005 09:05 6618363177 REDWINE TESTING SVCS ... „, .f'k ~ , ~~ . ~~ ., RAt~.~'~'Y ~ 'fit ~,, ~: ~1' ~ 4~f .~_i, :i . ,~ . t.. .., ~~. .j. `; . ~. ~ ~,. PAGE 02f 04 '~'+~c' ~ T~mk ~ ~ T~k 3 ~ ."n1c 4 $tiirt~oe ~ ; ~ ..6, ;~ , ~• i•1~IIRq ,4 ` r ~ .i. .. '~` •j ' ~ ,. ~ C~ ~ ~.L jl'[ IC 1~. ~ . . ~ . I '~~~~ • ~.~•r :. y 4• ~ , ' 4 • ~ .~. , y~i '.J .. ,'~~.y '~Pi ~~~ ,i ~r f . „~ 'til, ~ ~~~_;~.~^ ~ ~ '.Y. .y . •s . Y~. ~~ ~ •~ i ~ ~ ~ 1~•It ~ . . ~ 1 'lM S, ~~ ' , . ' ~~i. .. ,~.' T~ ~~ ,;i ; ~ 12/06/2005 09:05 661$363177 REDWINE TESTING SVCS ~~ ~ ~ i • ~ ~,~. _. ;. i~ 'r• PAGE 03/04 r,~ ~~ •'' ~~ ~;•. 7 Ors ~~ • • I ' ~.~ ~ •Y ~ • • ~/ • w •• ! ~ ~ • ~ • ~~ I '~ ~ •~ • czar B . ~ .. .. _ ~, . ., ~; ~ ceia ~ o~a~ ~ cu ~ ~ .Z ~ ~ • t M •4M ~~!•R~ ~ / ~. ~ • • ~ • ~ ~ •~ ~ r Y."~..i`wM~ c~' r ~ ~+.~. rIG ~3 r~ . :~. ~ . X12106/2005 -09:05 6618363177 REDWINE TESTING SVGS ' ~' ~~ ~~ ~, ' ~ ~ •~ .. • ~~~ ~~A~ ~~ ~ X~ ~~ a1rARt' ~~ ~~ ~~ •~ , '~AT~ ;,~~ 1w,R'i~ ` ~CHT '~ . ,, ~, ~1iGRF .;,• ~ 4e ;S'- ,'~~~~ ' _ 1 'I~FA'!'~It ,.:~ ;.ti.: .', : '' ,: c: ~~~'~11+f~ I" A'LfJ9~ ,i ~`: '. ,~ . ~~. PAGE 04/04 s , .. ;'..