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Home My WebLink AboutBUSINESS PLAN 7/13/2006 (~ ~ i U VERIZON WIRELESS 10701 HWY 178. _ ~ ., ~ , ~- MESA MA~~ ~~ +'VERIZON WIRELESS - MESA MARIN _____ __________________ SiteID: 015-021-00337 + Manager SKIP SEVERANCE BusPhone: (559) 268-7 Location: 10701 HWY 178 Map 104 CommHaz igh City BAKERSFIELD Grid: 16C FacUn' s: 1 AOV: CommCode: KCFD STA 42 ~IC Code:4~ EPA Numb: DunnBrad• -216-7078 ------------- ------------------------- Emergency Co ct / Title Emerge y Contact / Title SKIP SEVE CE / / Business hone: (559) 268-7878x siness Phon ( ) - x 24-Ho Phone ( x 24-Hour Phon ( ) - Page Phone ( ~ ~~ x Pager Phone ( ` H mat Hazards: Fire ImmH th DelHlth Contact SHAWN STACEY Phone: (916) 357-2520x _ MailAddr: 255 PARKSHORE DR State: CA City FOLSOM Zip 95630 Owner VERIZON WIRELESS .Phone: (925) 279-6455x Address 2785 MITCHELL DR State: CA City WALNUT CREEK Zip 94598 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK ~.>~see on my inqui Y Af 4hoss individuals responsible fer 4k5t~jPilf ~ gpyp fnfprmati4n, I c®Ptify under penalty of la that I have personally exami ed and am fiarr Iliac with the IntOrmat'on s~.~bmi tee arid. ba3Heav6 the intprmation is tr e, accura e, and comol i 1 ~?j Q 10 8i'x~~~;ture ° e ~NT'p A~~ ~ 9 ~p0~ E5~ NM~~o 55~~ -1- 03/28/2006 ~~ .^~ y t. VERIZON WIRELESS - MESA MARIN SiteID: 015-021-003370 Manager MARK IVERSON BusPhone: (661) 664-5601 Location: 10701 HWY 178 _ __ Map 104 CommHaz :High City BAKERSFIELD Grid: 16C FacUnits: 1 AOV: CommCode: KCFD STA 42 EPA Numb: SIC Code:4812 DunnBrad:88-463-8305 Emergency Contact / Title Emergency Contact / Title NETWORK OPERATIONS / CONTROL CENTER MARK IVERSON / OPS MANAGER Business Phone: (682) 831-3523x Business Phone: (661) 664-5601x 24-Hour Phone (800) 264- 24-Hour Phone (661) 203-3205x Pager Phone ( ) 4lD2o x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact SHAWN STACEY Phone: (866) 694-2415x MailAddr: 255 PARKSHORE DR BLDG B State: CA City FOLSOM Zip 95630 Owner VERIZON WIRELESS Phone: (866) 694-2415x Address 255 PARKSHORE DR BLDG B State: CA City FOLSOM Zip 95630 Period to TotalASTs: - Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK CALL MARK IVERSON, 203- 3205, FOR INSPECTIONS. 0 X007 ~''~ed on my inquiry of those indivic;uals fe"p~'n~iz''e for obtaining the informati und an, I certify er p ,aalty cf !aw that { have person examine ! ll d i ` a an y ar l familiar with the inf submits ormation d and believe the . acc, nformation is t -~ ; d -~ ~ .. , ~or rue, -~le ~. ~/Z o Si natur ~7 9 e Date -1- 07/16/2007 ,, ti F VERIZON WIRELESS - MESA MARIN SiteID: 015-021-003370 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP ELECTRIC STORAGE BATTERY F IH S 2040.00 LBS Hi ELECTRIC STORAGE BATTERY F IH L 51.60 GAL Hi DIESEL #2 F IH DH L 210.00 GAL Low -2- 07/16/2007 P S -3- 07/16/2007 ~ !i t F VERIZON WIRELESS - MESA MARIN SiteID: 015-021-003370 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME ELECTRIC STORAGE BATTERY Days On Site VALVE-REGULATED LEAD-CALCIUM BATTERY 365 Location within this Facility Unit Map: Grid: SEALED BATTERY CASE CAS# ~SolidE TMixtur~mbient~E ~ AmbientT~E OTHER NTSPECIFYYPE AMOUNTS AT THIS LOCATION - Largest Container Daily Maximum Daily Average 170.00 LBS 2040.00 LBS 2040.0.0 LBS t1HL,LjtCLVUb lLV1°lYV1VJJIVI~ owt. Rs cAS# 73.00 Lead No 7439921 8.00 Sulfuric Acid (EPA) No 7664939 Y11~GHKL H.7.7L" .7.71~1L' 1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Hi ~ Inventory Item 0003 Facility Unit COMMON NAME / CHEMICAL NAME ELECTRIC STORAGE BATTERY VALVE-REGULATED LEAD-CALCIUM BATTERY Location within this Facility Unit Map: SEALED BATTERY CASE Fixed Containers at Site ~ Days On Site 365 Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture ~ Ambient ~ Ambient OTHER - SPECIFY AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 4.30 GAL 51.60 GAL 51.60 GAL 11HGtiI'CLVU.7 1.V1~lYV1V~1V 1.7 SWt. RS CAS# 73.00 Lead No 7439921 8.00 Sulfuric Acid (EPA) No 7664939 2.00 Polypropylene No 9003070 ri1-~GtitCL Ei.7.71;.7.71~1~1V 1 a7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Hi -4- 07/16/2007 F VERIZON WIRELESS - MESA MARIN ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME DIESEL #2 LOW SULFUR DIESEL FUEL Location within this Facility Unit AST STATE - TYPE PRESSURE Liquid Mixtur~mbient SiteID: 015-021-003370 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE CONTAINER TYPE Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 210.00 GAL 210.00 GAL 210.00 GAL tu~~r~ttL~ua winr~.~v~lvla aWt. RS CAS# 99.00 Diesel Fuel No. 2 No 68476346 1.00 Naphthalene, Crude Or Refined No 91203 I1HGE~tCL 1~5 ~JL' A w71~1L' 1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -5- 07/16/2007 r ~ ~ F VERIZON WIRELESS - MESA MARIN SiteID: 015-021-003370 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 03/09/2007 ~ PHONE 800-621-2622 AFTER NORMAL BUSINESS HOURS, LOCAL PERSON IN CHARGE WILL BE NOTIFIED AND WILL RESPOND. SITE SHOULD BE IDENTIFIED BY SITE NUMBER. DURING REGULAR HOURS, USE CONTACT NUMBERS PROVIDED IN SECTION 2: EMERGENCY NOTIFICATION. _ , ~ _.. P~ul1./lvYcc 1V 1J loll ~ P~VdI. UGlV1Vll _i_ ~ /.-. r UAJ11V LVV I.ll ~ ~VQI.UQL1V11 P~LlIClyClll:y 1.1C 1.11Ud1 t'1di1 -6- 07/16/2007 F VERIZON WIRELESS - MESA MARIN SiteID: 015-021-003370 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 03/09/2007 ~ BATTERIES ARE LOCATED INSIDE LOCKED COMMUNICATIONS SHELTER AND ARE MONITORED 24-HRS PER DAY BY THE LOCAL SWITCHING STATION. DIESEL FUEL IS DOUBLE-WALLED CONTAINMENT AND IS ALSO MONITORED BY LOCAL SWITCHING STATION. BOTH ARE INSPECTED ONCE PER MONTH BY SITE TECH. Release Containment 03/09/2007 DOUBLE-WALLED FUEL TANK. CONTAINMENT OF ANY SPILL IS MADE BY A POLYETHLENE LINER UNDER 3 TO 6" OF CRUSHED STONE WHICH SURROUNDS THE BLDG AND GENERATOR LOCATIONS. Clean Up INTERNATIONAL TECHNOLOGY CO 800-262-1900 03/09/2007 V1.11C1 iCC w7 Vl,Ll. l.:C til:LlVCLV1V11 -7- 07/16/2007 .~' F VERIZON WIRELESS - MESA MARIN SiteID: 015-021-003370 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~7~JCV10.1 nclG CLi uw7 Utility Shut-Offs ELECTRICAL - E SIDE OF BLDG 03/09/2007 Fire Protec./Avail. Water 03/09/2007 1 HALON 1211 FIRE EXT (9 LBS) L SIDE OF ENTR DOORS. Building Occupancy Level 03/28/2006 UNMANNED SITE -8- 07/16/2007 F VERIZON WIRELESS - MESA MARIN SiteID: 015-021-003370 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 03/09/2007 ~ MSDS SHEETS ON FILE. rctyC G nciu ivi ru~.uic ~~c nC1u 1VL r uI~UIC U.SC -9- 07/16/2007 ~'~,~ ~.. 1~ Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Mesa Marin Food Mart/Northeast Chevron Facility ID #: TKMT44-042992 Facility Address: 11101 Highway 178, Bakersfield, CA 93306 (City) Reason for Submitting this Form (Check One) X Addition of Designated Operator Facility Phone #: 661-366-4886 ^ Update Certificate Expiration Date Designated UST Operator(s) for this Facility ALTERNATE 3 (Ontional) Designated Operator's Name: Jessica L. Meyers Relation to UST Facility (Check One) Business Name (If different from above): Confidence UST Services, Inc. ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 800-339-9930 ^ Service Technician x Third-Party International Code Council Certification #: 5313857-UC Expiration Date: June 30, 2009 ALTERNATE 4 (Optional) Designated Operator's Name: Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: ^ Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: ALTERNATE 5 (Optional) Designated Operator's Name: Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: ^ Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f). Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please Print): Mohamed Muthana SIGNATURE OF TANK OWNER: DATE: August 9, 2007 OWNER'S PHONE #: NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY JANUARY 1, 2005. THE LOCAL AGENCY LIST IS AVAILABLE AT: www.waterboards.ca.gov/ust/contacts/cu~a aQVS.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 ,* ,'.~_ _ -- Owner Statements of Designated'Underground Storage Tank (CYST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Mesa. Marin Food Mart/Nordreast Chevron Facility ID #: TKMT44-042992 Facility Address: 1 I I01 Highway 178, Bakersfield, CA 93306 (City) Reason for Submitting this Form (Check One} ^ Change of Designated Operator Facility Phone #: 661-366-4886 X Update Certificate Expiration Date Designated UST Operator(s) for this Facility P7?iM d i2 V Designated Operator's Name: Douglas M. Young III Relation to UST Facility (Check One) Business Name (If di~'erent from above): Confidence US7'Services, Inc. ^ Owner ^ Operator - ^ Employee __ -I7esignafed Operator's Phorie #: 8U0=339-9930 ^ Service Technician x Third-Party International Code Council Certification #: 0878646-UC ~ Expiration Date: September 22, 2008 Ai.TF.RNATTi. 1 /fhstinnntt Designated. Operator's Name: Jennifer Davis Relation to UST Facility (Check One) Business Name (!f different from above}: Corrftdence UST Services, lnc. ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 800-339-9930 ^ Service Technician x Third-Party International Code Council Certification #: 5252886-UC Expiration Date: March 15, 2009 __ _ ALTERNATE 2 (Optional) Designated Operator's Name:. Edward Mitchell- _ - ~ Relation to UST Facility (Check One) • Business Name (If di,~'ererrt from above): Confidence iI,ST Services" ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 800-339-9930 ^ Service Technician x Third-Patty International Code Council Certification #: 5258845-UC Expiration Date: May l5, 2008 I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator{s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, fide 23, section 2715(c) - (f). Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please Print): ~ ~~~ ~ ~(~ ~, ~~~ G'' SIGNATURE OF T}ANK OWNS DATE: ~ I t! ~ [ ~~ OWNER'S PHONE #: NOTE: 1) SUBMIT THIS COMPLETED FORM TO.THE LOCAL AGENCY {NOT_THE STATE WATER RESOURCES' CONTROL, BOARD) BY JANUARY I, 2005. THE LOCAL AGENCY LIST IS AVAILABLE AT:11'~.t~i~.waterboards.ca.,ovhist/contactsfcu~ a~r•s.irtinL 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITffiN 30 DAYS OF THE CHANGE. November 2004