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HomeMy WebLinkAboutBUSINESS PLAN 2/12/2007_ _ _~ _- _ ~~~ DOWNTOWN CHEVRON -- -- ~ ~~'~ 2317 L STREE - ~ . ~- T _~ _ ,~1 CHEVRON DOWNTOWN FOOD MART-SULLIV Manager ~eJ,.~ J~~>R,t?y~ Location: 2317 L ST City BAKERSFIELD CommCode: BFD STA O1 EPA Numb: SiteID: 015-021-001920 BusPhone: (661) 638-0310 Map 103 CommHaz Extreme Grid: 30A FacUnits: 1 AOV: SIC Code:5541 DunnBrad: Emergency Contact / Title Emergency Contact / Title EFREM TORRES / MANAGER JAMES YOUNG / RETAIL FUEL 1'~GR Business Phone: ( 661) 638-0310x Business Phone: (661} 330-0261x _ 24 -Hour Phone ( ~O6 -) 340 -299' x 24 -Hour Phone ~ : ( ) - x Pager Phone (661} 433-8259x Pager Phone ( } - x .............. Hazmat Hazards: Fire Press ImmHlth DelHltli ................ Contact ~~~,a ~A'y~,dG~ Phone: (661) 638-0310x MailAddr: 2317 L ST State: CA City BAKERSFIELD Zip 93301 .............. Owner SERVICE STATION HOLDINGS Phone: (661) 393-5017x Address 200 E MINNER AVE State: CA City BAKERSFIELD Zip 93308 Period to TotalASTs: - Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST ~N~'~ ~ ~ ~ ~ ~Q~T Based on my inquiry of those indivldu~ls respo sible for obtaining the information, I certify unde penalty of law that I have p®rsonally exam e and am familiar with the information sub ~ e and believe the information is true, acc ~ nd complete. 2-j~-~7 Date -1- 01/29/2007 F CHEVRON DOWNTOWN FOOD MART-SULLIV SiteID: 015-021-00190 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: CHEVRON DOWNTOWN FOOD MART-SULLIV Cross Street Business Type: Org Type: Total Tanks 4 IndnRes/Trust: No PA Contact: Dsg Own/Oper ICC Nbr: PROPERTY OWNER INFORMATION Name JAMES YOUNG Phone: (661) 330-0261x Address: City State: Zip: Type CORPORATION Name JAMES YOUNG Address: City Type CORPORATION BOE UST Fee# UNKNOWN Financ'1 Resp: SELF INSURED Legal Notif Date:01/13/1999 Name:ADAM HENSLEY State UST # . TANK OWNER INFORMATION Phone: (661) 330-0261x State: Zip: Phone: (366) 107-10 x Tt1:GENERAL MANAGER 1998 Upg Cert#: 00810 -2- O1/29/~007 'f' ~ 3' F CHEVRON DOWNTOWN FOOD~MART-SULLIV SiteID: 015-021-00190 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP ............. PROPANE ~ E F P IH G 2 0 0. 0 0 FT3 Fib. REGULAR GASOLINE L 12 0 0 0. 0 0 GAL 1'~ttid REGULAR UNLEADED F IH DH L 12000.00 GAL 1'~Cid PREMIUM UNLEADED F IH DH L 12000.00 GAL NTdd MIDGRADE GASOLINE L 8000.00 GAL Mod PREMIUM GASOLINE L 8000.00 GAL l~~d DIESEL L 12000.00 GAL Lnw -3- 01/29/007 -4- O1/29/~007 F CHEVRON DOWNTOWN FOOD MART-SULLIV = ~ Inventory Item 0005 COMMON NAME / CHEMICAL NAME PROPANE Location within this Facility Unit STATE T TYPE PRESSURE _ Gas I Pure Above Ambient SiteID: 015-021-001920 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 74-98-6 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 FT3 200.00 FT3 200.00 FT3 tiHG1'itCLV U ~ 1:V1~lYV1V L".1V 1 D °sWt. RS CAS# 100.00 Propane Yes 749$6 t1HGA1tL 1-~JJL' S~1~1J;1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME REGULAR GASOLINE Location within this Facility Unit 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 12000.00 GAL 12000.00 GAL 12000.00 GAL nriGAlu~ V U 5 1. V1~lY V1V ~1V 1 J °sWt . RS CAS# 100.00 Gasoline No 8006619 tYL~GE~tCL L-1A~~551~1~1V 1 7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Matt -5- 01/29/2007 F CHEVRON DOWNTOWN FOOD MART-SULLIV = ~ Inventory Item 0006 COMMON NAME / CHEMICAL NAME REGULAR UNLEADED Location within this Facility Unit STATE TYPE ~ PRESSURE Liquid Mixture I Ambient SiteID: 015-021-00190 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 8006-61=9 TEMPERATURE CONTAINER TYPE Ambient ~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 12000.00 GAL 12000.00 GAL I 12000.00 GAL n~,~~~vua uvl~irviv~lvl~ _ %Wt. ~ RS ~ CAS# 100.00 Gasoline No 8006619 t1HGL-1tCL KJ al~,~~1~11;1V1~7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0007 COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED Location within this Facility Unit STATE TYPE PRESSURE Liquid TMixture ~mbient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map : Grid : -- CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient -~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL 12000.00 GAL 1'1HGEi1'CLVU.7 1.V1~lYV1VL"1V1~J %Wt. RS CAS# 100.00 Gasoline No 8006619 t1HGHtCL Ya.7AL" ~7.71Y1L' 1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -6- O1/29/~007 F CHEVRON DOWNTOWN FOOD MART-SULLIV SiteID: 015-021-0019217 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME MIDGRADE GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient, UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 8000.00 GAL 8000.00 GAL 8000.00 GAL r~~ratcL~u~_ cc.mir~iv~:iv~l~a %Wt. _ _ RS CAS# 100.00 Gasoline No 8006619 ru-~~~cc~ r~5~~a~i~~~iv 1 a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mod ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME PREMIUM GASOLINE Location within this Facility Unit Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: -- CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient .Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 8000.00 GAL 8000.00 GAL 8000.00 GAL nriaxrcLVUS COMPONENTS oWt. RS CAS# 100.00 Gasoline No 800561.9 ritiGLitCL 1~~ .7L' Jw71~1L~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MC1 No No No No/ Curies / / / Mod -~- 0l/29/ZOOS F CHEVRON DOWNTOWN FOOD MART-SULLIV SiteID: 015-021-001920 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME DIESEL Days On Site 365 Location within this Facility Unit Map: Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION -" Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL 12000.00 GAL _ _ __ y _ t1F~GHKLVUJ C:V1~lYV1Vl'J1V l~J - - %Wt . - _ ~-.- - , - _- - - - - - RS - CAS# 100.00 Diesel Fuel No. 2 No 68476302 ril-~L,LittL Ha5t5551~1t;1V'1'~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies / / / L~t+v -8- O1/29/~007 F CHEVRON DOWNTOWN FOOD MART-SULLIV SiteID: 015-021-001920 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 07/20/2006 ~ CONTACT CITY FIRE DEPT 326-3979; LARGE RELEASE, CONTACT OES 800-852-7550. Employee Notif./Evacuation____~ _ 02/26/1999 CONTACT POLICE 911. CONTACT FIRE DEPT 326-3979 OR 911. CHECK ALL ROOMS AND EVACUATE PER MAP. rur~llc 1VOL1L . ~ ~VaCUaLlon Emergency Medical Plan 04/04/2006 CONTACT 911 OR MEMORIAL HOSPITAL. -9- 01/29/2007 F CHEVRON DOWNTOWN FOOD MART-SULLIV SiteID: 015-021-00190 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 07/20/20176 ~ NORMAL NOZZLE SPILLS ARE CONTAINED WITH PROPER ABSORBENT IMMEDIATELY. ANY MAJOR SPILL WOULD BLOCKED OFF AND REPORTED CONTAIMED AND CERTIFIED HAZARD WASTE COMPANY WOULD BE USED. xe-rease- ~onLainmenL _ _ l.1Cd11 U~J V 1.11C 1. iCCSVUiLC LiC: l.lVdl.l Vll -10- O1/29/Z007 `v f.. F CHEVRON DOWNTOWN FOOD MART-SULLIV SiteID: 015-021-00190 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ especial riazaras Shut=Of-f-s-- _ _ ___ ~ _ _ _~____ _ 04/04 2006 LOCK BOX - NO Fire Protec./Avail., Water 07/20/2006 FIRE HYDRANT - SW CRNR L & 24TH. Building Occupancy Level 04/04/2005 13 EMPLOYEES -11- O1/29/~007 :~; • c• F CHEVRON DOWNTOWN FOOD MART-SULLIV SiteID: 015-021-00190 ~ Fast Format ~ ~ Training Overall Sites ~ ~ Employee Training 07/20/2005 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEE HANDBOOK, EMPLOYEE SAFETY MANUAL, SAFETY CHECKLIST, AND REVIEW FOUR VIDEOS; EMPLOYEE SAFETY AND YOU, MANAGING WORK PLACE SAFETY, HAZARDOUS COMMUNICATION AND ROBBERY PREVENTION+ Held for Future Use nciu ivi. r u~,ulc vac -12- O1/29/~007 BAKERSFIELD FIRE DEPT j ~ `UNIFIED PROGRAM INSPECTION CHECKLIST ' Prevention Services rr~t~ 900 TYuxtun Ave., Suite 210 ~.,::..~~o- ~.~;~~.~ .~~.-~: ~ ~ .. ,: ,.r ...t ..;, . a,.. T ... .,, .~ , .. ; •-..a„ .:::.. ArxfM s Bakersfield. CA 93301 .SECTION 1: Business Plan and Inventory Program ~ Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME t~WY~1lJwUv ~ NSP CTIO DATE O NSPECTION TIME ADDRESS ~ ~ t' ~3 f ~ HO ENO. ~~ ~~3~~3r ~ O OF ~ M LOYEES FACILITY CONTACT USINESS ID NUMBER 15-021- l g ~~. Section 1: Business Plan and Inventory Program ~~~)(~~`" ^ ROUTINE OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (~=Compliance` OPERATION V=Valation l COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUS111@SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY r ^ VERIFICATION OF INVENTORY MATERIALS fCJ ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION C ^ PROPER SEGREGATION OF MATERIAL -------- ---------------- _ - ---___ . ^ VERIFICATION OF MSDS AVAILABILITY -- - --- --- - -- -- - - --- - ---- - -- --- ------- --- . -- 21 ~~~ _____ ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: ^ YES ^ NO THIS INSPECTION? PLEASE CALL US AT (881) 328-3979 Inspector (Please Print) Fire Prevention / 1" In / Shitt of Site/Station k B ~ sls White -Prevention Services Yellow -Station Copy Pink - Business Copy FD2048 (Rev, tylf05) ~". _ ~.-'~^~.;:...:~.~~,.,r~--~^~y°".,....Jr~7"`_ ..:,.-.,:_-.....-~'.,.-_^.~-'_._..`.~:r."`°~T~;_=-::••C~~: .~s.,. .... ....-.,--.: .....:..-..-.:;-i: ~..,,...•„;....~~;;,,-may.:-~.p- -~-- - ,-~..-. -. .-... .-..,-,.r" .~ ~ ,~..~ /`I~~~`• .~'~~>~\ C[TY OF BAKERSFIELU FIRE DEPARTMENT ~~ ~ / M~ OFFICE OF ENVIRONMENTAL SERVICES y~~`, _UNIFIED PROGRAM INSPECTION CHECKLIST ------ ~'w ~g~,~~'~ ~1Z1S~jC~Piesiar Avte ;j 3i`i~{F1~yruE{a~erstield, CA 93301 I FACILITY NAME Qt`~~WN C{~cJ ~'o i-`i INSPECTION DATE ~ ~~ ' ~_ Section 2: Underground Storage Tanks Program ~~~~~~;~ ^ Routine ~imbined ^ Joint Agency ^Multi-Agency Co plaint ^ Re-inspection Type of Tank Q(t,}~=C~ ~ Number of Tanks Type of Monitoring _ ~ Ltd Type of Piping OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data on the Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there beeri 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 overtill/overspill protection'? C=Compliance V=Violation Y=Yes N=NO Inspector Office of Environmental ervices (661) 26-3979 white - 1?nv. sues. sines Site Responsible Party Pink -Business C,~~y T1 1, + CHEVRON DOWNTOWN FOOD MART-SULLIV ___________________ SiteID: 015-021-001920 + Manager APRIL BARNES BusPhone: (661) 638-0310 Location: 2317 L ST Map 103 CommHaz High City BAKERSFIELD Grid: 30A FacUnits: 1 AOV: CommCode: BFD STA O1 SIC Code:5541 EPA Numb: DunnBrad: --------------------- Emergency Contact / Title Emergency Contact / Title R JAMES YOUNG / RETAIL FUEL MGR Business Phone: (661) 638-0310x Business Phone: (661) 330-0261x 24-Hour Phone ( - 3x 24-Hour Phone ( ) - x Pager Phone ( 69-0e~~2x- Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth ------------ ~~re--~ • %"u ~C~c-~ c~ Phone : ( 6 61) 6 3 8 - 0 310 x MailAddr: 2317 L ST State: CA ` City BAKERSFIELD Zip 93301 ~ Owner SERVICE STATION HOLDINGS Phone: (661) 393-5017x Address 200 E MINNER AVE State: CA City BAKERSFIELD Zip 93308 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~~ PROG A- HAZMAT l ~~ ENT ~ U L 2 0 2006 PROG U - UST l 3 t<J~ ~~ ~5 ~ D~ ~x~ ~ 0~ ~ `~ ~~ `~ 3ased on my inquiry of those individuals ~ ( ~~ responslbie for obtaining the information, I certify ~~ under ;aenalty of law That I have personally examined and am familiar with the information t ~, submitted and believe the information is true, ~J _ accu te, and co late. t re ` Dat -1- 04/04/2006 UNDERGROUND STORAGE TANK PERMIT APPLICATION TO CONSTRUCT /MODIFY /MINOR MODIFICATION OF AN UST H H R 9 P 1 D ~JRI wRTN T PERMIT NO. ~. "U? TYPE OF APPLICATION: (Check one item only) ^ NEW FACILITY n MnnlFl[`ATION OF FACII ITY 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 ^ NEW TANK INSTALLATION AT EXISTING FACILITY YX MINOR MODIFICATION OF FACILITY TARTING DATE ROPOSED COMPLETION DATE FACILITY NAME 7D XISTING FACILITY PERMIT NO. AGILITY DDRESS ITY IP CODE PE OF BUSINESS PN # KO NER HONE NO .. e. DDRES ITY IP CODE ONTRACTOR A LICENSE NO. CC NO. DD ITY IP CODE 93~ HONE O. ~~ ~ AKERSFI ITY BUSINESS LICENSE NO. - ORKMANS COMP NO. ` INSURER BRIEFLYDESCRIBE THE WORK TO BE DONE ~~CTiD~.L . ~ /~~~~~~ ~ ~EKSdPS. , WATER AGILITY PR VIDED BY DEPTH TO GROUND WA ER SOIL TYPE EXPECTED AT SITE NO. OF TANK TO BE INSTALLED ARE THEY FOR MOTOR FUEL ^ YES ^ NO SILL PR ENTION CONTROL AND COUNTER MEASURES PLAN ON FILE 'YES ^ NO TNIC CFCTIf1Al IC C(lR IIAf1T(1R FI IFI TANK NO. OLUME NLEADED EGULAR PREMIUM DIESEL VIATION d~ ~~ PHIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. OLUME NLEADED EGULAR PREMIUM IESEL VIATION FOR OFFICIAL USE ONLY APPLICATION DATE FACILITY NO. NO.OF TANKS FEES $ The applican s recelve understands, and will comply with the attached conditions of the permit and any they state local and federal regulations. orr~ ~be,~t completed under perutlry of perjury, and to the best of my knowledge, is true cor t. BY: APPLICANT NAME (PRINT) THIS APPLICATION BECOMES A PERMIT WHEN APPROVED (Rev. OZ/OS) O n JOB CARD POST CARD AT JOB SITE ..~~ Tel: (661)326-3979 tq ~oc.?vacy C~~'~c~t-~ .5'c9~~IVGtFts e~-~m(cJl~ apCHESj ~CCR_SS cir~ BAKERSFIELO a ~~TY z,a ~g33o 1 ~k Fd ~ ~ 8330-/ . PripNE uo PERAiIT No ~~~ ~ ~~ INSTRUCTIONS: PLEASE CALL FOR AN INSPECTOR ONLY'NHEN EACH GROUP OF INSPECTIONS WITH THE SAPdE NUMBER ARE REACY THEY WILL RUN IN CONSECUTIVE ORDER BEGINNING WITH NUMBER ONE 00 NOT COVER `NORK FOR ANY NUtv1BERED GROUP UNTIL ALL ITEMS IN THAT GROUP ARE SIGNED OFF BY THE PERMITTING AUTHORITY. FOLLOWING THESE INSTRUCTIONS WILL REDUCE THE NUMBER OF REQUIRED INSPECTION VISITS AND THEREFORE PREVENT ASSESSMENT OF ADDITIONAL FEES'. INSPECTION DATE INSPECTOR vy ,> BACKFILL OF TANK(S) I - -- - - SPARK TEST CERTIFICATION OR MANUFACTURES IviETHOD - . .... .. . .. ... . . _ - -- ... _ _ - - -- --... -------- CATHODIC PROTECTION OF TANK(S) .. PIPING SYSTEM ~' ; .~ .: l PRIMARY PIPING SECONDARY PIPING 1 .- ....... ..... .-r.__. -. ..._.._.. .. ...-- - TYPE OF PIPING. O FLEX O FIBERGLASS ~-~--'-----~--._ ._ _._.. .----_.---..._..-----~---------- CATHODIC PROTECTION SYSTEM-PIPING DISPENSER PAN SECONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETECTION ' ' `` `~' ~ CONTINUOUS VAPOR MONITORING ' E~~JHANCHED LEAK DETECTOR TEST LEVEL GAUGES OR SENSORS, FLOAT VENT VAL`/ES^-(~~~~f 1-'l7\V~l ~ / r ~ ~~~0 1~ ,(_ - ~~~ 11507 ~i ~l~ 1C'd ~I , . _.. _._ -. . - . FILL TIGHT FILL BOX(ES) $COn50=r> . . . ..-... _.. - - - _ PRODUCT LINE LEAK DETECTOR(S) _._ .. -. LEAK DETECTOR(S) FOR ANNUAL SPACE-D.~+V. TANK(S) __ b10NITORING WELL(S)/SUMP(S) - H21J TEST j SPILL PREVENTION BOXES FINAL j MONITORING WELLS, CAPS & LOCKS I FILL BOX LOCK (f )~ J~ ~{l f ~ Q~ ~ ,_, ~tv10NiTORINGREQUIREMENTS TYPE ~C~~I~Q~~N°3S~ `p 1 AUTHORIZATION FOR FUEL DROP 1 . ~ ~ CONTRACTOR S(~NSC'~' . .~Jv\eCV~QV~ lt[~ - _. -. LICENSE No. ~~-I:S. I G .~~.~~~~- CONTACT uvG`~e., ~ - .. PHONE No..3~d~'0-66 L7 Bakersfield Fire Dept. >- P 1 o Prevention Services ~J1RJ>t 900 Truxtun Ave #201 ~RrJr r Bakersfield, CA 93301 (d1743 ~~ .~-, L 5:L~IEt:1EL Pdi}F:1'H -----`- ,, , , `=EhJ°"'k ---- r=,LFi}I'9 - -- 5'I'F' =~IJt"1F' L 1 : u 9 Pdi;~kTH FUEL ~LtiRf°1 ~ `1 F~ l3 UP•1F' tiF'R 6. '~'UOr ~ : 35 F't~t FUEL F',Ltikf'9 - , r~Pk t,. '~'t]iJt, 4:~y F'f9 , I_ '_~ : Pi-thJ :EP•JS+~ik 1 ;3 14 DI::F'Etd:ER F'hIJ FUEL r~Lr~Rt°1 AF'R ~:,. 21~U~~ a: '5 F'h^t '~ L 4 : y 1 tVi?kTH ' 1TF' :,IJh9P FUEL HLr-~F?°1 rF'F.' 6 . '~Oi:ir ~ : ~6 PP9 L.1 ii : F'hfJ :=,Eh1~~JF' 15 16 L:~I:~,F'EfU3E1;' P~hJ F~iEL riLti)='f°l ~~;, ~r LI1:F'il'J SEPdt~tJk 17 1i; li I SF'ENc~Ek F'~PJ FUEL ~LHRt°t HF'k G. ~CaG6 4:3t Pt°i STF .=,LIt°1F , FUEL ~;LtikP9 ~F'k t. LUUr 4:33 F't9 LI: :1/tiPJ :EPJ:_~?~k 1'~ tl.l L:~ I ~~PEPL~Ek F'r;rJ .~ FUEL i-iLr=ikl'9 I ----- SEPJSCaR AI:ARt°1 ----- ~ L 4:SUPREME SOUTH STP SUN1P FUEL ALARNI APR 6.. 2006 4:00 PN1 f I ----- SENSCak ALARM ----- j L 9:DISP 1 2 ' DISPENSER PAN FUEL ALARNI APk 6. 2006 4:01 PN1 i f. r i ' - 1:'.ia',_~:::b: ALARNI ----- 1.1ii:i~L-~l-' .1 1 L~ I :~~ iiVSER PAIV j FUEL ALARNI: APR 6. 2006 4:02 PM w SEfVSOR ALARNI L11:DISP 5 6 D I SF'EtVSER FAIV FUEL ALARNI APR 6. 'x'006 4:04 F't°1 ----- SENSt~R ALARI°t ----- L12:DISF' 7 8 DISPENSER F'AhJ FUEL ALARI°1 APR 6. 2170E 4: U5 PM _, s. i ----- SENSU» HLARth ----- f L 3:UNL SOUTH STP SUMP j FUEL ALARM APR 6. 2006 ~ : 0? F'M SEIVSOR ALARNI L14:DISF' 11 1'~' DISPENSER F'AIV FUEL ALARNI ' APR 6, 20;x76 4:477 PN1 ,i SENSOR A1..~;~:11 L14:DISF' 11 1'~' DISPENSER PAN FUEL ALARNI AF'R 6. 20176 4:0~ PN1 r ----- SENSOk ALARNI ----- L 1:PLUS SOUTH STP SUt°1P FUEL ALARM APR 6. 2006 4:11 F't°1 ----- SENSCaR ALARNI ----- ~ L13:LiISP 5 10 ~ DISPENSER PAtV FUEL ALARI°1 APk 6. ?~ n_~t. -+ : 1 ? PN1 i ~4 ~~ BASERSFIELD FIRE DEPT -~- ~, •' ' ..~ ~_ a Prevention Services UNIFi~ED GROGRAM INSPECTION CHECKLIST; ~~te sooTruxtunAve.,sutte210 . ~,: , -,~, r~~~:~~.~,.: ~~ ~..~ s ::: ,,, , _ ..,:<< .......:. .. . ...:. ~,.,., ,... .~:,; _,,.;- - ~~>rN Bakersfield, CA 93301 SECTION 1: Business Plan an Inventory ~ra ~ Tel.: (661) 326-3979 ti ., lT ~~_,.. ~ _F~ /i'Un~i~,~~>~/,~1~/hJ Fax: (661) 872-2171 FACILITY NAME NSPECT N DATE I O INSPECTION TIME ~ J / ` ~ `p Z1/ J ADDRESS HONE NO. O OF EMPLOYEES FACILITY CONTACT USINESS ID NUMBER / 15-021- 6~~ Section 1: Business Plan and Inventory Program ~~'~~ ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND . ^ BUSIrI@SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ~. ^ . VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION f~- ^ ^ PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND EDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WAST ON SITES 'AYES ~rwV QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (681) 926-3979 ~~N G~~z~ ~~~ Inspector (Please Print) Fire Prevention / t" In / Shift of Site/Stetion k White -Prevention Services Yellow - Station Copy Pink - Buainese Copy FD2049 (Rev. 02105) ".~ .~'~~ ~~~ ~ C[T1' OF BAKERSF[EI.U FIRE DEPARTMENT ~~ OFFICE OF >;NVIRONI~IEN"I'AL SERVICES .y~~ tJNIFiED PROGRAM INSPECTION CHECKLIST ,W ~4ti,,!'A 1715 Chester Ave., 3~`' Floor, Bakersfield, CA 93301 FACILITY NAME ~cUal ~/AJ r!.~~~~k~ INSPECT-ION DATE ~-2~r'~ Section 2: Underground Storage Tanks Program ^ Routine ~ombined ^ Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection Type of Tank ~`,Uls~c~% c~y¢l~ Number of Tanks ~ `j Type of Monitorin ~,-~~'~;,;'! Type of Piping ~o C w~ /( OPERATION C V COMMENTS Proper tank data on the Proper ownerloperator data on the Permit fees current Certification of Financial Responsibility Monitoring record adequate and current ~o - ~ ~ ~ ~ ~ Maintenance records adequate and current N JiO,tl ~, Failure to correct prior UST violations Has there been an unauthorized release? Yes ~/~ No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks ___ OPERATION Y N COMMENTS SPCC available SPCC on the with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overt711/overspill protection'? C=Compliance V=Violation Y=Yes N-NO Inspector: ~4r't A.J ~7~'¢i~i~- ~~- Office of Environmental Services (661) 326-3979 ~l'hitc - inv. Svcs. f ness Site esponsible Party Pink -Business Cnpy .~ r-~~„ - -~: <. ~ _ ~~ ; ~--~.. -~ 6. /ev V^ ~ ,~ ~ ..~. i, Cl=.'t.E'1 r,'~ 33fII ~~ ?y Hf°i .. , :: l t.l l ._~ i -TUt~ REF'iiRT ~t.l . r ~ ~ I ,~ 1' I ~_; PJ ~ PJ~ ?Rf°li~L 1 rr~?r rrl ~ ~r:•, r:EF ~:~RT 1 1 ;-a I} NkP1E :l.Ilflt. = 3'_'41 i~HL I u i.~,~ ~I. = 4863 iatiLS yU°., ~It.Lr~_~E= 4052 i=FiL T~_' ~;Li_If"lE = 3241 C:r'L IiL I ~3HT = 53.63 I N~_'HE~, t.:hTER t?uL = O GtiLS i;,i~TER = O.OO I NC?HE `I'Ef°1F' = 59.8 LiEG F T ':PLUS 1.+'~JLUP9E = 5412 GtiL:3 ULLHGE = 4?33 ijHL 9O°i. ULL~GE= 3? 18 Gr";L5 TC' ''Jti}LUNJE = 54u'2' c;HL HEIGHT = 50.00 IPJCHE~ t..1~iTER tl+;iL = U i_;r=~L t.:t~TER = L .CIO I PJi_ HEti TEP'1F' = 62.4 UEia F 'T :3 : UhJLEi-;UELi '~.? C+LUP9E = 10351 i;HL ULLr'GE = 169CI i :nl. '3Cc~ ULLtiGE= 485 C~r-,I.;' TC 1?~,3LUt"lE = 1 C1380 i_~~;L-, HEIGHT =IO'2.25 IPl~ +tl.:.. 6JHTEk = O.OO I I i~ HI.:=, TEMP = 55 . y 'Ii~;ij F tJCiLUf°lE _ "416'2 Gr;L:~ ' ULLtiGE = 386? i;~iLE , yO;,V. UI.Lr~;,E= 3064 GtiL:~ i (! TC' VuLUt°lE = 4140 G~iLE HEIGHT = 61.?3 INiHE:, ' ' WHTER 'vGL = u C:HL ~ i ~~ I~JHTER = O . LCI I fV~'HES 1 TEMP = 67.2 UEG F ~ i ~' ~;,s. . T 5 : UhILEr=;LiELi t}CSLUt°tE = 3936 Gi~L ULLr'iC:E = 8108 i=;riL~~ ~ 9O"~ ULL~~=~E= 6903 i;F1L~ , TC' VULUt°1E = 3909 ir;LE~ HEIi:;HT = 43.41. INi='HEE WrTER Vti}L = i I i::riL:3 WHTER = U . 8O 1 I t'JC'HE TEt^~P = 69. ? DEG F T 6:SUPREt°1E VCiLUt~lE = 316? i;;L -SEI:i: ULLri=~E= 4Li59 ii=iL:3 TC' 1?~LUN1E _ '31 X15 i3HL: HE I CaHT = 5O . p 1 I PJi`. HES t~JHTER t1UL = u GHLE 6Jr~TER = O.OC I I PJi. HE : TEt°1F' = 69.8 UEG F T ?:LiIE~EL 'viiLUt°lE = 36'2.. Gr~L ULLf;i_;E = 841 ~, i;hL~_ 9O"u ULL~i=~E= r21 1 i3hL TC VULUf°lE = 361'2 i=,r~L HEIGHT = 40.94 IN~_:HE~, 6J~;TER VUL = CI i=,HLS I.JhTER = U . OO I PJi_ HE°~ TEt°1F' = 69.4 I!E~, F .i x ~i x x* Et51Li x x x x x ~ MU~IITC}~iING SYSTE~VI CE~tTI~CA'~'~Cl~T For Use By All Jurisdictions ~tftiit the State of Cal{{otzur, AuHtority Cited: Chapter S~?, HeaitJe acrd Safety Cade; CJtapter it5y Aivisiott 3. ?title ,23. California Code of Regulatiwts This form must be treed tp dacutneot testing and setviCing of inrntitaiTng eguiptnent. A sew ceatificatiort or ar.oott must be~pattd ftar each. tnortic-amid Avs_tem cotttrnl rases! by Rhe toctnnician vvlto perf~nos the work. A ea~py of this Cotz~n must be provided to rate tank system owaedaperator. The owner/operator must su[7nloit a ' of this farm to alts local ageecy regulating UST systems witbuttz 3d days of test dale. A.. Gtroeral.[~nfoxmatian Facility NautTe; ~d W~l+f~, ~~t P 1/f~,~ Alar7~E. S`r~~ f~'lcaf~rr~-tr B [dam Na.: SifieAddt,ess: 23~~.~ ,~f= CttY• ~~~~' ~ Zip: F+a~ci lity Ccsntact 1}ettwn: - - _ Cotttatt Phorte~ Nv.: (~_J ]Vlake/Model of Manitaring System: ~/'~~Y'Cp ~/YI C Date af'1'esting/Sernicing: ~ / ~~/ O ~ B. Invea><tory aI IJquipment ~'t~ibed/Ct~fied Tanlt m: 1 +!S ~ etc.. ~) >r Tank Gauging Ptnbc. ~d Annular Space or Vault Sensor. Piping Suntp /TittYUCh Sepsot(s~ )'*ill Sump Scasor(s)_ ~. Mechanical Litre Leak Detester. q Electronic Line Leak Detaxor. D Tank Ovetf'Yi l /high-Level Sensor. D.~oth~e~ [.a, a td went t e and TanklD: }~ itt-Tank C~ugittg Prdbe. ~ AnnularSpace orVault Sensor. l'FF Piping 3nutp / Ttettcb Sensor(s). D 1"ill Sump Scitsor(a). ® MGdtanical Lute Leak Detector. D Bleehonic La rte Leak Dcbectar. U Tank Uverfiil I.High•LCVeI Sensor. A t7thra (stredfv oaaiotntat true and Madcl: ~- Model: c ~~tL'~et~ Model: ~C.a~~ ~ { Mold: Madrl: LL? Mudd: Model: Model: para. Mod~d: ~r~l~~~'~~1sStLt Model • s'~,tP~m ~+' Model: _ - Mode1: pLl) Modci: Modc1: 'lm• ~ ~~ Vic.. M Iu-Tank Gaugjag Probe. ~ Annular Speoc or V anlt Sensor. 3$ Piping Swop /Tnonch 5ensot(s). O Fall Sump 5ensorls). ~ Mecbanical [.ice lmk Defeco4r, J] PJephottic Lute Leak Dctetxor. O Tanlt Overt`ll /High-L+,wel Sensor. O t]cltar s ocYf eat and 'I'sntl[ ID: ~~ ~ In--Tank Gauging Probe. ~ Annular Space tx Vault Sensor. ~ Piping StAttp!'15~ettch Sensor(s). D FII Sump Senso~[s). ~ Mechanical Line Leak 1}e3ecYaa: D [Gltclronic Line Leak Detector. 17 rank Ove~il /High-Level Sensor. Model. Model: ''1a~sX •'Si-Lse,.^ Mosel: s gyp' ~r~r Model: Maa~i• ~~~ Model• Modci: Model: Model: ~~~L ~Ir~.~Clr~L Mods:~`' s~a_r Model: Model• Model• Model: nispeaseTr m: ~ ~-~~_ ns~,t~r m: ,~ ~-Z o O DispcnserQpattainrnetttSensor(sk Model: OI~spensert;:onraintherttSensor(s). Mode]: 1~ Shear Valve(s)- Jill' Shear Naive(s). O Disttattaes Containment F1rmt[sl and L']u~fst ~ Disecns~r Cbnhdnmr~t F7natfsl end t~ninfel Dier]Q3: f.~/~ D Dispenser Corttalttment Sertsor(sJ~ Model: - ~! Shear Valve(s). ~] bisoettser Goataintneimt Float(sl sad t:htun(sl. pislteaser im: 0 Dispdtsot ibnlainrnent 5ertsor(s). O Shear Vaive(ak D Disrxttser Containment Plaiatds~ a, Model• lbhsptznser IA: l "7- I_8 pi~erlD~ O Dispenser t"aotaiatnettt Scosor(s). Model: O Diapptser Cotrtaiternettt Setispr(s). Model: ~ Sbcar Yalve(s). O Shear Valve(s). ODi nser "nmatt F! s and C71sin s ~ Di sec Containment F! s and Cltei s *~f the facility enacts morn tents or dispensers, copy this hortit. Include information far every tank and dApratser at alto facility. C. Ctcation . I certify that sue egtdpmneae ldcut78ed [n thole document vra~s ittspected/aerKced ltt acat+ivlance vrlth rue inanidactaicrs' guidellnt~. Attached to this Cerlfdicitlian i9 iMt-rm~ian (ep, mamtfatturere' cheddstr:) nocesaaa7 tp verity that thfa Rnulbzmetto~u is correct a~ s Plat ]?9sq ahowing tLe laxont of nit-goitaring bgt>ipmepd. Far syq egpipinent ertpahie of geoerstitig snclr t~eporftS I{ have slap tit;sclted a copy aE tJtc report; (c,ieek erdI tYrQt '): (~ Syatetn sef-a p O Alarm ltistatY ~P~'t Tochtdtxttq Natrte (paint): '~1"tc.G.Q LfJ. li4iti,~! yt~ Signattere: --z.f .,~r~ Certiftcadon Nv.: 006~~5-/17S C.ieet7sc. Nv-. ~i~~l,(~_~ TcsCing Comps^Y Nattte: ~- P2tone No.:( 6~) 32 7 93Yt Site Addtess• ~~ ~ ~ $~: ~1~F~~tiC~~ ~- Date of Testin~l5erviaing ~1G j~~s' page i ar 3 Y3A2 Mottitoring Systtsm GeTd~icsl3on D. Resalts o~ Testin~~,~ ~. Comments• Page 2 d 3 03Jb~ 5o4Ewure Veirsion x~taliod: F. In-Ts~It ~aug~ng !SIR E~aip~egts ~ (~aeck this box if tank B~SinB is used only for iQVeetoty oontrvl. D Check this box if no cenk gauging or SI4t equipment is installed. 'xttis section trust be carzapleted i ~ in teak waging equipment is used bty pexfarm leak detedianr monit+~xing. O Yes 4 No• Hgs aU iarput wiring been inspected for proper entry and tetrrunatian, including testing fa ground faults? O Yes ^ No's 'Rrere all tank gauging p~abos visually inspected far damage artd residue buildup? ^' Yes ©No* Was aCC~aracy of system p~coduct kvpi readings testedT 4 Yes O No* Wss aecuracy of system water Ievel readings testaed7 G1 Yes ^ No* W~ all probes reinstalled properly? D Yes D No* Were a1i items on the egitipandrt manafacturePs maintenance checkhx completed? * xn the l iecttaia kI, below, describe lnrow stied wheII these de6cieacie5 were or w7[ be oazrected. G. Lfnue L~ttt Detectflrs (LLI]): D Check this box ifLt Ds si'c not installed Xes ^ No• Y"ar; esluiptt-errt start-up Qr aonniueI equipnneirt certifiieaaott, was a beak simulated w Yeriiy Li.D perfa~nnaaQe? ^ NfA (check all rhot aFJ+I7'1 Simulated Ieak rate: ~ 3 g,p.6.; ^ 0. t g.p.h ; D 0.2 g.p.h. Ati Yes ^ No* Were aI! LLUs confirmed operativaral and a«xuate arithin reguiatary s~ogoiretneots4 ~ Yes C] Nos Was the testing appatants properly calibrated? Yes ^ Not For m~echomfcal LLDs, does the LLb restrict product flow if it detects a Iea1c7 D N/A ^ Yes D No* Fox clecxronic LLDs, does the turbine automatically shut off if the I.LI] detects a Ieaki! N/A 4 Yes D Na* Far electronic IdAs. does the tutbizte autanadcally shat aff if gray poztion Qf the monitoring systeot is disabled N!A or discanneoted7 ^ Yes ^ Na * For eiecti'onic 7,LDs, does tfte turbine autagrratirsilly shut off if any porn corn of fire manitorintg system mralfiu:ctions 1,81 NIA or fails a test? O Yes D Na'~ Far alectranic LLDs. have ail aoassiblo wiring connections beets visually inspected? N/A Yea t~ Na* Were a1} items vn we equiprmeat raaanutacttura's maintenance checklist campledod? • xn toe Section $ below, desct~ibe Lave and when these de8ciencles ~ or wla be caxtected, H. Cat;nments: 1's~ge 3 of 3 airei on,~urGng System CcRtitieattnA $ite Addt+CSS: ~ J~ ~ _ _ S~~ ~~AI~ . . _ . _ ,~ _ bin.t,, , . . . . . . . . . . . . . . . . .~ Qt) "t]b . .~ lcl~?NMk/6+.p• , _ . . . . , . . . - _ _ . ~~ . .S~ 9 .~~. _ _ _ tyate m~ dra.~: ~~ ~ E ~ins[raacliops If you already have a diagram that shows all xequited ittfom~atiotx, ypu maiy include it, rather than khis page, with your Mottitoriing Sysbeim Cexf~cation_ du your site plan, show the general layout of taroks and piping. Gleamy identify locations of the fallowing egtripmeat, if instaDcd: rn~anitaring system coiitrot panels; sensors mnnitox;ng tank annular spaces, sumps, dispenser pans, spilt cantRiners, or ether secondary cotttaimrteat areas: mechanical or eiectx+alnit line leak detectors; andun-tank licpeid 1eve1 pmbeg {if used #'ar leak detection}. ,tn fire space provided, no6ee t>xe date this Site Plaa was prepareXl. page r of ~ ash V,A-POktI.ESS MA,NUFAC7'CT~.tING, ~.NC. LDT'-$9Q Lesk Detectolr Pest g,,~ord oote~tar Date L e~L Leak Detector irr 8ubtaerslble Pump Test at Aispeleselr ~ubeaerswble Farop )Cden4Bcaban anerfac Model N . ~~ Serial erne er e Leak Detector tdentifcat;on acmre;~` l7 Other Styl ak e biapliragm-type Piston-type t~ Tamper-proof seal installed? Yes ,__. No I. Operating Pump Pressure_ ~$ tysi (para. l5) 2. Gallons per hour rate _ Q (pares 22) 3. Line presstu~e whit peAmp shux uff 20 x-si {para. 23) 4. Bleedback Test with pump off S.S ml (para. 2G) -~ ~- Step-tlerougte titxre to full flow ~ `seconds (pare- 30) 6- freak detector stays in leak search position. (para. 42) Yca ~ No L>E.A,K D~'I'ECTOR TEST Note: Faso ~ Leak dcEtCtar fits test protocol Feel ~ Leak deteetoa. fails test pcoevcol Pass / a~au Fdrrn 8900 {9- l -96) roduct _ e Le Detector 'Cumpietc therms) expansion test before filing leak detector. 1996 Vaporless Mannefacturiog, loc., Prescott Valley, AZ VAPORLES~ MA-N[TT'ACTT_T~RIlI~~, ,INS. LAT~94 Leak l]eteefor'I'est Record Con ctor `~ tome v r~~ !sr C ~Y D a I.ycahon product ~lua'c;an $' uc. ~f3~4cce ty ~a~uufacturer Submersible pump Idenblficgpion odcl o. Seri umber Leek Detector Ideq#ificetion anu c Descrin3ion ~b ~' Other Style I Detector -~Jt1~` Diaphragm-type Piston-type k.. Tamper-proof scat installed? Yes, Nu Leak Detector in Submers~rle ,pump Test at bispeaser 1. Operattng pump pressure--2~ psi (para. i5) 2. Gallons per hour rate~p 3. I.inE press~e with pump shut o~_ / $~Sl {Para. 23j 4- Bleedback Test wi4 pump off~s5 nnl (para. 2G} 5. Step-t)rraugh time to full #Iow ~ _ seconds {para. 30} 4• ~~ detector stays in Ieak search position. {para. 4Z} yes ~, No >J>~~x DLTECroR TEST Note: Favs f Lcak de[ecWr fits test prot4COl IK'aN ~ [.cah detealcu f~i IS tcsll~nxol Paso ~ Fail Farm 8900 (9-1-96) 'Complete thcrtnal expansion test bet'arc Failing leak detector, [996 Vaparless Manufacturing, Inc., Prescott Valley, A„Z VAPQ~ESS ~~ANiJ~A,C'TURZNG,I,NC:. LDT--890 ~,eak Aetectar '~'+~st Record Contractor Cuswt~ner ~/-;/a~/C~~--~'ui r~ir161~7` f~cx 6s~tr'f_`D_Gc~h ~ ~ Iliry~ titm ch'°t ~ J~' ~~ 6 ~3/~ L S~: ~3a,~e ~s~i tom{ ~ • g'I wG /1/. Tee -an Snbmersi8le Pump Iderxtiflcatiurr Mantrfacttrrrer Madt:l No. Send Number ~e~a a~~ Leak Detector tdcntfi~icatwaa Manuihe:turer _.. Desarint'toa Odler Stvie Leak Aetector 1~~~ 7`' Diaphragm-type Pistrnt-type ,~_ Tarrlper-proof seal installed? Yes_ Na Leak Iletectot- fn Snbmersfble Damp Test at I~is~e~tser I. Operating Pump Pressttrc~~~si (,para. 15} 2. Gallons pear horn ra#e _ '3 • ~ (~.ra- 22) s - Line pressure with pump shut a£~F 16 psi (para. 23 j 4_ Bleedback Test wish plrmp off } #1 rnt (para. 2~} 5_ Step-through time to full flow~'sectmds (para. 3U} 6. beak deteetpr stays iu, feak search position, (pare 42) Yes ~-- No LEAK DETECTOR TEST Mote: Fars = t~tk detector Errs lest protocol Fail =beak detector fails test protocol l?ASS ~ Faii Ftmn 8440 (9-l-4~ *CompIcte tirerrnat expartsion tes# before faiiirtg leak detectar_ i94G Vaptrrless Manufac#uring, Inc., Frest:att Yalicy, ,A,Z VAP(]R~ESS NXA~NUFAC'I`Ul~'~TCi, INC. LDT-890 Leak Det~etor Test Record Contractor Customer ~eRj (fR.f)~~ ~~te,~/M~'h7- dal.yt~ti+"acsryz C6~~t/Yi7H Diu L,oca 'o pro ct ~ /~' -Q ~ 2 3/7 L Sf ,~csr~~yrc~'~el~C~ CFt - f]i~sf~ Tt~hnlGXdil Svbmersi6le Pump Iden~tificatinn Manufactuuer Modt:1 Na_ Scriail Numlaer ;~~~~ Leek Detector lldentfi~ication Manufacturer Descrin;~o~n_ Othar Stye ~.eak betector ~~I„„aCifC~9`` Uiaphragna-typc Pistaa~type_ is _ Tamper-proof scat installed? Yes Na X.eak Detector in Sttbxtiersibie l?uump Text at Dispenser I . Operating Pump Pressure ~ ~ vsi (para. 1 S} 2. Gul3ons per hvur rate ~. b (para. 2Z) 3. Line Pressure with pump shtrx off ~ ~ _ »si (para. 23) 4. ~leedback Test with pump nijF 70 tnI (para. 26} 5. Step-through time to fu11 ftaw ~ _ scctn;ds (para. 30} 6. Leek detcctnr stays in Ieak search position. (para. 42) ~'es y No .LEAK DE'T'ECTOR TTST Note: less =Leak dcaector Bts xst pmweol F~ = Lcsk cfetECL01' fitiLa test prbtOnat Pass Faii Forzr- 8900 (9-1-96) 'Compicte thermal expansion test before foaling Iealc detector. t 996 Vaporiess Mattu#'actttring, Ioc., Prescott Valk}; AZ i .~ CAIY-VALLEY EQUIPAIiENT 3500 GI~MORE AVENUE a BAKERSF1ELb, CA 9330$ l~ • {661) 327-9341 FAX: {669} 325-2529 CONTRACTpR'S LIC.#784'! 74 A HAZ ~' 'ro: f'~ t'f/~ r7 I from: ,~I.GGP .. - fax: ~ j °~~'~~ / / Pages= fNCLUDING CON~R nTT; ,p.C~.Q ~ mate: Re: cc: 0 f O Far Review ^ please Comm~rrn ^ Please Reply p please Recycle Cvmmenfs: //~~' )~ B ~~NTTQRING ~YSTEIV~ CERTIk~C,A,TION For Use By,A[1 Jurrsdre~fotts ~tliin the Stub of Calijpnrat~ A~ulhorFry Gtited: tlruprtr (7, .fifeadth vad Safety Code: [ynaptsr l d~ Divi.4iott 3, 7~FNe 23, Cal~fomia Code of ~ReBulalionr This form must be ttsod to documcttt tcs4ng and servicing of nn'ntituring txluipment. A~~*ate cetrliic0.t3otl or tart xttust bed for each m~rtitaritrp,~y$$~ teattiol nand by the technician who pexfiortns the won&. ~A- Dopy of this foam must be pra•~ided to the tank sysient awtter/aperato+r. The avvner/opetatar must strbndt a copy of this frntrt to the local agetrcy regttlatiag UST systems within 30 day& of test date. A. i^~neral Inforrnatitm Facilitp Nattte: ~-r,~~"••~r^ ~~~~_- ~OI.t~L1 Sj~e Il'?4N('t'uv' Bldg. No.:~ situ AddreAS: ~3/ ~ ~ S9= •-- City: ~cr.,,~.r.!"s c.Ea~ T p: Facility Contact Pelt: _ Cootaat Phone No•: (~,_, l MakelModel of Monitrning Sgstem: ~ ~ ~ ~~Ca ~!'I? C Date of Teatingl'5erviciatg: ~,/6 / DB S. xlovtzntaiy ~ Sgaiprilent TesfedlCtert~~ C•-IIECR SOfC RAfR~ Yi~e7 W Ywm1Y~ C Y Tank ~: ~ ' ~ in Tank l"rsugigg Probe. Mudd: 9 Ia-Tank Gang'tntg Frebc_ 1+~~1t,_____~_, Modc1; ~ l ~ Annular Space or Vault Satter. Model: A Annular Spaao as Vault Sensor Yau+r Uy Model: t Piping Sump / Tt+emrb saasatis). Modal: ~ Piping Sump I Tstara6 Sensor fs3. Model: Su.sx G S~a,~4!" D ~dl Sump Scrisot~s). Model: ^ hill $utnp 3easor(s). Model: ~1 Mcchattical Line Lmk Detector. Model: _~~..._._., ~ Mechanical Lim Leak betrecor. Model: / - D Elecirorda Line Leak I7clCdar: Mold: D Lint J cak Deletion. Model: -- D Tank Ove~11111'~-Level Seo~sar. Madti: 0 Tank tlvecfili / ~ghrL•cvet Sensa~r_ Model: O gyres arrd tuodd in SeCtitm E an P 2 O Odtdr t sod iri Section $ OID 2 . Tank ib: ~ Tank ID• Q1' Lr•'tarrk Gaupjng lynobt. MgdCl: D Ia-Tank Gauging Pro1fG Model: ~ Annular Space or Vault Sensor. Model: .5E D Aaaular Spate a Vault SeriSOr. Model; !~ Piping 5uotp /Ttetied Scnsas(s). Model: 5t,rt+s~ ~t~rSuY' D Piping Sump /1Ycflch Seasot(s). Model: O Fll Sump Sertsot(s). Modal; O Fill Samp 3etraoe{8)- Model: ~ Meehanie$] Lune Leak betatron. Model: L D Mcrharrical Line Leak Detector. Model: O Eletttoaic Liae Leak 1)dedar Model: D Bie+ctronie Trnre Leak Detector. Model; D Tank t?veTtill llliglr-Level Season. MOdri: ©Tan><Ovesfiil /FTrgh-Level 5eneor. Model: D Other rstt cad rnadt•1 in Sectia~n 8 on Pa 2 . O Other ui t and trade! in H ao P ioispe~r iou: - 1~~ l~p• In:2 ~ - D bispcazscr Containment Serprot(s). Model: O Aispaaser Corytainmont 9etrsox(s). Model: ~lGShear vatvC(s). ~ Shear Valve(s). D bi Containment F7 s cad ptairt s 4 Di ser Caatairiri>wtt F! s d 'a s Di m: '3'y _. - Aispertser111: -' 0 D Dispmrsar Caa+taiameat sensor(s). Model: - _ a aispeaser c~onraiemcttc sensor(s). Mc~d: ~ Shear Yaivo(s). f~1 Shear Yahrots). D Di ser C3nntaionment Fl s n,rd Chains . Q Ui scr Caartaiaatertt Fl s cad Choi s . ~ Confainmeat sensor(s). Model: --- O Ats' peaser user Contaiomcxrt Se~nsoe(s). Mudd: i,~Shear Valve(a}. iS~hear Valve(s). D Cantairitntmt Pl sand Chains . Q Di ertar Containment F1 s and Quda s . +If the facility ootdains a7orC tats or dispenstxs, co~- tries t;otln. ltoclade eatot'roanon tar every tags aaa atapegiaar at me raiart~y_ C. Cerd~t:Yitlotl ->; eertlfp that lltie tgvuptnent Weoli~al itr this doatnrte~t ~ laspcrudlserviced in accordsuace will. rlhc tnsnatl~rrers' gnide#udes. Attsdred bo tLis Certidir~oer i9 ldbrma8on (e~gr msaoficlarerg' dreddiats) ttt~oeasary en vet7lfp tlrtrl this InfaRnaeRiaa is tarred and a Plot Plat: s>,owing the iaront dmooitoring ega~tnenf. For arty tgaiparreat npabie aCgeotral9ng such repoAe, I Gave nfLsu attadwd a copy at'the repo ; (c&eck at[tkae k D System set-ttp ~lsts> ~history~~ Tedtrticitm Name tprittl): W. ~,,~~~~- Sigttature• -'~ Cticctiftcadon Na: ~A~-d5 l~'?~ Lactose. Na: ~~`~/ ~0 ~" Testing C'~mpany Nattre: ~~,~-1/~! J ~ u..~ry~°t~7` .Phone A1o.:( l }, 3~,7~'~3*~j Site Addre~: '~ ~ ~ ~ L ~ .t • ~~',..• '~/~~'.g' - Data of TestnglSGt+ricingt ~~ D 6 Page i d3 Morut+dliu~ S9stem CtrtiGratiaar l~. Resalts o~ ~estingi5eiwicing software version Installod• .~~ Yes [] No's Were all sensors installed at lowest point of scoorrdary cantainme»t anct positioned sa that othat egsdptnent wiii not intert'ere wit4 their r o on? Yes ^ No# If alarms are relaysd to a cClnate rnonitatang stafiion, is all caunmurdcations equipment (e.g. modem) l~ l+TlA operational? Xes ^ No's For pressurized piping systdns, does the tur~lne autcomatit~aIIly shut down, if the piping secondary Cvrrteit)mdtt C! NfA monitoring system detects a leak, fails to c~peratet or is e]ectricalIy disaDnnected? If yes: which sensors initiate positive shutdown? (CltecJ~ all thaat apply) i~ Sumpli'rench Sensors; ^ Dispenser Cotrtaimneot Sensors. Did confirm ' 've sbut~own due to leaks sear failurrldisconrreccionT Yes; D Na. Yes ^ No'" For tank systems that utilize the manitoriag system aS the primary tank overt tl watreing device (i.a no I~ N/A, tnechatrical overfill pnevemian valve is inemlledl, is the overfill wamaing alarm visible and audible at the tank ftll Sand d 7 IF so, at what of tank i does the alarm tri ~ Yes* Od No 11Vas any monitoring egtripanent t+cplaced? If yes. identi~r spoCific sensors, probes, ~ other equipment replaced and list the n~facwrer name and riaodd for al! t in Sec~on lreloW Yc~sf Q No 11Vas liquid iour~d inside any secondary contaittrne:tt systems designed as dry systems? (Check nit that apply) O e In Section E below, dt'be true and when tlrege dt:ticlendes w~;re ar all! be corrected. E. Comments: ~Sirla// f~rdta.,* o~ 1RS~,.~p~4r/R.S ~c~d ~k Y-~e S'9' (!L T'~rbr'rie .5cclrr,~, ~e a oc3 a3rox F In Tsuwk Gauging 1 SIR Egnipn,ent; (deck this box if tank ganging is used only for inventory cvrt4rol. D Qteck this box if na tani~ ganging yr SIR egnipmertt is instaltod. This sectfon must be completed ~l'ixs-tank gaugirsg equiprent is ased to perform Iealc detection motrirtoriug. iasn °te the t7sltvwl t:ht~tist: D Yes d No* Has alI input vviriag been inspected far pnpeat entry and tetrrrination, irrcludnrr; D xes C~ Nv* Woe all tank gaugin8lunbes visually inspected for dsnu<ge artd r+e~idne build Yes D No* Was accuracy of systetrr pr+odtra level readings Bested? D Xes D No* Was aceLUacy of system water love] readings tested? (] Yes ©No* Were alt probes reinstalled propetiy? © Yes D No* v[rere alt it~ris on ehe equipment tnanufactu~r's maintenance checklist ovmplR * Itt the Section H, below, describe tRO~v stud when the®e deR9denidcs rovane or will be corrected. G. Line beak Detectors (LLD): O check this box if x.LDa are not installed. 7Ces ^ No* For equipment start-rp or anmial equipmem certific~ticm, was a Irak simulated co verify L.I,D mace? ^ NIA (t"_'heck a!1 tfiot APP13'1 Sirturlated leak rate: ~(3 g.p.h.; D p_l g.ph ; O U.2 gp.b. ~ Yes Yes JRI Xes L7 Yes ~ Yes D Yes ~ No* were all I1.Ds canfrtmed operational and accurate within regulatory requirements? D No* ~ Was the Besting apparatus properly cah'brated? 0 l~Io* l±or mechanical I.I.Ds, does the 1,.~L1] restrict product flow if It detects a leak? O N/A d Nn* For elecorordc T-LDs, does the turbdne automatically shut off if the 1:1.D detects a leak? to ve• ~ Nos For elecknaric T113s, does thrr turbine autornatically shuk off if any ~ N/A or discanr~cBed? O No* For electtmic I.i.Ds, does the turbine autorryaticalty shoe off il' any P ~ N!A or fail a test? O Na* J For elec4tvnic LZI]S, have all aCOessillle w}~ ~~~ O~ ,,;, of the trranitomriog system is disabled of the rnamtoriog system ~ Yes J D No* ~ were au lts~ms an the equipment marr>afacarrer's maintenance checklist comply in ttte Se-~ian }~, below, despribe Crow 9nd when these de8drmcEes ~ver+e at• wllt be onrrectcd! ~. Connne~ats: e mot: ~-~a,,'l~o! ~ r/c I,~a.~C rale~ccta~. , Fade 3 aF 3 ~ f 14Ii0AItiDliOg ~$bEID ~iCCtil~CStiOd Site A,ddres~ ~~~ Site ~'l~tII . _ _ ~~ . . _ .175 _ aanwl~r. ~ . . -----~.... o ._.._.. ............. .. _ :::::-~----~r-.$~t.::--~--::::::::: :::::::::::::::::: :::::::::-lz~1r:::~~~::::~~:::::::::::::::::::::--~ : : : : :: : : : : ~ ~g. : $ Lt ~ : : : :~ f : : : : : : ~: : : : : : : : : : : : : : _ : ........._.._........~~t~! ~bdat:......:: ~• Date map was deawn: ~ r~_ t~,~ xastructians `you already have a diagtam that shows all required infiatmetiody you r~nay incituie it, rather than tide page, with your Monitvrittg System Certiixcation. On your site plan, show the general layout of tanks and Piping. Clearly ideut:fy lorativns df the i'allav~ring agent, if iunstalled: m~oaitoriug systeta cou~t+nl parcels; sensors uzonitoring tank aacnilar Spaces, sumps, dispenser pans, spill coatau.,srs, or other seoonclary containment areas; mecl~7nical ar erectnoaic lint leek detectors; and in~ank liquid levee] pzobes (if used for leak detection). Yn the space provided, note tho date this Site Flaza was prepared. rage ? oi~~' 45~eo VAk~RL~SS MA.NiTFAC'X'iJR.~NG, xNC. LDT-$90 Leak Detector Test Record tCdCSbr / ~y r A~~.-~~el l~lll ~Ari_:Vilwtrll~.~ fJwf-.,y~wi. ~l_ ~~ O)~rwf~ Date ~ F ct Sabt»ersible Pomp Identlflcatemo Manufacturer Mme. Seris~l~!iumlyer Leak Detector Identification Manu~ctttrer ~7esrxivtion Other Style Leak Detector ,~-~'u~c~_ ~'f' Oiaphsagm-type Piston-type !~` Tamyper-proof seal installed? Yes Na_ Leak Detector in Submersible Purop 'Vest at Dispenser I. Operating Pump Pressure ~ ~ vs~i (paw. 15j 2. Gallons per boor rate '~, _ Q (pat-a. 22) 3. Line pressure with pump shut off~si (para. 23) 4. Blcedback Test with pump ofl' ~i~~nil (pars. 2~ 5. Step-through brine to full flbw~_secovds (pata_ 30) 6. Lea1G detector stays in leak search position. (para. A2) Xes v No LEAK DETECTOR PEST' Note: Pnse =Leak detector fits nest protocol Pail = L,cak dcttrwr f9i1s test proopcpl Pass / Fail Form 8900 {9-I-96) *Camplete thcrrrtal expansion test before failing Teak detector, ~~~ Vflpalriess lvianufecturibg, Ittc., FreSCOtt vavey, UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD / LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMff NO. l ~ ~ ~ D ~'/Rl ARTAI T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DETECTION ^ LINE TESTING ' ~ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ^ 10 PERFORM FUEL MONITORING CERTIFICATION SITE'L FO RMATION ' . FACILITY ~ NAME 8 PHONE NUMBER OF CONTACT PERSON ~- '""1q~~Ls+q~s ADDRESS L L v' e.r- OWNE~(~IE ~~ OPERATORS NAME ~~ ~ ~eww. PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES 'El NO TAN # V L ME C NTENTS ~ / ~? OO ~'7 1~ 3 a ,o ~ t t~~ m c~ a v ~' ~ ©©~ ~% ~,~~ ~~©~ I~t`v r TANK TESTING COMPANY ., NAME OF ESTING COMPANY 2.C~14ann NAME 8 PHONE NUMBER OF CONTACT PERSON ~ ~` ~~9-~A MAILING ADDRF,,S$ ~,J NAME 8 PHONE NUMBER OF TESTER OR SPECIAL INSPECTOR `~ -Q1~.9.- CERTIFICAT`IO~N #: _ `~ ~ t9 ' V` DATE 8 TIME TEST TO BE CONDUCTED ICC #: TEST METHOD _ SIGNATURE OF APPL 1 ` DATE ~~~~?~ bJ~ APPROVED BY DATE FD 2095 (Rev. 09/05) UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT N0. ~-~ ~ O3 ~J~ s sasP> n Pine ~Rr~r r 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 ^ LINE TESTING ^ SB•989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ~TO PERFORM FUEL MONITORING CERTIFICATION SITE.INFO RMATION FACILITY ,' NAME 8 PHONE NUMBER OF CONTACT PERSON ADDRESS OWNERS NAME ` ~ OPERATORS NAME ~ PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES NO TANK# VOLUME CONTENTS I ~C`?d ~" 7 G L ~ ~ L .fo -~ L L - - ANK TESTING COMPANY ~~ NAME OF TESTING COMPANY ~ NAME 8 ONE NUMBER CON ACT PERSON MAILING ADDRESS ~~ NAME 8 PHO NUMBER OF EST OR SPECIAL INSPECTOR CERTIFICATION #: r ~' DATE & TIME TEST TO BE CONDU T o~ ICC #: TEST METHOD SIGNATURE OF APPLIC DATE APPROVED BY DATE -Q /~ QOb FD 2095 (Rev. 09/05) %~.v~ 7 ~i&~G