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BUSINESS PLAN (3)
~` ~~~. ~ ~~: I , . ~ RIO BRAVO MARKET ~~ ~~ ~ i r ^~. ~' v~ f ~~ ~~., ~~~ l l o~~ •~ G;o ~ 5~ `~ of ~~ . ,. ~ s., .. ~~i~_ 1.:'. ~ ~' ~SE~~ ~. .. L:{- ~. +S±GV'vs-^.'~~.7 i E~ LL' ~T~'4A 1. iVN ~11 ~_ ~ _ . DATE ! ~ ~~, ~ ~ FA Y. f~iAe~=f- ,~ F,~l~tI1TY ADD~"5k,:~~ ~co G : ~.~= n ~ ~= „~~ r. ,. ~ o.,e~r ~j t C i (~i /~-Q ~' : ~ ~ S pia ~ ~~ ~ /oG Y r 4 4 -u~- ~~ ,,tq~S:'1 ~cG~' tF .' i ~~~ I' tI~T A~ilar Spas . ' . % ~~ ci . , ;, ,. I ~ T~k 1 ~~ '~'stik x Tsx~h 3 ,'l'aaotk B ~~$, ~ ~~~: ~~ ~ ~ ~~,; ~ti~d Pre~wra ~ `:; ~~~~.. ~ ~~ T6ne % -~ :fig ~ i~; r. '_ J ' t °, ~~~II .F.., .. f - ~~~ `. - ,.. ;~ ~, I ~7 .f... ~. i ~~; ~ I ~ ~' i -;~~ ``~;f ne $ ~ f Lint 3 Gi;E'iy ~ I iR~lKia ~~::;j •~ ~`~' " I ~ '~tbe ~ - ~~ ~ . J~X( 57;. , j tip. I ~ ~ . . •,... .. ., '~5-.~ ~ ~ yy~~, L.~OIi .:~. ~'~ ` ~~~ ~~'~` ~ . ~ . ~,, ; ~9 ,i~ . -, Q~~ ~ .. : ~ : . 3 g~ ~ x: ~ ~~ P ;~= ; j ~~~~~ ,.~ ~ ; ~~ ~~.4 ;:;. ~,;d <<R }~ ,~' k :~' ~~`T:~ ~ I Ori~~~ ~~D i X111 1.riA i l~' iL~~ViT ~~~1.~) ~~. y,. ~ i ; D'I'E ~. . ;: ~. a,..: bm . K~, ... ~~ ,:~. f..:- I " FAGII.. 1A~ ~ FACXI;,1'~'Y AI~L?R~•95 ~ .~,D ~~ (, (- ~,/}~~_~?n1~ D ~ f~ ~1~! 7~.4 . ~3, ;:[ .. ~'A,;. , ~:~ Ttirbine ~~ . ~;:,;;. fir, ,, ,... ~~; ;_: 5aagt ~ ~~: ;; . ' ` Snap Z ~ 5u~np ~ !_ ~~ t _ i { - ~ ~ ~.. ~~ ... ; fi~ ~ , as , . ` ' , ~ '' ~ :. ~ '~V~rA . ~ ~ ~;~ ~ ~- Ogg i~ ~ ~, ~~ , . ~ = ~ Y.q I ~~~ ~ ' ~ ~~f N ,.~~ ~ ~t~on . ~qSS~ A ~~.~ 1'1 .` ..i ' ~ I ~/ n~y,-, ~~ ~~';. ~rlilE Bacicets ' ~, ~i~np 4 Qv+i~rliA.1~ . , ~ . UverQ11 Z QrssH~l 3 (}verfiil 4 ~~... I ~:,, :~ ~/~s- ~~_.~~ ; ~ ~: } : bi water (0 7-'-~. ~ o"I;'.,.~ , ~~~ i fiirn~ _ //_.~ 3D /.' D -- +~,~`~ ~ ' lst. ... ~~ ~ iy .' n I ~~~ c: ~.' a. ~ I ~ , ~'; Page 2 of,~ ~.~ ~ ~~~~ S i it.. ~' ~::. ;,,~ ~,; _t `. ;; ~:'= ~~,; •.. ~ UDC TOTING ~• .~;_, r~~ '~~'< < ~: I # START TINiB ' ~ I~EIGR"I" Cl~' ~:~: • . i ~VATLR ,, ! ~'1~ATER ~EIGgT '~ ~~.. ~~- ~ ~. ~vdTE~ ;,:: Y. ,t '. ~..~ .., i ~.: .;; . ,:~: f5 - ~'., _, f. ~:. ~: Trt `:±.,,r . ~' ;• F•1 ~~t= : i ~~ I ~~~~ M1~,' f.•~. v. $~;; r ~. ;:' 1 k: -.: 3' zCi?1i~~f SYSTEM CERTIFiCA'I`IUN FORI-~ P~=~• ~: UIS~EiVSEii ,,~ ,J j i rf a -~3 ~~ ~..r. ~ . ~33;~ 7 . _F ~~~ 2 ~ D ~ ER 3 { D~SE~t a DI~P~N~ ::° D28PEN'S~;R 6 _ 3DISPENSBR'~ - DISPENSER 8 START TIME . tNTi'IAL ' •~ I~I+C~;HT 4F • wA~R Tim ~f+VATER ~ • ~VVATER ~IEiGHT • ~cc~-~on lcsccruTVR$~ - • Page 3 of _ 1(~f~ (~ Il ~(l~ ------__ SB989 TESTING FAILURE REPORT SITE NAME : f Q ~~O l7/AK-~c~ DATE` /: I,`(1 Cl (, ~~ ADDRESS: ' ~j p TECHNICIAN: QSR [J CITY : ~ SIG23,~~. SITE CONTACT: THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE THE SB989 TESTING. LIST OF PARTS REPLACED/REPAIRED: REPAIRS : rI(~(U LABOR: ~QOV~, FARTS INSTALLED : ~ ~~~ i ~€~~~~~~~~~a~ ~~~~~~~ ~~~~s ~~~~~ TC? E1E~EO~3~ ~E_~; Li~E TESTlS°~~ %~E39V9 S;=C~E~~~~ :' ~tr~T~Ei~EVE~~3T TEST°s~i ~T~~i~y-rE{'a,E~-€ppT+~~95 TE~6gd~(~~Ep~~TO'~~r'~E'oE3e~ E~3E4 1~v.~i~a! 1 L~ESYY2 1,.-~.~'•.Ti~"3Gii S jCJitl - ~ r a _ ~' "^° JI.iV !\=~-11E,L:i~ 13Ve See. 21~ ~~ ~a:~ej-s~e~d, L~ 933u1 'L'ei.: i6~? ~ 32~-3979 ~: i~6i} 852-2i7i ?~~~ ~i ?EP,M11 I`d0. t~~' Li ENH~INCEO LEAK DETECTlO~! ^ _INE TESTING ~ SB-~S9 SECGN>=.RY CONTAIN!`dtEN i TESTING i TANK T;GHTNESS TEST u T O FERFCR;G'i FUEL ~:'O!\ITORiNG CE? T !F;C:-'. T O'' 3' ~ _ ~.~.c.~..v~,.,._ t: _ - -- ~AC?i IIV Via.=?,~iE & s"eo c ~lL...~ze. C.~ r,'oE~t.-3:^,T ~,~'Ei~3"';'d ~s~w-t~ %?'1:~-- ~ ~x=~.~u.~ ~ Cpl - ~'`?~ -- ~~ t~~ 'ADDRESs 01^.~NERS NAivIE ~ ~s?E;~ATS~~;S s`~`;a,y~ ~PEFEi`~;T T o CP=rte L lvc:. TANKS TO BE TESTED ~.-i` S~ ~s tr ` _.F jV t -^JY IA[+?I- E TESTING COUlP~NY . '41t1~c:, :~!?~3fiESS l ~d rSt~ . ~A ~ 33a~. ~vnn= ~ ~o~E r~unn~l=~ o= T~s T E€? aa, s o3A~ it~s~~cTOR SATE Q ~}~r~'= T~sT To R~ co~voucT~o r~~ m•,r~l ltrti , ~ 1, ~~ ~ I ~01i ~ t ~(~ :€e~~ T u~E a r~'Pa~tc~t~~r ' :O, ~=fit r ~ :~tit~NE i~:~~~2i~Eit ~`*, i"oN?:SwT F'cF~'y,t;~k\ -- _ -- - :CEP, !FiCATIGN =: ~5~3~'t~ C °-° aS63~'~ ~~- acC r- jrES- ~ErRCr~ ;APPROVED BY __- - .._...__.__-- - iD,=,T= ~G2?G6 + RIO BRAVO MARKET ____________________________________ SiteID: 015-021-001125 + Manager SIGWAN PARK Location: 6201 LAKE MING RD City BAKERSFIELD BusPhone: (661) 872-5151 Map 104 CommHaz Moderate Grid: 04D FacUnits: 1 AOV: CommCode: KCFD STA. 45 EPA Numb: SIC Code:5411 DunnBrad: Emergency Contact / Title Emergency Contact / Title TAI YOUNG PARK / OWNER SI GWAN PARK / MANAGER Business Phone:- (661) 87.26 Business Phone: (661) 872-5151x 24-Hour Phone (661) 419-4978x ~ 24-Hour Phone (626) 664-1234x Pager Phone ( ) - x Pager Phone - Hazmat Hazards: Fire Press ImmHlth DelHlth Contact ~3G-d~ ~A~ ~4~~~ pgrlC Phone: (661) 872=7~~ MailAddr: 6201 LAKE MING RD State: CA City BAKERSFIELD Zip 93306 Owner ~__ ___ .___.G ~'o~~ `~p~'~y ~~r'~ Phone: (661) 872- ~6d Address 6201 LAKE MING RD State: CA City BAKERSFIELD Zip 93306 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: ~ Emergency Directives: ~ PROG A - HAZMAT 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. ~~ J Signature Date ENl'~ MAY p ~ 2006 -1- 04/03/2006 UNIFIED PROGRAM INSPECT10Pt CHECKLIST~~' :::..: . SECTION 1: Business Plan and Inventory Program BASERSFIELD FIRE DEPT a Prevention Services fl~~ 900 Truxtun Ave., Suite 210 ~Rrr Bakersfield, CA 93301 Tel.: (661) 326-3979 '- Fax: (661) 872-2171 FACILITY ME NSP CTION ATE NSPECTION TIME °~ a ~ ADDRESS HONE NO. O OF EM LOYEES ~ ~ ~ y, FACILITY CONTACT USINESS ID NUMBE 15-021- l Section 1: Business Plan snd Inventory Program _~j ~ ~ ~~ ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY,^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIfi@SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS CORRECT OCCUPANCY r ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION D PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES _ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: ^ YES L~1-f~0 QUESTI S REGA DI THIS INSPECTION? PLEASE CALL US AT (881) 326-3978 Inspector (Please Print) Fire revention / 1" In /Shift of Site/Stetion H esponsible PaAy (Please Prat) White -Prevention Services Yellow -Station Copy Pink - Buaineae Copy FD20~9 (Rev. 02105) ,_3 S ,~I~~j4~~LL ~~~'tp~ C[TY OF BAKERSFIEI.H FIRE DEPAR'I'MEN"C ;~~ ~ ~ ~°~ OFFICE OF ENVIRON>\'IENTAL SERVICES e~ ~ye~ I.INIFIED PROGI~AIVI INSPECTION CHECKLIST ~~~w ~g~,+++~ 1715 Chester Ave., 3r1 Floor, Bakerstield, CA 93301 FACILITY NAME ~1O ~Cta1,~_~~('`~ INSPECTION DATE ~ 01 Section 2: Underground Storage Tanks Program ^ Routine ~ombined ^ Joint Agency ^ Multi-Agenc Complaint ^ Re-inspection Type of Tank ~~.~_ Number of 'l'ank Type of Monitoring ~G~~h Type of Piping OPERATION C V COMMENTS Proper tank data on the Proper ownerloperator data on the Permit lees 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 SIZES 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? ff yes, Does tank have overtilVoverspill protection'? C=Compliance =Violation Y=Yes N-NO Inspector: Office of Environmental Services (661) 326-3979 white - finv. Svcs. ~~~ -- Business Site Responsible Party Pink -Business Copv C] CITY OF BAKERSFIELD FIRE DEPARTMENT ~~ OFFICE OF ENVIRONMENTAL SERVICES •yp~~ UNIFIED PROGRAM INSPECTION CHECKLIST W ~4tiv~~ 1715 Chester Ave., 3`d Floor, Bakersfield, CA 93301 FACILITY NAME~~[~, ~'q,t~~° ADDRESS ?~ ~ FACILITY CONTACT INSPECTION TIME Section 1: Business Plan and Inventory Progra INSPECTION DATE I Z- Z~ ' ° ~ PHONE NO. ~~,~~ BUSINESS ID NO. 15-210- ~~~ NUMBER OF EMPLOYEES ~ m ~ ~U' ^ Routine ^ Combined ^ Joint Agency ^Muiti-Agency ^ Complaint ^ Re-inspection • OPERATION C V COMMENTS Appropriate permit on hand -'~;~ , ~,y~ ~ Business plan contact information accurate d. ~~ ~ , ~L Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: ^ Yes ~ No Explain: Questions regarding this inspection? Please call us at (805) 326-3979 __~ GtIVBJV~~. Business Site Responsible Party Inspector: 1" y "~~ ~~ White -Env. Svcs. Yellow -Station Copy Pink -Business Copy J av RIO BRAVO MARKET SiteID: 015-021-001125 Manager SI GWAN PARK BusPhone: (661) 872 ~~~ Location: 6201 LAKE MING RD Map 104 CommHaz Moderate City BAKERSFIELD Grid: 04D FacUnits: 1 AOV: CommCode: BFD STA 10 EPA Numb: SIC Code:5411 DunnBrad: Emergency Contact / Title Emergency Contact / Title JAI SUK PARK / OWNER SI GWAN PARK / MANAGER Business Phone: (661) 872-7866x Business Phone: (661) 872-7866x 24-Hour Phone (661) 419-4978x 24-Hour Phone (626) 664-1234x Pager Phone ( ) - x Pager Phone (213) 550-6707x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact JAI SUK PARK Phone: (661) 872-7866x MailAddr: 6201 LAKE MING RD State: CA City BAKERSFIELD Zip 93306 Owner JAI SUK PARK Phone: (661) 872-2548x Address 4801 CHENIN BLANC PL State: CA City BAKERSFIELD Zip 93306 Period to TotalASTs: = Gal Preparers TotalUSTs: _ Gal Certif'd: RSs: No ParcelNo: Emergency Directives: I IF , MAT ENT'p ~C ~- U S T PROG U - ~ 5 2007 :?:'_ "ftI"„ _ ..C' i ~~ (=fi'!'~I (iJl.~a t~o ^l~p---. ~r~il y, SU_^''.': ~~I~ ~':i12'1B t{'18 Illl''Gr~~l~flOf~ i~ °P~!~~ arri,~: (e. ~~" complete. ~ fv .V; '' _-- ~ C~}'ilo.:Utz '.. .. ~ ~a t -1- 10/09/2007 .. ;~ F RIO BRAVO MARKET SiteID: 015-021-001125 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: RIO BRAVO MARKET Cross Street Business Type : FjAS y}+~+E'~ ° ~ ~~Yvc~v~- Org Type Total Tanks 2 IndnRes/Trust: No PA Contact: Dsg Own/Oper AARON KOOP ICC Nbr: 5246167-UC PROPERTY OWNER INFORMATION Name SI GWAN PARK Phone: (661) 872-7866x Address: City Type INDIVIDUAL Name SI GWAN PARK Address: City Type INDIVIDUAL BOE UST Fee# UNKNOWN Financ'1 Resp: SELF INSURED Legal Notif Date:02/16/2001 Name:JAI SUK PARK State UST # . State: Zip: TANK OWNER INFORMATION Phone: (661) 872-7866x State: Zip: Phone: (166) 178-66 x Ttl:OWNER 1998 Upg Cert#: 00815 -2- 10/09/2007 F RIO BRAVO MARKET SiteID: 015-021-001125 ~ ~ Hazmat Inventory By Facility Unit ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED GASOLINE F IH DH L 12000.00 GAL Mod PREMIUM UNLEADED F IH DH L 8000.00 GAL Mod CARBON DIOXIDE F P IH G 300.00 FT3 Min -3- 10/09/2007 -4- 10/09/2007 F RIO BRAVO MARKET SiteID: 015-021-001125 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: SPLIT TANK SYSTEM 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 12000.00 GAL 12000.00 GAL 12000.00 GAL tiAGAKllUUS C:UMYUIV~IV'1'S °sWt. RS CAS# 100.00 Gasoline No 8006619 t11'1GHK1J L~. 7.7 L" .7 J1~1L" 1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0006 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED Days On Site 365 Location within this Facility Unit Map: Grid: SPLIT TANK SYSTEM CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient -~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 8000.00 GAL 8000.00 GAL 8000.00 GAL 17EiGL'iCCLU U •7 1. V1~lY V1V L' 1V 1 .7 %Wt. ~ RS CAS# 100.00 Gasoline No 8006619 ISHGHtCL H. 7~J~A.71~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 10/09/2007 F RIO BRAVO MARKET SiteID: 015-021-001125 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: N WALL UTILITY RM CAS# 124-38-9 STATE TYPE Gas Pure = PRESSURE TEMPERATURE Above Ambient Ambient CONTAINER TYPE _ PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Co300100rFT3 Daily 300100m FT3 I Daily 300r00e FT3 rir~~Htc~vu~ winr~iv~;iv~l~~ %Wt. RS CAS# 100.00 Carbon Dioxide No 124389 nt~,~tirc~ r~~~~aai~ir.lvl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -6- 10/09/2007 r, n F RIO BRAVO MARKET SiteID: 015-021-001125 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 02/21/2001 ~ TANKS ARE MONITORED BY GILBAREO~EMC. Employee Notif./Evacuation 05/05/2006 IF WE HAVE A RELEASE WE WILL NOTIFY BFD. Public Notif./Evacuation 05/05/2006 IF WE HAVE A LARGE RELEASE WE WILL CALL BFD, 911 AND A CLEAN-UP CONTRACTOR WHO IS LICENSED. Emergency Medical Plan 02/21/2001 IN CASE OF AN EMERGENCY WE WILL GO TO THE NEAREST HOSPITAL. -7- 10/09/2007 F RIO BRAVO MARKET SiteID: 015-021-001125 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/05/2006 ~ WILL USE KITTY LITER AS ABSORBENT FOR SMALL SPILLS, LARGE ONES WILL CALL BFD. Release Containment 05/05/2006 IF A RELEASE OCCURS WE WILL SHUT OFF POWER, CALL 911 AND BFD. Clean Up 05/05/2006 WILL USE KITTY LITER FOR SMALL SPILLS, LARGE ONE CALL CLEAN-UP CONTRACTOR AND NOTIFY BFD. V1.11C1 1CC~VULLC HUl.1Vdl.lVil -8- 10/09/2007 F RIO BRAVO MARKET SiteID: 015-021-001125 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~JC l.:1a1 nct ~.ai u~ Utility Shut-Offs 03/27/2007 GAS - SW WALL BLDG ELECTRICAL - S WALL W OF REAR DOOR WATER - S OF FIRE HYDRANT NEXT TO DRIVEWAY W OF BLDG Fire Protec./Avail. Water 01/12/2007 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS ON EACH WALL INSIDE BLDG AND TWO WATER HOSES IN REAR OF BLDG AND AT GAS PUMP ISLAND. FIRE HYDRANT - NW SIDE OF LOT NEXT TO DRIVEWAY. Building Occupancy Level 03/23/2006 2 EMPLOYEES -9- 10/09/2007 F RIO BRAVO MARKET SiteID: 015-021-001125 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/05/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: KNOW WHERE PUMP SHUT-OFF IS AND HOW TO READ MSDS. rayc ~ nc.iu iii r u~uic tic nc.LU ivi ruLUi~ use -10- 10/09/2007 APPLICATION TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION BAKERSFIELD FIRE DEPT. ~~R~ Prevention Services wirTAl f 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 PERMIT N0. ~ ~~~ ~^-7 ENHANCED LEAK DETECTION ^ LINE TEST ^ SB-989 SECONDARY CONTAINMENT TESTING 1 1 TANK Tlf_NTNFCC TFRT i T(1 PFRF(1RM FI IFI Mn~IIT(1RWr (:FRTIFICATI(1~ ~f:~ ti t UNDERGROUND STORAGE TANKS ~,, SITE INFO RMATION ,..... FACILITY NAME & PHONE NUM E OF CO TACT ERSON ADDRESS ~ ~ ~ ~ _ p~ 33~ 6 OWNERS NAME OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES ^ NO TANK # V LU E C NTENTS -, i a a ~ y -~ TANK:,TES,TING COMPANY NAME OF TESTING C PANY t C3Y1 NAME 8 PHONE NUMBER F CO TACT PERSON MAILING ADDRESS NAME & PHONE NUMBER OF ESTER OR SPECIAL INSPECTOR CERTI ICAT N #: DATE 8 TIME TEST TO BE CONDUCTED O O ~ ICC #:. ~ ^ ^ ~ ~ /.L , / V' V TEST METHOD SIGNATURE OF APPLICANT ` C D TE .~ _ S ~ U 'APPROVED BY ~ DATE 6 0 FD 2095 (Rev. 09/05) BAKERSFIELD FIRE DEPT. BILLING & PERMIT STATEMENT ~~' B~ E R S F I'';p~~.. n Prevention Services ~" FIRE ~ ' 1600 Tnixtun Ave Ste 401 ~~~AARTMET PERMIT NO.: T T -0570 1~ , . `~ Bakersfield CA 93301 Tel.: (661) 326-3979 • Fax: (661) 852-2171 • LOCATION OF PROJECT 6201 LAKE MING BLVD • • PROPERTY OWNER RIO BRAVO CHEVRON STARTING DATE COMPLETION DATE 6119/O7 1 OAM NAME MATT PROJECT NAME ADDRESS PHONE NO. 872-7866 PROJECT ADDRESS CITY BAKERSFIELD STATE CA ZIP CODE 93306 • •' CONTRACTOR NAME JAMES RICH CA LICENSE NO. 809850 •• • TYPE OF LICENSE, EXPIRATION DATE PHONE NO. 392-8687 CONTRACTOR COMPANY NAME RICH ENVIRONMENTAL FAX NO. ADDRESS 5643 BROOKS CT clrY BAKERSFIELD ZIP CODE 93308 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. ^ ^ G ~ ~ ^ ^ Alarms -New & Modifications - (Minimum Char e) $280 00 • • 84 • g . ^ 98 Over 10 000 Sp Ft x 028 =Permit fee Sq Ft 98 ^ , . . . , ~ ^ Sprinklers -New & Modifications - (Minimum Charge) $280 00 ^ 84 . ^ 98 ^ Over 10 000 Sq Ft Ft x 028 =Permit fee Sq ^ 84 . , . , . . ^ s8 ^ Minor Sprinkler Modifications (< 10 heads) $ 96 00 [Inspection Only] ^ 84 . ^ 98 ^ Commercial Hoods -New & Modifications $ 470 00 8a . ^ 98 ^ Additional Hoods $ 58 00 ; 84 . s8 ^ Spray Booths -New & Modifications $470 00 ; 8a . ^ 98 ^ Aboveground Storage Tanks (Installationllnsp.-1 ~' Time) $180.00 ^ ^ 82 ^ Additional Tanks $ 96.00 ^ 82 ^ Aboveground Storage Tanks (Removal/Inspection) $109.00 ^ 82 ^ Underground Storage Tanks (Installation.lInspection) $878.00 (per tank) ^ 82 ^ Underground Storage Tanks (Modification) $878.00 (per site) ^ 82 ^ Underground Storage Tanks (Minor Modification) $167.00 ; 82 ^ Underground Storage Tanks (RemovaQ $573.00 (per tank) ; 84 ^ Oilwell (Installation) $ 96.00 . 84 ^ Mandated Leak Detection (Testing) /Fuel Monit.Cert/SI3989. Note: $96.00 for each type of test /per site (even if scheduled at the same time) $ 96.00 (per site) CK # 1774 $96 ^ ^ ^ ^ 82 ^ ents $ 96.00 (per tent) ; 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $96 per hour) $ 96.00 + (5 hrs. min. standby fee /Inspection)=$576..00 ^ 84 ^ After hours inspection fee $121.00 ^ 84 ^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 96.00 (per hour) ~ 84 ^ Portable LPG (Propane): NO.OF CAGES? _ $ 96.00 ; 84 ^ Explosive Storage $266.00 ; 84 ^ Copying & File Research (File Research Fee $50.00 per hr) 25¢ per page ~ 84 ^ Miscellaneous 84 FD 2021 (Rev. 06/0 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to File) 1-PINK (to Customer) _ _ __ _ _ _ _ ~. „_ -~ ~ C I MONITORING SYSTEM CERTIFICATION I For Use By All Jurisdictiotu Within the State of California t tat/sority Cite& Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulatrons "i'his Form must be used to document testing artd servicing of monitoring equipment. A segarate certification or report must be prepare f'or each monitoring system control panel by the technician who performs. the work. A copy of this form must be provided to the tank systett~ owner/operator. The owner/operator must subm it a copy of this form to the local agency regulating UST systems within 30 days of test date. A. Gencrai Information Facility Name; ~~ _~(Iid-t~'U ~ !~l/~G'~ Bldg, No.: Site Address: (~~-f~/ ! ~41~~ ~!/~J~? ~C,,1/[~ Crh`~ ~~~LI F/,G~~--a,~_ ZtP~ L~eL- Facility Contact Person: Contact Phone No.: Malec/t`~fodcl. of Monitoring System: J L ~~ --- -- Date of Testing/Servicing: ~l !7l ~ 7 ]3. Inventory of Equipment Tested/Certified. INSPEC'T'OR ON-SITE: YES/ O AME: Check the appropriate boxes to indicate sQecific equipment inspected/serviced; _ lank 1D: ~Z-t~(,~~ ~P~-l / - 'Tank ID: f~~'"'7`'f Lf T ~] In=i'~,nk Gauging Pr be Model: i / ` ~ In-Tank Gauging Probe. ModeL• 4 _ -~ U}-~ ~1 Annular Space or Vaul[ Sensor. Model: ~ Annular Space or Vault Sensor. Model: ~y(L_ Piping Sump /Trench Sensor(s). Model: ~lJ~ ~ Piping Sump /Trench Sensor(s). Model: ~~~ ^ ('ill Sump Sensor(s). Model: ^ Fill Sump Sensor(s). ModeL ~ ~~techanical Line Leak Detector. Model: ,~-C1~"'J ®Mechanical Line Leak Detector. Model: ~r~~ ^ ELICCVOnIC Zinc Leak Detector. Model: ^ Electronic Line Leak Detector. 1`Aodel: ^ Tank Overall /High-Level Sensor. Model: ^ Tank Overfilt7 High-Level Sensor. Model: ^ Other (s ecif e ui ment t e and mode! in Section E on Pa e 2}, ^ Other (s eei a ui ment a and mode! in Section E on Pa e 2}, Tank ID: Tank ID: O In-"Tank Gauging Probe. Model: ^ In-Tank Gauging Probe. Model: ^ Annular Space or Vault Sensor. ModeL• ^ Annular Space or Vault Sensor. Model: O Piping Sump /Trench Sensor(s). Model: ^ Piping Sump /Trench Sensor(s). Model: ^ Fill Sump Sensor{s}. Model: ^ Fill Sump Sensor(s). Model: D Mechanical Line Leak Detector. Model: ^ Mechanical Line Leak Detector. Model: U Electronic Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: ^ Tank Overfill /High-Level Sensor. ModeL• ^ Tank Overfill /High-Level Sensor, Model: ^~Other (specify equipment type and model in Section E on Page 2). ^ Other (specify equipment type and model in Section E on Page 2). Dispenser fD: J -`~ Dispenser ID: ~~" Disj,cnser Containment Sensor(s). Model: ~~ kJ Dispenser Containment•Sensor(s). Model: ~-O,F ~ Shear Valve(s). ,~J Shear Valve(s). ' ^ Di,,,enser Cont~~inment Float s and Chain s}. ^Dis enser Containment Float s and Chains . Dispenser CD: _ Dispenser IDt ^ Dispenser Containment Sensor(s). Model: { ^ Dispenser Containment Sensor(s). Model: D Shear Valve(s). ^ Shear Valve(s). „ ~O Dispcnsa• Containment Float(s) and Chain(s)• r ^Dis enser Containment Ploat(s and Chain s). I Dispenser 1D: _ Dispenser ID: ^ Dispenser Containment Sensor(s), Model: ^ Dispenser Containment Sensor(s). Model: O Shear Valve(s). ^ Shear Valve(s), ^Disl>ensc,~ Containment Float(s) and Chain(s). CJ Dis enser Containment Floats and Chain s). [ (the Cac,ilny contains more tanks Or dispensers, copy [his form. Include information for every tank and dispenser at the facility. C. CC;t'CiftCatiOn - t certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' };u;der;nes. Attached to this Certlficatiat is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring a ulpment. For any equipment capable of generating such reports, I have also attached a copy of the report; (check all that apply): System set-up '~ rm history report 'T'echnician Name (print): ~-9y wl,.¢~y Signature: Certification No.: ~~7 jam] /~G ~` ~ ~~hC2/~,~--/JLr License. No.: Ct;G~ ~Q ~~f "testing Company Nrune: RICH ENVIRONMENTAL Phone No.:.( 661 ~ 392-86$7 Site Address: t„}~'J1 ~ ~ (,.~! ~ /)+ ~ ~~~~~y LQC~ate of Testing/Servicing: ~//_7 / Q~ Page i of 3 U31U1 Monitoring System Certification ll. Results of Testing/Servicing Software Version Installed: /~/,~ _ _ ('.. ,,, .,I~hn hhn fnllnwinn nh anlt lict~ ~. v n.~„ 1'es O ° Is the audible alarm o erational? ,~ Yes ^ ° ]s the visual alarm o erational? ~ }'es ^ ° Were all sensors visually inspected, functional! tested, and confin-ned o erational? ~ Ycs ^ ' ° Were a!1 sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their pro er o eration? ^ Ycs ^ ° ]f alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) ~ N/A operational? f~ Yes ^ ~ ° For pressurized piping systems, does the turbine automaticafiy shut down ifthe piping secondary containment ^ N/A monitoring system detects a Eeak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) 1~'Sump/Trench Sensors; Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ~ Yes; ^ No. ^ Yes ^ ° For tank, systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no N/,q mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? [f so, at what percent of tank capacity does the alarm trigger? ^ es ~ No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re lacement arts in Section E, below. ^ °' ~'~ ~ No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) 0 Product; O Water. If es describe causes in Section E below. . ~ Yes ^ o Was monitorin s stem set-u reviewed to ensure ro er settin s? Attach set u re orts, if a licable L~ Y'cs ^ ° Is all monitoring equipment operational per manufacturer's specifications? * In Section L bclow, describe how and when these deficiencies were or will be corrected. 1/. C~'on~t~~ents: Page 2 of 3 03101 T'. In-~~~anl< Gauging /SIR Equipment: Check this box if tank gauging is used only for inventory control. d Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitarit~g. ~. ~/lll /1l~lG O Yes lllG iV11V T D No I 111 Has all input wiring been inspected for proper entry and termination, including testing for ground faults? O Yes O o Were all tank gauging probes visually inspected for damage and residue buildup? ^ Yes D o Was accuracy of system product level readings tested? O Yes ^ o Was accuracy of system water level readings tested? l~ Yes G o Were all probes reinstalled properly? D >'es O ~ o Were all items on the equipment manufacturer's maintenance checklist completed? 111 lne >CCr10n 17, DCIO W, GCSCr[Ul' ^UW slnU wuCU lI1 CSC UC11l IGI1 LIGJ WGIC V{ mu uc w~ ~c~.ae~+. G. Lille Leak Detectors (LLD): ^ Check this box if LEDs are not installed. (~'n lt~nlatn fhn fnllnwinn nhnrtrlict~ ~ ~. ~8l Yes t0 No" For equipment start-up or annual equipment certifscation, was a Leak simulated to verify LLD performance? ^ N/A (Check a!! that apply) Simulated leak rate: ~3 g.p.h., ^ ~. I g.p.h , ^ 0.2 g.p.h. 'yam 1'es ^ o Were all LLDs confirmed operational and accurate within regulatory requirements? 1'es ^ o Was the testing apparatus properly calibrated? ~ Yes ^ o Fa' mechanical LLDs, does the LLD restrict product flow if it detects a leak? 0 N/A Q Ycs O o For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ~ N/A D Ycs ^ o' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ~ N/A or disconnected? ^ Ycs © o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ~ N/A or fails a test? (U Yes ^ 'o For electronic LLDs, have all accessible wiring connections been visually inspected? N/A . 1'es O o Were all items on the equipment manufacturer's maintenance checklist completed? ul ulc .~ccuun n, UGIV W, UC5l'1"IUC~ 11UW i11~U when UICSe QCI1C1enCleS WCCe 01' Wlll DC COCreCICq. 1-I. Conlrncnts: Aage 3 of 3 03101 _~ Monitoring System Certification Form: Addendum for VacuunzlPressure Interstitial Sensors ~ LG 163-1, Enc. II I. Results of VacuumJPressure Itilonitoring Equipment Testing ~ ' This page should be used to document testing and servicing of vacuum and pressure interstitial sensors. A copy of this form must be included with the Monitoring System Certification Form, which must be'~provided to the tank system owner/operator. The owner/operator must.submit a copy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date. • Manufacturer; Motyel: System Type: Pressure; ^ Vacuum Sensor ID Component(s) Monitored by thtr Sensor: Sensor Functionality Test Result: ~] Pass; ^ Fail Tnteratitial Communication Test Result: ^ Pass; ^ Fail Gompouent(s) Motif toted by this ~encor:• Suuar Functionality Test Result: II Pass;' ~ j] Fail Interstitial Communication Test Rtsult: ^ Pass, ^ Fail~~ Component(s) Monitored by this Sensor: ScnsorFunctionality TcstRcsult: ^ Pass; ;^ Fail Intcrstitisl Communication Test Rtsu1C ^ Pass; ^ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: ^ Pass; ^ Fail lntcrstitial Commuai.cation Test' Result: r] Pass; ^ Fail ' 'Component(s) Monitored by this Sensor: • S easor Functionality Test Result: ^ Pass; ^ Fail Tntexsdtial Co**~*nnnication Test Result: [] Pass; ^ Fail ' Component(s) Monitored by t1ilr.Sensor: SensorFuncdonalityTest Result: ^ Pass; ,^ Fail Interstitial Communication Test Result: ^ Pass; ^ Fail Component(s) Monitored by•tixis Sensor: ' Sensor Functionality Vest Result: ^ Pass; ^ Fail jnterstitial Communication Test Result: ^ Pass; ^ Fail Component(s) Mo~ltored by this Sensor: _ Sensor Fun~tianality Test Result: ^ Pass; ^ . Farb • Infcrstitial CotrimuuicationTest Result: ^ Pass; ^ Far! Component(s) Monitored by thIr Sensor: ' Sensor Functionality Test Result: ^ Pass; . ^ Fail ~ Interstitial Co+*+m„n;caliori Test Result: ^ Pass; ^ Fail Component(s) Monitored by this Sensor: ' Sensor Functionality Test Result: L], Pass; ^ Fai! Interstitial Communication Test Result: ^ Pass; ^ Fail How was Interrfitial communication veriled? ' .^ Leak Introduced •atFar End of Interstitial Space;! ^ Gauge; ^ Visual Inspection; .{] Other (Describe lit Sec. J, below) Vacuum war rertored to operalin~ levels Ln uli interstitial spacer: ^ Yes ^ No (~fno, describe in Sec. J, below) J'. Courments: ~ ' Psge of ~ If t6c sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space aL the furthest point &oai the sensor, vacuumlpressure has been demonstrated to be communicating thrapgbout the interstice. , Monitoring System Certification Site Address: 1 Gl~ l L.~ ~ ~ r~ UST Monitoring Site Plan - ----------------- -------- `=~r3~---------------- x ~ -------------------------------..---r---------------- -\ -------------------N---. ----- ----f~ Q ------------ Date map was drawn: ~/ ~ 7 / D 7 In~'~uctions 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}. Tn the space provided, note the date this Site Plan was prepared. ` Page ~~ of ~ osioo . r.,.. 563 HRQQ~S C',1' ~RS~'~~I~]a,C.A.9330$ . p~~xc~E (661) 392-eGe7 & k'.~ (66~,) ~9~~Q6a1 M~~fi.HBN~rS~T~?i~+$K I3.~im~`~TOR m~4T ;riQR:x ~~~~m W/O~c Fac :i.l ~ •ty ~Tam,e ~ ~ ~(~/fc/tl Gri~,~C~i~ PrQc;luc~ Z,i.rxe T~~ (~'re$sizre~ Suattazt, Cdxavi,ty) ~'~Su(L•~ PR(:-DUC~' LE.~K DETECTO7E2 `.P~?,~E T.EST TRZ~' PASS s~x.aza z~rrzsa~,R a~LOW P,~z OR / J ~1.~ L a-~ . ` ./ . T,/.A TifgNMEGN~J/C~4'I_ ASS ~n L~/1 ^_ // ~ . S~RTAL ~..~. NO BAxL _ L/T~ ~Y'P~_ X'NS PASS,: I ::erti£y the a}aove teats were conducter3.on this data accoxding Eo Red ~;Tac~et k~um}tis £ielr•~ meat aQpa,xatus t~est:.i.ng par'oceduxe an lim.itat~.ana, Tti~:r Mechanical Leak Detector .Test pass / fail is • datsx~mix~ed by using a lcra £].ow thzesho7.~l trzp rate o:F 3 gallon: ,per hour ox' less at 1~ BSI. I .s~cknowled~c. e L-xiat a].1. data ea~lected is true and eoxraat Ga Ckie ?asst Tech :.._i~...,7-' / v; LG'C~ i sigr~,e~ture : Aate :,_.,.,! ` ~ ~`~ • ~.•. ., ,. SWRCB, January 20( . 5pill~Bucket Testing Report Forxn 7~is form is intended for use by contractors performing annual testing of UST spill containment structures. •The completed form ar, printoutsfrom.tests (-fapplicable), should be provided to the facilityAwner/operator forsubr-sittal to the local regulatory agency. 1. FACILTrYINFORMATION`~•~•. ~ _ . Facility Name: k tU w ~_~ ,,._ _ _-- - . Facility Address: G, }p L, ~ ~~t ~ ~~ V~ ~'G.Q ~3' . Facility Contact: Phone: Date Local Agency Was Notil7ied of Testing : '• • Name of T.ocal Agency Inspectrsr {rfpresent. during testing: d . ' 2.. TESTING CONTRACTOR INFORMATION Company Name: (L i {, y ~'v vino-v.~-c~r/^ Tce}znician Conducting Test:. -fed ~ Credentials: CSLB Contractor., ICC Service Tec SWRCB Tank Tester. Other (S ec~) License Number(s): y 3 UCKET TESTIlVG 1NFOItMA,TION T.ct].,f~/hnrlTTc~,i• Nvclrnctafic VBdIllm Other ___ Tort Equipment U~eci: (S •l, , : Equipuiea5 Resolution: Identify SpiII Bucket {ByTank~ Number, Stored Product, eta 1 ~ Z.. 2' ~ 3 4 Bucket Installation Type: ~• ect Bur}' on in rn Sum t B Contained in Sum Direct.Bury Contained in Sum Direct Bury Contained in Sum Bucket Diameter. / ~-tj ~ ~ ti ' }3 ucket Depth: f r ~.J / r ti Wait time between applying vncuwn/water and start of test: ,~j1 J ~v ~^'1 ~ "2/ ~ r '\.~ Test start Time (TJ: /, ' .~-~ =OID ~ Initial Reading S;RJ: ,,~ 1' , v . Test End Time (TP): ;~ .~.~ .,, % <~'~ ' - fiirial Reading (Rr,): -~./ ~ r ~J Test Duration (Tp - TrJ: a , ~ ~;,;~ r Change in Reading (Rg-RJ: , ~J .v . Pass!r'aiI T6icshold or Criteria: l ' ,~ s ,~ I Comments - (irrclude'Informatlon on repairs made prior toTestin~, acrd recommended~ollox~up forfailed tests) ' CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that al! the to ormatlon contained in this report is true, accurate;`and i'n full compliance with legal require»rents. Technician's Sigtahue' r; ~ Date: ~ ~ ~ ~ 'Q ~ . ~ State laws and regulations d t currently uire testing to be performed by a qualified contractor. However, local rcquirtmmrs may lx more striagrat, 1. .I. - - i.:: i'J~ ;! . I '. '.I I rI'd i:! I:.... ~.I'I lli~i i~ll1l~ I 111.1 I II'!h _ I~i.;~~rif.'J Y'.1? i.~r:'.~;HI.J.f~ ~) is J. r ll'If: i.!I}ir~f.a.l..l.i ~Pdl; }~t::F'I!:•l~i~ ' f:l~;l:l'd1~I'Jr.~.".~ ,I'J}: ~ i(dltiL.ll;l.. ~ :.1~ 51':1`1 l rL:.;ra I=~~ ;fil .I :I I'd I:' 1'(.:I:t•:ij~f~. ..-;1.;1.1.:1, Pdi; . iw'I~J1_~.i-5~!, 1 ia,,1•iJlf•ii;i;; . r'il•:1''I f l''Ji1~ :I f~il' 'I~~: ~,:t;1 f 1J'~4't::£-; I, ,111 I :I i ;I . id~; f~,I.~J" Ili-',~i~1i f'J•' 1,,11:;!.:1: 1 l;i ird ' l li 1 ;I"I 1`71! l~r','l"r-: r,"I' l:.itjl.i: • fdf; 7'ti°1F: I ,if 11''1 ~l. .1,11,1 ..1. f.•, 7~,:r;l. !'1;'1111'•;+rl'C LI .:~ . i',':I'I'El°I LANGUtii:al:. E1V~~L I SH iYSTEJ°1 DATE:-'f IME FGkN1rlT 40hJ DD YY',CY HH : P9M : SS .xt°I ;HIC'"1' J'tt°u:: 1 i~f3~,1~i.E'i~ iJtII"1' .I1t°IC ... r!r:';:1IiJ.I:I: iHll'J 111"11. :S ).±)}:sri151...}-~i• lH I F'1' 'J' I I"Iri .} 1~ I f iriliL.L:1, 'A1Vi•: pE>? 1 i~il r i;` I:JAF;I'•11 ly~::'a ~I ~tiFiL,Et 'firth r"irJr+IUr~t- r:JAkPJ1 rV~:~~ i ISaHI.ED .iNE F1:RItiC~lr,_` i,J;-;RNtI'•Y_:i r'I SFiI~LF:D .I rJf A1'JJVUHI. 6JFiF:IV 1 J'JU:=~ 1 1 :iA r7 I, I: rJ `EI~IP r~GMF'I; PJ~1FtT 1 Gld ~F;LlJE 4 r~Et; F i : bt7.0 iT I CK HE I GH7' GF`I=~:F'1' r [:,i=iFJLECr I°F~kC)TGi;GL IfA'1'H FC:RhIA'I' JE I GWZ' )AYL I GHT SAV I Nr, T I hIE :JaJ6~BLED tTtaRT DATE ;Pk WEE}, 1 SUN 2:0u AJ°! :IVrr DHTE lCT WEEP; 4 SUfV EtVD 'F I tHE '? : 00 AN1 F:r:-D T Rl C1' 1.Gr;a+aL Fk I N'rG1..JT D r ~,~;1T.I~:n r:'uDE u110000 CGlhP•!UlVIC:A7'1GN5 SETUI% pOkT SETT I PJGS CGP9M HGAkU = ~ c kS -• ~ ~s'2 > BAUD RA•rE 1200 PAk I T1' Ei/E1V S'I'GP b I 'f : 1 ST:?P DATA LENG'T'H : 7 DA'rfi AUTG TRANSMIT SETT I tVf~S HUTG I.EHK HLAk!°1 L I hl I T DTSABLEU AU'r0 HIGH WATER LII°IIT DISABLED AUTG GVEkF I I.L 1. [ r-J I T DISABLED AUTG LGw PRGDUCT D 1 SAI3LEL AUTG THEFT LIt°1IT DISABLED AUTO DELIVERY START DISABLED AUTG DIwL I VER'~ END D I J3ABL)rD AUTG EXTERNAL I tVPUT GPJ DISABLED AUTG EXTEkrJaL I rVPUT GFF DISABLED AUTG SEIVSGR FUI~'L aL~;RI°1 D I SA}3LED HUTG SENJaGR WA'T'ER HLARNI DISABLED AUTO SEtVSGR GUT ALARI°J DISABLED RS--2'32 SECUkI'rY I GGUE OOOL300 RS-23'2 Ef'JD vF !`1ESSAGE ENA>3LED T I : UfVLEADEG 87 PkGDUGT i~GD1= l THEkr9Ai, CGEFF :. UuU7~~i~ TANK D I at°IETI±R 1 'w'H . J O THIdK, F'kGF I LE 4 FTS FULT. V,>L : 12044 96 . ! I tVC_:H VOI_ ti7! 2 E4 . ! I rdCJ-I '~GL : uU50 32.0 I NiH •~1GL : ~3C~i7 FLGAT S 1 ~I:: a. a I IV . ea'~r WATER WARN I tVia : 2.0 H I G}{ LJHTIrk L I hl I T: 2 .5 I°IAX GR LABEL VGL: 12044 GVERF I LL L I r11 T 95"~; 11441 HIGH F'RGCiUi:T 9.5`• 1144! DELIVER'! Llt°JIT !Q°i 1204 LOw PRGDUCP 10oC+ LF.Ak: ALAkI'1 L [ 1°1 I T : SS SUDDEN LESS L 11°J I T : yy TAIVK TILT U.00 h1AtVIF4LDED TANKti: Ta : AJGNE LEAK M I t'J PER 1 Gii f r:: 0°~ . 0 LEAK M I PJ AIVhJII+iL U% • 0 PEkfGDIC TEST' TYPE ,~TiilVliAkli ANtVUAL TEST F'H I L ALrIRr'1 DISaIjLF.L> PERIGDIC TEST FAIL ALFiRh'1 DISAFLED GRGSS TEST FA I'I. ALF;R1.1 L; I SABLL:L~ HtVN TEST H't/Ek'aG I PJG : GFF PEk T)rF.;T AVEF'AG I Nia : GFF TANK TEST IVG•I' f FY : GF'F TNx TST I PNGIV IjkEh;K :GFF DELIVERY DELr'=;'~' 5 t•'I I IV • - --- F'R01~iU:T i''C+L~L. 'LIiERI°N;l. i=:OFFF :. GiJ0700 7'Ahll: U1r'jMETFR 1'Fi.1U 1'HiV): PROF I L,E 4 PTS FULL VOL 8029 yF; . 1 I fJC:H 'JUL : 6475 6~! . 1 [NCH 1:v'L 4034 3'= . u I hJC'Ii VUL 1587 r-'L.OHT' ;~ [ ~:;~ : 4 . u t IV . x496 I,JHT1=:k I~Jf~RfJIIVG G.0 H IGH Wr~iTER L I I°I I T: 2.5 I'1H`<, OR 1.HSE1~ VOL: x029 OVERFI}..L. Llf`11T 95% '1ti27 FI1%N FR~SL,UC'C 950/ 7627 UFI_l~'ER'Y I.,I1~9JT l0 ~a2 I_~il~J F'RODUC'C' 500 L.F_.F,}; HLARI°1 L I h9l'I' : `j9 ;~UI~L,EN L~~k,S _trlh•II'T: 93 "I'r;N}Q, T i I_T 0.00 I°IHId I L=OL.GEL~ 'FhfV};S "f It ; fV01JE Ll;A1: f'l l tJ PT:R [ i)Li I C : 0 0 LFF`~K f'111V HfJhIUHL. 0%~ 0 F'ER ! iiD I i~ '1'L'ST "TYPE STANDHRU r-~IVPJIJ~;L `PE'ST FHIL ALHRI"1 D I ;JHBLED PF:RfOD1C TEuT PHIL HLF1Rf~l D I SAi3LED GROSS "LENT FHIL r'~LHRI°l D I A}3LEL1 HfJh! `LEta'C rVERH~:~ 1 fJi~ : OFF PF R ']'ES'L AVERAi~ 11'JG : OFF TAIV}: 'I'ES'f NOT l F'Y : OFF "I'I'll~: 'l'S'f S! F'HOi'J )3REi~K :OFF UEL1~?FR1' I~EL.HY 5 MIIV '1'1;'5'1' OfJ riHTl~ HLL TAtV!' ~~7'r=;R7' T I hIE: : L~ 1 ~HPL.ED I'}r'ST )<,'riTE: : G .:!0 GAL. WR I?UkH'f I i:)IV 2 HOURS I.L•:Ak: "fIJ~T REPORT FORE°1AT NORP9AI. _ ... _ . -- - L I6111I L~ {=%CfJ:_iUR-`J1r1'UP_ - HL(i1<:PI H 1 ~; I i:>)i`''i' ItiEPURT - _ ____. IIV--'I'r;N}; HI_HRI'1 -~---_ L 1:At'UVULAR 'f R i -S'I'HTE (SINGLE FLOAT ? CFiTir%ORY ANNULAR SPHc;E L ~' : B? STP NUI°IP TR I --tiiTr-iTE (S I IVGLE FLOAT ) i;HTEGORY S"I'P SUMP L 3:92 STP SUP'IP TRI-STATE (SINGLE FLUHTi CATEf~ORY STP SUMP T ]:UNLEADED 87 LOW PRODUCT ALHRtH JUIV 25. 2u07 11 :28 PI°1 JUN 1. 200'7 5:'21 F'f~! I°lAY 6 . '2 G 0'7 7:17 PIH I IVVAL I D FUEL LE'JEL AUC: 17. 2003 8:49 Pf9 APR 12. 20G'~ 2:07 Pf°1 ', FE5 6, 2000 4:43 PI°) PROF3E OUT APR 4. 2GG5 1:?:49 PP'1 L 4: U I SPEtVSER PAN I--2 TRI-STATE (SINGLE FLOAT) CATEGORY DISPEIVSEk PAiV L a: U I :.;F'EfJL;ER PHIV 3-4 Tk i -c.;~~T.1/•= C'S:I fJGLE FL;UAT), r.:ATEGORY . ;~~ r~ 1 SPENSER FAN EXTERhJHI_ I NF'UT SETUP I'JGIVE OUTPUT IEI.r,'! :SETUP R 1 : 137 TURBI tV COMIROI. TYPE : . STr-~tVDHRU ~~ PJOR}°1HLLY CLOSEU LIQUID SENSOR ALI°1S L 2 : FUEL HLARI°1 L 4 : FUEL ALARI°I L 5 : FUEL ALARI°I L 2:SEhlcOR 4UT ALARM I.. 4 : SENSOR OUT ALARM L 5:5EN5OR OUT HLARI°1 R 2:92 TUPBIIV iOIVTk(iL T`!PE STANDARD NORh1HLLY i~LOST~D LIQUID SEIVBOR ALI°IS L 3:FUEL HLHRM L 4:FUEL ALARM L 5 : FUEL ALARM L 3:SENSOR OUT ALARI°I L 4:SEtV;3OR OUT ALAR~'1 L S : SENSOR C>UT ALARI°I DELIVERY NEEDED JUfV 25. 200? t3:41 At°i h1AY :~1. 20U7 3:31 PM MAY 6. 2007 5:5y F'hl r, M._HISTi:)k kEPURT I _.___. I IV-TtiN}; ALHRI'1 --~ __. T 1 : UNLEADED C77 LOI~J PRODUCT ALARJ°! JUIV 25. 1007 11 :?t3 P!°1 JUN 1 > 2007 5:21 PP~I MAY b. 2607 7:17 FM I IVVAI. I D FUEL LEVEL AUG 17. 2003 13:49 Pt°! APR 12. 200;3 2:07 PM FE5 6. 21300 4:43 PP9 PRONE OUT HPR 4. 2005 12:49 Pf~1 UEL I VERY lVEEUEU July 25. 2007 8:41 AM MAY 31. 2007 3:31 PM 1°1AY fi. 2007 5:59 PI°1 i';~LHX21"1- H I STOkY REPORT-- ' ; ; a `;. -'--- I fV-TANK. HLARI°I -•- -- T 2 : SUPF,Et°!E 52 L~?W PRODUCT r~LAR1~9 APk 5. ~U07 F£$ 1 1 2 I L : ~~2 AI~1 . 007 JIJN-15. '003 7 : G5 9:50 PJ°I PI°I I fdVAI;.IU FUEL, LEVEL JUL~I;~. 1999 6:21 PM JA1V BY , 1999 2: Oi P!`7 PROBE t~`UT APR 4 : ~~2005 1 '? : 15 PI.1 T• 3~7='`1'WHRE )`'t`,i I ;~ ! O!V LEVE; VERSIGtV 15.tii 50FTWAREt1 ,;~}i;t315~-100-•B CRE;~TED - ti'1.10.23.08, 5-t°I~DULEti 3301 61 -001 -A SYSTEM FEHTURE;.; PER I OD T C I IV-TAPJK TESTS AIVIVUAL I N--THIVK TESTS U.~'0 GHL,!HR PLLD PRECISION TEST SPEC; I HI. UEL I VER`! fV~EDEL, I IAY 28, 2007 8' 35 Ff°t MAY 2087 9:3.5 PM _. _ 4 . 20117 ? : 52 PI°1 :;•1, f-ti..ni~i i ... ... ---- - SENSOR F~LARI~I _._ _. _ _. L 1:AIVPlULHR ~~lV(dULt~R SPACE FUEL ALHRf°1 JUL 13, 2u06 4:16 Fin FUEL ALi-3RIh JUL i 4. L000 1 i : 3'% Hf~f .~*~r:ri ni_~~,i,rr.~i ncr~,•i:t Fi1.i9K1"I YtIr:,1vJS'i rtrr~.~,., -- --- :.;F:rI:~C;F' r~;L~;RNi ------ '~':8`,' ;7TP 2~UI~(P ' ~ _-- - I fV-TAfd}: FiLARNi -- - --• -- - _- ... _--AL1=SRI°1 FiIaTCtK1' REF'~>R'}' I 1= :3UI°If' T ? :;~UPRi~h1E 92 JEI.. i'i1..AF~I~I _ - SECJ:3C1R AL.ARi°1 ----- JL 13, '`'UOr.: a:1~7 F''NI L;;W PRJ1:flfi~T ALARi'1 I- i:ANIVULAR J1uL F;I +F:'I°l AF'R 5.~:uu7 11:22 Ahi AtJfVULHR :JPACE .. JI. 1 ~1. '00~ t 1 ::J4 Ai°i FEB 1 1 . '2007 7:05 Pi°1 JUPJ 15. 2'003 9:50 PI°i Fl1EL AI..ARIh JUL 17, 200't 4:4~ Phi JEL. F+1_F~RI~1 )b' t7. 20u3 7:G:3 F'l°i I NVALI li FUEL. LEVEL U F'h 2 '2 FUEL ALARhi '2006 4:16 PM l3 _F;I~r1 H1;=;~sl~;J i~>r~~;>=.~r I J L 1 . 1995 6: 1 JArJ :~1. 1y9y ~:o} Phi . JUI. .___._- J'F'!'JSuR ~+L,ARI.4 -----. PRuBE ~1}T FUEL ALARhi ~ JUL 14• LUO.r 11:32 AI°i ;3 : `i'ce' S"I'P DUI°1F' 'F' SUi°IP APR 4. 1005 12:15 Phi - - __ - N1 Fi 1 ~;TCIk~' ...~EIaGRT JE[. AL.F;f?i°i ~LaR JL 1,3. :dui}6 4:15 P!°I D>;LIVIrRY NEEFJED •------- S1Th1SOR ALARhi ---_- JEi. 'hl Ftt;t°I JUPJ '~5. '?007 8:35 PI°1 L 2 ; 87 S'PP 5U1°iP .. li 1 i MAY 28 • 2007 9 . ;35 Pr1 EZ'P SUMP .. ~ , 2005 I 1 : ~+a r~hl h1A`f 4. 2007 7:52 PM FUEL ALARhi Pi°! IE{_ F;L.AF?rl _ JuL 1?. 2007 a:~~ -Fit JUL. 17, 20107 4:41 +~' 1'7. ~~OD3 'l: U4 FP4 FUEL HLARI'1 ,~~;RJ°I H } ~'1'UR`f REPORT JUL 13 . 2cJaG 4 ' 14 Phl ~rJt~tUR r;LARr•1 --.- . - $'f'c.:'TEi~1 w ri=iTU ~ kEPC}RT' FUEL ALHRf°1 4 AhI 4 : F~ I ti~Pf iV~Ek Pi~rJ 1 -? - - -• - - - - - - - JUL 14 . 2UU5 1 1 ~ 3 ~:~F'EiVtiEF; F'ArJ ALL FUrJC.TICNS NOF:1°1AL - IFL ALARhi II~ l 3. '~'(il:lc a : 1 5 PI°I _ _ _ ~ -- -- ;~i~rd;UC~R ALARh1 - -'2 ' ' - _ ARi°i NIS'I'OR`' RF.PUR J 1 AI 4:UI'SPEr1:~ER F L F;L. IEL AL.~1r'I°i pISPENSEk PA1V __ 5EIVS~}R ALARI"i -- "" ,_ IL- 1 4 . -~itu5 I I : UL~ Ai°1 FUF•.L AL.ARP1 JUL 17. 2007 4:4a Fhl __ L 3:92 NTP ::;lih1P ll~l.. F9L.ARI°I ------ w=,E1'dSOh ALARhi - ... -- 3-4 ' aTF SUf°iP FUEL. ALAi~li :41 F'i°i rU 1 7 . '~ U03 7 : 1 ? PI°1 J L 5 : D I SPEhJ`JER PAI jU7 4 JUI• I7• :f~Rhl Hl;~'ruR`f kFP~;k't DI:.~PF.hJSEi? PAPJ FUEI. AI.ARP'1 i ALARP'1 ~ JUL 17. 2U07 4:4~ PI°i FUEL 15 P-"i JUL 13• '''U~16 4: _ 5 : D 1::)PI~NSER PF11V ~s--4 JUL 17. 2GD7 5:07 F'r1 ALARI°i " ~PEiV:=REF,' F'F;tV FUEL 34 At ( H 2U05 11: 14 iEL ALARi°i , ..JUL. JL 1 3. 20u6 a : 1 5 Phi SY:9'('Er'I ;TAT'U5 REPORT - ~ ~ ------ - _F~L(~RM t-iI.,TOR~ REPORT JEL. A1.A)?I°J JL 1 4. '~i`iC15 1 t :37 Ahl -- - - -- _ _ _ -- _ - ._ -..- . ALL FurJOTIOIV'.J NURi°iHL -....--- SEr•J~GR ALARi°i ---'--- AI.ARhI H ISTORY RE a L 4: G i SPEPiSER FA('1 1-'2 JE.1_ F=il_ri}~{'1 I'1l~n.y-'P~t'1`~i~R I'~i~ )tt 17. ~:ri0;=+ '~':l:i Pl'1 ----- IPJ-TAiVY, ~LARIn ----- FUEL. ALHRi°t'`` d : 44 Phi ' .F~;;'h'f FI1 I~TUR` REF'OR'1• ~ 2007 ~ JUL 17. T 1 : U}VLEADED 37 ---- :=;L-;PJ,~~F.' ALnRt°! -----•- LGW F'Rti~GUCT ALARI°i FUEL ALARhh JUL 13. ^OUG 4:19 Phi F, ; CHFR ;FPJ uf<: a -- ~ JUN '?5. '?007 1 1 :'?8 PI°l JUN i . '007 5:21 Pi°I FU£L ALARM -- -- ._- ;:;E'IdJG'1'~ r=;I_ARi°1 MA`f 6.. '?00'7 7:17 PI°{ JUL l4• '005 11 :35 Hi°l 'F t-~Ui°1P I PdVAL I D FUEL LEVEL JF.1.. i=;I.-r+Rr'i . '2QU7 4 : a 1 Ph9 JL i ? AUG 17. 2003 8:49 Phi _ A1.ARJ°I H I STORY REPUF~T-'-~-- __ _ . APR 12. 200:3 2:07 PI°i _ . -- F_Pd ;c:?R ;I~r=+kl"1 - ._ _. ~ ' ' FEB E„ '''OOU 4 : 4G PI°t ~ _._-. --- tiEPJS:k ALARhi ---_.__ ~'.:r~7 ~: 1 F' ~;Ui°IF' .1 ~l • ° " L 5:t~INPEPJ:~ER FAN 3-q i .'t " ~I iF I ALFiRI°i PROBE OUT DISPEIVSER PAN .. . - AF'R 4. 21705 12:49 PJh FUEL Ai.ARJ°i J(..__I?._~'O~i ~ 4:41 Pt°t JUL 17. '2'007 4:45 Pr1 ~- - - ~3GPJS~:1;' ALAi2r9 _~__.._. I : r+rdNL1i..AR DEL i 11ER`f NEEUED FUEi. ALARI°i JfVUi_hF' sPA~:E JUN 25. '20Q7 3:41 HIH JUL l3• 20uF, 4:19 Phl 1L1. HI-AR1~f i°iW`1` 31. 2007 3:31 PI°i Ji. i 7 . 2i"Ir~ r a : 42 Phl i"1A1' 6. 2007 5:59 Ph1 FUEL ALHRP1 L t?. ~'I~i'J'7 d;F~ ~'t°I JUL 14. 2005 11 :37 Ah} NYS'('E~~I ::NTH"]'Uk~ REPORT ALI_ F'UI~lC;"I' I t71'Jk~ NORMAL MQNITUR. CERT: FAILURE REPORT ~~~ -ti., . . ~-~~- THE FOLLOWING COMPONENTS WERE REPLACED/REP. TESTING. REPAAI,RS: V ~~ LABOR; ~d~~ PARTS IN'I'ALLED: ~D'ZJ.,~ NAME: TFTI.E: SIGNATURE: THE AB`.OVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTYON TAKEN TO REPAIR TFZE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVII20r1MAN`.TAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIItONMENTAL OF ANY FINES OR PENAI,TTES OCCURI1vG FROM NON-COMPLIANCE. A COPY' OF THIS D O CUMENT HAS BEEN LEFT ON-SITE FOR YOUR CONVIENF,NCE. ~ . DEPT UNDERGROUND STORAGE TANKS . BAKERSFIELD FIRE ; Prevention Sercrices ,.,~ ~,.A~,~~~:~~~,~u,~.~,~,., ~~~~ A1~!/1 r 900 Truxtun Ave., Ste. 210 APPLICATION ~~ l ~ Bakersfield, CA 93302 TO PERFORM ElD t LINE TESTING w ~ Tel.: (b61) 326-3979 1 S8969 SECONDARY CONTAINMENT TESTING ~ ~~; (661) 852-2171 /TANK TIGHTNESS TESTAND TO PERFORM FU[L MONITORING CERTIFICATION Page 1 of 1 ~~ C" _ --~ t`U FERMI"~ N0. rr\\ ` V ~ . ~ ^ ENHANCED LEAK DETECTION ^ LINE- TE~7NG.--~- -- ~~~__ ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST TO PERFORM FUEL MONITORING CERTIFICATION . TE INF MATI N FACILITY ~ NAME & PHONE NUM E OF C TACT ERSON . ADDRESS CQ (~~ ~~ °133U~ OWNERS NAME OPERATORS NAME PERMIT TO OPERATE M0. N_UMSER OF TANKS TO BE TESTED I PIPIN G IN TO B TE TED9 ^ YE T iF N ENT$ l - is o~y /~ ~ . TANK;TEST.ING COMPANY NAME OF TESTING Cf~PANY -- 4~i T .~n ~4'L.l ~ ~ V'C~"Yl YVt o ~~-~ NAME ~ PHONE NUMBER 5~.~~1 ~ F CO ~ C TACT PERSON ~ ~°r ~ ~ ~ ~S . MAILING ADDRESS (~ NAME & PHONE NUMBER OF ESTER OR SPECIAL INSPECTOR CERTI ICAT N #: . ~ "~ G~._._.._ DATE & TIME TEST TO BE CONDUCTED Q O ~ ICC #:. ~ ~ ~ ~ ~ ~ , / v TEST METHOD SIGNATURE OF APPLICANT C b TE '~ - ~'r- U {_ FHi ®___ N~9,F.~ ES PE@MIT ~UEI ~AR I~RQ1EEEl ._._ _ /APPROVED 8Y ~ . DATF FD 2095 (Rev. 09/05) BAKERSFIELD FIRE DEPT, ~31~1..lNG & PERMIT STATEMENT Preve>~tion se~rv3.ces r/Ar 900 Truxtun Avenue, Suite 210 pERMiT NO.: ~~>rY ~ Bakersfield, CA 93301 Tel.: (6611 326-3979 8_Fax:_( 61 852,~21~7 - ,i~ F ~ 'a„eft ~ ~ - T . ~ t LOCATION OF PROJECT ~ PROPERTY OWNER `M STARTWG DA"fE ~., ~ L ^ - l !1 U COMP N DATE ' ~'IE ~, /,(~ ~-~~J ~ / ' ( PROJECT NAME ~ ADDRESS l NE NO P HO ~~ f ~ ~~ PROJECT ADDRESS ~ ~ / ~//n~ CfTY ~~ STATE ZfP CODE CONTTiACTORNAME CA LICENSE NO. ' TYRE OF LICENSE. EJ(PIRATION PATE PHONE NO_,,.~ I i C J ~ CONTRACTOR C ANY E ~ FAX NO.j^ ~ r 1 ADDRESS ~ CnY Z1P CO (. OFFI US ,~ . ^ Alarms -New & Modifications - (Minimum Charge) $262.50 ~~ ', ~ 98 ____ FL O 000 3 20 013925 =Permit fee Ft x S ~ D q. ver , q. . sa Q i difi ati kle N Mi S S M Ch i $2'!0 00 ~ c mum pr rs - ons - ( n arge) n ew o . 98 ^ _ Over 5, 000 Sq. Ft. Sq. Ft x .042 =Permit fee ~ 98 ^ Minor Sprinkler Modifications (< 10 heads) 00 [Inspection On1yJ $ 93 ~ . 98 ^ Commeraa! Hoods - New ~ Modifications $ 398 28 ~ . _ 98 _ ! D Additional Hoods $ 36 00 ~ . 9f3 C~ _ Spray Booths -New & Modifications $458 00 ~ . _ 98 _ C7 ~ Aboveground Storage Tanks (Installation/lnsp.•1~Time) $165.00 ~ ~ ___ ^ ~ ^ Additional Tanks Aboveground Storage Tanks (Rernoval/lnspection} $ 26.00 $109.00 82 82 ^ Underground Storage Tanks (/nstaUaGonJlnspection) $878.00 (per tank) 82 ^ Underground Storage Tanks (Modifxration) $878.00 (per site) 82 ^ Underground Storage Tanks (Minor Modtrleation) $155.00 ~ 82 O_ Underground Storage Tanks (Removal) $675.00 (per tank) 84 ^ Oihvell (Installation) ~ 84 -~ Mandated Leak Detection (Testin /Fuel Montt, Cert. $ 81.00 (perst e 82 ^ Tents rtenn ~ D After hours Inspection fee $122.00 sa ^ Pyrotechnic - {Per event, Plus Insp. Fee Q $90 per hour) $ 60.00 + (5 hrs. mitt, stand -by tee !Inspection) _ $510.00 84 D RE-INSPECTION(S) / FOL10W-UP INSPECTION(S) $ 93.00 (per hour) 84 ^ ~ Portable LAG (Propane): NO. OF CAGES? $66.00 Bn ^ Explosive Storage _ $249.00 ~ ~ Co in ~ File Research File Research Fee $33.00 er hr pY 9 ( p } 25 ¢ per page ~ 84 © Miscellaneous ; 84 FD 2021 (Rev. 09/05) 1 . (tRl(:IN Gt WHITF rtn Troa¢uM 1-YFf 1 r1W J1n FIla1 iS7UJL( f1n Cncfnroarl ~.. ~: SUNRAY PETROLEUM INC Manager MIKE RUSSELL Location: LANDCO (RED RIBBON) City BAKERSFIELD SiteID: 015-021-003447 BusPhone: Map Grid: CommCode: KCFD STA 66 EPA Numb: SIC Code: DunnBrad: (661) 615-6010 CommHaz High FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title LARRY ROWLAND / VICE PRESIDENT MIKE RUSSELL / FIELD FOREMAN Business Phone: (661) 615-6010x Business Phone: (661) 615-6010x 24-Hour Phorie {661) 615-6010x 24-Hour Phone (661) 201-3826x~ Pager Phone (661) 978-8050x Pager Phone (661) 201-3826x Hazmat Hazards: Contact LARRY ROWLAND Phone: (661) 978-8050x MailAddr: PO BOX 82156 ~ State: CA City BAKERSF IELD Zip 93380-2156 Owner SUNRAY PETROLEUM INC Phone: (661) ~-8-8$58x Address PO BOX 82156 State: CA Lt~J~'' ~v (~ City BAKERSFIELD Zip 93380-2156 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ENT'p ~~~ ~ 2 X007 ~aseci on my inquiry of those individua9s i'E'S;?O~lgIL1E? tf~r ohtaining ''"'~ in'fr;s'R1at10n, ~ CF;rt1¢y u n' er ~}~; ra ally of I~~~ ~tf~a~~ i ha~re per,~o~alfy e>:emir~e;;~ and ~.m fa~niiiar N?nth thG in¢crrration sui7r°~itted an,~ '~~-;.ieve the information is true, accurate, and c ~mr~letP. ~ ~ ~~~ ~°ianature date -1- 07/16/2007 P SUNRAY PE~'ROLEUM INC SiteID: 015-021-003447 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards) Frm ~ DailyMax ,Unit,MCPI PHASETREAT 8638 L 55.00 GAL Hi WAXTREAT 8301 L 55.00 GAL Hi FLOCTREAT FCTW 9023 L 55.00 GAL UnR -2- 07/16/2007 -3- 07/16/2007 F SUNRAY PETROLEUM INC SiteID: 015-021-003447 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ r~www RllTT 1.TT wwT / ivtrrTwlT iv-nr wtw wwr. AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 55.00 GAL 55.00 GAL 55.00 GAL 17.L-1GL-ICCLVUJ l.Vl"lYV1VJ;1V1J ~Wt. RS CAS# 60.00 Aromatic Solvent No 64742-95-6 5.00 o-Xylene, m-Xylene, p-Xylene No 1330207 30.00 1,2,4-Trimethylbenzene No 95636. 3.00 Propyl Benzene No 98828 2.00 Propanal No 67630 ilt]L~t1RL H.7 .7 T~J.71•IJJ1V 1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Hi -4- 07/16/2007 STATE TYPE ~~~ PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture I Ambient ~ Ambient DRUM/BARREL-NONMETAL ., F SUNRAY PETROLEUM INC SiteID: 015-021-003447 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WAXTREAT 8301 Days On Site 365 Location within this Facility Unit Map: Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture~Ambient ~ Ambient DRUM/BARREL-NONMETAL AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 55.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 20.00 SURFACTANT No 9016459 44.00 Aromatic Solvent No 64742-95-6 5.00 o-Xylene, m-Xylene, p-Xylene No 1330207 30.00 1,2,4-Trimethylbenzene No 95636 1.00 Propyl Benzene No 103651 nric~x[~t~ riA A~~J~J1~1b1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME FLOCTREAT FCTW 9023 Days On Site 365 Location within this Facility Unit Map: Grid: CAS# Liquid TMixtur~ Ambient~E ~ AmbientT~E DRUM/BNARRELENONMETAL~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 55.00 GAL HAZARDOUS COMPONENTS %wt. HA RSA CAS# ZARD AS SESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR~ -5- 07/16/2007 F SUNRAY PETROLEUM INC SiteID: 015-021-003447 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ HC, j.CilC:y 1VV1.111Cd1.1Vi1 Employee Notif./Evacuation OES 800-852-7550 IN THE EVENT OF OIL SPILL. 911 ALL OTHER. 07/10/2006 Public Notif./Evacuation .Emergency Medical Plan 07/10/2006 911 CALLED. BAKERSFIELD MEMORIAL HOSPITAL. -6- 07/16/2007 F SUNRAY PE~'ROLEUM INC SiteID: 015-021-003447 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 07/10/2006 ~ ALL OIL PROPERTIES REGULARLY INSPECTED BY ARCO, DOG, CAL WATER, ETC. BERMS SURROUND TANK FARMS TO MINIMIZE OIL SPILLS. iCC1CCl,w7C l.Vll l.d 111L11C11L Clean Up 07/10/2006 AFTER CALLING OES, PERSONNEL WILL BE DISPATCHED WITH BACKHOE, VAC TRUCK AND ANY OTHER REQUIRED EQUIPMENT AND MATERIAL TO REMEDY THE SITE. STAINED EARTH WILL BE USED TO REINFORCE BERM OR USED FOR ROAD TOP. V1.11C1 1CC.7-Vl.L1.l:C L'il:l.lVdl.1V11 -7- 07/16/2007 c. ?~^ -u.r + RIO BRAVO MARKET ____________________________________ SiteID: 015-021-001125 + Manager SIGWAN PARK Location: 6201 LAKE MING RD City BAKERSFIELD CommCode: KCFD STA 45 EPA Numb: BusPhone: (661) 872-5151 Map 104 CommHaz Moderate Grid: 04D FaCUnits: 1 AOV: SIC Code:5411 DunnBrad: Emergency Contact / Title Emergency Contact / Title TAI YOUNG PARK / OWNER // SI GWAN PARK / MANAGER / Business Phone: (661) 872- ~~"o~ Business Phone: (661) 872- ~(f'b~ 24-Hour Phone (661) 419-4978x 24-Hour Phone (626) 664-1234x Pager Phone ( ) - x Pager Phone ( 213 ) c,~p--~ 8~ Hazmat Hazards: Fire Press ImmHlth DelHlth Contact ~ p~:~r ~~~ sukr Phone: (661) .872-fix /lv'a MailAddr: 6201 LAKE MING RD State• CA City BAKERSFIELD Zip 93306 ------------------------------- ~ ~+ 5 ~ Owner G~r~- ~ Phone: (661) 872-x~ ' cddress BAKERSFIELDING RD 7 0~ ( ~,j~ ~C~/r`G I ( State : CA y `( 0 l=~/"""' Zip 93306 Period to Preparers Certif'd: ParcelNo: i TotalASTs: = Gal TotalUSTs: = Gal RS s : No Emergency Directives : n ,~(~~~ PROG A - HAZMAT 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. ~© ignature Date ENT'D ~ u ~ ~ ~ coos D ~'~~~ ~~DD7 SSA ~- 5~oa~ ~~" ~~ -1- 04/03/2006 "' ~ BAKERSFIEILD FIRE DEPT ~~ ~ Prevention Services UNIFIED PROGRAM INSPEC 10N CHECKLIST ~ ~~~~ 900 Truxtun Ave., Suite 210 - .:,.~:_~,•,Y.~.;,:v.~:,._.. ~, :. , .,:.:,,.r ... . ...... .: ..~ .. ,;:...~.: ,..-. ., ,:: ,_< .:. ~w>rM Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program ~ Tei.: (661) 326-x979 Fax: (661) 872-2171 FACILITY NAM NSPECTION DAT E INS PECTION T IME ~ 7 r r ADDRESS ~ ~ HONE NO. O OF EMPLOYEES ~ / t'l/ V /N-' 1 ~ ~ Z ~ < FACILITY CONTACT USINESS ID NUMBER 15-021- Section 1: Business Plan and Inventory Program ^ ROUTINE MBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=Compliar'!ce` OPERATION V=violation I _ ____ __ COMMENTS ___ _ ^ !APPROPRIATE PERMIT ON HAND . ^ BUSIt1BSS PLAN CONTACT INFORMATION ACCURATE ^ ° VISIBLE ADDRESS ^ CORRECT OCCUPANCY ~` O VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION EN ~1 ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY _ ^ VERIFICATION OF HAZ MAT TRAINING ~) ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ~I1 ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ~l ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ^ NO EXPLAIN: - QUE IONS REGARDING THIS INSPECTION? PLEASE CALL U8 AT (881) 928-3979 Inspector (Please Print) Fire Prevention / 1" In / Shift of Site/Station q Bus' it a es a Party Prnt) White -Prevention Services Yellow -Station Copy Pink - Buaineae Copy FD20~9 Rev. 02105) FACILITY NAM Section 2: Underground Storage Tanks Program INSPECTION DATE~~ ^ Routine mbined ^ Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection Type of ank ~~1~c,Gl~ :.,~~ fl Number of Wanks ~~-- Type of Monitoring GL D Type of Piping -~~w,d/~ OPERATION C V COMMENTS Proper tank data on the Proper ownerloperator data on file Permit tees current Certification ot~ 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 ~l~'-- NO Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number ol~Tanks OPERATION Y N COMMENTS SPCC available SPCC on t3{e with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? [f yes, Does tank have overtilUoverspill protection'? C=Compliance V=Violation Y=Yes N=NO Inspector Office of Environmental Services (661) 326-3979 ~'~ ~"~~~~ CITY OF BAKERSFIELD FIRE DEPARTMENT ~~ OFFICE OF ENVIRONMEN"TAL SF,RVICES •y~1 UNIFIED PROGRAIi~I INSPECTION CHECKLIST ;W ~Rti,,!~~~ 1715 Chester Ave., 3~`' Floor, Bakersfield, CA 93301 Busines Site esponsible Party ~~'hite - Rnv. Svcs. Pink -Business Cory ~-` ..--~ FEB 17. '~uU6 1'x:56 Pf•1 J1 JTEt°i :JThTUti; kEF'~!RT HLL F LU'~1? 'I' I ?~h~1S hd?3?I°1tiL I tV~1ENTUk'': kEF'?ikT T 1 : UPJLEHDEIt S VULUf°lE = 8635 ~~LS 9U`5 ULLHt;E= ~_i i:~ 'iji=iL.'-_', ~~ TC I1L1LUt°lE = 85x6 GHLS HEIGHT = 86.13 1 tVCHE~.; IhJATEk VC~L = U i;HLS WtiTEk = ii.UU INCHES TEMP = 68.1 UEG F T 2: SUFkEN1E 92 ! '~.~?~L.Uf°lE _ :;186 GHLS ULI_tiGE = 4813 GhLS ' 9!].~ ULLr-ii;E= 4U4U GHL T~' '+/?:iI.U1°lE _ ~~169 Ca~LS HEIGHT = 53.39 INCHES W(iTEk 'ti?.>L = 0 GHLS ' WATER = O.OU INCHES TEMP = 6^r . 3 LiEG F n * ~ EIVD ~ ~ *. n ' 1 ~t~g E R S F I D F/ICE ~A R TM ~' April 10, 2006 RONALD J. FRAZE FIRE CHIEF Mr. Tai Young Park Rio Bravo Market 6201 Lake Ming Road, Bakersfield, CA 93306 Re: Guidelines for Unsupervised Dispensino REMINDER NOTICE .Gary Hutton, Senior Deputy Chief Dear Mr. Park: Administration 326-3650 It has come to our attention that many convenience stores who sell gasoline, like yourselves, are closing late at night. If you are using card readers and leaving Deputy Chief Dean clason your fuel pumps on, this is defined in the California Fire Code as: "Unsupervised ---0perations~Training------- Dispensing:"--~--- -- 326-3652 Deputy chief Kirk Blair Unsupervised dispensing is allowed when the owner or operator provides, and is accountable for daily site visits, regular equipment inspection and maintenance, Fire Safety/Prevention Services including any unauthorized release or spills, posted instructions for safe operation 326-3653 of dispensing equipment, and posted telephone numbers for the owner or operator. Signs prohibiting smoking, prohibiting dispensing into unapproved 2101 "H" Street containers and requiring vehicle engines to be stopped during fueling shall be Bakersfield, CA 93301 conspicuously posted within site of each dispenser. OFFICE: (661) 326-3941 FAX: (661) 852-2170 In addition, a sign shall be pasted in a conspicuous location reading: In case of spill or release: RALPH E. HUEY, DIRECTOR 1) Use Emergency Pump shut-off PREVENTION SERVICES 2) Report the accident FIRE SAFETYSERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 3) Fire Department Telephone Bakersfield, CA 93301 4) Facility address OFFICE: (661) 326-3979 FAX: (661) 852-2171 During the hours of operation) stations having unsupervised dispensing shall be David Weirather provided with a fire alarm transmitting device. A telephone not requiring a coin to Fire Plans Examiner operate is acceptable. The fuel leak detection system must have a remote or 326-3706 phone modem to insure off-site monitoring during hours of unsupervised dispensing. During hours ofi darkness, sufficient lighting must be maintained so Howard H. Wines, ilt that all signs associated with fueling operation are conspicuous and readable. A Hazardous Materials Specialist gallon container of an absorbent material used for spills must be made available 326-3649 to the public during hours of unsupervised dispensing. Afire extinguisher with a minimum 2A, 2B, and 2C rating must be located on dispenser island during hours of unsupervised dispensing: r4 To: Mailing List of Valued Customers ~ Reminder Notice Re: Guidance for Unsupervised Dispensing ' ~ April 10, 2006 Page 2 1 If you are currently having hours of unsupervised dispensing, you must comply with the above-mentioned requirements. . Starting April 15, 2006, this office will conduct random checks of all fueling stations within the city limits for compliance. If you shut your station down after normal business hours and are not pumping fuel, please disregard this reminder notice. Should you have any questions, please feel free to call meat 661-326-3190. Sincerely, Ralph E. Huey, Director of Prevention Services By: Steve Underwood, Fire Prevention Officer REH/db