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Home My WebLink AboutBUSINESS PLAN (5),, ~~ .~ ,~f \`\ ,~,~' . `y~.~ ~ ~ i ~ ~ ARCO STATION #583 ~~' - ~ ~ ~ i ;;~~ 3220 MING AVE. ", -- - r •'•t.. -. ~~ ~ ~I. M.. ~e /~7~~, ~ y 3 ~ c~~ ~,~ ~. ~~,~~~~ i -~(' ,~ ~~ ~,- JUL i 7 zu~3 t ,. =; ARCO 00583 Manager Location: City /~ 'J~ ~/ SiteID: 015-021-001007 EDMOND NASSAR 3220 MING AVE BAKERSFIELD CommCode: BFD STA 07 EPA Numb: BusPhone: (661) 398-0303 Map 123 CommHaz Moderate Grid: 11B FacUnits: 1 AOV: SIC Code:5541 DunnBrad:03-959-6507 Emergency Contact / Title Emergency Contact / Title Ti C Z ' ~ S~'iu EDMOND NASSAR / FRANCHISEE anrn nrn TrTm~rTnrTrE E IT~ 4S - rdM ' ~~~ Business Phone: (661) 398-0303x Business Phone: (°^^` ''" '"max 2 4 -Hour Phone ( 6 61) .~6fT5~-~6 R"19-47~ 2 4 -Hour Phone r ° ^ ^ ` ^ '' ~' .: ? ^_ ~ ~-- Pager Phone ( ) - x Pager Phone ($'~ ) 77f1 -~t7(o3 x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact M A-RCE.L-C) ~A N~ Lc~ Phone : ( 714 ) 6 7 0 -~ ~ ~ ~ ~~3~7~ MailAddr: PO BOX 6038 State: CA City ARTESIA Zip 90702-6038 Owner BP WEST COAST PRODUCTS LLC Phone: (714} 670-3 Address PO BOX 6038 State: CA ~'j7~ City ARTESIA Zip 90702-6038 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG U - UST ~~ ~ ~ ENT'D BAR ~ 9 ~oa7 ~;a'.`~d en my inquiry of those individuals the informatio ~ e rc~port;~ib{e for obtaining rsonally enalty of law that I have p ation r d p un e examined and am familiar with the inform formation is true, i n the submitted and be1i ete, accurate, and comp na ure ~ ~ Vct ~~ Z.XG i'1i1~/1 R -1- 01/24/2007 3 F ARCO 00583 SiteID: 015-021-001007 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: ARCO 00583 Cross Street Business Type: Org Type: Total Tanks 4 IndnRes/Trust: No PA Contact: r z~'!o'79S Dsg Own/Oper A-NDRES ~~k~'1-d ICC Nbr: ~.~.~da~~-UC PROPERTY OWNER INFORMATION Name Phone : ~-~^,~;-~''-,-z--6~4~ Address : e ~l ~TF C(,i S'Ta-"~ E7'~ ~GLt,tTI'L/US C~NTE7Z ~$~ °7 `7 ~-- D~(p~ City State: Zip: Type CORPORATION Name Address City Type TANK OWNER INFORMATION Phone: EL+'r~ Ccrs7'aM~- ~~iLt,(Ti'z~S C~^~ ~'~ State: Zip: CORPORATION BOE UST Fee# 000506 Financ~l Resp: Legal Notif ~ ~ ~ -'Z Z fir- b "7 l0~ Date:12/26/2001 Phone: (371) 453-21 x Name:MICHAEL WILSON Ttl:ARCO RETAIL FAC MGR State UST # 1998 Upg Cert#: 00801 -2- 01/24/2007 • m I: ~ F ARCO 00583 SiteID: 015-021-001007 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED MID GRADE GASOLINE F IH DH L 10000.00 GAL Mod UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod PREMIUM F IH DH L 10000.00 GAL M©d ~N~~o~D GASOLINE.=~ - _ F IH DH L 10000.00 GAL M©d WASTE LIQUID F DH L 55.00 GAL Mod CARBON DIOXIDE F P IH G 400.00 FT3 Min WASTE ABSORBENT F IH S 55.00 GAL UriR -3- ~ 01/24/2007 '" -4- 01/24/2007 F ARCO 00583 SiteID: 015-021-00100"7 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME UNLEADED MID GRADE GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: N SIDE OF LOT CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE Liqui~Mixture ~ Ambient dent CONTAINER TYPE UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 5000.00 GAT., nt~~xrcLVUa ~.~rir~iv~,iv l ~ %Wt. RS CAS# 1.00.00 Gasoline No 8006519 I'1[~GHKL 1~~5~J.71~1tS1V lb TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: N SIDE OF LOT CAS# 8006-67.--9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~mbient ~mbient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 2500.00 GAL nriZARDOUS COMPONENTS gWt. RS CAS# 100.00 Gasoline No 8006519 ISHGKKL E-».7r,~J1~1L"1V1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 01/24/2007 r F ARCO 00583 SiteID: 015-021-001007 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME PREMIUM Days On Site 365 Location within this Facility Unit Map: Grid: N SIDE OF LOT , CAS# 8006-61-9 Liquid TMixtur~mbRient~E ~ AmbientT~E ~ER GROUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 5000.00 GAL - nnat~xLVUa ~.vrirvlvnlvt~ %Wt. RS CAS# 100.00 Gasoline No 8006619 t1tiGL-1tCL tiaar.aai~ir,lvl~ 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 UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: N SIDE OF LOT CAS# 8006-61-9 Liquid TMixture ~-Ambient~E ~ AmbientT~E ~ UNDEROGROIUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL I 2500.00 GAL ruzurucLV V ~ ~.v1.1rv1v n1v t J %Wt• RS CAS# 100.00 Gasoline No 8006619 riti[~tiRL ti p J ~ J Jl•1L' 1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -6- 01/24/2007 F ARCO 00583 SiteID: 015-021-001007 ~ ~ Inventory Item 0010 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE LIQUID Days On Site FLAMMABLE 365 Location within this Facility Unit Map: Grid: INSIDE FENCED ENCLOSURE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Liquid TWaste -~mbient ~ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GAL tiAGl~ittLVUJ ~:v1~lrviv~tvl~ %Wt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No ri1~GHKU L~J JL' J 51~1L" 1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod ~ Inventory Item 0007 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: OUTSIDE~YARD NEAR SIDE WALL OF FAC CAS# 124-38-9 ~GasATE TPureE ~-AboveSAmbEent CEMePERAiURE INSUL TANKN/RCRYOGENIC rY g AMOUNTS AT THIS LOCATION Largest Co400100rFT3 Daily 400100m FT3 I Daily 200r00e FT3 riAZARDOUS ~.vrirviv~ly 1 ~ %Wt. RS CAS# 100.00 Carbon Dioxide No 124389 ritiG!-~KL HJ J~JJ1~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -7- 01/24/2007 4` 't F ARCO 00583 SiteID: 015-021-00100"7 ~ ~ Inventory Item 0008 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME MOTOR OIL Days On Site ~~- ~ ~-~~C" 3 6 5 Location within this Facility Unit Map: Grid: BACK ROOM OR FRONT SHELVES CAS# 8020835 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture I Ambient ~ Ambient -~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 0.25 GAL 30.00 GAL 15.00 GAL ti[jGl-1ttUUUJ 1.:V1~1ru1V1;1V 1"5 %Wt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 til-~GHKL H.7 JJ;.7J1~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min ~ Inventory Item 0009 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE ABSORBENT Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE FENCED ENCLOSURE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Solid TWaste -Lmbient ~ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GAL tis-~c~HtcLUUJ uvrirulvr,lv"1J %Wt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No MIXTURE t1EjGHhCL 11. 7.7 L" .7 J1~1L' 1V 1 w7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / UnR -8- 01/24/2007 F ARCO 00583 SiteID: 015-021-001007 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 08/10/2006 IN THE EVENT OF MINOR TO MAJOR SPILL, OR FIRE, EMPLOYEE OR OWNER WILL CALL 911 AND LOCAL AGENCY. EMPLOYEES ARE TRAINED IN THE USE OF PERSONAL PROTECTION EQUIPMENT TO MINIMIZE CONTACT WITH HAZARDOUS MATERIALS/WASTE. OFFICE OF EMERGENCY SERVICE: 800-852-7550 NATIONAL RESPONSE CENTER: 800-424-8802 BAKERSFIELD PREVENTION SERVICES: 661-326-3979 9 Employee Notif./Evacuation 08/10/2006 IF A LARGE RELEASE OF GASOLINE SPILL OR WASTE OCCURS, THE OWNER, OR STORE MANAGER, OR EMPLOYEES WILL TAKE IMMEDIATE ACTION TO HAVE ALL EMPLOYEES LEAVE THE PREMISES BY THE SAFEST EXIT. ALL EMPLOYEES WILL BE ASKED TO ASSEMBLE A"T A SAFE ASSEMBLY AREA LOCATED AT THE SOUTHEAST SIDE OF THE SITE, OR AT A SAFE UPWIND LOCATION. METHOD OF EVACUATION IS VERBAL. PERSON RESPONSIBLE FOR NOTIFICATION IS: EDMOND NASSAR, FRANCHISEE. Public Notif./Evacuation 08/10/2006 IF A MAJOR SPILL OCCURED THAT WOULD EFFECT THE SURROUNDING BUSINESS, WE WOULD FIRST CONTACT THE FIRE DEPT AND FOLLOW TRIER INSTRUCTIONS. IN THE EVENT OF A MAJOR SPILL, THE PERSONNEL IN CHARGE SHALL SECURE THE FACILITY BY DEACTIVATING ALL DISPENSERS AND SUBMERSIBLE PUMPS. IF EVACUATION IS NECESSARY, ALL PERSONNEL ARE INSTRUCTED TO PROCEED TO AN AREA AWAY FROM THE DANGER ZONE. THE PERSONNEL IN CHARGE AT THE TIME SHALL THEN NOTIFY THE LOCAL EMERGENCY RESPONSE DEPARTMENT AND ARCO MAINTENANCE DEPT. Emergency Medical Plan 08/10/2006 FOR SMALL INJURIES, THE OWNER OR STORE MANAGER WILL UTILIZE THE FIRST AID KIT. FOR MINOR TO MAJOR INJURIES, THE OWNER OR STORE MANAGER WILL CALL EITHER 911 OR MAY CONTACT THE CLOSEST MEDICAL/CLINIC CENTER, WHICH IS: MEMORIAL HOSPITAL, 420 34TH ST, 327-4647. -9- 01/24/2007 F ARCO 00583 SiteID: 015-021-OOlOCJ7 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 08/10/2006 ~ RELEASES ARE PREVENTED BY INSTALLED OVERFILL DEVICES, SUCH AS, FLAPPER VALVES, HIGH LEVEL ALARMS, OR BALL FLOATS. OTHER SPILL PREVENTION DEVICES ARE IMPACT VALVES AND BREAKAWAY DEVICES. SERVICE STATIONS ARE ATTENDED BY TRAINED PERSONNEL, AND GASOLINE IS DELIVERED BY TRAINED TRUCK DRIVERS. Release Containment 08/10/2006 IN THE EVENT OF A LEAK OR SPILL: 1. ATTENDANT SHOULD SHUT OFF ELECTRICITY TO THE PUMPS/TURBINES AT THE MAIN ELECTRICAL PANEL AND CLOSE THE IMPACT VALVES; 2. THE ON-SITE EMERGENCY COORDINTAOR OR DESINGEE WILL CONTACT 911 (FIRE DEPARTMENT) AND EXPLAIN THE EMERGENCY AND WILL CONTACT ARCO MISSION CONTROL. IF NECESSARY, THE ON-SITE EMERGENCY COORDINATOR OR DESIGNEE WILL REQUEST AN AMBULANCE OR OTHER MEDICAL ASSISTANCE; 3. EVACUATE. IF DEEMED NECESSARY BY THE ON-SITE EMERGENCY COORDINATOR OR DESIGNEE, ALL TRAFFIC ON SITE WILL BE HALTED, AREA CONED OFF, AND ALL EMPLOYEES AND CUSTOMERS WILL BE DIRECTED TO A SAFE AREA OPPOSITE THE DANGER. THERE ARE TWO EXITS: FRONT ENTRANCE AND REAR EMERGENCY EXIT. ALL PERSONS WILL EVACUATE THROUGH ONE OF THESE DOORS AND GATHER IN AREA FURTHEST FROM DANGER. MANAGER ON DUTY WILL ACCOUNT FOR ALL STATIONS PERSONNEL AND CUSTOMERS (WHEN POSSIBLE); 4. CONTAIN THE LIQUID BY CONSTRUCTING BERMS AND/OR BY COVERING THE SPILL.WITH A FIREPROOF ABSORBENT MATERIAL. ,PREVENT LIQUID FROM ENTERING STORM DRAINS WHENEVER POSSIBLE; 5. SCENE MANAGEMENT SHALL HAVE THE RESPONSIBILITY OF THE ON-SITE EMERGENCY COORDINATOR OR DESIGNEES UNTIL THE ARRIVAL OF FIRE OR POLICE PERSONNEL. UPON ARRIVAL OF THESE PERSONNEL, THE EMERGENCY COORDINATOR WILL COOPERATE WITH AND OFFER ANY ASSISTANCE THAT IS REQUESTED; 6. IMMEDIATELY FOLLOWING AN EMERGENCY THE ON-SITE EMERGENCY COORDINATOR WILL PROVIDE FOR THE DISPOSAL OF CONTAMINATED MATERIAL AS DIRECTED BY THE LOCAL FIRE DEPARTMENT OR COUNTY HEALTH AGENCY. (ALL SPILLS WILL BE REPORTE'I~ TO AT ~~ '~~-vim-;. ~ . THE BP ENVIRONMENTAL COMPLIANCE SPECIALIST WILL MAKE REPORT TO PERTINENT AGENCIES INCLUDING NRC, CA OES, ~Li7E C~tS~Gi1~t~2 cSGLGt.%!ri/US G~iyT~2 _ ~1~~'-~?c~-~J7~a3 __ -10- 01/24/2007 F ARCO 00583 SiteID: 015-021-001007 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Clean Up 08/10/2006 IN THE EVENT THAT A SPILL IS SMALL, STATION PERSONNEL SHOULD APPLY ABSORBENT TO THE GASOLINE SPILL BY SWEEPING THE ABSORBENT ONTO THE SPILL. ONCE THE ABSORBENT HAS SOAKED UP THE LIQUID, SWEEP UP THE ABSORBENT AND PLACE IT IN A 55-GALLON DRUM. IF THE SPILL IS LARGER, CALL 911 AND ATTEMPT TO CONTAIN IT. LARGE SPILLS ARE CLEANED BY BP-DESIGNATED CONTRACTORS, OR AS DESIGNATED BY FRANCHISEE OR FRANCHISE SERVICE STATIONS. EMPLOYEES RESPONSIBILITIES: EMPLOYEES WILL KNOW THE LOCATION OF THE NEAREST STORM DRAIN AND LOCATION OF ABSORBENT MATERIAL TO BE USED TO PREVENT THE SPILL FROM REACHING THE STORM DRAIN. IN THE EVENT OF A MAJOR SPILL, EMPLOYEES ARE INSTRUCTED TO CALL 911 AND REPORT. Other Resource Activation -11- 01/24/2007 F ARCO 00583 SiteID: 015-021-001007 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~peciai riazaras Utility Shut-Offs 08/10/2006 A) GAS - NO B) ELECTRICAL - PANEL IN BACK ROOM C) WATER - SIDEWALK D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 01/24/2007 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - 30FT E OF FAC MING AVE. Building Occupancy Level 04/03/2006 2 EMPLOYEES -12- 01/24/2007 1;- 1. F ARCO 00583 SiteID: 015-021-001007 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 08/10/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE IN COMPLIANCE BINDER IN OFFICE. BRIEF SUMMARY OF TRAINING PROBRAM: EMPLOYEES ARE TRAINED ON USE OF SAFETY EQUIPMENT AND TOOLS TO MINIMIZE CONTACT WITH HAZARDOUS MATERIALS/WASTE. EMPLOYEES ARE TRAINED AND REQUIRED TO DIAL 911 FOR EMERGENCY CALLS AND EVACUATE THE PREMISES. EMPLOYEES ARE TRAINED IN THE USE OF SPILL CLEAN-UP, FIRST AID KIT, FIRE EXTINGUISHERS, ELECRICAL AND GAS SHUT-OFF AND USE OF TELEPHONES. EMPLOYEES ARE TRAINED TO ADVISE ANY RESPONSE AGENCY AS TO THE NATURE AND LOCATION OF THE PROBLEM. INITIAL TRAINING IS CONDUCTED AFTER HIRING NEW EMPLOYEE. TRAINER IS THE OWNER OR MANAGER OF THE STORE. REFRESHER TRAINING IS DONE EVERY YEAR. TRAINING TOPICS ARE: 1. HAZARD COMMUNICATION PROGRAM; 2. MATERIALS SAFETY DATA SHEETS; 3. SAFE HANDLING OF CHEMICALS; AND 4. EMERGENCY EQUIPMENT AND EMERGENCY RESPONSE PLAN. Ydy C G _ ~ ~ r •aciu tvi ~-u~.uic v.~c -13- 01/24/2007 - ~. ~, F ARCO 00583 SiteID: 015-021-001007 ~ Fast Format ~ ~ Training Overall Site ~ _, ncl.u ivt r u~.utc vac -14- 01/24/2007 l ~,, ~~~0 . BUSINESS ACTIVITIES UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION ~~~~ Page 1 of ,. L FACILITY IDENTIFICATION FACILITY ID # 1 EPA ID # (Hazardous Waste Only) z. 1 5 0 2 I 1 0 0 7 CAL000244144 BUSINESS NAME (Same as FaciliTy Name or DBA -Doing Business As) a. ARCO # 00583 II.; ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility... If Yes, lease com lete these ages of the UPCF... A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases ®YES ^ NO a HAZARDOUS MATERIALS INVENTORY (include liquids in ASTs and USTs); or the applicable Federal threshold . _ CHEMICAL DESCRIPTION (OES 2731) quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emer enc lan is re uired ursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTS) UST FACILITY (Formerly swxcl# Form n) 1. Own or operate underground storage tanks? ®YES ^ NO 5. UST TANK (one page per tank) (Formerly Form B) 2. Intend to upgrade existing or install new USTS? ^yES ®,~ 6. UST FACILITY UST TANK (one per tank) i UST INSTALLATION -CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) 3. Need t0 report C10Sing a UST? ^YES ® NO 7. UST TANK (closure portion -one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTsI Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or ^YES ®NO s. NO FORM REQUIRED TO CUPAs ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? ®yES ^ NO 9. EPA ID NUMBER -provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted recyclable RECYCLABLE MATERIALS REPORT (one materials (per H&SC §25143.2)? ^YES ®NO lo. per recycler) 3. Treat hazardous waste on site? ONSITE HAZARDOUS WASTE ^ YES ®NO 11. TREATMENT -FACILITY (Formerly DISC Forms 1772) ONSITE HAZARDOUS WASTE TREATMENT -UNIT (one page per unit) (Formerly DISC Fonns 1772 A,B,C,D and L) 4. Treatment subject to financial assurance requirements (for Permit by ^YES ®NO 1z CERTIFICATION OF FINANCIAL Rule and Conditional Authorization)? r . ASSURANCE (Formerly DTSC Fnrm lzs2) 5. Consolidate hazardous waste generated at a remote site? ~ REMOTE WASTE /CONSOLIDATION ^ YES ®NO 13. SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) 6. Need to report the closure/removal of a tank that was classified as ^yES ®NO la HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? . CERTIFICATION (Formerly DTSC Form 1za9) E. LOCAL REQUIREMENTS fYou may also be required to provide additional information by your CUPA or local aeenov 1 15. b~ b ~ ~0~7 ~NT'p t~PR ---~ ARCO # 00583, Belshire Environmental Services, Inc. Page 1 of 20 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Pa e of F' IDENTIFICATION FACILITY ID # BEGINNING DATE loo. ENDING DATE tot. (Agency Use Only) 1 5 0 2 1 1 0 0 7 02/28/07 02/28/10 BUSINESSNAME(SameasFACiLi1'Yx.4t.~:orDSA-DoiagsusiuessAs) 3 BUSINESS PHONE 102 ARCO # 00583 (661) 398-0303 BUSINESS SITE ADDRESS to3. 3220 MING AVENUE CITY 104 ZIP CODE tos. CA BAKERSFIELD 93304 DUN & BRADSTREET to6. SIC CODE (4 digit #) ioz 03-959-6507 5541 COUNTY tos. KERN BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE no. EDMOND NASSAR (661) 398-0303 _. IL:.BUSINESS OWNER `' _.... OWNER NAME t t t. OWNER PHONE uz. BP West Coast Products LLC (714) 670-5373 OWNER MAILING ADDRESS: t t3. P.O. BOX # 6038 CITY 114 STATE its. ZIP CODE 116 ARTESIA CA 90702-6038 III. ENVIRONMENTAL CONTACT CONTACT NAME uz CONTACT PHONE its. MARCELO PANELO (714) 670-5373 CONTACT MAILING ADDRESS: BP West Coast Products LLC t t9. P.O. BOX # 6038 CITY 120 STATE izi. ZIP CODE t22. ARTESIA CA 90702-6038 -PRIMARY- iV. EMERGENCY CONTACTS -SECONDARY- NAME iz3. NAME tza. EDMOND NASSAR ELITE CUSTOMER SOLUTIONS CENTER TITLE 124 TITLE tzs. Franchisee BUSINESS PHONE tzs. BUSINESS PHONE t3o. (661) 398-0303 888-778-0763 24-HOUR PHONE* iz6. 24-HOUR PHONE* tat. (661) 979-0713 888-778-0763 PAGERI CELL tz7. t3z. (661) 979-0713 ADDITIONAL LOCALLY COLLECTED INFORMATION: t33. Certification: 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 familiaz with the information submitted and believe the info n is true, accurate, and complete. SIGNATURE OF O OPE TOR OR SIGNATED SEN TIVE DATE i3a. NAME OF DOCUMENT PREPARER 135. `~-_- a3'o~- ~~ Belshire Environmental Services, Inc. NAME OF SIGNER (print) ~ f 136. TITLE OF SIGNER 137. EDMOND NASSAR Franchisee ARCO # 00583, Belshire Environmental Services, Inc. Page 2 of 20 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) ® MATERIAL(NON-WASTE) ^ WASTE (one a e er material er building or area) ^ADD ^DELETE ®REVISE REPORTING YEAR 2005 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 ARCO # 00583 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 (EPCRA ~ ^ YES ® No UNDERGROUND STORAGE TANK 'i MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1 5 0 2 1 1 0 0 7 ~ ~ 1 oft E2-H5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No 2os GASOLINE If Subject to EPCRA, refer to instructions COMMON NAME GASOLINE 207 EHS* ^Yes ®No 208 CAS# 8006-61-9 209 `If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required byCUPa.) FLAMMABLE LIQUI D, CLASS 16, UN1203 210 HAZARDOUS MATERIAL TYPE (Check one item only) ^ a. PURE ®b. MIXTURE ^ c. WASTE .211 ~ RADIOACTIVE ^Yes ®No 212 CURIES 213 PHYSICAL STATE (Check one item only) ^ a. SOLID ®b. LIQUID ^ c. GAS 214 LARGEST CONTAINER 10,000 215 FED HAZARD CATEGORIES 216 (Check all that apply) . ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2ts STATE WASTE CODE 220 20,000 40,000 N/A NIA 221 DAYS ON SITE: 222 UNITS' ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 Check one item onl • If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ® b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ^ d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # ~ 1-5 226 BENZENE 22~ ^Yes ®No 22a 71-43-2 zzs 2 0-10 230 ETHANOL 231 ^Yes ®No 232 64-17-5 233 3 8-15 234 XYLENE z3s ^Yes ®No 23s 1330-20-7 z3~ a 7-14 238 TOULENE z3s ^Yes ®No 2ao 108-88-3 241 5 242 243 ^Yes ^NO 244 245 If more hazardous components are present at greater than 1 ~ by weight if non-carcinogenic, or 0.1 k by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION gas ARCO # 00583, Belshire Environmental Services, Inc. Page 3 of 20 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) ® MATERIAL(NON-WASTE) ^ WASTE (one age per material er buildin or area ^ADD ^DELETE ®REVISE REPORTING YEAR 2005 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 ARCO # 00583 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL zoz (EPCRA) ^ YES ® NO OUTSIDE YARD NEAR SIDE WALL OF FACILITY ~ MAP# (optional) 203 GRID# (optional) zoo FACILITY ID # 1 S 0 2 I 1 0 0 7 1 of 1 H6 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes No zos CARBON DIOXIDE If Subject to EPCRA, refer to instructions COMMON NAME CARBON DIOXIDE 207 EHS` ^Yes ®No zoa ca,s# 124-38-9 209 "`If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by cuPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) ®a. PURE ^b. MIXTURE ^ c. WASTE 211 RADIOACTIVE ^Yes ®No 212 CURIES 213 PHYSICAL STATE 214 (Check one item only) ^ a. SOLID ®b. LIQUID ^ c. GAS LARGEST CONTAINER 4OO 215 FED HAZARD CATEGORIES z1s (Check all that apply) ^ a. FIRE ^ b. REACTIVE ®c. PRESSURE RELEASE ®d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 200 400 N/A N/A zz1 DAYS ON SITE: . 222 UNITS' ^a. GALLONS ^b. CUBIC FEET ®c. POUNDS ^ d. TONS 365 Check one item onl " If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BlN ^ d. STEEL DRUM ^ h. SILO ®I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ^ a. AMBIENT ®b. ABOVE AMBIENT ^ c. BELOW AMBIENT 22a STORAGE TEMPERATURE ^ a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ®d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # ~ 100 zzs CARBON DIOXIDE zz7 ^Yes ®No 2za 124-38-9 zzs 2 230 231 ^Yes ^ NO 232 233 3 234 235 ^Yes ^ NO 236 237 4 238 ~ 239 ^Yes ^ NO 240 241 5 242 243 ^Yes ^NO 244 245 If more hazardous components are present at greater than 7% by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION zas ARCO # 00583, Belshire Environmental Services, Inc. Page 4 of 20 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) ^ MATERIAL(NON-WASTE) ® WASTE one age er material r building or area) ^ADD ^DELETE ®REVISE REPORTING YEAR 2005 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 ARCO # 00583 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL zoz (EPCRA) ^ YES ® NO INSIDE FENCED ENCLOSURE MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1 5 0 2 1 'i ~ I Q Q 7 1 of 1 K5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No zos WASTE ABSORBENT 8r DISPENSER FUEL FILTER If Subject to EPCRA, refer to instructions COMMON NAME WASTE ABSORBENT & DISPENSER FUEL FILTER 207 EHS" ^Yes ®No zo6 CAS# N/A 209 "`If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CuPA) FLAMMABLE SOLID 210 HAZARDOUS MATERIAL 211 RADIOACTIVE ^Yes ®No 212 CURIES 213 TYPE (Check one item only) ^ a. PURE ^b. MIXTURE ®c. WASTE PHYSICAL STATE (Check one item only) ®a. SOLID ^b. LIQUID ^ c. GAS 214 LARGEST CONTAINER 55 215 FED HAZARD CATEGORIES 216 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 25 55 110 352 221 DAYS ON SITE: 222 UNITS" ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 Check one item onl * If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ C. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ® d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 22a STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # MIXTURE OF SILCATE & HYDROCARBONS 1 89-90 z2s 227 ^Yes ®No 22s MIXTURE N/A zzs & SPENT FUEL FILTERS , 2 230 231 ^Yes ^ NO 232 233 3 234 235 ^Yes ^ NO 236 237 Q 238 239 ^Yes ^ NO 240 241 5 242 243 ^Yes ^NO 244 245 If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 ~ by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 ARCO # 00583, Belshire Environmental Services, Inc. Page 5 of 20 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) ^ MATERIAL(NON-WASTE) ® WASTE (one a e er material er building or area ^ADD ^DELETE ®REVISE REPORTING YEAR 2005 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 ARCO # 00583 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 (EPCRA) ^ YES ® No INSIDE FENCED ENCLOSURE MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1 5 0 2 1 ~ 1 0 Q 7 _ i 1 of 1 K5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No zos WASTE FLAMMABLE LIQUID Itsub;ecttoEPCRA,refertoinstructions COMMON NAME WASTE FLAMMABLE LIQUID 207 EHS* ^Yes ®No 208 cas# N/A 209 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) FLAMMABLE LIQUID 210 HAZARDOUS MATERIAL TYPE (Check one item only) ^ a. PURE ^b. MIXTURE ®c. WASTE 211 RADIOACTIVE . ^Yes ®No 212 CURIES 2t3 PHYSICAL STATE (Check one item only) ^ a. SOLID. ®b. LIQUID ^ c. GAS 214 LARGEST CONTAINER 55 215 FED HAZARD CATEGORIES 21s (Gheck all that apply) ®a. FIRE. ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 25 55 1 ~ Q 134 221 DAYS ON SITE: 222 UNITS* ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 Check one item onl * If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ® d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT z24 STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 89 90 z2s MIXTURE OF GASOLINE & WATER OR 227 ^Yes ®No z2s N/A MIXTURE 229 OTHER CONTAMINATION IN GASOLINE , 2 230 231 ^Yes ^ NO 232 233 3 234 235 ^Yes ^ NO 236 237 ¢ .238 ~ 239 ^Yes ^ NO 240 241 5 242 243 ^Yes ^NO 244 245 If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL~LOCALLY COLLECTED INFORMATION gas ARCO # 00583, Belshire Environmental Services, Inc. Page 6 of 20 . CUPA Bakersfield Fire Department ~ Hazardous Materials Division 2101 S Street Bakersfield, CA 93301 {661) 326-3911 UNDERGROUND STORAGE TANKS -FACILITY TYPEOF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMR ® 5. CHANQE OF INFORMATION (Sped/yefMnga • ^ 7. PERMANENTLY CLOSED SITE (Cfktdrate Nam only) ~] 4. AMENDED PERMIT focal use only) ^ 8. TANK REMOVED n A 1F61PARARV RITF fl r'1!.`I IRF 400 1. FACILITY !SITE INFORMATION FACILITY tD rt ; 5 Q 2 I 1 ~ 0 7 t SRE NAME (Same as FACILITY NAME or DBA ARCO# AQ583 9 BUSINESS ADDRESS 3220 MING AVENUE cm BAKERSFIELD ZIP CODE 93304 NEAREST CROSS STREET WIBLE ROAD FACILITY OWNER TYPE ^ 4. LOCAL AGENCYlDISTRICT• ® t. CORPORATION ^ 5. COUNTY AGENCY' BUSNESB ® 1. GAS BTATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 8. STATE AGENCY' TYPE ^ PARTNERSHIP 7. FEDERAL AGENCY' 402 ^ 3 2 DLSiR1BUTOR 4. PROCESSOR OTHER qp8 . TOTAL NUMBER OF la tacPty on htdian Reservatlon or -M owner of UST Is a pudic agency: name of supervisor of TANKS M4 SITE trustlands7 division, sec8on w otfiw which operates the UST. 4 404 (Thle U ttte carrtact parson for the tank records) vas ® No 405 TERESA MILES 408 11. TANK OPERATOR INFORMATION TANK OPERATOR NAME EDMOND NA$SAR am PHONE (661) 398-0303 408 TANK OPERATOR TYPE ^ ~, CORPORATKN ® 2. lNDIVtDUAL ^ 4. LOCAL AGENCY/OiSTRIC7 ^ 7. STATE AGENCY 413 & PARTNERSHIP 5. COUNTY AGENCY ^ S. FEDERAL AGENCY ll1. TANK OWNER INFORMATION TANK OWNER NAME BP West Coast Products, LLC PHONE (714) 870.8373 475 414 MAIUNG ADDRESS 4 Centerpointe Drive ~ 4t,1 cm La Palma 417 CA aya aP CODE 90623 ata TANK OWNER TYPE ® 7, CORPORATION ^ 2• INOMDUAI. ^ 4. LOCAL AGENCY /DISTRICT ^ 7. STATE AGENCY 420 3. PARTNERSHIP 5. COUNTY AGENCY ^ 8_ FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER Tv rnn Ha a a - 0 4 i 4 s 5 Call (916) 322 - 9669 n questions arise 42i V. PETROLEUM UST FlNANCIAL RESPONSIBILITY INDICATE METHOD(S) ^ t, SELF~NSURED ^ 4. SURETY BOND ^ 7. 9TATE FlJND ^ 10. LOCAL GOVT MECHANIBM ^ 2 GUARANTEE ^ 6. LETTER OF CREDIT ^ & STATE FUND 8 CW LETTER ^ 99. OTHEA: $. INSURANCE 8. EXEMPTION 9. STATE FUND a CD 422 VI. LEGAL NOTIFICATION AND MAILING ADDRESS Check one box ~ hrdcate which address should be used for legal rwtificgtlona eM medtng. Lsgal notlNratbtts and nmNMgs wpl be serrc b the tank owner ONLY, unless box 1 or 2 k ^ 1. FAC[LIT1' ^ 2. PROPERTY OWNER ® 3. TANK OWNER 4?3 checked. VII. APPLICANT SIGNATURE CerliRcatiort: I certify that the information prwlded herein is true end nccurete to Ire best of my knowledge. . SIGNATUREOFAPPUCJINT .r - .._.. DATE 424 PHONE 714-fi70-5373 NAME OFAPPUCANT(pim) ARCELO PANELO a~ TITLE OFAPPUCnxTEnYlI'Onmental t+Ompliance SpeClailSt STATE UST FACILITY NUMBER (Farfocal use ony) 428 1988 lN'GRADE CERTIFICATE NUMBER (Forbcaf use only) 429 ARCS # 00583, Belslrire Environmental Services, Inc. Page 7 of 20 CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 93301 (661) 326-3911 UNDERGROUND STORAGE~TANKS -TANK PAGE 1 TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 4. AMENDED PERMIT ® 5. CHANGE OF INFORMATION ^ 6. TEMPORARY SITE CLOSURE (Check one item only) ^ 3. RENEWAL PERMIT ~ ^ 7. PERMANENTLY CLOSED ON SITE (Specify reason -for local use only (Specify change -for local use only) ^ 8. TANK REMOVED 430 FACILITY ID # 1 BUSINESS NAME (Same as FACILITY NAME or DBA) 3 1 5 0 2 1 1 0 0 7 ARCO# 00583 BUSINESS ADDRESS CITY ZIP CODE 3220 MING AVENUE BAKERSFIELD 93304 LOCATION WITHIN SITE (Optional) 431 - -- - - L TANK DESCRIPTION (d scaled lof fan with the /oca6on of,the,USF.s s[ern mcludmgbuildin s and lafldmarks shall be sukmitted to the local a enc : _ ___ TANK ID # ~ - 432 TANK MANUFACTURER 433 _ _ COMPARTMENTALIZED TANK ^ Yes ® No 434 XefX@S If "Yes", complete one page for each compartment. DATE INSTALLED (YEAR/MO) ~ 99~ /O1 435, TANK CAPACITY IN GALLONS ~ O,000 436 NUMBER OF COMPARTMENTS ~ 437 ADDITIONAL DESCRIPTION 438 II. TANK CONTENTS -- - - TANKUSE 439 PETROLEUMTYPE 440 ® 1. MOTOR VEHICLE FUEL ®1a. REGULAR UNLEADED ^ 2. LEADED ^ 5. JET FUEL (If marked, complete Petroleum Type) ^ 1b. PREMIUM UNLEADED ^ 3. DIESEL ^ 6. AVIATION FUEL ^ 2. NON-FUEL PETROLEUM ^ 1c. MID-GRADE UNLEADED ^ 4. GASOHOL ^ 99. OTHER ^ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS # (from Hazardous Materials Inventory page) 442 ^ 4. HAZARDOUS WASTE (Includes Used Oil) GASOLINE 8006-61-s ^ 95. UNKNOWN III. TANK'CONST,Rl1CTION TYPE OF TANK ^ 1. SINGLE WALL ^ 3. SINGLE WALL WITH ^ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) iiy 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ^ g5. UNKNOWN ^4. SINGLE WALL IN A VAULT ^ 99. OTHER TANK MATERIAL -primary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 5. CONCRETE ~ ^ 95. UNKNOWN 444 (Check one item only) ^ 2~ STAINLESS ^ 4. STEEL CLAD W/ FIBERGLASS ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 99. OTHER STEEL REINFORCED PLASTIC FRP TANK MATERIAL -secondary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 95. UNKNOWN 445 (Check one item only) ^ 2 STAINLESS ^ 4. STEEL CLAD W/FIBERGLASS ^ 9. FRP NON-CORRODIBLE JACKET ^ 99. OTHER STEEL REINFORCED PLASTIC (FRP) ^ 10. COATED STEEL ^ S. CONCRETE TANK INTERIOR LINING ^ 1. RUBBER LINED ^ 3. EPOXY LINING ^ 5. GLASS LINING ^ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ^ 2. gLKYD LINING ^ 4. PHENOLIC LINING ®6. UNLINED ^ 99. OTHER (Check one item only) (For local use only) OTHER CORROSION ^ 1. MANUFACTURED CATHODIC ^ 3. FIBERGLASS REINFORCED PLASTIC ^ 95. UNKNOWN q4g DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ^ 4. IMPRESSED CURRENT ^ 99. OTHER (Check all that apply) ^2.SACRIFICIALANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR fNSTALLED 452 (Check all that apply) ®1. SPILL CONTAINMENT 1991 ®1 ALARM ^ 3. FILL TUBE SHUT OFF VALVE ® 2. DROP TUBE 1991 ®2. BALL FLOAT ^ 4. EXEMPT ® 3. STRIKER PLATE 1991 IV. TANK'LEAK:DETECTION (A;description of the monitoring program shat/be submitted to the Iota! agency) IF SINGLE WALL TANK (Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) : 454 ^ 1. VISUAL (EXPOSED PORTION ONLY) ^ 5. MANUAL TANK GAUGING (MTG) ^ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ^ 2. AUTOMATIC TANK GAUGING (ATG) ^ 6. VADOSE ZONE ®2. CONTINUOUS INTERSTITIAL MONITORING ® 3. CONTINUOUS ATG ^ 7. GROUNDWATER ^ 3. MANUAL MONITORING ^ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ^ 8. TANK TESTING BIENNIAL TANK TESTING ^ 99. OTHER °V. TANK`CLOSURE {NFORM,ATIQN /,PERMANENT CLOSURE;,IN PLACE ESTIMATED DATE LAST USED (YYIMM/DD) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ^ Yes ^ No Revised 6111/2002 ARCO # 00583, Belshire Environmental Services, Inc. Page 8 of 20 CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 93301 (661) 326.3911 L UNDERGROUND STORAGE TANKS -TANK PAGE 2 ~ VI. PIPINQCONSTRU CTION(~xreckanthe: UNDERGROUND PIF>iN6 ASOVEGAOUND PIPING SYSTEM TYPE ®i. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY ' 458 ^ 1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 459 ^ t.51NGLE WALL ^ 3. LJNED TRENCH ^ 99.OTHER 480 ^ 1. SO4GLE WALL ^ 95. UNKNOWN 482 CONSTRUCTtOW ®p DOUBLE WALL ^ 95. UNKNOWN ^ 2. DOUBLE WALL' ^ 99. OTHER MANUFACTURER MANUFACTURER: A.O SMITH MANUFACTURER 483 ^~t. BARE STEEL ®e. FRP COMPATIBLE W/ t00%METHANOL ^ 1. BARE STEEL ^ 8. FRP COMPATIBLE W/100%M£THANOL MATERIALS AND ^ 2 STAINLESS STEEL ^ 7. GALVANRED STEEL ^ 2. STAINLESS STEEL ^ 7. QALVANIZED STEEL CORROSION PROTECTION ^ 3. PLABTIC COMPATIBLE W TTI1 CONTENTS ^ 95. UNKNOWN ^ 9. PLASTIC COMPATIBLE W ITN CONTENTS ^ 8. FLEXIBLE (HOPE) ^ 99.OTHEA ( ~ ~ ®4. FIBFSiCiLASS ^ 8. FLEXIBLE (HOPE) ^ 98.OTHER ^ 4. FOIEAGLAS9 ^ 9. CATHODIC PROTECTION aPPJY) ^5. STEEL WJ COATING 9. CATHODIC PROTECTON 454 ^ 6. STEEL W! COATING D 95. UNKNOWN 465 Vtl. PtP1NQLEAF{DETECTION(Checkall+hatapNy)fadeacrfpUorrottltemordtompprogr~matla6besubm8tedtothebca/agency.) UNDERGAOtJND PIP1N0 ABOVEGROUND PIPING SB4GLE WALL P~IIiG ~ 488 SINGLE WALL PIPING 467 PRESSURIZED PIPWG {Check aUOtat apply): PRESSURIZED PIPING (Chedt a(I that apply): ^ 7. ELECTRONIC LBVE LEAK DETECTOR S.0 GPH TEST) J(~ AUTO PUMA SHUTOFF FOR ^ i. ELECTEiONiC UNE LEAK DETECTOR 3.0 GPH TEST W fT~i AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE ANU SYSTEM DISCONNECTION +AUDIBLE AND VISUAL SS TEM FAILURE AND BYSTEM DISCONNECTION+AUDIBLE AND VISUAL L ~ ALARMS ^ 2. MONTHLY 02 GPH TEST M ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRftY TEST (0.1 GPH) ^ 9. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 4. DAILY VISUAL CHECK CONVFIJTI0J4AL SUCTION SYSTEMS: ^ 5. DAILYYISUALMONRORINGOFPUMPMG3YSTEM+TRIENNIALPIPINGINTEGAITV CONVENTIONAL SUCTIONSVSTEMS: TEST (O t GPH) ^ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ 8. TRIENNIAL iNTEGRtTYTEBT (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. BELF MONITORING SAFE SUCTION 9YSTEMS (NO VALVES M BELOW GROUND PIPINO): ^ 7. SELFMONITORMG GRAVITY FLOW: ^ 9. BIENNAL OJiE0R17Y TEST (0.t GPTQ GRAVTY FLOW: ^ 8. DAILY VISWhL MONITORING ^ 8. BIENNIAL INTEGRITY TEST(D.t GPH) SECpNDARLLY CONTABNED PIPING 9ECONDAAB.Y CONTAINED PIPING PRESSURIZED PIPING (Chedt ad that appy): PRESSURIZED PIPING (Check a!! That appy): 10. CONTINUOUS TURBINE SUMP SENSOR1y@j,AUDIBLEANDViSUALALARMSAND 10. CONTINUOUS TURBINE SUMP SENSOR76(~J_AU093LEANDVISUALALARMSAND {Check one) (Check orrey ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ e. AUTO PUMP SHUT OFF W HEN A LEAK OCCURS ®0. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND BYSTEM ^ b. AU70 PUMP SHUT OFF FOR LFAKS, SYSTEM FAIUJAE AND SYSTEM DISCONNF~710N NO AUTO PUMP SHUT ~F ^ e DISCONNECTION - ^ C. NO AUTO PUMP SHUT OFF ® 17. AUTOMATIC LINE LF1UC DETECTOR (3.0 GPH TEST) Vy,Q}j FLOW SHUT OFF Ofl ^ t t AUTOMATIC t EAK RESTRlC7ION . ^ t2. ANNUALOJTEORITYTEST(0.tGPH) ^ 12 ANNUALINTEGATIYTEST(0.1 GPH) SUCTIOWGRAVTTY SYSTEM: SUCTIONIGRAVTTYSVSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS ^ 73. CONTINUOUS Sl1MP SENSOR+AUDIBLE ANq VISUAL ALARMS EMERGENCY GENERATORS ONLY (Checkallthatapply): EMERGENCY GENERATORS ONLY (Chadca0 that applyJ: ^ 14. CONTINUOUS SUMP SENSOR WRFIO~ AUTO PUMP SHUTOFF+AUDIBLE AND - ^ t4. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF+AUDIBLE AND VISUAL ALARMS VISUAL ALARMS ^ 75. AUTOMATIC LINE LEAK DETECTOR (3A GPH TEST) y_YLT ITT FLOW SHUT OFF OR ^ t5. AUTOMATIC LME t.EAK DETECTOR (3.0 GPH TEST RESTRICTION ^ 16. ANNUAL INTEGRITY TEST ^ 18. ANNUAL INTEGRITY TEST ^ 17. DAILY VISUAL CHECK ^ t7. DAILY VISUAL CHECK Vltl. DISPENSER CONTAINMENT DISPENSER CONTAWMENT ^ 7. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ 4. DAILY VISUAL CHECK DATE INSTALLED 468 ^ 2. CONTINUOUS DISPENSER PAN SEt430R+AUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LRJER / MONRORING Not Available ®3. CONTINUOUS 015PEN513I PAN SENSOFiyy)~ AUTO SHUT OFF FOR DISPENSER •AUDIBLE AND VISUAL ALARMS ^ 8. NONE 466 • IX. OWNERIOPERA70R SIO[VATURE I certlry Mat Ole frdamaflon provided heroin b We and aearote to the fnMt at ary knowledge. SIGNATURE OF OWNERrOP DATE 470 :~ ,~-r~ NAME OFOWNER/OPERATOR t) 477 TITLE OF OWNERJOPEFTATOR 472 NIARCELO PANELO Environmental Compliance Specialist RevhW 811 V2002 ARCO # OOS83, Belslure Environmental Services, Inc. Page 9 of 20 CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 93301 (661) 326-3911 UNDERGROUND.:STORAGE TANKS - _TANK PAGE 1 TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 4. AMENDED PERMIT ® 5. CHANGE OF INFORMATION ^ 6. TEMPORARY SITE CLOSURE (Check one item only) ^ 3. RENEWAL PERMIT ^ 7. PERMANENTLY CLOSED ON SITE (Specify reason -for local use only (Specify change -for local use only) ^ 6. TANK REMOVED 430 FACILITY ID # 1 BUSINESS NAME (Same as FACILITY NAME or DBA) 3 1 S 0 2 1 I~~ ~ 1 0 0 7 ~ ARCO# 00583 BUSINESS ADDRESS CITY ZIP CODE 3220 MING AVENUE BAKERSFIELD 93304 LOCATION WITHIN SITE (Optional) 431 I. TANK DESCRIPTION A scaled :~ .. .with the locafion'o..:a- UST s stem includin buildin sand landmarks shall be subrnittedto the local a enc -) TANK ID # 2 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ^ Yes ®No 434 XerXes If "Yes", complete one page for each compartment. DATE INSTALLED (YEARlMO) ~ 99~ ~O1 435 TANK CAPACITY IN GALLONS 1 0,000 436 NUMBER OF COMPARTMENTS ~ 437 ADDITIONAL DESCRIPTION ~ 438 -- II. TANK,CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1. MOTOR VEHICLE FUEL ® 1a. REGULAR UNLEADED ^ 2. LEADED ^ 5. JET FUEL (1(marked, complete Petroleum Type) ^ 1b. PREMIUM UNLEADED ^ 3. DIESEL ^ 6. AVIATION FUEL ^ 2. NON-FUEL PETROLEUM ^ 1c. MID-GRADE UNLEADED ^ 4. GASOHOL ^ 99. OTHER ^ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS # (from Hazardous Materials Inventory page) 442 ^ 4. HAZARDOUS WASTE (Includes Used Oil) GASOLINE 8006-61-s ^ 95. UNKNOWN _ Ili. TANKCONSTRUCTION _ TYPE OF TANK ^ 1. SINGLE WALL ^ 3. SINGLE WALL WITH ^ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) ®2~ DOUBLE WALL EXTERIOR MEMBRANE LINER ^ g5. UNKNOWN ^4. SINGLE WALL IN A VAULT ^ gg, OTHER TANK MATERIAL -primary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 5. CONCRETE ^ 95. UNKNOWN 444 (Check one item only) ^ 2 STAINLESS ^ 4. STEEL CLAD W/ FIBERGLASS ^ 8. FRP COMPATIBLE W/100% METHANOL ^ 99. OTHER STEEL ~ REINFORCED PLASTIC FRP TANK MATERIAL -secondary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 95. UNKNOWN 445 (Check one item only) ^ 2~ STAINLESS. ^ 4. STEEL CLAD W/FIBERGLASS ^ 9. FRP NON-CORRODIBLE,JACKET ^ 99. OTHER STEEL REINFORCED PLASTIC (FRP) ^ 10. COATED STEEL ^ 5. CONCRETE TANK INTERIOR LINING ^ 1. RUBBER LINED ^ 3. EPOXY LINING ^ 5. GLASS LINING ^ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ^ 2. ALKYD LINING ^ 4. PHENOLIC LINING ®6. UNLINED ^ 99. OTHER (Check one item only) (For local use only) OTHER CORROSION ^ 1. MANUFACTURED CATHODIC ^ 3. FIBERGLASS REINFORCED PLASTIC ^ 95. UNKNOWN 448 DATE INSTALLED, 449 PROTECTION IF APPLICABLE PROTECTION ^ 4. IMPRESSED CURRENT ^ 99. OTHER - (Checkall that apply) ^ 2. SACRIFICIAL ANODE (For local use on/y) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check all that apply) ®1. SPILL CONTAINMENT 1991 ®1 ALARM ^ 3. FILL TUBE SHUT OFF VALVE ® 2. DROP TUBE. 1991 ®2. BALL FLOAT ^ 4. EXEMPT ® 3. STRIKER PLATE 1991 - IV. TANK LEAK DETEGT'ION (A description o/the monrtonng-program shalt be submitted to the-local_ayency) ~..~ IF SINGLE WALL TANK (Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) : 454 ^ 1. VISUAL (EXPOSED PORTION ONLY) ^ 5. MANUAL TANK GAUGING (MTG) ^ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ^ 2. AUTOMATIC TANK GAUGING (ATG) ^ 6. VADOSE ZONE ®'2. CONTINUOUS INTERSTITIAL MONITORING ® 3. CONTINUOUS ATG ^ 7. GROUNDWATER ^ 3. MANUAL MONITORING ^ 4. STATISTICAL INVENTORY RECONCILIATION (SIR)+ ^ 8. TANK TESTING BIENNIAL TANK TESTING ^ gg, pTHER V. TANK CLOSURE INFQRMATION /PERMANENT CLOS.URE'IN PLACE ESTIMATED DATE LAST USED (YY/MM/DD) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ^ Yes ^ No ttevrsea envzuvz ARCO # 00583, Belshire Environmental Services, Inc. Page 10 of 20 CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street BakersBetd, CA 93301. (661) 32(x3911 UNDERGROUND STORAGE TANKS -TANK PAGE 2 vl. PIPING coNSTRUCnoN (Checlrae Met aPWYJ UNDERGROUND PIPING ABOYEGROUND PIPING 8Y6TEM TYPE ®1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 458 ^ t. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 459 ^ t.SGJGLE WALL ^ S.IJNEDTRENCH ^ 99.OTHER 460 ^ t. SINGLE WALL ^ 95. UNKNOWN 462 CONSTRUCTIOW ®2 DOUBLE WALL ^ 95. UNKNOWN ^ 2. DOUBLE WALL' ^ 99. OTHER ' MANUFACTURER MANUFACTURER: 0.O SMITH MANUFACTUREF( __ 468 ^ 1. BARE STEEL i~ 8. FRP COMPATIBLE WI 10096 METHANOL ^ t. BARE STEEL ^ 8. FRP COMPATIBLE W/ 700 % METHANOL. MATER}Al.S AND ^ 2.37AINLE3$ STEEL ^ 7. GALVANIZEp STEEL ^ 2. STAMLE33 STEEL ^ 7, flALVANIZEO STEEL coAROSroN PROTECTION ^ 3. PLASTIC COMPATIBLE W ITFt CONTENTS ©95. UNKNOWN ^ 3. PLASTIC COMPATIBLE W ITt(CONTENTS ^ 8. FLEXIBLE (HOPE) ^ 99.OTHER ~ the< ~ ®4. FiBERGULSS ^ 8. FLEXIBLE (HOPE) ^ 8A OTHER ^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION J ^5. STEEL W/COATING 9. CATHODIC PROTECTKMI q84 ^ 5-STEEL W/COATING ^ 95. UNKNOWN 485 VII. PIPING LEAK DE CTION (Chedr aAthatapWYJ(a desatpdort oirhe marttkxing yo9ram shalt be sl>brnttfad to the local agency.) UNDERGROUND PIPING ~ ABOVEGROUND PIPING S94GLE WALL P~WO 488 SOiOLE WALL P~iNG 467 PRESSURIZED PIPING (Check aethatapply): PRESSURIZED PIPING (Check aP Mat apply): ^ 1. ELECTRONK: LINE LEAK DETECTOR 3.0 GPH TEST ]ymj AUTO PUMP SHUTOFF FOR ^ t. ELECTRONIC LINE LEAK Dt'TEC70R 3.0 GPH TESTyOffH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM OISCONNECTION+AUDIBI.E AND VISUAL LEAK. SYSTEM FAILURE AND SYSTEM DISCONNECTION+AU018LE AND VISUAL ALARMS ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 2. MONTHLY 0.2 flPH TEST ^ 8. ANNUAL INTEGRITY TEST (O.t GPH) ^ 3. ANNUAL INTEGRITY TEST (0.1 GPM) ^ 4. DAILY VISUAL CHECK CONYENTK#4AL SUCTK)N SV3TQ4S: ^ 5. DAILY VISUAL MONITORING OF PUMPRJG SYSTEM +TRIENNIAL PIPING INTEGRITY CONVENTIONAL SUCTION SYSTEMS: TEST (D.1 GPI ~ ^ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ e. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION b`YSTEt4S (NO VALVES 9J BELOW GROIiND PIPING): ^ 7. SELF MONRORINfl ~ SAFE SUCTION SYSTEMS (NO VALVES iN BELOW GROUND PIPING}: ^ 7. SELFMONITORINO GRAVITY FLOW: ^ 9. BIENNUU. INTEGRITY TEST (0.1 (iPFn GRAVITY FLOW; ^ 8. DAILY VISUALMONRORIND ^ 9. BIENNULL.INTEGRITY TEST (O.i GPH) SECONDAR9.Y CONTA9tE0 PiPMG SECONDAA9.Y CONTAB7FA PIPING PRESSURIZED PIPIND (Checke6thetepplyk PRESSURZED PIPING (Cheek alt thattlppp~): 70. CONTINUOUS TURBINE SUMP SENSOR WfiH AUDIBLE AND VIBUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR ~+ AUDIBLE AND VISUAL ALARMS AND (Chedcone) (Chedcorre) ^ e. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ s. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ® b. A11T0 PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c NO AUTO PUMP SHUT OFF DISCONNECTION ^ c. NO AUTO PUMP SHITT OFF ® 7 7. AUTOMATIC LWE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW 9HLri OFF OR ^ 1t AUTOM TIC E K RESTRICTION . A A L ^ 12 ANNUAL INTL-CiRRY TEST (O.t GPt~ ^ 12 ANNUAL INTEGRRYTEST (0.t GPH) SUCTIONIGRAVITYBYSTEM: SUCTIONIGRAVTN SYSTEM: ^ 73. CONTWUOUSSUMPSENSOR+AUDI6L.EANDVISUALALARMS ^ 13. CONTINUOUS SUMPSENSDR+AUDIBLEANDYISUAIALARMS EMERGENCY GENERATORS ONLY (Cherkasttta! apply): EMERGENCY GENERATORS ONLY (Chedr aB Mat ap~YJ: ^ t4. C.ON7tN000S3uNP3ENSOR,~jQ1JjAUTOPUMPSHUTDFF+AUDIBLEAND. ^ 14. CONTWUOUSSUMPSENSORWRFiOUTAU70PUMPSHUfOFF+AUDIBLEAND VISUAL ALARMS VISUAL ALARMS [] 75. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST} WfTH U 1=toW SHUT OFF OR ^ tS. AUI'OMATTC LINE LEAK DETECTOR (3.0 GPH TEST RESTRICTION ^ 18. ANNUAL RJTEGRITY TEST ^ 1& ANNUAL INTEGRITY TEST ^ 17. DAILY VISUAL CHECK ^ 77. DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CDNTA9JMENT ^ t. FLOAT MECW W ISM 7NA7 SHUTS OFF SHEAR VALVE ~ ^ 4. DAILY VISUAL CHECK DATE INSTALLED 488 ^ 2. CONTINlKXJ3 DISPENSER PAN SENSOR +AUDIBLE AND VISUAL ALARMS ^ S. TRENCH LINER / MONTORIN3 Not Available ®3. CONTINUOUS DISPFJJSER PAN SENSOR WITH AUTO SHUT OFF FOR OISP[346EA +AUDIBI.E AND VISUAL ALARMS ^ 6. NONE 489 IX. OWNERJOPERATOR SIGNATURE i certify Net Me Inlomlatlon pra4dad herein is true and accurate M the best of my knowledge. SIGNATURE OF OWNEAIOPERATO DATE 47g --- 3~r~~ NAME OFCWNERlOPERA OR(pNnp 47f TTTLE OF OWNERlOPERATOR 472 MARCELQ PANELO Environmental Compliance Specialist Revisal 8!11!2002 ARCO # 00583, Belsture Environmental Services, Inc. Page 11 of 20 ~;. ` CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 93301 (661) 326-3911 C UNDERGROUND ,STOR. TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 4. AMENDED PERMIT (Check one item only) ^ 3. RENEWAL PERMIT (Specify reason -for local use only 1 5. CHANGE OF INFORMATION L~ 6. TEMPORARY S17E CLOSURE ^ 7. PERMANENTLY CLOSED ON SITE (Specify change -for local use only) ^ 8. TANK REMOVED 430 FACILITY ID # 1 BUSINESS NAME (Same as FACILITY NAME or DBA) 3 1 5 0 2 1 1 0 0 7 ARCO# 00583 BUSINESS ADDRESS CITY ZIP CODE 3220 MING AVENUE BAKERSFIELD 93304 LOCATION WITHIN SITE (Optional) 431 I. TANK DESCRIPTION Asca(ec:~-k: (an wdh.the location o/the UST,s stern include ~ kui(dings and landmarks shaUbesubrnitted to the local a enc J.~ _. TANK ID # 3 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ^ Yes ®No 434 Xerxes If "Yes", complete one page for each compartment. DATE INSTALLED (YEAR/MO) ~ 99~/O1 435 TANK CAPACITY IN GALLONS ~ O,000 436 NUMBER OF COMPARTMENTS ~ 437 ADDITIONAL DESCRIPTION 438 II. TJANK;CONT,,ENTS _ TANK USE 439 PETROLEUM TYPE 440 ® 1. MOTOR VEHICLE FUEL ^ 1a. REGULAR UNLEADED ^ 2. LEADED ^ 5. JET FUEL (If marked, complete Petroleum Type) ^ tb. PREMIUM UNLEADED ^ 3. DIESEL ^ 6. AVIATION FUEL ^ 2. NON-FUEL PETROLEUM ® 1c. MID-GRADE UNLEADED ^ 4. GASOHOL ^ 99. OTHER ^ 3 CHEMICAL PRODUCT . . ^ 4. HAZARDOUS WASTE (Includes COMMON NAME (from Hazardous Materials Inventory page) - 441 CAS # (from Hazardous Materials Inventory page) 442 Used Oil) GASOLINE 8006-61-s ^ 95. UNKNOWN IIL TANK'CONSTRUCTION _ TYPE OF TANK ^ 1. SINGLE WALL ^ 3. SINGLE WALL WITH ^ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 ® 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ^ g5. UNKNOWN (Check one item only) ^4. SINGLE WALL IN A VAULT ^ gg. OTHER TANK MATERIAL -primary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 5. CONCRETE ^ 95. UNKNOWN 444 ^ 2 STAINLESS ^ 4. STEEL CLAD W/ FIBERGLASS ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC FRP TANK MATERIAL -secondary tank ~ ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 8. FRP COMPATIBLE W/100% METHANOL ^ 95. UNKNOWN 445 ^ 2. STAINLESS ^ 4. STEEL CLAD W/FIBERGLASS ^ 9. FRP NON-CORRODIBLE JACKET ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC (FRP) ^ 10. COATED STEEL ^ 5. CONCRETE TANK INTERIOR LINING ^ 1. RUBBER LINED ^ 3. EPOXY LINING ^ 5. GLASS LINING ^ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ~ ^ 2, ALKYD LINING ^ 4. PHENOLIC LINING ®6. UNLINED ^ 99. OTHER (Check one item only) (For local use only) OTHER CORROSION ^ 1. MANUFACTURED CATHODIC ^ 3. FIBERGLASS REINFORCED PLASTIC . ^ 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ^ 4. IMPRESSED CURRENT ^ 99. OTHER (Check all that apply) ^ 2. SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450. TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check all that apply) ®1. SPILL CONTAINMENT 1991 ®1. ALARM ^ 3. FILL TUBE SHUT OFF VALVE ® 2. DROP TUBE BALL FLOAT ^ 4. EXEMPT ®2 1991 . ® 3. STRIKER PLATE 1991 IV. TANK LEA}('DETECTIQN (A description of thempnitoring program shal{,be submitted to the7ocal agency) IF SINGLE WALL TANK (Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) : 454 ^ 1. VISUAL (EXPOSED PORTION ONLY) ^ 5. MANUAL TANK GAUGING (MTG) ^ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ^ 2. AUTOMATIC TANK GAUGING (ATG) ^ 6. VADOSE ZONE ®2. CONTINUOUS INTERSTITIAL MONITORING ® 3. CONTINUOUS ATG ^ 7. GROUNDWATER ^ 3. MANUAL MONITORING ^ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ^ 8. TANK TESTING BIENNIAL TANK TESTING ^ 99. OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YY/MM/DD) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ^ Yes ^ No ARCO # 00583, Belshire Environmental Services, Inc. Page 12 of 20 CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street BakerstIleid, CA 93301 (661) 326-3911 ~- UNDERGROUND STORAGE TANKS -TANK PAGE 2 Vi. PIPINQ CONSTRUCTION ap thal aDPI UNDERGROUND PIPING ABOVEGROUND PIPIIIQ SYSTEM TYPE ®1, PRESSURE ^ 2. SUCTION ^ 3.ORAVITY 458 ^ 1. PRESSURE ^ 2. SUCTION ^ 3. ORAVTTY 459 ^ 1. SINGLE WALL ^ 3. LINED TRENCH ^ 98.OTHER 460 ^ 1. SINGLE WALL ^ li5. UNKNOWN 462 CONSTRUCTlOW ®2. DOUBLE WALL ^ B5. UNKNOWN ^ 2. DOUBLE WALL' ^ 99. OTHER MANUFACTURER MANUFACTURER: A.03MrtH MANUFACTURER 483 ^ 1. BARE STEEL ®8. FRP COMPATIBLE W7100% METHANOL ^ 1. BARE STEEL ^ e. FRP COMPATIBLP W/ 100% METHANOL MATERIALS AND ^ 2. ~~~~ ~~ ^ 7. GALVANIZED STEEL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL CORROSION PROTECTION ^ 3. PLASTIC COMPATIBLE W RH CONTENTS ^ 95. LN+DCPIOWN ^ S. PLASTIC COMPATIBLE W RH CONTFIJT3 ^ 8. FLEXIBLE (HDPE) ^ 69.OTHER (~ ~ ®4. FIBERQLA33 ^ 8. FLEXIBLE (HOPE) ^ 99.OTHER ^ 4. FIBERGLASS ^ 9. CATHODIC PFlOTECTION ~~) ^6. STEEL W/ COATING 9. CATHODIC PROTECTION 464 ^ 5. STEEL W! COATING ^ 95. UNKNOWN 485 Vll. PIPINQ LEAK DETECTION (Chedcasv~atapplylladascripsa~olthemwuta&gprograms+iaBbesubmmedromekcd .) UNDERGROUND PIPING ABOVEGROUND PIPNG tNlIQLE WALL PIPING 466 SINGLE WALL PPM10 467 PRESSURIZED PIPINQ (Chatlt eU that aDDN): PRESSURIZED PIPING {Chadr elt fiat appy): ^ /. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST ~ AUTO PUMP SHUTOFF FOR ^ t. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TESTl'Yjj]j AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND 81'Sl'EM DISCONNECTION + AUDIBLE AND VISUAL LEAK. SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ALARMS ^ 2. MONTHLY 02 GPH TEST ~ ^ 2. MONTHLY 02 OPH TEST ^ 9. ANNUAL INTEGRITY TEST (0.1 OPFI) ^ 3. ANNUAL INTEGRITY TEST (0.1 GPHj ^ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SVSTEM6: ^ 5. DAILY.YISUALMONfTORIPIGOFPUMPINGSYSTEM+TRIENNIALP(PMGINTEGRITV C NYENTiONALSUCTiONSYSTEMS: ~--O TEST (01 QPFO tt t ~ L~ 6. DAILY VISUAL MONRORINO OF PIPMQ AND PUMPING SYSTEM ^ 8. TRIENNIAL INTEGRITY TEBT (0.7 OPI~ SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7 SELF MONTTOAINO SAFE SUCTION SYSTEMS (NO VALVF~ IN BELOW GROIRJD PIPING): ^ 7. SELF MONTTORINQ ORAVTTV FLOW: ^ 9. BIENNIAL INTFORTTY TEST (0.1 GPHj ORAVTTY FLOW; ^.8. DAILYYISUAL MONITORING • ^ B. BIENNIAL INTL-0RITY TEST (0./ GPi1) SECONDAALLY tbNTATNED PIPING 8EC0lIDAF1LLV CONTAR7ED PIPNG PRESSURQEDPIPING(Checkallthatappb): PRESSURIZED PIPING(ChedraAttmteppry): 10. CONTINUOUS TURBINESULdpSENSOR~AUDIt3LEAN0VISUALALARMSAND 10. CONTINUOUBTURBINESUMPSENBORJpQ,]]~AUDIBLEANDVISUALALARMBAND (Check one) (Check one) ^ a AUTO PUMP SHUT OFF W HEN A LEAK OCCURS ^ a AIiTU PUMP SHUT OFF WHEN A LEAK OCCURS ® b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAtlUt1E AND SYSTEM ~ ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION NO AUTD PUMP SHUT OFF - ^ c DLSCONNFX;TION . 0 c' ~ PTO PUMP SHUT OFF ® 1 i. AUTOMATIC LINE LEAK DETECTOR (9.0 GPH TEST) W Tti FLOW SHUT OFF OR ^ ti AUTOMATIC K RESTRICTION . LEA ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) ~ ^ 12 ANNUAL INTEGRITY TEST (0.1 GPi~ SUGTIONA3RAVf7Y SYSTEM: SUCTIONIGRAVtTY SYSTEM: ^ 1 S. CONTINUOUS SUMP SENSOR+AUDIBLE AND VfSUAL ALARMS ^ 19. CONTINLK)US SUMP SENSOR+AUDIHLEAND VISUAL ALARMS EMERGENCY GENERATORS ONLY (CAatlr eB that eDD1YJ: EMERGENCY GENERATORS ONLY (COaclt aH drat appyJ: ^ 14. CONTINUOUS SUMPSENSOR~()~(QAUTOPUMPSHLtiOFF+AUDfBLEANO . ~ [~ 14. CANTINUOUSSUMPSENSORWIi}IOUTAUTOPUMPSHUTOfF+AUDIHLEAND VISUAL ALARMS VISUAL ALARMS ^ 15. AUTOMATIC LINE LEAK DETECTOR (S.0 GPH TEST) ~QI IT FLOW SHUT OFF OR Q 15. AUTOMATIC LINE LEAK DETECTOR (3.0 QPH TEST RESTRICTION ^ 18. ANNLIALII4TEGR[TYTEST ^ 16. ANNUALMTEGRITYTEST ^ 17. DAILY VISUAL CHECK 17. DAILY VISUAL CHECK Vlll. DISPENSER CONTAINMENT DISPENSER CONTAINMENT [~ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ a. DAILY VISUAL CHECK DATE WSTALLED 466 ^ 2 CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LINER! MONRORU4G Not Available ~ S' CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS ^ 6. NONE 469 1X. OWNER/OPERATOR SIGNATURE I eer5ty that the inlormefion provided herein is true end eeeurote to the best of rtry kmxledpe, SIGNATURE OFDWNER/OPERAT DATE - 470 _ _ ... 3 ~ ~,- ,~ ,l NAME OF OWNERK)PERATOR 471 TITLE OF OWNERA7PERATOA ~ 472 MARCELO PANELO Environmental Compliance Specialist Rsvlaed 11/11/5002 ARCO # OOS83, Belslure Environmental Services, Inc. Page 13 of 20 • CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 93301 (661) 326-3911 UNDERGROUND°'STORAGE TANKS =TANK PAGE TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 4. AMENDED PERMIT ® 5. CHANGE OF INFORMATION (Check one item only) ^ 3. RENEWAL PERMIT (Specify reason -for local use only (Specify change -for local use only) 1 LJ 6. TEMPORARY SITE CLOSURE ^ 7. PERMANENTLY CLOSED ON SITE ^ 8. TANK REMOVED - 430 FACILITY ID # 1 BUSINESS NAME (Same as FACILITY NAME or DBA). 3 1 5 0 2 1 1 0 0 7 ARCO# 00583 BUSINESS ADDRESS CITY ZIP CODE 3220 MING AVENUE BAKERSFIELD 93304 LOCATION WITHIN SITE (Optional) 431 L TANK DESCRIPTION ~ scaled lot Ian wifh'the IocaE,~s~ ~ftiie UST s stemincluding 6uifdiri sand landmarksshali be submitted to tl. ;__ - ~ cnc . (A TANK ID # 4 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ^ Yes ®No 434 X8i'X2S If "Yes", complete one page for each compartment. DATE INSTALLED (VEAR/MO) ~ 99ti ~O1 435 TANK CAPACITY IN GALLONS ~ O,000 436 NUMBER OF COMPARTMENTS ~ 437 ADDITIONAL DESCRIPTION ~ 438 -- - II. TANK CONTENTS _ _ TANK USE 439 PETROLEUM'I YPE 440 ® 1. MOTOR VEHICLE FUEL ^ 1a. REGULAR UNLEADED ^ 2. LEADED ^ 5. JET FUEL (If marked, complete Petroleum Type) ® 1b. PREMIUM UNLEADED ^ 3. DIESEL ^ 6. AVIATION FUEL ^ 2. NON-FUEL PETROLEUM ^ 1c. MID-GRADE UNLEADED ^ 4. GASOHOL ^ 99. OTHER ^ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS # (from Hazardous Materials Inventory page) 442 DOUS WASTE (Includes ^ 4 8006-61-9 Used Oi GASOLINE ^ 95. UNKNOWN _ III .:TANK ,GONSTRUCTI O N TYPE OF TANK ^ 1. SINGLE WALL ^ 3. SINGLE WALL WITH. ^ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 ®2. DOUBLE WALL EXTERIOR MEMBRANE LINER ^ g5. UNKNOWN (Check one item only) ^4. SINGLE WALL IN A VAULT ^ gg, OTHER TANK MATERIAL -primary tank ~ ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 5. CONCRETE ^ 95. UNKNOWN 444 ^ 2. STAINLESS ^ 4. STEEL CLAD W/ FIBERGLASS ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC FRP TANK MATERIAL -secondary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 95. UNKNOWN 445 ^ 2 STAINLESS ^ 4. STEEL CLAD W/FIBERGLASS ^ 9. FRP NON-CORRODIBLE JACKET ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC (FRP) ^ 10. COATED STEEL ^ S. CONCRETE TANK INTERIOR LINING ^ 1. RUBBER LINED ^ 3. EPOXY LINING ^ 5. GLASS LINING ^ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ^ 2, ALKYD LINING ^ 4. PHENOLIC LINING ® 6. UNLINED ^ 99. OTHER (Check one item only) (For local use only) OTHER CORROSION ^ 1. MANUFACTURED CATHODIC ^ 3. FIBERGLASS REINFORCED PLASTIC ^ 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ^ q. IMPRESSED CURRENT ^ 99. OTHER (Check alt that apply) ^ 2. SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check all that apply) iy 1: SPILL CONTAINMENT 1991 iy 1. ALARM ^ 3. FILL TUBE SHUT OFF VALVE ® 2. DROP TUBE 1991 ®2. BALL FLOAT ~ ^ 4. EXEMPT ® 3. STRIKER PLATE 1991 IV. TANK: LEAK DETECTION (A`description of the monitoring program shall be submitted to tqe local agency) IF SINGLE WALL TANK (Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) : 454 ^ 1. VISUAL (EXPOSED PORTION ONLY) ^ 5. MANUAL TANK GAUGING (MTG) ^ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ^ 2. AUTOMATIC TANK GAUGING (ATG) ^ 6. VADOSE ZONE ®2. CONTINUOUS INTERSTITIAL MONITORING ® 3. CONTINUOUS ATG ^ 7. GROUNDWATER ^ 3. MANUAL MONITORING ^ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ^ 8. TANK TESTING BIENNIAL TANK TESTING ^ 99. OTHER V. TANK CLOSURE INFORMAl'IQN`7 PERMANENT CLOSURE {N PLACE" ESTIMATED DATE LAST USED (W/MM/DD) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ^ Yes ^ No ARCO # 00583, Belshire Environmental Services, Inc. Page 14 of 20 CUPA . Bakersfield Fire Department • Hazardous Meteriais Division 2101 H Street Bakersfield, CA 93301 (661) 326-3911 UNDERGROUND STORAGE TANKS -TANK PAGE 2 SYSTEM TYPE Vi. PIPINOCONSTRU UNDERGROUND PIPING ®t. PRESSURE ^ 2. SUCTK)N ^ 3. GRAVITY 456 CTION(aadrantnaff Y) ^ 1. PRESSURE Al30VEGROUND PIPING ^ 2. 3UCTK)N ^ 3. GFVIYm 489 ^ 1. SINGLE WAIL ^ 3. LINED TRENCH ^ 98.OTHER 460 ^ i. 6M1GLE WALL ^ 95. UNKNOWN 462 CXxJSTRUCTiOW ®~ DOUBLE WALL ^ 95. UNKNOWN ^ 2. DOUSIE WALL' ^ 99. OTHER MANUFACTURER MANUFACTURER: A.O SMITH MANUFACTURER 463 ^ 1. BARE STEEL ®S. FRP COMPATIBLE Wl 500%METHANOL ^ t. BARE STEEL ^ 6. FRP COMPATIBLE WI100%METHANOL MATERLALS AND ^ 2 STAINLE33 STEEL ^ 7. GALVANIZED 9TEEL ^ 2 STAINLE33 STEEL ^ 7. GALVANiZE~ 6TEEL CORR0.41ON PROTECTION ^ 3. PLASTIC COMPATIBLE W TTH CONTENTS ^ 95. UNKNOWN ^ 3. PLASTIC COMPATISLE WTTH CONTENTS ^ 8. FLEXIBLE (HDPE) ^ 99.OTHER ( ~ ~ ®4. FlBERGLA39 ^ 6. FLEXIBLE (HDPE) ^ 99.OTHER ^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION ~) D5. STEEL W! COATING n ., ,..7ui,nv. ee.vrr..r,..., .c, ^ 6. STEEL W/COATING ^ 95. UNKNOWN 485 UNDERGROUND PIPMCi SAiGLE WALL P9WAG 480 PRESSURIZED PIP9VO (Check ffi1 thatappfy): ^ 1. ELECTRONIC LWE LEAK DETECTOR 3A GPH TEST w~ri' AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS ^ 2 MONTHLV 0.2 GPH TEST ^ 3. ANNUAL INTEGRm TEST (O.t GPH) CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUALMONRORINGOFPUMPIN(3SYSTEM+TRIENNIALPIP6JGtNTEGRm TEST {0.1 GPH) ~', SAFE SUCTION SYSTEMS (NO VALVES W BELOW GROUND PIPING): I^ 7. SELFMONITORINO VRY FLOW: 9. BIENNIAL INTEGRm TEST (O.t GPH) SECONDARB.Y~tONTAINED PIPING PRESSURIZED PIPING (Check eU tltffi aPPH): t0. CONIINUOU57URBINESUMPSENSOR~FLAUDIBLEANDVISUALALARMSAND (Check one) ^ a AUTO PUMP SHUT' OFF WHEN A LEAK OCCURS ® b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ a NO AUTO PUMP SHUT OFF ® 11. AUTOMATIC LINE LEAK DETECTOR (3.0 OPH TEST))Q(jjY{{ FLOW SHUT OFF DR RESTRICTION ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTIONR3RAVm SYSTEM: ^ 19. CONTWUOU9SUMPSENSOR+AUDIBLEANDVISUALALARMS , SNlGLE WALL P~WO 487 PRESSURIZED PIPING (ChedcaUUmtappy): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST /~(t AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DLSCONNECTK)N+AUDIBLE AND VISUAL AWTM3 ^ 2. MONTHLY A2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ 8. TA93JNIAL INTEGRm TEST {0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVm FLOW: ^ 8. DAILY VISUAL MONTOAING ^ 9. 81ENNIAL INTEGRmTE3T (0.1 GPH) 9ECONOARILY CONTAMED PIPING PRESSURIZED PIPING (CAedreUtlratapply): 10. CONiTNUOUSTURBINESUMPSENSOR~AUDIBLEANOVISUALALARMSAND {Check one) ^ a AUTO PUMP 8HUT OFF W HEN A LEAK OCCUA8 ^ b. AUiO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ^ 1 t. AUTOMATIC LEAK ^ 12. ANNUAL 9dTEGRm TEST (0.7 GPH) SUCTION/ORAYm SYSTEM: ^ 19. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (c:heckeUlAat apply): ^ 14. CONTINUOUSSUMP SENSOAAUTO PUMP SHUTOFF+AUDIBLE AND . VISUAL ALARMS ^ 15. AUTOMATIC UNE LEAK DETECTOR (3A GPH TEST) wrrHOln FLOW SHUT OFF OR RESTRICTKX4 ^ td ANNUAL INTEGRITY TEST ^ 17, DAILY VISUAL CHECK EMERGENCY GENERATOR9 ONLY (Check aU thaf appry): ^ ta. CONTINUOUS SUMP SENSORWrTHOUrAUTOPUMPSHUTOFF+AUDIBLEAND VISUAL ALARMS ^ 15. AUTOMATIC UNE LEAK DETECTOR (3.0 GPH TEST ^ 18. ANNUALMTEGRITYTEST ^ 17. DAILYVISUALCHECK (uure:rvxnwrvlalNMav1 (J i. FLOATMECFUWISMTHATSHUTSOFFSHEARVALVE ^d. DAILVVISUALCHECK DATE 9dSTALLED 489 ^ 2, CONTNUOU3 DISPENSER pAN SENSOR+AUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LINER / MONTTORlNO Net Availahla ®9. CONTINUOUS DISPENSER PAN SENSOR 1~V T i AU70 SHUT OFF FOR DISPENSER +AUDIBLE AND VISUAL ALARMS ^ 6. NONE 469 ( 1 wmty dfe! the inlortnation Provided herein h W e and accurate to iho beat of rtry knowledge. - -- ---- - --- ----_--- SXiNATURE OF OWNE~OF1Gfa4i_$g_ _ DATE ~ i am NAME OF OWNERAPERATOR(preM) 471 TITLE OF OWNERlOPERATOR 472 MARCELO PAPIELO Environmental Compliance Specialist Revised en i/2602 AItCO # 00583, Be1slTire Environmental Services, Inc. Page 15 of 20 HAZARDOUS MATERIALS BUSINESS EMERGENCY PLAN EMERGENCY PROCEDURES ARCO # 00583 3220 MING AVENUE, BAKERSFIELD, CA 93304 1. EMERGENCY RESPONSE PLANS AND PROCEDURES A. In the event of a release or threatened release of hazardous materials, provide the following immediate notifications: Immediately call: Local emergency response personnel 911 (Fire, paramedics, police or sheriff) State Office of Emergency Services (800) 852-7550 or (916) 262-1621 Immediately call the appropriate jurisdiction: The Bakersfield Fire Department Hazardous Materials Management Division: (661) 326-3979 Person(s) within the business required responding to a hazardous materials incident: Name: EDMOND NASSAR Telephone: (661) 398-0303 Name: TERESA MILES Telephone: 714-670-5373 Name: ELITE CUSTOMER SOLUTIONS CENTER Telephone: (8001272-6349 B. Identify the local emergency medical facility that will be used by your business in the event of an injury caused by the release of a hazardous material: Name: BAKERSFIELD MEMORIAL HOSPITAL Address: 420 34TH STREET City: BAKERSFIELD, CA 93301 Phone: (661327-4647 2. PREVENTION Gasoline. Gasoline spills can result in environmental contamination, fire, and explosion. Releases of gasoline can occur when underground storage tanks are overfilled, when motorists overfill vehicle tanks, or drive off. The releases are prevented by installed overfill devices such as flapper valves, high level alarms, or ball floats. Other spill prevention devices are impact valves, and breakaway devices. Service stations are attended by trained personnel, and gasoline is delivered by trained truck drivers. ARCO # 00583, Belshire Environmental Services, Inc. Page 16 of 20 HAZARDOUS MATERIALS BUSINESS EMERGENCY PLAN EMERGENCY PROCEDURES ARCO # 00583 3220 MING AVENUE, BAKERSFIELD, CA 93304 Carbon Dioxide. Liquefied carbon dioxide is an extremely cold liquid/gas and is stored under high pressure in a gas cylinder. The small gas cylinders, containing 20 to 50 pounds of liquid carbon dioxide, must be stored upright and be firmly secured with chain to the wall. Those large cylinders (containers), which contain 200 to 400 pounds of liquid carbon dioxide, must be either chained or anchored to the floor. Securing the cylinder prevent falling or being knocked over. The gas cylinder must be capped at all times and transported with drum cart. The extremely cold part of pipes and valves on top of the cylinder will cause moist flesh to stick fast and tear when one attempts to withdraw from it. A leak will result in the formation of dry ice, and contact with dry ice, liquid carbon dioxide, or cold gas can cause frostbite to skin, eyes, and exposed tissues. Breathing low concentration of carbon dioxide can cause nausea, dizziness, mental confusion, and visual disturbance, shaking, headache, and respiratory problem. Liquid carbon dioxide has a high evaporation rate and when heated to above 52 Degree C (125 Degrees F) will generate high pressure. Store away from heat and ignition sources and out of direct sunlight. High temperature can generate high pressure in the tank/cylinder and cause rupture if the safe relief valve fails to operate. Do not store the container or cylinders where they come into contact with moisture. 3. MITIGATION In the event of a major release of gasoline: 1. Attendant should shut off electricity to the pumps/turbines at the emergency shut off switch and/or the main electrical panel. 2. The on-site emergency coordinator or designee will contact 911 (Fire Department) and explain the emergency, and will contact ELITE CSC. If necessary, the On-Site Emergency Coordinator or designee will request an ambulance or other medical assistance. 3. Evacuate. If deemed necessary by the On-Site Emergency Coordinator or designee, all traffic on site will be halted, area coned off, and all employees and customers will be directed to a safe area opposite the danger. 4. Contain the liquid by constructing berms and/or by covering the spill with a fireproof absorbent material. Prevent liquid from entering storm drains whenever possible. 5. Scene management shall be the responsibility of the On-Site Emergency Coordinator or designees until the arrival of fire or police personnel. Upon arrival of these personnel, the Emergency Coordinator will cooperate with and offer any assistance that is requested. 6. Immediately following an emergency the On-Site Emergency Coordinator will provide for the disposal of contaminated material as directed by the local Fire Department or County Health Agency. If neither agency gives such direction, coordinator will call ELITE CSC for removal and disposal. In the event of a fire: 1. Attendant should shout FIRE ALARM and call 911 (Fire Department). 2. Stop fluid flow by shutting off electricity to the pumps at the main electrical panels and close impact valves. 3. Evacuate by stopping all traffic on site and direct all personnel and customers to a safe area opposite the danger. 4. Scene management is the responsibility of the On-Site Emergency Coordinator or designees until the arrival of public safety response ARCO # 00583, Belshire Environmental Services, Inc. Page 17 of 20 HAZARDOUS MATERIALS BUSINESS EMERGENCY PLAN EMERGENCY PROCEDURES ARCO # 00583 3220 MING AVENUE, BAKERSFIELD, CA 93304 personnel. Upon arrival of these personnel, the Emergency Coordinator will cooperate with and offer assistance, as requested. In the event of a carbon dioxide release: Carbon dioxide is cold, asphyxiant, and powerful cerebral vasodilator gas. If there are signs of visible ice on the cylinder or parts such as pipes, it is a sign of a leak and needs to be reported to your manager immediately. In the event of release, evacuate the store, and allow the liquid/gas carbon dioxide to evaporate and the gas to dissipate. Attempt to close the main source valve to stop the release is not recommended unless if is safe to do so and you have adequate personal protection gears. If the area must -be entered by emergency personnel, Self-Contained Breathing Apparatus (SCBA), Kevlar gloves, and appropriate foot and leg protection must be worn. 4. ABATEMENT In the event that a spill is small, station personnel should apply absorbent to the gasoline spill by sweeping the absorbent onto the spill. Once the absorbent has soaked up the liquid, sweep up the absorbent and place it in a 55- gallon drum. If the spill is larger, call 911, attempt to contain it, and follow the scene management instructions in Section 3, Mitigation. Large spills are cleaned by BP designated contractors, or as designated by the franchisee for franchise service stations. 5. EVACUATION Alarm shall be given by shouting to initiate an evacuation at the facility. If deemed necessary by the On-Site Emergency Coordinator or designee, all traffic on site will be halted, area coned off, and all employees and customers will be directed to a safe area opposite the danger. To evacuate the Sales Area, office or storage area, leave facility; go to area opposite danger using the front and/or back doors and proceed to the staging area or area opposite danger zone. Call 911 and report emergency. Call ELITE CSC; give details of emergency. 6. EARTHQUAKES BP WEST COAST PRODUCTS LLC has contracted with maintenance contractors to conduct post-earthquake inspections following an earthquake. Inspections will take place as soon as possible after a 5.5 or greater magnitude quake. After earthquake employees will: 1. Make sure gasoline inventories are secure. Secure all underground storage tank systems (emergency pump shut-off switch and main electrical for the turbines) at the main electrical panel. 2. If there are any signs of structural damage to the building or island canopy, keep everyone away from the damaged area. If danger is imminent, shut down facility operations until it has been deemed safe to continue. 3. Call ELITE CSC immediately. If there's an immediate danger, call 911 for assistance. 4. If there is any indication of loss of gasoline from tanks or lines, shut down the dispensing system immediately. 5. If there is ARCO # 00583, Belshire Environmental Services, Inc. Page 18 of 20 HAZARDOUS MATERIALS BUSINESS EMERGENCY PLAN EMERGENCY PROCEDURES ARCO # 00583 3220 MING AVENUE, BAKERSFIELD, CA 93304 visible gasoline from dispensers, be sure to use absorbent material. 6. Even if gasoline inventories appear normal, conduct inventory reconciliation and visual checks twice a day until aftershocks subside. 7. HAZARDOUS WASTE CONTINGENCY See Section 3, Mitigation, "In the event of a major release. " 8. UNAUTHORIZED RELEASE RESPONSE PLAN See Section 3, Mitigation, "In the event of a major release. " Release reporting will be completed by the Environmental Compliance Specialist (MARCELO PANELO). 9. SITE SECURITY As applicable on an individual facility basis, you should assess the security and vulnerability of your business from intentional acts both from within your business (sabotage) and from the outside (vandalism and terrorist acts). This assessment should consider testing your security system and procedures on a regular basis. Details of this assessment should not be included in this plan as it is a public document. 10. EMPLOYEE TRAINING PLAN All employee training shall be documented and updated annually New employee training. Topics as follows: 1. Identification, location and securing of G02. 2. Review BERP including emergency escape procedures and evacuation assembly location. 3. Discuss fire risks from flammable liquids, combustible materials, static electricity and propane (if applicable). 4. Locate all fire extinguishers. 5. Review list of chemicals used at facility, MSDS's and their location. 6. Handling, identification and proper storage and labeling of hazardous waste. 7. Identify location of UST monitoring alarm. 8. Instruct on use and location of emergency shut-off switches. 9. Discuss procedures used to respond to minor and major spills. Training is conducted as described above for new employees and on a yearly basis for all employees. ARCO # 00583, Belshire Environmental Services, Inc. Page 19 of 20 F ,~. • 2 3 4 5 6 7 8 9 10 11 12 13 BUSINESS NAME: Arco #00583 SITE ADDRESS: 3220 Ming Ave. CITY: Bakersfield ZIP: 93304 MAP DATE: 03-07-07 SURVEY BY: A. R. DRAWN BY: D.B. I AGENCY FACILITY #: SITE MAP B C D E F G H I ] K L International House of Pancakes '..The Corner Pocket Family Billiards ~~~ t ; ~ '. ~ '~ C ~ _ ~ ?o; moo, ao, -oo~ Eoo~ a~i°o ago a~0i°ol 3 ' ~ ~ ~ ~ ~ ~ STORAGE T ...._. __.... p .. ..... __. ~ e__~ ~., ... B CONTAINER __ , '.MSDS ~ /: tl/ 1 __ _ _..._ _. _ O O arc rn rn R o _~_ ' BR ~. _ °' a ~ O 3 W O ,i~ O MO o M C ! v° '0' ~ .v o ~ • O m c ~, a m 3 -i`' ~ L o a y _......__ . >..._.._ _ . ;.. _ _ EM _ 0 _.. .._.._.. p o+ m ® Drveway ' Driveway _ _._ . ....... Ming Ave Valley Plaza-:Mall N ' LEG END SHUTOFF R ~ CASHIER O ABSORBENT F~, FLAMMABLE LIQUID MSDS MSDS & EMERGENCY PLAN BR BATH ROOM O EMERGENCY SHUT OFF ~ FIRE HYDRANT ~ WELL ORING CL ~QU DSTIBLE TB TRASH BIN ~ ~ SEWER/FLOOR DRAIN O ELECTRICAL PANEL • TANK MONITOR O WATER MC MOTOR COOLANT ~ ~ ~ FENCE ~ FIRST AID O LIQUID WASTE DRUM ~ EVACUATION AREA ~ PPE MO MOTOR OIL f ONDIfIONING A/(~' UN ~ FIRE EXTINGUISHER O SOLID WASTE DRUM /( /\O~~ OVERFILL ALARM C TELEPHONE EM EMERGENCY EXIT I CQZ COz CYLINDER ® STORM DRAIN ARCO # 00583, Belshire Environmental Services, Inc. Page 20 of 20 Permit to Operate To Be Posted Hazardous Materials/Hazardous Waste~Unified Permit C4NDITION5`OF PERMIT~DN REVERSE SIDE PERMIT ID#015-021-001007 ~~ This permifi is; issued for the following: ARCO 00583 '' Hazardous Materials Plan 3220 MING AV E, BAKERSFIELD CA 93304: Hazardous Waste Generator and/or Treatment Underground Storage of Hazardous Materials '~ _._"`.'.". Sf ,^~ -r;>~' = ~r Y. n d3 ~~ ~`~,r '~ =~ l1~fJ~ h %:~ PI~I~J[ ~ ! .s~ r~ {ru;frifd~tair+i' ?: „, { ~ I~ '{ti'r; L{1NI-:ate 'fC-ARIF.fS k~~CD. a~ ~Yf.~T'~~iC,~,:- *fTANf1JMAE,EhVL ',;!-~~'V~`]'fU~d IP~TCTNdil•; J~P~':~~{~(HUPlIT(;R :, @ ~, ,~ M I I~ _ I~_,- fa:ezs~:~ea ~ :x+~....v ~~~.._ ~. ~~ ....,~.y .y.~ ''~ ~ s _}~ ~4arL~~J' .zS ~ ,.. ~' .~2.ei }'~ -. ' ~. _.~} ._.. .. ~ K,~pw3 ~.`.~'~ ' ~ ,_ i 't' z -i~^.'~b~1:..~,.:.::.,. _. ... - 0001 PREMIUM UNLEADED 1000G` ~GaIN~ 1991 CC'-'_13LE WALL FIFE L'+.5.5 UNKNOWN PRESSURE AUTOMATIC LEAK DETECTORS 0002 REGULAR UNLEADED 10000 Gal-, 1991 DOUBLE WALL FIBERGLASS UNKNOWN PRESSURE AUTOMATIC LEAK DETECTORS 0003 UNLEADED PLUS/MIDGRADE 10000 Gal 1991 DOUBLE WALL FISEfZGLASS ~ UNKNOWN PRESSURE AUTOMATIC LEAK DETECTORS ~( v~/L~-c4 /~ G~ iy rI i a ` ~ , t ~ ~ Issued by: Approved by: Bakersfield Fire Department ~ ~ / _ dFFICE OF PREVENTION SERVICES ~ 7a(,J,t/ s ~ R S_F ! ~._. 900 Truxtun Ave. Suite 210 ~='~ '' FIRE Bakersfield, CA 93301 D RrM ~ Voice (661) 326-3979 Issue Date: July 1, 2006 FAX (661) 852-2171 Expiration Date: 3une 30, 7.009 `~ n ~'`~ ~ ~o ~ ~`~ D ~G~~L~~ ~IUN 2 6 2QQ6 UNDERGROUND°STORAGE-:TANKS.- FACILITY TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ® S. CHANGE OF INFORMATION (Specify change - ^ 7. PERMANENTLY CLOSED SITE (Check one item only) ^ ~ q. AMENDED PERMIT local use only)_contact information ^ 8. TANK REMOVED ^ 6. TEMPORARY SITE CLOSURE 400 - I. FACILITY-/SITE INFORMATION'"° FACILITY ID # I - .1 SITE NAME (Same as FACILITY NAME or DBA} 3 6 0 0 1 Arco# 0583 3 BUSINESS ADDRESS CITY ZIP CODE 3220 Ming Ave Bakersfield 9304 'NEAREST CROSS STREET 401 FACILITY OWNER TYPE ^ 4. LOCAL AGENCY/DISTRICT' Wible RD ^ S. COUNTY AGENCY' ® 1. CORPORATION BUSINESS ® 1 GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY' TYPE ~ ^ 7. FEDERAL AGENCY' 402 ^ 3. PARTNERSHIP ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ OTHER 403 TOTAL NUMBER OF ~ Is facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of TANKS ON SITE trustlands? division, section or office which operates the UST. (This is the contact person for the tank records) 4 404 ^ Yes ® No 405 406 II. TANK OPERATOR INFORMATION ___ TANK OPERATOR NAME 407 PHONE 408 Edmond Nassar (714) 670-5248 MAILING OR STREET ADDRESS 409 P.O. Box 6038 CITY ~ 410 STATE 411 ZIP CODE 412 Artesia CA 90702-6038 TANK OPERATOR TYPE ® 1. CORPORATION ^ 2~ INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 7. STATE AGENCY 413 ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 8. FEDERAL AGENCY III. TANK OWNER INFORMATION TANK OWNER NAME ~ 414 PHONE 415 BP West Coast Products LLC (714) 670-5248 MAILING OR STREET ADDRESS 416 P.O. Box 6038 CITY 417 STATE 418 ZIP CODE 419 Artesia ~ CA 90702-6038 TANK OWNER TYPE ® 1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 7. STATE AGENCY 420 ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 8. FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER 1 Call (916) 322 - 9669 if questions arise TY (TK) HQ 4 4 - 0 4 1 4 6 5 az1 V. PETROLEUM UST F{NANCIAL RESPONSIBILITY - INDICATE METHOD(S) Q 1. SELF-INSURED - ^ 4: SURETY BOND ® 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND 8 CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ~ ^ 9. STATE FUND 8 CD 422 VI: LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. T Legal notifications and mailings will be sent to the tank owner ONLY, unless box 1 or 2 is ^ 1. FACILITY ^ 2. PROPERTY OWNER ® 3. TANK OWNER 423 checked. VII. APPLICANT SIGNATURE - - Certification: I certify that the information provided herein is true and accurate to the bestof my knowledge. SIGNATURE OF APPLICANT DATE 424 PHONE 425 $/2/206 (714) 670-5248 NAME OF APPLICANT (print) 426 TITLE OF APPLICANT 427 Scott Hartwell Environmental Compliance.Specialist STATE UST FACILITY NUMBER (FOrlocal use only) 428 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 429 UNDERG'ROUND~ STORAGE TANKS - TANK PAGE-1 ~ TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 4. AMENDED PERMIT ® 5. CHANGE OF INFORMATION ^ 6. TEMPORARY SITE CLOSURE (Check one item only) ^ 3. RENEWAL PERMIT ^ 7. PERMANENTLY CLOSED ON SITE (Specify reason -for local use only (Specify change -for local use only) ^ 8 TANK REMOVED 430 FACILITY ID # 1. BUSINESS NAME (Same as FACILITY NAME or DBA1 I ~ 3 6 0 0 1 Arco 0583 ~ BUSINESS ADDRESS CITY ZIP CODE ° 3220 Ming Ave Bakersfield 93304 LOCATION WITHIN SITE (Optional) - ~ 431 L TANK DESCi21PTfON . :. - /A scaled. tot tan with fhe-loca6or~ of'thA .UST s stern indudin nuifdin s and tandrnarks-ahal(be subrniKed to.fhe local.a e~~c ) < _ _ TANK ID # ~ 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ^ Yes ®No 434 ~ Xerxes If "Yes", complete one page for each compartment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 10, 000 ADDITIONAL DESCRIPTION 438 - ,; - - II. TANK CONTENTS _ TANK USE 439 PETROLEUM TYPE ~ 440 ® 1. MOTOR VEHICLE FUEL ® ta. REGULAR UNLEADED ^ 2. LEADED ^ 5. JET FUEL (If marked, complete Petroleum type) ~ 1b. PREMIUM UNLEADED ^ 3. DIESEL ^ 6. AVIATION FUEL ^ 2. NON-FUEL PETROLEUM ^ 1c. MID-GRADE UNLEADED ^ 4. GASOHOL ^ 99. OTHER CHEMICAL PRODUCT ^ 3 . ^ 4. HAZARDOUS WASTE (Includes COMMON NAME (from Hazardous Materials Inventory page) 441 CAS # (from Hazardous Materials Inventory page) 442 Used Oil) Gasoline ^ 95. UNKNOWN ~ 8006'01'9 r llL .TANK'CONSTRUCTION~~ . _ , :;=~;. ., ,, , - - ~~ ~_ TYPE OF TANK ^ 1. SINGLE WALL. ^ 3. SINGLE WALL WITH ^ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 DOUBLE WALL EXTERIOR MEMBRANE LINER ^ g5 UNKNOWN ® 2 . . (Check one item only) ^4. SINGLE WALL IN A VAULT ^ gg_ OTHER TANK MATERIAL -primary tank ^ 1. BARE STEEL ®3. FIBERGLASS !PLASTIC ^ 5. CONCRETE ^ 95. UNKNOWN 444 ^ 2. STAINLESS ^ 4. STEEL CLAD W/FIBERGLASS ^ 8. FRP COMPATIBLE W/100% METHANOL ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC FRP TANK MATERIAL -secondary tank ^ 1. BARE STEEL ~ ®3. FIBERGLASS /PLASTIC ^ 8. FRP COMPATIBLE W/100% METHANOL ^ 95. UNKNOWN 445 ^ 2. STAINLESS ^ 4. STEEL CLAD WlFIBERGLASS ^ 9. FRP NON-CORRODIBLE JACKET ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC (FRP.) ^ 10. COATED STEEL ^ 5. CONCRETE TANK INTERIOR LINING ^ 1. RUBBER LINED ^ 3. EPOXY LINING ^ 5. GLASS LINING ^ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ^ 2. ALKYD LINING ^ 4. PHENOLIC LINING ®6. UNLINED ^ 99. OTHER (Check one item only) (For local use only) OTHER CORROSION ^ 1. MANUFACTURED CATHODIC ®3. FIBERGLASS REINFORCED PLASTIC ^ 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ^ 4. IMPRESSED CURRENT ^ 99. OTHER (Check all that apply) ~ ^ 2. SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check all that apply) ®1. SPILL CONTAINMENT ^ 1. ALARM ®3. FILL TUBE SHUT OFF VALVE ® 2. DROP TUBE ®2. BALL FLOAT ^ 4. EXEMPT ® 3. STRIKER PLATE ,., _ IV. TANK LEAK DETECTION (A descrrptton of the rrronitoring programshall6e submitted to,the ocal agency)..., '" IF SINGLE WALL TANK (Check all that apply). ~ 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) ~. 454 ^ 1. VISUAL (EXPOSED PORTION ONLY) ^ 5. MANUAL TANK GAUGING (MTG) ^ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ^ 2. AUTOMATIC TANK GAUGING (ATG) ^ 6. VADOSE ZONE ®2. CONTINUOUS INTERSTITIAL MONITORING ^ 3. CONTINUOUS ATG ^ 7. GROUNDWATER ^ 3. MANUAL MONITORING ^ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ^ 8. TANK TESTING ~ . BIENNIAL TANK TESTING ^ g9. OTHER V. TANK CLOSURE INFORMATION / PERMANENT.CLOSURE iN PLAQE` ESTIMATED DATE LAST USED (YY/MM/DD) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ^ Yes ^ No Revised 6It 712002 UNDERGROUND STORAGETANKS =TANK PAGE 2,.. VL PIPING CONSTRUCTION (Check at/that apply). I UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 458 ^ 1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 459 ^ 1. SINGLE WALL ^ 3. LINED TRENCH ^ 99. OTHER 460 ^ 1. SINGLE WALL ^ 95. UNKNOWN 462 CONSTRllCTIONI ®2 DOUBLE WALL ^ 95. UNKNOWN ^ 2. DOUBLE WALL' ^ 99. OTHER MANUFACTURER MANUFACTURER_ MANUFACTURER 463 ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100 % METHANOL ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100 % METHANOL MATERIALS AND ^ 2 STAINLESS STEEL ^ 7. GALVANIZED STEEL ^~2. STAINLESS STEEL ^ 7. GALVANIZED STEEL CORROSION PROTECTION ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 95. UNKNOWN ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER (check all that ®4. FIBERGLASS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER ^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION apply) ^5. STEEL W! COATING ^ 9. CATHODIC PROTECTION 464 ^ 5. STEEL W! COATING ^ 95. UNKNOWN 4fi5 VII. PIPING LEAK"DETEGTIQN "~ °" '` "' I ~hecl. aJ,that'apply)(a,descnpticn ocfhe monitoring program sha I be submlttedYo the local agency.) ° ~ _, ;-,;._ UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check al/ that app/y): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM +TRIENNIAL PIPING INTEGRITY CONVENTIONAL SUCTION SYSTEMS: , TEST (0.1 GPH) ~ ^ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TRIENNIAL INTEGRITY TEST (0.1 GPH) ^ 6 SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): . ^ 7. SELF MONITORING ~ SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ~ ^ 7. SELF MONITORING GRAVITY FLOW: ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) GRAVITY FLOW: ^ 8. DAILY VISUAL MONITORING ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ~ ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ® b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ^ c. NO AUTO PUMP SHUT OFF ® 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR ^ RESTRICTION 11. AUTOMATIC LEAK ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply): EMERGENCY GENERATORS ONLY (Check all that apply): ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND VISUAL ALARMS VISUAL ALARMS ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST RESTRICTION ^ 16. ANNUAL INTEGRITY TEST ^ 16. ANNUAL INTEGRITY TEST ^ 17. DAILY VISUAL CHECK ^ 17. DAILY VISUAL CHECK Vllt: <DISPENSER CONTAINMENT DISPENSER CONTAINMENT ® 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ 4. DAILY VISUAL CHECK DATE INSTALLED 468 ^ 2. CONTINUOUS DISPENSER PAN SENSOR + gUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LINER /MONITORING ® 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER +AUDIBLE AND VISUAL ALARMS ^ 6. NONE 469 IX. 01NNER%OP.ERATQR:SIGNATURE I certify that the information pr ed herein i rue and accurate to the best of my knowledge. SIGNATURE OF OWNER PERATOR DATE 470 8/2/2006 NAME OF OWNER/OPERATO rin 471 ~ TITLE OF OWNER/OPERATOR 472 Scott Hartwell Environmental Compliance Specialist Revisetl 611112002 UNDERGROUND STORAGE3;TANKS -TANK PAGE 1 TYPE OF ACTION ~ 1. NEW SITE PERMIT ^ 4. AMENDED PERMIT ® 5. CHANGE OF INFORMATION ^ 6. TEMPORARY SITE CLOSURE (Check one item only) ^ 3. RENEWAL PERMIT ^ 7. PERMANENTLY CLOSED ON SITE (Specify reason -for local use only (Specify change -for local use only) ^ 8_ TANK REMOVED 430 FACILITY ID # - 1 BUSINESS NAME (Same as FACILITY NAME or DBA~ 3 6 0 0 1 ~~>~ 0583 BUSINESS ADDRESS - CITY ZIP CODE 3220 Ming Ave Bakersfield 93304 LOCATION WITHIN SITE (Optional) ~ 431 I: TANK DESCRIPTION " - ~... .4 scaled ~ lot plan ~i~~th the (acubon ofdh8 USTs stern iricludin budder s and landmarks shalF pe submitted to the locala enc -- TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ^ Yes ®No 434 't XerXeS If "Yes", complete one page for each compartment. DATE INSTALLED (YEARfMO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 10,000 ADDITIONAL DESCRIPTION ~ 438 II. TANK CONTENTS TANK USE 439 -_ PETROLEUM TYPE 440 ® 1. MOTOR VEHICLE FUEL ® 1a. REGULAR UNLEADED ^ 2. LEADED ^ 5. JET FUEL (If marked, complete Petroleum Type) ^ 1b. PREMIUM UNLEADED ^ 3. DIESEL ^ 6. AVIATION FUEL ^ 2. NON-FUEL PETROLEUM ^ tc. MID-GRADE UNLEADED ^ 4. GASOHOL ^ 99. OTHER CHEMICAL PRODUCT ^ 3 . ^ 4. HAZARDOUS WASTE (Includes COMMON NAME (from Hazardous Materials Inventory page) 441 CAS # (from Hazardous Materials Inventory page) 442 Used Oil) Gasoline ^ 95. UNKNOWN 8006-01-9 IU. 'TANK~~.CONSTRUGTIO~N~ _ ' ~" TYPE OF TANK ^ 1. SINGLE WALL ^ 3. SINGLE WALL WITH ^ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 44 3 ® 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ^ g5. UNKNOWN (Check ane item only). ^4. SINGLE WALL IN A VAULT ^ gg. OTHER TANK MATERIAL -primary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 5. CONCRETE ^ 95. UNKNOWN 444 ^ 2. STAINLESS ^ 4. STEEL CLAD W/ FIBERGLASS ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC FRP TANK MATERIAL -secondary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 95. UNKNOWN 445 ^ 2. STAINLESS ^ 4. STEEL CLAD W/FIBERGLASS ^ 9. FRP NON-CORRODIBLE JACKET ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC (FRP) ^ 10. COATED STEEL ^ 5. CONCRETE TANK INTERIOR LINING ^ 1. RUBBER LINED ^ 3. EPOXY LINING ^ 5. GLASS LINING ^ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ^ 2. ALKYD LINING ^ 4. PHENOLIC LINING ®6. UNLINED ^ 99 OTHER (Check one item only) (For locat use only) OTHER CORROSION ^ 1. MANUFACTURED CATHODIC ®3. FIBERGLASS REINFORCED PLASTIC ^ 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ^ 4. IMPRESSED CURRENT ^ 99. OTHER (Check all that apply) ~ ~ ^ 2. SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check all that apply) ®1. SPILL CONTAINMENT ^ 1. ALARM ®3. FILL TUBE SHUT OFF VALVE ®2. DROP TUBE ~ ®2. BALL FLOAT ^ 4. EXEMPT ® 3. STRIKER PLATE IV: TANK LEAK.(~ET~CTION (Adescnpbonoftbemonitonng•programshallbesubmittedto;the/ocafagency) ,,; IF SINGLE WALL TANK (Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) : 454 ^ 1. VISUAL (EXPOSED PORTION ONLY) ^ 5. MANUAL TANK GAUGING (MTG) ^ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ^ 2. AUTOMATIC TANK GAUGING (ATG) ^ 6. VADOSE ZONE ® 2. CONTINUOUS INTERSTITIAL MONITORING ^ 3. CONTINUOUS ATG ^ 7. GROUNDWATER ^ 3. MANUAL MONITORING ^ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ^ 8. TANK TESTING BIENNIAL TANK TESTING ~ ^ 9g. OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE,IN<PLACE ESTIMATED DATE LAST USED (YY/MM/DD) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ^ Yes ^ No Revised 6171/2002 UNDERGROUND STORAGE TANKS.. -TANK PAGE 2 Vi. PIPING CONSI UNDERGROUND PIPING SYSTEM TYPE ®1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY ^ 1. SINGLE WALL ^ 3. LINED TRENCH ^ 99. OTHER CONSTRUCTION/ ®Z. DOUBLE WALL ^ 95. UNKNOWN MANUFACTURER MANUFACTURER- ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100% METHANO MATERIALS AND ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL CORROSION PROTECTION ^ 3. PLASTIC COMPATIB LE WITH CONTENTS ^ 95. UNKNOW (check all that ®4. FIBERGLASS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER apply) ^5. STEEL W/ COATING ^ 9. CATHODIC PROTECTION Vll PIPING LEAK-~ETECTION'Checkartnata t )'a aU that anoly) ~ ~ ' 458 ^ 1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 459 460 ^ 1. SINGLE WALL ^ 95. UNKNOWN 462 ^ 2. DOUBLE WALL ^ 99. OTHER MANUFACTURER 463 L ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100% METHANOL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER ^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION 464 ^ 5. STEEL W/COATING N ^ 95. UNKNOWN 465 t ~ PPyt UNDERGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE'AND VISUAL ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVITY FLOW. ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ® b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ® 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR RESTRICTION ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check alt that app/y): lphonof~the morlltaling program shall be submdted fa the local agency.) _ ~ _ ABOVEGROUND PIPING SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) • SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVITY FLOW: ^ 8. DAILY VISUAL MONITORING ^ 9. BIENNIAL INTEGRITY TEST (0:1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ^ 11. AUTOMATIC LEAK ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTIONlGRAVITY SYSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply): ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND VISUAL ALARMS VISUAL ALARMS ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST ' RESTRICTION ^ 16. ANNUAL INTEGRITY TEST ^ 16. ANNUAL INTEGRITY TEST ^ 17. DAILY VISUAL CHECK ^ 17. DAILY VISUAL CHECK VIII. ~D15PEN5ER CONTAINMENT --- DISPENSER CONTAINMENT ® 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ 4. DAILY VISUAL CHECK DATE INSTALLED 468 ^ 2. CONTINUOUS DISPENSER PAN SENSOR +AUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LINER /MONITORING ® 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER +AUDIBLE AND VISUAL ALARMS ^ 6. NONE 469 IX. OVVNER/OPERATOR~SIGNATURE -- -- I certify that the information provi erei is true and accura~ to the best of my knowledge. SIGNATURE OF OWNER/OP ATOR DATE 470 81212006 NAME OF OWNER/OPERATO t) 471 TITLE OF OWNER/OPERATOR - 472 Scott Hartwell Environmental Compliance Specialist ~ UNDERGROUND STORAGE °TANKS -TANK PAGE 1 ~ TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 4. AMENDED PERMIT ® 5. CHANGE OF INFORMATION ^ 6. TEMPORARY SITE CLOSURE (Check one item only) ^ 3. RENEWAL PERMIT ^ 7. PERMANENTLY CLOSED ON SITE (Speci/y reason -for local use only ~ (Specify change -for local use only) ^ 8. TANK REMOVED 430 FACILITY ID # - _-,1', _ - BUSINESS NAME (Same as FACILITY NAME or DBA~ 3 6 0 0 1 0583 BUSINESS ADDRESS - CITY ZIP CODE 3220 Ming Ave Bakersfield 93304 LOCATION WITHIN SITE (Optional) 431 I. TANK DESCRIPTION (A scaled oloC ~(an tvlth the IQCatiOn o%the UST s stem includin buddin sand (andmerks shall besubmitteddolhe toeahe enc I TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ^ Yes ® No 434 3 ~ XeYXeS - If "Yes", complete one page for each compartment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 10,000 ADDITIONAL DESCRIPTION ~ 438 II. TANK CONTENTS TANK USE 439 PETROLEUM TYPE ~ 440 ® 1. MOTOR VEHICLE FUEL ^ ta. REGULAR UNLEADED ^ 2. LEADED ^ 5. JET FUEL (If marked, complete Petroleum Type) ^ tb. PREMIUM UNLEADED ^ 3. DIESEL ^ 6. AVIATION FUEL ^~ 2. NON-FUEL PETROLEUM ® tc. MID-GRADE UNLEADED ^ 4. GASOHOL ^ 99. OTHER ^ 3 CHEMICAL PRODUCT . ^ 4. HAZARDOUS WASTE (Includes COMMON NAME ((rom Hazardous Materials Inventory page) 441 CAS # (from Hazardous Materials Inventory page) 442 used oll> Gasoline ^ 95. UNKNOWN 8006-01-9 IIL TANK_CONS~TRUCTION~~ :_ __ TYPE OF TANK ^ 1. SINGLE WALL ^ 3. SINGLE WALL WITH ^ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 ® 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ^ g5. UNKNOWN (Check one item only) ^4. SINGLE WALL IN A VAULT ^ gg. OTHER TANK MATERIAL -primary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 5. CONCRETE ^ 95. UNKNOWN 444 ^ 2. STAINLESS ^ 4. STEEL CLAD W/ FIBERGLASS ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC FRP TANK MATERIAL -secondary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 95. UNKNOWN 445 - ^ 2~ STAINLESS ^ 4. STEEL CLAD W/FIBERGLASS ^ 9. FRP NON-CORRODIBLE JACKET ^ 99. OTHER (Check one item on/y) STEEL REINFORCED PLASTIC (FRP) ^ 10. COATED STEEL ^ 5. CONCRETE TANK INTERIOR LINING ^ 1. RUBBER LINED ^ 3. EPOXY LINING ^ 5. GLASS LINING ^ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ^ 2. ALKYD LINING ^ 4. PHENOLIC LINING ®6. UNLINED ^ 99. OTHER (Check one item only) (For local use only) OTHER CORROSION ^ 1. MANUFACTURED CATHODIC ®3. FIBERGLASS REINFORCED PLASTIC ^ 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ^ 4. IMPRESSED CURRENT ^ 99 OTHER . (Check all that appy) ^ 2. SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check all that apply) ®1. SPILL CONTAINMENT ~ ^ 1. ALARM ®3. FILL TUBE SHUT OFF VALVE ® 2. DROP TUBE ®2. BALL FLOAT ^ 4. EXEMPT - ® 3. STRIKER PLATE IV. TANK LEAK QETECTION (A descri Oonoftheirronitoriri" p g program shalt besubmitted to the localagency) IF SINGLE WALL TANK (Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) ~ 454 ^ 1. VISUAL (EXPOSED PORTION ONLY) ^ 5. MANUAL TANK GAUGING (MTG) ^ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ^ 2. AUTOMATIC TANK GAUGING (ATG) ^ 6. VADOSE ZONE ®2. CONTINUOUS INTERSTITIAL MONITORING ^ 3. CONTINUOUS ATG ^ 7. GROUNDWATER ^ 3. MANUAL MONITORING ^ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ^ 8. TANK TESTING BIENNIAL TANK TESTING ^ 99. OTHER V. TANK CLOSURE INFORMATION /PERMANENT CLOSURE IN'PLACE .ESTIMATED DATE LAST USED (YY/MM/DD) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ^ Yes ^ No Revised 6!1112002 UNbERG-ROUND ,STORAGE TANKS -TANK PAGE 2=' VI. PIPING CONSTRUCTION'(Checkad-thatappty) •, - - UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 458 ^ 1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 459 ^ 1. SINGLE WALL ^ 3. LINED TRENCH ^ 99. OTHER 460 ^ 1. SINGLE WALL ^ 95. UNKNOWN 462 CONSTRUCTION/ ®2 DOUBLE WALL ^ 95. UNKNOWN ^ 2. DOUBLE WALL' ^ 99. OTHER MANUFACTURER MANUFACTURER. MANUFACTURER 463 ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100% METHANOL ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100% METHANOL MATERIALS AND ~ 2 STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL CORROSION PROTECTION ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 95. UNKNOWN ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER (check all that ~ ®q. FIBERGLASS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER ^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION apply) ^5. STEEL W/ COATING ^ 9. CATHODIC PROTECTION 464 ^ 5. STEEL W/ COATING ^ 95. UNKNOWN 465 _ VII. PIPING LEAK DETECTIQN (Check~al! that appryj(a dascnption of the monitoring prog)emshal( 4? `submitted to the meal agency I '~ UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL LEAK, SYSTEM FAILURE ANO SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ALARMS ^ 2. MONTHLY 0.2 GPH TEST ~ ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ~ ^ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY CONVENTIONAL SUCTION SYSTEMS: TEST (0.1 GPH) - ~ ^ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING ~ SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVITY FLOW: ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) GRAVITY FLOW: ^ 8. DAILY VISUAL MONITORING ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND 10. .CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ® b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ~ DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ^ c. NO AUTO PUMP SHUT OFF ® 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR ^ 11 AUTOMATIC LEAK RESTRICTION ~ - .. ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) ' SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply): EMERGENCY GENERATORS ONLY (Check all that apply): ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND VISUAL ALARMS VISUAL ALARMS ^ 15, AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST RESTRICTION ^ 16. ANNUAL INTEGRITY TEST ~ ^ 16. ANNUAL INTEGRITY TEST ^ 17. DAILY VISUAL CHECK ^ 17. DAILY VISUAL CHECK _ VVN. DISPENSER CONTA{LAMENT DISPENSER CONTAINMENT ® 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ 4. DAILY VISUAL CHECK DATE INSTALLED 468 ^ 2. CONTINUOUS DISPENSER PAN SENSOR +AUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LINER /MONITORING ® 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER +AUDIBLE AND VISUAL ALARMS ^ 6. NONE 469 >.. IX. 01NNER/OPERATO'R SIGNATURE I certify that the information provided herein is true and accurate to the best of my knowledge. SIGNATURE OF OWNER/OPER DATE q70 8~2~2UU6 NAME OF OWNER/OPERATOR(p ) 471 TITLE OF OWNERIOPERATOR q72 Scott Hartwell Environmental Compliance Specialist Keviseaenuzuuz ~/ UNDERGROUND.;.STORAGE„TANKS -TANK PAGE1 TYPE OF ACTION ~ ^ 1. NEW SITE PERMIT ^ 4. AMENDED PERMIT ® S. CHANGE OF INFORMATION ^ 6. TEMPORARY SITE CLOSURE (Check one item only) ^ ~ ^ 7. PERMANENTLY CLOSED ON SITE 3. RENEWAL PERMIT ' (Specify reason -for local use only (Speci/y change -for local use only) ^ 8. TANK REMOVED 430 FACILITY ID # ~.I 1 BUSINESS NAME (Same as FACILITY NAME or DBA~ 3~ 6 0 0 1 ~:. 0583 BUSINESS ADDRESS CITY ZIP CODE 3220 Ming Ave Bakersfield 93304 LOCATION WITHIN SITE (Optional) 431 1. TANK DESCRIPTION ~'~ ~ to scaled. tot, ian. with fhe {OCet~on of the US's stem mclud~m tui;dhi. s and landmarkshall cesubmittedto the ipCat agency) _ _ TANK ID # ~ 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ^ Yes ®No 434 (~ XerxeS If "Yes", complete one page for each compartment. - DATE INSTALLED (YEARfMO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS ~ 437 10,000 ADDITIONAL DESCRIPTION ~ 438 - II. TANKCONTENTS ` _ ~ 440 TANK USE 439 PETROLEUM TYPE ~ ® 1. MOTOR VEHICLE FUEL ^ 1a. REGULAR UNLEADED ^ 2. LEADED ^ 5. JET FUEL (If marked, complete Petroleum Type) ®1b. PREMIUM UNLEADED ^ 3. DIESEL ^ 6. AVIATION FUEL ^ 2. NON-FUEL PETROLEUM ^ tc. MID-GRADE UNLEADED ^ 4. GASOHOL ~ ^ 99. OTHER ^ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS # (from Hazardous Materials Inventory page) 442 ^ 4. HAZARDOUS WASTE (Includes Used Oil) Gasoline ^ 95. UNKNOWN $OO6-01-9 III. TANK,GQNSTRU,CTION - a ,„_ TYPE OF TANK ^ 1. SINGLE WALL ^ 3. SINGLE WALL WITH ^ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 ®2. DOUBLE WALL EXTERIOR MEMBRANE LINER ^ g5. UNKNOWN (Check one item only) ^4. SINGLE WALL IN A VAULT ^ gg, OTHER TANK MATERIAL -primary tank ^ 1. BARE STEEL ®3. FI8ERGLASS /PLASTIC ^ 5. CONCRETE ^ 95. UNKNOWN 444 ^ 2. STAINLESS ^ 4. STEEL CLAD W/FIBERGLASS ^ 8. FRP COMPATIBLE W/100% METHANOL ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC FRP TANK MATERIAL -secondary tank ^ 1. BARE STEEL ®3. FIBERGLASS! PLASTIC - ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 95. UNKNOWN 445 ^ 2. STAINLESS ^ 4. STEEL CLAD W/FIBERGLASS ^ 9. FRP NON-CORRODIBLE JACKET ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC (FRP) ^ 10. COATED STEEL ^ 5. CONCRETE TANK INTERIOR LINING ^ 1. RUBBER LINED ^ 3. EPOXY LINING ^ 5. GLASS LINING ^ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ^ 2_ gLKYD LINING ^ 4. PHENOLIC LINING ®6. UNLINED ^ 99. OTHER (Check one item only) - (For local use only) OTHER CORROSION ^ 1. MANUFACTURED CATHODIC ®3. FIBERGLASS REINFORCED PLASTIC ^ 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ^ 4. IMPRESSED CURRENT ^ 99. OTHER (Check all that apply) ^ 2. SACRIFICIAL ANODE SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check aH that apply) ®1. SPILL CONTAINMENT ^ 1. ALARM ~ ®3. FILL TUBE SHUT OFF VALVE ® 2. DROP TUBE ~ ®2. BALL FLOAT ^ 4. EXEMPT ® 3. STRIKER PLATE _ 1V. TANK t_EAK DETECTIQN (A description of the monitodny program shau besubmitted to the loca(agency) IF SINGLE WALL TANK (Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) : 454 ^ 1. VISUAL (EXPOSED PORTION ONLY) ^ 5. MANUAL TANK GAUGING (MTG) ^ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ^ 2: AUTOMATIC TANK GAUGING (ATG) ^ 6. VADOSE ZONE ®2. CONTINUOUS INTERSTITIAL MONITORING ^ 3. CONTINUOUS ATG ^ 7. GROUNDWATER ^ 3. MANUAL MONITORING ^ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ^ 8. TANK TESTING BIENNIAL TANK TESTING ^ 9g. OTHER V. TANK CLOSUREAINFORMATION (PERMANENT CLQSURE IN PLACE ESTIMATED DATE LAST USED (YY/MM/DD) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ^ Yes ^ No Revised 6/11/2002 ., UNDER~G'ROUND STORAGE TANKS -TANK PAGE 2 .; !~ VI. PIPING'CONS UNDERGROUND PIPING SYSTEM TYPE ®1. PRESSURE ^.2. SUCTION ^ 3. GRAVITY ^ 1. SINGLE WALL ^ 3. LINED TRENCH ^ 99. OTHER CONSTRUCTION/ ®2. DOUBLE WALL ^ 95. UNKNOWN MANUFACTURER ' • MANUFACTURER ^ •1. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100 % METHANOI MATERIALS AND ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL CORROSION '~ PROTECTION ^ 3. PLASTIC COMPATIB LE WITH CONTENTS ^ 95. UNKNOWN (check all that ®q. FIBERGLASS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER i aPPIY) ^5. STEEL W/COATING ^ 9 CATHODIC PROTECTION _ , ~~ VII. PIPING _ IEAKxDETECTtON (Check an that apply)(a T..RU6TION>(cneckantnatapply) ~ ~ ~" ~ - - ABOVEGROUND PIPING 458 ^ 1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 459 460 ^ 1. SINGLE WALL ^ 95. UNKNOWN 462 ^ 2. DOUBLE WALL' ^ 99. OTHER MANUFACTURER 463 UNDERGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM +TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVITY FLOW: ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ^ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS, ® b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ® 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR RESTRICTION ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) - SUCTION/GRAVITY SYSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply): ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100% METHANOL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER ^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION ^ 5. STEEL W/COATING ^ 95. UNKNOWN 465 npbon or [Fie monitoring program sha1~ he s~itimittedto the !peal-agency l ABOVEGROUND PIPING SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVITY FLOW: . ^ 8. DAILY VISUAL MONITORING ^ 9 BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) - ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ^ 11. AUTOMATIC LEAK ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTIONIGRAVITY SYSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply): ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND VISUAL ALARMS ~ VISUAL ALARMS ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST RESTRICTION ^ 16. ANNUAL INTEGRITY TEST - ^ 16. ANNUAL INTEGRITY TEST ^ 17. DAILY VISUAL CHECK ^ 17. DAILY VISUAL CHECK -- VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ® 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ 4. DAILY VISUAL CHECK DATE INSTALLED 468 ^ 2. CONTINUOUS DISPENSER PAN SENSOR +AUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LINER /MONITORING ® 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER +AUDIBLE AND VISUAL ALARMS ^ 6. NONE 469 _ IX. 011VNER/OPERATORSlGNATURE I certify that the information provided her ~ is true and accurate to the best of my knowledge. SIGNATURE OF OWNERiOPE OR DATE 470 8/2/2006 NAME OF OWNER/OPERATOR(pri 471 TITLE OF OWNER/OPERATOR 472 Scott Hartwell Environmental Compliance Specialist Revised 611 112 0 0 2 .~. ~.._ s UNIFIED PROGRAM INSPECTION CHECKLIST ~,,, ,., . ., .,,_, .., .. ~ ~R~r .SECTION 1: ,Business Plan and Inventory Program ~' BABEIltSFIE1LD FIRE DEPT Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAM O ©~ NSPE TION ATE NSPECTION TIME ADDRESS HO ENO. O OF EM YEES Vl~ ~ ~ , FACILITY CONTACT USINESS ID NUMBER 15-021- IQ~ Section 1: Business Plan and Inventory Program ~ S ~b ^ ROUTINE OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ / [~' ^ Business PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ENT'D J U L 2 7 2006 ^ 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 8 ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ~10 EXPLAIN: _ IS INSPECTION? PLEASE CALL U9 AT (861) 926-3979 / V Inspector (Please Print) Fire Preven ton / 1u In / Shift of Site/Stetion Y Business White -Prevention Sarvicea Yallow -Station Copy Pink - Buainese Copy FD2049 (Rw.02/05) -;~ r ~YV ~~~ ~ CITY OF BAKERSFIEI.U FIRE UEPAR'I'MF.NT b\~ OFFICE OF ENVIRON>\'IF.NTAL SERVICES • ~~~`~ LtN[FIE® PROCCRAM INSPECTION CHECKLIST w ~g~``~ 1715 Chester Ave., 3~`' Floor, Bakersfield, CA 93301 FACILITY NAME t}~e ~t ~ INSPECTION DATE__~Q~-- Section 2: Underground Storage 'Tanks Program ^ Routine ~mbined ^ Joint Agency ^ Multi-Agenc ~ Complaint ^ Re-inspection Type of Tank ~fil S Number of "fanks Type of Monitoring _Ct c t:~ 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 been an unauthorized release? YeS NO Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? if yes, Does tank have overtilUoverspill protection'? C=Compliance V=Violatic ~ Y=Yes N=NO Inspector: Office of Environmental Services (661) 32 -3979 White - t{nv. Svcs. Pink -Business Copv Business Site Responsible Party ,.. .; + ARCO 00583 __________________________________________ SiteID: 015-021-001007 + Manager EDMOND NASSAR BusPhone: -(661) 398-0303 Location: 3220 MING AVE Map 123 CommHaz Moderate City BAKERSFIELD Grid: 11B FacUnits: 1 AOV: CommCode: BFD STA 07 SIC Code:5541 EPA Numb: DunnBrad:03-959-6507 Emergency Contact / Title Emergency Contact / Title EDMOND NASSAR / FRANCHISEE ARCO MAINTENANCE / Business Phone: (661) 398-0303x Business Phone: (800) 272-6349x 24-Hour Phone (661) 665-2047x 24-Hour Phone (800) 272-6349x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact TERESA MILES Phone: (714) 670-3958x MailAddr: PO BOX 6038 State: CA City ARTESIA Zip 90702-6038 Owner BP WEST COAST PRODUCTS LLC Phone: (714) 670-3958x Address PO BOX 6038 State: CA City ARTESIA Zip 90702-6038 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: ~ Emergency Directives: ~ PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG U - UST Bas®d an my inquiry of those individuals responsible far obtaining th® informatia~rsonally under penalty of law that I haves i~~rmation examined and am familiar wit submitted and be-ieve the,ln or anon is true, accurate, and c ,plate. ~ •' ~~ ~ • .~ ~ T -~~~ Date ~~anature ~~~~~ s~?'~,a ENT'D ~ u ~ ~ o ~aa~ ~~ ~~ 5 ~~p~ -1- 04/03/2006 ....' ~r UNIFIE® PROGRAM INSPECTION CHECKLIST ~ SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME ~~~_A~~~-------------__-------.- --- __----__ ----- ----___ INS ECTI N~E ~ ~k_o_~ .-- _ INSPECTION TIME ------ ---------. ADDRESS - - - - C=~~ PH NE o. 3 _'03 Q_-- - No. of Employees --__._--__.---- --- _ L - ------- ~ FACILITYCONTACT Business ID Number 15-021- Section 1: Business Plan and Inventory Program ^ Routine ombined D Joint Agency ^Mutti-Agency ^ Complaint ^ Re-inspection `C~V IV=Voatlonnce) OPEitATION COMMENTS LY APPROPRIATE PERMIT ON HAND ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ ^ VISIBLE ADDRESS ~^ CORRECT OCCUPANCY ~ ^ VERIFICATION OF INVENTORY MATERIALS f --- --------------_ _----- ------------------- .....---------------._._..__.... ----_..__.-_.._.. ...,__.._.._ CJ ^ VERIFICATION OF QUANTITIES ^ ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL C~ ^ VERIFICATION OF MSDS AVAILABILITYE ^ VERIFICATION OF HAT MAT TRAINING ^~^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~^ EMERGENCY PROCEDURES ADEQUATE Id ^ CONTAINERS PROPERLY LABELED LX ^ HOUSEKEEPING -- - ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE ~ ON HAND i ANY HAZARDOUS WASTE ON SITE: ^ YES Ly'IVO EXPLAIN: GARDIN T INSPECTION? PLEASE CALL US AT ~G6'I ~ 326-3979 I / Inspector Badge No., White -Environmental Services Yellow -Station Copy /'--~Business~onsible Party ---- Pink -Business Copy 1 ~. , ,~~tw4~' '~~~~` CITY OF BAKERSFIELD FIRE DEPARTMENT ~6 ~ ~ b~ OFFICE OF ENVIRONMENTAL SERVICES ~~ y~1 UNIFIED PROGRAM INSPECTION CHECKLIST \~~_;w ~gti,0~'~ 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 _~ ~ ~~~~~ FACILITY NAME~;~Q o ~ INSPECTION DATE ~ ~~ Section 2: Underground Storage Tanks Program ^ Routine I~Combined~ ^ Joint Agency ^Multi-Agency ~ ^ Complaint ^ Re-inspection Type of Tank ~ Number of Tanks Type of Monitoring C,G'12 Type of Piping _ ~~~ OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data on file Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? YeS NO Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance =Violation Y=Yes N=NO Inspector: Oftice of Environmental Services (805) 326-3979 p~i~ Business Site Responsible•Party White - F.nv. Svcs. Pink -Business Copy ~.~ 3 ~z ~ d Bakersfield Fire Dept. UNIFIED PROGRAM INSPECTION CHECKLIST Enironmental Services 1715 Chester Ave ACTION 1 Business Plan and Inventory Program Bakersfield, CA 93301 Tel: (661}326-3979 FACIL.ITti NAfytE . n vn. c ..+~ ~....~+.. . ii.~c ADCRESS PHONE No. No. of E ployees FACILITYCONTACT ~ ~ Business ID Number 15 021- /OD 7 Section 1: Business Plan and Inventory Pn~gram O Routine Combined ^ Joint Agency ^Multt-Agency ^ Complaint O Re-inspection C V `V=v'lotatlonnce ~ OPERATION COMMENTS L1Y ^ APPROPRIATE PERMIT ON HAND ~~ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE i 43' •^ VISIBLE ADDRESS (~~/ ^ CORRECT OCCUPANCY ~/~ ^ VERIFICATION OF INVENTORY MATERIALS ®/J ^ VERIFICATION OF QUANTITIES ---- - ^ VERIFICATION OF LOCATION C~;'~ ^ PROPER SEGREGATION OF MATERIAL ~•~ ^ VERIFICATION OF MSDS AVAILABILITYE C(Ij^ VERIFICATION OF HAT MAT TRAINING LY ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ~O CONTAINERS PROPERLY LABELED GY ^ HOUSEKEEPING GJ ^ FIRE PROTECTION ^/, ^ SITE DIAGRAM ADEQUATE & ON HAND ~~ --------- -...--..~.- i}- . _.....------------------------------ --._. ....._.. ~` ANY HAZARDOUS WASTE ON SITE: ^ YES ~I'VO EXPLAIN QUESTIONS ~~ CARDING HIS MISPEC710N? PLEASE CALL US AT ~66'I ~ 326-3979 ~"? ._ Inspector Badge No., Business Site Responsible Party Whlle • Environmental Services Yellow • Station Copy Pink -Business Copy ~l ~~ iii. ~••~/ fir.... '" I~I/~,f,1.D FI,P J~~ F ~ CITY OF BAKERSFIEI.D FIRE DEPAR'T'MENT ~~ _ ~ °~ OFFICE OF E;NVIRONI~IEN'1'Al. SERVICES `~ y~J UNIFIED PROGRAItiI INSPEC'T'ION CIiF,CKI.IST \'=_~w ~g~,~!'I~ 1715 Chester Ave., 3'`' Floor, Bakersfield, CA 93301 FACILITY NAME~~a(Ir ~p~ u 'Cc ; Section 2: Underground Storage 'Tanks Program ~°p~, INSPECTION DATE `~ ~ 7 J ^ Routine ~ Combined ^ Joint Agency ^Molti-Agency ^ Complaint ^ Re-inspection Type of Tank ~(~iF Number of -Tanks Type of Monitoring ~` [_It 1 Type of Piping 6'~(t)(= OPERATION C V COMMENTS Proper tank data un the Proper owner;operator data on tilt Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations ' Has there been an unauthorized release? Yes No I / -~ 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? Ifyes, Does tank have overtill/overspill protection'? L=C;ompliance /' V=Violation Y=Yes N=NO Inspector: Otsice of Envi;onmental Services (661) 326-3979 /~ Business Site Responsible Party White - I'nv. Svcs. Pink -Business Cnpy _: ~' :a. - , ,f ~rbo'l BUSINESS ACTIVITIES UNIFIED PROGRAM CONSOLIllATED FORM FACILITY INFORMATION Page 1 of L.~FAC[LITY IDENTIFICATION FACILITY ID # ~ 1. EPA ID # (Hazardous Wastc Only) '-~ I ~ ~. 0 2 1 1 0 0 7 C A L000244144 BUSINESS NAME (Same as Facility Name or DBA -Doing Business As) ARCO # 00583 11. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does your facilitv... ~ If Yes, please complete these pages of the UPCF... A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above » gallons for liquids; X00 pounds for solids. or 200 cubic feet for compressed gases ®YES ^ NO a FAZARDOUS MATERIALS INVENTORY (include liquids in ASTs and USTs); or the applicable Federal threshold -CHEMICAL DESCRIPTION (OES 2731) quantity for an extremely hazardous substance specified in 40 CFR Part 3», AppendixA or B; or handle radiological materials in quantities for which an emer ency Ian is re wired ursuant to ]0 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly SwaCtr Farm A) 1. Own or operate underground storage tanks? ®YES ^ NO s. UST TANK (one page per tank) (Fnrmerly Form B> 2. Intend to upgrade existing or install new USTs? ^YES ®NO 6. UST FACILITY UST TANK (one per tank) UST INSTALLATION -CERTIFICATE OF COMPLIANCE (one pace per tank) (Formerly Form C) 3. Need CO repOR CIOSIng a UST? ^YES ® NO 7 UST TANK (closure portion -one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons; or ^YES ®NO s. NO FORM REQUIRED TO CUPAs ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? ®YES ^ NO ~. EPA IDNUMBER -provide at the top of this pate 2. Recycle more than 100 kg/month of excluded or exempted recyclable RECYCLABLE MA"fERIALS REPORT (one materials (per H&SC §25143.2)? ^YES ®NO lo. per recycler> ' 3. Treat hazardous waste on site? ONSITE HAZARDOUS WASTE ^ YES ®NO I I. TREATMENT -FACILITY (Formerly_ D'rsc Forms 177?) ONSI"1'E HAZARDOUS WASTE TREATMENT -UNIT (one page per unit) (Formerly DTSC Forms 1772 A, B,C,D and L) 4. Treatment subject to fiinancial assurance requirements (for Permit by ^YES ®NO 12 CERTIFICATION OF FINANCIAL Rule and Conditional Authorization) ASSURANCE (Formerly DTSC Form re;2> ~. Consolidate hazardous waste generated at a remote site? REMOTE WASTE /CONSOLIDATION ^ YES ®NO 13. SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1196) 6. Need to report the closure/removal of a tank that was classified as ^ yES ®NO 14 HAZARDOUS WASTE "FANK CLOSURE hazardous waste and cleaned onsite? CERTIFICATION (Formerly DTSC Form 1249) E. LOCAL REQUIREMENTS (You may also be required to provide additional information by your CUPA or local aeencv) 15. Page 1 of 20 T ~j UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page of 1. IDENTIFICATION FACILI"1'Y ID # BEGINNING DATE loo. ENDING DATE lol. (Agency Use Only) 1 5 _. - 0 2 1 1 0 0 7 12/22/05 ~ 12/22108 BUSINESS NAME(Swine as FACILITY NAME~or DBA- Doine Business .As) '- BUSINESS PHONE 10? ARCO # 00583 (661) 398-0303 BUSINESS SITE ADDRESS 1°3. 3220 MING AVENUE crrY 104- zIP coDC 1°~ CA SAKERSFIELD 93304 DUN & BRADSTREET 106 SIC CODE (4 digit #) log. 03-959-6507 5541 COUNTY los. KERN BUSINESS OPERATOR NAME 109- BUSINESS OPERATOR PHONE 11°. EDMOND NASSAR (661) 398-0303 II. BUSINESS OWNER OWNER NAME 111. OWNER PHONE I Iz BP West Coast Products LLC (714) 670-3958 OWNER MAILING ADDRESS: I r. P.O. BOX # 6038 CITY 114. STATE 115- ZIP CODE I I6. ARTESIA CA 90702-6038 III. ENVIRONMENTAL CONTACT CONTACTNAME 117- CONTACT PHONE I Is_ TERESA MILES (714) 670-3958 CONTACT MAILING ADDRESS: BP West Coast Products LLC 119. P.O. BOX # 6038 CITY 1'-0. STATE Iz1. ZIP CODE Izz. ARTESIA CA 90702-6038 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 1'-~ NAME Izs. EDMOND NASSAR ARCO CUSTOMER SOLUTIONS CENTER TITLE 124, TITLE 129. Franchisee BUSINESS PHONE I'-5. BUSINESS PRONE 130. (661)398-0303 800-272-6349 24-HOUR PHONE* 1'6. 24-HOUR PHONE* Isl. (661) 979-0713 800-272-6349 PAGER/ CELL 1'-~ Is2. (661)979-0713 ADDITIONAL LOCALLY COLLECTED INFORMATION: ,;3. Certification: Based on my inquiry of those individuals responsible for obtaining the information, 1 certify u nder penalty of lavv that I have personally examined and am familiar with the information submitte and believe the in ~ lion is tale, accurate, and complete. SIGNATURE OWNE OPERATOR O DESIGN ED REPRESE ATIVE I'4 • DATE NAME OF DOCUMENT PREPARER IsS. _.,•,~ n ~ l ~a ~!' ~ ~ Belshire Environmental Services, Inc. NAME OF SIGNER (print) ~./ I36. TITLE OF SIGNER 137. EDMOND NASSAR Franchisee Pale 2 of 20 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION hrdicate material OR waste (Do not combine material curd waste on one.fornr) ® MATERIAL(NON-WASTE) ^ WASTE (one page per material per buiiding or area) ^ADD ^DELETE ®REVISE REPORTING YEAR 2005 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 ARCO # 00583 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 i (EPCRA) ^ YES ® NO UNDERGROUND STORAGE TANK MAP# (optional) 203 GRID# (optional) I 1 204 FACILITY ID # 1 5 0 2 1' i 0 0 7 ! ~ 1 of 1 E2 - H5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No zas GASOLINE If Subject to EPCRA, refer to instructions COMMON NAME GASOLINE 207 EHS" ^Yes ®No 2oa cAS# 8006-61-9 209 '{f EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (complete if requiredbvcuPA) FLAMMABLE LIQUI D, CLASS 16, UN1203 210 HAZARDOUS MATERIAL TYPE (Check one item only) ^ a. PURE ®b. MIXTURE ^ c. WASTE 2t ~ RADIOACTIVE ^Yes ®No 212 CURIES 2t3 PHYSICAL STATE Zia (Check one item only) ^ a. SOLID ®b. LIQUID ^ c. GAS LARGEST CONTAINER 10,000 2ts FED HAZARD CATEGORIES 2t6 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT zt~ .MAXIMUM DAILY AMOUNT zta ANNUAL WASTE AMOUNT zts STATE WASTE CODE 2zo 20,000 40,000 N/A N/A zzt DAYS ON SITE: 2zz UNITS` ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 Check one item onl ' If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ® b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ^ d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 22a STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 1-5 226 BENZENE zz~ ^Yes ®No zza 71-43-2 zzs 2 0-10 z3o ETHANOL zit ^Yes ®No z3z 64-17-5 233 3 8-15 z3a XYLENE z3e ^Yes ®No z3s 1330-20-7 23~ a 7-14 23a TOULENE 239 ^Yes ®No 2ao 108-88-3 zat 5 2a2 243 ^Yes ^No 2aa za5 If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION gas Page 3 of 20 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM-CHEMICAL DESCRIPTION /nrlrcate nta/eria! OR waste (Do not combute ntaterirr! and waste on one form) ® MATERIAL(NON-WASTE) ^ WASTE (one page per material per building or area) ^ADD ^DELETE ®REVISE REPORTING YEAR 2005 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 ARCO # 00583 CHEMICAL LOCATION 20t CHEMICAL LOCATION CONFIDENTIAL zoz (EPCRA) ^ YES ® NO OUTSIDE YARD NEARSIDE WALL OF FACILITY MAP# (optional) 203 GRID# (optionaq 1 z°4 0 2 I j I ~ ~ 7 FACILITY ID # ] 5 ~ L 1 of 1 H6 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No zos CARBON DIOXIDE If Subject to EPCRA, refer to instructions COMMON NAME CARBON DIOXIDE 207 EHS* ^Yes ®No zoa cAS# 124-38-9 209 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Compete if required by CUPA) 2t0 HAZARDOUS MATERIAL TYPE (Check one item only) ®a. PURE ^b. MIXTURE ^ c. WASTE 211 RADIOACTIVE ^Yes ®No 212 CURIES 213 PHYSICAL STATE (Check one item only) ^ a. SOLID ®b. LIQUID ^ c. GAS 254 I-ARGEST CONTAINER 400 215 FED HAZARD CATEGORIES 216 (Check all that apply) ^ a. FIRE ^ b. REACTIVE ®c. PRESSURE RELEASE ®d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 200 400 N/A N/A 221 DAYS ON SITE: 2zz UNITS* ^a. GALLONS ^b. CUBIC FEET ®c. POUNDS ^ d. TONS 365 Check one item onl * If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ^ d. STEEL DRUM ^ h. SILO ®I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ^ a. AMBIENT ®b. ABOVE AMBIENT ^ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ^ a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ®d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 100 226 CARBON DIOXIDE zz7 ^Yes ®No 226 124-38-9 229 2 230 231 ^Yes ^ NO 232 233 3 234 235 ^Yes ^ NO 236 237 4 238 239 ^Yes ^ NO 240 241 5 242 243 ^Yes ^No zaa gas If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION zas Page 4 of 20 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION /ndicate maters! OR waste (Do not combine material a nd waste on one.fornr) ^ MATERIAL(NON-WASTE) ® WASTE (one page per material per building or area) ^ADD ^DELETE ®REVISE REPORTING YEAR 2005 zoo page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 ARCO # 00583 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 (EPCRA) ^ YES ® NO INSIDE FENCED ENCLOSURE ' - MAP# (optional) 203 GRID# (optionaq 204 I FACILITY ID # 1 S O 2 1 I ' 1 0 0 7 1 of 1 K5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No 206 WASTE ABSORBENT & DISPENSER Fl1EL FILTER If Subject to EPCRA, refer to instructions COMMON NAME WASTE ABSORBENT 8r DISPENSER FUEL FILTER 207 EHS' ^Yes ®No zoe CAS# N/A 209 'If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CuPA) 2to HAZARDOUS MATERIAL TYPE (Check one item only) ^ a. PURE ^b. MIXTURE ®c. WASTE 2t ~ RADIOACTIVE ^Yes ®No 2t2 CURIES 213 PHYSICAL STATE (Check one item only) ®a. SOLID ^b. LIQUID ^ c. GAS 214 LARGEST CONTAINER 55 215 FED HAZARD CATEGORIES 2t6 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 2t7 MAXIMUM DAILY AMOUNT zta ANNUAL WASTE AMOUNT 2t9 STATE WASTE CODE 220 25 55 55 352 2zt DAYS ON SITE: 222 UNITS' ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 Check one item onl ' If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ®d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 22a STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # MIXTURE OF SILCATE & HYDROCARBONS ~ 89-90 226 227 ^Yes ®No zza MIXTURE N/A z29 & SPENT FUEL FILTERS , 2 230 231 ^Yes ^ NO 232 233 3 234 235 ^Yes ^ NO 236 237 4 238 239 ^Yes ^ NO 240 241 5 zaz 2a3 ^Yes ^No 2aa zas If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION zas Page 5 of 20 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION Indicate nxrterial OR waste (Do not combine material rmd waste on one form) ^ MATERIAL(NON-WASTE) ® WASTE (one page per material per building or area) ^ADD ^DELETE ®REVISE REPORTING YEAR 2005 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 ARCO # 00583 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL zo2 (EPCRA) ^ YES ® NO INSIDE FENCED ENCLOSURE '~ MAP# (optional) 203 GRID# (optional) ' 204 FACILITY ID # 1 5 0 2 1 I 0 0 7 I 1 of 1 K5 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No zos WASTE FLAMMABLE LIQUID If Subject to EPCRA, refer to instructions COMMON NAME WASTE FLAMMABLE LIQUID 207 EHS' ^Yes ®No 208 CAS# N/A 209 'If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) ^ a. PURE ^b. MIXTURE ®c. WASTE 211 RADIOACTIVE ^Yes ®No 212 CURIES 213 PHYSICAL STATE (Check one item only) ^ a. SOLID ®b. LIQUID ^ c. GAS 21a LARGEST CONTAINER 55 215 FED HAZARD CATEGORIES 216 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 216 ANNUAL WASTE AMOUNT 21s STATE WASTE CODE 220 25 55 55 134 221 DAYS ON SITE: zzz UNITS' ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS ' 365 If EHS, amount must be in ounds. Check one item onl STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ® d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 22a STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) -EHS CAS # MIXTURE OF GASOLINE & WATER OR 1 89-90 226 227 ^Yes ®No z2s N/A MIXTURE zzs OTHER CONTAMINATION IN GASOLINE , 2 230 231 ^Yes ^ NO 232 233 3 234 235 ^Yes ^ NO 236 237 q 238 z3s ^Yes ^ No zao 2a1 5 2az za3 ^Yes ^No 2aa za5 If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION gas Page 6 of 20 CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 93301 (661) 326-3911 UND€RGROUND STQRAGE TANKS - FACiLtTY TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ® 5. CHANGE OF INFORMATION (Specify change - '^ 7. PERMANENTLY CLOSED SITE (Check one item only] ^ 4. AMENDED PERMIT local use only) ^ 8. TANK REMOVED ^ S. TEMPORARY SITE CLOSURE 400 I. FACILITY /SITE INFORMATION FACILITY ID # I 5 0 2 ~ I ~ 0 -] 1 SITE NAME (Same as FACILITY NAME or DBA ARCO# 00583 3 BUSINESS ADDRESS 3220 MING AVENUE ~ clrY BAKERSFIELD ZIP CODE 93304 NEAREST CROSS STREET WIBLE ROAD BUSINESS ® 1 GAS STATION ^ FARM 3 TYPE . ^ 2. DISTRIBUTOR ^ 4. PROCESSOI TOTAL NUMBER OF Is facility on Indian Reservation or TANKS ON SITE trustlands? 4 404 ^ Yes ® No FACILITY OWNER TYPE ® 1. CORPORATION ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ OTHER 403 ^ 3. PARTNERSHIP . 'If owner of UST is a public agency: name of supervisor of division, section or office which operates the UST. (This is the contact person far the tank records) aos TERESA MILES II. TANK OPERATOR INFORMATION LJ 4. LOCAL AGENCY/DISTRICT' ^ 5. COUNTY AGENCY' ^ 6. STATE AGENCY" ^ 7. FEDERAL AGENCY' 402 406 TANK OPERATOR NAME EDMOND NASSAR 407 PHONE (661) 863-0528 • 408 TANK OPERATOR TYPE ^ 1. CORPORATION ® 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 7. STATE AGENCY 413 ^ 3. PARTNERSHIP ^ ~ 5. COUNTY AGENCY ^ 8. FEDERAL AGENCY III. TANK OWNER INFORMATION TANK OWNER NAME' BP West Coast Products, LLC PHONE (714) 670-3958 415 414 MAILING ADDRESS 4 Centerpointe Drive 416 CITY La Palma 417 CAE 418 ZIP CODE 90623 419 - TANK OWNER TYPE ® 1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 7. STATE AGENCY 420 ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 8. FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY (TK) HQ 4 4 - 0 4 1 4 6 5 Call (916) 322 - 9669 if questions arise 421 I, V. PETROLEUM UST FINANCIAL RESPONSIBILITY - INDICATE METHOD(S) ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOV'TMECHANISM ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND 8 CD 422 VI. LEGAL NOTIFICATION AND MAILING ADDRESS Check or -~ ~, to indicate ,vhich addr ss should be uscL for legal notdications and mall~,ng. Legal no ~ ons and mailings vill Le sent to the tank or ner ONLY unless box 1 or 2 is ^ 1. FACILITY ^ 2 PROPERTY Ol^.'":~`? ^ 3 TANK OWNER 423 checked VII. 'APPLICANT'SIGNATURE Certification: I certify that the information provided herein is true and accurate to the best of my knowledge. SIGNATURE OF APPLICANT ~ DATE 12~22~OD 424 PHONE (714) 670-3958 NAME OF APPLICANT (print) TERESA MILES TITLE OF APPLICANT EnVlrOnmental COmpllanCe SpeClallst 426 STATE UST FACILITY NUMBER (for local use only) 428 1998 UPGRADE CERTIFVCATE NUMBER (For local use only) 429 Page 7 of 20 CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 93301 (6b1) 326-3911 _ UNDERGROUND STORAGE TANKS -TANK PAGE 1 TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 4. AMENDED PERMIT ~ ® 5. CHANGE OF INFORMATION ^ 6. TEMPORARY SITE CLOSURE (Check one item only) ^ ~ ^ 7. PERMANENTLY CLOSED ON SITE 3. RENEWAL PERMIT (Speci/y reason -for local use only (Specify change -for local use only) ^ 8. TANK REMOVED 430 FACILITY ID # 1 BUSINESS NAME (Same as FACILITY NAME or DBA) 3 1 ~ 0 2 1 1 0 0 7 ARCO# 00583 BUSINESS ADDRESS CITY ZIP CODE 3220 MING AVENUE BAKERSFIELD 93304 LOCATION WITHIN SITE (Optional) 431 I. TANK`DE$CRIPTION ; (A scaled-plot Rlan with,[he,.locaGOn ofthe UST sys(em indudir _ _ 'din s and laodni~irks-shall.be submitted ~~ ~ agencv) TANK ID # ~ 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ^ Yes ® No 434 Xerxes If "Yes", complete one page for each compartment. DATE INSTALLED (YEAR/MO) ~ 99~ ~O1 435 TANK CAPACITY IN GALLONS ~ O,000 436 NUMBER OF COMPARTMENTS ~ 437 ADDITIONAL DESCRIPTION 438 - - -- II. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1. MOTOR VEHICLE FUEL ®1a. REGULAR UNLEADED ^ 2. LEADED ^ 5. JET FUEL (If marked, complete Petroleum Type) ^ 1b. PREMIUM UNLEADED ^ 3. DIESEL ^ 6. AVIATION FUEL ^ 2. NON-FUEL PETROLEUM ^ tc. MID-GRADE UNLEADED ^ 4. GASOHOL ^ 99. OTHER ^ 3. CHEMICAL PRODUCT ^ '4. HAZARDOUS WASTE (Includes COMMON NAME (from Hazardous Materials Inventory page) 441 CAS # (from Hazardous Materials Inventory page) 442 Used Oil) GASOLINE 8006-61-9 ^ 95. UNKNOWN _ _ _ __ III. TANK CONSTRUCTION ` _ _ TYPE OF TANK ^ 1. SINGLE WALL ^ 3. SINGLE WALL WITH ^ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 ® 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ^ g5. UNKNOWN (Check one item only) ^4. SINGLE WALL IN A VAULT ^ gg. OTHER TANK MATERIAL -primary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 5. CONCRETE ^ 95. UNKNOWN ~ 444 ^ 2~ STAINLESS ^ 4. STEEL CLAD W/ FIBERGLASS ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC (FRP) TANK MATERIAL -secondary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 8. FRP COMPATIBLE W/100% METHANOL ^ 95. UNKNOWN 445 ^ 2. STAINLESS ^ 4. STEEL CLAD W/FIBERGLASS ^ 9. FRP NON-CORRODIBLE JACKET ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC (FRP) ^ 10. COATED STEEL ^ 5. CONCRETE TANK INTERIOR LINING ^ 1. RUBBER LINED ^ 3. EPOXY LINING ^ 5. GLASS LINING ^ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ^ 2. ALKYD LINING ^ 4. PHENOLIC LINING ® 6. UNLINED ^ 99. OTHER (Check one item only) (For local use only) OTHER CORROSION ^ 1. MANUFACTURED CATHODIC ^ 3. FIBERGLASS REINFORCED PLASTIC ^ 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION IMPRESSED CURRENT ^~99 OTHER ^ 4 . . (Check all that apply) ^ 2. SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check all that apply) ®1. SPILL CONTAINMENT 1991 ®1. ALARM ^ 3. FILL TUBE SHUT OFF VALVE 1 ®2. DROP TUBE 1991 ~ ®2. BALL FLOAT ^ 4. EXEMPT ® 3. STRIKER PLATE 1991 IV. TANKLEAKDETECT„ , ~ , ION (Adescrip,lion of the monitormq program shalt be submi[ed to the local agency) IF SINGLE WALL TANK (Check all that apply): 453 _ IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) : 454 ^ 1. VISUAL (EXPOSED PORTION ONLY) ~ ^ 5. MANUAL TANK GAUGING (MTG) ^ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ^ 2. AUTOMATIC TANK GAUGING (ATG) ^ 6. VADOSE ZONE ®2. CONTINUOUS INTERSTITIAL MONITORING ® 3. CONTINUOUS ATG ^ 7. GROUNDWATER ^ 3. MANUAL MONITORING ^ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ^ g, TANK TESTING 'BIENNIAL TANK TESTING ^ gg. OTHER V. TANK CLOSUREJNFORMATION /PERMANENT CLOSURE IN'PLACE ESTIMATED DATE LAST USED (YY/MM/DD) 455 - ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ^ Yes ^ No Revised 611 112 0 0 2 Page 8 of 20 -_ :, - CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 9330] (661) 326-3911 ~- UNDERGROUND STORAGE TANKS -TANK PAGE'2 -- - VI:' PIPING CONSTRUCTION tcneckalirnai~ap~ly~.r UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 458 ^ 1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 459 ^ 1. SINGLE WALL ^ 3. LINED TRENCH ^ 99. OTHER 460 ^ 1. SINGLE WALL ^ 95. UNKNOWN 46'< CONSTRUCTION( ®2 DOUBLE WALL ^ 95. UNKNOWN ^ 2. DOUBLE WALL' ^ 99. OTHER MANUFACTURER MANUFACTURER: A,0 SMITH MANUFACTURER 463 ^ 1. BARE STEEL ®6. FRP COMPATIBLE W/ 100% METHANOL ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100% METHANOL MATERIALS AND ^ 2 STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL CORROSION PROTECTION ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 95. UNKNOWN ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 8. FLEXIBLE (HDPE) ^ 99 OTHER (check all that ®q, FIBERGLASS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER ^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION apply) ^5. STEEL W/COATING ^ 5, STEEL W/ COATING ^ 95. UNKNOWN 46~ ^ 9. CATHODIC PROTECTION 464 VILPIPING~LE'AK DETECTION (Gh?ck all that aoptv)ta tle~cnAtion of the rnonite~rna ~rogiam~shan be s~bm~tted totheloca(age~n- I UNDERGROUND PIPING SINGLE WALL PIPING - 466 PRESSURIZED PIPING (Check a// that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING):' ^ 7. SELF MONITORING GRAVITY FLOW: ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): - 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ® b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ® 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR RESTRICTION ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM. ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply): ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND VISUAL ALARMS ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION ^ 16. ANNUAL INTEGRITY TEST ^ 17. DAILY VISUAL CHECK VIII. DISPENSER,CONTAINMENT DISPENSER CONTAINMENT ^ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ 4. DAILY VISUAL CHECK DATE INSTALLED 468 ^ 2. CONTINUOUS DISPENSER PAN SENSOR +AUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LINER /MONITORING Not Available ®3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER +AUDIBLE AND VISUAL ALARMS ^ 6. NONE 469 IX. OWNER/OPERATOR$IGNATU,RE _.. I certify that the information provided herein is true andaccurate to the best of my knowledge. SIG TURE OF OWNERlOPERATOR DATE q7p 12/22/0 ABOVEGROUND PIPING SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVITY FLOW: ^ 8. DAILY VISUAL MONITORING ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ^ 11. AUTOMATIC LEAK ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply): ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND VISUAL ALARMS ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST ^ 16. ANNUAL INTEGRITY TEST ^ 17. DAILY VISUAL CHECK NAME OF OWNER/OPERATOR(print) - -- `/ :/~ 471 TITLE OF OWNER/OPERATOR q72 TERESA MILES Environmental Compliance Specialist Revised 6I11I2002 Pale 9 of 20 CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 93301 (661) 326-3911 ;. UNDERGROUND STORAGE TANKS -TANK PAGE 1 _: - _- - TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 4. AMENDED PERMIT ® 5 CHANGE OF INFORMATION ^ 6. TEMPORARY SITE CLOSURE (Check one item only) ^ ^ 7. PERMANENTLY CLOSED ON SITE 3. RENEWAL PERMIT (Specify reason -for local use only (Specify change -for local use only) ^ 8. TANK REMOVED 430 FACILITY ID # 1 BUSINESS NAME (Same as FACILITY NAME or DBA) 3 1 ~ 0 2 I l 0 0 7 ' ~ ARCO# 00583 BUSINESS ADDRESS CITY ZIP CODE 3220 MING AVENUE BAKERSFIELD 93304 LOCATION WITHIN SITE (Optional) 431 1. TANK DESCRIPTION I - ' {a scaled e(ot o(an w~ttrrhe IocaGonaf the UST,s stem include bu.:.:.c -saildJandm~rks shall tie"su4mitted tolfie local a enc <1 TANK ID # 2 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ^ Yes ® No 434 Xerxes If "Yes", complete one page for each compartment. DATE INSTALLED (YEARIMO) ~ J91lO1 435 TANK CAPACITY fN GALLONS ~ O,000 436 NUMBER OF COMPARTMENTS ~ 437 ADDITIONAL DESCRIPTION ~ 438 II. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 ® 1. MOTOR VEHICLE FUEL ®1a. REGULAR UNLEADED ^ 2. LEADED ^ 5. JET FUEL (If marked, complete Petroleum Type) ^ 1b. PREMIUM UNLEADED ^ 3. DIESEL ^ 6. AVIATION FUEL NON-FUEL PETROLEUM ^ 2 . ^ 1c. MID-GRADE UNLEADED ^ 4. GASOHOL ^ 99. OTHER ^ 3 CHEMICAL PRODUCT . ^ 4. HAZARDOUS WASTE (InGudes COMMON NAME (from Hazardous Materials Inventory page) 441 CAS # (from Hazardous Materials Inventory page) 442 Used Oil) GASOLINE 8006-61-s ^ 95. UNKNOWN _ Itl. TANK`'CON$TRUGTION _ _ TYPE OF TANK ^ 1. SINGLE WALL ^ 3. SINGLE WALL WITH ^ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 ®2. DOUBLE WALL EXTERIOR MEMBRANE LINER ^ 95. UNKNOWN (Check oneilemanly) ^4. SINGLE WALL IN A VAULT ^ gg, OTHER TANK MATERIAL -primary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 5. CONCRETE ^ 95. UNKNOWN 444 ~ ^ 2~ STAINLESS ^ 4. STEEL CLAD W/ FIBERGLASS ^ 8. FRP COMPATIBLE W/100% METHANOL ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC (FRP) TANK MATERIAL -secondary tank ^ 1, BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 8. FRP COMPATIBLE W/t00 % METHANOL ^ 95. UNKNOWN 445 ^ 2. STAINLESS ^ 4. STEEL CLAD WlFIBERGLASS ^ 9. FRP NON-CORRODIBLE JACKET ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC (FRP) ^ 10. COATED STEEL ^ 5. CONCRETE TANK INTERIOR LINING ^ 1, RUBBER LINED ^ 3. EPOXY LINING ^ 5. GLASS LINING ^ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ^ 2 ALKYD LINING ^ 4. PHENOLIC LINING ®6. UNLINED ^ 99. OTHER (Check one item only) (For local use only) OTHER CORROSION ^ 1. MANUFACTURED CATHODIC ^ 3. FIBERGLASS REINFORCED PLASTIC ^ 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ^ 4 IMPRESSED CURRENT ^ 99 OTHER . . (Check all that apply) ^ 2. SACRIFICIAL ANODE (FOrlocal use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT'. YEAR INSTALLED 452 (Check all that apply) ®1. SPILL CONTAINMENT 1991 ®1. ALARM ^ 3. FILL TUBE SHUT OFF VALVE ® 2. DROP TUBE 1991 ®2. BALL FLOAT ^ 4. EXEMPT ® 3. STRIKER PLATE 1991 _ IV. TANK LEAK:.DETECTION (A descripfion of the monitonng program shall tie submitted ro the !Deal agency) IF SINGLE WALL TANK (Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) : 454 ^ 1. VISUAL (EXPOSED PORTION ONLY) ^ 5. MANUAL TANK GAUGING (MTG) ^ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ^ 2. AUTOMATIC TANK GAUGING (ATG) ^ 6. VADOSE ZONE ® 2. CONTINUOUS INTERSTITIAL MONITORING ® 3. CONTINUOUS ATG ^ 7. GROUNDWATER ^ 3. MANUAL MONITORING ^ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ^ B. TANK TESTING BIENNIAL TANK TESTING ^ 99. OTHER V. TANK CLOSURE INFORMATION /PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YY/MM/DD) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ^ Yes ^ No Page I 0 of 20 CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 93301 (661) 326-3911 UNDERGROUND STORAGE TANKS -.TANK PAGE 2 - VCrPIP{NG CO,,, NSTRUCT~IOIU_(Checkartrhatapplyl' ---T UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 458 ^ 1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 459 ^ 1. SINGLE WALL ^ 3. LINED TRENCH ^ 99. OTHER 460 ^ 1. SINGLE WALL ^ 95. UNKNOWN 462 CONSTRUCTION/ ®2 DOUBLE WALL ^ 95. UNKNOWN ^ 2. DOUBLE WALL' ^ 99. OTHER MANUFACTURER MANUFACTURER: A.0 SMITH MANUFACTURER 463 ^ 1. BARE STEEL ®6. FRP COMPATIBLE W/ 100% METHANOL ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100% METHANOL MATERIALS AND ^ 2 STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL CORROSION PROTECTION ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 95. UNKNOWN ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER (check all that ®q. FIBERGLASS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER ^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION apply) ^5. STEEL W/ COATING ^ 9. CATHODIC PROTECTION 464 ^ 5. STEEL W/COATING ^ 95. UNKNOWN 465 -- VII. PIPING LE'AK'DETECTION (Checkallthatapply)(ade~:riptionolthemonitorfngprogramshaibesubmdtedto%~theloca6agency.) UNDERGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM +TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVITY FLOW: ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ® b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ® 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR RESTRICTION ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply): EMERGENCY GENERATORS ONLY (Check all that apply): ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND VISUAL ALARMS VISUAL ALARMS ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST RESTRICTION ^ 16. ANNUAL INTEGRITY TEST ^ 16. ANNUAL INTEGRITY TEST ^ 17. DAILY VISUAL CHECK ^ 17. DAILY VISUAL CHECK VIIL -DISPENSER CONTAINMENT DISPENSER CONTAINMENT ^ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE INSTALLED 468 ^ 4. DAILY VISUAL CHECK ^ 2. CONTINUOUS DISPENSER PAN SENSOR +AUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LINER /MONITORING Not Available ® 3 CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER +gUDIBLE AND VISUAL ALARMS ^ 6 NONE 469 IX. OWNERlOPERATOR'SIGNATU RE __ I certify that the information provided herein is true and accurate to the best of my ki SIG~TURE OF OWNER/OPERATOR/(_ _ J7 NAME OF OWNERlOPERATOR(printJ TERESA MILES Revised 611 112 00 2 471 ABOVEGROUND PIPING SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVITY FLOW: ^ 8. DAILY VISUAL MONITORING ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ^ 11. AUTOMATIC LEAK ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS DATE 470 12/22/05 TITLE OF OWNER/OPERATOR -472 Environmental Compliance Spec Page 1 1 of 20 ialist CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 9330] (66]) 326-3911 UNDERGROUND STORAGE TANKS -TANK PAGE 1 TYPE OF ACTVON ^ 1. NEW SITE PERMIT ^ 4. AMENDED PERMIT ® 5. CHANGE OF INFORMATION ^ 6. TEMPORARY SITE CLOSURE (Check one item only) ^ 3. RENEWAL PERMIT 7. PERMANENTLY CLOSED ON SITE (Specify reason - /or local use only (Specify change -for local use only) ^ 8. TANK REMOVED 430 FACILITY ID # I 1 BUSINESS NAME (Same as FACILITY NAME or DBA) 3 1 ~ ~ 0 2 1 1 0 0 7 ARCO# 00583 BUSINESS ADDRESS CITY ZIP CODE 3220 MING AVENUE BAKERSFIELD 93304 LOCATION WITHIN SITE (Optional) 431 "'I. TANK'DESCRIPTION ~_,.._~:.~- : :h_ti~elo caho~~oftheUS7s~stemuic(udi truddinsandlandr;arnsslraLbesutin2itted"to~~ __~ .- TANK ID # 3 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ^ Yes ®No 434 Xerxes If "Yes", complete one page for each compartment. DATE INSTALLED (YEAR/MO) ~ 991IO1 435 TANK CAPACITY IN GALLONS ~ O,000 436 NUMBER OF COMPARTMENTS - ~ 437 ADDITIONAL DESCRIPTION 438 ll. TANK' CONTENTS - - TANKUSE 439 PETROLEUM TYPE 440 ® 1. MOTOR VEHICLE FUEL ^ 1a. REGULAR UNLEADED ^ 2. LEADED ^ 5. JET FUEL (If marked, complete Petroleum Type) ^ 1b. PREMIUM UNLEADED ^ 3. DIESEL ^ 6. AVIATION FUEL ^ 2. NON-FUEL PETROLEUM ® 1c. MID-GRADE UNLEADED ^ 4. GASOHOL ^ 99. OTHER ^ 3. CHEMICAL PRODUCT COMMON NAME (from ^ 4. HAZARDOUS WASTE (Includes Hazardous Materials Inventory page) 441 CAS # (from Hazardous Materials Inventory page) 442 Used Oil) GASOLINE coos-s~-s ^ 95. UNKNOWN __ _ 141. TANK'CONSTRUCfiION _ TYPE OF TANK ^ 1. SINGLE WALL ^ 3. SINGLE WALL WITH ^ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 ® 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ^ g5. UNKNOWN (Check one item only) ^4. SINGLE WALL IN A VAULT ^ g9. OTHER TANK MATERIAL -primary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 5. CONCRETE ^ 95. UNKNOWN 444 ^ 2. STAINLESS ^ 4. STEEL CLAD W/ FIBERGLASS ^ 8. FRP COMPATIBLE W/100% METHANOL ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC (FRP) TANK MATERIAL -secondary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 95. UNKNOWN 445 ^ 2~ STAINLESS ^ 4. STEEL CLAD W/FIBERGLASS ^ 9. FRP NON-CORRODIBLE JACKET ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC (FRP) ~ 10. COATED STEEL ^ 5. CONCRETE TANK INTERIOR LINING ^ 1. RUBBER LINED ^ 3. EPOXY LINING ^ 5. GLASS LINING ^ 95. UNKNOWN qq6 DATE INSTALLED 447 OR COATING ^ 2 gLKYD LINING ^ 4. PHENOLIC LINING ®6. UNLINED ^ 99. 07HER (Check one item only) (For local use only) OTHER CORROSION ^ 1. MANUFACTURED CATHODIC ^ 3. FIBERGLASS REINFORCED PLASTIC ^ 95. UNKNOWN qqg DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ^ 4 IMPRESSED CURRENT ^ 99 OTHER (Check all that apply) ~ ^ 2. SACRIFICIAL ANOD . . E (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check all that apply) ®1. SPILL CONTAINMENT 1991 ®1. ALARM ^ 3. FILL TUBE SHUT OFF VALVE ® 2. DROP TUBE 1991 ®2. BALL FLOAT ^ 4. EXEMPT ® 3. STRIKER PLATE 1991 IV ;TANK LEAK. DETECTION, (A descript~o,n-of the m~~uunag pro ,~_. gram shall''tie submlr_"d ro me taco/ agency). e IF SINGLE WALL TANK (Check all that apply). 453 1F DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) : 454 ^ 1. VISUAL (EXPOSED PORTION ONLY) ^ 5. MANUAL TANK GAUGING (MTG) ^ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ^ 2. AUTOMATIC TANK GAUGING (ATG) ^ 6. VADOSE ZONE ®2. CONTINUOUS INTERSTITIAL MONITORING ® 3. CONTINUOUS ATG ^ 7. GROUNDWATER ^ 3. MANUAL MONITORING ^ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ^ 8. TANK TESTING BIENNIAL TANK TESTING ^ g9. OTHER V. I HNFI I.LVJUKC INhtJK1Y1H I IUN /-YtKMHNtN'I C.LUJUFit IN YLHGt ESTIMATED DATE LAST USED (YY/MM/DD) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ^ Yes ^ No Pale 12 of 20 CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 93301 (661) 326-3911 UNDERGROUND STORAGE TANKS -TANK PAGE 2 __` _ ~~ VL~ PIP.tNG CONSTRU,CT~IO,N t~hecK ai(;that apply)_ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ®1. PRESSURE ^ Z. SUCTION ^ 3. GRAVITY 458 ^ 1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 459 ^ 1. SINGLE WALL ^ 3. LINED TRENCH ^ 99. OTHER 460 ^ 1. SINGLE WALL ^ 95. UNKNOWN 462 CONSTRUCTION/ ®2 DOUBLE WALL ^ 95. UNKNOWN ^ 2. DOUBLE WALL' ^ 99. OTHER MANUFACTURER MANUFACTURER: A.0 SMITH MANUFACTURER 463 ^ 1. BARE STEEL ®6. FRP COMPATIBLE W/ 100 % METHANOL ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100% METHANOL MATERIALS AND ^ 2 STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL CORROSION PROTECTION ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 95. UNKNOWN ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER (check all that ®q. FIBERGLASS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER ^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION apply) ^5. STEEL W/COATING ^ 9. CATHODIC PROTECTION 464 ^ 5. STEEL W/COATING ^ 95. UNKNOWN 465 ' VIL PIPINGLEAK~DETECTION (Che~kanth~tapply)(~ UNDERGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING)'. ^ 7. SELF MONITORING GRAVITY FLOW: ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ® b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM pISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ® 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR RESTRICTION ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS a tlescnptron of the moni[oring program,shall be submitted to the local agency.) --- ABOVEGROUND PIPING ,INIiLt WALL YI YINIi qti/ PRESSURIZED PIPING (Check all that apply).' ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVITY FLOW: ^ 8. DAILY VISUAL MONITORING ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ^ 11. AUTOMATIC LEAK ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply): EMERGENCY GENERATORS ONLY (Check all that apply): ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND VISUAL ALARMS VISUAL ALARMS ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST RESTRICTION ^ 16. ANNUAL INTEGRITY TEST ^ 16. ANNUAL INTEGRITY TEST _^ 17. DAILY VISUAL CHECK ^ 17. DAILY VISUAL CHECK Vlll. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ^ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ 4. DAILY VISUAL CHECK DATE INSTALLED 468 ^ 2. CONTINUOUS DISPENSER PAN SENSOR +AUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LINER /MONITORING Not Available ®3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER +AUDIBLE AND VISUAL ALARMS ^ 6. NONE 469 _ iX. OWNER/OPERATOR SIGNATURE I certify that the information provided herein is true and accurate to the best of my knowledge. SI TURE OF OWNER/OPERATOR ~ DATE 470 ~ ~~ ~~ 12/22/0 NAME OF OWNER/OPE~2ATOR(print) 471 TITLE OF OWNER/OPERATOR 472 TERESA MILES Environmental Compliance Specialist I Revised 6/11/2002 ~ ' Page 13 of 20 `_ --- _ _ TYPE OF ACTION (check one item only) CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 93301 (661) 326-3911 UNDERGROUND STORAGE TANKS -TANK PAGE ^ 1. NEW SITE PERMIT ^ 4 AMENDED PERMIT ® 5. CHANGE OF INFORMATION ^ 3. RENEWAL PERMIT (Specify reason -for local use only (Specify change - /or local use only) ^ 6 TEMPORARY SITE CLOSURE ^ 7. PERMANENTLY CLOSED ON SITE ^ 8. TANK REMOVED 430 ''., FACILITY ID # BUSINESS NAME (Same as FACILITY NAME or DBA) 3 1 5 0 2 I 1 0 0 7 ~ 1 gRCO# 00583 BUSINESS ADDRESS CITY ZIP CODE 3220 MING AVENUE BAKERSFIELD 93304 LOCATION WITHIN SITE (Optional) 43t I. TANK DESCRIPTION' .'. :aled.plof plan yid -_.-._~ locaGO~i of the UST s stem inGudirr. buildin sand (andmarksshall besuomitted to the Ic„o~ Qyc;r . _ TANK lD # 4 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK ^ Yes ®No 434 Xerxes If "Yes", complete one page for each compartment. DATE INSTALLED (YEAR/MO) ~ 99~ ~O1 435 TANK CAPACITY IN GALLONS ~ O,000 436 NUMBER OF COMPARTMENTS ~ 437 ADDITIONAL DESCRIPTION 438 __ _ ll. TANK CONTENTS - -- TANK USE 439 PETROLEUM TYPE - 440 ® 1. MOTOR VEHICLE FUEL ^ 1a. REGULAR UNLEADED ^ 2. LEADED ^ 5. JET FUEL (If marked, complete Petroleum Type) ® tb. PREMIUM UNLEADED ^ 3. DIESEL ^ 6. AVIATION FUEL ^ 2. NON-FUEL PETROLEUM ^ tc. MID-GRADE UNLEADED ^ 4. GASOHOL ^ 99. OTHER CHEMICAL PRODUCT ^ 3 . ^ 4. HAZARDOUS WASTE (Includes COMMON NAME (from Hazardous Materials Inventory page) 441 CAS # (from Hazardous Materials Inventory page) 442 Used Oil) GASOLINE coos-s~-s ^ 95. UNKNOWN .III. TANK CONSTRUCTION ~ TYPE OF TANK ^1. SINGLE WALL ^ 3. SINGLE WALL WITH ^ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 ® 2. DOUBLE WALL EXTERIOR MEMBRANE LINER ^ g5. UNKNOWN - ~ (Check one item only) ^4. SINGLE WALL IN A VAULT ^ gg. OTHER TANK MATERIAL -primary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 5. CONCRETE ^ 95. UNKNOWN 444 ^ 2. STAINLESS ^ 4. STEEL CLAD W! FIBERGLASS ^ 8. FRP COMPATIBLE Wl100°!o METHANOL ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC FRP) TANK MATERIAL -secondary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 8. FRP COMPATIBLE W/100 % METHANOL ^ 95. UNKNOWN 445 ^ 2~ STAINLESS ^ 4. STEEL CLAD W/FIBERGLASS ~ ^ 9. FRP NON-CORRODIBLE JACKET ^ 99. OTHER (Check one item only) STEEL REINFORCED PLASTIC (FRP) ^ 10. COATED STEEL ^ 5. CONCRETE TANK INTERIOR LINING ^ 1. RUBBER LINED ^ 3. EPOXY LINING ^ 5. GLASS LINING ^ 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING ^ 2. ALKYD LINING ^ 4. PHENOLIC LINING ®6. UNLINED ^ 99. OTHER (Check one item only) (For local use only) OTHER CORROSION ^ 1. MANUFACTURED CATHODIC ^ 3. FIBERGLASS REINFORCED PLASTIC ^ 95. UNKNOWN 44g DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION IMPRESSED CURRENT ^ 99 ^ 4 OTHER . . (Check all that apply) ^ 2. SACRIFICIAL ANODE (For /oca/use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check all that apply) ®1. SPILL CONTAINMENT 1991 ®1. ALARM ^ 3. FILL TUBE SHUT OFF VALVE ® 2. DROP TUBE 1991 BALL FLOAT ^ 4. EXEMPT ®2 . ® 3. STRIKER PLATE 1991 IV. TANK LEAK DETECTION (A descnptiodof the monitoring program shall be submkted to the lacaf agentyj IF SINGLE WALL TANK (Check all that apply): ~ 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) : 454 ^ 1. VISUAL (EXPOSED PORTION ONLY) ^ 5. MANUAL TANK GAUGING (MTG) ^ 1. VISUAL (SINGLE WALL IN VAULT ONLY) ^ 2. AUTOMATIC TANK GAUGING (ATG) ^ 6. VADOSE ZONE ®2. CONTINUOUS INTERSTITIAL MONITORING ® 3. CONTINUOUS ATG ^ 7. GROUNDWATER ^ 3. MANUAL MONITORING ^ 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + ^ 8. TANK TESTING BIENNIAL TANK TESTING ^ 99. OTHER V. TANK CLOSURE INFORMATION /PERMANENT CLOSURE IN'PLAGE ESTIMATED DATE LAST USED (YY/MM/DD) - 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons ^ Yes ^ No Revised 6/11/2002 Page 14 of 20 CUPA Bakersfield Fire Department • Hazardous Materials Division 2101 H Street Bakersfield, CA 93301 (661} 326-3911 UNDERGROUND STORAGE TANKS -TANK PAGE-2 VI. PIPING CpNSI _ UNDERGROUND PIPING SYSTEM TYPE ®1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY ^ 1. SINGLE WALL ^ 3. LINED TRENCH ^ 99. OTHER CONSTRUCTION/ ®2. DOUBLE WALL ^ 95. UNKNOWN MANUFACTURER MANUFACTURER: A.O SMITH ^ 1. BARE STEEL ®6. FRP COMPATIBLE W! 100 % METHANO MATERIALS AND ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL , CORROSION PROTECTION ^ 3. PLASTIC COMPATIB LE WITH CONTENTS ^ 95. UNKNOW (check all that ®4. FIBERGLASS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER aPPIY) ^5. STEEL W/ COATING ^ g CATHODIC PROTECTION a ,,., ..~;.~> ,. Vlf. PIPING LEAK DETECTION (Check al~that,apply)( UNDERGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM +TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) ' SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVITY FLOW. ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): - 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ® b.~ AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ® 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR RESTRICTION - ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply): EMERGENCY GENERATORS ONLY (Check al! that apply): ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF +AUDIBLE AND ^ 14. CONTINUOUS SUMP SENSOR WITH UT AUTO PUMP SHUTOFF +AUDIBLE AND VISUAL ALARMS VISUAL ALARMS ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST RESTRICTION ^ 16. ANNUAL INTEGRITY TEST ^ 16. ANNUAL INTEGRITY TEST ^ 17. DAILY VISUAL CHECK ^ 17. DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT ~..._._ DISPENSER CONTAINMENT ^ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ 4. DAILY VISUAL CHECK DATE INSTALLED 468 ^ 2. CONTINUOUS DISPENSER PAN SENSOR +AUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LINER /MONITORING Not Available ® 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER +AUDIBLE AND VISUAL ALARMS ^ 6. NONE 469 `IX. OWNERfOPERATOR"SIGNATURE - - - I certify that the information provided herein is true and accurate to the best of my SIGNATURE OF OWNER/OPERATOR ii NAME OF OWNER/OPERATOR(printJ TERESA MILES Revised 6/11/2002 471 Frlxnnnln alolNr. 458 ^ 1. PRESSURE 460 ^ 1. SINGLE WALL ^ 2. DOUBLE WALL' MANUFACTURER ^ 95. UNKNOWN ^ 99. OTHER 459 462 463 L ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100 % METHANOL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER ^ 4. FIBERGLASS ~ ^ 9. CATHODIC PROTECTION 464 ^ 5. STEEL W/ COATING ^ 95. UNKNOWN 46~ tle_sc ~~ ., hn pro ra,,u .. - 'p ~(tt~e m~ndo,' g g m shall be'sutrmittetl to the local age^cy./ - n hon o ~" N a ABOVEGROUND PIPING JINIiLt WHLL YIYINIa 4ti/ PRESSURIZED PIPING (Check all that applyJ.~ ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: ^ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVITY FLOW: ^ 8. DAILY VISUAL MONITORING ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) , ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ^ 11. AUTOMATIC LEAK ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS DATE 470 12/22/0 TITLE OF OWNER/OPERATOR 472 Environmental Compliance Spec Page 15 of 20 ^ 2. SUCTION ^ 3. GRAVITY ialist .. HAZARDOUS MATERIALS BUSINESS EMERGENCY PLAN EMERGENCY PROCEDURES ARCO # 00583 3220 MING AVENUE, BAKERSFIELD, CA 93304 1. EMERGENCY RESPONSE PLANS AND PROCEDURES A. In the event of a release or threatened release of hazardous materials, provide the following immediate notifications: Immediately call: Loca{ emergency response personnel 91 i (Fire, paramedics, police or sheriff) State Office of Emergency Services (800) 852-7550 or (916) 262-1621 Immediately call the appropriate jurisdiction: The Bakersfield Fire Department Hazardous Materials Management Division: (661) 326-3979 Person(s) within the business required responding to a hazardous materials incident: Name: EDMOND NASSAR Telephone: 1661) 398-0303 Name: TERESA MILES Telephone: (714) 670-3958 Name: ARCO CUSTOMER SOLUTIONS CENTER Telephone: 1800) 272-6349 B. Identify the local emergency medical facility that will be used by your business in the event of an injury caused by the release of a hazardous material: Name: BAKERSFIELD MEMORIAL HOSPITAL Address: 420 34TH STREET City: ~ BAKERSFIELD, CA 93301 Phone: (66I) 327-4647 2. PREVENTION Gasoline. Gasoline spills can result in environmental contamination, fire, and explosion. Releases of gasoline can occur when underground storage tanks are overfilled, when motorists overfill vehicle tanks, or drive off. The releases are prevented by installed ove~ll devices such as flapper valves, high level alarms, or ball floats. Other. spill prevention devices are impact valves, and breakaway devices. Service stations are attended by trained personnel, and gasoline is delivered by trained truck drivers. Page 16 of 20 =HAZARDOUS MATERIALS BUSINESS EMERGENCY PLAN EMERGENCY PROCEDURES ARCO # 00583 3220 MING AVENUE, BAKERSFIELD, CA 93304 Carbon Dioxide. Liquefied carbon dioxide is an extremely cold liquid/gas and is stored under high pressure in a gas cylinder. The small gas cylinders, containing 20 to 50 pounds of liquid carbon dioxide, must be stored upright and be firmly secured with chain to the wall. Those large cylinders (containers), which contain 200 to 400 pounds of liquid carbon dioxide, must be either chained or anchored to the floor. Securing the cylinder prevent falling or being knocked over. The gas cylinder must be capped at all times and transported with drum cart. The extremely cold part of pipes and valves on top of the cylinder will cause moist flesh to stick fast and tear when one attempts to withdraw from it. A leak will result in the formation of dry ice, and contact with dry ice, liquid carbon dioxide, or cold gas can cause frostbite to skin, eyes, and exposed tissues. Breathing low concentration of carbon dioxide can cause nausea, dizziness, mental confusion, and visual disturbance, shaking, headache, and respiratory problem. Liquid carbon dioxide has a high evaporation rate and when heated to above 52 Degree C (125 Degrees F) will generate high pressure. Store away from heat and ignition sources and out of direct sunlight. High temperature can generate high pressure in the tank/cylinder and cause rupture if the safe relief valve fails to operate. Do not store the container or cylinders where they come into contact with moisture. 3. MITIGATION In the event of a major release of gasoline: 1. Attendant should shut off electricity to the pumps/turbines at the emergency shut off switch and/or the main electrical panel. 2. The on-site emergency coordinator or designee will contact 911 (Fire Department) and explain the emergency, and will contact ARCO CSC. If necessary, the On-Site Emergency Coordinator or designee will request an ambulance or other medical assistance. 3. Evacuate. If deemed necessary by the On-Site Emergency Coordinator or designee, all traffic on site will be halted, area coned off, and all employees and customers will be directed to a safe area opposite the danger. 4. Contain the liquid by constructing berms and/or by covering the spill with a fireproof absorbent material. Prevent liquid from entering storm drains whenever possible. 5. Scene management shall be the responsibility of the On-Site Emergency Coordinator or designees until the arrival of fire or police personnel. Upon arrival of these personnel, the Emergency Coordinator will cooperate with and offer any assistance that is requested. 6. Immediately following an emergency the On-Site Emergency Coordinator will provide for the disposal of contaminated material as directed by the local Fire Department or County Health Agency. If neither agency gives such direction, coordinator will call ARCO CSC for removal and disposal. In the event of a fire: 1. Attendant should shout FIRE ALARM and call 911 (Fire Department). 2. Stop fluid flow by shutting off electricity to the pumps at the main electrical panels and close impact valves. 3. Evacuate by stopping all traffic on site and direct all personnel and customers to a safe area opposite the danger. 4. Scene management is the responsibility of the On-Site Emergency Coordinator or designees until the arrival of public safety response Page 17 of 20 HAZARDOUS MATERIALS BUSINESS EMERGENCY PLAN EMERGENCY PROCEDURES ARCO # 00583 3220 MING AVENUE, BAKERSFIELD, CA 93304 personnel. Upon arrival of these personnel, the Emergency Coordinator will cooperate with and offer assistance, as requested. In the event of a carbon dioxide release: Carbon dioxide is cold, asphyxiant, and powerful cerebral vasodilator gas. If there are signs of visible ice on the cylinder.or parts such as pipes, it is a sign of a leak and needs to be reported to your manager immediately. In the event of release, evacuate the store, and allow the liquid/gas carbon dioxide to evaporate and the gas to dissipate. Attempt to close the main source valve to stop the release is not recommended unless if is safe to do so and you have adequate personal protection gears. If the area must -be entered by emergency personnel, Self-Contained Breathing Apparatus (SCBA), Kevlar gloves, and appropriate foot and leg protection must be worn. 4. ABATEMENT In the event that a spill is small, station personnel should apply absorbent to the gasoline spill by sweeping the absorbent onto the spill. Once the absorbent has soaked up the liquid, sweep up the absorbent and place it in a 55- gallon drum. If the spill is larger, call 911, attempt to contain it, and follow the scene management instructions in Section 3, Mitigation. Large spills are cleaned by BP designated contractors, or as designated by the franchisee for franchise service stations. 5. EVACUATION Alarm shall be given by shouting to initiate an evacuation at the facility. If deemed necessary by the On-Site Emergency Coordinator or designee, all traffic on site will be halted, area coned off, and all employees and customers will be directed to a safe area opposite the danger. To evacuate the Sales Area, office or storage area, leave facility; go to area opposite danger using the front and/or back doors and proceed to the staging area or area opposite danger zone. Call 911 and report emergency. Call ARCO CSC; give details of emergency. 6. EARTHQUAKES BP WEST COAST PRODUCTS LLC has contracted with maintenance contractors to conduct post-earthquake inspections following an earthquake. Inspections will take place as soon as possible after a 5.5 or greater magnitude quake. After earthquake employees wi{I: 1. Make sure gasoline inventories are secure. Secure all underground storage tank systems (emergency pump shut-off switch and main electrical for the turbines) at the main electrical panel. 2. If there are any signs of structural damage to the building or island canopy, keep everyone away from the damaged area. If danger is imminent, shut down facility operations until it has been deemed safe to continue. 3. Call ARCO CSC immediately. If there's an immediate danger, call 911 for assistance. 4. If there is any indication of loss of gasoline from tanks or lines, shut down the dispensing system immediately. 5. If there is Page 18 of 20 \ r•. =HAZARDOUS MATERIALS BUSINESS EMERGENCY PLAN EMERGENCY PROCEDURES ARCO # 00583 3220 MING AVENUE, BAKERSFIELD, CA 93304 visible gasoline from dispensers, be sure to use absorbent material. 6. Even if gasoline inventories appear normal, conduct inventory reconciliation and visual checks twice a day until aftershocks subside. 7. HAZARDOUS WASTE CONTINGENCY See Section 3, Mitigation, "In the event of a major release. " S. UNAUTHORIZED RELEASE RESPONSE PLAN See Section 3, Mitigation, "In the event of a major release. " Release reporting will be completed by the Environmental Compliance Specialist (TERESA MILES). 9. SITE SECURITY As applicable on an individual facility basis, you should assess the security and vulnerability of your business from intentional acts both from within your business (sabotage) and from the outside (vandalism and terrorist acts). This assessment should consider testing your security system and procedures on a regular basis. Details of this assessment should not be included in this plan as it is a public document. I0. EMPLOYEE TRAINING PLAN All employee training shall be documented and updated annually New employee training. Topics as follows: 1. Identification, location and securing of C02. 2. Review BERP including emergency escape procedures and evacuation assembly location. 3. Discuss fire risks from flammable liquids, combustible materials, static electricity and propane (if applicable). 4. Locate all fire extinguishers. 5. Review list of chemicals used at facility, MSDS's and their location. 6. Handling, identification and proper storage and labeling of hazardous waste. 7. Identify location of UST monitoring alarm. 8. Instruct on use and location of emergency shut-off switches. 9. Discuss procedures used to respond to minor and major spills. Training is conducted as described above for new employees and on a yearly basis for all employees. Pave 19 of 20 ~ ~ - ,- SITE MAP BUSINESS NAME: Arco #00583 SITE ADDRESS: 322p Ming Ave. CITY: Bakersfield ZIP: 93304 MAP DATE: 5/25/05 AGENCY FACILITY #: B C D E F G H I J K L z 3 4 5 6 7 8 9 10 11 lz 13 INTERNATIONAL HOUSE THE CORNER POCKET OF PANCAKES FAMILY BILLIARDS moo ;'moo ;Qo , o ~°' ~C7° ~;ugo J o W O E A O Wo J o . D a' O ~ ~Z p ~ Z p 1 ~ TB STORAGE CONTAINER . _. _.......__... .E.M _ `_-' `__' ((O)) ~ MSDS ._._,_. ~ '. ' ;~ ~ O O ~ 3 _. , _ A O D: 1 ~ Q _ 0..__ _... _.._.. _ -- -...--- _. ~ __ W ~^.~• MO ~ o m' O ' ~ to -.O .._...... O __.. _..........._. ..._.....I ........ ^ Z ~ O Oa EM ~ C7 m MING AVENUE N VALLEY PLAZA MALL LEGEND ~ DISPENSER SHUTOFF ~ CASHIER A O ABSORBENT FL FLAMMABLE LIQUID MS S MSDS & 0 EMERGENCY PLAN BR BATH ROOM O GAS PUMP EMERGENCY FIRE HYDRANT ~ MONITORING WELL CL COMBUSTIBLE LIQUID ^ TRASH BIN TB ~ SEWER/FLOOR DRAIN SHUT OFF OE ELECTRICAL PANEL • TANK MONITOR O WATER MC MOTOR COOLANT ~ ~ ~ FENCE ~ F[RST AID OL LIQUID WASTE DRUM ~ ARAECAUATION ~ PPE MO MOTOR OIL A/`' AIR CONDITIONING ~ FIRE EXTINGUISHER OS SOLID WASTE DRUM /r /\O~~ OVERFILL ALARM ~ TELEPHONE EM EMERGENCY EXrr UNrr (,'02 COz CYLINDER ® STORM DRAIN Page 20 of 20 `X °' UNDERGROUND STORAGE TANK MONITORING PLAN -PAGE 1 "TYPE OF AC"PION ® 1. NEW PLAN ^ 2. CHANGE OF INFORMATION X101 PLAN "fYPE ®MONITORING IS IDENTICAL FOR ALL USTs AT "fFI1S FACILITY. ~10'- (Check one item only) ^ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID # (Agencl- Use Only) FACILITY NAME ARCO # 00583 Mo;. FACILITY srrE ADDRESS 3220 MING AVENUE "10a CITY BAKERSFIELD "0' II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in Mob. accordance with the equipment manufacturers' instructions; or annually, whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED ® I. ANNUALLY ^ 99. OTHER (Specify): n-ion. III. MONITORING LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., location of each s ensor, line leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g, current UST Monitoring Site Plan from a Monitoring System Certitication form; Flazardous Materials Business Plan map; etc.) which shows all required information, include it with this plan. IV. TANK MONITORING MONITORING [S PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) Mio_ ® I. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ®a. DRY ^ b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM Mi ~ PANEL MANUFACTURER: Veeder Root M~' MODEL #: TLS 350 "'~' LEAK SENSOR MANUFACTURER: Veeder Root Mia. MODEL #(S): 794390-409 "~"~ ^ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(Sl PANEL MANUFACTURER: M16 MODEL#: Mir. IN-TANK PROBE MANUFACTURER: M18~ MODEL #(S): M19~ LEAK TEST FREQUENCY: ^ a. CONTINUOUS ^ b. DAILY/NIGHTLY ^ c. WEEKLY n-izo. ^ d. MONTHLY ^ e. OTHER (Specify): M'--~ PROGRAMMED TESTS: ^ a. 0. I h. ^ b. 0.2 g. h. ^ c. OTHER S ecif Mz2 g~P~ .. P~ (p Y)~ M ^ 3. INVENTORY RECONCILIATION ^ a. MANUAL PER 23 CCR §2646 ^ b. STATISTICAL PER 23 CCR §2646.1 Mza. ^ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR X2645 TESTING PERIOD: ^ a. 36 HOURS ^ b. 60 HOURS Mzs. ^ 5. INTEGRITY TESTING PER 23 CCR §2643.1 TEST FREQUENCY: ^ a. ANNUALLY ^ b: BIENNIALLY ^ c. OTHER (Specify). M?6 . Mzz ^ 6. VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approvaq ^ 9~9. OTHER (Specify): ^~''-8 V. PIPE MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mso. ® 1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ® a. DRY ^ b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM Mai. PANEL MANUFACTURER: Veeder Root M3'~ MODEL #: TLS 350 M33. LEAK SENSOR MANUFACTURER: Veeder Root Msg. MODEL #(S): 794380-208 "~" WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? ®a. YES ^ b. NO M36 WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM "CRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO Mss ^ 2. MECFIANICAL LINE LEAK DETECTOR (MELD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK PESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED MELD MANUFACTURER(S): Mss. MODEL #(S): M'q~ ® 3. ELECTRONIC LINE LEAK DETECTOR (FLED) THAT ROUTINELY PERFORMS 3.0 g.ph. LEAK TESTS ELLD MANUFACTURER: VEEDER ROOT Ma°. MODEL #: PLED Mai. PROGRAMMED LINE INTEGRI"fY TESTS: ^ a. MINIMUM MONTHLY 0.2 g.p.h. ^ b. MINIMUM ANNUAL 0.1 g.p.h. Ma'. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO nias WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SI-1UTDOWN? ®a. YES ^ b. NO Maa. ^ 4. INTEGRITY TESTING TEST FREQUENCY: ^ a. ANNUALLY ^ b. EVERY 3 YEARS ^ c. OTFIER (Specity) Mas . Mab. ^ 5. VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY* ^ C. MIN. MONTHLY & EACH TIME SYSTEM OPERATED** Mai. * Requires agency approval ** Allowed for monitorin¢ of unburied emergency generator fuel piping only per HSC X25281 S(b)(3) ^ 6. PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) ^ 7. NO PRODUCT OR REMOTE FILL PIPING 1S CONNECTED TO THE UST(s) ^ 99. OTHER (Specify) nags. hwfwrc-V (06/03) - 1/~ 06/2i/03 r _I i ~~ UNDERGROUND STORAGE TANK MONITORING PLAN -PAGE 2 VI. DISPENSER MONITORING MONI"fORING OF AREAS BENEATH DISPENSER(S) IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) ~ "~'0~ ® I. CONTINUOUS ELEC~IRONIC MONITORING OF UNDER DISPENSER CONTAINMEN"T (UDC) PANEL MANUFACTURER: Veeder Root "~'~ MODEL #: TLS 350 ""'- LEAK SENSOR MANUPAC"PURER: Veeder Root °~"' MODEL #(S): 7943 80-2 0 8 n•i~a. WILL DETEC"PION OP A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? ®a. YES ^ b. NO X15' WILL A UDC LEAK ALARM "TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO n-is6. WILL FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM"TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO ~~'~ ^ 2. MECHANICAL ASSEMBLY (e.g., FLOAT AND CHAIN ASSEMBLY) IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK ASSEMBLY MANUFACTURER: ni's_ MODEL #(S): Ms2 ^ 3.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approvaq \160. ^ 4. NO DISPENSERS ^ 99. OTHER (Specify) M6(. VII. ENHANCED LEAK DETECTION ^ 1. WE FIAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK h~~°. DETECTION (ELD) FOR THE UST(S) COVERED BY THIS PLAN. PER 23 CCR §2644.1, ELD IS PERFORMED EVERY 36 MONTFIS AS REQUIRED VIII. TRAINING REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check atl that apply) n~so. I. ® THIS UNDERGROUND S"FORAGE TANK MONITORING PLAN (Required) 2. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required)* 3. ® THE FACILITY'S BEST MANAGEMENT PRACTICES (Required as of NIM/DD/1'Y) 4. ^ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. ^ CALIFORNIA UNDERGROUND STORAGE TANK LAW 6. ^ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS -MANUAL AND STATISTICAL [AIVENTORY RECONCILIATION" 7. ^ SWRCB PUBLICATION: "WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" 99. ^ OTHER (Specify): nns(. Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their iob duties and can access those documents when needed. By 1/1/2005, this facility will have a "Designated UST Operator" who has passed [he operator exam administered by [he International Code Council (ICC). By .hdy I, 2005, and annually thereafter, the `'Designated UST Operator will train facility employees in the proper operation and maintenance of the UST systems. This training will include, but is no[ limited to, the following: - Operation of the UST systems in a manner consistent with the facility's best management practices. - The facility employee's role with regard to the leak detection equipment. - The facility employee's role with regard to spills and overfills. - Whom to contact for emergencies and leak detection alarms. For facility employees hired on or afrer July 1, 2005, the initial trainine will be conducted within 30 days of the date of hire. IX. COMMENTS/ADDITIONAL INFORMATION Please use this section to include any additional UST system monitorinb related information (e.g., additional information required by your local agency): mas. "Monitoring systems manual maintained by contracted, licensed pump and tank technicians. Best Management Practices are maintained in the H.S.S.E. Retail Facility Programs Manual (Green Binder). X. PERSONNEL RESPONSIBILITIES THE FACILITY OPERATOR DESIGNATED IN SECTION XI BELOW IS RESPONSIBLE FOR PEFORMING MONITORING. BP WEST COAST PRODUCTS LLC IS RESPONSIBLE FOR MAINTAINING AND TESTING ALL MONITORING EQUIPMENT. XI. OWNER/OPERATOR SIGNATURE CERTIFICATION: I certify that the information provided herein is true and accurate to the best of my knowledge. OWNER/OPERATO ~ IGNATURE REPRESENTING ~ DATE: ~q+ ^ Owner M9o. '~ .~ ©~~ ~ ---"--~~ ®Operator / OWNERlOPERATOR NAME ( nt): -~ nt~z. OWNER/OPERATOR TITLE: m~'. EDMOND NASSAR Franchisee (Agency Use Only) This plan has been reviewed and: ^ Approved ^ Approved With Conditions ^ Disapproved Local Agency Signature: Date: Comments/Special Conditions: hwfwrc-d (06/03) - 2/5 06/25/03 UNDERGROUND STORAGE TANK RESPONSE PLAN -PAGE 1 (one roan per facility) TYPE OF ACTION ® I. NEW PLAN ^ 2. Ch1ANGE OP INFORMATION Roi. ~ I. FACILITY INFORMATION FACILITY lD # (Age~~cy Use Onl}) FACILITY NAME Roz- ARCO # 00583 FACILITY SITE ADDRESS Ro3. CITY Roa. 3220 MING AVENUE BAKERSFIELD II. SPILL CONTROL AND CLEANUP METHODS This plan addresses unauthorized releases from UST systems and supplements the emergency response plans and procedures in the facility's Flazardous Materials Business Plan. - If safe to do so, facility personnel will take immediate measures to control or stop any release (e.g., activate pump shut-off, etc.) and, if necessary, safely remove remaining hazardous material from the UST system. - Any release to secondary containment will be pumped or otherwise removed within a time consistent with the ability of the secondary containment system to contain the hazardous material; but not greater than 30 calendar days, or sooner if required by the local agency. Recovered hazardous materials, unless still suitable for their intended use, will be managed as hazardous waste. r Absorbent material will be used to contain and clean up manageable spills of hazardous materials. Used absorbent material will be stored in a properly labeled and sealed container until removed from the site by a licensed hazardous waste transporter. - Facility personnel will determine whether or not any water removed from secondary containment systems, or trom clean-up activity, has been in contact with any hazardous material. If the water is contaminated, it will be managed as hazardous waste. If the water has a petroleum sheen (i.e., rainbow colors), it is contaminated. A thick floating petroleum layer may not necessarily display rainbow colors. Water (hazardous or non-hazardous) from sumps, spill containers, etc. will not be disposed to storm water systems. %- We will review secondary containment systems for possible deterioration if any of die following conditions occur: 1. Hazardous material in contact with secondary containment is not compatible with the material used for secondary containment; 2. Secondary containment is prone to damage from any equipment used to remove or clean up hazardous material collected in secondary containment; 3. Hazardous material, other than the producdwaste stored in the primary containment system, is placed inside secondary containment to treat or neutralize released product/vvaste, and [he added material or resulting material from such a combination is not compatible with secondary containment. ' III. SPILL CONTROL AND CLEAN-UP EQUIPMENT PERIODIC MAINTENANCE: Spill control and clean-up equipment kept permanently on-site is listed in the facility's Hazardous Materials Business Plan. This equipment is inspected at least monthly, and after each use, and supplies are replenished as needed. Defective equipment is repaired or replaced as necessary. EQUIPlv1ENT NOT PERMANENTLY ON-SITE, BUT AVAILABLE FOR USE IF NEEDED: (Complete only if applicable) EQUIPMENT LOCATION AVAILABILITY Absorbent R10 Backroom R20' Onsite at all times R'o. Broom /dustpan RI ~ Backroom R'I' Onsite at all times R31. CiIOVOS R13 B1CkrOOm R32. OllSlte at all tlmeS R32. ' R13_ R23. R33. R14. R24. R34. R I s. R2s. R3 s. IV. RESPONSIBLE PERSONS THE FOLLOWING PERSON(S) IS/ARE RESPONSIBLE FOR AUTHORIZING ANY WORK NECESSARY UNDER THIS RESPONSE PLAN: NAME Rao. TITLE Rso. TERESA MILES Environmental Compliance Specialist NAME Rai. TITLE Rsi NAME ~ Rq'-- TITLE Rs2. NAME Rai. TITLE Rs. V. INDIRECT HAZARD DETERMINATION This information is required only when the presence of the hazardous substance can not be determined directly by the monitoring method used (e.g.; where liquid level measurements in a tank annular space or secondary piping are used as the basis for leak determination). THE FOLLOWING STEPS WILL BE TAKEN TO DETERMINE THE PRESENCE OR ABSENCE OF HAZARDOUS SUBSTANCE IN THE SECONDARY CONTAINMENT IF MONITORING INDICATES A POSSIBLE UNAUTHORIZED RELEASE: R60. Site operator will contact Elite Custamer Solutions Center (CSC) at 1-$00-ARCOFIX. A certified, trained pump and tank technician will be dispatched to the site to evaluate and repair alarm condition. hwfwrc-d (06/03) - 3h" 06/2/03 ~~i UNDERGROUND STORAGE TANK RESPONSE PLAN -PAGE 2 ' VI. LEAK INTERCEPTION AND DETECTION SYSTEM This information is required only for motor vehicle fuel UST systems constructed per the Alternate Construction Requirements of 23 CCR §2633, and only if the Leak Interception and Detection System (LIDS) does not meet the volumetric requirements of 23 CCR $2631(d)(I) through (~) (i.e., when accounting for rainfall and backfill material, the secondary containment volume is less than 100% of primary tank volume for a single US"I'; or in the case of multiple USTs in shared secondary containment, I i0% ofthe-lamest primary tank volume or 10°/, of aggregate primary tank volume, whichever is greater). ATTACH AN ADDITIONAL PAGE TO TFIIS PLAN CONTAINING THE FOLLOWING INFORMATION: - "I'he volume of the LIDS in relation to the volume of the primary container; - The amount of time the LIDS shall provide containment related to the time between detection of an unauthorized release and cleanup of the leaked substance; - The depth from the bottom of the LIDS to the highest anticipated level of groundwater; The nature of the unsaturated soils under the LIDS and their ability to absorb contaminants or to allow movement of contaminants; - The methods and scheduling for removal of all hazardous substances which may have been discharged from primary containment and are located in the unsaturated soils between the rimar containment and groundwater, including the L-DS sum VII. REPORTING AND RECORD KEEPING We will reporUrecord any overfill, spill, or unauthorized release from a UST system as indicated in this plan. Recordable Releases: Any unauthorized release from primary containment which the UST operator is able to clean up within eight (8) hours after the release was detected or should reasonably have been detected, and which does not escape from secondary containment, does not increase the hazard of tire or explosion, and does not cause any deterioration of secondary containment, must be recorded in the facility's monitoring records. Monitoring records must include: - The UST operator's name and telephone number; - A list of the types, quantities, and concentrations of hazardous substances released; - A description of the actions taken to control and clean up the release; - The method and location of disposal of the released hazardous substances, and whether a hazardous waste manifest was or will be used; - A description of actions taken to repair the UST and to prevent future releases; - A description of the method used to reactivate interstitial monitoring after replacement or repair of primary containment. Reportable Releases: Any overfill, spill, or unauthorized release which escapes from secondary containment (or primary containment if no secondary containment exists), increases the hazard of fire or explosion, or causes any deterioration of secondary containment, is a reportable release. Reportable releases are also recordable. Within 24 hours after a reportable release has been detected, or should have been detected, we will notify the local agency administering the UST program of the release, investigate the release, and take immediate measures to stop the release. If necessary, or if required by the local agency, remaining stored producUwaste will be removed from the UST to prevent further releases or facilitate corrective action. If an emergency exists, we will notify the State Oftice of Emergency Services. Within five (~) working days of a reportable release, we will submit to the local agency a full written report containing all of the following intormation to the extent that the information is known at the time of tiling the report: - The UST owner's or operator's name and telephone number; - A list of the types, quantities, and concentrations of hazardous materials released; - The approximate date of the release; - The date on which the release was discovered; - The date on which the release was stopped; - A description of actions taken to control and/or stop the release; - A description of corrective and remedial actions, including investigations which were undertaken and will be conducted to determine the nature and extent of soil, ground water or surface water contamination due to the release; - The method(s) of cleanup implemented to date, proposed cleanup actions, and a schedule for implementing the proposed actions; - The method(s) and location(s) of disposal of released hazardous materials and any contaminated soils, groundwater, or surface water. - Copies of any hazardous waste manifests used for off-site transport of hazardous wastes associated with clean-up activity; - A description of proposed methods for any repair or replacement of UST system primary/secondary containment systems; - A description of additional actions taken to prevent future releases. We will follow the reporting procedures described above if any of the following conditions occur - A recordable unauthorized release can not be cleaned up or is still under investigation within eight (8) hours of detection; - Released hazardous substances are discovered at the UST site or in the surrounding area; - Unusual operating conditions are observed, including erratic behavior of product dispensing equipment, sudden loss of product, or the unexplained presence of water in the tank, unless system equipment is found to be detective and is immediately repaired or replaced, and no leak has occurred; - Monitoring results from UST system monitoring equipmenUmethods indicate that a release may have occurred, unless the monitoring equipment is found to be defective and is immediately repaired, recalibrated, or replaced, and additional monitoring does not confirm the initial results. Record Retention: Monitoring records and written reports of unauthorized releases must be maintained on-site (or off-site at a readily available location, if approved by the local agency) for at least 3 years. Hazardous waste shipping/disposal records (e.g., manifests) must be maintained for at (east 3 years from the date of shipment. VIII. OWNER/OPERATOR SIGNATURE CERTIFICATION: I certify that the information provided 'n is true and accurate to the best of my knowledge. OWNER/OPERATOR SIGN RE DA"fE / ~ ago. ~ ! ~~ ~"~ OWNER/OPERATOR NAME (print) Rai. OWNER/OPERATOR TITLE R~' EDMOND NASSAR Franchisee (Agency Use On/yJ This plan has been reviewed and: ^ Approved ^ Approved With Conditions ^ Disapproved Local Agency Signature: Date: hwfwrc-d (06/03) - d/5 06/25/03 1 2 3 4 5 6 7 8 9 10 it 12 13 BUSINESS NAME: Arco #00583 SITE ADDRESS: 3220 Ming Ave. CITY: Bakersfield ZIP: 93304 MAP DATE: 5/25/05 AGENCY FACILITY #: B C D E F G H I J K L LEGEND DISPENSER SHUTOFF ~ CASHIER OA ABSORBENT FL FLAMMABLE LIQUID MSDS MSDS & EMERGENCY PLAN BR BATH ROOM • O GAS PUMP EMERGENCY FIRE HYDRANT M MONITORING WELL CL COMBUSTIBLE LIQUID TB TRASH BIN ® SEWER/FLOOR DRAIN SHUT OFF O ELECTRICAL PANEL • TANK MONITOR O WATER MC MOTOR COOLANT - - ~ FENCE (~ FIRST AID OL LIQUID WASTE DRUM ~ AREAUATION ~ ~ PPE MD MOTOR OIL A/ (,' U ~ ONDITIONING f FIRE EXTINGUISHER O SOLID WASTE DRUM /( ~ /\O/> OVERFILL ALARM C TELEPHONE EM EMERGENCY EXIT (~'O2 COz CYLINDER ® STORM DRAIN hwfwrc-d (06/03) - 5/5 06/25/03 09/22/2006 13:58 3103234433 t1NGER6Fi0UN0 STORAGE ?ANKS i..._ • 5'~ •• ' A~'PLICATI~N TD PERFOWIR ELD J uNE TESTlNL9 198989 SECONDARY CAhSTAINfiEE1Q'f TESTING (TANKTIGFI7'NF.SS TEST ANB i'O PeRPORM FUEI.9IIONlTaRtIJG CERTIF~I!C"A1~7pN ' P5RRMR' N0. ~'' ~' •+` It CET ! ~i~S a ,R~far r PAGE 02/05 BAI~I~t£~~`TELD F~~ DEPT. Pra~e~.ttioa S~~ices 90U'Ts~ixtun Ave., Ste. 2I0 Balcer$5e1d, CA 938D 1 . 'S'el.: (661) 326-3979 Fax: {66I) 852-2171 _ Pa3e 1011 FD 2D95 (RBV. 09!05} sre ~r~uSrt}T .~-:, ~... . ~ C E T Dispatch li ~ t c~2- MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations This form must be used to document testing and servicing of monitorin eqyuipment. A se arat certiT-ca ion or re rt must be re ared fo each monitorin s stem control anal by the technician who pedorms the work A copy of this orm must provided to the tan system owner operator. The owner operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Inforalatiop~ ~O ~ ~ ~ 3 Facility Name: ~iJj'`-- Site Address: 3 Z-~ ~ ~ /1/C- ~ City: B d . No.: ~5~~~~Zip: _ Facility Contact Person: ___! Cotrtact Phone No.: Make/Model of Monitoring System: ~~ ~.S 3~7 Serial Number Date of Testing/Servicing: ~/~,fi (. B. Inventory of Equipment TestedlCertified Check the aDDropriate Doxes to indicate speciSe equipment inspectedtserriced: T ID: $ I~Y1 I Tank ID: Fj S _ V /C i ~' r Tank Gauging Probe. Model: In-Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: fr Annular Space or Vault Sensor. Model: K- ~iping Sump 1 Trench Sensor(s). Model: t~~iping Sump /Trench Sensor(s). Model: IC. O Fitl Sump Sensors}. Model: K ZtJ (~FiII Sump Setsor(s). Model: _____ Z ^ Mechanical Line Leak Detector. ~ectronic Line Leak .Detector. Model: Model: /~- ~~-- -_ - ^ Mechanical Line Leak Detector. ^ Electronic Line Leak Detector. Model: Model: - ^ Tank Overfill [High-Level Sensor. Model: ~ O Tank Overfill /High-Level Sensor. Model: ~ DOther s ci ui meat and model in Section E on P e 2}. ^ Other s i ui meat and model in Section E an P e 2 . TanklD: TanklD: t '[ ' / ~ n-Tank Gauging Probe. Model: ~(n-Tank Gauging Probe. Model: Annutar Space or Vault Sensor. Model: lB~Annular Space or Vault Sensor. Modes: /t Piping Sump /Trench Sensor(s). Model: Piping Sump /Trench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). ModeL• K. ^ Mechanical Line Leak Detector. Model: ~hanical Line Leak Detector. Model: electronic Line Leak Detector. Model: ____ Electronic Line Leak Detector. Model: ^ Tank Overfill 1 High-Level Sensor. Model: O Tank Ove~ll /High-Level Sensor. Model: ^ Other ci ui meet and model in Section E on P e 2 . O Other ( i ui ment and model in Section E on P e 2 . Dispenser 1D: / - Z. Dispenser TD: 3 O Dispenser Containment Sensor(s). Modes: _ ~ ^ Dispenser Containment Sensor(s). Model; ^ Shear Valve(s). O' Shear Valve(s). O Dis enser Containment Fio sand Chains . D Dis ser Containment Floa s and Chains . Dispenser ID: Dispenser ID: ~~ ~.; ^ Dispenser Containment Sensor(s). Model: G ^ Dispenser Containment Sensor(s). Model: D Shear Valve(s). O Shear Valve{s). O Dis Haar Containment Flo s and C ins . O Di user Containment Ff sand Ch ins . Dispenser ID: ~ f' ~ / 2 Dispenser XD: ,~ '~ / ~ ~''~ D Dispenser Containment Sensor(s). ode[: - ~~ Z ^ Dispenser Containment Sensor(s). Model: _ Z~J ~ Z O Shear Valve(s). ^ Shear Valve(s). ^Dispenser Containment Floats and Chains . ~ O Dis Haar Containment Floats and Chains . *If the Facility contains more tanks or dispensers- cony this form. Include i nformation for every tank and disneaser at the facility C. Certification - I certify that the equipment identified in this document was inspect rviced in accordance "t6 the manufacturers' guidelines, Attached to this Certification is iniortnation (e.g. manufacturers' checklists) n ary to verify that this ' rmati is correct and a Plot Ptan showing the layout o monitoring equipment. For atgt equipment capable of ge ting such report, 2 e also ch opy of the report; (check atJ drat apyty): O S~~fJt~/~m set-up ~//Claret history report Technician Name (print): ` 'f /~ fie/~ Signature: Certification No.: 2 ~~ ~ { License. No.: 302015 Testung company Name: CHARLES E. THOMAS COMPANY Phone No.: (310) 323 6730 Address: 13701 So. Alma, Gardena, California 90249 Date of Testing/servicing:f/~ I r~ /~ Page 1 of 3 i ~~ Dr Resttits of.Testing/~ervicing C E T Dispatch Software Version .Installed: ,~ ~ ~` G ` Com Lete the follow in checklist: ages ^ No* Is the audible alarm o erational? Yes ^ No* Is the visual alarm o erational? s ^, No* Were all sensors visually ins ected, functional) tested, and confirmed o erational? Yes ^ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their ro er o eration? ^ Yes ^ No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) N!A operational? Yes ^ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ^ N/A monitoring system detects a teak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) ~umplTrench Sensors; ~spenser Con inment Sensors. Did ou coni=n•rn sitive shut-down due to leaks and sensor failure/disconnection? es; ^ No. ^ Yes ^ ~ No* For tank systems that utilize the monitoring system as the primary tank overt ll warning device (i.e. no I~'1[t%A mechanical overfill prevention valve is installed), is the overfill wanting alarm visible and audible at tt~e tank 511 int s) and o eratin ro eri ? If so, at what rcent of tank ca aci does the alarm tri er? ^ Yes* No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, ar other equipment replaced and list the manufacturer name and model for all re lacement arts in Section E, below. Yes* ^ No Was liquidd f~d inside any secondary containment systems designed as dry systems? (Check all that apply) ^ Product; Water. If es, describe causes in Section E, below. ^ No* -Was monitorin s stem set-u reviewed to ensure ro er settin s? Attach set u re orts, if a iicable Yes ^ No* Is all monitorin ui ment o erational r manufacturer's s cifications? Page 2 of 3 * In Section E below, describe bow apd when these deficiencies were or will be corrected. F. In-Tank Gauging /SIR Equipment: C E T Dispatch Check this box if tank gauging is used only for inventory control. Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the followinn checklist: ^ Yes ^ No* Has all input wiring been inspected for proper «..^,try and <=;±J;~ination; including testing for ground faults? ^ Yes ^ No* Were al] tank gauging probes visually inspected for damage and residue buildup? ^ Yes ^ No* Was accuracy of system product level readings tested? 0 Yes ^ No* Was accuracy of system water level readings tested? ^ Yes ^ No* Were all probes reinstalled properly? i ^ Yes ^ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section N, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors {LLD): ^ Check this box if LLDs aYe not installed. Cnmstlete the fnlhwipQ checklist- Yes ^ No* For equipment start-up or annual equipment c cation, was a leak simulated to verify LLD performance? O N/A (Check all that apply) Simulated leak rate: 3 g.p.h.; ^ 0.1 g.p.h ; ^ 0.2 g.p.h. Yes ^ No* Were alt LLDs confirmed operational and accurate within regulatory requirements? Yes ^ No* Was the testing apparatus property calibrated? ^ Yes ^ Al * Fvr mechanical LLDs, does the LLD restrict product flow if it detects a teak? N!A Yes ^ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ^ N/A Yes ^ No* Far electronic LLDs, does-the turbine automatically shut off if any portion of the monitoring system is disabled ^ N/A or disconnected? Yes ^ No* For electronic LLDs, does, the turbine automatically shut off if any portion of the monitoring system malfunctions ^ N/A or fails a test? Y ^ No* For electronic LLDs, have ail accessible wiring connections been visually inspected? ^ N/A Yes ^ No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 NDERGROL~'D STORAGE TANK IvIONITORLNG SYSTEM CERTI>i'ICATION Permit Number: Site Address' ~~ ~ZQ UST Monita~,~i ~ r/~i ,cam S~~ ase~ .~rwy.. ::: .'~:-~ ~ :~~ :Icy. .~ :::::::::::::::~::: ~.:::: .. .. .~:..~.7 ............ ............. ,~. . ~i 1. . . ~ . . ! . . . . . . . ,G:/~~C.: ~.~. - . . . . . . . . . . .... .. .:~: .5:~1. :,.... ~~ ....... ..... . ,. . ;~l. a .~ :: :: ~, : : : ~ `t ~'``': r 3 : : :.. : : : : : : : Aso :::: : : :: : ::::: : :: Date map was drawn: ~ /~/~`r' Instructions 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 IeveI probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. ~ r SWRCI3, danuarv 2006 Spill ~ueket 'T'esting Repol-~ ~or>c~ This form is intended for use 1n~ conn•actors performing a»nual testing of LIST spill contaitsment sh•uctures. The completed form. and printouts. from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regztlatory agent}-. 1. FACILITY YNF®RIVIATION Facility Name: (t C~5"'€ Date of Testing: D =ll -o Facility Address: ZZ~j ,,v Facility Contact: Phone: Date Local Agency Was Notified of Testing Name of Local Agency Inspector (f present during testingj: 2. TESTING CONTRACTOR INFORMATION Company Name: Technician Conducting Test: ~ ,c5 Credentials': d CSLB Contractor Q ICC Service Tech. Q SWRCB Tank Tester D Other (Specify) License Number(s): 3_ SPT[.L BUCKF,T TESTl11TA TN>k'ORMATInN Test Method Used: 0 Hydro tic ^ Vacuum er Test Equipment Used: S ~,~. ~ Equipment Resolution: .. . .......... Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 ^~"? h9 2 ~ 7 $~ 3 ~~ 4 Bucket Installation Type: Q Direct B ?~COntain in Sum D Direct B D~Gontaine in Sum D Direct Contain d in Sum 0 Direct B' ontain d in Sum Bucket Diameter: 2~~ 2 Z' 2 1 Z 1 2 /2 Bucket Depth: %„~ t + jS ~ l.S" +~' 1.S - ~ !.~ 15 ~S Wait time between applying vacuum/water and start of test: ~ U ~G ~ 3p 3G 3G 3G 3G Test Start Time (T~): ' ~ , ~o + •'~ ~ a+o `'`~ ~ ~ `~' +"~' w Initial Reading (RI): /o ' !6 / a / a . /o /G ~ ~ E ~Q ~ Test End Time (TF): lZ = w 2 _ ~ ~~ ~ ``' ~ ~ = ~ ~ ``~ - / ~ ~ ` `2 Final Reading (RF): d to % 1 d /t/ ~ / o ~ O t 1'a Test Duration (TF = T~): /{+~ ( ~t~ ~ ~ f ~ Change in Reading (Rp - R~: -~ ~ ---- '""` r' ""~ ---- Pass/Fail Threshold or n.~ Criteria: ©(Z~ Testa~esult:.. ass O Faif ass D Fail. , Pass a)Fail I'sss O:Fail - Comments -- (include information on repairs made prior to testing, and recommended follow-up for failed tests} CERTIFICATION OF I hereby certify that al! the infor Technician's Signature:, -N RESPONS E FOR CONDUCTING THIS TESTING in this rep true, accurate, and in full compliance with lega/l requirements. '~ Date: / d ~ /~ 4~ ~ State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may 1.a mnrP ctrin nwnt Electronic Leak Detector Test Data Sheet Station # ~~~ 3 Date G~ ~ ~ 2U G w Address 3 2~U / / t ~ N E7 i ~ ~~ Test Information I 2 3 ~ 4 5 Product ~ --7 c , S G~ / Manufacturer . V ~ ~/~ rj/~ Model ~ LG~ ~GC ,~ L L Line Bleed Back (ml) ~~/!~~ ~CJ~f / ~ Check Valve Holding Pressure (psi} / Z~~ ~ ~ ~~ ~ Test Leak Rate (ml/min) (gph) ~ ~j~D<f ~ G~fI~~ ~ ~~~- PASS or FAIL n~s ~S' 1 ~J! Comments: This letter certifies that the annual leak detector tests were performed at the above referenced facility according to the equipment manufacturers procedures.and limitations and the results as listed are to my knowledge true and correct. The mechanical leak test detector test pass/fail is determined using a low flow threshold trip rate of 3 gph at 10 PSI. Inspected By: Contractor Technician Signature ELD Test Sheet 3/14106 ~`t't=.'T'ENi tiETUF i>t'T 1 1 , 2UiJr c~ : ~ U S'f ~`I'EP9 l It'J I T"S U.S. _,', STEM LANGJIAGE EhJi~L I SH S'•:'STEM DATE!T I NlE FURMAT rlt) rJ LSD '~'••l`r~~ H H : J~tr'l : s Ak~U 0583 ::i~20 N1I N~~ AsJE BAKF.RSF I ELI:I CA 'i:3 ;Dd E,61 39 _i u3b3 ' SHIFT T I t°IE l: U i': CABLED °,HIF'r TI{"1E ':'_ : UISe;BLED SHIFT TII'I£ 3 : DIS'ABLEG 'SHIFT T I I°lE 4 U I SAI3LED ~ TAt'!h: I'ER T'ti.T [VEEUEU 4JkfV DISABLED TAhJ}; AIVN TST iVEEDED bJRN D I .~A)3LED L I fVF: faE-EfJABLE t'1E'rHGIi PASS LINE TEST L I I'JE PEk Tt"~T tVEEDEU WRN D I ~ABLEL+ LINE AIVPJ TST J'JEEDED UJRN Iy I SARLEU FR1fJT TC VULUPIES ENABLEIs TEt°1F COP9PENSt~T I GEV VALUE {USG F 'r: b0.0 ST I ~~K HE I f~HT UFFNET DISABLED Ft-F'R4T4C:4L DATA FORt°1rT HEIC.IHT PREC1SI41J TEST DURATIt~!'! H4 URS : I 't DAYL i GHT SAtI I Nu T I N1E ~_ D I ~~`AFiLEI's F.E-DIRECT L?lC:AL PRINTi3UT If I BAWLED EURO PROTt~CCiL PREF I `~ S NYSTEP'I SEC'i `Y CODE •' C:U:3Tt ,ABEL: U 1:~AI --~ ----- ~.r F'~''h'T SETT I Ni:~:~ t'tsNif°I E'_sHRL; 1 i:-,-'~~A'I ' Br=tt1D RtiTE ':+r~1_lU PAR I T`l : QJt riVE STUD BIT I 'aT4P DATA LENGTH: 8 DATA R8:-233 :~Ei'Uk I T`; ti :4UE DISABLED L~Tk NUki'1t~L :PATE: HIuH J i:•t?Mt°t B4ARLs '3 SS-SAT ! L3AIJU I?ATE : 5,00 PAR i T'~' NUNS ~'I'4P BIT : 1 ;;TUF DATi~ LEfd~TH: S DATA R1J-LV~? SEC:URiT`! CUDTr : U I BAWLED UTR tVORMIAL STATE : HIGH i REC:E I UER SETUP : NONE AU'r4 DIAL TfME SETUP: hJ+~ tdE RS-332 EPJD OF MESSHiaE D I SA]3LED AUTG' L; I HL ALARI°1 :SETUP I N-1'F;t'Jh T 1:87 I F'R+'~'DI ti_; 1 THERt°lrii. ~.;+'_+LFF :. ui: Cu7 TAJVK D 1 AI°IE'FEk 9 . UU TAhJk: FRr'FiLE ~'u FT6+ FIJI.L 1t~>L '684 87.4 3 P•JC;H ~IUL 9F.?d !32.8 I Nt:H L+iiL 5330 70 . `_' 1 fVC~H '~,l;,~L 9020 73.6 I t•JGH ''JQL Ss35G b9.0 I N+.~ H tt;.iL tilt79 E.4.4 I N~~ H 1tvL 752y 59.8 ItVCH ~:~?L F,957 55.'2 I hJC'H VUL .: G342 5U . 6 INCH ~10L 5707 46. C~ I fJ~'H ttC,+L; 5061 41 .4 I NG'H l~'4L 4413 36 , d I Ni'H 1t4L : 3737 33.3 INCH t14L 3157 '37 . r INCH ttfJL 2Fi60 2:3.0 I fdCH LlCtL 1973 1 i; , 4 I tVCH V4L 143? 13 , 8 I iVCH ~1QL : 966 9,'? INCH V4L 548 4.a INCH V4L 217 FLuAT S I ?!; : 2 .O I fV . Wr~'rEF: 6JAR N I N~:a 0.8 HIc~H WtiTEk LIMIT: 1.U MFiii 4R LABEL t1'OL : 9694 4t1EkF I I.I. L I t°1 I T 9 0 8'715 HIGH PRODUCT 95f 9199 DELIVERY LIMIT 15%a 145? L4l;J PRC~UUCT 611 LEAK :ALARM L I t°1 i T: 99 SUDDEt'J LOSS L I f"I I T : 99 ' rANY. TILT u . 00 PR~~BE OFFSET O.OII 5I F'H4N t°lAN I F4LDF,D TA(VKS 'r# : 02 L 1 tVE Mr=ttV I Ft1LUED TAt'JKS T#: N4tVE LEA}: ("I I N F'ER 14Ci 1 C' : Ofi U LEA}: P9I N "ANNUAL 0.''.i 0 1='ER 14D I ~ : TE~~T T4'F'E STFI fJDHRIi AtVNUAL TEST Fr?IL ALARNJ U I SAFLED PER I t~U 1 C TEST FA I L ALARM DISABLED uR4S`; TEAT FAIL ALAk~'I D I:~ABLEU AJVf•J TEST At1ERAG 1 NG : 4FF PER TE ~T HVEF.HG I PJr, : UFF TANK TE=~T .N+JTI~F'x': 4FF T(dI; TST ~~ I PHt?PJ E:REAK : t3FF ;_ T ~ : <<, F'Fcii1! IJi TI-IERh1i :. u007UCI TAPJ}'` } ~F' 92 . p0. TAP•J} F~!`' ~:'+F'ILE ~i~ PTS FULL ~.+1. 9684 J37.4 II'JC'H L+CiL 9624 9'? . I~ I PJi:H +?~:~L 9380 7C.i.'? I PJ:H 'w+r>L 9020 7 ~ . ~ INCH ?t~L 2850 69.U INCH 1;GL 80?5 64.4 IIVGH VGL 759 59 . N I Id%H lit]L .6957 55 .'.? INCH VOL : 634'2 5U.6 I PJi~H tiGL 5707 46.0 INCH VOL 5061 41 .4 I Nt~~H 1,'OL 4413 36.8 I Ni`.H VGL 37Ei7 ~'?.2 INCH VGL 3157 27.6 I JVCH 1.+OL 'x'550 23 . u INCH 'E;GL 1 973 18.4 INCH Vt']L 1437 13 . a I N~'H VGL 966 5.2 I Ni'H VGI. 548 4.6 INCH 1iGL '~17 FLOAT SIZE: 2.U IPJ. MATER WARN I rJ+:; 2 , 0 HIGH WATER LIt°IIT: 1.0 N1A.; GR i.ABEI. VGL : 9GCi4 OVERFILL LII°1[T 90i 2715 HIGH PRGDUCT 95% 9199 DELIVERY LINITT 15%; 1452 L~:LJ PF,GDUC'T 611 LEAk: ALARM LIMIT: 99 Sl1IiDEIV LESS L 1 I°IIT : 99 TANK TILT 0,00 PROBE OFFSET ~ 0.00 'F"F, - _ T HF.. Tr3Pd};~. TAPJY: i- r UL.L '." ~:'L ' ° V`V I IVCH '~.+'~]L ' 7E.? IIVC.H VOL ;'3.6 ! IVCH VGL i, 69.0 ItVCH ::t]L 64 .4 INCH V~'+L 59.8 1 NCH t1GL . 55.2 INCH 11G5L : 50.6 INCH 110E 46.0 I fVCH 110E 41 .4 I PJCH VOL : 36.6 INCH VOL : '32.2 INCH IiGL 27.6 IIVi::H VOL : '?3.0 INCH VGL 12.4 II'JCH VOL : 13.8 INCH VGL 9.2 I NC:H VGL 4.6 INCH VGL FLt]AT B I ZE WATER 6JARNI PJi; HIC;H WATER LIh~IT: I°lAi< GR LABEL VGL GVEF.FILL.LIMIT i HIt;H Pki7DUCT . I:~ELIVER`i LIMIT ' ~ `i C10 ~i~, FT,a 9e84 96'? 4 y; i 21.1 9U20 tiF50 8079 "5'? 9 6957 634'? 5707 51j61 4413 3767 3157 2550 1973 143? 966 546 217 2.0 IN. U.6 1.0 96J34 90fo 6715 95% 91'99 15~a 1452 LGIJ F'RGDUi`T 611 ]_EAK HLARJ°1 L I t°11 "I' : 99 F,IJDDEfV LGS• LIMIT: 99 TANK TILT 0.00 PROBE t]FFSET 0.00 -- - - -. T 4.91 THERMAL +'(iE~'F :.G00^01.-) TAI•JI<: Li I iN1E'I'Fik - 92 . UO TiIVY: F'F'GF I LE '-i-1 PT:J FULL '~,'?;~! yr194 27.4 1 tVCH 'tiC7L 9G'24 2:_' . ~3 I I'Ji'H t.'C>L 9380 72 . ~ I IVi'H Vt]I. 9LI'?0 73 . ~• I hJCH tiivL B~ 50 6'~! . 0 I rJCH '!COL 8t7?~~ 64.4 Ir,JCH 1;~:>L 75'9 59.8 I Ni_:H Vt]L 6957 55. - INCH +.JOL 6342 5tJ . 6 I JVi~H iJGL x;707. U6 , 0 INCH '~+O'L 5061 4l . 4 INCH V+:'~L 44! 3 36.8 INCH VOL : 3787 32.2 I NCH VGL 315'7 27.6 INCH ~,~OL : 2550 X3.0 I hJ+.?H VGL : 19?3 18.4 IIVi='H VGL 1437 _1; i : Jj--I rJ7F1 Vt7._.: ._ . _ .g66 - ; y,2 INCH VGL 546 ' 4.6 INCH 1iGL 217 FLGA'f SI?E: '?.0 IN. 4JATER bJARhVIIJG " 0.8 H I i; H 1JATER L I1^7 I T: 1 .0 t°lA?~ t]R LAFiEL IiGL: 5684 OVERF-ILL LIMIT 90% b'715 HIGH F'RC+L~UCT '95"'J 91 99 DEL 1'~+ER~'. LIMIT 1 5r 145 LORI PR'1DUGT 611 LEA};: ALARM L I I°i 1 T: 99 SUDDEN LGS:9 I_ i M I T : 99 TANK TILT 0.00 F'ROEE OFFSET 0.00 S i F'HG1J MAN I FGLGEI! TANK:. S I F'HO PJ h9AlV I PGLI!ED TAI+J}:S S 1 F'HG N MAIV I FGLDEI! TANKS Ttt : IVGIVE Tk: Ol Ttt: h10IVE LINE JhAN I FOLDED THhJKS LINE I~IAIV I FOLIiED TANKS LINE MAPJ I FC7L.IiED TANKS Ttt : IVGNE T# : NONE T# : IVGIVE LEAK: !°1 I IV FER I GD 1 ~_` : 0% LEAk: M I PJ PERIODIC : ~'J LEAK MIN PER I GD I C : 0";~ 0 0 _ 0 LEAK !~l I Pd ArJI^JUAL Or LEA)`: r'I I I'J APJNUAL : 0%~~ LE+i}: N1I IV ANIVUAL O 0 0 0 PER I ~ >D I i TEST T'; F'E ANhJ11f,L TE',=~T FAIL ,L.ARN1 L+I',9ABLELi FER I t]D 1 i~' TEST FFr I L ALARM D I Sr',BLED ~~R05S TEST FA I L ALARJ"1 D I :9ABLED AIdIV TE:=JT AVERA~' OFF FER TEST OFF TAPJ}: TES' ~~>FF TIJ}~; T ~T OAK :GFF DEL I VER`r 5 I°1 I N F'I_IJ°1P THE 1 u . 00~•~: FER } t]Ii I C TEST TYPE PER I C'+D I C TEST TYPE ~'fAIVUARL! ' ~TAIVIiARD ANIVUAL TirST FA I L ALARM DISABLED F'ERI~+IiIC 'TE,ST FAIL ALA)<;I^'I DISABLED GI:'OSS TFti,T FA I L ALARM DISABLED Aldhl TENT AVERAi_ 1 NG : OFF PER TEST Ai'ERAC I rdi; : OFF TF iOT 1 FY : OFF T HON BREAK:OFF I ELA'i 5 I°1I rJ I ,H,]LD I0.00% ANNUAL TEST FHIL ALARhI D I SABLEIi PERIODIC TEST FAIL ALARM D I StiELED GRUBS TEST FAIL ALARM DISABLED r;IVIV TEST AVERAGING: GFF PER TEST AVERAG I iVi~ : OFF TAJVK TEST NGT I FY : GFF ThJK TST SIPHON L~REAK :GFF DEL I'~ ' IiELA`r' 5 I°l.I PJ E~:H~sLU i u . IJUid 2- L1~i~I: Tl ~ ,,;[~ TE.~T CYPV Lir;'I'1= _ rl.L 'fFPiv IVIYV 1Ci, '?IIIJ: :~THk''I' T I I°1E D I SHBLED TE'~~T F?ATL: : lJ , 2CI i;;L:`H L~URr~TIC,~N ? Hi?UR ' TS P Er;RL`' ti:TOF' : D } 5 I.-Er=+}: TEE:T F.'EF'rL R'f F NG L-:SSURE LINE LEr`i}. S 1:8? rF:2.0:•'3.uIN FlFERu^L ,rJIN DIH LEN:200 FEET OIPJ DIr LEPJ: r) FEET HUTDOWPJ RATE: 3..U GF ~W F>RESSURE SHUT{3FF : h ]W PRESSURE U PSI :" NC1fVE ~F.: IVC}N-UEIVTED URE~UFFSET: D.OFS '~~E ~,;FFt~I;T : hi . I NE LEF;t' Li)!:}:t]LiT SETU 1GKvUT SCHEDULE ~IL`l TART T I N1E : L~ I :'CABLED TOF T I PIE D I S'~ABLED I~<~tU1Li SENSisR SETUF' 1 :8? t°1F;:)TEk AfVtVULHR I -STATE (~ I tVC:LE FLc3 fE~=a~R'~f ' : (iNIVI fLF~R SF L~ :137 f°1H)TEk FILL 1-STATE (:3I fV~:aLE TEi3UR'•t irTf-IER a ~ , ~ '; ::37 I lA:)TF.R TURBINE `_ : 89 ! 1 ,:~ R I -STr;TE t S I bIGLE FLvr,~<,k ATEGORY STP StJN1P ,,~~ CP : 2.0; 3. U I N F i BEk~:Y,I}~5 i ''., . U T M' D I A LEtV : ~UCI FEET I~i~, ,~ : ~~~ SLAVE t=;t'dNULf-YR I ~i~~~, . G I IV D I A LEPJ : CI FEET +fR I - ~:THTE (S I tVGLE FL~H~'! HUTI:?UWt'J RATE : 3 . U ~ PH.; C•HTEIatiR 1' i-itdNULAR SPtiG~i ~~~, ~I~,P FkESSURE ,HUT~~FF : NDw • :% ~,, k~. '~tnl PRESSURE U F'S I „ 1 I, ~ a I} EIVSUk : PJ(ItV-VEIVTEL, ' ` , ~ ` 5 : s3? 5LA'~'E F I LI. ;,TRI -S'I'TE ~: ~, I NC;L.F FLOAT } i RESSURE UFF:3ET: Q.OF'SI ;i;HTEuURI' ~JTHER SEPJSDRw:. ~' r ' L 6 : B! :JLAVF: TURBINE ~' M+~ ~' ~;: Tk I -:3T~TL { : ~ I Nc;LE FLUh: CA'PE~~URY' F' [ P I tVC, SUf iF ,`.' I i;lre +j~ '~'~ i~ ~~ ~L. 7:83 r~TVfJIJLr=~R ~ '~ . GATEGi7R1' ANIVLILI=;R SPA''.. '('!! 3:3t ,1>14~ ~~~::I~. 1'F' : 2' . CI,',3 . i) I tV F I FiERGI.f;k,°u I. d : 83 F r ~ I. '~' • ~, . Lt I N Li I A LF' I : ,'UL4 FEET TRI -~:T . + ~' I tdl yLE FLr~n7''~ .uIP! LiIH J: CI FEET .' `~r~_ i;THEk SLN,trR~ t) _ ~:NtJTCiFF : IVt3t~: s G G F'S I ~ ` ~s.~ L 9 : r] 9 T F I -:? i;rTEG~ LE FL?1 SUI°1F' L 1 CI : y 1 i~hlhVIJLAR TRI -STATE { S J tVUL& ,CHTEG4RY t)THER L11:31 FILL TRI-STHTE ;SINGLE ~'r:-tTEGCiRY OTHEk 1x.12:91 TURB I t'JE TRI-STHTE iSIt'JGLE F CATEt~Gkl' STP SUthP L1;J:IiISF'' 1-~' TRI -ST+~TE ~::~ I NGLE FL C:ATEz+()R ~ : ):i I SPENSEk TRI-STATE (SINGLE FL C:ATEG~~RY : DI ~PENSER L15:LiISF' 5-G TRI-STHTE (SIPJGLE FLUH CHTEGi~kl' D I SPEfVSER F LIE~:DISP 7-8 TRI -STATE { ti, I tdGLE FL CATE~~~iRY DI ~PEIVSER "LI?:DISF' 3-lU ~~ - TRI°STr~TE iSJN~~LE FLDAT} C:ATEGt7R''i' LaISPEt'JSER PF~N ~~ i i L18:DI:~P 11-12 ' kI-STHTE {SINGLE FLOA "' TEG~.ik l' Li I SF'EPV DER F `i7.~~13:LiIaF 13-14 ' ;: TRI - ThTC (S J t'dc;LE FL~r-~T Cr~TEui>R'' : LiISFEN~ER PAN L_'O:D TRI -:~ 3LE F'L~~~T 7 C'~TEi~ ?ENSEF'. PAN - - - L. `" ' - - - - L _F k 1:+=,liEkF I LL ALAkr•1 L ~± -1= UEL ALARr9 T',;F'E : L S 4: F UEL ALARM :3TANliF;kU L15:FUEL ALARM !'dt?kP9ALLi' i}F'EtV L18:FUEL ALARM L 1 y :FUEL ALARf°1 L 7:SENSGR UUT ALAR{°I 11'J-TAI'dK AL,riRr1S 'L S:SEPJ:=:~.^ik c?IJT AI.ARt°1 ALL'r;VEFFILL ALAR1"1 L 9:SE1'JSUk GU1' ALAt~f"! ' ALL:HIUH FRGDU:T ALAR!°l L14;SENSGk GUT ALARM ALL : MA; Pkuli Ui~_.T ALARf°1 L 1 _~ . SENSOR C}UT ALARM , L 1 N : SENSt1R UUT ALARf°1 L19:SENSUk UUT ALARM L 7:SHORT ALARM L >3:SHGRT ALARM L 9:NHURT ALARM Lt4:SHGRT ALARh] Ll5:SHURT ALARM L18:;3Ht}RT ALhRr'1 L 19 : SHGRT ALARr'1 U 3:91 F'LLI~-L l rJE D I;=;rBLE }ETUP L 1 ~:aU I D SENSOR ALN1S - L10:FUEL ALARM i~ 1 : ~;'7 L 1 1 : FU£I. ALARPI I.12 : FUEL ALARM I_ I ~lJ I D SElVStlF? ALMS L 14 : FUEL ALARNI L I : FUEL ALAF hi L 15 : FUEL ALARM . L~~ :FUEL ALAkh'1 L 10 : FUEI. ~LARr1 L 3 : FUEI.. ALr3RM L 19 : FUEL ALAF.M L 5 : FUEL ALARM L 10 : SEtVSGR GUT F;LARt°I '• L 5 : FUEL ALHkJ°1 L 1 1 : ~+61VSOR OUT ALF;RNI L l :i :FUEL ALARJ°i L 12 : SE Pd FOR GUT ALARNI I,14:FUEL ALARM I.14:~ENSGR UUT ALARt°i L1?:FUEL ALARM L15:SErJSGR GUT ALARf"I L20:FUEL ALARNI L18:SEtVSUk UUT ALAkr'1 L 1 :S£N~;GR GI.JT AI ARr~I L19:SENSUR GUT ALARNI .. L 2 : SEIVSGR UUT ALARf°1 L 10 : SHGRT ALARM L 3:SENSGR UUT ALARf"i L11:SHORT ALARM ' ' L 4 : SErdSGk UUT ALARM L 1 '~ : SHUIt ALARI°1 I L 5:SENSUk t}UT ALARM L.1~,SHURT ALARM L b:SENSOR UUT ALARM L1.~.SHGRT AI~' M i ' ' L13:SEIVSGR GUT ALARM L10::Hf,R~ M L1b:SENSUR UUT ALARM L19. :M L 17 : SE NSGR C}UT ALARNI L~~O:SEIVSGR UUT ALARM L 1:SHGRT ALARM I.~ : SHGRT F1LFiF'J'1 L 3:SHGRT ALARf°I L 4:SHURT ALARM L S:SHGRT ALARM L G:SHGRT ALARM L 13 ::3HUP' aLHRM L 1 b : 'U'" 'ALARM L ' `'nti. iLARt°I L ~ • ~T r3LARt°1 U L18:L~:. _ t~ i :3PEPJ':~ER PiPJ L~E'I'LIF' L~r;T_r'=; ~~JAF.I1 i PJ! ALAF.t°1 H I ST'Uk'':' REF•GkT - SENSOR HLAI:'r~i --___ L 1:87 MASTER ANNULAR firJNULAR ~;F•AUE SErJSUR UUT ALARf°i Gi:,T 27. X005 13:4ti FUEL ALARNI U~'T 27. 2005 1:30 SETUF DATA WARhJIIVU AUi. ;s. 2005 13:33 x ~ ~ ~ EfdD * ~ x ~: x ALARP9 HI;TGR'i' REFGRT ~ENk~t3k ALARf°l L < : 87 r'IASTER FILL OTHER SENJSUkS• :~EIJ~UR GUT ALAkt'I ' ,`_>GT ~~7. '~QUS 1:3:48 F'UI;L HLARr9 G+.: T 27. 2055 13:::32 'tiE'CUF DATA WAFYJIIVi_, HU 3, 2UUJ 1 :i • ~.3:~ ;~ * ~ x n ;~ ,_ F°lA: ~Tia;' TI IR'E~I PIE STF' ;`~lll°lP FUEL ALhI=:I^'1 :_~ETCIF' C!ATA WnF'f•dI Pd+= AUK=y =. ~Ci05 I'j::3~.1 x. ~ x x x. Eh•JI.i :{ ~ 7~ i F' F'~_'+~T __ L I~t:~~9 FILL - - -- vTHEk t:EP•JS~iF'~: :EPJF:~:'F' ~>UT AL~;Rrt FUEL ~',LARI°I ~!~'T ~, , '005 1:=.?:4' SETUP' LiATr IJAkfd I NG r;UG 3. ?t~05 I :3 FiLAF:NI HI.;T~~R;•" REF~Sk1' ----- SENSCSR ALARf°1 - L 6 :87 SLF~'~1E TURBINE F' I F' I Nf~ ~ Ut°1F~ FUEL ALARf•1 AFk 14. 2UUb 19 :5'3 SENS%~k OUT ALARM ' FUEL ALARPI fiC'T 27. 20U5 1:3:3 ALARM H 1 t:~TC;k'~' REF'tiSRT ------ SEfV~s?R ALARI"I - - L 4 : ci? SLA1iE ANNULAR. ANIVUL~tR SF'AC.E FIIEL ALAkt~1 OCT ''7. 2005 15:25 SEIV~{iR ~SUT ALARP9 !JCT '?`r ~ '005 15:18 FUEL AL.ARI°1 OC'T 27. '?005 1 ~~ : 09 hLAt~f°1 H I :3TUR'f REP+_~kT •---- -- :~EPJ~;~OR ALARh9 -~ L 5 : 8" SLA1/E F I I_L tSTHER SEPJ:J+?RS 'EIV=:Cik OUT ALHRrI FUEL ALARI"I vGT ~ -" f'" .5:37 :!~TLI :Pd I Ni} r;lli L":3•' ~ ~ ~ .~ x EIVIi ~ . hLARh'I H I ST+?R'' REPORT ----- SFJ;1S~;?R ~LARhI - L 7:84 AfVNULAR ANNUL~Ik SPACE :~EIV +]k fiUT ALF;RI°t UCT '17..:'005 13:44 FUE1. ALARh1 C.;i?T '~?. '?Ou5 13:40 . ~E"1'UF DATA IJARhdII'JG AUG 3. '?OU5 13:33 EfVL! ~ ~ .~ x ~ ~ ~ ~ EPJU ~ x *. ALARr9 HIST~}k :' PEF'C>RT ----- SEIV84};' ALARf`9 -- L ~~:89 TURBINE STF' suf~F> SENSGR OIJT ALAkr1 O[;T ~7, '?005 13:44 F~ tEL ~I..Ak!°I OGT ;_'7. 2005 13:43 SETUP LiATr; WARNING AUiS 3. 2005 13:33 iR x ~ ~ E hl[i * x ALARM H I STOR`,'' kEF'~SF,'T ----- ~EJVS?:iR ALHRh'1 -- L 1 0 : 91 ANNULAR OTHER ;~iEPJet~kS tiEPJSGk OUT HLARh1 GC'T '? ,' , 20015 I ~~ : 4 9 ~JETUF' Di~Tr~ W~kfVIIV~~ ri~ IF, '~.: UIJ ~;Lf~Rh9 H I ~; I'C+F?`~` kEPCSkT ----° SEJVSOR ;=~LARt°1 ----- L11:~1 FILL ??THER SENSORS SEfVSt_iE' OUT HLAk'I"f O'T 27.3U1J5 13:4! FUEL ALARr1 OCT '?7- 2Uu5 13:46 SETUP ]7ATA WAkNINu r;UG 3. 'aC105 13:33 r it :? ii * E IVLi ~ ~ iE x x r ALARfH H I STvR`r' kEF'OR'I' SEhJ.St)R i;LARri L ] ~ : '3 I TURK I f'•JE =:TI' ;SUMP FUEL ALrRP1 AF'k 10. OOE; 19:4[1 E;EfVw:C_',k c)UT ALHRrI OCT '?7. 20015 13:49 FUEL HL-ARf°I OGT ;:7. 20115 13:.J7 t EhdU x ,- ;, - D I:=:I'Ef'J:=;Ek F'Hrd ~Erl +C+k GUT r';LAkr9 FUEL AL~kr~l :ETUP DATA LJAkrllrJ~_ r•;IJ~": - . 21105 1 ;~; : 3 x ~ x ~ END n ~ . r'';Li lkh! H I STGR'',' kEF'i7kT ----- SEN ;~_}k ALA1~1~9 --- L1rJ:DISF 7-8 DISF'E1V:~ER F'AfV SEIVSGR JU1' AI.HRr9 taC'T '?7. ~~005 13:49 FUEL ALARM SETIJF' DATA WARNING AUG 3. '?005 1:6:33 ALikhJ NIST~=~R.' REPi;R ----- SEIJSC3k ALARM L14:L~I SF' 3-4 DI.SF'ENSER PAM1I SErJSt?P, OUT ALAF,'f°l 0~'T :~7. 2005 1:~ : 49 FUEL ALAkr'I U~~T 27. 2U05 13:'~t SETLIF' DHTA WARI'JI1VG AUK:; 3. 2005 13 : ,:33 ALARrI F' I S 1'~;+R`' RF:F'UkT ----- SEPJ'~~)k ALAI?I'1 - L15:UISF' 5-6 DtSPErd:~Ek AArd~ SENti;i=;k :;LIT fiLrikhl i}i=T 2?. 2005 13:49 FIJEI..ALARr~' ~Jr~T 13: ="7 SET =;kN I N~' ALIc: 13::33 'X ~ * EfVL; ~ f ~ r ALARM H [ ST~;i1:'Y REPGRT -- --- SENSL~R ALtikr1 - TiISPEfJSER PAIV SErISG):` GUT ALARM tiC7' 27 . '2UC15 i ,3:49 FUEL c;LARf°1 f7CT ~7. 'x'005 1;-±:28 SETUP DATA WARNING AUt; 3. 2u05 13:33 :,:. ~4 L18:LiISF' 1i-12 ' DISFErJSEk F'APJ ~ETLIF' DATr I~JARNIhJ~ ticT 11. 2005 y::~ SE'TUF' L}ATA I.JARN I N~_ SErJSUR t}UT ALAkf•1 i~ CiC:T 1 1 , 20Ut 9:'~4 ALAn, Ct>R.` REF'+~t,'`-,'T * n ~ x ~ EfVD .n :~ x ----- SEIVS~JR ALARM -__.__ L2U:DISF 15-lb DISREIVSER F"riN :JEPJS{~R UUT ALARM ,OCT ?7. 2005 1:3:49 FUEL ALARr9 OCT 27. 2005 13:24 SETUF DATA In1ARC'•JI NG AUG 3. 1705 13:3 =~ ALARI°l NI5'Ft1R~' REl?~iRT * '` ~--- -- SE1JSGk ALARI°1 -- LI y:DISF' 1:~-14 L~I:3F'EIVSEk F'AI'J SENSiiR CiUT ALARI"J c;r?T 27. 2UU5 13:49 FUEL. ALARht i+C=T 27, 2005 13:29 . SETUP DATA UJAkNIrdG AUG ;7, 2005 13:33 x ~ ~ ~ +~ ErdU ~ x ~ ~ ri E1VL:~ 10/09/2006 10:09 3103234433 CET PAGE 01105 UhIbERGFtOUNb ST03taGE TANRS ~~~ ~`~ ~~~• . 8 '~ P~9~m~m, 8~141~C5 . ~ . , ~ .- ~/~'~ n+s~tTTn Ave., Ste. 210 ' IRTAI r 90a ~ APPLICATOON .~~ Haket~field, Ch, 93301 TO PERFORM ELD 1 UNETESTING TCL: (661) 325-3939 / SB96B 9fPARY CONTAINMENT TESTING k`~ (661) 852-2171 /FANK TIGKTNE33 TEST ANO TD PERFORM FUEL leQNffD12tNG CEF"RFIGA.TION p~ i pf 1 RSFf~IR NO. ~ ~ ~ . Q ~IANC~ LEAK DE7~CT14N , ~ LINE TESTING ^ SB•889 SECONDARY CQNTAWfYENrTESTING ICI _ nCeTllIrFTRAI _ _ _ _ _ _ _ _ _ ~ TIO FACIL ~a NANE b Pfl~ ~~ $R CF COTITACT PERSON ApDitESS 3'LZO M !~ av~ Q ~tS NAL9E OPERATtlR$19AME PER1AiT TQ OPERATE ND. idU696ER OF TAN $E TESTED I ~ YE3 ~,, ' 7ANKTF57iN©COMPANY NAME~r 71NB GGI~ANY NE `IS~3$R OF CONTAGY PEkS~Q1{ ` ~~~ PN ~,.~ /~ f}/~ p ~ BER OF TEST [I~OR SAEC~L IN9PECTQR CERTIFICATION *~~, ~n G p~yrF 71YE TEST TO 8E CDHD R'T~a ! ~ ~ I v iC :' fl: ~.•~ ~'4 ~ 'IEBT A~TNOD ~C•.• S16NA7URE OF AF'PLJ DATE APPROVED BY ~ DATE FO 2495 (Rev, 44148) by November 22, 2006 Designated Operator Program Bakersfield Fire Dept. Office of Prevention Services 900 Truxton Avenue, Suite 210 Bakersfield, CA 93301 SUBJECT: Change of Designated UST Operator Notification Arco Facility 00583 3220 MING AVE BAKERSFIELD, CA 93304 Dear Sir/Madam: BP West Coast Products LLC 4 Centerpointe Dr. La Palma, CA 90623 USA VIA FEDEX ~~~~ ~~ti~ In accordance with the California Code of Regulations, Title 23, Chapter 16, Section 2715, Subsection (a) where: "The owner shall inform the local agency of any change of designated UST operator(s) no later than 30 days after the change", BP West Coast Products, LLC (BP) is submitting the attached document as notification of a change in the Designated Operator (DO) for the identified facility. The attached notification of change supersedes any similar document previously submitted by BP. It is the intent of BP to minimize the number of changes in DO assignments in the future to ensure consistency in the site-specific inspections and training. BP appreciates the opportunity to make adjustments to this evolving program as we strive to meet the spirit of the regulations and local CUPA requests. Please contact Scott Hartwell with BP West Coast Products, LLC at 714-670-5248, if you have any questions concerning the specific change notification submitted with this cover letter. Sincerely, ~~~ Chris Moul Compliance Manager BP West Coast Products, LLC Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of Compliance with UST Requirements Facility Name: ARCO - 00583 Facility ID #: Facility Address: 3220 MING AVE BAKERSFIELD, CA 93304 Reason for Submitting this Form (Check One) ^ Change of Designated Operator Facility Phone #:661-398-0303 ^ Update Certificate Expiration Date PRIMARY Designated Operator's Name: Andres Rubio Relation to UST Facility (Check One) Business Name (If different from above): Belshire Environmental Services, Inc. ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: (949) 460-5200 ^ Service Technician ^ Third-Party International Code Council Certification #: 5256795-UC Expiration Date: 3/2/2007 ALTERNATE 1 (Optional) Designated Operator's Name: refer to backup document Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: refer to backup document ^ Service Technician ^ Third-Party International Code Council Certification #: refer to backup document Expiration Date: refer to backup document ALTERNATE 2 (Optional) Designated Operator's Name: refer to backup document Relation to UST Facility (Check One) Business Name (If different from above): refer to backup document ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: refer to backup document ^ Service Technician ^ Third-Party International Code Council Certification #: refer to backup document Expiration Date: refer to backup document Designated UST Operator(s) for this Facility I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f). Name of tank Owner (print): Chris Moul Signature of Tank Owner: Date: 11122/06 Owner's Phone # (714) 690-2349 In December 2004, BP West Coast Products, LLC submitted a separate letter to the local agencies documenting compliance with UST regulations. A copy of this letter can be made available upon request. ALTERNATEI Designated Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Council certification #: pending (see attached) Expiration Date: 10/16/2008 ALTERNATE2 Designated ' Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Council Certification #: 5247974-UC Expiration Date: 12/10/2006 ALTERNATE3 Designated Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Council Certification #: 5234433-UC Expiration Date: 07/26/2008 ALTERNATE4 Designated Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Council Certification #: 5295245-UC Expiration Date: 09/19/2008 ALTERNATES Designated Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Council Certification #:5289249-UC Expiration Date: 07/26/08 ALTERNATE6 Designated Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Council Certification #: 5244506-UC Expiration Date: 09/29/2008 ALTERNATE? Designated ., Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Council Certification #: pending (See attached) Expiration Date: lO/12/ZOOH ALTERNATE8 Designated Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Parry International Code Council Certification #: 5252945-UC Expiration Date: O1/28/O7 ALTERNATES Designated Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Council Certification #: 5256795-UC Expiration Date: O3/O2/O7 ALTERNATE 10 Designated Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Council Certification #:5257843-UC Expiration Date: O4/22/O7 ALTERNATE 11 Designated Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Council Certification #: S282O3H-UC Expiration Date: O4/11/O8 ALTERNATE 12 Designated Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Council Certification #: 5275957-UC Expiration Date: O1/2O/O8 ALTERNATE 13 Designated Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Expiration Date: 11/17/08 Council Certification #: 5246896-UC ALTERNATE 14 Designated Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Expiration Date: l l/03/08 Council certification #: pending (see attached) ALTERNATE 15 Designated ' Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Expiration Date: 10/17/08 Council Certification #: pCnding (See attached) ALTERNATE 16 Designated Relation to UST Facility (Check One) Business Name ^ Owner ^ Operator ^ Employee Designated ^ Service Technician ® Third-Party International Code Council Certification #: 5296378-UC Expiration Date: 10/04/08 ALTERNATE 17 Designated Relation to UST Facility (Check One) Business Name Owner ^ Operator Employee Designated ^ Service Technician ® Third-Party International Code Expiration Date: 10/10/08 council certification #: pending (see attached) ALTERNATE 18 Designated Relation to UST Facility (Check One) Operator's Name: Business Name ^ Owner ^ Operator ^ Employee (If different from above): Designated ^ Service Technician ® Third-Party Operator's Phone #: International Code Expiration Date: Council Certification #: °=Y c:o~tlr~r~ ~sr Cc~~~ter Test I~p~r Tnternatzonal (:ode Counci.2. Computer Exam Repgrt BATE: 20/16./2006 EXAM TITLE: CA t7nde.rground Storage Taak System Operator •- i7C (CUO) NAME: YEOMP.N, REID LOC.A.TOR: YEK~;0035 EXAMINATION RESULT: PASS Cangxatulationst You have passed the S>A Underground Storage Tank System operator - UC (CUO) Your ICC certificate and wallet. card will be mailed .to you within.six.weeks after the end of the month in which you passed the exam., Your name as it appears above on this notice wi.l.l be painted on ,your certificate and wa .l.et card. It is very impoatant that you ;::stiff LaserGsade and ICC of any changes in your name and/or address.. ICC requires a change of address in writing. Flease fax your change of address to iCC at (562) 692•-2845 cr mail .it tc: ICC Certification. Services 5360 Workman Mill Rcad DC1 NQ~`~~~~ 1~~l1~~'E~C38RT Sincerely, LaserGrade I;aserGrade.Camputer Testing P (? ~oX 87245 tiancoixve~, WA..98687_-•`7245 800-211=-2?54 or 360~~896'-9111 www.LaSergrade...cam Applicant LpGator: Y~KOQ035 Testing provided by: LAS92I03 San Diego Flight Training 8795 Aero Dx.ve,. Suite 103 San Diego., CA 92123 858-569-1.82.2 i8~~-lid ,, ~~~~ COiWPL17"~i'd ~`E3TlNla'- Computer Test Report International Code Council Computer Exam Report DATE: 10/17(2006 EXAM TITLE: CA ~7ndexground Storage Tank System Operator - UC (CUO) NAME: NGI7YEN, BOBBY LOCATOR: NGK02069 EXAMINATION RESULT: PASS Congratu.Lations! You have passed the CA Underground Storage Tank System Operator - UC ICUO) Your ICC certificate and wallet card will. be mailed to you within six weeks after the end of the month in which you passed the exam. Your name as it appears above on this notice wi71 be printed on your certificate and wallet card. It is very important that you notify LaserGrade and ICC of any changes in your name and/or address. ICC requires a ~hanq~ of address in wri.tinq. Please fax your change of address to ICC at (562) 692-2845 or mail it to: ICC CertiPical'ion services 5360 Workman Mill Road DO N~7~'~tC~~~ T~~1S ~i~~~~QeR7 Sincerely, LaserGrade Applicant Locator; NGK02069 LaserGrade Computer Testing Testing provided by: LAS95803 P D BpX 87245 Sky Walk, Inc. Vancouver, WA 98687•-7245 6151 Freeport Blvd. Suite 158 800-211-2"154 ox 360-896-917.1 Sacramento, CA 95822 wraw.lasergxade.tom 916-391-1957 -.J ~ R~. r......w Jnn.n.. ..n ...~~ (~ 4 6 y I Wd 90~80~£ eooZ/vl/4L :a3~0 zra :abed ~ ~8816E9£9L8 :WO13 ~~ww~~, car~,~rr,~,+~ r~~rmica Computer Test Report International Code Council Computer Exam Report DATE: 10/10/2006 EXAM TITLE: CA Underground Storage Tank System Operator - UC (CUO) NAME: CARNE, DANYEL LOCATOR; CAK02422 EXAMINATION RESULT: PASS Congratulations! You have passed the CA Underground Storage Tank System Operator - UC (CUO) Your ICC certificate and wallet card will be mailed to you within six weeks after the end of the month in which you passed the exam.. Your name as it appears above on this notice will be printed on your certificate and wallet card. It is very important that you notify LaserGrade and ICC of any changes in your name and/or address.. ICC requires a change of address in writing,. Please fax your change of address to ICC at (562) 692-2845 or mail it to: ICC Certification Services 5360 Workman Mill Road DO NOT L~Se~ 1~~IIS 6F~E~~RT Sincerely, LaserGrade ~~~2~ LaserGrade Computer Testing P O Box 87245 Vancouver, WA 98687-7245 800-211-2754 or .360-896-9111 www..lasergrade.com Applicant Locator: CAK02422 Testing provided by: LAS90801 Long Beach Flying Club 2631 E. Spring St. Long Beach, CA 90806-2218 562-290-0321 ,- ~~~ ~a~err~t aoae~ur~ r~srfnrca Computer Test Report Inte=national Code Council. Computer Exam Report RATE: 10/12/2006 EXAM TITLE: CA Underground Storage Tank System Operator - UC (CUO) NAME: WOLF, JAMES THOMAS LOCATOR: WOK00869 EXAMINATION RESULT: PASS Congratulations! You have passed the CA Underground Storage Tank System Operator - UC (CUO) Your ICC certificate and wallet card will be mailed to you within six weeks after the end of the month in which you passed the exam„ Your name as it appears above on this notice will be printed on your certificate and wallet card.. It is very important that you notify Lasei-Grade and ICC of any changes in your name and/or address.. ICC requites a change of address in writing. Please fax your change of address to ICC at (562) 692-2845 or mail it to: ICC Certification Services 5360 Workman Mill Road DO N O~~t(~~~ ~{~ I~ 6F~'E~~BRT Sincerely, LaserGrade Applicant Locator: WUK00869 LaserGrade Computer Testing Testing provided by: LAS94602 P 0 Box 87245 Sequoia Institute-Sierra Campus Vancouver, WA 98687-7245 8291 Earhart Road Hangar 6 80D-211-2754 or 360-896-9111 Oakland, CA 94621 ~~ '30.6 www.lasergrade.com 510-638-1973 := ~~~~~~ GOMPUTE/4 TEST//VC3 Computer Test Report International Code Council Computer Exam Report DATE: 11/03/2006 EXAM TITLE: CA Underground Storage Tank System Operator - UC (CUO) NAME: MACIAS, JOSHUA LOCATOR: MAK03669 EXAMINATION RESULT: PASS Congratulations! You have passed the CA Underground Storage Tank System Operator - UC (CUO) Your ICC certificate and wallet card will be mailed to you within six weeks after the end of the month in which you passed the exam. Your name as it appears above on this notice will be printed on your certificate and wallet card.. It is very important that you notify LaserGrade and ICC of any changes in your name and/or address. ICC requires a change of address in writing.. Please fax your change of address to ICC at (562) 692-2845 or mail it to: ICC Certification Services 5360 Workman Mill Road DO NO~~tC~S~~ ~~I~~~I~~gRT Sincerely, LaserGrade Applicant Locator: MAK03669 LaserGrade Computer Testing Testing provided by: LAS92601 P O Box 67245 Helistream, Inc Vancouver, WA 98687-7245 3000 Airway Ave, Suite 350 800-211-2754 or 360-896-9111 Costa Mesa, CA 92626 `~~~~ ~ www.lasexgrade..com 714-662-3163 i RightFax 12!27!2005 9:18 PAGE 002/006 Fax Server "~ ~~ ~~~ ~~~ I 1 ~~~ t1NDERGROUt~ ST~tA(~E TANlt ;~. :-;~ * .~t~~-~. Prevention Sesv~ees ~~~' ~~~C~~~N _, ~ 900 Trwctun Ave., Ste. 210 TOCONSTRUCT-INSTALL NEW TANK (NEW FACIL(T1~ ! w *~ Bakersfield, CA 93301 NEW TANK INSTALLATION (EXiSTIN(~ FACILITY) / ~ Tel.: 1661) 326-3979 MODIFICATION ~ a IrNOR MODIFlCAT~i ' FAC/LlfY ~~ ~ Fax: (661) 852-2171 PERMR' N0. it n„ t.,..~' O ~~,~~ P~g~ 1 d 1 TYPE OF APPLICAT'10N: ^ NEW TANK INSTALL f NEW FACILRY O NEW'FANK INSTALLATION !EXISTING FAgLITY ,..._.... ___ ,.__ __,... ., ...,~~.-,-~.,~ cwru rrv ~.~-~ii~w unn~c~srvn~r nc Fecn m ARTiI~ HATE ~C L~03 ~ coMw.t=rooi+n~~ ' Z 3,6 3 ACK.li1' NAIh~ w ~ cam. FAC1lRY PERMT NO• ACILRY ACORE38 P CODE ~ tiUSMESS R ANK pYYNER OO '~ ~C ~~ P~-~~ L a CODE Q G~ Z "L ~ ~T~r ~ .. ~ rw . lK'N0. GC NO. T~-.gyn. ~ ~ ~ -, ss ~~-s=~s7~ a I c.o ~ ~..r...~ ~ ~~ NO. - CRY @U&NES9~U~1.9E NO: COMP NO. NSURQi _ to Cv 34-z-'~'= ~ So -. ~z~"'~o S~ \r^owa~iaE THE wear TO 6E oar ~''~ ~ -C` ` ~~ C ~~ I } . ~ ` r / , , ~~~~~~ ~ ~ i F- co~.~ L~,~.~-~'~ TCt~ my Gz. ~-= ~ L~:L. L~ 4~L.~tG f ~ ~ r ., - - - - - - WJITER TO fACILRIf PRW WEO BV TO SOtI TYPE EXPECTED AT s-TE N0. OF TANKS TO tiE INSTALLED pRE Tt4EY FORldOTOR FUEL O ^ SPlll PREUFNTWN CONTROL AND COUNTER MEASURES PIMI ON FLE O O vES No vES No TINS BECTlDN M fait MOTOR F{!EL TANK NO. tUM SEl. T10t1 ' "Z 1O ~C ? 3 0 ~. . .`+ to ~ X 4 ('.. TiQ6 sectai- is fort NaN MoTnit fuEY. srotuet=_ •~NKs TANKNU. y~A170N ThC applic~f has rcottveal, totde-sem+dx o~cd will congrly with d~¢ atrachedtondiRorn of die permit and ony other sto>e. local andferterer! rsgwlatiwu 7~risfo>m been ~Ided tmaEi prmally ~OpJ+ifY tmd w th best of my Aveowh:dga, is dne aisd c~rr+eex APPR01f®8'I: APAUC/Wl' NAME (PRRm APPLICANT S1GNwTURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FDZ488 pw..agn UNDERGROUND STORAGE TANK ~ Bakers$eld Fire Dept. ~~ Environmental Service PERMIT APPLICATION TO ~ s 8 ~ e r I n 90o Truxtun Ave., ste. 210 f,IB/ Bakersfield, CA 93301 CONSTRUCT /MODIFY /MINOR ~R>r~ r MODIFICATION OF AN UST ~~y Tel: (661)326-3979 j~~~ Fax:~(6/6/1~)~852-2171 PERMIT NO. i Y I ~.~ -~!~ 3~ O~//~ ~ ~/ ~ ~~~~G~~ C/ Page 1 of 1 TYPE OF APPLICATION: (Check one item only) ' ^ NEW FACILITY ^ NEW TANK INSTALLATION AT EXISTING FACILITY n MADIFICOTIAN OF FOCII ITY n MINOR MODIFICATION OF FACILITY TARTING DATE PROPOSED COMPLETION DATE AGILITY NAM~~~ !STING FACILITY PERMIT NO. FACILITY ADD+R~ESS ~ ITY ~~ la~~~. IP CODE ~~/ ~~~v PE F BUSINESS s / /O./` PN # ANK O R L/~ ,~ Ol % ' ~„y HONE NO DDRESS ~~ ~~ ITY// IP CODE ONTRA TOR ~i ~i~~,~ ~ A LICENSE NO. ~G%~`3 ICC N0. z~~si~ ~-~~ DDRESS ITY J IP CODE PHONE NO. q --~ BAKERSFIELD CITY BUSINESS LICENSE NO. ORKMANS COMP NO. ~ ~ -- .sue INSU R `~-~~ BRIEFLY DESCRIBE THE WORK TO BE DONE , --~- WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO.OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL ^ YES ^ NO SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ^ YES ^ NO THIS SECTION IS FOR MOTOR FUEL TANK NO. OLUME UNLEADED REGULAR REMIUM DIESEL VIATION 'HIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. OLUME UNLEADED REGULAR PREMIUM DIESEL VIATION The applic t has received, u rstands, and will comply with the attached conditions of the permit and any other state, local regulatio . f77iis fo ben completed under penalty of perjury, and to y wled , is true and correct. APPROVED BY: APPLICANT NAME (PRI ) THIS APPLICATION BECOMES A PERMIT WHEN APPROVED SAX f3Ack 9~5- ~~a_s'Z~o A~'~/ 0 n _ _~ ~ / BELSNtRE =~ ~!( ENVIRONMENTAL Scope of Work SERVICES, 1N6: Facility: BP 00583 Date: 8/11/2005 Job Number: 2625 3220 MING AVE BAKERSFIELD, CA Estimate No: 247 Contact: Rick Kinnaman Repair Location: Dispenser'.- Various Work o be performetl: Investigate!to findcreakspossible have to remove dispensersto install bluline,repair penetaations or bravo;repair with vulkum on all 8..dispensers Repair;Location: Fill Sump - 87 Slave VNork to be performed: Replace 87 stave fill and vapor bucket like for like 'Repair Location: Piping - 87 Work to be performed: Helium test to find leak in 87 secondary piping possible have to fix bravo nut or break ;ground and repair some piping Repair Location: Turbine Surnps ~ Various Work to be performed: Investigate'to find`-leaks possible fiberglass sump to collars or instal blueline :..penetrations as needed in the 91,$9,and 87main turbinesumps' i . 4J 9Z65::~ ~;~t~' SB1266.8 6.8 6.8 9.75 2.25 SB1286.8X6.0 6.8 6.8 9.75 2.25 SI6.8X6.0 SB12B6.8X5.2 6.8 6.8 9.75 2.25 S16.8X5.2 S81266,8X5.0 6.8 6.8 9.75 2.25 SI6.8X5.0 S61266.SX4.6 4.6 6.8 9.75 2.25 3.63 S81286.8X3.9 6.8 6.8 9.75 2.25 SI6.SX5.0, SI5.OX3.9 S612B6.8X3.5 4.6 6.8 9.75 2.25 3.63 S14.5X3.5 S812B6.8X2.7 4.6 6.8 9.75 2.25 3.63 S14.SX3.5, SI3.5X2.7 SB1266.SX2.5 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.SX2.5 SB12B6.8X2.25 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, S13.5X2.25 SB12B6.8X2.0 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X2.0 S61286.8X1.9 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X2.5, SI2.aX1.9 S812B6.SX1.8 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, S13.5X1.8 SB12B6.8X1.4 4.6 6.8 9.75 2.25 3.63 S14.5X3.5, SI3.5X1.4 SB12B6.8X1.0 4.6 6.8 9.75 2.25 3.63 SIa.5X3.5, SI3.sXi.a, SIi.3xi.o 581266.8X.84 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X1.4, SI1.3X.84 L~_- ~ ,n ~r _ sue- - P ® E.G ~ I SB Pellethane Series ® - ~ L 10 Stud Single Sided c -~. S81083.7 3.7 4.8 8.38 1.63 4.1 SB1084.8 4.8 4.8 8.38 1.5 SB1064.8X3.5 4.8 4.8 8.38 1.5 _ S610B4.SX2.7 2.7 4.8 8.38 1.5 2.94 '_ SB10B4.BX2.5 4.8 4.8 8.38 1.5 SI3.5X2.5 SB1084.8X2.25 4.8 4.8 8.38 1.5 SI3.5X2.25 SB1064.8X2.0 2.0 4.8 8.38 1.5 2.94 S81084.SX1.9 2.7 4.8 8.38 1.5 2.94 Sf3.5X2.5, SI2.4X1.9 S81084.8X1.8 2.7 4.8 8.38 1.5 2.94 SI2.6X1.8 SB1084.8X1.4 2.7 4.8 8.38 1.5 2.94 SI3.5X2.5, Si2,4X1.4 SB10B4.SX1.0 2.7 4.8 8.38 1.5 2.94 SI3.5X1.4, SI7.4X1.0 S81084.8X.84 2.7 4.8 8.38 1.5 2.94 SI3.5X1.4, SI1,4X.84 SB Pellethane Series O 12 Stud Single Sided The SB SERIES Split Repair Boots are designed to enable repairs s to be performed entirety inside the sump. They can either use the ~ I n I s existing studs from previously installed leaking penetrations or they p can completely overlay the entire old fitting. Constructed of fuel and water resistant PellethaneO, once installed the boots are filled ~ ~ with Bostik 1100FS to help form a impenetrable barrier to water. All band clamps, tech screws, and fill tubes are included. Ut SB Pellethane Series O 4 Stud Single Sided ~J SB Pellethane Series O 8 Stud Single Sided S8861.9 1.9 1.9 6.63 2.0 3.56 56861.9X1.4 1.4 1.9 6.63 2.0 3.56 SBBB1.9X7.0 1.4 1.9 6.63 2.0 3.56 SI1.3X7.0 S6661.9X.84 1.4 1.9 6.63 2.0 3.56 SI7.3X.84 SB862.7 2.7 2.7 6.63 1.75 3.56 S6882.7X2.4 2.4 2.7 6.63 1.75 3.56 SBBB2.7X2.0 2.4 2.7 6.63 1.75 3.56 SI2.4X2.0 SB882.7X1.9 2.4 2.7 6.63 1.75 3.56 SI2.4X1.9 S8882.7X1.8 2.4 2.7 6.63 1.75 3.56 SI2.4X1.8 SBBB2.7X1.4 2.4 2.7 6.63 1.75 3.56 S12.4X1.4 S68B2.7X1.0 2.4 2.7 6.63 1.75 3.56 S12.4X1.4, SI1.3X1.0 SB882.7X.84 2.4 2.7 6.63 1.75 3.56 SI2.4X1.4, S11.3X.84 SBBB3.7 3.7 3.7 6.63 2.0 3.56 - 56883.7X2.7 3.7 3.7 6.63 2.0 3.56 SI3.5X2.7 S8863.7X2.5 3.7 3.7 6.63 2.0 3.56 SI3.5X2.5 S88B3.7X2.25 3.7 3.7 6.63 2.0 3.56 SI3.SX2.25 S8883.7X2.0 3.7 3.7 6.63 2.0 3.56 SI3.5X2.0 SBSB3,7X1.9 3.7 3.7 6.63 2.0 3.56 S13.SX2.5, S12.4X1.9 S6883.7X7.8 3.7 3.7 6.63 2.0 3,56 S13.SX7.8 56863.7X1.4 3.7 3.7 6.63 2.0 3.56 SI3.5X1.4 SB863.7X1.0 3.7 3.7 6.63 2.0 3.56 SI3.5X1.4, SI1.3X1.0 SBBB3.7X.84 3.7 3.7 6.63 2.0 3.56 S13.5X7.4, SI1.3X.84 _ -= BELS/~/RE `_~ ~ = ENVIRONMENTAL i Ar ~~'= = SERVICES, INC. Site Niap Location Name: Date: - ,~B ~ BESI#: ~- ~~ Address: o ~ ~ Cross Street: ~~ ~~ ~ City: 5 s State• Scope: 'YIIN7 r~ rS I~ [~ w 6 ~~ ~ ,~~ __ ~ S~ '~ O~C~~ C~ C~ O ~, rev. 10/15/03 . ~ ... §; ' ', ~ r' ' •t"., . 6 ' t , ~ ~'~ n ~ I I ~ ,9 4 I:~ " , ~ i ' ~ '• ~ 4 • , • '.' .\", I. • •, ' • ,.. '~~ ,~ • . • .• .. , t M", • •; ,' ~ State CK CallEorn4a 111 .'J (~.~,~~;,~ CONTRACTORS STATE LICENSE BOARD , ~~( i -~ ~9.~^~"" ACTIVE LICENSE , ', ' ~ ~ ,.' Conmmor ~ AHdn ~ ~ ...-~`;";~ , ' ~ w«,,.w~., 808313 ~~., CORP ',, ' ''""'~~ w,a.,,wa. BELSHIRE ENVIRONMENTAL •. •5 • ,~• '". SERVICES INC ~ ,' ' • ' . .u«t,t A HAZ .. ', ~ .' ~ ' • ~,~.'..o"~ 05/31/2006 i . , , . 1 . t, ~ ~ • •• t.1 1' ;~ :~ v} i COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUNIErif WITH RESPECT TO WIi1CH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE PSURANCE AFFORDED HY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POL1C(ES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAGIAS. INSR ~ pPOgJTE EFFBCyTVE DATE ~MlDI one ~~ LTR TYPE OF NISURANCE POIIGIf NUMBER GENERALLIABIUTY EACHOCCURREIJCE S 1,000,00 X coc~TCwLGENERAL Lu~aam 916038-03 06/14/2005 06/14/2006 FIRE oAMAGe (Any «,~ r~re> s 100, 000 cLAUns MADE XQ occuR MED E7CP (Any one ~a,l s 5 ~ 0 A PERSONAL i ADV WJURY S 1 OOO, 0 GENERAL AGGREGATE f 1,000,0 GENIAGGREr;ATEUMTTAPPUESPEft PRODUCTS-COMPlOPAGG S I,OOO,OO POU(.Y ,jELo-T LOC AUTOCHOBfLE LJA81LJiY X aurAUro 916042-03 06/14/2005 06/14/2006 i ~~ r~ F LIF~pT s 1.000,00 ALL OWNED AUTOS ' BODILYWJVRY A SCHEDULEp AUTOS (Pot pxsvtQ f X HIRED Auros BOp0.Y B'I.NRY X NON-OV1RdED AUTOS (P0t I S PROPERTY DAMAGE (Pe[ aoade~t) f GARAGE LV161LITY AUTO ONLY-EA ACCIDENT i ANY AUTO OTHER 71-IFNV EA ACC S AUTO ONLY' AGG S ExcESS LAABIUTY EACH ocwRRENCE s 5 , 000 000 X occuR ~ CIAIMSNIADE EO 5337678-O1 •06/14/2005 06/14/2006 AGCREC,aTE s 5.000,0 B s DEDUCIBLE S ' RETENTION S S WORKEliS COMPENSATIOII AND ~ TORY LIMITS 3~. Elt EJNPLOYERS LLl6dITY - EL EACH ACCtDENi S EL DISEASE _ EA EMPL S EL DISEASE -POLICY LIMIT S B ontractors Pollution Liability 916039-03 06/14/2005 06/i4/2006 $1,000,000 Limit DESCRIPTION OF OpERq]1QH$1LO~ATIOI~Sf VESi1CLE5lE1CGLUSIONS ADTbED BY ENDORSEME_PP.:TJSPECIAL PR01f4SIDN5 : _. RE: Proof Evidence Only ' ~l0 day notice of cancellation in the event of non-payment of preatium. CERTIFICATE HOLDER /WDTnONAL INSURED;INSURER L --- =Proof/Evidence Only'**==~=' ACORD 25S (7197) - - ~R V ®~~ty - a! ~ ~~ ~ ^ ~ ~6~ ^ L.~ ~ ! ~ ~~'H H,d ~ @,.s II ~ i ®~ C~ B 'M ~ S-.~ DATE (61N,fDD/yyj 05/16/2005 PRODUCER (949) g57-4500 FAX (94g) 857-4800 Millennium Risk Manag~ltent & Insurance Services Li tense II: OQ3480 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE (iOLDEIL THIS CERTIFICATE DOES NOTAMEND, EXTEAID OR ALTER 7HE COVERAGE AFFORDED t3Y THE POLICIES BELOW. 5530 Trabuco Road _ Irvine, CA 92520 • INSURERS AFFORDING COVERAGE 1NSURED BeTshire Environmental Services. Inc.. INSURER A; Zurich American ~~ 25971 Towne Centre Drive INSURERS: Steadfast Insurance Foothill Ranch, CA 92610 INSURERc wsttRER o- ' WSURER E ~ cANCELLAnoN SHO[Il.D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUB'!G GOMPANYNNI ENDEAVOR TO MAIL PAYS YVRTTTEM NOTICE TD THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE 70 MAIL SUCH NOTICE SHALL IMPOSE NO 06LK'AT~N AR LIAHlLITY OF ANY KRVD UPON THE COMPA AGENTS OR REPRESENTATNES AUTHORRID REPRESENTA - --- - _ _ O RD CORPO ION 1988 . tiffs ;~.. 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"~diftva i'irt,~' ne}sy4d'ti.)~+,'[~'7,'~A.yry'.y~p:,':i_.~/~ ~:~;s~P. ~aj;,,.., 'irk •rr•' n .C.::'''r , ~i%.._' -a4::>':•.~^::: M i r'"iT~.. ~ w! i $^. ~ •r{: ,•r,~y~: PniS.tr m. I i !:5::•^x'.% •'.. e y- .:~: ,yy 'i~w!• b~•~+f:i'!L:ra.e:- ;~'~<: •., .~Y'...~r~ . ~.,~ ,.a<'~~ °^,::w•::rx • ,Y~',,'• n ?"t'!r''b'~r~ ~~•„C0. ~:"..;..' ',~3i:r~!. `.?:(p .fi. 1• 'Y4ititx"1`v!t~ ~G145"~' !`~`THrr?~t •~7r4~~~'''~~~T fi ...~;Ttih .. ,,p'Q.•`~ ``'0:,~ .`,~S' .. As4vk 1,y 4' •~. 4 -'r~i h.: \' .~;r ~ .O.:.r ~~~~'" ~f~ ~.{{t,`/+ CHtir.•`;~1tl•vr !."~'~/5~k'.v'4'tt'M,i' ,~ ~..'~': J~7q'7{~' ~;,r•r xP Pn y~' ,,~r~..{CJ.~~~•'.:%V o!f.~!, 'Q:. .; ry~'r, i .~ •~~•~-(..~'. f:f~''~.r~j,' r'} ZP^l"h.!A'.O~O,q•a ~.~'.~,.. _ f f~.:~ .. .,y Q •4.. r''. .~ h~ ]~ ; ^af:" P5'd~'P~.~~~•,-~rq,~~3y~,~~~"bk'."'~44rq i +:! 9'~'':1'',Y;; ~.{~}~~>-`' ; " ~•p'~r!`"~; .11',~,.,~,.,,. M nCi'~;0.+y.~.~2 :,i~lt~:'~.•, l' +,y,/'! .. ''JC.:. ~`"'tu^•^... .. •n'. . ~'•~`~;r1rrPdn1 ` y,,e~,'~. r~tih.,1~(~~ ,:' .~;~ ' ;,": ..'.J'.+'M"'4:. ~,~;c,. ~' .~«h'r~ {. .rr'1' Yq~~}U~7(f~,~~,jy~w••~~'ryN~~ Y.':.. :''. n:'x..:. "C.". ..;~.. .M; „m> of~, +. •, .tr~„ ..r•.*;.• , °~n~`^ r. ~ y ..,,'~,~,1ik'r~~"^..W,h,t~~~.; • ^°!~ir •;~ ~ ,~ i~y,.y`.`',r,. fb :'t!h'',v .{ryl"/i7~, ~r ~•.~Ji~l~rtQV r _ x.~ .•. } ~. .~~?.,•4. ff~~1w 1}•1,({ Aid 1 p rf• - .1+.. In kof!'t': ~~,. i~ ~.j. •n7~p:+Jp ,r„ .. vE:::,L"-~I.r~~ : ,.. i -~ ~rt~r . J'r ~} n•~,4.,_ :'v:.^. "~' `y-fir., ..a.. .. °=., ,..,: _ ~ / BEISH/RE' _ l fNVIRUNMENTAL '~ SERVICES, lNC. Scope of Work Facility: BP 00583 Date: 8/11/2005 Job Number: 2625 3220 MING AVE BAKERSFIELD, CA Estimate No: 247 Contact: Rick Kinnaman Repair. Location: Dispenser.- Various Work to be performed: Investigate o find creaks possible have to remove dispensers'to install blulhe repair penetartions or-bravo,,repair with vulkum'on all 8 dispensers Repair Location: Fill Sump - 87 Slave Work to be performed: Replace 87 slave fill and vapor bucket like far ike Repair Location: Piping - 87 Work to be performed: Helium test to find leak in 87 secondary,piping possible have to fix bravo nut or break ground and repair some piping Repair Location: Turbine Sumps -Various Work to be performed: Investigate to find'deaks possible fiberglass sump to collars ar instal blueline penetrations as needed in the 91,89,and 87mainturbine sumps ® • SB1063.7 3.7 4.8 8.38 1.63 4.1 SB1084.8 4.8 4.8 8.38 1.5 SB1084.8X3.5 4.8 4.8 8.38 1.5 SB10B4.8X2.7 2.7 4.8 8.38 1.5 2.94 S810B4.8X2.5 4.8 4.8 8.38 1.5 SI3.SX2.5 SB10B4.8X2.25 4.8 4.8 8.38 1.5 SI3.5X2.25 SB10B4.8X2.0 2.0 4.8 8.38 1.5 2.94 SB10B4.8X1.9 2.7 4.8 8.38 1.5 2.94 SI3.5X2.5, SI2.4X1.9 S610B4.8X1.8 2.7 4.8 8.38 1.5 2.94 SI2.6Xi.8 SB1064.8X1.4 2.7 4.8 8.38 1.5 2.94 SI3.5X2.5, S12.4X1.4 SB10B4.8X1.0 2.7 4.8 8.38 1.5 2.94 SI3.5X1.4, SI1.4X1.0 SB10B4.8X_84 2.7 4.8 8.38 1.5 2.94 SI3.5X1.4, SI1.4X.84 SB Pellethane Series 12 Stud Single Sided S812B6.8 6.8 6.8 9.75 2.25 SB1266.8X6.0 6.8 6.8 9.75 2.25 SI6.8X6.0 SB1266.BX5.2 6.8 6.8 9.75 2.25 SI6.8X5.2 SB1266.8X5.0 6.8 6.8 9.75 2.25 SI6.8X5.0 SB1266.8X4.6 4.6 6.8 9.75 2.25 3.63 SB1266.8X3.9 ' 6.8 6.8 9.75 2.25 SI6.SX5.0, SIS.OX3.9 S812B6.8X3.5 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5 SB12B6.8X2.7 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X2.7 SB1266.8X2.5 4.6 6.8 9.75 225 3.63 SI4.5X3.5, SI3.SX2.5 SB12B6.8X2.25 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X2.25 SB7266.SX2.0 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X2.0 S612B6.8X1.9 4.6 6.8 9.75 225 3.63 SIa.5X3.5, SI3.5X2.5, SI2.axt.s SB12B6.8X1.8 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X1.8 S81266.8X1.4 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X1.4 SB1286.8X1.0 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.SXt.4, Sit.3xt.o S612B6.SX.84 4.6 6.8 9.75 2.25 3.63 Sia.5x3.5, SI3.SX1.a, SI1.3X.84 9765 ±__ __ The SB SERIES Split Repair Boots are designed to enable repairs e to be performed entirely inside the sump. They can either use the e I n 1 existing studs from previously installed leaking penetrations or they o t can completely overlay the entire old fitting. Constructed of fuel and water resistant PellethaneC~, once installed the boots are filled ~ I with Bostik 1100FS to help form a impenetrable barrier to water. All band clamps, tech screws, and fill tubes are included. U~ SB Pellethane Series 4 Stud Single Sided SB Pellethane Series 8 Stud Single Sided S8867.9 1.9 1.9 6.63 2.0 3.56 S6881.9X7.4 1.4 7.9 6.63 2.0 3.56 S6881.9X1.0 7.4 7.9 6.63 2.0 3.56 SI1.3X1.0 SB861.9X.84 1.4 1.9 6.63 2.0 3.56 SI1.3X.84 SB8B2.7 2.7 2.7 6.63 1.75 3.56 SB882.7X2.4 2.4 2.7 6.63 1.75 3.56 SBBB2.7X2.0 2.4 2.7 6.63 1.75 3.56 SI2.4X2.0 S68B2.7X1.9 2.4 2.7 6.63 1.75 3.56 S12.4Xi.9 S6882.7X1.8 2.4 2.7 6.63 1.75 3.56 SI2.4X1.8 SB8B2.7X7.4 2.4 2.7 6.63 1.75 3.56 SI2.4X1.4 S88B2.7X1.0 2.4 2.7 6.63 1.75 3.56 SI2.4X7.4, SI1.3X1.0 SB882.7X.84 2.4 2.7 6.63 1.75 3.56 SI2.4X1.4, SI1.3X.84 SB863.7 3.7 3.7 6.63 2.0 3.56 S6863,7X2.7 3.7 3.7 6.63 2.0 3.56 S13.SX2.7 S8883.7X2.5 3.7 3.7 6.63 2.0 3.56 SI3.SX2.5 SBBB3.7X2.25 3.7 3.7 6.63 2.0 3.56 SI3.SX2.25 S8883.7X2.0 3.7 3.7 6.63 2.0 3.56 SI3,5X2.0 S8663.7X1.9 3.7 3.7 6.63 2.0 3.56 SI3.SX2.5, SI2.4X7.9 S8863.7X7.8 3.7 3.7 6.63 2.0 3.56 S13.SX7.8 SB863.7Xt.4 3.7 3.7 6.63 2.0 3.56 SI3.5X1.4 S8863.7X7.0 3.7 3.7 6.63 2.0 3.56 SI3.5X1.4, SI1.3X7.0 SB863.7X.84 3.7 3.7 6.63 2.0 3.56 SI3.5X7.4, SI1.3X.84 = BEL~f~/RE `_ _~ ~_ ~ ENVIRONMENTAL ~~'~~= SERV/CES, INC. Site Map Location Name: Date: - .~p~ BESI#: G-~~ Address:. o ~~ ~ Cross Street: wt ~~ ,~ City: s s State: Scope: ~IN% d ~~ L ~l~j ~ - • ~ ~~ ~~ ~~~C~ O C~ O rev. 10/15/03 ' , . • I , I ~~' ? ,• t • ' , Iii' I I t ,., , ~ • i. { . i ' . ~` .. . i ' , ~ ' ` ' '. . ~ • ~ Stale Of California I • ~, M`~• • (a,~~CONTRACTORS STATE LICENSE BOARD ~;~( ~ ,,•' Comumrr ACTIVE LICENSE ~ ' Atkin • . ' ' I •^"''~ W~~.wrwi 808313 c~.r CORP h~M~w W n,~ ~ ''•~ ~~ BELSHIRE ENVIRONMENTAL ,.• "f' ~ SERVICES INC , ~~ . ~• • 1 ~ ~ ~*~~~~~°^~ 05/31/2006 ~, , ,. . ' ~ .. . ll J I• . • • ' . , t ~ ~ I .n ,.4 li I ' i ~, ' ' •' • 4 ~I 9 ~ . . • ~ it • . ' i i ' i, j ' t i • J i ~ 'I • ' • i~ , ti .. , • •' , j ~ '. ~! ~i • ~ ~~ i ; ; COVERAGES i i i P,CO~?D ~ ~~D~~Di DVi'~~f~. V1 ~D~-D~IPsII ^ i DD~~~1~66~~~ DATE(M-yi/DD/Yy) o6/is/zoos PRODUCER (949) 857-4500 FAX (949) 857-4800 Millennium Risk Management & Insurance Services Li tense ~ OC13480 7titS CERTIFICATE IS ISSUED AS A l1AATTER OF INFORMAT1pN ONLYAND CONFERS NO Rl6tifS UPON THE CERTIFICATE HOLDER TtItS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOyy_ 5530 Trabuca Road Irvine, CA 92620 - INSURERS AFFORDING COVERAGE INSURED Be7shire Environmental Services, Inc. INSURmA: Zurich American ~- 25971 Towne Centre Drive INSUReR6: Steadfast Insurance Foothill Ranch, CA 92610 INSURER C: asuRFR o: wsLmER E: THE POUGES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE MSURED NAMED ABOVE FOR THE POL]CY PERIOD INDICATED. NOTWRIiSTANDING ANY REQU1RDUtENT, TERM OR CONDITION O~ ANY CONTRACTOR OTHER DOCUMENT VNTH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE PSURANCE AFFORDED QY THE POUGES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. eNSx ~ ~TE ~cTrvE ~AiE new /D n~ I.ne(Ts LTR tYPEOFWSURANCE POIIGYNUMBER GENERALLY161UTY EACH OCCURRENCE S 1,DOO,DO X coasae~clA~cENERA~LfAaaM 916038-03 06/14/2005 06/14/2006 TIREOAFLAGE(Myonefue) s 100,000 cLAUns Nu+DE X~ occuR MED E7~ (MIr aye r~+l s 5.000 q PEJtSONAL c Aov WJURY s 1 000, 000 GEtiERALnccttEGATE s 1,000,0 GEN7_AGGPEfaATELBdITAPPUESPER- PRODUCTS-COMPJOPAGG S I,000,OO POLJCY ,~~ LOC AUTOMOBILE LIA9AM X ANYAL?O 916042-03 06/14/2005 06/14/2006 COMBIN®SINC~E LM~tl T (Ea;11 s 1 OOD~ ALL OYVNED AUTOS ~ BODILY INJURY A SCIlEDULEP RUTOS (Pa Pa~~ f X HIRED AUTOS BOp0.Y WJURY X Nov-owrt~ auros IP°~ e~°'`I f PROPERTY DADAAGE (Pei aaade~dl f GARAGE lW61U'fY ~ ~ AUTO ONLY-EA ACCIDE3~T7 E • A~'^~O oTHERTHAN EA nee s AUTO ONLY_ AGG S ExcESS L.waurY EACrI ocamRFJacE s 5.000 000 X occuR ~ ctAC~nsuinDE EO 5337678-O1 •06/14/2005 06/14/Z006 AGGREGATE f 5.000,0 B s DEOUCT~I.E s eE rENnav s s • vvoRlcERS COMPENSATION AND TORY LIRAITS ~". ER EMPLOYERS LJABILITY - E L EACt~ accroENr s • El_DISEASE-EA S £L DISEASE - POUC1f LIMIT S B antractors Pollution Liability 916039-D3 Q6/14/2005 06/14/2006 $1,OOD,OOD Limit DESCRIPTION OF OpERgl7QN$lIO~ATIOfSSIV~pCLES/F7CCLUSIONS ADDED BY ~ 4 ; _. KTfSPECWL PROYWONS ~E: Proof Evidence Dnly - =10 day notice of cancellation in the event of non-payment of premium. CERTIFICATE HOLDER Aootrtorul wsuRED; INSURER L E(TER: CANCELLATION SNOIILO ANY OF THE ABOVE DESCRIBED POUGES BE CAN~I ~ ~ flET-0RE THE EXPIRATION DATE THEREOF, THE ISSIJMfG COA1IPANY WIIl ENDEAVOR TO MAR DAYS WRnTEN NOTICE TO THE CEttTFiCATE HOLDER NAMED TO THE LEFT. 6UTFARURE TO NAIL SUCH NOTICE $HALI IM1IF056 NO OgL16ATION aR LIAHfLITY OF ANY KIND UPON THE COMPA AGENTS OR f2EPRESENTATIVES. _-='---Pr•oaf/Evidence Oniy'~'~'*~-•- aurHOSU~DREPRESr~IrA :~- ~~v...w ~...r-. .~ -]•A~y~yJ~4,r~(j+~-r.r 2 -." f rl`l_ - ~~`l~~ - - i ACORD 25S (7!97'1 ~~C 3~ •f~ i cd _ RD C0~2P0 bK'I988 ~'•~. •N:,• `"rte V ~ ^M' ~r,1, ~ 4~ !~ ~' r..k i!ai a c. :Lift,, x '"1'y ~.. '.r,E•,w, ,.'~ •'~- ?Tx .~~, •~':~ :ter r .f?t ~ `r arf t .r ~ '4: .ties' ,f~",.~:.'~: Y •. ,~pGG ~!y-, .,~.~ wr ~.. ~• ..a~arlnd .A. !94f ''~'~' .r. f ,t •,'~ •a R . •'•• • :r ~' is.•'E~~ ~ :°ir• .' '^S;.w r +.:r•:' r L , " y.n,t , j•:; ~ ; 'A .: '; !'ate:.... .n: nn ~J~,,^0,~~.. 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Y0. ;'f~"~ e(:1;~' j~",hr;,. .f.:: ,'f: ,, !' ~ .. •' ~yr.,, •., 1', ,. A ^,1 '. t.tii .1,' ..CV...•Vl. ~ '.1 f9e~ •~,'r'M'•~~ 6 F~'. F`;yL.r.' jiV' ,~ y..: -i~~,rC.:~•S~ la~:,~la'•~~~~,r i'`'r'A~~,r:11f!.• n.~. ~ <a. b~~~ 't•' 1/,yyyiYyyl.~.'~Pe4^...~ ~ •.• ti,;;~~~T~;~; r.4! +'t J1.rFi''•' w,°'~ irk' 0 ur`W Y ~a .ssJ. ;.C 'd !••~ ''`''. •Y,J.~ ~4F'~~,y~~. aReF'' ' . k. j t `.. .~:'' ~tt; :b•°' q, ~ tWh4• .:;i a` z""a~,nrY+lttc... .~... i :'~•i•': r{'.:r~ ..aar•'~w8;:..=\`r%'ti''3:t^:'°•~, .. ... • .. ~/ BELSH/RE _ _~-, ~_ ENVtKUNMEN7~L s~KV~cES, tNC.. Scope of Work Facility: BP 00583 Date: 8/11/2005 Job Number: 2625 3220 MING AVE BAKERSFIELD, CA Estimate No: 247 Contact: Rick Kinnaman Repair Location: Dispenser -Various Work to be performed: Investigate;to find'leaks possible have to remove dispensers to install bluline repair penetrrtions or bravo repair with vulkum on all 8 dispensers Repair Location: FiII Sump - $7 Slave V11ork to be performed: Replace 87 slave fill and vapor bucketJike for'like Repair Location: Piping - 87 Work to be performed: Helium test to find leak in 87 secondary piping' possible have to fix bravo nut or'break ground"and repair some piping Repair Location: Turbine Sumps .Various Work#o be performed:lnvestigate to find'-.leaks,possible fiberg)ass sump to collars or instaFblue-ine ..penetrations as needed in the 91,89,and 87main'turbine sumps S81266.8 6.8 6.8 9.75 2.25 SB1286.8X6.0 6.8 6.8 9.75 2.25 SI6.8X6.0 S812B6.BX5.2 6.8 6.8 9.75 2.25 SI6.8X5.2 S612B6.8X5.0 6.8 6.8 9.75 2.25 S16.8X5.0 S81266.8X4.6 4.6 6.8 9.75 2.25 3.63 S61266.8X3.9 6.8 6.8 9.75 2.25 SI6.SX5.0, SI5.OX3.9 ' S812B6.8X3.5 4.6 6.8 9.75 2.25 3.63 S14.5X3.5 SB1266.8X2.7 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X2.7 SB12B6.8X2.5 ' 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, S13.5X2.5 SB12B6.8X2.25 4.6 6.8 9.75 2.25 3.63 S14.5X3.5, S13.5X2.25 SB1286.SX2.0 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X2.0 SB1286.8X1.9 4.6 6.8 9.75 2.25 3.63 SIa.5X3.s, SI3.5X2.5, SI2.axt.9 S812B6.BX1.8 4.6 6.8 9.75 2.25 3.63 S14.5X3.5, SI3.5X1.8 SB12B6.8X1.4 4.6 6.8 9.75 2.25 3.63 S14.5X3.5, S13.5X1.4 SB12B6.8X1.0 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, Sl3.5Xt.a, Stt.3X1.0 SB12B6.8X.84 4.6 6.8 9.75 2.25 3.63 SIa.5X3.5, St3.sxt.a, SIt.3X.ea 9265 ~ III - -- - - - -_ %:'4: _. The SB SERIES Split Repair Boots are designed to enable repairs e to be performed entirely inside the sump. They can either use the E ~ A i existing studs from previously installed leaking penetrations or they p can completely overlay the entire old fitting. Constructed of fuel c and water resistant ~ellethane©, once installed the boots are filled ` with Bostik 1100FS to help form a impenetrable barrier to water. All band clamps, tech screws, and fill tubes are included. U~ SB Pellethane Series O 4 Stud Single Sided ~'J SB PeNethane Series O 6 Stud Single Sided SB861.9 1.9 1.9 6.63 2.0 3.56 SBBB7.9X1.4 1.4 1.9 6.63 2.0 3.56 S88B1.9X1.0 1.4 1.9 6.63 2.0 3.56 SI1.3X7.0 S8881.9X.84 1.4 1.9 6.63 2.0 3.56 SI7.3X.84 SBBB2.7 2.7 2.7 6.63 1.75 3.56 SB882.7X2.4 2.4 2.7 6.63 1.75 3.56 SBBB2.7X2.0 2.4 2.7 6.63 1.75 3.56 SI2.4X2.0 S6882.7X1.9 2.4 2.7 6.63 1.75 3.56 SI2.4X1.9 SBBB2.7X1.8 2.4 2.7 6.63 1.75 3.56 SI2.4X1.8 S88B2.7X1.4 2.4 2.7 6.63 1.75 3.56 SI2.4X7.4 SBBB2.7X7.0 2.4 2.7 6.63 1.75 3.56 SI2.4X1.4, SI1.3X7.0 S8882.7X.84 2.4 2.7 6.63 1.75 3.56 SI2.4X7.4, SI1.3X.84 56863.7 3.7 3.7 6.63 2.0 3.56 SB883.7X2.7 3.7 3.7 6.63 2.0 3.56 SI3.5X2.7 S88B3.7X2.5 3.7 3.7 6.63 2.0 3.56 SI3.5X2.5 SBBB3.7X2.25 3.7 3.7 6.63 2.0 3.56 SI3.SX225 S8863.7X2.0 3.7 3.7 6.63 2.0 3.56 SI3.5X2.0 S68B3.7X1.9 3.7 3.7 6.63 2.0 3.56 S13.SX2.5, SI2.4X1.9 SBBB3.7X1.8 3.7 3.7 6.63 2.0 3.56 SI3.5X1.8 58863.7X7.4 3.7 3.7 6.63 2.0 3.56 S13.5X1.4 S6883.7X1.0 3.7 3.7 6.63 2.0 3.56 513.5X1.4, SI1.3X1.0 S6863.7X.84 3.7 3.7 6.63 2.0 3.56 513.5X1.4, 511.3X.84 __` ~ = ENVIRONMENTAL ~~'~'== ~ SERVICES, /NC. Site Nlap Location Name: Date: - ,~p~ BESI#: G; Address:. o ~ ~ Cross Street: ~ ~ ~ ~ ~ City: ~s s State: Scope: ~IN~ ~ rS I~ t~ w I 6 >~ ~ ,~~ -- ~ S~ Y~ O~?OD C~C~O~ rev. 10/15/03 i i ., ' . , ; ' ,~ ~ 4 ,'i .~ ~~ Stala O( California ~ ; ; ~a•~~;,~ CONTRACTORS STATE LICENSE BOARD I,~~ I • , ' ,r'~ • , 7F`1`'~""• ACTIVE LICENSE ' ' I ,,. Conmmor ~ i • AKolrr r~ ~ . ' I ...~'r.+ a~,.w~..8~8~~3 cnq CORP ~' ~ `'~~~ w.r.~w~,. BELSHIRE ENVIRONMENTAL '' ''~f ~ ~ SERVICES INC ~ ~ . a16Noon. 05/31/2006 ' ... ,. I: ~ ., u i - - - COVERAGES i /\l~T~- ~~64~~~~~6~~~ ~~ ~~~~9~C ® ~~ `~E._. DATE(b1M/DIIIYy) 06/16/2005 PRODUCER (ggg) 857-4500 FAX (949') 857-4800 Mi 11 ennilim Risk Management & Ynsurance Services Li tense ~ OC13480 THIS CERTIFICATE IS ISSUED AS R GAATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER TFlES CERTIFICATE DOES NOTAMEDfD, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 5530 Trabuca Road _ Trv-ine, CA 92620 • ENSURERS AFFORDING COVERAGE INSURED BeTshire Environmental Services, Inc. INSURERFI' Zurich American ~- 25971 Towne Centre Drive INSURER 6: Steadfast Insurance Foothill Ranch, CA 92610 INSLIRERC WsuRER D: ' WsuRER E: THE POUGES OF INSURANCE 115TED BELOW HAVE BEF1d ISSUED TO THE MSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED- NOTWITHSTANDING ANY REQUIRpNENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRH RESPECT TO WIi1CH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED I~l(THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDfI10NS OF SUCH POLICIES- AGGREGATE LBdITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIlIAS- INSR L7R TYPE OFNISURANCE POLICY NUNBEA POUCY DATE POLICY RAT10N DATE MIDD ~~ _ GENERALtIAB1UTY EACHOBCURRENCE S 1,000,00 X coTa~TCwL GENERAL UA@0.(TY 916038-03 06/14/2005 06/14/2006 FIRE DAMAGE (a+y «,~ ure) s 100, 000 cLAUns MADE ~X occuR MEO EXP (My one v~nn7 s 5 , 000 A PERSONALLADVWJURY S 1 000,000 cENFJTAL AGGREGATE : 1, OOO, 000 cElr1 nGGRESATe LmaTTAPPUES PEfi PRODVCrs- coMProP AGG s I ,000, 00 POLICY JOE T LOC AUTDMOBttE LIASAI7Y X ANYAUTn 916042-03 06/14/2005 06/14/2006 COMB WED SINGLE L4~YT (E'er s 1000,00 ALL owxED Autos BODILY WJURY scr~ouLEp Auros (P« pefsav f A X HIRED nuros 80p0.Y WJURY X NON-DNRJED AUTOS (Pa ecride~A) s PROPERTY DAMAGE (Per aocidenF) s GARAGE LIABIL.TTY AUTO ONLY- EAACCIDENT S ANY AUTD OTHER THAN EA ACC 5 AUTO ONLY_ AGG S ExcESS LIAB11iY FACtI OCCURRENCE s 5, 000, 000 X occuR ~cxar~is-nADE EO 5337678-DI •06/14/Z005 06/14/Z006 AGGREGATE s 5,000,0 B s DEDUCTBL.E s RETENTION s S WORKERS COMPEHS1lT10N AND - TORY Ip~NTS '?`. ER EMPL.UYERS LIA64IfY EI EACTIACCtDEM S EL DISEASE-EAETAPL S ' F.t-DISEASE - POLICY L6AIT S B ontractors Pollution Liability 816039-03 06/14/2005 06/14/2006 $1,000,000 Limit DESCRIPFION OF OpERIItiTIQN$ILO~ATIOt~SNEHICLESIDCCLU510N5 ADDED BY ENDORSBAENTISPECIAL PROYISNTNS . ~ _. . RE: Proof Evidence Only - - =10 day notice of cancellation in the event of non-payment of premium. CERTIFICATE HOLhER ADDITN7NAL WsuRED; INSURER LEITER CANCE1.lATlON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E7(PIItAT10N DATE THEREOF. THE ISSIJRlG COMPANY In(nl ENDEAVOR TO tIATL DAYS YYRITTEN NOTICE TO THE CERTF{CATE HOLDER NAFDED TO THE LEFT, 8UT FAILURE 70 MAIL SUCH NOTICE SHALL IMPOSE NO pgIJGATION DR LIABILITY OF HNY KIND UPON T'HE COESPA AGENTS OR it1=PRESENTATNES -----Proof/Evidence Only'**=~•-- AurrsoRU3mi HEPRESENTA ACORD 25S (7/9 T) © RD CORPO ION 1! i~.~• T• AT~ •~ ~{ . b"' ' i• i~ i'.. ~4n r~ •v eai~: :"~ o '~^ <ITA.?4r~• ~j •Y,i,F r, p r.• -"•• r.R. • rP iR, . ,~ H. , ~t •• 4- ,1^.~,;v• itr jjtt~~ F.+BI~r•,i "" +~• • ~..,;~%~'"• ''~~f'+~'x „o4,yn~... •r.,.,i. #,. 'lTw. f k ~ ~•.~ :.fir : '"~W' •:?~ ~t ~:~?'7.;• \.`T.4'-:"~`,~3 '~•.e° ~` ';l. ,r p~~W~~'vt(.1", ,~Aj yi.+.. kf„`.. ~:.'.4ic;'.r b~ ', t:. ,'j: `' ' -+~t.",ri...., ,~.~' •.1 1fitM^• / . T,. r:I.•::.•T{.,~fa1RX •::~,•' ' t .. _ ~~JT'h'?~~~'~1'',''•f4Ljiy~,y `iY"~.%5," :'~~~~•. ,s~~+,,j~' ~t~ rKj• „2"~}}`_~a'.~`Kv.:7~,~,'i'Ny=•~; Tt Y~ti?i~. '•^'bi `yi•.'.t: „gf~" . . ^S'r 11;:3..• r' r:,•tv'.n'. 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Scope of Work Facility: BP 00583 Date: 8/11/2005 Job Number: 2625 3220 MING AVE BAKERSFIELD, CA Estimate No: 247 Contact: Rick Kinnaman Repair location: Dispenser'- Various VNork to be performed: Investigate'tto find leaks possible have'to remove dispensers to install bluline repair penetrations or bravo. repair with vulkum on all 8 dispensers Repair.Location: Fill Sump - 87 Slave Work to be performed: Replace 87 slave fill and vapor bucket'like for ike 'Repair>;>Location: Piping - 87 Work to be perfoirmed: Helium test to find leak in 87 secondary piping' possible have to fix bravo nut or break ground'and repair some piping Repair Location: Turbine Sumps -''Various Vllork to be pertormed:lnvestigate to find leaks possible fiberglass sump to collars or instal blueline penetrations as needed in the 91,89,and 87main turbine+sumps __- ^ ~ - - ` r* : ~ ® o fix.--. SB Pellethane Series 12 Stud Single Sided S610B3.7 3.7 4.8 8.38 1.63 4.1 S81084.8 4.8 4.8 8.38 1.5 SB1084.8X3.5 4.8 4.8 8.38 1.5 _ S61064.8X2.7 2.7 4.8 8.38 1.5 2.94 SB10B4.8X2.5 4.8 4.8 8.38 1.5 SI3.5X2.5 S61064.8X2.25 4.8 4.8 8.38 1.5 SI3.5X2.25 SB10B4.SX2.0 2.0 4.8 8.38 1.5 2.94 S81064.8X1.9 2.7 4.8 8.38 1.5 2.94 SI3.5X2.5, SI2.4X1.9 S81064.8X1.8 2.7 4.8 8.38 1.5 2.94 SI2.6X1.8 SB1064.8X1.4 2.7 4.8 8.38 1.5 2.94 SI3.5X2.5, Si2.4X1.4 SB10B4.8X1.0 2.7 4.8 8.38 1.5 2.94 S13.SX1.4, SI1.4X1.0 SB1084.8X.84 2.7 4.8 8.38 1.5 2.94 SI3.5X1.4, SI1.4X.84 S81266.8 6.8 6.8 9.75 2.25 SBi266.8X6.0 6.8 6.8 9.75 2.25 SI6.8X6.0 SB12B6.BX5.2 6.8 6.8 9.75 225 SI6.8X5.2 S612B6.8X5.0 6.8 6.8 9.75 2.25 S16.8X5.0 S612B6.8X4.6 4.6 6.8 9.75 2.25 3.63 SB12B6.8X3.9 ' 6.8 6.8 9.75 2.25 SI6.8X5.0, SI5.OX3.9 S812B6,8X3.5 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5 S812B6.SX2.7 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X2.7 SB1266.8X2.5 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.SX2.5 SB12B6.8X2.25 4.6 6.8 9.75 2.25 3.63 SI4.SX3.5, SI3.5X2.25 S81286.8X2.0 4.6 6.8 9.75 225 3.63 SI4.5X3.5, SI3.SX2.0 S812B6.8X1.9 4.6 6.8 9.75 2.25 3.63 SIa.5X3.5, SI3.5X2.5, 512.4X1.9 S812B6.8X1.8 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X1.8 SB1286.8X1.4 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X7.4 S81266.8X1.0 4.6 6.8 9.75 2.25 3.63 S14.5X3.5, SI3.SX1.4, SI1.3X7.0 S81286.8X.84 4.6 6.8 9.75 2.25 3.63 S14.5X3.5, SI3.SX1.4, SI1.3X.84 9765 „ The SB SERIES Split Repair Boots are designed to enable repairs 6 to be performed entirely inside the sump. They can either use the ~ ~ a :,_ existing studs from previously installed leaking penetrations or they p can completely overlay the entire old fitting. Constructed of fuel and water resistant Pellethane®, once installed the boots are filled ° ~ ' with Bostik 1100FS to help form a impenetrable barrier to water. All band clamps, tech screws, and fill tubes are included. u` SB Pellethane Series 4 Stud Single Sided SB Pellethane Series 8 Stud Single Sided S8867.9 1.9 1.9 6.63 2.0 3.56 SBBB7.9X7.4 1.4 1.9 6.63 2.0 3.56 SB861.9X1.0 1.4 1.9 6.63 2.0 3.56 SI1.3X1.0 S8661.9X.84 7.4 1.9 6.63 2.0 3.56 SI7.3X.64 S6862.7 2.7 2.7 6.63 7.75 3.56 SB6B2.7X2.4 2.4 2.7 6.63 1.75 3.56 SBBB2.7X2.0 2.4 2.7 6.63 1.75 3.56 SI2.4X2.0 SB682.7X1.9 2.4 2.7 6.63 1.75 3.56 S12.4X7.9 SBBB2.7X7.8 2.4 2.7 6.63 1,75 3.56 S12.4X1.8 SB6B2.7X1.4 2.4 2.7 6.63 1.75 3.56 SI2.4X1.4 SB6B2.7X1.0 2.4 2.7 6.63 1.75 3.56 SI2.4X1.4, SI1.3X1.0 S68B2.7X.84 2.4 2.7 6.63 1.75 3.56 SI2.4X7.4, SI7.3X.84 SBBB3.7 3.7 3.7 6.63 2.0 3.56 SB883.7X2.7 3.7 3.7 6.63 2.0 3.56 SI3.5X2.7 S8883.7X2.5 3.7 3.7 6.63 2.0 3.56 SI3.5X2,5 S6863.7X2.25 3.7 3.7 6.63 2.0 3.56 SI3.SX2.25 SB6B3.7X2.0 3.7 3.7 6.63 2.0 3.56 SI3.5X2.0 S8683.7X7.9 3.7 3.7 6.63 2.0 3.56 S13.SX2.5. SI2.4X1.9 58863.7X1.8 3.7 3.7 6.63 2.0 3.56 SI3.SX1.8 S8683.7X1.4 3.7 3.7 6.63 2.0 3.56 SI3.5X1.4 S6663.7X1.0 3.7 3.7 6.63 2.0 3.56 SI3.5X1.4, SI1,3X7.0 SB6B3.7X.84 3.7 3.7 6.63 2.0 3.56 SI3.SX7.4, SI7.3X,84 _~ ~- - ENVIRONMENTAL ~~'-~ SERVICES, INC. Site Map Location Name: Date: - .CBS BESI#: G-"~~ Address:. o ~ Cross Street: ~~ ~~ ~ City: S s State: Scope: m~N~ r~ r~ i~ ~ w d >~ c ,p~ _ . £ D~ ~~ O~OD C~C~OD rev. 10/15/03 ' ~i~ • , . . ., ,. ';~ ~ t ., ~i i •~ , • • , ,' 'r .E ~ ,•. ,., . ... . ', ~; ,. • ~ ~ ~ ' ~ Siate 01 Callfornla • +~,.• • ('A,~~~CONTRACTORS STATE LICENSE BOARD , li~~ { ,,' Conmmn ACTIVE LICENSE ~ ~ ~ ACdn Q Q•n.C -wL ,' I ~'~~•~, i. Wa~.W~N.i VOVV~ V tMtr CORP ~ ~ .~ ~. '''•! w•..,,w.,. BELSHIRE ENVIRONMENTAL 5 ' °~~ SERVICES INC ' • .' • cr~u.roou• 05/31/2006 {1 / ... .. •• ~ ii I J ' " Y ff~~(~pj'~~ - - -~~-®®~I a®(gp-,~~-~°-'_i_ :~ ~ V/ZLJTM' ~~~~~~~~~~~ ~~ ~~~~~~~ ® ® ®i®41C~ ~ DATE(MM/DDlyy) r+ 06/162005 ' s PRODUCER (9¢9)857-4500 FAX (949?857-4800 THIS CERTIFICATE IS ISSUED AS A fiRATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Millennium Risk Management & Insurance Services yOLDER.THISCERTIFiCATEDOESNOTAMEND. Li cease # (}Q3480 ALTER THE COVERAGE AFFORDED BY THE POLiCIE ES BUELpW_ . 5530 Trabuca Road _ 2rvlne, CA 92620 ~ ENSURERS AFFORDING COVERAGE INSURED BeTshire Environmental Services, Inc. INSURERa Zurich American ~~ 25971 Towne Centre Drive INSURER e: Steadfast Insurance Foothill Ranch, CA 92610 INSURERC wsuRER D: " ~ INSURER E: COVERAGES ~---- THE POLICES OF INSUFt/W(:t LIJ1 tL HELUYY FiAVt BtEN ISSUED 1 O THE INSURED NAMED AHOYE FOR t HE. POLICY PERIOD INDICATED. No'fWITy$TANDING ANY REt1U1RpNENT, TERM OR CONDn70N O~ ANY CONTRACTOR OTHEf2 DOCUMENT WffH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE WSURANCE AFFORDED QY THE POLICIES DESCRIBED HERFIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND t~NDTT10N5 OF SUCH POLICIES. AGGREGATE LQ+AffS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF WSURANCE POLt(.Y NUMBER POLICY EFFECTrvE DATE POLICY EXPIRATION DATE MID .LIMITS GENERAL LIABILITY ~ EACH OCCINZRENCE s ]. ~ 000, OO X cor~RCIAL Get+ERAL UA@R.TIY 916038-03 06/14/2005 06/14/2006 FIRE DAMIAGE (ary «,~ wc) a 100, 000 G.AUAS MADE Q OCCUR MED EXP (Any one Parson) S $, 000 A PERSONAL t ADV INJURY S 1, 000, O c,~+ERALnccRECaTE s 1,000,0 GEN',LAGGRE6ATELWIRAPPUESPER: PRODUCTS-COMPIOPA(aG S 1,000,00 POLICY kCOT- LOC AUTOMOBILE LlflBIIJiY X aNYAUro 916042-03 06/14/2005 06/14/2006 COMBWED .S~'tGLE LIRN'T tE'~"o s 1,000,00 ALL owNED Auros •• BODRY 1NJlJRY A ~ scHEDIaEp AUros tP« p«sa~ r X NnzED Auros Y IL X NON-0VVNF.D AUTOS ~P~ e> S PROPERTY DAMAGE (Pet eaade;d) S GARAGE LVIBILITY AUTO ONLY-E1I ACCIDENT r ANY AUTO DTHEA TFIAN EA ACC r AUTO ONLY. AGG S ExcESS LVI6CJTY EACH ocwRReNCe r 5 , 000 000 X occuR ~cLauvlsr,IIADE EO 5337678-O1 •06/14/2005 05/14/Z006 AGGREGATE r 5,000,0 B s DEWCTBI.E S RETF1tTION S S WORKERS COMPENSATION AND ~ TORY LILIITS '~~. ER ~ EMPLOYERS LIABa1TY ~ EJ_ EACH ACCIDFJJT - S EL DISEASE-EAEMPL S ELDISEJ4SE-POUCYLMAIT S B ntractors Pollution liability 916039-03 06/14/2005 06/14/2006 $1,000,000 limit DESCRIPTION OF O(:ERgJIQN$ROCA715~Sf VF~IK:LES/000LUSYONS ADDED BY ENOORSEIAEh'T/SPECIAL PROY45~N5 ~ _. • RE: Proof Evidence Only " =10 day notice of cancellation in the event of non-payment of premium. CERTIFICATE HOLDER ADDInONALtNSURED;INSURFJtLE7TER CANCELLATION SHDLk.D ANY OF THE ABOVE DESCRIBED POLICIES BE CJIpICEIJ FD BEFORE THE EXPIRATION DATE THEREOF. THE ISSU@IG COMPANY W01 ENDEAVOR TO RIAIL DAYS YVRI'Tl'EPI NOTICE TD THE CERTFICATE HOLDER NAMED TO THE LE'"T, - ~ BilT FAILURE Tb NAZI SUCH NOTICE SHALL IMPOSE NO DgLIGATK)N DR LIASII.ITY OF ANY KRJD UPON THE COMPA AGENTS OR (CEPRESPNTATNES. -- - - =Proof/Evidence Onl y'~*# = ='-' AurHORr~D REPRESENTA Y .< .... .,.. 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Scope of Work Facility: BP 00583 Date: 8/11/2005 Job Number: 2625 3220 MING AVE BAKERSFIELD, CA Estimate No: 247 Contact: Rick Kinnaman Repair Location: Dispenser-Various Work to be performed: Investigate to find eaks possible have to remove dispensers'to install bluline repair penetaations or bravorepair with vulkum on all 8 dispensers Repaiir Location: FiU Sump - 87 Slave Jllork to be performed: Replace 87 slave fill and vapor6ucket like forlike Repair'Location: Piping - $7 JVorkto be performed: Helium test to find leak in 87 secondary: piping'. possible have to fix bravo nut or break. ground and repair some piping Repair Location: Turbine Sumps -Various Work to be performed: Investigate'to find `leaks possible fiberglass sump to collars or instal blueline penetrations as needed in the 91,89,and $7main turbine sumps j I U A 1 b~ E D SB Pellethane Series- 10 Stud Single Sided c SB Pellethane Series O 12 Stud Single Sided SB10B3.7 3.7 4.8 8.38 1.63 4.1 SB10B4.8 4.8 4.8 8.38 1.5 SB1064.8X3.5 4.8 4.8 8.38 1.5 S81084.8X2.7 2.7 4.8 8.38 1.5 2.94 "` ~SB10B4.8X2.5 4.8 4.8 8.38 1.5 SI3.5X2.5 S610B4.8X2.25 4.8 4.8 8.38 1.5 SI3.5X2.25 SB10B4.8X2.0 2.0 4.8 8.38 1.5 2.94 SB10B4.BX1.9 2.7 4.8 8.38 1.5 2.94 SI3.5X2.5, SI2.4X1.9 S81084.8X1.8 2.7 4.8 8.38 1.5 2.94 SI2.6X1.8 SBi0B4.8X1.4 2.7 4.8 8.38 1.5 2.94 S13.5X2.5, S12.4Xi.4 S81084.8X1.0 2.7 4.8 8.38 1.5 2.94 S13.5X1.4, SI1.4X1.0 SBi0B4.8X.84 2.7 4.8 8.38 1.5 2.94 SI3.SX1.4, SI1.4X.84 SB12B6.8 6.8 6.8 9.75 2.25 SB12B6.8X6.0 6.8 6.8 9.75 2.25 SI6.8X6.0 SB12B6.SX5.2 6.8 6.8 9.75 2.25 SI6.8X5.2 S81266.8X5.0 6.8 6.8 9.75 2.25 SI6.8X5.0 S612B6.BX4.6 4.6 6.8 9.75 2.25 3.63 S612B6.8X3.9 6.8 6.8 9.75 2.25 SI6.8X5.0, SI5.OX3.9 SB1266.8X3.5 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5 SB1266.8X2.7 4.6 6.8 9.75 2.25 3.63 SI4.SX3.5, S13.5X2.7 SB72B6.8X2.5 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X2.5 SBi2B6.8X2.25 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, S13.5X2.25 S81266.8X2.0 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.SX2.0 SB1286.8X1.9 4.6 6.8 9.75 2.25 3.63 SI4.SX3.5, SI3.5X2.5, SI2.4X7.9 S81286.SX1.8 4.6 6.8 9.75 2.25 3.63 S14.5X3.5, S13.5X1.8 S612B6.8X1.4 4.6 6.8 9.75 2.25 3.63 SI4.5X3.5, SI3.5X1.4 SB1286.8X1.0 4.6 6.8 9.75 2.25 3.63 S14.5X3.5, SI3.5X1.4, SI1.3X1.o SB1266.8X.84 4.6 6.8 9.75 2.25 3.63 S14.SX3.5, S13.SX1.4, SI1.3X.84 97 The SB SERIES Split Repair Boots are designed to enable repairs e to be performed entirely inside the sump. They can either use the ' F ~ A ' •,. existing studs from previously installed leaking penetrations or they p can completely overlay the entire old fitting. Constructed of fuel ~- and water resistant PellethaneO, once installed the boots are filled ` I a~ with Bostik 1100FS to help form a impenetrable barrier to water. All band clamps, tech screws, and fill tubes are included. U` SB Pellethane Series ~~ 4 Stud Single Sided SB Pellethane Series 8 Stud Single Sided S8861.9 1.9 1.9 6.63 2.0 3,56 SB8B1.9X1.4 1.4 1.9 6.63 2.0 3.56 S6861.9X1.0 1.4 1.9 6.63 2.0 3.56 SI7.3X1.0 SB661.9X.84 1.4 1.9 6.63 2.0 3.56 SI1.3X.84 SBBB2.7 2.7 2.7 6.63 1.75 3.56 SBBB2.7X2.4 2.4 2.7 6.63 1.75 3.56 SB8B2.7X2.0 2.4 2.7 6.63 1.75 3.56 SI2.4X2.0 SBBB2.7X1.9 2.4 2.7 6.63 1.75 3.56 S12.4X1.9 SBBB2.7X1.8 2.4 2.7 6.63 1.75 3.56 SI2.4X7.8 S8882,7X1.4 2.4 2.7 6.63 1.75 3.56 SI2.4X1.4 S8862.7X1.0 2,4 2.7 6.63 1.75 3.56 SI2.4X1.4, SI1.3X1.0 S8882.7X.84 2,4 2.7 6.63 1.75 3.56 SI2.4X1.4, SI1.3X.84 S68B3.7 3.7 3.7 6.63 2.0 3.56 56883.7X2.7 3.7 3.7 6.63 2.0 3.56 S13.5X2.7 S6883.7X2.5 3.7 3.7 6.63 2.0 3.56 SI3.SX2.5 S88B3.7X2.25 3.7 3.7 6.63 2.0 3.56 S13.SX2.25 SB863.7X2.0 3.7 3.7 6.63 2.0 3.56 SI3.5X2.0 SBBB3.7X1.9 3.7 3.7 6.63 2.0 3.56 SI3.SX2.5, SI2.4X1.9 S8883.7X1.8 3.7 3.7 6.63 2.0 3.56 S13.SX1.8 S8883.7X1.4 3.7 3.7 6.63 2.0 3.56 SI3.5X1.4 SB883.7X1.0 3.7 3.7 6.63 2.0 3.56 SI3.5X1.4, SI1.3X1.0 S8863.7X.84 3.7 3.7 6.63 2.0 3.56 S13.SX1.4, S11.3X.84 _ _ BELSH/RE ~, ~- _ '~_~_~- ~~ = ENVIRONMENTAL ~~~'~= SERVICES, INC. Site Niap Location Name: Date: - .~p~ BESI#: ~- Address: o ~ ~ Cross Street: wr ~~ ~ City: s s State: Scope: m~Ny r~ r~ i~ r~ W d ~~ ~ ,p~ _. ~ S~ ,Ck =s16 O~~o C~c~o~ rev. 10/15/03 ' \,; ~ ~ • •. i , .~ ~. • .;• ,~ ~ •• I ~ • . •: .• • .,. I . •; ~•• ~ ~ ~ .' • . • • •' • i~ ,. ~ ~ ~ ~ ' ~ Stala Of California ~•~ ~a,;,, CONTRACTORS STATE LICENSE BOARD l i~i ~ ~f Coniu'a~~ ACTIVE UCENSF i ,,,,.-,~''i'•'.r~ u.~,.wT», 808313 cwr CORP ~ `' s ~ ''~ w~r.~wn,. BELSHIRE ENVIRONMENTAL .' "..• "~~~ SERVICES INC • . ' . u.~'"wM~q A HAZ • •• a~a..on.05/31/2006 •• ~ III '' ~ , , • • } .. .I - ! ~ ~~ • t~ t{ f COVERAGES i ~G®R®~,- C~~i`[~t~~CA`i'E ~~ L~~,~I~fl~ ~S~IJ(~E DwTE (MMroDlYy) o6/i6/zoos PRODUCFJ2 (g'49) 857-4500 FAX (949) 857-4800 Millennititn Risk Management & Insurance Services Li tense ~ OC13480 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THECER'fIFlCATE HOLDER. Ttl1S CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 5530 Trabuco Road Irvine, CA 92520 ~ INSURERS AFFOROlNG COVERAGE INSURED BeTshire Environmental Services, Inc. wsURERw Zurich American ~~ 25471 Towne Centre Drive INSURERS: Steadfast Insurance Foothill Ranch, CA 92610 INSURERc eNSUREIt D: wsuRER E: THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED (~ ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRFNlENT, TERM OR CONDITION OE ANY CONTRACTOR OTHER OOCUMFJJT WTTH RESPECT 70 WHICH THIS CERTIFICATE MAYBE ISSUF~ OR MAY PERTAIN. THE WSURANCE A1I=0RDED ETY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLApNS- INSR L-~ TYPE OF WSURANCE POLICY NUNBHt POLICY EFFECi1VE DATE POU EXPIRATION DATE M!D LIeDRS GENERALLWBRTTY ~+~~~~ s 1,000,00 X coMR~ecu+LGENERAL LIA@RITY 916038-03 06/14/2005 06/14/2006 FIRE ovlT~taGE (a+r «,~ ~I s 100, 000 clAUns r~nAOE X^ occuR NED EXP W,y one yononl s 5 , 0 A PERSONAL c ADV WJURY s 1 000, 000 GENERAL AGGREGATE s 1,000,0 GF]J7_AGGREGATEL9~tTTAPPUESPER: PRODUCTS-COMPlOPAGG i 1,000,00 POLICY ~~ IOC AUTOMOBtt.E LIABRITY X AntYAUro 916042-03 06/14/2005 06/14/2006 GOMBWED SINGLE LMTT IE'~dA1~ s 1000, ALL ONMED AUTOS BODILY WAIRY s SCF~DUIED AUTOS ~~ ~~ A X HAZED autos BOI)0.Y AiJURY s X NoN-owN~ Auras IP" I PROPERTY DWMA.GE (Pe[ acrideri) S GARAGE L4IBAJTY AUTO ONLY - FA ACCIDENT E ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S ExcESS LWBQJTY EACH occuRRENCE s 5 , 000, 000 X occuR ~ca_AwISMADE EO 5337678-O1 •06/14/2005 06/14/Z006 aGGREGATE : 5,000,0 B s DEDUCreLE s RETErmoN s s WORKERS COMP@tSATTOtI AND ~ TORY LmvTS :'". F12 EMPLOYERS UABA.ITY EJ_ EACN ACCIDENT S EL.DISFASE-FAEMPL S F-L oLSEASE - POLICY LAJIIT s B ontractors Pollution liability 916039-03 06/14/Z005 06/14/2006 $1,000,000 Limit DESCRIPTK)N OF OpERf~TIQN$ILOS•1171OFSw~itCLES/EXC~U510NS ADDED BY 6JDORSEWF1YTlSPECWL PRW15~N5 , ~ - ~ ` E: Proof Evidence Dnly =10 day notice of cancellation in the event of non-payment of premium. CERTIFICATE HOLDER ADDITIONAL INSURED; IN5URt7t LE'ITEFC CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUQYG COMPANY W@J_ ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TD THE CERTFTCATE HOLDER NAMED TO THE LEFT, 61/T FAR.URE 70 MAlLSUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABltTTlf OF ATIY KRIU UPON THE C066PA AGENTS OR i`GEPRESENTATNES. ----=Proof/Evidence Only'~~*==~= aurHORIZEDREPRESENTw _ -. -- -~....~ .. ~:.-,.~ . - c~a.~g~~~_t~-F~' f ---KY ors - _ 'r'y~`f •` _ -- - - ACQRD 25S (7/9~ - - - -- - - _ - p RD CO~iPO ION 1958 ~ • EJ ,x "y' • ~~ " . 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'C~r .:e,4:.:r, •tF .(~t^: •t~y a vim, .: ., . V "~' i ylq, far .. .;, ...ta:. i4«;.?'.:.~-:, •: K^' ~ ~ .a e+ ~ i~' ti• . `fi1r-11^~:t"-i•• i1 Q' t• t. y, ' '' :. ~ i n.ql' .A ~i F'.hw/ p "vt' "+1•!. .... C2' •1 ',~" _. Yjj;~~ '4T'M1n~~''"r`~ r (r i'L~ii,;2 aA ~•G`rt.~r .r~ ~ r:'1,~• t•+4`;k1+': rrf+A'•1^~."GS~G 4,~.07~ '`r~aNa;~", •F'GA .. n.....: .. r. • -~. ~,:ptj, t{(.~ ~ .fit;; .,,',.• 1 •i.¢.~i' •117 '13~~~. '"'~, '~•~,4r, ,r r . ~'.+;n r .~ ~a ; 4 I i ~6f it ~' b''l'.{re.;•G~![~r «J''yl.r,,~ .. I ,•,~ 3w ,pi;r'. .S y' J,~ ... , I ~`_ ~~ MONITORING SYSTEM CERTIFICATION For Use B.1- Atf Jurisdictions WFthin the Slate of Cal~;fornia Authoritp Cited: Chapter 6 7, Health and Sc;fety Code; Chapter 16, LYgision.3, 7Ytle 23, Cahfornia,Code of Revelations This form mustbe usedto document testing and servicing of monitoring equipment. A separate certification or reportmustbe prepared for each monitoring system control panel by the technician who performs the work: A-copy of this forsn.mustbe provided°to the tenlc system ownerloperator. The ownerloperator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information i Facility Name: LBP WEST COAST PRODUCTS. LLC I_ I SS#: 10583 I Site Address: 3220 MING AVE ~~ ~ City: . BAICERSFIELD (2i 93304 '- 1 Fnci]ityCoatactPerson: -.lp.u~-~G~~ Contact PhoneNo.: wry/ 6705'3Z~ ; MakelModelofMonitoringSystem: ,~~~~a-~--_ rr't_5 35'~ i DateofTestiagfService: ~o-z,T-dS, B. Inventory of Equipment TestedlCertified Check flue anuraoriate bo~aes to indicate soe:eific eaummeint insoeetedlserviced: Tnak ID: ' ,+~ Tea1t ID: g ~ s / TankGa Probe: {ModeL• i3 73w-1 o n-TeakGa Probe: ModeL• $u{734o -lD nnularS nceorVaultSeasor: Model: 3 p. -Yo nnulnrS ace or Vault Sensor Model:- `t~{3 0-Yo Sum lTrenchSensor .s : 1 ModeL• g 3yo~-z~S Sum lTrenchSensor s : Model: '74~f3$a~Log i11Sum Sensors : ,ModeL• r19y3~o-Zog i11S Sensor- s : ModeL• 4Y3~o -Zo$ echenicalLiaeLeakDetector. ;Model: echar>icnlLirleLeakDetector. ~ ModeL• ectroaic Line Leak Detector 'ModeL• ~ V cz - u,c> ectroaic Lme Leak Detector ModeL• Ov ModeL• X900 9 / -oo/ Ov ModeL• gO o / - o of er S ec' e e end model inSect iori.E oa P. a 2. er S ec' e e and.model.in Section E oa Pa e 2 TankiD: TenkID: ~i 1 n-TankGau ' Probe: !Model: ' ~ o-~O nTankGn ~ Probe: Model: $ 340 -c0 nnularS ace orYsultSensor: j ModeL• 4b-c~o~j nnularS ace orVaultSensor Model: g go - o S reachSeasor s : ;ModeL•- gj0 Zo8 i ~ S renchSensor s : Model: ~i~! 0 ?~ ills Sensor s : ModeL• gj -z08 i11Sum Season s : ModeL• g0 ~~'~ echariicalLineLeakDe:tector. ;ModeL echaaicelLiaeLeak.Detector. Model: ectronic Line Leak Detector ~ ModeL ' 'ViZ~ I.LD ectroaic Line Leak Detector ModeL' J 1~- - C.C,"D Ove i ModeL• boll -ool Ov Modek `79~O~i/`oo er, S ec' a ui . t e, and model is Section E on Pa e 2 er, S ec' a ui a and model in Section E on Pa e 2 D' eraser ID: t - Z Dis enser ID: 3 ` is enser Containment Sensors: j_ModeL- ' zog enser Containment Sens s : ModeL v B ShearV-slues . , ShearV.alve s . is enser Containment Floa s and Ch ' s 's enser Containment Floa s and Ch ' s Dis enser ID: - (~ D' enser ID: `7 - ~ Dis enser Containment Sensors: !Model: i 2~F> is enser Containment Sensor( s): ~ Model: ~ Zo 8 Shear Valve(s).. _ ~- Shear Valves . i ~ is enser ContainmentFloa s andCh ' s is enser ContainmentFloa s _ andCh ' s Di enser ID: -~/D Dis enser ID: j -- ! ~ is enser Containment Sensors: ~ Model: i Zoe is enser ContainmentSenso s : 'Model: ~c~ 8 hearValvc s . ; heaxValves . 's enser Corxtairunent Floa s and Ch ' s 's enser Containment Flo a and Ch ' s *If the facility contain's more tanks or dispensers, copy this form. Include information for every tank and dispenser at this facility. C. Certification - I certify that the equipment identified in this documentwas inspected/:enticed in aaordance wfth the manufacbemo' guidelines.- Attached to. this Certification ~ in8ormation (e.~ manufacturers' checklists) neceaary to verify that tha information is correct and s Plot Plan shmvlu~g the layout of monitoring e ' meat For any~lurpment capable ofgenererting ~wch reports, I heaealoo attached a copy of the report; (cTerck ati that apply)d stem-set ~'1ar7n history++~~-~ Te6chnicianNeme (Print): ~4„~~ne_. ~i,or,~,..~-,~_ SiEnnture: CertificationNo.: ~ Ob~oS~-!?~ I LicenseNo.: ! X8804 8 1 Testin~CornpanyName: i TAIT ENVIRONMENTAL SYSTEMS I Phone No.: 071.41560-8222 I Page 1 of 3 03N1 e MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulatwsu This form must be used to document testing and servicing of rr~onitoring equipment. A separate certification or report must be -prepared for each monitoring svstem control panel by the technician who performs the work. A copy of this form must be provided to tl~e tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: ~a.c y Service Station No.: '® 8- ~ 3 Site Address: 3 zzo A-~ ~ v~ q Pao City: ~w~5 ~'~ ~?'1'D Zip: Facility Contact Person: 1 a,,,,, o,,~ wc~,p a /' Contact Phone No.: G ? o S 3 L% Make/Model of Monitoring System: 'TC S 3 S'~ Date of Testing/Service: _ t a - z 7 = ~ s- B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced: Tank ID: Tank ID: ^In-Tank Gauging Probe: Model: ^In auk Gauging Probe: Model: ^ Space or Vault Sensor. Model: ^ Space or Vault Sensor ~ Model:. ^Pip' ump/Trench Sensor (s): Model:- . ^Piping S /Trench Sensor (s): Model: . ^Fill Sump r (s): Model: ^Fill Sump Se r (s): Model: ^Mechatrical Lin Detector. Mode • ^Mechanical Line Detector. Model; ^Electronic Line Leak etector el: ^Electronic Line Leak etector Model: ^Tank Overfill/High-level or odel: ^Tank OverfilUHiglrleve or. Mode ^Other, S c' odel in Section E on Pa e 2 pother, S ui . an 1 ' ection.E on pa e 2 Tank ID: Tank ID: ^In Tank Gauging Pro M ^ln-Tank Gauging Probe: 1: ^Annular Space or salt Sensor: Model: ^Annular Space or Vault S or M ^Piping Sump ch Sensor (s): Model: ^Piping Sump/Trench or (s): Model: ^Fill Sump or (s): Model: ^Fill Sump Sensor Model: ^Mec Line Leak Detector. Model: ^Mechanical Leak Detector. Model: ^Electronic Line Leak Detector Model: ^Electroni ine Leak Detector Model: ^Tank Overfill/High-level Sensor: Model: ^Tank erfill/High-level Sensor: Model: ^Other, S ui . and model in Section E on Pa e 2 ^Other, S and model in Section E on Pa e 2 Dispenser ID: 1 -1 Dispenser ID: / ,~` - ! ~ ispenser Containment Sensors: Model: ispenser Containment Sensor(s): Model: hear Valve(s). Shear Valve(s). ^D' er Containment Floa s and Chains ^D' er Containment Floc s and s Dispenser ID: Dispenser ID: ^Dispenser Containment Sensors: Model: ^Dispenser Containment Sensor(s): Model: ^ Sheaz Valve(s). ^ Shear Valve(s). ^Dis user Containment Floa s and Chains ^Dis eraser Containment Floa s and Cha' s Dispenser ID: Dispenser ID: ^Dispenser Containment Sensors: Model: ^Dispenser Containment Sensor(s): Model: ^ Shear Valve(s). ^ Shear Valve(s). ^D' er Contaimnent Floa s and Chains ^D' er Containment Floa s and s *If the facility contains more tanks or dispensers, copy this form Include information for every tank and dispenser at this facility. C. CertlflCatlOII - I certify that the equipment identified in this document was inspected/serviced in accordance with the manafactarers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists), necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the report; (check aU that apply): ,System set-up ~9,Alarm history report Technician Name (Print): -Q~~,,,ctin '~.Cas~ro. , Signature: ~~ a Certification No.: o0 6 t75o b y y License No.: 588 098 Testing Company Name: TAIT ENVIRONMENTAL SYSTEMS Phone No.: (714) 560-8222 Page 1 of 3 03ro1 Monitoring System Certification r Monitoring System Certification j SS#: p583: 3220 MING AVE, BAKERSFIELD, CA 93304 ,Date of TestinglServicing X10/27/2005 D. Results of TestingJSer~icing Software V ersion Installed: Z ~ /.~ _ o Complete the following checldist: ' Yes ~ No* Is the audible alarm o erational? es ~ ' No* Is the visual alarm o ezational? es No* . Were all sensors visuall .ins ected, functionall tested, and confirmed o erationaP? es No* Were all'sensors installed atlowestpoint of secondary containment andpositioned so that other equipmentwill not interfere with their ro er o eration? Yes o* If alarms are relayed to a remote monitoring station.. is all..communicntions equipment (e.g..modem) NIA. operational? No* For pressurized piping systems,. does the turbine automatically.shut down if the piping secondary containment. NIA monitoring system detects a leaf fails to operat ,ores electrically disconnected? Ifyes: which sensors initiate i tS h trd ? Ch tlth t ~r C iti k i hS t nmen ves u own ( a enc ensor penser on a ensors. pos ec a app y) Did you confian positive shut down due to leeks nod sensor`failureldisconaa n? es ~ No. Yes Ido* For' tank systems that. utilize the monitoring system as the primary tank ovesfrll w device. (i.e. no 9 ~ IA mechanical overfill prevention valve is installed, is -the overfill warning alarm visible. and audible at the tank D (6 fill- s and o eratin roe If so, at what ercent oftenk ca a ' doesahe alarmtsi er? ....9'0 Yes"` No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and listthe manufactauer name and model for all r lacement arts in SectionE, below. Yes* o Was liquid found inside any secondary contaimnent systems designed ns dry systems? (Check aI! ihcda~j-J Product• Water. If es describe causes inSection$ below. es No* Was m~onitorin s stem set reviewed to ensure ~ o er'se s? es No* Is allmonitorin a meat o erationa! ex manufacturer's s ecifications? * In Section E below, descr~e how and when these deficiencies were or will be corrected. E. Comments: ! /~(. ( '(~ ~-oG~-y ~ E S ~-~-e,.~- ~ F(~ n ~I- y^c~,( cr ~s i I T l i j I i Page 2 of 3 03A 1 ~SS~~ X0583: 3220 MING AVE, BAKERSFIELD, CA 93304 ~ Date of TestinglServicing: X10/27/2005 ~' ~+'. In Tank Crauging /SIR Equipment: eckthis boxiftank gaugingis used onlyforinventory control heck this box if ao tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: e s N o * Has all input wiring b e en insp a cte d for proper entry and terminatior~ including to sting for ground faults? es ~ No"` Were all tank gauging probesvisuellyinspectedfordamageandresiduebuildup? es No* Was accuracy of system product level readings tested? es No* Was accuracy of system water level readings tested? es No* Were all probesreinstelledproperly? es No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, descr~e :how and when these.de5ciencies were or will"be corrected. G. Line Leak Detectors (LI,D): ChecltthisboxifLL,Dsarenotinstalled. Complete the. following checklist: s No* For equipment. start-up or "ariauel equipment certification, was.. a -leak. simulated to verily I;I:D perfo;maace7.. NIA (Checkatithatappt~)jSimulntedieekrnte:.gphl; ®O:l gp.h? ®U.2.g.p.h.3 "Notes: " 1. Required"for equipment startrup ceitsficatron end annual ceitification. 2. Unless`mandatedbylocal"agency, ceitifxcation.required onlyfor electronic LLD start-up. Yes No* .Were allLLDs.confinnedoperationaland"accurate within regulatoryrequiremeats? Yes No* Was the to"shag apparatus properly calibrated? es No* For mechanical ILDs,.does the LLD rasirict product Sow if it detects a leak? IA Yes o* Far electronic LI:.Ds, does the turbine automatically shut off if the LLD detects sleek? NIA Yes No* .For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled NIA or disconnected? Yes No* Fox electronic LLDs, does fhe turbine automatically shut off if any portion of the monitoring system malfunctions NIA or fails a test? Yes No* For electronic LLDs, have all accessible wiring comiections beenvisuallyinspected? NfA Yes No* Were all items onthe equipment manufacturer's.maintenence checklist completed? * In the Section H, below, descx~e how and when these deSciencies wane or will be corrected. H. Comments: Page 3 of 3 03A1 SS#: 583: 3220 MING AVE, BAKERSFIELD, CA 93304 Date of Testing/Servicing: '10/27/2005 Monitoring System Certification UST Monitoring Site Plan ::::: o .i~ ~: ~: :::::::::::::::: . ~ ~ .s 9~ i 5: ~ a $-I M ~ ~ . ~ . ~ ® ® ®.. ' ~~ S . . .s~;•ea- d m ~~se,~ns~5 ~'F<<15~v~s~i5ar~ Q'~131~~d~C 5'P.d~sbfs .. . r=~ : :Di5~~5~SoiR3' dv~.~il II~Xi~!'M '. ~ ¢~-s~~ k-•. .o o. 1 .~ . ~.r/ . .. . 0 . .~ . . 0.... . . Instructions If you already have a diagram that shows all required information, you may include ii; rather than this page, with your Monitoring System Certification. On your site plan; show the general layout of tanks and piping. .Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this. Site Plan was prepared. Page ~_ o~ 05A0 BP West Coast Products, LLC Electronic Leak Detector Test Data Sheet SS#: 0583 Address: 3220 MING AVE BAICERSFIELD, CA 93304 Date: 10/27/2005 Test Information 1 2 3 .4 5 Product '~ °p ~ 4 Manufacturer VR.- ~/ (~ Model c~ Line Bleed Back (ml) ~-. •--- . ^--~ Check Valve Holding Pressure (psi) ---- --- Test Leak Rate (mUmin) (gph) ou, / ff9~i/I 1 u.~ PASS or FAIL 45 5 4,5 5 X74,¢5 S . Comments: This letter certifies that the annual leak detector tests -were performed at the above referenced facility according to the equipment manufacturers procedures and limitations and the results as listed are to my knowledge true and correct. The mechanical leak detector test pass/fail is determined using a low flow threshold trip rate of 3 gph at 10 PSI. Inspected By: Contractor: Tait Environmental Systems Technician Signature: r SWF{CB, January 2002 Page l of 'ZZ r, Secondary Containment Testing Report Form 7]ais form is intendedfor use by coniractars performingperiodic testing of UST secondary contcainmerit systems. Use the appropriatep~ages of this form to report results for a!! components tested The compietedform„ written testproc¢c~,aes, and prir~oelis from tests (~f'applicable), shoreId be provided to fhe facility owner/cperator,for submittal in Hze Ioca! regr,~latory agency. 1. FACILITY INFORMATION SS#: 0583 Facility Name: BP West Coast Products, LLC Date ofTesting: ! O - z~7 - o S Facility Address: 3220 MING AVE City: BAKERSFIELD Zip: 93304 Facility Contact: ~ --~ Gam.. ~~ Phone: ~ ; ! ~ O S'~ z/ Date LocalAgencyV~lasNotifiedofTesting: ~j Name of Local Agency Inspector (ifpresenf during festirtgJ: !J - ~ Z. TESTING CONTRACTOR INFORMATION CompanyName: TAIT ENVIRONMENTAL SYSTEMS Technician Conducting Test: ~-;~,v~~,~ ~ -- Credentials: ~CSLH Licensed Contractor CSWRCB LicensedTnnkTester - " ' - - License Type: A ASB HAZE C10 License Number. 588098 Manufacturer Trafnin~ -~ _ Manufacturer - ~ ~ Co on s Date Tr ' E ices 3. SZTMIViARY OF TEST RESZTLTS Component Pas: Fail Te:ied Made Component Pass Fail Te:ted Made a~~ ~; ~ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ~S1 F~~~ ^ ^ ^ ^ ^ ^ ^ ~ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^. ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ If hydrostatic testingwas performed, describe what was done with the water after completion of tests: t~~' ~~~ ~~L11/ ~ ~r1~.pN 'CXc_l 5 CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING ~" To tke best of ~aey kxowte~a, tke facts stated in tk/s doeauresnt arcs accarmte axd in fa~tl co~phance wick tegai nsyainemexts Technician's Signature: Dom; ~ ~ -- Z~' - o S SWRCB, January2002 Page 2of~~ I .r 4. 5PILL/OVERFILL CONTAINMENT BOXES SS#~ 0583 nata• 10/27/2005 Facilit is Not Equip ed WithS ilUOverfill Containment Boxes ^ SpilUOverfill Containment Boxes are Preseat, butwere NotTested ^ TestMethod DevelopedBy. ^ Spill BucketMenufacturer ^ Other (Spec2,ty) ustryStandard ^ Professional Engineer TestMethodUsed: ^Pressure 0 Other (S~ec~) ^ Vacuum ~jydrostatic TestEquipmentUsed: ~ Equipment Resolution: S~illBox#~-I,~ S~illBoz~ fj 5j Spill Box#g S~ill Box# Bucket Diameter: ~'~~~ 11 Q (1 ~~\ 1 I Q 1I ~U 1 z 1 ~ ~ ~ 1/ ll Bucket Depth: ~y l N ? ~( ~ ~I ~/ 1 ~ 1 ~~ ~ Wait time between applying pre ssurelvacuumlwater and startin test: ~~ 1~ ~~ ~ ~ fj ~ ~ ~ ~m i~ $•Q~I ~ ~I1 ~~fYl ~ t'l ,~~ ~ ~1 ~M l 1(~ Test start Time: :30 ~ : 3C~ j%3O ~; 3p /:3~ •'3d ; 3d /• 30 Initial Reading (R~: ~ • U (~ • O ~ 'O ~ • O - O (~ - U (9 •O • (J Test End Time: 2?3(~ : 30 Z: 3o Z:3v Z: 3o Z= 3U Z= 3v Z- 30 Final Reading (Rg) : ~ • U , c~ ~ • V (~ - o (~ • p (~ - O (~ _ p - D Test Duration: ~ ~-{ ~. ~. ~ ~ ~. fL ~ (L Change is Reading(Rp-R~: o ~ ~ d O O C~ C~ PassJFail Threshold or Criteria `Q ~- 5 5 - 4 55 ~4 S S ~ S S 4, S S pq $ S ~45 5 ~4 S S Test Re:ult w.. ~ _ .. .: ~ ~ - _ _..: - ~. ass Pass F~ .. .• ... _ ass .: ,<.... ~-`~S ?'4'55 P~ 55 (~c 55 Comments - (include information on repairs made prior to testing and recommended follow-t,g~ for failed tests) City of Bakersfield Fire & Prevention Services ~ M~ Address . 3 ~- a / n ~ ~ Business Name: ~l~'~ ~a~/0 ~ Aboveground Tank Business Plan Hazardous Waste Mitigation NLIB Sprinkler & Alarm Pla Underground Tank Other: Delta MicroImaging, Inc 9961 N Lower Sacramento Rd Stockton, CA 95210 1-209-478-3600