HomeMy WebLinkAboutBUSINESS PLAN 2007
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I I: ARCO - AMlPM
I A~. 2698 MT. VERNON
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.UNIFIED PROGRAM INSPECTION CHECKLIST
. Prevention Services
D 900 Truxtun.Ave.;'Suite 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 872-2171
.-;..SECTI.ON 1:~ Business Plan and Inventory Program
.-"
FACILITY CONTACT
uS A-~\..
UC-f'tflOf;
TE niiSPECTION TIME
j (:17
P~l).~. 58 G.:;).
BUSINESS ID NUMBER
15-021-
C v (C comPlianCe)
V=Violation
W 0 ApPROPRIATE PERMIT ON HAND
nv1S Business PLAN CONTACT INFORMATION ACCURATE
OPERATION
COMMENTS
Jt
.Q..o \" (,lA- Ad--. 13
o VISIBLE ADDRESS
CORRECT OCCUPANCY
VERIFICATION OF INVENTORY MATERIALS
~ VERIFICATION OF LOCATION
VERIFICATION OF QUANTITIES
o PROPER SEGREGATION OF MATERIAL
.~ VERIFICATION OF MSDS AVAILABILITY
~ VERIFICATION OF HAZ MAT TRAINING
VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
EMERGENCY PROCEDURES ADEQUATE
CONTAINERS PROPERLY LABELED
HOUSEKEEPING
FIRE PROTECTION
SITE DIAGRAM ADEQUATE & ON HAND
DYES
-rfNO
ANY HAZARDOUS WASTE ON SITE?
EXPLAIN:
PLEASE CALL US AT (661) 326-3979
White - Prevention Services
Yellow - StatioD Copy
Pink - Business Copy
FD 2155 (Rev. 09/05
"
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INSPECTIONS
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
BUS}NESS PLAN &
INVENTORY PROGRAM
UNIFIED PROGRAM INSPECTION CHECKLIST
Page 1 of 1
FACILITY NAME: -''^t. Ul t'NI1N t- fO~6S AIM. Ptltl
INSPECTION DATE: ~
Section 2: Underground Storage Tanks Program
o Routine ~ombined 0 Joint Agency 0 Multi-Agency
Type of Tank Number of Tanks
Type of Monitoring Type of Piping
o Complaint
ORe-Inspection
OPERA TION
C V
COMMENTS
Monitoring record adequate and current
Maintenance records adequate and current
Failure to correct prior UST violations
Has there been an unauthorized release?
Proper tank data on file
Proper owner I operator data on file ~ec.-- No
Permit fees current
Certification of Financial Responsibility
DYes
No
Section 3: Aboveground Storage Tanks Program
Aggregate Capacity
Number of Tanks
Tank Size(s)
Type of Tank
OPERATION y N COMMENTS
SPCC available I
SPCC on file with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?)
If yes, does tank have overfill I overspill protection?
C = Compliance V = Violation Y = Yes N = No
Inspector:
~.~
Questions regarding this inspection? Please call us at (661) 326-3979
White - Prevention Services
Pink - Business Copy
KBF-7335
FD 2156 (Rev. 09/05)
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.-
246685 ARCO :371
2698 r.-JT "./EF~N@N
BAKEF~SF I ELD ~=;A
A04 707 45t;051~0 1
.~ .
,JUL 24. 200"7 9: 52 An
S.'!E3TEr"l STATUS REPOF:T
ALL FUNCT I ONF5 NORr..lI-\L
INVENTOR'! REPORT
T 1: 87 REG U NL
VOLUr..1E 14DDt! GAUl
ULU~GE 55'37 GALS
90% ULLAGE= 3726 GALS
TC VOLUME 13E: 14 GALS
HE I GHT 77 . 84 I 1.,ICHEt:~
["'JATER '~IOL 19 GALS
I,JATER iJ . 79 I NCHEt:~
TEr"lP 79 . S'DEG F
T 2: 91 PRH.l
VOLUr"lE
ULLAGE
90% L{LLAGE=
TC \lOLUr"'lE =
HEIGHT '
["'JATER \lOL
, WATER
TEI''lP
UNL
7480 GALS
4-:369 GALS
:3184 CALS
7:373 GALS
70.D7 INCHES
o GALS
O.DO INCHES
:30.:3 DEG F
""-"";?:~~NI-h':oi,""~-,-*:",,,::,,:_,,_.;;!
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-
BUSINESS ACTIVITIES ~}~S
UNIFIED PROGRAM CONSOLIDATED FORM
FACILITY INFORMATION
Page] of -
I.F ACILITY IOENTlFICA TlON
FACILITY JD # 11 I 5 I, I 0 1 2 II I I 0 I 2 I 6 I 5 I I I 1.1 EPA ID # (Hazardous Waste Only) 2
CALOOO226017
BUSINESS NAME (Same as Facility Name or DBA - Doing Business As)
ARCO # 00371
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, please complete these pages of the UPCF...
A. HAZARDOUS MATERIALS
I-lave 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 HAZARDOUS MATERIALS IN VENTOR Y
(include liquids in ASTs and USTs); or the applicable Federal threshold 1:8:1 YES D NO 4. - 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
ememency plan is required pursuant to 10 CFR Parts 30, 40 or 70'1
B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Formerly SIVRCB FOfm A)
I. Own or operate underground storage tanks') 1:8:1 YES D NO 5 UST TANK (one page per tank) (Formerly Form B)
2. Intend to upgrade existing or install new USTs') DYES [gJ NO 6. UST FACILITY
UST TANK (one per tank)
UST INSTALLATION - CERTIFICATE OF
COMPLIANCE (one page per tank) (Formerly Form C)
3. Need to report closing a UST') DYES 1:8:1 NO 7. UST TANK (closure por1ion- one page per lank)
C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs)
Own or operate ASTs above thesc thrcsholds:
---any tank capacity is greater than 660 gallons, or DYES 1:8:1 NO R. NO FORM REQUIRED TO CUPAs
mthe total capacity for the facility is greater than 1,320 gallons?
D. HAZARDOUS WASTE
I. Generate hazardous waste? [gJ YES D NO EPA ID NUMBER - provide at the top of this
9
page
2. Recycle more than 100 kg/month of excluded or exempted recyclable RECYCLABLE MATERIALS REPORT (one
materials (per H&SC ~25143.2)'? DYES 1:8:1 NO 10. per recycler)
3. Treat hazardous waste on site? ONSITE HAZARDOUS WASTE
DYES 1:8:1 NO I] TREA TMENT - FACILITY (Formerly DTSC
Forms 1772)
ONSITE HAZARDOUS WASTE
TREATMENT - UNIT (one page per unit) (Formerly
DTSC Forms 1772 A.B.C,D and L)
4. Treatment subject to financial assurance requirements (for Permit by DYES 1:8:1 CERTIFICATION OF FINANCIAL
Rule and Conditional Authorization)') NO 12 ASSURANCE (Formerly DTSC Form 1232)
5. Consolidate hazardous waste generated at a remote site') REMOTE WASTE / CONSOLlDA TION
DYES 1:8:1 NO 13. SITE ANNUAL NOTIFICATION (Formerly
DTSC Form 1196)
6. Need to report the closure/removal of a tank that was classified as DYES 1:8:1 NO HAZARDOUS WASTE TANK CLOSURE
hazardous waste and cleaned onsite? 14 CERTIFICA TION (Formerly DTSC Form 1249)
E. LOCAL REQUIREMENTS (You mav also be required to provide additional information bv vour CUPA or local agencv.) 15
ENT'D MAR 2 0 2006
Page I of 16
f
,i' !
UNIFIED PROGRAM CONSOLIDATED FORM
FACILITY INFORMATION
BUSINESS OWNER/OPERATOR IDENTIFICATION
FACILITY ID #
(Agency Use Only)
I. IDENnFICA nON
BEGINNING DATE
11/30/05
ENDING DATE
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As)
ARCO # 00371
BUSINESS SITE ADDRESS
2698 MT VERNON AVENUE
CITY
BAKERSFIELD
DUN & BRADSTREET
03-959-6507
COUNTY
KERN
BUSINESS OPERATOR NAME
MUNTHER M. HAWATMEH
104.
II. BUSINESS OWNER
OWNER NAME
BP West Coast Products LLC
OWNER MAILING ADDRESS
P.O. BOX # 6038
CITY
ARTESIA
]14 STATE
CA
UI.ENVIRONMENT AL CONTACT
] 17
CONTACT NAME
JANET WAGER
CONTACT MAILING ADDRESS
P.O. BOX # 6038
CITY
ARTESIA
BP West Coast Products LLC
]20 STATE
CA
IV. EMERGENCY CONTACTS
-PRIMARY-
NAME
MUNTHER M. HAWATMEH
TITLE
Franchisee
BUSINESS PHONE
(661) 872-5862
24-HOUR PHONE*
(661) 703-7273
PAGER! CELL
(661) 664-8101
ADDITIONAL LOCALLY COLLECTED INFORMA nON:
]23.
Page of
]00
CA
ZIP CODE
93306
SIC CODE (4 digit #)
554]
]06
109
BUSINESS OPERATOR PHONE
(661) 872-5862
I]]
OWNER PHONE
(714) 670-5321
1]5.
ZIP CODE
90702-6038
CONTACT PHONE
(714) 670-5321
12 r.
ZIP CODE
90702-6038
-SECONDARY-
124
NAME
ARCO CUSTOMER SOLUTIONS CENTER
TITLE
]25.
BUSINESS PHONE
800-272-6349
24-HOUR PHONE'
800-272-6349
]26
]27
]01.
102
103.
105.
107
108.
] ]0.
] 12
113
] ]6
]] 8
1 ]9
122.
128.
129.
130.
131.
132.
133
SIG
Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certity under penalty of law that I have personally examined and
am familiar with the information submitted and believe the information is true, accurale, and complete.
136.
MUNTHER M. HAWATMEH
Franchisee
Page 2 of 16
NAME OF DOCUMENT PREPARER
Belshire Environmental Services, Inc.
135
137
c;:
UNIFIED PROGRAM (UP) FORM
HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION
Indicate materia/ OR waste ( Do not combine materia/and waste on oneform) [8J MA TERIAL(NON-W ASTE)
D WASTE
(one page per material per building or area)
DADD
DDELETE
200
Page
of
IXlREVISE REPORTING YEAR 2005
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As)
ARCO # 00371
CHEMICAL LOCATION
CHEMICAL LOCATION CONFIDENTIAL
(EPCRA ) 0 YES I:8l NO
202
FACILITY ID #
1 of 1
II. CHEMICAL INFORMATION
CHEMICAL NAME 205 TRADE SECRET 0 Yes ~ No
GASOLl N E If Subject to EPCRA, refer to instructions
COMMON NAME GASOLINE 207 EHS* 0 Yes ~ No
CAS# 8006-61-9 209 *If EHS is "Yes", all amounts below must be in Ibs.
FIRE CODE HAZARD CLASSES (Complete if required by CUPA) FLAMMABLE LIQUID, CLASS 1 B, UN1203
203 GRID# (optional)
C7 - F8
204
206
208
210
HAZARDOUS MATERIAL
TYPE (Check one item only)
PHYSICAL STATE
(Check one item only)
FED HAZARD CATEGORIES
(Check all that apply)
AVERAGE DAILY AMOUNT
213
o a. PURE t81b MIXTURE 0 c. WASTE
211 RADIOACTIVE DYes [8JNo
212
CURIES
215
o a. SOLID [ZIb. LIQUID
o c. GAS
214 LARGEST CONTAINER 20,000
216
[8J a. FIRE 0 b REACTIVE 0 c. PRESSURE RELEASE [8J d. ACUTE HEALTH [8J e. CHRONIC HEALTH
221
222
217 MAXIMUM DAILY AMOUNT
218 ANNUAL WASTE AMOUNT
STATE WASTE CODE
220
16,000
32,000
N/A
UNITS*
Check one item onl
STORAGE
CONTAINER
t81a GALLONS Db CUBIC FEET 0 c. POUNDS 0 d TONS
. If EHS, amount must be in ounds.
STORAGE TEMPERATURE
[8J a AMBIENT
De PLASTIC/NONMETALLIC DRUM Oi FIBER DRUM Om GLASS BOTTLE o q. RAIL CAR
o f CAN OJ. BAG On PLASTIC BOTTLE o r. OTHER
o g. CARBOY o k. BOX Do. TOTE BIN
o h. SILO o I. CYLINDER Dp TANK WAGON 223
o b. ABOVE AMBIENT Dc. BELOW AMBIENT 224
o b. ABOVE AMBIENT Dc. BELOW AMBIENT o d CRYOGENIC 225
o a. ABOVE GROUND TANK
[8J b. UNDERGROUND TANK
Dc TANK INSIDE BUILDING
o d. STEEL DRUM
STORAGE PRESSURE
[8J a. AMBIENT
%WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS #
1-5 226 BENZENE 227 DYes I:8l No 228 71-43-2
2 0-10 230 ETHANOL 231 DYes IXl No 232 64-17-5
3 8-15 234 XYLENE 235 DYes I:8l No 236 1330-20-7
4 7-14 238 TOULENE 239 DYes IXl No 240 108-88-3
5 242 243 DYes DNo 244
229
233
237
241
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
Page 3 of 16
,
"
UNIFIED PROGRAM (UP) FORM
HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION
Jlld;c{(/e mater;al OR waste (Do 1I0t combille mater;al alld waste 011 olleform)!ZI MA TERIAL(NON-WASTE)
o WASTE
(one page per material per building or area)
DADO
DDELETE
200
Page
of
[gJREVISE REPORTING YEAR 2005
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As)
ARCO # 00371
CHEMICAL LOCATION
3
CHEMICAL LOCATION CONFIDENTIAL
(EPCRA) 0 YES ~ NO
202
203
GRID# (optional)
204
FACILITY ID #
CHEMICAL NAME
CARBON DIOXIDE
COMMON NAME CARBON DIOXIDE
CAS# 124-38-9
FIRE CODE HAZARD CLASSES (Complete if required by CUPA)
1 of 1
II. CHEMICAL INFORMATION
205 TRADE SECRET
L10
DYes [gJ No
206
If Subject to EPCRA, refer to Instructions
207
209
EHS* DYes [gJ No
*If EHS is "Yes", all amounts below must be in Ibs.
208
HAZARDOUS MATERIAL
TYPE (Check one item only)
210
213
/SI a. PURE Db MIXTURE 0 c. WASTE
211 RADIOACTIVE DYes /SINo
212
CURIES
PHYSICAL STATE
(Check one item only)
FED HAZARD CATEGORIES
(Check all that apply)
AVERAGE DAILY AMOUNT
215
o a SOLID /SIb LIQUID
o c. GAS
214 LARGEST CONTAINER 400
216
o a. FIRE 0 b. REACTIVE /SI c PRESSURE RELEASE IZI d. ACUTE HEALTH 0 e. CHRONIC HEALTH
221
222
217 MAXIMUM DAILY AMOUNT
218 ANNUAL WASTE AMOUNT
STATE WASTE CODE
220
200
400
N/A
UNITS*
Check one item onl
STORAGE
CONTAINER
Da GALLONS Db CUBIC FEET IZI c. POUNDS 0 d. TONS
. If EHS, amount must be in ounds.
STORAGE TEMPERATURE
o a. AMBIENT
De. PLASTICINONMETALLiC DRUM o i. FIBER DRUM Om GLASS BOTTLE o q. RAIL CAR
o f CAN o j.BAG On PLASTIC BOTTLE o r. OTHER
o g. CARBOY o k. BOX DO. TOTE BIN
o h. SILO /SII. CYLINDER Dp TANK WAGON 223
/SI b. ABOVE AMBIENT Dc. BELOW AMBIENT 224
o b. ABOVE AMBIENT Dc. BELOW AMBIENT /SI d. CRYOGENIC 225
o a. ABOVE GROUND TANK
Db. UNDERGROUND TANK
Dc. TANK INSIDE BUILDING
o d. STEEL DRUM
STORAGE PRESSURE
o a AMBIENT
%WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS #
100 226 CARBON DIOXIDE 227 DYes [gJ No 228 124-38-9
2 230 231 DYes o No 232
3 234 235 DYes 0 No 236
4 238 239 DYes DNo 240
5 242 243 DYes ONo 244
229
233
237
241
245
If more hazardous components are present at greater than 1 % by wei9ht if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required
information.
ADDITIONAL LOCALLY COLLECTED INFORMATION
246
Page 4 of 16
UNIFIED PROGRAM (UP) FORM
HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION
Indicate material OR waste ( Do not combine material and waste Oil oneform) 0 MA TERIAL(NON-WASTE)
~ WASTE
DADO
DDELETE
!8JREVISE REPORTING YEAR 2005
I. F ACILlTY INFORMATION
(one page per material per building or area)
200 Page of
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As)
ARCO # 00371
CHEMICAL LOCATION
CHEMICAL LOCATION CONFIDENTIAL
(EPCRA) 0 YES ~ NO
203 GRID# (optional)
E12
FACILITY ID #
1 of 1
II. CHEMICAL INFORMATION
CHEMICAL NAME
WASTE ABSORBENT & DISPENSER FUEL FILTER
COMMON NAME WASTE ABSORBENT & DISPENSER FUEL FILTER
CAS# Nt A
FIRE CODE HAZARD CLASSES (Complete If required by CUPAI
205
DYes [8J No
TRADE SECRET
If Subject to EPCRA, refer to instructions
207
EHS* 0 Yes [8J No
*If EHS is "Yes", all amounts below must be in Ibs.
209
HAZARDOUS MATERIAL
TYPE (Check one item only)
211 RADIOACTIVE DYes IZINo
212
CURIES
o a. PURE Db MIXTURE IZI c WASTE
PHYSICAL STATE
(Check one item only)
FED HAZARD CATEGORIES
(Check all that apply)
AVERAGE DAILY AMOUNT
IZI a. SOLID Db LIQUID
DeGAS
214 LARGEST CONTAINER 55
IZI a. FIRE 0 b. REACTIVE 0 c. PRESSURE RELEASE IZI d. ACUTE HEALTH IZI e CHRONIC HEALTH
25
55
55
217 MAXIMUM DAILY AMOUNT
218 ANNUAL WASTE AMOUNT
STATE WASTE CODE
221
UNITS'
Check one item onl
STORAGE
CONTAINER
lZIa. GALLONS
Db. CUBIC FEET 0 c. POUNDS 0 d. TONS
. If EHS. amount must be in ounds.
De. PLASTIC/NONMETALLIC DRUM
o f CAN
o g. CARBOY
o h. SILO
o b. ABOVE AMBIENT
o a ABOVE GROUND TANK
o b UNDERGROUND TANK
Dc TANK INSIDE BUILDING
IZI d. STEEL DRUM
o i FIBER DRUM
OJ. BAG
o k. BOX
o I. CYLINDER
o m. GLASS BOTTLE
o n. PLASTIC BOTTLE
o o. TOTE BIN
o p. TANK WAGON
o q. RAIL CAR
o r. OTHER
STORAGE PRESSURE
IZI a. AMBIENT
o c. BELOW AMBIENT
STORAGE TEMPERATURE
IZI a. AMBIENT
o b. ABOVE AMBIENT
o d. CRYOGENIC
o c. BELOW AMBIENT
%WT
HAZARDOUS COMPONENT (For mixture or waste only)
MIXTURE OF SILCA TE & HYDROCARBONS
& SPENT FUEL FILTERS
228
NtA, MIXTURE
EHS
CAS #
DYes [8J No
89-90 226
227
2
230
231 DYes 0 No
232
3
234
235 0 Yes 0 No
236
4
238
239 DYes D No
240
5
242
243 DYes ONo
244
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
Page 5 of I 6
3
202
204
206
208
210
213
215
216
220
222
223
224
225
229
233
237
241
245
246
UNIFIED PROGRAM (UP) FORM
HAZARDOUS MATERIALS INVENTORY FORM - CHEMICAL DESCRIPTION
Indicate materia/ OR waste ( Do not combine materia/and waste on oneform) 0 MA TERIAL(NON-WASTE)
[2J WASTE
(one page per material per building or area)
DADD DDELETE [8JREVISE REPORTING YEAR 2005 200 I Page of
I. FACILITY INFORMATION
BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3
ARCO # 00371
CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202
INSIDE TRASH ENCLOSURE (EPCRA ) DYES ~ NO
II I 5 li:liii:ii:1 0 I 2 II 012 I 6 I 5 I I . MAP# (optional) 2031 GRID# (optional) 204
FACILITY ID # 1 of 1 E12
II. CHEMICAL INFORMATION
CHEMICAL NAME 205 TRADE SECRET DYes [8J No 206
WASTE FLAMMABLE LIQUID If Subject 10 EPCRA, reter to Instructions
COMMON NAME WASTE FLAMMABLE LIQUID 207 EHS* DYes [8J No 208
CAS# Nt A 209 *If EHS is "Yes", all amounts below must be in Ibs.
FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210
HAZARDOUS MATERIAL 212 I CURIES 213
TYPE (Check one item only) o a. PURE Db MIXTURE !ZI c. WASTE 211 RADIOACTIVE DYes !ZI No
PHYSICAL STATE 215
(Check one item only) o a SOLID !ZIb LIQUID o c GAS 214 LARGEST CONTAINER 55
FED HAZARD CATEGORIES 216
(Check all that apply) !ZIa FIRE D b. REACTIVE D c PRESSURE RELEASE !ZI d. ACUTE HEALTH !ZIe CHRONIC HEALTH
AVERAGE DAILY AMOUNT 2171 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 2191 STATE WASTE CODE 220
25 55 55 134
221 I DAYS ON SITE: 222
UNITS' !ZIa. GALLONS Db CUBIC FEET o c. POUNDS o d. TONS 365
(Check one item only) . If EHS, amount must be in pounds.
STORAGE
CONTAINER o a. ABOVE GROUND TANK o e. PLASTIC/NONMETALLIC DRUM o i. FIBER DRUM Om GLASS BOTTLE o q. RAIL CAR
Db. UNDERGROUND TANK o f CAN o j.BAG On PLASTIC BOTTLE o r. OTHER
o c. TANK INSIDE BUILDING o g. CARBOY o k. BOX Do TOTE BIN
!ZI d STEEL DRUM o h. SILO o I. CYLINDER Dp. TANK WAGON 223
STORAGE PRESSURE 181 a. AMBIENT Db ABOVE AMBIENT Dc. BELOW AMBIENT 224
STORAGE TEMPERATURE 181 a. AMBIENT o b. ABOVE AMBIENT Dc BELOW AMBIENT o d CRYOGENIC 225
%WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS #
89-90 226 MIXTURE OF GASOLINE & WATER OR o Yes ~ No NtA, MIXTURE
1 OTHER CONT AMINA TION IN GASOLINE 227 228 229
2 230 231 DYes D No 232 233
3 234 235 DYes 0 No 236 237
4 238 239 DYes DNo 240 241
5 242 243 DYes DNo 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
Page 6 of 16
CUPA
Bakersfield Fire Department. Hazardous Materials Division
2101 H Street Bakersfield, CA 93301 (661) 326-3911
I ·
" ,'_.":
UNIDERGRotiND~;rQR;AGE'rANK:s:ij.~Gll..IJY .
,.':,:'H.;_ ".".~,; ':'__,-_-/:,.' _.>.;',~__::,,-.,,< ,j,_,_: -,':,::~,,,~_;'J--y-;<i/_:',' .;:,-,~-,__-:-:::~,:",>".;: ., --,';;':A->.<_-,_'~-_"__ _ :.,.,.,'(',:", ,'~,_
o 1. NEW SITE PERMIT 0 3 RENEWAL PERMIT ~
o 4 AMENDED PERMIT
D
,. .>' ;.~;;-:.
o 7. PERMANENTLY CLOSED SITE
o 8. TANK REMOVED
TYPE OF ACTION
(Check one item only)
5
2698 MT VERNON AVENUE
BAKERSFIELD
ZIP CODE 93306
NEAREST CROSS STREET
Columbus Street
FACILITY OWNER TYPE
0 4 LOCAL AGENCYIDISTRICT'
0 5. COUNTY AGENCY'
D 6. STATE AGENCY'
D 7 FEDERAL AGENCY' 402
2
404
o 5. COMMERCIAL
o OTHER 403
*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 for the tank records)
JANET WAGER
11:\':r~NKOF\~R~T0RJNFORM~;!;lb.N~
\W,>,~", "r?.t ----"o-y;':;/(;; ---',/:< ':: 'if, ,'.J' "t2. -' ,-\y;,.;_-~,
MUNTHER M. HAWATMEH
IZI 1. CORPORATION
D 2. INDIVIDUAL
o 3. PARTNERSHIP
BUSINESS
TYPE
~ 1. GAS STATION D 3 FARM
o 2. DISTRIBUTOR 0 4. PROCESSOR
TOTAL NUMBER OF Is facility on Indian Reservation or
TANKS ON SITE trustlands?
TANK OPERATOR TYPE
D 1. CORPORATION
o 4.
D
!II..T~~K OMVNERINFORI'JJAtloN..
[8J 2. INDIVIDUAL
D 3. PARTNERSHIP
413
TANK OPERATOR NAME
TANK OWNER NAME BP West Coast Products, LLC
414
415
MAILING ADDRESS 4 Centerpointe Drive
416
CITY
La Palma
417
ZIP CODE 90623 419
TANK OWNER TYPE
IZI 1. CORPORATION D 2. INDIVIDUAL
o 3. PARTNERSHIP
R.i~. i......IE).......:..QFEeilJ~L1~tlQN':US+.SJ;dRP;. :G...............~..'...........'.E.......'..
nJ:f:':~:,:::','- '~,:c:WAtt4~,_:,,:, .:.(:}:,.::: :";:;:,)}::;:::. --,,:::::t~<::::, __:-)"4i@i:Witf&fi?
465
420
DATE
424
11/30/05
PHONE (714) 670-5321
TITLE OF APPLICANT Environmental Compliance Specialist
428
1998 UPGRADE CERTIFICATE NUMBER (For local use only)
429
Page 7 of 16
,~~.
CUPA
Bakersfield Fire Department. Hazardous Materials Division
2101 H Street Bakersfield, CA 93301 (661) 326-3911
TYPE OF ACTION
(Check one item only)
181 5. CHANGE OF INFORMATION
o 6. TEMPORARY SITE CLOSURE
o 7. PERMANENTLY CLOSED ON SITE
o B. TANK REMOVED 430
o 1. NEW SITE PERMIT 0 4. AMENDED PERMIT
o 3. RENEWAL PERMIT
FACILITY 10 #
5
BUSINESS ADDRESS
2698 MT VERNON AVENUE
LOCATION WITHIN SITE (Optional)
(Specify reason - for local use only
o
(SpeCify change - for local use only)
BUSINESS NAME (Same as FACILITY NAME or DBA)
3
2
6 5
ARCO# 00371
CITY
ZIP CODE
BAKERSFIELD
93306
431
TANKID# 1
432
DATE INSTALLED (YEAR/MO) 2000107
435
ADDITIONAL DESCRIPTION
TANK MANUFACTURER
Xerxes
TANK CAPACITY IN GALLONS 20,000
433
COMPARTMENTALIZED TANK 0 Yes 181 No
If 'Yes", complete one page for each compartment.
434
436
NUMBER OF COMPARTMENTS 1
437
438
440
TANK USE 439
181 1. MOTOR VEHICLE FUEL
(If marked, complete Petroleum Type)
o 2. NON-FUEL PETROLEUM
o 3. CHEMICAL PRODUCT
o 4. HAZARDOUS WASTE (Includes
Used Oil)
PETROLEUM TYPE
18I1a. REGULAR UNLEADED
o 1b. PREMIUM UNLEADED
o 1c. MID-GRADE UNLEADED
o 2. LEADED
o 3. DIESEL
o 4. GASOHOL
GASOLINE
COMMON NAME (from Hazardous Materials Inventory page)
o 5. JET FUEL
o 6. AVIATION FUEL
o 99. OTHER
441
CAS # (from Hazardous Materials Inventory page)
8006-61-9
442
TYPE OF TANK
01. SINGLE WALL
I:8J 2. DOUBLE WALL
443
(Check one item only)
TANK MATERIAL - primary tank
o 1. BARE STEEL
o 2. STAINLESS
STEEL
o 1. BARE STEEL
o 2. STAINLESS
STEEL
(Check one item only)
TANK MATERIAL - secondary tank
(Check one item only)
TANK INTERIOR LINING
OR COATING
o 1. RUBBER LINED
o 2. ALKYD LINING
(Check one item only)
o 3. SINGLE WALL WITH
EXTERIOR MEMBRANE LINER
04. SINGLE WALL IN A VAULT
1813. FIBERGLASS I PLASTIC
o 4. STEEL CLAD WI FIBERGLASS
REINFORCED PLASTIC FRP
I:8J 3. FIBERGLASS I PLASTIC
o 4. STEEL CLAD WIFIBERGLASS
REINFORCED PLASTIC (FRP)
o 5. CONCRETE
o 3. EPOXY LINING
o 4. PHENOLIC LINING
OTHER CORROSION
PROTECTION IF APPLICABLE
(Check all that apply)
SPILL AND OVERFILL
o 1. MANUFACTURED CATHODIC
PROTECTION
o 2. SACRIFICIAL ANODE
o 3. FIBERGLASS REINFORCED PLASTIC
o 4. IMPRESSED CURRENT
(For local use only)
(Check all that apply)
YEAR INSTALLED
I:8J 1. SPILL CONTAINMENT
[8J 2. DROP TUBE
[gI3. STRIKER PLATE
450
TYPE (For local use only) 451
o 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM
o 95. UNKNOWN
o 99. OTHER
o 5. CONCRETE
o 8. FRP COMPATIBLE W/100% METHANOL
o 95. UNKNOWN
o 99. OTHER
444
2000
2000
2000
o B. FRP COMPATIBLE W/100% METHANOL
o 9. FRP NON-CORRODIBLE JACKET
o 10. COATED STEEL
o 95. UNKNOWN
o 99. OTHER
445
o 5. GLASS LINING
[gI 6. UNLINED
o 95. UNKNOWN
o 99. OTHER
446 DATE INSTALLED
447
o 95. UNKNOWN
o 99. OTHER
(For local use only)
448 DATE INSTALLED 449
OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452
03. FILL TUBE SHUT OFF VALVE
o 4. EXEMPT
I:8J 1. ALARM
1812. BALL FLOAT
IF SINGLE WALL TANK (Check all that apply):
o 1. VISUAL (EXPOSED PORTION ONLY)
o 2. AUTOMATIC TANK GAUGING (ATG)
o 3. CONTINUOUS ATG
o 4. STATISTICAL INVENTORY RECONCILIATION (SIR) +
BIENNIAL TANK TESTING
453
o 5. MANUAL TANK GAUGING (MTG)
o 6. VADOSE ZONE
o 7. GROUNDWATER
o B. TANK TESTING
o 99. OTHER
IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): 454
o 1. VISUAL (SINGLE WALL IN VAULT ONLY)
[gI 2. CONTINUOUS INTERSTITIAL MONITORING
o 3. MANUAL MONITORING
ESTIMATED QUANTITY OF SUBSTANCE REMAINING
gallons
Page 8 of 16
TANK FILLED WITH INERT MATERIAL?
. 0 Yes 0 No
CUPA
Bakersfield Fire Department. Hazardous Materials Division
2101 H Street Bakersfield, CA 93301 (661) 326-3911
.lJNDER~:RO,W^Nt>::SlJ::>R'~GE;iAN~Sf":,T'ANkRA~62,
.-:_ '...,' .:",:",:"" ,oj. ';~<;,,,-,- _c__ .C,,',';-,..' ;.:-__'_'_ ./_:>~ "_',>__ . ',-- ," ',,":...',-'1'/,",-
,'/
",,',
.'~LRjRING. CONSmRUCTION (Chec~ ailtha!:gp;'ly)
UNDERGROUND PIPING
[8J 1. PRESSURE 02. SUCTION 03. GRAVITY 458 01. PRESSURE SUCTION 03. GRAVITY
o 1. SINGLE WALL 0 3. LINED TRENCH 0 99. OTHER 460 0 1. SINGLE WALL 0 95. UNKNOWN
CONSTRUCTION/ [8J 2. DOUBLE WALL 095. UNKNOWN 02. DOUBLE WALL. 099. OTHER
MANUFACTURER
MANUFACTURER: AO. SMITH MANUFACTURER 463
01. BARE STEEL [8J 6. FRP COMPATIBLE WI 100% METHANOL 01. BARE STEEL 06. FRP COMPATIBLE W/100% METHANOL
02. STAINLESS STEEL 07. GALVANIZED STEEL 02. STAINLESS STEEL 07. GALVANIZED STEEL
o 3. PLASTIC COMPATIBLE WITH CONTENTS 0 95. UNKNOWN 0 3. PLASTIC COMPATIBLE WITH CONTENTS 0 8. FLEXIBLE (HOPE) 099. OTHER
[8J 4. FIBERGLASS 08. FLEXIBLE (HOPE) 099. OTHER 04. FIBERGLASS 0 9. CATHODIC PROTECTION
05 STEEL W/ COATING 09. CATHODIC PROTECTION 464 05. STEEL W/ COATING 095. UNKNOWN
..'., 'f/;I L P I PI NGH"E;~~';RE;TE;J}ml,~~!i9.b~f}<i3JI th'a/'apply)( ai:i~CripiiO(/ 6:rtlie,!hoiJiiaril1g'p/8~?Fri;~Hair6e,'siJbinitt@!ti5;th~1iq'f'8li"'$gel1c/)i:YH!(' ..
UNDERGROUND PIPING ABOVEGROUND PIPING
SINGLE WALL PIPING 466 SINGLE WALL PIPING
PRESSURIZED PIPING (Check all that apply) PRESSURIZED PIPING (Check all that apply)
o 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR 0 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
o 2. MONTHLY 0.2 GPH TEST 0 2 MONTHLY 0.2 GPH TEST
o 3. ANNUAL INTEGRITY TEST (0 1 GPH) 0 3 ANNUAL INTEGRITY TEST (0.1 GPH)
o 4 DAILY VISUAL CHECK
SYSTEM TYPE
MATERIALS AND
CORROSION
PROTECTION
(check all that
apply)
CONVENTIONAL SUCTION SYSTEMS
o 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY
TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING)
o 7 SELF MONITORING
GRAVITY FLOW
o 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)
o a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
[8J b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM
DISCONNECTION
o c NO AUTO PUMP SHUT OFF
[8J 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR
RESTRICTION
o 12. ANNUAL INTEGRITY TEST (0.1 GPH)
SUCTION/GRAVITY SYSTEM:
o 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 (30 GPH TEST) WITHOUT FLOW SHUT OFF OR
RESTRICTION
ANNUAL INTEGRITY TEST
DAILY VISUAL CHECK
459
462
465
467
CONVENTIONAL SUCTION SYSTEMS
o 5 DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM
o 6. TRIENNIAL INTEGRITY TEST (0 1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING)
o 7. SELF MONITORING
GRAVITY FLOW
o 8 DAILY VISUAL MONITORING
o 9. BIENNIAL INTEGRITY TEST (01 GPH)
SECONDARILY CONTAINED PIPING
PRESSURIZED PIPING (Check all that apply).
10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND
(Check one)
o a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
o b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM
DISCONNECTION
o c. NO AUTO PUMP SHUT OFF
o 11. AUTOMATIC LEAK
o 12. ANNUAL INTEGRITY TEST (0.1 GPH)
SUCTION/GRAVITY SYSTEM
o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS
EMERGENCY GENERATORS ONLY (Check all that apply).
o 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF + AUDIBLE AND
VISUAL ALARMS
o 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST
o 16. ANNUAL INTEGRITY TEST
o 17. DAILY VISUAL CHECK
FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE
CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS
CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS
o 4. DAILY VISUAL CHECK
o 5. TRENCH LINER / MONITORING
o 6. NONE 469
IXiiibWNERlQRERATQBI$JGN~J:CJRE'f!j;futilf;i;>:
y knowledge.
JANET
Revised 6/11/2002
471
DATE
11/30/05
TITLE OF OWNERIOPERATOR
Environmental Compliance Specialist
472
470
Page 9 of 16
"
.'
/'
CUPA
Bakersfield Fire Department. Hazardous Materials Division
2101 H Street Bakersfield, CA 93301 (661) 326-3911
I:
TYPE OF ACTION
(Check one Item only)
o 1 NEW SITE PERMIT
o
....UNDERGRQl1NDSTO~AGEt~NkS;- TANkf?A(3E;:1
o 4. AMENDED PERMIT ~ 5. CHANGE OF INFORMATION 0 6. TEMPORARY SITE CLOSURE
o 7. PERMANENTLY CLOSED ON SITE
o 8. TANK REMOVED
FACILITY 10 #
5
BUSINESS ADDRESS
2698 MT VERNON AVENUE
RENEWAL PERMIT
(Specify change - for local use only)
430
(Specify reason - for local use only
93306
BUSINESS NAME (Same as FACILITY NAME or DBA)
3
o
2
6
5
ARCO# 00371
CITY
ZIP CODE
BAKERSFIELD
LOCATION WITHIN SITE (Optional) 431
DATE INSTALLED (YEAR/MO) 2000107
ADDITIONAL DESCRIPTION
TANK USE
12] 1 MOTOR VEHICLE FUEL
(If marked, complete Petroleum Type)
o 2 NON-FUEL PETROLEUM
o 3 CHEMICAL PRODUCT
04
(Check one item only)
TANK MATERIAL - primary tank
(Check one item only)
TANK MATERIAL - secondary tank
(Check one item only)
TANK INTERIOR LINING
OR COATING
(Check one item only)
OTHER CORROSION
PROTECTION IF APPLICABLE
(Check all that apply)
SPILL AND OVERFILL
(Check all that apply)
435
439 PETROLEUM TYPE
:T:~~.K(.~~$.C;RI Fltl~N,.:::"...:":j..j:~;rjet::;jjji;~<;:~,~;;;;;~:"-
s stemincluding:6..,;!idin' s and landmarks shall be subinilted!otfie}0<381 agenc 'I)
TANK MANUFACTURER 433 COMPARTMENTALIZED TANK 0 Yes ~ No 434
If "Yes", complete one page for each compartment
TANK CAPACITY IN GALLONS 12,000
436
NUMBER OF COMPARTMENTS
437
TANISi;,C0NJ:ENTS:,
438
o 2. LEADED
o 3 DIESEL
o 4 GASOHOL
o 5 JET FUEL
o 6. AVIATION FUEL
o 99. OTHER
o 1a REGULAR UNLEADED
[8] 1b PREMIUM UNLEADED
o 1c. MID-GRADE UNLEADED
GASOLINE
COMMON NAME (from Hazardous Materials Inventory page)
442
o 1. SINGLE WALL
[8] 2. DOUBLE WALL
o 1. BARE STEEL
02. STAINLESS
STEEL
o 1. BARE STEEL
02. STAINLESS
STEEL
01. RUBBER LINED
o 2. ALKYD LINING
441
CAS # (from Hazardous Malerials Inventory page)
8006-61-9
III. TANKA30NSTRUCTION"
o 3. SINGLE WALL WITH 0 5 SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443
EXTERIOR MEMBRANE LINER 0 95. UNKNOWN
04 SINGLE WALL IN A VAULT 0 99. OTHER
[8] 3 FIBERGLASS I PLASTIC 0 5. CONCRETE 0 95. UNKNOWN 444
04 STEEL CLAD WI FIBERGLASS 0 8. FRP COMPATIBLE W/100% METHANOL 0 99. OTHER
REINFORCED PLASTIC (FRP)
~ 3. FI8ERGLASS I PLASTIC 0 8. FRP COMPATIBLE W/100% METHANOL 0 95. UNKNOWN 445
o 4. STEEL CLAD W/FIBERGLASS 0 9. FRP NON-CORRODIBLE JACKET 0 99. OTHER
REINFORCED PLASTIC (FRP) 0 10. COATED STEEL
o 5. CONCRETE
o 3. EPOXY LINING 0 5. GLASS LINING 0 95. UNKNOWN 446 DATE INSTALLED 447
o 4. PHENOLIC LINING [8J 6. UNLINED 0 99. OTHER
o 3. FIBERGLASS REINFORCED PLASTIC
o 4. IMPRESSED CURRENT
(For local use only)
448 DATE INSTALLED 449
01. MANUFACTURED CATHODIC
PROTECTION
o 2. SACRIFICIAL ANODE
YEAR INSTALLED
[8J 1. SPILL CONTAINMENT
~ 2. DROP TUBE
[8] 3. STRIKER PLATE
IF SINGLE WALL TANK (Check all that apply);
o 1. VISUAL (EXPOSED PORTION ONLY)
o 2 AUTOMATIC TANK GAUGING (ATG)
12] 3 CONTINUOUS ATG
o 4. STATISTICAL INVENTORY RECONCILIATION (SIR) +
BIENNIAL TANK TESTING
o 95. UNKNOWN
o 99. OTHER
(For local use only)
450
TYPE (For local use only) 451
OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 452
o 3. FILL TUBE SHUT OFF VALVE
o 4. EXEMPT
2000
12]1. ALARM
[8J 2. BALL FLOAT
2000
2000
453
o 5. MANUAL TANK GAUGING (MTG)
o 6. VADOSE ZONE
o 7. GROUNDWATER
o 8. TANK TESTING
o 99. OTHER
IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only)
o 1. VISUAL (SINGLE WALL IN VAULT ONLY)
[8] 2. CONTINUOUS INTERSTITIAL MONITORING
o 3. MANUAL MONITORING
-::S~~iTAt9K$r..Q$lJ R~::rJfF0RiViA'FIEfN.I p!;RiViAt9~NTQ~0SlJ Rg')NtijL1P:C.Ei'"
455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING
9allons
456 TANK FILLED WITH INERT MATERIAL?
DYes 0 No
457
Page 10 of 16
CUPA
Bakersfield Fire Department. Hazardous Materials Division
2101 H Street Bakersfield, CA 93301 (661) 326-391 I
. UNDERG'ROUND STORAGE TANKS ,.TANKRAG.E2
'~.,,', ',~~~, d"-",,,'" ,". - _' ^,_,,<,<,;\~';,''?2:-_'-:<_.' - IY':(...0U::;O-:----:-'.--,
/'
<"'
'"
I,
SYSTEM TYPE
")'V'J.> F?IPING C:"0Ns'JiRlJc'JilQN (C;;ebk;alithJt~;;iy).
UNDERGROUND PIPING
~1 PRESSURE o 2. SUCTION o 3 GRAVITY 458 o 1. PRESSURE 03 GRAVITY 459
01 SINGLE WALL o 3. LINED TRENCH o 99. OTHER 460 01. SINGLE WALL 095 UNKNOWN 462
~ 2. DOUBLE WALL o 95. UNKNOWN o 2. DOUBLE WALL. 099. OTHER
MANUFACTURER AO. SMITH MANUFACTURER 463
01. BARE STEEL [gJ 6. FRP COMPATIBLE W/100% METHANOL 01. BARE STEEL 06. FRP COMPATIBLE W/100% METHANOL
02. STAINLESS STEEL 07. GALVANIZED STEEL 02. STAINLESS STEEL 07. GALVANIZED STEEL
03. PLASTIC COMPATIBLE WITH CONTENTS 0 95. UNKNOWN 0 3. PLASTIC COMPATIBLE WITH CONTENTS 08. FLEXIBLE (HOPE) 099. OTHER
04. FIBERGLASS 0 8. FLEXIBLE (HDPE) 099. OTHER 04. FIBERGLASS 0 9. CATHODIC PROTECTION
05 STEEL WI COATING 09. CATHODIC PROTECTION 464 05. STEEL W/ COATING 095. UNKNOWN
..\VII:': I?,lf?lt)I~!I;!=~I:f:Qp;rpq[!QNJCheck allth?tapply)(adesciipiio.h'(i(ih!J.monitofing:progr?msijaiF6e'silbfhliiedio:the/ocalageii'cy)2
UNDERGROUND PIPING ABOVEGROUND PIPING
SINGLE WALL PIPING 466 SINGLE WALL PIPING
PRESSURIZED PIPING (Check all that apply). PRESSURIZED PIPING (Check all that apply).
o 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR 0 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
o 2. MONTHLY 0.2 GPH TEST 0 2 MONTHLY 0.2 GPH TEST
o 3 ANNUAL INTEGRITY TEST (0.1 GPH) 0 3. ANNUAL INTEGRITY TEST (0 1 GPH)
o 4. DAILY VISUAL CHECK
CONSTRUCTION/
MANUFACTURER
MATERIALS AND
CORROSION
PROTECTION
(check all that
apply)
CONVENTIONAL SUCTION SYSTEMS'
o 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY
TEST (0 1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING):
o 7. SELF MONITORING
GRAVITY FLOW
o 9. BIENNIAL INTEGRITY TEST (0.1 GPH)
SECONDARILY CONTAINED PIPING
PRESSURIZED PIPING (Check ai/ that apply)'
10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND
(Check one)
o a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
J:8J b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM
DISCONNECTION
o c. NO AUTO PUMP SHUT OFF
[gJ 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR
RESTRICTION
o 12 ANNUAL INTEGRITY TEST (0.1 GPH)
SUCTIONIGRAVITY SYSTEM:
o 13 CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS
EMERGENCY GENERATORS ONLY (Check all that apply):
o 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF + AUDIBLE AND
VISUAL ALARMS
o 15 AUTOMATIC LINE LEAK DETECTOR (30 GPH TEST) WITHOUT FLOW SHUT OFF OR
RESTRICTION
o 16 ANNUAL INTEGRITY TEST
o 17. DAILY VISUAL CHECK
DISPENSER CONTAINMENT
DATE INSTALLED 468
46:
';"".
r;"->.~.:o
467
CONVENTIONAL SUCTION SYSTEMS
o 5 DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM
o 6. TRIENNIAL INTEGRITY TEST (0 1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING)'
o 7. SELF MONITORING
GRAVITY FLOW:
o 8. DAILY VISUAL MONITORING
o 9. BIENNIAL INTEGRITY TEST (01 GPH)
SECONDARILY CONTAINED PIPING
PRESSURIZED PIPING (Check a/I that apply).
10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND
(Checl< one)
o a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
o b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM
DISCONNECTION
o c. NO AUTO PUMP SHUT OFF
o 11. AUTOMATIC LEAK
o 12. ANNUAL INTEGRITY TEST (01 GPH)
SUCTION/GRAVITY SYSTEM
o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS
EMERGENCY GENERATORS ONLY (Check all that apply):
014.
015.
016.
o
CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF + AUDIBLE AND
VISUAL ALARMS
AUTOMATIC LINE LEAK DETECTOR (30 GPH TEST
ANNUAL INTEGRITY TEST
17. DAILYVISUALCHECK
Not Available
FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE
CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS
CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS
DAILY VISUAL CHECK
TRENCH LINER / MONITORING
NONE 469
JAN
Revised 6111/2002
DATE
I 1/30/05
470
471
TITLE OF OWNER/OPERATOR
Environmental Compliance Specialist
472
Page 11 of 16
/,//
IjI /-
HAZARDOUS MATERIALS BUSINESS EMERGENCY PLAN
EMERGENCY PROCEDURES
ARCO # 00371
2698 MT VERNON AVENUE, BAKERSFIELD; CA 93306
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
(Fire, paramedics, police or sheriff)
9] ]
State Office of Emergency Services
(800) 852-7550
or (916) 262-] 62 ]
Immediately call the appropriate jurisdiction:
The Bakersfield Fire Department
Hazardous Materials Management Division:
(66]) 326-3979
Person(s) within the business required responding to a hazardous materials incident:
Name: MUNTHER M. HAWATMEH
Name: JANET WAGER
Name: ARCO CUSTOMER SOLUTIONS CENTER
Telephone: (661) 872-5862
Telephone: (714) 670-5321
Telephone: (800) 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:
Address:
City:
Phone:
BAKERSFIELD MEMORIAL HOSPITAL
420 34TH STREET
BAKERSFIELD, CA 93301
(661) 327-4647
Name:
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.
Page 12 of 16
_...../--
'i'. /r"
HAZARDOUS MATERIALS BUSINESS EMERGENCY PLAN
EMERGENCY PROCEDURES
ARCO # 00371
2698 MT VERNON AVENUE, BAKERSFIELD, CA 93306
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. M ITICA TION
In the event of a maior release of qasoline: 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 13 of 16
//
'i> ./
HAZARDOUS MATERIALS BUSINESS EMERGENCY PLAN
EMERGENCY PROCEDURES
ARCO # 00371
2698 MT VERNON AVENUE, BAKERSFIELD, CA 93306
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 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 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 14 of 16
.' '
.
.,
/
til/
HAZARDOUS MATERIALS BUSINESS EMERGENCY PLAN
EMERGENCY PROCEDURES
ARCO # 00371
2698 MT VERNON AVENUE, BAKERSFIELD, CA 93306
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 (Janet Wager).
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 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.
Page I 5 of 16
"
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SITE MAP
./'
BUSINESS NAME: ARCO # 00371
SITE ADDRESS: 2698 MOUNT VERNON AVE !CITY: BAKERSFIELD I ZIP: 93306
MAP DATE: 07/07/05 I I AGENCY FACILITY #:
/r
~~.,.~, ~\''8!'':.'l1'<~.,,:~..'.w.;.'.j,~~!;fJ''M~~~;'~;.lJ''-''.''{~''.9;'~l7.;'':'' .~; , ;.h'St!.,:::;:;"~,:,,, ~,. .:.,1"~,;,' -'.....~~ ~..., ',.-i.'.".,,-
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BAKERSFIELD FIRE DEPI'
Prevention Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 872-2171
~
---'
"
UNIFIED PROGRAM INSPECTiON CHECKLIST
SECTION 1: Business Plan and Inventory Program
NSPECTION TIME
o ROUTINE
Section 1: Business Plan Jlnd Inventory Program
COMBINED 0 JOINT AGENCY 0 MUL TI-AGENCY-O- COMPLAINT
e ~ ~ ~~1
ORE-INSPECTION
C v (C=ComplianCe)
V=Violation
OPERATION
COMMENTS
ApPROPRIATE PERMIT ON HAND
Business PLAN CONTACT INFORMATION ACCURATE
VERIFICATION OF INVENTORY MATERIALS
VISIBLE ADDRESS
CORRECT OCCUPANCY
VERIFICATION OF QUANTITIES
VERIFICATION OF LOCATION
PROPER SEGREGATION OF MATERIAL
-etvrv AU~ .
... _m______ -------.~--'J-08 Z(J(Jt---------
VERIFICATION OF MSDS AVAILABILITY
VERIFICATION OF HAZ MAT TRAINING
EMERGENCY PROCEDURES ADEQUATE
CONTAINERS PROPERLY LABELED
HOUSEKEEPING
cl O~~t~ &rir5 ~<'
FIRE PROTECTION
SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE?
EXPLAIN:
DYES
o~
PLEASE CALL US AT (661) 326-3979
Inspector (Please Print)
Fire Prevention /1st In / Shift of Site/Station #
White - Prevention Services
Yellow - Station Copy
Pink - Business Copy
FD2049 (Rev. 02/051
~
.'"':-/
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave.. 3rd Floor. Bakersfield. CA 93301
FACILITY NAME
A'tt 0
A.v.. ~\.'--
INSPECTION DATE
~ I~&t,
Section 2: Underground Storage Tanks Program
o Routine ~mbined 0 Joint Agency 0 Multi-Agency 0 Complaint. 0 Re-inspection
Type of Tank l)u..1R-5 Number of Tanks :l
Type of Monitoring C f..,. t-Y\... Type of Piping fi.l)F
OPERA TION C V COMMENTS
. V
Proper tank data on tile V
Proper owner/operator data on tile V V
Penn it fees current \..,.. V
V v
Certification of Financial Responsibility
Monitoring record adequate and current 1'-"""
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
AGGREGA TE CAPACITY
Number of Tanks
OPERA TION Y N COMMENTS
SPCC available
SPCC on tile with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MYF?
If yes, Does tank have overtill/overspill protection?
C=Compliance
Y=Yes
N=NO
Inspector:
Office of Environmental Services (661) 326-3979
~f~ //~
usiness SHe ResponsIble Party
White - Env. Svcs.
Pink - Business Copy
~ i
~IFIED PROGRAM INSPECTION CHECKLIST . I
SECii~;;;;IS PIR~";~~;;--'..
Bakersfield Fire Dept.
Environmental Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
Tel: (~61) }~6~~2I2 _om
::=:~T~1i:-&~J~(ii0..~.~~..
-----.-.---
INSPECTION DATE
INSPECTION TIME
PHONE No. .-------- No. o;-EmPiOy~--m .
FACILITYCONTACT
Business 10 Number
15-021-
Section 1: Business Plan and Inventory Program
LI Routine
Combined
LI Joint Agency
LI Multi-Agency
LI Complaint
(] Re-inspection
c V
( C=Compliance )
V=Violation
OPERATION
COMMENTS
LI LI APPROPRIATE PERMIT ON HAND
LI LI BUSINESS PLAN CONTACT INFORMATION ACCURATE
Ll (:J VISIBLE ADDRESS
LI LI CORRECT OCCUPANCY
LI Ll. VERIFICATION OF INVENTORY MATERIALS
-------..-.-.--.-.------..----...-----------.--..----..._n.._._._ ----.--- ..--. --. . . -..t .. uo.._.__. -.-
~:~~~~~;~;;~~;~......l:
9__~.__~_~~~~~_SEG~:~~~~~~F.~~~~~I~__ _________.. -j-_....___.
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I
ENT'O SEp.o-l--2rros--.---.
Cl Cl VERIFICATION OF HAT MAT TRAINING
Cl Cl EMERGENCY PROCEDURES ADEQUATE
(] LI CONTAINERS PROPERLY LABELED
LI LI. FIRE PROTECTION
LI Cl SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE?:
(] YES
Cl No
EXPLAIN:
IS INSPECTION? PLEASE CALL US AT (661) 326-3979
WMe - Environmental Services
Yellow - Station Copy
Pink.. Busin888 Copy
Business Siie-ResPonsible pa,ty(PkisSe Prinij-
~
~
4, - ';;.
..--
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF I~NVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITYNAME~R820
INSPECTION DATE
Section 2:
Underground Storage Tanks Program
o Routine ~Combined 0 Joint Agency
Type of Tank DuJF"
Type of Monitoring LL~
o Multi-Agency 0 Complaint
Number of Tanks 'Z-
Type of Piping SuJ L-
ORe-inspection
OPERA TION C V COMMENTS
Proper tank data on tile
Proper owner/operator data 011 file
Pennit 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
OPERA TION Y N COMMENTS
SPCC available
SPCC on tile with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?
If yes, Does tank have overtill/overspill protection'?
C=Compliance
V=Violation
Y=Yes
N=NO
Business Site Responsible Party
Pink - Au,illess Copy
~. ',5
+ ARCO 00371 ========================================== SiteID: 015-021-000265 +
Manager : MUNTHER M HAWATMEH
Location: 2698 MT VERNON AVE
City BAKERSFIELD
BusPhone:
Map : 103
Grid: 21B
(661) 872-5862
CommHaz : Moderate
FacUnits: 1 AOV:
CommCode: BFD STA 08 SIC Code:5541
EPA Numb: DunnBrad:03-959-6507
+==============================================================================+
+=======================================+======================================+
Emergency Contact / Title Emergency Contact / Title
MUNTHER M HAWATMEH / FRANCHISEE ARCO CUSTOMER /SOLUTIONS CTR
Business Phone: (661) 87.2-5862x Business Phone: (800) 272-6349x
24-Hour Phone : (661) 703-7273x 24-Hour Phone : (800) 272-6349x
Pager Phone (661) 664-8101x Pager Phone () x
+---------------------------------------+--------------------------------------+
I Hazmat Hazards: Fire Press ImmHlth - DelHlth I
+------------------------------------------------------------------------------+
Contact : JANET WAGER Phone: (714) 670-5321x
MailAddr: PO BOX 6038 State: CA
City : ARTESIA Zip : 90702-6038
+------------------------------------------------------------------------------+
Owner BP WEST COST PRODUCTS LLC Phone: (714) 670-5321x
Address : PO BOX 6038 State: CA
City : ARTESIA Zip : 90702-6038
+------------------------------------------------------------------------------+
Period to TotalASTs: = Gal
Preparer: TotalUSTs; = Gal
Certif'd: RSs: No
ParcelNo:
+------------------------------------------------------------------------------+
Emergency Directives:
PROG A - HAZMAT
PROG H - HAZ WASTE GEN
PROG U - UST
Based on my inquiry of thOse individuals
responsible for obtaining the information, I certify
under penalty of law that I have person~lIy
examined and am familiar with the information
submitted and believe the information is true,
accurate, and complete.
V\~~~ ~-}_o6
Signa ure. Date
ENTV APR 04
2006
+==============================================================================+
-1-
03/30/2006
-j
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~
i
BAKERSFIELD FIRE DEPI'
Prevention Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 872-2171
UNIFIED PROGRAM INSPECTION CHECKLIST .~,
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SECTION 1,: Business Plan and Inventory Program
ADDRESS
o ROUTINE
Section 1: Business Plan end Inventory Program
COMBINED -0--- JOINT AGENCY--o MUL TI-AGENCy-O--COMPLAINT-O RE-INSPECTION
c V ( C=ComPliance) OPERATION COMMENTS
V=Violation -.. ---------------...- ------- ----- ------------.---
----.-------- ---------------- .. -------------
)Zi-D ApPROPRIATE PERMIT ON HAND
AD Business PLAN CONTACT INFORMATION ACCURATE
~ 0 VISIBLE ADDRESS
~ 0 CORRECT OCCUPANCY
~ 0 VERIFICATION OF INVENTORY MATERIALS
..Jlr 0 VERIFICATION OF QUANTITIES
~D VERIFICATION OF LOCATION
~D PROPER SEGREGATION OF MATERIAL
-_.._--_._~~------,--_.__._-------------_. --.----.--- ..--- .---- ------- ----.._.---- ..-.. '..'_m___'___" _____ __.___ ___. .___._._.___.__..__..___._.~_._ --... -...---....-.----
~ 0 VERIFICATION OF MSDS AVAILABILITY
~ 0 VERIFICATION OF HAl MAT TRAINING
~ 0 VERIFICATION OF ABATEMENT SUPPLIES AND
PROCEDURES i""lla_...
&---0 EMERGENCY PROCEDURES ADEQUATE L.iVI U JAN 3 0 2006
~o CONTAINERS PROPERLY LABELED
j}f1 0 HOUSEKEEPING
AD FIRE PROTECTION
~ ----_.
SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE?
EXPLAIN: -.ld.!A57L 0 h 7{t;
~ j1VES 0 NO
.J.prl"l Gr1< ~u_______________
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (681) 328-3979
~lVIotJ t-A-1/2/f ?-'1- ..
Inspector (Please Print) Fire Prevention /lot In / Shift of SlteISlalion It
White - Prevention Services
Yellow - 51elion Copy
Pink - Business Copy
FD2049 (Rev. 021051
~..
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave.. 3rd Floor, Bakersfield. CA 9330 I
FACILITY NAM E 11m / fm
I
hl! l/[w~AJ
INSPECTION DATE J-ls-ob
Section 2:
Underground Storage Tanks Program
o Routine 62f-eombined 0 Joint Agency
Type of Tank D~~61f u/AI f
Type of Monitbring t,Lt .ffJiA -1lz:,7
L
o Multi-Agency 0 Complaint
Number of Tanks 6. I.-J<..
T'ype of Piping Lb-G4Jz (A./ .t{1
,
ORe-inspection
)-1..<; :?5 n
OPERA TION C V COMMENTS
Proper tank data on tile IV V
- .. V
Proper owner/operator data on tile Iv
Penn it fees current J ./ /
Certification of Financial Responsibility V ,,/
Monitoring record adequate and current V -
V -
Maintenance records adequate and current
Failure to correct prior UST violations vA-
Has there been an unauthorized release? Yes A-/;L) rNu -
Section 3:
Aboveground Storage Tanks Program
TANK SlZE(S)
Type of Tank
AGGREGATE CAPACITY
Number of Tanks
OPERA nON Y N COMMENTS
SPCC available
SPCC on tile with OES
Adequate secondary protection
Proper tank placarding/labeling
Is tank used to dispense MVF?
If yes. Does tank have overfill/overspill protection?
C=Compliance
V=Violation
Y=Yes
N=NO
White - FflV. Svcs.
Pink - RlIsiness Copy
Inspector: f.A40AJ f~t.-LA fJ--:J
Office ofE'nvironmemal Services (661) 326-3979
-,,~..- .....--. ~c,._...-~---=';;':-"=----- _or _ f-"-~~_~ ".,,";
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. 24668-5 ARCO :371
2E.98 I.n \IERNON
BAKEF:~::;F I ELD CA
.JAN 25. 2006
~ ~'"
3:20 pr"1
"-,
SystEM STATUS REPORT
T I:DELIVERY NEEDED
INVENTORY REPORT
T 1: 87 REG UNL
'v'OLUI"lE 2161 GALS '
ULLAGE 17542 GALS
90% ULLAGE= 15571 GALS
TC VOLUME 21E.l GALS
HEIGHT 19.58 INCHES
I,JATER VOL 19 GALS
WATER 0.78 INCHES
TEt'W 59.4 DEG F
T 2: 92 PREt"l
VOLUI"lE
ULLAGE
90% ULLAi;E=
TC VOLUI"lE
HEIGHT
WATER \IOL
LJA TER
TEI"lP
UNL
2876 GALS
8973-GALS
7788 GAL~3
2869 GALS
::::4.79 INCHES
o GALS
o . 00 I NCHEf3
t,:::: . 5 DEG F
t!".
M M M M M END'M M M M M
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UNDERGROUND STORAGE TANK
MONITORING PLAN - PAGE 1
1f}0
~
04-06-06 13:4
TYPE OF ACTION
PLAN TYPE
(Check one item only)
C8:I I. NEW PLAN 0 2. CHANGE OF INFORMATION
C8:I MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY.
o THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S):
I....:FA.CILITYINFQRl\iATION..
M02.
FACILITY NAME
ARea # 00~71
M03.
FACILITY SITE ADDRESS 2698 MT VERNON A VENUE
M04.
CITY BAKERSFIELD
MOS.
II. 'EQIHPl\iENl'TESTINGANDPREVENTJVEl\iA.IN'f:ENANCE.
State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in M06.
accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel.
MONITORING EQUIPMENT IS SERVICED IZI I. ANNUALLY 0 99. OTHER (SpecifY):
· III~M:ONIJ:ORINGLOCA'fIONS. .... . ..
: ,>-, - ,- --- - ,- '" ... >, ---- ,-" - -. ':""""" ," -., """ ,,--- - - . ,
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 sensor,
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 Certification
form, Hazardous Materials Business Plan ma ,etc.) which shows all re uired information, include it with this Ian.
IV.TANKl\iQNITORING .
M07.
MIO.
MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply)
C8:I I. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTlTlAL) SP ACE(S) OR SECONDARY CONTAINMENT V AUL T(S)
SECONDARY CONTAINMENT IS: C8:I a. DRY 0 b. LIQUID FILLED 0 c. UNDER PRESSURE D d. UNDER VACUUM
PANEL MANUFACTURER: Veeder Root M12. MODEL #: TLS 350
LEAK SENSOR MANUFACTURER: Veeder Root M14. MODEL #(S): 794390-409
o 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S)
PANEL MANUFACTURER: M16. MODEL #:
",
'IN-TANK PROBE MANUFACTURER: M18. MODEL #(S):
LEAK TEST FREQUENCY: 0 a. CONTINUOUS 0 b. DAlL YINIGHTL Y
o d. MONTHLY D e. OTHER (SpecifY):
PROGRAMMED TESTS: 0 a. 0.1 g.p.h. 0 b. 0.2 g.p.h. D c. OTHER (SpecifY):
o 3. INVENTORY RECONCILIATION' 0 a~MANUAL PER-23 CCR 92646 - Db. STATISTICAL PER 23 CCR *2646.1 .
o 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR 92645
TESTING PERIOD: 0 a. 36 HOURS
o 5. INTEGRITY TESTING PER 23 CCR 92643.1
TEST FREQUENCY: ,0 a. ANNUALLY
o 6.VISUAL MONITORING DONE: 0 a. DAILY
o 99. OTHER (SpecifY):
MIl.
M13.
MIS.
M17.
M19.
o c. WEEKLY
M20.
M21.
M22. M23.
M24.
D b. 60 HOURS ENT'D A P R 1 2 2006
o b. BIENNIALLY D c. OTHER (SpecifY):
o b. WEEKL Y (Requires agency approval)
M2S.
M26. M27.
M28.
V.PIPEMQNIJ:()RING
MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply)
C8:I I. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT
SECONDARY CONTAINMENT IS: C8:I a. DRY 0 b. LIQUID FILLED 0 c. UNDER PRESSURE 0 d. UNDER VACUUM M31
PANEL MANUFACTURER: Veeder Root M32. MODEL #: TLS 350 M33.
LEAK SENSOR MANUFACTURER: Veeder Root M34. MODEL #(S): 794380-208 M3S.
WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? C8:I a. YES 0 b. NO M36.
WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? C8:I a. YES 0 b. NO M37.
o 2. MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF
PRODUCT FLOW WHEN A LEAK IS DETECTED
MLLD MANUF ACTURER(s): M38. MODEL #(S):
C8:I 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS
ELLD MANUFACTURER: RED JACKET M40. MODEL #: CPT
PROGRAMMED LINE INTEGRITY TESTS: 0 a. MINIMUM MONTHLY 0.2 g.p.h. 0 b. MINIMUM ANNUAL 0.1 g.p.h.
WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? IZI a. YES 0 b. NO M43.
WILL ELLD F AILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? C8:I a. YES 0 b. NO M44.
o 4. INTEGRITY TESTING
TEST FREQUENCY: ,0 a. ANNUALLY
o 5. VISUAL MONITORING DONE: '0 a. DAILY
M39.
M41.
M42.
o b. EVERY 3 YEARS 0 c. OTHER (SpecifY) M4S. M46.
o b. WEEKL y* 0 c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED" M47.
... Requires agency approval .. Allowed for monitoring of unburied emergency generator fuel piping only per HSC !i25281.5(b)(3)
o 6. PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR 92636(a)(3)
o 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s)
o 99. OTHER (Specify)
M48.
hwfwrc-d (06/03) - 1/5
06/25/03
:
UNDERGROUND STORAGE TANK
MONITORING PLAN - PAGE 2
VI.dDISPENSER MONITORING
MONITORING OF AREAS BENEATH DISPENSER(S) IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply)
~ I. CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT (UDC)
PANEL MANUFACTURER: Veeder Root M51. MODEL #:
LEAK SENSOR MANUFACTURER: Veeder Root M53. MODEL #(S):
WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS?
WILL A UDC LEAK ALARM TRIGGER AUTOMATiC PUMP SHUTDOWN?
WILL FAlLURE/DlSCONNECTiON OF UDC MONITORING SYSTEM TRIGGER AUTOMATiC PUMP SHUTDOWN?
o 2. MECHANICAL ASSEMBL Y (e.g., FLOAT AND CHAIN ASSEMBLY) IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK
ASSEMBLY MANUFACTURER: M58. MODEL #(S):
o 3.VISUAL MONITORING DONE: 0 a. DAILY 0 b. WEEKLY (Requires agency approval)
o 4. NO DISPENSERS
o 99. OTHER (Specify)
M50.
TLS 350
794380-208
~ a. YES 0 b. NO
~ a. YES D b. NO
~ a. YES D b. NO
M52.
M54.
M55.
M56.
M57.
M59.
M60.
M61.
.YlI...ENIIA,.NCEDLEAKDETECTION<.
M70.
VUI....TRAfNING.
REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply)
I. ~ THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required)
2. ~ OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required)*
3. ~ THE FACILITY'S BEST MANAGEMENT PRACTiCES (Required as ofMM/DDIYY)
4. 0 CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS
5. 0 CALIFORNIA UNDERGROUND STORAGE TANK LAW
6. 0 STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATiON: "HANDBOOK FOR TANK OWNERS - MANUAL AND
STATISTICAL INVENTORY RECONCILIATiON"
7. 0 SWRCB PUBLICATION: "WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS"
99. 0 OTHER (Specify): M81.
Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and can access those documents when needed.
By 1/1/2005, this facility will have a "Designated UST Operator" who has passed the operator exam administered by the International Code Council (ICC). By July I,
2005, and annually thereafter, the "Designated UST Operator"wiII train facility employees ifi the proper-operation-and-maintenance- of the UST systems. This training
will include, but is not 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 after July 1,2005, the initial training will be conducted within 30 days of the date of hire.
IX.COMMENTS/ADDITIONALINFORMATION
Please use this section to include any additional UST system monitoring-related information (e.g., additional information required by your local agency): M85.
*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).
M90.
- 5~ O/;
M91.
M92.
OWNER/OPERATOR TiTLE:
Franchisee
M93.
(Agency Use Only)
This plan has been reviewed and:
o Approved
o Approved With Conditions
o Disapproved
Local Agency Signature:
Comments/Special Conditions:
Date:
hwfwrc-d (06/03) - 2/5
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/
UNDERGROUND STORAGE TANK
RESPONSE PLAN - PAGE 1
(One form per facility)
TYPE OF ACTION
I2SI I. NEW PLAN
D 2. CHANGE OF INFORMATION
ROI.
FACILITY ID # (Agency Use Only)
FACILITY NAME
ARea # 00371
FACILITY SITE ADDRESS R03. CITY
2698 MT VERNON A VENUE BAKERSFIELD
.IIL<SPILLfJ0NTROLA.N-DCLEANlffPMETH0DS.......
This plan addresses unauthorized releases from UST systems and supplements the emergency response plans and procedures in the facility's Hazardous 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.
>> Absorbent material will be used to contain and clean up manageable spills of hazardous materials. Used absorbent material will be stored in a properlv labeled and
sealed container until removed from the site bv a licensed hazardous waste transporter.
>> Facility personnel will determine whether or not any water removed from secondary containment systems, or from 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 the following conditions occur:
I. 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 product/waste stored in the primary containment system, is placed inside secondary containment to treat or neutralize
released product/waste, and the added material or resulting material from such a combination is not compatible with secondary containment.
]....FACILITYINFORMATI0N.
R04.
UI.S.PILL.CONTROL.A:NDCLEAN-UP'E.'QUI. PM.E.. NT
.. _.." q' _ _ ., d' ~,. , " ,
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.
EQUIPMENT NOT-PERMANENTLY ON-SITE, BUT AVAILABLE FOR USKIFNEEDED:'-(Com--Iete oiir-ifa -lie-able) _.-
EQUIPMENT LOCATION A V AILABILITY
Absorbent RIO. Backroom R20. Onsite at all times
Broom I dustpan Rll. Backroom R21. Onsite at all times
Gloves R12. Backroom R22. Onsite at all times
R13. R23.
R14. R24
R30.
R3I.
R32.
R33.
R34.
R15.
R25.
R3S.
IV. . RESPONSIBLE PERSONS
THE FOLLOWING PERSON(S) IS/ARE RESPONSIBLE FOR AUTHORIZING ANY WORK NECESSARY UNDER THIS RESPONSE PLAN:
NAME R40. TITLE RSO.
TERESA SANTANA MILES
NAME
R41. TITLE
RSI.
NAME
R42 TITLE
RS2.
NAME
R43 TITLE
RS3.
, ",", . .. ", d " " _.
V. INDIRECT HAZARDDETERMINATJON
This information is required Q!l\y 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 Customer Solutions Center (CSC) at 1-800-ARCOFIX. A certified, trained pump
and tank technician will be dispatched to the site to evaluate and repair alarm condition.
hwfwrc-d (06/03) - 3/5
06/25/03
I /
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I
UNDERGROUND STORAGE TANK
RESPONSE PLAN - PAGE 2
........VI.LEAKINTERCEPTION.:\ND.J)ETECTIONSy..STEM ....
This information is required !lily for motor vehicle fuel UST systems constructed per the Alternate Construction Requirements of 23 CCR 92633, and only if the Leak
Interception and Detection System (LIDS) does not meet the volumetric requirements of 23 CCR 92631(d)(I) through (5) (Le., when accounting for rainfall and
backfill material, the secondary containment volume is less than 100% of primary tank volume for a single UST; or in the case of multiple USTs in shared secondary
containment, 150% of the largest primary tank volume or 10% of aggregate primary tank volume, whichever is greater).
ATTACH AN ADDITIONAL PAGE TO THIS PLAN CONTAINING THE FOLLOWING INFORMATION:
)> The volume of the LIDS in relation to the volume of the primary container;
)> The amount of time the LIDS shall provide containment rdated 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 rim containment and roundwater, includin the LIDS sum .
Y.I...RF.fPR:tING.AND.iU:CORDKEEPIN<;d
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 fire "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 product/waste will
be removed from the UST to prevent further releases or facilitate corrective action. If an emergency exists, we will notify the State Office of Emergency Services.
Within five (5) working days of a reportable release, we will submit to the local agency a full written report containing all of the following information to the extent
that the information is known at the time of filing the report:
c.- ~)- _ The UST owner's. or operator~s .name-arid 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 methodes) of cleanup implemented to date, proposed cleanup actions, and a schedule for implementing the proposed actions;
)> The methodes) 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 defective and is immediately repaired or replaced, and no leak has occurred;
)> Monitoring results from UST system monitoring equipment/methods indicate that a release may have occurred, unless the monitoring equipment is found to be
de(ective 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 least 3 years from the date of shipment.
. VIlI. OwNERlOPERATORSIGN"ATURE
-La
R70.
o
PERATOR NAME (print)
MUNTHER M. HAWATMEH
R71.
OWNER/OPERATOR TITLE
Franchisee
R72.
(Agency Use Only)
This plan has been reviewed and:
o Approved
o Approved With Conditions
o Disapproved
Local Agency Signature:
Date:
hwfwrc-d (06/03) - 4/5
06/25/03
1/..
I \
.;
BUSINESS NAME: ARCO # 00371
SITE ADDRESS: 2698 MOUNT VERNON AVE I CITY: BAKERSFIELD I ZIP: 93306
MAP DATE: 07/07/05 I I AGENCY FACILITY #:
A
B
c
E
o
F
G
H
K
L
M
2
GOLDEN BUFFET
MCDONALDS
MOUNT VERNON AVE
3
4
~
5 z
oCt
to
0
........ to
oCt
oc
6
7
. -'eO
','
-
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.. .............(f)...
(f)
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:::l
...J
""0
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: ~
~ ,L_________i__________,__~..
_.{ UNLEADED ~ ''.,
~, ,,'. 20,000 ~ ,:
~-------------- ~~~~~~~:: :::: :~------- !EJ i~
~~.: p~i;~~ru I_ELI.'=: .I~::
'''~:T9
0"
:'tC I MSDS EJ
8
9
10
oCt
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........c...
12
't Q9t+ +
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13
LONG DRUGS..
99 CENT STORE
LEGEND
~ DISPENSER - CASHIER 0 ABSORBENT [ill FLAMMABLE UQUID I MSDS I ~~~~G~NCY PLAN IBRI BATH ROOM
SHUTOFF
8 GAS PUMP ~ 8 M ON ITOR ING ICll COMBUSTIBLE ~ ~
· EM ERGENCY FIRE HYDRANT WELL UQUID TRASH BIN SEWER/FLOOR DRAIN
SHUT OFF
o ELECTRICAL PANEL . TANK MONITOR e WATER I MC I MOTOR COOLANT FENCE + FIRST AID
@ UQUID WASTE DRUM * EVACUATION t PPE IMOI MOTOR OIL I AI cl AIR CONDITIONING 't FIRE EXTINGUISHER
AREA UNIT
0 SOUD WASTE DRUM ((0>> OVERFILL ALARM C TELEPHONE IEMI EM ERGENCY EXIT I C()21 CO,CYUNDER ~ STORM DRAIN
\ :juST -.- SENSOR _ DISPENSER
hwfwrc-d (06/03) - 5/5
06/25/03
'y.
'\:
;,;:'.,'
~111
SiteID: 015-021-000265
ARCO 00371
Manager : MUNTHER M HAWATMEH
Location: 2698 MT VERNON AVE
City BAKERSFIELD
BusPhone:
Map : 103
Grid: 21B
(661) 872-5862
CommHaz : Moderate
Facunits: 1 AOV:
CommCode: BFD STA 08
EPA Numb:
SIC Code:5541
DunnBrad:03-959-6507
Emergency Contact / Title
MUNTHER M HAWATMEH / FRANCHISEE
Business Phone: (661) 872-5862x
24-Hour Phone (661) 703-7273x
Pager Phone (661) 664-8101x
~L/ T~
Emergency Contact
.Jl.!ReO CUSTOMER
Business Phone:
24-Hour Phone
Pager Phone
/ Title
/ SOLUTIONS CTR
~OO) 2.7L. b.:S4~^
.(..g-OO) 212 - tB49x
(m )/7t -o7h.3x
Hazmat Hazards:
Fire Press
ImmHlth DelHlth
Owner
Address
City
BP WEST COST PRODUCTS LLC
PO BOX 6038
ARTESIA
Phone: (714) 670 .5321J(:5"573
State: CA
Zip 90702-6038
Phone: (714) 670-5321Je5S7,3
State: CA
Zip 90702-6038
Contact : .JANET WAElI~R l-^..A~cIZ.LO --Pf:\N 81..(j
MailAddr: PO BOX 6038
City ARTESIA
Period
Preparer:
Certif'd:
ParcelNo:
to
TotalASTs: =
TotalUSTs: =
RSs: No
Gal
Gal
Emergency Directives:
PROG A - HAZMAT
PROG H - HAZ WASTE GEN
PROG U - UST
yf\()DfJ
. ....~u.lrY of those individuals
, :1"'f.O Gn my I.. "
-I~-S;~ft~ll:!\~ for QP!anlng the Information. I certl,f,Y
-, I "..',' I th t I have persona Y
unde~ peMlty of faw", a 'th the information
exammed and am amI lar WI ,.
submitted and believe the information IS true,
accurate, and complete.
ENT'D MAR 29 2007
'2. -1...3- ~1-
Date
Alifl-{ ~lfAlfXO(\'\W)
"
-1-
01/24/2007
;:r'1
F ARCO 00371
SiteID: 015-021-000265 1
STORAGE CONTAINER DATA (UST FORM A)
,
Last Action Type:
FACILITY/SITE INFORMATION
Business Name: ARCO 00371
Cross Street :
Business Type: Org Type: ~Z:;fD'7ljO
Total Tanks : 3 IndnRes/Trust: No PA Contact:
Dsg Own/Oper : ,M~CHAEL COLm'lBe- A N 1J~E~ 'Rtt IS 10 ICC Nbr: ..a..2 3 H.2 B- - UC
PROPERTY OWNER INFORMATION
Name : .A&€O CUSTOMER phone: (800) :272 C349x
Address: eLITE )-~~- 77 J'-efl (OS
City : State: Zip:
Type :
TANK OWNER INFORMATION
Name : -AReO CUSTOMER phone: -(-800 ) 272 6349x
Address: eL, fr;;z <t-~~- 778-076?3
City : State: zip:
Type :
BOE UST Fee# : 000506
Financ'l Resp: SELF INSURED
Legal Notif :
Date:01/11/2000 phone: (371) 453-21 x
Name:MICHAEL WILSON Ttl:ENVIRON. ADMIN.
State UST # : 1998 Upg Cert#: 00717
-2-
01/24/2007
.0 'i'.
F ARCO 00371
f= Hazmat Inventory
p== MCP+DailyMax Order
SiteID: 015-021-000265
By Facility unit
Fixed Containers on Site
L
L
G
S
L
9
9
9
DailyMax IUnitlMCP
20000.00 GAL Mod
12000.00 GAL Mod
400.00 FT3 Min
55.00 GAL UnR
55.00 GAL UnR
Hazmat Common Name...
I SpecHazIEPA Hazards I Frm 1
REGULAR UNLEADED
PREMIUM GASOLINE
CARBON DIOXIDE
WASTE ABSORBANT
WASTE FLAMMABLE LIQUIDS/SOLVENT
j
F
F
F P
F
F
IH DH
IH DH
IH
IH
DH
-3-
01/24/2007
;,,,.
-4-
01/24/2007
'1'
~, I
SiteID: 015-021-000265 9
Facility Unit: Fixed Containers on site '9
Days On Site
365
F ARCO 00371
p= Inventory Item 0005
F= COMMON NAME / CHEMICAL NAME
REGULAR UNLEADED
Location within this Facility Unit
UNDERGROUND STORAGE TANK
Map:
Grid:
CAS #
8006-61-9
STATE - TYPE
Liquid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
UNDER GROUND TANK
Largest Container
20000.00 GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
20000.00 GAL
Daily Average
20000.00 GAL
HAZARD U OMPO
%Wt. RS CAS #
100.00 Gasoline No 8006619
o S C
NENTS
ARD ME
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH DH / / / Mod
HAZ ASSESS NTS
f= Inventory Item 0004
F= COMMON NAME / CHEMICAL NAME
PREMIUM GASOLINE
Facility Unit: Fixed Containers on Site 9
Days On Site
365
Location within this Facility Unit
UNDERGROUND STORAGE TANK
Map:
Grid:
CAS #
8006-61-9
STATE - TYPE
Liquid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
UNDER GROUND TANK
Largest Container
12000.00 GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
12000.00 GAL
Daily Average
12000.00 GAL
%Wt. I
100.00 Gasoline
HAZARDOUS COMPONENTS
~
CAS# I
8006619
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH DH / / / Mod
HAZARD ASSESSMENTS
-5-
01/24/2007
..'
SiteID: 015-021-000265 9
Facility Unit: Fixed Containers on Site 9
Days On Site
365
F ARCO 00371
p= Inventory Item 0006
==== COMMON NAME / CHEMICAL NAME
CARBON DIOXIDE
Location within this Facility Unit
OUTSIDE STORAGE ROOM
Map:
Grid:
CAS #
124-38-9
- TYPE
Pure
PRESSURE - TEMPERATURE
Above Ambient Cryogenic
CONTAINER TYPE
INSUL.TANK / CRYOGENIC
Largest Container
400.00 FT3
AMOUNTS AT THIS LOCATION
Daily Maximum
400.00 FT3
Daily Average
200.00 FT3
%Wt. RS CAS #
100.00 Carbon Dioxide No 124389
HAZARDOUS COMPONENTS
HAZARD ASSESSMENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ CUries F P IH / / / Min
f= Inventory Item 0001
= COMMON NAME / CHEMICAL NAME
WASTE ABSORBANT <I1N ~ SPeNT Pll~ L P/L"re~
Facility Unit: Fixed Containers on Site 9
Days On Site
365
Location within this Facility Unit
INSIDE TRASH ENCLOSURE
Map:
Grid:
CAS #
STATE - TYPE
Solid Waste
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
DRUM/BARREL-METALLIC
Largest Container
55.00 GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
55.00 GAL
Daily Average
25.00 GAL
MP NENT
%Wt. RS CAS #
90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No
AND SILICTES I1JJb SP13Nf FUGL RJ"fEILS' No
HAZARDOUS CO 0 S
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH / / / UnR
HAZARD ASSESSMENTS
-6-
01/24/2007
'it
SiteID: 015-021-000265 ,
Facility Unit: Fixed Containers on site 9
F ARCO 00371
f= Inventory Item 0007
F== COMMON NAME / CHEMICAL NAME
WASTE FLAMMABLE LIQUIDS/SOLVENT
Days On Site
365
Location within this Facility Unit
INSIDE TRASH ENCLOSURE
Map:
Grid:
CAS #
STATE - TYPE
Liquid Waste
PRESSURE ---- TEMPERATURE
Ambient Ambient
CONTAINER TYPE
DRUM/BARREL-METALLIC
Largest Container
55.00 GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
55.00 GAL
Daily Average
25.00 GAL
%Wt. RS CAS #
90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No
HAZARDOUS COMPONENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F DH / / / UnR
HAZARD ASSESSMENTS
-7-
01/24/2007
.,'
SiteID: 015-021-000265 "I
Fas t Format "I
Overall site "I
04/04/2006
F ARCO 00371
I
F Notif. /Evacuation/Medical
Agency Notification
IN THE EVENT OF MINOR TO MAJOR SPILL, OR FIRE, EMPLOYEE OR OWNER WILL CALL
911 AND LOCAL AGENCY. EMPLOYEES ARE TRAINED ON THE USE OF PERSONAL
PROTECTION EQUIPMENT TO MINIMIZE CONTACT WITH HAZARDOUS MATERIAL WASTE.
OFFICE OF EMERGENCY: 800-852-7550
NATIONAL RESPONSE CENTER: 800-424-8802
BAKERSFIELD FIRE DEPARTMENT: 326-3979
Employee Notif./Evacuation
04/04/2006
FOR ANY EMERGENCY, CALL 911 AND REPORT.
EVACUATE, IF NECESSARY, TO A SITE OPPOSITE DANGER AREA.
CALL YOUR FIELD SUPERVISOR; GIVE DETAILS OF EMERGENCY.
YOUR FIELD SUPERVISOR WILL NOTIFY ATLANTIC RICHFIELD MAINTENANCE, AREA
MANAGER AND MAIN OFFICE. EMERGENCY SERVICES 800-852-7550 AND/OR LOCAL
OFFICE 326-3979.
Public Notif./Evacuation
04/04/2006
ALARM SHALL BE GIVEN BY. SHOUTING OR EMPLOYEES WILL TAKE IMMEDIATE ACTION TO
HAVE ALL PERSONS LEAVE THE PREMISES BY THE SAFEST EXIT. ALL PERSONS WILL BE
ASKED TO ASSEMBLE AT A SAFE ASSEMBLY AREA UPWIND.
Emergency Medical Plan
09/21/2006
FOR SMALL INJURIES THE OWNER OR STORE MANAGER WILL UTILIZE THE FIRST AID KIT
BOX. FOR MINOR TO MAJOR INJURIES, THE OWNER, OR STORE MANAGER WILL CALL
EITHER 911, OR MAY CONTACT THE CLOSEST MEDICAL/CLINIC CENTER, WHICH IS
LOCATED AT: BAKERSFIELD MEMORIAL HOSPITAL, 420 34TH ST, 327-4647
-8-
01/24/2007
"
SiteID: 015-021-000265 "I
Fast Format "I
Overall Site "I
09/19/2005
F ARCO 00371
I
F Mitigation/Prevent/Abatemt
Release Prevention
RELEASES ARE PREVENTED BY INSTALLED OVERFILL DEVICES SUCH AS FLAPPER VALVES,
HIGH LEVEL ALARMS, OR BALL FLOATS. OTHER SPILL PREVENTION DEVIVES ARE
IMPACT VALVES, AND BREAKAWAY DEVICES. SERVICE STATIONS ARE ATTENTED BY
TRAINED PERSONNEL, AND GASOLINE IS DELIVERED BY TRAINED TRUCK DRIVERS.
Release Containment
09/19/2005
IN THE EVENT OF A LEAK OR SPILL:
1. ATTENDANT SHOULD SHUT OFF ELECTRICTY TO THE PUMPS/TURBINES AT THE MAIN
ELECTRICAL PANEL AND CLOSE THE IMPACT VALVES.
2. THE ONSITE EMERGENCY COORDINATOR OR DESIGNEE 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. 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. IN THE EVENT
OF A FIRE EMPLOYEE SHOULD: 1. SHOUT FIRE AND CALL 911. 2. STOP FLUID
FLOW BY SHUTTING OFF ELECTRICITY TO THE PUMPS AT THE MAIN ELECTRICAL PANELS
AND CLOSE IMPACT VALVES.
Clean Up
09/21/2006
IN THE EVENT THAT A SPILL IS SMALL, STATION PERSONNEL SHOULD APPLY
ABOSROBENT 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 2,
MITIGATION. LARGE SPILLS ARE CLEANED BY BP DESIGNATED CONTRACTORS, OR AS
DESIGNATED BY THE FRANCHISEE FOR FRANCHISE SERVICE STATIONS.
-9-
01/24/2007
" .
F ARCO 00371
I
F Mitigation/prevent/Abatemt
Other Resource Activation
SiteID: 015-021-000265 9
Fas t Format 9
Overall Site 9
-10-
01/24/2007
'.'
SiteID: 015-021-000265 9
Fast Format "I
Overall Site "I
F ARCO 00371
I
F Site Emergency Factors
Special Hazards
Utility Shut-Offs
09/21/2006
A) GAS - NONE
B) ELECTRICAL - ELECT PANEL IN BACK ROOM
C) WATER - SIDEWALK
D) SPECIAL - EMER FUEL PUMP SHUT-OFF SWITCH IN SALES AREA NEAR CASHIER
E) LOCK BOX - NO
Fire Protec./Avail. Water
Building Occupancy Level
. 03/20/2006
5 EMPLOYEES: 1-2 PER SHIFT (3 SHIFTS)
-11-
01/24/2007
.;.
SiteID: 015-021-000265 9
Fast Format "I
Overall site "I
03/20/2006
F ARCO 00371
I
F Training
Employee Training
MATERIALS SAFETY DATA SHEETS ON FILE: MSDS AND BUSINESS EMERGENCY PLAN IS
LOCATED IN THE COMPLIANCE BINDER, LOCATED IN THE OFFICE AREA.
BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED ON USE OF SAFETY
EQUIPMENT AND TOOLS TO MINIMIZE CONTACT WITH HAZARDOUS MATERIALS/WASTE.
EMPLOYEES ARE TRAINED AND REQUIRED TO DIAL FOR EMERGENCY CALLS, 911 AND
EVACUATE THE PREMISES. EMPLOYEES ARE TRAINED IN THE USE OF SPILL CLEAN UP,
FIRST AID KIT, FIRE EXTINGUISHERS, ELECTRICAL 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 SUCH AS 1.
HAZARD COMMUNICATION PROGRAM 2. MATERIALS SAFETY DATA SHEETS 3 . SAFE
HANDLING OF CHEMICALS, AND 4. EMERGENCY EQUIPMENT & EMERGENCY RESPONSE PLAN.
Page 2
Held for Future Use
-12-
01/24/2007
., -. . ~
! ., ;.
F ARCO 00371
I
F Training
Held for Future Use
SiteID: 015-021-000265 9
Fast Format "I
Overall Site 9
-13-
01/24/2007
'-- -
-~-
BP West Coast Products LLC
4 Centerpointe, LPR 4-453
La Palma, California 90623
Mailing Address: Box 6038
Artesia, CA 90702-6038
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Voice (714) 670-5152
Fax (714) 670-5420
Email: stacb2@bpcom
April 1 0, 2007
TO:
Bakersfield Fire Department
- Office of Prevention Services
900 Truxton Ave" Suite 210
Bakersfield, CA 93301
FROM:
'\
~:S & 1> ~()1r
~?1
*~6
~
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ENf'O APR 16 Z007
Becky Stackhouse, Permit Coordinator
Environmental Compliance
On behalf of Marcelo Panelo, Environmental Compliance Specialist
RE:
Change of Ownership - Permit I D #015-021-000265
Former ARCO #00371, locate at 2698 Mt. Vernon Ave., Bakersfield CA 93306
was sold to Munther Hawatmeh, . , CA 93306,
661-872-5862, on March 27, 2007.
The new owner has been asked to notify you and to register ownership, Designated
Operator is now the new owner's responsibility,
;r
../11
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~fl
This retail gasoline dispensing facility is no longer owned or operated by
BP West Coast Products LLC,
If you have any questions, please contact Marcelo Panelo at 714-670-5373,
. < ... f ~
______...,.-1..._
Permit to Operate
.. T()aePo$t~~.
,-" .-, ,. . ,;;:,:,:,:-,,:":Pi;:':~-'<'-.'
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Hazardous l'oiIaterials/HaiardouS,Was1itlJnified Permit
...,' '-',',. " '-'''',"~-. ",":' '.' ' ''',. ,'-, - ":' ,,-,.- ,'. ",."::
CON DIJi:['ON'gcQ FPERMIT(n~ .:REVifRSE..SID E
PERMIT 10#015-021-000265
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This Jte~miris)$sued for the following:
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t:;;i
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HazardijijS:M~'t~~iaIS Plan
t1~zarda~s..\i\(a~t~:Generator and/or Treatment
....,:.l)'n'dergrQund ~t9r~ge of Hazardous Materials
.~lf:~~~W;~~:?",,"i::,i (~~ ~~~J~~r
ARCO 003 71 -'ijij1~!Ji;>"f'}:'; ." ...
2698 MT VERNON AVE, BAKERS~lELO CA;933'06.
0001 PREMIUM UNLEADED
12000
PRESSURE
()t#-'-~
~
Issued by:
.- ,-"',. ,'"
. ".:':-.>-'- '-- - - :--. '
- '-'. , . . , , ,.
Bakersfi~ldF]r'~,:D~pa'rtr11e>M. . .. :..<
OFFICE OF PREVENTIONSERVICES'\,h~,k;
900 Truxtun Ave,. Suite21ci<;:;;~:;d"';o~i;,;.i;:3(;';'
Bakersfield, CA 93301
VOice (661) 326-3979
FAX (661) 852-2171
Approved by:
4fofk
~
Issue Date: July 1, 2006
Expiration Date:
June 30, 2009
~,
101 JE(C1ETI\W~ Inl ~
Jill JUN 2 6 2006 lUJ ___ ~
f'.-~
~:~~~rrI'..!L'W.~:1r;6-.::,9.~ ~ '...
(J
TYPE OF ACTION
(Check one ilem only)
U$JDERGRQlPN[)STQ~AQI; T'<<NKS ,. F~C1J-ITY
o 1. NEW SITE PERMIT 0 3 RENEWAL PERMIT [gJ
o 4 AMENDED PERMIT
o
I. FACILITY I SliJiE::INF0RMATI0N<
5. CHANGE OF INFORMATION (Specify change-
local use only)
6 TEMPORARY SITE CLOSURE
D 7 PERMANENTLY CLOSED SITE
o 8. TANK REMOVED
FACILITY 10 #
,~',;"--." '
400
3
CITY
ZIP CODE
SITE NAME (Same as FACILITY NAME or DBA)
BUSINESS ADDRESS
2698 Mt. Vernon Ave
NEAREST CROSS, STREET
Columbus
Bakersfield
93306
o 4. LOCAL AGENCY/DISTRICT"
o 5 COUNTY AGENCY'
D 6 STATE AGENCY'
D 7 FEDERAL AGENCY"
402
401
FACILITY OWNER TYPE
[gJ 1. CORPORATION
D 2. INDIVIDUAL
D 3. PARTNERSHIP
BUSINESS
TYPE
[gJ 1. GAS STATION
D 2 DISTRIBUTOR
D 3. FARM
D 4. PROCESSOR
D 5. COMMERCIAL
D OTHER 403
TOTAL NUMBER OF
TANKS ON SITE
Is facility on Indian Reservation or
trusUands?
*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 for the tank records)
406
~~RA~~R;iN~Q~Mi"6()N
TANK OPERATOR NAME
Munther Hawatamah
MAILING OR STREET ADDRESS
P.O. Box 6038
409
D 2. INDIVIDUAL
D 3. PARTNERSHIP
410
ZIP CODE
90702-6038
412
CITY
Artesia
TANK OPERATOR TYPE
~ 1. CORPORATION
413
" /. ::l:~:::, (,~:~:c~>: r~L ,:;~~';--~'_ i::::) ':' <~,::::::: i:%iT:~;": ::: ,::::::: ',':'.~: :' \,: ,::::;..:>, :'. :.- \:.' <i '
...IIL~,.:rANK"OWNER:INFORM~T
v;, ~'_"_____,,'_1:"~;k L~ ccL"t;> (','Lii<"1: ".~2i:'
MAILING OR STREET ADDRESS
P.O. Box 6038
416
CITY
Artesia
417
ZIP CODE
90702-6038
419
TANK OWNER TYPE
CORPORATION
D 2. INDIVIDUAL
o 3. PARTNERSHIP
D
420
Certification: I certify that the information provided herein is true and accurate to the best of my knowledge.
DATE
8/2/2006
424 PHONE
(714) 670-5248
425
426 TITLE OF APPLICANT
427
Environmental Compliance Specialist
STATE UST FACILITY NUMBER (For local use only)
428 1998 UPGRADE CERTIFICATE NUMBER (For local use only)
429
f '1
NEW SITE PERMIT
UNBEZRGROUNB STORAGETAN~S - TAN~PAGEZ:1
~ 5. CHANGE OF INFORMATION 0 6. TEMPORARY SITE CLOSURE
D 7. PERMANENTLY CLOSED ON SITE
o 8. TANK REMOVED
TYPE OF ACTION
(Check one item only)
o
o
RENEWAL PERMIT
FACILITY 10 #
3
o
o
1
6
BUSINESS ADDRESS
2698 Mt. Vernon Ave
LOCATION WITHIN SITE (Optional)
o 4. AMENDED PERMIT
(Specify reason - for local use on/y
(Specify change - for local use only)
430
.1
BUSINESS NAME (Same as FACILITY NAME or DBA)
0371
CITY
Bakersfield
ZIP CODE
93306
431
TANK 10 #
"{" . ..... .' '" .'. ..<..~;,s.;11",;Y:~~'59.s~~.~le!IQ,~~:.. . . ....... ...............
la,;.w/ththeO/ocatidii"of thelJST.s stem indudin 'buildin sand laiJdmarks.shall
432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK 434
Xerxes If "Yes". complete one page for each compartment
1
DATE INSTALLED (YEAR/MO)
2000/August
435 TANK CAPACITY IN GALLONS
20,000
436 NUMBER OF COMPARTMENTS
437
ADDITIONAL DESCRIPTION 438
," "Ztll::TANK;ebN1fENT~I;
t8J 1. MOTOR VEHICLE FUEL
(If marked. complete Petroleum Type)
o 2. NON-FUEL PETROLEUM
o 3. CHEMICAL PRODUCT
D 4 HAZARDOUS WASTE (Includes
Used Oil)
o 95. UNKNOWN
Gasoline
COMMON NAME (from Hazardous Materials Inventory page)
D 3. SINGLE WALL WITH
EXTERIOR MEMBRANE LINER
04 SINGLE WALL IN A VAULT
!Zl 3. FtBERGLASS I PLASTIC
o 4. STEEL CLAD WI FIBERGLASS
REINFORCED PLASTIC FRP
t8J 3. FIBERGLASS / PLASTIC
o 4. STEEL CLAD WIFIBERGLASS
REINFORCED PLASTIC (FRP)
o 5. CONCRETE
o 3. EPOXY LINING
o 4. PHENOLIC LINING
(Check a/l that apply)
SPILL AND OVERFILL
01. MANUFACTURED CATHODIC
PROTECTION
o 2. SACRIFICIAL ANODE
t8J 3. FIBERGLASS REINFORCED PLASTIC
o 4. IMPRESSED CURRENT
449
450
TYPE (For local use only) 451
PETROLEUM TYPE
~ 1a REGULAR UNLEADED 02 LEADED
0 1b. PREMIUM UNLEADED 03 DIESEL
0 1c. MID-GRADE UNLEADED 04 GASOHOL
YEAR INSTALLED
~ 1. SPILL CONTAINMENT
t8J 2. DROP TUBE
~ 3. STRIKER PLATE
t~~\W',:T'#.NK '.[r:AKbJ;J;Ee"ION"(Adesg$bOIl()t'th~;;;()nitoi'ih~Y"ifid~'-!ri~ha)fB~~~brnitt~dt'o7iJi~'f()';;;ft~b~ncy):fi ...d,y' .:n,,::. . o/d..f . .
IF SINGLE WALL TANK (Check a/l that apply)- 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) 454
o 1. VISUAL (EXPOSED PORTION ONLY) 0 5. MANUAL TANK GAUGING (MTG) 0 1 VISUAL (SINGLE WALL IN VAULT ONLY)
o 2 AUTOMATIC TANK GAUGING (ATG) 0 6. VADOSE ZONE t8J 2. CONTINUOUS INTERSTITIAL MONITORING
o 3 CONTINUOUS ATG 0 7. GROUNDWATER 0 3 MANUAL MONITORING
o 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + 0 8 TANK TESTING
BIENNIAL TANK TESTING 0 99. OTHER
,t}f .~.. ...........,i;;~vst~p;~K....cL6sXjRE..J.iji1oRIvit..tioijj!tPERMAN ENi;.....CL.O~tjRE.IN..PL.ApE~;;
TANK USE
439
TYPE OF TANK
o 1. SINGLE WALL
~ 2. DOUBLE WALL
(Check one "em only)
TANK MATER\AL - primary tar:'ok
o 1. BARE STEEL
02. STAINLESS
STEEL
o 1. BARE STEEL
02 STAINLESS
STEEL
(Check one "em only)
TANK MATERIAL - secondary tank
(Check one item only)
TANK INTERIOR LINING
OR COATING
01. RUBBER LINED
D 2. ALKYD LINING
(Check one item only)
OTHER CORROSION
PROTECTION IF APpliCABLE
(Check all that apply)
ESTIMATED DATE LAST USED (YVIMM/DD)
Revised 6/1112002
440
o 5 JET FUEL
o 6 AVIATION FUEL
o 99. OTHER
441
CAS # (from Hazardous Materials Inventory page)
442
8006-01-9
D 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM
o 95. UNKNOWN
o 99. OTHER
o 5. CONCRETE
D 8. FRP COMPATIBLE WI100% METHANOL
443
o 95. UNKNOWN
o 99. OTHER
444
o
o
o
o 5. GLASS LINING
~ 6. UNLINED
o 95. UNKNOWN
o 99. OTHER
8. FRP COMPATIBLE WI100% METHANOL
9. FRP NON-CORRODIBLE JACKET
10. COATED STEEL
445
o 95. UNKNOWN
o 99. OTHER
446 DATE INSTALLED
447
(For local use only)
o 95. UNKNOWN
o 99. OTHER
448 DATE INSTALLED
OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452
03 FILL TUBE SHUT OFF VALVE
o 4. EXEMPT
~ 1. ALARM
t8J 2 BALL FLOAT
455
ESTIMATED QUANTITY OF SUBSTANCE REMAINING
gallons
457
456 TANK FILLED WITH INERT MATERIAL?
DYes 0 No
UNDERGROUND SrOR1\6E!:,]" ANKS '" T ANKJ?AGE 2
,",::;"'.>"':,'.,:_,:',' ,- ',"',-' :'-',;- :-':~'--f""''S''';_ - .:,,<, _ _:_':~>~~'-'<--'^-_- - ,-,.,A
SYSTEM TYPE
VI.. PIPING CONSTRUCTION (Check all that apply)
UNDERGROUND PIPING ABOVEGROUND PIPING
~1 PRESSURE o 2. SUCTION 03. GRAVITY 458 01 PRESSURE o 2. SUCTION 03 GRAVITY 459
o 1 SINGLE WALL o 3. LINED TRENCH o 99. OTHER 460 01 SINGLE WALL 095 UNKNOWN 462
~ 2. DOUBLE WALL o 95. UNKNOWN 02 DOUBLE WALL. 099. OTHER
MANUFACTURER 461 MANUFACTURER 463
01. BARE STEEL 06. FRP COMPATIBLE W/100% METHANOL 01 BARE STEEL 06. FRP COMPATIBLE W/100% METHANOL
02. STAINLESS STEEL 07. GALVANIZED STEEL 02 STAINLESS STEEL 07. GALVANIZED STEEL
03. PLASTIC COMPATIBLE WITH CONTENTS 0 95. UNKNOWN 03. PLASTIC COMPATIBLE WITH CONTENTS 0 8. FLEXIBLE (HOPE) 099. OTHER
.~ 4. FIBERGlASS 0 8. FLEXIBLE (HDPE) 0 99. OTHER 0 4. FIBERGLASS 0 9. CATHODIC PROTECTI.oN
05 STEEL W/ COATING 09. CATHODIC PROTECTION 464 05. STEEL W/ COATING 095. UNKNOWN
.VII,: PIPING<LE~~!OETEc::fION ,,'(Chec/{'~/lth';tiipply)(ad.i$tr!ptJ8Aof,themoniiohAgp;og(amshall be su6;niii~dtoih~Joca"age;;cyr;'
UNDERGROUND PIPING ABOVEGROUND PIPING
SINGLE WALL PIPING 466 SINGLE WALL PIPING
PRESSURIZED PIPING (Check all that apply); PRESSURIZED PIPING (Check all that apply):
o 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR 0 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
o 2 MONTHLY 0.2 GPH TEST 0 2 MONTHLY 0.2 GPH TEST
o 3. ANNUAL INTEGRITY TEST (0 1 GPH) 0 3. ANNUAL INTEGRITY TEST (0.1 GPH)
o 4. DAILY VISUAL CHECK
CONSTRUCTION/
MANUFACTURER
MATERIALS AND
CORROSION
PROTECTION
(check all that
apply)
CONVENTIONAL SUCTION SYSTEMS:
o 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY
TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING)
o 7 SELF MONITORING
GRAVITY FLOW
o .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)
o a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
~ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM
DISCONNECTION
o c. NO AUTO PUMP SHUT OFF
~ 11. AUTOMATIC LINE LEAK DETECTOR (30 GPH TEST) WITH FLOW SHUT OFF OR
RESTRICTION
o 12. ANNUALlNTEGRITY TEST (0.1 GPH)
SUCTION/GRAVITY SYSTEM
o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS
EMERGENCY GENERATORS ONLY (Check all that apply):
465
467
CONVENTIONAL SUCTION SYSTEMS
o 5 DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM
o 6. TRIENNIAL INTEGRITY TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING):
o 7. SELF MONITORING
GRAVITY FLOW
o 8. DAILY VISUAL MONITORING
o 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)
o a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
o b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM
DISCONNECTION
o c. NO AUTO PUMP SHUT OFF
o 11 AUTOMATIC LEAK
o 12. ANNUAL INTEGRITY TEST (0.1 GPH)
SUCTION/GRAVITY SYSTEM
o 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
DAILY VISUAL CHECK
o 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF + AUDIBLE AND
VISUAL ALARMS
o 15 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST
o 16. ANNUAL INTEGRITY TEST
o 17. DAILY VISUAL CHECK
'DISPENSI:&!c::ONTAINMENT".
FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE
CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS
CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS
'.\:)'". "IX.OWNER/OPERATORSIGNATURE:,
:\,<:~;~t':"
DATE
8/2/2006
470
471
TITLE OF OWNER/OPERATOR
Environmental Compliance Specialist
472
",. < -;0;,
TYPE OF ACTION
(Check one item only)
FACILITY 10 #
3
BUSINESS ADDRESS
2698 Mt. Vernon Ave
LOCATION WITHIN SITE (Optional)
TANK 10 #
2
DATE INSTALLED (YEAR/MO)
-20001 August
ADDITIONAL DESCRIPTION
o 1 NEW SITE PERMIT
o
UNBE.RGROl:Jf\.It:)STOR~GE T ~NKS - T~NK:r>~GE11
o
o
o
6. TEMPORARY SITE CLOSURE
7 PERMANENTLY CLOSED ON SITE
8 TANK REMOVED
430
3 RENEWAL PERMIT
6
o
1
o 4. AMENDED PERMIT
(Specify reason - for local use'only
435 TANK CAPACITY IN GALLONS
12,000
TANK USE
Ik.TANK"eONfI1ENTS<
440
~ 1 MOTOR VEHICLE FUEL
(If marked. complete Petroleum Type)
D 2. NON-FUEL PETROLEUM
D 3. CHEMICAL PRODUCT
D 4. HAZARDOUS WASTE (Includes
Used Oil)
o 95. UNKNOWN
TYPE OF TANK
(Check one item only)
TANK MATERIAL - primary tank
(Check one item only)
TANK MATERIAL - secondary tank
(Check one Item only)
TANK INTERIOR LINING
OR COATING
(Check one item only)
OTHER CORROSION
PROTECTION IF APPLICABLE
(Check all that apply)
SPILL AND OVERFILL
(Check all that apply)
o
439 PETROLEUM TYPE
D 1a REGULAR UNLEADED
IZI 1 b. PREMIUM UNLEADED
o 1c, MID-GRADE UNLEADED
D 2. LEADED
o 3. DIESEL
o 4 GASOHOL
Gasoline
COMMON NAME (from Hazardous Materials Inventory page)
D 1. SINGLE WALL
~ 2. DOUBLE WALL
D 1. BARE STEEL
02. STAINLESS
STEEL
o 1. BARE STEEL
D 2. STAINLESS
STEEL
D 1 RUBBER LINED
D 2. ALKYD LINING
(Specify change - for local use only)
BUSINESS NAME (Same as FACILITY NAME or DBA)
0371
CITY
Bakersfield
ZIP CODE
93306
431
434
436 NUMBER OF COMPARTMENTS
437
438
D 5. JET FUEL
o 6. AVIATION FUEL
o 99 OTHER
441
CAS # (from Hazardous Materials Inventory page)
442
8006-01-9
o 3. SINGLE WALL WITH
EXTERIOR MEMBRANE LINER
04 SINGLE WALL IN A VAULT
n.lti;T:ANK--~:O,-NSTRLJC'TION ,-"'_:}:_;;~
o 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM
D 95. UNKNOWN
D 99. OTHER
443
IZI 3. FIBERGLASS / PLASTIC
D 4. STEEL CLAD WI FIBERGLASS
REINFORCED PLASTIC FRP
~ 3. FIBERGLASS I PLASTIC
o 4. STEEL CLAD W/FIBERGLASS
REINFORCED PLASTIC (FRP)
o 5. CONCRETE
o 3. EPOXY LINING
o 4. PHENOLIC LINING
D 1. MANUFACTURED CATHODIC
PROTECTION
D 2. SACRIFICIAL ANODE
ESTIMATED DATE LAST USED (YY/MM/DD)
Revised 611112002
D 5. CONCRETE
D 8. FRP COMPATIBLE W/100% METHANOL
o 8. FRP COMPATIBLE W/100% METHANOL
o 9. FRP NON-CORRODIBLE JACKET
D 10. COATED STEEL
D 95. UNKNOWN
D 99. OTHER
o 95. UNKNOWN
o 99. OTHER
445
444
D 5. GLASS LINING
IZI 6. UNLINED
D 95. UNKNOWN
D 99. OTHER
447
446 DATE INSTALLED
(For local use only)
o 95. UNKNOWN
o 99. OTHER
~ 3. FIBERGLASS REINFORCED PLASTIC
o 4. IMPRESSED CURRENT
450
TYPE (For local use only) 451
YEAR INSTALLED
~ 1. SPILL CONTAINMENT
~ 2. DROP TUBE
~ 3. STRIKER PLATE
>lv,...tAt{~T!!EAK1DETECTION'(~desEriptio~;'fJ~kmdnjtori~gprdgiams,,~1i be.;~bihjtt~dto..th~";~I'Fag~;j~~j,;
IF SINGLE WALL TANK (Check all that apply): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only)
o 1. VISUAL (EXPOSED PORTION ONLY) 0 5. MANUAL TANK GAUGING (MTG) D 1. VISUAL (SINGLE WALL IN VAULT ONLY)
o 2. AUTOMATIC TANK GAUGING (ATG) D 6. VADOSE ZONE ~ 2. CONTINUOUS INTERSTITIAL MONITORING
D 3 CONTINUOUS ATG D 7 GROUNDWATER 0 3. MANUAL MONITORING
o 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + 0 8 TANK TESTING
BIENNIAL TANK TESTING 0 99. OTHER
Xt5i!TP.NK:CUOSUREJN)=ORMATI0N rPERMANENTCl..OSURE:IN'PI..ACE
448 DATE INSTALLED
449
OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 452
D 3 FILL TUBE SHUT OFF VALVE
o 4. EXEMPT
~ 1. ALARM
~ 2. BALL FLOAT
455
ESTIMATED QUANTITY OF SUBSTANCE REMAINING
galions
456 TANK FILLED WITH INERT MATERIAL?
DYes D No
457
~\ 1 ~
\'
UNIDERGROUNID STORAGE TANKS ':0 T~NJ<PAGE5s~';
SYSTEM TYPE
VI. PIPING CONSTRUCTION (Check all that apply)
UNDERGROUND PIPING ABOVEGROUND PIPING
[8]1 PRESSURE o 2. SUCTION o 3. GRAVITY 458 o 1. PRESSURE o 2 SUCTION 03 GRAVITY 459
o 1. SINGLE WALL o 3. LINED TRENCH o 99 OTHER 460 o 1. SINGLE WALL 095 UNKNOWN 462
[8] 2. DOUBLE WALL o 95. UNKNOWN o 2. DOUBLE WALL. 099 OTHER
MANUFACTURER 461 MANUFACTURER 463
01. BARE STEEL 06. FRP COMPATIBLE WI 100% METHANOL 01 BARE STEEL 06. FRP COMPATIBLE WI 100% METHANOL
02. STAINLESS STEEL 07. GALVANIZED STEEL 02. STAINLESS STEEL 07. GALVANIZEQ STEEL
03. PLASTIC COMPATIBLE WITH CONTENTS 095. UNKNOWN 03. PLASTIC COMPATIBLE WITH CONTENTS 08. FLEXIBLE (HDPE) 099. OTHER
04. FIBERGLASS 0 8. FLEXIBLE (HDPE) 0 99. OTHER 0 4. FIBERGLASS 0 9. CATHODIC PROTECTION
05 STEEL WI COATING 09. CATHODIC PROTECTION 464 05. STEEL WI COATING 095. UNKNOWN
yll:';J?II?ING....LE~l'\iDEllEq];IQN"{Ch~li"W)jthatajJply)(a.'d~WHpiionojjhe' mohii&nng''f;rog;ilrnshallbesub;;)iti~&to:tii~io2iliilgefi2Yj)!l7.i:'' ..<7
UNDERGROUND PIPING ABOVEGROUND PIPING
SINGLE WALL PIPING 466 SINGLE WALL PIPING
PRESSURIZED PIPING (Check "II that apply):, PRESSURIZED PIPING (Check all that apply).
o 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUTOFF FOR 0 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
o 2. MONTHLY 0.2 GPH TEST 0 2 MONTHLY 0.2 GPH TEST
o 3. ANNUAL INTEGRITY TEST (0.1 GPH) 0 3. ANNUAL INTEGRITY TEST (0 1 GPH)
o 4 DAILY VISUAL CHECK
CONSTRUCTIONI
MANUFACTURER
MATERIALS AND
CORROSION
PROTECTION
(check all that
apply)
CONVENTIONAL SUCTION SYSTEMS.
o 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY
TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING)
o 7. SELF MONITORING
GRAVITY FLOW
o 9. BIENNIAL INTEGRITY TEST (01 GPH)
SECONDARILY CONTAINED PIPING
PRESSURIZED PIPING (Check all that apply).
10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND
(Check one)
o a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
[8] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM
DISCONNECTION
o c. NO AUTO PUMP SHUT OFF
[8J 11. . AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR
RESTRICTION
o 12. ANNUAL INTEGRITY TEST (0.1 GPH)
SUCTION/GRAVITY SYSTEM
o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS
EMERGENCY GENERATORS ONLY (Check all that apply).
014
015.
016.
017.
CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF + AUDIBLE AND
VISUAL ALARMS
AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR
RESTRICTION
ANNUAL INTEGRITY TEST
DAILY VISUAL CHECK
465
467
CONVENTIONAL SUCTION SYSTEMS:
o 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM
o 6. TRIENNIAL INTEGRITY TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING)
o 7. SELF MONITORING
GRAVITY FLOW
o 8 DAILY VISUAL MONITORING
o 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 AL!,RMS AND
(Check one)
o a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
o b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM
DISCONNECTION
o c. NO AUTO PUMP SHUT OFF
o 11. AUTOMATIC LEAK
o 12. ANNUAL INTEGRITY TEST (0.1 GPH)
SUCTION/GRAVITY SYSTEM
o 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS
EMERGENCY GENERATORS ONLY (Check all that apply).
014.
015.
016.
o
CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUTOFF + AUDIBLE AND
VISUAL ALARMS
AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST
ANNUAL INTEGRITY TEST
17 DAILY VISUAL CHECK
DISPENSER CONTAINMENT
DATE INSTALLED 468
jY,fiL DISPENSER,CON:r,6.INMEKrr
1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE
2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS
3 CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS
DAILY VISUAL CHECK
TRENCH LINER I MONITORING
NONE 469
IX.:XQWNER)OPERAllOR,SIGNAllURE'
NAME OF OWNER/OPERATO
Scott Hartwell
Revised 6/1112002
,:-"-}>;4:t",:.~:::,,~
'<tt/:,~
DATE
8/2/2006
470
471
TITLE OF OWNER/OPERATOR
Environmental Compliance Specialist
472
'l- c...