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Home My WebLink AboutBUSINESS PLAN (2) I ,-,", ~;~ ?:A :\('.~ l) ~~ B [1';0. ~ W lo. 0 .. - ~Z .> r- ,.~;( .,i... , ' \ J \ I) \ I! I: '. ~ ( - ~FASTRIP - - . . 1)501 MO~OOD STORE _'"_ T VERNON A '. --"i--' "'_~_ __ VE. i-//(}.oo I Us1#7~ro 701 b-;x) m J .' ~-; .. ., ~O\1 FASTRIP 773 SiteID: 015-021-000620 Manager : NASSER JABER Location: 3501 MT VERNON AVE City BAKERSFIELD BusPhone: Map : 103 Grid: 15A (661) 872-1389 CommHaz : Moderate FacUnits: 1 AOV: CommCode: BFD STA 08 EPA Numb: SIC Code:5541 DunnBrad: . Emergency Contact NASSER JABER Business Phone: 24-Hour Phone Pager Phone / Title / MANAGER (661) 872-1389x (661) 872-1389x () x Emergency Contact R CRAIG LINCOLN Business Phone: 24-Hour Phone Pager Phone / Title /Oiree..J..t>r ~~pkAJ (661) 393-7000x (661) 393-7000x () x ;.l.t:'.c:. Hazmat Hazards: Fire ImmHlth DelHlth Period Preparer: Certif'd: ParcelNo: to Phone: (661) 393-7000x State: CA Zip 93380-2515 Phone: (661) 393-7000x State: CA Zip 93380-2515 TotalASTs: = TotalUSTs: = RSs: No Gal Gal Contact : R CRAIG LINCOLN MailAddr: PO BOX 82515 City BAKERSFIELD Owner Address City JAMIESON HILL PO BOX 82515 BAKERSFIELD Emergency Directives: PROG A - HAZMAT PROG U - UST ~\)O '1 Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ~N'f" MA~ 2 ~ ,661 -1- 01/31/2007 F FASTRIP 773 siteID: 015-021-000620 1 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: FASTRIP 773 Cross Street : Business Type: Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper : DOUGLAS M YOUNG III ICC Nbr: 0878646-UC . PROPERTY OWNER INFORMATION Name : R CRAIG LINCOLN Phone: (661) 393-7000x Address: City : State: Zip: Type : CORPORATION TANK OWNER INFORMATION Name : R CRAIG LINCOLN Phone: (661) 393-7000x Address: City : State: Zip: Type : CORPORATION BOE UST Fee# : 019753 Financ'l Resp: SELF INSURED Legal Notif : Tank Owner Mailing Address Date:04/26/2000 Phone: (366) 170-00 x Name:R CRAIG LINCOLN Ttl:VP State UST # : 1998 Upg Cert#: 00759 -2- 01/31/2007 SiteID: 015-021-000620 9 By Facility Unit 9 Fixed Containers on Site 9 I SpecHazIEPA Hazards I Frm I DailyMax IUnitlMCP F IH DH L 8620.00 GAL Mod F IH DH L 8620.00 GAL Mod F IH DH L 8620.00 GAL Mod F FASTRIP 773 p= Hazmat Inventory p== MCP+DailyMax Order Hazmat Common Name... REGULAR UNLEADED GASOLINE .---{- - --:;:"-7- D; e-5 e:::-<-- PREMIUM UNLEADED -3- 01/31/2007 ( -4- 01/31/2007 F FASTRIP 773 p= Inventory Item 0001 F== COMMON NAME / CHEMICAL NAME REGULAR UNLEADED GASOLINE SiteID: 015-021-000620 1 Facility Unit: Fixed Containers on Site 1 Days On Site 365 Location within this Facility Unit UST BELOW ISLAND Map: Grid: CAS# 8006-61-9 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container };l000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 8620.00 GAL Daily Average 4060.00 GAL %Wt. RS CAS# 100.00 Gasoline No 8006619 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod HAZARD ASSESSMENTS p= Inventory Item 0002 = COMMON NAME / _ CHEMICAL NAME 'D{e5~ #.:2..... -- Facility Unit: Fixed Containers on Site 1 Days On Site 365 Location within this Facility Unit UST BELOW ISLAND Map: Grid: CAS # 6Y76-J-V;"~ STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container l.,1000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 8620.00 GAL Daily Average 4526.00 GAL HAZARDOUS COMPONENTS %Wt. 'D)e-e.~ H?//2- RS CAS # 100.00 No 8006619 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 01/31/2007 SiteID: 015-021-000620 , Facility Unit: Fixed Containers on Site, F FASTRIP 773 F Inventory Item 0003 = COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED Days On Site 365 Location within this Facility Unit UST BELOW ISLAND Map: Grid: CAS # 8006-61-9 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container ~OOO. 00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 8620.00 GAL Daily Average 3871.00 GAL %Wt. I 100.00 Gasoline HAZARDOUS COMPONENTS CAS#a006619I ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod HAZARD ASSESSMENTS -6- 01/31/2007 SiteID: 015-021-000620 , Fast Format , Overall Site , 10/25/2000 F FASTRIP 773 I f= Notif./Evacuation/Medical Agency Notification CALL 911. Employee Notif./Evacuation 07/27/2006 ALL EMPLOYEES ARE TRAINED AND AWARE THAT IN THE EVENT OF AN EMERGENCY SITUATION THEY ARE TO FOLLOW THESE PROCEDURES: 1) SHUT OFF (IF POSSIBLE) MAIN POWER BREAKER 2) EVACUATE THEMSELVES AND ANYBODY IN OR AROUND THE PREMISES 3) CALL 911 4) NOTIFY CLOSE NEIGHBORS TO EVACUATE, IF NECESSARY. Public Notif./Evacuation 07/27/2006 EVACUATE ANYBODY IN OR AROUND THE PREMISES AND NOTIFY CLOSE NEIGHBORS TO EVACUATE, IF NECESSARY. Emergency Medical Plan 05/12/1998 NEAREST HOSPITAL. -7- 01/31/2007 J , SiteID: 015-021-000620 9 Fast Format 9 Overall Site 9 07/27/2006 F FASTRIP 773 I p= Mitigation/Prevent/Abatemt Release Prevention ALL EMPLOYEES SHOULD BE AWARE OF LOCATION OF EMERGENCY SHUT-DOWN CONTROLS FOR GASOLINE EQUIPMENT. PROCEDURES TO FOLLOW IN THE EVENT OF AN EMERGENCY ON THE GAS ISLAND ARE AS FOLLOWS: A) IF A CUSTOMER OVERFILLS A VEHICLE TANK RESULTING IN A SMALL SPILL - HOSE DOWN THIS AREA WITH WATER. B) IF A CUSTOMER DRIVES OFF WITH GAS NOZZLE IN CAR FILL TANK RESULTING IN A SUBSTANTIAL FLOW OF GASOLINE - SHUT DOWN ENTIRE SYSTEM, CALL FIRE DEPT, CALL DISTRICT MGR, CLEAR THE GAS ISLAND. C) IF VEHICLE DAMAGE TO ONE PUMP RESULTS IN A LEAK - SHUT DOWN POWER TO THIS PUMP ONLY. HOSE DOWN AREA AND CALL YOUR DISTRICT MGR. D) IF AN ADJACENT BUSINESS/BLDG IS ON FIRE - SHUT DOWN THE ENTIRE GAS ISLAND EMERGENCY CONTROL SHUT-OFF. FIRE DEPARTMENT WILL ADVISE WHEN TO RESUME NORMAL GASOLINE OPERATIONS. E) THE STORE WILL HAVE A LISTING OF EMERGENCY PHONE NUMBERS POSTED NEAR SALES COUNTER. Release Containment 03/31/2006 GAS PUMPS HAVE EMERGENCY SHUT-OFFS. ABSORBENT MATERIAL IS STORED NEAR IN CASE OF SMALL SPILLS. Clean Up 07/27/2006 ABSORBENT MATERIAL USED TO SOAK UP SPILLS AND STORED IN AN APPROVED CONTAINER TO BE DISPOSED OF BY A HAZARDOUS WASTE HAULER. -8- 01/31/2007 ... OJ SiteID: 015-021-000620 , Fast Format , Overall Site "I F FASTRIP 773 I f= Mitigation/Prevent/Abatemt Other Resource Activation -9- 01/31/2007 SiteID: 015-021-000620 "I Fas t Format "I Overall site "I F FASJRIP 773 I /. F/ S~te Emergency Factors Special Hazards utility Shut-Offs A) GAS - E EXT CRNR OF BLDG B) ELECTRICAL - E INT REAR STOCKROOM C) WATER - E EXT CRNR OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO 03/31/2006 OF BLDG Fire Protec./Avail. Water 07/27/2006 PRIAVTE FIRE PROTECTION - FIRE EXTINGUISHERS: ONE NE REAR INT STOCKROOM AREA AND ONE W SIDE INT DOORS TO GAS ISLAND. FIRE HYDRANT - SW CRNR UNIVERSITY & MT VERNON ADJ TO FIRE DEPT. Building Occupancy Level 5 .j...p ~ {;~/!6y~ -10- 01/31/2007 .'. . / ~ .~ F FASTRIP 773 / I ' f=/,Training Employee Training SiteID: 015-021-000620 9 Fast Format 9 Overall Site 9 01/31/2007 / BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES SHOULD BE AWARE OF LOCATION OF EMERGENCY SHUTDOWN CONTROLS FOR GASOLINE EQUIPMENT. PROCEDURES TO FOLLOW IN THE EVENT OF AN EMERGENCY ON THE GAS ISLAND ARE AS FOLLOWS: IF A CUSTOMER OVERFILLS A VEHICLE TANK RESULTING IN A SMALL SPILL - HOSE DOWN THIS AREA WITH WATER; IF A CUSTOMER DRIVES OFF WITH A GAS NOZZLE IN CAR FILL TANK RESULTING IN A SUBSTANTIAL FLOW OF GASOLINE - SHUT DOWN ENTIRE SYSTEM, CALL FIRE DEPT, CALL DISTRICT MANAGER, CLEAR THE GAS ISLAND; IF VEHICLE DAMAGE TO ONE PUMP RESULTS IN A LEAK - SHUT DOWN THE POWER TO THIS PUMP ONLY. HOSE DOWN AREA AND CALL DISTRICT MANAGER; AND EACH STORE WILL HAVE A LISTING OF EMERGENCY CONTACT PHONE NUMBERS POSTED NEAR THE SALES COUNTER Page 2 Held for Future Use Held for Future Use -11- 01/31/2007 '" .. <.::,... i' FASTRIP 773 SiteID: 015-021-000620 Manager NASSER JABER Location: 3501 MT VERNON AVE City BAKERSFIELD BusPhone: Map : 103 Grid: 15A (661) 872-1389 CommHaz : Moderate FacUnits: 1 AOV: CommCode: BFD STA 08 EPA Numb: SIC Code:5541 DunnBrad: Emergency Contact / Title Emergency Contact / Title NASSER JABER / MANAGER R CRAIG LINCOLN / DIR/MAINTENANCE Business Phone: (661) 872-1389x Business Phone: (661) 393-7000x 24-Hour Phone : (661) 872-1389x 24-Hour Phone : (661) 834-4503x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Owner Address City JAMIESON HILL : PO BOX 82515 : BAKERSFIELD Phone: (661) 393-7000x State: CA Zip : 93380-2515 Phone: (661) 393-7000x State: CA Zip : 93380-2515 Contact : R CRAIG LINCOLN MailAddr: PO BOX 82515 City : BAKERSFIELD Period : Preparer: Certif'd: ParcelNo: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency Directives: PROG A - HAZMAT PROG U - UST Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true accurate, a~ ' ~. ~/ Signature DatffC-'f/-C.L 7 ENf1J A U (j () S too, -1- 07/11/2007 ~i STORAGE C NTAINER D Last Action Type: FACILITY/SITE INFORMATION Business Name: FASTRIP 773 Cross Street : Business Type: Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper : DOUGLAS M YOUNG I I I ICC Nbr: 0878646-UC PROPERTY OWNER INFORMATION Name : R CRAIG LINCOLN Phone: (661) 393-7000x Address: City : State: Zip: Type : CORPORATION TANK OWNER INFORMATION Name : R CRAIG LINCOLN Phone: (661) 393-7000x Address: City : State: Zip: Type : CORPORATION BOE UST Fee# : 019753 Financ'l Resp: SELF INSURED Legal Notif : Business Mailing Address Date:04/26/2000 Phone: (336) 600- x Name:R CRAIG LINCOLN Ttl:DIR/MAINTENANCE State UST # : 1998 Upg Cert#: 00759 o SiteID: 015-021-000620 ~ ATA (UST FORM A) F FASTRIP 773 -2- 07/11/2007 ,- SiteID: 015-021-000620 9 By Facility Unit 9 Fixed Containers on Site 9 I SpecHazIEPA Hazardsl Frm 1 DailyMax IUnit/MCP F IH DH L 8620.00 GAL Mod F IH DH L 8620.00 GAL Mod F IH DH L 8620.00 GAL Low F FASTRIP 773 f= Hazmat Inventory f== MCP+DailyMax Order Hazmat Common Name... REGULAR UNLEADED GASOLINE PREMIUM UNLEADED DIESEL #2 . -3- 07/11/2007 -4- 07/11/2007 F FASTRIP 773 f= Inventory Item 0001 F== COMMON NAME / CHEMICAL NAME REGULAR UNLEADED GASOLINE SiteID: 015-021-000620 , Facility Unit: Fixed Containers on Site 1 Days On Site 365 Location within this Facility Unit UST 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 8620.00 GAL Daily Average 4060.00 GAL HAZARDOUS COMPONENT %Wt. RS CAS # 100.00 Gasoline No 8006619 S HAZARD ASSES MEN TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod S TS f= Inventory Item 0003 ~ COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED Facility Unit: Fixed Containers on Site 9 Days On Site 365 Location within this Facility Unit UST 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 8620.00 GAL Daily Average 3871.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS # 100.00 Gasoline No 8006619 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 07/11/2007 SiteID: 015-021-000620 9 Facility Unit: Fixed Containers on Site 9 F FASTRIP 773 p= Inventory Item 0002 F= COMMON NAME / CHEMICAL NAME DIESEL #2 Days On Site 365 Location within this Facility Unit UST Map: Grid: CAS # 68476-34-6 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE UNDER GROUND TANK Largest Container 12000.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 8620.00 GAL Daily Average 4526.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS # 100.00 Diesel Fuel No. 2 No 68476302 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low HAZARD ASSESSMENTS -6- 07/11/2007 SiteID: 015-021-000620 , Fast Format 9 Overall Site 9 10/25/2000 F FASTRIP 773 I f= Notif./Evacuation/Medical Agency Notification CALL 911. Employee Notif./Evacuation 03/28/2007 ALL EMPLOYEES ARE TRAINED AND AWARE THAT IN THE EVENT OF AN EMERGENCY SITUATION THEY ARE TO FOLLOW THESE PROCEDURES: SHUT OFF (IF POSSIBLE) MAIN POWER BREAKER; EVACUATE THEMSELVES AND ANYONE IN OR AROUND THE PREMISES; CALL 911; AND NOTIFY CLOSE NEIGHBORS TO EVACUATE, IF NECESSARY. Public Notif./Evacuation 07/27/2006 EVACUATE ANYBODY IN OR AROUND THE PREMISES AND NOTIFY CLOSE NEIGHBORS TO EVACUATE, IF NECESSARY. Emergency Medical Plan 05/12/1998 NEAREST HOSPITAL. -7- 07/11/2007 SiteID: 015-021-000620 1 Fast Format 9 Overall Site 9 03/28/2007 F FASTRIP 773 I p= Mitigation/Prevent/Abatemt Release Prevention ALL EMPLOYEES SHOULD BE AWARE OF LOCATION OF EMERGENCY SHUT-DOWN CONTROLS FOR GASOLINE EQUIPMENT. PROCEDURES TO FOLLOW IN THE EVENT OF AN EMERGENCY ON THE GAS ISLAND ARE AS FOLLOWS: IF A CUSTOMER OVERFILLS A VEHICLE TANK RESULTING IN A SMALL SPILL - HOSE DOWN THIS AREA WITH WATER; IF A CUSTOMER DRIVES OFF WITH GAS NOZZLE IN CAR FILL TANK RESULTING IN A SUBSTANTIAL FLOW OF GASOLINE - SHUT DOWN ENTIRE SYSTEM, CALL FIRE DEPT, CALL DISTRICT MGR, CLEAR THE GAS ISLAND; IF VEHICLE DAMAGE TO ONE PUMP RESULTS IN A LEAK - SHUT DOWN POWER TO THIS PUMP ONLY. HOSE DOWN AREA AND CALL YOUR DISTRICT MGR; IF AN ADJACENT BUSINESS/BLDG IS ON FIRE - SHUT DOWN THE ENTIRE GAS ISLAND EMERGENCY CONTROL SHUT-OFF. FIRE DEPARTMENT WILL ADVISE WHEN TO RESUME NORMAL GASOLINE OPERATIONS; AND THE STORE WILL HAVE A LISTING OF EMERGENCY PHONE NUMBERS POSTED NEAR SALES COUNTER. Release Containment 03/31/2006 GAS PUMPS HAVE EMERGENCY SHUT-OFFS. ABSORBENT MATERIAL IS STORED NEAR IN CASE OF SMALL SPILLS. Clean Up 07/27/2006 ABSORBENT MATERIAL USED TO SOAK UP SPILLS AND STORED IN AN APPROVED CONTAINER TO BE DISPOSED OF BY A HAZARDOUS WASTE HAULER. -8- 07/11/2007 SiteID: 015-021-000620 , Fast Format =t Overall Site 9 F FASTRIP 773 I p= Mitigation/Prevent/Abatemt Other Resource Activation -9- 07/11/2007 SiteID: 015-021-000620 9 Fast Format 9 Overall Site 9 F FASTRIP 773 I p= Site Emergency Factors Special Hazards Utility Shut-Offs 03/28/2007 GAS - E EXT CRNR OF BLDG ELECTRICAL - E INT REAR STOCKROOM OF BLDG WATER - E EXT CRNR OF BLDG Fire Protec./Avail. Water 07/27/2006 PRIAVTE FIRE PROTECTION - FIRE EXTINGUISHERS: ONE NE REAR INT STOCKROOM AREA AND ONE W SIDE INT DOORS TO GAS ISLAND. FIRE HYDRANT - SW CRNR UNIVERSITY & MT VERNON ADJ TO FIRE DEPT. Building Occupancy Level 03/28/2007 5-6 EMPLOYEES -10- 07/11/2007 ~ , ", F FASTRIP 773 I F Training Employee Training SiteID: 015-021-000620 , Fast Format '9 Overall Site '9 01/31/2007 BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES SHOULD BE AWARE OF LOCATION OF EMERGENCY SHUTDOWN CONTROLS FOR GASOLINE EQUIPMENT. PROCEDURES TO FOLLOW IN THE EVENT OF AN EMERGENCY ON THE GAS ISLAND ARE AS FOLLOWS: IF A CUSTOMER OVERFILLS A VEHICLE TANK RESULTING IN A SMALL SPILL - HOSE DOWN THIS AREA WITH WATER; IF A CUSTOMER DRIVES OFF WITH A GAS NOZZLE IN CAR FILL TANK RESULTING IN A SUBSTANTIAL FLOW OF GASOLINE - SHUT DOWN ENTIRE SYSTEM, CALL FIRE DEPT, CALL DISTRICT MANAGER, CLEAR THE GAS ISLAND; IF VEHICLE DAMAGE TO ONE PUMP RESULTS IN A LEAK - SHUT DOWN THE POWER TO THIS PUMP ONLY. HOSE DOWN AREA AND CALL DISTRICT MANAGER; AND EACH STORE WILL HAVE A LISTING OF EMERGENCY CONTACT PHONE NUMBERS POSTED NEAR THE SALES COUNTER Page 2 Held for Future Use Held for Future Use -11- 07/11/2007 713 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Fastrip #31 (Exxon) Facility ID #: 3018 Facility Address: 3501 Mt. Vernon Avenue, Bakersfield, CA 93306 Reason for Submitting this Form (Check One) (City) 0 Change of Designated Operator Facility Phone #: 661-872-1389 X Update Certificate Expiration Date Desi2.nated UST Ooerator(s) for this Facility PRIMARY Designated Operator's Name: Douglas M. Young III Relation to UST Facility (Check One) Business Name (If different from above): Confidence UST Services, Inc. DOwner o Operator o Employee Designated Operator's Phone #: 800-339-9930 0 Service Technician x Third-Party International Code Council Certification #: 0878646-UC Expiration Date: September 22, 2008 AL TERNA TE 1 (Ootional) Designated Operator's Name: Jennifer Davis Relation to UST Facility (Check One) Business Name (If different from above): Confidence UST Services, Inc. DOwner o Operator o Employee Designated Operator's Phone #: 800-339-9930 0 Service Technician x Third-Party International Code Council Certification #: 5252886-UC Expiration Date: March 15,2009 ALTERNATE 2 (Optional) Designated Operator's Name: Edward Mitchell Rel~tion to UST Facility (Check One) Business Name (If different from above): Confidence UST Services, Inc. DOwner 0 Operator o Employee Designated Operator's Phone #: 800-339-9930 0 Service Technician x Third-Party International Code Council Certification #: 5258845-UC Expiration Date: May 15,2008 I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (t). Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (please Print): Jamieson Hill Co. SIGNATURE OF TANK OWNER: -s;s ~~ DATE: March 23. 2007 OWNER'S PHONE #: 661-393-7000 NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY JANUARY 1, 2005. THE LOCAL AGENCY LIST IS AVAILABLE AT: www.waterboards.ca.gov/ust/contacts/cupaagys.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 ~ , UN1FIED PROGRAM INSPECTiON CHECKLIST ::' BAKERSFIELD FIRE DEPI' Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield. CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 i4~}:"',;:'i;C;;~~'~:,y,~""~1;~;~J''''7,i.,,"'1-:i;'.':~j;;;.~'' k~4;:"'"l::-".~~:" .ti' .._-"s:;.,t':>:~,;;';:~'-'i("-,,,,.(,".;.'j:..:";,,Y:,,..,," ~,,!,:'.',,.,~'......"- ' ;. :<:"'/:"'.. .,~-;,.,_..,'-' .' '.'.:", .l:~.:::"_,,i': SECTION 1: Business Plan and Inventory Program FACILITY N~ \ . ro..51\, ADDRESS INSPECTION TIME o OF EMPLOYEES JS'() FACILITY CONTACT USINESS 10 NUMBER 15-021- !) D ROUTINE - - Section 1: Business Plan and Inventory Program ~~~ COMBINED -0.-- JOINTAGENCy-1:f MULTI-AGENCy-O--COMPLAINT - D RE-INSPECTION C V (c=complianCe) V=Violation OPERATION COMMENTS ApPROPRIATE PERMIT ON HAND Business PLAN CONTACT INFORMATION ACCURATE VISIBLE ADDRESS CORRECT OCCUPANCY VERIFICATION OF INVENTORY MATERIALS ~ ~~ D VERIFICATION OF QUANTITIES o VERIFICATION OF LOCATION D PROPER SEGREGATION OF MATERIAL 0/ D VERIFICATION OF MSDS AVAILABILITY ENrD AUG 03 2006 VERIFICATION OF HAZ MAT TRAINING EMERGENCY PROCEDURES ADEQUATE CONTAINERS PROPERLY LABELED HOUSEKEEPING FIRE PROTECTION SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: DYES ~o Inspector (Please Print) Fire Prevention 11"ln 1 Shift 01 Site/Station # ING THIS INSPECTION? PLEASE CALL US AT (661) 328-3979 White - Prevention Services Yellow - Stetion Copy Pink - Business Copy FD2049 (Rev. 02105) ~ -.. ,,/ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield. CA 93301 FACILITY NAME ~8..S-\-t-1 ~ INSPECTION DATE~O~ Section 2: Underground Storage Tanks Program o Routine ~ombined 0 Joint Agency 0 Multi-Agency 0 Complaint Type of Tank 1{h)R5 Number of Tanks .3 Type of Monitoring C-t_Jt'.. Type of Piping ()WC:: ORe-inspection OPERA TION C V COMMENTS ~ Proper tank data on file V Proper owner/operator data on file '-' V Pennit fees current V V Cel1ification of Financial Responsibility V- Iv Monitoring record adequate and current V V Maintenance records adequate and current "'" V Failure to correct prior UST violations V 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 spec available SPCC on file with OES Adequate secondary protection Propcr tank placarding/labeling Is tank used to dispcnse MYF? If yes, Does tank have overfill/overspill protection? C=Compliance Y=Yes N=NO Whitc - fOIlV. Svcs. Pink - Rusincss Copy Inspector: Office of Environmental Services (661) 326-3979 'f MONITORING SYSTEM CERTIFICATION 0t~ For Use By All Jurisdictions Within the State of California / Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be otepared for each monitorin~ system control panel by the technician who performs the work. A copy of this form must be provided t(;>,:the taDk system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30, days of this date. - A. General Information Facility Name: #773 Fastrip #31 Site Address: 3501 Mt. Vernon Avenue City: Bakersfield Bldg. No.: Zip: 93306 Facility Contact Person: Omero Garcia M1tke/Model of Monitoring System: Veeder-Root TLS 350 Contact Phone No.: 661-393-7000 Date of Testing/Servicing: 8/9/2006 !:.!~~~p~~~!:t~t~2~!~~~~~~~~se~~~ed TanklD: 12000 gal. Regular- Tank ID: 12000 gal. Super ~ In-Tank Gauging Probe. Model: 847390-107 [!] In- Tank Gauging Probe. Model: 847390-107 E!J Annular Space or Vault Probe. Model: 794390-420 E!J Annular Space or Vault Sensor. Model: 794390-420 E!J Piping Sump / Trench Sensor(s). Model: 794380-208 E!J Piping Sump / Trench Sensor(s). Model: 794380-208 o Fill Sump Sensor(s) Model: 0 Fill Sump Sensor(s). Model: E!J 'Mechanical Line Leak Detector. Model: FX1V [iJ Mechanical Line Leak Detector. Model: FX1V o Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model: E!J Tank Overfill / High Level Sensor. Model: 794390-107 ~ Tank Overfill / High Leval Sensor. Model: 794390-107 o Other (specify equip. type and model in Sec. E on Pg. 2) 0 Other (specify equip. type and model in Sec. E on Pg. 2) Tank ID: 12000 gal. Diesel Tank ID: W In-Tank Gauging Probe. Model:847390-107 0 In- Tank Gauging Probe. Model: E!J Annular Space or Vault Sensor. Model:847380-420 0 Annular Space or Vault Sensor. Model: E!J Piping Sump / Trench Sensor(s). Model: 794380-208 0 Piping Sump / Trench Sensor(s). Model: 0 Fill Sump Sensors(s). Model: 0 Fill Sump Sensor(s). Model: [XJ Mechanical Line Leak Decector. Model:FX1DV 0 Mechanical Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model: ~ Tank Overfill / High Level Sensor. Model:847390-107 0 Tank Overfill / High Level Sensor. Model: 0 Other (specify equip. type and model in Sec. E on Pg. 2) 0 Other (specify equip. typs and model in Sec. E on Pg. 2) Dispenser ID: 1&2 Dispenser ID: 3& 4 [iJ Dispenser Containment Sensor(s). Model: 794380-208 ~ Dispenser Containment Sensor(s). Model: 794380-208 [x] ShearValve(s). E!J Shear Valve(s). o Dispenser Containment Float(s) and Chain(s). o Dispenser Containment Float(s)and Chain(s) Dispenser ID: 5&6 Dispenser ID: 7 & 8 [!J Dispenser Containment Sensor(s). Model: 794380-208 ~ Dispenser Containment Sensor(s). Model: 794380-208 ~ Shear Valve(s). ~ Shear Va1ve(s). ~ Dispenser Containment Float(s) and Chains(s). o Dispenser Containment Float(s) and Chain(s). Disp~J;lser ID: Dispenser ID: o l)ispenser Containment Sensor(s). Model: ' o Dispenser Containment Sensor(s). Model: o Shear Valve(s). o Shear Valve(s). o Dispenser Containment Float(s) and Chain(s) o Dispenser Containment Float(s) and Chain(s). . . *Ifthe faCIlIty contams more tanks or dIspensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification - I certify that the equipment identified in this document was inspected/services in accordance with the manufacturers' guidlines. Attached to this Certification is infonnation (e.g. manufacturers' checklist) necessary to varlfy that this infonnation is correct and a plot plan showing the layout of monitoring equipment. For equipment capable of generating such repo..... I have attached a copy .fthe report; (check all /hill apply) ~ ~rt Technician Name (print): Joseph Stroope Signature' Certification No: A31226 LicenS~804904 Testing Company Name: Confidence UST Services, Inc. Phone No: 800-339-9930 Site Address: 3501 Mt. Vernon Avenue, Bakersfield, CA 93306 Date of Testing/Servicing: 8/09/2006 l' ,; D. Results ofTesting/Servicing " Software Version Installed: 7.04 Complete the following checklist: [i] Yes o No* Is the audible alarm operational? x Yes r 1 No* Is the Visual alarm operational? x Yes I I No* Were all sensors visually inspected, functionally tested, and confIrmed operational? ~ Yes DNo* Were all sensors installed at the lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? I [J Yes BNO* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) x N/A operational? [i] Yes DNo* For pressurized piping systems, does the turbine automatically shut down if the piping secondary DN/A containment monitoring system detects a leak:, fails to operate, or is electrically disconnected? If yes: which sensors initate positive shut-down? ~ Sump/Trench Sensors[i] Dispenser Containment Sensors Did you confmn positive shut-down due to leaks and sensor failure/disconnected? [iJ Yes; 0 No; WYes DNo* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no DN/A mechanical overfill prevention valve is installed), is the overfill warning alarm visual and audible at the tank fIll point(s) and operating properly? If so, at what percent of tank capasity does the alarm trigger? I 90 1% o Yes* [i]No Was any monitoring equipment replaced? If Yes, identify specifIc sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. o Yes* ~No Was liquid found inside any secondary containment systems designed as dry systems? o Product; 0 Water. If yes, describe causes in Section E, below. Irx v..." r 1 No* Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. [x Yes [ ] No* Is all monitoring equipment operational per manufacturer's specifIcations? * In Section E below, discribe how and when these deficiencies were or will be corrected. E. Comments: i' ,j F. In-Tank Guaging I SIR Equipment: W Check this box if tank guaging is used only for inventory control. D Check this box if tank guaging or SIR equipment is installed. This section must be completed if in-tank guaging equipment is used to perform leak detection monitoring. Complete the following checklist: ~ Yes D No* Has all input wiring been inspected for proper enter and termination,inc1uding testing for ground faults? - No* Were all tank guaging probes visually inspected for damage and residue buildup? x Yes x Yes No* Was accuracy of system product level readings tested? x Yes No* Was accuracy of system water level readings tested? x Yes No* Were all probes reinstalled properly? - D Were all items on the equipment manufacturer's maintenance checklist completed? ~ Yes No* * In the Section II, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): o Check this box if LLD's are not installed. C h f, II h kr omplete t e 0 OWID cec 1St: WYes DNo'" For equip. start-up or annual equipment certification, was a leak simulated to varify LLD performance? (Check all that apply) Simulated leak rate: 1iJ3 g.p.h.: 00.1 g.p.h.; 00.2 g.p.h.; -[if Yes o No'" Were all LLD's confmned operational and accurate within regulatory requirments? LX] Yes No'" Was the testing apparatus properly calibrated? ~Yes No'" For machanical LLD's, does the LLD restrict product flow if it detects a leak? ~ N/A o Yes No'" For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? ~ WN/A DYes CJ No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is [x] N/A disabled or disconnected? DYes c:::J No* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system ~N/A malfunction or fails a test? DYes ONo* For electronic LLD's, have all accessible wiring connections been visually inspected? !--;: ~N/A !Xl Yes No Were all items on the equipment manufacturer's maintenance checklist completed? * In tbe section II, below, describe how and when these deficiencies were or will be corrected. H. Comments: " ~ ~:" FASTRIP 31 3501 MT VERNON AVE BAKERSFIE~D CA 93306 805-872-1389 AUG 8, 2006 11:35 PM ~WSTEI'1 STATUS REPORT - - - - - - - - - --- - ALL FUNCT I ONS NOR~1AL 1 NVENTORY REPORT T 1: UNLEADED VOLUI"IE IILLAGE ~O?i ULLAGE= Te V0Lur1E HEIGHT WATER VOL [,.JATER TEt1P T 2:DIESEL VOLUI1E ULLAGE 90% ULLAGE= TC VOLUI"lE HEIGHT WATER VOL WATER TEI"lP T 3 : PREI"lU I 1"1 VOLur"IE ULLAGE 90% ULLAGE= TC VOLUI"lE HEIGHT WATER VOL t.JATER TEr1P 8960 3102 1895 8806 77.24 o 0.00 84.5 4780 7282 6075 4711 46.42 o 0.00 91.9 2092 9970 8763 2045 25.50 o 0.00 91.6 GALS GALS GALS GALS INCHES GALS INCHES DEG F GALS GALS GALS GALS INCHES GALS INCHES DEG F GALS GALS GALS GALS INCHES GALS INCHES DEG F M M M M MEND M M M M M -~~ ~- ............."'/.~ \._-~ -...- ";.,." -- .",/ j/ .;//;:"./ ~.'>. ..- ~i~~l'" ,','t;' CO!"1I1UNICATIONS SETUP PORT SETTI NGS : COI"ll"l BOARD BAUD RATE PAR I TV STOP BIT : DATA LENGTH: 1 <RS-232) 9600 NONE 1 STOP 8 DATA AUTO TRANSl"l IT SETTI NGS : AUTO LEAK ALARI4 LI m T DISABLED AUTO HIGH WATER LIMIT DISABLED AUTO OVERFILL LIMIT DISABLED AUTO LOW PRODUCT DISABLED AUTO THEFT LIMIT DISABLED , AUTO DELIVERY START DISABLED AUTO DELIVERY END DISABLED AUTO E><TERNAL I NPUT ON DISABLED AUTO EXTERNAL INPUT OFF DISABLED AUTO SENSOR FUEL ALARM DISABLED AUTO SENSOR ~JATER ALAR!"! DISABLED AUTO SENSOR OUT ALARI"l. ," i DISABLED RS-232 SECUR ITY CODE : 000000 f:S-232 END OF l"lESSAGE DISABLED ."- ~ ~,.~",,---"'_"":'" ~~.....~--------....". ~~;~.::::~'-'~: :. I N-TANJ(',SETUP - - .::-~_..-:- ,- '- ..:;.::" . -~. ~~::.: T 1 ~UNLEADED PRODUCT CODE THERt1AL COEFF . TANK DIAt"lETER TANK PROFILE FULL VOL : 1 : . 000700 : 111.00 1 PT 12062 FLOAT SIZE: 4.0 INCHES i,JATER l,JARN I NG 2.0 HIGH WATER LIMIT: " a=: .;:...:.J !"IA>< OR LABEL VOL: 12062 O\/ERF I LL LI IvlIT 9m~ HIGH PRODUCT 10855 95~~ DELIVERY 1 t 459 LI I'll T 15% 1809 LOW PRODUCT : 700 LEAK ALARr'1 LI!"IIT: 50 SUDDEN LOSS LI rvll T : 99 TANK TILT 0.00 [vIAN I FOLDED TANKS Ttt: NONE I LEAK r'11 N ANNUAL : 1206 i PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARtv) DISABLED PERIODIC TEST FAIL '~ ALARlv, DISABLED - R~~O- 13 oS--TEST FA I L --ALARI"-l DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DEL I \jERY DELAY 1 r'11 N ~-- .........- .~ .......------ T 2:DIESEL PRODUCT CODE THERr'1AL COEFF TANK D I Ar'1ETER TANK PROFILE FULL VOL 2 : .000450 111.00 1 PT 12062 FLOAT SIZE: 4.0 INCHES WATER WARNING : HIGH WATER LIMIT: rvw< OR LABEL VOL: OVERF I LL Ll M IT HIGH PRODUCT DEll VERY Ll !"lIT 2.0 '-' a=: 0:::..:..1 12062 90~. 10855 95% 11459 15% 1809 700 50 '3'3 0.70 LOW PRODUCT : LEAK ALARlvl L I Iv' IT: SUDDEN LOSS L I Iv' IT: TANK TILT MANIFOLDED TANKS Tit: NONE LEAK MIN ANNUAL: 1206 I , PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALAR!"l DISABLED PERIODIC TEST FAIL ALARrv} DISABLED GROSS TEST FAIL ALARrv) DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF INK TST SIPHON BREAK:OFF DELIVERY DELAY 1 MIN ,- -/.- "'--. r' r '-, ...~...---..., ~- '- ~_' .'-'0' , ,':"".- . T :3 :PREHulrv1 PRODUCT CODE THERMAL COEFF TANK DIAMETER TANK PROFILE FULL VOL : :3 : .000700 : 111.00 1 PT 12062 FLOAT SIZE: 4.0 INCHES [,..IATER ["'JARNI NG : .'. 2.0 HIGH WATER LIMIT~' 2.5 MAX OR LABEL VOL: OVERFILL LIMIT : HIGH PRODUCT DEL 1 VERY L 11"11 T 'I 2062 90~. 10855 95% 11459 15% 1809 LOW PRODUCT : LEAK ALARM LIMIT: SUDDEN LOSS LIMIT: TANK TILT 700 50 99 0.50 IvlAN I FOLDED TANKS Tll: NONE LEAK MIN ANNUAL: 1206 PERIODIC TEST T'lPE STANDARD ANNUAL TEST FAIL ALARrvl D I SABLErI PERIODIC TEST FAIL ALAR!V] DISABLED GROSS TEST FAIL ALAR~1 DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFV: OFF TNK TST SIPHON BREAK:OFF DEL I VERY DELA'y' 1 rv'I N ;...---'-=-~ -' , ,- , ~-""---J----- . -----..-----._~ ' LEAK TEST r"lETHOD TEST CSLD : ALL TANK Pd = 95%% CLIMATE FACTOR :r"10DERATE I I- I , I, - \'1 ":,..;,\,, ,. \". .~ ~ ~\:';'-- ,;~. -: . f"~/}~,>::< ' ~/;;~::: - , i~~"~:'. ~: t' , ;.. ~1' ; ',L'rGUID SENSOR SETUP ( 1 : UNLEADED ANNUAL NORr"lALL Y CLOSED CATEGORY, : ANNULAR SPACE ,",' \~(~.. - ~ --- L 2:DIESEL ANNULAR NORt'lALLV CLOSED CATEGORY : A t'mULAF: :3Pf~CE L 3: :::~UPREI"lE ANNUAL TF:I -STATE (SI NGLE FLOfH) CATEGORV : ANNULAR sr~CE L 4: UNLEADED SUI"1P TRI-STATE (SINGLE FLOAT) CATEGORY : STP SUI"IP L 5: DIESEL sur"IP TRI-STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 6 :SUPREr"'E SUt'lP TRI-STATE (SINGLE FLOAT) CATEGORY : STP SU!"tP , L 9:DISP 1-2 TRI-STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN LI 0 :DISP 3-4 TRI-STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN Lll :DISP 5-6 TRI-STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN Ll2 :DISP 7-8 TRI-?TATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN L13 :TRNSITION sur"lP TRI-STATE (SINGLE FLOAT) (.;ATEGORY : PIPING sur"1P r' / ,: OUTPUT, RELAY SETUP R 1: UNLEADED-PREl'1 lUI"l TYPE: STANDARD -NORMALLY CLOSED LI OU ID SENSOR AU'tS L 1 :FUEL ALAR!"1 L 3: FUEL ALARl'1 L 4: FUEL ALARt'l L 6: FUEL GiLAR!"1 L 9:F-UEL ALARM Ll 0 : FUEL ALARI"1 L 11 : FUEL ALARr'1 L I 2 : FUEL ALARt"l LI 3 : FUEL ALARr"t L 1 " : FUEL ALAR!"1 L 1: SENSOR OUT ALARr"! L 3 : SENSOR OUT 'ALARr1 L 4:SENSOR OUT ALARM L 6:SENSOR OUT ALARM L 9: SENSOR OUT ALAR!"t LI 0 : SENSOR OUT ALARI"] Ll1:SENSOR OUT ALARM L12:SENSOR OUT ALARM L13:SENSOR OUT ALARM L 1 :SHORT ALARI"1 ' L 3 : SHORT ALAR!"1 L 4 :SHORT ALARI'1 L 6: SHORT ALAR!"1 L 9 :SHORT ALAR!"1 LI 0 : SHORT ALAR'''1 L11 : SHORT ALARr"l L1 2 : SHORT ALARi"j L 1 3 : SI-tORT hLARI"1 {~.'-~:..- t, \' R 2:DIESEL TYPE: " ---: ' STANDARD NORI"IALL y. CLOSED I N-TN'iK ALARr"lS" T 2' LEAK ALARlvl l i OU I D SENSOR AU'IS L 2: FUEL ALARI'1 L 5: FUEL ALARr'1 L 9: FUEL ALARI1 LI 0: FUEL ALARI"! Lll : FUEL ALARt'1 L 1 2 : FUEL ALARt'1 Ll3 :FUEL ALAR!"1 L 1 4 : FUEL ALARr"1 L 2: SENSOR OUT ALARl"t'.'? _L 5 : SENSOR OUT ALARt'1c-'/' L 9: SENSOR OUT ALARI"1 ,-,:/ LI 0 :SENSOR OUT ALARI"l;;- Lll:SENSOR OUT ALAP~- LI2:SENSOR OUT ALARM LI3:SENSOR OUT ALARM L 2 : SHORT ALARI"l/K L 5: SHORT ALARI-d' L 9: SHORT ALfjR("l LI 0 : SHORT ALARt"! Lll : SHORT AhltlRI"j L 1 2 : SHORT" AEARt'1 L 13: BHORJ./ALARf"" I - .-.-------'"'- "-.~---~~~,,~ . --" -....--...~...~ , i CSLD TEST RESULTS 9. 2006 8:00 AM T 1: UNLEADED 0.2 GAL....HR TEST PER: AUG 9. 200E. ; ~~;.~:-; /- " T 2:DIESEL 0.2 GAL/HR TEST PER: AUG 9. 2006 PASS T 3 :PREr"IUIt'l 0.2 GAL/HR TEST PER: AUG 9. 2006 PASS '-- SYSTEr"l SETUP AUG 9. 2006 II :42 AM SYSTEr"j UN I TS U.S. SYSTEr"J LANGUAGE ENGLl SH FASTRIP 31 3501 MT VERNON AVE BAKERSFIELD CA 93306 805-872'-1389 SHIFT TIME 1 SHIFT TII'1E 2 SHIFT TIME 3 7:00 AI"l DISABLED DISABLED PERIODIC TEST l,JARNI NGS DISABLED ANNUAL TEST WARNINGS DISABLED SVSTEI"1 SECUR I TV CODE : 000000 /' ,;f-__....."""'i:"I............~_. -~.~. "\.-~ _ .............-..-...--- ./-'1""..' ./~.:" :tJ' . ,'I: R" 4i'OUERF I LL TIFE: ,.lSTANDARD :,jlJORMALL Y OPEN .\J ~ ALARM IN-TANK ALARr"lS ALL:QVERFILL ALARM 0LL : H I pH PRODUCT ALARr"1 ALL .r"lAX F'RODUCT ALARM ~-: . .;" R :5: TY~I;: ;: " " ~ :..~ ')..t "J' - NO '\i';iLAF-'"1 ASS I G M"lE NTS - "'ft,," '11-, " SOFT1"I~RE REV.ISION LEVEL VERS ION 7 . 04 - ~OFTl..IAREIt ~4956q-007-E ~REI-\TED - '34. 11 .1;.8.09.09 S-MODULEIt 330160-060 { SYSTH1 FEATURES: A\..A PERI9DIC IN-TANK iE~S ANNUHL IN-TANK TE<::'TS', ", CSLD W ,\, " ~OFTL~~RE REV I S I ON LEI/EL XERSION 7.04 ' ~OFTWAREIt 349500-007-E GREATED - 94.11.18.09.09 ~-~ODULEIt 330160-002-14 SYSTEM FEATURES: ~~~I9DIC IN-:-TANK TESTS HNtWI-\L IN-TANK" TE"'TS - CSLD .::J R 6: TYPE: ~.~...".; ---"'........-~--- _...-......~ --...................-..w - -..., - NO ALARM ASSIGNMENTS - SOFTWARE REVISION LEVEL VERSION 7.04 SOFTWARE It 349500-007-E CREATED - 94.11.18.09.09 S-MODULEIt 330160-002-A S'lSTEI"l FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS CSLD SOFTWARE REVISION LEVEL VERSION 7.04 SOFTWARE It 349500-007-E CREATED - 94.11.18.09.09 S-MODULEIt 330160-002-14 SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS CSLD / SOFTWARE REVISION LEVEL VERSION 7.04 ~~tTWAREt(.34 9500-007-E CR~i'E13---.. 94 . II . 1 8 .09.09 ~ - - S-/"10DULE;t 330160-002-A SYSTEr"l FEATURES: PERIODIC IN-TMK TESTS ANNUAL I N-TA~lF. TESTS CSLD SOFTWARE REVISION LEVEL VERS ION 7.04 SOFTWARE It 349500-007-E CREATED - 94.11.18.09.09 S-MODULEIt 330160-002-14 SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS CSLD .--... - "--~""'-"-.-~~" -"'-~ .--~'- ,...... T--.,_ . R 7: T\'PE: - NO ALARI"I i'1SSIGNr"lENTS - ALARf"1 HI STORV REPORT - - - JEI~SvF.' f1LARf"l ----, L 1: Ui-.JL2f~[)E[! ANNUAL ANNUU~R SPACE FUEL ALARI"l AUG 4, 2006 11 :37 AM FUEL ALAR!"! AUG 4, 2006 11:27 AM FUEL ALARI"} AUG 15, 2005 9:34 AM ALARr"l H I STORY REPORT ----- SENSOR ALARr"l L 2:DIESEL ANNULAR ANNULAR SPACE FUEL ALARI"! AUG 4, 2006 11:34 AM FUEL ALARf"l AUG 9. 2005 7:55 AM rUEf. f~LARt"l AUG ~, 2005 8:13 AM ALARt"l HI STOR',' REPORT ----- SENSOR ALARM L 3:SUPREME ANNUAL ANNULAR SPACE FUEL ALARr"! AUG 4, 2006 11 :33 AM FUEL ALAR!"1 AUG 4, 200b 11:33 AM FUEL ALAR!"! JUN 23. 2006 4:24 PM ../~ --- " . ....__...~ ~ 1- ~,"",--,. .,"'-------. \ ALARt"! H I STORY REPORT ----- SENSOR ALARM L 4:UNLEADED SUMP STP SU~1P FUEL ALAR!"! AUG 4. 2006 11 :31 AM FUEL ALAR!"! AUG 9. 2005 7:49 AM FUEL ALAR!"! AUG 2. 2005 8:16 AM ALARI"I H I STORY REPORT ----- SENSOR ALAR!"l L 5 :DIESEL SUP'lP . .' STP SU~'lP FUEL ALARM AUG 4. 2006 11: 32 A!"I FUEL ALARI"! AUG ,9. 2005 7:51 AM F UEL ALAR~1 AUG 2. 2005 8:14 AM ALARM HISTORY REPORT --:-~ SENSOR ALARM ----- ~ b: l?UPRH-IE SUI"!P oTP oUI"\P FUEL ALAR!"! AUG 4. 2006 11: 32 At"! FUEL ALARI"l AUG 9. 2005 7: 52 At"l FUEL ALARI"! AUG 2. 2005 9:37 AM r ~, -,,- . J'-r~ . I . ..-..........-._". ...,r-- .r "t:} . ALAR!"! H I STORY REPORT It! c:~: SENSOR ALARM L 7: OTHER SENSORS SETUP DATA WARNING APR 18. 1995 9~q~~~M SENSOR OUT ALARM ~{' APR 18. 1995 9:D6 AM ALARM HISTORY REPORT SENSOR ALARM -~--- , L 8: " OTHER SENSORS SETUP DATA WARNI wi' ~PR 18. 1995 9:08 AM SENSOR OUT ALARM . APR 1 8. 1995 9 :{J6. At"} ALARt"l H I STORY REPOR1' --.--- SENSOR ALAR!"! L 9:D1SP 1-2 DISPENSER PAN FUEL ALARI1 AUG 4. 2006 11: 38 AI"} FUEL ALAR!"! AUG 9. 2005 8:08 AM FUEL ALARM JUN 14, 2005 5:55 AM c , ./" -~ - ____'......._-_............~~ \-...,__ p'.....,... \' ~/--.._...-, \ ALAR!"! H; f.'r0..~Y R,EPORT \ ' SEN3JR {\U:R!!"!' ----- LI0:D1SP 8'4 ': DISPEN::;ER r-','":N FUEL ALARI"1 AUG 4. 20uG 11: 39 At"] FUEL AL,j(i'1 AUG 9. :::-n05 8: 11 At"! \ , " FUEL ALAR!"! ~. I ~ AUG .-, 2005 8: 19 AI1 '\- c.. " ALARM HISTORY REPORT ----- SENSOR ALARM L11 :DISP 5-6 DISPENSER PAN FUEL ALARM AUG 4. 2006 11:39 AM FUEL ALAR!"} AUG 15. 2005 9:32 AM FUEL ALARI"! AUG 9. 2005 8:13 AM ALAR!"! H [;:;'1 C'RY );;'.. r<lP 1 ----.. ~:L~~SOR i-1LARI'1 ----- LI2:DISP 7-8 DISPENSER PAN FUEL ALARI"1 AUG 4. 2006 11 :41 AM FUEL ALARt"} AUG 9. 2005 8:06 AM FUEL ALARM '~~UN 14. 2005 5:53 AM '.-> ....;' .' '.~ ".. \ ~ '~~ , . ~'~''\l-.,... .~''};...''? '), ~,. . " ALARI'1 H I STORY REPORT ...~:..<~.; "~'; ----- SENSOR ALARt"1 LI3:TRNSITI0N SUMP F'I PING SUI'1P FUEL ALARM AUG 15. 2005 '3: 33 AI''! FUEL ALAR!"! AUG 9. 2005 8:02 AM FUEL ALAR!"1 JUN 14. 2005 5:56 AM .._.__J.~- ~..~ ~ ........~..--.........--.-.~~ 1 -~-=--::: ~ " ' "..." :~.-.~~\r ~-{ ~ - .,.:::.~~:- j'~+' ~ "to ~ - . ".:. :'~..' '- ;.....f~:.:... . AU~R;'i to I STORY REPORT ----- SENSOR ALARM , L1 4 : D I SP 1 1 -1 2 DISPENSER PAN .__-~ SENSOR OUT ALAPM MAY 31. 2005 8:45 AM FUEL ALARt"l AUG 9. 2004 12:35 PM SENSOR OUT ALARI"' OCT 22. 2003 9:18 AM .-2\LARI"l H I STORY REiYORT SENSOR ALC,F""l L1 f-~: em iER SE NS(i RS ALARf'" H I STORY REPORT :=3ENSOR ALARI1 L16: OTHEB ~: ENSORS ALARt"l H I STORy' REPORT ----- SENSOR ALARM~~--- L 1: UNLEADED ANNUAL ANNULAR SPACE FUEL ALARI"l AUG 4. 2006 11 :37 AM FUEL ALARr"1 AUG 4. 2005 11 :27 AM FUEL ALARI1 AUG 15. 2005 9:34 AM .^'..... "-. " '-.. -........., R 8: TYPE: AS'::;IC;I~I"lENTS - NO ALARt"l ~ ~ <,j~ ---"I ---- I N-TANK ALAR!"} T 1: UNLEADED , ' HIGH PRODUCT ALARI"1 PI"! AUG 9. 2006 12:03 FASTRIP 31 3501 1''lT VERNOl~ AVE BAKERSFIE~D_CA 93306 805-872-1:J8':l AUG 9. 200~ 12:04 PM S'lSTEt"l STATUS REF'ORT ALL-FUNCTIONS-NOR~AL ---- IN-TANK ALARI"1 T .) :DIESEL HI i:'H PRODUCT ALARr1 AUG 9. 2006 12:04 PM FASTRIP 31 3501 l"lT VERNON '~\!~_ BAKERSFIELD CA,':l:.::3U6 805-872-1389 AUG 9. 2006 12:04 PM S'lST~I"l_ S~AT ~s _R~P~R~ _ ALL FUNCT IONS NORt"lAL ~ -. ....~- .......~..~ ..... -~,~~ '.'- ~ , .A...-r--.,..,....__----:.;::..'..._.~ IN-TANK AtARM ---.'- T 3 :PREI1UIM HIGH PRODUCT ALARM AUG 9. 2006 12:04 PM ' FfiSTR I P 3 J :3501 t"1T VEl :"ION A'v'E ....BAKERSF I ELI, t:A 93:306 ' 805-872-1389- AUG 9. 2006 12:05 PM S'lSTEM STATUS REPORT - - - - - - - - - - - - ALL FUNCTI ONS NOR1'lAL INVENTORV REPORT T 1: UNLEADED \lOLUI"1E ULLAGE -.- 90~~ ULLAGE= Te VOLUf"1E HEIGHT . l,JATER VOL , L,JATER TEI"1P T 2:DIESEL VOLUI1E ULLAGE 90~i ULLAGE= TC \/OLUt"lE HEIGHT v.JATER VOL WATER TEr1P T 3 :PREI"1Ulr1 VOLUlvlE ULLAGE '30~. ULLAGE= Te VOLurvlE HEIGHT WATER VOL WATER TEt"1P 7829 '::ALS 4233 I~;ALS 3026 ,jALS 7687 IGALS 68.61 INCHES {J GALS 0.00 INCHES 85.8 DEG F 4612 GALS 7450 GALS 6243 GALS 4545 GALS 45.19 INCHES o GALS 0.00 INCHES 92.2 DEG F 1979 GALS 10083 GALS 8876 GALS 1935 GALS 24.52 INCHES o GALS 0.00 INCHES 91.6 DEG F M M M M MEND M M M M M ~ - ^--..--....~ ' .~.; ~_ _~,i. __'~...._ ----- 'SENSOR ALARr1 Lll :DISP 5-6 DISPENSER PAN FUEL ALARt"1 _ _ AUG 9. 2006 12:~b PM FASTRIP 31 3501 MT VERNON ~~~__ BAKERSFIELD CA ~~~Ub 805-872-1389 AUG 9. 2006 12:27 PM SYSTEM STATUS REPORT ALL FUNCT IONS NORt1AL ----- SENSOR ALAR!"1 LI3:TRNSITION SUMP PIPING SUr1P FUEL ALARM 7 PI~ AUG 9. 2006 12:2, " F ASTR I P :3 1 3501 1"IT VERNON AVE BAKERSFIELD CA 93306 805-872-1389 -. AUG 9. 2006 12:27 PM SYSTEI1 STATUS REPORT LI3:FUEL ALARM \ '.......', ',-- '"'--~... ~ -.:-__--v.___ - '--- ..-..-. ~- . "".-- /- SENSOR ALARr"t L 1 : UNLEADED ANNUAL /-. .ANNULAR SPACE ::;':- FUEL ALARI"1 I,~AU~ 9. 2006 12:21 PM "?~' SENSOR ALARI"1 /It...,,.,L 9 :DISP 1-2 DISPENSER PAN FUEL ALARt1 AUG 9. 2006 12:24 PM ----- SENSOR ALARr"l Ll 0 :DISP 3-4 DISPENSER PAN FUEL ALARr1 AUG 9. 2006 12:24 PM ----- SENSOR ALARl"l Ll2 :DISP 7-8 DISPENSER PAN FUEL ALARl"l AUG 9. 2006 12:25 PM -- ..-....-....;~--.w'--~_____ ~...;... -... ~......_.,_ --1 ----- SENSOR ALARM L 4: UNLEADED SUI"1P STP sur'w FUEL ALAR!"! AUG 9. 2006 12:18 PM ----- SENSOR ALARM L 5: DIESEL sur"IP STP S ur1P FUEL ALARM AUG 9. 2006 12:19 PM ----- SENSOR ALARJ"! L 6:SUPREME SUMP STP SUI"1P FUEL ALARM AUG 9. 2006 12:20 PM ----- SENSOR ALARr"t L 3: SUPREI"IE ANNUAL ANNULAR SPACE FUEL ALARM AUG 9. 2006 12:20 PM ----- SENSOR ALARI"l L 2:DIESEL ANNULAR ANNULAR SPACE FUEL ALARI"I AUG 9. 2006 12: 21 pr1 ~~: < SWRCB, January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: #773 Fastrip #31 I Date of Testing: 8/9/2006 Facility Address: 3501 Mt. Vernon Avenue, Bakersfield, CA 93306 Facility Contact: Omero Garcia I Phone: 661-393-7000 Date Local Agency Was Notified of Testing : 7/10/2006 Name of Local Agency Inspector (ifpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services, Inc. Technician Conducting Test: Joseph Stroope Credentials 1: X CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester o Other (Specify) License Number(s): CSLB #804904 ICC #5258844-UT Tester # 061720 3. SPILL BUCKET TESTING INFORMATION Test Method Used: x Hydrostatic o Vacuum o Other Test Equipment Used: Lake Test Equipment Resolution: 0.0625" Identify Spill Bucket (By Tank 1 Regular 2 Super 3 Diesel 4 Number, Stored Product, etc.) Bucket Installation Type: o Direct Bury o Direct Bury o Direct Bury o Direct Bury x Contained in Sump x Contained in Sump x Contained in Sump o Contained in Sump Bucket Diameter: 12.00" 12.00" 12.00" Bucket Depth: 12.05" 13.75" 13.25" Wait time between applying 30 min. 30 min. 30 min. vacuum/water and start oftest: Test Start Time (Tr): 11 :OOam 11 :OOam 11 :OOam Initial Reading (Rr): 12.00" 13.50" 13.25" Test End Time (TF): 12:00pm 12:00pm 12:00pm Final Reading (RF): 12.00" 13.50" 13.25" Test Duration (TF - Tr): 1 hour 1 hour 1 hour Change in Reading <RF - ~): 0.00" 0.00" 0.00" PasslFail Threshold or 0.0625" 0.0625" 0.0625" Criteria: Test Result: X Pass o Fail X Pass o Fail X Pass o Fail o Pass o Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained' this report is true, accurate, and in full compliance with legal requirements. Date: 8/9/2006 1 State laws and reg Ions do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. ... .... _ _._~_ ,_'._~" ~._._._ ...~___u~.____.._______...__~ . .. BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD I UNE TESTING I SB989 SECONDARY CONTAINMENT TESTING !TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION Page1of1 PERMIT NO. I TT- l.{ 0 1} ENHANCED LEAK DETECTION TANK TIGHTNESS TEST 'S8-989 SECONDARY CONTAINMENT TESTING PERMIT TO OPERA TENO.- NUMBER OF TANKS TO BE TESTED TANK # IS PIPING GOING TO BE TESTED? VOLUME .E!': YES .E!': NO CONTENTS TANK TESTING COMPANY NAr.1E ll. PHONE NUr!lBER OF CONTACT PERSON . \ L APPROVED BY FD 2095 (Rev. 09105) t:. "_~"";; ~."V. . ~.~ +- FASTRIP 773 ========================================= SiteID: 015-021-000620 + Manager Location: 3501 MT VERNON AVE City BAKERSFIELD BusPhone: Map : 103 Grid: 15A ( 661 ) 872 -13 8 9 CommHaz : Moderate FacUnits: 1 AOV: CommCode: BFD STA 08 SIC Code:5541 EPA Numb: DunnBrad: +==============================================================================+ +=======================================+======================================+ Emergency Contact / Title Emergency C~t~~~ Title NASSER JABER / 8:QIIN lZEKf.fJ'lLipCJo/,u 'I Business Phone: (661) 872-1389x Business Phone: (661) 393-7000x 24-Hour Phone : (661) 872-1389x 24-Hour Phone : (661) 393-7000x Pager Phone' : () x Pager Phone : () X +---------------------------------------+----------------------------~---------+ I Hazmat Hazards: Fire ImmHlth DelHlth I +----------~------------7------~-------------------------------------------+ Contact : ~ 1. (!.."rcH:!::> ~;# ~ Phone: (661) 393 -7 0 0 Ox MailAddr: PO BOX 82515 State: CA +"- ~~ =: - - - - ~ --t~~~~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~~~ - - ~ - ~==~~ - - - - - -- - - - - - - --+ Owner JM1ICON HILL Phone: (661) 393-7000x Address : PO BOX 82515 State: CA City : BAKERSFIELD Zip : 93380, +------------------------------------------------------------------------------+ Period to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: +-~~~~~~~~-~i~~~~i~~~~-----~~~P\--------------------------------------------+ PROG A - HAZMAT l b Ll PROG U - UST - 0 Based on my inquiry of those \ndlvlduQls responsible for obtaining the Information, I certify under penalty of law that I have personally examined and am familiar with the Information submitted and believe the information is true, accurate, and ~ . ~ 5'.d~1: Signature ~~ 1jD\ 1 ~ <b f'\OO t\ ~ 0\ . 7;5>0 . i '!J 7> ~ rP "cr- 'f. '!J \)v '\ () '\) \ ENTV JUL 2 . i 2006 +==============================================================================+ -1- 03/31/2006 p~ - BAKERSFIELD FIRE DEPI' Prevention Services 900 Truxtun Ave.. Suite 210 Bakersfield. CA 93301 Tel.: (661) 326-3979 Fax: (661)872-2171 UNIFIED PROGRAM INSPECTtON CHECKLIST fit".. 'A.r. ....... -- - ~:';_''';": ~r*~~t,'lJ',,~..."fif"i.l,jj.~r.:-;,~'i.:';"'.J<1'-:~~ ~'~.4Al>",,,,<:, :"':";'-,' ,'W;"N'~~',/;;,_ '.'7,." 'i;<.'i~'i.)'".~ '...:~~ ',:, :;,-q:'..-,:,,~'-'.1" _'-"'.',V." . ,;, :":~'/:" '_" .,,; ,~...:". '".",:" '~-\;""' ;,' SECTION 1: Business Plan and Inventory Program FACILITY NAME ADDRESS FACILITY CONTACT NSPECTION TIME I. . ( (J,oo o OF EMPLOYEES USINESS 10 NUMBER 15-021- o ROUTINE Section 1: Business Plan and Inventory Program OMBINED --E]'- JOINT -AGENCY----O MUL TI-AGENCY-O-- COMPLAINT ORE-INSPECTION c V (C=comPlianCe) V=Violation ft-O ~_O p..0 ~O 9<-.0 Jil'0 .~O <9\0 OPERATION COMMENTS ApPROPRIATE PERMIT ON HAND Business PLAN CONTACT INFORMATION ACCURATE VISIBLE ADDRESS CORRECT OCCUPANCY VERIFICATION OF INVENTORY MATERIALS VERIFICATION OF QUANTITIES VERIFICATION OF LOCATION PROPER SEGREGATION OF MATERIAL &;f\.. 0 VERIFICATION OF MSDS AVAILABILITY .6t' 0 VERIFICATION OF HAl MAT TRAINING ~ 0 VERIFICATION OF ABATEMENT SUPPLIES AND 'PROCEDURES ~ 0 EMERGENCY PROCEDURES ADEQUATE p. 0 CONTAINERS PROPERLY LABELED ~ 0 HOUSEKEEPING ~ 0 FIRE PROTECTION tN11J.', FE B 0 &>>--0 SITE DIAGRAM ADEQUATE & ON HAND DYES o NO ANY HAZARDOUS WASTE ON SITE? EXPLAIN: _ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 32&-3979 1)J/YltJU OAt-fA- f- 1- :. Inspector (Please Print) Fire Prevention 1111 In 1 Shift of SitelStation # . elSchool Site Responsible Party (Please Print) White - Prevention Services Yellow - Station Copy Pink - Businese Copy FD2049 (Rev. 02105) p ~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave.~ 3rd Floor, Bakersfield~ CA 93301 FACILITY NAME ,FAf.7IlJp INSPECTION DATE Section 2: Underground Storage Tank~ Program o Routine ~ombine(f 0 Joint Agency Type of Tank ~</JJfIL- t.J/4-Il Type of Monitoring o Multi-Agency 0 Complaint Number of Tanks ~ Type of Piping Duu bIt -ut/A H ORe-inspection OPERA TION C V COMMENTS Proper tank data on file 1/ Proper owner/operator data on file 1/ Pennit fees current V ...) Certification of Financial Responsibility V -- Monitoring record adequate and current V .-I Maintenance records adequate and current V' 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 file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: ?AIYIoAJ /J-AIL-7/1- 7-7- Office ofEnvironmencaJ Services (661) 326-3979 Whitc - Fnv. Svcs. Pink - Busincss Copy Site Responsible Party ,<t~!_::'~;~.;'(.~~~~'~':0:~..~.,;:.;..t"-.,,,. "., <'t.".-..-;<.':~~...";;"~...:!,,~.,,_":..c~...,.... _.<" i ~a, '~'.'\'t:-. (\ (.~::.; t ./ .,~." ......... ,. ,,' ~.. -..r-.o,. '.. '~.'~' ~:'; .1\'; , .::;, '-" :'..:;.:' ~:"...-",:. "rl. .~...: ~f':;':(. ;';. ~>: t':'...,,,;" ~~,__~"l'o:,.i ~"i::'::" '".' -. '~ JI-\N _' j "i" i I I, T 1 :11i;~O;rJl.i' [I '.:? ..' HB 'n~~'f'_ PH: ,Hf'l:j]. ~I!I it" h'i:c:;:; T 2: D 1 E;::'~EL. 0.2 GHLHF: TEl3T PER: .]!~N ':: 1. 20Clt, lr-,;:;;'C; ..r T :3: l'~:'1 i:1 i, II 0.2 ':;,-1 :E::rr PER: .J, ,:' ii i. ~:OOt~. hi~:::'_: F Hl::;l r.' 11 :.:11 :Y:dJ~Ji'l \(EPtll;IN i-.~"J?_ 8;;1.1:.1<::---::1- r l-J.li ,'r; ~G:31~ 8D5.-:~:?~~-1 :Jf.::'~_1 JHN 31. 2006 10:45 AM t. .<~ l~':'j':',i 1':1'1 :---:T,'---;ru;'~: I"U-':::'F:l ilL.!. fill.! l!,::,r.J:::i r'V:.J..lhL I r'J\/nrr<:F."{ kH"::,},:1' T 1: IJNLb--1[IU' \/\) L IJI'li:: UL.Li1CE '31];:,: UL.U,;,:i:: = Te \/OLUI'IF, HE i i:~HT ldATH~ ""':JL L'JATEF: TH'lF' \\.\,:, T 2: D 1 E::.:EL. \/':.,LUI"IE ULL!,'-;E 9[(,; ULLr.i':;E= F; \/C'UJt"lI-:: HE I '.~HT I,,'J~\TEF: "--'C'L l,..JHTEF: TEr"lP T ::~:: Ffl.J1U 1 ["I \.IC'il_iJI'lE UU fi'A: ge\'" Ul,L"C\(X:~ 'F' \iC'I.I.II'-'lr,: HE I ';frr I,Jr-1TH~ \i':i1.. L,Ji-\TER -nJ'I!:'__ -- ~- ----,.' -' ---- cl ,~; ell 747\ f:,21:,.j ..j5:~:,\ .1:,.Oc: CI 1.'.1 _ ;J 1":1 1_~r'iL;:.; (~f-:1 L ~='I 1~~r-lL::~ 1~;hLL JI',j',:fW:::, Ci\U:: I I'JI:HE~:: [1[(: F fl ';~ . ~~ f:, 1 ~~':'1 {;i'iL;:.:.: ~;Ij:~:::.:: i';r;lL.~::~ ~? 2 C 1":r-)J..~~~; (', tlY? i_:,',L~: ;:;; t, . ~:' I 1 ['le: Hi::::.: (I I:;AU::: U . 00 1 NI':HE~: f::,'? . :=: LtF; F 1:-;C(31~1 i_~r,l .:'-3 -lei::':" ,:;,-',1.:::: ~.:'\~\'].fi l-...;f.;L.~:; 7':':::IJ '::,',L'.= '/el _ t ::: 11"ICflr-=}:: Ci (;r-'1 LE; CJ . UiJ i !',k,'HL:"::: i:, :e: . ~:.' [t [':; F -~.;- :~ ~T + FASTRIP 773 ========================================= SiteID: 015-021-000620 + I Manager Location: 3501 MT VERNON AVE City BAKERSFIELD - CommCode: BFD STA 08 SIC Code: 5541 EPA Numb: DunnBrad: +==============================================================================+ +=======================================+======================================+ Emergency Contact / Title Emergency Co~tact~ . (( Title NASSER JABER / JOHN Y-ERLm \.{Q~ jClthXdC~ Business Phone: (661) 872-1389x Business Phone: (661) 393-7000x 24-Hour phone : (661) 872-1389x 24-Hour phone : (661) 393-7000x Pager Phone. : () x Pager Phone () x +---------------------------------------+--------------------------------------+ I Hazmat Hazards: Fire ImmHlth DelHlth I +------------------------------------------------------------------------------+ Contact : Phone: (661) 393-7000x MailAddr: PO BOX 82515 State: CA City : BAKERSFIELD Zip : 93380 +---------------~--------------------------------------------------------------+ Owner JAMISON HILL Phone: (661) 393-7000x Address : PO BOX 82515 State: CA City : BAKERSFIELD Zip : 93380 +------------------------------------------------------------------------------+ Period to TotalASTs : = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: +------------------------------------------------------------------------------+ Emergency Directives: BusPhone: Map : 103 Grid: 15A (661) 872-1389 CommHaz : Moderate FacUnits: 1 AOV: PROG A - HAZMAT PROG U - UST fN17J AUGJ . o lOUR ea~fjd on my inquiry of those individuals re~ponslblt; for obtaining the information, I certify und~~ penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true accura I and co plete. ' ~tffl ~~l ~ ? cPg.-i- 5? \ 'I- ~ \A- {DD g-J -t'~-/ - Date .y +==============================================================================+ -1- 03/31/2006 tl\U , f .. MONITORING SYSTEM CERTIFICATION I '. For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6. 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations TT'-O 5"'1 I This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of this date. A. General Information Facility Name: #773 Fastrip #31 Site Address: 3501 Mt. Vernon Avenue City: Bakersfield Bldg. No.: Zip: 93306 Facility Contact Person: Omero Garcia Make/Model of Monitoring System: Veeder-Root TlS 350 Contact Phone No.: 661-393-7000 Date of Testing/Servicing: an /2007 ~:eV-=~bo~to2~~~~s~~~ed Tank In: 12000 gal. Regular Tank ID: 12000 gal. Super ~ In-Tank Gauging Probe. Model: 847390-107 [!] In-Tank Gauging Probe. Model: 847390-107 ~ Annular Space or Vault Probe. Model:79439O-420 [!] Annular Space or Vault Sensor. Model: 794390-420 ~Piping Sump / Trench Sensor(s). Model: 794380-208 ~ Piping Sump / Trench Sensor(s). Model: 794380-208 o Fill Sump Sensor(s) Model: 0 Fill Sump Sensor(s). Model: ~ Mechanical Line Leak Detector. Model: FX1V , [!] Mechanical Line Leak Detector. Model: FX1V o Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model: [!] Tank Overfill / High Level Sensor. Model: 847390-107 [!] Tank Overfill / High Leval Sensor. Model: 847390-107 o Other (specify equip. type and model in Sec. E on Pg. 2) 0 Other (specify equip. type and model in Sec. Eon Pg. 2) Tank In: 12000 gal. Diesel Tank In: ~ In-Tank Gauging Probe. Model:84739O-107 0 In-Tank Gauging Probe. Model: ~ Annular Space or Vault Sensor. Model: 794390-420 0 Annular Space or Vault Sensor. Model: [!] Piping Sump / Trench Sensor(s). Model:794380-208 0 Piping Sump / Trench Sensor(s). Model: 0 Fill Sump Sensors(s). Model: 0 Fill Sump Sensor(s). . Model: [i] Mechanical Line Leak Decector. Model: FX1 DV 0 Mechanical Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model: [!] Tank Overfill / High Level Sensor. Mode1:847390-107 0 Tank Overfill / High Level Sensor. Model: 0 Other (specify equip. type and model in Sec. E on Pg. 2) 0 Other (specify equip. typs and model in Sec. E on Pg. 2) Dispenser ID: 1&2 Dispenser ID: 3 & 4 [i] Dispenser Containment Sensor(s). Model: 794380-208 [!] Dispenser Containment Sensor(s). Model: 794380-208 [i] Shear Valve(s). ~ Shear Valve(s). o Dispenser Containment Float(s) and Chain(s). o Dispenser Containment Float(s) and Chain(s) Dispenser ID: 5&6 Dispenser In: 7 & 8 ~ Dispenser Containment Sensor(s). Model: 794380-208 W Dispenser Containment Sensor(s). Model:. 794380-208 ~ Shear Valve(s). ~ Shear Valve(s). o Dispenser Containment Float(s) and Chains(s). o Dispenser Containment Float(s) and Chain(s). Dispenser ID: Transition Sump Dispenser ID: . [!J Dispenser Containment Sensor(s). Model: 794380-208 o Dispenser Containment Sensor(s). Model: W Shear Valve(s). o Shear Valve(s). o Dispenser Containment Float(s) and Chain(s) o Dispenser Containment F10at(s) and Chain(s). . . * If the faCIlIty contams more tanks or dIspensers, copy thIS form. Include mformatIon for every tank and dispenser at the facility. C. Certification - I certify that the equipment identified in this document was inspected/services in accordance with the manufacturers' guidUnes. Attached to this Certification is information (e.g. manufacturers' checklist) ntUSSary to varify that this information is correct and a plot plan showing the layout of monitoring equipment. For equipment capable of generating s~c~ reports, I h~ve attached a copy of the report; (check all that app~) 0 System ~-~p I W AlanD:;2hist ry report TechmcIan Name (pnnt): Kristopher Karns SIgnature: K".A , ill /I A._ "" Certification No: 834106 License No: 804904 Testing Company Name: Confidence UST Services, Inc. Phone No: 800-339-9930 Site Address: 3501 Mt. Vernon Avenue. Bakersfield, CA 93306 Date ofTestinglServicing: 8/07/2007 D. Re~ults of Testing/Servicing ~. ''t Software Version Installed: 327.04 Complete the following checklist: [iJ Yes o No. Is the audible alarm operational? x Yes r -I No. Is the Visual alarm operational? x Yes r 1 No. Were all sensors visually inspected, functionally tested, and confirmed operational? ~ Yes DNo* Were all sensors installed at the lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? IUYes WNO* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) x N/A operational? I~ Yes o No. For pressurized piping systems, does the turbine automatically shut down if the piping secondary DN/A containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initate positive shut-down? ~ Sumpffrench SensorsWDispenser Containment Sensors Did you confIrm positive shut-down due to leaks and sensor failure/disconnected? [iJ Yes; 0 No; WYes DNo* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no DN/A mechanical overfill prevention valve is installed), is the overfill warning alarm visual and audible at the tank fIll point( s) and operating properly? If so, at what percent of tank capasity does the alarm trigger? I 90 J% ~ Yes. DNo Was any monitoring equipment replaced? If Yes, identifY specifIc sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. DYes. ~No Was liquid found inside any secondary containment systems designed as dry systems? tTxl Veo:: o Product; 0 Water. If yes, describe causes in Section E, below. I INo. Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. Lx Yes r 1 No. Is all monitoring equipment operational per manufacturer's specifIcations? * In Section E below, discribe how and when these deficiencies were or will be corrected. E. Comments: Replaced one 794380-208 sensor in the Super STP Sump (old sensor was missing float). F. In-T;nk Guaging I SIR Equipment: [iJ Check this box if tank guaging is used only for inventory control. D Check this box if tank guaging or SIR equipment is installed. This section must be completed if in-tank guaging equipment is used to perform leak detection monitoring. Complete the following checklist: ~ Yes 0 No* Has all input wiring been inspected for proper enter and termination, including testing for ground faults? I- No* Were all tank guaging probes visually inspected for damage and residue buildup? x Yes x Yes No* Was accuracy of system product level readings tested? x Yes No* Was accuracy of system water level readings tested? x Yes No* Were all probes reinstalled properly? I- D Were all items on the equipment manufacturer's maintenance checklist completed? ~ Yes No* * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): o Check this box if LLD's are not installed. c Ii I h kIi omplete the 01 oWln cec st: Ii] Yes DNo* For equip. start-up or annual equipment certification, was a leak simulated to varify LLD performance? (Check all that apply) Simulated leak rate: ~3 g.p.h.: DO.1 g.p.h.; 00.2 g.p.h.; ..." ~Yes - No* Were all LLD's confirmed operational and accurate within regulatory requirments? "1x J Yes No* Was the testing apparatus properly calibrated? ~Yes No* For machanical LLD's, does the LLD restrict product flow if it detects a leak? - N/A DYes No* For electronic LLD's, does the turbine automatically shut off if the LLD detects a leak? -- [iJ N/A DYes WNo* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system is [x] N/A disabled or disconnected? DYes. WNo* For electronic LLD's, does the turbine automatically shut off if any portion of the monitoring system ~N/A malfunction or fails a test? DYes WNo* For electronic LLD's, have all accessible wiring connections been visually inspected? i-= ~N/A ~Yes [ No Were all items on the equipment manufacturer's maintenance checklist completed? * In the section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: '" :t\ftD.e~ ~t Ref. Number: -ClQlltPUANCC WfnIt ~rlcc.'lKL'" Rep~ir HI..~_~: Replaced one 794380-208 sensor in the Super STP Sump. Comments: 13087 FASTRIP 3501 I"IT. VERNON BAKERSFIELD CA.93306 805-872--1389 AUG 7. 2007 9: '-\-0 AI"1 SYSTEI"J STATUS REPORT ALL FUNCT IONS NORI"IAL I N\IENTOR'f REPORT T I :UNL "./OLUf"lE ULLAGE 90?'o ULLAGE= TC VOLUI-iE HEIGHT "'lATER VOL lAlA TER TEI"lP T 2:DIESEL VOLUf"IE ULLAGE 90% ULLAGE= TC VOUklE HEIGHT WATER VOL lrJATER TEf'lP T :3 :PNL VOLUf1E ULLAGE 90% ULLAGE= TC VOLUf"IE HEIGHT L~ATER VOL WATER TEf"IP 8515 GALS 3547 GALS 2:340 GALS 8:351 GALB 73.79 I J'ICHES 11 GALS o . 75 I t'JCHES 87.5 DEG F 4413 GALS 7649 G~\LS 6442 GALS 4345 GALS 43.72 INCHES I] GALS o . 00 I NCHEf::; 94.3 DEG F 3872 GALS 8630 GALS 7483 GALS 330:3 GALS ~6 . 86 INCHES o GALS o . 00 I NCHE~; 88.9 DEG F ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ SYSTEf"1 SETUP AUG 7. 2007 9:40 AM SYSTEI"l UN I TS U.S. SYSTEI"1 LANGUAGE ENGLISH S\(STEf1 DATE/T Jl1E F{)Rr"IAT l'i0N DD yyyy HH:t"!f"I:SS :.:N FASTRIP 3501 I"IT. VERNON BAKERSF I ELD CA. 93:306 805-872- 138'3 SHIFT TH"IE I SHIFT TIf"IE 2 SHIFT TIl"IE 3 SHI FT T HiE 4 DIBABLED DISABLED DISABLED DISABLED TAf:lK PER TST NEEDED ["JRN DISABLED TANK ANN TBT NEEDED ["lRN DISABLED LINE RE-ENABLE METHOD PASS LINE TEST LINE PER TST NEEDED L,JRN DISABLED LINE ANN TBT NEEDED WRN DISABLED PR I NT Te \!OLUf"IES ENABLED TEJ"IP COf"lPENSATI ON VALUE (DEG F): 60.0 STICK HEIGHT OFFSET DISABLED ULLAGE: 90% H-PF:OTOeOL DATA FORf'lAT HEIGHT DAYL I GHT SA\! I NG T I f"IE Ef~ABLED START DATE APR WEEK :3UN ST ART T I 1"IE 2 : 00 AI1 END DATE OCT WEEK 6 SUN END TIf"lE 2:00 AI"l RE-DIREGT LOCAL PRINTOUT DISABLED EURO PROTOCOL PREFIX S SYSTEI"I SECUR I TV CODE : 000000 f"IA I NTENANCE H I STORY DISABLED TANK CHART SECURITy DISABLED GUSTOI"1 ALARI"IS DISABLED f"IASS/DENS I TV DISABLED COf"1l1UN I CAT IONS SETUP PORT SETTINGS: COI"ll"1 BOARD : 1 (ED I f"1 ) RS-232 SECURITY CODE : DISABLED CO'"II"\ BOARD '2 (RS-23'2) BAUD RATE 9600 PARITY NONE STOP BIT : I STOP DATA LENGTH: 8 DATA RS-232 SECURITV CODE : DIBABLED COf"If"1 BOARD 3 {RS-232) BAUD RATE 9600 PARITY NONE STOP BIT 1 STOP DATA LENGTH: 8 DATA RS-232 BECURITY CODE : D I :3ABLED AUTO TR;:WlBf"1J T BE1'T I NGS : AUTO LEAK ALARf"l LI '"I IT DISABLED AUTO HIGH I,~ATEF: LII"IIT D I :3ABLED AUTO OVERF I LL L I 1"1 I T DISABLED AUTO LOW PRODUCT DISABLED AUTO THEFT LIMIT DISABLED AUTO DELIVERY START DISABLED AUTO DELIVERY END DISABLED AUTO EXTERNAL I f'jPUT ON DISABLED AUTO EXTERNAL INPUT OFF DISABLED AUTO SENSOR FUEL ALARN DISABLED AUTO SENSOR LJATER ALAFU"l DISABLED AUTO SEI'-lSOR OUT ALARl"1 DIBABLED RB-2:32 END OF 1"IE~3SAGE DISABLED IN-TANK SETUP T 1 :UNL PRODUCT CODE THERf"IAL COEFF TANK D I AI"lETER TANK PROFILE FULL VOL FLOAT SIZE: ~JATER ltJARN I NG : HIGH ~'JATER L1f"IIT: i"IAX OR LABEL VOL: OVERFILL Llr"IIT HIGH PRODUCT DELIVERY LII"lIT LOW PRODUCT : LEAK ALARM LIMIT: SUDDEN LOE;S L I 1"1 IT; TANK TILT : PROBE OFFSET I .000700 111.00 1 PT 12062 4.0 IN. 2.0 3.0 12062 90% 10855 95;:.-~ 11459 15~~ 1809 500 99 9'3 0.00 0.00 S I PHON f"IAN I FOLDED TANKS Tit: NONE LI NE t"IAN I FOLDED TANKS Tf!: NC'NE LEAK (olIN PERIODIC: LEAK I'" IN HNNUAL 1 ~~ 120 I.;'... ."(. 120 PERIODIC TE::;T TYPE STANDARD ANNUAL TE:3T FA I L ALARI'1 DISABLED PERIODIC TEST FAIL ALARI"I D I :::ABLED GF:OSS TEST FAI L ALARr"1 DISABLED ANN TEST AVE RAG II.f; ; OFF F'ER TEST AVERAG I NG : OFF TANK TEST NOTIFY: OFF T NK T:::T SIP HON BREA/(: OFF DEL I VERY DELAY I r"l I N PUI'1P THRESHOLD : I O. OO?,. T 2: DIESEL PRODUCT CODE THERI"lAL COEFF TANK D I ~ll'1ETER TANK PROFILE FULL VOL FLOAT BIZE: ~JATER I,JARNI NG HIGH WATER LIMIT: MAX OR LABEL VOL: OVERFILL LIMIT : HIGH PF:ODUCT DELIVERY LII"IIT LOW PRODUCT : LEAK ~\LARI"I L I 1"1 IT: SUDDEN LOSS LIMIT: TANK TILT PROBE OFFSET 2 .000450 111.00 1 PT 12062 4.0 IN. 2.0 3.0 12062 90}. 10855 95% 11459 15% 1809 500 99 9'3 0.00 0.00 :3 I PHON I"IAN I FOLDED TANKS TP: NONE LINE I"IAN I FOLDED TANKS Tt:!: NONE LEAK 1"11 N PERIODIC: 1% : 120 LEAK 1"111'1 MJNUAL 1% 120 PERIOD[C TEST TYPE STANDARD ANNUAL TEST FA[L ALARI"l D I Bf.iBLED PERIODIC TEST FAIL ALARI"l D I ::::ABLED GROSS TEST FAIL ALAR!"l D I BABLED ANI'J TEST AVEF:A(; I NG : OFF PER TEST AVEf:AG I NG : OFF TANK TEST NOT I FY : OFF TNK TST SIPHON BREAK:OFF DEL [\iERV DELAY I 1"1 I N PUI"IP THREBHOLD : 10. [10% T 3: PJlJL PRODUCT CODE THERr"IAL COEFF TANK D I Af"IETER TANK PROFILE FULL \JOL FLOAT SIZE: WATER ~'.)ARN I NG : HI(;H ~,JATER LIr"IIT: I"IA/< OR LABEL VOL: OVERFILL LlfollT : HIGH f'RODUCT DELIVERY Lli"IIT lOIJJ PRODUCT : LEAK ALARt'" L [1"1 IT: SUDDEN lOSS LIMIT: TANK T[LT PROBE OFF:3ET 3 .000700 111.00 1 PT 12062 <1.0 ] N. 2.0 3.0 12062 90% 10855 ~J5% 11459 15}~ 1809 o 99 '3'3 0.00 0.00 :3 I PHON f"IAN I FOLDED TAI'JKS Tt:!: NONE LINE f'1AN I FOLDED TANKS Tll: NOI\JE LEAK 1"1 I N PER I OD I C : LEAK M[N ANNUAL Ik 120 1% 120 PER I OD I G TE:::;T TYPE STANDAF:D ANNUAL TEST FAIL ALAF-:I"I DISABLED PERIODIC TEST F;:;IL ALARI"! D I BABLED GF:OE;:3 TEST FAIL ALAR!"! rl I ::::ABLED ANN TEBT AVERACING: OFF PER TEST AVERAGING: OFF TAf\lK TEST NOTIFV: OFF TNK TST SIPHON BREAK:OFF DEL I VERY DELAY : 1 1'1 I N PUI'IP THF:ESHOLD : 1 0 . 00% LEAK TEST METHOD .- - - - - - - - - - -- TEST ON DATE : ALL TANK FEB 6. 2007 !:3TART T II"IE : D f SABLED TEST RATE : 0 . 20 GAL/HF: DURATION : 2 HOURS T8T EARLY STOP:DISABLED LEAK TEST REPORT FORI"lr-\T I'JORI'1AL LIQUID SE~SOR SETUP L 1 :UNL ANN NORI"IALLY ':;LOSED r::ATEGOF~Y : ANNULt~R SI='ACE L 2:DIE~3EL ANN NORI"lALLY CLOSED CATEGORY : ANNULAR SPACE L 3 :PNL ANN 1'1< I -STATE {S INGLE FLOAT,\ CATEGOR'/ : ANI'WLAR SPACE L 4: UNL :3TP TRI-STATE (SINGLE FLOAT} CATEGOF:V : STP SUHP L 5:DIESEL STP TRI-STATE (SINGLE FLOAT) CATEGOI?'/ : STP SUI"lP L 6:PNL E3TP TRI-!::;TATE (81 NGLE FLOAT) CATEGORY : STP SUI"IP L 9:DISP 1-2 TR I -STATE .; S I !'JeLE FLOAT) CATEGORY : DISPEN:3ER h'iI'J LIO:DISP 3-4 TR I-STATE U:::I NGLE FLOAT) CATEGORY : D I :3PENf3Ef.' PAl'l LI J :DISP 5-6 TRI-STATE (SINGLE FLOAT! CATEGOR",' : D I SPENSER PAN Ll 2: D I SP 7-8 TF: I-STATE (S I NGLE FLOAT I CA TEGO RY : D I ~3P E NSER PA N L 13: TRANS SUI'1P TRI -STATE (SI NGLE FLO,':jr; CATEGORV : PIPING SUHP Pur"]p SENSOR SETUP S 1 :Uf'.JL TAl'll< Ii: DISPENSE f"IODE: STANDARD S 2: Pi'lL TANK II: :3 DISPENSE I"IODE: STANDARD OUTPUT RELAY SETUP R 1 :UI'JL T'/PE: PUt"lP CONTROL OUTPUT TAI'lK Ii: I L I QU [D SENSOR AU"I~~ L 4: FUEL ALARr'1 L 9: FUEL f.\LARI"l L I 0 : FUEL ~,LARr"1 L J 1 : FUEL ALARI"l L I 2 : FUEL ALARI"1 L I 3 : FUEL ALARI"l L 4 : SENSOR OUT ALARl"! L 9:SENSOR OUT ALARf"l LIO:SENSOR OUT ALARM L J 1 : SENSOR OUT ALAR!"1 Ll 2 : SENSOR OUT ALAF:t"l L13:SENSOR OUT ALARH L 4 :SHORT ALARI"'I L 9 :SHORT ALARI"! L J 0 : SHORT ALAR!"I LIt : SHORT ALARI"I LI 2: SHORT ALARI'1 L J 3 : SHORT ALAR!"I I SD :31 TE ALARI"IS ISO GROSS PRES FAIL ISD DEGRD PRES FAIL ISD VAPOR LEAK FAIL ISD VI=' PF:ES FAIL 180 VP STf.\TUS FAIL ISD HOSE ALARI"1S ALL: GROSS ':;:OLLE(:T FA I L ALL:DEGRD COLLECT FAIL ALL:FLOW COLLE(;T FAIL R 2: PNL TVPE: PUI'1P CONTROL OUTPUT TANK il: 3 U'dU TO SENSOR ALI'1~; L 6 :FUEL ALARr"1 L 9:FUEL ALARH LI 0 : FUEL ALARI"l L II : FUEL ALARr"1 L12 : FUEL ALARI"\ LI 3 : FUEL ALAR!"I L 6: SENSOR OUT ALAF:I"I L 9: SENSOR OUT ALARI"! L 1 0 : SENSOR OUT ALARI"I LIJ :SENSOR OUT ALARH L 12: SENSOR OUT ALAR!"I L I 3 : SEN:30R OUT ALARr"] L 6 : SHORT ALARt'l L 9 :SHORT ALARr"j LlI]:SHORT ALAR,..1 Ll 1 : SHORT ALARl"1 L 1 3 : SHORT ALAR!"l 1:=::0 S r TE ALAF:I"I~ , lSD GROSS PRE::; Fi-iIL ISO DEGRD PRES FAIL ISD VAPOR LEAK FAIL ISD VF> PRES FAIL ISO VF STATUS FAIL I :3D HOSE ALARI''1:3 ALL: (;ROSS COLLECT FA I L ALL:DEGRD COLLECT FAIL ALL:FLOW COLLECT FAIL R :3:DIESEL T''/PE: STANDARD l'lORI"IALL Y CLOSED TANK Ii: 2 U ClU ID f:;ENSOR AU'IS L 5: FUEL ALARI"I L1 I] : FUEL ALARI"I L 12: FUEL ALAR,..\ L1 3 : FUEL ALARr"1 L 5: SENSOR OUT ALARI"! L J 0 : SEN::;OR OUT ALAR"'I L 12: SENSOR OUT ALARI''! L 1 3 : SENSOR OUT ALAR!'I F: 4: OVERF I LL ALARt'l TYPE: BTANDARD "K,\RI'lALLV OPEN mNK Il: NONE IN-TANK ALARHS ALL: OVERF ] LL ALARI"I ':'LL : HIGH PRODUCT ALARI"I ALL :I"IA>< PRODUCT ALARf"l SI'1ARTSENSOR SETUP = l' P c. I-? CATEGORY VAPOR PRESSURE 5 2:F.lvl 1-2 CATEGORY A I R FLOr,j fvlETER 5 :3:F .r") :]-4 CATEGORY AI F: FU)~,.) f'1ETER 5 4:F ./'" 5-6 CATEGOR'! A I R FLOt,.) I"IETER 5 5:r .fvf 7-8 CATEGORY A r R FLOt,.) ("JETER EVR/ISD SETUP EVR TYPE: \/ACUUI"t AS::; I ST IJACUIJ~'l AS::; I ST riPE HEALV VAC NOZZLE A/L RANGE MAX: 1.15 MIN: 0.95 VAPOR PROCESSOR TYPE NO 'v'Aj:>OR PROCESSOR ANALVSIS TIHES T (I"IE: 1 0: DO Alv1 DELA''{ fvll NUTES : ACCEPT HIGH OR'v'R: DISABLED [SO HOSE TABLE ID FP FL HL iC;A RP. --------------._--------- 01 01 DJ 02 01 UU 02 02 D2 02 [11 UU 0:3 0" 03 02 02 UU ~, 04 04 04 02 02 UU 05 05 0'" 0'-' 0:3 UU ,.) 06 OE. OE. 02 03 UU 07 07 07 02 04 UU 08 OE: 08 02 04 UlJ I3D A I RFLOht l"lETER I"IAP I D SER I AL NUfv! LABEL 1 8679 F .1"1 1-2 2 8674 F .f'l :]-4 3 8678 F.l"! 5-6 4 8684 F.f'1 7-8 ISD FUEL C;RADE HO:3E [''lAP 1 2 3 4 FP IvlHH f"!HH r"IHH IvlHH (0. ,'. Hn ------------------------ 01 201 301 901 U U 02 202 302 902 U U 03 20:] 303 903 5 U ,-, 04 904 204 :304 5 U 2 05 905 205 305 U U " '-' 06 206 :306 90E. U U 3 07 207 307 907 5 U 4 08 208 :308 908 5 U 4 LABEL TABLE UNASSIGNED 2 BLEND3 3 REGULAR 4 Ivll D GRADE 5 PREl''\J UI') Eo GOLD 7 BRONZE 8 SILVER 9 BLEND2 10 BLEND4 Pf"lC SETUP PROCESSOR CONTROL LE\.lEL: NONE SOF1'1;.)AF:E REV I S I ON lHiEL VERSION 327.04 :::OFTl:JAREII 346327-100-E CREATED - 07.02.06.10.28 s-r'IODULEIi 330160-004-a S't'STErV) FEATURES: PERIODIC IN-TAI'Jl< TESTS ANNUAL IN-TANK TESTS ISD PI.le ALARf"J HISTORY REPORT ------ SENSOR ALARI"! L I: UNL ANI'J ANNULAF: SPACE FUEL ALARJV) JUL 19. 2007 9:47 AM FUEL ALARI"! MAY 10. 2007 1 :15 PM SETUP DATA \..JARN I NG t"lAV 1 O. 2007 I 2 : 59 PI"l ~ ~ ~ ~ ~ END . ~ ~ ~ " ALARl"l H I STORY REPORT ----- SENSOR ALARM L 2:DIESEL ANN ANNULAR SPACE FUEL ALHRI"l JUL 19. 2007 9:49 AM FUEL ALAR~'l JUL 19.. 2007 g: 48 AI"] FUEL ALARI"! "'lAY 1 0.. 2001' I: 15 Plvl ---"- >. " '" " ~ END ;.; )E '.: '" '" ALARI"l HI BTCiR'! REPOF:T ,----- SENSOR ALARI"\ L 3:PNL ANN AI"INULAR SPACE SENSOR OUT ALARI"I JUL 24. 2007 10:01 AM FUEL AU~RI"I JUL 19. 2007 9:50 AM FUEL ALARt"1 JUL 19. 2007 9:49 AM ~ ~ '" "" .. END ^ ,,'.: ;.; )E ALARI") HI '3TOR'l F~EYORT ----- SENSOR ALARM ----- L 4:UNL STP STP SUI"IP FUEL ALARI"! JUL 19. 2007 9:27 AM SETUP DATA I"IARI'.J I NG l"IAV 1 O. 2007 12: 59 PI"! '" )E '" )E '" END ;( '" '" '" '" ALARI"1 HI STOF:V REPORT ----- :3EN:30R ALARI"! L 5:DIESEL STP STP SU11P FUEL ALARI"! JUL 19. 2007 9: 30 AI"I SETUP DATA WARNING MAY 10. 2007 12:59 PM ;( )E '" '" '" END * ;( '" '" )E ALARI"I HISTORY REPORT ----- 8ENSOF: ALARI"! ----- L b :PI"JL STP STP SUI"IP FUEL ALARI") JUL 19. 2007 9:31 AM SETU~' DATA WARNII'JG MAY 10. 2007 12:59 PM ~ * ~ ~ ~ END * * ~ * * ALARI"! HI :3TORY REPORT ::;:EN:30F: ALARI"1 L 7: OTHER SENSORS '" Cl'Jfj ?: ~ ;.; ;.: ". ;.: ::-; ~--.;.:; -;'t;- L:,,.....' , ALARI"1 H I STORY REPORT SEN:30R ALARI"! L 8: OTHER SENSORS "" '" "" ;.; jf END '" :.; '" '" '" ALARI"I H [ STORY REPORT ------ SENSOR ALARI"1 L 9:DISP 1-2 (J I BPENSER PAN FUEL ALARI'" JUL 19. 2007 9:37 AM SETUP DATA 1,~ARNr NG MAY 10. 2007 12:59 PM '" ~ ~ ~ ~ END '" '" ~ ~ ~ ALAR!"I HI:::;TORY F:EPORT ----.- SENE;OR ALARI"! LlO:DIBP 3-4 DISPENSER PAN FUEL ALAR/"/ JUL 19. 2007 9:39 AM SETUP DATA i'JARNI NG i"lAY 1 I). 2007 12: 59 PI"I .------ ~ :-.: ~ ~ ~ END ~ * * :.:, ~ * ~ ~ * ~ END ~ ~ ~ ~ ~ ---- IN-TA~~ ALARM T 3:PNL SUDDEN LOSS ALARM AUG 7, 2007 '3: Ell AI'1 ALARI"l HISTORY REPORT ----- SENSOR ALARI"] LI I :DISP 5-5 D I SF'ENSER PAN FUEL ALARI"] JUL 19.. 2007 9: 43 AI"I ---- IN-TANK ALARf"] T I :UNL SUDDEN LOSS ALARI") AUG 7. 2007 9:49 AM ---- IN-TANK ALARM ----- T :3 :PNL DEL I VER\' NEEDED AUG 7. 2007 9:51 AM SETUP DATA ~,JARN I NG MAY 10, 2007 12:59 PM ---- IN-TANK ALARr"! T I :UNL PROBE OUT * ?If ~ ;I;. ~ END j( ~ ~ )( '" AUG 7.. 2007 9:49 AI"] ---- IN-TANK ALARM ----- T 3:PNL PF:OBE OUT AUG 7. 2007 9: 51 AI"] ALARr"! H I STORY REPORT ----- SErt:30R ALARt"l L12:DISP 7-8 DlSPEI~SER PAN FUEL ALARl"] JUL 19. 2007 9:41 AM SETUP DATA (,JARt.II NG MAY 10. 2007 12:59 PM ---- I N-TANK ALAR!"! T 2:DIESEL DELIVERY' NEEDED AUG 7. 2007 '3: 50 Af"] FASTRIP 3501 I"IT.VERNON BAKER:3F I ELD CA.93306 805-872-1389 AUG 7, 2007 9:51 AM SYSTEI'! STATUS REPORT T I: SUDDEN LOSS A Lt-'tRf"l T 3:SUDDEN LOSS ALARM ---- IN-TANK ALARM T 2:DIESEL PROBE OUT AUG 7. 2007 9: 50 AI"] T 3:PROBE OUT T 3:DELIVERY NEEDED II..J\/ENTORV REPORT * ~ ;..; ~ '" END *- '" ~ * ~ ---- I I'J-TANK ALARI"! T 2 :DIESEL LOI/J TEI"1P [,JARN I ('.IG AUG 7. 2007 9:51 AM T 1 :UNL \/OLUI"lE ULLAGE 90% ULLAGE= TC \/OLUI"lE HEIGHT I,.JATER VOL WATER TEI"IP 8281 GALS 3781 GALS 2574 GALS 81 :30 GALS 72.01 INCHES o GALS [1.00 11'ICHES 85.9 DEG F ALARI"I HI STORV REPORT T 2: DIESEL 'v'OLUI'IE ULLAGE 90% ULLAGE= TC VOLUI"]E HEIGHT WATER \lOL WATER TEI'lP 9:31 1 GALS 2751 GALS 1544 GALS 9164 GALS 80.03 INCHES 19 GALS 1.06 INCHES 95.0 DEG F ----- SENSOR ALARr"l L I 3 : TRAN:3 sur"IP PIPING SUI"1P SETUP DATA 1"IARN I NG MAY 10. 2007 12:59 PM ~ * ~ * * END * * ~ * * T :3:PNL I NVENTOF:Y INCREASE INCREASE START AUG 7. 2007 9 : 51 Ar"! - SENe'I)Fi' ALARr"! L--5~DIESEL' STP C.'TP CUI"IP FUEL'" (;LARI"l AUG 7. 2007 1 0: 08 AI'l ----- SENSOR ALARIV] L11 :DISP 5-6 D I SPENf::ER PAN FUEL ALARlvl AUG 7. 2007 10: 1 4 Ar'l \/OLUI"lE HEIGHT vJATER TEr"IP 1675 GALS 21.82 INCHES 0.00 INCHES 8:::: : 9 DEi:; F INCREASE END AUG 7. 2007 \/OLUrvIE HEIGHT 1"jATER TErvlP 9950 C;ALS 85.33 I r~CHES 0.00 INCHES 92.7 DEG F ----- SEfllSOR L 4:UNL STP coTP cUl'lP FUEL'-'ALARr"] AUG 7. 2007 ALAR!" ----- SENSOR ALARr"j L 3:PNL ANN - ANNULAR SPACE FUEL ALAR/v, AUG 7. 2007 10:15 AM 9:55 Ar"1 10:08 At'l GROSS INCREASE; 8275 TC NET I NCRE?\BE; 8080 ------ SENSOR ALARr"l L 9:DISP 1-;-2 D I SPENSER F'f'\N FUEL ALARr"l - - ':"1"1 AUG 7. 2007 IU:IU " ----- SENSOF: ALARI"l L 3:PNL ANN ANNULAR SPACE FUEL ALARI"I AUG 7. 2007 10: 16 AI'" ,; ----- IN-TANK ALARt"1 T I :UNL HIGH PRODUCT ALARtvl AUG 7.. 2007 10:00 AI"I ----- ~;EN80R ALARI"] ALARI"! L 2:DIESEL ANN ----- SENSOR ANNULAR SPACE L10:DISP 3-4 FUEL ALARlv] DISPENSER PAN AUG 7.. 2007 10: 17 AI") FUEL ALARf1 AI'I AUG 7. 2007 10:11 ---- IN-TANK ALARf'1 T 2:DIESEL HIGH PRODUCT ALARf"l AUG 7.. 2007 10:01 AI"! -.---.- SENSOR ALAR'''I L 1 :UNL ANN ----- SENSOR ALARI"I ANNULAR :::;PACE L1 2 : D I SP 7-8 FUEL ALARr", D I SPENSEF: PAN AUG 7. 2007 10: 19 At"1 FUEL ALARI"! 1 [I: 1 '2 AI"1 --.-- IN-TANK ALARf"1 AUG ?. 2007 T 3:PNL HIGH PRODUCT ALARf1 AUG 7.. 2007 10:01 AI"J ----- 1 N-TANK ALAF:r"l T :3 :PNL SUDDEN LOSS ALARI"I AUG 7. 200'1 10: 01 At"l ----.- SENSOR ALAF:11 L12:DISP 7-8 DISPENSER PAN FUEL ALARf") _ Alje; 7. 2007 10: I J At"1 --:-:- SENSOR ALAR"'l L b:PNL STP STP Sur"lf> ~;Er'j:,X:'R OUT ALAR'''f ' HUG 7. 2007 10:22 AM - ---- ---~._y------~-- > . ----- SENSOR ALARM ----- LEo: PI'4L STP STP SUI"lP FUEL ALARr"] AUG 7. 2007 10:24 AM ----- SENSOR ALARM ----- L 6 :PNL STP STP SUI"lI') FUEL ALAR'''] AUG 7. 2007 10:25 AM __u IN-TANK ALARI"1 T 3:PNL PROBE OUT AUG 7. 2007 10:28 AM ---- I N-TAI'lK ALAR!"I T :3: PNL LOIJ TEIV]P ("JARN I NG AUG 7. 2007 10:29 AM ---- IN-TANK ALARlv] T 2:DIE::::EL PROBE OUT Aue; 7. 2007 10: 29 Alv] ---- IN-TANK ALARM T 2:0IESEL LOI.) TEI"IP (..JARN I NG AUG 7> 2007 10: 30 Alv] ---- IN-TANK ALARIV] ----- T 1: UNL PROBE OUT AUG 7. 2007 10:30 AM ---- IN-TANK ALAR;v] --.--- T I :UNL LO(..J TEMP 1,.JARNI NG AUG 7. 2007 10:32 AM FASTRIP :3501 f'lT.VERNON ~:A}(ERSF I ELD CA. 93306 Cl05-872- J :38'::' AUG 7. 2007 ID:32 AM SVSTEI"1 STATUS REPORT - - - -- - ALL FUNCT IONS NORr"IAL T I :UNL INVENTORY INCREASE INCREASE START AUG 7. 2007 10:30 AM VOLUfvlE HEIGHT LvA TER TEI"IP 7716 GALS 67.78 INCHES 0.00 INCHES 85.5 DEG F INCREASE END RUG 7. 200~ 10:34 AM 1.,IOLur"lE HEIGHT WATER TENP 8520 GALS 73. i?3 11'ICHES 0.Cl2 INCHES 85.6 DEG F GROBS INCREASE= 804 TC NET INCREASE= 789 -- ~ ~ ----- ----- SENSOR ALARlv! Ll2 :DISP 7-8 DISPENSEF: PAN FUEL ALARr"l AUG 7. 2007 10:38 AM ., , r ---- --- SENSOR ALAF:I"l Ll2:DISP 7-8 D I f;PENSEF: PAN FUEL (,LARI"] AUG 7, 2007 1 [I : 56 N" -----c-. BENSOR ALARI"] Ll2:DISP 7-8 D I SPEN:3ER PAN FUEL ALARI'I AUG 7. 2007 1 1 : 0:3 AI"I FASTRIP :350 I I"]T. VERNON BAKERSFIELD CA.93306 805--:372-1389 AUG 7. 2007 II :28 AM :3YSTH'\ STATUS REPOF~T ALL FUNCT I ort:; NORr"lAL ----- SENSOR ALARI"l Ll 3 : TRAN:=:: sur"IP !=' I P I NC; SUI"IP FUEL ALARI"! AUG 7. 2007 11: 29 AI'I .', ,..,. SWRCB, January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (if applicable), should be provided to thefacUity owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: #773 Fastrip #31 I Date of Testing: 8/7/2007 Facility Address: 3501 Mt. Vernon Avenue, Bakersfield, CA 93306 Facility Contact: Omero Garcia I Phone: 661-393-7000 Date Local Agency Was Notified of Testing : 7/23/2007 Name of Local Agency Inspector (ifpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services, Inc. Technician Conducting Test: Kristopher Karns Credentials 1: X CSLB Contractor X ICC Service Tech. o SWRCB Tank Tester o Other (Specify) License Number(s): CSLB #804904 ICC #5264406-UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: x Hydrostatic o Vacuum o Other Test Equipment Used: Lake Test Equipment Resolution: 0.0625" Identify Spill Bucket (By Tank 1 Regular 2 Super 3 Diesel 4 Number, Stored Product, etc.) Bucket Installation Type: o Direct Bury o Direct Bury o Direct Bury o Direct Bury x Contained in Sump x Contained in Sump x Contained in Sump o Contained in Sump Bucket Diameter: 12.00" 12.00" 12.00" Bucket Depth: 13.75" 14.00" 14.00" Wait time between applying 5 min. 5 min. 5 min. vacuum/water and start of test: Test Start Time (T1): 9:00am 9:00am 9:00am Initial Reading (RI): 12.00" 12.00" 11.50" Test End Time (T p): 10:00am !0:00am I 0:00am Final Reading (Rp): 12.00" 12.00" 11.50" Test Duration (Tp - T1): 1 hour 1 hour 1 hour Change in Reading (Rp - R1): 0.00" 0.00" 0.00" PasslFail Threshold or 0.0625" 0.0625" 0.0625" Criteria: Test Result: X Pass o Fail X Pass o Fail X Pass o Fail o Pass o Fail Comments - (include iriformation on repairs made prior to testing, and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCfING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: -KAA_~ fl~ Date: 8/7/2007 1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. .1'/ ,,/ .', ;: 0" UN~ERGROUNDSTORAGETANKS BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 APPlICA TION TO PERFORM ELD I LINE TESTING I S8989 SECONDARY CONTAINMENT TESTING ITANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION Page 1 of 1 PERMIT NO.P( { ./ D ~GftI 2S ENHANCED LEAK DETECTION 2S TANK TIGHTNESS TEST 2S LINE TESTING 2S S8-989 SECONDARY com AINMENT TESTING 2S TO PERFORM FUEL MONITORING CERTIFICATION SITE INFORMATION NAr.1E 8. PHONE NUr.1BER OF CONTAC , PERr.1IT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED TANK # IS PIPING GOING TO BE TESTED? VOLUME 16 YES 16 NO CONTENTS D TEST METHOD FD 2095 (Rev. 09105) ENTD JUL 3 0 2007 "\ f,\v -:-r->'- Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Fastrip #31 (Exxon) Facility ill #: 3018 Facility Address: 3501 Mt. Vernon Avenue, Bakersfield, CA 93306 Reason for Submitting this Form (Check One) (City) X Addition of Designated Operator Facility Phone #: 661-872-1389 D Update Certificate Expiration Date Desbroated UST ODerator(s) for this Facilitv AL TERNA TE 3 (Optional) Designated Operator's Name: Jessica L. Meyers Relation to UST Facility (Check One) Business Name (If different from above): Confidence UST Services, Inc. DOwner D Operator D Employee Designated Operator's Phone #: 800-339-9930 D Service Technician x Third-Party International Code Council Certification #: 5313857-UC Expiration Date: June 30, 2009 ALTERNATE 4 (Qpuonm) Designated Operator's Name: Relation to UST Facility (Check One) Business Name (If different from above): DOwner D Operator D Employee Designated Operator's Phone #: o Service Technician o Third-Party International Code Council Certification #: Expiration Date: ALTERNATE 5 (Optional) Designated Operator's Name: Relation to UST Facility (Check One) Business Name (If different from above): DOwner D Operator D Employee Designated Operator's Phone #: D Service Technician o Third-Party International Code Council Certification #: Expiration Date: I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (t). Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (please Print): Jamieson Hill Co. SIGNATURE OF TANK OWNER: DATE: Aueust 9. 2007 OWNER'S PHONE #: 661-393-7000 NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY JANUARY 1,2005. THE LOCAL AGENCY LIST IS AVAILABLE AT: www.waterboards.ca.gov/ust/contacts/cupa agys.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO TillS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 I.,. .~ 713 ~- Owner Statements of Designated Underground Storage Tank (USn Operator and Understanding of and Compliance with UST Requirements Facility Name: Fastrip #31 (Exxon) Facility ill #: 3018 Facility Address: 3501 Mt Vernon Avenue, Bakersfield, CA 93306 Reason for Submitting this Form (Check One) (City) o Change ofDesignatcd Operator Facility Phone #: 661-872-1389 X Update Certificate Expiration Date Desitmated UST Ooeratons) for this Facilitv PRIMARY Designated Operator's Name: Douglas M. Young ill Relation to UST Facility (Check One) Business Name (If different from above): Confidence UST Services, Inc. DOwner o Operator o Employee Designated Operator's Phone #: 800-339-9930 o Service Technician x Third-Party International Code Council Certification #: 0878646-UC Expiration Date: September 22, 2008 AL TERNA TE 1 (OI1tiOlUllJ Designated Operator's Name: Jennifer Davis Relation to UST Facility (Check One) Business Name (If different from above): ConfuJence usr Services, Inc. o Owner o Operator o Employee Designated Operator's Phone. #: 800-339-9930 o Service Technician x Third-Party International Code Council Certification #: 5252886-UC Expiration Date: March 15, 2009 ALTERNATE 2 (Optional) Designated Operator's Name: Edward Mitchen Relation to UST Facility (Check One) Business Name (If different from above): Confidence usr Services, Inc. DOwner o Operator o Employee Designated Operator's Phone #: 800-339-9930 o Service Technician x Third-Party International Code Council Certification #: 5258845-UC Expiration Date: May 15, 2008 I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee tmining, in accordance with California Code of Regulations, title 23, section 2715(c) - (f). Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (please Print): Jamieson Hill Co. SIGNATUREOFTANKOWNER:~~ DATE: March 23. 2007 OWNER'S PHONE #: 661-393-7000 NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY JANUARY 1,2005. THE LOCAL AGENCY LIST IS AVAILABLE AT: www.waterboards.ca.gov/ust/contacts/cupaagys.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004