HomeMy WebLinkAboutBUSINESS PLAN 10/25/2007
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COLLEGE HEIGHTS FOODMART
SiteID: 015-021-000443
Manager
Location: 3711 MT VERNON AVE
City BAKERSFIELD
BusPhone:
Map : 103
Grid: 15A
(661) 873-8503
CommHaz : Moderate
FacUnits: 1 AOV:
CommCode: BFD STA 08
EPA Numb:
SIC Code:S541
DunnBrad:
Period
Preparer:
Certif'd:
ParcelNo:
to
Emergency Contact / Title
ESA ESA /
Business Phone: (661) 871-7689x
24-Hour Phone (661) '872 ~209x
Pager Phone ( ) g 1-t.-1 $/0 x
Fire ImmHlth DelHlth
Phone: (661) 871-7689x
State: CA
Zip 93306
Phone: (661) -8-72 ~209x
State: CA <l.ft.- 13/ ~
Zip 93306
TotalASTs: = Gal
TotalUSTs: = Gal
RSs: No
Emergency Contact
ABRAHAM ESA
Business Phone:
24-Hour Phone
Pager Phone
/ Title
/ OWNER
(661) 871-7689x
(661) 8,9-2 ~2 8~^
( ) 3ol-~cox
Hazmat Hazards:
Contact :
MailAddr: 3711 MT VERNON AVE
City BAKERSFIELD
Owner
Address
City
ESA & ESA GEN PART
3711 MT VERNON AVE
BAKERSFIELD
Emergency Directives:
PROG A - HAZMAT
PROG H - HAZ WASTE GEN
PROG U - UST
ENi'O OCT 2 5 ,007
Based on r~~: :nquiry of ,those ,i,nj:vidua,l')
, '_ -', (u.Jtait""I~ uld IIl1ulllli::t(lon, I certIfy
,~_.....o ..,..U'C IU of law that I have personally
unde~ p~n:~~ am familiar with the information
~~~r;;,\~t~d and believe the information is true,
accurat n com lete.
/0 ks/d'J=
Date
-1-
10/25/2007
'r::- .s
F COLLEGE HEIGHTS FOODMART SiteID: 015-021-000443 ,
STORAGE CONTAINER DATA (UST FORM A)
Last Action Type:
FACILITY/SITE INFORMATION
Business Name: COLLEGE HEIGHTS FOODMART
Cross Street :
Business Type: Org Type:
Total Tanks : 3 IndnRes/Trust: No PA Contact:
Dsg Own/Oper : KENNETH DAVIS ICC Nbr: 5244381-UC
PROPERTY OWNER INFORMATION
Name : ESA ESA Phone: (661) 871-7689x
Address:
City : State: Zip:
Type : PARTNERSHIP
TANK OWNER INFORMATION
Name : ESA ESA Phone: (661) 871-7689x
Address:
City : State: Zip:
Type : PARTNERSHIP
BOE UST Fee# : UNKNOWN
Financ'l Resp: SELF INSURED
Legal Notif :
Date:11/29/2006 Phone: (166) 176-89 x
Name:ABRAHAM A ESA Ttl:OWNER ~
State UST # : 1998 Upg Cert#: 00739
-2-
10/25/2007
'r ':5,
F COLLEGE HEIGHTS FOODMART SiteID: 015-021-000443 9
p= Hazmat Inventory By Facility Unit 9
f== MCP+DailyMax Order Fixed Containers on Site 9
Hazmat Common Name.. . IspecHazlEPA Hazards I Frm I DailyMax IUnitlMCP
REGULAR GASOLINE F IH DH L 10000.00 GAL Mod
UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod
SUPER UNLEADED GASOLINE F IH DH L 6000.00 GAL Mod
WASTE OIL F DH L 55.00 GAL Low
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10/25/2007
'r ,I
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10/25/2007
F COLLEGE HEIGHTS FOODMART
f= Inventory Item 0001
= COMMON NAME / CHEMICAL NAME
REGULAR GASOLINE
SiteID: 015-021-000443 9
Facility Unit: Fixed Containers on Site 9
Days On Site
365
Location within this Facility unit
N AREA OF LOT
Map:
Grid:
CAS #
8006-61-9
STATE - TYPE
Liquid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
UNDER GROUND TANK
Largest Container
10000.00 GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
10000.00 GAL
Daily Average
5000.00 GAL
%Wt. I
100.00 Gasoline
HAZARDOUS COMPONENTS
~1
CAS # I
8006619'
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH DH / / / Mod
HAZARD ASSESSMENTS
f= Inventory Item 0002
= COMMON NAME / CHEMICAL NAME
UNLEADED GASOLINE
Facility Unit: Fixed Containers on Site 9
Days On Site
365
Location within this Facility Unit
N AREA OF LOT
Map:
Grid:
CAS #
8006-61-9
STATE - TYPE
Liquid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
UNDER GROUND TANK
Largest Container
10000.00 GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
10000.00 GAL
Daily Average
5000.00 GAL
%Wt. I
100.00 Gasoline
HAZARDOUS COMPONENTS
~
CAS # I
8006619
N
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH DH / / / Mod
HAZARD ASSESSME TS
-5-
10/25/2007
-,
F COLLEGE HEIGHTS FOODMART
f= Inventory Item 0003
= COMMON NAME / CHEMICAL NAME
SUPER UNLEADED GASOLINE
SiteID: 015-021-000443 9
Facility Unit: Fixed Containers on Site 9
Days On Site
365
Location within this Facility Unit
N AREA OF LOT
Map:
Grid:
CAS #
8006-61-9
STATE - TYPE
Liquid Mixture
PRESSURE
Ambient
TEMPERATURE
Ambient
CONTAINER TYPE
UNDER GROUND TANK
Largest Container
10000.00 GAL
AMOUNTS AT THIS LOCATION
Daily Maximum
6000.00 GAL
Daily Average
3000.00 GAL
%Wt. I
100.00 Gasoline
HAZARDOUS COMPONENTS
I~
CAS#a006619I
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH DH / / / Mod
HAZARD ASSESSMENTS
f= Inventory Item 0004
F= COMMON NAME / CHEMICAL NAME
WASTE OIL
Facility Unit: Fixed Containers on Site 9
Days On Site
365
Location within this Facility Unit
Map:
Grid:
CAS #
STATE - TYPE
Liquid 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
55.00 GAL
%Wt. RS CAS#
100.00 Waste Oil, Petroleum Based No 0
HAZARDOUS COMPONENTS
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F DH / / / Low
HAZARD ASSESSMENTS
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10/25/2007
SiteID: 015-021-000443 ,
Fast Format 9
Overall Site 9
07/06/1998
F COLLEGE HEIGHTS FOODMART
I
p= Notif./Evacuation/Medical
Agency Notification
CALL 911 TO NOTIFY EMERGENCY SERVICES.
Employee Notif./Evacuation
03/26/1991
EMPLOYEES ARE TO NOTIFY EACH OTHER AND EMERGENCY SERVICE, EVACUATE PUBLIC,
USE EMERGENCY SHUTOFF AND EXTINGUISHER WHEN REASONABLE, VACATE PREMISES TO
VACANT LOT WHEN NECESSARY TO AWAIT AUTHORITIES.
Public Notif./Evacuation
03/26/1991
EVACUATE STORE AND PREMISES IN THE EVENT OF HAZARDOUS SPILL OR FIRE.
Emergency Medical plan
03/26/1991
CONTACT EMERGENCY SERVICES, FLUSH CONTAMINANTS WITH WATER FROM SELF, REMOVE
CONTAMINATED CLOTHING, DROP AND ROLL IF ON FIRE.
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10/25/2007
SiteID: 015-021-000443 9
Fast Format 9
Overall Site 9
03/26/1991
F COLLEGE HEIGHTS FOODMART
I
p= Mitigation/Prevent/Abatemt
Release Prevention
ALL EQUIPMENT IS WELL MAINTAINED AND MANUFACTURED TO PREVENT SPILLS. USE OF
RELIABLE DELIVERY COMPANIES WILL BE MAINTAINED.
Release Containment
Clean Up
10/25/2000
PRIVATE SPECIALIST WILL BE CONTACTED.
Other Resource Activation
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10/25/2007
F COLLEGE HEIGHTS FOODMART
I
p= Site Emergency Factors
Special Hazards
SiteID: 015-021-000443 9
Fast Format 9
Overall Site "I
Utility Shut-Offs
GAS - N SIDE OF BLDG
ELECTRICAL - OUTSIDE NW CRNR OF BLDGi INSIDE SW WALL
WATER - S SIDE OF BLDG
08/31/2007
Fire Protec./Avail. Water
03/30/2006
PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS
Building Occupancy Level
03/30/2006
4 EMPLOYEES
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10/25/2007
J; !<
F COLLEGE HEIGHTS FOODMART
I
f= Training
Employee Training
SiteID: 015-021-000443 ,
Fast Format 9
Overall Site 9
01/29/2007
MATERIAL SAFETY DATA SHEETS ON FILE.
BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE INFORMED:
OF THE LOCATION OF EMERGENCY SHUT OFF SWITCH AND FIRE EXTINGUISHER - USE
WHEN SAFE AND NECESSARY; USE 911 UPON RELEASE OF HAZARDOUS MATERIALS OR
FIRE; EVACUATE STORE & LOT WHEN NECESSARY; NOTIFY OWNER; AND REMAIN IN AREA,
SAFE DISTANCE, FOR ARRIVAL OF AUTHORITIES.
Page 2
Held for Future Use
Held for Future Use
-10-
10/25/2007
f~'imcri:.:1.f:si';:,c;l;;;:':;~'B:<:'i5~w;;;rZ~E:~1~';::\f~S;~~.l;i~.'ir;:;;;""'::,,2;;;':~?f.~;;;"~.,;;:;:r._':,:7,;,:-.t'~....,
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
~QERGROUND STORAGE TANKS
. UNIFIED PROGRAM CONSOLIDATED FORMS
APPLICA TION
OPERA T1NG PERMIT APPLlCA TION
FACILITY FORM - (STATE FORM A)
One form per facility
Page 1 of 2
TYPE OF ACTION: (Checkoneifemon/y) lJ l,NEWSITEPERMIT
[J 6_ TEMPORARY SITE CLOSURE
[J 3_ RENEWAL PERMIT
'[J 7, PERMANENT SITE CLOSURE
lJ 5_ CHANGE OF INFORMATION (Specify change local use only)
[J 8, TRANSFER PERMIT
400
104
405
407
409
41
T04 TATE
TO ZIP CODE
o 4_ LOCAL AGENCYf DISTRICT
o 5, COUNTY AGENCY
416
417 STATE
418 ZIP CODE
41
01, CORPORATION/LCC
o 5. COUNTY AGENCY
o 2, INDIVIDUAL ~ARTNERSHIP 0 4, LOCAL AGENCY/ DISTRICT
o 6, STATE AGENCY 07. FEDERAL AGENCY
420
::iVII;SAPPLICANtiiSIGNATURE:":t;;;,':./:'jfY.,::;V".X::..i.:.:;:."
at.th~" iilr(MiI~ti6ri~b~lli~d' h~ii;iriij:tffil.""'~~ti,r~tl.;.,....riliikfJII.6b;;;'liarit~\"'ithi~'>ai~li:Jl~l.;;;.ri'
424 ATE II ~q / z,.()Ofo 425 PHONE
427
3
USINESS SITE ADDRES-S
103
FD 2093 (Rev. 11/06
Page 1 of 1
Bakersfield Fire Dept.
Environmental Services
1715 Chester Ave
Bakersfield, CA 93301
Tel: (661)326-3979
UST MONITORING PROGRAM
EMERGENCY RESPONSE PLAN
This monitoring program must be kept at the UST location at al/ times, The
information on this monitoring program ara conditions of the operating pennit.
The pennit holder must notify the Office of Environmental Services within 30
days of any changes to Ihe monitoring procedures, unless required 10 obtain
approval before making the change_ Required by Sections 2632(d) and
2641(h) CCR.
b
IF AN UNAUTHORIZED RELEASE OCCURS, HOW 'MLL THE HAZARDOUS SUBSTANCE BE CLEANED UP? NOTE: IF RELEASED HAZARDOUS SUBSTANCES REACH THE
ENVIRONMENT, INCREASE THE FIRE OR EXPLOSION HAZARD, ARE NOT CLEANED UP FROM THE SECONDARY CONTAINMENT 'MTHIN 8 HOURS, OR DETERIORATE THE
SECONDARY CONTAINMENT, THEN THE OFFICE OF ENVIRONMENTAL SERVICES MUST BE NOTIFIED 'MTHIN 24 HOURS.
k,~'t ~k~ ~Ld ~r ~U1-O.{l ~p'( tl~ Two ~tlN~ JSej Ot(L ~r
p\f'Odud " CHt. -+t,c UJ~k tlt\(J:'k('l~
DESCRIBE THE PROPOSED METHODS AND EQUIPMENT TO BE USED FOR REMOVING AND PROPERLY DISPOSING OF ANY HAZARDOUS SUesT ANCE,
~l~'(
kJ.c.r US-ct 0- fo aN tJ~O( b&~t- UAJ-cfl~{
3,DESCRIBE THE LOCATION AND AVAILABILITY OF THE REQUIRED CLEANUP EQUIPMENT IN ITEM ABOVE,
Mclt +D ~\c... E.Je h'i UtSlklt
DESCRIBE THE MAINTENANCE SCHEDULE FOR THE CLEANUP EQUIPMENT:
ektt-kJ. (D(lf"r
LIST THE NAME(S) AND TITLE(S) OF THE PERSON(S) RESPONSIBLE FOR AUTHORIZING ANY WORK NECESSARY UNDER THE RESPONSE PLAN:
NAME ,/11_
t:!!!!ot ?tv Wt
~A
A [;So-..
&sf}-
TITLE
PSc.(~t/ /~1If If
~Cu'+"'er j Owvret"
,
UNDERGROUND STORAGE TANK
Page 1 of 1
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax.: (661) 872-2171
MONITORING PROGRAM (FORM)
WRITTEN MONITORING PROCEDURES
This monitoring program must be kept at the UST location at 81 times,
The information on this monitoring program are conditions of the operating permit, The permit holder must notify the Office of Prevention Services within 30
days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and
2641 h CCR.
FACILITY NAME
c:()(lt ti\~J~t-
FACILITY ADDRESS
PIPING
t \.. tI
WHAT METHODS AND EQUIPMENT, IDENTIFIED BY NAME AND MODEL, WILL BE USED FOR PERFORMING THE MONITORING:
TANK
PIPING
l....
It
DESCRIBE THE LOCATION(S) WHERE THE MONITORING WILL BE PERFORMED (FACILITY PLOT PLAN SHOULD BE ATTACHED):
Q)Ck'h~ -tk t~~J, ~'llb~((
NAME
eSA
NAME
NAME
TITLE
NAME
TITLE
NAME
TITLE
REPORTING FORMAT FOR MONITORING:
TANK
PIPING
DESCRIBE THE PREVENTIVE MAINTENANCE SCHEDULE FOR THE MONITORING EQUIPMENT, NOTE: MAINTENANCE MUST BE IN ACCORDANCE WITH THE MANUFACTURER'S
MAINTENANCE SCHEDULE BUT NOT LESS THAN EVERY 12 MONTHS, J If, '\ A A L
Ckcl( If- CVc.."-f f;/.. QkQV\1-l~ pc. r IV\.\ r
DESCRI~:tTR~;::;:~t}E OP6T~:~ST S~~:;C+~G PI~~N;k:E ;rTORING EQUIPMENT
l
FD 2074c (Rev, 02/05)
~~
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
UNDERGROUND STORAGE TANKS
UNIF~D PROGRAM CONSOLIDATED FORMS
OPERATING PERMIT APPLICATION
TANK - (STATE FORM B)
(One form per UST)
Page 1 of2
TYPE OF ACTION (Check one item only): 0 1, NEW PERMIT nA. RENEWAL ERMIT
o 6. TEMPORARY CLOSURE 0 7. UST PERMANENTLY CLOSED ON SITE
(Check one item only. For a UST dosure or removal, complete only this section and Sections I, II, III, and IV below)
o 5. CHANGE OF INFORMATION
o 8, UsT REMOVED
430
{1J*~~qig~~litt5Q:r~M~I:~Q~j~i~tj
FACILITY 10 NO. (Agency Use Only)
DATE UST ISTALLED (YEAR/MO)
TANK CAPACITY IN GALLONS
TANK USE
o 1, MOTOR VEHICLE FUELING
IIf markect. complele Petroleum Type) )
o 7, MARINA ~UELlNG
o 3, CHEMICAL PRODUCT STORAGE
o 5. EMERGENCY GENERATOR FUEL STORAGE
o 95. UNKNOWN
o 4, HAZARDOUS WASTE IIncludes Used OU
o 6. OTHER GENERATOR FUEL STORAGE
o 99. OTHER (Specify)
TANK CONTENTS (PETROLEUM TYPE)
o la. REGULAR UNLEADED
o lb. PREMIUM UNLEADED
Ole, MIDGRADE UNLEADED
o 3, DIESEL
o 5, JET FUEL
o 6, AVIATION GAS
o 8, PETROLEUM BLEND'FUEL
o 9, BIO DIESEL
o 99, OTHER Specify)
1~~~~TANrqCQt(s;riRUCJil'
TANK CONTENTS NON PETROLEUM TYPE:
o 7. USEDOIL
o 10, ETHANOL
o 99. OTHER (Specify)
TYPE OF TANK (Check one item only
o 1, SINGLE'WALLED
o 2. DOUBLE WALLED
o 3. SINGLE WALL WITH EXTERIOR MEMBRANE LINER
o 95, UNKNOWN
TANK PRIMARY CONTAINMENT (Check one ilem only)
o 1, STEEL 0 6, INTERNAL BLADDER
o 3, FIBERGLASS 0 7. STEEL + INTERNAL UNING
o 95, UNKNOWN
o 99. OTHER (Specify)
TANK SECONDARY CONTAINMENT (Check one item only)
o 1, STEEL 0 6. EXTERIOR MEMBRANE LINER
o 3. FIBERGLASS 0 7, JACKETED
o 90. NONE
o 95. UNKNOWN
o 99. OTHER (Specify)
OVERFILL PREVENTION (Check one item only)
o 1. AUDIBLE & VISUAL AlARMS
o 2. BALlFLOAT
FILL TUBE SHUT-OFF VALVE
TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFill PREVEWION EQUIPMENT
o 2, GRAVITY
o 3, CONVENTIONAL SUCTION
o 4, SAFE SUCTION (23 CCR ~2636(a)(3)
PIPING PRIMARY CONTAINMENT (Check one ilem only)
o 1, STEEL 0 4. FIBERGLASS
o 90. NONE 0 95, UNKNOWN
PIPING SECONDARY CONTAINMENT (Check one ilem only)
o 1. STEEL 0 8. FLEXIBLE
o 4, FIBERGLASS 0 95, UNKNOWN
TURBINE CONTAINMENT SUMP (Check one ilem only)
o 01, SINGLE WALLED 0 02. DOUBLE WAllED
o 8. FLEXIBLE
o 99, OTHER (Specify)
o 10. RIGID PLASTIC
o 10, RIGID PLASTIC
o 99, OTHER (Specify) )
464
o 03. NONE
FD 2094 (Rev. 11/06)
.~
Page 1 of2
.""'f"
UNDERGROUND STORAGE TANKS
TANK - APPLICATION (CONT.D)
(STATE FORM B)
Page 2 of 2
VENT SECONDARY CONTAINMENT (Check one ~em only)
o 1, STEEL 0 4 FIBERGLASS 0 10, RIGID PLASTIC
VR PRIMARY CONTAINMENT (Check one item only)
o 1. STEEL 0 4 FIBERGLASS
o 90. NONE
o 99, OTHER (Specify)
:'~~~~~g~~i~:~" ~""tl{isg:t[~~t:(~~~~e!~I~mg~~~~~~~~m!2:,::'
VENT PRIMARY CONTAINMENT (Check one item only)
o 1, STEEL 0 4 FIBERGLASS 0 10. RIGID PLASTIC
o 90. NONE
o 99, OTHER (Specify)
o 10, RIGID PLASTIC
o 90. NONE
o 99, OTHER (Specify)
VR SECONDARY CONTAINMENT (Check one item only)
o 1, STEEL 0 4 FIBERGLASS 0 10, RIGID PLASTIC 090. NONE
VENT ANDIOR VAPOR RECOVERY PIPING TRANSITION SUMP(S)
o 01. SINGLE WALLED 0 02, DOUBLE WALLED 0 03, NONE
:,~:!;{'ifi:;'i:,+,';;trii_~}S:~~8;)~I,i'?;;i<i,\';i:;~:r:~::i.3;!;~;~i."-W!3~'~K!~::;i.~,,~,\:;;:(>-\;'(';~",~:*~'J,"'{':::~~::';:7;~,;e:~'if..",~::r';,~'I:\",\;ti~\!;gt
,',~J~'$EBt!!{;fll:I$IPleE:\~QN$;]Bl)G[IP.
o 99, OTHER (Specify)
RISER PRIMARY CONTAINMENT (Check one item only)
o 1, STEEL 0 4 FIBERGLASS 0 10, RIGID PLASTIC
RISER SECONDARY CONTAINMENT (Check one item only)
o " STEEL 0 4 FIBERGLASS 0 10, RIGID PLASTIC
FILL COMPONENTS (Check one item only)
o SPILL BUCKET INSTALLED
090. NONE
o 99, OTHER (Specify)
090, NONE
o 99. OTHER (Specify)
o STRIKER PLATE I BOTTOM PROTECTOR INSTALLED
VR SECONDARY CONTAINMENT (Check one item only)
o " STEEL 0 4 FIBERGLASS 0 10, RIGID PLASTIC 090, NONE
VENT ANDIOR VAPOR RECOVERY PIPING TRANSITION SUMP(S)
o 01, SINGLE WALLED 0 02, DOUBLE WALlED 0 03. NONE
""~.~';S_'{I;~"':~fy,~,..i";l..':.,~~,i;q;'M&"r.~; ~';W'~4::{.>v",'_"';;,'i',1'$I.;,Y: ;;~$~~}<':'-:;,1'j:i,:-:I,;~;::, :F~,,~:,::[':":;Jh)'f.i"
.NbER~E5,I$R~NSE~~\'tt)NlAI.~M '
","",-;,''-".-~, ;;.r:;;:t.1 ~'jii,,';:~-~,,';~'T'.,~\;~ 'f';";r'~~,,::.1''f.',~-;:j~}W.'f':'(.j,,\i.;:;'<;'~~ :;.:J:2(~,!,i,'I),~,,'J, ,<\t,'-.r:::-;"t'f;<;;;.:? ",,'C-
o 99, OTHER (Specify)
DOUBLE WALLED
020,
APPLICANT SIGNATURE
FD 2094 (Rev. 11/06)
r
\
'~cA One Beacon
." l~SURAN[E
COMMERCIAL GENERAL LIABILITY COVERAGE PART
DECLARATIONS
Company: EMPLOYERS FIRE INSURANCE
Transaction Type Issue Date
Office: ASIC ORANGE
Effective Date Rex Number Policy Number
FF' 1U28728
File Number
STANDARD COVERAGES
Each Occurrence:
Damage to Premises Rented to You (anyone premises):
Personal and Advertising Injury (anyone person or organization):
Medical Expenses (anyone person):
General Aggregate (except Products and Completed Operations):
Products-Completed Operations Aggregate:
OPTIONAL COVERAGES
$1, 000,000
$300,000
$1,000,000
$5,000
$2,000,000
$2,000,000
Liquor Liability - Each Common Cause:
Liquor Liability - Aggregate:
LIABILlTYCLASSIFICATIONSCHEDULEJSTANDARDCOVERAGES
$1,000,000
$2,000,000
Convenience Food stores-
with Gas
. ........................ ...............
. .......................................
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..PrOdUt:t$\
. .................~.... .,........
PREMISES
PRODUCTS
.......................
.......................
.......................
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.......................
.......................
.......................
.......................
.......................
.................. ...
.......................
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.............................,........'...-.........-........... ..........-.....................-......'.-................................,..-.................... ..........................'.'.............
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..'H.'<>HR~t~ "..,..'.,.,..'..,'....,..'.,.,..'.'..,i~pp~iji~{AnnUaF)
~~~~:~~~~~~~~ ~~ ~ ~~~~~ ~ ~:~ ~~ ~~:~~~~~::]~j) :la$Ji j~~~~~~ ~~~~~;:~:::~ ~~ ~~~ j:~ :~j~~j j~~~ j: ~:~~~[~ [~~j~Am:qij:":t ~j1:::::: :F':iji:l:1j~R~:tl
Gross Sales 410,000 1.884
.251
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$773
$103
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!
~
(
f
,
[
I
r
Gasoline Station - Self- 13454 PREHISES
Service PRODUCTS
Gallons
150,000
.742
$111
Included
Restaurants-Fast Food- 09l51A PREMISES
Franchise-No Alcohol PRODUCTS
Gross Sales
50,000
3.317
2.221
$166
$Ul
Hired Auto Liability
Nonowned Auto Liability
$17
$34
f
\'
i G15164 0602
INSURED COPY
Page 1 of 1
State of California For State Use Only
@ State of Water Resources Control Board
. .
. 0 Division of Financial Assistance
P,O. Box 944212
. Sacramento. CA 94244-2120
(Instructions on reverse side)
CERTIFICA TION OF FINANCIAL RESPONSIBILITY
FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM
A. I am required to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR:
D 500,000 dollars per occurrence D I million dollars annual aggregate
~ or AND u:y; or
1 million dollars per occurrence 2 million dollars annual aggregate
B, doh 1I....Jl ~ ftlk(" hereby certifies that it is in compliance with the requirements of Section 2807,
(NBITIfI 01 Tank Ownar or OperatOl1
Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations.
The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows:
C. Mechanism Mechanism Coverage Coverage Corrective Third Party
Type Name and Address of Issuer Number Amount Period Action Comp
5e\~ One.... ~Cllco,.., IICO'b J. "",\(lOft l \(Lf( CCo
:I: y\~)I.J rei ~ vflll-lt- ~~
~IJo 7
Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of
this certification also certifies that you are in compliance with all conditions for participation in the Fund.
D. Facility Name Facility Address
Co({~,,_ Lk~", w rooof V\{tt A-
Facility A'ame v Facility Address
Facility Name Facility Address
E. (;. ~:r z;:rp"..~ Date Name and Tille of Tank Owner or Operator
If. ~ 'L- tt/l5/r;,. Abr", ~W\ AEfA ~ Qj-\1.er I (:) VI v\ e.jI'
~ -
SrQnature of Witness or Notary Date Name of Witness or Notary
CFR (ReVised 04/95)
FILE: Original - Local Agency
Copies - FadlltylSlte(s)
UNDERGROUND STORAGE TANKS
UNIFIED PROGRAM CONSOLIDATED FORMS
tv-
OPERATING PERMIT APPLICATION
TANK - (STATE FORM B)
(One form per UST)
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
Page 1 of 2
lYPEOF ACTION (Check one item only): 0 1, NEW PERMIT 0 3. RENEWAL ERMIT
o 6. TEMPORARY CLOSURE 0 7. UST PERMANENTLY CLOSED ON SITE
(Check one item only, For a UST closure or removal, complete only this section and Sections I, II, III, and IV below)
o 5. CHANGE OF INFORMATION
o 8, UST REMOVED
430
FACILllY ID NO, (Agency Use Only)
BUSINESS NAME (Same as FACllIlY NAME or DBA-Doing Business As)
BUSINESS SITE ADDRESS
DATE UST ISTALLED (YEAR/MO)
TANK CAPACITY IN GALLONS
TANK USE
o 1, MOTOR VEHICLE FUELING
, (If markeg. complete Pelro/eum Type) )
o 7. MARINA ..UElING
o 3. CHEMICAL PRODUCT STORAGE
o 5, EMERGENCY GENERATOR FUEL STORAGE
o 95. UNKNOWN
o 4, HAZARDOUS WASTE IIncludes Used on
o 6. OTHER GENERATOR FUEL STORAGE
o 99. OTHER (Specify)
TANK CONTENTS (PETROLEUM TYPE)
o la, REGULAR UNLEADED
o lb, PREMIUM UNLEADED
Ole, MIDGRADE UNLEADED
o 3, DIESEL
o 5. JET FUEL
o 6, AVIATION GAS
o 8. PETROLEUM BLEND'FUEL
o 9, BIO DIESEL
o 99. OTHER Specify)
TANK CONTENTS NON PETROLEUM TYPE:
o 7, USEDOIL
o 10. ETHANOL
o 99, OTHER (Specify)
TYPE OF TANK (Check one item only
o 1. SINGLE WALLED
o 2. DOUBLE WALLED
o 3. SINGLE WALL WITH EXTERIOR MEMBRANE LINER
o 95, UNKNOWN
TANK PRIMARY CONTAINMENT (Check one item only)
o 1, STEEL 0 6, INTERNAL BLADDER
o 3, FIBERGLASS 0 7, STEEl+INTERNAlUNING
o 95. UNKNOWN
o 99, OTHER (Specify)
TANK SECONDARY CONTAINMENT (Check one item only)
o 1. STEEL 0 6, EXTERIOR MEMBRANE LINER
o 3, FIBERGLASS 0 7, JACKETED
o 90, NONE
o 95. UNKNOWN
o 99, OTHER (Specify)
OVERFILL PREVENTION (Check one item only)
o 1. AUDIBLE & VISUAL AlARMS
o 2, BAllFLOAT
o 3, FILL TUBE SHUT-OFF VALVE
o 4, TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFill PREVENTION EQUIPMENT
PIPING SYSTEM TYPE (Check one item only)
o 1. PRESSURE 0 2, GRAVITY
o 3. CONVENTIONAL SUCTION
04. SAFE SUCTION (23 CCR ~2636(a)(3l
PIPING PRIMARY CONTAINMENT (Check one Item only)
o 1, STEEL 0 4. FIBERGLASS
o 90. NONE 0 95, UNKNOWN
PIPING SECONDARY CONTAINMENT (Check one item only)
o 1. STEEL 0 8. FLEXIBLE
o 4, FIBERGLASS 0 95. UNKNOWN
TURBINE CONTAINMENT SUMP (Check one item only)
o 01. SINGLE WALLED 0 02, DOUBLE WALLED
o 8, FLEXIBLE
o 99, OTHER (Specify)
o 10. RIGIDPl.AS11C
o 10, RIGID PlASTIC
o 99. OTHER (Specify) )
, 0 03, NONE
FD 2094 (Rev. 11/06)
Page 1 of2
.-"UN~RGROUND STORAGE TANKS
TANK - APPLICATION (CONT.D) (STATE FORM B)
Page 2 of 2
o 90. NONE
o 99, OTHER (Specify)
;;,,:~:t~~~:~,9~!i~~~~t~;~~g~~~~i3)!Bxr~~~(~~!9~~iIB~~]Jg"
VENT PRIMARY CONTAINMENT (Check one item only)
o 1, STEEL 0 4 FIBERGIJl.SS 0 10. RIGID PIJl.STIC
o 90. NONE
VENT SECONDARY CONTAINMENT (Check one item only)
o 1, STEEL 0 4 FIBERGIJl.SS 0 10, RIGID PIJl.STIC
VR PRIMARY CONTAINMENT (Check one item only)
o 1, STEEL 0 4 FIBERGIJl.SS 0 10, RIGID PIJl.STIC
VR SECONDARY CONTAINMENT (Check one item only)
o 1, STEEL 0 4 FIBERGIJl.SS 0 10, RIGID PIJl.STIC
o 90, NONE
o 99, OTHER (Specify)
o 99, OTHER (Specify)
090, NONE
o 99, OTHER (Specify)
o 03, NONE
:gPNS:JiRQQmip":
RISER PRIMARY CONTAINMENT (Check one item only)
o 1, STEEL 0 4 FIBERGIJl.SS 0 10. RIGID PIJl.STIC
RISER SECONDARY CONTAINMENT (Check one item only)
o 1. STEEL 0 4 FIBERGIJl.SS 0 10, RIGID PIJl.STIC
FILL COMPONENTS (Check one item only)
o SPILL BUCKET INSTALLED
464i
090. NONE
o 99, OTHER (Specify)
464
090, NONE
o 99. OTHER (Specify)
464
o STRIKER PIJl.TE I BOTTOM PROTECTOR INSTALLED
VR SECONDARY CONTAINMENT (Check one item only)
o 1, STEEL 0 4 FIBERGIJl.SS 0 10, RIGID PIJl.STIC 090, NONE
VENT ANDIOR VAPOR RECOVERY PIPING TRANSITION SU"!1P(S)
o 01, SINGLE WALLED 0 02, DOUBLE WALLED 0 03. NONE
:'y!iR~J]~i~i~1t~i,ilg91~~~i~tl~(:YP:$
464
o 99, OTHER (Specify)
DOUBLE WALLED
020,
CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true, accurate, and In full compliance with legal
requirements,
Z-
DATE
APPLICANT SIGNATURE
FD 2094 (Rev. 11/06)
\
<
;
"'/
'.
;~,
:r~
UNDERGROUND5TORAGETANK5 ~
, ~
-~9"",.t\!l.>~fVbVf~~~~;~
'i-!JI
1.!f1
I
APPLICATION
TO PERFORM ELD / LINE TESTING
/58989 SECONDARY CONTAINMENT TESTING
fTANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
Page 1 of 1
PERMIT NO. I 71- o'( b crJ
o ENHANCED LEAK DETECTION
o TANK TIGHTNESS TEST
o 58-989 SECONDARY CONTAINMENT TESTING
")
FACILITY
ADDRESS
OPERATORS NAME
PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED
TANK #
DYES
o NO
CONTENTS
TEST METHOD
APPROVED BY
FD 2095 (Rev. 09/05)
BilliNG & PERMIT STATEMENT
.)
.
STARTING DATE
PROJECT NAME
PROJECT ADDRESS
o
o
Over 20,000 Sq. Ft.
Sprinklers- New & Modifications - (Minimum Charge)
o
Over 5,000 Sq. Ft.
o
Minor Sprinkler Modifications (< 10 heads)
o
Commercial Hoods - New & Modifications
o
Additional Hoods
o
Spray Booths - New & Modifications
o
o
o
o
o
o
o
o
Aboveground Storage Tanks (Installationllnsp.-1s1 Time)
Additional Tanks
Aboveground Storage Tanks (Removal/Inspection)
Underground Storage Tanks (Installation./Inspection)
Underground ,Storage Tanks (Modification)
Underground Storage Tanks (Minor Modification)
Underground Storage Tanks (Removaf)
Oilwell (Installation)
Mandated Leak Detection (Testi I Fuel Monit. Cert.
Tents
o
o
o
o
o
o
o
o
After hours inspection fee
Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour)
RE-INSPECTION(S) / FOLLOW';'UP INSPECTION(S)
Portable LPG (Propane): NO. OF CAGES? _
Explosive Storage
Copying & File Research (File Research Fee $33.00 per hr)
Miscellaneous
1 - ORIGINAL WHITE (to Treasury)
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Avenue, Suite 210
Bakersfield, CA 93301
Sq. Ft. x .013125 = Permit fee
84
98
84
98
84
98
84
98
84
98
84
98
84
98
84
98
82
82
82
82
82
82
84
84
82
84
84
84
84
84
. 84
. 84
.
. 84
. FD 2021 (Rev. 09/05)
$210.00
Sq. Ft X .042 = Permit fee
$ 93.00 [Inspection Only]
$ 398.26,
$ 36.00
$458.00
$165.00
$ 26.00
$109.00
$878.00 (per tank)
$878.00 (per site)
$155.00
$675.00 (per tank)
$ 72.00
$ 81.00 (per site)
$ 93.00 (per tent)
$122.00
$ 60.00 + (5 hrs, min. stand -by fee /Inspection) = $510.00
$ 93.00 (per hour)
$ 66.00
$249.00
25~ per p'age
1-YELLOW (to File)
1-PINK (to Customer)
j,.-,~ ..
+~~c:: f ;~bD~OO/"; '~=~~ ===f~';:::!!'J!1L=== == ==== = == = SiteID, 0 IS - 021- 000443 +
Manager :
Location: 3711 MT VERNON AVE
City BAKERSFIELD
BusPhone:
Map : 103
Grid: 15A
(661) 873-8503
CommHaz : Moderate
FacUnits: 1 AOV:
CommCode: BFD STA 08
EPA Numb:
SIC Code:5541
DunnBrad:77~019-0797
+==============================================================================+
+=======================================+======================================+
Emergency Contact / Title Emergency Contact / Title
BINDER DHALIWAL / OWNER /
Business Phone: (661) 871-7689x Business Phone: () x
24-Hour Phorie,: (661L ~96::-7571x 24-Hour Phone : () x
Pager Phone : () x Pager phone : () x
+---------------------------------------+--------------------------------------+
I Hazmat Hazards: Fire ImmHlth DelHlth I
+------------------------------------------------------------------------------+
Contact : Phone: (661) 871-7689x
MailAddr: 3711 MT VERNON AVE State: CA
City : BAKERSFIELD Zip : 93306
+------------------------------------------------------------------------------+
Owner ~nmER DIIl.LI'i'rnL /ftJ/~-/TA///1T'11 E >-~' fPhone: (661) 396-7571x
A<;ldress : 3711 MT VERNON AVE [5fl k ~5tl.. r PIA S~ate: CA
C~ty : BAKERSFIELD. !IV t4vvv Z~p:, 93306
+------------------------------------------------------------------------------+
Period to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
+------------------------------------------------------------------------------+
Emergency Directives:
PROG A - HAZMAT
PROG U - UST, ~
~1\b~1-( ~ ~ \JGW
o i\J~ ~
ENT'D DEe 13 2006
'1 tv'+dJ"",L
{d----
o~
Based .on my inquiry 01 thQ$~ l/'ldlviellJ~18
responsible for obtaining the Informatio.n, , oertify
under penalty of law that I have persona/l
exam',ned and am familiar with the infOfmatio~
submItted and believe the information is true
accurate. and complete. '
~~~..,
5i ature
/11- 7.7,0(;
Date
+==============================================================================+
-1-
03/30/2006
),j. -
~ . ~'
UNIFIED PROGRAM INSPECTION CHECKLIST
Prevention Services
900 Truxtun Ave., Stiite 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 872-2171
S'ECTION 1: Business Plan and Inventory Program
FACILITY NAME
r
INSPECpON DATE
I'f:J{,-, 7.0&
PHONE NO,
INSPECTION TIME
q~--
NO OF EMPLOYEES
ADDRESS
FACILITY CONTACT
BUSINESS ID NUMBER , tIt 1.-
15-021- '11 (.)
o ROUTINE
Section 1 : Business Plan and Inventory Program
o COMBINED 0 JOINT AGENCY 0 MULTI-AGENCY 0 COMPLAINT
RE-INSPECTION
C V ( c-comPllanCe) OPERATION
V=Violation
0 l!:J ApPROPRIATE PERMIT ON HAND
~ 0 Business PLAN CONTACT INFORMATION ACCURATE
)til 0 VISIBLE ADDRESS
~ 0 CORRECT OCCUPANCY
)1 0 VERIFICATION OF INVENTORY MATERIALS
~ 0 VERIFICATION OF QUANTITIES
.& 0 VERIFICATION OF LOCATION
~ 0 PROPER SEGREGATION OF MATERIAL
0 ~ VERIFICATION OF MSDS AVAILABILITY
0 g VERIFICATION OF HAl MAT TRAINING
0 QiJ. VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
)g 0 EMERGENCY PROCEDURES ADEQUATE
8 0 CONTAINERS PROPERLY LABELED
.l\3 0 HOUSEKEEPING
K:h 0 FIRE PROTECTION
0 ~ SITE DIAGRAM ADEQUATE & ON HAND
COMMENTS
J (Y\$D)
;vegJ. 1'~'II.I\l"\)(., ~"Cl~bS
~ V,...J ~--, he,." A.
'.... .- ,...\o.sod:.co-v\ c::>"'-St+c...
K)09~ S~ d \ <;
c:.'"
KBF.6013
ANY HAZARDOUS WASTE ON SITE? ~YES 0 NO
EXPLAIN: S5 c.."",\ d'rV\i ""'"' ~\} ~ W) ... .s.-b' ~ 0 i L... G\. ....J Not. A)::s;L )
\,'0 q .s-1e. t-G J:>""
4<-1/, 't;-" ra ":i 1.4-... z,.o. rJ. 0 ~ 'I
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979
c;:..~~/
Inspector (Please Print)
?-- 'I
Fire Prevention /1" In / Shift of Site/Station #
White - Prevention Services
Yellow - Station Copy
Pink - Business Copy
FD 2155 (Rev, 09/05
,.J,;. ~
INSPECTIONS
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
BUSINESS PLAN &
INVENTORY PROGRAM
UNIFIED PROGRAM INSPECTION CHECKLIST
Page 1 of 1
FACILITY NAME: (;() Jle~-c" H~ \.s.),,'b ~o9
INSPECTION DATE: J oh,7)e:,J,.
Section 2:
Underground Storage Tanks Program
D Routine D Combined D Joint Agency D Multi-Agency D Complaint D Re-Inspection
Type ofTank S \,0 .(\ '\?<?,<}\.L.L> Number ofTanks. -3
Type of Monitoring 7J:.1oJ ~I-' Type of Piping :v~""~ 0<>",,\;\.. u3A.Ll.....
OPERA TION C V COMMENTS
Proper tank data on file )0
Proper owner / operator data on file 0
Permit fees current /0 1->0 e. "'- h~o ",--\:. P ~"',^,rl:' (t V\. f C~tv' "'>:s,!l..
Certification of Financial Responsibility ~ tOo 'Pf'~ o~ .(:~ ^ " c.,\., \ ~.....~"'''~\,.
Monitoring record adequate and current )Q
Maintenance records adequate and current )0
Failure to correct prior UST violations NJA
Has there been an unauthorized release? DYes )9 No .:>0
\Ify
Section 3: Aboveground Storage Tanks Program
Tank Size(s)
Type ofTank
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 1 overspill protection?
C = Compliance V = Violation Y = Yes N = No
Inspector:
C7Ga-,,-' ^'J
~~/
usiness ite Responsib arty
Questions regarding this inspection? Please call us at (661) 326-3979
C c," 0 ~.\ 0
e>,,^,~
,As. t- .f c1 .r
f f,./'" ,^,,-n- ;;-"
-r~A~~.. 01' ....
..... "'_ '1:)0"""",
o ro !' c.-T <:.- ,
White - Prevention Services
Pink - Business Copy
KBF.7335
FD 2156 (Rev. 09/05)
i
,1.
~I {;
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979 0 Fax: (661) 852-2171
FIRE PREVENTION INSPECtiON
DISTRICT I BLOCK NO, DATE 10/1,-,)(1 & EE
FACILITY ADDRESS "1J I \ fV\1' V e , Y\ On ..,... CITY, STATE, ZIP 13" k..<2'.J.{)d ~ (t..
FACILITY NAME CO \\<2 c...~ \-\~\ ~"'t> .fooJ MANAGER'S NAME FACILITY PHONE NO,
I ,
BUSINESS OWNER'S NAME AND ADDRESS .- CITY, STATE, ZIP OWNEI!:S' PHONE NO.
BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING P.HONE NO.
t r,'
/ ' , \ " /' j!"'
,
OCC TYPE OCC LOAD II NO, OF FLOORS HIGH RISE BLD~ _" ! I ( '. k'lSER DATE I
-~
0 YES 0 NO
CORRECT ALL VIOLATIONS VIOLATION REQUIREMENTS
CHECKED BELOW NO,
1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U,f,C,)
COMBUSTIBLE WASTE I DRY
VEGETATION 2 Provide non-combustible containers with tight fitting lids for the storage of combustible waste and rubbish pending its
safe disposal. (U.F.C,)
COMBUSTIBLE STORAGE 3 Relocate combustible storage to provide at least 3 feet clearance around motor fuse box/fire door (N,E.C,) (U,f,C,)
4 Relocate fire extinguisher(s) so that they will be in a conspicuous location, hanging on bra,ckets with the top to the
extinguisher not more than 5 feet above the floor. (N,f,P,A, No, 10)
EXTINGUISHERS 5 Provide and install (amount) _____ approved (type & size) __________________ portable fire extinguisher to be
immediately accessible for use in (area) _____________________________ (U.f.C,)
6 Re-charge all fire extinguishers. fire extinguishers shall be serviced at least 'once each year, and/or after each use,
by a person having a valid license or certificate. (U,f,C,)
7 Provide and maintain "EXIT" sign(s) with letters 5 or more inches in height over each required exit (door/window) to
SIGNS fire escape, (U,f,C,)
8 Provide and maintain appropriate numbers on a contrasting background and visible, from the street to indicate the
correct address of the building. (B,M,C,) (U,F,C,)
9 Repair all (cracks/holes/openings) in plaster in (location) _____________________..:________________, Plastering
FIRE DOORS / shall return the surface to its original fire resistive condition. (U,B,C,)
FIRE SEPARATIONS
10 Rem 0 v e/ r e p air (ite m & 10 cat ion) _________________________________________________________' Self-closing
doors shall be designed to close by gravity, or by the action of a mechanical device, or by an approved smoke and
heat sensitive device, Self-closing doors shall have no attachments capable of preventing the operation of the
closing device. (U,f,C,)
11 Remove all obstruction from hallways, Maintain all means of egress free of any storage, (U,f,C,)
EXITS
12 Provide a contrasting colored and permanently installed electric light over or near required exit (location)
______________________________ to clearly indicate it as an exit. (U.F.C,)
STORAGE 13 Remove all storage and/or other obstructions from fire escape landings and stairways stair shafts, (fire
escapes/stair shafts are to be maintained free from obstructions at all times,) (U,f,C,)
14 Extension cords shall not be used in lieu of permanent approved wiring, Install additional approved electrical outlets
ELECTRICAL APPLIANCES where needed, (N.E.C,) (U,f,C,)
15 Remove multiple attachment cords from specific electrical convenience outlet (one plug per outlet) (N,E,C,) (U,f,C,)
OUTDOOR BURNING 16 Violation of Section 1102 dealina with recreational fires or ooen burnlna, IU,f,C,)
FIREWORKS 17 Violations of Section 7802 (U,f.C,) or 8.49,040 of the Bakersfield Municipal Code (B,M,C,) reoardino fireworks,
OTHER 18 As I€ q. vi. I ,.. (> J b"" <:;a c.. -t \ n '" 756/0 o{ ....U..... H<?c.1 t"-' ~l'''\J Cad c- -,
A ("\ '1 C h\Jc. _ t.Q o -{' / (\Oi. vV\ f> Or OW1'\Qrs/"',}J ra.C4.IA. or ('" J 1-(,; ~jJ
05
(\d't- +l, ~~r-\ S""b ~ \ t CAi'\ aMei,,-\'('l.^\ +O/M rL,~ ',1:,,<
+\.", /. ../
"'C"'c.'\c '-
...>
LC\ \ \ c,~6. rv\ ~ \:-,c. 0\(\ A 0 ,) 0 . V"\ t f\I\ ~ "" w . t'" "JI" So.> ,. <.;t <J r
~Te U. ),\j.c rwoo~ ~ · t <::\ \ \ ..f (') r ,'VI .
V<:" -fc, CO"'" 0 I ~ "'- 50
/ /. 32b. - 3\9CJ
CUSTOMER: -~~ ESOl 4. &-0 .Qvv~' LEGEND:
C,f.C, CALIFORNIA fiRE CODE
/"-- (Signature) (Please Print Name Legibly, Title) U,B,C. UNifORM BUILDING CODE
CVG/ZY-l ~j , B.M,C, BAKERSfiELD MUNICIPAL CODE
INSPECTOR: APNO,: -P-4 N,f,P.A. NATIONAL FIRE PROTECTION
(Signature) ASSOCIATION
N,E.C. NATIONAL ELECTRIC CODE
KBF.7320
White - Customer/Original
Yellow - Station Copy
Pink - Prevention Services
FD 2022 (Rev. 09/05)
j) . -'~ '1~ t:
+~J~ ~gri~ok~~~ ~:~============================= SiteID: 015-021-000443 +
Manager : BusPhone: (661) 873-8503
Location: 3711 MT VERNON AVE Map : 103 CommHaz: Moderate
City BAKERSFIELD Grid: 15A FacUnits' OV:
CommCode: BFD STA 08 SIC Code: 5541(J5'1 ~
EPA Numb: DunnBrad:77-0 9 0~97
::::~~~~~:::~~::::::::::::::::::::::::::::~:::~~:::::::::::::::::::::::
Emergency Contact / Title Emergency Contact / Title
-BINDER DlffiLIWAL / OWNER /
Business Phone: (661) 871-7689x ~ Business Phone: ((,..C#()il-t - ~f9x
2~-Hour Phone: (6{;1) ~9{; 757:tx"'Z)_ 24-Hour Phone: ({,(,I )~~ -S'lfqx
Pager Phone : ( ) <J'1-(}.. -9-ry x i Pager Phone : ( ) - X
+---------------------------------------+--------------------------------------+
I Hazmat Hazards: Fire ImmHlth DelHlth I
+------------------------------------------------------------------------------+
Contact : Phone: (661) 871-7689x
MailAddr: 3711 MT VERNON AVE State: CA
City : BAKERSFIELD Zip : 93306
+------------------------------------------------------------------------------+
Owner DIUDEIt DM1iliIWAL ~ ~ e~c-.. {;.p,~. Phone: (661) 39G 7~.:rrx
Address : 3711 MT VERNON AVE State: CA <6::t.d-- S-0l8',
City : BAKERSFIELD Zip : 93306
+------------------------------------------------------------------------------+
Period to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
+------------------------------------------------------------------------------+
Emergency Directives:
PROG A - HAZMAT
PROG U - UST
t^- 00 f\
IX Olf"l
\>>^ "DO \ ~ "J
I;J 11 /A
J 700 \ ~ . J
Ij. {rjJ
ENT'O NOV 2 9 2006
+==============================================================================+
-1-
11/29/2006
Ronald J. Fraze
Fire Chief
Gary Hutton
Senior Deputy Chief
Administration
326-3650
Deputy Chief Dean Clason
Operations/Training
326-3652
Deputy Chief Kirk Blair
Fire Safety/Prevention Services
326-3653
PREVENTION SERVICES
Ralph Huey, Director
900 Truxtun, Suite 210
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 852-2171
November 1, 2006
Mr. Esa A. Esa
College Heights Food (Formerly Lucky 7)
3711 Mt. Vernon Avenue
Bakersfield, CA 93306
NOTICE OF VIOLATION AND
SCHEDULE FORCOMPUANCE
Re: Failure to Notifv LocallmDlementina Aaencv of Chanae in
OwnershiD and Chanae in Business Name at 3711 Mt. Vernon
Avenue. Balersfield. CA 93306
Dear Mr. Esa:
During an annual inspection conducted by this office, it has been verified that you
are the new owner of the facility referenced above since April of this year.
You are in violation of Section 25510 of the California Health & Safety Code.
"Within 30 days of change in business name or change
in ownership you must notify the local implementing
agency.
In addition you must also show proof of general liability
insurance for your underground storage tanks as per
California Code of Regulations, Title 23, Division 3,
Chapter 16, Underground Tank Regulations."
You have 30 days to schedule and complete the transfer of ownership forms
along with proof of general liability.
To schedule an appointment, please feel free to contact me at 661 - 326-3190.
Should you have any questions, please don't hesitate to call me.
Sincerely,
RALPH E. HUEY, DIRECTOR OF PREVENTION SERVICES
.~ckau(J
By: Steve Underwood,
Fire Prevention Officer
:7~Me~~~~Yk.~ NN
------~--
'- . -:T-r- d ''1(g!{ .
c.-.f\e-j ~
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_...3
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State afCalifornia .
Authority Cite& Chapter 67, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ojRegulatlOns
This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepare
for each monitoring system control panel by the technician who performs the work. A copy of this form ~ust be provided to ~e. tank
system owner/operator, The owner/operator must submit a copy of this form to the local agency regulatmg UST systems wlthm 30
days oftest date,
A. General Information
Facility Name: tOI.f..-.S(.,f
Site Address: , n I) pJT:
f
!IF r61ffl
vJ::;Z./L/O -1J
F a::;{)r14?/
~E
City: B4a120FIS't...-iJ
Bldg. No,:
Zip: <j]}tJ~
T.~ - 100/
Contact Phone No.: (
Date ofTesting/Servicing: E!);lJ,Q&;
Facility Contact Person:
Make/Model of Monitoring System: IV (OV
B. Inventory of Equipmcnt Tcsted/Certified p
Check the appropriate boxes to indicate specific eguipmenl inspected/serviced: I /(.) ~ f L-'t-o~ (j N - f, , r:r-s-
Tank lD: u1IJLfs"7 Tank ID: P~'~)
~ In-Tank Gauging Probe, Model: {.tfJ(fJ/\J m In-Tank Gauging Probe, Model: I M(..U-V
o Annular Space or Vault Sensor. Model: 0 Annular Space or Vault Sensor. Model:
lia Piping Sump / Trcnch Sensor(s), Model: '-5 - ~ A ~ Piping Sump / Trench Sensor(s), Model: L.. ~ - J A
o Fill Swnp Sensor(s), Model: 0 Fill Sump Sensor(s). Model:
o MeChanical Line Leak Detector. Model: 0 Mechanical Line Leak Detector. Model:
o Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
o Tank Overfill / High-Level Sensor, Model: 0 Tank Overfill / High-Level Sensor. Model:
o Other s eci e ui ment e and model in Section E on Pa e 2 , 0 Other (s eci e ui ment and model in Section E on P e 2),
Tank rD: OI-b~J;"l Tank In:
o In-Tank Gauging Pro~. Model: I/\.JCL;'l.J 0 In-Tank Gauging Probe, Model:
o Annular Space or Vault Sensor. Model: 0 Annular Space or Vault Sensor. Model:
o Piping Sump I Trench Sensor(s), Madej: LS, > A 0 Piping Sump I Trench Sensor(s). Model:
o Fill Sump Sensor(s), Model: 0 Fill Sump Sensor(s). Model:
o Mechanical Line Leak Detector. Model: 0 Mechanical Line Leak Detector. Model:
o Electronic Line Leak Detector. Model: 0 Electronic Line Leak Detector. Model:
o Tank Overfill I High-Level Sensor. Model: 0 Tank Overfill I High-Level Sensor. Model:
o Other (specify equipment type and model in Section E on Page 2). 0 Other (specity equipment type and model in Section E on Page 2),
Dispenser ID: I - ). Dispenser ID: J - 'f
I:ill. Dispenser ContailUllent Sensor(s), Model: LS - ]-1- tit Dispenser Containment Sensor(s). Model: L ~ ~.t1
1'9- Shear Valve(s), m Shear Valve(s).
o Dis enser Containment Float s and Chainu. . 0 Dis enser Containment Float s and Chain s .
Dispenser ID: Dispenser ID:
o Dispenser Contairuncnt Sensor(s), Model: 0 Dispenser Contairunent Sensor(s), Model:
o Shear Valve(s), 0 Shear Valve(s).
o Dispenser Containment Float(s) and Chain(s). 0 Dis cnser Containment Float s and Chain s ,
Dispenser ID: Dispenser lD:
o Dispenser Contairunent Sensor(s), Model: 0 Dispenser Contairunent Sensor(s). Model:
o Shear Valve(s), 0 Shear Valve(s),
ODispe~E_Containment Float(s) and Chain(s). 0 Dis enser Containment Float s and Chain s .
~lfthe facility contains more tanks or dispensers, copy this fonn, Include infonnation for every tank and dispenser at the facility,
C ,,-Certification. I certify that the equipment Identified in this document was Inspected/serviced in accordance with the manufacturers'
guidelines. Attached to this Certification is Information (e.g. manufacturers' checklists) necessary to verify that this information Is.
correct and a Plot Plan showing the layout of monitoring ~uipment. For any equipment capable of generating such reports, I have also
attached a copy of the report; (check aU that apply): ~ System set-up ji(~r: his~tOry re rt
Technician Name (print): .,.. Y +v ~oV Signature: ~ __
Certifici:ltionNo,:(j')-D5"5'1?r7 'U-,;':1:J~}Ltldl.~-UT License, No,: ) Y 5r-~qtL\-O
Testing Company Name; RICH ENVIRONMENTAL Phone No,: ( 661 ) 392-8687
Site Address: J711 ...-11: Vi=:'tLVQ-1~.A-VF' 61llD2s F'lfL1)/01 Date ofTesting/Servicing: ....L(Jj~/E.k
1JJO&
Page I of3
03101
Monitoring System Certification
""
D. Results of Testing/Servicing
Software Version Installed: /. II
lL{le 0 3
Com Ictc thc followin checklist:
~ Yes 0 0 Is the audible alarm 0 erational?
Yes 0 0 Is the visual alarm 0 erationa\?
Ol. Yes 0 Were all sensors visuall ins ected, functionall tested, and contin-ned 0 erational?
,3 Yes 0 Were all sensors installed at lowest point of secondary containment and positioned so that other equipment wiII
nol interfere with their ro er operation?
If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem)
operational?
For pressurized piping systems, does the turbine automatically shut down ifthe piping secondary containment
monitoring system detects a leak, fails to opepite, or is electrically disconnected? If yes: which sensors initiate
positive shut-down? (Check all that apply) 'l29 Sump/Trench Sensors; KDispenser Containment Sensors.
Did ou confirm ositive shut-down due to leaks and sensor failure/disconnection? ~ Yes; 0 No,
o 0 For,tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no
~ N/A mechanical overfill prevention valve is installed). is the overfill warning alarm visible and audible at the tank
fill int(s) and 0 eratin pro erly? Ifso, at what percent of tank capacity does the alarm trigger? %
Was any monitoring equipment replaced? rfyes, identify specific sensors, probes, or other equipment replaced
and list the manufacturer name and model for all re lacement arts in Section E, below.
Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)
Product; 0 Water. If es describe causes in Section E below.
Was monitorin s stem set.u reviewed to ensure ro er settin s? Attach set u
Yes 0 Is all monitoring equipment operational per manufacturer's specifications?
;. In Section E below, describe how and when tbese deficiencies were or will be corrected.
DYes
o
DYes
o
es
~ No
!S
es
o No
E. Comments:
- ~,6s5L
fOl/v(J
IV
(JIF<;S L
<; U,..., P
IZ5r'?Ov~LJ
f3y ITGIf.
Page 20f3
03101
[L((Q03
F. In-Tank Gauging / SIR Equipment:
J&. Check this box if tank gauging is used only for inventory control.
o Check this box if no tank gauging or SIR equipment is installed,
This section must be completed if in-tank gauging equipment is used to perfonn leak detection monitoring.
C
th f II
h kl' t
omp ete e 0 owtnl!: c ec IS :
o Yes o No' Has all input wiring been inspected for proper entry and termination. including testing for ground faults?
CJ Yes DNa' Were all tank gauging probes visually inspected for damage and residue buildup?
CJ Yes o No' Was accuracy of system product level readings tested?
o Yes o No' Was accuracy of system water level readings tested?
CJ Yes o NO Were all probes reinstalled properly?
DYes o 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.
G. Line Leak Detectors (LLD):
)&t Check this box if LLDs are not installed.
Complete the followinl! checklist:
Yes o No' For equipment start-up or annual equipment certification, was a leak simulated to verify LLO performance?
~ o N/A (Check all that apply) Simulated leak rate: 0 3 g.p.h., 0 0, I g.p,h, 0 0.2 g.p,h.
0 Yes o No' Were all LLDs confirmed operational and accurate within regulatory requirements?
0 Yes o No' Was the testing apparatus properly calibrated?
0 Yes o NO For mechanical LLOs, does the LLD restrict product flow if it detects a leak?
o N/A
0 Yes o No' For electronic LLDs, does the turbine automatically shut off if the LLD detects a ,leak?
o N/A
0 Yes o No' For electromc LLDs, does the turbine automatically shut off if any portion of the momtoring system is disabled
o N/A or disconnected?
DYes o No' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions
o N/A or fails a lest?
0 Yes o No' For electronic LLDs, have all accessible wiring connections been visually inspected?
o N/A
0 Yes o No' Were al1 items on the equipment manufacturer's maintenance checklist completed?
...
In the SectlOD H, below, deSCrIbe how and when these deficIenCIes were or will be corrected.
H. Comments: - /lJO
LIVE L~~~ OEn~~~
IVJ~U.o
Page 3 of3
03101
"
1~I.e03
Monitoring System Certification
Site Address: 3/ II
vrr
UST Monitoring Site Plan a
\)fQ/l.XJ".,).fVf; , (3A-~lt~ PJ~L
(-1
7'])010
- - - - . . - - - - - -
:~
.v:i-
-~
- . :J
-_.::::~
...---- ~
~
~
~
l2
- -9-
- - - - D- . . - -
_ _ -I A.JLa - . - . - .
=1~:-~~1: -
'- -
is
~
- - - - - - . . - -
w' _ _ _
- '.
Date map was dra'M1: J6jllj~
Instructions
If you already have a diagram that shows all required information, you may include it, rather than this page, with your
Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identifY
locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular
spaces, sumps, dispenser pans, spill containers, or other secondary contairunent areas; mechanical or electronic line leak
detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan
was prepared.
Page ~ of.::L.
05100
I Ltle03
SWRCB, January 2006
SpiIIBucket Testing Report Form
This form is intended for use by contractors performing annual testing 0/ UST spill containment structures. The completed form and
printoutsfromtests (ifapplicable), should be provided to the/aciJity,owner/operator lor submittal to the local regulatory agency,
Facility Name: C-Ot.., t....};(
Facility Address: "'}II
Facility Contact:
Date Local Agency Was Notified of Testing : "
Name of Local Agency Inspector (ifpresent during testing): C
Company Name:
SWRCB Tank Tester
Other (Specify)
3.
Test Method Used:
Test Equipment Used:
Identify Spill Bucket (By Tank '
Number, Stored Product, etc.
Bucket Installation Type:
Bucket Diameter:
Bucket Depth:
Wait time between applying
vacuum/water and start of test:
Test Start Time (fv:
Initial Reading (Rv:
Test End Time erf):
Final Reading (Rr):
Test Duration (T f - T J:
Change in Reading (RF - Rv:
PassIFail Threshold or
Criteria:
4
Direct Bury
Contained in Sum
1(...;"
JOI""I(~
1).:
I
J'I"
sO ,,,/11 v
~ERTIFICATION OF TECHNICIAN R,ESPONSmLE FOR CONDUCTING THIS TESTING
I hereby certify that ulI the information conwined in this report is true, accurate; and in full complwnce with legal requirements.
Date: /(), )J~O&
Technician's Signature:
I State laws aDd regulations do no
may be more stringent '
, e testing to be performed by a qualified contractor. However, local requirements
..
7
Tl1t~~
!JI'<U::f1D
STI'lNDFIRD 15
"'ROBF. J.
PRO[)i)'~T 1
:-,ONe
6.1300
-1,5130
20('
g3,000
t-lmlE
93.131313
NONE
\2.6
NGrJE
12.0
NONE
3. (1013
rlONE
PROBr::S
PROBE
T'T'PE
GRADIENT
FLOATS
FLOAT TYPE
PROSE ?
TYPE
GRflDI(NT
FLOATS
FI_OAT TYPE
PR08E ~
T',.'PC::
GPADIENT
Fl._OATS
FLOAT TYPE
tL/b03
~UMRSR OF TANKS 3
1::: LJ'3
iM"1/{ 1
NAME
TANK T',.'PE
PRORE
PRODUCT
"1"NIF()LD
PPO[j Oi=FSET
\')ATFR OF"SF.T
DEL THRESHOLD
HIGH HJGH UM
HIGH HIGH O/e,
HIGH LIMIT
HIGH LIt1IT O/G
U)l.J L.?I>1TT
lOl-),i.rMIT OIG
\.N.r \ \"1,) LIMIT
L!](.I LGO) OIG
1,Ji'iTE:R UMH
I~ATER O/G
TANK 2
NAME
T!'IN\( TYPE
PROBE
PRODUCT
~1APj I "'OLD
PROD OFFSET
WATER OFFSET
OEL THRESHOLD
HIGH HIGH LIM
YIGH HIGH 0/13
HIGH LIMIT
HIGH UI'1IT Q/G
lOl.) LIMIT
L(1l~ UMIT O/G
LO~.! LOW LIMIT
l.OW LOI,J 0/13
WATER LIMIT
WATER 0/13
TANK ~
NI'lMr:
TANK WPE
P~08E
PRODUCT
Mf\NI FillO
PROD OF~SET
WATER OFFSET
DF.:L THRESHOl[)
YIGH HiGH U~1
HIGH HIGH (IIG
HrGH UMIT
HIGH LIMIT DIG
I,O\~ LIMIT
LOW LIMIT O/G
LOIJ LOlJ UMIT
LO\~ LQ(J O/G
1,ji1T[R ~JMIT
~Jfi TER LI(G
.,...,. t-' :-~ "'~)!.Ar.n
__ "" ,,1 MT. 1,.1!::r;>Nnf'
:::AI(r::~~~TELD CA. ' 933RiS
6F-J! ~ 871.7689 -
! 0/:?3/7.t38~
~:'r'STE:r~ :;r.TUP REPOi,"r
~~VSTF.il1 .~ ~..JFO
SEE A80lJE
~"t~,IlSU!<Er'lENT J.lN ITS
tJ,~M:NE I:JAlLONS
-. --'" TNrHI'"~
TEr1PERflTURE FAHRF:}.~6T
Cl.OCI(/CI1I.[NDAR
ilMr "TY' E '
- ' ,- ," L 24 !'((lUj;'
')fiTF ::;rYLE ^1i'VI10';YY
pft'r'!.IGHT SfKJ [NASI Ef'
o.[T TIM!:- - ,,'
C T ,',~ 13:10
vE. DATE 10/23~2006
SFNnNEL MOD>
M(lO[ '.-
START TTMF
FJ'ICi Tr~;[ "
SO"'TWAPP
"'ART"
lJERSrofJ
~ELU1Sr::o
S'-.'STGI 10
QF"ORT "RTNT
OEl.!l.JE:RIES
ALAr.'N8
LEAK TESTS
I. ! hif TI'STS
L Ir1 no;
!.'AK -',IMlT
~EAK LIt1IT 0/8
! 1.<["'T UNIT
THEFT !.. I M IT 01[;
01 rS~tu.AI,(OUS
,jY,:.TE:M FflIi rl/O
r)E:UUfRY 0[1 AY ,
HrSTOR~' lENrm~
PR I f.JT rNTER(:AL
T .1.P.....4J.J'2
1. 1 j
, I,V05/ 1998
oc~
1~':00
0:613
~NH8lfS
ENARL€:D
'NA8LED
ENAE:LED
iCNARLr.O
?€l0
NO'iE:
2"';.\113
NONE
NONE
'25
58
1
srI) 1131
9.00169
2 ROATS
GASOLINE
srD HH
:3. 9~~7
'2 FlOATS
GASOU NE
s'm 101
8.94409
2 FLOflTS
OIL
PROl)UCTS
PRODUCT
NI'Il>1!':'
TYPE
P~D[)IjCT 2
NAMr
TYP~
PRODUCT 3
NAME
TYPE
PROD 1
UNL€ADEO PLS
PROD 2
UNLEADF,D SUP
PROD 3
UNLEADEC) REG
PREM !LWI
STANDARD \5
PROBE '2
PRODUCT 2
NONE
0.500
-1. 600
2013
93.800
NONE
93.800
NONF:
lV6
f,n.NF:
12.t1
NONE
3.\308
NONE
UNl':S
NUM8ER OF LINES 0
REPORT SCHEDULES
INVENTORY
PRODUCT DETAIL
SCHEDULE NONE
PRODUCT SUMMARY
SCHEDULE NONE
PROOUCT USAGE DE:TAIL
SCHEI)UlE NONE
PRODUCT USAGE SUMMARY
SCHEDULE NONE
TA~JI( Df:TAIL
SCHEDIJI.E NONE
TANK SUMMARY
SCHEDULE NONE
RECONCILIATION
SCHEOUlE: NONE
l)[l. ! iJf.I?Y
PRODUC-T DETMi.
SCHF:auu:: "lONf.
PRODUCT SUMMARY
SCHEDULE ~DNt
DELIVERY HISTORY
SCHEDULE NONE
I'llARMS
ACTIIJE fil_,ARMS
SCHEDULE NON
CU::f1RED ALI'lRMS
SCHEOULE N0N
f\UiRM 4JSTORY
SCHEDULE NO~
SENSOR STATUS
SCHEDULE /-,'01
REGUU\TfJR'f
SCHEDULE NOI
D H-:SEL
STANDARD 1-5
PR08F: 3
PRODUCT 3
r~ONE
1. see
-1.130@
200
93.000
NONE
93,G00
~jONE
12.@
NONE
12.El
NONE
3.000
NONE
cmlf1 PORTS
COM~1 PORT 1
MODE
BAUD
[it'lTA 8TTS
STOP BITS
PARITY
SECURITY
C:OMM PORT 2
MODE
t=:f'JUD
DATA BITS
STOP 8ITS
PAR ITY
SECURITy
ACCE::;::; 1,
PHnNF. 1
REDIAL 1
ACCf~.S 2
PHONE 2
~I':!)IA'- 2
Aeets:,; :;,
"Hm.E ~
REDIAL ::"
"ccr-:ss 4
PHO"lE 4
RfDTAL 4
(lff'lL. OEUIJ
D T AI. RLARt1
D I AI. LEAf:
Cf\X/NODEM
DATA MOD[
r,jOD(
BAUD
OtHA BITS
STOP 8 ns
PARITY
SECURITY
i1CCES8 1
PHONE 1
;>[DIAI. 1
ACCeSS ?
PHONE 2.
REDIAL :?
ACC"!O;S 3 ,
PHONE ~
REDfAI_ 3
ACCES~, 4
P!-I@[ 4
REDIAL 4
f) I 1'11_ !)ELIV
DIAL ALARM
i) J AI. U:AJ<
, Ff;,,>< MOD'.
ACCF::3S 1
PHONE i
ACCESS ::>
PHO~~E 2
Recross 3
PHOtiE 3
AC:CF.:SS 4
PHmJE d
FAX DEL HJERY
Ff'lX ALf'lRM
FAX I_":AK
FA:>; ~:EPORT
ILlf.c03
I_EAK TESTS
NATr.VE
1206 SAUD
11 81TS
1 STOP BIT
NQ PAR HY
CONFIDF:NCr
r"IN TEST T]11E
LEf\!< TEST
T I'1~JK 1
TANK 2
TANK 3
TEST SCHEDULES
TANK I
SCHEDUL.E
, TIME
TANK ?
SCHEDULE
TIME
TANK :,
SCHEDULE
TU~'
ALARM ON TEST
9':<.0'1,
4
AUXILIAP'~ INPUTS
INPUT j
\3.213
(1.20
0.20
ACTIlJE ClllSr:
NAr1E AUXIUflRV-
t'lUX INPUT % NON
INPUT 2 '
ACTIVE CLOSEI
NAMt:' AUXIL rARY .
AUX INPUT O/G' . NON!
TS-ROM
NATJI,JE
12~30 BAUD
8 8 ITS
1 STOP BIT
NO PAf;:;ITY
28TH DAY
21:30
28TH DAY
22:313
o ISA81.ED
ANNUNr:IATORS
GRAGE PEPro!)
CHANNEL !
OUTPI/T GROUPS
A-P '1-------_
O-FF -----____-------
r:HflNN[i ? -------
OUTPUT GROUPS
A-P y______________
D-FF ----_____ -
CHANNEL 3 -------
OUTPUT GROUPS
A-P Y__________
Q-FF ----______ -----
CHANNEL 4 ' ------
OUTPUT GROUPS
A-P y--______
Q-FF ______ -------
('HANNEL 5 ----------
0( ITPUT O/(OUPS
~-P ------__________
o ~ ----_______
~4~NNFL ~ -----
OUTPUT G/(rll,IPS
fIt-p ---______
O-F~ ---___ -------
CHANf.J~L 7 ----------
OUTPUT nf?nJ ,Pc:
~-p -~~~~-~-----
Q_I=F ______.._____
CHANNF.L 8 ----
OUTPUT GROUpe;
A-O __________
Q-I=~ __________==:===
Dr SAWED
28TI-I DA'r'
??:38
FAIL NO
f
D I SA8lED
MOI)UlATfD A@uwrATOR
TT t1E:01.IT ('\
OUTPUT GROUPS
A-I' Y---------------
O~I=~ -----~_--_-_---
c;OL II) ANNUNOATOf<>
TIM~OUT 0
OUTPUT GROUPS
A-I' ----------------
Q-FF ----------------
DISA8LED
f.ATIUE
1200 BAUD
:3 8ITS
1 STOP BIT
NO PARITY
RELI1'r'S
DISARm
RELAY 1
TlMEflUT
OUTPUT GROUPS
A-P ----------------
Q-F~ ----------------
RELAY?
TTMI::(lIJT
OIITPUT GROIJPS
A-P ----------------
Q-FF ----------------
1'"
.,J
tJISA8LED
Pi
DJSA81.t:D
SENSORS
NUMBER OF SENSORS 5
DISABLE[)
SENSOR J
NAME"
STr) 0-'8
SHISOR ?
NAME:
3TD O/G
<:D~SOR 3
NAME
STO O/G
SENSOR 4
NAME
STD O/G
SENSOR 5
NAME
STDO/G
ST[)
UN!.. -SUMP
A! ,I, GROUPS
STO
SUP-SUMP
AU. GROUPS
STT)
Dr[SEL-Sll~1P
AU. GROUPS
STD
i)ISP )-2 PAN
ALL GROUPS
srD
DISP-3-4 PAN
A!.l GROUPS
"T :: ~ Tf~tif"'O
,,7.1.1 NT IJt:'~"
8AKE~'SFT, . ,_RNON
.,.LD LA. 9"3136
66J.. 87i,. 7689'-' .
1 ('l/?>;/?00'<;
68.0013
69. 00€1
7'3.000
71. 000
7? 0013
73.0130
74.0130
75.000
7('.,1300
77 . '11130
78.011\0
79.13130
'.30.000
81. 1300
82.1300
83.0130
84. (300
85.0013
86.0lil'l
87.0010
88.000
89.0013
9121.1300
91. 0110
'I? . [1013
j ,:';: 14
TANV cOTT
~-- ,UP P'POPT
Ul~J)( 'In
9728. '3 GAL
TANK f,/AM,
T,'1~~1( TYi:', C' !1f,J1 .' Ar)
DJAMFTt:'p' ~TANI)AR[) 15-
, .F:I<GT4 9? ~H
Df.!. Tkh"SHO J1?" CIo9
P~OI)IIf'T'--' If);?l1e 1111
PROf) NA~" PpOD/le"- . I'
PPCH) TYP'~ PPIY, ;
tiP=:"FT p' rlf~r-,:At)r:f) Pi_S
OFF=Sr:T /.) 0, C:'C\
MA/.!Il=nr f) -1.. "0
PR0RF ". " f,JO/.w
PR08[ No, Ppo,<r' f'
!-lOfty" - 8T[t li1i
FlOAT'TYPE " r.:'0AT~
GRAD T (NT GAsnl.,TNt
~lG~ [1MIT 9.R916~
HIGH I 1MfT 0 ' 91.1:111
LOI-! LINTT /'-' NONE
'_Cli,) ',TIoP,,- .1'1/" 12.0'1
f-iTGH Hrr;~! . "'-Jnf,/,
~Tn" -
.,4 H TGY rvn q:<;, 00
L Okl U"~I .) ,'-!ONr
IJ)t.) UJI. n/l~j 2 ' Bn
WATER lIMIT NONE
I.JAT[R UI>JIT 0 r,'3. 80
~EMPCOMP -'.J T "iONE
'1P J GRAU IT'r' f1P" 6 R--:'48
ALPHA (;? "(:l
~ ." "<J
m. PTI)S .126, 00
RTD lOe 1 5
RTD I.DC 2 1 J" 49
RTD lac ~ 18.93
RTf) lOC 4 4~.8i
PTO lOC S 60.47
- 77.19
TANI< NO. 2
7793.742
7909.965
81323.747
8135,740
8245.836
8353.928
8458.906
8561 . 6413
8661.993
8759.830
'<38'54,995
8945.199
9032.387
9116.361
9196.901
9273.760
934h, 651
9415.248
'l479.I,57
9537 . 90~1
959I,698
9638.910
96813.211
9711.746
97?7.'l99
t Cj(e;03
STRAPPING l)ATA
9728.0 GAi_
INCHES
e'l.'300
1. 00li1
7.13013
3.000
4.0.~13
5.0'130
6,,13~l'1
7.06121
8,1300
9.000
10.e011
11. 0130
1,2.13130
13.~0L3
14.000
1~.00~
16.A00.
17.006
j8,~~0
19,13013
?0.0A~
21.1300
22.800
23.e00
24.1300
25.0013
26.0130
27.00121
28.0130
29.1300
30.13013
31. 13121121
32.000
33.800
34.1300
35.0013
36.000
37.13013
38.0013
39.13013
40.1300
41.01210
42.13130
43.1300
44,,1300
45.000
46.0013
47.1300
48.01313
49.13130
50.13130
51. 131313
52.1300
53.13013
5<1.'300
55.0130
56. 1300
57.01313
58.0013
59.13130
60. 1300
61 . 1313121
62.000
63.000
64.01313
65.0130
66.1300
67.000
TANI( NAME
TANK TYPE
DIAMETER
LENGTIi
I}(L T~RESHt)LD
PRODUCT
PROD NAME
PROD TYPE
OFFSET P
OFFSET IN
MANIFOLD
PROBE
PROBE T'YPE
FLOATS
FLOAT TYPF.:
GRADIENT
HIGH LIMIT
HIGH LHlIT OIG
IJI~) LIMIT
lm~ LIMIT O/G
HIGH HIGH
HIGH HIGH (I/G
1,.Ol~ Wil
LO~i LmJ rJ/G
WATER LHllT
WATER LIMIT O/G
TEMP COMP API
API GRAVITY
ALPHA
NO. RTDS
RTD LOC 1
RTD lOC 2
RTD Lor 3
RTD LOC 4
RTD UJC 5
PRFMIUM
STANDFlRD 15
92.00
337.98
7.01'1.1313
PRODUCT 2
PRO[) 2
UNLF.:ADED SUP
c;L50
-1. 00
NilNE
PROBE 2
'3T1) 101
2 FLOATS
GASOLINE
8.95597
93.130
NONE
12.1313
NONE
9~.00
NONE
1:V30
NONE
3.1210
NONE
68/548
51. 313
3'20.130
5
11. 49
313.93
45.81
6~.47
77.19
GALLONS
0.01313
16.253
47.788
89 .. 1389
135.'l52
189.395
:248.608
312.985
382~48
454.647
531. 211
E,1l. 458
695. 1.39
78?Gl~d
P,?:).954
968,709
1~66, 135
11~,r;.0P,0
i?f.8.'l53
1374-1372
1<187.. 163
1592.260
j 7134, 252
1818.03;:,
)934,758
2053.074
2174.1344
22%.426
24713.1:16
2545.091
267/.h92
2801.381
2931. A78
3063.129
3196.041.
3330.361
3465.4131
3601..094
3738.804
3877.031
4016.~33
4156.422
4296.629
4437 . 092
4579.422
4721.879
4864.399
500t, 97.~
5148.744
5290.441
5431.945
5571. 708
'5711. 151
5850.2139
5988.815
6126.9135
6262.599
6397.638
6531. 959
6664.520
67911.220
6926.985
7055,<190
7182,909
7307.863
7431.573
7553.957
7674.925
STRAPPIND
JNCHF.:S
0.000
1..003
2.13130
3.0B0
4.000
'5. e100
6.008
7.(100
8.008
9.088
18.660
J 1. 000
12.600
13,008
1.4.0130
15.0011
IE.. 080
17,088
18.00.6
19.0130
26.E166
?1..0IJr)
22.1300
2:':.000
'24.000
2'5. 1~0fj
26.080
27.0\16
28.0130
29.000
30.000
:Q.600
32.080
33.1309
34.01Jf.1
\5.e00
36.008
37,8i10
38.008
39.660
40.00(1
41.121013
42.000
'L3 . 008
44.000
4'5. 0~30
4E..0efl
d7 <3('10
48.138,3
49..0Vl0
50. 600
'5 UJ00
52.068
53.000
:'\4.000
';,'),0t:Jl1
56.090
57 . ~300
58.608
59.8El8 .
60.000
t:,-1.000
62.660
~)3. one
64.000
1-\5.0013
6E..00fl
67.i1qe
f)ATA
GALLONS
11.660
16, ?53
47. 78.9
:39.089
135.9~2
189.395
248.608
31?9BS
3BZ; ~'k
454.647
531.21.1
611.458
695.139
?R2.1134
873.954
968.7139
1066. 1-35
j 166. 600
1268.953
1374. ~72
1482.163
15<12, ?f,f3
1704.252
\818.035
1934.758
2053.1374
2174.044
2296.426
2428.136
254,'1,091
2672.692
7.801. J81
2931.1378
30F.3.129
31%.041
3330.361
.3465.4131
3601,,094
3738.8104
3877.031
40916.'533
41~6.422
4296.629
4437.892
4579.422
4721, ,1'179
4%4.399
"i118':;.9?0
5148.744
5296.441
~431. 945
5571.7138
57) 1. 151
58S6.209
5988.815
';126.985
l'.2€.2. 599
6397.638
6531. 959
6664. ,520
67%"220
6926.985
765'5.490
7182..909
7387.81:.3
7431.'573
7553.957
7674.925
68.1380
€,9.3013
70.0013
71. eBB
72 . OOB
73.000
74.060
?5.eqq
?6.flOB
77.900
r8.0fl6
79.00@
Be.flV8
B).@BCl
82.8130
8,3'.13013
84.@90
85.(11313
86.ea0
S?BI'lI:!
88.@80
89.01313
98.008
91. 800
92.800
TANK NO. J
TANK Ni1ME
TANk' TYPE
D IAMET(R
LEN.GTH
DEL THRESHOLD
PRODUCT
PROD NAME
PROD TYPF
OFFSET p
OFi=SET (~
MAN! FOLD
PROBE
PROSE TYPE
I=LOr'lTS
FLOAT Typ[
GRADIENT
HIGH lfMfT
HIGH UMIT O/G
LOl,! LIMIT
cow UMlT 0/6
HIGH HIGH
HIGH HTGH CVI]
LOW LOll
LOW Low 0/6
WATER LIMIT
WATER Ur1IT 0/13
TEMP COMP API
API GRAUITY
ALPHfl
NO. RTI)S
RTD LOe 1
Rm ! OC 2
RTD LOC 3
RTf) '.OC 4
RTD LOC 5
t l{&03
7;:;93.242
79139.965
81323.747
8135.74(3
8245.-936
83~~.928
8458.906
8561.64\3
8661.993
8759.8Je
8854.Q95
8945,199
913.32. :38?
9116.361
9196.901
9273.7613
9346.651
94J5.248
9479.157
953? . 9as
9591.698
9638.919
9680.211
97( 1 . 746
9?27.999
ST~APP!NG hA~~LL0NS
INCH~, ~,0aS
0.00B 16.253
l.e0e 47.788
2.eee 89.1389
3.000 135.952
4.0g0 189.395
5.000 24B.f,~8
6.0130 ~12.985
7.13130 387..048
S.0~0 454.647
9.eee ~31.211
1@.000 611.458
11.000 695.139
12.e~0 782.034
13.900 873.QS4
14.000 ge8.709
15.0130 1066.135
16.000 1166.080
17.000 1268.953
18.0130 i~74.072
1.9.1300 1482.163
20.000 1592.260
21. 800 17~4. 252
22.~0e 18i8.035
23.1300 1934,758
24.e~0 2053.074
25.000 ?174.044
26.01313 2296.426
27.000 ~42e.136
28.00e 2~45.091
29.000 2~7?692
30.0130 2801.381
31.000 ?931.07~
32.0013 3063.129
33.000 3196.1341
34.13003330.361
35.000 3465.401
36.080 3601.094
37.000 ~7~9.B134
38.~e0 3877.031
39.000 4~16.533
4e.0~0 4156.422
41.B~0 4296.629
42.000 4437.1392
43.080 4579.422
44.000 472J.879
45.000 4864.399
46.000 5006.920
47.080 ~148.744
4B.000 5290.441
49.0130 5431.945
~0.e0e 5571.708
51.3013 5711.151
52.000 5850.209
53.0G0 5988.815
54.006 6126.905
55.800 6262.599
56.000 6397.638
57.000 6531.959
S8.eBa 6664.5213
59.800 6796.220
613.000 6926.985
61.eee 7~55.4ge
62.000 7182.909
63.6013 7~07.S63
~4.000 7431.573
65.000 7553.957
66.60ij 7674.925
67.0013 ,
972&.0 l1t'll
DI ESEl
STI'tNDARD )5
92.06
:\37.98
21313.00
"ROD( fCT ,3'
PRO/) ,~
1),4L>AI)f.f) ,",[G
1. ~-9
-L00
NONE
'PROBE 3
STD 101
2 i:U)ATS
OIL
8.94409
n.60
NONE
12.06
NOI~E
93.00
'!ONE
12.0[1
to/ONE
J.88
NONE
6&/54&
63.59
320.00
5
11. 49
38.93
4S.81
f.A.47
77.19
68.000
69.01313
7121.1'100
71.000
n.f'300
73.000
74.12100
75.8013
76.000
77.12108
78.12100
79.600
8121.000
81.000
82.1300
83.1300
84.600
85.00121
86.12180
87.000
88.1312113
89.060
90.000
91. 000
92.000
ll{ ~03
7793.242
7909.965
807.3.747
81:)5.740
8245.836
8353.928
8458.906
8561. 640
8661. 993
8759.830
8854.995
8945.199
91332.387
9116.361
919FS.G01
9273.760
9346.651
9415.248
9479, 157
9537.905
QS91.E.98
9638.910
9680.211
9711,.746
9727.999
07/12/2006 19~31
PROBE SYNC ERROR
TANK NO. 1
C H TEXI1CO
3711 t1T. VER~iON
811KERSFIElD CA. 9330~
661.871.7689
07/12/2006 15:17
PROBE SYNC ERROR
TANK NO. 1
Hl/23/2006
13:18
ALARM HISTORY
07/1~/2006 15: 14
PROBE SYNC ERROR
TANK NO. !.
10/23/2006 ~3:04
STANDARD SENSOR
DISP 1-2 PAN
SENSOR NO. 4
07/'2/2006 1d.:08
PROBE SYNC ERROR
TANK NO. 1
07/12/2006 12=36
PROBE SYNC ERROR
TANK NO. 1
07/ 1. 2/2006 1. 2: 36
PROBE SYNC ERROR
TANK kiO. 1
10/23/200~ 1~:03
STANDARD SENSOR
()),SP-~-4 PAN
SENSOR NO. 5
10/23/2006 13:02
STANDARD SEf~SOR
UNl-SUMP
SENSOR NO. J
10/23/2006 1.,:02
STANDARD SENSOR
SUP-SUMP
SENSOR NO. 2
10/23/2006 13:01
STANDI1RD SENSOR
OIESEL-SUMP
SOJSOR NO.3
('\9/21/2006 1~l: 23
PRINTER OUT OF PAPER
08/27/21306 19:39
pmJER UP
07/12/2006 12:34
NO PROBE DETECTF.D
TI1NK NO. 1
07/12/2006 12:23
PROBE SYNC ERROR
TANK NO. 1
07/12/2006 12:20
PROBE SYNC ERROR
TANK NO. !
07/11.,...2006 12: 19
PROBE SYNC ERROR
TANK NO. 1
08/27 <?00E. :t 9: 39
pmiER DmJN
07/19/2006 16:134
NO PROBE DETECTrD
TANK NO. 1
07/13/201216 7:29
POI.JER UP
07/13/212106 7:13
POWER DOWN
07/13/2006 6:36
~O PROBE ~F.TECT~D
TANK NCi. 1
07/12/2006 12:18
PROBE SYNC ERROR
TANK NO. 1
07/12/20136 17:13
PROBE SYNC ERROR
TANK NO. 1
07/12/201216 17.:12
PROBE SYNC ERROR
TANK NO. 1.
07/12/2006 12:138
PROBE SYNC ERROR
TI1NK NO. 1
07/12/20136 12:07
PROBE SYNC ~RROR
TANK NO. 1
07/13/2006 6:3J
PROBE SYNC ERROR
TANK NO. 1
137/13/212106 5:59
pm~ER UP
07/13/2006 5:58
P(1I.JER !)O\~N
07/t2/2006 1?:06
PROBE SYNC ERROR
TANK NO. 1
07/1J/2006 12:47
PROBE SYNC ERROR
TANK NO. 1
07/11/1006 t~:d6
PROBE SYNC ERROR
TANK ~~O. 1
1217/11/2131216 12: 39
NO PROBE DET(CT~D
TANK NO. 1
08/09/2006 8:43
STANDARD SENSO~:
UNl-S1.lt1P
SENSOP "10. 1
Ut-1LEAD
9728.r:l Gf'lL
1'1{p03
PROD 2
LEAK TEST 0.20/3 GPH
LEAK THRESHOLD 0.100 GPH
CONFII)F:NCE LEVEL '~g. 0Y.
TEST STARTED 22:30
TEST STARTED 09/28/?006
LAST DELIVERY 9:44
L~ST OFLIUERY 09/21/2066
GROSS CAPACITY 17.6(,
8EGIN GROSS 1709.5 GAL
BEGIN NET 1~83.4 GAL
BEGIN I_FIJEI.. 22.,e47 IN
BEGIN TEMP 84.461 F
8EGIN WATER 0.0 GAL
BEGIN WATER 0.0130 IN
f.Ni) TIME ?:44
END DATE 139/29/2006
END GROSS 1709, 5 GAL
END NET 1683.4 GAL
[ND I_EUEL 22.1'l46 IN
END TEMP 84.465 F
FND WATER ~.~ GAL
END WATER 0.000 IN
I-iOURLY DATA
07/IJ2/2006
PO~JER UP
18:50
07/1.12/2006
POl.J[R DOlJt-J
1~:49
09/1711/2006
POWER UP
Ct9/17I1/;>006
PO~JER DmJN
20:44
r~ f.I Tt:XAUl
371 j I1T. l)ERNON
8AKERSFIELD CA. 93306
661. 871. 7689
20:<14
08/10/'21306 14:44
PRINTER OUT (IF PAPEP
10/2312(:\1iIE, 13: 20
LEAK TEST R~PORT
PROD 1
08/~9/2g06 8:43
STANDHRD SENSOR
Ut4L -SUMP
SENSO~: NO. 1
~EAK TEST 0.200 GPH
LEAK THRESHOLD 0.100 GPH
CONFIDENCE LEVEL 99.0t:
TEST STARTED 22:30
TEST STARTED 09/28/2006
LAST DELIVERY 9:42
LAST QELIUERY 09/21/2006
GROSS CAPACITY 59.4t:
BEGIN GROSS 5779.4 GAL
BEGIN NET 5677.0 GAL
BEG IN !EUEL 52. 54R IN
BEGIN TEMP 85.217 F
BEGIN WATER 8.0 GAL
BEGIN WATER 0.639 IN
END TIME 4:54
END DATE 09/29/2006
END GROSS ~774.6 GAL
END NET 5672.3 GAL
END '_E!JEl 52.513 IN
END TEMP 85.228 F
END WATER 8.0 GAL
END WATER 0.639 IN
HOURL Y NHA
TI/1E
23:29
0:29
1: 29
2:29
DEG F GAL
84.462 1683.42
84.464 1683.42
84.46<1 1683.38
84.465 1683.36
08/119/2606 ' 8: 43
STANDARD SENSOR
UNL -SUt1P
SENSOR NO. 1
08/~9/7006 8:43
STANDARD SENSOR
IJNL -SIJ~1P
SENSOR NO. 1
SLOPE -0.13132 GAIJHR
SLOPE Lml -0.1303 GAL/HR
SLOPE HIGH -0.13131 GAVHR
TEST RESULT PASSED
SLOP~ EQUALS CALCULATED
LEAK RATF.
08..1~9/?006 8:41
STANDARD SENSOR
UNL -SUt1P .
SENSOR ~~O. i
08..109/2~~6 8:36
STANDARD SENsor;;
1Jt-1L -SUMP
SENSOR ~~O. 1
08/09/20136 8:35
STANDARD SENSOR
UNL-SlIMP
SENSOR NO. 1
08/09/20136 8=35
STANDARD SENSOR
UNL-SUMP
SENSOR NO. 1.
TH1E
7.3: 29
0:29
1: 29
2:29
3:29
4:29
DEG F GAL
85.217 '5681~ 15
85.215 5688.35
85.219 %80.33
85.217 5680.32
85.228 5680.28
85.232 5680.26
9728.13 GAL
PROD 3
LEAK TEST 13.2013 GPH
LEAK THRESHOLD 0.100 GPH
CONF I DENCE I_EVEl 99. 0t:
TEST STARTED 22:38
TEST STARTED 09/28/2006
LAST DELIVERY 23:24
LAST DELIVERY 138/14/2006
GROSS CAPACITY 10.3Y.
BEGIN GROSS 11382.9 GAL
BEGIN NET 984.1 GAL.
BEGIN LEVEL t5.410 IN
BEGIN TEMP 86.464 F
8EGIN \~ATF.:R 5.5 GAL
BEGIN WATER 0.5136 IN
END TIME 2:29
END DATE 09/29/2006
END GROSS 1002.8 GAL
END NET 984.1 GAL
END !-E(JF.:L 15.41.0 IN
END TEMP 86.440 F
END \~ATF.R 5. ~ GAL
END WATER 0.506 IN
DIESEL
08/09/2006 8:35
STA~JDARO SH1SOR
UNL-SIJMP
SENSOR t-m. 1
SLOPE -0.478 GAL/HR
SLOPE lm) -e. set) GAL/HR
SLOPE HIGH -0.450 GAL/HR
TEST RESULT FAILED
SLOPE EQUALS Cf'lLCULf'lTED
LEAK RATE
08/09/2006 7:26
PRINTER OUT OF PAPER
08/09/2006 6:05
STANDARD SENSOR
UNL-8UMP
SENSOR ~IO. )
HOURL Y DATA'
TIME
23:29
0:29
1:29
2:29
DEG F GAL
86.458 989.~9
86.454 989.67
86.448 989.63
86.440 989.59
SLOP( 0.011 GAL/HR
SLOPE LOW 0.010 GAL/HR
SLQPE HIGH ~.~t2 GAL/HR
TEST RESULT PASSED
SlOPJ:: mUALS CFlI.CULATr.D
LEAK RATE
\'. :,.:. ~r:>~,Ac:.ci
~7 ~~. MT. 1.)F.Rt"iCI~.:
:::WEI<SFr~'j) I~A. 'J33(J6
661. :371 . 7t,~:'3
1. ~1/'~~~/?~10h ~t 3: (11.
f1U\Rpi ~EPOf~'c
" i:1/?~,/?(18f,
STAr~[)H~:D c;;[NSOR
~) r tSC__-',~,Ut'1P
sn~sor' ~~C. "
',,:::,: (\1
I~ :4 T,-y.ArO
3711 ~1T. UERHOr'
'::I'<.KF..RSF T EU) f":A. 933i'l1=.
f,E.1. 871. 7689
,0/?312l3Ql6 1,3:, ('2
KAP.~! REPORT
i l~n;>:/?(10h
STANDAR[) SENSOR
q l~d;I.I~\P
SEfj~;O': I~O. '?
1,-:<;:(12
!-: i.-l T~Y.A(~':I'"
,:'::7 U t.n. UFRrJCiH
8AKF.RSFTELD CA. 9331216
66:l. 871. 7689
11~/23/2006 ~3:02
AL.ARr'j REPORT
1 '1/23/200';
STANDfi,~[l SErISC1f?
UNI.,-SUMP
SE~ISOP rJO. 1
13:02
"-
I
I~ '1 T'::YACO
<.7),' MT. UERt.iOf"
8fiKF~SFTEJ_D CA. q3306
617,1.871.7689
11:'1/23,/'1.00'<; 1,3: 03
ALARr~ RFoORT
10/23/2006
STANDARD SENSOR
D!,,;P-3-.:1 PAN
SENSOR NO.5,
~,3: 03
,~ y TEXACO
371. t MT. l,lF.:P,,'.Q'"
8AKF.RSFtF.CO CA. 9:'.386
661.871.7689
1, (7)/2:)/'2'386
',3:04
AU\RM REPOPT
HV23/?006
STANDARO 80180P
DISP 1-:2 P!-)~~
sniSOR NO. 4
1,:";:04
_I Llh D3
,
/t;!p()3 ~
MONITOR CERT. FAILURE REPORT
SITE NAME: COL'_ fb~ )ff;1(nfn---S 'F{JC/(}~ DATE: 10 ..1).cJ &;
ADDRESS:,nn n1. i.I{J1..,;.)uV TECHNICIAN: t,.C(A-V ~-'\~
COMPLETE
REPAIRS:
'- MLL iJ /()k~() ,70 tJiZ' IV$'/.fu...EtJ C;v 4'L L
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LABOR:
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PARTS INTALLED:
~U'1/E
NAME~ Cd'/!.. -- TITLE: M-!Ir/~/ltfi--
~N:n~~dDlp~~~ 1Jts FULL RESPONSmILITY OF NOTIFYING
THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR
THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVlRONMANTAL FOR
ANY NEEDED RETESTING. TillS ALSO RELEASES RICH ENVIRONMENTAL OF
ANY FINES OR PENALTIES OCCURlNG FROM NON-COMPLIANCE.
A COpy OF THIS DOCUMENT HAS BEEN LEFT ON-SITE FOR YOUR
CONVIENENCE.
, .
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BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave.. 3te. 210
Bakersfield, CA 9330 l
Tel.: (661) 326-3979
Fax: (661)852-2:-:
UNDERGROUND STORAGE TANKS
'i.~
./
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APPLICATION
TO PERFORM ELD I LINE TESTING
I SB9B9SECONDAI~Y CONTAINMENT TESTING
(TANK T1GHTNESS TEST AND TO PERFORM
FUEL MONITORINCi CERTIFICATION
:'~~' :)
Page 1 of 1
PERMIT NO, C
o ENHANCED LEAK DETECTION 0 $8-989 SECONDARY:ONT ;\NMENT TESTING
o TANK llGHTNES~ TEST ---
I -----
I FACILITY II _ Ii _ _ III ~ .~^ \".l-.- ~"...J If\~ rt I L NAME & ~?~~N~~ER. OF ~N~qT PE~~~ zQ
"- ....( )\1 ec.\~....J..1 Lr- \'~l t/\ 2. I ( .A '~, ' I 1\, A i I I 1", " Y I )~1 \1_/'" l) j I .. ""-~...:-.
ADDRESS ~/'7 ti i V.~ ..l-, \ 10 If It r\lf'i _ p) \(f.'
~ \ \ l J',~ \.1_,,':' \' ..\"
OWNERS NAME
/
OPERATORS NAME
PERMIT TO OPERATE NO.
NUMBER OF TANK~; TO BE TESTED
TAI~K #
IS PIPING GOING TO BE TESTED?
VOLUME
DYES
,'K
CONTENTS
TANK TESTING COMPANY
NAME & ,~H.(lNF NIIM"''''' ....e ('I'\"T^,"'" D=<:;:: I ~
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0J /) /7 1\
D-. ' f:) U
TIFICATION #:
l
;;:H METHOD
I
I
J
APPROVED BY
ce 2D95 (Rev. 09/05)
~ ~,
, .
I PERMIT NO.:
~
- 1d40~
BAKERSFIELD FIRE DE .
Prevention Services
900 Truxtun Ave::1ue, Suite 210
Bakersfield, CA 933C
BILLING & PERMIT STATEMENT
lOCA nON OF PROJECT
STARTING DATE
'-T'
PROJECT NAME
PROJECT ADDRESS
ADDRESS
r:)CcC! ~~ /3/1 f~:C){<~ S
':OUOiENO'2t'J,} Q' , .;
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CONTRACTOR flAME
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0 Alarms - tJew & Modifications - (Minimum Charge) $262,50 . 84
98
Over 20,000 Sq. Ft. Sq. Ft. x .013125 = Permit fee . 84
0 98
0 Splinkler~, - New & Modifications - (Minimum Charge) $210,00 . 84
,98
0 Over 5,000 Sq. Ft. Sq. Ft x .042 = Permit fee 84
98
0 Minor Sprinkler Modifications (< 10 heads) $ 93.00 [Inspection Only} 84
98
-, 84
0 Commercial Hoods - New & Modifications $ 398.26
98
0 Additional Hoods $ 36.00 84
98
0 Spray Booths - New & Modifications $458.00 84
98
0 Aboveground Storage Tanks (lnstallationl\nsp,.1~ Time) $165.00 82
0 Additional Tanks " $ 26.00 82
0 Aboveground Storage Tanks (Remova//lnspection) $109.00 82
0 UndergrO'Jnd Storage Tanks (/nsta//ation./fnspection) $878,00 (per tank) 82
0 UndergroJnd Storage Tanks (Modification) $878.00 (per site) 82
0 Underground Storage Tanks (Minor Modification) $155,00 82
0 Underground Storage Tanks (Removan $675.00 (per tank) I 84
0 Oilwell (Installation) $ 72.00 I 84
~ Mandated Leak Detection (festj~Fuel Manit, Cert)" $ 81,00 (per site) I 82
0 Tents .-.'n"'___.~.~ $ 93.00 (per tent) I 84
0 ANerhournmspecfion fue $122.00 : 84
0 Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour) $ 60.00 + (5 hrs, min, stand -by fee Ilnspection) = $510.00 . 84
0 RE-INSPi':CT/ON(S) / FOLLOW-UP INSPECT/ON(S) $ 93.00 (per hour) . 84
0 Portable LPG (Propane): NO. OF CAGES? $ 68.00 . 84
0 Explosive Storage $249.00 . B4
0 Copying I~ File Research (File Research Fee $33,00 per hr) 25~ per page . 8A
0 Miscellaneous . B4
. . .
, .
. . .
FO 2021 (Rev, 09/05)
1 . ORIGINAL WHITE (to Treasury)
1.YELLOW (to File)
1-PINK (to Customer)
UNIFIE'D PROGRAM INSPECTiON CHECKLIST
~~
B"~
BAKERSFIELD FIRE DEPI'
Prevention Services
900 Truxtun Ave.. Suite 210
Bakersfield. CA 93301
Tel.: (661) 326-3979
Fax: (661)872-2171
~,,'';,~::'''.~.~'i.~-l'~'!;i.\~rM(>.:i.~'.'~;.r.~~ ,"-t};'''-'''I..-'';';,'.;'' "IY' ;';;:\~l~::;;-".~'/,(1(".; /;.!i..i'.'^:";",:~ ..-', ...<fC-,'.'I'"....-~. ,'-, ',1 ,-".: _ ::<:- ./~ ,".. "r'~,~>.,,_ .' ",'.::" J',"";."'_' i': ~!"-' ~..; ;.,
SECTION 1: Business Plan and Inventory Program
FACILITY NAME
ADDRESS
FACILITY CONTACT
7
c/
UslNESs 10 NUMBER
15-021-
D ROUTINE
Section 1: Business Plan find Inventory Program
'1::1- JOINT-AGENCy----O MUL TI-AGENCy-O'COMPLAINT
D RE-INSPECTION
C V (c=compliance)
V=Violation
~, D
~o
fJ'----" D
OPERATION
COMMENTS
ApPROPRIATE PERMIT ON HAND
o Business PLAN CONTACT INFORMATION ACCURATE
VISIBLE ADDRESS
CORRECT OCCUPANCY
VERIFICATION OF INVENTORY MATERIALS
VERIFICATION OF QUANTITIES
VERIFICATION OF LOCATION
PROPER SEGREGATION OF MATERIAL
VERIFICATION OF MSDS AVAILABILITY
VERIFICATION OF HAl MAT TRAINING
vf\. D VERIFICATION OF ABATEMENT SUPPLIES AND
~OCEDURES
~ EMERGENCY PROCEDURES ADEQUATE
,..a D CONTAINERS PROPERLY LABELED
~ D HOUSEKEEPING
~ D FIRE PROTECTION
4fl\ D SITE DIAGRAM ADEQUATE & ON HAND
DYES
D NO
ANY HAZARDOUS WASTE ON SITE?
EXPLAIN:
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (681) 326-3979
1/11floJU tt4izA- P -' 1-
Inspector (Please Print) Fire Prevention /1" In I Shift of SitelStation #
ible Party (Please Print)
White - Prevention Servic&$
Yellow - Station Copy
Pink - Bus;nasa Copy
FD2049 (Rev. 02105)
: ~
t: -/-'" -.....
CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3'd Floor, Bakersfield, CA 93301
FACILITY NAME !.. udJl 1
INSPECTION DATE ;<.. 2('O~
Section 2:
Underground Storage Tanks Program
o Routine e:aCcombined 0 Joint Agency
Type of Tank DY4J,t~ {L.A(;l
Type of Monitoring Ll.--p
o Multi-Agency 0 Complaint
Number of Tanks .3
Type of Piping P~/libL ~ cA/ A- {t
ORe-inspection
OPERA TION
c V
COMMENTS
Proper tank data on file
'(<7 t..--
S7P/L.~-
IV i..fol
Proper owner/operator data on 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
.AJ~No
Section 3:
Aboveground Storage Tanks Program
TANK SIZE(5)_
Type of Tank
AGGREGATE CAPACITY
Number of Tanks
OPERA TI0N 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=CompJiance
V=Violation
Y=Yes
N=NO
In,peao,,!.AIYVJN CJtzA f -1-
Office of Environmental Services (661) 326-3979
White - Fnv. Svcs.
Pink - Business Cory