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HomeMy WebLinkAboutUST-REP. 10/29/2005 ~s ~~ _ _ _ (UNDERGROUND STORAGE TANK) FILE # _ _ ~ CHEVRON STATION #9$109 !~ 1131 OAK STREET -- -- - - - . .'t ,: ,~,' .< t ~~ ~~ iy ;~ UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. ~~-~ a ~7a BAKERSFIELD FIRE DEPT. s R S A I n prevention Services /-lR! A/~TN T 900 Truxtun Ave., Ste. 210 .~ Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of t ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ~ TO PERFORM FUEL MONITORING CERTIFICATION SITE INFORMATION FACILITY ~ ~` , ~ ~Q . O NAM` ~~ N N~ UMBER OF CONTACT PER~ON~, l~ "- DDRESS ~ ~ ~ ( - ~' l ~^ ~ 1 ~ ~~ ~CiV~ J b~~~ /`~ ~ WNERS NAtyl,n ~ ~ 1 ` ~-~ Y l•V l'v PERATORS NAI~C Ej 1,,,, ~~ ERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTE D IS PIPING GOING TO BE TESTED? ^ YES ^ NO _ _ _ TANK# VO LUME CONTENTS tt / G© ~'~` ~ le ~ ~ TANK TESTING COMPANY.. NAME OF TESTING COMPANY N ~ & NONE~`iBER OF C~ONT~ACT P~E,RQ~ N 11..--``~~~~`"' Z.~~ M ILI G ADDRESS 5 ~J~YI~ ~ G 2u. ~ ~xsr~~ ~ ~•r~_ ~ 4 '~-~ ~-~- ~- e1~25~ C~ NAME & PHONE UMBER OF TESTER OR P CIAL INSPECTO ~~~ -~o~~~ ~i-53~~ fe~5 ERTIFICATION #: - ~-05 _©~t53 ATE ~ IME T ST TO BE CON[jU+)CTED l r CC ~: 525 ~~~ r U r EST METHOD IGNATU E OF APPLICANT ~ DATE ~,b ___ __ TH.1 APPLI TI. BECOME APE MiT , ~Fi. ' APRR VED~ PPROVED B ___, DATE FD2106 Jeanni;!~vec~;,~98109 HMBP.pdf ~ u .~.;_~.~_~.~..,~ ,~~,u~~ ~.~,.~~~x~ ~~x~ m.~.~ Page 1 ~,~ 1 CHEVRON PRO DUCTS COMPANY P.O. BOX 6004 SAN RAMON, CA 94583 (925) 842-9002 CALIFORNIA Certified Unified Program Agency HAZARDOUS MATERIALS BUSINESS PLAN HMBP 2006 Chevron Stations, Inc. #98109 1131 Oak St 1131 Oak St, Bakersfield, CA 93304 (661) 324-7621 EN1~'p q ~~ ~ ~y3 X006 FOR POSTI NG l N THE EMERGENCY RESPONSE BINDER at the CASHIER ARE PHON E Jeanrn (~Loven 98109 HMBPµpdf ~ ~~~~~~' ~~~~~~~ ~ ~~~~ ~~~~ Page 2 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION ~ ~ I .IDENTIFICATION FAGLITYID# O O _ Q O 0 - 0 0 0 0 0 0 + BEGINNING DATE +~ ENDINGDATE +o+ 01101 /2006 121318006 BUSNESSNAME(s3measFAG~irvNAMeaoeA-ouirgeuAne~A~ a BUSNESiFHONE +~ Chevron Stations Inc. #98109 (881) 324-7621 BUSNESSSTEADDRESS +~ 1131 Oak St GTY +oa ZIPCODE +~ Bakersfield CA 93304 DUNK BRADSfREET +as SCCODE(4digit#) +~"/ 00-914-0559 5541154111753817542 couNTY +~e Kern BUSNESSOFERATORNAME +~ BUSNESSOPERATORFHONE ++0 Chevron Stations Inc. #98109 (881) 3247621 II.BUSINESS OWNER OWNER NAME +++ OWNERRiONE ++2 Chevron Products Com n Attn: Permit Desk L2375 B-1 925-842-9002 p OWNERMAILINGADDRESi ~N~ AU ,3 P.O. Box 6004 GTY ++a SPATE ++s ZIPCODE ++e San Ramon CA 94583 III.ENVIRONMENTAL CONTACT CONTACT NAME ++~ OONTACi FHONE ++s Chevron Products Com an Attn: Permit Desk, L2375- B1 925-842-9002 OONTACi MAILINGADDRESS ++v P.o. Box sooa GTY +p SPATE +2+ ZIPCODE +22 San Ramon CA 94583 -PRIMARY- IV. EMERGENCY CONTACTS SECONDARY- NAME +~ NAME +~ Chevron Maintenance Dis tch Chevron Emergency Information Center (CTEIC) TITLE +2a TITLE tea Solve One H el Desk Chevron Emergency Information Center (CTEIC) BUSNESiH-IONE +zs BUSNESSR-IONE tz5 866-845-4254 8oo-23t-0623 24HOURRiONE +2s 24HOURFi-IONE +~ Ct12VfOn InfOmiation COntCi 80Q231-0623 Chevron Emergency Information Center Boo-23i-o623 SAGER# +27 PAGER# +a2 ADDITIONALLOCALLY COLLECTED INRJRMATION: Ca6firdion :Bated on my inquiry of tense indviduals rsponsbleforobtenirg theinformdion, I oatify under pe>i!ty of IaN the I haepasondly ecanined aW anfaniliawiththeinformgionsibmittedaldbAieretheinform3ionistruQaxur3e; a~doompl6e GNATURE OF ONM62IOPERATOR OR DESIGNATED R~RESBJTATIVE DATE +aa NAME OF DOCUMENT PR~ARFR +~ C rPro~&acGs C~ry/fRi~+r~ SAQery ~R.~.S 311/2006 Rldlard S. Allen, R.E.H.S. NAME OF SIGN62 (pri irt) 136 TITLE OF SIGN9t +37 Chevron Products CompanylRichard S. Allen, R.E.H.S. Retail HESSpecialist ~~~ ~ UR'3= (1/99) ~ ` O~ OES Ibrfn 273, ~r, 1 ~~ l'/ ~~n~ ~(\" 4 ` ~-' //~ ~ ~} "J ~ . ~ "~ 5 ~~~ ~Ig~ ~ 2006 eanni.Loven 98109 Slte Ma~cPdf .,..~~~.~~~~.e .~...~.,_~~.~ .~.... .k.~,.u~.~~~M.~._ ~_..~...,.~Page 1"l N ~ I ~ ~ ~ - I RiDB. I ® I Sfi[ DAi/, ~_-.-__. __ _.~ 1 / ~ ~" roiro~ro~roi ~ 'I I(.~I I{.~I I{.~I I{.~I I II II 11 I a I I I II II I 9 W l&J I~1 l'~1 t~J ~ zl I I ; ~~~ __ __ az I e~ ~ I I 1~~T_ ~ ~ I aa~. - - olr, !~I I I -----" ~~ } I I vl I ' ,~ I I I ~ I I I ' l Iy ;; r I I ~ ~® ~ 7 ~ I e4- ° j ° `°"~"' '°jP A I b`°` 6RDUND b CRADE RUN o R... I puma w.na ~-na Yt W YRT ~ p6/OYU ~H RN~11tW, G Q ClMlgl DAIS STRE;;1' ~ ~JJeanrn;Coven " 98109 HMBP pdf ~ Page 9 EMERGENCY RESPONSE PROCEDURES GASOLINE and CARBON DIOXIDE FIRE OR EXPLOSION DATA Carbon dioxide is not flammable. CAUTION: Compressed Gas Cylinder may explode in heat of fire. HEALTH HAZARD CAUTION: 1. Vapors may cause d~irless or suffocation. 2. Contact with liquid carbon dioxide may cause frostbite. In the event of a fire, spell, leak, or suspected leak in the tanks, piping, or cylinder, or natural dksasters such as an earthquake or flood, the following steps are to be taken as applicable 1. TURN OFF PUMPS using khe Emergency Pump Shut-0ff Switch. 2. EVACUATION : If there is any immediate danger, ANNOUNCE to all persons on the site: 'There is an emergency. Please tum off your engines and leave the station on foot immediately." 3., CALL FOR HELP incase of an emergency by dialing 9-~ -~ and giving the fdlowing information: 'THERE IS A FIRE /GASOLINE SPILL at the station (1131 Oak St, Bakersfield )." If anyone is trapped or needs medical attention, kell the answering dispatcher . Stay on the phone and be prepared to answer any questions concerning the situation. 4. LOOK AROUND to asstre that all others have left the station if necessary, particularly those in vehicles who may need assistance or may r>ot have heard the emergency annoLm cement. Assist or direct assistance to, anyone having difficulty leaving the station area, and anyone who may be injured. 5. ATTEMPT TO EXTINGUISH any small or incipient fire if you can do so safely. Have the fire extinguisher ready to use in the event of any spill. Try to contain arty large spill, or use absorberrt on smaller spills. 6. REPORT to arriving erergency response personnel to provi de them with any information or assistance they might need using the Hazardous Materials Business PIaNEmergency Response Procedures. 7. CONTACT the station Operator if s/he is riot already at the station. Use the list below for emergency contacts: Station Manager 8. NOTIFY Chevron Maintenance-Solt' a One by phone WITHIN 24 HOURS 1-866-845254 or CHEVRON EMERGENCY INFORMATION CENTER 1500-231-0623 Chevron will notify the appropriate State and Local agences unless the situation requires uroent immedate response by the agencies , in which case the OPERATOR shoud notify these agencies: 1. LOCAL UST AGENCY :Bakersfield City Fire Department / (661) 326-3979 2. CALIFORNIA OFFICE OF EMERGENCY SERVICES (24 Hours),80x852-7550 3. NATIONAL RESPONSE CENTER (24 Hours), 800424-8802 9. Operator should attempt to isolate leak location by inspection. 10. Chevron will coordinate whatever crorrective action s need to be taken beyond the Operators capal~lities. Chevron will file whatever reports need to be filed with local arld state agencies, and send a cgpy to the station for the Operator's files. 11. EVACUATION: In the event evacuation is necessary, the attendant will announce for all customers and personnel to evacuate the building using the nearest exit door. All persons should go to the emergency assembly area as designated on the site map. Bring the Hazardous Materials Business PlanlEmergency Response Procedures to assist emergency responders. 12. RE-ENTRY : If evacuation has Occuned aril emergency resporxle rs have been called, re~rrtering this facility should take place with exkreme caution and ordy under the direction of the senior enlerc~ency responder on site and Chevron personnel. THESE ENOGRGENCY RESPONSE PROCEDURES MUST BE POSTED CONSPICUOUSLY ON SRE ALONG WITH THE ATTACHED SITE PLAN URA (1/99) OES Fonn 2731 Jeannioven~-~ 98109-HMBP Qdf ~~~~~~~ ~~~ ~ ~ ~f~~~~ ~~~ Page10~~ SITE SPECIFIC EMERGENCY RESPONSE TRAINING PLAN Employees must be given this training before starting work, and refresher causes must be provided annually. Records must be kept to show when each station employee has been given his/her safety training. Use the folkwving outline and make copies as needed. Have employee date and sign this document upon completion of training. Retain these records for a minimum of three years. I. FIRST THINGS TO IQ~+IOW: A EMERGENCY PUMP SHUT-0FF: This toms off the turbine pumps that provide flow to the dispensers from the turdergroruxi tanks. Incase of a leak, shutting off the pumps will help to prevent spills. LOCATION: 1-CASHIER AREA. 1-0UTSIDE BUILDING. 1- DISPENSER ISLAND B. ELECTRICAL PANEL: The panel allows you to selectively cut off power to IigMs, signs, pumps, etc. The main switch kills all power at the site. LOCATION: BACKROOM OF STORE C. WATER SHUT-0FF: The water shut-0ff may be necessary in some cases. LOCATION: LANDSCAPE AREA ON MAIN D. NATURAL GAS SHUT-OFF : If your station has natural gas, it maybe necessary to shut-0ff the natural gas flow in an errrergency. LOCATION: NONE E. FIRST AID KIT: LOCATION: BACKROOM OF STORE F. FIRE EXTINGUISHER :Use Drily on small fires that you can handle. Do not attempt to extingr.ish large fires on your own; call 9-1-1 for help. LOCATION: 1-AT~CASHIER AREA 1- BACKROOM OF STORE G. SPILL RESPONSE KIT: Use FM-186 in accordance to manufactures n~ommendatiors. FM-186 is to be used to immediately dean up small Gasoline and Diesel spills. Incase of large spill, merely try to contain it; a vaa,nrm truck should be used to dean up any large spills. LOCATION: BACKROOM OF STORE H. EMERGENCY EVACUATION AND ASSEMBLY AREA: LOCATION: EAST SIDE OF BUILDING ON MAIN I. NEAREST MEDICAL FACILITY: Employees should know what facilities are available in case customers or other employees need medical attention. Mercy Hospital (661) 632-5275 (661) 632-5000 (661) 632-5279 2215 Truxtun Ave Bakersfield, CA 93301 0.7 m i N E UF>rF (1/99) OES Farm 2731 Jeanrn ~Loven - 98109 HMBPupdf ~,.,~, ...,,._~.....~. ._b,.,~,.,.,~.~ . ~ .,~.._.__,,aw~.,...~._.,~.,n.m.~_z..~.~,~.._~.~~..,m~.,,.Page 11 II. All employees should review the Service Station Monitoring Plan, of which this training plan is a part. Specifically, each employee should understand the procedures to be used in responding to various kinds of emergencies, and know how to monitor for leaks of hazardous materials. As a supplement to this package, employees shoud also review the Emergency Response Plan filed by your business to the appropriate local agency. Thirdly, employees should review and have access to the Materials Safety Data Sheets you have on file for each of the hazardous nrdterials scored at the station and must be drilled in all emergerxy response procedures contained herein. III. FIRST AID PROCEDURES for EXPOSURE TO GASOLINE AND DIESEL FUEL A EYE CONTACT: Flush with water for 15 minutes while hddi ng eyelids open. Get medical attention. B. SIdN CONTACT: Flush with water whle removing contaminated clothing and shoes. Follow by washing with soap and water. Do not reuse clothing or shoe s until Leaned. If irritation persists, get medical attention. C. INHALATION (Breathing}: Remove victim to fresh air and provide oxygen ff tx~eathing is d'~cult. If not breathing, give artificial respiration. Get medical attention. D. INGESTION (Swallowinal: DO NOT INDUCE VOMITING BECAUSE GASOLINE CAN ENTER LUNGS AND CAUSE SEVERE LUNG DAMAGE! If vomiting occurs spontaneously keep head below hips to prevent aspiration of liquid into lungs. Get medical attention. E. NOTE TO PHYSICIAN: if more than 2.0 ml per kg has been ingested and vomiting has not occuned, emesis should be induced with medical supervision. Keep victim's head below hips to prevent aspiration. If symptoms such as loss of gag reflex, cornWsi ores or uncamsciousne ss occur before emesis, gastric lavage using a cuffed erx~tracheal tube should be cxnsidered. F. For further information, consult the Materials Safety Data Sheets for these products and for other hazardous materials. FIRST AID FOR EXPOSI~RE TO OTHER MATERIALS: Consult the waming advice on container labels or refer to the MSDS for that product. ANNUAL CLASSROOM EMPLOYEE TRAINING TOPICS Hazwoper Hazard Communication LodcoutlTagout California Impact Valve ,& Nozzle Operation Fire Safety Safety Orientation SB 1981njury Illness & Prevention Program Emergency Response & Spill Cleanup Procedures Robbery Prevention System Alcohol and Tobacco Awareness Document prepared by: Chevron Products Company/Richard S.Allen, R.E.H.S., Retail HES Specialist UFCF (1/99) OES Form 2731 Jeanni ;Coven , 98109 HMBP pdf ~ ~~~~~~~~~~ ~~„~ ~ #~ ~~ ~ ~ Page 12 Hazardous Materials Business Plan/Emergency Response Employee Training Log BUSINESS NAME: Chevron Stations, Inc. #98109 ADDRESS: 1131 Oak St, Bakersfield, CA 93304 Em to es must si n this rrri to rove the received their INRIAL and/or ANNUAL Emer en Re once Tr inin EMPLOYEE SIGNATURE DATE OF TYPE OF TRAINING EMPLOYEE NAME TRAINING Initial or Annual Refresher UFCF (1199) OES Form 2731 ~~ i 3~ 2~ ai ~~~+~, °~ ~° o~ y ~ ~j~ a~-~~ ~~ ~02- r '~ ,,. .• , ~;~~