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Home My WebLink AboutBUSINESS PLAN 7/12/2007--- 1, .. ,---- - - -- -- -- - - - -- ~~ 7-ELEVEN 16329 1701 PACHECO RD _. l ~~ ~~ i ~ ~ - _ - ~r Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST B t: R s F , 0 900'IYtixtun Ave.; suite 210 FIRE Bakersfield, CA 93301 SECTION 1: Business-Plan and Inventory Program ° aRrM Tel.: (661) 326-3979 • ~ Fax: (661) 872-2171 FACILITY NAME ~ ~ ~ 3 INSPE TIO DATE INSPECTION TIME ~~t ~lao•7 ADDRESS PHONE NO. NO OF EMP OYEES FACILITY CONTACT BUSINESS ID NUMBER 15-021- 0 ~ Section 1: Business Plan and Inventory Program _ _ _ r._- _ ____ ^ ROUTINE ~OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (C=Compiiance~ OPERATION V=Violation COMMENTS ~ APPROPRIATE PERMIT ON HAND BUSIf1eSS 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 HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES f YJ ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUEST/II~NS RE~AI~ING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1" In /Shift of Site/Station # White -Prevention Services _ Yellow -Station Copy ^ YES ~NO Business Site / Responsibl Pink -Business Copy FD 2155 (Rev. 09/05 :?' :~ INSPECTIONS B E R S F f L D BUSINESS PLAN & ~RrM r INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: ''7-!~ Section 2: Underground Storage Tanks Program INSPECTION DATE: 7 rod b ^ Routine ~ombined ^ Joint Agency ^ Multi-Agency ^ Complaint ^ Re-Inspection Type of Tank 1~1,_tilF('S Number of Tanks Type of Monitoring ~Gi~ Type of Piping QW j= OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? ^ Yes Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank Aggregate Capacity Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill /overspill protection? C =Compliance V =Violation Y =Yes N = No Inspector: Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services Pink -Business Copy 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 ~.`~. KBF-7335 FD 2156 (Rev. 09/05) _, ~; 7-ELEVEN 16329 (PACHECO) Manager SHINDA UPPLE Location: 1701 PACHECO RD City BAKERSFIELD SiteID: 015-021-000807 BusPhone: (661) 834-1350 Map 124 CommHaz Moderate Grid: 19A FacUnits: 1 AOV: CommCode: BFD STA 05 EPA Numb: CAL000274227 SIC Code:5541 DunnBrad:00-734-7602 Emergency Contact / Title Emergency Contact / Title SHINDA UP PLE / FRANCHISEE DISPATCH I / Business Phone: (661) 834-1350x Business Phone: (800) 828-0711x 24-Hour Phone (800) 845-0031x 24-Hour Phone (800) 828-0711x Pager Phone (661) 303-6711x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact RANDY MARTIN Phone: (253) 796-7170x MailAddr: PO BOX 711 State: TX City DALLAS Zip 75221-0711 Owner 7-ELEVEN INC Phone: (253) 796-7170x Address PO BOX 711 State: TX City DALLAS Zip 75221-0711 Period -~ to TotalASTs: = Gal Preparers ` - - -- _ TotalUSTs: ~ = iU,odc~ Gal Certif' d: ~ RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG U - UST Based on my inquiry of those individuals. responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and belie~~ the information is true, accurate, and co . ete _ I t Si ~~ ~_7 gna ure Da e ~N~°D AU G 2 0 Zf~~: -1- 06/29/2007 F 7-ELEVEN 16329 (PACHECO) SiteID: 015-021-000807 ~ ~TORACF. CONTATNF.R T~ATA fiJST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7-ELEVEN 16329 (PACHECO) Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper IAN MOORELAND ICC Nbr: 5250115-UC PROPERTY OWNER INFORMATION Name : -D3TS~Pm I ~/- ~ (~,li._e,,~ plirtC~ -S`6~6~ 8~-8~-7-1~ Phone : ( Address : {~ D ~ ~d~}L '~//- C c~a L~iti-~- Ce,C'-~~`~" ~ 3 '7Rly - 71 ~ O City StateiT-}C Zip: 7~~a/-d? r~ Type CORPORATI ON TANK OW N ER INFORMATION Name ~ " '7-~~ ~ivr lC , Phone : (-8-88-)-828-73-3-~- Addres s : /? p . ,t~~C '7// - ~ c~a 1.~.~ Q~~ -°~-- a53 - '74 Co - -t t ~ a City ~~Q~ StateT~ Zip : 7~~~ / _ d 7 ~ ~ Type CORPORATI ON BOE UST Fee# 31896 Financ'1 Resp: INSURANCE Legal Notif _ _~ ~ _ n v Date:03/28/2006 Phone: --(-3~5} - Name:RANDY MARTIN Tt1:GASOLINE & ENVIRON COMPLIANCE MGR State UST # 1998 Upg Cert#: -2- 06/29/2007 F 7-ELEVEN 16329 (PACHECO) SiteID: 015-021-000807 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod MIDGRADE UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod SUPER UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod CARBON DIOXIDE F P IH G 1275.00 FT3 Min WASTE FLANIMABLE LIQUIDS/SOLVENT F DH L 55.00 GAL UnR WASTE ABSORBANT F IH S 55.00 GAL UnR -3- 06/29/2007 r -4- o6/a9/aoo~ F 7-ELEVEN 16329 (PACHECO) ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Location within this Facility Unit UNDERGROUND FRONT PARKING STATE TYPE PRESSURE Liquid TMixture Ambient SiteID: 015-021-000807 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE ~~ CONTAINER TYPE Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 10000.00 GAL 10000.00 GAL 7500.00 GAL riHGHKLVUS wl~lrc~lvr:lvl~ %Wt. RS CAS# 100.00 Gasoline No 8006619 riEiLGf~tCL H.75L' ~51~11~J1V 1 ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME MIDGRADE UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 7500.00 GAL ruyc~rucLV V ~ ~.vrlrvtvlJty t S %Wt. RS CAS# 100.00 Gasoline No 8006619 nr~c,r~L s-~J Jr~a.71•lr~ly 1 a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 06/29/2007 F 7-ELEVEN 16329 (PACHECO) SiteID: 015-021-000807 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME SUPER UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 7500.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Gasoline No 8006619 nrjc,rucL riJJr,JJl~iriv t J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 124-38-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE ~~a.-s~(~c~~~ TPure ~-Above Ambient Cryogenic INSUL .TANK / CRYOGENIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 4~--T-~- X60 ~b s ~5--~e-~-~ aoo ~ s 3 HAZARDOUS COMPONENTS , oWt. 100.00 Carbon Dioxide RSI CAS# No 124389 L31iLitiiCL LiJ J1=,J J1"1P~LV1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -6- 06/29/2007 ' F 7-ELEVEN 16329 (PACHECO) SiteID: 015-021-000807 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE FLAMMABLE LIQUIDS/SOLVENT Days On Site 365 Location within this Facility Unit Map: Grid: ~, NEAR TRASH ENCLOSURE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste Ambient ~ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No tit~c~titcL s-~J Jr,Jarl~iv i J TSecret RS BioHaz RadioactivejAmount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / UnR ~ Inventory Item 0006 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE ABSORBANT Days On Site 365 Location within this Facility Unit Map: Grid: NEAR TRASH ENCLOSURE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Solid Waste Ambient ~ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL_ 55.00 GAL 25.00 GAL nr~c~rucLVUa ~.vl~lrvivl_,lv1a ~Wt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No I1t~Gtii'CL HJ w7P~~7J1~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / UnR -7- 06/29/2007 F 7-ELEVEN 16329 (PACHECO) SiteID: 015-021-000807 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 02/27/2007 ~ AFTER CALL 911, THE BAKERSFIELD CITY FIRE DEPT WILL BE NOTIFIED ALONG WITH THE CALIFORNIA STATE OFFICE OF EMERGENCY SERVICES 800-852-7550. Employee Notif./Evacuation 02/27/2007 THE STORE ATTENDANT WILL NOTIFY OTHER EMPLOYEES AND CUSTOMERS BY A SHOUT THAT THE BLDG MUST BE EVACUATED. ALL PERSONS MUST EVACUATE THROUGH THE FRONT DOORS TO THE EVACUATION STAGING AREA SHOWN ON THE FACILITY DIAGRAM. Public Notif./Evacuation 02/27/2007 THE STORE ATTENDANT WILL NOTIFY OTHER EMPLOYEES AND CUSTOMERS BY A SHOUT THAT THE BLDG MUST BE EVACUATED. ALL PERSONS MUST EVACUATE THROUGH THE FRONT DOORS TO THE EVACUATION STAGING AREA SHOWN ON THE FACILITY DIAGRAM. Emergency Medical Plan 10/21/1998 POLICE AND FIRE DEPT OR NEAREST ER IS TO BE USED IN THE EVENT OF INJURY. -8- 06/29/2007 F 7-ELEVEN 16329 (PACHECO) SiteID: 015-021-000807 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 02/27/2007 ~ EMERGENCY FUEL SHUT-OFF SWITCHES ARE LOCATED IN THE FRONT OF THE STORE AND NEAR THE STORE COUNTER. THE UNDERGROUND STORAGE TANKS ARE EQUIPPED WITH OVERFILL/OVERSPILL PROTECTION. TANK FLUID LEVELS AND INTERSTITIAL SPACE ARE MONITORED BY A VEEDER ROOT TLS350 MONITORING SYSTEM. TANK TURBINES ARE EQUIPPED WITH LEAK DETECTORS WHICH RESTRICT FLOW IF A LEAK IS DETECTED BENEATH DISPENSERS OR ALONG PIPING RUNS. Release Containment 02/27/2007 ABSORBANT, LOCATED INSIDE THE STORE AT THE LOCATION SHOWN ON THE FACILITY DIAGRAM, IS TO BE USED FOR SMALL FUEL SPILLS (LESS THAN 5 GAL). THE BAKERSFIELD FIRE DEPT WILL RESPOND TO LARGER FUEL RELEASES BY PLACING SAND OR ABSORBANT ON THE SPILL. Clean Up 02/27/2007 ONCE A SPILL HAS BEEN CONTAINED, THE SAND OR ABSORBANT WILL BE CHARACTERIZED AND DISPOSED OF AT A PROPER DISPOSAL FACILITY. V 411C1 iCC~VUl I:G L'il:L1VGLL1V11 -9- 06/29/2007 F 7-ELEVEN 16329 (PACHECO) SiteID: 015-021-000807 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards 05/09/1995 ~ Utility Shut-Offs 04/25/2006 A) GAS - NE SIDE OF BLDG OUTSIDE B) ELCTRICAL - NE CRNR OF OFFICE C) WATER - STORE FRONT SIDE D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 07/18/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS IN STORE PER FIRE CODE. FIRE HYDRANT - NE CRNR OF LOT ON PACHECO & H ST. Building Occupancy Level 03/31/2006 6 EMPLOYEES -10- 06/29/2007 . . ., z= r F 7-ELEVEN 16329 (PACHECO) SiteID: 015-021-000807 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/27/2007 ~ MATERIAL SAFETY DATA SHEETS ON FILE BEHIND STORE COUNTER. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED ON THE OPERATION OF THE UST IN A MANNER CONSISTENT WITH BEST MANAGEMENT PRACTICES, EMERGENCY CONTACT INFORMATION, SPILL/OVERFILL RESPONSE PROCEDURES, HAZ WASTE PROCEDURES, MONITORING EQUIPMENT OPERATION AND ALARM RESPONSE PROCEDURES. TRAINING IS CONDUCTED ANNUALLY, OR WITHIN 30 DAYS FOR NEW EMPLOYEES, BY THE DESIGNATED OPERATOR. rays ~ nciu iui ru~.uie use ne.i.u iui ruLUie use -11- 06/29/2007 ,r + 7-ELEVEN 2125-16329 _________________________________ SiteID: 015-021-000807 + Manager Location: 1701 PACHECO RD City BAKERSFIELD CommCode: BFD STA 05 EPA Numb: BusPhone: (661) 834-1350 Map 124 CommHaz Moderate Grid: 19A FacUnits: 1 AOV: SIC Code:5541 DunnBrad:00-734-7602 Emergency Contact / Title Emergency Contact / Title SHINDA UPPLE / FRANCHISEE DAVID LISAC / FIELD CONSULT Business Phone: (661) 834-1350x Business Phone: (661) 303-4720x 24-Hour Phone (800) 845-0031x 24-Hour Phone (800) 845-0031x Pager Phone (661) 303-6711x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact JUDY SOPER Phone: (858) 715-2772x MailAddr: PO BOX 711 State: TX City DALLAS Zip 75221 Owner 7-ELEVEN INC Phone: (858) 715-2772x Address PO BOX 711 State: TX City DALLAS Zip 75221 Period to Preparers Certif~d: ParcelNo: TotalASTs: _ TotalUSTs: _ RSs: No Gal Gal Emergency Directives: PROG A - HAZMAT PROG U ~ UST A ~~ i 1 ~'w s~'~~~~ o~~ ~ ~,~°°. ~ 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 " 'E' Sign a Date J~( 18 X06 -1- 03/31/2006 ,~ .~; ~: ELEYE(1 S. Letter of Transmittal Date: May 23, 2006 Attention: Mr. Steve Underwood Company: City of Bakersfield Fire Dept. Address: 900Truxton, Suite 210 Bakersfield, CA 93301 RE: 7-Eleven #16329 1701 Pacheco Rd. Bakersfield, CA Enclosed are: ^ Business Plan ^ Business Activities ^ Business Owner/Operator Identification ^ Hazardous Materials Chemical Inventory ^ Underground Storage Tank -Facility ® Underground Storage Tank -Tank ^ Emergency Response Plan ^ Written Monitoring Procedures ^ Site Map ^ Owner/Operator Agreement ^ Test Results - ^ Other: Comments: To correct grade type from Midgrade to Regular on Tank #2 Shane Partridge Gasoline & Environmental Compliance Manager 702-270-7160 L Rachel Rodriguez Sr. Administrative Assistant 503-977-7745 ;~ UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) Page _ of _ TYPE OF ACTION ^ 1 NEW SITE PERMIT ^ 4 AMENDED PERMIT ®5 CHANGE OF INFORMATION ^ 6 TEMPORARY SITE CLOSURE (Check one item only) ^ 7 PERMANENTLY CLOSED ON SITE ^ 3 RENEWAL PERMIT (Specify reason-for local use only) (Specify reason -for lopl use only) ^ 8 TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) FACILITY ID: ~ 3 7-Eleven #16329 LOCATION WITHIN SITE (Optional) 43f 1701 Pacheco Rd., Bakersfield, CA I. TANK DESCRIPTION /A~scaled plot plan with the loeati'on of the UST. system including buildings aril landmarks'sh"all besubmitted~~to=tlie local aenc.., ~,_, TANK ID # ~ asz TANK MANUFACTURER a33 COMPARTMENTALIZED TANK ^ Yes ®No a3a 2 Joor If "Yes", complete one page for each compartment. DATE INSTALLED (YEAR/MO) a3s TANK CAPACITY IN GALLONS a3s NUMBER OF COMPARTMENTS a37 4/1985 10,000 ADDITIONAL DESCRIPTION (For local use only) 438 ~,. It:TAN,K CONTEN;'TS' - - - TANK USE 439 PETROLEUM TYPE aao ® 1. MOTOR VEHICLE FUEL ®1a. REGULAR UNLEADED ^ 2. LEADED ^ 5. JET FUEL (If marked complete Petroleum Type) ^ 1b. PREMIUM UNLEADED ^ 3. DIESEL ^ 6. AVIATION FUEL ^ 2. NON-FUEL PETROLEUM ^ 1c. MIDGRADE UNLEADED ^ 4. GASOHOL ^ 99. OTHER ^ 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) aaf CAS# (from Hazardous Materials Inventory page) 442 ^ 4. HAZARDOUS WASTE Gasoline (Includes Used Oil) ^ 95. UNKNOWN ~' " IIL TANK CONSTRUCTION ` e~ y. _, TYPE OF TANK ^ 1. SINGLE WALL ^ 3. SINGLE WALL WITH ^ 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER ^95. UNKNOWN ® 2. DOUBLE WALL ^ 4. SIGNLE WALL IN VAULT ^ 99. OTHER TANK MATERIAL -primary tank ®1. BARE STEEL ^ 3. FIBERGLASS /PLASTIC ^ 5. CONCRETE ^ 95. UNKNOWN 444 (Check one item only) ^ 2. STAINLESS STEEL ^ 4. STEEL CLAD W/FIBERGLASS ^ 8. FRP COMPATIBLE W/ ^ 99. OTHER REINFORCED PLASTIC (FRP) 100% METHANOL TANK MATERIAL -secondary tank ^ 1. BARE STEEL ®3. FIBERGLASS /PLASTIC ^ 5. CONCRETE ^ 95. UNKNOWN 4a5 (Check one item only) ^ 2. STAINLESS STEEL ^ 4. STEEL CLAD W/FIBERGLASS ^ 8. FRP COMPATIBLE ^ 99. OTHER REINFORCED PLASTIC (FRP) W/100% METHANOL ^ 5. CONCRETE ^ 10. COATED STEEL TANK INTERIOR LINING ^ 1. RUBBER LINED ^ 3. EPOXY LINING ^ 5. GLASS LINING ^ 95. UNKNOWN 4as DATE INSTALLED 447 OR COATING ^ 2 ALKYD LINING ^ 4 PHENOLIC LINING ^ 6 UNLINED ^ 99 OTHER (Check one item only) (For local use only) OTHER CORROSION ^ 1 MANUFACTURED CATHODIC ^ 3 FIBERGLASS REINFORCED PLASTIC ^ 95 UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION ^ 4 IMPRESSED CURRENT ^ 99 OTHER (Check one item only) ^ 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE Qocal use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 ®1 SPILL CONTAINMENT 2004 t hat apply) ^ 1 ALARM ®3 FILL TUBE SHUT OFF VALVE ®2 DROP TUBE 2004 ^ 2 BALL FLOAT ^ 4 EXEMPT ®3 STRIKER PLATE 1997 2004 IV. TANKIEAK DETECTION (A description of the morntonng program'spall tie submitted to"the local agency:) ` ,- ~ .- ~~__ IF SINGLE WAL L TANK (Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER asa (Check one item only) ^ 1 VISUAL (EXPOSED PORTION ONLY) ^ 5 MANUAL TANK GAUGING (MTG) ~ ^ 1 VISUAL (SINGLE WALL IN VAULT ONLY) ^ 2 AUTOMATIC TANK GAUGING (ATG) ^ 6 VADOSE ZONE ®2 CONTINUOUS INTERSTITIAL MONITORING ^ 3 CONTINUOUS ATG ^ 7 GROUNDWATER ^ 3 MANUAL MONITORING ^ 4 STATISTICAL INVENTORY RECONCILIATION ^ 8 TANK TESTING + (SIR) BIENNIAL TANK TESTING ^ 99 OTHER >IV; TANK.CLOSURE•INFORMATION / PERMQNENT° CLOSURE IN PLACE ". ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 456 REMAINING TANK FILLED WITH INERT MATERIAL? a57 gallons ^ Yes ^ No UPCF (1/99 revised) Formerly SWRCB Form B _` UNIFIED PROGRAM CONSOLIDATED FORM TAN K UNDERGROUND STORAGE TANKS -TANK PAGE 2 ., ,; ~ , ~..~ _,,.~~ Page - of VL~PIPING CONSTRUCTION (Check au that apply) UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ^ 1. PRESSURE ^ 2. SUCTION ^ 3, GRAVITY 458 ^ 1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 459 CONSTRUCTION I ®1. SINGLE WALL ^ 3. LINED TRENCH ^ 99.OTHER 460 ^ 1. SINGLE WALL ^ 95. UNKNOWN 462 MANUFACTURER ^ 2. DOUBLE WALL ^ 95. UNKNOWN ^ 2. DOUBLE WALL ^ 99.OTHER MANUFACTURER 461 MANUFACTURER a63 ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE w/100% METHANOL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ UKNOWN ^ 3. PLASTIC COMPATIBLE W/CONTENTS ^ 99. OTHER ® 4. FIBERGLASS ^ 8. FLEXIBLE (HDPE) ^ 5. STEEL W/COATING ^ 9. CATHODIC PROTECTION 464 .VII. PIPINGsLEAK_DETEGTION ~:cbec:authatapply),(Adescri SINGLE WALL PIPING ass PRESSURIZED PIPING(Checkall that apply): ® 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS. ^ 2. MONTHLY 0.2 GPH TEST ® 3. ANNUAL INTEGRITY TEST (O.1GPH) CONVENTIONAL SUCTION SYSTEMS ^ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): ^ 7. SELF MONITORING GRAVITY FLOW ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^c. NO AUTO PUMP SHUT OFF ^ 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUTOFF OR RESTRICTION ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTIONIGRAVITY SYSTEM ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF +AUDIBLE AND VISUAL ALARMS ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION ^ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 17. DAILY VISUAL CHECK _ . VIII. DISPEI DISPENSER CONTAINMENT DATE INSTALLED 1997 Shane Partrid ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE wnoo/METHANOL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ 3. PLASTIC COMPATIBLE W/CONTENTS ^ 8. FLEXIBLE (HDPE) ^ 99. OTHER ^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION ^ 5. STEEL W/COATING ^ 95. UNKNOWN ass pUon of the monitq'ring N .,,,r n shall be submitted to (he local agency ) ABOVEGROUND PIPING SINGLE WALL PIPING as7 PRESSURIZED PIPING (Check all that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION +AUDIBLE AND VISUAL ALARMS. ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1GPH) ^ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply) ^ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ 6. TRIENNIAL INTEGRITY TEST (0. f GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVITY FLOW (Check all that apply): ^ 8. DAILY VISUAL MONITORING ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ^ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^c NO AUTO PUMP SHUT OFF ^ 11. AUTOMATIC LEAK DETECTOR ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM ^ i3. CONTINUOUS SUMP SENSOR+AUDIBLE'ANDVISUALALARMS EMERGENCY GENERATORS ONLY (Check all that apply) ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF +AUDIBLE AND VISUAL ALARMS ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) ^ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 17. DAILY VISUAL CHECK ;ONTAINMENT ^ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ 4. DAILY VISUAL CHECK asa ®2. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LINER I MONITORING ^ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + ^ 6. NONE nnniQi a eninvienni AI AD~dC IX. OWNER/OPERATOR SIGNATURE "'; -, provi herein is true and accurate to the best of my knowledge. ~~ TOR DATE ,a3_~~ PRAT rint) TITLE OF OWNER/OPERATOR 3 Gasoline & Environmental Com liance Mana er use only) 473 Pernut Approved (For local use only) Permit Expiration Date (For local use only) 475 469 a72 UPCF (1/99 revised) Formerly SWRCB Form B ~. ELEYEt1 ~' Letter of Transmittal Date: May, 2006 Attention: Hazardous Materials Division Company: City of Bakersfield Fire Dept. Address: 900 Truton Ave., Suite 210 Bakersfield, CA 93301 RE: ~7=Eleven-#1:63299,-170=1=P-acheco-Rd~ 7-Eleven #16549, 4647 Wilson Rd. 7-Eleven #17721, 3601 Stockdale Hwy 7-Eleven #32241, 4101 Calloway Dr. 7-Eleven #32376, 9600 Brimhall Rd. Enclosed are: ^ Business Plan ^ Business Activities ^ Business Owner/Operator Identification ^ Hazardous Materials Chemical Inventory ® Underground Storage Tank -Facility ^ Underground Storage Tank -Tank ^ Emergency Response Plan ^ Written Monitoring Procedures ^ Site Map ^ Owner/Operator Agreement ^ Test Results - ® Other: Financial Responsibility Comments: Shane Partridge Gasoline & Environmental Compliance Manager 702-270-7160 f Rachel Rodriguez Sr. Administrative Assist t 503-977-7745 4 sE~~v.~~,~. thy., State of Califomia For State Use Only o ~ _ State of Water Resources Control Board ~'4t~ w Division of Clean Water Programs - ~~,:. P.O. Box 944212 - ~,,,,,w„,. Sacramento, CA 94244-2120 (Instructions on reverse side) CERTIFICATION 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: 500,000 dollars per occurrence ~ 1 million dollars annual aggregate or AND or ® 2 million dollars per occurrence ® 2 million dollars annual aggregate B. 7-Eleven. InC. hereby certifies that it is in compliance with the requirements of Section 2807, (Name of Tank Owner or Operator) 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 T e Name and Address of Issuer Number Amount Period: Action. Com Liability Insurance Illinois Union Insurance Co. $2,000,000 per c/o ACE Environmental Risk UST G2379486A Occurrence & 4/30!2006 436 Walnut Street 001 $2,000,000 to Yes Yes Philadelphia, PA 19106 Annual 4/30/2007 Aggregate 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 certifiies that you are in compliance with all conditions for participation in the Fund. D. Facility Name Facility Address 7-Eleven #16329 1701 Pacheco Rd., Bakersfield, CA Facility Name Facility Address 7-Eleven #16549 4647 Wilson Rd., Bakersfield, CA Facility Name Facility Address 7-Eleven #17721 3601 Stockdale Hwy, Bakersfield, CA E. ign lure of Tan O er or Operator Date Name and Title of Tank Owner or Operator ~-/~ /p~ Shane Partridge-Gasoline & Environmental ( Compliance Manager ' nature of Witnes r Notary Date Name of Witness or Notary 5'a(v D(~ Rachel Rodri uez CFR (Revised 04/95) U ~ FILE: Original -Local Agency Copies -Facility/Site(s) SE ~~°~~~ ;UHF State of California .For State Use Only ~`: ~.°; State of Water Resources Control Board ~' Division of Clean Water Programs ;o;:. P.O. Box 944212 ~~IiFOPN~P Sacramento, CA 94244-2120 (Instructions on reverse side) CERTIFICATION 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: 500,000 dollars per occurrence ~ 1 million dollars annual aggregate or AND or ® 1 million dollars per occurrence ® 2 million dollars annual aggregate B. 7-Eleven, InC. hereby certifies that it is in compliance with the requirements of Section 2807, (Name of Tank Owner or Operator) 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 T e Name and Address of Issuer Number Amount Period Action Com Liability Insurance Illinois Union Insurance Co. UST G2379486A $2,000,000 per Occurrence & 4/30/2006 c/o ACE Environmental Risk 436 Walnut Street 001 $2,000,000 to Yes Yes Philadelphia, PA 19106 Annual 4/30/2007 Aggregate 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 7-Eleven #32241 4101 Calloway Dr., Bakersfield, CA Facility Name Facility Address 7-Eleven #32376 9600 Brimhall Rd., Bakersfield, CA Facility Name Facility Address E. ign ture of T nk O ner or Operator Date Name and Title of Tank Owner or Operator ~~~ l b~ Shane Partridge-Gasoline & Environmental C li omp ance Manager ignature of Witn or Notary Date Name of Witness or Notary ' c~v 5=o~~-z~ Rachel Rodri uez CFR (Revised 04/95) ~J FILE: Original -Local Agency Copies -Facility/Site(s) CERTIFICATION OF FINANCIAL RESPONSIBILITY 7-Eleven, Inc. (formerly known as The Southland Corporation) hereby certifies that it is in compliance with the requirements of Subpart H of 40 CFR part 280. The financial assurance mechanisms used to demonstrate financial responsibility under 40 CFR part 280 are as follows: Storage Tank Liability Insurance Policy No. UST G2379486A 001 issued by Illinois Union Insurance Company, effective April 30, 2006, tlu-ough Apri130, 2007, with a retroactive date of November 24, 2005, and covering underground storage tanks for taking corrective action and/or compensating third parties for bodily injury and property damage caused by accidental releases in the amount of TWO MILLION DOLLARS ($2,000,000) "per occurrence" and TWO MILLION DOLLARS ($2,000,000) "annual aggregate" as specified by 40 CFR §280.93; and To the extent of its eligibility, participation in various State fiends and State assurance programs as set forth in 40 CFR §280.101. 7-ELEV C. By: ~ . Name: Title: ~ Vice ~ esident Date: _~~t ~~ Zy0 ~O STATE OF TEXAS ) COUNTY OF DALLAS ) SUBSCRIBED AND SWORN TO BEFORE ME this ~~t day of , 2006. 'DIY Pc~ ~ ~ (.Ci ~~ :~'~ ~ ~`•.h ~ Mary B. Gamero No ary P is In and For Said County and *1 :~*j Notary Public, State of Texas State ~:~~. ;gip,: My Comm. Expires 01!20110 Qf 1~. j My Commission,Expires: ~ I ~ ~ ~~~ / .~7 516202.2/SP2/76088/0209/04280G UNIFIED PROGRAM CONSOLIDATED FORM TANKS - UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®S.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 ,, . . I. FACILITY / SITEJNFORMATION `' " BUSINESSNAME(Same as FACILITY NAME Or DBA-Doing Business AS) 3 'FACILITYID# 1 7-Eleven #16329 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* ® 1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aoa ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* ao2 TOTAL NUMBER OF TANKS Is facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ® No aos aos II. PROPERTY OWNER INFORMATION _:: ~~_ - -- PROPERTY OWNER NAME aos PHONE aoa Bobbie Stokes MAILING OR STREET ADDRESS aos 1348 Mentone Ave. # C CITY ago STATE aff ZIP CODE atz Grover Beach CA 93433 PROPERTY OWNER TYPE ^ 1. CORPORATION ®2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL at3 III. TANK OWNER INFORMATION TANK OWNER NAME ata PHONE ats 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS ass P.O. Box 711 Attn: Gasoline Acct CITY a» STATE afa ZIP CODE ats Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY iV.'BOARD OF'EQUALIZATION UST STORAGE`fEE"ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, " V. PETROLEUM UST FINANCIAL RESPONSIBILITY ~. s_ _ INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz VI. LEGAL NOTIFICATION ANl7 MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 VII. APPLICANT SIGNATURE - Certi Icatl - I certify t at t information provided herein is true and accurate to the best of my knowledge. SIG T E OF AP CAT DATE aza PHONE azs 5 26 D ~0 702-270-7160 NAM OF APPLICAN print) azs TITLE OF APPLICANT azs Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) aza 1998 UPGRADE CERTIFICATE NUMBER (For local use only) azs UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS - UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 L FACILITY_I SITE INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) 3 IFACI LITY ID# 7-Eleven #16549 1 NEAREST CROSS STREET ao1 FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT' 4647 Wilson Rd., Bakersfield ® 1. CORPORATION ^ 5. COUNTY AGENCY' BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY' TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER 403 ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* aoz TOTAL NUMBER OF TANKS IS facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos il. PROPERTY OWNERiNFORMATION PROPERTY OWNER NAME aos PHONE aoa 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS aos P.O. Box 711 Attn: Gasoline Acctg CITY a1o STATE all ZIP CODE a1z Dallas TX 75221-0711 PROPERTY OWNER TYPE ^ 1. CORPORATION ®2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL a13 - III. TANK OWNER`INFORMATION - TANK OWNER NAME a1a PHONE 415 7-Eleven, 'Inc. 702-270-7160 MAILING OR STREET ADDRESS a1s P.O. Box 711 Attn: Gasoline Acct CITY a1~ STATE a1a ZIP CODE a1s Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY IV. BOARD OF,.EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE ^ 1.SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz VL LEGAL NOTIFICATION AND-.MAILING ADDRESS. , Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER 423 VII. APPLICANT SIGNATURE'' Certifi do - certify th t the i formation provided herein is true and accurate to the best of my knowledge. SIGN T E OF AP L NT DATE aza PHONE azs ~Zb n b 702-270-7160 NAM F APPLICANT rint azs TITLE OF APPLICANT azs Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) azs 1998 UPGRADE CERTIFICATE NUMBER (For local use only) azs UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS - UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page of TYPE OF ACTION ^ t. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®S.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 L FACILITY /SITE INFORMATION ,~:,_. . - - BUSINESSNAME (Same as FACILITY NAME orDBA-Doing Business As) 3 FACILITYID# 7-Eleven #17721 t NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* ® 1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER ao3 ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* ao2 TOTAL NUMBER OF TANKS IS facility on Indian Reservation or *If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos °' IL' PROPERTY OWNER INFORMATION: - .' PROPERTY OWNER NAME aos PHONE aos 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS aos P.O. Box 711 Attn: Gasoline Acctg CITY ato STATE att ZIP CODE atz Dallas TX 75221-0711 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL ai3 III. TANK'OWNER INFORMATION TANK OWNER NAME ata PHONE ass 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS ais P.O. Box 711 Attn: Gasoline Acct CITY ate STATE ats ZIP CODE ats Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY IV.`BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, a, V. PETROLEUM UST FINANCIAL-RESPONSIBILITY INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD a22 VL LEGAL NOTIFICATION AND MAILING ADDRESS - Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 VII. APPLICANT SIGNATURE .. Certifica on I rtify that t e inf rmation provided herein is true and accurate to the best of my knowledge. SIGNA OF APPLI T DATE a2a PHONE a2s S ~Z-(~ n ~ 702-270-7160 NAME OF APPLICANT (p ) azs TITLE OF APPLICANT a2~ Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) ate 1998 UPGRADE CERTIFICATE NUMBER (For local use only> a2s UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS - UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 - I. FACILITY I'SITE INFORMATION -` _ ~, ,..... BUSINESSNAME(Same as FACILITY NAME or DBA-Doing BusinessAS) 3 -FACILITY ID#' 7-Eleven #32241 1 NEAREST CROSS STREET aoi FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 4101 Caflowa Dr ®1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aoa ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* aoz TOTAL NUMBER OF TANKS Is facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos II. PROPERTY OWNER INFORMATION PROPERTY OWNER NAME aos PHONE aoa WECI - 99 -3LLC 972-361-5000 MAILING OR STREET ADDRESS aos 15601 Dallas Parkwa ,Suite 40 CITY ato STATE a» ZIP CODE aiz Dallas TX 75001 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL at3 IIL TANK"OWNER INFORMATION ~ "~ TANK OWNER NAME aia PHONE 4t5 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS ais P.O. Box 711 Attn: Gasoline Acct CITY a» STATE ata ZIP CODE ais Dallas TX 7522 1-07 1 1 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY '" IV. BOARD OF EQUALIZATION UST STORAGEfEE ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Call (916) 322-9669 if questions arise azt V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE ^ 1.SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz ,.. VI. LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 VII. APPLICANT SIGNATURE Certificaf n - I ertify that t e inf mation provided herein is true and accurate to the best of my knowledge. SIGNA RE APPL C DATE aza PHONE azs ~ 1'~ b 702-270-7160 NAME PPLICANT (p ~ t) azs TITLE OF AP (CANT azs Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) aza 1998 UPGRADE CERTIFICATE NUMBER (For Ioca1 use only) azs UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS - UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®S.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4, AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 >. L. FACILITY / SITEJNFORMATION ~- ~,; ._ BUSINESSNAME(SameasFAC~uTYNAMEoro6A-DoingBus~nessAS) 3 -FACILITY ID#~ 1 7-Eleven #32376 NEAREST CROSS STREET aoi FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 9600 Brimhall Rd. ®1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aos ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* aaz TOTAL NUMBER OF TANKS Is facility on Indian Reservation or •If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the U5T (This is the contact person for the tank records.) 2 404 ^ Yes ® NO 405 406 II'. PROPERTY OWNER INFORMATION .:, ,. ,.~ PROPERTY OWNER NAME 407 PHONE aoe American West Lands Co. MAILING OR STREET ADDRESS aos P.O. Box 524 CITY 410 STATE 41 ZIP CODE atz Bakersfield CA 93302 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL ats ._III. TANK OWNER INFORMATION TANK OWNER NAME afa PHONE ats 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS ass P.O. Box 711 Attn: Gasoline Acct CITY an STATE a~a ZIP CODE ats Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY ., ; IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Cail 916 322-9669 if uestions arise 4zs _~., .-,:. V. PETROLEUM UST FINANCIAL RESPONSIBILITY°- INDICATE ^ 1.SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz .,a b VI. LEGAL NOTIFICATION AND MAILING ADDRESS _ _.e~ Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER azs VII. APPLICANT SIGNATURE - - Certificaf n - certify that th info ation provided herein is true and accurate to the best of my knowledge. SIGNA UR F APPLI DATE aza PHONE azs ~ 26 0(0 702-270-7160 NAME APPLICANT (prl ) 4zs TITLE OF APPL CANT az~ Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) aza 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 4zs UPCF (1/99 revised) Formerly SWRCB Form A r + 7-ELEVEN 2125-16329 _________________________________ SiteID: 015-021-000807 + Manager BusPhone: (661) 834-1350 Location: 1701 PACHECO RD Map 124 CommHaz Moderate City BAKERSFIELD Grid: 19A FaCUnits: 1 AOV: CommCode: BFD STA 05 SIC Code:5541 EPA Numb: DunnBrad:00-734-7602 Emergency Contact / Title Emergency ntact / Title SHINDA UPPLE / FRANCHISEE DAVID LISI'~ / FIELD CONSULT Business Phone: (661) 834-1350x Business Phone: (661) 303-4720x 24-Hour Phone (800) 845-0031x 24-Hour Phone (800) 845-0031x Pager Phone (661) 303-6711x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact j Shane Partridge Phone : ( 858 ) MailAddr: PO BOX 711 ---- - State: TX City DALLAS Zip 75221 Owner 7 -ELEVEN INC Phone : ( ~) -7-2x Address PO BOX 711 State: TX ~~~-~~~"~<<O~ City DALLAS Zip 75221 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: - Emergency Directives: ~ PROG A - HAZMAT PROG U - UST ~~ APR 25 2006 ~~°~~ Based on my inquiry of those individuals responsible for obtaining the information, I certify under perialty of law that I have personally examined and am familiar with the information submitted and believe the information is true, a te, and c ' te. ® yi~-D~ Si a Date -1- 03/31/2006 B E R S F I D F/RE ARTM T March 31, 2006 RONALD j. FRAZE ~ Mr. Judy Soper FIRE CHIEF ~ 7-Eleven 1701 Pacheco Road Gary Hutton, Senior Deputy Chief ~; Re: Failure to Perform /Submit Annual Fuel Monitor Certification Administration ~. ~ 1~OTICE OF VIOLATION & 326-3650 SCIIEDULE FOR COMPLIANCE Deputy Chief Dean Clason Operations/Training Dear Judy Soper, 326-3652 Our records indicate that your fuel monitor certifications is due/past due on Deputy Chief Kirk Blair 03-08-06. Fire Safety/Prevention Services 326-3653 You are or will be in violation of Section 2638(a) California Code of Regulations, i Title 23, Division 3, Chapter 16. 2101 "H" Street "All monitoring equipment shall be installed, calibrated, operated Bakersfield, CA 93301 and maintained in accordance with manufacturers instructions, and OFFICE: (661) 326-3941 certified every 12 months for operability, proper operating condition, FAX: (661) 852-2170 and proper calibration." i Therefore you have 30 days (April 27, 2006) to comply. Failure to comply may RALPH E. HUEY, DIRECTOR result in revocation of your Permit to Operate. PREVENTION SERVICES FIRE SAFETY SERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 ~~ ~ Should you have any questions, please feel free to contact me at 661- 326-3190. Bakersfield, CA 93301 OFFICE: (661) 326-3979 Sincerely yours, FAX: (661) 852-2171 ~' Ralph E. Huey, David Weirather Director of Prevention Services Fire Plans Examiner 326-3706 ! ~~ ~~~~~u~ ~ J ~ v "vv"~~ ~~ U HOward H. Wines, III ' By: Ste e nderwood -- Hazardous Materials Specialist Fire Prevention Officer 326-3649 REH/SU/db "Serving the Community For.~Vlore 2ranA Century" ,..:~ UNIFIED PROGRAM CONSOLIDATED FORM /~ TANKS ~ UNDERGROUND STORAGE TANKS -FACILITY I (one page per site) Page of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 I. FACILITY !SITE INFORMATION ~, ~, r. BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business AS) s FACILITY ID# t 7-Eleven #16329 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT' ® 1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4: PROCESSOR ^ 6. OTHER aos ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* aoz TOTAL NUMBER OF TANKS Is facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ® No aos aos II. PROPERTY OWNER INFORMATION PROPERTY OWNER NAME 407 PHONE aos Bobbie Stokes MAILING OR STREET ADDRESS aos 1348 Mentone Ave. # C CITY 410 STATE 411 ZIP CODE atz Grover Beach CA 93433 PROPERTY OWNER TYPE ^ 1. CORPORATION ®2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL ats III. TANK`OWNER INFORMATION ..,. _ . TANKOWNER NAME ata PHONE ats 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY a» STATE ata ZIP CODE 4ts Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY -- IV. BOARD OF`EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER ", TY TK HQ 44- 3 1 'i 8 1 6 Call 916 322-9669 if uestions arise az, V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE ®1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ^ 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz VI. LEGAL-NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER azs VII. APPLICANT SIGNATURE -_ Cert ica o I certi t the information provided herein is true and accurate to the best of my knowledge. SIG E OF PPL DAT aza PHONE azs ~j ~L~ LyD ~ 702-270-7160 NA OF APPLICA T (print) azs TITLE OF APPLICANT av Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (FOrloca~ use only) azs 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 4zs UPCF (1/99 revised) ~ Formerly SWRCB Form A r, UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page of (.,IDENTIFICATION" FACILITY ID# ~ I - ~ t BEGINMNG DATE i~~ ENDING DATE tot F ; A Q Q Q , 3/1 /2006 3/21 /2007 BU$INES$ NAME (Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 7-Eleven #16329 661-834-1350 BUSINESS SITE ADDRESS to3 1701 Pacheco Rd. CITY toa ZIP CODE tOs CA Bakersfield 93305 DUN & BRADSTREET 106 SIC CODE (4 digit #) to7 00-734-7602 5541 COUNTY 1oa Kern BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE tto Shinda & Paramjeet Upple 661-834-1350 IL "'BUSINESS OWNER . OWNER NAME - - 111 - -- OWNER PHONE . 11G 7-Eleven, Inc. 702-270-7160 OWNER MAILING ADDRESS tt3 P.O. Box 711 Attn: Gasoline Acctg CITY 114 STATE Its ZIP CODE 11s Dallas TX 75221-0711 T I1L ENVIRONMENTAL`'CONTACT __ __ _- CONTACT NAME tt7 _ _ _ CONTACT PHONE _ tte Shane Partridge 702-270-7160 CONTACT MAILING ADDRESS 119 P.O. Box 711 Attn: Gasoline Acctg CITY t2o STATE 121 ZIP CODE 122 Dallas TX -- 75221-0711 - - -_ _ -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- - ~, NAME 1za ~ NAME tza 7-Eleven Emergency Dispatch I 7-Eleven Emergency Dispatch I TITLE 124 TITLE t2s Emergency Service Emergency Service BUSINESS PHONE tzs BUSINESS PHONE 130 1800-828-0711 800-828-0711 24-HOUR PHONE 126 24-HOUR PHONE t31 1-800-828-0711 800-828-0711 PAGER # tz7 PAGER # 132 ADDITIONAL LOCALLY COLLECTED INFORMATION: C ifi ation: Ba don my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally ex mi ed and a f iliar with the information submitted and believe the information is true, accurate, and complete. SIG RE OF O NE PER ESIGNATED REPRESENTATIVE DA E 13a NAME OF DOCUMENT PREPARER .136 3J2~ 2 v-D~6 Rachel Rodriguez NAME OF SIGNER (prt ) 136 TITLE OF SIGNER t37 Shane Partridge _ Gasoline & Environmental Compliance Manager UPCF (1199 revised) HMP 2 (Back) Instructions OES FORM 2730 (1199) UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) ^ MATERIAL(NON-WASTE) ® WASTE one a e er material er buildin or area ®ADD ^DELETE ^REVISE REPORTING YEAR 2005 200 Page . of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 7-Eleven #16329 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL zo2 (EPCRA) ^ YES ® NO NEAR FACILITY TRASH ENCLOSURE ~ MAP# (optionap 203 GRID# (optionap zoa FACILITY ID # 1 of 1 il. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No 2os WASTE FLAMMABLE LIQUID If Subject to EPCRA, refer to instructions COMMON NAME GAS-WATER MIXTURE 207 EHS* ^Yes ®No 208 cas# N/A 209 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by ouPa,) z10 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ^ a. PURE ^b. MIXTURE ®c. WASTE RADIOACTIVE ^Yes ®No 212 CURIES 213 PHYSICAL STATE (Check one item only) ^ a. SOLID ®b. LIQUID ^ c. GAS 21a LARGEST CONTAINER 55 2t5 FED HAZARD CATEGORIES 21s (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 219 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 25 55 55 134 221 DAYS ON SITE: zz2 UNITS' ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 Check one item onl ' If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ®e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ®r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ® d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT zza STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 89-90 22s MIXTURE OF GASOLINE & WATER OR 227 ^Yes ®No 2za N/A MIXTURE zzs OTHER CONTAMINATION IN GASOLINE , 2 230 231 ^Yes ^ NO 232 233 3 234 ~ 235 ^Yes ^ NO 236 237 ¢ 238 239 ^Yes ^ NO 240 241 5 2az za3 ^Yes ^No zaa zas If more hazardous components are present at greater than t % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required Information. ADDITIONAL LOCALLY COLLECTED INFORMATION gas UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) ^ MATERIAL(NON-WASTE) ® WASTE one a e er material er buildin or area ®ADD ^DELETE ^REVISE REPORTING YEAR 2005 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 7-Eleven #16329 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL zoz (EPCRA) ^ YES ® NO ENCLOSURE NEAR FACILITY TRASH _ i I MAP# (optional) 203 GRID# (optionaq I zoo FACILITY ID # ~ 1 Of 1 1 II. CHEMICAL INFORMATION 2os CHEMICAL NAME TRADE SECRET ^Yes ®No zos WASTE ABSORBENT & DISPENSER FUEL FILTER If Subject to EPCRA, referto instructions COMMON NAME WASTE ABSORBENT & DISPENSER FUEL FILTER 207 EHS* ^Yes ®No 2oa CAS# N/A 2os *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Compete if required by CUPA) 210 HAZARDOUS MATERIAL 211 RADIOACTIVE ^Yes ®No 212 CURIES z13 TYPE (Check one item only) ^ a. PURE ^b. MIXTURE ®c. WASTE PHYSICAL STATE (Check one item only) ®a. SOLID ^b. LIQUID ^ c. GAS 21a LARGEST CONTAINER 55 215 FED HAZARD CATEGORIES 216 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT z17 MAXIMUM DAILY AMOUNT 21s ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 25 55 55 352 zz1 DAYS ON SITE: zzz UNITS' ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 Check one item onl * If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC 80TTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ® d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # MIXTURE OF SILCATE & HYDROCARBONS 1 89-90 zzs zz7 ^Yes ®No zza N/A MIXTURE zzs & SPENT FUEL FILTERS , 2 230 231 ^Yes ^ NO 232 233 3 234 235 ^Yes ^ NO 236 237 4 z3a z3s ^Yes ^ No 2ao 2a1 5 za2 za3 ^Yes ^No 2ao za5 If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION gas __ __ _ =- ~~ •~ UNDERGROUND STORAGE TANK MONITORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited.' Title 23 CCR, Sections 2632(d)(1), 2634(d)(2), and 2641 (h) TYPE OF ACTION ^ 1. NEW PLAN ^ 2. CHANGE OF INFORMATION Mol. PLAN TYPE ®MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. Moz. (Check one item only) ^ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): .. L FACILITY INFORMATIQN - FACILITY ID # (Agency Use Only) FACILITY NAME 7-EleVefl #16329 M03. FACILITY SITE ADDRESS 1701 Pacheco Rd. M04 CITY Bakersfield Mos. II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in Mob. accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED ® 1. ANNUALLY ^ 99. OTHER (Specify): Mop. III.' MONITORING LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., Location of each sensor, line leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring System Certification form, Hazardous Materials Business Plan ma ,etc.) which shows all re uired information, include it with this Ian. _..... IV. TANK 'MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) M10' ® L CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM MI 1. PANEL MANUFACTURER: V@@CI@fROOt Mlz' MODEL #: TLSSSO M73. LEAK SENSOR MANUFACTURER: V@@d@~ROOt Mla. MODEL #(S): H47$JO-42O MIS. ^ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(Sl PANEL MANUFACTURER: M16 MODEL #: ntlz IN-TANK PROBE MANUFACTURER: MIS. MODEL #(S): Mtg. LEAK TEST FREQUENCY: ^ a. CONTINUOUS ^ b. DAILY/NIGHTLY ^ c. WEEKLY M2o. ^ d. MONTHLY ^ e. OTHER (Specify): MzI . PROGRAMMED TESTS: ^ a. 0.1 g.p.h. ^ b. 0.2 g.p.h. ^ c. OTHER (Specify): Mzz . Mz3. ^ 3. INVENTORY RECONCILIATION ^ a. MANUAL PER 23 CCR §2646 ^ b. STATISTICAL PER 23 CCR §2646.1 Mza. ^ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645 TESTING PERIOD: ^ a. 36 HOURS ^ b. 60 HOURS Mzs. ^ 5. INTEGRITY TESTING PER 23 CCR §2643.1 TEST FREQUENCY: ^ a. ANNUALLY ^ b. BIENNIALLY ^ c. OTHER (Specify): Mz6. Mz~. ^ 6.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approval) ^ 99. OTHER (Specify): M28. V. PIPE 1VIONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mao. ® 1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM M31. PANEL MANUFACTURER: V@@d@I'ROOt M3z. MODEL #: TLS$SO M33. LEAK SENSOR MANUFACTURER: V@@CI@1'ROOt M34 MODEL #(S): 794380-352 & 794380-208 M35. WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? ®a. YES ^ b. NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M3z ^ 2. MECHANICAL LINE LEAK DETECTOR (MELD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED MELD MANUFACTURER(S): M3S. MODEL #(S): M39. ® 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS ELLD MANUFACTURER: PLED M40' MODEL#: 152567 & 152583 Mal. PROGRAMMED LINE INTEGRITY TESTS: ^ a. MINIMUM MONTHLY 0.2 g.p.h. ^ b. MINIMUM ANNUAL 0.1 h. g•P• Maz. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Mai. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Maa. ® 4. INTEGRITY TESTING TEST FREQUENCY: ®a. ANNUALLY ^ b. EVERY 3 YEARS ^ c. OTHER (Specify) M4 5. M46. ^ S.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY" ^ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED'' Mal. • Requres agency approval •• Allowed for monitoring of unburied emergency generator fuel piping only per HSC §25281.5(b)(3) ^ 6. PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) ^ 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ^ 99. OTHER (Specify) Mas. UN-022A - 1/3 www.unidocs.org Rev. 10/14/03 1" Underground Storage Tank Monitoring Plan -Page 2 of 2 ' VI. DISPENSER MONITORING ` ' ' MONITORING OF AREAS BENEATH DISPENSER(S) IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mso. ® l .CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT (UDC) PANEL MANUFACTURER:VeederROOt Mst. MODEL#:TLS35O Msg. LEAK SENSOR MANUFACTURER: VeederROOt M53. MODEL #(s): 794380-352 Msa. WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? ®a. YES ^ b. NO Mss. WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M66. WILL FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO Msz ^ 2. MECHANICAL ASSEMBLY (e.g., FLOAT AND CHAIN ASSEMBLY) IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK ASSEMBLY MANUFACTURER: mtss. MODEL#(S): Msg. ^ 3.VISUALMONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agencyapprovai) M60. ^ 4. NO DISPENSERS ^ 99.OTHER (Specify) M6t. VII. ENHANCED LEAK DETECTION ^ 1. WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK Mso. DETECTION (ELD) FOR THE UST(S) COVERED BY THIS PLAN. PER 23 CCR §2644.1, ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED VIII. TRAINING REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) Mso. 1. ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 2. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 3. ® THE FACILITY'S BEST MANAGEMENT PRACTICES (Required as of January 1, 2005) 4. ^ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. ^ CALIFORNIA UNDERGROUND STORAGE TANK LAW 6. ^ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS -MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 7. ^ SWRCB PUBLICATION: "WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" M81. 99. ^ OTHER (Specify): Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and can access those documents when needed. By January 1, 2005, this facility will have a "Designated UST Operator" who has passed the California UST Sytem Operator Exam administered by the International Code Council (ICC). By July 1, 2005, and annually thereafter, the "Designated UST Operator" will train facility employees in the proper operation and maintenance of the UST systems. This training will include, but is not limited to, the following: - Operation of the UST systems in a manner consistent with the facility's best management practices. - The facility employee's role with regard to the leak detection equipment. - The facility employee's role with regard to spills and overfills. - Whom to contact for emergencies and leak detection alarms. For facility employees hired on or after July 1, 2005, the initial training will be conducted within 30 days of the date of hire. - IX. COIVIMENTSYADDITIONAL INFORMATLON- Please use this section to include any additional UST system monitoring-related information (e.g., additional information required by your local agency): Mss. Note regarding Section X. Pending certification of a Designated UST Operator, the following person has authority for performing the monitoring activities and maintaining leak detection equipment covered by this plan. NAME: JOB TITLE: _... X. PERSONNEL RESPONSIBILITIES AS OF JANUARY 1, 2005, THE "DESIGNATED UST OPERATOR" IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT APPLICATION -FACILITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION EQUIPMENT COVERED BY THIS PLAN, AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS OF THE FACILITY'S UST SYSTEMS IN ACCORDANCE WITH 23 CCR § 2715(b . XI OWNER70PERATOR SIGNATURE. E ~TIFICAT N: I ertify that the information rovided herein is true and accurate to the best of my knowledge. W E /OPERA O TURE REP_ ,RESENTING DATE: Mgt. ~er M90. O ~ ~~ ~ Z erator ~ OWNER/OPERATO NAM nt): M92. OWNER/OPERATOR TITLE: M93. Shane Partridge Gasoline & Environmental Compliance Mgr (Agency Use Only) This plan has been reviewed and: ^ Approved ^ Approved With Conditions ^ Disapproved Local Agency Signature: Date: Comments/Special Conditions: UN-022A - 2/3 www.unidocs.org Rev. 10/14/03 ~~ :s WRITTEN MONITORING PROCEDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify local agency 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: 7-Eleven Store #16329 Facility Address: 1701 Pacheco Rd., Bakersfield Date: March 1, 2006 _ A. Describe the frequency of performing the monitoring: Tank The site consists of three double walled plasteel tanks (1-Regular Unleaded 10k gal, 1-Premium 10K gallon, 1-Midgrade 10k gallon) and are monitored continuously with a VeederRoot TLS350 Piping Product lines are double wall Envirflex and are monitored continuously with a VeederRoot TLS350. The turbine sump sensors activates audio/visual alarms and provides positive shutdown of the turbines B. What methods and equipment, identified by name and model, will be used for performing the monitoring: Tank The method of leak detection for the tanks is Interstitial Monitoring of the double wall tanks Using the VeederRoot TLS350 Tank Gauge programmed for a threshold of /2gph. VeederRoot model #847390-420 probes are used for the monitoring. High level alarms activate audio/visual and external alarms Piping The piping is monitored continuously by Electronic Line Leak Detectors. The turbine Sump sensors provide positive shutoff and activate audio/visual alarms. The piping is Precision tested annually at a threshold of .1gph. Dispensers are equipped with under- Dispensor containment with VeederRoot liquid sensors model #794380-352 that Provide positive shutdown of the turbines C. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: The individual responsible for the monitoring equipment is the store operator, Shindra Upple operator will contact 7-Eleven Dispatch 1 800-828-0711 or any alarm conditions on the VeederRoot The local maintenance contractor will be dispatched. 7-Eleven, Inc. is responsible for maintaining the equipment. The Environmental Manager is Shane Partridge. D. Reporting format for monitoring: Tank Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Monitoring records will be kept at the location and at a central office Location Piping Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Third party annual test results will be submitted to the agency. ...g ^ ~ . ~,. ~ i Written Monitoring Procedures 7-Eleven #16329 Page 2, March 2006 E. 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. Tanks and product lines are continuously monitored and alarmed. Alarm histories are printed each month and investigated for corrective actions by the designated operator. Equipment repairs; replacement are performed as needed. F. Describe the training necessary;for the operation of UST system, including piping, and the monitoring equipment: Employees are trained on the operation of the UST in a manner consistent with "Best Management Practices", Emergency Contact information, Spill/Overfill response procedures, Hazardous Waste Procedures, and Monitoring equipment operation and alarm response procedures. Training is conducted annually , or with 30 days for new employees, by the designated operator. - - EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify LOCAL AGENCY 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: 7- Eleven Store #16329 Facility Address 1701 Pacheco Rd., Bakersfield 1. If an unauthorized release occurs, how will 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 within 8 hours, or deteriorate the secondary containment, then LOCAL AGENCY must be notified within 24 hours. In case of a gasoline spill- Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. Employees will be notified to evacuate if deemed necessary. A contractor will be contacted to remove the spill as necessary, In case of a small carbon dioxide release- the tank will be visually inspected for obvious signs of the release point. If possible the control valve will be shut off. In the case of a large release of carbon dioxide, employees will be notified to evacuate and Contact 911 and 7-Eleven Dispatch. In case of fire- the alarm will be sounded by shouting "Fire" and the building will be evacuated. Employees will contact 911 and assemble at the designated assembly area as depicted on the site map. If safe, employees will shut off power and control fire using fire extinguishers. 2. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substances. Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. A contractor will be contacted to remove the spill as necessary. 3. Describe the location and availability of the required cleanup equipment in item 2 above. Absorbent is located inside the store in the backroom. 4. Describe the maintenance schedule for the cleanup equipment. Inventory of absorbent is periodically checked. 5. List the name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan. Shane Partridge, Gasoline & Environmental Compliance Manager 702-270-7160 Date ~~ ~ ~ Bakersfield Fire Dept. U(~~IED PROGRAM INSPECTION CHECKLIST Enironmental Services -~~.:. 1715 Chester ve SECTION 1 Business Plan and Inventory Program Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAtiIE ~~ ~/~ /7 INSPECTION DATE INSPECTION TIME _ _ - -- PHONE No No. of Employees ADDRESS 1 FAC;IIITYCONTACT ~ Business ID Number 15-42 l - Section 1: Business Plan and Inventory Program ^ Routine ~ Combined ^ Joint Agency ^Mutti-Agency ^ Complaint ^ Re-inspection C V \ V=V'o ationnce ~ OPERATION ~^ APPROPRIATE PERMIT ON HAND --L--~-----.-.---------------..~----------------_ --------- 19' ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^"~ ^ VISIBLE ADDRESS ~^ CORRECT OCCUPANCY lam' ^ VERIFICATION OF INVENTORY MATERIALS Ly ^ VERIFICATION OF QUANTITIES ~^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL COMMENTS i_ I ~_ __ -- -------- VERIFICATION OF MSDS AVAILABILITYE f .....- -- VERIFICATION OF FIAT MAT TRAINING S II~O VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ~J' ^ CONTAINERS PROPERLY LABELED ~^ HOUSEKEEPING ^ ~ FIRE PROTECTION ^ ^ SITE DIAGRAM ADEQUATE ~ ON HAND L ~: ~ _ Kccc~ ~~ -~L~Q ~ ~~~t~~r.~- --__..-_..._. ........... ..._.--.._._ 1 ANY HAZARDOUS WASTE ON SITE: ^ YES ~ NO EXPLAIN: QUESTIONS~tEGAROING HIS PECTI/ON~~ PLEASE CALL US AT (66~) 326-3979 Inspector Badge No., white -Environmental Services Yellow - 9tetbn Copy t~.,1_ Business Site Responsible Party Pink • t3usinesa Copy ~~ .~`' • .~~----_ '~~~~EI.D FfR ~~w o~ CITY OF BAKERSFIELD FIRE DEPARTMENT O `~ ~ ro OFFICE OF H;NVIRONI~~IEN"1'AL SERVICES ~~ y~' UNIFIED PROGRAM INSPECTION CHECKLIST =;w ~~~,~~'~' 1715 Chester Ave., 3`~`' Flnor, Bakersfield, CA 93301 ...,,~ FACILITY NAME ~~~ ~ INSPECTION DATE 5 " 1 • 7 Section 2: Underground Storage Tanks Program ^ Routine ~ Combined ^ 3oint Agency ^Mulfi-Agency ^ Complaint ^ Re-inspection Type of Tank ~~,y~ Number of Tanks Type of Monitoring ~ L ltrl Type of Piping [k,1~_ OPERATION C V COMMENTS Proper tank data on file Proper owner~'operator data un file Pennit fees cun•ent 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 NU / Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling (s tank used to dispense MVF? If yes, Does tank have overfilVoverspill protection'? C=Compliance V=Violation Y=Yes N=NO Inspector: Oflice of Environmental Services (661) 326-3979 ~1'hitc - Fnv. Svcs. '~ - Business Site Responsible Party Pink - Business Cory UNIFIED PROGRAM INSPECTION CHECKLIST? .SECTION 1: Business Plan and Inventory Program BAKERSFIELD FIRE DEPT Prevention Services p ~1ltR 900 Truxtun Ave., Suite 210 ~RrM Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME ~ ~ ~ / /j, 1/(/n (//~ ~ NSP TIO DATE INSPECTION TIME ADDRESS HO ENO. O OF EMPLOYEES 1 FACILITY CONTACT USINESS ID NUMBER ~s-oz~- b Section 1: Business Plan and Inventory Program ^ ROUTINE OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND BUSIt12SS 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 HAZ MAT TRAINING VERIFICATION OF ABATEMENT SUPPLIES AND PR EDURES ^ EMERGENCY PROCEDURES ADEQUATE _ ^ CONTAINERS PROPERLY LABELED ' ^ HOUSEKEEPING , / ^. t~l/ FIRE PROTECTION ~/b SITE DIAGRAM ADEQUATE & ON HAND .. ~rs~.l= v~- s~ ~ l_~ r~ w~ ANY HAZARDOUS WASTE ON SITE? ^ YES LWN(~ EXPLAIN: __ QUESTIO REGARDI G T IS INSPECTION? PLEASE CALL US AT (881) 328-3979 ~/ Inspector (Please Print) Fire Preve on / 1" In / Shilt of Site/Station ~ Business White -Prevention Services Yellow - Stetion Copy Pink - Buaineas Copy ~ ~~ati ~ FD2048 (Rw. 1Y2J05) -o ~~ 1~e ~ ~ Ms W ;y~1 ~ ~ ~ ? . ~ R • ~~ i ~~~:~~ ~~ FACILITY NAME '~~l CITY OF BAKERSFIELD F IRE DEPARTMENT OFFICE OF ENVIRON>\'IEN'1'AL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r`' Floor, Bakersfield, CA 93301 INSPECTION DATE ~ ~ g Q b Section 2: Underground Storage Tanks Program ^ Routine ~ombined ^ Joint Agency ^hulti-Agency ^ Complaint ^ Re-inspection Type of Tank 1~ Number of Tanks Type of Monitoring _ t~ L ~ Type of Piping ~(`~ _ OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data rni the Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations 4 / Has there been an unauthorized release? Yes NO V Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPAC[TY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling [s tank used to dispense MVF? If yes, Does tank have overtill/overspill protection'? C=Compliance =Violation Y=Yes N=NO Inspector: Office of Environmental Services (661) 32G-3979 ~~~hitc -Env. Svcs. Pink -Business C~~py r Bu es Site Responsible Party Z - J _ 1 -~ • Tan/mology 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 08/09/2006 Order Number: 3147948 Dear Regulator, Date Printed and Mailed: 08/17/2006 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #16329 MARKET 2133 1701 PACHECO ROAD BAKERSFIELD, CA. 93307 Testing performed: Secondary Containment-Spill Container Secondary Containment-Sumps\Under Dispenser Sincerely, 0~~ ~a~~ Dawn Kohlmeyer Manager, Field Reporting s = Work Order: 3147948 Seeandary Containment Testing depart Foz-m Thrs form is i~rreirdad for rrsc by' CorrtracrGrs perfornurrg pEriodic testing Qf UST spCOnctvey cnntalnnrent sysre~r_ Lrse the apprvprrate pages n/this form to report resrrfts for utl comp~nenrs tested The completed form, written rest procedures. urrd prrnrouts from rests (tYapplicable), should be provided ro the fucrliry awrrer/operalor fvr subtn i7fa1 do the focell re~utarcuy~ agerrri•. ~. 1~ACa.rrY rnrnp'aR2UfA'~'YON f C:ompanp ltiam~rp,~ ~n f ~~ -Technician Conducting Test; ~~;~ d /~~ ~ 2 Crzdentials: ~CSLB Licensed Cd~tractar ~ 5Wi2CB Licensed T~utk Tester ~~ ' - - - Licerese "]'~-pe and ..~- t ;,^.. y7~/~f~,,, M~tufatturer L ]'- Date ~/-o ~ ~ ~~ r E .._ ~- _~___ 3. S~NIMA~Y Off' TCST RESU3,TS Number of Tanis Tasted:[ _ Number of Piping Runs Tested: ~ Member of Suhmersib fe Pump Surnps Tested: f ~ Number of iJ17C Boxes Tested rhutnber of Fi1i Surnns Tested: ?7 ,Number of flvertill Boxes "["tsred: / _ Component Pass~p'ai] Comments _ I " ~ fi __s ~ _ • "~ I_ ~ ~ ~• . ._ .. _,_ _ . .. C ~ ~ ~ ., " ~ ~ ~..~... _ ... r 1 4 -~ -_ ~ _ _. ~~ ~ A ~ / Technician', Sibnature: /' Uate:~~ ~`"~`~~f ___ SWRCIi I)ecetnbzr ?001 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 2. TESTING CONTRACTOR II~'QRMA'Y'XON Work Order: 314 7 9 4 8 6. PIPING SUMP TESTING ~8e ~ of Test Method Developed Sy: Sump Manufacherer ~dustry Standard Professional Engineer " Other ~S~ecify) Test Method Used: Presstue Vacuutn ~ydmstatic ' other (~ecifyj Test Equipment ETsed: v ~ Equipmart Resolution: ~ ~P®Ol # ~J 9ump # Sump ~ Sump # Sump Diarnet~ $-. Sump Depth: ., . Sump Material: 6 s f,•~ Height from Tank Top to Top of - Highest Piping Penetration: - Height from Tank'I'op to Lowest Electrical Pme4atiosr ? J~ ~` Condition of sump prior to testing: . ~ Partian of Sump Tes ~ - Does hirbine shut down when _ sump Se1LS8r detects liglrid (both product and wattr)?' es No NA Yes No NA Yea No NA Yes No NA Turbine shutdown response time Is system programmed for Fait- safe shutdown?` es No NA Yes No NA Yes No NA Yes No NA was fail-safe verified to he .. pressure/vacuiun/w~ater and starting test: '_ ~~~. ~ Test Stay[ Time: _ f f..~ Initial Reading (R,}: ' ' n cx7o' .oo o' .4Goao' .a~ooo- .pornoa" Test End l ime: / j,?/ ~ Final Reading (RF): ~ peoQ.,? f. obod? . TestD~uation: ~ a'}1711~• ~ mrnl. 15 -~i. 5 tN. ~~. 15rnirv. 1'''llr~J, Change in Reading (RF-R~}: ,~. .o~ pass/Fail Threshold or Criteria: ~ _.002' ff_, pp 2' ~ ,d~2` ±I_,OO2' Was sensorrernoved far testing? es No NA Yea No NA Yes No NA Yes No NA Was sensor properly replaced and verified functional afte r No NA Yes No NA Yes No NA Yes No NA testing? Comments - (viclude information cm repairs made prior to testing, Qnd recnmme~ded follow-up for failed tesu} Tarilrnology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 314 7 9 4 8 9. ;,PILLlUVERFI;I,I, CaNTAINMELNT 807~CE5 ~8e of Facility is Not Equipped With 51pi1l/pverfill Contairut~t Boxe __ -_ s Spill/Overfill Containutent Boxes arc Present but `-' , wue Not Tested Test Method Developed sy: Spill Bucket lVEailufaCti uer dustry Standard ~_. Other (~S~ecafy) professional Engineer Test Method Used: pressure Vacuum Other (S}iecify) yarost~ti~ Test ui Eq pment Used; -~ L,* Equipment Resolution: ry Spill Box #~•d "5pi11 Boz # Spits Boz # 8ueket Diameter: Sill Boz q ~ Bucket Depth: `~ ~ ~ Wait time between . applying. -~~ Fressure/vaCUUmlwafer and starting test; r.-. ~ .~ "Pest Start Time: _ ~p~ Initial Reading (R,}: . d b pp o Zest End Time: /~ • ~ f~,~ '- Final 12tading (~): _ .. oa , . _ - Tast Duration: - _. _. ~S~r.:.. ~ M . _ .~ . Pass/Fail Threshold or ~ ~ vooi ~ ~` ~__ _~ Criteria; t ~ ~- ~e7J Comments - (include infotmaf ton o~ rapairs made prior to lesfinp, and recommended o!!ow- f up jorfailed tests) w Tanlrnology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS ~ Tdt?/~Q'f0/0+,~/ TEST DATE:O8/09/2006 WORK ORDER NO.: 3147948 CLIENT:7-ELEVEN, INC. SITE: 7-ELEVEN #16329 P.O. BOX 711 MARKST 2133 1701 PACHSCO ROAD DALLAS TX 75221 BAKERSFIELD CA 214-841-6714 Tank Interstital Tests Piping Interstital Tests -' TANK PRODUCT MANUFACTURER RESULTS --- -- - - REG UNLEAD REG UNLEAD PREMIUM 93307 LINE PRODUCT MANUFACTURER RESULTS Suma 8~ Under-Dispenser Containment Tests Sump/ DISP.# MANUFACTURER P/F 2 REG MAIN Total Containment Pass 2 REG MAIN Totaf Containment Pass 1 REG SYP OPW Pass 1 REG SYP OPW Pass Tanknology representative: BRIAN DERGE Services conducted by: STEPHEN COULTER ~_ _ "~' UMP TESTS ~~~~~ SECONDARY CONTAINMENT TEST RESULTS Test Date: Work Order: 08/09/2006 3147948 Type Tank or Disp # Manufacturer Model or Material Diam./Width/Length (") Depth (") Test Method Start Time Initial Level Level Change Finish Time Final Result Pass/ Fail STP Sump 2 REG MAIN Total Containment Plastic 48 39 VPLT 1146 9 +.00002 1201 9 Pass STP Sump 2 REG MAIN Total Containment Plastic 48 39 VPLT 1202 9 +.00002 1217 9 Pass Spill Container 1 REG SYP OPW Plastic 13 13 VPLT 1146 6 -.00010 1201 6 Pass Spill Container 1 REG SYP OPW Plastic 13 13 VPLT 1202 6 -.00015 1217 6 Pass Comments: i Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:08/09/06 WORK ORDER NUMBER3147948 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #16329 COMMENTS 989 retest. 87 stp & 87 syphon fill sump both passed. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 08/17/2006 08:11 KOHLMEYER ITE DIAGRAM ~ Tanlv>tdbgy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 08/09/06 CLIENT:7-ELEVEN, INC. WORK ORDER NUMBER3147948 SITE:7-ELEVEN #16329 W 7-11 #16329 S N 1701 PACHECO RD H BAKERSFIELD w 2/11 /97 ~ REG REG PREM I I I O O O ' O A 0 0 P/S P/S ST ST Printed 08/17/2006 08:11 KOHLMEYER ~.. - - ,-~• _ .~ - - - Tankna/oc~y j 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 KERN CTY - ENVIROMENTAL HEALTH 2700 M STREET SUITE 300 BAKERSFIELD, CA. 93301 Date Printed and Mailed: 08/17/2006 RECEivE~ Test Date: 08/09/2006 AUG 2 3 2006 Order Number: 3147948 _ _ KERN COUNTY --- __ - _ _ _ ENVIRONMENTAL HEALiH SERVICE Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #16329 MARKET 2133 1701 PACHECO ROAD BAKERSFIELD, CA. 93307 Testing performed: Secondary Containment-Spill Container Secondary Containment-Sumps\Under Dispenser Sincerely, ~ c?W-~ ~a~~m~t~ Dawn Kohlmeyer Manager, Field Reporting i Work Order: 314 7 9 4 8 ~ -~ - .~~ ~ Secondary Containment 'Vesting Report dorm Thu form is btreixt2d jcr use by Corrtracfprs ptrjorrarxg periodic testing of UST secondary cnxralr+mexr systetrrs- Use the apprvprrare pages of rhrs form to report results for at! componexts tested Tire completed form, written rest prncerhtres, rtnd prtxtours from rests (~YapplicableJ, should be provided to lhe1ucil try owtrer/operator for srtbtn ittal ro the !Deaf -egularvey age+zr~•. ~. ~ACUrrY rnroR.~r,~~etoN Pacilin' Name: ~ / Date of Testing: '~"-Q~~ _~ Facility Address: j D ~ kris %e ~ rf ~~ 7Z Facility~Contact: r~A Phone: (~(~ „ J ~ T._ Date Local Ageney Was iv ified of Testing : game of Local Agenc;: Inspector Present: 2, T~S'I"IP+TG CUN'IRACTOR ~I)F'oRMA'CxO1H I C:ompanp Nam - C~ ~ ; Technician Conducting Test: ~ r 1 Credentials: SLS Licensed Cdntractor ~ SWRCrB Licensed Tank Tester _ ~Z License 7-ype and . , ! ~- ..._ Training by Manufacturer Ma~tufacturer ComponenI(s) pate Trait7ine Expires ! I •- • - : ~_ 3. SC]MMARY Q~ TCS'f RESULTS dumber of Tanis Tested: _ Number of Piping Runs Tested: Number oY Submersible Pump Surnps Tasted: f •`-l+~i~mber of ~i11 Sumps Tested: ~ ~ Number of UDC Boxes Tested Nurrtbcr of Overfill Boxes "["erred; Component Pass~>Fail Comments _ / ~,/ `F.~y/~! /I HI~A ~~ S I ~t~ ~: ~ ~ ~ T ~--I ~ 1 ' ~ ~ -- _ , _ .,. .. C I ~ ~~ ~ ~ 1 . _ - j l _ , . ~. •- -._ i ~ -~ ---te .~ e ~ Technician's 5ibnatvre: / Dare: t~ ~Z'f7`~~f ___ S WRCIi tlccember ?001 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 314 7 9 4 8 6. pl<PING SUMP TESTING ~Se ____ of~ Test Method Developed By: Sump Manufactterer ~dushy Startdard Professional Engineer " Other (S~ec~) Test Method Usod: :. Presstue Vacttirm ~;ydrostatic ' Other (Spec~y} Test Equipment Eked: tf ~ 1Cptupment Resolution: , pro r # ') Sump # Snmp ~ Sump # Sump Diametel: $'. Sump Depth: .~ .- Sump Material: 6 s .~,~~ Height from Tank Top to Top of - Highest Piping Penetration: - ~ ~' Height from Tank Top to Lowest ? ,f Electrical Penetration: ~` Condition of Sump prior to testing: ~ Portion of Svmp'1'es N - Iaoea turbine shut down when _ - - sump sensor detects liquid (bath product and wattr)7 es No NA Yes No NA Yea No NA Yes No NA Tutlrine shutdown response time Is system programmed for faii- safe shutdown?~ es No NA Yes No NA Yes Na NA Yes i~io NA Was Fail-safe verified to be ~~ i op4rdtional? Yes No NA Yes No NA Yes No NA Yes No NA Wait time between a}ypiying pressurcJvaCUlmJwater and starting test: ' ~ ~Q~ •'„ Test Start Time: ~ f 1,.~ Initial Reading {Ft,}: ~ •- Test End Tune: ~ o /fir' ~ 00 o .O[7oao' .ooooo• .poooa' Final Reading (RF): ~ pepp,~ f.oa~7 . TestDtuation: ~ ,'Yi+IJ. ~ mrn1, ~5 ++~. 5 ~n~. ~a. l5rn~r~. r~i~l. Change is Reading (R~R~}: .,t. ,o~ pass/Fail Threshold or Criteria: ~ _.002' f/_. pp 2' ~f- ,OQ Z` +r .002' Was sensor removed for testitsg? es No NA Yea No NA Yes No NA Yes No NA Was sensor properly replaced and verified fttnctioaal a#ter ~ No NA Yes No NA Yes No NA Yes Na NA testing? Comments _ (r>r~ude information ue repairs made prior to testing, and recnmmerrded fallow-up for failed tests} ~ ~--- Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 314 7 9 4 8 9. ~PILI:dO'VERFjY,L CO1vTAIlYM~N1' B07tE5 ~8e -- of -_ Facility is Not Equipped With 9pi11/dverfill Containment Boxes Spi1llOverfill Containment $oxfs ate Present, but w~ Not 'T'ested Test Method Developed $Y~ 5pi1F Bucket I~4anufactsuer d~Y Standard Professional Engineer Other {S}ieca~J Test Method Used: Pressure Vacuum ydtastatic Test Equipment Uscd: Other r~c~, L,~ Equipment Resolution: ~ SpiD Box # ~;•y ~ Spill Boz # 3pili Bnz # Spill Boz p 8ueket Diatrteter: Bucket Depth; "~ ~ ~ _ Wait time between . applying. "~~ pressure/vacuumlwater and starting test; _ ~., ~ .~ "Pest Start Time: _ ~~~ Initial kcading (R,}: - - - - - . G b oQ a .- zest F.nd Time: f~ j f c,~1 - Final I{tadin8 (R~): "aa ~ .. -- Test Duration: /S~ ,A ~ - Change in Reading (R~ ~ ~", ` - r R~}~ o ~ t7oor S ~ ~- Pass/Fail Threshold or Criteria; ~ '~ ' `~^E7J Comments - (include injor-nafioa on repQirs made prior to 1ectinR and recammendedfollow-rrp jor failed Bests} .~ Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS ~ Td''rf/C11t?/OC~' y TEST DATE:08/09/2006 WORK ORDER NO.: 3147948 ~_ CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #16329 P.O. BOX 711 MARKET 2133 1701 PACHECO ROAD DALLAS TX 75221 BARERSFIELD CA 214-841-6714 Tank Interstital Tests TANK PRODUCT MANUFACTURER RESULTS REG UNLEAD REG UNLEAD PREMIUM Piping Interstital Tests 93307 LINE PRODUCT MANUFACTURER RESULTS Sumu &Under-Dispenser Containment Tests Sump/ DISP.# MANUFACTURER P!F - 2 REG MAIN Total Containment Pass 2 REG MAIN Total Containment Pass 1 REG SYP OPW Pass 1 REG SYP OPW Pass representative: BRIAN DERGE Services conducted by: STEPHEN COULTER C~ UMP TESTS ~~~ SECONDARY CONTAINMENT TEST RESULTS s Test Date: Work Order: 08/09/2006 3147948 Type Tank or Disp # Manufacturer Model or Material Diam./Width/Length (") Depth (") Test Method Start Time Initial Level Level Change Finish Time Final Result Pass/ Fail STP Sump 2 REG MAIN Total Containment Plastic 48 39 VPLT 1146 9 +.00002 1201 9 Pass STP Sump 2 REG MAIN Total Containment Plastic 48 39 VPLT 1202 9 +.00002 1217 9 Pass Spill Container 1 REG SYP OPW Plastic 13 13 VPLT 1146 fi -.00010 1201 6 Pass Spill Container 1 REG SYP OPW Plastic 13 13 VPLT 1202 B -.00015 1217 6 Pass mments: it 1 1 1 I I 1 1 A `~ 1 1 I ~'1}an 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512) 451-6334 FAX (512) 459-1459 TEST DATE:08/09/06 WORK ORDER NUMBER3147948 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #16329 COMMENTS 989 retest. 87 stp & 87 syphon fill sump both passed. PARTS REPLACED QUANTITY . 4 ~ - DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED ~~ ,;" ~` t~ ~ ~ ;;:-,. , , HELIUM PINPOINT,LEAK TEST RESULTS Printed 08/17/2006 08:24 KOHLMEYER . -~ SITE DIAGRAM ~ Tanlv~obgy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 08/09/06 WORK ORDER NUMBER3147948 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #16329 Printed 08/17/2006 08:24 KOHLMEYER UNIFIED PROGRAM CONSOLIDATED FORM - TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 ,, L' FACILITY /.SITE INFORMATION BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 ;.FACILITY'ID# 1 7-Eleven #16329 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* ® 1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY' TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aoa ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* aoz TOTAL NUMBER OF TANKS Is facility on Indian Reservation or *If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos I1. PROPERTY OWNER INFORMATION __ ., .. PROPERTY OWNER NAME aos PHONE aoa Bobbie Stokes MAILING OR STREET ADDRESS aos 1348 Mentone Ave. # C CITY ago STATE att ZIP CODE atz Grover Beach CA 93433 PROPERTY OWNER TYPE ^ 1. CORPORATION ®2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL ats IIL`TANK OWNER INFORMATION ~, ----- - TANK OWNER NAME ata PHONE ats 7-Eleven, Inc. 253-796-7170 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY ate STATE ata ZIP CODE ats Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY IV BOARD OF'EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, ," ,; V. PETROLEUM UST FINANCIAL.-RESPONSIBILITY ` INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD a22 VI. LEGAL NOTIFICATION AND MAILING ADDRESS .. , ~_~-x . ,. Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will b sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 VII. APPLICANT SIGNATURE . Certification - I certify t o ovided herein is true and accurate to the best of my knowledge. SIGNATURE PP CA DATE aza PHONE azs 7/28/06 253-796-7170 NAME OF A LICANT (print) azs TITLE OF APPLICANT a2~ Randy Martin Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) aza 1998 UPGRADE CERTIFICATE NUMBER (FOrlocaluseonly) azs UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page of L JDENTIFICATION- _ ~ - - -- FACILITY ID# G DATE too ~ - t E - tot F A I O O O $/ /2006 12/31/2007 BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE toz 7-Eleven #16329 661-834-1350 BUSINESS SITE ADDRESS 103 1701 Pacheco Rd. CITY 1oa ZIP CODE tos CA Bakersfield 93305 DUN & BRADSTREET too SIC CODE (4 digit #) 107 00-734-7602 5541 COUNTY 1oa Kern BUSINESS OPERATOR NAME t09 BUSINESS OPERATOR PHONE Ito Shinda & Paramjeet Upple _ __ _ - _ 661-834-1350 ~__ _-- --- - I -t BUSINESS OWNER OWNER NAME ~ ~ ~ ~ OVVNEF2 PHONE 1t2 7-Eleven, Inc. 253-796-7170 OWNER MAILING ADDRESS tt3 P.O. Box 711 Attn: Gasoline Acctg CITY 11a STATE Its ZIP CODE Its TX Dallas 7 221-0711 5 _ _ III. ENVIRONMENTAL CONTACT __ _ _ _ __ _ CONTACT NAME tt7 _ CONTACT PHONE 11e Randy Martin 253-796-7170 CONTACT MAILING ADDRESS Its P.O. Box 711 Attn: Gasoline Acctg CITY t20 STATE t2t ZIP CODE 1z2 Dallas TX 75221-0711 -PKIMARY- IV. EMEKGENCY GUNI ACTS -SEGUNDAKY- NAME t23 NAME tze 7-Eleven Emergency Dispatch I 7-Eleven Emergency Dispatch I TITLE tea TITLE t2s Emergency Service Emergency Service BUSINESS PHONE t2s BUSINESS PHONE 130 1800-828-0711 800-828-0711 24-HOUR PHONE tzs 24-HOUR PHONE tat 1-800-828-0711 800-828-0711 PAGER # 1z7 PAGER # 13z ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Ba don yin i of th a individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and m fa e i rmation submitted and believe the information is true, accurate, and complete. SIGNATUR F O OP R R OR DESIGNATED REPRESENTATIVE DATE t34 NAME OF DOCUMENT PREPARER t35 7/28/06 Rachel Rodriguez NAME OF SI NER (print) 136 TITLE OF SIGNER 137 Randy Martin Gasoline & Environmental Compliance Manager UPCF (1/99 revised) HMP 2 (Back) Instructions OES FORM 2730 (1/99) EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify LOCAL AGENCY 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: 7- Eleven Store #16329 Facility Address 1701 Pacheco Rd. Bakersfield If an unauthorized release occurs, how will 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 within 8 hours, or deteriorate the secondary containment, then LOCAL AGENCY must be notified within 24 hours. In case of a gasoline spill- Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. Employees will be notified to evacuate if deemed necessary. A contractor will be contacted to remove the spill as necessary. In case of a small carbon dioxide release- the tank will be visually inspected for obvious signs of the release point. If possible the control valve will be shut off. In the case of a large release of carbon dioxide, employees will be notified to evacuate and Contact 911 and 7-Eleven Dispatch. In case of fire- the alarm will be sounded by shouting "Fire" and the building will be evacuated. Employees will contact 911 and assemble at the designated assembly area as depicted on the site map. If safe, employees will shut off power and control fire using fire extinguishers. 2. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substances. Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading ~e of the spill. A contractor will be contacted to remove the spill as necessary. 3. Describe the location and availability of the required cleanup equipment in item 2 above. Absorbent is located inside the store in the backroom. 4. Describe the maintenance schedule for the cleanup equipment. Inventory of absorbent is periodically checked. List the name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan. Randy Martin, Gasoline & Environmental Compliance Manager 253-796-7170 Date 7/2R/~C, ~~ _ ~; r UNDERGROUND STORAGE TANK MONITORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited.• Title 23 CCR, Sections 2632(d)(1), 2634(d)(2), and 2641 (h) TYPE OF ACTION ^ 1. NEW PLAN ^ 2. CHANGE OF INFORMATION Mol. PLAN TYPE ®MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. Moz. (Check one item only) ^ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I: FACILITY INFORMATION FACILITY ID # (Agency Use Only) _ _ FACILITY NAME 7-Eleven #16329 M03. FACILITY SITE ADDRESS 1701 Pacheco Rd. M04 CITY Bakersfield Mos. II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in M06. accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED ® 1, ANNUALLY ^ 99. OTHER (Specify): Mop. III. MONITORING LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., location of each s ensor, line leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring System Certification form, Hazardous Materials Business Plan ma ,etc.) which shows all re uired information, include it with this Ian. IV. TANK 1VIONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) Mlo. ® 1. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM MI t. PANEL MANUFACTURER: V@@d@PROOt M12 MODEL#: TLS35O M13. LEAK SENSOR MANUFACTURER: V@@d@I'ROOt Mla' MODEL #(S): 847$90-420 Mls. ^ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(Sl PANEL MANUFACTURER: MI6. MODEL #: M17 IN-TANK PROBE MANUFACTURER: Mls. MODEL #(S): M19. LEAK TEST FREQUENCY: ^ a. CONTINUOUS ^ b. DAILY/NIGHTLY ^ c. WEEKLY Mzo. ^ d. MONTHLY ^ e. OTHER (Specify): Mzl . PROGRAMMED TESTS: ^ a. 0.1 g.p.h. ^ b. 0.2 g.p.h. ^ c. OTHER (Specify): Mzz . Mz3. ^ 3. INVENTORY RECONCILIATION ^ a. MANUAL PER 23 CCR §2646 ^ b. STATISTICAL PER 23 CCR §2646.1 Mza. ^ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645 TESTING PERIOD: ^ a. 36 HOURS ^ b. 60 HOURS M25. ^ 5. INTEGRITY TESTING PER 23 CCR §2643.1 TEST FREQUENCY: ^ a. ANNUALLY ^ b. BIENNIALLY ^ c. OTHER (Specify): Mz6. Mzz ^ 6.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approvap ^ 99. OTHER (Specify): Mzs. V. PIPE MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) M30. ® 1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM M31. PANEL MANUFACTURER: V@@deCROOt M3z. MODEL #: TLS35O M33. LEAK SENSOR MANUFACTURER: V@@CI@I'ROOt M34 MODEL #(S): 794380-352 & 794380-208 M35. WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? ®a. YES ^ b. NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M37. ^ 2. MECHANICAL LINE LEAK DETECTOR (MELD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK [S DETECTED MELD MANUFACTURER(s): M38 MODEL #(S): M39. ® 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS ELLD MANUFACTURER: PLED M40 MODEL #: 152567 & 152583 Mal. PROGRAMMED LINE INTEGRITY TESTS: ^ a. MINIMUM MONTHLY 0.2 g.p.h. ^ b. MINIMUM ANNUAL 0.1 g.p.h. Maz. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Mai. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Maa. ® 4. INTEGRITY TESTING ~ ~rnam r 0.'71 I--7 r~ M45. M46. i r~rv;~vii~~ r . {pl G. l11YIV Ul1LL 1 <J u. c v cry r ~ [ nt+[~,~ I_..I ~. v 1 nr,r~ t~Nc~IrYl ^ S.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY* ^ c. M[N. MONTHLY & EACH TIME SYSTEM OPERATED" Mai. • Requires agency approval `• Allowed for monitoring of unburied emergency generator fuel piping only per HSC §25281.5(6)(3) ^ 6. PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) ^ 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ^ 99.OTHER (Specify) Mas. UN-022A - 1/3 www.unidocs.org Rev. 10/14/03 :~ • Underground Storage Tank Monitoring Plan -Page 2 of 2 VI. DISPENSER MONITORING MONITORING OF AREAS BENEATH DISPENSER(S) IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mso. ® 1. CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT (UDC) PANEL MANUFACTURER: VeederROOt Mst. MODEL #: TLS350 Msg. LEAK SENSOR MANUFACTURER: VeederROOt Mss_ MODEL #(s): 794380-352 Msa. WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? ®a. YES ^ b. NO M55. WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M56. WILL FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO Msg. ^ 2. MECHANICAL ASSEMBLY (e.g., FLOAT AND CHAIN ASSEMBLY) IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK ASSEMBLY MANUFACTURER: Mss' MODEL #(S): M59. ^ 3.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approval) M60. ^ 4. NO DISPENSERS ^ 99. OTHER (Specify) M61. VII. ENHANCED LEAK DETECTION _. ^ 1. WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK Mao. DETECTION (ELD) FOR THE UST(S) COVERED BY THIS PLAN. PER 23 CCR §2644.1, ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED VIII. TRAINING REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) Mao. I . ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 2. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 3. ® THE FACILITY'S BEST MANAGEMENT PRACTICES (Required as of January 1, 2005) 4. ^ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. ^ CALIFORNIA UNDERGROUND STORAGE TANK LAW 6. ^ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS -MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 7. ^ SWRCB PUBLICATION: "WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" ^ OTHER (Specify): Mst. 99 . Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and can access those documents when needed. By January 1, 2005, this facility will have a "Designated UST Operator" who has passed the California UST Sytem Operator Exam administered by the [ntemational Code Council (ICC). By July 1, 2005, and annually thereafter, the "Designated UST Operator" will train facility employees in the proper operation and maintenance of the UST systems. This training will include, but is not limited to, the following: - Operation of the UST systems in a manner consistent with the facility's best management practices. - The facility employee's role with regard to the leak detection equipment. - The facility employee's rote with regard to spills and overfills. - Whom to contact for emergencies and leak detection alarms. For facility employees hired on or after July 1, 2005, the initial training will be conducted within 30 days of the date of hire. IX. COMMENTS/ADDITIONAL INEORMATLON Please use this section to include any additional UST system monitoring-related information (e.g., additional information required by your local agency): Mas. Note regarding Section X. Pending certification of a Designated UST Operator, the following person has authority for performing the monitoring activities and maintaining leak detection equipment covered by this plan. NAME: JOB TITLE: X. PERSONNEL RESPONSIBILITIES AS OF JANUARY 1, 2005, THE "DESIGNATED UST OPERATOR" IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT APPLICATION -FACILITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION EQUIPME~} COVE D BY THIS PLAN, AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS OF THE FACILITY'S UST S EMS ACCORDANCE WITH 23 CCR § 2715 ). XI. OWNER/OPERATOR SIGNATURE CERTIFICATIO . I rtify t at th nformation provided herein is true and accurate to the best of my knowledge. OWNER/OPERA R GNATU REPRESENTING DATE: Mgt. ® Owner M90. ® Operator Jul 28, 2006 OWNER/OPE TOR NAME (print): M9z. OWNER/OPERATOR TITLE: M93. Randy Martin Gasoline & Environmental Compliance Mgr (Agency Use Only) This plan has been reviewed and: ^ Approved ^ Approved With Conditions ^ Disapproved Local Agency Signature: Date: Comments/Special Conditions: UN-022A - 2/3 www.unidocs.org Rev. 10/14/03 WRITTEN MONITORING PROCEDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify local agency 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: 7-Eleven Store #16329 Facility Address: 1701 Pacheco Rd., Bakersfield Date: July 28, 2006 A. Describe the frequency of performing the monitoring: Tank The site consists of three double walled plasteel tanks (1-Regular Unleaded 10k gal, 1-Premium 10K gallon, 1-Midgrade 10k gallon) and are monitored continuously with a VeederRoot TLS350 Piping Product lines are double wall Envirflex and are monitored continuously with a VeederRoot TLS350. The turbine sump sensors activates audio/visual alarms and provides positive shutdown of the turbines B. What methods and equipment, identified by name and model, will be used for performing the monitoring: Tank The method of leak detection for the tanks is Interstitial Monitoring of the double wall tanks Using the VeederRoot TLS350 Tank Gauge programmed for a threshold of /2gph. VeederRoot model #847390-420 probes are used for the monitoring. High level alarms activate audio/visual and external alarms Piping The piping is monitored continuously by Electronic Line Leak Detectors. The turbine Sump sensors provide positive shutoff and activate audio/visual alarms. The piping is Precision tested annually at a threshold of .1gph. Dispensers are equipped with under- Dispensor containment with VeederRoot liquid sensors model #794380-352 that Provide positive shutdown of the turbines C. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: The individual responsible for the monitoring equipment is the store operator, Shindra Upple operator will contact 7-Eleven Dispatch 1 800-828-0711 or any alarm conditions on the VeederRoot The local maintenance contractor will be dispatched. 7-Eleven, Inc. is responsible for maintaining the equipment. The Environmental Manager is Randy Martin. D. Reporting format for monitoring: Tank Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Monitoring records will be kept at the location and at a central office Location Piping Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Third party annual test results will be submitted to the agency. ~.~ ~ - ,. Written Monitoring Procedures 7-Eleven #16329 Page 2, July 2006 E. 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. Tanks and product lines are continuously monitored and alarmed. Alarm histories are printed each month and investigated for corrective actions by the designated operator. Equipment repairs; replacement are performed as needed. F. Describe the training necessary for the operation of UST system, including piping, and the monitoring equipment: Employees are trained on the operation of the UST in a manner consistent with "Best Management Practices", Emergency Contact information, Spill/Overfill response procedures, Hazardous Waste Procedures, and Monitoring equipment operation and alarm response procedures. Training is conducted annually , or with 30 days for new employees, by the designated operator. { .~ _~ 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512)451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 ~, BAKERSFIELD, CA. 93301 .~ ~"~~ Test Date: 07/11/2006 "~ ~~ ~~Q~ G~'~""! ~ ~,1~-~' Order Number: 3147433 ' Dear Regulator, Date Printed and Mailed: 07/'t8/2006 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #16329 MARKET 2133 1701 PACHECO ROAD BAKERSFIELD, CA. 93307 Testing performed: Secondary Containment-Dispenser Pan\Sump Secondary Containment-Line Interstitial Secondary Containment-Spill Container Secondary Containment-Sumps\Under Dispenser Secondary Containment-Tank Interstitial Sincerely, ..~ C):~~ f~a~~rr~l1~ Dawn Kohlmeyer Manager, Fietd Reporting SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS a ®T~n ~t9 TEST DATE:07/11/2006 WORK ORDER NO.: 3147493 CLIENT:7-ELEVEN, INC. SITE: 7-ELEVEN #16329 P.O. BOX 711 MARKET 2133 1701 PACHECO ROAD DALLAS TX 75221 HAKERSFIELD CA 214-841-6714 Tank Interstital Tests TAN K PRODUCT MANUFACTURER RESULTS REG UNLEAD Total Containment PASS REG UNLEAD Total Containment PASS PREMIUM Total Containment PASS Piping Interstital Tests 93307 LINE PRODUCT MANUFACTURER RESULTS Regular syphon Total Containment PASS Sumn & Under-Disuenser Containment Tests Sump! DISP:#' MANUFACTURER P/F 1REG MAIN Total Containment Fail 1REG MAIN Total Containment 2REG SYPHO Total Containment Pass 2REG SYPHO Total Containment Pass 3PREMIUM Total Containment Pass 3PREMIUM Total Containment Pass 1 REGULAR Total Containment Pass 1 REGULAR Total Containment Pass 1\2 Total Containment Pass 1\2 Total Containment Pass 3\4 Total Containment Pass 3\4 Total Containment Pass 1REG M FIL OPW Pass 1REG M FIL OPW Pass 1 REG M VAP OPW Pass 1 REG M VAP OPW Pass 2REG S FIL OPW Fail 2REG S FIL OPW 2REG S VAP OPW Pass 2REG S VAP OPW Pass Tanknology representative: BRIAN DERGE Services conducted by: STEPHEN COULTER µt~ SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS ~ ~- Tats~ol TEST DATE:o7/11/2006 WORK ORDER NO.: 3147493 CLIENT: '1-ELEVEN, INC. $ITE: 7-ELEVEN #16329 P.O. BOX 711 MARKET 2133 1701 PACFiECO ROAD DALLAS TX 75221 BAKERSFIELD CA 93307 214-841-6714 Sump &Under-Dispenser Containment Tests Continued Sump/ DISP.# MANUFACTURER P/F 1REG Total Containment Fail 1REG Total Containment 2REG Total Containment Pass 2REG Total Containment Pass 3PREM1 Total Containment Pass 3PREM1 Total Containment Pass 1REGUL Total Containment Pass 1REGUL Total Containment Pass 1\2 Total Containment Pass 1\2 Total Containment Pass 3\4 Total Containment Pass 3\4 Total Containment Pass 1REG M OPW Pass 1REG M OPW Pass 1REG M OPW Pass 1REG M OPW Pass 2REG S OPW Fail 2REG S OPW 2REG S OPW Pass 2REG S OPW Pass 3PREM OPW Pass 3PREM OPW Pass 3PREM OPW Pass 3PREM OPW Pass ' ..... SECONDARY CONTAINMENT TEST RESULTS SITE NAME: 7-ELEVEN #16329 16329 DATE: 07/11/2006 WORK ORDER 3147493 SITE ADDRESS: MARKET 2133 1701 PACHECO ROAD BAKERSFIELD CA 93307 REASON FOR TEST: Groundwater Level " from grade TANK INFORMATION AND INTFRSTITIAI TESTS Tan Product Tank Size Dia. Material Manufacturer Depth ~ ~ ~ Test Method Start Time Initial Level Finish Time Final Result Pass/ Fail 1 REG UNLEAD 9600 109 DW STEEL Total Containment g7 Vacuum 950 -10 ,.Hg 1050 -10 ..Hg PASS 2 REG UNLEAD 9600 109 DW STEEL Total Containment 39 Vacuum 945 -10 ..H9 1045 -10 ~~Hg PASS 3 PREMIUM 9600 109 DW STEEL Total Containment 40 Vacuum 1130 -10 ,.Hg 1230 -10 „Hg PASS 4 5 6 7 8 Comments: I INF INFORMATION AND INTFRSTITIAI TESTS Tan Product Dia. Len. feet Material Manufacturer Volume allons Test Method Start Time Initial Level Finish Time Final Result Pass/ Fail 1 Regular syphon 3.00 20 Plastic Total Containment 5 Pressure 930 5 psi 1030 5 psi PASS 2 3 4 5 6 7 8 Comments: Test Date: 07/11/2006 =~.« iw, Work Order: 3147493 SECONDARY CONTAINMENT TEST RESULTS SUMP TESTS Type Tank or Disp # Manufacturer Model or Material Diam./Width/Length ~ ") Depth (") Test Method Start Time Initial Level Level Change Finish Time Final Result Pass/ Fail STP Sump t REG MAIN Total Containment Plastic 48 39 ---- 9 -5.00 ---- 4 Fail STP Sump 1REG hAAIN Total Containment Plastic 48 39 ---- ---- -°---- ---- ---- STP Sump 2REG Total Containrnent Plastic 48 37 VPLT 1110 8.5 -.00001 1126 8.5 Pass STP Sump 2REG Total Containment Plastic 48 37 VPLT 1127 8.5 -.00001 1142 8.5 Pass STP Sump 3PREMIUM Total Containment Plastic 48 40 VPLT 1110 8.5 -.00002 1126 8.5 Pass STP Sump 3PREMfUM Total Containrnent Plastic 48 40 VPLT 1127 8.5 -.00004 1142 8.5 Pass Piping Sump 1REGULAR Total Containment Plastic 48 40 VPLT 1110 16 -.00044 1126 16 Pass. Piping Sump 1 REGULAR Total Containment Plastic 48 40 VPLT 1127 16 -.00001 1142 16 Pass Dispenser Sump 1\2 Total Containrnent Plastic 46x23 31 VPLT 1220 13 +.00003 1236 13 Pass Dispenser Sump 1\2 Total Containment Plastic 46x23 31 VPLT 1237 13 +.00000 1252 13 Pass Dispenser Surnp 3i4 Total Containment Plastic 46x23 31 VPLT 1220 12.5 +.00003 1236 12.5 Pass Dispenser Sump 3S4 Total Containment Plastic 46x23 31 VPLT 1237 12.5 +.00000 1252 12.5 Pass Spill Container 1 REG M FIL OPNJ Plastic 13 13 VPLT 944 8 -.00005 959 8 Pass Spill Container 1REG M FIL OPW Plastic 13 13 VPLT 1000 8 +.00003 1015 8 Pass Spill Container 1 REG M OPW Plastic 13 13 VPLT 944 8 -.00001 959 8 Pass Spill Container 1REG M OPW Plastic 13 13 VPLT 1000 8 +.00000 1015 8 Pass Spill Container 2REG S FIL OPW Plastic 13 13 VPLT 944 8 -5.6730 959 8 Fail Spill Container 2REG S FIL OPW Plastic 13 13 --- ---- ------ ---- --- Spill Container 2REG S VAP OPW Plastic 13 13 VPLT 1022 8 +.00001 1039 8 Pass Spill Container 2REG S VAP OPW Plastic 13 13 VPLT 1040 8 -.00001 1056 8 Pass Spill Container 3PREM FILL OPW Plastic 13 13 VPLT 1022 8 +.00000 1039 8 Pass Spill Container 3PREM FILL DPW Plastic 13 13 VPLT 1040 8 -.00185 1056 8 Pass Spill Container 3PREM OPW Plastic 13 13 VPLT 1022 8 -.00047 1039 8 Pass Spill Container 3PREA~ OPW Plastic 13 13 VPLT 1040 8 +.00129 1056 8 Pass Comments: Regular Main STP sump failed using visual measurements. Regular Main STP sump failing through product piping penetration. Regular Syphon spill container not leaking through drain. SPILL CONTAINER IS DIRECT BURY! i Tankr~o%gy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:07/11/06 WORK ORDER NUMBER3147493 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #16329 COMMENTS 3 year 989 testing. Tested 3 tank interstitials; all passed. Tested 1 piping secondary; pass. Tested 3 STP sumps; Regular Main failed, all else passed. Tested 1 piping sump; pass. Tested 2 dispenser sumps; all passed. Tested 6 spill containers; Regular syphon fill failed, all else passed. PARTS REPLACED QUANTITY DESCRiPT10N HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT-LEAK TEST RESULTS Printed 07/18/2006 06:43 SBOWERS ITE DIAGRAM ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 07 /11/0 6 WORK ORDER NUMBER314749 3 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #16329 7-11 #16329 ~ 1701 PACHECO RD ~' BAKERSFI ELD w 2/11 /97 ~ REG REG PREM I I I O O O o a a A 0 0 W ~ P/S S N P/S ST ST Printed 07/18/2006 06:43 SBOWERS Work Order: 314 7 4 9 3 r ' Secondary C tainment Testing Report ~'orrn 7iris./nrm is +ftt2ndt:[f jar- trs~ h~ conrr ~ rs performing periodic testing of tiS7'secondorv cnntainmenr svstenes. Lase 11+f: appropriate pages n1 this fnrtn ro rep .sufrs jot• .t1! components tested The compfefed joint, wrrtren test procedures. and printours frrnn rests (?fappficoble),~ Hold 6e pra~rded to the. jpcilfty oN•rtCr,~uperalur jar subrnittaf to the locat regufau>r}• agPnct~. 1FACILITY INI±ORMATInN . Facijit}~ Name: ~ *~~` • Date of Testing: d ~~~~+~o -• •• •- Facilin•Address: p~ ae ,.,,~;e .~~oix ~ • Facilin• Contact: ~ ~ _ Phone: r ~ ~ ~~ ~~ Sb ~ ~---•~- Date Locai Agency Was tJottfied of 'ng : ~ ~ . Name of Local A•renc}• Inspector Rre t: ~ 1 2. TES ~ G CONTRACTOR IN~'ORMATIOIY Company Name:~]'~, rcclmician i:nnducting "1"est: ~ •• -•-- ~ ~ i C:rcdentials: SLB License tractor ~=SWRCB i.iCensed Tank Tester ~~ ~~ f,icense T}•pe and ~:'-T" ~ ai ~ t~~ D - •- + 'vlanufacturer _ ~ ,~ Training by Manufacturer Com onen s _ p u) Date 'T'raining Expires - ~-- l ~~ ~ Q ~ `d e ~~~ _... S ~ i . ~ ... _~ 3. ' MIVXARY p~' TEST RESULTS -r~ ~Vutnber of'Tarilcs "Tested: E Numbc:r~of Submersible Pump Sumps ~ Ivumhcrof Piping Runs Vested: stcd: • N '~Iu~reber of t-~ill Sumps Tcsted: ~ ) ;, umber of UDC Boxes Tested: ~ Numbcr oi' Uverfil] Boxes T"esied: ~'- ~ Component = Pass Fail Comments . ~w~~ - _ r.,~a~. Jv (7 - -.. _. .,lam a~+t -- -- -- f (' -- Technician's Signaturt:: - Uate:~ +~7-~ ~ ~ SWRCB ~ ... _ December ?001 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 314 7 4 9 3 Secondary ~ ntainment Testing deport Form :rYrrs_lurn: ee ttuended,Jor rue by contr ~ lars perfottr~inA perirulic testing o% (1ST secondary containment svst2ma•. L'se the appropriate /xr~es nj this form to re tesarttsfar a!! componants tested. The completed form, written resl prrx:edttr~s: a,ad prtnrouts from tcsls• t'if applicableJk hoktd be provided to rJre facitiry oH•rrer.~operr~tor for submirtp! to the toeal !B~!lif2lUT~' CI~£P3l ;l? FAC7LTrY IItiFQ1iMAT~nN ': Facility 'tiante" Date of 7estina: Facility Address: r. i Facilin• Contact: ~ Phone: • Date Loca] Agency Was Notified of sting : ~ ~ slam` t of local A~~ency Inspector Pre -i t: "~"~-~-- 2. TE . IIUG CONTRACTOR lNi<'ORMA'~'ION Compan}~ tiame: fed3nician Conducting Test: "•~ - :' Crea~tials: r;+ CSLB Licensed ntractor ~_ 5 WRCB Licensed lank Tester License .t"ype and a: "'"" Training by Manufacturer _ ManufacLUrtic Cotrtponent(s) Date Training Expires 1 3. U MMARY OF TEST RESULTS : yamberef'1'anlsTested: !fiNumber of Subihe ibi P S AiumberofPipingRuns'rested: ' r e ump ump& ested: Number of [.1170 Boxes Tested: Dumber of Fill Sumps Tweed: Tvumber of Overfill Boxes 7"ested: - ~` _,__ Component Pass Tail ! Comments t -i - ' - ~i ;- -- - +-- ,~ ~ _ - -^ -'--~ Tecimician'~ S--~rtaturc: Uatc: ----- ~ -- SW'RCB L Decetnnar 2UG ] Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147493 4. TANK ANNiJIa.AIt TES'I'iNG Pa~~e - of - ._ 'Test Method Developed Iiy: Tank Manufacturer ~tdustry Standard Professional Engineer --, Other {~ecify) Tess Method C+sed; k ~ Pressure ~ acuum ~ -' Hydrostatic Other (Sped) Test Equipment Used: A ,~ ~ - . Equipment 1Zesolution: ~ ~a .•%[ Is Tank Exempt Fram Testing?~ Tank it Yes Taok ~ ~ Tank # ,~? Tank # Tank Ca aci p ty~ ° ye9 o Yes o Yes NO • 'rank Material: L70 -tni. ~F~l lp~ pp W g -. bb Tank Manufacturer: . . ~ ~- M .W. S __. Product Stnrod: e vl l?~o.~ t __ Wait trine between a 1 n PP Yt $ .. ° ~ '~ pressurei~acuumlwater and -- -. starting test: '' ~ ~iH ~ A.. 1 est Start Ti roc; ,~~ ! .S`o / ~ / _ __ India! Reading (R~: -, f • ~ ~ . ^ Test End Time: ~ J^ ~ SO _. ~~30 final Reading (RF): ~ Test Duration: ^IO ~~ .N Change in Reading {RF-Rr}: f O 1'asslFail Threshold or CYiteria: .- o a Was sensor removed for testing? I es No NA .~i~ ~ No NA ,~s~ 'a~?~ 0'~ ~ No NA Ye N Wac sensor properly replaced and ~eritFed functi l tL .~ No NA s o TtiA -. - ona a cr testing? Es No NA No NA Yes Nv NA Comments - (include infortrrati , an repairs made prtorto testing, & t'ecommended fotlow~-up forfailed tests) ._. t -~ ~ .__ . ., `Secondary containment systems whe a continuous nwnitor-ing automatically monitors both the pritrtary and secondary coutxinmen?. such as systems that are hydmstaticall onitgred or under constantyacnum, Sre exempt from periodic conffiirunent testing, {California Code afltegr-larions, Title 23, Sectitm 7(a)(6)} Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147493 I - Teat Method Developed By: Test Mcthod Used: Test F,qu~eut used_ ~Yle. y~.,~1p ~P~ ~ '' k' 7 ZV~B~Cl181. , 5. SEC5U1+[DARY PI)P;E TESTIIHG ~ ~-~'~ . ing M.anufacturrt ~dustry Standard ~ ~ Profiessianal Engineer . ~ (~~'~ sure Vacttt~ Hy~rost~tEc ~' (~~J'~ Equipa~t ReaoIutiaai: Q ~~Q' ~ r # ! ~~E )Etm # PlpinE Bam ~ >~ lGte ~ ,T•L p ~ ~ a `Yu'~ MBlall{$CLII[ICCC: Pipmg F}18II3CtCd: { Length of Piping Rte: Product 5tncbd: ' Metlwd and location of PiPmB-Mm isolation• e~M „~ ~~.'. wait tune between app}ying press~meivaouumf water and starting test: ~ ...,•.. - Vest Start Time: Imbal Riradmg (R,). ~• rest Bnd Time: f Fiual Reading t~)= Test Deuaotion: ~ Change in Reading (R~- l?asa/Fail 'Irtvesltold or Criteria: SS Coogm~eut's - (inctaede im~ornratioR on irs made prior to IesirRg, axd rmwrded follo-~kp f~ failed 1e4JSj . Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147493 &. )PIPING SUMP TESTXitiIG ~°---°f---- Test Method Developed $y: ~. ~~ Sump Marttifsctvrer ~Gitdustry Staa~dard Professional Engineer Other {Specify} Test Method [Jsed: pressure Vacu4un ydrostatic ~~~ Other (Specify) Test Equipment Used: E. ump # J Sump # ~ En;uiptnartResvlutiarn: , pogo 'I Samp # Sump # Sump Diameter: ~''" ~'" ~'" Sump Depth: ,Z ' .. yp " Sump Material: fa af: c a {„c f-' ~ ~ Height from Tank Top to Top of Highest Piping Penetration: ~ ,~ ~ _ .~' ~V~ f~ •. Height from Tank Top to Lowest Elcctrical Penetration: ~ ~/ . ? .. ,J, ~` ~ /~ 7 Condition of sump prior to t25tln~: //` (..gyp ~~rl Portion of Sump Tes . S " . S ~ fCn ' Does turbine shut down whin sump sensor detexts liquid tbath product and wafer}7' cs No NA ~ ~ No NA ~ No NA ~ No NA Turbine shutdown response time Is system programmed for fail- safe shutdovm7 es No NA ~ Na NA ~ No NA es No NA Was fail-safe verified to be operational2' yes No NA Yes No NA Yes No NA Yes !Vo NA Wait time between applying pressurelvacuum/water and starting test: _ ~ ~.` ~..~.•~n ~ frt•ir Test Start Time: -~ J I - p > /~r o ~/ ~' t ~/e2 Initial Reading (R,): ~• , o' .otx7oa' .OOPOO' .000OP" Test End Time: -- ~ /~ ~ /l ~ Final Reading (Rg): -- , o ~ - TestUntr'ation: rY11n1• ! rrtinl, I5 +ti1. !~ (a. l5rnlay. !'''tlnl. Change lII Reading (RA-R~). ~"- ^~ ~ r OQOO PasslFailThresholdorGYiteria: f~,pp2" f/_,pp2" *iL.pC7Z` }f_.QD2° V4+'as sensor removed far testing? es No NA No NA No NA No NA Was sensor properly replaced and verified functional at'tet testing? a No NA ea No NA ~ No NA Y s No NA Comments - (utclude informalio~ repaf rs made prior to felling, amd recommended follow-eep jar failed t~stsJ r h Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147493 7. UNDER- DENSER CONTAINMENT (UDC) TESTllVG Page _ of ____ Gorttmertts -- {include inforrnatiore onr pairs made prior to testing, and recarnntended fo!!ow-up for failed tests) -- .. . Test 1~+lethod Developed By_ C Manufacturer ~Ildustry Standard Professional >rngincer er CSpecifY) Test Method Used: ssuTe V aeuum yar03t8t1C her (Specify) Test Equipment Ustd: iJ ~. 7 - Eq~xipment Resolution: , o UB _ ~ UDC ;a UDC # UDC # UDC Manufaettuer: ~ .~{.,;R ~. . ¢ UDC Matcrisi: ~}~e UDC Depth: /'' ,~' _ Height fra® UDG Bottom to Top '. ~ ~ ~ _ ~~ of Highest Piping Penetration: height from UDC Bottom to G,~'.- Qr+, Lowest Electrical Peae~ation: {J Q Condition of [7DC prior to testing: Oo Portion of UDC Tested /.?_ S' ' _ Does turbine shutdown when _ l_rDC sensor detects liquid No NA cs No NA No NA Yes No NA (both product and water)?~ Twbine 91tutYlown response time Ts sysfiem programmed for fail- safe shutdown? No NA es No NA .~fo NA Yes No NA Was fail-safe verified to be yg No NA Yes No NA Yes No NA Yes No NA optrarional? Wait time between applying ~ pressurw„IVacmrmlwater stud '- ~~ starang nest +» %..- ..~ ~%+ Test Start Time: J !..? ! D / ]nitial Reading (l~k .oooa~' o o' qoo' .d Test F.ad Time: / /,? , f Finsl Reading (RF): '+;•.o ~. .o x'est Aeration: ~ 5 ,~rrti. 15 rYl r t 5 fs1+n-. 4 !s • J • . E 5 ~ rr-. L r-hr of . Chatrge in Reading (RFRr): _ PasslFail Threshold or Criteria: . U02' '~f_, flp2` ~j_, oaf" ~" s '~~ .OC ,,yam { '7 4' Was sensor removed for testing? No NA a No NA No NA Yes No NA was sensor yroperly replaced and No NA es No NA _ ~fo NA Yes No NA verified functional after testing? Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 314 7 4 9 3 is 9. ~ SPII.LIOVERFII~I, CONTAINMENT BOXES Page__oF_,. Facility is riot l;.quipped With iil/pvetfll Contaiument Boxes SpilllOverFill Containment B 'are Pnesettt, but were Not Ttsted 't'est 14fethod Developed By: Spil] Bueket Manufacturer ~-ridustry Standard Professional Engineer Other {Spec) Test Method Used: pressure Vacuum Ydrvstatic _ Other (Specify} Test Equipment Used: ~/ L Equipment Itesolutian: ~ o $ucket Diameter: $ucket Depth: Wait time between Spill Boz #~~r ,Spill Boz # pill Box # ~yt Sill Box q !3 . r3 • ~3 J ,. _ J • ~. ..~_ applying• pressiarlvacuurn/water and starting test: Test Start Time: Initial heading {R,): / f ~-~ . ^ y~" ~ J ~..,;w~ / + ter' ~ / g - / Jb ~e Test End Time: Final Reading (RF): _~.. Test Duration: Change in Reading (RF- :.Q.~odc /c• 9 ~ ~ _ -- X03 dos ~,. ¢, S` _ -~- ~-, off! .w I v..' J / 1S^ ,~ /,S` .;~. /5....• x.; Rr) PassJFail Threshold or Criteria: '~GC ~^Vrre~4 ~G~ ~ ~ ~' ~' pd,~ ~ , t~~~ ~, t~0~ ~ .db Comments - (include infvTma non repairs mule prior to leyling, and recommended follow-up for Jailed tests) _ _._ ..__ .~ _.,` y M ~ Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147493 9. L/OVERFII~L CONTA,IiYME1VT BQ~S Page _ _ oC_ Facilityc is Not Equipped With 5 l7verfill Containment Boxes SpilVOvcr>;'il] Containment $ox Present, but were Not Tested "' Test Method Developed By: ~ :Spill Bucket Manufacturer ~tlustry Standard Professional Engineer ``!! Other (Specify) Test Method Uscd: ~ Pressure ~ Vacuum ydrostatie Other (Sloec~} Test Equipment Used: ~ z Equipment Resolution: , o Bucket Diameter. i!I Boz #f: << ~,~Spill Hna # ~ ~ Spill $ox # Spill Box # f ~ ~ • Bucket Depth: f ~~ , Wait time between 1 applying pre•ssurelvacvumlwater and starting test: ~ ~,... ~ L/ 5.,,, ,;~ Test Stara 'l'ime: Initial Reading (R,): J O Jt, o ~}~ ~~d -• -~ - . Test End Time: ,~ J© /O /p ~ --• ....- - Final Reading (ItF): _ f o o .ooJ~, ' ,caw.? _ _ ~ -- Test Duration: / ,~ /,r...;.~ . lS ' ...~~ ,~ _ Change in Reading (RF- - ---- PassJFail Threshold or C:riteria: ,,,~ QD~ ~ f, ~ O ~ '- - >,s.. i Comments - {include infurrnaiio n repairs made prior to telling, and recommended fU(!ow-up far failed tests] ~ .. i ..-.._ k .-...__- -..- ... ,.. _ .. - i t Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 May-17-06 13:50 TANKNOLOGY UNDERGRQUND ~TORAG~ TANKS APPLICATI TO PERFORM ELD f E TES G ! 88989 SECONDARY ONTAIN ENT TESTING !TANK TIGHTNESS T T AND PERFQRNI FUEL MONITORING RTIF[C ION ~ ''") PERMR NO. ~~ r ~ ` BAKERSFIELD FIRE DEPT. Prevention Services 900 'lYuxtun Ave., Ste. 210 Bakers~teid, CA 93301 Tel.: (661 ~ 326-3979 Fax: (66i) 852-2171 Page 1 of 1 ~,, H ~t Tr ^ ENHANCED LEAK D ECTION ^ LINE TESTING ~58-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS T 7 _ ___^ TO PERFORM FUEL MONITORING CE~1`IFICATION ~___ SITE INFORN447lON FACILITY ~ ~~ ~ ~~Z~ N11,IVAE S PHONE NUMBER OF CONTACT PF,RSON ADDRESS ~ ry0, dt G1~ ~ ~ ~ BctkQx°sf~ etd •, ~-~ ~ 330 7 OWNERS NAM/E . OPERATORS NAME ~~ NUMBER OF TANKS T BE TES' .... _.. TANIC~#_._ . . NAME d ~~ GATE S I-- - . I APPROVED BY 909 308 1239 P.O1 TO OPERATE NO. INTENTS __~ - --'---------- ---------. -----.__...._...-----I i TANK TESTING CIdrNPANY ._._- NAIYIE 8 PHONE NUMBER OF CONTACT P RSON rc~e Sol She D Teme~la C~ g_ 2580 _~ --~t- _....... DR LyERTIFICATION #: _ ~ , ItC ~ TEST METHOD 525 `{-'7 5 b - ul T "'fE 5 i _....._... ~+ R FT N BATE _ --- _ i FD 2095 (Rev. 09!05) Mar-O1-06 07:28 TANKNOLOGY °''- '' ~- iJNDERGF20UN STOR E 7AMKS 4 ~ APPLICATI N , TO PERFORM ELD ! INE TES ING ! 56989 SECONDAR CONTA MEMT TESTINt; 1TANK TIGHTNESS EST AND ~ • ` I ~F rat., -~'~" PERMIT NO. ~ \ ~7'' 909 308 1239 P.O1 ~ BAKERSFIELD FIRE DEPT. a ax s.a~ n Prevention Services ~~~~ ARTAf t 90O ('ruxrun ~ti-r., Ste. 21U Sakerstir:•Ic1, (.A 0330] Paye 1 of ? ^ ENHANCED LERK TECTION~ ^ LINE TESTING ^ SB-989 SECONDARY r.;ONTAiNMENT' TESTING ~. © TANK TIGHTNESS -Sl ~ I~;..< ~:r.r.Tl -:!, :•a~ ,:I;~Nr,-;;~i:ill °r;:aT!r ;r? - --._.._..._.__.. ._._ _._.. ... _..-..---~---. .- ._._.~ --`---- ---... ._..__.. . .. I ~_ ..... + . • ---.. .__...._.- ---- ...SITE INFORMATION -•- - --_ .--- ---- ... _ .-._... __,.. .. r - ::..~ ;: ~ ~ .. .r; p _.._......_._.._ .-.. __ _ ... ADDRESS ,~~~ P~ N CD ~'O~D r~7^l~r~~LO 933a `7 .. .. .. __ ~.-- -- - -- - __ ~_. ... _ I I OWNERS NAME i i .. r .. ..~ -'r r. , I NUM6ER C?f' TANKS lT? iirC r i _~~! % i IS PIPING_GOING TO 6E TESTED?, ~ YES.. LI NO. _.... TAN1~ iF (. VOLUME __-_ __- _ CONTENTS. ~ I _ .... ._.. ._.. .. .. - -- ---....._,.... ..-_ _I_. ._. .. i { . _- ' ; - ~- -- ~ .... ._ . ~ j .... } ~ -- ~--_.-._--~-- I i •~ -..._......._ ' .... y ~ __.....---' - --. ._.... _.. .. .... ' i TANK TESTING COMPANY NAME OF TESTING C PAN t:r•.r r~ n :=a•:,I~rt_ !~!.,ta7G}::; ~ ~!` ?.-~!d: ~ ~ ~ - ~ ~ ~: r - - __. ._.-- ...- --- ~--- ---~ .._... _._.. .._. 7.5:7 ~G `'"~~ MAILING ADDRESS ~ /_ ~._ __._- ~ ~~V NAME 8 PHONE NUM R O TE ER OR SPECIAL INSPECTOR CERTIFICATIO-J~t ' DATE 8 TIME TEST TO E CONO GTED ~r: ~ ~' _ TEST MET OD ~ZS ry~G ~~ ' SIC,NATUt2E OF APPII A T ~ ~ -~ ~" _,_ DATE - ._..`_ ~..._Z _ t _..-. ---- -_ .-...~ .-. .... T .1$ APPS,. CATION~ECOI~IES A PERMIT IALHEN..APP~VED.. ' r~RPROVEt) BY } -~QATE - _.. ...-. f } I FD 20~JFi (Fiev 09!05) - - -- _, ~: '~~ --, ~j ..~-. ~ C/,~'C~'~- '1 e~,~ ~ ~~~ ..~~' ~~ ~ ~~ r - -~~ 2 `" f~ ~~ ~ ,_`_ Feb-24-O6 11:39 TANKNOLOGY _~ ~ ~~ ,_ UNDFRGROUNDSTORAGETANKS APPLICATI(JN TO PERFORM ELO / ~INE TES ING / S8989 SECONDARY CON7A1 MENT TESTING (TANK TIGHTNESS T~5T AND ; ~• ~.E`, 909 308 1239 P_Ol SAKERSFIELD FIRE DEPT. N zi R 9 P I n PlrcVen~iOn Services f11R1 ARTS T g{){) TTttxtult Avc~., :~t:e. 211 Bakersfield, t.'1~ S133f)1 Tel.: (fi(i 1. M :32~, -3<)79 Page 1 of t PERMIT NO ~~ ~ ~ O ~~~ ^ ENHANCED LEAK DEl'ECTION ^ LINE TESTING ^ SF3-989 SECONOARY f:ONZAINMEN'C TF_$i'ING ^ TANK TIGHTNESSTESi T r, ;•;i,~ire:.t~,! ;~;;;,! ".:Pl.~':~':N~`•:;r:i•s~>; - --- . SfTE INFORMATION ___. _.... . _. .._ _. . ..... , i FACILITY `'~~ ' .~ AI)L7RF.53 /-70 ~ P~cH co ~or1> a'~~rF~~ I~ 933v 7 - - _ a _ . _ _ .. _ .__ _ -- -~-- ----- ..__. _ _ _ . . ;`)WNF.iRS NAME `7-rl ~~Jt. C,cJ~~ ~ _.~ .. . .. --~- - N11141E3ER :)~ TANK$ l t) 13~_ ~ t:b)# 1+ ES PIPING GOING_TO BE TESTED?_ __._-, ~, YES L NO _ _.. _ I -- ' TANK # _- ... ... . _ ._ VOLUME.. .._ . ..-_...---- ... _. CONTENTS. . . _.. _.. ,. .. ... 4. ' ~ , 4 I _l_ TANK TESTING COMPANY - NAME OF TESTING Cd IPAN `. ~ ?•';tiPAt-. w ,^E'~.ti~st.:'.!i?iss~_':::C s •: :,.c;;•!: _. r--_ -. ` MAILING ADDRESS ~i f7 ~ C~I.~P~ 'S~ ctn.. ~- J~`e t°*~t~ C~~ `'° ~ `7 Z- j~C/ NAME 8 PHONE NUMHER OF TE ER OR SPECIAL INSPECTOR I CERTIFICATIO -- DATE & TIME TEST 70 BE COND CTEU ~ ~ ~ _ ~ ~ TEST MET OD ' SiGNA'CURF OF APPLIGA~ r '. _ , ' DATE - ~~~ ' .. - -- _- _-- -- -- .___.-----z'~~~_ .__ _'.-. --. ~; _ T~1lS APP_LICATiQN BECOMES A PERMIT Wt#EN APPROVED. APPROVI_D 6Y DATE - rl) 2035 (Rev. 09!05} ;,s , MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3 Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, 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 tg the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: 7-ELEVEN #16329 Site Address: MARKET 2133 1701 PACHECO ROAD Facility Contact Person: Manager Make/Model of Monitoring System: TLS 350 PLUS B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced Date of Testing/Service: 03/09/2006 Work Order Number: 3145519 Tank ID: 87 PRIMARY Tank ID: 87 SIPHON X In-Tank Gauging Probe. Model: MAG 2 X In-Tank Gauging Probe. Model: MAG 2 X Annular Space or Vault Sensor. Model: 420 Annular Space or Vault Sensor. Model: 420 X Piping Sump(Trench Sensor(s). Model: 352 Piping Sump/Trench Sensor(s). Model: 352 Fill Sump Sensor(s). .Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: PLLD Electronic Line Leak Detector. Model: Tank Overfill/High-Level Sensor. Model: ATG X Tank Overfill/High-Level Sensor. Model: ATG Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). TanklD: Tank D: X In-Tank Gauging Probe. Model: MAG 2 In-Tank Gauging Probe. Model: X Annular Space or Vault Sensor. Model: 420 Annular Space or Vault Sensor. Model: ~( Piping Sump french Sensor(s). Model: 208 Piping SumplTrench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: X Electronic Line Leak Detector. Model: PLLD Electronic Line Leak Detector. Model: X Tank Overfill/High-Level Sensor. Model: ATG Tank Overfill/High-Level Sensor. Model; Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). Ispenser 1/2 Dispenser ID: 3/4 XO Dispenser Containment Sensor(s) Model: 352 X Dispenser Containment Sensor(s) Model: 352 X^ Shear Valve(s). X Shear Valve(s) Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). - Ir the racmry contains 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/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 Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): ~ System set-up X^ Alarm history report Technician Name (print): WILLIAM ROGERS Signature: !/'~ ~~J~j~~ Certification No.: 8520 License. No.: Testing Company Name: Tanknology Phone No.: (800) 800-4633 Site Address: 8501 N. MoPac Expressway, suite 400, Austin, TX 78759 Date of Testing/Servicing: 03/09/2006 City: BAKERSFIELD CA Zip: 93307 Contact Phone No: 834-1350 Page 1 of 3 Based on CA form dated 03/01 Monitoring System Certification :~ :~ Monitoring System Certification Site Address: MARKET 2133 Date of Testing/Service: 03/09/2006 1701 PACHECO ROAD D. Results of Testing/Servicing Software Version Installed: 121.00 Complete the following checklist: x Yes No • Is the audible alarm operational? 0 Yes No • Is the visual alarm operational? Q ves No • Were all sensors visually inspected, functionally tested, and confirmed operational? 0 Yes ^ No' Were all sensors installed at lowest point of seccndary containment and positioned so that other equipment will not interfere with their proper operation? Yes ~ No • x N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? O Yes ~ No * ~ N/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails too erate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (check all that apply) x~Sump/Trench Sensors; ^x Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks apdsensor failure/disconnection? ^x Yes No Q Yes ~ No' ~ NIA For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e.: no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? 90 Yes' ~X 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. Yes' Ox No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) ^ Product; ^ Water. If yes, describe causes in Section E, below. ^X Yes ~ 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 manufacturers' specifications? In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: ON THE 87 PRIMARY TANK THERE IS ALSO A PIPING SUMP WHICH CONTAINS A 352 SENSOR Page 2 of 3 Based on CA form dated 03/01 r. :~' Monitoring System Certification Site Address: nnet?ttGT ~~•t~ Date of Testing/Service: 03/09/2006 1701 PACHECO ROAD F. In-Tank Gauging /SIR Equipment Check this box if tank gauging is used only for inventory control. Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: Yes ^ No • Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes ~No • Were all tank gauging probes visually inspected for damage and residue buildup? Yes ~ No • Was accuracy of system prcduct level readings tested? _ , , QYes ~No • Was accuracy of system water level readings tested? X Yes ~No ` Were all probes reinstalled properly? 0 Yes ^ No • Were all items on the equipment manufacturers' maintenance checklist completed? In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD) : ~ Check this box if LLDs are not installed. Complete the following checklist: ^ x Yes ^ No ` ^ NIA For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? Check all that apply) Simulated leak rate: xQ 3 g.p.h ~ 0.1 g.p.h ~0.2 g.p.h x Yes ~ No • Were all LLDs confirmed operational and accurate within regulatory requirements? x Yes ~ No' Was the testing apparatus properly calibrated? Yes ~ No ` ~ N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? 0 Yes ^No ` ^ N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? Yes ^No • ^ NIA For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? Yes ^No • ^ N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ves ~No ' ~ N/A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes ^No • Were all items on the equipment manufacturers' maintenance checklist completed? ` In the Section H, pelOW, C1eSCnbe how antl when these deflClenCles were or well be corrected. H. Comments: Page 3 of 3 Based on CA form dated 03/01 n t i 1'w "~1 '.~ 7-ELEVEN 16329 (PACHECO) Manager :' Sh „~~. U PP1 C Location:_ 1701 PACHECO RD City BAKERSFIELD CommCode: BFD STA 05 EPA Numb : C ,~ ~ DO ~ ~7~~ ~-] SiteID: 015-021-000807 BusPhone: (661) 834-1350 Map 124 CommHaz Moderate Grid: 19A FacUnits: 1 AOV: SIC Code:5541 DunnBrad:00-734-7602 Emergency Contact / Title Emergency Contact J Title SHINDA UPPLE / FRANCHISEE / Business Phone: (661) 834-1350x Business Phone: (6b~-) ~3--4~-2-A-x~ 24-Hour Phone (800) 845-0031x 24-Hour Phone (800) 845-0031x~ Pager Phone (661) 303-6711x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth .Z f 7 O Contact c~~.L F~ ~/~~`/ MAR-' "~ Phone: ~-@~-}-2~-9-~x MailAddr: PO BOX 711 State: TX City DALLAS Zip 75221-0711 Owner 7-ELEVEN INC Phone: (''^~-278---~~ 0x Address PO BOX 711 State: TX City DALLAS Zip 75221-0711 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG U - UST ~~ Ba~~d on my inquiry of those individuals ~® ~~ ~ ~ respon~ibie for obtaining the information, I certify ~©Q, under pen of la -4hat I have personally examin® en am mil'ar with the information submi d ay~d b ieve the information is true , accu te, d c ple 2 6 ~~ S' nature Date -1- 01/24/2007 ~ .. i. Q` Y _j~ F 7-ELEVEN 16329 (PACHECO) SiteID: 015-021-000807 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7-ELEVEN 16329 (PACHECO) Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper ~9 ~ mOaPs ~~ d ICC Nbr : -~2~26-3~ =-U~ ~~~rv n Name TTT7TT T_ i^ T r Address: City Type ~ID~VIDi7A~~ Name Address: City Type CORPORATION qua _ R TNFORMATION 7-Eleven, nC. phone Gasoline Acctg. P. O. Box 711 to : zip Dallas, TX 75221-0711 - TANK OWNER INFORMATION 7-Eleven, Inc. Phone: Gasoline Acctg. P. O. Box 711 ° : zip Dallas, TX 75221-0711 (5.~-1-~-3~3-~Z'0'x ( ~~~ 3-~7-2.6x-- ~53-7~1[0-~?/~ o BOE UST Fee# 31896 Financ'1 Resp: INSURANCE Legal Notif ~ _ , ,~„~ „," _ ,„_- Date: 03/28/2006 ~ Phone: Name : S-~d~~~AAi~FR~~C~'-- ~ ~ Ttl :GASOLINE & ENVIRON COMPLIANCE MGR State UST # 1998 Upg Cert#: -2- 01/24/2007 = SiteID: 015-021-000807 ~ By Facility Unit ~ Fixed Containers on Site ~ t' L ~ F 7-ELEVEN 1632.9 (PACHECO) ~ Hazmat Inventory ~ MCP+DailyMax Order = Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod MIDGRADE UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod SUPER UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod CARBON DIOXIDE F P IH G 1275.00 FT3 Min WASTE FLAMMABLE LIQUIDSjSOLVENT F DH L 55.00 GAL UnR WASTE ABSORBANT F IH S 55.00 GAL UnR -3- O1f24f2007 -4- 01/24/2007 F 7-ELEVEN 16329 (PACHECO) SiteID: 015-021-000807 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 7500.00 GAL I3HGt1tCLVUJ l.Vl"1rV1V81V1J -- - %Wt. RS CAS# 100.00 Gasoline No 8006619 tiL-1GHKL E1~7~1:.~~1~1t1'LV1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME MIDGRADE UNLEADED GASOLINE Location within this Facility Unit UNDERGROUND FRONT PARKING STATE TYPE PRESSURE Liquid Mixture ~ Ambient Facility Unit: Fixed Containers on Site ~ Days On Site 365 _ Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 7500.00 GAL nrlarltcl~vuJ ~.vrirvivl:,lv1J %Wt. RS CAS# 100.00 Gasoline No 8006619 i1HG1-1tCL Si.~ JL~J.71~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 01/24/2007 ,_ ~ ^~~ , F 7-ELEVEN 16329 (PACHECO) ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME SUPER UNLEADED GASOLINE Location within this Facility Unit UNDERGROUND FRONT PARKING STATE TYPE, PRESSURE Liquid TMixture Ambient SiteID: 015-021-000807 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 7500.00 GAL riHGL-]tCL V U .7 1,U1~lYUlV ~1V 1 ~ - oWt. RS CAS# 100.00 Gasoline No 8006619 t1HGHKL L~~.7J;aJ1~1J;1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0004 COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Location within this Facility Unit STATE TYPE PRESSURE _ Gas TPure ~-Above Ambient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 124-38-9 TEMPERATURE CONTAINER TYPE Cryogenic INSUL.TANK / CRYOGENIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 425.00 FT3 1275.00 FT3 638.00 FT3 lltiGt]iCLV V.7 L.V1lYV1V L'iV 1.7 %Wt. RS CAS# 100.00 Carbon Dioxide No 124389 I11iGHKL E',.7.71;.7.71~11~,1V 1 ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -6- 01/24/2007 F 7-ELEVEN 16329 (PACHECO) SiteID: 015-021-000807 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE FLAMMABLE LIQUIDS/SOLVENT Days On Site ' ~ 365 ~ Location within this Facility Unit Map: Grid: NEAR TRASH ENCLOSURE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Waste Ambient Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# I 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No t1AGKKL L-~.75L' S~1~1J;1V l TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / UnR ~ Inventory Item 0006 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE ABSORBANT Days On Site 365 Location within this Facility Unit Map: Grid: NEAR TRASH ENCLOSURE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Solid Waste ~mbient ~ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL I 25.00 GAL ru-~~s-ucl~vu~ ~.~1~iru1V>;1V l a oWt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No tlE~G1~tCL 1j. 7.7L" J51~1J;1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / UnR -7- 01/24/2007 F 7-ELEVEN 16329 (PACHECO) SitelD: 015-021-000807 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 10/21/1998 ~ AFTER CALL 911, THE BAKERSFIELD CITY FIRE DEPT WILL BE NOTIFIED ALONG WITH THE CALIFORNIA STATE OFFICE OF EMERGENCY SERVICES 800-852-7550. Employee Notif./Evacuation 04/25/2006 IF TION W ., MADE VE AL ` AND 911/WI~L BE C L LE E O TERIALS , OT THE FI D PT AND ~S-TA3'~ OES . THE STORE ATTENDANT WILL NOTIFY OTHER EMPLOYEES AND CUSTOMERS BY A SHOUT THAT THE BLDG MUST BE EVACUATED. ALL PERSONS MUST EVACUATE THROUGH THE FRONT DOORS TO THE EVACUATION STAGING AREA SHOWN ON THE FACILITY DIAGRAM. Public Notif./Evacuation FIRE DEPT. 10/21/1998 THE STORE ATTENDANT WILL NOTIFY OTHER EMPLOYEES AND CUSTOMERS BY A SHOUT THAT THE BLDG MUST BE EVACUATED. ALL PERSONS MUST EVACUATE THROUGH THE, FRONT DOORS TO THE EVACUATION STAGING AREA SHOWN ON THE FACILITY DIAGRAM. Emergency Medical Plan 10/21/1998 POLICE AND FIRE DEPT OR NEAREST ER IS TO BE USED IN THE EVENT OF INJURY. -8- 01/24/2007 ~ .. ' f'r ~ F 7-ELEVEN 16329 (PACHECO) SiteID: 015-021-000807 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 03/31/2006 ~ S'I'~1NI~RD~ GASQ~IN$~ STATIONf~ETY FEATU~E"S 7tiQR GAS PU~YPS,\ AUTO~'HU'~~FS, NEAR THE STORE COUNTER. THE UNDERGROUND STORAGE TANKS ARE EQUIPPED WITH OVERFILL/OVERSP ON. TANK FLUID LEVELS AND INTERSTITIAL SPACE ARE MO BY A MS 3500 ONITORING SYSTEM. TANK TURBINES ARE EQUIPPED WITH LEAK DETECTORS WHICH RESTRICT FLOW IF A LEAK IS DETECTED BENEATH DISPENSERS OR ALONG PIPING RUNS. ~Y~-ems. ~.a~fi 'f'LS 3sc~ (EMERGENCY FUEL SHUT-OFF SWITCHES ARE LOCATED IN THE FRONT OF THE STORE AND IA' (~~SoIZC'~2~~ LOCATED INSIDE THE STORE AT THE LOCATION SHOWN ON THE FACILITY DIAGRAM, IS TO BE USED FOR SMALL FUEL SPILLS (LESS THAN 5 GAL). THE BAKERSFIELD FIRE DEPT WILL RESPOND TO LARGER FUEL RELEASES BY PLACING SAND OR ABSORBENT ON THE SPILL. Clean Up US ONCE A SPILL HAS BEEN CONTAINED, THE SAND OR ABSORBENT WILL BE CHARACTERIZED AND DISPOSED OF AT A PROPER DISPOSAL FACILITY. ~,_ V V11G1 l~.c .7vut ~.c rlt.. l~1VQl. 1.V11 Release Containment 10/21/1998 VICES. 04/25/2006 -9- 01/24/2007 ~. J ~ F 7-ELEVEN 16329 (PACHECO) SiteID: 015-021-000807 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards 05/09/1995 ~ Utility Shut-Offs 04/25/2006 A) GAS - NE SIDE OF BLDG OUTSIDE B) ELCTRICAL - NE CRNR OF OFFICE C) WATER - STORE FRONT SIDE D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 07/18/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS IN STORE PER FIRE CODE. FIRE HYDRANT - NE CRNR OF LOT ON PACHECO & H ST. Building Occupancy Level 03/31/2006 6 EMPLOYEES -10- 01/24/2007 ~_ c i ~i F 7-ELEVEN.16329 (PACHECO) SiteID: 015-021-000807 ~ Fast Format ~ ~ Training Overall Site ~ .Employee Training 04/25/2006 MR.T~R~~AL SA,E~'P~ DAT L~ O ~ . ,-. S F TRAIN G ROGRAM: THE EMPLOY T~tAINING DONE W N H D NSIS O READ G TH HMMP ITH PECI ATTE TION O T E EM E SE P ~ URES. ~E ESHER T NG IS D~N~ AL Y THE DD~IGI~A ED OPERATOR. MSDS SHEETS ON FILE BEHIND STORE COUNTER. BRIEF SUNIl~IARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED ON THE OPERATION OF THE UST IN A MANNER CONSISTENT WITH BEST MANAGEMENT PRACTICES, EMERGENCY , CONTACT INFORMATION, SPILL/OVERFILL RESPONSE PROCEDURES, HAZ WASTE . PROCEDURES, MONITORING EQUIPMENT OPERATION AND ALARM RESPONSE PROCEDURES. TRAINING IS CONDUCTED ANNUALLY, OR WITHIN 30 DAYS FOR NEW EMPLOYEES, BY THE DESIGNATED OPERATOR.- Rcl~,a 1V1 rul.U1C 11~G nCLU LVL rUI.ULC USC -11- 01/24/2007 4 b°~`u. Ot, 1Nt State of California ~ For.State Use Only `•"; State of Water Resources Control Board "' ~' Division of Clean Water Programs ~~ : . P.O. Box 944212 o,,,op„ ~ Sacramento, CA 94244-2120 (Instructions on reverse side) CERTIFICATION 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: 500,000 dollars per occurrence ~ 1 million dollars annual aggregate or AND or ® 2 million dollars per occurrence ® 2 million dollars annual aggregate e. 7-Eleven. InC. hereby certifies that it is in compliance with the requirements of Section 2807, (Name o_f Tank Owner or Operator) " ~ Califomia Code of Regulations. -- " --` - - - - - - 18, Division 3, Title 23, Article 3, Chapter The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: C. Mechanism ~ ~ ,M_ echansm ~ ~ Coverage Coverage Corrective Third=Party T e Name and.Address of Issuer Numb';e~~ ~` Amount- '= Period . Action , Com Liability Insurance Illinois Union Insurance Co. $2,000,000 per c/o ACE Environmental Risk UST G2379486A Occurrence & 4/30/2007 436 Walnut Street 002 $2,000,000 to Yes Yes Philadelphia, PA 19106 Annual 4/30/2008 Aggregate Note: /f 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 _ -- - °- "_ -=° ~ --- - 7-Eleven #16329 1701 Pacheco Rd., Bakersfield;, CA Facility Name Facility Address 7-Eleven #16549 4647 Wilson Rd., Bakersfield, CA Facility Name Facility Address 7-Eleven #177 1 3601 Stockdale Hwy, Bakersfield, CA / E. Signatur f T Owner r O rator Date Name and Title of Tank Owner or Operator • ~ `~ Randy Martin-Gasoline & Environmental Compliance Mgr. i L 3 Signature of Witness or Notary Date Name of Witness or Notary - - a 3 -O Rachel Rodriguez CFR (Revised 04/95) V ~ FILE: Original -Local Agency Copies -Facility/Site(s) UNDERGROUND STORAGE TANKS A~~1_~~AT~®~ TO PERFORM ELD /LINE TESTING 7 SB989 SECONDARY CONTAINMENT TESTING (TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION Aiy ~~..,~., BAKERSFIELD FIRE DEPT. B Ei b 9F1 A FIRS Prevention Services A1rTM ~' 1600 Truxtun Ave., Ste. 401 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-21? 1 Page 1 of 1 .~ f PERMIT NO. ' ` ~ - '~~''1 ^ ENHANCED LEAK DETECTION ~^y LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING Tnr.lt( Tint-ITNGCR TFCT P4, Tfl PFRF(lRM Fl IFI M/>NIT(IR WC~ CFRTIFICATInN r SITE INFORMATION - FACtLITY 7- Eteveu ~ 11o32R NAME & PHONE NUMBER OF CONTACT PERSON 6~ _ v - - 3 0 ADDRESS ~?n 1 T'gclneco ~.d. C~glcer5~eid °133D1}- _OWNERS NAME _ -_ - --- - - OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? YES ^ NO TANK# VOLUME CONTENTS ~ ~(~nv ~7- ul~~ ~_ ~ °-~©~ g,'7 - ~. ulot~ (stave 3 ~ l0 0o a I - Pf~ecti,~~+ m r-- i .TANK TESTING COMPANY. NAME OF TESTING COMPANY TanICnOIO InC. ~y>' NAME & PHONE NUMBER OF CONTACT PERSON Anthony Cheeks (951) 676-4060 j MAILING ADDRESS ~1~85 Enterprise Circle S, Suete ® Temecula, CA 92590 j NAME & PHONE NUMBER OF WtU.1~0C~cRS TESTER OR SPECIAL INSPECTOR: c~Qt~.77~...q$~3 CERTIFICATION #: CONDUCTED:TEST'TO BE ~~`~/07 ~ ?AM ~ '~~ #~ 52 51 W 2(0 ~^- ~ 1 METHOD SIGNATURE OF APPLIC i DATE: ~t/ZZ/a~ ' ;,, i°.ATL- B G, - ,.F~: QED, APPROVED BY DATE S Q FD 2095 (Rev. 09/05) y, -.m, 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 02/16/2007 Order Number: 3151032 Dear Regulator, Date Printed and Mailed: 03/07/2007 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #16329 MARKET 2133 1701 PACHECO ROAD BAKERSFIELD, CA. 93307 Testing performed: Leak detector tests Line tests Monitor Certification Sincerely, ~~ ~a~~ Dawn Kohlmeyer Manager, Field Reporting TANKNOLOGY CERTIFICATE OF TESTING ~ TdI7/Q~OI~Y 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 TELEPHONE (512) 451-6334 FAX (512) 459-1459 PURPOSE: COMPLIANCE TEST RESULT SUMMARY REPORT TEST DATE: 02/16!07 WORK ORDER NUMBER: 3151032 CUSTOMER PO: CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #16329 P.O. BOX 711 MARKET 2133 DALLAS, TX 75221 1701 PACHECO ROAD BAKERSFIELD, CA 93307 Manager (214)841-6714 (661)834-1350 TEST TYPE: TLD-1 PrnA~~et Pinp Tinhtnass Test Results IMPACT LINE LINE LINE DELIVERY TEST RESULT FINAL LEAK RATE (gPh) VALVE ID PRODUCT MATERIAL TYPE A B C D A B C D FUNCTf©K 1-SLAVE 1 REG UNLEAD 2 2 REG UNLEAD FIBERGLASS PRESSIIRE P 0.000 Y 3 3 PREMIIIM FIBERGLASS PRESSIIRE P 0.000 Y FYistinn I ine 1_eak Detector Test EXISTING LEAK DETECTOR EXI T NG LEAK DETECTOR LINE ID MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # RESULT 1-SLAVE 1 2 2 VEEDERROOT SLECTRONI 152567 P 3 3 VSEDERROOT ELECTRONI 152582 P New Rpnlar_ampnt 1 ina 1 aak Dptc±r_tnr Tact RE LA ED LEAK DETECTOR `#1 REpLA ED LE DET ECTOR #2 LINE MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER "'MODEL # SERIAL # RESUL ID ^ u, vwuc~ uc~aucu ~cpvi~ u,iuuuauu,,, visas www.wnKUViugy.ww anu seiec~ vas-Line icepuru-wrer~r, ur conuicr yuur ~oca~ ianicnoiogy ou~ee. Tester Name: WILLIAM ROGERS Technician Certification Number:1647 ~~s~~ Printed 03/07/2007 08:21 KOHLMEYER INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tan TEST DATE:02/16/07 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3151032 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512)451-6334 SITE:7-ELEVEN #16329 TANK" INFORMATION Tank ID: 2 2 Tank manifolded: YES Bottom to top fill in inches: 145. o Product: REG UNLEAD Vent manifolded: YES Bottom to grade in inches: 154. o Capacity in gallons: 9, 600 Vapor recovery manifolded: YES Fill pipe length in inches: 36. o Diameter in inches: l09 . oo Overfill protection: YES Fill pipe diameter in inches: 4. o Length in inches: 251 Overspill protection: YES Stage I vapor recovery: DUAL Material: Dw STEEL Installed: ATG Stage II vapor recovery: ASSIST CP installed on: / / COMMENTS TANK TEST RESULTS Test Method: VacuTect LEAK DETECTOR TEST RESULTS Test method: FTA Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: VEEDERROOT Ingress Detected: Water Bubble Ullage Model: ELECTRONIC Test time: S/N: 1s256' Open time in sec: inclinometer reading: Holding psi: VacuTect Test Type: NoT Resiliency cc: NOT T VacuTect Probe Entry Point: ESTED Test leak rate ml/m: 1s9. o TESTED Pressure Set Point: Metering psi: 2s Tank water level in inches: Calib. leak in gph: a.oo Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type: Tr.D-1 LINE A B C D Material: FIBERGLASS Diameter (in): 2 . o Length (ft): 200. o Test psi: 50 Bleedback cc: o Test time (min): 3o NOT NOT NOT Start time: 07:45 TESTED TESTED TESTED End time: 08:15 Final gph: 0.000 Result: PASS Pump type: PRESSURE PUmp make: RED JACKET COMMENTS Impact Valves Operational: YES Printed 03/07!2007 08:21 INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tan TEST DATE:02/16/07 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3151032 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #16329 TANK' INFORMATION Tank ID: 3 3 Tank manifolded: No Bottom to top fill in inches: 148. o Product: PREMIUM Vent manifolded: YES Bottom to grade in inches: 157. o Capacity in gallons: 9, 600 Vapor recovery manifolded: YES Fill pipe length in inches: 39.0 Diameter in inches: 109.00 Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 251 Overspill protection: YES Stage I vapor recovery: DUAL Material: Dw STEEL Installed: ATG Stage II vapor recovery: Ass=ST CP installed on: / / COMMENTS TANK TEST RJ`SULTS Test Method:VacuTect LEAK DETECTOR TEST RESULTS Test method: FTA Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: VEEDERROOT Ingress Detected: Water Bubble Ullage Model: ELECTRONIC Test time: S/N: 152582 Open time in sec: Inclinometer reading: Holding psi: VacuTect Test Type: NoT ReSlllency CC: NOT T VacuTect Probe Entry Point: ESTED Test leak rate ml/m: ia9. o TESTED Pressure Set Point: Metering psi: zs Tank water level in inches: Calib. leak in gph: s . 00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST`RESULTS Test type: T~-i LINE A E C D Material: FIBERGLASS Diameter (in): 2 . o Length (ft): 2 0 0 . o Test psi: 50 Bleedback cc: o Test time (min): 30 NoT NoT NoT Start time: 07:45 TESTED TESTED TESTED End time: 08:15 Final gph: o. 000 Result: PASs Pump type: PRESSURE Pump make: RED JACKET COMMENTS Impact Valves Operational: YES Printed 03/07/2007 08:21 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of Califomia Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3 Title 23, Califomia Code of Regulations This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or report must be prepared for each monitoring svstem control panel by the technician who performs the work. A copy of this form must be provided to 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 test date. A. General Information Facility Name: 7-ELEVEN #16329 Site Address: MARKET 2133 1701 PACHECO ROAD Facility Contact Person: Manager Make/Model of Monitoring System:TLS350 PLUS Work Order Number: B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced City: BAKERSFIELD CA Zip: 93307 Contact Phone No: 834-1350 Date of Testing/Service: 02/16/2007 3151032 Tank ID: 87 SIPHON Tank ID: 87 PRIMARY X In-Tank Gauging Probe. Model: MAG 2 X In-Tank Gauging Probe. Model: MAG 2 X Annular Space or Vault Sensor. Model: 420 Annular Space or Vault Sensor. Model: 420 X Piping Sump/Trench Sensor(s). Model: 352 X piping SumplTrench Sensor(s). Model: 352 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: X Electronic Line Leak Detector. Model: PLLD X Tank Overfill/High-Level Sensor. Model: EXT ALARM Tank Ove~ll/High-Level Sensor. Model: EXT ALARM Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). Tank ID: Tank ID: In-Tank Gauging Probe. Model: MAG 2 In-Tank Gauging Probe. Model: X Annular Space or Vault Sensor. Model: 420 Annular Space or Vault Sensor. Model: X Piping Sump/Trench Sensor(s). Model: 208 Piping SumplTrench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: X Electronic Line Leak Detector. Model: PLLD Electronic Line Leak Detector. Model: Tank Overfill/High-Level Sensor. Model: EXT ALARM Tank Overfill/High-Level Sensor. Model: Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). ispenser 1-4 DispenserlD: X^ Dispenser Containment Sensor(s) Model: 352 Dispenser Containment Sensor(s) Model: X^ Shear Valve(s). Shear Valve(s) Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). " If the facility contains 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/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 Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): ~ System set-up X^ Alarm history report Technician Name (print): WILLIAM ROGERS Certification No.: 8520 Signature: ~/`' G~J~~~ License. No.: Testing Company Name: Tanknology Phone No.: (800) 800-4633 Site Address: 8501- N. MoPac Expressway, suite 400, Austin, TX 78759 Date of Testing/Servicing: 02/16/2007 Page 1 of 3 Based on CA form dated 03!01 Monitoring System Certification Monitoring System Certification Site Address: MARKET 2133 Date of Testing/Service: 02/16/2007 1701 PACHECO ROAD D. Results of Testing/Servicing Software Version Installed: 121.00 Complete the following checklist: X Yes ^ No • Is the audible alarm operational? Q Yes ~ No' Is the visual alarm operational? Q Yes ~ No' Were all sensors visually inspected, functionally tested, and confirmed operational? Yes ^ No' Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes ~ No' X N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? ^X Yes ~ No • 0 N/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (check all that apply) ^x Sump/Trench Sensors; ^x Dispenser Containment Sensors. Did you confirm positive shut-down due to Teaks and sensor failure/disconnection? ~ Yes ^ No x0 Yes ~ No • ~ N/A For tank systems that utilize the monitoring system as the primary tank overfill waming device (i.e.: no mechanical overfill prevention valve is instaNed), is the overfill waming alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? so ~~o ~x Yes' ~ 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. Yes, ^X No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) ^ Product; ^ Water. If yes, describe causes in Section E, below. ^X Yes ~ 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 manufacturers' specifications? * In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: REPLACED A 352 SENSOR IN THE 87 PRIMARY TANK PIPING SUMP Page 2 of 3 Based on CA form dated 03/01 Monitoring System Certification Site Address: MARKET 2133 Date of Testing/Service: 02/16/2007 1701 PACHECO ROAD F. In-Tank Gauging /SIR Equipment ^ Check this box if tank gauging is used only for inventory control. ^ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: 0 Yes ^ No' Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes ^ No • Were all tank gauging probes visually inspected for damage and residue buildup? ^x Yes ^ No • Was accuracy of system product level readings tested? Yes ^No' Was accuracy of system water level readings tested? X Yes ^No' Were all probes reinstalled properly? 0 Yes ^No • Were all items on the equipment manufacturers' maintenance checklist completed? ' In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD) : ^ Check this box if LLDs are not installed. Complete the following checklist: Q Yes ^ No' ^N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? Check all that apply) Simulated leak rate: x^ 3 g.p.h ^ 0.1 g.p.h ^0.2 g.p.h Yes ^ No' Were all LLDs confirmed operational and accurate within regulatory requirements? ^X Yes ^No' Was the testing apparatus properly calibrated? ^ Yes ^ No • ^ N/q For mechanical LLDs, does the LLD restrict product flow if it detects a leak? Q Yes ^No' ^ N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? 0 Yes ^No • ^ N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? Yes ^No * ^ N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? Q Yes ^No • ^ N/A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes ^No' Were all items on the equipment manufacturers' maintenance checklist completed? m the Section h, below, tlescnbe now antl when these oefciencies were or will be corrected. H. Comments: Page 3 of 3 Based on CA form dated 03/01 SWRCB, January 2002 Page 1. Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests (af applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN # 16 3 2 9 Date of Testing: 0 2/ 16 / 2 0 0 7 Facility Address: MARKET 2133 1701 PACHECO ROAD, BAKERSFIELD, CA, 93307 Facility Contact: Manager Phone: (6 61) 8 3 4 -13 5 0 Date Local Agency Was Notified of Testing : / / Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY , INC . Technician Conducting Test: WILLIAM ROGERS Credentials: ~ CSLB Licensed Contractor ~ SWRCB Licensed Tank Tester License Type: TANK TESTER License Number: 3 -164 7 Manufacturer Training Manufacturer Component(s) Date Training Expires / / / / / / / / 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repair Spill Box 1 REG FILL ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 1 REG FILL ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 2 REG FILL ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 2 REG FILL ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 3 PRE FILL ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 3 PRE FILL ~ ^ ^ ^ ^ ^ ^ ^ If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: ~~~ ~ Date: 0 2 / 16 / 2 0 0 7 SWRCB,`January 2002 9. SPILL/OVERFILL CONTAINMENT BOXES Page 2 Facility is Not Equipped With SpilUOverfill Containment Boxes: SpilUOverfill Containment Boxes are Present, but were Not Tested: Test Method Developed By: ~ Spill Bucket Manufacturer ~ Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: T- ~ Equipment Resolution: Spill Box # 1 REG FILL ~ _ gpill Box # 1 REG FILL ~ Spil- Box # 2 REG FILL ~ _ _. ___._ ~. Spill Box # 2 REG FILL Bucket Diameter: 11 11 11 11 Bucket Depth: 12 12 12 12 Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS 15 MINS 15 MINS Test Start Time: 8: 4 7 9: 0 6 8: 4 7 9: 0 4 Initial Reading (RI ): 7 7 6 6 Test End Time: 9: 0 2 9:21 9: 0 2 9:19 Final Reading (Rg ): 7 7 6 6 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading (R g - RI) . 0 0 0 01 .0 0 0 01 .0 0 0 0 3 - . 0 0 012 Pass/Fail Threshold or Criteria: . 0 0 2 0 0 . 0 0 2 0 0 . 0 0 2 0 0 . 0 0 2 0 0 Test Result: %~ Pass ~ Fail ~ Pass ~ Fuil ~ Pass ~ Fail ~ Pass ~ Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) S~WRCB,'January 2002 9. SPILL/OVERFILL CONTAINMENT BOXES Page 3 . Facility is Not Equipped With SpilUOverfill Containment Boxes: SpilUOverfill Containment Boxes are Present, but were Not Tested: Test Method Developed By: ~ Spill Bucket Manufacturer Other (Specify) ~ Industry Standard ~ Professional Engineer Test Method Used: ~ Pressure Other (Specify) ~ Vacuum ~ Hydrostatic Test Equipment Used: Equipment Resolution: II.. p Y Spill Box # 3 PRE FILL Spill Box # 3 PRE FZLL Spill Box # Spill Box # Bucket Diameter: 11 11 Bucket Depth: 12 12 Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS Test Start Time: 8 ~ 47 9:04 Initial Reading (RI ): 6 6 Test End Time: 9:02 9:19 Final Reading (RF ): 6 6 Test Duration: 15 MINS 15 MINS Change in Reading (R p- RI) -. 0 0 0 0 4 -. 0 0 0 0 8 Pass/Fail Threshold or Criteria: .00200 .00200 'l'est Result: ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail COmmentS - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:02/16/07 WORK ORDER NUMBER3151032 CLIENT:7-ELEVEN, INC. SITE:'1-ELEVEN #16329 COMMENTS Witness compliance - lines/MC/LD/SB. All tests passed, (.5) hour labor, replaced (1) 352 sensor in the 87 primary tank piping sump, parts billed on WO # 3151383 PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 03/07/2007 08:21 KOHLMEYER ITE DIAGRAM ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 02/16/07 WORK ORDER NUMBER3151032 CLIENT:7-ELEVEN, INC. 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MoPac Expressway, Suite 400, Austin, Texas 78759 Work Order: 31510 3 2 ~,•,~ ~~ ~ .. __ t ..~~ -~ d ~~. . E, .. . ~. :.. .. s z pr.,~ i d.~ ~'. . , ~. " ~.. _ .,:°;~.~_ ~~~ >r ~ .._. , ~_ ,gym .. ~ ~ :_., : ~ ~.. s ':: ;fir ~ ~ ~:• a %.r..~z . ~ .. , ..•., -_ ._., ~3 .. 3. .,.:p ~~. `,.n~ e o Y ' . _ s -i _, +< r a.sw e.z r ~ yE~ 3 ~ R_ „ ,.' ~? +F 1 `. Y I . '~` ~, a z ~ -. .. a ,V c ~ _ .. 'a.. ~:c. ~ t w. ~ ~ ~ ~, ~.«f ~ i ~ a .m .> ~ ~ -~ ~-ta=~ _ •' .,~, :~ a~. ~, ~< ti _ -.. ,. , . . L > -a- a?s x3 _ y .- t • A. .~ 15,b ~__ a,: _/ .e„. ..c .. K w. _- r a e ~ xr~.r _.. +.. 4 ~ v 3 wf.'t H~n+..'cdx ..a .. .. .»_. .. ,. .~t: .. ___ vr s, # s v q.... a~' e a ~ I f .: <Jd as •. _- e~t'R ~' _ oYJ -y, ~~ ~ ~ iHY"t a~`.D;S i~ ~:Z_~. '~P:. ~ N 5i~ [,&re"f (. h . ., ... .. » .._ ~n _ ,. _~,_. ,... <.-~ r x =ref e=.. ... t ~~ i _ ~~ _. _. ~. ~ x t. , er i~..,.. ~, # r - 3 ~ ~ s gr, a. ~ ~ ; j. ~ ed e. __ >: .. , Tanknology Inc. 8501 N. 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F ~~~ Y ¢ ,~ ~ r :11w, II Aga d , t. ~ a sp 3 y r ww .,.. g .. tN%...~t 4~ A w xn o ~ ~ ? r ,~ ~ , __ n #av _ ~. m .Y a e _ .,. ~` Tanlrnology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 i Work Order: 31510 3 2 ~. ~g .w =- r > - _ ,_ ~~~: ~ ~~ J. _ o~ ayR i. i ti~,Q - '4'~ . i _ ~ r . ..~_ ~ _ _ ~t _ ra .- ~ -- , F C_ ~~ , <dt 63.x. ~~ %~= u ~ ~r _ ~ s i~A. • r-\a cl ,r ..„}ram t~F. t >3W P~ T" .'~ Y' s a si. t. t ~ w &n ~ r - 4 *i .dV rte"(,". a .. ..., f~ s v. 3'+i..3~*,R;~? r <s~ ~ 3 .f t :.oa .,,... ~ r- _ 1 f4~K~'w,o PP (~ ~t : _ .... .:,... ..~ . ..... . 1, si," ~.~ 1. «. ~ jl e.di}{ ~Y r ~b g'1 f A r _ . ~ ~. ~d sus s 1 `+~S^'} _ . .. '.T > e _„ < ~. ~. :mi a ~_ ..rte _ , ~. - ~~ .. Y. .7 y .t _ .. t - _ ~. ~ _ ~c= _Y ~~ ~' ... - ~ : <s; s~~ - ~`t~ _ ' ~'~S i ~?t+5e3 ~'~r.* 3 ~a`_ ~.:' a#.Arj. C'>`:r, _ b ,J.hkr w n~, .. ~ . r .. .~ ."~ _ % .. .-; > - "x w .. .. ,_. - . . v 3 jai, . ~ g 4:::- Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 ~, c Work Order: 31510 3 2 - _ _ - 3 - ... ..z .. xyk ~'~' c... ~, ~ . ~..Y ..- ...ti > is .. >, .. : w .x ~~ ~~~ t 5-.. >, ~c~~ W ~i ~~~ ... 4 ~ j r '= ~..'~-;~ .t.~~ ', r.:~t~ r~a ~~~:;~~ `o ~~ r __• ~ ~, J,,~;~ M ~ e 3~ g.Ht~~ x , x ~~z,• e,i,P _ .. Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: 7-Eleven #16329 Facility ID #: 235038 Facility Address: 1701 Pacheco Rd. Bakersfield, CA 93304 Reason for Submitting this Form (Check One) ©Change of Designated Operator Facility Phone #: 661-834-1350 ^ Update ICC # and/or Expiration Date Designated UST Operator(s) for this Facility Primar9 (Optional) Designated Operator's Name: John Ablakat Relation to UST Facility (Check One) Business Name (If d~erent from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician ^D Third-Party International Code Council Certification #: 5279288-UC Expiration Date: 03/09/2008 ALTERNATE 1 (Optional) Designated Operator's Name: Tony Mansour Relation to UST Facility (Check One) Business Name (If d~erent from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician ©Third-Party IntemationaI Code Council Certification #: 5269136-UC Expiration Date: 11/17/2007 ALTERNATE 2 (Optional) Designated Operator's Name: Sarkis Zoumalan Relation to UST Facility (Check One) Business Name (If d~erent from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician ®Third-Party International Code Council Certification #: 5238439-UC Expiration Date: 07/09/2008 1 certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f). Furthermore, I understand and am in compli~'ce with the~requirements (statutes, regulations, and local ordinances) applicablg~tO undergroun~'storage tanks. NAME OF TANK OWNER (Please Print): 7-EL~ 1~ Y MARTIN SIGNATURE OF TANK OWNER: DATE: 2/15/2007 OWNER'S PHONE #: (253) 796-7170 November 2004 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements -continued ALTERNATE 3 (Optional) Designated Operator's Name: Kevin Watermolen Relation to UST Facility (Check One) Business Name (lf different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 916-212-7973 ^ Service Technician O Third-Party International Code Council Certification #: 5250470-UC Expiration Date: 12-21-2008 ALTERNATE 4 (Ontionall Designated Operator's Name: Jessica Tuttle Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 831-537-7663 ^ Service Technician ~ Third-Party International Code Council Certification #: 5286530-UC Expiration Date: 07-03-2008 ALTERNATE 5 (Optional) Designated Operator's Name: Jim Palmer Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 831-840-5235 ^ Service Technician ~ Third-Party International Code Council Certification #: 5254109-UC Expiration Date: 2-21-2007 ALTERNATE 6 (Optional) Designated Operator's Name: Brian Ellsworth Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 707-815-251 I ^ Service Technician x^ Third-Party International Code Council Certification #: 5263224-UC Expiration Date: 7-7-2007 ALTERNATE 7 (Optional) Designated Operator's Name: Aaron Celaya Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 510-364-0385 ^ Service Technician ^D Third-Party International Code Council Certification #: 5246905-UC Expiration Date: 01-20-2007 ALTERNATE 8 (Optional) Designated Operator's Name: Darrell Riley Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 619-206-8379 ^ Service Technician ~ Third-Party International Code Council Certification #: 5248975-UC Expiration Date: 11-29-2008 ALTERNATE 9 (Optional) Designated Operator's Name: Darren Austin Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 858-699-2751 ^ Service Technician x^ Third-Party International Code Council Certification #: 5250436-UC Expiration Date: 11-11-2008 ALTERNATE 10 (Optional) Designated Operator's Name: Eric Banghart Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #:310-467-2529 ^ Service Technician ^D Third-Party International Code Council Certification #: 5250118-UC Expiration Date: 11-9-2008 ALTERNATE 11 (Optional) Designated Operator's Name: Blake Herness Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 951-288-1519 ^ Service Technician x^ Third-Party International Code Council Certification #: 5249180-UC Expiration Date: 12-12-2008 February 15, 2007 BAKERSFIELD FIRE DEPARTMENT 900 TRUXTUN AVENUE, SUITE 210 BAKERSFIELD, CA 93301 RE: Statement of Compliance and Designated Operator Dear Sir or Madam: Gilbarco/Veeder-Root, acting as the authorized agent of Safeway/Vons is submitting on behalf of the company, the attached Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of Compliance with UST Regulations for the subject fuel facility to register this site and Designated Operators with the county. The owner understands that with the submission of this document, Gilbarco/Veeder-Root is stating, on behalf of Safeway/Vons that each location is in compliance with all applicable UST regulations. Further, as specified in regulations Title 23, Section 2715 (c)-(f), the individuals listed as designated operators for the location will complete and document a monthly inspection to be maintained in accordance with the applicable requirements. Each statement of compliance being submitted herein is based on: (1) Gilbarco/Veeder- Root reasonable and good faith review of facility operations to evaluate compliance with applicable UST regulations, as well as information provided by facility operations as of the date the statement of compliance is made, and (2) Gilbarco/Veeder-Root's understanding of the applicable UST regulations and requirements as of the date the statement of compliance is made. Should you have any questions or require further information please do not hesitate to contact me at (303) 986-8011. Sincerel ~~,;~ Sherry Peczka Designated Operator Program Manager Gilbarco/Veeder-Root Enclosures