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HomeMy WebLinkAboutBUSINESS PLAN (2)~a~ " i ~~1~, ~l ;~ ~, W ~~ ~~ ~ ~l ~'i ~~ '~ ~~ HOWARDS MINI MARKET i, n 3200 PANAMA LN ~ ~ r, ~~~ _.-_,i v1 ,ri ~ . t ~.~ HOWARDS 351 SiteID: 015-021-000706 Manager CHONG TAE & UNKYONG CHOW Location: 3200 PANAMA LN City BAKERSFIELD BusPhone: (661) 833-1561 Map 123 CommHaz Moderate Grid: 24C FacUnits: 1 AOV: CommCode: BFD STA 13 EPA Numb: SIC Code:5541 DunnBrad:l7-364-9625 Emergency Contact / Title Emergency Contact / Title ANDREW SIMMONS / OPERATOR JACO OIL / TANK OWNER Business Phone: (661) 900-8851x Business Phone: (661) 393-7000x 24-Hour Phone (661) 559-9435x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact R CRAIG LINCOLN Phone: (661) 393-7000x MailAddr: PO BOX 82515 State: CA City BAKERSFIELD Zip 93380-2515 Owner JACO HILL Phone: (661) 393-7000x Address PO BOX 82515 State: CA City BAKERSFIELD Zip 93380-2515 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST t3ased on my 'n~~uiry ofi those individual, Pesponsi~;ls for obtaini ng fife information, I certify under penalty of Iav~r that I hav e personally examined and am familiar with the information submitted and beli eve the information is true, accurate. ~~-°,,,,,,,N~`,Q Signature -" - / -7 - 7 ~ Dat~ ` / ENT's ~~ ~ 0 '~ ~~~~ -1- 07/12/2007 F HOWARDS 351 SiteID: 015-021-000706 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: HOWARDS 351 Cross Street Business Type: Org Type: Total Tanks 4 IndnRes/Trust: No PA Contact: Dsg Own/Oper EDWIN MICHELE ICC Nbr: 5258845-C PROPERTY OWNER INFORMATION Name JACO OIL Phone: (661) 393-7000x Address: City Type CORPORATION Name JACO OIL Address: City Type CORPORATION BOE UST Fee# 019753 Financ~l Resp: SELF INSURED Legal Notif Date:04/28/2000 Name:ANDREW SIMMONS State UST # State: Zip: TANK OWNER INFORMATION Phone: (661) 393-7000x State: Zip: Phone : (13 2 ) 6 - Tt1:OPERATOE 1998 Upg Cert#: 00774 x -2- 07/12/2007 F HOWARDS 351 SiteID: 015-021-000706 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP REGULAR UNLEADED GASOLINE F IH DH L 12000.00 GAL Mod REGULAR UNLEADED GASOLINE F DH L 12000.00 GAL Mod PREMIUM UNLEADED GASOLINE F DH L 12000.00 GAL Mod DIESEL #2 F IH DH L 12000.00 GAL Low -3- 07/12/2007 -4- 07/12/2007 F HOWARDS 351 SiteID: 015-021-000706 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME REGULAR UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 LiTA1.d Mixture PRESSURE TEMPERATURE CONTAINER TYPE qu' T -~mbient ~ Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest 12000100rGAL Dai112000100m GAL I Daily5000r00e GAL ntiGtittLVUJ ~.v1~1rv1vrlvtS %Wt. RS CAS# 100.00 Gasoline No 8006619 IlEiGEitCL 1-1.7 A~.7 A1~1~1V 1J 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 REGULAR UNLEADED GASOLINE Location within this Facility Unit UST STATE - TYPE PRESSURE Liquid Mixtur~ 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 12000.00 GAL 12000.00 GAL. 6500.00 GAL ru-auruu~vvo ~.vi•irvi~rl~t5 °sWt. RS CAS# 100.00 Gasoline No 8006619 i"L[y[~t]iCL ti. 7.7 P~w7 iJl"1LilV1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod -5- 07/12/2007 >~ F HOWARDS 351 SiteID: 015-021-000706 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 Liquid TMixture ~mbient~E ~ AmbientT~E UNDEROGROIINDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 12000.00 GAL 12000.00 GAL 3000.00 GAL titac~t~tcLUU~ ~~rirulvnlvi~ %Wt. RS CAS# 100.00 Gasoline No 8006619 ti1~GH2CL L~~5~J~1~1~1V 1 ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME DIESEL #2 Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 68476-34-6 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture~Ambient Ambient -~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL 3000.00 GAL nric~rucLVUa 1,V1~1rV1Vr,1V1.7 oWt. RS CAS# 100.00 Diesel Fuel No. 2 No 68476302 I1L~iLrEitCL 1-1~7.7r,JJ1~1r,1V 1.7 TSecret RS BioHaz RadioactivejAmount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -6- 07/12/2007 F HOWARDS 351 SiteID: 015-021-000706 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 07/27/2006 ~ CALL 911 AND,IF NEED,CALL STATE EMERGENCY OFFICE 800-852-7550 OR 619-262-1621. Employee Notif./Evacuation 05/01/2007 DIAL 911. SHUT OFF (IF POSSIBLE) MAIN POWER BREAKER. EVACUATE THEMSELVES AND ANYONE IN OR AROUND PREMISES. NOTIFY NEIGHBORS TO EVACUTATE, IF NECESSARY. Public Notif./Evacuation 07/27/2006 NOTIFY NEARBY RESIDENTS AND SURROUNDING FACILITIES. Emergency Medical Plan 03/31/2006 CALL 911, MEMORIAL URGENT CARE, 6501 MING AVE, 397-4004 OR MERCY HOSPITAL, 2215 TRUXTUN AVE, 327-3371. -7- 07/12/2007 P HOWARDS 351 SiteID: 015-021-000706 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 05/01/2007 AREAS ARE KEPT CLEAR OF COMBUSTIBLE PRODUCTS. PUMPS HAVE EMERGENCY SHUT-OFF SWITCH. ABSORBANT MATERIAL KEPT ON PREMISES. 9 Release Containment 11/02/2000 SMALL SPILLAGE, SHUT DOWN MAIN SWITCH, CLEAN AREA, DISPOSE (IF NEEDED) OF HAZARDOUS MATERIAL MAJOR SPILLAGE, NOTIFY FIRE DEPT FOR ASSISTANCE, CALL OPERATIONS MANAGER 393-7000. Clean Up 05/01/2007 VEHICLE OVERSPILLS, SMALL SPILLAGE: CLEAN AREA, IF NEEDED, DISPOSE OF MATERIALS AS INSTURCTED. DRIVE-OFF WITH NOZZLE: SUBSTANTIAL SPILL, SHUT ENTIRE SYSTEM. VEHICLE DAMAGE TO PUMP: SHUT DOWN POWER TO PUMPS, CLEAN AREA, IF POSSIBLE, CALL OPERATIONS MANAGER. ADJACENT BUILDING ON FIRE: SHUT DOWN ENTIRE GAS ISLAND EMERGENCY CONTROL SHUT-OFF, FIRE DEPT WILL ADVISE TO RESUME NORMAL OPERATIONS. Other Resource Activation 12/01/1994 NOTIFY DISTIRCT (OPERATIONS) MANAGER TO CALL OUT RESPONSE EMERGENCY PERSONNEL. -8- 07/12/2007 ,. F HOWARDS 351 SiteID: 015-021-000706 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~Nc~:lal na.~aiua Utility Shut-Offs 05/01/2007 ELECTRICAL - SE CRNR OF BLDG WATER - SE CRNR OF BLDG SPECIAL - GASOLINE SHUT-OFF INSIDE BLDG ON GAS CONSOLE Fire Protec./Avail. Water 07/27/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - NE CRNR PANAMA & WIBLE. Building Occupancy Level 03/31/2006 8 EMPLOYEES -9- 07/12/2007 . ~~ F HOWARDS 351 SiteID: 015-021-000706 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/01/2007 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES ARE TRAINED AND AWARE THAT IN THE EVENT OF AN EMERGENCY THEY ARE TO: SHUT OFF (IF POSSIBLE) THE MAIN BREAKER; EVACUATE THEMSELVES AND ANYBODY IN OR AROUND THE PREMISES; DIAL 911; NOTIFY CLOSE NEIGHBORS TO EVACUATE IF NECESSARY; AND NOTIFY EMERGENCY RESPONSE TEAM. rayC ~ Held for Future Use aiciu ivi i• u~.uic roc -10- 07/12/2007 '~ ~~~~1 _ HOWARDS 351 SiteID: 015-021-000706 Manager CHONG TAE & UNKYONG CHOW Location: 3200 PANAMA LN City BAKERSFIELD CommCode: BFD STA 13 EPA Numb: BusPhone: (661) 833-1561 Map 123 CommHaz Moderate Grid: 24C FacUnits: 1 AOV: SIC Code:5541 DunnBrad:17-364-9625 Emergency Contact / Title Emergency Contact / Title ANDREW SIMMONS / OPERATOR JACO OIL / TANK OWNER Business Phone: (661) 900-8851x Business Phone: (661) 393-7000x 24-Hour Phone (661) 559-9435x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact R CRAIG LINCOLN Phone: (661) 393-7000x MailAddr: PO BOX 82515 State: CA City BAKERSFIELD Zip 93380-2515 Owner JACO HILL Phone: (661) 393-7000x Address PO BOX 82515 State: CA City BAKERSFIELD Zip 93380-2515 Period to TotalASTs: = Gal Prepares: TotalUSTs: = Gal Certif'd: _ RSs:. No. ParcelNo: Emergency Directives:. ,^ ' I PROG A - ~ HAZMAT ~~U~ PROG U - , UST ~Y ~ Ear D ~ A~ o i 200 (3ased on my inquiry of those individunl~ responsible for obtaining the informa tion, I Cortify under penalty of law that I have per~pn~lly examined and am familiar with the information submitted and believe the informa tion is true, accurate, and com lete. _ ' y~°,L" ~ ignature Date -1- 04/16/2007 F HOWARDS 351 SiteID: 015-021-000706 ~ - STORAGE CONTAINER DATA (UST FORM A) Last Action Type: - FACILITY/SITE INFORMATION Business Name: HOWARDS 351 Cross Street Business Type: Org Type: Total Tanks 4 IndnRes/Trust: No PA Contact: Dsg Own/Oper EDWIN MICHELE ICC Nbr: 5258845-C PROPERTY OWNER INFORMATION Name JACO OIL Phone: (661) 393-7000x Address: City State: Zip: Type CORPORATION Name JACO OIL Address: City Type CORPORATION BOE UST Fee# 019753 Financ'1 Resp: SELF INSURED Legal Notif Date:04j28/2000 Name:ANDREW SIMMONS State UST # TANK OWNER INFORMATION Phone: (661) 393-7000x State: Zip: Phone: (132) 6 - Ttl:OPERATOE 1998 Upg Cert#: 00774 x -2- 04/16/2007 F HOWARDS 351 SiteID: 015-021-000706 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP ~c~f~v'' ~~le ~:aD~iA.~~ F IH DH L 12000.00 GAL Mod ~~ ~ pcl per- ~,v ~C~l~ c~(a~a 1 ~iv~ F DH L 12 0 0 0 . 0 0 GAL Mod , PREMIUM ~tj~~'~`i4~ d ~~~ ~~ F DH L 12 0 0 0. 0 0 GAL MOd ~~ e,G ~~ - -- F IH DH L 12 0 0 0 . 0 0 GAL Mod -3- 04/16/2007 r "`~.~ -4- 04/16/2007 F HOWARDS 351 SiteID: 015-021-000706 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME REGULAR ~'~C~~ l'N ~ Days On Sit e y 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~mbient ~ Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest 12000100rGAL Dai112000100m GAL Daily5000r00e GAL t1AGLitCLVUJ 1:V1~lYV1V1a;1V1J %Wt. RS CAS# 100.00 Gasoline No 8006619 t1L~GHKL HJ J~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 ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME REGULAR f~CN ~ ~~ed ei~°~1'rv ~- Days On Site 365 Location within this Facility Unit Map: Grid: UST CAS# 8006-61-9 STATE TYPE PRESSURE Liquid Lixtur~mbient ~ TEMPERATURE CONTAINER Ambient -~ER GROUND TYPE TANK AMOUNTS AT THIS LOCATION .Largest Container Daily Maximum ~ Daily Average 12000.00 GAL 12000.00 GAL 6500.00 GAL I1HGL'iLCLVUJ 1.V1~lYV1Vr,1V1.7 °sWt . RS CAS# 100.00 Gasoline No 8006619 t31iGKCCL 1-]J J~J.71.1P~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod -5- 04/16/2007 F HOWARDS 351 ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME PREMIUM (~/~~xo%~ G~i~o1/.~G Location within this Facility Unit UST STATE TYPE PRESSURE Liquid TMixture~ Ambient SiteID: 015-021-000706 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient -~ER GROUND TANK AMOUNTS AT THIS LOCATION - Largest Container Daily Maximum Daily Average 12000.00 GAL 12000.00 GAL 3000.00 GAL • tiE~G1~tC1lVUJ 1;V1~lYV1V~1V"1"5 %wt. Rs cAS# 100.00 DIESEL FUEL NO. 2 No 68476302 t1HGF]tClJ L~J J~JJ1~1r;1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mod ~ Inventory Item 0004 COMMON NAME / CHEMICAL NAME Location within this Facility Unit UST STATE TYPE PRESSURE Liquid TMixtur~ Ambient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS_# ~~~/7CP : 3l to TEMPERATURE CONTAINER TYPE Ambient -~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 12000.00 GAL 12000.00 GAL 3000.00 GAL nrjGKttUVUJ l,ul~lrvlv~lvl.7 %Wt. 10 0 . 0 0 _ .~ frc.,~ ~^ ~ RS No CAS# - - -- riE~LG1~KL 1-155~~J1~1~1V"1"~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -6- 04/16/2007 P HOWARDS 351 SiteID: 015-021-000706 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 07/27/2006 ~ CALL 911 AND,IF NEED,CALL STATE EMERGENCY OFFICE 800-852-7550 OR 619-262-1621. Employee Notif./Evacuation 07/27/2006 A. DIAL 911. B. SHUT OFF (IF POSSIBLE) MAIN POWER BREAKER. C. EVACUATE THEMSELVES AND ANYBODY IN OR AROUND PREMISES. D. NOTIFY NEIGHBOR(S) TO EVACUTATE, IF NECESSARY. Public Notif./Evacuation NOTIFY NEARBY RESIDENTS AND SURROUNDING FACILITIES. 07/27/2006 Emergency Medical Plan 03/31/2006 CALL 911, MEMORIAL URGENT CARE, 6501 MING AVE, 397-4004 OR MERCY HOSPITAL, 2215 TRUXTUN AVE, 327-3371. -7- 04/16/2007 S '} F HOWARDS 351 SiteID: 015-021-000706 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 07/27/2006 ~ AREAS ARE KEPT CLEAR OF COMBUSTIBLE PRODUCTS. PUMPS HAVE EMERGENCY SHUT-OFF SWITCH. ABSORBENT MATERIALS KEPT ON PREMISES. Release Containment 11/02/2000 SMALL SPILLAGE, SHUT DOWN MAIN SWITCH, CLEAN AREA, DISPOSE (IF NEEDED) OF HAZARDOUS MATERIAL MAJOR SPILLAGE, NOTIFY FIRE DEPT FOR ASSISTANCE, CALL OPERATIONS MANAGER 393-7000. Clean Up 07/27/2006 VEHICLE OVERSPILLS, SMALL SPILLAGE: CLEAN AREA, IF NEEDED, DISPOSE OF MATERIALS AS INSTURCTED. DRIVE-OFF WITH NOZZLE: SUBSTANTIAL SPILL, SHUT ENTIRE SYSTEM. VEHICLE DAMAGE TO PUMP: SHUT DOWN POWER TO PUMPS, CLEAN AREA IF POSSIBLE, CALL OPERATIONS MANAGER. ADJACENT BUILDING ON FIRE: SHUT DOWN ENTIRE GAS ISLAND EMERGENCY CONTROL SHUT-OFF, FIRE DEPT WILL ADVISE TO RESUME NORMAL OPERATIONS. Other Resource Activation 12/01/1994 NOTIFY DISTIRCT (OPERATIONS) MANAGER TO CALL OUT RESPONSE EMERGENCY PERSONNEL. -8- 04/16/2007 F HOWARDS 351 SiteID: 015-021-000706 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~YC~iai nu~aiu~ Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - SE CRNR OF BLDG C) WATER - SE CRNR OF BLDG D) SPECIAL - GASOLINE SHUT-OFF INSIDE BLDG ON GAS CONSOLE E) LOCK BOX - NO 03/31/2006 Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - NE CRNR PANAMA & WIBLE. 07/27/2006 Building Occupancy Level 03/31/2006 8 EMPLOYEES -9- 04/16/2007 ~.. F HOWARDS 351 SiteID: 015-021-000706 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/01/2007 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUNIMARY OF TRAINING PROGRAM: ALL EMPLOYEES ARE TRAINED AND AWARE THAT IN THE EVENT OF AN EMERGENCY THEY ARE TO: SHUT OFF (IF POSSIBLE) THE MAIN BREAKER; EVACUATE THEMSELVES AND ANYBODY IN OR AROUND THE PREMISES; DIAL 911; NOTIFY CLOSE NEIGHBORS TO EVACUATE IF NECESSARY; AND NOTIFY EMERGENCY RESPONSE TEAM. rayc a nciu .~vi r ui.uic vac nclu .~vi ru~.uic lJSC -10- 04/16/2007 .a35/ Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Howard's #4 (Exxon) Facility ID #: 46941 Facility Address: 3200 Panama Lane, Bakersfield, CA 93312 (City) Reason for Submitting this Fonn (Check One) ^ Change of Designated Operator Facility Phone #: 661-833-1561 X Update Certificate Expiration Date Designated UST Operator(s) for this Facility PRIMARY Designated Operator's Name: Douglas M. Young III Relation to UST Facility (Check One) Business Name (If different from above): Confidence UST Services, Inc. ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 800-339-9930 ^ Service Technician x Third-Party International Code Council Certification #: 0878646-UC Expiration Date: September 22, 2008 ALTERNATE 1 O tional Designated Operator's Name: Jennifer Davis Relation to UST Facility (Check One) Business Name (If different from above): Confidence UST Services, Inc. ^ Owner ^ Operator ^ Employee _ - _ __ Designated Operator's Phone #: 800-339-9930 ^ Service Technician x Third-Party International Code Council Certification #: 5252886-UC Expiration Date: March 15, 2009 ALTERNATE 2 (Optional) Designated Operator's Name: Edward Mitchell Relation to UST Facility (Check One) Business Name (If different from above): Confidence UST Services, Inc. ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 800-339-9930 ^ Service Technician x Third-Party International Code Council Certification #: 5258845-UC Expiration Date: May 15, 2008 I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f). Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please Print): deco Hell Co. SIGNATURE OF TANK OWNER ('~~~ ~ ~-~` DATE: March 23, 2007 `~~ OWNER'S PHONE #: 661-393-7004 NOTE: I) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY JANUARY 1, 2005. THE LOCAL AGENCY LIST IS AVAILABLE AT: www.waterboards.ca.gov/ust/contacts/cu~a ~s.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 .'a.tD ~ P~~w4~' ``~~~\ CITY OF BAKERSFIELD FIRE DEPARTMENT `6 ~ ~ ro; OFFICE OF ENVIRONMENTAL SERVICES ~~ y.` UNIFIED PROGRAM INSPECTION CHECKLIST \~w ~gtip'~~ 1715 Chester Ave., 3~d Floor, Bakersfield, CA 93301 ,~~~ FACILITY NAME `~bQ 1dR'1 ~ INSPECTION DATE I-.~ Z Section 2: Underground Storage Tanks Program ^ Routine Combined ^ joint Agency ^ Multl-Agency ^ Complaint ^ Re-inspection Type of Tank S.~JL C (` ~Q J Number of Tanks 3 Type of Monitoring ~(~ Type of Piping _SUl S ~ C`. ~ OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data on the Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks 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: Oftice of Environmental Services (805) 326-3979 Business Site Re ponsible Party white - ('nv. Svcs. Pink -Business Copy UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY AME ~ ~ INSP TI N DATE INSPECTION TIME ~ a ~r -- __ ADDRESS ~ ------ ----- --- - - - - ----_ _------ _---- - - ---- `a ~ ~- -- ----- ------- . PHONE N No. of Employees FACILITYCONTACT Business ID Number 15-021- Section 1: Business Plan and Inventory Program ^ Routine ombined ^ Joint Agency ^Mutti-Agency ^ Complaint ^ Re-inspection ~% ~ \V=Voationnce) OPERATION COMMENTS T~J/ APPROPRIATE PERMIT ON HAND ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS CORRECT OCCUPANCY I ^ VERIFICATION OF INVENTORY MATERIALS VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION '4J/ L^. PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITYE ^ VERIFICATION OF FIAT MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~^ EMERGENCY PROCEDURES ADEQUATE ^ ^ CONTAINERS PROPERLY LABELED _.._ ---- - ---- - - ----_ ----- -- - ----- ----t -- -- --- ---- ___. -- --. .. .. ___ ___ __ ^ I-'IOUSEKEEPING ~^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: ^ YES EXPLAIN: IUESTION EGARDIN ~ T INSPECTIONS PLEASE CALL US AT ~GC'I ~ 326-3979 Inspec or ea ge No., White -Environmental Services Yellow • Slatbn Copy Business Site Respo ible Party Pink • Business Copy = ,~ .;~- + HOWARDS 351 _________________________________________ SiteID: 015-021-000706 + Manager :~ CHONG TAE & UNKYONG CHOW BusPhone: (661) 833-1561 Location: 3200 PANAMA LN Map 123 CommHaz Moderate City BAKERSFIELD Grid: 24C FacUnits: 1 AOV: CommCode: BFD STA 13 SIC Code:5541 EPA Numb: DunnBrad:17-364-9625 Emergency Contact / Title Emergency Co tact / Title CHONG TAE CHON / OWNER ~ • e~''t,,°-~ / OPS MANAGER Business Phone: (661) 900-8851x Business Phon~f"661) 393-7000x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact ~ . l_..r~ IV~ ~~~~) /J Phone : ( 6 61) 3 9 3 - 7 0 0 0 x MailAddr: PO BOX ~9-'~. g0•~~5 State: CA City BAKERSFIELD Zip X3.3-@-3-lj~$Q +-Owner-----rvn*Tn TTD r. ~ „>~Tni~Tr runrT~~'{W ~l r------Phone. (661) ---------X-----+ Address State: CA City BAKERSFIELD Zip Period to Preparers Certif~d: ParcelNo: TotalASTs: _ TotalUSTs: _ RSs: No Gal Gal Emergency Directives: PROG A - HAZMAT ~ PROG U - UST L ~~ V~ Based ~~ rriy inpulry of th©se individuals respo~Rif~-~ for o-~talnEng the Informatinon, I certify under penalt o4 law that I have personally examined arld am famltlar with the Information submitted and la~lfeve the Information is true, accurate, and complete. ENT'D J U L 2 7 2006 ES~bq~ I S ~~~ Signature - Date -1- 03/31/2006