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HomeMy WebLinkAboutUST-REPORT 11/8/2006" -"~VDERGROUND STORAGE TANKS) FILE # ,. ~~, ~ SHELL SERVOCE STATION ~ . ~. ;, - -- _- ~ ~~ 3605 ROSEDALE HWY. .~ -- - - . p •A F -~. C• ,\ i ~~~~ ~ - .- '-~ --- - ~ 1~ I~ \~ !~' 1~~ `,~~ _ ~. 1 _ '~`~ 1 y :5 `~, `{' ~- ' _;~z ~~ '~ :~ i ~ ~ . '.~ ~~ ~. ~,, ~~ ,; . ,. .~~. . ~~ .~ ry,~,! .~ ~~~ ~o 14,` UNDERGROUND STORAGE TANK MONITORING PROGRAM EMERGENCY RESPONSE PLAN (FORM) Page 1 of 1 B E R 5 F I D w/R! ARTM T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661)326-3979 Fax.: (661) 852-2171 This monitoring program must be kept ai the UST location at al limes. The information on this monitoring program are conditions of the operating pemtit. The permit holder must notify the Office of Prevention Services within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(dJ and 2641(h) CCR. FACILITY NAME ,~~c..l ~ FACILITY ADDRESS R c a~~. ~ ~ IF AN UNAUTHORIZED RELEASE OCCURS, HOW W ILL 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 THE OFFICE OF PREVENTION SERVICES MUST BE NOTIFIED WITHIN 24 HOURS. !pp ~ ~ I„Q~ { S~~ 1ls ~LJ~ ~ 0~ (Xt`t a~o~~pav~~~- 'f'0 ~~~t, a~ S~c~S ~rfL ~~p~(,l5 ~t (~ ` I I DESCRIBE THE PROPOSEDD METHODS AND EQUIPMlE-NT TO BE USED,F[O~R REMOVING AND PROPERLY DISPOSING OF ANY HAZARDOUS SUBSTANCE. DESCRIBE THE LOCATION AND AVAILABILITY OF THE REQUIRED CLEANUP EQUIPMENT IN ITEM ABOVE. ~}~Sotl~~~k g~~b Itic~} C.aS~~cr DESCRIBE THE MAINTENANCE SCHEDULE FOR THE CLEANUP EQUIPMENT: ,1~ f _ ~Ct, ~0.`(~ O / ~, „ ~ ~~~ r ~r ^ ~~ ~ I~ ----- LIST THE NAME(S) AND TITLE(S) OF THE PERSON(S) RESPONSIBLE FOR AUTHORIZING ANY WORK NECESSARY UNDER THE RESPONSE PLAN: ~ I NAME ~ ~ ~~~ TITLE , / L' IN ~ ~ t~ NAME TITLE NAME ~ TITLE NAME ^---- - ------ ~ TITLE `-------------- NAME TITLE FD2074b (Rev. ovosl . _..._,..._, . ,. _ .. ~....._..Kw..._ Steve Underwood Flnanctal Res onstblli Form 1 df Pa a 2,, ,~. _... _ _~. ... __.._~_.._. ., ...~ ,.w__.P _.._. ~tY__...,., .P.. ... ... _ ~ r..~ _ ... ~~.. ..... .. . ... .. ~ . __.. .._,..._v„_..~........._.._.9 _,.~, Sate d C2lifmia For Sae Use'Chly . State of Water Resarces Cmtrd Board Divisor d` Rrgncial A~s~nce P.O. Sic 9A42'12 Saramato, CA 94244-2120 ,. (I nStfUCt10n$On fENBSeSIde) ,~ ' '. CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. Iamregiiredtodarat9rateFrencialR~or~tility inlherec~iredamarLsas~edfiedinSection2807,Cf~a18,Div.3,Tit1e23,CCR ^ 500,000 ddlars pa oaxrrence ^ 1 minim ddlars arrtel ~g-e~ cr AND a ~millim ddlars rerrwe ^ 2 minim ddlars amd a e are er c g p ~g o ar B. ~ L C d hereby certifies that itis in compliance with the requirements of (Nam oI'rankOwnerorOpe/ator) California Code ofRegulations, Title 23, Division 3, Chapter 18, Article 3, Section 2807. The medianisms used to demonstrate finanaal responsibility as required by Section 2807 are as follows: ~, C.'tv~chanism Me:charnsrii Coverage Coverage Cor~ecbve Third Party T e Name and Address; oflssuer Number Amount Penod-' Action Co ~oU~~~~.~~ ~~ «ro7 Note: If you are using the State Fund as any part ofyour demonstration offinancial responsibility, your execution and submission of this cerb'ficati0n also certifies that you are in compliance and shall maintain compliance with all ~nditions for participation in the Fund. See insbvctions D. Facility Name Facility Address ' S~ ~ 0..~ OS'e ~ G/ Faci lity Name Faci lity Address Facility Name Facility Address E. Signature of Tank Owner or Operator Date Name and Title of Tank Owner or Operator ~~~ ~%~~~ a ~ ~` Signature of Witness or Notary Date Name of Witness or Notary / / CFR (Raises ()8106) FILE: Origirel -Loral Agax~r Copies-Fadlity/Site(s) Steve Underwood Flnal hwfwrc a (Rev 7.20 2006),doc Page 1 i i f f i i i { 4 I I I t i I l t 1 1 3 t i i i UPCF Hwfwrc-a - 1/4 Rev8/2006 _._._._., _ ...... ....... - .....,.. _ .... _......._ 1 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION -- FACILITY FORM (One form per facility) TYPE OF ACTION ^ 1. NEW PERMIT ^ 3. RENEWAL PERMIT .CHANGE OF INFORMATION 400• (Check one item only) ^ 6. TEMPORARY SITE CLOSURE ^ 7. PERMANENT SITE CLOSURE ^ 9. TRANSFER PERMIT I. FACILITY INFORiVIATION SiTE 404. FACILITY ID # TOTAL NUMBER OF USTs ` ' ~ (Agency Use Only) _ BUSINESS NAME (Same as FACILITY NAMEDr DBA oing Business As) 3 ~~ e. G BUSINES SITE ADDRESS 703• ~ CITY ~ ^ (T 104• Is the facility located on Indian Reservation or Trust lands? ^ 1. Yes ^ 2. No aos. 'll. 'PROPERTY`"`OWNIrR INFORMATION PROPERTY OWNER NAME 407• ~ PHONE ~ 408• • h~ ~ a f t $ 30 ~- 7 MAILING ADDRESS 409• L CITY 410. ~d STATE 411. ~~ ZIP CODE ~'3 30 412• k..• III. TANK QPERATOR INFORMATION OPERATOR NAM ~~ ~~ Toi PHONE ' ~ ©~ n ~~ ~ ~ T02 MAILING ADDRESS ro3 r' CITY T 4 i~..~ t STATE TO5 ZIP CODE ~A- ~ 330 $ T~ - IV. TANK OV{%NER I~FiORMATI(}N TANK OWNER N ME 414. PHONE ais. 1 ~ ~. - 3®~f~7 MAILING ADDRESS a~6. ~. o~ daf~ CITY a» T TE 418• ZIP CODE 419• TANK OWNS TYPE ^ 1. CORPORATIOWLLC ^ 2. INDIVIDUAL ^ 3. PARTNERSHIP ^ 4. L CAL AGENCY/DISTRICT azo. ^ 5. COUNTY AGENCY ^ 6. STATE AGENCY ^ 7. FEDERAL AGENCY - ~: BbARtS~oF EQUALIZ4TION. UST ~TOF2AGE FEE ACCOUNT N~Mi~ER ,., TY (TK) HQ 44- ~ p) "L 2 .7 ~ ~ Call (916) 322-9669 if there are questions. 421 Vf.~ PER~IAIT :HOLDER INFO~IU~ATTOM Issue permit and send legal notifications and mailings to .FACILITY OWNER ^ 3. TANK OWNER ^ 4. TANK OPERATOR ^ 423 5. FACILITY OPERATOR SUPERVISOR OF DIVISION, SECTION, OR OFFICE (Required For Public Agencies Onty) aoc. .~ ~`N,~ APPLICANT SI~NATUF~E CERTIFICATION: I certify that the information provided herein is true, accurate, and in full compliance with legal requirements. SIGNAT E ~- _ DATE aZa• PHONE azs. ~ ~-` f/- - ~ ~ o~~/ Soy >>y NAME (print ~ ~ ~ 1 a26• ~J TITLE ~ 42~ (/ f~ ~. Page 2 Steve Underwood Final hwfwrc a (Rev 7 20 2006) doc ._ .Y ..:_ 3,x~,. m. ~.~ _.. ,n ,.._~ . .. ,r.... ~ ~.~,~ u.. u~~.. „_. ..~~w.~ ,. , ... UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION -FACILITY FORM PAGE2 BUSINESS NnnAME r 3 f~Cc9~,e~ a~c sh~tl BUSINESS IT ADDRESS ~n s"PRfiMARY DE~tGNATED OPEf~ATOR INFQRMATION ~ PRIMARY DE IGNATED OPERAT ~ ~ Dora R NAME PHONE Doib c 30 BUSINESS NAME/'~ Dojo ~4©~ MAILING ADDRESS ~ Doia CITY ~ ooze STATE oo~r ZIP CODE ooig ~30~ ICC CERT. # DOth EXPIRATION DATE oo~i RELATIONSIP TO UST FACILITY (CHECK ONE) DOtj . . OWNER ^ 2.OPERATOR ^ 3. EMPLOYEE ^ 4. SERVICE TECHNICIAN ^ 5. THIRD PARTY AL.~ RNATI= DESIGNATED OP~FtATOR tNFORt(14ATiON "~` i DO2a ALTERNATE DESIGNATED OPERATOR NAME PHONE D026. BUSINESS NAME Do2~ MAILING ADDRESS Do2a CITY Dote, STATE Doer Zlp CODE D02g ICC CERT. # D02h EXPIRATION DATE D02i RELATIONSIP TO UST FACILITY (CHECK ONE) D02j ^ 1. OWNER ^ 2.OPERATOR ^3. EMPLOYEE ^ 4. SERVICE TECHNICIAN ^ 5.THIRD PARTY (Attacn an aaaiuonal page It necessary.) cerEify that, for this facAity, the individual(s)-listed above will serve as' Designated UST Operator(s).' The individual(s) will conduct and document morithly facility inspections-and annual facility employee training, in accordance with California Code of Re wtatiohs Title 23, Section 271:5 c - f NAME OF TANK OWNER (Please Print) D03a SIGNATURE OF K OWNER: ~~ ~ -~ DATE: D03b UPCF Hwfwre-a - 2/4 Rev8/2006 ~..a~ ..w~: , ~..~ v . _. ~ ~u .~ _, .. , u~ ~.~~... F...t.._ - ~ns .....~x._ ..~~_ ~.. Page 1 `Steve Underwood -Final hwfwrc c dot ~_ ..~r~.., ~, .~,a_._~.,~... f .~r~.~ _.M.,~.,~,,a,~ .,.. _..•~,~,~_ ,.~.~2d ~~an ,a N. ..,. i i l 1 t i I 4 5 z } k f i t f I S } d 1 1 UPCF Hwrwrc-c - 1/2 Rev. 8/2006 i I ~. m. ......_.... ~_._ ~a.... .._.. _.__..._ _.~..... _ .__..... _ .... _._,_.. _.. _...... _..__.._ _. _.. ___.. _ _ _... __.. t UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK CERTIFICATION OF INSTALLATION /MODIFICATION FORM One form er ro'ect I. FACILITY INFORMATION s~: ~:• FACILITY ID # (Agency Use Only) ~ BUSINESS NAME (Same as FACILITY NAME) a BUSINESS SITE ADDRESS 103 CITY ~~• ~lii. INSTALLATION"hROJECT D SCRIPTION ~~ Type of Project (Check all that cooly) as3a WORK AUTHORIZED UNDER PERMIT ^ 1. TANK INSTALLATION OR REPLACEMENT (NUMBER or DATE): ^ 2. PIPING INSTALLATION OR REPLACEMENT ^ 3. SUMP INSTALLATION OR REPLACEMENT ^ 4. UNDER DISPENSER CONTAINMENT INSTALLATION OR REPLACEMENT ^ S. OTHER a&st DESCRIPTION OF WORK BEING CERTIFIED as3c - III. CONTFfACTOR Il~IFORMARION ,.c NAME OF CONTRACTOR WHO PERFORMED INSTALLATION / a8za CONTRACTOR LICENSE # aazb MODIFICATION ICC CERT. # aszc . IV, CERT`f~ICATION I certify that the information provided herein is true, accurate, and that the following conditions have been satisfied: • The installer has met the requirements set forth in 23 CCR §2715,- subdivisions (g) and (h). • The underground storage tank, any primary piping, and any secondary containment were installed according to applicable voluntary consensus standards and any manufacturer's written installation instructions. • All work listed in the manufacturer's installation checklist has been completed. • The installation has been inspected and approved by the local agency, or, if required by the local agency, inspected and certified by a registered professional engineer who has education and experience with underground storage tank system installations. SIGNATURE OF TANK OWNER OR OWNER'S AGENT DATE a~• PHONE assn ~~ CERTIFIER'S NAME (print) ae5 CERTIFIER'S TITLE: a~ NAME OF CERTIFIER'S EMPLOYER (DBA) aasb CERTIFIER'S RELATIONSHIP TO TANK OWNER asst ^ 1. TANK OWNER ^ 2. TANK OPERATOR ^ 3. CONTRACTOR ^ 4. PROPERTY OWNER ^ 5. OTHER AUTHORIZED AGENT OF TANK OWNER Page 1 Steve Underwood Final hwfwrc b (Rev 8 2006)_ doc, •M ..._., ... n, _~ .,_...~ .~. , .~., ,_,..~ .~ .,.. rn ... w, i i 3 1 i 3 r x i 1 i 3 i i i I i I f t r 1 I i r 'I i F UPCF hwfwrc-b- 1/2 Rev. 8/2006 4 1 ......... ._......_.. .... .., _.._... ... .. _..._._._,_. ...._._.._.._ ..._,....... . .. __.... .. ,, ,. _.,. ._,._. ._, _, ., .. _. .. _.._ ._. .. ___ .___.. _..... _.,. _.. __.-.. ._....._... ._. ... __.. _..~.. ......... .... ..__....._. .,_~._ ._._.. __... ...__....... _- .- i UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION -TANK FORM (One form per UST) TYPE OF ACTION ^ 1. NEW PERMIT ^ 3. RENEWAL PERMIT ^ 5. CHANGE OF INFORMATION ^ 6. TEMPORARY UST CLOSURE ^ 7. UST PERMANENTLY CLOSED ON SITE ^ 8. UST REMOVED Check one item onl . For a UST closure or removal, com lete onl this section and Sections I, 11, III, and IV below aso Date UST Permanently Closed: a3ob .,. -~ FACILITY~INf,..ORMAtiON FACILITY ID # (Agency Use Only) 0. - - ' BUSINESS NAME s t ~. '• BUSINESS SITE ADDRE r-- 103. CITY ~ ~ L 10a• II. 7ANK• DE$CRIPTIO TANK ID # j a3z. l TANK MANUFACTURER a~ number of tank units. This tank is: ^ 1. A STAND-ALONE TANK ^ 2.ONE OF TWO OR MORE COMPARTMENTS a3a. DATE UST SYSTEM INSTALLED ass DATE EXISTING UST a35D DISCOVERED: NUMBER OF COMPARTMENTS 437 TANK CAPACITY IN GALLONS aas UL TANK USE and CO.N.TiNTS TANK USE ^ 1. MOTOR VEHICLE FUELING D 3. CHEMICAL PRODUCT STORAGE ^ 4. HAZARDOUS WASTE (tndudes Used Oil) ^ 5. EMERGENCY GENERATOR FUEL STORAGE ^ 6.OTHER GENERATOR FUEL STORAGE ^ 7. MARINA FUELING ^ 95. UNKNOWN ^ 99. OTHERS eci 439• TANK CONTENTS PETROLEUM: ^ ta. REGULAR UNLEADED ^ 1b. PREMIUM UNLEADED ^ 1c. MIDGRADE UNLEADED ^ 3. DIESEL ^ 5. JET FUEL ^ 6. AVIATION GAS ^ 8. PETROLEUM BLEND FUEL ^ 9. BIO-DIESEL 0 99. OTHER PETROLEUM S eci 440• NON-PETROLEUM: ^ 7. USED OIL ^ 10. ETHANOL ^ 99.OTHER (Specify): IV TANK GONStf$UGTIpN TYPE OF TANK : ^ 1.SINGLE-WALLED ^ 2. DOUBLE-WALLED ^ 95. UNKNOWN aa3 TANK PRIMARY CONTAINMENT ^ 1. STEEL ^ 3. FIBERGLASS D 6. INTERNAL BLADDER ^ 7. STEEL + INTERNAL LINING ^ 95. UNKNOWN ^ 99. OTHER (Specify): aaa. TANK SECONDARY CONTAINMENT ^ 1. STEEL ^ 3. FIBERGLASS ^ 6. EXTERIOR MEMBRANE LINER ^ 7. JACKETED ^ 90. NONE ^ 95. UNKNOWN ^ 99. OTHER (Specify): 445• OVERFILL PREVENTION ^ 1. AUDIBLE 8 VISUAL ALARMS ^ 2. BALL FLOAT ^ 3. FILL TUBE SHUT-0FF VALVE ^ 4. TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT asz V.'FRODUGT >„~YftASTE.PIPING iaNSTR~J.GTiOIV PIPING SYSTEM TYPE ^ 1. PRESSURE ^ 2. GRAVITY ^ 3. CONVENTIONAL SUCTION ^ 4. SAFE SUCTION (23 CCR §2636(a)(3)) asa. PIPING PRIMARY CONTAINMENT ^ 1. STEEL ^ 4. FIBERGLASS ^ 8. FLEXIBLE ^ 10. RIGID PLASTIC ^ 90. NONE ^ 95. UNKNOWN ^ 99.OTHER S eci 464a PIPING SECONDARY CONTAINMENT ^ 1. STEEL ^ a. FIBERGLASS ^ 8. FLEXIBLE ^ 10. RIGID PLASTIC ^ 90. NONE ^ 95. UNKNOWN D 99. OTHER S eci abab TURBINE CONTAINMENT SUMP: ^Ot SINGLE-WALLED ^ 02. DOUBLE-WALLED 0 03 NONE 464c V_I. -VENT: AND VAPOR''R<;C4UERY,(.uR) PIPING GONSTRUCTION . VENT PRIMARY CONTAINMENT ^ ~1. STEEL ^ 4. FIBERGLASS ^ 10. RIGID PLASTIC ^ 90. NONE ^ 99. OTHER (Specify): 4644 VENT SECONDARY CONTAINMENT ^ 1. STEEL ^ 4. FIBERGLASS ^ 10. RIGID PLASTIC ^ 90. NONE ^ 99.OTHER (Specify): acac VR PRIMARY CONTAINMENT ^ 1. STEEL ^ 4. FIBERGLASS ^ 10. RIGID PLASTIC ^ 90. NONE ^ 99.OTHER (Specify): a6ar VR SECONDARY CONTAINMENT ^ 1. STEEL ^ 4. FIBERGLASS ^ 10. RIGID PLASTIC ^ 90. NONE ^ 99.OTHER (Specify): 464 VENT AND/OR VAPOR RECOVERY PIPING TRANSITION SUMP(S) : ^ 1.DOUBLE-WALLED ^ 2.SINGLE-WALLED ^ 3. NONE 464h VII;RISER t, FILL P,.IPE CONSIRU CT.,lQN • RISER PRIMARY C©NTAINMENT ^ 1. STEEL ^ 4. FIBERGLASS ^ 10. RIGID PLASTIC ^ 90. NONE ^ 99. OTHER (Specify):. 4641 RISER SECONDARY CONTAINMENT ^ 1. STEEL ^ 4. FIBERGLASS ^ 10. RIGID PLASTIC ^ 90. NONE ^ 99.OTHER (Specify): 46a) FILL COMPONENTS ^ SPILL BUCKET INSTALLED ast ^ STRIKER PLATElBOTTOM PROTECTOR INSTALLED asl h . `: VI11.UNDER.pISP;ENSEF2CON7`AINMENT'°(IDC) UDC Construction TYPE _ t SINGLE-dVALLED ^ 2. DOUBLE-WALLED ^ 20. NO DISPENSERS 'n''h UDC CONSTRUCTION MATERIAL 1 STEEL - 4. FIBERGLASS ^ 10. RIGID PLASTIC ^ 99. OTHER (Speelfq) a^x< IX. CORROSION'PROTECTiO'N STEEL COMPONENT PROTECTION Z SACRiFiCia,LANODE(S) ^ 4. IMPRESSED CURRENT o i50E4TiOrJ aax X. APpLI~i~iNt SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the information provided herein is true accurate and in full com Tian with le al re uirements. APPLICANT SIGNATURE DATE ago. UNDERGROUND STORAGE TANK BAKERSFIELD FIRE DEPT. MONITORING PROGRAM (FORM) B E Jt 5 P t D Prevention Services ~/R/ 900 Truxtun Ave., Suite 210 WRITTEN MONITORING PROCEDURES ARTJM T Bakersfield, CA 93301 Tel.: (661) 326-3979 Page 1 of 1 Fax.: (661) 872-2171 This monitoring program must be kept at the UST location at al times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Prevention Services within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641 h CCR. FACILITY NAME FACILITY ADDRESS DESCRIBE THE FREOUENC OF PERFORMING THE MONI RING: TANK PIPING WHAT METHODS AND EQUIPMENT, IDENTIFIED BY NAME AND MODEL, WILL BE USED FOR PERFORMING THE MONITORING: TANK i PIPING DESCRIBE THE LOCATION(S) WHERE THE MONITORING W ILL BE PERFORMED (FACILITY PLOT PLAN SHOULD BE ATTACHED): Wl~lt~~' f t~ l~,S ~6)tti~ fJ~' ®~IC.L LIST THE NAME(S) AND TITLE(S) OF THE PEOPLE RESPONSIBLE FOR PERFORMING THE MONITORING AND/OR MAINTAINING THE EQUfPMENT: NAM~~~~ J TITLE ~~ ~~ NAME , f/ TITLE NAME TITLE NAME TITLE NAME TITLE REPORTING FORMAT FOR MONITORING: TANK L W~, PIPING 'an ~~ •• DESCRIBE THE PREVENTJVE 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. y (` (~ ~ Crt ~ 1~ ~ ~ ~ n~ ~~ ~O,A ~~' C/\ ~~ . ~~~ ` y V ~Ii~1~ DESCRIBE THE TRAINNING NECESSARY FOR THE OPERATION OF UST SYSTEM, INCLUDING PIPING, AND THE MONITORING EQUIPMENT: ~C ` ~~ FD 2074C (Rev. avos> ~, MARKEL INSURANCE COMPANY ' - SHAND MORAHAN PLAZA EVANSTON, ILLINOIS 60201 MARKEL Policy No. MSP610279 - O1 GARAGE COVERAGE PART DECLARATIONS ITEM ONE -Named Insured and Mailin Address/Policy Period -Shown in Policy Declarations. Form of Business: [ X ]Individual ~ ]Partnership [ ]Corporation [ ]Limited Liab. Co. [ ]Other Effective Date: 0 2 / 14 / 0 6 12:01 A.M., Standard Time ITEM TWO -SCHEDULE OF COVERAGES This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply AND COVERED AUTOS only to those "autos" shown as covered "autos". "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of the symbols from the COVERED AUTOS Section of the Garage Coverage Form next to the name of the coverage. Entry of a s mbol next to LIABILITY rovides covera a for " era e o erations". COVERED AUTOS COVERAGES io~m necovEREDAU OSSSec~onol LIMIT PREMIUM the Garage Coverage Form aMws which autos are covered autos) Each "Accident" Aggregate - "Garage Operations" "Garage Operations" LIABILITY "Auto" Other Than Other Than Onl "Auto" Onl "Auto" Onl 29 $ 1,000,000 $ 1,000,000 $ 3,000,000 $ 980 PERSONAL INJURY PROTECTION (P.I.P.) SEPARATELY STATED IN EACH P.1.P END. MI NUS $ - O - DEDUCTIBLE $ ADDED P.I.P. (or equivalent added No-Faultcov.) SEPARATELY STATED IN EACH ADDED P.I.P ENDORSEMENT $ PROPERTY PROTECTION INS. (P.P.I.) SEPARATELY STATED IN THE P.P.I. ENDORSEMENT MINUS (Michigan only) $ DEDUCTIBLE FOR EACH ACCIDENT $ AUTO MEDICAL PAYMENTS $ $ MEDICAL PAYMENTS See CA2505 $ 5, 000 $ 8 UNINSURED MOTORISTS UM $ UNDERINSURED MOTORISTS~when notinclud d $ $ GARAGEKEEPER'S COMPREHENSIVE COVERAGE EACH LOCATION MINUS $ DED. FOR EACH COVERED AUTO FOR LOSS CAUSED BY THEFT OR MISCHIEF SPECIFIED CAUSES OF LOSS OR VANDALI M SUBJECT TO MAXIM M DED TIBL $ COVERAGE $ S U UC E FOR ALL SUCH LOSS IN ANY ONE EVENT COLLISION COVERAGE $ EACH LOCATION MINUS $ DED. FOR EACH COVERED AUTO $ PHYSICAL DAMAGE COMPREHENSIVE COVERAGE ACTUAL $ SPECIFIED CAUSES OF LOSS CASH VALUE oR cosr of SEE SUPPLEMENTARY COVERAGE REPAIR $ SCHEDULE FOR LIMITS FIRE AND THEFT COVERAGE WHICHEVER IS SS $ LE AND DEDUCTIBLES COLLISION COVERAGE MINUS $ TOWING AND LABOR t"~ caiiio~iaj $ for each disablement of a private passenger auto $ FORMS AND ENDORSEMENTS APPLYING TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT TIME OF ISSUE: CA0005(07/97), CA0040(02/03), CA0143(02/97), CA0302(12/93), CA2361(12/02) CA2376(05/04), CA2505(07/97), CA2507(12/93), CA2518(09/98), CA9917(07/97) IL0021(07/02), MCA023(03/00), MCATERR2(O1/05), MD028(03/99), MIL004(03/00) MIL006(03/00), MIL127(03/00), MIL140(10/O1), PN-CA-TERR(05/04) PREMIUM FOR ENDORSEMENTS $ ESTIMATED TOTAL PREMIUM ** $ THIS DECLARATIONS MUST BE COMPLETED BY THE ATTACHMENT OF SUPPLEMENTARY SCHEDULE * Forms and Endorsements applicable to this Coverage Part omitted if shown elsewhere in the policy. ** This policy may be subject to final audit. *** (Or equivalent No-fault coverage.) THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD MD027 (03/99) Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 ~~~. UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING I S8989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM -FUEL MONITORING CERTIFICATION PERMff NO. ~~- ~ ~• L ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ TANK TIGHTNESS TEST ^ TO PERFORM FUEI BAKERSFIELD FIRE DEPT. ~iR~ Prevention Services ARTII T 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ~S~ Cfl CVi.On~ ~SB-989 SECONDARY CONTAINMENT TESTING MONITORING CERTIFICA ',SITE INFO RMATION ,... . FACILITY ~ ~ L ~ . O ~ NAME 8 PHONE NUMBER OF CONTACT PERSON ADDRESS OWNERS NAME OPERATORS NAME ~O~ PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES ^ NO T N # V LU CONTENTS TANK-.:TESTING COMPANY NAME OF TES G CO ANY NAME 8 PHONE NUMBER OF CONTACT PERSON MAILING ADDRESS ~ ~~ ~ NAME & PHONE N MBER OFT STER OR SPECIAL INSPECTOR CERTIFICATION #: DATE & TIME TES TO BE CONDUC ED ICC #: TEST METHOD SIGNATURE OF APPLI NT ~ ~ C DATE APPROVED BY DATE FD 2095 (Rev. 09/05) ~v B~~L i~IG & PERMIT STATEMENT sAx,ERSFIELD FIRE DEPT. D Prevention Services PIR! 900 Truxtun Avenue, Suite 210 PERMIT NO.: wRfII r Bakersfield, CA 93301 rPl • tr,F 11 't7F,-~Q74 S Fax (Fife 11 flri2-2171 • - ~ ~ LOCATION OF PROJECT ^~ ~- ^ v PROPERTY gK1ME - -O ,COMPLETION DATE ~ , ~-% q STARTING DATE _ NAME PROJECT NAME -- -- - ------ , 1 -- ~ ,n~ ~ /-~ --- - - ADDRESS O~ ~ s 1yty~`1 ~rn~, YVC `~ P E N0. _ PROJECT ADDRESS ~ CITY ~~ ~ STATE _ ZIP CODE ~ ~` • • •- ~ CONTRACTOR NAME - --- - -- -- CA LICENSE NO. TYPE OF LICENSE. EXPIRATION DATE PHONE NO. CONTRACTOR COMPANY E FAX NO. L ADDRESS ~ ~ CffY /~ / ~ ZIP CODE /] ~~ G ~ ~ ~ Alarms -New & Modifications - (Minimum Charge) $262 50 ^ • ~ . . 98 000 Sq Over 20 FL 013125 =Permit fee Sq FL x ~ p . , . . 98 ^ Sprinklers -New & Modifications - (Minimum Charge) $210 00 ~ . 98 ^ FL Over 5 000 Sq Ft x 042 =Permit fee Sq ~ . , . . 98 ^ Minor Sprinkler Modifications (< 10 heads) $ 93.00 [Inspection On1yJ ~ 98 ^ Commercial Hoods -New & Modifications $ 398 26 ~ . . 98 ^ Additional Hoods $ 36.00 ~~ 98 ^ Spray Booths -New & Modifications $458 00 ~ . 98 ^ Aboveground Storage Tanks (Installation/Insp.-1 ~ Time) $165.00 82 ^ Additional Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Removal/Inspection) $109.00 82 ^ Underground Storage Tanks (/nstallation.llnspedion) $878.00 (per tank) 82 ^ Underground Storage Tanks (Modification) $878.00 (persite) 82 ^ Underground Storage Tanks (Minor Modification) ~ $155.00 82 ^ Underground Storage Tanks (RemovaQ $675.00 (per tank) 84 ^ ilwell (Installation) $ 72.00 84 Mandated Leak Detection (Testing) /Fuel on . C rt. $ 81.00 (persite) 82 ^ Tents $ 93.0 er enfj 84 ^ After hours inspection fee $122.00 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour) $ 60.00 + (5 hrs. min. stand -by fee /Inspection) _ $510.00 84 ^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION{S) $ 93.00 (per hour) 84 ^ Portable LPG (Propane): NO.OF CAGES? $66.00 84 ^ Explosive Storage $249.00 ' 84 - ^ Copying & File Research (File Research Fee $33.00 per hr) 25¢ per page ; 84 O Miscellaneous ; 84 FD 2021 (Rev. 09/05) 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to Flle) 1-PINK (to Customerl L. w 51~'i2CB, January 2002 Secondal y containment Testing Report Form t~c~5 Page ~ of ~ 'This fnrn~ is iruandrrd for use by contraca .,rs performing pariodic testing of UST secor+dary cnntatnment .<ystems. Use the nppropriare pages oflhis form to report results for all components tested The completed form, whiten test procedures, and printouts Ji•om tests (rf applicableJ, shou:tl be provided to the facility owner/operator for submittal to the locot regulatory vgency. 1 FAC'Ii,TTY TNFnI2MATT()N Facility Name: Date of Testing: - Facility Address: (O W TA i ~ Facility Contact: Phone: Date Local Agency Was Notified of Testing Name of Local Agency Inspector (tfpresent during testirt~; 7 TFC'i'TN(3!'`('1NTRAC'Tr1RTNFnRMATT(lN i'ompany Name: RICH ENVIRONMENTAL Technician Conducting Test: '~]p lv Credentials: 'S CSL$ Licensed Contractor Q S WRCB Licensed Tank Tester License Type. C611TJ40 License Number: 809850 ~_ I,~V _ Manufacturer ~nufacbtrerT„~ainine Com ovens Date Trainin E iron INCON INCON TS-ST5 3_ SUMMARY OF TF.fiT RFSITI.TC Component Pass Fail Not Tested Repairs Made Component Pass Faii Not Tested Repairs Made L nnvll~i~ O ^ ~B' l7 ~ m ^ ^ ^ ~ C. ~. CTS}" ?~' ^ 0 ^ C) D ^ ^ r,L r~,1 ~ ^ ^ ^ ~DS ~ G m a ^ r q `dec.. '~ Gas -~ ^ ^ ^ Ub ' ~ ~' ^ ^ ^ mil ec.. ', ^ ^ ^ UDC. 3-~t ^ ^ a ql eri~ c . ~ ~, n ^ ^ U'pC ~ ^ ^ ^ it hydrostatic testing was performed, describe what was done with the water after completion of tests: RECYCLE AND REUSED CERTIFICATION OF TECFCNTCIAN I2ESPONSTT3I,,E FOT2 CONDUCTING THIS TESTING '!'o the hest ofmy knowledge, t/ie facts stated !n this documett! are vccurate and In jul! pomp/lance wi!!t legal requlrentenrs Technician's Signature:_ f~--- Date: ~ ' ~ l.! - d ___---_ Slv1:CI3, January 200) Page?' of~ Secondary Containment Testiag Report Form TJ,is jorm is intended for use by contraca~rs performing periodic tasting of UST secondary containment .rystams. Use the appropriate pngrs oflhis form to report +•esults far all components tested. The completed form, wrllten tes! procedures, and prinroutsJi~om tests (rf applicable), shou!a be provided to the facility owner/operator for submittal to the local regulatory agency. 7 FACTT.iTY iNFnRMATiCIN f=acility Name: Dare of Testing: '/ - ("~ F'aciliry Address: O S b >R~ Facility Contact: Phone: Date Local Agency Was Notified of Testing Name of Local Agency Inspector fifpresent during testing}: 7 T~Q't`TN/'`_lYINTD A!^TlIA iNTi l1D11iTAT7l1N CompanyName:RICF-] ENVIRONMENTAL T'eclurician Conducting Test: Credentials: '~CSL13 Licensed Contractor C SWRCB Licensed Tank Tester License Type. C611D90 License Number: 809850 Manufacturer Manufacturer~,t•afniny Com onen s Date Trainin E fires _ INCON INCON TS-ST5 3. SUMMARY OF TEST RESULTS Component Pass Fai{ Not Tested Repair9 Made Component Pass Fait Not Tested Repairs Made l/-/a ^ o ^ ^ ^ o c~ C- r' ^ o '~ n o o ^ ^ - ^ ^ ^ ^ ^ o ^ (.LCIC-~~ ^ o Q D a ^ ^ D ^ U ^ ^ D D ^ ^ D ^ o ^ r ^ a ^ ^ a ^ D ^ ^ 0 ^ ^ p ^ ^ ^ ^ ^ D ^ ^ CJ 0 0 o D ^ D ^ tt hydrostatic testing was perfprmed, describe what was done with the water after completion, of tests: RECYCLE AND REUSF~ CERTIFICATION OF TECTINTCIAN RESPONSTBLE FOR CONDOCTING THIS TESTING "I'o ttre hest of my knowledge, [!te facts stated !n this document are accurate and !tt fuil compliance .with legal requirements Technician's Signature: ~-~"~'- /`-f~ Date: ~° ~~' ~ ~ ~~ ~ ~ SWRCB, January 2002 4. TANK ANNULAR TESTING Page_~ of ~~ Test Method Developed By; O Tank Manufacturer {t1 Industry Standard O Professional Engineer O Other (Sped) Test Method Used: O Pressure » Vacuum O Hydrostatic O Outer (Spec~J Test Equipment Used: 4in. DIAL GAUGE ~~t~ '' 'v`'''f~' Tankl# Tank#~( ~ ~:~t. R~q ;~°~-~~~ ~ i hg= Equipment Resolution: .596 Tank# Tanis # Is Tank Exempt From Testing?' '.Yes 0 No Yes ^ No Yes 0 No D Yes [; No Tank Capacity: Tank Material: Tank Manufacturer. Product Stored: Wait time between applying pressureJvacuan/water and startin ~ test: ~ ~~ i Test Start Time: lnitiai Reading (R,): Test End Time: Filial Reading (Rr:): 'l'est Duration: Change in Reading {Rr-Rt): Pass/Fail Threshold or Criteria: Test Resulf: O Pass ^ Fail 0 Pass 0 Fait O Pass 0 Fail 0 Pass t7 Fail Was sensor removed for testing? p Yes O No 0 NA ^ Yes D No O NA O Yes ^ No 0 NA 0 Yes ^ No !? NA Was sensor properly replaced and verified functional after testin ? 0 Yes 0 No 0 NA 0 Yes 0 No 0 NA d Yes ^ No 0 NA ^ Yes 0 No DNA Comments - (incltule it formation an repairs made prior to resting and recommendedfollox~ upfor jailed rests) _.- ~ ~ Secondary contaimnent systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment testing. (California Code of Regulations, Title 23, Section 2637(a}(6)} a~- SWRCl3, January 2062 S ~CFf'l1NT6AVPTA~i Tri'.CTTNf_` 1 ~ (~s' ~'~'-_ Page ~ of Test Method Developed By: ^ Piping Manufacturer icl Industry Standard Q Prafessiona! Engineer ^ <7ther (Spec(ly) Test Method Used: ~ Pressure 0 Vacuum ^ Plydrosiatic U Other (Spec{fy) Test Equipment Used: 4 in . DIAL GAUGE Equipment Resolution: . 5% ^~~ ~ ~ Piping Run # 81 Piping Run ~- Piping Rua ~ Piping Run r Piping Material: ~ Piping Manufacturer: y~ ',!~ ~C Piping Diameter; ~ ~~' ,, a 4 u Length of Piping Run: Product Stored: U C1(, 8~ ~!1(, ~ `}y~(, g~ Unf: Q)~ Method and location of i in -run isolation: fi~t~Svm ,r,Sv"rr, 1(15VYY1 ~`1' Wait time between applying pressurelvacuum/water and startin test: f'odVG ~3pm~ n~ r'D V~~ 30 m; ~ 30 r»: ~ ~1~~'© . 3Drn~'/` Test Start Time; : y5lam 0~. 55 rar+~ 1~ : M5 ~ ~ 30 *^ Initial Reading (R~): ! ~ Test End Time; j0', 4 IqY~+ , '~) ;5~j l:W\ } : 1 FJ M ~ ~~ ' 1^ Final Reading (Rr): E s ; • Test Duration: ~pU~ I~10U'2 OV ~^10' Change in Reading (R~-Rt): "S~ ~~ Pass/Fai! Threshold or ~ Criteria: ~ ~ '~. -.~` Test Result: Pass p Fai! Pass Q Fall Pass 0 Fafl ass Q Fal! _Comments - (include tnjormation an repairs made prior to Testing, and recommendedjollow-up orjalled tests) < <..~ ~~ S SWRCi3, January 2002 5. SECONDARY PIPE TESTING Page ~ of Test Method Developed By; Q Piping Manufacturer ~ Indtutry Standard 0 Professional Engineer Q Other (Specie) Test Method Used: ~ Pressure O Vacuum (, Hydrostatic Other (Specify) ' .Test Equipment Used: 4 in . DIAL GAUGE Equlptttent Resolution: . 5~ ~~! Pipine Run #~ Piping Run #9`~ ~qg} Plying Run laq~ ~y~ Piping Run !a~~ ~l~ Piping Material; { ~' ( ' b 14 11as PipingManufactwer: VY~~GnOWn `lnkrow~n 1lnknoW~ nknbW~ Piping Diameter: ~' a~ a~' ~ ~' Length of Piping Run: Product scored: t~L 8' Prem ell m q) rem q lvlethod and location of i in -run isolation: ~Dt` -n,s~M ap~',~in SUm `r-,f1 1tt~ , ~ 1 SUYr~ Wait time between applying pressure/vacuum/waterend startin test: ~(n VCnr ~ 3D m: ,.~ o 11 UGC' ~ m, ,n r~C1JG rn ~,n , JC~ m ~ ~ Test Start Time; ,3~ N. ~' : t{ cj Arn ~ ~ ; 5t7 Ar-'1 ) e7 ~ 1J iYl Initial Reading (Ri): J i 5 Test End Time: ;30 t~ . lD: y5t~m 11:55Am 1:15 Final Reading (Rr): ~j Cj rj Test Duration: 1V1ptJ1(Z y1pU2 rJV'2 hl?VK Change in Reading (Rr-R,}; '~, ~„~ `~,, Pass/Fai1 Threshold or Criteria: ~ .~ .~ ~~ Test Result: 'Pass Q Fail ~ Pass 0 FaU ~ Pass O Fail Pass ^ Fail Comments - (!nclude information on repabs madeprlor to testln~and recommended follow-upa(or ja!!ed tests} ( ~~ lg5 S WRCB, January 2002 Page ~ of l~ c c?w rnrtr.e vv vrvrw mtr c'rnvr_ Test Method Developed 6y: ^ Piping Manufacturer ~ Industry Standard Q Professional Engineer O Other (Sped) Test Method Used: ~ Pressure 0 Vacuum O Hydrostatic 1J Other (Spec{fy) .Test Equipment Used: 4 i n . DIAL GAUGE Equipment Resolution; . 5~ ~~ , Piping Run ti ~ Piping Rvn q t>~ Piping Run #~,~ Piping Run f! Piping Material; ~; ~' i ~f ~ Piping Manufacturer: Ur1~InOuJll Unknown Un1cr ~ Piping Diameter: '~' • a ~' ~ '' ' Length of Piping Run: Product Stored: D i ~ f D i i ~ r Method and location of i in -run isolation: fits um t1 UM 1n vri Wait time between applying pressurc/vacuum/water and startin test: roc`uG ~ ~ M ~ n ) rpC1vC.'~ , YtiZ ~ n 3~ tYl ~ n Test Start Time: ? 4Sarn ~Q.SS~~. )a: i5v~ lnitiai Reading (R~: ~ S Test End Time: 10 t 4S A-~. •1 ! : 55 qr, ~ : 1 r~ f=inal Reading (Re}: Test Duration: h. U ~ ~ ~ (~ U ~ ~ V Change in Reading (Re-R,): L~~ Pass/Fail Threshold or Criteria: ~~ Z~ Test Revult: "d. Pass D Fail Pass ^ Fatl Pass O FaU 0 Pass Q Fail CO17] men is - (include lnformatfon on repairs made prior to testing, and recommended follow-up for fa!!ed tests) S11'RCB, January 2002 6. PIPING Si)MP TESTING <<-tlg~ Page ~ of~ Test Method Developed By: ^ Sump Manufacturer 1~ Industry Standard ^ Professional Engineer ^ Other (Specify) Test Method Used: [] Pressure D Vacuum X7 Hydrostatic 13 Other (Specify) Test Equipment Used:INCON TS-STS Equipment Resolution:,oooin. Sump # Sump # q ~ Sump # Sump # Sump Diameter; ~ ' ~' `' Sump Depth: rj 3 `• Jam' O ~ , rJ0 ~. Swnp Material: Y ~` •Height from Tank Top to Top of Hi hest Pi in Penetration: ~ ~~ ~ ~~J~ Height from Tani: Top to Lowest Electrical Aenetration: ^^ ~, d ~ a 1 ^ d Condition of sump prior to testing: G 12~n G Q.iA~ C~ C-;A Y1 Portion of Sump Tested' 41'R~ ~A~ hla noes turbine shut down when sump sensor detects liquid (both roduct and water ?~ ` ^ Yes U No ~NA ^ Yes ^ No .~NA DYes D No~NA ^ Yes ^ No ^ NA Turbine shutdown response time ~»k~ /~ Un W t1 n n ,~ 7s system programmed for fail-safe shutdown?~ DYes DNo'`~NA ^Yes ^No~d.NA ^Yes DNo~NA DYes DNo ONA Was fail-safe verified to be o erational?~ DYes ^ Na ~A ^ Yes O No~JA ^ Yes D No ~ R Yes D No DNA Wait time between applying pressure/vacuum/water and starting test; rn i :n ~ rn; /1 ~ Wt ~ in Test Stan Time: -t~QH~t 4:o~ph'~ til;~ ~:~~ fA~3 p'1 ;~ a'1 initial Reading (R~: 3.03Qin 3.Ua$ l n S.~I~ n 5.~0'ai n ~#.3~ ie1 y •~ i ~ Tesr End Time: ~:~ Q1T1 y ;3Cj M ~a;0a 20~; ril ~ ~ ~8 ~ ' 3 M Final Reading (Rrk 3.4~ 3,0~ i n raDui/1 5.ao'3 in 4~7~n ~~~~tr1 Test Duration: ~ ;n M,n ~/1 ~(~ Yj~ ~(~ Change in Reading(Rr-Ri): .OOa~n ~tXjlir~ ~DOIi^ ~Q7D~n ,Dppin ,pr~p;n Pass/Fai! Threshold or Criteria: , p0 ', ~ , p(oa;~ ppol`,n , 6 in ,Qpa;n , L~Ua1~~c~ Test Result: ass ^ Fail ~~ass D Fail Pass D Fail ^ Pass ^ Fail Was sensor removed for testing? Yes ^ No DNA ~j'es ^ No DNA Yes ^ No ^ NA DYes ^ No 0 NA Was sensor properly replaced artd verified functions] after testis ? Yes ^ No DNA `Wes D No DNA Yes ^ No l7 NA ^ Yes ^ No DNA COR1meQtS - (include information on repairs made prior to les-ing and recommended o!!ow-up for failed test ' if the entire depth of the sump is not tested, specify how much was tested. If the answer to ~ of the questions indicated with an asrerisk (~} is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160} l (--~.«5 __--____ S1l•'RCB, January 2002 (_ PTPiiUC SiIMP TFC;TiNC Page ~~ of ~ f Test Method Developed By: 0 Sump Manufacturer ltd lndusiry Standard O Professional Enginerr O Other (Specify) Test Method Used: ^ Pressure ^ Vacuum 81 Hydrostatic ^ Other (Sped} Tes[ Equipment Used; INCON TS-STS Equipment Resolution: , oooin . Sump # p,TG Sump #91 ~ Sump # ., Sump ti Swnp Diameter: Sump Depth: Swnp Material: •Height from Tank Top to Top of Hi hest Pi in Penetration: Height from Tani: Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Testedt Does turbine shut down when sump sensor detects liquid (both roduct and water ?~ ` ^ Yes U No DNA ^ Yes ^ No DNA 0 Yes ^ No DNA D Yes ^ No ^ NA Turbine shutdown response tithe Zs system programmed for fail-safe shutdown?' Dyes D No ^ NA ^ Yes ^ No ONA 0 Yes ^ No DNA ^ Yes O No ^ NA Was fai{-safe verified to be o erationai?' p Yes D No ^ NA pYes D No 0 NA ^ Yes O No DNA ^ Yes D No ^ NA Wait time between applying pressure/vacuum/water and starting test: /~T ~ J-1_ 1 G''1 ~ t,1 Yvt' y ~1U l ~L' ~(~ Test Start Time: lnitial Reading (Ri): Test End Time: Finat Reading (Rr): Tesr Duration; Change in Reading (RF-R,): Pass/Fail Threshold or Criteria: Test Result: O Pass ^ Fail D Pass ^ Fa11 ^ Pass D Fail ^ Pass D Fail Was sensor removed for testing? O Yes 0 No DNA ^ Yes D No ^ NA D Yes D No DNA D Yes D No ^ NA Was sensor properly replaced and verified functional after testin ? ^ yes O No ^ NA O Yes ^ No O NA D Yes ^ No O NA ^ Yes O No ^ NA - COmmeIIts - (incPude in ormatlon on re airs mode rior to test/n and recommended oJlow-u or failed tests ~-rt'G~ 5 v i~'1 ~S W c.Y~ rte' ~cs~~~~-~o Sv ~a ~n~l~v i r~~1~~'~Q~ , r^l ~ r u?~ wtinc~~ t If the entire depth of the sump is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk (') is "NO" or"NA", the entire sump must be tested. {See SWRCB LG-160) ~ ~t ~~".5 ----~.. SWRCB, January 2002 7 i1NnFR_nICPF.NCFR C'(INTATNMF.NT t'iJDCI TESTING Page ~ of ~ 1 . Test Method Developed By: A Q UDC Manufacturer !~ ]ndustry Standard 0 Professional Engineer Q Other (Specify) Test Method Used: ^ Pressure 0 Vacuum ~ Hydrostatic Other (Spec~J Test Equipment Used: INCON~ TS-STS - Equipment Resolution: .oooin. ~~t. :~~ .:. - ' UDC # ~ UDC # UDC # UDC # ' UDC Manufacturer: e, nUWr r -~ow 'nl:rowr n OW`(` UDC Material; tlDef lq +~ UDC De the D`' Height from UDC Bottom to Top of Hitrhest Pi in Penetration: O' 8 • p ~ o / ' ~ t7 ~ t Height from UDC Bottom to Lowest Electrical penetration: , , 3 .-. 3 ! ` ~' Condition. of UDC prior to testin : c fl-'1 cl ~e-w'~ C~ e~ Cl e•Ai/l Portion ofUDC Tes[ed ka ti 1R h\ ~ Does turbine shut down when UDC sensor detects liquid (both roduct and water ?~ 0 Yes 0 No :~NA 0 Yes ^ No ANA Q Yes U No ANA 0 Yes Q No ~NA Turbine shutdown re onse time to V h ~n1CYlOWV~ Ys Y~OWY~ Cs system programmed for fail- safe shutdown? O Yes ^ No t~NA O Yes QNo ~NA o Yes I7 No~NA 0 Yes ONo `~NA Was fat I-safe verified to be o erational?' ^ yes d No S1~IA ^ Yes ^ No ANA 0 Yes 0 No ANA (]Yes 0 No ANA Wait time between applying pressure/vacuurrJwater and startin lest Mien min h~~11 ~yt'1t~ Test Start Time: ~11a 7;Cfj 7: prn 5:5 ~ )apr~ ;0 pen Cnitial Readin (R,): ~.831in ?.8~°I1r ~. 7.n ~•~.? i in t}+ ,n r^ Test End Time: lc:lol Co: a7 '~:a4 1. ~-Opm :};t pr, :eC7 rh 7f ~l r ; y Final Readin Rr): ,~,$~~n w7• ~» ~. min a~ja •3~~ y• 4~%t ~^ `~ Test Duration: in t1'fit~ min } thin tri~h ihi~ M.n it Chan a in Readin (RF_Rr): .doa~» . 00o n , tSD}•n . QboJ+ rtX~'~n , Ot5) in , ooo~a~ ,000 ~ Pass/Fail Threshold or Criteria: I , to s airy ~0 ;~n , rn . OQ~>n ~ rn , ~r Test Result: Pass [:] Fail Pass ^ Fail Pass 0 Fail Pass 0 Fail Was sensor removed for testing? es d No Q NA ' Yes ONo C]NA Yes ^No ^NA Yes ^No UNA Was sensor properly replaced and verified functional after testin ? es ^ No i7 NA Yes O No O NA Yes ^ No O NA t~Yes O No U NA ComrrtentS - (include rnjormatfon on repairs made prior to lesrin~ and recommended ollow-up for jailed rests) ~ if the entire depth of the UDC is not tested, specify how much was tested. If the answer to a~ of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-164) .. y~s SWRCB, January 2002 7. UNDER-DISPENSER CONTAINMENT UD TESTING Page ~ ~ of ~! Test Method Developed By: ^ UDC Manufacturer !~ Industry Standard D Professional Engineer ^ Other (Spec~J Test Method Used: Q Pressure D Vacuum ~ Hydrostaric O Other (Sped} Test Equipment Used: I NCON• TS-STS Equipment Resolution: . oooi n . '~~ UDC # UDC # - UDC # UDC # UDC Manufacturer: in n UDC Material: ,~ A UDC De th~. ~' ' Height from UDC Bottom to Top of Hi hest Pi in Penetration: ~ , ` Height from UDC Bottom to Lowest Electrical Penetration: [ 1 `.. '7 t 1 ~ , ''1 Condition. of UDC prior to tesrin C ~W1n Cl~AY1 Portion ofUDC Tested m Yj tT Does turbine shut down when UDC sensor detects liquid (both roduct and water ?~ ^ Yes 0 No ebl,NA (] Yes ^ No c~NA d Yes ^ No DNA D Yes ^ No DNA Turbine shutdown res onse time n k Ouse n lssystentprogrammedforfail- safe shutdown? Dyes ^No~NA DYes DNo~lA ^Yes ^No ^NA DYes DNo ONA Was fail-safe verified io be o erational?~ ^ Yes ^ No ~A ^ Yes Q No~.TIA ^ Yes ^ No DNA ^ Yes DNo DNA Wait time between applying pressure/vacuurn/water and startin test 1'Yt, /~ ~ (~i>71 ` Test Start Time: ~41 ~', ? a 157 rn initial Readin (R : ~-Alai~ 4.Oldin in ~'~ Test End Time: 3;'S7 a, t-{; t+- a'.SE, ;)a lr'+ Fina! Iteadin Rr>: y.o13;n b)p;n ,n - 30tH Test Duration: ;y~ ryt,yt rytjy~ -n Chan e in Readin (RF-Rt): • Oa6i r` . bvg~ r •'OODi h , 061; t\ Pass/Faii Threshold or Criteria: , Q~tn ~ D ;n Da~r< . OOa,~r Test Result: ~ Pass L7 Fail Pass D Fail ^ Pass ^ Fail ^ Pass D Fail Was sensor removed for Testing? Yes ^ No DNA Yes DNo DNA ^ Yes ^ No Q NA 0 Yes DNo ONA Was sensor properly replaced and verified functional after testin ? Yes ^ No ^ NA Yes O No DNA 0 Yes O No ^ NA ^ Yes 0 No 0 NA Comments -(include information on repairs made prior to testier and recommendedfollaw-up for failed test ' tf the entire depth of the UDC is not tested, specify how much was tested. If the answer to any of the questions Indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) _l~«S SWRCl3, January 2002 o crt t nmz•o l~nNTA rNML`NT cTTliirP TFCTTN('_ Page ~ ~ ' of ~ Facili is Not ui ed With Fill Riser Containment Sums ^ Fitl Riser Containment Sumps are Present, but were Not Tested ^ Test Method Developed By: ^ Sump Manufacturer Industry Standazd ^ Professional Engineer ^ Other (Specify) Test Method Used: C Pressure ^ Vacuum ~ Hydrostatic ^ Other (Sped} Test Equipment Used: INCON TS-STS Equipment Resolution:.000ir1. Fi)! Sum # Fill Sum # Fill Sum # Fitt Sum # Sum Diameter: Sum De the Height from Tank Top to Top of Hi est Pi in Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testin Portion of Sum Tested ` Sum Material: Wait time between applying pressure/vacuum water and startin test: 1 C i 1, JU S Test Start Time: Initial Readin RT): Test End Time: Final Readin (R ; Test Duration; Chan e in Readin R R ): Pass/FaiJ Threshold or Criteria: Test Result: D Pass 0 Fail ^ pass ^ Fail 0 Pass ^ Fail 0 Pass ^ Fail [s there a sensor in the sump? ^ Yes ^ No Q Yes Q No ^ Yes p No ^ Yes ^ No Does the sensor alarm when either product or water is detected? O Yes ^ No 0 NA ^ Yes 0 No 0 NA Cl Yes ^ No ^ NA ^ Yes ^ No Q NA Was sensor removed for testing? ^ Yes ^ No O NA ^ Yes ^ No ^ NA ^ Yes O No O NA ^ Yes ^ No ^ NA Was sensor properly replaced and verified functional after testin ? ^Yes ^No ONA ^Yes ^No ONA ^Yes ^No ^NA ^Yes ^No i?NA Comments - (include information on repairs made orlor to /estinQ, and recommended - ---- (~-~ Lss~ 5 S WRCB, January 2002 Page ~~ of 9. SPILIJOVERFII,L CONTAIIYMENT BOXES Facili is Not E ui ed With S ilUOverfill Containment Boxes ^ Spill/Overfill Containment Boxes are Present, but were Not Tested ^ Test Method Developed By: O Spill Bucket Manufacturer 1~ Industry Standard ^ Professional Engineer D Other {Specify) Test Method Used: ^ Pressure ^ Vacuum ffi Hydrostatic D Other (Specie) Test Equipment Used: ZNCO N 7'S-STS Equipment Resolution: . oooiri . ~~`;' ,•`r; . Spill Box tfjPl $~ Spill Box #~)pQ q I Spiti Box C ~ ~ Spit! Box i~~~ BuckeE Diameter: ,. ~. a,, B ucket D epth: ~ ~" ~~' o~ ~ ~ o~ Wait time between applying pressure/vacuum/water and startin test: -'~~/~ h'-„1 p'1`i^ h1~ri Test Start Time; :SpA-n ~()~Il)Hw~ ~,~Ot~ }D~•~OAT'~ 9;50~r++ y6:lut~Tr~ 1',~'}pr, )a.o$ Initial Reading(R~): (~.(~~;.~ te.fo5~lii^ (o.~3c1%n b•7 ~n 7~163~n '],11n3;r, ~•`Y~1~t, a.ctn°1~,t• Test End Time: 14'•Olowr+ )0!ol5pw~ 10'.l)~ l~'.a~~ ~b'.Ob~ S6. a5lar^ )a'OapM )a:o~ptr. Final Reading(Rr): b•b54•~~ fo.ta5'{~n ta:13a•~n to.~3o1;n 7.1b3;>r l.tb3~-, a.9~p~r, a•gt,6'`n Test Duration: ~1YI~ ~j»i;n ~~?'»•n ~ ~n ~/~ ~rjm•,n ~rjm~n ~JM~~ Change in Reading (RF-Rr): , t~ ~~ ~ GOOD .000~x SOW+-~ ,CW'r1 .G~c~p~r~ ~UOOin ,Ot71•;n Pass/Fail Threshold or Criteria: ~ ~~~ ~~ , OOa ,~ ~ i OD o1 t /1 ~ OOo1 + r` Test Result: ass 0 Fait Pass ^ Fail ~ Pass ^ Fai! Cl~.Pass ^ Fail Comm¢21t9 - (include irtJormation on repairs made prior to testing and recanmended follow-up for failed rests) l ~l ~ ~ 5` SWRCB, January 2002 9. SPILC/OVERFILL CONTAINMENT BOXES Page r3 of Facili is Not E ui ed With S ilUOverfill Containment Boxes O Spi11/Overtl! Containment Boxes are Present, but were Not Tested ^ Test Method Developed By: O Spilt Bucket Manufacturer ~ Industry Standard 0 Professions[ Engineer 0 Other (Sped) Test Method Used: O Pressure O Vacuum >~ Hydrostatic O Other (Specjjy) Test Equipment Used; INCON TS-STS Equipment Resolution: • o0o i n . ,Y . ' - ~`fj(„ Spilt Box # Spill Boz # Spi11 $ox # Spill Box # Bucket Diameter: )a ~'~ Bucket Depth: /~ ~~ Wait time between applying pressure/vacuum water and startin test: , .~ m' +1 Test Stan Time; t0',~AM ~0;$eZ~1 Initial Reading(R~): 5,lal~n 5.loab~n Test End Time: 10'•~W+~ ~l ; 0$1sY-1 Fins! Reading (Rt): b,b~0~n S.b~01'n Test Duration: '~m~n hti n Change in Reading (Rr-Rt): ,CiJlit~ . oa4~n Pass/Fail Threshold or Criteria: ~ DO [3' Test Resalt: sass ^ Fall O Pass O Fail O Pass 0 Fail Q Pass 0 Fail Comments - (include lnformatian ox repairs made prior to resting u„d recommended follow-up~or failed tests) .. ~~c~~ /~ 3'~ SB.989 TESTING FAILURE RE FORT SITE xAME ' ._~~ ~~ ~'T~"CZ G?..I~ DATE : ~ ~ ~ `1 `U C7 ADDRESS • ~ioOS Ps.~~~~ ~1+y~rECxrrlClArr: ~/~~ ~~~~~ ~~~ CITY• gjH~~1C~( 1~'SIGxATURE: SITE CONTACT; T&E FOLLOWIxC3 COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TAE SB989 TESTING. LIST OF PARTS REPLACED/REPAIRED: REPAIRS : 1'VD-~t..2, LABOR : ~ V O n-Qi PARTS INSTALLED : J~ (~~-~,_ SUMP LEAK TEST REPCiRT TEST STARTED 10:10 Ah? 'Fr,T '=TART[:D t1Gft:1f200r, BEGIN LEVEL F.,r`~47 IN .lD T1'!~1E 1Ei:1:5 AP1 END DATE E+4.'14i2A06 LEAK THRESHOLD 0,0fr2 IN i ..~ ~ '?E^ I cT „l L'' ?ASJ'tJ o, ~C!F~, TF^T 4TRF<;T~~(,r ;.:~: 10 Ahl TEST STARTED 09f14/200E~ SEC;IN I_E!)EL 6.7324 it~i ENf,~ TItiE 15: 2:i Ahl :;•dD DATE 99: 14/2006 END LE~:'EL 6, TZ2 IN EAk; THRE~:HQLD t~, 0Gt2 TtJ TEST RES~ILT PASSED. 91 Sh'L TES's' STARTr_D 16:1t~ Ar•i TFSI' ~ T ARTED 09/14/2095 BEGih! LEVEL 7.1634 IN `.~?~I? ?'; h!E 10:25 AFI . END DATE 09f14/200~~ END I..E!JF!_ i .1633 IN LEAK THRESHOLD 0.002 IN -n`? T.L-~;ULT ~RSSED ,~ G'a'~SPL '-''.' ` ,.ARTEG ~ 0:33 A'7 TEST STARTED 09/)4/2006 ':;f'rI!v LEVEL x.6210 IN END TIM1r.E 10:45 A~, ~'N!.) !SATE 0Q!14f290h END LEVEL 5.6205,Ihi i..EAi' THRESHOLD F7.092 IN TEST P•ESULT PASSED USLSPL TI-.^,T `.iTRC?Tc:D i17: °~2 iii•1 TE^T STARTED 9'J%14f2006 $FJ~Tr~ _E+.Jr_L 5.6204 IN END TIME 11:0.; n"r`~ :NG DATE Nyi14!?dh6 Eh~D LEU.L 5.6291 IN _-A1C THRE=;HrL,D r9.i02 IN TEST ~'.E'.=t!L? PASSED SUMF LEAY•.. TEST REPORT -''7>-''p!_ _- - -..... ! ~-f < g ~-rp ' B75 : TESTSTARTED 05/i4i2Cr0F_, END TIME a::4 pr:'. , ~~~!'Y!'J 'JfiTr _14i1~1/1.pk'!b END LEVEL ?.©285 Ii• ' :_;~!<' TH;aESHG LD r~,00'2 IiJ TEST RESULT r ASS 278TP TEST STARTED 9:gp AM TEST 'TRRTED ~39/14i2b06 BEGIN LEVEL 6.6541 IN ND TIME END DATE 1 p: a5 Af9 0911~~2096 END ~-E'•'eL LEAK THPESHOLD ~. .,4a E ' rrrc,- qE„r„ ,. 0 062 1 N ., T C,T!~RTED TES-r .;TAR"i ED '~~EGIN Lr1JEL _ND TIr~!E Eh+G LE.UEL. ` ~.AK TNRESHOL ?EST RE'oL!L ~; ~ ?p /IUf 14%s:l+~'~ ~, 0~,,1 Yv ~9 J.' 1 ~/,2EttitF. x.02 1r'.. C; 0,602 IN PASSED ---- ---91^rtp TEST 'STARTED k~9/14i2006 ~;EG iaV E4!EL 5.:'_939 Irv END TIME. 12:23 P"' END LEVEL 5.2036 Iti ::AK 'HRESHOUJ e, i~F~2 ?N TEST RE ~~ !LT PASSED ~~.,i l .. _... ..- -` PASSED - ._ 91ST.r 8'VPR TEST"-;TRRTED TEST STARTED ' 9:50 Ah1 09/14/2005 BEG.l I~! I_EUEL END TIn;E 6. ra'29 IN END !;RTE 10:06 AM 99114/20305 END LEVEL 6.7326 IN LEAK THRESHOLD 9.002 IN TEST RESULT PASSED '31 SF'L TEST STARTED 9:59 Ahi TEST .STARTED 0?/14f2996 BEGIN LEVEL 7,1627 IN ENr) T.IPiE 10:96 AM END DATE END LEVEL 09/14/2006 LEAK THRESHOLD '.16.35 IN 0.902 IN TEST RESULT PASSED --;: r-r '~: T AE;TS 17 ;1:47 r1i4 5i14; 20k6 TEST ~.TAR.TED E X040 Iri S . i • END T I PlE .- qi r 4/2E+a6 0 ,! S t :~HTE .. 2030 Ih' 5 END 1.E+.!EL[:' . D i~.902 ItJ t r1p 1 . PAS_ TEgT RESs!L SIIMr i_ERr; 'iES- kEF1JR~ DSI. S~ TEST STARTED 1:03 ?h. - '-i'IARTE,7 +_1~~!l.~/2906 P~EGTN :.E!JEL k.3375 '1" ' 4~r, - .,,L- , ~~r~ END DA?E 09i.14/20Cd6 ~r•iC; ' = VE i. 4, 3376 i;v LEAK: THRESHOLD 0.00:' Ir. suriP LEAK TES;° ~.~ FORT _-- '~t5'L SbP TEST '~TARTEC ?^;; ` :T Tr:RTE!~ 39%14r20N6 BEGIN. LEVEL 4, 3;93 i^ -^ii~ TIi~F ~,4 ?hi ,END DATE 09.~14i2C_30r_+ =•ID `-"VEf 4.:;384 i.i~ LEAr'•, THRESHOLD 0.902 IM -'!' f'rrr~ ' °R's'EU ... ~ •_ S!!r+P LEAK TEST kEPORT _ - _ SUMP LEAP: TEST REPORT Si tPrp ;_EH4' TES' REPGk'' ---`_ 3.-~ i-2 y-_~;; 4 r. TE ' . TARTEC ~ Prf 7: E~ TEST STAP,'i ED ., 5: 5? PP' -cT r,~ ~Ap: { EC, ;: t ? P~: ; :_ , , : ~. _ ~ TF~;T s;TARTED , h9%14r2hG+r ~~ ; '-:TARTED 99r14.~60b . ...._.-- r"~tf2Tr_iJ 4h4/i4!'1b96 -~ '' ~ BE[;IN L EUEL . 927: IN 2 RE!3IN LEi!Ei_ 2.3314 TN c ~,,~!;'7_' iF; ' LEU_L BEC;it~ a . END T':ME . 7~ 24 rtq ~;-0;~ T I.Ptc END DATE r;: i.2 "r 9 a9ii4iZ6G6 r7 ; C~i ,,-;;~t , *~qt' '~ ~ g•~!14:20!1ti~ ' T END DA.E 69/14r260E, _tdD ~_Et)EL 2.3%92 TN ~trD C,r ?TE ,,.°,s~ ::,t1i'4 ItJ -• ' ~:Nn LEUEL ~. I AK THRESHOL ~. y265 TN I D 6 902 Ih LEAk,' THRF_SHGLD 0.hd2 IN _ ,,n ._ . -'- -, ; E-f THP.ESHULD Fi.G+O~ iN ~ N ~ __ . . .._ST RESULT PASSED T;_gT RESULT frYltt3 -~y~ i4a=al. ~~A`SL`' ~ ~~ ~i ~~ 7'8 -E. '~ - -- Si1!r1p LEAk: TE`T F'r~OkT '.~TARI'ED r'~d9 !'M TEST STARTED 95/i~+/20dE• 9-i.9 TEST STARTED 09r14i29bE• };EGItd ' EUEL 4.~~573 IN EEGTN +_EVEL 1,41958 iN _ END TIME 6:12 Pr" T c;T T n 4:44 PPt TES. AR,E ENn TIME 724 PM Eun ~?RTE 951141'2096 .'. ^Tr7RTrn 419114/2995 ~ Nn DATE +a~,/ E 141'"'1° ENCT LEVEL 4.3559 IN LEC+EL 4.9i2N Ihi BE~IN END LEUEL ~.955~ IN ~ ~ r, T) RESHGLD ~ ` I N 0.00 t:j~~ Tj;gE 4: i5 ~M ~_EH~; THRESHOL D 0. (~02 IN . ~ ~ - T TE. 1T R~SU~ ~ M1 PA.,.,LD END DATE 09114x24196 TEST RESULT PASSED _ . ' LEAK: THRESHOLD F1.y01 It; ci iMP LEA;•:: TEST E<'E?GF''; ._, -. `A DN T ^ ~ STAkTE~'~ E.-• 0aii4:290h ~J C~a./?4:'2006 ?:46 I~pi cj«~14: <'E~416 ~::2r' ~'t9 i-c!~Ei l.r;~'~ I;1 BE~~h~ SUf4rs i Et-1K TE ;;T RE~'ORT SUMP LEAK TE ST REPOK.`C END C~~-T)- 09/14%2006 ? Iiv _ 3 _ y 1-2 _ ~,3i ; r ;-'t-!RESHOLC;, ~, 007. Ih' TEST STARTED ?:' ': °~ GPi TEST STARTED ^-~' -r fi~ :C Pr'1 _ ' _--,.__.~- - - "r:~~ STARTED . . 95/14/296Ei c •_;TARTED. 9EaIN LEUEL •95/14x2906 '2 829: IN SCIMP L EAi! Tf:S" REPOR' BEGIN LEUEL 2.5284 IN r'.NU TI,hE . ~;?~ °f4 E";D T; f9E 7:40 Ph1 E T ND DA,E 69x141006 . i -i 2 END DATE 69x14x2096 ;-F•;D )_EI,~cL 82:3 IN 2 ND I.. +JEL 2. ;+2n2 IN LEAF; THRESHOLD . I k7 062 N TEST STAP.T. ED ~: ~' pM LEAK THRESHOLD 6.092 IN TEST !?ESIILT . 4=flSSED ,..;.,;"'' ;TARrI-!1 ii9i14i2G1N6 TEST R.ESUi_ T r-~ PA.-,,,E.D gcO; h; :.E~,;E_ :.. h~ .~La'.I1. .. ~_~ ~_6 ENU DATE d511~12.99E. i~~9 IN E - ~. f•;D ~VEL i. . .~^,- ^~'i-iRTED 6: i2 PPi LEAK THRESHOLD ~+.602 Ih . °'=ST ::STARTED 7:%5 i'r9 p~gT STARTED 09/1412606 ''SST ~1F,fiUi_T ='ASSED TEST STAP..TED 69114x2005 4 41EOTN I VEL 4 3,;54 IN BEGilJ LEUEL ;;.4.1955 IN _ . ENCi TIP4F , 6: 2? PM END TIME END !?ATE 7:40 PM 09x14-%29H6 !=NCB DATE 4:t ~r14r::!~66 SUMP LEHK Tk:;' krpgF~- END LEVEL ,~,. 0y54 IN F_ND LEVEL i.E AK Ti•;RESHOLD 4.35441 IN 092 Ihl 9 ;~; ~~~ ~~- ! EAK THRESHOLD 0.002 IN TEST RE.S'UL ;'' . PASSED ~ TEST RESULT PASSED . _ E TAR' L~ ~ 2: i~:= pn: -- .} _ ,. .. THAT D w~ `14x2906 SrGlfv LEL+E! ':419x, It• ' ` ; ;.f!1 ";,tile ,; 2..y~ ., EHC' OAT,: 09/1~ix?.~]0b + =•'TupL :'. Wcjr4 i:N LEAK ESHOLD 9.602 Its; HS.. C-Li _ - ,~i~Mp LEAs: TE'`'T REPORT -- _+JI~k l ?~' LEUt- ~.9Eiy Ih. BE!a -,,,in ,,dE 1?•t~2 r~M ENO UPTE 691.424306 - 6.602: IN LE'AI<; THRE,HgLp :' '?E=,LILT ?ASSEG Ss `,~ '`~UiVDi=RGROUND STORAGE TANKS ....,., ~......~..,,. i.:;vl:.%.^J•:..:t,nlLYSlullFlaY~W~MfYrOIdWtl10101tlIN-YOY~YSYtl14YWAYefAY ~~~L1C~TION 70 PERFORM ELD /LINE TESTING / S8989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM 1=UEL h10NITORING CERTIFICATION 'l-fR/ A~ f ~ t "T--o 3SZ PERMIT NO. L`~ ENHANCED LEAK DETECTION LINE TESTING ^ TANK TlGH7NESS TEST _ . ;TO PERFORM FUEL MONITORING CERTIFICATION BAKERS;FIELD FIRF- DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (66I) 852-2171 Pie 1 of 1 ^ SB-989 SECONDARY CONTAINMENT TESTING ~. FACILII~Y ~ NE NUMBER OF CONTACT PERSON ADDRESS ~ G\~ - OWNERS NAME ~ d ~~1 OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED PIPIN 0 D Y • T N a ~G' .. ~ ~ )'1 ,~ ,, ~'/~NK t~S,. ,1~G COMPANY NAh1E O TESTING COMPANY a ~ NAME ~ HONE NUMBER OF ONTAC PERSON I p ~ O MAILING ADDRESS L ~ ~ NAME ~ PHON NUMBER OF TESTED R SPECIAL INSPECTOR CE IFICATION DAl'E i£ TIME T T TO E CONDUCTED + O ~~ ICC #: TEST METHOt~ SIGiVATURE OF APPLICANT C DATE APPROVED BY DATE c FD 2095 (Rev. I ~~~~~~G ~ PERMIT STATEMENT BAKERiSFIELD FIRE DEFT. ~ ,; ; Prevention Services i~Ei2iiii9T NO.. AR Y. ! 9001Yuxtun Avenue, SuiCe 210 ~ Bakersfield, CA 93301 . LOCATION OF PROJE ~ PRORERTY OWNER START"ING DACE ~ -- i ' f " ~MPLtT10N DA m~~ / IVVIJ, NAME PROJECT" NANI ", ~~~ ~ , ADDRESS PHONE NO. PkOJECT ADOkESS _. _.. C ZlP CODE • CONTRACTOR E ~ CA LICENSE NO. ~ TYPE.OF LICENSE. EXPIRATION DATE PHONE N0. CONTI~ACI k CO Y - FAX NO. ' n/ _ a-!V1rJ~ ADURESS ,~js; L - C ZIP CODE .-, n-> ;3~ OFFICE ~~- _ .~. ^ Alarms -New & Modifigtions - (Minimum Charge) $262 50 ~' ~ . ' 98 Over 20 000 Sq. FL Sq. FL x .013925 =Permit fee i 8 ^ , ^ Sprinklers - New R Modifications - (Minimum Charge) $210.00 ' ~ ' 98 ^ Over 5 000 Sq. FL Sq. FL'x.042 =Permit fee ~ , 98 ^ Minor Sprinkler Modifications (< 10 heads) $ 93.00 [Inspection Onlyj ~ 98 ^ Commercial Hoods -New & Modifications $ 398 26 ~ ~ . 98 ^ Additional Hoods $ 36 00 ~ . 98 ^ Spray Booths -New & Modifications $458 00 ! ~ . 98 ^ Aboveground Storage Tanks (/nsta/latioNlnsp.-1~ Time) $165.00 82 ^ Additional Tanks $ 26.00 '! 62 ^ Aboveground Storage Tanks (Removal/lnspection) $109.00 ~ 82 ^ Underground Storage Tanks (Instal/ation.llnspection) $878.00 (pertank) '~ 82 ^ Underground Storage Tanks (Modfication) $878.00 (persite) 82 ^ Underground Storage Tanks (Minor Modification) $155.00 t32 ^ Underground Storage Tanks (Remova/j $675.00 (per tank) ~ ^ Oilwell (Installation) 72.00 1 ' 84 ^ Mandated Leak Detection (Testi g) I Fuel Monit. Cert. 81.00 (persite) 82 ^ Tents $93.00 (per tent) ~ ^ After boars inspection ee $122.00 ~ "l ; 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour) $ 80.00 + (5 hrs. min. stand ~y tee ilnspectlon) _ $510.00 84 ^ RE-INSPECTION(S) /FOLLOW-l!P INSPECTION(S) ' $ 93.00 (per hour) 84 ^ Portable LPG (Propane): NO.OF CAGES? $66.00 84 ^ Explosive Storage $249.00 ~ ^ Copying & Fiie Research (File Research Fee $33.00 per hr) 25~ per page 'i 84 ^ Miscellaneous ': ~ FD 2021 (_~ v. 08/05). 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to File) 1-PINK (to Customer) F°_ IIND GROUND STORAGE TANK ~r ~~ ;~ PERMIT APPLICATION TO CONSTRUCT /MODIFY /MINOR MODIFICATION OF AN UST PERMIT NO. [_ J~_~' ,D '~S 3 -J TYPE OF APPLICATION: (Check one item only) ^ NEW FACILITY - ~' MODIFICATION OF F Bakersfield Fire Dept. Environmental Service ' n 900 'IYuxtun Ave., Ste. 210 ~~t~ Bakersfteld, CA 93301 A~ T Tel: (661)326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ NEW TANK INSTALLATION AT EXISTING FACILITY LITY ^ MINOR MODIFICATION OF FACILITY _._ __-- r TARTING DATE ~ ~ Q ~ ~ ~ Q~ - .~~ROPOSED COMPLETION GATE f "' Imo" "CJS AGILITY NAME. ~- - ---~ -_ ------ ~-- ---__Rose a~_,t e _ s,~ ~ ~. ~- ------------ --_----- -__ ---__ _-~ ----- _ _ AGILITY ADDRESS ITV PE OF BUSINESS ANK OWNER ----_...._.. ;__~_~uuy ~~~ a _ -- - ---- ~ADDRErrSS ~.y~p -- _ -~ ITV S~ -ii,~- --- -~~ KGRSf~ ~, ORKMANS COMP NO- .~' JGL.rca~ I~ ves' , FACILITY PERMIT NO. CYf . N IP COOE ;A LICENSE NO CC NO. 7y~ 73.5~-1~ z~s~ IP CODE ~ ~' a4 . q3~J ~v,~T R _ C ~-,F, ~ - s_~,e ~~ c_~ - _ ___ .... _. . ~_. _ _ . ., _- __ . _ __ _ ._ DEPTH TO Gf UND WATER LJ~ .. '' _ . -__ _.. .... . ... . . . _ . ...._ ... SOIL TYPE EXPECTED AT SITE '- - NO- OF TANK TO BE INSTALLED ~ /1/~~ ARE THEY FOR MOTOR FUEL ^ VES ^ NO SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE .YES ^ NO fHIS SSECTION IS FOR MOTOR FUEL TANK NO. ~V M ~ 11N EA ~ 2 GULAR PREMIUM IESEL VIATIOI 1 ~ ~ v~~ ~~e~ `~G~ ~ ' ~ ~B~ G? _...-. ~ __ - ~ -- - -- f iet° nip c~_r, _._... __ _ _ __.-S .. _ _ __ _____. THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. LUME FOR OFF NLEADEO EGULAR REMIUM r ESEI VIATION _ 77te upplir'nru lots received, tuuiercturuis, arut will rowply with the nrtaehed eunditiurrs of the permit ntul ruty other soar, !a•ul tntd federal regtdatir~'. 7his~J~nu eta' hero rornpleted utuler petutlry rJ'perjury, rtnd to dte hest u(nrv knowledge, is true urtd correct. APPROVED BY' APPLICANT NAME (PRINT) APPLICANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED 0 n := ,r :~ ...ti<<i~ Ju~~c~~iin Vallcy /fir I'ollutic~n ('ontrc~l 1)i~trict ~Cl'illll A~)hI1C~lUOt1 i'ul': I I r11 I I ! 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N'IIIIINIuta-I1t11 ns.IUn11 ~,IF•Ir 1 .r'~~ G rll\ ~ ~ 1'1:5 ~ Nt- ~ tilt' ('NI-I~t1-UP 1 At-II II1~ r I `.t 1 111 17~ I t 11\ NSI III' It;1Kt;l 111' Lnuwn ) •t l~1 NIllA1 N.4 f1+I:t 1>F 1{I1.11Nf tiS _ IN.tiI:\rr IrAtt ~ III 1 1 \' I'I~ItA111 Ilt )I.I -I Ici ONI 1" I lu }uu rr~luctil ;r ('O(' (Gt'A kr~ ic~~') pnur to rrrrlvur}; your n f( `' ~ ~ 1'1:5 b1Q Nt.1 t, 1-1 ~t'kll' l It -N t -I I t N I11'~Ii N f (-I: ~tl)1111~1('A'IION 1 (-It \Vlil('ll AI'I'I.I(-n llt)N Iti h1n1-1 {urrlu~l.• 1'rnnll tr"~ If knu~~n, arni use n.111111un.11 tihrrl•.It ncrr,•,;uy'! ~Q e ~ Pe PRoc~1.r L7' U~N~~ /R~~h' ~i fives w.•~Th A•~• rm ~ Th ~~~e+~' 6Lgss ~lolW~ e L~ e e Ek,sT `iv ~" ttt~yv~ - ,g~:T~°eNsc/ts ~~''Tb ~:'L ~BA-~ erA rhP .v's ~s`=1'~ ,~ P v QR ,s' ~Ten~ E.o VR ~oI R - 11.1\'1. 1'(111 l \'1 I: nl'1'1 11 l- Ft-1< nN A'[( (-It 1' 11 1 IN 1111 P:\~ 1 , Iti 11115 1'Kt H'I 1(I 1' Zt -NI I> I'ltt 11'1 1(1.1" 1 OIt 1111 I'I<t -I'l ril l - 1 Iti(.'' ~~l"1:5 ~ ~ Nt) '/ 1`, 1111ti r\I'1'I lt'r\ I tt IN S(IItI\N I-11 t- nti i 11F ( f 1'F,S tt l tit 11 I t )! I:I I l II.K r\ Nt) Ill 'C t )f \'!OI n llt )N Il~ yr, N(1\'/Nl l' l; tilt n N(-Il('1~ ~It-t'uAll'1.1~~' I! 11 I'1. (-It I'I:IN 1 Nr\~I l 1 N AI'I'LIl :\N'I N( ) _ . - O~)luma) tirchun __ . :__ E IU t lli c -, ~~ III.I Ii) H Yl d' .41t1 .\ ' 11~\R) 1': \ H 1 11 I I .1 N 1 I is 111111 N 1 H I111~I \UIJINIr\Itl'I'IUx.It,1!~1> ~~ ~ ~1"r, ~ ~Nlr ~ ~Scntl ullil h1 ' " "IN11'I.t 1 1 ~ ~l c, ~ ~Nu I ~tirnJ ulGl 1'11'11.01 nl'1'I.Ic'nNl i I 1\1 \II x~o b Unr d ~~e w ~ a d _ _ -- - . _ __. ___ _ 9_- z ~- o s L llt~Nr\1111:1 r-1 r\I'I'! Il :\N) I):1'fl- 1~~~~~~ It11< nl't'I-1~~I 1-t\'I l' FII.INti 1'F1. fn('ll I Il' III N,nthrln Kr•I~umal (111rrr~ • 4?.ill Klrrnan Avcnur, Suilr I IQ • A1o<Irslu, l~ithtumia '15 t56-')1:?I ' (311'1) 511-641-Q • I AX (2119) 557-6475 ('rnN.ll Kr)a~~n.-1 Oftu•r • 199t11::rs1 (irllyshur}; Avrnuc • frcvlu, ('alilinnia ')i71.b-11244 • (tii9) Zi11 5'11111 • I n\ (Sti9) 3iQ-6061 5uudu•ul Kr!•lull.ll (lllu c ' 'llNl Ai 51n•rt• 5ulir 275 • {I;-kcrtilicki, <'alllinnia ') i N11 ? ~ TI- • (hh I } l ~6 h9U1- • (A \ l bb 1) 326-(r92;i p.• 111 .IMMI .~~. °#1 ~ :r' .. San Joaquin Valley Unified Air Pollution Control District Supplemental Application Form GAS4LlNE DISPENSING This loan rnust be accompan/od by a cornoleted Auolfcalton for Authorrty to Construct snd Psrrnit to Overate Iorm. ~~ Perri~t to be issued to Ros ~ ~i~,c ~_..~~ ~ L -- - _ ___ _ _ _..--- ---- location whore tho equ~pmowt wilt bo operated: T-ten ale 6?:_` ~~~~ ~'_t°._._.__,~~iML/ . ~/i e,~S ~i e~ f~ . 9~, ~~~- --- _ _. _ _._.. Currem PermN to t-perate number lif epplipble): • lnstruct~ons t . Complete a separate form for each tank and dispensing syt:lem which hat a different type of Phaso 1 or j Phase 11 vapor nrcovory system with as much information as poeslble. ? ~Attech a copy of the sits plan showing underground fuel and vapor Ilncs and locetbn of dispenser ~slends. Note: intorrnstlon on Yapor Recovery Executive Orders is avallabb online at: wwu-•.arb.Ca.Qpvlvaporlvgppr htm Gasoi~ne Storage Tanks and Nozzles quantity of Tanks Type of Tanks ~ y•+ec~ one ror ~e,x t'arr~l Cspecity In Gatitms (rnQM:dre a ~ ra~,~~ Typo and Grade of FUt#1 - ~ ____ ~Underpround .1 Aboveground' ____ ~~~Q Underground ^ Aboveground' _ is ~' . rJ~~14~ /~/ ^ Underground a Aboveground' _. _ _. ._ _ ~J Underground ~ Above-ground' Total Numti+~ of (3asoiine Dispensers: - s• Toth Number of Gasoline Ruellttg Points: 'bt•~nmurn nur. ibvi cl vehrJuc w-wch czn bo luaw! ~t ana I+mu. .xr.-~dy n.» vorr,.los v~r alupe•~ae ;~ Total Number of Gasoline Dispenainp Noszka: -.- _ _-- __ _. _ rpo nd rnc:r,+oe aeael~ _1 ~. -. _ ___ __~.-- Tote) fVumber of Vapor Recovery instruction Signs: _-_-~ ~s~+ow, cleuAy reaaaala Horn eery hmrmrnyp.rn•; "For Abovte~cbund T>iaks Manufacturor: CARE Executive order Number: PLEASE CONTINUE ON REVERSE S'DE 710f '}''~ _ a Phase 1 Vapor Recovery System ~~ Manufacturer. ® ~/ CARE Executive Order Number: 2 ~ Component Manufacturor Model Number Splfl Containment Bucket (Produd) ,~ 2 p U SDIII Containment t3udcat (Vspor) ~ ~ ~ Oebr~s Bucket (Product) Detuia 6uoket (Vapor) Rolatabto Adaptor (Product) ~/ A~ ~ Rotatable Adaptor (Vspor) 11/~ ~ ~ i~S ,~ Drop Yubo O ~; Dust Cep (Product) ~ ~ ~ 3 _ TT' ._ ",(_ Dust Cap NaP~'1 p ~ , r~ - •- yr " L%~ PressunNaeuum Vent Valve Extractor Fitting ~ ~~ ~ ~J rv Ball Float Vent Vahre Additional Equipment Not Listed Above T c.. W JS~ Phase it Vapor Rec©very System Manutactut+rer. g~q~ ,~c' 8ystsm Type: ^ Ba ance Vacuum Assist U Burner CARS Executive Ober Number: _ Component . Mantlfa~tur~er Modai Number Norsb ~ O~ CoaYiaiHose ~__._,~rOfJ'D--~'~ 8~ Broaksway FMting ~~,VL l>3 1'O/' V _.. ~.._ plspenser ~~~'~( ~q -______ _~eCv .__ y._ ~~``Z- BSS Additiona! Equiptanent Not Listed Above _ __! ~ _~ ty, .9~ v - - - -- ~.. o e ~ l- 7 -d c- ~ t~ ~. +, fi'ose dace stieLl- 3 t~ o _°~,~ Res ~ d/~~. e /fwd ~3kF~Ds~ GA . 93.~oS? << ~RvP~s~d ~~d,~F~~~~-r,~a.~-~ R~~~.~c~ ~iP~:ss'e.~ u/r~yv~~ ~~`~~~~se~C'.s w. ~ f~~-Br~~e~~ ,~ , ` Z'~vs~~~ ~ ~s: x) - ~°~.~--~~r~ e~n s/ w uud ~~ y ~ s f~-~~.~ ~ ~' ~°~~'T~i~ur,~~~vT s°ur,,P,~ i~~,' ~ s T~1+1'd i~/vim ;~ s 1,uT ~~u~ti stews°~~'s . 3 ~l .move :s~, ~N~~~ w~+~ ~ F,'lr~re ~ ~Lrf.ss~ ~°.E'~d~re.T, veivT~//i}~,a~ ~.;w~ ~, ' .:Lit~s'1r~~L ~, ~, sj~, -T~ ~~u~/~ wry ~~. ~,~a~u~r-Y~r~ ~~~,~.e ~~p> a~ .y~~s°%~~t s. u ~, I ~~~eo m~ ~ '~~ ~v~R 3~fc~`s~ Tim .~~f/ ,s ~, ~ ~' e. ,t= x ~ s~ i~~ t~ivd e~'. ~~v ~.~~~ ~~~ ec TR, ~u~-,C ~,u d~ ~ i To 1~~,~1 mew ~t-~~ ~ C/d~ u~,k'~~N~ Io ~, ~~i3~ ~Q ~~s~~~us~s~ 7 ' livsT~3t oC ~~/y ~'~i/fse ..~ vit/~r~ 1Z~-Cvv~~'y jys-T yr, ~~~ '/Ira~'J'r~-s' " /. ~=~ ~~:-~,q , c~~ 7n -1"~~bf i+~~s o ~Pe mom, _~ . ~ ~ ' 1,r~G~rt=T; o,+~ hr~s "ih.~~e ~ ~-~R - ~'ti~ ss ~Nd~,ewc~ (pm;~,~~ u//~LL. .slv,~y~~~ ~N14's~ ~Ne. CoNU~~T~~~ %v ~~ ~~~~. "~',~~.~~~Co I~i.~~~NSe~'s ~ hr~to~ ~.~ea~de~? 1J~~~es ~v.P T/i.Pe.e. ~`~1~.~-.L L ~iE'v~c~it G~ . 1. uN~ ey~lc~J /''~,.t s ~ /~R ~~rJ ~~; ~6'r M~-NNOI.E a~ ~~~ R .~ , ~ • . . /i I ~.. • . SUM b ~=~,~vlw~ ~F~~1c'. SAT e ~ 1• r,~ J1rS 5 GONGRETE 5LA8 L~ .~wN . , , ~ . ~ ~ ~t ~~~ ' 1 . . - f/' lop b~-T~~,O CORD bRIP R~.l,,+ rN~~ • t~R ,:vim ~'-- r~rK Ur Ir, 7i.;~ __.._ __. 3 r-~v, f Ys F~ Sop~~r~' .~,r ~r _ r VEEOER ROOT LE/-DER GA9~E VEEDER ROOD ~//y~.~,., r MOUN TIN6 'SL CYf ~/E v''r' ~'` ~,'~ 4k'~ fi`'' ~, MV' ~ ~ i,rv ~~ .~ ~~D e~ )N -- - - wn!~.c f~~.oJ ~'~rRb,;~~' t+~.rk'• 3 ~p~ SUBMER51F3LE PUMP ~ MONITORING Q~SFMF31 tF5 1~os~ ~A ~~ ~e ~ L.. ~~ S-Cl9 ~ ~'fl~.~a, ~~ 9.3,3 ~- ii~~ III ~: '~ --- ~ _ d+f~ St/~'r, a1 w ~" ~~ 1~ yL .yl yll~.M~ MG RA1~ d R {L _ \) /O .___ ~Br SI WI'l!• M!M vr, ~A J ~"~ ~,~..~ .~~ .~„ Sys ,~ u.rscn ~ p G '~.Y,ltlfi.t ~Alll~ -~"F/~t .\ ,\ (,.N K i~kly~ Tv~ ~,, ~•~N~..'T _:_\ t i L -~--~!~~' ~l ~'Raj~uc;~' ~ -,~~c l~ ~~s-~d~~~ 'S`hy ~ ~ 3~~ s- ~ f~>Qs~ c~a ~ ~ ~ ~~ y ~~F~,~s c~ - q~~p~ l T/ Jc~~~ k~ V ~4 , F1c , ~ ~ i~. P~ ;~ Q ,~ ~'ile~,S ~~~1 2,i SAL r I _11ll ll./ i~~ T r'FR"~~ ~~~• '' L3 S~ `~' ~ ,,,sF~~ ~;'~ ~~ 2 ,,r 11 S e ~~ rd'~~ ~ i I-~ r ` y, ~,~! ~~~ V t~ i --- ---~ OSM~'fb Fiv7R7 r, ~!/' N6 G•X z~~- ~rT~r-~cx Co~,ve~! o R ~c~s'ec~~J-~~ S~~ L L 3~0 ~~nse~~~~ 1f~'y 3 ~~1r2 ~ ~ RVsln, ~T~ TeRr~ar~T.e~ F. ~1::v6 .. 34 „-x 3t "xZ+t 1~ ~ Kr f=, ~ c ,~ `/~-i}S.s s.~.M~~ D/ W ~c~. ~/, ~., d Rpfe ~qGe ~~y ~~s~~RGG ~~wt e r.Nr P,P~ __ __ - --- -- ~ ~,~~r~R ~g~sh ~ ~N ~~ { ' 0 ~ ~ ~ ~. s;deww~k r ~, ~ 2 EA. ~ pfi/Y/" •MNI~f ~~ ~ +1 a m ~ ~ RR°dµ~r ~~ °R ~ ~ ~ e~s Ao tl~-~^~u V ~ ~~~ s,deu~A~K ~ du L l~ I 4~ i I~UU . ~, N Rosec~p~e sticLl ~~~Rase~ate 1f~~ A~KeRs~~et~ ~A. ~ ~s'~'evG ,CoT P~.~N ,- Sc~~e ~ Ta tm' bR~wN by t3ob Ukde~~loo~ t , Y f ~, _. __ «y 4 s, Rose ~A~e ~u'y ~~~~~ ,~(~ ~~° Z ~ ~ a m a ~~s~d~c~ -}~ -- ~ s;de w,vtk ~44 2.E~ , it /~i/Y/' -MA~r n~i~~tP u ~ ~ ~. ~ ~ -. `~ ~ ,~ ~ ~ ~ ~u' f(6 u _ V~ .8810 eie v plw ~~~ yt,eT LiM{ 0lW ~ J~~~.3 a ~ ~i vA~K~3 ~~ 1 i Q rr ~~ K pRob~ ~~ ~(~ ~`I~,baR Q Dg ~ ~l~L, oP~~~~ck.Boit ~Rod,~,'N~ P .jeae ® ~ ,cc aox ' ~ , ~ ~ r7r~'s7~nrC 1w 'Y, RcSe~p,Le Shc ~L ~, ~ ~~arRosedA~e ~~'~ 1ipK~~s~i~CD Vin. N; N ~,~01" p,!.~N ~. SCAGe ~ Tc ~o i _. ~R~N by dob uXdeR~acd j ``1i1' `, ~~ z'..o.~,~F C[T~ OF B.~hERSF[ELD __ ~J;y ~ OFFICE OF E:~~"IR0~ti1E:~T:~L SER`~ICES ~p ,, ~ 171 Chester .ave., Bakersfield, Ca (661) 3?6-3979 ., ~.~s~~r:~'~rltt~~ :~t~:~H~) LySTRL'CTIOVS: Please call for an inspa;toronly when each group of inspections with the same number are ready. They will run in consccutive order beginning with iumbcr I. OU `10T cover work for any numbered group until all iterru in that group arc signed orFby the Permitting .authority. Followin¢ these instructions will reduce chc number ur n;quircd inspection visits and thtrcforc prcvrnt assessment of additional fees. TANKS AND BACKFILL INSPECTION DATE INSPECTOR 8acktill of Tank(s) Spark Tat Certification or Manufactures Method Cathodic Protection of Tank(s) Vl;-.rr t,i~ P?+Mrl~y t z~ o~ rtt,~ PIPING SYSTE~~1 Piping do Raceway w/Collection Sump ~y~ ~ C:Q~ "~ I < (~'~ ~ •, C ~` \/,~ = I6.S~ ~ (3 f~ ~ S2(etrgZq - uz Corrosion Protection of Piping, Joints. Fill Pipe C Electrical Isolation of Piping From Tank(s) Cathodic Protection System-Piping Dispenser Pan ~ - CC /'ANfl.-DV !'AM'A INfUC1.rf• AVCO CtI r o~ATO!'TfAN r P• V f1CTC/"'f•rAN Liner Installation -Tank(s) ~,., Liner Installation -Piping L ~~ # °k ~ 5~7=6.~ 9r= 6;~ V>?=6.Z ~~1,~~ Ifs` 06 S'~lo(D4tZ4 -vL Vault With Product Compatible Sealer - Level Gauges or Sensors. Float Vent Valves Product Compatible Fill Box(es) Product line Leak Detector(s) Leak Detector(s) for Annual Space-D. W. Tank(s) `tonitoring Well(sySump(s) • H2O Tut Leak Detection Device(s) for Vadose/Groundwater Spill Prevention Boxes /~k5'r 5tr~c "1-.nrRi. OK - t/:t7/QF• 4-(~ FINAI. Monitoring Wells, Caps & Locks fill Box lock ~ ,\lonitoring Requirements Type Authorization for Fuel Orop ' CONTRr\CTOR a ~ L~' LICENSE q `~~t2'~3S-~A .. ~ S25S Zq-i - vi. '7NT,\CT ~O~ UN~L2Wd°.~ PtIONE q ,203-- ,5'I $4' ... ;;,; t ,.. JI'~'13Ef~GROUND STORAGE TANKS 1. ;~ BA-KERSFIFLJa FIRE..DEFT. ^.~ ~:.°°~~°~u4e~~~.^'~,^~ ~ 1 1!'JR/ Preveat~tpa 13ervices }' Aalr ! 900 Truxtun Ave., Ste. 210 ,~IP~'~)t:~-T~17~ ~~ ~ Bakersfield, CA 93301 TO PERFORM ELD !LINE TESTING ~~ Tel.: . (661) 326-3979 f SB989 SECONDARY CONTAINMENT TESTING `~ Fax• (661) 852-2171 !TANK TIGHTNESS TEST AND TO PERFORM . FUEL. MONITORING CERTIFICATION Page 1 of 1 PERiLiiT N0. l ~ -` ~ ~~.7 C~ ENHANCED LEAK DETECTION ^ LINE TESTING ~SB-989 SECONDARY CONTAINMENT T,ESTI,gJG ^ TANK l"IGHTNESS TEST ^ TO PERFORM FUEL MONITORING CERTIFICAT ~ ~ FACILITY ~ ~ NAME 8 PHONE NUMBER OF CONTACT PERSON ADDRESS ~ ~ f1 Vd\'.~J - OWNERS NAME 1 OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED I PIPING I T D? ^ TAN # ' ~1 C ~ / l i ,. , ~'gNK~~'~S; IN.G COMPANY ,, , ~ .. , NAME OF TESTI COMP NY NAME S PHONE NUMBER OF CONTACT PERSON (WAILING ADDRESS ,5~1v ~ 3 ~ ~ - ~ Ca-- ~~ ~~ NAME ~ PHONE ER OF TESTER 0 / PECIA[, INSPECTOR ~~.. CERTIFICATION #' ~ DATE & TIME TEST TO BE CONDUCTED ICC #: TEST METNOp SIGNATURE OF APPLICANT C DATE i APPROVED BY DATE ~3 ~ ~ -~ ~1~..~I~~I~r ~ PERMIT STATEMENT BAKERSFIELD FIRE DEFT. I, .~- .,. ~ Prevention Services AR f~AI f 900 Truxtun Avenue, Suite 210 r~Ei~rrril-P NO" -1 BakersSeld, CA 93301 rPt. ~ r~~ t - s2~-s9~q s FaX~ r~~ 1 ~ ~~2-21 ? 1 LOCATION OF PROJECT ~,~ ~ PROPERTY OWNED.-~ ~a' START ING DATE ,~ ^' COMPLEr10N D .v V Ow{ NAME '! PROJcCT NAME ~ ~ DRESS O L PHONE NO. PROJECT' ADDRESS ~ CITY ST E ~j(1{i ~. ZIP CODE • •' • RACTO ptRjvtE ~~ CA LICENSE NO. TYPE'OF LICENSE. EXPIRATION DATE / (~ PHONE N0. CONTRACTOR C~O~v1PANY E ~ ~ ~~ FAX NO. R - 8- AllORcSS - / ,~ ~" / ~ CnY ZIP CODE -o(Qa ^ Alarms -New & Modifications - (Minimum Charge) $262 50 . 98 Over 20 000 Sq. FL Sq. Ft x .013125 = Permit fee ~ ^ , _ 98 ^ Sprinklers -New & Modifications - {Minimum Charge) $210 00 ~ . 98 ^ Over 5 000 Sq. Ft. Sq. Ft x .042 = Pennif fee ~ , 98 ^ Minor• Sprinkler Modifications {< 10 heads) $93.00 [inspection Only] ~ 98 ^ Commercial Hoods -New & Modifications $ 398 26 ~ . 98 ^ Additional Hoods $ 36.00 ~ 98 ^ Spray Booths -New & Modifications $458 00 ~ . . 98 ^ Aboveground Storage Tanks (Instauation/Insp: 1~Time) $165.00 82 ^ Additional Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Removal/Inspection) ~ - $109.00 82 ^ Underground Storage Tanks (/nstallarion.llnspedion) $878.00 (pertank) 82 ^ Underground Storage Tanks (Mod;rigtion} $878.00 (per site) 82 ^ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Underground Storage Tanks (Removan $675.00 (pertank) 84 Oilwell pnstallation) $ 72.00 ~ ~ ~ ` Mandated Le etection (Testing) I Fuel Monit. Cert. $-81.00 (persite) 82 ^ Tents $93.00 (pertent) j 84 ^ Afterhours inspection ee $122.00 - 84 i ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour) $ 60.00. + (5 hrs. min. stand -by tee /Inspection) _ $510.00 64 ^ , RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 83.00 (per hour) 84 ^ Portable LPG (Propane): NO.OF CAGES? $66.00 ! ~ ^ Explosive Storage $249.00 • ~ ^ Copying & File Research (File Research Fee $33.00 per hr) 25¢ per page " 84 ^ Miscellaneous ~ ~; 84 FD 2021 (f~ev. 09/05) -, SWRCB, January 2002 t,~ e ~ 4 ~°1 Secondary Cantainn4ent Testing Report I+, orm This form is intended for use by contractors performing paR}odic taat/ng of UST secondary eontpinment systwns. Ifsa the appropriate pages of this form to report results for all.components tested The completed form,; written •test procealuie,` and printouts from tests (if applicable), should be provided to t1~e facility owner/operator for submi~tta! to fire local -eg{rlatpry age cy. 1 Ti' A CTS .ITV 7NFf1121Vf s TTl1N Facility Name: ~ ~ Date of Testin : - 1- o Facility Address: (o[jf" ~Q, ~ ~. Facility Contact: Phone: Date Local Agency Was Notified of Testing Name of Local Agency Fnspector (if present during testin ; 1 TTi'CTTN(, ("(1NTRS!'7'lli2 TNlif1RMATTt7N CompanyName;RICH ENVIRONMENTAL Technician Conducting Test: j• Credentials: ~CSLB Licensed Contractor Q SWRCB Licensed Tank Tester License Type. C611D4Q License Number: 809850 Manufacturer i» o Went s Date T 'n' ~ Ex Tres INCON INCON TS-STS 3. SUMMARY OF TEST RESULTS Camportent Pass Fail Nat. Tested lis~airs ade Comporteat p~ g~j ~' t t Repairs ade U nL S"1 `Army\w+2 ^ ^ ~. ^ DSC. Sec . ~. ,2. © ^ a r1~ `An v 0 D ^ -V~uT ^ ~ ' ^ nl.. $1 Sec . ~ D D ` D q ^ ~ D ~ ~-2 ~ a a a ~ o ~ a ~ seg. ~ ^ o ^ voc ~-a ^ ' o V Sec . ~2 `~ 0 D . Q _ USX: 3' C~ : 'Cf SeL.. `. ~ fl p p fl p fl .~ tf hydrostatic testing was perfQnned, describe what was cioiltwith the water ailer: completion of tests: _ RECYCLE AND REUSF,,,,,,~I _ ` j CERTIFICATION OF TECHNICIAN.RESFGN$I$LE FOR CONDUCTING THIS °TESTWG ~ ! To the best of my knowledge, t/te facts stated Pn tul~ dpetr~tpri pre accurate and Gt fuU eomplfanee wltb legal nypir .~ Teclutiician's Signature: ~~_- Date:3' al'O 1. - -- a8 SWRCB, January 2002 o a ~ c Secondary Containment Testing Report Forml This form is intandad for use by contractors patformittg pa~iodic tasting of UST secondary containment systems. I~xe ilea appropriate pages of this form to report results for all co»rponents tested The completed form,: written test pra~cadyretr, and pri~atouts from tests (IJ'applicable), sl~auld be provided to tyre facility owner/operator for subtnltta! to the fora! regulatpry ag cy, 1. FA[''Tf.tTV lfiF~`nRMATT()N Faciliry Name: ~rtt.\ '~~IOn Date of T~.sti : 3~ 2.1.06 Facility Address; 3(aQj OS2.t~`A ~1W ta1C~l'?F~tt Faciiiry Contacr. - Phone: Date Local Agency Was Notified of Testing Name of Local Agency Inspector (jj'present during testin Corn n Name:RICH ENVIRONMENTAL Technician Conducting Test: ~ pn opy~. Credentials: !~ CSLi3 Licensed Contractor ~ 0 SWRCB Licensed Tattic Tester i_icenszType. Cb11D40 License Number. 809850 ' N INCON INCON TS-STS ~ __ ~ _ __ _N 3. SUMMARY OR~TEST RESULTS ,, Comgoaent Pass Fail IYot. a li~paiss Made Component ~ Pass ~'ai! T t (i~apairx ade Una ~ ~ti ^ ^ ~ a ^ © , o : :a ~i 'll m 0 D f~ ~ D 0 D~ 0 ~ ~; l ur~+ D ^ ~, D D a~ ^ a 1Jn~ 87 ~\ ~ D 0~ D 0 ©` p D °t 't D [] ^ D ~ ~ ~ D D ~k ~f D l] D D ^ 0 0 D 0 Cl 0 0 D' 'D fl D o b ^ ^ C~ ^ D o D D n, ~ o ^ o Q ~^ o D ~ o ^ D Q ` a Q 0 D Q Q ~ p ^. if hydrostatic testing was perfQrtned, describe what was dgge with`t-se water after. completion of tests: RECYCLE AN~7,REUS~D j CERTIFICATION OF "i'ECHNICIAN.»~iPQN$~Bt,E FOR CONDUCTING THIS TESTING To eke best of my knowledge, the facts stateQ in ibis dogtcptsat ass accurate and !n,(htl! co~pJiance uitiq 4ga1 sager , ~ amts Technician's Signature:JCa~YVtQ' ~ Date:3 -011! O _~ ~~ 5 WRCII, January 2002 d. TANK ANNTii.AR TF.~TTN[,' Fage o ~~ 'Celt Method Developed ]3y: A Tank Manuthcturr~ j~ Industry Standard [] Prafwsional En~tteeF O Other (Specify) lest Iv1et[tod Used: D Ptessure T] Vacuum D Hydrostatsc Other (Spec) 1'estEquipmentlJsed: 41n. DIAL GAUGE r ~~~~J ~~~Fl wt'~ %~ L~ `,1Y,, a•..,, ~;~".2~; s ,r Tank# VY1L$~ "t'xnk# ~~ Equipment R.esolutlon:.5% Tank# ~ Taak.# (s Tank Exempt From Testing?r Yes !?No Yes pNa Yes QNo C]Yes C1 N 9 Tank Capacity: (~( (,( ~,t/ Tank Material: e, ~` 'T'ank Manufacturer: ~ W VYt~CYtt7Wd1 Ptvduct Stored: riL ~ Wait time between applying pressure/vacuum/water attd stat•tisii7 test: ' Test Start Titre: W-Q•-~ \~~ ]nitial Reading (Rt): Np~ ~,p~ Test End Time: Final Reading (R~): -lest Duration: ~ ~ Change in Reading (RF-Rr): ('ass/Fail Threshold or Criteria: Test Result: D Pa C3 Fall ^ Pas U Fail D Pa ^ Fail ^ Aa3s ?: D Fail Was sensor removed for testing? Q Yes No C7 NA ^Yes No DNA QYes No QNA []Yes 'Q~1o ^NA Was sensor properly replaced and verified functional afrer testin ? Q Yep No QNA ^Yes o ONA OYes Nv ^NA ^Yes D:No ['JNA ~- laments - on ref~airs mpde prior to testing, ctnd . ~ ; `Secondary containment systems where khe :.ontinuous monitoring automatically monitors both the pritnary• and sewn containtneui, surJt as systems that are ltydroratically monitvrod-ot under constant vaevwn, are extmpt from periodic co>ata esling. {California Code of Regulations, Titre 23, Section 2b37;(a){6)} . ;. j ~tmeTit , ~; 1 Ir _~/_i~L l !4-~ w~1' l4~Ni ~ ,P EXf.H~ ~,,~, psi v~ S WRCt3, Jaauary 2002 ' ~_ CF.('t7I~T1nAi2V ATPF TFCTiN[~' . Page of ~47 Tesi Method Developed sy: l7 F'ping Manufacturer fd Industry Standard ^ Professions! Sngitt~er ^ C Cher (Sped) 'f est hletlzad Used: ~ P: essure C3 Vacuum fl Hydrostatic her (Sped) D (.' _ 'l'est Equipment Used: 4 3n . DIAL C :HUGE '' ~`~~es~r .: ~ . i } ~ ~ Piping R ~i # ~ Pi~ iAE Rtun~ ~ Equipment Resolution: . 5% Piping Run ~! Plpln~ Run .tl Piping Material: ~ Q, ~' Piping Manufacturer: Un W r•»o~ti y~ Pipinb Diat~teter: a'• ~~ , ,. ~~ Length of Piping Run: ~ ~ / /~j r Product Stored: ~ a) ~ trP..rn ~~ ?.~ firi ~ V ~iE ?. ~ Method and [oration of i ing-run isolation: ~~~ ~ ~v1~ 1~~. ~ t'1 Sump ~. i ri Sur~,P '~j p,~} .n' J~vr+^P 1~'ait rune between applying pressure/vacuum/water and starting test: min IMF n 30 r^~'r 3a r+.:`... Test Start Time: 'O; qm 1d:15 qr~ ~.Q; ~ ~ Initial Reading{Rt): rj~ps; t i `J S Kest I;nd Ttme: '1~:15w~, 11'.15ta~, lt'. a-~ l~ ,1 a Final Reading (Rr): ~ ~j ~ $( ~ Test Duration: t1U y'1pUR u2 Change in Reading (Rr-R~: ~ ~~ Pass/Fail Threshold or Critersa: ~ ~ „~` Test Result: e~ Pas U Fai! ..~ Pass D Fail ~ Pass D Fall Pass ; ~ Fail Comments -- (seclude reformation oe r:. pairs made prior to tr"streJ~rted recommendedfollow-up forfalled tests) `i .. _ S WRCB, 3anuary 2002 ~e S 'of 70~ S_ c~rn~vnsuv prp~ 'r~c~rnvr_ Test Method Developed By: ^ Piping Manufaciur4r id industry Standard D Professional Ert>Zincar O Other (Sped} 'Test Method Used: ~ pressure ^ Vacuum ^ Hydnostatle ^ Other (Sped} ' Test EquipmentUsed: 4in. ~~ ~ E~1i~lj .y~,ik' r ~~ +'~ ~,'.; DIAL GAUGE .. Piping Run P( iu Run 1?quipmentResoltttion: .59~ • ' Piping Run L~ Plpl ~Ruit, L $~ Piping Material: ~ s ~ 1q ,$' ~ Piping Manufacturer: ~ Vr1Y~tOW'tl V»~6ryoWY1 urtlCnpwn ~ ~pwn Piping Diameter: `~ a`' ~' .Z:'' Length of Piping Run: ? SO'' /so ' f s0~ 5f7;~' Product Stored: ~Di@.St.J 2 ~ie~e~ j VnL ~~ ~nL ~ .~ Method and location of i ink-run isokation: ~~ ; ~;,~ .$ump ~Y •~n ~ti+n~ '~jpp~ i~ ~r»p ~o~C iln' ~rv~~ Wait time between applying pressure/vacuum/water and startin test: w.~ n 30 r'^` ti , ~ 1"`'r~ ~ ~h Test Start Time: 0~.1 r~ ~ ~JAr+1 ~~~. SA'-h l~~,y A1'`` Initial~Reading (R,): rj ; rj , S • ~ "L'est End Time: ~~ .~5 tats a'~ 5 ia•4s ~, la~. s F'irial Reading (RF): 5 ; r'J• rj i ~~ Test Duration: pun 12 oti72 t)U2 Change in Reading (RF-R~: ~ ~~ Pass/Pail Threshold or Criteria: ~` ~~ ' ~l 'Test Result: t~Pass d Fail -l~ Pass 0 Fall '~B.Pass 0 Fsil '~ Pais ; ^ Fell Comments - ~'rrclude information on repairs mad~rior to testing, and recommendedfallow-up for~ailetl test S WRCI3, January 2002 S. SECONllARV RIPE TF.CT1fN[~ Z Page of °~ Test Method Developed By: ^ Piping Manufacturer id industry Standard d Professions! Engineer D Other, (Sped) 't'est Meti~od Used: ~ P~•essure ~ Vacvvm ^ Hydrostatic D Qther (Sped) `l'est Equipment Used: 4 i n . DIAL GA[IGE ~ ' '~.<~?!~F~ ~ ~~va ~ Piping Run 3VI-Llr1 Pi~ ing Ram #~nL~ , Equipritent Resolution: . 5~ Piping Run Pipi Rqp ~# ' Material: Piping 3 , , Piping Manufacturer: kripWin Vn1triOW~n Vn1C 'r1 Piping Diameter; '~-• ' - '- Lenbdt of Piping Run: ~ O`' 1 ~y ~50~ ` Product Stored: V`nti ~ VA'pp'tt `}~i, ~ Vlq~0i4 2 UtIL $1 Method and location of i in~~-run isolation: ~~ "~ ~rnp ~~'~ ~~ ~ e_ ~'Y~ SJY~`P '. Wait time between applying pressure/vacuum/water and s[artin test: ~~ 1~h h^ .r 30 /'"t'*~ . i Test Start Time: ~l', rj pW~ `~',~ -41~ ` ',~ y~.~ Initial Reading (R,): ~~ ; rj Test End Time; ~;~$ p,r,~ ~a; ~',GjD to Final Reading (RF): rj ~ r S , Test Duration: ~n~uf2 t7v Chance in Reading (RF-RJ: ~ Pass/Fail Threshold or Criteria: Test Result: -® Pass ^ Fail ~. Pass D Fai! ass D Fail l7 Pala : D Fail Comments - (include irtformarioa on repairs made prior to testirr~ and recommended follow-rip for~afled tests r SWRCF3, Jacwary 2002 6_ PiP7Ntf+ rrn-an -rsc-,r,rwT~ - ~ Pnga .7 of Test Method Developed Sy: f3 Sump Manufacturer ~ tudustry Standard O Professional F.ngiaeer ^ Othher (S ec~) 'Test Method Used: p Pressure Q Vacutun Td Hydrostatic Q Other (S eel) , Test Equipment Used: INCpN TS -STS Equipment Resolution: ~ 000 in . ~~/ ~~~~4; b , r3' Sump # ~}tn~- ~'"~ $um~ Clj Samp # Sump t~ Sump Diameter: ~ " Sump Depth: ~ ~•' rj~ ~. Sump NLaterial; , Height from Tattk Top to Top of `! ~, ~ ~~ ~ ^.. Hip=hest Pi in Penetration: tb O~ Height from Tanl: Top to Lowest g i. ~~ _ p., l} Laectrical Penetration: O Condition of sump prior to testing: Portion of Sump Testedt ~ ~o~Ohh ~1 Does turbine shut down when sump sensor detects liquid (both ^ Yes 0 No ~VA tJ Yes O No ANA ^ Yes ^ No KyNA ' D Yes.. A NO ^ NA roduct and water 7~ Turbine shutdown response time ~ r Vn kneW~ Is system programmed far fail-safe S11ULdUWA? la Yc ~ 0 No c~NA tJ Yes O No 1i3NA l7 Yes 0 No `B~IA ^ Yes A NQ ^ NA Was fail-safe verified to be o erationat?~ D Y~ 3 [J No .ANA QYes DNo ~NA D Yes O No ~'NA ^Yes D Np DNA Wait time between applying pressure/vacuum/water and starting test: ~ 1'h~.c~ Wt, ~ Yb1i r Test Sta='t Time: a ~ y1 rt~. a:s-) lo~.aoar lo;yb~ la:5wpr• t'.~o~+~ Initial Reading {Ri): y .2,13;;, 4. ~)~ it 3 31~;~ 3.31a;-~ 5 . 5.(o56'y+ Test End Time: a' S h -~~ O;~w~. 11:polAt~ ):o1b~r Final Reading(RF): ~ . y.a1y~ 3.31o1~n 3311 itn FJ•la°I~un 5.~~a•h Test Duration: IS .;~1 /S ~ /S p /S ,,d .wr,tJ ChangzinReading(RF-R~: .1s04~'n 'O~U~'~ •Co0-y1 .oo)~n ,oo0~n •hoo`~r~ Pass/Fail Threshold or Criteria: , 4Ue?:+n ,Oda:r. . DOo'1',t+ ~,cxt~:~ ~, v0a--~ ~,bOa;11 Test ltesalt: i~ i'ass D Fail ~$ Pass D Fail ~ Pass ^ Fail ^ Past Fafl Was sensor removed far testing? ~lYe:s DNo ^ NA ~(es ^ No 0 NA `Yes DNo DNA. D Y~ ^ DNA Was sensor properly replaced aad verified functional aftertestin 7 ~~ DNo 17 NA q~Yas la No DNA $Yes DNo DNA• DYes . QNq -DNA ,.. Comments.- (inchcde Information on re-airs made prior to testing. and reeommeatded tnllaw~un for fatted tesecl I -~~YCC~ ' - ~>nL . hY~ 14TG'1 1r~rE ~~s ~~ a Sur~,o Sc~ d; ~ y~o~C-}`~-~-_~ ---- ' lr [he entire depth of the sump is not tested, specify how much was tested. if the answer to gpy of the questions indicated ?gtth an asterisi: (*) is "NO" or "NA", the entire sum;. must be tested, .(S~ SWRC$ LG•160) ~~ S W RCl3, January 2002 7. UNDER-DISPENSER CONTAI1~TiYIENT (UDC) TESTING rage 8 of Test Method Developed 13y: {~ t -DC Manufacturer 1>a Industry Standazd D Professional Fatginaer ^ Cther (Spec{ry) ~ "Test Method Used: 0 Pressure Q Vacuum ~ Hydrostatic ~ ^ Other (Specify) Test Equipment Used: INCON 3 ' ?i TS~STS EquipmentResolutlon: . oooin: • } J,,~~~~;, ~~ UDC # - C # UDC # - ~ UDC # UDC Manufacturer: ~n r WY1 ~wwvti UDC Material: ~ ~ UDC Deptlr: `' ' height from UDC Bottom to Top of Hi pest Pi in Penetration: _ rr t. ~e ~, ~ • ` ~ ' E-ieight from UDC Bottom to Lowest Electrical Penetration: ~b~ 1~~ _ Ib•~ ~~' Condition of UDC prior to testinJ: C I'oe•cion of UDC Tested ~q Does turbine shut down when UDC sensor detects liquid (both ruduct and water ? ^ Yc . ^ No CIA ^ Yes ^ No t~NA ^ Yes ^ No ETA ^ Yes Q filo ANA '- ' Turbine shutdown tes onse time .n nk wh Y` Is system programmed foc fail• sate shutdown?~ l7 Yc~- ^No ~.NA Q.Yes ^No CIA la Yes ^No ANA DYe9 ^rIo ANA Was fail-safe verified to be o erational?~ Q Yc ; QNo ANA ^Yes ONo NA '~ ^Yes ^No ANA QYes ^>rlo ANA Wait time between apptping pressure/vacuum water and srartin test m+ ~ ~ ~, ,n 3Q 'fY1 ~ in 3~ , ~ Test Start Tiine: ` initial Readin' ~r~ t:. ~n b t~ , Test L-'nd Time: ; :pQ ` ; Final Readin R~ : ~h 1h .a1 ~~ •,~b - ~ , ~~` •~ n Tzst Duration: „/ 5 5 . 5 /~ ~ Chan«e in Readin R R ,Q(~p,h •~. , in ~--+ , ,r~ ~O '~r ih p it PasslFail Threshold or Criteria: . boe1:~ p~;w. ;n, oo;e1 ir. , Ao~a;r, , bOr"a+n -,opa;n , oq~'ti+ Test Result: 'ass ^ Fall Pass ^ Fait Pass ^ Fai! Pans ^ Fail Was sensor removed fortesting? -Ye>: QNo ^ NA 'Yes ONo ^NA Yes ^No ONA C~-Ye~ 0 dIVA Was sensor properly replaced and verift~d functional after'testin ? 49tYc ^ No Q NA Yes QNo ^NA Yes ^No ^NA Yes ^ ^NA Comtuents -- include i~nrmation on r ,airs mode prior to testing, and t tf the entire depth of the UDC is not test. i, specify how much was tested. If the answer to g_tly of the questions indicate with an ast~risic (*) is "NQ" or "NA", the entire U' +C must bt tested: (Sae SWRCB LG-160) SWRCB, January 2002 7. UNDER-DLSPENSER Cfl~ITA3NMENT (UDC) TESTING Page C1 of„~_ 'test Method Developed By: O UDC Manufacturer ~ industry Standard ^ Professioaal Engineer D Other (Specify) 'l'est Method Used: ^ Pressure ^ Vacuum ~ Hydrostatic '. ^ Other (Sped) 'i'estEquipmentUsed: INCON TS-STS Equipment lZesoiution:.oooin: <a i~~' ' "~ ' '~ UDC # - i t`j IUDC # 1- UDC # UDC li UDC Manufacturer: V,nkrUWr n1~Yt~1,~n UDC Material: 1 UDC De the Height from UDC Bottom to Top ~' ` ~ of Hi hest Pi in Penetration: ~ t7 ° Height from UDC Bottom to D ~ ~ ~ Lowest Electrical Penetration: 1 d ~ Condition of UDC prior to testin r: C.. Portion of UDC Tested Does turbine shut down when UDC sensor detects ]iqui@ (both q Yes DNo QNA D Yes DNo ~1~[A ^ Yes ^No ^NA 0 Yes ^ ~ ^ NA roduct and water ? " Turbine shutdown res nse tithe ~n~(, ~ Wt" ]s systemprogamtnedforfail- ' pYes ^No ~lA Dyes DNot~IA ^Yes ^No QNA ^Yes ^jdo ^NA safe shutdown? Was fail-safe verified to be ' p yts DNo ~ NA ^ Yes O No `®,~IA O Yes D Na DNA ^ Yes. ^ l~io C] NA v erationa]? Wait time between applying pressure/vacuum/water and ~ ~~ startin test IM~Yti ~~`` Test Start Time: ; ~ [nitial Readin R ~y, .h , ih Test )ind Time: ~ ~ I Final Readin (Rx : - $O-n ~,y, ~jJ,,~ Test Duration: ~ Cftan~~e in Readin R -R : ,r, ~ aDl f>", .ooo:r 1 . -~ PasslFailThresholdorCriteria: ,pp(,l:r- ,t~O'd:~ ~ .Ct~;n ,dJ~;r- Test Result: Pass Q Fall . ~ Pass ^ Pail t7 Pass ^ Fail D Pass ~ ^ Paii Was sensor removed for testing? ~'es ^ No ^ NA Yrs DNo ^NA ^ Yes 17No ^NA ^Yes 0 ^NA Was sensor properly replacod and verified functional aftertesti ? Yes DNo >~ NA ~3les Q No DNA Q Yes DNo DNA ^ Yes © QNA _ Comments - (include information on repairs made prior ta, te~sling, and recommeRdedjollow-upfor failed _t_estsl - ~ _ [f the entire depth of the UDC is not tested, specify how rnuC~t Was tested. If the answer to ~r y of the questions indieate~ with an asterisk (*) is "NO" or "NA", the entire U3.)C must be tested, (See SWRCB LG-16o) S W12C13, January 2002 8. FILL RISER CONTAINMENT SUMP TESTING P$ge ~~ of fiacili is Not E ui ed With Fili Riser Containment Sutri s ^ Fill Riser Containment Sumps arc Pres.~nt, but were Not Tested !7 Test Method Developed By: ^ Sump Manufacturer iSIndustry Standard ^. Professional Eagitrper Q Other (Spec{ry) ' Test Method Used; 0 '.'ressure ^ Vacuum ID Hydrostatic G+ ether (Sped ' Test Equipment Used: INCON T S-STS EquiprrtentResolution:.0~01n. •~°k~~ 1'~ ~~ri .: ~'.I Sum # F Fili Sum # Fill Sum # Ftli Sum # Sum Diameter: _ Sum De the Height from Tank Top to Top of Hi hest Pi in Penetsatiotl: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing' _ Portion of Sum Tested Sum Material: Wait time between applying pressurelvacuutn/water and starting test: ~ ~ ~ ,1 `~- 1 '" Test Start Time: Initial Readin R Test End Time: Final Readin RF): _ Test Duration: ' Chan fe in Readin R . Pass/Fail Threshold or Criteria: Test Result: ^ Foss p Fail D Pass D Fall D Pass D Fail ^ Pas9 0 Fait Is there a sensor in the sum ? ^ yes D No Q Yes 0 No Q Yes ^ No ^ Yes'i Q No .Does the sensor alarm when either product or water is detected? ^Yos ^ No ^.NA ^ Yes ^No ^NA ^ Yes 17No ^NA 'i DYes C~No QNA ~. Was sensor removed for testis ? ^ Yes ^ No DNA ^ Yes ^ No O NA D Yes 0 No ^ NA ^ Yts No Q NA Was sensor properly replaced and verified functional after testis ? ~ O Yes ^ No DNA. ^ Yes ONo DNA 0 Yes ^No DNA ~~ ^Yos q No Q NA Cotr~ments - (inc~ lucle i Torma[ion on r•s airs made for to teatin and recommended ollow~u or ailed tests ~ i fs_ 1 ~~l ~(1`AS Yti~ -~i ~~ S v vh1JS' ~C~ ~D~. ~'E '~- i ~~3-- _, .;'i:~:u, anuary 2002 -- - Page `~ o~~ f!s!• _ ___ 9. S]PILLIUVERFILL CONTAINMENT BOXES ~! c ztCt!it~~ i~ Not 1=.guippcd With S ill/Oves-til[ Containment Boxes ^ i,ilL Ch•crtTll Containment Boxes are Present, but were Not Tested C7 ' f':i[ ;vle[t,od i)eveloped 8y: ^ Spill Bucket Manufactw~er >~ ]ndustry Standard ^ Professional Engineer 1~ ,'~ _ C] Other (Specify) •-~I ! mss[ :~!~d~od Used: CJ Pressure C_1 Vacuum >?`J Hydrostatic ~ ^ Other (SpecrfyJ _ ~~. ;cs[i:guip,nentUsed: INCON TS-STS EguipmentResolution: .oooin. : Y. Vn~ Spit! Box # $1 Q(~Spill Box #q~ ~ ' < ~ }, _ Spill Box #pS ~, Spif! Box # . , . ;;ue~:c[ i~iainetet: p'' ld'. _ _ _ __ '•,~;'ait [imp het\veen applying ~ ;;!;CSju,~ervacuurraiwaterand ~~:~ ~~~<< lime: •,apw~- 1o:yb>A~ '.a0 lo;~br+r• Jo1:rw I~ ~) k ~~~;;:~; i<~nding cR[): a.5ab,-, ~.9ab:h a. ;,, a.y35,,, I:oHS;ri l.oy5;h _I~t~C Lflii '~"ime: f 10:36At~ 1 •.ua+++~ 10:35 Ar- 1 ',oa~>,. lay ao ~a :36 ' ~ ~i _ _ rin«li<dading~Rr)~ '.9o'Z6~•. ~.9a5~r •y~v~ir- a.~~34;r 1-~yS~r J.0 ~r r f ~~1 LIUI'aiiUn: 1 ~Y1. (~~ \(~ } J f!h~h Chan.;e in Reading (R,:-R[}: , n00 -r, . OOl-~1 , O0~ ~~ , 004 i•~ ~ OOb'•~n AUO~~ ~'- F~c~;: }'ail -l'hreshold or [ l •i 'i ~ , ova ~ ~, , ova ~~ ~U,a. ~^ ~ , rc: a: ----- - _ - esi ttesult: ~vPBSS lJ Fai! Pass D Fail ~ Pass ^ Fail ^ Pass Cl Fai! ~:,ir:nrprents - ("include information an repairs made prior to testing, and recommended follow-up for failed tests) SUf9P LEAK TE'ai' REPORT ,,757 1 TEST~.TfiRTED 2:41 PM 'CF ;T ~, T AP•.TEG 8312112886 BErIN LEVEL. 4.21y8 IN F:.ND TIMc 2:56 FM , END DATE 0312112046 -ND L'e.VEf 4.213a ):N LEnY. THRESHOLD -J.002 IN TEST RES~.JLT- PASSED 93 ~21.:'06b 3: 1.3 PM SUMP LEAK TEST REPORT 87:,TP TEST STfiRTED 2:57 PM 7E;;T 3TAP,TE?~ ~+:,; 21 /2086 BE+3IN LEUEL 4,2141 IN =!~!:; TIME 3:13 fM ,END DfiTF_ 03x2112406 l.,ND LEVEL 4.2144 IN LEAF; THRESHOLD 4.042 IN TEST RE;'.ULT PASSED DSLSTP TEST ~THk'TED 1:14 PM TEST STARTED 0;;12112406 GEGIN LEUEL 5.65b1 IN END TIME 1:26 PM END LEI.EL 43/21.'7845 LEAK TI~RES,HOLD 0. g~2 N TEST RESUL'C PASSED L+GC1112 T. E^T STAI;TFG TEtiT STARTED GErIN LEVEL END TIP1E END L'~ATE ENG LEUEL LEAK THRE.:HOL TEST RESULT '?' 41 PM 83121/2086 ~~. 7651. IN 2: Sb Ph! @. 11I.'284b 3.7626 IN D r~.402 TN FAILED DC9-14 TEST STARTED 2:41 PM TEST STARTED 03/21/2086 BEGIN LEVEL 1.4481 IN END TT!'1E 2:~6 PM ' END DATE 43/1/2406 END LEUi1 1.4499 IH LEAK THRESHOLD 8.01+2 IN 7E'a'T REa!JLT INCREASED DS'LSTP TEST S?'ARTED 12:.54 PM TEST STARTED 031211208E, L3EGIN LE?JEL S, r,S{,,5 IN END TIME 1:09. PM END DATE 83121/280b END LEt+EL 5.6562 IN LEAK THRESHGLD 0.002 IN TEST RESULT pAS~ !331?.11.2000 12: 3b Pal .. SUI4P LEAK TEST REPGRT JiSLb'P I L TEST STARTED 7ES7" STARTED 12:21 PM 03/211-~0b BEGIN LEUEL END TIME 1.8450 IN END DATE END LE+JEL 12: ;s6 PM 03121/200(; LEAK THRESHOLD TEST RF SULT 1.6451 IH 8.002 IN _ PASSED 87SPILL -• TEST ,;TARTER TEST STARTED 18:46 AM BEGIN LEUEL ENG TIME 031211200fi 2.9265 IN END END LEUr:L 11:02 AM .031211'2806 LEAK THRESHOL D g TEST RESULT ~ IN PASSED +331_•;1 r ~00b 12:28 Phi SUMP LEAK TEST REPOF,<'t ' i)SLSPIL j TEST STARTED TEST tiTARTED 12:95 PM 0312ir~0b BEGIN LEUEL END TJ ihE 1,0q,Sg IN " , ENG GATE 12:20 Plq ENG LEUEL 03/g11,Z006 1.4851 IN LEAK THRESHOLD TEST RESULT , 0.092 IN PASSED 87SPILL TEST STARTED 18:28 AP1 TEST STARTED 03!21/2006 BEGIN LEVEL 2.9263 IN EN6 TIME 10:35 AM END 4ATE 03/21/208b END LEUEL 2.9261 IN LEAK THRESHOLD 0.082 IN TEST RESULT PASSED /!73/21f200b 11:02 AM SUMP LEAK TEST REPORT `12S~IL TEST STARTED 10:46 RM TEST STARTED 03/21/2086 BEGIN LEVEL 2.4356 IN END TIME 11:02 AM ENG DATE 03121/2806 FND LEUEL 2.4344 IN LEAK THRESHOLD 8.082 IN TEST RESULT PASSED 91STP TEST STARTED 18: 4b AM TEST STARTED 03/21/2006 BEGIN LEUEL 3.3120 IN END TIME 11:82 AM END DATE 03111/2805 END LEUEL :3.3115 IN LEAK THRESHOLD " 9.002 IN TEST RESULT PASSED . ,.- 91SFiL~ .- • -. .~ TEST STARTED 18:20 AM TEST STARTED id312112006 BEGIN LEUEL 2.4621 IN END TIME 10:35 AM END DATE 83/21/2006 END LEUEL 2.4615 iN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED 91STP TE5T STARTED 18:28 AM TEST STARTED 03.21/2086 BEGIN LEUEL 3.3126 IN ENO TIME 10:35 AM { END DATE 03/21/2006 END LEUEL 3.3120 IN LEAK THRESHOLD 9.002 IN TEST RESULT ry .PASSED,` l2 if C,3 ,. i unc1112 SUMP LEAF:. TEST REPORT LiL`~C 1= TEST STARTED 4:4.`.~ Ph1 EST aTflF?TAG b?~r:L1r200an. ?EGIPI LE4+E.L 3,279E, IN :Nl.i TIt~tE .~~:C90 I'1 ~fD DATE 93r21:200e, ND ~~~UI-L :: 27Ei8 IN _EAK THRESHOLD . 9. bF72 I N TEST f~.E~;ULT t-`A~:SED iJDC~-4 TEti7 :~Tr"iRTED 4: 4`, Pf9 TEST STRR.TEi! H3%i!29L~6 3EGI!I LEVEL 2.':165 IN END TIP1E 5:00 Ff`I .ND Di}TE; ~~:v'31t~0O6 AND LEl1EL '?.2167 IN _EAK THNE~ia)LD E+.Od2 IN TEST RESULT PASSED !JD1:.a-E TEST STARTED 4:45 rr~ TEST ;iTARTED 03rd r2'dE~6 SEGIN LE+!EL 3.9267 IN "ND TIMF_ 5:06 F~~P! ENt~ DATE 93/2'1/2906 :ND LEVEL :.tiE1.E.~ IN .AK THREt'HGLD 9.99'? IN EST RESl1LT pFiS,~sEL+ L IDC7-8 'EST ti7R?-'TEC;~ 4.4.5 PI'1 BEST STARTED 93r2ir209+a :EGIN LE~:!EL ~`.a91n I1~1 ND TIhIE ~~:99 Phi :ND LATE ~~?:~71!2d06 •ID LEVEL 2.5915 I N 1~K THRE'EHGLD y3,P~2 IN ~T P,ESUL1" PASSED 03~~21r':4E+H6 4:44 PM SUMP LEAK TEST REPGRT UDi:I-2 TEST STARTED 4:2:9 PM TEST ~,'CRRTED 9:r`21r209E ~I SEGIN LEVEL 3.2793 IN ~:ND TIME 4.44 Ph} ~~ Eh1D DATE 03r11r2986 I, END LEVEL 3.2707 IN LERK THRESHGLU 0.0x2 IN TEST RESULT Pf~SED UDC3-~+ TEST STARTED 4:25 PM ` TEST STARTED 93r21r2996 LIEGIN LEVEL 2.2171 IN ' END TIME 4:44 Ph1 END DATE b3r2ir2986 END LEVEL 2.2169 IN E:RK THRESHOLD 0.002 IN TEST RESULT PASSED IIDCS-,:i TEST STARTED 4:29 PM TEST STr~RTED ~13!21r2096 BEGIN LEVEL 3.8271 IN AND TIME 4:44 PM .ND DATE 93r2ir2906 .ND LEVEL 3.0265 IN •EAK THRESHOLD 0.602 IN TEST RESULT PASSED UDC7-S TE°T a^Tflf1TED 4:29 PM TEST STARTED 03r21~t~06 SEGIN LEVEL 2.$972 IN cND TIME 4:44 PM .ND DATE 0ir21r2906 iND LEVEL 2.8917 IN _EAK TNRESHOLD 0.042 IN -°T RESULT PA5SEU • TEST STARTED 3;13 PM TEST STARTED 83r21r2$g6 BEGIN LEVEL 3.7612 IN END TIME 3:22 PM END DATE 03rZir2gBb END LEVEL 3.7697 IN LEAK THkESNGLD ~7,d62 IN TEST RESULT p~~~ UDC;9-19 .TEST STARTED 3:13 PM TEST STARTED ~21r2g06 BEGIN LEVEL 1,4519 IN END TIME END DATE 3'28 PM END LEVEL ~21r2I066 LEAK THRESHOLD 18~9b7 IN TEST RESULT PASSED r _._ ' UD1:1112 TEST STARTED 83r21520P0N6 ~ BEGIN LEVEL 3.7618 TN END TIME 3:13 Phl ?END DATE d3/21r28B6 END LEVEL 3.7611 IN LEAK THRESHOLD d. 002 IN TEST RESULT PASSED UDC9--10 TEST STARTED 2:57 PI9 ' TEST STARTED 03r21r2006 BEGIN LEVEL 1.4498 IN END TIME 3:13 PM END DATE S3r21r2096 F•_ND LEVEL 1.4588 IN LEAK THRESHOLD " 8.092 IN 1 EST RESULT PASSED i a ~~~ SB9~i 9 TESTING E`AILURE REPQRT SITE NAME : ~~ \` ~~~ ~ 1 DATE : ~- a) 'l.J~"~ ADDRESS : ~~~~ ~C1S~.(1Y~~, ~~~T, TECHNICIAN ~~)~ ~0(3YY,~?_. C I7: Y : SIGNATURE : ~/- ~~~3'f/Y11~' / Ak~.~i~~C.~ SITE CONTACT: THE FOLLOWING COMPONENTS WERE REPLACER/REPAIRED TO COMPLETE THE SB969 TESTING. LIST OF PARTS REPLI~CED/REPAIRED: 12EPAIRS : l~~ LABOR ; ~ Q~1~ PARTS INSTALLED:~O'(~R~ UNdERGROUND STORAGE TANKS .,. _.: _.....,,~..~:.~,,,..,.r.,.~,.~...~. . ~~ APPLICATION TO PERFORM ELD /LINE TESTING >' ! S8989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION ~zu 3 BAKERSFIEI.D FIRE DEFT. w~Rr Prevention Serv3rces AT 900 Tn~xtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 rcmm~ ~w. 1 I ^ ENHANCED LEAK DETECTION ^ LWE TESTING ~$B-B89 SECONDARY CONTAINMENT TESTWG ^ TANK TIGHTNESS TEST ^ TO pFRFORM FUEL luI~NIT~RING GERTIFICAT FACILITY ~ NAME b PHONE NUAi18ER OF CONTACT PERSON ADDRESS ~ ~ ~ OWNERS NAME '~ OPERATORS NAME pERMITTO OPERATE N0. NUMBER OF TANKS TO BE TESTED PIP ~ ~ ~/~/'~ q Cif ( ~ ~ 1 ~ f /] / ~ ' TgN!(.E8;1NCi COIiAPANY NAME OF TESTI COMP NY NAME 8 PHONE NUMBER OF CONTACT PER80N MAILING ADORES3 >~ CQ~ ~ V ~. NAME 8 PHONE ER OF TESTER 0 P~IA~, INSPECTOR ,/l_ CERTIF1CATlON #~ ' ' DATE & TIME TEST TO BE CONDUCTED ICC #: TEST AAETHOp SIGNATURE OF APPLICANT C DATE APPROVED 8Y PATE FD 2095 (Rev. 09!05) .. B1L.LING 8t: PERMIT STATEMENT '~ ..~. ~2'-{ ~ 3 BAKERSFIELD FIRE DEFT: ~~ Prevention Services ' PERlYIIT NO.: A "'^ ^ 900 Truxtiui Avenue, suite ~ 1 u Rf~ r Baket~sfield, CA 93301 LOCATION Of PROJECT ~.~ ' ^ Y ' PROP67tY OWN~-'~' ,- ~, c ,, ~. 4 ~ C' COY ~--~Q' STARTING DATE COMPLETION v0a~ NAME ` PROJECT NAME t ~- S U. PHONE N0. PRO.IEGTADDRESS CRY ST E ~ ZIP CODE • RACTO ~~ CA LiCFJVSE NO. •^ • 'TYPE OF LICENSE. EXP97ATION DATE PHONE NO. CONTRACTOR C~NPANY E FAX NO- ADDRESS ~ ~ i ' ~ CfTY ZIP CODE ~ O ! _ , a n $262 5p dif M i Ch ^ Ai N & M ti ~ in mum arms - ew ig s - ( arge) o o . 98 FL O 000 S 20 Of3125 = Permit bee S FL x ~ ^ ver q. . q. . 98 ^ inklers Mi i N tions - Ch & M difi S $210 00 ~ n - ( mum arge) ew o ca pr . 98 ^ Ov FL 000 S 5 042 =Permit fee FL x S ~ er q. , . q. 98 ^ Minor S rinkler Modifications (< 10 heads) 00 (Ins ection Onl ] $93 ~ p y . p 98 ^ Commercial Hoods -New 8 Modifications 26 $ 398 ~ . 98 ^ Additional Hoods 00 a 36 ~ . 98 ^ Spray Booths -New & Modifications $458 00 ~ . 98 ^ Aboveground Story a Tanks {Mstalletionltnsp.-1' Time) $165.00 ~ ^ Addltlonal Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Removalllnspedion) $109.00 ~ ^ - Underground Storage Tanks (InstallationJlnspectbn) $878.00 (pertank) 62 ^ Underground Storage Tanks (Mod~ication) $878.00 (persite) ~ ^ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Underground Storage Tanks (RemovaQ $675.00 (per tank) 84 ^ Oilwell (Installation) $ 72.00 ~ 64 Mandated Le etedion (Testing}! Fuel Montt. Cert. $ 81.00 (persite) 62 ^ Tents $93.00 (pertent) 84 ^ Afterhours inspection - 5122.00 ~ 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee ~ $90 per hour) $ 60.00 t (5 hrs. min. stand -by t>3e Anvperlbn) _ $510.00 84 ^ RE-1NSPSCTION(S) /FOLLOW-UP /NSPEC770N(S) S 83.00 (per hour) . 84 ^ Portable LPG (Propane): NO.OF CAGES? $66.00 84 ^ Explosive Storage $249.00 ' ^ 84 ^ Copying & File Research (File Research Fee $33.00 per hr) 25¢ per page '' 84 ^ Miscetlaneous ', ~ B4 FD 2021 fRev . ~9I051 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to flle} 1~PIPiK (to Customer) ',, r ~, ~ '~ Ui~it7Ei~2GROUND STORAGE TANKS ': ~;~, '`3) ,~i~~'~I~~TIOIV :~"'~ 1"O PERFORM EL01 LINE TESTING `.~ 158969 SECONDARY CONTAINMENT TESTING '~'i ' /TANK TIGHTNESS TEST AND TO PERFORM FUEL CvtUNITORING CERTIFICATION PERMI"f NO. ~ ~~ ~ ~ ~ a BAKERSG~IELD FIRE DEFT. ~1rRr Preventioa Services AJtI'Al 900 ZYuxtun Ave., Ste. 210 .~- Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Pie 1 of 1 L~ EiVHANCED LEAK DEFECTION _ 1~1~~INE TESTING ^ SB-888 SECONDARY CONTAINMENT TESTWG T.~NK 7"IC:NTNFSC TFCT /M TC1 PFRF(1RM FI IFI MC1NITf1RINC~ f:FRTiFIRGTICIN ;. FACILITY ~ NE NUMBER OF CONTACT PERSON ADDRESS C ~, OWNERS NAME r ~ ~- Oi'ERA7URS NAME PERMIT TO OPERATE N0. NUMBER OF TANKS TO BE TESTED 1 PIPING 01 T T D Y S ^ T N # V ,~ / ~~~ ~~/ r ,... ,.. , ,> w Ip•.. :. TANK TF$ , ,~~tG COMPANY NAME OF TESTING COMPANY. ~ ~ NAMES HONE NUMBER OF ONTAC PERSON ~ ~ ~' O MAILING ADDRESS L NAME & PHON NUMBER OF TESTER R SPECIAL INSPECTOR CE IFICATION DATE & TIME T ST TO E CONDUCTED ~ ~ 'n^ I t ICC #: TEST METHOt~ 51GiVATURE OF APPLIC T C DATE I APPROVED BY OATS 3" ~~ ~©~ ~ FD 2095 (Reu. 01/05) i i } ~ -~~" ~~ .~ ~~ STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL 80ARD UNDERGROUND STORAGE TANK PERMIT APPLICATION -FORM A COMPLETE THIS FORM FOR EACH FACILITY/SITE '~.,ou-c~~s ct V % °~~, mo ,w. . ~~> MARK ONLY ~ I NEW PERMIT a 3 RENEWAL PERMIT ~ 5 CHANGE OF INFORMATION O 7 PERMANENTLY CLOSED SITE ONE ITEM ~ 2 INTERIM PERMIT a 4 AMENDED PERMIT ~ 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) DBA OR FACILITY NAME V F~L-~ S1 ~ E1--1,. NAME OF OPERATOR J~SO IJ 1C.L) b ~ ~L 1 C.1~ ~{ A N ~ ADDRESS NEAREST CROSS STREET PARCEL N (OPTIONAL) 3looS RAC-~`~E I-IW`i' CITpY~NAME/~ ~ ST C ZIP~02~b~ T Oc~N F1~ Q ~, S~f~c ~~ Cis, ~~~ A 'J~ ~ 3 ~ ~ 2 ~ ~ J O / BOX ®CORPORATION Q WDMWAI [~ PARTNERSHIP OLOCAL-AGENCY (~ COUNTY-AGENCY' QSTATE-AGENCY' ~ FEDERAL-AGENCY' TO INDICATE DISTRICTS ' N owner d UST is a public agency, complete the blowing: rorne d supervisor d rrivKion, sedan or otfxx; whidr operates the UST TYPE OF BUSINESS ~ T GAS STATION Q 2 DISTRIBUTOR ~ N OF TANKS AT SITE E. P. A. I. D. N (optional) 0 3 FARM Q 4 PROCESSOR O 5 OTHER RESERVATION OR TRUST LANDS 3 N/ A EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) -optional DAYS: NAME (LAST, FIRST) PHONE N WITH AREA CODE k~o J ~3- N L~oS~ ( ~ o`-~ DAYS: NAME (LAST, FRST) PH E N WITH AREA CODE ~~Lt( YP~56 44 CobS~ 3~- o79 o c Pl o , . Z NIGHTS: NAME (LAST, FIRST) P NE N WITH AREA CODE iLuo JP soty L~,o5~~~3-09 a`~ NI HTS: NAME (U1ST, FRST) PH NE N WITH AREA CODE ~~~ ~L~UIf~ L~oS~ o3~-~f-3oo s II. PROPERTY OWNER INFORMATION - (MUST BE COMPLETED) NAME EQUILLOIQ ENTERPRISES LLC CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS / boz b indcate Q WDMOUAL QLOCAL-AGENCY 0STATE-AGENCY p p P. O. BOX H O O D r~ , Lpl CORPORATION Q PARTNERSHIP 0 COUNTY-AGENCY QFEDERAL-AGENCY GTY NAME STATE ZIP CODE PHONE N WITH AREA CODE ~,ARTINEZ CA 94553 , Ni. TANK OWNER INFORMAT{ON - (MUST BE COMPLETED) NAME OF OWNER EQUILLON ENTERPRISES LLC CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS / boxto ndxxte ~ WDIVIDUAL QLOCAL-AGENCY 0STATE-AGENCY P. O. BOX H O H O ~ CORPORATION a PARTNERSHIP ~ COUNTY-AGENCY ~ FEDERAL-AGENCY CITY NAME STATE ZIP CODE PHONE N WITH AREA CODE MARTINEZ, CA 94553 IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER -Call (916) 322-9669 if questions arise. V. PETROLEUM UST FINANCIAL RESPONSIBILITY - (MUST BECOMPLETED) -IDENTIFY THE METHOD(S) USED / box b bdpte ®1 SELF-WSURED ~ 2 GUARANTEE ~] 3 MISURANCE I] ! SURETY BIXJD Q 5 LETTER OF CREDR Q 6 EXEMPTKIN Q 7 STATE FUND O 8 STATE FUND d CHIEF FINANCIAL OFFICER LETTER ~ 9 STATE FUND d CERTIFICATE OF DEPOSIT a 10 LOCAL GOVT. MECHANISM O gs OTHER Vi. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent t0 the tank owner unless hOx I or II is checked. CHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTIFICATIONS AND BILLING: 1. Q II. ® III. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF RJURY; AND TO THE BEST OF MY KNOWLEDGE, lS TRUE ANO CORRECT TANK OWNERS NAME PRINTED E) ANK OWNER'S TITLE DATE MONT}WAY/YEAR ~' HS&E REPRESENTATIVE "^ LOCAL AGENCY USE ONLY COUNTY # JURISDICTION # FACILITY # m LOCATION CODE -OPTIONAL CENSUS TRACT N - OP1tONAL SUPVISOR - DISTRICT CODE -OPTIONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMRAPPLICATION - FORM B, UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY. OWNER MUST FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORMA (6.95) B E~R S F i l~/RE wRTM December 1, 2005 RONALD J. FRAZE ~ Rosedale Shell FIRE CHIEF 3605 Rosedale Hwy. Bakersfield, CA 93308 Gary Hutton, FINAL REMINDER NOTICE Senior Deputy Chief Administration ~ RE: Necessary Secondary Containment Testing Requirements by 326-3650 ~ December 31, 2005 of Underground Storage Tank (s) Located at ~ the Above Stated Address Deputy Chief Dean Clason Operations/Training f 326-3652 ~ Dear Valued Customer, Deputy Chief Kirk Blair Over the last six months this office has continued to send reminder notices regarding Fire 5afety/Prevention Services secondary containment testing. 326-3653 Code requires that all secondary containment systems must be tested 6 months post construction and every 36 months there after. 2101 "H" Street Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Bakersfield, CA 93301 Health & Safety Code) of the new law mandates testing of secondary containment OFFICE: (661) 326-3941 components upon installation and every 36 months, thereafter, to insure that the FAX: (661) 852-2170 systems are capable of containing releases from the primary containment until they are detected and removed. Our records indicate that your facility is due prior to December 31, 2005. RALPH E. HUEY, DIRECTOR PREVENTION SERVICES Those sites that have not been tested and have not pulled a permit prior to December 31, r-IRE SAFErr SERVICES • ENVIRONMENrA~ SERVICE8 2005, will have their permit to operate revoked. 900 Truxtun Avenue, Suite 210 ! This office does not wish to take such action, which is why we will continue to send monthly Bakersfield, CA 93301 ~ reminders. OFFICE: (661) 326-3979 FAX: (661) 852-2171 ~ Contractors are already booked several weeks in advance. I urge you to schedule your testing date as soon as possible to avoid possible revocation of your permit to operate. David Weirather Fire Plans Examiner Should you have any questions, please feel free to call me at (661) 326-3190. 326-3706 Sincerely, Howard H. Wines, III RALPH E. HUEY, Director of Prevention Services I Hazardous Materials Specialist _ 326-3649 Steve Undervvood ! Fire Prevention Officer SU:db F/RE ARTM RONALD J. FRAZE FIRE CHIEF Gary Hutton, Senior Deputy Chief Administration 326-3650 Deputy Chief Dean Clason Operations/Training 326-3652 Deputy Chief Kirk Blair Fire Safety/Prevention Services 326-3653 2101 "H" Street Bakersfield, CA 93301 OFFICE: (661) 326-3941 FAX: (661) 852-2170 RALPH E. HLIEY, DIRECTOR PREVENTION SERVICES FIRE SAFETY SERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 OFFICE: (661) 326-3979 FAX: (661) 852-2171 David Weirather Fire Plans Examiner 326-3706 Howard H. Wines, Ilf Hazardous Materials Specialist 326-3649 January 5, 2006 Mr. Bob Underwood B C Enterprises, Inc. 7104 Elkhorn Street Bakersfield, CA 93313 NOTICE OF VIOLATION Re: Requirement for Certified Installer to be Physically Present on Site Deaz Mr. Underwood, The following violation was noted during a scheduled piping inspection at the Rosedale Shell Station, 3605 Rosedale Highway on January 4, 2006: Underground Storage Tank Regulations, Title 23 of the California Code of Regulations, Section 2715(h) requires an individual possessing an ICC UST Installer Certificate to be "physically present at the work site." There was no such certified individual present on site during the January 4, 2006 inspection. The inspection was cancelled until the site can return to compliance. In order to avoid further regulatory action, please ensure that all regulatory conditions of the permits issued to you by this office are fully complied with. Sincerely, RALPH E. HUEY, Director of Prevention Services By: Howard H. Wines, III Hazardous Materials Specialist Professional Geologist No. 7239 ICC UST Inspector No. 5266824-UI cc: Contractor file: BC Enterprises "SerUing the Community For ~I~tore Sian A Century" C- ~ !2G 7Fr RICH ENVIRONMENTAL 5643 BROOKS CT.- BAKERSFIELD, CA 93308 OFF.(661)392-8687 FAX(661)392-0621 A(~iTRiTE TM PIPELINE TESTER PRECISION PRODUCT LINE TEST TEST RESULTS DATE: 03-16-06 BILLING: SHELL STATION SITE: SHELL STATION 3605 ROSEDALE HWY 3605 ROSEDALE HWY BAICERSFIELD, CA 93308 BAKERSFIELD, CA PRODUCT PRODUCT MECHANICAL MONITOR ~'R DUCTC LINE TEST LEAK DETECTORS LEAK DETECTOB Disp#5&6, 7&8 UNL-87 .000-PASS PASS ANNULAR & SUMP PREM-91 -.002-PASS PASS ANNULAR & SUMP DIESEL .000-PASS PASS ANNULAR & SUMP Disp#1&2, 3&4, 9&10, 11&12 UNL-87 -.005-PASS PASS ANNULAR & SUMP PREM-91 .000-PASS PASS ANNULAR & SUMP DIESEL -.003-PASS PASS ANNULAR & SUMP COMMENTS A PRECISION TEST WAS PERFORMED ON PRODUCT LINES AT THE ABOVE LOCATION USING THE ACURITE TM PIPELINE TESTER I HAVE REVIEWED THE DATA PRODUCED IN CONJiJNCTION WITH AES PROTOCOL, AND THEREFORE SATISFIES ALL REQUIREMENTS FOR SUCH TESTING AS SET FORTH BY NFPA-329-92 AND USE 40 CFR PART 280. THE RESULTS OF TESTING ARE SHOWN ON THE FOLLOWING PAGE. INCLUDED WITH THE REPORT ARE REPRODUCTION OF DATA COMPLIED DURING THE TEST WHICH FORMED THE BASIS FOR THESE CONCLUSION. THIS INFORMATION IS STORED IN A PERMANENT FILE IF FUTURE VERIFICATION OF TEST RESULTS IS NEEDED. I DECLARE UNDER PENALTY OF PERJURY THAT I AM A LICENSED TANK TESTER IN THE STATE OF CALIFONIA AND THAT THE INFORMATION CONTAINED IN THIS REPORT IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. TES '~tTIFIED BY: AARON KOOP CERT# 03-1649 ~~ _F. ~ --- ~ - ~~ - ~ ~ ~. RT Cl~ E1ti~R~?~.~lErTTA.L ~ 5643 HRAOK3 CT '8'ARCER~F`IELD, GP-. 93308 OFFICE (661) 392-B 687 & 3'AX (661) 392-0621 ACURITE '~Q RIPSLTNE TEST}ZR WORK SHEET ~ I~ PATE : 3 •'~- ~ ~ W / 0 # : ~--_,__- Faci I ity Name : ~ ~~' ~T34T~~'^1 I 3 L.os os oS Facility ~"~dress: !~ ~~ ~ ~~+edi~~, G+1 R33 ~,~56~r ` Product Line `t'ype {Pressure', 5uctian,' Gravity) : ~ . Pump Manufacturer: ~~ ~~='K'IT Isplation D2echani.am: $~- .~'~5 PRODUCT START TIME END TII~ TEST VOLUME RESULT /READING /READING PRESSURE RATE PA&S/ 00:00/GPH OO:QQ/GPH (PSI) (GPH) FAIL spaN,-~ tfrl ~• ~-*7 ~:vS . v r? t? 1:35 • o7v ~ S~ , avv Jiy4Ss arse sn.- pRi»+ 9 ! 1; lu . D?o ~ : O , ~~Y ,~~ - . o o Q ms's S ~r a~r.- DrEtr~~ 1.15 •olsS }:yS oUS S~ .ooO ~RSS VryL-$'1 2;gv .CSS ov ~, .DSo C- / O _ .Qa.~r"' ~}~jS p~w,•91 ~t:yn •o$b ~:lO ,o5a $p . ~oc~ ~/f-S`> ~~~s+~~- a:us .d~3 3:is .owo ~~ -•Qo3 p~w5 I certify that tha above line tests were conducted according to the equipment manufacturer's procedures. The results as listed are to my knowledc}e true and correct. The test pass/fail is determined using a threshold o~ 190 ml per hour (0.05 GPH) rate at 1 1/2 times workzng pressure or 50 psi which ever is greater. Tech: ri~"~~ K~~ State License:# ~~r~~+ Sign MFG.CER2'IFICATION:# 60~.I,,T I • I i i 1 ._ _ -- ~, __.. ~-zcQ53 MONITORING SYSTEM CERTIFICATION ~""^" For Use By All.turisdicttons Within the State of California i atthoriry Cite& Chapter 6 7, Heairh and Safety Code; Chapter 1 b, Divfsion 3, Tine 23, California Code ofRega,larions "Phis form must be used to document testing and servicing of monitoritgg equipment A separate certification ox repo~l~e preuare •or eac:;i monitories system control,panel by the technician who performs We work A copy of this form must be provided to the tank system owner/oparitor. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 clays of test date. ~~. tr~enerai Infe~rmatian Ea~ility Name: _5 ~'~~ .~7S~n~ Bldg. No.: ~iteAddress: c3Co05 1'~o`~~CE't-~ {-~Z_.!~( City ~f~~S~ILG~ Zip: y3~°~ Facilirv Contact Person: ~~o~ G ~'fl Contact Phone No.: {~`} i41ai:~i,`vlodei of Monitoring System: V ~IE2~RovT BLS -vim SU Date of Testing/Servicing: ~ ~ro / ~Co t. i[nwentury of Equipment Tested/Cer#ified Cl:z~.: she appropriate loxes to indicate specific enuipment inspected/aerviced: ~ ._--- 'i~~~t, ti): U-'\L-~ TanklF): A/~~L ~ G~l,~ 7'anl: Gauging I~robe. Model: /-1 U} - (~Tn-Tank Gauging Probe. Model: YN tU-- -~nnui:,r Space or `fault Sensor. Model: G I L~ ~ 1~ ular Space or Vault Sensor. Model: ~/ ~-,/ ~ L~9 Piping Sump /Trench Sensor(s). Model: ~ Piping Sump /'IYench Sensor(s). Model: 3S~ ~ J tll Sump Sensor(:). Model: ^ ,ll Sump Sensor(s). Modes: ~ L~ ,7vicchanical Line Leak Detecxor. Model: f~ Mechanieal Line Leak Deteobor. Model: l rL ,Ti~~T U 731ecrronic Linc Leak Deterxor. Model: ^ Electronic Line Leak Detector. Model: ~ v 1'anlc Overfill / F-1i3},-Level Sensor. Model: ^ Tank Overfill / Iiigt~Levei Sensor. Model: ^ Other (specify equi meet a and model in Section E on P 2 ^ Other s ui eat and model In Section E on R 2 . '1':,nlt Il): Ple~`~~ Tank ID: i~in=1'tu,lcc Gauging Probe. Model: t+tl\~t7' ( [] In-Tank Gauging Probe. Model: Ly1'.lnnular Space or'Jault Sensor. Model: 301 ^ Annular Space or Vault Sensor. Model: l~l'ipiug Sump/ Trutch Sensor(s). Model: 35a ^ Piping Sump /Trench Sensor(s). Model: U fill 5utnp Sensor(::). Model: ^ Fill Sump Sensor(s). Model: E~R-lechanical Line Leak Detector. Model: ~ ~'WLit.~T ^ Mechanical Line Leak Detector. Model: . O L-'•lectronic Line Leak Detector. Model : ^ Electronic Line Leak Detector. Model: ~ ^ '1'ruilc Overfill / 1-Ii;h-Level Sensor. Model: ^ Tank Croerfill /High-Level Sensor. Model: Ll Other (specify equi meut type and model in Section E on Page Z). ^ Other (specify 'pment and nmdel in Section B on I3a a 2). ~~ L'i~uscr ID: ' ( 0~ 7 ~ l til Dis eraser ID: ~ .ga~r l~ispenser ContaUUnent Sensot{s). Mode ; rrtVJ L ~ispenser Containment Sensor{s). Model: C3~ / ~he:u Valve(s), L'J Shear Valve(s). U 17ispenser Containment Flea s and Chains . Die eraser Containment Floats and Chains . Dispenser Ill: i5r ,~penser Contai,uuent Sensor(s). Model: jJv~vit/ Dig~enser ID: ~-~J IJ~Jispenser Containtnenr 3~nsor(s). ltifodel; _ ~,gvDr~.sal i I~ Sl,z~u Valve(s). O l~isper,ser Conraittment Float(s) and Chain(s). C'j Shear Valve(s). ^ Die tenser Containment Floa s and Chains . Dispenser !D: ~ Dispenser ID: ! of +~Dispenser Contai,ment Sensor(s). Model: t~t7 l ^ Aispenser C.or:tainmcnt Sensor(s). Model: .~CRy ll~She;u- Valve(s). ^ Shear Valve(s). C1L)ispenser Containment Float(s) and Chains . ^ Die eraser Containment Floats and Chains . `elf the litcilii_y contains more tanks or dispensers, copy this form. Ittclttde information for every tank and dispenser at the ~DitY. ~:. CC1~ifiCSilOri - I certify that the equipment identified in this document was inspectedlserviaed la accordance tivtth the tl4auufacturers' buidelines. Atts~ched to this Certification is information (e.g. ntaaafacturers' checklists) necessary to verify that tbis ~nfsirmatlon is rurrect and a Plot Plan showing the layout of mouitorittg equipment. For any equi eat capable of generatingsuch repoxts,I Gave also attached a copy of the report; (check a!1 th apply).• C~"System cet-up Alarm story report • '1'ecln-,ician Name (I,rint): ~,4 t~-rJ ~zs'7- Si ' ne: Ccailication No.: _ ©O~o - ~ ~ - i o~17 ~ License. No.: s"' ~-CO/ ~D ~' tJ 'I'csring Company Na,ne: RICH ENVIRONMENTAL Phone No.: 8 87 ' `3 Coo s ~ S~~A-t-~ if -~-_~ ~9~- bite Address: 'J~ Date of Testittg/Servieittg: 5 / IMP /J(v ibioniloring System Certification Page I of 3 03101 _ ._ 12.53 ii1. results of Testing/Servicin~gj ~ori~care Version h?stalled: ~' ` ~ V i n~nnlece the t'oliewing checklist: Yes ^ ° Is the audible alarm o erationa!? Yes ^ o Is the visual alarm o eYational? Yes ^ ° Were all sensors visual ins ected, ttutetionall tested, and canfin-ned o erationa!? Yes ^ o Were all sensors installed at lowest point of secondary containment and positioned so that other equipment wi II not interfere with their roper o eration? __ rl Yes ^ o If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) Si~N/A operational? 1'~s ^ o For pressurized piping systems, does the turbin,e Automatically shut clown ifthe piping secondary containment ^ N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check al! that apply} D Sump/Trench Sensors; O Dispenser Containment Sensors. Did you confirm ositive shut-down due to leaks and sensor failure/disconnection? ^ Yes; ^ No. _ ,;~ Yes ^ o For tank systems th:;t utilize the manitaring system as the primary tank overfill warning de +ice (i.e. no L~ NIA mechanical overfill E; evention valve is iiitailed), is the overfill wal'tvng alarm visible and audible at the tank fll int(s) and operating properl ? If so, at what ercent of tank capaci does the alarm tri er? °% _ ~~ 1 of s~` No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the tr-anufacr;.~rer itatne and model for all replacetnent parts in Section E, below. _ :.~ t es* No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) C~ Product• ^ Water. lF es describe causes in Section E below. Yes ^ o Was monitorin s stem set-up reviewed to ensitro proffer settings? Attach set up reports, if applicably Yes ^ o Is all monitoring equipment operational~ermanufacturer's specifications? _ ^` In Section E below, describe how and k~~teu these deiici4ncies were or will be corrECted. ~':. it Ol'YI,ITit?I]tS: ., ,' Pago 2 of 3 03 l 0 l - ---- - ~ ! z~ ~ F. Ixt-Tank Gauging /SLR. Equipment: f~ Check this box if tank gauging is used only for inventory control a Chock this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perfo~rnn leak detection monitoring. C'mm~lete the fol}owina checklist: ^ Yes. ^ o Has ail input wiring been inspected for proper entry anal termination, including testing for ground faults? ^ Yes ^ o Were all tank gauging probes visually inspected for damage and residue buildup? ^ Yes ^ ~ o Was accuracy of system product level readings tested? ^ Yes ^ o Was accuracy of system water level readings tested? ^ Yes ^ ° Were all probes reinstalled properly? O Yes' ^ o Were all items on the equipment manufactureer's maintenance checklist completed? fi rn the 5ect+on tt, de+ow, aescr+pe uow ono waen inese netictenctes were or wt++ pe correctett. G. Line Leak ~'etectors (LLD): ^ Check this box if LLDs are not installed. ('mm~latP the fnlln~wino rhPeklicf~ Ig Yes ^ N0` For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ^ NIA (Check all that apply) Simulated leak rate: ~3 g.p.h., ^ 0. I g.p.h , ^ 0.2 g.p.h. Yes. ^ o Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ^ o Was the testing apparatus properly calibrated? Yes ^ o For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^ N/A Yes ^ o G~N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? O Y"es ^ o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled d N/A or disconnected.? ^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions E~N/A or fails a test? ^ Yes ^ o Far electronic LLDs, have all accessible wiring connections been visually inspected? I N/A Yes ^ ° Were all items on the equipment manufacturer's maintenance checklist completed? ~~ to rue aecnon rt, he+ow, nescrtae dew ana waen these aerterenctes were or wut pe correctea. 1[3. C.timments: Page 3 of 3 43101 onitoring System Certification UST Monitoriz site .Address: ~ C~ ~ `~ a 3f~D,4c~ }-~~ Site Plan 12~ s3 ----------------------------------------------------- ------------- ----~~rve;--------- --------------------- ------------- - ~ -- ---3~ - - 37'P- --------------- 7 11 Date map was drawn: ~ / l(P/_~p Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring Systfm Certification. On your site plats, show the general. layotrt of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. Page of os~oo /I 2~~ T r'' .~c~..~.~fSNM~NTA T. 5643 BROOKS CT $AFCER3FIELD,CA,93308 OFFICE(b61)392-Bb$7 & FAX (6b1)392-0621 *'~.,5'N~,T~CBL...L3.~?~ D8T8CTnR T -ST wJd#L Fac j.l i ty Name : ~ ~~ ~~~~''~ Fac3.lity Address = 3~'S ~~~~'~ ~~y _,~~~SFr~ ~ ~.4 Product Line Type (Pressure, Suction, C3ravity) 5$~ PRClDUCT LEAK DETECTOR TYP$ TEST TRIP PASS SBRIAL 23t1M88R EELOW PSI OR L/ri TYPE R'~~ ~IS~-T ~ ~g~ ~hL ~ 9FRIAL # W ~ ~~ 230 ~~~~ FAiT, - L/D TYPE ~b 7 .~~~~ _S~ S$RIAL # ~O ~7 NO f~ ( S ~ FAIL L/D TYPE z ~ 3SRIAL # U ~ ~~ NO ~ ra ~~ FAIT, ~~ ~ ~ y L/D TYPE YES PASS s~~sAL # z3o FAIL z certify the above tests were conducted on this, date according to Red ,;racket pumps field test apgaxatua testing procedure an limitations. The: Mechanical Leak betectox Test pass / fail is determined by using a low flow threshold trip rate of 3 gallon per hour or less at ZO PST. I acknowledge that all data collected ie true ar..d correct to the best of m}~ knowledge _ Tech:~~~~ ~~~ s ign~~t Date : ~ r/~ -d r;•• /z~s3 ~- MONITOR CERT. FAILURE REPORT SITE NAME: ~ ~I-t- 5~"~ ~ DATE: ~ -!~ ~~ ~~~ ~os~~,~.~ ~Y TEf'HNICIAN: ,qy~},~,~.,,f ~~`'. CITY: ~~'~S F~+~~-+~ r ~ SIGNATURE: THIS FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS: lya~''~ LA.I~OR: i~/~'~ PAI7,TS INTALLED: N~ NABIE: TITLE: ~IG]yATURE: TFik: ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR TAB: ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMANTAL FOR ANT NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANS' FINES OR PENALTIES OCCURING FROM NON-COMPLIANCE. A C~~PY OF THIS DOCUMENT HAS BEEN LEFT ON-SITE FOR YOUR COP+TVIENENCE. T 1 : REQ.: ULAR F•FC;llut?'f COPE 1 '1'HEFNIF;L. ~UEFF :.U00/UO T~~I'Jk: Li I HI°IETER 5'~ . GU 1'rirJ} F'j?iiFILE 1 PT FULL l!OL 5728 I°IET'EF: DHTr; N'J tL+•::+A'f :~ 1'~E : ~l . 0 I N • 8450 b;IHTEJ? t•JriRIYIIVG U.8 HI~:H LJ~TER LIMIT: 1.5 P'IH:=.: i;k Lr;BlrL L+OL : 5?28 C~VERI-'ILL LIMIT 50%~ 8755 H I C=H PF:~~>DUCT 95`ti 5241 I)EL. I'•iEf`,` L I I"I ] T +~°• ., 3a9 L.EAp: HL.HRh1 L I f°I I T: 3 SU1;IiE,hl L.ti~S::, LIhIIT: 50 r•lrihll PILDED TAP1k:S' T# : Nl'+IVE LEr;h: I`1IPt F'ERIdL+IC: O~J 0 LL-:h}~ I^11 fV rr~IiVU~rL GiJ U F'Ek 1 ~>Li I C 'f E:;T T'iPE STANDr;kD ~rlydU;L T'E::T FHIL ALARri DISABLED I•Ek' I ~:JIi l ~ TEST FA I L ALHkF1 D I E;ABLELi ~ R~~+S ,, 'I'E ST FA [ L "EARN DISABLED HNFJ TE. ~T H~~+ERHG 11Vi1: OFF I-ER TE:_:T' HVERAGING: OFF THhI} TEST IVOT I FY : OFF T'fJk: T':I'I' SIPHfirJ BREHk::OFF 1.~F.L 11+'Ek''i' DELA'! 3 hJ! tV T '? : Li 1 E:~EL F'•kODUCT CODE 2 THF.rzl°Ir-it. r_.OEFF : .0U0~750 'THNK U I i1MET1rR 92 . UG THFJ}: F'F.GF I LE 1 PT FULL VOL : 9728 I°lE"1'ER BATA NO FLOr;'f SIZE: 4.0 1N. 6196 WHTER WARNING 0.8 HIGH 6dATER LII°IIT: 1 ,5 r1H;~; dR LABEL VOL : 5728 OVERFILL LIMIT 90i< 8755 H 1 GH PRdUUGT 55%~ 5241 GEL 111ER1' LII°1I T 14% 1311 LOW PRODUCT 500 LEAK HLARM LIMIT: 5 ~~UDLiEFJ LOSS LIMIT: 5p TkN}; 'f I LT 1 .45 t°lAN I FULUED THINKS T#: NONE _ 'Z6~~' T 3:PREMIUM ~ PRODUCT CODE 3 THERMHL rOEFF :.0170700 . THNK DIAMETER 52.00 TAIVK PROFILE 1 PT FULL VOI. : 9728 METER CiATA NO FLOAT S1ZE: 4.G IN. 849E WATER LJARNING 0.8 HIu^H WHTER LIhIIT: 1.5 MAX OR LABEL VOL: 5728 OVERFILL LII°1 I T 50%s 8755 HIGH PRODUCT 95~: 9241 U£LIVERY LIMIT 09: 0 LOW PRUDU,~T 500 LEA}: ALARM LII°i I T : 3 SUDDEN LOSS LIMIT: 50 TAIVK TILT 2.44 MAN}FOLDED TAFJKS T#: NOFJE LEHK t°1 I N PERIODIC : Oi LEAK NI I fV PER [ODIC : Oi 0 U LEA}: MIN ANNUAL 0: ~ LEAK M I iV ANtVUAL 0°> . U 0 F•ER I OU I C'. TEST TYPE STANDARD APINUAL TEST FHIL ALARM DISABLED PEkIOD14' TEST FAIL ALARM DISABLED uRdSS 'f EST FAIL HLARM D I f~tBLED ANIV TEST HVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF 'fNK TST SIPHON BREAK :OFF DELIVER',' DELAY 3 t~lI N F~ERIODIC TEST TYPE STANDARD ANFJUAL TEST FHIL ALARM DISABLED PERIODIC: TEST FAIL HLARhJ DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST IVOT I FY : OFF T1VK, TST SIPHON BREAK :OFF Ul~L I VER'i I-ELAY 3 M I N f°1r=~R 16, cQDb 11 32 FNN - =~llr L1 ^)r_,U'':~ r:~:+:~EL~nLE Hb,Yy . :~'~`5TEr1 U N I T5 U.S. i"1ri1? 1 a •~UU6 1 1 :31 AN't J`I'JTEP"I LANGUAGE EIVUL l SH S; °TEt°1 DATE./C I I••lE FUk1°IHT .. ~ ~-~ }'Ei°I ;T~r'ri I; : REF ~Jf~T' Nf.+IV DD YYYY HH :I"Ir9 : SS xM - - ... - - -- - - - - - - ~ HELL i-tLf- f-'Ur•I~_T10YJE: FJGRh1AL '3r.D5 RCY.3EDHLE HL,J`c'. BAk;ER ~F I ELD , CA :~~HIFT TIME 1 13:Oi~ AM :JHIFT TIP'IE '~ 4:OG Af•I SHIFT T 1 f°1E D U I NABL:EL"~ .`JNIFT TIME 4 DISAbLETi SHIFT BIR PRINTGU'fS w~:::'F'11,,IhkE 1.2E''•; I S I GPI LEt1EL EIVF;BLED •~.~t=:};~~tC>r4 ii9.u~ Iia;ILY BIR PRINTGUTS ;::iF1'I.:1r;REtt 34t;11'~-lU0-13 DI:.;HBLED ~_`F:E~1'EIi - 55.1~.'?9.23.}'~ Tlik:ETELj DELIVERY' ENr;bLED ~~-r9()I)ULF.~s 3;JU16C1-1 l''-A TC T1C:Y.ETED LiELIVERY °`:~TEI"t FEHTURES : D I SAbI.ED F'ER i ~.1D 1 ~:~ I td-THlVK 7')rSTS GLOSE DAY GF 6JEEK r;l~1h~JUr-;L. T rJ-THtJk: TE°~TS ;;UfV i~.~LU DA ] L`,' DL'VY VAR RPTS BIR DISABLED PLLL~ MEEKLY DUTY I,iAR kPTS IJ . 10 Rr'PE'r I T I V G I Sr~BLED U. '? U kEPE'r I T I 1~ F'ER I GIi I C DLV`f VAR RPTS i,dP'I-LD DISABLED G . 10 riUT(i DA I L't BGCiK VAR F,PTS u. '~ 0 RIrPET' I T I V Ti I SABLED WEEKL't BOOK VAR RPTS D I ABL.ED F'EF.I GTi I C HCJGK VAR RPTS - DISABLED DAILY VAR AtVALY RPTS DISABLED WEEKLY VAR AIVALY RPTS Ii I SABLED PERIGDIC VAR ANHLY kPTS DISABLED TANK PER 'TST IVEEIiED WRN DISABLED TANK HfVlV TST NEEDED I.JRN Ii 1 S'lHLED L I fVE RE-FINABLE METHOD PASS L I !VE TEST L I IVE F'ER TST NEEDED WRfJ U I SAEILED LINE ANN 'PST NEEDED WRN DISABLED PRINT TC'. VOLUMES D I :,ABLER TEMP CCiMPEfVSATIGPJ 'VALUE (DEG F 7: 6U.G ' STICK HEIi~HT GFFSET D I SN BLED H-PRG'TGCGL DHTA FGRMAT HEIGHT DhYLIi3HT SAVING TIl~1E EfVAHLED START DATE ' FiPR WEEK 1 SU!•J START T I NIE ? : 0 U At°I EfVD DATE GiJT WEEK 6 SUN 1~NP TIME ?:u0 aP1 T/. i 1~~ r..OMr1UNICA'1'IGNS SETUP FGRT SETT I rduS CGNINI bGARD 5 f RS-Atl5> bHUD RATE : 2AUU PARITY tVGIVE STOP HIT 1 STGP DHTA LENGTH: B DHTA I;GMM bGARD 6 i8-Sr;T > BAUD RATE 5600 PARITY NGNE STGP EIT : 1 STGP DATA LENi~TH: 6 UHTH RECEIVER SETUP: IVG NE AUTsi DIAL TIME SE'fUF: NONE RS-'?32 SECURITY CGDE UUUU00 kS-^32 EiND OF MESSHGE DISABLED AUTG UTAL.ALARM SE'PUP vUI1'u'I' RELA; SETUF Lk:HP; 'I'L.`.;r iMETHOLi - - - - - - - - - - - - 'I'£:.i,..riNIJUr=iLL'1:raLL TrNI'. R ! ' 8° ~nt'd t.JEE}; 1 SUIV T'f>/E: =~"I'ri1? I' 'f I hlE Li 1:3hlBLEC+ STf=1IYDHRD TE ~:T F?i;~'E :0.20 ~aHL.•'Hk NGRh1ALLY CLG QED UUI;;+yl'IUPI 2 HOURti L i ~3U I D F;EIVSOk ALh'IS L 1:FUEL ALARM Li:~t}. TkF;'I' I?EL'~JRT FCSkWir~T L 1:HIGH LIQUID ALARM PJURhiHL k 2:GI£SEL T'; F•E STiiNGHRD WOkhIHLLY CLOSED L I ~d U ] D SE 19SOk HLMS L 2:FU£L h~LAkhl L 2:H1C,H LIGiU]D ALAkhI R 3:91 1.IWUIL'~ ';E1•IE>UF? :SETUP TYPE: _ _. _ .. _ ._ - _ -- - -- - STkNDHRD ' hlvl2l~+-ILLY CLOSED L. 1 : 3 ( ~, rte DIJf',L 1=I."C', Nir~H tJi-1PUk ~~r+`!'Li:i)R`,'' 5TP SUMF LIGUIL} SEI'JSOR kLh1S L 3 : FUEL ALARI°i L 3:HIGH LIQUID ALARMM 1. '~ : L I ESEL ATP I>Url. FLT . H J ~: H ~+FPOR i:'ie1'E+_,+ik'~` hTP SUh'lP L. 3:51 :~TF C!Ur~L FL'r . HIi;N +lr`iPOR C:FiTr.GUh''>' tiT~' SUMF' I_ 4 : b7 ~fJPlULHk L+IS~;I. FL.UriT H'•'GROSTHT I is RELv' NC 1 L I HT I GN SETUP i=:AT~~:Ok`i AIVPJULHk SPHCE -_ _. _ _ _ _ _ _ _ _ _ _ AUTGf°1AT ] G DH [ LY CLOS I Nu L. 5: G I ESEL HI919ULAR T I t°lE : 2:00 AIM IlUHL FLUHT H'fPRONTHT I iriTEi~~>k';' HNNULAR SFACE HUTO 3HiFT dl CL?)SIhh~ T 1 !°lE : 4 : lt0 AP1 HUTO SH1FT is2 i'LOSTN~ I. E : 51 NPIf9ULt1k T 11ME : G I SHBLED liUHL FLi>HT HYDkG'THTTG i::HTE~ OkY i-1NPlULrTR SFF++- E r`1UTG FAH I FT p3 CL.GS I Ni; 'r I i'•IE : U 16HHLED ~;UTU SHIFT t34 CLGS I NG L ?:(UUfJE TIhIE: 12:00 AIM 1'kl-L"PATE <SIruCLE FLvHTi i_riTE~3C>k`! UTHEk :~ENSCIRS PERIGDIG RE%ONi;1LIA1'IGhI Mt>P£ : MONTHLY t;LARM: DISABLED I. d : tuG tvE rJ•~;kl°IHLLY C'L+?SED TEh1F ~•UhlFEhlSFtTION i;;=aTEGUk''i' i~THEk SENS55kS ;,TAIdiSARD BUS SLti)T FUEL r1ETER THI9K - - TANk: l°IAP-EMPTY - - - F~LHRIM H I ::T4k'f REFC+kT' ---._-- BYSTEh1 HLHRhi ---~-- Bt;TTERY IS UFF ~7AN t. 1596 B:UO Ar9 ;t n ~ iE EI9D +~ x # t~ ALARM H I STOK`f kEL'GkT ---- 119-THNK ALARM ----- T 1 : F'ELULAR I NvHL I D FUEL LEtrEL FEFi 2B. 20Ue, 5:34 PM END HLHRM Hl;~TOR.' kEFC_iRT ---- i N-THNX. HLHkh( ----- T 2:DIEB£L i=iLi-iRl-I HI;~TVrc1` REFuRT • -~-- Ih4-TF=tI•Jk rtLARh1 ----- 7" 3 : F'RI rl l Uhl x x .~ *~ EfJD ii x x~ x HI_~kl°1 H I tTCiR'; I~EP~ rR7' ----- Ir'J-7"HNK. HLHRf°1 -~---- '1' :1. Y X ~ Eh~Ii x x ,c ~ :* i~iLi=ik1"1 H I ;]Ti.1R'i' kEF'GRT _....___ ErJ'tiJiiR ALHkh'I ----- L i:J^ STP STF• SUIMF SEI+JSGR GLIT HLr'=ikf°I P•IHR 16. '~Oq6 10:55 Hrt L I id U I Ii 6Jr=ik N I Nt3 MrR 16, 2806 9:a5 Hrl H I ~:~H L T t,! U I Ii HLHRh'I t°ItiR 16. '~UU6 9:3J3 Hr°I r1Lr=jRl°I H I STUR'1 RERiJRT' ------ ~ENSGR HLrikrl ----- L 8 : NUPJE GTHEk SEIVBURS FUEL ALHRM N1Hk lb. 2UU6. 1U:55 Ahl :ETUF' DHTA LJ;RN I Nta FEB 16, 2006 :i:55 PJ°t i;LHRM H I STGRY REF't?RT ----- SENSGR HLHRh9 ----- L ~ : Li I ESEL STF S'ri; ::uMF' SEtVSGR GUT ALARrI N1HR 1 b. 20U6 1 U: 55 HI°l FUEL ALtikf°1 hIHR 16, '`OOG 10:1'% HA1 FUEL tiLtiRIN h1AR 16. :1006 9:3:~ AM ,<~n~xENrifi~;i:~~ NLiikhl HI~TGRY REF'URT __.__- SErVSUR HLHRh1 ----- L ~i : 91 S1'F' ST'F' SUMP SENSOR GUT NLHRNI I°IHR 16. ~qq6 10:55 HN1 LIL~UID UJHRNIhJG MAk 16, '?006 i0:1! AM HIGH L1~JUID ALARM N6=~,R 16, °.006 9:36 HP1 ENU x ~ ~ ~ if HLHRhI H I BTUR'i' REPORT --~•- SENSUk HLHRM ---- L 4:87 HNNULHR HNIVULNR SPHC.E ~ENSUR OUT HLHF.M MNR 16. 2006 10:55 tiM L+~W L I 6~U I D HLHRM MHR t&. 2UU6 9;39 J~iM LGW LfWUIU HLHRM FFFj 24, 2806 7:4U HMI i ~LrRrl H i STUk.' kEF'GR'~f~ ----- SENSGR HLHRM -----i L S:LIIESEL ANNULAR ` HhJNUI.HR SFHCE ~ :;ENSGR GUT ALHkrI NIAR t 6, 2006 10:55 i-1f°l LG~J L I i~U I D RLHRhI ' 1MNR 16. 2006 9:3a Hhl LUW L I l~U I U I;LHRM FEB c4, ',1006 7:41 Nhi ;t x. n .~ ~ END ~ ~ ~ ;~ NLHRNI H I S1'UR4' REP~sRT ------ SENSOR ALHF.J°1 ----- L 6:91 HNhJULHR HIVNULAR SPACE SENSOR UUT r;LARM NIAR 16. 200E 10:55 HM LUW L I 61ll 1 U ALI;kM MAR 16. 2006 5:37r;M LUW LIGUTA HLHRM FEB '24. 2006 7:41 HM x ii ;t x ENU 3t it ai 3E ie HLHRM H1STUk'1 kEFURT ------ SEIVSUR i;LARM ----- L 7:NGNE GTHER SENSORS SEJ~Gk UUT NLHRNI MHR iE, 2006 10:55 At°1 FUEL HLARM FEB '~4. 2UG5 7:43 fi!"i FUEL HLHRM 1=E13 zl. 2UUb 1:57 F•Jh i - -.- ~ -- a' , UNDERGROUND STORAGE TANKS s`~ ..,,. BAKERBFIELD FIRE D EPT. . .A~. .. ~ , . >tl,~ .~~ ~,rn~ Prevention Services ~ . ,... .......... r . ?~ ~ I t l~ 900 Tnixtun Ave., Ste. 210 ~ APPLICATlQN ~~~ Bakersfield, CA 93301 ~ !' ~ • TO PERFORM ELD! LINE TESTWG >~:1 Tel.: (661) 32b-3979 1 SBS89 SECONDARY CONTAINMENT TESTiNt3 -~ Fa3C: {661) 852-2171 "1'~~ ~ /TANK TIGHTNESS TEST AND TO PERFORM ~ FUEL MONITORING CERTIFICATION Pape 1 M 1 ;~~Li"'- ,'~'~ ~~ t PERMIT NO. ~ • - ?~~ , ^ ENHANCED LEAK DETECTION ~1.INE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING 1 1 I Tn\IV TIl~1JT\ICCC TGCT SCI TA bCOCnQAA CI ICI GAnulrnf}wr 1"`CI~r~Clrannu MA I .. FACILITY ~ NE NUMBER OF CONTACT PERSON ADDRESS t _ ~(f I !L i OWNERS NAME rd ~ OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED P N Y N ~ --~/ n IANK,7~S'~ING COMPANY `' NAME O TESTIN COMPANY a ~ NAME ~ HONE NUMBER OF ONTAC PERSON ~~ MAILING ADDRESS Q ' NAME 8 PHON NUMBER OF TESTER R SPECIAL INSPECTOR CE IFICATION DATE & TIME T ST TO E CONDUCTED N ,n^ ~i~' ' 1 ICC 8: TEST METHOD , SIGNATURE OF APPLICANT L~ DATE APPROVED BY DATE FD 2095 (Rev. 011105) ~ - ~2~ ~ ~1~LiNG & PERMIT STATEMENT ~' BAKERSFIEYID FIRE DEPT. ~ Prevention Services P!R/ 900 '1'nixtun Avenue, Suite 210 PERMIT NO.: A~ T Bakersfield, CA 93301 r..1 rccz7 ~n~ ~n~e a 7:~.,• lF~77 S7Sri_n1'f7 LOCATION OF PRO ~~ ' ~ PROPERTY OWNER~r (^J STARTING DATE ~ • ~7 ! ~ ~ ' ` OMPLETION OA ~ ~~ .~/( ~ U NAME O PROJECT - •' /Vl (_' ADDRESS pHONENp. PROJECT ADDRESS C ZIP LADE - CONTRACTOR CA LICENSE NO. ~ TYPE OF LICENSE. EXPRATION DATE PHONE NQ CONTRAC R CO 1 FAX NO. ^ I ~'i ADDRESS r ~ ~ i C. I C ZIP CODE ~ ~D ) $262 ^ Al r s -N w & M difi ns - Mi i m Ch 50 ati ~ ( n mu arge m o c a e o . 98 FL Over 20 000 S 0?3i25 = Permh free FL x S ~ ^ , q. . q. 98 ^ e} S rinklers -New & Mod~lcations - (Minimum Char $210 00 ~ p g . 98 ^ FL Over 5 000 S FL x 042 =Permit fee S ~ , q. . q. 98 ^ Minor Sprinkler Modifications (< 10 heads) 00 (inspection Onlyj S 93 ~ . 98 ^ Commercial Woods -New & Modifications $ 398 26 ~ . 98 ^ Additionaf Noods $ 36 00 ~ . 98 ^ S 13ooihs -New & Modifications ra $458 00 ~ p y . 98 ^ Aboveground Stora a Tanks (lnstallatiordinsp: t'~ Time} $165.00 82 ^ AddfBonat Tanks S 26.00 82 ^ Aboveground Storage Tanks (RemovaNlnspeZtion} $109.00 82 ^ Underground Storage Tanks (lnstal/atlonJlnspection) $878.00 (pertank) 82 ^ Underground Storage Tanks (Modification) $878.00 (per site) ~ 82 ^ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Underground Storage Tanks (RemovaQ $675.00 (pertank) 84 ^ Oitwell pnstaltatbn) 72.00 ~ 84 ^ Mandated Leak Detection (Testi ) I Fuel hAonlL Cert. 81.00 (per srteJ 82 ^ Tents . $93.00 (pertent) i 84 ^ After hours inspection ee $122.00 ' ~ 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee ~ S90 per hour) $60.00 + (5 hrs. min. stand -by fee /InspaWon) _ $510.00 84 ^ RE iNSPECTlON(S) /FOLLOW-UP INSPECTION(S) $93.00 (per hour) i 84 ^ Portable LPG (Propane): NO.OF CAGES? $66.00 ! 64 ^ Explosive Storage $249.00 i 84 O Copying & Fite Research (File Research Fee 833.00 per hr) 25¢ per page ~' 84 ^ Miscellaneous ,~ 84 FD 2021(Ijev. 0&!05) r t - OR1r31NAL WHITE (to Tr77asury) 1•YELLOW (to File} t~INK (to Customer)