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HomeMy WebLinkAboutUST REP. 1/25/2006(UNDERGROUND STORAGE TANKS) FILE # ~+ ~~` DELI-MART -- - - _ - - . -" 9628 ROSEDALE HWY. o ~ f ~' -__ _ ____ r___ -___ __ __ r .. .~ j ~, ,; L` ;' ,~ - .,. ~.~ - sa . . ,~ . UNDERGROUND STORAGE TANK PERMIT APPLICATION H 8 R 8 P 1 D TO CONSTRUCT /MODIFY /MINOR ~~RL MODIFICATION OF AN UST r PERMff NO. ~-C tY1 -~ t{-(~ 2.. TYPE OF APPLICATION: (Check one item only) ^ NEW FACILITY n MODIFICATION OF FACILITY BAKERSFIELD FIRE DEPT. Prevention Services 900 Tnixtun Ave. , Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ NEW TANK INSTALLATION AT EXISTING FACILITY f~v1611NOR MODIFICATION OF FACILITY TARTING DATE ROPOSED COMPLETION DATE - FACILITY NAME e. \ ~~Q~` XISTINGFACILITY PERMIT NO. FACILITY ADDRESS 9 c~'~8 '\aos \e. ~~. IT ~ o.~ s~.~\~. ~ IP CODE 9'33 ~ ~. PE{~O~F BUSINESS PN # ANK OW NER ~ ~'~.a~o. ~ ~c- HONE NO Ct„t~\ 5~~ S~ y O DDRE S qc~ ~~ ~~se_ o\e~ ~v~ ITY ~o.~.~~~~-e~.~ ~ IP CODE 1~- ONTRACTOR ~~S.S i o~S ~ A LICENSE NO. `r~ ~Ey 3 ~ H4~. ICC NO. l ~b33 - l~ DDRESS, . ITY IP CODE PHONE N b(~\~ g33 --9sb\ BAKERSFIELD CITY BUSINESS LICENSE NO. N P~ ORKMANS COMP NO. y 5h a - CO INSURER \~~~~ BRIEFLY DESCRIBE THE WORK TO BE DONE ec~ ` or e CC a3 ' ~~ S 2-c- ,~~ a~ ~ s ~ u~~ s ~ -r ~ : v : ~ WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO. OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL ^ YES ^ NO SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ^ YES ^ NO THIS SECTION IS FOR MOTOR FUEL TANK NOr . _ OLUME NLEADED EGULAR PREMIUM DIESEL VIATION ~ Sao o THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. OLUME NLEADED EGULAR PREMIUM DIESEL VIATION FOR OFFICIAL USE ONLY APPLICATION DATE FACILITY NO. NO.OF TANKS FEES $ " /,. The applicant ~ received, u erst s, and will comply with the attached conditions of the permit and any other state, local and federal regulation orm b n c leted under penalty of perjury, and to the best of my knowledge, is true and correct. V~ ~ C~`t~ ~ -~` 5 'c1 ~ ° d'`~S acs O APPROVED BY: APPLICANT NAME (PRINT) APPLICANT SIGNATURE N a~- THIS APPLICATION BECOMES A PERMIT WHEN APPROVED (Rev. 02/05) \~ 6p c~ r* FRDM :BSSR,INC FAX ND. :6615$$2786 Feb. 10 2006 02:4OPM P2 • ~' .. ~ • MQiVI`T~RINC>< S"YSTEM~ CERTIFICt#TION ~' Pvr Use $ ALl JurisrliCtinns Withi-t the State ref CulFfnrniu . ' Autl:riritv'Cited: CAupter 6.7. Health u-u! Scfery Crxlr; Ckuptri !6, Olwf.,riun 3. i <tle ~~..Culrforneu Cr,Je of Rrgulutfi,n.~r . "'T'his farm must he used~to document testing dnd seiyicing of monitoring Cquipment. A~,genarate certiPtia[iori or r Wort must be prepared ~r cx mani~ri~sYs~tem cottt~t ganef by lira technician who performs the work..A copy of this farm must b~ provided to the tank system ownet/oper4tor. The owtaCr/operator triust submit a copy of this forth to the local agtney regulating US'f systems within 30 • days of test date. • A. General Xnfnr ~ . )=aeility Name. 1#tdg. IJo. ' Site Address: ~ i~~~/'~-~'~ i~'° City: Zip: ~W r ---) ,S~ FaeiT~y Contact Petsoa• Contact Phone Mo.: .l • • Make/Model of Monitoring Syst 0 ~ Date of Testing/Servicing: ~ 1 ,~ B. Inventory of ~gipment'x'ested/Certified •! . Tank Ii]: ~ In-TsrikGauging Probe. i4Todet:f~'~YJE~XGGiOVIJ q' Attntriae Space or Vault Sensor. ModeL• ' Q Piping Sump / Tn:ach Sa s). Models l:sil Sump Sensor(s). ,~~ Mndei::i'~ 17 ~" Mechanicai Lina•Ltak Detoctor. Model: O Electronic.laae C.ealc Detector... Model: O Tank t~verfd! /High-Lever Sensor. • ModeF: _ --_ fl Other ui at t and rrrodel ir1 Sectloa E oa Pa 2)_ ' Tpaok)D: In-Tank Gaugutg pr+pbe. ~ ' .. •.: M : Annular Space or V avli Sensor. Model: ' D Figin$ Sump /'Ylxttctt Sen9r ). Model:. Fill Sump Sensor(s). ,~'~~ Madd: ~ ~ -~.~~ Mechatticttl l,.it:e I:ealt ~ctector. Model: D fitaaronic Line Leak Detector. ~ ~ Modal: T] Trek OvrrCtll/.High-Level Sensor.. Matlal: fl Other u i went and modes in Sectitm 6 ott a 2 . Dispen+er IDr ~" ~.Dispcnser Contafttryent Sensor(s). , ModeL• Shear Valve(s). ~ • ~: -• .. Dispenser Cot=tainraeni i=last(s) and Chain(s). Dispemer TD: t ~ ~'• ' yl$ DispenserContai m tit Satsor(S). Maclel: Shear Valve(s). .. • Dispenser ]ml: _ R~ pispensar Containment Sensor(s)., :Mode ,Shear Valve(s).. '. ~ .. _ r. .', . ... Tacit I1D: ~~ ' . Ia-Tank 4suging Prnbe. Model: O Annular Sp~e or Vault 3ensvr. ModeL• l7 Piping Sump / TrGrtch s). ModeL• . 4~ fill Satrap Sensor(s). ~~ Modei:,t'Z,'~ D. Mechanical Line Dealt T)evxtor. Model: ---.... --- O tleerronic [.inc Leak Detector. Model: O Taiilr Overfill /High-Level Sensor. ModeL• Q Other s i ui t and model in Section 8 on P e 2). Tank YD: O In-'T'ank Gauging Probe. Model: O Annular Space or Vault Sensor. Model: O Piping Satrap /Trench Sensor(s). Medal: O Fi115ump Sensor(s). Model: O Mechanlral line Lrak Detector. Mudd: O EleCtr4nic Line Lesk Dctxtor. ModcL- l1 Tank Ovefill /High-Level Sensor. Model: fl Other tsoeeitY equitntrtent tyae and.tnodel in Section 1"s on Page 2). _ _ ~ Dispenser Containmens Sensor(s). • Model: Shear Valve(s). Dispettset ID'. ~ D Dispenser Cotttaitrmeart Sensor(s). Modes: p Shear Valve(s). (~ Dispenser Containment I7oat(s) and Cgaia(s). -- DTapaascr ID: O Dispenser Containment Sensor(s). Model; fl. Shear Valvo(sh ' %lf the facility contains snore tanks or dispenstas, copy this form Iracltsde information for livery tapir and dispenser at the facility. C, GertifiCatiaA - I txrtity that the equipment identified le this tiocumeat was itlspeCted/serviced in aceatylance with' the eramrfltcturers' gtrLdelinea: Aftrached to this L`,erdtication m itKorasattan (e.P, mauniacturers' checklists) accessary to verify that this igfarntattan is oprTOCt and a Plot Plan showing the T~yotlt at moal~rine equipment. Bor orgy egvipnteat capable generating such rope , Y have also attached a copy oa[ the re (e a1T ]System set-up. O to re s Technician Nuiiie (gripe): ~~ ~ -- Slgnnture: Certiiica#ion No.: '~ License. No:: ~~ ,~, /~/~ - Testing Company Natite: ~ _ one No.:~T~/ f '~;~~~~~~~ .Site Addt~css• . ~ Date of Trsting/5etvit:ing: ~~ oatoi I i FROM :BSSR,INC FAX NO. :6615882786 Feb. 10 2006 02:41PM P3 a ._ .~ D. ~iesults of TestittglSerYicing Softwetrc Vrtsion [astalJnd: ! ~. ~ ___ Complete the fallowi.~e ehecktitte Yes ^ No* Is [hc audible alarm o erational?~ Yes p t~o* Is the visual stlarm o rational.? cs D Not Were all sensors 4isuall ins cud, Pltncdonall tested, and confirmed o rational? Yes Q Not Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere•with their r r o lion? Q Yes ©Na+ If alarms are relayed to a remote monitoring station, is all communications equipment {e.g. modem) ' NIA operations!? Yes O No* For pressurized piping systems, does the turbine automatically shut down if the pipiet$ secondary eontaiement D N/A monitoring system detecu a leak, fIIilS to OprratE, or is clectricxily disconnected? If yes: which sensors inidxte ' posidye shut-down? {Check alt that apply) ~b"utnpiTrench Sensors; C] Dispenser Containment Sensors. Did u coefirm 'rive shut-dowel due to leaks and sensor tailtae/discannection? es; Q 1Vo. ^ Yes ^ No* For tank systems that utilize the monitoring system as the primary tank pve~ll warning device (i.e. no ~' N/A' tttechanioal ove~ll prevention valve is installed), is the overfill warttietg alarm visible and audible at the tank fill ie s) and o ratin I ? If so, at what set of tank acit does the alarm tri er? 96 ^ Yes* ~ No Was any monitoring aquipment replaced? if yes, identify spxiPtc sensors, probes, or other equipment replaced and list the t:taettfactuter names and made! for all re laceee-ent arts in Section E, below. O Yes' ~;No Was liquid found iteside any secondary containment systems designed as dry systems? (Check at! Thal apply) D Product; O Water. Ef s. describe causes in Section >~. below. Yes O No* Was monitorin s stem set-u z~viewed to ensure ro r settin ?Attach set u re rts, if a licable Yee D Not Is ail monitotirt ui t o tional mattufacttuer•'s s ifications? * itt Section E lxtow, des+crlbe haw and when tdese deIIeieneies were or wilt be oorrectect, ~i. COlnitle'II~Si i • Page Z ni3 t-3/Ot l FROM :BSSR,ING FAX N0. :6615882786 Feb. 10 2006 02:41PM P4 ..'„ • F: , in-Tank Gauging /SIR •Equippient: O Clteck this box if tank gaugia$ is used only for inventory control: ' .~' ~ Q Check this box if no tank gauging or SIR equipment is installed. This section mist be completed if in=tank gauging equipment is used to perfo~ITrt leak detection martitotYng. 1".mm~letr klre follnwiren Cheekllat: Yes D No* Eias alI input wiring bees inspected for proper entry and terrrunation, including testing for ground fauns? Yes D No" Were alt tank gauging probes Oisuaity inspected far damage and residue buildup? Yes 4 No* was accuracy of system product level readings tested? Yes ^ No* Was accteracy of system water level teadittgs tested? Ye8 I] No* Were all proltcs reinstalled properly? . 'Yes ©No* Were all items oe the equipment maltufacturec's maintenance cizeckl'tst completed? • 171 the Section Hi belOW, dC2Crtbe IIOrY entl Wti811 toes! tletlcleACles ware or.ww oe coerecaea. G. Tine Leak Detectors (LLD): ^ Chcctc this box if LLDs are not installed. ~~ :•;: Cam et o the [otto win caeclulea• Yes ^ No'e For eeauipeltent scan-up ar armual equipment eartlfication, was a kale'simulated to verify LLD perfarrnatece? 4 NIA (Check all clear apply) Simulated leak rate: ~3 g.p.h.: ^ Q.1 g.p.h : O 0.2 g.p.h. . ^ Yes O No' Wel+e all LLDs eottfumed operatiotl$1 and accurate within regulatory requirettients? Yes. Ca No* Was the testing apparatus properly calibrated? . ~ Yes • Cl, Nv*: For mechanical LI.Ds. dues the I,.I.U restrict product flow iF it detects a leak? . D N/A Q Xes' O ~ No" For electronic I.LDs, does the turbine automatically shut off if the LLD detects a leak? •N/A O Yes C1 No" For, electronic i "T.~ does the turbine automatically shut off if any portion of the ttlonitoririg system is disabled • N!A .ordisconrlect~? . D Yes No* For electronic: r.r_ns. does the turbine automatical[y shut off if any portion of the tttonitoriag •system maifurections • NIA . . ar fails, a tes,?. D Yes O No*. • For electronic Ll..ps, have all accessible wiring connections been visually inspected? . NIA Yes 'NO• Were all,ioetns on the equipment manufactuier's roaintettance checklist completed? y In the 3 ectlan H, t~elaw: describe haw and when: these detidendes were or wiU be corrected. ~ Comments: _._. ; :,-~ If you alreatfy havt a•diagraui~-tbat..slzows~lt.r~ ~~Orr~~tionr.you.~Y,include it, rather•than this page, with your Meai;oriag Systcm_,Certiifoation••: Qq.youY sits Flan, sliov~r. the $~eral .leyottt;of'tanks -and•piping. ' Clearly identify location.6 of the following egtuptmet~,,• if izistelled:"` monitarlitg'syatem' oontrol panels; Ssnsors..inonitgring tank• arms ar spa~cs, sumps, dispenses pan~;•sptll coatazaua,-or.otl~r..SC.cot~da_ry...~4ntainmcrtt ~~~ tnocttanical or e3ectronic line leak dctcctorsr and in-tank liquid level probes (if used for leak dctcetion). Irt the space provided, note the date this Site Plan was prr~parcd. :~:1::J ':.: ~~ `1 , • pads ~^ of os{oo FROM :BSSR,INC FAX N0. :6615882786 ' ,~ ...... :! ..., 'vL'1Q a,14s~iJ.~l rj~t~t;8; :iaA; :.i ::C~.L'c..'i.1:a.:ti~1 L. MottrEOring System CertllScatlon ~ • ~ ~ . ~ ~ ~ , ,' . ,, .. Feb. 10 2006 02:42PM P5 .... ..'3•rJ ., - ~'S.T~:1~Vlan~to~~ng~•Site:'Plan j .. - Site Address; ;1 . •r. ,. , . ' .. .... ... ~__.._~., .. _~. .. .. _~..+:1'.::.........s •v.:tgY'-''.v'.I M1: PR W+_•.W111iY'i r.L •..r u• ~ ..... ... ... ... /rV •.. _ .. ~, .....f. ..._ .. ...... .. .. ~~:1" . . . . . . . . . . . . . . . . . , ;ir., >s :~--.. , . . . . . . . • ~ . .e' r r r. . ~. . ~ i . i -t r ,., .. .. .. :,al ~vwrj'f•{.wy197d~rA•t•.a• +try ra~tr •..•r .:JL•r1i. .ei'.L11,n .i r. r .'I. Qr . . . i5 :aa9'r cty !x`. :,1': 'I. . . :t' r ... • 't• .'.i. .. ~ !'... ~w~.rr r . . . r • ' , r ~ r~U~y~i~&'lU 1uU'b1a ~tA'i, .1 tii ~~:' 7CS3U dt(!1 ~`J%V! 7•ti~ V '!•~, ~~.1 ~11. r •• .y. ,. t }. 1:•' • . . .. , ... ~..,.. v._..t.. ~. .!. r:. T..:'r,~ ~ • ~.!"• •z'v,1.•.:<<}ar 1.r .. 1.~ . . . . . . . •t. . .r'.. , • r h~;.t%t,;1 ~11Y *';T 1~1. 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Tank 2 Tank 3 Tank 4 Start Time Inftial Pressure Farad Tinge . Final Pressure - CertitYcatiox~ (Si~iatnre) ' Secandaty Piping . ~7 ~( ~ SL . Start Time Line 1 ;~f5 ~m .Lune ~ ~ ~%~GlS' I.fne 3 ~ ~ Line 4 Initial Pressure ~' ( ~ l Sl~~ Lud Tittle p f ~ p :~ ~ D ,; C7 dal Pressure ~` ~ . , j ~~S CertiFicatfat- '~ r ~ ~~ (SlgzYature) r l~~ss /Ass /per ~ Page 1 oi• ~,. ,. . . FROM :BSSR,INC l FAX N0. :6615882786 Dec. 30 2005 12:09PM P3 r . SECQ11TpARY SYSTEM CER'Y'~`ICATIUN FOIt11+I .. DATE I.%~~~~--[~ • . ' FACILITY ID '~' 'm R~ •FACILII"~ ADDRESS_ ~••~ ~~.4~ ~.~€~5~'T~~~~ ~.-•~v~t~s Turbine Swaps S~'7 G~ f 1g1 C ~ ., Sump 1 ~ Sump 2 Sump ~ Sump 4 Start Time ,t; ~~.. ~ 3: ~7 3~ Initial Height of Water ~. ~, ~ g i ~ ~ . r Water Height ~ r ~ ~/,. ~ ~ ~ d~ ~ [~r Time ~ ~. 3 : S 3 %S 3 Water Height ~ -~ s6 ~- ~ 3 ~) ~ 6 k Time 5"; 3 ~ 3: S t ~~ S'6 water Height (_?~'~ ~ - 3 $ Z . L y~ . Certification (S tune} ~ ~ ~ ~ f ~ Y~sS 9'9-S~' ~}r5 5 Overfill Buck~ate Start Time Qverl'ill i ~_' ~ „~ Overfill 2 y c~ 1 Uverfill 3 ~- 3 O~-erf"i114 ~ : ~ ~' Y><titial Height . o~ Water ~ ~ ~~ 3 ~'~ ~ ~. ~ ~..~ ~f . . Ttia~e ~ ; ~ g 1: ~ ~ ~ . ~ ~. ~ ~ 'Water Height . 3 S 1 ~ • S 3 . ~ '~. Time ~ ;, ~. j `~ ) .c> ~•- ~ ~ ? ~ : (2. Water HeiP,ht . ~l ~( I ~,. ~ r ~ 3 • ~ ~.~ Certification ~' ~ ~ s ~ ~~ , pis ~ ~ /J~rs Page ~ flf _ p ~.~ ~ ~~A S F~ r FROM :BSSR,INC FAX NO. :6615882786 Dec. 30 2005 12:09PM P4 . SECONDARY SYSTEM CERTIFICATION FORM I?ATE }~ 5' ~ ' . ` _ FACII..~'Y ID ~ ' Rr''r p'ACILITY ADDRESS ' A-~'(~' P~B~ ~ ~r~r~~S gSumps ~~ ~ t h ~ r ., Suxap 1 Sump 2 Sunup 3 Sump 4 Start Time ,y:, ~.~.,r + ~,/ ~ ~ Initial Height of Water ~./_gg~~ ~ Time .~.~-S' ~'f:1.o X1=2-v Water Hei~# bl- $' ~d 5 ~ . ~ Time ~.~-8 ~ ~= 2-3 ~;~ ~3 Water Y~eigt~t ~j. ~ ~ /~ 7 ~$ Certification ~'`~ `~ ~ ~ ~ '/~ Y~S~ .;~;r~e./~sr~cyu /~>> Oi-erfill $uckets Overfill x QverPiU 2 Overfill 3 Overfill a Start Time ~ <y . { S: a-~. II11tiA~ ~Ieigilt of Water ~ ~ ~ 3 j y 3 . ~o [ ( ~-SYt s t Time ~. ° ~ ^ 2 5' ~' ~-5 Water Height ~ . ~ 3 g ~, ~p l YS Water Heigh# ~ . ~~ 3. / ~ ~ 5 CertificslioA ~~~ ~` ~.f~ ~f (Signature) . ~nCr~~~5~9 PASS Page 2 of ,,,_ ~-f~~~ FROM :$SSR,INC FAX N0. :66152786 Dec. 30 2005 12:10PM P5 SECONDARY SYSTEM CERTIFiCA'I'ION FORM ~~ DATE ~ -~. D M O 'FACILITY' YD FAG[I.ITX ADDRESS dT m -= ~ UDC TESTYNG . ". DISPENSER 1 DISP~TSER 2 DISPENSER 3 DISPFNSEIt 4 START TIME f a~, 2 ~ : :,~' ~ . 'L INITIAI, HEIGHT OF WA~'EIt ~. ~ 6 ~j I `/ ~~ bc~s ~ ~-7,~2 tf . .3%$'~~-$ TYYviE 1~~-2~ j U:.~p j~ ~~~ ~ = V~IATER HEIGHT 3-~~ r ~~ ~'~tg`o ~-7.~Z, ~~$~ TIME /D : 2 Q ~~ ; ~ ~ f~? ``~~ ' ~ : ~. WATER HEIGHT ~; s ~G~ ? ~ ~5 G.~~ ~ ~ }fig. cE~cTr~I~N { ~ ~ ~ ~' ~" 5S R~55 y~+~-a a Q~5 S DESP'ENSER 5 DISPENSER 6 DISSPENSER 7 YlX~SPENSEIi 8 START TIME A~t1'I'YAL HEIGHT' OF , WATER TIME WA1~R HEIGHT TIME WATER . . HEIGHT CERTIFICA'1'iON (SIGNATYJRL~ . Page 3 of ,._ FRAM :BSSR,INC FAX N0. :6615882786 "n~•cp~~^ f ~ ~i; E r~~~ PSfR~TFS~~~ • ~ • ~•,r. T~ngp.,T ta, n 9 f '?,r?~/2gC~i ?.ktCy7~AM :+~ F ~c.~pFTi~ firyFR y ' ` • ,~,ma ~ C'!~lY r~T 4E?'itRT • c,n.rc1 .77 ¢:{'J., T~-pT ~^r~y TCr,~ o• ~a aM T•",^5?~S''A~TCn f7f~7.p./?.9Py . . l ~` i ~, itAD !_; PflNS~F' ° +; t w ! 1•i Ej ~ r,C.,! T hi i :Th ?; n. ~•~ -•t'~ .i.n '}c,Tr j'~r~ia~~~5 ' •~i-. • • rr qs1 7 g vrr.T 5~A~~~~ ~~/211~.~1jx~•, "` 'j ~ ~ ~ i FNlS + Fl~l ~ ~ TJv t ' '' ~ ~ .t !' 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TK'ST nTRRTFf~ ~ 2i~Glr?$Aa FNF~ TT-?F ~R: 1r~. ~7M 1 r. ~+t'r!.19CSNn+ !~ ? ~?~i? Tod ~ TCy7 RC.y`~l[T ~ •PAS7Er? ~ ~, Yrr7 SyTAFTCTI ?(~: ?'4 CdM .f TcrY ~;Y~,~YT':'C4 11r~1C)f^q(h.'+ ~% t ~ gC1;74 I C~le1. t+Zrd' v C41T^~ TTM~ ;'~'?~. 2LM ~~ Flan npr~ +?r7A7'7>:!q~ l- ~~yyK T>-il?F.~sNfS!_M1 TQ 0aT ~N _ - _ ..~_ ......~--~~1 r~Y ;TfiRMMYrr)r • ~ ~ `~qW?':1L9~+ ~•er'14T }~Y~IS :1 T Ilj: y C1,1 +J, .. ate `•YUFt~'S, ^ ~ ~.'~. is FiU` -~t... T ~,.rprLi4r ~. • ••'S . ' FROM :BSSR,INC 0 •968 k~J~~'~i~E MW4'. :~F,K~SFiEl:7 Cf~. • B'S.SR TES?ER 56+. ~C''R ?Tr7 51: h!'.•~ i„~rr'4~{ ~!'~'y~" K?1rla~.iR i • 87VRP '-^e- S"';ik'rE;ti , •611, ?tq ?E~ T .ST~}R?ED 1?0/20@~ 13ELi.t~ f,rl~til~ d,ibi6 IN EPtD TIME 1:.7 PP~~ tND LEVEL 4.3517 FPy EFlK T!i!?E84+~~D Ch. C7~ iN T~sT RESULT Rf~ED r FAX NO. :66158827$6 ". •ti ` ~~~ ~ •" . ~~,~ya1h~~~$j~'7 i , e++;ma_ ~..'Au TEST ,s'z'rnlRi ~ , • 91~I!.i_ ' . TEST BTRRTED ,1Ri20~2905' ~ ~{~~ T 46 PM Mr ? ~ ~ , ,i r, r '1l:+Al7~R ` ,',.~'~x9t^ Tr. 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'SST STAt~TED i2/"~0r~'E'V5 (:S'. BE~iI~ LF:UEL 5.5451 IN ,...., ~'~ND TIME :3' -PE,~ a,'.•:. • ~ a,,..:.~Y~ttD DRTE~ 1 ~~~~45b~~ ~ ~ ~: IrEST .TP~RESWOLD O'~$SED :+,'.i i;~,:~; ' 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. HUEY, 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, III ' Hazardous Materials Specialist 326-3649 December 1, 2005 Deli-Mart 9628 Rosedale Hwy. Bakersfield, CA 93312 FINAL REMINDER NOTICE RE: Necessary Secondary Containment Testing Requirements by December 31, 2005 of Underground Storage Tank (s) Located at the Above Stated Address Dear Valued Customer, Over the last six months this office has continued to send reminder notices regarding secondary containment testing. Code requires that all secondary containment systems must be tested 6 months post construction and every 36 months there after. Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and every 36 months, thereafter, to insure that the 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. Those sites that have not been tested and have not pulled a permit prior to December 31, 2005, will have their permit to operate revoked. This office does not wish to take such action, which is why we will continue to send monthly reminders. Contractors are already booked several weeks in advance. 1 urge you to schedule your testing date as soon as possible to avoid possible revocation of your permit to operate. Should you have any questions, please feel free to call me at (661) 326-3190. Sincerely, RALPH E. HUEY, Director of Prevention Services ~~~ Steve Underwood Fire Prevention Officer SU:db ~J~uii~ ~e ~i~oin~stc ~ ..~1~1a~ ~J1~asy ~~~~~sf,~ ~; UNDERGROUND STORAGE TANKS ~s~ BAKERSFIELD FIRE DEPT. ~ Prevention Services ..,YMW,.,,.,,,~,,,,ry~~.~.,wr,,~„~..,w,,.~,. ~~,, f~Rr ?; ARTY T 900 Truxtun Ave., Ste. 210 APPLICATION ~' CA 93301 Bakersfield TO PERFORM ELD /LINE TESTING ?~ , Tel.: (661) 326-3979 S6989 SECONDARY CONTAINMENT TESTING Fax: (661) 852-?.17 1 !TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION Page 1 of 1 ~ ~~ PERMIT NO. j v ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTINI, ^ TANK TIGHTNESS TEST ~ TO PER FORM FUEL MONITORING CERTIFICATION ;' FACILITY j l~ ~~ ADDRESS ~1 n ~~ ~O i lY E 8 PHONE NUMBER OF CONTACT PERSON i o~.~1a~. ~~ ~(9~C7 OWNERS NAME -r~Ro~ OPERATORS NAME PERMIT TO OPERATE N0. i NUMBER OF TANKS TO BE TESTED IPIN IN T B T TED9 ^ YE ^ NO ____ __. __.___-__.____. _. T _ CONTENTS_^-----------_-_-._: i 1Z I~ ~ ~------------------ ..... 1Z.~ , i TANK TESTING COMPANY NAME OF TESTING COMPANY NAME & Ph ~s~ iZ. MAILING ADDRESS ~1 ^~~ ~-~3~, ~ _ ~ _ 1\ , _~ NAME 8 PH(NIE,N,UMBER OF TESTER O PE Al INSPECTOR ~~ DATE 8 T1ME TEST TO BE CONDU-C7TED ~ /~ ~ ~:~~ L SIGNATURE OF APPLI N ~ ~ ,, 1 . . APPROVED BY ~ ~~ ---- E N ~ O CONTACT PERSUN Sw~. ~ ~jU,~sz.~,~,,2.~C+ ~ Q~~JC~ i CERTIFICATION -- -- -- - ICC #• ~ T'EST METHOD '~ 5z.~o ~ zq ~v - ~7` DATE ~ ~~ PPROVE(Z----------------- -_-.._._.__..: DATE /~ ~0 ' ©~ ~ _ _ _ --- FD 2095 (Rev. 09;051 -- - UNDERGRO D ORAGETANK3 BAKERSFIELD FIRE DEPT. ~~R^ Prevention Services ~w" A/~TII T 900 Truxtun Ave., Ste. 210 APPLIC ~T~ ~N ~ Bakersfield, CA 93301 TO PERFOR LD / INE TESTING Tel.: (661) 326-3979 / SB989 SEC DA CONTAINMENT TESTING Fax: (661) 852-2171 ffANK TIGHT EST AND TO PERFORM FUEL MONITORING CERTIFICATION ., page 1 of 1 PERMff NO. ~ ~'- ~ 3d ~ ^ ENHANCED LEAK DETECTION ^ LINE TESTING W SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ^ T(7 PFRFnRM FI1FI MnNIT(IRING CFRTIFICATInN ,.. :~:.. ..... ... I .. F I N i FACILITY ' \~; , /~ ~~ NAME &~~ E Nl1MBER OF C05 A~CT~PE~ON ~~ ~•J~ ADDRESS ~ I ^~~ ~~~ ~ ~ l Y ^ i ^ 'nA OWNERS NAME \./ M 1 ~~ ~ OPERATORS NAME ~ i PERMIT TO OPERATE NO. ; NUMBER OF TANKS TO BE TESTED IPI 1 T TE T YE Q N E C NTENTS 2 l 0 ~ ~I ~-e~ I~ ~ 3 ~ ~ ~ ~ Q ~J i~~ --I~-~ ' - < '` _ TANK;.TESTING COMPANY NAME OF TESTING COMPANY ~~~ ~ ~ _ ME~&~P NE NUMB R 0 CONTASPER~N~~ MAILING ADDRESS ~1 ,.,~ ~il_.._ , _ 1 ~~ ~ ~~ , L,~-~ ~ ~ ~ ~ ~~~~~ NAME &'P ~ UMBER OF TES ER OR SPECIAL INSPECTOR 1 CERTIFICATION #: DATE 6 TIME TES TO BE C N~ CT D ICC #~~ ~~~ r ~~ TEST METHOD SIGNATURE OF A PLf NT DATE APPROVED BY DATE Z. ~3 ,u FD 2095 (Rev. 09/05)