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HomeMy WebLinkAboutBUSINESS PLAN 7-11 ~#aa6a~> 12916 ROSEDALE HWY. 7.. 1 ~~- - n~enc~gy 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 02/20/2007 Order Number: 3151146 Dear Regulator, Date Printed and Mailed: 03/12/2007 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #22647 MARKET #2133 12916 ROSEDALE HIGHWAY BAKERSFIELD, CA. 93312 Testing performed: 989 Turbine Sump Test Secondary Containment-Dispenser Pan\Sump Secondary Containment-Spill Container Sincerely, ~ a~ ~~~ Dawn Kohlmeyer Manager, Field Reporting SWRCB, January 2002 Page 1. Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN #22647 Date of Testing: 02/20/2007 Facility Address: MART #2133 12916 ROSEDALE HIGHWAY, BAKERSFIELD, CA, 93312 Facility Contact: Manager Phone: (6 61) 5 8 9- 0 9 8 8 Date Local Agency Was Notified of Testing : / / Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY , INC . Technician Conducting Test: WILLIAM ROGERS Credentials: ~ CSLB Licensed Contractor ~ SWRCB Licensed Tank Tester License Type: TANK TESTER License Number: 3-1647 Manufacturer Training Manufacturer Component(s) Date Training Expires / / / / / / / / 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repair Secondary Pipe 1 REG ^ ~ ~ ~ UDC 3f4 ~ ^ ^ ^ Secondary Pipe 2 MID ~ ^ ^ ^ Spill Box 1 REG FILL ~ ^ ^ ^ Secondary Pipe 3 PRE a ^ ^ ^ Spill Box 1 REG FILL ~ ^ ^ ^ Piping Sump 1 REG ~ ^ ^ ^ Spill Box 1 REG VAPOR ~ ^ ^ ^ Piping Sump 1 REG a ^ ^ ^ Spill Box 1 REG VAPOR a ^ ^ ^ Piping Sump 2 MID ~ ^ ^ ^ Spill Box 2 MID FZLL ~ ^ ^ ^ Piping Sump 2 MID ~ ^ ^ ^ Spill Box 2 MID FILL ~ ^ ^ ^ Piping Sump 3 PRE ~ ^ ^ ^ Spill Box 2 MZD VAPOR ~ ^ ^ ^ Piping Sump 3 PRE ~ ^ ^ ^ Spill Box 2 MID VAPOR ~ ^ ^ ^ UDC 1/2 ~ ^ ^ ^ Spill Box 3 PRE FILL ~ ^ ^ ^ UDC 1/2 ~ ^ ^ ^ Spill Box 3 PRE FILL ~ ^ ^ ^ UDC 3/4 ~ ^ ^ ^ Spill Box 3 PRE VAPOR ~ ^ ^ ^ If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: ~~~ -> Date: 0 2/ 2 0/ 2 0 0 7 SWRCB, January 2002 Page 2 . Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from Pests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN #22647 Date of Testing: 02/20/2007 Facility Address: MARKET #2133 12916 ROSEDALE HIGHWAY, BAKERSFIELD, CA, 93312 Facility Contact: Manager Phone: (6 61) 5 8 9- 0 9 8 8 Date Local Agency Was Notified of Testing : / / Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY , INC . Technician Conducting Test: WILLIAM ROGERS Credentials: ~ CSLB Licensed Contractor ~ SWRCB Licensed Tank Tester License Type: TANK TESTER License Number: 3 -164 7 Manufacturer Manufacturer Training Component(s) Date Training Expires / / / / / / / / 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repair Spill Box 3 PRE VAPOR ~ ^ ^ ^ ^ ^ ^ ^ If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: J~~ ~ Date: 0 2/ 2 0/ 2 0 0 7 ~- SWR~B, January 2002 5. SECONDARY PIPE TESTING Page 3 . Test Method Developed By: , ~ Tank Manufacturer ^X Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: ~ pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: ~~..~ __ " J` "• ~"""^"'"" `~' Piping Run # 1 REG Piping Run # 2 MID Piping Run # 3 PRE Piping Run # ,~~:. : . t~_ _ ..... .. ~ Piping Material: GEOFLEX GEOFLEX GEOFLEX Piping Manufacturer: ENVIRON ENVIRON ENVIRON Piping Diameter: 2 2 2 Length of Piping Run: 5 0 5 0 5 0 Product Stored: REG UNLEAD MIDGRADE PREMIUM Method and location of REG UNLEAD MIDGRADE PREMIUM piping-run isolation: Wait tune between applying pressure/vacuum/water and 15 MINS 15 MINS 15 MINS starting test: Test Start Time: 7: 5 5 7: 5 5 7: 5 5 Initial Reading (RI ): 5 5 5 Test End Time: 8:55 8:55 8:55 Final Reading (RF ): 1 5 5 Test Duration: 1 HOUR 1 HOUR 1 HOUR Change in Reading (RF - Rt ): -4 0 0 Pass/Fail Threshold or 0 0 Criteria: 0 7•cst Result: ~ Pass a Fail ~ Yass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) n SWRCB, January 2002 6. PIPING SUMP TESTING Page 4 Test Method Developed By: ~ Sump Manufacturer ~ Industry Standard ~ Professional Engineer Other (Sped) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: VPLT Equipment Resolution: _ ~ ~;,;~. ' tiump# 1 REG ~ Sump# Tl REG ~~ Sump# 2 MID Sump# 2 MID Sump Diameter: 4 2 4 2 4 2 4 2 Sump Depth: 3 5 3 5 31 31 Sump Material: PLASTIC PLASTIC PLASTIC PLASTIC Height from Tank Top to Top of Highest Piping Pentration: 8 g l0 10 Height from Tank Top to Lowest Electrical Pentration: 6 6 6 6 Condition of sump prior to testing: OK OK OK OK Portion of Sump Tested: 1 2 " ABOVE SAME SAME SAME Does turbine shut down when sump sensor detects liquid (both product and water)?* ^yes UNo^N UYes UNoUN UYes ^NoUN ~ Yes UNo~1 Turbine shutdown response time: Is system programmed for fail-safe shutdown?* ^ ^ ~ Yes N N ^ ~ ~ Yes N N ^ ^ ~ Yes N N ^ ^ Yes No Was fail-safe verified to be operational?* ^ ^ ~ Yes N N ^ ~ ~ Yes N N ^ ^ ~ Yes N N ^ ^ Yes No Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS 15 MINS 15 MINS Test Start Time: 9: 0 8 9: 2 7 9: 5 6 10:14 Initial Reading (RI ): 10 10 12 12 Test End Time: 9: 2 3 9: 4 2 10:11 1 0: 2 9 Final Reading (Rg ): 10 10 12 12 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading (RF- RI ): - .00003 - .00005 - .00003 .00001 Pass/Fail Threshold or Criteria: . 0 0 2 0 0 .0 0 2 0 0 .0 0 2 0 0 .0 0 2 0 0 Tesl Result: ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail Was sensor removed for testing? ~YesUNoUNA ~YesUNoUNA aYesCUNoUNA Yes UNoU~T W l l d d as sensor proper y rep ace an verified functional after testing? ^ X Ye ~ N ~ NA ^ X Ye ~ N ~ NA ^ X Ye ~ N ~ NA ^ X yes ^ NO U N COmlrieritS - (include information on repairs made prior to testing, and recommended follow-up for failed tests) 1 If the entire depth of the sump is not tested, specify how much was tested. If the answer to anv of the questions indicated with an asterisk (*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160) SWRCB, January 2002 6. PIPING SUMP TESTING Page 5 - Test Method Developed By: ~ Sump Manufacturer ^X Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: VPLT "€ ~,_ ~ '" s`,~ trump # 3 PRE Sump# 3 PRE ~ ~. Equipment Resolution: Sump # Sump # Sump Diameter: 42 42 Sump Depth: 31 31 Sump Material: PLASTIC PLASTIC Height from Tank Top to Top of Highest Piping Pentration: 8 8 Height from Tank Top to Lowest Electrical Pentration: 6 6 Condition of sump prior to testing: OK OK Portion of Sump Tested: t SAME SAME Does turbine shut down when sump sensor detects liquid (both product and water)?* ^yes ^No^N Yes ^No~N ^Yes ^No^N Yes ^No~i Turbine shutdown response time: Is system programmed for fail-safe shutdown?* ^ ^ ~ Yes N N ^ ~ ~ Yes N N ^ ^ ~ Yes N N ^ ^ Yes No Was fail-safe verified to be operational?* ^ ^ ~ Yes N N ^ ~ ~ Yes N N ^ ^ ~ Yes N N ^ ^ Yes No Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS Test Start Time: 10:3 7 10:5 7 Initial Reading (RI ): l0 l0 Test End Time: 10:52 11:12 Final Reading (Rg ): 10 10 Test Duration: 15 MINS 15 MINS Change in Reading (R g - RI ): - . 0 0 0 0 2 - . 0 0 0 01 Pass/Fail Threshold or Criteria: . 0 0 2 0 0 .0 0 2 0 0 Test 12esult: ~ Pass ~ Fa-I ~ Pass ~ Fail ~ Pass ~ I' ail ~ Pass ~ Fail Was sensor removed for testing? Yes^No^NA Yes^N NA ^Yes^No~NA Yes ^No W l l d as sensor proper y rep ace and verified functional after testing? ~ Ye ~ N ~ NA ~ Ye ~ N ~ NA ^ Ye ~ N ~ NA ^ Yes ^ N Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) t If the entire depth of the sump is not tested, specify how much was tested. If the answer to anv of the questions indicated with an asterisk (*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160) SWRCB, January 2002 7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING Page 6 Test Method Developed By: ~ UDC Manufacturer ~ Industry Standard ~ Professional Engineer Other (Sped) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: 71 ~"'"""~"'~ ~ ':~~'~1 Evw w .rA.~Mr.Mawewtnw~we.::ia .R •. .._... UDC# 1/2 UDC# 1/2 UDC# 3/4 UDC# 3/4 UDC Manufacturer: ENVIRON ENVIRON ENVIRON ENVIRON UDC Material: PLASTIC PLASTIC PLASTIC PLASTIC UDC Depth: 3 0 3 0 3 0 3 0 Height from UDC Top to Top of Highest Piping Pentration: 10 10 10 l o Height from UDCTop to Lowest Electrical Pentration: 8 8 6 8 Condition of UDC prior to testing: OK OK OK OK Portion of UDC Tested: 1 2 ~~ ABOVE SAME SAME SAME Does turbine shut down when sump sensor detects liquid (both product and water)?* yes ^No~N Yes ~No~N Yes ~No~N ~ Yes ^No~ Turbine shutdown response time: Is system programmed for fail-safe shutdown?* ^ ^ ~ Yes N X N ^ ^ ~ Yes N X N ^ ^ ~ Yes N X N ^ ^ Yes No X Was fail-safe verified to be operational?* ^ ^ ~ yes N X N ^ ^ ~ Yes N X N ^ ^ ~ Yes N X N ^ ^ Yes No X Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS 15 MINS 15 MINS Test Start Time: 9: 0 9 9: 2 7 9: 5 6 10:14 Initial Reading (RI ): 12 12 12 12 Test End Time: 9: 2 4 9: 4 2 10:11 10:2 9 Final Reading (Rg ): 12 12 12 12 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading (Rg- RI ): - .00005 - .00003 - .00000 - .00000 Pass/Fail Threshold or Criteria: . 0 0 2 0 0 . 0 0 2 0 0 . 0 0 2 0 0 . 0 0 2 0 0 Test Kesult: ~ Pass ~ Fail ~ Pass ~ Fail ~ Pats ~ Fail v Pass ~ Fai! Was sensor removed for testing? Yes No^NA Yes^No^NA Yes^No~NA Yes ~No~l Was sensor properly replaced and verified functional after testing? ^ ~ ~ X Ye N NA ^ ~ ~ X Ye N NA ^ ~ ~ X Ye N NA ^ ^ X Yes N A Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) 1 If the entire depth of the UDC is not tested, specify how much was tested. If the answer to an~_of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) SWRCB, January 2002 9. SPILL/OVERFILL CONTAINMENT BOXES Page 7 - Facility is Not Equipped With SpilUOverfill Containment Boxes: SpilUOverfill Containment Boxes are Present, but were Not Tested: Test Method Developed By: ~ Spill Bucket Manufacturer ~ Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: VPLT Equipment Resolution: ~w~H... ~ ~`•~";" '~~ ~' Spi1 B 1 REG FILL Spill Box # 1 REG FILL Spill Box # 1 REG VAPOR Spill Box # 1 REG VAPOR Bucket Diameter: 11 11 11 11 Bucket Depth: 12 12 12 12 Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS 15 MINS 15 MINS Test Start Time: 9: 0 9 9: 2 7 9:10 9: 2 7 Initial Reading (RI ): 7.5 7.5 8 8 Test End Time: 9: 2 4 9: 4 2 9: 2 5 9: 4 2 Final Reading (RF }: 7 .5 7.5 8 8 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading (R g - RI) - • 00004 .00000 .00000 - .00001 Pass/FailThresholdor Criteria: .00200 .00200 .00200 .00200 'l'est Result: ~ Ps~ss ~ Fail ~ Pass ~ Fail ~ Pass rail ~ Pass Fail COmmeIItS - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWR~B, January 2002 9. SPILL/OVERFILL CONTAINMENT BOXES Paga ~ 8 . Facility is Not Equipped With SpilUOverfill Containment Boxes: SpilUOverfill Containment Boxes are Present, but were Not Tested: Test Method Developed By: ~ Spill Bucket Manufacturer Other (Specify) ~ Industry Standard ~ Professional Engineer Test Method Used: ~ Pressure Other (Specify) ~ Vacuum ~ Hydrostatic Test Equipment Used: VPLT Equipment Resolution: r "'. { ~ Spill Box # 2 MID FILL Spill Box # 2 MID FILL Spill Box # 2 MID VAPOR Spill Box # 2 MID VAPOR Bucket Diameter: 11 11 11 11 Bucket Depth: 12 12 12 12 Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS 15 MINS 15 MINS Test Start Time: 9: 5 6 10:14 9: 5 6 10:14 Initial Reading (RI ): 8 $ 9 9 Test End Time: 10:11 10:2 9 10:11 10:2 9 Final Reading (Rp ): $ 8 9 9 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading (R F - Rt ) . 0 0 0 01 - . 0 0 014 - . 0 0 0 0 4 - . 0 0 0 01 Pass/Fai1 Threshold or Criteria: . 0 0 2 0 0 .0 0 2 0 0 .0 0 2 0 0 .0 0 2 0 0 'l'est RcsuU: ~ Yass ~ Fail ~ Pass ~ Fail ~ Pass ~ Tail ~ Pass ~ Fail COmmerits - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWR~B, January 2002 ~e~ Page 9 9. SPILL/OVERFILL CONTAINMENT BOXES Facility is Not Equipped With SpilUOverfill Containment Boxes: SpilUOverfill Containment Boxes are Present, but were Not Tested: Test Method Developed By: ~ Spill Bucket Manufacturer ~ Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: VPLT Equipment Resolution: ~ -~- ~~M~ 4 ~_ ,~ ~ ; ~n~R.. . ~~ ~ , << ~ 1 t. S ~IIBox# 3 PRE FILL p' S ~IIBox# 3 RE FILL p' p # 3 PRE VAPOR g i gox Spill Box # 3 PRE VAPOR Bucket Diameter: 11 11 11 11 Bucket Depth: 12 12 12 12 Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS 15 MINS 15 MINS Test Start Time: 10:3 6 10:5 6 10:3 6 10:5 6 Initial Reading (RI ): 7.5 7.5 8.5 8.5 Test End Time: 10:51 11:11 10:51 11:11 Final Reading (Rg ): 7 .5 7 .5 8 .5 8 .5 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading (R g - RI) - • 00025 .00006 .00000 .00001 Pass/Fail Threshold or Criteria: .00200 .00200 .00200 .00200 'l'est Result: ~ Yass ~ Fail ~ Pass ~ Fail ~ Pass ~ N'ail ~ Pass ~ Fail COmmeIIts - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~ Tanb~ology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:02/20/07 WORK ORDER NUMBER3151146 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #22647 COMMENTS Syr SB-989 testing on all components. Tanks are single-wall, no tests necessary. 87 Piping Secondary Failed. All other components passed. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 03/12/2007 08:32 ACRAMER a ~, SITE DIAGRAM ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 02/20/07 WORK ORDER NUMBER9151146 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #22647 58 -• ~~ Fill sump lids, but no fill sumps on all tanks SUP MID UL O O O 0 0 0 ST ST ST z w 7-11 # 22646 12196 Rosedale Hwy Bakersfield, CA, 93312 661.589.0988 Printed 03!12/2007 08:32 ACRAMER ~~ Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: 7-ELEVEN #22647 Facility ID #: 235151 Facility Address: 12916 ROSEDALE HWY. BAI{ERSFIELD, CA 93312 Reason for Submitting this Form (Check One) D Change of Designated Operator Facility Phone #: 661-589-0988 ^ Update ICC # and/or Expiration Date Designated UST Operator(s) for this Facility Prima O tional) Designated Operator's Name: John Ablakat Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician ~ Third-Party International Code Council Certification #: 5279288-UC Expiration Date: 03/09/2008 ALTERNATE 1 (Optional) Designated Operator's Name: Tony Mansour Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician ©Third-Party International Code Council Certification #: 5269136-UC Expiration Date: 11/17/2007 ALTERNATE 2 (Optional) Designated Operator's Name: Sarkiss Z,oumalan Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician ®Third-Party International Code Council Certification #: 5238439-UC Expiration Date: 07/09/2008 I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2/7'1~5~(jc) - (fl. Furthermore, I understand and am in complian i~h the rdquir dents (statutes, regulations, and local ordinances) applicable undergro~d sage tanks. NAME OF TANK OWNER (Please Print): SIGNATURE OF TANK OWNER: DATE: 2/15/2007 OWNER'S PHONE #: (253) 796-7170 November 2004 Qwner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements -continued ALTERNATE 3 (Optional) Designated Operator's Name: Kevin Watermolen Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 916-212-7973 ^ Service Technician x^ Third-Party International Code Council Certification #: 5250470-UC Expiration Date: 12-21-2008 AI,TF.RNATF. 4 (nntinnall Designated Operator's Name: Jessica Tuttle Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 831-537-7663 ^ Service Technician ~ Third-Party International Code Council Certification #: 5286530-UC Expiration Date: 07-03-2008 ALTERNATE 5 (Optional) Designated Operator's Naine: Jim Palmer Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 831-840-5235 ^ Service Technician (] Third-Party International Code Council Certification #: 5254109-UC Expiration Date: 2-21-2007 ALTERNATE 6 (Optional) Designated Operator's Name: Brian Ellsworth Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 707-815-2511 ^ Service Technician x^ Third-Party International Code Council Certification #: 5263224-UC Expiration Date: 7-7-2007 ALTERNATE 7 (Optional) Designated Operator's Name: Aaron Celaya Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 510-364-0385 ^ Service Technician D Third-Party International Code Council Certification #: 5246905-UC Expiration Date: 01-20-2007 ALTERNATE 8 (Optional) Designated Operator's Name: Darrell Riley Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 619-206-8379 ^ Service Technician ^D Third-Party International Code Council Certification #: 5248975-UC Expiration Date: 11-29-2008 ALTERNATE 9 (Optional) Designated Operator's Name: Darren Austin Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 858-699-2751 ^ Service Technician ^D Third-Party International Code Council Certification #: 5250436-UC Expiration Dater 1 1-11-2008 ALTERNATE 10 (Optional) Designated Operator's Name: Eric Banghart Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 310-467-2529 ^ Service Technician x^ Third-Party International Code Council Certification #: 5250118-UC Expiration Date: 11-9-2008 ALTERNATE ll (Optional) Designated Operator's Name: Blake Herness Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 951-288-1519 ^ Service Technician ^D Third-Party International Code Council Certification #: 5249180-UC Expiration Date: 12-12-2008 .. ,: February 15, 2007 BAKERSFIELD FIRE DEPARTMENT 900 TRUXTUN AVENUE, SUITE 210 BAKERSFIELD, CA 93301 RE: Statement of Compliance and Designated Operator Dear Sir or Madam: Gilbarco/Veeder-Root, acting as the authorized agent of Safeway/Vons is submitting on behalf of the company, the attached Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of Compliance with UST Regulations for the subject fuel facility to register this site and Designated Operators with the county. The owner understands that with the submission of this document, Gilbarco/Veeder-Root is stating, on behalf of Safeway/Vons that each location is in compliance with all applicable UST regulations. Further, as specified in regulations Title 23, Section 2715 (c)-(f J, the individuals listed as designated operators for the location will complete and document a monthly inspection to be maintained in accordance with the applicable requirements. Each statement of compliance being submitted herein is based on: (1) Gilbarco/Veeder- Root reasonable and good faith review of facility operations to evaluate compliance with applicable UST regulations, as well as information provided by facility operations as of the date the statement of compliance is made, and (2) Gilbarco/Veeder-Root's understanding of the applicable UST regulations and requirements as of the date the statement of compliance is made. Should you have any questions or require further information please do not hesitate to contact me at (303) 986-8011. Sincerely, ~~~~ Sherry Peczka Designated Operator Program Manager Gilbarco/Veeder-Root Enclosures