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Home My WebLink AboutBUSINESS PLAN (3)if-7-ELEVEN 17721 ~ 3601 STOCKDALE HWY + 7-ELEVEN 2125-17721 _________________________________ SiteID: 015-021-000817 + Manager Location: 3601 STOCKDALE HWY City BAKERSFIELD CommCode: BFD STA 07 EPA Numb: BusPhone: (661) 834-3093 Map 123 CommHaz Moderate Grid: 02B FacUnits: 1 AOV: SIC Code:5541 DunnBrad:00-734-7602 Emergency Contact / Title Emergency Contact / Title TAJINDER&KULSINDER / FRANCHISEE D*~--r*~ r~Z Dqu,d L.~~ u~-/ FIELD CONSULT Business Phone: (661) 834-3093x Business Phone: (-8-88) .711-4876x3719 24-Hour Phone (800) 845-0031x 24-Hour Phone (800) 845-0031x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact ~ Shane Partridge Phone: O ~5-=2-7~72"x MailAddr: PO BOX 711 State : TX ~~'~~~"~ r ~ ~ City DALLAS Zip 75221 Owner 7-ELEVEN INC Phone: (-S~s8-)~x Address PO BOX 711 State : TX boa-~.7o --7 t fo0 City DALLAS Zip 75221 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif~d: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST ~~~. ~ o~ ~ ~~ ~~ 0 ~ Based on my inquiry of those individuals O~ ` responsible for obtaining the information, I certify ~ ~` under penalty of law that I have personally ` , /~ examined and am familiar with the information submitted and believe the information is true, acc te, and com te. /a-d~ Date Sig i r ENT'D q pR ~ ~ 20 06 t______________________________________________________________________________+ -1- 03/31/2006 ,~ - ,. ~ ~ ` UNIFIED PROGRAM INSPECTION :CHECKLIST SECTION 1: Business Plan and Inventory Program ~- Prevention-Services e r R s r, D~ 900 Tnixtun Ave., Suite 210 rFt;RE _ Bakersfield, CA-93301 v aRrM Tel.: (661) 326-3979 ~ 'Fax: (661) 872-2171 FACILITY NAME ~ ~- ~ ~~ ~~ INSP~ ION DA 23 0 NSPE TIME ADDRESS PHONE NO. NO OF E~G-~~ EES FACILITY CONTACT - BUSINE SID NUMBER 15-021- ~l'~ ^ __ Section 1: Business Plan and Inventory Program ROUTINE C[1d' OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT _ ^ RE-INSPECTION C V (c=compliance OPERATION V=Violation COMM ENTS ^ APPROPRIATE PERMIT ON HAND - ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS - ^ VERIFICATION OF QUANTITIES ~(~'~~ 'tl ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ .EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIONS ~GARDING„TH1,811NSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # Business Site /Responsible Party (Please P int) White -Prevention Services Yellow -Station Copy Pink -Business Copy ^ YES ^ NO FD 2155 (Rev. 09105 ;,,,_:. INSPECTIONS BUSINESS PLAN & INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: '~~' ~ B E R S F I L D F/IPE A/PTM T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 INSPECTION DATE: 7 ~ 3 Section 2: Underground Storage Tanks Program ^ Routine L~Combined ^ Joint Agency ^ Multi-Agency Complaint ^ Re-Inspection Type of Tank L ~ ~ Number of Tanks Type of Monitoring ~ Type of Piping ~it~ OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? ^ Yes o Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill /overspill protection? C =Compliance V =Violation Y =Yes N = No Inspector: Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services Aggregate Capacity Number of Tanks Business Site Resp ib a Party Pink -Business Copy KBF-7335 FD 2156 (Rev. 09/05) _f .. _ ~. r ,. ~\, ^ A 7-ELEVEN 17721 (STOCKDALE) Manager ~EJ~-i.c~tJ 7A/Ch~~ Location: 3601 STOCKDALE HWY City BAKERSFIELD SiteID: 015-021-000817 BusPhone: (661) 834-3093 Map 123 CommHaz Moderate Grid: 02B FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb : C ~ L Od d ~ ~ya-33 SIC Code:5541 DunnBrad:00-734-7602 Emergency Contact / Title m_e~r~ency Contact _E / Title TEJINDER TAKHAR / FRANCHISEE ~ 1~~S4~}~h ~ / ~EIELD-C-eNS-LILT Business Phone: (661) 834-3093x Business Phone: ~~~~ ta8'-c~?~~ 24-Hour Phone (800) 845-0031x 24-Hour Phone t ~dc~ ~~~-a?~~ Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact Randy Martin Phone: a 7 ~-~~70 (~ - 60x MailAddr: PO BOX 711 - State: TX~ City DALLAS Zip 75221-0711 Owner 7 -ELEVEN INC Phone : 3 7~9~~o-~7~/?O ( 7-@~') ~-9-~-~-1-~$~c Address PO BOX 711 State: TX City DALLAS Zip 75221-0711 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG U - UST Based on my inquiry ofi those individuals the informatio i r ng responsible for obtain rsonally e under pen Hof law hat I have p and' am f ~ni iar with the information true i i ~~~ , ne s exam the information submi d and be ev 0 /C ~ e acc t a ~ z 6 ~ ZQ~~ Date Signature -1- 01/24/2007 ~- ~; F 7-ELEVEN 17721 (STOCKDALE) SiteID: 015-021-000817 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION . Business Name: 7-ELEVEN 17721 (STOCKDALE) Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust : No PA Contact : ~~~~//~ - ~/~ Dsg Own/Oper ~®B~R~-23~-E~E-~d~~`3n~ YYtpp(2~ I~/3- 1~ ICC Nbr: ~~~ 13 rT~ D37L~D~i1~T_V nr„rnT~D INFORMATION Name Address: City Type CORPORATION Name -~T~,. Address: City Type CORPORATION 7-Eleven, Inc. Gasoline Acctg. P. O. Box 711 gate Dallas, TX 75221-0711 7-Eleven, Inc. Gasoline Acctg. P. O. Box 711 tate Dallas, TX 75221-0711 Phone : (-~8~8 } - 9 asa ~ ~~~- ~~ ~~ Zip. RMATION Phone: - 9 X53 - 7cllo - 7/ 7C7 Zip: BOE UST Fee# 31896 Financ'1 Resp: INSURANCE Legal Notif ~ ^ , _, . _ Date:03/28/2006 Phone: (~) ~~---~, Name: ~'RandyMartin Ttl:GASOLINE & ENVIRON COMPLAINCE MGR State UST # ~ --_ 1998 Upg Cert#: 0078T -2- _ 01/24/2007 '.' ~ Tj t. Q, F 7-ELEVEN 17721 (STOCKDALE) SiteID: 015-021-000817 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod UNLEADED PLUS GASOLINE F IH DH L 10000.00 GAL Mod SUPER UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod WASTE FLAMMABLE LIQUIDS/SOLVENT F DH L 55.00 GAL UnR WASTE ABSORBENT F IH S 55.00 GAL UnR -3- 01/24/2007 -4- 01/24/2007 F 7-ELEVEN 17721 (STOCKDALE) SiteID: 015-021-000817 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 7500.00 GAL HALARllUUS CUMPON~N7S ~Wt. RS CAS# 100.00 Gasoline No 8006619 tYF1GHKL H~J~J51~1~1V 1 7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME UNLEADED PLUS GASOLINE Location within this Facility Unit UNDERGROUND FRONT PARKING STATE TYPE PRESSURE Liquid TMixture~ Ambient Facility Unit: Fixed Containers on Site ~ Days On ,Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE ~~ CONTAINER TYPE Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 7500.00 GAL HAZARDOUS COMPONENTS °sWt. RS CAS# 100.00 Gasoline No 8006619 nr~arircL ti~ ~~~ain~lvl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 01/24/2007 ~ F 7-ELEVEN 17721 (STOCKDALE) SiteID: 015-021-000817 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME SUPER UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING ~ CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient ~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 7500.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Gasoline No 8006619 riAGHKL HJ JL' J ~1~1~1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ COMMON NAME j CHEMICAL NAME WASTE FLAMMABLE LIQUIDS/SOLVENT Days On Site 365 Location within this Facility Unit Map: Grid: NEAR TRASH ENCLOSURE CAS# STATE TYPE PRESSURE TEMPERATURE Liquid TWaste ~ Ambient ~ Ambient CONTAINER TYPE _ DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum ..Daily Average 55.00 GAL 55.00 GAL 25.00 GAL nt~~tstcLUU~ ~.ut~irvlv~ivta oWt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No nH.Gt1tCL s-i~ a~a~ri~ly-lam TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA ~USDOT# MCP No No No No/ Curies F DH / / / UnR -6- 01/24/2007 F 7-ELEVEN 17721 (STOCKDALE) SiteID: 015-021-000817 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE ABSORBENT Days On Site 365 Location within this Facility Unit Map: Grid: NEAR TRASH ENCLOSURE CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Solid Waste Ambient Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GAL HAZARDOUS COMPONENTS °sWt . RS CAS# HAZARD A SSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ ~ Curies F IH / / / UnR -7- 01/24/2007 :(- F 7-ELEVEN 17721 (STOCKDALE) SiteID: 015-021-000817 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 05/20/1999 CALL 11. AFTER CALL 911, THE BAKERSFIELD CITY FIRE DEPT WILL BE NOTIFIED ALONG WITH THE CALIFORNIA STATE OFFICE OF EMERGENCY SERVICES 800-852-7550. Employee Notif./Evacuation STS--9E-3- ~,. = 04/25/2006 PT HAZMAT AND THE STORE ATTENDANT WILL NOTIFY OTHER EMPLOYEES AND CUSTOMERS BY A SHOUT THAT THE BLDG MUST BE EVACUATED. ALL PERSONS MUST EVACUATE THROUGH THE FRONT DOORS TO THE EVACUATION STAGING AREA SHOWN ON THE FACILITY DIAGRAM. Public Notif./Evacuation 05/20/1999 THE "STORE ATTENDANT WILL NOTIFY OTHER EMPLOYEES AND CUSTOMERS BY A SHOUT THAT THE BLDG MUST BE EVACUATED. ALL PERSONS MUST EVACUATE THROUGH THE FRONT DOORS TO THE EVACUATION STAGING AREA SHOWN ON THE FACILITY DIAGRAM. Emergency Medical Plan 04/25/2006 POLICE AND FIRE DEPT 911. NEAREST ER IS TO BE USED IN THE EVENT OF INJURY. -8- 01/24/2007 +' F 7-ELEVEN 17721 (STOCKDALE) SiteID: 015-021-000817 ~ Fast Format ~ ~;l~iitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 04/25/2006 ~ n~ v-~cuiT~OFFS, 1 EMERGENCY FUEL SHUT-OFF SWITCHES ARE LOCATED IN THE FRONT OF THE STORE AND-~ NEAR THE STORE COUNTER. THE UNDERGROUND STORAGE TANKS ARE EQUIPPED WITH OVERFILL/OVERSPILL P N. TANK FLUID LEVELS AND INTERSTITIAL SPACE ARE MO BY A MS 3500 MONITORING SYSTEM. TANK TURBINES ARE EQUIPPED ITH LEAK DETECTORS WHICH RESTRICT FLOW IF A LEAK IS DETECTED BENEATH DISPENSERS OR ALONG PIPING RUNS. Release Containment ~ 04/25/2006 D ASOLINE STATION SAFETY FEATURES FOR GAS PUM~A~T-T-9-3~U - VAPOR SHIELDS . SHEER-OF A~~'~ . gI~~S-S-LD~ ES PROPERLY STORED IN SMALL SAFETY CONTAINER W-I-'Fi~P PER FITTINGS . BUS ESB--EI~RGFNCY PLAN ON FILE AT EACH -'FOR . _ KITTY LITTER, LOCATED INSIDE THE STORE AT THE LOCATION SHOWN ON THE FACILITY DIAGRAM, IS TO BE USED FOR SMALL FUEL SPILLS (LESS THAN 5 GAL). THE BAKERSFIELD FIRE DEPT WILL RESPOND TO LARGER FUEL RELEASES BY PLACING SAND OR ABSORBENT ON THE SPILL. Clean Up 01/25/1996 Other Resource Activation -9- 01/24/2007 -ONCE A SPILL HAS BEEN CONTAINED, THE SAND OR ABSORBENT WILL BE CHARACTERIZED AND DISPOSED OF AT A PROPER DISPOSAL FACILITY. ~, i - y F 7-ELEVEN 17721 (STOCKDALE) SiteID: 015-021-000817 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~JCL 1011 I1dG ClL U.y' Utility Shut-Offs 01/07/1990 A) GAS - NONE B) ELECTRICAL - BACK ROOM HALLWAY C) WATER - STORE FRONT SIDE D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec.jAvail. Water 10/04/2006 - FIRE EXTINGUISHER IN STORE PER FIRE CODE.. ~~~~~~~~ Building Occupancy Level 03/31/2006 7 EMPLOYEES -10- 01/24/2007 ., j -; F 7-ELEVEN 17721 (STOCKDALE) SiteID: 015-021-000817 ~ ` Fast Format ~ ~ 'T'raining Overall Site ~ Employee Training 04/25/2006 ~ MATERIAL SAFET~'~.DATA SHEETS ON BRIEF SUNIl~IARY OF T i~TG.. PROGRAM: SEE HAZ S'~ATERIALS HANDLING PROCEDURES NG AND EMPL~EE AW~N'E' S FAO ~ ~ MSDS SHEETS ON FILE BEHIND STORE COUNTER. BRIEF STJNIMARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED ON THE OPERATION OF THE UST IN A MANNER CONSISTENT WITH BEST MANAGEMENT PRACTICES, EMERGENCY CONTACT INFORMATION, SPILL/OVERFILL RESPONSE PROCEDURES, HAZ WASTE PROCEDURES, MONITORING EQUIPMENT OPERATION AND ALARM RESPONSE PROCEDURES. TRAINING IS CONDUCTED ANNUALLY, OR WITHIN 30 DAYS FOR NEW EMPLOYEES, BY THE DESIGNATED OPERATOR. rieiu Lei ruuute use nCiu tVi ru~.uLC VAC ti -11- 01/24/2007 - _- ~ ,r' STOCKDALE FAMILY DENTISTRY Manager ~QC • Ecrc Sic,,\\ '(~•~ QS Location: 3615 STOCKDALE HWY 2 City BAKERSFIELD CommCode: BFD STA 03 EPA Numb: ~~ SiteID: 015-021-000479 BusPhone: (661) 832-0895 Map 102 CommHaz Minimal Grid: 35D FaCUnits: 1 AOV: SIC Code:8021 DunnBrad: Emergency Contact / Title Emergency Contact / Title ERIC S SMALL DDS / OWNER / Business Phone: (661) 832-0895x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact ERIC S SMALL DDS Phone: (661) 832-0895x MailAddr: 3615 STOCKDALE HWY 2 State: CA City BAKERSFIELD Zip 93309 , Owner ERIC S SMALL DDS Phone: (661) 832-0895x Address 3615 STOCKDALE HWY 2 State: CA City BAKERSFIELD Zip 93309 Period to Preparers Certif' d: ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN C3ased on my inquiry of those individuals responsible for obtaining the information, 1 certify under penalty of law that 1 have personally examined and am familiar with the information sub ' t~'.and believe the information is true, rate, and complete. , i ~, ~%~ , ~'' Signature - ~ Date TotalASTs: _ TotalUSTs: _ RSs: No Ik~~`~ ENTD ~ ~ ~ ~ ~ ~~~~ Gal Gal ° ~ Office Hours By Appointment ° STOCKDALE FAMILY DENTISTRY ERIC S. SMALL, D.D.S. _ ~' ,~ 3615 Stockdale Hwy., Ste. 2 ~ ° Bakersfield, CA 93309 `Tel: (661) 832-0895 ~ `" . ~ Fax: (661) 832-8462 ~„ a,.~ `~~.. °~ , .. ~.. _ , -1- 02/16/2007 ~r F STOCKDALE FAMILY DENTISTRY ~ Hazmat Inventory MCP+DailyMax Order = SiteID: 015-021-000479 ~ By Facility Unit ~ Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER R L 5.00 GAL Min -2- o2J16/2o07 -3- 02/16/2007 F STOCKDALE FAMILY DENTISTRY SiteID: 015-021-000479 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: DARKROOM CAS# Liquid TWaste ~ Ambient~E ~ AmbientT~E ~ PLASTOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# Silver No 7440224 111iGL-iCCL Hw 7~7P~Jw71~1L'1V1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/16/2007 P STOCKDALE FAMILY DENTISTRY SiteID: 015-021-000479 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification Employee Notif./Evacuation ,~ tU1J1ll: 1V 1.l 1..11. ~ I.:+V 0.l~U0.1.1 V11 P~lllCly Clll:y 1.1C U1C:d1 t'1d11 -5- 02/16/2007 F STOCKDALE FAMILY DENTISTRY SiteID: 015-021-000479 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention - i.~~i Release Containment ~~Clean Up ~p~\oco~ t ~ P\o~c.~ V 1.11C i. iCC~UUiC.:C HC: l.1Vdl.1 Ui1 -6- 02/16/2007 ,, _ ~. F STOGKDALE FAMILY DENTISTRY SiteID: 015-021-000479 ~ Fast Format ~ ~ite Emergency Factors Overall Site ~ iJ~JCU1d1 ridGdLU.y' ~ n p~ . O ~~'~~ c ~ c~ n ~c`~.1 = Fire Protec./Avail. Water ii ~~ ~~~~n cc~~ ~ c~ ~ (J C ~ c ~ h~ aco..~~ ~e.x~ ~- o b\oc~~ w~. c~c.c~ ~ s WO.~~ 5~..~- C7~~ ~~n COr~pc eSSor ~o~~ ~ 1pct~k a ~ ~~~~~ oh ~r~~- w~sk S,dc v~ -~h~ c©on~. ~:~ apprvx . ~ -~-~ = Building Occupancy Level 31 ~oP~~ o ccu.~~~~ -7- 02/16/2007 i~ _ ~, // F STOCKDALE FAMILY DENTISTRY SiteID: 015-021-000479 ~ Fast Format a -- - -- 'raining Overall Site ~ Employee Training' C''~C~-t1-4~o.,~ ~ ~ ~~e~c~ ~ R S~C..~- c v n -~~ r S~ ec ;~ ~ Zc~ ~-~`~~ ~~©~oco~ ; ~ p~c~c~. ruyC ~ Held for Future Use . 1 J L . nc.~u ivi L-u~..ui.c vac -8- 02/16/2007 `~ UNIFIED PROGRi4M INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACIt.ITY NAME INS ECT N D INSPECTION TIME ^^. ADDR SS ( ( [~ r-( ~'~(~~ PHONE No. Na. of Employees FACIIITYCONTACT Business ID Number 15-021- Section 1: Business Plan and Inventory Pn~gram ®Routine ombined ^ Joint Agency ^Mnlti-Agency ^ Complaint ^ Re-inspection ,,C,, /~ C V=Viotationnce) OPERA'f ION LY/ ® APPROPRIATE PERMIT ON HAND ^ BUSINESS PLAN CONTACT INFORMATION' ACCURATE COMMENTS ^ VISIBLE ADDRESS Ld' ^ CORRECT OCCUPANCY ~ ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION (~^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITYE -----J-- -------- -----------~------- --..------..-----....__..__ ___..._._~.---------._..-- _.__...._...__ ----------__ ----- -- --- -- ------ L7 ^ VERIFICATION OF HAT MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES I!1 ^ EMERGENCY PROCEDURES ADEQUATE ~^ CONTAINERS PROPERLY LABELED -J-- ------ --- - - . - -------- --- -- -- - ---- U ^ HOUSEKEEPING ---f----------------------------------- -----~.----- ----------..._...._----- -------------------- -------_._._..----.. LJ ^ FIRE PROTECTION ~'9 ^ SITE DIAGRAM ADEQUATE $c ON HAND ANY HAZARDOUS WASTE ON SITE: ^ YES D.PQO EXPLAIN: QUESTIONS R ARDING T IS IN PECTION? PLEASE CALL US AT ~F)G'I ~ 326-3979 ------- - - -- -- __....--- -1---------- Inspector Badge No., White -Environmental Services Yellow - Stettin Copy (~ ~ Business to Responsible Party Pink -Business Copy j1 ' _< ,~~~w~~' "~~~ CITY OF BAKERSFIELD FIRE DEPARTMENT ~~ ~ ~ ~~ OFFICE OF ENVIRONMENTAL SERVICES ~`~ y~` UNIFIED PROGRAM INSPECTION CHECKLIST ~w ~gti,,~'~ 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~ ` ~ ~ INSPECTION DATE t~ ~ Section 2: Underground Storage Tanks Program ^ Routine ~.ombined ^ Joint Agency ^MultI-Agency ^ Complaint ^ Re-inspection Type of Tank ~ft)~ Number of Tanks 3 _ Type of Monitoring /~-1 Pn Type of Piping ~~t~ OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit tees current Certification of Financial Responsibility Monitoring record adequate and current ~ Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No \./ Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY, Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? [f yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: Oftice of Environmental Services (805) 326-3979 White - F.nv. Svcs. Pink -Business Copy ~~ s~ Busine Site Responsible Party -ti UNIFIED PROGRAM INSPECTION CHECKLIST ~' ,,;,~ .SECTION 1: Business Plan and Invenrtory Program ~' BAKERSFIELD FIRE DEPT Prevention Services , 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME ~ ~~ ~ A ~ /' (_ ~~ ~ _ ~ /Q1` Off) lV1 /-C~/JU,~6, i',~n/ NSPE©I ~D ~ ~ II `J INSPECTION TIME ADDRESS ~_ ~© S~~c t~~ - NO NE N ~~c -3~ ~ ~ O OF EMPLOYEES FACILITY CONTACT `~ ~/ USINESS ID NUMB;.S'OZ~ ~ 1 Q ~ [.. 1 Section 1: Business Plan and Inventory Program ~ ~~ ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (~=Compliances OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND BUSItII?SS PLAN CONTACT INFORMATION ACCURATE ~~ O" T ®r9 "~ ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ J L7 ^ PROPER SEGREGATION OF MATERIAL ---------------------------- ------_ -- VERIFICATION OF MSDS AVAILABILITY ----__ _---- __...._...._..._---------_ __~~.- - -- ------ - ----_--------- ~ ~~ ^ VERIFICATION OF HAZ MAT TRAINING / O ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROC DURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION CCr3' ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITE? YES C~f NO EXPLAIN: - _ /// ~~~~ _ REGARDII~IG CIS INSPECTION? PLEASE CALL U8 AT (881) 328-3979 (Please Print) Fire Prevention / t" In /Shift of Sife/Station 1/ t~~ Business Site/School Site Responsible Party (Please Print) White -Prevention Services Yellow - Station Copy Pink -Business Copy FD2048 (Rw. ~JOS} ,~ ~ INSPECTIONS BUSINESS PLAN & INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST • H D E R S F I L D F/IitE ARTM r BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 FACILITY NAME: 1 ° ( I Section 2: Underground Storage Tanks Program INSPECTION DATE: f©~ OCR ^ Routine Combined ^ ~ oint gency ^ Multi-Agency ^ Complaint ^ Re-Inspection Type of Tank L ~ p Number of Tanks Type of Monitoring ~I^~ Type of Piping ~«)~ OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? O Yes o Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank Aggregate Capacity Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill /overspill protection? C =Compliance V =Violation Y =Yes N = No r' Inspector: Questions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party White -Prevention Services Pink -Business Copy 335 /~~~ FD 2156 (Rev. 09/05) ~~W Ta/'I/CI'f0/OC~j/ 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 07/25/2007 Order Number: 3153867 Dear Regulator, Date Printed and Mailed: 07/31/2007 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #17721, MKT 2133 3601 STOCKDALE HIGHWAY BAKERSFIELD, CA. 93309 Testing performed: Leak detector tests Line tests Monitor Certification Sincerely, Dawn Kohlmeyer Manager, Field Reporting ~n TANKNOLOGY CERTIFICATE OF TESTING 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 TELEPHONE (512) 451-6334 FAX (512) 459-1459 PURPOSE: COMPLIANCE TEST RESULT SUMMARY REPORT TEST DATE: 07/25/07 WORK ORDER NUMBER: 3153867 CUSTOMER PO: CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #17721, MKT 2133 P.O. BOX 711 3601 STOCKDALE HIGHWAY DALLAS, TX 75221 BAKERSFIELD, CA 93309 Manager (972)828-7908 (661)834-3093 TEST TYPE: TLD-1 Product Pi a Ti htness Test Results IMPACT LINE LINE LINE DELIVERY TEST RESULT FINAL LEAK RATE (gph) VALVE ID PRODUCT MATERIAL TYPE A B C D A B C D FUfJCTlO SOIITH 1 RSGIILAR DW FLEX PRESSURE P 0.000 Y NORTH 2 REGIILAR DW FLEX PRESSURE P 0.000 Y 3 3 PREMIUM FLEX PRESSURE P 0.000 Y Existine Line Leak Detector Test EXISTING LEAK DETECTOR 1 EXI G LEAK`DETECTOR 2 LINE ID MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # RESULT SOIITH 1 RED JACKET FX1V 02051899 P NORTH 2 VAPORLESS LD2000 04041224 P 3 3 VAPORLESS LD2000 04041227 P Now Ronlaromonl 1 ino I oaf rlo4ortnr To~4 REP LA ED LEAK DETE T R #'1 R7` LA D LEAK DET E T R #2 LINE MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # RESUL ID run uw„cr uciancu repun mrurrnauun, vrsn www.ramcnmogy.com ana select vn-r.me rcepons-wxnr, or conracL your local ranKnoiogy ounce. Tester Name: PATRICK M PFRANG Technician Certification Number:1590 ~~ Printed 07/31/2007 08:21 ACRAMER INDIVIDUAL TANK INFORMATION AND TEST RESULTS i Tan TEST DATE:07/25/07 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3153867 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #17721, MKT 2133 TANK IFEFCIRMATION Tank ID: souTx i Tank manifolded: No Bottom to top fill in inches: 128.0 PfOdUCt: REGIILAR Vent manifolded: No Bottom to grade in inches: 134. o Capacity in gallons: 9, 653 Vapor recovery manifolded: YES Fill pipe length in inches: 32 . o Diameter in inches: 96.00 Overfill protection: YES Fill pipe diameter in inches: 4. o Length in inches: 323 Overspill protection: YES Stage I vapor recovery: DUAL Material: STEEL Installed: ATG and CP Stage II vapor recovery: sALANCE CP installed on: / / COMMENTS TANK TEST>REStJLTS Test Method: VacuTect LEAK DETECTOR TEST RESULTS Test method: FTa Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: REn JACKET Ingress Detected: water Bubble Ullage Model: Fxly Test time: S/N: ozosies9 Open time in sec: 4.00 Inclinometer reading: Holding psi: is VacuTect Test Type: NoT Resiliency cc: 9o xoT VacuTect Probe Entry Point: T ESTED Test leak rate ml/m: 1s9. o TESTED Pressure Set Point: Metering psi: s Tank water level in inches: Calib. leak in gph: a . 00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type: TLD-i LINE A B C D Material: Dw FLEX Diameter (in): i. 5 Length (ft): 25.0 Test psi: 50 Bleedback cc: o Test time (min): 6o xoT NoT NoT Start time: 09:22 TESTED TESTED TESTED End time: 10:22 Final gph: 0.000 Result: PASS Pump type: PRESSURE Pump make: RED JACKET COMMENTS Impact Valves Operational: YES Printed 07/31/2007 08:21 INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tan TEST DATE:07/25/07 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3153867 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #17721, MKT 2133 TAN K'1NFORMATION Tank ID: NoRTx 2 Tank manifolded: No Bottom to top fill in inches: 126. o PfOdUCt: REGULAR Vent manifolded: No Bottom to grade in inches: 132. o Capacity in gallons: 9, 599 Vapor recovery manifolded: YES Fill pipe length in inches: 30. o Diameter in inches: 96 . oo Overfill protection: YES Fill pipe diameter in inches: 4. o Length in inches: 323 Overspill protection: YES Stage i vapor recovery: DUAL Material: sTEEL Installed: ATG and CP Stage II vapor recovery: sALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Test Method:VacuTect LEAK DETECTOR TEST RESULTS Test method: FTA Start (in) End (in) Dipped Water Level: New/passed Failed/replaced Newlpassed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: vApoRLESs Ingress Detected: water Bubble Ullage Model: LD2ooo Test time: S/N: o+osias4 Open time in sec: s. 00 Inclinometer reading: Holding psi: 20 VacuTect Test Type: NoT Resiliency cc: llo xoT VacuTect Probe Entry Point: TESTED Test leak rate ml/m: 1s9. o TESTED Pressure Set Point: Metering psi: 14 Tank water level in inches: Calib. leak in gph: s . 00 Water table depth in inches: Results: pass Determined by (method): Result: COMMENTS COMMENTS LINE TEST,RESULTS Test type: T~-i LINE A B C D Material: Dw FLEX Diameter (in): 1.5 Length (ft): 35.0 Test psi: 50 Bleedback cc: o Test time (min): 6o NOT NOT NOT Start time: 09:22 TESTED TESTED TESTED End time: 10:22 Final gph: 0.000 Result: PASS Pump type: PRESSURE Pump make: RED JACKET COMMENTS Impact Valves Operational: YES Printed 07/31/2007 08:21 INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tan TEST DATE:07/25/07 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3153867 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #17721, MKT 2133 TANK INF042MATtON Tank ID: 3 3 Tank manifolded: No Bottom to top fill in inches: 126. o Product: PREMIUM Vent manifolded: No Bottom to grade in inches: 132. o Capacity in gallons: 9, 582 Vapor recovery manifolded: YES Fill pipe length in inches: 30. o Diameter in inches: 96. oo Overfill protection: YES Fill pipe diameter in inches: 4 • o Length in inches: 323 Overspill protection: YES Stage I vapor recovery: DUAL Material: LINED Installed: ATC and cP Stage II vapor recovery: sALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Test Method:vacuTect LEAK DETECTOR TEST RESULTS rest method: FTa Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: vAPORLSSs Ingress Detected: Water Bubble Ullage Model: LD2ooo Test time: S/N: o+o+~~~~ Open time in sec: z.oo Inclinometer reading: Holding psi: 20 VacuTect Test Type: NOT Resiliency cc: 75 NoT VacuTect Probe Entry Point: T ESTED Test leak rate ml/m: 1s9. o TESTED Pressure Set Point: Metering psi: 16 Tank water level in inches: Calib. leak in gph: 3.00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type: Tr.D-i LINE A B C D Material: FLEX FLEX Diameter (in): 2.0 2 . o Length (ft): 25.0 35.0 Test psi: 50 Bleedback cc: o Test time (min): 6o NOT NOT NOT Start time: 09:22 TESTED TESTED TESTED End time: 10:22 Final gph: o.ooo Result: PASS Pump type: PRESSURE Pump make: RED JACKET COMMENTS Impact Valves Operational: YES Printed 07/31/2007 08:21 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of Califomia Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3 Title 23, Califomia Code of Regulations This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: 7-ELEVEN #17721, MKT 2133 Site Address: 3601 STOCKDALE HIGHWAY City: BAKERSFIELD CA Zip: 93309 Facility Contact Person: Manager Make/Model of Monitoring System:TLS-350 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced Contact Phone No: 834-3093 Date of Testing/Service: 07/25/2007 Work Order Number: 3153867 Tank ID: T-1 RUL 1 Tank ID: T-2 RUL 2 X In-Tank Gauging Probe. Model: MAG X In-Tank Gauging Probe. Model: MAG Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: X Piping Sumplfrench Sensor(s). Model: 208 Piping SumplTrench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: X Mechanical Line Leak Detector. Model: FX1 V X Mechanical Line Leak Detector. Model: FX1 V Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: ~( Tank Overfill/High-Level Sensor. Model: FLAPPER Tank Ove~ll/High-Level Sensor. Model: FLAPPER Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). TanklD: TanklD: In-Tank Gauging Probe. Model: In-Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: Piping Sump/french Sensor(s). Model: Piping Sump/Trench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill/High-Level Sensor. Model: Tank Overfill/High-Level Sensor. Model: Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). Ispenser 1/4 Dispenser ID: Dispenser Containment Sensor(s) Model: 208 Dispenser Containment Sensor(s) Model: X~ Shear Valve(s). Shear Valve(s) Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). * If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this certification is information (e.g manufacturers' checklists) necessary to verify that this information is correct. and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): ^X System set-up X^ Alarm history report Technician Name (print): PATRICK M PFRANG Certification No.: A29052 ~~~%~~ Signature: License. No.: Testing Company Name:Tanknology Phone No.: (800) 800-4633 Site Address: 8501 N. MoPac Expressway, suite 400, Austin, TX 78759 Date of Testing/Servicing: 07/25/2007 Page 1 of 3 Based on CA form dated 03/01 Monitoring System Certification Monitoring System Certification Site Address: 3601 STOCKDALE HIGHWAY Date of Testing/Service: 07/25/2007 D. Results of Testing/Servicing Software Version Installed: 1 19.05 Complete the following checklist: x Yes No • Is the audible alarm operational? Q Yes ~ No * Is the visual alarm operational? ^x Yes No • Were all sensors visually inspected, functionally tested, and confirmed operational? Yes ^ No Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? X Yes ~ No * N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? Q Yes ~ No • ~ N/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (check all that apply) ^x Sump/Trench Sensors; ^x Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks apd sensor failure/disconnection? ^X Yes ^ No Yes ~ No * ~ N/q For tank systems that utilize the monitoring system as the primary tank overfill waming device (i.e.: no mechanical overfill prevention valve is installed), is the overfill waming alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? Yes' Q No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. ~x Yes' ~ No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) ^ Product; ^ Water. -f yes, describe causes in Section E, below. ~x Yes ~ No * Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. ^x Yes ~ No * Is all monitoring equipment operational per manufacturers' specifications? * In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: External overfill alarm is not working. Jbox cover missing face plate. Site has flapper valves and ball floats for overfill protection. Page 2 of 3 Based on CA form dated 03/01 Monitoring System Certification Site Address: 3601 STOCKDALE HIGHWAY Date of Testing/Service: 07/25/2007 F. In-Tank Gauging /SIR Equipment Check this box if tank gauging is used only for inventory control. ^ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: Yes ^ No' Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes ^ No * Were all tank gauging probes visually inspected for damage and residue buildup? Yes ^No' Was accuracy of system product level readings tested? Yes ^No' Was accuracy of system water level readings tested? X Yes ^No' Were all probes reinstalled properly? Q Yes ^No' Were all items on the equipment manufacturers' maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD) : ^ Check this box if LLDs are not installed. Complete the following checklist: Yes ^ No' ^N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? Check all that apply) Simulated leak rate: 0 3 g.p.h ^ 0.1 g.p.h ^0.2 g.p.h X Yes ^ No' Were all LLDs confirmed operational and accurate within regulatory requirements? X Yes ^ No' Was the testing apparatus properly calibrated? ^X Yes ^ No' ^ N/q For mechanical LLDs, does the LLD restrict product flow if it detects a leak? Yes ^No' Q NIA For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ^ Yes ^No' Q N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ^Yes ^No' ~ N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ^ Yes ^No' ^X N/A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes ^No' Were all items on the equipment manufacturers' maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 Based on CA form dated 03/01 SITE DIAGRAM i Tankr>lo,~ogy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 07 / 2 5 / 07 WORK ORDER NUMBER3153 867 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #17721, MKT 2133 • ~ ~ Direct Bury FillNapor Buckets 0 jTO T>O T /\ /~ '~ 1 4 3 O O ~ o L2 REG REG ~ ~ ~ STP L4 STP L3 n a D v -~ ~p N 2 1 ESO L1 STP A OO PREM 10 CP L5 ~Q VENTS Ove ill Alarm Printed 07/31/2007 08:21 ACRAMER `ATG Information WorkOrder# 3153867 150301 JUL 25, 2007 11:10 AM # 1:235067 7-11 17721 150302 JUL 25, 2007 11:10 AM # 2:3601 STOCKDALE HWY 150303 JUL 25, 2007 11:10 AM # 3:BAKERSFIELD,CA 150304 JUL 25, 2007 11:10 AM # 4:80749954505001 151700 JUL 25, 2007 11:10 AM SYSTEM TYPE AND LANGUAGE FLAG SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE/TIME FORMAT MON DD YYW HH:MM:SS xM ISOF00 JUL 25, 2007 11:10 AM MON DD YYW HH:MM:SS xM 110200 JUL 25, 2007 11:10 AM 235067 7-11 17721 3601 STOCKDALE HWY BAKERSFIELD,CA 80749954505001 SYSTEM CONFIGURATION SLOT BOARD TYPE 1 4 PROBE / G.T. 2 UNUSED 3 INTERSTITIAL BD 4 UNUSED 5 UNUSED 6 UNUSED 7 UNUSED 8 UNUSED 9 RELAY BOARD 10 UNUSED 11 UNUSED 12 UNUSED 13 UNUSED 14 UNUSED 15 UNUSED 16 UNUSED COMM 1 ELEC DISP INT. COMM 2 ELEC DISP INT. COMM 3 SERIAL SAT B COMM 4 UNUSED POWER ON RESET CURRENT 162778 161891 7848849 4412846 200209 199682 7832747 4407817 7829606 4396756 7828350 4401721 7821398 4395584 7818760 4397011 15005 14962 7829079 4402786 7835842 4393451 7830084 4390127 7819845 4392087 7818400 4400570 7825750 4396286 7625603 4397437 100618 100044 100446 100311 D 482382 481428 7837580 4393707 3153867 `ATG Information Work Order# 3153867 COMM 5 UNUSED 7819907 4384096 COMM 6 UNUSED 7816662 4380707 0 Iso100 JUL 25, 2007 11:10 AM TANK CONFIGURATION DEVICE LABEL CONFIGURED 1 REGULAR UL TANK 1 ON 2 REGULAR UL TANK 2 ON 3 PREMIUM ON 4 OFF 160200 JUL 25, 2007 11:10 AM TANK PRODUCT LABEL TANK PRODUCT LABEL 1 REGULAR UL TANK 1 2 REGULAR UL TANK 2 3 PREMIUM 4 160300 JUL 25, 2007 11:10 AM TANK PRODUCT CODE TANK PRODUCT LABEL 1 REGULAR UL TANK 1 1 2 REGULAR UL TANK 2 2 3 PREMIUM 3 4 4 160400 JUL 25, 2007 11:11 AM TANK FULL VOLUME TANK PRODUCT LABEL GALLONS 1 REGULAR UL TANK 1 10020 2 REGULAR UL TANK 2 10020 3 PREMIUM 10020 4 0 160700 JUL 25, 2007 11:11 AM TANK DIAMETER TANK PRODUCT LABEL INCHES 1 REGULAR UL TANK 1 92.00 2 REGULAR UL TANK 2 92.00 3 PREMIUM 92.00 4 0.00 160900 JUL 25, 2007 11:11 AM TANK THERMAL COEFFICIENT TANK PRODUCT LABEL 1 REGULAR UL TANK 1 0.000700 2 REGULAR UL TANK 2 0.000700 3 PREMIUM 0.000700 4 0.000000 161200 JUL 25, 2007 11:11 AM 3153867 'ATG Information Work Order # 3153867 TANK MANIFOLDED PARTNERS TANK PRODUCT LABEL MANIFOLDED TANKS 1 REGULAR UL TANK 1 NONE 2 REGULAR UL TANK 2 NONE 3 PREMIUM NONE 4 NONE O 162100 JUL 25, 2007 11:11 AM TANK LOW PRODUCT LIMIT TANK PRODUCT LABEL GALLONS 1 REGULAR UL TANK 1 900 2 REGULAR UL TANK 2 900 3 PREMIUM 900 4 0 162200 JUL 25, 2007 11:11 AM TANK HIGH PRODUCT LIMIT TANK PRODUCT LABEL GALLONS 1 REGULAR UL TANK 1 9519 2 REGULAR UL TANK 2 9519 3 PREMIUM 9519 4 0 162300 JUL 25, 2007 11:11 AM TANK OVERFILL LEVEL LIMIT TANK PRODUCT LABEL GALLONS 1 REGULAR UL TANK 1 9018 2 REGULAR UL TANK 2 9018 3 PREMIUM 9018 4 0 162400 JUL 25, 2007 11:11 AM TANK HIGH WATER LEVEL LIMIT TANK PRODUCT LABEL INCHES 1 REGULAR UL TANK 1 2.0 2 REGULAR UL TANK 2 2.0 3 PREMIUM 2.0 162800 JUL 25, 2007 11:11 AM TANK MAXIMUM VOLUME LIMIT TANK PRODUCT LABEL GALLONS 1 REGULAR UL TANK 1 10020 2 REGULAR UL TANK 2 10020 3 PREMIUM 10020 4 0 162900 JUL 25, 2007 11:11 AM TANK DELIVERY REQUIRED LIMIT TANK PRODUCT LABEL GALLONS 1 REGULAR UL TANK 1 1503 2 REGULAR UL TANK 2 1503 3 PREMIUM 1503 4 0 3153867 'ATG Information WorkOrder# 3153867 a 170300 JUL 25, 2007 11:11 AM LIQUID TYPE SENSOR LOCATION TYPE 1 DISP PAN 1-2 TRI-STATE (SINGLE FLOAT) 2 DISP PAN 3-4 TRI-STATE (SINGLE FLOAT) 3 RUL 1 TURBINE TRI-STATE (SINGLE FLOAT) 4 RUL 2 TURBINE TRI-STATE (SINGLE FLOAT) 5 PUL TURBINE TRI-STATE (SINGLE FLOAT) 6 TRI-STATE (SINGLE FLOAT) 7 TRI-STATE (SINGLE FLOAT) 8 TRI-STATE (SINGLE FLOAT) 120600 JUL 25, 2007 11:11 AM 235067 7-11 17721 3601 STOCKDALE HWY BAKERSFIELD,CA 80749954505001 TANK ALARM HISTORY TANK 1 REGULAR UL TANK 1 HIGH WATER ALARM JUL 25, 2007 9:45 AM JUL 12, 2006 10:30 AM AUG 9, 2005 11:31 AM OVERFILL ALARM JUL 25, 2007 10:03 AM APR 12, 2007 7:47 AM MAR 23, 2007 8:27 PM LOW PRODUCT ALARM JUl 25, 2007 9:42 AM DEC 16, 2006 11:05 AM NOV 5, 2006 11:21 PM HIGH PRODUCT ALARM JUL 25, 2007 10:08 AM AUG 11, 2006 11:02 PM JUL 12, 2006 10:57 AM INVALID FUEL LEVEL JUL 25, 2007 9:41 AM DEC 16, 2006 7:12 PM NOV 5, 200611:27 PM PROBE OUT JUL 25, 2007 10:09 AM JUL 25, 2007 9:41 AM NOV 6, 2006 8:09 AM HIGH WATER WARNING JUL 25, 2007 9:45 AM JUL 12, 2006 10:30 AM AUG 9, 200511:31 AM DELIVERY NEEDED JUL 25, 2007 9:42 AM DEC 15, 200612:41 PM NOV 5, 2006 11:11 PM MAX PRODUCT ALARM JUL 25, 2007 10:08 AM JUL 12, 2006 10:57 AM LOW TEMP WARNING JUL 25, 2007 10:10 AM JUL 12, 2006 10:22 AM AUG 9, 2005 3:00 PM TANK 2 REGULAR UL TANK 2 HIGH WATER ALARM JUL 25, 2007 9:44 AM JUL 12, 2006 10:30 AM JUN 14, 2006 11:13 AM OVERFILL ALARM JUL 25, 2007 10:18 AM JUN 23, 2007 7:08 AM 3153867 ATG Information Work Order # 3153867 MAY 30, 2007 9:46 PM LOW PRODUCT ALARM JUL 25, 2007 9:40 AM FEB 22, 2007 5:51 PM NOV 5, 2006 10:33 PM HIGH PRODUCT ALARM JUL 25, 2007 10:19 AM JUN 23, 2007 7:09 AM MAY 17, 2007 3:37 PM INVALID FUEL LEVEL JUL 25, 2007 9:40 AM NOV 5, 2006 10:38 PM JUL 12, 2006 10:59 AM PROBE OUT JUL 25, 2007 10:19 AM JUL 25, 2007 9:39 AM NOV 7, 2006 11:43 AM HIGH WATER WARNING JUL 25, 2007 9:44 AM JUL 12, 200610:30 AM JUN 14, 2006 11:13 AM DELIVERY NEEDED JUL 25, 2007 9:40 AM FEB 21, 2007 5:51 PM NOV 5, 2006 10:22 PM MAX PRODUCT ALARM JUL 25, 2007 10:19 AM JUL t2, 2006 10:57 AM LOW TEMP WARNING JUL 25, 2007 10:20 AM TANK3 PREMIUM HIGH WATER ALARM JUL 25, 2007 9:39 AM JUL 12, 2006 10:32 AM AUG 9, 200511:46 AM OVERFILL ALARM JUL 25, 2007 10:23 AM NOV 19, 2006 12:49 PM JUL 12, 2006 10:52 AM LOW PRODUCT ALARM JUL 25, 2007 9:34 AM MAY 6, 2007 5:44 PM NOV 5, 2006 9:37 PM HIGH PRODUCT ALARM JUL 25, 2007 10:25 AM JUL 12, 2006 10:57 AM INVALID FUEL LEVEL JUL 25, 2007 10:26 AM JUL 25, 2007 9:36 AM NOV 5, 2006 9:36 PM PROBE OUT JUL 25, 2007 10:25 AM JUL 25, 2007 9:34 AM NOV 6, 2006 8:10 AM HIGH WATER WARNING JUL 25, 2007 9:39 AM JUL 12, 2006 10:32 AM AUG 9, 2005 11:46 AM DELIVERY NEEDED JUL 25, 2007 9:34 AM JUL 17, 2007 8:36 PM JUL 6, 2007 9:34 AM MAX PRODUCT ALARM JUl 25, 2007 10:25 AM JUL 12, 200610:57 AM LOW TEMP WARNING JUL 12, 2006 11:04 AM 130200 JUL 25, 2007 11:12 AM 235067 7-11 17721 3601 STOCKDALE HWY BAKERSFIELD,CA 80749954505001 LIQUID ALARM HISTORY REPORT 3153867 'ATG information WorkOrder# 3153867 SENSOR LOCATION 1 DISP PAN 1.2 JUL 25, 2007 8:33 AM SENSOR OUT ALARM JUL 25, 2007 8:30 AM FUEL ALARM JUL 12, 2006 1:19 PM SENSOR OUT ALARM 2 DISP PAN 3-4 JUL 25, 2007 8:33 AM SENSOR OUT ALARM JUL 25, 2007 8:29 AM FUEL ALARM JUL 12, 2006 1:19 PM SENSOR OUT ALARM 3 RUL 1 TURBINE JUL 25, 2007 8:33 AM SENSOR OUT ALARM JUL 25, 2007 8:27 AM FUEL ALARM MAY 19, 2007 8:49 PM FUEL ALARM 4 RUL 2 TURBINE JUL 25, 2007 8:33 AM SENSOR OUT ALARM JUL 25, 2007 8:28 AM FUEL ALARM JUL 12, 2006 1:19 PM SENSOR OUT ALARM 5 PUL TURBINE JUL 25, 2007 8:33 AM SENSOR OUT ALARM JUL 25, 2007 8:26 AM FUEL ALARM JUL 12, 2006 1:19 PM SENSOR OUT ALARM 3153867 UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD !LINE TESTING 1 S6989 SECONDARY CONTAINMENT TESTING (TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION s+- -+- - H B R S I D P/R! ARTS ! BAKERSFIELD FIRE DEPT. Prevention Services 1600 Truxtun Ave., Ste. 401 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 PERMIT NO. "~ ~ ~~ ^ ENHANCED LEAK DETECTION ALINE TESTING ^SB•989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST QTO PERFORM FUEL MONITORING CERTIFICATION SITE INFORMATION FACILITY 7_11 # 17721 NAME 8 PHONE NUMBER OF CONTACT PERSON 661-834-3093 ADDRESS _360.1_Stockdale.Rwy.., Bakersfield, CA 93309 _ OWNERS NAME Southland OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED 3 IS PIPING GOING TO BE TESTED? ^ YES X^ NO TANK # VOLUME CONTENTS 1 10,000 87 Octane 2 10,000 87 Octane 3 10,000 91 Octane TANK TESTING COMPANY NAME OF TESTING COMPANY Tanknolo InC. 9Y~ NAME 8 PHONE NUMBER OF CONTACT PERSON Mark Lindsey 800-666-2176 @Xt.16 MAILING ADDRESS 41785 Enterprise Circle S. Suite D Temecula, CA 92590 NAME & PHONE NUMBER OF Patrick Pfrang 512-848-4140 TESTER OR SPECIAL INSPECTOR: " CERTIFICATION #: _ - - _ - - -- DATE 8~ TIME TEST TO BE 7/25107 at 8: AM CONDUCTED: 1Ce #~ 5259475-UT TEST TLD-7, FTA METHOD R AP ANT DATE: 6/27/07 T ~ ~ O [3 .M,E~ ~ ~FM~" ~ A~i~ ViE~ APPROVED BY DATE V FD 2095 (Rev. 09/05) BILLING & PERMIT STATEMENT ate- ~ BAKERSFIELD FIRE DEPARTMENT B E R S F I D Prevention Services "" 1600 Truxtun Avenue, Suite 401 ARTM T PERMIT # TT-O~j 3 Bakersfield, CA 93301 Phone:661-326-3979 • Fax:661-852-2171 • LOCATION OF PROJECT 3(o015TOCIGD.4l_E H-WY • ~ • ~M CER.T Oj-/25/Oj 8~4M STARTING DATE O~~2J~/O~" COMPLETION DATE 0~/2.JT/~J~ PROPERTY OWNER NAME PROJECT NAME ~-Fi (_I/V ~i N 2~~~2 ADDRESS PHONE # PRO]ECTADDRESS 36015TOCICD~4l_E f-I~W`r ~Y STATE ZIP CODE • •' CONTACT NAME M.4R.IG (_I NDS ~Y ~ LICENSE # •' • TYPE OF LICENSE EXPIRATION DATE PHONE # 4DD-~v~(o-21~~ CONTRACTOR NAME T~k N iCN Ol_O~`( I N C FAX # ADDRESS 41~-85>/NT~RP1215>/ CIi2CLE 50litTH-D CITY T>/M~CI~(,l~k srATE C~k ZIP CODE 92590 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ^ ^ ^ Alarms -New & Modification (minimum charge) $280 ^ • 84 ^ 98 over 20 000 sq ft 028 x sq ft $0 ^ 84 ^ , . ^ 98 ^ Sprinklers -New & Modification (minimum charge) $280 ^ 84 • 98 ^ over 5 000 sq ft $0 028 x sq ft ^ 84 , . 98 ^ Minor Sprinkler Modification (<10 heads) $96 (inspection only) ^ 84 ^ 98 ^ Commercial Hood (New & Modification) $470 ^ 84 98 ^ Additional hood $58 ^ 84 ^ 98 ^ Spray Booth (New & Modification) $470 ^ 84 ^ 98 ^ Aboveground Storage Tank (Installation/One Inspection) $180 ^ 82 ^ Additional tank $96 ^ 82 ^ Aboveground Storage Tank (Removal/Inspection) $109 ~ 82 ^ Underground Storage Tank (Installation/Inspection) $878/tank ; 82 ^ Underground Storage Tank (Modification) $878/site . 82 ^ Underground Storage Tank (Minor Modification) $167 ^ ^ 82 ^ Underground Storage Tank (Removal) $573/tank ^ 84 ^ Oil well (Installation) $96 ^ 84 px Mandated Leak Detection (test)/Fuel Monit Cert/S6989 NOTE: $96 for each type of test/site even if scheduled at the same time $96/site CI-t~K. #402 ~~^ ^ 82 ^ Tent $96/tent ^ 84 ^ After hours inspection fee $121 ^ 84 ^ Pyrotechnic (per event, plus inspection fee of $96/hr) $96 + (5 hrs min standby fee/insp)=$576 ; 84 ^ Re-inspection/Follow-up Inspection $96/hour ^ 84 ^ Portable LPG (Propane): # Cages: $96 ^ 84 ^ Explosive Storage $266 ^ 84 ^ Copying & File Research (File Research fee $34/hr) $0.25/page ; 84 ^ Miscellaneous 84 FD2021 (Rev OS/07) 1 -ORIGINAL (TreaSUry) i -YELLOW (File) i -PINK (Customer) JOB CARD POST CARD AT JOB SITE INSPECTION RECORD-USTs ~'"`.s- B H R 8 P I D F~~a ~~er~ r BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 FACILITY NAME ~ ..~ ~ ~ 'OWNER ~~ ..1 r ~(~~• ADDRESS ~ ~~ ADDRESS ,'n 9 ~ ~ C lJ ` CITY STATE ZIP Q 3 3 0 9 CITY ~ STATE ZIP BAKERSFIELD CA PHONE NO. ~ ~ , j ' ~ PERMR N0. Ad INSTRUCTIONS: PLEASE CALL FOR AN INSPECTOR ONLY WHEN EACH GROUP OF INSPECTIONS WITH THE SAME NUMBER ARE READY. THEY WILL RUN IN CONSECUTIVE ORDER BEGINNING WITH NUMBER 1. DON T COVER WORK FOR ANY NUMBERED GROUP UNTIL ALL ITEMS IN THAT GROUP ARE SIGNED OFF BY THE PERMITTING AUTHORITY. FOLLOWING THESE INSTRUCTIONS WILL REDUCE THE NUMBER OF REQUIRED INSPECTION VISITS AND THEREFORE PREVENT ASSESSMENT OF ADDITIONAL FEES. INSPECTION DATE INSPECTOR TANKS AND BACKFILL _ _ _ __ BACKFILL OF TANK(S) SPARK TEST CERTIFICATION OR MANUFACTURES METHOD CATHODIC PROTECTION OF TANK(S) PIPING SYSTEM PIPING & RACEWAY W/COLLECTION SUMP, L~'" O ~' t CORROSION PROTECTION OF PIPING, JOINTS, FILL PIPE ELECTRICAL ISOLATION OF PIPING FROM TANK(S) CATHODIC PROTECTION SYSTEM-PIPING . DISPENSER PAN SECONDARY CONTAINMENT, OVERFILL PROTECT ION, LEAK DETECTION LINER INSTALLATION -TANK(S) LINER INSTALLATION -PIPING 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) MONITORING WELL(S)/SUMP(S) - H2O TEST LEAK DETECTION DEVICE(S) FOR VADOSE/GROUNDWATER SPILL PREVENTION BOXES FINAL MONITORING WELLS, CAPS & LOCKS FILL BOX LOCK MONITORING REQUIREMENTS TYPE AUTHORIZATION FOR FUEL DROP CONTRACTOR IeCE~S~j ~]C r15 t ©lYS CONTACT Kf)SS LICENSE NO. ~ ~`'~ /~~D ~~ ~AZ- ) PHONE NO. ~ ~ ~ '" ,~i ~.`lrrl FD 2097 (Rev. 09105) BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 02/23/2007 Order Number: 3151149 Date Printed and Mailed: 03/16/2007 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #17721 MARKET #2133 3601 STOCKDALE HIGHWAY BAKERSFIELD, CA. 93309 Testing performed: ~ 989 Turbine Sump Test Secondary Containment-Dispenser Pan\Sump Secondary Containment-Spill Container Sincerely, Dawn Kohlmeyer Manager, Field Reporting i ' / f ,`: . A~ S`tVRCB, 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 (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN #17721 Date of Testing: 02/23/2007 Facility Address: MARKET #2133 3601 STOCKDALE HIGHWAY, BAKERSFIELD, CA, 93309 Facility Contact: Manager Phone: (661) 834-3093 Date Loca] Agency Was Notified of Testing : / / Name of Local Agency Inspector (if present during testing): Steve Underwood 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY , INC . Technician Conducting Test: WILLIAM ROGERS Credentials: ~ CSLB Licensed Contractor ~ SWRCB Licensed Tank Tester License Type: A License Number: 743160 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 d Secondary Pipe 1 REG NORTH ~ ^ ^ ^ UDC 3/4 ~ ^ ^ ^ Secondary Pipe 2 REG SOUTH ~ ^ ^ ^ UDC 3/4 ~ ^ ^ ^ Secondary Pipe 3 PRE A ~ ^ ^ ^ Spill Box 1 REG FILL ~ ^ ^ ^ Secondary Pipe 3 PRE B ~ ~ ~ ^ Spill Box 1 REG FILL ~ ~ ~ ^ Piping Sump 1 REG ~ ^ ^ ^ Spill Box 1 REG VAPOR ~ ^ ^ ^ Piping Sump 1 REG ~ ^ ^ ^ Spill Box 1 REG VAPOR ~ ^ ^ ^ Piping Sump 2 REG ~ ^ ^ ^ Spill Box 2 REG FILL ~ ^ ^ Piping Sump 2 REG ~ ^ ^ ^ Spill BOx 2 REG FILL ~ ^ ^ ^ Piping Sump 3 PRE ~ ^ ^ ^ Spill Box 2 REG VAPOR ~ ^ ^ ^ Piping Sump 3 PRE ~ ^ ^ ^ Spill Box 2 REG VAPOR ~ ^ ^ ^ UDC 1/2 ~ ^ ^ ^ Spill BOx 3 PRE FILL ~ ^ ^ ^ UDC 1/2 ~ ^ ^ ^ Spill Box 3 PRE FILL ~ ~ ^ ^ If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: J~~ ~ Date: 0 2/ 2 3/ 2 0 0 7 S VJRCB, 7anuary 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 tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN #17721 Date of Testing: 02/23/2007 Facility Address: MARKET #2133 3601 STOCKDALE HIGHWAY, BAKERSFIELD, CA, 93309 Facility Contact: Manager Phone: C 6 61) 8 3 4- 3 0 9 3 Date Local Agency Was Notified of Testing : / / Name of Local Agency Inspector (if present during testing): Steve Underwood 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC . Technician Conducting Test: WILLIAM ROGERS Credentials: ~ CSLB Licensed Contractor ~ SWRCB Licensed Tank Tester License Type: A License Number: 74 316 0 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 ad Spill Box 3 PRE VAPOR ~ ~ ^ ~ ~ ^ ^ ^ 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 3/ 2 0 0 7 S`WRCB, 7anuary 2002 5. SECONDARY PIPE TESTING Page 3 . Test Method Developed By: ~ Tank Manufacturer ^X Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: X~ pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: Equipment Resolution: ? .. ,: «.~ Piping Rnn # 1 REG NORTH piping Run # 2 REG SOUTH _ > ~ _ piping Run # 3 PRE A piping Run # 3 PRE B Piping Material: ~ GEOFLEX GEOFLEX GEOFLEX GEOFLEX Piping Manufacturer: ENVIRON ENVIRON ENVIRON ENVIRON Piping Diameter: 2 " 2 " 2 " 2 " Length of Piping Run: 2 5' 2 5' 2 5' 2 5' Product Stored: REGULAR REGULAR PREMIUM PREMIUM Method and location of REGULAR REGULAR PREMIUM PREMIUM piping-run isolation: Wait time between applying pressure/vacuum/water and 15 Min 15 Min 15 Min 15 Min starting test: Test Start Time: 0 9: 2 5 0 9: 2 5 0 9: 2 5 0 9: 2 5 Initial Reading (Rt ): 5 5 5 5 Test End Time: 10:2 5 10:2 5 10:2 5 10:2 5 Final Reading (Rp ): 5 5 5 5 Test Duration: 1 Hour 1 Hour 1 Hour 1 Hour Change in Reading (Rp - Rt ): 0 0 0 0 Pass/Fail Threshold or 0 Loss 0 Loss 0 Loss 0 Loss Criteria: 'lest Result: L~ Pass ~ Nail ~ Pass ~ l~'ail L~ Pass ~ Dail ~ Pass ~ Dail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRCB, January 2002 6. PIPING SUMP TESTING Page 4 . Test Method Developed By: ~ Sump Manufacturer ^X Industry Standard ~ Professional Engineer Other (Sped) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: VPLT .. su mp # 1 REG Sump # 1 REG Equipment Resolution: - --- - Sump # 2 REG Sump # 2 REG Sump Diameter: 4 2 4 2 4 2 4 2 Sump Depth: 3 2 3 2 3 2 3 2 Sump Material: Plastic Plastic Plastic Plastic Height from Tank Top to Top of Highest Piping Pentration: 8 8 8 8 Height from Tank Top to Lowest Electrical Pentration: 2 2 2 2 Condition of sump prior to testing: OK OK OK OK Portion of Sump Tested: t 2 " Above 2 " Above 2 " Above 2 " Above Does turbine shut down when sump sensor detects liquid (both product and water)?* yes ~No^N Yes ^No~N ^Yes ~No~N ~ Yes ~No~T 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/waterand starting test: 15 Min. 15 Min. 15 Min. 15 Min. Test Start Time: 0 9: 5 7 10 : 2 4 10:4 5 11:0 3 Initial Reading (Rt ): 10 10 10 10 Test End Time: 10:12 10:3 9 11:0 0 11:18 Final Reading (Rp ): 10 10 10 l0 Test Duration: 15 Min. 15 Min. 15 Min. 15 Min. Change in Reading(RF-RI ): .00007 .00003 .00009 .00008 Pass/FailThresholdorCriteria: +/-.00200" +/-.00200" +/-.00200" +/-.00200" Tc:st Kesult: ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ 1^~ail ~ V:us ~ F ai4 Was sensor removed for testing? ~Yes~No~NA ~Yes~No^NA ~Yes~No~NA Yes ~No~T Was sensor properly replaced and verified functional after testing? ^ ~ ~ X Ye N NA ^ ~ ~ X Ye N NA ^ ~ ~ X Ye N NA ^ ^ X Yes N COmmerits - (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 6. PIPING SUMP TESTING Page 5 - Test Method Developed By: ~ Sump Manufacturer ~ Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Sped) Test Equipment Used: VPLT F .~.r.. .. ~.~_ _ - - - ~ ~'~' ~4 ::~' , i ~u mp # 3 PRE Sump # 3 PRE Equipment Resolution: ,......_. ~_~ Sump # Sump # Sump Diameter: 4 2 4 2 Sump Depth: 4 5 4 5 Sump Material: Plastic Plastic Height from Tank Top to Top of Highest Piping Pentration: 11 11 Height from Tank Top to Lowest Electrical Pentration: 2 2 Condition of sump prior to testing: OK OK Portion of Sump Tested: t 2 " Above 2 " Above Does turbine shut down when sump sensor detects liquid (both product and water)?* ayes aNoaN ayes aNoaN ayes aNoaN ~ Yes aNoav 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/waterand starting test: 15 Min. 15 Min. Test Start Time: 11:30 11:50 Initial Reading (RI ): 13 13 Test End Time: 11:4 5 12:0 5 Final Reading (RF ): 13 13 Test Duration: 15 Min . 15 Min . Change in Reading (Rg- RI ): .00022 - .00004 Pass/Fail Threshold or Criteria: +/ - . 0 0 2 0 0 " +/ - . 0 0 2 0 0 " Test Result: ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail ~ Yass ~ bail Was sensor removed for testing? ~YesaNoaNA ~YesaN NA YesaNoaNA ayes aNoa~T Was sensor properly replaced and verified functional after testing? ~ ~ ~ Ye N NA ~ ~ ~ Ye N NA ^ ~ ~ Ye N NA ^ a Yes N Comments - (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 a~%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 n Other (Specify) Test Equipment Used: VPLT Equipment Resolution: -+-~-Y• ~"~'s~' `~ UDC# 1/2 UDC# 1/2 UDC# 3/4 UDC# 3/4 UDC Manufacturer: TCI TCI TCI TCI UDC Material: Fiberglass Fiberglass Fiberglass Fiberglass UDC Depth: 3 0 3 0 3 0 3 0 Height from UDC Top to Top of Highest Piping Pentration: 15 15 14 14 Height from UDCTop to Lowest Electrical Pentration: 6 6 6 6 Condition of UDC prior to testing: OK OK OK OK Portion of UDC Tested: t 2 " Above 2 " Above 2 " Above 2 " Above 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 Min . 15 Min . 15 Min . 15 Min . Test Start Time: 0 9: 5 9 10:17 10:4 5 11:0 2 Initial Reading (RI ): 17 17 16 16 Test End Time: 10:14 10:3 2 11:0 0 11:17 Final Reading (Rg ): 17 17 16 16 Test Duration: 15 Min. 15 Min. 15 Min. 15 Min. Change in Reading (Rg- RI ): .00001 .00001 .00000 - .00002 PasslFailThresholdorCriteria: +/-.00200" +/-.00200" +/-.00200" +/-.00200" Test Result: ~ Pass ~ F'ail ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail Was sensor removed for testing? Yes^No^NA Yes^No^NA Yes^No^NA Yes ~No~N Was sensor properly replaced and verified functional after testing? ^ ~ ~ X Ye N NA ^ ~ ~ X Ye N NA ^ ~ ~ X Ye N NA ^ ^ X Yes N COmmeIItS - (include information on repairs made prior to testing, and recommended follow-up for failed tests) t If the entire depth of the UDC is not tested, specify how much was tested. If the answer to ate! of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) $WRCB, 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: : .. - ', ~ ~~ ~ S X11 Box # 1 REG FILL ` ~' ~`~ `» ~ ~ ~~ p' s _ S III Box # 1 REG FILL p' 1 REG VAPOR Spill Box # 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 15 Min. 15 Min. 15 Min. 15 Min. starting test: Test Start Time: 0 9: 5 8 10:17 0 9: 5 8 10:17 Initial Reading (Rt ): 6 6 7 7 Test End Time: 10:13 10:32 10:13 10:32 Final Reading (Rg ): 6 6 7 7 Test Duration: 15 Min. 15 Min. 15 Min. 15 Min. Change in Reading (R F - Rt) - .00001 - .00000 .00003 .00002 Pass/FailThresholdor +/-.00200" +/-.00200" +/-.00200" +/-.00200" Criteria: "Test Result.: ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~WRCB,January 2002 9. SPILL/OVERFILL CONTAINMENT BOXES Page $ 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 ~y ~~ ~.. s , ti ~.~:.::,~g:3v,...ar.~~ pill Box # 2 REG FILL Equipment Resolution: f ~ .. .. ,~ r ~~_ -__.~ Spill Box # 2 REG FILL Spill Box # 2 REG VAPOR Spill Box # 2 REG VAPOR Bucket Diameter: 11 11 11 11 Bucket Depth: 12 12 12 12 Wait time between applying pressure/vacuumlwaterand starting test: 15 Min. 15 Min. 15 Min. 15 Min. Test Start Time: 10:4 5 11:0 2 10:4 5 11:0 2 Initial Reading (Rt ): 6 6 7 7 Test End Time: 11:0 0 11:17 11:0 0 11:17 Final Reading (RF ): 6 6 7 7 Test Duration: 15 Min. 15 Min. 15 Min. 15 Min. Change in Reading(Rg-Rt ) -•00005 -.00000 -.00002 -.00002 PasslFailThresholdor Criteria: +j-.00200" +j-.00200" +j-.00200" +j-.00200" Test 12esult: L - I Pass ~ [ail ~ ['ass ~ Fail ~ Pass ~ Fail ~ Pass ~ hail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~WRCB,.January 2002 9. SPILL/OVERFILL CONTAINMENT BOXES Page 9 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 a Hydrostatic Other (Specify) Test Equipment Used: VPLT Equipment Resolution: ,. ~~` i - ~ t ~;"- ' ~ t_ Spill Box # 3 PRE FILL Spill Box # 3 PRE FILL Spill Box # 3 PRE VAPOR 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 15 Min . 15 Min . 15 Min . 15 Min . starting test: Test Start Time: 11:2 9 11:4 9 11:2 9 11:4 9 Initial Reading (RI ): ~ ~ ~ ~ Test End Time: 11:44 12:04 11:44 12:04 Final Reading (Rg ): ~ ~ ~ ~ Test Duration: 15 Min. 15 Min. 15 Min. 15 Min. Change in Reading (R p - Rt) - • 00002 - .00008 - .00005 - .00005 Pass/FailThresholdor +/-.00200" +/-.00200" +/-.00200" +/-.00200" Criteria: `Kest Result: ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~ Tanlv~o%gy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:02/23/07 WORK ORDER NUMBER3151149 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #17721 COMMENTS Syr SB-989 testing on all components. Tanks are single-walled, no tests necessary. All Tested Components Passed. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 03/16/2007 08:25 ACRAMER , ."a. SITE DIAGRAM ~ Tanlv~ology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 02/23/07 WORK ORDER NUMBER3151149 CLIENT:7-EL$VSN, INC. SITE:7-ELEVEN #17721 r O O ,O ,O N s ~ ~ 0 REG REG ~ ~v ~ STP STP N STP 10OAK OV OF PREM CP ~Q VENTS Printed 03/16/2007 08:25 ACRAMER .. - • Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: 7-Eleven #17721 Facility ID #: 235067 Facility Address: 3601 Stockdale T.-IaVY. Bakersfield, CA 93309 Reason for Submitting this Form (Check One) ®Change of Designated Operator Facility Phone #: 661-8343093 ^ Update ICC # and/or Expiration Date Desil=laated UST Operator(s) for this Facility Prima O tional Designated Operator's Name: John Ablakat Relation to UST Facility (Check One) Business Name (If d fferenf from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician ^O Third-Patty 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 Counci] 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 (Ifd~erent from above): ^ Owner ^ Operator ^ Employee. Designated Operator's Phone #: 818-992-8981 ^ Service Technician ®Third-Party International Code Council Certification #: 5238439-UC Expiration Date: 07/09/2008 I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f). Furthermore, I understand and am in complian 'wi'th th equirements (statutes, regulations, and local ordinances) applicable ~'dergr and orage tanks. ~~ r'' NAME OF TANK OWNER (Please Print): 7-E - Y MARTIN SIGNATURE OF TANK OWNER: DATE: 2/15/2007 OWNER'S PHONE #: (253) 796-7170 November 2004 • . - Ov.tier Statements of Designated Underground Stora e Tank (UST) Operator and Understandin of and Compliance with UST Requirements -continued ALTERNATE 3 (Optional) Designated Operator's Name: Kevin Watennolen 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 ^D Third-Party lnternationa] Code Council Certification #: 5250470-UC Expiration Date: 12-21-2008 ALTERNATE 4 (Optional) 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 ^D Third-Party International Code Council Certification #: 5286530-UC Expiration Date: 07-03-2008 ALTERNATE 5 (Optional) Designated Operator's Name: Jim Paltrier 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 ^O 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 (lf different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 707-815-251 I ^ Service Technician D 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 froth above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 510-364-0385 ^ Service Technician ^D Third-Party International Code Council Certification #: 5246905-UC Expiration Date: 01-20-2007 ALTERNATE 8 (Optional) Designated Operator's Name: Darrell Riley Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 619-206-8379 ^ Service Technician ~ Third-Party International Code Council Certification #: 5248975-UC Expiration Date: 11-29-2008 ALTERNATE 9 (Optional) Designated Operator's Name: Darren Austin Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 858-699-2751 ^ Service Technician O Third-Party International Code Council Certification #: 5250436-UC Expiration Date: 11-11-2008 ALTERNATE 10 (Optional) Designated Operator's Natne: 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 ~ Third-Party International Code Council Certification #: 5250118-UC Expiration Date: 11-9-2008 ALTERNATE 11 (Optional) Designated Operator's Name: Blake Herness Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 951-288-1519 ^ Service Technician ^D Third-Party International Code Council Certification #: 5249180-UC Expiration Date: 12-12-2008 ^'f" February 15, 2007 BAKERSFIELD FIRE DEPARTMENT 900 TRUXTUN AVENUE, SUITE 210 BAKERSFIELD, CA 93301 RE: Statement of Compliance and Designated Operator Dear Sir or Madam: Gilbarco/Veeder-Root, acting as the authorized agent of Safeway/Vons is submitting on behalf of the company, the attached Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of Compliance with UST Regulations for the subject fuel facility to register this site and Designated Operators with the county. The owner understands that with the submission of this document, Gilbarco/Veeder-Root is stating, on behalf of Safeway/Vons that each location is in compliance with all applicable UST regulations. Further, as specified in regulations Title 23, Section 2715 (c)-(f), the individuals listed as designated operators for the location will complete and document a monthly inspection to be maintained in accordance with the applicable requirements. Each statement of compliance being submitted herein is based on: (1) Gilbarco/Veeder- Root reasonable and good faith review of facility operations to evaluate compliance with applicable UST regulations, as well as information provided by facility operations as of the date the statement of compliance is made, and (2) Gilbarco/Veeder-Root's understanding of the applicable UST regulations and requirements as of the date the statement of compliance is made. Should you have any questions or require further information please do not hesitate to contact me at (303) 986-8011. Sincerel , Sherry Peczka Designated Operator Program Manager Gilbarco/Veeder-Root Enclosures ,. % _.~ UNIFIED PROGRAM CONSOLIDATED FORM IAIVI~J r~ '~~~ , UNDERGROUND STORAGE TANKS -FACILITY v (one page per site) Page of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 I. FACILITY /SITE INFORMATION --- BUSINESSNAME (Same as FACILITY NAME or DBA-Doing Business As) g FACILITY ID#'-- 1 7-Eleven #17721 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* ® 1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aoa ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* ao2 TOTAL NUMBER OF TANKS Is facility on Indian Reservation or *If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos `. II. PROPERTY OWNER JNFORMATION PROPERTY OWNER NAME aoy PHONE aoa 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS aos P.O. Box 711 Attn: Gasoline Acctg CITY aio STATE aii ZIP CODE a~2 Dallas TX 75221-0711 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL at3 III. TANK OWNER INFORMATION ~ TANK OWNER NAME aia PHONE ats 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS ENT'D A p R ais P.O. Box 711 Attn: Gasoline Acct CITY a» STATE ale ZIP CODE ass Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER ` TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise ~z, V. PETROLEUM UST FINANCIAL RESPONSIBILITY - - ----- INDICATE ®1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ^ 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD az2 VI. LEGAL NOTIFICATION ANb MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER 423 VIL APPLICANT SIGNATURE Cert ica ion - I certif that t information provided herein is true and accurate to the best of my knowledge. SIG RE OF NT DATE aza PHONE azs 3 ~ 26'0 ~ 702-270-7160 NA OF APPLICA (pri 426 TITLE OF PPLICANT a2~ Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) a28 1998 UPGRADE CERTIFICATE NUMBER (For local use only) azs UPCF (1/99 revised) Formerly SWRCB Form A } UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page of -- - L IDENTIFICATION' _ __ -- -- - I -- FACILITY ID# _ ~ BEGINNING DATE 1U° ENDING DATE ~~~ F A O O O 3/1 /2006 3/31 /2007 BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 7-Eleven #17721 661-834-3093 BUSINESS SITE ADDRESS io3 3601 Stockdale Hwy CITY ioa ZIP CODE io5 CA Bakersfield 93309 DUN & BRADSTREET 106 SIC CODE (4 digit #) X07 00-734-7602 5541 COUNTY roe Kern BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE ~~o Tejinder & Kulshinder Takhar 661-834-3093 11. BUSINESS OWNER OWNER NAME _ ~~~ OWNER PHONE 112 7-Eleven, Inc. 702-270-7160 OWNER MAILING ADDRESS 113 P.O. Box 711 Attn: Gasoline Acctg CITY iia STATE 115 ZIP CODE 116 Dallas TX 75221-0711 i III. ENVIRONMENTAL CONTACT' - -- CONTACT NAME _ - - - >» CONTACT PHONE iia Shane Partridge 702-270-7160 CONTACT MAILING ADDRESS 1t9 P.O. Box 711 Attn: Gasoline Acctg CITY 120 STATE i2t ZIP CODE 122 Dallas TX 75221-0711 -PRIMARY- . i IV. EMERGENCY CONTACTS -SECONDARY- NAME izs NAME i2a Tejinder Takhar 7-Eleven Emergency Dispatch TITLE ~Za TITLE 129 Franchisee Emergency Service BUSINESS PHONE 125 BUSINESS PHONE i3o 1800-828-0711 800-828-0711 24-HOUR PHONE 126 24-HOUR PHONE i3~ 1-800-828-0711 800-828-0711 PAGER # 127 PAGER # i3z ADDITIONAL LOCALLY COLLECTED INFORMATION: Ce Ic tion: Base on m inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally ex in d nd am f miliar ith the information submitted and believe the information is true, accurate, and complete. SIG T E OF OW E TOR OR DESIGNAT D REPRESENTATIVE DAT 134 NAME OF DOCUMENT PREPARER 135 3 ~2A ?.cn0 (o Rachel Rodriguez NAM F SIGNER (print) 136 TITLE 0 SIGNER 137 Shane Partridge Gasoline & Environmental Compliance Manager UPCF (1/99 revised) HMP 2 (Back) Instructions OES FORM 2730 (1 /99) UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) ^ MATERIAL(NON-WASTE) ® WASTE one a e er material er buildin or area ®ADD ^DELETE ^REVISE REPORTING YEAR 2005 zoo Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 7-Eleven #17721 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 (EPCRA) ^ YES ® NO NEAR FACILITY TRASH ENCLOSURE MAP# (optionap 203 GRID# (optional) 204 FACILITY 1D # 1 of 1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No zos WASTE FLAMMABLE LIQUID if subject to EPCRA, refer to instructions COMMON NAME GAS-WATER MIXTURE 207 EHS* ^Yes ®No zoe CAS# N/A 209 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required byCUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) ^ a. PURE ^b. MIXTURE ®c. WASTE 211 RADIOACTIVE ^Yes ®No 212 CURIES 213 PHYSICAL STATE (Check one item only) ^ a. SOLID ®b. LIQUID ^ c. GAS 214 LARGEST CONTAINER 55 215 FED HAZARD CATEGORIES 218 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 21a ANNUAL WASTE AMOUNT z19 STATE WASTE CODE 220 25 55 55 134 221 DAYS ON SITE: 222 UNITS* ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 Check one item onl ' If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ®e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE I8 r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ® d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # MIXTURE OF GASOLINE & WATER OR ~ gg gp zzs 227 ^Yes ®No 22a N/A MIXTURE 22s OTHER CONTAMINATION IN GASOLINE , 2 230 231 ^Yes ^ NO 232 233 3 234 235 ^Yes ^ NO 236 237 4 238 239 ^Yes ^ No zao 2a1 5 242 243 ^Yes ^No 2aa 2a5 If more hazardous components are present at greater than 1 % by weight If non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 248 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) ^ MATERIAL(NON-WASTE) ® WASTE one a e er material er buildin or area ®ADD ^DELETE ^REVISE REPORTING YEAR 2005 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 7-Eleven #17721 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL zo2 (EPCRA) ^ YES ® NO NEAR FACILITY TRASH ENCLOSURE ~~ MAP# (optional) 203 GRID# (optional) zoo FACILITY ID # ~_ ~ 1 oft II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No 2os WASTE ABSORBENT & DISPENSER FUEL FILTER If subject toEPCRA,retertoinstructions COMMON NAME WASTE ABSORBENT 8r DISPENSER FUEL FILTER 207 EHS' ^Yes ®No zoa ca,s# N/A 209 `If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) ^ a. PURE ^b. MIXTURE ®c. WASTE 211 RADIOACTIVE ^Yes ®No 212 CURIES 213 PHYSICAL STATE (Check one item only) ®a. SOLID ^b. LIQUID ^ c. GAS 214 LARGEST CONTAINER 55 215 FED HAZARD CATEGORIES z16 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 219 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 25 55 55 352 z21 DAYS ON SITE: 2z2 UNITS' ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 Check one item onl ' If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ® d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON z23 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 22a STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # MIXTURE OF SILCATE & HYDROCARBONS 1 89-90 zzs 227 ^Yes ®No 22e N/A MIXTURE zzs & SPENT FUEL FILTERS , 2 230 231 ^Yes ^ NO 232 233 3 234 235 ^Yes ^ NO 236 237 4 z3s 23s ^Yes ^ No zao 2a1 5 2az 243 ^Yes ^No zaa za5 If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION gas ~ ~ r UNDERGROUND STORAGE TANK MONITORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited.• Title 23 CCR, Sections 2632(d)(1), 2634(d)(2), and 2641 (h) TYPE OF ACTION ^ 1. NEW PLAN ^ 2. CHANGE OF INFORMATION Mol. PLAN TYPE ®MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. Moz. (Check one item only) ^ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): L, FACILITY INFORMATION FACILITY ID # (Agency Use Onty) FACILITY NAME 7-Eleven #17721 M03 FACILITY SITE ADDRESS 3601 $tOCkdale HlghWay Moa. CITY Bakersfield Mos. - II,, EQUIPMENT TESTING AND PREVENTIVE'MAINTENANCE -: State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in Mob. accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED ®1. ANNUALLY ^ 99.OTHER (Specify): Mop. III. 1VIONITORING LOCATIONS '' _ _ This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., location of each s ensor, line leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring System Certification form, Hazardous Materials Business Plan ma ,etc.) which shows all re uired information, include it with this Ian. IV. TANK MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) M10' ^ i. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ^ a. DRY ^ b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM MI I' PANEL MANUFACTURER: M12 MODEL #: M13. LEAK SENSOR MANUFACTURER: t Mla. MODEL #(S): MI5. ® 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S) PANEL MANUFACTURER: VeederROOt M16 MODEL #: TLS350 M" IN-TANK PROBE MANUFACTURER: VeederROOt M18 MODEL #(S): MAG-2 M19. LEAK TEST FREQUENCY: ^ a. CONTINUOUS ^ b. DAILY/NIGHTLY ^ c. WEEKLY Mzo. ® d. MONTHLY ^ e. OTHER (Specify): MzI . PROGRAMMED TESTS: ^ a. 0.1 g.p.h. ^ b. 0.2 g.p.h. ^ c. OTHER (Specify): Mzz . Mzs. ^ 3. INVENTORY RECONCILIATION ^ a. MANUAL PER 23 CCR §2646 ^ b. STATISTICAL PER 23 CCR §2646.1 Mza. ^ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645 TESTING PERIOD: ^ a. 36 HOURS ^ b. 60 HOURS Mts. ^ 5. INTEGRITY TESTING PER 23 CCR §2643.1 TEST FREQUENCY: ^ a. ANNUALLY ^ b. BIENNIALLY ^ c. OTHER (Specify): Mz6. Mzz ^ 6.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approval) ^ 99. OTHER (Specify): Mzs. _ _ _ _ V. PIPE'MONITORING . MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mao. ® 1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM M31 PANEL MANUFACTURER: VeederROOt M3z. MODEL #: TLS35O M33 LEAK SENSOR MANUFACTURER: VeederROOt Msa. MODEL #(S): 794380-208 M35. WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? ®a. YES ^ b. NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M37 ® 2. MECHANICAL LINE LEAK DETECTOR (MELD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED MELD MANUFACTURER(S): VanOf IeSS M38 MODEL #(S): LD2000 M39. ^ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS ELLD MANUFACTURER: i"i40 MODEL#: MaI. PROGRAMMED LINE INTEGRITY TESTS: ^ a. MINIMUM MONTHLY 0.2 g.p.h. ^ b. MINIMUM ANNUAL 0.1 g.p.h. M42 WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Mai. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Maa. ® 4. INTEGRITY TESTING TEST FREQUENCY: ®a. ANNUALLY ^ b. EVERY 3 YEARS ^ a OTHER (Specify) M4 5. M46. ^ S.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY* ^ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED** Mai. * Requires agency approval ** Allowed for monitoring of unburied emergency generator fuel piping only per HSC §25281.5(b)(3) ^ 6. PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) ^ 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ^ 99. OTHER (Specify) M48 UN-022A -1/3 www.unidocs.org Rev. 10/14/03 ,+;s~ Underground Storage Tank Monitoring Plan -Page 2 of 2 ..:, . ` VI. DISPENSER.'MONITORING: _ ` MONITORING OF AREAS BENEATH DISPENSER(S) IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mso. ® 1. CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT (UDC) PANEL MANUFACTURER: VeeClerROOt Mst. MODEL #: TLS35O Msz. LEAK SENSOR MANUFACTURER: VeederROOt - Mss. MODEL #(S): 794380-208 Msa. WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? ®a. YES ^ b. NO M55. WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M56. WILL FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO Msz ^ 2. MECHANICAL ASSEMBLY (e.g., FLOAT AND CHAIN ASSEMBLY) IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK ASSEMBLY MANUFACTURER: Mss. MODEL #(S): Msg. ^ 3.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approvap M60. ^ 4. NO DISPENSERS ^ 99. OTHER (Specify) M61. VII. ENHANCED LEAK DETECTION -__ ^ 1. WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK Mso. DETECTION (ELD) FOR THE UST(S) COVERED BY THIS PLAN. PER 23 CCR §2644.1, ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED VIII. TRAINING ;: ; REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) Mso. 1. ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 2. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 3. ® THE FACILITY'S BEST MANAGEMENT PRACTICES (Required as of January 1, 2005) 4. ^ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. ^ CALIFORNIA UNDERGROUND STORAGE TANK LAW 6. ^ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS -MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 7. ^ SWRCB PUBLICATION: "WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" 99. ^ OTHER (Specify): Mst. Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and can access those documents when needed. By January 1, 2005, this facility will have a "Designated UST Operator" who has passed the California UST Sytem Operator Exam administered by the International Code Council (ICC). By July 1, 2005, and annually thereafter, the "Designated UST Operator" will train facility employees in the proper operation and maintenance of the UST systems. This training will include, but is not limited to, the following: - Operation of the UST systems in a manner consistent with the facility's best management practices. - The facility employee's role with regard to the leak detection equipment. - The facility employee's role with regard to spills and overfills. - Whom to contact for emergencies and leak detection alarms. For facility employees hired on or after July 1, 2005, the initial training will be conducted within 30 days of the date of hire. ` IX. COMMENTS/ADDITIONAL INFORMATION Please use this section to include any additional UST system monitoring-related information (e.g., additional information required by your local agency): Mss. Note regarding Section X. Pending certification of a Designated UST Operator, the following person has authority for performing the monitoring activities and maintaining leak detection equipment covered by this plan. NAME: JOB TITLE: `X. PERSQNNEL;RESPONSIBILITIES .:.. . :... . __ _ AS OF JANUARY 1, 2005, THE "DESIGNATED UST OPERATOR" IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT APPLICATION -FACILITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION EQUIPMENT COVERED BY THIS PLAN, AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS OF THE FACILITY'S UST SYSTEMS IN ACCORDANCE WITH 23 CCR § 2715 ). __ 7XI. OWNER/OPERATOR SIGNATURE:. C FICATI N: I ertify that the information provided herein is true and accurate to the best of my knowledge. O E PERAT IG ATURE REP SENTING DATE: Mgt. Omer M90. O ~ /~^/ ~~ / V' perator / C OWNER/OPERATOR AM (print): M9z. OWNER/OPERATOR TITLE: M93. Shane Partridge Gasoline & Environmental Compliance Mgr (Agency Use Only) This plan has been reviewed and: ^ Approved ^ Approved With Conditions ^ Disapproved Local Agency Signature: Date: Comments/Special Conditions: UN-022A - 2/3 www.unidocs.org Rev. 10/14/03 -_ x- , , WRITTEN MONITORING PROCEDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify local agency within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h} CCR. Facility Name: 7-Eleven Store #17721 Facility Address: 3601 Stockdale Highway, Bakersfield, CA Date: March 1, 2006 A. Describe the frequency of performing the monitoring: Tank The site consists of three 10,000 gallon single walled cathodically protected steel tanks (1-Regular Unleaded, 1-Midgrade, 1-Premium) and are monitored monthly with a VeederRoot TLS350 Piping Product lines are double wall Enviroflex and are monitored continuously with a VeederRoot TLS350. The turbine sump sensor activates audio/visual alarms and provides positive shutdown of he turbines. B. What methods and equipment, identified by name and model, will be used for performing the monitoring: Tank The method of leak detection for the tanks is Continuous Statistical Leak Detection (CLSD) using the VeederRoot TLS350 Tank Gauge programmed for a threshold of .2gph VeederRoot model MAG-2 probes are used for the monitoring. High level alarms activate audio/visual and external alarms Piping The piping is monitored continuously by VeederRoot liquid sensors model #794380-208 located in the turbine sump of each tank. The turbine sump sensors provide positive shutoff and activate audio/visual alarms. Vaporless LD2000 line leak detectors are located on the turbine and programmed for a leak threshold of 3gph. The piping is precision tested annually at a threshold of .1 gph~. Dispensers are equipped with under- dispenser containment with VeederRoot liquid sensors model #794380-208 that provide positive shutdown of the turbines. Enhanced This site has a single wall component of the tank system and utilizes Enhanced Leak Leak Detection (ELD) to include a Tracer Tight Test completed in 2003 and every 3 years Detection thereafter C. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: The individual responsible for the monitoring equipment is the store operator, Tejeinder Takhar. The operator will contact 7-Eleven Dispatch 1 800-828-0711 for any alarm conditions on the VeederRoot. The local maintenance contractor will be dispatched. 7-Eleven, Inc. is responsible for maintaining the equipment. The Environmental Manager is Shane Partridge . • (:, Written Monitoring Procedures 7-Eleven #17721 Page 2, March 2006 D. Reporting format for monitoring: Tank Current status reports are available from the Veeder-Root TLS 350 as a print out and from The display screen. Monitoring records will be kept at the location and at a central office location. Piping Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Third party annual test results will be submitted to the agency. E. Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturer's maintenance schedule but not less than every 12 months. Tanks and product lines are continuously monitored and alarmed. Alarm histories are printed each month and investigated for corrective actions by the Designated Operator. Equipment repairs; replacement are performed as needed. F. Describe the training necessary for the operation of UST system, including piping, and the monitoring equipment: Employees are trained on the Operation of the UST in a manner consistent with Best Management Practices. Emergency contact information, Spill/Overfill response procedures, Hazardous Waste Procedures, and Monitoring equipment operation and alarm response procedures. Training is conducted annually, or within 30 days for new employees, by the Designated Operator ~: - 4 - r. EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify LOCAL AGENCY within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641 (h) CCR. Facility Name: 7- Eleven Store #17721 Facility Address 3601 Stockdale Hwy., Bakersfield CA If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion hazard, are not cleaned up from the secondary containment within 8 hours, or deteriorate the secondary containment, then LOCAL AGENCY must be notified within 24 hours. In case of a gasoline spill- Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. Employees will be notified to evacuate if deemed necessary. A contractor will be contacted to remove the spill as necessary. In case of a small carbon dioxide release- the tank will be visually inspected for obvious signs of the release point. If possible the control valve will be shut off. In the case of a large release of carbon dioxide, employees will be notified to evacuate and Contact 911 and 7-Eleven Dispatch. In case of fire- the alarm will be sounded by shouting "Fire" and the building will be evacuated. Employees will contact 911 and assemble at the designated assembly area as depicted on the site map. If safe, employees will shut off power and control fire using fire extinguishers. 2. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substances. Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. A contractor will be contacted to remove the spill as necessary. 3. Describe the location and availability of the required cleanup equipment in item 2 above. Absorbent is located inside the store in the backroom. 4. Describe the maintenance schedule for the cleanup equipment. Inventory of absorbent is periodically checked. List the name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan. Shane Partridge, Gasoline & Environmental Compliance Manager 702-270-7160 Date NOU-7-2006 12:19 FROM:P 29803111 T0: 16613960569 P.2 Sessions SPECIAL INSPECTION RE_PO_RT_ Seven-Eleven Store # 17721 Date: November 7, 2006 3601 Stockdale Highway Bakersfleid, CA 'i`h followir~ results for ~e above location represent the tx~tusions of the Special Inspection, which are t¢ presented to the regulatory agency. Tank No. 2 Capacity 10,000 gallons Dimensions 7'11'x27' Product Fuel C Tide Z3-Z663 P„,~,~ fA1L ( ) Tank has bean cleaned so that no residue n9mains on the tank walls X .( ) (A) Determine that tank has been vacuum tested at a X vacuum of 5.3 inches of Hg for not less than one minute. (B) Witness ultrasound test average of 75°b, ar X greater of original thickness. Visuaily ch~lced the internal lining for discontinuity, X compression, tension cracking and corrosion. Test for thickness and hardness of the lining in X atxor~damce with nationally recognized industry codes. • Test 1t-e fining using an etectricat resistance Holiday X Detector in accordance with nattonally recognized industry codes, Holidays located, repaired and r~s-tested ~( ) Tank is suitable for continued use for a minimum of 8ve (5) years X .( ) Tank is suitable for continued use for a minimum of five (5) years ONLY if ~ is refined, or other improvements are made. ( The tank lining is no longer suitable for continued use and shall be closed in accordance with ArtiGe 7. ~ Speaal Inspection covers only the cornosion control aspects of the tank internals. The corrosion b trol aspects of the tank externals would be the sut~ect of a separate report. inspector Dan Lawhvm anal Engineer Robert Paul P.E. STAMP 2243 Aspen Mirror Way Sufte 204 Lau®hlin, NN 89029 B: _ ~~ _ ROFESS/p ~~~ ~~FiT p ~~ ed Professional Engineer Plc. Corrosion 111 1 ~o G~ ~n Date: 3131/2008 ~ No. 111 ~f~rf OF GAttF~ NOU-7-2006 12:21 FROM:P 29803111 T0: 16613960569 P.1 5 St'18S1On8 SPECIAL INSPECTION REPORT Si~~: Seven-Eleven Store # 17721 Date: November 7, 200fi Act r+ess: 3601 Stodcdale Highway Bakersfield, CA Tt~e Nowing results for the above location r~resent the conclusions of tt~e Special Inspection, which are to. presented to the regulatory agency. ' Tank Na. 3 Capaaty 10,000 gallons Dimensions 7'41' x 2T Product Fuel Title 23-2683 ~4 Tank has been leaned so that no residue remains on the tank walls X (A) Determine that tank has bean vacuum tested at a X vacuum of 5.3 inches of Hg for not less than.one minute. {B} Witness ultrasound test -average of 7596 or X great®r of original thickness. Visually d~edced the internal lining for discontinuity, X compression, tension cracking and corrosion. Test for thickness and hardness of the fining in X accordance with nationally recognised industry codes. Test the lining using an electrical resistance Holiday X Detector in accordance with nationally recognized industry codes, Holidays located, repaired and re-tested Tank is suitable for continued use for a minimum of five (5) years X Tank is suitable for continued use for a minimum of five (5) years QNLy if it is relined, or other improvements are made. The tank lining is no longer suitable for continued use and shall be Dosed in acxordance with Article 7. Speaal Inspection covers only the corrosion control aspects of the tank irrtemals. The corrosion el aspects of the tank externals would be the subject of a separate report. Inspector Dan Lawhom onal Engineer Robert Paul P.E. S~AAI~P_ 2243 Aspen Mirror Way Suite 204 Laughlin, NV 89029 .. -- ed Professional Engineer No. Corrosion 1 t1 ~~~oa RT PryG` Fy m Date: 3/31/2008 ~ ~ No. 111 i J ,r~.CORR0S~0?w~; NDU-7-2006 12:19 FROM:P 29803111 T0: 16613960569 P.1 ;~ $888iOn8 ~ SP C,IAL INSPECTION REPORT iif~a: Seven-Eleven Store # 17721 Date: November 7, 2006 Tess: 3601 Stockdale Highway Bakersfield, CA following results for the abo+m location represent the contusions of the Special Inspection, whicfi are td presented b the regulatory agency. Tank No. 1 Capacity 10,000 gallons Dimensions T11' x 2T Product Fuel C~ Title 23-2863 PASS FAIL '( ) TaMt has been Leaned so that nv residua remains on the tank walls X ( ) (A) Determine that tank has been vacuum tested at a X vacuum of 5.3 indtes of Hg for not less than one minute. . (B) Witness ultrasound test -average of 75°r5 or X greater of original thickness. Visually checked the irrtemal lining for discontinuity. X compression, tension txacking and corrosion. Tes! for thickness and hardness of the lining in X accordance with nationally recognized industry codes. Test the lining using an ®ledrical resistance Holiday X Detector in accordance with nationagy recognized industry codes, Holidays located, repaired and re-tested ( ) Tank is suitable for continued use for a minimum of five (5) years X ( ) Tank is suitable for continued use for a minimum of five (5) years ONLY iF it is relined, or other improvements are made. ( The tank lining is no longer suitable for continued use and shall be closed in accordance with Article 7. I'h a Special Inspection covers only the comasion oorrtrot aspects of the tank internals. The corrosion ro I aspects of the tank externals would be the subject of a separate report. "ng inspector fan tawhom ~r ssionat Engineer Robert Paul P.E. TS AMp ass 43 Aspen Mirror Way Suite 204 Laughlin, NV 89029 #i nature: Q~o>:ESSro~ c ister~ Professional Engineer No. Conosion 111 yq~~ ~~,aT a,~G`~a *' iration Date: 3131/2008 w ~ Ito. 111 4< ,p,,_~~RROS~O~~? UNDERGROUND STORAGE TANKS '" ~, ...... .; .....: .. .......... n:.i,L•:..-:a:::F-_-~.-..cammyaA4fnn1Un1U1P:11 APPLICATION TD PERFORM ELD 1 LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING !TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. ~ ` "' BAHERSFIELD FIRLr DEPT. •~R~ Prevention Services dRf'Ii 1600 Truxtun Ave., Ste. 401 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: 1661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DETECTION ^ LINE TESTING $1 SB-889 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ^ TO PERFORM FUEL MONITORING CERTIFICATION / ~ _ FACILITY 7- E+~Yeh ,~ {7 ! a.l I I! S-TE:INFOEi1NJkT10N NAME & PHONE NUMBER OF CONTACT PERSON M - I I ADDRESS ~3~01 S{ockdale Hrv i3alttrs•Field C~ °t33o°l OWNERS NAME OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YE TANK # V UIIIE CONTENTS ~ - 5o1,c4~h '~OD2'7 8?- R Iqh Z - ~loaih 10 0 27 S7- 2e ~~R 3 100? 91-'~r~,w+~um TANK TESTING C0141PANY NAME OF TESTING COMPANY Tanknolo ~ gyp nC. NAME a PHONE NUMBER OF Anthony Cheeks (951) 676-4060 CONTACT PERSON MAILING AOORESS 41785 Enterprise Circle S. Suite D Temecula, CA 92590 NAME & PHONE NUMBER OF ~j (I R(ja~Cj TESTER OR SPECIAL INSPECTOR: JJ 2~ ~~3 CERTIFICATION M: DATE m TIME TEST TO BE .~ J23~O~ ~ ~,f `A CONDUCTED: ` ~1(" 'CC il: ~~~ tp Z~ « 1 ~+r 1 yl 1 _ METHOD SIGNATURE OF APPL{CAN GATE: ~ 1~ ~~ APPROVED BY DATE CL FD 2095 (Rev. 09/05) f/Z 190f919606 ~ceolou~uey Nd ZE~lO LOOZ/90/ZO UNDERGROUND STORAGE TANK PERMIT APPLICATION TO - $~~RS i D CONSTRUCT /MODIFY /MINOR 4 ~Rrr r MODIFICATION OF AN UST PERMIT N0. ~ v~ TYPE OF APPLICATION: (Check one item only) ^ NEW FACILITY ^ MODIFICATION OF FACILITY Bakersfield Fire Dept. Environmental Service 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ NEW TANK INSTALLATION AT EXISTING FACILITY ,~' MINOR MODIFICATION OF FACILITY TARTING DATE ROPOSED COMPLETION DATE AGILITY NAME ~~ ~ ~~7Z~ (STING FACILITY PERMIT NO. FACILITY ADDRESS ~O/ .Svc ~/~~~ i~ ITY ~~rf •~P//~ t~i~ IP C E ~~~ PE OF BUSINESS L~.f' ~~ ~ai v PN # ANK OWNER ~/ PHONE NO DDRESS /7~V ~ ~ ~ f/ /y {' y I%1~~/~/ ~/1 ~ IP C^O~DE{~ /J ZZ ONTRACTOOR /~i~~ ,~jf~j~~G/YI~G//~ ~ LICENSE NO. ~83~3 ICC NO. 23 ~'i2 cJ ~ DDRtES~S n ZJ / 7/ G~'a! G /~~ ITY i ~ ~~i ~ IPQCODyE~' /~CO~CJ PHONE NO. c p, 7~ / U~ K/E~RSFIELD CITY BUSINESS LICENSE NO. C/~ ~~ 0 RKMANS COMP/N~O. /y ~C~ ~ C/ INSURER L ~ ~~ ~ / /~ `''~ '~ BRIEFLY DESCRIBE THE WORK BE DONE / ffi~ ~ ~/ ~/~c1' /l ~G c 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 TANK NO. is run my i vrc rues iH15 SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. OLUME NLEADED REGULAR REMIUM DIESEL VIATION OFFICIAL USE ONLY The applicant )uzs ~ogived, and lands, and will comply with the attadted conditions of the permit and any other state, local regulations. 77tis~,~jti .Tuts bQ,e, co~ted under penalty of perjury, and to th,~ bestef my kn9wledge, is true and correct. APPROVED BY: APPLICANT NAME (PRINT) THIS APPLICATION BECOMES A PERMIT WHEN APPROVED ~ 0 n UNDERGROUND STORAGE TANK APPLICATION TO PERFORM A TANK LINING RE-INSPECTION PERMIT NO. ~R"CIrY1~LI.C, H H R 3 F I D SIR! AI~T~ T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 Fax: (661) 852-2171 Page 1 of 1 ~. FACILITY ADDRESS (.o AC'S ~e~~ ~°. ~ 3 3 ~~ OPERATORS NAME ~~~ ~ ~~. \nd-e.~ c~. Nov' PERMIT TOO ERATE NO. c~ f S/- O L (- U v O S- / 7 OWNERS NAME NUMBER OF TANKS TO BE TESTED ~ IS PIPING GOING TO BE TESTED ^ YES ®/I~O TANK NO. CONTENTS VOLUME ~ io \ ~ ~ ~co~~.e, `O o ~ 00 4 -TANK TESTING COMPANY .. 0 ~ ~~~ MAILING ADDRESS NAME(&~PHONE NUMBER OF CONTACT PERSO 'f'ro S ~~di~ il'~ SAS `~ TEST METHOD ~~~~~- ~3-~(ob3 Q~c- ~~S ~. ~'~~~ NAME OF T TER OR SPECIAL INSPECTOR r ~o~o~r~ ~v~.\ CERTIFICATION NO. C~ ~\~ DATE & TIME TEST IS TO BE CONDU ED oV l.~ co c1~00 ~.~~ SIG TUBE OF AP (CANT ~"~_ c ~~ DATE // ,+~ /_ 7 0 ~ b V VJ AP O BY DATE FD2077 (aev. oziosl `~ ~\ i ~ I ~~ ~ v ~ _~. i t,n G3 2_ ~~ r C~3~_~~ 1Z 333 ~~~~. ~. BELSHIRE -_ _° - / ENVIKONMEN lAL 25971 Towne Centre Drive Lake Forest, CA 92610 (949) 460-5200 Fax (949) 460-5210 Transmittal Date: September 11, 2006 TO: Steve Underwood City of Bakersfield Fire Dept. 900 Truxton Ave., Ste. 210 Bakersfield, CA 93301 FROM: Jim Brown Sent Via: FedEx Ground Ref# 358673110011200 RE: Spill Bucket Test 7-Eleven Site# 17721 3601 STOCKDALE HWY BAKERSFIELD, CA 93309 ~;`~~ _ o ~c~ Q ~^ As Requested ^ For Review ^ Sign & Return ^ For Your Use ®ForYourFiles Quantity Description 1 Spill Bucket test performed on 9/5/2006. Comments: Please do not hesitate to call me at (949) 460-5200 if you have any questions or concerns regarding this work. Jim own Project Manager ,~.~ - SWRCB, January 2006 Spill Bucket TestingReport Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: - 77L / Date of Testin -,~- C~ Facility Address: , j ~! ~'f?,L,E ~ /a.. w Facility Contact: Phone: Date Local Agency Was Notified of Testing Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Technician Conducting Test: Credentialsl:. CSLB Contractor ICC Service Tech. SWRCB Tank Tester Other (Sped) License Number(s): 3. SPILI~.B~UCKET TESTING INFORMATION Test Method Used: ydrosta ' Vacuum Other Test Equipment Used: - = - - - ~~ a Identify Spill Bucket (By Tank 1 / 2 6'7S"~ (/ Number, Stored Product, etc.) Equipment Resolution: -- 3 ~~1G1 t/~? 4 Bucket Installation Type: Direct Bury Contained in Sum Direct Bury Contained in Sum Direct Bury Contained in Sum Direct Bury Contained in Sum Bucket Diameter: ~ ~ /y'~ y ~~ Bucket Depth: / ~~ f ~ Wait time between applying vacuum/water and start of test: /v AFi~ ~~ pct O~tii~ Test Start Time (TI): ,3 r'y > : ~ 9 P ~' ~!'t1,3 ~ ,S ;' ,s ~J ~ ~ - 3 yr ~~ s0 0• Initial Reading (RI): ,~ v~y8 .S. 0;.3Z t(. S,f2o y, SSZG ~_ ?,443 3 _ 300 Test End Time (TF): f-Sri' 6 =~Y o ~ ,s- ~ ° (.`/~ ~ = `f f p 7 : vsc~-''+ Final Reading (RF): S. ~ S. 2- Y• s t(, ,5,~~ 3 . 3 o b / 3 _ 3 0 /` Test Duration (TF - T~: f'~i~,k /,S~y~ /3 itN1~ /,~i4 „~ ,4r ~ Change in Reading (RF-RI): .e-- ~ / ~, '(7- Pass/Fail Threshold or Criteria: ~ , fU ~ Z ~~ 7~'/-t~ _ 0~ "Z 7`"~ d 0 O2 ~~~ Icst t~c~,ulL - _ k as: _ tall _ j_ ';i~ hail ~ 'a.~sJ I ,ail _i I',us I ai _ - CoII1rilCritS - (include information on repairs made prior to testing, and recommended follow-up for failed tests) • CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature:~.~,%. ~~~~"`~" ~ Date: ~ rte! ~d ~ ' 1 State.laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements maybe more stringent. T~ __ `~ ~ BELSHlRE _ ENVIRONMENTAL Scope of Work _ ~ :~ SERVICES, INC. Facility: 7-11 17721 1 Date: 6/19/2006 Job Number: 3220 360 STOCKDALE HWY BAKERSFIELD, CA Estimate No: 393 Contact: Location: General Work to be performed: Location: Fill Sump - 87 Master Work to be performed: Replace 87 Tank #1 Direct bury vapor. bucket like for like Location: Fill Sump_-$7 Siphon Work to be performed: Replace 87 Tank #2 Dirct bury fill and vapor bucket like forlike USINESS NAME: ~ _ El-eVQ~v-, -{~ t-1~ Z~ SITE ADDRESS: ~j(op ~ S L~ a0.\ ~ CITY: (~a~2 f S >,-G l cl ZIP:o~ -~-~OO) MAP DATE: ~J-`a •p (p SURVEY BY: ~~, b~ DRAWN BY: AGENCY FACILITY #: A B C D E F G H I ] K L M 1 '1 2 3 4 s 6 s 9 10 ><~~" 11 12 13 J u S-a. C 1 a ('e ~ ~- t S ~_ t ~ ~ • ,~~ao V ' L Q 9 I ~~ c -~ s~ P ~ ~ ~ }~ __ ~- i ' (z~, ~~a I LEGEND ,/~~ -- DISPENSER SHUTOFF ~ ~~ CASHIER / OA ABSORBENT V FL FLAMMABLE LIQUID ~SDS MSDS & / EMERGENCY PLAN BR BATH ROOM _ /'\ GAS PUMP /'~) EMERGENCY / / ~ FIRE HYDRANT MONITORI '~~_~~ ~ rnp~g~~g~7gLE `~.L V~Ip ~-- TB I ~~/; TRASH BIN ~/~ SEWFR!FLOOR DRAM SHUT OFF ' /I E~ ELECTRICAL PANEL ~ TANK MONITOR / O WATER / MC ~, MOTOR COOLANT ~ FENCE /~ FIRST AIU /, L~ LI UID WASTE DRUM Q / 1 /~ EVACUATION AREA ~ ~ ~ PPE /~ MOTOR OIL ,MO ~N A C. ~8 ~ / AIR CONDITIONiNG~ ~ FIRE EXTINGUISHER _. 0 UNIT /( ~S~ SOLID WASTE DRUP1 / / I(O)~ OVERFILL ALARM /C TELEPHONE ~EM . EMERGENCY EXIT / C02 COz CYLINDER -8--~'~"'~' ~o O '~'~~~ ~ UST ~ +_ SENSOR ~_ DISPENSER ~ y TRANSFORMER TOR COOLANT CERTHOLDER COPY S~°~4TE . P.o. BOX 420807, SAN FRANCISCO,CA 94142-0807 -COMPENSATION FN Sl1R-AN-GE U ~ ~ CERT[FICATE OF WORKERS' COMPENSATION INSURANCE \' -ISSUE DATE: 04-01-2006 PROOF OF EVIDENCE ONLY SG 2597.1 TOWNE CENTRE DRIVE LAKE FOREST CA 92610 GROUP: 400426 POLICY NUMBER: 0000276-2006 CERTIFICATE ID: 304 CERTIFICATE EXPIRES: 04-01-2007 04-01-2006/04-01-2007 JOB: WAIVER OF SUBROGATION AVAILABLE UPON REQUEST " This. is to certify that we have issued a valid Workers'.Compensation insurance policy in a farm approved by the California Insurance Commissioner 'to the employer named belovv for the policy period indicated,,; This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. Tfiis certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term. or condition of any contract or other document with respect to which this certificate of insurance may •be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions; of such policy. THORIZED REPRESENTATI PRESIDENT ~- ".,EMPLOYERS LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - KAREN CASS, PRES - EXCLUDER. , ENDORSEMENT #1600 - LARRY MOOTHART, SEC, TRES - EXCLUDED. ENDORSEMENT 1!`2065 ENTITLED CERTIFICATE HOLDERS NOTICE EFFECTIVE 04-01-2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER ... BELSHIRE.ENVIRONMENTAL SERVICES, INC. SG , 125971.T.OWNE CENTRE DR .,.FOOTHILL RANCH CA 92610 ev.2-as! ~ ~ _ PRINTED' : 03-18-2006 M0408 SG _ ~ s - I1JSA ~ LTK j ~ :TYPE OFINSURAHCE GEMERALLIELBILTTY PODGY NUtdBER .. PODGY Ef~-CiIYE POLICY EXPIRATIO DATE DATE MfOD N - SITS FACHOi;aIRUSNCF a I,QOU,p00 X cor,~esxcwLGENeTCALL.tA~nm 9I6038-d3 U6/I4/20Q5 06114/~OQ6 FIRE DAMAGE[.4nyxe6re) s IU13,000 clAlnrts)naDe QX occuA t~D ow (~sr «,~ P~«I) s S , 000 _: Q PERSONAL G ADV W1URY S Z ~ QQQ, QQO GEtiEAALAGGIZEGATE S Z„000,000 GENLAGGF2£6ATECIktffAPPLIE.SPEFL' PRODUCTS-GOMP/OPAGG S ~~Q{}Q~QD POLICY ~ LOC ALITOMOBIIF LIABtETTY X ArtYAUro 9I6042-03: 05/I4/20QS 06/I4Fc006 COR18llJED SINGLE LIEN'T ~'a°°~"4 s I,OOO,OU ALL OWNED AUTOS '- HODIEY WJURY S SCHEOULFp AUTOS ~'~ ~~ A X HIRED AUTOS BODILY RLIURY S X !!ON-ONR`!F9 AUTOS IPef a¢iderd) PROPERTY DAMAGE S ' (Pef acciderL} • CsARAGE LLggILrTY ~ ~ ~ ALTTD ONLY- EA ACClDt3JT E ANY AUTO OTHER T}111N7 EA ACC S AUTO ONLY' AGG S EXCESS tIABt(-CIY EACEi OCCVRRETICE S S, QQQ, OE~O X occuR ~cLAmnstnADe EQ 5337678-QI •06/14/ZOGS 06/I4/Z006 AGC.IZEGATE r S,OW,ObQ~ B - a _ Df17UCTlBLE S RETENT]ON S ~ _s S 1KORKERS COAIPEHSAT[ON AMID TORY LIIUTTS ;~`_ FR r EMPLOYERS' LIABILITY . El. EACH ACCIOEN7 S EL DISEASE-EA [?'APL S . E,L OISERSE-POLICY LIMIT S B ontt~actors Pollution Liability 916D39-43 06/I4/Z005 06/14/2006 $I,000,000 LitTrit OESCt2[PTTON OF O~EW~'IQNS1,LfN...A7ICtt~,SIVB{ICLES/EXCLUSIOtSS pDbI~BY ENDORSEIAETvT7SPECVLL PILOYt51OKS . - - •. ~ _. _ - = E: Pr-oof Evidznee Unly ~1Q day notice of cancellation in the event of nvn-payment of preliriLlm. CERTIF(CATEtfQLDER ADDIT[aHAttr+sulzm;INSUREAt>=iTER: ~~ C~NeE€-~TfQK SHOULD AIlY OF THE A80YE -ESCRTHEO POLh~ES BE cANcELr Fn BEFORE THE p~tftATION DATETHEREOF TKE fSSUTEtG COHIPANYV{Id1_ENDEaW2T0IAAIT- ' DQYSVYHIFi'ENN07SCETOTKECERTFiCATEHOIDERFUII~SEDTO'TFLELFr-F; B'JTFAILU[iE TO MNLSUCH IlOTICE SHALL IfctPOSE FFO OBLIGATION aR 1_IA3II-T-Y OEELEIYKAiETUPONTHECOTdPA AGENTS OR[tEP6ESENTA'f1VES_ ----=Proof/Ev-idence ~tT~y~-~~~_°- AUTFiORTLIDRI=PEZESEDTTA _ ACQRD Z5S [(!3~ c' " p EZD CO~PQRAI lyrt -I~oo l..ll Y Ct[i+u~..a THE POLICIES OF INSURANCE LISTED 6ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ASOV{_ FOR THE POLICY PERIOD tNDICATED_ NOTWITHSTANDING i r~;gNY REQIIIR.EN[ENT, TERM OR CONI)ITIOEV OF ANY CONTtZACi aR OTHER DOCUlLiF1Sf W[Tli RESPECTTO WHICH THtS CERTIFICATE MAY BE ISSUED OR 'ltirsAY PERTAIN, II-IJ= tNSLIRAl`ICE AFFORDEB BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ACL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH "`Pot IcIES_ IIGGREGAII= LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ .. - - -- - 1~ .. i .. '1 ~ ~ ' i ~ . .r t .. .. , y ~ ( ~ , .. ~ .. • State Ot California "" u„«; CONTRACTORS STATE.LICENSE BOARD >' ~~'"' T~°'°"°""« ACTIVE.CICENSE ~ ~-" Conaumcr - ~ . . :lffuirs', , ' ~ ~en,.wma,'$08313 - . Em~Y cORP ~ ~ i '+ ~ ~ BurMenName BELSHIRE':ENV~IRONMENTAL A SERVICES INC w n . I; cb.ar ui«i(s) ~ A N~ . ~ ~- ~ " cxd~.oeeo~. 05/31/2008 ~ . .~ •\ • .. ' T ( ' , D~ . .. ~ ` =T = I SELSHIRE ~'~~ = ENVfRC7NA4ENTr1L Scope of Work SERVICES, lNC. Facility: 7-11 17721 3601 STOCKDALE HWY Date: 6/19/2006 Job Number: 3220 BAKERSFIELD, CA Estimate No: 393 Contact: Location: General Work to be performed: Location: Fill Sump `= 87 Master Work to be performed: Replace 87 Tank #1 Direct buryvapor bucket like fog like Location: Fill Sump - 87 Siphon Work to be performed: Replace 87 Tank #2 Dirct bury',fill and vapor bucket like for like C D E F G H I J K L ~a 1.~~ ~_ 1 ~~~2 1a-lQo V '' I L Q ~~ 9 9 ~- J _• O ~ 1 ~ ~ ~ ~ ~ c ~` ~ ~ s. ~~ io ~ ~ ~ °}~ _~ ~, ~-;a i LEGEND ~; DISPENSER L__~ SHUTOFF /- CASHIER v A O ABSORBEM' V F(, ' FLAMMABLE LIQUID /~$D$ __. ._, MSDS & ~BR ggTH RUOM EMERGENCY PLAN ~~ GAS PUMP EMERGENCY / ~ FIRE HYDRANT MONITORI --~ ~ LIQUID BLE TB /`~ TRASH BIN / ~\j~.` SEWER/FLOOR DRAIN SHUT OFF ~~E~ ELECTRICAL PANEL ~ TANK MONITOR / O WATER f _MC, MOTOR COOLANT ~~ - ~ FENCE /~ FIRST AID /; L LIQUID WASTE DRUM ~ EVACUATION ~ ~ ~ ~ x ~ PPE V iM0! MOTOR OIL / ON A C. AIR CONDI110NING~'i~ FIRE EXTINGUISHER AREA ~ UNIT 1~! S,/ SOLID WASTE DRUM ~ / / I(O)~ \ OVERFILL ALARM ~C / TELEPHONE /; EM EMERGENCY EXIT / COZ LINDER C~ ~ ~~~ ~ UST ~ i- SENSOR ~_ DISPENSER ~ ~ TRANSFORMER ~o~- ~ ~SFn MnTO= COOLANT ~. CERTHOLDER COPY S~~T~ - P.O. BOX- 420807, SAN FRANCISCO,CA 94142-0807 GOMPEIVSATION - t-N-S l.1 R-A N-G E - ~U ~ ~ CERT[F(CATE OF WORKERS' GOMPENSAT(ON [NSURANGE `+ ~ZSSUE DATE: 04-01-2006 GROUP: 000426. - POLICY NUMBER: 0000276-2006. CERTIFICATE ID: 304 - CERTIFICATE EXPIRES: 04-01-2007 04-01-2006/04-01-2007 PROOF OF EVIDENCE OfVLY SG 25971 TOWNE CENTRE DRIVE- LAKE FOREST CA 9261Q c10B: WAIVER OF SUBROGATION AVAILABLE. UPON REQUEST This is to certify that we have issued a valid 1Norkers'.Compensation insurance policy in a farm approved by the California Insurance Commissioner to the employer named below for the policy period indicated,,; This policy is not subject to cancellation by the Fund except upon 30 days advance written notice #o the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may .be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. " HORIZED REPRESENTATI PRESIDENT -''.EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 -KAREN CASS, PRES - EXCLUDED. . ENDORSEMENT #1600 - LARRY MOOTHART, SEC, TRES - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER BELSHIRE ENVIRONMENTAL SERVICES, INC. SG X25971 T.OWNE CENTRE DR .FOOTHILL RANCH -CA -52610 SG M0408 .2-os} - - - PRINTED' ; 03-18-2006 i ~_ - - .- i ~ ~~ ~ ~.'EYPE OFIItSURATlCE ~ .. POE.ICYNUN[HER POUGY Ei~_ GT15lE DATE POLICY EXPIRATION DATE kfJDD _ I.LNITS I GENERAL LIEf6ILffY' ~ ~- EACH OCCUR.ftEZtCE S ~., ddo ~ ddQ • X coc~austcwLGExE3rALLIA$fUTY 9I6038-d3 Q6/14/~OQS Of:~14/ZOQ~ FtREw~MAGE(~snr~r,~1 a I00,000 ciAlMS MAnE a occuR ~ t~D I>~ (Arnr «,~ P~~+I s S , 0©0 A PERSOtu~t c ADV IN~uRY a 1., OQO ~ pdp GBYQtALAG`GRE6ATE s - _ 2, U(lo, ot}o GE?ILAGGRE&ATEUNIITAPPLI_ESPEFC PRPWGTS-COMPIOPAGG S I,ddQ,QQ POLICY ~ LOC . AUT~4S0671-E LIAStUTY _ COMBQJID SJAtGIE t.l&UT S X AtiYAUro 97.6042-03; 06/I,~/20US 06/I4/~6d6 ~~Id°"~ I,t~dd,dU AiLOWNEDAUTOS '- ~ BODILYlN.1VRY S SCHEOULEp AUTOS 1Pa pxsmij ~ X HIRED AUTOS BOf/tLY 9`LrtlRY X NoN-owrlED airros (P°~ I s ~ PR04'ERTY DAMAGE S ' [P~ acadeNj CsARAGE LIAHILTfY - AUTi)ONLY-EAACCIDEFfT S AIYYAUTO OTHERTt~iN EAACC S AUT6ONLY: AGG S occESS Lu+BSrm • EACrt occvRREricE r 5' , dd4, 06d X occuR ~cz~alnnsnnADe EU 5337678-DI •06/I.4/ZUdS os/i4/Zdd~ AGCri>:GAre r 5_,Q4ld,dOd• B s DeDUCrISLE a RETFSti)ON S ~ S - 4YORKEIZS COASPEKSA7t0l1 AND TORY LttWTS ? . ER ~ EMPLOYERS LIABlLi"fY ~ F L., EitCEi ACCIDEXT S EL..DtSFASE-FAEINPLO 5 .Fi olsEASr:- POLICY Lp47tT s .~I.,dQU,dd(T Lim-[t ontractoc~s Pollution B L iability 916439-t~3 Q6/I4/Zd05 U6/I4/20QF .DESCIZIPT)DN OF OeERfS]IQNSILOCATIChYSIVS_fICLEStF7CCLI7SIDN.S ADO®$Y ENDpF25F_IAIIG{75YEGIAL PFiO1[iJK1NS . ~ s ~~: Proaf EV2dznce ©i~7y ~1f2 day notice of cancellation in the event of tlon-~Saytitent of prellliuln. CERTtF(CA'FE HQLDER twotstat~ru, ttasuRm: tNSUtz~i LEiTFx: • ~ Ci41'~CEZ-LA770ht • -==--=FraoffEv-iden~e Oz1y'~*~=== SKOULDAtQYOFTHEAHO1tERE5CFZfHEdPOLICIESBECRNCELLEDHEFORETHE EXPb'~AT(ONDATETHEREOF TKE6SUH~tGCOMP12NtYt+t>LLETIDEAVORTQF~fllli. DAYS WdR'TF1t NOTICI=TDTKE CERTIFLC47'E HOLIER fIACdEDTO'FKE LEr"~ 6'JTFRILUIZETQMAlLSUCEi N071CESF{ALLIhfPOSEK003tiGAT[ONDRUR?U-nY OFESxY CcA't4 UPOFt THE CO~SfPA liGENTS OFt KF36FSEIITAT11lES. . AEFtKOt;iLID R1=FkFSF~1FA _ _ t~~,e v eter~~~=~? 'IHE PO[JCIES OF INSURANCE LISTFI} BELOW HATE BEEI+i ISSUED TO THE INSURED NAIvSt=D ABOVE FORTHE POLICY PE{2lOD Ii~it3[GATED_ FtoTW[iliS7"gtlptNG ~~ qir( REQUIE(HUTENI', TERN[ OR CONDITION OF ATtY GOt~(TFtACT OR OTHEJZ DOCUM>=1~IT WETH RESPECT TO W[-I1CH TFitS CERTIFICATE MAYBE 1SSUID OR _=MAY PERTAIN, THi= INSURANCE AFFORDED 9Y1~-iE PO[.1CtE5 dESCR18ED IiERIIN IS SUBJECTTO ALL THE TERtvtS, IXCLUStONS AND COR2DIT70NS OE SUCH ^" onl Ir_Ii=S •AGGREG4TE LIMITS SHOWN MAY HAtlE BEEN REDUCED SY PAID CLAIMS_ f-~ c i i .. it \. , ~ ' ~° , .. V • ~ .. State OfiCalifornia ~ ~• " - u„a CO.NTRACTORS:STpTl;.L`ICENSE BOARD ~" ' ~ ~°'°""`"" •.ACTIVE.LICENSE ' ~.... COnSUmlr - • Affairs'. • ~ ~ ~ ~~,.wm,~•80831.3 EMily CORP •y . ~ e..i°°~~,m..BELSH(REEN~/~IRONMENTAL • . ~ •- .. ~ , ~•.`. ~ ~W°~°~~~° 05/31/2008 . ~' ~~ ".e . i ~• ;:... . - ~ , • I~ ,. I - BELSHf1~E _- T ~ I ENV/KC3NMENTAL sEKVrcES, rNC. Scope of Work Facility: 7-11 17721 Date: 6/19/2006 Job Number: 3220 3601 STOCKDALE HWY BAKERSFIELD, CA Estimate No: 393 Contact: ..Location: General 'Work'to be performed: Location: Fill Sump -, 87 Master Work to be performed: Replace 87 Tank #1 Direct bury'vapor bucket like for like '' 'Location: Fill Sump - 87 Siphon Work to be performed: Replace 87 Tank #2 Dirct bury_fill and vapor bucketlike for like USINESS NAME: ~ . E1~,V2v~ '~ 1-1-7 Z~ SITE ADDRESS: 3(pQ , s ~~ a0. C'~~ CITY: QA~. f S t-G ~ G, ZIP: ~-~oG~ MAP DATE: ~p-1~ ~p(p SURVEY BY: 1-Mp~. ~j( DRAWN BY: AGENCY FACILITY #: I A B C D E F G H I J K L N I 2 3 ~Q - ~ ~ 1 4 5 6 9 to ~•~, 11 12 13 * -. O n ~~-~Qo ~ L 1' I - J p ~--- J ~~ - s n s. ,,vat ~ `~~,1o d~V'~ -f'-aS~b71 ~I " PAL ~~a I LEGEN D DISPENSER I SHUTOFF L /- CASHIER ~A O f ABSORBENT V F~, ! FLAMMABLE LIQUID ~SDS __. .-_ / EMEORGENCY PLAN BR BATH ROOM _ ~~) EMERGENCY ~ ~ FIRE HYDRANT ~ _~J" M,ONITORIyG DQUID BLE ~0{{t~ TB ~ ~ SEWER1Fl00R DRAIN TRASH BIN ~~- SHUT OFF ~~E~ ELECTRICAL PANEL ~ TANK MONITOR / O WATER ~_MC MOTOR COOLANT ~~ - ~ FENCE /~ FIRST A1D LIQUID WASTE DRUM ~ * EVACUATION AREA ~ ~~ PPE ~M~! MOTOR OIL L QN A/ C. ~ AIR CONDTTIONING~~1 F]RE EXTINGUISHER UNIT ~ ... . V{ Slj SOLID WASTE DRUM ~ / / !(O)~ \ OVERFILL ALARM ~C / TELEPHONE ~/ : EMERGENCY EXIT EM. / COZ C~~LINOER ~N"' _ ~ / UST ~ +- SENSOR ~_ DISPENSER ~ y TRANSFORMER TOR ~ ~~~ COOLANT ~. . 1 / - 'T .tea • - CERTHOLDER COPY SG S~~T~ - P.O. BOX 420807, SAN t=RANCISCO,CA 94142-0807 - COMPENSSATION FAFSIlRAN-EE U ~ D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ;^ 'ISSUE GATE: 04-01-2006 GROUP: 000426 - POLICY NUMBER: 0000276-2006 CERTiF1CATE ID: 304 - - CERTIFICATE EXPIRES: 04-01-2007 04-01-2006/04-Ot-2007 PROOF OF EVIDENCE ONLY $G JOB: hIAIVER OF SUBROGATION AVAILABLE. 25971 TOWNE CENTRE DRIVE UPON REQUEST ' LAKE FOREST CA 9261Q - This is to certify that we have issued a valid Workers' ,Compensation insurance policy in a form approved by the California Insurance Commissioner 'to. fhe employer named below for the policy period indicated,.; This policy is not subject to cancellation by the Fund except upon 30 days advance written notice #o the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may •be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. THORIZED REPRESENTAT( PRESIDENT - '.EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 -KAREN CASS, PRES - EXCLUDED. ~ , ENDORSEMENT #1600 - LARRY MOOTHART, SEC, TRES - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER BELSHIRE ENVIRONMENTAL SERVECES, INC. SG ,25971 T_OF~iNE CENTRE DR J FOOTHILL RANCH CA 92610 M0408 .2-osy - - - .PRINTED' 03-18-2006 • • f - 4Z ~~~/R t~/Tf[- ~F~~~Y ~~m/8 4~~ E g PRODUCER (g¢9~$5~'-4-5QQ -~r$O() MiZlennzti~i Rise Manage~ertt & Ittsurartce Services L.i tense ~ OUQ-3480 5530 Trabuca RDaci - 3:rV late, CA °2620 ,rzsuRED BeTshire Enviratt~r~...tsta7 Services. Inc. 25871 Ta~ne.Centfie Drive Foothi~il Ranch, CA 9-2610 Fa[Ji R 6 91 R 0A Yd !t !.6 Gk 8 !9 F.... VD (~p~2~O~ TEAS CERTIFICATE IS ISSUED AS A fv~TTER QF I~tFORI~3lif T(ClN dHLYAFtD CONFERS I`IQ RIGHTS C)PQPI THE CERTIFICATE FfOLF3ER.. TH[5 CERTIFICATE DOES HC3TAf~9Eh'D, E;~(ENg OR ALTER THE CL}VERAGE AFF(3RDET3 PY Tt3E Ft}LtCIES BEL4Yy_ . • INSURERS AFFORt~IFIG CL)YERAGE JNSUR~tA: Zur7c}t At;taricatt -- ENSUR&a~ Steadfast Insurance ' ttasuRER r~ ~rsuRt3t a- tusutrsz E: ~ _ C,QVERAGES THE PQUCIES OF IHSI7RANCE L)STED SF10VY HAVE B1~1I ISSUED To THE INSURED NAkiED ABOVE FORTHE POLICY PERIOD IND[CATED_ NOTW[THSTi4l~lDIN6 I tq gI,IY REQUIKi3~FEKr 1FSZM OR CONDITION OE ANY CONTRACT Uf2 OTHEfZ DOCUAdEI`1T WITH RESPECT TD WFiiCH THtS CERTIF[(.ATE &L4Y BE ISSUED OR •'iti~L4Y'PERTRIN, THE R`tSUEtANCE AFFORDEEt 9Y7~-tE PO[.1C(ES DESCRlfiED HEREfN IS SUBJEGTTO ALL THE TERivtS, EXCLUSIONS AND COtlDtilDNS OF SUCH :.' POLIC[ES_~AG(xFZEGATE LI6AITS SHAWN MAY HAtlE BEER! REDUCED BY ARID CUlI3~eiS_ S' ~~ TY?E OF R15lIRAPICE ~ ~ .. POClCYM16dBE~i POLIGYEEEECttYE DATE POUCYEXPIR'AT[ON DATE MIDD LCdCfS . .. _ ( GENERALLIFL6[LffY EACHOl;CURRl=NCE S I.rUOO~OQQ X co~aazcwLGFxEtrALUA&nmr 916038-03 06/X4/2005 06/14/Z006 flR1= DAFdAGE (Any me Ere( a 100, 0(10 caAlnns t'v44DE ~ occuR ~ tI~ED E7Q't~Y a,e r~«,l s 5, 000 A PERSOP+nt ~ Aov w~uRY s Z, 000, 000 GEtiFRALAt=GREGATE S _ 1,000,000 GEKLAGGRECATEUk((1'APPLtESPEK PRDOUGTS-COh1PlOPAGG S 1iQQQ~00 PO[1CY JPERCT LOC . AUTQBdOBfI-E LfAHIEITY CC~FASIFlm SJKGLE IJWUT s ` X azyYAUro 915042-03; 06/1.4/2005 06/I4/ t00& tE° ~~ 1 k OQQ, ~ AIlOWNEQAUrOS ' SOD/LYINJUfZY s sCi-/mtlLEP AUTOS ~~ ~~ ~ X HIRED AUTOS BOOILY ~tlVRY X PION-aVVNEt) AUf05 IPaf esidait) S [)AMAGE 5 • ~~ 8~~ • GAkAGELV(BtLiTY ~ aUTOOHLY-EAACCIDEtJT s ANYAUI.O aTNE12lTIKP1 EA ACC S AUTO aNLY: AGG S I7CCE55 LJABtLITIf EACH OCCURRENCE S ~ 5 ~ OQQ ~ Q(;(j X occuR ~cLAnusavwe EQ 5337678-DI •06/14/Z005 06/I4/Z006 AcGru=GATE r 5,000,000. }~ B S DEOUCf[eLE S RETET~titON 5 _i s l^~ORKERS CORSPEl'lSATTON APtD TORY U0.tSTS ?~`_ Q2 EMPLOYtTLS LIIiRFt_iilf E.L EACf i ACCmEN7 S EL[itSFASE-FAEMPLO S FLOtsEaSE-POLICYLfahlT s $1,000,000 Lituit antr~actars Pollution B L iabi17ity 916039-03 06/I4/Z005 06/14/2006 . nESCRlPTplt Ot= oFE3uUlQnis¢ocaTior+srvS±x~srECCLUS[oPZSaDD® sYEnDVRSraarh~tsrt~.~ recutwnsna ~ zE: Proof Evidence Only =10 day notice of cancellation in the event of Hatt-payntettt of pre-~Iium. I CERT[FtCATE HQLflER ( ADD~r[aruu. -NSURE~: IPCSURax tFiTER: ~ t:AI~eELLATtoI~ -~ ==-=Fraof/Evidence O~t'I}ri4'~-='= SHOULD ANY OF THE A80YE RESCRIHEO POC1CtES BE C1lNCFI t Fn BEFOFZE THE Ea"P{RATTON OATETHERffiF. TKE 65U@!G COhSPANYVYfLL ENDEAVa€t TO IGfAtt_ DQYSWRtFTFStNOT3CET07HECT32TIFiGi7BHOLDH2F7ACdEDTO'nLELEPT, H:fTFAtLURET6'MAlLSUCFI NO'nCESE{ALL(7dPO5EtLOOStIGATICNDRf ~e~t'--tT'~ OFE;PtYlEA~tF2 UPOPi TEiECO[3PA AGENiS aR (ZEpRESENTAIltilE3 ~ AUTttQRTLEO ti73'kESE]~ITA ' ~~ .. •~° .. ~ r • ~ ~ ' • ~ '~ ~ . • -State,~Jf'Califomia I I '° - ~ G,d~ CONTRAGTORS:STpTE.LICENSE BOARD ;' '""'~~ •` :.I T~°'""'""'" ' ~.ACTIVE:LICENSE '• ~- . :Consumer - • Affairs'. ' ~~..wma,'80831;3 - Emur CORP ~ ., a~.~..~~,m. BELSHIRE'~ENV~IaONMENTAL ' ~~ ~ . ' - ~ .. •~ r ~~ ~ ~ CIa.dlb.tim(s1 A HAZ. ~ ®, ~ ~ ~ . 1 ~ I' ~ ~ . ~~•~~^ ~~• 05/31 /2008 ~ . ~' •' `~ • . • .. -•~. . {• .. ~ ~. °! ^ f BEISHIRE IJENVIKONMFNTAL Scope of -Work sERVicFS, rnrc. Facility: 7-11 17721 3601 STOCKDALE HWY Date: 6/19/2006 Job Number: 3220 BAKERSFIELD, CA Estimate No: 393 Contact: Location: General Work to be performed: Location: FiILSump = 87 Master Work to be performed: Replace 87 Tank #1 Direct bury vapor bucket like for like Location: FiII Sump= 87 Siphon Work to be performed: Replace 87 Tank #2 Dirct bury fill and vapor bucket like for like BUSINESS NAME: ~ _ E1.~V~„-, ~ 1-7-] SITE ADDRESS: ~j(aQ ` s C.~G d0.` MAP DATE: ~j-~~ •p (p SURVEY BY: h~v~O~ A B C D E 1 2 3 4 s 6 9 i I~~1- CITY: (~a~FZ.f S i-G ~ ~~ ZIP: 330~J I dDRAWN BY: AGENCY FACILITY #: I ' F G H I J K L M u S-Q- C. ti ~ a ~~ ~ ~-{ S 1~-~Qo to ~•~, , II 12 J 13 ~I ~, d~o..~l-;q I of >. - i ~~° ~ • ~ O ~; ~E t8C ~ Q ~ 0 ~ ~ 9 I r-- R o ~ ~ ~ ~ ~ I ~ ~~ ~ s n C n '~ LEGEND ~-- DISPENSER / • ~_, SHUTOFF ~~ CASHIER \/A O ~ ~~ ABSORBENT F(, ~ FLAMMABLE LIQUID `~1SDS __..._, EMEDRGENCY PLAN BR BATH FUOM GAS PUMP ~~ ~ EMERGENCY / / ~ FIRE HYDRANT MONITORI RBLE ... LIQUID TB TRASH BIN /X SEWER/FLOOR DRAIN ' ~-``~ SHUT OFF /~E~ ELECTRICAL PANEL ~ TANK MONITOR / O WATER /' M C MOTOR COOLANT ~ ~ ~ FENCE /~ FIRSi AID /~ L~ LIQUID WASTE DRUM /~~ SOLID WASTE DRUM ~~ '~'~ ~ /(* / C\O/) \ / EVACUATION AREA OVERFILL ALARM UST / `~ ~~ /` ~ i_ PPEf~M~! MOTOR OIL TELEPHONE a/ ; EM EMERGENCY EXIT SENSOR ~_ DISPENSER N p ~ A~ C. ~+/ COz ~ ~ AIR CONDIIIONING~ 1 FIRE EXTINGUISHER UNIT C~~LINDER - ,~.~~'~•~-'s~'~' ~ i icFn rnnTOR TRANSFORMER ~"I~Il- COOLANT_~ CERTHOLDER COPY I - S~~TE _ P.O. BOX 420807, SAN t=RANCISCO,CA 94142-0807 -COMPENiSATIC+N ~ - E [•F S CI F2-A N-G E U ~ ~ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE \Y •ISSUE DATE: 04-01-2006 GROUP: 000426 POLICY NUMBER: Ob00276-2006 CERTIFICATE ID: 304 CERTIFICATE EXPIRES: 04-Ot-2007 04-01-2006/04-01-2007 PROOF OF EVIDENCE ONLY SG JOB: WAIVER OF SUBROGATION AVAILABLE. 25971 TOWNE CENTRE DRIVE UPON REQUEST LAKE FOREST CA 9261Q. - • This is to certify that we have issued a valid Workers',Compensation insurance policy in a farm approved by the California Insurance Commissioner ~o the employer named below for the policy period indicated,.; This policy is not subject to cancellation by the Fund except upon 30 days advance written notice #o the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded ' by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may .be issued or to w(iich it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. . ~'~~ " HORIZED REPRESENTATI PRESIDENT - '!EMPLOYERS LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 -KAREN CASS, PRES - EXCLUDED. ENDORSEMENT #1600 -LARRY MOOTHART, SEC, TRES - EXCLUDED. ENDORSEMENT 1#2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2004 I5 ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER BELSHIRE ENVIRONMENTAL SERVICES, INC. SG •:25971 .T.OWNE CENTRE DR J FOOTHILL RANCH CA 92610 SG ' M0408 2-05? ~ PRINTED' : 03-18-2006 • s - g PRODUCER (g•49~85~'-4SQfJ -4•$QO Mil1s?nniEiai Ride Manage;aertt & Ynsurance Seruices _ Lei cetrsa ~ OC13480 553Q Trabc~ca Raad _ 7=r~tine, CA 32-620 - tNSURSD f3eTsbi re Envi rohs~...asta7 Sere i ces ~ Inc. ' 25371 Tawne Centfie Drive Footh-i77 Ranch, CA 92610 f ~ tNSUCrm E: ` ~_ G.E?VERAGES THE PQ{ICIES OF INSURANCE LISTII7 BELOW 1-fAVT= BF~EN [SSU1=o I o 3 tiE IT1SUtzr1~ ruilN~y twuve; tuK ~ nt YVUCY Y~ttivo 1NDtcATED_ NOTW(TFtSTAt1p(NG i rs qNY REQUfR.Hf~NI, 7FRM OR CO(~ITION OF /t,NY CONTRACT OR OTHESZ DOCUCv1>=)Sl" W(TH RESPECT TD WHICH 7H(S CERTlF1CA'('E bA.4Y gE (SSUID OR ;'h,~sRY PERT:4IN. THE INSURANCE AFFORDED ~1fT[-IE POF.1C(ES QESCRlBED H13tE3N IS SUEiJECTTO ALl THE TE72MS, EXCLUSIONS AND CONDCi7oNS OF SUCFf "~POL)C[ES_~/It;GREG4TE LIMCCS SHOWN N)AY RAVE BEEN REDUCED BY PAID CLAIMS_ i ~.~ ~.7YPEOFIKSURANC~ .. .. ~y-ZrNO~g@{ ~ POLIGIfEFEEL'nYE DATE PDL[CYEXP(R0.TION DATE MIOD L.kN71"S a. ~ GEN~RAL(J(;S[CITY EACH OCCURRENCE S 1, OQO a OQQ X coitauszcwLr~EN~tzALLtASUm 916038-d3 Q6/I4f2QQ5 UF114/Zt305 FiREruv~ACe(~~er~) S 1U0T000 canons twwe a occuR ~ tv~D ExP (Any one ~«,) s 5, URI) ,4 PERSOt~u+t t ADV wauxY s 1, QQ~, f1(IQ GaiEwatAt:cRECATe s _ i,aga,oaa GENLAGGRE$ATEUkttiAPPL1ESPER PRODUCTS-COhTPK]PAGG S 1„4f}Q,OQ POLICY jE ~ LOC . AUT04t08RE LIA87LilY COfABINEI] SINGLE LgWT s X nrtYAUro 9Ifi04Z_D3. 06/14/20US 06/I.4/2QQ6 ~~idaiQ I, f)QQ, UQ pLLONRfFDgUf05 ' ~ ~ BOOIE_YlNJVRY . SCHEDULEp AUTOS (Pa pamN S A X F(1REDAUT05 60OKY9'WRY X NON-OWNED AUTOS S (P~ewden[) PROPERTY DAMAGE 3 ' (P®F accider~} GARAGE LV48ILfTY AUCD ONLY-FA ACCIDENT S ANYAU('O OTHER THAN FA ACC S Aura ONLY: pGG S EXCESS LV16iLl'CY EACH OCCURRENCE S ~ ~ OOO i OI3I] X occuR ~c(AausnnADe Et? 5337678-QI -Q6/I4/Z005 U6/I4/2U06 AGGRESAtE s 'S,O()O,i)00• B s DF_6UCT[8LE S RETEMiON S '•n S . IKORKFKS COPdPEl1SAT[ON 0.NO TORY Unt1'CS ?'`_ ER , . ~~~~ ~~~ E L Eli.CEi ACCtDENC S >=LDtSEASE-EAFTAPL S ELOtSFASE-POtJCYLIaAIT s $1.UUfl,Oll() Lituit antractors Pollution B L iability 916039-Q3 D6/14/Z405 Q6/I4/20QF: n e 6 aA>a~.>,~m ~ ab$•~~. ~ l36f36/ZRO~ TH[S CERTIFICATE IS IS5[lEfJ AS A T~.AITER OF 1NFOR1t~AT)f1I1 ©NLY~iND CONFERS NO RlCYF{i-S f1POTd THE CERTIFICATE F{t3L~?EfZ. THIS CFIZTIFICATE DOES Ht3TA~5Eh')~, EXTF_ND [?R ALTER THE CO~IE}ZaGE dFFt3RDEf33 I'Y THE PC)LICIES BELLZW_ • . • ENSURERS AFFORI~INCY CL?YERt~GE INSURZ~T2 A- ~UI"T Cf( ~IiI~r7 L~.Ti -` iNSURSaa; Steadfast Insurance UasuRr=R ~ 1FrsuRt3x o- . DE5C42IPTpN OF oQER/S)1QNS20cA17cmtstYSifeLES~EXCLUS[otts ADbED SY ENDORSEtaEhTISPEC~Ai.. PFtoYtstONS . - - .p , 2E. Proaf Ev~dance Only - - =1E? day notice of cancellation in the event of rlQn-payment of pr~e)fliutn. cERTiF(CATEH(7LDER .aooiriorustu~+suRED;trrsvrR£czt~irete: ~ CAtlICELLATiaN •~ SKO(ltAl{HYOFTHEASOYERESCFZSHEOPOLICIESBECANOELL.EL~BEFOKETTiE EXPfRATYOCF DATE'if1ERffiF, TKE L45ElENG CDh[P~AM[t tII.L ET~FDEaVCRt rO ILfAtL t=AY5Y1RtFtFriNOTSCET07HECII2TIFSGi7'EHOt~Btt,W6tIDT+7TH6~-T 6uTFRlL[fRETO6f0.1LSUCti NO'TIGESE{ALLfI,tPO5ENO03i1GATIONDRlfA3i~-flY oFAttY IOFstF2 tlPOlt THE COSSPA AGENiS oR F2EPRESENTATlY65. ==-=Froaf/Ev-idence t3i~tly'~-=:= Au~rsoRr~ntz~t~FSENrA ~ _ ACORII zrs.5 Cftstl - - - - © RD CQ~f'O tOi~I'f988 • ~~. • .~ . .. , `r .. , ~ ~ . - ' ~ ~ ~:~r • .. ~tate.SJfrCalifornia ~ " ~ ~ --' , [f~~C~ONTRACTORS:ST~4tE.L`ICENSE BOARD ;' '~'`~ , :Consumer -.AC'fIVE.LICENSE ~ ^~~ , t ';:`I • Affairs', ;, - • ~ ~ ,~~,.wm,~'80831:3 EMS, CORP -~ , ~ a.,~<~~m. BELSHfRE:EN1/:IRONMENTAL ~ a. • - ~ , r ;~ERVIC~S .INC ~ - ,. ~• l eh,a~ v,~i,, A ~ I?,Z. -, ~.. r~w„s.~o~. 05/31/2008 - :~ • 1 ~ • . - -,,. ~• y ' i ~ I UNDERGROUND STORAGE TANK ~i ~~. PERMIT APPLICATION TO ~~' CONSTRUCT /MODIFY /MINOR f',' MODIFICATION OF AN UST ,~ H 8 9 P D PIR! ~Rrr r PERMIT NO. ~ V TYPE OF APPLICATION: (Check one item only) ^ NEW FACILITY ^ MODIFICATION OF FACILITY Bakersfield Fire Dept. Environmental Service 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ NEW TANK INSTALLATION AT EXISTING FACILITY ,~' MINOR MODIFICATION OF FACILITY TARTING DATE PROPOSED COMPLETION DATE AGILITY NAME ISTING FACILITY PERMIT NO. ACILI (.~JO/S ~rOC ~//~/ ~~~w ITY ~ /fir I •PI~ ~/7 /``C IP ~Q~~V (/~f PE OF BUSINESS _ / LET ~~ ~a"i~t1' PN # ANK OWNER ~~ PHONE NO DDRESS ~o` ~ ~'' iii ITY ,G~//mss' Tyr IP CODE 7~Z2 ~ ONTRACTOR /~~~~ ~ ,~~,~~~.~-/ ~ A LICENSE NO. X8'3/3 CC NO. Z3 ~z~~ DDRESS ~Q Zs'~~/ ~uw[ ~ /~/~-' ITY ~,y /'-~ ~~ ~ IP C DrE~' ~O~CJ HONE NO. - `~ia ~~ KERSFIELD CITY BUSINESS LICENSE NO. Obi 7 0 RKMANS COMP NO. ~~ - o NSURER .~' `~~ BRIEFLY DESCRIBE THE WORK BE DONE r ~ / ~/ ~/~c~" /l c 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 'i ^ YES ^ NO TANK NO. THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. OLUME NLEADED REGULAR REMIUM IESEL VIATION The applicant has ived, and lands, and will comply with the attached conditions of the permit and any oilier state, local regulations. 77tis b, or~ted under petut[ty of perjury, and to tl~ best~f my knowledge, is true and correct. APPROVED BY: APPLICANT NA~ (PRINT) THIS APPLICATION BECOMES A PERMIT WHEN APPROVED c~ 0 n .~ s 05/22/2006 13:04 FAX 0Sl16f20t~6 12:55 15106148811 1~~b zz, aoo~ Ms. Judy Sopa- 7-Eleven, III,c, 9771 Clai7xnot]t lv,[esa, Suite E Sala Diego, CA 92124 J Eltxail: 'so er -1 l.c m f~ oo21ao7 PACE 91 MI'ANIES~ING Areserre and 5uaiain Global Aasefc d Mlroshvehrrp ~A ~r 54~ T~ltq~.A 946?7 ''ItL(511~ 6148BOD"I~(SI(}) b14-8811 ~~. w ~Q Cathodic Protect~4t13ystem 5tatns Summary • score #: xrraf [Bateerenad. e,~ Dltegf•Cgrrl/COtLEp!!f0l,A,~]dSbp00pt: 7/9104 - Cathodic ~rgtecclga Sycteut ~' rnaef MACE Crit~rJn ^ 3-Yelr CertlAcle:on GvnuplNed: Yes • ReCtlfieY UC Oat~tt ~ volc4i ~$ ampec~q Corrpro Tecttnlcllm; Albert Nlak~ ' Corrprq p4on! Ns f~Q Reference; Cathodic Protectloa System Tro>dlhlestioot Survey '~'hreo (3) Undeargroumd Fne1 Stnt'>~-ge '~'abks 7-11 Store #~77ZX Qa 36a1 Stocktiftle ~i~gh~vay, Bakersfield, CA 93309 Dear Ivls. Soper: Cotxprv Companies, Inc. e77gi»eerixxg personnel r~rvetttly co77apleted a t~ltodic pratcctio~n syat+ecn troubleshoot survey to evaluate the statvs of the ilrx]ptes~d cuzaeint cathodic prote+~tion, system (CPS) at the above referenced locatiott. The CPC was fouz]d to have zero voltage and current output during a 6a-day check an September 16, ~a05 by Tat7lfnologyr. ,A. troubleshoot survey ~rtts scheduled and wag cvmducted on January 9, 2~d6 to determine if all co7~nponeztts of the Cl?S have been returned to proper i'il~-ctxon and to ca7lfiit~ that tlxe CPS is pravidi~,g adequate levels o~ corrosion protcctiotx to the u~dei~g>rouild fuel starage tattles at t$e zGferenced locatxott. Survey results ;ludfcate ttlat the three (3) unti~Cgrouttd fuel storage fatales at this facility meet the crite~a for ca#hoci~ic protectio~p, cd~l~ta~ine~d in MACE IQtexu~atiioual Standard RPOZ85-02 and xa acco7'deance with the applicable USEPA and State oi' California refluirementg. The su7ryey of Store No. 17721, feted alu Bakersfield, CA was completed by Corrpro'e cartrnsian 'engiaee,rxng tech7aiclans ou JAnuary 9, 2006, This zepozt vutlinr,.s the teat p;Cnceduzes utilised during the troubleshaot survey aad the subsequent results, 'Tito rapart preseats canelus~Ca7s relative w the operational status of the cathodic protection systetxl. Field data obtained duxiog the survey has beezt tabulated ar~d is imcluded in Appendix A, of this report. C~R~tPR(~ CCx ;575-4256 Page 1 of 3 ~ 003/007 ' 0512212006 13:04 FA}i 85lI612006 12:55 1510614BB11 FAG'E 02 SYSTEM 1~ESCRIP'TION The CQS consists of d~isaibuted anode beds ener~ed by a 50-volt, 1Q-ampere rectifier. 'fie cathodic prateati+on system is designed to prevent god-side corrosson ofn thv ttn+re (3) uedergrouud fuel storage tanks arrd dispcrrser piping at the site. SST FRQCEDiI.RES The structure-to-soil poton~tial taaeasurerneuts w obtained by placing a eoppcr/eappe~r-~sniFate refereace cell in contact with the soli axrd coiuzeotng a test lead bctwccn the ~,cfcrcncc cell and the negative ternninal of the voltmeter. 'The ~ssitive carrrr~ctioxs trtaessaty to co~lete the measuring circuit was trade by directly coxrtactirl~ t3~e structure under test. These readings were recorded with the system operating (Ou.) arrd with tJxe current momentazxly interrupted (Instant ~. "Static" potentials were measured before energizill~p the xextif8r, Electrical Continuity was Confirmed bciweexr rile subject structures and the CPS by ~e rnvasurement of potentials (a value less that 3 mV eanfirms electrical continuity). RESULTS ~1~1~3,A,NALYSx$ Rata gathered during this stitvey axe tabulated azi~. presented ~ Appendix A. The criteria used for the cathodic protection of buried metallic stru~tnres axe xafdren,eed i>n the Federal Register 40 CFR Parts 280 and 281, which are in aceords'trlce wilt the NACU International Standard Recommended Practice ItP0285-02. Local 'structeu~ta~oil potential measurements °wt<re recorded wx#h the clxxre~at applied axed intencuptcd. Tlac structure-to-soil potential measurements obtained satlsTicd the -850 millivolt "instant OfP' potential criteria. Hence, the tairks ltueet the Ct1teT18 SOT CathOdiC protection aS cstablishad by Federal Regulations. AU tac,lcs are electrically continuous. sYS~EriI SICTRVEYS 'l'ire cathodic protcatiosr system should be resurVtiyed ova a regular basis to eva'urA coutizYUOns effective gpCratioxl. Federal Code of Regula'tians ti~ndate rho syatern be surveyed at least ante Gvcry three (3) years. The next mandated US'1' ~ttrvey is due in three (3} y~rs (i.e, before January, 2009) end avert' ttt~ree (3) years therea#~er. 1~C~M.MEIYDAZ'YONS ~ erdes to ensure that rite cathodic protections sy5,'I~m gives ccantinual effective pcrforpoanca, a p~veritatxve tnaintcnatlce program ixtust be initi$ted. This prograux ~onust include bi-monthly surveillance of tlxe rectifier urUits, and periodic coplete system evaluatinn&. The bi-monthly surveillance includes recording unit output levels and tontine maantoaance as recluiured The periodic awvays are best conducted by n qualified Cgrrosion engineer and allow adjustraae~nt of the system to rxreet cavimamental and structural cl~rges. In a,ccvxdance with 4U CFR Parts 280 and 281, the rectifier surveallanCe mast be cdndu~ted bi-monthly, vyit>x complete syste~nn evaluations at tree (~) year intervals. CCI #575-4256 Page 2 oi'3 ' 05/222006 13:05 Fp}{ f~j 004/007 05/1fi12006 12:55 15106148811 FAGS 03 Based on the xcsulte of this survey, it ie aozu3l~ded that the oathodic pzoteotian system at ~torc No, 17721 is operating effectively and no kher additions ar modifications are requited at this tiI1JG. Survey results indicate the etndergrouitd fuel 3bb?agC tanks at 'tb,is facility mcet certain criteria for cathodic protcctxoq canrain,$d izl NACE Txttcrttational Standard I,tP0285-Q2 and are itta compliance with regulations for tha State a~Cali~irxrtia. Should you have arty gttGStians ax cauunents ct~tloemiztg this report please do rzat hesitate to contact me at 510-6X4,8804, Hxt, 22~ yr Ben lvtc~pddertt, F.xt. 244. Sincerely, Ivan Mathew, J?. , Aistrict Jrzagineering 9upe~rvisor/NACE CP Specxa~#st No. 5317 Calxpro Companies, Inc. IMB1VIc.F/ts/Scrver G: Regianttl/All Reports/ZU06 RelscYiC'tsJ57S-4256 Emct. Data, Eteozonic Invoice to Follow cc:~arlcnc Worley (7-Elevezt) Via Email: cwot1e01 Cer7.7- I 1 cow, "xeg$Y $c~ (7'E1ov8u) by Umail at pbu~OlCt-l l.com /Stephea Olenicb (`I'anlmalogy) by &mail: so - wtan c3 .con art Schutza (Tankxt,ology) by E-mail: u tanknolo .cap Ckuis McDertnaad ("~'Qnkrtology) by Umail: erttcdernzand a7tar~lcnala ,/~"oart Mchalick (Coxxpro) by E-+a~ta{l: tn~ehaliCr~corrnro cam CCX #~~s-4256 Pale 3 of 3 05!22/2006 13:05 FA}f 05/16/2006 12:55 15106~d661~ ~~~~~~~ l~ 005/407 PAGE 0a TEST ],ATE, ' 05/22/2006 13:05 FAX I~j006/007 05l15/209b 12:55 15106.48$1] PAC£ 95 XtECT~F~R OPER.4~T,ING RECORD 7-Eleven Store #: 17721 (e~ 36(?1 Sto~tdale Hi. ~ ~e ld. C,A. Tylso ofRectif~er Unit: Model SSP - ~~gt Rectifier Mfg. By: U .v AC fit: 11 s Volts S.2 . . A~raperes Rated DC Output: „ 5Q_Yalts ~Q,., Tazget Cuxrcz~t Output: RBCORD OF REA-Dl'N(3S AND INSPECTIONS Co~gtinu#tY l~lata Mid-Grade Tank O.q xnV Continuous Premiuxn'I'ank O.O.,mY Cotlt~ous lte Taaik 0.0. V Continuous Dis erasers OA„t1~V C~tix~uvu,S GQ #575236 Page 1 of I . ~~ 05!22/2006 13:06 FAX ~5I1,6l2006 x.2:55 1510b148B11 coR~.as><oly s~vE~ lzav nar,A. ANn r,~s>r~s ~ ooz/oo7 ~ PAGE 06 ~ Cpznpany: 7-Eleven. Inc Cottt~lct; 7udv Sover Job Title: Catb~odic PcotsCtion System Troubleshoot Re-S~ey Job Site: 7 Eleven Store #17721 ~ 3601 Stt~okdal~ Hiah~ra~ Bakersfield- CA Teclauician: Albert Nickey pate: ,~,(9lOb ___ __ _ TASULA,'>[~ON OF 1~ATA "X'ABLE All potential rgleasttrC7triazlt5 al'1t recorded in (-) millivolts. Ref No_ Location X.... 2. 3. Remax][S 1 Re ulcer Grade'~'a~ttk aatb~ Fill Riser End 343,. 1933 $$4 Twine End 33b 2240 1865 x lte ttlar Gx~B Tank orth Fill Rise[ End 30~ 223Q 990 Turbine Bud 29~ 2180 106a 3 Frem3u1111 Grade 'x~k ., Fill Riser Eztd 36 2210 963 Turbine Eud 26 1870 1360 4 DiLs egsers .... ]. 33 1539 985 2 319..._,..,,,. 1990 IU45 S Veants 1 sad 1$sa 903 2 3 1886 $90 3 341_ 1873 882 NO ea; 1. "Sta~c" structure-to-soil potential. 2. "ON" slxuctnr~o-to-soil lavt~entiai messarerna~tts. 3. "Instant OFF" suture-ta-sail potential zneasue#~aents. 4. AlZ tlr[ee (3} taws arc catlaadically pratectcd pele MACE International -550 mV lsotentisl cathodic polarization criteria. 5. All three {3) ca~nks are electrically cominuous wiitlz each other aced with the recti#ler negative (by the ~ 3 mY potential difference between su~ject streicmres). CCaf A~~7$-4256 Page 1 of 1 f~ ~ 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 07/12/2006 Order Number: 3147500 Dear Regulator, Date Printed and Mailed: 07/26/2006 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #17721 MARKET #2133 3601 STOCKDALE HIGHWAY BAKERSFIELD, CA. 93309 Testing performed: Leak detector tests Line tests Monitor Certification Secondary Containment-Spill Container Sincerely, Dawn Kohlmeyer Manager, Field Reporting ;. TANKNOLOGY CERTIFICATE OF TESTING ~ rpn 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 TELEPHONE (512) 451-6334 FAX (512) 459-1459 PURPOSE: COMPLIANCE TEST RESULT SUMMARY REPORT TEST DATE: 07/12/06 WORK ORDER NUMBER: 3147500 CUSTOMER PO: CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #17721 P.O. BOX 711 MARKET #2133 .DALLAS, TX 75221 3601 STOCKDALE HIGHWAY BAKERSFIELD, CA 93309 • Manager (214)841-6714 (661)834-3093 TEST TYPE: TLD-1 Prnrlnr_+ Pina Tinh+naec Taco Rncnl4c LINE LINE LINE DELIVERY IMPACT ID PRODUCT MATERIAL TYPE TEST RESULT FINAL LEAK RATE (gph) VALVE A B C D A B C D FUNCTION SOUTH 1 REGIILAR DW FLEX PRESSURE P 0.000 Y NORTH 2 REGULAR DW FLEX PRESSURE P 0.000 Y 3 3 PREMIUM FLEX PRESSURE P 0.000 Y Fvic4inn I inn 1 Halt ~ln+nr4nr Tnc+ EXt -- -- ST1NG LEAKDET ECTflR#1 EXIST ING'LEAK DETE CTOR.#2 LINE - - --- r-- ID MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # RESULT SOUTH 1 RED JACKET FX1V 10205 1899 P NORTH 2 VAPORLESS LD2000 04041227 P 3 3 VAPORLESS LD2000 04041224 P ~, Nnw KCnl9 nmm~nt 1 inn 1 n~lr f)n+en+i.~ Te.c4 REP LACED LEAK DETECTOR`# _______ _ ___ EPLACED"LEAK D . ECT LINE ID MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # RESUL .... ..~~~~..~ ....~auw ~~yv~ ~ uuviu~auvii, vqu www.iaunuVlVSy.WU1 AuU SCICGL Vn-LInC ISCp07L5-W I(HY, or contac~ your local ianicnoiogy omce. Tester Name: WILLIAM ROGERS ~~~~ Technician Certification Number:1647 Printed 07/26/2006 07:23 SBOWERS INDIVIDUAL TANK INFORMATION AND TEST RESULTS .. i Tanknology TEST DATE:07/12/06 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3147500 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #17721 TANK~INFORMATION Tank ID: soUTx 1 Tank manifolded: No Bottom to top fill in inches: 12s . 0 Product: REGULAR Vent manifolded: No Bottom to grade in inches: 134.0 Capacity in gallons: lo, 027 Vapor recovery manifolded: YES Fill pipe length in inches: 32 . o Diameter in inches: 96 . oo Overfill protection: YES Fill pipe diameter in inches: 4 • o Length in inches: 323 Overspill protection: YES Stage I vapor recovery: DUAL Material: STEEL Installed: ATG and cP Stage II vapor recovery: sALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Test v~ethod:vacuTect LEAK DETECTOR TEST RESULTS Test method: FTA Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: RED JACKET Ingress Detected: Water Bubble Ullage Model: FXiv Test time: S/N: iozos 1899 Open time in sec: 3.00 Inclinometer reading: Holding psi: la VacuTect Test Type: NoT Resiliency cc: 6o NoT VacuTect Probe Entry Point: T ESTED Test leak rate ml/m: is s . o TESTED Pressure Set Point: Metering psi: to Tank water level in inches: Calib. leak in gph: s . 00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Tt~st-type' TLD-1 LI[~IE .9 E C ~ Material: Dw FLEX Diameter (in): 1.5 Length (ft): 25.0 Test psi: 50 Bleedback cc: o Test time (min): 60 NoT NoT NoT Start time: 12:04 TESTED TESTED TESTED End time: 13:04 Final gph: 0.000 Result: PASS Pump typo; PRESSURE Pump make: RED JACKET COMMENTS Impact Valves Operational: YES Printed 07/26/2006 07:23 INDIVIDUAL TANK INFORMATION AND TEST RESULTS .~~ ~ Tanknology TEST DATE:07/12/06 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3147500 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #17721 TANKIt~FORMATION T~ Tank ID: NoRTx 2 Tank manifolded: No Bottom to top fill in inches: 126. o Product: REGULAR Vent manifolded: No Bottom to grade in inches: 132. o Capacity in gallons: 10 , 027 Vapor recovery manifolded: YES Fiil pipe length in inches: 30 . o Diameter in inches: 96. oo Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 323 Overspill protection: YES Stage I vapor recovery: DUAL Material: STEEL Installed: ATC and CP Stage It vapor recovery: BALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Test Method:vacuTect LEAK DETECTOR TEST RESULTS lest method: FTA Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: vAPORLESs Ingress Detected: Water Bubble Ullage Model: Ln2ooo Test time: S/N: o4oaizz~ Open time in sec: 6.00 Inclinometer reading: Holding psi: 21 VacuTect Test Type: NoT Resiliency cc: so NoT VacuTect Probe Entry Point: T ESTED Test leak rate ml/m: is9. o TESTED Pressure Set Point: Metering psi: is Tank water level in inches: Calib. leak in gph: a . 00 Water table depth in inches: Results: PASS Determined by (method): Result: ' COMMENTS COMMENTS LINE TE$T RESULTS lest type'., Tr~n-1 LINE A B <C U Material: DW FLEX Diameter (in): 1.5 Length (ft): 35.0 Test psi: 50 Bleedback cc: o Test time (min): 6o NOT NOT NOT Start time: 12:04 TESTED TESTED TESTED End time: 13:04 Final gph: 0.000 Result: PASS PUmp type: PRESSURE PUmp make: RED JACKET COMMENTS Impact Valves Operational: YES Printed 07/26/2006 07:23 INDIVIDUAL TANK INFORMATION AND TEST RESULTS %~ Tan TEST DATE:07/12/06 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3147500 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #17721 TANK 115FORN~"AT~tON ; Tank ID: 3 3 Tank manifolded: No Bottom to top fill in inches: 126. o Product: PREMIUM Vent manifolded: No Bottom to grade in inches: 132. o Capacity in gallons: 10, 027 Va por recovery manifolded: YES Fill pipe length in inches: 30. o Diameter in inches: 96 . oo Overfill protection: YES Fill pipe diameter in inches: 4 . o Length in inches: 323 Overspill protection: YES Stage I vapor recovery: DUAL Material: LINED Installed: ATG and cP Stage II vapor recovery: BALANCE CP installed on: / / COMMENTS TANKTEST RESULTS Test Method:VacuTect LEAK DETECTOR TEST-.RESULTS T~,~~;t mi;thod FTA Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VAPORLESs Ingress Detected: Water Bubble Ullage Model: LD2ooo Test time: S/N: oaoaiaz4 Open time in sec: 5.00 Inclinometer reading: Holding psi: 23 VacuTect Test Type: NoT Resiliency cc: so NOT TESTED VacuTect Probe Entry Point: Test leak rate ml/m: la9.o TESTED Pressure Set Point: Metering psi: is Tank water level in inches: Calib. leak in gph: s . 00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS TF~st;type: TLn=i LING A B C"° D Material: FLEX FLEX Diameter (in): 2.0 2 .0 Length (ft): 25.0 35.0 Test psi: 50 Bleedback cc: o Test time (min): 60 NOT NOT NOT Start time: 12:04 TESTED TESTED TESTED End time: 13:04 Final gph: 0.000 Result: PASS Pump type: PRESSURE Pump make: RED JACKET COMMENTS Impact Valves Operational: YES Printed 07/26/2006 07:23 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3 Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: 7-ELEVEN #17721 City: BAKERSFIELD CA Zip: 93309 Site Address: MARKET #2133 Contact Phone No: 834-3093 3601 STOCKDALE HIGHWAY Facility Contact Person: Manager Make/Model of Monitoring System:TLS350 Work Order Number: 3147500 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced Tank ID: 87 SOUTH Tank ID: 87 NORTH X In-Tank Gauging Probe. Model: MAG 2 X In-Tank Gauging Probe. Model: MAG 2 Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: X Piping Sump/Trench Sensor(s). Model: 208 Piping Sump/Trench Sensors}. Model: 208 Fill Sump Sensors}. Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: FX1V Mechanical Line Leak Detector. LD2000 Model: Electronic Line Leak Detector. Model: Electronic line Leak Detector. Model: Tank Overfill/High-Level Sensor. Model: ATG X Tank OverfilllHigh-Level Sensor. Model: ATG Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). TanklD: TanklD: X In-Tank Gauging Probe. Model: MAG 2 In-Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: X Piping Sump/Trench Sensor(s). Model: 208 Piping Sump(Trench Sensors}. Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: X Mechanical Line Leak Detector. Model: LD2000 Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: X Tank Overfill/High-Level Sensor. Model: ATG Tank Overfill/High-Level Sensor. Model: Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). ispenser 1/2 Dispenser ID: 3/4 Dispenser Containment Sensor(s) Model: 208 X Dispenser Containment Sensors} Model: 208 X^ Shear Valve(s). X Shear Valve(s) ^ Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: Dispenser {D: ^ Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: ^ Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: ^ Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: ^ Shear Valve(s). Shear Valve(s). ^ Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this certification is information (e.g manufacturers' checklists) necessary to verify that this information is correct. and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): ^ System set-up XD Alarm history report Technician Name (print): WILLIAM ROGERS Certification No.: 8520 Date of Testing/Service: 07/12/2006 Signature: ~"' ~", ~~~' i~~ License. No.: Testing Company Name: Tanknology Phone No.: (800) 800-4633 Site Address: 8501 N. MoPac Expressway, suite 400, Austin, TX 78759 Date of TestinglServicing: 07112!2006 Page 1 of 3 Based on CA form dated 03/01 Monitoring System Certification Monitoring System Certification site Address: MARKET #2133 Date of Testing/Service: 07/12/2006 3601 STOCKDALE HIGHWAY D. Results of Testing/Servicing Software Version Installed: 119 Complete the following checklist: 0 Yes ^ No ` Is the audible alarm operational? 0 Yes ~ No • Is the visual alarm operational? Q Yes ~ No' Were all sensors visually inspected, functiona{ly tested, and confirmed operational? Q Yes ^ No " Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes ~ No • X N!A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? Q Yes ~ No' ~ NIA For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (check all that apply) ^x Sump/Trench Sensors; ^X Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ^x Yes ^ No ~x Yes ~ No' ~ NIA For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e.: no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? 90 ~Io Yes` ~ No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. Yes' ~x No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) [] Product; ^ Water. If yes, describe causes in Section E, below. ~X Yes ~ No • Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. ~~X Yes ~ No ` Is all monitoring equipment operational per manufacturers' specifications? ' In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: Page 2 of 3 Based on CA form dated 03/01 Monitoring System Certification Site Address: MARKET #2133 Date of Testing/Service: 07/12/2006 3601 STOCKDALE HIGHWAY F. In-Tank Gauging /SIR Equipment Check this box if tank gauging is used only for inventory control. Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: O Yes ^ No' Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes ~NO' Were all tank gauging probes visually inspected for damage and residue buildup? Yes ~No' Was accuracy of system product level readings tested? Yes ~ No • Was accuracy of system water level readings tested? O Yes ~ No a Were all probes reinstalled properly? Yes ^ No • Were all items on the equipment manufacturers' maintenance checklist completed? ' In the 5ecuon N, below, descnbe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD) : [] Check this box if LLDs are not installed. Complete the following checklist: o Yes ^ No ~ ^NiA For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? Check ail that apply) Simulated leak rate: Q 3 g.p.h ~ 0.1 g.p.h ~0.2 g.p.h ^X Yes ~ No' Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ~No' Was the testing apparatus properly calibrated? ^X Yes ~ No , ~ N?A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^ Yes ^No' Q N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? Yes ^No' 0 N(A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? Yes ^No ` 0 N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? Yes ^No * 0 N?A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes ^No • Were all items on the equipment manufacturers' maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 Based on CA form dated 03/01 SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS ~ Tat?hcrtcalc?c~y' TEST DATE:07/12/2006 WORK ORDER NO.: 3147500 CLIENT: 7-ELEVEN, INC. SITE; 7-ELh'~7EN #17721 P.O. BOX 711 MARKET #2133 3601 STOCKDALE HIGHWAY DALLAS TX 75221 BAKERSFIELD CA 93309 214-841-6714 Tank Interstital Tests Piping Interstital Tests TANK PRODUCT MANUFACTURER RESULTS REGULAR REGULAR PREMIUM ~ LINE PRODUCT MANUFACTURER RESULTS Sum & Under-Dis enser Containment Tests Surnp/ DISP.# MANUFACTURER P/F 3 91 FILL OPW Pass 3 91 FILL OPW Pass 1 87S FILL OPW Pass 1 87S FILL OPW Pass 2 87N FILL OPW Pass 2 87N FILL OPW Pass Tanknology representative: BRIAN DERGE Services conducted by: WILLIAM ROGERS v - ~~J~~ UMP TESTS ,~,,, ~ SECONDARY CONTAINMENT TEST RESULTS Test Date: Work Order: 0 711 2/2 0 0 6 3147500 Type Tank or Disp # Manufacturer Model or Material Diam./Width/Length (") Depth (") Test Method Start Time Initial Level Level Change Finish Time Final Result Pass/ Fail Spill Container 3 91 FILL OPW Plastic 11 12 VPLT 10:52 6 .00062 11:07 6 Pass Spill Container 3 91 FILL OPW Plastic 11 12 VPLT 11:10 6 -.00003 11:25 6 Pass Spill Container 1 87S FILL OPW Plastic 11 12 VPLT 10:53 6 .00031 11:08 6 Pass Spill Container 1 87S FILL OPW Plastic 11 12 VPLT 11:10 6 .00015 11:25 6 Pass Spill Container 2 87N FILL OPW Plastic 11 12 VPLT 10:53 6 .00012 11:08 6 Pass Spill Container 2 87N FILL OPW Plastic 11 12 VPLT 11:10 6 -.00006 11:25 6 Pass Comments: t ~ Tanlv~o%gy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:07/12/06 WORK ORDER NUMBER3147500 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #17721 COMMENTS Lines, lds, monitor, spilll buckets and ESO passed. PARTS REPLACED QUANTITY DESCRtPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 07/26/2006 07:23 SBOWERS ITE DIAGRAM ~ Tanla~ology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 07/12/06 WORK ORDER NUMBER3147500 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #17721 O ~ E ,O ,O N S ~ ~ '~ REG REG ~ 1 STP STP N STP 10OAK OV OF PREM CCO VENTS Printed 07/26/2006 07:23 SBOWERS e Work Order: 3147500 Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 \ _. ~ t Work Order: 3147500 ~t~t-tis~tt:t~-ti ('~-r~lain~3~,~~ t cwtilt'~ 3~~~~~~,t°t ~~t~r~ Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 ..r ~,~ Work Order: 314 7 5 00 .__~_ - _ _..o._.._-- --- °~ k i •. - _. Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 UNDERGROUND STORAGE TANKS ,~ ~ ~ M-- ~.~~.~,,, & S R 9 P I D F/R~ ,~-~ APPLICATION ~Rr~r s TO PERFORM ELD /LINE TESTING '°"~ / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. '-" BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave. , Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ~ TO PERFORM FUEL MONITORING CERTIFICATION SITE INFORMATION -, : - _ FACILITY 7_EleVeri #'17721 NAME & PHONE NUMBER OF CONTACT PERSON Manager - (661) 834-3039 ADDRESS 3601 Stockdale Hwy., Bakersfield, Ca 93309 OWNERS NAME OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? YES ^ NO TANK# VOLUME CONTENTS . „ ~ ' TANK TESTING COMPANY NAME OF TESTING COMPANY Tanknolo I11C. 9y~ NAME & PHONE NUMBER OF Anthony Cheeks (951) 676-4060 CONTACT PERSON MAILING ADDRESS 41785 Enterprise Circle S. Suite D Temecula, CA 92590 NAME & PHONE NUMBER OF Will Rogers (909) 772-9853 TESTER OR SPECIAL INSPECTOR: CERTIFICATION #: DATE & TIME TEST TO BE 7/~ 2/06 - 12noon CONDUCTED: 1OC #~ 5251926 - UT TEST METHOD SIGNATURE OF APPLICAN DATE: /~/Z/O~ APPROVED BY DATE !~ ~ ~~' s FD 2095 (Rev. 09/05) C,~Z~ 3~q8 UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE O I ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check o ne item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 I. FACILITY !SITE INFORMATION BUSINESS NAME same as FAC~uTY NAME or DSA-doing Business As> 3 FACILITY ID# 7-Ele en #17721 ~ NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* ® 1. CORPORATION ^ 5. COUNTY AGENCY* i3USINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY' TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aos ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* aoz TOTAL NUMBER OF TANKS Is facility on Indian Reservation or *If owner of UST is a public agency: name of supervisor of division, section or office REMAGNiNG AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 404 ^ Yes ® NO 405 406 IL PROPERTY OWNER INFORMATION PROP ERTY OWNER NAME aos PHONE aoB 7-Ele ven Inc. 253-796-7170 MAILII WG OR STREET ADDRESS aos P.O. Box 711 Attn: Gasoline Acctg CITY ato STATE a>> ZIP CODE ail Dalla s TX 75221-0711 PROP ERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL afs 111. TANK OWNER INFORMATION `' ~ <:. TANK OWNER NAME ata PHONE ats 7-Ele ven, Inc. 253-796-7170 MAILI NG OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY ate STATE ate ZIP CODE 419 Dalla s TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY ., . IV: BOARD OF`EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY ~ "K HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise azt ~, _ _ <., V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDIC ATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM MET OD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: i ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz VL CEGAL"NOTIFICATION AND MAILING ADDRESS ` Check to indicate which address should be used for legal notifications and mailing. one box Legal n otifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER az3 ~~ ~ ~ ~ ~ ~~UI1. APPLICANT SIGNATURE a ..~; Certifi~ atio Ice ' y that th infor lion provided herein is true and accurate to the best of my knowledge. SIGN'p , R DATE aza PHONE azs 7/28/06 253-796-7170 NAM OF APPLICANT (print) azs TITLE OF APPLICANT azs Rand y Martin Gasoline & Environmental Compliance Manager STAT E UST FACILITY NUMBER (For local use only) aze 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 429 UPCIF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page _ of FACILITY ID# I ' t BEGINNING DATE iu0 ENDING DATE tot F A ! O O O 8/1/2006 12/31!2007 BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE toz 7-Eleven #17721 661-834-3093 BUSINESS SITE ADDRESS tos 3601 Stockdale Hwy CITY too ZIP CODE toy CA Bakersfield 93309 DUN & BRADSTREET tos SIC CODE (4 digit #) to7 00-734=7602 5541 COUNTY 10e Kern BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE tto Tejinder & Kulshinder Takhar ---- 661-834-3093 ---~- iL BUSINESS t1WNER OWNER NAME ___- iii OWNER PHONE ~ i~ 7-Eleven, Inc. 253-796-7170 OWNER MAILING ADDRESS tts P.O. Box 711 Attn: Gasoline Acctg CITY tta STATE tts ZIP CODE tts Dallas TX 75221-0711 - IIL - --- ENVIRONMENTAL CONTACT ___ - - CONTACT NAME tt7 CONTACT PHONE tie Randy Martin 253-796-7170 CONTACT MAILING ADDRESS tts P.O. Box 711 Attn: Gasoline Acctg CITY t2o STATE tzt ZIP CODE tzz Dallas TX 75221-0711 -PRIMARY- ----- IV. EMERGENCY CONTACTS -SECONDARY- NAME _ tzs NAME tza Tejinder Takhar 7-Eleven Emergency Dispatch TITLE tza TITLE tzs Franchisee Emergency Service BUSINESS PHONE tzs BUSINESS PHONE tso 1800-828-0711 800-828-0711 24-HOUR PHONE tzs 24-HOUR PHONE tst 1-800-828-0711 800-828-0711 PAGER # t27 PAGER # tsz ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNAT RE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE t34 NAME OF DOCUMENT PREPARER t35 ae /Z 7/28/06 Rachel Rodriguez NA E OF SIGNER ( int) t36 TITLE OF SIGNER 137 Randy Martin Gasoline & Environmental Compliance Manager UPCF (1/99 revised) HMP 2 (Back) Instructions OES FORM 2730 (1/99) EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify LOCAL AGENCY within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name: 7- Eleven Store #17721 Facility Address 3601 Stockdale Hwy., Bakersfield, CA If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion hazard, are not cleaned up from the secondary containment within 8 hours, or deteriorate the secondary containment, then LOCAL AGENCY must be notified within 24 hours. In case of a gasoline spill- Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. Employees will be notified to evacuate if deemed necessary. A contractor will be contacted to remove the spill as necessary. In case of a small carbon dioxide release- the tank will be visually inspected for obvious signs of the release point. If possible the control valve will be shut off. In the case of a large release of carbon dioxide, employees will be notified to evacuate and Contact 911 and 7-Eleven Dispatch. In case of fire- the alarm will be sounded by shouting "Fire" and the building will be evacuated. Employees will contact 911 and assemble at the designated assembly area as depicted on the site map. If safe, employees will shut off power and control fire using fire extinguishers. 2. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substances. Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. A contractor will be contacted to remove the spill as necessary. 3. Describe the location and availability of the required cleanup equipment in item 2 above. Absorbent is located inside the store in the backroom. 4. Describe the maintenance schedule for the cleanup equipment. Inventory of absorbent is periodically checked. 5. List the name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan. Randy Martin, Gasoline & Environmental Compliance Manager 253-796-7170 Date 7/2R/()f UNDERGROUND STORAGE TANK MONITORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited.• Title 23 CCR, Sections 2632(d)(1), 2634(d)(2), and 2641 (h) TYPE OF ACTION ^ 1. NEW PLAN ®2. CHANGE OF INFORMATION Mol. PLAN TYPE ®MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. Moz. (Check one item only) ^ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) _ _ FACILITY NAME 7-Eleven #17721 M03. FACILITY SITE ADDRESS 3601 $tOCkdale HlghWay Moa' CITY Bakersfield Mos. II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in Mob. accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED ® 1. ANNUALLY ^ 99. OTHER (Specify): Mop. III. MONITORING .LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., location of each sensor, line leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring System Certification form, Hazardous Materials Business Plan ma ,etc.) which shows all re uired information, include it with this Ian. _.._ . _.. IV. TANK 1VIONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) Mlo. ^ 1. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ^ a. DRY ^ b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM Mu. PANEL MANUFACTURER: M12 MODEL #: M13. LEAK SENSOR MANUFACTURER: t Mta' MODEL #(S): Mts. ® 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S) PANEL MANUFACTURER: VeederROOt MI6. MODEL #: TLS35O M1z IN-TANK PROBE MANUFACTURER: VeederROOt M18 MODEL #(S): MAG-2 M19. LEAK TEST FREQUENCY: ^ a. CONTINUOUS ^ b. DAILY/NIGHTLY ^ c. WEEKLY Mzo. ® d. MONTHLY ^ e. OTHER (Specify): Mz1 . PROGRAMMED TESTS: ^ a. 0.1 g.p.h. ^ b. 0.2 g.p.h. ^ c. OTHER (Specify): Mzz . Mz3. ^ 3. INVENTORY RECONCILIATION ^ a. MANUAL PER 23 CCR §2646 ^ b. STATISTICAL PER 23 CCR §2646.1 Mza. ^ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645 TESTING PERIOD: ^ a. 36 HOURS ^ b. 60 HOURS Mzs. ^ 5. INTEGRITY TESTING PER 23 CCR §2643.1 TEST FREQUENCY: ^ a. ANNUALLY ^ b. BIENNIALLY ^ c. OTHER (Specify): Mz6 . Mzs. ^ 6.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approval) ^ 99.OTHER (Specify): Mzs. V. PIPE MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) M30. ® 1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM M31. PANEL MANUFACTURER: VeederROOt M3z. MODEL #: TLS35O M33. LEAK SENSOR MANUFACTURER: VeederROOt M3a. MODEL #(S): 7943RD-2O8 M3S. WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? ®a. YES ^ b. NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M3z ® 2. MECHANICAL LINE LEAK DETECTOR (MELD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED MLLDMANUFACTURER(s): Val?OI'IeSS /Red Jacket M38' MODEL#(s): LD2000 / FX1V M39. ^ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS ELLD MANUFACTURER: M40 MODEL #: Mal. PROGRAMMED LINE INTEGRITY TESTS: ^ a. MINIMUM MONTHLY 0.2 g.p.h. ^ b. MINIMUM ANNUAL 0.1 g.p.h. Maz. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO M43. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Maa. ® 4. INTEGRITY TESTING TEST FREQUENCY: ®a. ANNUALLY ^ b. EVERY 3 YEARS ^ c. OTHER (Specify) Mas. Ma6. ^ 5. VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY* ^ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED** M4~. " Requires agency approval ** Allowed for monitoring of unburied emergency generator fuel piping only per HSC §2528 1.5(6)(3) ^ 6. PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) ^ 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ^ 99. OTHER (Specify) M48' UN-022A -1/3 www.unidocs.org Rev. 10/14/03 ., Underground Storage Tank Monitoring Plan -Page 2 of 2 VI. DISPENSER 1VIONITORING MONITORING OF AREAS BENEATH DISPENSER(S) IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mso. ® 1. CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT (UDC) PANEL MANUFACTURER: V@ed@rROOt Mst. MODEL #: TLS35O Msz. LEAK SENSOR MANUFACTURER: V@@d@fROOt M53" MODEL #(s):794380-208 Msa. WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? ®a. YES ^ b. NO Mss. WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO Ms6. WILL FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M57. ^ 2. MECHANICAL ASSEMBLY (e.g., FLOAT AND CHAIN ASSEMBLY) IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK ASSEMBLY MANUFACTURER: Msa. MODEL #(S): Msg. ^ 3.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approvaq Mho. ^ 4. NO DISPENSERS ^ 99. OTHER (Specify) M6t. VII. ENHANCED LEAK DETECTION ^ 1. WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK Mso. DETECTION (ELD) FOR THE UST(S) COVERED BY THIS PLAN. PER 23 CCR §2644.1, ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED VIII. TRAINING REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) Mso. 1. ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 2. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 3. ® THE FACILITY'S BEST MANAGEMENT PRACTICES (Required as of January 1, 2005) 4. ^ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. ^ CALIFORNIA UNDERGROUND STORAGE TANK LAW 6. ^ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS -MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 7. ^ SWRCB PUBLICATION: "WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" 99. ^ OTHER (Specify): Mat" Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and can access those documents when needed. By January 1, 2005, this facility will have a "Designated UST Operator" who has passed the California UST Sytem Operator Exam administered by the International Code Council (ICC). By July I, 2005, and annually thereafter, the "Designated UST Operator" will train facility employees in the proper operation and maintenance of the UST systems. This training will include, but is not limited to, the following: - Operation of the UST systems in a manner consistent with the facility's best management practices. - The facility employee's role with regard to the leak detection equipment. - The facility employee's role with regard to spills and overfills. - Whom to contact for emergencies and leak detection alarms. For facility employees hired on or after July 1, 2005, the initial training will be conducted within 30 days of the date of hire. IX. COMMENTS/ADDITIONAL INFORMATION Please use this section to include any additional UST system monitoring-related information (e.g., additional information required by your local agency): Mss. Note regarding Section X. Pending certification of a Designated UST Operator, the following person has authority for performing the monitoring activities and maintaining leak detection equipment covered by this plan. NAME: JOB TITLE: X. PERSONNEL, RESPONSIBILITIES _. AS OF JANUARY 1, 2005, THE "DESIGNATED UST OPERATOR" IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT APPLICATION -FACILITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION EQUIP ENT COVERED BY THIS PLAN, AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY V]SUAL INSPECTIONS OF THE FACILITY'S STEM 'ACCORDANCE WITH 23 CCR § 2715(b). XL OWNER/OPERATOR SIGNATURE CERTIF ATIO :Ice fy that information provided herein is true and accurate to the best of my knowledge. OWNE OPE OR SIG ATU REPRESENTING DATE: M9i" ® Owner M90. ® Operator 7/28/06 O ER/OPERATOR NAME (print): M9z. OWNER/OPERATOR TITLE: M93. Randy Martin Gasoline & Environmental Compliance Mgr (Agency Use Only) This plan has been reviewed and: ^ Approved ^ Approved With Conditions ^ Disapproved Local Agency Signature: Date: Comments/Special Conditions: UN-022A - 2/3 www.unidocs.org Rev. 10/14/03 w ~ s ~._ WRITTEN MONITORING PROCEDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify local agency within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name: 7-Eleven Store #17721 Facility Address: 3601 Stockdale Highway, Bakersfield, CA Date: July 28, 2006 A. Describe the frequency of performing the monitoring: Tank The site consists of three 10,000 gallon single walled cathodically protected steel tanks (1-Regular Unleaded, 1-Midgrade, 1-Premium) and are monitored monthly with a VeederRoot TLS350 Piping Product lines are double wall Enviroflex and are monitored continuously with a VeederRoot TLS350. The turbine sump sensor activates audio/visual alarms and provides positive shutdown of he turbines. B. What methods and equipment, identified by name and model, will be used for performing the monitoring: Tank The method of leak detection for the tanks is Continuous Statistical Leak Detection (CLSD) using the VeederRoot TLS350 Tank Gauge programmed for a threshold of .2gph VeederRoot model MAG-2 probes are used for the monitoring. High level alarms activate audio/visual and external alarms Piping The piping is monitored continuously by VeederRoot liquid sensors model #794380-208 located in the turbine sump of each tank. The turbine sump sensors provide positive shutoff and activate audio/visual alarms. Vaporless LD2000 line leak detectors are located on the turbine and programmed for a leak threshold of 3gph. The piping is precision tested annually at a threshold of .1gph. Dispensers are equipped with under- dispensercontainment with VeederRoot liquid sensors model #794380-208 that provide positive shutdown of the turbines. Enhanced This site has a single wall component of the tank system and utilizes Enhanced Leak Leak Detection (ELD) to include a Tracer Tight Test completed in 2003 and every 3 years Detection thereafter C. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: The individual responsible for the monitoring equipment is the store operator, Tejeinder Takhar. The operator will contact 7-Eleven Dispatch 1 800-828-0711 for any alarm conditions on the VeederRoot. The local maintenance contractor will be dispatched. 7-Eleven, Inc. is responsible for maintaining the ------- equipment. The Environmental Manager is Randy Martin J. ~ , ~ ~ Written Monitoring Procedures 7-Eleven #17721 Page 2, July 2006 D. Reporting format for monitoring: Tank Current status reports are available from the Veeder-Root TLS 350 as a print out and from The display screen. Monitoring records will be kept at the location and at a central office location. Piping Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Third party annual test results will be submitted to the agency. E. Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturer's maintenance schedule but not less than every 12 months. Tanks and product lines are continuously monitored and alarmed. Alarm histories are printed each month and investigated for corrective actions by the Designated Operator. Equipment repairs; replacement are performed as needed. F. Describe the training necessary for the operation of UST system, including piping, and the monitoring equipment: Employees are trained on the Operation of the UST in a manner consistent with Best Management Practices. Emergency contact information, Spill/Overfill response procedures, Hazardous Waste Procedures, and Monitoring equipment operation and alarm response procedures. Training is conducted annually, or within 30 days for new employees, by the Designated Operator ~ ~r Tanla~ology 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: 04/20/2006 Order Number: 3146316 Dear Regulator, Date Printed and Mailed: 05/02/2006 F% Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #17721 MARKET #2133 3601 STOCKDALE HIGHWAY BAKERSFIELD, CA. 93309 Testing performed: CP sixty day rectifier inspections Dynamic Pressure Source Liquid Removal tests Stage II pressure decay tests Sincerely, Dawn Kohlmeyer Manager, Field Reporting ~. SAN JOAQUIN VALLEY AIR POLLUTION CONTROL DISTRICT Dynamic Pressure Source Test Source Information FACILITY PARAMETERS GDF Name and Address District Inspector Phase II System Type 7-ELEVEN #17721 n/a Phase II System Type MARKET #2133 Device Type Used Balance GILBARCO 3601 STOCKDALE HIGHWAY MANOMETER Assist BAKERSFIELD,CA 93309 Hirt Phase I System Type Hasstech Permit # s-2123-1-9 EVR OpW Healy Other E.O g-70-52 2 Point Coaxial Manifolded? 0 or N Date of Last Calibration: 01/25/2006 Type of Test: Wet / Dry Leak Check: Pass / Fail Dynamic Back Pressure, Inches H ~J Nozzle Grade 40 CFH 60 CFH 80 CFH 1-ew4005 all 0.14 0.31 0.52 2-ew4015 all 0.16 0.34 0.60 3-ew4005 all 0.11 0.21 0.42 4-ew4015 all 0.13 0.25 0.44 Test Conducted By: Test Company: Date of Test: ALEX ESKANDARIAN TanknOlOgy 04/20/2006 Signature: Confirmation # Tester Certification # (~ ~ TU ' 06-6243 t3120 San Joaquin Valley Unified Air Pollution Control District Pressure Decay Test TP201.3 Confirmtion. No.: Permit No: 06-6243 Testing Comganv s-2123-1-9 Site Name: 7-ELEVEN #17721 Address: MARKET #2133 BAKERSFIELD Phone: 661834-3093 Phase I System? EV r` 2 t. Coaxial Phase II System? BALANCE r ASSIST !OTHER Total Number of Nozzles: 4 Nozzles for Tank # 1: 4 Nozzles for Tank # 2: 4 Balance "Nozzle End" hoses must be drained prior to test. Name: TANKNOLOGY Address: 41785 Enterprise Circle S Suite D Temecula CA 92590 Phone: (951)676-4060 Tanks Manifolded? Yes Work Order: 3146316 Nozzles for Tank # 3: 4 Nozzles for Tank # 4: Number of hoses over 100m1: 0 Tank Information 1 2 3 4 All 1. Product Grade 87t1 87t2 91 2. Actual Tank Capacity, gallons 9653 9599 9582 0 28834 3. Gasoline Volume, gallons 3631 4285 2299 0 10215 4. Ullage, (V) gallons (line #2 minus line #3) 6022 5314 7283 0 18619 5. Start Time 09:45 6. Initial Test Pressure, inches H2O 2.00 7.. Pressure after 1 minute, inches H2O 2.00 8. Pressure after 2 minutes, inches H2O 2.00 9. Pressure after 3 minutes, inches H2O 2.00 10. Pressure after 4 minutes, inches H2O 2.00 11. Pressure after 5 minutes, inches H2O 2.00 12. Allowable Final Pressure (See table 1A or 1B) 1.92 13. Pass /Fail PASS Nitrogen introducing point. Phase I vapor coupler or Phase II vapor riser: Phase I / ,Phase II Record Vapor Coupler Integrity Test Assembly pressure after 1 minute: 2.02 What type of pressure device used : Incline Manometer ~ Mechanical ~ Digital -must do drift tes 1-25-06 Enter Calibration date for pressure device (90 days ). 0.02 Enter initial tank ullage pressure (Vent if over 0.5 in. w.c. ) 3 Enter flowmeter rate, F (Must be 1 to 5 CFM ). t2= V 4.07 Enter Calculate ullage fill time, t2. 3:45 Enter actual fill-time. [15221 F 0.00 Enter ending value of drift test (Must be 0.01 in. w.c. or less ). Tester: ALEX ESKANDARIAN ~n n . Signature: ~ r v ~------ Tester ID: t3120 Test Date: 04/20/2006 LIQUID REMOVAL- TEST TP CARB 201.6 Testing Results Facility Name: 7-ELEVEN #17721 Facility Address: MARKET #2133, BAKERSFIELD, CA. Test Date: 04/20/2006 Test Unit S#: System Type: Page 1 Work Order: 3146316 Disp # Grade GPM Wall Fuel Gallons Post Fuel in hose Liquid -Removal Pass/ Fail Retention 1 all 0.000 0.000 0.000 0.000 0.000 all hoses passed. less than 100m1. 2 all 0.000 0.000 0.000 0.000 0.000 no liquid removal required. 3 all 0.000 0.000 0.000 0.000 0.000 4 all 0.000 0.000 0.000 0.000 0.000 Technician: Alex Eskandarian r Signature: ;/~~ TANKNOLOGY 41785 Enterprise Circle S Suite D Temecula CA 92590 (951)676-4060 TANKNOLOGY CATHODIC PROTECTION RECTIFIER MAINTENANCE Customer Location: 7-ELEVEN #17721, MARKET #2133, 3601 STOCKDALE HIGHWAY, BAKERSFIELD CA 93309 Location of Rectifier Unit: ABOVE DOOR IN STOREROOM Type of Rectifier Unit: Number of Anodes: Unknown Type of Anode: Type of Ground Bed: Distributed Surface Location: Around Tanks Rectifier Manufatctured by: universal Model: SSP Serial Number: 961891 Rectifier AC Input: 115 volts 6.2 amps ~ 1 phase 60 Hz Rectifier DC Output: 50.0 volts 10.0 amps Shunt: 50 my 10.0 amps Installation date: Comments: CP operating properly: Yes Settin 9 t?C°Output volts DC Output Amps Date Recorded by Remarks 1 8.30 1.14 04/20/06 AE 2 3 4 5 6 7 8 9 10 11 12 13 14 15 W.O. 3146316 Technician: ALEX ESKANDARIAN ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:04/20/06 WORK ORDER NUMBER3146316 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #17721 COMMENTS Conf.#06-6243 Compliance Vapor Recovery Testing and 60-Day Rectifier Check Passed. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS'TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 05/02/2006 08:22 SBOWERS c SITE DIAGRAM . ran 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 04/20/06 WORK ORDER NUMBER3146316 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #17721 O O E ,~ ,~ N .,. S ~ ~ ,~ REG REG ~ ~~ ~ STP STP N STP ~A OV OF PREM 10K ~Q VENTS Printed 05/02/2006 08:22 SBOWERS May 15, 2006 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 Mr. Tejinder Takhar 7-11 3601 Stockdale Hwy. Bakersfield, CA 93309 NO~"ICE OF VIOLATION & SCH~~ULE FOR COMPLIANCE Re: Failure to Perform a.lr.hubmit Three Year Cathodic Protection Certittcation Dear Mr. Takhar: Our records indicate that yciUw three year cathodic protection certification is past due. If you have performed this test, please forward those results to my attention immediately. If you haven't {performed this test you are in violation of Section 2635 2(a) of the California Crlde of Regulations, Title 23, Division 3, Chapter 16 Underground Tank Regulatfr~rts. "Field-installed cathodic protection systems shall be designed and certified as adgt~uate by a corrosion specialist. The cathodic protection system shell be tested by a cathodic protection tester within 6 months of ifi9tallation and at least every 3-years thereafter." Therefore, prior to June 12, ~I)06 you will perform the necessary testing as required by Code. Failure tti comply may result in revocation of your Permit to Operate. Again, if you have recently ~ei-formed this certification test, please forward the results to my attention and df~regard this notice. Should you have any questia7hs, please feel free to call meat 661-326-3190 Sincerely, Ralph E. Huey, Director of Prevention Services Cr. By: Steve Underwood, Fire Prevention Officer REH/SU/db s 11!21/2005 17:18 5123807215 PAGE 02105 $~-989 SEG~NDARY C4NTIl[NMENT SUIIAMARY RESULTS ~ ~~~ TEST DATE:OR/09/2003 WORK ORDER NO.: 81420A7 7-EL8vs1a, INC. 51TE: 7-*z*• 1«17721 CLIENT: >z.a. ~eax X11 MARKET 82133 3603. $TOC1iDALLr SIGfli~IY ~~}r.T.ac T7C T5221 3PI9LD CA X3309 2i4-$474-5774 Tank lnterstital Tests Piping lnterstital Tests ;,Viii :'~l~~t~1U6'`r'!' ~~`~F ~~,;...; . _ .. . ..,. ..... ., . - . •.:. ,. ..:_ .. . Sum $e Under-Dis eraser Containment Testa ... .. .,.. .. ' I:. . .:' ~.: Y.~~.. ... ~: 1 'li 'y .lFl ,: ;,:.. ': ~. ; ~" : i•K: l l~~ ~~~~~' ' M . ; :1 1~' ' '': (:' ..., , . .. R~ ,,;~ ? .,:•... , _ il l ~. iat 'iUFi~ '.'.. ' ; ; . . ; r i •i (; ~'.~ .. .. •~.... .. ~~ .:K .~.. .. ~ .-.. 1..... 2-REG SO. OPW Pass 1~REG NO. pPW Pass 3-PREMIUM bPW Pass lapresentative: BERRY 9Et,LOt1 5eroices cantluctetl by: ALBERT .l. gUEIROs G2 ~ '~' m m m a ~ ~~ SECdNt]ARY C~NTAI~MEIrIT TEST RESULTS 31TE NAME: 7-ELEVEN #17721 1'721 ATE: p$~~09l20D5 WORK ORDER 3142U97 SITEAURRESS: NIARKETi~2i33 341 STOCKI7ALE HIGMVu~AY 3AK~RSFIELD CA 93309. REASON F'OR TEST: Cgmpfance Groundwater Level{" from rade Tr. HIV ~~ ~1 Tlw~~ 41 Fi IIITC~t•TITIf1 TrC~Q ian P.vduct Tank Size `v Dia. • -- • Material 146anatadurer aeptt+ ; ~~} TeK Method Stain Time nd"+al Leant Flnisar Time Fine[ Result Pass! Fail 1 REGULAP. 50027 98 STEEL Z 4EGULAR 10027 96 ST1=EL g 'REMIUM 10027 96 LIN.t} 4 5 8 7 S Comments: r rue ~renQiurartnu aun rn[rFasnrinL TF4T5 ~~ to CV m M N to u7 m m CV .-i N e-I TanN Product ~ra• Len. 'Material !I~arxrF~lurEr Voume ~onS Teat IJlathod Start Time IniGa[ Level Fnish Time Final ReSUIt Pass! Fail 9 2 3 4 5 6 7 B Cmnmerits: \$ `o-.., L E~EVEn ~~ Letter of Transmittal Date: May, 2006 Attention: Hazardous Materials Division Company: City of Bakersfield Fire Dept. Address: 900 Truton Ave., Suite 210 Bakersfield, CA 93301 RE: 7-Eleven #163299, 1701 Pacheco Rd. 7-Eleven #16549, 4647 Wilson Rd. 7~--Ele_v_en-#1-7_Z2.1-_36.01-Stoe d'ale~Hv y 7-Eleven #32241, 4101 Calloway Dr. 7-Eleven #32376, 9600 Brimhall Rd. Enclosed are: ^ Business Plan ^ Business Activities ^ Business Owner/Operator Identification ^ Hazardous Materials Chemical Inventory ® Underground Storage Tank -Facility ^ Underground Storage Tank -Tank Comments: Shane Partridge Gasoline & Environmental Compliance Manager 702-270-7160 ^ Emergency Response Plan ^ Written Monitoring Procedures ^ Site Map ^ Owner/Operator Agreement ^ Test Results - ® Other: Financial Responsibility Rachel Rodriguez Sr. Administrative Assist t 503-977-7745 LL ~'~u~i F. ~4E State of California For State Use Only p ~~` ~''°; State of Water Resources Control Board w Division of Clean Water Programs P.O. Box 944212 ~,,,,,p„,• Sacramento, CA 94244-2120 (Instructions on reverse side) .CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: 500,000 dollars per occurrence ~ t million dollars annual aggregate or AND or ® 2 million dollars per occurrence ® 2 million dollars annual aggregate B. 7-Eleven. InC. hereby certifies that it is in compliance with the requirements of Section 2807, (Name of Tank Owner or Operator) Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: C. Mechanism Mechanism Coverage Coverage Corrective Third Party T e Name and Address of Issuer., Number Amount Period Action Com Liability Insurance Illinois Union Insurance..Co. $2,000,000 per c/o ACE Environmental Risk UST G2379486A Occurrence & 4/30/2006 436 Walnut Street 001 $2,000,000 to Yes Yes Philadelphia, PA 19106 Annual 4/30/2007 Aggregate Note: If you are using the Sfate Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certifies that you are in compliance with all conditions for participation in the Fund. D. Facility Name Facility Address 7-Eleven #16329 1701 Pacheco Rd., Bakersfield, CA Facility Name Facility Address 7-Eleven #16549 4647 Wilson Rd., Bakersfield, CA Facility Name Facility Address 7-Eleven #17721 3601 Stockdale Hwy, Bakersfield, CA E. ign ture of Tan O er or Operator Date Name and Title of Tank Owner or Operator - ~/~ rod Shane Partridge-Gasoline & Environmental Compliance Manager ' nature of Witnes r Notary Date Name of Witness or Notary C~v 55~ U(o Rachel Rodri uez CFR (Revised 04/95) U ~ FILE: Original -Local Agency Copies -Facility/Site(s) *`'%;;° .N State of California ~ a For State Use Only o`s, State of Water Resources Control Board ;~' ~ Division of Clean Water Programs ~,: . P.O. Box 944212 „„op~ . Sacramento, CA 94244-2120 (Instructions on reverse side) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: 500,000 dollars per occurrence ~ t million dollars annual aggregate or AND or ® 1 million dollars per occurrence ® 2 million dollars annual aggregate e. 7-Eleven, InC. hereby certifies that it is in compliance with the requirements of Section 2807, (Name of Tank Owner or Operator) Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: C. Mechanism Mechanism Coverage Coverage Corrective Third Party T ,e Name and Address of Issuer Number.. Amount Period Action Com Liability Insurance Illinois Union Insurance Co. $2,000,000 per c/o ACE Environmental Risk UST G2379486A Occurrence & 4/30/2006 436 Walnut Street 001 $2,000,000 to Yes Yes Philadelphia, PA 19106 Annual 4/30/2007 Aggregate Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certifies that you are in compliance with all conditions for participation in the Fund. D. Facility Name Facility Address 7-Eleven #32241 4101 Calloway Dr., Bakersfield, CA Facility Name Facility Address 7-Eleven #32376 9600 Brimhall Rd., Bakersfield, CA Facility Name Facility Address E. ign ture of T nk O ner or Operator Date Name and Title of Tank Owner or Operator ~/~ /~~ Shane Partridge-Gasoline & Environmental C t ompliance Manager ignature of Witn or Notary Date Name of Witness or Notary ' c~1v J =a(o-z? Rachel Rodri uez C1rK (Revised 04/95) ~'' L~ FILE: Original -Local Agency Copies -Facility/Site(s) CERTIFICATION OF FINANCIAL RESPONSIBILITY 7-Eleven, Inc. (formerly ]mown as The Southland Corporation) hereby certifies that it is in compliance with the requirements of Subpart H of 40 CFR part 280. The financial assurance mechanisms used to demonstrate financial responsibility under 40 CFR part 280 are as follows: Storage Tank Liability Insurance Policy No. UST G2379486A 001 issued by Illinois Union Insurance Company, effective April 30, 2006, through April 30, 2007, with a retroactive date of November 24, 2005, and covering underground storage tanks for taking corrective action and/or compensating third parties for bodily injury and property damage caused by accidental releases in the amount of TWO MILLION DOLLARS ($2,000,000) "per occurrence" and TWO MILLION DOLLARS ($2,000,000) "annual aggregate" as specified by 40 CFR §280.93; and To the extent of its eligibility, participation in various State fiends and State assurance programs as set forth in 40 CFR §280.101. 7-ELEV C. r By: ~ .~-i Name: STATE OF TEXAS COUNTY OF DALLAS Title: Vice • -esident Date: _~~~l~c/ • - _~, ZED SUBSCRIBED AND SWORN TO BEFORE ME this ~~~ day of , 2006. ~, ~- ~ 7 ~. Mary B. Gamero No ary P is In and For Said County and Notary Pubilc, state of Texas State My Comm. Expires 01/20/10 My Commission Expires: 516202.2/SP2/76086/0209/042806 UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6,TEMPORARY SITE CLOSURE 400 L FACILITY /SITE INFORMATION ,. ~ . BUSINESSNAME(SameasFACILtTYNAMEOrDBA-Doing Business AS) 3 FACi~ITYID# 7-Eleven #16329 ~ ~ NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT' ® 1. CORPORATION ^ 5. COUNTY AGENCY` BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY"' TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aoa ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY' aoz TOTAL NUMBER OF TANKS Is facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos II. PROPERTY'OVIINER;INFORMATION.; _ ,b.. ,:: PROPERTY OWNER NAME aos PHONE aoa Bobbie Stokes MAILING OR STREET ADDRESS aos 1348 Mentone Ave. # C CITY aio STATE ati ZIP CODE ail Grover Beach CA 93433 PROPERTY OWNER TYPE ^ 1. CORPORATION ®2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL at3 IIL TANK OWNER INFORMATION TANK OWNER NAME aia PHONE ais 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS ais P.O. Box 711 Attn: Gasoline Acct CITY a» STATE ais ZIP CODE ats Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY `IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, V.:P-ETROLEUM UST FINANCIAL RESPONSIBILITY ` INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD a22 VI. L=EGAL NOTIFICATION ANDMAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 VIL APPLICANT SIGNATURE Certi icati - I certify t at t information provided herein is true and accurate to the best of my knowledge. SIG AT E OF AP CAT DATE aza PHONE azs 26 D ~0 702-270-7160 NAME OF APPLICAN print) azs TITLE OF APPLICANT azz Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) azs 1998 UPGRADE CERTIFICATE NUMBER (Forlocal use only) 429 UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 I. FACILITYISITEINFORMATION BUSINESSNAME(SameasFACiuTYNAMEorDBA-DoingausinessAs) 3 FACILITY ID#' 7-Eleven #16549 t NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCYiDISTRICT* 4647 Wilson Rd., Bakersfield ® 1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aos ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* aoz TOTAL NUMBER OF TANKS IS facility on Indian Reservation or *If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No ao5 aos ... ~ IL PROPERTY OWNER'°INFORMAT~IO~N :_ PROPERTY OWNER NAME aos PHONE aos 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS aos P.O. Box 711 Attn: Gasoline Acct CITY ato STATE att ZIP CODE ail Dallas TX 75221-0711 PROPERTY OWNER TYPE ^ 1. CORPORATION ®2. INDIVIDUAL 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL ats III. TANK OWNER INFORMATION: TANK OWNER NAME aia PHONE ats 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY ate STATE ata ZIP CODE ats Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ago ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER . TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise a2, V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANGE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz ,.. VI. LEGAL'NOTIFICATION ANb MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER aza VII. APPLICANT SIGNATURE Certifi do - certify th t the i formation provided herein is true and accurate to the best of my knowledge. SIGN T E OF AP L NT DATE / aza PHONE az5 S i ~ o ~ 702-270-7160 NAM F APPLICANT rint azs TITLE OF APPLICANT az7 Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local useoniy) aza 199$ UPGRADE CERTIFICATE NUMBER (FOrloca~ use only) a2s UPCF (1199 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 I: FACILITY /.SITE 1NFORMATION , . BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITYD# 7-Eleven #17721 t NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT` ® 1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY' TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aoa ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY` aa2 TOTAL NUMBER OF TANKS Is facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos ~. , _. - ":: -11. RROPERTY QWNER=INFORMATION _..._. PROPERTY OWNER NAME aos PHONE aoa 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS aos P.O. Box 711 Attn: Gasoline Acct CITY afo STATE atf ZIP CODE atz Dallas TX 75221-0711 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL at3 '' ` °' 11L TANK OWNER INFORMATION ,: , TANK OWNER NAME afa PHONE ats 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY ate STATE ata ZIP CODE ats Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY ` - IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, _. , V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz VI. LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 VII. APPLICANT SIGNATURE Certifica on I rlify that t e inf rmation provided herein is true and accurate to the best of my knowledge. SIGNA OF APPLI T DATE aza PHONE azs s ~Z(, m (0 702-270-7160 NAME OF APPLICANT (p ' ) azs TITLE OF APPLICANT a2~ Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) aza 1998 UPGRADE CERTIFICATE NUMBER (For local use only) azs UPCF (1199 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 ` `I. FACILITY/SITEINFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 FACT LITY ID# 1 7-Eleven #32241 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT' 4101 Callowa Dr ® 1. CORPORATION ^ 5. COUNTY AGENCY" BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY' TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aoa ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY' aoz TOTAL NUMBER OF TANKS Is facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos ,.. , II. PROPERTY OWNER INFORMATION " PROPERTY OWNER NAME aos PHONE aoa WECI - 99 -3LLC 972-361-5000 MAILING OR STREET ADDRESS aos 15601 Dallas Parkwa ,Suite 40 CITY ato STATE ait ZIP CODE atz Dallas TX 75001 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL at3 III. TANK OWNER INFORMATION : ` TANK OWNER NAME ata PHONE ats 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS ate P.O. Box 711 Attn: Gasoline Acct CITY ate STATE ata ZIP CODE ats Dallas TX 7522 1-07 1 1 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY IV BOARD OFEQUALlZATION UST STORAGE-'FEE ACCOUNT NUMBER :.. , TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, -. , V. PETROLEUM UST FINANCIAL RESPONSIBILITY -,.: INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD ~ azz ~~~~ ~ ~~~'. -.. ~ ~ ~' ~~~~ VI. LEGAL NOTIFICATION AND MAILING~ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 VII. APPLICANT SIGNATURE Certificat' n - I ertify that the inf rmation provided herein is true and accurate to the best of my knowledge. SIGNA RE APPL C - DATE aza PHONE azs ~ ~ ~ b 702-270-7160 NAME PPLICANT (p ' t) aza TITLE OF APP ICANT azs Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (Forlocal use only) a28 1998 UPGRADE CERTIFICATE NUMBER (For local use only) azs UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®S.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 I: FACILITY /SITE INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) 3 -FACILITY.D# 7-Eleven #32376 1 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 9600 Brimhall Rd. ® 1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6.~STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aos ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* 402 TOTAL NUMBER OF TANKS IS facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 2 aoa ^ Yes ®No aos aos ,.:.. II PROPERTY OWNER:'INFORMATION -- PROPERTY OWNER NAME aos PHONE aoa American West Lands Co. MAILING OR STREET ADDRESS aos P.O. Box 524 CITY ato STATE att ZIP CODE atz Bakersfield CA 93302 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL ats °` III. TANK OWNER INFORMATION TANK OWNER NAME ata PHONE ats ' 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY ate STATE ata ZIP CODE ats Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ago ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY IV BOARD OF`EQUALIZATION UST STORAGE fEE ACCOUNT Nt7MBER" TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise 4z1 ,, .: , V. PETROLEUM UST FINANGIAL_ RESPONSIBILITY . ' INDICATE ^ 1.SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz ~. VI. LEGAL NOTIFICATION AND MAILING ADDRESS_ _.; . ....:... Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER azs VII. APPLICANT 31GNATURE Certificat' n - certify that th infor ation provided herein is true and accurate to the best of my knowledge. SIGNA UR F APPLI - DAT i aza PHONE azs .~~ 2G 0~ 702-270-7160 NAME APPLICANT (prl ) aza TITLE OF APPL CANT av Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) aza 1998 UPGRADE CERTIFICATE NUMBER (For local use only) azs UPCF (1/99 revised) Formerly SWRCB Form A