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STOCKDALE WEST TEXACO " 13004 STOCKDALE HWY t~ ~~ tti.~.,~ e~ ~~ + STOCKDALE WEST TEXACO _______________________________ SiteID: 015-021-001902 + Manager KHENG CHAD Location: 13004 STOCKDALE HWY City BAKERSFIELD BusPhone: (661) 589-8982 Map 122 CommHaz Moderate Grid: 02B Fa~cUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code:5541 DunnBrad: Emergency Contact / Title Emergency Contact / Title KHENG CHAO / MANAGER LONNG CHAO / MANAGER Business Phone: (661) 587-8987x Business Phone: (661) 393-8828x 24-Hour Phone (661) 587-8116x 24-Hour Phone (661) 589-2407x Pager Phone (661) 330-8540x Pager Phone ( ) - x Hazmat Hazards: Fire DelHlth Contact Phone: (661) 589-5982x MailAddr: 13004 STOCKDA.LE HWY State: CA City BAKERSFIELD Zip 93312 Owner TAK FOUY CHAO Phone: (661) 589-5982x Address 13004 STOCKDALE HWY State: CA City BAKERSFIELD Zip 93312 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ PROG A - HAZMAT PROG C - COMM HOOD PROG H - HAZ WASTE GEN PROG T - ABOVEGROUND STORAGE TANK PROG U - UST Based on my inquiry of those individuals responsibVe for obtaining the information, 1 certify under penalty of law 4hat I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. Q~ `~~ ~ ENTbAUG 10 2006 ti ~~ ~n~ ~~~` Signature Date -1- 04/04/2006 _ , -a - -- ._ _ Is~y MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California . Authority Cite& Chapter 6 7, Health and Safety Code; Chapter l6, Division 3, Title 23, California Code oJXegulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepare for each monitoring smote ct~ontrol 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: Ct~EV'~-c~~y Bldg. No.: Site Address: /~CaOLl~4~Uc~k.~A~= Kt..1 ~ Ciry: Z~t`3t~t45f~E~~., Zip: Facility Contact Person: ~lfl-~~L'~1 Contact Phone No.: (!,~ Make/Model of Monitoring System: ~t~E'tleC~ - ~.-'-~ L Date of Testing/Servicing: .~ / / `t /~ B. Inventory of Equipment Tested/Certified INSPECTOR ON-SITE• YE~AME: Checlr the annrnnriare hn,rec rn indicnre specific enuioment inspected/serviced: Tank ID: ^ ~(-- ~ ~ Tank [D,: ~L- ~ $ _ ~-,ln-Tank Gauging Probe. Model: /Y1F) L~7 --- -in-Tank Gauging Probe. Model: ~ ffG ,tom Annular Space or Vauft Sensor. Model: ~/.~O ~p[ ,g,J~Annlllar Space or Vault Sensor. Model: ~-PipingSump/Trench Sensor(s). Model: ~l~~ ,i~PipingSump/Trench Sensor(s). Model: ~O$ ^ Fill Sump Sensor(s). Model: ^ Fill Sump Sensor(s). Model: echanical Line Leak Detector. Model: ~~~ cJ/jGG~T ~ Mechanical Line Leak Detector. Model: l2,=J~ ~IflCkE ~ ^ Electronic Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: Q Tank Overfill /High-Level Sensor. Model: ^-Tank Overfill / High•Level Sensor. Model: Q .Other (s cif a ui ment t e and model in Section E on Pa e 2 . ^ Other (s eci a ui ment a and model in Section & on Pa e 2 . Tank tD: ~f2C.t'h L}'~ CSPt..~Y.~ Tarik 1D: ~rE.Srr.L_ [!~I~t-~~ _ ~^]n-Tank Gauging Probe. Model: ~1L~ _____ ,$Lln•Tank Gauging Probe. Model; /7.~Ca ~ Annular Space or Vault Sensor. Model: L{~j ~f Z (,xT ~J f~Annular Space or Vault Sensor. Model: C/ ~ <SPL~ T , ~d'.iping Sump /Trench Sensor(s), Model: ~ag , Piping Sump !Trench Sensor(s). Model: , ~O$ ^ Fill Sump Sensor(s). Model: ^ Fill Sump Sensor(s). Model; ~ „~-1Vtechanical Line Leak Detector. Model: f~.~ y~Rt-l~r echanicai Line Zeak Detector, Model: ~ G fl ~1AC.~~~' ^ Electronic Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: ^ TanJc Overfill /High-Level Sensor. Model: ^ Tank Ove~ll /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). Dispenser ID: ~1 ~ Dispenser [D: 3l ~-( ~-Dispenser Containment Sensor(s). Model: EfIU A~ERV. ispenser Containment Sensors}. Model: . BEr<lU ~~ 4~ Shear Valve(s). .®-Shear Valve(s). . . O Dis enser Containment Floats and Chain s). ^Dis enser Containment Floats and Chains . Dispenser ID: S ~ Dispenser ID: ~ ~ Dispenser Containment Sensor(s). Model; ~~ U ~ !LE}kl~ ~ _ .)Dispenser Containment Sensor(s). Model: ~}} UJ~2~AV ~~hear Valve(s). Shear Valve(s). ^ Dispenser Containment Float(s) and Chain(s). D Dis enser Containment Floats and Chains . Dispenser !D: _S't l[7 Dispenser ID: ,>} Dispenser Containment Sensor(s). Model: ,BEfjU~1~r'3y I ^ Dispenser Containment Sensor(s). Model: }-Shear Valve(s). ^ Shear Valve(s). ^Dispenser Containment Float(s) and Chain(s). l7 pis enser Containment Floats and Chain s). *It the tacihty contains more tanks or dispensers, copy Chis form, include information for every tank and dispenser at the facility. C. CertlfiCatiOt7 - 1 certify that the equipment tdentified 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 lnformatlon is correct and a Plot Plan shotivittg the lnyou[ of monitoring equipment. For any equi meat capable of generating such reports, 1 have also attached a copy of the report; (check all that apply): ~~ystem set-up larm history report Technician Name (print): ~~/~t/~pnj ~~pn/ Signature: Certification No.: _,~~3y ~3 S License. No.: sa.'k`'`,c}$o- J ~ Testing Company Name: RICH ENVIRONMENTAL Phone No.:.C 661. ~_ 342-8687 Site Address: /30p~( 557DGIGS~I.E r+w`~.~~~Ic~,~sEc~D~el3 DaieofTesting/Servicing: 3/1~E/ O-') Page I of 3 03101 Moniroring System Certification _ . - -- - - ~ S~~c D. Results of Testing/Servicing Software Version Installed: /`i .U t Yes O o Is the audible alarm o erational? Yes ^ o Is the visual alarm o erational? Yes ^ ° Were all sensors visually ins ected, functional) tested, and confin-ned o erational? es ^ ° Were al! sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their pro er o eration? O Yes ^ ~ If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) ,~ N/A operational? Yes ^ o For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ^ NIA monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply)~Sump/Trench Sensors; O Dispenser Containment Sensors. Did you confirm ositive shut-down due to leaks and sensor failure/disconnection?,i~`Yes; 0 No. O Yes O o For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no ~N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operatin pro erly? If so, at what ercent oftank capacity does the alarm tri ger? O es o Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re lacement arts in Section E, below. O es o Was liquid found inside any secondary containment systems designed as dry systems? (Check alt that apply) O Product; ©Water. If es, describe causes iri Section E below. Yes ^ o Was monitorin s stem set-u reviewed to ensure ro cr satin s?Attach set u re orts, if a licable Yes ^ ° is all monitoring equipment operational per manufacturer's specifications? to ~ecnon ~ below, descnue norv ttnd when tnese aenciencles were or will be corrected. E. Comments: Page 2 of 3 03101 l 5 ~ ~c F. In-Tank Gauging / SIlZ Equipment: ~.Gheck 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. \.VIII IVIV © Yes I p o Has ail input wiring been inspected for proper entry and termination, including testing for ground faults? ^ Yes ^ o Were all tank gauging probes visually inspected for damage and residue buildup? ^ Yes ^ ° Was accuracy of system product level readings tested? ^ Yes O ° Was accuracy of system water level readings tested? ^ Yes ^ o Were al l probes reinstalled properly? O Yes ^ o Were all items on the equipment manufacturer's maintenance checklist completed? In tn6 JCCTIUn [Y, pClOw, QeS I'r1UC UUW Uilu IY UGU 111G~C UGIIC IC 11610D 1V Olc v~ nu1 uc cv1 ac~.w~s. G. Line Lealc Detectors (LLD) r'mm~lntn thn fnllnwina nharklict• ^ Check this boz if L1:Ds are not installed. ,'fz~--Yes O No` f•or equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? D N/A (Check a/!that apply) Simulated leak rate:~3 g,p.h,, O 0. I g.p.h , D 0.2 g.p,h. Yes O o Were all LLDs confirmed operational and accurate within regulatory requirements? Yes O o Was the testing apparatus properly calibrated? Yes O o For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^ N/A ^ Yes O o For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? N/A ^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled N/A or disconnected? ^ Yes O o For electronic LLDs, does the turbine automatical ly shut off if any portion of the monitoring system malfunctions N/A or fails a test? O Yes Q o For electronic LLDs, have all accessible wiring connections been visually inspected? N/A es O o Were aJl items on the equipment manufacturer's maintenance checklist completed? - ~n uie ~ecnon n, oetow, aescnne now anu when [nese aenciencies were or wtll pe correcteq. H. Comments: Page 3 of 3 Q3101 Sal ~d Monitoring System Certification UST Monitoring Site Plan Site Address: -- ------- f - _~_ ~_ ~~ - 1--'=-------- Date map was drawn: ~/~/ d'7 Ins' suctions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical ox electronic Iine leak detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Pian was prepared. Page __~__ of-~-- os~oo 1 soya 56~k3 BRaO~S C'R CBRS~'x&~I,D,O.A.9330$ OFk'TC7E (651) 392,s~87 & FAX (661) 351,g~U6~1 2SF_,,_ HC,,y~~~A7 L~'*~ i2Ts"~'FiCR't1R Tfi4m i V W/0~: Fao:l.li~~' tame; ~~-U~~ . i ~'ac:l.li~Y Address ; ~~`-{ ~TLY_._k~ f~L<-= ~il~.J~ , ~i~k~~2S•FTE , rf~ Pr4c:lue~ Lane Type {Presauz~e, Buprl.az~, B:ravlGy) ~~'byQ-E T PFtfJDLTCT LEAK DETECTOR TXP~ T TFEST TRTp PA6S': s~:.Rx.A,z~ z~t~asEZt BET~OW Pf32 OR ~ g ~ . s&.RI.AL # /fIE~H ~-T~~- 3PQ /~ ~I_' ~~ i . L/A ~'XPE c7 J~1Gk~r 4 SRZ2~.A.I. # n1EGlit}n1~ ~t (,~ 2P0 / p~-'- ff'ATI.! L/A TY'PE_~~ . ~ r ~s q ( . Si~RxRT, ,~~GGtfAnJ~G(31.._ Ep f~-. FA.TL _ I,/~7 T'Y'PE Qom- ~Lk~T ~s~` SER1~, # ~~H N"~ L NO /a F.A.,LL~ I ::ertify the above tests wexe con@uate~3 an thi8 date acaarding ~a Red ~faaket Pumps fie3.d test apps.xaL-ua tesrj.ng jpaC'oCedure as limitat~.arsa. TtL:: Mechan.iraJ. Lea3c DPtect.ox Test bass /fail is detexminec~ by wing a lava flow ttzreshold trip rate of 3 galJ.o:n per b.aus or leas at lA PSI. Z s~cxnowledge that a).1 data aollaeted i~t tru® and GOrr6ot to tkie beet of rr4~ knowledge . Sigi~e~Cura: ~~~--'~,~t - D&te t~-~~ ~7 ~ a•. - 1s~Y6 SWRCB, Jani:ary 2006 Spill~Bucket Testing Report Form ' This form is intended for use by contractors performing annual testiirg of UST spill containment sh~retttres. '77ie completed form anil.- printoutsfromtests (ifapplicable), should beprovided to tbefacilily:owfier/opeiatorfor sitbmittal.to the local regulatory agency. • • r, a ~+Tr 7mz7 iwT~nblbf A T-A1~T ..'' i, i•~avawra~.~ Facility Name: G Ev o~I ' ' Date ofTt:s ' -- ; r"~ . FacilityAddress: i Uc~ vG.ir.-Oft i~~ ~ Faciiity Contact: N Phone: Date Local Agency Was Notified of Testing : ; ~ . Name of Local Agencylnspector (~fPresent.during testtn~: • pjJ E ~ . ~ m~e~rrnTr^~ ~nwrrR srvrnti T11TT~']72MA'1'i[1TT Company Name: i2r~ v~ M L .Technician Gbnducting Teat: 2~32~} ,v c.~ti1 . Credcatialat; CSLB Contractor„ C Service T SwRCB TankTcster Other eei ) License Number(s): 5 a-~ ~ ~ v - J T' . Z CpTT.T. RTT!`Ki+'.T'1`x'C7'fNC. iNiiARMATIC)N Test lvicthod Uaed: static Vacuum Ckher . Tort Equipment Used: >~"SUA +_ &Iuipmaat Resolution: Identify Spill $u,cloet (By'Tank' I Number, Stored Product, etc. g 7 2 ~.. • g ~ 3 9 l 4 ~'- ~~ L Bucket Installation Type: Direct Bury Con in S tttict $ - Contained in S t B Contained is S irt;ct $ Co is S Bucket Diameter: ~ ~ ~ ~ - a.`~ ~• ~ h.~ t Bucket Depth: ) ' ` J ' `` . 12= ` I ' ` wait ti>~ between applying vacuum/mater a~ad start offset: 3U t''~"^~ ~ !v~$'it1 ~ n1 3Q /stun/ Test Start Time (T'd: v t~ U O ~ ~ v Ai+~. o Piy1 Initial Reading (Rt): , ~ g % , , • 9 t ~ // ' , TestEBdTitnef~Fr ...~~~ m v~,~ a:3~ M as~P Final Reading (Rp): 9 " 9' t ~~ ~ . ~ ~ . Teat Duration (Tp - T~: / H t~- .. ~ j K 1 I-i F~ •/ Change in Reading (RF - R~: p t ~ O ~ ~ ~ ~ ~ t Pasa/FaII Threshold or Criteria: OCR Q~` COminents - {utclude information on repairs made prior to testlntr, and necomnie Q ~~ nded follow-un for failed O 1 ~ testa] ~-y~~~.t1 ~~,pTl~_ FyU~-k-c.Z Ff`fS~E.~. ~~1~. Uc,-l'~-E~ 1j5 /9 [.~ ~lefiLl~ ~,n/ (.Jfl`-~-. STA~c~--~ Hf~S `~iE•E•/ NUZ~~E;t]~ 14N ~' ~iJ~I..L N1911E ySPS~ ~E~Pr<AL.E D. ~tk£T ~...~... CERTIFICATION OF TECHNICL4N RESPONSIBLE FOR CONDUCTING THiS TESTING I hereby cart{ jy that all the information contained in this report is b ue, accuracy and !n full compllaltce with legal requirements Technician's Signattrre:~~~ ~--' .. ~ Date: 3 ' t ~{ ' U7 State i$wa and regulations do not etitrently r'cquirc trsting to ba performed bya qualified aonuactor, However, local izquirameatg iuay be more ctriagoaL SION LEVEL S E VER ION 14~O1 COMMUNICATIONS SETUP IIV-TANK SETUP SOFTWAkEg346G14-100-B ------ ---___ ------ --- --- CREAT);D - 97.G3.12.2D.41 T 1:UNLEADED NO SOFTWARE MODULE PORT SETTINGS: PRODUCT CODE 1 SYSTEM FEATUR!~S: THEkhIAL COEFF :.OOD700 PEk10DIC IN-TANK TESTS CUMM BGARD : 1 (RS-2327 TANK DIHMETER 96.00 ANNUAL IN-TANK TESTS BAUD RATE 1200 TANK PROFILE 1 PT PARITY ODD FULL VOL 12000 STOP BIT 1 STOP DATA LENGTH: 7 DATA FLOAT SIZE: 4.0 IN. 8496 HUTO TkANSMIT SETTINGS: WATER WARNING 2,0 HIGH WATEk LIMIT: 3.0 AUTO LEAK ALARM LIMIT DISABLED MAX OR LABEL VOL: 12000 AUTO HIGH WATER LIMIT OVERFILL LIMIT 90% SYSTEM SETUP DISABLED 16800 - AUTO OVERFILL LIMIT HIGH PRODUCT dQ MAR 14. 2007 2:44 Phl DISABLED 0 11 AUTO LOW PRODUCT DELIVERY L1hlIT !0% DISABLED 120D SYSTEM UNITS AUTO THEFT- LII'1IT DISABLED LOW PRODUCT 5D0 U,S. AUTO DELIVERY START LEAK ALARM LIMIT; 99 SYSTEM LANGUAGE DISABLED SUDDEN LOSS LIMIT: 50 ENGLISH AUTO DELIVERY END TANK TILT 0.00 SYSTEM DHTEiTIME FOF'th1HT DISABLED MON DU YYYY HH:MM:SS xM AUTO EXTERNAL INPUT ON MANlFOLDED TANKS DISABLED Ttt: NONE STOCKUALE CHEVRON AUTO EXT!RNAL INPUT OFF 13004 STOCKDALE DISABLED BAKERSFIELD CA AUTO SENSOR FUEL ALARM LEHK MIN PERIODIC: 0!0 DISABLED • 0 AUTO SENSOk WATER ALARhI SHIFT TIME ! DISABLED DISABLED LEAK MIN ANNUAL Or SHIFT TIME 2 DISABLED AUTO SENSOR OUT ALARM 0 SHIFT TIME 3 DISABLED DISABLED SHIFT TIME 4 DISABLED PERIODIC TEST TYPE PERIODIC TEST WARNINGS STA NDHRD DISABLED ANNUAL TEST WARNINGS ANNUAL T'ES L DISABLED RS-232 SECURITY ALARM D1SAbLETi PRINT TC VOLUMES CODE 000000 PERIODIC TEST FAIL ENABLED ALARM DISABLED TEMP COMPENSATION GROSS TEST FAIL VALUE (DEG F ): 60.0 ALARM DISABLED RS-232 END OF MESSAGE H-PROTOCOL DATA FORMAT DISABLED ANN TEST AVERAGING: OFF HEIGHT PER TEST AVERAGING: OFF RE-DIRECT LOCAL PRINTOUT DISABLED THNK TEST 1VOTIFY: OFF SYSTEM SECURITY TNK 1'ST SIPHON BREAK:OFF CODE 000000 DELIVERY DELAY 15 MIN T 2:PLUS PRODUCT CODE 2 THERMAL COEFF :.000700 TANK DIAMETER 96.00 TANK PROFILE t PT FULL VOL : 12000 FLOAT SIZE: 4.0 IN. 8496 WATER WHRNING : 2.0 HIGH WATER LIhIIT: 3.0 MAX OR LABEL VOL: 12066 OVERFILL LIMIT 90i 10800 HIGH PRODUCT 95% . 11400 DELIVER`! L I hl I T f Oi 1200 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 0.00 MANIFOLDED TANKS Tts: NONE T 3 : I/REM I UN1 PRODUCT CODE 3 THERMAL CO£FF :.000700 TANK DIAMETER : 129.00 TANK PROFILE 1 PT FULL VOL 16000 FLOAT SIZE: 2.0 IN. 8496 WATER WHRNING 2,0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 16000 OVERFILL LIMIT 90% 9000 HIGH PRODUCT 95i 9500 DILIVERY LIMIT l0i • 1000 LOW PkODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 0.00 MANIFOLDED TANKS Tis : NONE ~s~~~ T 4:DJESEL PRODUCT CODE 4 THERMAL COEFF :.00040 TANK DIAMETER 129.00 TANK PROF I I.E 1 PT FULL VOL 10000 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 10000 OVERFILL LIMIT 90%s 9000 HIGH PRODUCT 95i 9500 DELIVERY' LIMIT 10% 1000 LOW PRODUCT 500 LEAK ALARM L[MIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 0.00 MANIFOLDED TANKS Tk: NONE LEAK MIN PERIODIC: Oo LEAK MIN PERIODIC: OQ LEAK t~1IN PERIODIC: 00 • 0 ' LEAK MIN ANNUAL 0% LEAK MIN ANNUAL 0r0. LEAK MIN ANNUAL 0% 0 ~ 0 PERIODIC TEST TYPE PERIODIC TEST TYPE PERIODIC TEST TYPE STANDARD STANDARD STANDARD ANNUAL TEST FAIL ALARM DISABLED PEk I OD I C 'L'EST FH I L ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF THfVK TEST NOTIFY: OFF TNK TST SIPHON BREAk:OFF DELIVERY DELAY 15 I°I I N ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANIV TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY l5 i~IN ANNUAL TE5T FH1L ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 15 h11N LEAK TEST METHOD TEST ON DATE :ALL 7'HNK JAN 1. 199b START TIME : DISABLED TEST RATE :0.20 GAL: HR DURATION 2 HOURS LEAK TEST kEPORT FORNIHT NORMAL 1s~~6 LIGUID SENSOk SETUF R 2:89 STP ALARM HISTORY REPORT - - - - - - - - - - - - TYPE STANDARD ---- IN-TANK ALARM ----- L 1:87 STA NORMALLY CLOSED TRI-STtiTE (SINGLE FLOAT) T !:UNLEADED CATEGORY STP SUMP LIQUID SENSOR ALMS OVERFILL ALARM L 2:FUEL ALARM MAR 2. 2007 11:26 PM L 2:89 STP L 6:FUEL ALARM FEB 13. 2007 12:01 PM TRI-S`fATE (SINGLE FLOAT) FEB 10, 2007 12:04 PM CATEGORY STP SUMP R 3:91 STP LOW PRODUCT HLARM TYPE: NOV 25. 2006 5:23 PM L 3:91 STP STANUHRD TRI-STATE (SINGLE FLOAT) NORMALLY CLOSED IfVVALID FUEL LEVEL CATEGORY STP SUMP NOV 25, 2006 5:20 PM LIGUID SENSOR ALMS L Q:DIESEL STP L 3:FUEL ALARM DELIVERY NEEDED TRI-STATE (SINGLE FLOAT) L ?:FUEL ALARM MAR 5. 2007 9:05 AM CATEGORY STP SUMP FEB 5. 2007 10:00 AM JAN 30. 2007 6:24 PNl • R 4:DIESEL STP L 5:$7 ANN TYPE: TRI-STATE (SINGLE FLOAT) STANDARD CATEGORY ANNULAR SPACE NORMALLY CLOSED LIQUID SENSOR ALMS L 6:89 ANN L 4:FUEL ALARM TRI-STATE (SINGLE FLOAT? L ?:FUEL ALARM CATEGORY ANNULAR SPACE ALARM HISTORY REPORT L 7:91-D ANN ---- IN-TANK ALARM ----- TRI-STATE SINGLE FLOAT) CATEGORY AIVNULAR SPACE T 2:PLUS AELIVERY NEEDED OGT 30. 2006 5:24 PM ALARM HISTORY REPORT ---- IN-TANK ALARM ----- T 3:PREMIUM DELIVERY NEEDED FEB 5. 2007 1:39 AM OUTPUT RELAY SETUP R 1:87 STP TYPE: ALARM HISTOR`! REPORT STANDARD ---- IN-TANK ALARM ----- NORMALLY CLOSED T 4:DIESEL LIQUID SENSOR ALMS L !:FUEL ALARM DELIVERY NEEDED L 5:FUEL ALARM JAIV 9. 2007 12.30 PM AEC 13. 2006 10:28 AM ALARM HISTORY REPORT ORY REPORT ALARM HIST _ -- SENSOR ALARM ----- L 1:57 STP _ ____.- SENSOR ALARM ------ STP SUMP L 5:87 ANN FUEL ALARM ANNULAR SPACE MAR l4. 2007 1:22 Pri FUEL ALARM ,,, 3 PM 1 : ~. rIAR 14. 2007 SETUP DATA WARNING JAN 1. 1996 8:02 AM SETUP DATA WARNING JAN 1 . 1996 B : 02 AI"1 ALARM HISTORY REPORT ALARM HISTORY REPORT ----- SENSOR ALARM ------ L 2:89 STF ------ SENSOR ALARM --~-- STP SUMP L 6:89 ANN FUEL ALARM ANNULAR SPACE MAk 14. 2007 1:18 Prt FUEL ALARM 2007 1:19 PI"1 MAR 14. SETUP DATA WARNING JAN 1. 1996 8:02 AM SETUP DATA WARNING JAN 1. 1996 8:0~ Arl ALARNI HISTORY REPORT HISTORY REPORT ALARM ------ SENSOR ALARM ----- L 4:D[ESEL STP ----- SENSOR ALARM ----- STP SUMP L 7:91-D ANN FUEL ALARM ANNULAR SPACE MAR 14. 2007 2:04 Pf"i FUEL ALARM_ 1:16 F'rl MAR !4. 20U7 FUEL ALARM MAR 14. 2007 1:15 PM SETUP DATA WARNIfdG 8:02 AI"1 JAN 1. 1996 SETUP DATA WARNING; JAN 1. 19yb 6:02 AM `~q yd ~5 quo MONITQR CERT: FAILURE REPORT` ~T~..N~• ~,H~.~ t'~-o~.J ~ DATEt 3 - ~ ~-l -c~'7 ADDRESS• /~3cxx-~ b~t~..1c-S~t. c.~ ~t~.1YTECHNICIAN: ~~R.~/~o..~ ~'~~^~ TBE~FOLLOWING COMPONENTS WERE.REPLACEI7/RE~'AIRED TO COMPLETE TESTING. . R~AIRS• ~~ c L- ~, = L _ ~J cyk-~ T ~ f~5LA ~(_-~ U ,~~P ~.J . ~_ ~~aE ~.~P,L.~- bP ~t.~-- ~ ~~tiET~Eey 5 Z'c~ ~~ ~Pt.fic,.E~. ~AB4$: n,E-~ ~ E PARTS:INTALLED: /VcJ n!'~ NAME'. VL~~~ ~ 1~\t ["/~~.~(.~ '~['t.~~ { .a-S V`~ CSI THE ABOVE NAMED~P~OI~AKES FULL RESPONSIBII~ITY OF NOTIFYING THE APPROPRIATE TY TO SAYE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED ROBLEMS AND N01'IFYII~TG RICH ENVTRONMANTAL FOR ANY NE~.DED RETESTING. THIS ALSO RELEASES RICH ENVIItONME1~ITAL OF ANY FINES ORPENAI.TIES OCCURIlVG FROM NON COMPLIANCE. A COPY; OF THIS DOCUMENT HAS BEEN Y,EFT ON-SITE FOR YOUR CO ~ ~ CE. ~ _ rs9 ~o UNDERGROUNQ STORAGE TANKS APPLICATION TO PERFORM ELp / UNE TESTING / S8988 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION BAKER$FIELD FIRE DEPT. ~~~~ Pnwentioa Services AITU T 9d0 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (66I j 326-3979 Fax: (661j 852-2171 ~ l C Page, ~, 3 _ ~ ~(_ o-~ PERMIT N0. ` • ~~ 1^ ENHANCED LEAK DETECTION ~ ^ ^ SB-888 SECONDARY CONTAINMENT TESI7NG 1 1 TA U1C Tlf^_u'TNCCC TC CT .~ TA DCDCAD~~ FI fCl ~Af1NITllDIN/~ f:FDTIFIf:A f7N .. I '%f,+ FACILITY NAME 8 PHO E MBER F NTACT PERSON ADDRESS ~.., OYVNERS NAME OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANK$ TO 8E TESTED I PIP N N Y T ~Zk 2 jZ ~ to ~ - TANK TESTING COMPANY NAME OF TES COM Y NAME d HONE NUMBE C ACT P 0 MAILINQ ADDRESS .~..' NAME HONE NU ER OF TES SPECI NSPECTO CERTIFICATION 3: DATE 3 TIM ES B C DUCTED ICC ~: TEST METHOD SIGNATURE OF AAPUCANT C' DATE --~ APPROVED 8Y pq'~ FD 2095 {R6V. 09/05] _ . f. BAKERSFIELD FIRE DEPT. BILLING Sc PERMIT STATEMENT Prevention Sexvices <r~Rt T 900 'IYuxtun Avenue, $uitc 210 ,PERMIT NO.: ~ ~ " ' Bakersfield, CA 93301 , ~ ~ LocwTION oc PROJECT PItOPERrI' OvvrrQt ~ 5TARTNIG DATE _ I CCIMPt~T10N DATE O eu-aE PROJECT NAME ,/~/~ O t ~ ~ ApDRESS ENO. PROJECTADDRfiSS f ^ ~ / CITY bTATE ~ /I ~ COOE CAN'fRACTOR 1UJAE , CA LICENSE N0. TYPE OF LICENSE. EXPMTgH DATE PHONE a ~ ~ g M COMR4C70R COMPANY NAME ~ ~ FAX N0. ^(/~ / ; r,~ss ~f n (.~' %~ ~ tr l1(1 ~~ ~~ --_ ~"" ~K~ (.-,( rp~~ ~~D S~ ^ Alarms NNnlmu Char w & Modifications - e) 5282 50 N ~ • ( - g e m . 98 000 S Ft Over 20 i=t x 013125 = Permit fee S ~ p q. , . q. 98 ^ rinkler§ -New & Modifications - {Mrnimum Char S ) 00 $210 ~ ge p . 98 ^ 000 Sq Over 5 Ft 042 = Permit fee Ft x S ~ . , . q. . gs ^ Minor S rinkler Modifications (< 10 heads) 00 [inspection Only] :93 ~ p . 98 ^ Commercial Floods -New & Modifications 26 S 398 ~ . 98 ^ AddiflonaJ Hoods 00 8 36 ~ . O Spray Booths -New & Modfications $458 00 ~ . 9t3 ^ round Store a Tanks (IrrstarlafYONlnsp.-t • Thee) $165:00 13Z ^ Additional Tanks i 26.00 ~ 62 ^ Aboveground Storage Tanks (Removatrlrupectlon) $109.00 ~ ^ Und round Storage Tanks (lnstallatronJlnspecNon) $878.00 (pertank) 82 ^ Underground Storage Tanks (f~Aodlfication} $878.00 (persite) ~ ^ Underground Storage Tanks {Minor Modiflration) $155.00 ~ ^ Underground Story a Tanks.{Remove/) $875.00 (pertankJ 84 ^ Oilti,rell pnstallation) 372.00 Ira Mandated Leak Detection (Testing) / ue! fiAonit Cart S 81.00 (persite) ~ ^ Tents $93.00 (pertentl 84 ^ Arlser Hours inspector .tea ;azs.oa ea ^ Pyrotectlnlc -(Per event, Plus Insp. Fee ®S90 per hour) $ 60.00 t (5 IvB, min. stand ~y flee nnspedfon) _$510.00 134 [] RL~INSPECTION(SJ /FOLLOW-UP INSPEGTION(S) ;93.00 (per hour) 84 ^ Portable LPG (Propane): NO.OF CAGES? $66.00 84 Q F~k>slve Storage $249.00 84 O Copyi & File Research (File Research Fee 333.00 per hr) 25¢ per page 84 ^ MisceUaneotrs ~ 84 Fp 2021 (RI,W. IJ9P05) 1 -ORIGINAL WHITE (to Treasury) 1•YELLOW (to Flle) 1•PINK (to Customer} ,~ - -- - .--~--- - Ft1;Cht F~VJ~tCtNlVtEhtTAI `~ ~ ~.. -7 p -,--r-Q ~~ ~,6~,~32 ~s~~~~r~,~rr~t ~~av~~F ~ ~5 9 7 ~, EyiC #$,'09850 ~: ~ s r = , ~~ s - . . ~ ~ 5k543.~RC~OKS CT° r 1 ;. ~. .~AIQERS~IEIfl`iE~A 933b8 37p8 ~ _ r ~ ~ . ; ` ~ /1 /~,. ` DATF (G~1? 392 86 7 ~ r U ~ _ ; Y a. ~ Washingl'on Mutyal° W~~s'yyiNc~t~riMU3t+t.4tgaNx ~A am 3DB -" ~ ' h ~. ~ ~~ + } gyp ( 9AK4RSF~~L MN ° "' ~ ` : r'" r .° o ( ,WIdN~am~i u~ ~ , 93 ~NY _ 7 ~ 1 ) q !~ C ` _ '~ ~/~ \y~' J ~ °~""~~ - F FOR. v1J_. a ~ ~ ' ApTHGRI G 9~ NA~UA~ _ ~-~y~/j ,~f~.~ ~''~/~ . ,~ _ _ J_ .. _ - _ - .~., . _ _. _ ... 3. * ~ `~~~ Pagc~ of~ ~econdat y Containment Testing Report Form. 'i'bis fnrn, is inronded for usa by eontract~rs performing periodic testing of UST serondory containment systems. Use tha approprtate pages of this form to report ~`esults fnr all components tested. The completed form, written test procedures, oHd printouts from rests (tfapplicable), shou':i be provided to thefacility owner/operatorforsubrnitta! to the local regulatory agency. r FerrT.rrv rNFl1T11VTerrnN ~, tk72CF3, January 2Q02 Facility Name: 5 pC:, ~w ~~. W ~ Date of Testin -,p 7 I'aciliry Address: 3 C, W {,. Faciiity Contact: Phone: Uate Local Agency Was Notified of Testing PJame of Local Agency Inspector (ifpresent during testing: m~c~r`rN~ rnNTt?ermnu rNril1RMeT7(7N Company Name: RTCH ENV IRONidENTAL T'ecltniaian Conducting Test: ~ p Z ej-[./~- Credentials: ~ CSLB Licensed Contractor ^ SWRCB Licensed Tank Tester License Type. C61ZD90 License Number: 809850 _ Manufacturer Manufacturer Traf in¢ Com ovens Date Trainin E ices INCON INCON TS-STS 3_ SZ1iNMARV (~}~'I'F.CT RFc'CiT-.Tfi:: Component _ Pass Fail Not Tested Repairs Made Component paw Faii Not Tested Repairs Made ^ o ^ ^ p a. ^ _ G Cl ^ 0 CJ 0 Q Ci _ _ O D O C7 p p ^ p 0 0 ^ D ^ 0 0. D _.__ Q ^ d 0 ^ ^ CJ ^ . a p o ^ ^ ^ ^ ~ O ^ U U O O Q L7 ^ ^ a o ^ ^ ^ r Q ^ ^ ^ rJ "CJ f~ 0 Q 0 0 Q ^ Q !7 ^ n o ^ a a a fl ^ 0 0 ^ Q a ^ a it nyarostanc testing was perfprmed, describe what was done with the water a8er completion of tests: RECYCLE AND REUSED ' .. _ CERT.TFICATTON OF TECHNTCIAIV RESPONSTBLE FOR CONDUCTING THIS TESTING !'o tfi a best of my knowledge, t/~e jack stated t'n t/11s document are accurate and !n ju!/ compliance whir /ega! requirements Technician's Signature: Cs.o S3D77/~ 9-rlrL 'Date:_ 7^,Z~ ~`/' ~, 1 t%~e~~a S WRCB, January 2002 Page ~,yf L/ 9. SPILL/QVERFTLL CONTAINMENT BOX)uS Facili is Not $ ui ed With S ilUOverfili Containment coxes ^ Spill/Overfill Containment Boxes are Present, but were Not Tested ^ Test Method Developed By: t7 Spill Bucket Manufacturer )~ Industry Standard i7 Profassiona(1~ngineer 0 O[her (Spec~f Test Method Used: O Pressure Q Vacuum ~ Hydrostatic ^ Other (Specify) TestBquipmentUsed: INCON TS-STS ~ ~ •, ~r Equipment Resolution:.oooi.n. ,, , ~ °.' .''~~~": L Spill Box #,~ Sp111 Box # Spi[i Box # Spill Box # Bucket Diameter: ~ 2" Bucket Depth: t l.t,`t Wait time between applying pressure/vacuum/water and startin test: 6 Test Start Time; ~ Z714 ti. ~ c~ Initial Reading (Rr): S', Test End Time: FinaiReading(Rr): '^ ,Z~o Test Duration: l~M- SY1MVi Change in Reading (Rr-Rt}: ~D-0 Z Pass/Fail Threshold or Criteria: ' O Q Z Test Result: Pass ^ Fai! ^ Pass Q Fail ^ Pass ^ Fa;l ^ Pass Q Fail COt17triCIlt$ - (include lnform¢tiorr on repairs mode prior ro restLrR, and - ,~ «> r ,:. /~a ~1~6 SR989 TESTING FAILURE REPORT SITE NAME : S ~~ ~.L° W C~.~eP~ DATE : / -_~Z" ADDRESS : 3 w TECHNICIAN : cur CXTY : 5 ~1L.~ ~ $ I crrATUItE SITE CONTACT: ' THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE T$E SB989 TESTING. . LIST OF PARTS REPLACED/REPAIRED: REPAIRS • ,~ ~af,~r~ ~5~.- c.~4~ ll C3~z('-l.y 27 -a7~ r "' LA80R: ~ ~/~S ~. ~ i i . i j i PARTS INSTALLED: ` O~l1J •~' ~ L~1 ~~~ -~ _~ ~c~c,k~ c~~ c X20 ~.~ . . ~ i ~.i `s .. _ ~. ~ ~ ~( ~l0 OSLFILL TEST STARTED 6~[7 AM TEST S1'RR7ED 94/28r2007 BEGIN LEUEL 5.23t~6 IN END TIME 6:4s AM END DATE $4/28200? r_ND LEUEL S.?.368 IN LEAI! THRESHOLD ©. $~32 IN TEST kESULT PASSED SUMP LEAK: TEST REPORT r!SLF I LL TEST STARTED 644 Art TEST oTRRTED $4/28%2007 EEGIN LEUEL 5.2365 IN END TIME 659 RM ENU DATE 04/2x/2007 END LEUEL `.2364 TN LERY. THRESHOLD E.00i Ira TEST RESULT PRSSF_D s `- UNIFIED PROGRAM INSPECTION CHECKLIST' .SECTION 1: Business Plan and Inventory Program ~~ir ~wrr BAKERSFIEILD FIRE DEPT Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME ~ ~~ -• NSPE 10 ATE NSPECTION TIME ADDRESS HON N O OF E~AP YEES l C ~* p c FACILITY CONTACT S NESS ID UM R 15-021-' 9~ S®ction 1: Business Plan and Inventory Program ^ ROUTINE MBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ ^ BUSit1eSS PLAN CONTACT INFORMATION ACCURATE VISIBLE ADDRESS J~~ t / v CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PRO DURES EMERGENCY PROCEDURES ADEQUATE ~~~ U.L 31200 ^ CONTAINERS PROPERLY LABELED _ ^ HOUSEKEEPING FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ~O EXPLAIN:. - __ OUESTIONS~GARDII~G/TFjf~INSPECTION? PLEASE CALL US AT (881) 328-3979 (Please Print) Fire Prevention / 1" In /Shift of SNe/Staiion 8 White -Prevention Services Yellow -Station Copy Pink - Buaineae Copy FD2l)4!i (Rev. 02/05) i_ . :~ ~~iw~~' `~~ ~\ CITY OF BAKERSFIELD FIRE DEPAR"I'MENT ~~ ~ ~ M~ OFFICE OF ENVIRONMENTAL SERVICES `~ , y~~' UNIFIE® PROGRAM INSPECTION CI~ECKLIST -,wE'~g~,d~ 1715 Chester Ave., 3'•~ Floor, Bakersfield, CA 93301 FACILITY NAME ~'~E CL~~ ~ ",~ ~ G~.OI~ [NSPEC"I~ION DATE__JI ~~~, Section 2: Underground Storage Tanks Program ^ Routine ~mbined Joint Agency ^Mulfi-Agency plaint ^ Re-inspection Type of Tank Number oI~"Tanks Type of Monitoring _~ t~blti Type of Piping OPERATION C V COMMENTS Proper tank data on file Proper owner/~~perator data un file Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior tJST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY' Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection'? C=Compliance =Violat' i Y=Yes N=NO Inspector: Office of Environmental Services (661) 326-3979 Whitc - Gnv. Svcs. Business to Re nsible Party Pink -Business Cony