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Home My WebLink AboutBUSINESS PLAN 10/2008;i 4, _ U JACK IN THE BO% ~~3576 ~,_ I, 10 UNION AVENUE ---- - I - - - - --- - ---- - ~73`12~ r-.~ -: ;, UNIFIED PROGRAM INSPECTION CHECKLIST:' .SECTION 1: Business Plan and Inventory Program A_~~~n ~. BAKERSF1tE1LD FIRE DEPT a Prevention Services Fitts '900 TYuxtun Ave., Suite 210 ~wt-~r Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 ~~~ FACILITY AME ~ NSPE ~ ~ ~ / NSPECTION TIME ~ ~j ADDRESS HO N NO. O OF EMPLOYEES V 1~~~~ ~L FACILITY CONTACT USINESS ID NUMBER 15-021- ~~ '1 Section 1: Business P{an and Inventory Program ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Vblation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIfteSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ ~^ CORRECT OCCUPANCY - VERIFICATION OF fNVENTORY MATERIALS ~~~t® ~~~1\I '~ 4~ fa5eas~,y ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~Y ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED L~~ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ^ NO EXPLAIN: REGARDj>~IG/THIS INSPECTION? PLEASE CALL US AT {861) 326-3979 Inspector (Please Print) Fire Prevention / 1" In / Shift of SRe/Station p Basins ool Site Responsible arty (Please Prat White -Prevention Services Yellow -Station Copy Pink - Buaineae Copy FD2049 (Rw. Oy05) = ~~ INSPECTIONS B E R S F I L D BUSINESS PLAN & _- ~RrM r INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: C1(ytc~1 VL~~,~6"~~ Ute~. S-~t1~ Section 2: Underground Storage Tanks Program INSPECTION DATE: ~_ ^ Routine C3/Combined ^ Joi Agency ^ Multi-Agency ^ Complaint ^ Re-Inspection Type of Tank ,~ (~ ~° ~ Number of Tanks Type of Monitoring _(~ (~n 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? ^ Yes QiIVo 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 White -Prevention Services 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 Bus' s e Responsible Party Pink -Business Copy KBF-7335 FD 2156 (Rev. 09/05) FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION ~~'.~~ Page _ of I. IDENTIFICATION 015-021-002367 9/19/07 ongoing Same as FACILITY NAME or DBA -Doing Business As) Quick Stuff #7723 (661) 861-0543 10 Union Avenue Bakersfield ~ ~,~ ~O CA 93307 04-211-7200 ~ egrt 5541 Kern Joanna Harris (661) 861-0543 II. BUSINESS OWNER Jack in the Box, tnc. (858) 571-2689 9330 Balboa Avenue San Diego CA 92123 III. ENVIRONMENTAL CONTACT JMM Management Group, LLC (847) 888-0276 A M 2496 Technology Drive Elgin IL 60124 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- Ed Osinski Jorge Parra Area Manager Director of Operations (661) 337-9981 (858) 414-2431 (661) 337-9981 (858) 414-2431 erte ecateon: ase on my Inquiry o t ose In eve ua s response a or o taeneng t e en ormateon, certl un er pena ty o aw t at ave persona y examine and am familiar with the information submitted and believe the information is true, accurate, and complete. ~., ~ 9/19/07 Daniel A Erickson NAME OF SIGNER (print) Daniel A Erickson Compliance Manager UPCF (1/99 revised) 4 OES FORM 2730 (1/99) _- - ~J TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TI E 3. E L IT X (Check one item only) ~ 4. AMENDED PERMIT specify change local use only n STANK REMOVED 6.TEMPORARY SITE CLOSURE 400 I. FACILITY /SITE INFORMATION (Sameas FACILITY NAME or DBA-Doing Business As) 3 1 5 • ~~~ 0 2 1 °<~ ~`~~ 0 0 2 3 6 7 ~ Quick Stuff #7723 ~ NEAREST CROSS STREET 401 Q 1. CORPORATION ~ 5. COUNTY AGENCY* x ~ Z. INDIVIDUAL ~ 6. STATE AGENCY* TYPE ~ 2. DISTRIBUTOR ~ 4. PROCESSOR ~ 6. OTHER 403 ~ 3. PARTNERSHIP ~ 7. FEDERAL AGENCY* aoz s as rty on n Ian eservatlon or owner o is a pu is agency: name o supervisor o rvision, section or o Ice w Ic REMAINING AT SITE trustlands? operates the UST (This is the contact person for the tank records.) 3 aoa ~ Yes ~ No aos a05 II. PROPERTY OWNER INFORMATION 408 Jack in the Box, Inc. (858) 571-2689 409 9330 Balboa Avenue a1z San Diego CA 92123 x 3. PARTNERSHIP ~ 5. COUNTY AGENCY ~ 7. FEDERAL AGENCY a1s III. TANK OWNER INFORMATION a1a 41s Jack in the Box, Inc. (847) 888-0276 2496 Technology Drive 417 418 419 Elgin IL 60124 x azo 3. PARTNERSHIP ~ 5. COUNTY AGENCY ~ 7. FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - 3 8 9 6 2 a - I questions arise 4z, V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE METHOD(S) Q 1.SELF-INSURED ~ 4.5URETY BOND ~ 7. STATE FUND ~ 10. LOCAL GOVT MECHANISM 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 ec one ox to in Icate w is a ress s ou a use or ega note ications an mal Ing. ega notifications and mailings will be sentto the tank owner unless box 1 or Z Is checked. ~ 1. FACILITY ~ 2. PROPERTY OWNER ~ 3. TANK OWNER azs VII. APPLICANT SIGNATURE Certification - I certify that the information provided herein is true and accurate to the best of my knowledge. •J e~..~.~1 ~ 9/19/07 (847) 888-0276 pant Daniel A Erickson Compliance Manager (FOr local use only) (For local use only) UPCF (1/99 revised) 8 Formerly SWRCB Form A UNIFIED PROGRAM CO 5 LIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) Pageof TYPE OF ACTION ~ i NEW SITE PERMIT ~ 4 AMENDED PERMIT ~ 5 CHANGE OF INFORMATIOPJ ~ 6 TEMPORARY SITE CLOSURE (Checkone item only) ~ 7 PERMANENTLY CLOSED ON SITE 3 RENEWAL PERMIT (Specify reason -for local use only) (Specify reason -for local use only) ~ 8 TANK REMOVED 430 BU$INE$$ NAME (Same as FACILITY NAME or DBA -Doing Business As) Quick Stuff #7723 3 (Optional) 431 sca e p of p an wlt t e ocatlon o t e system Inc u Ing ul Ings an an mar s s a e su mltte to t e oca agency. # es x o a3a 1 Xerxes If "Yes", complete one page for each compartment. DA E $ L AR/ K C A O P RT S 43~ 1973 20,000 1 (For local use only) 438 C T T aao Q 1. MOTOR VEHICLE FUEL ~ 1a. REGULAR UNLEADED ~ 2. LEADED ~ 5. JET FUEL (If marked complete Petroleum Type) ~ 1 b. PREMIUM UNLEADED ~ 3. DIESEL ~ 6. AVIATION FUEL 2. NON-FUEL PETROLEUM ~ 1c. MIDGRADE UNLEADED ~ 4. GASOHOL ~ 99.OTHER 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) (from Hazardous Materials Inventory page ) 4. HAZARDOUS WASTE (Includes Used Oil) 9S. UNKNOWN (Check one item only) EXTERIOR MEMBRANE LINER ~ 95. UNKNOWN a 2. DOUBLE WALL ~ 4. SIGNLE WALL IN VAULT ~ 99.O1'HER TANK MATERIAL-primary tank X (Check one item only) ~ 2. STAINLESS STEEL ~ 4. STEEL CLAD W/FIBERGLASS ~ 8. FRP COMPTIBLE W/100 % METHANOL 99.OTHER REINFORCED PLASTIC (FRP) TANK MATERIAL-secondary tank )( (Checkone item only) ~ 2. STAINLESS STEEL ~ 4. STEEL CLAD WIFIBERGLA55 ~ 8. FRP COMPTIBLE Wl100% METHANOL ~ 99.OTHER REINFORCED PLASTIC (FRP) ~ 10. COATED STEEL 5. CONCRETE OR COATING ~ 2 ALKYD LINING ~ 4 PHENOLIC LINING ~ 6 UNLINED ~ 99 OTHER (Checkone item only) (For local use only) OTHER CORROSION ~ 1 MANUFACTURED CATHODIC ~ 3 FIBERGLASS REINFORCED PLASTIC ~ 95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ~ 41MPRESSED CURRENT ~ 99 OTHER (Check one item only) ~ 2 SACRIFICIAL ANODE (For local use only) (local use only) (Check all that apply) ~ 1 SPILL CONTAINMENT 2002 ~ i ALARM 2002 ~ 3 FILL TUBE SHUT OFF VALVE x^ 2 DROP TUBE 2002 ~ 2 BALL FLOAT 2002 ~ 4 EXEMPT x^ 3 STRIKER PLATE 2002 (A description of the monitoring program shall be submitted to the local agency.) (Checkall that apply) (Check one 1 VISUAL (EXPOSED PORTION ONLY) ~ 5 MANUAL TANK GAUGING (MTG) item only) ~ 1 VISUAL (SINGLE WALL IN VAULT ONLY) 2 AUTOMATIC TANK GAUGING (ATG) ~ 6 VADOSE ZONE ~ 2 CONTINUOUS INTERSTITIAL MONITORING 3 CONTINUOUS ATG ~ 7 GROUNDWATER ~ 3 MANUAL MONITORING 4 STATISTICAL INVENTORY RECONCILIATION ~ 8 TANK TESTING ($IR) BIENNIAL TANK TESTING ~ 990THER ESTIMATED DATE LAST USED (YR/MO/DAY) ESTIMATEp QUANTITY OF SUBSTANCE REMAINING TANK FILLED WITH INERT MATERIAL? gallons ~ Yes ~ No UPCF (12/99 revised) 10 Formerly SWRCB Form B UNIFIED PROGRAM C NSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS - TASK PAGE 2 VI. PIPING CONSTRUCTION (Check all that apply) Page _ of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE O 1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY aye ^ 1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 459 CONSTRUCTION ^ 1. SINGLE WALL ^ 3. LINED TRENCH ^ 99.OTHER a6o ^ 1. SINGLE W/\LL ^ 95. UNKNOWN a6z MANUFACTURER Q 2. DOUBLE WALL ^ 95. UNKNOWN ^ 2. DOUBLENIALL ^ 99.OTHER MANUFACTURER A.O. Smith 46t MANUFACTURER 463 ^ 1. BARE STEEL ~ 6. FRP COMPATIBLE w/t 00% METHANOL ~ 1. BARE STEEL ~ 6. FRP COMPATIBLE w/t00%METHANOL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ Unknown ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ 3. PLASTIC COMPATIBLE W/CONTENTS ^ 99. Other ^ 3. PLASTIC COMPATIBLE W/CONTENTS ^ 8. FLEXIBLE (HDPE) ~ 99. OTHER 4. FIBERGLASS ^ 8. FLEXIBLE (HDPE) ^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION 5. STEEL W/COATING ^ 9. CATHODIC PROTECTION a6a ^ S. STEEL W/COATING ^ 95. UNKNOWN 465 (Check all that apply) (A description of the monitoring prograitt shall be submitted to the local agency.) SINGLE WALL PIPING 466 SINGLE WALL PIPING 46~ PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): ^ i. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT ~ 1. ELECTRONIC LINE: LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + SHUT 01=F FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. ^ 2. MONTHLY 0.2 GPH TEST ^ 2. MONTHLY 0.2 GPH TEST 3. ANNUAL INTEGRITY TEST (O.1GPH) ~ 3. ANNUAL INTEGRITY TEST (O.iGPH) ^ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS (Check all that apply) ^ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM +TRIENNIAL PIPING 5. DAILY VISUAL MIONITORING OF PIPING AND PUMPING SYSTEM ^ INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): ^ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) 7. SELF MONITORING SAFE SUCTION SYSTEfu15 (NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ^ 7. SELF MONITORING 9. BIENNIAL INTEGRITY TEST(0.1GPH) GRAVITY FLOW (Check all that apply): ^ 8. DAILY VISUALNIONITORING ^ 9. BIENNIAL INTEGRITYTEST (0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSU RIZED PIPING ICheck all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ALARMS AND (Check one) a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ~ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS O b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM ^ b AUTO PUMF' SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION c. NO AUTO PUMP SHUT OFF ^ c NO AUTO PUMP SHUT OFF Q 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT 11. AUTOMATIC LEAK DETECTOR ^ OFF OR RESTRICTION 12. ANNUAL INTEGRITY TEST(0.1 GPH) ^ 12. ANNUALINTE(iRITYTEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ^ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Checkall thatapply) EMERGENCY GENERATORS ONLY (Check all that apply) 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF * ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AU70 PUMP SHUT OFF'" AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) ^ SHUT OFF OR RESTRICTION ^ 16. ANNUAL INTEGRITYTEST (0.1 GPH) ^ 16. ANNUAL INTEGRITYTEST (0.1 GPH) ^ 17. DAILY VISUAL CHECK ^ 17. DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ^ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ 4. DAILY VISUAL CHECK DATE INSTALLED a6a ^ 2. CONTINUOUS DISPENSER PAN SENSOR +AUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LINER /MONITORING 2002 ^X 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 6. NONE 469 ^ DISPENSER +AUDIBLE AND VISUAL ALARMS IX. OWNER/OPERATOR SIGNATURE I certify that the information provided herein is true and accurate to the best of my knowledge. ~~ A ~ 9/19/07 NAME OF OWNER/OPRATOR(print) Daniel A Erickson Com liance IVlana er ermrt um er or oca use on y ermrt pprove or oca use on y ermrt zprrabon ate or oca use on y UPCF (12/99 revised) 12 Formerly SWRCB Form B UNIFIED PROGRAM CONSOLIDATED F RM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) Page _ of - TYPE OF ACTION ~ 1 NEW SITE PERMIT ~ 4 AMENDED PERMIT ~ 5 CHANGE OF INFORMATION ~ 6 TEMPORARY SITE CLOSURE (Check one item only) ~ 7 PERMANENTLY CLOSED ON SITE 3RENEWALPERMIT (Specify reason-for local use only) (Specify reason-for local use only) ~ 8 TANKREMOVED 430 B U $I N E$$ NAME (Same as FACILITY NAME or DBA -Doing Business As) Quick Stuff #7723 3 (Optional) 431 sca e p of p an wlt t e ocatlon o t e system Inc u Ing ul mgs an an mar s s a e su mltte to t e oca agency. tk es x o a3a 2 Xerxes If "Yes", complete one page for each compartment. D EIN ALDYA/MO G R F TS a3~ 1973 10,000 1 (For local use only) 438 CO 440 a 1. MOTOR VEHICLE FUEL ~ ta. REGULAR UNLEADED ~ 2. LEADED ~ S. 1ET FUEL (If marked complete Petroleum Type) ~ ib. PREMIUM UNLEADED ~ 3. DIESEL ~ 6. AVIATION FUEL 2. NON-FUEL PETROLEUM ~ ic. MIDGRADE UNLEADED ~ 4. GASOHOL ~ 99.OTHER 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) (from Hazardous Materials Inventory page ) 4. HAZARDOUS WASTE (Includes Used Oip 95. UNKNOWN (Check one item only) EXTERIOR MEMBRANE LINER ~ 95. UNKNOWN a 2. DOUBLE WALL ~ 4. SIGNLE WALL IN VAULT ~ 99.OTHER TANK MATERIAL-primary tank ~ ~( (Check one item only) ~ 2. STAINLESS STEEL ~ 4. STEEL CLAD W/FIBERGLASS ~ 8. FRP COMPTIBLE W/100% METHANOL 99.OTHER REINFORCED PLASTIC (FRP) TANK MATERIAL -secondary tank )( (Checkone item only) ~ 2. STAINLESS STEEL ~ 4. STEEL CLAD W/FIBERGLASS ~ 8. FRP COMPTIBLE W/100% METHANOL ~ 99.OTHER REINFORCED PLASTIC (FRP) ~ 10. COATED STEEL 5. CONCRETE OR COATING ~ 2 ALKYD LINING ~ 4 PHENOLIC LINING Q 6 UNLINED ~ 99 OTHER (Check one item only) (For local use only) OTHER CORROSION ~ 1 MANUFACTURED CATHODIC Q 3 FIBERGLASS REINFORCED PLASTIC ~ 95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ~ 41MPRESSED CURRENT ~ 99 OTHER (Check one item only) ~ 2 SACRIFICIAL ANODE (For local use only) (local use only) (Checkall that apply) ~ 1 SPILL CONTAINMENT 2002 ~ 1 ALARM 202 ~ 3 FILL TUBE SHUT OFF VALVE 2 DROP TUBE 2002 ~ 2 BALL FLOAT 2Q~2 ~ 4 EXEMPT 3 STRIKER PLATE 2002 (A description of the monitoring program shall be submitted to the local agency.) (Check all that apply) (Check one 1 VISUAL (EXPOSED PORTION ONLY) ~ 5 MANUALTANK GAUGING (MTG) item only) ~ 1 VISUAL (SINGLE WALL IN VAULT ONLY) 2 AUTOMATIC TANK GAUGING (ATG) ~ 6 VADOSE ZONE ~ 2 CONTINUOUS INTERSTITIAL MONITORING 3 CONTINUOUS ATG ~ 7 GROUNDWATER ~ 3 MANUAL MONITORING 45TATISTICALINVENTORYRECONCILIATION ~ 8TANKTESTING (SIR) BIENNIAL TANK TESTING ~ 990THER • ESTIMATED DATE LAST USED (YR/MO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING TANK FILLED WITH INERT MATERIAL? gallons ~ Yes ~ No UPCF (12/99 revised) 10 Formerly SWRCB Form B UNIFIED PROGRAM CONS LIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 VI. PIPING CONSTRUCTION (check all that apply) Page _ of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ~ 1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY a58 ^ 1. PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 459 CONSTRUCTION ~ 1. SINGLE WALL ~ 3. LINED TRENCH ~ 99.OTHER 46a ~ 1. SINGLE WALL ~ 95. UNKNOWN a62 MANUFACTURER ~ 2. DOUBLE WALL ^ 95. UNKNOWN ^ 2. DOUBLE WALL ^ 99. OTHER MANUFACTURER A.O. Smith 461 MANUFACTURER a63 ^ 1. BARE STEEL ~ 6. FRP COMPATIBLE w/too% METHANOL ~ 1. BARE STEEL ^ 6. FRP COMPATIBLE w/too°h METHANOL ^ 2. STAINLESS STEEL ~ 7. GALVANIZED STEEL ~ Unknown ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL 3. PLASTIC COMPATIBLE W/CONTENTS ^ 99. Other ^ 3. PLASTIC COMPATIBLE W/CONTENTS ^ 8. FLEXIBLE (HDPE) ~ 99. OTHER ^X 4. FIBERGLASS ^ 8. FLEXIBLE (HDPE) ^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION ^ 5. STEEL W/COATING ~ 9. CATHODIC PROTECTION a6a ~ S. STEEL W/COATING ~ 95. UNKNOWN a65 (Check all that apply) (A description of the monitoring program shall be submitted to the local agency.) SINGLE WALL PIPING a66 SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. ^ 2. MONTHLY 0.2 GPH TEST ~ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 3. ANNUAL INTEGRITY TEST (0.1 GPH) 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS (Checkall that apply) ^ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM +TRIENNIAL PIPING ^ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): ^ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) ^ 7. SELF MONITORING SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ^ 7. SELF MONITORING ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) GRAVITY FLOW (Checkall that apply): ^ 8. DAILY VISUAL MONITORING 9. BIENNIAL INTEGRITYTEST (0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ALARMS AND (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS Q b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM ^ b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ^ c NO AUTO PUMP SHUT OFF 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT 11. AUTOMATIC LEAK DETECTOR ^ OFF OR RESTRICTION 12. ANNUAL INTEGRITYTEST (0.1 GPH) ^ 12. ANNUAL INTEGRITYTEST (0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM ^ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ^ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF' ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) ^ SHUT OFf OR RESTRICTION ^ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 17. DAILY VISUAL CHECK ^ 17. DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ^ t. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ 4. DAILY VISUAL CHECK DATE INSTALLED a68 ^ 2. CONTINUOUS DISPENSER PAN SENSOR +AUDIBLE AND VISUAL ALARMS ^ 5. TRENCH LINER /MONITORING 2002 ^X 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR ^ 6. NONE 469 DISPENSER +AUDIBLE AND VISUAL AIARMS IX. OWNER/OPERATOR SIGNATURE I certify that the information provided herein is true and accurate to the best of my knowledge. 9/19/07 NAME OFOWNER/OPRATOR (print) Daniel A Erickson Com liance Mana er ermit um er or oca use on y ermrt pprove or oca use on y ermn xpvation ate or oca use on y UPCF (12/99 revised) 12 Formerly SWRCB Form B IFIED P OGRAM CONS LID TED FOR TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 1 (two pages per tank) Page_of TYPE OF ACTION ~ 1 NEW SITE PERMIT ~ 4 AMENDED PERMIT ~ 5 CHANGE OF INFORMATION ~ 6 TEMPORARY SITE CLOSURE (Check one item only) ~ 7 PERMANENTLY CLOSED ON SITE 3 RENEWAL PERMIT (Specify reason-for local use only) (Specify reason -for local use only) ~ 8 TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) Quick Stuff #7723 3 (Optional) 431 sca e p of p an wlt t e ocatlon o t e system Inc u Ing ul Ings an an mar s s a e su mltte to t e oca agency. # es X o a3a 3 Xerxes If "Yes', complete one page for each compartment. DATE i STALL D /MO ANK I G B O S a3~ 1973 7,000 1 (For local use only) 438 S 440 1. MOTOR VEHICLE FUEL ~ 1 a. REGULAR UNLEADED ~ 2. LEADED ~ 5. JET FUEL (If marked complete Petroleum Type) ~ lb. PREMIUM UNLEADED ^X 3. DIESEL ~ 6. AVIATION FUEL 2. NON-FUEL PETROLEUM ~ 1c. MIDGRADE UNLEADED ~ 4. GASOHOL ~ 99.OTHER 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) (from Hazardous Materials Inventory page ) 4. HAZARDOUS WASTE (Includes Used Oip 95. UNKNOWN (Check one item only) EXTERIOR MEMBRANE LINER ~ 95. UNKNOWN 2. DOUBLE WALL ~ 4. SIGNLE WALL IN VAULT ~ 99.OTHER TANK MATERIAL-primary tank x (Check one item only) ~ 2. STAINLESS STEEL ~ 4. STEEL CLAD W/FIBERGLASS ~ 8. FRP COMPTIBLE W/100 % METHANOLO 99.OTHER REINFORCED PLASTIC (FRP) TANK MATERIAL-secondary tank x (Check one item only) ~ 2. STAINLESS STEEL ~ 4. STEEL GLAD WIFIBERGLASS ~ 8. FRP COMPTISLE Wl100% METHANOL ~ 99.OTHER REINFORCED PLASTIC (FRP) ~ 10. COATED STEEL 5. CONCRETE 3. OR COATING ~ 2 ALKYD LINING ~ 4 PHENOLIC LINING ~ 6 UNLINED ~ 99 OTHER (Check one item only) (For local use only) OTHER CORROSION ~ 1 MANUFACTURED CATHODIC ~ 3 FIBERGLASS REINFORCED PLASTIC ~ 95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ~ 41MPRESSED CURRENT ~ 99 OTHER (Check one item only) ~ 2 SACRIFICIAL ANODE (For local use only) (local use only) (Check all that apply) ~ 1 SPILLCONTAINMENT 2002 2002 1 ALARM ~ 3 FILL TUBE SHUT OFF VALVE 2 DROP TUBE 2002 ^X 2 BALL FLOAT 2002 ~ 4 EXEMPT Q 3 STRIKER PLATE 2002 (A description of the monitoring program shall be submitted to the local agency.) (Check all that apply) (Check one 1 VISUAL (EXPOSED PORTION ONLY) ~ 5 MANUAL TANK GAUGING (MTG) item only) ~ i VISUAL (SINGLE WALL IN VAULT ONLY) 2 AUTOMATIC TANK GAUGING (ATG) ~ 6 VADOSE ZONE ~ 2.CONTIN000S INTERSTITIAL MONITORING 3 CONTINUOUS ATG ~ 7 GROUNDWATER ~ 3 MANUAL MONITORING 4 STATISTICAL INVENTORY RECONCILIATION ~ 8 TANKTEST{NG (SIR) BIENNIALTANKTESTING ~ 990THER ESTIMATED DATE LAST USED (YR/MO/DAY) ESTIMATED QUANTITY OF SUBSTANCE REMAINING TANK FILLED WITH INERT MATERIAL? gallons ~ Yes ~ No UPCF (12/99 revised} 10 Formerly SWRCB Form B UNIFIED PROGRAM C NSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -TANK PAGE 2 V{. PIP{NG CONSTRUCTION (Check alkhat apply) Page _ of _ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE Q 1. PRESSURE ~ 2. SUCTION ~ 3. GRAVITY asa ~ 1. PRESSURE ~ 2. SUCTION ~ 3. GRAVITY ase coNSrRUCnoN ^ 1. SINGLE WALL ^ 3. LINED TRENCH ^ 99.OTHER a6o ^ t. SINGLE WALL ^ 95. UNKNOWN a6z MANUFACTURER a 2. DOUBLE WALL ^ 95. UNKNOWN ^ 2. DOUBLE WALL ^ 99.OTHER MANUFACTURER A.O. Smith ast MANUFACTURER a63 ^ 1. BARE STEEL ^ 6. FRP COMPATIBLE w/1oo% METHANOL ^ 1. BARE STEEL ~ 6. FRP COMPATIBLE W/1 OOMo METHANOL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ Unknown ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL 3. PLASTIC COMPATIBLE W/CONTENTS ~ 99. Other ~ 3. PLASTIC COMPATIBLE W/CONTENTS ^ 8. FLEXIBLE (HDPE) ~ 99. OTHER 4. FIBERGLASS ~ 8. FLEXIBLE (HDPE) ~ 4. FIBERGLASS ~ 9. CATHODIC PROTECTION ^ 5. STEEL W/COATING ^ 9. CATHODIC PROTECTION asa ^ 5. STEEL W/COATING ^ 95. UNKNOWN a65 (Check all that app ly) (A description of the monitoring program shall be submitted to the local agency.) SINGLE WALL PIPING a66 SINGLE WALL PIPING ae/ PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + 'SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. AUDIBLE AND VISUAL ALARMS. ^ 2. MONTHLY 0.2 GPH TEST ^ 2. MONTHLY 0.2 GPH TEST ^ 3. ANNUAL INTEGRITYTEST (0.1 GPH) ~ 3. ANNUAL INTEGRITYTEST (O.iGPH) 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS (Checkall that apply) ^ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM +TRIENNIAL PIPING S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): ^ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) ^ 7. SELF MONITORING SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW ~ 7. SELF MONITORING 9. BIENNIAL INTEGRITY TEST (0.1 GPH) GRAVITY FLOW (Checkall that apply): ^ 8. DAILY VISUAL MONITORING ^ 9. BIENNIALINTEGRITYTEST(0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check al I that apply): PRESSU RIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) ALARMS AND (Check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM ^ b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION ^ c. NO AUTO PUMP SHUT OFF ^ c NO AUTO PUMP SHUT OFF 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT 11. AUTOMATIC LEAK DETECTOR ^ OFF OR RESTRICTION ^ 12. ANNUALINTEGRITYTEST(0.1 GPH) ~ 12. ANNUALINTEGRITYTEST(0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM ^ 13. CONTINUOUS SUMP SENSOR +AUDIBLE AND VISUAL ALARMS ^ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Checkall that apply) EMERGENCY GENERATORS ONLY (Checkall that apply) ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF" ^ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF' AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) ^ SHUT OFF OR RESTRICTION 16. ANNUAL INTEGRITY TEST (0.1 GPH) ~ 16. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 17. DAILY VISUAL CHECK ^ 17. DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ^ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ 4. DAILY VISUAL CHECK DATE INSTALLED a6e ~ 2. CONTINUOUS DISPENSER PAN SENSOR +AUDIBLE AND VISUAL ALARMS ~ 5. TRENCH LINER /MONITORING 2002 ^X 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR 6. NONE a69 ^ DISPENSER +AUDIBLE AND VISUAL ALARMS IX. OWNER/OPERATOR SIGNATURE I certify that the information provided herein is true and accurate to the best of my knowledge. 9/19/07 NAME OF OWNER/OPRATOR(print) Daniel A Erickson Com liance Manager ermit um er or oca use on y ermit pprove or oca use on y ermit xpirahon ate or oca use on y UPCF (12/99 revised) 12 Formerly SWRCB Form B UNDERGROUNDSTORAGETANK RESPONSE PLAN -PAGE 1 (One formperfacility) 01. TYPE OF ACTION ~ 1. NEW PLAN Q 2. CHANGE OF INFORMATION 1. FACILITY INFORMATION FACILITY ID # (Agency Use Only) _ _ U I ES NAM ame as FA ILI NA Quick Stuff # 7723 BUSINESS SITE ADDRESS CITY 4. 10 Union Avenue Bakersfield II. SPILL CONTROL AND CLEANUP METHODS is p an a resses uncut onze re eases rom systems an supp ements t e emergency response p ans an proce ures in t e aci ity s czar ous aterla s Business Plan. • [f safe to do so, facility personnel will take immediate measures to control or stop any release (e.g., activate pump shut-off, etc.) and, if necessary, safely remove remaining hazardous material from the UST system. • Any release to secondary containment will be pumped or otherwise removed within a time consistent with the ability of the secondary containment system to contain the hazardous materiaS, but not greater than 30 calendar days, or sooner if required by the local agency. Recovered hazardous materials, unless still suitable for their intended use, will be managed as hazardous waste. • Absorbent material will be used to contain and clean up manageable spills of hazardous materials. Absorbent material may be reused until it becomes too saturated to be effective. U will then be managed properly. Used absorbent material, reusable or waste, will be stored in a properly labeled and sealed container, • Facility personnel will determine whether any water removed from secondary containment systems, or from clean-up activity, has been in contact with any hazardous material. If the water is contaminated, it will be managed as hazardous waste. If the water has a petroleum sheen (i.e., rainbow colors), it is contaminated. A thick floating petroleum layer may not necessarily display rainbow colors. Water (hazardous ornon-hazardous) from sumps, spill containers, etc. will not be disposed to storm water systems. • We will review secondary containment systems for possible deterioration if any of the following conditions occur: 1. Hazardous material in contact with secondary containment is not compatible with the material used for secondary containment; 2. Secondary containment is prone to damage from any equipment used to remove or clean up hazardous material collected in secondary containment; 3. Hazardous material, other than the product/waste stored in the primary containment system, is placed inside secondary containment to treat or neutralize released product/waste, and the added material or resulting material from such a combination is not compatible with secondary containment. Ill. SPILL CONTROL AND CLEAN-UP EQUIPMENT ERI 1 MAINTENAN pi contro an c can-up egwpment ept permanent y on-slte a lste m t e as rty s Hazar ous arenas usiness Pan. is equipment is inspected at least monthly, and after each use, supplies are replenished as needed. Defective equipment is repaired or replaced as necessary. EQUIPMENT NOT PERMANENTLY ON-SITE, BUT AVAILABLE FOR USE IF NEEDED: (Complete only if applicable) EQUIPMENT LOCATION AVAILABILITY Absorbent Pads/ granular R70' Store Room R20' Available at all times R30. R71. R21. R31. R12. R22. R32. R13. R23. R33. R14. R24. R34. R15. R25. R35. 'IV. RESPONSIBLE PERSONS:.. - - THE FOLLOWING PERSON(S) IS/ARE RESPONSIBLE FOR AUTHORIZING ANY WORK NECESSARY UNDER THIS RESPONSE PLAN: NAME TITLE Paul Deneka Manager, Environmental Engineering NAME 41• TITLE s1. Jorge Parra Director of Operations NAME 4 TITLE NAME TITLE V. INDIRECT HAZARD DETERMINATION....... T is m ormatlon 1s require on y w en t e presence o t e czar ous su stance can not e venhe irect y y t e momtonng me o use (e.g., w ere 1qw eve measurements in a tank annular space or secondary piping are used as the basis for leak determination). THE FOLLOWING STEPS WILL BE TAKEN TO VERIFY THE PRESENCE OR ABSENCE OF HAZARDOUS SUBSTANCE IN THE SECONDARY CONTAINMENT IF MONITORING INDICATES A POSSIBLE UNAUTHORIZED RELEASE: R60. hwfwrc-e (9/24/04) - 1 /3 UNDERGROUND STORAGE TANK RESPONSE PLAN -PAGE 2 - VI. LEAK INTERCEPTION AND DETECTION SYSTEM T is m ormation is require on y or motor ve ice ue systems constructe pert e A ternate onstructton equirements o 2 2633, an on y i t e Lea Interception and Detection System (LIDS) does not meet the volumetric requirements of 23 CCR §2631(d)(1) through (S) (i.e., when accounting for rainfall and backfill material, the secondary containment volume is less than 100% of primary tank volume for a single UST; or in the case of multiple USTs in shared secondary containment, 150% of the largest primary tank volume or 10% of aggregate primary tank volume, whichever is greater). ATTACH AN ADDITIONAL PAGE TO THIS PLAN CONTAINING THE FOLLOWING INFORMATION: • The volume of the LIDS in relation to the volume of the primary container; • The amount of time the LIDS shall provide containment related to the time between detection of an unauthorized release and cleanup of the leaked substance; • The depth from the bottom of the LIDS to the highest anticipated level of groundwater; • The nature of the unsaturated soils under the LIDS and their ability to absorb contaminants or to allow movement of contaminants; • The methods and scheduling for removal of all hazardous substances which may have been discharged from primary containment and are located in the unsaturated soils between the primary containment and groundwater, including the LIDS VIL REPORTfNG ANb R€CORD KEEPING - We will report/record any overfill, spill, or unauthorized release from a UST system as indicated in this plan. Recordable Releases: Any unauthorized release from primary containment which the UST operator is able to clean up within eight (8) hours after the release was detected or should reasonably have been detected, and which does not escape from secondary containment, does not increase the hazard of fire or explosion, and does not cause any deterioration of secondary containment, must be recorded in the facility's monitoring records. Monitoring records must include: . • The UST operator's name and telephone number; • A list of the types, quantities, and concentrations of hazardous substances released; • A description of the actions taken to control and clean up the release; • The method and location of disposal of the released hazardous substances, and whether a hazardous waste manifest was or will be used; • A description of actions taken to repair the UST and to prevent future releases; • A description of the method used to reactivate interstitial monitoring after replacement or repair of primary containment. Reportable Releases: Any overfill, spill, or unauthorized release which escapes from secondary containment (or primary containment if no secondary containment exists), increases the hazard of fire or explosion, or causes any deterioration of secondary containment, is a reportable release. Reportable releases are also recordable. Within 24 hours after a reportable release has been detected, or should have been detected, we will notify the local agency administering the UST program of the release, investigate the release, and take immediate measures to stop the release. If necessary, or if required by the local agency, remaining stored product/waste will be removed from the UST to prevent further releases or facilitate corrective action. If an emergency exists, we will notify the State Office of Emergency Services. Within five (S) working days of a reportable release, we will submit to the local agency a full written report containing all of the following information to the extent that the information is known at the time of filing the report: • The UST owner's or operator's name and telephone number; • A list of the types, quantities, and concentrations of hazardous materials released; • The approximate date of the release; • The date on which the release was discovered; • The date on which the release was stopped; • A description of actions taken to control and/or stop the release; • A description of corrective and remedial actions, including investigations which were undertaken and will be conducted to determine the nature and extent of soil, ground water or surface water contamination due to the release; • The method(s) of cleanup implemented to date, proposed cleanup actions, and a schedule for implementing the proposed actions; • The method(s) and location(s) of disposal of released hazardous materials and any contaminated soils, groundwater, or surface water. • Copies of any hazardous waste manifests used for off-site transport of hazardous wastes associated with clean-up activity; • A description of proposed methods for any repair or replacement of UST system primary/secondary containment systems; • A description of additional actions taken to prevent future releases. We will follow the reporting procedures described above if any of the following conditions occur: I A recordable unauthorized release can not be cleaned up or is still under investigation within eight (8) hours of detection; I Released hazardous substances are discovered at the UST site or in the surrounding area; 1 Unusual operating conditions are observed, including erratic behavior of product dispensing equipment, sudden loss of product, or the unexplained presence of water in the tank, unless system equipment is found to be defective and is immediately repaired or replaced, and no leak has occurred; I Monitoring results from UST system monitoring equipment/methods indicate that a release may have occurred, unless the monitoring equipment is found to be defective and is immediately repaired, recalibrated, or replaced, and additional monitoring does not confirm the initial results. Record Retention: Monitoring records and written reports of unauthorized releases must be maintained on-site (or off-site at a readily available location, i approved by the local agency) for at least 3 years. Hazardous waste shipping/disposal records (e.g., manifests) must be maintained for at least 3 years from the date of shipment. VIII. OWNER/OPERATOR SIGNATURE CERTIFICATION: I certify that the information provided herein is true and accurate to the best of my knowledge. WNER E A IG ATU A ~ _ ~ ~ , ~ ~ T ~f 09/19/07 OWNER/OPERA OR NA M E (print) ~~' OWNER/OPERATOR TITLE Daniel A Erickson Compliance Manager (Agency Use Only) This plan has been reviewed and: ~ Approved ~ Approved With Conditions ~ Disapproved Local Agency Signature: Date: hwfwrc-e (9/24/04) - 3/3 UNDERGROUND STORAGE TANK MONITORING PLAN -PAGE 1 TYPE OF ACTION ^ 1. NEW PLAN Q 2. CHANGE OF INFORMATION 7' 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): 1. fACILITY INFORMATION ' FACILITY ID # (Agency Use On y) _ BUSINESS NAME (Same as FACILITY NAME) Quick Stuff #7723 Mo3. BUSINESS SITE ADDRESS ]0 Union Avenue 04' CITY Bakersfield os. '11: EQU'IPME TT G D L, TE e tate aw requires t at testing, preventive maintenance, an ca i ration o monitoring egwpment e.g., sensors, pro es, me ea etectors, etc. e performed at the frequenty specified by the equipment manufacturers' instructions, or annually, whichever is more frequent, and that such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED Q 1. ANNUALLY Moe. ^ 99.OTHER (Specify): Mm. IIL''MONITORfNG LOCATIONS __ Is monitoring p an must inc u e a ite an s owing t e genera tan an piping ayouts an t e ocations w ere monitoring is pe orme i.e., ocatlon o eac 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 S ystem Certification form, Hazardous Materials Business Plan map, etc.) which shows all required information, include it with this plan. IV. TANK MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) 7 ^x 1. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: K^ a. DRY ^ b. LIQUID FILLED ^ c. PRESSURIZED ^ d. VACUUM M77. PANEL MANUFACTURER: Veeder Root M7z. MODEL #: TLS 350 R M13. LEAK SENSOR MANUFACTURER: Veeder Root M7a. MODEL #(S): 794390- 409 Mzs. ^ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL. TANK(,C_l PANEL MANUFACTURER: Mib. MODEL #: M77. IN-TANK PROBE MANUFACTURER: Mzs. MODEL#(S): M79. LEAK TEST FREQUENCY: ^ a. CONTINUOUS ^ b. DAILY/NIGHTLY ^ c. WEEKLY Mzo. d. MONTHLY Mz7. ^ ^ e. OTHER (Specify): M22. PROGRAMMED TESTS: ^ a. 0.1 g.p.h. ^ b. 0.2 g.p.h. ^ c, OTHER (Specify): M23. ^x 3. INVENTORY RECONCILIATION ^ a. MANUAL PER 23 CCR §2646 0 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 42643.1 TEST FREQUENCY: ^ a. ANNUALLY ^ b. BIENNIALLY ^ c, OTHER (Specify): Mzb. Mzi. ^ 6.VISUAL MONITORING: ^ a. DAILY ^ b. WEEKLY ^ 99.OTHER (Specify): Mzs. V. PIPEfdIOMTORIN'G MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) 30. ^x 1. CONTINUOUS MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ~ a. DRY ^ b. LIQUID FILLED ^ c. PRESSURIZED ^ d. VACUUM M31. PANEL MANUFACTURER: Veeder Root M3z. MODEL #: TLS 350-R M33. LEAK SENSOR MANUFACTURER: Veeder Root M3a. 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. ^x 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): F.E. Petro M38' MODEL #(S): STP-MLD! STP-MLD-D M39. ^ 3. ELECTRONIC LINE LEAK DETECTOR (FLED) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS ELLD MANUFACTURER(S): Mao' MODEL #(S): Mal. PROGRAMMED IN LINE TESTING: ^ a. MINIMUM MONTHLY 0.2 g.p.h. ^ b. MINIMUM ANNUAL 0.1 g.p.h. Maz. WILL ELLD DETECTION OF A PIPING LEAKTRIGGER 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) M45. M46. ^ 5. VISUAL MONITORING: ^ a. DAILY ^ b. WEEKLY ~ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED` M47. ' Allowe or monitoring of unburied emergency generator fuel piping only per HSC §25287.5(6) ^ 6. SUCTION PIPING MEETS EXEMPTION CRITERIA PER 23 CCR 42636(a)(3) 13) ^ 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ^ 99.OTHER (Specify) M48. hwfwrc-d (9/24/04) - 1 /4 UNDERGROUND STORAGE TANK MONITORING PLAN -PAGE 2 .DS , MONITORING OF AREAS BENEATH DISPENSER(S) IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mso. 0 1. CONTINUOUS MONITORING OF UNDER DISPENSER CONTAINMENT (UDC) PANEL MANUFACTURER: Veeder Root Mss' MODEL #: TLS 350 R Msg. LEAK SENSOR MANUFACTURER: Veeder Root Msa. MODEL #(S): 794380-208 Msa. WILL DETECTION OF A LEAK IN THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? ^x a. YES ^ b. NO Mss. WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? x^ a. YES ~ b. NO M56. WILL FAILURE(DISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ^x a. YES ^ b. NO Msg. 2. MECHANICAL CONTINUOS MONITORING (e.g., FLOAT AND CHAIN ASSEMBLY) IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK MANUFACTURER: Msa. MODEL#(S): Msv. ^ 3.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY M60. 4. NO DISPENSERS ^ 99.OTHER (Specify) M61. ' : -' UII. ENHANCED,LEAK DETECTION 1. WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST PERFORM ENHANCED LEAK ~~ DETECTION (ELD) FOR THE UST(S) COVERED BY THIS PLAN. PER 23 CCR §2644.1, ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED VI11. TRAINING REFERENCE DOCUMENTS MAINTAINED AT FACILITI(.~ C ec a tat app y Mso. 1. 0 THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 2. ^x 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): Mai. Personnel with UST monito i i i ~ v v u s 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. D The facility employee's role with regard to spills and ove~lls. © Whom to contact for emergencies and leak detection alarms. For facility employees hired on or afterJuly 1, 2005, the initial training will be conducted within 30 days of the date of ` IX. COMMENTS/ADDITIONAL INFORMATION _. ease use t is section to me u e any a itiona system monltonng-re ate in ormation e.g., a itiona in ormation require y your oca Mas. agency): X. PERSONNEL RESPONSIBILITIES ' ` WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION EQUIPMENT COVERED BY THIS PLAN TITLE 23 CCR § 2715(c), AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS OF THE FACILITY'S UST SYSTEMS IN ACCORDANCE WITH TITLE 23 CCR § 2715(c). XI. OWNER/OPERATO~t SIGNATURE .~~ CERTIFICATION: I certify that the information provided herein is true and accurate to the best of my knowledge. OWNER PE ATOR SI NATUR EPRE NTING ATE: (~ ~ - Q Owner Meo. 9119107 ` Operator OWNER/OPERATOR TITLE: OWNER/OPERATOR NAME (print): Daniel A Erickson Compliance Manager (Agency Use Only) This plan has been reviewed ^ Approved ^ Approved With Conditions ~ Disapproved and: Local Agency Signature: Date: Comments/Special Conditions: hwfwrc-d (9/24!04) - 3/4 AP#----.._~ _ CALII{'ORNIA ~NNO`I'ATO SITE MAP I~RF.PAItt:D IIY: I`°1_ _ L r ~ O ~ slaN aour INC. .1~t K BUSINESS NAh1E IN Tt lE BOX 3576 QUICK STUFF~{7723 DATE Oi /14/2006 __ to BUSINESS ADDRF;SS_______ I.INION AVENUE: BAKERSFIELQ ZIP CODE 93307-1549 _____ _ ---- DI2nWING SCALi; ~"_4O'}: a B c ~ E F= ~_ H MAP SYMBOLS p UNION AVENUE O SHUT?ROFFL PANEL GAS © R 1 ]J OFF SHUT _ ~ WATER SHUT-OFF O EMERGENCv PUMP ® ~ SHUT-OFF O t o ~ TANK MONITORING TMA` ALARM O TELEPHONE FIRST AID KIT 2 8 ~ FIRE ExiwCUISHER ~ m c ® STORM DRAIN P O _ ~ 2 SANITARY SEWER STAGING AREA ~ EVACUATION/ FUEL j ~ \ MSDS LOCATION D MSDS 3 w Z PIPING 1_r_________1 I ~ ~ ~ U ~ ~ FIRE HYDRANT ~ Q J ' 'I I t I FENCE EMERGE CY RESPONSE ~ I I N ERE ~I I J EQUIPMENT/ABSORBENTS 7,000 GAL ~ I I DI EL j-r---------~ I ~ ~ ® ~ Q V O ABOVEGROUND STORAGE TANK u ~ ~ 0 O ~ ~ - ~ t I / w __ JI UNDERGROUND 1 4 I I r ® - ~ STORAGE TANK f a ~ O j'n ~~ I I ~ ~ I~ I I i y^~ I I P ~ O r ~ O GASOLINE (FLAMMABLE LIQUIDS) ~•J - r ~ I r Il ~ - --------- I I II I ~^ ob C~ ~ ~ O U DIESEL FUEL O (COMBUSTIBLE UOWDS) o ' O MOTOR OILS k LUBRICANTS Z ~ ~ ) ~ ° ~ I I O (CUMPUSt15tE uOUIDS) ~ ' - _ _ ~-r ~-~ L---~'----~ JACK IN THE BOx ST R CARBON DIUxIDE CO 5 m C G 0 O & C- O E SEE MAP 2 (COMPRESSED GAS) 0.000 CAL AL 2 10 00(1 G R y PROPANE O PREMIUM REGULA (FLAMMABLE LIQUID) O ANTIFREEZE/COOLANTS E G WASTE OIL W (FLAMMABLE l10U10) I CW CAR WASH PRODUCTS ERE 6 ,~.v - . _ _ _ W- - _-s __ _D _- -.~ - -ff ._ .-r.-._.-. O . _ ~.__._. _. _. r TANK VENTS ~.. -GREASE INTERCEPTOR 7 ~I i RESIDENTIAL AP#__ ~ CALIFORNIA ANNOTATED SITE MAP PREPARED BY: BUSINESS NAME JACK IN THE BOX 3576 QUICK STUFF 7723 N / ~ _ DATE 0~ /~ x/2005 Desfo ~ caour eNc BUSINESS ADDRESS i 0 UNION AVENUE B AKERSFIELD ZIP CODE 93307- ~ 549 DRAWING SCALE ' ' ± 1 =40 - A e c ~ E F ~ H MAP SYMBOLS Z O ELECTRICAL PANEL O SHUT-OFF ~ /~ NATURAL GAS / ~: ;HUT-OFF - OW WATER SHUT-OFF © EMERGENCv PUMP SHUT -OFF TMA TANK MONITORING `,~ ALARM DINING AREA O TELEPHONE 2 ~ FIRST AID KIT D F~ FlRE EXTINGUISHER STORM DRA IN B DRIVE THRU SAwTARY SEWER ~ STAGING AREA E VACUA TION/ ~ I1MMP IIMMP, AND MSDS 3 ^ ~ MSDS LOCATION ° FIRE HYDRANT A '( ~ ~ _ 1 +~~-~~ FENCE ^'y CRF EMERGCNCY RESPONSE ~ O KITCHEN ----~ EpUIF'MFNI/AD50RE3FNT5 ~ Q O ~ ~ _ __ ~ ~ SF RAGf iANK --~- 4 _ ~ OO F I^ ~ ~'I UNDERGROUND - - ~ S10RACE TA CASHIER a RESTROOM ~ NK HMMP X11, ~ ~ ~ ~ GOOIER MSDS ~ ~ a O GASOLINE ® (FLAMMABLE LIQUIDS) O DIESEL FUEL RESTROOM ~/ (COMBUSTIBLE LIQUIDS) / ® / O MOTOR OILS & LUBRICANTS 0 ~ ~ ~ (COMBUSTIBLE LIQUIDS) r REEZER CO CARBON DIOXIDE j ~ (COMPRESSED GAS) ` PROPANE OP (FLAMMABLE UOUID) ~ ~ ANTIFREEZE/COOLANTS OFFICE ~ O O _ WASTE OIL W (FLAMMABLE LIQUID) - ~ T A STORAGE i ~ O CW CAR WASH PRODlICTS 6 LIJ M OFFICE ` ERE FREEZER WALK-IN COOLER STORAGE L'~ (~ CO Q ~ C \ .~ O - . ., . .~. MAPS 1 CALIFORNIA ANNOTATED SITE MAP PREPARED BY: °~ DESIGN ~~' GROUP ING BUSINESS NAME JACK IN THE BOX X3576/QUICK STUFF// 7723 DATE 3/19/2004 DRAWING SCALE ~y 10 BUSINESS ADDRESS UNION AVENUE BAKERSFIELD ZIP CODE 93307-1549 1"=40'± A B C D E F G H MAP SYMBOLS Z O UNION AVENUE O SHUTTROFFL PANEL O NATURAL GAS F 1 ~ SHUT-OF O WATER SHOT-OFF T 1 O EMERGENCY PUMP ® ~ ~ SHUT-OFF O 4 ^ ~ TANK MONITORING TMA ALARM O TELEPHONE FIRST AID KIT 2 B p, ~ FIRE EXTINGUISHER \ m c ® STORM DRAIN ~ 0 SANITARY SEWER O ~ EVACUATION/ FUEL r I ~ I \ HMMP HMMP, AND MSDS MSDS LOCATION 3 Z PIPING\ 1_r_ ~t Mbo __, I obl ~ FIRE HYDRANT Q i -~-->E- FENCE J i I I EMERGENCY RESPONSE ERE TS I I I EQUIPMENT/ABSORBEN ~ 7,000 GAL ~ I i ~ DI S EL T I I I ABOVEGROUND 4 o -r--- ( ~ \ ~/ ~ h ~ ~ , - ~ ~ I -----~ ~ ~ ~ I ® ® O STORAGE TANK I~ ~I UNDERGROUND - ~ STORAGE TANK ~I ' I o I ~ o-;'; I I I O GASOLINE W I ~ II li I I Op ~ ^ O (FLAMMABLE LIQUIDS) (,~ ~~ ~~il---~ L~____ ~ b^ _____~ I ^ b I O DIESEL FUEL (COMBUSTIBLE LIQUIDS) Q _ I I I I I I M MOTOR OILS & LUBRICANTS O Z I o ~ ~ o~ l I (COMBUSTIBLE LIOUIOS) ~ ~_~ ~_~ L---- __---J JACK IN THE 80X D O CD O O & C-STORE GAS) SED (COMPRES 5 m 10,000 GAL 20,000 GAL SEE MAP {j2 PROPANE O PREMIUM REGULAR (FLAMMABLE LIQUID) O ANTIFREEZE/COOLANTS V WASTE OIL D O E p ~~ C ) (FLAMMABLE LIQUI m m CW CAR WASH PRODUCTS ERE I 6 - 0 .-. .-~ .-. _.-.-,-•-•-•-. o. .-. .- .~ ~ j 1 TANK VENTS GREASE INTERCEPTOR ; 7 1 ~ APS 2 BUSINESS NAME JACK BUSINESS ADDRESS 10 IN THE BOX #3576 UNION AVENUE CALIFORNIA ANNOTATED /QUICK STUFF#/7723 BAKERSFIELD SITE MAP DATE 3/19/2004 ZIP CODE 9330?-1549 PREPARED ,3Y: ~~~ DESIGN G'iRGDP INC' ~~ DRAWING SCALE ~ 1' =40'± a e c o E F G H MAP SYMBOLS O ELECTRICAL PANEL O SHUT-OFF I ' O SHUTROFFGAS ~ i O WATER SHUT-OFF = O EMERGENCY PUMP SHUT-OFF TMA TANK MONITORING ~~ ALARM DINING AREA O TELEPHONE ~ FIRST AIO KIT 2 FIRE EXTWGUISHER ~ a ® ® STORM DRAIN DRIVE THRU SANITARY SEWER ~ STAGING AREA EVACUATION/ HMMP HMMP, AND MSDS ~ ~ MSDS LOCATION ` ~ FIRE HYDRANT I ~ -x-x- FENCE l I ~ EMERGENCY RESPONSE ERE Q KITCHEN EQUIPMENT/ABSORBENTS O ABOVEGROUND ® STORAGE TANK /~ ~ UNDERGROUND I~ - ~I 4 Op O /~ STORAGE TANK CASHIER a RESTROOM~ ~' MSDS ~ ~ O COOLER O GASOLINE O a ~ ~ (FLAMMABLE LIQUIDS) DIESEL FUEL O i ~ (COMBUSTIBLE LIQUIDS) RESTROOM ~ MOTOR OILS & LUBRICANTS O ~ ® ~/ (COMBUSTIBLE LIQUIDS) ~ ~ ~ ~ FREEZER S D O D CO 5 /_k U (COMPRES GA ) S ED ~ O PROPANE \ (FLAMMABLE LIQUID) OA ANTIFREEZE/COOLANTS OFFICE ~ WASTE OIL O O O E (FLAMMABLE LIQUID) STORAGE i ~ OT CW CAR WASH PRODUCTS TMn OFFICE 6 ~ ~ ERE FREEZER WALK-IN COOLER STORAGE ~ O E ® C0 O ~ c ~ 7 ~ ,, 1 :i:'I, ~~ MAPS BUSINESS BUSINESS , NAME JACK ADDRESS 10 CALIFORNIA t~NNOTATED SITE MAP IN THE BOX #3576 QUICK STUFF#7723 DATE 01 /14/2006 UNION AVENUE BAKERSFIELD ZIP CODE 93307-1549 il.Y ~ J~ '"'GG 11 l/ PREPARED HY: : , IIDESIGN GROUP INC DRAWING SCALE 1' =40'± A e c D E F G ~ MAP SYMBOLS Z UNION AVENUE O SHUTTROFFL PANEL 1 NATURAL GAS T FF O ~ SHU -O OW WATER SHUT-OFF O EMERGENCY PUMP ® ~ ~ SHUT-OFF O ~ o ~ TANK MONITORING Ti MA` ALARM ~ OT TELEPHONE FIRST AID KIT 2 8 ~ ~ FIRE EXTINGUISHER \ ~ ® STORM DRAIN P O r z ~ SANITARY SEWER STAGING AREA ~ EVACUATION/ FUEL j ~ \ HMMP HMMP, AND MSDS MSDS LOCATION 3 w z PIPING 1_T____ , Ibo _____.~ I o~~ FIRE HYDRANT ~ Q i I I ~- FENCE J ~ I I I ERE EMERGENCY RESPONSE I EQUIPMENT/ABSORBENTS iI 7,000 GAL ~ I DI EL ~- ---- I I ----- I ® J Q BOVEGROUND o i I ~ ~ ~ ~ ~ U STORAGE TANK -- - I I ~ w fl UNDERGROUND I ' 4 it ~ ~ I ® _ - STORAGE TANK I'o I ~ o-;'; ; I O w oo I' I II l "' I I P ~ O ~ ~ ~ O GASOLINE G (FLAMMABLE lIOUIDS) Q ___ i ~ i r i j j~ -~r-o- I C] b l ~ O O DIESEL FUEL (COMBUSTIBLE LIQUIDS) Q I I I I ~ MOTOR OILS & LUBRICANTS Z I I I ° I I I O COMBUSTIBLE LIQUIDS) ~_~ ~_~ L___-____-J G G 0 O JACK IN THE BOX & C-STORE ( CO CARBON DIOXIDE PRESSED GAS CO 5 m 0,000 GAL AL 2 10,000 G SEE MAP #2 ) M ( PROPANE O PREMIUM REGULAR (FLAMMABLE LIQUID) O ANTIFREEZE/COOLANTS V O WASTE OIL E O ;;O G (FLAMMABLE LIQUID) o ... CW CAR WASH PRODUCTS ERE I 6 0 .- 6.-. -.-.-.~•-•-• o . -..._.~. . i TANK VENTS GREASE INTERCEPTOR RESIDENTIAL !f AP# 2 CALIFORNIA [ANNOTATED SITE MAP PREPARED BY: 'y BUSINESS NAME _JACK IN THE BOX 3576 # QUICK STUFF 7723 / # DATE _01 /14/2006 YDES~cN GROUP BNC BUSINESS ADDRESS 10 UNION AVENUE BAKERSFIELD ZIP CODE 93307-1549 DRAWING SCALE ' ' ± 1 =40 a B c D E F G H MAP SYMBOLS O O ELECTRICAL PANEL SHUT-OFF 1 ~ i O NATURAL GAS ~ SHUT-OFF WO WATER SHUT-OFF O EMERGENCY PUMP SHUT-OFF TMA TANK MONITORING ~~ ALARM DINING AREA TO TELEPHONE 2 ~ FIRST AID KIT \ FIRE EXTINGUISHER ® STORM DRAIN DRIVE THRU SANITARY SEWER ~ STAGING AREA EVACUATION/ HMMP HMMP, AND MSDS MSDS LOCATION 3 ^ ^ ~ FIRE HYDRANT /~ I L~ - FE 1 ~ ~ NCE I ~ ERE EMERGENCY RESPONSE O KITCHEN EQUIPMENT/ABSORBENTS ABOVEGROUND STORAGE TANK 4 OP O ~ I~ - ~I UNDERGROUND ~--' STORAGE TANK CASHIER a RESTROOM~ ~~ HMMP ~ ~ \ COOLER GASOLINE MSDS O \ O G a ® (FLAMMABLE LIQUIDS) O DIESEL FUEL / ~ (COMBUSTIBLE LIQUIDS) RESTROOM ~ ® O MOTOR OILS & LUBRICANTS ~/ O ~ ~ (COMBUSTIBLE LIQUIDS) FREEZER CARBON DIOXIDE CO 5 ~ (COMPRESSED GAS) ~ O PROPANE P (FLAMMABLE LIQUID) ~ O ANTIFREEZE/COOLANTS OFFICE \ WASTE OIL W O O (FLAMMABLE LIQUID) STORAGE i ~ O CW CAR WASH PRODUCTS TMA OFFICE 6 ~ ERE FREEZE WA STORAGE LK-IN COOLER n O ~j E ® Ll U GD O \ G ~ \ 7 O ~ Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: ~ k ~~ ~ $~^ 7 7 Z Facility ID #: p 15' O L I- 0 0 Z~ (0 7 Facility Address: ~ 0 (,f y~ i 0 rn ~} U 2.V~U ~- ~3a Ketr s k i i1d C A 9 3 3 D 7 Reason for Submitting this Form (Check One) fl Change of Designated Operator Facility Phone #: fo ~ 1 $ (p ] - p 5 y 3 ^ Update Certificate Expiration Date Designated UST Operator(s) for this Facility PRIMARY Designated Operator's Name: ~~~ i ,e,l A El-i ~ kso •. Relation to UST Facility (Check One) Business Name (If different from above): J~ M 1Yla-,a +e-n eve"}' ~rvu ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 8 ~7 ~j$~j - Ox,-](o ^ Service Technician Third-Party International Code Council Certification #: ~0 1.f Z (y ~ - (~(e Expiration Date: f / f ~ p (p ALTERNATE 1 (Optional) ~ ~ Designated Operator's Name: ~c`,~,QX Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: l?~Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: ALTERNATE 2 (Optional) Designated Operator's Name: a, Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: [Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: NOTE: THE LOCAL REGULATORY AGENCY MUST BE NOTIFIED OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. 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 compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER OR OWNER'S AGENT (Please Print): SIGNATURE OF TANK OWNER OR OWNER'S AGENT: ~av.;e,l A. Ert'ckso~ DATE: ~I2Lo~D~ OWNER'S PHONE#: (8y~~ 835 -~L7~ September 2004 [V ~35~ ~, JACK IN THE BOX QUICK STUFF SitelD: 015-021-002367 Manager JOANNA HARRIS Location: 10 UNION AVE City BAKERSFIELD BusPhone: (661) 861-0543 Map 103 CommHaz Moderate Grid: 31D FacUnits: 1 AOV: CommCode: BFD STA 06 EPA Numb: SIC Code:5541 DunnBrad:04-211-7200 Emergency Contact / Title Emergency Contact / Title JOANNA HARRIS / MANAGER ED OSINSKI / AREA MANAGER Business Phone: (661) 861-0543x Business Phone: (858) 555-8381x 24-Hour Phone (661) 205-8635x 24-Hour Phone (661) 337-9981x Pager Phone ( ) - x Pager Phone (877) 502-1773x Hazmat Hazards: Fire Press XmmHlth DelHlth Contact JMM MANAGEMENT GROUP LLC Phone: (847) 888-0276x MailAddr: 2496 TECHNOLOGY DR State: IL City ELGIN Zip 60123 Owner JACK IN THE BOX INC Phone: (858) 571-2689x Address 9330 BALBOA AVE State: CA City SAN DIEGO Zip 92123 -1516 Period ~~ ~~2ou1 to t2-31' 2OU~ TotalASTs • ~ = 2/000 Gal Preparer : s`~EV~ s aiV~ERSO~ ~ TotalUSTs : 3 3 7, oov Gal Certif' d: ~~~~ ~ RSs : No ParcelNo: ~ Emergency Directives: PROG A - PROG C - HAZMAT COMM HOOD ENT'D MAR ~ A ~oU' PROG T - ABOVEGROUND STORAGE TANK PROG U - UST Based on my inquiry of those individuals raspansit`r(e for obtaning the information f i ~O~ , cert fy under penalty of lav% that i hav e persorafly examined and am familiar with ttte irifarmation submitted and f,elieve the inform~~tion is true , accurate, compieie. gn ture d ate -1- 02/01/2007 F JACK IN THE BOX QUICK STUFF SiteID: 015-021-002367 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: JACK IN THE BOX QUICK STUFF -~' 7-723 Cross Street ~-2~c.Nr~~s-4G 1-.~-~f Business Type: GAS STATION Org Type: CORPORATION Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper ICC Nbr: PROPERTY OWNER INFORMATION Name EB--6~N~Si~3 J ~-~c ~ ~ ~r'ti*~ ~s ~x - ~ ~ Phone : ( 8 5 8 ) 5~ ~ - R ~ '-y' Address : y 33v rso-c. vs~~ ~~ City ~-~ a~~c~ a State: c.t- Zip: i u z,3 Type CORPORATION TANK WN F RMA Name ~ ~e-Fc Address : °7 3 3 ~ +3~L.d3 c..4- City ~-~ p.~ ~ Type CORPORATION O ER IN O TION i ~! ~]~@- ~ s3 ~Jx t ./ C„ Phone : ( 8 5 8 ) ~ ~ ~ - ° ~ Q' V A't/~ S 7 r - Z-~ ~ ~ State: c~ Zip: `'r u Z3 BOE UST Fee# : Financ'1 Resp: SELF INSURED Legal Notif Date:05/20/2002 Phone: (538) 589- x '~ Name:KARL HUY TtI:AUTHORIZED AGENT State UST # 1998 Upg Cert#: 25509 i -2- 02/01/2007 F JACK IN THE BOX QUICK STUFF SitelD: 015-021-002367 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP REGULAR UNLEADED GASOLINE F IH DH L 20000.00 GAL Mod PREMIUM UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod DIESEL #2 L 7000.00 GAL Low CARBON DIOXIDE F P IH G 2600.00 FT3 Min -3- 02/01/2007 -4- 02/01/2007 JACK IN THE BOX QUICK STUFF SiteID: 015-021-002367 ~ = Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ = COMMON NAME / CHEMICAL NAME REGULAR UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: S SIDE OF SITE CAS# 8006-61-9 = STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~-Ambient ~ Ambient ~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 20000.00 GAL 20000.00 GAL 15000.00 GAL °sWt . 100.00 Gasoline HAZARDOUS COMPONENTS RSI CAS# No 8006619 aarau a-aiw ea. aUy~.~a~aLi. i v TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod = Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ = COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: S SIDE OF SITE 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 7000.00 GAL ~Wt. 100.00 Gasoline HAZ RSI CAS# No 8006619 ARD A SSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod HAZARDOUS COMPONENTS -5- 02/01/2007 JACK IN THE BOX QUICK STUFF SiteID: 015-021-002367 ~ = Inventory Item 0005 Facility Unit: Fixed Containers at Site ~ = COMMON NAME / CHEMICAL NAME DIESEL #2 Days On Site 365 Location within this Facility Unit Map: Grid: S SIDE OF SITE CAS# 68476-34-6 = STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient -~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 7000.00 GAL 7000.00 GAL 5000.00 GAL HAZARDOUS COMPONENTS ~Wt. 100.00 Diesel Fuel No. 2 RS CAS# No 68476302 HHGLiK.1~ AS~r;55M.r;lV'1'~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Low = Inventory Item 0004 COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Location within this Facility Unit KITCHEN Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 124-38-9 = STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPure Above Ambient Cryogenic INSUL.TANK / CRYOGENIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 2600.00 FT3 2600.00 FT3 2000.00 FT3 °sWt . 100.00 Carbon Dioxide HAZARDOUS COMPONENTS RSI CAS# No 124389 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -6- 02/01/2007 JACK IN THE BOX QUICK STUFF SiteID: 015-021-002367 ~ Fast Format ~ = Notif./Evacuation/Medical Overall Site ~ Agency Notification Fti~ r~~.nr ~~~ ~~~~~~ (s~-f-~~r~t~r err . f3 ~ -~ r~s F ~ ~ u ~ M,l ,~,~-~ ~.+-~... ~e- a s ~, (e ie ~ -~ 3 2.. 7 - `f ~ Y 7 --- Employee Notif./Evacuation 04/27/2006 EMPLOYEES ARE TRAINED TO MEET IN THE WEST PARKING LOT. ~ -~ E /~ E ,~ U~ e.a-o-~tx~ ~ ,/ ~ru-rr, p-- :J o A~ nr N ~!- ~ /d~R-rL- ~'~ G~ ~e 1 - ~3~ ! - o l '~ ~ Public Notif./Evacuation /.1a-iG.vn.._s(,r~~t~ (=ice (~~~T (Q (o( - ~~-~~7~ G/d- cr1'-"G ~ c....C cs}= C ~-t,~'ir-ct ~ ..~ c~, SC ¢-~l i c~ S QUO - ~'~ 5 Z -- 7 r.~U N 0' ~ o .v ry- L K-~. S /' v ,.!"s ~ c{ n/~I 2, g 4`G - ~ z-~f ,- ~ ~O Z Emergency Medical Plan 04/27/2006 MOVE VICTIM TO FRESH AIR AND CALL EMERGENCY MEDICAL CARE. IF NOT BREATHING, GIVE CPR; IF BREATHING IS DIFFICULT, GIVE OXYGEN. IN CASE OF FROSTBITE, THAW FROSTED PARTS WITH WATER, KEEP VICTIM QUIET, AND MAINTAIN NORMAL BODY TEMPERATURE. -7- 02/01/2007 F JACK IN THE BOX QUICK STUFF SiteID: 015-021-002367 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 04/27/2006 ~ THE HAZARDOUS AT THIS BUSINESS ARE FIRE AND SPILLS ASSOCIATED WITH GASOLINE DISPENSING. GASOLINE DISPENSING IS SUPERVISED BY TRAINED PERSONNEL. ADDITIONAL HAZARDOUS MATERIALS ARE STORED IN MINIMUM QUANTITIES AND STORED IN SMALL, UNBREAKABLE CONTAINERS. ALL UNDERGROUND STORAGE TANKS ARE MONITORED USING AN APPROVED MONITORING METHOD. Release Containment F ~ d !~ 5 T~ ~ ~ ~,-,/ s~ f/' ~ f ~ ~/C~ ~' ~ pou.-.3 c..~ - ~..~ ~1- u, o~ b ~" ~ r~ ~'~ ~ t -~ [~t,o w~ L- `r NI,G .J t ~J'f~-~ f~ _ S w. ~ ~ ~.. S ~°' cr C.S ~a ~5 c?~ e2-~" ~-a V ~ ~.~ (./ L'lL~ (~ S O'X-iS s-~T M~9'~ ~ ~t-~ ~ '~'~[-~f/J l .~/ /! PP c~mJ~'"0 ~-~'~~ C~~~ Ct~ n/ T ~ (./CriL- ~ ,~-~/~ ~ j~Kc-v° ~'~~ V'1 f o i ~ Y~ 6 ~ , t ,~ t7r.~ ~~~ .~ T ~ Clean Up 04/27/2006 EMPLOYEES ARE TRAINED EVERY 6 MONTHS ON HAZARDOUS CLEAN-UP. ALL NEW HIRES ARE TRAINED BEFORE BEING ALLOWED TO WORK. v 41161 itG~VUlI:G .L'iI. V.L VGl VLV11 -$- 02/01/2007 F JACK IN THE BOX QUICK STUFF SiteID: 015-021-002367 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ oNC~:lal na~aica5 - ~AIZfiOiJ ~iox+v}c. -~c~2u~/ iF A Re~eq~c U1~tS '~ OCCUR i~S-nt ~'{tc ~ui~+n~. Ste -Fhe q t~gGlleal COL feiPtiSe Respvn~e ~lAn. 1JL111L~/ L711C1L-V11~ ~ ~ ~ t_. 1° ~- ~, Y° s r1- mot, T O"Y r" t .J S ~ ,_ - i~iic r.t.v~..c~... /ravaii. rra~.ct V~-~-(~ 2./~-,~ l" l~ v~,y- t-L~ l~ t ~J N ul c.~s~2 n/~ ~ ~' s c 1~- , ~ /t'S i S c D ~ +'~ cc, r ~ v ~ ~~. -~ k ~ 7S /~ ,./' tD 1~ r ~ ~-~-~-~' ,-, ir'n-~'~- L7 Ll111d 111y VI: I: U~lCilll,:y LCVC1 -9- 02/01/2007 ~ JACK IN THE BOX QUICK STUFF SitelD: 015-021-002367 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 04/27/2006 ~ BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED EVERY 6 MONTHS ON HAZMAT AND MSDS. EMPLOYEE TRAINING RECORDS ARE ON FILE. rages ~ 11G 1~A 1V1 L' k~.LL1G V~7G nC1l.L L.VL r ul.u.LC U5~ -10- 02/01/2007 ~. ~~~ . _ Spill/Release Response Plan for Carbon Dioxide D.O.T. Guide Number 21 Fire or Explosion: Cannot catch fire, but container may explode in heat of fire. Health Hazards: Vapors may cause dizziness or suffocation. Contact with liquid may cause frostbite. Emergency Action: • Keep unnecessary people away; isolate hazard area and deny entry. • Inert gases displace oxygen. Stop leak if you can do it without risk while avoiding suffocation. Assure sufficient oxygen is available before attempting rescue. • Do not touch or walk through spilled material. • Avoid breathing gases. • Stay upwind, out of low areas and open all doors to ventilate area before entering • Contact the supplier for additional assistance to stop the release. Fire• • Move container from fire area if you can do it without risk. • Apply cooling water to the sides of the container that are exposed to the flames until after the fire is extinguished. Stay away from tanks end. First Aid: • Move victim to fresh air and call emergency medical care; if not breathing, give artificial respiration; if breathing is difficult, give oxygen. • In case of frostbite, thaw frosted parts with water. • Keep victim quite and maintain normal body temperature. Prevention Procedures: • Store tank and/or cylinders with valve protection caps installed. • Tank and cylinders should be stored upright and firmly secured to prevent falling or being knocked over. • Containers should be stored in a cool, dry, well ventilated area away from sources of heat or ignition and direct sun light. • If you suspect any problems with the tank notify the supplier immediately to have the system inspected. Trainin;;• • Employees shall be trained on the above hazards associated with carbon dioxide gas and the preventative measures to prevent a release. • Training shall include evacuation procedures in the event of a release. • If compressed gas cylinders are present, employees shall be training on the handling of the cylinders and the use of the valve caps to prevent accidental damage to the valve. 1:\HAZMATUackintheBox\co2-Spill Plan.doc AP# ~ CALIFORNIA I~NNOTATED SITE MAP PREPARED RY: 16N CROUP 6NC BUSINESS NAME JACK IN THE BOX #3576/QUICK STUFF# 7723 DATE 01 /14/2006 DRAWING SCALE BUSINESS ADDRESS 10 UNION AVENUE BAKERSFIELD ZIP CODE 93307-1549 1' =40'± a B c ~ E F G H MAP SYMBOLS Z L PANEL O TR UNION AVENUE SHUT OFF p G NATURAL GAS 1 ~ SHUT-OFF T WO WATER SHUT-OFF 1 O EMERGENCY PUMP ® O SHUT-OFF ~ TANK MONITORING T~~ ALARM O 9 o ° TO TELEPHONE FIRST AID KI7 2 B ^o ~ FIRE EXTINGUISHER \ C ® STORM DRAIN ~ S SANITARY SEWER O z ~ STAGING AREA ~ EVACUATION/ r , \ HMMP HMMP, AND MSDS FUEL I I M505 LOCATION '3 z PIPING 1_~ o__ ___o ~ ~ ~ FIRE HYDRANT Q ~ I I ~~ FENCE "'~ I I ERE EMERGENCY RESPONSE I EQUIPMENT/ABSORBENTS 7,000 GAL ~ I I J Q ABOVEGROUND O DIESEL 1-r---- ~ ~ ~ ~ ° -----, I ° ~ ~ ® U O STORAGE TANK '-~ 'I t ,P l/ ~ I I UNDERGROUND - -~ 4 i ~ it ~~ I I~ , I I ® w C G STORAGE TANK w ( I I o-~ I I Q I I I, I I I ~ O ~ O ° C C G GASOLINE O (FLAMMABLE LIQUIDS) ! ^ v a ~ F\i 1--- I~-r---- I II I ~o b I -----~ I ob ~ O v DIESEL FUEL O (COMBUSTIBLE LIQUIDS) Z I I I oO I I ~ O MOTOR OILS & LUBRICANTS (COMBUSTIBLE LIQUIDS) ~- \ L_--_ O O ___--J JACK IN THE BOX & C-STORE CARBON DIOXIDE CO (COMPRESSED GAS) 5 m 10,000 GAL 20,000 GAL SEE MAP #2 PROPANE O PREMIUM REGULAR (FLAMMABLE LIQUID) O ANTIFREEZE/COOLANTS ~J WASTE OIL O E p G (FLAMMABLE LIQUID) e e CW CAR WASH PRODUCTS ERE I 6 0 .- ~.-. -,-.-~•-•-•-• o • -•---•-~- • o TANK VENTS GREASE INTERCEPTOR RESIDENTIAL MAPS BUSINESS BUSINESS 2 NAME JACK ADDRESS 10 IN THE BOX #3576 UNION AVENUE CALIFORNIA ANNOTATED /QUICK STUFF#7723 BAKERSFIELD SITE MAP / ~ DATE 01 14 2006 ZIP CODE 93307-1549 PREPARED BY: d~si GROUP dNc DRAWING SCALE 1' =40'± a e c ~ E F G H MAP SYMBOLS ELECTRICAL PANEL O SHUT-OFF ~ NATURAL GAS OG ~I i SHUT-OFF = WO WATER SHUT-OFF O EMERGENCY PUMP SHUT-OFF TMA TANK MONITORING ~~ ALARM DINING AREA O TELEPHONE ~ FIRST AID KIT 2 F~ FIRE EXTINGUISHER ~ ~ ® ® STORM DRAIN DRIVE THRU SANITARY SEWER ~ STAGING AREA EVACUATION/ HMMP HMMP, AND MSDS MSDS LOCATION 3 ~ ~ FIRE HYDRANT ~ ~ ~~ FENCE 1 "~ EMERGENCY RESPONSE ERE ~ KITCHEN EQUIPMENT/ABSORBENTS O ABOVEGROUND ® STORAGE TANK F / ~ _ I~ ~I UNDERGROUND `-~ !~ O O CASHIER a RESTROOM ' STORAGE TANK HMMP ~ MSDS ~ ~ ~ ~ COOLER O GASOLINE ~ O a ® (FLAMMABLE LIQUIDS) DIESEL FUEL ~ ~ / (COMBUSTIBLE L1QUiDS) RESTROOM ~ O MOTOR OILS & LUBRICANTS ~ ® ~/ (COMBUSTIBLE LIQUIDS) ~ ~ ~ FREEZER CO S 5 L~ !~ (COMPRESSED GA ) ~ O PROPANE (FLAMMABLE LIQUID) AO ANTIFREEZE/COOLANTS OFFICE ~ O O O O (FLAMMA BLE LIQUID) ~} STORAGE iO CW CAR WASH PRODUCTS t I I TMA, OFFICE 6 ~ ERE ~ STORAGE FREEZE WALK-IN COOLER ~ O ~. CO ~ , ~ G ~ 7 O UNIFIED PROGRAM INSPECTIO~CHECKLIST prevention Services B E a s F r , 0 900 Truxtun Ave., Suite 210 -°~~ - ~- --- ---- ---u-~~---______- -~- _~ -- FiR~ Bakersfield, CA 93301 ARTM t Tel.: (661) 326-3979 SECTION .1: Business Plan and Inventory Program ; ~ Fax: (661) 872-2171 ~; FACILITY NAME - ~ INSPEC ION DATE(,[ INSPECT /,N TIME ADDRESS - (~ U, ri I dyJ 1iv C PH~ NO. ~ ~,% O OF LOYEES FACILITY CONTACT ~ BUSINESS ID NUMBER 15-021- ~,'3 Section 1: Business Plan and Inventory Program ^ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ( C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIf12SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS 2006 ^ VERIFICATION OF QUANTITIES ^ 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 L~ (/ ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES '~ NO EXPLAIN: rcer-Dula QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (667) 326-3979 c~ ~~ Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # B s Site / Responsi le Pa se Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 j`Z:T - Y INSPECTIONS - B E R S F I L D BUSINESS PLAN & ,ierM r INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: JQc,k- + n -tLc. ~''C Section 2: Underground Storage Tanks Program 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: ~~ ~ d~ ^ Routine ~9- Combined ^ Joint Agency ^ Multi-Agency ^ Complaint ^ Re-Inspection Type of Tank D W ~~ h ~ r ~3)aSS Number of Tanks Type of Monitoring ~~~,,,~~~~ Type of Piping 17~SS ~n.26 ~ ~ -~~ Lit --5 ~-. e ~ 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 .~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 V =Violation Y =Yes N = No .r'', Inspector: C~~~----- Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services Q~~.IV ~! Busi ss ite Responsible Pa Pink -Business Copy KBF-7335 FD 2156 (Rev. 09/05) (:,i_:T 0 . 2iiCi6 1 : `~0 F'P9 . ~J1':=TEh'J ;~Tr-i l'L I ~ F.'EF'C+I<'T ' HL.L. FI_If'dC"I'I~~_+I•Jt-~ P•Jt:~Rf1~L I NaiEIUT~_~)<.",'' kEr'C+F1 '.tT}; HE t ~ BHT' _ ~J ~~ . 1 I ~ ~ ' J[.: : 1w! r '~ ~ PkEf'1 I [ IP I '41.1."•~> ULL,r~ii:i)/'= GU`_~: i_;i-iL.` TC '_~'L.I_Jf'1L: _ -''U I ~ ~i'iL HEI~~HT = al.?' 1P•I~:HE :tT}; HEIt~HT= 41.?~ 1hJC'HE:=, WrTEk.',:i~L = 0 ~~hLS IsIATER = 0.01:1 I f~Jt'HE:=~ TEl"1F' _ "r"", . ^ LiEi=; F `C 3:LiIF.EL IIi.LriGE = 46=.1 UF;LS Il' , t">L.I it"IF.. _ ~. r 9 GtiL ~~ il}.,~=;i-1`r = a:~.'4a IrdiHE :.;'['}; FiE I ~_~HT-. 43 .'44 I fVCHEti I~.I~;'1'1~}:' .rill., _- iJ i~r;LS ' -1~L~1,.jF: _ ^r.. ~ LiEi; F ~~ ~_ UNIFIED PROGRAM INSPECTION CHECKLIST=S ~.. ..,ate...-F: SiPs~i<,'.."2a. w\. .ate.. :_ Y'4 .~: .:~ , ... x.t. .SECTION 1: Business Plan and Inventory Program BAKERSFIELD FIRE DEPT Prevention Services ~lt~ 900 Truxtun Ave., Suite 210 ~RtM Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAM NSPECTION DATE NSPECTION TIME ' ~ ~~~ ,~-I~G ~~, ~U ADDRESS HONE NO. O OF EMPLOYEES UN: N FACILITY CONTACT USINESS ID NUMBER 15-021- Section 1: Business Plan and Inventory Program ^ ROUTINE OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ~^ BUSlftt?SS PLAN CONTACT INFORMATION ACCURATE ~^ VISIBLE ADDRESS ~'' ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ~-- ^ VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY /~ O ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND ROCEDURES /~\, ^ ~/ EMERGENCY PROCEDURES ADEQUATE ~ ~ ^ CONTAINERS PROPERLY LABELED -- ^ HOUSEKEEPING X.-;. /~R ^ f / FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ^ NO EXPLAIN: _ QUESTIONS REGARDING THIS INSPECTION? PLEA8E CALL US AT (861) 328-3878 AM/A.J ~~1~'7i4- p Inspector (Please Print) Fire Prevention / 1" In / Shift of Sfte/Station q mess Sit ool a Responsible alty (Please Print) White -Prevention Services Yellow -Station Copy Pink - Buainesa Copy FD20~8 (Rev. OQ/08) 4 • _~~ ~> - ~ ,V~~` J~~>~ CITY OF BAKERSFIELU FIRE DEPARTMENT e ~ r ro~ OFFICE OF F,NVIRONNiENTAL SERVICES `~ y'~'e UNIFIED PROGRAM INSPECTION CHF,CKLIST ~,_w ~gti,0'~ 1715 Chester Ave., 3r'~ Floor, Bakersfield, CA 93301 FACILITY NAME ~TAI'.~ %N ~ r ~~ INSPEC~~ION DATE ~ ~ ~~~,C~ Section 2: Underground Storage Tanks Program ^ Routine ombined ^ Joint Agency ^Muhi-Agency ^ Complaint ^ Re-inspection Type of ank ,~,~1~. w~y.~( Number of Tanks .~ Type of Monitoring _ Type of Piping 1 c.~~~ OPER.<~TION C V COMMENTS Proper tank data on file Proper owner/operator data on the 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) Tvpe of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS ' SPCC available SPCC on the with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overtill/overspill protection'? C=Compliance V=Violation Y=Yes N=NO Inspector: ~ '~ Office of Environmental Services (661) 326-3979 1~l~hitc - I?nv. Svcs. Pink -Business Cary Business Site Responsible Patty ~' Sri ~ w ~'`~' .. .. ;i,.~ , :~ , l 1 D I IP•11 +._~PJ HVE . B~};ER~JF' I ELD. ~'h . FEE 1 . 2uoG I I : ~J8 NP9 ~`,'STEP~1 STATUS kEF'~JRT rLL F U PJ~_ T I t a l+J:~ I'•J~=}kl°1r~L I hJsdEf+JTtrk.' kEPUkT T 1 : UIVLEr~DED Gr ~SLUI°1E = 9948 Gr~L:~. ULLHGE _ '755 i;HL:=:, 90-°•: IJLLF;GE= 778} GtiL:=~ TC' '~+i~LUME = 998E %AI. '. HEIGHT = 58.82 II•dC'tll_i' 5T}~. HEIGHT= 58. a'2' 1 hJi`NJ:=, L+JHTEk 1tt?L = Q ~ ~~L WHTEk = i.l . 00 I i•~Jr'i-f}=:._~ TEI°111 = 5=J . ? DES= }, T :' : PREM I UNl ULLti+~E = 723; t;riL ; 90:'+~ ULL~i;E= 6196. +=:~LS TC VULUNIE = ~~14? i;~L:=: HEI%HT = 4CI,'?9 1 fd~,"rIE;=: ~T}~: HE 1 ~~ HT= 40 . ?9 J i+JC.'l-II WHTEk = 0.00 II•JCIiI~~~ TEI°JF' 65 . U f_~E~_~ P T 3:DIE~EL • ULL~iGE = 41;..? ~ ~ ,r 9095 ULLr~GE= ;~,i;;q ~ ~,i ,. HEIGHT = 51.'=!5 II'JC'IiL:' 5TK HEIGHT= 51 . •~~, I r•It'HI". 4JtiTEk V~?L = i ~:=~riL WHTEk = i:~ . ~-i~ i 1 rdCHF TEI°iP = E•'~ . i t tit~i_ F x * * n EIVLi ,~z; ` _ + JACK IN THE BOX 3576 =-_---___________________________ SiteID: 015-021-002367 + i Manager JOANNA HARRIS BusPhone: (661) 861-0543 Location: 10 UNION AVE Map 103 CommHaz High City BAKERSFIELD Grid: 31D FaCUnits: 1 AOV: CommCode: BFD STA 06 SIC Code:5541 EPA Numb: DunnBrad:04-211-7200 Emergency Contact / Title - Emergency Contact / Title JOANNA HARRIS / MANAGER ~ 0~~~~/ AREA MANAGER Business Phone: (661) 861-0543x Business Phone: (858) ~~-~~ X55- ~~ 24-Hour Phone (661) 205-8635x 24-Hour Phone ( (o(PI) 33`1 -°1881 x Pager Phone ( ) - x Pager Phone (~-j~~) ~p~ -17~ j~ x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact JMM MANAGEMENT GROUP LLC MailAddr: 820 TOLLGATE RTD City ELGIN Phone: (770) 418-4904x State: IL Zip 60123 Owner JACK IN THE BOX INC Address 9330 BALBOA AVE City SAN DIEGO Phone: (858) 571-2689x State: CA Zip 92123-1516 Period to Preparers Certif'd: ParcelNo: TotalASTs: _ TotalUSTs: _ RSs: No Gal Gal Emergency Directives: PROG A - HAZMAT PROG C - COMM HOOD PROG T - ABOVEGROUND STORAGE TANK PROG U - UST ~NT~~~ R ~ ~ coos Based on my inquiry of those individu&Is 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 ~~ ~ ~ ~D D Signature Date -1- 04/03/2006 t¡" , . '~ ¿!fJ · 111:~~~M ~"'A""DN.I~~~ACBUI,.T~ August 31, 2004 ---- (LuG ~ Bakersfield Fire Department Fire Prevention - Environmental Regulations 900 Truxton Avenue, Suite 210 Bakersfield, CA 93301 Subject: - Chã~~e of Billing/Mailing ~ ~~k in the Box, Inc. _____" Quick :stDft#:¡-7-2ß--- 10 Union Avenue -~> -- -. .. -~--Bak:ersfielâ,CA'93307 To Whom It May Concern: TitanJMM Management Group, LLC (TitanJMM) was recently retained by Jack in the Box, Inc. (JIB) as the consultant of record to manage all compliance related activities for the above referenced facility. The purpose of this correspondence is to ensure that all future mailings for the above referenced facility are mailed to the appropriate address: TitanJMM Management Group, LLC 820 Tollgate Road Elgin, IL 60123 Attached is an amended CUPA Business Owner/Operator Identification form. If you have any questions, or require additional information, please contact the undersigned at TitanJMM (847- 888-0276). Sincerely, TITANJMM MANAGEMENT GROUP, LLC r¿;~ Matthew J. Thompson Program Manager Attachment TitanJMM Management Group, LLC 820 Tollgate Road, Elgin, IL 60123 Phone: (847) 888-0276 and Facsimile: (847) 888-0279 www.titanjmm.com ~~~ UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page , of I I. IDENTIFICATION FACILITY ID# I I I~til I I 15i,.:11 ] r 11 III BEGINNING DATE 100 I ENDING DATE 101 3/1/04 ONf,Olllf¡ BUSINESS NAME (Same os FACILITY NAME or DBA-Doing Business As) 31 BUSINESS PHONE 102 ð""CK S""'FF # 'U1.3 (661) 9&1- 05+3 BUSINESS SITE ADDRESS 103 10 UNION A'lfVlAE CITY 1M I ZIP CODE 105 6AI'E ItS Flht> CA '1330=1- DUN & BRADSTREET 106 SIC CODE (4 digit #) 107 04-2\\- =tz,OO 55+1 COUNTY 108 1C.£n.Ñ BUSINESS OPERA TOR NAME 109 BUSINESS OPERATOR PHONE 110 ------_. :rOJtC7 E. _PI! R.~A - - -'~ '- - -- - ------- .' - --- - --- --- (sse) sos-snr - - -- - -- ß. BUSINESS OWNER OWNER NAME III OWNER PHONE ' 112 ;JIICll. ,... THe. Bo)C. I"'c.. (841) aas - 02i" OWNER MAILING ADDRESS 113 620 TI1I.L.éJATE. (toll " CITY 1141 STATE J15 I ZIP CODE 116 n(,¡IIJ 11. 60IZ3 UI. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 -n1~pJ:SMM M"'AI"~MEalt E]/tC>uP, ¡'L.(.. / ^,,"T1tHõw TftOMP60aJ (84t) geø - 02llø CONTACT MAILING ADDRESS 119 e '2..0 íOLL~A,.t: 12.01\0 CITY 120 I STATE 121 I ZIP CODE 122 HQIN II,.. 6012.3 -pRíMARY- tv. EMERGENCY cöNtActš -šEcöNfiARY- NAME 123 NAME 128 3"OI\W"'1\ if An.C\.\ S Jo1tG,~ PA'UlA TITLE 124 TITLE 129 fflrCl LIl'f M1tAlI\ 6Ef\, ARU NlltAlA£jE/1. BUSINESS PHONE 125 BUSINESS PHONE 130 (bbl) ðbJ.. 05+3 (85e) 505'- 51"1' 24-HOUR PHONE - .' 126 24-HOUR PHONE 131 (55S) \00- HZ3 (sse) 414- Z43\ PAGER # 127 PAGER # 132 (SU) 35-1- =f38~ (an) 33=t ~ 640-+ ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certity 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, SIGNATUR£1ÌÌTd;::;:::..~R DESIGNATED REPRESENTATIVE DATE 1341 NAME OF DOCUMENT PREPARER 135 6/31/0+ MAT1lf"E.W TIfoMP,oN NAME OF S\}NER (print) 136 TITLE OF SIGNER 137 J'~'" ItJ TIt£ Go\t. ,"'(.. eJf; TITlttw3'MM ^,,"NAQ~"'U~N7 r 12 0 (j1t".N\ Nt,.", A C;t:R. G'l.(j,1 P ,.. Lc... UPCF ( 1/99 revised) 4 OES FORM 2730 (1/99) · ~e Jack in the Box Inc. VIA AIRBORNE EXPRESS #8031266250 March 28, 2003 Mr. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services Bakersfield Fire Department Prevention Services 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 SUBJECT: Notice of Violation Quick Stuff #7723 10 Union Avenue, Bakersfield, CA Dear Inspector Underwood: This is in response to the Notice of Violation dated March 19, 2003, indicating that you have not received a Business Plan and Chemical Inventory for the subject facility. Enclosed is a copy of the required plan, dated April 23, 2002. Our records show that a copy was submitted to your office at that time. I apologize for any confusion or error on our part. An annual update of this plan will be prepared shortly, to be kept on file at the facility, and a copy will be sent to your office, If I can be of further assistance, please call me at 858-571-2689. Thank you for your attention in this matter. Sincerely, ~ ~ Paul Deneka, Manager Environmental Engineering ~ ße~'\ t Enclosure t-lc:w ~C(" ß\J~~ ~æ.~ ~ ~{ÀC~ iff',. ~~~M ~k cc: L. Comma, Quick Stuff Operations ßo~ J 9330 Balboa Avenue. San Diego, CA 92123-1516. 858.571.2121 · www.jackinthebox.com ¥... ..; ., ~ - FilE .ß4137¿ Jack In The Box #3576/Quick Stuff #7723 Hazardous Materials Business Plan. " YEAR 2002 10 Union Avenue (Facility Address) Bakersfield (Facility City) Kern (Facility County) POST TIDS DOCUMENT ON SITE SO IT WILL BE AVAILABLE IN THE EVENT OF A GOVERNMENT AGENCY INSPECTION, SITE ASSESSMENT OR AUDIT. -,3676 lED PROGRAM CONSOLIDATED FOR FACILITY INFORMATION BUSINESS ACTIVITIES Page J of '1 I. FACILITY IDENTIFICATION FACILITY 10# I I I I I I I I I I I I I I I 1 I EPA 10# (Hazardous Waste Only) 2 BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business AS) 3 Jack In The Box #3576/Quick Stuff #7723 I. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility... If Yes, please complete these pages of the UPCF... A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases (include liquids in ASTs and USTs); or the [jYESD NO 4 -I HAZARDOUS MATERIALS INVENTORY- applicable Federal threshold quantity for an extremely hazardous CHEMICAL DESCRIPTION(OES 2731} substance specified in 40 CFR Part 355, Aappendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS lUSTs) lKJ YES 0 NO 5 -I UST FACILITY (Formerly SWRCB Form A) 1. Own or operate underground storage tanks? -I UST TANK (One page per lank) (Formerly Form B) 2. Intend to upgrade existing or install new USTs? DYESKJ NO 6 -I UST FACILITY -I UST TANK (One per tank -I UST INSTALLATION - CERTIFICATE OF COMPLlANCE(one page per Iank}(Fo~erly Form C) 3. Need to report closing a UST? DYES~NO 7 -I UST TANK (closure portion-one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS lASTs) Own or operate ASTs above these thresholds: DYES[] NO 8 -any tank capacity is greater than 660 gallons, or -I NO FORM REQUIRED TO CUPAS -the total capacity for the facility is greater than 1,320 gallons? 0, HAZARDOUS WASTE 1. Generate hazardous waste? DYES [lJ NO 9 -I EPA 10 NUMBER-provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted DYEs/K] N010 -I RECYCLABLE MATERIALS REPORT recyclable materials (per HSC 925143,2)? (one per recycler) 3. Treat hazardous waste on site? DYES[] N011 -I ONSITE HAZARDOUS WASTE TREATMENT - FACILITY (Formerly DTSC Form 1772) -I ONSITE HAZARDOUS WASTE TREATMENT -UNIl(one page per unit) (Formerly DTSC Form 1772A,B.C.D, and L) 4. Treatment subject to financial assurance requirements (for Permit DYESŒJ N012 -I CERTIFICATION OF FINANCIAL by Rule and Conditional authorizaton)? ASSURANCE (Formerly DTSC Form 1232} 5. Consolidate hazardous waste generated at a remote site? DYES!XJ N013 -I REMOTE WASTE/CONSOLIDATION SITE ANNUAL NOTIFICATION (Formerly DTSC Form 1232) 6. Need to report the closure/removal of a tank that was classified as DYES~ N014 ../ HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? CERTI FI CATION (Formerly DTSC Form 1249) E. LOCAL REQUIREMENTS 15 (You may also be required to provide additional information by yourCUPA or local agency,) UPCF (1/99) 2 " CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 661 326-3979 FACILITY INFORMATION Business Avtivities Addendum FACILITY 10 # BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) Jack In The Box #3576/Quick Stuff #7723 Page -z,. of ~ III Ir I.åTFn .._._~ 0.1 Is your Facility Compliance Plcm subject to review by... for satisfying the conditions of these permits? H, DEPARTMENT OF TOXICS SUBSTANCES CONTROL DYES ŒJNO v" STANDARDIZED PERMIT . All Modifications DYES ŒJNO v" Non-RCRA HAZARDOUS WASTE FACILITY DYES ŒJNO ý' RCRA HAZARDOUS WASTE FACILITY I. SAN JOAQUIN VALLEY UNIFIED AIR POLLUTION ŒJYES DNO ý' AUTHORITY TO CONSTRUCT CONTROL DISTRICT ŒJYES DNO v" PERMIT TO OPERATE J, STATE WATER RESOURCES CONTROL BAORD CENTRAL VALLEY REGIONAL WATER QUALITY CONTROL DYES ŒJN04 ý' WASTE DISCHARGE REQUIREMENT (WDR) BOARD .., DYES ŒJNO v" GENERAL PERMITS DYES ŒJNO ý' SPECIFIC PERMITS DYES ŒJNO ý' NATIONAL POLLUTION DISCHARGE ELIMINATION SYSTEM (NPDES) K. CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD DYES ŒJNO ý' REGISTRATION PERMIT L. KERN COUNTY RESOURCES MANAGEMENT AGENCY ENVIRONMENTAL HEALTH SERVICES PERMITS DYES ŒJNO ý' Domestic Water Well Permit DYES ŒJNO v" Haz Mat Monitoring Well Permit DYES ŒJNO ý' Septic System Permit DYES ŒJNO v" Public Swimming Pool Permit DYES ŒJNO v" Food Facility Construction Permit DYES ŒJNO v" Solid Waste Local Enforcement Agency (LEA) Related Permits DYES ŒJNO v" Medical Waste Related Permits M. CITY OF BAKERSFIELD WASTE WATER DIVISION ŒJYES DNOs ý' INDUSTRIAL WASTE WATER DISCHARGE PERMIT NOTE: v" If you checked YES to any part of Sections III-H to III-M above, then please address all applicable permit requirements in the Facility Compliance Plan, UPCF (1/99) 2 · D PROGRAM CONSOLIDATED FO FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page of I. IDENTIFICATION FACILITY ID# I I II I I I I I I I I I 11 I ~~~%~~G DATE 100 I ENDING DATE 101 12/31/2002 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) J I BUSINESS PHONE 102 Jack In The Box #3576/Quick Stuff #7723 661-861-0543 BUSINESS SITE ADDRESS 103 10 Union A venue CITY 104 I CA ZIP CODE 105 Bakersfield 93307-1549 DUN & BRADSTREET 106 SIC CODE (4 digit #) 107 04-211-7200 5541 COUNTY 108 Kern BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 Jack In The Box, Inc. (858) 571-2689 II. BUSINESS OWNER OWNER NAME III OWNER PHONE 112 Jack in the Box, Inc. (858) 571-2689 OWNER MAILING ADDRESS 113 9330 Balboa A venue CITY 114 I STATE liS I ZIP CODE 116 .;t San Diego CA 92123-1516 m. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 Paul Deneka (858) 571-2689 CONTACT MAILING ADDRESS 119 9330 Balboa A venue CITY 120 I STATE 121 I ZIP CODE -. 122 San Diego CA 92123-1516 -PRIMARY· IV. EMERGENCY CONTACTS -SECONDARY· NAME 123 NAME 128 Joanna Harris Robert Fakinos TITLE 124 TITLE 129 Manager Area Manager BUSINESS PHONE 125 BUSINESS PHONE 130 661-861-0543 661-394-7017 24-HOUR PHONE 126 24-HOUR PHONE 131 661-588-4511 661-394-7017 PAGER # 127 PAGER # 132 661-394-7017 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. SIGNATURE OF OWN Elf r T ~ATED REPRESENTATIVE DAï 134 NAME OF DOCUMENT PREPARER 13S l{ 2.-3/07- RHL Desie:n Group. Inc. NAME OF SIGNER (print) 136 TITLE OF SIGNER 137 ,a~L- ;?e:r/¿-~ """""""-1""c:c ~~ !>oI"Uvt2-é..J,iN,.r ,./'I'r'--. I€:'/'t I Ø'C C ~....r'( UPCF ( 1/99 revised) 167 OES FORM 2730 (1/99) CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMUCALDESC~ON I8IADD 200 of~ OREVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) Jack In The Box #3576/Quick Stuff #7723 CHEMICAL LOCATION South side of Site ODELETE FACILITY ID # 201 CHEMICAL LOCATION CONFIDENTIAL - EPCRA MAP# (optional) o YES 181 NO 203 GRID# (optional) 4 1 II. CHEMUCAL INFORMATION 205 TRADE SECRET DYes 181 No CHEMICAL NAME PETROLEUM HYDROCARBON COMMON NAME REGULAR UNLEADED CASU 8006-61-9 FIRE CODE HAZARD CLASSES (Complete if required by CUPA) I-B FL If Subject to EPCRA, refer to instructions 207 EHS* DYes 181 No 209 *If EHS is "Yes". all amounts below must be in lbs. HAZARDOUS¥^ TERIAL TYPE (Check one item only) 211 RADIOACTIVE 0 Yes 18] No 212 CURIES o a, PURE 18] b. MIXTURE 0 c. WASTE PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) AVERAGE DAILY AMOUNT 214 LARGEST CONTAINER 20,000 o a, SOLID 18] b, LIQUID o c. GAS ~ a. FIRE 0 b. REACTIVE 0 c. PRESSURE RELEASE lit d. ACUTE HEALTH ~ e. CHRONIC HEALTH 219 STATE WASTE CODE 217 218 ANNUAL WASTE AMOUNT 1 221 UNITS· Check one item onI STORAGE CONTAINER 18] a, GALLONS 0 b. CUBIC FEET 0 c. POUNDS 0 d. TONS · If EHS, amount must be in ounds. o a. ABOVE GROUND TANK IX! b. UNDERGROUND TANK Dc. TANK INSIDE BUILDING o d. STEEL DRUM o 1. FIBER DRUM o j. BAG o k. BOX o 1. CYLINDER o m. GLASS BOTILE 0 q, RAIL CAR o n. PLASTIC BOTILE 0 r. OTHER o o. TOTE BIN o p, TANK WAGON De. PLASTIC/NONMETALLIC DRUM o f. CAN o g, CARBOY o h. SILO o b, ABOVE AMBIENT STORAGE PRESSURE 18] a. AMBIENT o c, BELOW AMBIENT STORAGE TEMPERATURE 18] a. AMBIENT o c, BELOW AMBIENT o d, CRYOGENIC o b. ABOVE AMBIENT %WT HAZARDOUS COMPONENT (For mixture or waste amy) EHS CAS # 15% 226 METHYL TERT BUTYL ETHER 227 DYes 181 No 228 1634-04-4 2 15% 230 TOLUENE 231 DYes 181 No 232 108-88-3 3 21 % 234 XYLENE 235 DYes 181 No 236 1330-20-7 4 5% 238 BENZENE 239 DYes 181 No 240 71-43-2 5 5% 242 1,2,4- TRIMETHYL BENZENE 243 DYes 181 No 244 95-63-6 III. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE f'~ p E,.rl¿ 1C-.1- - J'V',f')...r~ I:" a.-.- f';,.,rv - C.rJ'C(. t"t.. Ý j?--J /o-z. UPCF (1/99) 169 OES Form 2731 202 204 206 208 210 213 215 216 220 222 223 224 225 229 233 237 241 245 246 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMUCALDESCRTIMOON [8JADD ODELETE 200 OREVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) Jack In The Box #3576/Quick Stuff #7723 CHEMICAL LOCATION South side of Site FACILITY ID # 201 CHEMICAL LOCATION CONFIDENTIAL - EPCRA MAP# (opûonal) 202 o YES [8J NO 203 GRID# (optional) 204 CHEMICAL NAME PETROLEUM HYDROCARBON COMMON NAME PREMIUM UNLEADED CAS# 8006-61-9 FIRE CODE HAZARD CLASSES (Complete if required by CUPA) I-B FL 1 II. CHEMUCAL INFORMATION 205 TRADE SECRET 4 DYes [8J No 206 If Subject to EPCRA, refer to instNctions 207 208 EHS* DYes [8J No 209 *IfEHS is "Yes". all amounts below must be in Ibs. 210 HAZARDOUS~TE~L TYPE (Check one item only) 213 o a, PURE 181 b. MIXTURE 0 c. WASTE 211 RADIOACTIVE 0 Yes 181 No 212 CURIES PHYSICAL STATE (Check one item only) FED HAZARD CATEGORIES (Check all that apply) A VERAGE DAILY AMOUNT 215 o a. SOLID 181 b. LIQUID o c. GAS 214 LARGEST CONTAINER 10,000 216 I2ìJ a, FIRE 0 b. REACTIVE 0 c. PRESSURE RELEASE ~ d. ACUTE HEALTH IïI e. CHRONIC HEALTH 217 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 221 222 7 UNITS· Check one item onl ) STORAGE CONTAINER 181 a. GALLONS 0 b, CUBIC FEET 0 c. POUNDS 0 d. TONS · If EHS, amount must be in ounds. o a, ABOVE GROUND TANK ¡g¡ b. UNDERGROUND TANK Dc. TANK INSIDE BUILDING o d. STEEL DRUM STORAGE PRESSURE 181 a. AMBIENT De, PLASTICINONMETALLIC DRUM o f. CAN o g, CARBOY o h. SILO o b. ABOVE AMBIENT o i. FIBER DRUM o j. BAG o k, BOX o l. CYLINDER o m. GLASS BOTILE 0 q, RAIL CAR o n, PLASTIC BOTTLE 0 r, OTHER o 0, TOTE BIN o p. TANK WAGON 223 o c. BELOW AMBIENT 224 STORAGE TEMPERATURE 181 a, AMBIENT o b, ABOVE AMBIENT o c. BELOW AMBIENT o d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CASU 10% 226 METHYL TERT BUTYL ETHER 227 DYes [8J No 228 1634-04-4 229 2 9% 230 TOLUENE 231 DYes [g] No 232 108-88-3 233 3 14% 234 XYLENE 235 DYes [g] No 236 1330-20-7 237 4 5% 238 1,2,4- TRIM ETHYL BENZENE 239 DYes [8J No 240 95-63-6 241 5 5% 242 BENZENE 243 DYes [g] No 244 71-43-2 245 III. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE r~ pI; ¡vé~ - /\A...~1'r9 C/ê- €',../V. é',.if~ vL DATE Y (2-;1 /0 L 246 UPCF (1/99) 169 OES Form 2731 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMUCALDESC~ON ØADD DDELETE 200 DREVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) Jack In The Box #3576/Quick Stuff #7723 CHEMICAL LOCATION South side of Site FACILITY ID # 201 CHEMICAL LOCATION CONFIDENTIAL - EPCRA MAP# (optional) 202 o YES ø NO 203 GRID# (optional) 204 4 CHEMICAL NAME PETROLEUM HYDROCARBON COMMON NAME DIESEL FUEL #2 CAS# 68476-34-6 FIRE CODE HAZARD CLASSES (Complete if required by CUPA) II-CL 205 DYes ø No 206 If Subject to EPCRA. refer to instructions 207 208 EHS* DYes ø No 209 *If EHS is "Yes", all amounts below must be in lbs. 210 HAZARDOUS ~ TERrAL TYPE (Check ole item o!Ùy) 213 o a. PURE t8:I b. MIXTURE 0 c, WASTE 211 RADIOACTIVE 0 Yes t8:I No 212 CURIES PHYSICAL STATE (Check one item o!Ùy) FED HAZARD CATEGORIES (Check ail that apply) A VERAGE DAILY AMOUNT 2IS o a. SOLID t8:I b, LIQUID o c. GAS 214 LARGEST CONTAINER 7,000 216 iii a. FIRE 0 b. REACTIVE 0 c. PRESSURE RELEASE o d. ACUTE HEALTH IËI e. CHRONIC HEALTH 217 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 221 222 UNITS* Check one item o!ù ) STORAGE CONTAINER t8:I a. GALLONS 0 b, CUBIC FEET 0 c. POUNDS 0 d. TONS . If EHS. amount must be in ounds. o a, ABOVE GROUND TANK Q:! b, UNDERGROUND TANK Dc. TANK INSIDE BUILDING o d, STEEL DRUM STORAGE PRESSURE t8:I a. AMBIENT De. PLASTICINONMETALLiC DRUM o f. CAN o g, CARBOY o h. SILO o b. ABOVE AMBIENT o i. FIBER DRUM o j. BAG o k. BOX o I. CYLINDER o m. GLASS BOTTLE 0 q, RAIL CAR o n. PLASTIC BOTTLE 0 r, OTHER o 0, TOTE BIN o p. TANK WAGON 223 o c, BELOW AMBIENT 224 STORAGE TEMPERATURE t8:I a. AMBIENT o b. ABOVE AMBIENT o c. BELOW AMBIENT o d. CRYOGENIC 22S %WT HAZARDOUS COMPONENT (For mixture or waste only) 231 EHS CAS # DYes 181 No 228 68476-34-6 DYes 181 No 232 91-20-3 DYes 181 No 236 NONE DYes 181 No 240 229 99.5% 226 DIESEL FUEL NO.2 2 0.5% 230 NAPHTHALENE 3 234 PETROLEUM DISTILLATES 4 238 5 242 227 233 235 237 239 241 243 DYes 181 No 244 245 III. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE to? <fT.-t, L (1 € ,J£ (µff- - ^'Vf tV","" t"""tL. E ,v u It:' ,..r 4 rL DATE '-f/Z)/ÓL 246 UPCF (1/99) 169 OES Fonn 2731 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ~ADD DDELETE 200 DREVISE I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) Jack In The Box #3576/Quick Stuff #7723 CHEMICAL LOCATION Storage area of Kitchen FACILITY ID # WI CHEMICAL LOCATION CONFIDENTIAL - EPCRA 1 MAP# (optional) 203 202 D YES ~ NO CHEMICAL NAME CARBON DIOXIDE COMMON NAME C02 CASt 124-38-9 FIRE CODE HAZARD CLASSES (Complete if required by CUPA) INRT -G 2 n. CHEMICAL INFORMATION 205 TRADE SECRET 204 DYes 181 No 206 If Subject to EPCRA. refer to instructions 207 208 EHS* DYes 181 No 209 *If EHS is "Yes". all amounts below must be in Ibs, 210 HAZARDOUS !)1A TERIAL TYPE (Check one i!em only) 213 181 a. PURE 0 b. MIXTURE 0 c. WASTE 2ll RADlOAcrrvE 0 Yes 181 No 212 CURIES PHYSICAL STATE (Check one i!em only) FED HAZARD CATEGORIES "" (Check all that apply) AVERAGE DAILY AMOUNT 215 o a. SOLID 0 b, LIQUID 181 c. GAS 214 LARGEST CONTAINER 2,600 216 o a. FIRE 0 b, REAcrrvE 181 c, PRESSURE RELEASE 181 d, ACUTE HEALTH 0 e, CHRONIC HEALTH 217 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 221 222 2 0 UNITS' Check one item onl STORAGE CONTAINER o a. GALLONS 181 b. CUBIC FEET 0 c, POUNDS 0 d, TONS · If EHS. amount must be in ounds. o a. ABOVE GROUND TANK Db. UNDERGROUND TANK ZJ c. TANK INSIDE BUILDING o d, STEEL DRUM De. PLASTIC/NONMETALLIC DRUM o f. CAN o g. CARBOY o h, SILO o i. FIBER DRUM o j.BAG o k. BOX o I. CYLINDER o m. GLASS BOTILE 0 q. RAIL CAR o n. PLASTIC BOTTLE 0 r, OTHER o 0, TOTE BIN o p. TANK WAGON 223 STORAGE PRESSURE o a. AMBIENT 181 b, ABOVE AMBIENT o c. BELOW AMBIENT 224 STORAGE TEMPERATURE o a. AMBIENT o b. ABOVE AMBIENT o c. BELOW AMBIENT 181 d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 100% 226 CARBON DIOXIDE 227 D Yes ~ No 228 124-38-9 229 2 230 231 D Yes ~ No 232 233 3 234 235 DYes 181 No 236 237 4 238 239 DYes 181 No 240 241 5 242 243 DYes 181 No 244 245 III. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 246 tø~ 1?£,Jé~ ^"~ /"\/ ~ t':' /L.. é"...../v t!:"r ~ 'f /2..7 /OÌ- UPCF (1/99) 169 OES Form 2731 e e SECTION I BUSINESS EMERGENCY PLAN: EMERGENCY PROCEDURES Emergency response plans and procedures are an integral part of the Business Emergency Plan. By taking the time to review these procedures for your establishment, you will avoid complications resulting from inaction or misguided action during an emergency, Once these plans and procedures are implemented, your employees will have an informative guide to follow in the event of an emergency. 1. EMERGENCY RESPONSE PLANS AND PROCEDURES A. If you have a release or threatened release of hazardous material, your business is required by State Law to provide immediate notification ofthe following agencies Immediately call: LOCAL FIRE EMERGENCY RESPONSE PERSONNEL (Fire, paramedics, police, or sheriff) 9-1-1 or (800) 852-7550 (916) 262-1621 STATE OFFICE OF EMERGENCY SERVICES: ~ Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SERVICES: 805-326-3979 PERSON(S) WITHIN THE FACILITY WHO ARE NECESSARY TO RESPOND TO A HAZARDOUS MATERIALS INCIDENT: Name: Joanna Hams / Store Manager Telephone: 661-861-0543 Name: Robert Fakinos / Area Manager Telephone: 661-394-7017 B. IDENTIFICATION OF THE LOCAL EMERGENCY MEDICAL FACILITY OR MEDICAL ASSISTANCE A V AlLABLE TO YOUR BUSINESS APPROPRIATE FOR POTENTIAL ACCIDENT SCENARIOS: NAME: ADDRESS: CITY: PHONE: MERCY SOUTHWEST HOSPITAL 2215 TRUXTON A VB BAKERSFIELD 661-632-5281 1 e e \ 2. PREVENTION Describe the kinds of hazards associated with the materials present at your business. Provide infonnation on the steps taken at your business, or the policies or procedures now in place, to help prevent an accidental release of a hazardous material. Issues for discussion may include safety, storage, and containment procedures. Be specific for each type of hazardous material at your business. The hazardous at this business are fire and spills associated with gasoline dispensing. Gasoline dispensing is supervised by trained personnel. Additional hazardous materials are stored in minimum quantities and stored in small, unbreakable containers. All underground storage tanks are monitored using an approved monitoring method. 3. MITIGATION .~ Describe the procedures to be followed to reduce the severity of a release or threatened release of a hazardous material at your business. The procedures should detail the actions to be taken by employees to stop a release, contain a release, or to reduce the problems associated with a release. What is your immediate response to a spill, fire, explosion or airborne release at your facility? Small incidents: For leaks and spills less than 5 gallons, isolate the area and contain with absorbent material. Clean up the spill immediately to prevent spreading. For fires, turn off pumps, use fire extinguisher if it can be done safely. Larger incidents: Turn off pumps using emergency pump shut-off, call 9-1-1, evacuate to-: emergency assembly area, wait for emergency personnel to respond. Immediately contact Paul Deneka, Jack in the Box Environmental Manager at 858-571-2686. 4. ABATEMENT Describe what you would do to stop and remove each hazard. How do you handle the complete process of stopping a release, cleaning up, and disposing of released materials at your business? What aspects of the response are beyond your ability and need to be handled by others? Who would you call to handle the release? Small incidents will be handled with the on-site clean-up equipment, (i.e., brooms, shovel, absorbent material, mops, etc.). For larger incidents, the on-site manager will turn off the pumps, èall 9-1-1, and the Environmental Manager. For suspected leaks the Environmental Manager will contact an authorized contractor to assist in the investigation of the incident. If a UST leak is confmned, then reporting will be done by the Jack in the Box, which complies with UST regulations. Jack in the Box will coordinate with any contractors required to stop a release, clean up a release and/or dispose of materials. All materials will be disposed of in accordance with state, federal and local laws and regulations. 2 5. EVACUATION a'RE-ENTRY e Describe the procedures to be followed for immediate notification and evacuation of your facility and the re-entry procedures after evacuation has occurred. If warranted, evacuate to the designated assembly located at: At the driveway along Union Avenue The manager or lead employee will take a head count to verify all employees have evacuated safely. The manager or employee will confer the responding agencies to indicate the magnitude of the emergency. Re-Entry into the facility will only take place after the manager verifies with the responding agency personnel to ensure it is safe. 6. EARTHQUAKES Identify the areas and equipment in your business that would require immediate inspection or isolation due to their vulnerability to earthquake related ground motion. Check for equipment such as gas cylinders, piping, drums, etc., that may need to be secured or spillage that may require mitigation or abatement. Key areas to inspect are the UST tank monitor alarm panel, dispenser islands, and any additional hazardous materials storage areas. ') 7. HAZARDOUS WASTE CONTINGENCY Specific procedures for prevention, mitigation and abatement of a release of hazardous waste generated at your business. This section only applies to hazardous waste generators. This business does not generally generate waste. If any waste is generated it would be watec gasoline mixture removed ITom the underground tanks. 8. UNAUTHORIZED RELEASE RESPONSE PLAN Specific procedures for mitigation, abatement and reporting of an unauthorized releases ITom an underground storage tank (UST). The plan must address a release ITom a single wall or double wall tank system as applicable. This plan should cover the entire UST system. This section only applies to UST owner/operators. Refer to the Underwound Storage Tank Monitoring and Response plan If a released hazardous substance reaches the environment, increases the fire or explosion hazard, is not cleaned up ITom the secondary containment within 8 hours, or deteriorates the secondary containment, then the local agency will be notified IMMEDIATELY 3 SECTION II e e BusmœSSEMERGENCYTRAllITNG Employers are required by State law to have a program providing employees with initial and refresher training. The Business Emergency Plan shall include a training program that is reasonable and appropriate for the size of the business and the nature of the hazardous materials handled. The training program shall take into consideration the responsibilities of the employees to be trained. The training program shall, at a minimum, include: B. C. D. E. F. .') G. H. 1. A. Methods for the safe handling of hazardous materials stored at your business, including familiarity with the characteristics and hazards of each material and measures employees can take to protect themselves from chemical hazards. Procedures for coordination with local emergency response organizations. Correct use of emergency response equipment and supplies under the control ofthe business. The Cal OSHA Hazardous Communication Standards. The prevention, abatement and mitigation procedures you have developed for your business and explained on the Business Emergency Plan. The emergency evacuation plans you have developed, the notification procedure used to alert people to evacuate, and the closest location to obtain appropriate emergency medical care. Procedures to coordinate with and assist the local emergency personnel that may respond to your facility. Who and how to call for iIIlI1)ediate assistance in the event of an accident involving hazardous materials; Procedure for ensuring the appropriate personnel receives initial and refresher training. ALL EMPLOYEE TRAINING SHALL BE DOCUMENTED AND UPDATED ANNUALLY Use the attached employee training log or similar form for record keeping. 4 e e EMERGENCY RESPONSE PROCEDURES In the event of a fire, spill, or a leak or suspected leak in the tanks and/or piping, the following steps are to be taken as applicable: 1. TURN OFF PUMPS using the Emergency Pump Shut-Off Switch. 2. EVACUATION: If there is any immediate danger, verbally ANNOUNCE to all persons on the site: "There is an emergency. Please turn off your engines and leave the station on foot immediately." All employees are to meet at the emergency assembly area. 3. CALL FOR HELP in case of an emergency by dialing 9-1-1 and giving the following information: "THERE IS A FIRE / GASOLINE SPILL at the gas station at 10 Union Avenue." If anyone is trapped or needs medical attention, tell the answering dispatcher. Stay on the phone and be prepared to answer any questions concerning the situation. 4. LOOK AROUND to assure that all others have left the station if necessary, particularly those in vehicles who may need assistance or may not have heard the emergency announcement. Assist, or direct assistance to, anyone having difficulty leaving the station area and anyone who may be injured. 5. ATTEMPT TO EXTINGUISH any small or incipient fire if you can do so safely. Have the fire extinguisher ready to use in the event of any spill. Try to contain any large spill, or use absorbent on smaller spills. 6. REPORT to arriving emergency response personnel to provide them with any information or assistance they .~ might need. 7. CONTACT the following individuals if not already at the station: a) Primary Contact: Name: Joanna Harris Title: Manager Bus #/24 hour/Pager #: 661-861-0543/ 661-588-4511 / b) Secondary Contact: Name: Robert Fakinos Title: Area Manager Bus #/24 hour/Pager #: 661-394-7017/ 661-394-7017 / 661-394-7017 c) Alternate Contact: Paul Deneka Title: Manager, Environmental Engineering Address: 9330 Balboa Avenue, San Diego CA 92123-1516 Phone: 858-571-2689 8. NOTIFY Jack in the Box, Inc. or the Emergency Maintenance Contractor by phone IMMEDIATELY. Jack in the Box will notify the appropriate State and Local agencies. A. LOCAL AGENCY: Bakersfield Fire Department PHONE NUMBER: 661-326-3979 B. CALIFORNIA OFFICE OF EMERGENCY SERVICES, (800) 852-7550 (24 HOURS) C. LOCAL POLICE AND FIRE DEPARTMENTS, 911 9. On-Site Manager should attempt to isolate leak location by inspection. 10. Jack in the Box will coordinate whatever corrective actions need to be taken beyond the Manager's capabilities. Jack in the Box will file whatever reports need to be filed with local and state agencies. 11. EVACUATION: In the event evacuation is necessary, the attendant will announce for all customers and personnel to evacuate the building using the nearest exit door. All persons should go to the emergency meeting area as designated on the site map. 12. RE-ENTRY: If evacuation has occurred and emergency responders have been called, re-entering this facility should take place with extreme caution and only under the direction of the senior emergency responder on site. e e EMPLOYEE TRAINING PLAN Employees must be given this training before starting work, and refresher courses must be provided annually, Records must be kept to show when each station employee has been given his/her safety training. Use the following outline and make copies as needed. Have employee date and sign this document upon completion of training. Retain these records for a minimum of three years. I. FIRST THINGS TO KNOW: A. EMERGENCY PUMP SHUT-OFF: This turns off the turbine pumps that provide flow to the dispensers from the underground tanks. In case of a leak, shutting off the pumps will help to prevent spills. Employees are to be trained on the use and location of each shut-off switch. LOCATION: 2 on light poles Sw corner & N. of Islan B. ELECTRICAL PANEL: The panel allows you to selectively cut off power to lights, signs, pumps, etc. The main switch kills all power at the site. Employees are to be trained on the use and location of the panel. LOCATION: East side of building & inside C. WATER SHUT-OFF: The water shut-off may be necessary in some cases. Employees are to be trained on the use and location. LOCATION: .¡; D. NATURAL GAS SHUT-OFF: If your station has natural gas, it may be necessary to shut-off the natural gas flow in an emergency. LOCATION: East side of building E. FIRST AID KIT: Employees are to be trained on the use and location. LOCATION: in the Cashier Area and JIB storage F. FIRE EXTINGUISHER: Use only on small fires that you can handle. Do not attempt to extinguish large fires on your own; call 9-1-1 for help. All employees are to be taught proper use and location of fire extinguishers. - LOCATION: 5 inside building, see map #2 G. ABSORBENT: In the form of kitty litter, absorbent can soak up small spills of gasoline, diesel fuel, or other petroleum products. Absorbent should be used rather than washing spills down a drain. In case of large spill, merely try to contain it; a vacuum truck should be used to clean up any large spill. Employees are to be trained on the use and location of spill kits. LOCATION: Store room of store H. Emergency Response Plans: Employees are to be trained on the location of this plan and its contents. They should also be familiar with MSDS's and the information contained in them. LOCATION: at the cashier area I. Safety Procedures: Employees are to be trained on the proper safety procedures and to notify customers when appropriate, i.e. customer smoking on the island, children pumping gasoline or playing near dispensers, etc. 2 II. NEAREST MEDICAL FACIL' Employees should know what facilit'are available in case customers or other employees need medical attention. 1. NAME: MERCY SOUTHWEST HOSPITAL ADDRESS: 2215 TRUXTON AVE, BAKERSFIELD PHONE NUMBER: 661-632-5281 III. All employees should review the Hazardous Material Plan, of which this training plan is a part. Specifically, each employee should understand the procedures to be used in responding to various kinds of emergencies, and know how to monitor for leaks of hazardous materials. As a supplement to this package, employees should also review the Emergency Response Plan filed by your business to the appropriate local agency. Thirdly, employees should review and have access to the Materials Safety Data Sheets you have on file for each of the hazardous materials stored at the station and must be drilled in all emergency response procedures contained herein. IV. FIRST AID PROCEDURES (For exposure to gasoline or diesel fuel): A. EYE CONTACT: Flush with water for 15 minutes while holding eyelids open. Get medical attention. B. SKIN CONTACT: Flush with water while removing contaminated clothing and shoes. Follow by washing with soap and water. Do not reuse clothing or shoes until cleaned. If irritation persists, get medical attention. C. INHALATION (Breathing): Remove victim to fresh air and provide oxygen if breathing is difficult. If not breathing, give artificial respiration. Get medical attention. .~ D. INGESTION (Swallowing): DO NOT INDUCE VOMITING BECAUSE GASOLINE CAN ENTER LUNGS AND CAUSE SEVERE LUNG DAMAGE!lf vomiting occurs spontaneously keep head below hips to prevent aspiration of liquid into lungs. Get medical attention. E: NOTE TO PHYSICIAN: If more than 2.0 ml per kg has been ingested and vomiting has not occurred, emesis should be induced with medical supervision. Keep victim's head below hips to prevent aspiration. If symptoms such as loss of gag reflex, convulsions or unconsciousness occur before emesis, gastric lavage using a cuffed endotracheal tube should be considered. F. For further information, consult the Materials Safety Data Sheets for these products and for other hazardous materials. FIRST AID FOR EXPOSURE TO OTHER MATERIALS: Consult the warning advice on container labels or refer to the MSDS for that product. Document prepared by: Environmental Staff, RHL DESIGN GROUP, INC., 707-765-1660 I:\HAZMA T\JackintheBox\ERP MERGE.doc 3 e e HAZARDOUS MATERIALS TRAINING REQUIREMENTS As the owner/operator of a business that handles hazardous materials, you must have the following: + A Hazard Communication Plan (also known as an Employee Right-to-Know Plan) + A SARA Tier II Chemical Inventory Report (in California this report is included in the Hazardous Materials Management Plan, also known as the CA Business Emergency Plan) + An Emergency Response Plan + An Underground Storage Tank Monitoring and Leak Detection Plan + A Release Reporting Plan " Each of these plans requires employee training. Training must be documented by a written description of the topics covered and by a dated signature of the employees receiving the training. Annual refresher training is required and the introduction of new hazardous materials or changes in procedures require immediate retraining. Training requirements that are common to more than one of these plans only needs to be given once to satisfy all of the plans containing that requirement as long as the_training addresses the concerns of each plan. Training for the Hazard Communication Plan must include the following elements: + An overview of the requirements contained in the Hazard Communication Regulation and the worker's rights under the Regulation. · Locations of any operations in their work area where hazardous substances are present. · Location where a copy of the written Hazard Communication program is made available to them. · How to read labels and Material Safety Data Sheets (MSDS) to obtain appropriate hazard information, including physical and health effects of hazardous substances in the work place. · How to detect the presence of or the release of hazardous substances in the work place. · How to minimize their exposure to these hazardous substances by proper use of engineering controls, work practices, and/or personal protective equipment (gloves, etc). · Emergency and first aid procedures to follow if employees are exposed to hazardous substances. e e Spill/Release Response Plan for Carbon Dioxide D.O.T. Guide Number 21 Fire or Explosion: Cannot catch fire, but container may explode in heat of fire. Health Hazards: Vapors may cause dizziness or suffocation, Contact with liquid may cause frostbite. Emergency Action: Keep unnecessary people away; isolate hazard area and deny entry. Inert gases displace oxygen. Stop leak if you can do it without risk while avoiding suffocation. Assure sufficient oxygen is available before attempting rescue, Do not touch or walk through spilled material. A void breathing gases. Stay upwind, out of low areas and open all doors to ventilate area before entering Contact the supplier for additional assistance to stop the release. .~ Fire: Move container from fire area if you can do it without risk. Apply cooling water to the sides of the container that are exposed to the flames until after the fire is extinguished. Stay away from tanks end. First Aid: Move victim to fresh air and call emergency medical care; if not breathing, give artificial respiration; if breathing is difficult, give oxygen. In case of frostbite, thaw frosted parts with water. Keep victim quite and maintain nonnal body temperature. Prevention Procedures: Store tank and/or cylinders with valve protection caps installed. Tank and cylinders should be stored upright and finnly secured to prevent falling or being knocked over. Containers should be stored in a cool, dry, well ventilated area away from sources of heat or ignition and direct sun light. If you suspect any problems with the tank notify the supplier immediately to have the system inspected. · Date: April 22, 2002 e e 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 is a condition of the operating permit. The permit holder must notify Bakersfield Fire Department 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 Jack In The Box #3576/Quick Stuff #7723 Facility Address 10 Union Avenue, Bakersfield A. Describe the frequency of performing the monitoring: Tank Continuous Electronic Monitoring Secondary Containment testing will be performed every 36 months. Piping Continuous monitoring mechanical Line Leak Detector. Annually all monitoring equipment is inspected by a certified contractor. B. What methods and equipment, identified by name and model, will be used for performing the monitoring: Tank: Veeder Root TLS-350 system with CLSD. model # 848290-022 Mag probe Model #847390-109 (0.1 gph) ~ Interstitial sensor 794390-409 Piping Veeder Root TLS-350 system with the following sensors Turbine Sump Sensor model # 794380-208 Dispenser Sump model # 794380-208 Line Leak Detector: FE Petro STP-Mechanical C: Describe the location(s) where the monitoring will be performed (facility plot plan-- should be attached): The monitor is located in the Inside Storage room of Store. D. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment. Joanna Harris / Manager Robert Fakinos / Area Manager Paul Deneka / Manager, Manager, Environmental Engineering E. Reporting Format for monitoring: . Tank: A written monitoring log. Piping: A written monitoring log and annual certification F. Describe the preventative maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturers' maintenance schedule but not less than every 12 months. The monitoring systems shall be certified annually in accordance with manufacturer's recommendations G. Describe the training necessary for the operation of UST system, including piping, and the monitoring equipment: The operators receive initial and annual refresher training in accordance to the manufacturers recommendations. Refer to the stations environmental binder, located in the office for more detailed information. · Date April 22, 2002 e e 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 is a condition of the operating permit. The permit holder must notify Bakersfield Fire Department 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 Jack In The Box #3576/Quick Stuff #7723 Facility Address 10 Union Avenue, Bakersfield 1. 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 Bakersfield Fire Department must be notified within 24 hours. For small spills the on site personnel will use absorbent material to clean up the released material. In the event of a larger spill, the on site manager will call 9-1-1 (if necessary), and the company representative to assist in the emergency. .;¡ 2. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substances. Spent absorbent will be placed into an approved container and disposed of in accordance with all Local, State, and Federal laws and regulations. Any additional equipment will be provided be the responding contractor. 3. Describe the location and availability of the required cleanup equipment in item 2 above. Absorbent is maintained on site and restocked as needed. Any additional equipment is maintained by the contractor, and available on an as needed basis. 4. Describe the maintenance schedule for the cleanup equipment. Absorbent is inspected weekly and reordered as needed. 5. List the name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan: Joanna Harris / Manager Robert Fakinos / Area Manager Paul Deneka / Manager, Manager, Environmental Engineering ON-SITE TRAININ.RM - NEW EMPLOYEE TRAI1 VERIFICATION Name of Company: Street Address: City, Zip Code: Employee Name (print) I acknowledge that I have received and understand environmental compliance training in the followin areas lease initial or mark Nt A for not a licable: Date ementIBusiness Plan Employee Signature Training verified by Social Sec. Number Date Instructor Date MAINTAIN TIDS FORM THE ENTIRE TIME THE EMPLOYEE WORKS AT THE FACILITY e ON-SITE TRAINING FORM e ANNUAL REFRESHER TRAINING VERIFICATION Name of Company: Street Address: City, Zip Code: Employee Name (Print) I acknowledge that I have received and understand environmental compliance training in the following areas (please initial or mark N/A for not applicable): Date Employee Signature Training verified by Social Sec. Number Date Instructor Date MAINTAIN TillS FORM THE ENTIRE TIME THE EMPLOYEE WORKS AT THE FACILITY MAP# CALIFORNIA AJjNOTATED SITE MAP BUSINESS NAME JACK IN THE BOX #3576/0UICK STUFF#7723 BUSINESS ADDRESS 10 UNION A VENUE BAKERSFIELD DATE 4/22/2002 ZIP CODE 93307-1549 A 18~ 2 3 w z c::( -.J 4 5 w <..9 c::( o :z: ::J 0:::: 00 6 7 B I) c F G PREPARED BY: ~ DRAWING SCALE 1"=40'± " H MAP SYMBOLS CD ELEC1RICAL PANEL SHUT-OFF ® NATURAL GAS SHUT-OFF ® WAlER SHUT-OfF ® EMERGENCY PUMP 1)6 SHUT-Off ~ TANK MONITORING ALARM CD 1ELEPHONE c{þ FIRST AID KIT tñ FIRE EXTINGUISHER e, Ë§ STORM DRAIN I SANITARY SEWER STAGING ARr¡ EVACUATION HMMP ~~~:ilO~D MSDS MSDS 6 FIRE HYDRANT "*-* FENCE (@ EMERGENCY RESPONSE EQUIPMENT/ABSORBENTS C) ABOVEGROUND STORAGE TANK ~--... UNDERGROUND I I ~-~ STORAGE TANK ® GASOLINE (FLAMMABLE UQUIDS) ® DIESEL FUEL (COMBUSTIBLE UQUIDS) ® MOTOR OILS ok LUBRICANTS (COMBUSTIBLE UQUUe @ CARBON DIOXIDE - (COMPRESSED GAS) ® PROPANE (FLAMMABLE UQUID) @ ANTIFREEZE/COOLANTS @ WASTE OIL (FLAMMABLE UQUID) @ CAR WASH PRODUCTS D E UNION AVENUE I "'-I I a e * ® FUEL r 1 PIPIN~ -!-T---------, I leSo oeS I I I I I I 7,000 GAL : : D~L Î6-~-----~-6 ¡ /-, I I /-, I \! I I 1011 of.: I I <:;> II II I : ¡/ t-~H--- II Lr---------, I 1611 1160 061 lei lei 1 I I 0 II 0 I I '_/ ....-/ L J ®® 10,000 GAL 20,000 GAL PREMIUM REGULAR JACK IN THE BOX & C-STORE SEE MAP #2 A 8 c D E F G PREPARED BY: DRAWING SCALE 1"=40'± H MAP SYMBOLS CD ELECìRlCAL PANEL SHUT-Off ® NA ruRAL GAS SHUT-Off ® WATER SHUT-OfF ® EMERGENCY PUMP SHUT-OFF ð TANK MONITORING ALARM ø TELEPHONE c{F FIRST AID KIT Ær FIRE EXTINGUISHER e § STORM DRAIN * SANITARY SE~ STAGING AREJ EVACUATION HMMP ~~~:i10~ND MSDS MSDS Ò FIRE HYDRANT *-* FENCE (~) EMERGENCY RESPONSE EQUIPMENT/ABSORBENTS C) ABOVEGROUND STORAGE TANK ---~ UNDERGROUND I ) ~-~ STORAGE TANK @ GASOlINE (FlAMMABLE UQUIDS) ® DIESEL FUEL (COMBUSTIBLE UQUIDS) ® MOTOR OILS &: LUB~ (COMBUSTIBLE UQUI @ CARBON DIOXIDE > (COMPRESSED GAS) ® PROPANE (FlAMMABLE UQUID) @ ANTIFREEZE/COOlANTS @ WASTE Oil (FLAMMABLE UQUIO) @ CAR WASH PRODUCTS MAP# 2 CALIFORNIA 1\ljNOTATED SITE MAP BUSINESS NAME JACK IN THE BOX #3576/QUICK STUFF#7723 BUSINESS ADDRESS 10 UNION A VENUE BAKERSFIELD DATE 4/22/2002 ZIP CODE 93307-1549 le~ ,,- I Ær DINING AREA 2 ,,- I [] 3 I ~ \ --~ ~ 4 CASHIER 5 6 7 ®