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, ~ ~ >~' ~, ,~ ~~, ,`~ ~ ~ i QUICK SHOP ~~ l ' rf i; 349 UNION AVE ~" ~E R S F I_L r F/RE ~ARTM T RONALD J. FRAZE FIRE CHIEF Gary Hutton, Senior Deputy Chief Administration 326-3650 Deputy Chief Dean Clason Operations/Training 326-3652 D April 10, 2006 Mr. Balwinder Shergill Quick-Shop Mini Mart P.O. Box 60425 349 Union Avenue Bakersfield, CA 93307 REMINDER NOT{CE Re: Guidelines for Unsupervised Dispensino Dear Mr. Shergill: It has come to our attention that many convenience stores who sell gasoline, like yourselves; are closing late at night. If you are using card readers and leaving your fuel pumps on, this is defined in the California Fire Code as: "Unsupervised Dispensing.". Deputy Chief Kirk Blair Fire Safety/Prevention Services 326-3653 2101 "H" Street Bakersfield, CA 93301 OFFICE: (661) 326-3941 FAX: (661) 852-2170 RALPH E. HUEY, DIRECTOR PREVENTION SERVICES FIRE SAFETY SERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 OFFICE: (661) 326-3979 FAX: (661) 852-2171 David Weirather Fire Plans Examiner 326-3706 Howard H. Wines, III Hazardous Materials Specialist 326-3649 Unsupervised dispensing is allowed when the owner or operator provides, and is accountable for daily site visits, regular equipment inspection and maintenance, including any unauthorized release or spills, posted instructions for safe operation of dispensing equipment, and posted telephone numbers for the owner or operator. Signs prohibiting smoking, prohibiting dispensing into unapproved containers and requiring vehicle engines to be stopped during fueling shall be conspicuously posted within site of each dispenser. In addition, a sign shall be posted in a conspicuous location reading: In case of spill or release: 1) Use Emergency Punp shut-off 2) Report the accident 3) Fire Department Telephone 4) Facility address During the hours of operation; stations having unsupervised dispensing shall be provided with a fire alarm transmitting device. A telephone not requiring a coin to operate is acceptable. The fuel leak detection system must have a remote or phone modem to insure off-site monitoring during hours of unsupervised dispensing. During hours of darkness, sufficient lighting must be maintained so that all signs associated with fueling operation are conspicuous and readable. A gallon container of an absorbent material used for spills must be made available to the public during hours of unsupervised dispensing. Afire extinguisher with a minimum 2A, 2B, and 2C rating must be located on dispenser island during hours of unsupervised dispensing ::~a~~n~ tie (~~m~rur~ ,~°°a~ ~/.~~~xe ~Jfaa~ `y~ C~e~-~~rn~ To: Mailing List of Valued Customers Reminder Notice Re: Guidance for Unsupervised Dispensing April 10, 2006 Page 2 If you are currently having hours of unsupervised dispensing, you must comply with the above-mentioned requirements. . Starting April 15, 2006, this office will conduct random checks of all fueling stations within the city limits for compliance. If you shut your station down after normal business hours and are not pumping fuel, please disregard this reminder notice. Should you have any questions, please feel free to call meat 661-326-3190. SincereVy, Ralph E. Huey, Director of Prevention Services ay: Steve Underwood, Fire Prevention Officer REH/db " ~ ~ ~~~ UNIFIED PROGRAM INSPECTION CHECKLIST? ~„l ~~ ..:,~ . ~~:~.,~. ~ : ~,....,..~.., ~ .., , ,:.....:., . ~ ~ . , ...,::. Rrr r A .SECTION 1: Business Plan and Inventory Program . ~ BASERSFIEILD FIRE DEPT Prevention Services 9001Yuxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME NSPECTION DATE NSPECTION TIME ., ~ l ! r-Gd ADDRESS HONE NO. O OF EMPLOYEES ~ i ~ 32Z-~,I Z \ FACILITY CONTACT USINESS ID NUMBER ` ~ 15-021- ~ ~ Section 1: Business Plan and Inventory Program ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (C=Compfiatx;e~ OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ Business 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 ~~~,LJ ~~~ ~. ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE /~ ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ,~fil ^ FIRE PROTECTION !/~ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: ^ YES ^ NO n'-t~ s~~ ~/A~,~~ ~-;2~ -~c-z_~g~.~F1~-~j.~~r?s_-----~?-~~~'~' -~--~41~-~C'~L-~4~- I /IS QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (681) 328-3879 G~ Inspector (Please Print) Fire Prevention / 1'~ In / Shift of Site/Stetion # L~Business Site/School Site Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink - Buaineas Copy FD20~9 (Rev. 02/05) ~, d~~~~~' '~~~\ CITY OF BAKERSFIELD FIRE DEPAR'I'MF.NT `6 ~ ro; OFFICE OF ENVIRONMENTAL SERVICES ~' yp` UNIFIED PROGRAM INSPECTION CHECKLIST ~wE'~g~,0~~ 1715 Chester Ave., 3r`' Floor, Bakersfield, CA 93301 FACILITY NAME ~U~,~ `-ShoT_Ly~~~ INSPECTION DATE ol -~~`0--~-- Section 2: Underground Storage Tanks Program ^ Routine ~mbined ^ Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection Type of Tank ~~~.~J~ cc~,4(( Number oI'Tanks 3 Type of Monitoring _ Type of Piping ,~-~- t.,[t~ r'~ 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 [s tank used to dispense MVF? If yes, Does tank have overfill/overspill protection'? C=Compliance V=Violation Y=Yes N=NO Inspector: ~~/~/~ CJ'~~,~•~~- !' Office of Environmental Services (G61) 326-3979 white - F nv. Svcs. Pink -Business Copy Business Site Responsible Party ,w. - .:. .,,,v. ._~ .... . .. w~- ..-., .. ,- .: .. r......~..-... Y` ' . ~ti„ I ~ i ______~_ i •Ti iTi ti • f~tl' T ~M_~~_~~ I ._i~t_!c: x.iFQ~1 i T-. ri f .l -rs ~~ .~Ti~~~ '':~13.= ' ~ "r 1ff.'•fFi.1 i f `Vi'i; ~r nC 7G! [i Ian ~.}.T~~~( I ~ •••, Y ` • yIy'}.°FI1i ~i ''T z r Sn T_j; 1'~~ ~~I"iLC~iIJ I 1 f : 5 ! i :-i i=y '4th ~ ~r.?r} f Yi ii' ~ f1C'x 7x ~ ,,i tt~:~:~.i~,.t, I i t ~ ;;iiN.F.;tf1T ;ujif~: s i t a t t a t x i t 5 ;tf~i i min . -. ff ~t i~t a_t~ ,h,;Fl ~_,-k;i;4 iii -_fx_ _ ~~ J r~:! . .5 ~~.?'LS! i'. i v 1',i ',i IL~•;t~, ,_ .-~. i ~ ,. t:: 1 ~ ~i i~' S ! t 1 ,'~'~t+ .t ~,~ '~~7 - -- iii' ~ ' .~~ 5; v:~ •i1 _,,,~ii , ~;Ki~~t '~L~ i - _t ~=1 ~f ~• x3.=,7 MONITORZl~JG SY~T~M CERTYFICATION for Use By X11 Jurisdictions ZrVithtn the State of California tutira•iry fired: Chapter 6.7, health and Snfety Code; Chapter 16, Division 3, Title 23, Cal~ornia Code ofRegulutivns Chis fu nn must be used cu docrment testing and servicing of monitoring equipment, A,,4eosrace pertific~@tion or rcpo,t rn,~t b4 ureparr;.i r~x ~:,_h ntiunitorin~ystem control panel by thz technician whn performs the wort;. A copy of this form must be providzd to the taut: ~l:~i~m awnzr/operator. Thz owner/operator must submit a copy of this form to the local agency regulating UST systams within 3li ~i;;y vi tzst date. .z. tyexieral Ynforr~aatian l~r ili,y Name: ONI~, ~~p Bldg. No.: __.•__ . _ sites :~iJdress: ~~ (,rtJl (9~V ~tl_~_ City: ,~~,t- t~L.t~ ZiP:~v~ ---..... t~scilitl ContacrPersou: _ Contact PhoneNo.: (-~, ~_.__._ ,~•t:~l;c: f`~tad~l of Monitoring System: tr 1.~~_~q"~X~-y~(2.~ Date of Testing/Servicing: ~/~%_</~„ i%. Yttvi.t><tot~r ~#' Equipment Tested/Certified ~'La,,; tLr :appropriate 6o~cs to indicate specilte equlpmen[ inspected/serYieetl: "" 1'::ul, tD: __~~U t„~7 - Tank ID: PLtI S SraL __._ I I~ i~ ~ tn-l:,ul. G.uiging Pi•ube, ~ Mode}: ~t~.~ '~ In-Tank Caliging Probe. Model: l~ __.__._. _ 4 ~~ :~unul;u~ Spike or Vattl[ Se,tsor, Model L ~ -,3 ~ Annular Space or Vault Sensor. Model f _ ~j 1=ipr,s~, Sump !'T'rench Sensor(s). lvlodcL ~s-3 ~ Piping Sump /Trench Sensor(s). _ ModCL• •- 1• }~ili Sump Sensor(s). Model; ^ Fi11 Sump Sensor(s). Model: _ :N ;8 itlc~hiuii~al Line heal: Detector, Model: ~ Mechanical Linc Leak Detector. Model: ~ _-_,__ '~i i U 1ac~•n-onir Line Leak Dztecto,•. Model: D Electronic Line Leak Detector. Model; -_,• _ _ _,--.- l; O 1:r,tk 0~•crtill I High-Level Sensor. Model: ©Tank Overfill /High-Level Sensor. Model: _ ,.- J l?nc~:r h ecif ~ e ui ment t • e and model in Section E on Pa e 2 . O Other s eci' a ui ment t e and modei in Section E on 1'a a 31. ~l'ap is ID: TSn1C ID: ~ to-1'~„k Gauging Probe. Model: ~~ ta.7 ^ !n-Tank Gauging Probe. Model: __. •-_.. , ~..~ :~u,wtar Space or Vault Sensor. Model; ^ Annular Space or Vault Sensor. Model: •~_. ' t ~3 Pipu,~ Sump /'trench Sensors}. Model: ~ - ^ Piping Sump /Trench Sensor(s). _ Model: __ t ~l bill Sump Sensor(y). .Model; ^ Fill Sump Sensor(s). __ Model: -~__.- - _ ~' $ i~it~:h:uiical Line Leak Derector. Model; r Pt ^ Mechanical Line Leak Detector. _ ModzF. ___ .. •_... p, M ~ la~~trouii; Linz Lzak Dtrecror. Model: ^ Electronic Line Leak Detector. ModeL• _ ,~ ~`! i~ 1':u~k vs crtill I l3igit-Level Sensor. Mode}: ^ Tank Overfill / HigJt•Level Sensor. Model: _ _-___,_ ~' J C)d,~r is ~c;h~ ei ui manr tv a and model in Section E on Pa e 2 . Q Other {s eci z ui ment + e and mods! in Section E on Pa z '1 i Dispenser Jll: __ I ~ Dispenser ID: ~ ° `~ _. ~f ~,t?i;peuser Containment Sensor(s). Ivlodel: ~~ -~ Dis znser Containment Sensors . P O ModtL• ~._----_ _ _ l~ p+ ~ tihc:u~ ~- stvzls)• Cg Shear Valve(s). ~I i~ is t?i ~ Miser Containment Float(s) and Chains}. _...~ ^Dis enser Containment Float(s) and Chain s). Dispeus~r Ill: Dispenser ID: ___ __ -'~ r:I Disptn>a'r Containment Sensor(s). Model: O Dispenser Containment Sensor(s), Model: _ ------ -- v ~h,;ar ~';th~z(s}• O Shetu Valve(s). +° "t ::~ Cii; xnszr Containment Floats and Chains . ^Dis enser Containment Floflt(s and Chain(s), ~ ~~ llispe„set till: Dispenser XD: ,u •}u+, th~pans~r Containment Senior(s). ~~ ~ l ' V ' Model: O Dispenser Containment Sensor(s). Model: _____-. _.•_, .. _..... q . ti},;:,, :ih els)• O Shear Valve(s). t: ~1 ^D;s,cns~r Conrunment FJou, s and Chains . O Dis eraser Containment Floflt(s and Chains . ^J.f Ill: ,is~il;[}• conra;ns more sanl:s or dispensers, copy tilts fo,•in. IneludL information for every tank and dispenser at the facility. ~~. CCi't1~1Ct3t1Uri - I certify that the equipment identified in this document eras inspected/serviced in accordance with the manuf'acturers' ;uidrliiies. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this inforn,ativn i~ ~urrecc and a Ylot Ptan showing the Layout of n,unitaring equipment. Bar any equipment capable of generAting such reports, t hart also :urachrd a copy of the report; (check rat! flint apply): '$d System set-up ~, rnx history eport 1'~~lu,iciaii Name (print): •(L~~rt l v~iA-S o'er Signature: ___1 _-----_.-... ~ei~tiiir:uion Nu.: D b~.,5'1a-~ License. No.: 61 /D40- # 809850 __R__ _,_. i'z~riu~Co,upatiyNruue: RICH ENVIRONMENTAL PhoneNo.:t661 ~ 392-8687 ~it~ .~.~idr~ss: ~y~ 12~1p'l1 ~1p +b•11~~~leyp Daft; of TestinglServicing: l~,/?,~r~'dS. Pagel of3 U3:'o1 ltiioiiitoring System CeriiliCation „.~. t~~szJlrs of ~>Ce,tinglServicing ~ 5 ti~in~;~i~ Version Installed: ,l~-~~ v __ L'~m~~icrr the t'nllowin~ checklist: ~ti14 Y~~ - ^ No* Is the audible alannt o erationnal? i! i.--;- t `«~ ~ ^ Nu* ---~I Ts the visual alarm o erational? _.._.^ ~ ~ 1'cs L7 No* Were all sensors visuall via acted, fttnctionall tested, and confirmed o erational? it--- . ~i 1 << ^ Nu* -- Were all sensors utstalled at lowest poin[ of secondary containment and positioned so that other equipment ~r itl ~~ ,._ _ _ not interfere with their ro per o erasion? _ _ ' - L] Nu* if alarms are relayed to a remote monitoruto station, is all cotrununications equipment (e.o moiler]) I~ ~~ '~1 NiA operational? ~~ ~ 1 cS ^ No* For pressurized pipin4 systems, does the turbine automatically shut down if the piping secondary con~ainrn>'nt ^ NIA monitoring system detects a leak, fails to operate, or is electrically discomiected? if yes: which sensors u~iriaia ', 11 ~ positive shut-down? (Check call that apply) QI~ Sump/Trench Sensors; bit Dispenser Contairunienr Sensors. Did ou confirm ositive shut-down due to ieahs sensor failureldisconnection? 1~Yes; ^ No. i _ ____ ~~ - ~ * i i + , u ~ ~; t7 No ce ( .u. no For tank systems that utilize the monitoring system as the prunary tank overfill warning dev ~ ~, Ni'A mechanical overfill prevention valve 1S installed), 1S the overfill warning alarm visible and audible at the. tzini. till uint s} and o e.ratinJ ru erl ? Tf so, at wEtat ercenr of tank ca aci does the ala~7n triu:~er? '' „ _~! -- _ _ ~~_~ l'~:^ ,1 ~ J~ No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment repl:~cr~i _ and lot the trutttufacturer name and model for all re lacement arts in Section E, below. _;; " l .:1 ~ ~:,~` I~3. No Chec,E all slant apY ~ ~:! ^ Was liquid found inside any secondary containment systems designed as dry systems? ( I'roducr, 0 Water, If es, describe causes in Section E, below, ~ I ~' 1 ~~ --- l7 Nu* Was monitorin s stem set-u reviewed to ensw•e ro er settin s? Attach set u re orts, if a liable _ _~! - - 1'~~ ^ No* Ts all monitorin a ui meat o erational er manufacturer's s eci6cations? ~~ lt, ,action E below, describe how and when these deficiencies were or will be corrected. i~. ~'uinme><1ts: Page 2 of 3 -~3;i~r ~L'_ .iu (ll':uzk Gauging /SIR Equipment 1ji1 Check this box if tank gauging is used only for inventory cuntrul. ^ Check this Uox if no tank gauging or SIR equipment is installed. 1'iris section nwst be completed if in-tank gauging equipment is used to pexform leak detection monitoring. i'r,,,: r,ler~ rhN tillinwiner checklist] U `i ~ 5 ^ No* Has all input wiring; been inspected for proper entry and termination, including testng for ground faults? ~ ~ ~~ f_i 'i ~.~ _ ~~ id ~~ :•~ l7 No* O No* Were all tank gaugins probes visually inspected for damage and residue buildup? •! _.... i Was accuracy of system product level readings tested? ~ ii _.. _~; `u _ l U 1'~ s O No* Was accuracy of system water level readings tested? Y_.f ! Lf 1. s ©No* Were all probes reinstalled properly? :{ L~ l ~:; ....___ ^ No* Were all items on the equipment manufacturer's maintenance checklist completed? ~! s ^ lu thr ~eciion H, below, describe how an~i when tbe5e deficiencies were or viii be corrected ~. Line i,e:tt: Detectors {Z,LD): O Checkthis box if LLDs are not installed. r^,,,n„L+r.. rh.+ i'nlfnwina rhwrlrlict~ ~l Yes O No* For equipment start-up or atuiual equipment certification, was a leak simulated to verify LLD performance" O N!A (Cl~eck all that apply) Simulated leaic rate: ~ 3 g.p,h.; ^ 0.1 g.p.h ; ^ 0.2 g.p.h. .! ~_ _ es ^ No* _ Were all LLDs confirmed operational and accurate within regulatory requirements? t~1 ~s ^ No* Was the testing apparatus properly calibrated? V ' ~ 1' ~~ ^ No* For niechanicai LLDs, does the LLD restrict product flow if it detects a leap? I ~! ^ NIA _ __j _ L] ~~cS ^ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? 1 f _ L] 1' ~; - N!A O No* _ 1 For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disahl~~i ~9 N!A or disconnected? ~' J 'i ~a D No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system tnalfuncrionti !I II !~. NIA or fails a test? ' ~ ' v Ycs O No* For electronic LLDs, have all accessible wiring connections been visually inspected? ~~ _ ~ N!A ~` ! ~k 1'es ^ No* Were all items on the'equipment manufacturer's maintenance checklist completed? __l !si the Section H, below, describe how and when these deficiencies were or will be corrected. ~~. z:Ornin~sits: Page 3 of 3 ~ ~;~~ f s A~loniroriv}; System Certification US'Y' Monitoring Sife Plan s;~~ -~~~~~~~~: 3y 5 v ~rv~J .k.~ (~•a'x~2S~~~ L~- C-~ Q~C~ 7 _--.__.... j. ............ .................................. :y 3~:::'? ~::::::...::::::::.::: ....... f . i.ff . ~, . ~. .,. . . ~ a _ . 4Z J Q. O ~ .~ ~~. .Q p - - ~ .rya ~i,, . .~ ..~ . . ~ 4 • ~tivi~....... ......... .. .. Dace snap was drawn: .1~ ~~~ !J Instructions if you t~L~ef3dy have a diagram that shows all required information, you nay include it, rather than this page; wirh ~ uur Viotiito~~islg System Certification. On your site plan, show the general layout of tanks and piping. Clearly idontii~ locarions of the following equipment, if installed: monitoring system control panels; sensors monitoring tanl; ~~nnu(nr sp~~ces, sumps, dispenser pans, spill containers, ar other secondary containment areas; mechanical or electronic li~1e leal•. detc:CtUrs; dllC! I!]-tank liquid Level probes (if used for leak detection}. In the space provided, note the date this Site ['l~n ~.:i Prel.~ared. Pflge ~_ cf ~ o{ t~~i ~1~~5) ~. R~Cu' EN~',TR~,1~1E,~~'AL ` 5643 BROOKS CT SA]CERSFISLD,CA.93308 , OFFIC$(661)392-8687 & FAX (661)392-0621 MS~a,ZjJCAL ~(_'TOR TSST W/0#: Facility Name: ©L?~. ~ Facility Address:.~ydf 1J 74'C~ /f'i,•t ]"1~L ,, ~''~ r Product Line Type (kxassura, Suction, aravity)~ -~~ SS PRODUCT LEAK DETECTOR TYPE TSST TRIP PASS sSRInL rrvaas$R BELOW PSI OR L/D TYP ~ A8 SERIAL # ~ F L ~~11 LAS ~ L/D TYP$~.~~ YSS AS SERIAL #~. ~~ ~-5~% NO ~~ BAIL ~vs~s L/D TXBS ~~ -~ '~ ° SERIAL # NO , ~ F L ~, j L/D TYPE YSS BA$$ BERIAL # HO FAIL I certify the above teats were conducted on this date according to Red Jacket Bumps field test apparatus testing procedure an limitations. The Mechanical Leak Detector Ttst pass / fail is determined by using a low flow threshold trip rate of 3 gallon per hour or leas at 10 PsI. I acknowledge that all data collected is. true and correct to Che beat of my knowledge. Tech: ~~~~ yZ~ ~_ Signature : Date : ~ ~ ~' r ~ ~- 6: -y s: ---- f.ONTpCT Fkt~RAM REPORT ---- WED HOV ?3:05 11:42:37 Aro TANK 3 STRTIOti t~tE: _____ FGLA'; FT?OGi~"{ REPORT ---- uU1CK SHOT' t,~~i zq~py ~z.Ylj 11:4.;:2C Ail ~4? UHiC$i Ate 7AtitC IS: STGTIUiti r~i"u^~E: SNt:ERSFIELD CA `~3=47 TYPE BF Tim: STEEL i~'?#I+:t: 6HOF STEEL INSIDE DIRM: %.00A in :' iiNlOt# kl~E ~ STEEL TOTAL t10LUr1E:1B183.000 gal ?~:EP~FIELG i'F :!330? COfdTACT 1 TILTED?: NO NAt~; CIir4TACT 1 ~7'WEEN FILL ~ CENTER: MO ^EHBE: M.C. EETWEEN FFt~sE & CENTER: ~'ELp'~ i TiED TO P,ELA~~: RELAY 1 @.000 in (d~~lt~ : RELAY 1 G~7NTR~:T I8: NORMAL pETWEEN PROBE.. FILL: 0.080 in fiiEC,"iG: FUEL LEVEL aPROBE: ~ -15777.216 in TIP1It~tF: nX31 ti+n~ CntdTACT 2 ~ FUEL LEVEL W FILL: 0.000 in L4T!'HF.G~: LATCHED NAME: ~~ILDANN 2 FR~1BE .S.'N: SW83556}I23 yEHSE: N.C• PROBE SPEED-O-WIkI::9.112 uSE!Cfin TIEu TO RELA`r: RELAY 1 ~~ERT SCALE: 8.008 gal1in ~OHTACT IS: rk)Rt~ ~:~ERT HEIG1iT: 0.000 in itdITIltI PkODUCT LEVEL: 12.0Fri3 in C+INTf~:T 3 PREMSI~F 3 'NITIAL N20 LEVEL: 8.@Q1 in NuME: N C HIHI ALARFI: 10080.008 gal . ~,i;E: T1ED TO RELR`t~ . . TtELN~t i HII~! ALARM: y5e0.eee 9ai itTW 41(.1~1:`_~.00PJ gel ~ Ct7NTACT IS: -~~ iiI WATER pLAGM: 3.098 in THEFT ALF~Y1: 28.888 gal ~~~ 0 9 Cs]NTACT 4 REC ~AR 2 , ~RODUCT NAME: FRE4IANN 4 ':EtJSE: N.C. TIED TO RELA'; : P.ELRY 1 Gi~~i1h~' i I~: t~R1'~. rrjtiiTFu T 5 NAt~: xr~ast~ 5 TIED TO kELAY: REIRV ~1 . CONTflCT I5: NORI!(1L COt~tTACT 6 tiH ~: i~'fRARHN 6 7'EHSE: N.C. TIED TO k'ELp`~: RELAY 1 l'T~NTNCT IS: NORM COr{TACT 7 NRI9E: .. DISP1256 7 SEtdSE: N.C. TIED TO RELA4': RELAY 1 ~.. r_iltdTACT IS c NORMAL CONTACT 8 NAtiE: DI$P347$ 3 SEI`1`E: H.C, TIED TO RELp,' : RELA`~ 1 COtiTACT IS: ~~ 1 -.-- 7At~ SETUP REPORT; ------- DIED FIOV 23,0'3 i1~41:35 tit~l STRTION~NIp~: 344 UNION 41tlE BAKE4tSFIELD CR 93307 t~3E50 TNU JUN 30,00 8:39 Alf Tflh~+ 1 TANK IS: INORMAL TYPE OF TRt~C: I STEEL STEEL It~iIDE DIAM: .000 in TILTED?~ VOl1A1E:101 .000 ~O BETWEEN FILL & CENTER: N(1 BETWEEN PROBE & CENTER: .000 in BET6IE~N PROBE & FILL: .000 in FUEL lEt~1 B PROBE: .000 in FL~L LEVEL B FILL: .000 in PROBE SAN: BW3556~f4 PROBE SPEED-4-WIRE:9.~t' uSEC~in 1~RT SCALE: 65.280 galiin VERT HEIt7HT: _ 6.288 in INITIAL PRODUCT LEVEL: F 37.0+ in INITIAL H2O LEVEL: 0.001 in HI6N ALARM: 1600.000 qa LCD q• .000 ga. 363.080 gal NI VRTER RLA~i: 00fl in ,ter RL;'~l1:. 2:009 9aI LEA; FtLf~: 8,2 9al~ty FR[~l~T: _ 4tE6 UNLEAD - -7RNK2------ TIC I5: T`rPE OF TANK: STEEL STEEL. INSIDE DIA!!: x.000 in STEEL TOTAL VOLU11E:1Bi&x.000 9aI TILTED?: Nt7 BETWE£H FILL & CENTER: ': t~ BETWEEN PROBf & CENTER:: x.008 in BETidEEN PROBE & FILL: x.080 in FUEL LEVEL @ PRE: ].080 in FUEL LEVEL @ FILL: x.080 in PROBE STN; 8fiS3S5H3 PROBE SPEED-0-W1~:9.183 uSfCiin VERT ,ALE: 8.089 gal~in VERT HEI6Ht: t~.0!!0 in INITIAL PRODt~T LEVEL: 25.808 in INITIAL tt110 LEVEL.: 0.091 in HINI AIRRFI: 100.000 gal tfi5H ALAp9: 95.080 gaI Ll~ RLARM: - 553.000 gal HI WRTER 4~.AR19: 3,008 in THEFT AL~?!1: 18.080 aai LEAK ALfl~i: a.2 gC1Thr PRODi}C,T : ~`~'t~Miw I I ~l S ~ x:+::~xx:+::rw ~:;1{~ii;CT aLARt~ *:~***~*~! '~***•*~'k't CONTAI;T FARM **.******* t+tEC.+ t•#GV 2:~r35 1I:59:5'o AP1 WED N+1~! 23~+~5 11:49:51 Aft CCNTpCT 1- TiIE N~IU 30,84 1:41:45 PM --•--•~- ALARM RFPaRT --------- WED NQ~1 23,E 11:43:56 AM ~~~ir•Tn+~.T 1: OFf STATION NAt~: . . rt11CK, SHOP FREt{Atvf~i a: "pF UWL[}Rf~$•t 2: ON 6~'•#zDANN 2: 349 UNION AVE 8tk'ER5'FIELD Cfl 93.307 TUE N9U 38,04 12:59:x9 PM llltLlt 2: Q~ TANK 1 PR~JCT: RE UNLEAp • ~~~ 3 r ~ THU J.4, 2fl,05 10:59:05 AM H1 6~iTER ALARPt: FF:EtTSltt'~ 3: CUFF WED J:iN 1995 12:. 5:92 Pt9 WED JAFt 1995 12:. :95 PPi WED J~1 1905 7:' b:32 At9 PFEt1ANN 4: LOW RLARN; TC.~E Nf1t1 38,94 l:ii:iji PP4 FRI OCT 07,05 3: :49 Pt4 FfiEftANN 4: ~ TUE SEP 27,05 11: 7:53 Ati TIDE JUH 0795 1:, 1:36 PM • HIGH Alf~tl: KTRASUMP 5: TUE HOV 22;05 3:1 p:02 Ah# C'il'~N J~JN 29,05 11:`y:16 AN THU NOU i?:95 8:z fa:38 AM T~?A'?,LttIF 5: t}FF SUN N1W 9695 6:? :46 At9 HIHI ALAii'M: ~ **~'~~*•*:~ ~:i~NTArT hLAk!1 *:e*a::~ = +~~toStitc III S'7STEM RESET =_- SUN MAR 26,05 5.`, x;31 Ate C~:f~ tt;;!1 ?.3,tJ~i 11:51:1? At9 WED NCR1 23,05 11:50:25 AP9 k'T~IANti f.: PROSE: THU JAN 29,85 12:1Y :11 Pt7 TUE NOV 3904 kj4~ ~,1 b; 1:01:33 - - - - - - - - - - - -' TNPtK 2 PRODUCT: - P - - REMIUM kTRAF#t4~ ~.; ~{ • ; DISP1256 7: NI WATER ALARt4: ~ WED FER 23,85 11:10:53 AM FRI JAN 21.95 i2:5 :3~ PC4 DISP1.5b 7. OFF FRI 3AN 21,95 i2:5~ :96 Ptl WEG JAN 1995 12:4 :57 Ptt ~ ALt~.H: DI`3P3478 8: SUN OCT 1695 9:4 '19 PM • TUE NuU 30,94 1:40:19 PM SUN 4CT 9205 6:1 :33 Pt9 tiISP3478 8: t~F THIS A<1G 25,85 9:1' :43 Ptq PROBE: TUE JUFt 21.95 11:4 _ :54 AM ~_ - • TAt4C 3 PRL~4UCT: RE~ ~ULAR 2 HI WATER ALARt9: TH~J JAN 2935 11:1 1:14 AM **~`*~` ~'~~=T ~~ ~'~*'~ WED JAH 19,95 1:13 I~G Jt~N 19:95 1:0~ :5$ Ptl ~:31 PC9 *:+~**k**~~ it1f1?ACT RLARM ***~**.~a {JE(? t~1tJ 23.05 11;50:33 AM Lm) ALARM: C+~ED h{~S!+ '?3.jS5 11:54:41 AFi I'N]N NOV 21 X95 2:511:4? Pti • • PREMANt! 4: OhI THiS Nrrl 17105 6:4t~:3.5 Atl FRI NOV 1105 2~2rt:1t3 PM Cf?t•Tf#?CT 1: (q, HIGH R1.Afit7: WED JAN 19,05 1?:5i~:42 PM PROBE: THfS JAN 2q~95 11:341:33 W9 + • j Ir~fS ~~~ ~1It1CT AtARGl4 *~~:~ NUV LJ rQJ 11:5J.34 ~ ' A~~t~Stik_III S't5TE14 RESET = ~..~~,~ COHTEiCT ALf~PP ***'~~'* WED HOU 't3,ti5 11 ~5~54 AP1 WEG t{Qt1 2305 11.5712 AP9 GISP347$ $~ ~ ' ~~#~~x COPPTt~T Ai.AkCl ~~*** ' (dEp P{O!J 23:$.5 11.566@ API :-~~~ CONTACT Ati~P9 ~* IdfG P~E,~ 2365 11:5$;29 API XTP2ASUtM1P 5: ON GI5Pi256 7: ON '' i i <<~51 MONITOR CERT. FAILURE REPORT SITE NAME: D'U~ ~C'~'CJP DATE: It- ~'~ "~ a~DDRESS: 3y~'i V U!U'V /1-111k TEC~zczAN:~~~c.) ~^'~~i. CITY : (~¢'y(.it(lr('N f~.~.1J 3IGNATIIRE SITE CONTACT: THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE THE MONITOR CERTIFICATION TESTING. LIST OF PARTS REPLACED/REPAIRED: REPAIRS: ~~~ LAAOR: . ~~~~ PARTS JI/N~~SATA,LLED _/VV'V r, :,.~ UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING !TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. l ~ ~ v ~"~ ~;iR~ °arr ~ BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of t ^ ENHANCED LEAK DETECTION ^ L NG ^ S&989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST TO PERFORM FUEL MONITORING CERTIFICATION ` SI , IN MATT N FACILITY U 1~ S O E NUMBER OF CONTACT PERSON ADDRESS ~ ~~ ~( ,( ~~ l(~, OWNERS NAME OPERATORS NAME 'PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPIN GOI G T T TED? YES ^ NO TANK V ON NTS 2- ~ W/1, ~ P ~5 8 ~ r~2 Vv,, - `'~ ~ ' TANK TESTING COMPANY NAME OF S71 G COMPANY N ME S PHONE NUMBER OF CONTACT PERSON ' a-~c~ ~ MAILING~AD~RESS A ~~ NAME 8 PHONE NUMBER OF TESTER OR SPECIAL INSPECTOR CERTIFICATION #: DATE S TIME TE T TO BE CONDUCTED l -a -o - oc~ ICC #: TEST METHOD SIGNATURE OF APPLtCA ~ ~~~„_ DATE ~ ~ ~ D 5 / APPROVED BY DATE Pf lb FD 2095 (Rev. 09/05) BILLING & PERMIT STATEMENT FPERA~tT NO.: BAKERSFIELD FIRE DEPT. Prevention Services P,1Bt 900 Truxtun Avenue, Suite 210 ARfAI T Bakersfield, CA 93301 ' Tel_ ~ fhh l l 32h-3979 S Fax: fhh l l 852-2171 LOCATION OF PRC'°^"- PROPERTY OWNER STARTWG DATE COMPLErtON DATE ~a3 -os ~_~~ _a s NAME PROJECT NAME U ADDRESS (.,( (~ ~ ~,LG~ PHONE NO. PROJECT ADDRESS ~ (; CnY ~ ~~,~ V ~ l STATE ZIP C~jDE y~ i ~' CONTRACT R NAME CA LICENSE NO. ~~!~ ~~. ~c~n •' ~ • TYPE OF LICENSE EXPIRATION DATE PHONE NO. . 4a -~~g. CONTRACTOR COMP Y E --~ ~n `~.11~U1~ FAX NO. (.~Ce - ~RoZ~D a. ADDRESS ~ ~ ~ ~ ~~ G~ C ~ ` tnJIV ZIP COnD'E~ x ~ l cJ 5 ~ ~ ^ Alarms -New & Modifications - (Minimum Charge) $262 50 • ~ . 98 000 Sq F~ Over 20 013125 =Permit fee FL x Sq ~ ^ . , . . 98 ^ Sprinklers -New & Modifications - (Minimum Charge) $210 00 . 98 ^ Over 5 000 Sq. FL FL x .042 =Permit fee Sq ~ , . 98 ^ Minor Sprinkler Modifications (< 10 heads) $ 93.00 [inspection Onlyj ~ . 98 ^ Commercial Hoods -New & Modifications $ 398 26 ~ . 98 ^ Additional Hoods $ 36.00 ~ 98 ^ Spray Booths -New & Modifications $458 00 ~ . 98 ^ Aboveground Storage Tanks (Installation/Insp.-1~Time) $165.00 ~ ^ Additional Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Removal/Inspection) $109.00 82 ^ Underground Storage Tanks (lnstaBation./Inspection) $878.00 (pertank) 82 ^ Underground Storage Tanks (Modification) $878.00 (per site) 82 ^ Underground Storage Tanks (Minor Modfigtion) $155.00 82 ^ Underground Storage Tanks (Removal $675.00 (per tank) 84 Oilwell (Installation) $ 72.00 ~ 84 Mandated Leak Detection (testing) !Fuel Monit. Cert. $ 81.00 (per site) 82 Tents $ 93.00 (per tent) 84 ^ After hours inspection fee $122.00 ~ 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour) $ 60.00 + (5 hrs. min. stand -by fee !Inspection) _ $510.00 84 ^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) 84 ^ Portable LPG (Propane): NO.OF CAGES? $66.00 84 ^ Explosive Storage $249.00 84 ^ Copying & File Research (File Research Fee $33.00 per hr) 25¢ per page ; &- ^ Miscellaneous ; 8a FD 2021 (Rev. 09!05) _ nat~t-uot wNITE (to Treasurvl 1-YELLOW (to File) 1-PINK (to Customer ~,. . --`_ .FIRE PREVENTION INSPECTION ` B EF,RE ` L D ARTM T BAKERSFIELD FIRE DEPT. ~},(~ 0-, / Prevention Services 900 Truxtun Ave., Ste. 210 ~ ~ Bakersfield, CA 93301 Tel.: (661) 326-3979 ^ Fax: (661) 8 2-2171 .~~ DISTRICT BLOCK NO. DATE \ ~ ~ ~ EE ~ - ~ ~ FACILITY ADDRESS ~ ~ ~ CITY, STATE, ZIP~,~~gl ~t ~rG \ ` ~ , FACILITY NAME (''~ ~~ ~ ~ ~„~{^~ ~7 F I TY H~ ~ MANAGER'S NAME,._` • ~ ~ ~-~J \' V f ~ M ^ ` ~ BUSINESS OWNER'S NAME AND ADDRESS `~ OWNER' PHO ENO. CITY, STATE, ZIP BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO. ,,.. ,i,7 J •~ 7 L^ v -OCC TYPE OCC LOAD NO. OF FLOORS HIGH RISE BLDG RISER GATE ^ YES ^ NO ,I CORRECT ALL VIOLATIONS VIOLATION REQUIREMENTS CHECKED BELOW ao. l ` IBLE WASTE/DRY COMB 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.) UST VEGETATION 2 Provide non-combustible containers with tight fitting lids for the storage of combustible waste and rubbish pending its safe disposal. (U.F.C.) COMBUSTIBLE STORAGE 3 Relocate combustible storage to provide at least 3 feet clearance around motor fuse boxlfire door (N.E.C.) (U.F.C.) 4 Relocate fire extinguisher(s) so that they will be in a conspicuous location, hanging on brackets with the top to the extinguisher not more than 5 feet above the floor. (N. F.P.A. No. 10) EXTINGUISHERS 5 Provide and install (amount) _____ approved (type & size) __________________ portable fire extinguisher to be immediately accessible for use in (area) _____________________________ (U.F.C.) g Re-charge al{ fire extinguishers. Fire extinguishers shall be serviced at least once each year, and/or after each use, by a person having a valid license or certificate. (U.F.C.) •~ 7 Provide and maintain "EXIT" sign(s) with letters 5 or more inches in heig t ove h ire~~®C(door/window) to SIGNS fire escape.. (U.F.C.) ~J g Provide and maintain appropriate numbers on a contrasting background and visible from the street to indicate the correct address of the building. (B. M.C.) (U.F.C.) g Repair atl (cracks/holes/openings) in plaster in (location) ___________________~___________________. Plastering FIREDOORSI RATIONS FIRE SE shall return the surface to its original fire resistive condition. (U.B.C.) PA 10 Remove/repair (item & location) _________________________________________________________. Self-closing doors shall be designed to close by gravity, or by the action of a mechanical device, or by an approved smoke and heat sensitive device. Self-closing doors shall have no attachments capable of preventing the operation of the closing device. (U.F.C.) EXITS 11 Remove all obstruction from hallways. Maintain all means of egress free of any storage. (U.F.C.) 12 Provide a contrasting colored and permanently installed electric light over or near required exit (location) ___ to clearly indicate it as an exit. (U.F.C.) STORAGE 13 Remove all storage and/or other obstructions from fire escape landings and stairways stair shafts. (Fire escapes/stair shafts are to be maintained free from obstructions at ali times.) (U.F.C.) 14 Extension cords shall not be used in lieu of permanent approved wiring. Install additional approved electrical outlets ELECTRICAL APPLIANCES where needed. (N.E.C.) (U.F.C.) 15 Remove multiple attachment cords from specific electrical convenience outlet (one plug per outlet) (N.E.C.) (U.F.C.) OUTDOOR BURNING 16 Violation of Section 1102 dealin with recreational fires or o en burnin U.F.C. FIREWORKS 17 Violations of Section 7802 U.F.C. or 8.49.040 of a Bakersfield Munici al Code B.M.C. re ardin fireworks. OTHER 18 ~ ~ C... ~ `~ ~9J G .s7 re?. ~ ~ f ~ +1~~ /`~ ~~ r. l / ~ ~. "~ Z ~ ~ 6 ~. -t..-~ r~ ~~t ~. ) -z. 1 ~ ~ ._ CUSTOMER: ~~y~ --" LEGEND: C.F.C. CALIFORNIA FIRE CODE (Signature) (Please Print Name Legibly, Title) U.B.C. UNIFORM BUILDING CODE INSPECTOR: , --( ~ ~---•-------.- AP NO.: ~~ b-~ B.M.C. BAKERSFIELD MUNICIPAL CODE N.F.P.A. NATIONAL FIRE PROTECTION (Signature) I ASSOCIATION N.E.C. NATIONAL ELECTRIC CODE ~/ White -Customer/Original Yellow -Station Copy Pink -Prevention Services FD 2022 (ReV. 09/05) z4 i. yI + QUICK 5__________________________________________ SiteID: 015-021-001386 + Manager BusPhone: (661) 322-2102 Location: 349 UNION AVE Map 103 CommHaz Moderate City BAKERSFIELD Grid: 32C FacUnits: 1 AOV: CommCode: BFD STA 06 SIC Code:5541 EPA Numb: DunnBrad: +______________________________________________________________________________t Emergency Contact / Title Emergency Contact / Title BALDWINDOR SHERGILL / OWNER BALBIR SHERGILL / Business Phone: (661) 872-8742x Business Phone: (661) 872-8742x 24-Hour Phone (661) 322-2102x 24-Hour Phone (661) 366-7116x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire DelHlth Contact Phone: (661) 322-2102x MailAddr: 349 UNION AVE State: CA City BAKERSFIELD Zip 93307 Owner JOHN SOHAL/BALDWINDOR SHERGILL Phone: (661) 322-2102x Address 2612 VYN DR State: CA City BAKERSFIELD Zip 93306 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST used on my inquiry of those individuals responsible for obtaining the information, 1 certify under penalty of iaw that I have personally examined and am familiar with the information submitted and believe the information is true, ccurate, and complete. ~-' ~ 3~ p gnature Date p0`~ ~5001~~~ ~JSp~ ~ ~'h ~~~ ENT'D OC T 31 2006 -1- 04/03/2006 • V"v E R S F I D ~(~ ~~ F/RE ~ ~1 R TM T December 1, 2005 Q w~c~ 5`~ ~ RONALD J. FRAZE .Q i,~k=gt~ mi Mart FIRE CHIEF ~ P.O. Box 60425 Bakersfield, CA 93307 Gary Hutton, ! Senior Deputy Chief FINAL REMINDER NOTICE Administration ! RE: Necessa Seconda Containment Testin Re wrements b ~ ry ry 9 q~ Y 326-3650 December 31, 2005 of Underground Storage Tank (s) Located at Deputy Chief Dean Clason ~ the Above Stated Address Operations/Training 326-3652 Dear Valued Customer, Deputy Chief Kirk Blair ~ Over the last six months this office has continued to send reminder notices regarding Fire Safety/Prevention Services secondary Containment testing. 326-3653 Code requires that all secondary containment systems must be tested 6 months post construction and every 36 months there after. 2101 "H" Street Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Bakersfield, CA 93301 Health & Safety Code) of the new law mandates testing of secondary containment OFFICE: (661) 326-3941 components upon installation and every 36 months, thereafter, to insure that the FAX: (661) 852-2170 systems are capable of containing releases from the primary containment until they are detected and removed. Our records indicate that your facility is due prior to December 31, 2005. RALPH E. HUEY, DIRECTOR PREVENTION SERVICES ~ Those sites that have not been tested and have not pulled a permit prior to December 31, flRE 3AFETYSERVICE3•ENVIRONMENTALSETIICE3 2005, will have their permit to operate revoked. 900 Truxtun Avenue, Suite 210 ! This office does not wish to take such action, which is why we will continue to send monthly Bakersfield, CA 93301 reminders. OFFICE: (661) 326-3979 FAX: (661) 852-2171 Contractors are already booked several weeks in advance. I urge you to schedule your testing date as soon as possible to avoid possible revocation of your permit to operate. David Weirather Fire Plans Examiner ~ Should you have any questions, please feel free to call me at (661) 326-3190. 326-3706 Sincerely, Howard H. Wirte3, 111 RALPH F/.' HUEY, Director of Prevention Services Hazardous Materials Specialist ' - 326-3649 v Steve Underwood Fire Prevention Officer SU:db J ~re ~os~sm~s~ ~ ..~J!Lota ~Jll~an ~~~~ ~i essf~ .. '; UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / S6988 SECONDARY CONTAINMENT TESTING (TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT N0. ~ ~ --' f/R/ ARlr r BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DETECTION LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING n TANK TIGHTNESS TEST ~ TO PERFORM FUEL MONITORING CERTIFICATI N ITE INFO RMATION " , FACILITY - - NAME & PHONE NUMBER OF CONTACT PERSON ADDRESS e t,~ OWNERS NAME OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED 1 PIPIN IN T BE TESTED? Y S NO L CONTENTS W~ 3 .~- 1 TANK,TESTING COMPANY ,: NAME OF TES 6 C PA ~ ~ NAME & PHONE NUMBER OF CONTACT PERSON ...- MAILING ADDRESS ~~ ~ .~ .-. NAME 8 PHONE NUMBE F TESTER OR SPECIAL INSPECTOR - ~ Q CERTIFICATION DATE & TIME TEST TO BE CO DUCTED : O ICC #: ~--~r (i (~~ °l U ~ \ TEST METHOD SIGNATURE OF APPLIC T ~~_ _ ~ ~ DATE (• i APPROVED BY DATE r~ 3 FD 2095 (Rev. 09/05) AIL>LING & PERMIT STATEMENT BAKERSFIELD FIRE DEPT. Prevention Services ""° 900 Truxtun Avenue, Suite 21 U f PERMIT NO.: ARTII T B~ersfield, CA 93301 1 • LOCATION OF PROJECT vl - • PROPERTY O STARTING DATE COMPLETION DATE NAME ` , 1 V l 1`nl.- PROJECT NAME r` ADDRESS o PHONE NO. PROJECT ADDRESS CnY i ~ STATE -/J K /LIB ZIP CODE • •~ CONTRACTOR NAME CA LICENSE NO. ~~ • TYPE OF LICENSE. EXPIRATION DATE PHONE ~'~2~~s~ CONTRACTOR COMPANY NAME ~ ~ ~ FAX NO. ADDRESS ~ e _ ~ CITY ~ ZIP CO • • ~ O Alarms -New & Modifications - (Minimum Charge) $262 50 • ~ • . 98 Ft Over 20 000 Sq 013125 =Permit fee Sq Ft: x ~ ^ , . . . 98 ^ Sprinklers-New & Modifications - (Minimum Charge) $210 00 ~ . 98 ^ 000 Sq. Ft. Over 5 Sq. FL x 042 =Permit fee ~ , . 98 ^ Minor Sprinkler Modifications (< 10 heads) $ 93.00 [Inspection Only] ~ 98 ^ Commercial Hoods -New & Modifications 26 $ 398 ~ . 98 ^ Additional Hoods $ 36 00 ~ . 98 O Spray Booths -New & Modifications $458 00 ~ . 98 ^ Aboveground Storage Tanks (Instal/anon/Insp.-1~' Time) $165.00 82 ^ Additional Tanks $ 26:00 82 O Aboveground Storage Tanks (Removal/Inspection) $109.00 82 ^ Underground Storage Tanks (/nstallationJlnspedion) $878.00 (pertank) 82 ^ Underground Storage Tanks (Modification) $878.00 (per site) 82 ^ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Underground Storage Tanks (Removan $675.00 (pertank) 84 ^ Oilwell (Installation) 2.00 84 Mandated Leak Detection (Testin uel Monft. Ce . $ 81.00 (per site 82 O Tents $ 93.00 er en 84 ^ After hours inspection .fee $122.00 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee ~ $90 per hour) $ 60.00 + (5 hrs. min. stand -by fee /Inspection) _ $510.00 84 ^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) 84 ^ Portable LPG (Propane): NO.OF CAGES? $ 66.00 84 ^ 1=xplosive Storage $249.00 84 ^ Copying & File Research (File Research Fee $33.00 per hr) 25¢ per page ; 84 ^ Miscellaneous ; 84 FD 2021 (Rev. 09/05) 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to File) 1-PINK (to Customer) C.~ / ~~° _____ MONITQRING SYSTEM CERTIFICATION For Use By A11 Jurisdictions Within the State of California Authority Ci1e& Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code oJRegulatioru Tlus form must be used to document testing and servicing of monitoring equipment. ~~eparate certification or report must be preaare for each monitoring-system control aanel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: Qy/~ /L ~'~~ Bldg. No.: Site Address: ~yq </~/42J /tt~~ City: -R~~/LSfi~"~.D Zip: Facility Contact Person: Contact Phone No.: ~~ Make/Model of Monitoring System: ~~~ /,fr i77JSi t(i` T-~ y Date of Testing/Servicing: /1 l~/~ B. Inventory of Equipment Tested/Certified (`6erb r6.+ o :or.. Lnv>c rn inrlinntP snrrifir enrrinmenf incnected/serviced[ Tank [D: ( ~ Tank 1D: t] - ~ in-Tank Gauging Probe. Model: (ya In-Tank Gauging Probe. Model: ~ Annulaz Space or Vault Sensor. Model: LS ~~ ~ Annular Space or Vault Sensor. Model: LS- ® Piping Swnp /Trench Sensor(s). Model: (-5- 1, Ij~ Piping Sump /Trench Sensor(s). Model: ~ ^ Fill Sump Sensor(s). Model: ^ Fiil Sump Sensor(s). Model: ~ >\lechtuucal Line Leak Detector. Model: F ~T~rl7 ~ Mechanical Line Leak Detector. Model: O ^ Electronic Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: Q Ttuik Overfill /High-Level Sensor. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Others ci ui ment a and model in Section E on Pa e 2 . ^ Other s eci a ui mcni and model in Section E on Pa e 2 . Tank ID: ,/J 9/ Taak ID: In-Tank Gauging Probe. Model: ^ In-Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: f.S ~ ~ ,_, ^ Annular Space or Vault Sensor. Model: ~' Piping Sump / Tretich Sensor(s). Model: C.~ ~ ^ Piping Sump !Trench Sensor{s). Model: O Fill Sump Sensor(s). Model; ^ Fill Sump Sensor(s). Model: ,~ Mechanical Lute Leak Detector. Model: ^ Mechanical Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model; ^ 1`ank Overfill /High-Level Sensor. Model: ^ Tank Ove~l] /High-Level Sensor, Model: ^ Other (specify uipment and model in Section E on Page 2). ^ Other (s ify ui ment. and model in Section E on Page 2). Dispenser 1D: 1 _ ~ Dispenser ID: ~ ` ~ Dispenser Containment Sensor(s). Model LS- ~ ~ Dispenser Containment Sensor(s). Model: L.<-- J~ Shear Valve(s), , _ ~ Shear Valve(s). _ ^ pis enser Con4~inment Floa s and Chains . ^Dis enser Containment Floats and Chains . Dispenser ID: Dispenser ID: ^ Dispenser Containment Sensor(s). Model: ^ Dispenser Containment Sensor(s). Model: ^ Shear Valve(s). ^ Shear Valve(s). ^ Dispenser Containment Float(s) and Chain(s). ^Dis enser Containment Floats and Chains . Dispenser ID: bispenser ID: ^ 1~ispenscr Containment Sensors). Model; ^ Dispenser Containment Sensor(s). Model: Q Shear Valve(s). ^ Shear Valve(s). C7Dis enser Containment Float(s) and Chain(s). ^Dis enser Containment Floats and Chains . 'lf tfre facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C,~CertiftCation - t certify that the equipment Identified In this document was Inspected/serviced !n accordance with the manufacturers' guidelines. Attached to this Certlflcation is information (e.g. manufacturers' checklists) necessary to verify that this ioformation is . correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the report; (check ail that apply); J~ System set-up (~ m history re oM 'T'echnician Name (print): tQy,4Z/ i~~J Signature: CertificationNo.:l1rS7)~S-!~7 1CC.~~1f4/~13- cJi License,No.: ~p Testing Company Name: RICH ENVIRONMENTAL Phone No.; ~ 6b1 } 392-$687 Site Address: ~y g cJn>/r > ~L/~' ~~/~S/`'r,a: t~ ~ ~! Date of Testing/Servicing: ~-/~/~ Page I of3 03]01 Monitoring System Certification •~9~ D. Results of Testing/Servicing Software Version lnstalled: ('mm~lafn fhn rnllnwino rharlrlicf• yV Yes- Q voV Is the audible alarm o erational? Yes 0 o Is the visual alarm o erational? Yes ^ o Were all sensors visuall ins ected, functionall tested, and confin-ned o erational? Yes O o Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their ro er operation? ^ Yes ~ o f alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) N/A operational? Yes O o For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment O N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) ~Sump/1'rench Sensors; j~Dispenser Containment Sensors. Did ou confirm ositive shut-down due to leaks and sensor failure/disconnection? ~! Yes; O No. Yes O o For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no '~ N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill int(s) and o rati ro erl ? If so, at what rcent of tank ca aci does the alarm tri er'1 ^ es No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re lacement arts in Section E, below. p es No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) O Produci• O Water. If es describe causes in Section E below. Yes D o Was monitorin s stem set-u reviewed to ensure ro er settin s? Attach set u re orts, if a licable ,~ Yes ^ o Is all monitoring equipment operational per manufacturer's specifications? * In Section E below, describe bow and when these deficiencies were or will be corrected. E. Comments: Pa$e 2 of 3 ~ 03101 ~g4 g F. In-Tank Gauging /SIR Equipment: ~( Check this box if tank gauging is used only for inventory control. ^ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform Leak detection monitoring. fmm~lete the fnllnwino checklict~ O Yes O o Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ^ Yes ^ o Were all tank gauging probes visually inspected for damage and residue buildup? ^ Yes ^ o Was accuracy of system product level readings tested? ^ Yes Q ° Was accuracy of system water level readings tested? ^ Yes Q o Were all probes reinstalled properly? ^ Yes O ° Were all items on the equipment manufacturer's maintetuutce checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD) Com fete the followin checklist: ^ Check this box if LLDs are not installed. ~! Yes 0 Not For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ^ N/A (Check all that apply) Simulated leak rate: ~ 3 g.p.h., ^ 0. I g.p.h , [7 0.2 g•p.h. Yes ^ o Were all LLDs confirmed operational and accurate within regulatory requirements? Yes q o Was the testing apparatus properly calibrated? ~ Yes ^ o For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^ N/A ^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? b~ N/A O Yes ^ o For electronic LLDs, does the turbine autotnatically shut off if any portion of the monitoring system is disabled ~ N/A or disconnected? ^ Yes o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions N/A or fails a test? O Yes ^ o For electronic LLDs, have all accessible wiring connections been visually inspected? N/A Yes ^ o Were all items on the equipment manufacturers maintenance checklist completed? m one accuon n, oerow, taescr>Ibe now ana when these deficiencies were or wilt be corrected. H. Comments: Page 3 of 3 03101 C .- ~ Monitoring System Certification UST Monitoring Site Plan Site Address: ---------------~~a-l~ -----~-~--- ----------------- -- ----------- --------------------- - v- ---- -- ----------- --------------------- - -~ -~ Q ---- -- -~-- j' -~ --- -~ ----------- --------------------- ----------- --------------------- _ . - - -~- -' 4`- ---- - ~b ~ - - ---- - ------------•-------- ------- - - ----------- •-------------------t ~ ~-.-----~ - ~-- -~ Date map was drawn: I I /~/Q(~ Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Cleazly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid Level probes (if used for leak detection). In the space provided, note the date this Site Pian was prepared. Page `f" of of osioo iy~~~ 5S~k3 a~.aaz~s CT ~:A:~CFRSFx~I~A,CA.93308 OF'FTCk'.(661)3512-95$7 & FAX (661)392^0621 t~jRGIiaNrCAL L~:A-~ ixEmgs''T~R TE9T W/Q#: Fac:l.lity Name ; ~rJ~GIC ~ /~~ Fa-c:I.~.i.~y Addre~s;.~4~ i21~/ ~ /~/,~' ~'l~i ~'1~~ C~~i Proc;lue~ L1.zle T~'pe {Pressure, 9uctiau, gravity} r~SsU~+~ PRC>DUCT L~.~K AETEC~'OR TXk?~ ~ TEBT TRIP PARS sz~ciz.~ z~uz~aFat ~3ET~QW P~Sx OR 8Ek2ZAT+ # ~.---..,,, kt0~ 9 BA.xL ~~7 / -- L!~ TXPE M~~r1 1P~f2- YPS AS saxtx,~ # ~,~ O~'T(~O -_ zoo ~/ FAIL ~v 5 _ CJ " 6FRT.AI, # ~T(LO ~p x g ~r- ~ (-Cr~1 q~ _ VV L/A TX'P~ XIS ?A83 SFlRIA~ #~_.,. A'f0 FAIL T, :;ertify tl~.e above teats were conducted on this deco according to Red ~:facl~et Pumps field test apparatus testS.ng pzocedure an limitations. ~'ln:~ Mechani.ca]. Leak Detector. Teat ,pass / fail ie determined by aging a .lcr+r flow th.resk;.old trzp rate of 3 gallon per hour ox leas aL lA PST. t -~clcnowiedge that all data oallected is true and aorreat Co Che beat of rr}~ ]cnowledge . Tech : ~~-~'v --- S igna~C ur. e pate: / 1 ~~1 'd~~ a~. k. // ~ / ' V ~ ~ / ._F ~~ .. .. .. ~ ~~~g~ =~._.. MONITOR CERT. FAILURE REPORT SITE NAME• Qy~G 1C .~/~~ DATE: /I -~-1-~'~ ennxrr.c.c• ?u9' i~nJl~~~l .+Fi/~ 'I'F.(`ANiC.'IAN: ~Y~rJ rti9'Sr'z~ CITY• ~9'x~~S ri~G D THE FOLLOWING COMPONENTS WERE TESTING. RF~PAIRS: tiD ~~ LABOR: ~~~~ PARTS INTALLED: _~,D~.~' NAME: _ TITLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBII.ITY OF NOTIFYIIVG THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIIt THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIItONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCiJRING FROM NON-COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON-SITE FOR YOUR CONVIENENCE. /'~ ?4 ~' ----. swxcs, January 2006 Spill Bucket Testang Repoi-~ Form Tfris form is intended for use by contractors performing annual testing of LIST spill containment structures. The completed form and. printouts from .tests (f applicable), should be provided to the facility.owner/operator for submittal to the local regulatory agency. I. FACILITY INFORMATION Facility Name: .J/ Date of Testing: .p' Facility Address: 3 ~/~' ~/dam ~' Facility Contact: Phone: Date Local Agency Was Notified of Testing : Name of Local Agency Inspector (if present during iesting~: • 2. TESTING CONTRACTOR INFORMATION Company 1~Iame: I C~ ~'} ~ ~r/V tiJ ~ , .Technician Conducting Test: {1,y.9.-v wvYSU Credentials: CSLB Contractor ICC Servi Tech. SWRCB Tank Tester Other (S eci ) License Number(s): ~ ~, 53 ~ CJ 3. SPILL BUCKET TESTING INFORMATION Test Method Used: drostatic Vacuum Other Test Equipment Used: Equipment Resolution: Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 'U'~ L ~~ • 2 LU ~ ~/ 3 9,,__ q P [-,~ ~ ~J Bucket Installation Type: t Bury acct Bury irect Bury Direct Bury ontained in S on in S Contatn to S Contained in S Bucket Diameter: ~ 1 .' ~ . ~ Bucket Depth: ~ y' I ~~ " 1 y ~~ Wait tinlc etween applying vacuum water and start of test: ~~ v~ l ~ ~0 wr ~ t~ ,~~ ~ t .J Test Start Tirne (T~: /'a : w. • •~~ Initial Reading ~: /Q / " Test End Time (TP): ~ X00 rt a :Qp n., 'OQ Fins] Reading (RF): /Q ~ • , IQ ~, Test Duration {T'F - T~: Change in Reading (RF . Ril: ' ~• ~ ~~ 7 v ~ r ~ Pass/Fail Threshold or ~ ~ •, ., Criteria: Q Comments - (include information on repairs made prior to tesn'ne and recommended follnw..vn {~. CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTIIVG I hereby certify drat all tht lnformation contained in this report is bue, accurate; and ~f~ compliance with legal requirement. Technician's Signature: ~ t Date: 1 ~'~'~'•~( ~ ~ State laws and regulations don urrendy r e testing to be performed by a qualified contractor. Howtver, Ioca[ requirements may be more stringent. /v~4',° ~_ - .,. - ONE S'TClP ~ s b4~++z~s~rzz2 ~ 5 ~.3~~ ~d~ urvronra,VE~v~~ ~ ~ "' ~ " ~ ~ ~ _ ~~ ~, E3AKERSFI~tD; GA 93307 ,; . ~ l3A-'rE - ~ " - " ~.t;- ~. ' -rr ~~ ', - .. .. ~,. >- ~' , =, ., ~ t r ~ 9 A _ - - ~Y~~~ -Po~~aF , ~ ,, - ~ 6 G , ,~- P t.. ... - , .~ x ,. /~~} ... r. i.i>tiie~, INK h1tSSrPN BANK " ~ - 1330 TRUXTIJN ayfNLtE ~ ~ - BA1CfRSFIELD CA 93301 - ; J : f~ , a . ~ ~ ~c, J ~ FOR AUTH '61C;NA' TV ~ l Pn y'~ ~ ~. ~ ~ ±a ; 7 r " l UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING ! 58989 SECONDARY CONTAINMENT TEi3T7NCi !TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT N0. ~ ~- _.. ~7 ~ ( Q BAKERSFIELD FIRE DEPT. Prevention Services a><!R~ ArtT~/ f 900 Truxtun Ave., Ste. 210 ,~ Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: {bb 1) 852-2171 Page 1 of f ^ ENHANCED LEAK DETECTION LINE TESTING ^ SB-9a8 SECONOARY CONTAINMENT TESTING !-l _ _ ~ r oco cnou n Irl 1.in Al1T(1R Ih1(: CFRTI FlCATI N U IHrvA IIVnInCJJ ICJI ivr ~...v ~,~._~. FACILITY 1 _ .......,.~.. ............ ...._--..... ._. ... I F TI N NAME 6 PHONE NUMBER OF CONTACT PERSON ADDRESS ~~ OWNERS NAME OPERATORS NAME PERMIT TO OPERATE N0. NUMBER OF TANKS TO 8E TESTED k~ -~ - ~ ,TANK:TESTING COMPANY NAME OF TEST~IG C PA y~ . - ~ - - - k - NAME b PHONE NUMBER OF CONTACT PERSON -~r D MAILIN G D A R E SS ~ n NAME 8 PHONE NUMeE F TESTER OR SPECIAL INSPECTOR CERTIFICATION DATE 8 TIME TEST TO 8E CO DUCTED ICC aY: TEST IAETHOD SIGNATURE OF APPLICANT DATE ! r. .~ O APPROVED BY DATE FD 2095 (Rev. 09/05) B{L•LfNG & PERMIT STATEMENT rrR>t / ~/ ~ `~ BAKERSFIELD FIRE DEPT. Prevention Services onn Tti„~rr„n avenue. Suite 210 ~~"rR1~` Bakersfield, CA 93301 PERMIT NO.: - .. ~ • LOCATION OF PROJECT PROPERTY Vl S'rAN7WG GATE COMPLETION DATE - ~~"¢ Ul PROJECTNAI~AE ~ PROJECTADORESS r ~. ADDRESS CfTY l O TE I PNONENO. ZIPCOOE CONTRACTOR NAME r • •' CA LICENSE N0. , •• • TYPE OF LICENSE EXPIRATION DATE PNON~ ~ _ ~~ CONTRACTOR COMPANY NAME ~~ jj ~(~ jj r) V 1 (JCS F~ ~ O T /S I lJ AOOftESS ~ ~ ,, ~ CRY ZJPCO ~.~^ ~(.J ._ • ~ 262 50 • ~ ^ AlarTns -New & Modifications - (MinQrlum Charge) . $ 98 013125 =Permit fe F S ~ ^ Over 20,000 Sq. Ft. e L x . q. 98 i i Ch ifi ti M $210 00 ~ ^ arge) n ca ons - (M mum Sprinklers -New 8 od . 98 ^ FL 00 S 5 O 042 =Permit fee FL x 5 ~ q. ver ,0 . q. 98 ^ ^ Modifications {< i0 heads) Mino inkle S ecborl Only) 00 jlns $ 93 ~ r pr r . p 98 ^ r New & Modifications C i l H d 26 $398 ~ omme oo c a s - . 98 ^ Additional Hoods 538 00 ~ . 98 ^ ____ ra Booths -New 8 Modifications S $458 00 ~ p y . 98 as Above round Storage Tanks postal/atiaMnsp.-1' Time) $165.00 ~ ^ Additional Tanks 5 26:00 82 ^ Aboveground Storage Tanks (RemovaWlnspedion) $109.00 82 ^ Underground Storage Tanks pnsra/labbnJlnspection) $878.00 (per tank) 82 ^ Underground Storage Tanks (Modification) $878.00 {persite) 82 ^ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Under round Storage Tanks (Remova0 $675.1 (perhankJ 84 ^ Oilwell (Installation) .00 84 ~1-~ Mandated Leak Detection (Testi ue Monk. Ce $ 81.00 (persite 82 D Tents $ 93.00 r 84 ^ A/ter hours Inspection fee $122.00 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee ~ 590 per hour) $ 60.00 + (5 fvs. man. starltl -by tee nnspecUon) = $510.00 84 ^ Rt~INSPECTION(S) /FOLLOW-UP /NSPECT/ON(SJ ~ 93.00 (per hour) 84 ^ Portable LPG (Propane): NO. OF CAGES? $66.00 84 ^ Explosive Storage $249.00 84 O Copying & File Research {File Research Fee 533.00 per hr) 25¢ per page 8A ^ Miscellaneous ^ ~ ~ FD 2021 (Rev. 09!05) 1 -ORIGINAL WHITE (fA Treataury) 1•YELLOW (t0 Ftle) 1-PIMN ftn Ci~afrv..e~ KERN BUSINESS FC~aMS MFG. (661) 325-5818 ~, Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST ~ g__ ~__R_,s.._.F-,_ D 9ooTruxtun Ave., Suite 210 ~~_=~-====~ --=_=-=-~- ~ ~- -~-~ ~-=-=~-=-~-~ Fine Bakersfield, CA 93301 i SECTION 1: Business Plan and Inventory Program ~; ARTM ~ Tel.: .(667111 82.6-3A79 4~' , ~ Fax: (661) 872-2171 ~ ~ ~ / e FACILITY NAME INSPECTION DATE INSPECTION TIME v~ ~ c k Sir P ~ 3 oG ..1 ADDRESS ~ ~ ~ ~ ~ ~ ~ PHONE NO. ~~ NO OF EMPLOYEES © 1 2 FACILITY CONTACT BUSINESS ID NUMBER 15-021- Sectlr~n 1: 8usln~ess Pl~srrand Ihy~er~~c~ry Prcgra ^ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ( C=Compliance OPERATION V=Violation COMMENTS ^ ~ APPROPRIATE PERMIT ON HAND Noa-~ (,p~7 ~ i0~,.,,`,~ ~~ 1 /~ ^ BUSIneSS 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 ^ VERIFICATION OF HAZ MAT TRAINING ^ ~ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~°°" G Q'~""-'"~ Sl ~ `z S ^ EMERGENCY PROCEDURES ADEQUATE ~7 ^ CONTAINERS PROPERLY LABELED ~ ^ HOUSEKEEPING ~^ FIRE PROTECTION ~ ~, ^ H~ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ^ NO EXPLAIN: V - nar-ouio QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~~L~, } ~ _ \ ~ Inspector (Please Print) Fire Prevention / 1s' In /Shift of Site/Station # Bu ss Site / Re ease Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD_2155 (Rev. 09/05 • i r _ .~ INSPECTIONS BUSINESS PLAN & INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: ~~~L~ STO,~ • B D E R S F I L D P/li<E Ali<TM T Section 2: Underground Storage Tanks Program INSPECTION DATE: ~~/ 3 ^ Routine ^ Combined ~ Joint/~°`gency ^ Multi-Agency ^ Complaint ^ Re-Inspection Type of Tank ~~ staal Clc ~ /f ~,•~ l.s~Number of Tanks Type of Monitoring ~ A~Type of Piping Q,t,_tsK 26 y7 OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current N o ~9 r .~-J-~ d y~ ~1~'t 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 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 OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill /overspill protection? C =Compliance V =Violation Y =Yes N = No Inspector: ~ ~~ ~"~' ^') ~ L~ Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services Aggregate Capacity Number of Tanks 1 ~% , Business Site Responsible Party Pink -Business Copy KBF-7335 FD 2156 (Rev. 09/05) a. f • ~.