HomeMy WebLinkAboutUNDERGROUND STORAGE TANK #1- ~~
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~I UNDERGROUND STORAGE TANK (1`~~'FILE)
I,; LUCKY 7 ~'
~~, 726 S. UNION AVENUE
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Cr"iL AJALLEY PAGE 02
'0412112006 99:31 6613252529
MON~TOR~IVG S~tS~M C~RTxF~CA.'~'IUN
Fur Usr fay Add Jurisdictions Within the State of Cadifnrnia
AiHhnrirY Cued,' Chnpr~r 6. i, lYeaith and Safery CrN1e; Cbd}5ter 1!, Division 3, Titl6 23, Califvrraia Carle r;/'Rc,~~teluriutt.r
Thi;< form must be•used to document [csting and serviGin~ of monitt)Yittg equiptnEnt. A. seaarate ecrtiFication or reotarl musr be nreoartd
I'or each munit~ring system control nttnel by the [echniciatt who pet•.i'tynns the work- A copy of this form must be pt~t)vidcd to nc~ tank
;system ownt:r/opt:rator, The nwnerlapera;,~;• tnvsi submit, a copy n1" this farnt to the local agency regutatin~ [..tiT systente within 3C1
days of test dace,
A• GetneralIn~ortnativa
Facility Name:
~ - ~- $1dg, No. __ .
-~
Site Addre,; _~F-~-~-~~0~~.,~~~. city: ,~e~~'~~ ,.-.Y ~~p= ~_--- --_
F-aciJity Con+acl Person: _ _ - Contact Phone Na.: (. - _)_,
Makc/tbladei of Monitoring System ~~`~S+~yi ~ Date oCTes[ing/$ecvicinr: 'j! I~ i 0 ~
T3. Inventory of Equipment TestetilCertiiGed
Cheek the ~ trv time b4aett to indicates colic a td meat ins ectedlser~icede ,.... _ _
~. ~~.. _
'l'ank ID: 7'tink ID: ~ ~ ~ ._
_
~ !u-Tani. [iatu,,ing prohe, Mt,dcl; ~ to-7gnk Gauging Probe. 1vlodcl; . ~_. -
:;j .4unulnr Spurr. or Vuuh Sensor. Model: _ - -
~ pit+ing Sump 1 Trrnrh SensoKs}, Modc1: ,_$'t~I~~~'a~_ D annular Spaec or Vault Sensor.
~ 1?iping Sump ! Trcnclt 5cnsar(s), MadeL•
Mndct: ,$~ ~Clr1~bJC„~_
L"1 Fill Sump .Sca4rn'isl. Madta: ~l dill Sump $enspr(s).
chanicli Line Leak DetraCtar
~ l4t Model:
Mc,dt:l: ~~
,@+1 Mechanir.al line l.cak De+CCtar. Mt,del: .
e -,_
D Plccrrenic Line t neF Dclectnr. Model; _ _ Gi )?lectranie Line Leak Dctettpr, Model; _
^ Tank t>verfill t Hi~eh-Level Sensc,r, Model: -~ '1`nnk Ovcrfll /High-i.evel Sensor. 1'vlvdeL• -_
^, Other (s ccif c ui mcnt t and model in Secrion E vn Fa e ~ . ~„~Othcr s ccif ui nt t c and model in SCCtiatt E tot pace 2).
~
/L
k fl)
'l' "]~tYnlilA: ar-~ r.
r
:
an
1~ Jn•Tank Gauging Prgbe. Model: _~~ ~ !n-Tank Gauging Prate. fHodel: ~~~_
J Annular 5p:ttx a• Vauh Sensor, Modct; _ d Annetlar Space or Vauh 5ensar, Model; _.
Qr piping Swap / Trench Sensa~(s). Model: ~E,aJml ele~~l^ ~ Piping Sump I Trenclt 5ensor(s}_ Mtadt`I: ~G_t,~S_E'iil~_
U Fil! tit~mp 5ensntYs). Modc1; ~ d ~iA Sump Scnsot-(s}, ivtoclcl; ,
4$ Mcchitnit:ttl Line Leak Detector. Mede1: ^ IVltxhaniea/ Linc Leak Dettxtor. .Model:
U Electronic Linc Lcak Iletcctor. Model: _ _ - ^ ityltaaronic Line Lr~k Detector. Model: _.,____ .
p Tank Ovcr(itt l High-Love! Sensor. RAotlct; _` ^ ~'nnk Ovtxfiit I Niglt-V;.evel $cnsor. Model:
n n.:,e.,~,.,.,.:r„ nn~.:,,...uw. r.nn. ~.,d mnrtot :n SrCtiAn 1± l,n P:,~c 2t. ^ (')ther tsoecii'v equinment tout: and model in Section E on Pa::c 3)-
[lispenser 1D: ~ Z Di.+tittJnscr XI]:
tj3 Dispt:nsrr Conlilit,m~ttl Sensor(s), Model: ~~~} !g'l~ispanser Containment Seneor(s). Madcl; .S~C~
i~ Sltcnr ~'aJvc(~1- ~ Shear Valve(s).
O tJi. fmci' Cc>nltti:tmcnl Plgs,t(S) and Chain(s}, D ,his nserCan[ainment 1'loat(s} and Chains .
Dispenser If). _._~_ _ - DiapeltsPS ID: _-- _ _ ~_
1$ pi:pcnsCr Cnntainmenr Scnsor{s), Model: ~t*+o.>d Sflt+TmV' ^ L'litpcnstr Containment Sensor(s). Me,del: _ - ..,~
CtiT 5hunr V,tlve(sl. ^ 3hdar Valve(s).
^ DiS enact Containment Fla2tt(s and Chain(s}, D . !s nscr Comainrncnt Floa s) and Chain(s),
t)isJxnscr th.._~(r' Ilis}iehser If): -- - -,~.,_._ _
~ Dispenser C.nm.tinment Senser(s). Mooch S~a+td ~Er~d'oY' ^ 131spenser Containment Sensrr(s}_ Jvlodcl; ~~,_,.,____
~ Shear Vnlre(v). 4 ${tiL"er Valve(s).
^Dicpenccr Ct,ntainmcnt Float{s) and Chains}, ^ T1!~penscrContainmcot F1oat(s) and Chains}._
*li the facility contains mart tanks or dispenca•s, copy this form. include inform~iien for every tan$ and dispenser nt. the facility,
C. Certi~icatlian • f certify that the egniptt,ent identified in this document was inspecit:$/service$ in aocnrdanee ~ailh [hc manuf:,cturers'
guidelines. Attached to thfs CertiTicatlon is intorntmtion (e,R. tnattufacturers' checklists) necessary to verity chat [his ini'nrnmtitat is
correct anti m Plot Plan showing the layout of monitoring equipment. Frrt° tiny tquipment capable of generstin~ such reports, [have ,U,so
auttehed a copy oC[her rr (check eL/lhar apply): O System sot-ilp Cl Alalrm history rept~rt
Technician Name (print):.~i 1~Lt'C~ iA/, ~h.t.~- - Sistittture: ~~-.- ~' '~ ~ _ _
Ccrtilicatinn Nn.: O~ 6 Q,~~/,~„r, _ _ (_icchtie, No,; ,.~
Testing Cc.,mpany Name: , ~tf 1/~,f~' ~ -lyr P/?'7~s ~ T~l,oae Na.:~ ~~,r~ Z 1"~,~~
Site Addrcsx; „~~ .5,~_~~,,t;flu ~~__S~i~,,~~~c. Datt: of-Ccgti:tigl5ervicing: ~! f~`~~ D~
Page l of ~ u3mt
~VTnnlturing System CertiPcsttion
CAL VALLEY PAGE 03
04f21f2006 09:31 6613252529
D- Resvltti of Tc.~;tinrglSctl•vit~ilag
5atiware Version Installed: ,~'~ ,,..--
Yes
~ Ycc
Ycs
1$ Ycs
Q Yes ^ No's
^ No"
(~ No''
d No'~
D Noy'
N1A Is the audible piarn, o erosional?
[s the visual alarm 0 eratio~al?
Were alt sensors visual! ins Coed, funetionail teslcd, and confirmed n Cratignsl?
were all 5cnSgrs installed at lowest point o£ stcondary cgntainmt:nt and positioned so that other cquipnectrt will
not interferC with their rq era erasion?
If alarms ere rolayed to a remote mnni#tiring station, is all cgr7rtmuniCations txluipmcnt (e.g. mudrm?
Operational?
^ Ycs ~ No" 1^pr pressurized piping systems, dt)e$ the turbJrit; automatically shut down if the pipiteg secondary cc:ntaiamenl
^ N!A monitoring system dt:tecls a leak, faits to ope~atc, at' is electrically dicconnCCted? If yes: which scnsnrs initiate
pgsitive shirt-down? (Cheek all Ihur apply) Id ~umprT'rench Sensors; d t)ispenscr Cantainmenr Scns<ers.
Did nu conrnn Ositive shut-down clue to leaks an sensor failurddisconncctinn? ^ Yes; Q Na.
^ Yc, ^ I~a~ Far tank systems that utilize the moaitt)rin~ System as the primary tank ovC~h warning tiCvice (i.e. no
NIA mechanical overfill prevention valve is installed), is the avcriill warning alarm visible and ttudii,Jc nt the urnk
fill oint s) and o rosin ro ri ? if sn, et what rCent Of tank ca Ci does the alarm tri er? _ r~
^ Yc.~ ~ No Was any monitoring equipment tEplaced? If' yea, identify Specific sensors, probes, or other trquil~mcm rcplnccd
tend list the manufacturer name and made! for ~~f.ac laecment its in Scctign E, below,
Ycs' ^ No Was liquid Found inside any secondary eontainYrient systems ttesigncd as dry systems? {t"heck a!t rhar rrrpJr)~
Pmdvct; ~ Water. [f cs, describe causes in ~tetion E, below,
Yes ^ Nay Was manitarin s stem set-u reviewed to erlslli~e.. ro r settin s? Attach set a re arts, iFa licable
.Yes ^ No's Is all mvnitorin a ui rncnt 4 erosional cr ma.tltyfacturer•s s eCitications?
'k Tn Section 1r hel(~w, rtcscril~e hae~ and wteera these deliCiencies wat'r~ or wilt be cgrrected.
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Page 2 X4'3 o:wi
GAL VALLEY PAGE 04
04!21!2006 09:31 6613252529
)F'. [>tI-TaIIk Gauging / $~R ~gEli~meni: ~ ~hetk this box if tank gauging is used only fnr inventory co»trof.
(3 rrheck this box if no tank gauging or SIR equipment ie insWllcd.
This section must be completed if en-tank ~augin~ cquipi=Herat is used to perfgrm i+rak detection rnonitot•in~;.
i~ Yes ^ No's Has all input wiring been inspected For proper try and rermination, including testing far ground
~ }(cc ^ No" Were aU t:,tnk gauging probes visually inspeeteti Coy damage and residue buildup?
~ Ycc Q Nn* Was accuracy of system product level reaciing9 ti*.sted?
....
~ Yee ^ Nt+'r Was accuracy of system water Itvel txadings te5t~~d?
~[ Yes C) No'" Were tell probes reinstatlcd properly?
Yeti ^ Noa Were all items on the equipment manufacturer`s tl7aintenaitce Checklist carnpleted?
'~ In the Section H, 17Clow, describe hOrv and when these JefiCleneiit;~i were or brill Ue corrt:+t:ted.
Cs. Tine Leak Detectors {LLD): ^ Check this Bdx if I.Lt7s are not installed.
-. ..- - -
~ Yes ^ Ncrr' Far equipment start-up or annual r:quiprnent cattitaeation, was 8 leak simulat to vCri y LL per ormaner,
^ 1~11,A fChcek all rhea apply} Simulated leak rate: ^ 3 g~p.h•; ^ 0.1 g.p.h ; d Q.2 g.p.h.
~ Yes O No'r Were 2l! LLl?s conFin~~od operational and accurtltt~ within regulatory ttquiremt:nts?
Ycs ^ N«~ Was the testing apparatus properly calibrated? __._
~ Ycs ^ No" Fnr mechanical LLDS. does the LLl] restrict product Stow il' it detects a leak?
^ NIA
...............
^ Ycs d Nv° Por electronic LLtas, does the tutbinc automaticajl~+ shut ofg if the LLb detects a feak?
i~, N!A
Q Ycs ^ Nq'" Fvr electronic LLbs, does the turbine automatic~liy sHut off if any portion of [he monitoring system is disabled
NIA ardisrgnneCted?
O Ycs ^ No"' For elccannic LT,Ds, does the turbine act[omatica]!y shut off if any portion of the monitoring Rysrem ms~Ifunctions
N/R or fails a tryst?
^ YCF D Nc~'~ F'or etecu'oniC LLt]s. have all :.iccecsible wiring crJiik~ection8 bet:ri viSU111y illspectCd?
~ "J/A ....,...
Ycs ^ Na'" V~ct~ a.li items on the equipment manufacturer's rtittPntcnanee checklist coirtpleted?
•~ In the Section FI, liela~r, desrrebc hoW and when these deficiencies tiVettie or wilt be corrected.
H. Comments:
1'agt: 3 of 3
03/Ut
~iL VALLEY PAGE 05
04!21/2006 09:31 6613252529
Monitoring Systetn Certification
Si1C AddreSS~ ~~ ~~
T M,nnito>~ling Site Plan
~ ~ 1.~-~
..
. .
........... .. d ...... $~:....r.......... ..
Date mar was drawn: ~/~~.
Instructiatts
1f you already have a diagatn that shows a]1 required inforrzzatiptll; you may include it, rather than this gage, with your
Monitoring System CertiFcat-an. On your site plan, show tlae general layout of tanks and piping. Clearly identify
locations of rkte fotlowirtg equipment, if insta![ed: monitoring sy5ft:m control panels; sensots rttonitaring tank ana~~lar
spaces, sumps, dispenser pans, spill containers, or other secondary' ebntainroertt areas; mechanical or eleCtnonic line leak
detectors; and in-tank ;iquid level prahes (if used for leak detectiari): In the space provided, note the date this Site Plan
was prepared.
rase ~ O{~ Q$Ip0
04121/2006 09:31 6613252529 CAL VALLEY PAGE 06
Sv/RCQ, January 2006
Spill ~uciCet T'estii~g Repoxf 1~'oxm
This•Jorm is intended fOr aesP by coatraclors performing errrtual resting of US7'spill Contai~nsenl strcectures. The completed forrri and
printouts from trsts (if npplicahle), should he provided to the faea'tfty owner/oprrrtlor jot submiitrrl ro th¢ Ioca1 rggu(Q~p,y Ag~nc~,.
~ a..-,r. r..,.. ~,~. ~..,..- ~ - -- -
2_ CDTT r
C.~:.RTI>KICA"C'ION OF TF.CHNICIA,N I2F.5PONSIBf,~ I'p~ CONDUC"rlrt~; THIS TRSTJNG
f I,errbj, crrXif,'V that al! xhe infarrnatiart Contained ih this repnrC is trele~ aecrrrale, and In fitfl compliance ~vdlt Irga! requirenerats.
Tethnitian's Sigpature; ~~
' State Paws and regulations do nOt currently tCquire testing to be performed by a qual~ed contractor, ~iowever, local requiremetlts
may be mare stringent.
2. '~"ESTTiyTG CONT~A,CTOI~,TN~'O1~IVIATION
Company Name: ~, R ,
ci,
Techniciae Conducting Test: ttYC4
Credentials': CSLS Conrracto ICC Service Tech. ~WRCB Tank Tester Other
License Number(s); ~,~y/7r ~
04!21/2006 09:31 6613252529 CAL VALLEY PAGE 07
,`
v, VA~'OZtLESS A+IANZt~"ACT~T~tING, ANC.
LDT-~89U Leak Dettitort T~,st Record
~~ _.
Cyrsbomer
r ~- ;-~
~~D 6 71~6~c ,~Sp
.~uuanersAlDre rump ~
Mar'~f .--ctu ,der M e1 No.
~~~f r _ _
Leak Detector 1lcir~i
anufactiner b-~
~ - -~-_ D~phragzt~h'Po
t?iston-type_ ~
Tamper proof seal installed? Ycs~i No~^
1 er
Qther S,ty~le I.e,lc betecto3
Leak Detector i~ Subll~~rsible bump
Test at Dispel sex
1. ()pcratxng Pump Pressw-e r' si („ I S)
2_ GaOons per hpurrate~ _(para. 2z)
3. Litre pressure with pump shut oD' Jf ~~ _
-~P~ (pare: ~3)
4. 8leedbaelc Test with lrtunp off ~.S m1 (pars: ~'b)
~~~
5. Step-through tirnue ro t'ull flow .3 seca~ds (per,. 30)
6. Leak detector stays in Iealc search position, (pares 42) Yes~~~
Na
LEAK DETECTOR TEST
Naoe: Pass ^ Lnk de:ecwr firs uxt protoovl
Fair ti talc aetccror fails tcst protocor
J'ass v~
Fail
Fenn 8900 (9-1-9G) 'Complete tlerrnl~f expansion test before failing Leak detector.
.~ 199b Vaporless l~+fatltu#'ae
tuning, lac., Prescott Vallcy, AZ
0412112006 09:31
1
-•J
6613252529
CAL VALLEY
VAPORLESS MANiJ~"ACTURIN~, INC.
PAGE 08
LbT,890 Leak bt~ctut~ 'l'est Record
rda ct~, ..... ~'amer
Date '' ~~ ~ ~`~ _~ _
oduct
Snbmerslbte pump ldeettfficatioa
acttu-er Mom.
S ~a- IAN bcr
LeakAetector Id~~ittFcatiun
draft inner Descriti~
Other SS le _ ale Detector
? ~~ Diaphragm-type......
Piston-type~~_~
T~+p~-proof seat installed? Xes Na
beak Detector in Suliltterei6le pumip
Test at D.isp~iltser
1. Operating Pump Preey~ure ~~si (p~.a. 15)
2. Gallons per boor rate ~ p ,~(para_ 22)
3. Line pressure with pump shut off
~~isi (pat~l.23)
4. Bleedback Tcst with pump o#I'_ ~4 xnl (partx. ~~
S. Strap-through tirrte to full IIow____,~ ~se:conds (pd9`da. 30)
6. Leak detector stays in leak search pasition_ (pares. 42 Xes
,~
No
LEAK DETECTOK TEST --
Note: Peas ~ Leak. detector rn.s test protocol
Faii -~ Leak deteeWr f~i1g OestprotoCnl
PAS;s___~j .~
Fagl
~~
Form 8900 (9-I-96) '"Cortapiete therrr~ expansion test before failing Leak detoetor.
1996 Vaportess manufacturing, Ines Prescott Valley, AT
., -04!2112006 09:31
~J
6613252529
CaL VALLEY
VA.PO~LE~5 ~'L4,N[~'ACTURING, ~1~TC.
PAGE 09
LDS'-89p teak Detector ~,'est Record
~act~
~stamar
try
Sttbmersibte Putmp~
IN .
Prod c-t
feria! Number
~ ---~ ••~•~~~. Auennrrczthlpn
Descrip
GCS Diaphragm-type.
Pistp~o-type ~_
Tamper--proof seat installtxl? Yes No
~~ `~~.
Leak Detector in Su>arsable Pump
Tes# at Ais~elrser
I • aP~~g Pump Pressnre~si (para. ] 5}
2. Gallons per boor rate ~ ~ (paxa. 2~)
3. I.irre pressure with pump sirux a#~~~i (pars, )
4_ Bleedback Test with pump off ,$~
5. Step-through tiizte to full flaw ~ seconds (pstra. 30}
G. F..eak detccdor stays in leak search poeitiorr. (paza. 4z) Yes c{
No
LEAK DETECTOR TEST
Node: Pass = Leah dc~ctbr fits test protxol
fi:U =1.,cak dercctar fads tes[ protxol
1?8SS F.~
Faal
-~_
k Lea1c betector
' Porrn $90C (9-]-96} *Complete thermal expansion best before failing leak deflector.
~' I99G Yaporless 1V+isnufacturing, Inc., Prescott Valley AZ
e~
~~z I
RIB ate. 3 ~1~~~ Ci ~a~e Awe
• _ ~f~s18E G~4 ~~~J~
>~Ji~-327-~~34~
-~hiE, 1~~~7 gaa~~6i-32~-g~3~9
~OIRE~: '~J~ - Utz tl :_~#',~ __ ~; _ t
~' - ...._
was n,~,„aTr °'J' ~QJ~BI 1 J~ ~
li,er eonv~mn o fi~ '~ v ter 0.01 ~l ] . +~+s~e-,~11 ~aroea ~ rte, ,rs~aw~a der rnna~e r~q~s aer r~x. -
sE,~+>m~m~t.
•VLf 11~1C "gyp ~ ~-~~y /~
~' a IIfYIG (~~, GTapu~~,yy l'ny~ ~~~ ~ ~ ~iM1 YAT.
b : OS .SflJe 112252*2K t ~Z O
2
r~ 13:2o So 22a 2// 2
ty~ ~e~H GLO95 PASS =AIC
-. ao2 ~ X-
-- . AOZ ~'
'""' T{E~iE P61 SfI~T 1x01 JAd1.~ -
~ ~ E-~.1 tao~ r7N~,
Sa 20 ~ 2a3 ... j
r{ : oo so
~~~ zo2 ~
~ ~ ~ P~
-• a~ ~
t
I decta re ruder pecla3ty of perjgry that I aat a Jicensed #a~k tester in the Strl#e o
the J~iormatton contatrtad in thls reJooct to #ree:lld cerrect to the beat ci my Jce~owtsdg ~ and #ha~
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UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING
/ S6989 SECONDARY CONTAINMENT TESTING
/TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
i ~~~
~ FIRS
,'
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
PERMIT NO. ~~~ ~ ~~
^ ENHANCED LEAK DETECTION ~ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING
^ TANK TIGHTNESS TEST ~ TO PERFORM FUEL MONITORING CERTIFICATION
SITE'1NFORMATIQN
FACILITY LUCICy 7 #3 NAME & PHONE NUMBER OF CONTACT PERSON
ADDRESS 726 S. Union Ave.
OWNERS NAME Sun Valley Oil
OPERATORS NAME Same PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? YES ^ NO
TANK # VOLUME CONTENTS
1 Diesel
2 Diesel
3 91 UL
4 87 UL
TANK TESTING COMPANY
NAME OF TESTING COMPANY Cal-Valley Equipment Bruce W. Hinsley 661-327-9341
MAILING ADDRESS 3500 Gilmore Ave. Bakersfield, Ca. 93308
Bruce W. Hinsley 661-327-9341 CERTIFICATION #: 006-05-~ 178
DATE & TIME TEST TO BE CONDUCTED Aprll 19, 2006 12:00 ICC #:
SIGNATURE OF APPLICANT ~~ DATE April 4, 2006
•~- T tS P -LlC Tl N' B C ES A. ~" ...E R p.
APPROVED BY ~ ~ / DATE ~ 6
FD 2095 (Rev. 09/05)
~-~~ 02/06/2006 12:27 6613252529 CAL VALLEY
GAL-VALLEY EQUIPMENT '
3500 GILMORE A1/ENUE
BAKERSFIELD, CA 93308
{86i) 327-9341 FAX: {8G7) 325-2529
CONTRAGTQR'S LIG.#x$4170 A HA7_
7b:
PAGE 01
CpL. -VALLEY
EQU IPMENT
Frain: ~y~.-
Fax: a ~ r~ ~ ~ Pages: / S INCLU131PIG COVER
arr _S~-rr.Jv ~/,ti~~ Gabe: ~/ ~
Re:
CC:
^ Urgent U For Review ^ Please G4t11tnent ^ Please Reply
^ Phase Recycle
Comments:
._
--
CAL VALLEY PAGE 02
• 02/06/2006 12:27 6613252529
swl~cs, ~r~n- zoos
Page _[,_ ~ ?
Secanda~'y ~ontamme:~t T~est~ing Repot Forte
Thin form is i„terded, fay u~ ry cans perjar„~~>Ig periodic iesebrg o.~~'seoondary cont~ru::n~„r sysrem~. U.~ tt,~e
apprvpriateP aftk~aform to rep~vrt r~dtsfor a!! can~nraeirls tested The c+anp!#edform writferl test prioee~+~es, acrd
przntout8frnirr tests rrJ'appTicable), airould beprovided to thef~ci~ity owner/o,~erator fnr submittal to the focal regulatory agency.
1E. F,A,(~~dTY INF~RMA'~'~(~1 pp
17acG1ity Natnm ~ _ ~ 1_ `? . „~ '-+li X}811: 0~~~8t7IIg: e- 2 S -- /A ~ _
l^F;RTiN'[('.:1'IQN 171F T~C1fN1CiAN 1tESPC1N8lB)~.T~ F4[1 CONUUCT1i~G TRIS TESTt~iG
To rke bear afr,~r kntawd~dgary t1 keys meted ter tkia doe~tme~lf ,per ac~tlratr altd iii J~efl emwplimree witk tegM regaheme»ts
TEChrtician's 3ignatare: Date. ~-- z. S a ~
k'scility Contact Plbozre:
Date T..aca] Agency Was Natif~rl of Testing
Name ryf T ocat Atlency insvectar ftlvresetrt drr+ing testi~gl:
If hydrastat~ testing wss performed, describe what was doae with theJwatar after~com1(ple(tion of tests:
L..) ~ ~r r ~ ,.s i ~[~ ~ ~ n k ~ ~~9 ~~Aan._<rS6iZ4s4..~~i~f(.~.f~~LI.L B~ It ~' A- ~- >t 6 r w ~
I_ 02!0612006 12:27 6613252529 CAL VALLEY PAGE 03
SWRCB~ 3am>ary 2002
'"~
O£ ~~
~ TAlYlt~ ANIVLTLAR TEST~IVG
Test Mdhod beveloped EY LI Tan1c Ialanufacturcr U Iadn
~ Standard U Professional Engineer
U Other (SpecJY1
Test Method used. U Pressure U Vactuur,
u Ocher (S J Hydraatatic
Test Egni t Used:
Isgnip~,e~ Resohttion:
1s Tank Exempt Frwn 7'estitt
?' Teak ~ Tank # 1'aak ~ 7aak #
g
Tank 4apaCxty: U Yes U ~ U Yes U No U Ycs U No U Yes U No
Tank Material:
Tank Matnrf
Product Stored:
Wait tune between applying
Ar+~reJvscmatohvater and
stattin test:
Test Start Timms
I>aidial Reader (R,);
Test ~ Tixae:
Finial Reading (RF}r
Test Dwation:
Change in R.ead;nB (R,rIt,J:
PassJFail Tlueslmld +or Criteria:
T~~t-:R~~
~
:.
... ,:
Wes sensor moved fm. testing? AEI Pis ~,U'Ir'd[IT:,:~ ~ ~I Fes' .L#:P'~L:--
U Yes U No U NA ' `R~>~Ps~ U.,Fi~iL: . ~~ ~U Pass Lf"~t11.
W~ ~ Pr'OP~IY ~P~~ and UYcs U No U NA,
U U Yes UNo U NA UYes U No U NA
verified ~nctioual at'ter test- 7 Ycs U No U N1#
U Yes U 1Vh ~! NA
U Yes U No ~J NA
U Yes U No !,I IUA
fa
Secondary containrrrent sygte~ whero the continuwrm thonit
Con~itrtuent, suc6~ as systems that are hydrostatics °~ sntorttatiCatly monitors 60~ tho primary acrd s
testing: {California Code of,Regulations~ Title 23 ~ tnonitwe+d or under cotrstatlir vaerrntn, are exompt from period~'e ~~me,rt
Soctaon Zt537(a~(6)}
02/06/2006 12:27 6613252529 CAL VALLEY PAGE 04
5W~CB, Jsnnary 20p2
FagG ~ of ~--
tttCfrl~e ' ormalPon 4Vt ' s made for M tee}nJ2 acrd
PAGE 05
CAL VALLEY
' 02/06f2006 12:27 6613252529
SWRCB, Jsntzaty 20U2 ~ °f ~
6. PIPING SI7M~" TESTING
Test Method developed Ay: U Su~onp Manufaoturer xstdustry Btandatd U Professional Biagirreel'
U t7<ber (5 f J
Test l+~iethod Used: U k'ness~R+e U Vacuwn ~H3'~'c'
U Other t~P~iIY
T~ $quipment Used: Equi Resolutiaa:
tRomn #Et'al s R , r / a 1 S~tWE #~l~J e w ei !3l Stll~t! ~ ~ ?:. ! $l1IDp ~ Gl ~ r i ~ _
S~um~p(D~iamtetea:
17L717) Deptfe.
Sump Material:
Height fry Tank Tap to Top of
Hi t P~ Fefletia4ion•
Height lsom Taek Top to I:owest
Electrical Pe~tetrBTioa:
Condition °f sump prior to test~gr
Portion of Sump Tested'
Does turbine shirt dove when
suing sensor detects liquid (both
roduct and water ?~
'Itulniae shutdown response time •°
U
,,
rr
~
U Yes ~ No U NA
a: /
r
,~
-+
°'
U Yes QQNo U NA
,ts f ~
„
f
«
~ i.
Yes If(No
~:
A lJ~ ,
4~ - - -- -
.,
t r
Xes 1~1 Na U AIA
I
Rr ~
Ys system progtsnutted for fat I-safe
+ L1 Yes U No ~' NA U Xcs U No It~INA L! Yes U No ~ NA U Yes U No IAf NA
shutdovan~7
Was fail-safe verified to be
~ LJ Yes U TT° ANA UYes U No l,~'YriA UXcs U NTo Ul<NA. UYes UNo ~ NA
lineal?
Wait between applying
pressuxefvacttteelwaterond starting
Lest: ~
Test Stett Time: Q ~ '7? z ! ~
l~aitial Ite~ieg (Il,~: '~ • 4, `f `
Tat End Tirc~e: "'J ~ '~',
Final heading (~k
Test Dmatzan:
Change in Reading (Rr-R,): ~, ~ ..~ ,
Pasell sil 'Threshold or Criteria:
'Trtst 3~es'Wt: - ~;Yrmts t1::IP~' '~.
_. : ;~ i~~Rl~e" ~ '~:>~iil°, l~l:~~euer..:LJ~'~li. ' 7~1"''Pe~i~: ' ~1~~'~t:.
..
Was sensor removed for xes4ing? 18[Xes U Na U NA 0(tYes U 7Vo I..I NA ppYes U No U Na U NA
U NA ~'X'cs
Was taensc-r properly replaced ~
' ~Q Yes U No U NA ~~,~ U Na U NA l~tYee U No U NA t81.Yes U No U NA
verifiiedfunctional ath~t+est
?
Comime7otts ~- (irdrmle rnJyrnation orr,•e, parrs „~ade~or ro tesrin~ and r~com~„~dcd foltmi+~uA. j~rlatled rests)
~ If the entire depth of the stoop is not Tested. speoify how mach was tested. tf the saativer to ~ of the questions indicated with an
asterisk (') is `°NO" or'°NA", the emire acaap rm~st be tested. (See SWRCB LG-I60)
` 02/0612006 12:27 6613252529
swRC$, ranuaty 2002
Test MleYhod Used:
Test t;quipaient used;
ay: U iJDC Manufachirer
u Other (S~cify)
U ~resstue
U Gtt~a- lSns+cifvi
+r
BottoKn to 7'op
Rf
~CIIRtR'BftQA:
i3otto2q tp
~enetrabon: "~~~~
~r~
PAGE 06
CAL VALLEY
~~o~F 7
).KENT x'E$TLN~
1Q'Tndnstry Standard U Professiomal irttgineer
U Vacuum 1~H
ltesvlufion:
.r .r ~ ~ri
~ 11sr~ q .. h
i3oea tarblue shy dawn wher>w U Yes ~No U NA
UDC sensor detects liquid (both U Yes Il~No U NA U Yes ~No U NA U Yes ~jNo U NA
act acrd w ?-
Turbiae sbutdawn tine .~ y
~ forfa~
~ U Yes U No DANA UYes UNo D
~NA UYeg UNo ~A UYes UI>io ~AtA
safe shatdo
wnT .
Was fail-safe vt~rifi~d to be
~~. U Yes !~ No ~Q NA U Xcs U No 11iNA U Yes U No jtf NA Lf Yes U No
wait time between, applyiag
prCSSta~ClvaClitim/water and
+ O,
1 (~ ~
~7 .
Al ~ j` Ji ~. ~ ib ~F -Il -J r w ~.. ~
~t~esr:aKC9nlaE: ~ 'q(; P~4R• 'r `U.~~ ~ ,~• i~'ecx` = E!`F'tlL • ~1hrsS" U'• ~ PA~~ .1,.(; .
Was senasar removed foot Oesting? ,Yes U No U NA lQXes U No U NA ~ Yes U No U NA Yes U No U NA. i
Was sensor properly replmced and es U No U NA
verified oFattclionai after to ? 1!d'Yes U No U NA iQ Xcs U No U NA df Yes (..1 No U 1~1A
~OllarifCIItS -- Cmatunh infarrnorevn on repiaits nfade~rior ro te~tin~and rsc~wv+»+e~dew(~Od~aw-npfor~ai-ed testa)
~ Tf the entire depth of the LJDC is noot tested, specify haw mach arcs festal. if the answer to i of the questions indicated with an
astehslt {*} is °NfJ" err ••NA", d-e entire ITDC mnst 6e tested. (See SVVILGB 1~C'r-1f~~
PAGE 07
CAL VALLEY
02/06f2006 12:2? 6613252529
^aWILC$, Jant~ty 2002 Page ~ of
t3. k7.I.x. RISER C(3,tV'T,A-Il~IMENT SUMP TEST?NG ~ .~. _
Foci ' is Nat With Fill ].user Containment seen a
Fil (li.i, er C.ontaitsz~eM Sum ase Fros~ent, but cwere Not Testod U
Test Method Developed $y: U 5uenp Msnu~chtrer u Iredusay Standard U Pe+pfessional Engineer
U other '
Ted Method Used: U Presaue+a U Vaoutan U Hydrostatic
u other fs ~J
Tai Eauitmtent Used: 13aeeimnant R,esalution:
from Tank 7'oA to Top of
t P~itt~l~tteEratioa:
from Tank Top tq Lowest
:al Peuetration•
an of sump prior Lo
Wait time; between app
pt+~surelvacnumlwatar
+asc t~ ~.: ~ ' u:?~I.:•.',~
,,. , iyi :. [~`i?t~ll=:: ~ ~
~ ~ U`I?~E '{~' ' .
is there a sensor in the ? U Yes U No U Yos U Na U Yes U No tJ Yes u No
boas the sensor alarm tvhett
etthar product or water is U Yes U Na U NA U Yes U Na U NA U Yes U No U NA U Yes U No U NA
detetx~ed?
Was ecnsar removed four testittg7 U Yes U No U NA U Yes U Na U NA U Xes U No LI NA U Yes U Na U NTA
Was acnsar properly replaced snd t,~ Yes U No u NA
aerified functio~aa,1 after testes ~ UYes UNa UNA UYes UNo UNA UYes UNo UxA
GOpltitP.llts -- (srtraiude i>: ,,,,,urrp~e on repraera,na~de prior to tesrthx and s+eco~rrnerdedfottow-up.f vr fail®d tegres)
02/06f2006 12:27 6613252529 CAL VALLEY PAGE 0$
sw~,c~, .~,~, zuoz
~~.~ o~ 7
~i
.~
F/RE
A R TM T April 10, Zoos
Mr. Mohammed Rafia
Lucky 7
726 S. Union Avenue
Bakersfield, CA 93307
RONALD J. FRAZE REMINDER NOTICE
FIRE CHIEF
Re: Guidelines for Unsupervised Dis~ensin4
Gary Hutton,
Senior Deputy Chief Dear Mr. Rafia:
Administration
326-3650
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
Deputy Chief Dean Clasen your fuel pumps on, this is defined in the California Fire Code as: "Unsupervised
Operations/Training Dispensing."
326-3652
Unsupervised dispensing is allowed when the owner or operator provides, and is
Deputy Chief Kirk Blair accountable for daily site visits, regular equipment inspection and maintenance,
Fire Safety/Prevention Services including any unauthorized release or spills, posted instructions for safe operation
326-3653 of dispensing equipment, and posted telephone numbers for the owner or
operator. Signs prohibiting smoking, prohibiting dispensing into unapproved
2101 "H" street containers and requiring vehicle engines to be stopped during fueling shall be
Bakersfield, CA 93301 conspicuously posted within site of each dispenser.
OFFICE: (661) 326-3941 In addition, a sign shall be posted in a conspicuous location reading:
FAX: (661) 852-2170
In case of spill or release:
RALPH E. HUEY, DIRECTOR 1) Use Emergency Pump shut-off
PREVENTION SERVICES 2) Report the accident
FlRE SAFETY SERVICES • ENVIRONMENTAL SERVICES
900 Truxtun Avenue, Suite 210
3) Fire Department Telephone
Bakersfield, CA 93301 4) Facility address
OFFICE: (661) 326-3979
FAX: (661) 852-2171 During the hours of operation, stations having unsupervised dispensing shall be
David Weirather 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
Fire Plans Examiner phone modem to insure off=site monitoring during hours of unsupervised
326-3706 dispensing. During hours of darkness, sufficient lighting must be maintained so
Howard H. Wines, 111 that all signs associated with fueling operation are conspicuous and readable. A
Hazardous Materials Specialist gallon container of an absorbent material used for spills must be made available
326-36x9 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:
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 rahdom 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.
Sincerely,
Ralph E. Huey,
Director of Prevention Services
" ~~~~
By: Steve Underwood,
Fire Prevention Officer
REHld b
B A-E R
F/RE
ARTM
RONALD J. FRAZE
FIRE CHIEF
Gary Hutton,
Senior Deputy Chief
Administration
326-3650
Deputy Chief Dean Clason
OperationslTraining
326-3652
D
March 31, 2006
Mr. Mohammed Raffia
Lucky 7
726 S. Union Avenue
Re: Failure to Perform /Submit Annual Fuel Monitor Certification
lrl`OTICE OF VIOLATION &
SCIDULE FOR COMPLIANCE
Dear Mohammed Raffia,
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. HLTEY, DIRECTOR
PREVENTION SERVICES
FlRE 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
Our records indicate that your fuel monitor certifications is due/past due on
02-15-06.
You are or will be in violation of Section 2638(a) California Code of Regulations,
Title 23, Division 3, Chapter 16.
"All monitoring ~tluipment shall be installed, calibrated, operated
and maintained ir1 accordance with manufacturers instructions, and
certified every 12 months for operability, proper operating condition,
and proper calibration."
Therefore you have 30 days (Apri127, 2006) to comply. Failure to comply may
result in revocation of your' Permit to Operate.
Should you have any questions, please feel free to contact me at 661- 326-3190.
Sincerely yours,
Ralph E. Huey,
Director of Pre noon Set~w~ices~
By: Steve Underwood
Fire Prevention Clfficer
REH/SU/db
"Serrving the Community ~'or~Vlore ~ianA Century"
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING
/ S6989 SECONDARY CONTAINMENT TESTING
/TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
PERMIT NO. ~~ ~~ v
u_ r. ~: ~ ~s ~':..~
~1 ~ F1RC
D$~A RTMI (IT
>~
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
Page 1 of 1
^ ENHANCED LEAK DETECTION ^ LINE TESTING ~ SB-989 SECONDARY CONTAINMENT TESTING
^ TANK TIGHTNESS TEST ^ TO PERFORM FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY Lucky 7 #3 _
NAME & PHONE NUMBER OF CONTACT PERSON
ADDRESS 726 S. Union Ave.
OWNERS NAME Davies Oil
OPERAI ORS NAME Same PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES ^ NO
TANK# VOLUME CONTENTS
1 87 UL
2 91 UL
3 Diesel
4 Diesel
TANK TESTING COMPANY
NAME OF TESTING COMPANY Cal-Valley Equipment Bruce W. Hinsley 661-327-9341
MAILING ADDRESS 3500 Gilmore Ave. Bakersfield, Ca. 93308
Bruce W. Hinsley 661-327-9341 CERTIFICATION#:
DATE & TIME TEST TO BE CONDUCTED December 28, 2005 09:00 ICC #:
SIGNATURE OF APPLICANT ~~ DATE D@C. 7, 2005
T F APRLICATI;UN B:ECOMES.. ERMI:T . ; ESC AF~PRO-VED
APPROVED BY DATE ,~ ~ 2
FD 2095 (Rev. 09/05)