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~, E~ I~ ~~:~.~ . ~~~ ~ ,+, I ~.~ f~ ~ . ;~ ,~ ~.- , `J / 1 ( READY GO'` MAltK~T ~3 " ~ 1600 VALHALLA DRIVE 280023C ~ ~~ ~ <~ ~ ,C1 c, ~.. ~ ~ ~ ,, .I ~ _. _... _ ~~ ,~ `'~ ~9 .~ `1 'J^1 \v I { ;~ 02109/2007 13:55 6613252529 CAL VALLEY CAL-VALt~y EQUIPMENT 350U GILMpRE AVE. BAKEI~SFtE~p, ~A g3gpg (667}327-9341 FAX: 01)325--25~g CONTRACTQR'S LtC.#7&4'170 A HA,Z FaX To; Fans Ate ~~~ G Fk+om: PAGE 01 ~ Pages: ~f rNCLU~tNC CQVER Date: ~c Re: - C:C: V~eJ'r! ~ For R~rieuv [~ Please Camm~t D Please Izeply ^ Please Recy~^fe Gomrnen~s: n ~~ 02/09!2007 13:55 6613252529 CAL VALLEY PAGE 02 n~ro~r-ro~r~ro s~tsx,~nar c~~Txz~zc~TxoN i'•'ar Use By All JurLrdictt?dras Within ahe Srtrte of Galiforrsia Authority Citrcl.• Chapter 6. ~ llea/rh crud Safety Code; Chapter /6, laiUisiarr 3, Title 23, Citiifo~iQ Cady of Reguluriuna This form mugt be used to document teSdng and scrvicing of monitoring equiptttertt. A I'or each onitorin s stem con I antJ by [hc technician who performs the work, A co ~ ecrti(ioatio~or roport must bt 9reryared py of this form must bC prvvidod to the lank systcrrt owner/operator. -The owner/oper~i~r mull submit a Copy of this Form to the loeai agencp regulating L:3T systems within 3p- days of test datc_ A. General In urn Facility NamC: ~~¢ Site Address:1~pJ Fucility Contact Pctson: B Idg. No,;~~ City: 6L/ ~,~ 7ip: -..~~ tNake/Niodel of Monitorin ~ Contact Phone No.: (-- ,~)_" ~ System: ~~ `- I3. Inventory of equipment Tested/Certified Date of Testing/Servicing: ,~ ./-~~~6' Tank Ip: -$ L -"' ~ fn-Tank Gauging Prolx. Annular $paCC Or Vault SCRSOr. ~ Pipinn Sump /Trench Sensor(s). ^ Fill Sump Sensor(s). l~ Mechanical Line Leak tetector. i7 Electronic Line Leak Detector. ^ Tank Overfill ! Higlt-Level Sensor Tank ID: _ ~ In-Tank Gauging Probe. 4Q Annular Spaec ar Vault Sensor. ~ Piping Sump !Trench Sensor(s). ^ Fi11 Sump Senson(c}. 24 Mechnnica! Line Leak Detector, ^ Elettronic Line Leak 1]electar, D Tttnk OvCrtill /High-t,e~l Sen<or, ^ Other is if ui matt t c and Dispenstr )p- -~ ~ Dispenser Containment Senior{s). ~ Shear Valvetsl. Model: Modci: - i1 Model: Model; Made]: Model: Mode]: ~~~~~' odct in Section 1= on Page 21. Model: Model: Mork); Model; Model: Model; Model: model in Section L nn v,RA ~~ •+ cnscr tiomammenl i'l08[(5 and Chain( Dispenser ID: ~D,spenserConutinmenr Sensor{s). Modci; $ Shear Wa14C(C), Di;getts¢r ID: Mooch Model: ~~~ Model: _ Model: _ ~- Modcr; Model: ~~ Model; - ~`~ ode] in Suction E on Pa~c 21 Modct: Model: -- Madel; ~"' Model: _ Model: "- Model: Model: u, mFnt [ and matte! i n $ectiun i3 on t'aec 2 , Dispenser ID: :~ ~ Dispenser Containmcttt Sensor(s). Model: SOS/ /bpd ~ Shear Valve(s). - TsnklD: ^ In-Tank Gauginfi Prohc, ^ AnoutarSpacc or Vault 5ensor- ^ 1?iping Sump / T,-onch Scnsor(a}, ^ Fi[I Sump Sensor(s). ^ Mechanical Linc Leak Ihtector. ^ Electronic Line Leak Detector. ^ Tank Overfill / Higit-Level Sensor 4 Chher (s ecif c ui ment e e and Tank %D: ^ In-Tank G:augin€ prp;~, ^ Annular Spscc or Vault Sensor. ^ Piping SumplTrench Sensor(s). ^ ['i l! 5u,np Scnsor(a). d A'lechgnicaf lane Leak Detector, ^ Electronic Line Leak Detector. ^ 'l'ank Ovetfill / t•Iigh•Levcl 5ensar. ^ Other coif Disp¢nser ID; - C] Dispenser Containment Sensor(s). Model: D Sltear Valve(s). -^~ ~ Ditpettscr Containment Sensot~s). Model; Dispenser ID; ®Shear V;tlvc(s), O Dispenser Containment Sensor(s)_ Model; _ ^Dis e:uer Containment Float(s) and Chains , ^ Sltcar Valve(s). - "lfthe i'trcility Contains more tanks ur dispensers, copy this form. lncludc infnorn,attion for very tank sod distpcn5cra ~ he I'aciliry. ~• t-e~tlflC~tlOlt - I Certify that the ¢quipment identified in this document was inspeetedlserviced itt accordance ta~ith the mannfaeturers' guidelines. Attached to this Gertilcation is information (e,g, naantdhcttrrers' checklists) neccFSary to verify that this Infrtrmation is correct and a t'let Plan showing the layout of monitorltte equipment. Tor any equipment capable of geteerating such reports, I have also attached a copy of the report; (check all that apply : O Sy:rtem set-up ^ allarm histo Technician Name (print): "t,~l+a t'Y report ~I -~~,. Signature: ~,+ ~11.:..~ CertiFication No,; ~,~/~ _~_ .-,~z License. Np.; ~~ Testing Company Name: ~~_ Site Addre,.: ~~-~/~~ ~~~~ Phone Na.:~~[v"/ ~~~j -~~~~ Date orTesting/scrvicing: ~/~SF~p- /~p~.. Monitoring 3ystent CCrtilicstian Page ~ oT3 n3rot 02/09!2007 13:55 6613252529 ~• Results of TestingJServicing Sofiwarc Versign Installed: ~~ ComtyleLe the foltowfr^o nt,o..b;;.... CAL VALLEY PAGE 03 x es ~ No's ~ Ye ^ + Is the audible aJarrrt o eratignal? s Nb ~ ~ Yes ^ N 's Is the visual alal'm o erational7 '- o ~•Yes ^ No" Wcre alt sensors visual! ins cted, functional! tested, and confirmed o erationAt? . Were all sensors installed ^ Yes q N " at Iowost point of secondary contrtinmeni and positioned so that other equipment will opt interfere with their ro er o erasion? o ~ N!A if alantts are relayed to a remote monitoring station, is all opetatiorlal? communications e i ^ ti`s ~ No" qu pment (e_o. modem) For pressurized piping system ^ N/A s, does the turbine automatically shut down if the i rn secondary containment monitoring system detects a leak, fails to operate p p g or i , s elcctricaJl disconnected? positive shin-down? (Check aU 1ha~ apps) ^ $Urn y If yes: which sensor; initiate ^ Yes ^ No+ bid ou confirm ositive shutdown duo to Icaks an psensor failureldisconnerctpion?cr Containment Sensors. Pc)r tank systems th ^ Ye C] 0~ N/!1 s; No_ at utili~x the mo~~itorin s stem mtchanicaJ overfill prevention vafvc is installed) is th P v w r c Yes ~ NO e overfil warn ng alarm visibie and audible At the tank fill pint(s) and o eratin ro Crl ? if so, at what erecnt of tank ca stir does the alarm tri er? V1cas qtly monitoring e ui m ' ^ Ycs* f$ N q p ent replaced? If fo and list the manuf8cturcr name and model for all redJaccment art bw char equipment replaced ~~ o S r i W a l n d s n as liquid found inside an seconds y ~' o0ntainment s t Yes ^ N * ys Product; ^ Water, If ems designed as dry systems? (Chrc-k ull char crpp/y) ^ ,describe Causes in Section E below o ~ Yes ^ No" , , Was manitorin s slam set-u reviewed to ensure rb r scttin ? Attach set u nr orts, if a IiCable Is aN manitorit7 ui mCnt o scions! ' '~ Yn Section E below, r manufscturer s s eCificationa? describe stow And when these deficiencies wet•e or will b - e corrected. ~:. Com,atents: S`raad .s /..~ . r~,._ ._. _ _ ~.. .. „ _ Page 2 ni3 ^~ U3/n~ 02/0912007 13:55 6613252529 CAL VALLEY PAGE 04 F. Inc-Tank Ganging I SYR ~qui,pment: a~Chcck this box if tank gauging is used only for inventory control. ^ Check this box if no tank gauging nr SlR equipment is installed. "This section must be completed if in-tank gauging equipment is used to perfvzm leak detection monitoring. C,orrt lete'~he folitiwin checklist. ^ Yes ^ No" Sias ail input wiring been inspected for - o Were all tank au in 4 Ycs ^ N • g g g p~b~ visually in petted For damage nd (residue buildup?sting for ground Faults? O Yes D No's Was accuracy of system product level rcadinge tested? d Yes ^ No' Was accuracy of system water level rcadinge tested? - D Ycs ^ Na* Wc~ np probes rciastalled properly? ^ Yes ^ No* Wero all items on the equipment manufacturer's maintenance checklist completed? * in the Section ~, below, describe how and when these deficiencies were or. will be corrected. G. Line ~.eak Detectors (LLI)}; d _ Check this box if l LDs are not tnstalled_ Cam ]ere the i'oilowin checklist: Yes ^ No* For equipment Start-up or annual equipment certlfitauon, was a leak simulated to verify LLD performance? ^ NlA (Ckrr.~k all rbcrl apply) Simulated leak rate' ~3 h,; ^ g•P- O.l g.p_h ; O 0,2 g,p.h, Ycs d No* Were all LLps conFu'med operational and accurate within rcgulatary ~qu;rcments? ~ Yes ^ Nor Was tht: testing apparatus properly calibrated? ~ ~'c-s ^ NOS` For mechanical LLDs, does the LLl] restrict product flow if it detects a leek? ^ .NlA ^ Yes J7 No"' For clectronit LLDs, dots the turbine autornar;cally shut aff if the LLD detects a leak? ~ N/A ^ Yes ^ No; For electronic LLDs, does the turbine automatita!]y shut off ;{any portion of tllc inonitaring system ;s disabled ~ N!A or disconnected? ^ Yes ^ No" For electronic i-l ns, does the turbine autpmatleally shu[ off if arty portion of the monitoring system maifpnctions ® N/A or fails a test? ^ Ycs O No* FOr electronic LLDs, have all accessible wirin Connections been uisuall ills ~ $t N1A g y petted. ~ Ycs ^ No* ~Jcre ..l! hams Un the equipment manufacturer's maintenance checklist completed? '~ (n the Section H, below, describe how and when I:hese deficiencies were or will be corrected. H. Comrrtt'nts: ]Page 3 of 3 usnrt 2/0912007 13:55 6613252529 CAL VALLEY PAGE 05 A'[onitorinR System CcrtificAtion site Address: ~ ~ sT Mvn>ltoring S><te flan Date map was drawn ~/~ Q~ IriStCLiCt1tNIS if you already have a diagram that shows all required inforn~.tion Monitoring System Ccr~tiflcatiorr, Dn yavr site plan, show the general ay utl f ~~~t~a ~ names page, with your P p >3 Clearly identify locations of tGe fallowing equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, disperser pans, spill containers, yr oti~er secpadary containment areas; mechanical or electson.ic line leak detectors; and in-tank liquid level probes (if used fvr leak detection). In the space provided, note [lie date this Site Dian was prepared. Fabc t of~ ns~ao 02/09/2007 13:55 6613252529 CAL tlALLEV PAGE 06 Spill bucket Testing deport F'orlm swRCB, Jaauary2t)()6 77irs form is rntenaTed for use by co~t~cfars printor~fsfrom teats rf'aPpl~'ble), should ~~ annual tasting of f1S.T'spill corrai~e„ient strrrcttre~ T1ie co»~ered form armed porwided to the facility owner/apercrtor for submittal to the local s~egtdatoo~j, crgancy i. FAC'll,~Ty INI,ipRMATION Facility Address; ~ ~ ~ DateofTes k'acility Canbact: ~~ "p ' ~ a Date T oval ABer-cY Was NotiSed ofTesting : Fhone: Name ofLocal Agency ta~ectar {ifpresent ditringresrirg): Z. 'I'ESTAV'G CONTRA,C~'OR aNFORMATiON Cot~u y AiaQie: ".['eclmieian Conducting Test: p Crederttialsi: ~CSL$ Cantract~or ^ ICC Service ech. 0 SWitCB Wank Tester ^ Othex License Numherfst~ yrru, ~_ w 3. SPILL BIJCI~T VESTING INk'ORMATIOIIT Test Method Used: ~~ytirostatic ^ Vacuuttt Test I.?qui~unent Used: 1/.'r. _ _ . Q ~~ ... y. eye„ aucicer (t!y lonk Naember, ,SYared Product, etc. ] - f!L 2 g/ vL Bucket Installation Type: 03Direei Bury 1~Direct Bury Bucket Dieimeter: ^ is Sums + ^ Contained in , ., Bucket Depth: 1 ~" ,~ Wait tune between applying 1 Z ~cuubuhvater end start oftest: ~ . Test Start'I~me (Ti): ~ ~ Initial Readitt~ (Ri); ~ ~ „ • Test Eod Time • p,~ ~ ~.. Final Readigg (RF): , D ~ Test Dtaatiart (x'F - T,}: Gbenge in Reading (Rr-Rt}: P83S~eil Ttit'eStloid Or ~rytit~Ct'i3: I'eat~Result: •~ [~ N F•.? ... •ZS+. ~AmxlRerit9 -- incha~e i ~ ' - to Fads ~.:D.F on on re s >uade tp iestin,~ and ri Resolution: 3 4 ~ Direat ~Y L] birect Bury ^ Cot~inod in Stan ~1 Cantttined .in CERTxFTCtiTIptY OF TF-CHMCIAN R~SPONSLBLR FDR CQNDUCTIl~IG T~II3 TESTING I hat~eby can!sfy tJ&~ crA tl ~e infor~ismfoa eonta~lned in this reinort is trice, aceitrate, mid iar jrrll eo,-l~-lia»ce wdlfi legal r~egrrlrensenta. Tcx.}inicten's SiSnature• Date: -~..a ` State taws and regulations do not current) Wray be more t Y r+etluire besting to lac perforaaed by a ctualified contractor. Hawover, ioeal r'equirerr~ents - 02!0912007 13:55 6613252529 CAL VALLEY PAGE 07 .~ ~APURLES~ MANUFACTURING, LNC. . - ~ ~C~n~a~ - - LDT-89D Leak !Detector Test Record - - _ DatC afl P UCt Manufact~uer Submersible Pump.identlt`ication Mo el N . ~1 N~tnbea ., ~~ L.eak Deeector I~#etatitacatian ~S , le Leale Detect t ~~~, DiaPln'agm-type Pistatt-typc~L- Tamper-proof seal installed? Y ~~ No Leak Detector in Submersible Pam Test at Dispenser t- apaa#>,ng Furnp Presstu~e 2 2 psi (para. l5) 2. Gallons par hour ratt? 3 D (para. z2) 3. Line pressure with p~ shut off .~.r~psi (para. 23) 4. Bleedback Test with pt>sup o ff~~p~ ~ (per. 2~ 5. Step-through time to full flow~~seconds {para. 3d) 6. Leak dctet:tor stays in teak acaz~ch position. (para. 42) Yes_c_ No LEAK DETECTOR TEST ~_ Note: Pass s Leak dceectar file test imotocol i+ail ~ Leak detector fails Lest prototot Pass ~~ ~-~ F~1 Form $90C (9-1-96) '"Ca~rrtplete thermal e7tpa[1Sioa test before failing Ieak detector. 1996 V'aparless M~ufactttrixeg, 7nc., Prescott 1FalIey, AZ ' 02!09/2007 13:55 6613252529 CAL VALLEY PAGE 08 '~APpRx.-ESS M.,APTUFAC~`U~G, INC. ~,DT-89o ~.cak Detector Test ~.tecord ste ~O Technician u~acturer P~duct Submersible Pamp Iderttffiaatio~ erial Num ~c Leek Detector Ide~tiflcation De 'on ~~q' e~I-eak Ikezctar ~~~~f-~~ Diapbraga~.typc Pistorn-type 1~ Tamper proof seal installed? Yes` No ~~ Leak Detector in ,Submersible Pump Test ~t Dispenser I • ~~~ Aunp Fresstnc~si (para. l5) 2. Gallons per hour race ~, 0 __(para. 22} 3. Line pressure with pump shut of#' si (Para. 23) 4. Sleedback Test with ptunp off ml (para. 26} 5. SLeP-through time to l'iexl flaw`seconds (para. 30) 6_ Leak detector stays in leak search pdsitiou. (pare 42) Yeses No _ LEAK DETECTOR TEST Nue: pass =Leak detector fts a~ protxol Fait = Leak dttcctor faire test protnoot passe Fail -~~ Foam 8900 (9-I-96} *CempJete them cxpaasion test before failing leak dcteccor. I996 Vaporless iM~ufa . cM'ing, Izxc., Prescott Valley, A~ ~, ~o~.,~ cx~-va~,~~ Y61~ m - ~s~~ ~~~~ a w B~~af~,~~d, q4 933~~ ~ ~E: 51-327-9341 a ADDS; ~~ iJA~ fit: ~ CAL a ~'~~~51-32~-~3~3?~ ~ ~, ~; SAE ~ (JG , ~1 l~~ ~; ~ ~ 4~-1. i 1~iE ~ .. ~ ~ ~~~~ Dl+dae IhQ d $6$~ 1 ~Ipgpt~ ~ ~Y~°t~9fl~dp~q~~t+sia tr10.Q11~811~wil~~,+Rq~,~ ~rrnry~atp~p~~. w p±~G'DUCi ~~ ~ ~' ~~ a 9• yS ~ 22.e ~ f ~~ ~ ~r~. t ~x n,~s ass r~u~ V r t 'Qv ~~ ~ ~, ~ ~.- .. ~: ... ~ PRODUCT ~~ ~ T ~ ... ~ vG ~ o.~S sa 2.1d t+~~r ~'~~, c~+wr~c~ss ~ ~ ~~ ~, ~ ` ~ s' -- al ~ v' - N LL7 ~ ..~~ m r, BPS: ~ { ~ *~~ L'~~~ ~ 1 yp~ t^M r~ ~ ~ ~l .M-1 ~ , ~ ~ ~~ N m m N 0~ m ~ • ~ . ~ y . f declare vender penalty of per u ~ _._ 1 ry that ! ~ a Ji t7 e J ~ nformatlon cflntAlned la thla report le true and ~eq~ tank tester fn tf~e State of CaJffotrlla and th cor ~~~ t t . rec to the bo^t ~. ».,. ~._ _.. e ~ . • Friday, February 09, 2007 1:21 PM Trish Carlos 6618319399 p.01 UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD I LINE TESTING I SB989 SECONDARY CONTAINMENT TESTING (TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION ~r PERMR NO. I I .. ~ ~~ S 9 P ~~~~ ARTAI t BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANKTIGHTNESSTEST ® TO PERFORM FUEL MONfrORING CERTIFICATION SITE INFORMATION FACILITY Ready Go Market NAME 8 PHONE NUMBER OF CONTACT PERSON ADDRESS 1600 Valhalla Drive OWNERS NAME Ready Go Market OPERATORS NAME Same PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED9 ^ YES ^ NO TANK# VOLUME CONTENTS 1 87 UL 2 91 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 #: 04104900 DATE 8 TIME TEST TO BE CONDUCTED NOVember 2O, 2000 08:00 ICC #: SIGNATURE OF APPLICANT ~~ DATE OCtOber 6, 2006 APPROVED BY DATE '~°" ~ - _ ~ -~ - -- `'~ ~ ~ FD 2095 (Rev. 09/05) 06128/2006 16:37 6613252529 CAL VALLEY PAGE 02 SWIRCB, January 2002 ~a~~ o>; 7 Secondary Containment Tes'btng Rcpaxt Form Thrsjort» is rrttendmd for use 8y conlr~etor's Psrforn,igg periodic resting ojUST seta aPProP~~e pages ajthis jor»r !o repdrf rssulls for all Cpaarpar~nls reseed. 1'he cpnrpl ~ men ~~ems Use the prirrroerts frarA tests fil4Gplicublel. should be prpvtded to the jacr•Irty nwr,er/npprnt~,. ~nr ,suhnrftlnl-o the /~ es, and 1. FACILITY ~1F4ItNiATIO.N ~ °~' a8~y Iraeility Name: 1=scility p~~; Dapp of Testee 0 Facility Contact: bate Local A Phone: gency Was No iSed of Testing ; Naive of Local Agency Inspector (ifpresenr d6trvtg tecri 2. TESTING CpN'x1ip,CI'OR INFORN,[AT~ON Compare Name: Teclatticiaa Condtec$Ag Pest; Credentials: li(CSLB Licensed Conhactor Ll SWi2CB .Licensed. Tank Tester License Type: ~ ~,S License Number: "} p Y / 7rs ,d s. SUA'IMARY OF TES's' RESULx'S Component Pena Fdl ,t,~ ~ie Component s u u u U U u ~ u u u u u u ~ u u u g ~G u u u -~ u u u u u u u u u u u u '~I U IJ U All u u u ff hydrostatic testing vas perfen~ebed, ~~e what was done with the water alter Cemnletinn of tests; Pori Fad 1O~ ~ ecepa Toted Mel U u U L! u u u ~~ u u u I~i U u ' u Lf u u u Li u u u ~ u u u U u u u i.a u u u u u u u u u u LI u u u u I_ ~ CERTIFICATION Off' TECII1~Ti.~IAN RESp4NSIBL$ FOR CONDUCTIIITC TBIS •~'I;STING ~'o ,the best' ojsry k„eawtdd~,e, t~-e faetx atareid ire rJl~is dpeuenctet ¢re ec~carate and rte jrtlleoeeepliaeee-e with lell~repui'neeeeteis Technician's $ignatyra• .___.` Date: ~~ 06/2812006 16:37 6613252529 CAL VALLEY PAGE 03 SWRC13, laauary 2002 Test Method ]]e~-ekrped By: Test Method UsecL• Test Irquipmerat Used: r ~•_ . 4. TANi~ ANi1TiJLAR 'I'lE3TIlVG U Tank Manufacuurer Q~ lndnstry U Other (SP~i'11') lJ P'restntt~e ~, Vacuum U Other (S~ec~) Tank "" ~ Tank # Pagr~ ~ of Standard U Profossional Bngirxeer U NYdnostatic . 13qu' ent Resolution: Task # Is Tank Exempt From Testing?' U Yes AND Tank # Tank Capacity U yes U Na U yes U No U yea U No Tank Material: Tank Manufacturer, Prodnct Stored: Wait time between applying press~e/vscutmx/waber and start tt;St; Test Start Time: ~ ~ Initial Reading (Rr]; Test End rime: .^ ~ _ -- Final Reading (Its]: Test Duration: Change i>x ltcadii~ (REr•R~: Pass/Fail Tlueshold or C it i • ^• r er a _ Tcst RcstlEit+ 1P 1.TFa11 U Pass .'IJ:F~q~ . • j•i Paas U Fa1a L~ ~rda U >Ftali Was sensor removed for testing? ~ Yes U No U NA Was semgor properly replaced and y U Yes U No U NA U Yes U No LI I+IA U yes U No U NA verified functioned after testis ? ~ os U Na U NA U Xes U No U NA IJ Yes U No U NA U Yes U N o lJ NA Commen#~ - ;~ }e t7rm~ on irs made prior ro r~srirrQ rnrd „A~,.,....,^a..,z.,, t~r_.__ --- : .... ' Secondary C°rd8idttleIIt SyBiemR wlier+c the Cotttitmoug atogitoring autrnmatiCA1[y monitors both the oorrfaimnent, sack as systems that are hydrostatically motutared ar undo canshattt vacuum are rxe Pr'in~Y and secondary testing, {CaGfrnrnia Cade ofRegoiations, Title 23, Section 2637(ax6]} ~ ~"' geriodic contaimnent 06/28/2@06 16:37 6613252529 CAL VALLEY PAGE 04 S~RCB, Jam~ary 2002 ~8e ~ of? s, 3ECQNDARY FIP~ TESTING Test Method Developed gy; fJ Pipintg Man~ufachn,er +d ~d"~rY 5~d ~ U ~'o£essional Engiaecr U ~~ (sP~t~) Test Method Used: Pressure U Vacuum U Hydrostatic U Other Pciffy) Test Equipment Used: ~Pn-~ ltesolutaon: Piping Material: Piping I[tnn Piping 1Run Piping Rung # Piping Rna # Piping Manufacturer: Piping I7ianaetcr. , M ~, 1-engt6 of Piping Run; ' ~ ProdtlCt .QtOf~d_ ~ 2t? 1V.[eNtod and location of 9 'n -run isolation: ,~ Wait time between aPP~B prESSU~/vacuum/water and stsrtin test: Test Start Time: ~~ initial Readm~g (]tt); Test End Time: ~ , Fir~a! iteacltng {lt~}: Test Duradion: Change in Reading (RF,R~}_ l t Pass/Pail Thtealtola or CritEria; Teat. Resaltw : mss ~':. t)•Fsil. ' • ~ : U .. U Pass. U P,a11.. ~ ~ P~i4 ~ L1 Fall . Commence , include in a-rxa rio ir oa irs made br to testi , ansd re~ptamended o11ow- or ai7'ed tests 06/28!2006 16:37 6613252529 SWRCB, Jannaty 2002 Test Metl<od .Developed 13y. Teat Method used: Test Fes, iupmem Used: 'Y-„ U Sip Ivlanufacturer U Other (Sperm) u Pressure U Other (~~~ fv) '1' S... e-~ C CAL VALLEY PAGE 05 Page ~ of "f ~ TESTA~iG ~ Industry Standard U Professional finglrteer u Vacuum pQ Hydrostatic nip~nent Re~s+oltttioe: ~ ~ _ ~ . _ Stnnp Diameter -- ~ r M °°•"t' ~7 Sump # 3unap # , n J1[rnp Depth. ~f Sump Maberia[: ~ Height from Tank Top to Top of ~ ~ Ni eat Pi i PeraetretiaA: r Height from Tank Top to Lowest ~ Electlnical Petutratian: ~~ Condition of sump prier to beating; ~ ~ ,~ Portion of Sump Tcstedr r Does 4rrbirre shut down when sump sensor detects liquid {bot]t ' i~Yes UNo LI NA I~f;Y UN duct and water 7 es o UNA Lt Y~ UNo UNA UYes UNo UNA 'I't~ine shutdown respor>;ae time Is system programmed for fai!-safe ` L U Yes UNo ~ 4 e i shutdown? Was fail-safe verit'ied to be , U Yes UNo liA U Yes UNo UNA U Yes L' No UNA o ttonal?` Wait time betaeea applying U Yes UNo ~4NA U Yrs UNo b~1VA UYea UNo UNA U Yes UNo UNA pr+:ssurehracvan~/water atld starting ~ `- teat: Test Start Time: Initial Read' ~$ (Rr): $ ~ ~ O Test Fnd Time: ~ O ~ , ' Final Reath ~ ~~ ! ~ 7 ~ Test i7uratio ~ Change in Reading (ItF-Rr): Passlp'rul Threshold or Criteria: Test Itestollt: I~°Piss L Fsil•. ~ amiss U Felt u Paa$ ~ ti ~sl[• ' Was siensor remavcd for testing? ~ Yes UNo UNA U Pena U 3~!' Was sensor prnperlY ~plaeed and ~Q Y U l~Y~ UNo UNA LI Yes UNo UNA U Ye:s L.lNo UNA veri#"resd funetiorral after testi es No UNA Q~Yes UNo UNA U Yes UNo UNA U Yes UNo UNA Commlenfs - (ir,~frrafe irr ox-+Jatian on repQirs made Prior to restrn~ aid,~erv»ra,.a,.aea ~.n__-- ---- ~ -- ' Tf the entire dept]Il of the sump is not tested, specify how much trsterislt (*) is "Ir1ID^ or °NA", the entire vvas If the answer bo g~ of the questions irldicabCd with aq sump mud be tested- (see SWIZC~ LG-l60} 06!2812006 16:37 6613252529 CAL VALLEY PAGE 06 SWRCB, January 2002 7. UNDER DISPEN$)~R CON7'ArNMEN7' Page ~ o~~ Tesc Method Developed By; LI UDC Marnrfactwer UD TESTING ~a S~~ a U Professional Engineer " U Other ~'~ Test Method iJaed: u Pt>~ssu~ u vaotnrn7 k~ydroatatic Test ipn'tetrt Used: U otltcr ifY~ s'C`~ a%pmerrt Resolution; UDC M.atnifactutt~ UDC # UDC # IIaC # UDC # UDC Mat¢rial: UDC 2„ P •• u Height from UDt: Bottom to Top ~ .' ~" afH eat Pi i Penedation: l2'~ K '~ ee Fleight from UDC Battptn to ~ ~(" J..oweat Electrical Pearetration• +-1" ,~ Condition of UDC prior to " " teatin : Portion of UDC Tested e1 GI art ° Does hn'bitte shut dawn whe O ~ ° ° n UDC sensor detects liquid (bout ~i'es `fj~No U NA Yes 1~N trot and wager ' o U NA Y0s ~,~To U NA 'l'ea la U NA Y~binc shutdown to time ~ s?'~ Pm1p'atnrned far fail- f ' L1 Yes 1J No ANA ~ .':.----~ .. _ sa e ahutdown7 verified m ~ , UYes UNo J~iA UYes UNo ANA uYes UNo ~QNA operatiotra W !J Yes UNo I~NA U Yes U IVa ~A U Yes !J Na la~1A U Y ait time bet9veen appiYmg , es UNo A1,4 presstueh'aClttuRlwaterond startin test Test Semrt Time- Initial Readin ~ ~ ~ i Teat End, Tina: ~ ? Final Read ' . o , 20 - Test Duratiort• fl Ch in Readin R ~ Pass/Fail Threshold or Criteria: Teat.>Ct~glt: • ~ Was sensor removed for testing? Peas U Fall phas L! >(~ U ~aQ ~g,Ycg UNo U NA Yes U IV , Pose CJ )l~dl . Was sensor prvpp9y ~ ~~ d o U NA. t~Yea UNo U NA f Q Yes U IVa U NA p an verified firnctional afLertestin b9,Yea UNo U NA 64Yes UNo U NA Yes UN _ COt>tlAlClpES o u NA ~Ycs UNo U NA - rndtede +ttfnrutatto+l oR r s nPapTe for fo_te,4trrrx: and mcom,.~,.~- a r ~-._.- -- r .... ~ If the entire depth of the UDC is twt tested asterisk (') ig "Nt3" or "NA°, the entire UDC m~irst 6e~testcdr~(~ Rt~B I,G_ t ~is~r b0 ~ o~ ~e cptestions indicated with an 06/2812006 16:37 6613252529 CAL VALLEY sWRCl3, Jaaoa;ry 2002 8. FILL I~SEIt CONTAINM~IIT SUMP T]E.S Fac$i is Nat i With Fi11 Riser t:oatainment Fill Riser Corttaimrilent Sumps ere Present, but w~ Not Tested U Tcst Method Developed By~ U Saa>p Manufacturer U Industry Steudand rest Method Used: lJ ~~ ~P~~') u Pressure u Vacmteu Test U ~~ t"5' r ) Equipment Used: fiorr, Tunic Top to Top of t P" in pEA: from Tanlt Top to Lowest .al Peaettatioa• on of sump prior to Welt time belwcen applyinr P~~elvacuun~/watcr and PAGE 07 Page ~ of 7 1.1 PrOfe831or~i ~~;aeer u xY~'oatetic ipmenlt R~oIutioa: S- ump # FiII Snap # Ig there a sensor in the 7 ~ ffi U .~ U 1~a11 . ~ U Yes UNo U Pass U Yes r^~ - ~ UN ~ ~ ~ •Paas. U Fait ~ ',. U Fa~f s e sensor alarm when e~~oduCt ~ a'~er is Was sensor rearoved for testiag7 V4fies sensor }er1y relplaced axtd verified functional after testi 7 U Yes LI No U Nq U Yes UNo r~ NA U Yes UNo U NA UYes UNo U Yes UNo u Xes rJ No o U NA U NA U NA U Xes U Ycs UNo U Yrs UNo U Yes UNo UNo U Nq U NA U NA U Yes UNo - U Yes LI No U NA U Yes UNo U NA, U Yes UNo U NA omments - indude- on-tQtlon on ' . -nade r~arto testi„~_ end„a, ..,_.....-1_~ r_., _ 0612812006 16:37 6613252529 CAL VALLEY PAGE 08 5WRC8, January 2002 ,Page ~ af~ {r/r#rrde r or~ratton ort -'eA~i~s made rior to testing etrd UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION ,,~~,-'~ ,~,,. BAKERSFIELD FIRE DEPT. ~ ~ FIRd ~ ' Prevention Services ~ARTMT 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 - Fax: (661) 852-2171 Page 1 of 1 PERMIT NO ` ~ ~ "~J / ^ ENHANCED LEAK DETECTION ~ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING I~ TANK T~rHTNFSS TEST ~ T(l PFRF(~RM FtIFI MnNITnRING CERTIFICATION SITE INFORMATION FACILITY Ready GO Market NAME & PHONE NUMBER OF CONTACT PERSON ADDRESS 1600 Valhalla Dr. Bakersfield, Ca. 93309 ~ OWNERS NAME Ready Go Market OPi~RATORS NAME Same PERMIT TO OPERATE NO. I NUP~I6ER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? I$( YES ^ NO ~ TANK# VOLUME CONTENTS ~ 1 87 UL 2 i 91 UL I I I I i 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 #: 3648 DATE 8 TIME TEST TO BE CONDUCTED NOVember 23, 2005 13:00 ICC #: TEST METHOD wF ~r-QO- SIGNATURE OF APPLICApIT ~~ ~ DATE October 26, 2005 ~' ? H :APPLICATION BECOMES. A PERMIT H N APPROVE APPROVED BY ~~, ~,_ ~~,~~ DATE !~ ~~ /~~ FD 2095 (Rev. 09/05) 12/01/2005 16:19 6613252529 CAL VALLEY PAGE 02 MONITORING SYSTEM CERTIFICATION For Use ,4y Al1,TuristJlclidns Within the Stare of California Authority Cited: Chapter 6.7, HNetrh and Satcry Code: Chapter 16, Dtvislon 3. Tir1e 23, California Code of Regularivrts Thic form must be used to document testing and servicing of monitoring equipment. A separate certification or repsrt_must be oreparcd ' !-or each monitorin~;Sys[cm contrnl,nancl by the technician who performs the work, A copy of this form must be provided to the tank vyttem uwnCr/operator. The owner/operator must submit a cppy of this form to the local agency regulating UST systemv within 3() days of lest date. A. Genera! in rmatinn Facility Natne: Qzcati~p /y1mYLI f „~ $]dg. No.:__ Site Address: ~p0, ~~hes,/~~ .. City _,~g~~[~ 7,ip; __, Facility Contact Person: Contact Phone No.: MakelModCl of Monitoring System:.~~a`1c.~~P Date of Testing/ServiCing: _I~l 231 bS B. Invefttory aF Tquipment ~'esled/Certitfed Check the appropriate boxes to intHC6lte specific em,iomenl insneeted/eer.,i.~.i~ 7-ank ID: _ 1 K 7 LGG ~ In-Tank GaUgin~?mhc. Model: _, ~ Annular Space or Vault SCnsnr. Model: l~ Piping Sump / Trtneh Scnsot~s). Madei: l3 Ftti Sump Senscu(s). Model: ti9' Mechanical Line Lcak DclccMr. _ Modct: ^ Electronic Line Leak Y]aector_ Model: ^ 'fank (avertill / Higlt•Lcvc1 Sensor. Model: Oihcr (s cClf ui mcnt 1 C and mode( In Section E on Pp a 2). Tank ID: ~ In-Tank Gaming ProbC. Model: ~ Annular Space or Vault Sensor. Modci: ~ Piping Sump J Trench Sensor(s}. Model: Fill Sump Sensor(s). Model: ~ M11echanrCal Line Leak Yacteclor. Model: ^ E:Icc[ronir Line L.cak Detcctnr, __ Model: ~^ Tunk Qvcrtill / lli;h-l-evcl Sensor. _ Model: _~~ i] []that (specify eguipmtm type and model in Section [ nn Paee 21. Disp¢acer If1: _~ L . ~ DispcnserContainment Scn.~or(s). Motlcl: 4 Shear VaivC(c). u us cosec t_ontatnm~nt hroat(s) and Chain(s). I)ispencer ID; _~ ~l(' Dispenser Conlainmcnt 5tnsor(c)- Model: L~,~esdOreae.- 63 Shcai Valve(.}, - "" U Dispenser Conrt-inmcnt F1aat(s and Chain(s). .~ Dis e r ID °°~ Tank IA: ^ to-Tank Gouging I robe_ ^ Annular Spatz or Vault SCttSOr. ^ ['ipine Sump /Trench Sensor(s). ^ Fill $tlmp Sensor(s). ^ Mechanical Linc I..cak Dettctor. ^ Eleu[mnic Lint Leak f~ctector. ^ Tank Overfill ! High•Level Sensor Tank ID: Model: __ Model: ModeF _~ Model: _ _ . Model: _._ MgdCt: Model: model in Section E on Pat ^ [n-'Y'ank Gau~+in~ Probe. ^ Annular 5pncc or Vatth Sensor. ^ Piping Sump /Trench Sensor([;). ^ FIII Sump Sensor(s). ^ Mtchanical Line Lcak Detector. ^ >`Iectronic Linc Leak Detector, ^ Tank 4ver~f 11 /High-bevel Sensor ^ O[Ittr fsnccifv rx,u;nmrnr r,.nP ~nrl Dispenser J[D: ._ a~~6 L713ptnscr ~olltalntiltn[ $CttSOr(S). Shear Valve(s)_ ^ Dis enserCont;tinmenr Float(s) ant Dispenser iD: ^ Dispenser Conlainmcnt Sensor(s). CI Shear Valve{s). ^ D15raCn5cr COn[linment Flaar/cl non Model: ,_ Model; Model: Mndcl: _ Madcl: Model; ~ ___ Modtl: nodal in Section E on Pn,c 21. Model: ~j~~tG~~rac~ Chain(s). MIodel p ~~ Dispenser [D: ~ Dispenser Conlainmcnt Sensor(s). Model: ~-e.- ^ Dispenser Cnntainmtnt $cngpr(s). Model: [~ Shear Valve(S). ^ Shear Valve(s). ~~~ ^Dis enact Containment Fioar(s and Chains . L:1 Dis nserConrainment Floor(s) and Chains . ' II'rhe facility contains mnrC tanks or dispensers. copy this form. [nCl-Idt information for every rank and dispenserat the ftcilily. ~-. CEt-LiIlCatlon - I certify that the equiprttent identiPed in this document was inspected/selwiced in accordance with the manufacltlrets' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary tv vetilti that this information is correct and a Plnt Plan showing the layout of tiwnitnring equipment. Fnr any equipment captable of generating such reports. ! ItBve also attached a rnpy of the report; (check alt rltar ply): ^ 5ystem set-up ^ arm hiSCOry report Technician Name (print): ,ytC$ ~ Signature: ~1.~ _ _ r _,. _ Cettification No.: _ ,~~~ License. IvTO.: ~~ Testing Company NamC; , ~- A ~ ~~ ~.i ~ ~- phone iVO-: f ~6 Site Addre.s: ~OO~~~t /s~~'~,~~ ~r ~/ ~. -~ ~ T3ntc of TCStinglSenicing: ~f.~3/ ~~ Page t of 3 [131111 P4onitorinR Systcrtt Certi#ictltion 12101/2005 16:19 6613252529 CAL VALLEY PAGE 03 D. Itesal!ts of Testing/Servicing Sotlware Version Installed: com late the Follawin chcCk6st: Yea Q Na# is the audible alarm erational? Yes ^ Nq+ Is the visual alarm o rational? ~ Yes ^ Ycs ^ hto* L~ N * Were all sensors visuall ins Ctcd, funCl'ionali tested, and confirmed o rational? ~ ' o Were all sensors installed at lowest point of secondary containment and positioned so that other i cqu pntenr wit] not imerfcre with their ro r o ration? ^ Ycs D No's ~ N/A 1f alarms are relayed to a remote monitoring station, is alJ communications equipment (e.g. rnodorrt) operations!? ^ 1'es >~ No" O NIA Far pressurized piping systems, does the turhinc automatically shut down if the piping secondary containment monitoring system detects a Icak, fails [o operate, or is etcctrically disconnected? If yes; which ~cnsor• c inmate . positive shut-down? (Chrrk «U ~hcu «pply) ^ 5ump/Trench Sensors; ©Uispenser Containment Sensors ^ Ycs ^ N * . Did you confirm asitive shut-down due to leaks and sensor faiturefdistonoection? ^ Yes; ^ No. F o ~ N/A ar tank systems thDt utilize nc~ monitoring system as the primary tank overfil] warning device {i,c. no m l l i ec tan ca ovcrFilI prevention valve is installed), is rho overfill warning alarm visible and auciiblc at the tank ^ Ycs" ~ N lit! lot(s) and o eratin ro ri ? If so, at what ercent of tank CA acit does the alarm trioRcr? 9'c VV o as any monitoring equipment replaced? If yes, identify specific sensors, probes or other equiprtrcnt re laced , p :+nd list the manufacturer nitme and model for alJ re lacemcnt arts in Section E below ^ Yes+° ~ No , . Was liquid found irtsidC any secondary containment sysr;ems designt;d as dry systems? (Check cr!! rhpt apply) D Product: ^ Watcr_ tf s, describt: causes irf SCCtIOn >1, below. Yos ^ No" Was monitorin s stem Set-u reviewed to ensure ro settin s? Attach set u rc orts if x licahle Yes ^ No# , is all monitorin tri ment o Crational cr manufacttrrer'S S ecificatians? • [n Seeti on E helaw, describe how and when these deficiencies were or will he corrected. E. Connments: ~/ .Set,.ro I ~ ~[~~~. ~h ~ W~ c .~il~/'t! ~t'~~~___i~~~s~ GAO dv~~lrl'J~+ t'aC arc ' ~ ' ~ .r ~ bLrie ~ s~_rifnYS_.~~14~ ~.- .N.,~t?~f- C OH Page2of3 It3/Ill 12/01/2005 16:19 6613252529 CAL VALLEY PAGE 04 I''. In-Wank Ganging /SIR F.quiplmCnt: ~ Check this box if tank u in is used only for inventory control. ^ Check this bpx if no tank aug~n or SIR ~ g• S et~uipmcnt is installed. This section must be eotnplCled if in-tank gauging equiprrtent is used to pctforrn leak dctectian monitoring, - ~•~ ,•• -•~u we wrreccca_ ~• tn2 ea DeteCtOrS (LI..D): ^ Ch~k this box if t_[.As are not installed, `" In the St=et;on N, helow, describe how and when these C' L' L k ~ Ycs D Not ^ N!A For eyaipment start-up ar annual equipment cerLiCicatian, was a Ieak simulated tp verify t.T p perforrna ? h • _ n~ e lC ck ul! that apply) Simulated leak ntc: ~ 3 s,p,h,; ^ p, l g.p.h ; ^ 0 Q g p h Yc~ ^ Nvt Werc all LLl]s confirmed operational and accurate within regulatory reClu]rcmenls? 1'c+ ^ Na* Was the tCSting apparatus properly calibrated? ~ Yes ^ Ives Far mcchattical LLDs, does the LLD restrict product flow if it detects a Ieak? CI N/A ^ Yes ^ Not For electronic 1..LDs, does the [urbiAC automatically shut off if the LLD detects a Ie k? NIA a ^ Yes ^ No" N/A For electronic L1rDg, does the turbine automatically shut ofF if any portion of the monitoring system is disabled Qr dI3Ca11tfCCtcd? D Yev U Nos ~( For ClcctroniC LLI7s, dots the turbine aptbmatically shut pff if any portion of the monitorin s t lf j N!A g ys em ma unctions or fails a test? ^ Ycc ^ Na* (~ NIA Forefectronic l..LDs• have alI accessible wiring connections been visually inspected? Ygs ^ Noy' Vl~cr~ ali items nn the equipment manufacturer's maintenance checklist completed? ~ [n the S ection FI, bellow, describe haw and when these deiRCiencies were or will he corrected. H- Conimenka: Pa~e3af3 o3J01 2fA1/2A65 16:19 6613252529 CAL VALLEY PAGE 05 Monitoring Systert~ Certilicatipn U~~' ~OItItOr1A~ ~1t8 ~~atfl Site ~Ldctres5: ~~tlb ~dc IL.~ I/.s ~2_ .~_ ..._ ., . _ . -./J/.. ~~::~:::;:::::: ;~DY'~:: ::::::::::::::::::::::::: ~: . FIJI ,?af~in+. - ~, --~. Date rnSp was drawn: ~/~/~~' IrtsEx'uctions tf you already have a diagram that shows alt required in Formation, yt)u may include it, rather than this page, will, your Manitot'in~ System Ccrtificatit~tt, ()n your site plan, show the locations of the following equipment, if installed: monitoring sys em ontx~J ptt clsnscn5os pmonigtorit~getank nenwlar spaces, sumps, dispenser pans, spilt ectntainers, or other secondary containment areas; mecharticaf or etectmnic lime Ieak detectors; and in-tank Iiqutd level probes (if used for leak detection). Cn Lhe Space provided, note the dale this Site Plan was prepared. Page ~ of nsroo 12/01/2005 16:19 6613252529 CAL VALLEY PAGE 06 v~o~L~ss n~rruF,~icfru~[rr~, ~rrc, I-D'~'-894 Leek Detectpr Test 1~eCprd Con ~~ tali '- ~~~~~~ _ ,~oduct 5ubmers~le pumnp Identification .Ivies ufaetnrer ~ - ~erisl Numbcr Leaf Aetector Identification Mama actor ~ Ie ak Detector aC ~.? ]'' Tamper-praofseal installed? Yes Diaplaragm~-type Piston~type ~v-'~ No Leak t]etecta~r in Sttbmersibte 1°nrr~ 'Vest at Dispe>aser 1. ppcrating Pump Pressuxe ~ 2 ~,si (para. ISj 2. Gallons per hour rate 3 •p (Para- 22) 3. Line pressure with pump shat off ~~si (para. 23) 4. Bleedback Test avith 1'~P off_,~ (para. 26j S. Step-tktrough titre to fi11I tlOw~~scconds (para. 30) b. Leak detector stays m teak search position. (para. 42} Yes !.~ No LEAK DETCCTOR TEST N4ft: p994' F xy detCCtor fiG4 te9t p1'4locnl Fail - Irnk drdx:tm rails tcsl protocol Pass v ~_ Fail Form 89pC (9-1-9bj sComglett thermal e 1996 Vaporless Marzufacturing~ac.c Fr escott Valley, AZ ~r 12/01!2005 16:19 6613252529 CAL VALLEY PAGE 07 vA.PC3RLESS M,A.NUFA.CTXJRZNG, ~lYC. LDT-89~ Leak Detector ',['est ~tecaxd tractor i~storner tiuatin~ersihhte pomp tdentidicatyon oturer 11+iodcl No. Sew, r~ymbe~ r~ _ .. Leak Detector Tdentificatieri Mpp~~ufac iption Piston-type ,~ Tamper-protst'seaI installed? Yes No Leak Detector irk Subr>;iersible pump Test at Dispenser !- dperating Ftarrrp Fressure~-,2.._Psi (para. I S) 2. Gallons per hour rate D .(para. 22) 3. Line pressure with ' pump shut ofF~psi (para. 23) 4. Bleedback Test vriflz ptmtp off ---~~m! (para. 26} 5. Stt:p-through tirxlie to fnl! flow~~seconds (para. 30) fi. Leak detector stays in leak search position. (para. 92) Yes~~ No LEAK DE7'I;CTOR TEST Note: pass = Jxak dco~t:lor fits teat protocol Fail - Jig detector fails te9t protocol .Pass ~. F'ai] -~,. Other S e I.ea~ Deter Form 89t)C (9-1-96} '"Cornplcte thertnaI ~ ! 996 Vaporless Mariu~fac~tu=ring~n~ prGS~ n Valley ~ for. Tec 'clan ~ Q ~~ ~~ ~~ ~ \ ` 1 ~, s + READY GO MARKET _____________________________________ SiteID: 015-021-001394 + Manager Location: 1600 VALHALLA DR City BAKERSFIELD CommCode: BFD STA 07 EPA Numb: BusPhone: (661) 835-8518 Map 123 CommHaz Moderate Grid: 02C FacUnits: 1 AOV: SIC Code:5541 DunnBrad: ----------------- Emergency Contact / Title Emergency Contact / Title HAN MO CHUNG / DENNY / Business Phone: (661) 835-8518x Business Phone: (661) 331-9043x 24-Hour Phone (661) ~1~3 24-Hour Phone ( ) - x Pager Phone (661) 373-6877x ~Fq9 Pager Phone ( ) - x Hazmat Hazards: Contact Phone: (661) 835-8518x MailAddr: 1600 VALHALLA DR State: CA City BAKERSFIELD Zip 93309 Owner HAN MO CHUNG Address City BAKERSFIELD Phone: /33©3 ~Yotltr~eYtLF ~L State: Zip . CA ~13~ ~~'7if 93311 +------ . Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: I PROG A - HAZMAT PROG U - UST ANT o ~~ I~ ~ 6 ~~ ps Based on my inquiry of those individuals responsible-for ok~taining 4he information, I certify uiicipr penalty of law that I have personally exar'r7ined and am familiar with the information submitted ant! believe the information is true, accurata, arld complete. Signature Gate ____________________________ -1- 04/03/2006 MUNIFIED PROGRAM INSPECTION CHECKLIST' .SECTION 1: Business Plan and Inventory Program BAHERSFIELD FIRE DEPT a Prevention Services R/~t 900 Truxtun Ave., Suite 210 AiRt/ T Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NA E NSPECTIO DA INSPECTION TIME ADDRESS ~ ~ HONE NO. O OF EMPLO ES ~A 0 a .c,~- lA FACILITY CONTACT USINESS ID NUMBER /' 15-021- I %J~ Section 1: Business Plan and Inventory Program ~j ^ ROUTINE BINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (C.Compliance` OPERATION V=Violation l - -- COMMENTS _ - -- --------- -- ---- - -- ------- - - ^ --- APPROPRIATE PERMIT ON HAND ' AA' ~19~~ ®C ^ BUSIt1QSS 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 PR ^ VERIFICATION OF ABATEMENT SUPPLIES AND DURES ^ ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITES ^ YES LJ'NV EXPLAIN: - ~ _ OUESTIO EGARDI T INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector ' (Please Print) Fire Prev on / 1" In / Shift of SRe/Station q Business White -Prevention Services ~ Yellow - Station Copy Pink - Business Copy FD2049 (Rw.02/OS) =~ ~~+w~' `~~ \ CITY OF RAKERSFIELD FIRE DEPARTMENT ~~ ~ ~ °~ OFFICE OF ENVIRONI~IEN'i'AL SERVICES y~l LiNiFIED PROGRAM INSPECTION CHECKLIST `=_~wE'~g~,~~'~ 1715 Chester Ave., 3r`' Floor, i3akerstield, CA 93301 FACILITY NAME ~C~c~y ~a {I/~G1 INSPECT ION DATE Section 2: Underground Storage Tanks Program Routine ~mbined ^ Joint Agency ^ Multi-Agency Co a~ t ' Re-inspection Type of Tank ~(~ I`dumber of Tanks Type of Monitoring I~ Type of Piping ~ OPERATION C V COMMENTS Proper tank data im file Proper o~tinerloperator data un 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 ~+~ith OES Adequate secondary protection Proper tank placardin~'labeling Is tank used to dispense MVF? If yes, Does tank have overfill; overspill protection`' C=Compliance '=Violatio Y=Yes N-NO Inspector: Office of Environmental Services (661) 326-3979 Busine s Site R tole Party ~~'hite - f nv. Svcs. Pink -Business Cnpv UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / S6989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION ~. , ...~ BAKERSFIELD FIRE DEPT. ~~ (~ PYeVeritlOri Sel'~71C@S FIRa d d RTM,T ~ 900 Truxtun Ave., Ste. 210 .~, y Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 PERr.11T NO ` ~ ~ ~~ ^ ENHANCED LEAK DETECTION ^ LINE TESTING ~SB-989 SECONDARY CONTAINh4ENT TESTING ^ TANK TIGHTNESS TEST ^ TO PERFORM FUEL MONITORING CERTIFICATION FACILITY Ready GO Market NAME 8. PHONE NUMBER OF CONTACT PERSON i I aDDRESS 1600 Valhalla Drive I O`~VNERS NAME Ready GO Market OPERATORS NAME Same PERMIT TO OPERATE NO. NUi•,~BER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES ^ NO TANK# VOLUME CONTENTS 1 87 UL ~ 2 i 91 UL ' I i 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#: 04104900 DATE & TIME TEST TO BE CONDUCTED IVlay 12, 2UU6 08:UU ICC #: SIGNATURE OF APPLIC NT ~~ ! DATE May 8, 2006 i IS - PPLI .ATI .N BECOMES A PE -MIT H A PROVES} A.ppROVEC BY DATE ~ 4 FD 2095 (Rev. 09/05)