HomeMy WebLinkAboutBUSINESS PLAN (3)
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_,oR G HOUSING AUTHORITY ~i
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SEP 2 3 2003
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St~~t2CS, ?annary 2002 - - Pagc ~ _ of J
- ~ ~ Secondary Containment Testing Report Form _
T1ns form is iruandad for usa by contractors p¢rfortring p¢riodlc resting of UST secondary ccwrtainmenr systems Usa th¢
~;: Proprt;;:e y;.g~s aj"!h, •'s Orm %: '2ror~ ~.:.:.'t ~ .;' - ;. ~::: : r~ ; ";., - ., ',' • ,: . ; ' _,-,
yrinlouis from tests (rf applicable), should be protirded to thefocility owner/operatorjor snbmitta! to the local regulatory agency.
1. FAC~TY INFORMATION
Facilityivame: pi> > ~~t10f C'A~ -» P ix2Ya pW{e('S t?aieofTeslin - -O
Facility Address: ~~ ~~ So,~ o' Pk '~-
Facility Contact: Phone: ~,
Daie Local Agency Was Notified ofTestuig : -~ _a !o
Name o1 Local Agency inspector Cfpreseni during testing):
• ^t`Tl~~T
_ j, j-~JYjj\l7f l„Vl\1l~til.A V.i~al.i:v -
~,onipeny Name: WtA --'f' ~'el
Z-ech~iciar. Conducting Test:- ~ . , '~
Credentials: ~ CSLB Licensed Contrac[or
License Type. R ~ ~ ^ SWRCB Licensed Tank Tester
License Number: Spa ~7
Manufacturer Manufacturer Training
Com onen. sl Date Train- Ex fires
_
INCON INCON TS-STS
~.
z_ SIiMiVfARY OF TEST RESULTS .
Component _ Pass ,
..
Fat! . " Not Repairs
.,
toleu ~ 15~1e u f ~ I Not I rteparrs i
C'^mccnenf Piss T'r~? , ~1cv ,ti«„c
g-y- a~ v r=7 G Q D 0 0 Cl
^l o o n o D ^ a
~-- --- --
-jY.~L~rs;~~n Sec-- ~~
'~
D
^
c ^ G D G
i1i ^ D r~ i 0 D ^ fI
D D ~ ^ ^ D ^ G ^
D D D U D ^ ^ ^
0 D D D O ^ ^ f
Q O Q tJ 0 L~ D 0
D D a ~ a ^ G ^ ^
- ~ O D D ^ - - ^ D ^ . ~ ,~
a ~ D D D ^ D D ~ G ;;~
_ ] f hydro~ztic testing was perfQrtned, describe what was done with the water after completion of tests:
RECYCLE AND RELtSFD __
CERTiFICATiON OF TECHNTCIAN RESPONSIBLE FOR CONDUCTING TEAS TESTING
-!'o the hest oftny knowtedg tlfe facts stared in this document are accurate and InJutl coRtpliance with legal requirements
r ~' ~ ~~'r ~' ~~: ` Late: C~ % " lV t~
)-CChai:, ii3n'i Sigralure~. -
~~aa
SWRCB, January 2002
5. SECONDARY PIPE TESTII`IG
page ~ of3
Tes[ Method Developed $y: ^ Piping Manufacturer w tnousuy arauua u .~ ....•~~,•_..__ _._a-_ _
^ Other (5pec~)
Test Method Used: 1~ Pressure G Vacuum ',Hydrostatic
^ Other (Spec{fy)
Equipment Resolution: . 5%
Test Equipment Used: 9 i n . DIAL GAUGE
-`~~~ ~ ~ Piping Run #~ Piping Run # Piping Run # Piping Run #
:~
Piping Material; t W
Piping Manufzcturer: Un1<now ~
Piping Diameter: 3`
ength of Piping Run:
; h fr '
,
Product Stored: ~+ G.
Method and Iocation of
i ie¢-run isolation:
r ri vm 4
Wait time between applying ~5 a,
8-y-o i
press;;re/vacuum/water and
i
7~jm, ,~
k
'
n test:
start
Test Start Titne: 2
t~,•o~7iltn ~ ~ ~•~~~m
5
Initial Reading.(R,}: .~O~,n 3.b~s~ ~
Test 'r.nd Time: ~~ , $tvr+ ~l ~.
Firial Reading (RF): . to~s,^ 3• b75. n
Test Duration: }-`.~m~ r1 ~Srn~~
Change in Reading (RJR,}: , 00o i r. , 6 oa ~ ~
Pass'Fail Threshold or DUu'~ ~ t'
Criteria;
Test Result:
c~Pass 0 Fail
^ Pass Q Fail
~ Q Pass ^ Watt
G Pass G Fait
Comments - (include rnjormalion or repa'rs made prior 1e lestrnR and recori'r?anded jollorv-utJ jor jailed teas)
p '~
~ 3g a~
-7 _ -F- !3
SB.989 TESTING FAILURE REPORT
SITE NAME' ~y5~n~, ~y~'1Oti~ C~1 U-~`i ~11SZFi~OW{JrS DATE: D' ~I' O
ADDRESS :3\'6_1s,~~w~til Sow ~~r~-1 TECxNZCxAN:
CITY :~jAX~ ~~ ~ E`~ SIGNATUZE
SITE CONTACT:
THE E`OLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COI~.P7..ETE THE SB989
TESTT_tIG .
LIST OF PARTS REPLACED/REPAIRED:
REPAIRS' i~--~~'F1~~L.~` ~~?'f~(r~1Q(1 1>"~X
LABOR:
PARTS INSTALLED ~~ vn~'c~D~n~b~ _
j 3g~a a
_ rf~,
.ESL
TE^? -"ARTED ' ! = 2., Ark
cEG.~ LEVEL. z.b?54 ?N
ENR RAT: E E3/H4'!2G,gr,
LErr; -THZESH(i! U G3.~~~~2 Zt
T. cT v~ cl ~~~( ?ASS[.i3
_ 7rA~
:)SLR cC
Tic- S'A° cC) :4ki A':
-- :-: i ARTED ~~S/0?/2~j66
8E+3??~ l_E~JE_ _.67~~ ti
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w i~~) T ~'i[ i 1 . `~~ hA
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-r_~_. ___ .- _ _ _
LEAS; THRESHOLD b.EiE~ i^;
i
For I/~se B_y All Jurisdictions pJithin the State of Cal fornia
Authority Cited: Chapter 6.7, Health and Safery• Code; Clz~nter •'e5, Division 3, Title 23, California Code of Rega;laiions
This form must be used to document testing and servicing of monitoring equiptent. g ~e~arate certification or resort must be prepared
far each manitorin~ stistem control panel by the techr_ician wha performs the work. A copy of this form must be provided to the tank
system ownerioperator. The owner/operatgr must submit a copy of this form to the local agency regulating liST systems N~ithin 30
days of test date. ~ ~ _ .
A. Ge>l~efa~ Il~~ >!~a>r~oa
Facility Name: .~ ~~~ ~~~}~~t' ~+~ (~e~,
SiteAd~ress: .~~'~1.Fi t~1~~St) -,st'r~
Bldg. No.:
Cit_y';L~~~.x~'~'~~~ Zip- q`3~
Facility Contact Person: 9_ ~~/ %;i~ 1U5F~1(~ Contact Phatte \o.: (~~/ ) ~~/ °~~X'~`D/
Makei~~adel of ~•tonitorina S,%stem: (/J.(~ ~ ~~j/~(.7,i~~~ Gate of Testing.%Servicing: ~'' / ' 6~
~. Ins e>lltol~- of Fq~~p~e>l'>it `~~s~edf~~rt~I~~cI J~Ivb ~ 73.
Check the appropriate boxes to indicate specifc equipn!entinspected(serviced:
Tank ID:
Tank ID: I~~
;;I
'i~ ^ In-Tank Gauging ;?robe. Model: I ^ in-Tank Gauging Probe. Iviodel: ~'
~' t~ Annular Space or Vault Sensor. Model: I ^ ~*!t!ular Space or Vault Se,.sor. Medei: 'I
Pipi!ig Suatp ~; Tench Sensor(s). Model: ~ I ^ Piping SU!T'iB /Trench Sensors}. 1vlodei: ~.il
~~ ^ Fill Sump Sensor(s). Model: ^ Fill Sump Sensor(s). Model:
~~I ^ Iviechanicat Line Leak Detector. Model: ~I ^ l~iechanical Line Leak Detector. tiledel:
N ^ Electronic Line Leak Detector. ',-iadel: ~I ®Electronic Line Leak Detector. Model:
' ^ Tank Overfil: /High-Level Sensor. Model: ij ^ Ta-!k Overfill i" High-Level Sensor.
Model:
'`
:I ^ Other (specif;- equipment tyFe and model in Section E on Page 2).. Ij ^ Other (specific equipment tyFe and model in Secron E on Page 2).
_
I+
b~ Tank ID:
I
Tank ID: ~;;
,,
I'; ^ in-Tan1c augiag Probe. Model: ^ In-Tani: Gauging Probe. Model: j
~~ ^ Annular Space or Vault Sensor. Model: ~ '3 =,nnular Space or Vault Sensor. 'viodel: 'I
~:
i~ ^ Piping Sump ,•' Trench Sensor(s}. Model: ' ! ~ ^ Piping Sump, ;` Trench Sensor(s). Model: ~!
E ^ Fill Sump Sensors). ~ 'Model: ~ ~ ^ Fill Sump Sensors}. Medei:
id ^ Mechanical Lira Leak Detector. 1Rodel: i t ^ it4eclianical Line Leak Detector. Model:
1;
~i ^ Electronic Line Leak Detector..,
Model: I
I ^ Electronic. Line Leak Detector. i
l~~iodei: ii;
~~ ^ Tank Overfill % High-Level Sensor. l4odel: I I ^ Tank Overfill %High-Level Sensor. ~4odeI: ~~
~
G ^ Other s e,,ifi~ oral ment t;• e and model in Section E on Page 2 . I i ^ Ottter stiecifv e '! ment ty ., and model in Section E on Page 2 . ,
~
j,
!~ Dispensee ID; i
I
Dis eraser ID:
; p ,
I'
p ^Dispenser Containment Sensor(s). ?viodel: I j ^Dispenser Containment Sensor(s). 'tiiodel: ill
'u ^ Shear Valve(s). ~ ' a Sliear Val.~e(s). ~''
I` ^Dispenser Cont_~inmcnt Float(s) and Chain(s). ^Dispenser Containment Float(s) a-id Chain(s). r
i Dispenser ID:
,
, Dispenser ID: i
d ^ Dispenses Containment Sensor(s). Model: ~ ^Dispenser Contain_r!-ient Sensor(s). l~iodel:
I~~ ^ Shear V aloe(s). ~ ^ Shear Valve(s).
^Dispenser Containment Floats} avid Chain(s). ~ ^ Disperser Containment Float(s) and Chain(s).
N
~ Dispenser ID:
I
I Dispenser ID:
®Dispenser Containment Sensor(s).
I Model: ^Dispenser Containment Sensor(s). l4odel:
~~ ®Shear Valves}. ~~~ ^ Shear Valves}. `~
~~~, ^Dispenser Contai!tn-,ent Float(s) and Chain(s). I,~i ^ Disperser Containment Float(s) and Chain(s).
xIf the facility conains more tanks or dispensers, copy this form. Include inforn!ation for every tank and dispenser at the facility.
~. ~t'1$flf ~~t~~II - I certify that the ea~uipment identified in this document was inspected serviced in accordance with the manufacturers'
guidelines. .?t?ached to this Certification is itsformatioa! (e.g. manufacturers' checklists) necessary to verifg- that this information is
correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capab{e of generating se!ch reports, I have also
attached a copy of the re~t9 {ch ck att flaol apply): ^ S`~ste*ra s6t-tap ~tartrt hi t rv po
Tec'nnician Name {print]:~ i_~,L.~F_ Signature: _
CertifcationNo.: (7~- (~ati ~a~8~(o~~ U1. 1 License. ~ a_: ~3~ ~~ Q ~ I't"~Z
Testing Company Name:
Site Address: ,'S (~
_ Date of TestiZgiServieing: ~~ ( %~~
Page 1 u` 3 03%01
1Vionitorittg SystLtn Certificatiott
l~. Results ®f a esting/~ervicia~g
Software Version lnstalled:
Com fete the folloywi n checl:.9ist:
Yes 8 No'~ Is the audible alarm operational?
Yes ®No* Is the visual alarm operational?
` Y ®No* Were all sensors visually inspected, functionally tested, and confirmed operational? f
es ment will
e
ui
th
r
Yes ®Ne'~` q
p
er
eat o
Were all sensors installed at lowest point of secondary containment and positioned so t
~ not interfere with their proper operation?
modem)
t
i
® Yes ~ Ne* (e.g.
pmen
If alarms- are relayed to a remote :ronitoring station, is all communications equ
~ ,~ N; ~. operational? ~
tainment
d
® Yes ®No* ary con
For pressurized piping systems, does the t~zrbine automatically shut down if the piping secon
G~ N,'""~ monitori_ng system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate
positive shut-down? (Check alt that apply] ~ Stunp.!Trencl: Sensors; ~ Dispenser Containment Sensors.
II
Did you confirm positive shut-down due to leaks and sensor failure, disconnection? ®Yes; ~ No. ~~
~
no
(i
e
i
d
i
® Yes ~ No' .
.
ce
ev
ng
For tanK systems that utilize t're monitoring system as the priman~ tanl: overfill warn
'~ N A mechanical overfill prevention valve is installed}, is the overfill warning alarm visible and audible at the tank ~
fill point(s) and operating properly? If so; at what percent of tank capacity daes the alarm trigger? %-o
t re
laced ~
i
h
~ I Yes* ~ No p
pmen
er equ
I
Was any monitoring equipme~?t replaced? If yes, identify specific sensors. probes, or ot
~
,
and list the manufacturer name and model for all replacement parts ii-i Section E, below.
® Yes* No Was liquiC found inside any secondary cor,~ainrnent systems des:geed as dry systems? (Check all that appl}) '~ ~
Product; ®Water. If yes, describe causes in Section E, below.
=Yes ®No~ Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable i
~LYes ~ No* Is all monitoring equipment operational per manufacturers specifications? I!
'° In Section E below, describe how and when these deficiencies were or w-it tte correctea.
Page 2 of 3 Q3iQ1
$; . Iat-T'aII~ Gaatgir~g f Sllz ;~quip~e~te ^ Cheek this box if tank gauging is used only for inventory control.
Check this box if no tank Gauging or SIR equipment is installed.
Phis-section must be completed if in-tank gauging equipment is used to perform leak detection monitoring.
l:OIIi lei
^ Yes s ins LOtit35Ylit Leacct-i~~~.
^ ?~To* ~ Has all input wiring been inspected for proper ent-y and termination, including testing for ground faults?
^ Yes ®No" ,Were all tank gauging probes visually inspected for damage and residue buildup?
^ Yes ®Now Was accuracy of system product level readings tested?
^ Yes ®No* Was accuracy of system water level readings tested?
^ Yes ^ No* ~ Were alI probes reinstalled properly? ~
' ®Yes ^ Noz ~ Were alt items on the equipment manufacturer's maintenance checklist completed?
r Iri the Section 1--~, below, describe how alEd when it-ese aexacaemcses ~svere ~r rreai urc w„c~«~.
G. Line ~:eak Detect®~ S (~ I.I~~< l Check this box if LLDs are not installed.
~.~u, ,~«
^ Yes ~ «a~ s.,~:~,:
^ No°' .~yn
For equipment start-up or annual equipment certification; was a leak simulated to verify LLD performance?
^ Nr:x,. ,
' (Check all that appll) Simulated leak rate: ®3 g.p.h.; ^ d.l g.p.h ; ^ G.2 a.p.h. ~
y ~
^Yes ^ No'~` Were all LLDs confirmed operational and accurate within re6ulatory requirements? ;~
^Yes ^ NoR Was the testing apparatus properly calibrated? ~`
^Yes ^ Nc'r For mechanical LLDs, does the LLD restrict product Claw if it detects a leak?
Nib ~
~
^ Yes ~ ^ Noy For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak?
^ N; .=i
^ Yes ^ NoX For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled
^ lv'i 4 or disconnected?
^ Yes ! ^ No' For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ~
^ N~ ~4 or fails a test? i
^ Yes ^ h+'o' For electronic LLDs, have all accessible wiring connections been visually inspected?
^ N./~ ~I
^ Yes ^ No* Were ail items on the equipment manufacturer's maintenance checklist completed? ~~
''` Itt the Section I, below, describe how and when these deiacienc~es were or watt pe correciea.
~. C~rn~nents:
Page 3 of 3
o3~oi
1 _ _
i6~mnitm~°°ssnb ~~ste ~:e~tificat~oa~
_ ~-
Site ~d~~ss: -~ f ~ iY){ ~f
L. J~,~ -\J~ f i~ ~LYl".~
. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '~ . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i . . . . . .
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--~-~.---~--~----~-~~..~-f~~..........-~--- ---....- -~
t3ate ~Iap ~~as tira~~: `v ; % !cQr!o .
li~st~cti®~s
If you already ;~a.ve a diagram that shots aL re~rured i~iorn~ation, yo~~ I~Iay i:?clt?de it, rat~Ier thcc?1 ti'I~S page, s.~-ith
your I~Ionitorirg Systelr~ ~ertif cation. i)n voF.zr site plan, show the general layout of tanl~s and pipil~g. ~leajly
1derlti~y IOCat1~i~S QI the foil®~ft'1i3g °,~t,.'sIpIE2~Ilt, 4f ITlstatled: IrrEJI~Itorillg System C~Lltrol panels; SenS~rS r=E®r~tor?ng
tank armular spaces, s?:rrlps, dispenser pax-~s, spill col~talners, or other secondary eontair.~nent areas; Iz-~ectlan~cal or
electronic line ;Pak detectors; a~Id in-tankk liquid level ure-~es f-f used for leak detection). III the space provFded,
note tl2e date t~~s site 'Ian ~,°as prep red.
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DATE_ . tPJ!E TcS I _: `3E ~.GNQUv i t~ ;3vC~ ~' t iST .?=! !-~'t~.
SIGNATVP;= QF P=iCANT ' ~1~ a ~~ ~- !I=iCT= rJ~ ~ rj~ ~ ~
APFRO~~EG BY app: r
_ C J'* ^V
UNDERGROUND STORAGE TANKS B1~Et,'~EIELI) FI}.ZE DEPT.
- - ®~ ~__
~
~ H SRS I D
~e~~ Prevention Services
~~~L~~~T'®~ {
~ .ifitt'1~ ~ 900 Truxtun Ace., Ste. 210
~ _
B
k
fi
l
9
A
,~
a
ers
e
d, CA
3301
TO PERFORM ELD /LINE TESTING Tel.: (661) 326-3979
/ SB989 SECONDARY CONTAINMENT TESTING
(TANK TIGHTNESS TEST AND TO PERFORM FUEL
Fax: (661) 852-217 i
MONITORING CERTIFICATION
Page 1 of 1
L~, +~ ~
PERMIT NO
~ ~ ~ l ~V
.
^ ENHANCED LEAK DETECTION ^ LINE TEST ING ^ SB-989 SECONDARY CONTAINMENT TESTING
^ TANK TIGHTNESS TEST ~ TO PERFORM FUEL MONITORING CERTIFICATIOPd
_~ --
-
- ,-
SITE INFORMATION
!.
!FACILI Y
-
I _
-~N SAE & PRONE NUMBER OF COPdTACT PERSON
X11 ~~~~ ~i ~4~-ti- ~ ~ ~~.,~al,v1.. ~.eun~~, ~...d__ (o bl -1031- .~S DO X 1 X01
y-,vvncJ?~'~1~K~C~[JLJM1~ ~Xl~ • l /i ~ /~~T
OWNERJSjNAME ~ ~
PERATORS NAME PERMIT TO OPERATE NO.
I
WUMBER OF TANKS TO BE TESTED _
I
I _ TANK # __ __ IS PIPING GOING TO BE TESTED? ^ YES ^ NO _J
-
~______ VOLUME
CONTENTS
f
1 _ _
__
~
I I
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- ---
G
-------
---- --- --
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- - --- - _ _--
! i
~ TALK TESTING COMPANY
ANA OF TESTING COMPANY IPJAME PHONE NUMBER OF CONTACT PERSON I
o~+~_.., ~-~ ~e•, weo ~ • ~~~ . ~,l.c~o Zo(o! - l3 ~- 6 913
/'. o, ~ JSb? ~eato - CH 933oa - ~S~ 7
NAME & PHONE NUMBER OF ESTER ORS CIAL INSPECTOR CERTIFICATION ;r:
Qvw: G:~2~_, ~~t- 3~f3- ?~7~ i ob- o~foo
,DAT/E 1&,~TIME TEST TO BE CONDUCTE ~ ~O ~ ~ ~• ~ n~ PCC #~ !TEST METHOD
~?.o /7 ~.S s7y3-
~SIGNATURE OF PLICANT DATE
PPPROVEDBY ,~ ~ /'l/'~il~iiavS~Ij DATE n/"1ti/!1 f_ ,
FC2106
--~- :..
+ KERN CO HOUSING AUTHORITY ___________________________ SiteID: 015-021-001123 +
Manager MARY ALICE LOPEZ
Location: 3015 WILSON RD
City BAKERSFIELD
BusPhone: (661) 393-2150
Map 123 CommHaz Low
Grid: 12C FacUnits: 1 AOV:
CommCode: BFD STA 07
EPA Numb:
SIC Code:
DunnBrad:
Emergency Contact. / Title Emergency Contact / Title
MARY ALICE LOPEZ / MANAGER ADT / ALARM
Business Phone: (661) 832-3206x Business Phone: (661) 322-1961x
24-Hour Phone (661) 631-8500x 24-Hour Phone (661) 322-1961x
Pager Phone (661) 337-5446x Pager Phone ( ) - x
Hazmat Hazards: Fire ImmHlth DelHlth
Contact MANUEL DIAZ Phone: (661) 631-8500x2403
MailAddr: 601 24TH ST State: CA
City BAKERSFIELD Zip 93301
Owner. HOUSING AUTHORITY OF KERN COUNTY Phone: (661) 631-8500x
Address 601 24th ST State: CA
City BAKERSFIELD Zip 93301
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives:
PROG A - HAZMAT
PROG C - COMM HOOD
PROG U - UST
Baset~ on my inquiry of those individuals
responsible for obtaining the information, 1 c®rtify
under penalty of law that 1 have personally
examined and am familiar with the information
submitted and believe the information is true,
accurate, an complete.
i' I ' V -
Date
Sig iature
ENT q pR 2 ~ 2006
-1- 04/03/2006
~'o
t~
i -
• `
UNIFIED PROGRAM INSPECTION CKLIST ~~ „~;
SECTION 1: Busi Plan aid Inventory Program y
OII /)A1, ~ A-fill~P/~~Q ~
BASERSFIELD FIRE DEPT
Prevention Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 872-2171
FACILITY E W C
J ~ ~ ~lU f ` NSPECTION DATE
~~ •/ ~~ NSPECTION TIME
UO
~ ~ ~.j~o , n~
ADDRES /; ~ ~
'7 iJJJ U(~( HONE NO. O OF EMPLOYEES
/
~
t W /
FACILITY CONTACT /~~
- ,6b / d USINESS ID NUMBER
~s-o2~- ll a--3
Section 1: Business Plan and Inventory Program
^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
C V (c=compliance OPERATION
V=Violation COMMENTS
^ APPROPRIATE PERMIT ON HAND
~. O BLISIn@SS PLAN CONTACT INFORMATION ACCURATE
^ VISIBLE ADDRESS
^ CORRECT OCCUPANCY
^
^ . VERIFICATION OF INVENTORY MATERIALS
VERIFICATION OF QUANTITIES
^ VERIFICATION OF LOCATION
VVV
^
^
PROPER SEGREGATION OF MATERIAL
VERIFICATION OF MSDS AVAILABILITY - b
/
r f' ~ ~ ~ 2 2006 ~ ~~
f
^ VERIFICATION OF HAZ MAT TRAINING
^ VERIFICATION OF ABATEMENT SUPPLIES AND
R CEDURES
^
EMERGENCY PROCEDURES ADEQUATE _
^ CONTAINERS PROPERLY LABELED
^ HOUSEKEEPING
^
~^ FIRE PROTECTION
SITE DIAGRAM ADEQUATE 8 ON HAND )
ti
- ~ ~ --
ANY HAZARDOUS WASTE ON SITES ^ YES ^ NO
EXPLAIN: - _ -
QU TIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT (881) 328-3979
~~~
Inspector (Please Print) Fire Prevention / 1" In / Shift of Site/Stetion # Basins ite/School Sfte Responsible Percy (Please Prnt)
White -Prevention Services Yellow -Station Copy Pink - Busineae Copy FD2049 (Rev. 02l~5)
r.= < .
~~~~' "~~ ~ C[TY OF BAKERSFIEL:U FIRE DEPARTMENT
e ~ ~ b~ OFFICE OF ENVIRON1t~lENTAL SERVICES
~'' y~I UN[FIED PROGRAiYI INSPECTION CHF,CKLIST
=W ~Rti,,!'A 1715 Chester Ave., 3~`' Floor, Bakersfield, CA 93301
FACILITY NAME ~~~i)u~ ~S-~ ~~i71~~,y~ INSPECTION DATE ~-~~ /~~
Section 2: Underground Storage Tanks Program
^ Routine ~CSmbined
Type of Tank
Type of Monitoring _
^ Joint Agency ^hulti-Agency
Number of Tanks _
"type of Piping _
OPERATION C V COMMENTS
Proper tank data on the
Proper owner/operator data on tilt
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 Nolte'
Section 3: Aboveground Storage Tanks Program
TANK SIZE(S)
Type of Tank
AGGREGATE. CAPACITI~'
Number of Tanks
OPERATION Y N COMMENTS
SPCC available
SPCC on the \+~ith OES
Adequate secondary protection
Proper tank placarding%labeling
Is tank used to dispense MVF?
If yes, Does tank have overtillioverspill protection'?
C=Compliance V=Violation Y=Yes ]~'-N0
Inspector: ..~~'~
Office of Environmental Services (661) 326-3979
\\'hitc - inv. Svcs.
Pink - Bu~incss Copy
^ Complaint ^ Re-inspection
~C1
Bustness Site Responsible Party