HomeMy WebLinkAboutBUSINESS PLAN
i'
F
1
C~RDINAIr
" °~OJ~u9M,..~oe.
r Cii3
--~-.
r~-rl.~ = `~ t~~~ ~ FYI ~~ 1~~.~ .~ - ~_ '~ ACT I~_
~~~~~
~`~
,~
~~-
.~
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING
/ S8989 SECONDARY CONTAINMENT TESTING
(TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPT.
~iRi Prevention Services
w1~Td ! 900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
Page 1 of 1
PERMR NO. ~ ~ - ~ T ~G
^ ENHANCED LEAK DETECTION 1^1 LINE TESTING SB-989 SECONDARY CONTAINMENT TESTING
f--1 r~nur-~ccc rccr 1 1 Tn oCDCl1D~A CI ICI ~Al1AlITl1DIA1(_ CG{7TIFICATI(lAI
SITE INFO RMATION
FACILITY ~ I NAME 8 NE NUMBER OF CONTACT PERSON
ADDRESS
c
Y
OWNERS NAME
OPERATORS NAME PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED IS PIPING GOIN TO BE TESTED? ^ YES ^ NO
TANK # V L ME CONTENTS
TANK TESTING COMPANY
NAME OF TESTING C PANY ~ NAME 8 HONE NUMBER 0 T CT PE t~ ~ ~~~
MAILING ADDRESS ~~ r _~ ~ ~ J~
(~
NAME 8 PHO NUMB R F TESTER R SPECIAL INSPECTOR CERTIFICATION #:
DATE & TIME T S~O BE C DU T D
f ®O W Y~ L ICC #: TEST METHOD
SIGNATURE OF APPLIC~T ~l r~~ ~'Y] ~_ - DATE ~ -~ _~
APPROVED BY DATE
~Il._LING & PERMIT STATEMENT
. PERMIT NO.:
^•
BAKERSFIELD FIRE DEPT.
Prevention Services
PCB! 900 Tnixtun Avenue, Suite 210
~Rrr r
Bakersfield, CA 93301
Tel.: (661) 326-3979 S Fax: (6611 852-2171
•
LOCATION OF PROJECT
-`~ - ~ •
PROPERTY OWNER
`Tr~n ~ 31- S o ~ d
STARTWGDATE __-y-J COtiA I DA~ ~ NAME ~ /~ _` ~n ry~
~
J
PROJECT NAME RE Y ~ O ~ O, ^ ONE NO.
P
H
PROJECT AD ^ \ r , / _
V`I U l V CfTY ~ (f r ~ { STATE ~ n
1~(
\•--r /x.'11 ~J'~ ZIP CODE
. • '
CONTRACTOR NAME CA LICENSE NO. .
• '
TYPE OF LICENSE EXPIRATION DATE PHONE NO. ~ / (y-~
C/SJn 7~
CONTRACTOR COMPANY NAME-- -- -
( ~- ;z FAX NO.
d
ADDRESS ~ ( ~; - CnY ' ZIP CODE ~ n~Q (~i
J ~ ~ ~
$262
50
Ch
i
Mi
fi
i
^
~
arge)
n
mum
ons - (
cat
Alarms -New & Mod . 98
Ft
00 S 013125 =Permit fee
FL x
S ~
~ Over 20,0
q. .
q. 98
Ch
Mi
i
ti
M
difi $210
00 ~
^ . arge)
n
mum
ca
ons - (
o
Sprinklers -New & . 98
F
S 042 =Permit fee
Ft x
S ~
^ t
Over 5,000
q. .
q. 98
< 10 h
d
ti
dif
i
kl
M ection Onl
)
00 [Ins
$ 93 ~
^ s)
ons (
ea
ica
Minor Spr
n
er
o y
p
. 98
^ dif
ti
M
N
8 26
$ 398 ~
ica
ons
ew
o
~
Commercial Hoods - . 98
^ d
l H 00
$ 36 ~
s
Additiona
oo . 98
i $458
00 ~
^ ons
Spray Booths -New & Mod cat . 98
^ Aboveground Storage Tanks (Installation/Insp.-1 ~ Time) $165.00 82
^ Additional Tanks ! $ 26.00 82
^ Aboveground Storage Tanks (Removal/Inspection) $109.00 82
^ Underground Storage Tanks (Installation./lnspedion) $878.00 (pertank) 82
^ Underground Storage Tanks (Modfication) $878.00 (persite), 82
^ Underground Storage Tanks (Minor Modification) $155.00 82
^ Underground Storage Tanks (Removal $675.00 (pertank) ~
^ Oilwell (Installation) $ 72.00 ~
Mandated Leak Detection (Testing) ! Fue $ 81.00 (per site) 82
^ Tents $ 93.00 (per tent) ~
^ ~ After hours inspection .fee $122.00 ~
^ Pyrotechnic - (Per event, Plus Insp. Fee ~ $90 per hour) $ 60.00 + (5 hrs. min. stand -by fee nnspection) _ $510.00 ~
^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) ~
^ Portable LPG (Propane): NO.OF CAGES? _ $66.00 ~
^ Explosive Storage $249.00 ^ ~
^ Copying & Fife Research (File Research Fee $33.00 per hr) 25¢ per page : ~
^ Miscellaneous ^ ~
FD 2021 (Rev. 09/05)
1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to File) 1-PINK (to Customer)
+ ELITE MOBIL MART ____________________________________ SiteID: 015-021-001065 +
Manager BusPhone: (661) 833-6507.
Location:. 3620 WILSON RD Map 123 CommHaz Moderate
City BAKERSFIELD Grid: 11D FacUnits: 1 AOV:
CommCode: BFD STA 07
EPA Numb:
SIC Code:5541
DunnBrad:77-020-8038
--------------
Emergency Contact / Title Emergency Contact / Title
TIM TRAM / OWNER KAREN K TRAM / OWNER
Business Phone: (661) 833-6507x Business Phone: (661) 833-6507x
24-Hour Phone (661) 827-8889x 24-Hour Phone (661) 827-8889x
Pager Phone ( ~~y 1 J~C31 ° 5Q ~Q ~ Pager Phone ( 714 ) (,23 -- 38(~
Hazmat Hazards: Fire ImmHlth DelHlth
Contact Phone: (661) 833-6507x
MailAddr: 3620 WILSON RD. State: CA
City BAKERSFIELD Zip 93309
Owner TIM TRAN Phone: (661) 827-8889x
Address 3002 BOULDER RIDGE RD State: CA
City BAKERSFIELD Zip 93313
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives: ~
PROG A - HAZMAT
PROG U - UST
NOTE: NEW OWNER AS OF 05%/7-'06
of those individuals
m inquiry - certify
Based on y the informati0~'rsonaffy
responsible for obtafnfn9that f have p
under penalty of law . .
and am famiUar with the informaUOn
examined believe the information is true,
submitted and fete.
accurate, and comp ' is~~
/l/ _/t/ Date
Signature
Fi(~
~~l
112006
~1~~~`~
s ~
~ ~5~` ~~ ~
~~~~ X
-----------------------------
-1- 06/13/2006
}7-
< ?• r `
' l ~~- J ~~ NloBt L M~he.T
-_ __~~~ SiteID: 015-021-001065 +
~~
Manager BusPhone: (661) 833-6507
Location: 3620 WILSON RD Map 123 CommHaz Moderate
City BAKERSFIELD Grid: 11D FacUnits: 1 AOV:
CommCode: BFD STA 07 SIC Code:5541
EPA Numb: DunnBrad:77-020-8038
Emergency Contact / Title Emergency Contact' Title
Ti M T~ / OWNER ~ ~-,Q.E,,~.l / OWNER
Business Phone: (661) 833-6507x Business Phone: (661) 833-6507x
24-Hour Phone (661) ~ $a7 24-Hour Phone (661)_ x$27-~ 8~
Pager Phone () Pager Phone
+-----
--------------?~ -----~=-y~ Dlo----+-------------------~~ --70 ==t~~0~ --+
Hazmat Hazards: ~ Fire ImmHlth DelHlth
Contact
MailAddr: 3620 WILSON RD
City BAKERSFIELD
Phone: (661) 833-6507x
State: CA
Zip 93309
..
Owner __ _-- _ _ _ _ ~_ 4 _.. ~7 1 R~1 ~T1C~tt~.) Phone : ( 6 61) - - - - - - - -
Address 3620 WILSON RD State: CA ~27_~j~~f
City -BAKERSFIELD Zip 93309
Period to
Preparers
Certif'd:
ParcelNo:
TotalASTs: = Gal
TotalUSTs: = Gal
RSs: No
Emergency Directives: I
PROG A - HAZMAT
PROG U - UST
based on mY inquiry of those individuals
. resoansible for obtaining the information, I certify
under penalty of law that I have personally
examined and am familiar with the information
submitted and believe the information is true,
accurate, and complete.
Dat
~" ~~` ~~
`X' ,
5~ ~~~~
~NT~-MAY 2 4 2006
-1- 04/03/2006
l~'NDERGROUND STORAGE TANK
MONITORING PROGRAM (FORM)
WRITTEN MONITORING PROCEDURES
Page 1 of 1
B E R 5 F D
~IRI
ARTM T
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax.:. (661) 872-2171
This monitoring program must be kept at the UST location at at times.
The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Prevention Services within 30
days of any changes ro the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and
2641 fh) CCR.
FACILITY NAME
DESCRIBE THE FREQUENCY OF PERFORMING THE MONITORING:
TANK
C
PIPING
~flv~~1~1r ` ~
WHAT METHODS AND EQUIPMENT, IDENTIFIED BY NAME AND MODEL. WILL BE USED FOR PERFORMING THE MONITORING:
TANK
ifcc:~c~ Rod ~ 1~S ~ 3 SAD
PIPING
DESCRIBE THE LOCATION(S) WHERE THE MONITORING W ILL BE PERFORMED (FACILITY PLOT PLAN SHOULC BE ATTACHED):
~ov..~~' ~~~ ~o~~~r V.l'cs~ C~I~L~
i
LIST THE NAME(S) AND TITLE(S) OF THE PEOPLE RESPONSIBLE FOR PERFORMING THE MONITORING AND;OR MAINTAINING THE EQUIPMENT:
I
~ I
:. rvnMt ~ ~` TIRE -
tiara ~CCId ~t~ Fk.r
NAME
REPORTING FORMAT FOR MONITORING
TANK
I
~ ~ tti~
PIPING
C L ~L.
I
' DESCRIBE THE PREVENTIVE MAINTENANCE SCHEDULE FOR THE MONITORING EQUIPMENT. NOTE: MAINTENANCE MUST BE IN ACCORDANCE WITH THE MANUFACTURER'S
MAINTENANCE SCHEDULE BUT NOT LESS THAN EVERY 72 MONTHS.
yc.a~l~ ~~~ {~~~. q~td~tc~s
! DESCRIBE THE TRAINING NECESSARY FOR THE OPERATION OF UST SYSTEM, INCLUDING PIPING, AND THE MONITORING EQUIPMENT:
I
~~r ~~ gt~~Z~t~c.S I,
FD 2074c (Rev. 02105)
I~NDERGROUND STORAGE TANK
ri
MONITORING PROGRAM
EMERGENCY RESPONSE PLAN (FORM)
Page 1 of 1
B E R 5 F f D
SIR!
ARTM 1
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
Tel.: (661)326-3979
Fax.: (661) 852-2171
This monitoring program must be kept at the UST location at al times-
The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Prevention Services within 30
days of any changes ro the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and
2641(h) CCR.
FACILITY NAME (( .`{~. `{
~l~ 1~ ~ 1
FACILITY ADDRESS i
3~do ~~5orr Rd
IF AN UNAUTHORIZED RELEASE OCCURS. HOW WILL THE HAZARDOUS SUBSTANCE BE CLEANED UP? NOTE: IF RELEASED HAZARDOUS SUBSTANCES REACH THE
ENVIRONMENT, INCREASE THE FIRE OR EXPLOSION HAZARD. ARE NOT CLEANED UP FROM THE SECONDARY CONTAINMENT WITHIN 8 HOURS. OR DETERIORATE THE
SECONDARY CONTAINMENT, THEN THE OFFICE OF PREVENTION SERVICES MUST BE NOTIFIED WITHIN 24 HOURS.
For sa~.~~ SQ~~ts c,~~tl v~~ ~~(~~ ~ ~~cr 4s ~~ a~so~`~,f-, ~ ~a~~
5Q<<t5 ~~c1 X11 Qi l ~ ~~p
i
DESCRIBE THE PROPOSED METHODS AND EQUIPMENT TO BE USED FOR REMOVING AND PROPERLY DISPOSING OF ANY HAZARDOUS SUBSTANCE. i
kc1~~ (~~c.~ s~o~ a~-1" S~~- cN ~ gc~c(o~t ~ot~,~nc~B
i
~~
I
DESCRIBE THE LOCATION AND AVAILABILITY OF THE REQUIRED CLEANUP EQUIPMENT IN ITEM ABOVE. j
~~6~` ~O~ul~. Q~
i
DESCRIBE THE MAINTENANCE SCHEDULE FOR THE CLEANUP EQUIPMENT:
~(~.t~~d ~a~~~
i
i
LIST THE NAME(S) AND TITLE(S) OF THE PERSON(S) RESPONSIBLE FOR AUTHORIZING ANY WORK NECESSARY UNDER THE RESPONSE PLAN:
NAME ~ TITLE
l 1 fd~iY c
NAMt
f ITLE
NAMt
TITLE
4b (Rev. 02/05)
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
~~Rt 1715 Chester Ave., CA 93301 (661) 326-3979 •
ARfM f
~. UNDERGROUND STORAGE TANK FACILITY
- ...., ..
^ t NEW SITE {.! 3 RENEWAL PERMIT ^ S CHANGE OF INFORAAI1T10N (Stab type of charge) ^ 7 PERINANENTLY CLOSED SITE
- TYPE OF ACTION PERMIT ^ 4 AMENDED PERMIT ^ 8 TANK REMOVED 100
(CheUc one itNrl ONy- ^ 8 TEMPORARY SITE CLOSURE
I. FACILITY /SITE INFORMATION
i
BUStNE~S.~E (~ ~ j C1O~~E a ' OoM~~~a a) 3 FACILRY 10 N 1
NEAREST CROSS STREET t ;I~' r 401 FACILITY OWNER TYPE ^ 4 LOCAL AGENCY/DISTRICT•
i (~ ~ ~ o A t } t p 0 ~ (J, ^ 1 CORPORATION ^ S COUNTY AGENCY'
' BUSINESS J w `!~ pppCCC(((pww ~DMOUAL ^ 8 STATE AGENCY'
~ TYPE 1 GAS STATION ^ 3 FARM ^ S OTHER 403 ^ 7 PARTNERSHIP
^ 2 DISTRIBUTOR ^ 4 PROCESSOR ^ 6 COMMERCUU. ^ 7 FEDERAL AGENCY' 402
TOTAL NUMBER OF TANKS I. fau7y an Indbn R.aervatbn a 'N owner of LIST a pubUe agency'. name of wpervba of
REMAINING AT SITE tnutlard.7 (b ~ ~~p o~ ~ yxi lank rooorda)T.
104 ^ Yp 403 408
Ii. PROPERTY OWNER INFORMATION
Y77"
( I~INDMDWL ^4 LOCAL AGENCY/DISTRICT
^ 1 CORPORATION ^ 3 PARTNERSHIP ^ S COUNTY 4GEfrCY
109
^ 8 STATE AGENCY 413
^ 7 FEDERAL AGENCY
III. TANK OWNER INFORMATION
TANK OWNER NAME 4i+ rnv~.c -•-
416
MAILING OR STRE~E•TgA/D~DRESS ~/~
~J CJC! ~ ~®~ y« - 419
CfT'Y 417 STATE 418 LP
- L lLk
TANK OWNER TYPE ~jpMpUAL ^ 4 LOCALAGENCY /DISTRICT --
^ B STATE AGENCY
420
^ 1 CORPOFtAT10N ^ 3 PARTNERSHIP ^ S COUNTY AGt.NCY ^ 7 FEDERAL AGENCY
N. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER
TY (TK) HQ 4 4 - Call (916) 322-9669 if questions arise 4z1
V. PETROLEUM UST FINANCWL RESPONSIBILITY
INDICATE METHOD(S) 1 SELF•INSUREO ^ 4 SURETY 80N0 ^ 7 STATE FUND ^ 10 LOCAL GOVT MECHANISM
^ 2 GUARANTEE ^ S LETTER OF CREDIT ^ 8 STATE FUND d CFO LETTER ^ 99 OTHER: 4Z2
^ 3 INSURANCE ^ 8 EXEMPTION ^ 9 STATE FUND d CD
~ VI. LEGAL NOTIFICATION AND MAILING ADDRESS
I:h.ek one pox to Irdleat. whkh addr.as.houW be uNd for Iepal notMeafbn. and ma41n0. 1 FACRITY ^ 2 PROPERTY OWNER ^ 3 TANK OWNER 473
Lepal. notlfleatlon and maWrg wttl b..ant Oo tl+. tank ewn.f urdau pox 1 a 2 b ehedted.
Vil. APPLICANT SIGNATURE
Certlfleatlon: I e.rdy that tl+. Intartnatlon provld.d ttsr.trt b tru. 8 aeauab to the pest of my krtowladpe 4z3
91GNATU OF APPLICANT DAT{E~ 424 ~/P~H/ONE }/{~ ~~/j~1~~~
~
~
^
J `~`~
V
CO
4z7
--~ ME OF APPLI (prlnU 420 TITLE F AP ICANT -
A ILL N (ot tue only) 1 U (or k7ea1 up o )
Ram A
State of Califomia For State Use Only
State of Water Resources Control Board
Division of Financial Assistance
P.O. Box 944212
Sacramento, CA 94244-2120
(Instructions on reverse side)
CERTIFICATION OF FINANCIAL RESPONSIBILITY
FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM
A. 1 am requited to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter I8, Div. 3, Title 23, CCR:
^ 500,000 dollars per occurrence ^ I million dollars annual aggregate
or AND or
^ 2 million dollars annual a
re
ate
ll
illi
d
gg
g
ars per occurrence
m
on
o
B. hereby certifies that it is in compliance with the requirements of Section 2807,
(Name of Tenk Owner or Operator)
Article 3, Chapter 18, Division 3, Title 23, Califomia Code of Regulations.
The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows:
C. Mechanism Mechanism Coverage Coverage Corrective Third Party
T e Name and Address of Issuer Number Amount Period Action Com
~C~~
'-~
Nofe: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of
this certification also certifies that you are in compliance with all conditions for participation in the Fund.
D. Facility Name Facility Address
~c ~ D~~ V ~ ~ o f R
Facility Name Facility Address
Facility Name Facility Address
E. Sign lure of Tank Owner or O for Date Name and Title of Tank Owner or Operator
ti~" °~
Signature of Witness or Notary Date Name of Witness or Notary
CFR (Revised 04/95) FILE: Original -Local Agency Coptes - Macuny~r[e(s)
~r C[T~' OF BAKERSFIELD
e ~~ OFFICE OF EiYVIRONMENTAL SERVICES
~` ~~rr
. ri~~ 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
r` -' ~'' ""' UNDERGROUND STORAGE TANKS -TANK PAGE 1
P,o. d
rYOE OF ~GTION ^ t. NEW SITE PERAMT ^ a. AMtJvOlO PERMIT ^ !. CHMK'+E OF INFORMATION) ^ S. TEMPORARY SITE CLOSURE
Cn.ck arr~ .ran onhl ,.., /
6y~. RENEWAL PERANT ^ 1. PERAMNENTLY CLOSED ON SITE
(SOr~N ~+~ • ~ bear wr oM'J (soKb ~qa • ~ bes/ ura oM'J ^ e. TANK REMOVED
BUSINESS NAME IS~d as FACILITY NAME or O6A • Odra btwrtwa N) ~ FACILITY 10 6 ~
LOCATION WITHIN SITE (GpQD~M1J ("
-- ~h~~ h,~I l~ioLY
L TANK DESCRIPTION
TANK t r ~ a32 I TANK MrANU~ACTURER ~ ~ ~ a73 I COMPARTMENTALIZED TANK `O~YSS ^ No :
In11'J-~ C~ C M Yas'. OomO~~ dM 0~9e for satCf+ oornCartmarq.
uaa
~. TANK CONIEN7~
TAtK US! 49! PETROLEUl1 TYPE a,.
~ MOTOR VEMCLE fUEi REQtJIAR UNLEADED ^ 2 LEADED
O to ^ S. JET FU0.
(y rna~ O0~~ ~~ ~) -
/
L~L~6. PREMUTA uNIFADED ^ 9. OIES0. ^ e. AvuTIDN FUEL
^ z. NON~U0. PETROLEUM ^ to ~~ tgi.fADED ^ a. GASOHOL ^ 94. OTHER
i ^ ). Cr1EMK.AL PRODUCT CO~6rpN NAME (born l~Yaowabus A40wIWt Mratr'~Y DrDrl
411
CAS / (Avm HazarWur AUbrlrb 4rrrrtbrypapa) 44:
! ^ a. HAZARDOUS WASTE (MCAbrr
urw orJ .
j ^ 9s. ur+ra+owN .
rl. TANK CONSTRUCTION
1 T PC Vr 1 N~ ~
~~ WALl. U .7. wRI~G WALL WRM U S. SRK)LE WALL WITH WTFRNAL BI.ADOER SYSTEtrI 143
(CnICn OIII 4nn oN1'1 ~
,
Od~Z DOIJELE NMLL ~
OW A V
T~ ^ 96. UNIQrOVMN
~ J
1tA
^ 1. SR~IOLE WALL ^ liD. OTHER
' TANK MATERIAL • pMWy Carat 1. BARE STEEL ^ 3. FIBERGLAS.4 / PUSTIC ^ S. CONCRETE ^ 9S. UW040WN 44a
(C1trNr ono ibrrr ary) ^ 2 STAINLESS STEEL ^ 4. STEEL CLAD WIFIBERQlA33
RE9~FORCED PLASTIC (FRP) ^ 0. FRP COMPATIBLE WT100% METHANOL ^ 91a. OTHER
TANK MATERIAL • IIaOt1r10afy tank ^ 1. BARE STEEL 1 GLASS /PLASTIC
^ ^ 6. FRP COMPATIBLE W/100% METHANOL ^ 96. UNOrOWN 145
(en•rx on. learn arpl ^ t STAINLESS STEEL ,
,
LW4. STEEL CLAD WIFIBERQLASS O Y. FRP NON-0pRROO1BI.E JACKET O laY. oTHER
RErrFOacED PLASTK: (~ ^ ,o. coATI:D sTeEL
^ s. ooNCRETE
TANK INTERIOR LJMJMILi ^ t. RUBBER LSEO ^ >f. EPOXY LJNwo ^ s. GLAS8 LJNNIG ^ 66. tXruIOWN 116 DATE INSTALLED 44T
oR cDATU1K)
rr~ ~ arrr arMrl O Z ALJLYD t.M~1G ^ 1. PFLENOLIC Lbat+G {,~A. UMJf~tD O 9D. oTNER r~~ ~ ~
OTHER CORROSION ^ T. MANUFACTURED CATHODIC D~ FIBERGLASB REINFORCED PLASTIC ^ 66. UNKNOMM 416 °A~ °'~^~D
PROTECTION IF AAPLK:ASLE PROTECTION
(CMeIr oM ram ~Y) ^ t SACRtFIC1AL ANODE O 4. IMPRESBEp CURRENT ^ tiD. OTHER
(For bcN rrrr! oNyJ
SPILL ANO OVERFILL
(cMek ar tMr raohl
~,~ YEAR INSTALLED 430 TYPE (For ktW urrr orYy)
,C,,T/t. SPILL CONTApdtiENT 10~
,U~t DROP TUBE ~,QQ~,_
U 3. STRIKER PLATE
~.=. :,w~': j-'~'~.'3e•~~yr'4' :i:4 .s'a`les' ~~QP;;~NIi;T~111KCdAKO
,.
IF sI-wu t+tuu.L 1'AAtK (~ +~ Lna.oo9rk
^ t. VISUAL (EXPOSED PORTION ONLY) ^ i MANUAL. TANK OAUGINCI (MTTO)
^ 2. AUTOMATIC TANK LiALW WO (ATO) ^ a. VADOSE lANE
^ ). CONTINUOUS ATO ^ 7. GROUNDWATER
^ •. STATISTICAL 6WENfORY RECONCILIATION (SIR) • ^ ~. TM6( TESTING
BIENNIAL TANK TlSTINO ^ ~. OTHER
^ 1. }RSUAL (9WOLE WALL IN VAULT ONLI~
LE U•/2/ COIYTINUOlJ3 INTERSTTfIAI MONRORINO
^ 3. MANUAL MONRORINO
ona
.. __ --
. V. TANK CLOSURE INPORMATKIN I PER6IANENT CLOSURE IN PLACE
lSTIMMTEO OAT! LAST LISlD (YWUAO/OAY) 466 lSTWATlO GUANTRY OP SUSSTANCd RlAWNM40
aMona
466 TALK FILLED WITiI INERT MNTERIALT
^YM ^No
431 OVERFILL PROTECTION EpUIPMENT: YEAR INSTALLED ~' 2
_ ^ 1. ALARM ^ ~. FILL TUBE SHUT OFF VALVE _~
_ ^ 2 BALL FLOAT ^ Oo~ a 4. EXEMPT
167
UPCF (71'99) 8:1CUPAFORM313WRC~'~C
CITY OF tIAKER9FIELD
OffK:E Of ENVIRONMENTAL SERVICES
1715 CMst~r Aw., t)ak~nflNd, CA 9JJ01 (6A1) ~2t1.~79
6~ WT • TANK -AO!
f
a
vl rrtao caNSTttucTlDN (al.a- r trl.t agp/q
UNOEROROUND PIPING i ABOVEGROUND PIPING
SYSTEM rvPE ~ PRESSURE ^ 2. SUCTION ^ 3. GRAVITY 458 ^ I. PRESSURE ^ 2. SUCTION ^ ~_ ca.v.,..
CONSTRUCTIOW' ^ I' SINGLE WAIL ^ ]. LINED TRENCH ^ 90. OTHER 480 i ^ t. SINGLE WALL
MANUFACTURER, DOUBLE WALL ^ t-S. UNKNOWN ^ 2. DOUBLE WALL
' ~ MANUFACTURER 461 I MANUFACTURER
^ t. BARE STEEL ^ 6. FRP COMPATIBLL tAr t00% 6ETHANOL
MATERIALS ANO ; ^ 2. 9TAINIE3$ STEEL ^ 7. GALVANZED STEEL
CORROSION
~ PROTECTION . ,^~ ]~. PLASTIC COMPATIBLE WIT}1 CONTENT$ ^ >a8, UNgpyyN
! Ci'4. FIBERGLASS ^ B. FLEXIBLE (HOPE) ^ 9sa. OTHER
,^ S. STEEL W/ COATING ^ 9. CATHOOK; PROTECTION 484
^ 93. UNKNOWN
^ 99. OTHER
^ t. BARE STEEL ^ 6. FRP COMPATIBLE W/ tOp% 1~
^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL
^ ]. PLASTIC COMPATIBLE WITH CONTENTS ^ 8. FLEXIBLE (MOPE) ^ 9Y. OTHER
^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION
^ S. STEEL w/ COATING ^ gS, UNKNOWM
a~
•E
46
VN. PM~NtO LEAK DETECTK)N (Cheat of thet agoty) ------.--
PIPING
.w•~r. •~nrr ~~~ fee
PRESSURIZED PIPING (C/teGc a1 t71et appyJ:
^ t . ELECTRONIC LINE LEAK DETECTOR 7.0 OPN TEST ~ AUTO PUMP SFNJT OFF FOR
LEAK SYSTEM FAILURE. AND SYSTEM OISCOMECTION +AU06LE AND VISUAL
ALARMS
^ 2. MONTHLY 02 QPN TEST
^ 3. ANNUAL OtTEGRITY TEST (0.1 GPM)
~ CONVENTIONAL SUCTION SYSTEMS:
^ S. DAILY VISUAL MONTTORWG OF PUMPMG SYSTEM + TNIB6•BAL PpBiG O~ITEGRrtY
TEST (0.1 GPM)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPUr('k
^ 7. SELF MONfTORING
GRAVm FLOW:
^ 9. BIENNIAL INTEGRITY TEST (0.1 ciPH)
sECONDARLY CONTAINED PIPBq
PRESSURIZED PlPlti(i (Chedr M /hat apto/y):
~ 10. CONTiNUpU3 TURBINE SUMP SENSOR ~ AUWBIE AND VISUAL ALARMS AND
~)
AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
i b. AUTO PVMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SY3TEu
CONVENTIONAL SUCTION SYSTEMS (Cheat N tltat appy):
^ 5. GAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM
^ 6. TRIENNIAL INTEGRm TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING}
^ 7. SELF MONITORING
Gw+vITY FLOW (Cheat a/ Mat ayp/y):
^ 8. DAILY vrsuAL MONRORING
^ 9. BIENNIAL utrEGRITY TEST (0.1 GPH)
SECONDARILY CONTAINED PIPING
PRESSURIZED PIPING (Cheat d that apyy):
10. CONTINUOUS TUR88iE SUMP SENSOR IVY} AUDIBLE AND VISUAL ALARMS AND (dlseJt one)
^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
n
~~wt~e ~ww ~nnu ~
PRESSURIZED PIPING (CMGt a/ tYNt eppy~
^ t. ELECTRONIC LOrE LEAK DETECTOR 3.0 GPH TEST ~1 AUTO PUMP SHUT OFF FOR LEAK,
SYSTEM FAILURE. AND SYSTEM DISf~N4ECT10N + AUDIBLE AND VISUAL ALARMS
^ 2 MONTHLY 02 GPM TEST
^ 3. ANNUAL IMEGRRY TEST (O.t GPH)
^ 4. OAIIY VISUAL CHECK
Vll{.~)IYIYCV1~h
CND ALtTO PUMP SHUT OFF ~ ~. ..~.~. ~.__ ~".~•~• ~•~.++~.•.rw.v.r.•...vwr~ryW V.J1GI.I VIJWni~LVINf~
^ G ND AUTO PUMP SHUT OFF
~~
UJ t t . AUTOMATIC LINE LEAK DETECTOR (9.0 OPN TESn ~ FLOW SHUT OFF OR ^ t t. AUTOMI-TIC LEAK DETECTOR
RESTRICTION
^ 12. ANNUAL tttTEGRITY TEST (0.1 GPFt) ^ t2 ANNUAL INTEGRRY TEST (O.t GPH)
SUCTION/GRAVTTY SYSTEM: SUCTIONKiftAVITY ~,~~
^ t 3. CONTINUOUS SUMP SENSOR +AUOIBLB AND VISUAL ALMMB ^ i3. CONTINUOUS SUCrP SENSOR + AUDIBLE AND VISUAL ALARMS
EMERGENCY GENERATORS ONLY (Cheat a/rrtaBpyJ EMERGENCY GENERATORS ONLY (Cheek ar Ihataypt)~
^ t 4. CONTNUOU9 SUMP SENSOR ~ AUTO PUMP StttlT OFF • AUDIBLE AND
^ 14. CONTINUOUS SUMP SENSOR ~ AUTO PUMP SHUT OFF + AUDIBLE ANO VISUAL
VISUAL ALARMS ALARMS
I ^ t S. AUTOAMTIC LINE LEAK DETECTOR (S.0 GPH TEST) ~ FLOW sHlrT OFF OR ^ 1S. AurOM11TiC L WE LEAK DETECTOR (3.0 GPH TEST)
i RESTRICTION
~ ^ tH. ANNUAL INTEGRITY TEST (0. t GPH) ^ 18. ANNUAL INTEGRITY TEST (0.1 GPH)
^ t 7. GAILY VISUAL CHECK ^ t1
7
AILY VISUAL CHECK
G
.. ~_..fii...~ ~~~
M ~
Y~e
{1
t~ fj: y~y~~,+j_.r
']I ::~.: Y t. 'S.{~~ 3tllY~~ ~~~L`~•~i:. .R.~iTXa:~~ ~1!
DISPENSER CONTAINMENT ^ t.
FLOAT MECHANISM THAT SHUT'S OFF SHEAR VALVE ^ 4. DAKY VISUAL CHECK
OAT INSTALLED 468
^
2. ~NTINUOUB DISPENSER PAN SENSOR + AUDIBLE AND VISUAL AlJ1RM3 ^ S. TREtrCH LINER / MONRORING
,
.
t~i/CONTIT~I)OUS 018PEN8ER PAN SENSOR ~ AUTO SHUT OFF FOR DISPENSER + AUDIBLE ANp VISUAL. ALARMS ^ 6. NONE 489
DL OWNERIOPERATOR SIONATUR6
I eartih that me v~tamabon Prorieed hereto le aw soarrNe to the heat of ^tY knotMedpe.
SIGMA U Of ONMER/OPERA OR GATE 470
~
D
F OWNERIO TOR (prtnq .471
~~ TRIE OF OWNER/O
47Z
RR '~FOR
(C/
UPCF (7/99) S:ICUPAFORMSISWRCB-B.WP~
,~~'' CITIc' OF B~-KERSFIELD
~~ OFFICE OF EiYVIROIYMEiYTAL SERVICES
~i,rr
~~rr 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
-' ~ ""' UNDERGROUND STORAGE TANKS -TANK PAGE 1
P.o. _ a
rvPE OF ACTION ^ 1. NEW SITE PERltaT ^ .. AMENDED PERMIT ^ !. GRANDE Of INFORMATION) ^ d. TEMPORAAY SITE CLOSURE
i G+~C- OM ~fMr onhJ
^ 1. PERMANENTLv CLOSED ON SRE
^ ]. RENEWAL PERMIT (~~, ~~ • ~ be~l ub ~Yl (SO«h ~~p+ • ~ ibeal use ~YJ ^ e. TANK REMOVED
BUSINESS NAME (Same M RACIUTV NAME v OBA • Oorq Birlrww N- ] FACILITY 10 •
IOCA
L TANK DESCRIPTK~N
TANK 10 • .]Z TANK MMNUFA TURER AJJ ~ -~
CAMPARTMENTAIIZED TANK Yes ~' No s
N'Yaa', aomDlsla ans 0a9a far satl~ aamParonara.
OAT I 1 ) IN NU i
Wa
L TANK COItTEltTS .
r TANK USE 439 PtTADIEUM TYPE .•
MOTOR VESICLE FUEL ~/
~i REGUINt UIiFJ10fA ^ 2. LEADED ^ S. JET FUEL
(Mrnarkad ~r P ~/ ^ 10. PREMIUM UNLEADED ^ 7. DIESEL O 8. AVIATION FUEL
^ z. NoN•FVEL PETTtoLEUM ^ ,a LBDGRADE UNLEADED ^ •. GASOHOL O 90. oTHER
^ ]. CHEMKJ1L PRODUCT
! O .. HAraROOUS WASTE t~+cwa~aa col~~oN NAME (Ilom hYatrabrw Araaw+ara man aa+1 .., CAS +t (Warn -/asa~ot>,a lmvnaro+E•l +•.
ua.a an
j ^ 9s. uNKNOwN
rl. TANK C0N9ntUCT1ON
TYPE vF rANK ^ ~. Swclsg vYALL O s. SL~JOLH WALL WITH ^ s. sr+oLE wALJ. vVITH INTFANAL BLADDER SYSTEM 4.]
~ (cn.cx on..awn «r» (~ t DOUBLE WALL EXTERIOR MESeaANE L1NER ^ ~. uNlv~lOwN
^ 4. sB~oLE WALL W A VAULT ^ Ey OTNER
TANK MATERIAL, . prMUry faNt ,. BARE sTTa ^ 3. FreERGU-ss /PLASTIC ^ 3. CONCRETE ^ 9s. uwaaowN 4N
(CMrJr ona mwn aM'1 ^ 2 STAINLESS STEEL ^ 4. STEEL CLAD NuFIBERGIASS
FRP)
REBdFFORCED PLASTIC ^ B. FRP COIrPAnBI.E vvnoo% METHANOL ^ 9si. OTHER
i TANK MATERIAL • aaoandary lank ^ 1. BARE STEEL (
^ ]. FIBERGLASS /PLASTIC ^ 0. FRP COMPATIBLE W/700% 6ETFWI0I ^ 96. UNOrIOWN 4.5
(CMtlr ona 4an aM'1 ^ 2 STAMILESS STEEL '~J 4. S'TEEL ^ 0. FRP N0N•00RR0O18LE JACKET ^ 9Y. OTHER
~D ^ t0. COATED STEEL
O s. ooNC~ETE
TANK INTERIOR LNMKi ^ !. RLJOeFR L~ O 3. EPOXY tINPq ^ s. O1J188 ILNLNO ^ 96. UNIQrOMM 44s DATE MISTAt1ED 447
OR COATLNG
^ t ALKYD Ll1~s~Ki ^ 4. PFENDUC LIWING ~0. UNLYrEO ^ YO. OTHER
rC/rea ona ewa oNN _ -_ LFabed Iqa orYY)
~TEC~TION~~APPLICABLE ^ ,. MANLIFACTLIRED CATHODIC `~ 3_ FIBERGLASB REaIFDRCEO PLASTIC ^ 96. UNKNOVYN 44e DATE MrSTALLED
~~~~ ^ 4. gNPRESSEp CURRENT ^ 90. OTHER ~ ~~ usa ~/
(ce.~Jr on. Sam arm O t sACRlFlGIAL ANODE ~
SPIV ANO OVERFILL ~~ YEAR WSTALLED 430 TYPE (forbeN use odyl 4S1
(cn.cw,r mar aopy) ,6,.d/~'. sP,LL CoNrAwMENT ~
~ t~J' 2 DROP TUBE ~.
.. _ .. ~
STRIKER PLATE
OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 432
,,^ I1. AL/1RM ^ ~. FILL TUBE SHUT OFF VALVE ~..~
LJl'Z BALL FLOAT ~ I~ ^ 4. EXEhP'T
-- .,~'•'''r. a-~~gY:>+?4- r~i:'~'~..Fy.a..k~r:':~NL•~T~NK1~.~AK~,..ii~/:~"'Itt'v'.a~t~";nt.~.~ [t~~, >Y„<. '=~
^ t. VISUAL iEXP0BE0 PORTION ONLY) ^ s. MANUAL. TANK OAUOIW(I 1~G1 ^ t. VISUAL (SLNGLE WALL IN VAULT ONLY)
^ z. AUTOMATK; TANK GAUG4q (ATO) ^ !. VAOOBE LANE Q„I. COMINIJOUS INTERSTRUL MONITORING
^ 7. CONTINUOUS ATO ^ 7. GROUNDWATER ^ 7. MANUAL MONITORING
^ .. 9TATISTK:AL BYVENT0RY RECONCNJATK]N (Slit) • ^ 0. TANK TESTUrG
. BIENNIAL TANK TESiTNO ^ yo, OTHER
... _ - V:-TANK CLO>dtlRl 1NF0RMATKIN I PIRMANINT CLOdIJRQ IN PLACa
ESTIMATED OAT! WT USED (YRIAADIDAY) 488 ESTMAATSO OUANTRY OP SUBSTANCE REA~WNM10 488 TANI(PILLED WITH INERT MATERIALS
^ YM ^ No
487
UPCF (7/99) 3:1CUPAF0RM313WRC~•~~
-~ CITY OF BAKERSFIELD
OFFICE Of ENVIRONMENTAL SERVICES
'~ ~ t71S CMsNT Aw.. 8akranArald, CA 9301 (6St) 7979
j~ UBT • rAMK PAD!
~ des
VL X1110 CONSTRUCTION (CAa4tt M nut gpipy~
UNOEROROUNO PIPING ABOvEGROUNO PIPING -~
SYSTEM tYPE t PRESSURE ^ 2
SUCTION ^ )
GRAVITY 4S6 ^ t
SUCTION ^ ). CRANKY
PRESSURE ^ 2
.
. .
.
4~
CONSTRUCTIOW'^ ' SINGLE WALL ^ ). LINED TRENCH ^ 90. OTHER 460 ^ t. SINGLE WALL ^ 95. UNKNOWN ~ 4E
MANUFACTURERI~ DOUBLE WALL ^ 96. UNKNOWN ^ 2. DOUBLE WALL ^ 99. OTHER
~ MANUFACTURER 46t MANUFACTURER ~
^ t. BARE STEEL ^ 0. FRP COMPATIBLE W/ 10011 METFtANOI ^ t. BARE STEEL ^ 6. FRP COMPATIBLE W/ t001111~T}y~~
MA7ERULS ANO ~ ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL
PROTECT ON ^ )• PLASTIC COMPATIBLE WTM CONTENTS ^ 96. UNKNOWN ^ 3. PLASTIC COMPATIBLE WITH CONTENTS ^ 8. FLD(IBIE (HOPE) ^ 9Y. OTHER
FIBERGLASS ^ 6. FLEXIBLE (HOPE) ^ 9Y. OTHER ^ 4. FBERGLASS ^ 9. GTHOOK; PROTECTION
^ S. STEEL w/ COATING ^ 9. GTHOOK: PROTECTION 464 ^ S. STEEL wl COATING ^ 95. UNKNOWN 4 fi:
VM. P~M1G LEAK DE TECTION (CAw* at! nut Applp) ': •:'r r:
UNDERGROUND PIPING ABOVEGROUND PIPING
WALL PIPI 466
j SING WALL PIPING 46%
PRESSURIZED PiPINO (C7aecic a/ nut alpip/y~ PRESSURIZED PIPING (CAaGt at/ nut appy):
^ t . ELECTRONIC L.OrE LEAK DETECTOR 3.0 GPDI TEST ~ AUTO PULP SHLR OFF FOR ^ t. ELECTRONIC LWE LEAK DETECTOR 3.0 GPN TEST ~ AUTO PUAP SMUT OFF FOR LEAK,
LEAK. SYSTEM FAILURE. ADD SYSTEM DISCODMIECTION ~ ALDNLB ND VISUAL SYSTEM FA0.URE. AID SYSTEM DISCODI~t:T10N ~ AUDIBLE AND VISUAL ALARMS
AlAR1A3 ^ 2 MONTHLY 02 OPN TEST
^ 2. MONTHLY 02 QPN TEST ^ 3, ADriUAL p~Ggtry TEST (0.1 GPM)
^ 3. ANNUAL OtTEGRIT1f TEST (0.1 QPIQ
^ 4. DAILY VISUAL CDIECK
CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (CASCk uI tlut aPPh):
^ S. GAILY VISUAL MONITORWG OF PLMP84G SYSTEM ~ TR1ENiAL PP84G p~fiECiRITY ^ S. DAILY VISUAL MONtTORlNG OF PIPING ANO PUMPING SYSTEM
! TEST (0.1 GAM) ^ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH)
SAFE SUCTION SYSTEMS (NO VALVES W BELOW GttOUND PPBiGX SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PtPING~
^ 7. SELF MONRORING ^ 7. SELF MONRORINO
GRAVm FLOW: GRAVm FLOW (txnc* at/ tAstaAPp/y}
^ 9. BIENNIAL INTEGRITY TEST (0.1 GPM) ^ 8. OA0.Y VISUAL MONRORYd(i
^ 9. BIEDdr1AL INTEGRITY TEST (0.1 GPH)
SECOIDARILY CONRAINED PIPING SECONDARILY CONTAINED PIPING
PRESSURIZED PIPR~Ki (CMat a-I fhat apply): PRESSURIZED PIPING (CMek an tlut apply}
~ 10. (CONTIDAIOUS TLtR81DIE SUMP SENSOR ~ AUDIBLE ADD VISUAL ALARMS ADD 10. CONTINUOUS TURBBrE SUMP SENSOR Y~ j} AUDIBLE AND VISUAL ALARMS AND (thsG[ one)
' AUTO PUMP SMUT OFF WHEN A LEAK OCCURS ^ a. AUTO PUMP SMUT OFF WHEN A LEAK OCCURS
N OFF FOR LEAKS. SYSTEM FAILURE ADD SYSTEM
~ ~• ^ b. AUTO PUMP SMUT OFF FOR LE/11(S. SYSTEM FAILURE ADD SYSTEM DISCOM~lECf10N
DISCONNECTK)
~ d G No AUTO PUMP sMUr OFF ^ c No Au7o PUMP sMUr OFF
~~ NE LEAK DETECTOR (3.0 GPH TEST) mjtj FLOW SMLR OFF OR
L^f t t. ~ ^ 11. AUTOMATIC LEAK DETECTOR
T
TY T
R
T
P
^ ^ 12. ANNUAL INTEGRITY TEST (0.1 GPH)
I
(0.1 G
M)
12. ANNUAL WTEG
ES
SUCTIONKaRAVTIYSYSTEH: SLICTIODYGFtAVTTY SYSTEM
^ 13. CONTINUOUS SUMP SENSOR ~ AUDIBLE ADD VISUAL ALARMS ^ 13. CONTiN0003 SUCwP SEDISOR ~ AUDIBLE ANO VISUAL ALARMS
EMERGENCY GENERATORS ONLY (CDweat rV ISM ~~ EMERGENCY GENERATORS ONLY (CAaek aV nut apphq
^ 14. CONTINUOUS SUMP SENSOR ~ AUTO PUMP SHUT OFF ~ AUDIBLE AND ^ 14. CONTINUOUS SUMP SENSOR ~ AUTO PUMP SHUT OFF * AUDIBLE AND VISWL
VISUAL ALARMS ALARMS
^ 13. AUTOMATIC LINE LEAK DETECTOR (3.0 GPM TEST) ~ FLOW SDILlT OFF OR ^ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST)
RESTRICTION
j ^ 16. ANNUAL INTEGRITY TEST (0.1 GPM) ^ 18. ANNUAL INTEGRITY TEST (0.1 GPH)
^ 17. DAILY VISUAL CHECK ^ 17. DAILY VISUAL CHECK
a. .Y ~
i a.
?~. - -'w ,ter., a~,~.,e~~~~f{a~. la - ~ .. G ~`.y~ -: 7 ~'
~
(~r`
:T
'
~-
~
~
~
,,
.M
. F-f
c.. ~FT
%~4
-c.'!GT
-
r d~ SKit:
1
' DISPENSER CONTAINMENT ^ t. FLOAT MECHANISM THAT SDNITS OFF SHEAR VALVE ^ 4. DAILY VISUAL CHECK
OAT INSTALLED 468 ^ 2. COMIDA10U8 DISPENSER PAN SENSOR ~ AUDIBLE ADD VISUAL ALARMS ^ S. TRENCH LINER / MONRORING
. CONTNUOU9 DISPENSER PAN SEN90R 1~ AUTO SHUT OFF FOR DISPENSER * AUDIBLE ANO VISUAL ALARMS ^ 6. NONE ~9
DL OWNER/OPERATOR SIGNATURE
I asruN that tM MlbrtnaWOn aaldw heralin la bw arW aaaarata to tha trMt of my wtowgdp•.
~ SI RE Of OWNERIOPERATOR DATE 470
~~
NAME O OWNEWOPERATOR (pnht) 471 TRLE Of O RIOPERATO 472
UPCF (7/99) S:\CUPAFORMSISWRCB-B•WPC
~~~ C[Tlr' OF BAICERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
=" ~~~r
'~Ra 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 ~ ~.
r~" ~ ""• UNDERGROUND STORAGE TANKS -TANK PAGE t "
P'o' a
ryPE OF ACTpN ^ t. NEW SITE PERMIT ^ ~. AMENDED PERMIT ^ 3. CHANGE OF INFORMATION) ^ d. iEMPORAAY $ITE CLOSURE
. G'1.CM OM ~I~III OIVy!
^ 1. PERMANENTLY CLOSED ON SRE
^ ]. RENEWAL PERMIT (~~, Mson • ~,~« u~ ~Y1 (sw~h elwngr • pr,~ ~~ ~Y1 ^ e, TANK REMOVED ,
BUSINESS NAME (Sang «FACIUTV NAME a OBA • OanpAutln«I A•1 ) FACILrtY IO E I ~
O
L TANK OESCRIPTION
I A1vR IU • -.sa .-... -vim ((. vncn ( COMPARTMENTALIZED TANK C]T Y« U NO a
(li~ A .i. ~ . r L ~ _(.1 M -Y«•. oa„pet. ans p.y. (or «a+ con,partrn.n.
u.. a+t-r1
~~
L TANK COKTENi~ .
~ TANK USE 4~! PETROLEUINTYPE k
i MOTOR VENK~ fiLJEI ^ ti REGULAR Ufi.EADED ^ 2 LEADED ^ S. JET FUEL
i (M rnulord. N ~~ ~) ^ 10. PREMTLBA UNLEADED ~OIESEL ^ 6. AVIATKNd FL~L.
^ 2. NON-FUEL PETROLEUM ^ to A~OGRADE UfiF.ADED . ^ ~. GASOHOL. ^ 9D. OTHER
^ ]. CHEMICAL PRODUCT CO~w~ON NAME (Atxn Ifrtan7bw uw~waei kMn4ryP~1
KI CAS t (nom rlaaeowRtr wa~.a annara+sa.) sa:
^ .. NALIRDOUS WASTE (Ax'wd.1
uaae OQ .
j ^ 9s. uNlaow++
M. TANK CONSTRUCTION
TYPE OF TM1C ^
i
8EgLE WALL ^ S. SM10LE VYALL 1MTN ^ S. 3lIGLE WALL 1MT}I INTERNAL BLADDER SYSTEM Ili
j (Cnau one Avn oNyJ ,
~
/
L~/L DOUBLE vW1LL T~
~
~
L ^ t)6. UN1W01M~
j ^ 4. SWDLP WAL
A V
AIX.
W ^ 9D. OTHER
TANK MATERIAL • O~~Y faftk .BARE STEEL ^ 3. FIBERQlA33! PLASTIC ^ S. CON(StETE ^ 95. U4NOVOVVRd 11~
(CAsek aN itaer urY) ^ 2. STAViES3 STEEL ^ 4. STEEL CLAD WIFIBERGLASS ^ !L FRP COMPATIBLE W/100% METHANOL ^ 9D. OTHER
rrravcncrreu rtna ~ ti trey/
TAN!( MATERIAL - aKall0ry taltk ^ 1. BARE STEEL ^ ]
FIBERGL/LRS! PU-9TIC ^ S. FRP COMPATI8LE WHOp% AETHANOL ^ 9S. UNQdOVIM ~
(CnarJr oeta Inr- arY1 ^ 2 STANE.ESS STEEL ~
/
L1Lf': STEEL CLAD W/FIBERGLA33 ^ 0. FRP NON-CORRODIBLE JACKET ^ 9Y. OTHER
REIPFORCED ~~ (~ ^ 10. COATED STEEL
O s. coNCRETE
TANK INTERIOR L1dMKi ^ t, RUBBER LMT O S. EPOXY LMp~iG O s. OLAS8 LINING ^ 9s. uNlc+DVl~i us GTE NSTAe a cn s17
OR COATING
^ 2 ALXYD L1ON0
^ ~. PFENOUC LM~dO ~
W/o. LJMJIED ^ 9i. OTHER
CAsen oM Iwlf
OTHER CORAOSKIN ^ t. MANUPACTLiREO GTNOOIC FIBERGLASS REWFORCED PL bul uaa
ASTIC ^ 96. UMOrOWN 11•! DATE WSTAI I Ffl K9
PROTECTION ~ APPUCABL.E PROTECTION
^ •. OHPRESSEO CURRENT
^ siB. OTHER
(Cnadr ona i(anr aMy) ^ Z SACRIFICIAL ANODE (Forbal usa aM'1
YEAR INSTALLED ISO TYPE (Forbealleta oM')
SPILL ANO OVERFILL ISt OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452
T /
SPILL COHTAWLEHT
k aI ntal ~
~
'
y)
Cn ~~ ^ 1. ALARM ^ ]. FIl1 TUBE SHUT OFF VALVE -
.
pp
oe
(
~
/
2, pROp TUBe
L~
J ono 3 ^~ BALL FLOAT OD ~ ^ I. EXfbP'f
,
.
./
LG ]. STRU(ER PLATE ~.~
.. ... •.
;,:_ '.•.'"'.y;, .. ,, .4 M1 ' ••.: ¢~
r `:.;.; ~ •~ ~ ::,..;.11k: TANK LQAK
..
~
.
, d4'riT, fi: ~ . ' ~ 'iir ~~ 4 ~ ~:.
-
IF SOIOLS WALL TANK (CMak M Iilai aigply} 16S a OOU01.! WALL TANK OR TANK WRN BLADDER (CMut oeN XaRI ONYk ~
^ t. VISUAL (EXP'OBED PORTION ONLY) ^ 6. MANUAL TANK GAUGING (MTO) 1l. VISUAL (SWGLE WALL IN VAULT ONL`>7
^.
^ 2. AUTOMATIC TANK GAUGMIO (ATO) ^ d. VADOSE ZONE ,,
,
t~'~. CONiiNUOU$ INTERSTRIAL MDNRORINO
^ ]. CONTINUOUS ATO ^ 7. GROUNDWATER ^ 3. MANUAL MONITORING
^ l STATISTICAL MNENTORY RECONCIWTKkI (Slit) • ^ B. TANK TESTING
BIeNN1A1. TANK TESTMq ^ yp, OTHER
- ----
_ . _..- . - ... - :.-, ..:.. - . V. TANK CLOBtJItQ INfORMATKkI ! PlRMANdNT CIJDSURE IN PLa1Ca
.
`
-
lSTIMATl0 a-rO LABT USED (YRlMO(oAn Lee ESTBMTEp GUANTm oP SLIBBTANCE RBMAINMIG sae TANK FILLl0 WITH INERT MATERIALI
UPCF (7/99) 3:1CUPAFORMS~SWRC~'~C
CITY OF BAKERSFIELO
OFFICE Of ENVIRONMENTAL SERVICES
1715 CTl~star Aw., 8ak~rsANd, CA 9~J01 (bat) 324,1979
UBT • TANK PAGE
~~ ~ a ~
K f ~NIO CONSTRUCTION (CMat a/ tlwt ~o0/Y1
UNOEROROUNO PIPING j ABOVEGROUND PIPING
SrSTEM TYPE I PRESSURE ^ 2. SUCTION ^ ]. GRAVITY 4S6 ^ I. PRESSURE ^ 2. SUCTION ^ ]. GRAVITY
a=
^ I. 91NGLE WALL ^ ]. LINED TRENCH ^ 9Y. OTHER 460 ^ I. SINGLE WALL ^ 95. UNKNOWN
CONSTRUCTIOW' aF
MANUFACTURERi~000BLE WALL ^ 96. UNKNOWN ^ 2. DOUBLE WALL ^ 99. OTHER
~ MANUFACTURER 46t MANUFACTURER ~
^ I . BARE STEEL ^ 6. FRP COMPATIBLE VV/ 100lL IrETIlANOI ^ 1. BARE STEEL ^ 0. FRP COMPATIBLE W/ 100% METF1ANpL
MATERIALS ANO ' ^ 2, gTAINLE99 STEEL ^ 7. GALVANIZED STEEL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL
CORROSION-
' PROTECTION ^ ]• PSASTIC COMPATIBLE NATFI CONTENTS ^ 96. UMQ~gNM ^ ]. PLASTIC COMPATIBLE WITH CONTENT$ ^ 8. FLEXIBLE (HOPE) ^ 91i. OTHER
,L~~/FIBERGLASS ^ 0. FLEXIBLE (ELOPE) ^ 9Y. OTHER ^ 4. FIBERGLASS ^ 9. CATHODIC PROTECTION
^ S. STEEL W/ COATING ^ 9. CATFIOOIC PROTECTION 484 ^ S. STEEL W/ COATING ^ 93. UNKNOWN 46`
VN. PI<•Mi0 LEAK DETECTION (CAac>t aI Nat appy) ;':~:; -:
UNDERGROUND PIPING ABOVEGROUND PIPING
j PIPI 468 31Nti WALL PIPING 48.
PRESSURIZED PIPING (CMck a/ tllat apply): PRESSURIZED PIPING (CAack d Nat apply):
^ t . ELECTRONIC LINE LEAK DETECTOR 3.0 OPN TEST ~{ AUTO PUMP SF1Uf OFF FOR ^ t. ELECTRONIC LWE LEAK DETECTOR ].0 GAM TEST ~TI(AUTO PUMP SMUT OFF FOR LEA!(
LEAK SYSTEM FAILURE. AND SYSTEM DISDOt'1'ECT10N ~ AUDBLE AND V18UAL SYSTEM FAILURE AND SYSTEM WSCONdECTgN ~ AUDBLE AND VISUAL ALARMS
't'L't'R~ ^ 2 MONTHLY 02 OPH TEST
^ 2. MONTHLY 02 QPN TEST ^ ]. ANNUAL ptTEQ~y TEST (0.1 QPFq
^ 3. ANNUAL RITEGRRY TEST (0.1 QPIt)
^ 4. DAO.Y VISUAL CHECK
CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (CMdc a/ Nat appy):
^ S. DAILY VISUAL MONtTORINK3 OF PUMPB4G SYSTEM • TRIB'1iAl PpWG INTEGRrtY ^ S. DAILY VISUAL M01'RTOR04G OF PIPING AND PUMPING SYSTEM
TEST (O.t GPM) ^ 6. TRIENNW. INTEGRITY TEST (0.1 GPFq
I SAFE SUCTION SYSTEMS (NO VALVES W BELOW GROUND PIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING}
^ 7. SELF MONRORING ^ 7. SELF MONTTORIN(i
.
GRavm Flow: GRAVrrY Ftow (aNat ~ Nn apply):
^ 9. BIENNIAL INTEGRITY TEST (0.1 GPIs) ^ 8. pA0.Y VISUAL MOf4fTORWG
^ 9. BIEMd1Al 7dTEGR1IY TEST (O.1 GPH)
SECONDARILY CONTABIED PBMNO SECOlDARILY CONTAINED PIPpI(i
PRESSURIZED PIPING (Cheat a/ Nat apply): PRESSURIZED PIPING (Cheek of Nat appy~
10. CONTIM10U3 TURBINE SUMP SENSOR ~ AUDIBLE AND VISUAL ALARMS ANO
~ ( ~)
t0. CONTINUOUS TURBBiE SUMP SENSOR 11VI'TFI AUDIBLE ANO VISUAL ALARMS AND (thedl one)
p a AUTO PUMP SMUT OFF WHEN A LEAK OCCURS ^ a. AUTO PUMP SMUT OFF NMEN A LEAK OCCURS
OFF FOR LEAKS. SYSTEM FAILURE AND SYS'TEtiA
~
~ ^ D. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE ANp SYSTEIN DISCONNECTION
DISCONNECTION
~
' ^ G NO AUTO PUMP SMUT OFF
J e. NO AUTO PUhP SMUT OFF
~,/' L ^
Ird t 1. AUTOMATIC LWE LEAK DETECTOR (3.0 GPM TEST) ~,t(FLOW SMUT OFF OR 11. AUTOMATIC LEAK DETECTOR
,.~ RESTRICTION
^ 12 AMAIAL INIEGRITY TEST (0.1 GPH)
L9 t2. ANNUAL WTEGR(11f TEST (0.1 GPIq .
SUCTION/GRAVITY SYSTEM: SUCT10WGtIAVTTYBYSTEM:
^ t ]. CONTINUOUS SUMP SENSOR ~ AUDIBLE AND VISUAL ALARMS ^ 13. OOKTiMJOUS SUMP SENSOR • AUDIBLE AND VISUAL ALARMS
EMERGENCY OENERATORB ONLY (CllacR of Nat a;goq) EMERGENCY GENERATORS ONLY (CAadt a1 tllat appl»
^ 14. CONTOaJOUS SUMP SENSOR AUTO PULP Stll)f OFF ~ A11018LP MD ^ 14. CONTINUOUS SUMP SENSOR AUTO PUMP SMUT OFF ~ AUDIBLE AHD VISUAL
VISUAL ALARMS ALARMS
^ t S. AUTOMATS UNE LEAK DETECTOR (1.0 GPM TEST) ~ FLOW 9t4)T OFF OR ^ 1 S. AUTOMATIC LWE LEAK DETECTOR (S.0 GPH TEST)
RESTRICTION
^ t 8. ANNUAL INTEGRITY TEST (0.1 GPM) ^ 18. ANNUAL INTEGRITY TEST (0.1 GPH)
^ 17. GAILY VISUAL CHECK ^ 11
Y
I
A
~
A
IL
V
L
C
ECK
7
G
SU
1
~
~~
I{
~
p
~
~
'
/Y~l
~l
1
~
4,
DISPENSER CONTAO&IAENT ^ 1. FLOAT MECHANISM THAT SMUTS OFF SMEAR VALVE ^ 4. DAILY VISUAL CHECK
GATE STALLED 468 ^ 2. NTOHUOUB DISPENSER PAN SENSOR ~ AUOIBLti AND VISt1AL ALARMS ^ S. TRENCH LINER !MONITORING
CCX)NTWUOUS DISPENSER PAN SE1J30R ~ AUTO SMUT OFF FOR DISPENSER • AUDIBLE AND VISUAL ALARMS ^ 6. NONE 489
DL ONfNER/OPERATOR SIGNATURE
I certiy Nal Ina Mhxmabon proNOad haraln la trw ane aoaxata to n+a Datl a1 mY lulowladpa.
j SI T E OF OWNER/OPERA OR GATE 470
~- ,a ~
NAME O OWNER/OPERATOR (prNt) 471 TRLE OF 0 RIO BATOR 472
i
UPCF (7/99) S:ICUPAFORMSISWRCB-B.~U
ELITE MOBIL MART SiteID: 015-021-001065
Manager TIM TRAN
Location: 3620 WILSON RD
City BAKERSFIELD
BusPhone: (661) 833-6507
Map 123 CommHaz Moderate
Grid: 11D FacUnits: 1 AOV:
CommCode: BFD STA 07
EPA Numb:
SIC Code:5541
DunnBrad:77-020-8038
Emergency Contact / Title Emergency Contact / Title
TIM TRAM ~ / OWNER KAREN K TRAN / OWNER I
Business Phone: (661)
833-6507x
Business Phone:
(661) ~
833-6507x
24-Hour Phone (661) 827-8889x 24-Hour Phone (661) 827-8889x
Pager Phone (661) 431-5090x Pager Phone (714) 623-3866x
Hazmat Hazards: Fire ImmHlth DelHlth
Contact KAREN CHHAN Phone: (661) 833-6507x
MailAddr: 3620 WILSON RD State: CA
City BAKERSFIELD Zip 93309
Owner TIM & KAREN TRAN Phone: (661) 827-8889x
Address 3002 BOULDER RIDGE RD State: CA
City BAKERSFIELD Zip 93313
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives:
PROG A - HAZMAT
PROG U - UST
~N~`~ J U ~ ~ ~OQ7
~]^,~ I
;,~~~.d on rr?y irgUiry
i 3 those In ~~~,~{duals
o,
the information, ! c.;;ti~y
ng
reaponr'-;e nor oe.aEn
eralty of la4^~ tha. I have pe~ronally
under ?
xamined and am familiar with the information
e
submitted and believe the information is true,
let°
accurate, and comp
Z~~-~7
_
Signature ~ _ __
Date
-1- 07/11/2007
F ELITE MOBIL MART SiteID: 015-021-001065 ~
STORAGE CONTAINER DATA (UST FORM A)
Last Action Type:
FACILITY/SITE INFORMATION
Business Name: ELITE MOBIL MART
Cross Street
Business Type: Org Type:
Total Tanks 3 IndnRes/Trust: No PA Contact:
Dsg Own/Oper AARON KOOP ICC Nbr: 5246167-UC
PROPERTY OWNER INFORMATION
Name KAREN K TRAM Phone: (661) 833-6507x
Address:
City
Type INDIVIDUAL
Name KAREN K TRAN
Address:
City
Type INDIVIDUAL
BOE UST Fee# 039984
Financ'1 Resp: STATE FUND
Legal Notif
Date:02/11/2000
Name:TIM TRAN
State UST #
State: Zip:
TANK OWNER INFORMATION
Phone: (661) 833-6507x
State: Zip:
Phone: (111) 6 -
Ttl:OWNER
1998 Upg Cert#: 00807
x
-2- 07/11/2007
F ELITE MOBIL MART SiteID: 015-021-001065 ~
~ Hazmat Inventory By Facility Unit ~
~ MCP+DailyMax Order Fixed Containers on Site ~
Hazmat Common Name... ~SpecHazIEPA Hazards) Frm I DailyMax IUnit~MCP)
UNLEADED GASOLINE F IH DH L 15000.00 GAL Mod
SUPER UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod
DIESEL F IH DH L 5000.00 GAL Low
-3- 07/11/2007
-4- 07/11/2007
F ELITE MOBIL MART SiteID: 015-021-001065 ~
~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
UNLEADED GASOLINE Days On Site
365
Location within this Facility Unit Map: Grid:
UST CAS#
8006-61-9
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Liquid TMixtur~mbient ~ Ambient -~ER GROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
15000.00 GAL 15000.00 GAL 15000.00 GAL
nr~ZARDOUS COMPONENTS
gWt. RS CAS#
100.00 Gasoline No 8006619
I1L~GLiiCL tiJ JP~.7 iJl•1L'1V 1.7
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH DH / / / Mod
~ Inventory Item 0003
COMMON NAME / CHEMICAL NAME
SUPER UNLEADED GASOLINE
Location within this Facility Unit
UST
STATE TYPE PRESSURE
Liquid TMixture ~ Ambient
Facility Unit: Fixed Containers on Site ~
Days On Site
365
Map: Grid:
CAS#
8006-61-9
TEMPERATURE CONTAINER TYPE
Ambient -~ER GROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum I Daily Average
10000.00 GAL 10000.00 GAL 10000.00 GAL
^Y
ru-~c~x~cLVU~ ..OMPONENTS
%Wt. RS CAS#
100.00 Gasoline No 8006619
LSHGl-iRL H. 7.7 L' JJ1.1P~1V 1.7
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH DH / / / Mod
-5- 07/11/2007
F ELITE MOBIL MART SiteID: 015-021-001065 ~
~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
DIESEL Days On Site
365
Location within this Facility Unit Map: Grid:
W OF MARKET CAS#
68476-34-6
Liquid TYPE PRESSURE TEMPERATURE ~EROGROIINDRTANKE
TMixture ~mbient ~ Ambient
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
10000.00 GAL 5000.00 GAL 4000.00 GAL
llclc~rucl~v~o ~.vl•1rv1v~1v1J
%Wt. RS CAS#
100.00 Diesel Fuel No. 2 No 68476302
171'~[~t]itL tiJ ~7 ~w7 J1.1L~1V 1J
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH DH / / / Low
-6- 07/11/2007
F ELITE MOBIL MART SiteID: 015-021-001065 ~
Fast Format ~
~ Notif./Evacuation/Medical Overall Site ~
~ Agency Notification 05/24/2006 ~
CALL 911, NOTIFY FIRE DEPT, OFFICE OF ENVIRONMENTAL SERVICES 326-3979 OR
800-424-8802.
Employee Notif./Evacuation
TELL EVERYONE TO LEAVE IN A LOUD VOICE.
10/16/1990
Public Notif./Evacuation 05/24/2006
WORD-OF-MOUTH. STATION EMPLOYEE AT EACH ENTRANCE TO KEEP PUBLIC OUT OF THE
HAZARDOUS AREA.
Emergency Medical Plan 05/24/2006
CALL 911 AMBULANCE.
-7- 07/11/2007
,, ,
F ELITE MOBIL MART SiteID: 015-021-001065 ~
Fast Format ~
~ Mitigation/Prevent/Abatemt Overall Site ~
~ Release Prevention 10/16/1990 ~
GAS PUMPS HAVE NOZZLES EQUIPPED WITH VAPOR RECOVERY SYSTEM. ALL STORAGE
TANKS ARE MONITORED DAILY.
Release Containment 05/24/2006
KITTY LITTER OR OTHER ABSORBENT MATERIAL.
Clean Up
CALL ENVIRONMENTAL CLEAN-UP COMPANY.
10/16/1990
Other Resource Activation
-8- 07/11/2007
~.
F ELITE MOBIL MART SiteID: 015-021-001065 ~
Fast Format ~
~ Site Emergency Factors Overall Site ~
_, ,_
.~~c~.iai raac~atuo
Utility Shut-Offs
ELECTRICAL - INSIDE W WALL OF STORE
WATER - ALL CRNRS OF BLDG
02/28/2007
Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - 2 FIRE EXTINGUISHERS.
01/30/2007
NEAREST FIRE HYDRANT - 200FT S OF STORE ON WILSON RD NEXT TO MAILBOX.
Building Occupancy Level
2 EMPLOYEES
05/24/2006
-9- 07/11/2007
.::
P ELITE MOBIL MART SiteID: 015-021-001065 ~
Fast Format ~
~ Training Overall Site ~
~ Employee Training 05/24/2006 ~
MATERIAL SAFETY DATA SHEETS ON FILE.
BRIEF SUMMARY OF TRAINING PROGRAM: ON-THE-JOB TRAINING FOR NEW EMPLOYEES IN
THE USE OF GAS CONSOLE, PUMPS, ETC.
rays ~
. 7 J L .
11G 11A LVl 1"1.AV UlC Vw7G
nciu l.vi ru~.uic ~5C
-10- 07/11/2007
~-n ~~Z.~
5 ~ti RC,B, January 2002
~usas
4 Q~
Page i of _I
- Secondary Containment Testing Report Form .
"I'l~is jorm is intended jar use by controcr~rs perjorrning parlodlc testing ojUST secondary containment .tystams. Lisa th¢
appropriate pages of /his jorm to report ~•esults for al(conrponerts tested. The completed jorm, written test procedures, and
printouts from tests (rf applicable), shou(:l be provided to the jacility owner/operator for submittal to the local regulatory agenc~~.
I . FACILITY iNFnRMATTON
Facility Name: eqc~ p p . Date of Testin
Facility Address: 't pri py;tiY fed
Facility Contact: Phone:
llate Locai Agency Was Notified of Testing
Name of Local Agency Inspector ((jpresent during tesrln~; {
~ •lrtti•cvnvr_ rllt~uerTllu rnrzrnuMe^rrnrv
Con~panyNatne:RTCH ENVIRONMENTAL
Tecliniaian Conducting Test: r
Credentiais: HCSLB Licensed Contractor ,aL,~ ~ UT
0 SWRCB Licensed Tank Tester
License Type. C611D40 License Number: 809650
_ Manufacturer Manufacturer Trafnln¢
Com ovens Dete Trainin E Tres
INCON T INCON TS-STS
3. SUMMARY OF TFST RFSiTLTS . .
Component Pass Fai! Not
Tested Repair Component
Made Pass Fail Nof
Tested Repairs
Made
Ui'11. '~ nnu A2 ~ ^ 0 ^ rj- ^ 0 ^
nnv ;Art ~ a D a - ^ ^ ^
rer~ 9 +- ~ ^ ^ ^ ~ rn ^ ^ D
t- ^ ^ ^ UnL 81 ;1 ^ ^ ^
~. ^ ^ U r!<! V ~~ ^ D ^
~~ m ^ ^ 0 0 0 f
rn a a ^ ~ .D r~ ^
~v 3- ^ o ^ ^ ^ ^ ~
It hydrostatic testing was.perfp*med, describe what was done with the water after completion of tests:
RECYCLE AND REUSRD "
CERTIFICATION OF TECHNTCIAN RESPONSTBLE.FOR CONDUCTING THIS TESTTNG
'/'D. the best ofmy knowledge, tfie jacrs stated in this docrtmettl ttre acegr¢[~ and In juU compliance with legal requ(rements
Trchnician's Signature: ~-" Date:~b'~,3' ~~
1~SaS
swRCB, ~a„nary zooz
4, TANK ANNULAR TESTING
j
Page _'_ of
Test Method Developed By: p Tank Manuf'actwcr ~ ]ndustry Standard p Professional Engineer
O Other (Spec~J
Test Method Used: p Fressure ~ Vacuum ^ Hydrostatic
^ Other (Speed)
Test Equipment Used: 9 i n . DIAL GAUGE Equipment Resolution: . S%
s .i~ ~_
--~a
. - ~ 7ts:_
.
...
`` : Tank# Tank#~~ ~
Tank# Tank#
is Tani; Exempt From Testing?' 0 Yes ;Ef.No ^ Yes ~l0 0 Yes ^ No ^ Yes G No
'tank Capacity: ~K 5K
Tank Material: C,@, ~t"e ~ f
Tank Manufacturer: h W
Product Stored: h A~~+
Wait time between applying
pressure/vacuum/water and
starting test: ,30~ ~~ y~
Test Start Tirne: a ~ K~ I~
Initial Reading (R,): ~ p
Test End Time: ~ ~~
Final Reading (Rr:): a h
Test Duration:
v
Change in Reading (RF-Rr):
.Pass/Fail Tltresltold or.C[iteria:
Test Result: ~. Pass ^ Fali ~P885 ^ Fail ^ Pass q Fai! 0 Pass 0 Fail
Was sensor removed for testing? Yes 0 No 0 NA Yes ^ No ^ NA ^ Yes ^ No ^ NA i7 Yes ^ No L', NA
Was sensor properly replaced and
dNA
~ ON
~
'
verifiedfunctionaiaftertestin ? o J
es ONo ^NA ^Yes ^No ^NA OYes ^No ONA
COmmen#S - (include it formatrort on repairs made prior 1o testing and recomnrendedfollow up forjailed tests)
' Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary
containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic ContaitlmCnt
testing, (California Code of Regulations, Title 23, Section 2637(a)(6)}
cY~~S
S WRCB, January 2002
c cxrntvneuv pipes ~r~c'rrtvn
Page ,~ of ,~
Test Method Developed t3y-. 0 Piping Manufacturer ic7 Industry Standard 0 Professional Engineer
O Other (5pec~)
Test Method Used: id Pressure 0 Vacuum ~ Hydrostatic
^ Other (Spec{fy)
Test Equipment Used: gin. DIAL GAUGE Equipment Resolution: . 5~
Piping Run # Piping Run # Piping Run # Piping Ran #
Piping Material: 1(,
Piping Manufauurer:
Piping Diameter: ~• ~ ~'
Length of Piping Run: ~- i?~f~ ~~"
Product Stored:
UhL
UYf~. f
1
Method and Location of
i in -run isolation; ~
1115 ~ ~
~ ,
Wait limo between applying
pressure/vacuum/water and
startin test: q ${'
~ W ~$'t
~ Elq,~ ~-
1711 f~ W t$ R-
11~
Test Start Time: _~
~;
Initial Reading (R~: ;
Test End Time: ; 4~ pr» ~ ;
Final Reading (Rr): ~ ~ ; ~
Test Dtuation:
Change in Reading (RF-Rt):
Pass/Fail Threshold or ~
Criteria: ~ ~~
Test Resalt: ~~ass 0 Fat( ass 0 Fall .Pass i7 Fall Pass 0 Fail
__Commettfs - (include informarton on repairs made prfor to testing and recommended llow-up forJalled tests)
ti
7 ~.
SWRC13, January 2002
c c~rnivn s av ZuroF Ttv c~rnvr
~ ~tsa s
Page ~ of
Test Method Developed By: D Piping Manufacturer fd Industry Standard [] Professional Engineer
D pthcr {Specljy)
Test Method Used: ~ Pressure D Vacuum D Hydrostatic
Q Other (Spec~y} '
Test Equipment Used: 4 i n . DIAL GAUGE Equipment Resolution: . 5916
:~ -
Piping Run # L
Piping Run #
Piping Run #
Piping Run #
Piping Material:
Piping Manufacturer:
Piping Diameter: ~'
Length ofPiping Run: f 00
Product Stored: j e{
Method and location of
i in -ruo isolation: ~
t tin
Wait time between applying
pressurehacuum/wateraad
stariin test:
~ 1Y1i n
Test Start Time: b, ~Qp1r1
Initial Reading (R,): ~ ;
Test End Time; L;
Final Reading (Rr): ~' ~
Tesi Duration: ~ ~~~~
Change in Reading {RF-Rt):
Pass/Fail Threshold or ~
Criterie• ~,~
Test Result: Pass ^ Fail ^ Pass ^ Fni1 O Pass ^ Fail 0 Pass ^ Fafl
Comments - (include lnformallon on repairs madeprlor to testrn~ and recommendedfollow-up jorfa!/ed tests}
ti
t~sas
SWRCB, January 2002
6. PIPING SUMP TESTWG
Page~of~
Test Method Developed By: 0 Sump Manufacturer >~ Industry Standard ^ Professional Engineer
0 Other (Specify)
Test Method Used: []Pressure 0 'Vacuum ftl Hydrostatic
D Other (Sped)
Test Equipment Used: INCON TS-STS Ec}uipment Resolution: , oooin.
- Sump # Surnp # , Sump # Sump #
Sump Diameter. (p' ~ '' ~'
Sump Depth: " .36 ,
Swnp Material: ~~j ~~
-Height from Tank Top to Top of
Hi est Pi in Penetration: ~O'• 1 G ~'
1-leight from Tank Top to Lowest
Electrical Penetration: ~ ~ ~ 1 y' , ~/ ~,
J7
Condition of sump prior to testing: C) P~qh G1 pY1 [r py~
Portion of Sump Tested'
Dces turbine shut down when
sump sensor detects liquid (both
induct and water ?~
D Yes . LJ No ~6(NA
^ Yes ^ No ~
O Yes D N~NA
^ Yes ^ No ^ NA
Turbine shutdown response time ~ hQW
Is system programmed for fail-safe
shutdown?~
^ Yes ^ No ~lA
^ Yes ^ No ~NA ~"
0 Yes ^ No .es,~vA
^ Yes D No 0 NA
Was fail-safe verified to be
o erational? ^ y~ ^ No
78~IIA
D Yes 0 No~4VA
D Yes D No 'OVA
^ Yes 0 No DNA
Wait time between applying
pressure/vacuurn/water and starting
test:
M ~ +'1
~
~ /~
/n + yr
Test Start Time: ~
U. ~ 1.7v111+ti U.SYM~+ ~~.4 ~ Ptr!
lnitia! Reading (R,): y ~~,n +h ~ ~~4 ' ~.03{4:R ~. ~~+n
Test End Time: );~p~ t a1~ ~ ~,. j~:~~ b:SbAm
Final Reading (RF); ~:~ i irr y 4.D~5;n ~.0~,5~n
TestDuratian; ~ ' Alin
Change in Reading (Rr-R~: . Q~~+~ r ()Qptn DDp+V1 .ODOi+~ ~ GW ~rf . ()qpi n
Pass/Fail Threshold or Criteria: ~ +b ~n ,
• {~~,n . lwol+n ~ m v7+n ~ bin
Test Result: ~ Pass ^ Fail ~ Pass ^ Fail -~ Pass D Fail ^ Pass D Fail
Was sensor removed for testing?
Was sensor properly replaced and
verified functional after testin 7 Yes ^ No ^ NA
yes ^ No 0 NA a 0 No ^ NA
es D No ^ NA Yes 0 No ^NA
Yes ^ No ^ NA ^ Yes ONo ^ NA
^ Yes ^ No ^ NA
COIDII3(rIIt3 - (include information on repairs made prior to [esting and recommended follow up or jailed tests)
t If the entire depth of the sump is not tested, specify how much was tested. If the answer to ~ of the questions indicated with an
asterisk (•) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160)
<<l SaS
SWRCB, January 2002
7. UNDER-D7.SPENSER CONTAIlVMENT (UDCI TESTING
Page ~ of
Test Method Developed By: ^ UDC Manufacturer !>d Industry Standard ^ Professional Engineer
^ Other (Specify)
Test Method Used: 0 Pressure ^ Vacuum >~ Hydrostatic
^ Other (Specrfy)
Test Equipment Used: INCON TS-STS Equipment Resolution:.oooirt.
-
~ UDC # - UDC # - UDC # - UDC # -
.
UDC Manufacturer; h no r wn tn'CfK7Wr'`
UDC Material: ` L, ~ ~ [,
UDC De the '
Height from UDC Bottom to Top ~ 3~ , ~~ . ~ ~ ~
of Hi best Pi in Penetration: L
Height from UDC Bottom to 1 ~, ,~ a ~ r ~ ~, •
Lowest Electrical Penetration:
Condition of UDC prior to
testin :
C~>¢.ti'~y'1
G~elAin
~„1~1AY1 55
~1Z~
Portion of UDC Tested rrt y''~ ip
Does turbine shut down when -
UDC sensor detects liquid (both
~ ^ Yes ^ No Cf~NA 0 Yes Q No e~NA ^ Yes ^ No ANA 0 Yes ^ No"~lA
roduct and water ?
Turbine shutdown res once time pw p~ ~~~ ~ ~
Is system programmed for fail-
safe shutdown?`
^ Yes ^ No ~QdA
^ Yes ONoCi;l![VA
^ Yes ^ No~1A
0 Yes (JNo~VA
Was fail-safe verified to be
o crational?~ ^ Yes ^ No CdNA O Yes ,Q No C6~NA 0 Yes ^ No
~iA
OYes ONo~NA
Wait time between applying
pressure/vecutun/water and 1
starrin test ~
Test Start Time: ' ~
initial Readin Ri : ~
Test End Time:
~
Final Readin Rr): ~
Test Duration:
Chan a in Readin {RF-Rr}:
Pass/Fail Threshold or Criteria:
Test Result:
Was sensor removed for testin
? ^ Pass _ el
Y ^ Pass ail ^ Pass alt ^ Pass ail
g
Was sensor properly replaced and es ^ No ^ NA es 0 No ^ NA es ^ No DNA es ^ No UNA
verified functional after testin ? ~'es ^No ^NA dies ^No DNA t ~'es ^No ^NA Yes ^No ^NA
~ if the entire depth of the UDC is not tested, specify how much was tested. If the answer to ~X of the questions indicated with an
asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160)
~ 5'~5
SWRCB, January 2002
8. FILL RISER CONTAINMENT SUMP TESTING
Page ± of . /
Facili is Not E ui d With Fill Riser Containment Sums ^
Fill Riser Containment Sumps are Present, but were Not Tested ^
Test Method Developed By: ^ Sump Manufacturer Industry Standard ^ Professional Engineer
^ Other (Specify)
Test Method Used: ^ Pressure ^ Vacuum 81 Hydrostatic
^ Other (Spec)
Test Equipment Used: INCQN TS-STS Equipment Resolution:. 000 i n .
Ffll Sum # Fill Sum # F[Il Sum # Fill Sum #
Sum Diameter. '~
Sum De the
Height from Tank Top to Top of
Hi estPi in Penetration: ~ •
~~ +
~~ ~ +
~~ ~
Height from Tank Top to [.owest
Electrical Penetration: ) 6 ,• J r ,!
v ~ ~ ~ ~
Condition of sump prior to
testing:
~ I,,,k1
y~r1
A
Portion of Sum Tested
Sum Material: ~ ; ~ {
Waittime between applying
pressure/vacuum/water and
startin test:
)MI ,n
fy., ~
rn ~
Test Start Time: : Olu m ;,'~ , Ol4 r i~
'
Initial Readin R+): .313~~ }$ -h •n .y +ri .l~C r1 . yD+n
Test End Time• . ~ } 'p~ ~, P pM
'
Final Readin {RF : 1 if+ 3} in
, .n 3. n • da.1 iS.esr ,} p'r.
Test Duration: M: ma Ir1i~ lM~n ) !nlin /rti
Chan a in Readin R R,): ,poll , OGp'.n .OMir r OCi-n .OOG•~ :r
Pass/Fail Threshold or Criteria: ,~ a:n ,DO ,y~ , pQ ,n ,(w ,A .OOd+n ~ OOa+n
Test Result: ~-P85S t7 Fai[ ~ Pass ^ Fail ~1 Pass ^ Fail ^ Pass ^ Fail
!s there a sensor in the sump? Yes ^ No ~'cs ^ No Yes ^ No ^ Yes 0 No
Does the sensor alarm when
either product or water is
detected?
D Yes D No ~4vA
D Yes 0 No ~IA
0 Yes ^ No ~lA
D Yes ^ No CJ NA
Was sensor removed for testing? es ^ No ^ NA Yes ONo DNA Yes DNo DNA D Yes ^No ONA
Was sensor properly replaced and
verified functionalaRertestin 7
es DNo DNA
Yes ^No ^NA
es DNo DNA
DYes DNo DNA
Comment8 -- (include information on repairs made prior to testing, end recommended follow up for failed tests)
~saS
SWRCB, January 2002
9_ SPTf.I•J[~VERFIIJ. ('ONTAi11T1VfENT $OXES
Page ~. of
Facili is Not E ui ed With S ilUOverfilI Containment Boxes 0
Spill/Overfill Containment Boxes are Present, but were Not Tested 0
Test Method Developed By: ^ Spil] Bucket ManuFacturer ~ Industry Standard ^ Professional Engineer
G Other (Specify)
Test Method Used: ^ Pressure ^ Vacuum N Hydrostatic
G Other (Specify)
Test Equipmcnt Used: INCO N TS-STS Equipment Resolution: . oooin .
til
~.
S tll Box ~
~L P
Silt Box #
~~Q P
s ;ll Box # Q
~. P I S tlli3oxfl
YOQ P'
Bucket Diameter:
Bucket Depth: ~' 1~•' /a `~ f~.
Wait time between applying
pressure/vacuum water and
startin test:
i'~1i (~
~Q 1'7-~A
b 1q. /~
• /~
Test Start Time: ~;~p~n 11:50~^'~ f.7: :bb ~O:a4~tn IO:ylAnn I:t{
Initial Reading (Ril: ~L~-q ~,(.01,n rj15~•`~ 5 3.3`~l: 3.389: y.~Jgin
Test End Time: f 1:30Ar- ~:OJ M I . ~:~ r ~C:~a+n ID;Sib~+rn ~ .~;.~r
Final Reading{R}): ,~Qp,q ~. Din ~~, S.~Sa-n 3.394:,, 3.3pfi•n t{. •
~n
Test Duration: ~ l1'li/1 15m:n ~JMi,n ~~JMiA ~~/1 I i ~M~~
Change in Reading (RF-Rr)~ .~]ob .h . OOJ. r1 ~ bb1)h , o o'D ~ ~ . t>yaJ~,. . 60Gi l1 . Qb) -n ~ 00 j+/~
Pass/Faii Threshold or
ct;teria:
. aoa •..
- 6od,v-
• ota~ :n ~
. tao~~~.
Test Result: ~ ~P8SS ~ Fai! 0 Pass ^ Fail ~ Pass Q Fail '(Pass ^ Fail
Comments - (include information on repairs made prior to testing and recommended~ollow-up for jailed tests)
~~lsas
SWRCB, January 2002
9. SPILY/OVERFILL CONTAWIi4ENT BOXES
Page I _ of
Pacili is Not E ui ed With S ilUOve~II Containment Boxes 0
Spill/Overfill Containment Boxes are Present, but were Not Tested O
Test Method Developed By: p Spill Bucket Manufacturer 1~ ]ndustry Standard 0 Professional Engineer
^ Other (Sped)
Test Method Used: ^ Pressure 0 Vacuum ~ Hydrostatic
O Other (Sped)
Test Equipment Used: INC ON TS-STS Equipment Resolution: . oooin .
;:~
~
L Spill Box #~(,
Spll[ Box #
Spit! Box #
Spill Box #
Bucket Diameter; ,~'
Bucket Depth: ~~''
Wait time between applying
pressure/vacuurn/water and
startin test:
3O iw.~^
Test Start Time; yD;~YM- ~; j lAlt'f
Initiai Reading (R~): ~,OV~in . 5. d13in
Test land Time: j0:~}/Mn jD:56Aan
Final Reading (R}): 'S, pyy;jr, ~ wf
Tesi Duration: K~r-j n ~ ~
Change in Reading (RF-Rt): , ppp,~ t (spat n
Pass/Fail Threshold or
Criteria:
t ~.~i ~ /~
Test Result: e~ Pass ^ Fail O Pass ^ Fail O Pass O Fail 0 Pass O Fail
Comments - include fn ormalion on re airs .Wade rior to testin ,and recommended ollow-u or ailed tests
87STP
rCC~• STARTED 11:50 Rl~l
TEST STRRTEC; 10/13.2006
at=.GiN LEVEL 4.7344 1'N
~~n h~ME 12:05 PP1
END LEVEL i0r73,t006
LEAK THRESHOLD a. 3`51 IN
TEST RESULT 00z IN
PRSSED
87STP
PEST _.TP~RTED i 1:14 AI'1
TEST STARTED 10x13/2006
I?EGiN I_EVF_L 4.1343 Itd
END TIME 11:39 AM
END f?RTE 10/13!2006
END LEUEL 4.7346 IN
LEAK THRESHOLD 0.0N2 IN
TEST RESULT .PASSED
a7SP!
~~~ST ''?TARTED 11:50 Art
TEST STARTED 10/13/2006
i3E~~IW ! c:V'EL 4.6010 IN
END TIME 12:05 PM
ENU DATE 1!x!13/2006
END LEUEL 4.6009 IN'
LE:iK THRESHOLD 0.002 IN
TEST RESULT PASSED
67SPL
TE':;T STflRTEL' 11:14 AM
TEST STARTED 19/13/2006
?EGIN i._EVEL 4.6097 IN
END TIME - 11:30 RM
END DATE 1iv13r2086
END LEUEL 4.6005 IN
LEnK THRESHOLD 0.002 'iN
TEST RESULT PASSED
DSLSTP
TEST STARTED 10:24 RM
TEST STARTED 10x13/2006
BEGIN !.FUEL 4.0360 IN
END TIME 10:39 AM
END DATE 10/13/2006
END LEUEL 4.0358 IN
LEAK THRESHOLD 0.002 IN
TEST RESULT PAS5EG
DSLSTP
rFT tiTRRTED Iq:41 AM
TEST STARTED 10!13/2006
BEGIN i_EVEL 4.0358 IN
END TIME 1.0:55 AM
Et~D ORTE 1x/13/2806
ENP LEVEL. 4.0.58 IN
LEAK THRESHOLD 0.002 IN
TEST RESULT PASSED
DSLFILL
TEST STARTED b PM
tiE~~Itr i_E!,FL
END TIME' 1Hr13/2006
''• %492 IN
END !iATE
END LEUEL 1:22 PM
Nr13i'?096
LEAK TH""~•
TEST RESL~!~ 7 H0L9 6.1401+ IN
0' d~ I{~
PASSED
DSLFILL - ---
Th,_aT :.Tr.RTED 11:50 Ph1
TEST STARTED 10/13/2806
BEGIN I.-E'JEL 6.1402 IN
END TIME .1:05 PM
:tdO !?RTE 10x13/2006.
ENI) LEUEL 6.1401 IM`
LEAK 1't-PESHOLD 0.002 IN
TEST REST!LT PASSED
~ DS:LSPL
TEST STARTED 10:24 RM
TEST ~.TRRTEU 10/13/2006
6EGIN LEUEL 5.0444 IN
END TIME .18:39 AM
END DATE- 18x13x2006
E.ND LEVEL `.0440 IN
LEAK THR.ESHOLG 0.8tT2 IN
TEc;T RESULT PASSED
91SPL
T'E~~T STARTED 10:24 Ahl
TEST STARTED 10/13/2006
BEGIN LEUEL 3.3513 'IN
END TIME 16x39 AM
Eh;D DATE iQx13r2006
ENU LEUEL 3.3906 IN
LEAK THRESHOLD 0:002 IN
TEST RESULT PRSSED
TEST STARTED 10:41 AM
Tr_ST STARTED 10x13/2606
BEGIN LEVEL 5.0437 IN
END TIME 10:56 AM
END DATE 10x13/2806
Et•;D LEVEL x.0434 IN
LEAK THRESHOLD 0.802 IN
TET F'E.S'Ui_T PASSED
91SPL
TEST STARTED 10:41 RM
TEST STARTED 10/13/2046
BEr;IN !_EUEL 3.3899 IN
END TIME 10:56 RM
ENO i?ATE 10-'13/2006
END LEUEL 3.3892 1N
!_E!-iK ?'!-!RESHOLU 0.002 IN
T7FST RESULT PRSSED
'31UPR ~ y ~' o~S
TFST STAP.TE1i 1:44 PM
TE=.; ~?TARTED lEix13/2006
BEGIN LEVEL 0.0000 IN
END T?ME 2:04 PM
END DATE 10x13x2006
FND iFUEL 0.0000. IN
LEAK THRESHOLD 0.0~SSED
TFST k.E SULT
91STP
rE~"' STARTED
TEST STARTED 1: 4y PM
10%13/2006
BEGIN !._EUEL 4.2974 IN
2:04 PM
END TILL
ENr hRTE 10/13/2006
END LEVEL
t; THRESHOLD 4.2972 IN
x.1.902 ItJ
LEA
TEST RESULT PASSED
_. ... --- :jt.VPR
TEST STARTED 1:4`-' PM
/'140
! 0/1
r;~;T STARTED q
1 1
0.91
4
BEGIN LEVEL .
x:04 PM
Eh{7 "•, it1E
END DATE. 16/11x2006
0985 IN
4
.
~N"v i-~''~Ei- 00:' IN
R
SHOLG O'
EAK
SEG
~~
f,
T
E~~; PAS
':11)PR
TEST STARTED 2:06 PM
TE"" :?TART_D 10r1:zr2006
BEGIN! LEUEL 4.09SS IN
AND ?It9E :22 PM
END DATE 10/13x2006
AND ~_E.VEL 4.0977 ItJ
LEAK THRESHOLD 0.002 IN
TEST r1.ESULT ?ASSED
37FILL
TEST =:TARTER 2:06 PM
TEST STARTED 10/13/2006
E:Er,TN LEUEL 5.3135 IN
END TIME 2:22 PM
END ?P,TE 10/13/2086
END LEUEL 5.3I39 IN
.LEAK THRESHOLD 0.002 IN
TEST RESULT PRS'SE0
91VPR
TEST STARTED 2:06 Prl
TE,T STARTED 18.13!2006
BEGIN LEUEL 0.8000 IN
F:NIi TI't9E '1:22 PM
END DATE 10!13!2086
END !_EVEL x.0080 IN
LEAK THRESHOLD 0.902 IN
TEST F'ESULT PASSED
91STP
TE_'_T STARTED 2:+6 PM
TEST STARTED 10/13/2006
RF'~,If•1 LE_t1EL 4.2974 ~ 1
~
ENL~ T I rIE 2:22 ~h
END BATE 10/13/2006
END LEVEL 4.2977 IN
"LEAK THRESHOLS t3.f96~ ~~
.
TEST RESULT S
PA•
~ e
~~tsa_S '
:3. ~I! L
TEST :aTRP,"fED '1:25 PM
TEST :=TAkTED 1~''13i2006
EtEGI N LEVEL 5.31 S` I P;
AND TINE 1:41 Pht
END DATE 10:132006
END !_E~.JEL X155 IN
LEAk: THRESHOLD 0.002 IN
'TEST r:E$ULT PASSED
'a1FiL
TEST STARTED 1:05 Pt~l
TF~?.T STgitTEu 16.'1312006
BEGIN LEVEL 3.4330 Ira
::,~ TIME 1:21 PM
END DATE 19/13/1096
Eta!7 !_~_UEL ?.4336 IN
LEAK THRESHOL D 0.9x2 IN
T E.SI' ?ESULT PASSED
27VPR
TEST `+'TAR ~ cD 3.: 9i. PM
TEST STARTED 19/13/2096
5E~3IN !_EVE!_ 5.1522 IN
1:12 PM
END TIME
AND DATE 10i13~2~~06
END LEVEL 5.1521 IN
;GAK. THRESHOLD 0.092 IN
TEST RES! ILT PASSEL
13%].'%1996 1'05 PM
S1!MP LEAK TEST REFORT
'~1FILL
TEST STARTED 12:50 Phi
TEST E;7ARTED 19/13/1006
BEGIN LEVEL 3.4336 IN
ENt? ~ I ME i : 95 PC'1
END DATE 10i13:~.2006
END !_EUEL :.4335 IN '
LEAK THRESHOLD 0.002. IN
T= S1' s?ESULT PASSED
37UPR
TEST f,TAF.TED 12:59 PM
TEST STARTED i0i13~2005
I+EG':N i_EVEL 5.1525 IN
END TIME 1:05 PM
END l?ATE 19~13i200fi
END LEVEL 5.1523 IN ~
-EAk: THRESHOLD .0.002 IN
TEST RESULT PASSED
,.
~yS~s
UNDERGROUkU STORAGE TANKS
~._8 i A 8
a~..r~.-:::~.r.'::+i.~^:.Y.T.`Y~~.a:.i~a~!S V•ar•Nn..t^...rF AM.~.rr...:..~~..~.........:):%':.i~:l':1'..:.~.. ~~17 J~
r
APPLICATI~IV ,,~
TO PERFORM ELD !LINE TESTING
1 SB989 SECONDARY CONTAINMENT T>=STIFir_
!TANK TIGHTNESS TEST AND TO PERFCRh.~I
>=UEt_ MONITORING CERTIFICATIO~1
`~T _~,
1 l
O~~O
IT
O
_
PERM
.
N
BAKERSFIEL1r' r IRE DEPT_
Prevention -~e-~-i yes
900 Truxtun P--=_ --~. 2!0 /~
Bakersfield, C.- := := '. - = ~bJ! ~/
Tel.: (66!) 32:-~---
Fax: (b6!) 85='- / /~~ J~~,G
Page 1 of 1
_~
^ ENHANCED LEAK DETECTION L/~ Li,:~ "FST!NCc. ~ SB-989 SECONDARY ' ~ %-= `•~dENT TESTING '.
^ SANK TIGHTNES; TEST _ ^ TQ PERFr~R~,1 F~IF_~ MC;N!TORtNG CERTIPtGAT10N -
-- -- -
' . JI / ! ~l
FACILITY `- „j _.~. ~: NAME & PHONE NUMBER Of CONTACTF==3 -`
:-
,.
. y' ..
,; _
ADfIP,F_SS i ~ ( s r I _ -- ~ ,{ - r
. _ _- ..
G, ; 4- Il .
._~___~.~._~___f __.---- --- _ ~-
OVVNERS NAM£
'~RATORS NAME: - --- ------- -- _-_ i PERMIT TO OPERATE NO. - ~ ~---
~_NUMBER OF.-T:_ANK:_70 BE TESTED !F ~IPi~~-^r~ :=(1iN~3 TC~_9~.TcSTED7_________ O Y S ^ ~'
i TAIJK # ~ ~'L'LUME CC `:~ ~'S
,.
-~
:."~ '
,'
;.~ ~~
.,
-~< -
__. ~ _ _. _.. ---.------ ----. _ _.- . - -- -r -- - ._.._~_..------ - ~--------_-~ - _ -- - -
--- , . _.
.~
._
N
I
I
j TANK T~EST'lNG COMPANY
NAME OF TESTiNC~ C / PANY~ ~ J l r
~• ~ i `
MAILING ADDRES::~ ~.~-r' _ y -- ..
_ ___
NAME J3 PHONE NTIMBER pF TESTER OR SPECfAL INSPECTOR
r '. i ..
DATE & TIME TE~S~'[JO BE COJjIDUCT~D : -•
~ NAME 8 ?HONE NUMBER
~ ~ ~~..
1 a--:_-~ .. ~
:--' ~~-' L-..i-l~.
.~~ CF..RTIFICATION #:
C' ~~
!-.,
lCC #:
'.3T METY,OD
SIGNATURE OF APPLICANT ~-~ ,.• -,; _ _ - r-
~ --- _ -- -
~N.t~`A~.~}.E~,~Tf~J!~~C.4~?9_F~B6h1T~Cd.~~.APRE~(~1~ED - ----- ...
X ._
' APPROVED 8Y DP.TE
_ . : -95 (Rev. 09105;
'°~
:p ~ _
~..
,,
=-ELITE MOBIL MART SiteID: 015-021-001065
Manager :T~ 'M ~ ~~~
Location: 3620 WILSON RD
City BAKERSFIELD
BusPhone: (661) 833-6507
Map 123 CommHaz Moderate
Grid: 11D FacUnits: 1 AOV:
CommCode: BFD STA 07
EPA Numb:
SIC Code:5541
DunnBrad:77-020-8038
Emergency Contact / Title Emergency Contact / Title
TIM TRAM / OWNER KAREN K TRAN / OWNER
Business Phone: (661) 833-6507x Business Phone: (661) 833-6507x
24-Hour Phone (661) 827-8889x 24-Hour Phone (661) 827-8889x
Pager Phone (661) 431-5090x Pager Phone (714) 623-3866x
Hazmat Hazards: Fire ImmHlth DelHlth
Contact ~-Pr2~ C~~'1J Phone: (661) 833-6507x
MailAddr: 3620 WILSON RD State: CA
City BAKERSFIELD Zip 93309
Owner TIM & KAREN TRAM Phone: (661) 827-8889x
Address 3002 BOULDER RIDGE RD State: CA
City BAKERSFIELD Zip 93313
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif~d: RSs: No
ParcelNo:
Emergency Directives:
PROG A - HAZMAT
PROG U - UST
Based on my inquiry of those individuals
onsible fur obtaining the information, I certify ~~~ F
E
resp
under penalty of law that I have personally
information
th B 2 6 2007
e
examined and am familiar with
the information is true,
submitted and beli
ete
l
accurate, and comp
V ~ ~ -a7-0
Signature Date
-1- 01/30/2007
~: ;~ _,
F ELITE MOBIL MART SiteID: 015-021-001065 ~
' STORAGE CONTAINER DATA (UST FORM A)
Last Action Type:-
FACILITY/SITE INFORMATION
Business Name: ELITE MOBIL MART
Cross Street
Business Type: Org Type:
Total Tanks 3 IndnRes/Trust: No PA Contact:
Dsg Own/Oper AARON KOOP ICC Nbr: 5246167-UC
PROPERTY OWNER INFORMATION
Name KAREN K TRAN Phone: (661) 833-6507x
Address:
City State: Zip:
Type INDIVIDUAL
Name KAREN K TRAN
Address:
City
Type INDIVIDUAL
BOE UST Fee# 039984
Financ'1 Resp: STATE FUND
Legal Notif
Date:02/11/2000
Name:TIM TRAN
State UST #
TANK OWNER INFORMATION
Phone: (661) 833-6507x
State: Zip:
Phone: (111) 6 -
Ttl:OWNER
1998 Upg Cert#: 00807
x
-2- 01/30/2007
F ELITE MOBIL MART SiteID: 015-021-001065 ~
~ Hazmat Inventory By Facility Unit ~
~ MCP+DailyMax Order Fixed Containers on Site ~
Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP
UNLEADED GASOLINE F IH DH L 15000.00 GAL Mod
SUPER UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod
DIESEL F IH DH L 5000.00 GAL Low
-3- 01/30/2007
-4- 01/30/2007
F ELITE MOBIL MART
~ Inventory Item 0001
COMMON NAME / CHEMICAL NAME
UNLEADED GASOLINE
Location within this Facility Unit
UST
STATE TYPE PRESSURE
Liquid TMixture~Ambient
SiteID: 015-021-001065 ~
Facility Unit: Fixed Containers on Site ~
Days On Site
365
Map: Grid:
CAS# `
8006-61-9
TEMPERATURE CONTAINER TYPE
Ambient -~ER GROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
15000.00 GAL 15000.00 GAL 15000.00 GAL
-• rlti~.ytcl~~ua ~~lnr~.lv~lvla
%Wt. RS CAS#
100.00 Gasoline No 8006619
riAGAKL A~~L' JJL~1t51V 15
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH DH / / / Mod
~ Inventory Item 0003
COMMON NAME / CHEMICAL NAME
SUPER UNLEADED GASOLINE
Location within this Facility Unit
UST
STATE TYPE PRESSURE
Liquid TMixture ~ Ambient
Facility Unit: Fixed Containers on Site ~
Days On Site
365
Map: Grid:
CAS#
8006-61-9
TEMPERATURE CONTAINER TYPE
Ambient ~ UNDER GROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum I Daily Average .-
10000.00 GAL 10000.00 GAL 10000.00 GAL
nrj~r~tcL~u~ ~vrirvlvlJivl~
%Wt. RS CAS#
100.00 Gasoline No 8006619
nr~~rj.tcL r~~~~aal~ilJlvl~
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH DH / / / Mod
-5- 01/30/2007
F ELITE MOBIL MART SiteID: 015-021-001065 ~
~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
DIESEL Days On Site
365
Location within this Facility Unit. Map: Grid:
W OF MARKET CAS#
68476-34-6
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Liquid TMixtur~ Ambient ~ Ambient ~ UNDER GROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum I Daily Average
10000.00 GAL 5000.00 -GAL 4000.00 GAL
ru~uruc,_,vvv ~.vi•irvtvr~ilTS
°sWt. RS CAS#
100.00 Diesel Fuel No. 2 No 68476302
Ilti[~tiiCL H. 7.7 P~.7 J1"1P~1V 1 iJ
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F IH DH / / / Low
-6- 01/30/2007
F ELITE MOBIL MART SiteID: 015-021-001065 ~
Fast Format ~
~ Notif./Evacuation/Medical Overall Site ~
Agency Notification 05/24/2006 ~
CALL 911, NOTIFY FIRE DEPT, OFFICE OF ENVIRONMENTAL SERVICES 326-3979 OR
800-424-8802.
Employee Notif./Evacuation 10/16/1990
TELL EVERYONE TO LEAVE IN A LOUD VOICE.
Public Notif./Evacuation 05/24/2006
WORD-OF-MOUTH. STATION EMPLOYEE AT EACH ENTRANCE TO KEEP PUBLIC OUT OF THE
HAZARDOUS AREA.
Emergency Medical Plan 05/24/2006
CALL 911 AMBULANCE.
-7- 01/30/2007
F_ELITE MOBIL MART SiteID: 015-021-001065 ~
Fast Format ~
~ Mitigation/Prevent/Abatemt Overall Site ~
Release Prevention 10/16/1990 ~
GAS PUMPS HAVE NOZZLES EQUIPPED WITH VAPOR RECOVERY SYSTEM. ALL STORAGE
TANKS ARE MONITORED DAILY.
Release Containment 05/24/2006
KITTY LITTER OR OTHER ABSORBENT MATERIAL.
Clean Up 10/16/1990
CALL ENVIRONMENTAL CLEAN-UP COMPANY.
Vl.ilCl rce~curce AcL1vaLlon
-g- 01/30/2007
-F-.-ELITE MOBIL MART SiteID: 015-021-001065 ~
Fast Format ~
~ ~ Site Emergency Factors Overall Site ~
J~JC l:1 GL1 1'1dGdL Cdr
Utility Shut-Offs 06/13/2006
A) GAS - NONE
B) ELECTRICAL - INSIDE W WALL OF STORE
C) WATER - ALL CRNRS OF BLDG
D) SPECIAL - NONE
E) LOCK BOX - NO
Fire Protec./Avail. Water 01/30/2007
PRIVATE FIRE PROTECTION - 2 FIRE EXTINGUISHERS.
NEAREST FIRE HYDRANT - 200FT S OF STORE ON WILSON RD NEXT TO MAILBOX.
Building Occupancy Level 05/24/2006
2 EMPLOYEES
-9- 01/30/2007
a .
'' F~ELITE'MOBIL MART SiteID: 015-021-001065 ~
~ Fast Format ~
~ Training Overall Site ~
.Employee Training 05/24/2006
MATERIAL SAFETY DATA SHEETS ON FILE.
BRIEF SUNIMARY OF TRAINING PROGRAM: ON-THE-JOB TRAINING FOR NEW EMPLOYEES IN
THE USE OF GAS CONSOLE, PUMPS, ETC.
rctyC L
nciu ivi r u~.uic vac
Held for Future Use
-lo- of/3o/200~
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING
I S6989 SECONDARY CONTAINMENT TESTING
!TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
PERMIT N0. ~~ ~~
>w/R/
parr r
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
Page 1 of 1
^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING
^ TANK TIGHTNESS TEST TO PERFORM FUEL MONITORING CERTIFICATI
FACILITY `;SITE- INFO RMATION
NAM E NUMBER OF CONTACT PERSON
ADDRESS -
OWNERS NAME
~l 1~Y~
OPERATORS NAME PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED IS PIPING GOIN TO BE TESTED9 ^ YES ^ NO
T NK # VOLUME CONTENTS
~~
5 ~
r TANK,TE$TING COMPANY
NAME OF TES G CO PA ~ NAME 8 PHONE NUMBER CONTA T PERSON
MAILING ADDRESS ~ ' D
NAME 8 ~ MB OF TEST O
DATE 8 TIME TEST TO BE CO DUCTE
~ SPECIAL INSPE TO -- -
~,:
D ,~c~~/
~ Uw --A~RTIFICATION
I~C #:
TEST METHOD
SIGNATURE OF APPLICANT ~' DATE ,_
!'~
-APPROVED BY ~ I ~ ~ DATE ~ 3
v FD 2095 (Rev. 09/05)
k
.,
='UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1: Business Plan and inventory Program
BAKERSFIELD FIRE DEPT
Prevention Services
~~jj 900 Trfixtun Ave., Suite 210
ARrI s Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 872-2171
NSPEC ON D E INSPECTION TIME
FACILITY NAME
Q
HON O. O OF E PLOYEES
ADDRESS ~~3 ~ 07
~
USINESS ID NUMBER
FACILITY CONTACT 15-021-
Section 1: Business Plan and Inventory Program ~~ ~ ~ S p'~
^ ROUTINE OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
C V (C=Compliance OPERATION
V=Violation COMMENTS
^ APPROPRIATE PERMIT ON HAND
11 ~L
C~/'LJ BUSIft@SS PLAN CONTACT INFORMATION ACCURATE
^ VISIBLE ADDRESS
"V ^ CORRECT OCCUPANCY
- VERIFICATION OF INVENTORY MATERIALS
,,
_ /
LY/ ^ VERIFICATION OF QUANTITIES
~^ VERIFICATION OF LOCATION
G]/h
~/G PROPER SEGREGATION OF MATERIAL
-
VERIFICATION OF MSDS AVAILABILITY ~~~
- -- - --- -- ---- - -~---~ ~i-y--~-- ~ -~ --- ------ _ --------
O
^ VERIFICATION OF HAZ MAT TRAINING
~~^ VERIFICATION OF ABATEMENT SUPPLIES AND
OCEDURES
PR
-
/
(d ^ EMERGENCY PROCEDURES ADEQUATE
^ CONTAINERS PROPERLY LABELED
^ HOUSEKEEPING
^ FIRE PROTECTION
^ SITE DIAGRAM ADEQUATE 8 ON HAND
ANY HAZARDOUS WASTE ON SITE? ^ YES L1Li1VV
EXPLAIN: - -
OUES~NS REfaAjRDING THIS INSPECTION? PLEASE CALL US AT (861) 926-3979
(Please Print) ,.., Fire Prevention / 1" In / Shitt of Site/Station q
White -Prevention Services Yollow - Station Copy Pink -Business Copy FD2W9 (Rw. 02105)
~i~~' ``~ ~ CITY OF BAKERSFIEi:D FIRE DEPARTMENT
e ~ ~ ro OF~'1CE OF ENVIRONI~~IENTAI. SERVICES
,.,~ y,' UNIFIED PROGRAI~'1 INSPECTION CHECKLIST
;~ _w ~g~;,~~'~ 1715 Chester Ave., 3r`' Floor, Bakersfield, CA 93301
FACILITY" NAME E.~~-~ ~~~t ( ~~a r'r INSPEC"LION DATE Q C b
Section 2: L"nderground Storage Tanks Program
^ Routine ~ombined ^ Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection
Type of Tank (().r~-~,e S Number of Tanks `~
Type of Monitoring ~l ~ ~ Type of Piping _ 1~~
OPERATION C ~~ COMMENTS
Proper tank data on file
Proper ownerroperaun~ 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 No
Section 3: Aboveground Storage Tanks Program
TANK SIZE(S)
Tvpe of Tank
AGGREGATE CAPACITlr'
Number of Tanks
OPERATION Y N COMMENTS
SPCC available
SPCC on the v~~ith OES
Adequate secondary protection
Proper tank placarding,~labeling
Is tank used to dispense MVF?
If yes, Does tank have overfill%overspill protection'?
C=Compliance '=Violation 1'=Yes N=NO
Inspector:
Office of Environmental Services (661) 326-3979
Business Site Responsible Party
~~1'hitc -tiny. Svcs. Pink - Business Cnry