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Home My WebLink AboutBUSINESS PLAN (3)c7-ELEVEN 16549 4647 WILSON RD t~ ~ ~- Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST;` e E R s F , 0 900Trt~xtun Ave., Suite 210 -- .---~~---_..~----_..~_---._~ _----~ ~__-_:_ ___ ___ .__-_~ FiRE Bakersfield, CA 93301 -- SECTION 1: Business Plan and Inventory Program "'~'"' r Tel.: (661) 326-3979 ~.: ~ Fax: (661) 872-2171 C V (C=Compliance OPERATION V=Violation COMMENTS - ~ ^ APPROPRIATE PERMIT ON HAND ^ BUSIf1eSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ' ~~Tro D ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS i ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION 6 ~0 ^ PROPER SEGREGATION OF MATERIAL ~B ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES 5 ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED i ^ HOUSEKEEPING ~~ ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8 ON HAND vac am ANY HAZARDOUS WAST ON SITE? AYES ^ rNO EXPLAIN: '~ w ~ ~P w..~ a~7 ~ ~ S' I ~ O ~ c.l< t~ V~ ~-• d ~'~~ C w r P ~~ ~°a r '~ CJC, ~v~ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~ ~~~L ~ ~ y Inspector (Please Print) Fire Prevention 11~` In /Shift of Site/Station # es Site / espo Pay li White -Prevention Services Yellow -Station Copy Pink -Business Copy - FD 2155 (Rev. 09/05 Section. 1: Business Plan and Inventory Program LJ ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION ~? _ INSPECTIONS - BUSINESS PLAN & INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST B~~ E R S F 1®L D F/IPE ~RrM r Page 1 of 1 FACILITY NAME: ~ ~ ~ ~ e J e ~ Section 2: Underground Storage Tanks Program INSPECTION DATE: ~~ ^ Routine ~ Combined ^ Joint Agency ^ Multi-Agency ^~omplaint ^ Re-Inspection Type of Tank STe~I Cla~ ~bs: ~ Number of Tanks Type o~Moni~ r~g_ ~. ~ ' Type of Piping ~g~ss~rce w OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? ^ Yes~No Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank Aggregate Capacity Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill /overspill protection? C =Compliance V =Violation Y =Yes N = No Inspector: ~ 1G ~"~'~~ ~'' '~ Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Business Site Responsible Party Pink -Business Copy KBF-7335 FD 2156 (Rev. 09/05) .,.. ` ~w4y" '`~`~ CITY OF BAKERSFIELD FIRE DEPARTMENT ~d ~~ OFFICE OF ENVIRONMENTAL SERVICES a`' .y~ UNIFIED PROGRAM INSPECTION CHECKLIST _~~p~ 1715 Chester Ave., 3'd Floor, Bakersfield, CA 93301 FACILITY NAME ~ ~ F ~ ~- ~ e ~ INSPECTION DATE ~ Z ~ 1 ~ 0 6 Section 4: Hazardous Waste Generator Program EPA ID #~,AC cjc3 C~ 27 ~ 23 O ^ Routine ~ilil Combined D Joint Agency ^Muiti-Agency O Complaint ^ Re-inspection OPERATION C V .COMMENTS Hazardous waste determination has been made EPA ID Number Authorized for waste treatment an or story e Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use ~ Lo ~lZ,~~ Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided ~ Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels ~ 7q, Proper management of used oil filters ~l _A T' Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal ---- - - Inspector: (~~~i~~~``~-".f ~~ Office of Environmental Services (661) 326-3979 Business Site Responsible P y White -Env. Svcs. Pink -Business Copy. .-r- •' 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 09/25/2007 Order Number: 3155160 Dear Regulator, Date Printed and Mailed: 10/12/2007 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #16549, MKT 2237 4647 WILSON ROAD BAKERSFIELD, CA. 93309 _ Testing performed: Dynamic Pressure Source EVR-Pressure Vacuum Vent Cap tests EVR-Stage I Pressure Integrity Drop Tube EVR-Stage I Static Torque tests Liquid Removal tests Stage II pressure decay tests Sincerely, ~~ ~a~~~ Dawn Kohlmeyer Manager, Field Reporting ' ~ SAN JOAQUIN VALLEY AIR POLLUTION CONTROL DISTRICT TP-201.4 Dynamic Back Pressure Source Information FACILITY PARAMETERS GDF Name and Address 7-ELEVEN #16549, MKT 2237 District Inspector ABSENT Phase II System Type Phase II System Type 4647 WILSON ROAD Device Type Used Balance MANOMETER Assist BAKERSFIELD,CA 93309 Hirt Permit # S-2130-1-4 E.O G-70-52 Phase I System Type EVR 2 Point Hasstech Healy Other Coaxial Manifolded? YO or N Date of Last Calibration: 02/12/2007 Type of Test: Wet / Dry Leak Check: Pass / Fail Nozzle Grade Dynamic Back Pressure, Inches H ~ Re lt 40 CFH 60 CFH 80 CFH su 1 E.W. 4005 ALL :11 .28 .52 PASS 2 E.W 4015 ALL .14 .26 .44 PASS 3 E.W. 4015 ALL .09 .21 .38 PASS 4 E.W 4005 ALL .08 .22 .45 PASS Test Conducted By: Test Company: Date of Test: TIMOTHY COULTER Tanknology 09/25/2007 Signature: Confirmation # Tester Certification # '.~~ 07-8810 T-6037 San Joaquin Valley Unified-Air Pollution Control District Pressure Decay Test TP201.3 Confirmtion. No. Permit No: Site Name: Address: 07-8810 S-2130-1-4 7-ELEVEN #16549 MARKET #2237 BAKERSFIELD Phone: 661833-0732 Phase I System? EVR / 2 / Coaxial Phase II System? BALANCE / ASSIST /OTHER Total Number of Nozzles: 4 Nozzles for Tank # .1: 4 Nozzles for Tank # 2: 4 Balance "Nozzle End"-hoses must be drained prior to test. Testing Comgany Name: TANKNOLOGY Address: 41785 Enterprise Circle S Suite D Temecula CA 92590 Phone: (951)676-4060 Tanks Manifolded? Yes Work Order: 3155160 Nozzles for Tank # 3: 0 Nozzles for Tank # 4: 0 Number of hoses over 100m1: 0 Tank Information 1 2 3 4 All 1. Product Grade 87 91 2. Actual Tank Capacity, gallons 9766 10081 0 0 19847 3. Gasoline Volume, gallons 7707 2687 0 0 10394 4. Ullage, (V) gallons (line #2 minus line #3) 2059 7394 0 0 9453 5. Start Time 1150 1245 1245 6. Initial Test Pressure, inches H2O 2.00 2.00 2.00 7. Pressure after 1 minute, inches H2O 1.99 1 99 8. Pressure after 2 minutes, inches H2O 1.97 1.97 9. Pressure after 3 minutes, inches H2O 1.96 1.96 10. Pressure after 4 minutes, inches H2O 1.95 1.95 11. Pressure after 5 minutes, inches H2O 1.93 1.93 12. Allowable Final Pressure (See table 1A or 1 B) 1.84 1.84 1.84 13. Pass /Fail PASS Nitrogen introducing point. Phase I vapor coupler or Phase II vapor riser: Phase I / Phase I Record Vapor Coupler Integrity Test Assembly pressure after 1 minute: 2.11 What type of pressure device used : Incline Manometer ~ Mechanical ~ Digital -must do drift tes 7-31-07 Enter Calibration date for pressure device (90 days ). 0.01 Enter initial tank ullage pressure (Vent if over 0.5 in. w.c. ) 3 Enter flowmeter rate, F (Must be 1 to 5 CFM ). 2:03 Enter Calculate ullage fill time, t2. t2= y 2:01 Enter actual fill-time. ~ [1522] F 0.00 Enter ending value of drift test (Must be 0.01 in. w.c. or less ). Tester: TIMOTHY COULTER Tester ID: T-6037 ~~ _ Signature: Test Date: 09/25/2007 San Joaquin Valley Air Pollution Control District TP 201.1 C/D Drop Tube Tests Report Form Permit Number: S-2130-1-4 Site Name: 7-ELEVEN #16549, MKT 2237 Address 4647 WILSON ROAD City BAKERSFIELD Zip93309 Test Company: Technician: Test Certification: Calibration Date of Pressure Device ;,, TANKNOLOGY, INC. TIMOTHY COULTER 07/31 /2007 Drop Tube Drain Valve and Overfill Prevention Device Pressure Integrity Test ^ Strai ht Dro Tube ^X Overfill Prevention Device Drop Tube Drain Valve Pressure Test Flow Rate 80 ml/min -Drop Tube Overfill Prevention Device Tes Flow Rate 200 ml/min "Corrected" Overfill Device Leak Test Result Time to reach 2 Drain Valve Final Time to reach 2 Ove~ll Leak Final Overfill Minus Equals in. H2O at 80m1 Leak Rate' Pressure in. H~ at 200m1 Rate' Pressure Device Leak Rate Drain Valve Leak Rate Corrected Leak rate for Overfill Device Tank: Grade: ml/min in H~J ml/min in H~ ml/min ml/min ml/min 1 87 4 SEC 0.00 2.05 0.00 PASS 1 87 124 SEC 0.00 2.05 0.00 0.00 0.00 PASS 2 91 5 SEC U.UO 2.05 0.00 PASS 2 91 137 SEC 0.00 2.05 0.00 0.00 0.00 PASS Signature of Technician: Test Date: 09/25/2007 Work order: 3155160 LIQUID REMOVAL TEST `~ TP CARB 201.6 ~_ Testing Results Facility Name: Facility Address: Test Date: Test Unit S#: 7-ELEVEN #16549, MKT 2237 4647 WILSON ROAD, BAKERSFIELD, 09/25/2007 System Type: BALANCE Page 1 Work Order: 3155160 Disp # Grade GPM Wall Fuel Gallons Post Fuel in hose Liquid Removal Pass/ Fail Retention 1 ALL 0.000 0.000 0.000 0.000 0.000 P 2 ALL 0.000 0.000 0.000 0.000 0.000 P 3 ALL 0.000 0.000 0.000 0.000 0.000 P 4 ALL 0.000 0.000 0.000 0.000 0.000 P Technician: Timothy Coulter ~.` - Signature: TANKNOLOGY 41785 Enterprise Circle S Suite D Temecula CA 92590 (951)676-4060 STATIC TORQUE OF ROTATABLE PHASE 1 ADAPTORS Test Company: TANKNOLOGY, INC. Conducted By: TIMOTHY COULTER Date of Test: 09/25/2007 Facility Name: 7-ELEVEN #16549, MKT 2237 Facility Address: 4647 WILSON ROAD City: BAKERSFIELD 93309 Measurement units: inches-pounds Vapor Adaptor 1: ~,' Vapor Adaptor 2 Brand: OPW Brand: OPW ~ Vapor Ada{~tor 3 Vapor Adaptor d Brand: Brand: Model: 61 VSA Model: 61 VSA Model: Model: Grade: 1 REG UNLEAD Grade: 2 PREMIUM Grade: Grade: Tor ue 1: 70.000 Tor ue l: 95.000 Tor ue 1: Tor ue 1: Tor ue 2: 70.000 Tor ue 2: 95.000 Tor ue 2: Tor ue 2: Tor ue 3: 70.000 Tor ue 3: 95.000 Tor ue 3: Tor ue 3: Avera e Tor ue: 70.000 Avera e Tor ue: 95.0000 Avera e Tor ue: Avera e Tor ue: Able to Rotate 360 degrees?: X^ Yes ^ No Able to Rotate 360 degrees?: X^ Yes ^ No Able to Rotate 360 degrees?: ^ Yes ^ No Able to Rotate 360 degrees?: ^ Yes ^ No X^ Pass ^ Fail ^X Pass ^ Fail ^ Pass ^ Fail ^ Pass ^ Fail Product _~~iaptor l: Brand: OPW Product Adaptor 2 Brand: OPW Product Adaptor 3 Product Adaptor 4 Brand: Brand: Model: 61 SALP Model: 61 SALP Model: Model: Grade: 1 REG UNLEAD Grade: 2 PREMIUM Grade: Grade: Torque 1: 55.000 Torque 1: 60.000 Torque 1: Torque 1: Torque 2: 55.000 Torque 2: 60.000 Torque 2: Torque 2: Torque 3: 55.000 Torque 3: 60.000 Torque 3: Torque 3: Average Torque: 55.000 Average Torque: 60.0000 Average Torque: Average Torque: Able to Rotate 360 degrees?: X^ Yes ^ No Able to Rotate 360 degrees?: X^ Yes ^ No Able to Rotate 360 degrees?: ^ Yes ^ No Able to Rotate 360 degrees?: ^ Yes ^ No 0 Pass ^ Fail 0 Pass ^ Fail ^ Pass ^ Fail ^ Pass ^ Fail Tanknology Work Order # 3155160 ~~.. ~~, Ref. No.: AQMD Id: Site Name: Address: Leak Rate and Cracking Pressure of PN Relief Vent Valves 7-ELEVEN #16549, MKT 2237 4647 WILSON ROAD BAKERSFIELD Phone: 661833-0732 Testing Comlpany Name: Tanknology Address: 41785 Enterprise Circle S. Suite D Temecula, CA 92590 Phone: (951)676-4060 PN: Valve Manufacturer HUSKY Model Number. 4885 Pass~Fail: ,FAIL Manufacturer Specified Positive Leak Rate CFH : 0.05 Manufacturer Specified Ne ative Leak Rate CFH : 0.21 Measured Positive Leak Rate (CFH) 0.07 Measured Negative Leak Rate (CFH) Positive Cracking Pressure (in. H20) 6.30 Negative Cracking Pressure (in. H20) 'P!V Valve Manufacturer HUSKY Mode! Number. '4885 PasslFaii: ;FAIL Manufacturer Specified Positive Leak Rate CFH : 0.05 Manufacturer Specified Ne ative Leak Rate CFH : 0.21 Measured Positive Leak Rate (CFH) 0.10 Measured Negative Leak Rate (CFH) 0.24 Positive Cracking Pressure (in. H20) 2.85 Negative Cracking Pressure (in. H20) P!V Valve Manufacturer HUSKY Modei` Number: '4885 PasslFaii: FAIL Manufacturer Specified Positive Leak Rate CFH : 0.05 Manufacturer Specified Ne ative Leak Rate CFH : 0.21 Measured Positive Leak Rate (CFH) 0.21 Measured Negative Leak Rate (CFH) Positive Cracking Pressure (in. H20) 4,90 Negative Cracking Pressure (in. H20) PJV Valve Manufacturer HUSKY ..Model Number: j4885 PasslFail: ,PASS Manufacturer Specified Positive Leak Rate CFH : 0.05 Manufacturer Specified Ne ative Leak Rate CFH : 0.21 Measured Positive Leak Rate (CFH) 0.02 Measured Negative Leak Rate (CFH) 0.10 Positive Cracking Pressure (in. H20) 3,38 Negative Cracking Pressure (in. H20) 9.03 P/V Valve_ManufaC#urer HUSKY I Model Number: 4885 Pass/Fail (PASS Manufacturer Specified Positive Leak Rate CFH : 0.05 Manufacturer Specified Ne ative Leak Rate CFH : 0.21 Measured Positive Leak Rate (CFH) 0.03 Measured Negative Leak Rate (CFH) 0.14 Positive Cracking Pressure (in. H20) 2,gq Negative Cracking Pressure (in. H20) 8.56 'PN Valve Manufacturer HUSKY -Model Number; 4885 Pass/Faii:` ;PASS Manufacturer Specified Positive Leak Rate CFH : 0.05 Manufacturer Specified Ne ative Leak Rate CFH : 0.21 Measured Positive Leak Rate (CFH) 0.03 Measured Negative Leak Rate (CFH) 0.11 Positive Cracking Pressure (in. H20) 2,97 Negative Cracking Pressure (in. H20) 7,89 Tester: TIMOTHY COULTER Signature: ~~ Tester Id: Test Date: 09/25/2007 ~ ~-' SITE DIAGRAM ~~Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 09/25/07 WORK ORDER NUMBER3155160 CLIENT:? -ELEVEN, INC . SITE: 7 -ELEVEN #16 54 9 , MKT 2 2 3 7 rn ~v ~~ ~~ QCQ VENTS DROPTUBE FLAAPER VALVES SUP I O O O STP REG I OA ~ OF STP 10 W S N Mid grade tank still underground. All tank components have been removed tank and tank sumps filled with dirt and gravel. Printed 10/12/2007 08:26 ACRAMER - Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST ` R : F R s F . n 900TruxtunAve., Suite 210 - fiRE - Bakersfield, CA 93301 SECTION 1: Business Plan and-Inventory Program ' ° aRrM Tel.,• (661) 326-3979 Fax: (661) 872-2171 j FACILITY NAME tNSPE ION DA INSPECTION TIME ~C( ~105~ `~a ' ~ ADDRESS - PHONE NO. NO OF EMPLOYEES - ~- ~Co ~f7 C~ ~s FACILITY CONTACT - 'BUSINESS ID NUMBER 15-021- ~~~ _ - --- ---- - __- _ --- Section 1: Business Plan and Inventory Program ^ ROUTINE ~INED ^ JOINT AGENCY ^ 'MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION ' C V C=Compliance ( ) OPERATION V=Violation COMMENTS ^ i APPROPRIATE PERMIT ON HAND ~^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE i ^ VISIBLE ADDRESS ~ ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ENT'D J U ~ 2 3 ~Q07 ^ ' VERIFICATION OF QUANTITIES I~ ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL - i i j ~ ^ VERIFICATION OF MSDS AVAILABILITY ~ i ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED- ^ HOUSEKEEPING 3luut~ 1 ~ - ~ ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES LYiNO EXPLAIN: QUESTIOI~~tEGARD~HG~iIS INSPECTION? PLEASE CALL US AT (667) 326-3979 Inspec{or (Please Print) Fire Prevention / 1~` Ih /Shift of Site/Station # - - - White -Prevention Services - Yellow -Station Copy siness Site / R sponsible Party (Please Print) -_ Pink -Business Copy . - ~ - FD 2155 (Rev. 09105 _ - I .~ ~~: 'INSPECTIONS BUSINESS PLAN & INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: ~ r H E R S F I L D F/li<E ~RrM r Section 2: Underground Storage Tanks Program ~\ '- 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 INSPECTION DATE: 3 ^ Routine Lf~Gombined ^ Joint Agency ^ Multi-Agency ^ Complaint ^ Re-Inspection Type of Tank ~~~ Number of Tanks Type of Monitoring ,( ,d , _ rte- Type of Piping - - OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? ^ Yes ^ No Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank Aggregate Capacity Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill !overspill protection? C =Compliance V =Violation Y =Yes N = No 7 Inspector: Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services Business Sit Responsible Party Pink -Business Copy KBF-7335 FD 2156 (Rev. 09/05) ~. ~,.{ { ::.~. _ 7-ELEVEN 16549 :i (WILSON) SiteID: 015-021-000808 Manager.: Shut W~~C-~ Location: 4647 WILSON RD City BAKERSFIELD CommCode: BFD STA 07 EPA- Numb : e q.L 06 d ~ BusPhone: (661)833-0732 Map.: 123 CommHaz Moderate Grid: 11C FacUnits: 1 AOV: SIC Code:5541 a.~G~ DunnBrad:00-734-7602 Emergency Contact / Title Emergency Contact / Title SHUN & SHU WANG / FRANCHISEE © 5 ~-1~F` ,~ / . Business Phone: (661) 833-0732x Business Phone: ~_5~4~ ~~g-o-7 i~ 24-Hour Phone (661) 834-5830x 24-Hour Phone ~ FIQ~ fig. o? ~ / Pager Phone ( 661) 63 3 - 617 Ox Pager Phone (~6-' ` "' "' °~- Hazmat Hazards: ~ Fire Press ~ ImmHlth DelHlth -~~flo-'7i`~c-7 Contact -~ Randy Martin Phone: (~-) ''''^ '" G^y MailAddr: PO BOX 711 State: TX. City DALLAS Zip 75221-0711 ' 7` ^~ A ~ ~ ~~ a' Owner 7 -ELEVEN INC Phone : -~--- ~ . . Address PO BOX 711 State: TX City DALLAS Zip 75221-0711 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG U - UST Based on my inquiry of those individuals r the inf y ti ' o a e responsible for obtaining rsonall pe under pen_a~lt f law m f iliar with the information true d i i ~'~ ~po~ ~ LAY B , ne s exam 9 u submitte and be 'le e t information ~ ~ [3 ~ ~ ~D©~ co p accur , ~ ~ ~ b ~ date nature ~ -1- 01/24/2007 ~ ~~>_ 1• F 7-ELEVEN 16549 (WILSON) SiteID: 015-021-000808 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type:- FACILITY/SITE INFORMATION Business Name: 7-ELEVEN 16549 (WILSON) Cross Street Business Type: Org Type: Total Tanks 2 IndnRes/Trust: No PA Contact: ~~SQ!/5'C~C Dsg Own/Oper J-.t3 iJ Ylc1p~1?~ ~¢A-~ ICC Nbr: -~''"" TT 7 L tl S7'°~C DDODS.'~TV nrniNF_R_TNEORMATION Name 7-Eleven, Inc. Phone: Address : Gasoline Acctg. City P. O. Box 711 e: Zip: Type CORPORATION Dallas, TX 75221-0711 TANK-OWNER INFORMATION Name - 7-Eleven, Inc. Phone: Address : Gasoline Acctg. City P. O. Box 711 ate : zip Type CORPORATION Dallas, TX 75221-0711 BOE UST Fee# 31896 Financ'1 Resp: INSURANCE Legal Notif Tank Owner Mailing Address X53 • ?410- ~~?c7 02,3 - 7~~- 7 l7 U JJ 7 L%~- ~/ ~ G7 Date : 0 3/ 2 8/ 2 0 0 6 Phone : -~-3~3-)- 2 x Name: ~~~RandyMartin Tt1:GASOLINE & ENVIRON COMPLIANCE MGR State UST # 1998 Upg Cert#: -2- 01/24/2007 - -_ t ~ --.; F 7-ELEVEN 16549 (WILSON) SiteID: 015-021-000808 ~ ~ 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 10000.00- GAL Mod UNLEADED PLUS GASOLINE F IH DH L 10000.00 GAL Mod CARBON DIOXIDE F P IH G 1275.00 FT3 Min WASTE FLAMMABLE LIQUIDS/SOLVENT F DH L 55.00 GAL UnR WASTE ABSORBANT F IH S 55.00 GAL UnR -3- 0.1/24/2007 ~t.. -4- 01/24/2007 i~ F 7-ELEVEN 16549 (WILSON) SiteID: 015-021-000808 ~ ~ 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 FRONT PARKING CAS# 8006-61-9 Liquid TMixtur~mbient~E ~ AmbientT~E -~EROGROUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 7500.00 GAL nHGHrclJVUJ ~.vrlrvlvr,iV 1 S %Wt. RS CAS# 100.00 Gasoline No 8006619 riHGHtCL HJ JJ;JJ1"11',1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME UNLEADED PLUS GASOLINE Location within this Facility Unit UST FRONT PARKING Days On Site 365 Map: Grid: 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 I Daily Average 10000.00 GAL 10000.00 GAL 7500.00 GAL nHGHtu~vuJ COMPONENTS •°sWt. RS CAS# 100.00 Gasoline No 8006619 riHGHtClJ HJ JP~JJI~IJJIVIJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod Facility Unit: Fixed Containers on Site ~ -5- 01/24/2007 V 49 6 WILSON) 015-021-000808 Sit ID F 7-ELE EN 1 5 ( ~ e : ~ Inventory Item 0005 Facility Unit: Fixed Containers on Site ~ M N NA E HEMICAL NAME / COM O M C CARBON DIOXIDE Days On Site 365 h i i i hi ili i M id G on w Locat t n t s Fac ty Un t ap: r : CAS# 124-38-9 STATE T TYPE ~GaS I Pure PRESSURE Above Ambient TEMPERATURE CrvocTenic CONTAINER TYPE INSUL.TANK / CRYOGENIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average FT3 1275.00 FT3 FT3 ntic~HttllvuJ L.V1~lYV1VL~1V1J %Wt. RS CAS# 100.00 Carbon Dioxide No 124389 I3HGH.[tL H~J ~J P.~J JI"1P~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE FLAMMABLE LIQUIDS/SOLVENT Days On Site 365 Location within this Facility Unit Map: Grid: NEAR TRASH ENCL CAS# Liquid TWaste ~Ambient~E ~ AmbientT~E DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 55.00 GAL 55.00 GAL 25.00 GAL HAZARDOUS COMPONENTS oWt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No IlYaGKLCL 1-~J JL' JJl•1P~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards .NFPA USDOT# MCP No No No No/ Curies F DH / / / UnR -6- 01/24/2007 F 7-ELEVEN 16549 (WILSON) SiteID: 015-021-000808 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE ABSORBANT Days On Site 365 Location within this Facility Unit Map: Grid: NEAR TRASH ENCL CAS# ~SolidE TWaste ~mbient~E ~ AmbientT~E DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 25.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 90.00 MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No . I1LiGLiRL tiJ JL~JJ1.1P~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / UnR -7- 01/24/2007 F 7-ELEVEN 16549 (WILSON) SiteID: 015-021-000808 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/20/1999 ~ C~~,L.._91-1 AFTER CALL 911, THE BAKERSFIELD CITY FIRE DEPT WILL BE NOTIFIED ALONG WITH THE CALIFORNIA STATE OFFICE OF EMERGENCY SERVICES 800-852-7550. Employee Notif./Evacuation 04/25/2006 VEf~BAZ-AND.-C - - PLAN FILED i~BF-~-~-E~ RELEASE OF HAZ TIFY BAKERSFIELD ~ ATE OES. THE STORE ATTENDANT WILL NOTIFY OTHER EMPLOYEES AND CUSTOMERS BY A SHOUT THAT THE BLDG MUST BE EVACUATED. ALL PERSONS MUST EVACUATE THROUGH THE FRONT DOORS TO THE EVACUATION STAGING AREA SHOWN ON THE FACILITY DIAGRAM. Public Notif./Evacuation 05/20/1999 THE STORE ATTENDANT WILL NOTIFY OTHER EMPLOYEES AND CUSTOMERS BY A SHOUT THAT THE BLDG MUST BE EVACUATED. ALL PERSONS MUST EVACUATE THROUGH THE FRONT DOORS TO THE EVACUATION STAGING AREA SHOWN ON THE FACILITY DIAGRAM. Emergency Medical Plan 04/25/2006 NEAREST ER IS TO BE USED IN THE EVENT OF INJURY, OR CALL 911. -8- 01/24/2007 F 7-ELEVEN 16549 (WILSON) SiteID: 015-021-000808 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 04/25/2006 ~ S TrA~4' I ON GASi-PUNL$S C EMERGENCY FUEL SHUT-OFF SWITCHES ARE LOCATED IN THE FRONT OF THE STORE AND NEAR THE STORE COUNTER. THE UNDERGROUND STORAGE TANKS ARE EQUIPPED WITH OVERFILL/OVERSPILL ON. TANK FLUID LEVELS AND INTERSTITIAL SPACE ARE MO BY A L EMS 35.00 MONITORING SYSTEM. TANK TURBINES ARE EQUIPPEP TH LEAK DETECTORS WHICH RESTRICT FLOW IF A LEAK IS DETECTED BENEATH ISPENSERS OR ALONG PIPING RUNS. ~-~~~P..a~- -mss 3~ c~ Release Containment 04/25/2006 = SP~~~ G~YSOLIN~~STATIF ALV~ CEAPR~SSEFOGA~SES P~ZOPERLX' S V P R H L~S; H R- TTR+TTTTT.D T T~ TTT DnD~g F,yT_ rrTr~c_,_ B~],SI~ESS Ei~ERGENC`Y- PLAN ON~F'iILE H ~JSa~2 ('~ FS al'!-" ' R, LOCATED INSIDE THE STORE AT THE LOCATION SHOWN ON THE FACILITY DIAGRAM, IS TO BE USED FOR SMALL FUEL SPILLS (LESS THAN 5 GAL). THE BAKERSFIELD FIRE DEPT WILL RESPOND TO LARGER FUEL RELEASES BY PLACING SAND OR ABSORBENT ON THE SPILL. Clean Up 01/25/1996 -HB-E~ STRBE -ice) . - ~_ ONCE A SPILL HAS BEEN CONTAINED, THE SAND OR ABSORBENT WILL BE CHARACTERIZED AND DISPOSED OF AT A PROPER DISPOSAL FACILITY. Other Resource Activation -9- 01/24/2007 .. _ -; -~ F 7-ELEVEN 16549 (WILSON)- SiteID: 015-021-000808 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ especial riazaras Utility Shut-Offs 05/20/1999 A) GAS - NONE B) ELECTRICAL - BACKROOM HALLWAY C) WATER '- STORE FRONT D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 04/25/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS IN STORE, PER FIRE CODE. Building Occupancy Level 03/31/2006 6-7 EMPLOYEES -10- 01/24/2007 - • . ~~; F 7-ELEVEN 16549 (WILSON) SiteID: 015-021-000808 ~ Fast Format ~ :Training Overall Site ~ " Employee Training 04/25/2006 MATERTAi, SAFETY~TA SHEF,S~`$ ON FILr~. I n S OF RAIN G ROG ]CN CA E F G FUEL P LL, Cg~,L~6 TH EP IN CA OF SMAL FU SP~LL, DE RM E OTEN IAL ARC/ U EN TERIAL SORB PAD,- O~2 OR V SMAL ILLS LET EVAPORA MSDS SHEETS ON FILE BEHIND STORE COUNTER. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED ON THE OPERATION OF THE UST IN A MANNER CONSISTENT WITH BEST MANAGEMENT PRACTICES, EMERGENCY CONTACT INFORMATION, SPILL/OVERFILL RESPONSE PROCEDURES, HAZ WASTE PROCEDURES, MONITORING EQUIPMENT OPERATION. AND ALARM RESPONSE PROCEDURES. TRAINING IS CONDUCTED ANNUALLY, OR WITHIN 30 DAYS FOR NEW EMPLOYEES, BY THE DESIGNATED OPERATOR= Held for Future Use Held for Future Use -11- 01/24/2007 '+, 8501 N. MoPac Expressway, Suite 400 Austin,-Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 02/07/2007 Order Number: 3150841 Dear Regulator, Date Printed and Mailed: 03/05/2007 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #16549 MARKET #2237 4647 W I LSON ROAD BAKERSFIELD, CA. 93309 Testing performed: Leak detector tests Line tests Monitor Certification Sincerely, OrW-~ f~a~ 0 Dawn Kohlmeyer Manager, Field Reporting :• TANKNOLOGY CERTIFICATE OF TESTING ~ ~/7 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 TELEPHONE (512) 451-6334 FAX (512) 459-1459 PURPOSE: COMPLIANCE TEST RESULT SUMMARY REPORT TEST DATE: 02/07/07 WORK ORDER NUMBER: 3150841 CUSTOMER PO: CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #16549 P.O. BOX 711 MARKET #2237 DALLAS, TX 75221 4647 WILSON ROAD BAKERSFIELD, CA 93309 Manager (214)841-6714 (661)833-0732 TEST TYPE: TLD-1 D~..rl~~n4 Dino TinF~+nncc Tncf {7nm~14c .. IA9PACT'`+ LINE LINE ` LINE- DELIVERY TEST RESULT FINAL LEAK RATE (gph) VALVE ID PRODUCT MATERIAL ;TYPE A B C D A B C D FUNCTIO. 1 1 REG UNLEAD FIBERGLASS PRESSURE P 0.000 Y 2 2 PREMIUM FIBERGLASS PRESSURE P 0.000 Y Fvic+inn I inn I oalc Ilatar+nr Tact r- EXISTING LEAK DETECTOR #1' EXtST tNG LEAK DETECTOR #2 LINE MANUFACTURER MODEL# SERIAL# RESULT MANUFACTURER MODEL# SERIAL# RESULT ID __ _ 1 1 VEEDERROOT ELECTRONI 108123 P 2 2 VEEDERROOT ELECTRONI 200875 P Naw Rpnlar_pmant I ine 1 eak netertnr Test REP LACED'LEAK'DET ECTOR #1 "REPLACED LEAK BET ECTOR"#2 LINE ID MANUFACTURER _ MODEL # SERIAL # RESULT MANUFACTURER M©DEL # SERIAL # _. RESUL ror owner aetauea report mrormanon, v~s~t w~v.tan~cnoiogy.com ana seiecr vn-L~ne rcepons-wrcru-, ur cuniaci your ~ocai i anKnuiugy urr,cc. Tester Name: WILLIAM ROGERS Technician Certification Number:1647 ~~s~% Printed 03/05/2007 09:27 KOHLMEYER i INDIVIDUAL TANK INFORMATION AND TEST RESULTS i Tan TEST DATE:02/07/07 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3150841 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512)451-6334 SITE:7-ELEVEN #16549 TANK NFORMATIpN Tank ID: 1 1 Tank manifolded: No Bottom to top fill in inches: Product: REG UNLEAD Vent manifolded: YES Bottom to grade in inches: Capacity in gallons: 9, 766 Vapor recovery manifolded: YES Fill pipe length in inches: Diameter in inches: 109 . oo Overfill protection: YES Fill pipe diameter in inches: 4. o Length in inches: 251 Overspill protection: YES Stage I vapor recovery: DIIAL Material: Dw STEEL Installed: ATG Stage fl vapor recovery: BALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Test Methpd:VacuTect LEAK DETECTQR TEST RESULTS pest method: FTA Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: VEEDERROOT Ingress Detected: Water Bubble Ullage Model: ELECTRONIC Test time: S/N: ioeiaa Open time in sec: Inclinometer reading: Holding psi: VacuTect Test Type: NoT Resiliency cc: NoT V8CUT2Ct Probe Entry POlnt: TESTED Test leak rate ml/m: TESTED ia9. o Pressure Set Point: Metering psi: 2a Tank water level in inches: Calib. leak in gph: a. 00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS uNe TEST RESULTS - LINE A Test fi/pe TLD-i B C D Materlal: FIBERGLASS Diameter (in): 2 . o Length (ft): 75. o Test psi: 50 Bleedback cc: 0 Test time (min): 40 NOT NOT NOT Start time: O S : 34 TESTED TESTED TESTED End time: 09:14 Final gph: o. o00 Result: PASS Pump type: PRESSURE Pump make: RED JACKET COMMENTS Impact Valves Operational: YES Printed 03/05/2007 09:27 INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tan/v~ology TEST DATE:02/07/07 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER9150841 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #16549 TANK IMFORIN0.T10N Tank ID: 2 2 Tank manifolded: No Bottom to top fill in inches: Product: PREMIUM Vent manifolded: YES Bottom to grade in inches: Capacity in gallons: to , Ols Vapor recovery manifolded: YES Fill pipe length in inches: Diameter in inches: 10 9 . oo Ove~ll protection: YES Fill pipe diameter in inches: 4 • o Length in inches: 251 Overspill protection: YES Stage I vapor recovery: DUAL Material: Dw STEEL Installed: ATG Stage II vapor recovery: BALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Test Method:VacuTect LEAK DETECTOR TEST RESULTS Tsst method: FTA __.. Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: vEEDERROOT Ingress Detected: water Bubble Ullage MOdeI: ELECTRONIC Test time: S/N: zooe~s Open time in sec: Inclinometer reading: Holding psi: VacuTect Test Type: NoT Resiliency cc: NoT VacuTect Probe Entry Point: T ESTED Test leak rate ml/m: 1s9. o TESTED Pressure Set Point: Metering psi: 2s Tank water level in inches: Calib. leak in gph: a . 00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type 'T~-i LINE A ~- 6 ~C D Material: FIBERGLASS Diameter (in): 2 . o Length (ft): 75. o Test psi: 50 Bleedback cc: o Test time (min): 40 NOT NOT NOT Start time: 08:34 TESTED TESTED TESTED End time: 09:14 Final gph: 0.000 Result: PASS PUmp type: PRESSURE PUmp make: RED JACKET COMMENTS Impact Valves Operational: YES Printed 03/05/2007 09:27 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of Califomia Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3 Title 23, Califomia Code of Regulations This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system ownerloperator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: 7-ELEVEN #16549 Site Address: MARKET #2237 4647 WILSON ROAD Facility Contact Person: Manager Make/Model of Monitoring System:TLS350 PLUS B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced TanklD: 87 TanklD: 91 X In-Tank Gauging Probe. Model: MAG 2 X In-Tank Gauging Probe. Model: MAG 2 X Annular Space or Vault Sensor. Model: 420 Annular Space or Vault Sensor. Model: 420 X Piping SumplTrench Sensor(s). Model: 208 X piping SumplTrench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: X Electronic Line Leak Detector. Model: PLLD X Electronic Line Leak Detector. Model: PLLD Tank Overfill/High-Level Sensor. Model: Tank Overfill/High-Level Sensor. Model: Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). TanklD: TanklD: In-Tank Gauging Probe. Model: In-Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: Piping SumplTrench Sensor(s). Model: Piping Sump/Trench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill/High-Level Sensor. Model: Tank Overfill/High-Level Sensor. Model: Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). Ispenser 1-4 DispenserlD: Dispenser Containment Sensor(s) Model: 208 Dispenser Containment Sensor(s) Model: X^ Shear Valve(s). Shear Valve(s) Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) an d Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). ~ Dispenser Containment Float(s) and Chain(s). If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this certification is information (e.g manufacturers' checklists) necessary to verify that this information is correct. and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): ~X System set-up X~ Alarm history report Technician Name (print): WILLIAM ROGERS Certification No.: 8520 City: BAKERSFIELD CA Zip: 93309 Contact Phone No: 833-0732 Date of Testing/Service: 02/07/2007 Work Order Number: 3150841 Signature: ~G;t~" JG~r License. No. : Testing Company Name:Tanknology Phone No.: (800) 800-4633 Site Address: 8501 N. MoPac Expressway, suite 400, Austin, TX 78759 Date of Testing/Servicing: 02/07/2007 Page 1 of 3 Based on CA form dated 03/01 Monitoring System Certification Monitoring System Certification Site Address: .MARKET #2237 Date of TestinglService: _ 02/07/2007 4647 WILSON ROAD D. Results of Testing/Servicing Software Version Installed: 119.05 Complete the following checklist: ves ^ No' Is the audible alarm operational? Q Yes ~ No' Is the visual alarm operational? 0 Yes ~ No' Were all sensors visually inspected, functionally tested, and confirmed operational? Yes ^ No' Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes ~ No' X N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? QX Yes ~ No * ~ N/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (check all that apply) ~ Sumplfrench Sensors; ^X Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks 3pd sensor failure/disconnection? ^X Yes ^ No Yes ~ No • ^X N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e.: no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? ~~o Yes' ~x No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. Yes' ~x No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) ^ Product; ^ Water. If yes, describe causes in Section E, below. QX Yes ~ No' Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. Ox Yes ~ No' Is all monitoring equipment operational per manufacturers' specifications? ' In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: ESO PASSED ALSO Page 2 of 3 Based on CA form dated 03/01 Monitoring System Certification Site Address: MARKET #2237 Date of Testing/Service: 02/07/2007 4647 WILSON ROAD F. In-Tank Gauging /SIR Equipment Check this box if tank gauging is used only for inventory control. Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: Q Yes ^ No' Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ^X Yes ^No' Were all tank gauging probes visually inspected for damage and residue buildup? ^Yes ^ No' Was accuracy of system product level readings tested? ^Yes ^No' Was accuracy of system water level readings tested? ^x ves ^No' Were all probes reinstalled properly? ^x Yes ^No • Were all items on the equipment manufacturers' maintenance checklist completed? " In the Section H, below, deSCrlbe hOW antl when tneSe tleTlClenCleS Were or WIII De COrreCie(]. G. Line Leak Detectors (LLD) : ^ Check this box if LLDs are not installed. Complete the following checklist: Yes ^ No' ^N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? Check all that apply) Simulated leak rate: X^ 3 g.p.h ~ 0.1 g.p.h ~0.2 g.p.h ^X Yes ^ No' Were all LLDs confirmed operational and accurate within regulatory requirements? X Yes ^No' Was the testing apparatus properly calibrated? Yes ^ No' ^ N/q For mechanical LLDs, does the LLD restrict product flow if it detects a leak? x^ Yes ^No' ^ N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ^X Yes ^No' ^ NIA For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ^Yes ^No' ^ N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? Yes ^No' ^ N/A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes ^No' Were all items on the equipment manufacturers' maintenance checklist completed? ' In the Section H, below, describe how and when these deticiencies were or will be corrected. H. Comments: Page 3 of 3 Based on CA form dated 03/01 S~VRCB, January 2002 Page 1. Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN #16549 Date of Testing: 02/07/2007 Facility Address: MARKET #2237 4647 WILSON ROAD, BAKERSFIELD, CA, 93309 Facility Contact: Manager Phone: (661) 833-0732 Date Local Agency Was Notified of Testing : / / Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY , INC . Technician Conducting Test: WILLIAM ROGERS Credentials: ~ CSLB Licensed Contractor ~ SWRCB Licensed Tank Tester License Type: A License Number: 743160 Manufacturer Manufacturer Training Component(s) Date Training Expires / / / / / / / / 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repair ade Spill Box 1 REG FILL ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 1 REG FILL ~ ~ ^ ^ ^ ^ ^ ^ Spill Box 2 PRE FILL ~ ^ ^ ^ ^ ^ ^ ^ . Spill Box 2 PRE FILL ~ ^ ^ ^ ^ ^ ^ ^ If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTITr'G To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: ~~~ ~ Date: 0 2/ 0 7/ 2 0 0 7 SWRCB, Sanuary 2002 9. SPILL/OVERFILL CONTAINMENT BOXES Page 2 - Facility is Not Equipped With SpilUOverfill Containment Boxes: SpilUOverfill Containment Boxes are Present, but were Not Tested: Test Method Developed By: ~ Spill Bucket Manufacturer ~ Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: VPLT -_-_ - . _ .._ T., ~ _. ._ ._ - Eq - uipment Resolution: -- _, ~ .. ,.__ Spill Box # 1 REG FILL Spill Box # 1 REG FILL Spill Box # 2 PRE FILL $piu Box # 2 PRE FILL Bucket Diameter: 11 11 11 11 Bucket Depth: 12 12 .12 12 Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS 15 MINS 15 MINS Test Start Time: 9:18 9: 3 6 9:18 9: 3 6 Initial Reading (RI ): 6 6 6 6 Test End Time: 9: 3 3 9:51 9: 3 3 9:51 Final Reading (RF ): 6 6 6 6 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading (R p - RI ) - • 00003 - .00001 .00001 .00000 PasslFailThresholdor Criteria: .00200 .00200 .00200 .00200 Pest Result: ~~ Pass ~ Fail ~ Pass ~ Fail ' ~ Pass ~ Fail D Pass ~ Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:02/07/07 WORK ORDER NUMBER3150841 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #16549 COMMENTS Witness compliance - lines / MC / LD / SB. All Tests Passed. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 03/05/2007 09:27 KUNLMtYtK ITE DIAGRAM ~ Tanlv~ology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 02/07/07 WORK ORDER NUMBER3150841 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #16549 rn ~~ ~~ t` ~Q VENTS SUP I OA OV OF STP REG I OA OV OF STP 10K W S N Mid grade tank still underground. All tank components have been removed tank and tank sumps filled with dirt and gravel. 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MoPac Expressway, Suite 400, Austin, Texas 78759 •Work Order: 3150841 ,_ i " ~. _ . . ~~, ,.~~ r ~ ) _ b e -- .. ~; < .~ ~ _ e x f~ ...ems" . ~h ~. ryf~~ .,.. ~ . i ~ ,x }~ w=C ~• ve no-m ,,,.4 . -de. ate... .. .. 1 .-. + a +... Y:- ° ..~. ~ r. - E r ... ~. •M I i .. T ~~ e t f *° w .. . _ ~ .dN ~''~ ~ ae . ~ .. v yi ~ { .. ... -.. «..o _ i ~ _ _ _ t~ _' - ~ y .. ,I M 1~ -'~ ~ .... _ _ f ... ~ 2; _ c .~. - . w c 1 H d . ~_ ._ . ...., .A' x -, .N B w ..w Tanlrnology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 W ork Order: 315 0 8 41 z_, _. ~ r r~ . °~ : ~ ~"i ~ ~. ~ r ~„ a S= r w~+ ~~~~~~° ~ ._ .: ~ m ., , r ~ .~ .~~F;~T x _ ~ "'^ . _.~ o ~ , ma __ ~ _ : ~g ~ ~ ~ ,~. ~, t- K ~: - _ ., s s ~. ,. - ' ' ~' 2 :? ~~ a~ a ~ ~ : ' = ~ r fZc I ~ ~ ~ ~i .a i -? a P a.~, ~. ~ a,~ ~ ~ Poi= _ . 3 fib' 4 f. ~ - Ym ~ - S 1 '~ ` ~ ~~ - ~~ S ~ f ~ i . S t I ~ )•t i :. °E S ~ ..~ . . f °~. `. .{ r w r~i .. -.._. L ~ .. _ _ T ~. _ _ s t a ., _. _ .~ ,i F' e rw ~ { , - ~ ~ ~ i E i Y ~. w ? , bw o d. ~ to r~ ~ - .. ~ ...a ~. s ~k „,,~ F'. ~ :ww a Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 •Work l~-Srder: 3150841 p ... r u... : n,.. ,_ ° '.Y s __ r .. { F t c r ~ ~ £~- ~ .. -- lie,. ..a . ~. ~ _ _ a ~ . ~ - ~ ~ -~ b~a .~ ,~ ~_ ~.. . - ~ -.. a _ru >~~~- - ~ ~~. „p, ... _ -.... ~;* ~ ., ~ . , e ~ s "" .. _. ~~': ~ r~ H ' ,..~~ _ . _ - - _ `~~ ~ _ - _ a. v ~. . '- i ,, i r 1 i 1 l 1 Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 r~ n ._ ~~ •S Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: 7-Eleven #16549 Facility ID #: 235053 Facility Address: 4647 Wilson Rd Bakersfield, CA 93309 Reason for Submitting this Forth (Check One) ®Change of Designated Operator Facility Phone #: 661-833-0732 ^ Update ICC # and/or Expiration Date Designated UST Operator(s) for this Facility Primary (Optional) Designated Operator's Name: John Ablakat Relation to UST Facility (Check One) Business Name (If d fferent from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician O Third-Party International Code Council Certification #: 5279288-UC Expiration Date: 03/09/2008 ALTERNATE 1 (Optional) Designated Operator's Name: Tony Mansour Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician ®Third-Parry International Code Council Certification #: 5269136-UC Expiration Date: 11/17/2007 ALTERNATE 2 (Optional) Designated Operator's Name: Sarkiss Z,oumalan Relation to UST Facility (Check One) Business Name (If d~erent from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician ©Third-Party International Code Council Certification #: 5238439-UC Expiration Date: 07/09/2008 I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23„section 2715(c) - (f). Furthermore, I understand and am in complian~ee with re uirements (statutes, regulations, and local ordinances) applicable~to under oun~torage tanks. NAME OF TANK OWNER (Please Print): 7-ELF] !VDY MARTIN SIGNATURE OF TANK OWNER: / DATE: 2/15/2007 OWNER'S PHONE #: (253) 796-7170 November 2004 F 1 r Owner Statements of Designaced Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements -continued ALTERNATE 3 (Optional) Designated Operator's Name: Kevin ~Vatermolen Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 916-212-7973 ^ Service Technician O Third-Party International Code Council Certification #: 5250470-UC Expiration Date: 12-21-2008 ALTERNATE 4 fOntionall Designated Operators Name: Jessica Tuttle Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 831-537-7663 ^ Service Technician ~ Third-Party International Code Council Certification #: 5286530-UC Expiration Date: 07-03-2008 ALTERNATE 5 (Optional) Designated Operator's Name: Jim Palmer Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 831-840-5235 ^ Service Technician O Third-Party International Code Council Certification #: 5254109-UC Expiration Date: 2-21-2007 ALTERNATE 6 (Optional) Designated Operator's Name: Brian Ellsworth Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 707-815-2511 ^ Service Technician ~ Third-Party International Code Council Certification #: 5263224-UC Expiration Date: 7-7-2007 ALTERNATE 7 (Optional) Designated Operator's Natne: Aaron Celaya Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 510-364-0385 ^ Service Technician ^D Third-Party International Code Council Certification #: 5246905-UC Expiration Date: 01-20-2007 ALTERNATE 8 (Optional) Designated Operator's Name: Darrell Riley Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 619-206-8379 ^ Service Technician ~ Third-Party International Code Council Certification #: 5248975-UC Expiration Date: 11-29-2008 ALTERNATE 9 (Optional) Designated Operators Name: Darren Austin Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder•-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 858-699-2751 ^ Service Technician O Third-Party International Code Council Certification #: 5250436-UC Expiration Date: 11-11-2008 ALTERNATE 10 (Optional) Designated Operator's Name: Eric Banghart Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder•-Root ^ O«roer ^ Operator ^ Employee Designated Operator's Phone #: 310-467-2529 ^ Sen~ice Technician x^ Third-Party International Code Council Certification #: 5250118-UC Expiration Date: 11-9-2008 ALTERNATE 11 (Optional) Designated Operator's Name: Blake Herness Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 951-288-1519 ^ Service Technician x^ Third-Party International Code Council Certification #: 5249180-UC Expiration Date: 12-12-2008 February 15, 2007 BAKERSFIELD FIRE DEPARTMENT 900 TRUXTUN AVENUE, SUITE 210 BAKERSFIELD, CA 93301 RE: Statement of Compliance and Designated Operator Dear Sir or Madam: Gilbarco/Veeder-Root, acting as the authorized agent of Safeway/Vons is submitting on behalf of the company, the attached Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of Compliance with UST Regulations for the subject fuel facility to register this site and Designated Operators with the county. The owner understands that with the submission of this document, Gilbarco/Veeder-Root is stating, on behalf of Safeway/Vons that each location is in compliance with all applicable UST regulations. Further, as specified in regulations Title 23, Section 2715 (c)-(f), the individuals listed as designated operators for the location will complete and document a monthly inspection to be maintained in accordance with the applicable requirements. Each statement of compliance being submitted herein is based on: (1) Gilbarco/Veeder- Root reasonable and good faith review of facility operations to evaluate compliance with applicable UST regulations, as well as information provided by facility operations as of the date the statement of compliance is made, and (2) Gilbarco/Veeder-Root's understanding of the applicable UST regulations and requirements as of the date the statement of compliance is made. Should you have any questions or require further information please do not hesitate to contact me at (303) 986-8011. Sincerely, Sherry Peczka Designated Operator Program Manager Gilbarco/Veeder-Root Enclosures Aug-23-06 11x34 TANKNOLOGY s! UNDERGROUND Fi~ORAG~ TANKS 7~` 3FHIIN~IC'4@MnNNw~at~MaiS:l!la•:L'T~Inl11_NiaRRi7xViNUL I APPLICATIO ~~: TO PERFORM ELD / LI E TES ~~: 1 SB989 SECONDARY NT/UN ENT TESTING 1TANK TIGHTNESS TE T AND T PERFORM FUEL MONITORING RTIFICA . ON PERMIT NO. f-l ..~+~.~r.., ~ rl ~ Luc Tcc-nur_ 909 308 1239 P_O1 SAKERSFIELD FIRE DEPT. g Prevention Services w~Rt ARfM f 900 Truxtun Ave., Ste. 210 ~. Bakersfield. CA 93301 Te1.: (661) 326-3979 Fax: (661) 852-2171 Pape t of 1 ^ SB-9B9SECONDARYCONTAWME TEsnNr. ^ TANK TIGHTNESS T ^ TO PERFORM FUEL MONffORING CERTIFICATIO ~ MINOR MODIFICATION -"87 Yapor Bucket retest' ITE INFORMATION FACILITY '1-EleVtn #165A9 NAME & PHONE NUMBER OF CONTACT PERSON Mane er - (661) $33 - 0732 ADDRESS 4647 ilson~ Rd., Bakersfield, CA 933Q9 OWNERS NAME OPERATORS NAME PERMIT TD OPERATE NO. NUMBER OF TANKS T BE TEST D IS PIPING GOING T BE TESTED? ^ YES NO TAN R LUME CONTENTS t TANK TE$TINO COMPANY _ NAME OF TE8TINCi COMPANY Tanknoio inC. NAtnE a PHONE NUMBER OF Anthony Cheeks (951) 676-4D60 9Y~ CONTACT PERSON MAILING ADDRESS 41785 Enterprise Circle S. Suite D Temecula, CA 92590 NAPE & PHONE NUM ER OF Daniel Visaer: (951) 903-8153 CERTIFICATION s: TESTER OR SPECIALINSPECTOR: DATE b TIME TEST T BE 9/1/06 ~ eAM ICC r. rJ2~ ~~p.~ ~ (1T - -~jyIETHOD CONDUCTED: r-7 -s _tv A L~. SIGNATURE OF APPLICANT DATE: ~>~--- APPROYEDHY as ~A ~,7)r01 DATE f~1 a~ ~~ FD 2085 (Rev. 09/05) UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 .. I. FACILITY /SITE INFORMATION BUSINESSNAME(Same as FACILITY NAME Or DBA-Doing Business AS) 3 ''>FACILITY ID# <: 1 7-Eleven #16549 NEAREST CROSS STREET aos ,FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 4647 Wilson Rd., Bakersfield ~ ® 1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aos ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* aoz TOTAL NUMBER OF TANKS Is facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos II: PROPERTY-.:.OWNER INFORMATION PROPERTY OWNER NAME aos PHONE aoa 7-Eleven, Inc. 253-796-7170 MAILING OR STREET ADDRESS aos P.O. Box 711 Attn: Gasoline Acctg CITY aio STATE ait ZIP CODE aiz Dallas TX 75221-0711 PROPERTY OWNER TYPE ^ 1. CORPORATION ®2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL afs llf. TANK OWNER IN_FORMATIO.N~: aia PHONE ais TANK OWNER NAME 7-Eleven, Inc. 253-796-7170 MAILING OR STREET ADDRESS ass P.O. Box 711 Attn: Gasoline Acct CITY air STATE ass ZIP CODE ass Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, V. PETROLEUM UST FINANCIAL RESPONSIBILITY ~ ' ~~ INDICATE ^ 1.SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz 4 VI. LEGAL`RNOTIFICATION AND MAILING ADDRESS . Check one box to indicate which ddress should be used for legal notifications and mailing. ill be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 Legal notifications and maili ~ ViI:-APPLICANT $tGNATU,RE Certification - e ' that the inf r vided herein is true and accurate to the best of my knowledge. SIGNATU E PLIC DATE aza PHONE azs 7/28/06 253-796-7170 NAME OF'APPLICANT (print) azs TITLE OF APPLICANT a2~ Randy Martin Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) azs 1998 UPGRADE CERTIFICATE NUMBER (Fortocal use only) azs UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM - ~ FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page _ of _ 1 ;Ir1FA1T1~IrATIC1A1 - - --- l --- - - FACILITY ID# - - - - - ~ - BEGINNING DATE 100 ENDING DATE 10I ~ "'' 8/1 /2006 12/31 /2007 BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 BUSINESS PHONE ioz 7-Eleven #16549 661-833-0732 BUSINESS SITE ADDRESS fos 4647 W ilson Rd. CITY 104 ZIP CODE fos CA Bakersfield 93309 DUN & BRADSTREET 106 SIC CODE (4 digit #) t07 00-734-7602 5541 COUNTY 108 Kern BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 Shun L & Shu J Wang 661-833-0732 - II. 'BUSINESS OWNER -- OWNER NAME ~ ~ ~ OWNER PHONE 112 7-Eleven, Inc. 253-796-7170 OWNER MAILING ADDRESS 113 P.O. Box 711 Attn: Gasoline Acctg CITY 114 STATE its ZIP CODE »6 Dallas TX 75221-0711 III. ENVIRONMENTAL CONTACT - CONTACT NAME tin CONTACT PHONE t18 Randy Martin 253-796-7170 CONTACT MAILING ADDRESS 119 P.O. Box 711 Attn: Gasoline Acctg CITY 120 STATE i2i ZIP CODE izz Dallas TX 75221-0711 -PRIMARY- N. EMERGENCY CONTACTS -SECONDARY- NAME 1L3 NAME Sze 7-Eleven Emergency Dispatch I 7-Eleven Emergency Dispatch I TITLE 124 TITLE its Emergency Service Emergency Service BUSINESS PHONE t25 BUSINESS PHONE iso 1800-828-0711 800-828-0711 24-HOUR PHONE '.z6 24-HOUR PHONE 131 1-800-828-0711 800-828-0711 PAGER # 127 PAGER # i3z ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Ba o y inq ry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and m f iliar wit the infor tion submitted and believe the information is true, accurate, and complete. SIGNATUR OF NE OR DESIGNATED REPRESENTATIVE DATE X34 NAME OF DOCUMENT PREPARER 135 7/28/06 Rachel Rodriguez NAME OF SI NER (print) 136 TITLE OF SIGNER 137 Randy Martin _ Gasoline & Environmental Compliance Manager UPCF (1/99 revised) HMP 2 (Back) Instructions OES FORM 2730 (1/99) ~,,. UNDERGROUND STORAGE TANK MONITORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 23 CCR, Sections 2632(d)(1), 2634(d)(2), and 2641 (h) Mol TYPE OF ACTION ^ 1. NEW PLAN ®2. CHANGE OF INFORMATION PLAN TYPE ®MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. Moz- (Check one item only) ^ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITI' INFORMATION FACILITY ID # (Agency Use Only) - - FACILITY NAME 7-Eleven #16549 M03. FACILITY SITE ADDRESS 4647 WIISOn Rd. M04 CITY B81CerSfleld Mos. II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Slate law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in nao6. accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED ® 1. ANNUALLY ^ 99. OTHER (Specify): M07. III. MONITORING LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., location of each sensor, line leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring System Certifica tion form, Hazardous Materials Business Plan map, etc.) which shows all required information, include it with this lan. IV. TANK MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) Mlo. ® 1. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM M11. PANEL MANUFACTURER: VeederROOt M12. MODEL #: TI 535 M13. LEAK SENSOR MANUFACTURER: VeederROOt Mla. MODEL #(S): R473~30-429 Mls. ^ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(Sl PANEL MANUFACTURER: MI6. MODEL #: Mn. M18- MODEL# S : IN-TANK PROBE MANUFACTURER: ( ) Mtg. LEAK TEST FREQUENCY: ^ a. CONTINUOUS ^ b. DAILY/NIGHTLY ^ c. WEEKLY X120 M21. ^ d. MONTHLY ^ e. OTHER (Specify): M22. PROGRAMMED TESTS: ^ a. 0.1 g.p.h. ^ b. 0.2 g.p.h. ^ c. OTHER (Specify): M23. ^ 3. INVENTORY RECONCILIATION ^ a. MANUAL PER 23 CCR §2646 ^ b. STATISTICAL PER 23 CCR §2646.1 M2a ^ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645 TESTING PERIOD: ^ a. 36 HOURS ^ b. 60 HOURS M2s- ^ 5. INTEGRITY TESTING PER 23 CCR §2643.1 TEST FREQUENCY: ^ a. ANNUALLY ^ b. BIENNIALLY ^ c. OTHER (Specify): Mz6 M27. ^ 6.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agencyapprovaq M28. ^ 99. OTHER (Specify): V. PIPE MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mao ® 1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQU]D FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM M31. PANEL MANUFACTURER: VeederROOt M3z. MODEL #: TI S35O M33- LEAK SENSOR MANUFACTURER: VeederROOt M3a. MODEL #(S): 7943£i6-2O8 M35. WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? ®a. YES ^ b. NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO 1737. ^ 2. MECHANICAL LINE LEAK DETECTOR (MELD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW ~'~'HEN A LEAK IS DETECTED M39 MELD MANUFACTURER(s): M38 MODEL #(S): . ® 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS ELLD ;MANUFACTURER: PI I ~ Mao. MODEL #: 15567 Mal. PROGRAMMED LINE INTEGRITY TESTS: ^ a. MINIMUM MONTHLY 0.2 h. ^ b. MINIMUM ANNUAL 0.1 g.p.h. g~P• Mae. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO M43. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Maa ® 4. INTEGRITY TESTING TEST FREQUENCY: ®a. ANNUALLY ^ b. EVERY 3 YEARS ^ c. OTHER (Specify) M45. M46. ^ S.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY* ^ a MIN. MONTHLY & EACH TIME SYSTEM OPERATED** " Requires agrncy approval "" Allowed for monitoring of unburied emergency generator Cuel piping only per HSC §25281 Ma7. .5(6)(3) ^ 6. PII'ING [S SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) ^ 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE U5T(s) M48. P-l 00 /ITLJPA /CnPrifal _. UN-022A - 1/3 www.unidocs.org Rev. 10/14/03 .-' Underground Storage Tank Monitoring Plan -Page 2 of 2 VI. DISPENSER MONITORING MONITORING OF AREAS BENEATH DISPENSER(S) IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mso ® 1. CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT (UDC) PANEL MANUFACTURER: ~~Pe~PrROOt Msl. MODEL #: Ti S~5O Msz. M54 .. Mv _ VPP(IP.rROOt Ms3. MODEL# S :7~14~8O-ZO8 LEAK SENSOR MANUFACTURER: ( ) ntss . WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? ®a. YES ^ b. NO WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M56. WILL FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO Msg. ^ 2. MECHANICAL ASSEMBLY (e.g., FLOAT AND CHAIN ASSEMBLY) IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK Mss. MODEL # S : Msg. ASSEMBLY MANUFACTURER: ( ) M60. ^ 3.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Regwres agency appmvaq ^ 4. NO DISPENSERS M61. ^ 99. OTHER (Specify) VII. ENHANCED LEAK DETECTION ^ 1. WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK M70 DETECTION (ELD) FOR THE UST(S) COVERED BY THIS PLAN. PER 23 CCR §2644.1, ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED VIII. TRAINING REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) M80. 1. ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 2. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 3. ® THE FACILITY'S BEST MANAGEMENT PRACTICES (Required as of January 1, 2005) 4. ^ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. ^ CALIFORNIA UNDERGROUND STORAGE TANK LAW ^ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS -MANUAL AND 6 . STATISTICAL INVENTORY RECONCILIATION" ^ SWRCB PUBLICATION: "WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" 7 . M81. 99. ^ OTHER (Specify): Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and can access those documents when needed. By January 1, 2005, this facility will have a "Designated UST Operator" who has passed the California UST Sytem Operator Exam administered by the International Code Council (ICC). By July 1, 2005, and annually thereafter, the "Designated UST Operator" will train facility employees in the proper operation and maintenance of the UST systems. This training will include, but is not limited to, the following: - Operation of the UST systems in a manner consistent with the facility's best management practices. - The facility employee's role with regard to the leak detection equipment. - The facility employee's role with regard to spills and overfills. - Whom to contact for emergencies and leak detection alarms. For facility employees hired on or after July 1, 2005, the initial training will be conducted within 30 days of the date of hire. IX. COMMENTS/ADDITIONAL INFORMATION Please use this section to include any additional UST system monitoring-related information (e.g., additional information required by your local agency): Mss. Note regarding Section X. Pending certification of a Designated UST Operator, the following person has authority for performing the monitoring activities and maintaining leak detection equipment covered by this plan. NAME: JOB TITLE: X. PERSONNEL RESPONSIBILITIES 2005, THE "DESIGNATED UST OPERATOR" IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT AS OF JANUARY 1 , APPLICATION -FACILITY FORM W LL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION EQUIPMENT ERED $Y THIS PLAN, AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS OF THE FACILITY'S UST SYS IN ORDANCE WITH 23 CCR § 2715(b). ~. OWNER/OPERATOR SIGNATURE CERTIFICATION: cer,Hi'y tha the i rmation provided herein is true and accurate to the best of my knowledge. OWNER/OPERAT SI REPRESENTING DATE: M91. ® Owmer M9o- ® operator 7/28/06 M9z. OWNER/OPERA OR NAME (print): OWNER/OPERATOR TITLE: M93 Randy Martin Gasoline & Environmental Compliance Mgr /Agency Use Only) This plan has been reviewed and: ^ Approved ^ Approved With Conditions ^ Disapproved Local Agency Signature: Date: Comments/Special Conditions: UN-022A - 2/3 www.unidocs.org Rev. 10/14/03 EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify LOCAL AGENCY within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name: 7- Eleven Store #16549 Facility Address 4647 Wilson Rd., Bakersfield 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 LOCAL AGENCY must be notified within 24 hours. In case of a gasoline spill- Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. Employees will be notified to evacuate if deemed necessary. A contractor will be contacted to remove the spill as necessary. In case of a small carbon dioxide release- the tank will be visually inspected for obvious signs of the release point. If possible the control valve will be shut off. In the case of a large release of carbon dioxide, employees will be notified to evacuate and Contact 911 and 7-Eleven Dispatch. In case of fire- the alarm will be sounded by shouting "Fire" and the building will be evacuated. Employees will contact 911 and assemble at the designated assembly area as depicted on the site map. If safe, employees will shut off power and control fire using fire extinguishers. 2. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substances. Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. A contractor will be contacted to remove the spill as necessary. 3. Describe the location and availability of the required cleanup equipment in item 2 above. Absorbent is located inside the store in the backroom. 4. Describe the maintenance schedule for the cleanup equipment. Inventory of absorbent is periodically checked. List the name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan. Randy Martin, 7-Eleven Inc. Gasoline & Environmental Compliance Manager 253-796-7170 Date 7/2R/~h WRITTEN MONITORING PROCEDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify local agency within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name: 7-Eleven Store #16549 Facility Address: 4647 Wilson Rd., Bakersfield, CA Date: July 28, 2006 A. Describe the frequency of performing the monitoring: Tank The site consists of two double walled plasteel tanks (1-Regular Unleaded 10k gallon, 1-Premium 10k gallon) and are monitored continuously with a VeederRoot TLS350 Piping Product lines are double wall fiberglass and are monitored continuously with a VeederRoot TLS350. The turbine sump sensor activates audio/visual alarms and provides positive shutdown of the turbines. B. What methods and equipment, identified by name and model, will be used for performing the monitoring: Tank The method of leak detection for the tanks is Interstitial Monitoring of the double wall tanks using the VeederRoot TLS350 Tank Gauge programmed for a threshold of .2gph. VeederRoot model #847390-420 probes are used for the monitoring. High level alarms activate audio/visual and external alarms. Piping The piping is monitored continuously by Electronic Line Leak Detectors. The turbine sump sensors provide positive shutoff and activate audio/visual alarms. The piping is precision tested annually at a threshold of .1gph. Dispensers are equipped with under- dispenser containment with VeederRoot liquid sensors model #794380-208 that provide positive shutdown of the turbine. Enhanced This site has a single wall component of the tank system and utilizes Enhanced Leak Leak Detection (ELD) to include a Tracer Tight Test completed in 2003 and every 3 years Detection thereafter. C. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: The individual responsible for the monitoring equipment is the store operator, Shun Wang. The operator will contact 7-Eleven Dispatch 1 800-828-0711 for any alarm conditions on the VeederRoot. The local maintenance contractor will be dispatched. 7-Eleven, Inc. is responsible for maintaining the equipment The Environmental Manager is Randy Martin D. Reporting format for monitoring: Tank Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Monitoring records will be kept at the location and at a central office location. Piping Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen Third party annual test results will be submitted to the agency. ~._ ' Written Monitoring Procedures 7-Eleven#6549 Page 2, July 2006 E. 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 12 months. Tanks and product lines are continuously monitored and alarmed. Alarm histories are printed each month and investigated for corrective actions by the designated operator. Equipment repairs; replacement are performed as needed. F. Describe the training necessary for the operation of UST system, including piping, and the monitoring equipment: Employees are trained on the operation of the UST in a manner consistent with "Best Management Practices", Emergency Contact information, Spill/Overfill response procedures, Hazardous Waste Procedures, and Monitoring equipment operation and alarm response procedures. Training is conducted annually , or with 30 days for new employees, by the designated operator. Jun-22-06 13:35 TANKNOLOGY UNDERGROUND~.ST~RA~E TANKS APPLICATI N TO PERFORM ELp 1 NE TES NG J SB889 SEC~IDAR CWdTAI MENT TESTING lTANKTIGNTNES$ STAN 4 PERFORM FUEL M>7NITORING ERTIFIG TION PERMff NO. +~~ ~ ~ ~~ 909 308 1239 P.02 ~- r ~~Rr SAKERSFIELD FIRE DEPT. Pre~tention Seraic~ls 900 Tnlxtun Ave., Ste. 210 Baker~eid, CA 93301 Tei.: (6fil) 326-3979 Fax. (6r, i j 852-2171 Page 1 of 1 ^ ENNANCED LEAK TECTION ^ LINE TESTING Ln 58-989 SECONDARY CONTAINMENT TESTING ^ TANKTIGHTNE$S ST ^ TO f'ERFnRM I IJEL MONITORING CFRTIfIGAItUN --. ~,#_ _.. •__~_ SITEINFORMATIQN _ ._ _• __ •• FACILITY NAME E PHONE NUMBEk OF 'C}NTACT PERSON 7 ~r~ ~ ~ ~~~g 1 . M~N~~~Q - ~y ~4fo ~l7 ]~V+lsr, ~d. Sak~rs fie~~ ~ ~_ °t 33aq _ OWNERS NAME ~ I , ----~---• - OPERATORSNAMt _ NUMBER OF TANKS BE rES_ D ---~ ...._TAN _.__ ~ •-- - .. _... . PERMIT YO OPERATE. NO. PIPING GOING TD BE TESTED9 ^. YES__ ~ NO _- __ VOLUME _._._ __ .. GONTENTS_ __ . ; _~ APPRQVEpBY 1~L .. .. .1._ ... I -- - -I _._~ -... I - 7wNK TESTING COMPANY -- -- - -~~--~--_ ~ •-- ~~ ~n0 NaME 8 HONE NUMBEk OF cpNTAGT PEfiSDN - ~-_ ~~~ ~i`t'C# .. ~n~lon ~-eelcs r -s~) fd7~ _ 4a~a ~fn rise Ctlr~l~ SoL~ ~.~~ ~#ewleclAlc~~ L'~ '325RQ TER OR RECIAL INSPECTOR CERTIFICATION >K: _. ._ ICTEb ICf: a0; ~~~ ~~~~ ~ ~ 1 _ TEST METHOD ..--~ - DATE ~ ~ - T ~11 ATION B~.S?M.ES A~~LT H OVEQ---...... -DATE _- d' FD 2095 (Rey. 49/45) F ti P i I Jun-22-06 13:35 TANKNOLOGY _ 909 308 1239 1 1 ~~. . UNDERGRQI,tNQ18TC) APPLICATI N TO PERFCNtM ELD f E 56989 SECONDAR CC JTANK TIGHTNESS ST FUEI. MONITORING EEF PERMIT NO. I ~~ ^ ENHANCEp LEAK ^ TANK TIGHTNESS FACILITY AUUtttSS ;~O{ OWNERS NAME OPERATORS NAAAE NUMBER OF TANKS BE G _... TAN #..._ - .. ~ .. I .. ~ -- PERMIT Tp OPERATE NO. DOING TO BE TESTED, Q YES .._ ~Ma VQI.UME _ .CONTENTS _. ..~ -. . _ ... _ . . ~_ _ - - -~ -.~-- I . .. TANK TESTING COMPANY --- - .. NAMQ OF TESTING C RAPANY NAME 8 PHONE NUMBER OF Ct)NTACT ~NS~ MAILING ADDRESS ~"' ~~'-°+O~Y ~ ~' - ~-~"~''-~-`~'~= 5r ~ -- ~v X755 inter rise ~ir-c~e svul~-~ 5~e ~7~ ~em~~.ealc~C~{ ~25~1t~_ _ NAME d~ PHONE NUfYI ER OF 7 TER OR GCIAI INSPECTOR CERTIFICATION >X: ~' ve. G~- k_ ~q 5l 53 - .. _ _ ___ _ GATE !~ TIME T ST T BE CON CTED ICC #: _ ~ TEST METHOD 311;MA RE OF APP CANT T r~ -- ---- - - .. i ~-.. I .DATE V I _ __ i _ ~l TI~N_.~~COM~~ PE N ARPRQ~EQ_-. , ~- • APPROVED SY ~ _ • - - -- I DATE a`' ~!~ -- - .._ .. 9 {~ GAG . ~ ~ ~l q i( i i ~. E YANKS .f ~ i 1-!Rl w~rr NG MENT TESTING O PERFORM T10N ^ LINE TESTTNG P.Ol BAKERSFIELD FIRE DEPT. Frevettt3ota Berv~ces 900 Truxtun Ave., Ste. 21U Bakeraffeld. CA 93301 Tel.: {661) 32b-3979 Fax: (661 E 852-2171 Page 1 p( 4 ~S~AB9 SECONDARY CONTAINMENT TESTING L,1 I ()PERFORM FUEL M()NI I'C.)RING CERTIFICATION _ .__ _ .. . . _ ,,. SITE INFORMATION , _ I `-.~2~ NAME 8 PHONE NUMBER OF CONTACT PERSON ~P _ ._ Mana~e,r` -~-... ?~~~~ 1350 . _~° X01..3 ~ak~x`~-~iel~ ~ C,~l °I33o'~' ~ ------ /~M FD 2095 (Rev. 09/05) Jun-22-06 13x35 TANKNOLOGY 909 308 1239 P.03 i , '~ ` , Y A 3785 n TANKN L4G SO. CAf_IFQRNIA ', PH. (9 ) 67Fi-4060 .~ ~; 417 ENTERP TE=MFC;U I$h CIA. S., STE. D CA 92591) ~ ~ ~ „ ~ X523 ~ I. '. PAY ~ r~RQER oi• ~ ....... P ~ 1J1 ~ Y .._.. . I?S ~2ty0 Y rk, N.11. ~? ® Iilnrni.r 'i Ilifargo.cur Ir _ 7~~I ~-~~ ~ ~~ :: i ~.rr,? , M .. II^ ~03? ~51i' ~;L220002~9?~:^?260 2 50 261!• • • 4 .. _.. ..... _.._. n....-. ..~. _ -~.._ ...... ... .. ,,:r _ ~ r _. ,. _ ..._ .: .... .. ....... ; .. TANKN a LpGY I 50, CALIFORNIA 3 7 8 6 : r F'Fi. (9 ) G76.4()fib 4178 ENTERP SF CIH. 5., STE. O i ;~ I f:M~CU CA 92557(7 ~ ~.~I ~r~~ uATe (( IB-2a 7??0 ~~ , l PAY 1'~r rHC ~if~ nF117f f' S "~ ° 1~ ; ~ *'W ~?.~ f . .. ~7f M9 I ~ d I ` f~-~ I 1 ~ r Its F~r~O Esa k NA. ~,. :' i Idornia t Ilifnrcpun 1 Fart ~'~r ~ ~~ Cj ( :Y M u' ~©37 ~G11' ~:L220^O24?~;0 2 50 2 6 11 • .... , ...._ . _.,.._..... _ _ r._.;... ~_, -- ,. . :_.. .- ,._ ......-. ..... _ , S !ii 7 ~ C. 4~ ~ ~ L.Y 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 ~~ ~j~ KERN CTY - ENVIROMENTAL HEALTH 2700 M STREET SUITE 300 BAKERSFIELD, CA. 93301 Test Date: 07/12/2006 Order Number: 3147494 Date Printed and Mailed: 07/25/2006 ~G~`V~O 2 ~ 2°°6 ~~~ ~ ~®~~ st~~,~Es KER t~N~ E~R~N~~N Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #16549 MARKET #2237 4647 WILSON ROAD BAKERSFIELD, CA. 93309 Testing performed: Secondary Containment-Dispenser Pan\Sump Secondary Containment-Spill Container Secondary Containment-Sumps\Under Dispenser Secondary Containment-Tank Interstitial Sincerely, C1~'-~ ~a~~~r-~t.ys~ Dawn Kohlmeyer Manager, Field Reporting SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS TEST DATE:o7/12/2006 CLIENT: 7-ELEVEN, INC. P.O. BOX 711 DALLAS TX 75221 214-841-6714 Tank Interstital Tests -TANK PRODUCT MANUFACTURER RESULTS REG UNLEAD Total Containment PASS PREMIUM Total Containment PASS WORK ORDER NO.: 3147494 SITE: 7-ELEVEN #16549 MARKET #2237 4647 WILSON ROAD BARERSFIELD CA 93309 Piping Interstital Tests LINE PRODUCT MANUFACTURER RESULTS Sumo & Linder-Dispenser Containment Tests .Sump/ DISP.# MANUFACTURER P/F 1 REGULAR Total Containment Pass 1 REGULAR Total Containment Pass 1-2 Total Containment Pass 1-2 Total Containment Pass 3-4 Total Containment Pass 3-4 Total Containment Pass 1 REG FILL OPW Pass 1 REG FILL OPW Pass 1 REG VAP OPW Fail 1 REG VAP OPW 2 PREM FIL OPW Pass 2 PREM FIL OPW Pass 2 2 PREM V OPW Pass 2 PREM VAP OPW Pass Tanknology representative: BRIAN DERGE Services conducted by: STEPHEN COULTER ~`~ cC('_~1Nf1ARY r[1NT~INMFNT TEST RFSl1LTS SITE NAME: 7-ELEVEN #16549 16549 DATE: 07/12/2006 WORK ORDER 3147494 SITE ADDRESS: MARKET #2237 4647 WILSON ROAD BAKERSFIELD CA 93309 REASON FOR TEST: Groundwater Level "from grade Tan IHIV I~IIV r'VKIVIHIIV Product nI HIVU InI1C Tank Size RJ 1111NL I Dia. CJIJ Material Manufacturer Depth ~ ~~ Test Method Start Time Initial Level Finish Time Final Result Pass/ Fail 1 REG UNLEAD 10018 109 DW STEEL Total Containment 44 Vacuum 0845 -10 ~~H9 0945 -10 „fib PASS 2 PREMIUM 10018 109 DW STEEL Total Containment 43 Vacuum 0900 -10 °H9 1000 -10 °Hg PASS 3 0 0 4 5 6 7 8 Comments: Tan LtNt ~NrVKMHI Iv Product ry AIVU IIY 1 C Dia. RJ I I1IML 1 C Len. feet J 1 J Material Manufacturer Volume allons Test Method Start Time Initial Level Finish Time Final Result Pass/ Fail 1 2 3 4 5 6 7 8 Comments: UMP TESTS ,~ SECONDARY CONTAINMENT TEST RESULTS Test Date: Work Order: 07/12/2006 3147494 Type Tank or Disp # Manufacturer Model or Material Diam./WidttVLength (") Depth (") Test Method Start Time Initial Level Level Change Finish Time Final Result Pass/ Fail STP Sump 1 REGULAR Total Containment Plastic 48 44 VPLT 836 10 -.00002 851 10 Pass STP Sump 1 REGULAR Total Containment Plastic 48 44 VPLT 852 10 -.00001 907 10 Pass Dispenser Sump 1-2 Total Containment Fiberglass 39x16 3G VPLT 1033 18.5 -.00010 1048 1+3.5 Pass Dispenser Sump 1-L Total Containment Fiberglass 39x16 36 VPLT 1049 18.5 +.00013 1104 18.5 Pass Dispenser Sump 3-4 Total Containment Fiberglass 39x1G 36 VPLT 1033 17 -.000'20 1048 17 Pass Dispenser Sump 3-4 Total Containment Fiberglass 39x1G 36 VPLT 1049 17 +.00002 1104 17 Pass Spill Container t REG FILL OPW Plastic 13 13 VPLT 913 5.75 -.00001 928 5.75 Pass Spill Container 1 REG FILL OPW Plastic 13 13 VPLT 929 5.75 +.00195 944 5.75 Pass Spill Container 1 REG VAP OPW Plastic 13 13 VPLT 929 7.5 -6.5690 944 5.5 Fail Spill Container 1 REG VAP OPW Plastic 13 13 ----- --°- ------- ----- ----- Spill Container 2 PREM FIL OPW Plastic 13 13 VPLT 953 6 +.00001 1008 6 Pass Spill Container 2 PREM FIL OPW Plastic 13 13 VPLT 1009 G -.00001 1024 6 Pass Spill Container 2 2 PREM V OPW Plastic 13 13 VPLT 953 7 +.00013 1008 7 Pass Spill Container 2 PREM VAP OPW Plastic 13 13 VPLT 1009 7 -.00001 1024 7 Pass Comments: Regular vapor spill container contains no drain. Spill container is direct bury. ~: ~ Tanlv~o/ogy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:07/12/06 WORK ORDER NUMBER3147494 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #16549 COMMENTS 3 Year Tri-Annaul SB-989 Testing. Tested two tank interstitial; all passed; Tested two STP sumps; all passed; Tested two dispenser sumps; all passed; Tested four spill containers; Regular vapor failed all else passed. PARTS REPLACED QUANTITY bESGRtPT10N HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HEEIUM PINPOINT LEAK TEST RESULTS Printed 07/25!2006 07:46 SBOWERS ITE DIAGRAM ~_ ~ Tanlvtology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512) 451-6334 FAX (512}459-1459 TEST DATE: 07/12/06 WORK ORDER NUMBER3Z47494 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #16549 rn ~~ ~~ r` QQQ VENTS SUP I O a O ST REG I ~ ~ a ST 10 W S N Mid grade tank still underground. All tank components have been removed tank and tank sumps filled with dirt and gravel. Printed 07/25/2006 07:46 SBOWERS Work Order: 314 7 4 9 4 i Secondary C~ Thrc.~nrrn t; irttertd2d !br upe hr cwrf anprnpriare pugev of this farm to re and pt•inrouts. from tens 1?f applicubl ~egu~e7tory ogenci. • n#ainmen# Tes#ing Report Farrn ors pc7formfng perrodic resting of U.ST szcortdary cor:rairxmetrt systems. 1.'se fh~ results,for al! romprxrentt tested. The completed form, written lert procedures. ~huuld be provided ro the facility owner/operutor jot suErnittal ro the Ixaf 1. FAC7[)LITY INFQRMATIOIV Facifit; ?v'amz_ ,, Date of'Iesting: [~~.-~ Facility Address: ~ ~~•/ [' jQ~j ~ : Faciiit~~ Contact:W faM ~ Phone: ( ~ 3~. p~z,3~ __ . Datt: Local Agency Was [ified o [:sting : `~ ` M- K~ante of Local A2etic}• Inspector nr 2. T ING CONTRACTOR IINFORMATIOTI Comgam•Ivatne. ~„,~,r 'fechniciazt Cunductin~ Tcst: ~ Credentials: SLB Licens i ontractor - S WRCB Licensed Tank Tester f ___^ _,_ Lica~nse T~ pt; and li: ~ p viarwfacmrer Training by Manufacturer Component(s) Da[C TFAltltny Explre: ~ ., U L T - _ # ` ~~,-- ~ ~~ .__._~__. -- - v r D~-az ---~ l i 3. ~ UM!1xA1tY 4F TEST RESULTS Number of "Tanks Tested: Number of Piping Buns Tested: Number of 5ubmeraible Pump Sum ested: ,~ _ _ __ Number of UDC Boxes Tested. 'Number of i:ill Sumps Tested: I ~ ititunbcr of()verfill Boxes Tested: ~ ~ """ FF Component Pass Fail ~ Cotnmeots ~ ~~ .,rp.- Srt~ ~.M : ~ ~~ -~ ~.;~.. SrP S~~ ~ ~ --"- ~ `~ i is~ar~,'~__ . _.~ i , t _ U "{ r :r( Tee:• r 11 J~ L' ~ ." _._...... ~!~SL.t r.. ~~ ._4R+L~ ~ V i ....-. .~ . I :J .. - - --- - _ ,_ ~ - Technician's Signature:___ SVrRCB t llate: ©~ f,,,~ -~ ..- --- Dccernber 'Q~; Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147494 ~. TA1VK ANNULAR TF.STIN(i Page _ of 'lest Method Cleveluped By: ~ ~ Tank Manufacturer ~idustry Standard Professional Engineer Other {Specify) Test Method CJsed: ~ Pressure cuum T3ydrostatic Other (Specify) _ Test lquiytnent Uscd: e ~ Equipment Resolut;on: Q ~ .?~ . nk # Tack # Tank # Tank # Is Tank Exempt From Testing?t Yes Yes Yes N~ Yes rJ~ Tank Capacity: o f ~? .._ Tanis Material: ~ ~j,W. ~y~ t W she ~~- TankMantrfacturer: ~q 1 ~ ~~~~ ~ . . Product Stored: ,,i vit ~ ~ le,.:.s /rr 1171 Wait time between applying . pressurelvacutttnlwater and starting test: __,. , ~ ~ r,r, _ ,,,,,,~ -~ Test Start 'l'ime: ~".. f ~ ~~ lnitia] Reading (Rr): ~, ©^ ,_`~j •• Test End Time: ~j'9r5- ~~DQ Final heading {RF): ,_ /Q „~ 'Pest fluration: ~, r, C:hanbc in Reading (Re-Rt): Pass/Fail Threshold or Criteria: _ Was sensor removed for tasting? ~ o ~ s f es No NA 3 .~ Na NA Yes No NA Ycs No tv.1 Was sensorproperfy replaced and ~•erified furetional after testing? a No NA es Na NA Yes l~lo NA Yes Nn NA Comments - {include injormalto n repairs made prior to ieslirtg, & recommEnded folIox+~up jor failed tests] Secondary containment systems such as systems that are hydrostal Code of Regulations, Title 23, SG ~~ the continuous monitoring automatically monitors bath the primary and secondary conratnment. ponitored or uudcr constant vacuum, are exert from periodic containment testing. {Califurnia Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147494 b. PIpIIYG SUMP TEST'~IYG PagC~of~ Test Method Developetf By: Sump Manufactu~ dustry stanaa~ professional Enguteer Other (,Specify} Test Method Used: _ Pressure Vacuum hydrostatic Other (.Sped) Test Equipment Used: Lr Equipment Resolution- ~ ~~ Somp # ~ Sump tt ~ Sump # Sump # Sump Diameteei•: ~•~ ~-~ Sump Depth: Sump Material: ~~~, f~ ~ ~ Height from Tank Top to Top of Idighest Piping Penetration: ~ ,. ~ ~. Height li-om Tank Top to Lowest . 8lectrical PeaetraGioa: ~.. ~.. Condition of sump prior to ~ , UCSting: ~ 00 Portion of Sump Tes J~ .. - Does turbine shut down whca sump sensor detects ligaid (both ~ ~ Na NA es No NA Yes No NA Yes No NA ptocluct sad water)7 Turbine shutdown response time Is system programmed for fail- safe shutdown2~ es No NA ~ No NA Yes No NA Yes No NA Was fail-safe verified to be operational?• ; yeS No t+tA yes No 1dA Ycs No NA Yes Nn NA Wait tune between applying ' pressurelvacuum/water artd 3tatttn t t' ~~ es g / J In. n +i ''n Test Start Time: ~ $3~ gs~ ~~ $~ lnitiaiReading(R~}: .OD .pooao' aooo' .OOdao" Test End 'l'ime: I ~ ~ - 1~'inaI Reading (RF): ~, „~ Test Duration: ~!!~. 1 rrt~a, ~,tj rnl. !5 r~. 15 rnlt~. ~+~. Change in Reading (RP-R~: v "oooo I Pass/Fail Threshold or Criteria: ~ ,pp,z• ~~ , flog • }/ .moo ~' +/-.ooz' Was sensor removed for testin~ a No NA es No NA Yes No NA Yes No NA Was sensor properly replaced ' and verified fwnctional after es No A1A ~ No NA Yes No NA Yes No NA testing? Comments - (include infonxaiiox repairs made prior to testing, and recoxvnexdert jallox~up for jailed rests) i t Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 ' Work Order: 3147494 7. UNll3ER~ISPENSER CDN'I'AlNMENT (UbC) TESTING Page --°f- 'Test Method Developed By: DC iVl2inufachues ~dustry Standard Professional Engineer then (Specify) Test Method Used: ressure Vacuum ydrostatic then (specify} Test Equipment Used:1/ ~ Equipment Resolution: , # - ~ UI3C # - UDC # IIDC # UDC Manufacturer- ~„~ ; UDC Material: ' ~ ~~ UDC Depth: Height froum UDC Bottom m Top of Highcat Piping Pcnetratiom: l3eight from UDC Botmmto 13 '' / , Lowest Electrical Penetration: 3 CondiAOn of UDC prior to testing: Portion of [J17C Tested / . S - Does turbine shut down when _ --` `~ ' ~-- UDC sensor detects liquid s No NA es + No NA Yes No NA Yes No NA (both product and water)? T°rbine shutdown response timt la system prograrmned far fail- ? a No NA es , No NA Yes No NA Yc~ No NA safe shutdown Waa fail-safe verified to be operational?• Y' No NA Yes No NA Yes No NA Yes No NA Wait tune hetweert applying ~ T"" pressure/vacuumlwater and ~ ~ starting ust ~+s'~ p, L/.r..' Test Start Titne: / ~ IrtitialReading{R~): ,o O' .d t7oD' -~- Test End Time: !Q /1~ /D / o Final Reading (RF): ~ io ~l: oae , a ¢. Test Durarian: I ~ N . 15 ~r-r~ . i .5 rtlrlJ - i 5 mrlu. t ' N . I - 15+~ ~~ . _ f n.r -_.. Change in Reading (RF-R~): IO t. o a Pass/l~ail 1~reshold ar Criteria: .002` *(_,002" +r.OQZ" +f ,t70~` `~ . Was sensor removed for testing? No NA No NA. Yes No NA Yes No NA W as sensor properly replaced and verified functional after testing? + No NA ~ _- J No NA Yes No NA Yes No NA Cottttnents - (include inforrnalion n rep¢irs made prior !o lestin~ axd recomnvended follow-up forfailed tests) Tanknology-iVDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 314 7 4 9 4 9. ~ PII.>LJO'4'ERFILL C4NTAINIVIENT BOXES ~e ynf Facility is Not Equipped With. illlOverfill Containnent foxes SpiiUOverfill Containment Bo ars H~sent, but were Nat Tested - Test Method Developed $y: .,; ~ Spill Bucket Manufacturer ~'dusory Standard Professional Engineer ~ ~ Other{Sped) Tes# Method Used: Pressure Vacuum ~3Ydrostatic ' Other (Specify) Pest Equipment Used: {f lquipment Resolurion: . p Spill Bak #~; ~~ Spill Boz #~/y~,, Spill Box #. F.'r Spill Sox #t~,~ Bucket Diameter: •r- j I~ ~ ~ ~ Bucket Depth: _ ~ - ~3 Wait time between - - ~ applying ~` pressure/vacuumlwater .. and starting test: ~ yS.,.,,•„ ~~,~.~ ~ /, ~~ ' ~` ~ Test Start Time: Mti ! . ~ ~ ~ 9 ,~ `~S~ jd d %DG Initial Reading (R,): . Test End Time: . ~~ ~- c~ -- /~O $. ~ O fem. Finn! Reading (Rp): • _ _ j f. I S" . S ~e ~; doe - oo - ~ ~GeO/ r.e°ec Test Aeration: Ch ~ / ..,..: w / _..:.. I S :~ M J ,' _- / S....:. - 157.x.,•, -•• / .5.... ange in heading {RF- Rc)= ~-, oo- ~. S-~ ~ ~ =b ~ G ~ b ` Pass/Fail Threshold or oo eee . ooac - Criteria; ~ ~O~ f` ~ p~~ t ~ Qp~ ~'" p~~ Comments - (include inforMa n on repairs made prior to telling, axd reen~nmended fOllOw_~r~p fOY failed leStS) 'a N ~ ... - •-- ~ , . --. - r ~ f !D : Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 f -m- ~~ ~-~ ~ r 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 07/12/2006 Order Number: 3147494 Dear Regulator, Date Printed and Mailed: 07/25/2006 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #16549 MARKET #2237 4647 WILSON ROAD BAKERSFIELD, CA. 93309 Testing performed: Secondary Containment-Dispenser Pan\Sump Secondary Containment-Spill Container Secondary Containment-Sumps\Under Dispenser Secondary Containment-Tank Interstitial Sincerely, .~ Oar ~a~s Dawn Kohlmeyer Manager, Field Reporting SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS ®i, ~ T~l7P >~~t~ TEST DATE:o7/12/2006 WORK ORDER NO.: 3147494 CLIENT:7-ELEVEN, ZNC. SITE: 7-ELEVEN #16549 P.O. BOX 711 MARKET #2237 4647 WILSON ROAD DALLAS TX 75221 BARERSFIELD CA 214-841-6714 Tank Interstital Tests TANK PRODUCT. MANUFACTURER. RESULTS REG UNLEAD Total Containment PASS PREMIUM Total Containment PASS Piping Interstital Tests 93309 ...LINE PRODUCT -MANUFACTURER RESULTS Sumn &Under-Dispenser Containment Tests Sump/ DISP.#? MANUFACTURER i?/F 1 REGULAR Total Containment Pass 1 REGULAR Total Containment Pass 1-2 Total Containment Pass 1-2 Total Containment Pass 3-4 Total Containment Pass 3-4 Total Containment Pass 1 REG FILL OPW Pass 1 REG FILL OPW Pass 1 REG VAP OPW Fail 1 REG VAP OPW 2 PREM FIL OPW Pass 2 PREM FIL OPW Pass 2 2 PREM V OPW Pass 2 PREM VAP OPW Pass Tanknology representative: BRIAN DERGE Services conducted by: STEPHEN COULTER .'~~ -.. SFCnNI~ARY CnNTA1NMENT TEST RESULTS SITE NAME: 7-ELEVEN #16549 16549 DATE: 07/12/2006 WORK ORDER 3147494 SITE ADDRESS: MARKET #2237 4647 W ILSON ROAD BAKERSFIELD CA 93309 REASON FOR TEST: Groundwater Level "from rade A[~TITI AI TCCTC Tan 1 HIY R I IY f V R IYIF11 I V Product IY HIY V I IY I C Tank Size RJ 1 1 1 1 MG I Dia. G J I J Material Manufacturer Depth ~ 1~ Test Method Start Time Initial Level Finish Time Finat Result Pass/ Fail 1 REG UNLEAD 10018 109 DW STEEL Total Containment 44 Vacuum 0845 -10 °H9 0945 -10 ,MHO PASS 2 PREMIUM 10018 109 DW STEEL Total Containment 43 Vacuum 0900 -10 ..H9 1000 -10 "H9 PASS ;; 0 0 4 5 U 7 8 Comments: Tl~u wun 1\ITC~ Tan LIIYC IIYrVRIYIMIIV I Product Y MIYV IIYIG Dia. RJ IIIIfIG 1 Len. feet Material Manufacturer Volume allons Test Method Stari Time Initial Level Finish Time Final Result Pass/ Fail 1 2 3 4 5 6 7 8 Comments: UMP TESTS SECONDARY CONTAINMENT TEST RESULTS Test Date: Work Order. 07/12!2006 3147494 Type Tank or Disp # Manufacturer Model or Material Diam./Width/Length ('~) Depth (") Test Method Start Time Initial Level Level Change Finish Time Final Result Pass/ Fail STP Surnp 1 REGULAR Total Containment Plastic 48 44 VPLT 836 10 -.00002 851 10 Pass STP Sump 1 REGULAR Total Containment Plastic 48 44 VPLT 852 1U -.00001 907 10 Pass Disrx:nser Surnp 1-2 Total Containment Fiberglass 39x16 36 VPLT 1033 18.5 -.00010 1048 18.5 Pass Dispenser Swnp 1-2 Total Containment Fiberglass 39x16 36 VPLT 1049 18.5 +.00013 1104 18.5 Pass Dispenser Sump 3-4 Total Containment Fiberglass 39x16 36 VPLT 1033 17 ,00020 1048 17 Pass Dispenser Surnp 3-4 Total Containment Fiberglass 39x16 36 VPLT 1049 17 +.00002 1104 17 Pass Spill Container 1 REG FILL OPW Plastic 13 13 VPLT 913 5.75 -.00001 928 Vii./5 Pass Spill Container 1 REG FILL OPW Plastic 13 13 VPLT 929 5.75 +.00195 944 5.75 Pass Spill Container 1 REG VAP OPW Plastic 13 13 VPLT 929 7.5 -6.5690 944 5.5 Fail Spill Container 1 REG VAP OPW Plastic 13 13 ---- ----- ------- ----- ----- Spill Container 2 PREft4 FIL OPW Plastic 13 13 VPLT 953 6 +.00001 1008 6 Pass Spill Container 2 PREM FIL OPW Plastic 13 13 VPLT 1009 6 -.00001 1024 6 Pass Spill Container 2 2 PREM V OPW Plastic 13 13 VPLT 953 7 +.00013 1008 7 Pass Spill Container L PREM VAP OPW Plastic 13 13 VPLT 1009 7 -.00001 1024 7 Pass Comments: Regular vapor spill container contains no drain . Spill container is direct bury. °- ~ Tanlv~o/ogy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:07/12/06 WORK ORDER NUMBER3147494 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #16549 COMMENTS 3 Year Tri-Annaul SS-989 Testing. Tested two tank interstitial; all passed; Tested two STP sumps; all passed; Tested two dispenser sumps; all passed; Tested four spill containers; Regular vapor failed all else passed. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 07/25/2006 07:39 SBOWEKS ITE DIAGRAM ~~ i Tan/v>tology 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 07/12/06 WORK ORDER NUMBER3147494 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #16549 rn r- ~ ~~ r` 000 VENTS SUP I OA OV OF ST REG OA ~ OF ST 10 W S N Mid grade tank still underground. All tank components have been removed tank and tank sumps filled with dirt and gravel. Printed 07/25/2006 07:39 SBOWERS Work Order: 3147494 f i 5ecandary C~ Thrs li/rm rs +a>terrded /nr usN hr cart anprOprlarN nc7~P.,' f)f this forrrr ro re and prrntours.fr'om te.rrs lif upplieabl ~eguiatory age,tctc i • ntainment Testing Report ~alrrn ors pc7formi~gpersodir. resting of UST sacu~dary containment st~srems. l.~,e rho results,for all ramptxrenLt tester! The completed form, written test procedures. tfwuld be provided to the facilirp owner/operator jot submittal ro tke lncal Y. FACILITY INFQRMATION Facility ?r'ame_ ,, Date of-Iestin;: ~~~~ Yacility Address: stl ~,•/ ~ yr ~ i Facilit~~ Catttact fQ~ s Phone: ( ! 33'- 0~.3,? __ . Date Local Agency Was [ified o esting ~ `~ ltiame of Local Aee~tc~• Inspector rtt: 2. T >(NG CONTRACTOR INFORMATION r Compan,• Itiatne. Q„ ,~,r 'feChniCiaz[ i:unductin~ Tcst: ~ Credentials: SLB Licens ~ ontractor ~ S WRCB Licensed Tank Tester f ------ - CricCtlse Type and 4: /~ p Vlatwfacmrer Training by Maoufscturer Component(s) Uatc Trauti~g Expirzs i 'r 3. ~ U1VI!1~Akt1k' OF TEST RESULTS Number of-Tanks Tested: Number of Piping Runs Tested: Number 1,1' Submersible Pump Sum ested: ,~ _ _ _ Number of UDC E3oxes Tested: " ~~ Number of i:ill Sumps Tested. I Itiumbcr ~sfClverfil] Boxes Tested: ~ ~~~ Component Pass Fail i Cotnmeots ~~ ----•- _ - ~~ ~~; ~i~ Srt~ ~.~, ~ ,~ ~~ -~' ~--~] M1/Vii S/ r SVM I l". ~ --..- rl- u r '~ t 'a~~__ . t i - -- _. U ~i r1 ~e d ~` w,~r-i , I ~ t ~ ~~ iJ _ ,_ ~ - Tecftnician's $i=nature:___ i SViRGIi - llatc: ~~ ~~ -~~ - -~-- D~cctnaer ?Q0; Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147494 ~#. TA1~K ANNCJ)<,A.R TESTING Page _ of "I-est Method Developed By: t Tank Manufacturer ~dustry Standard Professional Engineer _ _ Other (Specify) Test Methcxl Clsed: ~~ Pressure .___ cuum I3ydrostatic Other (Specify) Test lquiptnent Usod: a Equipment Resolution: ©_ .~ uk # Truk # 3'ank # Tank # Is Tank Exempt From Testing?l Yes Yes Yes No Yes No Tank Capacity: o ~D --- TanicMaterial: ~ D,r,.f, 5~j .W. she _ Tank Manufacturer: ~q ! ~ .~~~~ . Product Stored: ~/ vIt l ~ ~^,,,,;. I[.1~71 _ _ Wait time between appl}nng . , _ _ pressurelvacuum/water and ~ . starting test: ^T~ ~ r , f, ,,,,~, Test Start'l'ime: g.~s dd - - lnitial Reading (R,): Q ~ ~ ~fp •- Test End Time: nj ~~ ~~DQ Final heading (RF): _ _.10,.~ "I'esf Durafion: ~, ~, Chanbc in heading (RF-Rt): Pass/Fail Tlueshold or Criteria: - acs s ~a~' -~ ~ D'$ai1 Was sensor removed for ~ tcsting? ~ ' es No NA .~ No NA Yes No NA Ycs ~ N~~ tvA Was sensor property replaced and verified functional after testing? a No NA es Na NA Yes No NA Yes Nn tyA Comments - {include infarrnultol~on repairs made prior to lesling, & recommended fallow-up for failed tesrsj ! ~~~ Secondary containment systems whey the continuous monitoring automatically monitors both the primary and secondary con~cnment, such es systems that are hydrostatical] onitoted or under constant vacuum, are exempt fromo periodic containment testing. {Califurnia C:nde of Regulations, Title 23, Secti 37ta)(ti}} Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 314 7 4 9 4 b. PLPIIVG StLTMP TFSTiIIYG p~C._.-.°f~ Test Method Developed $y: Sump Manufacturer dustry Standard Professional Engutocr 4thcr (Specify} Test Method Used: Pressure Vacuum ~Iydrostatic Other (Specify) Test Equipment Used: L~ Equipment Resolution: , ~~ Snmp # ~ Sump # ~ Sump # Sump # Sump Diametef: ~'.. ~. Sump Depth: , Sump Material: ~~,~ ~L ~ ~ Height from Tank Top to Top of highest Piping Penetration: ,r ,. (~ ~ ~. Height from Tank Top to Lowest Electrical Penetration: ~ •~ ~ ~~ Condition of sump prior to ~ . UCStlug: CD Portion of Sump Tes ~~ •• - Does turbine shut down when sump sensor detects ligaid (both ' ~ ~ No NA es . No NA Yes No NA Yes No NA product ead water)7 Turbine shutdown response time Is system programmed for fail- safe shutdown2' ~ es No NA ~ No NA Yes No NA Yes No NA Was fail-safe verified to be operational?' ; yC3 No NA Yes No NA Yes No NA Yes Nn NA Wa{t time between applying pressurelvacuum/waterond staittrlg TESL: ~^-- ~ J -n.',~ ~~ t '' . n Test Start Time: ~ gi(v gs-~ ~lc ~~ IrtitiaiReading{Ri): .pp .OCOpo' c~ooo' .oodoo" Test End 'Time: ~ ~ ~ ` F'inaI Reading (RF): ~> .~~ Test Duration: ~lq IAI. i rn +rJ ~ 15 -Ar . 15 r a. 15 rn i n~. I r~ rs . Change in Reading (Rp-R~: v "aooo I Pass,/Fail Threshold or Criteria: ~f ,po.Z` ~~ . t742" +l_ , pp 2' ~ _ ! .ooz Was sensor removed for testing a No NA es No NA Yea No NA Yes No NA Was sensor properly replaced and veriFied fiunctional after es No AiA ~ No NA Yes No NA Yes No NA testing? Comments - (include information repairs made prior to testing, and recomme~erijollow-up jor jailed tells} i Tanknology,-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3147494 :~ 7. UNpER Page ____ of YSPENSER CON'IAIIVMENT (UDC) TESTING Comments - (include i>rforntation n repairs made prior to testing, and recommended follow-up for failed tests) r 'test Method Developed By: DC Manufacturer ~ndustry Standard Professional Engineer then (SpecfYJ Test MCtfiod Used: ressure V acuutn ydTOStatiC then (5pecr,(y1 Test Equipment Used: 1/ ^~ Etluiprntnt Resolution: , # - ~ UDC # - UDC # ~ UDC # UDC Manufactt>rer- ./,,; ; l,1DC 1VLaterlal: r r' per UDC Depth: Height &orn UDC Bottanr m Tap 7 l of Highest Piping Pcnetratiom: ~ ~,]~ Height ftnmi3DC Bottom to ~~ ., j3 ., fewest Eloctrical Peneaalion: Condition of UDC prior to testing: Portion of tJ17C Tested / .S .-,~__.. ~._ i7oes turbine shutdown when UDC sensor detects liquid s No NA es + No NA Yes No NA Yes No ivA (both product and water)? Tnrbine slrutdown respor~.9e time la system prograr~ned far Earl a No NA ea , No NA Yes No NA Yes No NA safe shutdown? Was fail-safe verified to lx ~ y' No NA Yes No NA Yes No NA Yes No NA operational? ~__._ Wait tune between applying pressureJvaeuurn/water and ~ ,,~~''^^~ ~ starting test ~.,,•~ v.r.,' Test Start Time: j j _.__ Initial Reading {Ri): ,o t}' .d t)oo' Test End Time: !D /0 /o J o Final Reading (RF): ~ ~o ¢: oao , o ~. _ __ ~~ ~ ~ Test Duration: ~ ~ N. ~.5 rhl~. i.5n~r~l. I5min;. t " n]. I ISrti +r+ f n ~ . Change in Reading ~R~): /O f. o a Pass~ail Threshold or „ 002 /_ +/ 002" 002" +( oo Z' +/ C~iteria_ . . _. _ , Was sensor removed for testing? No NA No NA Yes No NA Yes No VA Was sensor properly replaced and No NA ~ ~ No NA Yes No NA Yes No NA verified func4onal after testing? , Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 ~ r, Work Order: 3147494 9. ~' PIL)L/0'~RFILL CDIVTAINII+IEI~tT BpXES ~e ynf - Facility is Not Equipped With. ilUOverfill Containmxnt Boxes SpiiUOverf~ll Containment Bo are Present, but were Not Tested Test Method Developed $y; . •; Spill Bucket Manufacturer ~'dustry Standard Professional Engmetr ~ Other {Sped) Test Method Used: Pressure Vacuum hydrostatic Other (Sped) 'Pest Equipmenrt Used: {f Equipment Resolution: . ~ Spill Boat #~;,~ ~ Spill Bo: #~, Spill Box !~, F.'r Spill Box #~/,~ Bucket Diameter; •r- ~ _ J~ ~ ~ Bucket Depth; ~ - Wait time between - ~~~ applying pressurelvaeuumlvrater is snd starting test: ~ ~ s....',~ ~5 ,.~,~ ~ ~• ~~+~ ' f ~` ~.. Vest Start Time: 3 ~n 4 _ r- ti `~S~ Id d JfjG Initial Reading (R,): . Test End Time: ~ . q -- ~~a $. ~ ~, o fem. Fina! Reading (Rp): ' - j f . ! ~ . 5 ~a ~ ~: one -; oo ~OOOI ~reOeG TestDuratian: ~ ,,,,~:,~ I :,~ / r .~ ,;, ! .' !5` : f5' /S' Change in Heading {RF- _, _. ...~ . ti,r, .... R~)= f. ao~ ~. ~~ ~ ~ ~ =O • a '~ d ` Aass/Fail Threshold or no eon ~ , nose Criteria: "' • r ~O ~ f' p ~~ t ~p~ '~ p - d n7 Comments - {inclurie informa non repairs made prior to ies+ing, and recanmended fotlow_up for fu ilyd tests) -- • - _ •~ eo Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 May-17~-06 13:51 TANKNOLOGY UNDERGROUNDS~ORAG TANKS APPLICATIO TO PERFORMM ELD (L E TESTI G ! SB989 SECONDARY ONTAIN ENT TESTING !TANK TIGHTNESS T AND T PERFORM FUEL MONITORING RTIFICA ION PERMIT NO. I ~ ~'~"' ~ L 909 308 1239 P.02 ~'' SAKERSFIELD FIRE DEPT. ' a Prevention Services f/RL DIRTY 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 TeI.: {661- 326-3979 Fax: (561) 852-2171 page 1 of 1 Q ENHANCED LEAK D ECTION ^ LINE TESTING I~ S6~89 SECONDARY CONTAINMENTTESTING ^ TANK TIGHTNESS T ~ T ^ TO PERFORM FLfEL MONITORING CERTIFICATION --_ -A _ ____ __ _ SITE INFORMATION _ FACILITY t- ~ ~ NAME 8 PHONE NUMBER OF ONTACT PERSON I 7 El~v r.~ # 5~#~ _- I . ~V+AN~6r~R -_ ~ 833- b 32 ADDRESS ~~ON~ ~- 1(sn- pot•~ $akers-~ietGQ ~ C}\_°13309 _ __ _____-{ I OVYNERS NAME OPERATORS NAME ~ PERMIT TO OPERATE NO. .... __ NUMBER OF TANKS T BE TEST D ~_ IYI$ PIPING GOING TO BE TESTEQ7! ^ YES ~ NO . _ ___~ --- - TANK~At_- _ _--- _--_-- -_.__-- VOLUME ~-- CONTEldTS-.--_.~ I ' I I ----- I --- - --•----- i _. ,_ TANK TESTWG COMPANY ----- -- NAME OF TESTING C MPANY ~ NAME 5 HONE NUMBER OF CONTACT PERSON ... - -- _ M.h kY10 ~ _ ~__ __ C_ _..~ . __..1T!'* r~~vly Ghee.ks - 5~ ~ (dT(o - X17100 MAILING ADDRESS ~ I'18 fin nse Ctr>:l2 - st~e ~~ fielnnecN t C~ q2 5 R O - ------ .. ~ __.._ _...--- - a --------- -- NAME 6 PHONE NUM ER OF TE TER OR ~PE_CI~AL_INSPECTOR GfiRTIFICATION #: GATE 3~ME T T T BE CON CTEO IGC #: r TEST METHOD Za o ~: - Z- -- - __52s ~'75fo-- UlT 1_ -- ---- .. _ . -------. 810NATURE~C T - --------.-DATE ~--_~•• - - ----........ -..._~ .._ I ___ _____ _ 1 ATION EC A P _ 1l.EQ_ ......__._ ________..__ APPROVED BY DATE ~ d~0 ~~ FO 2095 (Rev. 09105) May 17y-06 13 z 51 , TANKNOLOGY 909 308 1239 P . 03 'r 37 85 ~ TANKN OGY- O. CALIFORNIA PH. (909 s7s-a06o a1785 tJTERPRI CIR. S.. STE. D / ~ 76_24 3 EMECU CA 92590 L// a523 ~- C~ t22o ~f ~ DATE. ' TO THE f~' r r 1~~ ( I ~"`'~ ~ ~Q.tr J-~L`~. !, ORDER OE -- - - ~j ~-- G= t .. ..... - ® W s Fargo 6a•r h.A. Ca ornia w sfargo.con, '7-rI ~I~~1 z l F~c,-f•~ .~ - `~ 11.0 3 4 511' ~: L 2 2000 24 7~:D 7 260 2 50 26n• $ $I DO DOLLARS LJ •.~~ •••. ~. 3786 TANKN OGY- O. CALIFORNIA PH. (90 676060 41785 NTERPRI E CIR. S_ STE- D + EMECU CA 92590 ~•-- 76=~e~3 ;j ~ DATE ~iI ~ ~ tYLO '. PAY ~, r.. r ~t r--- m ~lCn~. p .....:... .. -t ~~~/ r r ~ C ~C i ~~ L-t . ~ L`-. IIOI LARS L*J '_ .' .. ~... ~1 _. ... ~~• W Is Fargo Ban , N.A. "i Ca rnia 'I sfargO.COm Fof{ `~ £~ M• 1i' 03? 611' ~:L22000247i:0 7 260 2 50 26~r' i ,., <-- - 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 04/10/2006 Order Number: 3146141 Dear Regulator, Date Printed and Mailed: 04/20/2006 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #16549 MARKET #2237 4647 WILSON ROAD BAKERSFIELD, CA. 93309 Testing performed: Secondary Containment-Spill Container Sincerely, CW~r ~a~~m~s~ Dawn Kohlmeyer Manager, Field Reporting SWRCB,.)anuary 2002 Page I . Secondary Containment Testing Report Form Th75 fOYT17 Zs t11tL'Tlded fOY ttS(' bl' COt1trQCt07_S perfortnlJlg pG'YIOdIC ZeSting Of CAST SG'G'ot1C{aJ'l' G'Otttat)t)71C'ttt SVStC'1tZS. L~1E' t{1 C' appropriate pages gf~this form to report results far all co~nppotrents tested. The completed fornt, written test procedures, and prtntouts front tests (if applicable), should he provided to the facility oticrter-loperator frn• submittal to the local regtdatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN #16549 Date of Testing: 04/10/2006 Facility Address: MARKET #2237 4647 WILSON ROAD, BAKERSFIELD, CA, 93309 Facility Contact: Manager Phone: (6 61) 8 3 3- 0 7 3 2 Date Local Agency Was Notified of Testing : / / Name of .Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC . Technician Conducting Test: JEREMY RIDER Credentials: ~ CSLB Licensed Contractor ~ SWRCB Licensed Tank Tester License Type: ahaz License Number: 743160 Manufacturer Manufacturer Training Component(s) Date Training Expires / / / / / / / / 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repair Spill Box 91 ^ ^ ^ ^ ^ ^ ^ ^ ^ a ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ o ^ ^ ^ ^ ^ ^ o If hydrostatic testing was pet-formed, describe what ti+-as done ~~-ith the Hater after completion of tests: left one labelled bucket on site CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the bc>ct of my knoicledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: ~-"~ % Date: 0 4 / 10 / 2 0 0 6 SWRCB, January 2002 9. SPILL/OVERFILL CONTAINI~'IENT BOXES Page 2 Facility is Not Equipped tit'ith Spi11-''Overfill Containment Boxes: SpilUOverfill Containment Boxes are Present, but were Not Tested: Test Method Developed By: ~ Spill Bucket :Manufacturer ~ Industry Standard ~ Professional Engineer Other 1SpE:cify) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Lsed: Equipment Resolution: Spill Box # 91 Spill Box # Spill Box # Spill Box # Bucket Diameter: 11 Bucket Depth: 10 «'ait tune between applying pressure%vacuwn~water and starting test: 3 0 Test Start Time: 0311 Initial Reading (R ~ ): 6.0 Test End Time: 0 3 41 Final Reading (Rp ): 6.0 Test Duration: 3 0 Change in Reading (R F - Rt) 0 Pass/Fail Threshold or Criteria: 0 Test Result: ~ Pass ~ Faii ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass o Fai( Comments - (include iitfor,nation on repaifs made prior to testing, and recommended follow-up for failed tests) SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS Tanla~o%gy TEST DATE:04/10/2006 CLIENT: 7-sLEVSN, INC. P.O. 80B 711 DALLAS T% 75221 214-841-6714 Tank Interstital Tests TANK PRODUCT 'MANUFACTURER ' `RESULTS REG UNLEAD PREMIUM WORK ORDER NO.: 3146141 SITE: 7-ELEVEN #16549 MARKET #2237 4647 WILSON ROAD BARERSFIELD CA 93309 Piping Interstital Tests LINE PRODUCT -MANUFACTURER RESULTS': Sumn &Under-Dispenser Containment Tests Sump/ DISP.#' MANUFAC'f13RER P/F " 2 91 FILL OPW Pass Tanknology representative: BRIAN DERGE Services conducted by: JEREMY RIDER ~~~ 6~~~. ~,,, +^ ~~~~ ~~ ~ Test Date: 04/10/2006 ' Work Order: 3146141 SECONDARY CONTAINMENT TEST RESULTS SUMP TESTS Type Tank or Disp Manufacturer Model or Diam./Width/Length Depth Test Method Start Initial Level Finish Final Pass/ # Material (°) (") Time Level Change Time Result Fail Spill Container 291 FILL OPW Plastic 11 in. t0in. Hydrostatic-24Hr 03:11 bin. none 03:41 6 in. Pass Comments: - Tanl~o%gy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:04/10/06 WORK ORDER NUMBER3146141 CLIENT:7-BLSVEN, INC. SITE:7-ELEVEN #16549 COMMENTS Retest on the 91 Spill Bucket Only. Bucket passed. Bucket called in for removal, 0604183254. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED , , HELIUM PINPOINT LEAK TESTRESULTS Printed 04/20/2006 06:59 SBOWERS ITE DIAGRAM ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 04/10/06 WORK ORDER NUMBER3146141 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #16549 rn ~~ ~~ ~~ W S N SUP I OA OV OF STP REG I OA ~ OF STP 10 phis tank is out of sevic out of system C~ VENTS Printed 04/20/2006 06:59 SBOWERS ~~ ~`F :, MaYr-22-06 11:41 TANKNOLOGY ~- UNOEROROUND ~tORA E TANKS "; .. ,x APPLICATI ~ 111 Tlp PERFq~t 4D - E ri~ ~ ! ~111YE! 8E>mNDA CONT IIEIWY TE!><riNq ' JTANK T14NTN~$D T AND Q PERFORNiI FUEL MONITORING ERTiFIC TIgN 909 308 1239 P_O1 BAKS~D FIRE DEFT. Ida Prevr>r~apc i9e>rwioes 9~0 ~rruAt~ A,te., ste. 2la B~eld. CA 93301 Tel.: (6~1} 326-3979 Fax: (b61) 652-2171 i~61Q01 Qf 1 PEgMMT NO. © ElD4~NCED LEAK D~TECTION ~~C--y~~~I uNE 7tS~H(i Q 8~~9 SECaNpARY CONTAINMENT TESTING Q TANK TIONTNESS Ty - - iLJ TO PERFORM FUEL MONITORING CERTIFICATION - ••- -._ _..-_ IT i FO TKNd ~ ...~ _..- _-.-.,.,._.. ..~- - .-r.....~. .......-~ -----._ FACLL.fTY ''.1~#J~~~ NAME S PHCyNE NUMBER OF CONTACT PERSON .1'aa 661.63,E-013E "D°~~ 4847 #Iltilr Rd. Bakersfield, 83309 __ ... .. ----- ..i owNl:RS NAME 711, in ___ ....._ . . -----... -- OPERATOfi3 NAME ~~111 PERMiT TO OPERATI: N4. Z 11NG TO 8E TESTEI77 _ YE ^ NO - -. • - •- ....-...110E M - - _.-...,., . CQHTENTS __. 10048 Premium (91) Uli. ~ LANK TlaTINO COMPANY NAME QF TeaTUas c¢MPANY TAnknoi inC. NAME i PnoNE NUMBER OP W~~ coUlbr I .~~~ CONTACT PERSON soa.aes.aix9. ..~~. wuuwoi-oalQElles .4178 Enterprise Cir+cie S. Suite D Temeeul>a, GA 92590 NAME Ik wNONE NUM R OR -.. - AEex Esitandsrian -- "C81ZteFICATION r: - - --- _. .. TEaTEA oR sPI:cIA~ Napxc :.~.•~¢~-B4i-2638 _ DATE i TIYE TEBt tq se uwd ~ ~~~ ~:~ ~ .._ j~C *; _ ----~ -- rEST ---~ - 30 Mlmn. CONDUGTEQ' I~TNQp Vl~ual Nyaro sIONATUI~ of AP oATC: $1x7!06 Appals 6r -' '~i! 1 S I S A DATE --~--- ....._- ....~d 2as8 (RSV, osro,~ oG -tub ql Ftt.~ SP~[~ g,sc~- a~.3L~c . JNDER oROtJND STORAGE TANKS ~"`"'i''"_ ~~ ,~ ~~ FIR! a.; APPLICATION FOR PERFORM DaPARTnrIfNT FUEL MONITORING CERTIFICATION ~"~"~~~~ ~IQ'~ ~~ 1C.1~ T_~~~ t ~ ! ~ ~.~ ADURES~ ~- , ' - _ (--~ ------- ----- ~~ ~ _r_ :.-, , i~~ Luc 5698/z--Zt-off SITE INFORMATION !1~iVNERS NAt1~ i C e TANK # ~~ - -- ~ - - . s ..------------ - ~N ~-- ~ i VOLUME 1~-- ~~ .; ~ ,l CONTENTS :NAME OF TESTING C~MPANY ~ TESTING COMPANY 'MAILIy~G ADDDRESS .r..- ~,~) - ~ ~1 ~ t DATE 8 .TIME TEST TO BE CONDUCT' ICC # r. ~ ; ~-- SIGNATURE OF,1aPPLICANT __ - ~' DATE ..- ... .~ -::. i' THIS APPLICATION BECOMES A PERMIT WHEN APPROVED ~i 4~FROVE l' 6Y iDATE i i - _n~ina i ~ i ~ % G ~__. Ball~ersfie7ci Fire Dept. Envir®nmental Seririces 900 Truxt:un ~~~~e., Ste.. 21.0 E~akc:rsfield, Ca 93301 Tel: (661 j ;26-3979 i~a~: (661.) 852-2171. Page 1 of 1 f ~f UNIFIED PROGRAM CONSOLIDATED FORM ~ TANKS ~ c ND STORAGE TANKS -FACILITY "~ ~ UNDERGROU (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®S.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEh1PORARY SITE CLOSURE 400 I. FACILITY I SITE INFORMATION BUSINESSNAME(SameasFACILITYNAMEorDBA-DOingBusinessAs) 3 FACILITYID# 1 7-Eleven #16549 ao1 FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* NEAREST CROSS STREET CORPORATION ^ 5. COUNTY AGENCY* ®1 . 4647 Wilson Rd., Bakersfield * BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER a03 ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* ao2 TOTAL NUMBER OF TANKS Is facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office which operates the UST (This is the contact person for the tank records.) REMAINING AT SITE trustlands? 3 aoa ^ Yes ®No aos aos .. ._. .. , II. PROPERTY OWNER`INFORMATION _ __ _ PROPERTY OWNER NAME aos PHONE aoe 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS 409 P.O. Box 711 Attn: Gasoline Acctg CITY 410 STATE all ZIP CODE a1z Dallas TX 75221-0711 PROPERTY OWNER TYPE ^ 1. CORPORATION ®2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL a13 `~ IIL TANK OWNER INf4RMATION" TANK OWNER NAME a1a PHONE a1s Inc. ' 702-270-7160 7-Eleven , 416 MAILING OR STREET ADDRESS P.O. Box 711 Attn: Gasoline Acct ~ CITY a1~ STATE a1a ZIP CODE 41B Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ago ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY N. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER ,, , : -- TY TK HQ 44- 3 1 8 9 6 Calf 916 322-9669 iT uestions arise az, _ _:: V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE ®1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ^ 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD a2z VI. LEGAL NOTIF{CATION AND-MAIL{NG ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 Vll. APPLICANT SIGNATURE fy P.. ,.__ Cert ficati n - I certi at t information rovided herein is true and accurate to the best of my knowledge. SIG E OF A NT D E aza PHONE a2s /~/?,~-~ b 702-270-7160 NAME OF APPLICAN (prin azs ~ TITLE OF APPLICANT a2~ Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) aze 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 429 UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page _ of L IQENTIFtCATION FACILITY ID# t BEGINNING DATE w~ ENDING DATE tot ' 3/1 /2006 3/31 /2007 BUSINESS NAME (Same as FACiuTV NAME or DBA -Doing Business As) s BUSINESS PHONE 102 7-Eleven #16549 661-833-0732 BUSINESS SITE ADDRESS tos 4647 W ilson Rd. CITY toa ZIP CODE tos CA Bakersfield 93309 DUN & BRADSTREET tos SIC CODE (4 digit #) 107 00-734-7602 5541 COUNTY to6 Kern BUSINESS OPERATOR NAME t09 BUSINESS OPERATOR PHONE tto Shun L & Shu J Wang _ 661-833-0732 IL ..BUSINESS OWNER -- - OWNER NAME - - - -- ttt OWNER PHONE ttz 7-Eleven, Inc. 702-270-7160 OWNER MAILING ADDRESS tts P.O. Box 711 Attn: Gasoline Acctg CITY tta STATE tts ZIP CODE tts Dallas TX 75221-0711 ill. ;ENVIRONMENTAL,CO NTACT' _ CONTACT NAME tt~ CONTACT PHONE tt6 Shane Partridge 702-270-7160 CONTACT MAILING ADDRESS tt9 P.O. Box 711 Attn: Gasoline Acctg CITY tzo STATE tzt ZIP CODE t22 Dallas TX 75221-0711 -PRIMARY- _ IV.'EMERGENCY CONTACTS -SECONDARY- ` NAME _ izs NAME - tze 7-Eleven Emergency Dispatch I 7-Eleven Emergency Dispatch TITLE 12~ TITLE tzs Emergency Service Emergency Service BUSINESS PHONE t2s BUSINESS PHONE tso 1800-828-0711 800-828-0711 24-HOUR PHONE t2s 24-HOUR PHONE tst 1-800-828-0711 800-828-0711 PAGER # t2' PAGER # tsz ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Bas o y inquiry of those individuals responsible for obtaining the inforrnation, I certify under penalty of law that I have persona lly ex in d nd am familia with the information submitted and believe the information is true, accurate, and complete. SIG AT E OF O ERATOR OR DESIGNATED REPRESENTATIVE DATE t3a NAME OF DOCUMENT PREPARER t35 ~r ?w'O Rachel Rodriguez NAME OF SIGNER (print t36 TITLE OF SIGNER t37 Shane Partridge Gasoline & Environmental Compliance Manager UPCF (1/99 revised) HMP 2 (Back) Instructions OES FORM 2730 (1 /99) UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) ^ MATERIAL(NON-WASTE) ® WASTE one a e er material er buildin or area 20o page of ®ADD ^DELETE ^REVISE REPORTING YEAR 2005 I. FACILITY INFORMATION 3 BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 7-Eleven #16549 zo2 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL (EPCRA) ^ YES ® NO E zoa NEAR FACILITY TRASH ENCLOS - MAP# (optionap 203 GRID# (optional) FACILITY ID # I 'I Of 1 11. CHEMICAL INFORMATION CHEMICAL NAME WASTE FLAMMABLE LIQUID COMMON NAME GAS-WATER MIXTURE CAS# N/A FIRE CODE HAZARD CLASSES (Complete if required by CUPA) HAZARDOUS MATERIAL TYPE (Check one item only) ^ a. PURE ^b. MIXTURE ®c. WASTE PHYSICAL STATE TRADE SECRET ^Yes Q9 No ~~ If Subject to EPCRA, refer to instructions EHS* ^Yes ®No 20 *If EHS is "Yes", all amounts below must be in lbs. z, 211 ~ RADIOACTIVE ^Yes ®No 2,2 I CURIES 2,4 LARGEST CONTAINER 55 ck one Item only) ^ a SOLID ®b LIQUID ^ c GAS Ch e ( FED HAZARD CATEGORIES FIRE ^ b. REACTIVE ^ c. PRESSURE REL ®a EASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH . (Check all that apply) OUNT 219 STATE WASTE COC 2,7 AVERAGE DAILY AMOUNT MAXIMUM DAILY AMOUNT 2,8 ANNUAL WASTE AM 55 55 134 25 zz, D AYS ON SITE: UNITS' ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 Check one item onl ' If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ®e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL A PLASTIC BOTTLE ®r. OTHER G ^ n ^ b. UNDERGROUND TANK ^ f. CAN . ^ j. BA ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ® d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # %WT MIXTURE OF GASOLINE & WATER OR 227 ^Yes ®No zza N/A, MIXTURE ~ gg gp 226 OTHER CONTAMINATION IN GASOLINE 231 ^Yes ^ NO 232 2 230 235 ^Yes ^ NO 236 3 234 239 ^Yes ^ NO 240 236 4 za3 ^Yes ^No 244 5 ~4~ If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing information. ADDITIONAL LOCALLY COLLECTED INFORMATION 2,s 223 zza zzs zzs 233 237 241 245 246 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY FORM -CHEMICAL DESCRIPTION Indicate material OR waste (Do not combine material and waste on one form) ^ MATERIAL(NON-WASTE) ® WASTE one a e er material er buildin or area ®ADD ^DELETE ^REVISE REPORTING YEAR 2005 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 7-Eleven #16549 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL zoz (EPCRA) ^ YES ® NO NEAR FACILITY TRASH ENCLOSURE MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1 of 1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^Yes ®No 206 WASTE ABSORBENT & DISPENSER FUEL FILTER If Subject toEPCRA,refertoinstructions COMMON NAME WASTE ABSORBENT & DISPENSER FUEL FILTER 207 EHS* ^Yes ®No 206 CAS# N/A 209 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CuPA) z1o 213 HAZARDOUS MATERIAL 211 TYPE (Check one item only) ^ a. PURE ^b. MIXTURE ®c. WASTE RADIOACTIVE ^Yes ®No 212 CURIES 215 PHYSICAL STATE (Check one item only) ®a. SOLID ^b. LIQUID ^ c. GAS 21a LARGEST CONTAINER 55 FED HAZARD CATEGORIES 216 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 216 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 25 55 55 352 221 DAYS ON SITE: 222 UNITS' ®a. GALLONS ^b. CUBIC FEET ^ c. POUNDS ^ d. TONS 365 Check one item onl ` If EHS, amount must be in ounds. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONMETALLIC DRUM ^ i .FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ® d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 22a STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 89-90 226 MIXTURE OF SILCATE & HYDROCARBONS 227 ^Yes ®No 226 MIXTURE N/A 22s & SPENT FUEL FILTERS , 2 230 231 ^Yes ^ NO 232 233 3 23q 235 ^Yes ^ NO 236 237 4 236 23s ^Yes ^ No zao 2a1 5 242 2a3 ^Yes ^No zaa 2a5 If more hazardous components-are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. 246 ADDITIONAL LOCALLY COLLECTED INFORMATION -r . ,- -,~~ ~. WRITTEN MONITORING PROCEDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify local agency within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name: 7-Eleven Store #16549 Facility Address: 4647 Wilson Rd., Bakersfield, CA Date: March 1, 2006 A. Describe the frequency of performing the monitoring: Tank The site consists of two double walled plasteel tanks (1-Regular Unleaded 10k gallon, 1-Premium 10k gallon) and are monitored continuously with a VeederRoot TLS350 Piping Product lines are double wall fiberglass and are monitored continuously with a VeederRoot TLS350 The turbine sump sensor activates audio/visual alarms and provides positive shutdown of the turbines. B. What methods and equipment, identified by name and model, will be used for performing the monitoring: Tank The method of leak detection for the tanks is Interstitial Monitoring of the double wall tanks using the VeederRoot TLS350 Tank Gauge programmed for a threshold of .2gph. VeederRoot model #847390-420 probes are used for the monitoring. High level alarms activate audio/visual and external alarms. Piping The piping is monitored continuously by Electronic Line Leak Detectors. The turbine sump sensors provide positive shutoff and activate audio/visual alarms. The piping is precision tested annually at a threshold of .1gph. Dispensers are equipped with under- dispenser containment with VeederRoot liquid sensors model #794380-208 that provide positive shutdown of the turbine. Enhanced Leak Detection This site has a single wall component of the tank system and utilizes Enhanced Leak Detection (ELD) to include a Tracer Tight Test completed in 2003 and every 3 years thPreafter_ _ C. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: The individual responsible for the monitoring equipment is the store operator, Shun Wang. The operator will contact 7-Eleven Dispatch 1 800-828-0711 for any alarm conditions on the VeederRoot. The local maintenance contractor will be dispatched. 7-Eleven, Inc. is responsible for maintaining the equipment The Environmental Manager is Shane Partridge D. Reporting format for monitoring: Tank Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Monitoring records will be kept at the location and at a central office location. Piping Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen Third party annual test results will be submitted to the agency. ~~ - Written Monitoring Procedures 7-Eleven #16549 Page 2, March 2006 E. 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 12 months. Tanks and product lines are continuously monitored and alarmed. Alarm histories are printed each month and investigated for corrective actions by the designated operator. Equipment repairs; replacement are performed as needed. F. Describe the training necessary for the operation of UST system, including piping, and the monitoring equipment: Employees are trained on the operation of the UST in a manner consistent with "Best Management Practices", Emergency Contact information, Spill/Overfill response procedures, Hazardous Waste Procedures, and Monitoring equipment operation and alarm response procedures. Training is conducted annually , or with 30 days for new employees, by the designated operator. ::°- ~y , UNDERGROUND STORAGE TANK MONITORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 23 CCR, Sections 2632(d)(1), 2634(d)(2), and 2641 (h) TYPE OF ACTION ^ 1. NEW PLAN ^ 2. CHANGE OF INFORb1ATION ivrol. PLAN TYPE ®MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. Moz. • (Check one item only) ^ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY I'NFORIVIATION FACILITY ID # (Agency Use Only) - - FACILITY NAME 7-Eleven #16549 Mo3. FACILITY SITE ADDRESS 4647 W IISOn Rd. M04 CITY Bakersfield Mos. II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in Mob. accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED ®1. ANNUALLY ^ 99. OTHER (Specify): Mop. -III. MONITORING LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., location of each sensor, line leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring System Certification form, Hazardous Materials Business Plan map, etc.) which shows all required information, include it with this lan. IV. TANK MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Chec'.~c all that apply) Mlo. ® 1. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACWM M11' PANEL MANUFACTURER: VeederROOt Mlz. MODEL #: TLS350 D413- LEAK SENSOR MANUFACTURER: VeederR00t Mla MODEL #(S): 547390-420 Mts. ^ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S) PANEL MANUFACTURER: M16 MODEL#: Mu. IN-TANK PROBE MANUFACTURER: Mtg. MODEL #(S): Mtg. LEAK TEST FREQUENCY: ^ a. CONTINUOUS ^ b. DAILY/NIGHTLY ^ c. WEEKLY ''a20 M2[. ^ d. MONTHLY ^ e. OTHER (Specify): PROGRAMMED TESTS: ^ a. 0.1 g.p.h. ^ b. 0.2 g.p.h. ^ c. OTHER (Specify): Mzz M23. ^ 3. INVENTORY RECONCILIATION ^ a. MANUAL PER 23 CCR §2646 ^ b. STATISTICAL PER 23 CCR §2646.1 M'za ^ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645 TESTING PERIOD: ^ a. 36 HOURS ^ b. 60 HOURS Mzs. ^ 5. INTEGRITY TESTING PER 23 CCR §2643.1 TEST FREQUENCY: ^ a. ANNUALLY ^ b. BIENNIALLY ^ c. OTHER (Specify): Mz6. Mzz ^ 6.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approval) ^ 99. OTHER (Specify): M^_8. V. PIPE MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mao. ® 1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM M31. PANEL MANUFACTURER: VeederROOt M3z. MODEL #: TL$35O M33- LEAKSENSOR MANUFACTURER: VeederROOt M3a. MODEL #(S): 7943~3O-ZO8 M35. WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? ®a. YES ^ b. NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M3z ^ 2. MECHANICAL LINE LEAK DETECTOR (MELD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED :.-tss. MODEL # S : MELD MANUFACTURER(s): ( ) M39 ® 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS ELLD MANUFACTURER: PLED Ma° MODEL #: 157567 Mal PROGRAMMED LINE INTEGRITY TESTS: ^ a. MINIMUM MONTHLY 0.2 g.p.h. ^ b. MINIMUM ANNUAL 0.1 g.p.h. Maz. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Mai. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Maa. ® 4. INTEGRITY TESTING TEST FREQUENCY: ®a. ANNUALLY ^ b. EVERY 3 YEARS ^ c. OTHER (Specify) Mas - Ma6. ^ S.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY* ^ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED** Mai. * Requires agency approval ** Allowed for monitoring of unburied emergency generator fuel piping only per HSC §25281 .5(b)(3) ^ 6. P[PING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) ^ ', - NO PRODUCT OR REMOTE FILL PIPING IS CO\TIECTED TO THE UST(s) ~ ^ 99 OTHER (Specit}~) Ma8. UN-022A -1/3 www.unidocs.org Rev. 10/14/03 =-~ ~. Underground Storage Tank Monitoring Plan -Page 2 of 2 VI. DISPENSER 1VIONITORING MONITORING OF AREAS BENEATH DISPENSER(S) IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mso. ® 1. CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT (UDC) PANEL MANUFACTURER: VeederROOt Msg. MODEL #: TLS35O Msz. LEAK SENSOR MANUFACTURER: VeederROOt Mss. MODEL #(S): 794380-208 M5A WILL DETECTION OF A LEAK CNTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? ®a. YES ^ b. NO Mss. VV[LL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M56. WILL FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO Msz ^ 2. MECHANICAL ASSEMBLY (e.g., FLOAT AND CHAIN ASSEMBLY) IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK ASSEMBLY MANUFACTURER: Mss. MODEL #(S): Mss- ^ 3.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approvaq M60. ^ 4. NO DISPENSERS - ^ 99. OTHER (Specify) M6i VII. ENHANCED LEAK DETECTION ' ^ 1. ~b'E HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK X70 DETECTION (ELD) FOR THE UST(S) COVERED BY THIS PLAN. PER 23 CCR §2644.1, ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED ,.: VIIL TRAINING , REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) Mso. 1. ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 2. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 3. ® THE FACILITY'S BEST MANAGEMENT PRACTICES (Required as of January 1, 2005) 4. ^ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. ^ CALIFORNIA UNDERGROUND STORAGE TANK LAW 6. ^ STATE V6'ATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS -MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 7. ^ SWRCB PUBLICATION: "WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" ^ OTHER (S ecif ): M81 99 y p . Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and can access those documents when needed. By January 1, 2005, this facility will have a "Designated UST Operator" who has passed the California UST Sytem Operator Exam administered by the International Code Council (ICC). By July I, 2005, and annually thereafter, the "Designated UST Operator" will train facility employees in the proper operation and maintenance of the UST systems. This training will include, but is not limited to, the following: Operation of the UST systems in a manner consistent with the facility's best management practices. The facility employee's role with regard to the leak detection equipment. The facility employee's role with regard to spills and overfills. - Whom to contact for emergencies and leak detection alarms. For facility employees hired on or after July 1, 2005, the initial training will be conducted within 30 days of the date of hire. IX. COMMENTS/ADDITIONAL INFORMATION Please use this section to include any additional UST system monitoring-related information (e.g., additional information required by your local agency): Mss Note regarding Section X. Pending certification of a Designated UST Operator, the following person has authority for performing the monitoring activities and maintaining leak detection equipment covered by this plan. NAME: JOB TITLE: X. PERSONNEL RESPONSIBILITIES AS OF JANUARY 1, 2005, THE "DESIGNATED UST OPERATOR" IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT APPLICATION -FACILITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION EQUIPMENT COVERED BY THIS PLAN, AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS OF THE FACILITY'S UST SYSTEMS IN ACCORDANCE WITH 23 CCR § 2715(6). XI. OWNER/OPERATOR SIGNATURE TIFICATI : I ertify that the information provided herein is true and accurate to the best of my knowledge. WN R/OPERAT R ATURE REP~SENTING DATE: M91 O er M90. [~e t ~ J ~-~ ~,q /~ 7 ra or Ow ER,~OPERATOR AM rint): ~tez. OWNER/OPERATOR TITLE: M9s. Shane Partridge Gasoline & Environmental Compliance Mgr (Agency Use On!}) This plan has been reviewed and: ^ Approved ^ Approved With Conditions ^ Disapproved Local Agency Signature: Date: Comments/Special Conditions: L'1-022A - 2/3 www.unidocs.org Rev. 10/14/03 F/RE ARTR T March 31, 2006 RONALD J. FRAZE FIRE CHIEF Ms. Shu Wang 7-Eleven Gary Hutton, 4647 Wilson Road Senior Deputy Chief Re: Failure to Perform /Submit Annual Fuel Monitor Certification Administration 326-3650 NOTICE OF VIOLATION & Deputy Chief Dean Clason SCHEDULE FOR COMPLIANCE Operations/Training 326-3652 Dear Shu Wang, Deputy Chief Kirk Blair Our records indicate that your fuel monitor certifications is due/past due on Fire Safety/Prevention Services 03-02-06. 326-363 You are or will be in violation of Section 2638(a) California Code of Regulations, ` " Title 23, Division 3, Chapter ~ 6. .2101 H Street Bakersfield, CA 93301 "All monitoring equipment shall be installed, calibrated, operated OFFICE: (661) 326-3941 and maintained in accordance with manufacturers instructions, and FAX: (661) 852-2170 certified every 12 months for operability, proper operating condition, and proper calibration." RALPH E. HL1EY, DIRECTOR Therefore you have 30 days (April 27, 2006) to comply. Failure to comply may PREVENTION SERVICES result in revocation of your Permit to Operate. FlRE SAFETY SERVICES • ENVIRONMENTAL SERVICES ' 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 Should you have any questions, please feel free to contact me at 661- 326-3190. OFFICE: (661) 326-3979 FAX: (661) 852-2171 Sincerely yours, David Weirather Ralph E. Huey, Fire Plans Examiner Director of Prevention Services 326-3706 ~~ ~ Howard H. Wines, III : C j .~ gy. Steve Underwood Hazardous Materials Specialist Fire Prevention Officer 326-3649 REH/SU/db "Serving the Community F'or~l~lore ~I1ianA Century" ;. .. 12f09/2005 11:25 5123807275 TANKNOLOGY-TR PAGE 02 ~. ~. PURPp$E: COMPLIANCE TEST DATE: Q3l02la3 CLIENT: 7-ELEVEN, INC. P.O. BOX 711 DALLAS. TX 75221 (214)841 ~7~4 TANKNpI.OGY CERTIFICATE OF TESTING 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTiN, TEXAS 78759 TEiEPHOiVE (512) 451-6334 FAX (512) 45>~1459 TEST RESULT SUMMARY REPORT WORK ORDER NUMBER: 3139217 CUST~DiuER Pb: SRE: T-ELEVEN 916549 MARKET 112133 4647 WILSON ROAD BA~RSEIELD, CA 93308 Manager (661839-0732 TEST TYPE: TLD-1 IIz s Irsxseuvt~~ laxssacr~-ss Ir sssvRS la ~ I vsspsxxaor I sLSCrRail<x l a o o~ ~ 5 0.000 o.ooo Y ForowneT UetatlBQ iCpUlt information, visit www.uu+knology.com and select CJn-Lint Repwts~WKAY, ar contact your local ranKnoiogy oxx~ce. Testes Name: ALBERT ~, pUE1ROS TaChntClan Gertifieatlon Number:gi 1449 ~~~~ Prin1~ 12f0Q/2p0510:14 KpHLME`lEF2 12/09/2005 11:25 5123807275 TANKNOLOGY-TR PAGE 03 INDIVIDUAL TANK INFORMAI'lON AND TEST RESULTS ~~ ~Q~191~ 8501 N IVIt7pAC EXPRESSWAY, SUITE d00 WORK ORDER NUMBER8139217 T@gT pATE:03/03/85 AUStiN,TEXA$78739~(512)451~3~I4 SITE;?-aL8Yli4Q Ik16549 C~IEN'f:7-sLSV81Q~ ~~ Tank tD: x i Tank manifoided: 19~D Bottom to top fill in Inches: Product: R>SG DNI.SAD Bottom to reds in inches: Vent marNfolded: YsS 8 Capacity in gallons: lv, 018 Vapor recovery manlF0lded: Yss Fill pipe length in inches: 4.0 I]iameter in inches: 109.00 Overfill protection: xss Fill pipe diameter In inches: DQAL L~angth in inches= Z51 Overspill protection: YSS Stage E vapor recovery: ASSIST Material: >79r sTS>lar. Stage II vapor recovery: Installed: ATti GP installed an: / / COMMENTS Start (fn) End (tn) NswJpassed FaBedr>'ep~ced New/pa9sed FaNad-repiacad Dipped Water Level: ~,p. ~ LD. ri1 L.D_ ~ ~-Q• ~ Dipped iSrnduct Level: Make: vssnsnxooT Prate Water Level: Model: t~C~o~c Ingress Detected: Water Bubble Ullage SIN: io~a.~ Tact time: peen time in sec: Inclinometer reading: Floldmg psi; 14 VaouTect Test Type: IaOT Resiliency cc: troT VsCUTed Prone Entry Paint TssTBD Test teak rate mllm: iss • o TS9T~ Pressure Set Point: Metering psi. Tank water level in inches: Calib. leak in gph: 3.00 Water table depth in inches: Rgsutts: pA9s Oetermined by (method): Result: coMMENTs COMMENTS MatariaL- FIHSRGLA.SS Diameter (in): ~ • v Length (R): 7 5.0 Test psi: S 0 Bleedback cC: 30 Test time (min): 30 troT ZipT ~10T Start time: 09 : as TggTgp TSSTSD T8ST13D End time: 09: s5 Final gph: 0.000 ResuR: PASS Pump type: pSSSSV~tlii Pump make: BSD JACICBT COMMENTS Impact Valves Operational: YSS Panted 1210912005 10:14 12/09/2005 11:25 5123807275 TANKNOLOGY-TR PAGE 04 INDIVIDUAL TANK INFQRMATION AND TEST RESULTS ~~ TEST DATE:o3/DT/OS 8501 N MOPAC EXPRESSWAY. SURE 400 WORK ORDER NUMBER9139217 CUENT:T-NI.BVBTi, INC. AUSTIN,TEXA578759(512)451~3.~I4 SITE:T-SLEVSbT t116549 Tank Ip: z Product: ~tz~~ Capacity in gallons: iD, ois Diameter In inches: ia9. oc L.angttl in inches: 351 Material: DOP ST>c8L COMMENTS Dipped Water LeveE: Dipped Product Level: Probe Water Level: Ingress Detected: Water Test tlme: Indinometer reading: VecuTect Test Type: VacuTect Probe Entry Point: Pressure Set Point: Tank water level In inches: Water table depth in inches: Determined ty (method): Result: 11 COMMFJ~It'S ~ Tank manitaldad: ~ Vent manifolded: Yes Vapor recovery manifolded: YI3S OveAlll prctectlon: Ytl;s Overspill protection: YIiS Installed: ~-YG CP installed on: / / Bubble Ullage NOT TSSTRn Material: Diameter (In): length (tt): Test psi: Bleedback cc: Test time (min): Start time: End time: Final gph: Result: Pump type: Pump make: L~i~,:.1.J ~.lt-y st~rass a.o 75.0 50 30 30 09sZ5 09:55 o.oao PA33 PRSSSflli>'< RBD SAC>CST Bottom to top fill in inches: Bottom to grade in inches: FIII pipe length in inches: Fill pipe diameter in inches: !. o Stage I Vapor recovery: ~~+ Stage II vapor recovery: ASSIST Naw/passad Failedheplaced Newlpassed Falledlreptaced . LD. tM L.D. S"1 t..d. 92 LD. $2 Make: v~sRxoor Model: sI.sr_'~'R~c SIN: zooa~s Open tlme in sea Molding psi: 19 Resiliency cc: NOT 35t leak rate mUm: 189.0 TSSTSD Metering psi: Calib.ieakingph: s.oo Results: pASs COMMENTS NOT NOT NOT TB$TSd TBSTSD TSSTSD Impact Valves Operational: 7rsa Printed 12lD9/2pQ510.14 12/09/2005 11:25 5123807275 TANKNOLOGY-TR `` '' PAGE 05 S~~~ ~~~~~~~1~~ -- ......._ _ . _.__ _ _ ___----~O~x~OI~~~ ~~cNons Within the State of Califom' ~rfomia Code of Re9uladons Art J1Nis~ ~~~ 3 TtYle 23, F~ usar-Sd 3atsfY Code; Chapter 18, et ~ Installed at ttte facU+ty a sePBreta con'ral Pan must ba Pro`~°d to ttre tank ,(Ke' d: Chapter s-~' ~~ ~ H mort i~en one ^rtortnns ~ n~1t, A caPY °f ~ ~t d80a- AutftorJtY and sarvicln9 ot'nOnx~ ~~ ~ `ten who g UST systems vdtnin 30 data Tti1e tnrm moat be used >o ~n>ent testi+B trilet aubrrdt a copy ~ ~1e ~"" to the kx~ at~- ~"'IaUn ~ 71p: 83~ tyda+11 w+nerloPer~. The ownerloPar~'~ BAtC>rRSF(EI..D w• 13enecal Irdorrrrstion Facility Name: 7-ELEVEN #1 E~549 slt~ Aadrass: MAIT~ 117133 4647 wtt_soN Rt~AD fatillhr Conted P~'On' ~ TTL5350 ~e/Mpdel of Monitoting gysiem:VEED~R00 ~, hmrerr'torY of Equipment TostadfCertltied 1nsp~g~aertliCed eneetc the appropriate uooces to Indicate specific equipment Tank IP: 1-R>=uuv+r. ~~. p~p,~r2 X IrfTenk t^aauging P1O~' X Anrwlar Space or VdYh Senior. Model: X Plping Sumprrrench serv9or(s). Model: 208 FNI Sump Sen9or(S)- ~~' ~ydcsl LM+a Leak t)etadeG Model: Elactlvnic Line Leak peteFmr. Modal: PLLD-1087 23 Yank ovmfilw•;1~-Level ser~so*. Mods: MAG-2 piper (specify egWP~ hips a~ madM ;n Batson E vn Pegs 2)- in-T2~c Gauping Probe. ~d~: ilnntllar Space or VauR Sarrsar- Model: ,_. piping Srxnp/Tranch Sen9pr(s). tykxlat: Fi11 Sump $gngpr(s}, Model: Mechanir~l Line Leak Detettar. Model: - Eleotrrric lute leak Detecbr- Model' Tank t?ver11111F1igh-level Sensor. Model: atl,er (spedfy equipment type and rrwdet In won E on page zi. City= C~ct Phone No: $3gt1T32 patg.of 7estinglSe~oe= t)31a2t2O~5 Walk prder Number. 3t3g2t7 Yank ID' 2-SUrcn X~ In-Tank Gauging ~o~~ Dispenser CdltalnmeM Smear(s) Model: 2~ _ $tlear VatYe(9), Dispenser fantairtrnent Fktat(9) and Chain(s). Anmi1M Space or Vault Sertsor- Plpkrg S„mprrrenoh $en9or(s). Fix Sump Sensor(s). (Vlachameal LYISe Leak OetaGtnr, ElaCbvniC Line Leak Detector. Tank bverrixrttlgh-~•~l Sensor Other Made1: Model: Model: MOdat ~~ Model: type and model In Sermon E on Ir~Tarlk Gauying Probe. Amular Space or Vaux Sensor. Piping SumpfTrench Sensor(s). FlII Sump Sensor(s). MedtaMcal Lino Leak Detector. E18Ctronic Line Leak Detector. Tank WerxlVHigh~eVel $ensar. Model: -~- MDdel: Model: Model: Model. Model tvtodal: --- Other (Specly equipment type and medal In Section E an page 2). Dispenser Containment Sensor(s) Modal: 209 Stlesr Valve(s) _.__ Dispenser Corrfainntent Float(s) and Clrein(s). Gepmear Cantak+rnant Sm~saKa) tel. Dispenser Containment Sensor(s). Shear Valve(s). Sheer Valve(s). DlepenesX OontaMurrerrt Fkxsas) and Chein(sy. Dispenser Con~inment Float(s) arW Cheirt(s). Dispenser ID. Dispenser !D. Dlspan9er Containment Sensor(s) Model:.... Shear Vahie(g), Dispenser Containment Foot(s) and (:pain(s). Dispenser Canminmant Ser+90Ka}. Model: _ Shear Valve(sy. Dispenser Containment Fbet(s) and Chain(s). ' If the facility cantalns mere tanks w dispensers, Dopy this form- Include lnftxmation far every tank and dispenser at the facility. C. Certificatlan I certify that the equipment Identified in this document was inspectodlSarvioed in accordance v~th the manufacturer' gultlelines. Agached to this Certification Is Informaton (e.g manufacturers' chedtllsb) necessary tp verify that this information is vorrect and a Site Plan shpwing the layout of manitaring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Ch®cJc all that apply): ~ System set-up X^ Alann hlstgry report Technician Name (print): ALBERT J. QUEIROS Sigrrsture: ~~ Certlflcatitxt No.: 01]Pr•t)5-067'1 License. No-: Testing Com)~any Name:Tankrloklgy .~ Phone IVo-: (800) 800-x633 Site Address: 8501 N. MaPac Expressway, Suite 400. Austin, TX 78759 _ Dais of TestingJServicing: 03/07!2005 ~• Monitoring System Certificatiole Page 1 of 3 Based on CA form dated 03101 12/09!2005 11:25 5123807275 TANKNOLOGY-TR Monitoring System Certifil;,ation ~~ ~~ MARKET X2133 aF,47 W ILSON ROAD D. Resuits of Testing/Servlcing Saftware version InstaNed: 119.05 OornQhte tha tollowin~ Chsekllst: PAGE 06 Date Of TestinglService: 0310 00$ -- E. Comments: 80TH 7LIRBINE SUMPS HAD SMALL AMOUNTS OF LIQUID IN THEM. SUN4PS PUMPED DRY, SENSORS LOCATED IN PROPER LOCATIONS. Page 2 M 3 Based on CA tarm dated 03/0 ' In 3ecfion E bek„a, describe how and when these dsfiaences were ar will be corrected. 12/09/2005 11:25 5123807275 TANKNOLOGV-TR PAGE 07 Monitoring System (Certification site Address: MARKET #2133 4647 WIL50N ROAD F. In Tank G2luging !SIR Equipment Elate of TestinglSenrioe: 03/02/20Q5 - D t^,ttadc this txnr ff tank geugirtg is used only for Utventory txxttrol. l-~ Check this box it no tank gauging or SIR equipment Is installed- This section must be cornptetad ff in~snk ~uging equipment Ia used ba perform lank detection monitoring. Complet! the following chacldist: ^X Yea ^No • Mas all input caking been Inspected for Prager entry and termlrration, including tt35ting for ground faults? Y~ ^ ~ • Were all tank gauging probes visu911y Inspected four damage- and residue buildup? Y~ ^NO • Was lrocurecY of system product k:vet naadktgs tested? QYee ^No • W85 accttrecy of system water level readirg5 tested? I x~ Yea n No • W~ ~I p rolnstaikd propedY? O Yea rl ~ , Were all items on the equipment martufaCturers' maintenance dleCklfst acmpletad? ' In the Sectlan Fi, bet4M-, desctitre haw and when these deflciendes were a will be corrected. G. Line Leak Detectors (LLD) : [] t:tteck this bcot if LLOs am not Installed. Cemnlaae the following ehtecltlist= ^x Ytiy ^ No • ^wA FOr equipment {Cheat all that X Yes ^ No • Were art LLDs X YBS ^ Y~ ^No' ^ No • ' ®wA WAS the testin For rneChanlCe Q Yes ^wo • ^ wa Far electranic ^% Yes ^NO • ^ NIA FOr electronlC ^Y~s ^No • ^ WA Fpt @teChonlC ^ Yes ~X .rag ~ • ^No ` ^ WA Fpr electronic Were all Items start-up or annu8l equipment certlRcatlon, was a ktak simul8ted to verify LLD performance? apply) Simulated resit rate: Q 3 g.p.h ^ 0-1 g.p.h ^02 g_p.h rnnflrrrted nperatipndl and accurate withirt regulatory requiran+enLs7 g apparatus properly p811brated7 d LLDs, tlt~ the LLD rsstr9et product flour if N detects a leak? LLDS, does the turbine auttxnatit:ailysbut off if the LLD detects d leak? LLDs, does tl'-e turbine automatically shut fxif If arty portion of the monitoring system is disabled or disconnected? LLDs, apes the turbine automaticsHy shut off if any portion of the monitoring gystem malfunctlons ar sails d test? LLDs, have all aCCes8lble wiring connectlans been visually inspected? 0 on the equipment manufatXurers' maintenance chedtli&t aompleted7 ' In the $ectlon H, below. describe how and when H. Comments: deficienCres were or will be corrected. ?age 3 of 3 Based tut GA farm dated Oy09 12/09/2005 11:25 5123807275 TANKNOLOGV-TR PAGE @8 Work Order: 313921y ....~ ~ ..-.rsa....r.r r r~r~tv7'stIVI1A1PN7' Rf1Yi'S 'Y`ank~aology-N'DE $900 Sfaoal Creek, $uxld:ing 200 Austia~, Tc~cas 78757 Cpmmems~(tlQCiufl¢ in~Grmatloa p~ ~ptiirs mAde!-rIOr m t~srirg, ant! reGDar~~ttfc*d tlnw•up forfrei(ed r~~isJ 12/09/2005 11:25 5123807275 TANKNOLOGY-TR PAGE 09 SF3.989 SECONDARY CONTAINMENT SUMMARY RESULTS ~`. TEST pATE:03/oa/aaos WpRK ORDER NO.: 31a9ai7 CLIENT: 7-~ ~~• $ITE: 7-~ Ma.6549 p.0. HCX 711 leAxltRS X4133 4d47 1fILSON EtO~D I}]1LL11S TZ 75aa1 •asrevarTRrfl Ca 2i4-841-6714 Tank Intelrstital Tests Piping Inte~stital Tests ,~2EG ol'W I Pss6 ....~ „-, nn.ti Pass 93309 Tankndogy rEDr~SBrltatlve: JERRY BELLOLI Services oonClu~ted by: A~L~B~ER~T J- QUEIROS G i% Sump S. Under-Dispenser Containment Tests F-~ N m tD N m m (J1 --I I? Z Z O r 0 c~ n m N m 12/09!2005 11:25 5123807275 TANKNOLOGY-TR PAGE 11 ~~ 8501 N MOPAC EXPRESSWAY, Sl11TE 400 AUSTIN, TEXAS 78759 (512) 451$334 FAX (512) 458-1459 TESTDATE:03/42/05 CLIENT:7 -SLEVSN, IDTC. tor. 13ataB, ids, 4~ bnokets pasa$d. WORK ORDER NUMBER3139Z17 SITE:7 -8L8V>Ri fib 54 9 COMMENTS PARTS REPLACED .,~_._.. wo.r,~nnnc,n•,d ~[ALII hdGVFR HELIUM PINPOINT TEST RESULTS (fF APPLiGABLE) _ 12109!2005 11:25 5123807275 TEST DATE: Q3/Qa/05 Gi.IENT:7-SLSV82i, ING. TANKN~LOGV-TR SITS DIAGRAM ~~ 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512) 451$334 FAX (512) d59-14.~ WORK QRDER Nt~+1BER9139214 gITE:7-SLSV~N #16549 PAGE 12 ~~ ~~ ~~ ~ VENTS ~ Sa ~ ~TP R ~ ~ VV ~ 8TP 1OR his tank is out of sevi out of system rnncu~ ~C7VCncw~ ,....t..~.,.~...~.._... 12/09/2005 11:25 5123807275 TANKNOLOGY-TR PAGE 13 Work 4rde><: 313 9 a 17 25093 7-t{ t6'3~9 x64'7 WIL84N RD BpKk'REFtELD•CA"d3304 PRE5BUI3E LINE L.Z=AK F,LaRM AOrs(,965a0Dti[1t~L 4 t :RUL ---•• - >~N94R r11nRM -- t~ SHtPY`Q~SN P~~t-~?~~, L d:D1sP'EMf3Efr PF1N 9-a rwR a- ?oae 8:4a rtM Fu6LE~D•,!r P1PiR 2. 2DOS e:06 An -- ~N66R PIIAItl'1 - ~..__ CkE3~u'~E L i NE tF.rd+ +a[riRft L 5:OS~EN3ER F'AN i ~= ~ L :RUL DISPBNBER PAN PL.GP BHUTppWN ALARM __.,.._ ~7Lti.fC a(,r1RM '---- sENSOR 9Uf ptARM MAR 2. 2005 @:D2 -VM1 4 StDISPENBER yqN i-r Tv~ _- 2005 tD:23 A~ Di'2DENSER 7?DN F~ ~ 005 8:05 aM -- 8£NfiQR pLAR1'7 -- __ t 2;R11L TuR$1ME 3UMF' f-RE~tRE t.tNE [.EAK •a.aFat BTP l3ulaP A 2:1~ 5 9:O1 ~ GRl>E~ L t PIE FAt t. MgFc ~, 2005 8 : ~l o riH irRF83uR£ L : PLE LF.rtY, rtLµRlw -- b~NSdk ALARM - L 2: RUL TURBl NE SilM4F ~ E3tx~ ggPigUR atrr ALi,Teh MAR 2. 2oag to:21 ~ OtL.AS~ti1t[fi~ -1[ARM - ---- tEP6Gk .,t,,a>zr- --~--- MWR 2. 2005 B:nB rw L t ~Rl1L AHNIA.AR RNNULNR BpAGE -- gENbpg ALARM ---_- FUEL NL+1RM L 44:13UL TURBINE $LR'tP MIAR 2. 2UU5 6:6e hK ~p BUMF sEPSOR OUT AL,A1S1 MAR 2. 2005 t0:2t rFl ----~ 8EN9GR atARPT ... --- ----- BEN84k QLAiiP'I [. 3:BUL ANNIA.AR 1 d:6;11 ruk&1-tE $UI'1P~- -- ANNIA.AR [~AL`E ~•p G~ --___ BENSUk pLr~Tf^t ----- FU~ ~~ FUE[. AL1aRM L 6:L16fi£N~S:Fr F.;h 3-.1 M14R 2, 2005 e: u4 AM }yam 2, 2005 6:03 HMI G1SPE:~k P.ah 3FPf.~JR OUT AL.FIRI"i NwR 2. 2005 10:24 AM Tanlmology-NDE 8940 Shoal Creek, Building 200 Austin, Texas 78757 f` UNDERGROUNQ STQRAGE TANKS '~= -....-_•::._..- -.w.uao:r.•.... _uNR.F..~-~!:aytNnn~-- ~i:i9 i n,. . APPLICATIQN - Tp PERFORM LLD! uNE TESTING ~I•`• ~ $S~ gEOpNDARY CONTAINMLNT TESTING '=1' RANK TIGHTNL9S TlBT AND TQ PERFORM FUEL MONITORINp CERTIFlOATiON PERMIT NO. ~ .. 4 • R1ll a BA»RBFIELD FIRS DEFT. Prcveation -ices 1600 Thixtua Ave., Ste. 441 Hakerstleld, CA 93301 'Itil.: (661) 526-3979 Faac (661) 852-2171 Page 1 of 1 ^ ENFIANCED LEAK DETECTION ^ LINE TEBTINq ^ BB-@88 SECONDARY CONTAflVMENT TE6TING ^ TANK TIOHTNEBB TEST ~ TO PERFORM FUEL MONITORING CERTIFICATION FACILITY ~` ~t~ Je„ ~ ~~~~ NAME ~ ~ ONE NUMBCR Op CONT~~A~T PLRBO ~ ADDRESS ~~~7 WiISOn std, &t,V.~t"Sft~Id ~ °E'S3G°I OWNERS NAME OPERATORS NAME PERMIT TO OPERATE NO, NUMBER OF TANKS TQ BE TE6TED IS PIPING D I TED7 YES NO TANK $ L NTLNT ~ ~- 9 `7 4 G ~ n~ l~ ~ cl~s te,l~l~.dl -'b'7 ~.w,iuwl TANK TR¢'~!N$ • P$ZIX NAME OP TE$TIN$ COMPANY Tanknolo ~ InC. I~y NAME i P11pNE NUMBER OF' Anthony Qhosks (951) 876-4060 CONTACT PEABON MAILING AOORE$6 ai78S Entsrprfse Clrcle S. Suite D Temecula CA 8259p NAME i PHONE NUMSIIR OF Wj1{ ~ T!$TER OR SPECIAL INSPECTOR: _ ~ 9 CERTIFICATION If: • CONpUCTED;tEST TO BE gI~ ~OT ~ ~~M ICC A: ~,~.r ~~ ~ `~ ~~ 1 MBTNOP SIGNATURE OF APPLIC T OATC: Ili ~ O ~ APPROVED BY , ~ .. DATE ' j C~ a FD 2095 (Rev. OB/Ob) £/Z 19099 L96 D8 /i8olouqu el Nd Z1 ~90 LDOZiIli10 0 N O O ~~ ~... ~/ce'p'.,-~o-r~.a~+i-..1~~''-~.+~ '__:~ .a ~_._~i tT~+r-:~ ~ ..- ~r::.~ ~ -~~~.. - ~- ~t _ ~ _ _ ; ~::, ~:f ~...__ _ _OQ~ 2 t-:~ .~~~tibE OOOOOO.w~i-,~-:._:: .. - ~f 1 - -- _ --~--- • ~ - 1 ~~ -~-- .. - __ .' ~ sD1fy ~ 1~' 1 4~'Q4 0 i. "S -k113 ~ ~ r w W i ELEYEtI ~~ Letter of Transmittal Date: May, 2006 Attention: Hazardous Materials Division Company: City of Bakersfield Fire Dept. Address: 900 Truton Ave., Suite 210 Bakersfield, CA 93301 RE: 7-Eleven #163299, 1701 Pacheco Rd. ~7_Eleven`-#1=6549; 4647=111filson_Rd~ 7-Eleven #17721, 3601 Stockdale Hwy 7-Eleven #32241, 4101 Calloway Dr. 7-Eleven #32376, 9600 Brimhall Rd. Enclosed are: ^ Business Plan ^ Business Activities ^ Business Owner/Operator Identification ^ Hazardous Materials Chemical Inventory ® Underground Storage Tank -Facility ^ Underground Storage Tank -Tank Comments: Shane Partridge Gasoline & Environmental Compliance Manager 702-270-7160 ^ Emergency Response Plan ^ Written Monitoring Procedures ^ Site Map ^ Owner/Operator Agreement ^ Test Results - ® Other: Financial Responsibility Rachel Rodriguez Sr. Administrative Assist t 503-977-7745 ,E~,`. °' r„ State of California ~ For State Use Only State of Water Resources Control Board p ~~ ~ . ~ Division of Clean Water Programs ~~' P.O. Box 944212 ~.~,,,pw,. Sacramento, CA 94244-2120 (Instructions on reverse side) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: 500,000 dollars per occurrence ~ t million dollars annual aggregate or AND or ® 2 million dollars per occurrence ® 2 million dollars annual aggregate e. 7-Eleven. InC. hereby certifies that it is in compliance with the requirements of Section 2807, (Name of Tank Owner or Operator) Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate trnancial 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 Liability Insurance Illinois Union Insurance Co. UST G2379486A $2,000,000 per Occurrence & 4/30/2006 c/o ACE Environmental Risk 001 $2 000 000 to Yes Yes 436 Walnut Street , , Annual 4/30/2007 Philadelphia, PA 19106 Aggregate Note: 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 7-Eleven #16329 1701 Pacheco Rd., Bakersfield, CA Facility Name Facility Address 7-Eleven #16549 4647 Wilson Rd., Bakersfield, CA Facility Name Facility Address 7-Eleven #17721 3601 Stockdale Hwy, Bakersfield, CA E. ign ture of Tan 0 er or Operator Date Name and Title of Tank Owner or Operator - ~ /~ /off Shane Partridge-Gasoline & Environmental li M C anager omp ance nature of Witnes r Notary Date Name of Witness or Notary 5~ D(p Rachel Rodri uez CFR (Revised 04/95) LJ ~ FILE: Original -Local Agency Copies -Facility/Site(s) 6E ~i..O~ .~ State of California f For State Use Only ~`~~ State of Water Resources Control Board _~' Division of Clean Water Programs ~::, . P.O. Box 944212 ~,~,,,p~,. Sacramento, CA 94244-2120 (Instructions on reverse side) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. 1 am required to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: 500,000 dollars per occurrence ~ 1 million dollars annual aggregate or AND or ® 1 million dollars per occurrence ® 2 million dollars annual aggregate B. 7-Eleven, InC. hereby certifies that it is in compliance with the requirements of Section 2807, (Name of Tank Owner or Operator) Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate trnancial 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 Liability Insurance Illinois Union Insurance Co. UST G2379486A $2,000,000 per Occurrence & 4/30/2006 c/o ACE Environmental Risk 001 $2 000 000 to Yes Yes 436 Walnut Street , , Annual 4/30/2007 Philadelphia, PA 19106 Aggregate Note: If you are using fhe 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 7-Eleven #32241 4101 Calloway Dr., Bakersfield, CA Facility Name Facility Address 7-Eleven #32376 9600 Brimhall Rd., Bakersfield, CA Facility Name Facility Address E. ignature of T nk O ner or Operator Date Name and Title of Tank Owner or Operator 26 ~~ Shane Partridge-Gasoline & Environmental li M C L anager ance omp ignature of Witn or Notary Date Name of Witness or Notary ~~c~v $=~~-~ Rachel Rodri uez CFR (Revised 04/95) `~ ~~ FILE: Original -Local Agency Copies -Facility/Site(s) CERTIFICATION OF FINANCIAL RESPONSIBILITY 7-Eleven, Inc. (formerly known as The Southland Corporation) hereby certifies that it is in compliance with the requirements of Subpart H of 40 CFR part 280. The financial assurance mechanisms used to demonstrate financial responsibility under 40 CFR part 280 are as follows: Storage Tank Liability Insurance Policy No. UST G2379486A 001 issued by Illinois Union Insurance Company, effective April 30, 2006, tluough Apri130, 2007, with a retroactive date of November 24, 2005, and covering underground storage tanks for taking corrective action and/or compensating third parties for bodily injury and property damage caused by accidental releases in the amount of TWO MILLION DOLLARS ($2,000,000) "per occurrence" and TWO MILLION DOLLARS ($2,000,000) "annual aggregate" as specified by 40 CFR §280.93; and To the extent of its eligibility, participation in various State fiords and State assurance programs as set forth in 40 CFR §280.101. 7-ELEV C. By: ~•~ .ni Name: Title: Vice• esident Date: ~~~~ Z1~0 tP STATE OF TEXAS COUNTY OF DALLAS SUBSCRIBED AND SWORN TO BEFORE ME this ~~~ day of , 2006. ~ L ~ 7 ,/- Mary B. Gamero No ary P is In and For Said County and Notary PubUc, state of Texas State b1y Gomm. Expires 01/20/10 My Commission Expires: 5162D2.2/SP2/7G088/0209/04280G UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®S.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 I:: FACILITY /SITE INFORMATIQN~ : . .. , . . BUSINESS NAME (Same as FACILITY NAME or DBA- Doinq Business As) 3 ~-.FACILITY ID# 7-Eleven #16329 - 1 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT' ® 1. CORPORATION ^ 5. COUNTY AGENCY' BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY` TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aoa ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY' aoz TOTAL NUMBER OF TANKS IS facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos IL PROPERTY OWNER INFORMATION- .. PROPERTY OWNER NAME 407 PHONE aoa Bobbie Stokes MAILING OR STREET ADDRESS aos 1348 Mentone Ave. # C CITY 410 STATE 411 ZIP CODE ail Grover Beach CA 93433 PROPERTY OWNER TYPE ^ 1. CORPORATION ®2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL a13 IIL TANK'.OWNER INFORMATION TANK OWNER NAME a1a PHONE a1s 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS a1s P.O. Box 711 Attn: Gasoline Acct CITY a1~ STATE ata ZIP CODE a1s Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ago ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY -.. .., , . . IV.BOARD OF EQUALIZATION UST STORAGE" FEE.:ACCOUNT. NUMBER- TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE ^ 1.SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz VI. LEGAL=NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 -. VII. APPLICANT SIGNATURE; ,: ,. Certi Icati - I certify t lat t information provided herein is true and accurate to the best of my knowledge. SIG AT E OF AP CAT DATE 424 PHONE azs 26 0 ~0 702-270-7160 • NAM OF APPLICAN print) azs TITLE OF APPLICANT az~ Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use oniy) 428 1998 UPGRADE CERTIFICATE NUMBER (For local use only) a2s UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®S.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 L FACILITY /SITE INFORMATION BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 'FACILITY ID#~: 7-Eleven #16549 1 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 4647 Wilson Rd., Bakersfield ® 1. CORPORATION ^ 5. COUNTY AGENCY' BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY' TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aos ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY' aoz TOTAL NUMBER OF TANKS IS facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos 11::P-ROPERTY=.OWNER INFORMATION PROPERTY OWNER NAME aos PHONE aoa 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS aos P.O. Box 711 Attn: Gasoline Acct CITY ato STATE apt ZIP CODE atz Dallas TX 75221-0711 PROPERTY OWNER TYPE ^ 1. CORPORATION ®2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL ats IIL TANK'OWNER-INFORMATION TANK OWNER NAME ata PHONE ats 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY ate STATE ata ZIP CODE ass Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY IV.BOARD OF~:EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER. . TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise az, V. PETROLEUM-:UST FINANCIAL RESPONSIBILITY INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD az2 VI. LEGAL NOTIFICATION AND. MAILING ADDRESS` Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 .., VII: ARP..LICANT SIGNATURE Certifi do - certify th t the i formation provided herein is true and accurate to the best of my knowledge. SIGN T E OF AP L NT DATE aza PHONE azs S /7~to o ~ 702-270-7160 NAM F APPLICANT rint azs TITLE OF APPLICANT azs Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) aza 1998 UPGRADE CERTIFICATE NUMBER (For local useon~y) a29 UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 .. L FACILITY L'SITE INFORMATION:.::., BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business AS) 3 FACILITY'ID#'.- 1 7-Eleven #17721 NEAREST CROSS STREET aoi FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT' ® 1. CORPORATION ^ 5. COUNTY AGENCY' BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aos ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY' aoz TOTAL NUMBER OF TANKS IS facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ISI No aos aos 11: PROPERTY OWNER INFORMATION PROPERTY OWNER NAME aos PHONE aoa 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS aos P.O. Box 711 Attn: Gasoline Acct CITY atD STATE att ZIP CODE ail Dallas TX 75221-0711 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL ais ,. IIf TANK"OWNER INFORMATION " " TANK OWNER NAME ata PHONE ais 7-Eleven, Inc. 702-270-7160 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY air STATE ate ZIP CODE ais Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY "IV: BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER" ,. TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise azt V. PETROLEUM UST FINANCIAL RESPONSIBIL-ITY INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(S) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz ~: VI. LEGAL NOTIFICATION AND MAILING ADDRESS, ` Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER az3 VII. APPLICANT SIGNATURE_ .., _ _ . ~ Certifica on I rtify that t e Inf rmation provided herein is true and accurate to the best of my knowledge. SIGNA OF APPU T - DATE aza PHONE azs ~ ~zb v ~ 702-270-7160 NAME OF APPLICANT (p ~ ) azs TITLE OF APPLICANT azs Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local useoniy) azs 1998 UPGRADE CERTIFICATE NUMBER (For local use only) azs UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®S.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 ... ,_ ;. .. , I; FACILITY /SITE INFORMATION' BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business AS) 3 "FACILITY ID#~' 1 7-Eleven #32241 _NEAREST CROSS STREET ao1 I FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 4101 Callowa Dr ®1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY' TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER aos ~ ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY' aoz TOTAL NUMBER OF TANKS Is facility on Indian Reservation or `If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos ;, .. ., ` II. PROPERTY OWNER~INFORMATIQN PROPERTY OWNER NAME aos PHONE aoa WECI - 99 -3LLC 972-361-5000 MAILING OR STREET ADDRESS aos 15601 Dallas Parkwa ,Suite 40 CITY a1o STATE all ZIP CODE a1z Dallas TX 75001 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL a1s Ilt: TANK OWNER INFORMATION: ` ` - a1a PHONE a1s TANK OWNER NAME 7-Eleven Inc. 702-270-7160 416 MAILING OR STREET ADDRESS P.O. Box 711 Attn: Gasoline Acct CITY a1~ STATE a1a ZIP CODE ale Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY azo ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY 1V BOARD O.F'EQUAL-IZATION `U3T STORAGE`FEE ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise 421 V. PETROLEUM UST FlNANGIAL RESPONSIBILITY :. . .: . INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD azz ,. ._ VL LEGAL NOTIF.IGATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. a23 Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER VII. APPLICANT SIGNATURE; Certificaf n - I ertify that the inf rmation provided herein is true and accurate to the best of my knowledge. SIGNA RE APPL C - DATE aza PHONE azs S ~ ~ c(~ ~ 702-270-7160 NAME PPLICANT (p ~ t) azs TITLE OF APP (CANT azs Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) aze 1998 UPGRADE CERTIFICATE NUMBER (For local use only) azs UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®S.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 l: FAGIL:ITY I SITE.INFORMATION . BUSINESSNAME(Same as FACIUTV NAME or DBA-Doing Business As) g .FACILITY ID#'. 1 7-Eleven #32376 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 9600 Brimhall Rd. ® 1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER ao3 ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* aoe TOTAL NUMBER OF TANKS Is facility on Indian Reservation or 'If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 2 aoa 405 ^ Yes ® No 406 I1. -PROPERTY OWNER INFOR"MATION ;. , PROPERTY OWNER NAME 407 PHONE aoe American West Lands Co. MAILING OR STREET ADDRESS aoe P.O. Box 524 CITY 410 STATE 411 ZIP CODE atz Bakersfield CA 93302 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL at3 III. TANK OWNER INFORMATION TANK OWNER NAME ata PHONE 4t5 7-Eleven Inc. 702-270-7160 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY ate STATE at6 ZIP CODE 4ts Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ago ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY IV. BOARD OF-EQUALIZATION UST STQRAGE FEE ACCOUNT NUMBER- TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise 421 V: PETROLEUM~UST FINANCIAL RESPONSIBILITY INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD a2z ,, V14.LEGALNOTIFICATIQN AND MAILING ADDRESS` Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box t or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 _. VIL:APPLICANT SIGNATURE. CertificaY n - l certify that th info ation provided herein is true and accurate to the best of my knowledge. SIGNA UR F APPLI DATE aza PHONE 425 .~ 26 O(o 702-270-7160 NAME APPLICANT (prl ) az6 TITLE OF APPL CANT 427 Shane Partridge Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) 428 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 429 UPCF (1/99 revised) Formerly SWRCB Form A + 7-ELEVEN 2125-16549 _________________________________ SiteID: 015-021-000808 + Manager BusPhone: (661) 833-0732 Location: 4647 WILSON RD Map 123 CommHaz Moderate City BAKERSFIELD Grid: 11C FacUnits: 1 AOV: CommCode: BFD STA 07 SIC Code:5541 EPA Numb: DunnBrad:00-734-7602 Emergency Contact / Title Emergency Contact / Title SHUN & SHU WANG / FRANCHISEE DAVID LISUK / FIELD CONSULT Business Phone: (661) 833-0732x Business Phone: (888) 711-4876x3720 24-Hour Phone (661) 834-5830x 24-Hour Phone (661) 845-0031x Pager Phone (661) 633-6170x Pager Phone (661) 633-6319x Hazmat Hazards: Fire ImmHlth DelHlth Contact -:~~ "' Shane Partridge _ - Phone : (vim-) ?-9~~-- ~ 17 ~~- MailAddr: PO BOX - State: TX 7~a~~7o-~icoa City DALLAS ~~~ ~ ~ Zip 75221-97 Owner 7 -ELEVEN INC Phone : (-8-7~-r ~i = ~ ~22x- Address PO BOX 7// State : TX ?~ ,a ~~ ~ ~ < <O ~ City DALLAS Zip 75221-" 07// 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 responsible for obtaining the information, 1 certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, a c a, and ~ te. ~'~~~ Si nature iDate ~~~a4 ENT'D APR 2 5 2006 -1- 03/31/2006