HomeMy WebLinkAboutBUSINESS PLAN (2)
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~ /, 11/17/2005 08: 42
6613252529
CAL VALLEY
PAGE 01
CAL-VALlEY EQUIPMENT
3500 GfLMORE AVENUE
BAKERSFIELD. CA 93308
(661) 327-9341 FAX: (661) 325.2529
CONTRACTOR'S lIC.#784170 A HAZ
CAL-VALLEY
EQUIPMENT
Fax
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Fax: r,S],- 2171
An: sre...Ve.. (/J;7d-evwooe:Y
From: 8~ l11'hs/ep-
~age$: :J
INCLUDING COVER
Date: 11-/7-0S-
Re:
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o Please Recycle
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State of Cali fomi a
State of Water Resources Control Board
Division of Financial Assistance
P.O. Box 944212
Sacramento. CA 94244-2120
For State Use Only
(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:
o
o
or
I million dollars per occurrence
AND
o
o
or
2 million dollars annual aggregate
500,000 dollars per occurrence
I million dollars annual aggregate
B.
hereby certifies that it is in compliance with the requirements of Section 2807,
(Name of Tank Owner or Operatorj
Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations.
The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows:
C. Mechanism
Type
Name and Address of Issuer
Mechanism
Number
Coverage
Amount
Coverage
Period
Corrective
Action
Third Party
Comp
~c I {-
See J\~t\ld
\ "~\.\\\O'N
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
+fP Cxo Cro qoq
Facility Address
g1()1 (fll~L.._ 0,,( u'fJ,tlt qJ]()y
Facility Name
Facility Address
Facility Name
Facility Address
E S. .L' / 0
. Igna~, If~ror perator
~.
~ p:=-
Date
[(-l- OS
Name and Title of Tank Owner or Operator
Signature of Witness or Notary
Date
Name of Witness or Notary
CFR (Revised 04/95)
FILE: Original- Local Agency
Copies - FacllitylSite(s)
FROM : I<HULLAR I NSAGENCY
~<~
FAX NO. :6613257556
Nov. 03 2005 11:55AM P2
, ACORD... CERTIFICATE OF LIABILITY I,NSURANCE I OA Tl (MM/DD/VYl
11-02-05
fROIIUCEA THIS CER11RCATE IS ISSUED 1.8 A MAmR OF INFORMATION
KHULLAR INSURANCE AGENCY O~~IAND CONFERS NO RIGHTS UPON THE CERTIFICATE
HO ER. THIS CERTIFICATE DOE8 NOT AMEND. EXTEND OR
301 "H"S'tREET # A AL: THE COVERAGE AFFORDED BY THE PQUCtES BELOW.
BAKERSFIELD CA 93304 INSURERS AFFORDING COVERAGE
. . ., -~- -.. .. ,... I~ A;,CENTURY - ..
INlIUAI!D SURETY COMPANY
~,.... _..
BATHINDA ENTERPRISES INSURER B: .,<<,-
--.. . . . ..,... ".-
DBA H P GO GO MINI MART IISlIIlSl c: -..' .. ..
~~.o:. .... -... ....." -..". .'-
I INSURER E;
COVERAGES
TI1E rouel!::':; OF INSURANCE USTED BELOW HIWE BEEN ISSUED TO THt INSURED NAMED MlOVE fOR THE POLICY rERlOO INDICATED. N01WI'I'H!lTANOING
ANY REQUIREMENT, TERM Ofl CONDlTfON OF M<4Y CONmACr OR OTHER DOCUMEioH WllIH RESPECT TO WHICH THIS CEATtI~CATE MAY R~ ISSUED OR
MAY PER1AlIII. THE INSURANC~ AFFORlJED BY THE POIJCIES DESCRIBED HEREIN IS SUI!.JECT TO ALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH
POUCIES. AOOAf-GAl'f UMITS SHOWN MAY HAVI:; IJ[;EN REDUCED BY PAlO CLAIMS.
'l'IPI Of' ~~ . - ~., NUIIIER JIOUCV
Gl!1I1!1W. LlA8I1JTY CC P 3 6 9148 2
COMMERCIAl G9lI;RAI. llAlllLflY
~ CLAlY6 MAIlE I fJ OCCllll
L1l11lts
.!;A~ OCCIlRR.~.~ .1 0 0 O.! 0 0 0
FIRE OAMAGe (My one 111e) ...1 0 0 , 0. 0..9 ._
}lElJ.~llllf~) .5...t.009-.
""lSON,.,. . IIOV I~.Y .1 , 00 Q, 000
.GENERAL A~OAT:~~~ .~ J. 1 99 0. , 0 D_ 0 .
..~.: COMPKll' AGG .1 L U () U , 0 Q.,o
I".PI' ^,OOIl!;GJ\TE LIMIT AF'f'l.or;:s rt:rl:
-. PRo -'''LOC
AI/TOM08ILE LlAlILlT'I
ANY AUTO
IIU OINNED AUTOS
SCHEOUI.l!D AUTOS
HIRED AUTOS
N~-OWN'D AVTOB
CDMBINF.D 91NGLE LIMIT .
lEI I~
BODILY II'MJRY .
(PerIl8fl!Of\)
BODilY IH.AJRV S
(Per ec_nQ
I'AOf'EF11Y DAMAGE S
(Pel lCC1denq
OAIlAOC IoUlIIIU'fY
ANY AUTO
AUTO ON!. Y . EA ACCIDelT
F.A ACe $
.
AQG
OlHER ntM
AUTO 0111 Y:
QCElIS lWI11ltY
Decun D CLAIMS MAOE:
CAel. OCOORAENCE
AGGRFOAtE
J
OCOVClII1H
FlETENTt()N .
WOIIlIIIII COMJEN8AtlON AND
"PLO'YIM' LWlILITI
$
--. ..,,-----,--- :'
STAT!fu .
~l.:. F-ACH ACC~fIIT .
E.l. ".ISEA.c:I; - ,It F,.M~Ove: $
El. DISEII8F. . POOCY L1Mll $
O'rlllll
B BUILDING CCP36914B 07-13-05 07-13-06
DElCRlPTlON OF OI'llRAlIOlIMDCA'IlONtMIIlCLEllIElU:WSIONII AlIIJI!D 8., ERIICIR8ElllllTlIIIIIClAl PROVllION8
BUS.PERS.PROPERTY = $60,000
200,000
CEATlFfCATE HOLDER
ADIIl1IDNAL IIIIlPlfJI: lN8UREft LlT1IR:
ACORD 25-8 (7107)
CANCE~LAT1ON
IKOU\D AIl'I 0.. 'rIlE AROW DESC:RIRD PClllCIU II~ CANCI!UID BEFORE lHllllPlIIATlON
DAn; 'rllEAtllIF, TIOI: I88UlNQ _ WILL ENIICAVOll TO MAIL l.Q.... DAYS WRmEN
N01ICE to 111. ClllTII'lCAlI HClLIHII NAIml 10 'rill! lit"'. lilt FAILURE 'l'O DO 10 9tIALL
NO 0IllQA1lOJt OR lIA8lQ'dlll1lt ~Mtl"~~~'~~rENl1I OR
UY.~ ", I t. !'~"".
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~1/06/2006 17:08
6613252529
CAL VALLEY
PAGE 131
c~
r:A'. - VALLEY EQUIPMENT
3500 G'lMO.RE AVENUE
BAKERSFIELD. CA 93308
(661) 327~9341 FAX: (661) 325-2529
CONTRACTOR'S llC.#784170 A HAZ
.' -",". .' .' "
CAL",VALLEY
EQUIPMENT
Fax
To: B~~04 ~
f:aJC: _ ~~-;;l./7)
All: -Y~.R ~~
Re:
From: Q , -,I ~
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P.ages: ~ fNClUDrNG COVER
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Comments:
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'01/06/2006 17:08
661325252'3
CAL VALLEV
PAGE 02
..
MONITORING SYSTEM CER'lTFICATION
For U.fff By All Jttri.1'dictiqn.s Witlli~L lhi! Slf.Jld ufCalifQmla
A/.I'(lfJrit)' Cited: Chapter 6,7. Health and Sajety Code: Chaplu /6. Divisi{)(l3. Tille 21, Calif.".,t-it.<< Code of Regulations
This form Inust be used [(I document testing and servicing of monitoring equipme.nt. ~~rtificalion or report mUSt be RreDa~d
ror each monitorinj! SV!llem control &;land by the technician .....ho performs the work. A copy of tl1is I'OI'1Tl musl be provided (lJ the tank
system owner/operator. The owneJ'/opc:ratOT must submit a copy of this form to the local agency rcgul2ring UST !i}'stem!; within 3D
days of lest d~He.
A. Gcnerallilrmal:fOn
Facility Narrte; P G tJ Gg qOtf
Sitt: Address; -...:3:YJ..LWt'hl e. Rd.
8Jdg. No.:
~ Cily; ~..r.:lLf!.Id!.. _ Zip: ___
Contacl Phone No.: (__)__
Date of TcstinglServiting, lLJ11J OS
Facility ContaCI Person:
Make/Model of Moni1t1ring System: ~~y-fl.qol'- Tt..S- 3S1
B. Inventory of Equipment Tested/Certified
elltek tM a ro jal" boxes U1 indil'(lllc 5 eirlc ul ",,,nIl ted/servieecf'
T:mk 10: --1 ,7 Vi.... TAnk lD: 9". vI..
l5r In. Tank v:l\1!,ling Probe. Mudel: JI'I;I~, ('jJ In-Tank Gauging Prahe. Model: --""1ajjj-:---
o I\.nnulnr Spacc or Vault Sen!or. Model: Q Annular S~ce Or Vault Sensor. Model;
~ Pip in: Sump! Tn:nch Sensor(s). Model: $~~~ l2S Piping Sump I Trench Sensor(s), Model: .sC4",.~~_
u Fill Sump Sensor(s). Mad!;l: 0 Fill SlImp Scnsor(.). Modd: _'_'_._
o Medlnnical Lint: u,al< Oeleclnr. Model: 0 Mechanical Line Leak DClectOr. M(1del: _ __
o F":lel'lnmi, LillI!' Leak Delector. Model; a Electronic line Leak Detector. Model:
CJ Tank Overlill/liigh-~\'c' Sc:n~or. Model: 0 Ta.nk Ovcrtllll Higl1.Levcl Sen~or. Model:. _' .__
o Other(s cdt' e ubmellllv e ClOd model in Seetinn 8 on Pl\ TO 2). CJ Other (sci ui ment t and model in SeClion ~ on Pn .2).
T"nk ID: 9/ ~ Tank IV;
B In-TlIllK GBugin~ Probe. MOdel; ..IJ1~. 0 In-Tanle Gnuging Probe. Model:.
o Annular Sp..'c~ or Vault Sensor. Model: CJ Annulsr Space or Vaul! Sen.~Qr. Model: __._._.
iii Piping Sump I Trcl1l.il SCnSOl'S). Model: S14-,.,.P S.rH{~_ 0 Piping Sump / Trench Scn..<or(s). MOOe!; ____._
o Fill Sump Scn~OI'(S). Model: _ CJ Fill SlIIl1p Sl:nsor(s). Model; _~'__'_
o Mechunic111 Line 1-1:.')1( Dele:!CtOt. Model: 0 Mechanical Line teak Deleclor. Modtl:
U I;.kclronic Line Ceal<. Deteclor. M<:Idel: 0 Electronic Linc Leak OCleclOr. Motlel;_.
o Tank Overfilll Hiah.\...evd Sensor. Mood; Q Tnllk Overfill/High-Level Sensor. Model:
U Olhcr Is. cclf e ui men, 1 and model in Scction e Oft Pn c 2). Cl Olher (s If' e ui mem I e and model in Section E on PM:e 2).
l)ispcn!R'r ID: [-'2.. Di!ipenscr 10;
fill Dh.penset'Containment SCl\sor(s). Mndel:~J.! s-t'~ttr CI Oi~pcnser Cnnlainl11cnl Scnsor(s). Ml)del~ ___- __,_
W She"r ValvC(s). 0 Shear Vlllve(s).
Q Oi, nscl' Cnnlainmcnl Flrnlt(s) ilnd Chain{s)_ Q I:>is cnser Conlninll1c:nt Floal(s and Chain{s).
Di~n!ler '0; . Dil;penser JO: '._
:!9 DispcllSerCOl1lainmerll Sell$or(~l. Model: ~~" Se!tS#Y' 0 Di~f1C11SerCO"h\imnenl Scnsor(sl. Model: _. _'___
~ S~ar \lalllelsl. Q Shear Valvees).
a Dis l\~rCo"'lainmcnl Floal(5) and Chni!l{s). 0 Dis enscrCont.:linmenl FloAI(S) and Chaines},
I)jspenser 10: Oisptnser ID:. _
tJ nisp~nscr Conll\inment Sensor(s). Model: Q Dispenser Contllil1r'ncnl Scnsol'(sl. Model: _ ____
l:I Shea, Valve(s), CJ ShCllr Valvc{s).
OD!. enserConrainmenl PlO(ll~51 "Jl<l Chllin 5). 0 Dis enscr Conlainl\'\tlnl Roal(, and Chain(s).
-If lhe I'llelli'y l'C3nISiIlS more lllnks or dbpe:nsers. cOP)' this form. Include informmion tor every lnnk and dispenser Il~ the r:.'cjlity
C. Certification ~ I certify that the eqlJipment jdentiRed ill I.hls dl)cument W9$ Inspected/serviccd in aCClJrdllJ1l;:C with tile mAJllItal'lUnrs'
j,:uldelines. Attached to this Certification jl> informallon (o.g. manufacturers' chccklist$) Ilee~aa,r to veri')1 lhnl IIlis infllmtatilln is
correclllnd a Plot Plan .~howlng the layout ormonito~ing equipment. For ~ny tquip.neru capable or gChcrnting such reports. I hnv(' al~l)
lltCacJled a copy or the ~~t: (eheck all Uteri apply); 0 Systemset.up 0 Alarm hi~tory report.
Tcchnicia.n Name (print): -OJCiLe..t w. ~fl~r/t/;?- Signature: ~;;.....p. ~ ~~~
C~rlificali()n No.: _S..6~vy~ Licenr.e, No_: 7'C''Y/7P-A_
T~~tirtg Company Name; ~/~/,4.lk.JL-/%.~'fltr.!Hrt". Phone No.{~C~ ) 327-'.:J:Jr
Site A(l(h'~ss; :.:JJJ.J_kfj,'k~~J Q..'"L... Dale:! orTeSling/Servicing: /LI./...c./ ~
MO"1itorfn" System CertifieaUOIl
rage l of .,
U3/11\
'01/06/2006 17:08
6613252529
CAL VALLEV
PAGE 03
~.
D. Results of Testing/Servicing
Software Version lnstalled:
/~. D<j
.
Com lete the followin (heckU5t:
Yes t:J No" Is the audible alarm. rational?
I>> Yes 0 No'" Is the visual alarm 0 erational?
li1l Yes tJ No'" Wel'e all sensors visuall ins ceted, functional! tested, and confirmed 0 erational?
J'/!J Yes CJ Noll: Were all sensors in$talled at lowest point of secondary containment and pCI.~ilioned so that other cquipmem will
not interfere with their 0 er 0 cratJon?
Ir alanns arc relayed to a remote monitoring station, is aJ/ cQf\'Ut1unications equipment (e,g. Inodcm)
opel'alional?
For pressuri7.ed piping systems. dOcs the lurbinc autolnatically shut down if the piping .c:ccondary containment
monitorin~ system detccts a h;ak. fails 10 operate, or is electrically disconnected? Ir yes: 'which senmrs initiate
positive shut-c1(1wn? (Check all that apply) mSump!Trench Sensors; Rf Dispenser Containmt:nt Sen~(}r~.
Did 'ou confirm osilivc shul-down due to leaks and' senSOr failUl'e/disconnectjon? !;l: Y~s; (J No.
e N(l'" r()r lank $Yl'llems that \.Itililtf the mQnitol'jng system as Ihe primary tank overfill warning clr.:v;ce (i,e. no
9 N/A mechanical overfill prevention "'lllve is installed), j!,: me overfill warning alllrm visible and audihle at the lank
fill oint(s) find 0 ratin ro erl ? If so, at what ercent of lank ea acit docs the alarm lri er'? %
Was 1m)' monitoring equipment replaced? If yes, identify specific sensors, probes. or other~cquipl'l1cnt replaced
and list the manufacturer name and model for all re laccmenl arts in Section E, below.
Wa!V liquid found inside any secondary containment systems deSigned as dry systems? (Check all /IUH apply) (J
Product: [J Water, If s. describe causes in Section e. below.
1& Yes t:J No" Wa!< monirorin s sl.Cm set-u revic:wed to ensure: TO ,r scttin s1 Altach set u
o Ye~ fiI No" J~ all n1oniLorin ui mcn! (} cratfonaJ et manufacturer's s ecificatlorlS?
'" In Section E below, deliicri~ how and wlien the.~e deficiencies ~ere or wflJ be c()mcted.
Yes
o No.
ex: NIA
o No.
o N/A
DYes
lJ Yes
t:J Yc~"
o No
[J Yes"
ffI' No
licablc
E. Comments: ~.If'o!JrA4'J:le.AI t:JdiJ~~~:n:rLqg~h.B::S:~rJl1 ~~
~~~.
..._----_..__..~--
----'----...
l'agB :2 of 3
1))/111
-01/05/2005 17:08
5613252529
CAL VALLEY
PAGE 04
7'
F. In- Ta~k Gauging I SIR Equipment:
a Check this box jf tank gauging is used only for inventor)' Cl')nlrol.
Q Cheek this box if no tank gauging or SIR equipment if; inslillled.
This section must be completed if in-tank ,gauging equipment is used to perlorm leak detection monitoring.
c
omplete the folJowin~ cheddisl;
9 Yes Q No" Has all Input wiring been inspected for pl'Opcr entry and termination, including testing for ground fault!;'!
lSP Yes Q No. Were nil tank gauging probes visually inspected for damage and residl,lc buildup?
ti' Yes Cl No'" Was accuracy of system product level readings tested?
i>> Yes o No'" Was accuracy of system watcr level readings tested?
Q} y~ Cl No* Were all ptObcs reinstalled properly?
~Ycs a NQ" Were all items on the equipment manufacturer's maintenance chel;klist complcted~
.. In the S~tion II. helo\". de..o;eribe how and wheJl these dencienc:ies were or wfll be corrected.
G. Line Leak Detectors (LLD):
tIC Check lhi~ bo~ i r LLDs are 110t installed.
c
It
h kr
omnlete the fo OWirUl c eo 1St:
. - \'erify' UD pcrfol'mllnce?
CJ Yes Q No'" For equipment SlaM-tip or annual equipment c.=rlification, was a leak simulated to
o NJA fChf!ck flU ,huf apply) Simulated leak fate: Q 3 g.p.h.; 0 0.1 g.p.h; a 0.2 g.p.n.
CJ Yc~ 0 No'" Were aJll.LDs confil1nc:d operational and accurate within reguliHory requirements?
0 Ye~ CJ No. Was the testing apparatus properly calibmted?
0 Yel'> Cl No'" For rnechanicall.LDs, does the LLO restrict prodl1ct flow if it detectS a teak?
Cl N/A
Cl Yes o No" For electronic LLOs. does the turbine automatically shut off if ll'lc LLD detects a leak?
o NlA
Cl Ye~ o No'" For eleC:tronic LLDs. does the turbine automatically shut off if any ponion of the rnoniloring system is diJ;lIbled
CJ N/A or d isconnecled?
0 Ye$ 0 No'" For electronic LLDII. docs the turbine automatically lIhlll off if any portion of the monitoring system m:llrunctil)ns
0 NIA 0" rairs a {cst?
0 Yes Q No* For elec:tronic LLDs. have all accessible wirlng connections been visually inspected~
CJ N/A
0 Yes o No* Were all ilems On the equiprnent manufacturer's maintenance checldisl completeCl?
'" (1'1 the Section H. below, desclibe hOw an(l wheJl these de(iciencies were or will he corrected.
H, C01l1ments:
Ptlge.3 of 3
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-. 01/86/2006 17: 08
661325252g
CAL VALLEY
PAGE 05
~,
Monitoring System Certification
,J 19-/ U.5T Monitoring S~te Plan
Si~e Address: .-2l.1>/ WJ'bi-!- ~ ~K1rr+;'t/~1 l'::A..
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Date map ms drawn: 11-/ J'lJ 0$ .
Instructions
If you already have a diagram that shows all required information, you may Inch,lQe it, rather than thjs page, with your
Monitoring System Certification, On your site plan, show the general layout of tanks and piping. Clc:ady identitY
locations of the following equipment, jf installed: monitoring system control panels; sensors monitortl1g mol( annular
spaces. sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak
detectors; and in-t.ank liquid level probes (if used for leak detection). In the space provided, note the date (hi!'; Site Plan
wa$ prep,lT<:d.
Page ~ or.!:!...-.
1I51flll
~ 01/06/2006 17:08 6613252529
CAL VALLEY
PAGE 06
':1'
"
CAt VAueY EQUIPMENT
3500 Gilmore Ave
Baketsfiekl. C8 93308
661..s27..Q34t Fax 681-325-2529
IMPRESSED CURRENT CATHODIC PROTECTION CEIn1RCA71ON
CONTACT: -....
PHONE:
Installation Date: /99~ ,
Hours: ~c;-,tJl{9 ~
Adjustment: f'. 1~c..d<<.rJL.J
SITE: tJ p ~ (l ~ () 9"tJ~
~()J J16'b~e ~
fiaK~~-H:e/~ Cr::t.
Model # J: II. E'1<<11I7Jh,'c.. Serial #'...!1ff~V
VoItQge: '17 Amps: _ ~
Coarse: P Fine: I
DATIe:: Il-(~ -OS.
Ft: l~[f EiZ-l~f~~1~ ~~r.~ J~~:I
I hereby certify that the minimum system potential requirements for Impressed Current Cathodic
Protection;
~ _~ Have Been Met
, J Have Not Been Met
for the systems referenced above: taken In accordance With the minimum standards of the National
Associatfon of COrrosion Englneem, and as done to comply wtth SPA and State ~s
-t3ru.c. e. f4(. Mb. ~ ,.
Technician Pertormlng T
Na~ 12 06 03:32p
DIANA ENT INC
661-835-0279
p.2
CAl VALlEY EQUIPMENT
3500 Gilmore Ave
Bakersfield. Ca 93308
661-327-9341 Fax 661-325-2529
DATE:
CONTAcrr:
PHONE:
,
Installatio I' Date:
/'11~
Hours; C,-/3tfQ
I
AdjustmeJ : -/- I Cot:{ rJ e.. \ CoOBe:
I
Structure :to Soil Potential R"dirigs For Previously Installed Systems (System Off )
Tank I Tank Fuel I Product Vent $ Or E Center Nor W f Electronicf
Number Size Type Une Une En<ti,,1fTan of Tank End of Tankl Conduit I
, 10 ~7 I /P;:tJ 'rO.quz. -O~..r't2. -o.1I'6tr 1-0.7/2 -t'. '/rtf,
.~ In i.-' q/ I A/~ 1-n.9112 -O'.Jl'39 -0. K.~I ,...-". '7/0 -I). 'il'Z~
10 <gq N~ 41.'?o'2- f-o-.'it~.s- -0. <rq"J f-P.7iJ9 -tJ3r26
Voltage:
'-17
D
Amps:
Fine:
-
I
i
I
Struc:ture 1 D Soil Potential Readings For Previously Installed Systems (System On )
I
Tank Tank Fuel \ Product Vent S or E I Center N or W I Electronic
Number Size Type I Une Une End~fTankl of Tank End of TanJd Conduit
I
it:: 7 I
~J
<;r,-?
I
2
:J
oK
'I,V
If} ..
h)'1t -1.268' -'J ..113"1
,M- 4--1, 2Jitr - i.1J1}
/1//11 ":'1. U~ i. iHlJ
'-V.l> -1.Ufr
~(). sr? - ;271
A ot -i.Cjg
-I. 0/ ">
_I. /)IJJ
).I'J&JSr
e
I
I hereby cert fy that the minimum 1=1 em potential requirements for Impressed Current Cathodic
Protection:
t::---:"::J Have Been Met
I f \ Have Not Been Met
tor the syster s referenced above: rken In accordance with the minimum standards of the Nmiona'
AssocIation (] Corrosion Engineers1 and as done to comply with EPA and State Directives
-z3ru...r. fl. V; J..h'h r/pu.... !
~ Technician P Jforming Tesf
- /-.
'"'
APPLlCA TION
TO PERFORM ELD 1 LINE TESTING
1 S8989 SECONDARY CONTAINMENT TESTING
ITANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661)852-2171
UNDERGROUND STORAGE TANKS
Page 1 of 1
PERMIT NO. I j'T -b~41
D ENHANCED LEAK DETECTION
D TANK TIGHTNESS TEST
D LINE TESTING
pg: TO PERFORM FUEL MONITORING CERTIFICATION
D SB-989 SECONDARY CONTAINMENT TESTING
Ot-th~/c l:c'
FACILITY Go Go Mart
NAME & PHONE NUMBER OF CONTACT PERSON
ADDRESS 3301 Wible Rd.
OWNERS NAME
OPERATORS NAME Same
PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED
TANK #
IS PIPING GOING TO BE TESTED?
VOLUME
DYES
o NO
CONTENTS
NAME OF TESTING COMPANY Cal-Valley Equipment
Bruce W. Hinsley 661-327 -9341
MAILING ADDRESS 3500 Gilmore Ave. Bakersfield, Ca. 93308
Bruce W. Hinsley 661-327-9341
CERTIFICATION #: 563454479
DATE & TIME TEST TO BE CONDUCTED November 18, 200509:00 ICC #:
TEST METHOD
,(),VEll
APPROVED BY
FD 2095 (Rev. 09/05)
i':--
n
+ LE-TOY MOTORS ======================================= SiteID: 015-021-002887 +
Manager : BINDESH PATEL
Location: 3901 WIBLE RD 2
City BAKERSFIELD
BusPhone:
Map : 123
Grid: 14B
(661) 396-8100
CommHaz : High
FacUnits: 1 AOV:
CommCode: BFD STA 07 SIC Code:
EPA Numb: DunnBrad:
+==============================================================================+
+=======================================+======================================+
Emer~e:qci( Contact / Title OWMWv Emergency <PPD-tAict / Tit~
'b iN \-'0. QJG / ~\t1etl\l"Z'\. Vo. Q1)U / 0 W
Business Phone: (6bl ) ~b -'kIOOx Business Phone: (bbl) 3tl g -OO'O'x
24-Hour Phone : (6b\. p~~'2> -&7d3x 24-Hour Phone : (~I ~~ ~7~~x
Pager Phone : (6&\) 2.03 -3qJf7.x Pager Phone : (6bl )203 -ijll-cgx
+---------------------------------------+--------------------------------------+
\ Hazmat Hazards: Fire Press React ImmHlth DelHlth I
+----~~-------------------------~----------------------------------------------+
Contact : BINDESH PATEL Phone: (661) 396-8100x
MailAddr: 3901 WIBLE RD 2 State: CA
City : BAKERSFIELD Zip : 93309
+------------------------------------------------------------------------------+
Owner BINDESH PATEL Phone: (661) 396-8100x
Address : 3901 WIBLE RD 2 State: CA
City : BAKERSFIELD Zip : 93309
+------------------------------------------------------------------------------+
Period to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
+------------------------------------------------------------------------------+
Emergency Directives:
GV~i~O ~ dw tb llS hwr~ >
(fl/.'J"1r..
/ U JUt
J 1 2006
PROG H - HAZ WASTE GEN
0~O~1 \
~~OO
+==============================================================================+
-1-
06/07/2006