HomeMy WebLinkAbout4101 CALLOWAY DRIVE (2)AUG-16-2007 14~28
P.02i06
UNIFIED PROGRAM CONSOLIDATED FvRM Tq(~KS
UNDERGROUND STORAGE TANKS - FACILITY
(one page per slte) Psge _ of _
TvPE OF ACTIO~1 O~• NEW SITE PERMIT ^ 8. R6NEW~-L PfiRM~T ~ 6.Cl~WNGE OP INFORMATION [~ 7.PERMANENT~Y CLOSED SITE
(Check one item ordy) O e. AMENDED PERAAiT specHy cfanp8 bC81 u8e ordy ^ 9. TANK REMOVED
a e.T~roo~ar sRe c~osu~ 4~
..
. (. FACILITY~I.;SITf INFO~RMATION:. ~. . .
BUSINESS NAME (Sxne ae FAfdLT' w~ME a DBn- Domp Busu~e~e tiil 3 FAC~ur~rio~~
,
7-Eleven #32241 ~ ~ ~
NEAREST CROSS STREET oo~ FACIL(TY OWNER TYPE 4, LOCAL GENCY/DISTRI CT'
4101 C8110W8 Dr ~ 1. CORPORATION ^ 5. COUNTV AGENCY'
BU51NES5 1. GAS STATION 3. FARM 5. COMMERCIA~ ^ 2. INDIVIDUAL ^ 8. STATE AGENCY'
TYPE ^ 2. OISTRIBUTOR ^ 4. PROCE3SOR ^ 6. OTHER ~ ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY' ao2
TOTAL NUMBER OF TANKS IS fadlfly on Indien IZeservation or 'ff ~~r of UST IS e pub~ic agency, nam9 0{ supen~sw of dhnsion, Settlon or oMCe
REMAINING AT SITE wstiantls7 ~~~ ~~ me U5T (Tnis ie me contact person fa n~e tank recoras.)
2 aos ^ Ves ~ NO 4os °~
1~. ~PROPERTY~OWNfR~INFOR~IilAiT10N~~. , ~
PROPERTY OWNER NAME ~~ PHONE ooe
W ECI - 99 -3LLC 972-361-5000
MAILING OR STREET AOORESS 409
15601 Dallas Parkwa , Suite 40
CITY aio STATE ~~~ Z1F' CODE a~2
Dallas TX 75001
PROP~RTY OwNER TYPE t. CORPORATION 2. INDIVIDUAL 4. LOCAL AGENCY / DISTRICT 6. STATE AGENCY
^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FE~ERAL o~3
.. . , . . . ....
III. ~TANK:,Q~AFIV~;IN~.ORAI~kTkONt ~:.:~..~
TANK OWNER NAME a~a PHONE .~s
7-Eleven Inc. 253-796-7170
MAILING OR STREET ADDRESS oi6
P.O. Box 711 Arin: Gasollne Acct
CITY a~7 STATE ~,e ZIP CO~E atg
Dallas TX 75221-0711
7ANK OWNER TYPE ~. CORPORATION 2. INDIVIDUAL a, IOCAL AGEn1CV / DISTRICT 6_ STATE AGENCY azo
^ 3. PARTNERSHIP ^ 5. COUNTV AGENCY ^ 7. FEDERAL AGENCY
N: BOARD OF EQUAL:IZ1tTlON':t~ET.~$~:ORAGE:~'E~:~IiCCC'UNT NtiAABfR
TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise 42i
V: PETROL• EUM..UST F~NkN,CIAL:;R~SPO;NSIBILITY
INDICATE ^ 1. SELF-INSURED ^ 4. SURETY BOND ^ 7• STATE FUND ^ 10. LOCAL GOVr MECNANISM
METH00(s) ^ 2. GUARANTEE ^ 5. LETTER OF CREOIT ^ 6. STATE FUN~ 8 CFO LETTER ^ 99. OTHER:
~ 3. INSURANCE Q 6. EXEMPTION ~ 9. STATE FUND & CD an
VI: LEGAL N.OTIFICAT~,ON'ANfl~~IVIAILINGADDREBS~
. . . . . . . . . . . .... . .... .. ..
Cneck one bmc to intllcete whkn a0Cres6 should De used for legal rwtlfiCations end melling.
LOg~I nplifiCatipne and madinp6 will pA 6gnl t0 ~1i6 tenk own9r un1eS8 b0Y 1 or 218 d18Clted. ^ 1. FACII~TY ^ 2. PROCERTY OWNER ~ 8. TANK OWIV~R a2~
~~ VII. APPLICANT SI.~NA'~URE.: .
CenincaUon - i cemry u-e I tion hereln Is true and accurate to Ihe besl of my knoMAedge.
SIGNATURE APP ANT DATE q24 PHONE d26
8/16/07 702-270-7160
NAME OF LICANT (print) 028 TITLE OF APPLICANT 4Z~
Randy M rtin Gasotlne & Environmental Compliance Manager
$TATE UST FACILITY NUMBER ~COrro~ use aay) ~~a 1998 UPGRADE CERTIFICATE NUMBER ~wioc~ use o~ry) ~~
UPCF f1l99 revised) FormerlV SWRCB Form A
AUG-16-2007 14~28
P.93i06
UNIfItU YKVC7KAM ~iV1V,VLIUAI CV rVR1Y1
TANKS
UNDERGROUND STORAGE TANKS - TANK PAGE 1
(M~o paBes per tank)
Depe ~ 01 _
TVPE OF ACTION ^ 1 NEW SITE PERMfT ^ 4 AMENDED PERMIT ~ 6 CMANGF OF INFORMATION ^ 6 TEMPORARY SfTE CLOSURE
~cneck o~e aem a+ir1 p 7 PERMANENTLY CLOSED ON S~TE
^ 3 RENEWALPERM~T {Spe~tyreason-forrow~useoNy) (SpeGryreason-~arioaiuseoruy) ^ 9 TANKREMOVED a30
BUSINESS NAME (S~me ee ~ACILffV NAME a OHA _ oo~~p e~,s~neea n6) FACILITY I D: ~
3
7-~I~ven #32241
~ocATiorv wirHiN siTE ro~~ ~'
410t Callowa Dr., Bakersfield, CA
1. TA . DES'CRIPTION :(~1 aoalod~plot p an with Ne locatlon•af the..y5T•ayatam Inc~uding bulldingm~.at~d:landma-ks'~shalt ~~a~rbmftted to the local
... ... .. .; .. ..
. . :. ~ .,. • . • . ... . .. .. .
~ 8 8AC : ' . . :.. •
TANK ~D # 4~ TAPfK MANUFACTURER 43J COMPARTMENTALIZED TAfVK Yes No ayo
4 Containment Solutions n'res'. ~e one pap! lol eBC~ ooRpB~anem•
OATE INSTALIED (YEAR~N~O) 4~a TANK CAPACITY IN GALLOIV3 4~ NUMBER OF COMPARTM~NY3 a57
10/2007 15,000 1
ADDITIONAL DESCRIPTION ~FOr ro~ use oruyl 490
• . ' . ;II. TANK.CONTENTB ~
TANK USE d3° PETROLEUM TYPE <a~
~ t. MOTOR VENICLE FUEL ~ 1e, REGULAR UNLEADED O 2 LFAOED ^ 5. JET FUEL
(Nmar~e0m~elePetroieumType) O ~b. PREMIUM UNLEADED O 3, DIESEL ^ 6. AVIATION FUEL
O 2• fVON-FUEL PETROLEUM ^ 1C, MIDGRADE UNLEIW6D ^ d. GASOHOL ^ 09• OTHEIZ
O 3. CMEMICAL PROpUCT CpMMON NAME (rrom -w~.dous ~er+o~s Hrernory osAe) °d1 CASt~ 1~-a" ~re~ wrete^e~ ~n"mv°'y pape ) ~42
Q a. Ha7ARDOUS WASTE Gesolirle 8006-61-9
(~no~aes ueea au
O 95, UNKNOWN
1I1...TANK'CbN97ftUCTlOIik'.. : ~
. . .. . . . . .... .... . .... ., . . .
'fYPE OF TANK ~. SINGLE WALI. ~ 9. SINGLE WALL WITH 5. SINGLE WALL WITH INTERNAL BLAOOER SMSI'EM 443
(CneGc one item ony) FJCTERIOR MEMBRANE LINER ^ 95. UNKNOWN
~ 2 OOUBLE WALI ^ 4. SIN(3LE WALL IN VAVLT ^ BB. OTHER
TANK MATERIAL - v~mory m~ 1. 6ARE STEEL 3. FIBERGLA55 / PLA371C 5. CONCRETE B5. UWKNOWN ~a
(Ghealc one Item on~» ^ 2, STAIN~ESS STEEL ~ d. STEEI CLAD W/RBERGIASS ~ 8. FRP COINIPATIBIE W! ^ D9• OTMER
REINFORCED PLASTIC (FRP) 100% METMANOI
TANK MATERIAL -eeca~oarytenk t, BARE STEEL 3. F~BERGLASS / PLASTIC O 5. CONCRETE O B5. UNKNOWN ~
(Cneew one item aMyl ^ 2, STAINLESS STEEI O e. STEEI CLAO WlFIBERGLASS ~ B. FRP COMPATIBLE ~ 99. OTMER
REINFORCEO PLASTIC (FRP) WnOM6 METHANOI
^ g. CONCRETE O ~0. COAT'ED STEEL
TANK INTERIOR LINING O ~. Rl18BER LINED ^ 3. EP~XY LINING ^ 6. GLASS LINING ^ 85. UNKNOWN qqg DATE INSTALLED ~~
OR COATING ^ 2 ALKVD LINING ^ 4 PHENOLIC LINING ~ e UNlINEO O~ OTFIER
(Cneck o~e ~~em aNp) ~ (FOr ioral uee onh) ~
o~r-iER COaROS~Ow ^ t MAHUFACTUREO CATMOOIC O 3 PIBERGlA98 REJNFpRCED PLABTIC ^~ UNKNOWN °~ DATE INSTALLED seB
wiorEC7bN ia ~POUCnBLE PROTECTION D 4 IMPRESSEG CURRENT O~ OTHER
(Cneae one nem onyl 0 2 SACRIFICIAL ANO~F (6a ieeei uee adY)
S~ILL AND OVERFILL VEAR INSTALL6D a~ TVPE (ar~i uw oror) a6+ OVERFILL PROTECTION EQUIPMENT;VFJIR IN5TALLED ~~
(Cneer a~i ~ 1 SPILL CONTAINMENT 2007
~nai aodyJ
~ 1 ALARM ~ 9 FILL TUBE SHUT OFF VAWE
~ 2 OROP TUBE ZOO7 ~ Z 9ALL FLOAT ^ 4 EXEMPT
~ 3 STRIKER PLATE ZOO7
~V. T71NK•LEAK OET~CTION (Aae~aro~onarum!nad-otina~armnoma~nnteo,to:meroea:eoancy.l
IF SINGLE WALL TANK ca,ack a~i n,ei ecarl d~ IF DOUBLE WALL TANK OR TANK WfTN BLADOER 4~
rrea~ aie i~rn cnvy)
O 1 V15UAL (EXPOSED PORTION ONLI~ ^ 6 MANUAL 7ANK GAUGING (MTG) 1 VISUAL (SINGLE WALL IN VAULT ONLY)
^ 2 AUTOMATIC TANK GAUGING (ATG) ^ 6 VADOSE ZONE ~ 2 CONTINUOUS INTERSTITIAL MONfTORING
O 3 CONT~NUOUS ATG ^ 7 GROUNOWATER ^ 3 MANUAL MONITORINO
^ 4 STATISTICAL INVENTORY RECONCIUATION Q 8 T/WK TESTING.
+(51R) B~ENNIAL TANK TE$TING ~ g9 OTFiER
•IV.'~ANK. ., OSU . '1NFO~tAA~17'I,ON.! M1-NENT~CL . !. . ~IN;PLACE •
ESTIMATEO DATE LAST USED (VR/MOlDAV) ~6'' ~~IAAA7ED OUAN7ITY OF SU657ANCE d~
REMAINING TANK FlLLEO WffM INERT MATERIAL7 ~~
genone D Yes p No
UPCF (1/99 revised) Formerly SWRC6 Form B
/ CITY OF BAKERSFIELD +r,
Pr • - +
~Rr~ r OFFICE OF ENVIRONMENTAL SERVICES ~
w. ,~ 1715 Chester Ave., Baker.sfield, CA 93301(661) 326-3979 ~
~ UST Ta~k -1
PWe _ of
TYPE OF ACTION ^ 1 NEW SITE PERMIT ^ J RENEWAL PERMIT ^ 3 CHANGE OF ~NFORMATION (S4ts type of chanpe) ^ 7 PERMANENTIY CLOSED ON SITE
Cneck one ilem ony
^ ~ AMENDEO PERMIT ^ 8 TEMPORARY SITE CIOSURE ^ 8 TANK REMOVED d29
BUSINESS NAME (Same a~ FACILITY NAME or DBA • Oolnq Buslness A~) ~ FACILITY 10 N ~ ~
~ ~~
~ LOCATION (Optlonsq
I. TANK DESCRIPTION
iANK 10 a 4J0 TANK AAANUFACTURER 471 COMPARTMENTALIZED TANK ^ Yea ^ No q~y
u/ /~ ~ I ~}~ V ~ If'Yes', eamplete one form for each compaRrtfent.
1 v [3 V l.
OATE INSTALL D(Y R/MO) 1~3 TANK CAPACITY IN GALLONS 1J4 NUMBER OF COMPARTMENTS 435
~~
AOOITIOw.: OESCRIPTION (Fo~ beal use ony) , 438
II. TANK CONTENTS
TANK USE 4~7 I VENIGLE FUEL TYPE 438
(~S 1 MOTOR VEMICIE FUEL ~ ta REGULAR UNLEADED
^ Z ~EA~ED ^ 5 JET FUEL
(1! marked, eomObte VeAkk Fuel Typa) I
^ 1D PREMIUM UNLEADED ~ OIESEL ^ 8 AVIATION FUEL
^ 2 USED Oll ^ te MIDGRAOE UNLEADED
^ 4 GASOHOL ^ 99 OTHER
^ 7 CHE~.::,;. L PROOUCT
^ 4 FWZARDOUS WASTE COMMON NAME (hom Hazardous Materials Inventory paye) +39 CAS B(from Hazardous Materials Inventory paye) 44p ,
^ 95 Uf;n~'1WN _
III. TANK CONSTRUCTION
TYPE OF TANK ^ ~ SINGLE WALL ^ ~ SINGLE WALL WITH ^ 3 INTERNAL BlAODER SYSTEM 4t1
Ct+eck one ir.m only ~ 2 DOUBIE WALI ~wOR MEMBR/WE UNER ^ gg UNKNOVYN
^~ SINGLE WALL IN A VAULT .
~ gg OTHER
TANK MATERWI (prlmary fank) ~~ ppRE STEEL ^ 4 STEEL CLAD W/ fRP ^ 5 CONCRETE ^ 95 UNKNOWN 142
Check one item ony ^ 2 STAINLESS STEEL ^ 3 FIBERGIASS ^ 8 FRP COMPATIBLE W/100% METFINNOL ^ 99 OTHER
TANK MATERtAL (seoondary tank) ^ 1 BARE STEEL 4 STEEL CIAD W! FRP ^ 8 FRP COMPATIBLE W/100% METHANOI ^ 95 UNKNOWN 443
Check one item only ^ Z STAINLESS STEEL ^ J f18ERGLASS ^ 9 FRP NON-COliRO018LE JACKET ^ 99 OTMER
^ 3 CONCRETE ^ 10 COATED STEEI
INTERIOR LININO OR COATINO ~~ RUBBER IINED ^ 3 EPOXY LINING ^ S GLA33 LINING ^ 9S UNKNOWN 4/4 .
Cheek one !tem ony ^ 2 AIKYD LININO ^ 4 PHENOLIC UNINO ~8 UNLINEO ^ 99 OTHER :
OTMER CORROSION ^ ~~UFACTUFiED CP ~J FlBERGLASS REINFORCEO PLASTIC ^ 9S UNKNOWN 4d3
PROTECTION If APPLICABLE
Check one Item ony
^ 2 gACRIFICIAL ANODE ^ 4 IMPRESSED CURRENT ^ 99 OTHER
SPILL ANO OVERFILL SPILL CONTAINMENT INSTALLEO (YEAR) OVERFILL PROTECTION EOUIPMENT INSTALLEO (YEAR) ~
448 447
C~eck all Mat appy OROP TUBE ' 0 Ysa ^ No 148 ^ 1 ALARM
3TRIKER PLATE ^ Yoa ^ No 449 ^ 2 BALI FLOAT
^ ~ FILI TUBE SHUT OFF VALVE
. •.. . :
:, , . ....., , . , . . : .. s.. ..
..... ....: :. .
:
' -::::.. :.. .
. . . ~ : . ...: `;... IV. TANK LEAK DETECTION '''': ~ '
IF SINOlB WALL TANK (Cheek ~U that apOb% IF DOU8l8 WALL TANK (CNack one Item ony): ~3~
^ 1 VISUAL (EXPOSED POR'fION ONIY) ^ 6 MANUAL TANK f3AUGINO (MTO) ^ 8 VISUAL (SINGIE WALL IN VAUIT ONLY) I
^ 2 AUTOMATIC TANK f3AU01N0 (ATO) ^ e VADOSE ZONE ~ 9 CONTINUOUS INTERSTITIAL MONITORING
^ J CONTINUOU9 ATO ^ 7 GROUNOWATER I
^ 4 STA7ISTICAL INVENTORY RECONCILIATION (SIR) ~ ~ 99 OTHER I
BIENNIAL TANK TF9TINO ~
V. TANK CLOSURE INFORMATION 1 PERMANENT CLOSURE IN PLACE
cSTIMA7E0 OATB U1ST U9E0 (YR/MO/OAY) ~Dt E9TIMIITED CUANTRY OF SU89TANCE REMAININO ~62 CiA9 TANK FILLEO WITH INERT MATERU-L7 ISJ ;
aal ^ Ve~ ^ No
Porm B
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
.. 1715 Ch~ste~ Av~., Bak~nfl~ld, CA 93301 (80S) J28-J979
UST • TANK PAOE 2
rps _ p~
SV§TEM ~`IPE'~^ ~ ~ SUCTION
~ A80VEGROUNO PIPINO INFORMAT~ON
`...---' ^ 2 PRES3URE ^ J ORAVITY
IS4 ~ ^ 1 SUCT~ON
UNDERGROUND PIPINO INFORMATION
2 PRESSURE ^ J GRAVITY ug
;ONSTRUCTION ;~~ gINGLE WAIL ^ 93 UNKNOWN I^ 1 SINGIE WALL
I~I.2 OOUBLE WALL ^ 99 OTHER ISO ^ 2 DOUBLE WAII
MATERIAl3 AND' ~ ~ eARE STEEI ^ 8 FRP COMPATIBLE W! 100% METHANOI
CORROSION
PROTECTION ^ 2 STAINLESS STEEL ^ 7 GALVANIZED STEEL
^ 7 PVC COMPATIBLE WITM CONTENTS ^ 93 UNKNOWN
~s FIBERGLASS ^ 8 FLEXIBLE ^ 99 OTHER
~^ S STEEI WI COATING ^ 9 CATHOOIC PROTECTION tSS
^ J UNEO TRENCH U 99 OTHER
^ 93 UNKNOWN
~Se
U 1 BARE STEEI U 6 FRP COMPATIBLE Wf 100% METMANOI
^ 2 STAINLESS 3TEEL ^ 7 GALVANIZED STEEL
^ J PVC COMPATIBLE WITH CONTENTS ^ 95 UNKNOWN
^ s FIBERGUSS ^ B FLEXIBLE ^ 99 OTHER
^ 3 STEEL WJ COATING ^ 9 CATNOOIC PROTECTION ~Sg
ABOVEGROUNO PIPING INFORMATION I UNDERGROUND PIPING INFORMATION
PRESSURI2ED PIPING (Ctfeek aA that applyX
^ 1 EIECTRONIC LINE LEAK OETECTOR J.0 GPH TEST YilJjj{ AUTO PUMP SHUT OFF FOR LEAK
SYSTEM fAll URE. AND SYSTEM OISCONNECTiON ~ AUDIBLE ANO VISUAL ALARMS .
^ 2 MONTHLY 0.2 GPM TEST
^ ] ANNUAL INTEGRITY TEST (0.1 GPM)
^ 4 OAILY VISUAL CHECK
CONVEMIONAL SUCT iON SYSTEMS (Check atl tAat appy):
^ S OAILY VISUAL MONITORING OF PUMPINO SYSTEM
^ 8 TRIENNUIL INTEGRITY TEST (0.1 GPM)
SAfE SUCTION SYS'• ~'~~3:
^ 7 SELF MONITORING
GRAVITY FIOW (Ch~._'~.:.0 that appy}
^ 8 OAILY VISUAL MONITORING
^ 9 BIENNUL INTEGRITY TE3T (O.1 GPH)
SECONDARILY CONTAINED PIPINO
PRESSUR12E0 PIPING ~i.heck aq that eppy):
~ 10 ~NTINUOUS TURBINE SUMP SENSOR VITF AUDIBLE AND VISUAL ALARMS AND (eheck one)
a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
^ D AUTO ~UMP SHUT OfF FOR LEAKS. SYSTEM FAILURE ANO SYSTEM DISCONNECTION
^ e NO AUTO PUMP SHllT OFF
'~ 11 AUTOMATIC LEAK DETECTOR
^ 12 ANNUAL INTEGRfTY TEST (0.1 GPM)
SUCTIOWGRAV~TY SYSTEM:
^ 13 COHTINUOU9 SUMP SENSOR +AUOIBLE AND V~SIUL. ALARMS
EMERGENCY OENERATORB ONLY (Chsck a0 tAat spply)
^ 14 CONTINUOUS SUMP SENSOR WITMOUT AUTO PUMP SHUT OFF ~ AUDIBIE AND
VISUAL ALARM$
^ 1S AUTOMAT~C IINE LEAK OETECTOR (~.0 GPH TESn
^ 18 ANNUAL INTEGRITY TEST (0.1 GPM)
^ 17 OAILY VISUAL CHECK
PRESSURI2ED PIPING (CAeek all that appy}
^ 7 ELECTRONIC LINE LEAIC DETECTOR J.0 GPH TEST ~ AUiO PUMP SHUT OFF
FOR IEAK. SYSTEM fA1LURE. AND SVSTEM DISCONNECTION + AUOIBLE AND
VISWIL ALAR7~AS
^ 2 MONTHLY 0.2 GPH TEST •
^ 3 ANNUAI INTEGRITY TEST (0.1 GPH)
CONVENTIONAL SUCTION SYSTEMS:
^ 4 DA~LY VISUAL MONITORING OF PUMPING SYSTEM ~ TRIENNIAL PIPING INTEGRfTY
TEST (0.1 GPH)
SAFE SUCTION SYSTEMS:
^ 5 SEIF MONROR~NG
GftAVITY FLOW:
^ B BIENNUIL INTEGRITY TEST (0.1 GPFQ
SECONDAF.~~Y CONTAINED PIPING
PRESSURRED PIPING (Check all that apF~ c
^ 7 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL AIARMS AND
(Check one)
^ e AUTO PUMP SHUT OFF WHEN A LE~1K OCCURS
^ b AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM
DISCONNECTION
^ t NO AUTO PUMP SHUT OFF
^ 8 AUTOMATIC LINE LfJ1K DETECTOR (7.0 GPM TEST)
^ 9 ANNUAL INTEGRITY TEST (0.1 GPM)
EMEROENCY GENERATORS ONLY (Cheek ao that appy)
^ 10 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF * AUDIBLE AND
VISUAL AUIRMS
^ 11 AUTOMATIC LINE LEAK OETECTOR (~.0 GPH TEST)
^ 12 ANNUAL INTEGRITY TEST (0.1 GPH)
^ 17 OAILY VISUAL CHECK
.;; , ,... ...
~
I DI T N
DISPENS R ~~ p~pAT MECNANISM TMAT SHUTS OFF SHEAR VALVE ^ 3 CONTINUOUS OISPENSER PAN SENSOR WITH AUTO SHUT OFF fOR OISPENSER ,
C~O{NTAINMENT q~"
Ix Yea ^ No ~-J~ ~~'~TINUOUS ELECTRONIC SENSOR ~ AUDIBIE AND VISUAL ALARMS • AUDIBLE AND VISUAL ALARMS
^ -- ~---~-~ -•~--•-
OWNE P O 31GNATURE
I eenly tnat tAs Info p ed nerein I~ trus 8 auunte W the be~t of my kno~Ned9e•
SIG H OF RlOP OR
~ll~-~-- OATE ~82
- S ^~ ~
ME OF N (P~nt) 4&1 TITLH OWNER/OPERA OR 1~
t
~ V ~! ~+~. / r N
Rorm 8
/
Pr
. r/Rt
ARTM T
- ........~.. .,....:
1. TANK DESCRIPTION
42g
1
TA KIOM s~U ~ANK MANUFAGiURER 471 COMPARTMENTAL12E0 TANK ^ Yos ~ 4~2
U 1 ~1 I ~~~! ... ~ ~~If11/~ N Ai. QIV It'Yes', complete one fortn for eacA compartment.
Q3
Fa, ~~ ~.~ ~~r~
TANK USE 4~7
~MOTOR VEHICLE FUEI
(If arlced, eompbte Vehkle Fuel Type)
^ 2 USED OIL
^ 7 CHE~.::,:. L PROOUCT
^ 4 HAZARDOUS WASTE
^ 93 Ul~n~' 1WN
II. TANK CONTENTS
VENICLE FUEL TYPE
^ ta REGULAR UNLEADED ^ y ~gpDED
^ tb PREMIUM UNLEADED
DIESEL
^ 1e MIDGFtADE UNLEADED
4GASOHOI
COMMON NAME (hom Hazardoue Materiala InvenWry pa9e)
IIi. TANK CONSTRUCTION
438
^ 5 JET FUEL
^ 8 AVIATION FUEL '
^ 99 OTNER
+J9 CAS 8(from Hazardous Materials Imentary page) 440
TYPE OF TANK ^ ~ SINGIE WALL ^ ~ SINGIE WALI WITM ^ 5 INTERNAI. BIADDER SYSTEM 141
Cheek one irom ony DOUBLE yyp~~
~ EXTER~~R MEMBRANE LINER ^ gg UNKNOVYN
^~ SINGLE WALL IN A VAUIT D gg OTHER ~
TANK MATERUIL (pAmary fenk) RE STEEL ^ 1 STEEL CLAD W/ FRP ^ 5 CONCRETE ^ 95 UNKNOWN 4l2
Cneck one item ony 2 STAINLESS STEEL ^ 3 FIBERGLASS ^ B FRP COMPATIBLE W/10096 METHANOL ^ 99 OTHER
TANK MATERWL (eecondary tank) ^ 1 BARE STEEL STEEL CIAD W/ FRP ^ 8 FRP COMPATIBLE Wl10096 METHANOL ^ 95 UNKNOWN 443
Check one item only ^ 2 STAINLESS STEEL 3 FIBERGLASS ^ 9 FRP NON-COftRODIBIE JACKET ^ 99 OTHER
^ S CONCRETE ^ 10 COATED STEEI
INTERIOR LININO OR COATING ~ ~ RUBBER LINEO ^ J EPOXY LINING ^ 5 GLASS IINING ^ BS UNKNOWN 414 .
Check one !tem ony ^ Z ALfCYp UNINO ^ 4 PHENOUC UNINO UNLINED ^ 99 OTHER _.
OTNER CORR0310N
PROTECTION IF APPLICABLB ^ ~~UFACTUFtED CP flBERGLAS3 REINFORCEO PIASTIC ^ 9S UNKNOWN 145
Check one Itsm oMy ^ 2 SACRIFICIAL ANODE ~ IMPRESSED CURRENT ^ 99 OTHER
SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) OVERFILL PROTECTION EQUIPMENT INSTALLED (YEAR) ~
~ae ~~
Cheek alt Mat apply DROP TUBE ' 0 Yea ^ No 448 ^ t ALARM
STRIKER PLATE ^ Yes ^ No 449 ^ 2 BAIL FLOAT
^ 3 FIIL TUBE SHUT OFF VALVE
,. .
_
: ' ~ ..:: ; N. TANK LEAK DETECTION ' "
IF 91NOL8 WALL TANK (Cheek ~II that apply): IF DOUBLB WALL TANK (Cheek one Item only): ~'.~
^ 1 VISUA~ (BXPOSED PORTION ONLY) ^ 6 MANUAL TANK OAUGING (MTO) ^ 8 VISUAL (SINGIE WIU.L IN VAULT ONLY) I
^ 2 AUTOMATIC TANK f3AUOINO (ATG) ^ 0 VADOSE ZONE CONTINUOUS INTERSTITIAL MONITORING '
^~ CONTINUOU9 ATO ^ 7 GROUNDWATER I
^ a STATISTICAL INVENTORY RECONCILIATION (SIR) • ^ 99 OTMER I
BIENNIAL TANK TE9TIN4 '
V. TANK CL03URE INFORMATION / PERMANENT CLOSURE IN PLACE
:371MI17E0 OATB LA9T USEO (YR/MO/OAY) 1St 89TIMATEG QUANTITY OF SUBSTANCE FiEMAININO 432 OA9 TANK FI~~ED WITH INERT MATERUL~ ~s~ :
a~~ ^ Ys~ ^ No
CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES . ~ ,
1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979
UST Tank -1
PWs _ of
Form B
TYPE OF ACTION ^ 1 NEW SITE PERMIT ^ J RENEWAL PERMIT ^~ CHANGE Of INFORMATION (State rype of ehanqe) ^ 7 PERMANENTLY CLOSED ON SITE
Cneck one ~tem ony
^ 4 AMENDED PERMIT ^ 9 TEMPORARY SITE CIOSURE ^ B TANK REMOVED
~ CITY OF BAKERSFIELO
OFFICE OF ENVIRONMENTAL SERVICES
.'~ 1715 Ch~ster Av~., Bak~nA~ld, CA 93J01 (80S) 328-3979
' UOT • TANK PAGE 2 I
raye ~1r
SVSTEM ~1'PE ~ ~ ~ SUCTION `
:ONSTRUCTION ; ~ ~ sINGIE WALL
~ ^ 2 OOUBIE WALL
UNOERGROUND PIPINO INFORMATION
^ t SUCTION ^ 2 PRESSURE ^ J GFiAVITY ~
^ 96 UNKNOWN I^ 1 SINGIE WALL
^ 99 OTHER ~SO ^ 2 OOUBLE WALL
^ J UNED TRENCH O 99 OTHER
^ 9S UNKNOWN
~54
lW1TERIALS AND ~~ ~ gpRE STEEL ^ 9 FRP COMPATIBIE W/ 100% METHANOL
CORROSION
PROTECTION ^ 2 STAINLESS STEEL ^ 7 GALVAN~ZED STEEL
,~^,/~' PVC COMPATiBIE WITH CONTENTS ^ 95 UNKNOWN
' L7ypIBERGIASS ^ B FLEXIBLE ^ 99 OTHER
i lJ S STEEL W/ COAT~NG ^ 9 CATHODIC PROTECTION ~3~
^ 1 BARE STEEL ^ e FRP COMPATIBIE W/ 100% METHANO~
^ 2 STAINLESS STEEI ^ 7 GALVANI2ED STEEL
^ J PVC COMPATIBLE WITM CONTENTS ^ 93 UNKNOWN
^ 4 FIBERGLASS ^ 8 FLEXIBLE ^ 99 OTHER
^ S STEEL W/ COATING ^ 9 CATHODIC PROTECTION a5g
A80VEGROUNO PIPING INFOIiMAT10N I UNDERGROUNO PIPING INFORMATION
PRESSUR12E0 PIPING (Checlc aA that applyk
^ t ELECTRONIC LINE LEAK OETECTOR 3.0 GPM TEST ~ AUTO PUMP SMllr OfF FOR LEAK
SYSTF.AA FAII URE, AND SYSTEM OISCONNECTION ~ AUDIBLE AND VISUAI ALARMS .
^ 2 MONTHLY 0.2 GPH TEST
^ ~ ANNUAL INTEGRITY TEST (0.1 GPH)
^ 4 DAILY VISUAL CHECK
CONVENTIONAL SUCT iON SYSTEMS (Ct»ck aq IMl apply):
^ S DAIIY VISUAL MONITORING OF PUMPINO SYSTEM
^ 8 TRIENNIAL INTEGRITY TEST (0.1 GPN)
SAfE SUCTION SYS'~~.ti~3:
^ 7 SELF MONITORING
GRAVITY FIOW (Ch~.: •.r.U IMt appy~:
^ 8 OAILY VISUAL MONITORING
^ 9 BIENNUIL INTEGRITY TEST (0.1 GPH)
8ECONDARILY CONTAINED PIPING
P ESSURIZED PIPING ~CAeek ap that eppy):
~ 10 CONTINUOUS TURBINE SUMP SENSOR Vy Ihl AUOIBLE AND VISUAL ALARMS ANO (ehedc ons)
AUTO PUMP SHUT OFF WHEN A LEAIC OCCURS
C AUTO ~UMP SHUT OfF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION
^ e NO AUTO PUMP SHUT OfF
^ 11 AIJTOMATIC LEAK OETECTOR
^ 12 ANNUAL INTEGRITY TEST (0.1 GPH)
SUCTIOWGRAVfT1' SYSTEM:
^ 1J COPfTINU0U3 SUMP SENSOR +AUOIBLE ANO VISUAL AL1~A8
EMERGENCY OENEFUTORB ONLY (Chedc a0 Nat ~ppy)
^ 14 CONTINUOUS SUMP SENSOR WITMOUT AUTO PUMP SMUT OfF ~ AUOIBLE ANO
VISUAI ALARM$
^ 15 AUTOMATIC LINE LEAK OETECTOR (~.0 GPH TES~
^ t8 ANNUAL INTEGRITY TEST (0.1 GPH)
^ 7 7 OAIIY VISUAL CMECK
PRESSURI2ED PIPING (CAeck all Nat aDWYk
^ 7 ELECTRONIC LINE LEAK DETECTOR J.0 GPH TEST ~ AUTO PUMP SHUT OFF
FOR IEAK SYSTEM FAILURE. AND SYSTEM OISCONNECTION • AUOIBI.E AND
VISUAL ALARMS
^ 2 MONTHLY 0.2 GPH TEST •
^ 3 ANNUAL INTEGRITY TEST (0.1 GPH)
CONVENTIONAL SUCTION SYSTEMS:
^ d OAILY VISUAL MONITORING OF PUMPING SYSTEM * TRIENNIAL PIPING IMEGRlTY
TEST (0.1 GPH)
SAfE SUCTION SYSTEMS:
^ S SELF MONRORING
GRAVITY FLOW:
^ 8 BIENNIAL INTEGRITY TEST (0.1 GPH)
SECONOAF.~~Y CONTAINED PIPINC
PRESSURIZEO PIPING (Chedc all Ihat ap~.yc
^ 7 CONTINUOUS TURBINE SUMP SENSOR WfTF AUDIBLE AND VISUAL ALARMS ANO
(Check one)
^ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
^ b AllTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM
OISCONNECTION
^ e NO AUTO PUMP SHUT OFF
^ 8 AUTOMATIC LINE LEAK DETECTOR (~.0 GPH TESn
^ 9 ANNUAL INTEGRfTY TEST (0.1 GPH)
EMEROENCY GENERATORS ONLY (Choclc a0 tAat apDb)
^ 10 CONTINUOUS SUMP SENSOR W11110UT AUTO PUMP SHUT OFF ~ AUOIBLE AND
VISUAL ALARMS
^ t t AUTOMAT~C IINE LEAK OETECTOR (3.0 GPH TEST)
^ 12 ANNUAL INTEGRITY TEST (0. t GPH)
^ 13 DAIIY VISWL CFIECK
,.:. , ;.., .. . !
` i l DISP TAIN N
DISPENS R ^ ~ FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ 7 CONTINUOUS DISPENSER PAN SENSOR wm+ AUTO SFIUT OFF FOR OISPENSER ,
O TAINMENT 0,~,~
~ ~CONTINUOUS ELECTRONIC SENSOR +AUOIBLE AND VISUAL ALARMS + AUDIBIE ANO VISUAL ALARMS ~
Yes ^ No
^ 4 OAIIY VISUAL CHECK
1 certlfy tl~at IAs Informatb vlded heisln b We 8 aaunts to tAs be~t of my knoiMeCqe.
SIGNATURE OF OW OPERA ~~~ DAT ^~
ME OF 0 PERAT (prlnq 48J TITLE O OWNE'
- -----~..~ ~ ~ p ~..
erm~t Numbsr ( or Iou1 ue~ oNy) ~ APP~ed
ABOVEGROUNO PIPINQ INFORMATION
Form 9
/ CITY OE BAKERSFIELD
H ~
• A~ ~ r OFFICE OF ENVIRONMENTAL SERVICES .~
~. ,~ 1715 Chester Ave., Bakersfield, CA 93301(661) 326-3979 ~
~ UST Tank -1
PNe _ ol
TYPE OF ACTION ^ 1 NEW SITE PERMIT ^] RENEWAL PERMIT ^ 3 CHANGE OP ~NFORMATION (State rype af chanqe) ^ 7 PERMANENTLY CLOSED ON SITE
Check one item only
^ ~ AMENOED PERMIT ^ 9 TEMPORARY SITE CLOSURE ^ B TANK REMOVEO dy9
BUSINESS NAME (3ame aa FACIIITY NAME or OBA • Oolrq Buaines~ As) ] FACILITY ID N ~
LOCATION (Optloneq
I. TANK DESCRIPTION
TANK 10 a 4~0 TANK MANUFACTURER 4J1 COMPARTMENTALRED TANK ^ Yea Ga'IGo 4J2
^ r' If'Yes', complete o~e tortn for eaeh compartment.
C! V
DATE INSTALLED (Y WMO) IJ3 TANK CAPACITY IN CALLONS 4J4 NUMBER O COMPARTMENTS 435
i ~..IC
AOOITIONI,: DESCRIPTION (For beal we ony) . 438
II. TANK CONTENTS
TANK USE 4J7 I VENICLE FUEL TYPE 4Jg
^ t MOTOR VEMICLE FUEL ^ ta REGUTAR UNLEAOED
^ 2 ~EADEO ^ 5 JET FUEL •
(If maAced, eompbte Vehlele Fuel Type) I
1b PREMIUM UNLEAOED ^ 3 DIESEL ~ 8 Aw-TION FUEL
^ 2 USEO OIL 1e MIDGRADE UNLEADED
^ 4 GASOHOL ^ 99 OTHER
^ ~ CHE1.:::. L PROOUCT
^ 4 HAZARDOUS WASTE COMMON NAAAE (hom Harardous Materials InvenWry pa9e) +J9 CAS ll (from Hazardow Materiats Inventory paye) 440 ,
^ 95 U1;n~'_1WN _
IIi. TANK CONSTRUCTION
TYPE OF TANK ^ ~ SiNGIE WALL ^ 3 SINGLE WALL WITH ^ S IMERNAL BLADDER SYSTEM 44t
C~eck o~e it.m oNy ~Q ppUBLE WAIL ~~OR MEMBRANE UNER ^ 95 UNKNOWN ;
^ 4 SINGLE WALI IN A VAUIT ^~ OTHER
TANK MATERIAL (pimary fank) ~~ gqRE STEEI ^ 4 STEEL CIAD W/ FRP ^ 5 CONCREfE ^ 95 UNKNOWN 402
CAeck one item ony ^ 2 STAINLESS STEEL ^ 3 FIBERGIASS ^ 8 FRP COMPATIBIE W/10096 METFINNOI ^ 99 OTHER
TANK MATERUU. (eetandary tankj ~~ gq~ gTEEI I~4 STEEL CLAD W/ FRP ^ B FRP COMPATIBIE W/1009L METHANOL ^ 95 UNKNOWN ~4J
Check one item ony ^ 2 STAINIESS STEEL ^ 3 FIBERGLASS ^ 9 FRP NON-CORRODIBIE JACKET ^ 99 OTHER
^ S CONCRETE ^ 10 COATED STEEL
INTERIOR LININO OR COATING ~~ RU88ER LINEO ^ 3 EPOXY LINING ^ S G1A33 IINING ^ 9S UNKNOWN 444 .
Check one !tem only ^~ q~yp ~~-~-rp ^ 4 PHENOIIC UNINO ~ UNLINED ^ 99 OTHER
I :
OTHER CORROSION ^ ~~UfACTUREO CP ^ ~ FlBERGLAS3 REINFORCED PIASTIC ^ 93 UNKNOWN 445
PROTECTION IF APPUCABLE
Cheek one Itsm ony ^ Z gACttIFIC1AL ANODE ^~ IMPRESSEO CURREM ^ 99 OTHER
SPILL AND OVERFIIL SPILL CONTAINMENT INSTALLED (YEAR) OVERFILL PROTECTION EQUIPMENT INSTALLEO (YEAR) ~
448 N7
Check all that aOPh OROP TUBE ' 0 Ve~ ^ No 448 ^ 1 ALARM
STR~KER PLATE ^ Yea ^ No 448 ^ 2 BALL FLOAT
^ 3 FILI TUBE SHUT OFF VALVE
- .....,. , .,. - . .. ..
, ~.: ....: :. .
, . .
.: :.. ;
N. TANK LEAK DETECTION ' ':, ~ .
IF 91NOLE WALL TANK (Cheek sll that appy): IF OOUBIE WAU. TANK (Check one item only): ~30
^ 1 VISUAL (EXPOSED PORTION
ONLY) ^ 6 MANUAL TANK OAUGINCi (MTO)
^ 8 VISUAL (SINGLE WALL IN VAULT ONLY) I
^ 2 AUTOMATIC TANK GAUC3INO (ATG) ^ 0 VADOSE ZONE ~.9 CONTINUOUS INTERSTITIAL MONITOR~NG '
^ ] CONTINUOU$ ATO
^ 7 GROUNDWATER 1 I
^ 4 $TATISTICAL IM/~NTOttY RECONCILUITION (SIR) • ^ 89 OTMER I
BIENNIAL TANK TESTINO ~
V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE
cST~MATEO OATH U19T USEO (YR/MO/DAY) ~31 HSTIMATEO OUANTRY OR SUBSTANCE REMAININO 432 CiA3 TANK FILLED WITH INERT MATERWl9 ~s~ ;
aN ^ Ys~ ^ No
Rorm B
CITY OF BAKERSFIELD ~
OFFICE OF ENVIRONMENTAL SERVICES
. , 1715 Ch~stsr Av~., Bak~nfl~ld, CA 93301 (80S) 328-J979
uar • TANK PAO! 2
,,
rape pf
ABOVEGROUNO PIPINQ INFORMATION
S~§TEM f`rPE ^ ^ t SUCTION ~
;ONSTRUCTION ~ ~ ~ gINGLE WALI
DOUBLE WALL
^ 7 OMVITY IS~ I^ 1 SUCTION ^ 2 PRESSURE U] GiiAVITY ~
^ 9'3 UNKNOWN ^ 1 S~NGLE WALL ^ 7 LINEO TRENCH ^ 99 OTMER
^ 99 OTMER ISO ^ 2 OOUBLE WALL ^ 9~ UNKNOWN
454
AAATERIAl3 AND ' Q 1 BARE STEEI ^ 8 FRP COMPATIBIE W! 100% METMANOL I^ 1 BARE STEEL ^ S FRP COMPATIBLE W/ 100% METHANOL
CORROSION
PROTECTION
^~ STAINLES3 STEEL
^ 7 GALVANIZED STEEL
^ 2 STAINLESS STEEL
^ 7 GALVANI2ED STEEL
^] PVC COMPATIBLE WITM CONTENTS ^ 9S UNKNOWN ^ J PVC COMPATIBLE WITH CONTENTS ^ 93 UNKNOWN
t FIBERGUISS ^ 8 FLEXIBLE ^ 99 OTHER ^ 4 FIBERGLASS ^ 8 FLEXIBLE ^ 99 OTHER
~ ~S BTEEI W/ COATING ^ 9 CATHOOIC PROTECTION ISS ^ S STEEL WI COATING ^ 9 CATHOOIC PROTECTION 158
UNOERGROUNO PIPINO INFORMATION
ABOVEGROUND PIPING INFORMATION I UNDERGROUND PIPING INFORMATION
PRESSURIZEO PIPING (Check aU Ihat appyk
^ t ELECTRONIC IINE LEAK DETECTOR 7.0 GPH TE3T ~{ AUTO PUMP SHUT aFF FOR LEAK
SYSTEM FA~I URE, AND SVSTEM OISCONNECTION +AUDIBLE ANO VISUAL AlARM3 .
^ 2 MONTNLY O.Y GPM TE3T
^ ~ ANNUAL INTEGRfTY TEST (0.1 GPM)
^ 4 OAILY VISUAI CHECK
CONVENTIONAL SUCT iON SYSTEMS (ChECIc aG fMt apply):
^ 5 DAILY VISUAL MONITORINO OF PUMPINO SYSTEM
^ 8 TRIENNIAL INTEGRITY TEST (0.1 GPH)
SAfE SUCTION SYS'•'~.ti~3:
^ 7 SELF MON~TORINC3
GRAVITY FIOW (Ch~.: •:,II that appy~
^ 8 OAILY VISWL MONITORING
^ 9 BIENNUIL INTEGRITY TEST (O.1 GPH)
8ECONDARILY CONTAINED PIYINO
PRESSURIZEO P~PING (~:hedc a0 fhat apply):
~ 10 CONTINUOUS TURBINE SUMP SENSOR ~ AUDIBIE AN~ VISUAL ALARMS AND (cheek one)
L~a AUTO PUMP SHUT OfF WHEN A LEAK OCCURS
d b AUTO ~UMP SHUT OfF FOR IEAKS, SYSTEM FAILURE AND SYSTEM OISCONNECTION
^ e NO AUTO PUMP SHUT OFF
^ 11 AUTOMATiC lEA1C DETECTOR
^ 12 ANNUAL INTEGRfTY TEST (0.1 CiPM)
SUCTIOWGRAVITY SYSTEM:
^ 13 CONTINUOU3 SUMP SENSOR ~ AUOIBIE AND VISUAL ALARM8
EMERGENCY OENERATOR9 ONLY (Cfbck a0 tliW apply)
^ 14 CONTINUOUS SUMP SENSOR TWI HOUT AUTO PUMP SHUT OfF ~ AUOIBLE AND
VISUAL AU1fiM3
^ 14 AUTOhNTIC IINE IEAK OETECTOR (J.0 GPH TESn
^ 78 ANNUAL INTEGRITY TEST (0.1 GPH)
^ 17 OAILY VISUAL CHECK
-°--- --- -- - -
PRESSURI2E0 PIPiNG (Cheek all that apply}
^ 7 ELECTRONIC UNE LEAIC DETECTOR J.0 GPH TEST WIT 1 AtlTO PUMP SHUT OFF
FOR LEAK SYSTEM fAILURE. AND SYSTEM DISCONNECTION + AUOIBLE AND
VISUAL ALARMS
^ 2 MOMHLY 0.2 GPH TEST
^ 3 ANNUAL INTEGRITY TEST (0.1 CaPH)
CONVEP(TIONAL SUCTION SYSTEMS:
^ 4 DAILY VISUAL MONITORING OF PUMPING SYSTEM ~ TRIENNIAL PIPING INTEGRITY
TEST (0.1 GPM)
SAFE SUCTION SYSTEMS:
^ 5 SEIF MONRORING
GRAVITY FLOW:
^ 8 81ENNWl.INTEGRITYTEST(0.1 GPFQ
SECONDAF~ Y CONTAINEC PIPING
PRESSURIZED PIPING (Cheek alt that ap~~ c
^ 7 CONTINUOUS TURBINE SUMP SENSOR WITH AUOIBLE ANO VISUAL AUIRMS ANO
(Chaek one)
^ a AlJTO PUMP SHUT OFF WMEN A LEAK OCCURS
^ b AUTO PUMP SHUT OFF FOR IEAKS. SYSTEM FAILURE AND SYSTEM
DISCONNECTION
^ t NO AUTO PUMP SHUT OFF
^ 8 AUTOMATIC LINE LEAK DETECTOR (~.0 GPH TEST)
^ 9 ANNUAL IHTEGRITY TEST (0.1 GPM)
EMER(iENCY l3ENERATORS ONLY (Check aE that apply)
^ 10 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHllT OFF +AUDIBLE AND
VISUAL ALARMS
^ t t AUTOMATIC IINE LEAK DETECTOR (7.0 GPH TEST)
^ 12 ANNUAI INTEGRITY TEST (0.1 GPH)
^ 13 DAILY VISUAL CHECK
,.,. _, ,:..; ...
- ` VI I D P TA N ENT .
OISVENS R ^ t fLOAT MECHANISM TMAT SHllTS OFF SHEAR V/LLVE ^ 7 CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR OISPENSER
CONTAINMENT ~
L~Yes ^ No ~ CONTINUOUS ELECTRONIC SENSOR +AU018LE AND VISUAL ALARMS • AUDIBIE ANO VISUAL ALARMS
r~
W O SIGNATURE
I eertly ttiat tne Info provlded hereln It Ws 8 aewnle W ths beft ol my knowledye.
SIGNATU OP OPERAT
- OATE , 48Z
~_~
ME OF OW RAT ( q
LJ~ ~L"
483 ~
TITLB 0 WNERlOPERATOR ~~
Form 9
/ ~ C[TY OF BAKERSFIELD
~R ~ r OFFICE OF ENVIR0IYMENTAL SERVICES ~
, P• ~ ~
~. ,~ 1715 Chester Ave., Bakersfield, CA 93301(661) 326-3979 ~
~ UST Tank -1
PWe _ of
TYPE OF ACTION ^ 1 NEW StTE PERMIT ^ J RENEWAL PERMIT ^ 3 CHANGE OF INFORMATION (State type of ehanqe) ^ 7 PERMANENTLY CIOSED ON SITE
Check one item ony
^~ AMENOED PERMIT ^ 8 TEMPORARY SITE CLOSURE
a~ FACIUTY NAME ar 08A ~ Doinp Buslnesa A~) ~ FACIIITY 10 M r
^ B TANK REMOVEO
42g
1
LOCATION (Optlonsq
1. TANK DESCRIPTION
TANK1IDa r r 4~0 TANK MANUFACrT_URER 4J1 COMPARTMENTALIZED TANK ^ Yee ' No 4J2
~'1 1 1 ~~n ( ~ ~ A...l ~I ~~ ~ 1rn V" nI P11~ ~Rf It'Yee'. tomplete one form for each compa ent.
9
u~e ony) . 438
II. TANK CONTENTS
TANK USE 4J7 VEHICLE FUEI TYPE 438
~ 1 MOTOR VEHICLE FUEL ^ ta REGULAR UNLEADED ^ 2 LEADED ^ 5 JET FUEL
If marked, compbta Vehkle Fuel Type) ~ ~b PREMIUM UNLEADED ^ 8 AVIATION FUEL '
^ 2 USED OIL ^ 3 DIESEL
~e MIDGRAOE UNIEADED ^ 4 GASOHOI ~~ OTHER
^ ~ CHEI.:~,:. L PROOUCT
^ 4 HAZARDOUS WASTE COMMON NAME (hom Hazardaus Materials Inventory paye) :J9 CAS fl (from Hazardous Materials Inventory paye) 440 ,
^ 95 U~;n~,'.1WN _
III. TANK CONSTRUCTION
TYPE OF TANK ^ ~ SINGIE WALL ^ ~ SINGLE WALL 4YITH ^ 51NTERNAL BLADDER SYSTEM 441
Check one it.m only ~ 0OU8LE yyp~~ ~ERIOR MEMBRANE LINER ~ gs UNKNOWN ;
^ 4 SINGLE WALL IN A VAULT ~ gg OTHER
TANK MATERUIL (pAmary tank) gqRE STEEI ^~ STEEL ClAO W/ fRP ^ 5 CONCRETE ^ 95 UNKNOWN 4e2
Cneck one item ony 2 STAINLESS STEEL ^ J FIBERGLASS ^ 8 FRP COMPATIBIE W/100% METHANOL ^ 99 OTHER
TANK MA7ERIAL (exandary tank) ~ ~~ STEEL 4 STEEL CIAD W/ fRP ^ 8 FRP COMPATIBLE W/1009i METFiANOL ^ 95 UNKNOWN 4e3
Check one item ony ^ 2 STAINLESS STEEL J FIBERGLASS O 9 FRP NW~FCORRODIBLE JACKET ^ 99 OTNER
^ S CONCRETE ^ 10 COATED STEEI
INTER~OR LININO OR COATING ~~ RUBBER LINED ^~ EPOXY LINING 5 GLA3S UNING ^ 9S UNKNOWN,
^ 464 .
Check one !tem only ^ y/LLKyp UtJi-rp ^ 4 PMENOUC IININO ~./~
,
Ol8 UNLINED ^ 99 OTHER
/- :
OTMER CORROSION
PROTEC710N IF APPUCABLE p~.~
^ t MANUFACTURED CP ~:/7 FlBERGLASS REINFORCED PIASTIC ^ 95 UNKNOWN 443
C~eck one It~m ony ^ 2 gACRIFICIAL ANODE u 4 IMPRESSED CURRENT ^ 99 OTHER
SPILL AND OVERFIII SPILL CONTAINMENT INSTALLED (YEAR) OVERFIII PROTECTION EQUIPMENT INSTALLED (YEAR) ~
~ae ~.~
Check all Nat appy DROP TUBE ' ~ Yea ^ No 448 ^ 1 ALARM
3TRIKER PIATE ^ Yea ^ No 149 ~2 BALL fLOAT
^ ~ FILL TUBE SHUT OFF VAIVE
~ - ....., , . ~. . , ..
~.. .:...; ~......:: .
, ~:.
~ :' ...:': IV. TANK LEAK DETECTION ' `_
IR 91NOLE WALL TANK (Check all that appN): IF OOUBLE WALL TANK (Check ona Itam only): ~3G
^ t VISUAL (EXPOSED PORTION
ONLY) ^ 6 MANUAL TANK OAUGINO (MTO)
^ 8 VISUAL (SINGLE WALI IN VAULT ONLY) I
^ 2 AUTOMATIC TANK (3AU(iINO (ATO) ^ 9 VADOSE 20NE ~ CONTINUOU3 INTERSTITIAL MONITORING '
^ J CONTINUOUSATO ^ 7 GROUNDWATER I
^ a STATISTICAL INVENTOFtY RECONCILIA7IaN (SIR) • ^ 99 OTHER I
BIENNIAL 7ANK TE9TING '
V. TANK CL03URE INFORMATION 1 PERMANENT CLOSURE IN PLACE
:STIMATED OA78 LA9T USEO (YFtIMOIDAY) 181 ESTIMATED OUANTITY OF SUBSTANCE REMAININO 434 OA9 TANK FILLED WITH INERT MATEFWL9 ~s~ :
a~l ^ Ysi ^ No
Form B
~ CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
.'"~ 1715 Ch~ster Av~., Bak~nfldd, CA 93301 (803) J28-3979
UST • TANK PApF =
V
~'~Oe _ OI
A80VEGROUND PIPINO INFORMATION
SV§TEM fVPE ~~~ SUCTION ~PFES3URE ^ 7 ORAVITY
;ONSTRUCT~ON ; ~ ~ g~NGLE WALL ^ 9S UNKNOWN
~~.2 DOUBLE WAII ^ 99 OTMER
UNOERGROUND PIPINO INFORMATION
~S/ ^ t SUCT~ON - ^ 2 PRESSURE U J GFtAVITY ~~y -
^ t SINGLE WALL ^ J LINEO TRENCH O 99 OTMER
ISO ^ 2 OOUBIE WALL ^ 93 UNKNOWN
~54
AAATERIA~S AND ' ~~~qRE STEEL ^ 9 FRP COMPATIBIE W/ 100% METHANOI I^ 1 BARE STEEL ^ 6 FRP COMPATIBLE W/ 100% METHANOI
CORROSION
PROTECTION
^~ STAINLESS STEEL
^ 7(~ALVANIZED STEEL
^ 2 STAINLESS STEEL
^ 7 GALVANI2ED STEEI
^] PVC COMPATIBLE WITH COP(TEPITS ^ 93 UNKNOWN ^ J PVC COMPATIBLE WITH CONTENTS ^ 93 UNKNOWN
~FIBERGLASS ^ 9 FLEXIBLE ^ 99 OTHER ^ 4 FIBERGUSS ^ 8 FLEXIBLE ^ 99 OTHER
~ U S STEEI W/ COATING ^ 9 CATNODIC PROTECTION !35 ^ S STEEL W/ COATING ^ 9 CATMOOIC PROTECTION 458
ABOVEGROUND PIPING INFORMATION ' UNDERGROUND PIPING INFORMATION
PRESSUR12ED PIPING (Cheek all that appyg ~^ .~
^ 1 ELECTRONIC LINE LEAK DETECTOR ~.0 GPM TEST~AUTO PUMP SHUT OFF FOR LEAK
SYSTEM FAII URE, ANO SYSTEM DISCONNECTION ~ AU018LE AND VISUAL ALARMS .
^ 2 MONTHLY 0.2 GPM TEST
^ ~ ANNUAL INTEGRITY TEST (0.1 GPH)
^ 4 OAILY VISUAL CHECK
CONVENTIONAL SUCTiON SYSTEAA3 (Cheek aG fhat apply):
^ S DAILY VISUAL MONITORING OF PUMPINO SYSTEM
^ 8 TRIENNUIL INTEGRITY TEST (0.1 GPH)
SAFE SUCTION SYS'•'~.ti~3:
^ 7 SELF MONITORING
GRAVITY FLOW (Ch~.: •..11 thal appy~
^ B OAILY VISUAL MONITORING
^ 9 BIENNUIL INTEGRITY TEST (O.1 GPH)
SECONDARILY COHTAINED PIPING
P SSURIZEO PIPING (Chetk all Net eppy):
~10 ~~~CO,///N'''TiNUOUS TURBINE SUMP SENSOR ~MTF{ AUDIBIE ANO VISUAL ALARMS AND (theek one)
C7.a AUTO PUMP SHUT OFF NRiEN A LEAK OCCURS
LJ b AUTO ~UMP SHUT OFF FOR IEAKS. SYSTEM FAILURE AND SYSTEM OISCONNECTION
^ e NO AUTO PUMP SNUT OFF
^ 11 AUTOMAT~C LEAK DETECTOR
^ 12 ANNUAL INTEGR(TY TEST (0.1 GPM)
SUCTIOWGRAVITI~ SYSTEM:
^ 1J CONTINUOU3 SUMP SENSOR ~ AUDIBLE /WD VlSUAL ALARMS
EMERGENCY OENERATOR9 ONLY (Chsdc a0 that appy)
^ 14 CONTINVOUS SUMP SENSOR wnTMOUr AUTO PUMP SHUT OfF ~ AUDIBLE AND
VISUAL ALARMS
^ 15 AUTOMATIC LINE LEAK OETECTOR (J.0 GPH TESn
^ 18 ANNUAL INTEGRITV TEST (0.1 GPH)
f~l ~~ oai~v wSUAI CHECK
.......__ ..~__ • .. ..-- ---
PRESSURIZED PIPING (Cheek all tMat appry~
^ 1 ELECTRONIC IINE LEAK DETECTOR 3.0 GPH TEST ~ AUTO PUMP SHUT OFF
FOR LEAK SYSTEM FAILURE, ANO SYSTEM DISCONNECTION ~ AUOIBLE AND
VISUAL AIARMS
^ 2 MONTHLY 0.2 GPM TEST • .
^ 3 ANNUAL ~NTEGRIIY TEST (0.1 GPH) ~
CONVENTIONAL SUCTION SYSTEMS:
^ 4 DAILY VISUAL MONITORING OF PUMPING SYSTEM * TR~ENNIAL PIPING INTEGRITY
TEST (O.i GPH)
SAFE SUCTION SYSTEMS:
^ 5 SELF MONRORING
GRAVITY FIOW:
^ 8 BIENNUIL INTEGRITY TEST (0.1 GPH)
SECONDAF.~~Y CONTAINED PIPING
PRESSURIZEO PIPING (Check alt fhat ap~~ ~:
^ 7 COKTINUOUS TURBINE SUMP SENSOR WIT AUDIBLE AND VISUAL ALARMS AND
(Check one)
^ a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS
^ b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAtLURE ANO SYSTEM
OISCONNECTION
^ C NO AUTO PUMP SHUT OfF
^ 8 AUTOMATIC LINE LEAIC DETECTOR (~.0 GPH TES~
^ 9 ANNUAL INTEGRITY TEST (0.1 GPH)
EMERGENCY OENERATORS ONLY (Chack a0 that eppy)
^ 10 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF * AUDIBLE ANO
VISUAL ALARMS
^ 11 AUTOMATIC IINE LEAK OETECTOR (3.0 GPH TEST)
^ 12 ANNUALINTEGRITYTEST(O.iGPH)
^ 1J DAILY VISUAL CHECK
.: . , . . ~. ~:.: .. . . .. . ;
- ` VI I DI P NMEN
DISPENS R ^~ FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ^ ~ CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFf FOR OISPENSER ,
C. O~ITAINMENT
rtr ~NTINUOUS ELECTRONIC SENSOR ~ AUDIBIE ANO VISUAL AIAHMS + AUOIBLE AND VISUAI AU1RM3
~_~~Yea ^ PW
^ 4 DAIIY VISUAL CMECK
i ~.wIM ~~~t Mw~ aovlded haraln Is ws 8~ceurate to the bett W my knowleaqe. _ _J
SIGNATURE Of NEFlO R/~jOR , OATE ~~~
~ ~~ ~ ~
-
w "°~
AME OF R/ T ( Mt) 4&1 TITIE9~ OWNER/OPERATOR 4~
~ c~, I'~ / (~-G ~-D wN ,P
ermR NumDer ( or loul ues only) errMt App-oved PermH plrsUon ~ts
Rorm B