HomeMy WebLinkAbout989 RESULTS 1/27/2009~~ -- ~~, ~y-
S W RCB, January 2002
.~ ~~~
Page ~ of ~
Secondary Containment Testing Report Form
Thir fnrm 1s inrendad jor use by controctors perjorming pariodic testing of UST secondary canrainment .rysrems. Use rhe
appropriare pages of /his form to repo~t results for all components tested The completed form, wrilten test procedures, and
prin~ou~s from ~ests ~f applicableJ, should be provided to the facility owner/operator jor submrtlal to ~he locn! regulalory agenc~~.
FA!'TT.TTV ThTFnRMATI(IN
Facilit Name: C( E / Date of Testing: -,~p
Facility Address: 3 I ~RN C~A1"iC-~~S~~-p ~ CA •
Facility Contaci: Phone~
Date Loca! Agency Was Notified of Testing : I• a• C~
Name of Local Agency Inspector ('fpresent during testiny~:
'f T7iCTT7V(: ("`f1NTRdfTllR TNFC]RMATi(lN
CompanyName:RICH ENVIRONMENTAL ~
Technician Conducting Test:
Credentials: ~ CSLB Licensed Contractor 0 SWRCB Licensed Tank Testcr
License Typc. C611D90 License Number: 809850
ManufacWrer Menufacturer Trainine
Com onen s Date Trainin Ex ires
INCON INCON TS-STS ~-APfL-~O~D
3. ~ITMMARV nF TF.fiT RF.Ci11.TC
Component Pass Fail Not
Tested Repairs
Made Component Pass Fail Not
Tested Repairs
Made
~" R- 0 D ,~ ^ ~ D ~ ~
g I U ^ .~ Q ;/I ^ ^ ~ L~
Nnr Q ^ .~ t7 ( s ^ 0 O
S RL ~ ^ ^ 0 ~~ ~( ^ ^ ~ G
8"~Z S R a ^ o ~, n ~
lf E D o ^ 9/ c~ ~ o Q ~
!Z S~ o ^ U ^ o o ^
~c r~ o ^ o ~-~ ^ o r~
~' o ^ o ~ a r~ a
Sr- ,~ ^ ^ ^ ^ r~~ ^ ^
S '~ o o r~ ^ o o ~;
- D O D ^ ^ ^ ~
u tiydrostatic zesting was perfprmed, describe what was done with the water after completion of tests:
RECYCLE AND REUSRD
CER7'[FICATI~N OF TECFINTCIAN RESpp1YSI8LE .T~'OR CONDUCTINC TH[S'i'ESTINC
To t/re besl afmy know/edge, Ure fac~s srated in (h!s documen! qre accurale and ireJu!! complionce wi1/i /ega/ requlrements
~
Technician's Signatur ~ Date: ~~ - ,~qN - Q ~f
~~ ~~ \`~ S~
5 WRCI3, January 2002
4. TANK AIVN[JLAR TESTING
Page Z of ~.
Tcst Mechod Developcd By: O Tank Manu}$crurcr }~ lodustry Standard 0 Profcssional Enginecr
Q Othcr (Spec~j
Test Method Used: 0 Pressure ~ Vacuum 0 Hydrostatic
0 Otlier (Specify)
Tcst Equipment Used: 9 in . DIAL GAUGE
. ..~~, ~. ~
~ `~+J ~`~ {`,,":"`" ~'~` ~`~ Tank # Tank ~!
,. Equipment Resolution: . 590
. . . ' . . ~:;~;Y;.
~~. .
Tank ~ Tank #~
[s Tank Exempt From Testing?~ 0 Xes 0 T1o U Yes ^ No 0 Ycs 0 No 0 Yes _ C_ No
'fank Capacity: __.
Tank Matcrial: ~
Tank MnnufecNrer:
Product Storcd:
Wait Cime between app[ying
pressure/vacuum/watet and
startin~ tesC
O'7-
~
~~
~
~1'est Stait "fime:
Initial Reading (R~):
Tesc End Time: ~ ~ ~
Finai Readiog (R~:):
Test Duretion: ~
Change in Reading (RF-R.,):
Pflss/Fail Thresitold or Criteria:
Test Resalt: 0 Pass p FaU 0 Pass ^ Fail ^ Pass O Fail 0 Pass ~ Fail
Was sensor removed Cor testing? O Yes D No 0 NA ^ Yes ~ No ^ NA 0 Yes ^ No ONA U Yes Q No f~ NA
W+~s sensor properly replaced and
verified functiona( after testin ? 0 Yes 0 No D NA ^ Yes ^ No O NA ^ Yes ^ No Q NA 0 Yes 0 No ~I NA
-
COI[f q1CI1tS -(rnclude i»fvrmalion on repairs made prior 10 lestin_¢, and recommended
cestsl
' Secondary containment systems where the continuous monitoring automatically monitors botli the primary and sccondary
containment~ s~ch es systems that are nydroscaticaJly monitored or under constant vacuum, are exempt from periodic containmenc
tcsting. {California Code of Regulations, Title 23, Section 2b3~(a)(6)}
SWRCB, January 2002
c c~CllNiieRV PTPF TFCT'INC:
~~~1~ ~~
Page ~ of U
Test Method Developed By: 0 Piping Manufacturer ~fcl [ndustry Standard 0 Professional Engineer
CJ Other (Spec~)
Test Method Used: ~ Pressure 0 Vacuum 0 Hydrostaric
0 Ocher (Specjfy)
Test Equipmem Used: q i n. DIAL GAUGE Equipment Resolution: . 5~
~~x1 - Pipine Ran # ~ Piping Run f# 3 Z, Piping Run # // Pipfng Run k 9/Z
Piping Material: TfC ~ C ~ ~
Piping Manufacturer: T ~ C I ~- ~
Piping Diameter: 2 Z 2 N
Length of Piping Run: r rJ
Product Stored: ~ E ~q / l
Method and location of
i in -run isolation;
f
Wait time between applying
pressurelvacuum/water and
starcin tes[:
~
Test Slurt Time: ~
lnitial Reading (K~):
'i'est End Time: f} /
Finel Reading (RF): ~j ~j S SI
Test Duration: f ~ ~
Change in Reading (R~Ri): '~ ~
Pass/Fail Threshold or
Criteria: O 0 1
Test Re.vutt: Pe O Fail ,~ Pas9 0 Fafl ~ Pas ^ Fail ,2~ Pass U Fail
COmments -(inc(ude informolion on repairs made prior lo leslin,q and recoMmended follow-up for jaifed tesrsJ
333 ~~ ~~
SWRC8,lanuary 2002
5. SECONDARY PIPE TESTING
Page ~ of ~
7es~ Method Developed By: ^ Piping Manufacturer ic7 todustry Standard 0 Professional Engineer
O Other (Spec~)
Test Method Used: ~ Pressurc 0 Vacuum ^ Hydrostaric
C] Other (Specjfy)
Test E;quipment Used: 9 i n. DIAL GAUGE Equipment Resolution: . 5~
~'~' Piping Ruu #~ Piping Run # Piping Run # Plping Ran #
Piping Material: + ~j C
Piping Manufacturer: ~
Piping Diameter: Z
Length of Piping Run:
Product Stored: j~~~ 5 FL
Method and location of
i in -rurt isolation:
~ `}' !
Wait time between applying
pressure/vacuum/water and
staltin SCSt:
~
Test Start Time:
lnitial Reading (R~): '~"j
Test End T'ime:
Final Readiqg (Rr):
Test Duratipn; ,~
Change in Reading (RF-R~): " `
Pass/Faif Thmshold or
Criteria: ~! -
Test Re3ult: ~4.Pass Q Fail ^ Pass ^ Fail 0 Pass ^ Fail 0 Pass 0 Fail
COmmerlt3 -(include injormotion on repairs made pr/or fo fesling and recommended foJlow-up forl'ailed testsJ
:~~a~~ ~
S W RCB,lanuary 2002
6_ PT'Pi~TC3 Ci)MP TESTING
Aage ~ of U
Test Method Developed By: ^ Sump Manufacturer ~ lndustry STandard ^ Professional fingineer
^ Other (Spec~)
Test Mechod Used: ^ Pressure 0 Vacuurn Yl Hydrostatic
I7 Other (Speci )
Tes~ Byuipment Used: INCON TS-STS Equipment Resolution: , o0o in .
Sump ti ~ Sump f Sump f# (_ Sump #
Sump Diametcr: ~ //J /N
Sump Depth: ~-
Swnp Material; F s' ~ ~ I~
Neight from Tank Top to Top oF
Hi est Pi in Penetration: l~ !~ J~/
Height &om Tank Top to Lowest
Eleccrical Penetradon: ~ r ~ ~
Condition of surnp prior to tcsting: /~/ ~'~.F ~'
Aortion of Sump Tested~ ! r b
Does turbine shut down when
sump sensor deuca liquid (both
oduct and water ?~
~ Yes ~No 0 t~2A
D Yes ~No ^ NA
O Yes 1~1 No 0 NA
~ Yes ^ No ~ NA
Turbine shutdown response time ~/ N f~ N~j,~
Is system pro~rammed for faii-safe
shutdown?~ ~ Yes 0 No ~ NA 0 Yes 0 No ~4 NA 0 Ycs Q No ~NA 0 Yes Q No ^ NA
W as fail-safe verified to be
o erational?~ p Yes D No ~ NA 0 Yes 0 No ~NA ~ Yes 0 No l~NA C1 Yes Q No 0 NA
Wait time between applying
pressurelvzcuum/wacer and starting
test:
2,.,
,.X.)F'1f
~ l'~~/J
~ /''//
z~~5~ sc~n T~~: ro~ A I S2 AM ~oi i, ~- i3 93i
Initial Reading(Ri): 5.0 5oZq ~ . y ~{.3'f3
Test End Time; ~OZ !IO I H ZB
Final Reading (Rf): 50 ~r! 'S 0 S In/ S. N 5.900 i `~•3y3~ .~~} ~N
Test Duration: I~j 15 / I N 15
Change in Readin$ (RF-Ri): O ! • 001 r I i
Pass/Fail Threshold or Criteria: , p~ Z i ~ , poZ, u,/
Test Result: pd Pass ^ Fail Pass 0 Fafl L~7 Pass 0 Fail ^ Pass ^ Fail
Was sensor removed for testing? Yes 0 No NA }a Yes ^ No ^ NA ~ Yes ^ No 0 NA D Yes 0 No 0 NA
Was sensor properly replaced and
verified functional after testin ? ~ Y~ Q No 0 NA ~9-Yes 0 No 0 TJA 1~Yes 0 No 0 NA Q Yes 0 No ~ NA
COlmme~[3 -(include information on repurrs mode prror to ~es~r~, and reeommended jollow-up for failed tes~s)
~ It the entire dept6 of the sump is not tested, spec;fy how much was tested. If the answer to ~ of the questions indicated with an
ascerisk (•) is "NO" or "NA", the entire sump must be tested, (See SWRCB LG-160)
:~ ~ ~ ~~~ 50
S W RCB, January 2002
7 i1NilF'R_nISPF.IVCRi2 ('(1N1'A-NMENT (UDC) TESTIIVG
Page tpof ~
Test Mechod Developed By v ` Q Ui~C Manufacturer ~ lndusuy 5tandard 0 Professional Engineer
O Oiher (Spec~J
Test Mcthod Used: ^ Pressure 0 Vacuum ~ Hydrostatic
O Ocher (Spectfy)
Test Equipment Used: INCON TS-STS Equipment Resolution; . oooi n.
UDC # - UDC €! ,3- UDC !! UDC #
UDC Manufacturer:
UDC Material:
UDC De th:
Height from UDC Bottom to Top
of Hi hest Pi in Penetration:
Height from UDC Bottom to
Lowest Electrical Penetration:
Condition of UDC prior to
testin :
C /~
Portion of l1DC Tested
Does turbine shut down when
UDC sensor detects liquid (both
roduct and water ?~
^ Yes ~(No 0 TdA
0 Yes ~J No ^ NA
0 Yes Q No Q NA
^ Yes C3 No ~ NA
Turbine shutdown res nse time
fssystemprogrammedforfail-
safe shutdown7 pyes O1Jo ~NA QYes ONo~NA OYes ONo ^NA OYes ONo ONA
Was fail-safe verified to be
o erational?' 0 Yes 0 No ~.4NA 0 Yes 0 No ~ NA 0 Yes p No ^ NA 0 Yes 0 No 0 NA
Wait time betwecn applying
pressure/vecuumlwater and
startin test
~ r-'1 ~/~J
~0 Mr1~1
Test Stert Time: 21 /22~ f M
Initial Readin R~ :
Test End Time: ! /
Final Readin RF): I•b lN
Test Duration: ! 5 I
Chati e in Readin (RF-R~): ~ ~ p,
Pass/Fail Threshold or Criteria: z~
Test Result: ~' Pass Cl Faii Pass 0 Feil 0 Pass 0 Fail ^ Pass U Eail
W as sensor removed for testing7 Yes D No ~ NA Yes ~ No ^ NA 0 Yes 0 No 0 NA 0 Yes 0 No U NA
W as sensor properly replaced and
verified functional after testin ? ~ yes ~ No ~ NA ~Yes G No Q NA O Yes ^ No O NA U Yes O No fJ NA
Cotnments -(incfude informa[ion on re~airs made prior ~0 lesting, and recommendedju!!ow-up jor fuiled ~esre)
' 1 f the entire depth of the UDC is not tested, specify how much was tested. If the answer to a~ of the questiorts indicated wich an
asterisk (;) i~ "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160)
.~--~3~~
SWRCB, lanuary 2002
R. ~rt.i. ur~FR rorrranvMENT SUMP TESTING
~
Page ~ of $
Facili 'ts Not E ui d With Fill Riser Containment Sum s Q
Fill Riser Containment Sumps are Present, but were Not Tested ^
Test Method Developed By: 0 Sump Manufacturer ~ Industry Standard 0 Professional Engineer
D Other (Spec~)
Test Method Used: 0 Pressare O Vacuum ~ Hydrostatic
0 Other ($pec~)
Test Equipment Used: INCON TS-STS Equipment Resolution: . 000 i n.
Filt Sum it Fill Sum # Fiil Sum # Fill Sum #~
Sum Diameter:
Sum De th:
Height from Tank Top to Top of
Hi ~est Pi in Penetration:
___
Height from Tank 1'op to Lowest
Electrical Penetration:
Condition of sump prior to
testin ;
Ponion of Sum Tested
Sum Material:
Wait time bctwcen applying
pressure/vacuum/water and
startin tes~ t:
J
~
Test Siart Time:
Initial Readin R~):
Test End Time:
Final Readin (RF :
Test Duration:
Chan e in Readin R R):
?ass/Fail Threshold or Criteria:
Test Result: ^ Pass 0 Fail 0 Pass 0 Fail ^ Pass 0 Fail p Pass Q Fail
Is there a sensor in ihe sump? ^ Yes ^ No p Yes 0 No ^ Yes ^ No ^ Yes 0 No
Does the sensor alarm when
either product or water is
detected?
O Yes Q No ^ NA
Q Yes ^ No ^ NA
0 Yes ^ No ~ NA
0 Yes ^ No ~ NA
Was sensor removed for testing? ^ Yes 0 No 0 NA 0 Yes ^ No 0 NA ^ Yes ^ No ^ NA ^ Yes ^ No 0 NA ~
Was sensor properly replaced and
verified functional after testin 7 ~ yes 0 TJo 0 NA ^ Yes ~ No 0 NA ^ Yes D No ^ NA ^ Yes D No i~ NA
Comments -(include in, formation on repoirs made prior to les~rnl~, ond recommended
.~~a-~~ s~'
SWRCB, January 2002
9 SPILIJOVERk'ILL CONTA]TYMENT BOXES
Page ~ of _~
Facili is Not E ui ed With S ilUOve~ll Containment Boxes 0
SpilllOver611 Containment Boxes are Present, but were Not Tested 0
Test Method Developed By: ^ SpiU Bucket Manufacturer ~ Irtdustry 5tandard ^ Professional Engineer
^ Other (Spec~J _
Test Method Used: 0 Pressure 0 Vacuum ~ Hydrusta~ic
0 Other (Spec~j
Test Equipment Used; INCON TS-STS Equiprnent Resolution: • ooOln .
~
~- Spill Box ~
~ Spill Box #
Spill Boz t~
Spill Box ~
Bucket Diameler: /2 /J ~Z
Bucket Depih: //J
Wait time between applying
pressure/vacuum/water and
sturtin tesr.
~ /
Tcst Stan Time: ( A P-( QI 1 A
lnitial Reading (R~): ~, ~ ~,
Test End Time: Z M
Fina! Reading (Rt•): 5_ . (
TestDuration: ( I 'SMfI.I
Changc in Reading (R~Rt): ! - O !
Pass/Fail Threshold or
Criteria;
2
I•J
.
Z l
Test Result: ~ Pass ~ Faii ~ Pass 0 Fail 0 Pass 0 Fail ~ Pass p Fail
Comments -(;nc~ude t„formatfon on repairs made prior !o lesling, and recommended fo!!ow-up for failed tes~s)
DSLSTF
TEST STRRTED 9:13 AM
TEST STRRTED 27i01i2609
BEuIN LEUEL 4.3434 IN
ENU TIME 9:28 RM
END ~ATE 27i81i2009
END LEUEL 4.3~131 IN
~~RK THRESHOLD 0.002 IN
TEST RESU~T PASSEG
91UPR
TEfiT STARTED 9:13 A!9
TES7 S7RRTE0 27i01i2009
BEGIN LEUEL 6.01£~6 IN
END TIME 9~28 AM
END DRTE 27i01~2089
END LEUEL 6.0190 IN
LERK THRESHOLD 0.002 IN
TEST RESULT PRSSED
~7UPR
TEST STARTED 9:13 AM
TEST STRRTED 27i01r2009
BEGIN LEVEL 5.1001 IN
END TIME 9~28 HM
EHU ~ATE 27i01~2009
END LEUEL 5.8997 IN
LERK THRESHOLD 0.002 IN
TEST RESULT PflSSED
`
87STP ~~•
----_. . _... . . . ..__. . ._
,
:~~ ~~9
TEST ~TRRTED 19:11 AM
7EST STARTED '27i01i2009 .
BEr_,zN LEVEL 5.6192 IN
END TIP1E 10:27 AM
ENP DATE 27i01~2009
END LEVE~ 5.0193 IN COL~EGE HEIGHTS
LEAK THRE~,HOLD 9.002 TN 3711 MT VEkNON
7EST RESULT PASSED I~RKERSFIELD
27ig1i2099 1:36 Pr~
~1ST P
SUMP ~EAK TEST REPORT
TEST STRRTED 10~11 RP1
TEST S7ARTED 27~91i2069 1_Z
BEGIN LEVEL 5.9003 IN
END TIME 10~27 pM TEST STRRTED 1:21 PM
END DRTE 27i01i2e09 TEST S7ARTEG 27i61i2605
END LEUEL 5.9001 IN BEGIN t_EVEL 1.6A94 IN
LERK THRESHOLD 0.602 IN ENL~ TIME 1:36 PM
7ES7 RESULT PASSED EN~ UHTE z~~az~?eey
ENU LEUEL 1.6HL8 IN
LEAK THRE~HOLU 8.002 IN
_-.-..,~.,-. -nG~uLl' INI:K~,._._ ...._~ TEST RESULT PRSSED
91STP
TES7 S7ARTED 10:34 AM
TEST S7AR7ED 27~01i2009
BEGIN LEUEL 5.8999 IN
END TIME 19:50 flt9
END DRTE 27i01~2805 COLLtGE HEIGHTS
END LEUEL 5.9009 IN 3711 MT UERNON
LEAK 7NRESHOLD 0.002 IN BRKERSFIELU
7EST RESULT PRSSED
27i01/26@9 1:54 PM
. . __ - ~ _ _. ...._.. _...._
_ _ .--- ~
- . =,UMP ~EHY: TES T REPORT
GSLSTP ~ __
_ ._ . _
i ~'=' P 1-2
TES7 STRRTED 9:31 RM
TEST STRRTED 27i81i2009 TE~T STRRTED 10:52 AM iEST STARTED 1:39 Pt1
• BEGIN LEUEL 4.3430 IN 7EST STARTED "L7i01i26E9 TEST STflRTED 27i~1i2d09
END TIME 9:46 R~i BEGIN LEVEL 5.0295 ~N BEGIN LEVE
L 1.6085 IN
END DRTE 27~01~2095 END TIME li~e~? Ar1 .
END TIME 1:54 Pr1
END LEUE~ 4.3441 IN END DRTE 27i01i2869 ENC~ pRTE 27i01i2609
LEfiK THRESHOLD 0.092 IN END LEUEL 5.8287 IN END LEUEL 1.60?7 IN
TEST RESULT PASSED LERK THRESHOLD 0.A02 IN LEAK THRESHOLD 9.002 IN
TEST RESULT PRSSED 7EST RESULT PASSED
._ _. ._.... _._ - - - ~ -~ -
91UPR
TEST S7RRTED 9:31 AM
TEST STARTED 27~01i2069
BEGIN LEVEL 6.0184 IN
END TIME 9:46 RM
END DRTE 27i01i200~3
END LEUEL 6.0190 IN
LERK THRESHOLD 0.002 IN
TEST RESULT PASSED
87UPR
TEST STAR7ED 9:31 flM
TEST STRRTED 27i61~2009
$EGIN LEUEL 5.1003 IN
END TIt1E 9=46 RM
END DRTE 27i01i2009
END LEUEL 5.0994 IN
LEAK THRESHOLD 0.002 IN
TEST RESULT PRSSED
/
3-4
TE5T STARTED 12~27 PM
TEST STARTED 27~01~~~9
BEGTN LEVEL 312842 PM
END TIME 27~B1i2g09
END DATE 3.6877 IN
ENO LEUEL
LERK THRESNOLD 9.P~~~
TEST RESULT
3-4
TEST STARTEU 1:04 PM
TEBT STARTED 27i01i2089
BEGIN LEVEL 3,6822 IN
END TIME 1~19 PM
END DAT£ 27i61i2869
END LEVE~ 3.6821 IN
LEAK THRESHQLD 6.002 IN
TEST RESULr PASSED
5a
. ----- - ._. _ . .. _._ ..-- - -
. .~~:~-~~ ~o
SB989 TESTING FAILURE REPORT
$ITE NAME : ( P~ 1 ~t~ 1~ticlS~~ DATE : L~ ~ JHN "~ 1
~DxESS:,~ 11 _~ Y~'(~I~1f1N ~U~ ~cxNSCi~: ~jQ~}NG10N Mf~-SON
C I TY : l J~.L~-~-~ ~~_ S I GNATORE :~ ~- ~ -~ ~
$ZTE CONTACT:
THE FOLLOWING CCIMPONENTS WERE REPLAC&D/REPAIRED TO CQMPLETE T$E SH989
TESTING.
LIST OF PARTS REPLACED/REPAIRED:
REPAIRS: /~_
.~.
LABOR : J~J~~
PART9 INSTALLED: N/~
~~ li.Y;51~~E~ ~tEi~:IF~a~f~
~}net•: ~I~YiN~U9- Sy`G~ ~~n0':~'aN~`'~7
f)p+e: 1/~'3/4t9 ~1 kec.ip.
i~a~~ln~
~~~~~t~~i~~tio~ ~Us~iiSla~~iJS~E~:~I~t1.5 ~
H4 F t7. S.~F j. u~~? ~ 19r.. Q~G~
fender riFtaii ~L.~~ 4~9~.~~
C.t; CF~~~1t 5192. ~~
IOta~ 1~~i1~zY~°_d ~~`~c.~~L~
Tota] payae'~i
; ~31~a Tir~e: 1ia20:33
fr ar.~ d~CZ: ~'.
H~L~'i-''i t~i~~1 YEF.R
~~ i
4/4/2~08 11:14:54 AM PAGE 3/003 Fax Server
, ~OB
BAICEitSFIELD ~YRE DEPARTN9ENT
~
' PER9~II`U' STAYEMEIVT
~ILLING Si~ a
prevention Services
~ ~
D FoR,~ `~ 1501 Truxtun Avenue, i~ FLR
r
a
PERMTT # -~~
` -~' ~,O ~ ~
• Bakersfleid, CA 93301
661-852-2171
Phone: 661+326-3979 o Fax:
.. ~ .
~OCATIONOFPRQ]EGT,
~~ ~ ~ S PitOPERTYOWNER '~
COMP ON DATE
STARlING OATE ' ' ~~ ' ~ 7, '
NAMB ~ ~.
ONE I
,~^`
PRO]ECTNANE n_y ~('~j_ C1 1 GLYI~~.T~ ~
~ ~~~~ ~
~ ~ ADDR PN
~j ~ , ~
DE
~
PRO7ECiAbDRESS~ ,I ~/~~ '~ n^ Y`.
\ 11 ~{ I V ~ IIP CO
Y~I~K~~i~.S~IFiLD STnT2 C~ /3 O~
• • •'
CpNfqACfOR NAME G UCEIISE ?'
~ r G .~ •' ' •
'TY~PErOF LICEN58t` L ~CPIRATIO OATE ' PFIONE 1„y[/~~ ~ QL .~/}+~
l~lQ.~ V ~ ~ r~ ~ ~i /~ ~'/ V U ,
~
CONiRACT'~R OOMPANY NAM2 ,' S
,~,
~ PAX A
_ _ ur
C~. • lj~~`
ADDRESS
' c-~ ~ Yl. ~ S G-~- _ ~~ ZiP GOD@
-•
~
~
.
All permits must b~ reviewed, s~amped, ~rad ~pproved P~tEO~t YO ~~~I~~~~~ W~~~.
.. y ' ; ~
O Alartn - New & ModiflCation (mintmum charge) $280 .
Over 10,000 sq ft $0 .028 x sq ft
O
O Sprinkler - New & Modificatian (minimum charge) $280
p Over 10,000 sq R $0 .028 x sq R
^ Minor Sprlnkler Modification (<30 heads) 84
$96 (Inspection only)
^ Commercial Hood (New & Madiflcatton) $470
O Additlonai hood ~58
O Spray Booth (New & Modiflcatlon) $470 9$ _
_.._ .. _ 8Z
p boveground Storage Tank (1 Inspectton per installation) AST $180/bnk 82 !
^ Addltional Tank ATt ~96/tank I
82
p Aboveground StorageTank (Removal/Inspectfon) ATR $109/tank aZ
^ Underground Stcragfl Tank (Installatfon/inspection) NI $878/bnk 82
0 Underground Storage Tank (Modification) MOD $878/site
82
^ Underyround Storege 7ank (Mlnor ModificaNanj MTM $167/site 84
^ Undarground Sto~age Tank (Removal) $573/tank .
84
~ Mandated Leak Detectlon (test)/Fuel M
;96/hr br each type of test/per stte ev
NOTE ~96/hr (2 hrs minimum)=$192
~ ~zy. ~ . ~ ~ ,s~.
~-t•° I
:
cheduled at the same tlme • ::.. :.: .:. :.: -:,e;, `° ~
82
~ 011 weil (Installation, Inspection, or re-Inspe on) ~96/hr
'
O 7ent
# #96/tent ~
O APoer-hours fnspectlon fee ' $121/hr (2 hrs minimum)=$242
$96/hr +(5 hrs min standby fee/insp)=$576 84
p Pyrotechnic (i permlt per event, pius an inspection fee of
#96/flr durinq business hours)
OTE: After hours P rotechnft event Ins ection is @ ~
121Jhr 5 hrs min standb fee lns = 605 '
O R~Inspedlon/Follow-up Inspectlon _ 84
$96/hr
p Portable LPG (Propane): # of Cages? ^ 96 hr 84
$~ 84
O Explosive Storage $266
84
p Copyiny & File Research (FlIe Research fee $50/hr) $0.25/page
84
^ Mlsce{laneous „
~ City nf 8a4eryfieid
' ~~# CUSTGP~cR ftC~,.~.iPT ~~~{
~ Dper: TUCNrOS5EN : Ty~e: R~~1 ~raa~et.: t '
~~ Dat~: 1i~$/0~ ~: Aecerpt nn:. 7l478
' Des~rip~ian QU3P.~lty AflO~ltTt
~}q FR SAFEiY 3~SF'EGTIQ~19~. ~9Q
'~ i. ~di
T~ 39~h
Yender detai? ~
CfS i HtCi', 24~,~ S 19~. ~~ ,
~atal ter~dered ~i~`'~~ •
'I Toi;al payme~t ~~g"~~
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COB 4/4/2~08 11:14:54 AM PAGE 3/003 Fax Server
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~ItLING ~~ pER~+~IY'~ STA7'EME11lT d B~~EitSFIELY~ FY6tE DEPARTNYENT
Prevention Services
PERMIT #~-~'-r ~p ~ o~ ~ i~r ' r 1501 Truxtun Avenue, ist FLR
,~,~}~ Bakersfield, CA 93301
~`~~''r Phone: b61+326-3979 o Fax: 661-852-2171
.
IOCATION OF PRQIECT ~ • ~ .
PROPERTY OWNER ~~/ ~~ )~~ I
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~ ~/ `
STARTING DATE _ OMPLETION D'~ .
~ NAME ,;/
~ ~
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PRQIECTADDRESS '
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COMRACTOItNAM``~ ~S F~.~ In Vn ~ S~., V
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CONTRACrOR aOMPANY NAME ~ ~
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AD~RESS' `~\ S ~, CRY~
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All permi~s mu~ be reviewed, s~atv~peaf, ~nd ~pproved P~t%Ofl8 YO ~~~YR1RlIW~S W~R~L.
~ . .
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$280
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0 arge)
Alartn - New & ModiFltation (minimum c .
f ft
028 x s
$0
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Over 10,000 sq .
q
h
i
i
m $280
O mu
arge)
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Sprinkler - New 8c Modification (m
ft
028
s
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~ Over 10,000 sq ft x
q
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$
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ection onl
$96 (Ins 84
^ Minor Sprlnkler Modification (<10 heads) y
p
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d
a $470
O on)
iflc
t
Commercial Hood (New & Mo
58
O Additlonal hood $
$470
^ Sprdy Booth (New 8t Modiflcatlon) 98
O boveground SWrage 7ank (1 Inspection per installation) AST $180/bnk $Z
^ Addltional Tank ATi $96/tank $Z
~ Aboveground Sborage Tank (Removal/Inspection) ATR $109/tank 82
~ Underground Starage Tank (Installatton/Inspection) NI $878/tank 82
^ Underground Storage Tank (Modlflqtion) MOD $878/site _ 8Z
C] Underground Storage 7ank (Minor Modification MTM $167/site - 82
~ Underground Storage Tank (Rem }-~"`~~-~---...w ~ $573/tank 84
Mandated Leak Detecdon (te /FUei Mont 5 89
NOTE: $96/hr for each type o ~er sRe even ~C..
cheduled at the same Ume 'R $96/hr (2 hrs minimum)=$192
~.~ ~,S-~
~•Z 84
o
~ OII well (Installation, InSpettion, or re-Inspectlon) X $g6/hr ~ 82
O Tent # $96/tent ~
O After-hours Inspectlon fee ' $121/hr (2 hrs minimum)=$242
O Pyrotechnic (1 permlt per event, plus an inspection fee of
;96/(~r during business hours) PY
OTE: After hours P rotechnic event Ins ection is @$121/hr $96/hr +(5 hrs min standby fee/insp)=$576
5 hrs min standb fee In5 = 605 84
^ R~inspection/Follow-up Inspect(on $96/hr 84
D Portable LPG (Propane): # of Cages? _ $96/hr 84
0 Explosfve Storage $266 ~
O Copyin9 8c F(le Research (Flfe Research fee $50/hr) $0.25/page ~
O Miscellaneous 84