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Home My WebLink About2011 RESULTS SWRCB, January 2002 1 1111111 VIII III IIII 11 IE Page_1_of_11_ Secondary Containment Testing Report Form This form is intendedfor 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 (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: ARCO#01960 1 Date of Testing: 111112011 Facility Address: 1701 BRUNDAGE LANE. BAKERSFIELD, CA 93304 Facility Contact: RICH GOSSETT I Phone: (714) 670-3958 Date Local Agency Was Notified of Testing: 1212812010 Name of Local Agency Inspector(if present during testing): PRESENT 2. TESTING CONTRACTOR INFORMATION Company Name: TANK-TEK ENVIRONMENTAL CORP. Technician Conducting Test: RICHARD THOMAS Credentials: ®CSLB Licensed Contractor ® SWRCB Licensed Tank Tester License Type: A (CSLB Lic.) License Number: 803705(CSLB Lic.) — 06-1672(SWRCB Lic.) Manufacturer Training Manufacturer Com orients Date Training Expires /CC CA UST SERVICE TECHNICIAN#5254736-UT JAN 22, 2011 SCWRCB TANK TESTER LICENSE#06-1672 JUN 30, 2012 FRANKLIN FUELING INCON SUMP TESTER#957353761 MAR 2, 2011 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Repairs Component Pass Fail Not Repairs Tested Made Tested Made 87(1)TANK ANNULAR ® ❑ ❑ ❑ 87 (2) FILL BUCKET ® ❑ ❑ ❑ 87S(1)SECONDARY PRODUCT Z ❑ ❑ ❑ 87(2)VAPOR BUCKET ® ❑ ❑ ❑ 87 (1) PRODUCT SECONDARY ® ❑ ❑ ❑ 87(3)TANK ANNULAR ® ❑ ❑ ❑ 87(1)STP SUMP ® ❑ ❑ ❑ 87(3) PRODUCT SECONDARY ® ❑ ❑ ❑ 87(1) FILL SUMP ® ❑ ❑ ❑ 87(3)STP SUMP ® ❑ ❑ ❑ 87(1) FILL BUCKET ® ❑ ❑ ❑ 87(3) FILL SUMP ® ❑ ❑ ❑ 87 (1)VAPOR BUCKET ® ❑ ❑ ❑ 87(3) FILL BUCKET ® ❑ ❑ ❑ 87(2)TANK ANNULAR ® ❑ ❑ ❑ 87(3)VAPOR BUCKET ® ❑ ❑ ❑ 87S(2)SECONDARY PRODUCT ® ❑ ❑ ❑ 91 (4)TANK ANNULAR ® ❑ ❑ ❑ 87(2) PRODUCT SECONDARY ® ❑ ❑ ❑ 91 (4) PRODUCT SECONDARY ® ❑ ❑ 87(2)STP SUMP ® ❑ ❑ ❑ 91 (4)STP SUMP z ❑ ❑ ❑ 87 (2)FILL SUMP ® ❑ ❑ ❑ 91 (4) FILL SUMP ® ❑ ❑ ❑ If hydrostatic testing was performed,describe what was done with the water after completion of tests: TECHNICIAN CARRIES A 535 GALLON TANK FOR TESTING WATER CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge,the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: I`'— "`I' Date: 111112011 IIIIIIIIIIIIIIIIIIII 12 IE SWRCB,January 2002 Page_2_of_11_ 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 (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: ARCO#01960 1 Date of Testing: 111112011 Facility Address: 1701 BRUNDAGE LANE. BAKERSFIELD, CA 93304 Facility Contact: RICH GOSSETT Phone: (714) 670-3958 Date Local Agency Was Notified of Testing: 1212812010 Name of Local Agency Inspector(if present during testing): PRESENT 2. TESTING CONTRACTOR INFORMATION Company Name: TANK-TEK ENVIRONMENTAL CORP. Technician Conducting Test: RICHARD THOMAS Credentials: ® CSLB Licensed Contractor ® SWRCB Licensed.Tank Tester License Type: A (CSLB Lic) License Number: 803705(CSLB Lic.) — 06-1672(SWRCB Lic.) Manufacturer Training Manufacturer Component(s) Date Training Expires /CC. CA UST SERVICE TECHNICIAN#5254736-UT JAN 22, 2011 SCWRCB TANK TESTER LICENSE#06-1672 JUN 30, 2012 FRANKLIN FUELING INCON SUMP TESTER#957353761 MAR 2, 2011 3. SUMMARY OF TEST RESULTS Not Repairs Not Repairs Component Pass Fail Tested Made Component Pass Fail Tested Made 91 (4) FILL BUCKET ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ 91 (4)VAPOR BUCKET ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ UDC#1-2 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ UDC#3-4 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ UDC#5-6 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ UDC#7-8 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ UDC#9-10 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ UDC#11 -12 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ If hydrostatic testing was performed,describe what was done with the water after completion of tests: TECHNICIAN CARRIES A 535 GALLON TANK FOR TESTING WATER CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: �` ""� v v""�J Date: 1/11/2011 SWRCB,January 2002 Page`3_of_11_ 4. TANK ANNULAR TESTING Test Method Developed By: ❑Tank Manufacturer ® Industry Standard ❑Professional Engineer ❑ Other(Spec) Test Method Used: ❑Pressure ®Vacuum ❑ Hydrostatic ❑Other(Spec) Test Equipment Used: 0—30"VACUUM GAUGES Equipment Resolution: +/_0.002" Tank#87 (1) Tank#87(2) Tank#87 (3) Tank#91 (4) Is Tank Exempt From Testing?' ❑ Yes ®No ❑ Yes ®No ❑ Yes ®No ❑ Yes ®No Tank Capacity: 10000 10000 10000 10000 Tank Material: FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS Tank Manufacturer: XERXES XERXES XERXES XERXES Product Stored: 87 87 87 91 Wait time between applying pressure/vacuum/water and 10 MIN 10 MIN 10 MIN 10 MIN starting test: Test Start Time: 9:00 AM 9:00 AM 9:00 AM 9:00 AM Initial Reading(Ri): -10" 40" .10" 40" Test End Time: 10:00 AM 10:00 AM 10:00 AM 10:00 AM Final Reading(RF): -10" -10" .10" -10" Test Duration: 1 HR 1 HR 1 HR 1 HR Change in Reading(RF-R,): 0" 0" 0" 0" Pass/Fail Threshold or Criteria: NO LOSS NO LOSS NO LOSS NO LOSS Test Result: ®,Pass E ®Pass: *❑Fa '> Sass ❑,Fail Pass. ❑Fair Was sensor removed for testing? ®Yes [:]No ❑NA Oyes [:]No ❑NA ®Yes ❑No ❑NA ®Yes []No ❑NA Was sensor properly replaced and verified functional after testing? ®Yes [:]No ❑NA ®Yes ❑No []NA ®Yes ❑No ❑NA ®Yes [:]No ❑NA Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) ' Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment,such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment testing. {California Code of Regulations, Title 23, Section 2637(a)(6)} S WRCB,January 2002 Page_4_of—11— 5. SECONDARY PIPE TESTING Test Method Developed By: ❑ Piping Manufacturer ®Industry Standard ❑ Professional Engineer ❑ Other(Specify) Test Method Used: ®Pressure ❑Vacuum ❑ Hydrostatic ❑ Other(Spec) Test Equipment Used: 0—15 PSI GAUGES Equipment Resolution: +I-0.002" Piping Run#87 (1) Piping Run#87 (2) Piping Run#87(3) Piping Run#91 (4) Piping Material: FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS Piping Manufacturer: A.O.SMITH A.O.SMITH A.O. SMITH A.O.SMITH Piping Diameter: 2"/3" 2"/3" 2'13" 2'13" Length of Piping Run: 145' 145' 145' 145' Product Stored: 87 87 87 87 Method and location of TEST BOOT/STP TEST BOOT I STP TEST BOOT/STP TEST BOOT I STP piping-run isolation: Wait time between applying pressure/vacuum/water and 10 MIN 10 MIN 10 MIN 10 MIN starting test: Test Start Time: 11:00 AM 11:00 AM 11:00 AM 11:00 AM Initial Reading(R,): 5.0 PSI 5.0 PSI 5.0 PSI 5.0 PSI Test End Time: 12:00 PM 12:00 PM 12:00 PM 12:00 PM Final Reading(RF): 5.0 PSI 5.0 PSI 5.0 PSI 5.0 PSI Test Duration: 1 HR 1 HR 1 HR 1 HR Change in Reading(RF-R,): 0 PSI 0 PSI 0 PSI 0 PSI Pass/Fail Threshold or NO LOSS NO LOSS NO LOSS NO LOSS Criteria: Test;Result: :Pass ❑Fail IZrPass ❑;Fail, ass. [ _Fail Pass [ -Fail Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) MADE REPAIRS ON 91 PRODUCT SECONDARY LINE INSIDE STP SUMP INSTALLED NEW BLUE LINE 3.5X2.4A DUE TO DAMAGED TEST BOOT r SWRCB,January 2002 Page_5_of_11_ 5. SECONDARY PIPE TESTING Test Method Developed By: ❑Piping Manufacturer ® Industry Standard ❑ Professional Engineer ❑Other(Spec) Test Method Used: ® Pressure ❑Vacuum ❑ Hydrostatic ❑ Other(Spec) Test Equipment Used: 0—15 PSI GAUGES Equipment Resolution: +I-0.002" Piping Run#87S(1) Piping Run#87S(2) Piping Run# Piping Run# Piping Material: FIBERGLASS FIBERGLASS Piping Manufacturer: A.O.SMITH A.O.SMITH Piping Diameter: 2"13" 2"13" Length of Piping Run: 15' 15' Product Stored: 87 87 Method and location of TEST BOOT/STP TEST BOOT I STP piping-run isolation: Wait time between applying pressure/vacuum/water and 10 MIN 10 MIN starting test: Test Start Time: 11:00 AM 11:00 AM Initial Reading(R): 5.0 PSI 5.0 PSI Test End Time: 12:00 PM 12:00 PM Final Reading(RF): 5.0 PSI 5.0 PSI Test Duration: 1 HR 1 HR Change in Reading(RF-R,): 0 PSI 0 PSI Pass/Fail Threshold or NO LOSS NO LOSS NO LOSS NO LOSS Criteria: Test:Result:: Pass ❑Fail ®1Pass ❑Fail , ❑Pass ❑Eail ❑Pass ❑;Fail- Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRCB,January 2002 Page-6—of_11_ 6. PIPING SL7W TESTING Test Method Developed By: ❑ Sump Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other(Spec) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other(Spec) Test Equipment Used: INCON SUMP TESTER Equipment Resolution: +/-0.002" Sump#87(1) Sump#87(2) Sump#87(3) Sump#91 (4) Sump Diameter: 48" 48" 48" 48" Sump Depth: 69" 69" 69" 69" Sump Material: FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS Height from Tank Top to Top of 22„ 28" 30" 25" Highest Piping Penetration: Height from Tank Top to Lowest 20" 22" 20" 22" Electrical Penetration: Condition of sump prior to testing: DRY DRY DRY DRY Portion of Sump Tested' ABOVE ABOVE ABOVE ABOVE PENETRATION PENETRATION PENETRATION PENETRATION Does turbine shut down when sump sensor detects liquid(both ®Yes ❑No ❑NA ®Yes [:]No ❑NA ®Yes [:]No ❑NA ®Yes ❑No ❑NA product and water)?* Turbine shutdown response time 3 SEC 3 SEC 3 SEC 3 SEC Is system programmed for fail-safe ®yes ❑No ❑NA ®Yes ❑No ❑NA ®Yes []No ❑NA ®Yes []No ❑NA shutdown?* Was fail-safe verified to be [Dyes ❑No ❑NA ®Yes ❑No ❑NA ®Yes ❑No []NA ®Yes ❑No ❑NA operational?* Wait time between applying pressure/vacuum/water and starting 10 MIN 10 MIN 10 MIN 10 MIN test: Test Start Time: 12:31 PM 1:37 PM 2:45 PM 2:45 PM Initial Reading(RO: 5.5355" 5.2076" 5.2604" 3.1326" Test End Time: 12:46 PM 1:53 PM 3:00 PM 3:00 PM Final Reading(RF): 5.5359" 5.2074" 5.2603" 3.1315" Test Duration: 15 MIN 15 MIN 15 MIN 15 MIN Change in Reading(RF-RI): 0.0004" -0.0002" -0.0001" -0.0011" Pass/Fail Threshold or Criteria: +/.0.002" +l-0.002" +l-0.002" +/_0.002" Test_Result �Pai, 4 '❑Fatl: �Pass ❑iFati- �`Eass ❑Fail S'Pass ❑Fail Was sensor removed for testing? ®Yes ❑No ❑NA ®Yes ❑No ❑NA ®Yes ❑No ❑NA ®Yes ❑No ❑NA Was sensor properly replaced and verified functional after testing? ®yes ❑No ❑NA ®Yes ❑No ❑NA ®Yes ❑No ❑NA ®Yes ❑No ❑NA Comments—(include information on repairs made prior to testing, and recommended follow-up for jailed tests) ABOVE IS THE LAST OF TWO BACK TO BACK 15 MINUTE TESTS If the entire depth of the sump is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk(*)is"NO"or"NA",the entire sump must be tested. (See SWRCB LG-160) SWRCB,January 2002 Page_7_of_11_ 7. UNDER-DISPENSER CONTAINMENT (UDQ TESTING Test Method Developed By: ❑ UDC Manufacturer N Industry Standard ❑ Professional Engineer ❑ Other(Spec) Test Method Used: ❑ Pressure ❑ Vacuum N Hydrostatic ❑ Other(Spec) Test Equipment Used: INCON SUMP TESTER Equipment Resolution: +/-0.002" UDC#1 -2 UDC#3 -4 UDC#5-6 UDC#7-8 UDC Manufacturer: TOTAL TOTAL TOTAL TOTAL CONTAINMENT CONTAINMENT CONTAINMENT CONTAINMENT UDC Material: FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS UDC Depth: 28" 28" 28" 28" Height from UDC Bottom to Top 6" 6" 6" 6" of Highest Piping Penetration: Height from UDC Bottom to 2,50" 2.50" 2.50" 2.50" Lowest Electrical Penetration: Condition of UDC prior to DRY DRY DRY DRY testing: Portion of UDC Tested ABOVE ABOVE ABOVE ABOVE PENETRATION PENETRATION PENETRATION PENETRATION Does turbine shut down when UDC sensor detects liquid(both ®Yes []No []NA ®Yes ❑No ❑NA NYes ❑No ❑NA ®Yes []No []NA product and water)?* Turbine shutdown response time 3 SEC 3 SEC 3SEC 3 SEC Is system programmed for fail- ®Yes [:]No ❑NA ®Yes safe shutdown?' ❑No ❑NA N Yes [:]No ❑NA N Yes []No []NA Was fail-safe verified to be N Yes ❑No ❑NA N Yes ❑No ❑NA NYes [:]No ❑NA ®Yes ❑No ❑NA operational?* Wait time between applying pressure/vacuum/water and 10 MIN 10 MIN 10 MIN 10 MIN startin test Test Start Time: 9:01 AM 9:01 AM 9:01 AM 9:01 AM Initial Reading(RI): 1.8503" 5.7004" 2.6429" 3.3826" Test End Time: 9:17 AM 9:17 AM 9:17 AM 9:17 AM Final Reading(RF): 1.8497' 5.7001" 2.6427' 3.3825" Test Duration: 15 MIN 15 MIN 15 MIN 15 MIN Change in Reading(RF-Ri): _ -0.0006" -0.0003" -0.0002" -0.0003" Pass/Fail Threshold or Criteria: +!-0.002" +!-0.002" +l-0.002" +/.0.002" Test;Result:. ®,Kass ❑?Fail 01- EYEarl ;" .M�Pass ;❑Vail—:,: 'Ml,,ass. ❑`Fail Was sensor removed for testing? ZYes []No ❑NA N Yes ❑No ❑NA N Yes ❑No ❑NA N Yes ❑No ❑NA Was sensor properly replaced and verified functional after testing? ®yes []No [:1 NA M Yes []No ❑NA N Yes ❑No ❑NA N Yes []No '❑NA Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) ABOVE IS THE LAST OF TWO BACK TO BACK 15 MINUTE TESTS If the entire depth of the UDC is not tested,specify how much was tested. If the answer to M of the questions indicated with an asterisk(*)is"NO"or"NA",the entire UDC must be tested. (See SWRCB LG-160) SWRCB,January 2002 Page_8_of—11— 7. UNDER-DISPENSER CONTAINMENT UDC TESTING Test Method Developed By ❑UDC Manufacturer ®Industry Standard ❑ Professional Engineer ❑Other(Specify) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other(Specify) Test Equipment Used: INCON SUMP TESTER Equipment Resolution: +/-0.002" UDC#9-10 UDC#11 -12 UDC# UDC# UDC Manufacturer: TOTAL TOTAL CONTAINMENT CONTAINMENT UDC Material: FIBERGLASS FIBERGLASS UDC Depth: 28" 28" Height from UDC Bottom to Top 6„ 6" of Highest Piping Penetration: Height from UDC Bottom to 2,50" 2.50" Lowest Electrical Penetration: Condition of UDC prior to DRY DRY testing: Portion of UDC Tested ABOVE ABOVE PENETRATION PENETRATION Does turbine shut down when UDC sensor detects liquid(both ®Yes ❑No ❑NA ®Yes [--]No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA product and water)?* Turbine shutdown response time 3 SEC 3 SEC Is system programmed for fail- safe shutdown?* ®Yes ❑No ❑NA ®Yes ❑No ❑NA [:]Yes ❑No ❑NA [:]Yes ❑No ❑NA Was fail-safe verified to be ®yes ❑No ❑NA ®Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA operational?* Wait time between applying pressure/vacuum/water and 10 MIN 10 MIN starting test Test Start Time: 11:24 AM 11:24 AM Initial Reading(Ri): 4.9307' 1.5682" Test End Time: 11:39 AM 11:39 AM Final Reading(RF): 4.9306" 1.5668" Test Duration: 15 MIN 15 MIN Change in Reading(RF-RI): -0.0001" -0.0014" Pass/Fail Threshold or Criteria: +/-0.002" +/.0.002" +1-0.002" +/.0.002" Test'Result: wPass . ❑Fail: �rPass Fail` t £Pass ❑Fail' ❑£Pass ❑-Fait _ -._ . Was sensor removed for testing? ®Yes [:]No ❑NA ®Yes [:]No ❑NA ❑Yes [:]No ❑NA [:]Yes ❑No ❑NA Was sensor properly replaced and verified functional after testin ? ®Yes ❑No ❑NA ®1'es ❑No ❑NA ❑Yes ❑No DNA ❑Yes ❑No ❑NA Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) ABOVE IS THE LAST OF TWO BACK TO BACK 15 MINUTE TESTS If the entire depth of the UDC is not tested, specify how much was tested. If the answer to my of the questions indicated with an asterisk(')is"NO"or"NA",the entire UDC must be tested. (See SWRCB LG-160) SWRCB,January 2002 Page_9_of_11_ 8. FILL RISER CONTAINMENT SUMP TESTING Facility is Not Equipped With Fill Riser Containment Sumps ❑ Fill Riser Containment Sumps are Present, but were Not Tested ❑ Test Method Developed By: ❑ Sump Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other(Specify) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other(Specify) Test Equipment Used: INCON SUMP TESTER Equipment Resolution: +/-0.002" Fill Su7187 (l) Fill Sump#87 (2) Fill Sump#87 (3) Fill Sump#91 (4) Sum Diameter: 48" 48" 48" 48"Sum De the 69" 69" 69" 69" Height from Tank Top to Top of N/A N/A NIA N/A Highest Piping Penetration: Height from Tank Top to Lowest 21„ 21" 22" 21" Electrical Penetration: Condition of sump prior to DRY DRY DRY DRY testing: Portion of Sump Tested ABOVE ABOVE ABOVE ABOVE PENETRATION PENETRATION PENETRATION PENETRATION Sump Material: FIBERGLASS FIBERGLASS FIBERGLASS FIBERGLASS Wait time between applying pressure/vacuum/water and 10 MIN 10 MIN 10 MIN 10 MIN starting test: Test Start Time: 12:31 PM 12:31 PM 12:31 PM 1:37 PM Initial Reading(RI): 2.8561" 2.1933" 4.4994" 4.5127" Test End Time: 12:46 PM 12:46 PM 12:46 PM 1:53 PM Final Reading(RF): 2.8561" 2.1948" 4.4992" 4.5128" Test Duration: 15 MIN 15 MIN 15 MIN 15 MIN Change in Reading(RF-Rj): 0.000" 0.0015" -0.0002" 0.0001" Pass/Fail Threshold or Criteria: +1-0.002" +1-0.002" +l-0.002" +1-0.00211 YTest Result,. ;Pass ,.❑Fair ;Pass.. ❑Fail j ;' °Pass ❑ Fail: z Pass ❑;_Fail;. Is there a sensor in the sump? ® Yes ❑No ® Yes ❑ No ® Yes ❑ No ® Yes ❑ No Does the sensor alarm when either product or water is ®Yes [-]No ❑NA ®Yes ❑No ❑NA ®Yes ❑No ❑NA ®Yes [:]No ❑NA detected? Was sensor removed for testing? ®Yes ❑No ❑NA ®Yes []No ❑NA ®Yes ❑No ❑NA ®Yes ❑No ❑NA Was sensor properly replaced and � ®Yes ❑No ❑NA ®Yes ❑No ❑NA ®Yes ❑No ❑NA ®Yes : No ❑NA verified functional after testing. Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) ABOVE IS THE LAST OF TWO BACK TO BACK 15 MINUTE TESTS SWRCB,January 2002 Page_10_of_11_ 9. SPILL/OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ Spill/Overfill Containment Boxes are Present,but were Not Tested ❑ Test Method Developed By: ❑ Spill Bucket Manufacturer ® Industry Standard ❑ Professional Engineer ❑ Other(Spec) Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other(Spec) Test Equipment Used:VISUAL Equipment Resolution: Spill Box#87(1) FILL Spill Box# Spill Box# Spill Box# 87 1 VAPOR .87 2) FILL 87 2 VAPOR Bucket Diameter: 16" 16" 16" 16" Bucket Depth: 14" 14" 14" 14" Wait time between applying pressure/vacuum/water and 10 MIN 10 MIN 10 MIN 10 MIN starting test: Test Start Time: 11:00 AM 11:00 AM 11:00 AM 11:00 AM Initial Reading(R,): 14" 14" 14" 14" Test End Time: 12:00 PM 12:00 PM 12:00 PM 12:00 PM Final Reading(RF): 14' 14" 14" 14" Test Duration: 1 HR 1 HR 1 HR 1 HR Change in Reading(RF-RI): 0" 0" 0" 0" Pass/Fa: Threshold or Criteria: NO LOSS NO LOSS NO LOSS NO LOSS ')hest Resullt: ( Pass ❑ Fail ®Pass ❑NFail, k;zwi#Pass : ❑,Fail (.Pass. ❑Fail' COmmentS— (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRCB,January 2002 Page_11_of_11_ 15. SPILL/OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ Spill/Overfill Containment Boxes are Present,but were Not Tested ❑ Test Method Developed By: ❑ Spill Bucket Manufacturer ®Industry Standard ❑Professional Engineer ❑ Other(Specify) 7 Test Method Used: ❑ Pressure ❑ Vacuum ® Hydrostatic ❑ Other(Spec) Test Equipment Used:VISUAL Equipment Resolution: K Spill Box#87 3 Spill Box#91 4 Spill Box#91 4 Spill Box#87(3) FILL p ( ) p ( ) p ( ) VAPOR FILL VAPOR Bucket Diameter: 16" 16" 16" 16" Bucket Depth: 14" 14" 14" 14" Wait time between applying pressure/vacuum/water and 10 MIN 10 MIN 10 MIN 10 MIN starting test: Test Start Time: 11:00 AM 11:00 AM 11:00 AM 11:00 AM Initial Reading(R,): 14" 14" 14" 14' Test End Time: 12:00 PM 12:00 PM 12:00 PM 12:00 PM Final Reading(RF): 14" 14" 14" 14" Test Duration: 1 HR 1 HR 1 HR 1 HR Change in Reading(RF-RI): 0" 0" 0" 0" Pass/Fail Threshold or NO LOSS NO LOSS NO LOSS NO LOSS Criteria: Test Result: ®Pass ❑Fail Z--Pass ❑Fail Z iftn ❑Fail ®Pass ❑Fail Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) UDC5-6 UDC3-4 TEST STARTED 8:46 AM TEST STARTED 9:01 AM TEST STARTED 01/11/2011 TEST STARTED 01/11/2011 ARCO 01960 BEGIN LEVEL 2,6435 IN BEGIN LEVEL 5,7004 IN 1701 BRUNDAGE LN END TIME 9:01 AM END TIME 9:17 AM BAKERSFIELD CA 93304 END DATE 01/11/2011 END DATE 01/11/2011 END LEVEL 2,6429 IN END LEVEL 5.7001 IN 01/11/2011 8:45 AM LEAK THRESHOLD 0,002 IN LEAK THRESHOLD 0,002 IN TEST RESULT PASSED TEST RESULT PASSED , SUMP LEVEL REPORT UDC7-8 UDC5-6 SUMP UDC1-2 1,851 IN SUMP UDC3-4 5,701 IN TEST STARTED 8:46 AM TEST STARTED 9:01 AM SUMP UDC5-6 2,844 IN TEST STARTED 01/11/2011 TEST STARTED 01/11/2011 SUMP UDC7-8 3,385 IN BEGIN LEVEL 3,3845 IN BEGIN LEVEL 2,6429 IN END TIME 9:01 AM END TIME 9:17 AM END DATE 01/11/2011 END DATE 01/11/2011 END LEVEL 3,3828 IN END LEVEL 2,6427 IN LEAK THRESHOLD 0,002 IN LEAK THRESHOLD 0,002 IN TEST RESULT PASSED TEST RESULT PASSED UDC7-8 TEST STARTED 9:01 AM ARCO 01960 TEST STARTED 01/11/2011 1701 BRUNDAGE LN BEGIN LEVEL 3,3826 IN BAKERSFIELD CA 93304 END TIME 9:17 AM END DATE 01/11/2011 01/11/2011 9:01 AM END LEVEL 3,3823 IN ARCO 01960 LEAK THRESHOLD 0,002 IN SUMP LEAK TEST REPORT 1701 BRUNDAGE LN TEST RESULT PASSED BAKERSFIELD CA 9:3304 UDC1-2 01/11/2011 9:17 AM TEST STARTED 8:46 AM TEST STARTED 01/11/2011 SUMP LEAK TEST REPORT BEGIN LEVEL 1,8515 IN END TIME 9:01 AM UDC1-2 END DATE 01/11/2011 END LEVEL 1,8503 IN TEST STARTED 9:01 AM LEAK THRESHOLD 0,002 IN TEST STARTED 01/11/2011 TEST RESULT PASSED BEGIN LEVEL 1,8503 IN END TIME 9:17 AM END DATE 01/11/2011 UDC3-4 END LEVEL 1,8497 IN LEAK THRESHOLD 0,002 IN TEST STARTED 8:46 AM TEST RESULT PASSED TEST STARTED 01/11/2011 BEGIN LEVEL 5,7006 IN END TIME 9:01 AM END DATE 01/11/2011 END LEVEL 5.7004 IN LEAK THRESHOLD 0,002 IN TEST RESULT PASSED UDC1112 TIFILL ARCO 01960 TEST STARTED 11:24 AM TEST STARTED 12:15 PM 1701 BRUNDAGE LN TEST STARTED 01/11/2011 TEST STARTED 01/11/2011 BAKERSFIELD CA 93304 BEGIN LEVEL 1,5682 IN BEGIN LEVEL 2,8561 IN END TIME 11:39 AM END TIME 12:30 PM 01/11/2011 11:36 AM END DATE 01/11/2011 END DATE 01/11/2011 ENO LEVEL 115668 IN END LEVEL 2.8560 IN SUMP LEAK TEST REPORT LEAK THRESHOLD 0,002 IN LEAK THRESHOLD 0,002 IN TEST RESULT PASSED TEST RESULT PASSED UDC9-10 TEST STARTED 11:09 AM T2FILL TEST STARTED 01/11/2011 BEGIN LEVEL 4,9313 IN TEST STARTED 12:15 PM END TIME 11:24 AM TEST STARTED 01/11/2011 ENO DATE 01/11/2011 BEGIN LEVEL 2, 1929 IN END LEVEL 4,9309 IN END TIME 12:30 PM LEAK THRESHOLD 0.002 IN END DATE 01/11/2011 TEST RESULT PASSED END LEVEL 2, 1924 IN ARCO 01960 LEAK THRESHOLD 0,002 IN 1701 BRUNDAGE LN TEST RESULT PASSED UDC1112 BAKERSFIELD CA 93304 TEST STARTED 11:09 AM 01/11/2011 12:15 PM TIFILL TEST STARTED 01/11/2011 BEGIN LEVEL 1,5684 IN SUMP LEVEL REPORT TEST STARTED 12:15 PM END TIME 11:24 AM TEST STARTED 01/11/2011 END DATE 01/11/2011 SUMP T1STP 5.535 IN BEGIN LEVEL 4.4981 IN END LEVEL 1,5682 IN SUMP TIFILL 2.856 IN END TIME 12:30 PM LEAK THRESHOLD 0,002 IN END DATE 01/11/2011 TEST RESULT PASSED SUMP T2F1LL 2, 193 IN END LEVEL 4,4993 IN SUMP TIFILL 4,498 IN LEAK THRESHOLD 0,002 IN TEST RESULT PASSED ARCO 01960 ARCO 01960 1701 BRUNDAGE LN BAKERSFIELD CA 93304 1701 BRUNDAGE LN BAKERSFIELD CA 93304 01/11/2011 11:39 AM 01/11/2011 12:30 PM SUMP LEAK TEST REPORT SUMP LEAK TEST REPORT UDC9-10 T1STP TEST STARTED 11:24 AM TEST STARTED 12:15 PM TEST STARTED 01/11/2011 TEST STARTED 01/11/2011 BEGIN LEVEL 4,9307 IN BEGIN LEVEL 5,5349 IN END TIME 11:39 AM END DATE 01/11/2011 END TIME 12:30 PM END LEVEL 4,9306 IN END DATE 01111/2011 LEAK THRESHOLD 0,002 IN END LEVEL 5.5356 IN TEST RESULT PASSED LEAK THRESHOLD 0,002 IN ?EST RESULT PASSED ARCO 01960 1701 BRUNDAGE LN BAKERSFIELD CA 93304 01/11/2011 12:46 PM SUMP LEAK TEST REPORT ARCO 01960 ARCO 01960 1701 BRUNDAGE LN 1701 BRUNDAGE LN T1STP BAKERSFIELD CA 93304 BAKERSFIELD CA 93304 TEST STARTED 12:31 PM 01/11/2011 1:21 PM 01/11/2011 1:53 PM TEST STARTED 01/11/2011 BEGIN LEVEL 5,5355 IN SUMP LEVEL REPORT SUMP LEAK TEST REPORT END TIME 12:46 PM END DATE 01/11/2011 T2STP ENO LEVEL 5,5359 IN SUMP T2STP 5,209 IN LEAK THRESHOLD 0,002 IN SUMP WILL 4,512 IN TEST STARTED 1:37 PM TEST RESULT PASSED TEST STARTED 01/11/2011 BEGIN LEVEL 5,2076 IN END TIME 1:53 PM TIFILL END DATE 01/11/2011 END LEVEL 5.2074 IN TEST STARTED 12:31 PM LEAK THRESHOLD 0,002 IN TEST STARTED 01/11/2011 TEST RESULT PASSED BEGIN LEVEL 2,8561 IN END TIME 12:46 PM END DATE 01/11/2011 T4FILL END LEVEL 2,8561 IN ARCO 01960 LEAK THRESHOLD 0,002 IN 1701 BRUNDAGE LN TEST STARTED 1:37 PM TEST RESULT PASSED BAKERSFIELD CA 93304 TEST STARTED 01/11/2011 BEGIN LEVEL 4,5127 IN 01/11/2011 1:37 PM END TIME 1:53 PM T2FILL END DATE 01/11/2011 SUMP LEAK TEST REPORT END LEVEL 4,5128 IN TEST STARTED 12:31 PM LEAK THRESHOLD 0,002 IN TEST STARTED 01/11/2011 T2STP TEST RESULT PASSED BEGIN LEVEL 2, 1933 IN END TIME 12:46 PM TEST STARTED 1:21 PM END DATE 01/11/2011 TEST STARTED 01/11/2011 END LEVEL 2, 1948 IN BEGIN LEVEL 5,2094 IN LEAK THRESHOLD 0,002 IN END TIME 1:36 PM TEST RESULT PASSED END DATE 01/11/2011 END LEVEL 5,2080 IN LEAK THRESHOLD 0,002 IN T3FILL TEST RESULT PASSED TEST STARTED 12:31 PM ARCO 01960 TEST STARTED 01/11/2011 T4FILL 1701 BRUNDAGE LN BEGIN LEVEL 4,4994 IN BAKERSFIELD CA 93304 END TIME 12:46 PM TEST STARTED 1:21 PM END DATE 01/11/2011 TEST STARTED 01/11/2011 01/11/2011 2:19 PM END LEVEL 4,4992 IN BEGIN LEVEL 4,5126 IN LEAK THRESHOLD 0,002 IN END TIME 1:36 PM SUMP LEVEL REPORT TEST RESULT PASSED END DATE 01/11/2011 END LEVEL 4,5128 IN LEAK THRESHOLD 0,002 IN SUMP T3STP 5,260 IN TEST RESULT PASSED SUMP T4STP 3, 135 IN ARCO 01960 ARCO 01960 1701 BRUNDAGE LN 1701 BRUNDAGE LN BAKERSFIELD CA 93304 BAKERSFIELD CA 93304 01/11/2011 2:29 PM 01/11/2011 3:00 PM SUMP LEVEL REPORT SUMP LEAK TEST REPORT SUMP T3STP 5,260 IN T3STP SUMP T4STP 3, 133 IN TEST STARTED 2:45 PM TEST STARTED 01/11/2011 BEGIN LEVEL 5,2604 IN END TIME 3:00 PM END DATE 01/11/2011 END LEVEL 5,2603 IN LEAK THRESHOLD 0,002 IN TEST RESULT PASSED ARCO 01960 T4STP 1701 BRUNDAGE LN BAKERSFIELD CA 93304 TEST STARTED 2:45 PM TEST STARTED 01/11/2011 01/11/2011 2:45 PM BEGIN LEVEL 3, 1326 IN END TIME 3:00 PM SUMP LEAK TEST REPORT END DATE 01/11/2011 END LEVEL 3, 1315 IN T3STP LEAK THRESHOLD 0,002 IN TEST RESULT PASSED TEST STARTED 2:30 PM TEST STARTED 01/11/2011 BEGIN LEVEL 5,2605 IN END TIME 2:45 PM END DATE 01/11/2011 END LEVEL 5,2604 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED T4STP TEST STARTED 2:30 PM TEST STARTED 01/11/2011 BEGIN LEVEL 3, 1328 IN END TIME 2:45 PM END DATE 01/11/2011 END LEVEL 3, 1327 IN LEAK THRESHOLD 0,002 IN TEST RESULT PASSED P __ T -Tf TRANSMITTAL TO ENVIRONMENTAL AGENCY Report submitted on: January 24, 2011 City of Bakersfield Fire Department, Prevention Services 2101 H Street Bakersfield, Ca 93.301 Attn: Bakersfield Fire Department TESTING SITE: ARCO#01960 1701 BRUNDAGE LANE, BAKERSFIELD, CA Test s checked below were erformed at tine above site O Precision Line Test Monitoring System Certification Pressurized Piping Leak Detection Certification U.S.T. Monitoring Site Plan Spill Bucket Testing Report Form x SB-989 Secondary Containment Testing Enclosed test results are submitted on behalf of: BP WEST COAST PRODUCTS LLC. If you have any questions or,concerns, please feel free to contact our office Phone: (707) 446-6151 — E-mail: tank-tek @cwnet.com Cc: ARCO#01960 TANK-TEK ENVIRONMENTAL CORPORATION 607 Elmira Road,PMB 336,Vacaville,CA 95687 — Ph.(707)446-6151 - Fax (707)446-6192 - E-mail:tank-tek @cwnet.com 31828 Cercle Chambertin,Temecula, CA 92591 — Ph.(951)699-8058 - Fax(951)699-8059 - E-mail:bballreich @verizon.net HOODS ALARMS SPG°3UKLER SYSTEMS SPRAY BOOTH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. /12: File Number: ;z5 Address: /70 / -,-B/Lj u (" ( . Bakersfield, CA 9331. Date Received: Business Name: ,4wc„p SYSTEM: J BUILDING SQUARE FEET: New Mod. ❑ ❑ Commercial Hood System Building Sq. Feet: ❑ ❑ Fire Alarm System Calculation Bldg. Sq. Ft: 1. ❑ ❑ Fire Sprinkler System C r 2. ❑ ❑ Spray Finish System 3. ❑ ❑ Aboveground Storage Tank 4. ❑ ❑ Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank ❑ ER Other: Comments: Date Time Signature Signature IE CONSTRUCTION PERMIT Application Number . . . . . Property Address . . . . . . ATN (11 Digits): Application type description Subdivision Name . . . . . . Property Use . . . . . . . . Application valuation . . . . Owner ------------------------ BP WEST COAST PRODUCTS LLC P O BOX 5015 BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES E R s F r D 1501 TRUXTUN AVENUE, 1sT FLR FIRE BAKERSFIELD, CA 93313 PARTM T � Office Phone: (661) 326 -3979 10- 10000382 Date 12/02/10 1701 BRUNDAGE LN 147 - 290- 18 -00 -8 FIRE DEPT 0 Contractor ------------------------ OWNER BUENA PARK CA 90622 ---------------------------------------------------------------------------- Permit . . . . . . MANDATED LEAK tETECT TEST Additional desc . Phone Access Code 1053297 Permit Fee . . 96:00 Plan Check.Fee 96.00 Issue Date . . . . 12/02/10 Valuation 0 Expiration Date 5/31/11 ---------------------------------------------------------------------------- Fee summary - -- Charged - -- - --- -- Paid Credited -- - -- - -- --- - - - - Due - -- --- - - - - --- ----------- - - - Permit Fee Total --- 96.00 96.00 .00 .00 Plan Check Total 96.00 96.00 .00 .00 Grand Total 192.00 192.00. 00 .00 CALL FOR INSPECTION (661) 326 -3979 Please state the Permit Number, the Job address, and the Type of Inspection. Requests for inspections should be made at least 48 hours in advance. DECLARATIONS Permit is issued in accordance with all applicable Federal, State and Local Ordinances. The permittee has properly signed and dated the reverse side of this form. This Permit.expires afterl80 days of inactivity. I have reviewed the above application, and find it to be correct/complete. Permittee: Date: HAZARDOUS MATERIALS STATEMENT —Yes—No Will the applicant or future occupant handle hazardous material or a mixture containing a hazardous material equal to or greater than the amounts specified on the list of extremely hazardous substances? See checklist for guidelines. _ Yes — No Will the proposed building or modified facility be within 1000 feet of the outer boundary of a school? —Yes—No Will the intended use of the building by the applicant or future building occupant require a permit for construction or modification from the Kem County Air Pollution Control District ( KCAPCD) or from the Bakersfield Fire Dept? See checklist for guidelines. —Yes—No I have read the Hazardous Material Guide and KCAPCD Permitting Checklist. I understand my requirements under the Calif. Health and Safety Code Sec. 6.95 and Calif Govt. Sec. 65850 and the requirements of the City of Bakersfield Fire Dept. regarding hazardous materials. Owner or Authorized Agent hone No. Date DECLARATIONS: The declarations below are mandated by the State of California under Section 19825 of the Health and Safety Code. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of the Division 3 of the Business and Professions Code and my license is in full force and effect. Lic. Class Lic. No. Exp. Date Contractors Signature Date OWNER- BUILDER DECLARATION I hereby affirm that under penalty of perjury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 commencing with Section 7000 of Division 3 or the Business and Professions Code) or that he or she is exempt there from and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)): I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044 Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he or she did not build or improve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon and who contracts for such project with a contractor(s) licensed pursuant to the Contractor License Law). I am exempt under Sec. B. & P. C. for the reason Owner Signature I Date WORKERS COMPENSATION DECLARATION I hereby affirm that under penalty of perjury one of the following declarations: Carrier I have and will maintain a certificate of consent to self - insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Policy No. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall forthwith comply with those provisions. Applicant: Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000) IN ADDITION TO COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097 Civ. C.) Lenders Name Lenders Address I certify that I have read this application and state that the information contained herein is correct. I agree to comply with all city ordinances and state laws relating to building construction and hereby authorize representatives of the city to enter the above mentioned - property for inspection purposes. Signature of Applicant or Agent I Date BAKERSFIELD CITY FIRE DEPARTMENT -- INSPECTION RECORD Post this Card at the Job Site and DO NOT Remove for Duration of Work Inspection Request Phone No. (661) 326 -3979 UST NEW INSTALL DESCRIPTION DATE SIGNATURE BACKFILL PRIMARY PIPE SECONDARY PIPE SECONDARY CONTAINMENT SENSORS AUTHORIZATION FOR FUEL ELECTRICAL SEAK -OFF (- - TANK TESTING UST REMOVAL DESCRIPTION DATE SIGNATURE AST NEW INSTALL DESCRIPTION DATE SIGNATURE MODIFICATIONS MINOR / MAJOR AST REMOVAL DESCRIPTION DATE SIGNATURE EVR UPGRADE PRIOR TO OPERATION OF ANY SYSTEM, ALL UST AND /OR AST SYSTEMS SHALL BE INSTALL, COMPLETE AND ACCEPTED BY MISC. ACTIVITY THE BAKERSFIELD CITY FIRE DEPARTMENT. FIRE DEPARTMENT (FINAL) REMARKS: BUILDING ADDRESS: %fin [r JOB DESCRIPTION: OCCUPANCY TYPE: OWNER: O PERMIT NO. CONTRACTOR: j AAA - ais PHONE 4r70 7 4{4{6 -6 /b FD 1743 UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING/ SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND FUEL MONITORING CERTIFICATION (Please note that these are separate individual tests and will be charged per separate type test accordingly.) PERMIT # ❑ ENHANCED LEAK DETECTION ❑ TANK TIGHTNESS B R 9 F I D P/R! FIRE r BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661 - 326 - 3979 -• Fax: •661- 852 -2171 Page 1 of 1 ❑ LINE TESTING lVf SB -989 SECONDARY CONTAINMENT ❑ FUEL MONITORING CERTIFICATION SITE INFORMATION FACILITY O A-C NAME & PHONE # OF CONTACT PERSON T Cc- e, ADDRESS /-;Pel ;g�lt.VDA�iE ,L.St�t1E J'�ii'k6t'� /��A �ji�3 D S� OWNER NAME ' 4/0 W OPERATOR NAME , Q / S4 A . E.c/re1eP.e/ SES /A/4 PERMIT TO OPERATE # # OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? YES ❑ NO TANK # VOLUME CONTENTS 400aD Ora TANK TESTING COMPANY' TESTING COMPANY Yak -?' K E•vv /ao vME�C/TA� co�•l° NAME & PHONE # OF CONTACT PERSON MAILING ADDRESS EZ4WtA'4AA19- D PM63340 •+!/A~/L -e CA 9S'Gd -?' NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR �2/c�tfi�7 R-0 -f�xl R-6 e��% 331) - 33�o f� CERTIFICATION # DATE .27 TO td1� DUCT �' Q� ICC # T r ^�� 14T' 7 TEST METHOD APPLICANT SIGNATURE G DATE,. .° . 3 ,( THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APP V BY 42C - DATE FD2095 (Rev 03/08) P _ i CITY OF BAKERSFIELD i *POST CONSPICUOUSLY* _ , : *NON- TRANSFERABLE* i BAI{�� ' • � - ' ` - . O �ycoM ena S I Business name ..: TANK -TEK ENVIRONMENTAL CORP Location address .: OUTSIDE CITY CgLIF0, Lic Nbr /Class '..: 11 00118947 CONTRACTORS } Issue date ....: 8/16/10 Expiration date .: 6/30/11 j License comment .: COMPLIANCE TESTING TANK -TEK ENVIRONMENTAL CORP Owner /Officer 607 ELMIRA ROAD, PMB 336 TANK -TEK ENVIRONMENTAL CORP VACAVILLE CA 95687 SLUNAKER, GREG i l BUSINESS TAX CERTIFICATE IS HEREBY GRANTED. LICENSEE IS TO COMPLY WITH ALL LAWS AND ORDINANCES. ISSUANCE OF THIS LICENSE DOES NOT CONSTITUTE AUTHORIZATION TO CONDUCT BUSINESS IF LICENSEE HAS NOT COMPLIED WITH ALL APPLICABLE LAWS AND ORDINANCES. THIS LICENSE IS ISSUED WITHOUT VERIFICATION THAT THE LICENSEE IS SUBJECT TO OR EXEMPT FROM LICENSING'BY THE STATE OF CALIFORNIA. 1 f J I TANK -TEK ENVIRONMENTAL CORP. City of Bakersfield Date Type Reference 11/23/2010 Bill 12/16/10 - BP 0196 11/24/2010 Original Amt. Balance Due Discount 192.00 192.00 Check Amount 17567 Payment 192.00 192.00 Bank- Bank Of Ameri Permit Fee Arco #01960 (Test Date 12/16/10) 192.00 i