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PROPERTY DETAIL
Property Detail Kern, CA JIM FITCH, ASSESSOR Parcel # (APN): 184 - 160- 21 -00 -9 Parcel Status: ACTIVE Owner Name: YAM BARBARA H ParcelQuest by CD -DATA N�qN� Sale 1 ,5 IE Use Code: 2304 Use Description: AUTOMOTIVE USES Mailing Address: 1999 TAFT HW BAKERSFIELD CA 93313 -9235 Situs Address: 1999 TAFT HWY BAKERSFIELD CA 93313 -9235 R010 Legal Description: S 1 T 31 R 27 PARCEL A OF LLA 96 -98 REC ASSESSMENT Sale 1 Sale 2 Total Value: $2,035,573 Use Code: 2304 Zoning: Land Value: $467,992 Tax Rate Area: 061030 Census Tract: 32.01/1 Impr Value: $1,442,181 Year Assd: 2009 Improve Type: Other Value: $125,400, Property Tax: Price /SgFt: % Improved 75% Delinquent Yr Park Type: Exempt Amt: HO Exempt ?: N Spaces: SALES HISTORY Sale 1 Seller (Grantor): S & W TRUCK STOP INC 1 st Trst Dd Amt: Code1: PROPERTY CHARACTERISTICS Sale 3 Transfer 09/30/2005 205270590 2nd Trst Dd Amt: Code2: Lot Acres: 1.430 Sale 1 Sale 2 Recording Date: 09/30/2005 12/20/1999 Recorded Doc #: 205270590 199179485 Recorded Doc Type: Total Rooms: Pool: Transfer Amount: $1,800,000 $400,000 Sale 1 Seller (Grantor): S & W TRUCK STOP INC 1 st Trst Dd Amt: Code1: PROPERTY CHARACTERISTICS Sale 3 Transfer 09/30/2005 205270590 2nd Trst Dd Amt: Code2: Lot Acres: 1.430 Year Built: Fireplace: Lot SgFt: 62,290 Effective Yr: A/C: Bldg /Liv Area: Heating: Units: Total Rooms: Pool: Buildings: 1 . Bedrooms: Stories: Baths (Full): Park Type: Style: Baths (Half): Spaces: Construct: Site Inflnce: Quality: Garage SgFt: Building Class:D Timber Preserve: Condition: AVERAGE Ag Preserve: Other Rooms: IIIIIIII�IIIIIIIIIII 46 IE *" The information provided here is deemed reliable, but is not guaranteed. 11 Business Search - Business Entities - Business Programs Page 1 of 1 Business Entities (BE) Online Services Business Search Disclosure Search E -File Statements Mail Processing Times Main Page Service Options Name Availability Forms, Samples & Fees Annual /Biennial Statements Filing Tips Information Requests (certificates, copies & status reports) Service of Process FAQs Contact Information Resources Business Resources Tax Information Starting A Business International Business Relations Program Customer Alert (misleading business solicitations) Business Entity Detail Data is updated weekly and is current as of Friday, July 16, 2010. It is not a complete or certified record of the en Entity Name: PEK CC, INC. Entity Number: C2928413 Date Filed: 09/21/2006 Status: ACTIVE Jurisdiction: CALIFORNIA Entity Address: 1999 TAFT HWY Entity City, State, Zip: BAKERSFIELD CA 93313 Agent for Service of Process: BARBARA YAM Agent Address: 1999 TAFT HWY Agent City, State, Zip: BAKERSFIELD CA 93313 * Indicates the information is not contained in the California Secretary of State's database. • If the status of the corporation is "Surrender," the agent for service of process is automatically revoked. Plea: Corporations Code section 2114 for information relating to service upon corporations that have surrendered ............ ............................... • For information on checking or reserving a name, refer to Name Availability. .......................... ............................... • For information on ordering certificates, copies of documents and /or status reports or to request a more exte Information Requests.. • For help with searching an entity name, refer to Search Tips. ............ ... • For descriptions of the various fields and status ty.. pe.s. , ref. er . to Field Descriptions. _and Status Definitions. ........ ............................... ......................................... ............................... Modifx Search New' Search Printer Friendly Back to Search Results .............. ............................... ......... ............................... ................. ............................... Privacy. Statement I Free Document Readers Copyright © 2010 California Secretary of State http://kepler.sos.ca.gov/cbs.aspx 07/21/2010 NEXT -FUNC: KEY: KEY DATA PROMPT KIPS #ROLLINQ SECURED ROLL INQUIRY P22241 ATN 184 160 21 00 9 ACTIVE Roll 1 Use Code 2304 File No Lgnd AG Presv NO APN 184 160 21 6 Lgl S 1 T.31 R 27 Q NE Acres 1.43 CPest SITE 1999 HIGHWAY 119 BAKERSFIELD BPS 1 SD 2 OF Y NT Y Owner YAM BARBARA H Doc 20527 0590 09/30/05 Bill 1999 TAFT HW BAKERSFIELD CA 93313 -9235 R.B.P. 11 10 09- 1118408 -00 -6 TRA -No 061 030 061 030 061 030 CHG DT Chg Type Mineral Land /PI 476,219 466,882 467,992 Imprvment 1,467,538 1,438,763 1,442,181 Other Imp 91,520 Pers Prop 33,880 Exmp Amt Net Value 1,943;757 .1,905,645 2,035,573 Tag PFI =HELP 2 =MENU 3 =RTRN 4 =TOG S =FUTR 9 =BILL 10 =UFL 11 =BUS 12= EVTSEL PF13 =NEW 14 =APN HIST 15= OWNERS 16= EXEMPT 17 =SUPPL 18 =ADDR 19 =ROLL CORR PF20 =PREV YR 21 =NEXT YEAR 22= TRAXREF 23 =NEXT 24 =PREY .07/21/10 14:30 Property Detail Kern, CA JIM FITCH, ASSESSOR Parcel # (APN): 184 - 160- 21 -00 -9 Parcel Status: ACTIVE Owner Name:. YAM BARBARA H ParcelQuest by CD -DATA Use Description: 'AUTOMOTIVE USES Mailing Address: 1999 TAFT HW BAKERSFIELD CA 93313 -9235 Situs Address: 1999 TAFT HWY BAKERSFIELD CA 93313 -9235 R010 Legal Description: S 1 T 31 R 27 PARCEL A OF LLA 96 -98 REC ASSESSMENT Sale 2 Sale 3 Transfer Total Value: $2,035,573 Use Code: 2304 Zoning: Land Value: $467,992 Tax Rate Area: 061030 Census Tract: 32.01/1 Impr Value: $1,442,181 Year Assd:. 2009 Improve Type: Other Value: $125,400 Property Tax: Price /SgFt: % Improved 75% Delinquent Yr 1st Trst Dd Amt: Code1: Exempt Amt: HO Exempt ?: N SALES HISTORY Sale 1 Sale 2 Sale 3 Transfer Recording Date: 09/30/2005 12/20/1999 09/30/2005 Recorded Doc #: 205270590 199179485 205270590 Recorded Doc Type: Transfer Amount: $1,800,000 $400,000 Sale 1 Seller (Grantor): S & W TRUCK STOP INC 1st Trst Dd Amt: Code1: 2nd Trst Dd Amt: Code2: PROPERTY CHARACTERISTICS Lot Acres: 1.430 Year Built: Fireplace: Lot SgFt: 62,290 Effective Yr: A/C: Bldg /Liv Area: Heating: Units: Total Rooms: Pool: Buildings: 1 Bedrooms: Stories: Baths (Full): Park Type: Style: Baths (Half): Spaces: Construct: Site Inflnce: Quality: Garage SgFt: Building Class: D Timber Preserve: Condition: AVERAGE Ag Preserve: Other Rooms: * ** The information provided here is deemed reliable, but is not guaranteed. Underground Storage Tank Facilities: 1. The permit holder shall comply with the monitoring, response, and plot plans approved by this Department. The underground storage tanks must also be monitored according to the applicable requirements in the California Code of Regulations, Title 23, Division 3, Chapter 16. 2. A copy of the facility's underground storage BARBARA YAM tank leak prevention monitoring program 1999 TAFT HWY (including monitoring plan, response plan, and plot BAKERSFIELD, CA 93313 plan), as approved by this Department, must be maintained on site. 3. All equipment installed for leak detection shall be operated and maintained in accordance with the manufacturer's instructions, including routine maintenance and service checks (at least once per year) for operability or running condition. 4. A report documenting the maintenance, monitoring, and any changes to the underground storage tanks shall be submitted to this Department each year on the form provided along with the permit or another approved by this Department. 5. The facility owner and operator shall ensure that the facility has adequate financial responsibility insurance coverage, as mandated for all underground storage tanks containing petroleum, and supply proof of such coverage to this Department. STATE REQUIRED SUPPLEMENTAL INFORMATION STATE UST ID# SIZE(GAL) CONTENT 15- 000 - 003290 -00001 20,000 UNLEADED 15- 000 - 003290 -00002 15,000 PREMIUM 15- 000 - 003290 -00003 8;000 DIESEL ENVIRONM TH PERMIT KERN COUNTYPUBLIC HEALTH SERVICESLDEPARTMENT ENVIRONMuE'NTA'L HEALTHISERVICES, DIVISI.ON;; 4 2700 M ST SUITE 300 BAKERSFIELDCA�93301 =` (661) 862 -8700 �wv w. o:kern' a us/ehtemail: eh'a c. ".kern:ca.us � REGULATED FACIL1TY:f`"�� OWNER(S)_0F REC TAFT HWY CHEVRdN') �` ��� `` . ,���' ° �, 4 ,' �'' � �C 13EK CC; INC 1999 TAFT HWY�'��^} (��' -` c�'j�9 '� �' r �X CFA I:D�FA0003910 BAKERSFIELD CfA�93313 '� J r ` ;��� ' 4 _ _ .� t{ 3 . c) i General Health :.Program - °'' = ,Y = =. `tiz 'nf , � ,. .F — �'"` - Permit # - ��� -- ��4dditional Infon BUS PLAN MED LOW RISK 1 UNIT _ �� 0002954', t)j UNDERGROUND`SJORAGE TANK PROGRAM (See tank information on_back) 0014219 ; 0 Expiration:-06K' FOOD MARKET c '�> ��i ! !? 0009012` 0 ` TOBACCO RETAILER - g°"" t1 ,� 1 0019921 TOBACCO C. it \2 0 �l ��.� �r= 'ti'T,�,� ,J '^,S�- ����- ''`+ ,)._. ,�. • �r `cam r� --^'' f�� on 11 Permit Issudd,: �07/01,2.010,� - Matthew ConstantlneIr �' �; Public Health�'Servlces� This ENVIRONMENTAL HEALTH' kF \ yPERMIT -is issued to the�owner(s) and establishment shown above subject to compliance with all applicable laws and regulations. — Permit is valid, unless�revoked or suspended for violation of applicable laws and regulations. ��-�- �,!�;�rf ,,� „r UNITED STAtft'W,69 &W.'- MM • Sender: Please print your name, address, and ZR+ a. SEP 2 2010 KERN COUNTY ENVIRONMENTAL HEALTH DIVISION Qf�'F-P""" COUNIN 2700 M STREET SUITE 30T""' NTv i E N i: SE271ICE.1 BAKERSFIELD CA 93301 ■ Complete items 1, 2, and 3. Also complete Item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. Article Addressed to: f BARBARA YAM TAFT HWY CHEVRON i 1999 TA FT H W Y BAKERSFIELD CA.- -9_3313 A. X Agent' B. Received by ( Printed Name) C�Datjof Deli �, D. Is delivery address different from Rem 1? ❑ Y If YES, enter delivery address below: ❑ No 3. Service Type Certified Mail 13 Express Mail 'Registered 'X9 Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number; - (Transter from service 6beq i =.7 0 0 71 2 5 6'0 0 0:0 ], 1 5 4 2 7 14091 1 i I Ps Form 3811, February 2004 Domestic Retum,171"pt Reviewer Date Reviewed /Signed ment Review /Approval Checklist Name - � '� Q FcumentuNarne.Af,0 Cross Reference No. - Certified Mail two copies to respondent Date Needed By: 6 � o Copy to SpecialisdTech Step 1. Step 2. Reviewer Date Reviewed /Signed (A) Approved (R) Returned to Originator Name Reviewer Date Reviewed /Signed (A) Approved (R) Returned to Originator Name Initial Peer Copy to file =- �/� Certified Mail two copies to respondent Canas ought Logged onto Enforcement Case Update � o Copy to SpecialisdTech Pitts — � Signed by Constantine Copies of signed document Scan of signed document Copy to file =- �/� Certified Mail two copies to respondent Logged onto Enforcement Case Update Copy to SpecialisdTech Postage I $ n Certified Fee O Return Receipt Fee Postmark Here O (Endorsement Required) C3 Res(ricted Deliv� — - - O(Endorsement Re BARBARA YAM Ln T°�fP° �I TAFT HWY CHEVRON ru r- Sent To 1999 TAFT HWY 0 ---° ......_.. BAKERSFIELD CA 93313', orfPO . -- PO Box N-- __.__.•. CW,, State, ZIP+4- - - - Certified Mail Provides: A mailing receipt A unique identifier for your mailpiece A record of delivery kept by the Postal Service for two years Important Reminders: • Certified Mail may ONLY be combined with First -Class Mail® or Priority Mail, • Certified Mail is not available for any class of international mail. • NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. Fo valuables, please consider Insured or Registered Mail. • For an additional fee, a Return Receipt may be requested to provide proof o delivery. To obtain Return Receipt service, please complete and attach a Returt Receipt (PS Form 3811 } to the article and add applicable postage to cover the fee. Endorse mailpiece "Return Receipt Requested °. To Cfi a fee waiver foi a duplicate return receipt, a USPS® postmark on your Certified MaiFreceipt is required. ■ For an additional fee, delivery may be restricted to the addressee c addressee's authorized agent. Advise the clerk or mark the mailpiece with th endorsement 'Restricted Delivery °. ■ If a postmark on the Certified Mail receipt is desired, please present the art Cleat the post office for postmarking. If a postmark on the Certified Ma receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry: PS Form 3800, August 2006 (Reverse) PSN 7530-02 -000 -9047 AEO Document Review /Approval Checklist Document Name: - T JA-f—�-T E v 0 Originator: y Dam Step 1. Reviewer Date Reviewed /Signed (A) Approved (R) Returned to Orilzinator Name Initial Peer _ py to file — TJl�-/ ■ Attach this card to the back of the mailpiece, Certified Mail two copies to respondent Callas ought Logged onto Enforcement Case Update. p'13 d Copy to Specialist/Tech Pitts BARBARA YAM TA FT H W Y CHEVRON 3. Service Type Mall ❑ Express Mail 1999 TA FT H W Y Cross Reference No. Date Needed By: 51,0w Step 2. ned by Constantine c I A Signature Agent pies of signed document F X �0�� Addresses, an of signed document B. Received by ( Printed Name) py to file — TJl�-/ ■ Attach this card to the back of the mailpiece, Certified Mail two copies to respondent I Logged onto Enforcement Case Update. D. Is delivery address different from kem 17 � Copy to Specialist/Tech If YES, enter delivery address below:. No ■ Complete items 1, 2, and 3. Also complete I A Signature Agent item 4 if Restricted Delivery is desired. X �0�� Addresses, ■ Print your name and address on the reverse so that we can return the card to you. B. Received by ( Printed Name) I CLDt /; � eily ■ Attach this card to the back of the mailpiece, I or on the front if space permits.. D. Is delivery address different from kem 17 � 1. A Addressed to: rticle If YES, enter delivery address below:. No BARBARA YAM TA FT H W Y CHEVRON 3. Service Type Mall ❑ Express Mail 1999 TA FT H W Y />P�Certifled I Registered Return Receipt for Merchandise BAKERSFIELD CA 9.3313 ❑Insured Mall ° C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number 7007 2560 00.01 5427 9409 (Transfer from service label) PS Form 3811, February 2004 Domestic Return Receipt -102595 -02 -M- 1540; D tr C3 D �•• Ir ism (, Postage $ L^ 31 vo Certified Fee ri C3 Return Receipt Fee Postmark C3 (Endorsement Required) Here O Restricted Delm � (Endorsement Re BARBARA YAM ru Total Postage I ru TA FT H W Y CHEVRON 1999 TA FT H W Y C3 L!�&iiejFAFt. _ BAKERSFIELD CA 933.134 Emstel rr, MATTHEW CONSTANTINE, DIRECTOR PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 2700 M STREET, SUITE 300, BAKERSFIELD, CA 93301-2370 VOICE: (661) 862-8700 FAX: (661) 862-8701 Web: www.co.kern.ca.us /eh E-mail: eh @co.kern.ca.us TAFT HWY CHEVRON c/o BARBARA YAM 1999 TAFT HWY BAKERSFIELD CA 93313 Dear Ms. Yam: "ONE VOICE" August 30, 2010 Administrative Enforcement Order (FA0003910 —Fueling Station) CLAUDIA JONAH, MD PUBLIC HEALTH OFFICER Xv Please find the enclosed settlement agreement entitled Consent Order proposed as a resul of an inspection(s) conducted on July 13, 2010. California state regulations prescribe the proced re to. calculate penalties for Enforcement Orders in order to determine the settlement amount. I you are in agreement with the terms in the Consen der, this Department is authorized to redu e. maximum settlement amount of $ to $3 2,600 discounted penalty plu $650 Departmental costs). Failure to reach an agreement in this matter will result in an issuanc o a Unilateral Order for the maximum allowable penalty amounts for the violations cited, or referral to the Kern County District Attorney's Office. Two copies of the Consent Order are enclosed. One copy is for your file. The second copy must be signed and returned to this Department with full payment.of the penalty amount. The signed Consent Order and payment must be received by this office by September 30, 2010. An informal hearing has been scheduled on at September 28, 2010 at 9:00 A.M. at the letterhead address to discuss the violations and settlement. If you have any questions, please contact Brian Pitts at (661) 862 -8704. Sincerely, ) ue_ Matthew Constantine Director MC:lvs:bdh Enclosures 4 Printed on Recycled Paper KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DIVISION HAZARDOUS MATERIALS MANAGEMENT PROGRAM CERTIFIED UNIFIED PROGRAM AGENCY in the Matter of Taft Hwy Chevron 1999• Taft Hwy Bakersfield, CA Facility .ID No. FA0003910 Respondent. Docket No. LV -07i 10 -03 CONSENT ORDER Health and Safety Code Section 25404. 1.1 1. INTRODUCTION. 1.1 Parties. The Kern County Environmental Health Services Division, Certified Unified Program Agency (Agency) and Barbara H. Yam (Respondent) enter into this Consent Order (Order) and agree as follows: 1.2 Site. Respondent operates three underground storage tanks at Taft Hwy Chevron, 1999 Taft Hwy, Bakersfield, CA (Site). 1.3 Jurisdiction. Jurisdiction exists pursuant to Health and Safety Code (HSC) Section 25404.1.1. 1.4 Inspection. The Agency inspected the site on July 13, 2010. 2. VIOLATIONS ALLEGED 2.1 The Agency alleges the following violations were noted during the inspection: 2.1.1 The Respondent violated California Code of Regulations, Title 23, Section 264.1(a), in that Respondent failed to implement a monitoring program which is capable of detecting an unauthorized release from any portion of the underground storage tank system at the earliest possible opportunity. The sensors in the regular unleaded and the CONSENT ORDER 1 diesel sumps had been elevated above the lowest point of the sump such that they would no longer alarm due to fluid accumulating in the sump. 2.1.2 The Respondent violated California Health and Safety Code, Chapter 6.7, Section 25299(a)(9) in that Respondent tampered with.or otherwise disabled automatic leak detection devices or alarms. 2.1.3 The Respondent violated California Health and Safety Code, Chapter 6.95, Section 25503.5 by failing to file a Hazardous Materials Business Plan. New businesses are required to file a Hazardous Materials Business Plan within 30 days after start up of operations. 2.2 The parties wish to avoid the expense of litigation and ensure prompt compliance. 2.3 Respondent waives any right to a formal hearing in this matter. Respondent agrees that due process has been provided with respect to this matter. 2.4 This Consent Order shall constitute full settlement of the violations alleged, but does not limit the Agency from taking appropriate enforcement action concerning other violations. 3. SCHEDULE FOR COMPLIANCE 3.1 Respondent shall comply with the following: 3.1.1 . Immediately,. Respondent shall remove the water and dirt from the underground storage tank sumps and relocate the sensors to the lowest point of the sumps. 3.1.2 On or before September 30, 2010, Respondent shall complete and submit a Hazardous Materials Business Plan for Taft Hwy Chevron. CONSENT ORDER 2 3.1.3 On. or before September 30, 2010, Respondent shall $3,250, of which $2,600 is a discounted Agency's costs. Agency a tota . of of the 3.1.4 Submittals: All submittals from Respondent pursuant to this Consent Order shall be sent to: Lydia V. von Sydow Kern County Environmental Health Services Division 2700 "M" Street, Suite 300 Bakersfield, CA 93301. 3.2 The penalties collected may be used by the Agency for education and training of personnel or the public to increase understanding and compliance with regulations governing hazardous materials. The penalties may also support services to improve emergency response to releases of hazardous materials. This will reduce the overall risk of injury to personnel due to hazardous material releases. 4. PAYMENTS . c 4.1 Respondent shall comply with the following: 4.1.1 No later than'September 30, 2010, Respond t shall pay the Agency $3,250, of which $2,600 is a discounted penalty d $65 sement of the Agency's costs. Respondent's check shall be made payable to Kern County Environmental Health Services Division, and shall be delivered to: Brian Pitts, Chief Kern County Environmental Health Services Division 2700 "M" Street, Suite 300 Bakersfield, CA 9.3301 4.2 If the Respondent fails to comply with the Schedule for Compliance (items 3.1 through 3.2), the Respondent agrees to pay the full penalty amount, $13,000, within thirty (30) days of notification by the Agency. CONSENT ORDER 3 5. OTHER PROVISIONS 5.1 Additional Enforcement Actions: By agreeing to this Consent Order, the Agency does not waive the right to take further enforcement actions, except to the extent provided in this Consent Order. 5.2 Penalties for Noncompliance: Failure to comply with the terms of this Consent Order may subject Respondent to civil penalties and /or punitive damages for any costs incurred by the Agency or other government agencies 'as a result of such failure, as provided by HSC Section 25188 and other applicable provisions of law. 5.3 Parties Bound: This Consent Order shall apply to and be binding upon Respondent and its officers, directors, agents, receivers, trustees, employees, contractors, consultants, successors, and assignees, including, but not limited to, individuals, partners, subsidiary and parent corporations, and upon the Agency and any successor agency that may have responsibility for and jurisdiction over the subject matter of this Consent Order. 5.4 'Effective Date: The effective date of this Consent Order is the date it is signed by the Agency. RESPONDENT Dated: Sign re. espondent Type or Print Name and Title of Respondent AGENCY (; Dated: Matthew Constantine, Director Environmental Health Services Division CONSENT ORDER -a NW �►�ei, v,` y I x I ,•� F •..r „,�� t� 7 aft Y 1 • I� I,d,D`o State Water Resources Control Board (a Linda S. Adams DIVl$lOn Of Water Quality Arnold Schwarzene gger Secretaryfor 1001 I Street Sacramento, California 95814♦ (916) 324 -7493 Governor Environmental Protection Mailing Address: P.O. Box 2231, Sacramento, California 95812 FAx (916) 341 -5808 ♦ Internet Address: http: / /www.waterboards.ca -.gov JAN 2 5 2007 - RECEIVED CERTIFIED MAIL NO. 7004 1160 0002 0462.4869 io JANaJ 2007 D 3� KERN COUN1Y Ms. Barbara Yam, Manager ENVIRONMENTAL HMALrH SERVICES Taft Highway Chevron 1999 Taft Highway Bakersfield, CA 93313 Dear Ms. Yam: APPROVAL OF REQUEST FOR RECONSIDERATION OF ENHANCED LEAK DETECTION (ELD) TESTING: TAFT HWY CHEVRON, 1999 TAFT HWY, BAKERSFIELD, CA 93313 This letter is in response to your request for reconsideration of the requirement to perform ELD. We have reviewed your request and the supporting documents you provided, and we have consulted with the local permitting agency and water purveyor. Kuljit Ghuman, the owner of well in question (State Well Number: 1503091 -001 AND. 002), stated the well is destroyed. Kern County Environmental Health confirmed that the well is destroyed. Based on the enclosed information, your request has been approved for the reason(s) indicated below. • UST system is not located within 1,000 feet of a public drinking water well. If you have any questions, please contact Sean Farrow at (916) 324 -7493. Sincerely, Kevin L. Graves, P.E. Underground Storage Tank Program Manager Enclosure(s): (basis for the decision) cc: See next page California Environmental Protection Agency. 0 Recycled Paper 0 . 0 1 1 Ms. Barbara Yam - 2 - cc: Mr. Joe Canas, Chief Kern County Environmental Health 2700 M Street - Bakersfield, CA 93301 Mr. Kuljit Ghuman, owner Johnny Quik Store # 143 2126 Taft Highway . Bakersfield, CA 93313 0 r GeoTracker 0 E Page I of 1 ..... .... ... 0 Zoomin 2X OZoomout 2X 0 Pan * Identify UST Sites Layers Show All sites within Any of public wells. Sites 1 2 MUST Sites *Public Wells /,Highways W r, Major Roads ,-Minor Roads ' USGS Quads El E Surface Water El ■SLIC Sites El MWatersheds, 0 MGW Basins El MVulnerability EJ M GAMA Sites Map Size: 1XE F—Redraw - Street: City: Zip: 1,Gol GeoTracker Home I Contact GeoTracker Help Desk I Road Maps by GDT Well and LUFT site positions are approximate. Locational accuracy will improve as state agencies and responsible parties obtain and report new information. I FA c, 11. 14 77,7, https://geotracker.waterboards.ca.gov/SCRIPTS/ESRIMAP.DLL?NAME=MOSERVER... 12/29/2006 12/28/2006 15:34 6618347 JOHNNY QUIK #1 .�1.4••I —mac► -2015 0'3:49 __.. 06 ' 4Y PKl ue : oe r ,TOHi'•!hl'r' (31 I {:_ t.,L�RF'IRHTE ENVIRONMENTAL HEALTH SERVICES DEPARTMENT STEVE McC4LLEY, R.E.H.S., "Director 2700 "M" STIf FT. $UIYE 300 NAXIASf1ELD, G !]201.2710 Voice. 4e6t) 6624700 fan (6611 66206701 TTt Mley: (400) 726.2929 v•nitil rh ®ralrem.u.trt 40 June 24, 2005 Beal Properties 5816 East Shields, #101 Fresno, CA 93727 - SLTBJBCT: Johnny Quick Store #143 Ladies and Gentlemen: PAGE 01 559 291 1656 P.02/03 RESOURCE MANACEMENT ACENCV ,DAVID PRICE III, RMA DIRECTOR Cee►munity NO Emnamic Deyvinp"m Depofunent En0immAn$ i Sunny Smins Depalte»nt fnvironmentat MUM Sewton Depenm•nr plannln8 D+psHment ROids ocoanment This is to advise you that your domestic well located on APN 514- 060.21, under Permit EH -2955, was properly destroyed on June 21, .2005. This is provided for your records. If you have any further questions, please contact me st (661) 962- 8'768. TH. jrw (Wuat`hudyklt2599 -w) 0) Sincerely, Steve: Mecaljey. r rTho�AVW' ,E.H.S. Environmental Health Specialist M . Water Quality Program + APFIZov AL" `�g2ov.► j � wA�7E,Q pu;R„F,,j�Xc . I I - Re; Johhny Quick,AK6,Taft H From: "Laurel Funk" <LAURELF @co.kern.ca.us> To: < MChristofferson @waterboards.ca.gov> Date: 7128/05 4:04PM Subject: Re: Johhny Quick, 2126 Taft Highway, Bakersfield, CA The well on the site, #1503091 -001, has been destroyed. i am not aware of any other public drinking water wells with in 1000 feet. Three other sites also received ELD notification because of this well. ARCO #81774/JAI Mini Mart, 2051 Taft Hwy, Bakersfield CXX) S and W Chevron, 1999 Taft Hwy, Bakersfield C5 0 O E -Z Mart Mobil, 2106 Taft Hwy, Bakersfield dO V7%)- If you have any questions, please give me a call. Laurel Funk Kern County Environmental Health Certified Unified Program Agency (CUPA) 2700 "M" Street, Suite 300 Bakersfield, CA 93301 Ph# (661) 862 -8763 Fax (661) 862 -8701 ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. • Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the mailpiece, or on the front if space permits. Article Addressed to: 4� - _ S & W TRUCK STOP INC 1999 TAFT Ht1/Y BAKERSFIELD CA 93313 2. PS Form A. X B. Received by ( Printed Name) I C. Date of D. Is delivery address different from item 1? O Yes If YES, enter delivery address below: 0 No 3. ervice Type -ffCertified Mail 0 Express Mall' Registered 13 Return Receipt for Merchandis 0 Insured Mall 0 C.O.D. 4. Restricted Delivery? (Extra Fee) 0 Yes U O. Mubil,a CERTIFIED bervrceTM MAILTM RECEIPT 1. (DOmeSt /C Mad Only No lnsurancerCoverage .tided Postage $ CertMed Fee Return Reolept Fee (Endorsement Required) Restricted Delivery Fee (.Endorsement Required) Told Postage & Fees l$ - S & W TRUCK STOP INC 1999 TAFT HWY BAKERSFIELD CA 93313 Postmark Here Certified M�j,�Provides: lesrensal aooa eUnr'oose -od S ■ A mailing r r A unique i r for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: • Certified Mail may ONLY be combined with First -Class Mail® or Priority Mai • Certified Mail is not available for any class of international mail. • NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. R valuables, please consider Insured or Registered Mail. • For an additional fee a Return Receipt may be nIquested to provide proof c delivery. To obtain Qum Receipt service, please complete and attach a Retui Receipt (PS Form 3811) to the article and add applicable postage to cover th fee. Endorse mailpiece 'Return Receipt Requested ". To receive a fee waiver fc a duplicate return receipt, a USPS® postmark on your Certified Mail•receipt' required. t • For an additional fee, delivery may be restricted to the addressee addressee's authorized agent. Advise the clerk or mark the mailpiece with tl endorsement "Restricted Delivery. • If a postmark on the Certified Mail receipt is desired, please present the an cis at the post office for postmarking. If a postmark on the Certified Mc receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. ENVIRONMENTAL HEALTH SEROICES DEPARTMENT STEVE McCALLEY, R.E.H.S., Director 2700 "M" STREET, SUITE 300 BAKERSFIELD,CA 93301 -2370 Voice: (661) 862 -8700 Fax: (661) 862 -8701 TTY Relay: (800) 735 -2929 e -mail: eh @co.kern.ca.us 320074 S AND W TRUCK STOP, INC 1999 TAFT HWY . BAKERSFIELD, CA 93313 n1i!: 04-p� October 15, 2004 R OURCE MANAGEMENT AGENCY DAVID PRICE III, RMA DIRECTOR Community and Economic Development Department Engineering & Survey Services Department Environmental Health Services Department Planning Department Roads Department Subject: Underground Storage Tank Designated Operator Requirements SECOND NOTICE All Underground Storage Tank (UST) facilities must notify this Department of the person who will serve as their Designated Operator. This requirement may be found in the California Code of Regulations, Title 23, Chapter 16, Section 2715. The notification is required to be submitted by January 1, 2005. The State is offering an UST Owner /Operator Outreach Session to provide information and answer questions about this new requirement. This session date and location is: Tuesday, November 2, 2004 9:00 A.M. —12:00 P.M. City of Bakersfield, Council Chambers 1501 Truxtun Avenue Bakersfield, CA 93301 Included with this notice is the form to notify this Department of each facility's Designated Operator. This form is to be completed and returned by January 1, 2005. Thank you for your cooperation in this matter. If you have any questions, please contact this Department at (661) 862 -8700. Sincerely, Steve McCalley, Director By: Joe Canas, REHS Hazardous Materials Specialist IV Unified Hazardous Materials/Waste Program Encl. ENVIRONMENTAL HEALTH SEROCES DEPARTMENT STEVE McCALLEY, R.E.H.S., Director 2700 "M" STREET, SUITE 300 V I %1L BAKERSFIELD, CA 93301 - 2370 Voice: (661) 862 -8700 �ygb -rg'8 Fax: (661) 862 -8701 TTY Relay: (800) 735 -2929 e -mail: eh @co.kem.ca.us August 26, 2004 S AND W TRUCK STOP, INC 1999 TAFT HWY BAKERSFIELD, CA 93313 Subject: Underground Storage Tank Requirements RROURCE MANAGEMENT AGENCY DAVID PRICE lll, RMA DIRECTOR Community and Economic Development Department Engineering & Survey Services Department Environmental Health Services Department Planning Department Roads Department The State of California has established new regulations for Underground Storage Tanks (UST). UST facilities must meet the following requirements to maintain compliance with current regulations. 1. Designated Operator: All UST facilities must notify this Department of the person who will serve as their Designated Operator. This notification is required by January 1, 2005. Enclosed is a flyer explaining these requirements. The State is offering several UST Owner /Operator Outreach Sessions to provide information and answer questions about this new requirement. Also included is a notice about those sessions. 2. Double Walled Pressurized Piping Leak Detection: The State is requiring line leak detectors that detect a 3.0 gallon per hour release from the primary containment be installed by November 9, 2004. A mechanical or electronic line leak detector may be used to fulfill this requirement. This requirement is in addition to the continuous monitors (sensors) in the piping sumps and under dispenser containments. This requirement is only for double walled pressurized piping. A flow chart is included to further explain these requirements. Thank you for your cooperation in this matter. If you have any questions, please contact this Department at (661) 862 -8700. Sincerely, Steve McCalley, Director By: Joe Canas, REHS Hazardous Materials Specialist IV Unified Hazardous Materials /Waste Program � r ENVIRONMENTAL HEALTH SEWES DEPARTMENT STEVE McCALLEY, R.E.H.S., Director 2700 W" STREET, SUITE 300 BAKERSFIELD, CA 93301 -2370 Voice: (661) 862 -8700 Fax: (661) 862 -8701 TTY Relay: (800) 735 -2929 c -mail: ch @co.kern.ca.us June 30, 2004 S AND W TRUCK STOP, INC. 1999 TAFT HWY BAKERSFIELD, CA 93313 R*URCE MANAGEMENT AGENCY DAVID PRICE lll, RMA DIRECTOR Community and Economic Development Department Engineering & Survey Services Department Environmental Health Services Department Planning Department Roads Department SUBJECT: NOTICE OF VIOLATION /ORDER TO COMPLY Location: 1999 TAFT HWY, BAKERSFIELD Known As: S AND W CHEVRON Permit #: Ladies and Gentlemen: FA0003910 / 320074 A file review was recently completed for the facility described above. The review was conducted to determine compliance with underground storage tank regulations and permit conditions. Violations identified were: Failure to complete and submit recertification of electronic monitoring systems on the under- ground storage tank system(s) (23 CCR 2630d and 23 CCR 2643(l)j). . Facility has not provided any documentation showing completion of an annual certification for the electronic monitoring equipment used on site. 2. Failure to complete the required inspections for the impressed current cathodic protection system installed at the underground storage tank site (Title 23 CCR, Section 2635a2A). The facility has not completed any of the required inspections of the cathodic protection system in place. All but the three-year recertification can be completed by staff familiar with required settings. This has not been completed or do mented. 3. Failure to complete a test of the secondary containme t systems to demonstrate that the system is capable of containing releases from the primary containment until a release is detected and cleaned up (H &SC 25284. 1 (a)(4)(B). Facility has not provided documentation showing that they have completed a test of the secondary containment for the tank or associated piping that makes up the underground storage tank system. r • State Water Resources Control Board Division of Water Quality 10011 Street • Sacramento, California 95814 • (916) 341 -5752 Mailing Address: P.O. Box 2231• Sacramento, California • 95812 FAX (916) 341 -5808 • Internet Address: http:ffwww.swrcb.ca.gov Gray Davis Winston H. Hickox Govetrwr Secretary for EnvironmentaThe energy challenge facing California is real. Every Californian needs to take immediate action to reduce energy consumption. Protection For a list of simple ways you can reduce demand and cut your energy costs, see our website at htip:/hvww.swrcb.ca.gov. AUG 2 2 2003 CERTIFIED MAIL 7003 0500 0004 5021 2405 Mr. Philip A. Welch, Vice President S & W Chevron 1999 Taft Highway Bakersfield, CA 93319 Dear Mr. Welch: DENIAL OF REQUEST FOR RECONSIDERATION OF ENHANCED LEAK DETECTION (ELD) TESTING: S & W CHEVRON, 1999 TAFT HIGHWAY, BAKERSFIELD, CA 93319 This letter is in response to your Request for Reconsideration of the requirement to perform ELD testing. We have consulted-with the Kern County Environmental Health and George Beal (water pury eyor),whghas confirmed that.your._facility is within 1,000 feet of a Beal Properties' public drinking water well. This well will' be connected to the Pumpkin Center Water District system and thus will remain active. Based on that, we have determined that your underground storage tank (UST) facility is subject to the ELD testing requirement. Your request has been denied for the reason(s) indicated below. [X UST. system(s) is within 1,000 feet of a public drinking water well. If you have any questions, please contact Mr. Ahmad Kashkoli at (916) 341 -5855. Sincerely, Eliza eth L. Haven, Manager Underground Storage Tank Program Enclosure(s): (basis for the decision) cc: Ms. Laurel Funk.... Kem County Environmental Health 2700 M Street, Suite 300 . - Bakersfield, CA 93301 California Environmental Protection Agency Recycled Paper �e1 ENVIRONMENTAL HEALTH SERAS DEPARTMENT STEVE McCALLEY, R.E.H.S., Director 2700 "M" STREET, SUITE 300 BAKERSFIELD, CA 93301 -2370 F Voice: (661) 862 -8700 Fax: (661) 862 -8701 TTY Relay: (800) 735 -2929 • e -mail: eh @co.kem.ca.us April 25, 2003 S AND W TRUCK STOP, INC 1999 TAFT HWY BAKERSFIELD, CA 93313 RESOURCE MANAGEMENT AGENCY DAVID PRICE Ill, RMA DIRECTOR Community and Economic Development Department Engineering & Survey Services Department Environmental Health Services Department Planning Department Roads Department Subject: Underground Storage Tank (UST) System Requirements Facility: S AND W CHEVRON, 320074 1999 TAFT HWY BAKERSFIELD Dear Sir or Madam, This department received the secondary containment test report dated December 3, 2002. This report indicates that the sumps failed the testing. The components that failed need to be repaired and retested. If the repairs can completed without breaking concrete a modification permit may not be required. If a modification permit is required, the current fee is $650. Once all repairs are completed, the secondary.c ontainment system is to be tested and the results submitted to this Department. This facility is currently out of compliance with the UST regulations. Failure to respond within the required time frame may result in enforcement actions by this Department. Please respond to this department in writing as to the status of the site testing by May 31, 2003. The system must be tested within 60 days of your response. If you wish to discuss these options, please contact Laurel Funk at (661) 862 -8763. Thank you for your cooperation in this matter. Sincerely, Steve McCalley, Director By: Joe Canas Hazardous Materials Specialist IV Unified Hazardous Materials /Waste Program STEVE McCALLEY, R.E.H.S., Director 2700 "M" STREET, SUITE 300 BAKERSFIELD, CA 93301 -2370 Voice: (661) 862 -8700 Fax: (661) 862 -8701 TTY Relay: (800) 735 -2929 e -mail: eh @co.kern.cmus S AND W TRUCK STOP, INC 1999 TAFT HWY BAKERSFIELD, CA 93313 October 25, 2002 SOURCE MANAGEMENT AGENCY DAVID PRICE 111, RMA DIRECTOR Community Development Program Department Engineering & Survey Services Department Environmental Health Services Department Planning Department Roads Department Subject: Secondary Containment Testing for Underground Storage Tank (UST) Systems Facility: S AND W CHEVRON, 320074 1999 TAFT HWY BAKERSFIELD Dear Sir or Madam, This Department has determined that the above mentioned facility is subject to the Secondary Containment Testing Requirements. The deadline for completing the testing is January 1, 2003. . As of this date, the results have not been submitted to this Department. Enclosed is information from the State Water Resources Control Board reminding tank owners of this requirement. If for some reason you feel that this information is incorrect, please contact this Department. The Hazardous Materials staff is available at (661) 862 -8700 to answer any questions you may have. Thank you for your prompt attention to this matter. Sincerely, Steve McCalley, Director By: Joe Canas Hazardous Materials Specialist IV Unified Hazardous Materials/Waste Program Enclosures 9 0 0 S AND W TRUCK STOP, INC. June 30, 2004 Re: FA0003910 Page 2 It is imperative that you take action to abate the listed violations. Please contact this office by tele- phone or provide information showing compliance with the violation(s) listed above. You are strongly urged to resolve this matter by July 31, 2004, in order to prevent the assessment of enforcement penalties. Please direct all correspondence or questions to Michael F. Driggs at (661) 862 -8744. Sincerely, Steve McCalley, Director a By: Joe Canas, R.E.H.S. Environmental Health Specialist IV Unified Hazardous Materials/Waste Program JC:AG :jrw (hm\green \ust compliance letter) STEVE McCALLEY, R.E.H.S., Director 2700 "M" STREET, SUITE 300 BAKERSFIELD, CA 93301 -2370 Voice: (661) 862 -8700 Fax: (661) 862 -8701 TTY Relay: (800) 735 -2929 e -mail: eh@co.kern.ca.us S AND W TRUCK STOP, INC 1999 TAFT HWY BAKERSFIELD, CA 93313 July 15, 2002 *SOURCE MANAGEMENT AGENCY DAVID PRICE 111, RMA DIRECTOR Community Development Program Department Engineering & Survey Services Department Environmental Health Services Department 0 Planning Department Roads Department Subject: Updated Underground Storage Tank (UST) Monitoring and Response Plans Facility: S AND W CHEVRON, FA0003910 1999 TAFT HWY BAKERSFIELD Dear Sir or Madam: The Kern County Environmental Health Services Department has recently reviewed the underground storage tank (UST) files. Many facilities do not have current and/or approved monitoring plans, response plans, and plot plans on file with this Department. These plans are to be submitted to and approved by this Department for each facility. Copies of the plans are to be kept at each facility site with the Unified Hazardous Materials /Waste Facility Permit. If you feel that you have already submitted these plans, please contact this Department to have your file reviewed. The submitted plans will be reviewed for completeness and you will be notified if updated plans are required. To assist you in completing these plans, the following forms have been enclosed: ' Monitoring Plan Cover Sheet*: This form is to be completed for each facility and attached to the monitoring plan developed for the facility. Monitoring Requirement Options *: This is a list of various options that facilities can use to monitor most UST systems. You may develop your monitoring plan(s) by picking and choosing the options that apply to the site. Specific site information is necessary to complete the monitoring plan. Samples of Log Forms: Most monitoring plans require the logging of inspections and test results. These forms may be used for that purpose. ' Emergency Response Plan Form *: This form is to be completed for each facility. In addition to the above information, a plot plan for the facility is to be submitted which shows the location of the tanks, monitoring sensors, buildings, alarm panels, and rectifiers. The plot plan is to be on an 8 1/2 x 11 sheet of paper. The forms noted with a * are available in Word and Word Perfect format. If you would like to receive the forms electronically, please e-mail your request to laurelf @co.kern.ca.us and the. forms will be sent to you. Copies of the Monitoring, Response, and Plot Plans are to be submitted to this Department within 30 days of the date of this letter. If the facility owner is not contacted within 30 days of submittal, the plans are considered approved by this Department. The permit holder must notify this Department within 30 days of any changes to the monitoring, response, and plot plans. Thank you for your cooperation in this matter. If you have any questions, please contact the Hazardous Materials staff at (661) 862 -8700 Sincerely, Steve McCalley, Director By: Joe Canas, REHS Hazardous Material Specialist IV Unified Hazardous Materials /Waste Program JC:lf Enclosures ENVIRONMENTAL HEALTH SERVICES DEPARTMENT STEVE McCALLEY, R.E.H.S., Director 2700 "M" STREET, SUITE 300 BAKERSFIELD, CA 93301 -2370 Voice: (661) 862 -8700 Fax: (661) 862 -8701 TTY Relay: (800) 735 -2929 e -mail: eh@co.kern.caus S AND W TRUCK STOP, INC 1999 TAFT HWY BAKERSFIELD, CA 93313 November 30, 2001 *3 ,Qoo7q RESOURCE MANAGEMENT AGENCY DAVID PRICE 111, RMA DIRECTOR Community Development Program Department Engineering & Survey Services Department Environmental Health Services Department Subject: Underground Storage Tank (UST) Requirements and Deadlines Facility: SAND W CHEVRON, FA0003910 1999 TAFT HWY BAKERSFIELD Planning Department Roads Department The State of_California has established new regulations for underground storage tanks. All UST files have been reviewed by this Department for compliance with both existing and these new regulations. The facility listed above must meet the following requirements to maintain compliance with current regulations. Secondary Containment Testing The following systems have at least one component which is secondarily contained (i.e., tank, piping, sump, or dispenser containment). Any tank using hydrostatic or vacuum monitoring is not required to be tested, however; piping, sumps, and dispenser containment still require testing. The secondary containment system is to be tested by the date listed below and every 36 months thereafter. If the date has already passed, the test must be completed within 60 days of this letter. If the system is untestable by an approved method, the system shall be tested by Enhanced Leak Detection (ELD). The facility shall have an ELD program reviewed and approved by this Department by July 1, 2002; implemented. by December 31, 2002; and the secondary containment system replaced by July 1, 2005. The testing and ELD requirements are enclosed. Tank # Tank Size Product Stored Test Due Date 1 20,000 UNLEADED 01/01/2003 2 15,000 PREMIUM 01/01/2003 3 8,000 DIESEL 01/01/2003 In addition to the above - mentioned requirements, all monitoring equipment shall be calibrated, operated and maintained in accordance with the manufacturers' instructions. The equipment shall also be certified for proper operating condition and calibration every 12 months. All testing is to be completed by a licensed or approved tester. Permits may be required for some of the tests. This Department shall be notified at least 48 hours prior to conducting any tests or inspections. The results of the test are to be submitted to this Department within 30 days of completion. If for some reason the owner or operator of this facility believes that the above information is incorrect, please contact this Department. An inspection and file review can be completed to clarify and /or correct the information. 0 r S AND W TRUCK STOP, INC SAND W CHEVRON, FA0003910 November 30, 2001 Page #: 2 California Air Resources Board (CARB) has implemented additional requirements for Enhanced Vapor Recovery. While the CARB requirements are separate from the UST requirements, modifications to comply with these requirements may activate the CARB requirements. Please contact the local Air District for assistance prior to making any modifications to this facility. Please contact the Hazardous Materials staff at (661) 862 -8700 if you need any assistance. Sincerely, Steve McCalley, Director By: Joe Canas, REHS Hazardous Material Specialist IV Unified Hazardous Materials/Waste Program r � CA Cert. No. 06530 Kern County Environmental Health Services Department Steve McCalley, R.E.H.S., Director 2700 M Street, Suite 300 Bakersfield, CA 93301 -2370 Voice (805) 862 -8700 FAX (805) 862 -8701 E -Mail: eh @co.kern.ca.us An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to the issuing agency: Use the space below to enter the following information in the format of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. Facility: S AND W CHEVRON, 003910 Location: 2166 TAFT HIGHWAY BAKERSFIELD, CA 93313 Owner: S AND W TRUCK STOP 2701 SIERRA VISTA STREET BAKERSFIELD, CA 93306 UST Site ID: 320074 BP Site ID: 003290 Issue Date: April 2000 %Y State of California 1W State .&f 1Water Resources Control Board Division of Clean Water Programs ; s P.O. Box 944212 Sacramento, CA 94244 -2120 (Instructions on reverse side) , CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: 500,000 dollars per occurrence -' 1 million dollars annual aggregate or AND LAJ or 1 million dollars per occurrence 2 million dollars annual aggregate B. hereby certifies that it is in compliance with the requirements of Section 2807, ( o ank Owner o opera r) Article 3, Chapter 1 , Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: 07 a 5��. ��►� � use ,�S x �p �s .V y (41 W7 �0 � -6, (�i C/ 'Cj 33j Aul d u G� Aow ', L M � Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certifies that you are in compliance with all conditions for participation in the 'Fund. D. Facility Name Facility Address 9q.1 3 Facility Name Facility Address Facility Name Facility Address E. Signature of Tank Owner or Operator Date . Name and Title of Tank Owner or.Operator - o� yY7, Slgn r Vne s ota Date Name of Witness or Notary CFR (Revised 04/95) FILE: Original -Local Agency Copies - Facility/Site(s) 0 0 0 a UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - FACILITY INFORMATION ' (One form per facility) TYPE OF ACTION ;Rr-,. NEW PERMIT 5. CHANGE OF INFORMATION ❑ 7. PERMANENT FACILITY CLOSURE 4V0' (ChCCA Ono item only) 3. RENEWAL PERMIT ❑ 6.-TEMPORARY FACILITY CLOSURE ❑ 9. TRANSFER PERMIT .:iM,l .�x "H :r�'i fir:•: . 6:. r J40t TOTAL NUMBER OF USTS AT FACILITY FACILITY D># 'r ct + F(Agency l se Only) �11 1 // Y BUSIN SS NAME (Same as Facility Name or DBA -Doing Business ids) L 1.Vt BUSINES SITE ADDRESS� t 103, CITY JO4• - Q - Q' l C� �.t�� Pt FACILITY TYPE '%-L. MOTOR VEHICLE FUELING ❑ 2. FUEL DISTRIBUTION .403, Is the facility located on Indian Reservation or 405. 3. FARM 4.- PROCESSOR D 6. OTHER TrLLst lands? ❑ 1. Yes J2;, 2. No yw l 1 • � � - ERT`''��.Of it A.RMA ISO - l ... ,. •,:RSID'-+•'1±�r,� •,- ...:ri,` +ry. .1, ..,��'w':�.�1:•. :- :li};': •.'S''�:, PROPERTY OWNER NAME 407 PHONE 408' T- , (L . :T_: IBC. f / ---i ptm C�CC�o� MAILING ADDRESS. 409. P92 7ME-C CITY 410' STATE 411• ZIP CODE 4tz. . .. .. ,.::.•:• ...: ..:„ a.,,.;.:. v.:.., •; n:•". '::•:rl ..,. ,.:.. .,1n } ^I,: yS.: �. ,1 .' Ri N r..L:f: ,.f.s_:i... .ur:. - •k.. .: t• ';1- 1. („ .vN . 1 i 1d.w:yHr,1< Y•: ,L'11�4d1If1 \!rM i^:, :.:eA'I:+ I S:'t: , ::'�'.•;- - c y %�!�:�'1�+����•,I��T �'' ;;:I ..ti ?r .�f r M • �st`� . � day ,.� `.•';i`. �i�'li; ..rr`P +'<e..t,.a;,- .4L•Yd''��,.t. = ;+7- 1.r:`J:n t'C - ''F ,i '.1.,. � �.Y�'T':�i'..,.-• .ar' ��,.:? r. :...ir ,• .....:.r ,„.r.l. .r... :�z•�°+, ��:t1 I.'` .`LnIYU:S�:l`.101:'k r..., .i.v, 4r.;jr;: r�� ✓•F �).• :;$Y -E i:Y:.1•'� .- ...:.� ,r...:..:i.. ....t :, ..!- ::. ".:.r. .. .:xr,r- '-r,}.��c::.a;L.: . +,. -F��� - TANK OPERATOR NAME 428-1 • PHONE 428 -2• l MAILING ADDRESS 428-3• CITY 428.4. STATE 428.5. ZIP CODE 428.6• .._..... :.. ..�rf•!:,.::_.:j.. -:- v':,,.. .. 1'1•. �ti 'i+:" :4: !::mac'_ il,: -.1•. •Y4. r7'1 fir. , - '...J.`.J..:.e.. ...,. ,.. .. r.._ ..,..,.•. r.,. +..... ,:z.,,'e .. A., _ ::xtr::i::J6�f.C't ;4 ,I,,.,. . }...• .9, i° `��:.w -J" " t � lii;! "'' - ;ems "..l.J::;;:i �:r :'•pn` }��7�i::! -. {!. a -.:' ... .R .iii t.:.._.' -.,. 't - .1/•1 . a,d l %`;. =�. .... r �'�1Jr17,'.. ,.1. .•:7.,'�., - . . ..: ^ ". :•r r.:....... �'�r: �Y:. '•'•:!fci, :: !::.• ::r li ii�:yi.:.. `l' .r.f!'.'. ,rN.,:.i.?" .�• dd'' `.IJ J i ... .,:1'.Y:� :::3,a. ,k, J ,h _...,., .:: ...•. �1...- .... ,J,c,.J•.., . -b: -� i. [<n.4.r:.. d•.Ci -.,. ,r�2'�� -. -. .u2!.:�In .I' ut.�.: i:,r 38'tir.'1t `:.i�! -ter, f4':v`• :•a`. .r:ir. TANK OWNER NAME 414. PHONE 415. ( UL0 i -� MAILING ADDRESS 416• CITY 417. STATE 41s. ZIP CODE 419. OWNER TYPE: ❑ 4. LOCAL AGENCY/DISTRICT ❑ 5. COUNTY AGENCY ❑ 6. STATE AGENCY 420. ❑ 7. FEDERAL AGENCY$. NON - GOVERNMENT '.:::.':.4..: .r ...�...r. ry:•.:•- .:�y.'i.r: �:):: 'If;�., 4':t -=•e ul.A: ti,:•:.t.',_"/Y1(' ,.ttp'y- :�':i":.KY•i:li,.- _ •,.i:Y :, ..lr •. '1.iM1.1•t is ^ -� ,a!�� !!! �ir.V rY- 'j ��(J�':i 1f. k r� .O.r %h: 'fi/.0� .V' l'O uV•V .f' T Y CTK) HQ 44- Call the State'Board of Equalization,' Fuel Tax Division, if there are questions. 421' �U'.tOiN ".:.}r4 : >!i S'l[.W.;,:;•.1:. :.J:v.n.x!•V:i' :i:Mq:.C:•SYp�: I.fi,- .,)�.: ;V�:'.P!FJ � �':� •IC:;Il�+��R1U,I'� _ -�;�� .,'�. �:. � �.. �`t x �Y ;•^3:;.c., ::y'.� - u7:'tS�;�:- ..r -. yS i. .'4:i?t.. ,•,.r .. �.,...4. •..Y�,...m. .t... -., .ti r.;`a••- •a�::.!, ... �:, .. ,,. -�I.O _ i .,,.; . • r . •'•i. t•• 4.v _ �+'ir'.iJ: •.x.1,.4.: %.: .=:Yi: 'l:(lr.. .J r! -r Issue permit and send legal-notifieationsand mailings to: 'Al. FACILITY OWNER ❑ 4. TANK OPERATOR 423. ❑ 3. TANK OWNER ❑ 5. FACILITY OPERATOR SUPERVISOR OF DIVISION, SECTION, OR OFFICE (Required for Public Agencies Only) 406. J:. �..::. t y 7 r,! .. ... ...r.r. rat .,. ....,. a:• i A �T'�;S ...r � .:,i:•. -al CERTIF! N: I certify that the information provided herein Is true, accurate, and in full compliance: with le a uirements. APPLIC SICUATURE -' DATE 424• .o�_� - PH NE 425. 6 a 8 -, APPLICANT N nt)n 426. APPLICANT TITLE 427 VLQ-li UPCF UST•A Rev. (1212007). 1/2 www.unidocs.org J e LJ4 �-,k (,Q, 5 it"I' A' VLIA • d 10&114V_� eEE :6Q BD SO unC Alk UW1ED PROGRAM CONSOLIDATED-FO RMW UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - TANK INFORMATION (One form per UST) TYPE-OFACTION (Check one item only. For a UST closure or removal, complete only this section and Se&aj 1, A 111, IV and.LV below) 430. 12r.a. NEW PERMIT [:1 3. RENEWAL PERMIT �&J. CHANGE OF INFORMATION r3 G. TEMPORARY UST CLOSURE 7. UST PERMANENT CLOSURE ON SITE 8. UST REMOVAL DATE LIST PERMANENTLY CLOSED: 4302. DATE EXISTING UST DISCOVERED! 4301, em O'RM FACILITY ID tl (Agency Use Only) BUSINESS NAME (Same as Facility Name or DBA-- Doing Business AS) BUSINESS SITE ADDPESS- 103. CITY 104. LCR9 HuY4, V., T TANK ID # 431 TANK MANUFACTURER 433• T. 434. �W CONFIGURATION: THIS TANK, IS k F uxr- D ' . A STAND-ALONE TANK Complete one pusc for each E 2 ONE IN COMPARTMENTED UNIT comommeru In the unit. - DATE LIST SYSTEM INSTALLED 435 TANKCAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. ill Z-1 De7V-*a '20, eno 41AND ��'db" --TAN TANK USE A-!&, MOTOR VEHICLE FUE . LING [3 1b. MARINA FUELING [3 !c. AVIATION FUELING 439. ❑ 3. CHEMICAL PRODUCT STORAGE ❑ 4. HAZARDOUS WASTE (Includes Used oil) ❑ 3. EMERGENCY GENERATOR FUEL JHSC §25281.5(c)1 ❑ - 6. OTHER GENERATOR FUEL ❑ 9S. UNKNOWN ❑ 99.9 R {SpecifL 439a. CONTENTS PETROLEUM: -Xia. REGULAR UNLEADED le. MIDGRADE UNLEADED ❑ Ih. PREMIUM UNLEADED 440• ❑ 3, DIESEL ❑ 5. JET FUEL ❑ 6. AVIATION GAS ❑ 6, PETROLEUM BLEND FUEL ❑ 9.OTHER PETROLEUM gSpccify2: 445311 NON-PETROLEUM: ❑ 7. USED OIL 10. ETHANOL ❑ t I. OTHER NON•PETROLEUM (Sw(IM: 4401t. "R" N A' TYPE OF TANK 1, SINGLE WALL 12F.-I DOUBLE WALL 95. UNKNOWN PRIMARY CONTAINMENT. ❑ L STEEL . . 'W3. FIBERGLASS ❑ 6. INTERNAL BLADDER ❑ 7. STEEL + INMRNAL LINING ❑ 93. UNKNOWN ❑ "-OTHER iry): 44411 SECONDARY CONTAINMENT ❑ 1. STEEL :W-J1, FIBERGLASS ❑ 6. EXTERIOR MEMBRANE LINER ❑ 7. JACKETED 4456 ❑ 90. NONE ❑ 95. UNKNOWN ❑ 996 OTHER (Specify): 445a OVERFILL PREVENTION ❑ 1. AUDIBLE &VISUAL ALARMS 4X2. BALL FLOAT J04. FILL TUBE SHUT-OFF VALVE 4. TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT PIPING CONSTRUCTION 1. SINGLE WALL 0-;, DOUBLE WALL ❑ 99. OTHER 460._ SYSTEM TYPE Iff-4. PRESSURE ❑ 2. GRAVITY Q 3. CONVENTIONAL SUCTION ❑ 4 SAFE SUCTION [23 CcR §Mm(a)(M 52, PRIMARY CONTAINMENT [1 I. STEEL ❑ 4. FIBERGLASS ❑ S. FLEXIBLE 39-JORIGIB PLASTIC .464. ❑ 90. NONE -[1 95. UNKNOWN ❑ 99. OTHER (Specify): 464L SECONDARY CONTAINMENT ❑ I. STEEL ❑ 4. FIBERGLASS ❑ 8. FLEXIBLE -�JO. RIGID PLASTIC i64b7 ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99_OTHER(§Rceif f); 464c. PrPrNGnVRBINE CONTAINMENT SUMP TYPE OLI. SINGLE WALL 2. DOUBLE WALL ❑ 90. NONE 4644L A Ow U -1 -T VENT PRIMARY CONTAINMENT ❑ 1. STEEL %A. FIBERGLASS ❑ 10, RIGID PLASTIC ❑ 90. NONE ❑ 99.'OTHER Secify): 464C. (p '6401. 1 464L VENT SECONDARY CONTAINMENT 0 1. STEEL ❑ 4. FIBERGLASS [3 10. RIGID PLASTIC ji;-90. NONE [3 99. OTHER (Specify): 464n. VR PRIMARY CONTAINMENT •4 1. STEEL ❑ 4 FIBERGLASS ❑ 1 D. RIGID PLASTIC ❑ 96. NONE ❑ 99. OTHER (Specify): 464g. 464 ) 2W VR SECONDARY CONTAINMENT ❑ 1. STEEL JXA, FIBERGLASS ❑ [3 10. RIGID PLASTIC ❑ [3 90. NONE ❑ 0 99. OTHER (Specify): '6 � 464h). VENT PIPING TRANSITION SUMP TYPE ❑ 1. SINGLE WALL ❑ 2. DOUBLE WALL 1240. NONE 4(A5. RISER PRIMARY CONTAINMENT 4 STEEL C) 4. FIBERGLASS C3 10.11IGIDPLASTIC C3 90. NONE ❑ 99. OTHER ;0`4. (Specify): 464 . ij, RISER SECONDARY CONTAINMENT ❑ 1. STEEL FIBERGLASS ❑ tO. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify). 464k. 4601. FILL COMPONENTS INSTALLED 19J. SPILL BUCKET J&3, STPUMP PLATFIBOTTOM PROTECTOR :9J. CONTAINMENT SUMP N CONSTRUCTION TYPE SINGLE WALL ❑ 2. DOUBLE WALL 3. NO DISPENSERS ❑ 90. NONE 46911, ................. 7 CONSTRUCTION MATERIAL ❑ 1. STEEL 04. FIBERGLASS ❑ 10. RIGID PLASTIC 99. OTHER (Specify) 4697 "-z 7. STEEL COMPONENT PROTECTION 1:3-2. SACRJFICIAL ANODE(S) ❑ 4. IMPRESSED CURRENT ❑ 6. ISOLATION 442. 2 Z Z. CERTIFICATION: I certify that this- UST system Is compatible with the hazardous substance stored and that the Information provided herein is true, - accurate, an full compliance with le al requirements. APPLICANT SIGNATURE' DATE -'L I . -2-t- L APPLICANT NAME (print) 471. APPLICANT TITL E 472. tyw�p'nA- V"A A-'--1A .1 L, UPCF UST-B Rev. (1212007) -112 www.unidoes.org -cl et,6:60 80 go 0 a F-1 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only: For a UST closure or removal, complete only this section and Sections 1, ll, Ill. IV. and L1 below) 430. 1. NEW PERMIT ❑ 3. RENEWAL PERMIT I 7fL4. CHANGE OF INFORMATION ❑ 6. TEMPORARY UST CLOSURE 7. UST PERMANENT CLOSURE ON SITE 0 & UST REMOVAL DATE UST PERMANENTLY CLOSED: 430E DATE EXISTING UST DISCOVERED. 430b. x. FACILITY INFORMATION FACILITY ID -9 (Agcner Use Only) - t 1- BUSINESS NAME (Same as Facilip+ Name or DBA - Doing Business As) 3• 7 BUSINESS SITE ADDRESS 103 CITY 104 :. .'..II TANK -DESCRIPTION. :::.:.:: •' :. WANK ID # 432. TANK MANUFACTURER 133• O TANK CONFIGURATION: THIS TANK IS 434• . A STAND -ALONE TANK Complele one page (or each 2 ONE M A COMPARTMENTED UNIT in the unit DATE UST SYSTEM INSTALLED 435• uA 2 TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. l III:° :'TAN) {USE AND CONTENTS..:::: TANK USE MOTOR VEHICLE FUEUNG ❑ 1b. MARINA FUELING ❑ lc.'AVLATION FUELING 439• 3. CHEMICAL PRODUCT STORAGE ❑ 4. HAZARDOUS WASTE (Includes Used Oil) ❑ 5. EMERGENCY GENERATOR FUEL IHSC f=a15(e)I ❑ 6. OTHERGENERATOR FUEL ❑ 95. UNKNOWN ❑ 99.OTHER (S' eci : 4391. CONTENTS PETROLEUM: ❑ la. REGULAR UNLEADED ❑ la MIDGRADE UNLEADED tXlb. PREMIUM UNLEADED 440. ❑ 3. DIESEL ❑ 5. JET FUEL U KAVIATION GAS _ Q S. PETROLEUM BLEND FUEL ❑ 9. OTHER PETROLEUM (Specify 440x. NON - PETROLEUM: ❑ 7. USED OIL 10. ETHANOL ❑ )1. OTHER NON - PETROLEUM (S cifY): 440b. ;T 'K CUNSTRT3CT'ION TYPE OF TANK [] 1. SINGLE tVALL DOUBLE WALL ❑ 95. UNKNOWN 443. PRIMARY CONTAINMENT ❑ 1. STEEL FIBERGLASS ❑ 6. INTERNAL BLADDER +++ ❑ 7. STEEL t INTERNAL LINING .❑ 95. UNKNOWN ❑ ".OTHER (Specify): 4444a SECONDARY CONTAINMENT ❑ 1. STEEL FIBERGLASS ❑ 6. EX- TERIOR MEMBRANE LINER ❑ 7. JACKETED 445. ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER S ifv . 44U OVERFILL PREVENTION ❑ 1. AUDIBLE & VISUAL ALARMS BALL FLOAT 404 FILL TUBE SHUT -OFF VALVE -4S =• ❑ A. TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT ;:.:V"PRODU.CTJ4't�STE PIPING CONS.TI2UCTION''.:. ; .:.. ; ....:.... PIPING CONSTRUCTION ).,SINGLE WALL DOUBLE WALL ❑ 99. OTHER 460 SYSTEM TYPE •hi. PRESSURE ❑ 2.GRAVITY Q 1. CONVENTIONAL SUCTION [] 4. SAFE SUCTION 123 GCR §2d16(a)g)j_ 458. PRIMARY CONTAINMENT ❑ L STEEL ❑ 4. FIBERGLASS ❑ 9. FLEXIBLE 9.10. RIGID PLASTIC 464• ❑ 90. NONE ❑ 95.UNKNOWN ❑ 99.071HERS ): 461a. SECONDARY CONTAINMENT ❑ 1. STEEL ❑ 4. FIBERGLASS ❑ S. FLEXIBLE 10. RIGID PLASTIC 04b. ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99.0THER (Specify); 464c. PIPINGfrIMINE CONTAINMENT SUMP TYPE 1. SINGLE WALL ❑ 2. DOUBLE WALL ❑ 90. NONE 4e4d. vI:". ENT VAPOR RECOVERTi? =(X?Rj AND RISE lFILL-PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT ❑ I. STEEL FIBERGLASS E3 10. RIGID PLASTIC [j 90. NONE ❑ 99.OTHER (Specify): q46 c VENT SECONDARY CONTAINMENT ❑ I. STEEL ❑ 4. FIBERGLASS ❑ ]0. RIGID PLASTIC �90. NONE ❑ 99. OTHER (Specify): 4644. VR PRIMARY CONTAINMENT JELL STEEL r3 4. FIBERGLASS [3 I0. RIGID PLASTIC [3 90. NONE 99. OTHER (Speci(y): 46a t _❑ VR SECONDARY CONTAINMENT ❑ I. STEEL �KC FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify): 464iu. VENT PIPING TRANSITION SUMP TYPE ❑ L SINGLE WALL [3 2. DOUBLE WALL -fi&90. NONE 4641. RISER PRIMARY CONTAINMENT STEEL C] '4. FIBERGLASS ❑ 10. RIGID PLASTIC C) 90. NONE [3 99.OTHER (Specify): 467. RISER SECONDARY CONTAINMENT ❑ 1. STEEL %A. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99.OTHER (Specify): 4464k. FILL COMPONENTS INSTALLED SPILL BUCKET . STRIKER PLATE/B07TOM PROTECTOR . CONTAINMENT SUMP 4512.c CONSTRUCTION TYPE SINGLE W ALL 2. DOUBLE WALL Q 3. NO DISPENSERS 90. NONE 469u. CONSTRUCTION MATERIAL ❑ L STEEL a, FIBERGLASS . ❑ 10. RIGID PLASTIC ❑ 99.OTHER (Specify) 469b. STEEL COMPONENT PROTECT70NI ❑ 2. SACRIFICIAL ANODE(S) ❑ 4. IMPRESSED CURRENT ❑ 6. ISOLATION 448•. IX -: APPLICANT SIGNATURE'. ; CERTIFICATION: I cer(Ifj- that this. UST system Is compatible with the hazardous substance stored and that the Information provided herein is true, accu d In full cam liance with legal requirements. , APPLICANT SIGNATURE DATE 47D APPLICANT NAME (print) J , 4iI' APPLICANT TITLE. ,Vt�Lo 472. UPCF UST-11 Rev. (12/200'1) - I/2 www.uoldocs.org E'd ESE =60 eQ SO UDC a r1 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - TANK INFORMATION (One forth per UST) �E OF ACTION (Check one item only. For a UST closure or removal, complete only this section and Sections 1, 11, 1U, IV, and LC below) 1. NEW PERMIT ❑ 3. RENEWAL PERMIT 2CS. CHANGE OF INFORMATION 6. TEMPORARY UST CLOSURE 7. UST PERMANENT CLOSURE ON SITE Q 8. UST REMOVAL 4J0 DATE UST PERMANENTLY CLOSED: 430& 1 DATE EXISTING UST DISCOVERED: 430 I: F,cILITY IZVFORMATION . FACILITY ID # (Agency Use Onti9 -' - ' 11 BUSINESS NAME (Same as Facility Name or DBA -Doing Business As) 3. BUSINESS SITE ADDRESS 103. jqqq 4LZY., CITY 104. DESCRIPTION ..::. • ::. ... : : . TANK ID # 432, TANK MANUFACTURER 433. m TANK CONFIGURATION: THIS TANK IS 434• A STAND -ALONE TANK Cemylele one page fercach 2.ONE IN A COMPARTMENTED UNIT computmau in the unit. DATE UST SYSTEM INSTALLED 435• TANK CAPACITY IN GALLONS 436, NUMBER OF COMPARTMENTS IN THE UNIT 437• •TANK USE AND CONTENTS TANK USE �a MOTOR VEHICLE FUELINO ❑ Ib. MARINA FUELING ❑ Ic. AVIATION FUELING 439' U 3. CHEMICAL PRODUCT STORAGE ❑ 4. HAZARDOUS WASTE (I d, es Used OiI) 11 5. EMERGENCY GENERATOR FUEL INSC I_5283.50) ❑ 6. OTHER GENERATOR FUEL ❑ 95. UNKNOWN ❑ 99. OTHER (Specify) : 439a. CONTENTS PETROLEUM: ❑ I%. REGULAR UNLEADED ❑ Ic. MIDGRADE UNLEADED ❑ 1b. PREMIUM UNLEADED fi5.3, DIESEL O 5. JET FUEL ❑ 6. AVIATION GAS ❑ S. PETROLEUM BLEND FUEL ❑ 9. OTIIBA PETROLEUM S Lmfv : 440.1. 440• NON - PETROLEUM: ❑ 7. USED OIL 10. ETHANOL ❑ 11.OTHER NON - PETROLEUM (Specify): 44ft TANK CONSTRUCTION ° .;`::.: `` :::. • .. TYPE OF TANK 1. SINGLE WALL . DOUSLE WALL Q 95. UNKNOWN ;43• PRIMARY CONTAINMENT ❑ 1. STEEL . jRr4. FIBERGLASS ❑ 6. INTERNAL BLADDER ' - ❑ 7. STEEL T INTERNAL LINING ❑ 95..UNKNOWN ❑ 99. OTHER (Spec): 444a. 44." SECONDARY CONTAINMENT ❑ L STEEL .04. FIBERGLASS ❑ 6. EA'TERIOR MEMBRANE LINER ❑ 7. JACKETED CI 90. NONE ❑ 95. UNKNOWN ❑ 99. HER (Specify): 445i 445• OVERFILL PREVENTION ❑ L AUDIBLE & VISUAL ALARMS W-,1. BALL FLOAT 1�. FILL TUBE SHUT -OFF VALVE ❑ 4. TANK MEETS RE UIREMENI'S FOR EXEMPTION FROM -OVERFILL PItF%TNTION EQUIPMENT _ 4 == :'VPRODUC:WASZ`E.PIP7NG CONSTRUCTION '. PIPING CONSTRUCTION ❑ 1. SINGLE WALL IF:j2. DOUBLE WALL _f�99, OTHER 460, SYSTEM TYPE � PRESSURE ❑ 2. GRAVITY 3. CONVENTIONAL SUCTION 4. SAF£ SUCTION f25 CCa §26 6w(3& t59. PRIMARY CONTAINMENT ❑ 1. STEEL ❑ 4. FIBERGLASS ❑ S. FLEXIBLE 10. RIGID PLASTIC ❑ 90. NONE ❑ 95. UNKNOWN [199. OTHER S ecify): 464L 464• SECONDARY CONTAINMENT ❑ L STEEL ❑ 4. FIBERGLASS ❑ B. FLEXIBLE 10. RIGID PLASTIC ❑ 90. NONE ❑ 95. UNKNOWN ❑ 99. OTHER (Specify): 464c. 464b. PIPING/TURBINE CONTAINMENT.SUMP TYPE ❑ 1. SINGLE WALL D 2. DOUBLE WALL ❑ 90. NONE 464d. VL YENTiVAPORRECOVERX (VR)•AND RISER] FILL-PIPE PBING CONSTRUCTION ' VENT PRIMARY CONTAINMENT ❑ L STEEL jEf-A. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99.0THL•R (Specify): 4464 VENT SECONDARY CONTAINMENT ❑ I. STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC .f 90. NONE ❑ 99. OTHER ( cifV � T S ^' Pe . ) 4 ' 464n. VR PRIMARY CONTAINMENT t' I. STEEL O 4• FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify): 46 A! r VR SECONDARY CONTAINMENT ❑ 1_ STEEL j�.4. FIBERGLASS ❑ 10. RIGID PLASTIC C3 90. NONE C1 99. OTHER (Specify): 4641,1 _VENT PIPING TRANSITION SUMP TYPE ❑ 1. SINGLE WALL ❑ 2- DOUBLE WALL 13�90. NONE 4= RISER PRIMARY CONTAINMENT . STEEL ❑ 4. FIBERGLASS ❑ 10. RIGID PLASTIC ❑ 90. NONE ❑ 99. OTHER (Specify): RISER SECONDARY CONTAINMENT ❑ i. STEEL 13-4. FIBERGLASS D 10. RIGID PLASTIC ❑ 90, NONE ❑ 99: OTHER (Specify): 46461' FILL COMPONENTS INSTALLED t. SPILL BUCKET 3. STRIKER PLATFA07TOM PROTECTOR IXA. CONTAINMENT SUMP 4 la-c. 'VII: • XTNDER DISPENSER CONTAl1�IMENT. (iJDC) .: :..: '. CONSTRUCTION TYPE L. SINGLE WALL ❑ 2._ DOUBLE WALL _ ❑ 3. NO DISPENSERS ,�j 90. NONE __. 469& CONSTRUCTION MATERIAL ❑ 1. STEEL �. FIBERGLASS ❑ K0. RIGID PLASTIC ❑ 99.OTHER (Specify) 4696. 469e. VM ; CORROSION PPROiTECTION :. ..::.'.:. '.. ; STEEL COMPONENT PROTECTION ❑ 2. SACRIFICIAL ANODE(S) ❑ 4. IMPRESSED CURRENT D 6. ISOLATION 448• .; .. : � IXAPPi;ICANT•SIGNATURE" � . = :...:..:; . CERTIFICATION: I eertifr that this. UST system is compatible with the hazardous substance stored and that the information provided herein is true, ncc nd In full compliance with legal requirements. APPLICANT SIGNATLRE DATE 470' APPLICANT NAME (pri nt 471' APPLICANT TITLE, �,�� p 47' J l LIPCF UST -B Rey. (1212007) -1/2 l N•wl+•.unldoa.org b•C1 e9E :60 8D SO unC r1 Adak UNIFIED PROGRAM CONSOLIDATED FOR UNDERGROUND STORAGE TANK CERTIFICATION OF INSTALLATION] MODIFICATION, '(One form per project) I: FACILITY INFORMATION FACILITY ID # (Agenry Use Qnly) BUSINESS NAME (Sane as Facility, N mme or DBA —Doing Business As) 3• BUSINESS SITE ADDRESS 103. CITY 109• Y_ z sF -� II. INSTALLATION / MODIFICATION PROJECT DESCRIPTION TYPE OF PROJECT (Check all that annlvl 481L WORK AUTHORIZED UNDER PERMIT assn. ❑ 1. TANK INSTALLATION OR REPLACEMENT (Number or Date): ❑ 2. PIPING INSTALLATION OR REPLACEMENT ❑ 3. SUMP INSTALLATION OR REPLACEMENT ❑ 4. UNDER DISPENSER CONTAINMENT INSTALLATION OR REPLACEMENT 5. OTHER DESCRIPTION OF WORK BEING CERTIFIED: 483c. III. CONTRACTOR INFORMATION NAME OF CONTRACTOR WHO PERFORMED INSTALLATION / MODIFICATION 4aza CONTRACTOR LICENSE # M" ICC CERTIFICATION # 482` IV. CERTIFICATION I certify that the information provided herein is true, accurate, and that the following conditions have been satisfied: • The installer has met the requirements set forth in 23 CCR §2715; subdivisions (g) and (h). • The underground storage tank, any primary piping, and any secondary containment was installed according to applicable voluntary consensus standards and any. manufacturer's written installation instructions. • All work listed in the manufacturer's installation checklist has been completed. ' • The installation has been inspected and approved by the local agency, or if required by the local agency, inspected and'certified by a registered professional engineer having education and experience with underground storage tanks stem installations. SIGNATURE OF TANK OWNER OR OWNER'S AGENT DATE 484. PHONE 497. ` CER S R' N ME (print) 485' CERTIFIER'S TITLE: 486' NAME 0 CERTIFIER'S EMPLgER /BA) 4H8' Cc � CERTIFIER'S RELATIONSHIP TO TANK OWNER 489' ❑ 1. TANK OWNER ❑ 2. TANK OPERATOR 3. CONTRACTOR ❑ 4. PROPERTY OWNER ❑ 5. OTHER AUTHORIZED AGENT OF TANK OWNER UPCF UST -C Rev. (12/2007) - I12 www.unidocs.org s•d eSC =60 BO SO unC • 0. " LIPIED PROGRAM CONSOLIDATED FORIO UNDERGROUND STORAGE TANK MONITORING PLAN - (Page I of 2) TYPE OF ACTION ❑ I. NEW PLAN 2. CHANGE OF INFORMATION 49u -I. PLAN TYPE 1. MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. A40 "2' (Check one Item only) ❑ 2. THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): _. ... .. ._. ,•.:., .::.., ..,. >: �: ... .. :. ...... ..: .. t =rte•, : FACILITY ID # (Ageney Use Only) 0 '; y G� i `: i{ BUSINESS NAME (Stone as Facility Name or DBA) 3, BUSINESS SITE ADDRESS 103' CITY 104' i --r 1A � -Z--(, r:.D 1]f' ..:>yc� ...%-: � .' ,,-•,_ . '.. �RYQ' YE5 N ��L� T i�,3 .:_ P..t R �.S V E1 N 1�. t�:•• ����•,, ����, ��yTT��, t�7��y/' CE'�:;�a;�;� "<'.�;.;�;,�:,:ai.. 1%.;' . " 't f!i:.�':': ., �,.�,:�'•.'. Testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) must be performed at the frequency specified _by the equipment manufacturers' instructions, or annually, whichever is more frequent, Such work must be performed by qualified personnel. 123 cCR 92632, 2634, 263e, 264D_ MONITORING EQUIPMENT IS SERVICED . ANNUALLY [3 99.OTHER ( S 490.3. (Specify): 490 -Sb. ...,. :_..: •h.. ...1., , ?b. 4x •. .S "AYi4. �- "�' ',. �!'•'d.:`:;: "'a,, m4gi >:.�.;r:K: j',!.k.". 43:Fy... 0-I ... .. :,, .M:.: pp s I'.i�.'1':i.1!.::. ... _. b.,�; ^"+;.•i: 5..1:i�l,w.•P•J) i Jf:• _ ! , 3k.: r,..,:., .i»•,..••,.. }'.' °i'�. ��� }�� ... ...4' ,.: .r., .- <.:::•G'.- •:• -�I f$r ,,, Sy yxa,,..;.irft k,O .�0.>•��. �t. .yl:f, .Mi;;i.. L {'r. ^.'1�1�K'�I,4 ,:!_ y: ... .. :, :..r Y_....i,v ;C::+F:.., ..: ?.a .tea . ...-`. •. i.0- =, ,-�•,.,: .f' .y5 t,..:. ❑ 1. NEW SITE PLOT PLANIMAP SUBMITTED WITH THIS PLAN %2. SITE PLOT PLAN /MAP PREVIOUSLY SUBMITTED [23 CCR 42632, 26341 4904. .:xi:•. ••,r•.. -• r: e1+•..: s• i• rw'c:�..mt.:VS><.q:7'.- S:Y.c >; :J�hrl.l'Y.1:.!.{��a �:k:�,Y .yv�Mw n.;;H.:: 0-;n, ^ii•r.;.l ,s.w ;6.:; ..t:k�,.i; ::S::i. ;�,;!. 1 - :T.AN�:,�I�OI?�I•T ��S1P;�'r�� f .::,.!,::: -, r _.-.. r•s.,.,; ,.,ti., +.•n.r,r" �.. i... ...;ti,:. -. .•n a•nai.a*e,• ..r .v sia;r�w,rn �Y15 CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) 490.3. WITH AUDIBLE AND VISUAL ALARMS. (23 CCR P632.26341 SECONDARY CONTAINMENTIS: 24, DRY ❑ b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d. UNDER VACUUM 490.6. PANEL MANUFACTURER: C�a"�C. I� QC Q - 490 7 MODEL #:, ?(Y1 490-8. LEAK SENSOR MANUFACTURER k 490 "9' MODEL W(S): 490'10' AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL _JANK(S). 123 CCR 926431 490-J 1, PANEL MANUFACTURER:. 3::LZP Qx_CO 490.11 MODEL #: r7 yx __ 490.11. IN -TANK PROBE MANUFACTURER j 49114' MODEL #(S): 490.15. LEAK TEST FREQUENCY: ❑ a. CONTINUOUS ❑ b. DAILY(NIGHTLY ❑ c. WEEKLY 490.16, ❑ d. MONTHLY ❑ e. OTHER (Specify): 490.17 PROGRAMMED TESTS: ❑ a. 0.1 g. h. ❑ b. 0,2 g.p.h, • ❑ c. OTHER (Specify): 490490.18. _ ❑. 3. MONTHLY STATISTICAL INVENTORY RECONCILIATION (23 CCR 92646.11 490-20. ❑ 4. WEEKLY MANUAL TANK GAUGING MTG)123 CCR 92643 TESTING PERIOD: ❑ a. 36 HOURS ❑ b. 60 HOURS 0-90:21: C I 4e0-22. ❑ 5. TANK INTEGRITY TESTING PER 123 CCR 92643.1) 4911-23. TEST FREQUENCY: ❑ a ANNUALLY ❑ b. BIENNIALLY 0 c. OTHER (Specify): 90-24. }; 490.26. ❑ 99. OTHER (Specify): 49 490-27, 490-26. rr.!iL.••., ' r : . rts g � (Qhec- .a�:•r ri ?„w,v�IN ... .,,, . k Cf'_ } . . . .. w .:.« •T- §y'= i';liJdta 1. CONTINUOUS MONITORING OF PIPEIPIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE & VISUAL ALARMS. 490'28• 10263661 SECONDARY CONTAINMENT IS: 1 a. DRY " ❑ -b. LIQUID FILLED ❑ c. PRESSURIZED Q d. UNDER VACUUM 49D•29. PAN EL M ANU FA CTU RER_- irSSL F,4 T? e.D 490.30. MODEL#: 490,31. LEAK SENSOR MANUFACTURER: Q 1�ga= 490-32, MODEL #(S): 4WJ3. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN. rer,a. YES ❑ b, NO 490.34• FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. tea. YES ❑ b. NO 490'33• $&2. MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3,0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF 490-36 PRODUCT FLOW WHEN A LEAK IS DETECTED. [23 ccRi2636) t MLLD MANUFA S): L 490 -37. MODEL # S : 490-8. ❑ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS. [23 cCR926361 490'39, ELLD MANUFAC'fURER(S): 4904D' MODEL #(S): 490.41. PROGRAMMED IN LINE LEAK TEST: ❑ a. MINIMUM MONTHLY 01 g.p.h. ❑ b. MINIMUM ANNUAL 0.1 g p.h. 490'42.' ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN, ❑ a. YES ❑ b. NO d5043• ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO 49044. ❑ 4. PIPE INTEGRITY TESTING, ~_ -_ "- J - 49045. TEST MUENCY: ❑ a. ANNUALLY ❑ b. EVERY 3 YEARS ❑ c. OTHER (Specify 49046. ❑ 5. VISUAL PIPE MONITORING. 49048. FREQUENCY: ❑ a. DAILY ❑ b. WEEKLY ❑ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED' 490.49, • • Allowed for monlmrina orunb"ad emerrency amemter fuel Pij� n JLonlr oer HSC 925281.3OX3] ❑ 6, SUCTION PIPING MEETS EXEMPTION CRITERIA. [23 CCR 92676(.x3)) 490.50. ❑ 7. NO REGULATED PIPING PER HEALTH AND SAFETY CODE, DIVISION 20, CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490-61. 99. OTHER (Specify) -- 'AM32: ' ❑ 490 -s3, UPCF UST -D (12/2007) - 114 www.unidocs.org �' •d e9B 360 60 SO unC Akk Ah UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND.STORAGE TANK - MONITORING PLAN - (Page 2 of 2) °DISPEl�� �?CO� N�' - C `:1�TONiT�i`O�RTN ` .,.•:.'VI.;UI�TD�•R !r UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 2�l. CONTINUOUS ELECTRONIC MONITORING ❑ 2. FLOAT AND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND -ALONE 490-541. Q 4. NO DISPENSERS Cl 99. OTHER (Speci ) 49D -54b. - -LEAK MONITOR MANUFACTURER: K3 490.11. MODIrL ff: 49aJ6. LEAK SENSOR MANUFACTURER: 0 �� t4 -4. >�� 490-57. MODEL i/(S): d90lS8. DETECTION OF A LEAK 1NTO.THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS, ❑ a. YES PE�1. NO 480.59, UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN.. YES -5Lb. NO 490.60. FAILURFJDISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. . YES ❑ b. NO 480.61. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER J_ . YES ❑ b. NO -09MI' UDC CONSTRUCTION 1S: 5jr.L SINGLE WALL ❑ 2. DOUBLE WALL 490.63. IF DOUBLE WALL: • 490'4"' UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a LIQUID ❑ b. PRESSURE ❑ c. VACUUM A LEAK WTTHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ e YES ❑ b. NO 490.Ub. ,4. c v. i. : 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49o:bs. A E MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. u CCR §2844.1 ® 2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490.66• ® 3. SPILL BUCKETS ARE TESTED ANNUALLY. 490.67• -... .. �i..: ^:.- L:.:'rt• ;'i:,5 •:•T.: - re r0-'. ,,- y15 " `"J. t,Y ':,¢ :r l.it, i ^:: is:7it�c'':•'sti:, '''''' yy��.+pp��.�� �.7�T�t �� ��"r:•s �'G:?!%VSa !:y:i .l4 i.'JJ'7`''F .,. -!.'• i,: ::;;. ,y'.:�."- !R +,. rrf:.�,:v:- �•lrra_ 1�:LliJV.O' Ttit:t,. i..;::i, y�i5',^;r.,, The following monitoring/maintenance records are kept for this facility: 490 6e.. ® a. ALARM LOGS Ej b. VISUAL INSPECTION RECORDS ❑ c TANK INTEGRITY TESTING RESULTS ❑ d. SIR TESTING RESULTS (and supporting documentation records) ❑ e. TANK. GAUGING RESULTS (and supporting documentation records)_ ❑ f. ATG TESTING RESULTS -(and supporting documentation records) ❑ S. CORROSION PROTECTION 6o_DAY LOGS, ® h. EQUIPMENT MAINr'TENANCE AND CALIBRATION RECORDS 5 - `` �w :�. w. 1w F '.J...!!...,r.....:. . 0-f•" �:r'1 -a :... :..:. .......... < y . .✓.r, .. , ,:•.:,:.::7., r ila:F =:; ri., c':T..fSi�F� IN Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties: 49DAOL REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 490.69b. * OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 490-690. ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS , 490.69d, ❑ CALIFORNIA UNDERGROUND STORAGE TANK. LAW 490-69.• ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: ''HANDBOOK FOR TANK OWNERS - MANUAL AND 490.69,. STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490 -699. ❑ OTHER (Specify): 490•69h. 490.691. This facility has a "Designated UST Operator" who has passed the California UST System Operator Exarn administered by the international Code Council 490-70' (ICC). The "Designated UST Operator" will train facility employees in the proper operation and maintenance of the UST systems annually, and within 30 days of hire. This training will include, but is not limited to, the following: 9 Operation of the UST systems in a manner consistent with the facility's best management practices. ➢ The facility employee's role with regard to the monitoring equipment as'specified in this UST Monitoring Plan. y The facility employee's role with regard to spills and overfills as specified in the facility's UST Response Plan , 9 Name(s) of contact person(s) for emergencies and monitoring alarms. ::.;, ;... ': .. °.r .s... n.. -.l f. .. .5 -{`:. �yr �,.•n.•(l' 4 :ti L�'I;, ::. t ^': '.;%'rSB= ':�`.': `:.`' :::'_�'is'':`. COQ''. 1" DI��T= �i�,:• ... �;_ . ,,..:::..: ,..,s •:... ,t�.��:�f. ;� �QR�l�IO ... ...... __..••a:as..:....,..:.. -n:K r`4... tqK'•;� .. ._ .. '. rj� <p.,ircii4l;ii:. o*;.: <�sP^ Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan. 49D-71. : .1/ -'• :xis .t = -'. :rl-S '- PER�S -ONNE The UST Owner /Operator is responsible for ensuring that 1.) the daily /routine UST monitoring activities and maintenance of UST leak detection equipment covered . by this plan occurs'2.) all conditions that indicate a possible rcleasi are investigated; and 3.) all monitoring records are maintained properly: THE FOLLOWING PERSON(S) ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: 490-72 TITLE: 490 -73. NAME: 490-74. TITLE: 490 -75. The Designated UST Operator shall perform a monthly visual inspection of the facility; provide a report to the owner /operator, and inform the owner /operator of any conditions that need follow-up action. OPERATOR. 'SIGN �'URE::•° •XII`� OWNERJ:.�i CERTIFIC ON: I ertify that the information provided herein is true and accurate to thebestofmy knowledge. APPLICAN IGNA DATE: 490-77, (S' REPRESEK7rNG: Q 1. Tank rata' 3. Fuility o"=/Omn for 3. Authoti=d R rotmtiidw of Oa er 490.76. APPLICANT NAME (Oft,�,bp& 49 0a8. APPLICA jgTr 49049' UPCF UST -D (1212007) - 3/4 / www.utlidocs.org R•d eqc :Rn An Qn unr 0 *JNDERGROUND STORAGE TANK RESPONSE PLAN — PAGE 1 (One form per facility) R01. TYPE OF ACTION ❑ 1. NEW PLAN ❑ 2. CHANGE OF INFORMATION I: ' FACILITY INFORMATION . FACILITY ID # (Agency Use Only) a ::�: sA.:,_ --. C :t ai: BUSINESS NAME (Same as FACILITY NAME) Roe, BUSINESS SrrE ADDRESS R03• CITY K04' -FA•EF S ][[..SPILL CONTROL 'AND CLEANUP METHODS This plan, addresses unauthorized releases from UST systems and supplements the emergency response plans and procedures in the facility's Hazardous Materials Business Plan. ➢ If safe to do so, facility personnel will take immediate measures to control or stop any release (e.g., activate pump shut -off, etc.) and, if necessary, safely remove remaining hazardous material from the UST system. D Any release to secondary containment will be pumped or otherwise removed within a time consistent with the ability of the secondary containment system to contain the hazardous material, but not bn:ater than 30 calendar days, or sooner.if required by the local agency. Recovered hazardous materials, unless still suitable for their intended use; will be managed as hazardous waste. ➢ Absorbent material will be used to contain and clean up manageable spills of hazardous materials. Absorbent material which has become too saturated to be . effective or which'is no longer intended for use will be managed as hazardous waste unless a waste determination in accordance with 22 CCR §66262.11 finds that it is non - hazardous. Used absorbent material, reusable or waste, will be stored in a properly labeled -2nd sealed container. Waste material shall be disposed appropriately. D Facility personnel will determine whether any water removed from secondary containment systems, or from clean -up activity, has been in contact with any hazardous material. If the water is contaminated, it will be managed as hazardous waste unless a waste determination in accordance with 22 CCR §66262.11 finds that it is non - hazardous. If the water has a petroleum sheen (i.e., rainbow colors), it is contaminated. A thick floating petroleum layer may not necessarily display rainbow colors. Water (hazardous or non - hazardous) from sumps, spill containers; etc. will not be disposed. to storm water systems. D We will review secondary containment systems for possible deterioration if any of the.following conditions occur; 1. Hazardous material' in contact with secondary containment is not compatible with the material used for secondary containment; 2. Secondary containment is prone to damage from any equipment used to remove or clean up hazardous material collected in secondary containment; 3. Hazardous material, other than the product/waste stored in the primary containment system, is placed inside secondary containment to treat or neutralize released product/waste, and the added material or resulting material from such a combination is not compatible with secondary containment. III: SPTLL:CONTI20L AND CLEAN =UP EQUIPMENT. PERIODIC MAINTENANCE: Spill control and clean -up equipment kept permanently on -site is listed in the facility's Hazardous Materials Business Plan. This equipment is inspected at least monthly, and after each use, supplies are.replenished as needed. Defective equipment is repaired or-replaced as necessary. E QUIPMENT NOT PERMANENTLY ON -SITE, BUT AVAILABLE FOR USE IF NEEDED: (Complete ly if applicable) EQUIPMENT LOCATION AVAILABILITY Rig. R20. 2 K30. R1 1. � S R2 1. S`C� R3 R12. �• R22. Ll R32, l� R13. R23, R33. R14. R24. Rio. R15. R25, R35. IV- THE FOLLOWING PERSON(S) IS /ARE RESPONSIBLE FOR AUTHORIZING ANY WORK NECESSARY UNDER THIS RESPONSE PLAN: NAME � f R40. J TITLE P.50. NAME r , tf % R41. TITLE / R51. ( NAME R42. TITLE R52. NAME R43. TTLE Rya: V. MONITORING INDICATORS IF MONITORING INDICATES A POSSIBLE UNAUTHORIZED RELEASE, STEPS TO VERIFY THE RELEASE WILL BE MADE AS FOLLOWS: RGO• ❑ Additional system testing or data collection O Inspection by qualified persons ❑ Rccalibration of equipment Other: UST Response Plan (3/2008) -.1/3 sd eGE =60 BO SO unC qNDERGROUND STORAGE TANK RESPONSE PLAN - PAGE 2 VI. REPORTING AND RECORD KEEPING We will reporr/record any overfill, spill, or unauthorized release from a UST system as. indicated in this plan. Recordable Releases: Any unauthorized release from primary containment which the UST operator is able to clean up within eight (8) hours after the release was detected or should reasonably have been detected, and which does not escape from secondary containment, does not increase the h52ard of fire or explosion. and does. not cause any deterioration of secondary containment, must be recorded in the facility's monitoring records. Monitoring records must include: ➢ The UST operator's name and telephone number; A list of the types, quantities, and concentrations of hazardous substances released; ➢ A description of the actions taken to control and clean up the release; 9 The method and location of disposal of the released hazardous substances, and whether a hazardous waste manifest was or will be used; A description of actions taken to repair the UST and to prevent future releases; D A- description of the method used to reactivate interstitial monitoring after replacement or repair of primary containment. Reportable Releases: Any overfill, spill, or unauthorized release which escapes from secondary containment (or primary containment if no secondary containment exists), increases the hazard of fire or explosion, or causes any detcrionttion of secondary containment, is a reportable release, Reportable releases are also recordable. Within 24 hours after a reportable release has been detected, or should have been detected, we will notify the local agency administering the UST program of the release, investigate the release, and take immediate measures to stop the release. If necessary; or if required by the local agency, remaining stored product/waste will be removed from the UST to prevent further releases or facilitate corrective action. If an emergency exists, we will notify the State Office of Emergency Services. Within five (5) working days, of a reportable release, we will submit to the local agency a full written report containing. all of the following information to the extent that the information is known at the time of filing the report: ➢ The UST owner's or operator's name and telephone number; ➢ A list of the types, quantities, and concentrations.of hazardous materials released; D The approximate date of the release; ➢ The date on which the release was discovered; D The date on which the release was stopped; D A description of . actions taken to control and/or stop the release; a A description of corrective and remedial actions, including investigations which were undertaken and will be conducted to determine the nature and extent of soil, ground water or surface water contamination due to the release;. A The method(s) of cleanup implemented to date, proposed cleantip actions, and a schedule for implementing the proposed actions; 9 The method(s) and location(s) of disposal of released hazardous materials and any contaminated soils, groundwater, or surface water. D Copies of any hazardous waste manifests used for off -site transport of hazardous wastes associated with clean -up activity; ➢ A description of proposed methods for any repair or replacement of UST system primary /secondary containment systems; ➢ A description of additional actions taken to prevent future releases. We will follow the reporting procedures described above if any of the following conditions occur: A recordable unauthorized release can not be cleaned up or is still under investigation within eight (8) hours of detection; Released hazardous substances are discovered at the UST site or in the surrounding area;. ➢ Unusual operating conditions are observed, including erratic behavior of product dispensing equipment, sudden loss of product, or the unexplained presence of water in the tank, unless system equipment is found to be defective and is immediately repaired or replaced, and no leak has occurred; Monitoring results from UST system monitoring equipment/methods indicate that a release may have occurred, unless the monitoring equipment is found to be defective and is immediately repaired, recalibrated, or replaced, and additional monitoring does not confirm the initial results. Record Retention: Monitoring records and written reports of unauthorized releases must be maintained on -site (or off -site at a readily available location, if approved by the local agency) for at least 3 years. Hazardous waste shipping/disposal records (e.g., manifests) must be maintained for at least 3 years from the date of shipment. VII. OWNEWOPERATOR.:SIGNATURE CERTIFICATION: I certify that the information provided herein Is true and accurate to the best of my knowledge. O OPERATOR SIGNATURE DATE / A P.70. 0*1'Tii E TO N ME rint R7r. OWNER/OPEPhTOR TITLE R72. (Agency Use Only) This plan has been review d and: ❑ Approved ❑ Approved With Conditio ❑ Disapproved Local Agency Signature: Date: UST Response Plan (312008) - 313 Di 'd eGE =60 B❑ SO unC 0 0 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: S &W Chevron Facility ID #: 329 6 Facility Address: 1990 Taft Hwy. Bakersfield, Ca 93313 Reason for Submitting this Form (Check One) X Change of Designated Operator 0 Update Certificate Expiration Date Facility Phone #: (661)398 -8882 PRIMARY Designated Operator's Name: Aaron Koop Business Name (If different from above): Rich Environmental Designated Operator's Phone # :(661)392 -8687 International Code Council Certification #: 5246167 -UC ALTERNATE Designated Operator's Name: James Rich Business Name (f d7fferent from above): Rich Environmental Designated Operator's Phone #:(661)392 -8687 International Code Council Certification #: 1064166 -UC ALTERNATE 2 fonetonn31 Designated Operator's Name: Business Name afdi„ferent from above): Designated Operator's Phone #: International Code Council Certification #: Relation to UST Facility (Check One) Ownner 0 Operator 0 Employee X Service Technician 0 Third -Party Expiration Date: 11 -12 -06 Relation to UST Facility (Check One) OOweer 0 Operator O Employee X Service Technician 0 Third -Party Expiration Date: 11 -12-06 Relation to UST Facility (Check One) OOneer O Operator 0 Employee 0 Service Technician 0 Third -Party Expiration Date: NOTE: THE LOCAL REGULATORY AGENCY MUST BE NOTIFIED OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f). Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground sto g NAME OF TANK OWNER OR OWNER'S AGENT (Please Print): SIGNATURE OF TANK OWNER OR OWNER'S AGENT: DATE: IQ.,- 15 — O / % OWNER'S PHONE #: 'Optritorts) O Oww O Opaw V B#40* I for a £a�i its► , DedimmW2n exNmr- ]AMU RICH On o V9TFusty(05JA040) Bun= Nap (A'fawqfmm aba4l RIM ENVIIZOMEMAL 0 0WOW • Q Ctper+tot 0 Ya 661 392.8687 OWPO d Opaubr s Pboae C. 166113924687' ®Smvioa Teszimialim 0 .TlifrarPl�ty . 1atanidaasl Cade Conaoil,Cart�cadai . • 166 -iJC • • ' ' . Bxpirnlion Dstt� "i 1 =12-06 tlo�al ®• 8esYls:o �� : G^?h;G!d -13 • . DUl U.W Operatoth Nimes'AAAON KOOF Rdsrlon b UST F q! (Clsrerk 0:sg) ; �► subs, woo (Ird(rewoogi IUCH B4V2 NM+I'PAL p .Owner ' p "ppe w a g*oyW.. . Det�ed Openror's Pbossa M: 661392.8687 � . ®8crvieo Teciwl,abm • C�bbd P • , ktata,t cd *64 9=11 CaditaSou #: 5246167 UC . 8xplration Duet 11 -12-06 . ALTZPWATBZ S X4 �. boowd OpeiaWj Nj*:• RYAN MA30N Rslattda to fift pset* (C Oaw Big= Nis (jf lAr"t from abo00 RICH BNYIFLONM WAL 0 Owner 4' Opa:� v 8:;tplom ' ' ' OasotsPha 1 267 oeTaba irly ' ` : chn O' Thrd•PAape 1 lateri doiul lids CouacA CatiBcation P:• 5261213 -UC 0 ,0WA& p Opaxw 0 Botploye¢`' • • Darlted Opaxfoir'� Pbcae o►: 0 8esvloe T,eo2mtatss vdr . Dra{ p�ited. OpetaEar 'aNaiaes��'t'g�/BN�p138YtT ... Re ?stlop•t��ibf'!'iru�ty(C�ak�1.t ' Btittaeuke (jid(6�rutnt�iplii about): RICY BNVIItO)M81!1TAL ' 0 " 8iaployoR;'` .; Dcii�nsted Ope:w'� Phciss.4t; 661 )392 -86 "$wine T btca i Qw CodsCo U4 Crsti W!" 6: 5261246 -UC 7 07 '. . dLTZRNAT$ 5 0 llo D!d 'Opxftws NA= KBVREK Rawioa to U . rsow.(C*04 , . .. ' butim Name (,V. dirdrw rob, above): RICH BNVIRONHWAL O Oww O Opaw V B#40* DetiDuted Opaisar'sPhbma its 661 392.8687 0 . Smvlca Tscbaiatsa O Third -Psity :.. . b ,"co, Code Cou ndl Mdacid6g W 5261193.UC • .> rsSoi� Dabs, 6 -18-07 :• • ... . Air ' tlo al Deii�ted Opantor's. Name: • BRIAN SCQTT • • - Ralasioa to U.3T �'�tdlllty (Oxy , �; . , Business Name lXld(0'a' 1 +above :.1 ICH VMONAWAL • 0 ,` Ovwaa• . O ' C&Ux : 0, B4b)eo•;' ' • l�tti flpwtor'i Piro tf: � 66� 392 -8687• � ' ®• 8esYls:o �� : G^?h;G!d -13 • . IotrauHa >ulCodaiCoi�moil�al►s's268644UC D 1x10.07 ` ALTUMIZ x' (O • ,' , Darted Operator's Hum Rsilatloa to US'TPs�{ligr (QisaEOti) Businw•Nsins'(�%d(�ira+sr�i+vAr cbov ,• .. t? : Oaraer 'C1 .Ojiaratat :• ,'O >�pployes DesiYaited Opaatar'1PI>aue : 0 ' Saw" Teel dd o 0' " Iasaostiaoel Code Coaactl oa 1�: .: Bxpt:atioos Dates. • • ' ; . , • . _ .; AMM11 tloxal ' .Desi�sfrdOpesotor's.Nime:' Re2stioaOvUSTF e�iiy(f�rc,EO�uJ ., , 8sssioessNso:e(ud(d'awVfrorn ab ys): 0 ,0WA& p Opaxw 0 Botploye¢`' • • Darlted Opaxfoir'� Pbcae o►: 0 8esvloe T,eo2mtatss vdr lntet�ltowl Cods Couaait CestiBoadoa 9s Uplrstioa bites Dasllitisted Opa&We NOk: . >•�.Nmtl Coda #1 . - RabdoA to T].SfTFsctl b'(QuotOntJ O Owner O Opesator : b Bm1o* O ftnioe Tcrbai" O' Ttrxsd mty ' 8xpasdoa� Ds3w • 0 0 'A • Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: S &W Chevron Facility ID #: 3;200r74/06.?.-2q6 Facility Address: 1990 Taft Hwy. Bakersfield, Ca 93313 Reason for Submitting this F rm (Check One) X Change of Designated Operator O Update Certificate Expiration Date Facility Phone #: (661)398 -8882 PRIMARY Designated Operator's Name: Aaron Koop Business Name (1f different from above): Rich Environmental Designated Operator's Phone #:(661)392 -8687 International Code Council Certification #: 5246167 -UC ALTERNATE s tt a Designated Operator's Name: James Rich Business Name (If diJf Brent from above): Rich Environmental Designated Operators Phone #:(661)392 -8687 International Code Council Certification #: 1064166 -UC ALTERNATE 2 tontional) Designated Operator's Name: Business Name (If different from above): Designated Operator's Phone #: International Code Council Certification #: Relation to UST Facility (Check One) OOwner O Operator U Employee X Service Technician O Third -Party Expiration Date: 11 -12 -06 Relation to UST Facility (Check One) 47 Owner O Operator O Employee X Service Technician 0 Third -Party Expiration Date: 11 -12-06 Relation to UST Facility (Check One) OOwner 0 Operator 0 Employee U Service Technician O Third -Party Expiration Date: NOTE: THE LOCAL REGULATORY AGENCY MUST BE NOTIFIED OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f). Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tavks. /� NAME OF TANK OWNER c� q // OR OWNER'S AGENT (Please Print): SIGNATURE OF TANK OWNER OR OWNER'S ,AGENT: DATE: 1Q— I s_ o 7 OWNER'S PHONE #: 5cptombcr 2004 C� J MONITORING PLAN COVERSHEET FACILITY INFORMATION Name J°4- �K) C--�i E-0 R V) f1 Operator: Ir ert �tiu 7T�J'h; J �rn� �,� Iran lAi�� C� Facility ID #: 10!) 1 a� Address: \qq� ��A� \Lid VA City: �{�S�e �� Stater Zip: TANK OWNER INFORMATION Name: c� M Eca(. S � tr +t °� V3 aC Address: City:�jQ�1� s �� � State: -A Zip: �3 1 ** If the tank owner and operator are not the same, an owner /operator agreement form must be completed and submitted to the Kern County Environmental Health Services Department. PERSON RESPONSIBLE FOR MONITORING 6 N Title: c) W r E�2_ TRAINING Describe the training necessary for the operation of the UST system, including piping and monitoring equipment: „ O SUBMITTED BY Name: Vt �- S".z ~'-k" Title:_ CaAj�. Phone:( MIKMa Date: 'g- la. -0a, A copy of the monitoring plan is to be kept on site with the Permit to Operate INTERNAL USE ONLY Approved by: Date: 0 i 11 EMERGENCY RESPONSE PLAN FORM UNDERGROUND STORAGE TANK MONITORING PROGRAM Facility Name: S�� �'il eA QArC1 Facility Address: 1. If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion hazard, are not cleaned up from the secondary containment within 8 hours, or deteriorate the secondary containment, the Kern County Environmental Health Services Department must be notified within 24 hours. SA =� nom_ 7l L� a 2. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substances. `,.� �, R i- So S, a\ Ste\ � bfltuts1�I n 12�S H A� A c\0 W &E.K u U .s ULP,\ f(Va6 MoQ.j nc, lbc4 3. Describe the location and. availability of the required cleanup equipment in item 2 above. T2pnor A A- -Fno,\r,5SL - 50 a AA SWSA f- )A:UW 4. Describe the maintenance schedule for the cleanup equipment. S 5. List the name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan: t oM e (3 e�X�.c S Q.o� t— cYUJ fl f.(LS WAINN 1 11; r. . , . • hm79 (5/02) . . .. •- � �. r ,f� SITE MAP Faeil;ty -s Jam,, /[ _ManaQa&Y7a . pEi�Kx.� a /� ALARNMONITORING ® STORM GRAIN ' VWT 141 Gb WA Y ®ELECTAICAL PANEL SHUTOFF O TELEPHONE a SANITATION SEWER TN MONITORING O U.G. WASTE OIL TANK WELLS <90 SHUTOFF GAS � FIRST AID KIT O EMERGENCY EMBLVAREA . WELLSVATION - lA ABSORBENT `W'} AR SHUTOFF i ® MSOS LOCATION O A.G. PRODUCT TANKIiiu Clete prepared: POST THIS INFORMA17ON ALONG WITH EMEAGENCY RESPONSE PROCEDURES IN AN EMPLOYEE ACCESSIBLE AREA. Environmental and Safety Workbook (4194) Q5R tl .� Unl• /s�vU Cr, i � Re5iro0m � fir! ` i i �i wS� I SHUTOFF EMERGENCY PUMP /� ALARNMONITORING ® STORM GRAIN ' FIRE HYDRANT U.O. PRODUCT TANK ®ELECTAICAL PANEL SHUTOFF O TELEPHONE a SANITATION SEWER Q MONITORING O U.G. WASTE OIL TANK WELLS <90 SHUTOFF GAS � FIRST AID KIT O EMERGENCY EMBLVAREA . WELLSVATION - lA ABSORBENT AR SHUTOFF .�F FIRE EXTINGUISHER ® MSOS LOCATION O A.G. PRODUCT TANKIiiu Clete prepared: POST THIS INFORMA17ON ALONG WITH EMEAGENCY RESPONSE PROCEDURES IN AN EMPLOYEE ACCESSIBLE AREA. Environmental and Safety Workbook (4194) _ � .. .. w� .� � y �� 2 Ir �, 0 UST ECIUANT OPERATION AND MOMITOAJNG LOG Feciiicy -CQ C! IJQ,i1 Martc►V�'sd• ____..__.�...... _ _.._.. Equipment - -- Ooie @auiomant Oovratleeail ( ✓I Anne UMB OXI (✓} Initials Weak 1 Yos No Q Yee o No' W"k t copmew ._. Weeks Yes M No Q Yot Q No Q WHk f COpWe1Mt I Weeks i as No Q i Yet Q No We* f comma Week1 Yet U No Q ? Yea Q No U WNkibmmems Weeks yes No Yet Q No :Q i Wilk 6 cwmtmt* 1 � _ Wow (Name f meturi) ftwonmentaf and vetety Workbook W94i • 1 • MONITORING REQUIREMENT OPTIONS TANKS DOUBLE WALLED (JACKETED) TANKS The double walled (jacketed) tanks have a continuous leak monitoring system in the annular space. The system is a (-; it bcc yco TLS - 3Sjj (make and model) and is located in M(LiAG4te=2? neara eeslri�d (panel location). The system is connected to an audible and visual alarm. A&42- The alarm panel is inspected daily for power and alarm status and is documented on a daily log sheet. For hydrostatic annular monitoring systems, if monitoring indicates a possible unauthorized release, the presence or absence of hazardous substance in the interstitial space will be determined by The leak test. and after product operating level. (method used)• have an automatic tank gauging (ATG) system that is capable of conducting a 0.2 gph system is a (make and model) and is located (panel location). The ATG is placed in the test mode at least monthly d ivery or when the tank is filled to within 10% of the previous month's highest The ATG gene maintained on site or at a hard copy (print out) of the test data after each test. The copies are The tanks have an automatic leak test. The system is a and after product delivery or when the operating level. The ATG generates a hard copy maintained on site or at (an approved location). gauging (ATG) system that is capable of conducting a 0.2 gph (make and model) and is located P nel location). The ATG is placed in the test mode at least monthly tat is filled to within 10% of the previous month's highest int \out) of the test data after each test. The copies are The interior lining will be inspected and certified before every five years there after. The cathodic protection system will be tested ald (impressed current systems) is located \ rectifier is inspected every days (at least every hours. The results documented on the inspection log. Rt system maintenance are kept for 6 %Z years. (an approved location). (ten years from lining date) and certified every three years. The rectifier (panel location)- The 0 days) for setting, power, and operating -oi4s pertaining to the cathodic protection 0 PIPING DOUBLE WALLED PIPING i The double walled piping has a continuous leak monitoring system in the turbine sump. The system is a G/),1j krp %L5 — •3.5z) (make and model) and -is located T s a.bo rtP (panel location). The system is connected to an audible and visual alarm. sheet. The alarm panel is inspected daily for power and alarm status and is documented on a daily log -AND- Positive Shut Down Options for Pressurized Piping 1. The monitoring system does not shut down the turbine when a release is detected. An automatic line leak detector is installed that detects a release equivalent to 3.0 gph. An annual piping integrity test is conducted that detects a release from the primary piping equivalent to 0.1 gph. OR 2. The monitoring system shuts down the turbine when a release is detected. An annual piping integrity test is conducted that detects a release from the primary piping equivalent to 0.1 gph. OR 31 The monitoring system shuts down the turbine when a release is detected and if the continuous monitoring system fails or is disconnected. MA The single walled pressurize[ flow if a release is detected or if PING ing has an automatic line leak detector that shuts off the product line leak detector fails or is disconnected. The system is a (make and model). The Panel is located (panel location). AI�Y1) 1. A piping integrity test that is hird party certified to detect a release of 0.2 gph is conducted monthly. OR 2. A piping integrity test that is third arty certified to detect a release of 0.1 gph defined at 150% of normal operating essure is conducted annually. SIN WE WALLED METAL PRESSURIZED PIPING CATHODICALLY PROTECTED The sing walled pressurized piping has an automatic line leak detector that shuts off the product flow if a release 's detected or if the line leak detector fails or is disconnected. The system is a (make and model). The Panel is located (panel location). -AND- 3. A pi 'ng integrity test that is third party certified to detect a release of 0:2 gph is conduc d monthly. OR 4. A piping i tegrity test that is third party certified to detect a release of 0.1 gph defined at 1 % of normal operating pressure is conducted annually. The cathodic protection system vill be tested and- certified every three years. The rectifier (impressed current systems) is located (panel location)- The rectifier is inspected every days (at least every 60 days) for setting, power, and operating hours. The results documented on the inspection log. Records pertaining to the cathodic protection system mainte�qpce are kept for 6 %z years. The single w\and n piping is monitored daily for the presence of air in the line and is documented by compe daily inspection log. AND - All check val %be e installed above gr ade, and an inspection method is provided to readily demonstrate this. OR A check valve is installe grade, and a piping integrity test, that is third party certified to detect a release of 0.1 gph defined at 15 ° o of normal operating pressure, is conducted at least once every three years. (Any metal suction piping must also meet the same cathodic protection requirements as pressurized piping) A piping integrity to that is third party certified to detect a release of 0.1 gph defined at 150% of normal operating pressure is c nducted at least once every two years. (Any metal gravity piping must lso meet the same cathodic protection requirements as pressurized piping) DISPENSER PANS The dispenser pans are monitored using a continuous leak monitoring system. The system is a 6/% ,ew TLS - 3 Sb (make and model) and is connected to an audible and visual. alarm. 'The system is located (panel location). �tuie/ The alarm panel is inspected daily for power and' alarm status and is documented on a daily log sheet. OR The dispenser pans are monitored using a continuous leak monitoring system. The system is a Sam1 /1.S ik� (make and model) and stops the flow of product at the dispenser when a leak in detected. -AND- Positive Shut Down Options for Dispenser Pans 4. The monitoring system does not shut down the turbine when a release is detected. An automatic line leak detector is installed that detects a release equivalent to 3.0 gph. An annual piping integrity test is conducted that detects a release from the primary piping equivalent to 0.1 gph. OR 5. The monitoring system shuts down the turbine when a release is detected. An annual piping integrity test is conducted that detects a release from the primary piping equivalent to 0.1 gph. OR 6. The monitoring system shuts down the turbine when a release is detected and if the continuous monitoring system fails or is disconnected. 90�' Dispenser pans will be installed before December 31, 2003 with an approved monitoring. The monitoring plan will be updated and approved at the time of installation. OVERFILL AND SPILL PREVENTION Each tank fill opening is equipped with an approved spill prevention container of minimum five gallon capacity. The container is equipped with a drain valve to permit spilled hazardous material to be drained into the tank primary containment. - AND - Each anit fill opening is equipped with an approved overfill prevention device which cannot allow manual override and alerts the transfer operator when the tank is 90% full by restricting the flow into the tank or by triggering an audible and visual alarm. OR ,7 Each tankfi•l. o ening is equipped with an approved overfill prevention device which cannot allow manual override and restricts, ee flow to the tank at least 30 minutes prior to tank overfill, the restriction occurs at no more than 95% of tFie_t capacity and triggers an audible and visual alarm at least five minutes prior to tank overfill. OR Each tank fill opening is equipped with an approv°ed-o eerrfill prevention device which cannot allow manual override and provides positive shut -off (100 %) of flow to' ank when the tank is no more than 95 % full. MONITORING EQUIPMENT MAINTENANCE (All facilities) Equipment and devices used to monitor the UST system will be calibrated, operated, and maintained in accordance with the manufacturer's instructions, including routine maintenance and service checks at least once per calendar year for operability or running condition. The Kern County Environmental Health Services Department will be notified at least two working days prior to the annual certification and the results submitted within 30 days. SECONDARY CONTAINMENT TESTING The secondary containment systems (i.e. tanks, piping, turbine (piping) sumps, fill sumps, and dispenser pans) will be tested every 36 months with the first test completed- before January 1, 2003. ENHANCED LEAK DETECTION MONITORING This facility is located within 1000 feet of a public drinking water well and has at least one component that is single walled (i.e. tank, piping, or no dispenser pan). The tank system will be. tested using an approved Enhanced Leak Detection program within 18 months of notification from the State and every 36 months thereafter. RECORD RETENTION Written monitoring reeords' W1T°be maintained o .s,�ite, r at for the following periods of time: an approve location) Three ye ars for monitoring and maintenance records t ;Five yea rslfor written performance claims pertaining to release detection systems, anc calibration/maintenance records for such systems. 6 %2 years for cathodic protection maintenance records. r ,'ti �.• 1 MONITOIDN.G SYSTEM CERTIFICI #ON For Use By All Jurisdictions Within the State of California Authority Cited. Chapter 6.7, Health and Safety Code, Chapter 16,: Division. 3, Title 23, California Code of Regulations This form must be•used to document testing: and..secvit ing of monitoring,'equipment. A stet certificatio or. r ort -must be re areil for each tnonittLg:hystem control panel by the technician'. who performs the work A copy,.of this f ust:be pro d tb.the tank system:ow4er /9perat6r. The. owner /operator must submits copy of this form.to,.the.locai,agency reoating UST sysferiis'.within, 30 days oftest: date. A. General: Information JUL 2 0 2010 Facility Name: CHEVRON Site Address' 9999 TAFT HWY Facility Contact Person: Make/Model of Monitoring System: TLS -350 B. Inventory of Equipment Tested/Certified Check the annronriate.holes to indicate snecifie eauipment insnected/serviced: Bldg; No.' 'City , BAXERSF,fE1. D, Zip' 93313 EAR ItContact l?fione� & E(VICES ) —0 Date.of Testing/Servicing. 711312010 Tank ID: UNL87 Tank ID: PREM91 • In -Tank Gauging Probe. Model: MAGI B In-Tank Gauging Probe. Model: 'MAG1 • Annular Space or Vault Sensor. Model' 409 ®.Annular: Space or Vault Sensor: Model ::4W • Piping Sump /Trench Sensor(s). Model: 208, ® Piping Sump./ Trench Sensor(s); Model: '208- ® Fih.Sump Sensor(s). Model: NO SENSOR- ® Fill :Sump Sensor(s}. Model: NO SENSOR ® Mechanical Line Leak Detector. Model: FX1 V I ® Mechanical Line Leak.Detector, Model FX1V ❑ Electronic Line Leak Detector. Model:. 0 Electronic Line Leak Detector: Model: ❑ Tank Overfill / High -Level Sensor. Model 0 Tank :Overfill / High?Levef Sensor: Model. ❑ Other (specify equipment type and model'in Section E on Page 2). 0 Other (specify equipment type and model'in,Seciion E on P* 2). Tank ID: DIESEL Tank D: B.In -Tank: Gauging Probe. Model: MAGI [],1n- Tank,6augingProbe. Model` :R Annular Space or Vault Sensor. Model: 409 0 Annular:Space or Vault Sensor. Model: ®:Piping Sump / Trench Senor(). Model: 208 Piping'Sump / Trench Sensor(s). •. Model: B:Fill Sump Sensor(s). Model: NO SENSOR` Q Fill Sump Sensor(s). Model: i_B Mechanical Line Leak Detector. Model: FX1DV []- Mechanical., Line Leak Detector. Model: . Electronic Line Leak Detector. Model; [] Electronic Line.Leak Dctectoi. Model: 0 Tank Overfill/ High -Level Sensor. ModeL• (] Tank Overfill / High =Level Sensor. Model: I D' Other' (specify equipment type and model in Section E on Rage 2). Other (specify equipment type and modctin Secdoa; 'Mouii<oring SystemCertification D. Results of Testing/Servicing Software Version Installed: Cmmnlaia tha fnllnwiina rharWkt- ® Yes ❑ No* Is the audible alarm operational? • Yes ❑ No* Is the visual. alarm operational? • Yes ❑ No* Were all sensors: visually' inspected; functionatty tested,:and eonfumed;operational? • Yes ❑ No* Were all sensors installed at lowest.point of secondary:containment.and:positioziw, so that other equipment will. not'interfere with theirproper..operation? • Yes ❑ No* If alarms are relayed to a. remote monitoring station, is all communications equipment (e.g., modem) ® N/A operational? • Yes ❑ No* For pressurized . piping systems; . dces the turbine automatically shut down if the piping secondary containment ❑ N/A monitoring system detects .a leak;. fails. to operate; or is electrically,disconnected? If yes: which sensors initiate" positive shut- down? .(Check all that apply) W. Sump/Trench.Sensors; ❑.Dispenser.Gontaimnent Sensors.. Did you confirm positive,shut -down due to leaks.and sensor failure /disconnection? ® Yes; ❑ No., D Yes ❑ No* For- tank systems that utilize the monitoring system as the' primary tank overfill warning device (i e:, no OVA mechanical overfill prevention valve is installed), is the overfill waming'alarm visible and audible at the tank fill point(s) and operating-properly? If so;, at what percent of tank capacity does the alarm.trigger? % ® Yes* ❑ No Was -any monitoring equipment replaced? If yes, identify: specific sensors; probes; or otliei equipment replaced and list the manufacturer name and model for all replacement parts in Section E; below. A Yes* No Was liquid found inside any secondary containment systems.designed as. dry systems? <(Check alt that apply) ❑ Product; JZl Water. If yes, describe causes,in Section E, below. ® Yes ❑ No* Was monitoring system set -up reviewed to ensure proper settings ?. Attach set up reports; if applicable ® Yes ❑ No* Is all monitoring equipment oPerational per manufacture r.' s:specifications? * In Section E below,,.describe how.and when these deficiencies Were or- will:be corrected, E. Comments: � Fo � ti � , -� .� t_ . .S%P S �.. -►.,. PS.. � �a 9 K ✓fir �. .Page 2 of 5 UN -036 - 2/4 www.unidocs.org 'Rev, OV17/08 0 • Monit4ring SyttemiCer.tification F. In-Tank Gauging SM Equipment: .9, ChepkOh-bokiftank gauging is used ,brAiy1t .prinventory ,control: ❑ Cuck, this:bok-ifnq tank gauging or, SIR equipment is installed.. This section must be, completed if in-tank, gaugm*g' equipment is used to perform ldak.detec.tio.n monitoring. Complete the following checklist: ❑ Yes ❑ No* Has all input wiring be' 6n:inspecte4 for, proper entry and termination, including testing for, ground faults? ❑ Yes ❑ No* Were all tank.gauging'probes visually inspected for'damage andxesidue build4p? ❑ Yes ❑ No* Was accuracy of system prodqct levil readings tested? ❑ Yes ❑ No* Was accuracy of systemwater levelyeadings-tested! ❑ Yes ❑ No* Were all probes reinstalled properly? ❑ Yes ❑ No* Were all items on the. equipment,manufacturer's maintenance checklist completed? In Section H, below, describe how and when these deficiencies were or will be'vorrected. G. Line Leak Detectors (LLD); ❑ Check this box if LLDs artnot installed. Comnlete the following checklist: 0 Yes ❑ No* y LLD perform ce For equipment start-up or annual equipment, certification, was a leak simulated to verify n ❑ N/A (Check q11 that ap g�p.4.; 0 0. 1 g7p 0:2 1 ply) Simulated.leak nAW I, El No* Were all ILLDs.confitmied operational and accurate ,witinreoWdt)ry,requirements? ;0 Yes ❑ No* Was the testing apparatus properly calibrated? Yes. ❑ No* Forntechanical LLD does heILD restrict product flbW'if it detects a leak? vn For electronic LLDS., does the turbine automatically shut off if theILD detects'a leak? M N/A, 0 Yes ❑ No* For electronic LLD 4oes4he.turbine automatically. shut off if any,portion of the monitoring system is disabled M N/A or disconnected?: ❑ Yes ❑ No* For electronic LLDs does % the turbine, automatically, shut off if any portion of the monitoring system malfunctions I@ N/A or fails atest? Yes 0 No* For electronic LLDs, have all.accessible wiring connections been,visually inspected? 0 N/A No* Were all items on:die equipment. manufacturff'S.maintenance checklist completed? In Section K below, describe, how and when.A.hese deficiencies were or will bt,correpted. H. Comments: Page 3 of 6 UN-036 — 3/4 wwwxvidomorg 01/17/09, ---------- Monitoring SYMM Ceffiftafi011 Site Address: _. I I Dale mV,wu Imi-actiazis, If you already have a diagram that,shows, all! required ,inh mationyoumayi, tide it, rather than pop with yoxit include System C 4rtif icafion. On your site plan, show the general,kyout.of bblm and piping: Clearly identify locations- of the following equipment, if insta1la-monitana g syst control panels, .sensors monitoring tattle annular space.s, sumps, di;penser pansspill: couWnembr.pthei secondary containment -areas, mechanical or electronic line leak detectors; and in-tank liquid level pmbes CLf used for leakAbOction)'i In,the Wce pxMded,,n6te the date this Site Plan wasprepared. page — of 0160, I 7" RICHENVIRONMENTAL 5643,BROOKS.CT. BAKERSFIELD, CA. 93.308 OFFICE: (661:)392 -8687 FAX (66:1 )392 -062.1 PRODUCT LINE,LEAK DETECTOR TEST WORKSHEET W /O #: FACILITY. NAME: TAFT HWY :CHEVRON FACILITY ADDRESS:..1999 TAFT HWY, BAKERFIELD, CA.. PRODUCT LINE TYPE: PRESSURE PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS :BELOW P.S.L.-OR SERIAL NUMBER 3 G.P.H. FAII;. UNL87 L/D TYPE : MECRANICAL YES: SERIAL #.RED JACKET NO FAIL PEM91 L/D TYPE: MECHANICAL YES ,SERIAL '# RED JACKET NO FAII. DIESEL L/D TYPE : MECHANICAL YES ASS �D SERIAL # RED JACKET 'NO FAIL L/D TYPE: YES PASS SERIAL # NO FAIL, I CERTIFY THE ABOVE TESTS WERE CONDUCTED ON THIS DATE ACCORDING TO RED JACKET PUMPS FIELD TEST APPARATUS TESTING PROCEDURE AND LIMITATIONS. THE MECHANICAL LEAK DETECTOR TEST PASS /-FAIL :IS DETERNIINEDBY USING. A .LOW FLOW .THRESHOLD TRIP RATE OF 3;GALLONS PER HOUR OR;LESS AT I6 P.S L.I ACKNOWLEDGE THATALL DATA COLLECTED IS TRUE AND-CORRECT-TO. THE BEST OF MY KNOWLEDGE: TECHNICIAN �y G+�t1Sl SIGNATURE: �!� DATE: 7113/10 • 0 SWRCB, January 2006: Spill, Bucket: Testing Report :Form This form is intended for use byz contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (rf applicable), should be provided toAe facility. owner /operator for submittal to the local regulatory agency. 1- FAC'.TT.IT TWORMATION Facility Name: CHEVRON Date of-Testing:, 7/13/10• Facility Address: 1999 TAFT HWY, BAKERFIELD, CA Facility Contact: Phone' Date Local Agency Was Notified of Testing Name of Local Agency Inspector (if present during: testing): 2. TESTING CONTRACTOR INFORMATION Company Name: RICH: ENVIRONMENTAL Technician Conducting' Test: ,Credentials': 0 CSLB Contractor X.ICC Service: Tech. 0 SWRCB Tank Tester. 0,0ther (Specie). License Number(s):a 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic: d Vacuum O Other Test Equipment'Used VISUAL Equipment Resolution. 0 Identify Spill Bucket (By Tank .Number, Stored Product; etc:) 1 UNL87 2 PREM91, 3 DIESEL 4 Bucket Installation Type: 0 Direct Bury X,Contained-in SUMP ❑ Direct Bury X. Contained in Sump, Q Direct Bury X Contained in Sump, d Direct:Bury ❑ Contained :in.Sum Bucket Diameter: 121i, ;12" 12" Bucket Depth: 16 16" 16" Wait time between applying vacuum/water and start of.test: M MIN 30M IN 30 MIN Test Start Time (Tj) �' •G 9 C.LJ Initial Reading (1Q Test End Time (TF): /`- '004 - -, .Final Reading (RF)• / y :Test;Duration (TF. —T�)t 1'=HOUR, 1 77HOUR 1 -HOUR Change in Reading (RF - ltd: Tass/Fail Threshold or Criteria: 0.00 If +/- 0:00 4A IT I +/-0.00 Comments — (include, information on repairs made prior to testing, and recommeridedfollow -up for fviled:tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR.CONDUCTING TiFi TESTING I hereby certify that aU the infof�n contained 4n this. report is true, accurate, and In fuU. compliance with.legal requirements. Technician's Signature: Dater 7/1340 ',State laws and regulations don t c ently ryre.testing to beperformed by aqualified ;contractor: However, ;heal. requirements may. be, more, stringent. • 0 SWRCB, January 2006 Spill, Bucket Tegtiog', Repo.rt.. Form :This form .is, inien&,dfior.use b y contractors pe� fI orming annual testing 6f UST containment slruclures:,The co letedform and 401 r.egu toly qge prinlouls, s e) aegily, oWne lqperalor 0 ld n6T. ,from tests (if applicable),. should,be provided to, the r for submitiallo 1he j , 4 L FAr11.1TV INFORMATION* Facility Name: CHEVRON —Dafe�d Testing: Facility Address: 1999 TAFT HW�Y RikKERSFIELD, CA, Facility Contact: 'Date Local Agency Was Notified of Testing,: Name of Local Agency Inspector (if present duringusting): 2. TESTING CONTRACTOR RINFO INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: RYAN, MASON Credentials: i.ICSLB' Contractor XICC Service Tech. L1,SWROTank T I ester I.. Other. (Specify) License Number(s): $02937`1' -UT 3- spull. RurkF. . T TFSTIrINIGINIZO . R-M . A . TIOX Test Method Used: X Hydrostatic :0 Vacuum Other - Test Equipment Used: VISUAL E Equipment R&soI.uti,on.,- 0106 men :Identify Spill Bucket (By Tank, 2 87 VAPOR 9 2, 3 3 4 B,kket Installation 'Typp:, I Li Direct Bury 0 0 Direct Bury b b Direct..Bury i i I Direct Bury Comments — (include.in/bimation,-9r; repOrsmade prior to. esi and recommended follow -up for failed ;Tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE, FOWCONDUCTING THIS'TESTING I hereby cerdA that all1he infiprm4tion contained in this report is true, accurdle, and4nfull.complianiee with lekal requirements. Technician's Signature: Date:` 71131,10` State laws and regulations do no cu ntl re testing to be. performed by'a:qualified contractor. However, local reqdie6m0fts rre re u may be. more stringent. Monitoring System Certification Form: AdWum for Vacuum /Pressure -Inicrs'titial:Sens 0 1. Results of Vacuum/Presgure.Monitormig EquipmentzTesting 37asa �" This page should be used to document: testing, and servicing - -of 'vacuum -and pressure interstitial sensors. A copy) of this form must be included with the Monitoring System Certifiieatibn Form, which must be gfibivid6d to., the =k system owner/operator. The owner/operator must submit it z copy of the Monitoring System Certification Form to the local agency regulating UST systems within A days of test.date., Manufacturer: tModel: System 1)rpe: Pressure; ❑ Vacuum Vacuum Sensor ID Components) Movitored'by this Sensor: Sensor Functionality Test Result' E] Pass; ❑Fail. Interstitial Communi,cation Test Result: ❑Pass; ❑Fail Component(s) Monitored by this. Sensor: Sensor Functionality Test,Result: [__1 Pass; ❑ Fail Interstitial Communication TestResult: ❑ Pass; ❑ Fail Components) Monitored �by 1his'Sensor: 'SenSOrL Functionatity Test Resu1t,[]:Pass-,. C]-Fiil Interstitial Communication Test ],Pass,;, ElFaff Component(s) Monitored by. this Sensor: Sensor Functionality Test Result:,[ ] Pass;. ❑ Faa MjerStjjialL Co mmunicatioA Test ResW[:) t:.❑ Pass;, ❑Fail Componefit(s), Monitored by this Sensor: Sensor Functionality Test Result: 'll: Pass;,. ❑ Fail Interstitial: Communication Test Result [],Pass; C3 Fail ...Component(s) Monitored:by: this Sensor; Sensor Functionality Test Result: EI:PaSS; 0 Fail: Interstitial Communication TestResult: ❑ Pass; ❑ Fail Component(s) Monitored by, this . Sensor: Sensor Functionality Test Result: ❑ Pass,' ❑ Fail Interstitial Communication'TestResult:- ❑ Pass; ❑ Fail Component(s) MonitoredLby.tbis-Sensor: .Semr.Functiona* Test Result: ❑ Pass;, ❑ Fail In.terstitial. Communication'Test R60. 0 Pass; El Fail -itomponent(s):MonkotW,by-..O&,,geiis.or.: Sensor Functionality Test Result: Pass; ❑ Fail Interstitial I I Communication Test Result- ❑ Pass; ❑ Fail 'tomponent(s).Monit6r6d by alias Sensor:; Sensor Functionality TdstResW "E] Pass; ❑ Fail Interstitial Communication Test Result-, Pass- Q Fail How was, interstitial communication verified? belaw) ❑ Leak Ibtroduce&at Far End of lnterstitial:Spke-.1 ❑ Gauge; ❑ Visua I.Inspection; []-.Other (Describe in Sec. J, below) Was vacuum/pressure restored to operating levels in afl.interstitial spaces? E] Yes ❑ No (If no, describe in Sec. J_belaw) J. Comments: N/A 'Page 4 of r furthest point from the It the sensor successfiffly detects a simulated vacuum/1P leak introduced in the int6rstitial, vace avthe fin . sensor, vacuum/pressure has been demonstrated to betommunicating .throughout the iht.ers,tice. UN-OMA -1n wwwsanidocs org. Rev, 01/26106 ISABLED URO PROTOCOL PREFIX` ...... IN -TANK' SETUP SOFTWAPE 1'tEVil§'ION. LEVEL SYSTEM SECURITY VERSION, 329.01 'COPE' T I..REGuLAR 101 " SOFtWAREO 346029-100-13, PRODUCT CODE I CREATED -- 0.9. 0i . 213. 15-.44 MAINTENANCE HISTORY THERMAL 'COEFF 1 1 DISABLED TANK DIAMETER 120.00 NO SOFTWARE MODULE TANK PROFILE 4 PTS *SYSTEM FEATURES: ' FULL VOL IiOF)l PERIODIC IN-TANK TESTS TANK CHART SECURITY 90.0 INCH VOL 16262 ANNUAL IN-TANK TESTS DISABLED 60-A INCH VOL 10044, 30.0 I*NCH.VOL 3804 CUSTOM ALARMS, DISABLED FLOAT SIZE: 4-.0 IN. WATER WARNI'NG 2:O SERVICE NOTICE HIGH WATER'LIMIT: 3.0 DISABLED :MAX,OR:LABEL,VOL: 19951 OVERFILL tI.MI 7 90% SYSTEM SETUP TSO 3166:COUNTRY 17956 .. - - - - - - - - - - - - :2010 CODE: PRODUCT 9�. 'JUL Ili :12:11 PM 18953 DEL I VERY: 11 M I T s 10 MASS/DENSITY' 1995 . SYSTEM UNITS P'l. SAPLED; LOW PRODUCT` 642 'LEAK ALARM. L I M I T: 99 SYSTEM LANGUAGE SUDDEN LOSS LIMIT: 50 ENGLISH- TANK TILT 0.00 ,.SYSTEM DATE/TIME FORMAT PROBE OFFSET 0.00 iNqo'Dtf. YYYV�HWHM:SS XN .CHEVRON :SIPHON. MAW*IfOLDED TANKS 1999 TAFT HWY T#-:: -NONE. BAKERSFIELD CA 1INEMAKFOLDED TANKS 661-398-8882 TO: NONE; SHIFT. TIME I DISABLED COMMUNICATIONS SETUP SHIFT TIME 2 DISABLED LEAX.;M I N'PERTOD I.C.:. 15% SHIFT TIME 3 DISABLED 2992 SHIFT TIME 4 DISABLED PORT: SETTINGS: : LEAK ;mi.N' ANNUAL 15% TANK PER TST NEEDED WRN 2 '992 DISABLED' COMM BOARD .(RS-232) ANN TST NEEDED WRN .1 BAUD RATE 1200 ,TANK DISABLED :PARITY 61)b PERIODIC TEST TYPE STOP BIT I STOP STANDARD LINE RE-ENABLE METHOD DATA, LENGTH:;, 7 DATA PASS LINE TEST RS-.282' SECURITY ANNUAL 'TEST FAIL 'CODE I-SABLEP DISABLED L I.NE PER TST NEEDED. WRN DISABLED l>.ERl,ODIC. TEST FAIL LINE ANN TST NEEDED WRN AUTO, TRANSMIT SETT 1,NGS:, ALARM.DI'SABLED DISABLED -AUTO: LEAK ALARM LIMIT GROSS! TEST FAIL 'PRTNT Td VOLUMES D I BA13LED: ALARM DISABLED ENABLED , AUTO HIGH WATER LIMIT DISABLED ANN'TE87AVEWING;: OFF- TEM P` COMPENSATION AUTO OVERFILL,LIMIT PER . TEST AVERAGING;. 'OFF VALUE: (bEG F '60.0 DISABLED ,STICK HEIGHT OFFSET AUTO LOW PRODUCT' TAW TEST, NOTIFY: -OFF ,-DISABLED D I SABLM ULLk.,E: 90% AUTO `THEFT LIMIT TNK TST`9lPk0k BREAK :OFF H-PROTOCOL DATA FORMAT AUTO DELIVERY'START DELIVERY DELAY 5 MIN 'HEIGHT DI - SABLED - ' PUMP THRESHOLD- - 1;0. 0-M DAYLIGHT SAVING TIME AUTO DELIVERY END. 'ENABLED DISABLED START DATE AUTO EXTERNAL INPUT ON APR WEEK *l SUN D.ISABLED' START TIME AUTO EXTERNAL INPUT OFF 2:00 AM DISABLED END DATE OCT WEEK 6 SUN AUTO SENSORfUEL-ALARM. END TIME DISABLED 2:00 AM AUTO SENSOR WATER 'ALARM DISABLED AUTO SENSOR OUT ALARM T 3;DIESEL T 2:SUPREM£.91. PRODUCT CODE PRODUCT CODE 2 THERMAL COEFF :.000450: THERMAL COEFF :.000700 TAW: DIAMETER 96, .00: TANK DIAMETER : 1 20.00 TANK PROFILE: 4 kS TANK PROFILE • 4 PTS. FULL VOL 78215, FULL VOL : 15104 72.0'1NCH:VOL : 6652 90.0 INCH VOL : 12349 48.0 1 NCH, VOL : 4147 LEAK`TEST METHOD 60.0 INCH VOL,- 7605 24.0 INCH VOL 1:540 30.0 INCH VOL 2843 _ TEST ON :DA TE ALL :TA NK 4.0 . FLOAT SIZE,: IN JAN 29. 2009 START TIME : DISABLED FLOAT SIZE: 4.0 IN. TEST '0.20 GAL /HR WATER WARNING 2.0 : WATER WARNING ?•0 HIGH.WATER LIMIT: 3.0. .RATE DURATION 2 HOURS ' HIGH WATER LIMIT: 3.0 MAXOR.LABEL VOL 7829 TST EARLY ST.OP:D'ISABLED MAX OR LABEL VOL: 15104 O.VERF IIL, LIMIT 90% LEAK T£S•1' REPORT OVERFILL LIMIT : 90 7046 .FORMAT NORMAL. 13593 HIGH PRODUCT 95% HIGH PRODUCT 95% 743,7 14348 DELIVERY LIMIT 10% DELIVERY LIMIT. 10% 782 15.10 LOW PRODUCT 359 LOW PRODUCT 468. PEAK ALARM LIMIT: 99 LEAK ALARM LIMIT: 99. SUDDEN- I:OSS- LIMIT: 50 SUDDEN. LOSS LIMIT: 50 ;TAW TILT 0:.00 TANK TLLT 0.00 PROBE OFFSET 0 -.00 PROBE OFFSET 0.00 SIPHON MA'NIFOLAED -TANKS LIQUID SENSOR SETUP- SIPHON MANIFOLDED TANKS T1i: NONE - TO: NONE LINE MANIFOLDED. TANKS L 1.07 ANNULAR LINE MANIFOLDED ,TANKS T #' NONE TRI - (:SI,NGLE FLOAT') TO.' NONE .STATE ., CATEGORY` : ANNULAR SPACE LEAK MI N. PERT OD IC;: 15% LEAK .MlN,PERIODIC: 1.5% 11 -74 ' 2265 LEAK MIN ANNUAL 1 :4 L 219 I .ANNULAR LEAK MIN ANNUAL 15% 1:1:774 TRI.- STATE.('SINGLE FLOAT) • 2265 CATEGORY. : ANNULAR: SPACE i' PERIODIC TEST TYPE: - `STANDARD PERIODIC TEST TYPE L 3:'AI'ESEL ANNULAR STANDARD ANNUAL TEST PAIL TRI -STATE (SINGLE FLOAT) `ANNUAL TEST FAIL ALARM DISABLED CAT EGORY ANNULAk.SPACE ALARM DISABLED: PER I.OD I., TEST FA'I'L ,PERIODIC TEST FAIL ALARM DISABLED L 4::87 $'f:P SUMP ALARM DISABLED GROSS TEST`ALAARM TR,I -STATE (SI:NGLE FL OAT) . GROSS TEST FAIL DISABLED CATEGORY':.STP SUMP ALARM DISABLED: ANN TEST AVERAGING: OFF ANN..TEST AVERAGING: OFF PER TEST AVERAGING: OFF L 5;,91; STP ,SUMP PER TEST AVERAGING: OFF TRI- STATE :(SI :NGIE,FLOAT:)` TANK, TEST NOTIFY: OFF. CATEGORY STP:SUMP TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK, : OF1? TNK TST SIPHON BREi4h CUFF L 6 : :D I iESEL STP SUMP DELIVERY DELAY 5 MIN TRI` -STATE (SINGLE .FLOAT) DELIVERY DELAY 5 MIN PUMP THRESHOLD: 1'0:':00% CATEGO11, : STP SUMP PUMP THRESHOLD 0. Do*: OUTPUT RELAY SETUP R I:REGULAR 87 TYPE' STANDARD NORMALLY CLOSED IN-TANK ALARMS T i:HIGH WATER ALARM T I:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 4:FUEL ALARM L 4*.SENSOR OUT ALARM R 2:SUPREME 11 TYPE:. STANDARD NORMALLY CLOSED IN -TANK ALARMS. .T,2'HIGH WATER, ALARM T.2'LOW PRODUCT ALARM, 'LIdUlD :SENSOR ALMS L 5:FUEL ALARM . SENSOR OUT ALARM R 1 3: D1 ESEL TYPE: STANDARD NORMALLY CLOSED IN-TANK ALARMS. T 3:HIGH.WATER ALARM T 3,:LOW PRODUCT ALARM LIQUID SENSOR ALMS L r,:FUEL ALARM L 6;SENSOR.OUT ALARM 'SMARTSENSOR SETUP 1&1:VAPOR PRESSURE CATEGORY VAPOR PRESSURE 'CATEGORY VAPOR VALVE B:ATM CATEGORY ATRP SENSOR PmC SETUP ALARM HISTORY.RERORT 'PMC VERSION: 01..02 I,N-TANK, ALARM --- VAPOR. :PROCESSOR TYPE T 2::SUPREMt VgEDERROOT POLISHER ANALYSIS TIMES TIME: '10.:oo J* DELAY MINUTES: I x x :x x A END x x x x x ALARM HISTORY REPORT ----- SYSTEM.ALARM PAPER'OUT JUN' f 9, 2016 6::42 PM PRINTER ERROR JUN, 19,1:2010 6`:-42 'PM ALARM HISTORY' REPORT ---- IN .-TANK ALARM T 3: D I ESEL. OVERFILL ALARM.. ZAN, 31. 20fo, PM w X END'x W x x x DEC 2 1 8.200'9 5:46 PM DEC: 13 '200 6:57 PM .ALARM HISTORY REPORT .. END :x X x x X -- - -..IN -TANK .ALARM Vt',REGULAR 87 OVERFILL ALARM JUL 11. 2010 �1 ' 5:42 PM JUL 4 20f'0 6: 04 :Pm, FEB 12. 2010 3117 AM, HIGH, PRODUCT ALARM JUL 4. 2.011:0 6:07 P11 ALARM HISTORY REPORT SENSOR 'ALARM, ----- L I.:81'ANNULAR (ANNULAR SPACE FUEL. ALARM. JUL 13, 2010 ib.,*20 Am SENSOR OUT ALARM FEB 20.: 2010 2:�O' PH SENSOR OUT ALARM x x END x x FEB 20- 2010 2:25 PM • 0 ALARM HISTORY.REPORT • - -- SENSOR ALARM - L 2:91 ANNULAR ANNULAR, ,SPACE FUEL ALARM JUL 13. 2010 10::21 AM SENSOR OUT ALARM NOV 25. 2009 1.:48 PM SENSOR 4UT ALARM NOV 15. 2009 4;46'PM x ENDaw, ALARM HISTORY REPORT SENSOR ALARM .L 3:,DIESEL ANNULAR ANNULAR SPACE FUEL ALARM JUL 13, 2g10 10:22 AM FUEL ALARM JUL 27. 2009 2,:.52 PM FUEL ALARM JUL 27. 2009 2:50.PH xxk ** END Xxxx ALARM HISTORY REPORT - - - -- SENSOR ALARM - - - -- L .457'.SFP SUMP STP SUMP' FUEL ALARM JUL 13. 201.0 10:19 AM FUEL ALARM JUL. 27. 2009 12:52 PM ALARM H'I:STORY REPORT - - - -- SENSOR ;ALARM - - - -- 1...6::91, STP SUMP .STP 'SUMP FUEL ALARM JUL 13. 2070 .10:19 AM FUEL ALARM JUL 27. 20139 12:53 PM R END w.x x ALARM HISTORY REPORT .SENSOR.ALARM - - - -- L 6:D:IESEL STP SUMP STP SUMP FUEL ;ALARM JUL 13', 2010 10:18 AM FUEL. 'ALARM JUL 13;, 201,Q 1`O::.f 8 AM SETUP DATA WARNING FEB 20. 2010 2:,57 PM 9 x * X: x END'. 0 • MONITORCERT.. FAILURE REPORT SITE NAME: CHEVRON DATE: 7/13/W DY ADDRESS: 1999 TAFT:Hwy, THE FOLLOWING COMPONENTS WERE TESTING. LABOR: PARTS INTALLED: NAME: TITLE,: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TOREPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING: RICH ENVIRONALANTALYOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES, OC(:URjNG FROM NON-COMPLIANCE. A COPY OF THIS ]DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIIENENCEi' .`'' y .. �. e ri - ' �, p.. � c a, A _ .1�_ _ .,. a.,.:4n'�k � .. ,� .� .. - �. _.. ....�..._ ,]L.. .. e .�. � ,, .. r � � . ... e _ _ _ .. .o- u . 4 � .� .a�k� ,. � .. _ si, MONIAkINGO. SYSTEM CERTIFI&TION ,For'We By, A11 lurisdictiow -W. ithin the :State "of California Authority Cited: 'Chapter. 6.7-H galth and ChO.ieir 10,, PMsh)n 3, Tide, 23; California Cod&qfReoldtions This form must bez used AoAocument testing and §ervicin r " 6 " ' ' i th A e�.certfflcution or report: g 6 monitoring.cquipment. monitoring system control panel by the technician ik',-hio. perf6rm's the wdrk...A copy ,. of this form musllbe.provi8ed to the 6j The ow-ncf/operatormust submit a co&.617 this forimt6the-locall'agOncy reg4latin U systems within 30 diLys of test date: A. General Information Facility Name: CHEVRON RECEIVED Bldg. No.: Site Address: 1999 TAFT HWY AUG J120mly:. BAKERSFIELD Zip: Facility Contact Person: I Contact Phone No.: . Makel"Model of Monitoring System: TLS-350 Date of Tes,ting/Servicing:7127/2009 H. Inventory A-Af ]III; Ifti-Iri-at"AW .4UWR.(DNMENTAL HEALTH SERVICES %I F�Aql %, Check the aiDDrooriate boxes to indicate specific eau!DMtnt insnected/serviced; 01 Tank ID: UNL87 Tank ID: PREM91 In-Tank Gauging Probe, Model: MAGI 0 &Tank Ou 'ing Probe Model:. MAGI Annular Space or Vault Sensor. Model: 409 9: Amiulir,SOiCe-or Vault Sensor. Modet 409 Piping Sump / Trenelf Sensor(s). Model: 208. O Piping -Sump Trench,:Smsor(s). . Model: 208: 0 Fill sump'sewor(%). Model; 140 SENSOR 0 Fiji ;Sump sensor( %). Model; NO SENSOR Mechanical Line Leak'Detector. Mo'&[- jFXIV ®.Mechauicat.Line LealcDeltector, Model FX1V: ❑ Electronic Line Leak Detector. Model: [I Electronic 1inc Lekk Detector. mode(; ❑ Tank Overfill i High7LevcI.S,ensdrL. ModeL. ❑ 'l'mtk Overflu rHigh-Leve . 11.,Senscr: Model: ❑ Other 0 pecift,vquipment.�ypc and.mqdcl_in-Section E on Page-2). *n E on ' Page 2).. ❑ Other (spccify6:q4iprncnt typeand. model in Scctio , Tank ID: DIESEL Tank ID` 0 In- Tank Cratiging-Ptobei model: MAGI 1 4qk'Gaugi" no iobe, Model: 0 Annular Space or.Vaalt.�Sensor. Model: 460 Space.,or..:Vpali*nsor; m6cl6k ED Piping Sump:! Trench Sensor(sY. Modd ' 20a ❑ Piping Sump, [Trench Scnsor(s). Model:: Z.Fili Sump Sensor(s). Model: NO SENSOR ❑ F.J1111-Sump Sensoq.$). Model: O .Mechanical line Leak Detector. Model; FXIOV '[1'Mccfianieaj Line Leak Detector. Model:' ❑ Electronic Line Leakbetcetor. %16del: El Electronic Uine1calel)etector. Model; ❑ Tank Overt IV H igh-Level'S6rison Model; UTanksh-cifilll lig h -Level S e nsor. )Nodal:: ❑ (specify equipment type and model in Scution'F'on Pagel) .. ' Section Eon Page 2): ❑ Clther.(specify equ , P mcnt t y p e and mode in Dispenser ID: 14 DispinserID: 1-4: 0 Dispenser ,coniiiii1mcirt Seowr(s). Model: _X , 361 ODis-pen%er Containment Scosor(s). Model:.: 361 Shear Valve(s). asil , ea:r V6W6(s).. ❑ Dispenser Containment Float .6) andChain(si. )i. -Conta fint nt F oat(s d,Chiin(s)'� 0,.T 5 me. i e 1 ),an Dispenser TD: 5-6 Dispenser JD: 7-4 14 Dispenser Contaii.iment:Scn,"S): .Model: 361 DispenserContairu,nent Senso sY. Model: 351 Shear Valve(s) ❑ DisponserC6ntAinmdntF46at(s')�and Cha*%). 0'I?jspenSer COF1tEUnMent+Ioat(s) and Chain(s)._ Dispenser ID: OAQ ispens-er-M.- 11-12. ZE)iSpc.nserContainfiiait.Sens6r(s). -Modcl: 361 Iffbispe'nse'r t6intainnient: Scrisor(s). 3SI EK Shear Valve(s).: Valve(s). M _E3Dispenser Containment, r-lbaq and Chain(!i) *If the facility:contains 4hore tanks or dispensers; 'copy ' this 'fo' Inckide inf6rmadon,foreye7 ty#k"and A ispenser at ih e' aci ity. C. Certificath 0 . =.i certify th at the equ pinent Ide ntified in thWOocument was inspected/serviced in rd a uti: with: the':manufacturers' guidelines. Attached to this, Certificatio'n checklisto nece-Mar"to virify Ahat this inforniationAs I i ." 1 1 " �y correct and :afPl6t Plloti'showing the Inybut.of monitoring.,equipment Tor any Oul i capable � pmen caps. e of'generating: tuch reports, I have also attached,a copy of the;rep6rt,�(check afft h a f-app, 0) Pg.tem. Wsvp IArm history report Technician Name. (print): , RYAN MASON ce Certification No.: A27367 =462,612134T U qsiroi i098"60, iT 140�, tesdngCompany Environmental Name; Rich Environmental Phone No.: (001) 391,8687 Testing Company Address: 6643'BROOKS CT. BAKERSIFIELb,tA03'08 — Date of Tqsti*,SefOcing; 712712009 ?age I of 4 UN-036 — 114 01117/08 a 0 Monitoring System Certificad'on, D. Results of Testi000rv1CMg%' Software Version Installed: 329.01 COMDlete the following checklist- Yes [].No* Is the audible*-al'arin.operational? Yes D No* Is the visual:alam,operationat? 0 Yes ❑ No* Were all sensors visually inspected, functionally . tested, and confirmed operational? IR Yes [D No* Were a] ' I sensors m*s011ed,at-lowest point Of secondary. containment and'positioned: soifiat other equipment will not interferewitb their proper . operation? * Yes ❑ No* if alarms are relayed to a,rem6te monitoring station; is :all, communications equipment (e.g., modern) 0 N/A operational? * Yes ❑ No* For pressurized piping' syst&Dsj:&esthe'turbine automatically shut down if the piping 11 secondary containment ❑ N/A monitoring system detects a4eak.: fails to. operate, or is .eiep.tricallv:dis,iooiiiiected? If yes- which sensors initiate positive shut -down? (Cheick all that app ly). 0,'SumprFrencb.Senso; rs-CIDIspenser,Cont4inment Sensors. I Did 'you confirm positive: ibut-domm. due to, Icaks,and sensor failureldisconnection? 0 Yes; 0' 0. N ❑ Yes ❑ No* For tank: systems that ufillie the monitoring system as t be primary tank ove r f ll warning 4eyice (Le.; no 0 N/A mechanical overfill prevention valve is installed);. is the overfill warning alarm visible and audible at the tank' filL.Odint(s):ii7adlopemtilig,property? If so; at whatpeident of tank .c'apk6ity:d6es:the,alarm,,trigger? EK Yes* [I NO; Was,any monitoring equipment replaced?' a yes idefitily. §p&ific sensors, probes,. or other :,equipment replaced and -list the manufacturer, riame: and model-16r all r'0pl6cer'fien't'p*rts"in Secti6n.'.E. below. ❑ Yes* 0 No Was liquid"found inside -any'secondary . containment :sytthms.:de-gioed as'dr.),:systems? tCheckal-1 that' apply) Cl _Product; El Water. if yesi describe Causes in Section 1 on E'below , 23 Yes ❑ No" Was. niotiitotiqg'sygtem;sct-up,rpyieWeo if applicable 9 Yes Q No* Is all'monitoring equip.mentoperguonal per manu fa cturer's specifications? In Section E helo*,i descHbe, how,and, when these: ill'bi corrected: e� were or, E. Comments: ANNULAR SENSM:ON DIESEL tANKWA8 FOUN b Td, 8EBROKEN AND WAS REPLACED AND RETESTED. RETEST PASSED. .Page: 2, . of 4 UN-036 - 2/4 R&1.01/17/08 4>- ManitdrinL7 Sys.te-m0ifificatio'h • F. In -Tank Gauging /:SIR 'tcniPment, 19:'Che6 k, thj,t if tank gauging I inventory control. gaugi orSIR eouipmencis installed. This section must be completed if in -tank gauging equipment.is- used ,topefforrn leak, detection,,monftbring. Complete the following checklist: ❑ Yes ❑ No* ffas all input Wiring been ispected, for proper entry.and termination, including testing fpr ground faults? ❑ Yes ❑ No* Were all tank 9 auging probes.,visuilly insped6d f6i damage and residue buildup? ❑ Yes ❑ No* Was accuracy of,systern product,'Icvel readings tested? F-I Yes ❑ No* Was, accuracy:of system water IeVel readings ,'tested? ❑ Yes ❑ No* Were all probes reinstalled prop&IY6 ❑ Yes ❑ No* Were all items on the equipment manuticturer's maintenance checklisucompleted? * In Section H., below, describe how and whewthese.deficlencks were.'or"W'ill bt corrected. G. Line Leak Detectors (LLD): ❑ Cheekthis'b6k ifL-LM are not tinstalled. Cfimnlr.tP thp WInwina rhpi-kfiet- 0 Yes ❑ No* For:, mtnCstart-up , or:- annual equipment cortiftation was aAeak simulated to verify LLD: performance? ❑ N/A (Check :allihatqpply) Sjinjulate,d,leak:jrAte:i IZ 3 [10.'] g.p. ® YCS ❑ NO* Veye AlILLDs xonffiThed -opetationi):and'Accuratc whhin tegulat6ry 'requireinenfs'Y ED Yes ❑ No* Was di&testing appAratus.prop.erlv,c,aljlbratedi. Z Yes ❑ For mechanical hanicaiLLP's,does. 1he"LLD 'restrict product flow: ifit: detects leak? ❑ N/A ❑ Yes ❑ 'No* For electronic 1,Lljs,;does.the.tarbine.auto.matically shut , t of if the-LL LLD ddedts,a leakI 0 N/A ❑ Yes ❑ Njo?k For, electr.onic L LOsI.rdbes the turbine automaticallysht.it off if any portion ofth6,:mofiit&ihg system is.disab led M N,1A ordisconnected? ❑ Yes ❑ No* 'kbrclettroiiic',LI,Ds'; does :�:ihe,tiirbine.atitomatically'shatoffifift ` portion ofthe itotihgsystem malfunctions y po on inon 9 N/A :or tails a test? ❑ Yes Es 0 No* FOtelectronic l.LDsihav6.� all .actp��iblelwiiin connee-tions -beenmsu'atly, irispected?: 9 N/X Yes ❑ 'No* Were all'items on the ent ufacturer'sbaintenance:c qWisicompleted) qqpipab -man h In Section H, below, descrli.be,hqw-and <when orwlll...be:cqrrectel. H. Comments: — UN-036 — 314 Page 3: ;of 4 awwanidocsorg Rev. 01/1.7/cA, 0 e --- -0 3Z"� Monitoring Systcm Certification UST Monitor] Site Address: b:aik�hs: If you already have, q':d' that shows 91 d,in ftAtiou; Y ou inay b6ludeft',. mther thah this 4ith your iagram, s ows mquird & Paget P" V Monitoring $ystem' Certification. J yotifsit�6:.ijlaniho.w.,,themerai.*out:ot,' and 10, CI-. �iden* OPP% locations . of the following equipment; ififistalled: monitcr':gisygft�control,pAwls;.,sensprs. mom t Bring annular SPaces, sumps, Oispense r pans,'spill z6fi m secondary: tidAersi,otbei ,coniainment,mus;:mechaaicaI bf.616ctronk line leak c detectors; and in-tank liquid level probes .:(if used forleak'detection)' in die spam provided, note Site Plan' was prepamd. 'page of 05100 RICH !WMQNMENTAL, 5643:'BROOK9 CT .9 KMSVIELD, CA. 93308 OFFICE (661)392-8687 FAX ,�,661)391 0621 PRODUCT LINF, LEAK DETECTOR TEST WORK SHEET wlo#'.- - FACILITY NAME: TAFT HWY. CHEVRON FACILITY ADDRESS:: 1090 TAPT HWY BAKERSFIELDfA. PRODUCT LINE TYPE: PRESSURE PRODUCT LEAKIDETE.C, TOR. TYPE TEST TRIP PASS BELOW- P.-Sj. 'M -.SERIAL NUMBER I G.P H. TAJL UNL87 L/D TYPIE:-, MECHANICAL, YES, 40 PASS SERIAL # REDJACKEJ pREM91 L/D TYPE:. MWJJAXICAj : YES 10 PASS S.ERIAI,4- RED J*Ck,ET DIESEL L/D TYPE: MF HAN"L YES PASS SERIAL4 RED JACKET,, L/D TYPE YES: ASS ;SERIAL It, FAIL I CER77FY,T - HEABOVE TESTS'. I JACKET-PUMPS TIELD TEST APPAI THE MECHANICAL I LEAK DETCC'T+ LOW FLOW THRESHOLD :TRIP RA" ACKNOWLEDGE THAT ALL .DATA ;- OF MY KNOWLEDGE. "PKDUCTEI):ONTHIS:DATEl ACCC CU.STE STING TROCEDURE AND Ll TEST PASS / MAIL IS-DETERMINE] jf'. GALLONS PERVOUROWLE"RI LLECTED-IS TRUE AND. CORRECT TECHNIC'TAN. k*AN MASON SIGNATURE:. DATE: 7-1'109 AIGTO RED. ATFONS.� 'USIN P.S. A IL� .161 "I TN E:BEST 32_01A1 S-t, SVrRCB..january 2006 sting,Repo , Spill R ipqokt TO rt Forth Thisj6rm is.intpndedfibr use `o contra ct?r,v' pe� fip mIng.j 6fV Tipillzc htdihihent,sfructures.The completed firm and printouts from lests (if applicidb&)i should be provided : to t6 kawv own Voperator fi '' Submittd; to the, local. reguMor gr. . or y agency., 1. FA r11T.ITV YN FORMATION Facility Name: CHEVRON D'ate of Tefting: 7 -27=09 Facility Address: 1999 TAFTEWY 13AKERSY1E'LDXA Facility Contact: pholie; Date Local Agency. Was Notiftedof Testing: FName of Local Agency - Inspector . (ifpresmt during ldting).., 2. TESTING CONTRACTOR MO I RMATION' Company Name: RICH ENVIRONMENTAL Technician Conducting Test-. RYAN MASON Credentials': !—'CSLB-Contractor, X IC , C . S , ervice Foch'. ELSWkCB tank Tester —:Other,(, , �p License Number(s). 52612!3" -UT 3. SPILL IMJOCET TESTING. INFORMATION Test Method Used: X Hydrostatic UNA= I m: F1 Other. "lest Fquipme-n(.U.sed"V1SUALI Eq'u.i0ment;R6so1qti,oh: .0.00 7 identify Sp1H B4cket,(Bv Tank 2 3 4 Number, Slored , Product, etc. ) V'N .LS 61E . SE'L Bucket installation Type: 0 Direct I�Ury X Contaihed,in:Sumv j[5rkcci Aury XcontainedibSump n:Dizt�tt,Bbry XCofitAined. in,Sump ',binct Bary U Contained - in Sump Bucket Diameter 12, 12", Bucket Deptb:: 16" 1.6" Wait time between applying vacuum4iterland,start of test;. 30 MIN 30 MIN, 30 MW Test Start Time (T—,)* I V:30.AM, 1110AM: i :AAM; TnitjaJ.Reading.r(Rj)- 1419 14". 14," Test Fnd Tlxbel(r-F): 1230pm 12'. 3 OPM, 12 30,Pm Final Reading (Ry): 14$0 14" Tcst Duration TD- ]-HOURI' lw HOUR, Change in Reading (RF -PII):: (Y 01) .Pass./Fail Threshold or Criteria:. "I 0:00 0.00 Comments, ( include - information omrqpqirs.ma4eprior 1646tihk, and .reebminended follow -up for failed tests) CF]ITIFICAtION diF TECHNICIAN .RESPONSIBLE" FORCO I ND . UCTING THIS TESTING I hereby certify.Aatall the information contained to thkrio6d.ls thie,:accurerreandinfull com p4xap;pvo lift legpl regaltemettts. A/ Datc:�:.: 7-27�09' Technician's -Sign ature: irete State laws and -r6gutitions:ddwt currently ,. 'u'jr&tesflngT . to be ' e'd-bya 4661ifidd"Ontracticyr.4 49%yever, local.requireibents may be more 9tringefit. SOFTWARE OLVI61ON LEVE L ' VERSION 329..01 SOFTWARE# 346:329-100-B CREATED -.09.01,29.15.414 NO SOFTWARE MODULE SYSTEM FEATURES: PFRIODIG IN--TANK TESTS .ANNUAL IN-TANK TESTS - SYSTEM' SETUP - - - - - - - - - - - - JUL 27. 2009 2:58 PM SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE/T.IME FORMAT MON DD YYYY HH.::*:SS -xM CHEVRON, 1599 TAFT:HWY BAKERSFIELD CA 661-390-8882..*� SHIFT .TIME I ' D.IS► BLED SHIFT TIHE�'Z :DISABLED, SHIFT TIME. 3': DI'S'ABLED. SHIFT TIME DISABLED TANK PER Tk NEEDED WRN DISABLED TANK ANN TST:NEEDEa WRN DISABLED .LINE RE-ENABLE kETHW: PASS LINE Al i LINE'PER,TST NEEDED WRN DISABLED. LINE ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATI'ON VALUE (DEG F ),: , - 60.0 STICK HEIGHT OFFSET DISABLED ULLACE:.90% H-PROTPOOL DATA.FORMAT HEIGHT DAYLIGHT SAVING TIME ENABLED:. ,START DATE APR WEEK 1: ouo START TIME 2:00 AM END DATE OCT WEEK '6 BUN END TIME 2:00 AM COMMUNICT[ONS SETUP PORT SETTINGS: . 1COMM.BOARD- : 1 (RS-232) BAUD: ATE 11 200 PARITY ODD. STOP Bit I STOP DATA LENGTH:, 7 DATA AS-932 SECURITY, CODE ImsABLEV AUTO TRANSMIT. SM,,I,N(38' AUTO LEAK ALAR.M. L I MIT AUTO HIGH WATER LIMIT AUTO OVERF-TLL LIMIT - DISABLED. ,AUTO LOW PRODUCT 'DISABLED-.' ;AUTO. THEFT LIMIT DISABLED- AUTO DELIVERY START AUTO DELIVERY END DISABLED AUTO' D:TTERNAL INPUT' ON .AUTO EXTERNAL INPUT OFF DISABLED-: ' AUTO FUEL- ALARM 'DISABLED. WATER ALARM, Dl SABLED 'AUTO SENSOR OUT ALARM,, DISABLED I N=tA GETUP' T,, 1,: 1 RE G ULAR 0 ' 7 PRODUCT' CODE ' I THERMAL.COtFF :.000700 TANK DIAMETER 120-00 TANK PROFILE. 4.PTS FULL VOL 1,9951 INCH V& 16262 60.A INCH VOL 10044 3,0.0 INCH VOL 3804 :F7LGAT SIZE: 4,0 IN 2.0 HIGH WATER LIMIT! 3.0 MAX ORLABEL VOL; 19:951 OVERFILL LIMIT 90% 17956 H IGH :PRODU I CT 95yo- 18953 D!EL.I_VERY LIMIT 1995 L061 , PRODUCT , 642 BU N'�'LOSS LIMIT: 150 TANK TILT: 0.00 RP68E OFFSET 0.00 BIPH6N MANIFOLDED TANKS TW' ''NONE LI,NE, MANIFOLDED.TANW8 -T )NONE' 'LEAK MIN PERIIODIC' .15% 2992 LEAK H'14 ANNUAL 15% '2992 PERIODIC TEST TYPE STANDARD ANNUAL TEST:FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM '.DISABLED GROSS ,:TEST FAIL ALARM DISABLED ANN 'PEST .AVERAGNG:: OFF PER TEST;AVERAGING: OFF TANK tg�Tl NOTIFY:' OFF TNk, Tst 81PHON BREAK:OFF DELIVERY D.F.LAY 5 MIN .PUMP THRESHOLD 10.00% T 2:SUPREME 91 2.,0 PRODUCT CODE 3.0 THERMAL COEFF :.:000.700 TANK. DIAMETER ? 1,20,00: TANK PROF:I LE 4" PTS ' . FULL VOL 1'5104 90.0 INCH VOL 12349 60.0 INCH VOL 7.605 30,0 INCH VOL 2843' FLOAT SIZE: 4.0 IN. WATER WARNING. 2.,0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 151:04 OVERFILL LIMIT 91rX 13593 HIGH PRODUCT 95% 14348 DELIVERY LIMIT LOX 1510 LOW PRODUCT. 469 LEAK ALARM LIMIT: 9.9 SUDDE14 LOSS LIMIT: 50 TANK TILT 0.00 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS TO: NONE., LINE MANIFOLDED TANKS. TO: NONE LEAK MIN PERIODIC: i5o 2265 LEAK MIN ANNUAL. 15a 2265 PERIODIC TEST TYPE. STANDARD ANNUAL TEST.FAIL. ALARM DISABLED PERIODIC'TEST FAIL ALARM D I SA13LED GROSS TEST FAI -L . ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 5 MIN. PUMP THRESHOLD : 10.00•.6 PRODUCT CODE, 3; . T;HERIV. COEFF' ::Ci0045Q' TANK DIAMETER 96 • 00 TANK ;PROF.,ILE 4 PTS FULL. VOL 7829' 72.0 I NCH VOL- :' 6652 48:'O INCH VOL; 4:147 24.0 INCH 'VOL : 1540 FLOAT SIZE *4.0 IN. WATER WARNING 2..0. HIGH WATER L °I"MIT: 3.0 MAX OR.;LABEL _VOL: 1829 OVERF I LL' ,I: I M I T 90%d 7046 HIGH %PRODUCT 95 °! 7437 DELIVI~RY`II MIT 10' 782 LOW ..,PRODUCT. : 359 LEA};. ALARM LI;MI`T.:, 99 SUDDEN LOSS is i M I T :; 50 TANK TILT a,.00 PROBE OFFSET' SIPHON',HANIFOL17O TANKS TO :' NONE;' LINE..MANLFOLDED TANKS T#:; NONE. LEAK, M.I Iii P£T1'I OP I C: 1.5! 117.4 LEAK MIN ANNUAL 15% 114 PERIODIC TEST TYPE, STANDARD ANNUAL TEST, FAIL,. ALARM:DISABLED I?£i3I.6DI0 TEST FAI;i. ALARM :DISABLED GROSS' TEST: ;FA`LL ;ALARM '.D:ISABLF A1414 TEST AVERAG I NG; OFF-, PER 1 ES'T AVERAG I`NG' OFF' TANK TEST NOTIFY. :. OFF, TNK TST SIPHON BREAK Orr 17EL1VERY_. vELAY: t 5: Ml N' PUMP THRESHOLD 10.;;009 • Z.b •LEAK TEST METHOD `TEST ON DATE; :.ALL TANK JAN.•29..2009 START ,.T;IME : DISABLED. TEST: RATE :'0.20 GAL /HR DURATION' a 2 HOURS TST EARLY STOP:DiSABLED LEAK TEST RE PORT FORMAT NORMAL .LIQUI"D..SENSOR SETUP L 1' :87 ANNULAR' TR 17STATE (SINGLE FLOAT ) CATEGORY: ANNULAR SPACE L 2.:91t.ANNULAR TRI'.- STATE (S;I;NGLE FLOAT.) CATEGORY :.HNNULAR SPACE L 3: U I i~SEL 'ANNULAR TRI.- STATE'tSTNGLE.FLOAT) CATEGORY ANNULAR SPACE L 4 %87:STP SUMP TRT —STATE (SINGLE FLOAT). CATEGORY ' STP :SUMP L . :5 ::.91 : STP SUMP . i TRIATE: (S.I•NGLE..FLOAT) CATEGORY': STP SUMP` L 6':DIESEL STP 'SUMP, TRI —STATE (SINGLE FLOAT) CATEGORY STP•.SUMP 9 LJ OUTPUT RELAY`'SETUPMPiRTSlrNaOR SETUP R i:REGULAR 87 s 1 ViF'OR PRESSURE,. TYPE: CATEGORY VAPOR PRESSURE STANDARD NORMALLY CLOSED s 2:CARBON'GANIST0R . "CATEGORY VAPOR VALVE IN -TANK ALARMS s a' ATM T i:HIGH WATER ALARM CATEGORY ATM P SENSOR T 1.LOW PRODUCT ALARM LIQUID SENSOR ALMS L 4:FUEL ALARM L 1:SENSOR OUT ALARM L 4:SENSOR OUT ALARM R 2:SUPREME 91 TYPE: STANDARD NORMALLY CLOSED IN -TANK ALARMS T 2:HIGH WATER:ALARM T 2:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 2:FUEL ALARM L 5:FUEL:ALARM L 2:SENSOR OUT ALARM L 5:SENSOR OUT ALARM R 3:DIESEL TYPE: STANDARD.' NORMALLY CLOSED IN -TANX ALARMS T 3:HIGH.WATER'.ALARM T 3 :LOW PRODUCT ALARM LIQUID..SENSOR ALMS L 3: FUEL ALARM L 6 : FUEL, ALARM L 3 :19ENSOR :OUT ALARM L 6:SENSOR OUT ALARM` P.IC SETUP PMC: VERSION:: 01.;02 VAP{Ow PR04E$SOR TYPE VEEDERROOT POLISHER: A NF1L�!S I: S T 1 ME$. T :IME• 1:0-00: A.K. DELAY MINUTES 1; ALARM HISTORY REPORT SYSTEM ALARM PAPER. OUT JUL:. 2.4'r 2009: ' 9 : a5; PM PRIIVTERi: ERROR: JUL 24., 2009 9:05 PM k N: . X -30 x END .x .x :x "x • ALARM H I5T'b.kY REPORT -- - I N -TAN}; .ALARM - - - -- OVERFILL "ALARM MAY'24-' 2009 I:37 PM APR ..26. 2009 12:49 FPM. x'NNXx END Xxxxx ALARM HISTORY REPORT I:N47ANK ALARM - - - -- T 2..SUPREME :91 # NIX 'x * END' W' X:. k x x. ALARM HISTORY RI~PORT --- IN -TANK ALARM --- - -- T 3"::.DTESEL: OVERFILL ALARM JUL, 26. 200.9 8 :12 PM. MAY 1`9 2005 6:17 AM x * w A : 9 END x X x X K ALARM HISTORY REPORT ----- SENSOR ALARM 7 L 2':91. ANNULAR ANNULAR SPACE FUEL ALARM: JUL 27, '2009 121,55: PM X % * A x END 'X W` x X.0 'w x j4' A END ALARM HtSTORY 'REPORT SENSOR ,ALARM z4:V, STP `SUMP STP 'SUMP ' FUEL .ALARM', JUL. til: 20.019 :1:2:;52 PM END, ALARM HI I BtORY;'REPORT SENSOR,ALARM L x:9:1 aTP SUMP STP SUMP, FUF.L'ALARM' JUL 27- 2009 12.53 PM END, W, K. x x x P LARM -HIIS-TORY REPORT SENSOR I ALARM ----- L &:DIESEL. STP SUMP STP SUMP F ALARM 112:53 PM Elib x x )i, ALARM :H - I STORY 'REPORT BENSOR ALARM OTHER SENSORS ALARK HI'sTPRY REPORT ALARM HISTORY REPORT SENSOR ALARM GENi�OR ALARM --- L 3::: DI E SE I L ;. ANNULAR' L 1:87 ANNULAR ANNULAR, SPACE' ANNULAR SPACE FUEL ALARM.. FUEL ALARM Vol "20,09 2.52 PM „ JUL 27, 209 1:30 PM f UEL ALARMI FUEL ALARM JUL 27. ;2009 2.50 ?M JUL 27. 2009 1;29 PM SENSOR OUT ALARM FUEL ALARM JUL. 27, 2009 2- 42: PM JUL 27. 2009 12:55 PM x * w A : 9 END x X x X K ALARM HISTORY REPORT ----- SENSOR ALARM 7 L 2':91. ANNULAR ANNULAR SPACE FUEL ALARM: JUL 27, '2009 121,55: PM X % * A x END 'X W` x X.0 'w x j4' A END ALARM HtSTORY 'REPORT SENSOR ,ALARM z4:V, STP `SUMP STP 'SUMP ' FUEL .ALARM', JUL. til: 20.019 :1:2:;52 PM END, ALARM HI I BtORY;'REPORT SENSOR,ALARM L x:9:1 aTP SUMP STP SUMP, FUF.L'ALARM' JUL 27- 2009 12.53 PM END, W, K. x x x P LARM -HIIS-TORY REPORT SENSOR I ALARM ----- L &:DIESEL. STP SUMP STP SUMP F ALARM 112:53 PM Elib x x )i, ALARM :H - I STORY 'REPORT BENSOR ALARM OTHER SENSORS . MONITOR CERT. FAILURE, REPORT SITE .NAME_: TAFTHWY-CHEVRON DATE': 7/21j69 THE FOLLOWING COMPONENTS TESTING. REPAILRS: REPLACE. DIESEL ANNULAXSENSOR LABOR NONE PARTS INTALLED.: I-'VEED,F,R-ROOT 409 VVRAP AROUN NAME: TITLE:: ETE THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY* OF NOTIFYING THE APPROPRIATE PARTY CORRECTIVE ACTION: TAKEN TO REPAIR THE ABOVE LISTED PROBLEMSAND: -NOTIFYING RICH ENVIRONMANTAL FOR ANY NEEDED . RETESTING...T,HI*S.%ALSO;RELEASE-.S:RI.C-, HENVIRONMENTAL OF ANY FINES OR PENALTIES. OC�WNG. FROM NON-COMPLIANCE. A COPY- OF THIS DOCUMENT, HAS BEEN,UFT- ON -SITE FOR YOUR CONVIEN.ENICE. • f t REC�JFD JAN 2 9 2009 SWRCB, January 2002 KERN COUNTY page Iof / ENVIRONMENT& HEALTH SERVICES Secondary Containment Testing Report Form This farm is intendedfor use by contractors performing perlodic 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 (rf applicable), should be provided to the facility owner /operator for submittal to the local regulatory agency 1. FACILITY INFORMATION Facility Name: V DateofTesting: rj•- f1!" -C. Facility Address: 1991 Facility Contact: j Phone: Date Local Agency Was Notified of Testing: t.•p (7-> Name of Local Agency Inspector ftfpresent during testing): vx Qqr rxT&- rArrrD w /'•Tl1D T%MnDMA TTfn1Y %1 Company Name: RICH 'ENV IRONMENTAL Technician Conducting Test: Credentials: X CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester License Type. C61ID40 Manufacturer License Number: 809850 Manufacturer Training Com onen s Date Training Expires INCON INCON TS -STS 3. SUMMARY OF TEST RESULTS If hydrostatic testing was performed, describe what was done with the water after completion of tests: RECYCLE AND REUSFD CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best ofmy knowledge, the facts .stated In (AIs document are accurate and In,jull compliance with legal requirements Technician's Signature: Date: TANI-09 aG Component N 1 11 0OM0 i7©©© MOM • Ltir �.�.♦ IMIR M Ell WA W-4-2=13 1 v OMOM M i!� .. �► • - =rte. ������/11�A71<_ � .u�������� • it tr �i1r� ©�� ��. 7u/ �ai� 1' ... - o0o nno® a . o imam= If hydrostatic testing was performed, describe what was done with the water after completion of tests: RECYCLE AND REUSFD CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best ofmy knowledge, the facts .stated In (AIs document are accurate and In,jull compliance with legal requirements Technician's Signature: Date: TANI-09 aG • J �, SWRCB, January 2002 d TANK ANNirI,AR TESTING Page Z• • of 9 Test Method Developed By: 0 Tank Manufacturer J? Industry Standard 0 Professional .Engineer Cl Other (Spec) Test Method Used: 0 Pressure 9 Vacuum U Hydrostatic 0 Other (Specify) Test Equipment Used: 4 i n . DIAL GAUGE - ;:t•,;.; 0014' - Tank# TankN zi Equipment Resolution: . 5% Tank# 1 Tank Is Tank Exempt From Testing?' 0 Yes •E NO 0 Yes ANo 0 Yes XNo ❑ Yes C: No Tank Capacity: Tank Material: Tank Manufacturer: N Product Stored: Wait time between applying pressure /vacuum /water and starting test: 0 M1 Test Start Time: Initial Reading (Rr): Test End Time: Final Reading (Rj): Test Duration: u Change in Reading (Rr -&): .Pass /Fail Threshold or Criteria: Test Result: ) ( Pass 0 Fall )21 Pass 0 Fait Pass 0 Fail ❑ Pass n Fail Was sensor removed for testing? A Yes 0 No DNA )d Yes ❑ No ❑ NA 0(Yes 0 No 0 NA ❑ Yes C No I.' NA Was sensor properly replaced and verified functional after testing? XYes 0 No 0 NA 'Yes ONO DNA ,'gYes 0 No DNA 0Yes 0No 0NA Com merits — (include if formal ion on repairs made prior to testing and recommended follow -up for jailed tests) r 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)) • 0 SWRCB, January 2002 5 SECONDARY PIPE TESTING Page J of Test Method Developed By: 0 Piping Manufacturer jt7 Industry Standard 0 Professional Engineer ❑ Other (Specify) Test Method Used: 11 Pressure 0 Vacuum D Hydrostatic 0 Other (Specify) Test Equipment Used: 41n. DIAL GAUGE }rte Piping Run # Piping Ran N Z Piping Material: I Equipment Resolution: . 5% Piping Run N 91 1 Piping Run u9 / Z P/ C ' Piping Manufacturer: I T I Piping Diameter: Z- ILL z Length of Piping Run: Product Stored: a Method and location of i in -run isolation: It.l IN Stwv D Wait time between applying pressure/vacuum /water and startin test: ?„ Test Start Time: Z32 N Z :,1-4 32 3y3 3z P M M Initial Reading (Rj: �6.7,N 3•�(o�'IN .1023 N 3bii •b Test End Time: Z4+pm 3 piti 3+-Z- vm 35 ► N ?-4 Final Reading(RF): 3•?bix iN L jk( (9 2-31 3. q 3. -44Ap i 23 try Test Duration: IS 15 IS M ibi V5 miN 15HW I 1 S t n/ 05 m r Change in Reading (RF -R,): -001 o.a oo Ci Pass/Fail Threshold or Criteria: Coo - 60 00 o6z ��� Test Result: is Pass 0 Fail ❑ Pass ❑ Fail V Pass 0 Fall 0 Pass 0 Fail Comments — (include information on repairs made prior to Jesting, and recomm SNk'RCB, January 2002 S. SECONDARY PIPE TESTING Page Lh- of 9 Test Method Developed By: 0 Piping Manufacturer :2 Industry Standard u Professional Engineer ❑ Other (Speci&) Test Method Used: It Pressure 0 Vacuum 0 Hydrostatic D Other (Specify) Test Equipment Used: 4in. GAUGE jLqL,�m—ent Resolution: .5%_ -DIAL Piping Run #DSL Piping Run ft Piping Run N Piping Run 0 Piping Material: Piping Manufacturer: Piping Diameter: Length of Piping Run: 50 ET_ Product Stored: Method and location of pip±g-run isolation: __ Wait time between applying pressurelvacuum/water and starting test: Test Start Time: Z, P '1 2-49 Initial Reading (R.1): 3c)4- ,--i Test End Time: Final Reading (RF): 3 Test Duration: 661 )&J Change in Reading (RF-R,): Pass/Fail Threshold or =j�j Criteria: .60Z NzIl'i Test Result: 14 Pass D Fall ❑ Pass 0 Fail D Pass 0 Fail U Pass D Fail Comments — include information on re airs made prior to testing, and recommended follow for jailed lesis) Aff SerzNbARLA -t-,A Df-,C- Fltin�T-rq-F-0 Fzn 6:1 Clj"ST- SWRCB, January 2002 z nrol,.,n errxru m1Ve'r7XT0- • Page -s- of 9 Test Method Developed By: Cl Sump Manufacturer Z Industry Standard 0 Professional Engineer ❑ Other (Spec) Test Method Used: 0 Pressure 0 Vacuum Z Hydrostatic D Other (Specify) Test Equipment Used: INCON TS —STS Equipment Resolution: ,0001n. Sump # jepr, Sump # SUmp # >5L Sump # Sump Diameter: 1 Sump Depth: 14 2 Sump Material: Height from Tank Top to Top of Himhest Piving Penetration: Z4 Ili t N Height from Tank Top to Lowest Electrical Penetration: 1-7 / Condition of sump prior to testing: Portion of Sump Tested' Does turbine shut down when sump sensor detects liquid (both product and water)?* Yes D No DNA )e Yes D No ❑ NA )4 Yes C No 0 NA C Yes ❑ No DNA Turbine shutdown response time Z S Is system programmed for fail -safe shutdown ?' Yes ❑ No DNA !(Yes ❑No DNA A(Yes 0 N 0 NA D Yes DNo DNA Was fail -safe verified to be operational?* Yes 0 No DNA )?Yes ❑ No ❑ NA Yes 0 No DNA 0 Yes 0 No ❑ NA Wait time between applying pressure /vacuum/water and starting test: 36 Zn 3p H IN 33" Test Start Time: I I 1544M M 122 Initial Reading (Ri): 1 LAF 1AJ 11491, I.$1 Z 1.812 i Test End Time: &09 rm 92-5AH I 2 Z Final Reading (RF): I. 6q t (09$ ZZ +�, I•BIZ tZ Test Duration: ml?J w 15 I Change in Reading (RF -Ri): / o nt Pass/Fail Threshold or Criteria: 00 Z Test Result: 1k Pass 0 Fail A Pass 0 Fail 9 Pass 0 Fail ❑ Pass 0 Fail Was sensor removed for testing? Yes 0 No D NA OZYes (I No 0 NA Yes 0 No 0 NA D Yes 0 No D NA Was sensor properly replaced and verified functional after testing? k yes ❑ No ❑ NA Yes 0 No DNA il)'Yes 0 No DNA ❑ Yes ❑ No DNA COMMents — (include information on repairs made prior to testing and recommended follow -up for ailed 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 SWERCB LG -160) - - - - - -- • S WRCB, January 2002 17 rrvntcv_nreoFnre>w to rnNTATNMFNT fUDrl TESTING Page o of Test Method Developed By: 0 UDC Manufacturer IR Industry Standard 0 Professional Engineer 0 Other (Specify) Test Method Used: 0 Pressure 0 Vacuum 9 Hydrostatic 0 Other (S ec �) Test Equipment Used: INCON TS —STS UDC # I —L UDC # 3—tk UDC Manufacturer: l v u Equipment Resolution:. 000i n . UDC # - e W9W k UDC Material: C jj4SS,, F ASS Eam S UDC Depth. A/ Height from UDC Bottom to Top of Highest Piping Penetration: 1 N 1 Height from UDC Bottom to Lowest Electrical Penetration: ZQ (� N 21 Ihi Condition of UDC prior to testing: CLEfrtIj CLEPrr1 C I E�F N �� Portion of UDC Tested I IAJ 19 IN Does turbine shut down when UDC sensor detects liquid (both product and water)?' k Yes 0 No 0 NA %Yes 0 No DNA CgYes 0 No DNA XYes 0 No 0 NA Turbine shutdown response time S t✓r— SEG 2 SAC Is system programmed for fail- safe shutdown?* KYes 0 N 0 N )9 Yes ONo 0 N Yes 0 N DNA Yes 0 N 0 N Was fail -safe verified to be operational?* Oyes 0 No 0 NA 9Yes 0 No ❑ NA R Yes 0 No 0 NA )I Yes 0 No DNA Wait time between applying pressure /vacuum/water and starting test 3o rt 30 MIN M+ Nj Test Start Time: 2 M 2 2-`i9 pm 2-Z 3 P,4 Initial Reading (RI): . 62 i 3-;01 to .f . t t Test End Time: 2 2 m IV 3 Final Reading RF): 2 3. , alk 3. 1 .►r 1.. f Test Duration: / 1 1150-1114 Change in Reading (RF -Rt): a, o. o. bttN IA/ o, a .b IbL- Pass/Fail Threshold or Criteria: �, N , ` Test Result: )d Pass n Fail Pass 0 Fail Q Pass 0 Fail Pass U Fail Was sensor removed for testing? Yes 0 No ❑ NA 19 Yes ❑ No 0 NA RYes ❑ No DNA Yes 0 No 0 NA Was sensor properly replaced and verified functional after testing? XYes 0 No 0 NA t�t'Yes 0 No 0 NA �dYes O No ❑ NA Yes 0 No r3 NA Comtnent9 —(include information on repairs made prior to tes in& and recommended follow -up forLaded rests) If the entire depth of the UDC is not tested, specify how much was tested. If the answer to �ny of the questions indicated with an asterisk ( *) is "NO" or "NA ", the entire UDC must be tested. (See SWRCB I.G -160) 0 0 _ ...... . ... ...... ..... . . . . .. . .....0 SWRCB, January 2002 a Tn mrn_riT.QrP1 VQ .0 rANTArNMRNT tUDrl TESTING 5� Page :7 of ,. W...,... - — - -- - - Test Method Developed By: 0 UDC Manufacturer 1d Industry Standard D Professional Engineer 0 Other (Specj&) _ 'rest Method Used: 0 Pressure 0 Vacuum N Hydrostatic D Other (Specify) Test Equipment Used: INCON TS -STS UDC # Cl- to UDC # It - l Equipment Resolution: .000in. UDC # UDC # UDC Manufacturer. UNICNIawpi lJOLINIM-.10 UDC Material: UDC Depth: 31. lid 3ty w Height from UDC Bottom to Top of Highest Piping Penetration: 12 N IN Height from UDC Bottom to Lowest Electrical Penetration: N Condition of UDC prior to testing: CZEA -N CLEA -N Portion of UDC Tested jtj Z Does turbine shut down when UDC sensor detects liquid (both product and water)?. teYes DNo DNA X Yes DNo DNA 0 Yes DNo DNA ❑ Yes D No 0 NA Turbine shutdown response time 2 2 SR Is system programmed for fail- safe shutdown ?' KYes ONo DNA Yes DNo DNA OYes 0 N 0 N ❑Yes 0 N DNA Was fail-safe verified to be operational')' k Yes DNo DNA RYes DNo ❑ NA 0 Yes 0 No 0 NA D Yes DNo DNA Wait time between applying pressure /vacuum/water and starting test 2 ,, JU t✓11 N 3o M!^1 Test Start Tune: Z? 34-5p" LS?-VA N9 om Initial Readin R w S. Z P4 2. Test End Time: Z 2 M Final Reading RF): 5• otu 2_A Z• Test Duration: Change in Reading F -R,): C.Cm thf Ia. can, W o t Pass/Fail Threshold or Criteria: .0 - Test Result: Pass Fall M Pass D Fail 0 Pass D Fail 0 Pass U Fail Was sensor removed for testing? YYes DNo DNA qYes DNo DNA ❑ Yes ❑ No DNA ❑ Yes 0 No DNA Was sensor properly replaced and verified functional after testin ? )e Yes 0 No 0 NA 91 Yes D No 0 NA 0 Yes ❑ No 0 NA D Yes D No 0 NA Comments - Include information on repairs made prior to lesting and recommendedfollow -up for failed tests) ' if the entire depth of the UDC 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 UDC must be tested, (See SWRCB LG -160) SWRCB, January 2002 Page of A Pri.7 17MIM I- IDNTAMMF.NT STIMP TESTING Facility is Not Equipped With Fill Riser Containment Sums 0 Fill Riser Containment Sumps are Present, but were Not Tested 0 Test Method Developed By: 0 Sump Manufacturer IN Industry Standard 0 Professional Engineer 0 Other (S ecijy) Test Method Used: ❑ Pressure 0 Vacuum 9 Hydrostatic 0 Other (Specl&) Test Equipment Used: INCON TS —STS Fill Sump # FIllSuM2#2jPB&j Equipment Resolution:. 000i n . Fill Sum # r>S I Fill Sump # Sump Diameter: tN I Sump Depth: Height from Tank Top to Top of Highest Piping Penetration: t Height from Tank Top to Lowest Electrical Penetration: IN lJ Condition of sump prior to testing: C LEAN N Portion of Sump Tested Sump Material: Wait time between applying pressure/vacuum/water and starting test: 14 Test Start Time: 04L,.gm I I 09 &M Initial Reading Rt): .L+2 I. 1. Test End Time: I I I I} A-H 1101 ft I 1 R Am Final Reading R 2 Z 1.44LhL IA 41 i N I.9-q4ijJ 1. 17, Test Duration: lsf4w 15rdit.1 I Change in Readin R R,): Pass/Fail Threshold or Criteria: 2 .0 2 Test Result: J9 Pass ❑ Fail Pass 0 Fail 51 Pass 0 Fail 0 Pass ❑ Fail Is there a sensor in the sump? 0 Yes X No 0 Yes )�No 0 Yes XNo ❑ Yes 0 No Does the sensor alarm when either product or water is detected? 0 Yes ❑ No )I NA 0 Yes 0 No X NA 0 Yes ❑ No XNA ❑ Yes ❑No n NA Was sensor removed for testing? 0 Yes 0 No NA 0 Yes 0 No XNA 0 Yes 0 No NA 0 Yes 0 No ❑ NA Was sensor properly replaced and verified functional after testin ? 1 0 Yes 0 No NA ❑ Yes 0 No kNA ❑ Yes ONo 4NA ❑ Yes ❑ No i7 NA Com ments — (include information on repairs made prior to testing, and recommended follow -up orfailed tests) �a S WRCB, January 2002 Page .9 - of / Q- Cpn.i JnVF.RFTLL CONTAINMENT BOXES Facili is Not Equipped With S ill/Overfill Containment Boxes 0 Spill /Overfill Containment Boxes are Present, but were Not Tested 0 Test Method Developed By: 0 Spill Bucket Manufacturer 2 Industry Standard 0 Professional Engineer 0 Other (Spec) Test Method Used: 0 Pressure ❑ Vacuum N Hydrostatic 0 Other (Specify) Test Equipment Used: INCON `. Bucket Diameter; TS -STS plll Box NVEE q Spill Box +V 12- irj Equipment Resolution: . 000 in . Spill Box # Spill Box # Bucket Depth: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: 3 100c1i aH / IZ Initial Reading (R,): -4, q Test End Time: 18rA 4H 1 p qt..t I t 5 1H Final Reading (RF): I Ole Test Duration: Ilsmjra 1 t Change in Reading (RF -R(): t4 tr4 , Pass/Fail Threshold or Criteria; OOL tJ Test Result: 1$ Pass 0 Fail Pass 0 Fail 0 Pass 0 Fail ❑ Pass 0 Fall COmmCnts - (include information on repairs made prior to resting and recommendedfollow -up for failed tests) x x x x x END x x x x x i i J �rttVKUN 1999 TAFT HWY. BAKERSFIELD.CA 93313 661 - 398 -8882 JAN 5. 2009 9:47 AM CHEURON 19yy TA '9 TAFT HWY 1999 TAFT HWY dAKERSFIELD BAKERSFIELD SYSTEM STATUS REPORT 05/01/2009 3:58 PM 05/01/2009 3'43 PM L 1 :SETUP DATA WARNING - SUMP LEAK. TEST REPORT bUh1P + -EAK. TEST REPORT L 4:SETUP DATA WARNING 1 -2 1 -2 INVENTORY REPORT TEST STARTED 3 :43 PM TEST STARTED 3:27 PM TEST STARTED 05/01/2009 TEST STARTED 05/01/2009 BEGIN LEA ,EL 0•b139 IN BEGIN LEVEL 6.6237 IN END TIME 3'42 PM T 1:REGULAR ENO TIME END DATE 3:58 PM 05,01/2009 END DATE END LEVEL 5/01/1609 VOLUME - ULLAGE - 14257 GALS 5694 GALS END LEVEL 0.6235 IN LEAK THRESHOLD 0.6236 IN 9051. ULLAGE= 3698 GALS LEAK THRESHOLD 0.002 IN TEST RESULT PASSED TEST RESULT PAS3EG TC VOLUME = 14273 GALS HEIGHT 79.68 INCHES WATER VOL 0 GALS 7 -8 7 -8 WATER TEMP 0.00 INCHES 58.3 DEC F TEST STARTED 3:43 PM TEST 3 3 7 P{�i TEST STARTED TEST STARTED 05/01/2009 5, 05/013: 01 / 2069 BEGIN LEVEL 6.1899 IN T 2:SUPREME BEGIN LEVEL END TIME 6.1897 IN 3:58 PM END TIME END DATE 3:42 PM VOLUME - ULLAGE = 5001 GALS 10103 GALS END DATE 05, 01/2009 `6.1900 END LEVEL 0501/2009 601 ULLAGE- 8592 GALS END LEVEL IN LEAK THRESHOLD 0.002 IN LEAK THRESHOLD 90% TEST RESULT 002 IN TO VOLUME = 5003 GALS TEST RESULT PASSER PASSED HEIGHT - 44.31 INCHES WATER VOL = 0 GALS WATER = 0.00 INCHES 9 -10 9-10 TEMP = 59.4 DEG F TEST STARTED 3:2? PM TEST STARTED 3:43 PM TEST STARTED 05/01/2009 T 3:1)IESEL• TEST STARTED 05/01/2009 BEGIN LEVEL 5.7509 IN VOLUME = 5242 GALS BEGIN LEVEL END TIME 5.7508 IN 3:58 PM ND E TIME 3:42 PM END DATE ULLAGE = 90% ULLAGE- 2587 GALS 1804 GALS END DATE 05/01/2009 05,01/2009 END LEVEL IN TO VOLUME - 5230 GALS END LEVEL LEAK THRESHOLD 5.7507 IN 0.002 IN LEAK THRESHOLD .002r 0 � y•002 IN TEST RESULT HEIGHT = WATER VOL - 57.91 INCHES 0 GALS TEST RESULT PASSED PASSE[) WATER = 0.00 INCHES TEMP = 64.8 DEG F x x x x x END x x x x x i i J 0 • 0 i t/ CHEVRON 1999 TAFT HWY CHEVRON 1999 TAFT HWY 1999 TAFT HWY BAKERSFIELD BAKERSFIELD 13AKERSFIELD 05/01/2009 2:47 PM 05/61/2009 3:04 PM 05/01/2009 12:53 Pr SUMP LEAK TEST REPORT SUMP LEAK. TEST REPORT SUMP LEAK TEST REPORT 3 -4 3 -4 DSLSTP TEST STARTED 2:32 PM TEST STARTED '"2:49 PM TEST STARTED 05/01/2009 TEST STARTED 12:43 PM TEST STARTED 05/01/2009 BEGIN LEVEL 3.7673 IN TEST STARTED 05/01 /2009 BEGIN LEVEL 3.7670 IN END TIME 2:47 PM BEGIN LEVEL 1.8128 IN END TIME 3:04 PM END DATE 05/01/2009 END TIME 12:58 PM END DATE 05/01/2009 END LEVEL 3.7670 IN END DATE 05/01/2009 END LEVEL 3.7669 IN LEAK THRESHOLD 0.002 IN END LEVEL 1.8129 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED LEAK THRESHOLD 0.002 IN TEST RESULT PASSED T EST RESULT PASSED 5 -6 5 -6 91VPR TEST STARTED 2:32 PM TEST STARTED 2:49 PM TEST STARTED 05/01/2009 TEST STARTED 12:43 PM TEST STARTED 05/01/2009 BEGIN LEVEL 3.8657 IN TEST STARTED 05/01/2009 5/01/2 BEGIN LEVEL 3.8654 IN END TIME 2:47 PM BEGIN LEVEL IN END TIME 3:04 PM END DATE 05/01/2009 END TIME 12:58 PM END DATE 05/01/2009 END LEVEL 3.8653 IN END DATE 05/01/2009 END LEVEL 3.8653 I14 LEAK THRESHOLD 0.002 IN END i_EVEL 6.1996 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED LEAK THRESHOLD 0.002 IN TEST RUSULT PASSED TEST RESULT PASSED 11 -122 11 -12 TEST STARTED 2:32 PM TEST STARTED 2:49 PM TEST STARTED 05/01/2009 TEST STARTED 05/01/2009 BEGIN LEVEL 2.4636 IN BEGIN LEVEL 2.4631 IN END TIME 2:47 PM END TIME 3:04 PM END DATE 05/01/2009 END DATE 05/01/2009 END LEVEL 2.4631 IN END LEVEL 2.4629 IN LEAK THRESHOLD 0.002 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED TEST RESULT PASSED 0 i t/ 0 0 • 0 TEc j SART T D 0/6967 ItA TES LEVEL BEGIN 1+3�ay005 05/01 Atl END DATE LTHRESHOLD 7.6967 IN O'PASSED END _EAK RE -� SOLT 87STP TEST STARTED 11:54 AM TEST STARTED 05/01/2009 BEGIN LEVEL 1.6960 IN END TIME 12:09 PM CHEVRON END DATE 05/01/2009 CHEVRON 1999 TAFT HWY END LEVEL 1.6956 IN 1999 TAFT HWY BAKERSFIELD LEAK. THRESHOLD 0.002 IN BAKERSFIELD TEST RESULT PASSED 05/01/2009 11117 AM 05/01/2009 12:42 PM SUMP LEAK. TEST REPORT SUMP LEAP: TEST REPORT r DSLFSMP DSLSTP 67STP TEST STARTED 12:27 PM TEST STARTED 11:02 AM TEST STARTED 05/01/2009 TEST STARTED 11:37 R1l TEST STARTED 05/01/2009 BEGIN LEVEL 1.9776 IN TEST STARTED TEST 05/01/2009 IN BEGIN LEVEL 1.8125 IN END TIME 11:17 AM B LEVEL 1.6972 AM END TIME 12:42 PM END DATE 05/01/2009 ND 11:52 END DATE 05/01/2009 END LEVEL 1.9778 IN ENU D TE 05/01/200y .1.6.002 6966 IN END LEVEL 1.8123 IN LEAK THRESHOLD 0.002 IN END LEVEL LEAK THRESHOLD 0.002 IN TEST RESULT PASSED LEAK THRESHOLD PASSED TEST RESULT PASSED TEST RESULT 87FSMP 91VPR TEST STARTED 11:02 AM 87VPR — TEST STARTED 12:27 PM TEST STARTED 65/01/2009 TEST STARTED 05/81/1009 BEGIN LEVEL 4.4226 IN TEST STARTED BEGIN LEVEL 6.11/2 IN END TIME 11:17 AM TEST STARTED 05/01/2009 0 09 AM END TIME 12:42 PM END DATE 05/01/2009 END DATE 05/01/2009 END LEVEL 4.4225 IN BEGIN LEVEL END TIME ?.6967 1 6967 IN END LEVEL 6.1995 IN LEAK THRESHOLD 0.002 IN END DATE 10:25 AM LEAK THRESHOLD 0.002 IN TEST RESULT PASSED END LEVEL 05/01/2009 TEST RESULT PASSED LEAK THRESHOLD 706002 TEST RESULT IN PASSED 0 TEc j SART T D 0/6967 ItA TES LEVEL BEGIN 1+3�ay005 05/01 Atl END DATE LTHRESHOLD 7.6967 IN O'PASSED END _EAK RE -� SOLT TEST 0 I 0 I CHEURON 1999 TAFT HWY BAKERSFIELD 05/01/2009 9:47 AM SUMP LEAK TEST REPORT 91STP TEST STARTED 9 :31 AM TEST STARTED 05/01/2009 BEGIN LEVEL. 4.7227 IN END TIME 9:47 AM END DATE 05/01/2009 END LEVEL 4.7226 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED 91FSMP TEST STARTED 9:31 AM TEST STARTED 05/01/2009 BEGIN LEVEL 1.4417 IN END TIME 9:47 AM END DATE 05/01/2005 END LEVEL 1.4415 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED 87UPR. TEST ARTED </9 DW TEST S TED 9 BEGIN LE R END TIME M END DATE 9 END LEU N LE RESHOL0 N TEST RESULT ERROR 91VPR TEST ARTED 1 AM TEST ST TED /01/2009 BEGIN LE 3.6332 IN END TIME 9:47 AM END DAT /01/2005 END L L 3.' 26 IN LE THRESHOLD 0.8w IN TEST RESULT PASSED 0 CHEVRON 1999 TAFT HWY BAKERSFIELD 05/01/2009 11:02 AM SUMP LEAK TEST REPORT DSLFSMP TEST STARTED 10:46 AM TEST STARTED 05/01/2009 BEGIN LEVEL 1.9773 IN END TIME 11:01 AM END DATE 05/01/2009 END LEVEL 1.9774 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED 87FSMP TEST STARTED 10:46 AM TEST STARTED 05/01/2009 BEGIN LEVEL 4.4224 IN END TIME 11:01 AM END DATE 05/01/2009 END LEVEL 4.4225 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED 87FSMP TES STARTED 10' 6 AM TEST TARTED 0 1/2005 BEGIN UEL LUME ERR END TIM 10:47 AM END DAT 05/01/2009 END L 0.0000 IN LEA THRESH 0.004 IN TE RESULT ERROR. 87STP blfiKTED 0:46 AM TEST RTED /01/2009 BEGIN L EL 1.5273 IN END TIME 11:01 AM D EN DATE 0S/01r2009 END LEU .5108 IN LEAK RESHOLD 002 IN TEST RESULT LFD CHEVRON 1999 TAFT HWY BAKERSFIELD 05/01/2009 9:25 AN :UMP LEAK TEST REPORT 91STP TEST STARTED 9:09 AM TEST STARTED 05/01/2009 BEGIN iEUEL 4.7224 IN END TIME 9:25 AM END DATE 05/01/2009 END LEVEL 4.7225 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED 91FSMP TEST STARTED TEST STARTED BEGIN LEVEL END TIME END DATE END LEVEL LEAK THRESHOI TEST RESULT 9:09 AM 05/01/2009 1,4438 IN 9:25 AM 05/01/2009 1.4427 IN .D 0.002 IN PASSED 0 0 .. 1 SB989 TESTING FAILURE REPORT SITE NAME: • 0 4-c-f kN/ DATE: S `;TAAI ADDRESS lCtLip IAFI- Rul;4 TECHNICIAN: 3izgkpc-1 M-fi tsw CITY Fly SIGNATURE SITE CONTACT: THE FOLLOWING COMPONENTS WERE REPLACED /REPAIRED TO COMPLETE THE SB989 TESTING. LIST OF PARTS yREPLACED/ REPAIRED : REPAIRS: jJl(� 3�2�0 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cite& Chapter 6 7, Health and Safety Code; Chapter 76, Division 3, Title 23, California Code q/Regulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prrpare for each monijQring system control panel by the technician who performs, the work. A copy of this form must be provided to the tank system owner /operator. The owner /operator must submit atrytths_ frTt�to the local agency regulating UST systems within 30 days of test date. �! W 6J A. General Facility Name:. ' nnnn Bldg. No.: "ty" p: 9 33 l L Site Address: �,�Q �1�-T 0.1�� Ci : `��It���� Zi Facility Contact Person: ,,n4j,1t-4y i��,�ntact Phone No.: ( (PCoi ) �3 �g Make/Model. of Monitoring System: C�IU *L.CO 'F-MIE-1, ��irC, s1 yr, CESDate of Testing/Servicing: E B. Inventory of Equipment Tested /Certified INSPECTOR ON -SITE E� NO NAME: FtirJIL- Check the uporopriate boxes to indicate specific equipment inspected /serviced: Tank 10: ( LU_AR Tanis ID•: _��-_ _ In -Tank Gauging Probe. Model:, (i�_(2 OIn -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vaulf Sensor. Model: 'Piping Sump/ Trench Sensor(s). Model: 19�f'iping Sump / Trench Sensor(s). Model: ❑ Fill Sump Sensogs). Model: Q Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: FK 1.V Mechanical Line Leak Detector. Model: FX ZU ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Tank Overfill % High -Level Sensor. Model: Q Other (specif equipment t e and model in Section E on Page 2 . El Other (specify equipment a and model in Section E on Page 2). Tank ID: n�,Sl _ Tank ID: -Tank Gauging Probe. Model: O In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: ISIn ❑ Annulat'Space or Vault Sensor. Model: Piping Sump / Trench Sensor(s). Model: O Piping Sump / Trench Sensor(s). Model: O Fill Sump Sensor(s). Model: 0 Fill Sump Sensor(s). Model: a Mechanical Line Leak Detector. Model: F5< 2 DU ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Tank Overfill / High -Level Sensor. Model: O Other (specify equipment type and model in Section E on Page 2). CJ Other (specify equipment type and model in Section E on Page 2). Dispenser ID: Dispenser ID: y� '-Dispenser Containment Sensor(s). Model: 1 '01— Dispenser Containment Sensor(s). Model: Shear Valve(s). Wltear Valve(s). ❑ Dispenser Containment Floats and Cliain s . Dis enser Containment Floats and Chains . Dispenser ID: S-1:0 Dispenser ID: Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Iff Shear Valve(s). r,.. Cl Dispenser Containment Roat(s) and Chain(s). ❑ Dispenser Containment Floats and Chain(s). Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: `,i Shear Valve(s). IRtShear Valve(s). ❑Dispenser Containment Float(s) and Chain(s). ❑ Dispenser Containment Floats and Chain(s). + If the facility contains more tanks or dispensers, copy this form. Include information fbr every tank and dispenser at the facility C. Certification - I certify that the equipment Identified in this document was Inspected /serviced in accordance with the manufacturers' guidelines. Attached to this Certification Is information (e.g. manufacturers' checklists) necessary to verify that this Information Is correct and a Plot Plan showing the Inyout of monitoring equipment; For any equi ment capable of generating such repoets, 1 have also attached a copy of the re o -t,; (ch ¢k a!1 [hat�a�pl�): 'System set -up Alarm history report Technician Name (print): � ` ��I Signature: `+ Certification No.: AD8 C;3I License. No.: app �a '1tCi' u� Testing Company Name: RICH ENVIRONMENTAL Phone No.:,( 661 ) 392_$(87 Site Address: q9 7i� fil�JY_• ��Ai[�.25�-=- rGIL��('R 93313 Date of Testing/Servicing: - Page I of 3 03101 Monitoring System Certification • x =.. .. D. Results of Testing /Servicing Software Version Installed: RH Complete the following checklist: 0 a\a -V.A. Yes I O o is the audible alarm operational? $ Yes O o Is the visual alarm o erational? Yes Cl o Were all sensors visually inspected, functional Ij tested, and confin -ned operational? Yes ❑ o Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? ❑ Yes ❑ o If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) )W- N/A operational? ,�L Yes O o For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment O N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut -down? (Check all that apply) ump/Tretich Sensors; J!�-Dispenser ontainment•Sensors. Did you confirm positive shut -down due to eaks and sensor failure/disconnection ?'-Yes; O No. ❑ Yes O o For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no YZi N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm tri er? % ❑ es No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re placement parts in Section E, below. O es No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) O product; ❑ Water. If yes, describe causes in Section E below. . iZ Yes O o Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable Yes O o Is all monitoring equipment operational per manufacturer's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of 3 03101 0 . 0 � \aA F. In -Tank Gauging / SIR Equipment: 'Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Com lete the followin checklist: ❑ Yes ❑ ° Has all input wiring been inspected for proper entry and termination, including testing for ground faults? O Yes O NO Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes ❑ ° Was accuracy of system product level readings tested? ❑ Yes O ° Was accuracy of system water level readings tested? ❑ Yes O ° Were all probes reinstalled properly? ❑ Yes ❑ ° Were all items on the equipment manufacturer's maintenance checklist completed? ' In the Section H, below, describe how and when these deficiencies.were or will be corrected. G. Line Leak Detectors (LLD): Complete the following checklist: ❑ Check this box if LLDs are not installed. Yes ❑ Not ❑ N/A For equipment start -up or annual equipment certification, was a leak simulated to verify LLD performance? (Check a// that apply) Simulated leak rate: 9�3 g.p.h., ❑ 0.1 g.p.h , ❑ 0.2 g.p.h. Yes ❑ ° Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ❑ ° Was the testing apparahis properly calibrated? -91 Yes ❑ ° ❑ N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ Yes ❑ ° N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ Yes ❑ ° `g N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? ❑ Yes ❑ ° 53�N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ❑ Yes ❑ ° N/A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes ° Were all items on the equipment manufacturer's maintenance checklist completed? t In the Section H. below. describe how and when these deficiencies were or will he enrrected_ H. Comments: Page 3 of 3 03101 0 0 0 0 a\ ',*J, \LV • Monitorhng system Certlticatlon Form: Addendum for VacuumMressure Interstitial Sensors LG 163- 1,.Enc. II I. Results of Vacuum/Pressure Monitoring Equipment Testing This page should be used to document testing and'smvicing of vacaum and ptessure interstitial sensors. A copy of this form must be included with the Monitoring System. Cezt. cation Porsis. which must be' provided to the tank system owner / operator. The owner /operator must.submit a copy of the Monitoring System Certification Form to the local agency regulating UST systems within 30 days of test date: Manufacturer: Mosel: System Type: RI Pressure; [2v&.== 72 4 Sensor ID Conlponent(a) Monitored by this Sensor: Sensor Functionality Test Result: 0 Pass' j] Fail Intoastidal Communication Test Result: Q Pass; Q Fail Components) Monitored by this 5eman' Sensor Functionality Test Result: ❑ Pass;-, j] Fail Interstitial Communication Test Result: Q Pass; ❑ Fail - Component(s).Monitored by this-Sensor: Sensor Funbdons.Hty Test Result: ❑ Pass; Fail . Interstitial Cousmtmication Test Result: ❑ Pass; ❑ Fail Component(s) Monitored by tills Sensor: Sensor Functionality Test iLeault: 9passi Q. Fail Interstitial Communication Test Result Q Pass; II' Fail ' Component(s) Monitored by this Sensor: Sensor Functionality Test Result: 0 Pass; '!] Fail Interstitial Corat n■ pication Test Result: ❑ Pass; ❑ Fail Component(s) Monitored by thle.Seasor: Sensor Functionality Test Result: II Pass;( Fat? Interstitial Communication Test Result: j] Pass; ❑ Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: 0 Pass; ❑ Fail Interstitial Communication Test Result: [] Pass; Q Fail Component(s) Monitored by this Sensor: Sensor Functionality Test Result: f I Pass; 0. Far Interstitial Communication'Test Result: n Pass; 0 Fail Components) Monitored by this Senson Sensor Functionality Test Result: 0 Pass; Q Fag ' -'Interstitial Communication Test Result: ❑ Pass; 0 Fail Components) Monitored by this Sensor:.* Sensor Functionality Test Result~ L] Pass; Cj Fail Interstitial Communication Test Result: D Pasr, Q Fail How was intenddal communication veritled? ❑ Leak Introduced atFar Fad ofIutemtitial S ace;! ❑ Gaup; . ❑ Visual ins' eotion, .0 Odw (Describe in Sea J, below Vacuum was restored to operating levels in all Interstitial spaces: Q Yes.. No (ffnc, describe in Sec. J, below) J. Comments: ,t_j ( Pt Page of If the sensor successfully detects a simulated vacuum)prc&wm leak introduced in the interstitial space at the furthest point from the sensor, vacuumlpreasure has been demonstrated to be communicating throughout the interstice. i • • Monitoring System Certification Site Address: UST Monitorinl7 Site P Date map was drawn:. 7 /�?i� Insr'ructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in -tank liquid level probes (if used for leak detection), In the space provided, note the date this Site Plan was prepared. Page of 05100 IX AM If i Date map was drawn:. 7 /�?i� Insr'ructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in -tank liquid level probes (if used for leak detection), In the space provided, note the date this Site Plan was prepared. Page of 05100 6 5643 BROOKS RAXERSIVILD,CA.93308 i OFFTCR (661) 392 -5687 A VAX (661)•392 -0621 MF.SZi$IiT,S:81= z�arr. r�r��'n� s�S"' zFio�� ®u�e�m i W/ O # _ ----- -�+- -- Facility Name: �I'f1~4l�•7i_ cEi`GC)eDr� FAcilit Product Line T"e 7Preasure, uctiaa, Gravity) PRODUCT LEAK DETECTOR TY$R TEST TRIP PAS& srJUAL NUMBER ARLOW Paz OR 8 L/1) TY -U$ SMRTAZ # 5219 - O- FAIL �1 8/R�L � RS # s % , a FAAIL n/D TYPE_ ? SERIAL # [� G Z-4- O F I,, /A TYPR YRS PASS! 88R,TA1. # No FAIL i 2 ,:ertify the above tests were cdnducted'.on this data according �o Aed Jackat PumPs field test apparatus testing procedura An limitations. Tb-i Mechanical Leak Detector Test pass / fail is'determined by uAing a low flow threshold trip. rate of 3 gallon par hour or lase at 10 #82. 2 •acknowledge tklat all. data aolleotad is true and correct to tha beat of my knowledge. Tech :��E1J Siga::ture: Date :� . i i i i i SWRCB, January 200 Spi- llucket Testing Report Form 'his fonn is intended for use by contractors perforating annual testing of CYST spill containment structures. -The completed form and. printouufromsests (ifapplicable), should keprovided to thefacility owner /operotorforsubmittal. to the local regulamry agency. 1. FACIIxTY INFORMAnox FwWty Namc:T'A1>T "t. \V' rtAF0 7CfJ I Date of Testing: Facility Address: t-: �f 3 ! Facility Contact 1W 0 MY Phone: (Q Date Local A ency Was Notified of Ttsting Co . Is z Name of Local Agency Inspector ({rpresent during testing): lL 2. TESTING CONTRACTOR INFORMATION Company Name: V Technician Conducting Test: Credentials : CSLB contractor. C "ce T SWRCB Tank Tester Other S ec ) License Number(s)i ! ��' . Comments — (include k&rmation on r^ pairs made prior to u: ft m d recommended fol low -UR forjatled• test.. CERTIICATION OF TECMUCIAN RXSPONSIBLE FOR CONDUCUNG THIS TESTING I hereby cer4& that all the information contained in this report is true, accurate; and in full compliance with legal requirement Technician's Signature: ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. ALARM HISTORY REPORT - - - -- SENSOR ALARM --- -- L 1:67 ANNULAR ANNULAR SPACE SENSOR OUT ALARM JUL 22, 2008 9:41 AM SENSOR OUT ALARM JUL 22, 2008 9:40 AM FUEL ALARM JUL 22, 2006 9:32 AM xx0xx END *xxxx ALARM HISTORY REPORT - - -- SENSOR ALARM - - - -- 2:92 ANNULAR 1NNULAR SPACE iENSOR OUT ALARM lUL 22, 2008 9:41 AM ;ENSOR OUT ALARM UL 22. 2009 9:40 AM UEL ALARM UL 22, 2009 9:34 AM • - ALARM HISTORY REPORT - -- -- SENSOR ALARM -- -- L 3:DIESEL ANNULAR ANNULAR. SPACE SENSOR OUT ALARM JUL 22, 2008 9:41 AM SENSOR OUT ALARM JUL 22. 2008 9:40 AM FUEL ALARM JUL 9. 2007 2:03 PM k# x u :. END x .h x x x ALARM HISTORY REPORT - - -- SENSOR ALARM - -- -- L 4:67 STP SUMP STP SUMP SENSOR OUT ALARM JUL. 22. 2008 9:41 AM SENSOR OUT ALARM JUL 22. 2008 9:40 AM FUEL ALARM JUL 22. 2008 9:27 AM • ALARM HISTOR', REPORT -- SENSOR ALARM - - - -- L 5:92 STP SUMP STP SUMP SENSOR OUT ALARM -JUL 22. 2008 9:41 AM SENSOR OUT ALr1RM JUL 22, 2008 9:40 AM FUEL ALARM JUL 22. 2008 9 :27 AM x x x x x END x x x x x ALARM HISTORY REPORT -- SENSOR ALARM - - - -- L 6:DIESEL STP SUMP STP SUMP SENSOR OUT ALARM JUL 22. 2008 9:41 AM SENSOR OUT ALARM JUL 22, 2008 9:40 AM FUEL ALARM JUL 22, 2008 9:28 PVI SYSTEM SETUP JUL 22, 2008 9:10 AM - SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATExTIME FORMiA.r MON DD YYYY HH:MM:SS xM CHEVRON 1999 TAFT HWY BAKERSFIELD.CA 93313 661-398 -8882 SHIFT TIME I DISAB SHIFT TIME 2 DISABLED SHIFT TIME 4 : DISABLED TANK PER TST NEEDED WRN DISABLED TANK ANN TST NEEDED WRN DISABLED LINE RE- ENABLE METHOD PASS LINE TEST LINE PER TST NEEDED WRN DISABLED LINE ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE (DEG F ): 60.0 STICK HEIGHT OFFSET DISABLED DAYLIGHT SAVING TIME ENABLED START DATE APR WEEK i SUN START TIME 2:00 AM END DATE OCT WEEK 6 SUN END TIME 2:00 AM SYSTEM SECURITY CODE : 000000 C�IMUNICATIONS SFTUA PORT $E�71NGS: NONE POUND RS -23 2 COD2r RI T 0000SSCU00 Y 0 IN_TANK SETUP T 1:REGULAR PR0DUCT CODE - THERMAL COEFF TANK DIAMETER I :.000700 TANK PROFILE : 120.0Q FULL VOL 90.0 INCH VOL 4 PTS : 19951 60.0 INCH VOL 30.0 1 W VOL 16262 ; 70944 3E04 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING NIGH WATER LIMIT:. Mrix OR LABEL VOL : OVER fiJLL LIMIT 1 5951 ; NIGH PRODUCT 95`; It{953 L)EL I VERY LIMIT 90'6 11956 104 • LOW PRODUCT 159J L1rA1{ ALARM LIMIT: SUDDEN LOSS 642 99 LIMIT: NY TILT 99 • MANIFOLDED TANKS 0.00 T #: NONE 0 T 218UPREME PRODUCT CODE : 2 THERMAL' TANK DIAMETER 120.00 TANK PROFILE 4 PTS FULL VOL 15104 90.0 INCH VOL 12349 60.0 INCH.VOL 7605 30.0 INCH VOL 2843 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 15104 OV£RFILL.LIMIT 95% 14348 HIGH PRODUCT 90% 13593 DELIVERY LIMIT 10% 1510 LOW PRODUCT 468 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 MANIFOLDED TANKS T#; NONE LEAK MIN PERIODIC:; LEAK MIN PERIODIC: 15% 151 2265 L 1552 +ANNUAL LEAD: MIN ANNUAL 15% LEAK MIN I 5:: 2268 2992 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAG OFF ING: PER TEST AVERAGINr,; OFF TANK TEST NOTIFY: OFF TNk TST SIPHON BREAIC:OFF DEL I VERY DELAY 5 1�1I N x'232 '' IBLFD ND OF M£:1,SAGE �/ PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY ; 5 MIN LEAK TEST METHOD TEST ON DATE : ALL TANK APR 26, 2000 START TIME : DISABLED TEST RATE :0.20 GAL /HR DURATION : 2 HOURS LEAK TEST REPORT FORMAT NORMAL LIQUID SENSOR SETUP- - - L 1:87 ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 2:92 ANNULAR TRI-STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 3:DIESEL ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 4:87 STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 5:92 STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 6:DIESEL STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP i • o ;jIESEL PRODUCT CODE 3 THERMAL COEFF :.000450 TANK DIAMETER 96.00 TANK PROFILE 4 PTS FULL VOL ; 7829 72.0 INCH VOL 6652 48.0 INCH VOL : 4147 24.0 INCH VOL 1540 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 7829 OVERFILL LIMIT 95% 7437 WISH PRODUCT 9Ui 7046 DELIVERY LIMIT 10% 782 LOW PRODUCT 359 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 MANIFOLDED TANKS To : NONE LEAK MIN PERIODIC: 15%: 1174 LEAK MIN ANNUAL 15h 1174 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TOT SIPHON BREAK:OFF DELIVERY DELAY . 5 MIN LA OUTPUT RELAY SETUP R 1:RECULAR TYPE: :STANDARD NORMALLY CLOSED TV -TANK ALARMS T I:HIGH WATER ALARM T I:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 1:FUEL ALARM L +:FUEL ALARM L 4:SENSOR OUT ALARM L I:SHORT ALARM L 4:SHORT ALARM R 2 :SUPREME TYPE: STANDARD IVOPJ °TALLY CLOSED IN -TANK ALARMS T 2:HIGH WATER ALARM T 2:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 2:FUEL ALARM L 5:FUEL ALARM L 2:SENSOR OUT ALARM L 5 :SENSOR OUT ALARM L 2:SHORT ALARM L 5:SHORT ALARM R 3:DIESEL TYPE: SThNDARD NORMALLY CLOSED IN -TANK ALARMS T 3:HIGH WATER ALARM T 3:LOI4 PRODUCT ALARM LIQUID SENSOR ALMS L 3:FUEL ALARM .L 6:FUEL ALARM L 3:2ENSOR OUT ALARM L 6:,ENSOR OUT ALARM L 3: =:HORT ALARM L 6.5HORT ALARM LARM HISTORY REPORT - -- IN -TANK ALARM - 1:REGULAR ETUP DATA WARNING PR 27, 2000 12.28 PM ALARM HISTORY REPORT AS HISTORY REPORT ECONC I L I'AT I ON SETUP - - - - -- I N -TANG: ALARM - - - -- T 2:SUPREME ALARM -` -- IN -TANK ALARM - - - -- UTOMATIC DAILY CLOSING SETUP DATA WARNING 2007 IME: 2:00 AM APR 27, 2000 12:51 PM ERIODIC RECONCILIATION APR 26. 2000 11:40 AM ODE: MONTHLY LOW PRODUCT ALARM EMP COMPENSATION SEP 5. 2007 4:-21 AM TANDARD NOV 27. 2005 5:56 PI'4 ALARM AUG 16, 2005 6:12 PM US SLOT FUEL METER TANK INVALID FUEL LEVEL 9:06 AM ANK MAP EMPTY APR 27, 2000 12:52 PM 4. PROBE OUT 1:41 PM OVERFILL ALARM NOV 23. 2004 1:53 PM 2005 APR 26. 2000 11:40 AM PM DELIVERY NEEDED ALARM APR 1. 2007 21. 2007 DEC 26. 2007 7:51 PM 6. NOV 20, 2007 12:57 PM SEP 4, 2007 5:28 AM LARM HISTORY REPORT - -- IN -TANK ALARM - 1:REGULAR ETUP DATA WARNING PR 27, 2000 12.28 PM ALARM HISTORY REPORT PR 26, 2000 11:40 AM VERFILL ALARM -` -- IN -TANK ALARM - - - -- PR 22. 2007 3:08 AM T 3:DIESEL PR 22. 2007 2:45 AM AN 26, 2006 2:58 AM SETUP DATA WARNING OW PRODUCT ALARM APR 27. 2000 APR 26, 2000 1:11 11:40 PM HM EP 12, 2005 9:06 AM UG 4. 2005 1:41 PM OVERFILL ALARM UL 22. 2005 8:36 AM JUN 8, 2008 8:00 PM IGH PRODUCT ALARM APR 1. 2007 21. 2007 7:04 2:50 PM AM AN AN 6. 2008 10:07 PM AY AY 27. 1. 2007 2007 11:08 PM 3:19 PM LOW PRODUCT ALARM SEP 29, 2005 12:44 AM NVALID FUEL LEVEL SEP 22, 2005 SEP 8. 2005 9 :50 4:O1 PM PM PR 27. 2000 12:28 PM ROBE OUT � HIGH PRODUCT ALARM OV 23, 2004 1 :13 PM JUN 8, 2008 MAR 2, 2008 7:59 5:06 PM PIH PR 26, 2000 11:40 AM APR 29, 2007 9:53 PM SLIVERY NEEDED INVALID FUEL APR 27. 000 LEVEL 1:11 Ph1 EB 25. 200B 4:41 AM CT 7. 2006 7:12 AM PROBE OUT EP 16, 2005 3:22 PM NOV 23, 2004 2:29 PM APR 26. 2000 11:40 AM DELIVERY NEEDED SEP 28. 2005 8:06 AM SEP 22, 2005 4 :57 AM SEP 7. 2005 11:53 PI-1 i I • ALARM HISTORY REPORT - "- I N -TANK ALARM - - - -- T 4: SETUP DATA WARNING APR 11. 20+Jh 7:45 AM PROBE OUT APR 11, 2006 7 :45 AM *1� # X x EfVD x* x* x ALARM HISTORY REPORT -- SENSOR ALARM - - - -- L 1:87 ANNULAR ANNULAR SPACE FUEL ALARM JUL 9. 2007 1:02 PM FUEL ALARM JUL 27. 2006 9:20 AM FUEL ALARM JUL 21, 2005 2:36 PM ECONCILIATION SETUP UTOMATIC DAILY CLOSING IME: 2:00 AM ERIODIC RECONCILIATION ODE: MONTHLY EMP COMPENSATIO14 TANDARD US SLOT FUEL METER TANK ANK MAP EMPTY LARM HISTORY REPORT - -- IN- TANK,ALARM - 1:REGULAR ETUP DATA WARNING PR 27. 2000 12:28 PM PR 26, 2000 11:40 AM VERFILL ALARM PR 22, 2007 3:08 AM PR 22. 2007 2:45 AM AN 26, 2006 2:58 AM OW PRODUCT ALARM EP 12. 2005 9:06 AM UG 4, 2005 1:41 PM UL 22. 2005 8:36 AM ICH PRODUCT ALARM AN 6. 2008 10:07 PM AY 27, 2007 11:08 PM AY 1. 2007 3:19 PM NVALID FUEL LEVEL PR 27. 2000 12:28 PM ROBE OUT OV 23, 2004 1 :13 PM PR 26. 2000 11:40 AM ELIVERY NEEDED ED 25, 2008 4 :41 AM CT 7. 2006 7:12 AM EP 16, 2005 3:22 PM 0 ti�khJ y1,8TOR�, ' 1 P�, kEFUkT RE1"1R A SR72/A - �p Gi,:;R a f 00 r NG 200 LOGd 0 1 j ; 51 Pl. sEP 1 >Rp1�UCT 40 AI-j AEG 6� Q00, ALq h'M pp Q I ID pU2L5 6; 1 t71 pR0 2000 BEVEL MOV E23 OUT 52 pM APR 26. 04 1 I VERY 00 11 0 AM S OV , 2 p0 7 DRD Ep 4. 200 0 7:51 2007 S:' 1257 /I 2Q y M ALARM HISTORY REPORT - - -- IN -TANK ALARM - - - -_ T 3:DIESEL SETUP DATA WARNING APR 27, 2000 l:ll PM APR 26, 2000 1140 All OVERFILL ALARM JUN 8, 2000 6:00 PM APR !• 2007 7:04 PM MAR 21. 2007 2 :50 AM LOW PRODUCT ALARM SEP 29, 2005 12:44 AM SEP 22, 2005 9:90 Pl. SEP 8. 2005 4:01 Pwl HIGH PRODUCT ALARM JUN 8. 2008 7:59 Pf °I MAR 2, 2008 5:06 PM APR 29, 2007 9:53 PM INVALID FUEL LEVEL APR 27, 2000 1:11 PM PRV$E OUT 3 APR 26, 2000 11:40 AM DELIVERY NEEDED SEP 28, 2005 8 :06 A1.1 SEP 22, 2005 4 :57 AM SEP 7, 2005 11:53 PM __ yr3TORy -- Iry� REp�RT T � TgNk ALARM '�- SEr01= ' APR r r DATA w 2OQ6ARryIryu PRO ,&L' our 7 : 46 AM R J 1. 2006 7:4$ AM Af A1,gRlh y1ST OkY pEpOR L i�. E7 SENSOR T F � ULHR gp UL�►R 1 HRM -_,_ JUL L 9 LARhJ ACE 20Q7 FOEL 1 : 0 �� jUl. 27 LAR M Ply JU EL AL S R`ry 006 9'20 AM 2006 2 : C +6 FM _ARM HISTORY REPORT - - -- SENSOR ALARM - - - -- 2:92 ANNULAR VNULAR SPACE JEL ALARM JL 9. 2007 1 :02 PM JEL ALARM JL 27, 2006 9:19 All UEL ALARM UL 21. 2005 2:34 PM x x x x END x x x x x LARM HISTORY REPORT - - -- SENSOR ALARM - - - -- 3:DIESEL ANNULAR NNULAR SPACE UEL ALARM UL 91 2007 2:03 PM UEL ALARM UL 9. 2007 1:45 PM UEL ALARM UL 9, 2007 1:32 PM AHISTORY REPORT - - - -- SENSOR ALARM - - - -- L 4:87 STP SUMP STP SUMP FUEL ALARM MAR 27, 2008 11:42 AM FUEL ALARM MAR 27. 2008 11:28 AM FUEL ALARM MAR 27. 2008 11:28 AM 9 x x x x END # X x x x ALARM HISTORY REPORT - - - -- SENSOR ALARM - - - -- L 5:92 STP SUMP STP SUMP FUEL ALARM JUL 9. 2007 1:01 PM FUEL ALARM JUL 27, 2006 9:16 AM FUEL ALARM JUL 21, 2005 2:33 PI °1 n+.nm•ti c1��t nr.rvn - - -- SENSOR ALARM - - - -- L 6:DIESEL °TP SUMP STP SUMP SETUP DATA WARNING JAN 6, 2008 10:22 PM FUEL ALARM JAN 6, 2008 8:54 PM FUEL ALARM JUL .9, 2007 12:24 PM x x X x W END x r x x w ALARM HISTORY REPORT - - - -- SENSOR ALARM - - - -- L 7: OTHER SENSORS Mc n Ac uj W al W pa H UF1 a * 7 - «a1 �c O m • O p' Z tJl w A rc h O o �a�H m 2 * W'w TW- W02 m * lix Q3FW -� O6a�� H 0 Opa o�- w U7 Ci t z�. � ,eG � � .. y � i - i S a �'� ., _.r.A it THE AB10VE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE ApROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR TJU ABppYE LISTED PROBLEMS AND N07VMG Afm ENVIRONMANTAL.FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH, ENVIRONMENTAL OF ANY FI14M OR PENALTIES OCCURING FROM NON:COMPLXANCE. A COPYOF THUS DOCUMENT HAS BEEN LEFT ON -BYTE FOR YOUR MONI14WRING SYSTEM CERTIFOATIO ikEIVED For Use By All Jurisdictions Within the State of California Authority C'itecc Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations This form must be used to document testing and servicing of monitoring equipment. A separate certifies' n or K )rt,rmauJ sue? prepare for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner /operator. The owner /operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. BERN COUNTY ENVIRONMENTAL HEALTH SERVICES A. General Infortrtation Facility Name: 6 HI ✓20'`� Bldg. No.:_32 9 0 Site Address: i eJ Lit' 1. � %� `'J y CItY: f�''� as FIEEC Q Zip: Facility Contact Person: Contact Phone No.: () Make /Model of Monitoring System: 3,�'} Date of Testing /Servicing: 13. Inventory of Equipment Tested /Certified INSPECTOR ON -SITE: a AME: Check the a ro riate boxes to indicates ecifie equipment ins ected /serviced: Lr Tank ID: Tank ID,: j� In -Tank Gauging Probe. Model:.( �$ In -Tank Gauging Probe, Model: 1 Annular Space or Vault Sensor. Model: O 4 Annular Space or Vault Sensor. Model: '402 Piping Sump/ Trench Sensor(s). Model: �lff Piping Sump/ Trench Sensor(s). Model: )ot Fill Sump Sensor(s), Model: -VO 5F'E- SO 7Z j9 Fill Sump Sensor(s). Model: i(%OEtJ1G�/L Mechanical Line Leak Detector. Model: :6 Mechanical Line Leak Detector. Model: ❑ !Electronic Line Leask Detector. Model: Cl Electronic Line Leak Detector. . Model: O Tank Overfill / High -Level Sensor. Model: Q Tank Overfilt/ High -Level Sensor. Model: ❑ Other (s )ecifv e ui ment type and model in Section G on Page 2). ❑ Other (specify equipment t pe and model in Section E on Page 2). Tank ID: S Tank ID: It In -Tank Gauging Probe. Model: r"6 1 ❑ In -Tank Gauging Probe. Model: l Annular Space or Vault Sensor. Model: 110 °l ❑ Annular Space or Vault Sensor. Model: _ Piping Swap / Trench Sensor(s). Model: ❑ Piping Sump / Trench Sensor(s). Model: _ajQE 4 Fill Sump SenSOr(S). Model: /J <E-L).(O�- ❑ Fill Sump Sensor(s). Model: 0 Mechanical Line Leak Detector. Model: K-ED Tit ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Tank Overfill / High -Level Sensor. Model: 0 Other (specify equipment type and model in Se on Page 2). © Other (specify equipment type and model in Section E on Page 2). Dispenser ID: `. nser ID: Dispenser Containment Sensor(s). N del: spenser Containment Sensor(s). Model: Shear Valve(s). L� ear Valve(s). 3'Dispenser Containment Floats and Chain(,sj. Dispenser lD: -- Dispenser ID: 7 -,? 6 Dispenser Containment Sensor(s). Model: G '6 Dispenser Containment Sensor(s), Model: 'f" ,SFti BUR Shear Valve(s). ;5 Shear Valve(s). ❑ Dispenser Containment Float(s) and Chain(s). ❑ Dispenser Containment Floats and Chain(s). Dispenser I D: °f' — 10 Dispenser ID: ^/ Dispenser Containment Sensor(s). Model: Txj SCV tt° Dispenser Containment Sensor(s). Modcl:,d,�2 Shear valve(s). Shear Valve(s). 0Dispenser Containment Float(s) and Chain,(s)• ❑ Dispenser Containment Floats and Chain(s). *If the Ihcifity contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the Facility. C. Certification - I certify that the equipment identified in this document was inspected /serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Pltut showing the layout of Inonitoring a uipmem. For any equ ment capable of generating such reports, 1 have also attached a copy of' the report; (check all that aappp�ly,): l � System set -up � rm history report Technician Name (print): � ✓�.Y"(/ Signature: Certification No.: 21& License. No.: Testing Company Name: RICH ENVIRONMENTAL Phone No.:,( 661 ) 392 -9697 Site Address: -Tg,E_8, y �,g EC, � e� Date of Testing/Servicing: Page I of 3 03101 Monitoring System Certification /� n��_. �, - 4���16�.1�1:..... .r � .�. i. ��.7:':i�V its D. Results of Testing /ServicinAe Software Version Installed: 119 U7 Complete the following checklist: • Yes ❑ ° Is the audible alarm operational? � Yes ❑ ° Is the visual alarm operational? Yes O ° Were all sensors visually ins ected, functi onal IX tested, and confin -ned operational ? Yes O o Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Cl Yes 0—N`6*-- ° If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) W N/A operational? Yes D ° For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment O N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate Positive shut -down? (Check all that apply) A"Sump /Trench Sensors; O Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks and sensor failure /disconnection? JR Yes; ❑ No. O Yes O ° For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? % ❑3 es No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. O es' No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) 0 Product; O Water, If yes, describe causes in Section E below. Yes ❑ ° Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable Yes -j O ° Is all monitoring equipment operational per manufacturer's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Con- ments: Page 2 of 3 03.101 • l°. In -Tank Gauging / SIR Equipment • NCheck this box if tank gauging is used only for inventory control. O Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. (` r f.lc 16n rnllnwin❑ ohanttlict• ❑ Yes ❑ N o Has all input wiring been inspected for proper entry and termination, including testing for ground faults? O Yes O o Were all tank gauging probes visually inspected for damage and residue buildup? 0 Yes O o Was accuracy of system product level readings tested? C3 Yes ❑ o Was accuracy of system water level readings tested? ❑ Yes ❑ o Were all probes reinstalled properly? ❑ Yes ❑ o Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leal( Detectors (LLD) Complete the following checklist: ❑ Check this box if LLDs are not installed. Yes ❑ Not For equipment start -up or annual equipment certification, was a leak simulated to verify LLD performance? O N/A (Check alllhat apply) Simulated leak rate: A3 g.p.h., O 0. 1 g.p.h , O 0.2 g.p.h. Yes O o Were all LLDs confirmed operational and accurate within regulatory requirements? Yes C3 o Was the testing apparatus properly calibrated? Yes ❑ NO For mechanical LLDs, does the LLD restrict product flow if it detects a leak? O N/A _' O Yes 70170 For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? N/A 1:1 Yes C1 o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled P, N/A or disconnected? 0 Yes ❑ o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions N/A or fails a test? O Yes ❑ o For electronic LLDs, have all accessible wiring connections been visually inspected? N/A Ycs O o Were all items on the equipment manufacturer's maintenance checklist completed? to (lie aecrlon H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 03101 • • Monitoring System Certification UST Monitoring Site Plan Site Address: /222 % �'i" - - ------------------ ----- - - - - -- ----------------- - - --- - - - - - - - - - - - - - - - - - -�J ----- �_.��. - - - - -- - - --------- - - - - - - - - - - - - - - - - - - - - - ----------------- - ------ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ----- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - ---- ---------- - - - - - - - - - -- - - - - - - - - - -- -- - - -- - - -- - - - - - - - - \ - - - - - - - -' - -a - -S - -I� E r�=- - - - - -- - - - - - -- -- -- -- - - -- - - -- ------ - - - - -- - - - - - - - - - -- - - - - - - - - - - - - - W - - - W - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - W - - I - - - - - - - - - - - - - - - - - f� --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- P(� - -------- ---- ... ------- L w ------- - ------ - -o""? Z��' - - - -�� ------- - - - - -- Date map was drawn: Ins'-uctions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitorung System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in -tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. Page `1 0 f- 05100 • . �2 5643 BROOKS C`,C SA- XSRSFXELD, CA. 93308 OFFICE (661) 392 -5687 P. P'AX (66:L)3.92-0621 Facility tame ; I �'T !� C Af6LI16� Facility Address:! 91 W /0 #L Pr4cluct Line Type (Pressure Suction, Gravity) PIR IMU'CT LEAK DETECTOR Typ-z TEST TRIP PASS! SNAlaZ, NUMBER ABLOW PSI OR - ^ L/A TYPE M —ct1 �I SS, s)mRxzL # QFcD �%du o l /1 s,i L/D T�fPE r"1 �Gn1Q't/ >� AS$ SERIAL #,.&L2 L/D TY'PE._/'G�(_ S Ass SERTAL ',# d J'9c N L /t] TYPE_ XSS PASS SERIAL # �.� r NO FAIL I certify the above- tests were conducted on this data according to Red ,:racket PumPs field test apparatus testing procedure an limitations, Thy:: Mechanical. Leak Detector. Test pass / fail is determined by using a 1vot flow threshold trip rate of 3 gallon per hour or less at 10 PSI. I :acknowledge that all data eollacted in true and correct to the best of Pqr knowledge. Siga- -iture : _ Date; - 9` SWRCB, January 200 Spill*Bucket Testing Report Form This jonn is intended for use by contractors performing annual testing of UST spill containment structures. The completed form an. printouts from.tests (iJapplicable), should be provided to the facility :owner /operatorfor submittal to the local regulatory agency. I. FACILITY INFORMATION Facility Name: % / G 1 Date of Testing: Facility Address: Facility Contact: Phone: Date Local Agency Was Notified of Testing Name of Local Agency Inspector ({jpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: ) C,1l c �VVi ti''ti Technician Conducting Test: r2 V Credentials': CSLB Contractor ICC Service Tech. SWRCB Tank Tester. Other ( ec!) License Number(s). 1 11- 3. SPILL BUCKET TESTING INFORMATION 'r-# V(.4-A TI-4, 77- 1,v,77 VAM111m Other Test Equipment Used / 0 Identify Spill Bucket (By. Tank' I 2 Number, Stored Product, etc. �1%L -% /'''7 Equipmenj Resolution: 3 � 4 PJ , L Bucket Installation Type: Direct Bury ontained in Sum Direct Bury ontained iti S Direct Bury. ntai vd fin-Mu7mB Direct Bury Contained in Sum Bucket Diameter. t,�j f . , / 7 Bucket Depth: Wait time between applying vacuum/water and start of test. ✓ -36 r f l% ��' t'ti J J �% "-I fv Test Start Time (TO: % %( :- r' / •'Q Initial Reading (Ril: Test End Time ('I'F): =Qv 0 ,,.1 Final Reading (RF): , nJ 1 Test Duraboa.(TF - TO: 7- Change in Reading (RF -RD: "� Qr ✓ , •`J Pass/Fail Threshold or Cri teria: Comments - (include information on repairs made prior to tes , and recommendedfollo%,upforfailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the in '»ration contained in this report is true, accurate, and In full compliance with legal requirements. Technician's Signature: Date: ' State laws and regulations do n bul ently re testing to be performed by a qualified contractor. However, local requirements may be more stringent • 0 SYSTEM SECURITY CODE : 000000 SOFTWARE REVISION LEVEL VERSION 119.04 SOFTWARE# 346119 -100 -E CREATED - 00.01.14.10.37 T 2:SUPREME IN -THNK SETUP PRODUCT CODE ' NO SOFTWARE MODULE - - - - - - - - - - - -- THERMAL COEFF :.00070( SYSTEM FEATURES: PERIODIC !N -TANK TESTS T 1:REGULAR TANK DIAMETER 120.0( ANNUAL [N -TAtVK TESTS PRODUCT CODE I TANK PROFILE FULL VOL 4 PTE 1510G THERMAL COEFF :.000700 TANK DIAMETER 120.00 90.0 INCH VOL 12345 TANK PROFILE 4 PTS 60.0 INCH VOL : 760E FULL VOL 19951 30.0 INCH VOL 284 90.0 INCH VOL 16262 60.0 INCH VOL 30.0 INCH VOL 10044 3804 FLOAT SIZE: 4,0 I14. 849E WATER WARNING 2,C FLOAT SIZE: 4.0 IN, 8496 HIGH WATER LIMIT: 31C SYSTEM SETUP - - - -9. WATER WARNING 2.0 MAX OR LABEL VOL: 15104 JILL 2007 2:28 Pt °1 HIGH WATER LIMIT: 3.0 OVERFILL LIMIT 95% 14348 MAX OR LABEL VOL: 19951 HIGH PRODUCT 90% OVERFILL LIMIT 95% 13593 SYSTEM UNITS 18953 DELIVERY LIMIT 101/0 U,S, HIGH PRODUCT 90% 1510 SYSU,l M LANGUAGE ENG ISH DELIVERY LIMIT 17956 10% LOW PRODUCT 468 SYSTEM DATE/TIME FORMAT 1995 LEAK ALARM LIMIT: SUDDEN LOSS LIMIT: 99 99 MON DD YYYY HH:MIH:SS xM LOW PRODUCT 642 TANK TILT 0.00 CHEVRON 1999 TAFT HWY LEAK ALARM LIMIT: SUDDEN LOSS LIMIT: 99 99 MANIFOLDED TANKS DAKERSFIELD.CA 93313 TANK TILT 0.00 TO; NONE 661 -35/08 -8882 MANIFOLDED TANKS SHIFT TIME 1 : DISABLED T#: NONE LEAK MIN PERIODIC: 15% SHIFT TIME 2 DISABLED 2265 SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED LEAK MIN PERIODIC: 15% LEAK MIN ANNUAL 15% 2992 2265 TANK PER TST NEEDED WRN DISABLED TANK ANN TST NEEDED WRN LEAK MIN ANNUAL 15% 2992 PERIODIC TEST TYPE DISABLED STANDARD LINE RE- ENABLE METHOD PERIODIC TEST TYPE ANNUAL TEST FAIL PASS LINE TEST STANDARD ALARM DISABLED LINE PER TST NEEDED WRN ANNUAL TEST FAIL P PERIODIC T EST FAIL DISABLED ALARM DISABLED ALARM DISABLED LINE ANN TST NEEDED WRN DISABLED PERIODIC TEST FAIL GROSS TEST FAIL ALARM DISABLED ALARM DISABLED PRINT TC VOLUMES ENABLED GROSS TEST FAIL ANN TEST AVERAGING: OFF ALARM DISABLED PER TEST AVERAGING: OFF TEMP COMPENSATION VALUE (DEG F ): 60.0 ANN TEST AVERAGING: OFF TANK TEST NOTIFY: OFF STICK HEIGHT OFFSET PER TEST AVERAGING: OFF TNK TST SIPHON BREAK:OFF DISABLED DAYLIGHT SAVING TIME TANK TEST NOTIFY: OFF DELIVERY DELAY 5 MIN ENABLED START DATE TNK TST SIPHON BREAK:OFF APR WEEK 1 SUN START TIME DELIVERY DELAY • 5 MIN 2:00 AM END DATE OCT WEEK 6 SUN END TIME 2:00 AM SYSTEM SECURITY CODE : 000000 0 LEAK TEST METHOD T O:UIESEL PRODUCT CODE 3 TEST ON DATE : ALL TANK THERMAL C:OEFF :.000450 APR 26. 2000 OUTPUT RELAY SETUP TANK DIAMETER 96.00 START TIME : DISABLED — — — — — — — — — — — — TANK PROFILE 4 PTS TEST RATE :0.20 GAL /HR FULL VOL 7829 DURATION 2 HOURS R 1:REGULAR 72.0 INCH VOL 6652 TYPE: 48.0 INCH VOL 4147 STANDARD 24.0 INCH VOL 1540 NORMALLY CLOSED LEAK TEST REPORT FORMAT NORMAL FLOAT SIZE: 4.0 III, 8496 IN —TANK ALARMS ALARM T 1 :HIGH WATER WATER WARNING 2.0 T 1:LOW PRODUCT ALARM HIGH WATER LIMIT: 3.0 LIQUID SENSOR ALMS MAX OR LABEL VOL: 7829 L 1:FUEL ALARM OVERFILL LIMIT 95% L 4:FUEL ALARM OUT ALARM 7437 L i:S£NSOR HIGH PRODUCT 90% L 4:SENSOR OUT ALARM 7046 L 1 :SHORT ALARM DELIVERY LIMIT 10 °r, L 4:SHORT ALARM 792 LIQUID SENSOR SETUP — — — — — R 2 :SUPREME LOWIPPODUCT 359 TYPE: LEAK ALARM LIMIT: 99 L 1:87 ANNULAR STANDARD SUDDEN LOSS LIMIT: 99 TR I --STATE c S [ NGLE FLOAT ) NORMALLY CLOSED TANK TILT 0.00 CATEGORY : ANNULAR SPACE MANIFOLDED TANKS IN —TANK ALARMS WATER ALARM TO: NONE L 2:92 ANNULAR T 2 :HIGH T 2 :LOW PRODUCT ALARM TRI —STATE (SINGLE FLOAT) LEAK MIN PERIODIC: 15% CATEGORY : ANNULAR SPACE LIQUID SENSOR ALMS 1174 L 2 :FUEL ALARM L 5:FU£L ALARM LEAK MIN ANNUAL : 15% L 2:SENSOR OUT ALARM 1174 L 3:DIESEL ANNULAR L 5 :SENSOR OUT ALARM TRI —STATE (SINGLE FLOAT) L 2:SHORT ALARM CATEGORY : ANNULAR SPACE L 5:SHORT ALARr1 PERIODIC TEST TYPE STANDARD R 3:DIESEL TYPE: ANNUAL TEST L 4 :87 STP SUMP ALARMLDISABLED TRI —STATE (SINGLE FLOAT) NORMALLY CLOSED CATEGORY : STP SUMP PERIODIC TEST FAIL ALARM DISABLED IN —TANK ALARMS L 5:92 STP SUMP T 3 :HIGH WATER ALARM GROSS TEST FAIL TRI —STATE (SINGLE FLOAT) T 3 :LOW PRODUCT ALARM ALARM DISABLED CATEGORY : STP SUMP LIQUID SENSOR ALMS ANN TEST AVERAGING: OFF L 3:FUEL ALARM PER TEST AVERAGING: OFF L 6:DIESEL STP SUMP L 6 :FUEL ALARM TRI —STATE (SINGLE FLOAT) L 3 :SENSOR OUT ALARM TANK TEST NOTIFY: OFF CATEGORY : STP SUMP L 6 :SENSOR OUT ALARM TNK TST SIPHON BREAK:OFF L 6 :SHORT ALARM DELIVERY DELAY 5 MIN r 0 x x x x x END x x x x x x x x x .k END x x x x x ALARM H15TORY REPORT - IN-TANK ALARM - T 2 :SUPREME SETUP DATA WARNI51 PM APR 27. APR 26• 2000 11:40 AM LOW PRODUCT ALARM PM NOV 27, 2005 AUG 16. 2005 8i57 PM AUG 14• INVALID 0 APR 2 00 12:52 Pill O23 U NOV 2004 1;53 PM APR 26. 2000 11 :40 AM DELIVERY NEEDED 04 AM 1y0V 29 . 2006 6 t 56 AM SEP 30. 2006 47 AM SEP 29, 2006 10• x x x x END x x x' • ALARM HISTORY REPORT RECONCILIATION SETUP - IN -TANK ALARM _._.. --- .._._. .._ ._._...._ ._.. T 1 : REGULAR AUTOMATIC DAILY CLOSING TIME: 2:00 All SETUP DATA WARNING APR 27, 2000 12 :20 PM PERIODIC RECONCILIATION APR 26. 2000 11:40 AM MODE: MONTHLY OVERFILL ALARM TEMP COMPENSATION APR 22, 2007 3 :08 AM STANDARD APR 22, 2007 2:45 AM JAN 26. 2006 2 :58 AM BUS SLOT FUEL METER TANK - - LOW PRODUCT ALARM TANK MAP EMPTY SEP 12. 2005 9:06 AM AUG 4. 2005 1:41 PM JUL 22, 2005 8 :36 AM HIGH PRODUCT ALARM MAY 27, 2007 11:08 PM MAY 1, 2007 3:19 PM APR 22, 2007 2 :42 AM INVALID FUEL LEVEL APR 27, 2000 12 :28 PM ALARM HISTORY REPORT PROBE OUT NOV 23. 2004 1 :13 PM - - ---- SYSTEM ALARM - - - -- APR 26, 2000 11:40 AM PAPER OUT JUN 17, 2007 3:36 AM PRINTER ERROR DELIVERY NEEDED JUL 2, 2007 5:41 AM OCT 7. 2006 7:12 AM BATTERY IS OFF SEP 16. 2005 3 ;22 Phl JAN 1. 199E 8 :00 AM SEP 11. 2005 11 :13 PM CLOCK IS INCORRECT APR 3. 2005 3 :01 AM x x x x x END x x x x x x x x x .k END x x x x x ALARM H15TORY REPORT - IN-TANK ALARM - T 2 :SUPREME SETUP DATA WARNI51 PM APR 27. APR 26• 2000 11:40 AM LOW PRODUCT ALARM PM NOV 27, 2005 AUG 16. 2005 8i57 PM AUG 14• INVALID 0 APR 2 00 12:52 Pill O23 U NOV 2004 1;53 PM APR 26. 2000 11 :40 AM DELIVERY NEEDED 04 AM 1y0V 29 . 2006 6 t 56 AM SEP 30. 2006 47 AM SEP 29, 2006 10• x x x x END x x x' ALARM HISTORY REPORT - - -- IN -TANK ALARM - T 3:DIESEL SETUP DATA WARNING APR 27, 2000 1 :11 P11 APR 26, 2000 11 :40 AM OVERFILL ALARM APR 1, 2007 7:04 PM MAR 21. 2007 2 :50 All MAR 17. 2007 3:40 AM LOW PRODUCT ALARM SEP 29, 2005 12:44 AM SEP 22. 2005 9:50 PM SEP 8. 2005 4 :01 PM HIGH PRODUCT ALARM APR 29, 2007 9:53 PM APR 1, 2007 7:02 PM MAR 28. 2007 12 :32 AM INVALID FUEL LEVEL APR 27, 2000 1:11 PM PROBE OUT NOV 23, 2004 2:29 PM APR 26. 2000 11:40 All DELIVERY NEEDED SEP 28, 2005 8:06 All SEP 22, 2005 4:57 AM SEP 7, 2005 11:53 PM x x x x x END x x x x x ALARM HISTORY REPORT SENSOR ALARM L 1 :87 ANNULAR ANNULAR SPACE FUEL ALARM JUL 9, 2007 1:02 PM FUEL ALARM JUL 27, 2006 9:20 All FUEL ALARM JUL 21, 2005 2 :36 PM ALARM HISTORY REPORT - - - -- SENSOR ALARM - - - -- ALARM HISTORY REPORT L 2:92 ANNULAR - - - -- SENSOR ALARM --- ANNULAR SPACE L 4:87 STP SUMP FUEL ALARM STP SUMP JUL 9. 2007 1:02 PM FUEL ALARM FUEL ALARM JUL 9, 2007 1:01 PM JUL 27, 2006 9 :19 All SETUP DATA WARNING FUEL ALARM MAY 3, 2007 8 :55 AM JUL 21, 2005 2 :34 PM SETUP DATA WARNING 9. 2007 1:45 PM APR 15, 2007 8:49 AM x x x x x END x x x x x x x x x x END x x x x x ALARM HISTORY REPORT - - - -- SENSOR ALARM - - - -- ALARM HISTORY REPORT L 3 :DIESEL ANNULAR - - - -- SENSOR ALARM - - - -- ANNULAR SPACE L 5:92 STP SUMP FUEL ALARM STP SUMP JUL 9, 2007 2:03 PM FUEL ALARM FUEL ALARM JUL 9. 2007 1:01 PM JUL 9. 2007 1:45 PM FUEL ALARM FUEL ALARM JUL 27, 2006 9 :16 AM JUL 9. 2007 1 :32 PM FUEL ALARM JUL 21. 2005 2:33 PM x x x x x END x x x x x x x x x x E14D x x x x x ALARM HISTORY REPORT - - - -- SENSOR ALARM - - - -- L 6 :DIESEL STP SUMP STP SUMP FUEL ALARM JUL 9, 2007 12:24 PM SETUP DATA WARNING FEB 19, 2007 10:20 AM FUEL ALARM FEB IS, 2007 11:16 PM xxxx *ENDxxx*x ALARM HISTORY REPORT --- -- SENSOR ALARM - - - -- s 1: OTHER SENSORS x x x x x END x x x x* ALARM HISTORY REPORT - - -- PRODUCT ALARM -- -- F 1:REGULAR x x x x* END * x x x x s ��r MONITOR • REPORT SITE NAME -T4-,F-7 G MLI? -O-r✓ DATE: 7' 0,-) TEC�CiAN: CITY:'1« F�' C. S1ti1VA1 Uttt.: THE FOLLOWING COMPONENTS WERE REPLACED/REP D TO TESTING. REPAIRS: LABOR:. m PARTS.INTALLED: NAME:. TITLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTHTING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMENTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON - COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIENENCE. • 0 z MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cite& Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code gJRegulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepare for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner /operator. The owner /operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information ?C;?— t? Facility Name: T�T }-I O� rmEyROti Bldg. No !! Site Address: -1 G ?A FT ii L) Y City: /'3ALngSFSt <�P Zip: Facility Contact Person: Contact Phone No.: Make /Model of Monitoring System: 1!'TL-,3f�kCo EM Date of Testing /Servicing: L /2 Z/�� B. Inventory of Equipment Tested /Certified Check the annrnnriate boxes to indicate specific eouioment insnected /serviced: Tank ID: Ij/LX, Tank ID: P.PE019 10 In -Tank Gauging Probe. Model: Q} In -Tank Gauging Probe. Model: m, I ® Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: 0 Piping Sump /'[Tench Sensor(s). Model: Piping Sump / Trench Sensor(s). Model: ��__ JA Fill Sump Sensor(s). Model: A Fill Sump Sensor(s). Model: o(J AJ �_ ® Mechanical Line Leak Detector. Model: g J(�tC Mechanical Line Leak Detector. Model: FIFE C� / ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Other(specify equipment a and model in Section E on Page 2). ❑ Other(specify equipment a and model in Section E on Page 2). Tank ID: Z),TQ1,E4_ Tank ID: ❑ In -Tank Gauging Probe. Model: ® In -Tank Gauging Probe. Model: A_7 ® Annular Space or Vault Sensor. Model: 4/O ❑ Annular Space or Vault Sensor. Model: a Piping Sump/ Trench Sensor(s). Model: ^a 6 ❑ Piping Sump / Trench Sensor(s). Model: �R Fill Sump Sensor(s). Model: v f ooi6r- ❑ Fill Sump Sensor(s). Model: Eff- Mechanical Line Leak Detector. Model: E r ❑ Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Tank Overfill / High -Level Sensor. Model: Cl Other (specify equipment type and model in Section E on Page 2). ❑ Other (specify equipment type and model in Section E on Page 2). Dispenser ID: 111 a _ Dispenser ID: 3 . Lf R Dispenser Containment Sensor(s). Model: IVQ ,5,F.r%6C _ Dispenser Cont i�nsor(s). Model: �u a �PSwO, ,ems tdl Shear Valve(s). �&t 2O Shear Valve(s). ❑ Dispenser Containment Floats and Chains . ❑ Dispenser Containment Floats and Chain(s). Dispenser ID: C, L Dispenser ID: 749 .® Dispenser Cont inment Sensor(s). Model: rtXj O- Dispenser Containment Sensor(s). Model: ,Uc) _5E• onQ 4 Z Shear Valve(s). R Shear Valve(s). ❑ Dispenser Containment Float(s) and Chain(s). ❑ Dispenser Containment Floats and Chain(s). Dispenser ID: 9, n Dispenser ID: / ( , /a &Dispenser Cnment Sensor(s). Model: A.&,Z . SE.(150,& 2F- Dispenser Cont —a nt Sensor(s). Model: ® Shear Valve(s). aShear Valve(s). ❑Dis enser Containment Float(s ).and Chain(s). ❑ Dispenser Containment Floats and Chain(s), if the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification - I certify that the equipment identified in this document was inspected /serviced in accordance with the manufacturers' guidelines. Attached to this Certification is Information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the report; (check all that apply): ,System set -up rm histo report Technician Name (print): PY�VA Signature: / Certification No.: 00[1-M- 117e1 1 c tit 5����13` License. No.: Testing Company Name: RICH ENVIRONMENTAL Phone No.:( 661 _392 -8687 Site Address: 199Q 7 {iFp llb)Y. 8 �1'EL n IAA Date of Testing/Servicing: % 1 a;9106 Page I of 3 Monitoring System Certification RECEIVED 03101 AUG 2 1 2006 KERN COUNTY ENVIRONMENTAL HEALTH SERVICES 0 0 l3to�� D. Results of Testing /Servicing Software Version Installed: / p5av Complete the following checklist: ® Yes ❑ ° Is the audible alarrn operational? ® Yes ❑ Is the visual alarm operational? 3 Yes ❑ ° Were all sensors visually inspected, functionally tested, and confin -ned operational? Yes ❑ ° Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? El Yes ❑ o If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) N/A operational? S Yes ❑ ° For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ❑ N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut -down? (Check all that apply) 0 Sump/Trench Sensors; Cl Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks and sensor failure /disconnection? ® Yes; 0 No. ❑ Yes Ll ° For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no 1A N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating property? If so, at what percent of tank capacity does the alarm tri er? % ® es ❑ No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. 0 es O No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ❑ Product; 5L Water. If yes, describe causes in Section E below. -5 Yes F—CTIT7 Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable Ca Yes I ❑ ° Is all monitoring equipment operational per manufacturen's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: _6.1 Al cIQ 1 zt) ALL TjABLI 50ry►,AA. 4)AT 99 1 EG i CT6-,&2,^ Page 2 of 3 03101 0 , 0 • • t3to'1� F. In -Tank Gauging / SLR Equipment: * Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Comnlete the followine checklist: O Yes O No Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ❑ Yes ❑ ° Were all tank gauging probes visually inspected for damage and residue buildup? ❑ Yes O ° Was accuracy of system product level readings tested? O Yes 0 No Was accuracy of system water level readings tested? ❑ Yes 0 ° Were all probes reinstalled properly? ❑ Yes ❑ ° Were all items on the equipment manufacturer's maintenance checklist completed? In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): Com lete the follo ing checklist: ❑ Check this box if LLDs are not installed. V Yes O NO* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? O N/A (Check all that apply) Simulated leak rate: Z 3 g.p.h., ❑ 0. 1 g.p.h , 0 0.2 g.p.h. '.® Yes ❑ - Were all LLDs confirmed operational and accurate within regulatory requirements? Q Yes ❑ ° Was the testing apparatus properly calibrated? 3 Yes ❑ ° For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ ° For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? 3 N/A ❑ Yes ❑ ° For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled 15 N/A or disconnected? ❑ Yes ❑ ° For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ® N/A or fails a test? ❑ Yes ❑ ° For electronic LLDs, have all accessible wiring connections been visually inspected? to N/A U Yes Cl ° Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: C A6AjC,7 p M t— n nlu �rE'6,i✓c_ Page 3 of 3 03101 Monitoring System Certification UST Monitorinl7 Site Plan Site Address: ----------------------------------------------- - - - - -- -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - UN L$'7- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------------------------------ -------- ------------------------------ - -- - - - - - - - - ---------------- -- - - - - - - - - - - rh9 ?-------- - - - - -- - - -- - - -- - - -- ---- - - - - -- - .... `� -- 7 - - - - -- --------------------------------------------------- -------------------------------- ---- D - - - _ifl ..... b-- - - - - - - - - - - - - - - - - - - - - - - - - - rh 77 Date map was drawn: 7 / ' �t'7 / rIAL, Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in -tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. Page H of L4 05100 RICH M=RONMENTA r. 5643 BROOKS CT BAKERSFIELD,CA.93308 OFFICE(661)392 -8687 & FAX (661)392 -0621 MRCHAN?CAL. LEAK DETECTOR TEST W /0 #: Facility Name: rAFT H WY cNF-VRa-1-1 Facility Address: d9Q 7-AFT 14Q - Product Line Type (Pressure, suction, Gravity) 'P12E56U2k5' PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS SERIAL NUMBER BELOW 3 0211 PSI OR AIL L/D TYPE RED J79Ck9t D ASS VN` SERIAL # 3a l4 NO FAIL L/D TYPE Q ,�:-T PQEr%9 I SERIAL ## NO / FAIL L/D TYPE C'T ES �lESEI- SERIAL # NO �G OL-.0) tV L/D TYPE YES PA 8 Mg SERIAL # l[dll/.t/�A�4.✓ l� FAI I certify the above tests were conducted on this date according to Rad Jacket Pumps field test apparatus testing procedure an limitations. The Mechanical Leak Detector Test pass / fail is determined by using a low flow threshold trip rate of 3 gallon per hour or less at 10. PSI. I acknowledge that all data collected is true and correct to the best of my knowledge. Tech: Signature: Date: 7`.-7 -0 G'• i SYSTEM SETUP JUL 27, 2006 12:17 PM SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE /TIME FORMAT MON DD YYYY HH:MM:SS xM CHEVRON 1999 TAFT HWY BAKERSFIELD.CA 93313 661398 -6662 SHIFT TIME 1 : DISABLED SHIFT TIME 2 DISABLED SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED TANK PER TST NEEDED WRN DISABLED TANK ANN TST NEEDED WRN DISABLED LINE RE- ENABLE METHOII PASS LINE TEST LINF PER TST NEEDED WRN DISABLED LINE ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE (DEG F ): 60.0 STICK HEIGHT OFFSET DISABLED DAYLIGHT SAVING TIME ENABLED START DATE APR WEEK 1 SUN START TIME 2:00 AM END DATE OCT WEEK 6 SUN END TIME 2:00 AM SYS -fill SECURITY CODE : 000000 • COMMUNICATIONS SETUP - - PORT SETTINGS NONE FOUND RS -232 SECURITY CODE : 000000 RS-232 END OF MESSAGE DISABLED U 114-- TANK SETUP- - - - - - T 1:REGULAR PRODUCT CODE 1 THERMAL COEFF :.000700 TANK DIAMETER 120.00 TANK PROFILE 4 PTS FULL VOL 19951 90.0 INCH VOL 16262 60.0 INCH VOL 10044 30.0 INCH VOL : 3804 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 19951 OVERFILL LIMIT 950 18953 HIGH PRODUCT 90% 17956 DELIVERY LIMIT 10i 1995 LOW PRODUCT 642 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 MANIFOLDED TANKS TO; NONE LEAK MIN PERIODIC: 15% 2992 LEAK MIN ANNUAL : 15%, 2992 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY : 5 MIN LEAK TEST METHOD [3(o 77 TEST ON DATE : ALL TANK APR 26, 2000 START TIME : DISABLED TEST RATE :0.20 GAL /HR DURATION : 2 HOURS LEAK TEST REPORT FORMAT NORMAL LIQUID SENSOR SETUP L 1:87 ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 2:92 ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 3:DIESEL ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 4:87 STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 5:92 STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 6:DIESEL STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP T 3:DIESEL T 2 :SUPREME PRODUCT CODE 3 PRODUCT CODE 2 THERMAL COEFF :.000450 THERMAL COEFF :.000700 TANK DIAMETER 96.00 TANK DIAMETER : 120.00 TANK PROFILE 4 PTS TANK PROFILE 4 PTS FULL VOL : 7829 FULL VOL 15104 72.0 INCH VOL 6652, 90.0 INCH VOL 12349 48.0 INCH VOL 4147 60.0 INCH VOL 7605 24.0 INCH VOL : 1540 30.0 INCH VOL 2843 FLOAT SIZE: 4.0 IN. 8496 FLOAT SIZE: 4.0 IN. 6496 WATER WARNING 2.0 WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 7829 MAX OR LABEL VOL: 15104 OVERFILL LIMIT 95% OVERFILL LIMIT 95% 7437 14348 HIGH PRODUCT 90% HIGH PRODUCT 90% 7046 13593 DELIVERY LIMIT 10: DELIVERY LIMIT 30% 782 1510 LOW PRODUCT 359 LOW PRODUCT 468 LEAK ALARM LIMIT: 99 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT 0.00 TANK TILT 0.00 MANIFOLDED TANKS MANIFOLDED TANKS TO: NONE TO: NONE LEAK MIN PERIODIC: 15% LEAK 11111 PERIODIC: 15% 1 174 2265 LEAK MIN ANNUAL : 15% LEAK MIN AI4NUAL : 15% 1174 2265 PERIODIC TEST TYPE PERIODIC TEST TYPE STANDARD STANDARD ANNUAL TEST FAIL ANNUAL TEST FAIL ALARM DISABLED ALARM DISABLED PERIODIC TEST FAIL PERIODIC TEST FAIL ALARM DISABLED ALARM DISABLED GROSS TEST FAIL GROSS TEST FAIL ALARM DISABLED ALARM DISABLED ANN TEST AVERAGING: OFF ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF TNK`TST SIPHON BREAK:OFF DELIVERY DELAY . 5 MIN DELIVERY DELAY . 5 MIN LEAK TEST METHOD [3(o 77 TEST ON DATE : ALL TANK APR 26, 2000 START TIME : DISABLED TEST RATE :0.20 GAL /HR DURATION : 2 HOURS LEAK TEST REPORT FORMAT NORMAL LIQUID SENSOR SETUP L 1:87 ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 2:92 ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 3:DIESEL ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 4:87 STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 5:92 STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 6:DIESEL STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP OUTPUT RELAY SETUP R 1 :REGULAR TYPE: STANDARD NORMALLY CLOSED IN -TANK ALARMS T !:HIGH WATER ALARM T I :LOW PRODUCT ALARM LIQUID SENSOR ALMS L 1 :FUEL ALARM L 4 :FUEL ALARM L !:SENSOR OUT ALARM L 4 :SENSOR OUT ALARM L 1 :SHORT ALARM L 4:SHORT ALARM R 2:SUPREME TYPE: STANDARD NORMALLY CLOSED IN -TANK ALARMS T 2:HIGH WATER ALARM T 2:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 2:FUEL ALARM L 5:FUEL ALARM L 2 :SENSOR OUT ALARM L 5:SENSOR OUT ALARM L 2 :SHORT ALARM L 5 :SHORT ALARM R 3:DIESEL TYPE: STANDARD NORMALLY CLOSED IN -TANK ALARMS T 3:HIGH WATER ALARM T 3:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 3:FUEL ALARM L 6:FUEL ALARM L 3:SENSOR OUT ALARM L 6:SENSOR OUT ALARM L 3 :SHORT ALARM L 6:SHORT ALARM RECONCILIATION SETUP AUTOMATIC DAILY CLOSING TIME: 2:00 AM PERIODIC RECONCILIATION MODE: MONTHLY TEMP COMPENSATION STANDARD BUS SLOT -FUEL METER -TANK TANK MAP EMPTY w..i� SOFTWAkE';RE_I S [$ LEVEL VERSION 1`�1 ( i?4 �• Jk SOFTWARE# 3461192,00 -E CREATED = 00.01.14.10.37 NO SOFTWARE MODULE SYSTEM FEATURES: PERIODIC IN -TANK TESTS ANNUAL IN -TANK TESTS -3 Co-7 --I ALARM HISTORY REPORT - - -- 1N -TANK ALARM - T I:REGULAR SETUP DATA WARNING APR 27. 2000 12:28 PM APR 26, 2000 11 :40 AM OVERFILL ALARM JAN 26. 2006 2:56 AM DEC., 31. 2005 12:59 PM LOW PRODUCT ALARM SEP 12. 2005 9:06 AM AUG 4, 2005 1:41 PM JUL 22. 2005 8:36 AM HIGH PRODUCT ALARM MAR 17. 2006 2:32 AM MAR 9, 2006 3 :00 AM FEB 1, 2006. 8:15 AM INVALID FUEL LEVEL APR 27, 2000 12:28 PM PROBE OUT NOV 23. 2004 1:13 PM APR 26. 2000 11 :40 All DELIVERY NEEDED SEP 16, 2005 3 :22 Pm SEP ll. 2005 11 :13 PM AUG 30. 2005 6:33 AM 0 0 ALARM HISTORY REPORT SENSOR ALARM L 1:87 ANNULAR ANNULAR SPACE FUEL ALARM JUL 27. 2006 9:20 AM FUEL ALARM JUL 21. 2005 2:36 PM FUEL ALARM JUL 26. 2004 1:06 PM x x x x x END x x x x x ALARM HISTORY REPORT - - -- IN -TANK ALARM - T 1:REGULAR SETUP DATA WAR14I NG APR 27, 2000 12:28 PM APR 26, 2000 11:40 All OVERFILL ALARM JAN 26. 2006 2:58 AM DEC 31. 2005 12:59 PM LOW PRODUCT ALARM SEP 12, 2005 9:06 AM AUG 4, 2005 1:41 PM JUL 22, 2005 8:36 AM HIGH PRODUCT ALARM MAR 17. 2006 2 :32 AM MAR 9. 2006 3:00 AM FES 1. 2006 8:15 AM INVALID FUEL LEVEL APR 27. 2000 12:28 PH PROBE OUT NOV 23, 2004 1:13 PM APR 26, 2000 11:40 AM DELIVERY NEEDED SEP 16, 2005 3:22 PM SEP 11, 2005 11:13 PM AUG 30, 2005 8:33 AM ALARM HISTORY REPORT - - -- IN -TANK ALARM - T 2:SUPREME SETUP DATA WARNING APR 27, 2000 12:51 PM APR 26, 2000 11:40 AM LOW PRODUCT ALARM NOV 27, 2005 5:56 PM AUG 16. 2005 6:12 PM AUG 14, 2005 8:57 PM INVALID FUEL LEVEL APR 27, 2000 12:52 PM PROBE OUT NOV 23, 2004 1 :53 PM APR 26, 2000 11:40 AM DELIVERY NEEDED DEC 11, 2005 1:42 PM NOV 26, 2005 5:1B PM OCT 24, 2005 8:08 PM x x x x x END x x x x x ALARM HISTORY REPORT - - -- IN -TANK ALARM - T 3:DIESEL SETUP DATA WARNING APR 27, 2000 1:11 PM APR 26. 2000 11:40 AM LOW PRODUCT ALARM SEP 29, 2005 12:44 AM SEP 22. 2005 9:50 PM SEP B. 2005 4:01 PM HIGH PRODUCT ALARM JUN 8. 2006 9:07 PM MAR 4, 2006 3:44 PM INVALID FUEL LEVEL APR 27, 2000 1:11 PM PROBE OUT NOV 23, 2004 2:29 PM APR 26. 2000 11:40 AM DELIVERY NEEDED SEP 29, 2005 8:06 All SEP 22, 2005 4:57 All SEP 7, 2005 11:53 PM • �3tdZ � ALARM HISTORY REPORT --- -- SENSOR ALARM -- L 1:87 ANNULAR ANNULAR SPACE FUEL. ALARM JUL 27, 2006 9:20 AM FUEL ALARM JUL 21. 2005 2:36 PM FUEL ALARM JUL 26. 2004 1:06 PM x x x x x END x x x x ALARM HISTORY REPORT - - - -- SENSOR ALARM - -- L 2:92 ANNULAR ANNULAR SPACE FUEL ALARM JUL 27. 2006 9:19 AM FUEL ALARM JUL 21, 2005 2:34 PM FUEL ALARM JUL 26. 2004 1:05 PM ALARM HISTORY REPORT ALARM HISTORY REPORT - - - -- SENSOR ALARM - - --- - - - -- SENSOR ALARM - - - -- L 3:DIESEL ANNULAR L 5:92 STP SUMP ANNULAR SPACE STP SUMP FUEL ALARM FUEL ALARM FUEL ALARM JUL 27. 2006 9:17 All JUL 27, 2006 9:16 All FUEL ALARM FUEL ALARM JUL 27. 2006 JUL 21. 2005 2:30 PM JUL 21, 2005 2:33 PM FUEL ALARM FUEL ALARM JUL 27. 2006 JUL 26. 2004 1:00 PM JUL 21, 2005 2:33 Pll x x x x x END x x x x x x x x x x E14D x x x x x ALARM HISTORY REPORT ALARM HISTORY REPORT - - --- SENSOR ALARM - - --- - - - -- SENSOR ALARM - - - -- L'4:87 STP SUMP L 6:DIESEL STP SUMP STP SUMP STP SUMP FUEL ALARM FUEL ALARM JUL 27. 2006 9:15 AM JUL 27. 2006 9:17 AM FUEL ALARM FUEL ALARM JUL 27. 2006 9:15 AM JUL 21. 2005 2:30 PM FUEL ALARM FUEL ALARM JUL 27, 2006 9:14 AM JUL 26, 2004 1:14 PM 13 'Z� • • vs c0 -7-1 MONITOR CERT. FAILURE REPORT SITE NAME: T—AFr /IQ, Y C.H9L, DATE: 7-1-7 -010 v THE FOLLOWING COMPONENTS WERE REPLACED/REPAtkED TO TESTING. REPAIRS: C li iA.cJ 6_10 ?J M LLV pnJ LABOR: PARTS INTALLED: I RE. D J AC-kET FA 1 DV DT�S�� TYl c L D NAME: TITLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON - COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIENENCE. r ► 3d_i. SWRCB, January 20 6 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form 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: % 1'iFT lfJ Y CH£ 0(rDAJ Date of Testing: 7- X7--0 1. Facility Address: Jy J Z8FT ML_1Y Facility Contact: Phone: Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (fpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Z.XG}F Technician Conducting Test: lZieliAl n/ _co/t,) Credentials: CSLB Contractor ICC Service Tech. Tester Other (Sped) License Number(s): 3. SPILL BUCKET TESTING INFORMATION Test Method Used: osta-tic Vacuum Other Test Equipment Used: Equipment Resolution: Identify Spill Bucket (By Tank 1 U ut_ 8 7 f)rLC. 2 PR61�9 Number, Stored Product, etc. TF58 L Frt-t- Bucket Installation Type: Bury taine in S Direct Bury ntained in Sum Direct Bury ontaine to S Direct Bury Contained in Sum Bucket Diameter: / a / Bucket Depth: J (o lZe (o Wait time between applying vacuum/water and start of test: 30 10' y I-) 3o X r 3U /'11,/(J Test Start Time (TO: 9.,00 ,c C) �'CjG /K Initial Reading (RO: /v t t l (it 1 t Test End Time (TF): 10:00A M /0-pio A^ p : peg Am Final Reading (RF): t' JV ' l 1 Test Duration (TF - Tt): / f J 2 / .H f } Change in Reading (RF -RD: 1 (S t` C I, Pass/Fail Threshold or Criteria: 6 Dt\ o t t Comments -(include information on repairs made prior to testing, and recommended follow -up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Date:_ 7 `,,) 7- Goa V ' State lawo and regulations do not currently Quito testing to he performed by a qualified contractor. However, local requirements may be more stringent. 0 • SB989 TESTING FAILURE REPORT SITE NAME: T6F1 Oil.1 GWE�%QO✓J DATE: 7 o27 -C7Co ADDRESS: 04C., T AFT` 1-i V `L TECHNICIAN: CITY : RA k t lZS F2E4 --%-) SIGNATURE SITE CONTACT: THE FOLLOWING COMPONENTS WERE REPLACED /REPAIRED TO COMPLETE THE SS989 TESTING. LIST OF PARTS REPLACED /REPAIRED: REPAIRS: PARTS INSTALLED:,en,o6' .� � I. i i 1 — 01- 27 -06•, : 20 RCVD p 11975 S'VV6; January 2002 Page ! of l Secondary Containment Testing Report Form 1'�, This fora, is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the ap 'ate pages of this form to report results for all components tested The completed form, written test procedures, and prr touts from tests (if applicable), should be provided to the facility owner /operator for submittal to the local regulatory agency. 2. TESTING CONTRACTOR INFORMATION ompan Name: 1. FACHM INFORMATION JU QrQ 17 3X74, 'technician Conducting Test C)S q V 5 e U N Date of Testing:s' Iredebtials: 9CSLB Licensed Contractor %� -}W rlLo'caWl icense T M: t: Phone: Manufa rer TmWne Com ens Date TrainingE fires ncy Was Notified of Testing dame of Local Agency Inspector (if present during testLt: 2. TESTING CONTRACTOR INFORMATION ompan Name: EMT" l 'technician Conducting Test C)S q V 5 Iredebtials: 9CSLB Licensed Contractor W?-CB Licensed Tank Tester 10 -10 ?1- icense T M: j License Number: U Manufacturer Manufa rer TmWne Com ens Date TrainingE fires IS 3. SUMMARY OF TEST RESULTS It hydrostatic testing was performed, describe what was done with the water after completion of tests: i CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING i'o the best of my knowledge, the facts stated In this document are accurate and In full compliance with legal requirements Technician's Sign 16 Date: Na 'oCy 104 0® ®, ,. :. - Wino , ► - _ Igo== 1�r,�►.' r� �onr.�in KIRM : nr..�o rangy■ ® MONO- inA� n�nin�► It hydrostatic testing was performed, describe what was done with the water after completion of tests: i CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING i'o the best of my knowledge, the facts stated In this document are accurate and In full compliance with legal requirements Technician's Sign 16 Date: Na 'oCy 104 0 -U W ni ia, +auuaUy �vv� 4. TANK ANNULAR TESTING Test Method Developed By: ❑ Tank Manufacturer Wndustry Standard 0 Professional Engineer ❑ Other (Spew) T st Method Used: ❑ Pressure Vacuum ❑ Hydrostatic 0 Other (Spec) st Equ# n 1 7t Used: Tank# R7 Tank# 9 Equipment Resolution: d 5 c•/L) Tenk# (� Tank# I Tank Exempt From Testing?' ❑ Yes ANA 0 Yes. Aio 0 Yes Y64 o 0 Yes ❑ No Tank Capacity: S' 8' nvIJG�A Tank Material: S Tank Manufacturer: Product Stored: Wait time between applying phessure ✓ vacuum /water and sdartin test: st Start Time: M-47" I S M S+ I itial Reading (RD: p Test End Time: 9 9 A� Final Reading (RF): Test Duration: Change in Reading (RF-Rr): O 4 t7 Pbss/Fail Threshold or Criteria: (j eat Result: fif Pass 0 Fail 9 P&6.. 0 Fail Pass 0 Fail ❑ Pass 0 Fail Was sensor removed for testing? Yes ❑ No 0 NA VYes 0 No ❑ NA *Yes 0 No DNA ❑ Yes ONO _I NA Was sensor properly replaced and rifled ftmctional after testis ? Yes 0 No 0 NA J Yes 0 No ❑ NA 1,0Yes 0 No ❑ NA ❑ Yes 0 No `J NA i _ iQomments — (include information on repairs made prior to testier and recommended follow -up for failed tests) Secondary containment systems where the continuous monitoring automatically monitor 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(ax6)) 0 S WRCB, January 2002 �I S. SECONDARY PIPE TESTING I (q-7� Page 3 of -q--. Test Method Developed By: ❑ Piping Manufacturer Wndustry Standard ❑ Professional Engineer ❑ Other (Specify) Test Method Used: •400!ressure ❑ Vacuum Aydrostatic ❑ Other fteco) T'llest Equipment Used i j Equipment Resolution: a C'Ja Piping Run # g7 Piping Run #ql Piping Run #jjj,,$' L Piping Run # Piping Material: ,v r.J ti,(r1(L r� ©HI r�l VW bw Piping Manufacturer. /+/,(�,� o. / �✓, .t�w�. i a..,.� Aping Diameter. 3 " •, Length of Piping Run: Product Stored: r04, � Method and location of pjp!Mrun isolation: ',J ;,/ a- /f narx,,/as Wait time between applying pressure /vacuum/water and starting test: QM 1^( 104 Test Start Time: , pjJ Initial Reading (R): i /- g / ;./ ^/ . y Test End Time: �ij,vl - /� Final Reading (RF): at9 i -3c►9, - / /- 479�. NgLJ. • S,-• Test Duration: Change in Reading (RFRD: CODI --• of OD /)_ _00 CD I; Pass/Fail Threshold or Criteria: _ Vest Result: ass 0 Fail ss .0 Fail Psss 0 Fail ❑ Pass ❑ Fail • SWRCB, January 2002 6- PiPyKG SUMP TESTING 11 f / 9'7 Page -q— of 4E, Test Method Developed By: ❑ Sump Manufacturer ;Wndustry Standard ❑ Professional Engineer 0 Other (Specify) Test Method Used: ❑ Pressure ❑ Vacuum )51jydrostatic 0 Other (Specify) Test Equi Used: 5 Equipment Resolution: e p On i rj Sump # 7 Sump # / Sump # L Sump # Sump Diameter. r Sump Depth: Q'' (aj� ••' Sump Material: Might from Tank Top to Top of Highest Pip!RS Pip! Penetration ., Height from Tank Top to Lowest Electrical Penetration: Q Condition of sump prior to testing: Portion of Sump Tested' Does turbine shut down when sump sensor detects liquid (both roduct and water)?* ❑ Yes 0 No jZiNA ❑ Yes ❑ No )§NA 0 Yes ❑ No )dNA 0 Yes ❑ No 1' NA Turbine shutdown response time Is system programmed for fail -safe shutdown? 0 Yes 0 No PA A ❑ Yes 0 No ,N e ° ' ❑ Yes No VNA 0 Yes 0 No ❑ NA Was fait -safe verified to be operational?* 0 Yes ❑ No d NA 0 Yes 0 No OA 0 Yes 0 No )(NA ❑ Yes ❑ No U NA Wait time between applying pressure/vacuum /water and starting test: Test Start Time: j g; • g, 34o 32m i Initial Reading (Rj): /;.,j yp '.� t - 83 :r 3 ; -' .1 Z Test End Time. :S : Sv Final Reading (RF): N-, 0; _ Tbst Duration: / i..i i.- Change in Reading (RrRi) i - /ice i-� DOrJi -✓ /. /.-� - DU .r Pass/Fail Threshold or Criteria: i •.,, . C10 a, , Test Result: Pass 0 Fall Z Pass 0 Fail J0 Pass 0 Fail ❑ Pass ❑ Fail Was sensor removed for testing? tIDYes ❑ No 0 NA Q Yes ❑ No ❑ NA p Yes 0 No ❑ NA ❑ Yes 0 No NA Was sensor properly replaced and verified functional after testin 7 1oYes . ❑ No DNA 4 Yes 0 No DNA . Yes 0 No ❑ NA ❑ Yes 0 No NA Comments - (include information on repairs made prior to testing, and recommended follow -up for failed 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 7. UNDER- DISPENSER CONTAINMENT (UDC) TESTING !%975 Page 4 f Test Method Developed By: 0 UDC Manufacturer Q Industry Standard 0 Professional Engineer 0 Other (Spec) Test Method Used: ❑ Pressure O Vacuum a Hydrostatic O Other (Spec) Test Equipment Used: INCON TS —STS UDC # UDC # Equipment Resolution: . 000 i n . UDC # UDC # UDC Manufacturer: V.,"S vv ,v t,_Jrj UDC Material: S� f''t S 11DC Depth: V " Height from UDC Bottom to Top of Highest Piping Penetration: Height from UDC Bottom to Lowest Electrical Penetration: n '' Condition of UDC prior to testing; (,�� C�1..C.T j C,CFA ni �JCi�rJ C Portion of UDC Tested t HIS Does turbine shut down when UDC sensor detects liquid (both product and water)?* O Yes O No X NA O Yes ❑ No 'PSNA O Yes ❑ No XIA ❑ Yes ❑ No X4A Turbine shutdown response time A- Is system programmed for fail- safe shutdown ?* ❑ Yes ❑ No )?,NA O Yes ❑ No ❑Yes ❑ NoA ❑Yes ❑ No TA Was fail -safe verified to be operational?* ❑ Yes O No NqA ❑ Yes Cl No JTWA 0 Yes 0 No *A 0 Yes ❑ No �WA Wait time between applying pressure /vacuum/water and starting test SOAA4 d tAAJA) /�/�('� U�1�'! iU i Test Start Time: 10JOAm il;CSA.A 10:2hm l --oSawt 0:5 , :C 10'49) 1 t: a.- fnitial Reading (RI): Test End Time: 1I : 5' I I : �w ,'~ 11:3 A`!M 11. oS :30. Final Reading (RF): p�j; J b =' ;. !. 389K Test Duration: A 0A Change in Reading RF -Rt): , (j Pass /Fail Threshold or Criteria: , ,� 1 h, Test Result: Pass ❑Fail ,V Pass O Fait Pass 0 Fail Pass 0 Fail Was sensor removed for testing? Yes ❑ No ❑ NA j� Yes 0 No 13 NA Yes ❑ No ❑ NA Yes ❑ No O NA Was sensor properly replaced and verified functional after testing? es ❑ No O NA 7 I'es O No ❑ NA es ❑ No ❑ NA Yes ❑ No ❑ NA Comments — (include information on repairs made prior to testintt and recommended follow-up for tailed tests) { 1 if the entire depth of the UDC 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 UDC must be tested. (See SWRCB LG -160) ......... --- - • - - -- • S W RC B, January 2002 7. lrNDFR_DISPF,NSFR CONTAiNMF.NT tilDC1 TF.9T1Nr M-975 i- Page U 0 i Test Method Developed By: ❑ UDC Manufacturer 6d Industry Standard ❑ Professional Engineer 0 Other (Spec) Test Method Used: D Pressure ❑ Vacuum X Hydrostatic ❑ Other (Specify) Test Equipment Used: INCON TS —STS Equipment Resolution: . 000in . _' %:;.•.l �s:?., - . - • UDC # 611 10 UDC # UDC # UDC # UDC Manufacturer. UDC Material: i E' UDC Depth: Height from UDC Bottom to Top of Highest Piping Penetration: Height from UDC Bottom to µ Lowest Electrical Penetration: ' ` Condition of UDC prior to testing: Portion of UDC Tested Does turbine shut down when UDC sensor detects liquid (both ❑ Yes ❑ No )M�qA ❑ Yes ❑ No NA 0 Yes ❑ No ❑ NA D Yes ❑ No ❑ NA i product and water)?. Turbine shutdown response time Is system DYes 0 N A ❑Yes 0 N )kNA ❑Yes 0 N DNA DYes ONO DNA safe shutdown? Was fail -safe verified to be operational?* ❑Yes 0 N ANA ❑Yes 0 N ANA ❑Yes 0 N 0 N DYes ❑No DNA! Wait time between applying pressure /vacuum /water and D/� A/ /'µ,ms starting test (/ Test Start Time: 11:5 5-40 11:40AMI I Initial Reading (Rj): Test End Time: SS'N.v : j C, (31)AIIA Final Reading RF ): Test Duration: Change in Reading F -R;): Pass/Fail Threshold or Criteria: w , ; n Test Result: Pass D Fail Pass ❑ Fail ❑ Pass D Fail O Pass D Fail , Was sensor removed for testing? Yes ❑ No D NA Yes D No D NA ❑ Yes 0 No O NA [)Yes O No DNA Was sensor properly replaced and `tYes ❑ No 0 NA Yes O No ❑ NA D Yes 0 No ❑ NA ❑ Yes 0 No O NA verified functional after testing? Comments —(include i ormation on repairs made prior to testing, and recommendedfollow- upforfailed tests) i If the entire depth of the UDC is not tested, specify how much was tested. If the answer to any of the questions indicated with an i asterisk ( *) is "NO" or "NA ", the entire UDC must be tested. (See SWRCB LG -160) S WRCB, January 2082 & FILL RISER CONTAINMENT SUMP TESTING I /q'7 Page -1 of Facility is Not Equipped With Fill Riser Containment Sumps ❑ Fill Riser Containment Sumps are Present, but were Not Tested 0 Test Method Developed By: ❑ Sump Manufacturer 04ndustry Standard 0 Professional Engineer 0 Other (Spec) Test Method Used: 0 Pressure 0 Vacuum Wydrostatic ❑ Other (Spec) Test Equipment Used: In COd\ T - 57 S Equipment Resolution: • 000 i rl :. Fill Sum p# Y7 Fill Sump # 2Z Fill Sum p kp-'$� Fill SumE # Sump Diameter. - 19 (19 Sump Depth: Obi r �.• Height from Tank Top to Top of Highest Piping Penetration: Height. from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: : ✓ E� Portion of Sump Tested Sump Material: /q, I OM) rJ Wait time between applying presswWvacuum/water and starting test W Test Start Time: Initial Reading - S O LC Cr/ Test End Time: - Final R Rr : Test Duration: J.-/ i. i.-� / /e" / " .� Change in Readin g Qk1Q: wme, -COW-- -,- , - Pass/Fail Threshold or Criteria: ` Test Result: JS Pass 0 Fall V Pass 0 Fail Pass 0 Fail 0 Pass C Fail Is there a sensor in the sump? XYes ❑ No gYes ❑ No Yes 0 No 0 Yes 0 No Does the sensor alarm when either product or water is detected? AYes 0 No 0 NA )dYes 0 No 0 NA ?Yes ❑ No C NA 0 Yes ❑ No 0 NA Was sensor removed for testing? N Yes ❑ No DNA1 DNA VYes ❑ No ❑ NA J11 Yes ❑ No ❑ NA 0 Yes 0 No U NA Was sensor properly replaced and verified functional after testing? MYes ❑ No 0 NA &Yes 0 No 0 NA UYes ❑ No ❑ NA 0 Yes ❑ No ❑ NA _ Comments — Clnclude information on repairs made prior to testing, and re comm ende(' fo Ito w -up for faile d tests) • "7dk SWRCB, January 2002 O_ CPYFjj vlP.RwnJ. rONTAYWF,NT HnXES LA -L-5 S Page et of Aj Facili is Not i With S iWOvecf'III Containment Boxes 0 S ill/Overfill Containment Boxes are Present, but were Not Tested ❑ Test Method Developed By: 0 Spill Bucket Manufacturer BAndustry Standard 0 Professional Engineer ❑ Other (Specify) Test Method Used: ❑ Pressure ❑ Vacuum �-iydrostatic 0 Other (Spec6) Test Equipment Used: ti C-O S - Equipment Resolution: . 000 i n. Spill Box # �% Spill Boa #2Z Spill Box # Spill Box # Bucket Diameter. Bucket Depth: Of v - Wait time between applying pressure/vacuum/water and starting test: 11✓ Test Start Time: Q Initial Reading (R): I .0 /24,. /- ?D/.:r •� Test End Time: Final Reading (RF): Test Duration: ;,.-/ /.,� i.•✓ ;✓ ,.i %•� Change in Reading (RF -&): ZZ2 j,/,/ Pass/Fail Threshold or Criteria: :. Test Result: Pass ❑ Fail fflPass 0-Fail I lVPass 0 Fail 0 Pass ❑ Fail Comments — (include information on repairs made pHor to testing, and recommended follow -up for failed tests) 0 • j! MONITWING SYSTEM CERTIF&EATION For Use By All Jurisdictions Within the State of California - , C;fed: C'huprer 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code oj'RegulcitioJis Chic funs muse be used to document testing and servicing of monitoring equipment. A separate certification or report must be preprlred moniTOrine system control panel by the technician who performs the work. A copy of this form must be provided to the rank sys[ m owner /operator. The owner /operator must submit a copy of this form to the local agency regulating UST systeri�s within 30 �ia� of r�sr elate. _Y_ Ce,ueral Information `3020 o0�3a -90 Ffic: ilit) Name: _� �_ 1-i C Aly Bldg. No.: _ - 3it Idr lcleiq _ Ctty 1�Tr)��Ll� Zip: - -..... F-ncllirl Contact Person: Contact Phone No.: 1vlodel of Monitoring System: TL _, _3 Y") Date of Testing /Servicing: h _1 a. iYlventoY y of Equipment Tested /Certified 1ro riare hoses io indicatespecific c ui men[ ins reefed /serviced: y! 'i':r,ti, iD: U 0 L. S _ Tank ID: Mli�r iQl f it l allk G-Cwging Probe. Model; I — In -Tank Gauging Probe. Model: 4'746 4 _ I uvular apace or Vault Sensor. Model J7 Annular Space or Vault Sensor. Model: tl'.J y ,1 ipin_ Sump 'Trench Sensor(s). Model: Piping Sump / Trench Sensor(s), Model: �Of(_ ! ,�-1 ill Sump Sensor(s). Model: V6 osX�kr_r 39 Fill Sump Sensor(s). ^_ Model: ,0 SE jJ�O/L- 11cchanical Line Leal: Detector. Model: glop X4f LIZ'' JO Mechanical Line Leak Detector. Model: 4U j- U 1:I�ci onic Line Leal. Detector. Model: ❑ - Electronic Line Leak Detector. Model: U lank Overfill / High -Level Sensor. Model: ❑ Tank Overfill / High -Level Sensor. Model: I ❑ cirl11-r 1sLrecifv e ui anent rype and model in Section E on Pa e? . _ ❑ Others eel , equipment t e and modal in Section E on Tank 1D: i�; ~ L- Tank ID: hr -1' uil: Gauging Probe. Model: t'? El In -Tank Gauging Probe. Model: nnular Space or Vault Sensor. Model: O ❑ Annular Space or Vault Sensor. Model: Sump / Trench Sensor(s). Model: ❑ Piping Sump / Trench Sensor(s). Model: _ Fill Sump SenSOr(S). Model; V& ❑ Fill Sump Sensor(s). Model: \tech utical Line Leak Detector, Model: 90 sf. tbri ❑ Mechanical Line Leak Detector. Model:. I U 1-.IccnUnic Line Leal: Detector. Model: ❑ Electronic Line Leak Detector. Model: ill u 1':a,k 0� eriill / High -Level Sensor. Model: ❑ Tank Overfill / High -Level Sensor. Model: I iJ llncC�r tspcCiti er ui menr ry a and model in Section E on Pa e? . ❑ Other (specify equipment a and model in Section E on Pa e 2)_ j Dulrruser lll: __� __ Dispenser ID: II X Dispenser Corirainmeni Sensor(s). Model: -tea sl",t1Tc;(Z Dispenser Containment Sensor(s). Model: � C4 G� jj i Sh :tr \ alvz}s). Shear Valve(s), it ;IIll t?i>L�nser Containment Flom(s) and Chain(s). ❑ Dispenser Containment Float(s) and Chain(s). lispenser ID: — [Q Dispenser ID: %- Dispenser Containment Sensor(s). Model: 4,Q &F V, 04 JS Dispenser Containment Sensor(s), Model:.UC2 S-Ey's c. 14 Sh.:ar Valve(s). )K Shear Valve(s). J 1)ispcns�r Containmenr Float s) and Chains . ❑ Dis enser Containment Floats and Chains . !� Dispenser ID: °f — 10 s_ Dispenser ID: Zt 1)isp,,uer Conrainment Sensor(s). Model: 000uo Dispenser Containment Sensor(s). Model: �� �llctn' V:ilvzls). Shear Valve(s). II ❑lli; r Containment Flour s) and Chains . _ ❑ Dis enser Containment Floats and Chain(s). ,if rl,c facility conrains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility C. C. ertification -I certify that the equipment identified in this document was inspected /serviced in accordance with the man ufact u •ers' }uidetines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correer and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports have also attached a copy of the rep rtv; �(tchec/k all char apply): System set -up a m histo y report C;:�ttiticianName (print): (1y4 - h'1/ O'k.J Signature: Czniiic:trionNo.: jW(A— QS— )L-)l License.No.: 1 /D40 #809850 letiuContpanyNafne: RICH ENVIRONMENTAL Phone No.:(6 6 1 392 -8687 t Site .�ddr�ss: � �j T- Awy ,F/„�GIQ (,4 Date of Testing /Servicing: 2 lj�_i`�J�j` Page I of 3 03'01 tAloiiitoriue System Certification s us in vC,)cl iJ. i�:esaafts of 'resting/Servicing • 19'.62 q i ......... lei,- the fiflinwin- eheeklist: 1-)d C3 Noj� ' C No" I Is the audible alarm operation,al? I N o Q No* Is the visual alarm operational? LY U No* No' I Were all sensors visually irisp cted, functionally tested, and confirmed operafional? ❑ N o,'O 0 Were all sensors installed at lowest point of secondary containment and positioned so that other eclyiptneat will nor interfere with their proper operation? Lj ❑ No* If alarms are relayed to a remote monitoring station, is all conurainications equipment rnot em) N/A operational? LJ No- For pressurized piping systems, does the turbine automatically shut down if the piping secondary conraininenr 0 -N,,'A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sellsol's uilllatu positive shut -down? (Check all that apply) g Sump/Trench Sensors; ❑ Dispenser Contaim-nenE Sensors. Did You confirm positive shut -down due to leaks gLid sensor failure/disconnection? A Yes; ❑ No. LJ ❑ No* FU For calik systems that utilize the monitoring, system as the primary rank- overfill warning de 4ce (i.e. 110 v ;9\ N A mechanical overfill prevention valve is installed), is the overfill warnina alarm visible and audibly at the. ullflk fill poin[(s) and operating property? If so, at what percent of tank capacity does the alarm Eri r? No Was any monitorLig equipment replaced? If yes, identify specific sensors, probes, or ocher equipriieiit replaced and list the Manufacturer name and model for all replacement parts in Section E, below. ,J C'S;` FA No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that aj).plv) Q Product; ❑ Water, If yes, describe causes in Section E, below, Was monitoring sysiem set-Lip reviewed to ensure proper settings? Attach Set Lip NPOM, if applicable A 1 cs ❑ No* Is all monitorin..- equipuent operational per Manufacturer's specifications? ii, ��ecion E below, describe how and when these deficiencies were or will be corrected. Page 2 of 3 V. to 'fink G- Auging / SIR Eq*ent: U 0. Check this box if *gauging is used only for inventory control. ❑ Check this box if no tan1c gauging or SIR equipment is insudkd. f his sic Lion must be completed if in -tank gauging equipment is used to perform leak detection monitoring;. r`, ., ,.t: =r.= ri« i;,llnwinu [•ht+vl:liCt LCt s U No* `i Has ail input wiring been inspected for proper entry and termination, including testing for ground faults? , L� .� U No* �! Were all tarilc au ins rubes visually inspected for damage and residue buildup? g g -P Y P 1; p. _�- Ci Y L s 1 ] —No * x � U No" Was accuracy of system product level readings tested? ? - -- - Was accuracy of system wafer level readings tested. L, 1 ��� U Nu'� Were all probes reinstalled properly? , Z ,s 'D No* I Were all items on the equipment manu aeturer's maintenance checklist completed? In 011 Section H, below, describe how and when these deficiencies were or will be corrected. -Aic Leal. Detectors (LLD): ❑ Check this box if LLDs are not installed. "i,,a,idelTO ri,r fi- dinwino Aaeldist: St s O No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performunce:' ❑ N/A (Check all that apply) Simulated leak rate: 'fad, 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? 1 s ❑ No* Was the testing apparatus properly calibrated? Yes Q No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? 0 N/A Ii Q Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? 04 NIA _ U Yes ❑ NO —� For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is dis"ibled N/A or disconnected? u Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfuncrions X N/A or fails a test? U ^Y,cs ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? l z; Q No* I Were all items on the equipment manufacturer's maintenance checklist completed? Iii the Section H, below, describe how and when these deficiencies were or will be corrected. it1. � t;t;iYnt!YYtS: Page 3 of 3 03A11 Niuuituring System Certification UST Monitorine Site Plan 5lie Address: s Sul �`l Date map was drawn: Instructions if �uu already have a diagram that shows all required information, you may include it, rather than this page, wide dour Nlouitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly idetalf" locarions of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular ;pa;:eS, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leal: detectors; and in -tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Man �\ a: prepared. Page / ::f y 0/00 1 a 13 `1 MONITOR CERT. FAILURE REPORT SITE NAME: s f (,.j [, 4 f:V aoe DATE: 7 ADDRESS: CITY: SITE CONTACT: TECHNICIAN. S I GiNATURE : THE FOLLOWING COMPONENTS WERE REPLACED /REPAIRED TO COMPLETE THE MONITOR CERTIFICATION TESTING. LIST OF PARTS REPLACED /REPAIRED: REPAIRS: V OF LABOR: 'V�F PARTS INSTALLED: . If RICH ENVLI2 E TAL 5643 BROOKS CT BAXE�tSFISLD,CA.93308 OFFICE(661)392 -8687 &:FAX (661)392 -0621 bf nir+Ar. iK nFr.T.>iFT�R TEST W /0 #: Facility Name:s� tJ cj� Vi2,0-0 Facility Address: Product Line Type (Pressure, Suction, Gravity) ?P S6 PRODUCT LEAK DETECTOR TYPE 'TEST TRIP PASS SERIAL NUXBER, BELOW PSI OR L/D TYPE lL4t E8 PASS SERIAL NL �'7 L/D TYPE -. A33 _)C1e{'L SERIAL #1VX0 TAQL� NO )D FA L/D TYPE SERIAL #,� NO BAIL L/D TYPE YES PASS SERIAL # NO FAIL I certify the above tests were condugted on this date according to Red Jacket Pumps field test appara�,t4s!4esting procedure an limitations. The Mechanical Leak Detector Test p4So / fail is determined by using a-low flow threshold trip rate of :3,got11on per hour or less at 10 PSI. I acknowledge that all data collacte.d is true and correct to the best of my knowledge. Tech Signature: Date: y �, SC1F "i'L +I,kE: REVISION LEVEL 2.0 HIGH WATER LIMIT: VERSION 119.04 SOFTWARE# 346119 -100 -E IN -TANK �UF' - - - - - - - - - CREATED - 00.01.14.10.37 --=--' PRODUCT 2.` T 1:REGULAR 3 NO SOFTWARE MODULE PRODUCT CODE 1 SYSTEM FEATURES: THERMAL COEFF :.000700 PERIODIC 111-TANK. TESTS TANK DIAMETER 120.00 ANNUAL IN -TANK TESTS TANK PROFILE 4 PTS FULL VOL 90.0 INCH VOL FULL VOL 19951 665'2 90.0 INCH VOL 16262 48.0 INCH VOL 60.0 INCH VOL 10044 2843 30.0 INCH VOL 3804 FLOAT SIZE: 4.0 IN. 8496 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING FLOAT SIZE: 4.0 IN. 8496 HIGH WATER LIMIT: WATER WARNING HIGH WATER LIMIT: S YSTEll SETUP - - - - - - MAX OR LABEL VOL: JUL 21 . 2005 2:11 PI °1 OVERFILL LIMIT . SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE:.'T I PllE FORMAT MON DD YYYY HH :MM:SS xM CHEVRON 1999 TAF'T HWY SAgERSFIELD.CA 93313 661--398-8882 SHIFT TIME 1 DISABLED SHIFT TIME 2 : DISABLED SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED TANK PER TST NEEDED WRN DISABLED TANK ANN TST NEEDED WRN DISABLED LINE RE- ENABLE METHOD PASS LINE TEST LINE PER TST NEEDED WRN DISABLED LINE ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE (DEC; F ) : 60.0 STICK HEIGHT OFFSET DISABLED DAYLIGHT SAkiING TIME ENABLED START DATE APR WEEK 1 SUN START TIME 2:00 AM END DATE OCT WEEK 6 SUN END TIME 2:00 AM SYSTEM SECURITY CODE 000000 HIGH PRODUCT DELIVERY LIMIT LOW PRODUCT LEAK ALARM LIMIT: SUDDEN LOSS LIMIT: TANK TILT . MANIFOLDED TANKS TO: NONE 2.0 MAX OR LABEL VOL: 3.0 OVERFILL LIMIT . 19951 HIGH PRODUCT 95i LIMIT 18953 DELIVERY ' 90% 17956 LOW PRODUCT 10%'. LEAK ALARM LIMIT: 1995 SUDDEN LOSS LIMIT: 642 TANK TILT 99 MANIFOLDED TANKS 0.00 Tii : NONE 2.0 3.0 15104 95% 14348 90% 13593 10% 1510 468 99 99 0.00 LEAK MIA PERIODIC: 15% 2265 LEAK MIN PERIODIC: 15 %.;LEAK MIN ANNUAL 15% 299.2;..- 2265 LEAK MIIV ANNUAL 15% PERIODIC TEST TYPE 2992 STANDARD PERIODIC TEST TYPE ANNUAL TEST FAIL STANDARD ALARM DISABLED ANNUAL TEST FAIL PERIODIC TEST FAIL ALARM DISABLED ALARM DISABLED PERIODIC TEST FAIL GROSS TEST FAIL ALARM DISABLED ALARM DISABLED GROSS TEST FAIL ANN TEST AVERAGING: OFF ALARM DISABLED' PER TEST AVERAGING: OFF ANN TEST AVERAGING: OFF TANK TEST NOTIFY: OFF PER TEST AVERAGING: OFF, . TNK TST SIPHON BREAK:OFF WATER WARNING 2.0 HIGH WATER LIMIT: Vim 2:SUPREME 7829 OVERFILL LIMIT;' --=--' PRODUCT 2.` PRODUCT CODE 3 THERMAL COEFF 0700 THERMAL COEFF TANK DIAMETER :.000450 96.00 TANK DIAMETER 120.00 TANK PROFILE 4 FT'S TANK PROFILE 4 PTS FULL VOL 7829 FULL VOL 90.0 INCH VOL 15104 12349 72.0 INCH VOL 665'2 60.0 INCH VOL 7605 48.0 INCH VOL 4147 30:0 INCH VOL 2843 24.0 INCH VOL 1640 FLOAT SIZE: 4.0 IN. 8496 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING FLOAT SIZE: 4.0 IN. 8496 HIGH WATER LIMIT: WATER WARNING HIGH WATER LIMIT: S YSTEll SETUP - - - - - - MAX OR LABEL VOL: JUL 21 . 2005 2:11 PI °1 OVERFILL LIMIT . SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE:.'T I PllE FORMAT MON DD YYYY HH :MM:SS xM CHEVRON 1999 TAF'T HWY SAgERSFIELD.CA 93313 661--398-8882 SHIFT TIME 1 DISABLED SHIFT TIME 2 : DISABLED SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED TANK PER TST NEEDED WRN DISABLED TANK ANN TST NEEDED WRN DISABLED LINE RE- ENABLE METHOD PASS LINE TEST LINE PER TST NEEDED WRN DISABLED LINE ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE (DEC; F ) : 60.0 STICK HEIGHT OFFSET DISABLED DAYLIGHT SAkiING TIME ENABLED START DATE APR WEEK 1 SUN START TIME 2:00 AM END DATE OCT WEEK 6 SUN END TIME 2:00 AM SYSTEM SECURITY CODE 000000 HIGH PRODUCT DELIVERY LIMIT LOW PRODUCT LEAK ALARM LIMIT: SUDDEN LOSS LIMIT: TANK TILT . MANIFOLDED TANKS TO: NONE 2.0 MAX OR LABEL VOL: 3.0 OVERFILL LIMIT . 19951 HIGH PRODUCT 95i LIMIT 18953 DELIVERY ' 90% 17956 LOW PRODUCT 10%'. LEAK ALARM LIMIT: 1995 SUDDEN LOSS LIMIT: 642 TANK TILT 99 MANIFOLDED TANKS 0.00 Tii : NONE 2.0 3.0 15104 95% 14348 90% 13593 10% 1510 468 99 99 0.00 LEAK MIA PERIODIC: 15% 2265 LEAK MIN PERIODIC: 15 %.;LEAK MIN ANNUAL 15% 299.2;..- 2265 LEAK MIIV ANNUAL 15% PERIODIC TEST TYPE 2992 STANDARD PERIODIC TEST TYPE ANNUAL TEST FAIL STANDARD ALARM DISABLED ANNUAL TEST FAIL PERIODIC TEST FAIL ALARM DISABLED ALARM DISABLED PERIODIC TEST FAIL GROSS TEST FAIL ALARM DISABLED ALARM DISABLED GROSS TEST FAIL ANN TEST AVERAGING: OFF ALARM DISABLED' PER TEST AVERAGING: OFF ANN TEST AVERAGING: OFF TANK TEST NOTIFY: OFF PER TEST AVERAGING: OFF, . TNK TST SIPHON BREAK:OFF WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL V,4L: 7829 OVERFILL LIMIT;' 95 7437 HIGH PRODUCT 90% 7046 DELIVERY LIMIT 10% 782 LOW PRODUCT 359 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 99 TANK` TILT 0.00 MANIFOLDED TALKS T #: NONE LEAK MIN PERIODIC: 15% • 1174 LEAK MIN ANNUAL 15% . 1174 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST S I PHOIV BREAK:OFF TANK TEST NOTIFY: OFF. DELIVERY DELAY 5 MIN DELIVERY DELAY 5 MIN TNK TST SIPHON BREAK:OFF DELIVERY DELAY : 5 MIN,. 1 LEAK TEST METHOD TEST ON DATE ALL TANK APR 26. 2000 START TIME ISABLED TEST RATE :0.20 GAL /HR DURATION 2 HOURS LEAK TEST REPORT FORMAT NORMAL • • D J LIQUID SENSOR SETUP L 1:87 ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE OUTPUT R HY SETUP - - - -it. - R 1:REGULAR TYPE: STANDARD NORMALLY CLOSED L 2:92 ANNULAR IN -TANK ALARMS TRI -STATE (;TINGLE FLOAT) T 1:HIGH WATER ALARM CATEGORY : ANNULAR SPACE T 1:LOW PRODUCT ALARM L 3:DIESEL ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 4:87 STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP LIQUID SENSOR ALMS L 1:FUEL ALARM L 4:FUEL ALARM L 1:SENSOR OUT ALARM L 4:SENSOR OUT ALARM L 1:SHORT ALARM L 4:SHORT ALARM R 2:SUPREME TYPE: STANDARD NORMALLY CLOSED j ALARM HISTORY REPORT -- SYSTEM ALAR # --- PAPER OUT JUN 25, 2005 2:41 PM PRINTER ERROR JUN 25. 2005 2:42 PM BATTERY IS OFF JAN 1, 1996 8:00 AM CLOCK IS INCORRECT APR 3, 2005 3:01 AM x x x x x END x x x x x L 5:92 STP SUMP TRI - •STATE (SINGLE FLOAT) IN -TANK ALARMS CATEGORY : STP SUMP T 2:HIGH WATER ALARM i T 2:LOW PRODUCT ALARM L G:DIESEL STP SUMP LIQUID SENSOR ALMS TRI- STATE {SINGLE FLOAT) L 2:FUEL ALARM ,CATEGORY : STP SUMP L 5:FUEL ALARM ALARM HISTORY REPORT L 2:SENSOR OUT ALARM - - -- IN -TANK ALARM - - - -- L S:SENSOR OUT ALARM L 2:SHORT ALARM T 1:REGULAR L 5:SHORT ALARM R 3:DIESEL TYPE: STANDARD NORMALLY CLOSED IN -TANK ALARMS T 3:HIGH WATER ALARM T 3:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 3:FUEL ALARM L 6:FUEL ALARM L 3:SENSOR OUT ALARM L 6:SENSOR OUT ALARM L 3:SHORT ALARM L 6:SHORT ALARM SETUP DATA WARNING APR 27. 2000 12:28 PM APR 26, 2000 11:40 AM LOW PRODUCT ALARM JUL 18, 2005 8:32 AM JUN 23, 2005 9:47 AM JUN 16, 2005 9 :58 PM I HIGH PRODUCT ALARM MAY 25, 2002 8:10 AM MAY 24. 2002 11:57 AM OCT 15, 2001. 4:29 AM INVALID FUEL LEVEL APR 27, 2000 12:28 PM PROBE OUT NOV 23, 2004 1:13 PM APR 26, 2000 11:40 AM DELIVERY NEEDED JUL 19, 2005 7:02 PM -- - -•_- JUL 17, 2005 10:22 PM JUL 15. 2005 11:56 PM RECONCILIATION SETUP AUTOMATIC DAILY CLOSING TIME: 2:00 AM PERIODIC RECONCILIATION MODE: MONTHLY TEMP COMPENSATION STANDARD BUS SLOT FUEL METER TANK TANK MAP EMPTY x x x x x END x x x x x ALARM HISTOR;Y xr,0yR- - - -- IN-TANK. ALARM -- -- T 2:SUPREME SETUP DATA WARNING APR 27. 2000:12:51 PM APR 26. 200011:40 AM LOW PRODUCT j�LARM JUN 8. 2005''10:21 AM MAY 12. 20051. 9:13 PM MAY 9. 20051 9:13 AM INVALID FUELLEVEL APR 27. 2000;.12:52 PM i PROBE OUT NOV 23. 20041 1:53 PM APR 26. 20001 11:40 AM DELIVERY NEE ED JUL 18, 2005' 5:14 PM JUL 17. 2005 8:54 PM JUL 15, 20051. 4:39 PM i I i xxxxxENPxxxx* i ALARM HISTOR� REPORT - --- IN -TANK ALARM - - - -- T 3:DIESEL SETUP DATA WRNING APR 27. 2000. 1:11 Pil APR 26. 2000'11:40 AM LOW PRODUCT ARM JUN 17, 2005 5:01 AM APR 7. 2005 2:48 PM MAR 16. 2005 3 :39 PM INVALID .FUEL LEVEL APR 27, 2000 1 :11 PM PROBE OUT NOV 23. 2004 2:29 PM APR 26. 2000 11:40 AM DELIVERY.NEE ED JUL 2. 2005 1:48 AM J N.16. 2005 12:53 PM M ,Y 10, 2005 5:15 PM ALARM HISTORY REPORT - - SEPJ3OR ALARM L 1:87 'ANNULAR ANNULAR SPACE FUEL ALARM JUL 26.. 2004 1:06 PI °l FUEL ALARM MAY 1. 2000 10:22 AM FUEL ALARM MAY 1. 2000 9:54 AM x n * ** END x x x x x ALARM HISTORY REPORT - -- SENSOR ALARM - - - -- L 2:92 ANNULAR ANNULAR SPACE FUEL ALARM JUL 26.. 2004 1:05 PM FUEL ALARM DEC 3. 2002 11-07 AM FUEL ALARM DEC 3, 2002 11:07 AM n** x* END X x x x ALARM HISTORY REPORT SENSOR ALARM - - -- L 3:DIESEL ANNULAR ANNULAR SPACE FUEL ALARM JUL 26, 2004 1 :00 P11 FUEL ALARM DEC: 3: 2002 8:22 AM FUEL. ALARM DEC 3, 2002 8:12 AM I ALARM':--:H I STO - RY REPO ALARM H GRY REPORT - - --- SENSOR ALARM - - -- -- S 'OR ALARM -- s 1: L 4:87 STP SUMP OTHER SENSORS STP SUMP FUEL ALARM JUL 26. 2004 1:11 PM FUEL Al ARM JUL 26. 2004 1:11 PM FUEL ALARM FEB 26. 2004 1:38 All x x x x x END x X A x x x x x END x x x x x ALARM HISTORY REPORT - - -- PRODUCT ALARM - - -- F 1:REGULAR I -- �- SENSOR A�ARM - - - -- ALARM HISTORY REPORT L 6:DIESEL STP SUMP STP SUMP --- SENSOR ALARM - - -= F;UF.L ALARM L 5:92 STP SUMP JUL 21. 2005 2:30 PM STP SUMP FUEL ALARM JUL O6 2004 1 :12 FM - - - -- SENSOR ALARM L 2:92 ANNULAR!'' 1 ANNULAR SPACE FUEL ALARM I JUL 21. 2005 2:34 PM i - - - -- SENSOR ALARM - - L 4:87 STP SUI F STP SUMP FUEL ALARM JUL 21, 2005 2:34 PM j I. SENSOR ' LARM - - - -- L 1:87 ANNULA ANNULAR SPACE FUEL ALARM JUL 21. 2005 12:36 PM FUEL ALARM i NOV 29. 2003 2:06 PM CHEVRON FUEL ALARM 1999 TAFT HWY I DEC 3. 2002 10:12 AM _ - SE „SOR,ALARM -- -- BAKERSFIELD.Ok 661 -398 -8882 3 93313 L 3D #,irSL ANNULAR ANNULAR SPACE i`... JUL 21. 2005 :40 RIYJ F UE ALAR,M JUL 2t;. ,2005 2;30 PM- SYSTEM STATU REPORT - ALL FUNCTION NORMAL x x x x END -- - -- SENSOR ALARM - - - -- L:592 STP SUMP STP: ' ' .SUM$ FUEL ALARM \� JUL.' 21 . 2;005 2:33 PM ALARM HISTORY REPORT - - - -- SENSOR ALARM - - -- L 6:DIESEL STP SUMP STP SUMP FUEL ALARM JUL' 26, 2004 1:14 PM FUEL ALARM MAR 15. 2003 4:28 AM FUEL ALARM FEB 12. 2003 12:16 PM SENSOR ALARM L;5.192 STP SUMP STP SUMP .FUEL ALARM JUL 21, 2005 2:33 PM ter y MONIT NG SYSTEM CERTIF TION,0014 For Us By All Jurisdictions Within the State of Cali , nia .- iurhorin" Cired: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegularions '!'his JOnll must be used to document testing and servicing of monitoring equipment. A sepetrate certification or report must be grzpnred for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tanlc ., •stem owner /operator. The owner /operator must submit a copy of this form to the local agency regulating UST systems within 30 ifays of rest date. :�. L e,neral Inform tion J;'.ttility Name: � � G V IA0r►J Bldg. No.: _ - Sir� _- kddrd»: _. 090 T4FT City: 6o 41ZX0_5FtjVc.D zip: hacili[l Contact Person: Contact Phone No.: Ni1ii.o :lviodel of ivionitoring System: Date of Testing/Servicing: P% / Q(a/ 4V B. Itiventory of Equipment Tested /Certified G „x,: dic :,00rouriare boxes to indicate soecific eauiomenr inspected /serviced: �! '1'a. Ill: _ Uyi L— $'t% TaW 1D: 7SF& Tank Gauging Probe. Model: &I - 1':utt. Gauging Probe. Model; V — I' Cr( Dnular Space or Vault Sensor. l� Pi})in f.; Sump !'french Sensor(s). Model: 0 Model• $ �nular Space or Vault Sensor. Piping Sump / Trench Sensor(s). . _ .... ..... Model: l9 Model- O Fill Stunp Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: Q I\lechmical Line Leal: Detector. Model: ❑ Mechanical Line Leak Detector. _ Model: ❑ 11cutrouic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: 0 Tank Overfill / High -Level Sensor. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ Onc,�r is ecif y e ui mint type and model in Section L-' on Pa e 2). _ ❑ Others eel equipment t e and model in Section E on Page 2). TaiLJ�10: EM-1 Tank ID: ❑ In -Tank Gauging Probe. ❑Annular Space or Vault Sensor. Model: Model: (It'i l;:u,k Gauging Probe. Model: _ 14 nuta, Space or. Vault Sensor. Model: C7 LtT]'ipin, Sump /Trench Sensor(s). Model: O ❑ Piping Sump / Trench Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: ❑ Fill Sump Sensor(s). Model: Cl Ni&h:utical Line Leak Detector. Model: ❑ Mechanical Line Leak Detector. Model: U Electronic Line Leak Detecror. Model: ❑ Electronic Line Leak Detector. Model: ❑ Tunk Overfill / High -Level Sensor. Model: ❑ Tank Overfill / High -Level Sensor. Model: ❑ UrhLl ks ecitY eq ui menr type and model in Section E on Pa 'e 2 . ❑ Other (specify equipment a and model in Section E on Pa Dispenser 1D: _ Dispenser ID: 'f7 t g i ❑ J)iSpeuser Containment Sensor(s). i' Shcar \� alvets). Model: ❑ Dispenser Containment Sensor(s). ( hear Valve(s). Model: ❑ 1?is�,enser Containment Floats and Chain(s). ❑ Dis enser Containment Float (s) and Chain(s), Dispense,• lD: j❑ Spenser Containment Sensor(s). Model: 0 Sllear V:dve(s). ❑ Dis enser Containment Floats and Chains . Dispenser ID: 13 Containment Sensor(s), Model: l9"Shear Valve(s). ❑Dispenser Containment Floats and Chains .. Dispenser lD: '13-4-ite Dispenser ID: � 0 )isp nicer Containment Sensor(s). 91 tiha:u• Viilve(s). Model: ❑ dispenser Containmenr Sensor(s). 'Shear Valve(s). Model: ❑Dii enser Conrainmenr Floats and Chains . ❑ Dis enser Containment Floats and Chain(s). ' ^lf the facility conrains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification -1 certify that the equipment identified in this document was inspected /serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equi ent. For any equip !pent capable of generating such reports, 1 have also attached a copy of the reporth �-ccheck n1111 tr nppI ): System set -ups t fecltniciaft Name (print): R/`+YCerti t�D Sig e: Certification No.: 3q I o License. N C 4 0— #809850 FesunaConfpwiyName: RICH ENVIRONMENTAL PhoneNo.:(661 392 -8687 Sitc' .address: r q 9D Date of c:iting/Servioing; r? 1.9 Page 1 of 3 03 /01 liionirorin; System Certification .�.a.''a;� ,.. ��., 0. of T esting /Servicing Sofmnie Version installed: l t CAJ*'i)AerL' Isle luliowlng checklist: _ Yds Cl Noy Is the audible alarm operational? E� s ❑ No* Is the visual alarm operational? ❑ No* Were all sensors visually Lis ected, fiarictionally tested, and confirmed operational? ❑ No* _ Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? (1 Y es ❑ Iya* if alarms are relayed to a remote monitoring station, is all conununications equipment (e.g. modern) .� N/A operational? tad 1 �.s ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ❑ N/A monitoring system detects a leak, fails to opera , or is electrically disconnected? If yes: which sensors iniriate positive shut - down? ("Check all that apply) Sump /Trench Sensors; 0 Dispenser CgyKin nenr Sensors. Did you confirm positive shut -down due to leaks Egid sensor failure /disconnection? es; ❑ No _ G 1`es* For tan]: systems that utilize the monitoring system as the prunary tank overfill warning device (i.e. nu N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank till oint(s) and operating properly? if so, at what percent of tank capacity does the alai-in trigger? �") L. Yos* Er No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. u Yes* No Was liquid found inside any secondary containment systems designed as dry systems? (Check all rhat apply) ❑ Product; ❑ Water. If yes, describe causes in Section E, below. ❑ No* _ Was monitoring system ser-up reviewed to ensure proper settings? Attach set up reports, if applicable Yes I ❑ No* Is all monitoring a iii meat operational Eer manufacturer's specifications? ir, Section E below, describe how and when these deficiencies were or will be corrected. E. cuttYments: Page 2 of 3 U3 /o t 0 F. In Tali : Gauging / SIR Equipent: 0 Check this box if A,Uging is used only for inventory cuntru L ❑ Check this box if no tank: gauging or SIR equipment is installed. This see don must be completed if in -tank gauging equipment is used to perform leak detection monitoring. the t'nilnwinp eheeklist: ❑ Z' ❑ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? U cs U No* Were all tank gauging probes visually inspected for damage and residue buildup? U Yes ❑ No* Was accuracy of system product level readings tested? • Y ,cs ❑ No* Was accuracy of system water level readings tested? • Ycs 1 ❑ No* Were all probes reinstalled properly? U Yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? iu riie Section H, below, describe how and when these deficiencies were or will be corrected. a. Litre Leiik Detectors (LLD): l� Check this box if LLDs are not installed. P,,,n,;lAr,l Hie t'idlmvina ehecl. list: ❑ Yes ❑ No* For equipment start -up or annual equipment certification, was a leak simulated to verify LLD performance.'' ❑ N/A (Check all that apply) Simulated leak. rate: ❑ 3 g.p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. Cl Yes ❑ No* Were all LLDs confirmed operational and accurate within regulatory requirements? O Y es ❑ No* Was the testing apparatus properly calibrated? ❑ Yes Cl No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or discomzected? Q Yes D No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions D N/A or fails a test? ❑ Yes ❑ No* For electronic LLDs, have all accessible wiring connections been visually inspected? ❑ N/A Q Yzs ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? ,- in tine; Section H, below, describe how and when these deficiencies were or will be corrected. 1t;t. Coinynents: Page 3 of 3 03 /0 l 0 • INionicoring System Certification Sire Address: I '390 T�-F-T tfw� a)W -5X- /� Plan 9 73Y3 ..... ; ;TAFT ..................... . ...................... ..............................I ...................................... I.............. .......... . ...... I.......................... ...................... ............................... ................. ....... «.....: ...... ..... ... (e ....... ..... : ::: : .................::::::�:...... ...vim:: :: ............... I......... ......�....... ......... .. ............................. i : : : . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . ... . . . . . . . . . . ........... ...... ... ............................... ........... .. ......I .................... . . . . . . . . . . �d?lL . c� ......... 1V 5 . . . . . . . . . . . . . . . Date map was drawn: q / 2(.Pl °y . Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locarions of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line teal: derecuors; and in -tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan w a; prepared. Page of o;rou • i �J El MONITOR CERT. FAILURE REPORT SITE NAME: � � - G�/ �y� DATE: r7 ^V�/ ADDRESS: 1 9 FT F J TECHNICIAN: Arn kt7t9 CITY: �J+ 1 � /`rT '7333 SIGMA SITE CONTACT: THE FOLLOWING COMPONENTS WERE REPLACED /REPAIRED TO COMPLETE THE MONITOR CERTIFICATION TESTING. LIST OF PARTS iMPLLLACED /REPAIRED: REPAIRS: /vo Y'E LABOR: rr IA E PARTS INSTALLED:L i T 3:DIESEL .CHEVRON ; }yz'L f PRODUCT CODE 3 1999 TAFT' HI�Y s� ,,IIV TANK SET' ;�; t 2 SUPREME THERMAL COEFF :.000450 BAKERSFIELD,CA 93313 ,' — =' '' - PRODUCT CODE :2 .TANK. DIAMETER 96.00 661 -398 -8882 —THERMAL COEFF :.0007QQ 'TANK PROFILE 4 PTS I T 1:REu ^ULAR 'TANK.'DIAMETER . 128::pA,, FULL VOL : 7829 JUL 26, 2004 12:53 PM PRODUCT CODE 1 ^ TANK. ,PROFILE 4 ?F 72.0 INCH VOL : 6662 THERMAL GOEFF :.OpOTF a� ,FULL VOL' : 1`61„ 48.0. INCH VOL : 4147 i idUK D I AMETER 120„ fiaj 90. Q ;l NCH VOL L; 24.0 INCH VOL 1540 I. PROFILE : . 4 } 60 .0'-INCH . VOL SYSTEM STATUS .REPORT ' ` FUEL VOL ` : :19 if .ip • 0 I INCH VOL ..0 INCH VOL 16 f' ALL FUNCTIONS NORMAL 6L1.0 INCH VOL : . 10 aQ4�, FLOAT SdZE: 4;0 .I.N B4 6 NCH VOL : 38#3b4 FLOAT SIZE : 4.0: I N . �6�G4 WATER . WflRN I NG 2� 0 HIGH. WATER ` LIMIT: 3Ii. 0 WATE� WARNING ' {. 2 oI FLOAT SIZF, ;:.4.,0 IN. 8436.1 ,!RIGHIWATER. LIMIT: 3. 4 ;MAX OR LABEL VOL: 7629 ` OVERFILL L'I M I T . 96% P, °.IrJHTER WARNING ' 2 «0{ }; R LABEL VOL : 1, 6104{ 74? 7 .KpH :WA -E LIMIT: 3,1 I {VER I'IL LIMIT 9 6; HIGH PRODUCT 9 s MAX' OR L1 EL VOL: ;. <19 i ! ; . 7 Qq 6 SYSTEM SETUP O,UI»RF I LL �'I1-1I T ! 'MI GN PRODUCT 9I396 ;DELIVERY LIMIT 1Ip3 18 10593 '7{ ( 'DELIVERY :LIMIT.- - 10' 'I . JUL 26. 20174:12 53 I'?M H.IGH PRODUCT 179` F�i` LOW �'ODUG ig t LEAK. RM; iI '' " ' Vii: • 9 DELIVERY LIMIT; 15 $'LOW:'.PRODUCT A j c 1} t ;LEAK ' AI~ARM LIMIT: !�', TANr+ 1T! $ „itt fi.h 71 .SYSTEM UNI :fS LOW PRODUCT i ;SUDDEN: LOSS LII,I...T U. ,C TANK TILT O.pp' MANIFOLDED TANK . .SYSTEM LANGUAGE LEAK ALARM. L I M.I T TO: NONE ENGLISH SUDDEN LOSS LIMIT:: ''MANIFOLDED TANKS SYSTEM.: DATE /TIME FORMAT TANK TILT 0 pt7 ;Tit : NONE MON DD YYYY HH:MM:SS aM, LEAK MIN PERIODIC: p MANIFOLDED TANKS CHEVRON Tit : NONE LEAK MIN PERIODIC: 153, X1999 TAFT�?�g 2265 LEAK MIN ANNUAL ! ' f 5% BAKERSF I E D , vA 661- 398 - 8882'' LEAK MIN PERIODIC: 15% 11174 2 52 LEAK MIN ANNUAL 15% n 2265, SHIFT TIME 1 : DISABLED SHIFT TIME 2 : DISABLED LEAK MIN ANNUL PER I OD I G TEST Ti Flrj . ST�,Nl) RD SHIFT TIME 3 DISABLED 2'. `; i. PERIODIC TEST TYPE I SHIFT TIME 4 DISABLED” STANDARD ANNUAL TEST FAIL TANK PER TST NEEDED WRN D1 I IbT T' Pi f ` ALARM D i tAal *ED DISABLED ANNUAL TEST FAIL TANK ANN TST NEEDED WRN s:F ^ ALARM DISABLED .I PERIODIC TEST FAIL DISABLED �d�t�IUA4 Ti*,: TE,�F I � ALARM DIaAHI ED �Ai»A M D PERIODIC TEST FAIL L ALARM DISABLEDI GROSS TEST FAIL LINE RE— ENABLE METHOD. ALARM DISABIED PASS LINE TEST PER IODICx�EST F�I ' GROS$.TEST FAIL ALA MOD ALARM DISABLED ANN TEST AVERAGING, FF LINE PER TST NEEDED.WRN t' r 1 PER TEST AVQINO FF DISABLED GROSS TEST FA L,. sl NN TEST AVERF�u ^ING OFF LINE ANN TST NEEDED: WRN °ALAjM�'D A AVE IIV4« OFD. TANK TEST::'Ns TIFY:: I FF DISABLED ' , ANN TEST F�VERFIGIN'' ` NT4NOIIr�' TNK TST SII?;MON,� PRINT TC VOLUMES PER TEST TEST AVER6G I N r ENABLED i K TP;T SIPHON :.BREAK : OFF DEL I.VERY Dia ,IaIY C 5 I . I N _TAW TEST NOT' FY � TEMP COMPENSAT I ON ! r. 14 "" TST S�'PHOfjI BREAK., LIB Y DELAY 'S •M ;dtJ. t ` VALUE (DEG F,. fa0. � y , •: t y STICK HEIGHT :OFFaET A ( 1 D I SABLED I •VERY DELAY : 5 I AYLIGHT:,SA11dNG .TItt@E ENABLED I t 1411; l q y t fil , ST'ART DATE ' APR' WEEK 1 SUN .START TLME 2.00 AM aCDT .DWEEK 6 SUN: tEr , ?, ..._ r�, ,,.END:TLME.... 2 :00. AM. es t T AL t N , f f UR F, ' - i { LEAK TEST.. REPORT FOR T i LIQUID SENSOR SETUP 1 - `�t<' 7j SE N$ q — — — — — — — — OUTPUT REL *ETU! F r.� L 1:87 ANNULAR TR I — STATE (SINGLE FLCtAT A R 1 : REG ULAR r J UL6 , 2004 Ai,,�y gk,'' CATEGORY ANNULAR SPA( TYPE: A i� S s i STANDARD 1 1 I NORMALLY CLOSED L 2:92 ANNULAR TRI —STATE (SINGLE FLOAti" ; ;;,N TANK ALARMS, '1 CATEGORY ANNULAR S8 T: HIGH:WATER ALARM LOW" `PRODUCT ALARMt Y AARON - r OR ALMS 599''TAFT HWY — S>rNSQFd AT.A L 3:DIESEL ANNULAR .FUEL AALARM 6' : 3A141wRSFIELD, L 4 p'i STS -- TR I —STATE (SINGLE FLOAT) , A ::FUEL :A1rARM ;�61* 398- 8882CA 9331:G (; ,�Tp ggUMP CATEGORY ANNULAR SPACE 1 :.SENSOR OU`T ;ALARM F{.I1 L,;ALARM L 4:SENS?OR QU'T - AL,A>M „ , ;J UL 26. 2004 1:00 Fit J5. 2p1�4 1 l ; PM1j :L, _1 :SHORT' ALARM L 4:SHORT'ALARM L 4:57 STP SUMP TRI —STATE (SINGLE FLOAT) R 2:SUPREME`_ SYSTEM STATUS REPORT CATEGORY STP SUMP TYPE: _ — — _ — STANDARD L 3:FUEL ALARM NORMALLY CLOSED L 5 :92 STP SUMP TRI —STATE (SINGLE FLOAT); INVENTORY REPORT (CATEGORY STP SUMP I IN —TANK ALARMS 7 - - - -r SENSOR. ALAN i - -` - -- T 2:HIGH WATER.ALARM L 4:87 STP 13UMA' T 2:LOW'PRODUCT ALARM T,I :R.EGULAR STP SUMP L 6:DIESEL STP SUMP j U�OLUME' 4122 GALS: FUEL ALARM'' TR I —STATE (SINGLE FLOAT), LIQUID SENSOR ALMS LgGE: = 15129 GAL.6 . JUL . 26. 2004 1'. 11; PM CATEGORY STP SUMP L 2:FUEL ALARM a L 5:FUEL ALARM v U�R1rAE 1933 Qf��}4"F'f L 2 : SENSOR OUT ALARM L 5:SENSOR OUT ALARM' R } L 2:SHORT ALAI M L 5:SHO �. RT ALA}�M a MF t tf 1 : x, '• r R 3:DIESEL zsr, i TYPE: STANDARD.: LU NORMALLY CLOSED U'LA y,; FU e n J11L... ..� 9m�s GE= 1 t C VOLUME _ IN —TANK ALARMS r 7 TIGHT. = 21.. Q1NCIR : 2 e T 3 : H I GH WATE ALARM .1 gTER UOL T 3:LQW PRODUCT ALARM!` ASTER; p.p0 INE$r. MP 88.7; Eig — , LIQUID ,SENSOR f�LMS L, 3.: FUEL: 'ALARM :. 1•= t I L; 6 :FUEL +ALARM) 3 1?I£SEL r L Si:N 01�. QU ALARM { t LUh}g 23.4,3,!' GAI+ r. .' i SF S OUL.M A 5486Gl� S 1;L'TiLA U,I�1GEm 4'C�3 t G t z11rl �, ,A M y k UQ�; ME 4 � 5'G � ,� �, — - SENSOR A .A *. i; GMfix'- 3 , 9 I �f L 6.011~SE 4s / r urFtP i� /FRL � M ER V S P i� AVER 0 . ©Q GH1a ;x FUELfAi ARk1 �' , ; t ; P 9�. �B, D£q JUL'' 86:, 2�10�}x END RECONCILIATION S T. � • � � 1 � 'l V. Wr Ig 3 1iK7 i44A'{`f� �. aiH VN l ri 199 : TAFTI ° W, � AUTOMATIC DAILY, 9L I ; i? ; e _ TIME: 2:00 Amt a �' 3 r � u�r : i 68 ' 9a tm q �} PERIODIC RECO NC'I I I A T MODE.. i ''� TEMP COMPENSATIf N STANDARD I' BUS SLOT FUEL MBE ER TAB TahlV MAD CM11T1< 3 A,RM+ ; �. JULf� • 20641"! A tra�PACE A M. 64 2004 1 .05: PM Sy TiwM : c �• li ALARM 1. H _ 'N . s$TWpVp '4 � RNVNI , TT R� lb_OFF APR27 20004 12:i51 PH, �6- ��aob: 11:140 AM N 1 1:996 8: 00 I..LOW'I:PRODUCT ALARM MAY 3, 2004 8::39 RR MAY 1, 2004 6:30 PK MAR 7. 2004 2:31 PH*, INVALID FUEL LEVEL APR 27, 2000 12:52 PH END x x x x 1-PROBE OUT END X j APR 26. 2000 11:40 AM :ALARM HI `T :1 :REQU: % Q :,ab DELIVERY NEEDED JUL 22, 2004 10:46 PH. JUL 21, 2004 10:37 AH,. JUL 17, 2004:.11 :49 A� A `4 4; 14TORY REPORT Ew§nv AT Alpw-— — — — !LOW PRODUCT tJ : Ub : FM 3:36 FEB' ww- -w 6 yu jj!- UN 6: QO AM ,AM OCT 24. JUN 15 'I PH ;2004 ;: 7:11 p 6:5 1 Am �4, 1tf�Y 44. 2004-* � �.7: 45 PH j "i:ALAR =4ilGIRli!PRODUCT: ;ALARM rMAY�-,25 -._.;4002 :',8:10 AM L 4:� STP INVALID ;FUEL 20'09 AM LEVEL:: 4:29 AM ALARM HISTORY REfORT APR :27, 2000_: 1 :11' PH ,VALID FUEL,LEVEL ---- IN-TANK ALA�M _T : K ALARM :27 . 2 ,000 12:26.8 PH *END Yc x FUEL ALARM T 3:DIESEL �PROBE OUT: FEB 26, 2004, 1:38; AM AiPR '26, 2b, 00 1.1 '40 AM I SETUP DATA WARNING APR 27. 2000 1:11 PH 'NEEDED. APR 26. 2000 11:40 AM I 11:4:Q AM � I DELIVERY :ALARM T, 20044:" 5 PH: LOW. PRODUCT JUL .17. 4004 Pit - 16 2004 tJ : Ub : FM 3:36 FEB' ww- -w 6 yu jj!- ,AM OCT 24. 2003 p 6:5 1 Am �4, j "i:ALAR L 4:� STP INVALID ;FUEL LEVEL:: M i�H I;Ktp Y REPORT APR :27, 2000_: 1 :11' PH sDl _T : K ALARM JUL 26. 2004. A -.11 r AM.; PROBE OUT FUEL ALARM FEB 26, 2004, 1:38; AM APR'�-26. 200G. 11:4:Q AM � I T, DELIVERY NEEDED 9 END JUL 19, 744: 15. 2004'' 2004'..12 ' 1 -�APR: 16, 2004 ' 7 : Pt: K. 77: -T F-' ny 1 71 1 ----- SENSOR ALARM. L 3:DIESEL:.ANNULAR ANNULAR 'SPACE: FUEL'.ALARM. JUL 26, 2004.. 1:.00 PH :FUEL ALARM DEC 0,-2002 0`22 im :iFUEL ALARM !DEC 2002 8:12 4m is ENI) 'x �4, j "i:ALAR L 4:� STP STPLLjjM1P FUEL 6 iL6 '20 JUL 2&. M, FUEL ALARM: JUL 26. 2004. A -.11 r AM.; FUEL ALARM FEB 26, 2004, 1:38; AM ENI) 'x 0 0 ALARM HISTORY REPORT ----- SENSOR ALARM L 6:DIESEL STP SUMP STP SUMP FUEL ALARM JUL 26. 2004 1:14 PM. FUEL ALARM HE ON'.. MAR 15, 2003 4:28 AM 9 jk FUEL ALARM h g., ja FEB 12. 2003 12:16 PM L 26. 2004 "M R; !M �STATUS REPORT 10iC d. fi AL "FUNCTIONS Ti� Eq! PI�MAL` ;It 'g, X END X x x x x SOFTWARE REVISION LEVEL 11,9.04 $0 ARE# 3461 L9 -1QO -E OA - 00-01-14i:40.37 ALARM HISTORY REPORT ----- SENSOR ALARM - - - -- L 7: I OTHER SENSORS x x x x X END X w x x x 7WARE MOD.UL9 FEATURES: IODIC: T.N=TANK TESTS A,L IN.-TANK T.MTS SWRCB, Januaiy 2002 • • Page of Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested The completed form, written test procedures, and printouts from tests (f applicable), should be provided to the facility owner /operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: $ $-r-J e-H-EVROIJ Date of Testing: -AV-0c/ Facility Address: D TA-F-7- - r+KEe- SFlV-4-P 33/ Facility Contact: Phone: Date Local Agency Was Notified of Testing: Name of Local Agency inspector (fpresent during testtn : 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: F avj� Credentials: 3 CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester License Type., C 611 D4 0 Manufacturer License Number: 809850 AUDaburer Trams , m' onen s Date Training Expires INCON INCON TS -STS 8/04 3. SUMMARY OF TEST RESULTS Component Component If hydrostatic testing was perfgrmed, describe what was dque with the water after completion of tests: RECYCLE AND REUSED CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, thefaS(s stated in this document are accurate and in full compliance with legal requirements Technician's Sign&4re:e Date: _ L ra G -W SWRCB, January 2002 • . Page Of Facility is Not Equipped With Spill/Overfill. Containment.Boxes ❑ Spill/Overfill Containment Boxes are Present, but were Not Tested ❑ Test Method Developed By: ❑ Spill Bucket Manufacturer Id Industry Standard ❑ Professional Engineer ❑ Other (Specify) Test Method Used: ❑ Pressure ❑ Vacuum N Hydrostatic ❑ Other (Snecifv) Test Equipment Used: INCON TS —STS F Spill Box # FUL, ' 1 Spill Box # Flet Bucket Diameter: `� `� Equipment Resolution: . 000in . . PAftpill Box # L l Spill Box # f� Bucket Depth: (q/( 1q. ` Wait time between applying pressure /vacuum/water and starting test: 3© 0 f.A/ �m c Aj C�� �1! Test Start Tune: I = QM t X"t *? 1 `301M 1 PoLA ;2 IK ' m Initial Reading (R): ,`Z 1(031 11P Ow , a 9'iw c;. /!q �• (plca?i„l I - foloo/ Test End Time: (oZ% qNPr" I 41 px(s v" %v"1 )%0 ( M Final Reading (RF): 2 -1(01 h • /(Q1 V (j. V. �/ %/ • Lo(o 010 . S$'s Test Duration: ShjW /5-41 f, yj I id 15" Cra 6iki,, A) 15An t.) Change in Reading (RF -R�: •Lpc%a)d . 04>/W .a7czwd -oo/tyj -oua -o4aahl Pass/Fail Threshold or Criteria: (,.j Ua l.j n -C9ga 1 Test Result: Pass 0 Fail &4ass ❑ Fail yof ass 0 Fail' ❑ Pass ❑ Fail Comments — (include information on repairs made prior to testing, and recommended follow -up for failed tests) 0 SB989 TESTING FAILURE REPORT SITE NAME: f>+,.,) r' Hvu po 1/ DATE: [ 0? & ~ T'� ADDRESS- /99b / ? f � � 41 �Y TECHNICIAN! " — 'V / "a/ SITE CONTACT: THE FOLLOWING COMPONENTS WERE REPLACED /REPAIRED TO COMPLETE THE SB989 TESTING. LIST OF PARTS REPLACED /REPAIRED: REPAIRS: LABOR: 4AV?�� PARTS INSTALLED: leoob • 0 Sao 3�� ^t::�3, January 2002 t!; Page r L� of Secondary Containment Testing Report Form AUG 2 6 2004 !'Iris for n') is intended for use by contractors performing perfodtc testing of UST secondary contair;i a� yyste� ms. Use •the_ -..- u <>pr iute paties o�'this form to report resulrs for all components tested The completed form, written test procedures, and priruouts fi•onr tests (if applicable), should be provided to the facility owner /operator for submittal to the - local- regulatory agency. 1. FACILITY INFORMATION 1= aciliry Name: CrJ e�i?Fi /PDT✓ Date of Testing: O t- acility Add►-ess: facility Contact: Phone:. Date Local A micy Was Notified of Testing: NaTue oi.Local Agency .Inspector (fpresent during testing): `- 2. TESTING CONTRACTOR. INFORMATION I Company Name: RICH ENVIRONMENTAL 'Technician Conducting Test: ,DS4 DAvis C l- edentials: _ 3 CSLB Licensed Contractor. 0 SWRCB Licensed Taak Tester LicellseType. C61 1D40 Manufacturer License Number: 809850 Maitnfa¢turer Traini ►n Component(s) Date Training Expires INCON INCON TS -STS 8/04: 3. SUMMARY OF TEST RESULTS Component Component 1 A�1� ■ !' ■ �l� fin '0 ■ smmm ' mot' �.i ��_� mom omm M-- if hydrostatic testing was perftacmed, describe what was done with the water after completion of tests: RECYCLE AND REUSED is F RTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of tit)) knowledge, the facts stated i is document are accurate and in full compliance with legal requirements Technician's Signature: Date: St\-'l« 'I3, - unary 2002 4. TANK ANNULAR TESTING I. '2NI iMUthod T)evclnned Rv n Tant Ai(nnnf'annn -ar 1:1 Tr rl„e +... Q +4 ,Aa.. d n Pacre C�-of 1:1 Other (Specify) �l 1'esI Ivtethod Used: 0 Pressure Z Vacuum 0 Hydrostatic ❑ Other (Spec II l'`st - .cltnptnentUsed: 4in DIAL GAUGE Eguipm w D entResolution; 5q' II ,,rN yak' t,r �s ank T # Tank # Tan lc # I �:l °atnl: a:xeml,t Prom Testing ?l 0 Yes 0 No ❑ Yes ❑ No ❑ Yes 0 No 0 Yes 0 No '1' utl,_ C.ataxcity: l ,artic 1t,�L�il:rrt.al: - �� -fang Nlanuiih:.rurcr: I� 1'11,l)ltlaCa Storecl.._, -_'- Ili \�'�,.lii tiuicbetwcen applying t�retisl.0 e; va�utu» water and I lniii -al Reading; (RI): Test Ind `T'imc - - - -• -` 1 111;3 Readin,(RO: l:esr Duration:_— j Change In Reading (RF -R(): l'ass!Fail 'Threshold or Criteria: . ';;test Result: ❑ Pass 0 Fail ❑ Pass 0 Fail ❑ Pass ❑ Fail ❑ Pass. 0 Fail j Was sensor removed for testing? 0 Yes 0 No 0 NA ❑ Yes 0 N 0 N 0Yes 0 N 0 N 0Yes ❑No 0 N I 'Ai;—is—sensor properly replaced and j verified functional aftactestin ? ❑Yes ON ❑NA ❑Yes 0 N 0 N ❑Yes ❑No DNA ❑Yes 0No DNA I ,,1 Cd.)uutxai_ *.nip; _- (inchide information on repairs made prior to testing, dnd recon7niended follow- 1jpfor failed tests) ' Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, st.,ch as systems that are hydrostatically monitored or under constant vacuum, are exeanpt from periodic containment - r .aQ ,fA >m,lafinnc Tirlp. 7.3- Section 2637(a)(6)1 qtr ; � d �ri �, �,. S `vl' 1'.l: f3, .I attuary 2.002 i 5. SECONDARY PIPE TT.STTNf Page —3— of 1'est Mzthod Developed By: ❑ Piping .Manufacturer 2 Industry Standard ❑ Professional Engineer ❑.Other (Spec) ^Te r IVlel.hod U.sLd: 1) Pressure 0 Vacuum ❑ Hydrostatic 0 Other (Specify) Test Equipment Used: 4 I n . DIAL GAUGE Equipment Resolution: . 5% Piping Run: # " Piping Run # Pipigg Run # Piping Run # Piping Material_ ~Piping Maim icturer: Piping Diainete:r l..tn,th of f'ipiiac Run: ' 1"roduct Stored: iviethod and location of ii Diu * -run i'301ation: Wait t:izne betwcen applying pressure /vacuum /water and tarr:ing test.: _...___ Pest Start Time: l.nitial 1,eading (.Ri): Test Ead Titne: �T inal Reading (Rr): Pest Duration: _ Change in Reading (RF -RO: Pass /.Fail Threshold or Criteria: `IlCest Result.— Pass 0 Fail ❑ Pass ❑ Fail ❑ Pass 0 Fail 0 Pass ❑ Fail Cox>rr menu — (include information on repairs made prior to testfng, and recommended S WR.CTI, .lanu.try 2002 • 7. UNDER- DISPENSER CONTAIN -AUNT (UDC) TESTING Page -5—of Method Developed By: ❑ UDC Manufacturer R Industry Standard ❑ Professional Engineer _ ❑ Other (Specify) l'e_sr. n<tedaod Used: ❑ Pressure ❑ Vacuum IM Hydrostatic I ❑ Other (Specify) � l� t l�quipmanr. Llsed: INCON TS -STS Equipment Resolution: . 000in. Ewa= UDC # UDC # amp UDC # UDC At _ U_D_C N_lani facturer: _U I)C Ivlaterall -I lll:)i . C)eptli: ~I lei �ht from li DC Bottom to Top of I- liabest Pipina Penetration: llei "Flit bona UDC Bottom to i Lowest Electrical Penetration; ! Corulition of 11DC prior to - -I Portion of UDC. Tested Does turbine ;hurt down when UDC DC. sensor detects liquid (both D Yes D No DNA D Yes ❑ No DNA D Yes D No ❑ NA 0 Yes ❑ No ❑ NA roduct and water ?' Turbine shutdown response time -ls systern progr"41iamed for fail- ❑Yes ❑No DNA ❑Yes ❑No DNA ❑Yes ❑No DNA ❑Yes ❑No DNA sat e shutdown ?' Was fail-safe verified to be u ptr;ational' ?{ ❑ Yes D No ❑ NA D Yes ❑ No O NA ❑ Yes ❑ No ❑ NA ❑ Yes 0 N ❑ NA Wait time between applying INCSSUre /vacu.um /Water and srartinfest %O Test Start Time: Initial Readin; (Rj): h- nd'I'ime:- _Kest l- final Readinc (Rr). - est Duration: Chan,ye in Reading (RF -R): Pass /Fai.l `Threshold or Criteria: Test Result: ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass O Fail Was sensor ro ni.oved for testing? ❑ Yes ❑ No D NA D Yes ❑ No DNA.. ❑ Yes ❑ No D NA D Yes ❑ No 0 NA W sus sensor properly replaced and O yes ❑ No ❑ NA ❑ Yes ❑ No ON A ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No ❑ NA vea ified functional after testin ? Comments - (include information on repairs made prior to testing, and recomnzeisded follow -up for failed tests) ' It 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) S yti' k' CB, January 2002 i Page to of S. FILL RISER CONTAINNCENT SUMP TESTING I acility�is Not Equipped With Fill Riser Colxtainment Sumps D t ill Riser Containment Sumps are Present, but were Not Tested 0 Test Method Developed By: ❑ Sump Manufacturer IRIndustty Standard ❑ Professional Engineer 0 Other (Specify) I� Pest 1b2ethod Used: D Pressure 0 Vacuum Z Hydrostatic 0 Other (Specify) Test L'quiptnentUsed: INCON TS —STS Equipmeut Resolution, .000in. 7 Fri Og Z:11 Fill SumE # Fill Sump # Fill Sump # Fill Sum p'# Sw 1 Diameter: 5unI) Depth: I teight fi:on-, Tank Top to Top of �Lm; h�: t Piping. Penetration: I l e iglit from Tank Top to Lowest Electrical Penetration: Condition of sutnp prior to 1:E;SCI.l1cr: 1?ortion of Sump Tested SLIM p Material: Wait time between applying pressttt•e /vacniim /water and .y y starting 1:cst: Test Start lime: Initial Reading (Rt ): rest L -'nd Time: Final Reading (Rr): TCSL Dur-ation: Change is Reading RF -RI): Pass /Fail_ Threshold or Criteria: Test Result- ❑ Pass 0 Fall D Pass ❑ Fail ❑ Pass ❑ Fail 0 Pass ❑ Fail is here a sensor in the sump? ❑ Yes 0 No D Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Does the sensor alarm when either product or water is IDYes 0 No DNA D Yes ❑ No DNA 0 Yes D No DNA 0 Yes ❑ No (I NA detected? 'Was sensor removed for testing? 0 Yes 0 No 0 NA ❑ Yes ❑ No DNA ❑ Yes 0 No ❑ NA ❑ Yes ❑ No DNA Was sensor properly replaced and D Yes ❑ No D NA 0 Yes 0 No DNA ❑ Yes ❑ No ❑ NA ❑ Yes ❑ No DNA. v�tnctional after testing? o.innients —(include information on repairs laude prior to testing, and recommended follow -up for failed tests) 0 0 W' i-'C3, January 22002 9. SPILL /OVERFILL CONTAINMENT BOXES Page -77 of yt aciJ.ity is Not Equipped With Spill /Overfill Containment Boxes ❑ tii.�ill /Overt!1 Containment Boxes are Present, but were Not Tested 0 Test Method Developed Icy: 0 Spill Bucket Manufacturer IR Industry Standard 0 Professional Engineer _ 0 Other (Spec) "Pest lViethod Used: 0 Pressure 0 Vacuum a Hydrostatic 0 Other (Specifj?) 1 e.sL - Equipment Used: INCON TS -STS Equipment Resolution: . 000in . 71 ME TM, Spill Box # Spill Box # Spill Box # Spill Box # tucker Diameter: tiackec Depth: Wait time between applying pressare /vaci. um /water and S[artin•-, test: cFlle� s 1'est Start Tile: Initial Readirig (Ri): Test . ,nd Time: Final Reading (Rr): "l'est Duration: 1 Change in Reading (RF -RO: FIass /F,ad 'Threshold or Criteria: "vest Result. ❑ Pass 0 Pail ❑ Pass ❑ Fail 0 Pass 0 Fail 0 Pass ❑ Fail Coi<nniepts - (include information on repairs made prior to testing, and recommended, 0' Secondary Containment T.Oting Report For ' M_ - DRAFT Pltege_t of `'" Aisforpt is intefidedftr use b)o ia-Whg of OTsavondary use aze all component-v lested monerloperaiorfor sub.-nival to the local e. "1 14:1 roty a gencip L- FACILITY INVO14LISLA TION Iwacifiry Name:-J. 4-. _C-tfU-vRoe_j Date Qf TestirkgL' 0,1 0 Q�__ facility Address: T.6rr. f+wz SAi4tZ JYS-1-3 - - I Fauiucv conract., Phone: .Date Local Agency Was Notified of Testing: II-IS-0.2- Co 'la'aav of Local Agency Inspector Prawnt' A0"'P*1E 2, TESTiNG CONTRACTOR INFORMATION Company Name: R I ICH AF41WX&4A1FAA1%oL_ Teclmiciwi Conductio.- Test; .4,o+gzkj kx4pp, Cvederaikils: tSLB Licensed Concractor SWPCB Lice-Mod Taak, Tester Lizense Type and #: CSQS •'Wl 040 ROqXSD S (b PP-B 90- I D% L8 53,aXID a Training by'Mantxfadurer Manufacturer Component(s ires DaLteTrai JA',; 600"1 7S T�s —CIO JUM 3. SUMMARY OFTE _r4 - ST RESULTS Number of Tanks Tested, ::s- - Number of Pining kuns Tested: P. Number of Submersible Pume Suipp Tested: __....Nurnber of Boxes Tested: Nuniber of VJU Sumps Tested-. 141 Numbex of Overfill Boxes Tested: IrM.- kl$* M�Mp%-' componew Puss cull COMMOuLs L #+WA1ULAtt iwr n .- FAKM-141 Vilre-XL TAwr_ 4ewtv(.49, Er Li U !4L rtl dE4. T-Mrvlr D uc . PIPIKO-k- a- jWVSJL !WC • o Q _—;i vnp with VKL 94'1 c5ojr pkrwp SVO-OP, 5vig M4011"' JvOf- FVKP JIVAP D 0 lie 9f PL7'w1T'R4Tbw:5 -Ov6;;F?- ACA4-4--- Z; cop MM rg4l_)" A/1M P 6EM-E> 0 be- I- R_ t,ptp,e Ub e- Lpf LJ 0 - OPIC UPC r 10 0 Te&uiician 's Sip 3' wal�i Rw CIA Date: nort-tniher 'N'l ZO 39Vd TZ9OZ6ET99 TO:TT EOOZ/ZO/TO . 4. TANIC AN NLJLAR TESTING j. 11 Ocher (SLeoff)) Passd ail Threshold: T"t Result: Comments — (include infomiation on re airs made pri6r to . ` � ---~_--� ~_-------_-_._------_-_'_----_-~_. � ' _--____.�. IIZWRi-A n��h�rm S. S:FC'ONDAR` r :PIPE TESTIN4 J. ftsc Ne.chod Devel0pc;d By; 0 Piping Malwfacturer LYSdustry Standard 0 Professional Engineer Test Method Uses: 0 Vueuum IN'1�jrrlroYtritic ~ - -.— Q Other 1\t.:tsurin� Equipment CJsed for Testing Ow to 'j"S f1pin.g Material: P;pilq Manufacturer: - -_ 1'ipllt l Diarnet'er: - Length ofpiping Run: _ Pruduct Stored: method and location of _ei2Uw -ruts isolation: _ ',Fait time lutwean applying presSUTe/vacuunUwoter IfId Test Stan Time initial Reading (PQ: 'Fob End Time: -� final ''Readitzg (RN): Test Duration: Clt:utge in Reading (Re-Ro: Pass,Fail Threshold: 'iesr Result: _ ML Piping Rkin # T07 —..I>-LA TOTArL 13 Olr ' ti iLmvp, PWP(Piging Run # 01 �"b'T14� ler>NTA,� D1 -M it gdZ7`1di S N10.46[Yiping Run N �•vnT ),,I &vr�4 _ Comments -- (lr:cl cde info - mation on r LI ior to tasting) CV6� l`.R nN.•r.�Y�t1.��• ��n Lo 35�+, J J'a; :lop„, t t �Ar► i i'�'.It�ra . .I t t t'Z'.ia'''� ;'dS'}a•+ 1 �' .. w (� .730, • `7- Cott, �s'wt� �i t t�>�+ a � s w„ a c c5-wu t t�i�w � � 1� •�n�.� • . •+try i 1 N , mar l ev . ~ADO l� -_ -� (� . 00455 1 1"s-S t'�r�is5 ' Comments -- (lr:cl cde info - mation on r LI ior to tasting) CV6� l`.R nN.•r.�Y�t1.��• ��n i LI 6. SUBMERSIBLE PUMP CONUI • t' SUMP 11' r agt: IPL 'fist 14le:thod Developed By: p Sump Manufacturer eladustry Standard 0 Professional Engineer _ _ 0 Other (5peoify,) _ _ 1 est Alothnd 'Uses; U Pressure 00 Vii =m --� -' lydrostatic -y 0 Other (Specify) 1.lcetsuring i?quiarlrtrtt Used forTestircg: t/ti! (t TS . -- _. - • .: .r: •ti. .... _::. ......,.... , 9fS'n':�:197%Li'' ��-�..�i�.'f$+7rY�• .r7n•�t' G7Y' Y' �9LriC !u ^�.!`SM'!3T:6T.f1m.�t?.•�ee iTfll�enbnvw�eyk :.e'rAwiwwww�..n -.-. ••• swup'Diameter: T- Sump Uepch: _ -- Ump Material; _ tiai,yht froui Tanis Top to Highest Pi ins pecletration; lleight From Tank Top to Lowest _F.lectii_caJ Penetration; '- _Couiditioo of sump prior to testing: Portion of Sump 'resLeidt _ yDocs turbuio shut duwn when ,ucnp sensor doLects either produot or water? _ hw -bind shutdown responxe time Is system programmed for fail -safe shutdown? Was fail -safe, verified to be Wait duce betwwn applying pressurelvacuum/water and starting coat: rest Stmt Time -, Jttitit+l Rwdinb Test End End Timo: .Final Reading (14): 'Pest Duration; � —_ Chaage in Reading (Rs -R,): 1'ns%'Fail Threshold',. -- 'N:sc Resu_lr: . Was sex>sor removed for testi ? _ 1Vas seusor properly replaced after+ tesrir)_q? Stunp # �4A K IN Sump # °Z r ?>jjFW4b-ump ti jej s- Lei e(A.. 6 ?P /y,4 AM All. IVILt '60 t-ii.,o. I 3-o-Por,�j g:g0 A, " I r. 4J 5R'M*V S • r rasa qo q+M 1: A" %mss �Y z5r �fAi y5�5 . ,Ili %t ev �J�IMh✓ •jam �'1!ti✓ :- FOJ41— FA L i5m1-�J i�md^l YES FAIL-- _ Frr41L K IN Sump # °Z r ?>jjFW4b-ump ti jej s- Lei e(A.. 6 ?P /y,4 AM All. IVILt '60 t-ii.,o. I 3-o-Por,�j g:g0 A, " I r. 4J 5R'M*V S • r rasa r�55A�w : ibla �4wt I5F) w I vr�'i iii! •oJsinl 15y+�,NJ �J�IMh✓ •jam �'1!ti✓ :- FOJ41— FA L :0V low Nit,. : �•��� YES Coinaaents w include tnforrrration on reruns mode t -ior to testis 4LL 54"Pe+� 'S`' _F' 'l[= —• A Li.r d_vf3 ScrvtpS Aop If the tearing method does not test the arttire dthth. of "the sump, specify how much of the sump was tested, hlethods not. tcstiag• rltc anti; a sump 81101.11d ortly be used if the monitoring systec7c prrovides fail -safe turbine shutdown. ' Wltt'c We submersible pump running, plact the seusor in product (discrimiueting bOnS01-11 sleuuld also be placed in water ). The tuna bCnveyen placing Clio seimr in product and the turf,• ino ahuttiug down is the respoaat time, This should be done if the secondary contaimnent testing method used does not test the eutirts volun10 Of the surnp, 1 too �J�IMh✓ •jam �'1!ti✓ :- 1 • 3�IVr,� � -I �'�4� reJ :0V low Nit,. : �•��� Coinaaents w include tnforrrration on reruns mode t -ior to testis 4LL 54"Pe+� 'S`' _F' 'l[= —• A Li.r d_vf3 ScrvtpS Aop If the tearing method does not test the arttire dthth. of "the sump, specify how much of the sump was tested, hlethods not. tcstiag• rltc anti; a sump 81101.11d ortly be used if the monitoring systec7c prrovides fail -safe turbine shutdown. ' Wltt'c We submersible pump running, plact the seusor in product (discrimiueting bOnS01-11 sleuuld also be placed in water ). The tuna bCnveyen placing Clio seimr in product and the turf,• ino ahuttiug down is the respoaat time, This should be done if the secondary contaimnent testing method used does not test the eutirts volun10 Of the surnp, i • • 1- iti,;ht from ITDC Bottom to Lowest Electrical Penetration: Coudicion at UDC prior to Poi tivn ot'UDC '1:'rst�! _ _ Does turbine shut down. when Ul)C sensor detects eithe or .pro&Ct or v��atrr't 'Turbine shwdown response Is system programmed for fail- safe shutdown'? Was Wl•safe veiitied to be uperallo al'? Wait ti,ite between applying pressureVvuauum/water and stamil),14 test: lest Start Tiine: lsutial Reading R .. _.. 'rest fnd 'Time: Fi,)aJ 'Rtsadin r.): �, .- Te,t Duration: Changge ir1 Redding (R(,•Rt); Pas.' Fail Tiweshold. 1 est Result: 1k'aa sdusoi rtmoved Erne Was sensor properly after te%t IA? I ,,7 J r, �,, J J 1 !n All 44 Yq J� w,rr-J o- :7� � k 10 .00rilry •ors Y Y� 5 lt'lp 34D 60w7 I k) • moo{ ry � • °� 1 .eo � • vID S • � ( 14) o��•�. 1I:1nA4*4 { Iqj.w 1St+ •J 4 _Cornmen_ts — ireelude to oraiation on re airs rntule prior to resrin ` Tr the itsting method does not test the entire doptb of the UDC, spocity how much of the UDC was tasted. lvlethods not testing th, entire UDC should o111y be used if the Monitoring system provides fa.ii -satr turbine shutdown. 1 )N-uh the submersible pump rwuung, place the sensor in product (discriirdnatiag sensory should also tae placed is wetter). The time between placing Uie 3onsor in product ling the turbine shutting down is the response time. This should be clone if the secondary eoutainment testing method used does not test the entire volume of the UDC cwa OA TUrr.rt,hor '20( r 413o —(Q.,. VL -- 7. TJNDER- D1SPEi"" :' Ii R CONI'A.1NMENT (UllC) TESTING . lest hlxLhoo Devolupad By; 0 UDC h•a n::i ::_carer - tdustry Standard 0 Professional Ensinocr 0 Other �.� "rest Method Uses: 0 Yressur <. 0 Vacuum MoRydrostatic Nl&aiuring rquipcnew Used for Testing; IvV C. w - '?'aw ' :• 1 UDC # UDC # 40 �, uDC Nlanufacturw -: yKkv►v.� . tin K maw_ vrt krne,•t Ad UllC A.l1tt� :tl ... _ _ Fl� ilCijt from UDC Bottorn to /,Pat / a < K / O IAOI 2�11� Pipii�Pwletr:ltiun: .,,_ , _ _ 1- iti,;ht from ITDC Bottom to Lowest Electrical Penetration: Coudicion at UDC prior to Poi tivn ot'UDC '1:'rst�! _ _ Does turbine shut down. when Ul)C sensor detects eithe or .pro&Ct or v��atrr't 'Turbine shwdown response Is system programmed for fail- safe shutdown'? Was Wl•safe veiitied to be uperallo al'? Wait ti,ite between applying pressureVvuauum/water and stamil),14 test: lest Start Tiine: lsutial Reading R .. _.. 'rest fnd 'Time: Fi,)aJ 'Rtsadin r.): �, .- Te,t Duration: Changge ir1 Redding (R(,•Rt); Pas.' Fail Tiweshold. 1 est Result: 1k'aa sdusoi rtmoved Erne Was sensor properly after te%t IA? I ,,7 J r, �,, J J 1 !n All 44 Yq J� w,rr-J o- :7� � k 10 .00rilry •ors Y Y� 5 lt'lp 34D 60w7 I k) • moo{ ry � • °� 1 .eo � • vID S • � ( 14) o��•�. 1I:1nA4*4 { Iqj.w 1St+ •J 4 _Cornmen_ts — ireelude to oraiation on re airs rntule prior to resrin ` Tr the itsting method does not test the entire doptb of the UDC, spocity how much of the UDC was tasted. lvlethods not testing th, entire UDC should o111y be used if the Monitoring system provides fa.ii -satr turbine shutdown. 1 )N-uh the submersible pump rwuung, place the sensor in product (discriirdnatiag sensory should also tae placed is wetter). The time between placing Uie 3onsor in product ling the turbine shutting down is the response time. This should be clone if the secondary eoutainment testing method used does not test the entire volume of the UDC cwa OA TUrr.rt,hor '20( � � t i .i 1.1 �� ,�.:1 i� ,.L.- i. e � � �:%' r. utysr ,tom- uaarliNSLKCUt`!"1'A:rNMLN'C ti1DC)'rLST1NG .rest Ivietltod D]evGlcped By: 0 UDC Nfartufavturer ffflndvstry Standard U Professional Engineer' _ I] Other (�!ec( fy,) '!rest Ivl;ethod Usts: 0 Prosslare CJ Vacuum ydrostatic _ 0 Ocher (Specify) _ i ZhTuring Ccltiipmtnt Ua(sd for Tescinq: I N C a-&) elm! • , UDC a UDC. # .`.f"i UDC N _UDC Manutxcturer: uh Yilp VatK vwwvv�v _ _ LYilll, Material: I+l�br S E_ _. UDC D> ,telly: - � _ � _.Iw Height *om UDC Bottom to l�� •� , �j ' I= liEltest Piping Penetration: Height 6rom UDC Bottom to Lowest Llectrical Penetration; I I t I vv Condition of UDC prior to Ir costink: CT Portloa of Test` '/g o'rro. -tip _.� Dees turbine shut down when UDC sensor detects either Me Turbine shutdown responae time Ys system prograrnmed for fail. sate shutdow,it ! T _ • Was W—safe verifed to be t)Lwaiio W? Wait time between applying pressureNacuunt/water aad r.> y-A( V In starting test: Test Start TintL: h � t � Q tN► ! t '���� l� t ' ! i4 w'?�� Trade! Reading P'): - •u •mo w. % 4 ry t !� _•� -7�oIM ,rest End Time: ! Awt`�� I t3� tt : `C�r4r, ! : �+« � nt :�! Readi�_(R .: ' 1 d . x'71 � ��i7 7 N � ' { ► v • 9 01 yJ . rl�J Test DUIFition: 1;5'„t v,rJ �� PKV*4 ( M91 wJ l..,Wr1 w► S +.� rJ`— r -►��t1 Chat)�e.in Readin, R -Rt : . ao / (+✓ , sey, j !►� . e� t !N • exo I r� .csO l f wj , Pass/Fail'rhreshold: • ab� (✓ . ea ly , p 1„� °p IOV Test Result: rG}-S 5t Was sensor removed for te9t•tn'7 ! .. f� .�.... Was sensor properly replaced zlz ax }er tastina? J COLr.Lments -- Iincl de informgtkm on repairs made prior ru tevlirn 'If the testing method does net rest the entire depth of the UDC, specify how much of the UDC was tested. Methurs ^or ; ;ri„� chi. 1 entire UDC should only be used if the mon tonn(z system orr -O!�c rq;t_— c„ ....�:....,...... 9 0 9, q.'PXLL/OVL,'R 'IL.L CON"- AINM.LN'1'130xF,s _ j1 eac Ihlt?lh,) J Developed Hy: U SpI Buckei 'MMUfncturc'r' Xaidustry Standard U FrofessiaW Engineer !A 0 Other (bp", Ijjj) '1'ea� 111Gtix�a Uses: ~._.... Cl Pressuie - M 0 V11OLum �ydlil'E rc,stetic . , lJ Other 1 t izasui- rig Equiip-�r ejitt Used for Testing: Cep — '�r�'�',�3��:�'•' =tl.ri i�'.i':i :i'i�l�i fi�t`�.'..k7.�r1.- :k:r:�,.. �.,;wlr�a?i�Jff�'/ .�e.�A .l�M71 �IGr � ��'r._�:.'! �..',�ivi �...: .�7�`� a5 'i.F.'x�3", ^:i.."'Si1�'.i."" Bucatc Deptl, _ Wait time benwen applying prrrrsureav:wouunl/water raid law -tinA lest; __ 'rtst Start 7'illlt . ^ -- --- lniti8l htading (ki)' Test End Tirne ._ Firwl Rtra.kng (Rv): 'Pest Duration: Cl>anbe Li lta.dinag (krrRt)� Yass<l ail Threshold: '1 est result: Spill 18oa N Shill 130x l3 Spill Box # PRE 4NIFA!-P- 7w .� 7F57— Cow wents — Onchide inforrnwir)rs on rep<7i?,s rnade nt'ivr to testing) This is a draft docuuiew intended for, public review and comment. .'our input is appreciated. Please direct any cornments regarding this form to: SWRCB UST ]Program, Attn: Scott Dawn 1001 1" Streen, Box 944212 Sacramento, CA 95814 Phone: (916) 341 -5873, Fax: (916) 341 -580S a -mail; bacons @r.wp.siA,rcb,ca.gov .wu rte r)nr.amhrr ^i' 1 0 0 8, FILL RISER CONTAINMEN•r 5'L7114P TESTMOr Te-st Method, Developed By: 0 SQLYIi) Manufacturer K-Ldustv-y Standard 0 Ottler gEtxify) _ ' ---- '1*C31 MOOLod Gscs: 0 Pressu I't ❑ Vacuum 0 Other (Spouij ) Nkuduriag Equipment Used for Testing'. I oU e- do-A) Rp�n LOVL *P1 ill Suak 0 91 111 U S U If I n PAZtO� F i) SLIMP DOP Height from Tank Top to 'Richest Piping, Penetration; from Tans* Top to JoNvost L,'lectfical Penetration:_ Condition of sump prior to yo, Lion of Sump Tested -Wair time between upplyine, pi-essx)j•e/vtLcuuWwa16r kind _S �drLjqg jOSt: Test Start Time: Tess End Time: Final ]�4adlng (R,,_): Tust Duratiorl: C'. '14jlge in Reading (X R Pass/l;.iill Threshold,-,.., 'list Result: L, rhvre z seiAsor in the sump? Does the sensor aifirm When eiLhcr product or water is ddtcctc:d? Was sensor removed fur WLI.s sensor properly repluod after resting? .r as C: or u. O'Professiotutl Eagirteer IJ . ydrostatic Comments — include information o),i t-e pqlrs made prior to testTa)---- 10 3b ji) ")17A-A /A -ID As" )S:j%1VAJ W OSUV-J IS VVk#J 15W Ad 4K j!j14; -15 Yylf L *of 1&0 ct PAIS tg Comments — include information o),i t-e pqlrs made prior to testTa)---- 10 ... i �:�. --•- APR- 4-01 WED 1:3:00 FROM B.S.S.R. INC. P.01 • BSSR5 Inc. 6630 Rosedaftlwy., # B Bakersfield, CA 93308 Phone # 661-588-2777 Fax # 661-588-2786 .4 . , . 4i fsimileasrriltl To: Fax: 9(r a From: Date: qIqljX Re: Pages: ❑ uwd korlkev ❑ Pam Comment 0 Please Reply ❑ Please Recycle 4- lawul- %n�, CerfificasiQn (�cmplef�d ovi Ap+,l2, �aDl. S +CJGhew.6yl- lq9q Ttt6fllwN, s�e/O /'lz�r Ca1Dt� G1�xc� u>��'ro- mom Nappima! Y.A ou 201000 20 1 0166$ 12 00, .5001 FAciLny Num DER-. CONTACT PERSON. 4 v S, TELEPHONE 61 -' Fe� ip Copg mom Nappima! Y.A ou 201000 20 1 0166$ 12 00, .5001 I ew"Im, 1& 01 , Af%lMn A V=_Q M MM IN APPLICAALF BOX! OnQ.system.tiave audib'li and vlsual.slarms? 'y t si�t6 U�Wjy, 01�t-ddk if 'the systern det6cw .. v S, .: - -' Fe� . . . . . . . . . . . . . . . . . system ed't6'P'fS*** viient uiiWto4ed "peft? y g S 664 S�CUQ6. prea�*4 ayss P ar;s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . % s imp. MdkrrdPWd SEN'SO" Y PLACING N APPLICABLE 130k� OF RS TEMD 0 AkYE-s OR N or . . . . . . . . . . Mig. No 0 .............. Levei *q 5 Y- .7 ft-Una Le& Detector: 0. Y t4 NO" a Leak Detector , r30 iJ 0 I ew"Im, 1& 01 , Af%lMn A V=_Q M MM IN APPLICAALF BOX! OnQ.system.tiave audib'li and vlsual.slarms? 'y t si�t6 U�Wjy, 01�t-ddk if 'the systern det6cw .. v S, .: - -' - I W" is' slicWnlcml� dlidofinkted? qplr;@ or . . . . . . . . . . . . . . . . . system ed't6'P'fS*** viient uiiWto4ed "peft? y g S 664 V TO VERIFY THE lNPdA0ATl0M)L90VEj factus pfficatons? s It airdertbles*p�rthen % late ` positive . . shut -down of the turbiriel DATF. -CE RTWIEDTECHN1614N'�-*..',':' W-wt.9 WANY.."AM.G. &VELEPHON ATTAWALL•C'ERTIFICAT16W, : IL 664 V TO VERIFY THE lNPdA0ATl0M)L90VEj 0 0 Cm 5643 BROOKS CT BAKERSFIELD,CA.93308 OFFICE(661)392 -8687 & FAX(661)392 -0621 ALERT 1000 UNDERFILL AND ALERT 105OX ULLAGE SYSTEM Precision Underground Storage Tank System Leak Test TEST RESULTS Test Date:06 -28 -2000 P.O.# BILLING:LUTREL SERVICES, INC. SITE:CHEVRON 6315 SNOW RD 1999 TAFT HWY BAKERSFIELD, CA 93308 BAKERSFIELD, CA 't PRODUCT VOLUME %FULL WETTED NON - WETTED PRODUCT LEAK WATER IN (GAL) PORTION PORTION LINE DETECTOR TANK UNLEADED 20000 69%_ +.0.028 PREMIUM 15000 70% -0.001 DIESEL 8000 70% +0.026 PASS -0.016 NO TEST 0" PASS -0.012 NO TEST 0" PASS -0.007 NO TEST 0" WATER BALANCE Measurements showed that water in the backfill area at the time of testing was below tank bottom, and therefore not a facter in test determination. A monitoring well or a well point was driven in the backfill area to determine that there is no water in the backfill at tank bottom. A precision test was performed on 'tanks at the above location using the Alert 1000 underfill system and the Alert 1050 ullage system. I have reviewed the data produced in conjunction with this test for purpose of verifying the results and certifying the tank systems. The testing was performed in acorrdance with Alert protocol, and therefore satisfies all requirements for such testing as set forth by NFPA 329 -92 and USEPA 40 CFR part 280. The results of testing are shown on the following page, and indicate whether the wetted and non - wetted portion passed or failed. Included with the report are reproduction of data compiled during the test which formed the basis for these conclusion. This information is stored in a permanent file if future verification of test results is needed. AL \NC 040 Te Certi mes J is State cert #99 -1072 , :::: ::::::i::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::;::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::: , 0.75 M I N U E 3 S 5 ALERT TECHNOLOGIES PLOT OF ULLAGE TEST DATA CHEVRON 1990 TAFT HWY. BAKERSFIELD. CA 93313 20000 GALLON UNLEADED TANK 12KHz AMPLITUDE RATIO 25KHz AMPLITUDE RATIO 1.5 750+ 0.75 1.5 12KHz DETECTION RATIO = 1.,00 M I N U T 3 E S 5 25KHz DETECTION RATIO = 1.01 TEST RESULT = PASS DATE AND TIME OF TEST: 6/28/00 11:53PM BEGINNING BOTTLE PRESSURE = 2800 ENDING BOTTLE PRESSURE = 2300 BEGINNING TANK PRESSURE = 1.5 PSIG ENDING TANK PRESSURE = 1.5 PSIG D+ E 0 LJ 9 0. M I N U E 3 S 5 A L ER T TECHNOL O GIES PLOT OF UL LA GE TEST DATA CHEVRON 1990 TAFT HWY. BAKERSFIELD, CA 93313 15000 GALLON PREMIUM TANK 12KHz AMPLITUDE RATIO 25KHz AMPLITUDE RATIO 0+ 0. M I N U E 3 S tl 12KHz DETECTION RATIO = 1.00 25KHz DETECTION RATIO = 1.00 TEST RESULT = PASS DATE AND TIME OF TEST: 6/29/00 12:22AM BEGINNING BOTTLE PRESSURE- 2800 ENDING BOTTLE PRESSURE = 1200 BEGINNING TANK PRESSURE = 1.5 PSIG ENDING TANK PRESSURE = 1.5 PSIG 0 9 0 9 ALERT TECHNOLOGIES PLOT OF UL LA GE TEST DATA CHEVRON 1990 TAFT HWY. BAKERSFIELD, CA 93313 i 8000 GALLON DIESEL TANK 12KHz AMPLITUDE RATIO 25KHz AMPLITUDE RATIO 0.75 1.5 750+ 0.75 1.5 750+ M M I I N N U U E 3 E 3 S S 5 `. 5 12KHz DETECTION RATIO = .997 25KHz DETECTION RATIO = 1.00 TEST RESULT = PASS DATE AND TIME OF TEST: 6/29/00 12:11AM BEGINNING BOTTLE PRESSURE = 2800 ENDING BOTTLE PRESSURE = 1800 BEGINNING TANK PRESSURE = 1.5 PSIG ENDING TANK PRESSURE = 1.5 PSIG LA 9 0 - �j 5643 BROOKS CT BAKERSFIELD,CA.93308 OFFICE(661)392 -8687 & FAX (661)392 -0621 AES MODEL PL•T -100R HYDROSTATIC PRODUCT LINE TESTER w /O #: Facility Name: C'14-rOPA 1) Facility Address : % C1 c '71�? —LT– Product Line Type (Pressure, Suction, Gravity) RE'C fte,- PRODUCT START TIME /READING END TIME /READING TEST PRESSURE VOLUME RATE RESULT PASS/ 1 ,U 1,- 10-30 00 © L 04 j Z 01� -, 0 1 2 6�4S I certify that the above line tests were conducted on this date according to the equipment manufacturer's procedures and limitations and the results as listed are to my knowledge true and correct. The test pass /fail is determined using a threshold of 190 ml per hour (0.05 GPH) rate at 150% working pressure or 50 psi which ever is less. The GPH rate is calculated as: ml/ 0.00106. Tech: JAMES J. RICH Signature: wM 'C State License:# 99 -1072 Date: y Oc-) Ile /G',¢, IW'4l S7 (0013- 30/ Sensor Installation Installation Hardware The Sump Sensor's Installation kit is shown in Table 1: Site Preparation 01 Table 1. Sump Sensor Installation Kit (P/N 330020 -076) Item Oty. Description Part No. 1 2 Mounting strip 330314 -001 2 2 #4 -20 x 3/8" Plastite screw 510500 -398 3 3 1/4 " -20 x 1/2" Bolt, hx hd 503328 -001 4 3 1/4 " -20 Speed nut 511000 -232 5 2 Wire nut 576008 -461 6 1 Sealing pack 514100 -304 7 1 Cord grip 331028 -001 8 2 Tie wrap 510901 -337 Check that the Sump Sensors field wiring is not connected to the console. Mounting Sensor to Support Member 1. Make sure no liquid exists in the sump. Failure to comply can result in undetected potential environmental and health hazards. 2. Attach one of the mounting strips to the top of the sensor using the 2 Plastite screws provided as shown in Figure 1. Important! The sensor must be positioned in the lowest part of the sump and it must be mounted in a true verti- cal position to ensure proper operation, of the float switch contained inside. 3. Depending on your mounting requirements (again see Figure 1), attach the second mounting strip to the first strip using two 1/4 -20 x 1/2 -inch screws and speed nuts. With the sensor resting on the bottom of the sump, wrap the mounting strip around the support member and secure it using a 1/4 -20 x 1/2 -inch screw and speed nut. 4. Carefully bend the mounting strip so that the sensor is in a true vertical position and still rests on the bottom of the sump. 5. Install the cord grip into the junction box. Feed the sensor cable through the cord grip on the junction box. Tighten the cord grip nut to ensure a water -tight seal at the cable entry. 07/18/2010 14:02 IFAX EH @CO.KERN.CA.US 07/16/2010 14:04 6613268934 RICH + Dept Main RICH ENVIRONWNTAL SERVICE STATION SER3CE5 5643 BROOKS CT. - BAKERSFIELD, CA 93308 OFF: (661) 326 -8402 FAX (661) 326 -8934 james.res gmalcom FAX COVER SHEET HATE: -7 ! �v TEWE: NO. OF PAGES: r n. ATTENTION: COMPANY: FAX #• �w �o 70� FROM: JAMIE MCCAIN IF YOU HAVE ANY QUESTIONS PLEASE CONTACT ME AT MY OMCE. THANK YOU la 001 /005 PAGE 01/05 07/16/2010 14:02 IFAX EH @CO.KERN.CA.US Dept Main fa002 /005 07/16/2010 14:04 6613268934 RICH. PAGE 02/05 1] i saai:ED . • EURO PROTOCOL PREFIX _ .... _._...._.......... - -- ...._ y/` S I IN -TANK SETUP SOFTWARE REVISION LEVEL -SYSTEM SECURITY - VERSION 329.01 SOFTWARE0 346329 -1006 CODE : 000000 T 1:REGULAR 87 PRODUCT CODE 1 CREATED - 09.01.29.15.44 MAINTENANCE HISTORY THERMAL COEFF :.000700 NO SOFTWARE MODULE 1 SAI3LED TANK DIAMETER : 120.00 TANK TANK PROFILE : 4 PTS' SYSTEM FEATURES: FULL VOL : 19951 PERIODIC IN -TANk TESTS ANNUAL IN- TANK.TESTS TANK CHART SECURITY 90.0 INCH VOL : 16262 DISABLED 60.0 INCH VOL : 10044 30.0 INCH VOL : 3804 CUSTOM ALARMS DISABLED FLOAT SIZE: 4.0 IN. WATER WARNING 2.0 SERVICE NOTICE HIGH WATER LIMIT: 3.0 DISABLED MAX OR LABEL VOL: 19951 OVERFILL LIMIT 90% SYSTEM SETUP ISO 3166 COUNTRY 17956 - - 13 20117 - - - - - JUL CODE: HIGH PRODUCT 95% 18953 DELIVERY LIMIT 10% MASS /DENSITY 1995 SYSTEM UNITS . • . D I SA73LED LOW PRODUCT 642 U.S. SYSTEM LANGUAGE LEAK'ALARM LIMIT: 99 SUDDEN LOSS LIMIT: ENGLISH .'50 TANK TILT 0.00 SYSTEM DATE /TIME FORMAT PROBE OFFSET 0.00 MON DD YYYY HH,:MM:BS xM CHEVRON SIPHON MANIFOLDED TANKS 1959 TAFT.HWY Tit: NONE BAKERSFIELD CA LINE MANIFOLDED TANKS 661--398 -8882 TO; NONE SHIFT TIME 1 : DISABLED COMMUNICATIONS SETUP I SHIFT TIME 2 DISABLED _ _ _ _ _ _ _ _ _ _ LEAK MIN PERIODIC: 15% SHIFT TIME 3 : DISABLED 2992 SHIFT TIME 4 : DISABLED TANK PER TST NEEDED WRN PORT SETTINGS: LEAK MIN ANNUAL 15% DISABLED TANK ANN TST NEEDED WRN COMM BOARD .:'1 (RS -232? 2992, DISABLED BAUD RATE 1200 PARITY ODD PERIODIC TEST TYPE LINE RE- ENABLE METHOD STOP HIT 1 STOP STANDARD PASS LINE TEST DATA LENGTH: ,7 DATA RS --232 SECURITY ANNUAL TEST FAIL. LINE PER.TST NEEDED WRN CODE : DISABLED ALARM DISABLED, DISABLED LINE ANN TST NEEDED WRN PERIODIC TEST FAIL DISABLED AUTO TRANSSMIT SETTINGS: ALARM DISABLED PRINT TC VOLUMES AUTO LEAK ALARM LIMIT GROSS TEST FAIL ENABLED DISABLED ALARM DISABLED AUTO HIGH WATER LIMIT TEMP COMPENSATION DISABLED ANN TEST AVERAGING: OFF VALUE (DEG F ): 60.0 AUTO OVERFILL LIMIT PER TEST AVERAGING: OFF STICK HEIGHT OFFSET DISABLED AUTO LOW PRODUCT TANK TFST NOTIFY: OFF DISABLED DISABLED ULLAGE: 90% AUTO THEFT LIMIT TNK TST SIPHON BREAK:OFF H- PROTOCOL DATA FORMAT DISABLED AUTO DELIVERY START DELIVERY DELAY 5 MIN HEIGHT DAYLIGHT SAVING TIME DISABLED PUMP THRESHOLD 10.00% ENABLED AUTO DELIVERY•END START DATE DISABLED' AUTO EXTERNAL INPUT ON APR WEEK 1 SUN DISABLED START TIME AUTO EXTERNAL INPUT OFF 2:00 AM END DATE D I SABLED OCT WEEK SUN AUTO SENSOR FUEL ALARM ,6 END TIME DISABLED 2:00 AM AUTO SENSOR WATER ALARM DISABLED AUTO SENSOR OUT ALARM 67/16/2010 14:02 IFAX EH @CO.KERN.CA.US 07/16/2010 14 :04 6613268934 T 2:SUPREME 91 PRODUCT CODE 2 THERMAL COEFF ;.000700 TANK DIAMETER 120,00 TANK PROFILE 4 PTS FULL, VOL : 15104 90.0 INCH VOL 12349 60.0 INCH VOL 7605 30,0 INCH VOL ; 2843 FLOAT SIZE: 4.0 IN. WATER WARNING 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 15104 OVERFILL LIMIT 90/1, 13593 HIGH PRODUCT 95%6 14346 DELIVERY LIMIT 104. 1510 LOW PRODUCT 468 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 0,00 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS TO.' NONE LINE MANIFOLDED TANKS TO: NONE LEAK MIN PERIODIC: 15% 2265 LEAK MIN ANNUAL 15?/4 2265 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 5 MIN PIMP THRESHOLD 10,00% RICH T 3 :DIESEL PRODUCT CODE 3, THERMAL COEFF :.000450 TANK DIAMETER 96,00 TANK PROFILE 4 PTS FULL VOL 7829 72.0 INCH VOL 6652 48.0 INCH VOL : 4147 24.0 INCH VOL 1540 FLOAT SIZE: 4.0 IN. WATER WARNING 2.4 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 7829 OVERFILL LIMIT 90% 7046 HIGH PRODUCT 95s6 7437 DELIVERY LIMIT ion 782 LOW PROWCT 359 LEAK ALARM LIMIT: 99 LUMEN LOSS •LIMIT : 5.0 TANK TILT 0100 PROBE OFFSET 0.00 SIPHON MANIFOLDED TANKS T#: NONE LINE MANIFOLDED TANKS TO: NONE LEAK MIN PERIODIC: 15%6 1174 LEAK MIN ANNUAL : 15% 1174 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 5 MIN PUMP THRESHOLD 1'0.009, + Dept Main LEAK TEST METHOD 16003/005 PAGE 03/05 TEST ON DATE : ALL TANK JAN 29. 2009 START TIME : DISABLED TEST RATE :0.20 GAL/HR DURATION : 2 HOURS TST EARLY STOP:DISABLED LEAK TEST REPORT FORMAT NORMAL LIQUID SENSOR SETUP L 1 :87 ANNULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 2:91 ANNULAR TRI - START~ (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 3 :DIESEL ANNULAR TRI -STATE (SINGLE FLOAT). CATEGORY : ANNULAR SPACE L 4 :87 STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 5:91 STP SUMP TRI -STATE (SINGLE FLOAT) CATEGORY : STP BUMP L 6 :DIESEL STP SUMP TRI --TAT£ (SINGLE FLOAT) CATEGORY : STP SUMP 67/16/2010 14:02 IFAX EH @CO.KERN.CA.US Dept Main Ia004 /005 07/16/2010 14:04 6613268934 RICH PAGE 04/05 PMC SETUP ALARM HISTORY REPORT OUTPUT RELAY SETUP PMC'VERSION 01.02 ° - - - - -- IN -TANK ALARM - - - - -- R !:REGULAR 87 VAPOR PROCESSOR TYPE VEEDER -ROOT POLISHEk T 2-SUPREME 9l TYPE: STANDARD NORMALLY CLOSED ANALYSIS TIMES TIME: 10:00 AM IN -TANK ALARMS DELAY MINUTZO: i T 1:HIGH WATER ALARM T !:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 4 :FUEL ALARM L 4 :SENSOR OUT ALARM * * END x x x R 2 :SUPREME 91 TYPE: STANDARD ALARM HISTORY REPORT NORMALLY CLOSED - - - -- SYSTEM ALARM - - - -- PAPER OUT IN -TANK ALARMS JUN 19, 2010 6:42 PM T 2:HIGH WATER ALARM PRINTER ERROR T 2:LOW PRODUCT ALARM JUN 19, 2b10 6:42 PI-1 LIQUID 'SENSOR ALMS ALARM HISTORY REPORT L 5 :FUEL ALARM L 5 :$ENSOR OUT ALARM - - -- IN -TANK ALARM -� - -- R 3�:+DIE2EL T 3:1)[E$EL TYPLi : STANDARD OVERFILL ALARM NORMALLY CLOSED JAN 31. 2010 8:41 PM * * x END x x x x x DEC 28, 2009 5:46 PM DEC 13. 2009 5:57 PM IN-TANK ALARMS T 3 :HIGH WATER ALARM T 3:LOW PRODUCT ALARM LIQUID SENSOR ALMS L 6:FUEL ALARM L 6:8ENSOR OUT ALARM ALARM HISTORY REPORT * x* x END x lE x x x ----- IN-TANK ALARM --- - -- T !:REGULAR 87 OVERFILL ALARM SMARTSENSOR SETUP JUL 11, 2010 8 :42 PM _ _ _ _ _ _ _ JUL 4, 2010 6:04 PM - _ FEB 12, 2010 3 :37 AM S !:VAPOR PRESSURE CATEGORY VAPOR PRESSURE DUCT ALARM HIGH PRODUCT ALARM JUL 4. PM. ALARM HISTORY REPORT 2:CARBON•CANISTOR CATEGORY VAPOR VALVE - - - -- SENSOR ALARM - - - -- L 1:87 ANNULAR S:ATM ANNULAR SPACE CATEGORY ATM.P SENSOR FUEL ALARM JUL 13, 2010 10:2q AM SENSOR OUT ALARM FEB 20. 2010 2:30 PM * * * x END SENSOR OUT ALARM FEB 20. 2010 2:25 PM FA 07/18/2010 14:02 IFAX EH @C0.KERN.CA.U8 07/16/2010 14:04 6613268934 ALARM HISTORY REPORT -- SENSOR ALARM --- -- L 2:91 ANNULAR ANNULAR SPACE FUEL .ALARM JUL 13. 2010 10:21 AM SENSOR OUT ALARM NOV 25. 2009 1 :4a PM SENSOR OUT ALARM NOV 15, 2005 4:46 PNI END w * ALARM HISTORY REPORT - -- -- SENSOR ALARM - - - -- L 3:DIESEL ANNULAR ANNULAR SPACE FUEL ALARM JUL 13. 2010 10:22 AM FUEL ALARM JUL 27, 2009 2:52 PM FUEL ALARM JUL 27. 2009 2:50 PM 9Xx ** END XAXxx ALARM HISTORY REPORT SENSOR ALARM L 4:87 STP SUMP STP SUMP FUEL ALARM JUL I.S. 2010 10:19 AM FUEL ALARM JUL 27, 2009 12:52 PM RICH + Dept Main ALARM HISTORY REPORT `— SENSOR ALARM - -- — L 5:91 STP SUMP STP SUMP FUEL ALARM JUL 13, 2010 10 :19 AM FUEL ALARM JUL 27, 2009 12 :663 PM �4 * END R * x * k ALARM HISTORY REPORT -- SENSOR ALARM - - - -- L 6:DIESEL STP SUMP STP SUMP FUEL ALARM JUL 13, 2010 10:18 AM FUEL ALARM JUL 13, 2010 10:1Q AM SETUP DATA WARNING FEE 20- 2010 2:57 PM mx06 x* END x*x*x 0005/005 PAGE 05/05 •i '7,. jib �. Al - SO _. ."fr JAO :Imlc XJMWA Ur a* 004 v9sow Paul* la" 'P ; u , .+.gyp, °" "K�. rid, V.'i . .xae— — .mIVW1. ft PAL { ` <Irr� WU -'Ott 4WAAW.W. = b++�sF,¢uwjii�SS• R 3 .7l .'�f4 aa��SfAfgc -q! -M!W— ! "u'�t,�' ]*—, '� U ' V �C.�gS:� a, {4 T4i�%�i'...�Ti, l,��x''.w"[r - ilk+ F'•� .'.J�Rf�RJ.iw�sfl[ -� GOMM- Mat STblkAi OVND F MT APE tA"`O io MONTHLY ZHSp jECTIOJ. Insectttin 177r: -� ✓ ,�--�° CAP City: 'ST tlper Conducting to section: JERRY Camicii Cefiltcation No.: RY C'ONZALEZ 805$915 -UC Expiration Hate 2J241201,2 . . Phone (661) 326 -8402 +apt. MONITORING PANEL I ALARM tH11, ORX NIA = Not la the it s tem veered on and in ro r o ratin mode? Yes No . 41, is moitort s not currentt 11 howin 2 allillr leak alarms ?' U the Alam liistoty Repoli 1 og for the previous month availtibl L3S"1' e. and has it been reviewed by tine, - ' (Attach a Ca a the alarm h' Me art/la to this ins ctioa rm} + a,ra %re ious month been nded to app ro riatel ? Are UST SYSTEM INSPECTION tank -top c aittsininem sumps free of b iW, deb ris. and hazardous substance? Note. 'q /the ateom, to irem a °Yes, ° ilap AD Iltaa't 6. SUMPS **em an alarm has occurred in the past month must-be inspected ija qualified servlct technician has not domed &lie taase o tits t- t7bc .vtpanded'to and a rrtt ameata[ton t vw-j, king a ro Hatt servire should 11e nrtached to this Yes I No Yes No NIA Yes TVn L'0cation= 31M ❑ ❑ , Sum Location: Sumo Location: Location: r � A M"m t ? . . 1 f - . . • . . .. Yes No NIA 31M I- r r u r � A M"m r �m��] tr WYE M11FOIN • r ; <1 �UL� r 1 �FL�� MA m 1" W _ al r 1 r :® �' • - M:1 . . 1/ -•1 .. . f •�tl •• "Al, .flM.wt� •° ��r .• t :tl r Y w �_— lotmoI Yet �; x€ rl, SF .� £. _ ��� it "�'- r w r e. a b. 1 n.- �. h • f 1 - • b.1 •'.. li PAP_ � it J 60 AAeSwf fp,�iy.yiy}4c``il.��"9�v a�. 4 t��t^Ai�n5 i 08/17/2010 11:19 IFAX EH @CO.KERN.CA.US Dept Main la 001/001 06/17/2010 11:22 6613268934 RICH PAGE 01/01 RICH ENVVIRONMENTA.L 5643 BROOKS CT. BAKERSFIELD, CA 93308 OFFICE (661)326 -8402 FAX (661)326 -8934 ianaes.xesla�.�mail.coxa DATE: to i�i TIME: NO.PAGES. ♦ n_aw7t'+v 11.1 crl u LA A T7!'1'AT. ATTENTION: PHONE #: AGENCY: c-y CELL #: CONF. NAME/DATE: FAX #: —� C DATE REQUESTED: I TIME REQUESTED: :oa .JA A - AA NAME: A•• NAME: ADDRESS: 1 p l 1 C�c\ --� ADDRESS: CITY: TP20I.4 BLOCKAGE TEST PHONE #: —I 6 _ PHONE #: OWNER: Z-6 ^ A SITE COMF: TrL`TifT/� 1 Y'IVVIYI IIV MY'N'1'A1. MM A1.1 -N -I N.. %l Iml- TP20I3 LEAK DECAY MONITOR CERTIFICATION TP20I.3B LEAK DECAY ON AGT LINE LEAK DETECTOR TEST TP20I.4 BLOCKAGE TEST SB989 ANNUAL SPILL BOAC, TEST TP7.0I.5 A/L RATIO TEST 3 -YEAR SB989 TEST TP201.6 LIQUID REMOVAL TEST LINE TEST TP20I.I11 TORQUE 'TEST TANK INTEGRITY TEST TPZOI.IC/D DROP TUBE TEST DESIGNATED OPERATOR INSPECTION TP201AE PN VALVE 'TEST FACILITY INSPECTION LEAK DECAY OF CLEAN AIR SEPERATOR CATHODIC PROTECTION VOLUME TO LIQUID RATIO TEST HELIUM TEST PERIODIC COMPLIANCE INSPECTION TECHNICIAN: ICC CERT# �9` 5 7 r NOTES: TESTING ESTIMATE LABOR ESTIMATE PARTS ESTIMATE TOTAL ESTIMATE ��' < lC c� � �, 0 S Permit #: N umber of Tanks: C - Comnliant NA - Not Applicable 9 UNDERGROUND STORAGE TANK (UST) BP #: I - Class I Violation II - Class lI Violation M - Minor Violation C NA Code w — ; G ` =M M COMMENTS FILE REVIEW (Review Date: ) UTO1 Statement of Financial Responsibility submitted (HSC 25292.2(a)) UT02 Copy of Owner /Operator Agreement submitted (HSC 25284) UT03 Written Monitoring Plan submitted and approved (CCR 2632(d)(1), 2641(h)) , UT04 Written Response Plan submitted and approved (CCR 2632 (d)(2),2641 (h)) UT05 ?'n al M itoring System Certification completed on and submitted (CCR 2630(d), 264 10)) Cathodic Protection System tested on UT06 (every three years) and the results submit e (CR 2635(a), 2662 (b)) UT07 Secondary Containment Systems tested an ' (every three years) and the results submitted CC 2637(a)) Enhanced Leak Detection completed on UT08 (every three years) and the results submitted (CCR 2635(a), 2662 (b)) SITE INSPECTION UT09 Written Monitoring Plan on site (CCR 2632(d)(1), 2641(h) UTI0 Written Response Plan on site (CCR 2632(d)(2), 2641(h)) UTI 1 Monitoring equipment functioning as designed (CCR 2632) UT12 UST Systems monitored according to Written Monitoring Plan (HSC 25293) UT13 Monitoring records are provided upon request (within 36 hours) (CCR 2712(b)) Spill /Overfill equipment installed and maintained properly UT14 (CCR 2635) Type of overfill equipment: UT15 60 -day inspection log maintained for impressed cathodic protection systems (CCR.2635(a)(2)(A)) Changes in usage /conditions to operate/monitoring UT16 procedures of the UST system or ownership changes reported within. 30 days (CCR 2712). UT17 All unused tanks are properly closed (HSC 25298) UT18 Any unauthorized release was properly reported within 24 hours (HSC 25295) Dispenser pan(s) installed ❑ Yes ❑ No Type of monitoring: Comments: POST INSPECTION INSTRUCTIONS: Within five days of correcting all violations, sign and return to the Agency at: Kern Co. Environmental Health Services Dept., 2700 °M" Street, Suite 300, Bakersfield, CA 93301, Attention: Signature (Violations have been corrected as noted) Date ENVIRONMENTAL HEALTH 580 4113 2098 (8103) \1 5 =� 3 s� of N� 1�LJ e S —Io j) s& s TC o j e !/ N � � ----- SENSOR ALARM - - - - -- L 3:DIESEL ANNULAR ANNULAR SPACE 'PUEL'ALARM .MAY 1, 2000 lo.,,15 AM Lf 3:DIESEL AfINULAR ANNULAR SPA(,-�E' FUEL ALARM MAY 1 2000'10:-16 AM SENSOR ALARM -L 2:92 ANNULAR ANNULAR SPACE" FUEL ALARM MAY 1, 2000 10:17 AM -----,,'SENSOR ALARM--- - 1. 1:87 ANNULAR ANNULAR SPACE FUEL ALARM MAY 1, 2000 10:22 AM ----- SENSOR iALARM L 6:D I ESEL 'STP• SUMP STP SUMP FUEL ALARM MAY 1, 2000 10:51 -AM SENSOR ALARM - - - -- L 4:87 STP SUMP STP SUMP FUEL ALARM RM MAY 11 '10:54 All - - - -- ..SENSOR ALARM - - - -- L 1:8Y ANNULAR ANNULAR SPACE FUEL'-ALARM M AY -�1,,� 2000 9:54 AM 's - - - -- SENSOR ALARM — — q�\ L 3 : D I ESEL ANNULAR• ANNULAR SPACE s k, FUEL ALARM MAY 1, 200Q 9:57 AM ----- SENSOR ALARM - -��;- L 1:87 .ANNULAR ANNULAR SPACE FUEL -ALARM o, MAY 1, ,, 2000 9 : 54i AM .1 - -- SENSOR ALARM - - - -- L; 3:DIESEL ANNULAR ANNULAR SPACE FUEL ALARM MAY 1..2000 9:58 AM - - - -- SENSOR ALARf °1 - -` -- -1. 2:92 `ANNULAR ANNULAR :SPACE FUEL ALARM MAY 1 ,x'000 9:55 AM • -- - -- SE14SOR ALARNI - - - -- L 5:92'STP SUMP f STP SUMP FUEL ALARM .. MAY 1, 2000 10:00 AM -- SERISOR �LARr•I - - - -- i ; � - L 2:92 ANNULAR L ANNULAR SPACE FUEL ALARM MAY 1, 2000 9:56 AM 7 KERN COUNTY ENVIRONMENTAL INSPECTION RECORD 2700. "M" STREET, SUITE 300 HEALTH SERVICES'`DEPARTMENT BAKERSFIELD; CA. 93301 HAZARDOUS MATERIALS PROGRAM POST CARD AT JOBSITE - (661) 862 - 8700, ; PERMIT #: 320074B OWNER:, S &W Truck Stop, Inc. .. FACILITY: S & W Chevron CONTACT: ADDRESS: 2166 Taft Hwy. ADDRESS: 2701 Sierra Vista Street CITY: Bakersfield; CA CITY: Bakersfield, CA 93306 . PHONE #: ( ) - PHONE #: (661) 366 -5542 INSTRUCTIONS: Please call for.an inspection or submit the requested information when ready. They will run in consecutive order beginning with number 1. DO NOT cover work for any numbered group or continue with the next phase of work. until all items in that group are signed off by the Permitting Authority. Following these instructions will reduce the number of required inspection visits and therefore the assessment of additional fees. INSPECTION DATE INSPECTOR TANKS & BACKFILL 1 Backfill of tanks 3 -9, -Oo u 1 Copy of installation check list —�(7 .W Bryan McNabb 2 ., Drop tube valves Sl PIPING SYSTEM - 1 Primary piping pressure /soap test 3 -9, -Oo u 2 Corrosion protection of piping & fill pipe —�(7 .W Bryan McNabb SECONDARY CONTAINMENT, OVERFILL PROTECTION - 2 Secondary, piping pressure /soap test 3_9_00 LICENSE # 2 Sump test CONTACT Bryan McNabb 2 ., Drop tube valves Sl t ' .Please contact the Fire Department at (661) 391 -7082 and Building (electrical) Department at (661) 862 -8661 to schedule final inspections with them before calling this "department for the final inspection. FINAL - 3 As -built drawings Lutrel Services, Inc. LICENSE # 3 Integrity test of system CONTACT Bryan McNabb 3 Overspill boxes Sl 4 'Line Leak Detectors /Positive'Shut Down 4 Monitor System Check r 4 Monitoring Requirements _ 4 Submittal of owner information and Form C CONTRACTOR Lutrel Services, Inc. LICENSE # 675587 CONTACT Bryan McNabb PHONE #-(661) 399 -0246 t , ,t . F , _ _ � 1 � ' , � � a. ,� it i , ENVIRONMENTAL HEALTH.SERAES C STEVE McCALLEY,: R.E.H.S., Director. 2700 "M" STREET, SUITE 300 BAKERSFIELD, CA 93301 -2370 Voice: (661) 862 -8700 &O"UR'CE MANAGEMENT AGENCY DAVID PRICE 111, RMA DIRECTOR , Community Development Program Department Engineering & Survey Services Department ' - Fax:-' (661) 862 -8701 Environmental Health Services Department � � � � '' . TTY Relay: (800) 735 -2929. • 'Planning Department e -mail: eG@co:kern.ca,us - Roads Department PERMIT TO. CONSTRUCT UNDERGROUND STORAGE FACILITY PERMIT NUMBER. 320074B . FACILITY OWNER(S) NAME/ADDRESS:. CONTRACTOR: S.& W Chevron S & W Truck Stop, Inc. Lutrel Services, Inc. 2166 Taft. Highway; ,: 2701 Sierra Vista Street 6315'Snow Road Bakersfield, CA Bakersfield, CA 93306 Bakersfield, CA 93308. License #: 675587 Phone No. (661) 366 -5542 Phone No. (661) 399 -0246 X NEW CONSTRUCTION PERMIT EXPIRES Anril 11, 2000 MODIFICATION _ OTHER APPROVAL DATE January 11, 2000 APPROVED .BY Laurel Funk Hazardous Materials Specialist :... ..... ..... ..... POST`ON PREMISES ..... ......... ..... ..... CONDITIONS AS FOLLOW: Standard Instructions 1.::... All,constructioii to be as per facility plans approved by this department and verified by inspection by Permitting Authority. { 2.• All.•equipment and materials in this construction must be installed in accordance with all manufacturers' specifications. 3 Permittee must contact Permitting Authority for on -site. inspections) with 48 -hour advance notice. : 4. Backfill material for piping and tanks to.be as per manufacturers'-specifications. 5`. Construction, inspection record card is included with permit given to Permittee. This card must be posted at job . site prior to initial inspection. Permittee must contact Permitting Authority and arrange for each group, of required, inspections numbered as-per instructions on card. Generally, .inspections will be made of: a. Tank and backiill _ b. Piping system with secondary containment c Overfill protection'and leak detection/monitoring d. Any other inspection deemed necessary by Permitting Authority. PERMIT TO. CONSTRUCT UNDERGROUND STORAGE FACILITY (Page-2) Standard Instructions Permit. No. 320074B 6. All underground metal connections (e.g. piping, fitting, fill pipes) to tank(s) must. be electrically isolated. and wrapped to a minimum 20 mil thickness with corrosion - preventive, gasoline_ resistant tape or otherwise protected from corrosion. 7. Primary and secondary containment of both tank(s) and underground piping must not be subject to physical' or chemical deterioration due to the substance(s) stored in-'them., 8. No product shall be stored in tank(s) until approval is granted by the Permitting Authority. 9. Monitoring requirements for this facility will be described on final "Permit to Operate." ACCEPTED BY: DATE: J 320074B.wpd � � ' s� ;... M r:. KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT 2700 "M" STREET, SUITE 300 BAKERSFIELD, CA 93301 PER NT NO, d O APN NUMBER_ / /2� APPLICATION DAT : , t 3 —6W APPLICATION FOR PERMIT TO CONSTRUCT /MODIFY UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY lew Facility LJ Modification of Facil umber of Tanks To Be Installed Type of Business XLkc-r . Facility Name Address I D % T R SEC (Rural B. Tank Owner, Address Installation at Existing Facil ility Permit # C'ty T-2A1;-�`�Cf--LZ0 Only) Nearest Cross Street_I_ACNOA)i Col Water To Facility Provided Ejy 'Z;6W� Depth To Groundwater3a0 I 'r Soil Characteristics At Facility, Phone #: Zip D. Contractor (.Lt!!(iE Contractor's License No. 'l. Address I o City Zi 95wg Phone # 39 --d Worker's Compensation Certi Ica Ion # CW Insurer o Proposed Starting Date I I I�A= Proposed Completion Date 118 (OLCM E. If This Application Is For Modification Of An Existing Tank Syst Briefly Describe Modifications Proposed (Excluding New Tank Installation at Existing Facilities) W F. Tank(s) Storage (Check All That Apply): Unleaded Other" Waste Other" Other` Tank # Unleaded Plus Premium Diesel Fuel Oil Waste Product 1 00 0-- ( 1 t, tXl t, t ► 1, c, t, '� (1 1► (1 o0 1► (► t► l► 11 11 l) I1 l► 11 11 (1 " Describe other products /waste: G. Initial Tank Integrity Test Informati n: Testing Company Name: 14 Phone # Test Method: Licensed Tester: A tank integrity test is not required if the tank is equipped with an interstitial monitor certified to meet the performance standards of a "tank integrity test." This form bbe comp ted u der penalty of perj Pan,0 to the best of my knowl a is true and correct. Signaturec Title Date HM36 (1/291961 TANK INORMATION FORM Facility ID: (Complete one form for all tanks with the same design) 1998: ❑ Yes ❑ No IA Tank Information Please Print Tank Numbers) 0 0 L ontent s) Vi1V_ Capacity CU) Tank Manufacturer: u;D A) Date Installed Tank Construction: ❑ Single -Wall )K_ Double -Wall ❑ Jacketed ❑ Vaulted ❑ Other Tank Material: ❑ Carbon Steel ❑ Fiberglass -Clad yi Fiberglass ❑ Concrete ❑ Other Methanol Compatible Yes ❑ No Tank Interior Lining: Unlined ❑ Lined (material) Corrosion Protection: ❑ Fiberglass -Clad ❑ Sacrif' 'al ode ❑ None • Polyethylene /Vinyl Other • Impressed Current (describe) Spill Containment: (make & model) l_Jt ( l� � Year Installed a Overfill Prevention: (make & model) lJ1"W U11 �V —' ��� Year Installed Tank Repairs: (dates & descriptions) Aw� B Please Print Type of System: Pipe Construction Piping Information 4 Pressure ❑ Suction ❑ Approximate length of this pipe run: • Single -Wall K Double -Wall ❑ • PVC Sleeve ❑ Other Gray't ❑ None Liner Raceway Pipe Material: ❑ Steel o Fiberglass F x ' e ( st mat real) A,v ❑JJ` cOther Pipe Manufacturer: Z O� � Date Installed C Monitoring Information Please Print and Check All That Apply Tank Monitoring: Primary: � Auto -Tank Gauge C1 Manual Gauging ❑ Statistical Inventory Reconciliation ❑ Groundwater • Vadose Zone `�A ❑nw Oth r Describe make and model G! I lJ pyl( -3 101 UFXUS Secondary: Liquid Sensor ❑ Vapor Sensor ❑ Hydrostatic ❑ Other Describe make & modelnHbAM N o Alarm: K Yes ❑ No Pipe Monitoring: Primary: Reduced Flow ❑ Shut Down ❑ Other Line Leak Det c r ea]� Detector / Describe make & model (F ne i_�(h —"� Secondary: Liquid Sensor y< ,, a or Se nso �g„aottheer Descri a make & mo 1 1 �/ 'S�/ Alarm: Yes ❑ No Pump Shut Down: Yes ❑ No HM3'8 0 9. TANK IIARMATION FORM Facility ID: (Complete one form for all tanks with the same design) 1998: ❑ Yes ❑ No I A Please Print I Tank Information Tank Number(s)b 0 � Conten (s) �� - � Capacity Tank Manufacturer: ULk Ll&,4 7 Date Installed / Tank Construction: ❑ Single -Wall 1�- Double -Wall ❑ Jacketed ❑ Vaulted ❑ Other Tank Material: ❑ Carbon Steel ❑ Fiberglass -Clad Fiberglass ❑ Concrete ❑ Other Methanol Compatible Yes ❑ No Tank Interior Lining: K Unlined ❑ Lined (material) Corrosion Protection:. ❑ Fiberglass -Clad ❑ Sacrif' 'Mal ❑ None • Polyethylene /Vinyl Other alAi_TiY -i�.� l • Impressed Current (describe) Spill Containment: (make & model) / b (Ie d1 C Year Installed '0� Overfill Prevention: (make & model) �J� Vl1OD '- eLhQ Year Installed 5-0z— Tank Repairs: (dates & descriptions) /UDC, B Please Print Type of System: Pipe Construction: Piping Information Pressure ❑ Suction ❑ Gravity / ❑ None pproximate length of this.pipe run: • Single -Wall Double -Wall ❑ Liner Raceway • PVC Sleeve ❑ Other Pipe Material: ❑ Steel ❑ Fiberglass F XQ14 X; 14 st iqa erisi) ❑G Other I i Pipe Manufacturer: 1 Date Installed / M C Monitoring Information Please Print and Check All That Apply Tank Monitoring: Primary: Auto -Tank Gauge ❑ Manual Gauging • Statistical Inventory Reconciliation ❑ Groundwater • Vadose Zone + ❑ Ot r Describe make and model f(L-Vtp Secondary: �— Liquid Sensor ❑ Vapor Sensor ❑ Hydrostatic ❑ Other , Describe make & model Alarm: K- Yea ❑ No Pipe Monitoring: Primary: Reduced Flow ❑ Shut Down ❑ Other Line Leak Dete r =� �r�4?ine -�Leak Detector Describe make & model rif o &� Fy 0-p7 -�` Secondary: Liquid Sensor , .V,_ apor sor C3 Other Descri a make & mo 1i,VA- Alarm: C�Sg9Pa — EL, Yes, ❑ No Pump Shut Down: Yes ❑ No HM38 a � ,. ..; TANK INIORMATION FORM Facility ID: (Complete one form for all tanks with the same design) 1998: ❑ Yes ❑ No- A Tank Information Please Print Tank Number(s)LL Q ntent &A711AM Capacity V� jj • Tank Manufacturer: I � Date Installed Tank Construction: ❑ Single -Wall Double -Wall ❑ Jacketed ❑ Vaulted ❑ Other ,Tank Material: ❑ Carbon Steel ❑ Fiberglass -Clad Fiberglass ❑ Concrete ❑ Other B Please Print Type of System: Pipe Construction: Piping Information KPressure ❑ Suction Approximate'length of this pipe run: ❑ Single -Wall Y_ Double -Wall ❑ PVC Sleeve ❑ Other ❑ Gravity ❑ None ❑ Liner Raceway Pipe Material: ❑ Steel o Fiberglass F�s �e� ( t mat}gri ) ❑ Other CV'f 1=i C.O/�IGIK�r1 WC Pipe Manufacturer: lJ1JV(FVIV Date Installed C Monitoring Information Please Print and Check All That Apply Tank Monitoring: Primary: Auto -Tank Gauge ❑ Manual Gauging Statistical Inventory Reconciliation ❑ Groundwater ❑ Vadose Zone //�'�1 ❑ Ot G r Describe make and model �W& Secondary: K Liquid Sensor ❑ Vapor Sensor ❑ Hydrostatic ❑ Other Describe make & model I bus IYPIA o25q 11 Alarm: Yes ❑ No Pipe Monitoring: Primary: Reduced Flow ❑ Shut Down ❑ Other Line Leak Dete o L' a Leak etector Describe make_ & model �(�j-- OI`? -'� Secondary: 4 Liquid Sensor nsor Other Describe make & mod 1 Alarm: Yes ❑ No Pump Shut Down: Yes ❑ No . HM38 Methanol Compatible Yes ❑ No Tank Interior Lining: Unlined ❑ Lined (material) Corrosion Protection: ❑ Fiberglass -Clad ❑� Sacrif���a1� � Npnl,�5 • Polyethylene /Vinyl i_ Other �ci� • Impressed Current (describe) Spill Containment: (make & model) CPO I C C�Ic Year Installedgem Overfill Prevention: (make & model) CPO (pt o^ ��dQ Year Installed Tank Repairs: (dates & descriptions) B Please Print Type of System: Pipe Construction: Piping Information KPressure ❑ Suction Approximate'length of this pipe run: ❑ Single -Wall Y_ Double -Wall ❑ PVC Sleeve ❑ Other ❑ Gravity ❑ None ❑ Liner Raceway Pipe Material: ❑ Steel o Fiberglass F�s �e� ( t mat}gri ) ❑ Other CV'f 1=i C.O/�IGIK�r1 WC Pipe Manufacturer: lJ1JV(FVIV Date Installed C Monitoring Information Please Print and Check All That Apply Tank Monitoring: Primary: Auto -Tank Gauge ❑ Manual Gauging Statistical Inventory Reconciliation ❑ Groundwater ❑ Vadose Zone //�'�1 ❑ Ot G r Describe make and model �W& Secondary: K Liquid Sensor ❑ Vapor Sensor ❑ Hydrostatic ❑ Other Describe make & model I bus IYPIA o25q 11 Alarm: Yes ❑ No Pipe Monitoring: Primary: Reduced Flow ❑ Shut Down ❑ Other Line Leak Dete o L' a Leak etector Describe make_ & model �(�j-- OI`? -'� Secondary: 4 Liquid Sensor nsor Other Describe make & mod 1 Alarm: Yes ❑ No Pump Shut Down: Yes ❑ No . HM38 x �g� ;Q %W 0 0 o_c — xr -I..- Safety Valves -D View Cut out for installation _.y 3" x 2" Containment Boots Side View V,c fz "I I -Ic 3.• r� � • Kern Co Unty F i�°e Department 5642 Victor Street .\ Bakersfield, CA 93308 - Telephone 805391-7000 • Fax 805399 -2915 TTY Relay Service 1- 800 - 735-2929 11L)SO&-Z: o J ( ) For Information Only 0 Fire Chief DANIEL G. CLARK Deputy Chiefs DENNIS L. THOMPSON, OPERATIONS ROBERT OXFORD, LOGISTICS STEPHEN A. GAGE, OPERATIONS LeCOSTEL HAILEY, OPERATIONS CARY L. ECKARD, FINANCE DATE: 7 —D PERMIT NO.: Lo 7 JOB ADDRESS: OWNER:liC� MEET ALL OF THE FOLLOWING REQUIREMENTS COMPLIANCE LIST: Dispensers and Other Related Equipment with Underground Tanks .(Use with Health'Departament:. Plan. Review Process for:. Underground Tanks) Note: All tank cutting .'hot work" requires a request for a standby from the fire department. Please submit a signed Standby Request form at least two working.. days prior to commencing operations. 1. Dispensing devices shall be located as follows: a. Ten feet or more from property lines, b. Ten feet. or more from buildings -having combustible exterior wall surfaces or buildings having noncombustible exterior wall surfaces that are not part of a one -hour fire - resistive assembly. Exception: Canopies constructed in accordance with the Building Code. C. Such that all portions of the vehicle being fueled will be on the premises of the motor vehicle fuel- dispensing station, d. Such that the nozzle, when the hose if fully extended, will not reach within 5 feet (1524 mm) of the building openings, and , e, Twenty feet (6096 mm) or more from fixed sources of ignition. (5201.4:1.2) Service • Pride . Commitment Dispensers and Other Related Equipment with Underground Tanks (Page 2 of 3) 2. Post conspicuous signs prohibiting smoking, dispensing into unapproved container, to stop engine and the location of emergency shut -off switch. (5201.8) 3. Install an emergency shut down device. Emergency shut -off switch shall be within 75 feet of but not less than 25 feet from dispensers. (5201.5:3) 4. Dispensing devices shall be in clear view of the attendant with no obstacles placed between the attendant and the dispensers. (5202.4.7) 5. The attendant shall at all times to be able to communicate with the person, in the dispensing areas. (5202.4.7 (5)) 6'. Provide fire extinguishers (2A20BC between 15 to 75 feet from dispensers. (5201.9) 7. Flexible joints shall be installed in accordance with Section 7901.11.7. An approved emergency shutoff impact valve incorporating a fusible -link shall be rigidly mounted and connected by a union in the fuel supply piping at the base of each dispensing device, including the satellite dispensers. The shear joint shall be mounted flush with the top of the surface on which the dispenser is mounted. (5202.5.3.2) 8. An approved emergency shutoff impact valve incorporating a fusible -link shall be rigidly mounted and connected by a union in the vapor - return line at the base of each dispensing device. The shear section of the valve shall be mounted flush with the top of the surface on which the dispenser is mounted. (5202:12.3.5) 9. Approved fire checks or other positive means of automatic isolation of underground storage tanks shall be installed in vapor - return piping to, prevent a flashback from reaching the underground tanks. Such devices also shall be installed in all vapor /air piping as close as practical to each burner or group of burners in a vapor incineration unit, and in all vapor- transfer piping as close as practical to. refrigeration, absorption of similar types of processing equipment. (5202.12.3.8) 10. Vents from vapor - processing units shall not be less than 12 feet (3658 mm) aboveground level and not. less than 8 feet (2438 'min) above the processing in itself. Vent outlets shall be directed and located such that flammable vapors will not accumulate,. travel. to an unsafe location or enter buildings. (5202:12.3.9) 11. Incidents involving leaks, fires, explosions, overheating or requiring shutting down equipment, other than for routine maintenance or tests, shall be immediately reported to the fire department. (5201.12.3.12) 12. An electrical disconnect switch shall be, provided for all dispensers in accordance with the Electrical Code. The disconnect shall be placed in the OFF position before repairing dispensers and before closing a motor vehicle fuel- dispensing station. (5201.5.4) Dispensers and Other Related Equipment with Underground Tanks (Page 3 of 3) --------------- - - - - -- Unsupervised Dispensing------------ - - ---- 13.. Unsupervised dispensing is allowed when the owner, or operator provides, and is accountable for, daily site visits, regular equipment inspection and maintenance, conspicuously posted instructions for the safe operation of dispensing equipment, and posted telephone numbers for the owner or operators. A sign shall be posted in a conspicuous location reading: IN CASE OF FIRE, SPILL OR RELEASE 1. ' Use emergency pump shutoff! 2. Report the accident! Fire Department Telephone No. 9 -1 -1 Facility address 14. Signs shall be conspicuously posted within sight of each dispenser as follows: Prohibiting smoking Prohibiting dispensing into unapproved containers Requiring vehicle engines to be stopped during fueling 15. Dispensing equipment shall comply with one of the following: 1. The amount of,fuel being dispensed is limited in quantity'. by a preprogrammed card, 2. Dispensing devices are programmed or set to limit uninterrupted fuel delivery to 25 gallons and require a manual action to resume continued delivery; or 3. Product delivery hoses are equipped with a listed emergency breakaway device designed to retain liquid on both sides of the breakaway point. 16. A fire extinguisher with a minimum rating of 2 -A, 20 -B:C shall be provided and located such that it is not more than 75 feet from any pump, dispenser or fill -pipe opening. (FP:CHD /rga 11/20/98) wp61 /rarriaga/prev02/ugtank. cp1 IL. y BUSINESS f ER/OPERATOR IDENTIFI £ION " Kern County Environmental Health Services Department 2700 M Street, Suite 300 Unified Program Consolidated Form (UPCF) Bakersfield, CA 93301 FACILITY INFORMATION (661) 862 -8700 Fax (661) 862 -8701. L IDENTIFICATION Page I of I FACILITY ID9 I BEGINNING DATE loo .101 FA0003910 1 151 - 0 1 0- 11 0 0 3 2 9 0 03/01/2005 ENDING DATE 02/28/2006 BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 BUSINESS PHONE 102 TAFT HWY CHEVRON 661 398 -8882 BUSINESS SITE ADDRESS 103 BUSINESS FAX 102a 1999 TAFT HWY 661 398 -8884 BUSINESS CITY 104 ZIP CODE 105 COUNTY 108 BAKERSFIELD CA 93313 Kern County DUN'& BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a None specified None specified BUSINESS MAILING ADDRESS 108a 1999 TAFT HWY BUSINESS MAILING CITY 108b STATE 1 08o ZIP CODE I08d BAKERSFIELD CA 93313 BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 BARBARA YAM IL BUSINESS OWNER OWNER NAME 111 OWNER PHONE 112 PEK CC; INC' OWNER MAILING ADDRESS 113 1999 TAFT HWY OWNER MAILING CITY 114 STATE 115 ZIP CODE 116 BAKERSFIELD CA 93313 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 THOMAS SCOTT /PHILIP WELCH (661) 398 -8882 CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a 1999 TAFT HWY. barbarayam @yahoo.com CITY 120 STATE 121 ZIP CODE 122 BAKERSFIELD CA 93313 - PRIMARY - IV. EMERGENCY CONTACTS -SECONDARY - NAME 123 NAME 128 THOMAS SCOTT PHILIP WELCH TITLE 124 TITLE 129 OWNER OWNER BUSINESS PHONE 125 BUSINESS PHONE 130 (661) 398 -8882 (661) 398 -8882 24 -HOUR PHONE 126 24 -HOUR PHONE 131 (760) 376 -8653 (661) 397 -9983 PAGER # O- 127 PAGER # O- 132 ADDITIONAL LOCALLY COLLECTED INFORMATION 133 APN: 18416021 Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 Electronic Signature 04/30/2010 1 NAME OF SIGNER (print) 136 TITLE OF SIGNER. 137 BARBARA YAM BUSINE - WNER/OPERATOR IDEN .ATION Kern County Environmental Health Services Department 2700 M Street, Suite 300 Unified Program Consolidated Form (UPCF) Bakersfield, CA 93301 FACILITY INFORMATION (661)862 -8700 Fax (661) 862 -8701 • Page I of I 1. IDENTIFICATION FACILITY ID# I BEGINNING DATE loo 101 FA0003910 1 1 151 - 1 0 1 0 11 - 0 0 3 1 2 1 9 1 0 03/01/2005 ENDING DATE 02/28/2006 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 BUSINESS PHONE 102 TAFT HWY CHEVRON 661 398 -8882 BUSINESS SITE ADDRESS [03 BUSINESS FAX 102a 1999 TAFT HWY 661 398 -8884 BUSINESS CITY 104 ZIP CODE 105 COUNTY log BAKERSFIELD CA 93313 Kern County DUN &.BRADSTREET 106. PRIMARY SIC 107 PRIMARY NAICS 107a None specified None specified BUSINESS MAILING ADDRESS lose 1999 TAFT HWY BUSINESS MAILING CITY loan STATE 108] ZIP CODE load BAKERSFIELD CA 93313 BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 BARBARA YAM 11. BUSINESS OWNER OWNER NAME 111 O 112 PEK CC, INC OWNER MAILING ADDRESS 113 1999 TAFT HWY OWNER MAILING CITY 114 STATE 115 ZIP CODE 116 BAKERSFIELD CA 93313 111. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 THOMAS SCOTT /PHILIP WELCH (661) 398 -8882 CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a 1999 TAFT HWY. barbarayam@yahoo.com CITY 120 STATE 121 ZIP CODE 122 BAKERSFIELD CA 93313 - PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY - NAME 123 NAME 128 THOMAS SCOTT PHILIP WELCH TITLE 124 TITLE 129 OWNER OWNER 'BUSINESS PHONE 125 BUSINESS PHONE 130 (661) 398 -8882 (661) 398 -8882 24 -HOUR PHONE 126 24 -HOUR PHONE 131 (760) 376 -8653 (661)3.97 -9983 PAGER # O - 127 PAGER # O - 132 ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 A PN : 18416021 Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and Ain familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT 11 REPARER 135 a $ice 01/29/2009 NAME OF SIGNER (print) 136 -ITI'LE OF SIGNER 137 BARBARA YAM BUSINESOWNER/OPERATOR IDENT C ATION Kern County. Environmental Health Services Department 2700 M Street, Suite 300 Unified Program Consolidated Form (UPCF) Bakersfield, CA 93301 FACILITY INFORMATION (661) 862 -8700 Fax(661)862 -8701 Page 1 of 1 I. IDENTIFICATION FACILITY ID4 1 BEGINNING DATE loo lol FA0003910 1 151 = 0 1 0- 0 0 3 2 9 0 03/01 /2005 ENDING DATE 02128/2006 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 BUSINESS PHONE . 102 TAFT HWY CHEVRON 661 398 -8882 BUSINESS SITE ADDRESS 103 BUSINESS FAX 102a 1999 TAFT HWY 661 398 -8884 BUSINESS CITY 104 ZIP CODE 105 COUNTY 108 BAKERSFIELD CA 93313 Kern County DUN & BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 10.7a None specified None specified BUSINESS MAILING ADDRESS logs 1999 TAFT HWY BUSINESS MAILING CITY 1086 STATE 108c ZIP CODE 108d BAKERSFIELD CA 93313 BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE I10 BARBARA YAM II. BUSINESS OWNER OWNER NAME I I I OWNER PHONE 112 PEK CC, INC OWNER MAILING ADDRESS 113 1999 TAFT HWY OWNER MAILING CITY 114 STATE 115 ZIP CODE 116 BAKERSFIELD CA 93313 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 'THOMAS SCOTT/PHILIP WELCH (661) 398 -8882 CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a 1999-TAFT HWY. barbarayam @yahoo.com CITY 120 STATE 121 ZIP CODE 122 BAKERSFIELD CA 93313 1 - PRIMARY- IV. EMERGENCY CONTACTS, -SECONDARY - NAME 123 NAME 128 THOMAS SCOTT PHILIP WELCH TITLE 124 TITLE ' 129 OWNER OWNER BUSINESS PHONE 125 BUSINESS PHONE 130 (661) 398 -8882 (661) 398 -8882 24 -HOUR PHONE 126 24 -HOUR PHONE 131 (760) 376 -8653 (661) 397 -9983 PAGER # 127 O - PAGER-4 132 O -. ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 APN : 18416021 Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 04/25/2008 NAME OF SIGNER (print) 136 TITLE OF SIGNER 137 steven obert - rich environmental M� ym, ".JI &VVU vu., o.,t rrLA V0tODGOI VV AMI VU EMb I)hk'1' lz 001 /002 KERN COUNTY ENVIRONMENTAL HMAL,TH SERVICES DEPARTMENT HAZARDOUS MATERIALS BUSINESS PLAN CERTIFICATION 04/2,1/2008 Page L of ? FAC"I. 1TY INFORMATION: Site ID: 003290 FH61ity Name: . TAFF IIWY C HEVRO N, FA0003910 I'hysiodl Location: 1999 TAFI IIWY City: BAKERSFIELD. CA Facility Phone: (661) 398 -8882 OWNER TNFORMATION FOR MAILING CORRESPONDENC'F, ONLY: Name: PRK CC. INC O O In care of :. BARBARA YAM 0 S Address: 1999 1'Al+ 1 IIW1r �1 City, State, Zip- BAKERSFIELD, CA 93313 Contact's Phone: (661) 664 -8258 Environmental Contact's )J -Mail Address: harharayamnyal1oo.com BILLING INFORMATION ONLY: Name: TAFT IIWY CHEVRON - Tn Care of: PEK CC, INC. ATTN: BARBARA YAM Address: 1999 TAFT IMrY City, State, Gip: BAKERSFIELD. CA 93313 Contact's Phone: (661) 398 -8882 EMERGENCY CONTACT 1NFOIJM TION: Nnlvlx; TITLE: NAME: RARRARAYAK OWNER Day Phone: (661) 398.8882 Day Phone: 24 hr Phone: 24 hr Phone; t Kok I ia3- <6 Ogg R F.G1 TL.ATED ACTIVITI KS AT '1•I: (IS FACILITY: Hazardous Material Business Plan 1 TWurgTound Storage Tank(s); ROF N: TK MT 44. 040878. CRRTYl� TCATTAN: PLEASE C'IILCK ALL THAT APPLY: The most recently submitted hazardous 'matcrials business plan and inventory are complete, accurate, and current. There have been no changes in the quantity of any hazardous mawrials as previously reported. No hamrdow materials subject to the inventory requiramantc are being handled that are not currently listed I have enclosed a business plan and inventory for the facility described above. Other: I cartify, under penalty of perjury, that the information provided above is correct. 'lYtle Q t Data Report 117000 I I a 3 T $USINf._.WWNER/OPERATOR Kern County Environmental Health Services Department 2700 M Street, Suite 300 Bakersfield, CA 93301 (661) 862 -8700 Fax(661)862 -8701 TION Unified Program Consolidated Form (UPCF) FACILITY INFORMATION ❑ NEW BUSINESS � 4 OUT OF BUSINESS 13 REVISE/UPDATE (EFFECTIVE 02/14/2007) Page I of 1 I. IDENTIFICATION FACILITY ID# I BEGINNING DATE 00 ENDING DATE 1. 51 - 0 1 0- 0 0 3 2 9 0 FA0003910 03/01/2005 02/28/2006 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 BUSINESS PHONE , TAFT HWY CHEVRON (661) 398 -8882 BUSINESS SITE ADDRESS 103 1999 TAFT HWY CITY 104 ZIP CODE 10 BAKERSFIELD CA 93313 DUN & BRADSTREET 106 SIC CODE (4 digit #) 107 None specified COUNTY 108 Kern County BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 BARBARA YAM II. BUSINESS OWNER OWNER NAME 111 OWNER PHONE 112 TAFT HWY CHEVRON OWNER MAILING ADDRESS 1999 TAFT HWY CITY 14 STATE � ZIP CODE ' I BAKERSFIELD CA 93313 ][II. ENVIRONMENTAL CONTACT CON_ TACT NAME 117 CONTACT PHONE s T (661) 398 -8882r CONTACT MAILING ADDRESS 9 1999 TAFT HWY. CITY 20 STATE i2i Z[P C ODE iz z BAKERSFIELD CA 93313 - PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY-. NAME II�VV 11 11 . ^�S� 123 NAME _ TIT TTT TTl TT1TT ITT 128 TITLE TITLE 129 BUSINESS PHONE 125 BUSINESS PHONE 1 0 24 -HOUR PHONE 126 24 -HOUR PHONE PAGER # O - PAGER # - O - ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 APN: 18416021 Environmental Contact E -Mail Address: barbarayam @yahoo.com Certification: Based on my inquiry of those individuals responsible for obtaining the information, I-certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTAT DATE 134 NAME OF DOCUMENT PREPARER �fec%wvuc $�maluAZ 02/14/2007 NAME OF SIGNER (print) 136 TITLE OF SIGNER _ 3 barbara yam � M ,,� plkn KERN COUNTYNIRONMENTAL HEALTH SERVI 'S DEPARTMENT HAZARDOUS MATERIALS BUSINESS INVENTORY 329 0 10/03/2005 Site ID: 003290 Pagel of 2 FACILITY INFORMATION: ��(,v� (� �U /�T^! Facility Name: FA0003910 Physical Location: 1999 TAFT HWY City: BAKERSFIELD, CA Facility Phone: (661) 398 -8882 OWNER INFORMATION FOR MAILING CORRESPONDENCE ONLY: Name: S *TTY \x7 TR r T(`u CTlli� IbiC py vve e, v:- -rrrr. In Care of: Address: � 6 City, State, Zip: `% Contact's Phone: Environmental Contact's E -Mail Address: 1999 TAFT HWY BAKERSFIELD, CA 93313 (661) 398 -8882 BILLING INFORMATION ONLY: Name: In Care of Address: City, State, Zip: Contact's Phone S AND W TRUCK STOP 1999 TAFT HWY BAKERSFIELD, CA 93313 (661) 398 -8882 EMERGENCY CONTACT INFORMATION: 3q -gg8tl NAME: TITLE �/ NAME: TITLE: TxO nxxn., � "4 "j %Q /J� Day Phone: (661) 398 -8882 6(C Day Phone: (661) 398 -8882 2 REGULATED ACTIVITIES AT THIS FACILITY: Hazardous Material Business Plan 3 Underground Storage Tank(s); BOE #: TK MT 44- 040878 NOTES: Report # 7010 BUSINE S..M WNER/OPERATOR Kern County Environmental Health Services Department 2700 M Street, Suite 300 Bakersfield, CA 93301 (661) 862 -8700 Fax(661)862 -8701 ON Unified Program Consolidated Form (UPCF) FACILITY INFORMATION ❑ NEW BUSINESS ❑ OUT OF BUSINES . ❑ REVISEIUPDATE (EFFECTIVE 10/03/2005 ) Page I of I I. IDENTIFICATION FACILITY ID# BEGINNING DATE ENDING DATE 1 5- 0 1 101-101 0 3 2 9 101' FA0003910 03/01/2005 02/28/2006 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) BUSINESS PHONE TAFT HWY CHEVRON (661) 398 -8882 BUSINESS SITE ADDRESS 1999 TAFT HWY CITY 104 ZIP CODE BAKERSFIELD CA 93313 DUN & BRADSTREET 106 SIC CODE (4 digit #) None specified COUNTY Kem County BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE BARBARA YAM H. BUSINESS OWNER OWNER NAME OWNER PHONE TAFT HWY CHEVRON OWNER MAILING ADDRESS 1999 TAFT HWY CITY 114 STATE Z[P CODE BAKERSFIELD 1 CA 93313 M. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE THOMAS SCOTT/PHILIP WELCH (661) 398 -8882 CONTACT MAILING ADDRESS 1999 TAFT HWY. CITY STATE 121 ZIP CODE BAKERSFIELD CA 93313 . - PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY - NAME 123 NAME THOMAS SCOTT PHILIP WELCH TITLE TITLE OWNER OWNER BUSINESS PHONE 125 BUSINESS PHONE (661) 398 -8882 (661) 398 -8882 24 -HOUR PHONE 126 24 -HOUR PHONE (760) 376 -8653 (661) 397 -9983 PAGER # 127 PAGER # ADDITIONAL LOCALLY COLLECTED INFORMATION: APN: 184 - 160- 21 -00 -9 Environmental Contact E -Mail Address: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTAT DATE 134 NAME OF DOCUMENT PREPARER �f�Ga b 10/03/2005 1 NAME OF SIGNER (print) Ub TITLE OF SIGNER REBECCA SCOTT % 0 BUSINESSMWNER/OPERATOR ID Kern County Environmental Health Services Department 2700 M Street, Suite 300 Bakersfield, CA 93301 (661) 862 -8700 Fax(661)862 -8701 ATION Unified Program Consolidated Form (UPCF) FACILITY INFORMATION 0 NEW BUSINESS 0 OUT OF BUSINES 0 REVISE/UPDATE (EFFECTIVE 02/18/2005 ) Page I of I I. IDENTIFICATION FACILITY ID# 1 BEGINNING DATE ENDING DATE 1 5- 10-11 0- 1 0 0 3 2 9 0 01/01/1900 01/01/1900 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 BUSINESS PHONE S AND W CHEVRON 1 (661) 398 -8882 BUSINESS SITE ADDRESS 1999 TAFT HWY CITY 104 ZIP CODE BAKERSFIELD CA 93313 DUN & BRADSTREET IU6 SIC CODE (4 digit #) COUNTY Kern County BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE II. BUSINESS OWNER OWNER NAME 111 OWNER PHONE S AND W TRUCK STOP, INC (661) 398 -8882 OWNER MAILING ADDRESS 1999 TAFT HWY CITY STATE ZIP CODE BAKERSFIELD CA 93313 III. ENVIRONMENTAL CONTACT CONTACT NAME 1171 CONTACT PHONE Hs THOMAS SCOTT/PHILIP WELCH (661) 398 -8882 CONTACT MAILING ADDRESS 1999 TAFT HWY. CITY 120 STATE ZIP CODE BAKERSFIELD 1 CA 93313 - PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY - NAME 123 NAME THOMAS SCOTT PHILIP WELCH TITLE 124 TITLE OWNER OWNER BUSINESS PHONE 125 BUSINESS PHONE (661) 398 -8882 (661) 398 -8882 24 -HOUR PHONE 126 24 -HOUR PHONE (760) 376 -8653 (661) 397 -9983 PAGER # 127 PAGER # ADDITIONAL LOCALLY COLLECTED INFORMATION: APN: 184 - 160- 21 -00 -9 Environmental Contact E -Mail Address: SANDWCHEVRON@AOL.COM Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law.that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTAT DATE 134 NAME OF DOCUMENT PREPARER ELF ,brace, 02/18/2005 1 NAME OF SIGNER (print) 136 TITLE OF SIGNER REBECCA SCOTT 0 0 KERN COUNTY •IRONMENTAL HEALTH SERVIA DEPARTMENT HAZARDOUS MATERIALS BUSINESS PLAN CERTIFICATION FEBRUARY 2004 FACILITY INFORMATION,: Site ID: 003290 Facility. Name:.* S AND W CHEVRON, FA0003910 Physical Location: 1999 TAFT HWY City: BAKERSFIELD, CA Facility Phone: (661) 398 -8882 OWNER INFORMATION FOR MAILING CORRESPONDENCE ONLY: Name: S AND W TRUCK STOP. INC In Care of: Address: 1999 TAFT HWY City, State, Zip: BAKERSFIELD, CA 93313 Contact's Phone: (66.1) 366 -5542 Environmental Contact's - E -Mail Address: BILLING INFORMATION ONLY: Name: S AND W TRUCK STOP In Care of: 43tsod Address: 1999 TAFT HWY City, State, Zip: BAKERSFIELD, CA 93313 Contact's Phone: (661) 398 -8882 EMERGENCY CONTACT INFORMATION: NAME: TITLE: NAME: TITLE: THOMAS SCOTT, OWNER PHILIP WELCH, OWNER Day Phone: (661) 398 -8882 Ext: Day Phone: (661) 398 -8882 Ext: Night Phone: (760) 376 -8653 Ext: Night Phone: (661) Ext: 45Ms. REGULATED ACTIVITIES AT THIS FACILITY: Hazardous Material Business Plan 3 Underground Storage Tank(s); BOE #: TK MT 44- 040878 All facilities with underground storage tanks are required to provide a valid Board of Equalization (BOE) Tank Account number to this Department. If a BOE number is not listed above, please provide the number or contact the BOE at (916) 322 -9669 and obtain one. CERTIFICATION: PLEASE CHECK ALL THAT APPLY: The most recently submitted hazardous materials business plan and inventory are complete, accurate, and current. There have been no changes in the quantity of any hazardous materials as previously reported. No hazardous materials subject to the inventory requirements are being handled that are not currently listed. I have enclosed a business plan and inventory for the facility described above. Other: I certify, under penalty of perjury, that the information provided above is correct. Title ate Report # 7000 KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT HAZARDOUS MATERIALS BUSINESS PLAN CERTIFICATION FEBRUARY 2003 FACILITY INFORMATION: Site ID: ' 003290 Facility Name: S AND W CHEVRON, FA0003910 Physical Location: 1999 TAFT HWY City: BAKERSFIELD, CA Facility Phone: (661) 398 -8882 OWNER INFORMATION FOR MAILING CORRESPONDENCE ONLY: Name: S AND W TRUCK STOP. INC In Care of: Address: 1999 TAFT HWY City, State, Zip: BAKERSFIELD, CA 93313 Contact's Phone: (661) 366 -5542 BILLING INFORMATION ONLY: Name: S AND W TRUCK STOP a In Care of: Address: 1999 TAFT HWY 00 City, State, Zip:, BAKERSFIELD, CA 93313 Contact's Phone: (661) 398 -8882 EMERGENCY CONTACT INFORMATION: NAME: TITLE: NAME: TITLE: THOMAS SCOTT,, OWNER PHILIP WELCH, OWNER Day Phone:` (661) 398 -8882 Ext , Day Phone: (661) 398 -8882 Ext: Night Phone: ; (760) 376 =8653 Ezt: Night Phone:. (661) 663 -9781 Ext: REGULATED ACTIVITIES ATTHIS FACILITY: Hazardous.Material Business Plan 3 Underground Storage Tank(s); BOE #: —rk M-F q&qo Cra All facilities with underground storage tanks are required to provide a valid Board of Equalization (BOE) Tank Account number to this Department. If a BOE'number is not listed above, please provide the number or. contact the BOE at (916) 322 -9669 and obtain one. CERTIFICATION: PLEASE CHECK ALL THAT APPLY: ® The most recently submitted hazardous materials business plan and inventory are complete, accurate, and up to date. There have been no changes in the quantity of any hazardous materials as previously reported. No u hazardous materials subject to the inventory requirements are being handled that are not currently listed. I -have enclosed a business plan and inventory for the facility described above. -Other:,, - I-certify, under penalty of perjury; that the information provided above is correct.—~ 0, wy-vLE Printed Name Title Signatufe Date Report n 7000 1 • • KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT HAZARDOUS MATERIALS BUSINESS PLAN UPDATE FEBRUARY 2002 FACILITY INFORMATION: Site ID: 003290 Facility Name: S AND W CHEVRON, #003910 Physical Location: 1999 TAFT HWY City: BAKERSFIELD, CA Facility Phone: (661) 398 -8882 OWNER INFORMATION FOR MAILING CORRESPONDENCE ONLY- Name: S AND W TRUCK STOP. INC � j U In Care of: v Address: 1999 TAFT HWY F E 8 — 5 2002 City, State, Zip: BAKERSFIELD, CA 93313 Contact's Phone: (661) 366 - 5542 BILLING INFORMMATION ONLY. - Name: S AND W TRUCK STOP In Care of: ---, Address: 1999 TAFT HWY _.. City, State, Zip: BAKERSFIELD, CA 93313 Contact's Phone: (661) 398 -8882 EMERGENCY CONTACT INFORMATION: NAME: . TITLE: THOMAS SCOTT, OWNER Day Phone: (661) 398 -8882 Ext: Night Phone: (760) 376 -8653 Ext: REGULATED ACTIVITIES AT THIS FACILITY: Hazardous Material Business Plan 3 Underground Storage Tank(s) NAME: TITLE: PHILIP WELCH, OWNER Day Phone: (661) 398 -8882 Ext: Night Phone: (661) 663 -9781 Ext: If this jbsility generates hazardous waste and does not have an EPA 1D number, Cali 1 -800- 618 -6942 and obtain one. Please provide this department with that number when it is available. ADDITIONAL INFORMATION REQUESTED: PLEASE CHECK ALL THAT APPLY: There are no changes to my business plan and inventory. I have enclosed a business plan and inventory for the facility described above. Other: I certify,' under penalty of perjury, that the information provided above is correct. Printed Name Title ignature C9-)y1D-7 Date Report # 7000 9 • KERN COUNTY EARONMENTAL HEALTH SERACES DEPARTMENT HAZARDOUS MATERIALS BUSINESS PLAN UPDATE V��d1I01 FACILITY INFORMATION: Site ID 003290 Facility Name: S AND W CHEVRON, #003910 Physical Location: /,7 City: BAKERSFIELD, CA Facility Phone: 66/- ° *,9 ey� OWNER INFORMATION FOR MAILING CORRESPONDENCE ONLY: Name: S AND W TRUCK STOP In Care of- Address: `� City, State, Zip: BAKERSFIELD, CA 93313 -4335 Contact's Phone: (661)3 54-2 BILLING INFORMATION ONLY: _- Name: S AND W TRUCK STOP In Care of: - Address: / City, State Zip: BAKERSFIELD CA 93313 -4335 Contact's Phone: 461- EMERGENCY CONTACT INFORMATION: NAME: TITLE: NAME: TITLE: S do 4W/9 er phi �i,o 6 w1� Day Phone: (�!� 3 �-� 2. Ext: Day Pho e: — lblal }39k -��� a Ext: -- Night Phone: Ext: — Night Phone: Ext: — Cellular /Pager Num er: 301 -69S5 Cellular/Pager Number: EPA Hazardous Waste ID Number (if applicable): CA-1 _ pn D r -7 3 -� D, ADDITIONAL INFORMATION REQUESTED: REQUIRED INFORMATION TO BE SUBMITTED: o Plot Plan Drawing (showing location of hazardous materials and utility shut offs). 0 Site Map (if your facility is in a rural location, a map to the facility is required). PLEASE CHECK ALL THAT APPLY: 0 There are no changes to my business plan and inventory. D I am unable to find a copy of my current plan and inventory. Please send me a copy. I have enclosed a business plan and inventory for the facility described above. Other: I certify, under penalty of perjury, that the information provided above is correct. I�lel 41 Printed Name wIda,e Signature Title Date Report # 7000 • 0 KERN COUNTY ENVIRONMENTAL HEALTH SERVICES (661) 862 -8700 HAZARDOUS MATERIALS BUSINESS PLAN FORM 2 Forms Due By: SECTION 1: BUSINESS IDENTIFICATION DATA C K 5 b P, -N 0--' A. Full Legal business NameWA B. Physical Location /Street Address: Gl R q l ACT 1 FYIGhi'lyl,c City: � 5 � l (fl. Zip: Business Phone: a <Mf 0- C. Mailing Address: CL E City: Zip: D. Have you filed a Business Plan with the department under a different name within the last two years? YES NO If yes, under what name did you file? E. This submission is a NEW or REVISED Business Plan F. Does your business handle any of the "acutely hazardous substances" listed on the enclosed handout in addition to other types of materials? YES NO SECTION 2: EMERGENCY NOTIFICATIONS In the event of an emergency involving the release or threatened release of a hazardous material, telephone 9 -1 -1, and then (800) 852 -7550 or (916) 262 -1621. This will notify your local fire department and the State Office of Emergency Services, as required by state law. Additional federal reports may be required. Persons who should be notified in case of an emergency at your business that have full access and can provide technical assistance: NAME AND TITLE DURING BUSINESS HOURS AFTER BUSINESS HOURS A. CJVYIP1'kl�B Si�� -1- _ Ph# Ph #��.�, B. �6i�.� 441&j tiUP, «► Ph# 661 Ph# 1&& 3 _17P l - CONTINUED ON REVERSE - (1) SECTION 3: LOCATION. OF THE MAIN UTILITY SHUT OFFS.FOR THE, ENTIRE BUSINESS A. Natural gas /propane: torn& 6ul l tyi CS briye t°129M e,e- B. Electrical: Time.! P.fi1m--,ad F� G1edd ✓ne-W �i�O�T 191 5 � C'_6'►'�P�f/'' C. Water: I D. Special/other: 9q nd i�inej ZJD&2iPW r/1 /"nalh 5� 'ekoy/j9 e1e5&6 1J'15C&Ir?76 -) OeleA E. Lock Box:. YES o NO. If yes, location: If yes does it contain: Site Plans? YES ' or NO MSDS? YES or NO Floor Plans? YES or NO Keys? YES or, NO SECTION 4: PRIVATE RESPONSE TEAM DESCRIPTION Do you have a group of employees trained to handle minor accidents involving hazardous materials at your business? YES or NO If yes, you must explain the level of training and equipment they possess and how they are notified to respond. A I erru�l�yee s -� ral��j l �, Wh �qe�c y sh OX are phme �iJrn(�Crs /oCdy, 5p0/ �lS; �rr�e y �t 4L,0j, /isf �y` i'n�r c��c y �Sise �rOC��v�es C�a`es Care ltlep� New e.11, SECTION 5: IDENTIFICATION OF THE CLOSEST APPROPRIATE EMERGENCY MEDICAL ASSISTANCE AVAILABLE TO YOUR BUSINESS #1 #2 , filed, 4 Penj0- Address: q60 00 t � Z— l 1(? - City: Phone: S 2 7S` (�� ) �0 �03 - / b 0 Comments /Additional information: - CONTINUED ON NEXT PAGE - (2) r � SECTION 6: EMPLOYEE TRAINING Employers are required by state law to have a program which provides employees with initial and refresher training in the following areas: 1) Methods for safe-handling of the hazardous materials used by your business; 2) The CAL OSHA Hazard Communication Standard; 3) Correct use of emergency response equipment and supplies available at your business; 4) The prevention; minimization, and cleanup procedures you have developed for your business and explained on the business plan forms; 5) The emergency evacuation plans you have developed, the notification procedures used to alert people to evacuate, and the closest location to obtain appropriate emergency medical care; . 6) Procedures to coordinate with and assist the local emergency personnel that may respond to your business; 7) Who and how to call for immediate assistance in the event of an accident involving hazardous materials. Describe the location of the written.plan and the training records which are required to be developed and maintained. State law requires your training records be inspected. -,076�f `'ems y - CONTINUED ON REVERSE - (3) SECTION 7: EXPLAIN WHAT PREVENTION, , MINIMIZATION, AND CLEANUP PROCEDURES YOUR EMERGENCY PLAN INCLUDES. INCLUDE A DESCRIPTION OF MONITORING METHODS AND PROCEDURES. A. Release prevention: `/'' All nozz%es ore � r�,` Pea �r�7 ��E 1n mid aF A, -A � -o4', a.1/ ho-5e_5 have, b!- Pub shu¢-&s - - ems► 6�n shin- QFC5' w es B. Release containment: an _1014 � �4Y • (N IA: � S IJ WOer- ?.• Ab_gar{DE� lnd&W 'afwzys vY► hand � !;IWl s A5 l� erupl� e5 0're 4a,(ned ) � A- use �1b�rrb� vsed z 4�1 �� 1`5 toll�e8e� G- 4a�ardOV.5 rrna cj d rv�n a� rem �l ' >�� pT,v* -ts rlvr �er'6 J�:r/ C, Cleanup: 10 i6oyhey Ind0wa:P 16ed 4, .5/6A - �r7 c1he tend o, ' Ic sp,H. rye w rgefiey pMne- noa -bens Are, aNa leZ61e - a04qt es 4�0 a D. UST monitoring SECTION 8: EXPLAIN THE NOTIFICATION METHOD AND EVACUATION PROCEDURES YOU HAVE DEVELOPED FOR THE EMPLOYEES TO USE IN' AN EMERGENCY. YOU MUST INCLUDE A MEETING POINT. A. Agency Notification: C�1,r elne% 7we y res nse �Orae vre /i�-s ©cr�hers' rna, wffr5 -) vme n v rs r rre _ > � d� 6s l WepaiS . � , arnd /l�e n Cevrl�j eo � � V6 n vnt ber r y yee c,1 /s 0-W4 W u)ho ww4, feev y. B. Employee Notification/Evacuation: and mew a_�- mad-bov 6 e� , bdnkr - CONTINUED ON NEXTPAGE - (4) SECTION 9: EXPLAIN WHAT PRIVATE FIRE PROTECTION SYSTEMS ARE IN PLACE THAT MAY ASSIST EMERGENCY RESPONDERS. - i're ln&M�ed ins ;Ide d6ze7 oiC4)11d« f, SECTION 10: LIST THE LOCATION OF ANY WATER SUPPLIES THAT MAY BE USED BY EMERGENCY RESPONDERS. / beef a4- s)/ P i5ka 17ee k o vv /al I, l / /Q.Y (,�� (��Pii�i i V �1, , certify that the information submitted on all the business plan forms is accurate and complete. I understand that this information will be used to fulfill my obligations under California Health and Safety Code Division 20 Chapter 6.95 et seq. and Title 42 U.S.G.C. Section 1100 et seq. and false information may be punishable by fine, imprisonment, or both. Signature Title Date G:9AZMAINFORMS\FORM2. W P D (5) 6/99 r L KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT HAZARDOUS MATERIALS INVENTORY FORM 4 BUSINESS NAME: S 4—W oC�h LOCATION.- i. L;f q q �t±l � CITY,ZIP,_ 3- , - er -tZ(°rG� PHONE #: !od2l STANDARD IND. CLASS CODE: f-Vk 1 OWNER NAME:Aee 5 ADDRESS: 30- 0 61d 56 -- 3 31 3 CITY, ZIP:I�O T 7'i a PHONE #: '76 NAME OF THIS FACILITY: REFER TO INSTRUCTIONS FOR PROPER CODES DUN AND BRADSTREET NUMBER Page I �f ID# Map Grid 1 2 3 J 4 5 6 7 8 9 10 11 Trade rams Type Largest Maximum Average Measure Cont Cont Cont % by NAMES OF MIXTURE:/COMPONENTS Secret ode Code Container Amt . Amt Units Type Press Temp Wt SEE INSTRUCTIONS Y/N Do, 0/0'o Jq 5,00 I a, 000 Gam( 0 I i y 1190 PRODUCT NAME �GS [ j [mmediate He alth Location �o�� �� Component & CAS rg �A s Component & CAS Erse E CAS 0 3 7 �I Z 3 f J Fire Delayed Health CAS Number Component & CAS T,4 M E [ J Reactivity/ [ J Sudden Release of Pressure # Days on Site [ "j& 5'1 f / 5 0 0 0 14 50 0 00 0 01 `i8d PRODUCT NAME S.,-ue)-eme 04, I s f j immediate Health Location m s ddle r 4aAk- Component & CAS ' #7'rlq 6 C'A5 /63 Va el u Component & CAS C7-6 €" e, A 5 6 3 W23 1-� J Fire [ J Delayed Health CAS Number f j Reactivity { j Sudden Release of Pressure # Days on Site [ 3 (os ] Component & CAS -rgl07 ,6 f-0 $ k 000 15700 g 0 0 D (�(J 01' f oo PRODUCT NAME J Immediate Health Location Ear.4 s' Component & CAS 11 z°Se I fiiC I #2 C/I 5,6g tl `% (p 3 z/ Component & CAS [ J Fire ( j Delayed Health CAS Number Component &CAS [ j Reactivity [ ] Sudden.Release of Pressure # Days on Site [ 3 (P5' J ,—EM RE GENCYCONTACTS #1 tom 6eG(Cte 5xt � q6n 3 ?G- �(o_�3_ Name Title 24 Hr Phon manjpftq�n Nw��� o c�ners 14,m (,6t (,63 -gli -1 ame Title 24 Hr. Phone Certification (Read and sign after completing all sections) I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached docmnents, and that based on my inquiry of those individuals responsible for.obtaining the information, I believe that the submitted information is true, accurate, and complete. ry Name and official_ title of owner /operator or owner /operator's authorized representative If Signi Date Signed � A 0 y� 3 SITE MAP Fac ii ry__ _ (2.Z.L° _ .—Manage _"1 7 ' 1 hd a1 0 Ile li ;f, if i u/fFT�K CT) r` Fue,� C1n1•15,00 ..:�� Se C /J�: I I t i i �I 1 1) TN Gate prepared: POST TNIS INF'ORMA77ON ALONG WITH EMERGENCY RESPONSE PROCEDURES IN AN.IMPLOYEF ACCESSIBLE AREA. EnWronmanlat and Safety Workbook 01'94► SHUTOFF PUMP ® AALAARK�MONITQRINO STORM GRAIN ' ' FIRE HYDRANT U.G. PROOUCTTANK ELECTRICAL PANEL SHUTOFF T TELEPHONE s SANITATION �' SEWER O MONITORING WELLS U -G. WA£Tc OILTANK �.:J Q� NATURALGAS SHUTOFF C3 FIRST AID KIT O EMERGENCY ASSEMBLY AREA ® OBSERVATION WELLS (2).. ABSORBENT WATER SHUTOFF � I& FIRE EXTINOWSHER � ® MSOS LOCATION ��....�� V * . A.G. PRODUCT ,ANK�O Gate prepared: POST TNIS INF'ORMA77ON ALONG WITH EMERGENCY RESPONSE PROCEDURES IN AN.IMPLOYEF ACCESSIBLE AREA. EnWronmanlat and Safety Workbook 01'94► MATTHEW CONSTANTINE, R.E.H.S., Director 2700 "M" STREET, SUITE 300 BAKERSFIELD, CA 93301 -2370 Voice: (661) 862 -8700 Fax: (661) 862 -8701 TTY Relay: (800) 735 -2929 Web: www.co.kem.ca.us /eh E -mail: eh @co.kern. ca. us Date: 07/13/2010 &URCEMANAGEMENTAGENCY TED JAMES, AICP, INTERIM RMA DIRECTOR Animal Control Department Community and Economic Development Department Engineering and Survey Services Department Environmental Health Services Department Planning Department Roads Department July ,13, 2010 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Facility ID: FA0003910 File #: 003290 Facility Name: TAFT HWY CHEVRON Inspection Tyne 19 Routine ❑ Reinspection ❑ Complaint Site Address: 1999 TAFT HWY BAKERSFIELD, CA 93313 Phone: (661)398 -8882 PROGRAMS INSPECTED: ❑ Business Plan ❑ HW Generator 9 UST ❑ APSA REINSPECTION REQUIRED: ❑ Business Plan ❑ HW Generator ❑ UST ❑ AP SA INSPECTOR: LYDIA VON SYDOW INSPECTION DATE: 07/13/2010 Page 1 of 4 FACILITY NAME: TAFT HWY CSON ADDRESS: 1999 TAIRWY BAKERSFIELD, CA 93313 FA ID: FA0003910 FILE ID: 003290 VIOLATION VIOLATION NUMBER UNDERGROUND STORAGE. TANK.REQUIREMENTS UT01 Facility has a site certificate of financial responsibility for underground storage tanks on file with regulatory agency [HSC 25292.2(a)]. UT02 Facility has an approved designated operator and that operator is performing the required inspections and training [Title 23, CCR 2715]. UT03 Facility has a written monitoring and response plan for USTs on site and on file with regulatory agency [Title 23, CCR 2632(d)(1) & 2641(h)]. UT05 Facility completed an annual monitoring system certification for an underground storage tank system and submitted it to the regulatory agency [Title 23, CCR 2630(d) 2641(])]. UT06 Cathodic protection systems for underground storage tank systems (where appropriate) certified every three years. Facility provided certification results to regulatory agency [Title 23, CCR 2635(a) 2662(b)]. UT07 Secondary containment systems for undeground storage tank systems tested every three years. Facility provided results to the agency [Title_23, CCR 2637(a)]. UT08 Underground storage tank systems (with single walled components) within 1000' of a drinking well must be tested with enhanced leak detection methods (ELD) every three years. Facility provided results to regulatory agency [Title 23, CCR 2635(a) & 2662(a)]. UT11 Facility's underground storage tank monitoring system is functioning as designed [Title 23, CCR 2632]. UT12 The underground storage system at the.facility is monitored according to site's monitoring plan or permit [HSC 25293]. UT13 Monitoring records for the undeground storage tank system are available upon request [Title 23, CCR 2712(b)]. UT14 Overspill and overfill equipment for underground storage tank(s) is present, properly installed, and functioning [Title 23, CCR 2635]. UT16 Change of ownership or monitoring method reported to the permitting agency within 30 days of change [HSC 25284(c); Title 23, CCR 2712]. UT22 Under Dispenser Containment (UDC) installed [HSC 25284.1 (a)(5)(c)]. UT23 Under Dispenser Containment (UDC) has approved and functional monitoring equipment [Title 23, CCR 2636(f)(1) and (g)]. V UT24 Leak detection sensors are properly secured at lowest point in sumps and annular spaces [Title 23, CRR 2641(a)]. UT25 Monitoring system shuts down the pump if a release is detected or the monitor fails or is disconnected [Positive Shut Down (PSD)]. Annual line integrity testing completed if no PSD [Title 23, CCR 2636(f)] UT26 Automatic line leak detectors installed on pressurized piping that detects a 3.0 gph leak [Title 23, CCR 2636(f)(2)]. UT27 Secondary containment and overspill containers are liquid /debris free [Title 23, CCR 2631(d)(4) & 2635(b)(1)]. INSPECTOR: LYDIA VON SYDOW INSPECTION DATE: 07/13/2010 Page 2 of 4 VIOLATION VIOLATION • UNDERGROUND STORAG NK REQUIREMENTS NUMBER (Continue UT28 No liquid leaks visible [Title 23, CCR 2632]. UT29 Fuel filters managed properly [HSC 25189(a)]. UT30 Documentation of hazardous and designated waste disposal [Title 22, CCR 66262.23]. FACILITY NAME: TAFT HWY CHEVRON ADDRESS: 1999 TAFT HWY FA ID: FA0003910 BAKERSFIELD, CA FILE ID: 003290 93313 SUMMARY OF OBSERVATIONS/VIOLATIONS No violations of underground storage tank, hazardous materials, or hazardous waste laws /regulations were discovered.. KERN CUPA greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. ❑x Violations were observed /discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25;000 for each violation. Your facility may be reinspected any time during normal business hours. If a second reinspection becomes necessary due to non compliance, a . reinspection charge of $100.00 per hour may be charged to the facility. You may request a meeting with the Program Manager to discuss the inspection findings and /or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. VIOLATIONS .VIOLATION DEGREE OF # VIOLATION CORRECTIVE ACTION REQUIRED UT24 CLASS I Reposition sensors to the lowest point in the sump and /or annular space. VIOLATION The sensors in the regular unleaded and diesel sumps were placed well above the bottom of the sumps. If they had been in their proper places they would have detected the water in the sumps and would have triggered alarms. INSPECTION COMMENTS: Remove water from all three sumps. Remove piles of dirt from the sumps. Keep all sensors vertical and in the lowest part of the sumps. COMMENTS: Go to http: / /www.co.kern.ca.us /eh /cupaprogram.asp for forms and information. INSPECTOR: LYDIA VON SYDOW SIGNATURE OF FACILITY REP: INSPECTION DATE: 07113/2010 Page 3 of 4 tification: I certify under per. of perjury that this facility has compiWith the corrective actions listed this inspection form. Printed Name of Owner /Operator Signature of Owner /Operator Page 4 of 4 Title Date 0 0 MATTHEW CONSTANTINE, R.E.H.S., Director 2700 "M" STREET, SUITE 300 BAKERSFIELD, CA 93301 -2370 Voice: (661) 862 -8700 Fax: (661) 862 -8701 TTY Relay: (800) 735 -2929 Web: www.co.kem.ca.us /ch E -mail: eh @co.kern. ca. us Date: 07/27/2009 i REOCE MANAGEMENT AGENCY DAVID PRICE III, RMA DIRECTOR Animal Control Department Community and Economic Development Department Engineering and Survey Services Department' Environmental Health Services Department Planning Department Roads Department July -27, 2009 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Facility ID: 'FA0003910 File #: 003290 Facility Name: TAFT HWY CHEVRON Inspection Type 9 Routine ❑ Reinspection ❑ Complaint Site Address: 1999 TAFT HWY BAKERSFIELD, CA 93313 Phone: (661)398 -8882 PROGRAMS INSPECTED: 19 Business Plan ❑ HW Generator 9 UST ❑ AGT REINSPECTION REQUIRED: ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT VIOLATION YES NO /NA VIOL. # BUSINESS PLAN REQUIREMENTS ❑ BP01 Inventory of hazardous materials is accurate, up to date, and complete [HSC 6.95, 25504, Title 19 CCR 2729]. ❑ 0 • BP02 Site layout/facility maps are accurate [HSC 6.95,25504; Title 19 CCR 27293. ❑ 19 BP03 Hazardous materials are stored in properly labeled and non- deteriorated containers [HSC 25124(b)(3)(A & B)]. ❑ 10 BP04 The hazardous materials inventory shall be submitted annually on or before March 1 [Title 19 CCR 2729.4(b)]. ❑ 0 ER01 Contingency Plan is complete, updated, and maintained on site [HSC 6.95,.25504;Title 19 CCR 2731 Title 22 CCR 66265.53 -54]. ❑ 0 ER02 Facility is operated and maintained to preventfmitigate fire, explosion, or release of hazardous material or waste which could threaten human health or the environment [Title 22 CCR 66265.31; Title 19 CCR 2731]. ❑ N ER03 Business has equipment required to, or appropriate for, safe handling of hazardous materials [Title 22 CCR 66265.32 &.34]. ❑ 0 TR01 Facility has a training program appropriate for the size and complexity of business and nature of hazardous materials handled [Title 19 CCR 2732; Title 22 CCR 66265.16]. ❑ N TR02 Training documentation is maintained on site for current personnel. [Title 19 CCR 2732; Title 22 CCR 66265.16]. COMMENTS: Go to http: / /www.co .kern.ca.us /eh /cupaprogram.asp for forms and information. GPS Coordinates: Latitude: 35.2666675952 Longtitude: - 119.0243473236 INSPECTOR: LYDIA VON SYDOW Page 1 of 3 INSPECTION DATE: 07/27/2009 FACILITY. NAME: TAFT HWY RON ADDRESS: 1999 TAF FA ID: FA0003910 BAKERSFIELD, CA 93 FILE ID: 003290 VIOLATION YES NO /NA VIOL. # UNDERGROUND STORAGE TANK (UST) INSPECTION REQUIREMENTS ❑ 9 • UT01 Facility has a site certificate of financial responsibility for Underground Storage Tanks on file with regulatory agency [HSC 25292.2(a)] ❑ 19 UT02 Facility has an approved designated operator and that operator is performing the required inspections and training [CCR 2715]. ❑ O UT03 Facility has a written monitoring and response plan for USTs on site and'on file with regulatory agency [CCR 2632(d)(1) & 2641(h)]. ❑ 9 UT05 Facility completed an annual monitoring system certification for an underground storage tank system and submitted it to the regulatory agency [CCR 2630(d) 26410)]. ❑ 0 UT06 Cathodic Protection systems for underground storage tank systems (where appropriate) certified every three years. Facility provided certification results to regulatory agency [CCR 2635(a) 2662(b)]. ❑ 19 UT07 Secondary containment systems for undeground storage tank systems tested every three years. Facility provided results to the agency [CCR 2637(a)]. ❑ 0 UT08 Underground storage tank systems (with single walled components) within 1000' of a drinking well must be tested with enhanced leak detection methods (ELD) every three years. Facility provided results to. regulatory agency [CCR 2635(a) & 2662(a)]. ❑ UT11, Facility's underground storage tank monitoring system is functioning as designed [CCR 2632]. ❑ 9 UT12 The underground storage system at the facility is monitored according to site's monitoring plan or permit [HSC 25293]. ❑ 9 UT13 Monitoring records for the undeground storage tank system are available upon request [CCR 2712(b)]. ❑ 9 UT14 Overspill and overfill equipment for underground storage tank(s) is present, properly installed, and functioning [CCR 2635]. ❑ 19 UT16 Change of ownership or monitoring method reported to the permitting agency within 30 days of change (HSC 25284(c); CCR 2712). ❑ 9 UT22 Under Dispenser Containment (UDC) installed. [HSC 25284.1 (a)(5)(c)]. ❑ 0 UT23 Under Dispenser Containment (UDC) has approved and functional monitoring equipment. [CCR 2636(f)(1) and (g)]. ❑ O UT24 Leak detection sensors are properly secured at lowest point in sumps and annular spaces. [CRR 2641(a)]. ❑ 9 UT25 Monitoring system shuts down the pump if a release is detected or the monitor fails or is disconnected (Positive Shut Down (PSD)). Annual line integrity testing completed if no PSD. [CCR 2636(f)] . ❑ R UT26 Automatic line leak detectors installed on pressurized piping that detects a 3.0 gph leak. [CCR 2636(f)(2)]. ❑ 0 UT27 Secondary containment & overspill containers are liquid/debris free. [CCR 2631(d)(4) & 2635(b)(1)] ❑ 19 UT28 No liquid leaks visible. [CCR 2632] 0 O UT29 Fuel filters managed properly: [HSC 25189 (a)] ❑ IN UT30 Documentation of hazardous and designated waste disposal. [Title 22 CCR 66262.23] INSPECTOR: LYDIA VON SYDOW Page 2 of 3 INSPECTION DATE: 07/27/2009 FACILITY NAME: TAFT HWY RON ADDRESS: 1999 TAAbW FA ID: FA0003910 BAKERSFIELD, CA 93W FILE ID: 003290 SUMMARY OF OBSERVATIONS/VIOLATIONS p No violations of underground storage tank, hazardous materials, or hazardous waste laws /regulations were discovered.. KERN CUPA greatly appreciates your efforts to comply with all the laws and regulations 9 Violations were observed /discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours If a second reinspection. becomes. necessary due to non compliance, a reinspection charge of $100.00 per hour may be charged to the facility. You may request a meeting with the Program Manager to discuss the inspection findings and /or the proposed corrective. actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: TAFT HWY CHEVRON ADDRESS: 1999 TAFT HWY FA ID: FA0003910 BAKERSFIELD, CA 93313 FILE ID: 003290 VIOLATIONS VIOL. NO VIOL. TYPE CORRECTIVE ACTION REQUIRED UT11 CLASS II VIOLATION Repair or replace the identified missing or malfunctioning equipment. Diesel annular sensor damaged and non- functional. Representative from Rich Environmental said that he would have to get another sensor from'the shop to replace the broken one. INSPECTION COMMENTS: INSPECTOR: LYDIA VON SYDOW INSPECTION DATE: 07/27/2009 SIGNATURE OF FACILITY REP: Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner /Operator: Title: Date: Page 3 of 3 I ENVIRONMENTAL HEALTH S&CES DEPARTMENT RES &CE MANAGEMENT AGENCY MATTHEW CONSTANTINE, R.E.H.S., Director DAVID PRICE III, RMA DIRECTOR 2700 "M" STREET, SUITE 300 Animal Control Department BAKERSFIELD, CA 93301 -2370 Community and Economic Development Department Voice: (661) 862 -8700 - Engineering and Survey Services Department Fax: (661) 862 -8701 Environmental Health Services Department TTY Relay: (800) 735 -2929 Planning Department Web: www.co.kern.ca.us /eh Roads Department E -mail: eh @co.kern. ca. us July 29, 2008 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 07/22/2008 Facility ID: FA0003910 File #: 003290 Facility Name: TAFT HWY CHEVRON Inspection Type IN Routine ❑ Reinspection ❑ Complaint Site Address: 1999 TAFT HWY BAKERSFIELD, CA 93313 Phone: (661)398 -8882 PROGRAMS INSPECTED: ❑ Business Plan ❑ HW Generator 9 UST ❑ AGT ❑ CalARP REINSPECTION REQUIRED:' ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑ CaIARP COMMENTS: Go to http: /iwww.co .kern.ca.us /eh /cupaprogram.asp for forms and information. GPS Coordinates: Latitude: 35.2666675952 Longtitude: - 119.0243473236 INSPECTOR: LAUREL D FUNK DATE: 07/22/2008 Page 1 of 3 FACILITY NAME: TAFT HWY CRON ADDRESS: 1999 TAFT FA ID: FA0003910 BAKERSFIELD, CA 933 FILE ID: 003290 VIOLATION YES NO /NA VIOL. # UNDERGROUND STORAGE TANK (UST) INSPECTION REQUIREMENTS ❑ • 0 UT01 Facility has a site certificate of financial responsibility for Underground Storage Tanks on file with regulatory agency [HSC 25292.2(a)] ❑ 0 UT02 Facility has an approved designated operator and that is performing the required inspections and training [CCR 2715]. ❑ 0 UT03 Facility has a written monitoring and response plan for USTs on site and on file with regulatory agency [CCR 2632(d)(1) & 2641(h)]. ❑ 0 UT05 Facility completed an annual monitoring system certification for an underground storage tank system and submitted it to the regulatory agency [CCR 2630(d) 2641 Q)]. ❑ 0 UT06 Cathodic Protection systems for underground storage tank systems (where appropriate) certified every three years. Facility provided certification results to regulatory agency [CCR 2635(a) 2662(b)]. ❑ 0 UT07 Secondary containment systems for undeground storage tank systems tested every three years. Facility provided results to the agency [CCR 2637(a)]. ❑ 0 UT08 Underground storage tank systems (with single walled components) within 1000' of a drinking well must be tested with enhanced leak detection methods (ELD) every three years. Facility provided results to regulatory agency [CCR 2635(a) & 2662(a)]. ❑ 0 UT11 Facility's underground storage tank monitoring system is functioning as designed [CCR 2632]. ❑ 0 UT12 The underground storage system at the facility is monitored according to site's monitoring plan or permit [HSC 25293]. ❑ 0 UT13 Monitoring records for the undeground storage tank system are available upon request [CCR 2712(b)]. ❑ 0 UT14 Overspill and overfill equipment for underground storage tank(s) is present, properly installed, and functioning [CCR 2635]. ❑ 0 UT16 Change of ownership or monitoring method reported to the permitting agency within 30 days of change (HSC 25284(c); CCR 2712). ❑ 0 UT22 Under Dispenser Containment (UDC) installed. [HSC 25284.1 (a)(5)(c)]. ❑ 0 UT23 Under Dispenser Containment (UDC) has approved and functional monitoring equipment. [CCR 2636(f)(1) and (g)]. ❑ 0 UT24 Leak detection sensors are properly secured at lowest point in sumps and annular spaces. [CRR 2641.(a)]. ❑ 0 UT25 Monitoring system shuts down the pump if a release is detected or the monitor fails or is disconnected (Positive Shut Down (PSD)). Annual line integrity testing completed if no PSD. [CCR 2636(f)] . ❑ 0 UT26 Automatic line leak detectors installed on pressurized piping that detects a 3.0 gph leak. [CCR 2636(f)(2)]. ❑ 0 UT27 Secondary. containment & overspill containers are liquid /debris free. [CCR 2631(d)(4) & 2635(b)(1)] ❑ 10 UT28 No liquid leaks visible. [CCR 2632] ❑ 0 UT29 Fuel filters managed properly. [HSC 25189 (a)] ❑ 0 UT30 Documentation of hazardous and designated waste disposal. [Title 22 CCR 66262.23] INSPECTOR: LAUREL D FUNK DATE: 07/22/2008 Page 2 of 3 FACILITY NAME: TAFT HWY C *RON ADDRESS: 1999 TAFTON FA ID: FA0003910 BAKERSFIELD, CA.9331W FILE ID: 003290 SUMMARY OF OBSERVATIONSIVIOLATIONS ❑ No violations of underground storage tank, hazardous materials, or hazardous waste laws /regulations were discovered. KERN CUPA greatly appreciates your efforts to comply with all the laws and regulations p Violations were. observed /discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during normal business hours. If a second reinspection becomes necessary due to non compliance, a reinspection charge of $85.00 per hour may be charged to the facility. You may request a meeting with the Program Manager to discuss the inspection findings and /or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: TAFT HWY CHEVRON ADDRESS: 1999 TAFT HWY FA ID: FA0003910 BAKERSFIELD, CA 93313 FILE ID: 003290 VIOLATIONS VIOL. NO VIOL. TYPE CORRECTIVE ACTION REQUIRED TR01 MINOR VIOLATION Develop and implement training program appropriate to hazardous materials handled by the business. Employee training by designated operator needs to be updated annually. INSPECTION COMMENTS: INSPECTOR: LAUREL D FUNK DATE: 07/22/2008 SIGNATURE OF FACILITY REP: Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner /Operator: Title: Date: Page 3 of 3 ENVIRONMENTAL HEALTH ICES DEPARTMENT MATTHEW CONSTANTINE, R.E.H.S., Director 2700 "M" STREET, SUITE 300 BAKERSFIELD, CA 93301 -2370 Voice: (661) 862 -8700 Fax: (661) 862 - 8701 TTY Relay: (800) 735 -2929 e -mail: eh @co.kem.ca.us RESOASE MANAGEMENT AGENCY DAVID PRICE Ill, RMA DIRECTOR Community and Economic Development Department Engineering & Survey Services Department Environmental Health Services Department Planning Department Roads Department May 25, 2007 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 05/23/2007 Facility ID: FA0003910 File #: 003290 Facility Name: TAFT HWY CHEVRON Inspection Type Routine ❑ Reinspection ❑ Complaint Site Address: 1999 TAFT HWY BAKERSFIELD, CA 93313 Phone: (661)398 -8882 PROGRAMS INSPECTED: I@ Business Plan ❑ HW Generator 0 UST ❑ AGT ❑ CaIARP REINSPECTION REQUIRED: ❑ Business Plan ❑ HW Generator 0 UST ❑ AGT ❑ CalARP VIOLATION YES NO /NA VIOL. # BUSINESS PLAN REQUIREMENTS 0 ❑ BP01 Inventory of hazardous materials is accurate, up to date, and complete [HSC 6.95, 25504, Title 19 CCR 2729]. ❑ 0 BP02 Site layout/facility maps are accurate [HSC 6.95,25504; Title 19 CCR 2729]. ❑ 0 BP03 Hazardous materials are stored in properly labeled and non - detoriated containers [HSC 25124(b)(3)(A & B)]. ❑ 0 BP04 The hazardous materials inventory shall be submitted annually on or before March 1 [Title 19 CCR 2729.4(b)]. ❑ 0 ER01 Contingency Plan is complete, updated, and maintained on site [HSC 6.95, 25504;Title 19 CCR 2731 Title 22 CCR 66265.53 -54]. ❑ 0 ER02 Facility is operated and maintained to prevent/mitigate fire, explosion, or releases of hazardous material or waste which could threaten human health or the environment [Title 22 CCR 66265.31; Title 19 CCR 2731]. ❑ 0 ER03 Business has equipment required to, or appropriate for, safely handling hazardous materials [Title 22 CCR 66265.32 &.34]. ❑ 0 TR01 Facility has a training program appropriate for the size and complexity of business and nature of hazardous materials handled [Title 19 CCR 2732; Title 22 CCR 66265.16]. ❑ 0 TR02 Training documentation is maintained on site for current personnel. [Title 19 CCR 2732;22 CCR 66265.16]. COMMENTS: Go to http:// www. co.kern.ca.us /eh /HazMatPage.asp for forms and information. GPS Coordinates: Latitude: 35.2666675952 Longtitude: - 119.0243473236 INSPECTOR: LAUREL D FUNK DATE: 05/23/2007 Page 1 of 3 FACILITY NAME: TAFT HWY RON ADDRESS: 1999 TAFT FA ID: FA0003910 BAKERSFIELD, CA 933 FILE ID: 003290 VIOLATION YES NO /NA VIOL. # UNDERGROUND STORAGE TANK (UST) INSPECTION REQUIREMENTS © ❑ UT01 Facility has a site certificate of financial responsibility for Underground Storage Tanks on file with regulatory agency [HSC 25292.2(a)] ❑ 0 UT02 Facility has an approved designated operator and that is performing the required inspections and training [CCR 2715]. © ❑ UT03 Facility has a-written monitoring and response plan for USTs on site and on file with regulatory agency [CCR 2632(d)(1) & 2641(h)]. ❑ 0 UT05 Facility completed an annual monitoring system certification for an underground storage tank system and submitted it to the regulatory agency [CCR 2630(d) 26410)]. ❑ O UT06 Cathodic Protection systems for underground storage tank systems (where appropriate) certified every three years. Facility provided certification results to regulatory agency [CCR 2635(a) 2662(b)]. ❑ 19 UT07 Secondary containment systems for undeground storage tank systems tested every three years. Facility provided results to the agency [CCR 2637(a)]. ❑ 9 UT08 Underground storage tank systems (with single walled components) within 1000' of a drinking well must be tested with enhanced leak detection methods (ELD) every three years. Facility provided results to regulatory agency [CCR 2635(a) & 2662(a)]. ❑ O UT11 Facility's underground storage tank monitoring system is functioning as designed [CCR 2632]. ❑ © UT12 The underground storage system at the facility is monitored according to site's monitoring plan or permit [HSC 25293]. ❑ 9 UT13 Monitoring records for the undeg round storage tank system are available upon request [CCR 2712(b)]. ❑ 0 UT14 Overspill and overfill equipment for underground storage tank(s) is present, properly installed, and functioning [CCR 2635]. ❑ 19 UT16 Change of ownership or monitoring method reported to the permitting agency within 30 days of change (HSC 25284(c); CCR 2712). ❑ 19 UT22 Under Dispenser Containment (UDC) installed. [HSC 25284.1 (a)(5)(c)]. 1@ ❑ UT23 Under Dispenser Containment (UDC) has approved and functional monitoring equipment. [CCR 2636(f)(1) and (g)]. ❑ 19 UT24 Leak detection sensors are properly secured at lowest point in sumps and annular spaces. [CRR 2641(a)]. ❑ 19 UT25 Monitoring system shuts down the pump if a release is detected or the monitor fails or is disconnected (Positive Shut Down (PSD)). Annual line integrity testing completed if no PSD. [CCR 2636(f)] . ❑ 19 UT26 Automatic line leak detectors installed on pressurized piping that detects a 3.0 gph leak. [CCR 2636(f)(2)]. ❑ 19 UT27 Secondary containment & overspill containers are liquid /debris free. [CCR 2631(d)(4) & 2635(b)(1)] ❑ 9 UT28 No liquid leaks visible. [CCR 2632] ❑ 19 UT29 Fuel filters managed properly. [HSC 25189 (a)] ❑ © UT30 Documentation of hazardous and designated waste disposal. [Title 22 CCR 66262.23] INSPECTOR: LAUREL D FUNK Page 2 of 3 DATE:. 05/23/2007 0 0 FACILITY NAME: TAFT HWY 0 . RON ADDRESS: 1999 TAFIMIY FA ID: FA0003910 BAKERSFIELD, CA 93311111111IF FILE ID: 003290 SUMMARY OF OBSERVATIONSIVIOLATIONS ❑ No violations of underground storage tank, hazardous materials, or hazardous waste laws /regulations were discovered. KERN CUPA greatly appreciates your efforts to comply with all the laws and regulations 19 Violations were observed /discovered as listed below. All violations must be corrected by implementing the corrective action listed by each violation. If you disagree with any of the violations or corrective actions required, please inform the CUPA in writing. ALL VIOLATIONS MUST BE CORRECTED WITHIN 30 DAYS OR AS SPECIFIED. CUPA must be informed in writing with a certification that compliance has been achieved. A false statement that compliance has been achieved is a violation of the law and punishable by a fine of not less than $2,000 or more than $25,000 for each violation. Your facility may be reinspected any time during.normal business hours. If a second reinspection becomes necessary due to non compliance, a reinspection charge of $85.00 per hour may be charged to the facility. You may request a meeting with the Program Manager to discuss the inspection findings and/or the proposed corrective actions. The issuance of this Summary of Violations does not preclude the CUPA from taking administrative, civil, or criminal action. FACILITY NAME: TAFT HWY CHEVRON ADDRESS: 1999 TAFT HWY FA ID: FA0003910 BAKERSFIELD, CA 93313 FILE ID: 003290 VIOLATIONS VIOL. NO VIOL. TYPE CORRECTIVE ACTION REQUIRED BP01 MINOR Update inventory of hazardous materials. Complete and submit a new Business Plan Packet UT01 MINOR File certificate of financial responsibility for Underground Storage Tanks at. facility. UT03 MINOR File written monitoring and response plan for USTs with regulatory agency and keep a copy on site. UT23 CLASS II Install and /or repair UDC monitoring equipment. INSPECTION COMMENTS: INSPECTOR: LAUREL D FUNK DATE: 05/23/2007 SIGNATURE OF FACILITY REP: &,III Certification: I certify under penalty of perjury that this facility has complied with the corrective actions listed on this inspection form. Signature of Owner /Operator: Title: Date: Page 3 of 3 ENONIVIENTAL HFALT10 ' DIVISION ; „2100 M STREET, SUITE 300, BAKERSFIELD, CA 93301-2370 VOICE: (661) 86218700 FA :.'((361)1 ((361) 862-8701 Web: www.co,kern.ca.us /eh E-mail eh @co.kern.ca.us "ONE VOICE"-... TAFT HWY CHEVRON c/o BARBARA YAM 1999 TAFT HWY BAKERSFIELD CA 93313 Dear Ms. Yam: August 30; 2010 RECW' E OCT - 1 2010 KERN COUNIiY Ef IARCIN IIENIA H-EA1 -1 SMNACES Administrative Enforcement Order (FA0003910 Fueling Station) . 1,0 ,.� CLAUDIA JONAH, MD PUBLIC HEALTH OFFICER tiv 2i0 Please find the enclosed settlement agreement entitled Consent Order proposed as a,resul of an. inspection(s) conducted on July 13, 2010. California state regulations prescribe the. proced a to. calculate penalties ifor. Enforcement Orders in order to determine the settlement amount. I you are in agreement with the terms in the Consen der, this Department is authorized to redu e maximum settlement . amount . of $ to $3 2 ;600 discounted penalty plu $650 Departmental .costs). Failure to reach an agreement in this matter will. result in an issuanc o a Unilateral Order for the maximum allowable . penalty amounts for the violations cited, or referral to the Kern County District. Attorney's Office: Two copies of the Consent Order are enclosed. One copy is for your file. The second copy must be signed and returned to this Department with full payment of the penalty amount. The signed Consent Order and payment must be received by this office by September 30, 2010. An informal hearing has been scheduled on at September 28, 2010 at 9:00 A.M. at the letterhead address to discuss the violations and settlement. If you have any questions, please contact Brian Pitts at (661) 862 -8704. GI .110t � Sincerely, u ` Matthew Constantine Director. MC:lvs:bdh Enclosures Printed on Recycled Paper ENVOONMENTAL HEALTI* DIVISION 2700 M STREET, SUITE 300, BAKERSFIELD, CA .93301-2370 VOICE: (661) 862-8700 FAX: (661) 862-8701 Web: www.co.kern.ca.us /eh E-mail: eh ®co.kern.ca.us «nnrF vnrr.F MATTHEW CONSTAN TINE. DIRECTOR PUBLIC HEALTH SERVICES TAFT HWY CHEVRON c/o BARBARA YAM 1999 TAFT HWY BAKERSFIELD CA 93313 Dear Ms. Yam: August 30, 2010 GkC1 - 1 200 Administrative Enforcement Order (FA0003910 —Fueling Station) CLAUDIA JONAH, MD PUBLIC HEALTH OFFICER \,jb 7� Uv xv c . Please find the enclosed settlement agreement entitled Consent Order proposed as a resul of an inspection(s) conducted on July 13, 20 1.0. California state regulations prescribe the proced e to. calculate penalties for Enforcement Orders in order to determine the settlement amo72d t. I you are in agreement with the terms in the Cons R der, this Department is authorized to e maximum settlement . amount of $ to $3 2,600 discounted penalty $650 Departmental' costs). Failure to reach an agreement in this matter will result in aniss o a Unilateral Order for the maximum allowable penalty amounts for the violations cited, or referral to the Kern County District Attorney's Office. Two copies of the Consent Order are enclosed. One copy is for your file. The second copy must be signed and returned to this Department with full payment of the penalty amount. The signed Consent Order and payment must be received by this office by September 30, 2010. An. informal- hearing has been scheduled on at September 28, 2010 at 9:00 A.M. at the letterhead address to discuss the violations and settlement. If you have any questions, please contact Brian Pitts at (661) 862-8704. t,4, - , , ?. ...., U.r•A ... _ .,. __ ... .t;:r- E..v .«.t:a _... .. .. `,1 .� .HWY ti r 3 d 7&68/1220 CA:93313 IV fjT KOF.AMEIC r MIN6'AVENUE ' uuv�'' �!►'00 =34`5311° h <+: � 2 2000�66;L +: L`2,673�•�44 L 281 +' �� � fi���: ,F� y�' r !r7 t Make checks payable to: INVOICE COUNTY OF KERN ENVIRONMENTAL HEALTH SERVICES DEPARTMENT 2700 M STREET, SUITE 300 BAKERSFIELD, CA 93301 -2730 (661) 862 -8713 Food (661) 862 -8791 Solid Waste (661) 862 -8733 Haz Mat (661) 862 -8797 Water/Housing We Now Accept Visa and Mastercard Payments BARBARA YAM PEK CC INC 1999 TAFT HWY BAKERSFIELD, CA 93313 Invoice ID Account ID Date IN0229146 I AR0007725 10/01/2010 FA0003910 TAFT HWY CHEVRON 1111111111111111111111111111111111111111111111111111111111111 IN 111111 I I I I I I I I I IN To avoid 50% Penalty, pay by: 01/01/1999 Total Due: $650.00 Amount Paid: Please return the top portion of this invoice notice with payment County of Kern RE: TAFT HWY CHEVRON, FA0003910 Environmental Health Services Department 1999 TAFT HWY BAKERSFIELD, CA 93313 Program Date Element Description Record Identifier Amount Invoice # IN0229146 -- Date of Invoice: 10/01/2010 10/01/2010 ZZ02 OTHER -.RMA- HAZARDOUS WASTE SET 22125 650.00 Total For this Invoice: 650.00 Total Amount Due for this Invoice -- Please Remit this Amount -- $650.00 You must notify Environmental Health of any changes of * Ownership * Billing Address * Business Name * Closure FAILURE to notify Environmental Health may result in LATE PENALTIES PERMIT DENIAL, OR REVOCATION Permits and Fees Paid are NOT TRANSFERABLE 2700 M Street, Suite 300 * Bakersfield, California 93301 * (661) 862 -8700 * FAX (661) 862 -8701 • • WNW