Loading...
HomeMy WebLinkAboutENVIERN. DEPART. INVESTIGATION RECO. 1992/1998 r : • rr • rr • • r . i AG ArM 0-1 gg�. ��.�.J�►.' �- MON�-ate Ed I NR 1 - .I� R► ��.�. � � _� �, -, / ,r� � � 'IAA ! +I, ' BUSINES WNER/OPERATOR IDENT CATION Kern County Environmental Health Services Department 2700 M Street,Suite 300 Unified Program Consolidated Form(UPCF) Bakersfield,CA 93301 11111 l 1111 53 FACILITY INFORMATION (661)862-8700 Fax(661)862-8701 IE Page I of 1 I. IDENTIFICATION FACILITY ID# I BEGINNING DATE loo Io1 FA0000018 1 5 - 0 1 0 - 0 0 0 0 1 8 05/19/2006 ENDING DATE 05119/2007 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 HAPPY GAS 661 831-2323 BUSINESS SITE ADDRESS 103 BUSINESS FAX iota 3221 TAFT HWY BUSINESS CITY 104 ZIP CODE 105 COUNTY 108 BAKERSFIELD CA 93313 Kern County DUN&BRADSTREET 106 PRIMARY SIC 107 PRIMARY NAICS 107a 5541 None specified BUSINESS MAILING ADDRESS 108a 3221 TAFT HWY BUSINESS MAILING CITY 1066 STATE 108c ZIP CODE 108d BAKERSFIELD CA 93313 BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 AMITA AND VIKRAM BUDIYAM II. BUSINESS OWNER OWNER NAME 111 OWNER PHONE 112 HAPPY GAS O_ OWNER MAILING ADDRESS 113 3221 TAFT HWY OWNER MAILING CITY 114 STATE 115 1 ZIP CODE 116 BAKERSFIELD CA 93313 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 AMITA BUDIYAN (661) 831-2323 CONTACT MAILING ADDRESS 119 CONTACT EMAIL 119a 3221 TAFT HWY sun93313 @yahoo.com CITY 120 STATE 121 ZIP CODE 122 BAKERSFIELD CA 93313 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 128 AMITA BUDIYAN YOGI SOLANKI TITLE 124 TITLE 129 OWNER CO OWNER BUSINESS PHONE 125 BUSINESS PHONE 130 (661)831-2323 (661) 831-2323 24-HOUR PHONE 126 24-HOUR PHONE 131 (661)900-2756 (661)900-1756 PAGER# 127 PAGER# 132 ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 APN: 18417026 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 1 NAME OF DOCUMENT PREPARER 135 E&d,.$yam 02/04/2008 ! O:FSIGNER[ 7AMita (print) 136 TITLE OF SIGNER 137 Budiyan 1111111 IIl 1 I 54 1 E KERN COUNTY ENVIRONMENTAL HEALTH 4:ARTMENT INVESTIGATION RECORD DRA OWNER ADDRESS ADDRESS ASSESSORS' PARCEL # CT CHRONOLOGICAL RECORD OP INVESTIGATION DATE I MC:Cd F'! �•, li' ��y�,... �i� �' � j� �, - ;� t. ... �, I fW �7 rot .. i �� � fZ 40/ //� - I I ,' i � - - -rt - - - - - - -- - -- - -- -- --- -- -- -- - fi - - - --- - - - - - - - -- - -- -- -- ------- • - -- _ -_ . . i ' r -- - - - _ _ - - . - -- --- - - -- - - ---- - - --- - - 1 --- - -- -- - - -- - -- -- - - - -- - --- - j - - -- -- -- - -- - - - --fi - - -- _ - - - - - - -- -- - i �t - - - --- ----- - - �---- 1019-7197 c46k a :�r6aL I)L5 jue jai �e-e4410�d 4j �4� 44 -4- 6L Wc4l c14 AV-4-7L + i I I I I I 4L II 1 ADOUe> I A a-adt--4�enj c4m4ro 44wTv-4 rs*�l ;A-"esfv� 114197 4 E 5 ' X171-0 �l / O r'( ,I � . o o-A N som vej o '41 50 I� I -'-F—-,s 1 U l I I 1 f �. . t _ .. � , t,. .. '_• �� _ � � l i .. •.. d � - +. a �1 4 `I I, I� V I * SUNWRY OF OBSERVATIONSIVIOLOONS ❑ No violations of underground tank, hazardous materials inventory, and hazardous waste laws, regulations, and requirements were discovered. KCEHSD greatly appreciates your efforts to comply with all the laws and regulations applicable to your facility. 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 proposed action, please inform KCEHSD in writing. All minor violations must be corrected within 30 days or as specified. KCEHSD must be informed in writing certifying 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 at any time. You may request a meeting with KCEHSD Program Manager to discuss the inspection findings and/or proposed corrective actions. The issuance of this Summary of Violations does not preclude KCEHSD from taking administrative, civil, or criminal action as a result of the violations noted or that have not been corrected within the time specified. VIOLATIONS. NO. MINOR MAJOR CORRECTIVE AQIION REQUIRED TRO dt ERO Ic C4 BPO 5 --4 �� GTO WDO UTO 4P duLzE II ATO COMMENTS: dnsp. Agency Re .: Zp Mp Facility Rep.: Date: Title' . gAhazmaticupainsp.2 580 41 13 2081(5-97) 1 ( YES NO NIA VIOL.# Hazardo1Waste Generator(continued) WASTE DISCHARGE ❑ ❑ ❑ WD01 Facility has a washrack, drain, or sump. Status: 11 active El closed WD02 Are above activities in compliance. (closed looped system or connected to sewer) UNDERGROUND STORAGE TANK (UST) MONITORING CODES Permit NO. C 1. No monitoring # PERMITTED TANKS 4L 2. Standard Inventory Control # UNPERMITTED TANKS 3. Modified Inventory Control 4. Statistical Inventory Rec. 5. Automatic tank gauge(list type) Owner& operator as indicated on permit: ❑YES KfNO 6. Continuous monitoring in tank annular If no, new er name & a ess: space/secondary containment g 7. Visual monitoring 8. Manual monitoring annular space 9. Temporarily abandoned under permit 10. Another method lldd2t2- 7 YES NO N/A VIOL. # PERMITTING ❑ ❑ UT01 Site has a permit to operate (HSC 25284) ❑ ❑ UT02 Permit is kept on the premises (KCOC 8.48.080) ❑ UT03 Change of ownership is reported to the permitting agency within 30 days (HSC 25284(c)) ❑ UT04 All UST(s) are properly permitted to operate or properly closed (HSC 25298, KCOC 8.48.270) MONITORING ❑ ❑ UT05 UST(s) monitored using method specified on the permit or approved the permitting agency(HSC 25293, KCOC 8.48.140) (Designat monitoring code(s) observed ) ❑ ❑ UT06 Monitoring records are provided to regulatory agency upon request (KCOC 8.48.035/.140) ❑ ❑ UT07 Automatic line leak detection system is installed& kept operational for all pressurized piping (HSC 25292) ❑ ❑ UT08 An annual report is submitted to regulatory agency (KCOC 8.48.130) ❑ ❑ UT09 Tank tightness test and/or piping test is being performed as required (Title 23 CCR) ❑ ❑ UT10 Alarm Response Plan submitted for electronically monitored tank system (Title 23 CCR 2632/34) ❑ ❑ UT11 Facility maintains evidence of Financial Responsibility for corrective action and for compensating third parties for bodily injury/property damage caused by a release from the tank system (HSC 25292, KCOC 8.48.175) ABOVEGROUND PETROLEUM STORAGE WANK ACT No. of Tanks: Product Stored: ❑Diesel ❑ Gasoline ❑ Crude oil Total Volume: bbls or gals ❑ Others Note: SPCC required for tanks with total storage capacity of z 10,000 gallons-240 bbls;for farms,nurseries,construction sites individual storage capacity of>20,000 gal or total storage capacity of>100,000 gallons. YES NO N/A VIOL. # ❑ ❑ ❑ AT01 SPCC Plan is prepared and certified by a registered engineer within last 3 yrs. ❑ ❑ ❑ AT02 SPCC Plan is maintained on site or nearest field office. ve 580 4113 2081(5-97) HAZARDOUS WASTE GENERATOP The waste generator page is used to identify your generator status and-all waste streams generated at your facility. 1. FACILITY ID NUMBER- Leave this blank. This number is assigned by this Department. This is the unique number which identifies your facility. 2. EPA ID # - Enter your facility's 12-character U.S. Environmental Protection Agency (U.S. EPA) or California Identification number. For facilities in California, the number usually starts with the letters "CA". If you do not have a number, contact the Department of Toxic Substances Control(DTSC)at(916)324-1781,(800)61-TOXIC or(800)618-6942,to obtain one. 3. BUSINESS NAME-Enter the full legal name of the business. A. NUMBER OF EMPLOYEES-Enter the total number of employees currently working at your facility. B. TYPE OF GENERATOR-Check the box that most closely applies to your facility. RCRA GENERATOR - Check the box that best describes the amount of Federal listed and regulated hazardous waste generated by your facility. Leave blank if your facility doesn't generate hazardous waste regulated under Subtitle C of RCRA (the Resource Conservation and Recovery Act of 1976). NON - RCRA GENERATOR - Check the box that that best describes the amount of California-only listed and regulated hazardous waste generated by your facility. Leave blank if your facility doesn't generate non-RCRA hazardous waste. Boxes include: ♦ Large Quantity Generator(greater than 1000 kg per Hazardous Waste per month) ♦ Small Quantity Generator(less than 1000 kg per month but greater than 100 kg Hazardous Waste per month) ♦ Conditionally Exempt Small Quantity Generator(less than 100 kg Hazardous Waste per month) Note: 1. 1 kg=2.2 lbs. 2. For Acutely Hazardous Waste or Extremely Hazardous Waste, facilities that generate greater than I kg per month are considered Large Quantity Generators and facilities that generate less are considered Conditionally Exempt Small Quantity Generators. C. PROCESS -Briefly describe all processes that generate hazardous waste(s)at your facility. E xample: p lating, machining, painting,vehicle maintenance,etc. D. WASTE DESCRIPTION-Describe the type of waste that is generated from each process listed. Example: heavy metal sludge, waste oil,etc. E. WASTE ID-List the Waste ID#'s for all RCRA and non-RCRA hazardous waste. Refer to 22 CCR§ 66261.126. F. AMOUNT PER YEAR-List the amount of hazardous waste generated from each separate process per year. G. UNITS—Enter the unit of measure that is most appropriate for the material being reported: kilograms,pounds,gallons, or tons. H. STORAGE METHOD - Enter the letter that corresponds to the type of storage used at your facility for each of the hazardous waste streams listed. A=Aboveground Tank B=Underground Tank C=Drums D=Roll Off Bin E=Waste Pile F=In Process Equipment 1. DISPOSAL METHOD - Enter the letter in the space provided to describe the disposal method used at your facility for each of the hazardous waste streams listed. A=Treatment Onsite B=Treatment Offsite C=Recycle Onsite D=Recycle Offsite E=Disposal at an approved location J. OWNER/OPERATOR NAME-Indicate the name of the person who signed the form. K. OWNER/OPERATOR TITLE-Indicate the title of the person who signed the form. L. DATE-Indicate the date the form was signed. HAZARDOUS WASTE GENERATOR KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Form 2700 M STREET,SUITE 300 BAKERSFIELD,CA 93301 (661)862-8700 Fax(661 862-8701 Page of I. FACILITY INFORMATION FACILITY ID# i 01A 16 1 O ( EPA ID#(Hazardous Waste Only) Z BUSINESS NAME(Same as Facility Name of DBA-Doing Business As) a #OF EMPLOYEES A t0kk v Cta �V w 3 II. TYPE OF GENERATOR PLEASE CHECK THE BOX THAT APPLIES B RCRA GENERATOR NON-RCRA GENERATOR FEDERAL WASTE) (CALIFORNIA WASTE ONLY LARGE QUANTITY GENERATOR ❑ ❑ (>1000 KG HAZARDOUS WASTE PER MONTH SMALL QUANTITY GENERATOR (>100 KG BUT<1000 KG HAZARDOUS WASTE PER MONTH) CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (<100 KG HAZARDOUS WASTE PER MONTH) III. WASTE STREAM IDENTIFICATION PLEASE COMPLETE THE TABLE BELOW. (SEE INSTRUCTIONS ON THE BACK FOR CODES AND EXPLANATIONS) C D E AMOUNT F G STORAGE H DISPOSAL I PROCESS WASTE DESCRIPTION WASTE ID PER YEAR UNITS METHOD METHOD it /certify that the information provided herein is true and accurate to the best of my knowledge. OWNER/OPERATOR NAME J OWNER/OPERATOR TITLE K OWNER/OPERATOR SIGNATURE DATE L .� • B. Emergency Medical Facility List the closest emergency medical facility that will be used by your business in the event of an accident of injury caused by a release or threatened release of a hazardous material HOSPITAL/CLINIC: S '0 , _,�G,� �oS�; \ PHONE NO: ADDRESS: CITY: ZIP CODE: C. Private Emergency Response DOES YOUR BUSINESS HAVE A PRIVATE ON-SITE EMERGENCY RESPONSE TEAM? ❑ Yes ® No If yes, provide an attachment that describes what policies and procedures your business will follow to notify your on-site emergency response team in the event of a release or threatened release of hazardous materials. CLEANUP/DISPOSAL CONTRACTOR List the contractor that will provide cleanup services in the event of a release. NAME OF CONTRACTOR: PHONE NO: �v�v► - 9-7 ADDRESS: CITY: ZIP CODE: D. Arrangements with Emergency Responders If you have made special (i.e. contractual) arrangements with any police department, fire department, hospital, contractor, or State or local emergency response team to coordinate emergency services, describe those arrangements in the space below: E. Evacuation Plan 1. The following alarm signal(s)will be used to begin evacuation of the facility (check all which apply): ,Verbal ❑ Telephone(including cellular) ❑ Alarm System ❑ Public Address System ❑ Intercom ❑ Pagers ❑. Portable Radio ❑ Other (specify): 2. ❑ Evacuation map is prominently displayed throughout the facility. 3.,R Name of individual(s) responsible for coordinating evacuation including spreading the alarm and confirming the business has been evacuated: '/�. � �� •�,�� F. Earthquake Vulnerability Identify areas of the facility where releases could occur or would require immediate inspection or isolation because of the vulnerability to earthquake related ground motion. Hazardous Waste/Hazardous Materials Storage Areas ❑ Production Floor ❑ Process Lines ❑ Bench/ Lab ❑ Waste Treatment ❑ Other: Identify mechanical systems where releases could occur or would require immediate inspection or isolation / because of the vulnerability to earthquake related ground motion. �/ ❑ Utilities ❑ Sprinkler Systems ❑ Cabinets ❑ Shelves ❑ Racks Pressure Vessels ❑ Gas Cylinders ❑ Tanks ❑ Process Piping Shutoff Valves ❑ Other: G. Emergency Procedures Briefly describe your business standard operating procedures in the event of a release or threatened release of hazardous materials/wastes: 1. PREVENTION (prevent the spill/release) - Consider the types of spills/releases associated with the hazardous materials/wastes p resent a t your f acility. What a ctions d oes your b usiness t ake t o p revent t hese s pills/releases f rom occurring? You may include a discussion of safety and storage procedures. c�s 2. MITIGATION (stop t he r elease/spill)- D escribe what a ctions a re t aken f o r educe t he h arm o r t he d amage t o person(s), property, or the environment, and prevent what has occurred from getting worse or spreading. What is your immediate ttresponse to a leak, spill, fire, explosion, or airborne release at your business? ILA- x t,�l S 47 3. ABATEMENT (clean up the spill/release)- Describe what you would do to clean up the spill/release. How do you handle the complete process of cleaning up and disposing of released materials at your facility? V. EMPLOYEE TRAINING All facilities which handle hazardous materials must have a current written employee training plan. The items listed below are required per Health and Safety Code Section 25504 (c)and Title 19 Section 2732. Training shall be provided: 4 Initially for all new employees. 4 Methods for Safe Handling of Hazardous Materials. Note: These training programs may take into consideration the position of each employee. Facility personnel are trained as follows: d Familiarity with all plans and procedures specified in the Contingency Plan. 4 Methods for Safe Handling of Hazardous Materials. 4 Safety procedures in the event of a release or threatened release of a hazardous material. 4 Use of Emergency Response equipment and supplies under the control of the business. 4 Procedures for Coordination with local Emergency Response Organizations. Additional training should include: 4 Internal alarm/notification procedures. 4 Evacuation/re-entry procedures and assembly point locations 4 Material Safety Data Sheet (MSDS)training including specific hazard(s)of each chemical to which employees may be exposed, including routes of exposure (i.e. inhalation, ingestion, absorption). VI. HAZARDOUS WASTE GENERATOR TRAINING If your business is a hazardous waste generator, you are required to provide training in hazardous waste management for all workers who handle hazardous waste at your site (22 CCR §66265.16). You are also required to document training. The items below are required. EMPLOYEE TRAINING 4 Facility personnel will successfully complete training within six months after the date of their employment or assignment to a facility or to a new position at a facility. 4 Employees will not handle hazardous wastes without supervision until trained. TRAINING DOCUMENTATION The owner or operator must maintain the following documents and records at the facility: 4 Job title for each position at the facility that is related to hazardous waste management, and the names of the employee(s)filling the position(s). 4 Description for each position listed above (must include required skill, education, or other qualifications as well as duties of employees assigned to the position. 4 Description of type and amount of both introductory and continuing training given to each employee. 4 Records that document that the requirements for training or job experience have been met. 4 Current employees' training records (to be retained until closure of the facility). 4 Former employees' training records (to be retained at least three years after termination of employment). IV. Emergency Equipment 22 CCR, Section 66265.52(e) [as referenced by Section 66262.34(a)(3)J requires that emergency equipment at the facility be listed. Completion of the following Emergency Equipment Inventory Table meets this requirement. EMERGENCY EQUIPMENT INVENTORY TABLE 1. 2. 3. 4. Equipment Equipment Category Type Location Description* Personal ❑Cartridge Respirators Protective, ❑Chemical Monitoring Equipment(describe) Equipment, ❑ Chemical Protective Aprons/Coats Safety ❑Chemical Protective Boots Equipment, ❑Chemical Protective Gloves and ❑Chemical Protective Suits(describe) First Aid ❑Face Shields Equipment ❑ First Aid Kits/Stations(describe) ❑Hard Hats ❑Plumbed Eye Wash Stations ❑Portable Eye Wash Kits(i.e.bottle type) ❑ Respirator Cartridges(describe) ❑Safety Glasses/Splash Goggles ❑ Safety Showers ❑ Self-Contained Breathing Apparatuses(SCBA) Other(describe) Fire ❑Automatic Fire Sptinkler Systems Extinguishing ❑ Fire Alarm Boxes/Stations Systems Fire Extinguisher Systems(describe) ❑Other(describe) Spill Absorbents(describe) CaT c` Control ❑ Berms/Dikes(describe) Equipment ❑ Decontamination Equipment(describe) and ❑Emergency Tanks(describe) Decontamination ❑ Exhaust Hoods Equipment ❑ Gas Cylinders Leak Repair Kits(describe) ❑ Neutralizers(describe) ❑Overpack Drums ❑Sumps(describe) ❑Other(describe) Communications ❑Chemical Alarms(describe) and ❑ Intercoms/PA Systems Alarm ❑Portable Radios Systems Telephones Ca ❑ Underground Tank Leak Detection Monitors ❑ Other(describe) Additional Equipment (Use Additional Pages if Needed.) Describe the equipment and its capabilities. If applicable,specify any testing/maintenance proceduresrnterva/s. Attach additional pages, numbered appropriately,if needed. • SITE MAP • A site plan and storage map must be included with your Contingency Plan. For relatively small facilities, these documents may be combined into one drawing. Since these drawings are intended for use in emergency response situations, larger facilities (generally those with complex and/or multiple buildings) should provide an overall site plan and a separate storage map for each building/storage area. A blank Facility Site Map has been provided on the reverse side of this page. You may complete that page or attach any other drawing(s) which contain(s) the information required below. Drawings are to be no larger than 11" x 17". Blue prints are not acceptable. 1. Site Plan: This drawing shall contain, at a minimum, the following information: a. Site Orientation (north, south, etc.) b. Date the map was drawn C. Locations of all buildings and other structures d. Parking lots and internal roads e. Outside hazardous materials storage or use areas f. Storm drain, sanitary sewer drain inlets, and dry wells g. All wells (water, monitoring of underground tank systems, etc) if applicable h. Evacuation routes, emergency exits, and staging/meeting areas i. Adjacent property use j. Locations and names of adjacent streets and alleys k. Entrance and exit points/roads 2. Storage Map(s): The map(s) shall contain, at a minimum, the following information: a. General purpose of each section/area within each building (e.g. "Office Area", "Manufacturing Area" etc) b. Location of each h azardous m aterial/waste s torage, dispensing, use, or h andling a rea (e.g. individual underground tanks, aboveground tanks, storage rooms, etc.). C. Entrances to and exits from each building and hazardous material/waste room/area d. Location of each utility emergency shut-off point (i.e. gas, water, electric) e. Location of each monitoring system control panel (e.g. underground tank monitoring, toxic gas monitoring, etc) CONSOLIDATED CONTINGENCY PLAN KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Form 2700 M STREET,SUITE 300 SITE MAP BAKERSFIELD,CA 93301 (661)862-8700 Fax(661)862-8701 Page of I. FACILITY IDENTIFICATION FACILITY ID# I D O O ,� EPA ID#(Hazardous Waste Only) 2 BUSINESS NAME(Same as Facility Name of DBA-Doing Business As) 3 -� a PP9 FT SITE ADDRESS 103 CITY 104 ZIP CODE 105 `S z 2Z \ \-Aw f1�_y �-1 c� 013 3 i3 DATE MAP DRAWN MAP# SUB-FACILITY#(if needed) b-7 For Site Map • Loading Areas t • Parking Lots • Internal Roads • Storm and Sewer Drains • Adjacent Property Use • Locations and Names of Adjacent Streets and l ° Alleys t 1 a Entrance and Exit Points and Roads Evacuation Routes fi 4 For Storage Map ( 3 Location of Each Storage Area 0 Location of Each Hazardous Material Handling Area 0 Location of Emergency Response Equipment NORTH S EHAZARDOUS MATERIALS INVENTORY- CHEMICAL DESCRIPTION MSTREET,Y ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Consolidated Form(UPCF) SUITE 300 HAZARDOUS MATERIALS D,CA 93301 Fax(661)862-8701 (one page per material per building or area) ❑ADD ❑DELETE ❑REVISE 200 Page_of, I. FACILITY INFORMATION BUSINESS NAME(Same as FACILITY NAME or DBA—Doing Business As) 3 �o-S ,. z CHEMICAL LOCATION r c� ` 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 ❑ YES ❑ NO O O MAP#(optional) 203 GRID#(optionaq 204 FACILITY ID# �, 1 0. 1 01 ( II.CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes V No 206 If Subject to EPCRA,refer to instructions COMMON NAME 207 209 EHS' ❑ Yes � No CAS# 209 *If EHS if"Yes",all amounts below must be in pounds FIRE CODE HAZARD CLASSES(Not currently required by KCEiiSD) 210 HAZARDOUS MATERIAL 213 TYPE(Check one item only) ❑a.PURE b.MIXTURE El c.WASTE 211 RADIOACTIVE ❑Yes �No 2[2 CURIES PHYSICAL STATE I '215 (Check one item only) ❑ a.SOLID �b. LIQUID ❑ c.GAS 214 LARGEST CONTAINER ,(J(,1p0, t^K� FED HAZARD CATEGORIES 216 (Check all[hat apply) FIRE ❑b. REACTIVE ❑ c.PRESSURE RELEASE ❑d. ACUTE HEALTH ❑ C. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 U 221 DAYS ON SlI- 222 UNITS' a.a.GALLONS ❑b. CUBIC FEET ❑ c.POUNDS ❑d.TONS 1 L s Check one item only) •If EHS,amount must be in pounds. J v STORAGE CONTAINER ❑ .a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m.GLASS BOTTLE ❑ q. RAIL CAR 5rb. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ it. PLASTIC BOTTLE ❑ r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE ❑ a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE ❑a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT(For mixture or waste only) EHS CAS# ) 226 227 ❑Yes ❑ No 228 229 2 230 1 231 ❑Yes ❑ No 232 233 3 234 l 235 ❑Yes ❑- No 236 237 4 238 239 ❑Yes ❑ No 240 241 5 242 243 ❑Yes ❑ No 244 245 If more hazardous components are present at greater than 1%by weight If non-carcinogenic,or 0.1%by weight If carcinogenic,attach additional sheets of paper capturing the required Information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA Please Sign Here Hazardous Materials Inventory-Chemical Description You must complete a separate Hazardous Materials inventory-Chentical Description page for each hazardous material(hazardous substances and hazardous waste)that you handle at your facility in aggregate quantities equal to or greater than 500 pounds,55 gallons,200 cubic feet of gas(calculated at standard temperature and pressure)or the federal threshold planning quantity for Extremely Hazardous Substances,whichever is less. Also complete a page for each radioactive material handled over quantities for which an emergency plan is required to be adopted pursuant to 10 CFR Parts 30, 40,or 70. The completed inventory should renect all reportable quantities of hazardous materials at your facility,reported separately for each building or outside adjacent area,with separate pages for unique occurrences of physical state,storage temperature and storage pressure. (Note: the numbering of the instructions follows the data element numbers that are on the Unified Program Consolidated Fort(UPCF)pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR,Appendix C,the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps the Kern County Environmental Health Services Department(KCEHSD)identify whether the submittal is complete and if any pages are separated. 1. FACILITY ID NUMBER-This number is assigned by KCEHSD. This is the unique number which identifies your facility. 3. BUSINESS NAME-Enter the full legal name of the business. 200.ADD/DELETE/REVISE-Indicate if the material is being added to the inventory,deleted from the inventory,or if the information previously submitted is being revised. NOTE: You may choose to leave this blank if you resubmit your entire inventory annually. 201.CHEMICAL LOCATION-Enter the building or outside/adjacent area where the hazardous material is handled. A chemical that is stored at the same pressure and temperature,in multiple locations within a building,can be reported on a single page. NOTE:This information is not subject to public disclosure pursuant to HSC§25506. 202.CHEMICAL LOCATION CONFIDENTIAL-EPCRA-All businesses which are subject to the Emergency Planning and Community Right to Know Act(EPCRA)must check"Yes"to keep chemical location infomation confidential. if the business does not wish to keep chemical location information confidential check"No". 203.MAP NUMBER-If a map is included,enter the number of the map on which the location of the hazardous material is shown. 204.GRID NUMBER-If grid coordinates are used,enter the grid coordinates of the map that correspond to the location of the hazardous material. If applicable,multiple grid coordinates can be listed. 205.CHEMICAL NAME-Enter the proper chemical name associated with the Chemical Abstract Service(CAS)number of the hazardous material. This should be the International Union of Pure and Applied Chemistry(IUPAC)name found on the Material Safety Data Sheet(MSDS). NOTE:If the chemical is a mixture,do not complete this field;complete the "COMMON NAME"field instead. 206.TRADE SECRET-Check"Yes"if the information in this section is declared a trade secret,or"No"if it is not. State requirement: lfyes,and business is not subject to EPCRA,disclosure of the designated trade secret information is bound by HSC§25511. Federal requirement: If yes,and business is subject to EPCRA,disclosure of the designated Trade Secret information is bound by 40 CFR and the business must submit a "Substantiation to Accompany Claims of Trade Secrecy" form (40 CFR 350.27) to USEPA. 207.COMMON NAME-Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. 208.EHS-Check"Yes"if the hazardous material is an Extremely Hazardous Substance(EHS),as defined in 40 CFR,Part 355,Appendix A. if the material is a mixture containing an EHS, leave this section blank and complete the section on hazardous components below. 209.CAS N-Enter the Chemical Abstract Service(CAS)number for the hazardous material. For mixtures,enter the CAS number of the mixture if it has been assigned a number distinct from its components. If the mixture has no CAS number,leave this column blank and report the CAS numbers of the individual hazardous components in the appropriate section below. 210.FIRE CODE HAZARD CLASSES-Fire Code Hazard Classes describe to first responders the type and level of hazardous materials which a business handles. This information is not currently required by KCEHSD. A list of the hazard classes and instructions on how to determine which class a material falls under are included in the appendices of Article 80 of the Uniform Fire Code. If a material has more than one applicable hazard class,include all. 211.HAZARDOUS MATERIAL TYPE-Check the one box that best describes the type of hazardous material:pure,mixture or waste. If waste material,check only that box. If mixture or waste,complete hazardous components section. 212.RADIOACTIVE-Check"Yes"if the hazardous material is radioactive or"No"if it is not. 213.CURIES-If the hazardous material is radioactive,use this area to report the activity in curies. You may use up to nine digits with a floating decimal point to report activity in curies. 214.PHYSICAL STATE-Check the one box that best describes(lie state in which the hazardous material is handled:solid,liquid or gas. 215.LARG EST CONTAINER-Enter the total capacity of the largest container in which the material is stored. 216.FEDERAL HAZARD CATEGORIES-Check all categories that describe the physical and health hazards associated with the hazardous material. PHYSICAL HAZARDS HEALTH HAZARDS Fire:Flammable Liquids and Solids,Combustible Liquids,P ro lmorics.Oxidizers Acute Health(Immediate):Highly Toxic,Toxic,Irritants,Sensitizers,Corrosives, Reactive:Unstable Reactive,Organic Peroxides,Water Reactive,Radioactive other hazardous chemicals with an adverse effect with short term exposure Pressure Release:Explosives,Compressed Gases,Blasting Agents Chronic Health(Delayed):Carcinogens,other hazardous chemicals with an adverse effect with long tern[exposure 217.AVERAGE DAILY AMOUNT-Calculate the average daily amount of the hazardous material or mixture containing a hazardous material,in each building or adjacent/outside area. Calculations shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days the chemical will be on site. if this is a material that has not previously been present at this location,the amount shall be(lie average daily amount you project to be on hand during the course of the year. This amount should be consistent with the units reported in box 221 and should not exceed that of maximum daily amount. 218.MAXIMUM DAILY AMOUNT-Enter the maximum amount of each hazardous material or mixture containing a hazardous material,which is handled in a building or adjacent/outside area at any one time over the course of the year. This amount must contain at a minimum last year's inventory of the material reported on this page,with the reflection of additions,deletions,or revisions projected for the current year. This amount should be consistent with the units reported in box 221. 219.ANNUAL WASTE AMOUNT-If the hazardous material being inventoried is a waste,provide an estimate of the annual amount handled. 220.STATE WASTE CODE-Ifthe hazardous material is a waste,enter the appropriate California 3-digit hazardous waste code as listed on the back of the.Uniform Hazardous Waste Manifest. 221.UNITS-Check the unit of measure that is most appropriate for the material being reported on this page:gallons,pounds,cubic feet or tons. NOTE:if the material is a federally defined Extremely Hazardous Substance(EHS),all amounts must be reported in pounds. If material is a mixture containing an EHS,report the units that the material is stored in(gallons, pounds,cubic feet,or tons). 222.DAYS ON SITE-List the total number of days during the year that the material is on site. 223.STORAGE CONTAINER-Check all boxes that describe the type of storage containers in which the hazardous material is stored. NOTE:If appropriate,you may choose more than one. 224.STORAGE PRESSURE-Check the one box that best describes the pressure at which the hazardous material is stored. 225.STORAGE TEMPERATURE-Check the one box that best describes the temperature at which the hazardous material is stored. 226.HAZARDOUS COMPONENTS 1-5(%BY WEIGHT)-Enter the percentage weight of the hazardous component in a mixture. if a range of percentages is available,report the highest percentage in that range. (Report for components 2 through 5 in 230,234,238,and 242.) 227.HAZARDOUS COMPONENTS 1-5 NAME-When reporting a hazardous material that is a mixture,list up to five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or.in the case of trade secrets,refer to manufacturer). All hazardous components in the mixture present at greater than 1%by weight if non-carcinogenic, or 0.1%by weight if carcinogenic,should be reported. If more than five hazardous components are present above these percentages,you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures,mineral and chemical composition should be listed. (Report for components 2'through 5 in 231,235,239, and 243.) 228.HAZARDOUS COMPONENTS 1-5 EHS-Check"Yes"if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355,or"No"if it is not. (Report for components 2 through 5 in 232,236,240,and 244.) 229.HAZARDOUS COMPONENTS 1-5 CAS-List the Chemical Abstract Service(CAS)numbers as related to the hazardous components in the mixture. (Repeat for 2-5.) 246.LOCALLY COLLECTED INFORMATION-Currently,no additional infomtation is required by KCEHSD. Hazardous Materials Inventory-Chemical Description You must complete a separate Hazardous Materials inventory-Chemical Description page for each hazardous material(hazardous substances and hazardous waste)that you handle at your facility in aggregate quantities equal to or greater than 500 pounds,55 gallons,200 cubic feet of gas(calculated at standard temperature and pressure)or the federal threshold planning quantity for Extremely Hazardous Substances,whichever is less. Also complete a page for each radioactive material handled over quantities for which an emergency plin is required to be adopted pursuant to 10 CFR Parts 30, 40,or 70. The completed inventory should reflect all reportable quantities of hazardous materials at your facility,reported separately for each building or outside adjacent area,with separate pages for unique occurrences of physical state,storage temperature and storage pressure. (Note: the numbering of the instructions follows the data element numbers that are on the Unified Program Consolidated Form(UPCF)pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR,Appendix C,the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps the Kern County Environmental Health Services Department(KCEHSD)identify whether the submittal is complete and if any pages are separated. 1. FACILITY ID NUMBER-This number is assigned by KCEHSD. This is the unique number which identifies your facility. 3. BUSINESS NAME-Enter the full legal name of the business. 200.ADD/DELETE/REVISE-Indicate if the material is being added to the inventory,deleted from the inventory,or if the information previously submitted is being revised. NOTE: You may choose to leave this blank if you resubmit your entire inventory annually. 201.CHEMICAL LOCATION-Enter the building or outside/adjacent area where the hazardous material is handled. A chemical that is stored at the same pressure and temperature,in multiple locations within a building,can be reported on a single page. NOTE:This information is not subject to public disclosure pursuant to HSC 625506. 202.CHEMICAL LOCATION CONFIDENTIAL-EPCRA-All businesses which are subject to the Emergency Planting and Community Right to Know Act(EPCRA)must check"Yes"to keep chemical location infomtation confidential. If the business does not wish to keep chemical location information confidential check"No". 203.MAP NUMBER-If a map is included,enter the number of the map on which the location of the hazardous material is shown. 204.GRID NUMBER-If grid coordinates are used,enter the grid coordinates of the map that correspond to the location of the hazardous material. If applicable,multiple grid coordinates can be listed. 205.CHEMICAL NAME-Enter the proper chemical name associated with the Chemical Abstract Service(CAS)number of the hazardous material. This should be the International Union of Pure and Applied Chemistry(IUPAC)name found on the Material Safety Data Sheet(MSDS). NOTE: if the chemical is a mixture,do not complete this field;complete the "COMMON NAME"field instead. 206.TRADE SECRET-Check"Yes"if the information in this section is declared a trade secret,or"No"if it is not. State requirement: if yes,and business is not subject to EPCRA,disclosure of the designated trade secret information is bound by HSC$25511. Federal requirement: if yes,and business is subject to EPCRA,disclosure of the designated Trade Secret information is bound by 40 CFR and the business must submit a "Substantiation to Accompany Claims of Trade Secrecy" form (40 CFR 350.27) to USEPA. 207.COMMON NAME-Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. 208.EHS-Check"Yes'if the hazardous material is an Extremely Hazardous Substance(EHS),as defined in 40 CFR,Part 355,Appendix A. If the material is a mixture containing an EHS, leave this section blank and complete the section on hazardous components below. 209.CAS 4-Enter the Chemical Abstract Service(CAS)number for the hazardous material. For mixtures,enter the CAS number of the mixture if it has been assigned a number distinct from its components. if the mixture has no CAS number,leave this column blank and report the CAS numbers of the individual hazardous components in the appropriate section below. 210.FIRE CODE HAZARD CLASSES-Fire Code Hazard Classes describe to first responders the type and level of hazardous materials which a business handles. This information.is not currently required by KCEHSD. A list of the hazard classes and instructions on how to determine which class a material falls under are included in the appendices of Article 80 of the Uniform Fire Code. if a material has more than one applicable hazard class,include all. 211.HAZARDOUS MATERIAL TYPE-Check the one box that best describes the type of hazardous material:pure,mixture or waste. If waste material,check only that box. If nnixture or waste,complete hazardous components section. . 212.RADIOACTIVE-Check"Yes"if the hazardous material is radioactive or"No"if it is not. 213.CURIES-If the hazardous material is radioactive,use this area to report the activity in curies. You may use up to nine digits with a floating decimal point to report activity in curies. 214.PHYSICAL STATE-Check the one box that best describes the state in which the hazardous material is handled:solid,liquid or gas. 215.LARGEST CONTAINER-Enter the total capacity of the largest container in which the material is stored. 216.FEDERAL HAZARD CATEGORIES-Check all categories that describe the physical and health hazards associated with the hazardous material. PHYSICAL HAZARDS HEALTH HAZARDS Fire:Flammable Liquids and Solids,Combustible Liquids,P ro horics,Oxidizers Acute Health(immediate):Highly Toxic,Toxic,Irritants,Sensitizers,Corrosives, Reactive:Unstable Reactive,Organic Peroxides,Water Reactive,Radioactive other hazardous chemicals with an adverse effect with short temp exposure Pressure Release:Explosives,Compressed Gases,Blasting Agents Chronic Health(Delayed):Carcinogens,other hazardous chemicals with an adverse effect with long term exposure 217.AVERAGE DAILY AMOUNT-Calculate the average daily amount of the hazardous material or mixture containing a hazardous material,in each building or adjacent/outside area. Calculations shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days the chemical will be on site. If this is a material that has not previously been present at this location,the amount shall be the average daily amount you project to be on hand during the course of the year. This amount should he consistent with the units reported in box 221 and should not exceed that of maximum daily amount. 218.MAXIMUM DAILY AMOUNT-Enter the maximum amount of each hazardous material or mixture containing a hazardous material,which is handled in a building or adjacent/outside area at any one time over the course of the year. This amount must contain at a minimum last year's inventory of the material reported on this page, with the reflection of additions,deletions,or revisions projected for the current year. This amount should be consistent with the units reported in box 221. 219.ANNUAL WASTE AMOUNT-if the hazardous material being inventoried is a waste,provide an estimate of the annual amount handled. 220. STATE WASTE CODE-lfthe hazardous material is a waste,enter the appropriate California 3-digit hazardous waste code as listed on the back of the.Uniform Hazardous Waste Manifest. 221.UNITS-Check the unit of measure that is most appropriate for the naterial being reported on this page:gallons,pounds,cubic feet or tons. NOTE:If the material is a federally defined Extremely Hazardous Substance(EHS),all amounts must be reported in pounds. If material is a mixture containing an EHS,report the units that the•material is stored in(gallons, pounds,cubic feet,or tons). 222.DAYS ON SITE-List the total number of days during the year that the material is on site. 223.STORAGE CONTAINER-Check all boxes that describe the type of storage containers in which the hazardous material is stored. NOTE:If appropriate,you may choose more than one. 224.STORAGE PRESSURE-Check the one box that best describes the pressure at which the hazardous material is stored. 225.STORAGE TEMPERATURE-Check the one box that best describes the temperature at which the hazardous material is stored. 226.HAZARDOUS COMPONENTS 1-5(%BY WEIGHT)-Enter the percentage weight of the hazardous component in a mixture. If a range of percentages is available,report the highest percentage in that range. (Report for components 2 through 5 in 230,234,238,and 242.) 227.HAZARDOUS COMPONENTS 1-5 NAME-When reporting a hazardous material that is a mixture,list up to five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or,in the case of trade secrets,refer to manufacturer). All hazardous components in the mixture present at greater than 1%by weight if non-carcinogenic, or 0.1%by weight if carcinogenic,should be reported. If more than five hazardous components are present above these percentages,you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures,mineral and chemical composition should be listed. (Report for components 2•through 5 in 231,235,239, and 243.) 228.HAZARDOUS COMPONENTS 1-5 EHS-Check"Yes"if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355,or"No"if it is not. (Report for components 2 through 5 in 232,236,240,and 244.) 229.HAZARDOUS COMPONENTS 1-5 CAS-List the Chemical Abstract Service(CAS)numbers as related to the hazardous components in the mixture. (Repeat for 2-5.) 246.LOCALLY COLLECTED INFORMATION-Currently,no additional information is required by KCEHSD. - r i HAZARDOUS MATERIALS INVENTORY- CHEMICAL DESCRIPTION KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Consolidated Form(UPCF) 2700 M STREET,SUITE 300 HAZARDOUS MATERIALS BAKERSFIELD,CA 93301 (661)862-8700 Fax 661)862-8701 (one page per material per building or area) [--]ADD ❑DELETE ❑REVISE 200 Page`of_ I, FACILITY INFORMATION BUSINESS NAME(Same as FACILITY NAME or DBA—Doing Business As) 3 CHEMICAL LOCATION nQ q 201 1 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 3-3 1'23 ❑ YES ❑ NO �' t� 'a (rAP#(optional) 203 GRID#(optional) 204 FACILITY 1D# 5A O D II.CHEMICAL INFORMATION CHEMICAL NAME O�� 205 TRADE SECRET ❑ Yes A No 206 If Subject to EPCRA,refer to instructions COMMON NAME ` 207 tog �^,�.t✓,�n,��Yv�, �=-St7 V,�..�-� EHS' ❑ Yes 91 No CAS# 209 •If EHS if"Yes".all amounts below must be in pounds FIRE CODE HAZARD CLASSES(Not cuff ently required by KCEHSD) 210 HAZARDOUS MATERIAL 213 211 RADIOACTIVE ❑Yes No 2 TYPE(Check one item only) ❑a.PURE b.MIXTURE ❑c.WASTE lz URIES C PHYSICAL STATE 215 (Check one item only) El a.SOLID b. LIQUID [I c.GAS 214 LARGEST CONTAINER / D FED HAZARD CATEGORIES 216 (Check all that apply) a. FIRE ❑b. REACTIVE ❑ c.PRESSURE RELEASE /0 d. ACUTE HEALTH 59 e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 1 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 1 STATE WASTE CODE 220 221 DAYS ON SITE: 222 UNITS' V a.GALLONS ❑b. CUBIC FEET ❑ c.POUNDS ❑d.TONS (Check one item onl ) •If EHS,amount must be in pounds. ( } STORAGE CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ ni.GLASS BOTTLE ❑ q. RAIL CAR W b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ I. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE 40 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 STORAGE TEMPERATURE IF a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT(For mixture or waste only) EHS CAS# 1 226 ./"227 ❑Yes ❑ No 228 229 r 2 230 �'1� 231 ❑Yes ❑ No 232 233 3 234 / 235 ❑Yes ❑ No 236 237 4 238 / 239 ❑Yes ❑ No 240 241 5 242 243 ❑Yes ❑ No 244 245 If more hazardous components are present at greater than 1%by weight if non-carcinogenic.or 0.1%by weight if carcinogenic.attach additional sheets of paper capturing the required Information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA Please Sign Here Hazardous Materials Inventory- Chemical Description You must complete a separate Hazardous Materials inventory-Chemical Description page for each hazardous material(hazardous substances and hazardous waste)that you handle at your facility in aggregate quantities equal to or greater than 500 pounds,55 gallons,200 cubic feet of gas(calculated at standard temperature and pressure)or the federal threshold planning quantity for Extremely Hazardous Substances,whichever is less. Also complete a page for each radioactive material handled over quantities for which an emergency plin is required to be adopted pursuant to 10 CFR Parts 30, 40,or 70. The completed inventory should reflect all reportable quantities of hazardous materials at your facility,reported separately for each building or outside adjacent area,with separate pages for unique occurrences of physical state,storage temperature and storage pressure. (Note: the numbering of the instructions follows the data element numbers that are on the Unified Program Consolidated Form(UPCF)pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR,Appendix C,the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps the Kern County Environmental Health Services Department(KCEHSD)identify whether the submittal is complete and if any pages are separated. I. FACILITY ID NUMBER-This number is assigned by KCEHSD. This is the unique number which identifies your facility. 3. BUSINESS NAME-Enter the full legal name of the business. 200.ADD/DELETE/REVISE-Indicate if the material is being added to the inventory,deleted from the inventory,or if the information previously submitted is being revised. NOTE: You may choose to leave this blank if you resubmit your entire inventory annually. 201.CHEMICAL LOCATION-Enter the building or outside/adjacent area where the hazardous material is handled. A chemical that is stored at the same pressure and temperature,in multiple locations within a building,can be reported on a single page. NOTE:This information is not subject to public disclosure pursuant to HSC§25506. 202.CHEMICAL LOCATION CONFIDENTIAL-EPCRA-All businesses which are subject to the Emergency Planning and Community Right to Know Act(EPCRA)must check"Yes"to keep chemical location information confidential. If the business does not wish to keep chemical location information confidential check"No". 203.MAP NUMBER-If a map is included,enter the number of the map oil which the location of the hazardous material is shown. 204.GRID NUMBER-if grid coordinates are used,enter the grid coordinates of the map that correspond to the location of the hazardous material. if applicable,multiple grid coordinates can be listed. 205.CHEMICAL NAME-Enter the proper chemical name associated with the Chemical Abstract Service(CAS)number of the hazardous material. This should be the International Union of Pure and Applied Chemistry(IUPAC)name found on the Material Safety Data Sheet(MSDS). NOTE: If the chemical is a mixture,do not complete this field;complete the "COMMON NAME"field instead. 206.TRADE SECRET-Check"Yes"if the information in this section is declared a trade secret,or"No"if it is not. State requirement: if yes,and business is not subject to EPCRA,disclosure of the designated trade secret information is bound by HSC§25511. Federal requirement: if yes,and business is subject to EPCRA,disclosure of the designated Trade Secret information is bound by 40 CFR and the business must submit a "Substantiation to Accompany Claims of Trade Secrecy" form (40 CFR 350.27) to USEPA. 207.COMMON NAME-Enter the common name or trade name of the hazardous material or mixture containing a hazardous material. 208.EHS-Check"Yes"if the hazardous material is an Extremely Hazardous Substance(EHS),as defined in 40 CFR,Part 355,Appendix A. if the material is a mixture containing an EHS, leave this section blank and complete the section on hazardous components below. 209.CAS#-Enter the Chemical Abstract Service(CAS)number for the hazardous material. For mixtures,enter the CAS number of the mixture if it has been assigned a number distinct from its components. If the mixture has no CAS number,leave this column blank and report the CAS numbers of the individual hazardous components in the appropriate section below. 210.FIRE CODE HAZARD CLASSES-Fire Code Hazard Classes describe to first responders the type and level of hazardous materials which a.business handles. This information is not currently required by KCEHSD. A list of the hazard classes and instructions on how to determine which class a material falls under are included in the appendices of Article 80 of the Uniform Fire Code. If a material has more than one applicable hazard class,include all. 211.HAZARDOUS MATERIAL TYPE-Check the one box that best describes the type of hazardous material:pure,mixture or waste. If waste material,check only that box. If tnixture or waste,complete hazardous components section. 212.RADIOACTIVE-Check"Yes"if the hazardous material is radioactive or"No"if it is not. 213.CURIES-If the hazardous material is radioactive,use this area to report the activity in curies. You may use up to nine digits with a floating decimal point to report activity in curies. 214.PHYSICAL STATE-Check the one box that best describes the state in which the hazardous material is handled:solid,liquid or gas. 215.LARGEST CONTAINER-Enter the total capacity of the largest container in which the material is stored. 216.FEDERAL HAZARD CATEGORIES-Check all categories that describe the physical and health hazards associated with the hazardous material. PHYSICAL HAZARDS HEALTH HAZARDS Fire:Flammable Liquids and Solids,Combustible Liquids,P ro horics,Oxidizers Acute Health(immediate):Highly Toxic,Toxic,irritants,Sensitizers,Corrosives, Reactive:Unstable Reactive,Organic Peroxides,Water Reactive,Radioactive other hazardous chemicals with an adverse effect with short term exposure Pressure Release:Explosives,Compressed Gases,Blasting Agents Chronic Health(Delayed):Carcinogens,other hazardous chemicals with an adverse effect with long term exposure 217.AVERAGE DAILY AMOUNT-Calculate the average daily amount of the hazardous material or mixture containing a hazardous material,in each building or adjacent/outside area. Calculations shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days the chemical will be on site. If this is a material that has not previously been present at this location,the amount shall be the average daily amount you project to be on hand during the course of the year. This amount should be consistent with the units reported in box 221 and should not exceed that of maximum daily amount. 218.MAXIMUM DAILY AMOUNT-Enter the maximum amount of each hazardous material or mixture containing a hazardous material,which is handled in a building or adjacent/outside area at any one time over the course of the year. This amount must contain at a minimum last year's inventory of the material reported on this page,with the reflection of additions,deletions,or revisions projected for the current year. This amount should be consistent with the units reported in box 221. 219.ANNUAL WASTE AMOUNT-if the hazardous material being inventoried is a waste,provide an estimate of the annual amount handled. 220.STATE WASTE CODE-If the hazardous material is a waste,enter the appropriate California 3-digit hazardous waste code as listed on the back of the.Uniform Hazardous Waste Manifest. 221.UNITS-Check the out of measure that is most appropriate for the material being reported on this page:gallons,pounds,cubic feet or tons. NOTE:if the material is a federally defined Extremely Hazardous Substance(EHS),all amounts must be reported in pounds. ff material is a mixture containing an EHS,report the units that the material is stored in(gallons, pounds,cubic feet,or tons). 222.DAYS ON SITE-List the total number ofdays during the year that the material is on site. 223.STORAGE CONTAINER-Check all boxes that describe the type of storage containers in which the hazardous material is stored. NOTE:If appropriate,you may choose more than one. 224.STORAGE PRESSURE-Check the one box that best describes the pressure at which the hazardous material is stored. 225.STORAGE TEMPERATURE-Check the one box that best describes the temperature at which the hazardous material is stored. 226.HAZARDOUS COMPONENTS 1-5(%BY WEIGHT)-Enter the percentage weight of the hazardous component in a mixture. if a range of percentages is available,report the highest percentage in that range. (Report for components 2 through 5 in 230,234,238,and 242.) 227.HAZARDOUS COMPONENTS 1-5 NAME-When reporting a hazardous material that is a mixture,list up to five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or,in the case of trade secrets,refer to manufacturer). All hazardous components in the mixture present at greater than I%by weight if non-carcinogenic, or 0.1%by weight if carcinogenic,should be reported. If more than five hazardous components are present above these percentages,you may attach an additional sheet of paper to capture the required information. When reporting waste mixtures,mineral and chemical composition should be listed. (Report for components 2-through 5 in 231,235,239, and 243.) 228.HAZARDOUS COMPONENTS 1-5 EHS-Check"Yes"if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR, Part 355,or"No"if it is not. (Report for components 2 through 5 in 232,236,240,and 244.) 229.HAZARDOUS COMPONENTS 1-5 CAS-List the Chemical Abstract Service(CAS)numbers as related to the hazardous components in the mixture. (Repeat for 2-5.) 246.LOCALLY COLLECTED INFORMATION-Currently,no additional information is required by KCEHSD. HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Consolidated For]orarea) 2700 M STREET,SUITE 300 HAZARDOUS MATE BAKERSFIELD,CA 93301 (661)862-8700 Fax(661)862-8701 (one page per material per bui [--]ADD []DELETE ❑REVISE 200 Page_of_ I. FACILITY INFORMATION BUSINESS NAME(Same as FACILITY NAME or DBA—Doing Business As) 3 GAS s rti1vk.' CHEMICAL LOCATION ``��QQ 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 � "G1 fLl(J� ��[3 1 [:1 YES ❑ NO FACILITY ID# a I MAP#(optional) 203 GRID#(optional) 204 —0Efj 0 II.CHEMICAL INFORMATION CHEMICAL NAME 2o5 TRADE SECRET ❑ Yes .®sNO 206 pG 4a� J If Subject to EPCRA,refer to instructions COMMON NAME � Ld '-07 208 Ll1rl Q•P� 5�I,� •�. EHS' ❑ Yes 9 No CAS# Q 209 *If EHS if"Yes",all amounts below must be in pounds FIRE CODE HAZARD CLASSES(Not currently required by KCEHSD) 210 HAZARDOUS MATERIAL 213 TYPE(Check one item only) ❑a.PURE POb.MIXTURE El c.WASTE 211 RADIOACTIVE [I Yes. }No 2I2 CURIES PHYSICAL STATE 215 (Check one item only) ❑ a.SOLID. LIQUID El c.GAS 2t4 LARGEST CONTAINER t �� f FED HAZARD CATEGORIES 216 (Check all that apply) —,Jb a. FIRE ❑b. REACTIVE ❑ C.PRESSURE RELEASE --J§�d. ACUTE HEALTH ,Ve. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 219 1 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 C� py `6c`'� 2zt DAYS ON SITE: 222 UNITS* GALLONS ❑b. CU131C FEET ❑ c.POUNDS ❑d.TONS Check one item only) •IfEHS,amount must be in pounds. STORAGE CONTAINER ❑ a. ABOVE GROUNDTANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m.GLASS BOTTLE ❑ q. RAILCAR tg—b. UNDERGROUND TANK ❑ f CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER ❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN ❑ d. STEEL DRUM ❑ h. SILO ❑ I. CYLINDER ❑ p. TANK WAGON 223 STORAGE PRESSURE 97 a. AMBIENT ❑ b. ABOVE AMBIENT ❑ C. BELOW AMBIENT 224 STORAGE TEMPERATURE )&a. AMBIENT ❑ b. ABOVE AMBIENT ❑ C. BELOW AMBIENT ❑d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT(For mixture or waste only) EHS CAS# 1 226 227 ❑Yes ❑ No 228 229 2 230 231 ❑Yes ❑ NO 232 233 3 234 235 ❑Yes ❑ No 236 237 4 238 / 239 ❑Yes ❑ No 240 241 5 242 / 243 ❑Yes ❑ No 244 245 If more hazardous components are present at greater than 1%by weight if non-carcinogenic,or 0.1%by weight If carcinogenic,attach additional sheets of paper capturing the required Information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA Please Sign Here BUSINE WNER/OPERATOR IDENAWCATION 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 NEW BUSINESS 1:1 OUT OF BUSINESS ❑ REVISEIUPDATE(EFFECTIVE 05/22/2006) Page I of I I. IDENTIFICATION FACILITY ID# 151 - 1011101 - 1010101011181 ' BEGINNING DATE 100 ENDING DATE 101 FA0000018 1 05/19/2006 05/19/2007 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 10 HAPPY GAS (661) 831-2323 BUSINESS SITE ADDRESS 103 3221 TAFT HWY CITY 104 ZIP CODE 10 BAKERSFIELD CA 93313 DUN&BRADSTREET 106 SIC CODE(4 digit#) 10 5541 COUNTY 108 Kern County BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 AMITA AND VIKRAM BUDIYAM II. BUSINESS OWNER OWNER NAME I 11 OWNER PHONE 112 HAPPY GAS Q- OWNER MAILING ADDRESS 113 3221 TAFT HWY CITY 114 1 STATE 115 ZIP CODE 11 BAKERSFIELD CA 93313 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 O CONTACT MAILING ADDRESS 119 CITY 120 1 STATE 121 ZIP CODE 122 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 128 AMITA BUDIYAN VIKRAM BUDIYAM TITLE 124 TITLE 129 OWNER OWNER BUSINESS PHONE 125 BUSINESS PHONE 130 (661) 831-2323 (661) 831-2323 24-HOUR PHONE 126 24-HOUR PHONE 13 (661)900-2756 (661)900-2756 PAGER# 127 PAGER# 132 O O' ADDITIONAL LOCALLY COLLECTED INFORMATION: 1 APN: 18417026 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 OWNERIOPERATOR OR DESIGNATED REPRESENTAT DATE 134 1 NAME OF DOCUMENT PREPARER 13 E". S'7." 05/22/2006 NAME OF SIGNER(print) 136 TITLE OF SIGNER 13 amita budiyon BUSINESWWNER/OPERATOR IDENTOCATION 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 NEW BUSINESS 0 OUT OF BUSINESS ❑ REVISE/UPDATE(EFFECTIVE 06/14/2007) Page 1 of 1 I. IDENTIFICATION FACILITY ID# BEGINNING DATE 100 ENDING DATE 01 FA0000018 1 5 - 0 1 101 - 101 0 0 0 1 8 05/19/2006 05/19/2007 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 10 HAPPY GAS (661) 831-2323 BUSINESS SITE ADDRESS 103 3221 TAFT HWY CITY 104 ZIP CODE 10 BAKERSFIELD CA 93313 DUN&BRADSTREET 106 SIC CODE(4 digit#) 10 5541 COUNTY 108 Kern County BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 AMITA AND VIKRAM BUDIYAM II. BUSINESS OWNER OWNER NAME 111 OWNER PHONE 112 HAPPY GAS ()- OWNER MAILING ADDRESS 113 3221 TAFT HWY CITY 14 STATE 11 ZIP CODE BAKERSFIELD CA 93313 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 ()- CONTACT MAILING ADDRESS 119 CITY 120 1 STATE 121 ZIP CODE 122 -PRIMARY- IV.EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 128 AMITA BUDIYAN VIKRAM BUDIYAM TITLE 124 TITLE 129 OWNER OWNER BUSINESS PHONE 125 BUSINESS PHONE 130 (661)831-2323 (661) 831-2323 24-HOUR PHONE 126 24-HOUR PHONE 131 (661)900-2756 (661)900-2756 PAGER# 127 PAGER# 132 O- O- ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 APN: 18417026 Environmental Contact E-Mail Address: sun93313 @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 1 NAME OF DOCUMENT PREPARER mb.A i. 06/14/2007 NAME OF SIGNER(print) 136 TITLE OF SIGNER 1 Amita Budiyan BUSINES&WNER/OPERATOR IDENTOCATION 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 ❑ NEW BUSINESS ❑ OUT OF BUSINESS ❑ REVISE/UPDATE(EFFECTIVE 08/22/2007) Page I of I I. IDENTIFICATION FACILITY ID# BEGINNING DATE too ENDING DATE 10 FA0000019 1 5 - 0 1 101 - 101 0 0 0 1 9 08/22/2007 08/22/2008 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 1 BUSINESS PHONE 1 02' DOLE ENTERPRISE INC-29-27 (661)589-4355 BUSINESS SITE ADDRESS 103 T29S R27E SEC 27 28 29 15 CITY to ZIP CODE 10 BAKERSFIELD CA 93308 DUN&BRADSTREET 106 SIC CODE(4 digit#) ° COUNTY 108 Kern County BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE Ho GORDON DOLE (661)979-1470 II. BUSINESS OWNER OWNER NAME I OWNER PHONE 112 DOLE ENTERPRISE INC (661)589-8088 OWNER MAILING ADDRESS 113 12850 ALLEN LN CITY na STATE I I ZIP CODE 116 BAKERSFIELD CA 93312 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE 118 Gordon Dole (661)589-8298 CONTACT MAILING ADDRESS 119 same as business CITY 120 1 STATE 121 ZIP CODE 12 CA -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 128 TITLE 124 TITLE 19 BUSINESS PHONE 125 BUSINESS PHONE 130 O" O" 24-HOUR PHONE 126 24-HOUR PHONE 13 1 O" O" PAGER# 127 PAGER# 132 O" O" ADDITIONAL LOCALLY COLLECTED INFORMATION: APN: Environmental Contact E-Mail Address: twladd @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 1 NAME OF DOCUMENT PREPARER �Pacliwmic $�ma�iuu 08/22/2007 NAME OF SIGNER(print) 136 TITLE OF SIGNER 13 Tom Ladd BUSINES WNER/OPERATOR IDENTISCATION 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 NEW BUSINESS 1:1 OUT OF BUSINES REVISE/UPDATE(EFFECTIVE 04/11/2005) Page I of I I. IDENTIFICATION FACILITY ID# BEGINNING DATE ENDING DATE FA0000018 1 151- 0 1 0 - 0 0 0 0 1 8 03/01/2005 02/28/2006 BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 1 BUSINESS PHONE HAPPY GAS (661) 831-2323 BUSINESS SITE ADDRESS I U3 3221 TAFT HWY CITY ZIP CODE BAKERSFIELD CA 93313 IUD DUN&BRADSTREET 106 SIC CODE(4 digit#) 5541 COUNTY Kern County BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE AMITA AND VIKRAM BUDIYAM II. BUSINESS OWNER OWNER NAME OWNER PHONE HAPPY GAS Q- OWNER MAILING ADDRESS 3221 TAFT HWY C[TY 114 1 STATE ZIP CODE BAKERSFIELD CA 93313 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE CONTACT MAILING ADDRESS CITY 120 STATE 121 ZIP CODE -PRIMARY- IV.EMERGENCY CONTACTS -SECONDARY- NAME I ZJ NAME AMITA BUDIYAN VIKRAM BUDIYAM TITLE 124 TITLE OWNER OWNER BUSINESS PHONE BUSINESS PHONE (661)831-2323 (661)831-2323 24-HOUR PHONE 126 24-HOUR PHONE (661)900-2756 (661)900-2756 PAGER# PAGER# ADDITIONAL LOCALLY COLLECTED INFORMATION: APN: 184 170 26 00 7 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 NAME OF DOCUMENT PREPARER E&d,. dr,.L. 04/11/2005 NAME OF SIGNER(print) 136 TITLE OF SIGNER Amita Budiyan 4. • 0 HAPPY GAS SiteID: , 015-010-000018 Manager : AMITA & VIKRAM BUDIYAN BusPhone : (661) 831-2323 Location: 3221 TAFT HWY Map : 142 CommHaz : UnRated City : BAKERSFIELD Grid: 02 FacUnits : 1 AOV: CommCode : GREFNFIELD AREA-STA 52 SIC Code : 5541 EPA Numb: \ DunnBrad: Emergency Contact / Title Emergency Contact / Title AMITA BUDIYAN / OWNER VIKRAM BUDIYAN / CO-OWNER Business Phone : (661) 831-2323x Business Phone : (661) 831-2323x 24-Hour Phone (661) 900-2756x 24-Hour Phone (661) 900-2756x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards : Fire ImmHlth Contact : AMITA & VIKRAM BUDIYAN Phone : (661) 831-2323x MailAddr: 1301 TAFT HWY State : CA City BAKERSFIELD Zip : 93307 BusOwner AMITA & VIKRAM BUDIYAN Phone : (661) 831-2323x Address 1301 TAFT HWY State : CA City BAKERSFIELD Zip : 93307 Period 05/08/1998 to 05/08/1999 TotalASTs : = Gal Preparer: TotalUSTs : = Gal Certif 'd: RSs : No Agency-Defined Topic Title MINI MART W/GAS . 1�� V -1- 05/14/2004 KERN COUNTY EIVIRONMENTAL HEALTH SERVICES DEPARTMENT HAZARDOUS MATERIALS BUSINESS PLAN CERTIFICATION FEBRUARY 2004 FACILITY INFORMATION: Site ID: 000018 Facility Name: HAPPY GAS, FA0000018 Physical Location: 3221 TAFT HWY City: BAKERSFIELD, CA Facility Phone: (661) 831-2323 OWNER INFORMATION FOR MAILING CORRESPONDENCE ONLY: Name: TONY HAWARA AND ISSA HAWARA /J-0-J v ` ers In Care of: I ,yt r�(tQv✓t -bvld' Address: 13130 FOOTHILL BLVD APO,44 1 -�- � JJ City, State,Zip: SYLMAR, CA 91342 ��v /4 Contact's Phone: Fnvironmentn! Contact's E-Mail Address: y i/r joy �7J BILLING INFORMATION ONLY: c-1 S ° Name: TONY HAWARA AND ISSA HAWARA In Care of: Address: 13130 FOOTHILL BLVD City, State,Zip: SYLMAR, CA 91342 Contact's Phone: EMERGENCY CONTACT INFORMATION: NAME: TITLE: NAME: TITLE: DAKHIL MOUSA, STORE MANAGER ISSA HAWARA Day Phone: (661) 831-2323 Ext: Day Phone: (661) 831-2323 Ext: Night Phone: (661) 204-8786 Ext: Night Phone: (661) 645-5001 Ext: REGULATED ACTIVITIES AT THIS FACILITY: Hazardous Material Business Plan 4 Underground Storage Tank(s); BOE#: TK MT 44-005600 All facilities with underground storage tanks are required to provide a valid Board of Equalization (BOE) Tank Account number to this Department. 1f 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: O 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. K­f s� Other: I certify,under penalty of perjury,that the information provided above is correct. w <g Printed Name ° Title Signature Date Report#7000 KERN COUNTY ERRONMENTAL HEALTH SERVIA DEPARTMENT HAZARDOUS MATERIALS BUSINESS PLAN CERTIFICATION FEBRUARY 2003 FACILITY INFORMATION: Site ID: 000018 Facility Name: HAPPY GAS, FA0000018 Physical Location: 3221 TAFT HWY City: BAKERSFIELD, CA Facility Phone: (661) 831-2323 OWNER INFORMATION FOR MAILING CORRESPONDENCE ONLY: Name: TONY HAWARA AND ISSA HAWARA f 3(3 VdT14;a 9L In Care of: l Address: 13426 OSBORNE ST s�&mAX CA City, State,Zip: ARLETA, CA 91331 Contact's Phone: BILLING INFORMATION ONLY: Name: TONY HAWARA AND ISSA HAWARA In Care of: /►:UJC Address: 13426 OSBORNE ST 1313o Foe)T�T City, State,Zip: ARLETA, CA 91331 S`f Contact's Phone: EMERGENCY CONTACT INFORMATION: - _ NAME: TITLE: NAME: TITLE: P�g(EO DAKHIL MOUSA, STORE MANAGER ISSA HAWARA Day Phone: (661) 831-2323 Ext: Day Phone: (661) 831-2323 Ext: Night Phone: (661) 204-8786 Ext: Night Phone: (661) 645-5001 Ext: REGULATED ACTIVITIES AT THIS FACILITY: Hazardous Material Business Plan 4 Underground Storage Tank(s); BOE#: 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: 2 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 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. -:�:SA #VAM D Printed Name Title Signature Date Report#7000 KERN COUNTY CIRONMENTAL HEALTH SERVI S DEPARTMENT HAZARDOUS MATERIALS BUSINESS PLAN UPDATE FEBRUARY 2002 FACILITY INFORMATION: Site ID: 000018 Facility Name: HAPPY GAS, #000018 Physical Location: 3221 TAFT HWY City: BAKERSFIELD, CA Facility Phone: (661)a29E;� OWNER INFORMATION FOR MAILING CORRESPONDENCE ONLY: Name: TONY HAWARA AND ISSA HAWARA In Care of: Address: 13426 OSBORNE ST City,State,Zip: ARLETA, CA 91331 Contact's Phone: BILLING INFORMATION ONLY: Name: TONY 1 AWARA AND ISSA HAWARA �/ l In Care of: D ---� Address: 13426 OSBORNE ST City, State,Zip: ARLETA, CA 91331 F E B - 6 2002 Contact's Phone: EMERGENCY CONTACT INFORMATION: NAME: TITLE: NAME: TITLE: rffll PaW.ML MOUSA, STORE MANAGER E- B�FSPNE-T-T Day Phone: (661) 831-2323 Ext: Day Phone: (661) 831-2323 Ext: Night Phone: (6(20y 22% Ext: Night Phone: (661)645-5001 Ext: REGULATED ACTIVITIES AT THIS FACILITY: Hazardous Material Business Plan 4 Underground Storage Tank(s) If this facility generates hazardous waste and does not have an EPA ID number, Call 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. C3 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 - Printed Name Title Signature Date Report#7000 KERN COUNTY AIRONMENTAL HEALTH SER&ES DEPARTMENT HAZARDOUS MATERIALS BUSINESS PLAN UPDATE MARCH 2001 FACILITY INFORMATION: Site ID: 000018 Facility Name: HAPPY GAS, #000018 ? Physical Location: 3221 TAFT HWY City: BAKERSFIELD, CA Facility Phone: (661)323-6063 OWNER INFORMATION FOR MAILING CORRESPONDENCE ONLY: Name: TONY HAWARA AND ISSA HAWARA In Care of. Address: 13426 OSBORNE ST City, State,Zip: ARLETA, CA 91331 Contact's Phone: Ck/ BILLING INFORPvIATION ONLIZ: Name: TONY HAWARA AND ISSA HAWARA In Care of- Address: 13426 OSBORNE ST City, State,Zip: ARLETA,CA 91331 Contact's Phone: 5-6?01 ` \ EMERGENCY CONTACT INFORMATION: NAME: TITLE: NAME: TITLE: RAHAL MOUSA, STORE MANAGER Day Phone: (661) 831-2323 Ext: Day Phone: (66 1) aj-a 2 w,? Ext: Night Phone: (661; Ext: Night Phone: (�(,�)�j =-$®�! Ext- Cellular/Pager Number: 7A3_4970 Cellular/Pager Number: y®j? q® EPA Hazardous Waste ID Number(if applicable): ADDITIONAL INFORMATION REQUESTED: REQUIRED INFORMATION TO BE SUBMITTED: o Plot Plan Drawing(showing location of hazardous materials and utility shut offs). o Site Map(if your facility is in a rural location,a map to the facility is required). PLEASE CHECK ALL THAT APPLY: There are no changes to my business plan and inventory. 19( 1 am unable to find a copy of my current plan and inventory. Please send me a copy. 19f I have enclosed a business plan and inventory for the facility described above. o Other: I certify, under penalty of perjury,that the information provided above is correct. 1 A-VA U Printed Nam Title Signature Date Report#7000 --- ' t I .�q.. v' Y���E �f ,� f r� `�.�..,, t 4 {,♦ t Y C F .��:;�� �_ �,y �:i' � � � ENVIRONMENTAL HEALTH SER*ES DEPARTMENT RE*JRCE MANAGEMENT AGENCY MATTHEW CONSTANTINE, R.E.H.S., Director DAVID PRICE III, RMA DIRECTOR 2700"M"STREET,SUITE 300 Community and Economic Development Department BAKERSFIELD,CA 93301-2370 Engineering&Survey Services Department Voice: (661)862-8700 Environmental Health Services Department Fax: (661)862-8701 Planning Department TTY Relay: (800)735-2929 Roads Department e-mail:eh @co.kern.ca.us November 14, 2007 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 09/24/2007 Facility ID: FA0000018 File#: 000018 Facility Name: HAPPY GAS Inspection Type Site Address: 3221 TAFT HWY BAKERSFIELD, CA 93313 0 Routine ❑ Reinspection Phone: (661)831-2323 ❑ Complaint PROGRAMS INSPECTED: ® Business Plan ❑ HW Generator O UST ❑ AGT ❑ CalARP REINSPECTION REQUIRED: 9 Business Plan ❑ HW Generator O 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]. ❑ ® BP02 Site layout/facility maps are accurate[HSC 6.95,25504; Title 19 CCR 2729]. ❑ D BP03 Hazardous materials are stored in properly labeled and non-detoriated containers [HSC 25124(b)(3)(A&B)]. ❑ O BP04 The hazardous materials inventory shall be submitted annually on or before March 1 [Title 19 CCR 2729.4(b)]. 9 ❑ 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]. ❑ ® ER03 Business has equipment required to, or appropriate for,safely handling hazardous materials [Title 22 CCR 66265.32&.34]. ❑ ® 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]. ❑ 19 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: 35.2664680111 Longtitude: -119.0385752889 INSPECTOR: LAUREL D FUNK DATE: 09/24/2007 Page 1 of 3 FACILITY NAME: HAPPY GAS• ADDRESS: 3221 TAFT FA ID: FA0000018 BAKERSFIELD, CA 933 FILE ID: 000018 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)] ❑ 19 UT02 Facility has an approved designated operator and that is performing the required inspections and training [CCR 2715]. ❑ 17 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)]. ❑ 17 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)]. ❑ d 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)]. ❑ I] 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]. ❑ f] UT12 The underground storage system at the facility is monitored according to site's monitoring plan or permit[HSC 25293]. ❑ IN UT13 Monitoring records for the undeground storage tank system are available upon request [CCR 2712(b)]. ❑ 17 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)]. D ❑ UT23 Under Dispenser Containment(UDC)has approved and functional monitoring equipment. [CCR 2636(f)(1)and (g)]. ❑ 9 UT24 Leak detection sensors are properly secured at lowest point in sumps and annular spaces. [CRR 2641(a)]. ❑ E9 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)] . ❑ N UT26 Automatic line leak detectors installed on pressurized piping that detects a 3.0 gph leak. [CCR 2636(f)(2)]. ❑ ® UT27 Secondary containment&overspill containers are liquid/debris free. [CCR 2631(d)(4)& 2635(b)(1)] ❑ 19 UT28 No liquid leaks visible. [CCR 2632] ❑ 19 UT29 Fuel filters managed properly. [HSC 25189 (a)] ❑ N UT30 Documentation of hazardous and designated waste disposal. [Title 22 CCR 66262.23] INSPECTOR: LAUREL D FUNK DATE: 09/24/2007 Page 2 of 3 FACILITY NAME: HAPPY GAS ADDRESS: 3221 TAFT FA ID: FA0000018 0 BAKERSFIELD, CA 93W FILE ID: 000018 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 Z 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 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: HAPPY GAS ADDRESS: 3221 TAFT HWY FA ID: FA0000018 BAKERSFIELD, CA 93313 FILE ID: 000018 VIOLATIONS VIOL. NO VIOL. TYPE CORRECTIVE ACTION REQUIRED BP01 CLASS II VIOLATION Update inventory of hazardous materials. ER01 CLASS II VIOLATION Maintain a copy of current contingency plan on site. UT01 CLASS II VIOLATION File certificate of financial responsibility for Underground Storage Tanks at facility. UT11 CLASS II VIOLATION Repair or replace the identified missing or malfunctioning equipment. Repair diesel overspill box UT23 CLASS II VIOLATION Install and/or repair UDC monitoring equipment. Install sensor in Red Diesel dispenser pan INSPECTION COMMENTS: INSPECTOR: LAUREL D FUNK SIGNATURE OF FACILITY REP: DATE: 09/24/2007 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 SOICES DEPARTMENT RESOLE MANAGEMENT AGENCY MATTHEW CONSTANTINE, R.E H.S., Director DAVID PRICE III, RMA DIRECTOR 2700"M"STREET,SUITE 300 Community and Economic Development Department BAKERSFIELD,CA 93301-2370 Engineering&Survey Services Department Voice: (661)862-8700 Environmental Health Services Department Fax: (661)862-8701 e Planning Department TTY Relay: (800)735-2929 Roads Department e-mail:eh @co.kem.ce.us May 25, 2007 CERTIFIED UNIFIED PROGRAM AGENCY (CUPA) HAZARDOUS MATERIAL INSPECTION FORM Date: 05/23/2007 Facility ID: FA0000018 File#: 000018 Facility Name: HAPPY GAS Inspection Type Site Address: 3221 TAFT HWY BAKERSFIELD, CA 93313 ® Routine ❑ Reinspection Phone: (661)831-2323 ❑ Complaint PROGRAMS INSPECTED: ® Business Plan ❑ HW Generator p UST ❑ AGT ❑ CalARP REINSPECTION REQUIRED: ❑ Business Plan ❑ HW Generator ❑ UST ❑ AGT ❑ CaIARP VIOLATION YES NO/NA VIOL.# BUSINESS PLAN REQUIREMENTS 19 ❑ BP01 Inventory of hazardous materials is accurate, up to date,and complete[HSC 6.95, 25504, Title 19 CCR 2729]. ❑ 9 BP02 Site layoutifacility maps are accurate[HSC 6.95,25504; Title 19 CCR 2729]. ❑ 9 BP03 Hazardous materials are stored in properly labeled and non-detoriated containers [HSC 25124(b)(3)(A&B)]. ❑9 ❑ BP04 The hazardous materials inventory shall be submitted annually on or before March 1 [Title 19 CCR 2729.4(b)]. ❑ O ER01 Contingency Plan is complete, updated, and maintained on site[HSC 6.95, 25504;Title 19 CCR 2731 Title 22 CCR 66265.53-54]. ❑ O 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]. ❑ O 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: 35.2664680111 Longtitude: -119.0385752889 INSPECTOR: LAUREL D FUNK DATE: 05/23/2007 Page 1 of 3 FACILITY NAME: HAPPY GA ADDRESS: 3221 TAFT 4W FA ID: FA0000018 BAKERSFIELD, CA 933 FILE ID: 000018 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)] ❑ 9 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)]. ❑ O 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)]. ❑ 9 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)]. ❑ Z UT07 Secondary containment systems for undeground storage tank systems tested every three years. Facility provided results to the agency[CCR 2637(a)]. ❑ O 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)]. ❑ Z 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]. ❑ Z UT13 Monitoring records for the undeground storage tank system are available upon request [CCR 2712(b)]. ❑ 19 UT14 Overspill and overfill equipment for underground storage tank(s) is present, properly installed,and functioning[CCR 2635]. ❑ O 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)]. ❑ O 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. [C RR 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)] . ❑ ® UT26 Automatic line leak detectors installed on pressurized piping that detects a 3.0 gph leak. [CCR 2636(f)(2)]. ❑ O UT27 Secondary containment&overspill containers are liquid/debris free. [CCR 2631(d)(4)& 2635(b)(1)] ❑ O UT28 No liquid leaks visible. [CCR 2632] ❑ 0 UT29 Fuel filters managed properly. [HSC 25189(a)] ❑ O UT30 Documentation of hazardous and designated waste disposal. [Title 22 CCR 66262.23] INSPECTOR: LAUREL D FUNK DATE: 05/23/2007 Page 2 of 3 FACILITY NAME: HAPPY GA ADDRESS: 3221 TAF FA ID: FA0000018 BAKERSFIELD, CA 931W FILE ID: 000018 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 xi 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: HAPPY GAS ADDRESS: 3221 TAFT HWY FA ID: FA0000018 BAKERSFIELD, CA 93313 FILE ID: 000018 VIOLATIONS VIOL. NO VIOL.TYPE CORRECTIVE ACTION REQUIRED BP04 MINOR The inventory shall be reviewed and updated within 30 days. BP01 MINOR Update inventory of hazardous materials. Complete a new business plan packet. UT01 MINOR File certificate of financial responsibility for Underground Storage Tanks at facility. INSPECTION COMMENTS: Submit a new business plan. Facility secondary is due to be tested by 7/2007 Cathodic is due to be tested by 9/8/2007 Tank interior lining is to be re certified by 6/24/2008 INSPECTOR: LAUREL D FUNK SIGNATURE OF FACILITY R P: DATE: 05/23/2007 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 ENV,IRONMENTAL HEALTH SERE DEPARTMENT •RESOURCE MANAGMENT AGENCY STEVE fI cCALLEY, R.E.H.S., Director o DAVID PRICE Ill, RASA DIRECTOR 2700"M"STREET,SUITE 300 Engineering&Survey Services Department Bakersfield,CA 93301-2370 �� i' �!< Environmental Health Services Department !Voice: (805)862-8700 °�� Qd Planning Department FAX: (805)862-8701 c y° Roads Department TTY Relay: 1-800-735-2979 Date: tP ! CERT IEID UNXFXED PROGRAM AGENCY Time In:' INSPECTION FORM Employee ID: Record ID Pro Ele Svc Result Action Ins m. Facility Violation - - r PROGRAM/ELEMENT SERVICE CODES RESULT CODES ACTION CODES CA00 AST CS00 UST 110 Routine Inspection 51 Inspection Refused 01 No Action/in compliance CB00 Business Plan 108 Followup Inspection 52 No Viol/Comp] achieved 03 Refer to Env Health CG00 Generatorfriered 53 Minor Viol.Observed 15 No Re-inspection required CP00 C.U.P.A. ) 54 Major Viol.Observed ENVISION FACILITY NO.: 0 FACILITY NAME: -- TYPE OF INSP.: Routine ❑Re-insp.❑Complaint FACILITY LOC TION-- INSPECTING AGENCY: TEL. NO. AY) (24 HR) ❑EHSD ❑KCFD ❑AG AM r PROGRAMS INSPECTED: PBuniness usiness Plan ❑HW Generator ;UST F1 AGT REINSPECTION REQUIRED: F1 NO F1 YES Plan ❑HW Generator ❑ UST ❑AGT CONSENT: Consent to conduct inspection which may involve obtaining photographs, review and copying of records, and determination of compliance with UST, AGT, and hazardous materials/waste handling requirements. CRpranted ❑Refused By (Name/Title):R61&j n t d 6n Reason (if refused): GENERAL REQUIREMENTS YES NO N/A VIOL. # TRAINING ❑ ❑ TRO1 Facility has appropriate training program (Title 19 CCR 2732 & 22 CCR 66265.16) ❑ ❑ TR02 Training documentation is maintained on site for current personnel(Title 19 CCR 2732 & 22 CCR 66265.16) CONTINGENCY/EMERGENCY PLAN ❑ ❑ ERO1 Contingency plan is complete, updated, and maintained on site (HSC 25504, Title 19 CCR 2731 & 22 CCR & 66265.53/54) ❑ ❑ ER02 Facility is operated and maintained to prevent/minimize/mitigate fire, explosion, or release of hazardous materials/waste constituents to the environment. Maintains all required or appropriate equipment including an alarm and communications system (Title 19 CCR 2731 & 22 CCR 66265.31-.34) BUSINESS PLAN YES NO NIA VIOL. # ❑ ❑ BPO1 Business plan is current & available during inspection (HSC 25503.5, Title 19 CCR 2729) ❑ BP02 Inventory of hazardous materials is complete (HSC 25504,Title 19 CCR 2729) ❑ ❑ BP03 Site layout/facility maps are accurate (HSC 25504, Title 19 CCR 2729) 58041132081(5.97) ADVISORY The site-specific Contingency Plan is the facility's plan for handling emergencies and shall be implemented immediately whenever there is a fire, explosion, or release of hazardous materials or waste that could threaten human health and/or the environment. The contingency plan shall be reviewed, and immediately amended, if necessary, whenever: 4 The plan fails in an emergency 4 The facility changes in its design, construction, operation, maintenance, or other circumstances in a way that materially increases the potential for fires, explosions, or releases of hazardous waste or hazardous waste constituents, or changes the response necessary in an emergency 4 List of emergency coordinators changes 4 List of emergency equipment changes Submit a copy of any updates or changes to this Department. II. EMERGENCY CONTACTS PRIMARY SECONDARY NAME PA' TA 123 NAME °�0 `3.1 SO laVLkI ' 128 TITLE OW M ll 124 TITLE 1/� ,�0— o 0 "C)C_ 129 BUSINESS PHONE�6 ( S 3 3 125 BUSINESS PHONE(6 I- <g 3 ,- 3 - , 130 24-HOUR PHONE I� a Qb , �,��-� 126 24-HOUR PHONE /'4 /r � 17S / 131 PAGER# / 127 PAGER# b ! b 132 III. EMERGENCY RESPONSE PLANS AND PROCEDURES A. Notifications Your business is required by State Law to provide an immediate verbal report of any release or threatened release of a hazardous material to local fire emergency response personnel, this Department, and the Office of Emergency Services. If you have a release or threatened release of hazardous materials, immediately call: FIRE/PARAMEDICS/POLICE/SHERIFF PHONE: 911 AFTER the local emergency response personnel are notified, you shall then notify this Department and the Office of Emergency Services. Kern County Environmental Health Department: (661) 862-8700 or after hours, call Dispatch at (661)861-2521 State Office of Emergency Service: (800)852-7550 or(916)262-1621 National Response Center: (800)424-8802 Information to be provided during Notification: 4 Your Name and the Telephone Number from where you are calling. 4 Exact address of the release or threatened release. 4 Date, time, cause, and type of incident (e.g.fire, air release, spill etc.) d Material and quantity of the release,to the extent known. 4 Current condition of the facility. 4 Extent of injuries, if any. d Possible hazards to public health and/or the environment outside of the facility. CONSOLIDATED CONTINGENCY PLAN FMSTREET,Y ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Form SUITE 300 COVER PAGE D,CA 93301 Fax(661)862-8701 Page of I. FACILITY IDENTIFICATION FACILITY ID# r EPA ID#(Hazardous Waste Only) Z 5 o to '10 10 C) L I8 BUSINESS NAME(Same as Facility Name of DBA-Doing Business As) 3 The Consolidated Contingency Plan provides businesses a format to comply with the emergency planning requirements of the following two written hazardous materials emergency response plans required in California: 4 Hazardous Materials Business Plan (HSC Chapter 6.95 Section 25504 (b) and 19 CCR Sections 2729-2732), 4 Hazardous Waste Generator Contingency Plan (22 CCR Section 66264.52), and, This format is designed to reduce duplication in the preparation and use of emergency response plans at the same facility, and to improve the coordination between facility response personnel and local, state and federal emergency responders during an emergency. A copy of the plan shall be submitted to this Department and at least one copy of the plan shall be maintained at the facility for use in the event of an emergency and for inspection by the local agency. Describe below where a copy of your Contingency Plan, including the hazardous material inventories, Training Records, and Site Map(s), are located at your business: PLAN CERTIFICATION 1 certify under penalty of law that 1 have personally examined and I am familiar with the information provided by this plan and to the best of my knowledge the information is accurate, complete, and true. Printed Name of Owner/Operator Title of Owner/Operator Signature of Owner/ perator Date We appreciate the effort of local businesses in completing these plans and are available to assist in any manner. If you have any questions, please contact this Department at (661) 862-8700. Kern County Environmental 2700 "M" Street, Suite 300 Health Services Department UNIFIED HAZARDOUS Bakersfield,CA. 93301 Certified Unified Program Agency MATERIALS / WASTE Phone: (661) 862-8700 FACILITY PERMIT NUMBER: FA0000018 Facility Name: HAPPY GAS Owner: HAPPY GAS Location: 3221 TAFT HWY 3221 TAFT HWY BAKERSFIELD BAKERSFIELD, CA 93313 ISSUED FOR THE FOLLOWING ACTIVITIES: Hazardous Materials Above Ground California Accidental Hazardous Waste Underground Tanks Business Plan Storage Tanks Release Program(RMP) Generator/Tiered Site ID# Site ID# ID# Classification Treatment State UST ID# Size(gal) Content 000018 NONE 320018 15-000-000018-000001 12,000 DIESEL 15-000-000018-000002 12,000 UNLEADED 15-000-000018-000003 12,000 PREMIUM 15-000-000018-000004 12,000 DIESEL (.3 rir w � THIS PERMIT IS GRANTED SUBJECT TO THE CONDITIONS LISTED ON THE BACK Issue Date: 07/01/2004 Expiration Date: 06/30/2007 -POST ON PREMISES - NONTRANSFERABLE SUMMARY OF CONDITIONS All Facilities: Hazardous Waste Generator Facilities: 1. The facility will be considered in violation and operating without a 9. Generators of hazardous waste are responsible for the safe permit if annual fees are not received within 30 days of the invoice management of such,including generation,accumulation,recycling, date. storage, treatment, transportation, and disposal in accordance with California Health and Safety Code,Chapter 6.5 and California Code 2. The facility owner must advise the Environmental Health Services of Regulations, Title 22. Department within 30 days of transfer of ownership. Underground Storage Tank Facilities: 3. The owner and operator must meet all applicable requirements of Chapter 6.5, 6.67, 6.7, 6.75, and 6.95 of the California Health and 10. The permit holder shall comply with the monitoring,response, and Safety Code, California Code of Regulations, and Kern County plot plans approved by Kern County Environmental Health Services Ordinance Code. Department.The underground storage tanks must also be monitored according to the applicable requirements in the California Code of 4. The Hazardous Material Inventory and Release Response Plan must Regulations,Title 23,Division 3, Chapter 16. be prepared and kept current at the site by the owner or operator at all times. 11. A copy of the facility's underground storage tank leak prevention monitoring program(including monitoring plan,response plan,and 5. All releases of hazardous materials must be reported to this plot plan), as approved by this Department,must be maintained on Department within 24 hours if contained within the facility site. boundaries or immediately if outside the facility property or beyond your control. 12. All equipment installed for leak detection shall be operated and maintained in accordance with the manufacturer's instruction, Above Ground Storage Tank Facilities: including routine maintenance and service checks(at least once per year)for operability or running condition. 6. The facility must maintain a Spill Prevention Control and Countermeasure (SPCC) plan on site for all aboveground storage 13. A report documenting the maintenance,monitoring,and any changes tanks that are subject to the Aboveground Petroleum Storage Act to the underground storage tanks- shall be submitted to this (California Health and Safety Code,Division 20,Chapter 6.67). Department each year on the form provided along with the permit or another approved by this Department. 7. The SPCC Plan must be certified by a Registered Professional Engineer once every three years. 14. The facility owner and operator shall ensure that the facility has adequate financial responsibility insurance coverage,as mandated for California Accidental Release Program Facilities: all underground storage tanks containing petroleum, and supply proof of such coverage to this Department. 8. The facility must notify this Department at least five calendar days before implementing any changes of any processes subject to the 15. The owner and/or operator must report any significant unauthorized California Accidental Release Prevention program. Completed release from underground storage tanks within 24 hours of discovery. documentation must be submitted within 60 days. This permit is the property of the Kern County Environmental Health Services Department and may be suspended or revoked for due cause BUSINESS ACTIVITIES 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. FACILITY IDENTIFICATION FACILITY ID# I EPA ID#(Hazardous Waste Only) 2 BUSINESS NAME(Same as Facility Name of DBA-Doing Business As) 3 V� IL ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page(KC Form 2730). Does your facility... If Yes;please com lete these pages of the UPCF.... A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 HAZARDOUS MATERIALS INVENTORY— gallons for liquids, 500 pounds for solids, or 200 cubic feet for CHEMICAL DESCRIPTION(KC Form 2731) compressed gases (include liquids in ASTs and USTs); or the YES ❑ NO 4 CONSOLIDATED CONTINGENCY PLAN applicable Federal threshold quantity for an extremely hazardous (KC Form 2733) substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is SITE MAP(KC Form2734) required pursuant to 10 CFR Parts 30,40 or 70? B. UNDERGROUND STORAGE TANKS(USTs) UST FACILITY(KC Form A) 1. Own or operate underground storage tanks? J0 YES ❑ NO 5 UST TANK(one page per tank)(KC Form B) 2. Intend to upgrade existing or install new USTs? ❑YES SR7NO 6 UST FACILITY UST TANK(one per tank) UST INSTALLATION- CERTIFICATE OF COMPLIANCE(one page per tank)(KC Form C) 3. Need to report closing a UST? ❑YES (?NO 7 UST TANK(closure portion-one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS(ASTs) Own or operate ASTs above a total capacity for the facility of greater than 1,320 gallons? ❑YES ONO 8 NO FORM REQUIRED TO KCEHSD D. HAZARDOUS WASTE 1. Generate hazardous waste? ❑YES NO 9 EPA ID NUMBER—provide at the top of this page WASTE GENERATOR FORM(KC Form2735) 2. Recycle more than 100 kg/month of excluded or exempted RECYCLABLE MATERIALS REPORT(one per recyclable materials(per HSC 25143.2)? El YES � NO to recycltt)(KC Form 2732) 3. Treat hazardous waste on site? ❑YES NO 11 ONSITE HAZARDOUS WASTE TREATMENT—FACILITY(KC Form 17720 ONSITE HAZARDOUS WASTE TREATM ENT—UNIT (one page per unit)(KC Form 1772") 4. Treatment subject to financial assurance requirements(for ❑YES NO 12 CERTIFICATION OF FINANCIAL Permit by Rule and Conditional Authorization)? ASSURANCE(KC Form 1232) 5. Consolidate hazardous waste generated at a remote site? ❑YES NO 13 REMOTE WASTE/CONSOLIDATION SITE ANNUAL NOTIFICATION(KC Form 1196) 6. Need to report the closure/removal of a tank that was classified as ❑YES NO 14 HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? CERTIFICATION(KC Form 1249) E. LOCAL REQUIREMENTS 's Have Regulated Substances(RS)stored on site at greater than the threshold REGULATED SUBSTANCES quantities established by the California Accidental Release Program ❑YES WNO 15 REGISTRATION(KC Form 2736) (Cal ARP)? A RS is any substance listed in Section 2770.5 of CCR Title 19, Division 2,Chapter 4.5. RISK MANAGEMENT PLAN(when required) Business Activities Please submit the Business Activities page, the Business Owner/Operator Identification page (KC Form 2730), and Hazardous Materials Inventory-Chemical Description pages(KC Form 273 1)for all submissions. (Note: the numbering of the instructions follows the data element numbers that are on the Unified Program Consolidated Forms(UPCF)pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR,Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps the Kern County Environmental Health Services Department(KCEHSD)identify whether the submittal is complete and if any pages are separated. 1. FACILITY ID NUMBER-Leave this blank. This number is assigned by this Department. This is the unique number which identifies your facility. 2. EPA ID NUMBER- If you generate,recycle, or treat hazardous waste,enter your facility's 12-character U.S. Environmental Protection Agency(U.S. EPA)or California Identification number. For facilities in California,the number usually starts with the letters"CA". If you do not have a number,contact the Department of Toxic Substances Control(DTSC)Telephone Information Center at(916)324-1781,(800)-61-TOXIC or(800)61-86942,to obtain one. 3. BUSINESS NAME-Enter the full legal name of the business. This is the same as the terms"Facility Name"or"DBA-Doing Business As"that might have been used in the past. 4. HAZARDOUS MATERIALS ONSITE-Check the box to indicate whether you have a hazardous material onsite. You have a hazardous material onsite if: It is handled in quantities equal to or greater than 500 pounds,55 gallons,or 200 cubic feet of compressed gas (calculated at standard temperature and pressure), It is handled in quantities equal to or greater than the applicable federal threshold planning quantity for an extremely hazardous substance listed in 40 CFR Part 355,Appendix A, Radioactive materials are handled in quantities for which an emergency plan is required to be adopted pursuant to Part 30,Part 40,or Part 70 of Chapter 10 of 10 CFR,or pursuant to any regulations adopted by the state in accordance with these regulations. If you have a hazardous material onsite, then you must complete the Business Owner/Operator Identification page (KC Form 2730)and the Hazardous Materials Inventory-Chemical Description page(KC Form 2731),as well as a Consolidated Contingency Plan(KC Form 2733)and Site Map(KC Form 2734). Do not answer"YES"to this question if you exceed only a local threshold,but do not exceed the state threshold. 5. OWN OR OPERATE UNDERGROUND STORAGE TANK(UST)-Check the appropriate box to indicate whether you own or operate USTs containing hazardous substances as defined in Health and Safety Code(HSC)§25316. If"YES",then you must complete one UST Facility page and UST Tank pages for each tank. You must also submit a plot plan and a monitoring program plan. 6. UPGRADE/INSTALL UST-Check the appropriate box to indicate whether you intend to install or upgrade USTs containing hazardous substances as defined in HSC§25316. If "YES",then you must complete the UST Installation-Certificate of Compliance page in addition to UST Facility and Tank pages,plot plan and monitoring program plan. 7. UST CLOSURE-Check the appropriate box if you are closing an UST and compl6te the closure portion of the UST Tank pages for each tank. Prior to closure of the tank,a tank removal application must be submitted and a closure permit obtained from the KCEHSD 8. OWN OR OPERATE ABOVEGROUND PETROLEUM STORAGE TANK(AST)-Check the appropriate box to indicate whether there are ASTs onsite which exceed the regulatory thresholds. (There is no UPCF page for ASTs.) This program applies to all facilities storing petroleum in aboveground tanks. Petroleum means crude oil,or any fraction thereof,which is liquid at 60 degrees Fahrenheit temperature and 14.7 pounds per square inch absolute pressure (HSC§25270.2(g)). The facility must have cumulative storage capacity greater than 1,320 gallons for all ASTs. NOT Subject to the Act(exemptions): An aboveground petroleum storage tank(AST)facility with one or more of the following(see HSC§25270.2(k))is not subject to this act and is exempt: A pressure vessel or boiler which is subject to Division 5 of the Labor Code, A storage tank containing hazardous waste if hazardous waste facility permit has been issued for the storage tank by DTSC, An aboveground oil production tank which is regulated by the Division of Oil and Gas, Certain oil-tilled electrical equipment including but not limited to transformers,circuit breakers,or capacitors. 9. HAZARDOUS WASTE GENERATOR-Check the appropriate box to indicate whether your facility generates hazardous waste. A generator is the person or business whose acts or processes produce a hazardous waste or who causes a hazardous substance or waste to become subject to State hazardous waste law. If your facility generates hazardous waste, you must obtain and use an EPA Identification number(ID) in order to properly transport and dispose of it. Report your EPA ID number in##2. Hazardous waste means a waste that meets any of the criteria for the identification of a hazardous waste adopted by DTSC pursuant to EISC§25141. "Hazardous waste"includes,but is not limited to,federally regulated hazardous waste. Federal hazardous waste law is known as the Resource Conservation and Recovery Act(RCRA). Unless explicitly stated otherwise,the term"hazardous waste"also includes extremely hazardous waste and acutely hazardous waste. If you generate a hazardous waste,you must complete the Hazardous Waste Generator Form(KC Form 2735) 10.RECYCLE-Check the appropriate box to indicate whether you recycle more than 100 kilograms per month of recyclable material under a claim that the material is excluded or exempt per HSC §25143.2. Check"YES" and complete the Recyclable Materials Report pages, if you either recycled onsite or recycled excluded recyclable materials which were generated offsite. Check"NO"if you only send recyclable materials to an offsite recycler. You do not need to report. 11. ONSITE HAZARDOUS WASTE TREATMENT-Check the appropriate box to indicate whether your facility engages in onsite treatment of hazardous waste. "Treatment"means any method, technique,or process which is designed to change the physical,chemical,or biological character or composition of any hazardous waste or any material contained therein,or removes or reduces its harmful properties or characteristics for any purpose. "Treatment"does not include the removal of residues from manufacturing process equipment for the purposes of cleaning that equipment. Amendments(effective 1/1/99)add exemptions from the d efinition o f"treatment"for certain processes u nder s pecific,l imited conditions. R efer to H SC§25123.5(b)for these specific exemptions. Treatment of certain laboratory hazardous wastes does not require authorization. Refer to HSC §25200.3.1 for specific information. Please contact KCEHSD to determine if any exemptions apply to your facility. If your facility engages in onsite treatment of hazardous waste then complete the Onsite Hazardous Waste Treatment Notification-Facility page and one set of Onsite Hazardous Waste Treatment Notification-Unit pages with waste and treatment process information for each unit. 12. FINANCIAL ASSURANCE-Check the appropriate box to indicate whether your facility is subject to financial assurance requirements for closure of an onsite treatment unit. Unless they are exempt, Permit by Rule (PBR) and Conditionally Authorized (CA) operations are required to provide financial assurance for closure costs(per 22 CCR§67450.13(b)and HSC§25245.4). If your facility is subject to financial assurance requirements or claiming an exemption, then complete the Certification of Financial Assurance page. 13.REMOTE WASTE CONSOLIDATION SITE-Check the appropriate box to indicate whether your facility consolidates hazardous waste generated at a remote site. Answer"YES"if you are a hazardous waste generator that collects hazardous waste initially at remote sites and subsequently transports the hazardous waste to a consolidation site you also operate. You must be eligible pursuant to the conditions in HSC§25110.10. If your facility consolidates hazardous waste generated at a remote site,complete the Remote Waste Consolidation Site Annual Notification page. 14. HAZARDOUS WASTE TANK CLOSURE-Check the appropriate box to indicate whether the tank being closed would be classified as hazardous waste after its contents are removed. Classification could be based on: Your knowledge of the tank and its contents The mixture rule Testing of the tank The listed wastes in 40 CFR 261.31 or 40 CFR 261.32. Inability to remove hazardous materials stored in the tank. If the tank being closed would be classified as hazardous waste after its contents are removed,then you must complete the Hazardous Waste Tank Closure Certification page. 15. LOCAL REQUIREMENTS —Check the box to indicate whether Regulated Substances (RS)are stored onsite above threshold quantities. If"YES"you must complete the Regulated Substance Registration(KC Form 2736). BUSINESS OWNER/OPERATOR IDENTIFICATION 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 ❑NEW BUSINESS ❑OUT OF BUSINESS REVISE/UPDATE (EFFECTIVE / / ) Page_of_ I.IDENTIFICATION FACILITY ID# / BEGINNING DATE DATE tot 1 � . olaoa ° l $ BUSINESS NAME(Same as FACIILITY NAME or DBA-Doing Business As) ,`{� 3 BUSINESS PHONE 3 toe 661- y5 3 ,'' �� BUSINESS SI E AD RESS (/ 101 3 2a I -Toy - H CITY 104 ZIP CODE 105 DUN&BRADSTREET 106 SIC CODE(4 digit#) 107 COUNTY 108 Kern Count BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 900 ` .2.7 St/, II.BUSINESS OWNER OWNER NAME III OWNER PHONE 112 ` UD I _ Clip 0 OWNER MAILING ADDRESS 113 CITY 114 STATE Its ZIPCODE 116 III.ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE Its CONTACT MAILING ADDRESS 119 CITY 120 1 STATE 121 1 ZIP CODE 122 -PRIMARY- IV.EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 128 rAI r R U=D l Vi+lq yo f So/a k,I-/ TITLE 124 TITLE 129 BUSINESS PHONE 125 BUSINESS PHON 130 3�- 32"3 66/� �31 - 323 24-HOUR PHONE 126 24-HOUR PHONE O _ ' s—&/s—&/E 131 I, 90o ��� s�G 99) PAGER# 127 PAGER# 132 ADDITIONAL LOCALLY COLLECTED INFORMATION: 133 APN: Environmental Contact E-Mail Address: < (;UTA q 313 ya" - C-0 K,-- 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 OWNER/OPERAITOR OR DESIGNATED REPRESENTATIVE DATE , 134 NAME OF DOCUMENT PREPARER 135 NAME OF SIGNER(print) 136 TITLE OF SIGNER 137 Business Owner/Operator Identification Please submit the Business Activities page,the Business Owner/Operator Identification page(KC Form 2730),and Hazardous Materials-Chemical Description pages (KC Form 2731)for all hazardous materials inventory submissions. For the inventory to be considered complete this page must be signed by the appropriate individual. (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR,Appendix C,the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps the Kern County Environmental Health Services Department (KCEHSD) identify whether the submittal is complete and if any pages are separated. I. FACILITY ID NUMBER-Leave this blank.This number is assigned by KCEHSD. This is the unique number which identifies your facility. 3. BUSINESS NAME-Enter the full legal name of the business. 100. BEGINNING DATE-Enter the beginning year and date of the report.(MMDDYYYY) 101. ENDING DATE-Enter the ending year and date of the report.(MMDDYYYY) 102. BUSINESS PHONE-Enter the phone number,area code first,and any extension. 103. BUSINESS SITE ADDRESS-Enter the street address where the facility is located. No post office box numbers are allowed. This information must provide a means to geographically locate the facility. 104. CITY-Enter the city or unincorporated area in which business site is located. 105. ZIP CODE-Enter the zip code of business site. The extra 4 digit zip may also be added. 106. DUN&BRADSTREET-Enter the Dun&Bradstreet number for the facility. The Dun&Bradstreet number may be obtained by calling(610)882-7748 or by Internet. 107. SIC CODE-Enter the primary Standard Industrial Classification Code number for primary business activity. NOTE: If code is more than 4 digits,report only the first four. 108. COUNTY-Enter the county in which the business site is located. 109. BUSINESS OPERATOR NAME-Enter the name of the business operator. 110. BUSINESS OPERATOR PHONE-Enter business operator phone number,if different from business phone,area code first,and any extension. 1 l l. OWNER NAME-Enter name of business owner,if different from business operator. 112. OWNER PHONE-Enter the business owner's phone number if different from business phone,area code first,and any extension. 113. OWNER MAILING ADDRESS-Enter the owner's mailing address if different from business site address. 114. OWNER CITY-Enter the name of the city for the owner's mailing address. 115. OWNER STATE-Enter the 2 character state abbreviation for the owner's mailing address. 116. OWNER'LIP CODE-Enter the zip code for the owner's address. The extra 4 digit zip may also be added. 117. ENVIRONMENTAL CONTACTNAME - Enter the name of the person, if different from the Business Owner or Operator, who receives all environmental correspondence and will respond to enforcement activity. 118. CONTACT PHONE-Enter the phone number,if different from Owner or Operator,at which the environmental contact can be contacted,area code first,and any extension. 119. CONTACT MAILING ADDRESS-Enter the mailing address where all environmental contact correspondence should be sent,if different from the site address. 120. CITY-Enter the name of the city for the environmental contact's mailing address. 121. STATE-Enter the 2 character state abbreviation for the environmental contact's mailing address. 122. "LIP CODE-Enter the zip code for the environmental contact's mailing address. The extra 4 digit zip may also be added. 123. PRIMARY EMERGENCY CONTACT NAME-Enter the name of a representative that can be contacted in case of emergency involving hazardous materials at the business site. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation. 124. TITLE-Enter the title of the primary emergency contact. 125. BUSINESS PHONE-Enter the business number for the primary emergency contact,area code first,and any extensions. 126. 24-HOUR PHONE-Enter a 24-hour phone number for the primary emergency contact. The 24-hour phone number must be one which is answered 24 hours a day. If it is not the contact's home phone number,then the service answering the phone must be able to immediately contact the individual stated above. 127. PAGER NUMBER-Enter the pager number for the primary emergency contact,if available. 128. SECONDARY EMERGENCY CONTACT NAME-Enter the name of a secondary representative that can be contacted in the event that the primary emergency contact is not available. The contact shall have FULL facility access,site familiarity,and authority to make decisions for the business regarding incident mitigation. 129. TITLE-Enter the title of the secondary emergency contact. 130. BUSINESS PHONE-Enter the business telephone number for the secondary emergency contact,area code first,and any extension. 131. 24-HOUR PHONE-Enter a 24-hour phone number for the secondary emergency contact. The 24 hour phone number must be one which is answered 24 hours a day. If it is not the contact's home phone number,then the service answering the phone must be able to immediately contact the individual stated above. 132. PAGER NUMBER-Enter the pager number for the secondary emergency contact,if available. 133. ADDITIONAL LOCALLY COLLECTED INFORMATION - Please include the Assessor's Parcel Number (APN) for the actual facility site and the Environmental Contact's E-mail address for facility correspondence,if available. 134. DATE-Enter the date that the document was signed. (MMDDYYYY) 135. NAME OF DOCUMENT PREPARER-Enter the full name of the person who prepared the inventory submittal information. 136. NAME OF SIGNER- Enter the full printed name of the person signing the page. The signer certifies to a familiarity with the information submitted and that based on the signer's inquiry of those individuals responsible for obtaining the information,all the information submitted is true,accurate and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE-The Business Owner/Operator,or officially designated representative of the Owner/Operator,shall sign in the space provided. This signature certifies that the signer is familiar with the information submitted and that based on the signer's inquiry of those individuals responsible for obtaining the information it is the signer's belief that the submitted information is true,accurate and complete. 137. TITLE OF SIGNER-Enter the title of the person signing the page. 7 ENVIRONMENTAL HEALTH 50CES DEPARTMENT R*URCE MANAGEMENT AGENCY STEVE McCALLEY, R.E.H.S., Director DAVID PRICE III, RMA DIRECTOR 2700 W"STREET,SUITE 300 Go Community and Economic Development Department BAKERSFIELD,CA 93301-2370 Engineering&Survey Services Department Voice: (661)862-8700 Environmental Health Services Department Fax: (661)862-8701 Planning Department TTY Relay: (800)735-2929 Roads Department e-mail:eh @co.kern.ca.us October 15, 2004 320018 AMITA AND VIKRAM BUDIYAM HAPPY GAS 3221 TAFT HWY BAKERSFIELD, CA 93313 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, �Sa Steve McCalley, Director /41 Z%�jl4 - r By: Joe Canas REHS Hazardous Materials Specialist IV Unified Hazardous Materials/Waste Program Encl. �I ';\,. 1�;�... ,� �t t�. T,-, ,, y,�.. �;`` �,` ENVIRONMENTAL HEALTH St ICES DEPARTMENT RESOURCE MANAGEMENTAGENCY STEVE McCALLEY, R.E.H.S., Director DAVID PRICE Ill, RMA DIRECTOR 2700"M"STREET,SUITE 300 Community and Economic Development Department BAKERSFIELp,CA 93301-2370 _ , , Engineering&Survey Services Department Voice:(661)862-8700g`a9g" Environmental Health Services Department Fax: (661)862-8701 Planning Department TTY Relay:(800)735-2929 • Roads Department e-mail:eh @co.kern.ca.us August 26, 2004 AMITA AND VIKRAM BUDIYAM HAPPY GAS 3 3221 TAFT HWY BAKERSFIELD, CA 93313 Subject: Underground Storage Tank Requirements 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 .0C9G°�ri OMIM W&DLu IMMEOPU � Gfin• a�r�m Fa d } I A L USE � Postage $ (f/mil u M Certified Fee Y I Retum Reclept Fee Po f (Endorsement Required) /7l C3 Restricted Delivery Fee •��av Q u t (Endorsement Required) I � M ru 0 HAPPY GAS 3221 TAFT A- WY ------------- i +B,4KERSFIEL D CA 93313 SECTION SENDER: PLITE THIS SECTION COMPLETE THIS DELIVERY • Complete items 1,2,and 3.Also complete A. Signature 1�, item 4 if Restricted Delivery is desired. X j',k-1+.,\(\ 1- ��� )"I _ I..O 13 Agent Addressee • Print your name and address on the reverse l t .` so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery • Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 11 ❑Yes 1. Article Addressed to: _ _ 11 If YES,enter delivery address below: No HAPPY GAS 3229 EAFT AMY " BAKERSFIE.?D CA 93313 3KSica Type ified Mail ❑Express Mail stered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yer. 2. i PS For T X595-02•M-1540 UNITED STATES POSTAL SERVICE 5,_� First-Class Postage&`r-aes Paid _ LISPS .Permit No.G-10 _ Sender: Please print yqi na e,,ddress, and-ZryP+4_' his b0z'— ._-..v o ` 0 `y KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT j J 2700 M STREET SUITE 300 BAKERSFIELD CA 93309-2370 J � ENVIRONMENTAL HEALTH SEk CES DEPARTMENT REPURCE MANAGEMENT AGENCY STEVE McCALLEY, R.E.H.S., Dire or DAVID PRICE/I/, RMA DIRECTOR 2700"M"STREET,SUITE 300 Community and Economic Development Department BAKERSFIELD,CA 93301-2370 Engineering&Survey Services Department Voice: (661)862-8700 Environmental Health Services Department Fax: (661)862-8701 Planning Department TTY Relay:(800) 735-2929 • 0 Roads Department e-mail:eh @co.kern.ca.us July 1, 2004 HAPPY GAS 3221 TAFT HWY BAKERSFIELD, CA 93313 SUBJECT: NOTICE OF VIOLATION/ORDER TO COMPLY Location: 3221 TAFT HWY, BAKERSFIELD Known As: HAPPY GAS Permit#: FA0000018/320018 Dear Amita and Vikram Budiyam: 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: 1. 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 stafffamiliar with required settings. This has not been completed or documented. 2. Failure to complete a test of the secondary containment 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. 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 i strongly urged to resolve this matter by August 1,2004,in order to prevent the assessment of enforcement penalties. r HAPPY GAS July 1, 2004 Re: FA0000018 Page 2 Please direct all correspondence or questions to Michael F. Driggs at(661) 862-8744. Sincerely, Steve McCalley,Director By: Joe Cams,R.E.H.S. Environmental Health Specialist N Unified Hazardous Materials/Waste Program JC:AG:jrw (hm\green\ust compliance letter) ENVIRONMENTAL HEALTH SEAES DEPARTMENT REOURCE MANAGEMENT AGENCY STEVE McCALLEY, R.E.H.S., Director DAVID PRICE Ill, RMA DIRECTOR 2700"M"STREET,SUITE 300 Community and Economic Development Department BAKERSFIELD,CA 93301-2370 Engineering&Survey Services Department Voice:(661)862-8700 Environmental Health Services Department Fax:(661)862-8701 Planning Department TTY Relay:(800)735-2929 • Roads Department e-mail:eh @co.kem.ca.us April 25, 2003 TONY HAWARA AND ISSA HAWARA 13130 FOOTHILL BLVD SYLMAR, CA 91342 Subject: Underground Storage Tank(UST) System Requirements Facility: HAPPY GAS, 320018 3221 TAFT HWY BAKERSFIELD Dear Mr. Hawara: This department received the secondary containment test report dated December 26, 2002. This report indicates that the product lines and Under Dispenser Containment were not tested. The deadline for completing the testing was January 1, 2003. Those components need to be tested. 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 L By: Joe Canas Hazardous Materials Specialist IV Unified Hazardous Materials/Waste Program ENVIRONMENTAL HEALTH SERAS DEPARTMENT SOURCE MANAGEMENT AGENCY STEVE McCALLEY, R.E.H.S., Director DAVID PRICE III, RMA DIRECTOR 2700"M"STREET,SUITE 300 �,. Community Development Program Department BAKERSFIELD,CA 93301-2370TH' Voice; (661)862-8700 Engineering &Survey Services Department Fax: (661)862-8701 Environmental Health Services Department TTY Relay: (800)735-2929 Planning Department e-mail: eh@co.kern.ca.as Roads Department October 25, 2002 TONY HAWARA AND ISSA HAWARA 13426 OSBORNE ST ARLETA, CA 91331 Subject: Secondary Containment Testing for Underground Storage Tank (UST) Systems Facility: HAPPY GAS, 320018 3221 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 ENVIRONMENTAL HEALTH SEROES DEPARTMENT IRSOURCE MANAGEMENT AGENCY STEVE McCALLEY, R.E.H.S., Director DAVID PRICE 111, RMA DIRECTOR 2700"M"STREET,SUITE 300 Community Development Program Department BAKERSFIELD,CA 93301-2370 Voice: (661)862-8700 Engineering&Survey Services Department Fax: (661) 862-8701 Environmental Health Services Department TTY Relay: (800)735-2929 Planning Department e-mail: eh @co.kern.caus Roads Department July 15,2002 D�W TONY HAWARA AND ISSA HAWARA 3� 13426 OSBORNE ST ARLETA, CA 913 31 Subject: Updated Underground Storage Tank(UST) Monitoring and Response Plans Facility: HAPPY GAS, FA0000018 3221 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. 0 0 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 l u--�-- gyp---- By: Joe Canas, REHS Hazardous Material Specialist IV Unified Hazardous Materials/Waste Program JC:lf Enclosures 300/ ENVIRONMENTAL HEALTH SEES DEPARTMENT SOURCE MANAGEMENT AGENCY wow STEVE McCALLEY, R.E.H.S., Director • DAVID PRICE 111, RMA DIRECTOR 2700"M"STREET,SUITE 300 ,11111 ; Community Development Program Department BAKERSFIELD,CA 93301-2370 Engineering &Survey Services Department Voice: (661)862-8700 Fax: (661)862-8701 Environmental Health Services Department TTY Relay: (800)735-2929 ; Planning Department e-mail: eh@co.kern.ca.us •• Roads Department November 30, 2001 TONY HAWARA AND ISSA HAWARA 13426 OSBORNE ST ARLETA, CA 91331 Subject: Underground Storage Tank (UST) Requirements and Deadlines Facility: HAPPY GAS, FA0000018 3221 TAFT HWY BAKERSFIELD 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. Cathodic Protection System The following tanks at this facility have an impressed current cathodic protection system. This system is required to be tested at least every three years by a corrosion specialist. This system is required to be tested by the date listed below. If the date has already passed, the test must be completed within 30 days of this letter. Tank# Tank Size Product Stored Test Due Date 1 12,000 DIESEL 04/13/2001 2 12,000 UNLEADED 04/13/2001 3 12,000 PREMIUM 04/13/2001 4 12,000 DIESEL 04/13/2001 v Interior Lined Tanks The following tanks at this facility have been interior lined to meet the 1998 compliance deadline. These tanks are required to be inspected within ten years by a coatings expert or a special inspector and every-five years thereafter. These tanks are required to be tested by the date listed below. If the date has already passed, the test must be completed within 60 days of this letter. Tank# Tank Size Product Stored Inspection Due Date 1 12,000 ' DIESEL 06/24/2008 2 12,000 UNLEADED 06/24/2008 3- 12,000 PREMIUM 06/24/2008 4 12,000 DIESEL 06/24/2008 TONY HAWARA AND ISSA HAWARA HAPPY GAS, FA0000018 November 30,2001 Page#: 2 Enhanced Leak Detection Monitoring According to the State's Geographic Information System mapping database, this facility is located within 1000 feet of a public drinking water well. The following tanks have single walled components (i.e., single walled tanks, piping, or no dispenser containment). Therefore, this facility is required to initiate Enhanced Leak Detection (ELD) monitoring. The State will be mailing an official notification soon, and upon notification, the facility has six months to have an ELD program reviewed and approved by this Department. The program shall be implemented within 18 months of the notification and repeated every 36 months thereafter. The ELD requirements are enclosed. Tank# Tank Size Product Stored 1 12,000 DIESEL 2 12,000 UNLEADED 3 12,000 PREMIUM 4 12,000 DIESEL 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 12,000 DIESEL 01/01/2003 2 12,000 UNLEADED 01/01/2003 3 12,000 PREMIUM 01/01/2003 4 12,000 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. TONY HAWARA AND ISSA HAWARA HAPPY GAS, FA0000018 November 30,2001 Page#: 3 California Air Resources Board (GARB)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 CA Cert. No. 0 6 2 6 4 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 Underground Storage Tank Facility has been issued in connection with UPGRADE the operating permit for the facility indicated below. The This upgrade compliance certificate is issued certificate number on this facsimile pursuant to Chapter 6.7,Section 25284(e), L California Health and Safety Code. 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: HAPPY GAS, 000018 Location: 3221 TAFT HWY BAKERSFIELD, CA 93313 Owner: DAVIES OIL CO c/o C L MARTIN P O BOX 80067 BAKERSFIELD, CA 93380 UST Site ID: 320018 BP Site ID: 000018 Issue Date: September 1, 1998 98C-4 � s ENVIRONMENTAL HEALTH SERVICES DEPARTMENT AWOURCE MANAGEMENT AGENCY STEVE McCALLEY, R.E.H.S.,frector • DAVID PRICE 111, RMA DIRECTOR 2700-M- STREET, SUITE 300 1 Community Development Program Department BAKERSFIELD, CA 93301-2370 , Engineering & Survey Services Department Voice: (805) 882-8700 Environmental Health Services Department 'FAX: (805) 882-8701 Planning Department TTY Relay: (800) 735-2929 • Roads Department e-mail: eh @kerncounty.coin July 10, 1998 Davies Oil Company Attention: Bill Davies P.O. Box 80067 Bakersfield, CA 93307 SUBJECT: REPLACEMENT OF PRODUCT PIPING ASSOCIATED WITH THE HAZARDOUS SUBSTANCE STORAGE TANKS LOCATED AT 3221 TAFT HIGHWAY, PUMPKIN CENTER, CALIFORNIA PERMIT #: 320018 Dear Mr. Davies: This is to advise you that this Department has reviewed the project results for the preliminary assessment associated with the replacement of the piping noted above. Based on the sample results submitted, this Department is satisfied that the assessment is complete. Based on current requirements and policies, no further action is indicated at this time. It is important to note that this letter does not relieve you of further responsibilities mandated under the California Health and Safety Code and California Water Code if additional or previously unidentified contamination at the subject site causes or threatens to cause pollution or nuisance or is found to pose a significant threat to public health. Changes in the present or proposed land use may require further assessment and mitigation of potential public health impacts. Thank you for your cooperation in this matter. Sincerely, Steve McCalley, Director By: Laurel Funk Hazardous Materials Specialist Unified Hazardous Materials/Waste Program cc: Hansen Engineering 320018.wpd Kern County Environmental UNIFIED HAZARDOUS Phone: (805) 862-8700 Health Services Department Certified Unified Program Agency MATERIALS / WASTE FAX: (805) 862-8701 2700 "M" Street, Suite 300, Bakersfield,CA FACILITY PERMIT FACILITY NAME: HAPPY GAS, 000018 OWNER'S NAME: RAHAL MOUSA P O BOX 80067 LOCATION: 3221 TAFT HWY BAKERSFIELD, CA BAKERSFIELD, CA 93307 Key Map No.: 123-36 ISSUED FOR THE FOLLOWING ACTIVITIES: 9 Underground Storage Haz Material Business Hazardous Waste Above-Ground Tanks (Permitted) Plan/RMPP (Authorized) Generator Storage Tanks 320018C Site ID #: 000018 NOT AUTHORIZED NOT AUTHORIZED 12000 GAL., SINGLE WALLED, GASOLINE, PRESSURE 12000 GAL., SINGLE WALLED, GASOLINE, PRESSURE 12000 GAL., SINGLE WALLED, PREM UNL/SUPER, PRESSURE 12000 GAL., SINGLE WALLED, DIESEL, PRESSURE THIS PERMIT IS GRANTED SUBJECT TO THE CONDITIONS LISTED ON THE BACK Issue Date: November 1, 1997 Expiration Date: November 1, 2000 — POST ON PREMISES — NONTRANSFERABLE HAZARDOUS MATERIALS / WASTE FACILITY PERMIT 11. A hazardous materials inventory plan must be prepared and kept current by SUMMARY OF CONDITIONS the owner or the operator of this facility. CONDITIONS: 12. An annual report shall be submitted to the Kern County Environmental Health Services Department each year after the monitoring has been 1. The facility owner and operator must comply with all conditions specified initiated. The owner or operator shall use the form provided along with the by this permit and must meet any additional requirements imposed by the permit or another approved by the Kern County Environmental Health permitting authority. Services Department. 2. The facility owner and operator shall ensure that the facility has adequate 13. All underground storage tanks designated as SINGLE WALLED on this financial responsibility insurance coverage,as mandated for all underground permit shall be equipped with an in-tank level sensor, which is to be storage tanks containing petroleum,and supply proof of such coverage to the utilized on a monthly basis to monitor for releases. The equipment must be permitting authority. certified as capable of detecting 0.2 gallon per hour,OR each tank shall be monitored utilizing Statistical Inventory Control Monitoring(SIR). The The facility will be considered in violation and operating without a permit SIR provider shall utilize a method which has been certified as being if annual fees are not received within 30 days of the invoice date. capable of detecting 0.2 gallon per hour. Monitoring requirements for SIR 4. The monitoringloperational requirements shall be implemented within 30 shall be consistent with those specified in Section 2646.1 of the California days of the permit issue date. Code of Regulations, as summarized within the Kern County memo to the site. 5. Any inactive underground storage tank which is not being monitored, as approved by the permitting authority, is considered improperly closed. 14. All underground storage tanks shall be retrofitted with an overfill prevention Proper closure is required and must be completed under a permit issued by system and overspill containers by December 1998, or as specified by the the permitting authority. Environmental Health Services Department. The overspill containers shall have a minimum capacity of 5 gallons, protected from galvanic corrosion, 6. The facility owner/operator must obtain a modification permit before: and equipped with a drain valve. a. Uncovering any underground storage tank after failure of a tank integrity test. 15. All equipment installed for leak detection shall be operated and maintained b. Replacement of piping. in accordance with manufacturer's instructions, including routine mainte- c. Lining the interior of the underground storage tank. nance and service checks(at least once per year)for operability or running condition. The facility owner must advise the Environmental Health Services 0 Department within 30 days of transfer of ownership. 16. All pressurized piping systems shall install pressurized piping leak detection systems and ensure that they are capable of functioning as specified by the 8. The owner and/or operator shall keep a copy of all tank monitoring records manufacturer. The piping systems shall be tested annually unless the facility at the facility for a minimum of three years, or as specified by the has installed a continuous monitoring system within the secondary contain- ment. within 24 hours of a request made by the local authority. 17. By December 22, 1998, the SINGLE WALLED tank(s) shall either be 9. The owner/operator must report any significant unauthorized release from removed under permit or lined on the interior with a noncorrosive material, permitted tanks within 24 hours of discovery. and provided with exterior corrosion protection,under a tank modification 10. The owner and operator must meet all applicable requirements of Chapters permit. 6.5,6.67, 6.7, 6.75, and 6.95 of the Health and Safety Code and applicable 18. An annual report shall be submitted to the Kern County Environmental sections of the California Code of Regulations and the Kern County Health Services Department(EHSD)each year after the monitoring has been Ordinance Code. initiated. The owner or operator shall use the form provided along with the AEG:jrw permit or another approved by the Kern County EHSD. hm 14swa.p UNDERGROUND STORAGE TANK UPGRADE STATUS REPORT (THIS FORM HAS BEEN COMPLETED FOR TANKS NUMBERED ) FACILITY NAME CONVENIENCE MARKET 096 - HAPPY GAS TANK OWNER CONVENIENCE MARKET 096 FACILITY ADDRESS 3221 TAFT HIGHWAY, BAKERSFIELD, CA FACILITY PERMIT # 320018C TANK(S) 4 OPTIONS TO MEET THE 1998 DEADLINE COMPLETION DATES Choose A, B, or C then enter the target or actual completion date(s) as appropriate Target Actual Permanent closure or removal of the tank and piping. Q B) Replacement of the tank and piping with a double-walled tank, e.6, S double-walled piping, and dispenser containment(required for non-motor vehicle fuel tanks). C) Tank and piping upgrade as follows: 1) Installation of striker plate(s) in tank. 2) Installation of a spill container at the fill tube. 3) Installation of an overfill prevention device with one of the following: a) Automatic shutoff device b) Ball float valve c) Audible and visual overfill alarm 4) Corrosion protection for the tank provided by one of the following: a) Tank made of non-corrodible material (such as fiberglass) b) Steel tank clad with(or encased in) noncorrodible material c) Steel tank upgraded with interior lining and exterior cathodic protection d) Steel tank upgraded with interior lining, exterior cathodic cathodic protection, and a bladder system 5) Corrosion protection for the associated piping provided by one of the following: a) Piping made of non-corrodible material (such as fiberglass) b) Installation of new fiberglass or other non-corrodible double- walled piping and dispenser containment c) Steel piping with corrosion-resistant coating and cathodic protection d) Steel piping upgraded with cathodic protection 6) Installation of a line leak detector with an automatic shutoff system/device. Please completCthis m and'fax-t (805) 862-8701, or mail to Kern County Environmental Health Services Depar700 M Street, uite 300, Bakersfield, CA 93301, by September 15, 1996. TANK OWNER OPERATOR/AG DATE HM96 (8/96) t t ENVIRONMENTAL HEALTH SERVICES DEPARTMENT _. STEVE McCALLEY, R.E.H.S. t4 '1.iT,6;;��� :A 2700 "M" Street, Suite 300 DIRECTOR 1 Bakersfield,CA 93301 4 6` (805) 861-3636 (805) 861-3429 FAX February 24, 1994 CONVENIENCE MARKET 096 P. O. BOX 80067 BAKERSFIELD, CA 93380 SUBJECT: 3221 TAFT HIGHWAY, BAKERSFIELD, CA PERMIT #: 320018C Dear Sir/Madam: The permit issued to the facility cited above provided one page of conditions/prohibitions for operation of the underground storage tank system. One of the conditions provided on that page specified that"the owner and operator ensure that the facility have adequate financial responsibility coverage, as mandated for all underground storage tanks containing petroleum, and supply proof of such coverage when requested by the permitting agency." Federal regulations which went into effect in December 1988 required that all underground storage tank facilities obtain financial responsibility coverage,using an approved mechanism to pay for the costs of cleanup and any third party liability, in case of a leak from the tank system, and provide evidence of that coverage to the local imple- menting agency by deadlines established in law. The amount of coverage required and the mecha- nisms which could be utilized were also specified in law. In an attempt to assist underground storage tank facilities comply with the financial responsibility requirements, the state developed a clean up fund,which was approved by the Federal EPA as a mechanism for meeting a portion of the Federal financial responsibility requirements. The state has prepared a summary of the clean up fund,how you pay into the fund,and the financial responsibility requirements. That summary has been enclosed with this letter. The Certificate of Financial Responsibility enclosed is the proof that this Department needs for the underground storage facility cited above. As shown by the example provided,you can utilize one statement for all underground storage tanks that you own or operate. Please review all information provided,complete the Certificate of Financial Responsibility enclosed, and return it by March 31, 1994. If you have any questions, feel free to can the Underground Storage Tank Program at (805) 861-3636. Sincerely, McCalley, Direct yreen, R.�EcH.S. Materials ' st IV AEG:jrw Hazardous Materials Management Program Enclosures (blocl2a) _ -- RESPONSE CHECKLIST Specialist reviewing the information returned: )Q U Date questionnaire was returned: Facility Permit Number: 00 Tanks located at the facility: r.u Z/ Was a reply received for each substance code assigned to the facility? X Yes No Does the facility need to provide additional information in order for the monitoring alternative to be acceptable? Yes �� No Describe what information is required: The monitoring alternat' a picked by the facility representative is acceptable for the facility tanks. Yes No (The monitoring alternative will be viewed as unacceptable if the alternative was not appropriate for the type of tank described on the facility profile or within the facility file. Example: The facility may wish to use the visual alternative for a tank that is not vaulted, or the tank size is not appropriate for the type of inventory monitoring chosen.) Additional Comments: Information has been reviewed and placed within the database: Date entered within the database: Entered by (name): AEG:= \rrcnnncP lic ENCLOSURE-- CHECKLISTL�� � Facility COLVeO etJce-, MAkk f 0% . .Permit # 3 2 O(U IS C This checklist is provided to ensure that all necessary packet enclosures were received. Please complete this form and return it to the Kern County Environmental Health Services Department, along with the Monitoring Alternatives Questionnaire, within 30 days of receipt. CHECK YES NO The packet I received contained: _ 1. Cover letter. 2. Facility Profile Sheet (provides Facility Permit Number and information on the underground storage tanks and piping, as provided on the application). The substance code in Column #2 should be referenced when reviewing the Monitoring Alternatives Fact Sheets and Ouestionnaires. 3. A Monitoring Alternatives and Upgrade Requirements Fact Sheet for each substance code referenced on the Facility / Profile Sheet. 4. A Monitoring Alternatives Questionnaire for each substance code referenced on the Facility Profile Fact Sheet. Signature of Person Completing the Checklist Title �Prl. �✓�-e- PoIT`) Date I I (green\chk1st.1) c", t R , ..�,..... .. . . �.._ _ I i FACILITY PROFILE SHEET 320018C CONVENIENCE MARKET 096 — HAPPY GA TAFT HWY. & WIBLE ROAD BAKERSFIELD, CA PERMIT # 320018C Substance Tank Tank Year Is piping Tan # Code Contents Ca aci Installed Pressurized? 1 MVF 3 REGULAR 12,000 1982 YES 2 MVF 3 UNLEADED 12,000 1982 YES 3 MVF 3 PREM-UNLEADED 12,000 1982 YES 4 MVF 3 DIESEL 12,000 1982 YES Positively shut off flow to.be tank when.the tank is no.more than 95 percent full.: - . .._-. CATHODIC PROTECTION - UPGRADING REQUIREMENTS All steel underground storage tank ank systems shall be upgraded under permit to install cathodic protection and interior lining by December 22, 1998. Field-installed cathodic protection systems shall be designed and certified by a corrosion expert. The cathodic protection system shall be tested under the direction of a cathodic protection tester within sixty days to six months of installation and at least every three years thereafter. MONITORING/RESPONSE PLANS All facilities shall submit a monitoring/response plan which includes the following information: 1. The name and address of the owner and operator who will do the monitoring. 2. A copy of the owner/operator agreement. 3. A summary of the method and equipment which is to be used to perform the monitoring. 4. The name and telephone numbers of the service contractor for any monitoring devices on site. 5. The maintenance schedule for the monitoring equipment. 6. The minimum training required to monitor the tank. pAv iE . 9 33g� 3 . 7L5 -25-0 POUID ce►�c(� ove t Pure ( OCt evvi . FLe,t CARD f UeL CO. l;`u'0T) 321- Nrs rUee,oe� We-etz, 4 : MONITORINV" A6TERNATIVES QUESTIONNAIRE FOR MVF 3 FACILITY TANKS _.. Facility Name: C VC01 e"Cl Im"1zei- 0 O_o � - � ibi.Facility Address: Rd . 'i34VecLSi::�_ j C4 - Owner's Name: C0 U QCW l GA-JLG M vase�1 '4'-626 Owner's Address: P.7• &Y SOD 69 W. (�33 g C7 Operator's Name: fl)&CAS 611 Co - Permit Number (obtained from the facility profile sheet): 3 Z001 -7, G Number of Tanks which have been assigned the NIM Code: All information has been received and reviewed and the following summarizes the monitoring alternative which I have picked for the MVF 3 tanks at this facility. I realize that the monitoring alternative must be approved by the local agency before implementation. (Place an X next to the alternative picked). 1. VISUAL MONITORING will be utilized. (I can inspect the exterior of all tanks, without using extraordinary personnel protective equipment). 2. IN-TANK LEVEL SENSOR will be installed in each tank, which are capable of detecting a leak of 0.2 gallons per hour. The sensor will be used to test the tank monthly. The facility will ALSO COMPLETE A TANK INTEGRITY TEST EVERY THREE YEARS, utilizing a licensed tester who's method has been certified to detect a leak of 0.1 gallons per hour. 3. IN-TANK LEVEL SENSOR has been installed in each tank, which is capable.of detecting a leak of 0.2 gallons per hour. The sensor will be used to test the tank monthly. The facility will ALSO COMPLETE A TANK INTEGRITY TEST EVERY THREE YEARS,utilizing a licensed tester who's method has been certified to detect a leak of 0.1 gallons per hour. Provide the following information on the system installed: System Manufacturer: YeedJe� Rca�,� System Model No.: TL 5 2 So L Date Installed: -- SEE PAGE 2 FOR ADDITIONAL ALTERNATIVES -- MOMTORING ALTERNATIVES QUESTIONNAIRE FOR MVF 3 FACILITY TANKS Permit No.: -2)2 OCR l 8 C- 4. VADOSE ZONE MONITORING will be utilized ALONG WITH ANNUAL TANK INTEGRITY TESTING. The facility will submit a proposal to the department for approval of the number, locations and design of monitoring wells. which will be utilized to monitor the underground storage tank systems. Each monitoring well will be equipped with a continuous monitoring device. 5. VADOSE ZONE MONITORING will be utilized ALONG WITH ANNUAL TANK INTEGRITY TESTING. The facility has already installed monitoring wells, and would like to utilize them. A plot plan of their locations and a drawing showing their construction are enclosed. The facility does/does not have continuous monitoring equipment installed within each well. Provide information on the monitor which has been installed within each well: System Manufacturer: System Model No.: Date Installed: 6. MODIFIED INVENTORY CONTROL MONITORING(tank gauging 2 days per week) for underground storage tanks which have a total tank capacity of 2,000 gallons or less, that do not have metered dispensers;ALONG WITH AN ANNUAL TANK INTEGRITY TEST utilizing a licensed tester who's method has been certified to detect a leak of 0.1 gallons per hour. 7. STANDARD INVENTORY CONTROL MONITORING (tank gauging 5-7 days per week) for underground storage tanks which dispense product from metered dispensers; ALONG WITH AN ANNUAL TANK INTEGRITY TEST utilizing a licensed tester who's method has been certified to detect a leak of 0.1 gallons per hour. Name of person completing this form: W(11 AM O A-O tE-,) Title: press b&,�A &—k)e-40-c._ Pia, Date: AEG:ch green\question RESORCE MANAGEMENT APNCY Environmental Health Services Department RANDALL L. ABBOTT /�� STEVE McCALLEY, REHS,DIRECTOR DIRECTOR ( Air Pollution Control District DAVID PRICE III 1 NJILLIAM J. RODDY, APCO ASSISTANT DIRECTOR Q / Planning&Development Services Department - TED JAMES, AICP,DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT . May 28, 1992 OWNERS/OPERATORS OF UNDERGROUND STORAGE TANKS Dear Sir/Madam: The Kern County Environmental Health Services Department has reviewed the monitoring requirements provided to your facility during the calendar year of 1991 . Enclosed you will find new monitoring requirements for your facility. Please obtain the permit issued for the facility cited below and read and reYl= —aep,: —vnents with those provided with this letter. The new _monitoring requirements supersede all monitoring requirements previously issued to your facility. It is the owner's responsibility to diligently maintain the UST system and guard against leaks . It is also the owner' s responsibility to assess and possibly mitigate any soil contamination that might occur if their system fails . FACILITY INFORMATION: Permit Number: 320018C Name: Convenience Market # 096 - Happy Gas 3221 Taft Highway Bakersfield, CA 93313 Please contact me at ( 805 ) 861-3636 extension 587 if you have any questions. Sincerely, Laurel Funk Hazardous Materials Specialist Hazardous Materials Management Program 2700 "M" STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861-3429 PRINTED ON RECYCLED PAPER MONITORING REOUIREMENTS:,MVF3TLMpr) 1. All underground storage tanks designated as MVF 3 within page 1 of this permit shall be monitored utilizing the following method: a. All tanks shall be tested once every three years utilizing a tank integrity test which has been certified as being capable of detecting a leak of 0.1 gallon per hour with a probability of detection of 95 percent and a probability of false alarm of 5 percent. The first test shall be completed before December 31, 1991, and subsequent tests completed before December 31, 1994. All tank integrity tests com- pleted after September 16, 1991,shall be completed under a valid unexpired permit to test issued by the Environmental Health'Services Department. b. Each tank shall be equipped with an in-tank level sensor,which is to be utilized on a monthly basis to monitor for releases. The equipment must be certified as capable of detecting 0.2 gallon per hour, defined at any normal operating product level in the underground storage tanks with a 95 percent probability of detection and a 5 percent probability of false alarm. 2. All underground storage tanks shall be retrofitted with overspill containers which have a minimum capacity of 5 gallons; be protected from galvanic corrosion, if made of metal; and be equipped with a drain valve to allow the drainage of liquid back into the tank, by December 1998, or as specified by the Environmental Health Services Department. 3. All equipment installed for leak detection shall be operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks (at least once per year) for operability or running condition. 4. An annual report shall be submitted to the Kern County Environmental Health Services Department each year after monitoring has been initiated. The owner or operator shall use the form provided and another approved by the Kern County Environmental Health Services Department. 5. All pressurized piping systems shall install pressurized piping leak detection systems and ensure that they are capable of functioning as specified by the manufacturer. The mechanical leak detection systems must be capable of alerting the owner/operator of a leak by restricting or shutting off the flow of hazardous substances through the piping, or by triggering an audible or visual alarm, detecting three gallons or more per hour per square inch line pressure within one hour. 6. All pressurized piping systems shall be tested annually unless the facility has installed the following: a. A continuous monitoring system within secondary containment. b. The continuous monitor is connected to an audible and visual alarm system and the pumping system. C. The continuous monitor shuts down the pump and activates the alarm system when a release is detected. d. The pumping system shuts down automatically if the continuous monitor fails or is disconnected. The first test shall be completed before December 31, 1991, and subsequent tests completed each calendar year thereafter. 3 RE*URCE MANAGEMENT A*ENCY Environmental Health Services Department RANDALL L. ABBOTT STEVE WCALLEY, REHS,DIRECTOR DIRECTOR Air Pollution Control District DAVID PRICE III WILLIAM J. RODDY, APCO ASSISTANT DIRECTOR Planning&Development Services Department TED JAMES, AICP,DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT January 3, 1992 Owners/Operators of Underground Storage Tank Systems Dear Sir/Madam: The Kern County Environmental Health Services Department has reviewed the monitoring requirements provided to your facility within the calendar year of 1991. A statement within the monitoring requirements was reworded to provide clarity. Please obtain the permit issued for the facility cited below, and read and replace the monitoring requirements with those provided with this letter. Facility Information: 320018C CONVENIENCE MARKET 096 - HAPPY GAS TAFT HWY. & WIBLE ROAD BAKERSFIELD, CA If you have any additional questions, please feel free to call me at (805) 861-3636, Extension 576. Sincerely, , Amy E. G en, R.E. Hazardou aterials Specialist Hazardous Materials Management Program AEG:cas \monitor.req 2700 "M" STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861-3429 V MONITORING REOUIREMENTS:(MVF3Spr) 1. All underground storage tanks designated as MVF 3 within Page 1 of this permit shall be monitored utilizing the following method: a. Standard Inventory Control Monitoring (tank gauging five to seven days per week). Kern County Environmental Health Services Department forms shall be utilized unless a facility form can provide the same information and has been reviewed and approved by the Environmental Health Services Department. (Monitoring shall be completed in accordance with requirements summarized in Handbook UT-10.) AND b. All tanks shall be tested annually utilizing a tank integrity test which has been certified as being capable of detecting a leak of 0.1 gallon per hour with a probability of detection of 95 percent and a probability of false alarm of 5 percent. The first test shall be completed before December 31, 1991, and subsequent tests completed each calendar year thereafter. All tank integrity tests completed after September 16, 1991, shall be completed under a valid, unexpired Permit to Test issued by the Environmental Health Services Department. C. All pressurized piping systems shall install pressurized piping leak detection systems and ensure that they are capable of functioning as specified by the manufacturer. The mechanical leak detection systems must be capable of alerting the owner/ operator of a leak by restricting or shutting off the flow of hazardous substances through the piping, or by triggering an audible or visual alarm, detecting three gallons or more per hour per square inch line pressure within one hour. d. All pressurized piping systems shall be tested annually unless the facility has installed the following: 1. A continuous monitoring system within secondary containment. 2. The continuous monitor is connected to an audible and visual alarm system and the pumping system. 3. The continuous monitor shuts down the pump and activates the alarm system when a release is detected. 4. The pumping system shuts down automatically if the continuous monitor fails or is disconnected. The first test shall be completed before December 31, 1991, and subsequent tests completed each calendar year thereafter. 2. All underground storage tanks shall be retrofitted with overspill containers which have a minimum capacity of 5 gallons; be protected from galvanic corrosion, if made of metal; and be equipped with a drain valve to allow the drainage of liquid back into the tank by December 1998, or as specified by the Environmental Health Services Department. 3. All equipment installed for leak detection shall be operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks (at least once per year) for operability or running condition. 4. An annual report shall be submitted to the Kern County Environmental Health Services Department each year after monitoring has been initiated. The owner/operator shall use the form provided within the Handbook UT-10. 3 RESUCJRCE MANAGEMENT AGENCY Environmental Health Services Department RANDALL L. ABBOTT STEVE WCALLEY, REHS,DIRECTOR DIRECTOR Air Pollution Control District DAVID PRICE III WILUAM J. RODDY, APCO ASSISTANT DIRECTOR Planning&Development Services Department TED JAMES, AICP,DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT PERMIT TO OPERATE UNDERGROUND HAZARDOUS STORAGE FACILITY Permit No.: 320018C State ID No.: 733 Issued to: CONVENIENCE MARKET 096 - HAPPY GAS No, of Tanks: 4 Location: TAFF HWY. & WIBLE ROAD BAKERSFIELD, CA Owner: CONVENIENCE MARKET 096 P. O. BOX 80067 BAKERSFIELD, CA 93380 Operator: DAVIES OIL COMPANY P. O. BOX 80067 BAKERSFIELD, CA 93380 Facility Profile: Substance Tank Tank Year Is piping Tank No. Code Contents Capacity Installed Pressurized? 1 MVF 3 REGULAR 12,000 1982 YES 2 MVF 3 UNLEADED 12,000 1982 YES 3 MVF 3 PREM-UNLEADED 12,000 1982 YES 4 MVF 3 DIESEL 12,000 1982 YES This permit is granted subject to the conditions and prohibitions listed on the attached summary of conditions/prohibitions By: -- UQd Steve McCalley Issue Date: November 4, 1991 Title: Director, Environmental Health Se s Department Expiration Date: November 4, 1996 -- POST ON PREMISES -- NONTRANSFERABLE 2700 "M" STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861-3429 o HAZARDOUS UNDERGROUND STORAGE FACILITY PERMIT SUMMARY OF CONDMONS/PROHIBITIONS CONDMONS/PROHIBITIONS: 1. The facility owner and operator must be familiar with all conditions specified within this permit and must meet any additional requirements to monitor, upgrade, or close the tanks and associated piping imposed by the permitting authority. 2. If the operator of the underground storage tank is not the owner, then the owner shall enter into a written contract with the operator, requiring the operator to monitor the underground storage tank; maintain appropriate records; and implement reporting procedures as required by the Department. 3. 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 when requested by the permitting authority. 4. The facility owner must ensure that the annual permit fee is paid within 30 days of the invoice date. 5. The facility will be considered in violation and operating without a permit if annual permit fees are not received within 60 days of the invoice date. 6. The facility owner and/or operator shall review the leak detection requirements provided within this permit. The monitoring alternative shall be implemented within 60 days of the permit issue date. 7. The facility underground storage tanks must be monitored, utilizing the option approved by the permitting authority, until the tank is closed under a valid, unexpired permit for closure. 8. Any inactive underground storage tank which is not being monitored, as approved by the permitting authority, is considered improperly closed Proper closure is required and must be completed under a permit issued by the permitting authority. 9. The facility owner/operator must obtain a modification permit before: a. Uncovering any underground storage tank after failure of a tank integrity test. b. Replacement of piping. C. Lining the interior of the underground storage tank. 10. The tank owner must advise the Environmental Health Services Department within 10 days of transfer of ownership. 11. Any change in state law or local ordinance may necessitate a change in permit conditions. The owner/operator will be required to meet new conditions within 60 days of notification. 12. The owner and/or operator shall keep a copy of all monitoring records at the facility for a minimum of three years, or as specified by the permitting authority. They may be kept off site if they can be obtained within 24 hours of a request made by the local authority. 13. The owner/operator must report any unauthorized release which escapes from the secondary containment, or from the primary containment if no secondary containment exists,which increases the hazard of fire or explosion or causes any deterioration of the secondary containment within 24 hours of discovery. AEG:jrw (green4)ermit.p2) 2 MONITORING REQUIREMENTS:(MVF3spr) 1. All underground storage tanks designated as MVF 3 within Page 1 of this permit shall be monitored utilizing the followhig method: a. Standard Inventory Control Monitoring(Tank gauging five to seven days per week). Kern County Environmental Health Services Department forms shall be utilized unless a facility form can provide the same information and has been reviewed and approved by the Environmental Health Services Department. (Monitoring shall be completed in accordance with requirements summarized in Handbook UT-10.) AND b. All tanks shall be tested annually utilizing a tank integrity test which has been certified as being capable of detecting a leak of 0.1 gallon per hour with a probability of detection of 95 percent and a probability of false alarm of 5 percent. The first test shall be completed before December 31, 1991, and a subsequent test completed before December 31, 1994. All tank integrity tests completed after September 16, 1991, shall be completed under a valid, unexpired Permit to Test issued by the Environmental Health Services Department. C. All pressurized piping systems shall install pressurized piping leak detection systems and ensure that they are capable of functioning as specified by the manufacturer. The mechanical leak detection systems must be capable of alerting the owner/ operator of a leak by restricting or shutting off the flow of hazardous substances through the piping, or by triggering an audible or visual alarm, detecting three gallons or more per hour, per square inch, line pressure within one hour. d. All pressurized piping systems shall be tested annually unless the facility has installed the following: 1. A continuous monitoring system within secondary containment. 2. The continuous monitor is connected to an audible and visual alarm system and the pumping system. 3. The continuous monitor shuts down the pump and activates the alarm system when a release is detected. 4. The pumping system shuts down automatically if the continuous monitor fails or is disconnected. The first test shall be completed before December 31, 1991, and subsequent tests completed each calendar year thereafter. 2. All underground storage tanks shall be retrofitted with overspill containers which have a minimum capacity of 5 gallons; be protected from galvanic corrosion, if made of metal; and be equipped with a drain valve to allow the drainage of liquid back into the tank by December, 1998, or as specified by the Environmental Health Services Department. 3. All equipment installed for leak detection shall be operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks (at least once per year) for operability or running condition. 4. An annual report shall be submitted to the Kern County Environmental Health Services Department each year after monitoring has been initiated. The owner/operator shall use the form provided within the Handbook UT-10. 3 1700 Flower Street ORN COUNTY HEALTH DEPARTA HEALTH OFFICER Bakersfleid,California 93305 Leon M Hebertson,M.D. Telephone(805)861-3636 ENVIRONMENTAL HEALTH DIVISION ��Il�irffJ DIRECTOR OF ENVIRONMENTAL HEALTH Vernon S.Reichard i ��llllll<l� May 7 , 1985 Mr.. Paul Lingenfelder P .O . Box 5188 Bakersfield , CA. 93388 Dear Mr. Lingenfelder : Regarding our phone conversation on May 3 , 1985 , your request for an extension on nine (9 ) invoice payments has been granted. Invoice numbers 050062C , 050072C , 090021C . are due May 26 , 1985 . Invoice numbers 32,0018C , 330075C , 330087C , 350026C , are due June 26 , 1985 . Invoice numbers 240009C , 460012C , are due July 26 , 1985 . If you have any further questions concerning this matter, please contact me at (805 ) 861 -3636 . Sincerely , Jane Warren JW : re DISTRICT OFFICES Delano . Lamont . Lake Isabelle . Mojave . Rldgecrest Shatter Tait NOTl3. Ei. .etive J ul Y 1. 19951alifornia Small-Businesses and California Businesses with 500 ei:...loyees or less must demonstrate at least$5,000, exclusive of the UST Cleanup Fund, businesses with over 500 employees must demonstrate at least$10,000. (Chap. 6.75 H&SC, • Se!A. 25299.32) ! The Chief Financial Officer or the owner or operator must sign,under penalty of pcijury, a letter worded EXACTLY as follows or-you may complete this letter by filling in the blanks with appropriate information: LETTER FROM CHIEF FINANCIAL OFFICER I am the Chief Financial Officer for L,4. C! $ (Business name,bus' dress,and cortespondence address of owner or operator) CIA This letter is in support of the-use of.the.Underground Storage Tank Cleanup Fund to demonstrate financial responsibilit::• f6r taking corrective action and/or compensating third parties for bodily injury and pre?::rty damage caused by an unauthorized release of petroleum in the.amount of at least $ !�iD 3 mot -- per occurrence and$ annual aggregate coverage. (Dollar Amcunt) (Dollar.Amount) Underground storage tanks at the following facilities are assured by this letter: Qcoz. 1� 1­_�yv, cvs ' (Name and address of each facility for which financial responsibility is being demonstra • I. Awo un t of ati,f tuad aggregate coverage being assured . bythis letter........................................................ ................... av 2. Tote! Tangible assets..........................................................>,...,.> $ 7 ° y. 3. Total liabilities............................................... $......................... 4. Tanl;b:�-,net worth(subtract line 3 from line 2. Lin 4 :ittst hie at :1)*. I hereby certif, `.teat the wording of this letter is identical to.the wording specified in subsection 2808.1(d)(1), Chapter•18,Divi.::on 3; Title 23 of the California Code of Regulations-. I declare under f egalty of per ury'that the foregoing is true and correct to the best of' knowledge'and belief. Executed at (;lace of Execution) Stgit _ (Printed Name) ' U9T-02FR revised 4n5 APR-01-2005 01 :02 P%"WPPYGAS 6F ' 831 2235 P. 02 "L:2S Ub Owner Statements of Designated Underground Storage Tank (UST)Operator mid U Werstanding of and Compliance with UST Requirements Pacility NAMO:WFY GAS M MART rui:iry ID 0. Facility,Addrwa:3221 TAFT RWY,l3AKrFR%rirj.r) CA at313 Rcaaon fnr 5uhntiittiug this roall(r-bccA 0=) ''I IWIWk:of DI-NiVIPtUd 0 1' PCMiV 'Oule cemi ricate EXPIM0011 Datc Dj-ign-'jgd TIST Q1kgrgtnr(A1 for this FaC.I.Ift 1'*%i&GAVd Qpnwes Now lamn Xnop Acia-.t-yr co us'r Facility fichrk pm; harm f".-I ai:"w Ld Ou,rwv U Qperatol 0 Srol*.M MsiG.naro)Opeteum'sPhow:*jS61)392-868" X Scr4:,.T:,0nidan D Third-P" lWarnafluiat Codc Council cmi-fl(Vion R! Vxpinllfov vu.1r. 11-12-0( �-MAMUM—uuw=��" DoilpmW Operatoev Name�lomea Rich f•±1.114,1 line.;111W 000� Billiness NAMO eihuvel-Rid)Ej,vii%ja4nq,-q,,j ca Effipikfyea Intgrnatimr)Code Courwil 1.•0•tificolion 4! 06•11A&UL 46 e'2PV!-P#W4: (Chock(7m) U Orvuw 12 BmployOe ho,r..'t is Thir4-PutY 1,40TE; THE LOCAL REGULATORY AGENCY MUST, BE MOTMIED OF ANY (34ANQLS TO MIS INFORMATFON WIT14114 30 T)AYS OF THE CMANIGF, at the I ol-. n.'illy liq;e,the find ividual(s) listed above will mrvz u Drv1j7i;acJ'oST Oparaiur(s"'i. 71je hdividual(s)--vil I �=aduut Auld dricument mordhly facility Wspecdons and annual facility employee traiWng.in with Califnniia Code of -Ragulgiollit, section 2713(c)-M lFurthemlore,I undentaod and am in compHance with the irequirenivas istatutes, g"A Ift"Al Av-divennivaA n-nv%14^ul61A*o%Psynelawn"AmnA kb"Irw N&ME OF'TkNK OWNLA OR OWNER'S 'Pleue Print): �J-ff) SIGNATURE<)r TANK OWNER OR.0 WISER,S ACEM DATE: OWNIER's PTIONE for 0116-Facift MW pRatmy De-Of-d Operator's Nuns:JAIAW RICH Retatioa to UST Faoility(&&a O.U) Susiaea N&w( dt fw%w fi=above):RICH BNVIRONMBNTAL O owow . Q Opeator.. O stwayo Dwpoated 0pa:{ibr's Pboue#:(661 392-8687 ® Sesvlce Teaba do O •TB IPLV . Iataaadcu:al Code Caunoil,Caacationli#ft166-UC '. 8xpiration Dsse:.12-12-06 ALT&RNATE 1' Ilona! . , . Dadpasted Operator's None:AARON KOOP 'Relation to UST noty!(duck 00) Sulam Nadu(rd&mwd froiis above:RICH BNVIIt0NIVEWPAL O'Oww -a Opp D BmoloyW:- DedInated Opa&Ws Phaao#.- 661 392-8687 ® 8avioo 7:#4midaa Oqird-P 1ptamsttcasl C044COUAW CUIMcation#:5246167-UC . 8xpiratlon Date: 11-12-06 ALTZP.NATE s (o 4!nW) - Desipxuted OpesaLar's Name:.RYAN MASON Rslattea to" SdT Faa{Uty(slacrkOnt) Bwdaeei Name(Tf d j�srsnt from abovs):RICH$NMONM.BNTAL 0 Owner •4. Opasior '0 &plum Designated Opaatbr'sPhoae Ut 661 3928687 it0 scar b TWImidaa 0, P%* j Iateri�tidwc4d'eCouacJlCatiScaticn.�Y:1261213-UC .SxpbstionDate:6-1:3-07:• . A'LT&�RIVAZ'�1' O tio'aal 3 , . ". .. .... Reladoa•td�7�'!'Farxtltty(s�salc OneJ DetS�itted,Operitar's Na>siai•.STSVEN•0�8RT BcutrieuNaaia(jfd(igs:mifiiomabovs):RZCHBNVIItONlvl JTAL D'Owna' `O Opetstot 0 Bmployo�;'` DeiWnited 00= s Phoiu.#:L661)392-9647;,' a .8wide Terhaieis�a" ."CY�lhird-l� Inteirrnidaw Co&coa2acil cctwl*don#:5261246-UC gxPi a Dates .9 T►07 ALTBRNATE Z fDaiiprused Operator's Nasaa ICBYIN KIRK Relaiioa to UStT Zraoillty,(C7+ 'k twaaeu Nun$afdo"Te:tfrons above):RICH ENVIItONiid WAL O OW= O Qpe:Raa' 'O B::ppl" Desiputed Oper or':Phone#: 661 3928687 V.aatvlaa Todmidab O Tlslyd-Party . latearsudonal Coda Couas4l C9WfWs4oA#,#5261193-UC .&tPlx-Id ra Dates 6-18-07 TB,RNATS tlorrat �. cup=wwam's.Nawr BRIAN SCOTT 7"C4 Busiaeis Nnma afd(0'srsdfiom above:.RICH BNVIRONuWrAL` . w O'Opajur 0 JR41 W...T.,erhuidsw G^7hird-P Iotaraadarut CodiCoursciLC.eitiSeatioa It:5268644-UC >1xpLatioa Data 10-10-07 ' ALTERNATE 2 (O uaral) DaftW&l Operatar's Nutu: Relidan to U9'PFA49 ty(Owk00) Buatness"Naiae(�d(8"srsist fi+vm cbove).' Q 0;"Cr O Opesatot "O Upleyra Deiipited Operator'sPhoaa#: O 8ervka TeschaioLa 0'T id•Party lakragbtoail Coda Couaetl Certxc4don 9., - B.xpf;atloat Date. ALZ`EBNAT81 Ilona! . Dails ated Opagoes Nsimw Rblation to U97FUWty(C*w*One) , Sulam Name((Fdj rsrsat from above): O'oww Q Opaator O.BDMvloyee•,, DaiBaW Opaddes Phone#: O Sexvloe Teahaioiaat� t3-ThW,i' IataisattonalC�ada Couaoi2 CrstiBcadoa#: � 8xpirasion bite: . • ALTERNATE Z (0 Ilona!• ' • w Dui3rutad Opaateu's Namb; Relstioa to LISn'Fact)tq(CyeukOru) BuiineuNasrui(jid(B'srsntfrokabovs): O Owner O OpasW 10 Bipploy94 . Desipnakd 0paator's Phone Il: O 8avloe Techaidan O'Third Patty' ?.#--a and Cade Couaoil cFtffl ttaa q: ' Bxptradon Dates APR-01-2005 01 :02 PM HAPPYGAS 661531 2235 P. 02 L:2";J b 04 J. C) -04-05 10:38 ) RcVD Owner Staterrients of Designated Uladerground Storagt! Twil,. (US •)Operator and Understanding of and Compliance -with UST Requirements -FA J iiVii;T ib" A$' M NI MART' F464M.ID 0. Facility Addran:3221 7AfT HWY, R—c&96n Fnr Suhmitting this foil er.-b­c'C'A 0iM­')' X - , Chwlwt:ut'Dotivixtud Opemlvr yicility'ljhone i-,t96 ......... tD ,[Ignignaigg] JIST t'jyk&rMtns.t&j for thl&z"M4. Rflr.►•),t W 01,FROPity(Ch"k 0M) IUI FIV'Inmerwil J Qu.net G Qpermtor Q FMploft tnternailuiat Codc Councli OnfiftWim('*574AI671-14' Vxpinllilw 11.12-06 r)sjigauid Operator's N:mjc 1 jamag ilicil Rusiness Nome(Ifdif .fb#vw,4-o(n aht,vej-RU Eon iwmnV;jW a l0-1 7`11untor 0 Ef"010yee Daslanwd t1neranee Pharic*!6611392.8687 hilernationel Code tl! 1()64 r M-L'L jbjj2UM.r,g 4' e�aPV!.P#W;: DinigAot"'d Dpgratk)6 Natilk: krNion.1.1 ,'ST Facility(Chuck ON) Businm Ni in.g U Ors:raw III 5irjPjoy** T-4 itt-tUo,J ThiM-;P" CM9 Qrrw! I NIV NOTE; THE LOCAL R17.0"IMATORY AGENCY MUST BE MOM IED OF -.101Y (:HAN1ULS TO MIS INFORMATFON WITHIN 30 DAYS C)f THE CRAJvrjP,, T-xrlitV ffint,for tke 'IWMv toli o''It' pige,the ixidividual(s) listed above will Die U11vidual(s)vJ11 cjadiiur wd document Monthly fac0ity inspections and annual facWtv employee tmining.in with CAhfbniia Code of U6rukdowt,t:t*e"a. section 2715(1:)-(T) Furthetmom I vadentud sad am in complance with the vVyArtnieftis (3tatut", V & :�rt1P.W NIOM QVTkNK OWN U( Z>k INJ r4 - 'T' 'Pleam Pri OP,OWNER'S -%.tjZrj,t nt): SIGNATURE,OF TANK DATE,- OWNER'S PHONE 4: --..2• i . KERN CO ENVIRONMENTAL HEALTH SER DEPARTMENT � ? 100 'M' STREET, SUITE 300, BAKERSFIELD, 301 TELEPHONE 805 862-8700 UNDERGROUND STORAGE TANK FACILITY INSPECTION REPORT PERMIT NO.: 320018C NO. OF TANKS: 4 Type of Inspection: Routine: 0 Reinspection: ❑ Complaint: ❑ Inspection Date: WAS THE PERMIT POSTED AT THE FACILITY?: YES❑ NO FACILITY NAME. CONVENIENCE MARKET 096 HAPPY GAS Date of Last Tightness Test: OWNER NAME: CONVENIENCE MARKET 096 Financial Resp. Cart. Submitted??Yes No _ FACILITY ADDRESS: 3221 TAFT HIGHWAY Annual Report Submitted?: Yes N �cs� ��� BAKERSFIELD, A Temporary Abandonment Permit issued?: Yes _ No OPERATOR NAME: u1e Q� �l ��� Response Plan Submitted?: Yes ___ No N/A X_ IS THE INFORMATIONJVDED AB Vp E CORR 'T?:,4/YES O�eA, %� in Permit Fees? Yes No_X If Yes, Amt IF NO, SUMMARIZE: Use codes below to describe type of Substance Tank Tank Is Piping Monitoring I monitoring observed when inspected. Tank II Code Contents Ca_ pacity Pressurized? Observed 1. No monitoring 1 MVF 3 REGULAR 12,000 YES 2. Standard Inventory Control 2 MVF 3 UNLEADED 12,000 YES 3. Modified Inventory Control 3 MVF 3 PREM-UNLEADED 12,000 YES 4. Statistical Inventory Rec. 4 MW3 /use f 12,00c) eS 5. Automatic Tank Gauge (list type) 6. Continuous Monitoring in Tank Annular Space/Secondary Containment / 7. Visual Monitoring 4 Manual monitoring annular space JJ��''// Temporarily Abandoned-under permit NUMBER Of TANKS ERrFfE .. ES T�. S 10. Another method IF NO, EXPLAIN _ OBSERVATIONS OF INSPECTOR: 1. Tan s in Use? Yes No❑ CORRECTIONS OF VIOLATIONS REQUIRED: 2. Tanks monitored as required? Yes M No❑— None 3. Overspill boxes installed around fills? Yes No❑ ❑ Begin monitoring immediately 4. Automatic line leak detector installed? Yes No❑^ Submit paperwork required 5. Unauthorized release observed? Yes❑ No ❑ Other Comments: VIOLATIONS OBSERVED: ❑ 100 Operation, abandonment, or modification of an underground storage tank system without obtaining a perdW. KCOC, Section 8.48.030; HSC Ch. 6.7, Section 25284 or 25298. ❑ 105 Failure to monitor tanks) usi the method pecified on the permit a pr by the local agency; KCOC S ctio 8.48„140; HSC Ch. 6.7 Section 25293. —��Me, ('V �� �I� ❑ 110 Failure to report unauthorized release; KCOC, Section 8.48.220; HSC Section 25295. 'tom 1 ❑ 115 Failure to close UST properly; KCOC, Section 8.48.270; HSC Section 25298. ❑ 120 Failure to install automatic line leak detection system and keep it operational for all pressurized piping; KCOC, Section 8.48.175; HSC Ch. 6.7, Section 25292. ❑ 125 Failure to maintain evidence of financial responsibility for taking corrective action and for compensating third parties for bodily injury and property damage caused by a release from the Underground Storage Tank system; KCOC, Section 8.48.117; HSC Ch. 6.7, Section 25292.2 If one of the numbered violations has been checked, Staff will need to reinspect your facility. As prescribed County Ordinance, a per-hour fee for extended services will be charged for all reinspections. To avoid or reduce reinspection costs: 1. ' Make the corrections for the violations observed. 2. Submit documentation as described above. 3. Respond by reinspection date, or within 7 days if immediate) is checked. /� ✓9� NOTICE TO COMPLY: If violations h ve been identified, deficiencies must be corre as specified. ❑ Immediately y Re_ inspect ter: — — NO REINSPECTION REQUIRED Hazardous Materials Specialis R eived By:__ »r.� TW"qMT51Aq.qG .*N/9_'q2 HTJA3H JAT14.qMt40,qTV.W1 1&1112, '111,5111 A13i9pp.Ms 'HE lam yrgy q. HU ?P (c00 WOHq?1:77, TY109.954 MOTT3.31:214.T YTTJT0A'4 X14AT ROAROT2 C(14U0Rr05q2MT6U an JMTO :w11vM9s M01"d :r0h090es! to q"r MR7 10 qv :3 Ire' :TV T MPq ON Y T. 111A 9 P.T TA 6,3 TZ"3,; '"',M P.3 0 P-! PAW '2e1 ner;c * T 'Rr_. 4❑ apil !,M9✓ 1'1 0 V V,0" :?P.A.0 v f•.1; -ib �'hrl 7.1 rfrd'­jR7 90 .Oz PA i F.;,-on6r., ,EiY 9Jirmdu2 rwns)l (-wnr,A T A7 C�E YT I P )I:: lhrl.Q ov 291` : :o�._-.Jrmdu? o.r'G qO1'A9.T f! .:r.A .?5Y ri 00 -c.qY SIM 14"4 M menrl Q ov GUIAMUR IV M, Q arvi anhoesh ol wof Bd _who:, ad -,lqnw hqvlqRdo n 11(j:r I:no-M gnioM >inC T Anr,T onnEI2du2 �bsi q003 It r, .T Wpm; vious"T hissam .1 213Y G 0 0 v :GSM ywwml WMA E 21Y .isq vnc,.-Jr,wr! .1 F?y 0 0 11 '14- 11111 )�jaro,-;uA .2 -4nc," !vi,iirarM auou. mQO .8 uPIA go n0' c,n 61 -�t i P;r V V DCroaam i2 SM"W fiJ*orA Jt V"AV UP MAMS ON U1 r, >i n E, T 1)a rwr"r !Ifl fi?: i?OF j Af Wry+ nwom Wvw. Ww LIP:;-' `,i ow,.�,,n r.r itmdik 04' `'n a Rd '"S"n IE.:I; 4 i If 117,1, loop Mc n"now noup r"! o"102 amon?"MI: nr, 7,1 :jr-j r wyorinpr -..,nr 9,10 yd nwains w irmiec aw -s he"Imm unrism sd: pwiu fRprF- r ', 7 M nwj"R WII "u ., n9y.I-n-TUE'rl. oj q'!J, qkmwu q­11 :-20f0 -u 2- l F., 6 0 E-0 3 E Wq'" J 0 DS)! b;15 1472V2 nornsm ;of st i nnan7U3 10•8ny o? an ioi pn?n6. io�,- 0SIOSM no qlu AMS11 ='-M .OT YSI"P YK S?�J? OMMP"M Sh Mani E2E541 P id WPM 19WS3 Y-0000a "I VnInT Inj qu, 415 vis ve j,anwr aA w: lot q, a I wwr in" ."Men no :F embsi in o� n 9" bpxnnn no •fiw jr-, so Wilmw 'lm c -0, wor 0 r-v t LEI j A—ME 1MVnMM 7W"CVL ' 1State of California Far star+'Apos7 tfa*Oadf, _ q State Water P " ur s Control Board + r. �® CERTIFICATION OF'.F_INANCIAL 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 I8,Div.3,Title 23.CCR. O300,000 dollars per occurrence t million dollars annual aggregate or AND or I miflion dollars per occurrence a 2 million dollars annual aggregate B. William C. Davies hereby certifies that it is in compliance with the requirements of Section 2807, (Nam*of Teat Omens or Op"mr) Article 3, Chapter 18,Division 3, Tdle 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807are as follows: C. Mechanism . Name and Address of Issuer Mechantstn_; Coverage <.Coverage Corrective Third Pi Type :Number Arrlount Period Action Com State Fund State Cleanup Fund not applicable state fund P. 0. Box 944212 $990,000 coverage Sacramento, Ca 94244-2120 for state fund per ontinous yes yes ccurence 990,000 W, P. Davies Oil Co. Inc,. not applicable for $10,000 renewed C.F.O. P. 0. Box 80067 annually yes yes state alternative per letter Bakersfield, Ca 93380 mechanism occurence $10,000 annual aggregate Note: N you are using the State Fund as any part ofyour 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.PacWryNam* FaeligAddras Renegade Truck Stop 2023 Mettler Frontage Road W. PacwtrNama Happy Gas (Convenience Market(096) rTaft Highway Bakersfield, Ca FadliryNam* - FmGgAddro Hungry's 6600 Rosedale Highway Pao7igNama Frazier Park Exxon r41 Frazier Mt Park Road azier ark, �A PadlipNam* Fa"IyAddraa Pioneer Truck Stop 1000 Garzoli Avenue Si of Tack gran Data Naga and llda elTanic(?tact ar OQauar /1 �G.�_ 3 0� Richard 0. Davies -Secretar Treaf Sigumn of t1/1WM W NoarY Naga of Wiaaaa a Neasr� A I., a f�R(OwS) FIrE Oil' — Apasy CopQo�FaeiliepSlte(a) 00 DAVIES OIL COMPANY D IES • Petroleum Marketing • Cardlock Fuels F • Exxon Distributor P.O. Box 80067 — Bakersfield, California 93380 — Phone (805) 323-6063 LETTER FROM CHIEF FINANCIAL OFFICER I am the chief financial officer for W. P. Davies Oil Company of P. 0. Box 80067, Bakersfield, Ca. 93380 and the operator of 3221 Taft Highway, Bakersfield, Ca. This letter is in support of the use of the Underground Storage Tank Cleanup Fund to demonstrate financial responsibility for taking corrective action and/on compensating third parties for bodily injury and property damage caused by an unauthorized release of petroleum in the amount of at least $10, 000 per occurrence and $10,000 annual aggregate coverage. Underground storage tanks at the following facilities are assured by this letter: 3221 Taft Highway, Bakersfield, Ca. 1. Amount of annual aggregate coverage being assured by this letter. . . . . . . . . . . . . . . . . . . $10, 000.00 . 2 . Total tangible assets. . . . . . . . . . . . . . . . . . . . $4, 064, 191 . 00 3. Total liabilities. . . . . . . . . . . . . . . . . . . . . . . . $2,789,694 .00 4 . Tangible net worth. . . . . . . . . . . . . . 00 — o . . . $1,274, 694 .00 I hereby certify that the wording of this letter is identical to the wording specified in subsection 2808. 1 (d) ( 1) , Chapter 18, Division 3, Title 23 of the California Code of Regulations. I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and b li /f. Executed at B keys i ld Ca. on /may' Signature: Name: Richard Davies Title: Secretary/Treasurer Si • E' VlI�ONMEN'T, EAL.+H SEIRVICES DL 'ARTMik' I i 1:' ,� 2700 M STREET, QUITE 300, E3AKERSFIELD, CA:93301 (305)861-3636 UNDERGROUND HAZARDOUS SUBSTANCE? STORAGE FACILITY INSPECTION REPORT PERMITS 320018C TIME IN q ,364TIME OUT _ _ NUMBER OF TANKS;.... ._.... _... ..... PERMIT POSTED? YES...... .__......... fro _ � INSPECTION DATE: TYPE OF INSPECTION- ROUTINE REINSPECTION COMPLAIN FACILITY NAME:CONVENIENCE MARKET 096 - HAPPY CAS FACILITY ADDRESS: 3221 TAFT HWY .. ................... ... .......,.....w_...............................,.,..w.........................,..........._........----........ ................................ BAKERSFIEL.D, CA OWNERS NAME:CONVENIENCE MARKET 096 OPERATORS NAME: D'AV I ES OIL. COMPANY {Ql�S.�l..........1���\G.I._ .... ............ ................ _.�...... COMMENTS: ............................._........ ..........w...... ... . ............._..._ ......... ..................... ............. .. ...........:_.. .....:..».w.......... .:. ._.... ................................,........:... __......:........... ._.... .. .u......... �.:. .:..........................__ ITEM VIOLATIONS/OBSERVATIONS t. PRIMARY CONTAINMENT MONITORING: q,a� a. Intercepting an directing system 'y Onu 6- b. Standard Inventory Control AL c. Modified Inventory Control r I �� �. In-tank Level Sensing Device L,� Groundwater Monitoring f. Vadose Zone Monitoring 2. SECONDARY CONTAINMENT MONITORING: a. Liner b. Double-Walled tank 'v c. Vault 3. PIPING MONITORING:. , Q(��,,�2 6tkitoo" a. Pressurized Suction c. Gravity S 'teOeS akQ 1 4. OVERFILL PROTECTION: CQ 5. TIGHTNESS TESTING bo 4� 6. NEW CONSTRUCTION/MODIFICATIONS �`�---- 7.' CLOSURE/ABANDONMENT l 8. UNAUTHORIZED RELEASE 9. MAINTENANCE, GENERAL SAFETY, AND OPERATING CONDITION OF FACILITY COMMENTS/RECOMMENDATIONS U ........._........................... _........ ................_..........................................................w..........,............._................... . .... .............. ........ .... . .. .. ................ ..........,......... REINSPECTW-ii EDUL eas C.no APPROXIMATE REINSPECTION DA�E/,INSPECTOR ,� REPORT RECEIVED BY: 1�1� ........_...... ... ............. � ..1. , ... ...... . . .... ENVIRONMEML HEALTH SERVICES DEPART' R T 21700 "MMt 1STR ,P� SU I'TE 300, BAKsEIRSFI EL0D" A. 9.3301 - (805)861-3636 UNDERGROUND HAZARDOUS SUBSTANCE STORAGE FACILITY INSPECTION REPORT PERMIT$& 320018C TIME IN (���jA- TIME OUT NUMBER OF TANKS: _ 4 PERMIT POSTED? YES NO .INSPECTION DATE: ' ` -. C ... . , TYPE OF INSPECTION : ROUTINE _ REINSPECTION „ COMPLAINT ,_ . _..I.-_......._ FACILITY NAME:CONVENIENCE MARKET 096 — HAPPY GAS TA . ............... .........._.................._.......... . ........ ............._.............. ...... ... ......... ............ .._. . ....... ..._ . ..................... . FACILITY ADDRESS: FT HWY. & WIBLE ROAD BAKERSFIELD, CA OWNERS NAME:CONVENIENCE MARKET 096 OPERATORS NAME:CONVENIENCE MARKET 096 COMMENTS ._....................................._.........................................................w.......................................................,._..................... ........................................................ .................... ....................................._................._ ._. .._............ ITEM VIOLATIONS/OBSERVATIONS 1. PRIMARY CONTAINMENT MONITORING: 0� a. Intercepting an directing system Standard Inventory Control Modified Inventory Control In-tank Level Sensing Device � l n_Q e. Groundwater Monitoring ) f. Vadose Zone Monitoring 'no to� � � 2. SECONDARY CONTAINMENT MONITORING: a. Liner � b. Double-Walled tank �v c. Vault 3. _kIPING MONITORING: a. Pressurized v`- b. Suction c. Gravity 4. OVERFILL PROTECTION: �} 5. TIGHTNESS TESTING (� ( �,� "I �$ 6. NEW CONSTRUCTION/MODIFICATIONS 7. CLOSURE/ABANDONMENT /VOA 8. UNAUTHORIZED RELEASE 9. MAINTENANCE, GENERAL SAFETY, AND OPERATING CONDITION OF FACILITY COMMENTS/RECOMMENDATIONS _................ ......................�............................................,................ ...... _.... .... . ...-. _.....................I......._........,._.... ............. .. ........ REINSPECTION CHEDU EDP ye ,no APPROXIMATE REINSPE T ATE: 4tNSPECTOR� .�.c�� 1..-K.� REPORT RECEIVED BY: - ., I ? 1 KERN CONTY AIR POLLUTION CONTROLATRICT 2700 "M" Street, Suite 275 Bakersfield, CA. 93301 (805) 861-3682 PHASE I VAPOR"RECOVERY INSPECTION FORM r. Station Name ) ', Location �� P/O# V6 Company Mailing Address ?o,, -Cit , Date st" Phone —12? ID-21) System pe: Sep. er/,Coaxial Inspector Notice Rec'd By TANK #1 TANK #2 TANK#3 TANK #4 1. PRODUCT(UL,PUL,.P,or R) 2. TANK LOCATION REFERENCE e � 3. BROKEN OR MISSING VAPOR CAP 4. BROKEN OR MISSING FILL CAP 5. BROKEN CAM LOCK ON VAPOR CAP 6. FILL CAPS NOT PROPERLY SEATED 7. VAPOR CAPS NOT PROPERLY SEATED 8. GASKET MISSING FROM-FILL CAP 9. GASKET MISSING FROM VAPOR CAP 10. FILL ADAPTOR NOT TIGHT 11. VAPOR ADAPTOR NOT TIGHT 12. GASKET BETWEEN ADAPTOR & FILL TUBE MISSING/IMPROPERLY SEATED 13. DRY BREAK GASKETS DETERIORATED 14. EXCESSIVE VERTICAL PLAY IN COAXIAL FILL TUBE 15. COAXIAL FILL TUBE SPRING MECHANISM DEFECTIVE 16.-- TANK DEPTH MEASUREMENT --f-- ( a I5 17. TUBE LENGTH MEASUREMENT 13 Y ' '- 18. DIFFERENCE(SHOULD BE 6"OR�LESS);.? 19. OTHER 20. COMMENTS: * WARNING: SYSTEMS MARKED WITH A CHECK ABOVE ARE IN VIOLATION OF KERN COUNTY AIR POLLUTION CONTROL DISTRICT RULE(S) 209, 412 AND/OR 412.1. THE CALIFORNIA HEALTH & SAFETY CODE SPECIFIES PENALTIES OF UP TO $1,000.00 PER DAY FOR EACH VIOLATION. TELEPHONE (805) 861-3682 CONCERNING FINAL RESOLU- TION OF THE VIOLATION(S) tr�r�rtr�rsYYr �Yz4�r�rzrk.�tzt,rt rzYtrtrtr�rtrti�rtrtr�rzrtrzftrs}trtrzYzrtrsYs4�rx�trtr 9149-1010 APCD:FILE • �� �. .. �� -- , - T -- v r KERN q&NTY AIR POLLUTION CONTROL�TRICT 2700"M" Street, Suite 275 Bakersfield, CA. 93301 (805) 861-3682 _ -�°P�HASE 11 'S VAPOR RECOVERY INSPECTION FORM Station Location 4(.,3l P/ O#,3Cy,;Z 0 I?" Q a( Company Address 7% 0-. Vhf ;Eim o Citrl y Contact 11 5'�G ��. �- Phone �3��� System Type: ,(BA RJ HI HE GH HA Inspector y �A (� Date -5-,-;2r7-9,a Notice Rec'd By ,e NOZZLE# GAS GRADE )� (7 ,� f t UL- L� NOZZLE TYPE 1. CERT.NOZZLE 2. CHECK VALVE 0 3. FACE SEAL Z Z 4. RING,RIVET L E 5. BELLOWS 6. SWIVEL(S) 7. FLOW LIMITER (EW) 1. HOSE CONDITION V A 2. LENGTH KI P 0 3. CONFIGURATION R 4. SWIVEL H 0 5. OVERHEAD RETRACTOR S E 6. POWER/PILOT ON 7. SIGNS POSTED Key to system types: Key to deficiencies: NC=not certified, B=broken BA=Balance HE=Healey M= missing, TO=torn, F=flat, TN=tangled RJ=Red Jacket GH=Gulf Hasselmann .,'AD=needs adjustment, L=long, L0=loose, HI =Hirt HA=Hasstech S= short MA=misaligned, K=kinked, FR=frayed. * INSPECTION RESULTS ** Key to inspection results: Blank=OK, '7=Repair within seven days, T=Tagged (nozzle tagged out-of-order until repaired) U= Taggable violation but left in use. COMMENTS: r VIOLATIONS: SYSTEMS MARKED WITH A "T OR U" CODE IN INSPECTION RESULTS, ARE IN VIOLATION OF KERN COUNTY AIR POLLUTION CONTROL DISTRICT RULE(S) 412 AND/OR 412.1. THE CALIFORNIA HEALTH & SAFETY CODE SPECIFIES PENALTIES OF UP TO $1,000.00 PER DAY FOR EACH DAY OF VIOLATION. TELEPHONE (805) 861-3682 CONCERNING FINAL RESOLUTION OF THE VIOLATION. NOTE: CALIFORNIA HEALTH & SAFETY CODE SECTION 41960.2, REQUIRES THAT THE ABOVE LISTED 7-DAY DEFICIENCIES BE CORRECTED WITHIN 7 DAYS.FAILURE TO COMPLY MAY RESULT IN LEGAL ACTION 9149-1015 APCD FILE Number T Date 7'SL Time 6/,f4 x Station Name Operator's Name Station Address 3221 W Major Cross Sheet . Telephone No { Inspector Defeo 7 D✓•J✓y {{ Totalizer Reading When Tagged ? ; WARNING Use of this device is prohibited by state law and un- authorized removal of this tag or use of this equipment will constitute a violation of the law punishable by a maximum civil fine of $1,000 per day or a maximum criminal fine of$500 per day and/or six months in jail. I declare under penalty of perjury that the device tagged was not used,nor was the tag removed,until the required { repairs were effected and the district notified. Repaired by Title (Please print) i Signature Date Time ti Totalizer Reading at Time of Repair Repair; made t BEFORE USING THIS DEVICE Telephone your local air pollution control district at If repairs were made to the nozzle body you must notify the County Department of Weights and Measures. Ser.# 082128 A FARWEST R %� «a w you, GL CORROSION w_E_w CONTROL -T. -COMPANY September 29,2006 Job Number JB2068 Happy Gas.&Mini Market 3221 Taft Hwy. Bakersfield,California 93313 . Attention:Amita Budiyan Subject: Operational Testing of the-Cathodic Protection S�stem at Happy Gas and Mini Market, J P 3221.Taft Hwy.,Bakersfield,California Dear_Amita Budiyan: The subject operational testing was conducted on September 28, 2006. The purpose of the inspection was to test the effectiveness of the impressed current cathodic protection system on four underground fuel storage tanks at the above location. The 50 Volt, 12 Amp rectifier is located in the storage area on the south wall of the building. Drawings and installation records of the cathodic protection (CP) system were not.made available at time of survey. SURVEY METHODS:, The survey consisted of the following: 1. Inspection of the rectifier and.anodes`(when-locations are known) to insure they are operating properly. 2. ,Measure operational status ofthe rectifier and all current outputs. 3. Measure structure-to-soil potentials at available test locations'. .4. Troubleshoot any noted problems and offer recommendations for.corrective actions. CATHODIC PROTECTION CRITERIA: All potential levels measured and recorded are referenced to the .criteria for cathodic protection as established by the National Association of Corrosion Engineers standard RP0169-2002, Section 6, Subsection.6.2.2.1.1. (Criterion 1): A negative (cathodic) potential of at least 850 millivolts with cathodic protection applied, as measured with respect to a saturated copper/copper sulfate(Cu/CuSO4)reference electrode contacting the electrolyte, is considered the- criteria for cathodic. protection of buried or submerged steel structures: Voltage drops other than .those across the structure-to-electrolyte boundary must be .considered for valid-interpretation of this voltage measurement. Subsection 6.2.2.1.2 (Criterion 2) A negative polarized potential of at least 850 millivolts relative to a saturated copper/copper sulfate (Cu/CuSO4)reference electrode. Subsection 6.2.2.1.3 (Criterion 3) A minimum of 100 millivolts of cathodic polarization between the structure surface and a stable reference electrode. The formation or decay of polarization can be measured to satisfy this criterion. G`ff4114 Armour Avenue, Bakersfield, California 93308•Telephone(661) 323-2077 • FAX: (661)323-2647 E-mail: sales @farwestcorrosion.com' •. Web Site:www.farwestcorrosion.com License No.248232 A r \�, �,' •. F FARWEST . . A R ,- CORROSION w E , CONTROL,'- �T= COMPANY September 29,2006 Job Number JB2668 California.Code-of Regulations Title 23: Waters Division 3:Water.Resources Control Board Chapter. 16: Underground Storage Tank Regulations,_Article 3, 2635..Impressed-.current.cathodic:.protection systems-shall be inspected no less than every 60 calendar days to ensure. that,they are-in .proper working order. SEPTEMBER,2006 RESULTS: The rectifier was found on and operating at the time of arrival. All system components were found to be fully functional.and operating.as designed. During.the inspection the rectifier,was'cycled off and back on in order.to obtain "Instant Oft' potentials. Both•initial "On" tank-to=soil .potentials and polarized"Off'potentials on the tanks indicated an acceptable level of cathodic protection exceeding NACE criteria:-Please-see the.attached-ddata sheet for survey results. RECOMM[ENDATIONS:. 1. Read and record the voltage and current.outputs of.the rectifier at a minimum',of every month.If voltage,and/or current outputs change,more than.10%,please call us to-inspect the system. We'-recommend that the entire cathodic,protection system.be tested annually by. a ' qualified corrosion engineer or technician.- 3. Any changes or.modifications to the piping that might require the connection of new equipment 'should'be reviewed by'-a.qualified'corrosion engineer.-to ensure that the . electrical isolation of the system will not be compromised. We trust that the enclosed information'is adequate for your needs. If you have any questions or if we can assist you in any way,please:do not hesitatc to call our office at(66.1).323-2077.. .- Sincerely, FARWEST CORROSION CONTROL COMPANY Joe Taylor NACE Corrosion Technician#115523 2 _ F FARWEST R` CORROSION wE -CONTROL —T� COMPANY"` September 29,2006 Job-Number.JB2068 HAPPY GAS.& MINI MARKET CATHODIC PROTECTION SYSTEM RECTIFIER INFORMATION . . September 28,2006 LOCATION OF UNIT Inside story a area.of buildin MANFACTURER- JA Electronic Manufacturing MODEL•NUMBER SS_1 SERIAL NUMBER -98023 HOUR METER 73084.9 RECTIFIER SHUNT SIZE: . 50 MillivoW15Am A:C.INPUT RATING: . Volts: 11.5 Amperes:9:6 D. C.OUTPUT RATING: Volts: - :-50 Am eyes �12 D. C.OUTPUT indicated Volts: 38.0 Am eres: . 6.1-0 D. C.-OUTPUT measured Volts: 38.22. Amperes: -6.12 . TAP SETTINGS: _ Coarser C of D Fine: 3-of 6 No 4justments were made to the rectifier. 3 • F FARWEST -t% R ".CORROSION ­.o..,W wE CONTROL T.= COMPANY September 29,2006 Job Number JB2068 Happy Gas&"Mini Market Structure-to-soil Potentials F6ur.(4):Underground Storage Tanks . Recorded,by: Joe Taylor Survey Date:-28 September,2006 Job#.JB 2068 Structure-to-soil Potentials(mV)_millivolts Structure- "ON" "OFF„ Diesel#2 UST -1860 -1083 Unleaded Supreme'UST 4831 4048 (North.Fill). Unleaded Supreme UST 71819 . -1076 .,(South Fill) Unleaded Regular-UST " 71828 -1082 (North Fill) Unleaded Regular UST 480L.. -1067 (South Fill) Red Dye Diesel UST -182$ -1081. ,Fuel Dispensers(mV),millivolts Structure "ON":. "OFF" Pump,# 1-2 -1716 -1087 Pump# 3-4 -1728. - -1084 Pump# 5-6 -1719 . -1082 Pump#"7 4 =1 717 -1082 Red Dye Diesel Pump -1727 -1086'- , 4. MONARING SYSTEM CERTIFOATIOI`�ECEIVED 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 ofRegulations OCT 1 2 This forth 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 re uE ia� "Hays s within 30 days of test date. EN OIDNtl T��LTH SERVICES A. General Information Facility Name: ��C, Bldg. No.: Site Address: 3 oz a 1 '� ;�� W`� City: �AICESZ� zip:._ 7, Facility Contact Person: $tMZ i IA- Contact Phone No.: Make/Model.of Monitoring System: S l,S- 3 Date of Testing/Servicing: B. Inventory of Equipment Tested/Certified INSPECTOR ON-SITE NO NAME: _Check the appropriate bores to indicate specific equipment inspected/serviced: Tank ID: Tank lD,: 153 In-Tank Gauging Probe. Model: fn ACS `I I n-Tank Gauging Probe. Model:�L — ❑ Annular Space or Vault Sensor. Model: ❑ Annular Space or Vault Sensor. Model: ',Piping Sump/Trench Sensor(s). Model: 9 eD F3 'fg Piping Sump/Trench Sensor(s). Model: QIZA 751 Fill Sump Sensor(s). Model: o fDi 'lff-Fill Sump Sensor(s). Model: 4b8 '2 Mechanical Line Leak Detector. Model: QZA'33VCYZT -�ff Mechanical Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: �4 Tank Overfill/High-Level Sensor.Model:, _ Tank Overfill/High-Level Sensor.Model: 'SAJ E(gf�j: ! ❑ Other(s ecif equipment t e and model in Section E on Page 2), O Other(s eci fy a ui ment type and model in Section E on Page 2). Tank ID: Sal Tank ID: 2l� C)=Z E, � '$f In-Tank Gauging Probe, Model: Mc-'1(CP ji�-In-Tank Gauging Probe. Model: YY1�Ca� O Annular Space or Vault Sensor. Model: ❑ Annular Space or Vault Sensor. Model: . -0 Piping Sump/Trench Sensor(s). Model: `1m '0 Piping Sump/Trench Sensor(s). Model: QCD . -15 Fill Sump Sensor(s). Model: ;2 0 ii?-Fill Sump Sensor(s). Model:Q ->� Mechanical Line Leak Detector. Model: Qf_IZS ;ff Mechanical Line Leak Detector. Model: fL_O c'�C.)G�k.Y ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: iZ Tank Overfill/High-Level Sensor.Model: 13At_ FIST a Tank Overfill/High-Level Sensor.Model: GA_ L F(_ T ❑ 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: a Dispenser ID: c) '®`Dispenser Containment Sensor(s). Model: (-r m co dispenser Containment Sensor(s).Model: i_ZF Shear Valve(s). -EX-Shcar Valve(s). ❑ Dispenser Containment Floats and Chain(s). ❑ Dis enser Containment Floats and Chains . Dispenser ID: SkP i Dispenser ID: 1 'tff Dispenser Containment Sensor(s). Model: t4 '®`.Dispenser Containment Sensor(s).Model: gctLo &-Shear Valve(s). Shear Valve(s). ❑ Dispenser Containment Float(s)and Chain(s). ❑ Dispenser Containment Floats and Chain (s). Dispenser ID: Dispenser ID: 0 Dispenser Containment Sensor(s).Model: IQ SjEk,3 c12 ❑ Dispenser Containment Sensor(s).Model: ri. -Shear Valve(s). O Shear 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 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 Certif•leation 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 equipment capable of generating such reports, I have also attached a copy of the report; (check all that apply): -System set-up 'Alarm history report Technician Name(print): STZA.) n Cae=-- Signature: Certification No.: tR a g��� L S S - d�3 License. No.: (n(oZy(J-(JCT' Testing Company Name: RICH ENVIRONMENTAL Phone No.:.( 661 ).392-8687 Site Address: 3'o�ro11 T��T 41`��fkll( �'�Fj.(� Date of Testing/Servicing: 9 /0(4 4Q- Page I of 03101 Monitoring System Certification cy D. Results of Testing/Servicino S Software Version Installed; l t- -QA Complete the following checklist: tY es O ° Is the audible alarrn operational? es O ° Is the visual alarm operational? es ❑ ° Were all sensors visual) inspected, functional( tested, and confin-red o erational? es ❑ ° Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? O Yes O ° If alarms are relayed to a remote monitoring station, is all communications equipment(e.g. modem) 12f N/A operational? Yes —0—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 operate,or is electrically disconnected?If yes: which sensors initiate positive shut-down? (Check all that apply) 1il-Sump/Trench Sensors; .Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? Yes; ❑No. O Yes O ° For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no 'g 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? % O es Iff-No Was any monitoring equipment replaced?Ifyes, identify specific sensors, probes,or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. ❑ es 13-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. ^0 Yes ❑ o Was monitoring system set-up reviewed to ensure proper settings?Attach set up reports, if applicable Yes ❑ ° 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 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 lets the folio win checklist. !21 Yes ❑ o Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Ea Yes O o Were all tank gauging probes visually inspected for damage and residue buildup? a Yes a o Was accuracy of system product level readings tested? _5� Yes ❑ o Was accuracy of system water level readings tested? Yes O o Were all probes reinstalled properly? Yes ❑ NO 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): ❑ Check this box if LLDs are not installed. Coin plet s the folio ing checklist: 72� 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: .193 g.p.h., O 0. 1 g.p.h, ❑ 0.2 g.p.h. $ Yes O o Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ❑ o Was the testing apparatus properly calibrated? Yes ❑ o For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ❑ N/A 0 Yes ❑ o For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? �-N/A ❑ Yes O N o For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled '2'N/A or disconnected? ❑ Yes O o For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions e N/A or fails a test? D Yes O o For electronic LLDs, have all accessible wiring connections been visually inspected? ®`N/A -0-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. H. Comments: Page 3 of 3 03101 -Monitoring System Certificntion Fop Addendum for vacuum/Pressure Interstltt ensors LG 163-1,Enc.II Results of Vacuum/Pressure Monitoring Equipment Testing This page should be used to document testing and servicing of vacuum and ptessute intcrstiOal sensors. A copy of this form must be included with the Monitoring-System Certification Form, 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; Model: System Type: Press=; Vacuum Sensor ID Component(s)Monitored by this Sensor: Sensor Functionality Test Result;op=; ❑ Fail InterstaW Communication Test Result:❑Piss; ❑ Fail Component(s)Monitored by this Sensor:' Sensor Functionality Test Result:❑Pass;-,❑ Fail Interstitial Communication Test Result:❑Pass; ❑ Fait Component(s).Monitored by this•Sensor: Sensor Functionality Test Result:❑Pass; II Fail Interstitial Communication Test Result:(]Pass; ❑ Fail Cornponent(s)Monitored by this Sensor: Sensor Funetionality Test Result:❑Pass; ❑ Fail SzitcrstitW Communication Test Result:0 Pass, Cl-Fail 'Component(s)Monitored by this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fail IntmstitW Communication Test Result:❑Pass; ❑ Fail Component(s)Monitored by thlr.Seusor: Sensor Functionality Test Result:❑Pass; II Fail Interstitial Communication Test Result:❑Pass; ❑ Fail Component(s)Monitored by'this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fail Interstitial Communication Test Result:0 Pass; ❑ Fail Components)Monitored by this Sensor: Sensor F=tionality Test Result:❑Pass; ❑.Fail Interstitial Communieation'Tost Rosu It❑Pass; j] Fail Components)Monitored by this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fnii Interstitial Communication Test Rcault ❑Pass; ❑ Fail Components)Monitored by this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fail Interstitial Communication Test Result:❑Pass; ❑ Fail How was Interstitial communication verified? ❑ Leak Introduced-at.Far End of Interstitial Space;` ❑ Gauge; ❑ Visual Inspection; Q Other(Describe to Sec.A below) Vacuum was restored to operating l evels in all Interstitial spaces: ❑Yes ❑No(if no, describe In Sec.J, below) J. Comments: Page of If the sensor successfully detects a simulated• vacuum/pressure leak introduced in tha interstitial space at the furthest point from the sensor,vacuum/pressure has been demonstrated to be communicating throughout the interstice. � e Monitoring System Certification UST Monitoring Site Plan Site Address: 2� (FT W.V Z A lLKOST-X'W,� (.-6_�. - - - - - - - - - =7" "q-_j4L)Y!- - - - - - - - - - - - - -- - - -. - - - - - - - - - - - - - - - - - P - - - - - - - - - �- - - - - - - - - - - - - - - - - C-it.�. - - - - - - - - - - - - - - - - - - - - - - - IFS 011-e x - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Z:- ags6� sot- - - - - -N - - - - - - - - - - - - - - - - -�ymcoSEn�Sot? -® - - rt -� - -® - - - - - - - - - - - - - - L-I.EAYt. i� l �"C �_ - - - - - - - - - - - - - - - - - - - - - - - - M - - - - - - Eii - - � -© - - - - - - - - - - - - - - - - - -N - - - - - - - _ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - �= = = - - - - - - - - - - - - - - - - - - - - - - = - - - - - - - - - - - - - - - - - - - - = = = �- - 6 - - - - - - - - - - - - - - - - - -� - - - - - - - - - - - - - - - - - : - - - - - �°- - - - - - - - - - - - - - - - - - - - -� - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -0 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (�j - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _ - - - - `n - - - Date map was drawn: In-s suctions 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 Iocations 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 ITT 5643 BROOXS Ox SAXERSV1BLD,CA.9330S OFPICyR (6 61)392-8687 a PAX (661) 392-0623, Mk�S'u�lkl`L7S'�1�+F%8$ D�'r'EG7'0Y2 TE3� i W/0#s Facility Ns=e; 1PP`f (a('SaZ, I 1 Facility Address 3221 "TAF—C t1WYy�P11j�t?��ZF.�?ICI,CPI T' Pra(luat Line Type Qressure, Suction, gravity) PRODUCT LEAK DETECTOR TScPR VEST TRIP P.�1SSi SF.A=AL NUXBRR aBLOw P52 OR XL/A �x�r 2EQ5ACacEt� s ass g� sRRZAL # NO l� FAZL� L/1) TYPEr gCXfCf G g q ` SFRI.A.L #._,_�SaQ� IffD �� FATLY i L/D `J.'YPR{ &4j Fr1 E AS 4Q)'L2 F.t.. SRRIAL #_(e7 j'4 NO FAIL E L/n T7t•PR SSRIA,L # I�off_ _ _.� xo RUL', I :;ertify the above tests were cdnducted on this data according io Red :raakat Pumps .field test_ apparatus testing procedure an limitations. This: Mechanical. Leak Detector. Test pass / fail is determined by using a low flow threshold trip rate of 3 gallon per hour or lees at 10 PST. I •steknowledgr,e that all data collected is true and oorroat to Che :beat of PTyr knowledge. Te Ch: !� SiguLture. �r Date; a 1 • I . t t7t SWRCB,January 241 SPUBucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures.•The completed form aA printouts from.tests(if applicable),should be provided to the facility:owner/operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION` Facility Name: P P Date ofTCSting: Q.a�•m Facility Address: F VzIAl 11• q l Facility Contact: A YY\'Z: TA Phone: t!(Q(�l� q eQ) - a�SC0 Date Local Agency Was Notified of Testing: 'G� •'� .®' Namo of Local Agency Inspector(ffpresent during testing): L c l��rJlC 2. TESTING CONTRACTOR INFORMATION. Co any Nane: 2T C H JE v 320 Technician Oondueting Test: N F_2`S' Credentials: CSLB Contractor.. Service h.' SWRCB Tank Tester. Other(Spec) License Number(s): t or2 to -U..1 3. SPILL BUCKET TESTING INFORMATION Test Method Used drosta ' Vacuum Oilier Test Equipment Used: e&(jLAl_ Equipment,Resolution Q5 Identify Spill Bucket(By-Yank'- 1 2 3 4 2E Number,Stored Product, eta ' --C=TZ, q l_ osrt cizz (JLES�I._ Bucket Installation Type: Dint B Direct B Direct Bury Direct B ontained C&Wned in S ia% Lino Bucket Diameter a ` • , 1 a' Bucket Depth: - ILA ' .y ' i y ' y' Wait time between applying vacuum/water and start of test � O -r-N 3� JAS �1 . QS d`n'L N 1 3 IQ).MZ Test Start Time(TO: l : oaC i m is l A Jnitlal Reading_OQ: ' ' / • i t • I } Test End Time(TF): f�CD d� l�'.QXZS(� l l: I (t dot Final Reading(Rr): l to K2>' ® r • I v" Test Duration(Tp-T): I-N DLKQ l-NO0-re- 1- tZ (-RG_L2 Change in Reading(RP•RD: Pass/Fail Threshold or Criteria Comments—(include information on repairs made prior to testing,and recommended follow ups forfailed tests') DIESEk,_ LF V_7az.j.Z(:S.�dip QQAtt� U AWE oo — N o'- ne,\_(Z E arc iJ2PssNS A tvY m p smrt'f wT-L � .. 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 reguiremertts. Technician's Signature: State laws and regulations do not currently require testing to he performed by a qualified contractor.However,1=1 requirements =Y ba more stringent. F1l MKl'r n t i VxY xnYVx 1 ALARM HISTORY REFUR T 4:DIESEL 21 l 71 --- SENSOR ALARM ----- PRODUCT CODE 2:STP RED DSL -- LANK ALARM ----- ---- IN-TANK ORM ----- THERMAL COEFF : .0 -IER SENSORS TANK DIAMETER NSOR OUT ALARM T 4:DIESEL 2 T 2:REG UNLEADED 87 TANK PROFILE > 24, 2007 10:14 FULL VOL OVERFILL ALARM OVERFILL ALARM :L ALARM APR 17. 2005 12:36 OCT 19, 2006 17:23 24, 2007 9:48 NOV 12, 2000 5:10 AUG 24, 2006 15: 18 FLOAT SIZE: 4.0 IN. AUG 23. 2000 3:14 JUN 22, 2005 6:59 :L ALARM WATER WARNING 9, 2006 8:..1.5 . . . HIGH PRODUCT ALARM HIGH PRODUCT ALARM HIGH WATER LIMIT: rRM HISTORY REPORT APR 17. 2005 12:36 OCT 19. 2006 17:23 NOV 12. 2000 5:09 AUG 24, 2006 15:10 MAX OR LABEL VOL: -- SENSOR ALARM ----- AUG 23, 2000 2:52 JUN 22, 2005 6:58 OVERFILL LIMIT 3:REG FILL INVALID FUEL LEVEL iER SENSORS AUG 28, INVALID FUEL LEVEL HIGH PRODUCT 2007 11 :00 VSOR OUT ALARM SEP 5, 2007 16:55 , > 24, 2007 10:14 JUL 5. 2007 8:22 JUL 30. 2007 7:50 DELIVERY LIMIT MAY 2. 2007 14:52 MAR 15, 2006 6:02 , =L ALARM PROBE OUT P 24, 2007 9:44 JAN 6. 2007 17: 15 PROBE OUT LOW PRODUCT 28, 2003 6: 10 JAN 6. 2007 17: 16 LEAK ALARM LIMIT: EL ALARM DEC DEC 14, 2003 19:46 APR 14, 2005 13:20 SUDDEN LOSS LIMIT: G 9, 2006 8:17 APR 14. 2005 10:45 TANK TILT RM HISTORY REPORT ' DELIVERY NEEDED DELIVERY NEEDED # NOLDED TANKS T : SEP 20, 2007 9:28 SEP 12. 2007 11 :24 T# NONE -- SENSOR ALARM ----" SEP 7. 2007 14:36 SEP 4, 2007 9:51 ,'STP REG UNL AUG 25, 2007 18:28 AUG 13. 2007 17:26 IER SENSORS LEAK MIN PERIODIC: ISOR OUT ALARM " > 24, 2007 10:14 ALARM HISTORY REPORT LOW TEMP WARNING LEAK MIN ANNUAL JUN 12. 1998 15:02 :L ALARM ----- SENSOR ALARM ----- > 24, 2007 9:47 L 6:STP SUPER SUMP :L ALARM OTHER SENSORS ALARM HISTORY REPORT PERIODIC TEST TYPE ` 9. 2006 8:16 SENSOR OUT ALARM STA SEP 24, 2007 10: 14 ---- IN-TANK ALARM ----- FUEL ALARM T 3:SUPER UNL 92 ANNUAL TEST FAIL ALARM DIS SRI°1 HISTORY REPORT SEP 24. 2007 9:39 INVALID FUEL LEVEL PERIODIC TEST FAIL -- SENSOR ALARM ----- FUEL ALARM FEB 9. 2006 14:18 ALARM DIS 5:FILL SUPER UNL JUL 26, 2007 12:31 DEC 6, 2005 11 :27 iER SENSORS :-----..-.... APR 14, 2005 12:26 GROSS TEST FAIL VSOR OUT ALARM ALARM HISTORY REPORT ALARM DIS > 24. 2007 10: 14 PROBE OUT -- SENSOR ALARM ----- APR 14. 2005 12:29 ANN TEST AVERAGING: :L ALARM L B:STP DSL 2 APR 14, 2005 10:01 PER TEST AVERAGING: 2, 2007 16:38 OTHER SENSORS DEC 28. 2003 6: 10 ,L ALARM SENSOR OUT ALARM TANK TEST NOTIFY: 2 5.ALARM 12:37 SEP 24, 2007 10: 15 DELIVERY NEEDED FUEL ALARM AUG 19, 2007 8:43 TNK TST SIPHON BREA SEP 24, 2007 9:37 JUL 30, 200.7 12:24 DELIVERY DELAY.,...._._ MAY 16, 2007 13:32 2I°} H I STORY REPORT FUEL ALARM �.-.-_-._._.....-. . . SENSOR ALARM AUG 9, 2006 8:21 LOW TEMP WARNING ALARM HISTORY REPOR ---- FILL SUMP DSL 2 APR 14. 2005 12:38 ---- IN-TANK ALARM IER SENSORS ISOR OUT ALARM ALARM HISTORY REPORT "1 T I :DIESEL RED > 24, 2007 10:14 ----- SENSOR ALARM ----- I INVALID FUEL LEVEL MAY 22, 2006 15:42 EL ALARM L I :FILL RED DSL p 24, 2007 9:34 OTHER SENSORS JUN 27, 2003 10:12 SENSOR OUT ALARM JUN 19, 1998 17: 16 IEL ALARM 3:37 SEP 24. 2007 10: 15 PROBE OUT ;g 19, 2007 JAN 6. 2007 17:15 FUEL ALARM DEC 17, 2005 18:50 SEP 24. 2007 9:a9 DEC 28. 2003 6: 10 FUEL ALARM FEB 21 . 2007 13:15 DELIVERY NEEDED JUL 26. 2006 9:49 FEB 13, 2006 18:00 AUG 1, 2005 5:43 TPUT RELAY SETUP _. -. . ----- SENS ----- ALARM H I StOAY7 ktPOT O LARM - - - - - - - - - - - ---- LANK ALARM ----- L 2:STP RED --- OTHER S E NS -- SENSOR ALARM ] :RED DSL T 2:REG UNLEADED 87 FUEL ALARM L 8:STP DSL 2 PE: OTHER SENSORS STANDARD OVERFILL ALARM AUG 9. 2006 8: 16 FUEL ALARM RMALLY OPEN OCT 19. 2006 17:23 AUG 9, 2006 8:21 AUG 24. 2006 15:18 FUEL ALARM JUN 22, 2005 6:59 APR 28. 2006 4:39 FUEL ALARM -TANK ALARMS FUEL ALARM AUG 9. 2005 12:28 ] :LEAK ALARM HIGH PRODUCT ALARM MAR 13. 200610:24 LL:LOW PRODUCT ALARM OCT 19. 2006 17:23 FUEL ALARM AUG 24. 2006 15: 10 - JUN 16. 2000 14:47 DUID SENSOR ALMS JUN 22, 2005 6:58 ALARM HISTORY REPORT 2:FUEL ALARM 2:SENSOR OUT ALARM INVALID FUEL LEVEL -- SENSOR ALARM ----- I :SHORT ALARM SEP 5, 2007 16:55 L ] :FILL RED DSL ALARM HISTORY REPO] 2:SHORT ALARM JUL 30, 2007 7:50 OTHER SENSORS MAR 15, 2006 6:02 FUEL ALARM -- SENSOR ALARM L -:FILL SUMP DSL ; FEB 21 , 2007 13: 15 2:REG UNLEADED PROBE OUT OTHER SENSORS >E: JAN G. 2007 17: 16 FUEL ALARM FUEL ALARM STANDARD APR 14. 2005 13:20 FEB 19, 2007 4:16 FEB 19, 2007 3:37 MMALLY OPEN APR 14, 2005 10:45 FUEL ALARM FUEL ALARM -TANK ALARMS DELIVERY NEEDED AUG 9. 2006 8:27 AUG 9, 2006 8:36 2:LOW PRODUCT ALARM SEP 12. 2007 11 :24 : SETUP DATA WARNING 11 2: INVALID FUEL LEVEL SEP 4, 2007 9:51 ALARM HISTORY REPORT AUG 9. 2006 8:31 AUG 13, 2007 17:26 )UID SENSOR ALMS ---- IN-TANK ALARM ----- ALARM HISTORY REPO) 3:FUEL ALARM 4:FUEL ALARM LOW TEMP WARNING T 4:DIESEL 2 ----- SENSOR ALARM 3:SHORT ALARM JUN 12. 1998 15:02 L 6:STP SUPER SUMP 4:SHORT ALARM OTHER SENSORS `- OVERFILL ALARM APR 17. 2005 12:36 FUEL ALARM JUL 26, 2007 12:31 LIQUID SENSOR SETUP NOV 12. 2000 5: 10 3:SUPER UNLEADED _ - - - - - - - - - - - >E: AUG 23. 2000 3:14 SETUP DATA WARNING STANDARD L ] :FILL RED DSL HIGH PRODUCT ALARM JUL 26. 2007 12:27 MMALLY OPEN Tkl-STATE. (SINGLE FLOAT) APR 17, 2005 12:36 CATEGORY OTHER SETUP DATA WARNING . SENSORS NOV 12. 2000 5:09 -TANK ALARMS 1 AUG 23. 2000 2:52 JUL 26. 2007 9:41 3:LOW PRODUCT ALARM ALARM HISTORY REPOT 3: INVALID FUEL LEVEL L 2:STP RED DSL INVALID FUEL LEVEL TRI-STATE (SINGLE FLOAT) AUG 28. 2007 11 :00 ----- SENSOR ALARM 1UID SENSOR ALMS CATEGORY : OTHER SENSORS JUL 5: 2007 6:22 L 5:FILL SUPER UNL 6:FUEL ALARM MAY 2. 2007 14:52 OTHER SENSORS PROBE OUT FUEL ALARM I:DIESEL 2 L 3:REG FILL JAN 6. 2007 17:15 MAY 2. 2007 16:38 'E TRI-STATE (SINGLE FLOAT) DEC 28, 2003 6: 10 FUEL ALARM STANDARD OCT 14. 2003 19:46 CATEGORY : OTHER SENSORS i APR 5. 2007 12:37 'MALLY OPEN DELIVERY NEEDED FUEL ALARM -TANK ALARMS i SEP 20. 2007 9:28 AUG 9. 2006 8: 17 L 4:STP REG UNL •-•-.. --..-...__._.�._........ . 4:LOW PRODUCT ALARM TRI-STATE (SINGLE FLOAT) SEP 7. 2007 14:36 ALARM HISTORY REPOR 4: INVALID FUEL LEVEL CATEGORY : OTHER SENSORS AUG 25, 2007 18:28 - .. �_ ----- SENSOR ALARM iUID SENSOR ALMS ALARM HISTORY REPORT L 4:STP REG UNL 8:FUEL ALARM OTHER SENSORS L 5:FILL SUPER UNL ---- IN-TANK ALARM ----- FUEL ALARM :COUNTER LIGHT CATEGORYE:(OTHERESENSORS T 3:SUPER UNL 92 AUG 9. 2006 8: 16 .E: FUEL ALARM :TANDARD INVALID FUEL LEVEL MAR 6, 2006 17:32 MALLY OPEN FEB 9. 2006 14:18 L 6:STP SUPER SUMP DEC 6. 2005 11 :27 SETUP DATA WARNING TANK ALARMS TRI-STATE (SINGLE FLOAT) APR 14, 2005 12:26 JAN 2. 2006 10:28 TANK A.ARMS CATEGORY : OTHER SENSORS PROBE OUT )LARM HISTORY DEPORT L:LOW PRODUCT ALARM APR 14. 2005 12:29 L: INVALID FUEL LEVEL APR 14. 2005 10:01 ----- SENSOR ALARM - L:PROBE OUT L 7:FILL-SUMP DSL 2 DEC 28. 2003 6: 10 _ 3:REG FILL L:DELIVERY NEEDED TRI-STATE -(SI-NGLE FLOAT-) ETHER SENSORS UID SENSOR ALMS CATEGORY S: OTHER SENSOR ?UEL ALARM DELIVERY L:FUEL ALARM AUG19. 2007p ��� g' 2005 8117 8:43 L:SENSOR OUT ALARM JUL 30, 2007 12:24 FUEL ALARM LISHORT ALARM L Q'STP DSL 2 MAY 16. 2007 13:32 4UG 9. 2005 12:34 L:WATER• ALARM TRI-STATE (SINGLE FLOAT) CATEGORY OTHER SENSORS ;ETUP DATA WARNING !:SUPER UNL 92 T 2:RE NLEADED 87 IN-TANK SETUP - - - - - - )DUCT CODE 6 PRODUCWODE 4 SEP 24, 2007 8:47 'RMAL COEFF : .000700 THERMAL COEFF : .000700 IK DIAMETER 95.00 TANK DIAMETER 95.00 T 1 : RED IK PROFILE 1 PT TANK PROFILE 1 PT PRODUUCT CT CODE 0 FULL VOL 11783 FULL VOL 11783 THERMAL COEFF : .000470 SYSTEM UNITS TANK DIAMETER 95.00 U.S. TANK PROFILE 1 PT SYSTEM LANGUAGE )AT SIZE: 4.0 IN. 8496 FLOAT SIZE: 4.0 IN. 8496 FULL VOL 11783 ENGLISH SYSTEM DATE/TIME FO 'ER WARNING : 2.0 WATER WARNING 2.0 MON DD YYYY HH:MM:S :H WATER LIMIT: 4.0 HIGH WATER LIMIT: 4.0 FLOAT SIZE: 4.0 IN. 8496 CENTER OR LABEL VOL: 11783 WATER WARNING 2.0 3221TAFTHWY ;RFILL LIMIT 97% MAX OR LABEL VOL: 11783 HIGH WATER LIMIT: 4.0 BAK CA.93313 11429 OVERFILL LIMIT 97% 11429 MAX OR LABEL VOL: 11783 :H PRODUCT 95% HIGH PRODUCT 95% o 11193 OVERFILL LIMIT 97i SHIFT TIME 1 4:3 11193 11429 SHIFT TIME 2 DISA IVERY LIMIT 13 DELIVERY LIMIT 17% HIGH PRODUCT 95% 20003 2003 SHIFT TIME 3 DISA 11193 SHIFT TIME 4 DISA PRODUCT : 330 DELIVERY LIMIT 17% iK ALARM LIMIT: 99 LOW PRODUCT 330 2003 PERIODIC TEST WARNI ADEN LOSS LIMIT: 99 LEAK ALARM LIMIT: 99 DISABLED IK TILT 0.00 SUDDEN LOSS LIMIT: 99 LOW PRODUCT 330 ANNUAL TEST WARNING TANK TILT 0.00 LEAK ALARM LIMIT: 99 DISABLED II FOLDED TANKS MAIVIFOLDED TANKS SUDDEN LOSS LIMIT: 99 NONE MA NONE TANK TILT 0.00 PRINT TC VOLUMES MANIFOLDED TANKS ENABLED K MIN PERIODIC: 0% LEAK MIN PERIODIC: 0% TO: NONE TEMP COMPENSATION 0 0 VALUE (DEG F ) : 6 K MIN ANNUAL 0% LEAK MIN ANNUAI. 0% LEAK MIN PERIODIC: 0% H-PROTOCOL DATA FOR 0 HEIGHT RE-DIRECT LOCAL PRI LEAK MIN ANNUAL 0% nn _. IODIC TEST TYPE 0 COMMUNICATIONS SETUP . STANDARD PERIODIC TEST TYPE STANDARD - - - - - - - - - - UAL TEST FAIL ANNUAL TEST FAIL PERIODIC TEST TYPE ALARM DISABLED ALARM DISABLED STANDARD PORT SETTINGS: IODIC TEST FAIL PERIODIC TEST FAIL ANNUAL TEST FAIL COMM BOARD 1 (RS- ALARM DISABLED ALARM DISABLED ALARM DISABLED BAUD RATE 9600 PARITY ODD SS TEST FAIL GROSS TEST FAIL PERIODIC TEST FAIL STOP BIT 1 STOP ALARM DISABLED ALARM DISABLED ALARM DISABLED DATA LENGTH: 7 DATA TEST AVERAGING: OFF GROSS TEST FAIL ANN TEST AVERAGING: OFF TEST AVERAGING: OFF PER TEST AVERAGING: OFF ALARM DISABLED AUTO TRANSMIT SETTIIV K TEST NOTIFY: OFF TANK TEST NOTIFY: OFF ANN TEST AVERAGING: OFF AUTO LEAK ALARM LIMI PER TEST AVERAGING: OFF DISABLED TST SIPHON BREAK:OFF TNK TST SIPHON BREAK:OFF TANK TEST NOTIFY: OFF AUTO HIGH WATER LIMI DISABLED IVERY DELAY 3 MIN DELIVERY DELAY 3 MIN 1 TNK TST SIPHON BREAK:OFF AUTO OVERFILL LIMIT AUTO LOW PRODUCT RM HISTORY REPORT -�� �_.., DELIVERY DELAY : 3 MIN DISABLED AUTO THEFT LIMIT - IN-TANK ALARM ----- ALARM HISTORY REPORT DISABLED LEAK TEST METHOD - - - - AUTO DELIVERY START :SUPER UNL 92 ---- IN-TANK ALARM ----- TEST WEEKLY ALL TANK DISABLED END ALID FUEL LEVEL SUN DISABLED 9. 2006 14:18 T I :DIESEL RED START TIME 1 :00 All AUTO EXTERNAL INPUT 6, 2005 11 :27 TEST RATE :0.20 GAL/HR DISABLED 14. 2005 12:26 INVALID FUEL LEVEL DURATION 2 HOURS AUTO EXTERNAL INPUT MAY 22. 2006 15:42 3E OUT JUN 27, 2003 10: 12 DISABLED SENSOR AUTO FUEL ALA 14, 2005 12:29 JUN !9. 1998 17: 16 DISABLED 14. 2005 10:01 LEAK TEST REPORT FROBE OUT ENHANCED AT AUTO SENSOR WATER AL, P 28, 2003 6: 10 JAN 6. 2007 17: 15 DISABLED DEC 17...2005 18:50 AUTO SENSOR OUT ALARI DEC 28. 2003 6:10 DISABLED :VERY NEEDED SOFTWARE REVISION LEVEL 19, 2007 8:43 VERSION 14:01 30, 2007 12:24 DELIVERY NEEDED SOFTWARE# 346014-100-B 16. 2007 13:32 JUL 26, 2006 9:49 CREATED - 97.03. 12.20.41 FED 10, 2006 10:100 RS-232 SECURITY TEMP WARNING AUG 1 , 2005 5143 NO SOFTWARE MODULE CODE : 000000 SYSTEM FEATURES: 14, 2005 ING PERIODIC IN-T4ih?V TVC'PC MONITOR CERT:FAILURE REPORT S E WANIE: DATE• ADDRESS. 3a a 1 F T rt c� TE!HEW.CIAN: ©l Chi crTY.;.. SIGNATURE: TM.F,oLLOWING COMPONENTS WERE REPLACEDMEPAUU TO COMPLETE TESTING. RF PAIRS: 2�PLACE z SQL C?z t=�i3b T��-S"C • LABOR: PARTSINTALLED: N ©N NAME:. TITLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESFONSIBTLITY OF NOTIFYING THE APrROPRIATE PARTY TO HAVE CORRECITVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIROMUNTAL FOR ANY NEEDED RETESTING.THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON-COMPLIANCE. A COPY OF THIS DOCUMMNT HAS BEEN LEFT ON-SITE FOR YOUR CONVWNENCE. MONITORING SYSTEM CERTIFICATION For Use By A!(Jurisdictions Within the State of California Authority Cite& Chapter G 7, Health and Safety Code;Chapter 16, Division 3, Title 13, California Code oJ7tegulatiot 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 pangl 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. Genera! Information �Dl Facility Name: rtikf � C-7 14,. Bldg.No.: Site Address: i3]l"ol.1 'i'H F 1 HWt( City: k6 E-rEL D Zip: 93-:90 Facility Contact Person: Contact Phone No.: ( Make/Model of Monitoring System: E I^v\.C- Date of Testing/Servicing: L/-o(, B. Inventory of Equipment Tested/Certified Check the ap ropriate boxes to indicate specific equipment inspected/serviced: Tank ID: QA)L 6-7 Tank ID: PREM-1 1 0� In-Tank Gauging Probe. Model: fy\P\C—n In-Tank Gauging Probe. Model: L1jA&7 ❑ Annular Space or Vault Sensor. Model: ❑ Annular Space or Vault Sensor. Model: * Piping Sump/Trench Sensor(s). Model:_ 76� IS Piping Sump/Trench Sensor(s). Model: e4D7, Fill Sump Sensor(s). Model: tA Fill Sump Sensor(s). Modcl: Q01 54 Mechanical Line Leak Detector. Model: QED JP<jt I IR Mechanical Line Leak Detector. Model: tZC1 J6 Ck6 r ❑ Electronic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: ❑ Tank Overfill/High-Level Sensor.Model: ❑ Tank Overfill/High-Level Sensor.Model: ❑ Other s ecif equipment t e and model in Section E on Pa c 2 . ❑ Other s eci equipment l e and model in Section F.on Page 2). Tank ID: Tank Ill: 0 In-Tank Gauging Probe. Model: •�f}[-I ® In-Tank Gauging Probe. Model:_1nA ❑ Annular Space or Vault Sensor. Model: ❑ Annular Space or Vault Sensor. Model: 50 Piping Sump/Trench Sensor(s). Model: ail 8 $ Piping Sump/Trench Sensor(s). Model: R ® Fill Sump Sensor(s). Model: o A ® Fill Sump Sensor(s). Model: ES Mechanical Line Leak Detector. Model: Lf ED J It C1 R Mechanical Line Leak Detector. Model eO J19( ` ❑ 6lectmnic Line Leak Detector. Model: ❑ Electronic Line Leak Detector. Model: 4 ❑ Tank Overfill/i-figh-Level Sensor.Model: ❑ Tank Overfill/Fiigh-Level Sensor.Model: ❑ 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 Ill: 11 '� Dispenser ID: 33i y ❑ Dispenser Containment Sensor(s).Model: ❑ Dispenser Containment Sensor(s).Model: &Shear Valve(s). 9 Shear Valve(s). ❑ Dispenser Containment Floats and Chain(s). ❑ Dis enser Containment Floats and Chain(s). Dispenser ID: 11 [ Dispenser ID: ? F ❑ Dispenser Containment Sensor(s).Model: ❑ Dispenser Containment Sensor(s).Model: CR-Shcar Valve(s). (3 Shear Valve(s). ❑ Dispenser Containment Float(s)and Chain(s). ❑ Dis enser Containment Floats and Chain(s). Dispenser ID: _ Dispenser ID: ❑ Dispenser Containment Sensor(s).Model: ❑ Dispenser Containment Sensor(s).Model: ❑ Shear Valve(s). ❑ Shear Valve(s). ❑Dispenser Containment Floats)and Chain(s). ❑ Dispenser Containment Float s)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 applv): System set-up aAlarrn history report Technician Name(print): '5-TCt)EN 0 1-3-CA-T Signature:O Certification No.: 02Rf�?I (S Q(o 1,9`4 b ucr License.No.: Testing Company Name: RICH ENVIRONMENTAL Phone No.:( 661 ) 392-8687 Site Address: k�1 8AkE tQS F3:E Q 1, C A 9 M3I Date of Testing/Servicing: /9 _LOG Page I of RECEIVED 03101 Monitoring System Certification AUG 3 1 2006 KERRY COUNTY J ENVIRONMENTAL HEALTH SERVICES • , f 1 �A . e.�.x a c.,:>•«:� dot I D. Results of'Yesting/Servicing Software Version Installed: i' • Corn fete the follo In checklist. 0 Yes ❑ No* Is the audible alarm operational? a Yes ❑ No* Is the visual alarm operational? A Yes ❑ No* Were all sensors visually inspected,functionafl tested and confirmed operational? A Yes ❑ No' Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their 2roper operation? ❑ Yes ❑ No' If alarms are relayed to a remote monitoring station, is all communications equipment' (e.g. modern) ®• N/A, operational? W Yes ❑ No'' For pressurized piping systems,does die 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 char apply) 0 Sump/Trench Sensors; ❑Dispenser Containment Sensors. Did you confirm ositive shut-down due to leaks and sensor fabure/disconnection? R Yes; Q No. Q Yes Q No" For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no 4 N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s and operating o er1 ? If so at what percent of tank ca2aciry does the alann trigger.? % ❑ Yes" ® 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 pans in Section E below. a Yes* ❑ No Was liquid found inside any secondary containment systems designed as dry systems? (Check all Mal apply)❑ Product; 0 Water. If yes,describe causes in Section E below. 53.Yes Q No" Was monitoring system set-u reviewed to ensure proper settings?Attach setup reports,If applicable Yes ❑ No•' Is all monitoring equip2lLnL9perational per manufacturer's s ifications? *In Section E below,describe how and when these defiriencies were or will be corrected. E. Comments:: 9 t S(jr-\e t-t N Z Qi-_, C l.l,.u,, AQ b L A5 _gErovEa . `�i� ts�P.� FtNfl��T `vlttSS ;�R�LiEI - o,..) sip . Page 2 of n3ioz i F. In-Tank G.a uging/SIR Equipment: ¢4 Check 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 mmt be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the folla•wIn checklist: ❑ Yes 10 N04- Has all input wiring been inspected for proper entry and termination,including testing for ground faults? 0 Yes ❑ No4 Were all tank gauging probes visually inspected for dwnage and residue buildup? O Yes 0 No+ Was accuracy of system product level readings tested? q Yes ❑ No* Was accuracy of system water level readings tested? ❑ Yes O No* ' Were all probes reinstalled properly? O Yes ❑ No"' J.re all items on the equipment manufacturer's maintenance checklist completed? *In the Section fl,below,describe how and when thesedeficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Com lete the folltiwin checklist: Yes ❑ No"� For equipment start-up or annual equipment certificarion, was a leak simulated to verify LLD performance? O N/A: (Check all that apply) Simulated leak rate: Z3 g.p.h.; ❑0.1 g.p.h; ❑0.2 g.ph. ,S Yes ❑ No" Were all LLDs confirmed operational and accurate within regulatory requirements? Jig Yes 0 No" Was the testing apparaws properly calibrated? R Yes O No" For mechanical LLDs,does the LLD restrict product flow if it detects a leak? O NIA, O Yes ❑ No"` For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? to N/A, 0 Yes ❑ No" For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled A N/A, or disconnected? 0 Yes ❑ No" For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfunctions A N/P, or fails a test? D Yes O No" For electronic LLDs,have all accessible wiring connections been visually inspected? NIA. A,Yes O No" Were all items on the equipment manufacturer's maintenance checklist completed? " In the Section 11,below,describe how and when these deficiencies were or will be corrected. hI. Comments: Page 3 of 3 03/01 I ' • Monitoring System Certification Form: Addendum for Vacuum/Pressure Interstitial Sensors LG 163-1,Enc.II 1. Results of Vacuum/Pressure Monitoring Equipment Testing 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 Certification Form, which must be provided io 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: Model: System Type: ❑Pressure;❑Vacuum Sensor ID Component(s)Monitored by this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fail Interstitial Communication Test Result:❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fail Interstitial Communication Test Result:❑Pass; ❑ Fail Component(s).Monitored by this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fail Interstitial Communication Test Result:❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fail Interstitial Communication Test Result:❑Pass; ❑ Fail Components)Monitored by this Sensor: Sensor Functionality Test Result:(]Pass; ❑ Fail Interstitial Communication Test Result:❑Pass; f] Fail Component(s)Monitored by this.Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fail Interstitial Communication Test Result:❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fail Interstitial Communication Test Result:❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fail Interstitial Communication Test Result:❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fail Interstitial Communication Test Result:❑Pass; ❑ Fail Component(s)Monitored by this Sensor: Sensor Functionality Test Result:❑Pass; ❑ Fail Interstitial Communication Test Result:❑Pass; ❑ Fail How was interstitial communication verified? .❑ Leak Introduced at Far End of Interstitial Space;' ❑ Gauge; ❑ Visual inspection; .❑ Other(Describe in Sec.J, below) Vacuum was restored to operating levels in all interstitial spaces: []Yes ❑No(7f no, describe in Sec.J, below) J. Comments: N o t4E D F TK L-cj ge 6 t✓A)�S M Q 9.:LT E Page of If the sensor successfully detects a simulated vacuum/pressure leak introduced in the interstitial space at the furthest point from the sensor,vacuum/pressure has been demonstrated to be communicating throughout the interstice. ! : 1 r� • Monitoring Systern Certification UST Monitoring Site Plan Site Address: �Q1� "LOFT �NOa j R kUsFZ6l, 7 c-8 93al, R69 V7c5ELFSiI f.SLL . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . * . . . . . . . * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : ' '. . . .. . . . .. . . * . .. . . . . .- . . . . . . C . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . Date snap was drawn: Instructions If you already hE(ve a diagram that shows all required information,you may include it, rather than this page, with your Monitoring Systrm 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 iti-tank liquid level probes (if used for leak detection). In the space provided,note the date this Site Plan was prepared. Page of nsm0 Z i � I • tag CH T.Alt 5643 BROOKS CT ZAXERSZXELD,CA.93308 OFFICE(661)392-8687 & PAX (661) 3920621 MEQHAU1C&L-LEAXJn=0T0R TEST WORK SHERI W/0#: Fac:Uity Name--EjjftfPf 67AS I Facility Address. -3aa► _7aFr Y EdkCAE-1E(.D_,�CA X33/3 Product Line Type reasuz Suction, Gravity) j"Oessyze I .PR(.)DUCT LEAK. DETECTOR TYPE TEST TRIP PASS SERIAL NUMBER BELOW PSI OR I L/b Txps RtD �1ACMZ ( ass E7 SERIAL #�jk� pAi1��� No /b FAIL L/D TYPE:.gZ GkC tb3 AS R 6'� SERIAL #._..!�)_fl. zo aArL PEr`9l ' .�. —L/- HckE r � Pas IpZ:E65L SERIAL NO �Q F L L/n TYPFs__ JAcOZE Qn> Ass f I :;ertify th.P above te:3ts were conducted on this date according to Red :(ae&et pumps ficald test apparatus testing procedure an limitations. Th,=: Mechani.ca.l. Leak. Detect-.or Test pass / fail is determined. by using a .lcwr Plow threshold trip rate of 3 gallon per hour or less at 10 PSI. I .acknowledge that all da.ta collected is true and correct to the best of my knowledge. I� Tech: Ills 3iga;tune: Date.. T-9-o6 1 G:• I i 7 T c4:DIESEL L ESEL 2 .`Lmr Ok SETUP J:SUPER UNL 92 - - - - - - - - - - - - OUTPUT RELAY SETUP ODUCT CODE 6 PRODUCT CODE 3 - - - - - - - - - - - ERMAL COEFF : ,000700 THERMAL COEFF : .000470 L 1 :FILL RED DSL NK DIAMETER 95.00 TANK DIAMETER 95.00 TRI-STATE (SINGLE FLOAT) R 1 :RED DSL NK PROFILE 1 PT TANK PROFILE 1 PT CATEGORY : OTHER SENSORS TYPE: FULL VOL 11763 FULL VOL : 11783 STANDARD NORMALLY OPEN OAT SIZE: 4.0 IN. 8496 FLOAT SIZE: 4.0 IN. 8496 L 2:STP RED DSL _ TER WARNING 2.0 WATER WARNING 2,0 TRI-STATE (SINGLE FLOAT) IT jALKAKLARMS CH WATER LIMIT! 4.0 HIGH WATER LIMIT: 4.0 CATEGORY : OTHER SENSORS ALL:LOW PRODUCT ALARM X OR LABEL VOL: 11783 MAX OR LABEL VOL: 11763 LIQUID SENSOR ALMS ERFILL LIMIT 97% OVERFILL LIMIT 97% L 3:REG FILL L 2:FUEL ALARM 11429 11429 TRI-STATE (SINGLE FLOAT) L 2:SEIJSOR OUT ALARM GH PRODUCT 95% HIGH PRODUCT 95% CATEGORY : OTHER SENSORS L 1 :SHORT ALARM 11193 11193 L 2:SHORT ALARM LIVERY LIMIT 17 DELIVERY LIMIT 17% 2003 2003 LOW PRODUCT : 330 L 4:STP REG UNL R 2:REG UNLEADED AKPALARMTLIMIT: 330 99 LEAK ALARM LIMIT: 99 TRI-STATE (SINGLE FLOAT) TYPE' STANDARD DDEN LOSS LIMIT: 99 SUDDEN LOSS LIMIT: 99 CATEGORY OTHER SENSORS NORMALLY OPEN IVK TILT 0.00 TANK TILT 0.00 NIFOLDED TANKS MANIFOLDED TANKS IN-TANK ALARMS : NONE TO: NONE L 5:FILL SUPER UNL TRI-STATE (SINGLE FLOAT) T 2:LOW PRODUCT ALARM CATEGORY : OTHER SENSORS T 2:INVALID FUEL LEVEI AK MIN PERIODIC: 0% LEAK MIN PERIODIC: 0% LIQUID SENSOR ALMS 0 0 L 3:FUEL ALARM AK MIN ANNUAL 0 1a LEAK MIN ANNUAL : 0% L 6:STP SUPER SUMP L 4:FUEL ALARM 0 0 TRI-STATE (SINGLE FLOAT) L 4:SHORT ALARM CATEGORY : OTHER SENSORS RIODIC TEST TYPE PERIODIC TEST TYPE R 3:SUPER UNLEADED STANDARD STANDARD TYPE: L B:STP DSL 2 NUAL TEST FAIL ANNUAL TEST FAIL TRI-STATE (SINGLE FLOAT) STANDARD ALARM DISABLED ALARM DISABLED CATEGORY : OTHER SENSORS NORMALLY OPEN RIODIC TEST FALL PERIODIC TEST FAIL LEAK. TEST METHOD IN-TANK ALARMS ALARM DISABLED ALARM DISABLED - - - - - - - - - - - - T 3:LOW PRODUCT ALARM TENT WEEKLY ALL TANK T 3:INVALID FUEL LEVEL OSS TEST FAIL GROSS TEST FAIL SUN - ALARM DISABLED ALARM DISABLED START TIME 2:00 AM LIQUID SENSOR ALMS _ TEST RATE :0.20 GAL/HR L 6:FUEL ALARM IN TEST AVERAGIIG: OFF ANN TEST AVERAGING: OFF DURATION :, 2 HOURS :R TEST AVERAGING: OFF PER TEST AVERAGING: OFF NK TEST NOTIFY: OFF TANK TEST NOTIFY: OFF R 4:DIESEL 2 TY LEAK TEST REPORT FORMAT STANDARD IK TST SIPHON BREAK:OFF TNK TST SIPHON BREAK:OFF E14HANCED NORMALLY OPEN LIVERY DELAY 3 MIN riFI.r VrRv rXT n„ ------------- ---- - -_-- . . -_ _ IN-TANK ALARMS T 4:LOW PRODUCT ALARM �v w T 4:INVALID FUEL LEVEL i C7 Jl 0 0 N. r fX <0 oMo � `� ° a v v W m Tr xa-n LIQUID SENSOR ALMS i• � 1%o F~ r m ¢a ¢ ,¢ z z x m m a 0 a E L 8:FUEL ALARM I _ --oACaA F_ .a a 1: a A a. a ce oo•3m m�0y F- z z z -. p a tixazxv F- F. rt:fm m_m 01 F x H �] Q r ? 7 7 w 3 O -(?D�x+ nAX7 R 5:000NTER LIGHT _ .a IT .a 0 .a a a a ¢ z a m w w- m TYPE: H s Q 3 (Y w W z z 0' lx Ix I c J I�o< a A w ca rn w F- �_ a a 0 0 0 a �3 z . U,— - STANDARD W w co U2 � I m 0 00 :fi NORMALLY OPEN F- E¢ w ¢ A0cAWz)3a)w A 1AF AF AZAZaz�a z•3tno w-- w orx> ww ce `u�Swyw>wowmwliiwwwxwxwwwwww.w x�••c r o co al F_ F- 7Jx,�O.J 1.![-JA 1A�W ]W !U].I(l2.I(q.1 z r c� a¢ m m m m m m m m m w m m -9 m ry i k X:<T O OWOLnO(0E-CQ CQF-Wf- Or¢oc¢oC¢oc¢FC¢ m a No M IN-TANK ALARMS •> oma.cnL5 > >-.� a- '?�. a �- ����o�o o� �m o I c ALL:LEAK ALARM I cL iJ ¢ QA tA¢A¢Gt¢A¢gQA¢gQAQA<Z c Ulm Am r rri ALL:LOW PRODUCT ALARM ALL:INVALID FUEL LEVEL i ALL:PROBE OUT ALL:DELIVERY NEEDED LIQUID SENSOR ALMS ALL:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM ALL:WATER ALARM _. .-- _ ---- 1 N-TANY ALARM - STEM SETUP _ _ SEIJsOR ALARM ----- - - _ _ _ ---- I(J-TANK. ALflRM ----- L 3:REG FILL G 9, 2006 7:29 T 3:SUPER UNL 92 OTHER SENSORS T 4:DIESEL 2 FUEL ALARM INVALID FUEL LEVEL AUG 9, 2006 6:17 OVERFILL ALARM STEM UNITS FEB 9, 2006 14:18 APR 17, 2005 12:36 .S. DEC 6, 2005 11 :27 FUEL ALARM NOV 12. 2000 5:10 STEM LANGUAGE APR 14, 2005 12:26 AUG 9, 2005 12:34 AUG 23, 2000 3:14 NGLISH STEM DATE/TIME FORMAT PROBE OUT SETUP DATA WARNING HIGH PRODUCT ALARM N DD YYYY HH:MM:SS APR 14. 2005 12:29 JUN 12, 1998 8:00 APR 17, 2005 12:36 APR 14. 2005 10:01 NOV 12, 2000 5:09 AUG 23. 2000 2:52 MKIN CENTER DEC 28. 2003 6: 10 ALARM HISTORY REPORT 21TAFT HWY INVALID FUEL LEVEL K CA.93313 ----- SENSOR ALARM ----- NOV 18, 2005 7:46 AUG 3, 2006 12:10 DELIVERY NEEDED L 4:STP REG UNL JAN 21 . 2005 4:53 AUG 3 OTHER SENSORS APR 1 , 2004 6:57 IFT TIME 1 4:35 AM JUL 25, 2006 15:56 FUEL ALARM IFT TIM£ 2 DISABLED JUL 8, 2006 14:26 AUG 9. 2006 8:16 PROBE OUT IFT TIME 3 DISABLED DEC 28. 2003 6:10 IFT TIME 4 DISABLED FUEL ALARM OCT 14, 2003 19:46 LOW TEMP WARN ING MAR 6, 2006 17:32 SEF 15. 1998 12:44 RIODIC• TEST WARN INGS APR 14. 2005 12:38 SABLED RT SETUP DATA WARNING NUAL TEST WARNINGS EPO TAN °x'16 10;2B DELIVERY NEEDED SABLED -_-- IN-TANI" ALARh! ----- HLHRNI HISTORY REPORT JUL 24. 2006 10:47 JUL 13. 2006 14:09 INT TC VOLUMES T 2:REG UNLEADED 87 _ JUN 20, 2006 12:21 ABLED ---- SENSOR ALARM ----- OVERFILL ALARM L 2:STP RED DSL NIP COMPENSATIOfJ OTHER SENSORS LUE (DEG F ) : 60.0 JUN 22. 2005 6:59 FUEL ALARM ALARM HISTORY REPORT FEB 27. 2004 5:02 AUG 9. 2006 8:16 PROTOCOL DATA FORMAT JUL 6, 2003 5: 17 ----- SENSOR ALARM -- IGHT FUEL ALARM L 8:STP DSL 2 -DIRECT LOCAL PRINTOUT HIGH PRODUCT ALARM APR 28, 2006 4:39 OTHER SENSORS SABLED JUN 22. 2005 6:58 FUEL ALARM FEB 27. 2004 5:02 FUEL ALARM AUG 9. 2006 8:21 STEM SECURITY JUL 8, 2003 5:16 MAR 13. 2006 10;24 FUEL ALARM DE : 000000 INVALID FUEL LEVEL -.•^ AUG 9, 2005 12:28 MAR 15, 2006 6:02 ALARM HISTORY REPORT FEB 9, 2006 16:37 JUN LI6I.A2000 14:47 ARM HISTORY REPORT APR 14, 2005 14:53 ----- SENSOR ALARM ----- L 5:FILL SUPER UNL -- IN-TANK ALARM ----- PROBE OUT OTHER SENSORS APR 14, 2005 13:20 FUEL ALARM I :DIESEL RED APR 14. 2005 10:45 i AUG 9, 2006 8:17 (VALID FUEL LEVEL DEC 28, 2003 6: 10 FUEL ALARM ALARM HISTORY REPORT Y 22. 2006 15:42 DEC 2. 2005 6:52 ----- SENSOR ALARM --- IN 27, 2003 10:12 DELIVERY NEEDED IN 19. 1998 17:16 JUL 19, 2006 9:04 FUEL ALARM L ( :FILL RED DSL JUL 16. 2006 6:37 AUG 9. 2005 12: OTHER SENSORS 'OBE OUT JUL B. 2006 8:40 34 FUEL ALARM :C 17. 2005 18:50 AUG 9, 2006 8:27 :C 28. 2003 6: 10 __ LOW TEMP WARNING ALARM HISTORY REPORT AUG L 9, 2005 12:33 JUN 12, 1998 15:02 :LIVERY NEEDED ----- SENSOR ALARM ----- SETUP DATA WARNING IL 26. 2006 9:49 L 7:FILL SUMP DSL 2 •--1ULl 12. 1998 0:00 ;B 13. 2006 18:00 OTHER SENSORS - IG 1 .-2005 5:43 AUG ALARM ALARM HISTORY REPORT 2006 8:36 - -- SENSOR ALARM -- SETUP DATA WARfVING L 6:STP SUPER SUMP AUG 9. 2006 8:31 OTHER SENSORS FUEL ALARM SENSOR OUT ALARM AUG 9, 2006 8:18 OCT 18, 2005 9:40 FUEL ALARM JU14 22, 2006 14:35 FUEL ALARM AUG 9, 2005 12:31 IN—TANK SETUP T _ _ _ _ _ _ _ 2:kEG UNLEADED 87 _ _ _ PRODUCT CODE 4 T 1 :DIESEL RED THERMAL COEFF •005700 PRODUCT CODE 0 TANK DIAMETER I PT THERMAL COEFF : .000470 TANK PROFILE TANK DIAMETER 95.00 FULL VOL 11783 TANK PROFILE I PT FULL VOL 11783 FLOAT SIZE: 4.0 IN. 8496 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH WATER LIMIT: 4.0 WATER WARNING : 2.0 MAX OR LABEL VOL: 11763 HIGH WATER LIMIT: 4.0 OVERFILL LIMIT 97% MAX OR LABEL VOL: 11783 11429 HIGH P OVERFILL LIMIT 971 PRODUCT 953 11193 11429 HIGH PRODUCT 95% DELIVERY LIMIT 2003 _11193 DELI'VERY' L I NI I T — : 17`ra LOW PRODUCT 330 2003 LEAK. ALARM LIMIT: 99 LOW PRODUCT 330 SUDDEN LOSS LIMIT: 0 00 LEAK ALARM LIMIT: 99 TANK TILT SUDDEN LOSS LIMIT: 99 MAIdIFOLDED TANKS TANK TILT 0.00 TU: NONE MANIFOLDED TANKS, TN: NONE LEAK MIN PERIODIC: 0°0 LEAK PI I N PERIODIC. 0% p LEAK MIN ANNUAL 0 LEAK MIN ANNUAL u PERIODIC TEST TYPE STANDARD PERIODIC TEST TYPE ANNUAL TEST FAIL STANDARD ANNUAL DISABLED ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED PERIODIC TEST PHIL GROSS TEST FAIL ALARM DISABLED ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF ANN TEST AVERAGING: OFF TANK TEST NOTIFY: OFF PER TEST AVERAGING: OFF, TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF TNK TST SIPHON BREAK:OFF npTTVFRY DELAY �3 MIN DELIVERY DELAY 3 MIN MONITOR CERT. FAILURE REPORT SITE NAME: PIP .60's DATE: A- 9- oC ADDRESS: itFT tiu TECHNICIAN: 1;1 6 VE-) 0gLdT CITY• McE,96 F1 Ct-D SIGNATURE: THE FOLLOWING COMPONENTS WERE REPLACED/REPAIItED TO COMPLETE TESTING. REPAIRS. N EEO -n s i gi-LL PA 11i LABOR: E PARTS INTALLED: 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. �F SWRCB,January 006 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. prwoutsfrom.tests(ifapplicable),should beprovided to thefaeility.owner/operatorforsubmittal to the local regulatory agency, 1. FACILITY INFORMATION Facility Name: P ;tint Q� Facility Address: -1-fvRry Facility Contact: AM Phone: Date Local Agency Was Notified of Testing: +_ o Name of Local Agency Inspector(rf present during testing): t�,j Q' 2. TESTING CONTRACTOR INFORMATION Company Name: .Technician Conducting Test: Credentials: CSLB Contractor 4fC Service coh. SWRCB Tank Tester Other( C LacenseNumber(s): `•kla lit 0: - 6it-1 (4 3. BUCKET TESTING INFORMATION Test Method Used: Hydrostatic_ Vacuum Other Test Equipment Used: t:F-7 tJ Equipment Resolution: Identify Spill Bucket(By-Tank 1 2 3 4 Number,Stored Product, etc.) PRF-tA Q t l 12 fi✓ Bucket Installation Type: D' D e in S nWned in Sum Contained in Sum Container Sum Bucket Diameter. 15 " Bucket Depth: IQ e r• r' ( a•� Wait time between applying ?�,, vacuum/water and start of test: d _� 3(VLZ �XL�✓�!tZ� /VL F Test Start Time(TO: 102CIA ItM-SOA a':a 34 i 9%• f A 19 10.,34A k Initial Reading W: S.3v-4D lr.3aq I .q ye& q'-{ (a.S5zQ (o �. fTest End Time(TF): I tA: (� I= s C(•Qt,f_N ; ' S (m:q9 Final Reading(RF): .3A-+( S"3a1 LISa. IS'Rt-I'-5 Test Duration(TF-TO: Wa Change in Reading(RF-Rl): L4 Pass/Fail Threshold or Criteria: Comments-(include informat6 on irs made rior and recommend u or ailed tests' CERTIFICATION OF TECIUMMAN RESPONSIBLE FOR CONDUCTING TSIS TESTING I hereby certify that all the information contained in this report is true,accurate;and in full compliance with legal requirements. Technician's Signature_ DatC: 15 f`t �YJ State laws and regulations do not currently require tasting to be performed by a qualified contractor.However,local requirements may be Mort stringent. -- �3 SUMP LEAK TEST REPORT 08. 09/2006 9:39 AM REDDIES SUMP LEAK TEST REPORT TEST STARTED 10:50 AM DIESIEL TEST STARTED 08/09. 2006 °.EGIN LEVEL 5.5553 IN Tcc; • STARTED 9:23 AM END TIME 11:05 AM TEST STARTED 016/09-12006 END DATE 08/09/'2006 BEGIN LEVEL 6.5502 IN END LEVEL 5.5561 IN END TIME 9:38 AM LEAK THRESHOLD 0.002 IN END DATE 88/09/2006 TEST RESULT PASSED END LEVEL 6.5488 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED 87FILL TEST STARTED 10:50 AM 91FILL TEST STARTED 08:09/200(; BEGIN LEVEL 5.3271 IN TEST STARTED 9:23 AM END TIME 11:05 AM TEST STARTED 08/09/2006 END DATE 08/09/2006 BEGIN LEVEL 5.9468 IN END LEVEL 5.3273 IN END TIME 9:39 AM LEAK THRESHOLD 0.002 IN END DATE 08/09./2006 TEST RESULT PASSED END LEVEL 5.9452 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED 08/09/2006 9:56 AP .SUMP LEAK TEST REPORT DIESIEL fl8/09�2000 10:4q TEST STARTED 0:41 AM TEST REPORT AM TEST. STARTED 08/09/2006 SUMP LEAP 9EGIN' LEVEL 6.5444 IN END TIME 5'56 AM REDDIES EkJD DATE 08/09/2006 TEST STARTED END LEVEL 6.5440 IN IN LEAK TEST BEGIN LEVEL D 58�99�2896 TEST RESULT O'PA85ED END TIME `.5546 IN 'ND DA TE 10:49 91FILL END LEVEL 08`39.12096)m TEST RESE:)iOLD 6 002 IN TEST STARTED 9:41 AM ULT PASSED TEST STARTED 08/09/2006 BEGIN LEVEL 5.9449 AM ^7FILL END TIME 089/2006 ST END DATE 5.9443 IN TE STARTED END LEVEL TEST STARTED 10:34 AN LEAK THRESHOLD 0.002 IN SEr,.iN LEVEL 08/69/'1 TEST RESULT PASSED 006 END DATE 5 10:49 AM END LEVEL 08"092065 LEAK THRESHOLD 5.3271 IN TEST RESULT 0.002 IN PASSED i SB989 TESTING FAILURE REPORT SITE NAME: DATE: ADDRESS:��'� � �C``� �—ll Jy TECHNICIAN: 5TV 3J-P K�C5a�I_- CITY: SIGNATURE: c THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS: N Q N) �. LABOR: f j U N F_ I PARTS INTALLED: NAME: TITLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES`FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR 1 THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMANTAL FOR f 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 I CONVIENENCE. i r. i i ,III MONITORING SYSTEM CERTIICATION For Use By Ail Jurisdictions Within the State of California .-I In hot-in,Cirei.- Chapter 6.7, Health and Suety Code; Chapter 16, Division 3, Title 23, Cal fornia Code of'Regularions l'his form must be used to document testing and servicing of monitoring equipment. A separate certification or report must ba prepared ix fact nionimrinr= system control panel by the technician who performs the work. A copy of this form must be provided to the tank s}.stinl owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 10 d.;ys of rest date. 3�pO1� : . General Information U 000 I r Facility Name: f14PC? 64-5 Bldg.No.: Jitc _-�,ddress: -? j/_7- City: /Ec, Zip: � l cilitl Contact Person: Contact Phone No.: Lmal,_Model of Monitoring System: 7—L6 -350 Date of Testing/Servicing: /dLS- ly. Inventory of Equipment Tested/Certified � p n t:l; ri:rlic ; /i >>ro riate boxes to indicates specific equipment menr ins tected/serviced: e) -us G7v i �-- II' T:ant,iv: 0A.1LY7 Tank ID: W/-79y lrr-l':wl,Gau,,ing Probe. Model:/ X In-Tank Gauging Probe. Model: ij Q _\IlnLI[af apace or Vault Sensor. Model: ❑ Annular Space or Vault Sensor. Model: Piping,Sunlp/Trench Sensor(s). Model:�Y_ ;i�Piping Sump/Trench Sensor(s). Model: fill Sump Sensor(s). Model: XFill Sump Sensor(s). Model: II Q (t1eCh.Lnical Line leak Detector. Model: ❑ Mechanical Line Leak Detector. Model: ❑ 1:1CCII'OraiC 1_ine Le,aJ.Dereaor. Model: ❑ Electronic Line Leak Detector. Model: 0 Lank Overfill/High-Level Sensor. Model: ❑ Tank Overfill/High-Level Sensor. Model: __ I LD-r)rher s eci!,z ui ment r e and model in Section L on Page 2). ❑ Other s eci' equipment t e and model in Section E on Pa 4 2). Tau1,1D: pJ F S iC L _ Tank ID: &E.O in-1'iiil:Gauging Probe. Model: 7/ In-Tank Gauging Probe. Model:1� I J _-�ruiular Space or Vault Sensor. Model: ❑ Annular Space or Vault Sensor. Model: _ it Pip;no sump/Trench Sensor(s). Model: Piping Sump/Trench Sensor(s). Model: _ I� >l•ill Sump Sensor(s). Model: A Fill Sump Sensor(s). Model: li a rL lcchwiical Line Leak Detector. Model: ❑ Mechanical Line Leak Detector. Model: U t:lccrrunic Line Leak Detector, Model: _ ❑ Electronic Line Leak Detector. Model: t=1 0 verfill/High-Level Sensor. Model: ❑ Tank Overfill/High-Level Sensor. Model: L-1 urh,f;ispecih equipment ui menr tv e and model in Section E on Pa 'e 2 . ❑ Other(s eci e ui ment a and model in Section E on Pave 2). l - . - -.I .Dispenser ID: __ I — _ Dispenser ID: 3 -�_`/ Dispctrser Containment Sensor(s). Model: 4J6 S L SU , Dispenser Containment Sensor(s). Model: , lIk Shear Valve(s). 5A Shear Valve(s). it la L„Ecnser Containment Floats and Chain(s). ❑ Dis enser Containment Floats and Ch ain(s), I Dispenser Ill: Dispenser ID: Dispenser Containment Sensor(s). Model: 4f 0 S Q QfL �3 Dispenser Containment Sensor(s). Model:. �4 Shear Valve(s). V Shear Valve(s). I, U Ciispmser Containment Floa(s)and Chain(s). ❑ Dis enser Containment Floats and Chains . ill Dispenser ill: 1 Dispenser ID: I 1)up�ns r Containment Sensor(s). Model: FA ❑ Dispenser Containment Sensor(s). Model: 4 slicar Valve(s). ❑ Shear Valve(s). l L7Di;p,�Jlser Colmuinment Floats and Chain(s). ❑ Dispenser Containment Floats and Chain(s). °1r rhe ri;cilhy contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the faoiliry. Via'.rtifieation-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 a mpment capable of generating such reports, t have also attached a copy of the report; (check all that apply) System set-up rm history report 1'echniciarr Name (print): QtJi4�V W1�'SC9'V Signature: I Certification No.: 06 Y):-7 License. No.: 61/D40— # 809850 1•esrin`CompwivName: RICH ENVIRONMENTAL Phone No.:(6 6 1 ) 392-8687 1:Af' t 8211 V gA-X.Ct5C1,6&Q; 64 Date of Testing/Servicing: Page I of 3 031 01 ltlorlialrino System Certification ;iy. i:tsufts of Y eating/Servicing »fr Version lnsratled: I N U Coii,I AvtL: cite fuilowing checklist: s ❑ No;1 Is die audible alarm o erational? 'I ❑ No* Is dle visual alarm operational? ` 0 No* Were all sensors visually inspected, functionally tested, and confinned operational? _ ❑ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipmzn.t tvil.l it II I not interfere with their proper operation? -- Ls 1 cs ❑ No* if alarms are relayed to a remote monitoring station, is all con-ununicatlons equipment (e.g. 111011Cn1) lam'N/A operational? I; 'i s ❑ No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary coatainjoetir 0 N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? if yes: which sensors initiate positive shut-down? (Cheek cd/that apply) k Sump/Trench Sensors; ❑ Dispenser Containment SBnSDr3. Did you confirm positive shut-down due to leaks sensor failure/disconnection? Yes; ❑ No. i U l:s ❑ No* For rank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no t ( N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at rho. rani: I _ till oint(s)and operating properly? if so, at what percen t of tank capacity does the alarm nxigoer? ru Z�s� t9 No Was any monitoring equipment replaced? If yes, identify specific sensors,probes, or other equipment replacr:rl _ and list the manufacturer name and model for all replacement parts in Section E,below. J 1's'" No Was liquid found inside any secondary containment systems designed as dry systems? (Check nll that aph,� 0 II _ Product ❑ Water. If yes, describe causes in Section E, below. _X 1'�s L-1 No* Was monitoring system set-u reviewed to ensure proper settings?Attach set tip reports, if applicable ---i 9 Yes ❑ No* is all monitoring eclLtipment operational 2er manufacturer's specifications) Iu Section E below,describe how and when these deficiencies were or will be corrected. C. 1}ff1f11�YYt5: Page of Gauging/SIR Equi*nt: Check this box if t4auging is used only for inventory cuntrul. ❑ Check this box if no tank gauging or SIR equipment is installed. This section muse be completed if in-tame gauging equipment is used to perform leak detection monitoring. coii,LL�ie the i'ollowing checklist: _U s ❑ No* Has all input wiring bees, inspected for proper entry and termination, including testing for ground faults? �I L3 '1�.� ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? U i Q NO Was accuracy of system product level readings tested? U Z'cs Q No* Was accuracy ofsysrem water level readings tested? U 1 cs ❑ No* Were all probes reinstalled properly? ( U Y :s ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? .n itrr Sr etion H, below,describe how and when these deficiencies were or will be corrected. C., Lin iLealc Detectors (LLD): Check this box if LLDs are not installed. C:u�,i Mere the following checklist: Y,cs ❑ No* For equipment start-up or aruival equipment certification, was a leak simulated to verify LLD performance ❑ N/A (Check all than apply) -Simulated leak rate: ❑ 3 a p.h.; ❑ 0.1 g.p.h ; ❑ 0.2 g.p.h. I I Cl Yes ❑ NO Were all LLDs confirmed operational and accurate within regulatory requirements? ❑ 1 es ❑ No* Was the testing apparatus properly calibrated? ❑ Yes ❑ 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 L� Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled j ❑ N/A or disconnected? U Y fs ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system malfuncrions j ❑ N/A or fails a test? Ll Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? !I ❑ N/A _ U Yes ❑ No* Were all items on the ec;_uipment manufacturer's maintenance checklist completed? irr fire Section H, below,describe how and when these deficiencies were or will be corrected. 1-1. Comments: - -- ..___.-_ STS-710-� r�►i�.ye��,�.2 �-c�J�ofLr-►,�J� � h��� r�JC L 1�....�.. _ Page 3 of 3 03411 AN,ioairoring System Certification UST Monitoring Site Plan Site--'Wdi-ess: 81 /+"i P,+9a2,S EILL Of 4k?3 12 jr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . . .* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . %. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q . . . . . . . . . . . . . . . . . . . . . . W . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . C . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0-3 . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .-- Date map was drawn: Instructions If ou already have a diagram that shows all required 0 ed information, you may include it, rather than this page; with our 1r 1""1011 Loring System Certification. On your site plan, show the general layout of tanks and piping. Clearly ldenid-� n locarions of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular SPLICes, Sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic title leak deiecfors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan prepared. Page �L of t • e MONITOR CERT . FAILURE REPORT SITE NAME: Y ��/�'� DATE: ADDRESS: a '� �'' TECHNICIAN: el CITY: ^ �� V SIGNATURE: SITE CONTACT: THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE THE MONITOR CERTIFICATION TESTING. LIST OF PARTS REPLACED/REPAIRED: : REPAIRS: LABOR: PARTS INSTALLED: i I 1;- 1�a-rf:iilk Gauging/ SIR Equi#nt: Check this box iftaleauging is used only for inventors' control. D Check this box if no tank gauging or SIR equipment is insralled, l'17ls sec don must be completed if in-tank gauging equipment is used to perform leak detection monitoring. tlie i'ollowing checklist: O s U No* Has all input wiring beet, inspected for proper entry and termination, includ'u-ig testing for ground faults? L3 ';cs ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? 0 Nu* Was accuracy of system product level readings tested? l� 7,s ❑ No* Was accuracy of system water level readings tested? FCTZ es ❑ No* Were all probes reinstalled properly? U Y ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed'? lu Mir srction H, below,describe how and when these deficiencies were or will be corrected. ��- i ine Leant Detectors (LLD): Check this box if LLDs are not installed. 0011.1 Mere rile 1'0110win checklist: 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.; O 0.1 g.p.h ; ❑ 0.2 g.p.h. I _ I ❑ Yes Cl No* Were all LLDs confirmed operational and accurate within regulatory requirements? w —� ❑ 1 es ❑ No* Was the testing apparatus properly calibrated? l- ❑ Yes ❑ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? �. _ ❑ N/A I ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if the LLD detects a leak? _ ❑ N/A 0 Yes ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ❑ N/A or disconnected? j 1"ts ❑ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions j ❑ N/A or fails a test? D Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? ,I _ ❑ N/A Ll i es ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? In rite Section H, below,describe how and when these deficiencies were or will be corrected. Jl�t. �oil�Ynetyts: 'lap Page 3 of 3 03-i?t oil Ajoaitoriiig System Certification UST Monitoring Site Plan . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' . . . . . . * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . j . . . . . . . . . . . . . . . 14 . . . . . b . . . . . . . . . . . . . . . . . . . . . . . . . . . ".. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . . .0 . . . . . . . . . . . . . . . . . . . 0 .0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . Fr . . . . . . . . . . . . . . . . . . . . . Dace map was drawn: Instructions If N ou already have a diagram that shows all required information, you may include it, rather than this pacre, with our ivl�uitoring System Certification. On your site plan, show the general layout Of tanks and piping. Clearly identifY loczirlons of the following equipment, if installed- monitoring system control panels; sensors monitoring tank WIIILOar Spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line ieak deTeciors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plall ,,\•as prepared. Page • • 0 • • MONITOR CERT . FAILURE REPORT SITE NAME: j4jQ n 6A:S DATE: 0 C ADDRESS: a3 TECHNICIAN: CITY: , �� V SIGNATURE: j� SITE CONTACT: THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE THE MONITOR CERTIFICATION TESTING. LIST OF PARTS REPLACED/REPAIRED: : REPAIRS: LABOR: PARTS INSTALLED: i I COMMUNIO ONS SETUP • T 2:REG UNLEADED 87 SOFTWARE REVISION LEVEL - _ - - - - _ - -IN-TANK SETUP PRODUCT CODE 4 VERSION 14.01 - - - - - - - - - - - - THERMAL COEFF : .000700 SOFTWARE# 346014-100-]3 TANK DIAMETER 95.00 PRODUCT T CODE 0 CREATED - 97.0.12.20.41 FORT SETTINGS: T 1 :DI RED TANK PROFILE 1 PT O NO :SOFTWARE MODULE (RS-232) THERMAL COEFF : .000470 FULL VOL 11783 CONY°t BOARD : 1 SYSTEM FEATURES: BAUD RATE 9600 TANK DIAMETER 95.00 PERIODIC IN-TANK TESTS PARITY ODD TANK PROFILE I PT FLOAT SIZE: 4.0 IN. 8496 ANNUAL IN-TANK TESTS STOP BIT 1 STOP FULL VOL 11783 DATA LENGTH: 7 DATA WATER WARNING 2.0 FLOAT SIZE: 4.0 IN. 6496 HIGH WATER LIMIT: 4.0 AUTO TRANSMIT SETTINGS: WATER WARNING 2.0 MAX OR LABEL VOL: 11783 HIGH WATER LIMIT: 4.0 OVERFILL LIMIT 97% AUTO LEAK ALARM LIMIT 11429 DISABLED HIGH PRODUCT 95% OVERFILL AUTO HIGH WATER LIMIT MAX LABEL VOL: 1197% LL LIMIT 97°r; 11193 DISABLED DELIVERY LIMIT 17% AUTO OVERFILL LIMIT 1195% , SYSTEM SETUP _ _ DISABLED HIGH PRODUCT 95% X003 - - - - 111 AUTO LOW PRODUCT LOW PRODUCT 330 AUG 9..9.. 'x'005 1'2:00 DISABLED DELIVERY LIMIT 17%7% LEAK ALARM LIMIT: 99 AUTO THEFT LIMIT 2003 SUDDEN LOSS LIMIT: 99 DISABLED LOW PRODUCT 330 TANK TILT 0.00 S AUTO DELIVERY START � LEAK ALARM LIMIT: 99 �':YST'ENt UNITS DISABLED I IA1V I FOLDED TANKS U.S. AUTO DELIVER`! END SUDDEN LOSS LIMIT: 99 T#'. NONE SYSTEM LANGUAGE DISABLED TANK TILT 0.00 ENGLISH AUTO EXTERNAL INPUT ON SYSTEM DATE/TIME FORMAT DISABLED IFOLDED TANKS TO: LEAK MIN PERIODIC: 0% MON DD YYYY HH:MM:SS . AUTO EXTERNAL INPUT OFF NONE 0 DISABLED kMI:IN CENTER AUTO SENSOR FUEL ALARM LEAK MIN PERIODIC: 0%; LEAK MIN ANNUAL 0% 3221TAFT HWY DISABLED 0 BAK C•A.93313 AUTO SENSOR WATER ALARM 0 DISABLED LEAK MIN ANNUAL 0% AUTO SENSOR OUT ALARM 0 PERIODIC TEST TYPE SHIFT TIME 1 4:35 AM DISABLED STAtDARD SHIFT TIME 2 DISABLED SHIFT TIME 3 DISABLED PERIODIC TEST TYPE ANNUAL TEST FAIL SHIFT TIME 4 DISABLED STANDARD ALARM DISABLED PERIODIC TEST WARNINGS PERIODIC TEST �A`I°L` ,...i. DISABLED RS-'232 SECURITY ANNUAL TEST FAIL ' ALARP1 DISABLED ANNUAL TEST WARNINGS CODE : 000000 ALARM DISABLED DISABLED GROSS TEST FAIL PERIODIC TEST FAIL ALARM DIS"BLED PRINT '1'C VOLUMES ALARM DISABLED. ENABLED GROSS TEST FAIL ANN TEST AVERAGING: OFF ALARM DISABLED PER TEST AVERAGING: OFF TEMP COMPENSATION RS-232 END OF MESSAGE I VALUE (DEG F ) : 60.0 ENABLED TANK TEST NOTIFY: 1 OFF ANN.TEST AVERAGING: OFF H-PROTOCOL DATA FORMAT PER TEST AVERAGING: OFF TIVK TST S I PHOIV BkEA) :OFF HEIGHT TANK TEST NOTIFY: OFF RE-DIRECT LOCAL PRINTOUT DELIVERY DELAY a MIN DISABLED TNK TST SIPHON BREAK:OFF DELIVERY DELAY 3 MIN T, 3:SUPT-R UNL 92 T 4:D I E,. , 2 OUTPUT RELAY SETUP PRODUCT CODE 6 PRODUCT S 3 LIQUID SENSOR SOP _ - - - - - - T - I - - THERMAL COEFF : .000700 THERhIAL EFF : .000470 TANK DIAMETER 95.00 TANK DIAMETER 95.00 _ _- - - - R 1 :RED DSL TANK PROFILE 1 PT TANK PROFILE 1 PT L I :FILL RED DSL TYPE: FULL VOL 11763 FULL VOL : 11753 TRI-STATE (SINGLE FLOAT) NORMALLY OPEN CATEGORY : OTHER SENSORS FLOAT SIZE: 4.0 IN. 8496 FLOAT SIZE: 4.0 IN. 8496 IN-TAIVK ALARMS WATER WARNING : 2.0 WATER WARNING 2.0 L 2:STP RED DSL T 1 :LEAK ALARM HIGH WATER LIMIT: 4.0 HIGH WATER LIMIT: 4.0 TRI-STATE (SINGLE FLOAT) ALL:LOW PRODUCT ALARM CATEGORY : OTHER SENSORS LIQUID SENSOR..ALMS MAX OR LABEL VOL: 11783' MAX OR LABEL VOL: 11783 ' OVERFILL LIMIT 97% OVERFILL LIMIT 97% L 2:FUEL ALARM 11429; 11429 L 2:SENSOR OUT ALARM HIGH PRODUCT 95%: . HIGH PRODUCT 95a L 3:REG FILL L 1 :SHORT ALARM L 2:SHORT ALARM 11193' 11193. TRI-STATE (SINGLE FLOAT) DELIVERY LIMIT 17X' DELIVERY LIMIT 17% CATEGORY : OTHER SENSORS 2003 2003 R 2:REG UNLEADED LOW PRODUCT 330 LOW PRODUCT 330; TYPE: LEAK ALARM LIMIT: 99 LEAK ALARM LIMIT: 99' L 4:STP REG UNL STANDARD SUDDEN LOSS LIMIT: 99 SUDDEN LOSS LIMIT: 99 TRI-STATE (SINGLE FLOAT) NORMALLY OPEN' TANK TILT 0.00 TANK TILT 0.00 CATEGORY : OTHER SENSORS hIANIFOLDED TANKS MANIFOLDED TANKS IN-TANK ALARMS T#: NONE T#: NONE T 2:LOW PRODUCT A ARh1 T 2:INVALID 'FUEL L 5:FILL SUPER UNL EVEL LEAK MIN PERIODIC: Oi TRI-STATE (SINGLE FLOAT) LIQUID SENSOR' ALHE LEAK hIIN PERIODIC: Of CATEGORY : OTHER SENSORS L 2:FUEL ALARM 0 0 L 4:FUEL ALARM LEAK MIN ANNUAL 0% LEAK MIN ANNUAL Oi L 2:SENSOR O;UT. AL RM 0 L 1 :SHORT %ARM L 6:STP SUPER SUMP L 2:SHORT AL ARM TRI-STATE (SINGLE FLOAT) PERIODIC: TEST TYPE PERIODIC TEST TYPE CATEGORY : OTHER SENSORS STANDARD STANDARI R 3:SUPER UNLEADED TYPE: ANNUAL TEST FAIL ANNUAL TEST FAIL STANDARD ?' L 7:FILL SS1F DSL 2 NORMALLY OPEN ALARM DISABLED ALARM DISABLE TRI-STATE (SINGLE FLOAT) PERIODIC TEST FAIL PERIODIC TEST FAIL CATEGORY : OTHER SENSORS ALARM DISABLED ALARM DISABLEI IN-TANK ALARMS T 3:LOW PRODUCT A ARM GROSS TEST FAIL GROSS TEST FAIL T 3:1NVALID'FUEL EVEL ALARM DISABLED L B:STP DSL 2 ALARM DISABLEI. TRI-STATE (SINGLE FLOAT) LIQUID SENSOR ALM ANN TEST AVERAGING' OFF ANiV TEST AVERAG 1 iVG: OF) CATEGORY. : OTHER SENSORS L 6:FUEL ALARIH PER TEST AVERAGING: OFF PER TEST AVERAGING: OFI TANK TEST NOTIFY: OFF TANK TEST NOTIFY: OFF R 4:DIESEL 2 TYPE: TNK TST SIPHON BREAK:OFF TNK TST SIPHON BREAK:OFF STANDARD NORMALLY OPEN DELIVERY DELAY 3 hI I fi DELIVERY DELAY 3 MIN cl IN-TANK ALARMS T 4:LOW PRODUCT f LARM T 4:1NVALID;FUEL �LEVEL LIQUID SENSOR ALMS L 6:FUEL ALARM �I R 5:COUNTER ,LIGHT TYPE: STANDARD LEAK TEST METHOD NORMALLY OPISN TEST WEEKLY : ALL TANK SUN IN-TANK ALA MS 4A START TIME ALL:LEAK A RhI 2:00 AM ALL:LOW PR 'DUCT ALARM TEST RATE :D.20 GAL/HR AL'L:INVALI �'. FUEL.LEVEI DURATION 2 HOURS ALL:PROHE UT ALL:DELIVE Y NEEDED LEAK TEST REPORT FORMAT LIQUID SENS R ALMS ENHANCED ALL:FUEL A ARM ALL:SENSOR OUT ALARM ALL:SHORT �LARM n • .in•rnn 7 nfllul LHRI°l HISTORY REPORT ALARM HISTORY REPORT ALARM HISTORY REPORT ----- SYSTEll ALARM ---• ---- IN-T*ALARM --- ----- SENSOR ALARM -# PAPER OUT n L 2:STP RED DSL � ALARM HISTORY REPORT JUL 28., 2005 5:39 T 3:SUPER UNL 92 OTHER SENSORS PRINTER ERROR FUEL ALARM ----- SENSOR ALARM ----- JUL 26. 2005 5:39 INVALID FUEL LEVEL JUN 16. 2000 15:28 L 6:STP SUPER SUMP FATTER,'I IS OFF APR 14. 2005 12:26 OTHER SENSORS JAN 11 1996 8:00 PROBE OUT FUEL. ALARM FUEL ALARM JUN 12. 1998 12:22 JUN 9. 2003 0: 16 APR 14, 2005 12:29 APR 14. 2005 10:01 FUEL ALARM I. FUEL ALARM DEC 28. 2003 6: 10 JUN 12, 1998 10:20 JUN 16. 2000 15:16 DELIVERY NEEDED FUEL ALARM FEB 10, 19 AUG 7. 2005 22:33 99 11:39 JUL 27, 2005 19:33 JUL 18, 2005 6:48 ALARM H I STORY REPORT --- IN-TANK ALARM --- LOW TEMP WARNING APR 14. 2005 12:38 T 1 :DIESEL RED ALARM HISTORY REPORT INVALID FUEL LEVEL ----- SENSOR ALARM ----- JUN 27. 2003 10: 12 L 3:REG FILL ALARM HISTORY REPORT JUN 19. 1998 17: 16 OTHER SENSORS JUN 12. 1998 8:41 SETUP DATA WARNING ----- SENSOR ALARM JUN 12. 1998 8:00 L 7:FILL SUMP DPL 2 -I PROBE OUT OTHER SENSORS DEC 28. 2003 6: 10 FUEL ALARM i APR 24. 2005 1 :10 ALARM HISTORY REPORT DELIVERY NEEDED FUEL ALARM AUG 1 . 2005 5:43 ---- IN-TANK ALARM -- DEC 25, 2003 9:53 FEB 8, 2005 7:07 DEC 13., 2004 15:25 T 4:DIESEL 2 SETUP DATA WARN I,NG JUN 12. 1998 8:'00 OVERFILL ALARM APR 17. 2005 12:36 ALARM HISTORY REPORT NOV 12, 2000 5:10 AUG 23. 2000 3: 14 ----- SENSOR ALARM ----- L 4:STP REG UNL HIGH PRODUCT ALARM OTHER SENSORS APR 17. 2005 12:36 SENSOR OUT ALARM NOV 12. 2000 5:09 MAY 9. 2005 17:01 AUG 23, 2000 2:52 FUEL ALARM FUEL ALARM HISTORY REPORT INVALID 2005 LEVEL DEC 26. 2002 . 10:38 ALARM HISTORY REPORT --- IN-TANK ALARM --- APR 1 . 2004 6:57 FUEL ALARM ----- SENSOR ALARM ---!-- AUG 1 . 2003 18:27 JUN 16. 2000 15:20 L B:STP DSL 2 ! T ':::REG UNLEADED 87 OTHER SENSORS I PROBE OUT FUEL ALARM OVERFILL ALARM DEC 28.- 2003 6: 10 JUN 16. 2000 14:47 ! JUN 22. 2005 6:59 OCT 14. 2003 19:46 FEB 27. 2004 5:02 SEP 15. 1998 12:44 FUEL ALARM JUL 8, 2003 5:17 JUN 12. 1998 12: 1 HIGH PRODUCT ALARM DELIVERY NEEDED FUEL ALARM JUN 22. 2005 6:58 JUL 16, 2005 11 :50 JUN 12, 1998 10:2;4 FEB 27, 2004 5:02 JUN 23, 2005 13:27 JUL S. 2003 5: 16 JUN G. 2005 9:0.1 ALARM HISTORY REPORT INVALID FUEL LEVEL ----- SENSOR ALARM ----- APR 14. 2005 14:53 L 5:FILL SUPER UNL APR 4, 2005 5:21 OTHER SENSORS MAR 14. 2005 14: 10 FUEL ALARM APR 23. 2005 23:30 PROBE OUT APR 14. 2005 13:20 FUEL ALARM APR 14.. 2005 10:45 DEC 25, 2003 15:54 ALARM HISTORY REPG?RT DEC 28. 2003 6: 10 FUEL ALARM ----- SENSOR ALARM ----- ALARM HISTORY REPORT' FI€H 1..2. 2003 18:56 9 1.: DELIVERY NEEDED OTHER SENSORS AUG 6, 2005 7:11 ----- SENSOR ALARM -- JUL 27, 2005 14:44 L 1 :FILL RED DSL JUL 13. 2005 7:38 OTHER SENSORS { SETUP DATA WARNING JUN 12, 1998 8:00 j LOW TEMP WARNING JUN 12, 1998 15:02 ----- SENSOR ALARM - L B:STP DSL 2 OTHER SENSORS FUEL ALARM AUG 9, 2005 12:28 ALARM ----- L 7:F i 1.1. SUMP DSL 2 OTHER ;SENSORS FUEL ALARM AUG 9, 2005 12:29 ----- SE(2,oR ALARM ----- L 3;REta �F;1LL OTHER .SEI+I-;C>R:j FUEL ALARM AUG - 9, 2005 12:34 i --- SENSOR ALARM ----- L G:STP SUPER SUMP OTHER SENSORS FUEL ALARM AUG 9. 2005 12:31 ----- -SENSOR OLARM ----- L 5:FILL`;SUPER UNL OTHER jSENSORS' FUEL; ALARM` I AUG 9, 20,05 12:34 I ----- SENSOR ALARM ----- L 4:STP REG UNL I OTHER SENSORS FUEL ALARM AUG 9. 2005 12:31 r . i ----- SENSOR ALARM ----- L :STP RED DSL OTHER SENSORS FUEL ALARM AUG 9, 2005 12:33 ----- SENSOR ALARM ----- i. L 1 :FILL RED DSL OTHER SENSORS FUEL ALARM AUG 9, 2005 12:33 i ,I 1'HUC u� CAL VALLEY 09i 0y�°2004 09:17 6613252529 t '001� � . .� CAL VALLEY EQUIPMENT 3500 Gilmore Ave Bakersfield, Cs 93308 661-327-9341 Fax 881-325-2528 IIMPRE$SED CURRENT CATMOD c PROTECTION CERnr-1CA77ON [GATE: 47�?-QE/ SITE: & GQ . CONTACT: � '"1• I T�{t! _,._, PHONE: �'•�9 �/Et9Y�'c Installation Date: ? Model 0 SS:T.....— Serial Hours: S6I00 Voltage: Amps: Adjustment: *1 Caar_c Course: Fine: � Structure to Soil Potential Readings For Previously Installed Systems(System OR j Tank 1, Tank Fuel Product Vent S or E I Center I N or W Electronlc Number size Type I Line I Line landotTankiof Tank End of Tan Condult Z• t Oi.v 2�+t — m —6 1 —.G r —G • si J%V ^y fe Vi'A jl2tl q/ I' !�r n -ri %&IV- J/W St.• t/ 5 p v '/» — k� -1C Structure to Sall Potential Readings For Previously Installed Systems ($yetem On) Tank Tank I Fuel Pmduct Vent 1 8 or E Center I N or W JElectronlel Number Size Type Line Line End of Tank of Tank MndofTenkl Condult -11792 VA t 00 1fti 12 -112 V AT t — a — ►ti t,. —!e v JUM all I hereby certify that the minimum system potential requirements for Impressed Current Cathodic Protection: • � Have Seen Met / ! �Cu L(i I•tg 9W-C !k CS E Have Not Been Met for the systems referenced above:taken In accordance with the minimum standards of the National Assoclatlon of Corrosion Engineers, and as done to comply with EPA and State Directives Technician Performing TA I w �� ,� ,. ., i� �I I SecondarWontainment Testing Rep.* Form 3 X--n tf' This form is intended for use by contractors performing periodic testing of UST secondary)containment systems. Use the 1-ippropriate pages of this form to report results for all components tested The completed form, written test procedures, and prinrozuts fi•oin tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION f=acility Name: I- Date of Testing: - g f=ac.ili I Address: -7 La f=acility Contact: Phone: Date Local Agency Was Notified of Testing Name of Local Agency inspector if present during testing}: _ 2. TESTING CONTRACTOR INFORMATION C:oinpany Name:R.I CH ENVIRONMENTAL 'Technician Conducting Test: V-0—S 1A a Credentials: 19 CSLB Licensed Contractor ❑SWRCB Licensed Tank Tester License Type. C611D40 License Number: 809850 1Man-efaaturer Igaining --Manufacturer Manufacturer Corn onen s Date Training Expires INCON INCON TS-STS 8/04: 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Repairs Component PASS Fail Not Repairs _ Tested Made Tested Made '_t�N� (� ❑ ❑ ❑ ❑ ❑ ❑ °!1 -A ❑ ❑ ❑ C ❑ ❑ ❑ = ❑ ❑ P9 ❑ I . 0 W ❑ o ❑ ❑ ❑ ❑ ❑ ❑ ❑ - A 0 ❑ ❑ 9 - 1A ❑ ❑ ❑ - S C ❑ ❑ ❑ A ❑ El 0 I. 1AA4 - ❑ ❑ ❑ QED - , ❑ a ❑ ,W:n ❑ P ❑ ❑ ❑ Q ❑ �P ►1�I S� ® ❑ ❑ ❑ a - ❑ o ❑ 0 ❑ ❑ 11 - ❑ ❑ ❑ ❑ ❑ ' � ❑ o ❑ If hydrostatic testing was pe firmed,describe what was done with the water after completion of tests: RECYCLE AND REUSED CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING lit the nest of my knowledge,the facts stated in this document are accurate and in fall compliance with legal requirements l eC1ll11CLaI1's SigrLal'ur Date: Pooz z and S WIZCB, January 2002 Page of - _ 4. TANK ANNULAR TESTING _....,.ate... Test McEll6d Developed Dy: ❑Tank Manufacturer )Industry Standard 0 Professional Engineer - -� - O Other(Spew)) Tesr Method Used: 0 Pressure M Vacuum ❑Hydrostatic 0 Other(Speci6) Test' quiptmentUsed* 41n. DIAL GAUGE Equipment Resolution: .5% Tank# Tank# S c�I�SL -rn Tank# Tank## Is Tank Exempt From Testing?' es O No nes O No A i'es O No kyes r]No Vank Capacity: Tank Material: I'ank Maliufacwrer: IIrodact Stored: )Fait time between applying hressurelvacuumiwater and ararting test: tQO AN 11-J A111 V Pft1Jj1C fi _ "feat Start Time: Initial Reading(Rt): Test I ndlTime: final Reading(R,:): 1'est DUriltioll: -Change in Reading(RF-RO: Pass/Fail Threshold or Criteria: `rest Result: ❑ Pass O Fail ❑ Pass ❑Fail D Pass D'Fail D Pass, O Fail Was sensor removed for testing? D Yes O No ❑NA ❑Yes ❑No DNA ❑Yes D No 0 N O Yes D No O NA Was sensor properly replaced and ❑Yes 0 N 0 N ❑Yes 0 N DNA ❑Yes ❑No DNA ❑Yes ONo DNA veriFed functional after testing? Co III 111� ltts — (include information.on repairs made prior to tesl#!g, and recommended ollow-tot for ailed tests) W._ I.A.1h 16 Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are bydrosta.tically monitored or under constant vacuum,are exempt from periodic containment eel _, (I-A. ­PD-milatinnc Title.?.;_ Section 2637(a)(6)1 SWRCB, )alWary 2002 ® Page of 5, SECONDARY PIPE TESTING Test Method Developed By: ❑Piping Manufacturer _j Industry Standard ❑Professional Engineer __ ❑Other(Specie) ]Test Method Used: :0 Pressure ❑Vacuum ❑Hydrostatic ----..._-_. ❑Other(Specify) t'es1Equipme-ntUsed: 4in.. DIAL GAUGE Equipment Resolution: .5% 7. n s r} Piping Run 51AII Pipiag Rwn Piping Ran# Piping Run: Piping Material: Pip in.g Manufacturer: Piping Diameter: L.engtll of Piping Run: Product Stored: Method and location of P.Titig_run isolation: Writ time betmeen applying pressure/vacuum/water and / starting test: Test Start Time: initial Reading(Rj): Test End Tune: — Final Reading(RF); Test Duration: Change yin Reading(RrR�: Pass/Fail Threshold or Criteria: �l _ Test RL-sult: ❑ Pass Ail ❑Fail d Pa s ❑Fail Pass ❑Fail Comments- (include information on repairs made prior to testing, and recommended follcww=up for failed tests) - ._�k�.....�i�.i SWRCB, January 2002 • Page of 7 _ 6. PIPING SUW TESTING II Tesr Metliod Developed By: O Stump Manufacturer &Industry Standard O Professional,En&eex ` l — — O Other (Specify) 'Pest Methbd Used: O Pressure O Vacuum fl Hydrostatic O Other(Specify) 'Test I;Llm`anent Used: INCON TS-5jg TS-5j Equipment Resolution: . 0 0Dttt # Sump# SumSurn # Sump Sump Diapneter: 73&`t Sttrp Depth: Sump Material: 10,06"d, a5 llui�r,ht from Tank Top to Top of 3i it 3 1% Hichdst Pi in .Penetration 1 iei`tu from Tank Top to Lowest t t C t t [liectrical Penetration: L Condition of sump prior to testing: L' ---&,h tq� n Portion Of Stump Tested' (36 a�`^ '3 0-�-4-�''°"t } C v-A Does turbine shut down when sump sensor detects liquid(both O Yes O No �NA O Yes, O No I(NA O Yes O No IP(NA O Yes O No I�NA product and water)?# Turbine shutdown response time Is system;programmed for fail-safe shutdown'? O Yes O No *A. O Yes O No ANA O Y O No .I�NA O Yes ONO �NA _ � Was fail-safe verified to be Dyes O No )kNA O Yes O No kNA O Yes O No 9(NA O Yes O No OA u eranonel?* Wait time between applying pressu eNvacuwunlwater and starting lest. Test Stare Tune: Initial ReadinS(Ri) Pest End Time: `� ; f 9, 3 l� `t`: 17- 50 1:i j� 9:3 b `x' 3 0 Final Reading(Rf): 3•�t�f: 3.717; �.1�3;w (�:�13;u .�("�- .�17��, y �,h .�a�;N Tesr Dw-ation: Change in Reading(RF-Ri): .00 001" V, .0 U0i t4 pUb,v, .bout V .O(jb"u Pass/Fail;Threshold or Criteria: ,;./ `,� ',✓ c ice✓ Test Result: IV Pass O fall Pass O Fail Bo"Pass O Fail IPPass O Fail Was sensor removed for testing? MYes O No O NA loxes O No O NA Q Yes O No DNA IOYes O No DNA Was sensor properly replaced and N Yes O No O NA ,VYes O No DNA VYes O No O NA VYes O No O NA verified functional after testin ? Comments— (include information on repairs matte prior to testing, and recommendedfollow-up for failed tests) &(-A zmi •A2nuu ALi pr Ala paijau4tlays lAt)A5 Ae l If the entire depth of the stump is not tested,specify how much was tested. If the answer to AU of the questions indicated with an asterisk('K) is"NO"or"NA",the entire sump must be tested. (See SWRCB LG-160) of MZCB,Januaty 2002 Page^__ M �. _ 7. UNDER-DISPENSER CONTAINNUNT (UDCA STING Test Method Developed By: ❑UDC Manufacturer Industry Standard 0 Professional Engineer -!_ ❑Other(Specify) -Test Method Used: ❑Pressure ❑Vacuum 8 Hydrostatic - �- - O Other (Spec) Test Equipment Used: INCON TS-STS Equipment Resolution: .000in. MITI—0 .1 a(l ' T]DC# UDC# ;'' `> UDC# - G UDC# UDC Manufacturer: UDC Material: 1.e( t. e. +D L)P I 3 " •c:. Grp ti lleight from UDC Bottom to Top �tc of Hi (lest Piping Penetration: l le fight from UDC Bottom to lr� a I k Lowest Electrical Penetration: O Condition n of UDC prior to �� � test i n�: Portion of UDC Tested ov" m Does nu•bine shut down when UDC.sensor detects liquid(both O Yes O No KNA ❑Yes O No $ZJA ❑Yes ❑No IOTA O Yes C3 No 4A product and water)? _Turbine shutdown response time %is system programmed for fail-. p yes ❑No .4A O Yes ❑No J,NA ❑Yes O No �lA ❑Yes ❑No KNA sale shutdown.?* Was fail-safe verified to be p Yes ❑No 0,NA 0 Yes ❑No ANA O Yes ❑No �NA ❑Yes D.No 41 NA operational?' Wait time between applying `30 � ^j t^pressure/vacuum/water and starting test_ 'Pest Start Time: b: / /0:10 `110: 3D b V30 10,/ 0. _InitialkeadinR Ri): 4 3•S`Ih'► to-�3 4S3L. •3 .,, Ccst End Time: 10:30- 10.q-,C 16 -">0 b b: D 1 ID: rival Leading .Rr): -'l. ,K ~k 3Aet h^ I Z- -836 3 a 4,3 di Test Duration: / 'yv�` / n,ia -/3-m:k /S`�•e, /- i�.,n r^�:vt �Sv•%e. Change in.Reading jrR : . 00b,� rt70(),rn •D `� •O =K , 00 (kK Xoli t -a00i`� .U00; Pass/Fail Threshold or Criteria: >00 A w -002.1 h • Obli i,WL 00 ' LOo L oo NA Test Result: X Pass ©Fail Pass O Fail Pass ❑Fail 1K Pass O Fail Was sensor removed for testing? O Yes ❑No NA ❑Yes O No A ❑Yes ❑No NA ❑Yes ❑,No XNA Was sensor properly replaced and O Yes O No �NA O Yes ❑No ZNArDYes ❑No ANA ❑Yes O No X1 NA verified functional after testing? Ct;'mrnents - (include information on repairs made prior to testing, and recomnaetaded follow-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 trust be tested, (See SWRCB LG-160) S W LtCB,January 2002 Page ce of-1_ S. FILL RISER CONTAINNMNT SUMP TESTING Facility is Not Equipped With Fill Riser Containment Sums ❑ Fill Riser Containment SMEs are Present,but were Not Tested ❑ Test Method Developed By: D Sump Manufacturer 19Industry Standard ❑Professional Engineer ❑Other(Spec*) Test Method Used: ❑Pressure ❑Vacuum 9 Hydrostatic ❑Other(Spec) Tesi Equipment Used: INCON TS—STS Equipment Resolution: .0 0 0 i n Fill Senn 9VAX Fill sump # vh Fill Sump# Fill Sump, um # SUMP Diameter: (o 1 3C,+ 3 Sump Depth: too' Q' p" 6leig[it fron-,Tank Top to Top of Ili est Piping.Penetration: Reight from Tank Top to Lowest 3D+ 1 O ct 3� t Q . Elecu•ical Penetration: Condition of sump prior to Portion of Sump Tested SUMP Material: c O x.b-e—fU&A cc S Wait time between applying p � ressure/Vacuum/water and YL d Y`^ v\ �j ,�^� as titter test: r v ,l 3 0 Test Start Time: W00 ' f-DO ' l //t fjb '/ Initial Reading(R O: Cam.qcl-3 &-//I to•&I .6/ .6 f - Test End Time: 11!j5- . 'l!r M 0 )/ ' 30 Final Reading(R F): : Test Duration: Chan 7e in Readin C0 7 r h Pass/Fail _ Threshold or Criteria: .dp ," ),`v -oo , ,. -W,�-��, .abj i C, I-bn i L VU z' .aOa 'L,. Test Result: .,Pass ❑Fail Pass ❑Fail kPass ❑Fail Pass ❑Fail Is there a sensor in the sump? 2 Yes ❑Na Yes ❑No 19,Yes ❑No gYes ❑No Does the sensor alarm when either product or water is ❑Yes ❑No KNA ❑Yes ❑No ANA ❑Yes ❑No XNA ❑Yes ❑No XNA detected? Was sensor removed for testing? KYes ❑No ❑NA AYes ❑No ❑NA AYes ❑No ❑NA Yes ❑No ❑NA Was sensor property replaced and verified functional after testin ? )Q Yes ❑No ❑NA $,Yes 13 No ❑NA AYes ❑No ❑NA j<Yes ❑No 13 NA Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) . S W'RC.B,January 2002 Page -7 of ! _, 9. SPILL/OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ Spill/Overfill Containment Boxes are Present,but were Not Tested ❑ 'rest Method Developed By: ❑Spill Bucket Manufacturer 2 Industry Standard ❑Professional Engineer ❑Other(Specify) 'Pest Method Used: ❑Pressure ❑Vacuum 19 Hydrostatic ❑Other(Specify) 'rest Equipment Used: INCON TS-STS Equipment Resolution: -000 in. Spill Box Spell Box# Spill Box# Spill$ox# l3ucicet Diameter: Bucket Depth: '' " p� �• Wait time between applying pressure/vacuum/water and �''� +t^ -�L.J ►"'�+ �" 3 a �'�` "� a Y"� + srartirtg test: .rest Stmt Time: O A. 1 Initial Reading(RI): 1 _L, 1711. 16 w 3191d9,114 Gl rZ.col 3r tt -3l/iu !-�l i, Test land Time: '-4+� D'.1OA, 16 :f0 /� SS� /Q' +. 'S �Q' 0 Final Reading(R1): �,, f'7� 3-$�`�t`• 'J. aq '� d�.(o/3 'h -6�3 "� l/.N �/ `k Test Duration: / r�z G. / r,;r.� r.,'ti / w.�o. l �.:,.. / ,'a l5►�i, ,N,'� Chance in Reading(RF-R�: •boa OOOZ w -00011-N 000;"- -bOCJ'k ©DO," Pass/fail Threshold or ooX OD Criteria: l d� - t`^ co + �^ ©tea t Test Result: Pass ❑Fail Pass ❑Fail KPOSS ❑Fail Pass ❑Fail Coma nentts (include N6 matton on repairs made prior to testing, and recommended follow=up for failed rests) SW L-CB,]arurarV 2002 Page f of Secondary Containment Testing Report Form 7Mils fi))-in iS ii7rO17ded for use by contractors performing periodic testing of UST secondary containment systems. Use the tare pa-es of this form to report results for•all components rested The completed form, written testprocedures, and P1 irirours from fests (ij'applicable), should beprovided to the facility owner/operator for submittal to the local regulatory agencv. 1, FACILITY INFORMATION 11 l'=ac it ity N Luil1.: Date of Testing: �� 1=aciiit) Adr�-rss: � - i 1=agility Concact: Phone: ji Dace Local A_,eney Was Notified of Testing �Nawie of Local Agency Inspector (ifpresent during testing): 2. TESTING CONTRACTOR INFORMATION �j Conlpamy'Name:RICH ENVIRONMENTAL � 1 cc11.I11C1t111 CDndUCttn r Test: , Ci-edetmals: 19 CSLB Licensed Contractor ❑SWRCB Licensed Tank Tester 1-icenseType. C61 1D40 License Number: 809850 I� Mauu.fa�tnrer Training Manufacturer Component(s) Date Training Expires I INCON INCON TS—STS 8/04, i 3. SUMMARY OF TEST RESULTS _ Component Pass Fail Not Repairs Component Pass Fail Not Repairs Tested Made Tested Made zY1�, t" N Nvt l ❑ ❑ 00 ❑ ❑ ❑ ❑ ❑ ❑ RD ❑ ❑ ❑ El !L , 1�I 0 0 19 ❑ - l SV 0 ❑ J �� �. •� tJ ❑ ❑ ❑ 0 u c!� ❑ 0 ® 0 0 0 � C] L� to ❑ 0 0 ❑ ❑ 0 D ❑ If hydrostatic testing was perf4rined,describe what was done with the water after completion of tests: RECYCLE AND REUSED CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To die best v f ut),knowledge,the facts stated in this document are accurate and in full compliance with legal requirerneWs `1'eclulician's Signature: Date: ,\ t«'133, .latliiary 2002 Page of_ _ 4. TANK ANNUL.&R TESTING t'eac A'ie:chad Dev,:loped By: Ci Tanlc Manufacturer Industry Standard 0 Professional Engineer f� C7 Other (Speck) l psi iviet?od L!sed: 0 Pressure X Vacuum ❑Hydrostatic _ D Other S eci i'cst i c uiprncrll'tlsed: 4in. DIAL GAUGE Equipment Resolution: . 5% — ii ce Tank# Tank# Tan k# Tank# Is 1,-ni_E_.empi lFrom Testing?l 0 Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes l7 No ''Cuntc� ipaciey — --- �. it (•n 11i: lVlElllllt:ii:dliri'r: 1'1C,)JuC:1 SCLHa Ci: _-- I Vvaii vkitc berm;en applying L l]icS�l.A"crVaCltttlll'walFr and II ,rareirl_; test: t l s, JA -- II i-c:+f �lQl_f_t'Itllc_ --- ll?IClal T'cst T:;rtd Tirnc: I lanai (itlr): 1 esf Dutatiol]: j C lla lie in Re iclin (RF-RO: _ I as.;.,Fail fhrzsl]ald or Criteria: T esi ❑ Pass ❑Fail ❑ Pass ❑Fail ❑ Pass D Fail ❑ Pass. ❑Fail " Vas, sensor removed for testing? 0 Yes ❑No 0 NA ❑Yes 0 No 0 NA ❑Yes 0 No 0 NA ❑Yes 0 No ❑NA properly replaced and i ❑Yes 0 N o DNA ❑Yes 0 No ❑NA D Yes 0 No ❑NA ❑Yes ❑No DNA j v�l'li4Cli CUl?Ct10T1i1I aFtCa'teStlll ? �,d.i 7G11Y1L'I1 5 --(include information.on repairs 792ade rior to testing, and recon7n7ended ollow-7a forfailed tests Secondary containment systems where the continuous monitoring automatically monitors both the pritaary and secondary tl—t arP 11vr11-nS'PSi.L'icaily monitored or under Constant vacuum, are exempt from periodic containment ", a'VV KCfI, Jamlavy 2002 Pape of S. SECONDARY PIPE TESTING < 'Nlzihod Developed By: ❑Piping Manufacturer Ja Industry Standard ❑Professional Engineer ❑Other (Specify) 1'�st l\kcd ()d LJsed: 9 Pressure ❑Vacuum ❑Hydrostatic ❑Other (Specify) 1:gphpmcca Used: 4 in DIAL GAUGE Equipment - ~- Resolution: 5� HEM I .-..i .'•....1_....i:::'. 'u.�. '+(V 's , " Piping Run Piping Run# Piping Run# Piping rPipino Material. OJJt- k'ipia. kvia11ukicwt-ar: LOAt>-fiC H 1'tptn�-Ulan]eLl-t �.enoth oz Piping Run: ' i-Irodlicr storcct: Cam, I ,vkelhod and locarioil of j i nipiu* dun iso;ation: -j Vv'3ir Lime berwcea applying j! pressure/vacuurnl'water and , �I31'Llil y Lost: ^" l nest heart•Ticcce: i lnieial Reading lRj): 1 t'inal Pleading(1Ir): l eSL Duration: 1.hange is Reading(RF-R[): r P;:issiFail Threshold or I l_r-aen-a: --- D T est Resul�; ass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail ,t wwnenzs _(include information on repairs made prior to testing, and recommended follow-ap for failed tests) Soh RCU, Jamiary 2002 6. PIPILNG SUNQ TE STING Page�of-7 K'J.er,"d Dcvcioped By: 0 S'Lunp Manufacturer D-A Industry Standard ❑Professional Engineer 0 Other (Speci]j�) V'tsl M'tffiod Usc"d: ❑Pressure 11 Vacuum 23 Hydrostatic 0 Other (Specify) Tcsi1,',:jLiipmt-,.nv Used: INCON TS—STS Equipment Resolution- 0 0 o n ME W Sum e. p# Sum'P# Sump# Sump "U111P D' I'vinLerial: ,2i�Iii from T--uik'fop Eo Top of ii rlt-i-lac from'l'aak'Cop to Lowest L,MdlriLhl Of SLUR)Prior to testing: Poriioxi of Swap Tested ' F— Does [Urbine shun down when SLI113.1)sensor de[ects liquid(both Dyes ONO DNA Dyes ONO DNA Dyes ONO DNA Dyes ONO DNA DrodLu! r and wacer)'?� T axbine shutdown response time Is system prograramed for fail-safe OYes ONo DNA 0 Yes DNo0NA DYes DNoDNA DYes ONO DNA ShMdOWIV" — Was fall-safe. verified to be Dyes ONO DNA Dyes ONO DNA Dyes ONO DNA ❑Yes ONO DNA pe orarional?' r iiii time beiwL-en applying �ICULUII/\vazer and starting + pressftrellv C.0 fes[Sian Tiin�- Initial RoadinU ([Ri): Final Reading DLII-arion: Ciiange in Reading(RF-Ri): 1 T)ass,TaiiThreshold or Criteria: ❑ Pass DFAil ❑ Pass ❑Fail ❑ Pass ❑Fall ❑ Pass 0 Fail l'W cis simsor rc moved for testing? ❑Yes ONO DNA Dyes ONO DNA Dyes ❑No DNA ❑Yes ❑No DNA al-s—sen's"Or—properly replaced and Dyes ONO DNA D Yes ONo DNA O Yes DNo DNA Dyes ONO DNA verified functional after testing? :1 - Cou,.inenfs — (inchide information on repairs made prior to testing, and recommended follow-up for failed rests) LI If'old Entire depth of the sump is not tested,specify how much was tested. If the answer to any of the questions indicated with an —11-1.;.", *\ 4"PJ A" (See 1SWRCBLCT-16G1 5VV'1 ij,.Ianlill'V 2002 Page 7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING 1'cst lvlo.thod Developed By: 0 UDC Nlanufacturer R Industry Standard 0 Professional Engineer 0 Other (Specify) t•,_sr Ivt4titod USUI: 0 Pressure 0 Vacuum ®Hydrostatic q 0 Other (Specify) (t test i yi.nhme nn Used: INCON TS—STS tResol u Resolution: Equipmen n: .o o o i n. UDC# UDC# UDC# UDC# Ul�C>✓1:tnuFacturer; ' UU(2 Maten-d: 111)�' llc ill: Height try}m iDC Bottom to Top Qlf k-li_.;hesr fi pim) Penetration: I� t loighr h•om liDC.Bottom to !..o`vesr E(eco ical Penetration: Cook ition o`UDC prior to I' icsfir�: Portion or UDC Tested Does turbine smut down when I' UDC sensordetects*liquid(both DYes DNo DNA OYes DNo DNA 0Yes 0 N 0 N 0Yes ONo 0 N product wid water)? I'Lirbine shutdown response time j Is system programmed for fail- OYes 0-No DNA OYes DNo DNA OYes DNo DNA 0Yes 0 N 0 N ,ate shuuiown'?' Was fail-safe verified to be Dyes DNo DNA OYes DNo DNA 0Yes 0 N 0 N 0Yes 0 N DNA f operational?` _ V ait tithe bervveen applying �I presSure!vacil.um/vvater and sl:a�till test Test Start T inie: Initial Reading(Rl): l inal Readin,,(.R,:): 'Fesa. Duratiol": Cl-Lan:;o in Readlna(R.g-Ri): Flass!Fail Threshold or Criteria: Test Resu t. 0 Pass 0 Fail p Pass 0 Fail 0 Pass 0 Fail 0 Pass 0 Fail Was sensor reMOved for testing? 0 Yes DNo DNA D Yes DNo DNA 0 Yes DNo DNA 0 Yes O No DNA Was sensor properly replaced and 0 yes 0 No ❑NA D Yes 0 No 0 NA 0 Yes 0 No 0 NA El Yes DNo DNA verified functional after testing? - x>treits s— (include information on repairs made prior to testing, and recommended follow-up for failed tests) ' If the imdre depth of the UDC is not tested, specify how much was tested. If the answer to M of the questions indicated with al is"NO"or"NA", the entire UDC must be tested. (See SWRCB LG-160) J auutv),2002 Page of 8. FILL RISER CONTAINM, ENT SUM['TESTING raciiii)i is Not F:,quipped With Fill Riser Con:taininent Sumps ❑ F'11 Riser Containment Sumps are Present,but were Not Tested 0 'Pest Method Developed By: ❑ Sump Manufacturer ISIndustry Standard D Professional Engineer 0 Other(Speed) 1'esi IvLetho'd Used: 0 Pressure ❑Vacuum 91 Hydrostatic 0 Other (Specify) ntUsed: INCON TS-STS Equipment Resolutioll: 0 0 0 i n ME Fill Sun Fill Sum e# Fill Sum Fill Su I 1�iatu fron-,'I'ank Top to Top of Piping Penetration: Height frorn Tanl(Top to Lowest Coadition of Sump prior to Portion ol-'Sump Tested Sunk Nlat:erial: Wait time between applying preSSUre/Vacuuni/water and 1 Test start Tillie: Initial Reading(Ri): 'f es t E a d Ti M e: I-'inat Readinc,,,(RO: Test Durar.ion: Change in reading(RF-Rj): ')I Pass/Fail'Ttireshold or Criteria: I Tesil lkesalt: 0 Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail ❑ Pass 0 Fail is there a sensor in the sump? ❑Yes 0 No 0 Yes ❑No ❑Yes ❑No ❑Yes DNo - Does the sensor alarm when eicher p rod uct or water is ❑Yes 0 No 0 NA OYes ONo DNA DYes ONo DNA DYes DNo CINd 'Was sensor removed for testing? ❑Yes ❑No ❑NA DYes DNo DNA DYes DNo DNA DYes ONo CINF W as sensor property replaced and actional after testin ? ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA ❑Yes ❑No ❑NA 0 Yes ❑No 0 N) -Ca tmaienis (include information on repairs made prior to testing, and 7•ecoinmended follow-up foi-failed tests) tics vy,1, —7 ��-CB,January 2002. Page of 9. SPILL/OVERFILL CONTAINMENT BoxF-s f-aciuLy is Not Ecluipped With Spill/Overfill Containment Boxes ❑ �spiiuov,-rfill Containment Boxes are Present, but Were Not Tested ❑ Tcst I\Acthod !.')e.vc1oped By: 0 Spill Bucket Manufacturer JR Industry Standard 0 Professional Engineer 0 Otlier (Spec6) Cc st lyk--1110d,Uscd: 0 Pressure 0 Vacuw-n N Hydrostatic 0 Other(Specify) Used: INC20N TS—STS Equipment Resolution: aooin. Spill Box# Sp11(Box# Spill Box# spin 13ox# Backet DepEh -.iii.6me b�iwezn applying II J)r,�SSW-eivacuuai/water and e,—test: V/0 tes fcsL SiarL TI)TIC'. I Initial Raidiago (Ri): TC-.1si I-',nd'171111c: Finat Reading(RI.): 11 I'cst Durat'011: lrchac ug in Roading(Rr-Rr)- a, t� -P,,,Iss/Fail'fhroshold or Yest Resafi-,, ❑ Pass ❑Fail ❑ Pass 0 Fail 0 Pass ❑Fail 0 Pass ❑Fail ter:wnnicwts— (include information on repairs inadepri.or to testing, and recommended fbilo-w-upforfailed tests) ,SW R CB,Ianuary 2002 `� l • � Page { of�-- Secondary Containment Testing Deport Form This jbrrn is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this forme to report results for all components tested The completedform, written testprocedures, and p)Jntouts from tests (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. _ 1. FACILITY INFORMATION 1-acilit N i'n'( Date of Testing: °j- I. ame: Y Facility Address: 14,-a C4— Facility Contact: Phone: Late Local Agency Was Notified of Testing: N ante of Local Agency Inspector if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name:RICH ENVIRONMENTAL Techaician Conducting Test: OS Credentials: X CSLB Licensed Contractor ❑SWRCB Licensed Tank Tester License Type. C61ID40 License Number: 809850 .� MMEMEMMMM MangbMrer jXainipg _ Manufacturer Coma one s Date Training Expires INCON INCON TS-STS 8/04 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Repairs Component Pass Fail Not Repairs Tested Made Tested . Made P 91 -A ( ❑ ❑ N ❑ G 19 ❑ Q ❑ ❑ ❑ 20 0 0 ❑ o ❑ - S EC - ❑ ❑ D A 0 ❑ 0 - ❑ ❑ ❑ QED - 1 ❑ a ❑ ❑ ❑ - -s 00 ❑ 0 ❑ S ti ;'® 0 ❑ ❑ 0 - AN Q El _ P ❑ ❑ ❑ 1 - U� ❑ ❑ ❑ If hydrostatic testing was pe firmed,describe what was done with the water after completion of tests: RECYCLE AND REUSED, CERTIFICATION OF TECHNICIAN RTSPONSIBLE FOR CONDUCTING THIS TESTING ro the best of•rtty knowledge,thefacts stated in this document are accurate and In fall compliance with legal require nents • " 0 'i'ectuiician's Signatur • % �'' -� Date: y .--' ',>ti-'tZC.t3,.1a��u;try 2002 • ® Page � of /-- _ _ _ 4. TANK ANNULAR TESTING `Vest n•IC,Lhud Developed By: ❑Tank Manufacturer :W Industry Standard 0 Professional Engineer 0 Other(Speci)5)) Test Nlethod Used: O Pressure R Vacuum 0 Hydrostatic _ ❑Other(Specifji) West L.quij LnzntUsed: 4in. DIAL GAUGE Equip,mentResolution: .5% .�..,; ,,,,t�;t.�,.• � Tanit# Tank# "rn Tank Tanis # # is Tank Exempt From Testing?t es O No es O No ,613ves ❑No 4VVes 0 No Pant:Caliacity: 1•ank Materiali-ank Mahufacrurer: 1, roduct Stored: - W!,Iit tirn4 between applying pressure/vacuu,li/water and srarting test.__ _ (� AN l'cSt Start Time: Inirial Reading(R,): Test Inds'rime: final Reading(R,): — Tesr Duration: Change in Reading(RF-R): Pass/Fail Threshold or Criteria: Test Result. 0 Pass 0 Fail 0 Pass 0 Fail 0 Pass 0 Fail 0 Pass. O Fail Was sensor removed for testing? O Yes 0 No DNA ❑Yes ❑No ❑NA 0 Yes 0 No 0 NA 0 Yes ❑No 0 NA W,ls sensor properly replaced and 0 Yes 0 N 0 N ❑Yes 0 N 0 N ❑Yes ❑No DNA 0Yes 0 N 0 N � verified functional after testitt ? Co m mentS — (include information on re airs made prior to testing, and recommended ollow-U for ailed tests N (GJ — Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary comaimnent, s,.ich as systems that are hydrostatically monitored or under constant vacuum,are exempt from periodic containment 1. _r n,,,.,,,,,«;,,,,� -r;tj o,A Section 2637(a)(M S`vVRCB,Jarulary 2002 ® Page of 5. SECONDARY PIPE TESTING Test Method Developed Hy: ❑Piping Manufacturer Q Industry Standard ❑Professional Engineer _ 0 Other(Spec) Tesr'Method Used: :M Pressure ❑Vacuum ❑Hydrostatic ❑Other(Specify) 1'esiEquipme-at Used: 4in. DIAL GAUGE EquipnzentResolution:t.5% F--.". r`-� Pipiing Run Pipinrg Run Piping Rttn# *Run, Piping Material: Piping Manufacturer: Pipint Dialn_eter: I.-eagtll of Piping Run: Product Stored: 1-lethod and location of � iu�_run isolation: nJ Um w Wait wne between applying pressure/vacuum/water and / Jr SCSI1111 test: — ��IS l 'T'est Start Ti1ne: � � Initial Reading(Ra): S� t 'Pest End Titne: ,/S Final Leading(RF): ' Test Duration: Change;in Reading(RF-R�: Pass/Fail Threshold or Criteria: cS/ Test Result: ❑ Pass Aail ❑Fail d Pas ❑Fail Pass ❑Fail Comments—(include information on repairs made prior to m6m, and recommended fnlloA-up for failed tests) is i t) Fx` nA bA5 J60 42rw lf-. SWRCB,January 2002 page of 7 6. YYPING SIT1ViCP TESTING it 'fear Method Developed By: ❑Sump Manufacturer It Industry Standard ❑Professional Enginoex. ' +�_ ❑Other(Specify) 1 1'esr Method Used: ❑Pressure ❑Vacuum 2 Hydrostatic _`_ ❑Other(Specify) Tesll-gL6ptnentUsed: TNCON TS—STS Equipment Resolution: .0ooin. ei12 # ; ;' t w Sump i Sump# Su 1P# ��1, Sump# Sump lliax-=er: �� •� �C ri SLUZIp Depth: t` (o d t SUMP lylaterial: hei-In from Tank Top to Top of 33,it J 3 q t t b t I Hi-hest Pi in .Penetration: liei�[it from Tank Top to Lowest + i t C +I oft �• l t Electrical'Penettanon: l Condit1011 of sLUnp prior to testing: C<--ot,v.. Portion of Sump Tested' �b dvk p d►M bV"A Toes turbine shut down when sunlp sensor detects liquid(both ❑Yes 0 N �NA ❑Yes ❑No. 5(NA 13 Yes 0 N kNA 13 Yes 0 N kNA rodlier kind water)?" TLLrbine shutdown response time k ) (A A 1s system;programmed for fail-safe ❑yes ❑No *A ❑Yes' ❑No �NA ❑Y 13 No DNA ❑Yes ONO PNA shutdown'?` Was fail-safe verified to be ❑yes ONO 9�'NA ❑Yes ONO NNA ❑Yes ONO f,NA ❑Yes ONO lA o perationaW Wait time between applying pressure/VICUL1lTl/water and starting test: Test Starc Time 9 v %:�� 'z�v 7:"5— " o U / ` ':v t7 °l lnitialReading(R,): 3,26i-n 3•-11 6-113-.11 1.x-014 Y-39&A 324, 'Pest band Tune: -30 q: ` `3' '}o `�:iS ��3a `l; J �j' 30 Final Reading(RF): '.3- IN 3•"]17 �.1I3;w (oJll3;� 1�� ••r�-17i�. y l-;a .�a��.. Test Duration: �f �t !"i rta !�ir•r✓t �r ��'`�• 1 7 �•+��• e/�i�..'h i'� ChangeinReading(RF-Ri): ,�61�w 001, h DOQ�� .bUb, .UUdin .OVd� bDOrr► . 000 k Pass/F-,til;Threshold or Criteria: ,:./ ',� ',✓ «✓ Nest Result: _ 0 Pass ❑Fail 1 Pass ❑Fail Pass ❑Fail wPass ❑Fail Was sensor removed for testing? Yes ❑No ❑NA Mes ❑No ❑NA \Pd Yes ❑No ❑NA 1OYes ❑No ❑NA Was sensor properly replaced and veritied functional after testin ? N Yes ❑No ❑.NA Yes ❑No ❑NA Yes ❑No ❑NA Yes ❑No ❑NA Cominents— (include information on repairs rnadeprior to testing and recommendedfollow-upforfalled tests) oPrc� AU( < r__l�p_�7y�=fiewtla•fs �1AS �p,(_� t'D-I c� lbe S yrA 6 i+-�s t— 'If the entire depth of the sump is not tested,specify how much was tested. If the answer to M of the questions indicated with an asterisk('w) is"NO"or"NA",the entire sump must be tested. (See SWRCB LG-160) SWRCB,January 2002 • Page of 7. UNDER-DISPENSER.CONTAINMENT (UDC}TEST]NG Test Method Developed By: 0 UDC Mant6ciurer R Industry Standard 0 Professional Engineer 0 Other(Specify) -fest Method Used: 0 Pressure O Vacuum 8 Hydrostatic - -- _ 0 Other (Specify) TesiEqu.ipmentUsed: INCON TS-STS Equipment Resolution: .000in. MEMBER= 2N �,k.:�•.�r ;gi:x• CTDC _ �ti�• .> # UDC# - G UDC# _UDC Manufacturer: UDC# UDC Material: C e Q `t Gtr Ilei-ht from LIDC Bottom to Top �tt �t� r� r of k•li quest Piping Penetration: d� -I.leight from UDC Bottom to Low Electrical Penetration: U p� u Condition of UDC prior to Ck,V` L} - � _ f � t -- test i n g: �Qrt ` 1� Portion of UDC Tested' Does turbine shut down when UDC sensor detects liquid(both 0 Yes 0 No KNA ❑Yes 0 No lkjA ❑Yes ❑No ETA O Yes 0 N 4A roduct and water)?* _Turbine shutdown res onse time l s system programmed for fail- safe shutdown?` 0 yes 0 No 7'RiA ❑Yes 0 No JkNA 0 Yes ❑No t�iA 0 Yes ❑No KNA Was tail-safe verified to be operational?' 0 Yes 0 No 0,NA 0 Yes ❑No ANA ❑Yes ❑No �NA 0 Yes ❑No ANA Wait time between applying pressure/vacuum/water and "30 le. V"": (A D ` _starting test_ Pest Start Time: initial Keading(Rr): III Hi <f_14 -3•gy ', (0.43 1 f•3 re,,t End Time: 6:30 b: b= 7D �b a b: D O: f=inal Reading(.RF): "'l• , `w .k '3..jk(° .-- -83 Test Duration: J �,w� ` / �►,r a n1.'k /gym, ' r+. vh.I /S-ik"e. Change in.Reading r-R : , 00b%-- 0'000t in -00(3 V%, •O ,w .rho r`� .00[ki -cool, .u0 a Pass/Fail Threshold or Criteria: .000\"-.j �00�.;% • O .00�•;t -001,%, .Ob ; p .00 "in _00 a`u Test Result: 3g Pass O Fail Pass 0 Fail K Poss ❑Fail X Pass 0 Fail Was sensor removed for testing? 0 Yes ❑No NA 0 Yes 0 No INA 0 Yes 0 No ONA 0 Yes ONo XNA Was sensor properly replaced and ❑yes ❑No g NA 0 Yes 0 No I ,NA 0 Yes 0 No 4 NA ❑Yes ❑No XJ NA verified functionaJ after testing? tCoinments -(include information on repairs made prior to testing, and recommendedfollow-upforfailed tests) " if the entire depth of the UDC is not tested,specify how much was tested. If the answer to M of the questions indicated with an asterisk(*) is"NO"or"NA',the entire UDC must be tested, (See SWRCB LG-160) S W RCB,January 2002 Page of—7- 8. FILL RISER CONTAICKMENT SUMP TESTING fr acilit is Not E quipped With Fill Riser Containment S!jijus 0 Fill Riser Containment Sumps are Present,but were Not Tested 0 Test Method Developed By: 0 Sump Manufacturer 31ndustry Standard 0 Professional Engineer 0 Other(Spec) Test Method Used: 0 Pressure 0 Vacuum 9 Hydrostatic 0 Other(Spec6) Test Equipment Used: INCON TS-STS Equipment Resolution: .0 0 0 i n Fill Sue'#86d rxi FOR sum # M # e t/A)Ljl Fill S?A2 &n Fill Sump# w Sump Diameter: Sump Depth: 1-i e ig[it front Tard(Top to Top of C) i C) Highest Pip ing,Penetration: EIei=-Iit from Tank Top to Lowest 1'.1ecrrical Penetration: Condition of sump prior to dewy. b _ W L eA V A ekv� \ testing: _-Portion of'Sump Tested m. e,, Pvs V WA y�_ -.'e_ Sump Material: f j� OA:s Wait time between applying L& pressure/vacuum/water and Q V\AL 3 VIA 0 Starting test: LTest Start Time: rbo r ll-i<— w-op I it:-/- #0 Initial Reading(Rj): 'rest End Time: *3 0 111 /5 11/.­30 /j,Ir 30 Final Reading(Rr): /At Test Duration.- Change in Readixig(RpRj): D 00 -,4 -jQ 00N. -8 V().'u 1 000,'%,, -000i'd .1>00-'n 000,',- •0(3(j j, %Ilass/Fail Threshold or Criteria: V0 j; *'% -0C4 i 0U Iz- L-Co') Test Result: "ass * 0 Fail K ass - 0 Fail j9Pass-_ 0 Fail KPass 0 Fail Is there a sensor in the sump? Yes 0 No $,Yes 0 No I&Yes 0 No XYes DNo Does the sensor alarm when either product or water is 0 Yes 0 No KNA 0 Yes DNo ANA 0 Yes DNo XNA 0 Yes DNo XNA detected? I Was sensor removed for testing? KYes 0 No 0 NA %Yes 0 No DNA D.No 1:1 NA Yes 0 No E)NA Was sensor properly replaced and Xyes DNo DNA Kyes DNo DNA C4Yes DNo DNA RrYes D No 13 NA verified functional after te gm? Co inm en ts - (include information on repairs n7ade prior to testing, and recommended follow-up for failed tests) SWRC.B,January 2002 Page —( Of-7 _ 9. SPILL/OVERIFUX CONTAT1MENT BOXES, t7a1 ility is Not 7✓ u ipped With S ill/Oveifill Containment Boxes ❑ Spill/Overfill Containment Boxes are Present,but were Not Tested ❑ Teat Method Developed By: ❑Spill Bucket Manufacturer JR Industry Standard ❑Professional Engineer _ D Other(Specify) 1'est Method Used: ❑Pressure ❑Vacuum N Hydrostatic _ ❑Other(Specify) 'T'est Equipment Used: INCON TS—STS Equipment Resolution: .000in. Spill Box# Spill Box# �, Spill Box#0 Spill fox# uclet Diameter: 'r, k> Bucket Depth: lkait time between applying , pressure/vacuum/water and ``- starting test: l"est Start Time: el 110 A-1 : S : fe-0-4` q tVAJ :S Initial Reading(RI); 7 /.31/;(4 Test l:ndTime: q,» 0 ,/(f I' 'r b .f0 4,. SS' �0'" -Y Q' 0 h Final Reading(RE): -�, l7 r 3.$�q% �j. 019 M X&I-5 'n oZ�6�3 `n `/ 'Lest Duration: � r��(i. 1 r�;h a, l w•,`�. l / H.;�. /S►��K Change in Reading(RrRt): •000 Ik ,b00,-. .000o. -OOO;1-. .e�o0;� .000-0. ►bOf7'k .00O,'L, Pass/)'ail Threshold or OO X , oO Co a Criteria: �^ �' t"` + `n 00 t "` Test Result: Pass ❑]Fail vdpfiss ❑Fail 9 Pass ❑Fail KPass ❑Fail ,C'.oir inents—(include information on repairs made prior to testinX and recommended follow-up for failed tests) AUG 2 5 2004 2-25-2003 A:59PM FROM CALVALLEY EQUIP 16613252529 P. 2 SECONDARY SYSTEM CLR'I'IFICATION FORM ; DATE-t Z FACILITY Ill FACILITY ADDRESS 64?,ft j1'A 3Z217--z f-wy- Turbine Sumps Sunli) 1* 87 Sulnp 2 q/ Sump 3 /ISL.#Z Sump 4 keW D1G. $tart'Tit�ie /p=S7 /d:1 D /0:/0 /: Initial lleight of Water q.S82" `� S6G .OY/' Time Water Ilelght • I'lnie � • Water Height Time /0:Z S p:d.5` ;sp". i Water Ileight ,5��" Z.S6G `' .oY/` i Certification (Signature) Over1111 Buckets JJI is 6 Overfill 1 Overfill 2 Overfill 3 Overfill 4 Start Time Initial Height ` of Water ` rime Water lleight Time I n Water Height ; Certwcatlon ; (Signature) /Ylar� Te1'hhq 14""'/l ke req,41eKgc 2 of_ 01- n c pVtY. c r/i p of d h ty 2-25-2003 A:59PM FROM CALVALLEY EQUIP 16613252529 P. 3 HAPPY PART 3221 TAFT HWY. 8AKERSFIELG.CA. WIPPY HART 12/26/2692 19:7.5 Ara .1221 TAF,r HWY. S01P LEAK TEST REPORT BAKERSFIELD CA. 12/26/2002 11:56 An OSL T—S TEST STARTED 16:16 AM SUMP LEAK TEST REPORT 3221 TAFTAHWY. TEST STARTED 12/26/2902 BEGIN LEVEL. 4.8416 IN R.DSL T BAKERSFIELD CA. END TIMt, 10 25 AM ENO DATE 12/26/2682 TEST STARTED 11:.'85 W 12/26/2992 1 1:12 Are, END LEVEL 4,8415 IN TEST STARTED • 12/26/2802 ' EAK THRLSH(Xi) 3.002 IN BEGIN LEUEL 4.5199 IN SUMP LEAK 'rLST REPMT TEST RESULT P END TIME 11:56 Art PASSED END DATC 12/26/M2 87 T—S END LEVEL 4.5198 IH 91 T-5 .LEAK. THRESHOLD 6.662 114 TEST STARTED 19:57 Art TEST RESULT PASSED TEST STARTED 12/26/2062 TEST STARTED 18:16 AM . BEGIN LEVEL 4.5823 I14 TEST STARTED 12/26/2062 END TIME 11:12 AM BEGIN LEVEL 2.5662 IN END DATE 12/26.,2962 END TIME 18:25 Am END LEVEL 4.5818 :N END DATE 12/26/2802 TEST RESULT 6.PASSED END EAK THRESHOLD 6.F*2 IN TEST RESULT PASSED l CORROSION- ELECTRICAL S'ER VICES. INC. FOLLOW UP CATHODIC PROTECTION SYSTEM SURVEY HAPPY GAS 3221 TAFT HIGHWAY PUMPKIN CENTER, CALIFORNIA Prepared For Sessions Tank Liners, Inc. 9521 West Fritz Lane Bakersfield, California 93307 Prepared By Corrosion-Electrical Services, Inc. 14020 Maryton Avenue Santa Fe Springs, California 90670 September 1998 14020 MARYTONAVENVE,SANTA FE SPRINGS, CALIFORNM 90670 PHONE.(562)921-9522 FAX:(562)921-6885 CA. LICENSE C-10 684718 • CORROSION- ELECTRICAL SERVICES, INC. TABLE OF CONTENTS INTRODUCTION 1 BACKGROUND 1 SURVEY PROCEDURES 1 SURVEY ANALYSIS 2 CONCLUSIONS AND RECOMMENDATIONS 2 TABLES • Potential Survey Data Sheet • Cathodic Protection System Maintenance Record Sheet • Rectifier Data Sheet 14020 MARYTONAVENUE,SANTA FE SPRINGS, CALIFORNIA 90670 PHONE.(562)921-9511 FAX.•(562)921-6885 CA. LICENSE C-10 684718 CORROSION- ELECTRICAL SERVICES, INC. INTRODUCTION This report contains information pertinent to the successful operation of the cathodic protection system located at Happy Gas, 3221 Taft Highway, Pumpkin Center, California, including present measurement data, survey procedures, and recommended maintenance program. The cathodic protection system is designed to protect four 12,000-gallon underground storage tanks, and associated subsurface metallic piping and vents. BACKGROUND The impressed current cathodic protection system installed at this facility in April 1998 consists of the following items: • Four 3-inch diameter x 60-inch long graphite anodes installed in one 10-inch diameter x 40-foot deep cathodic protection well (CPW). The well is backfilled with petroleum coke breeze and vented to the surface via PVC piping. A traffic-rated road-box is placed over the anode well. The anodes are connected to the rectifier by a header cable. • One J.A. Electronics rectifier rated at 50 volts and 12 Amperes (DC). • Cathodic protection test box that includes wire test leads for each underground storage tank. • Miscellaneous electrical fittings and cathode header cable. SURVEY PROCEDURES The following procedures were followed during the follow up survey: • The rectifier was inspected and the operating voltage and amperage were noted. • Structure-to-soil potentials were measured with a digital voltmeter connected between the structure and a saturated copper-copper sulfate reference electrode in contact with the earth. Test point locations are listed on the attached data sheets. • During the above procedure the tap settings on the rectifier were adjusted as needed to ensure that sufficient protective current is being applied to the underground metallic structures at this facility. 14020MARYTONAVENUE,SANTA FESPRINGS, CALIFORNIA 90670 PHONE:(562) 911-9511 FAX:(562) 921-6885 CA. LICENSE C-10 684718 1 CORROSION- ELECTRICAL SERVICES, INC. SURVEY ANALYSIS Structure to soil potential measurements for each test point are above National Association of Corrosion Engineers (NACE) design criteria of 850 millivolts (mV) with cathodic protection applied. Rectifier output(DC volts and amperes) and potential measurement data for each test location are shown on the enclosed data sheets. CONCLUSIONS AND RECOMMENDATIONS Based upon our visual inspection and the data obtained during the survey, Corrosion- Electrical Services, Inc., concludes and recommends the following: • The cathodic protection system is operating as designed and the underground tanks and associated piping are receiving adequate protective current. • Corrosion-Electrical Services, Inc., recommends that the rectifier data (volts and amps) be recorded weekly on the attached Rectifier Data Sheet and mailed or faxed to Corrosion-Electrical Services, Inc., on a quarterly basis. If any significant changes are observed in the volts and/or amperes on the rectifier, Corrosion-Electrical Services, Inc., should be notified immediately. • Along with the above Corrosion-Electrical Services, Inc., recommends, that in order to protect your investment, an annual survey be performed by a qualified individual. We will forward a letter approximately one year after the installation date requesting your authorization to perform this service on your behalf. 14020 M.ARYTONAVENUE, SANTA FE SPRINGS, CALIFORNIA 90670 PHONE: (562) 921-9522 FAX:(562) 921-6885 CA. LICENSE C-10 684718 2 CORROSION- ELECTRICAL SERVICES, INC. This follow up survey was conducted in accordance with the procedures described in the National Association of Corrosion Engineers (NACE) Standard Recommended Practice RP0285-95, Corrosion Control of Underground Storage Tank Systems by Cathodic Protection and American Petroleum Institute (API) Recommended Practice 1632, Cathodic Protection of Underground Petroleum Storage Tanks and Piping Systems. Thank you for the opportunity to assist you in this phase of your cathodic mitigation program. If you have any questions please contact us at your convenience. Respectfully, CORROSION-ELECTRICAL SERVICES,INC. a . S 'pl E. 0+�1 Engineer 00 Vim: NA Z JAY M.SHIPLEY i ... e.••• t i•••.M...........••1...: � . 4193 f i /\ • 6 i PECIA\ � r Latricia J. Brewis President 14020MARYTONAVENUE,SANTA FE SPRINGS, C4LIFORNM 90670 PHONE:(562) 921-9511 FAX.•(562)911-6885 CA. LICENSE C-10 68x718 3 CORROSION- r ELECTRICAL SERVICES, INC. CLIENT: HAPPY GAS CES NO.: 1476 TEST DATE: 9-28-98 SERVICE STATION NO.: SYSTEM LOCATION: 3221 TAFT HIGHWAY, PUMPKIN CENTER, CALIFORNIA ENGINEER: JAY M. SHIPLEY P.E. TECHNICIAN: M. HATHAWAY RECTIFIER DATA MANUFACTURER: JA ELECTRONICS SERIAL NO. : 98023 RATING: 50 VOLTS 12 AMPERES VAC OUTPUT: 5.0 VOLTS 2.0 AMPERES MONITOR CHECK: SETTING: A-3 HOURMETER READING 03995.0 HRS LAST READING 00000.0 HRS DATE 4-14-98 CHANGE IN READING 03995.0 HRS ACTUAL HOURS 4008.0 HRS DAYS OFF 0 FIELD TEST DATA STRUCTURE-TO-SOIL TEST LOCATION POTENTIAL (MV) I (on) I (off) FUEL TANK#1 - DIESEL -955 -399 FUEL TANK#2 - UNLEADED -955 -399 FUEL TANK#3 - PREMIUM -957 -399 FUEL TANK#4 - DIESEL -965 -399 FUEL TANK#5 - FUEL TANK#6 - VENTS - FIBERGLASS DISPENSER - DIESEL -939 -399 DISPENSER - UNLEADED/PLUS/PREMIUM/DIESEL -939 -399 DISPENSER - UNLEADED/PLUS/PREMIUM/DIESEL -938 -399 DISPENSER - UNLEADED/PLUS/PREMIUM/DIESEL -938 -399 DISPENSER - UNLEADED/PLUS/PREMIUM/DIESEL -939 -399 DISPENSER - WATER LINES - -940 -399 GAS CO. METER- ELECTRICAL CONDUIT - -941 -399 c CuCuSO4 18 ERIENCE LOCATION g: CP TEST BOX W REMARKS: (FIELD) FOLLOW UP SURVEY SYSTEM IS OPERATING AS DESIGNED ALL POTENTIALS ARE ABOVE THE NACE CRITERIA OF -850 MILLIVOLTS. 14020 MAR YTON A VENUE, SANTA FE SPRINGS, CALIFORNIA 90670 PHONE. ( 2) 921-9522 . . 5 2 - CA. LICENSE C-10 68.1718 CORROSION- ELECTRICAL SERVICES, INC. CATHODIC PROTECTION SYSTEM MAINTENANCE RECORD SHEET LOCATION OF RECTIFIER UNIT: INSIDE STORE ON SOUTH WALL TYPE OF RECTIFIER: AIR COOLED WALL MOUNTED TYPE OF ANODES: GRAPHITE NUMBER: 4 Ste: 31 X §0' LONG RECTIFIER MANUFACTURED BY: JA ELECTRONICS SERIAL#98023 RECTIFIER AC INPUT: ?j200 VOLTS 1 PHASE CYCLE RECTIFIER DC OUTPUT: s0 VOLTS 12 AMPERES DATE TURNED ON: APRIL 14. 1998 RECTIFIER READINGS RECTIFIER SETTING D.C. OUTPUT BY DATE REMARKS COARSE FINE VOLT AMPS A 2 3 1 GS 4-14-98 START UP SURVEY A 3 5 2 M.H. 9-28-98 FOLLOW UP SURVEY U W Z 14020 AlAR YTON A VENUE,SANTA FE SPRINGS, CALIFORNIA 90670 PHONE.(562) 921-9522 FAX (562) 921-6885 CA. LICENSE C-10 684718 RECTIFIER . QUARTERLY RECORD RECORD WEEKLY JOB # 1476 OWNER HAPPY GAS LOCATION 3221 TAFT HWY. PUMPKIN CENTER. CA, UNIT D.C. OUTPUT NO. VOLTS AMPS DATE TIME REMARKS BY 1 5 2 8-28.98 FOLLOW UP SURVEY M.H. UNIT NO. 1 UNIT LOCATION ON SOUTH WALL INSIDE STORE UNIT NO. UNIT LOCATION NORMAL RANGE: UNIT NO. 1 VOLTS 2 - S AMPS .05-5 UNIT NO. VOLTS AMPS o NOTE: IF UNIT STABILIZES OUTSIDE NORMAL, NOTIFY YOUR ENGINEER H! MAIL TO CORROSION-ELECTRICAL SERVICES INC. QUARTERLY ccU W INVOICE #bb000254 TEST DATE:/ 06/09/98 UNDERGROUND TANK TESTERS 15806 AVENUE 288 VISALIA, CA 93292 209-747-5220 TANK STATUS EVALUATION REPORT ----------------------------- ***** CUSTOMER DATA ***** ***** SITE DATA ***** DAVIES OIL CO. HAPPY GAS EXXON P.O. BOX 80067 3221 TAFT HWY. BAKERSFIELD, CA. PUMPKIN CENTER, CA. 93308 93309 CONTACT: CHUCK MARTIN CONTACT: PHONE # : 805-323-6063 PHONE # : ***** COMMENT LINES ***** CURRENT EPA STANDARDS DICTATE THAT FOR UNDERGROUND FUEL TANKS, THE MAXIMUM ALLOWABLE LEAK/GAIN RATE OVER THE PERIOD OF ONE HOUR IS . 05 GALLONS . TANK #1 : DIESEL FUEL 2 TYPE: STEEL RATE: . 017322 G.P.H. LOSS TANK IS TIGHT. TANK #2 : REG UNLEADED TYPE: STEEL RATE : . 013202 G.P.H. GAIN TANK IS TIGHT. TANK #3 : SUPER UNLEADED TYPE : STEEL RATE: . 009555 G.P.H. LOSS TANK IS TIGHT. TANK #4 : DIESEL FUEL 2 TYPE : STEEL RATE : . 022300 G.P.H. GAIN TANK IS TIGHT. ROB- SElltTH OPERATOR: Uc #r41-1411 SIGNATURE: -- DATE : 1 ******* T A N K D A T A ******** TANK NO. TANK NO. TANK NO. TANK NO. 1 2 3 4 TANK DIAMETER (IN) 96 96 96 96 LENGTH (FT) 26 . 59 26 . 59 26 . 59 26 . 59 VOLUME (GAL) 10000 10000 10000 10000 TYPE ST ST ST ST FUEL LEVEL (IN) 71 73 70 74 FUEL TYPE DIESEL 2 REG UNLD SUP UNLD DIESEL 2 dVOL/dy (GAL/IN) 116 .41 113 .22 117 . 89 111 .49 CALIBRATION ROD DISTANCE 1 10 . 65625 2 26 . 95313 3 41 . 93750 4 56 . 93750 5 74 . 93750 ******* C U S T O M E R D A T A ******** JOB NUMBER 000254 CUSTOMER (COMPANY NAME) DAVIES OIL CO. CUSTOMER CONTACT(LAST, FIRST) : CHUCK MARTIN ADDRESS - LINE 1 P.O. BOX 80067 ADDRESS - LINE 2 CITY, STATE BAKERSFIELD, CA. ZIP CODE (XXXXX-XXXX) : 93308 PHONE NUMBER (XXX)XXX-XXXX : 805-323-6063 ******* C 0 M M E N T L I N E S ******* ******* S I T E D A T A ******** SITE NAME (COMPANY NAME) : HAPPY GAS EXXON SITE CONTACT(LAST, FIRST) ADDRESS - LINE 1 3221 TAFT HWY. ADDRESS - LINE 2 CITY, STATE : PUMPKIN CENTER, CA. ZIP CODE (XXXXX-XXXX) 93309 PHONE NUMBER (XXX)XXX-XXXX GROUND WATER LEVEL (FT) 0 NUMBER OF TANKS 4 LENGTH OF PRE-TEST (MIN) 30 LENGTH OF TEST (MIN) 180 I s e 15 j Cr: TAME i START TIME: 10 :52:00:00 CURRENT TIME:11:52 :00:00 10 w a � - 0: .00030 7 C1: - .00317 —10 LEAR RATE: .01732 GPH LOSS PTA, 1;ERS ION 1.20 —15 0 15 30 45 60 bb000254.TST,i TIME (MINUTES) 06/09/90 Cri rJ TNY 2 START TIME: 18 :52:88:88 CURRENT TIME:11:52:80:88 10 w _ U r J z w — 8: .80011 C1: .80241 _1 Q LEAH RATE: .01320 GPH GAIN PTA, UERSION 1.28 —15 r I I I I I I I I I I I 4 15 30 45 60 bb808254.TST,i TIME (MINUTES) 86/89/98 1 Cr TAM{ 3 START TIME: 10 :52:00:00 CURRENT TIME:11:52 :80:88 10 Lo w z a J Lj — 8. ,88817 z C1: ° .80175 2 —1 —LEAH RATE : .88955 GPH LOSS PTA, VERSION 1.28 —15 0 15 30 43 60 B000254.TS T J TIME (MINUTES) 861-189/98 15 TANY 4 START TIME: 10 :52:08:88 CURRENT TIME:11:52 :88:00 10 w 4 y -r J" y .�J f S J � — 8: .80001 C1: .0048$ —1 —LEAH RATE : .02238 GPH GAIN PTA, VERSION 1.28 —15 0 15 30 45 60 bb880254.TST,1 TIME (MINUTES) 86/89/98 INVOICE #bb000254 TEST DATE: 06/09/98 UNDERGROUND TANK TESTERS 15806 AVENUE 288 VISALIA, CA 93292 209-747-5220 TANK STATUS REPORT -- ULLAGE TEST --------------------------------- ***** CUSTOMER DATA ***** ***** SITE DATA ***** DAVIES OIL CO. HAPPY GAS EXXON P.O. BOX 80067 3221 TAFT HWY. BAKERSFIELD, CA. PUMPKIN CENTER, CA. 93308 93309 CONTACT: CHUCK MARTIN CONTACT: PHONE # : 805-323-6063 PHONE # : ***** COMMENT LINES ***** CURRENT EPA STANDARDS DICTATE THAT FOR UNDERGROUND FUEL TANKS, THE MAXIMUM ALLOWABLE LEAK/GAIN RATE OVER THE PERIOD OF ONE HOUR IS . 05 GALLONS . TANK #1 : DIESEL FUEL 2 TYPE: STEEL SN: - . 17 TANK IS TIGHT. TANK #2 : REG UNLEADED TYPE : STEEL SN: - .26 TANK IS TIGHT. TANK #3 : SUPER UNLEADED TYPE: STEEL SN: . 07 TANK IS TIGHT. TANK #4 : DIESEL FUEL 2 TYPE: STEEL SN: - . 08 TANK IS TIGHT. OPERATOR: BOB UNTH S IGNATURE: DATE: ---LU#91-1431------- Zin ******* T A N K D A T A ******** TANK NO. TANK NO. TANK NO. TANK NO. 1 2 3 4 TANK DIAMETER (IN) 96 96 96 96 LENGTH (FT) 26 .59 26 .59 26 . 59 26 .59 VOLUME (GAL) 10000 10000 10000 10000 TYPE ST ST ST ST FUEL LEVEL (IN) 71 73 70 74 FUEL TYPE DIESEL 2 REG UNLD SUP UNLD DIESEL 2 dVOL/dy (GAL/IN) 116 .41 113 .22 117 . 87 111 .49 CALIBRATION ROD DISTANCE 1 10 . 65625 2 26 . 95313 3 41 . 93750 4 56 . 93750 5 74 . 93750 I ******* C U S T O M E R D A T A ******** JOB NUMBER 000254 CUSTOMER (COMPANY NAME) DAVIES OIL CO. CUSTOMER CONTACT(LAST, FIRST) : CHUCK MARTIN ADDRESS - LINE 1 P.O. BOX 80067 ADDRESS - LINE 2 CITY, STATE BAKERSFIELD, CA. ZIP CODE (XXXXX-XXXX) 93308 PHONE NUMBER (XXX)XXX-XXXX : 805-323-6063 ******* C 0 M M E N T L I N E S ******* ******* S I T E D A T A ******** SITE NAME (COMPANY NAME) : HAPPY GAS EXXON SITE CONTACT(LAST, FIRST) ADDRESS - LINE 1 3221 TAFT HWY. ADDRESS - LINE 2 CITY, STATE : PUMPKIN CENTER, CA. ZIP CODE (XXXXX-XXXX) 93309 PHONE NUMBER (XXX)XXX-XXXX GROUND WATER LEVEL (FT) 0 NUMBER OF TANKS 4 LENGTH OF PRE-TEST (MIN) 30 LENGTH OF TEST (MIN) 180 1 • 1 3.0 TANX 1 TIME -- 12:46 :82 Ld 2,0 z �- SN: -.17 PEAL{ SN: 3.52 3/ 2 UTa, VERSION i.88 UL J 50 500 5000 50000 bbB00254.SON FREQUENCY (HZ) 86/89/98 r A , Cr: � a TANY Z" TIME -- 12:55:30 Ld 2,0 z 7 0 1 ,0 SM: -.26 PEAL{ SM: 5.71 5I 4 -- UTA, UEREION 1.00 --.tl Uqw J,lk 50 500 5000 50000 bbB00254.SON FREDUEN0Y (HZ� 06/09/98 � s cr: 3,0 TANK 3 TIME -- 13:01 :38 ry 2,0 z J 7 1 ,0 �- EN: .07 �.J PEAR SN: 11.26 7/ 6 UTA, UERSION 1.80 50 500 5000 50000 bbB00254.SON FREQUENCY (H Z l 86/89/98 3,0 Cr: TAME 4 TIME -- 18:88 :28 2,0 J �= 1 .0 SM: PEAH SM: 8.82 9/ 8 UTA, VERSION 1,88 .0 50 500 5000 50000 bbB00254.SOM FREQUENCY (HZ� 86/89/98 UNDERGROUND TANK TESTERS 15806 AVENUE 288 VISALIA, CA 93292 (800) 244-1921 PIPING TIGHTNESS DETERMINATION; PL400 FORMAT TEST LOCATION: HAPPY GAS MARKET 3221 TAFT HWY. PUMPKIN CENTER, A. TEST OPERATOR: BOBBY G. SMITH OTTL LIC 97-1431 DATE: 06/09/98 TEST INITIAL FINAL VOLUME LEAK RATE LEAK RATE PASS FAIL DURATION PRESSURE PRESSURE DISPLACED DIESEL 2 30 50 47 4 -.0095 X PLS UNLD 30 50 43 6 -.0143 X SUP UNLD 30 50 40 10 -.0238 X DIESEL 2 30 50 46 8 -.0191 X COMMENTS: LEAK DETECTOR/S FUNCTIONING PROPERLY YES PLOT PLAN JOBSITF: LOCATION N A//> P1)v �1 p 2 7' E -,I'hr 7 4'!!*— w 3 # M NS It ✓CA,rs TANK SIZE PnODUCT I--GE ND #i lole 5 C 2 F F-11-1- .1- TUM31NF #2 lNe wL.D Tl- '11)[113INE WITH LEAK DETEc-ron #3 Fo OVIJISPILL CONTAINDI ON FILL #4 H 111--MOTE 0 VENT #5 F- ---[--..XI'IIACTonVAI..VE #6 m MoNi'vol"I SYCITCM #7 MANIFOLD SYST17W MW (VIC)NIT01:1 W1711- CORROSION-, ELECTRICAL SERVICES INC. START UP CATHODIC PROTECTION SYSTEM SURVEY HAPPY GAS 3221 TAFT HIGHWAY PUMPKIN CENTER, CALIFORNIA Prepared For: Sessions Tank Liners, Inc. PO Box 49061 Bakersfield, California 93308 Prepared By: Corrosion-Electrical Services, Inc. 14020 Maryton Avenue Santa Fe Springs, California 90670 April 1998 14020 MARYTONAVENUE,SANTA FE SPRINGS, CALIFORVIA 90670 PHONE.(562) 921-9522 FAX. (562) 921-6885 CA. LICENSE C-10 68,!718 CORROSION- ELECTRICAL SERVICES, INC. TABLE OF CONTENTS INTRODUCTION 1 INSTALLATION SPECIFICATIONS 1 SURVEY PROCEDURES 1 SURVEY ANALYSIS 2 CONCLUSIONS AND RECOMMENDATIONS 2 TABLES • Potential Survey Data Sheet • Cathodic Protection System Maintenance Record Sheet • Rectifier Data Sheet DRAWINGS • Site Map 14020AlARYTONAVENUE,SANTA FE SPRINGS, CALIFORNIA 90670 PHONE. (562) 921-9522 FAX:(562) 911-6885 CA. LICENSE C-10 684718 CORROSION: ELECTRICAL SERVICES, INC. INTRODUCTION This report contains information pertinent to the successful operation of the cathodic protection system located at Happy Gas 3221 Taft Highway, Pumpkin Center, California, including present structure-to-soil potential measurement data, survey procedures, and recommended maintenance program. INSTALLATION SPECIFICATIONS The impressed current cathodic protection system installed at this facility in April 1998 consists of the following items: • Four 3-inch diameter x 60-inch long graphite anodes installed in one 10-inch diameter x 40-foot deep cathodic protection well. The well is backfilled with petroleum coke breeze and vented to the surface via PVC piping. A traffic-rated road-box is placed over the anode well. The anodes are connected to the rectifier by a header cable. • One J.A. Electronics rectifier rated at 50 volts and 12 Amperes (DC). • Miscellaneous electrical fittings and cathode header cable. SURVEY PROCEDURES The following procedures were followed during the start up survey: • The rectifier was energized and the operating voltage and amperage were noted. • Structure-to-soil potentials were measured with a digital volt meter connected between the structure and a saturated copper-copper sulfate reference electrode in contact with the earth. Test point locations are listed on the attached data sheets. • During the above procedure the tap settings on the rectifier were adjusted as needed to ensure that sufficient protective current is being applied to the underground metallic structures at this facility. 14020 AIAR YTON A VENUE, SANTA FE SPRINGS, CALIFORNM 90670 PHONE:(562) 921-9522 FAX (562) 911-6885 CA LICENSE GIO 684718 j CORROSION- • ELECTRICAL SERVICES, INC. SURVEY ANALYSIS Structure to soil potential measurements for each test point are above National Association of Corrosion Engineers (NACE) design criteria of 850 millivolts (mV) with cathodic protection applied. Rectifier output(DC volts and amperes) and potential measurement data for each test location are shown on the enclosed data sheets. CONCLUSIONS AND RECOMMENDATIONS Based upon our visual inspection and the data obtained during the survey, Corrosion- Electrical Services, Inc., concludes and recommends the following: • The cathodic protection system is operating as designed and the underground tanks are receiving adequate protective current at this time. • The State required follow up survey will be conducted at this facility within the next four to six months. • Corrosion-Electrical Services, Inc., recommends that the rectifier data (volts and amps) be recorded weekly on the attached Rectifier Data Sheet and mailed or faxed to Corrosion-Electrical Services, Inc., on a quarterly basis. If any significant changes are observed in the volts and/or amperes on the rectifier, Corrosion-Electrical Services, Inc., should be notified immediately. • Along with the above Corrosion-Electrical Services, Inc., recommends, that in order to protect your investment, an annual survey be performed by a qualified individual. We will forward a letter approximately one year after the installation date requesting your authorization to perform this service on your behalf. 14020 MAR YTONA VENUE,SANTA FESPRINGS, CALIFORNIA 90670 PHONE.(562) 921-9522 FAX.(562) 921-6885 CA. LICENSE C-10 684718 2 CORROSION- ELECTRICAL SERVICES, INC. This start up survey was conducted in accordance with the procedures described in the National Association of Corrosion Engineers (NACE) Standard Recommended Practice RP0285-95, Corrosion Control of Underground Storage Tank Systems by Cathodic Protection and American Petroleum Institute (API) Recommended Practice 1632, Cathodic Protection of Underground Petroleum Storage Tanks and Piping Systems. Thank you for the opportunity to assist you in this phase of your cathodic mitigation program. If you have any questions please contact us at your convenience. Respectfully, CORROSION-ELECTRICAL SERVICES, INC. ,D\G,PROT- M. Sh ley '��:•'' • '•�'��� i Engineer NACE �%.yP` JAY M. SHIPLEY %....=•Nth..... •.............. s 4193 r° low atricia J. Brewis �� `spFCIAL�S� President ��000�,•� 14020 MARYTON A VENUE.SANTA FE SPRINGS, CALIFORNIA 90670 PHONE.(562) 931-9522 FAX:(562) 921-6885 CA. LICENSE C-10 684718 3 CORROSION- ELECTRICAL SERVICES', INC. CLIENT. HAPPY MART CES NO.: 1476 TEST DATE: 4-14-98 SERVICE STATION NO.: SYSTEM LOCATION: 3221 TAFT HWY PUMPKIN CENTER, CA. ENGINEER: JAY SHIPLEY P.E. TECHNICIAN: G. SAIZA RECTIFIER DATA MANUFACTURER: JA ELECTRONICS SERIAL NO. : 98023 RATING: 50 VOLTS 12 AMPERES VAC OUTPUT: 3 VOLTS 1 AMPERES MONITOR CHECK: SETTING: A-2 HOURMETER READING 0 HRS LAST READING HRS DATE CHANGE IN READING HRS ACTUAL HOURS HRS DAYS OFF FIELD TEST DATA STRUCTURE-TO-SOIL TEST LOCATION POTENTIAL OM I (on) I (off) FUEL TANK#1 - -1156 399 FUEL TANK#2 - -1154 399 FUEL TANK#3 - -1151 399 FUEL TANK#4 - -1150 399 FUEL TANK#5 - FUEL TANK#6 - VENTS - FIBERGLASS DISPENSER#1 - -1080 399 DISPENSER#2 - -1078 399 DISPENSER#3 - -1080 -399 DISPENSER#4 - -1079 399 DISPENSER#5 - -1079 399 DISPENSER#6 - -1078 399 WATER LINES - GAS CO. METER- ELECTRICAL CONDUfT - -1080 1 399 c CuCuSO4 REFERENCE LOCATION g: CORNER PLANTER AT TAFT HWY AND WIBLE RD. RE lVWM: (FiE1D) START UP SURVEY SYSTEM IS OPERATING AS DESIGNED ALL POTENTIALS ARE ABOVE THE NACE CRITERIA OF-850 MILLIVOLTS. 14 0'2'70 AIAR Y TUN A VEN UE, SA t t GY, t . - J CA. LICENSE C-10 684718 CORROSION- ELECTRICAL SERVICES', INC. CATHODIC PROTECTION SYSTEM MAINTENANCE RECORD SHEET LOCATION OF RECTIFIER UNIT: INSIDE STORE ON SOUTH WALL TYPE OF RECTIFIER: AIR COOLED TYPE OF ANODES: GRAPHITE NUMBER: 4 SIZE: 3 X 60 LONG RECTIFIER MANUFACTURED BY: JA ELECTRONICS 98023 RECTIFIER AC INPUT: 120 VOLTS 1 PHASE 60 �YCLE RECTIFIER DC OUTPUT: 50 VOLTS 12 AMPERES DATE TURNED ON: APRIL 14. 1998 RECTIFIER READINGS RECTIFIER SETTING D.C.OUTPUT BY DATE REMARKS COARSE FINE VOLT AMPS A 2 3 1 GS 4-14-98 START UP SURVEY U W Q z 14020j$L4RYTONAVENUE, SANTA FE SPRINGS, CALIFORNIA 90670 PHONE:(562) 921-9522 FAX: (562) 921-6885 CA. LICENSE C-10 684718 RECTIFIER QUARTERLY RECORD RECORD WEEKLY JOB # 1476 OWNER HAPPY MART LOCATION 3221 TAFT HWY. PUMPKIN CENTER, CA. UNIT D.C. OUTPUT NO. VOLTS AMPS DATE TIME REMARKS BY 1 3 1 41498 START UP SURVEY GS UNIT NO. 1 UNIT LOCATION ON SOUTH WALL INSIDE STORE UNIT NO. UNIT LOCATION NORMAL RANGE: UNIT NO. 1 VOLTS .05.7 AMPS .05-5 UNIT NO. VOLTS AMPS o NOTE: IF UNIT STABILIZES OUTSIDE NORMAL, NOTIFY YOUR ENGINEER III U it MAIL TO CORROSION-ELECTRICAL SERVICES INC. QUARTERLY U W } NORTH TAFT HWY CP TEST #1 ■ #2 #3 #4 7 1 i i � 1 2 2 1 2 0 j i 0 i 0 10 j I D I I D I 1 0 I 1 0 I 0 i 0 i i 0 10 I I I I I I 1 I I L j I L I L j I L j I 1 I I I I I I I l_1 j 1 u I U I I u `S j W 1 s l S S I 1 I 1 I I B L CPW E R ❑ ❑ STORE D A.C. ❑ ❑ RECTIFIER LEGEND ISLANDS AS BUILT C Corrosion Electrical Services CATHODIC PROTECTION ANODE WELL(CPW) ES Paramount,Califanla ■ CATHODIC PROTECTION TEST BOX J08 NO. 1476 CATHODIC PROTECTION SYSTEM LAYOUT SCALE NONE HAPPY GAS 3221 TAFT HWY DRM.BY L.0 PUMPKIN CENTER,CA. ENVIRONMENTAL HEALTH SOVICES DEPARTMENT RESOURCE MANAGEMENT AGENCY STEVE McCALLEY, R.E.H.S., Director • DAV/D PRICE/fl, RMA D/RECTOf 2700 W STREET, SUITE 300 i// Community Development Program Department BAKERSFIELD, CA 93301-2370 Engineering & Survey Services Department Voice: (805) 882-8700 Environmental Health Services Department PAX: (805) 882-8701 Planning Department TTY Relay: (800) 735.2929 • ' Roads Department e-mail: eh @kerncounty.com PERMIT TO 1 UNDERGROUND STORAGE FACILITY PERMIT NUMBER 320018M FACILITY OWNER(S) NAME/ADDRESS: CONTRACTOR: Happy Gas Davies Oil Company Cal Valley Equipment Co. 3221 Taft Highway 4700 Pierce Road 3500 Gilmore Avenue Bakersfield, CA Bakersfield, CA 93308 Bakersfield, CA 93308 License #447797 Phone No. (805) 323=6063 Phone No. (805) 327-9341 NEW CONSTRUCTION PERMIT EXPIRES March 3. 1998 X MODIFICATION OTHER APPROVAL DATE June 3 1997 APPROVED BY Laurel Funk Hazardous Materials Specialist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . POST ON PREMISES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CONDITIONS AS FOLLOW: Standard Instructions 1. This permit applies only to the modification of an existing facility involving the replacement of the product piping. 2. All construction to be as per facility plans approved by this department and verified by inspection by Permitting Authority. 3. All equipment and materials in this construction must be installed in accordance with all manufacturers' specifications. 4. Permittee must contact Permitting Authority for on-site inspection(s) with 48-hour advance notice. 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. 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. ACCEPTED BY: DATE: v- Z4 9::�k� 10 INVOICE #bs0000ll TEST DATE: 01/22/98 UNDERGROUND TANK TESTERS 15806 AVENUE 288 VISALIA, CA 93292 209-747-5220 TANK STATUS EVALUATION REPORT ----------------------------- ***** CUSTOMER DATA ***** ***** SITE DATA ***** DAVIES OIL CO. HAPPY GAS CONV. MARKET P.O. BOX 80067 3221 TAFT HWY. BAKERSFIELD, CA. PUMPKIN CENTER, CA. 93308 93309 CONTACT: CHUCK MARTIN CONTACT: PHONE # : 805-323-6063 PHONE # : ***** COMMENT LINES ***** CURRENT EPA STANDARDS DICTATE THAT FOR UNDERGROUND FUEL TANKS, THE MAXIMUM ALLOWABLE LEAK/GAIN RATE OVER THE PERIOD OF ONE HOUR IS . 05 GALLONS . TANK #1 : SUPER UNLEADED TYPE: STEEL RATE : . 023044 G.P.H. GAIN TANK IS TIGHT. TANK #2 : PLUS UNLEADED TYPE: STEEL RATE: .035850 G.P.H. GAIN TANK IS TIGHT. TANK #3 : DIESEL FUEL 2 TYPE : STEEL RATE: . 015596 G.P.H. GAIN TANK IS TIGHT. TANK #4 : REG UNLEADED TYPE : STEEL RATE: . 030152 G.P.H. GAIN 3 TANK IS TIGHT. OPERATOR: SIGNATURE• �rB� ° DATE:, • • ******* T A N K D A T A ******** TANK NO. TANK NO. TANK NO. TANK NO. 1 2 3 4 TANK DIAMETER (IN) 96 96 96 96 LENGTH (FT) 26 . 59 26 .59 26 .59 26 .59 VOLUME (GAL) 10000 10000 10000 10000 TYPE ST ST ST ST FUEL LEVEL (IN) 70 71 77 74 FUEL TYPE SUP UNLD PLS UNLD DIESEL 2 REG UNLD dVOL/dy (GAL/IN) 117 . 87 116 .41 105 . 69 111 .49 CALIBRATION ROD DISTANCE 1 10 . 65625 2 26 . 95313 3 41 . 93750 4 56 . 93750 5 74 . 93750 ******* C U S T O M E R D A T A ******** JOB NUMBER : 000011 CUSTOMER (COMPANY NAME) : DAVIES OIL CO. CUSTOMER CONTACT(LAST, FIRST) : CHUCK MARTIN ADDRESS - LINE 1 P.O. BOX 80067 ADDRESS - LINE 2 CITY, STATE BAKERSFIELD, CA. ZIP CODE (XXXXX-XXXX) 93308 PHONE NUMBER (XXX)XXX-XXXX 805-323-6063 ******* C 0 M M E N T L I N E S ******* ******* S I T E D A T A ******** SITE NAME (COMPANY NAME) HAPPY GAS CONV. MARKET SITE CONTACT(LAST, FIRST) ADDRESS - LINE 1 3221 TAFT HWY. ADDRESS - LINE 2 CITY, STATE PUMPKIN CENTER, CA. ZIP CODE (XXXXX-XXXX) 93309 PHONE NUMBER (XXX)XXX-XXXX GROUND WATER LEVEL (FT) 0 NUMBER OF TANKS 4 LENGTH OF PRE-TEST (MIN) 30 LENGTH OF TEST (MIN) 120 15 TARE 1 START TIME:02:58:09:88 CURRENT TIME:83:50 :00:00 1 � Lo w 2 J � 88 � — p: - .800B8aapp 45 C1: .BU4Z1 2 —10 —LEAH RATE : .02384 GPH GAIN PTA, VERSION 1.28 —15 0 15 30 45 60 bs888811.TST J TIME (MINUTES) 8i/22/98 15 TANX 2 START TIME:82 :58:08:00 CURRENT TIME:03:50 :88:89 10 LO w lei.. r 1 a J J Ld – 8; .80021 C1. .90656 –10 —LEAH RATE : .03585 GPH GAIN PTA+ VERSION 1.20 –15 0 15 50 4-5 so bs000611.TST,i TIME (MINUTES) 01/22/98 15 TANX 3 START TIME:85 :33:28:88 CURRENT TIME:86:33 :28:88 10 Lo w L) z 5 g C1: .88285 2 —10 LEAH RATE : .81568 GPH GAIN PTA, VERSION 1.20 —15 0 15 30 4.5 60 bsO88811.TST,2 TIME (MINUTES) 01/22/98 1s TANY 4 START TINE:85 :33:48:88 CURRENT TINE:86:33 :48:88 Ln W C J a .t 4 f J z � - 8: .88828 C1: .88551 r 1 --LEAH RATE : .83815 GPH GAIN PTA, VERSION 1.48 —15 0 15 30 45 60 bs88881i.TST,2 TIME (MINUTES) 81/24/98 INVOICE #bs000011 TEST DATE: 01/22/98 UNDERGROUND TANK TESTERS 15806 AVENUE 288 VISALIA, CA 93292 209-747-5220 TANK STATUS REPORT -- ULLAGE TEST --------------------------------- ***** CUSTOMER DATA ***** ***** SITE DATA ***** DAVIES OIL CO. HAPPY GAS CONV. MARKET P.O. BOX 80067 3221 TAFT HWY. BAKERSFIELD, CA. PUMPKIN CENTER, CA. 93308 93309 CONTACT: CHUCK MARTIN CONTACT: PHONE # : 805-323-6063 PHONE # : ***** COMMENT LINES ***** CURRENT EPA STANDARDS DICTATE THAT FOR UNDERGROUND FUEL TANKS, THE MAXIMUM ALLOWABLE LEAK/GAIN RATE OVER THE PERIOD OF ONE HOUR IS . 05 GALLONS . TANK #1 : SUPER UNLEADED TYPE : STEEL SN: - . 13 TANK IS TIGHT. TANK #2 : PLUS UNLEADED TYPE : STEEL SN: - . 16 TANK IS TIGHT. TANK #3 : DIESEL FUEL 2 TYPE : STEEL SN: - .30 TANK IS TIGHT. TANK #4 : REG UNLEADED TYPE : STEEL SN: - . 17 TANK IS TIGHT. 'tj ffn ° --- DATE : OPERATOR: fi,� �lAe�!�e!� SIGNATURE: ,�� i--------- ��/��4g -------------------- ---- ******* T A N K D A T A ******** TANK NO. TANK NO. TANK NO. TANK NO. 1 2 3 4 TANK DIAMETER (IN) 96 96 96 96 LENGTH (FT) 26 .59 26 .59 26 .59 26 . 59 VOLUME (GAL) 10000 10000 10000 10000 TYPE ST ST ST ST FUEL LEVEL (IN) 70 71 77 74 FUEL TYPE SUP UNLD PLS UNLD DIESEL 2 REG UNLD dVOL/dy (GAL/IN) 117 . 87 116 .41 105 . 69 111 .49 CALIBRATION ROD DISTANCE 1 10 . 65625 2 26 . 95313 3 41 . 93750 4 56 .93750 5 74 . 93750 ******* C U S T O M E R D A T A ******** JOB NUMBER 000011 CUSTOMER (COMPANY NAME) DAVIES OIL CO. CUSTOMER CONTACT(LAST, FIRST) : CHUCK MARTIN ADDRESS - LINE 1 P.O. BOX 80067 ADDRESS - LINE 2 CITY, STATE BAKERSFIELD, CA. ZIP CODE (XXXXX-XXXX) : 93308 PHONE NUMBER (XXX)XXX-XXXX : 805-323-6063 ******* C 0 M M E N T L I N E S ******* ******* S I T E D A T A ******** SITE NAME (COMPANY NAME) : HAPPY GAS CONV. MARKET SITE CONTACT(LAST, FIRST) ADDRESS - LINE 1 3221 TAFT HWY. ADDRESS - LINE 2 CITY, STATE PUMPKIN CENTER, CA. ZIP CODE (XXXXX-XXXX) 93309 PHONE NUMBER (XXX)XXX-XXXX GROUND WATER LEVEL (FT) 0 NUMBER OF TANKS 4 LENGTH OF PRE-TEST (MIN) 30 LENGTH OF TEST (MIN) 120 3.0 TAM} i TIME -- 07: 16:34 LJ 2,0 z J 7 Lo 1 ,0 PEAR SM: 6.73 3/ 2 UTA, VERSION 1.00 50 500 5000 50000 bsB008ii.SON FREQUENCY (HZ) Mi/22/98 TANY 2 TIME -- 07:23 :33 LJ 2,0 z J z 1 .0 SM: -.16 PEAH SM: 5. 15 r� 5/ 4 UTA, VERSION 1.00 .0 50 500 5000 50000 bsMOUMi1.SOM FREQUENCY (HZ� 81/22/96 3.0 TAMIL 3 TIME -- 07:30:57 Ld 2,0 z 7 1 ,0 SM: -.38 PEAS SM: 5.02 7/ 6 UTA, VERSION 1.00 50 500 5000 50000 bs9MM011.80M FREOUENCY (HZI Mi/22/98 3,0 TANH # TIME -- 87:35:36 m 2.0 0 z D I' 1 ,0 ED r SN: -. 17 PEAR SM: 3.75 9/ 8 UTA, VERSION 1.88 LJ 50 500 5000 50000 bs8888ii.SON FREQUENCY (HZ) 8i/22/98 UNDERGROUND TANK TESTERS 15806 AVENUE 288 VISALIA, CA 93292 (800) 244-1921 PIPING TIGHTNESS DETERMINATION; PL400 FORMAT TEST LOCATION: HAPPY GAS CONVENIENCE MARKET 3221 TAFT HWY. PUMPKIN CENTER, CA. 93309 TEST OPERATOR: � . BOBBY G. SMITH OTTL LIC 97-1431 DATE: 01/22/98 TEST INITIAL FINAL VOLUME LEAK RATE LEAK RATE PASS FAIL DURATION PRESSURE PRESSURE DISPLACED SUP UNLD 30 50 41 10 -.0238 X PLS UNLD 30 50 44 8 -.0191 X DIESEL 2 30 50 39 11 -.0262 X REG UNLD 30 50 36 13 -.0312 X COMMENTS: LEAK DETECTOR/S FUNCTIONING PROPERLY(!S )YES PLOT PLAN 30BSITE 1,dCA'TIOv f. ^&P .tiKc � k?eG� Cam. i T�J T t LJ t} l t s i TANK SIZE PRODUCT LEGEND I /` o o o D j C u c, F FILL TURBINE 4 v ; #2 V J S El WITH LEAK DETECTOR l (F, 04 ERSPrLL CONTAINER ON FILL, ��C �� :R REMOTE FILL E� EXTRACTOR VALVE #5 _ MONITOR SYSTEM #6 #7 �� MANIFOLD SYSTEM :: E WIRONMENTAL HEALTH SOVICES DEPARTMENT IkESOURCE MANAGEMENT AGENCY STEVE McCALLEY, R.E.H.S., Director DA WDPRICEIII,RMADIRECTOR 2700-M••STREET,SUITE 300 Engineering&Survey Services Department BAKERSFIELD,CA 93301 Environmental Health Services Department Phone:(805)862-8700 Planning Department FAX:(805)862-8701 gd=s Roads Department TANK INTEGRITY TESTING INSPECTION FORM THIS FORM MUST BE COMPLETED AT TIME OF INTEGRITY TEST BY THE TECHNICIAN ON SITE AND SUBMITTED WITH THE TANK INTEGRITY TEST RESULTS TO THE KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Facility Permit to Operate Number Facility Permit to Tightness Test Number %—� (el Facility Name��4� Facility Address .I-/ 7—A19- -L- <T A-.1aj �w)Zr.r, Facility Telephone Number Have you complied with the following safety requirements stated in UT-20, Section 25? YES/NO The area within 25 feet of any underground storage tank opening is free of smoking, open flames, and any other source of ignition. 4Z F-5 _ Legible signs with the words "NO SMOKING" are posted in conspicuous / locations around the testing area. The general public is restricted from the testing area by rope, flags, cones, and "if dark" a fluorescent barrier. Fire protection in the form of a 2A/20BC fire extinguisher is located wilthin the restricted area. 5 Vehicles utilized during the testing period, or within 25 feet of the underground storage tank opening, have adequate ventilation, and the tester has equipment which can be utilized to monitor the concentration of flammable vapors within the vehicle. 4e 5,5 Personal protective equipment, an eye wash and gloves, and a site safety plan are within the testing area. Equipment/materials is available to absorb and contain any small release of testing liquid which is discharged as a result of the test. (Examples include DOT-acceptable containers for storage of the absorbent and an adequate supply of absorbent). If the answer to any of the above questions is NO, stop the testing procedure IMMEDIATELY until compliance is obtained. COMPLETE REVERSE SIDE TANK INTEGRITY TESTING INSPECTION FORM continued Is the following data consistent with the information submitted on the application for Permit To Perform Integrity Testing (PTT)? YES/NO The number of tanks being tested Testing company Test method used L State Licensed Technician on site / State Licensed Technician's # Is the site layout consistent with the application plot plan? State exceptions for any NO answers to the above questions: I CERTIFY THATTHE AFOREMENTIONED FACTS ARE TRUE AND CORRECT UNDER PENALTY OF PERJURY. (Not valid if not signed and dated.) Signed this a,X day of _7-A A). , 19 at date month city and state a (SIGNATURE) -State Licensed Technician on Site (PRINT) -Stat Licensed Technician on Site HM54 Kern County Intcrnat Use Only Environmental Health Services Dapt. 11,11 NoZZI-Iedei! '''inks to Tesl t__ 2700 M Street, Suite 300 Test to iiwludc: '1111k nniv Bakersfield, CA 93301 );,tl►;1{�jpjttg (805) 862-8700 1`'1() Nc?�. ;L�App1. Date AI'PLIC'ATION FOR PERMIT '1'O TE'S"I' UNDERGROUND HAZARDOUS SUBSTANICES ST RACE TANK � POST ON PREMISES �3- A. Facility information Kern County' Environmental i-Icafth Services Dept. Penizit to Q,2�.rate !I �oO/ � _ zz (If there is no permit number, an application for a pet-i;iit to operate must be submitted and approved beFore the pe tit :o test can be processed). Proposed Test Itate:_�z-- _ f _ Facility N arts c - Address -Z��� TANK # SIZE PRODUCT nO13 O}' VANK COMMI.NTS Contact. Person Day Pljone Night B. Tank. Owner }nformaticm Owner Nante _ 4U d, � Phone Mailing Addres!: �.:.ip Cale , 7sly/OF C. Tes inA Coinyar.v Information Company Name Address Contact Person Day. "'t - •'7��— I�)tc�ne i � G'% ;f .� ._� Night _ I'lione Worker's Compensation Insurance 4 Liability Insurance # _LSr 13 Test Method Used it State Licensed 'fester CUD- Ms State Licensed 'rester # THIS APPLICATION S.COMES A PERMIT WHEN APPROVED • • . . . . . . . . . . . . . . . . . . . . . . . . . . POST ON PREMISES. . . . . . . . _..�. CONDITIONS AS FOLLOWS: I. It is the responsibility of the.11crmittec to obtain permits which in ay he required by ott,cr rqulat+ ry agencies prior to ig•.%tick City Fire and Building Departments'). 2. Permittee must notify the llaznrdous Materials Manag•crn2nt Program at (805)862 8700 ovent) foot hours prior it)vink iwcgrit_t to^t tcc .'allow the Hazardous Material Sp-ccialist the option cf performing; in inspection. 3. 'Tank integrity test must be per.Kern County Iinvironmrim] Health and Fire Departnnrnt approved metho0s as described in Handbook r.11 20. 4. it is the,state-licensed tester's resp.>nsitility to xno" aid adhere to till applicable laws regarding the handling of ha;ardous nwic,:alts. 5. The lanW integrity testing_nmpa ry n%ust have the state-licensed tester listed on tivu pcnni u,; siie pesfornting the test. 6. If any tester other than the one listed on the pernia and perntit application is to be utilized,prior consent must be granted by tic apliroviup specialist an the permit. Deviation front the submitted application is not allowed. ',. A modification pcnnit must be (,btaiiwd from tic drparuneni prior to exposing ihc tank t:) r:tent or mvestigaling a release or lakk;c' integrity test.. S. The following timetable lists pre- ctnc post-tank integrity test requirements: ACTIVITY DEADLINE Complete permit application submitted to At (cast one %%t6. prior tv tank the Hazardous Material Managen+ent Proe.rarn integrity test Notify the approving specialise At least 24 houcu; he fori teed of date and time of the tank integrity test Send written results of a test to the: No later than 3;'r days alter testing approving specialist is completed Notify the approving specialise. No later than 24 hours silcr of the results of a foiled/.inconclusivc test completion of nnidysis RECOMMENDAT IONSJGl1IDELINESI:OR'I11F,PEAFOR.MANCE OF A 'TANK INTEGRITY'ucsi'ON UNDERGROUND S1DRA(jh TANKS This department is responsible for enforcing;the state laws pertaining to underground storage.t;mks. Rcprc erta+tivcs from this deparunenl perfc;rw. inspections to ensure that the job performance is cor+sistent with permit reduircntents.applicahic 1aws,and surety standards. The following are offered to clarify the interests tined exp stations of this depilrt.meut. i. Jab site safety is one of our primary concerns. Tank i tteprily tests are inherently dangerous. it is the Icster's responsib1it; to know iiiet abide by CAL-OSHA regulations. The state-hceused tester is re-,ponsibie for any Wirt lestim company employees till the job site. 'l cu is. and equipment are to be used only for their dc;igncd (unction. 2. Properly state-licensed testers are assumed to understa:td the requirements of the permit issued, 11ic tester is responsible for kne..vingt:eud abiding by the conditions of the termit. Deviation from the permit conditions ntnv result in a stop-v,,ork order. 3. The testing company will be held responsible for the host-test papervork. Analyses documentation is necessary for each site in order to close a case file or move it into mitigation. Whan testers do nut follow through on necessary paperwork, an untnanageable fiixklog 01 incomplete cases results. If this centimes, prco(essitig time for completing new tank integrity tests will increase. THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND AUII,L COMPLY WI-1-11 -Fill.; ABOVE CONIi)NIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL, ANTI F L)ERAL REGi1_ATIONS. THiS FORM 14AS BEEN COMPLETED UNDER PENAL']')' OF PERJURY AND TO 'Till. BFS' UT" MY KNOWLEDGE IS TRUE' AND CORRECT. Owner's Authorized Signature Date /a-9Y Representative _. � Datc_____�._�_. INTERNAL USE ONLY ,// Total Fcc ��� _ laid On Permit .Appr ed '�v( L Receipt p� W .aslt_ __ Check. N_ 213.^ Dale Fee Received I?v Permit .Ex ration Date - _ � _. THIS APPLiCATION BECOMES A PERMIT WHEN APPROVED HM44 � \ a 00 3 USTMAN SIR SYSTEM Yearly Statistical Inventory Reconciliation (SIR) Report 1996 STATION NAME: CONVENIENCE MARKET 096 STATION #: C COMPANY NAME: DAVIES OIL COMPANY ADDRESS: 3221 TAFT HWY CITY: BAKERSFIELD ZIP: 93307 STATE: CA PHONE: COUNTY: KERN DATE OF REPORT: 02112197 MONITORING THRESHOLD: 0. 05 GPH LEGEND --> T - TIGHT/PASS *I* - INVESTIGATE/FAIL XP - IN PROCESS/INCONCLUSIVE ND - NO DATA SUBMITTED TANKID CAP JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC CDIE 12K T T T T T Z' T T T T T T CPLUS 12K T T T T T T T T T T T T CPREM 12K T T T T T T T T T T T T CUNL 12K T T T T T T T T T T T T SIR PROVIDER: USTMAN INDUSTRIES, INC. 12265 W. BAYAUD AVE. SUITE 110 LAKEWOOD, CO 80228 PH: 3031986-8011 FAX: 3031986-8227 SIR VERSION: 91. 1 I certify under penalty of perjury that all SIR results listed above ar��s c to . Signature of Tank Owner/Operator of Agent at • ENVIRONMENOAL HEALTH SERVICEODEPARTMENT STEVE WCALLEY, R.E.H.S. 2700 .M. serest, suite 300 DIRECTOR Bakersfield, CA 93301 (805) 861-3636 (805) 861-3429 FAX `�4%zSZG•G%�t� �1 TANK INTEGRITY TESTING INSPECTION FORM THIS FORM MUST BE COMPLETED AT TIME OF INTEGRITY TEST BY THE TECHNICIAN ON SITE AND SUBMITTED WITH THE TANK INTEGRITY TEST RESULTS TO THE KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Facility Permit to Operate Number Facility Permit to Tightness Test Number_ Facility Name Facility Address ,tea I Jh Facility Telephone Number �3 1 3023 Have you complied with the following safety requirements stated in UT-20, Section 25? YES/NQ ��L S The area within 25 feet of any underground storage tank opening is free of smoking, open flames, and any other source of ignition. _s Legible signs with the words "NO SMOKING" are posted in conspicuous locations around the testing area. The general public is restricted from the testing area by rope, flags, cones, and "if dark" a fluorescent barrier. Fire protection in the form of a 2A/20BC fire extinguisher is located within the restricted area. �— Vehicles utilized during the testing period, or w-,thin 25 feet of the underground storage tank opening, have adequate ventilation, and the tester has equipment which can be utilized to monitor the concentration of flammable vapors within the vehicle. � Personal protective equipment, an eye wash and gloves, and a site safety plan are within the testing area. -i' Equipment/materials is available to absorb and contain any small release of testing liquid which is discharged as a result of the test. (Examples include DOT-acceptable containers for storage of the absorbent and an adequate supply of absorbent). If the answer to any of the above questions is NO, stop the testing procedure IMMEDIATELY until compliance is obtained. COMPLETE REVERSE SIDE TANK INTEGRITY TESTING INSPECTION FORM continued Is the following data consistent with the information submitted on the application for Permit To Perform Integrity Testing (PTT)? YES/NO The number of tanks being tested Z/;e, 1" Testing company 22-,r7—. Test method used 9*��— State Licensed Technician on site /-/�,J/ State Licensed Technician's # .S Is the site layout consistent with the application plot plan? State exceptions for any NO answers to the above questions: I CERTIFY THAT THE AFOREMENTIONED FACTS ARE TRUE AND CORRECT UNDER PENALTY OF PERJURY. (Not valid if not signed and dated.) Signed this '/ day of /p , 19 ; at //1`S .a date month city and state T� (SIGNATURE) -State Licensed Technician on Site d s ..7� (PRINT) -State Licensed Technician on Site HM54 r Kern County Internal Use Only Environmental Health Services Dept. PTT No./ �Z1, # Tanks to Test 2700 M Street, Suite 300 ,' Test to include: Tank only Bakersfield, CA 93301 Tank/Piping,T _ (805) 861-3636 �li ��- ` PTO No �Appl. Date iv i APPLICATION FOR PERIVII'T TO TEST UNDERGROUND HAZARDOUS SUBSTANCES STORAGE TANK POr2T ON PREMISES A. Facility Information Kern County Environmental Heal j_Services Dept. Permit to Operate # (If there is no permit number, an ,ppiication for a permit to operate must be submitted and approved before the permit to te:s can be rocessed). Proposed Test Date: Facility Name ► ��c2 ��'N� Address (7.2 -:z/ TANK # SIZE PI QDUCT AGE OF TANK COMMENTS /0 it ..Y,4=0 — - Contact Person Day _ Phone (_) Night _ Phone'( B. Tank Owner Information Owner Name ,S'AAA E _ Phone ( ) MaWng Address _ Zip Code C. Testing Company Information Company Name /l.(/Of%Z424 CcLV/� Address /",-V e Aj3 -2 Contact Person Day , d Sitrt i�� Phone Night v' Phone Worker's Compensation Insurances` Liability Insurance # e t° Z Test Method Used / / tit A A Ilk 1'4 A State Licensed Tester _—��or lA i State Licensed Tester # ��, / THIS APPLICATION BECOMES A PERMIT WHEN APPROVED i i a v PS iA c y n \ 7040 °, o 'd �. � o 00 M o, Z 0 Er H pg �r fl D61a°o 5N 8 ° � � -�, ', ° � � ^ e� °'°y � � �. n ^ 'gyp S 'g� x o'er° �' ° �i y aq N tz! " _ y 8 Cd gi .0 O fR QQ r rod MO ^ �. art � yG g' C �. sr m do � Sc RS N .. �. s R 08 0.. 2, ..w 0 0 oil No CD Cr IF "R Er Er ^ . 'O a hn J a• w ^ oo oo -R ^ r m CD to p Q b � to � rr M c L. o rr a � 0 ^ gg .fig g F CL 0 o CL s cr — 9 pr pr T NE CaHT SS TESTING REPOR7#S EVALUATION FORM Specialist reviewing the tightness test report: Date tightness test reports were submitted: 11.411 � Date tightness tests were completed: Ad/13/95 Facility Permit Number: 30 06 Number of Tanks Tested at the site: (list the tanks by their tank numbers if provided) /, aQ "a . Was the method a test of the e e tank system, ing alone, or just the facility tanks? (describe) Did the facility pass all tests: Yes No (if no, provide the leak rate and a description of the tank(s) that failed the test) (failure is > 0.1 gal per hour) The facility will do the following to investigate the failed test: The test method certification that is submitted to the state specifies that each test method be completed in a certain manner. Is there anything within the results which would suggest that the tank test was improperly completed? Yes No (describe) Information has been reviewed and placed within the database:✓ YES NO Date entered within the database: /P71q`� HM25 Entered by (name) Q0 � 0 0 INVOICE #BS000154 TEST DATE: 10/13/95 UNDERGROUND TANK TESTERS 15870 AVENUE 288 VISALIA, CA. 93292 (800)244-1921 TANK STATUS EVALUATION REPORT ----------------------------- ***** CUSTOMER DATA ***** ***** SITE DATA ***** DAVIES OIL CO. HAPPY GAS CONVENIENCE MKT. # 096 P.O. BOX 80067 3221 TAFT HWY. BAKERSFIELD,CA. PUMPKIN CENTER,CA. 93309 93309 CONTACT: CHUCK MARTIN CONTACT: PHONE #: 1-800-549-0079 PHONE #: 805-831-2323 ***** COMMENT LINES ***** CURRENT EPA STANDARDS DICTATE THAT FOR UNDERGROUND FUEL TANKS, THE MAXIMUM ALLOWABLE LEAK/GAIN RATE OVER THE PERIOD OF ONE HOUR IS .05 GALLONS. THIS TEST IS PERFORMED USING THE USTEST PROTOCOL. TANK #1: REG UNLEADED TYPE: STEEL RATE: .034666 G.P.H. GAIN TANK IS TIGHT. TANK #2: DIESEL FUEL 2 TYPE: STEEL RATE: .029705 G.P.H. GAIN TANK IS TIGHT. TANK #3: PLUS UNLEADED TYPE: STEEL RATE: .032394 G.P.H. GAIN TANK IS TIGHT. TANK #4: SUPER UNLEADED TYPE: STEEL RATE: .017318 G.P.H. GAIN TANK IS TIGHT. OPERATOR: BOB SMITH SIGNATURE: �- DATE 1 ******* T A N K D A T A ******** TANK NO. TANK NO. TANK NO. TANK NO. 1 2 3 4 TANK DIAMETER (IN) 96 96 96 96 LENGTH (FT) 26.59 26.59 26.59 26.59 VOLUME (GAL) 10000 10000 10000 10000 TYPE ST ST ST ST FUEL LEVEL (IN) 73 80 74 79 FUEL TYPE REG UNLD DIESEL 2 PLS UNLD SUP UNLD dVOL/dy (GAL/IN) 113 .22 98.86 111.49 101.26 CALIBRATION ROD DISTANCE 1 10.65625 2 26.95313 3 41.93750 4 56.93750 5 74.93750 ******* C U S T O M E R D A T A ******** JOB NUMBER : 000154 CUSTOMER (COMPANY NAME) : DAVIES OIL CO. CUSTOMER CONTACT(LAST, FIRST) : CHUCK MARTIN ADDRESS - LINE 1 P.O. BOX 80067 ADDRESS - LINE 2 CITY, STATE BAKERSFIELD,CA. . ZIP CODE (XXXXX-XXXX) : 93309 PHONE NUMBER (XXX)XXX-XXXX : 1-800-549-0079 ******* C O M M E N T L I N E S ******* ******* S I T E D A T A ******** SITE NAME (COMPANY NAME) : HAPPY GAS CONVENIENCE MKT. #096 SITE CONTACT(LAST, FIRST) ADDRESS - LINE 1 3221 TAFT HWY. ADDRESS - LINE 2 CITY, STATE PUMPKIN CENTER,CA. ZIP CODE (XXXXX-XXXX) 93309 PHONE NUMBER (XXX)XXX-XXXX 805-831-2323 GROUND WATER LEVEL (FT) 0 NUMBER OF TANKS 4 LENGTH OF PRE-TEST (MIN) 30 LENGTH OF TEST (MIN) 180 15 Cr TANX i START TIME:02:07:20:00 CURRENT TIME:03:07:20:00 ........��.. ............ ---------------------------------------1.......... ......,..... �. Lo w z 5 Q J J � — —Co: .00045 7 Cl: .00317 1 U EAX RATE: .03467 GPH GAIN PTA, VERSION 1.20 —15 0 15 30 45 60 BS000154.TST,2 TIME (MINUTES) 10/13/95 15 Cr. TANX 2 START TIME:02:07:20:00 CURRENT TIME:03:07:20:00 10 w J 0 J Z — —Co: .00073 Cl: .00272 —1 EAX RATE: .02971 GPH GAIN PTAj VERSION 1.20 —15 0 15 30 43 60 B8000154.TST,2 TIME (MINUTES) 10/13/95 15 Cr TANX 3 START TIME:82:87:28:88 CURRENT TIME:83:87:28:88 1C V3 z 5 Q J J Z w - 8: .88382 z Cl: .88296 1 EAX RATE: .03239 CPH GAIN PTA, VERSION 1.28 - 15 F I I I I I I I I I I I 0 15 30 45 60 )35888154.TST,2 TIME (MINUTES) 10/13/95 15 Cr TANX 4 START TIME:82:87:28:88 CURRENT TIME:83:87:28:88 10 U) w z Q 0 J J bi - $: .00104 z Cl: .8$158 10 -LEAH RATE: .81732 CPH CAIN PTA, VERSION 1.28 -15 0 15 30 45 SC BS888154.TST,2 TIME (MINUTES) 18/13/35 INVOICE #BS000154 TEST DATE: 10/13/95 UNDERGROUND TANK TESTERS 15870 AVENUE 288 VISALIA, CA. 93292 (800)244-1921 TANK STATUS REPORT -- ULLAGE TEST --------------------------------- ***** CUSTOMER DATA ***** ***** SITE DATA ***** DAVIES OIL CO. HAPPY MART P.O. BOX 80067 3221 TAFT HWY. BAKERSFIELD,CA. PUMPKIN CENTER,CA. 93309 93309 CONTACT: CONTACT: PHONE #: 805-831-2323 PHONE #: 805-831-2323 ***** COMMENT LINES ***** CURRENT EPA STANDARDS DICTATE THAT FOR UNDERGROUND FUEL TANKS, THE MAXIMUM ALLOWABLE LEAK/GAIN RATE OVER THE PERIOD OF ONE HOUR IS .05 GALLONS. THIS TEST IS PERFORMED USING THE USTEST PROTOCOL. TANK #1 : REG UNLEADED TYPE: STEEL SN: -.05 TANK IS TIGHT. TANK #2: DIESEL FUEL 2 TYPE: STEEL SN: .16 TANK IS TIGHT. TANK #3 : PLUS UNLEADED TYPE: STEEL SN: -.01 TANK IS TIGHT. TANK #4: SUPER UNLEADED TYPE: STEEL SN: .28 TANK IS TIGHT. OPERATOR: SIGNATURE - DATE: � - UC #91-1431 ******* T A N K D A T A ******** TANK NO. TANK NO. TANK NO. TANK NO. 1 2 3 4 TANK DIAMETER (IN) 96 96 96 96 LENGTH (FT) 26.59 26.59 26.59 26.59 VOLUME (GAL) 10000 10000 10000 10000 TYPE ST ST ST ST FUEL LEVEL (IN) 73 80 74 79 FUEL TYPE REG UNLD DIESEL 2 PLS UNLD SUP UNLD dVOL/dy (GAL/IN) 113 .22 98.96 111 .49 101.26 CALIBRATION ROD DISTANCE 1 10.65625 2 26.95313 3 41.93750 4 56.93750 5 74.93750 ******* C U S T O M E R D A T A ******** JOB NUMBER : 000154 CUSTOMER (COMPANY NAME) : DAVIES OIL CO. CUSTOMER CONTACT(LAST, FIRST) : ADDRESS - LINE 1 P.O. BOX 80067 ADDRESS - LINE 2 CITY, STATE BAKERSFIELD,CA. ZIP CODE (XXXXX-XXXX) : 93309 PHONE NUMBER (XXX)XXX-XXXX : 1-800-549-0079 ******* C O M M E N T L I N E S ******* ******* S I T E D A T A ******** SITE NAME (COMPANY NAME) : HAPPY GAS CONV. MKT. #096 SITE CONTACT(LAST, FIRST) ADDRESS- - LINE 1 3221 TAFT HWY. ADDRESS - LINE 2 CITY, STATE PUMPKIN CENTER,CA. ZIP CODE (XXXXX-XXXX) 93309 PHONE NUMBER (XXX)XXX-XXXX 805-831-2323 GROUND WATER LEVEL (FT) 0 NUMBER OF TANKS 4 LENGTH OF PRE-TEST (MIN) 30 LENGTH OF TEST (MIN) 180 �Cr 3,0 TANK 1 TIME -- 83:46:18 .......��.�.....� ......�.�.�............��...�.�.....�.. �.�•...LL1..I\M.L■1LJ L.R......A•\...........i...........................J{.i...i.•1■L.i.V.J7..'1 L.A.. Ld 2,0 U) z C) J z C5 Lo SN: -.85 PEAK SN: 15.23 3/ 2 UTA, VERSION 1.88 ���, "" 6 �,w I a 50 500 5000 50000 118000154.80H FREDUENCY (HZ� 18/13/95 3,0 TANK 2 TINE -- 03:49:16 2,0 J SN. .16 PEAK SH: 7.37 5/ 4 UM VERSION 1.00 *w , � lz 50 5010 5000 50000 118888154.8ON FREOUENCY (HZ) 10/13/95 Cr: TANK 3 TIME -- 03:50:10 LJ 7.0 z C) J z Lo Lo' 1 .0 SN: -.01 2 PEAK SM: 8.85 b 71 5 UTA, VERSION 1.00 .a "\,Ij I LN W 53 5010 5000 500-00 BS800154.SON FREQUENCY (HZ) 10/13/95 3,0 Cr: -- TANK 4 TIME -- 03:56:21 Lu 2,0 -- 0 7RwowY +woes waLYa•• ^�-•.�•�••-••�• .�•..�• ••^•••••�• ••••....-...«-.-�.... Ysrn s.au.�.ri.Y7w.am.�scstTlvif oar Y:OY/H Yiq/F iG4.n 1r� r z Lo �- SN. .ze �J PEAK SN: 12.52 M 11/10 UTA, VERSION 1.00 .0 50 50,0 5000 5u"^),o B8000154.80N FREDUENCY (HZ� 1$/13/95 PLOT PLAN JOBSITE LOCATION N Ala n&,/ 114h le ew E W -S. a s7Q/LC G/ TANK SIZE PRODUCT LEGEND #1 ,� ,( F FILL T TURBINE #2 ,` sFL TL TURBINE WITH LEAK DETECTOR #3 P'(li-5 FO OVERSPILL CONTAINER ON FILL #4 L' S R REMOTE o VENT- #5 E EXTRACTOR VALVE #6 M MONITOR SYSTEM #7 [ MANIFOLD SYSTEM #8 MW MONITOR WELL UNDERGROUND TANK TESTERS 15870 AVENUE 288 VISALIA, CA 93293 (8W) 242-1921 PIPING TIGHTNESS DETERMINATION; PL400 FORMAT TEST LOCATION: � TEST OPERATOR., BOB SMITH OTTL LIC 91-1431 DATE: TEST INITIAL FINAL VOLUME LEAK RATE LEAK RATE PASS FAIL DURATION PRESSURE PRESSURE DISPLACED DREG UNLD 105( PLS UNLD -0 3 1 9 �- SUP UNLD zp q� DIESEL 2 0 1 COMMENTS: M LEAK DETECTORJS FUNCTIONtNG PROPERLY 109 NO PTT # PTO . . . . . . . . . . . . . . . . . . . . . . . . . POST ON PREMISES. . . . . . . . . . . . . . . . . . . . . . . . . . CONDITIONS AS FOLLOWS: 1. It is the responsibility of the Permittee to obtain permits which may be required by other regulatory agencies prior to beginning work (i.e., City Fire and Building Departments). 2. Permittee must n2t&the Hazardous Materials Management Program at(805)861-3636 twenty-four hours prior to tank integrity test to allow the Hazardous Material Specialist the option of performing an inspection. 3. Tank integrity test must be per Kern County Environmental Health and Fire Department approved methods as described in Handbook UT-20. 4. It is the state-licensed tester's responsibility to know and adhere to all applicable taws regarding the handling of hazardous materials. 5. The tank integrity testing company must have the state-licensed tester listed on the permit on site performing the test. 6. If any tester other than the one listed on the permit and permit application is to be utilized,prior consent must be granted by the approving specialist on the permit. Deviation from the submitted application is not allowed- 7. A modification permit must be obtained from the department prior to exposing the tank to retest or investigating a release or failed integrity test. 8. The following timetable lists pre-and post-tank integrity test requirements: Complete permit application submitted to At least one week prim to tank the Hazardous Material Management Program integrity test Notify the approving specialist At least 24 hours before test of date and time of the tank integrity test Send written results of a test to the No later than 30 days after testing approving specialist is completed Notify the approving specialist No later than 24 hours after of the results of a failed/inconclusive test completion of analysis RECOMMENDATIONS/GUIDELINES FOR THE PERFORMANCE OF A TANK INTEGRITY TEST ON UNDERGROUND STORAGE TANKS This department is responsible for enforcing the state laws pertaining to underground storage tanks Representatives from.this department perform inspections to ensure that the job performance is consistent with permit requirements, applicable laws,and safety standards. The following guidelines are offered to clarify the interests and expectations of this department. 1. Job site safety is one of our primary concerns. Tank integrity tests are inherently dangerous. It is the tester's responsibility to know and abide by CAL-OSHA regulations. The state-licensed tester is responsible for any other testing company employees on the job site. Tools and equipment are to be used only for their designed function. 2. Property state-licensed testers are assumed to understand the requirements of the permit issued The tester is responsible for knowing and abiding by the conditions of the permit. Deviation from the permit conditions may result in a stop-work order. 3. The testing company will be held responsible for the post-test paperwork. Analyses documentation is necessary for each site in order to close a case file or move it into mitigation. When testers do not follow through on necessary paperwork,an unmanageable backlog of incomplete cases results. If this continues, processing time for completing new tank integrity tests will increase. THE APPLICANT HAS RECEIVED,UNDERSTANDS,AND WILL COMPLY WITH THE ABOVE CONDITIONS OF THIS PERMIT AND ANY OTHER STATE,IDCA-L AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. Owner's Authorized Signature Date Representative Date INTERNAL USE ONLY /7 —/5 . l 5_ Total Fee 50 Paid On Permit Approved Receipt #_426—/. Cash Check# Date Fee Received By Permit Expiration Date 1/0 THIS APPLICATION BECOMES A PERMIT WHEN APPROVED HM44 Kern County Internal Use Only Environmental Health Services Dept. PTT No.TOIDir# Tanks to Test 2700 M Street, Suite 300 Test to include: Tank only Bakersfield, CA 93301 Tank/Piping (805) 861-3636 PTO No. 0/ Appl. Date%o 13- APPLICATION FOR PERMIT TO TEST UNDERGROUND HAZARDOUS SUBSTANCES STORAGE TANK POST N PREMISES A. Facility Information KcM County Environmental �i JiServices Dept. Permit to Operate # 302(SUS (If there is no permit number, an <pplication for a permit to operate must,be submitted and approved before the permit to tes can be rocessed). Proposed Test Date: Facility Name L j (19,4 r'X.ve-e--- 7 Address c?a2 C:2z a lid<,;3,z6P INK # SIZE PI;CIDUCT AGE OF TANK COMMENTS _—� to �15� AP Contact Person Day _ Phone ( ) Night _ Phone B. Tank Owner Information Owner Name c�'�M _ Phone ( ) Mailing Address _ Zip Code C. Testing Company Information Company Name Address 1 .Y?Q��-�8� `S� �A 9 3� r Z Contact Person Day .6 Sikh71ek Phone Q,�-9 ) 7�17&44-6 Night Phone Worker's Compensation Insurance W Xl6Jili Liability Insurance # C 2- Test Method Used State Licensed Tester -' Si141 z1f, State Licensed Tester # THIS APPLICATION BECOMES A PERMIT WHEN APPROVED USTMAN SIR SYSTEM Yearly Statistical Inventory Reconciliation (SIR) Report 1994 STATION NAME: CONVENIENCE MARKET 096 STATION #: C COMPANY NAME: DAVIES OIL COMPANY ADDRESS: 3221 TAFT HWY CITY: BAKERSFIELD ZIP: 93307 STATE: CA PHONE: COUNTY: KERN DATE OF REPORT: 04104195 MONITORING THRESHOLD: 0. 05 GPH LEGEND --> T - TIGHT/PASS *I* - INVESTIGATE/FAIL XP - IN PROCESS/INCONCLUSIVE ND - NO DATA SUBMITTED TANKID CAP JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC CDIE 12K T T T T T T T T T T T T CPLUS 12K T T T T T T T T T T T T CPREM 12K T T T T T T . T T T T T T CUNL 12K T T T T T T T T T T T T SIR PROVIDER: USTMAN INDUSTRIES, INC. 12265 W. BAYAUD AVE. SUITE 110 LAKEWOOD, CO 80228 PH: 3031986-8011 FAX: 3031986-8227 SIR VERSION: 91. 1 I certify uZIder penalty of perjury that all SIR results listed above are a-s ca u d. sg tur of Tank Owner/Operator of Agent at D I Enw� DAVIES OIL COMPANY •Petroleum Marketing •Wholesale&Retail Fuel P.O. Box 80067 — Bakersfield, California 93380 — Phone (805) 323-6063 — 3008 Sillect, Suite 220 April 13, 1995 Ms. Amy Green Hazardous Materials Specialist Kern County Environmental Health 2700 M Street, Suite 300 Bakersfield, CA 93301 Dear Ms. Green: Please find attached copies of (SIR) Ustman Statistical Inventory Reconciliation Reports for 1994 on the four retail facilities we monitor in Kern County for your files. All tanks indicated a "tight pass" status. Sincer - y, uc Martin TM Memorandum TO: Our Valued Customer FROM: Julie Decker,, JJ DATE: April 4, 1995 RE: 1994 Year End SIR Results Report Enclosed please find a revised copy of your 1994 year-end reports of SIR results. Please disregard the first set of reports. Keep the address labels that were mailed with them to mail the revised report to your regulator(s). If you have any questions, please feel free to contact me at 1-800-253-8054. We apologize for any inconvenience this may cause. TIGHTNESS TESTING REPORTS EVALUATION FORM ��'a 2 r Specialist reviewing the tightness test report: Date tightness test reports were submitted: z a Date tightness tests were completed:- /1 Facility Permit Number: X700 K Number of Tanks Tested at the site: _(list the tanks by their tank numbers if provided) a 3 -d' Was the method a test of the entire tank system, piping alone, or just the facility tanks? (describe) Did the facility pass all tests: Yes No (if no, provide the leak rate and a description of the tank(s) that failed the test) (failure is > 0.1 gal per hour) The facility will do the following to investigate the failed test: The test method certification that is submitted to the state specifies that each test method be completed in a certain manner. Is there anything within the results which would suggest that the tank test was improperly completed? Yes No (describe) Information has been reviewed and placed within the database: i� YES NO Date entered within the database: HM25 Entered by (name) r I t ENVIRONMENTAL HEALTH SERVICES DEPARTMENT STEVE WCALLEY, R.E.H.S. 1/� 2700 "M" street, suite 300 DIRECTOR Bakersfield, CA 93301 (805) 861-3636 .tip.. (805) 861-3429 FAX PF TANK INTEGRITY TESTING INSPECTION FORM THIS FORM MUST BE COMPLETED AT TIME OF INTEGRITY TEST BY THE TECHNICIAN ON SITE AND SUBMITTED WITH THE TANK INTEGRITY TEST RESULTS TO THE KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Facility Permit to Operate Number Facility Permit to Tightness Test Number Facility Name Facility Address 3a0/ 9(,)y Facility Telephone Number '33 1— 6?32,3 Have you complied with the following safety requirements stated in UT-20, Section 25? YES/NO \� e� The area within 25 feet of any underground storage tank opening is free of smoking, open flames, and any other source of ignition. Legible signs with the words "NO SMOKING" are posted in conspicuous locations around the testing area. The general public is restricted from the testing area by rope, flags, cones, and "if dark" a fluorescent barrier. e Fire protection in the form of a 2A/20BC fire extinguisher is located within the restricted area. Vehicles utilized during the testing period, or within 25 feet of the underground storage tank opening, have adequate ventilation, and the tester has equipment which can be utilized to monitor the concentration of flammable vapors within the vehicle. Personal protective equipment, an eye wash and gloves, and a site safety plan are within the testing area. e.> Equipment/materials is available to absorb and contain any small release of testing liquid which is discharged as a result of the test. (Examples include DOT-acceptable containers for storage of the absorbent and an adequate supply-of'absorbent):, If the answer to any of the above questions is NO, stop the testing procedure IMMEDIATELY until compliance is obtained. COMPLETE REVERSE SIDE t TANK INTEGRITY TESTING INSPECTION FORM continued Is the following data consistent with the information submitted on the application for Permit To Perform Integrity Testing (PTT)? YES/NO es The number of tanks being tested V e j Testing company c> Test method used ej State Licensed Technician on site C, State Licensed Technician's # 4) Is the site layout consistent with the application plot plan? State exceptions for any NO answers to the above questions: I CERTIFY THAT THE AFOREMENTIONED FACTS ARE TRUE AND CORRECT UNDER PENALTY OF PERJURY. (Not valid If not signed and dated.) Signed this Z I day of 3,a-,) , 19_jy at date month city ea state (SIGNATURE) -State Licensed Technician on Site DENNIS E. GOODAN (PRINT) -State Li HM54 INVOICE #dg000094 TEST DATE: 12/11/93 UNDERGROUND TANK TESTERS, INC. 917 WEST BELLEVIEW AVE. PORTERVILLE, CA 93257 (800) 244-1921 TANK STATUS EVALUATION REPORT ----------------------------- ***** CUSTOMER DATA ***** ***** SITE DATA ***** DAVIES OIL COMPANY, INC. HAPPY GAS CONVENIENCE MKT. 096 P.O. BOX-80067 3221 TAFT HIGHWAY BAKERSFIELD, CA. PUMPKIN CENTER, CA. 93308 CONTACT: MARTIN, CHUCK CONTACT: MARTIN, CHUCK PHONE #: 805 323-6063 PHONE #: ***** COMMENT LINES ***** CURRENT EPA STANDARDS DICTATE THAT FOR UNDERGROUND FUEL TANKS, THE MAXIMUM ALLOWABLE LEAK/GAIN RATE OVER THE PERIOD OF ONE HOUR IS .05 GALLONS. * THESE TESTS ARE PERFORMED USING THE USTEST PROTOCOL TANK #1: SUPER UNLEADED TYPE: STEEL RATE: .029229 G.P.H. LOSS TANK IS TIGHT. TANK #2 : PLUS UNLEADED TYPE: STEEL RATE: .049487 G.P.H. GAIN TANK IS TIGHT. TANK #3 : DIESEL FUEL 2 TYPE: STEEL RATE: .026662 G.P.H. LOSS TANK IS TIGHT. TANK #4: REG UNLEADED TYPE: STEEL RATE: .018051 G.P.H. LOSS TANK IS TIGHT. OPERATOR: DENNIS E. GOO,OAN SIGNATURE: � DATE: UTTL #92-1000 w, ;., ., �� �� ******* T A N K D A T A ******** TANK NO. TANK NO. TANK NO. TANK NO. 1 2 3 4 a' TANK DIAMETER (IN) 96 96 96 LENGTH (FT) 26.59 26.59 26.59 26.59 VOLUME (GAL) 10000 10000 10000 10000 TYPE ST ST ST ST FUEL LEVEL (IN) 72 69 74 72 FUEL TYPE SUP UNLD PLS UNLD DIESEL 2 REG UNLD dVOL/dy (GAL/IN) 114.86 119. 26 111.48 114 .86 CALIBRATION ROD DISTANCE 1 10.65625 2 26.95313 3 41.93750 4 56.93750 5 74.93750 ******* C U S T O M E R D A T A ******** JOB NUMBER : 000094 CUSTOMER (COMPANY NAME) : DAVIES OIL COMPANY, INC. CUSTOMER CONTACT(LAST, FIRST) : MARTIN, CHUCK ADDRESS - LINE 1 P.O. BOX-80067 ADDRESS - LINE 2 CITY, STATE BAKERSFIELD, CA. ZIP CODE (XXXXX-XXXX) : 93308 PHONE NUMBER (XXX)XXX-XXXX : 805 323-6063 ******* C O M M E N T L I N E S ******* ******* S I T E D A T A ******** SITE NAME (COMPANY NAME) : HAPPY GAS CONVENIENCE MKT. 096 SITE CONTACT(LAST, FIRST) : MARTIN, CHUCK ADDRESS - LINE 1 : 3221 TAFT HIGHWAY ADDRESS - LINE 2 CITY, STATE PUMPKIN CENTER, CA. ZIP CODE (XXXXX-XXXX) PHONE NUMBER (XXX)XXX-XXXX GROUND WATER LEVEL (FT) 0 NUMBER OF TANKS 4 LENGTH OF PRE-TEST (MIN) 30 LENGTH OF TEST (MIN) 240 15 Cr TAMIL i START TIME:04:38:48:88 CURRENT TIME:05:38:40:00 10 1-- v v v V v v \j V V V w � 5 J 0 J _Z w - —co: .00159 C1: -.00025 -10 --LEAH RATE: .02923 GPH LOSS PTA, VERSION 1.20 -15 0 15 30 45 60 dg880094.TST,i TIME (MINUTES) 12/11/93 15 Cr: TANK 2 START TINE:05:04:00:00 CURRENT TINE:06:04:00:00 10 Lo w C) z 5 r 0 0 tJ J 0 J Z w – 0: -.80878 z Ci: .00841 10 —LEAX RATE: .04949 GPH GAIN PTA, VERSION 1.28 –15 0 15 30 4-5 60 dg808094.TST,i TIME (MINUTES) 12/11/93 Cr: 15 TANK 3 START TIME:85:18:48:90 CURRENT TIME:06:18:48:08 10 w L) z 5 o 0 J J Ld - 9: -.89017 z Cl: -.80024 -10 LEAX RATE: .02666 CPH LOSS PTA, VERSION 1.28 -15 0 15 30 4-5 60 dg890094.TST,i TIME (MINUTES) 12/11/93 15 Cr : TANX 4 START TIME:84:38:48:88 CURRENT TIME:85:38:48:88 1C Lo w z 0 Q J C J z - -co: .00030 z C1: -.88816 ' -10 —LEAX RATE: .81885 GPH LOSS PTA, VERSION 1.28 -15 0 15 30 4.5 60 dg888894.TST,1 TIME (MINUTES) 12/11/93 INVOICE #dg000094 TEST DATE: 12/14/93 UNDERGROUND TANK TESTERS, INC. 917 WEST BELLEVIEW AVE. PORTERVILLE, CA 93257 (800) 244-1921 TANK STATUS REPORT -- ULLAGE TEST --------------------------------- ***** CUSTOMER DATA ***** ***** SITE DATA ***** DAVIES OIL COMPANY, INC. HAPPY GAS CONVENIENCE MKT. 096 P.O. BOX-80067 3221 TAFT HIGHWAY BAKERSFIELD, CA. PUMPKIN CENTER, CA. 93308 CONTACT: MARTIN, CHUCK CONTACT: MARTIN, CHUCK PHONE #: 805 323-6063 PHONE #: ***** COMMENT LINES ***** CURRENT EPA STANDARDS DICTATE THAT FOR UNDERGROUND FUEL TANKS, THE MAXIMUM ALLOWABLE LEAK/GAIN RATE OVER THE PERIOD OF ONE HOUR IS .05 GALLONS. * THESE TESTS ARE PERFORMED USING THE USTEST PROTOCOL TANK #1: SUPER UNLEADED TYPE: STEEL SN: .24 TANK IS TIGHT. TANK #2: PLUS UNLEADED TYPE: STEEL SN: -.12 TANK IS TIGHT. TANK #3: DIESEL FUEL 2 TYPE: STEEL SN: . 24 TANK IS TIGHT. TANK #4: REG UNLEADED TYPE: STEEL SN: .05 TANK IS TIGHT. OPERATOR: DENNIS E. OOODAN SIGNATURE: � DATE: UTTL #92-1000 � � ******* C U S T O M E R D A T A ******** JOB NUMBER : 000094 CUSTOMER (COMPANY NAME) : DAVIES OIL COMPANY, INC. CUSTOMER CONTACT(LAST, FIRST) : MARTIN, CHUCK ADDRESS - LINE 1 P.O. BOX-80067 ADDRESS - LINE 2 CITY, STATE BAKERSFIELD, CA. ZIP CODE (XXXXX-XXXX) : 93308 PHONE NUMBER (XXX)XXX-XXXX : 805 323-6063 ******* C O M M E N T L I N E S ******* ******* S I T E D A T A ******** SITE NAME (COMPANY NAME) : HAPPY GAS CONVENIENCE MKT. 096 SITE CONTACT(LAST, FIRST) : MARTIN, CHUCK ADDRESS - LINE 1 : 3221 TAFT HIGHWAY ADDRESS - LINE 2 CITY, STATE PUMPKIN CENTER, CA. ZIP CODE (XXXXX-XXXX) PHONE NUMBER (XXX)XXX-XXXX GROUND WATER LEVEL (FT) 0 NUMBER OF TANKS 4 LENGTH OF PRE-TEST (MIN) 30 LENGTH OF TEST (MIN) 240 3'0 -------------------- -------------------- --- ,i-- TANK 1 TIME -- 00:50:24 0 0 2,0 0 z 0 J z Lo 1 .0 SN: .24 PEAR SH: 8.24 5/ 2 UTA, VERSION 1.00 — I \� T,T w N 50 5001 5000 50000 dgBO0094.SON FREQUENCY (HZ� 12/12/99 Cr: 3,0 TANX 2 TIME -- 00:50:30 0 LJ 2,0 z J z Lo 0 r SN: -.12 PEAK SM: 13.16 A 6/ 3 UTA, VERSION 1.00 50 500 5000 50010 dg000094.SON FREQUENCY (HZ) 12/12/93 3 Cr. ,0 TANX 3 TIME -- 00:50:40 C> � 2.0 a z J z Lo i �- SM: .24 PEA) SM: 11.21 7/ 4 UM VERSION 1.00 i i l l y V)p w 50 5O,0 5000 50000 dg000094.SON FREQUENCY (HZ) 12/12 '93 Cr: TANK 4 TIME -- 23:05:27 ry 2,0 0 z z 1 ,0 SN: .U5 PEAR SH: 7.22 a 9/ 8 UTA, VERSION 1.00 0 500 5000 50000 d98 894.SON FREQUENCY (HZ) 12/14/93 r � 1 II f oo � a r C7 "` • 0 0 O �010, C) n� - O O Line Temp. %h z S. If Y" a Variance a _•� d Tester Temp. Ci 00 Variance 00 Air& �p N d Modulus O V �- O z 00 O +o o 00 Test z m M d Duration z Ln H. rn I Lr7 1 U J MO uri 0 � + A y ,gyp �•, `'' �.,.� fD �,�, ' 1 �) �J) Initial L� �1 (f) d l� v G Pressure 00 M..� O0 0 Final Z c Pressure p r•� N n 1 Volume r. 00 Displaced (� rt ° Leak Rate S 0 Z » Leak Rate z n 0 » Leak Rate z 0 Leak Rate z a i , a • Average Leak Rate Pass Fail I�t PLOT PLAN L f JOBSITE LOCATION 0 3 APT 4IGWWA L-T F Z- i i TANK SIZE PRODUCT LEGEND F FILL TURBINE #•2 Q /Q ^(_v> TL TURBINE WITH LEAK DETECTOR #3 C- �I SFL - C OVERSPILL CONTAINER ON FILL Ri REMOTE FILL #S E) EXTRACTOR VALVE #6 ',� MONITOR SYSTEM #7 �1 MANIFOLD SYSTEM PTT # rah PTO # . . . . . . . . . . . . . . . . . . . . . . . . . POST ON PREMISES. . . . . . . . . . . . . . . . . . . . . . . . . . CONDITIONS AS FOLLOWS: 1. It is the responsibility of the Permittee to obtain permits which may be required by other regulatory agencies prior to beginning work (i.e., City Fine and Building Departments). 2 Permit=must notify the Hazardous Materials Management Program at(805)861-3636 twenty-four bouts prior to tank integrity test to allow the Hazardous-Material Specialist-she option of performing.an-mspeakxL 3. Tank integrity test must be per Bern County Fmvironmental Health and Fire Department approved methods as described in Handbook UT-20. 4. It is the state-licensed tester's responsibility to know and adhere to all applicable laws regarding the handling of hazardous materials. 5. The tank integrity testing company must have the state-licensed tester listed on the permit on site performing the test. 6. If any tester other than the one listed on the permit and permit application a to be utilized,prior consent must be granted by the approving specialist on the permit. Deviation from the submitted application is not allowed. 7. A modification permit must be obtained from the department prior to exposing the tank to retest or investigating a release or failed integrity test. S. The following timetable lists pre-and post-tank integrity test requirements: ACITVITY nFAnT INE Complete permit application submitted to At least one week prior to tank the Hazardous Material Management Program integrity test Notify the approving specialist At least 24 hours before test of date and time of the tank integrity test Send written results of a test to the No later than 30 days after testing approving specialist is completed Notify the approving specialist No later than 24 hours after of Erie results of a Wiedltnconciusive test completion of analysis RECOMMENDATIONS/GUIDELINES FOR THE PERFORMANCE OF A TANK INTEGRITY TEST ON UNDERGROUND STORAGE TANKS This department is responsible for enforcing the state laws pertaining to underground storage ranks Representatives from this department perform inspections to ensure that the job performance is consistent with permit requirements, applicable laws, and safety standards. The following guidelines are offered to clarify the interests and expectations of this department. 1. Job site safety is one of our primary concerns. Tank integrity tests are inherently dangerous. It is the tester's responsibility to know and abide by CAL-OSHA regulations. The state-licensed tester is responsible for any other testing company employees on the job site. Tools and equipment are to be used only for their designed function. ? Property state-licensed testers are assumed to understand the requirements of the permit issued. The tester is responsible for knowing and abiding by the conditions of the permit. Deviation from the permit conditions may result in a stop-work order. 3. The testing company will be held responsible for the post-test paperwork. Analyses documentation is necessary for each site in order to close a case file or move it into mitigation. When testers do not follow through on necessary paperwork,an unmanageable backlog of incomplete rases results. If this continues, processing time for completing new tank integrity tests will increase. THE APPLICANT HAS RECEIVED,UNDERSTANDS,AND WILL COMPLY WITH THE ABOVE CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAI, REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. AFTER PROCESSING PL 7E MAIL THE PERMIT. Owner's Authorized Signature Date Representative Date INTERNAL USE ONLY / G' Total Fee � Paid On ` ' / 3 Permit Approved Dead _X� Receipt 1&y2&h Check # Date Fee Received By _ 2 THIS APPLICATION BECOMES A PERMIT WHEN APPROVED HM44 Kern County • Internal Use O Environmental Health Services Dept. PTT No.= Tanks to Test 2700 M Street, Suite 300 Test to include: Tank only Bakersfield, CA 93301 Tank/Pipmi (805) 861-3636 PTO No. Appl. Date ° � APPLICATION FOR PERMIT TO TEST UNDERGROUND HAZARDOUS SUBSTANCES STORAGE TANK P PREMISE A. Facility Information Kern County Environmental Health Services Dept. Permit to Overate #-�JOleFe - 9 (If there is no permit number, an application for a permit to operate must be.submitted and approved before the permit to test can be processed). Proposed Test Date: ,/,�l-/z) -'Y3/ AFTER PROCESSING PLEASE MAIL. Facility Name /4 i A/11? �4 d 14L_ Address TANK # SIZE PRODUCT AGE OF TANK COMMENTS / Z4,d0 S« Fc n 7 2 3 o Odo PGbtf Contact Person Day C�� ��/CLL Phone ( Night Phone (_a B. Tank Owner Information Owner Name Phone (_) Mailing Address /-`, 2• ��i it �� ,7 Zip Code j.3 3V G C. Testing Company Information Company Name TTNT)RRr1?0TTX1) TVTTC TFSTFRS . INC. Address n I�'� �`'r—=; T>;;r�l F4T�T-- Y - T'9�'� T'v e r n o 1-7 -,7 Contact Person Day DENNIS F. GOODAN Phone ( 900 ) 244-1921 Night g 1:.gE Phone ( ) Worker's Compensation Insurance # N/A Liability Insurance # P1644-492110 Test Method Used US T7ST. TEL-A-TEAT( . CA"TPrWJILLE't State Licensed Tester T)R n rt T s R a n o n a l State Licensed Tester # TJTTT, 92-1000 THIS APPLICATION BECOMES A PERMIT WHEN APPROVED T1,,GHTNESS TESTING REPORTS EVALUATION FORM Specialist reviewing the tightness test report: Date tightness test reports were submitted: mil' Date tightness tests were completed: Facility Permit Number:_ < Number of Tanks Tested at the site: / (list the tanks by their tank numbers if provided) / -, a- Via- y Was the method a test of the entire tank system, piping alone, or just the facility tanks? (describe) rnkt r c t .r V 42ie m Did the facility pass all tests: Yes X No (if no, provide the leak rate and a description of the tank(s) that failed the test) (failure is > 0.1 gal per hour) qdl /7 S Q 1-mdU q,:? UL r.�c Ln ecn lay j'yp �,�c,.�1 e �s� _ 1; n e �ro, The facility will do the following to investigate the failed test: Chick �al�� an- �5u-b moyo>'' The test method certification that is submitted to the state specifies that each test method be completed in a certain manner. Is there anything within the results which would suggest that the tank test was improperly completed? Yes '2L— No (describe) Information has been reviewed and placed within the database: YES NO Date entered within the database: -- Fntered by (name) C;�W =- RESACE MANAGEMENT AGACY Environmental Health Services Department RANDALL L. ABBOTT STEVE WCALLEY, REHS,DIRECTOR DIRECTOR �. Air Pollution Control District DAVID PRICE III {�[ '�� WILLIAM J. RODDY, APCO ASSISTANT DIRECTOR JA« ♦ Planning&Development Services Department TED JAMES, AICP,DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT PERMIT FOR THE PERFORMANCE PERMIT NUMBER: T0140 OF A TANK INTEGRITY TEST ON UNDERGROUND STORAGE TANKS LOCATED AT THE LISTED FACILITY FACILITY NAME/ADDRESS: OWNER(S) NAME/ADDRESS: TESTING COMPANY: Happy Gas Davies Oil Associated Environmental 3221 Taft Highway P. O. Box 80067 Systems, Inc. Bakersfield, CA 93313 Bakersfield, CA 93380 P. O. Box 80427 Bakersfield, CA 93380 Phone: (805) 321-9961 Phone: .(805) 323-6063 Phone: (805) 393-2212 STATE-CERTIFIED TESTING METHOD EMPLOYED AES System II STATE-LICENSED TESTER Irwin Linstead STATE-LICENSED TESTER'S #92-1131 PERMIT FOR THE PERFORMANCE PERMIT EXPIRES April 23, 1992 OF A TANK INTEGRITY TEST ON APPROVAL DATE January 23, 1992 / 4 TANK SYSTEM(S) APPROVED BY Laurel Funk AT THE ABOVE LOCATION HAZARDOUS MATERIALS SPECIALIST . . . . . . . . . . . . . . .POST ON PREMISES. . . . . . . . . . . . . . . . . CONDITIONS AS FOLLOWS: 1. It is the responsibility of the Permittee to obtain permits which may be required by other regulatory agencies prior to beginning work (i.e., City Fire and Building Departments). 2. Permittee must notify the Hazardous Materials Management Program at (805) 861-3636 twenty-four hours prior to .tank integrity test to allow the Hazardous Material Specialist the option.of'performing a spot check inspection. 3. Tank integrity test must be per Kern County Environmental Health- and Fire Department-approved methods as described in Handbook UT-20. 4. ' It,is.the-state-licensed tester's responsibility to know and adhere to all applicable.laws,regarding:the:handling_of, Hazardous materials:. 5 _ The tank integrity testing company,must have the state licensed, tester listed on the permit on site performing the __��` w4.. M•�teSt -..e-_..7.�....- T"'- _ '-b--sue.-.-.=_.......r-�..��.I'_ f ` SUITE 300 ti BAKERS FIELD,y CALIFORNIA 933014 ` y ,(805)- 8613636 FAX j(805) 861.3429 , PERMIT.FOR THE PERFORMANCE OF A TANK PERMIT NUMBER T0140 INTEGRITY TEST ON UNDERGROUND STORAGE ADDENDUM TANKS LOCATED AT THE LISTED FACILITY 6. If any tester other than the one listed on the permit and permit application is to be utilized, prior approval must be granted by the specialist listed on the permit. Deviation from the submitted application is not allowed. 7. A modification permit must be obtained from the department prior to exposing the tank to retest or investigating a release or failed integrity test. 8. The following timetable lists pre- and post-tank integrity test requirements: ACTIVITY DEADLINE Complete permit application submitted to At least one week prior to tank the Hazardous Material Management Program integrity test Notification to the specialist listed on permit 24 hours of date and time of the tank integrity test Send written results of a test to the No later than 30 days after testing specialist listed on the permit is completed Notification to the specialist listed on the No later than 24 hours after permit of the results of a failed/inconclusive.test completion of analysis RECOMMENDATIONS/GUIDELINES FOR THE PERFORMANCE OF A TANK INTEGRITY TEST ON UNDER- GROUND STORAGE TANKS This department is responsible for enforcing the state laws pertaining to underground storage tanks. Representatives from this department perform spot check inspections to ensure that the job performance is consistent with permit requirements, applicable laws, and safety standards. The following guidelines are offered to clarify the interests and expectations of this department. 1. Job site safety is one of our primary concerns. Tank integrity tests are inherently dangerous. It is the tester's responsibility to know and abide by CAL-OSHA regulations. The state-licensed tester is responsible for any other testing company employees on the job site. Tools and equipment are to be used only for their designed function. 2. - Properly state-licensed testers are assumed to understand the requirements of the permit issued. The tester is responsible for knowing and abiding by the conditions of the permit. Deviation from the permit conditions may result in a stop-work order. 3. . The testing company will be held responsible for the post-test paperwork. Analyses documentation is necessary for each site in order to close a case file or move it into mitigation. When testers do not follow through on necessary -paperwork, an unmanageable backlog of incomplete cases results. If this continues, processing time for completing new tank integrity tests will increase. Accepted by: _ 7 O R AGENT DATE. LF:cas` ([0140 h m34) - - Fm k1m U Im Associated Environmental' Systems, Inca P. O. Box 80427 Bakersfield, CA 93380 (805) 393-2212 AES - SYSTEM II PRECISION TANK & LINE TEST RESULTS SUMMARY Invoice Address ; Tank Location : W. O. #: 1604` FL_EETCARD FUELS HAPPY GAS I. D. Number: N/A P O BOX 81685 3221 TAFT HWY Technician :BNL P_,AI:ERSFIELD CALIF 93380 BAI:ERSFIF-LD CALIF Tech. #:89165 Van:4:0117 Date : 01/=8/92 Time Start : 06 :00 End : 14:00 County: KE Facility Phone#: N/A Groundwater ' Depth :.--IV/A . Blue Prints : hJ/A Contact : MGR Daterrime system was filled: 01/27/92 21 :00 Tank Fill/Vent Product Type Of Vapor Inches of Pump Tank Tank Capacity Product Tank Vapor Lines Line Recovery Water/Tank Type Material 1 12K DSL PASS PASS: PASS PH-1 0 0 TURF S W S 12K MID 89 PASS PASS PASS PH 0 0 TURP S W S 3 12K S/UL 98 PASS PASS INCL PH 0 0 TURP S W S 4 12K R/UL 87 PASS PASS PASS PH-8 0 0 TURB S W S Additional Information: SITE LOG TIME . Set Up .Egit,ip: _..- 06 :00: Bled Product 'Lines; 06 : 10 Bled Vapor Lines : 06 : 15 Bled Vent lines : 06 :20 Bled Turbine ; .06 : 10 Bled Suction Pump: . N/A Risers Installed : N/A a) Thia systtgm rand methc'd ' meeta thd -cr,itaria set faith - 16 .NFPW #3229.• b) Any failure listed above: MAy ,'requ rb: f,urther;-icti'on" -,check-wit h �:— a.1-1-,x;r_e-g u 1 ato r y a g e n c i e's. - w - �- -� ---- Copyri~ght tc) 1989 by AES' Itnc. Califoi^ni'a' O. T.`T. L. N�tmber� 112+1 'RWI`NQ LINSTEAD k. rJi f i3 Certified Technician Signature ; r 'f �', ii Date f ��g 3I1 O U1313SOUa A H IM HZE SU9 AddUH o JOJ 1110fie3 aUs � Y - lw ai� Sag Add H H j 3 } a inn- mu 000 f Y t 000 1a AZT 1 H 000 UIN AN ,t 4 000 in/s mzT l ; W3I S AS I U I N 3N N 0 N I A N 3 a 3 ilU 1 30S S U f , ss,o c i t w c6 .,,.-i Y"� t7 r1 (. ri I m lli& F•. C7. Flox Q0�� 3ai 4<u�rw7•ipltl, Cfa 9�3Qa (Q �i9 —tC iGt.. - AES/System 'II Precisian leak' Test Graph (Ov'er^Fill ) Invoice No. O 16042 Date : 01/28/9E Time i 07: 1.i�:.05 Technician : PNL Tank : 1 Tank Diameter ( in) 1 94 Volume (gal ) : 12000 Grade 'Level ( in) 1 145 Product. Level' ('in) : Water Level On Tank ( in) : 0 Specific Gravity : . 65 Coefficient Of Expansions 0. 0004622 Calibration Value (ml) : 500 Channel : 1 Level Segment From: 100 To 250 Temp Segment From : I To 225 ................. .m„�p,. ,,,,aw..,.,,..m,�.,,tiR,......a.,,...,,....;..�.�., . ,,. a.. ,y�,..um...�.,weoa�o.,.w..•..,�a .,�....,,.�.�4..,,..,,v.�.,......�..a.,,.,n....,,,e� V •r unc::..>nauwa T pE yli ur,•^^,smn:ndlubulnnn:.,mm.� IhUrur�(A.,,t;�a,.�t� „� ,� ,;� .n.,.�,,..a..�..,�..�...u���M��,,..........�..,.. ...m,n.a..,.�e�.��.,.,..��,...�.�..n...m.o,.�.,.w..n�.�...........�.�u�.a,..,.�.,..,.aa„a4�...�.�m..�.. ��e�.�� Change In Calibration Zone = 35 Calibration Unit (g1/un it ) : 0�377 Starting Temperature (F) : 59. 201 Head Pressure (psi (Htm) ) s 4. 30 Surface ' Area (sq. in) : 76. 9 Temp. . Change(F/h) : 0. 003 Level volume (gph) : -0. 03 Temp. volume (g ph) : 0. 01 Product. Line (gph) : . 006 Net change.(gph) - - 4 . QL`.SZ•.7ACOSS��. - - Copyr fight (c) 1.989 -by AES;".,Inc. - Notes' #a� s HAptPY` GAS.. , ` 1 TAFT HW_Y PAKERSFIELD CALIF HIGH LE1VE TESL G, M". CAL. F I RST AND" SECOND HOURS. • _ 1. �4 � 'mot v' i-9 b _ �`�' k t;t ,• .. y { .� � t �, � �-..�.•.r , � .. , a.•ire�tit,..-;5?'���f"j dh s a3 c 1 ,R-b aaa a1 +,r :L 1— i0 T1 M W T-1 t aR •t a�a S eD ," In = . F•. O. Hox 621 + eA 4<tsr�i'iold. CP1 933621 a z '393—_— 1a ' AES/System II -Precision leak Test Graph (OverFill ) Invoice No. a 16042A Datea 01/28/92 Time o 10:07:34 Technician: BNL Tanka 'P Tank Diameter ( in) : 94 Volume (gal) : 1 :000 Grade Level ( in) 1 . 145 product Level ( in) : 139 Water Level On Tank ( in) : 0 Specific Gravity : . 75 Coefficient Of Expansion : 0. 0006775 Calibration Value (ml ) : 500 Channel : E Level Segment Frame 1 To 1.50 Temp Segment From s 1 To 200 Il.:p 8178;•,••,•'nn^•••••^,••mlm,m`71„diltlln,,,„,....gm,,,....................n.,.7141n..,,,,,,,dfll..a� x•16 „ .j.............Jin..oeit° !I . m i'tt•'” 1 ,d...L•......lP.......... �v 116....... Change In Calibration ,.Zone 40 •Calibrat-ion Unit (gal/unit ) 0. 00330 Starting Temperature"-(F) a 47. 441 -Head pressure (psi (�tm) ) a 3: 76 Surface Area (sq. in) : 76. '.::' Temp. Change (F/h) a 0. 018 Level "volume (gph) a 0. 17 Temp. volume (gph) 1 0. 14 product Line (gph) a . 034 Net change (gph) : 0. 03 Copyright (c) 1989 by .AES,. Inca yam, Not es._# HAPF1Y. GAS- , 32P 1 fAFT HWY,,,9 BAKER CALI F i-1IGH LEVEL TEST =-5 0 mL CAL c. 1 FIRST AND. SECOND HOURS: z ;; r , 0=ti 'Ca S5, o c 1,as-b w cl V �. r� cr n m win � aR 1 � �m w M � '!n c= . Fl. Q. I3o�< E��1ti�a•,= ®L<®raY'imlcl. Ch1 933E1iA <80� 393 ..�:=1.= AES/System II Precision leak Test Graph (Over^Fill) Invoice No. : 16042A Date: 01/28%92 Time : 10:07:34 Technician: BNL Tank : 3 Tank. Diameter ( in) : . 94 Volume (gal) : 12000 Grade Level ( in) : 141 Product Level ( in) : 135 Water Level On Tank ( in) 1 0 Specific Gravity : . 75 Coefficient Of Expansion: 0. 0006711 Calibration Value (ml ) : 500 Channel : 3 - Level Segment From : 50 To 200 Temp Segment From : 1. To 150 I::'1�' 1:::11:::1� 1:::: �'!:! .,,.,.,ao,n.....n., ... ............�w,, ..,,.., woao....,......... ... ..,..,,,,.,.......,............ ..N..,......,,,,,.,....,..��,,,,,,,,...,..,,,......., a.,.,... ..,.,..,....., ....,..,.,...,..�.,u.,.., N 1i VP q,ntfr„u..,. �t:,.•ururur .a, t1! E FA 1 . 11 , 1: (J 1'.. .,.: Change In Calibration Zone A 49 Calibration Unit (gal%unit ) 0. 00269 Starting Temperature (F) :. 55. 615 Head Pressure (ps.i (Btm) ) : . 3. 66 Surface Area (sq. in) : 62. 2 Temp. Change (F/h) : —0. 004 Level volume (gph) : —0, 07 Temp. volume (gph) : —0. 03 Product Line (gph) : INCL Net change (gph) : —0. 04 Copyright (c)., 1989 by AES, - Inc i HAPPY GAS , ,cc1 •1TAFT'HWY , PAKERSFIELD -CA-L'IF HIGH LEVEL TEST CAL. F I RSTJ AND SECOND. HOUF2S. - j:• ` t t .r �' ss i aa•t:; ear c :L r-.o in m eifi M15. =-k I C:'- 4a ei m 'S In c .. r P1. 0. LAO 804�m/<®raTialcl. CKi saaSka <Ci 393-2:.1? AES/System II Precision leak Test. Graph " (OverFill) ' r Invoice No. : 16042A Date : 01/28/92 Time : 10:07:34 Technician : BNL Tank: 4 Tank Diameter; (in) : 94 Volume (gal ) 12000 Grade Level ( in) : 140 Product Level ( in) : 138 Water Level On Tank ( in) : 0 Specific Gravity : . 75 Coefficient Of Expansion: 0. 0006716 Calibration Value (ml ) : 500 Channel : 1 Level Segment - From : 1 To 200 Temp Segment From : 150 To 300 .......... ................................m,..,,,.. ..................,........ wo„... NA uu!� r'' :r•,r,.s..,..ntN,.......,..u.......,..nn...nrnn..ur..,.ur .drum.........utnr:a,mnrr..�....mu.. n, rumt:unu� qtr ,m......d:uu.,..., 1.1 .1. t!i ..a.... .e.,,.,.�... , . .....,.m......,�......... ........a. o.,a .,...,...,..�....... ..,w.. ... o.a ., .... .,. .............. .. ...,� .�»... ,.., ,,..,.., ......ve,.. .. .n. I,,,I ,{, a (,,.► �i„'n I,,,I Change In: Calibration Zone a 39 Cali brat ion- Unit (gal/unit ) =. 0. 00338 Starting” Temperature (F) :' 54- 823 Head Pressure (psi (Btm) ) : 3. 74 Surface Area (sq. in) : 78. 2 Temp. Change (F/h) ° : 0. 019 Level- volume (gph) : 0. 12 Temp. volume (gph) : Q1. 15 Product Line (gph) : . 002 Net change (gph) : -0. 03 • tramseaaraacaaaa _ - • R 4e.M.I..1 A �-- ? F!F4 S S3 L_. " '"" > F=1 6-1 S S Copyriphi , (c) 1989 •.by : AES, Inc. t� Not a s.'4# HAPPY: GAS` `, "1 TAF 'HWY -.; PAKERSFIELD-CAL•.IF. HIGH LEVEL- TEST S0Qt ML=CAL`: ` , . F I RST.j AiVD,i;SECOND 'HOURS. ? ' fit. u" � .t !•r t r - Associated Environmental Systems, Inc. P. O. Box 80427 Bakersfield, CA 93380 (805) -393-2212 Invoice NUmber HYDROSTATIC PRODUCT LINE TESL- WORK SHEET I -I-EST I RRODUC-I- I START I END I START I END I TEST VOL. I i NO. I I TIME I TIME I VOL. (ML) I VOL. (ML) I DIFF. (ML) l i I I I I t f I I I h,J l>(Q _ I I 1 —I I I. 1 21 I 1��' Z� 1 3 I i Z I t b i I I 1 I 1 1 I I CA— Divide the v01Atme differential by the test time ( 15 minCttes) and multiply by 0. 0158311, which will convert the volume differential from milliliters per minute to gallons per hour. The conversion constant is found by (60_ miri%hr;) /_,(3790_.ml/ga.l)_= 0. 0158311 . (min/hr) (gal/ml ). The conversion constant causes _the' milliliters and minutes to . cancel '. out. . _ 1 ' �'Ex Tf 'the .level: dr opped 3-m 1-:'-- �n 1:5 minUte�s then V y.. 3/'15 ml: /min. X Q. 015831r1 ` (min/hr )', (ga1/m1 ) 0 003- gal.%hr: } ' RESULTS OF THIS-7 WORK SHEET. TO BE, COMPILED 'ON, :RESULT,S' SHEET #GHTNESS TESTING REPO TS EVALUATION FORM Specialist reviewing the tightness test report: Date tightness test reports were submitted: a Date tightness tests were completed: Facility Permit Number: a 00/� Number of Tanks Tested at the site: (list the tanks by their tank numbers if provided) #� Was the method a test of the entire tank stem, piping alone, or just the facility tanks? (describe) L Did the facility pass all tests: Yes No (if no, provide the leak rate and a description of the tank(s) that failed the test) (failure is > 0.1 gal per hour) The facility will do the following to investigate the failed test: The test method certification that is submitted to the state specifies that each test method be completed in a certain manner. Is there anything within the results which woul4 suggest that the tank test was improperly completed? Yes ` No (describe) Information has been reviewed and placed within the database.: L YES NO Date entered within the database: Iiha`` Entered by (name) Aftr AAW LAUREL FUNK KC ENVIRONMEN'T'AL HEALTH 2700 M ST. SUITE 300 -----=--�J BAKERSFIELD, CA 93301 -. MARCH 25, 1992 DEAR MS. FUNK: Enclosed is the copy of the line and leak detector test results. The initial test of the unleaded premium line failed due to a faulty check valve in the functional element of the submotor. The check valve was replaced and the test run again. The valve could not be replaced while the testing company waited because the fluid level was too high to remove the valve without causing a spill. Si,cerrely, Paul G. LingenfeCl'der Operations Manager P.O. Box 81685, Bakersfield, California 93380-1685, Phone 805 589-5772 "SSOC�iated ETIVi.ronmental Sy stems n coup ig Department MrM so 2IF49 J N - o. Ho 1 1 ywo od, CA 9160:. (805)393-2212 BILLING ORDER 2/24/92 INVOICE NUMBER N° 16237 INVOICE ADDRESS: TANK LOCATION: TAKEN BY: D S J FLEET CARD FUELS HAPPY GAS P 0 BOX 81685 3221 TAFT HWY TECHNICIAN: BNL BAKERSFIELD, CA 93380 BAKERSFIELD, CA COUNTY: K CO. NOTIFIED: P.O.#: CONTACT: PAUL LINGENFELDER CONTACT: PAUL LINGENFELDER TEST DATE: 02/21/92 PHONE: 805-321 -9961 PHONE: 805-321 -9961 TEST TIME: 0800 .TANK SIZE PRODUCT INFORMATION 1 2 3 RETEST, ON 92 U/L P/L AND 4 TEST 3 LEAK DETECTORS 5 6 # $PER TANK TOTAL NOTES PRECISION TANK TEST MIN DAILY CHARGE 1 450 . 00 450 . 00 TOTAL DUE 450. 00 IN THE EVENT AN ACTION IS BROUGHT BY AES, INC.FOR THE COLLECTION OF SUMS DUE,REASONABLE ATTORNEY'S FEES AND COSTS SHALL BE PAID IN ADDITION TO THE SUM DUE. ACCOUNTS ARE DUE,NET UPON RECEIPT. ALL UNPAID BALANCES ARE SUBJECT TO A 1 1/2%SERVICE CHARGE. OUR SERVICE CHARGE IS FIXED AT 1 1/2%PER MONTH WHICH IS AN ANNUAL RATE OF 18%. CREDIT: C.O.D CHARGE APPROVED BY INDEMNITY BOTH THE CUSTOMER AND AES, INC. ACKNOWLEDGE THAT THE SUBJECT EQUIPMENT OF THIS TEST INCLUDES EXTREMELY COMPLEX MEASUREMENT TECHNIQUES WHICH TO A LARGE EXTENT RELY ON GENERALLY ACCEPTED STATISTICAL COMPUTATIONS. EACH MEASUREMENT MADE BY THE SUBJECT EQUIPMENT,THEREFORE,IS MADE IN ACCORDANCE WITH ACCEPTED STATISTICAL AVERAGING TECHNIQUES WHICH DO NOT COMPENSTAE FOR EACH STATISTICAL VARIABLE. AES,INC.,THEREFORE,MAKES NO WARRANTIES OTHER THAN WARRANTIES OF OPERABiLITY OF THE SUBJECT EQUIPMENT SUCH WARRANTY BEING LIMITED TO THE COST OF REPLACEMENT OR REPAIR OF THE SUBJECT EQUIPMENT. CUSTOMER SHALL INDEMNIFY AND HOLD HARMLESS AES,INC.AGAINST ALL CLAIMS AND CAUSES ARISING OUT OF OR RESULTING FROM ANY TANK LEAKAGE THAT MAY OR MAY NOT HAVE BEEN SENSED OR REGISTERED BY THE SUBJECT EQUIPMENT AND UPON NOTICE FROM AES,INC.SHALL APPEAR,DEFEND,PROSECUTE AND/OR CONDUCT OR CAUSE SAME TO BE DONE ON BEHALF OF AES,INC.,AND SHALL PAY,SATISFY,AND/OR HOLD HARMLESS AES,INC.AGAINST ANY JUDGMENT RESULTING THEREFROM. TECH.SIGNATURE: CUSTOMER SIGNATURE: DATE: DATE: '- Vissociated Environmental [jystems,, Inc. P' O. Box 80427 Bakersfield, CA 93,380 (805) -393-2212 AES _ SYSTEM 11 PRECISION TANK & LINE TEST RESULTS SUMMARY Invoice Addresso Tank Locationo W. O. #: 16237 CARD FUB-S HAPPY GAS 1. D. Number |'. U. BUX 81685 3221 TAFT HWY T e c h n i c I an:BNL Bn||ERSFIELD, CA 9338Q BAKERSFlELD CA Teoh. #n89165 Van#o@117 Date : 02/21/92 Time Gtarto 0800 Endo Countyo KE FacilitV Phone#: 805-321-9961 Groundwater Deptho Blue Printyv N/A Contact : PAUL LlNGENFELDER DeteVTime system was filledo t-,I/A ' Tank Product Type Of Vapor Inches of Pump Tank Tank Capacity Product Tank Line Recovery Water/Tank Type Material l 92 UL N/A PASS N/A N/A lURB UNK ` Additional %nformatimnn SITE LOG TIME Get Up Equip: 0800 Bled Pr.odUct L-inesn Bled Vapor Linewx Bled Vent linemn Bled Turbinmn Bled Suction Pumpo Risers %nmta% ledn a> This system and method meets the criteria met forth in NFPA #329. b) Any failure listed above may require further actionv check with all regulatory agencies. Copyright (o) 1989 by AESv Inc. California O. T" T. i-" Number : 92 . Certified Technician Signature i Date o | ', U. uux Da|(ersfjeld, 9J38@ Invoicc Number _ -_. HYDROSTATIC PRODUCT LINE TES[ WORK SHEE| - ----------............—.........................-- ......................'-................................. ' | ) ES[ | PRODUCT \ SlART \ END ! STAR | | EMU \ TEST VOL. | | NU. | | TIME | TINE | VOL. (NL) | VOL. (ML) | DlFF. (ML) | _____> _________| __________| } ...................... _| _ ..... ___ ............._.......................... ......... > ___� _ _________| | | | | | | | | ........................... __| ��������_| _�����L.�_| ___.| ...._...................................... ......... ______ | | ________ | | | \ | | | | | | | | | | | | | | | | r | | | | | _ ________________} I _��| ______| �� _) } � | | | � | � | | I | | i ..................... ............... .........................._! _____________�_1 | __._____\ ___________| ___�_________| �____________________ | | | | | | | | | \ _____ | _...._......._.............! ... ......................... .............._.| ______�__________ | | \ | | ! | | | | ................... | ---------- ........................__I | ____________�____ 1 | | | ..................... _____| _________| ........_ .................__| __ ........ | _ .......................... ...................| _ ................... ................. _............ ............ _ } /'ivide the volume differential by the test time ( 15 minutes) and /^0 /' iply by 0, 0158311 , which will convert the volume di [ferential / ''pm milliliters per minute to gallons per hour. The conversion constant is found by : (60 min/hr) / (3790 ml /gal ) = 0. 0158311 (min/hr) (gal /ml ) The convprsiun constant causes the milliliters and minutes to cancel out. Ex, IF the level dropped 3ml in 15 minutes then : 3/ 15 ml . /win. X 0. 0158311 (min/hr) (gal/ml ) = 0. 003 gal/hr. |R[SUL | S OF' THIS WORK SHEET TO BE COMPILED ON RESUL / S SHEET. v ` � oA AAAA EEEE SSSS ' AAA AAAA EEEE EEEE �� AAAA AAAA EEEE . ���SSSS AAAAA AAAA EEEE EEEE SSSSSSSSS Associated Environmental Systems, Inc. AES LEAK DETECTOR RESULTS ON H/O# qT | F oDDRESS: WIC# | RCHH1ClAN: ' ' ' Cl� l'Y La [YnE OF LEAK DETECTOR TESTED (CIRCLE ONE) PLD XLP OTHER SERIAL NUMBER: /� UUAL VOLUNE FULL OPERATING PRESSURE PSI. FUNCTIONAL ELEMENT HOLDING PRESSURE I. |'\E [EQlNG TlME METERING PRESSURE PSI. INDUCED LEAK RATE OF 3 GPM 10 PSI USING RED JACKET FTA LE0K DETECTOR DID RECOGNIZE 3 GPM LEAK �- LEAK DETECTOR DID NOT RECOGNIZE 3 GPM LEN/, FAIL REPLACED FAILED LEAK DETECTOR? (CIRCLE ONE ) YES NO TYPE OF NEW LEAK DETECTOR DLD PLD XLP OTHER SERIAL NUMBER OF NEW LEAK DETECTOR LEAK DETECTOR DID RECOGNIZE 3 GPM LEAN PASS LEAK DETECTOR DID NOT RECOGNIZE 3 GPM LEAK FAIL Y Headquarters P. O. Box 80427, Bakersfield, CA 93380 (805) 393-2212 (800) 237-0067 3651 Pegasus Drive, Suite 102 8akersfield, CA 93308 / /" 'o*x^ cccc 000� ' f 8*\ AAAA EEEE EEEE oA0D AAAA EEEE ���SSSS ��� �� � A/)AAA AAAA EEEE EEEE SS000SSSS Associated Envi, u//��menta] Systems` Inc. AES LEAK DETECTOR RESULTS DATE: W/O# ----Z71- t-J-4 --SITE ADDRESS: WlC# TECHNICIAN: ' ' PRODUCT TYPE: TYPE OF LEAK DETECTOR TESTED (CIRCLE ONE) PLD XLP OTHER SERIAL -NUMBER: ' RESIDUAL VOLUME FULL OPERATING PRESSURE PSI . FUNCTIONAL ELEMENT HOLDING PRESSURE PSI. METERING TIME METERING PRESSURE PSI. INDUCED LEAK RATE OF 3 GPH 010 PSI USING RED JACKET 'FTA LEAK DETECTOR DID RECOGNIZE 3 GPH LEAK knsl LEAK DETECTOR DID NOT RECOGNIZE 3 GPH LEAK FAIL REPLACED FAILED LEAK DETECTOR? (CIRCLE ONE ) YES NO TYPE OF NEW LEAK DETECTOR DLD PLD XLP OTHER 5ERIAL NUMBER OF NEW LEAK DETECTOR LEAK DETECTOR DID RECOGNIZE 3 GPH LEAK PASS LEAK DETECTOR DID NOT RECOGNIZE 3 GPH LEAK FAIL � Headquarters P. O. uox 80427, Bakersfield, CA 93380 (805) 393-2212 (800) 237-0067 3651 Pegasus Drive, Suite 102 Bakeqsfield, CA 93308 .'' ''''"" L -L - "�"o ' A AAAA EEEE EEEE ' ' nAAA hAAA EEEE `- SSSS AAAAA AAAA EEEE EEEE SSSSBSSSS Associated Environmental Systems, Inc. AES LEAK DETECTOR RESULTS DOTE: W/O# SITE ADDRESS: WIC# 503MA Won?, TECHNICIAN: ' ****************************************************************************** ' PRODUCT TYPE: TYPE OF LEAK DETECTOR TESTED (CIRCLE ONE) -'�P-D PLD XLP OTHER SERIAL NUMBER: RPSIDUAL VOLUME FULL OPERATING PRESSURE PSI. FUNCTIONAL ELEMENT HOLDING PRESSURE PSI. MrTERING TIME METERING PRESSURE PSI. INDUCED LEAK RATE OF 3 GPM @ : 1N PSI USING RED JACKET FTA LEAK DETECTOR DID RECOGNIZE 3 GPM LEAK ]�!M LEAK DETECTOR DID NOT RECOGNIZE 3 GPM LEAK FAIL REPLACED FAILED LEAK DETECTOR? (CIRCLE ONE ) YES NO ****************************************************************************** TYPE OF NEW LEAK DETECTOR DLD PLD XLP OTHER SERIAL NUMBER OF NEW LEAK DETECTOR LEAK DETECTOR DID RECOGNIZE 3 GPM LEAK PASS LEAK DETECTOR DID NOT RECOGNIZE 3 GPM LEAK FAIL Headquarters P. O. Box 80427, Bakersfield, CA 93380 (805) 393-2212 (800) 237-0067 3651 Pegasus Drive, Suite 102 Bakersfield, CA 93308 *u oouu u�-.;�� - ^ WA AAAA EEEE EEEE o0AA AAAA EEEE AAAAA AAAA EEEE EEEE SSSSSSSSS Associated Environmental Systems, Inc. AES LEAK DETECTOR RESULTS /N [Ex W/O# 4| | 4 A0URESS: W{C# ......................................... ................ __ | ECHNICIAN: ' ' ~ } 10UUCT lYPE: TYPE OF LEAK DETECTOR TESTED (CIRCLE ONE) PLD X L P OU|ER 5BoAL �NUMDER: KESIDUAL VOLUME FULL OPERATING PRESSURE PS FUNCTIONAL ELEMENT HOLDING PRESSURE PSl. METERING TIME - . METERING PRESSURE PSI. INDUCED LEAK RATE OF 3 GPH @: 10 PSI USING RED JACKET FTA LEAK DETECTOR DID RECOGNIZE 3 GPH LEAK LEAK DETECTOR DID NOT RECOGNIZE 3 GPH LEAK FAIL REPLACED FAILED LEAK DETECTOR? (CIRCLE ONE ) YES NO TYPE OF NEW LEAK DETECTOR DLD . PLD XLP OTHER SERIAL NUMBER OF NEW LEAK DETECTOR LEAK DETECTOR DID RECOGNIZE 3 GPH LEAK PASS LEAK DETECTOR DID NOT RECOGNIZE 3 GPH LEAK FAIL v |1padquarters P. O. Box 80427, Bakersfield, CA 93380 (805) 393-2212 (800) 237-0067 3651 Pegasus Drive, Suite 102 Bakersfield, CA 93308 RESOURCE MANAGEMENT AGENCY Environmental Health Services Department RANDALL L. ABBOTT STEVE WCALLEY, REHS,DIRECTOR DIRECTOR Air Pollution Control District DAVID PRICE III VALUAM J. RODDY, APCO ASSISTANT DIRECTOR ♦ Planning&Development Services Department TED JAMES, AICP,DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT TANK INTEGRITY TESTING INSPECTION FORM INSTRUCTIONS If the number of tanks tested exceeds the number of tanks listed on the permit, have the tester change the # of tanks on the file's copy of the permit to the correct number and initial it. Submit the actual number tested to the UST Permitting Program to assure the testing company is billed accordingly. Review the State of California's UST Tightness Test Methods List, the Licensed Tank Testers, and Tank Testing Companies Lists to determine the validity of any exceptions. If the company, method, or tester do not appear on the State of California lists, stop the test immediately until the testing company can comply with the permit conditions as issued. If the company, method or tester does appear on the State lists but differs from the one(s) listed on the permit; appraise the situation and determine if the test will be allowed to continue. CG:ch HM36 2700 "M" STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861-3429 RESOURCE MANAGEMENT AGENCY Environmental Health Services Department RANDALL L. ABBOTT STEVE WCALLEY, REHS,DIRECTOR DIRECTOR Air Pollution Control District DAVID PRICE III WILUAM J. RODDY, APCO ASSISTANT DIRECTOR ♦ Planning&Development Services Department TED JAMES, AICP,DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT TANK INTEGRITY TESTING INSPECTION FORM Date Facility Permit to Operate Number r 3C2 00 jef— Facility Permit to Tightness Test Number 7?9 O Facility Name Facility Address IC12 Facility Telephone Number Has the tester complied with the following safety requirements stated in UT-20, Section 25? YES/NO The area within 25 feet of any underground storage tank opening is free of smoking, open flames, and any other source of ignition. Legible signs with the words "NO SMOKING" are posted in conspicuous locations around the testing area. The general public is restricted from the testing area by rope, flags, cones, and "if dark" a fluorescent barrier. Fire protection in the form of a 2A/20BC fire extinguisher is located within the restricted area. Vehicles utilized during the testing period, or within 25 feet of the underground storage tank opening, have adequate ventilation, and the tester has equipment which can be utilized to monitor the concentration of flammable vapors within the vehicle. Personal protective equipment, an eye wash and gloves, and a site safety plan are within the testing area. Equipment/materials is available to absorb and contain any small release of testing liquid which is discharged as a result of the test. (Examples include DOT-acceptable containers for storage of the absorbent and an adequate supply of absorbent). If the answer to any of the above questions is NO, stop the testing procedure IMMEDIATELY until compliance is obtained. HM-35 2700 "M" STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861-3429 TANK INTEGRITY TESTING INSPECTION FORM continued Is the following data consistent with the information submitted on the application for Permit To Perform Integrity Testing (PTT)? YES/NO The number of tanks being tested Testing company Test method used State Licensed Technician on site State Licensed Technician's # Is the site layout consistent with the application plot plan? State exceptions for any NO answers to the above questions: tate L' ensed Technicia4osite azardous Materials Specialist Inspection Date HM35 „ RESC&CE MANAGEMENT AGCY Environmental Health Services Department RANDALL L. ABBOTT STEVE McCALLEY, REHS,DIRECTOR DIRECTOR Air Pollution Control District DAVID PRICE III WILLIAM J. RODDY, APCO ASSISTANT DIRECTOR Planning&Development Services Department TED JAMES, AICP,DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT PERMIT FOR THE PERFORMANCE PERMIT NUMBER: T0140 OF A TANK INTEGRITY TEST ON UNDERGROUND STORAGE TANKS LOCATED AT THE LISTED FACILITY FACILITY NAME/ADDRESS: OWNER(S) NAME/ADDRESS: TESTING COMPANY: Happy Gas Davies Oil Associated Environmental 3221 Taft Highway P. O. Box 80067 Systems, Inc. Bakersfield, CA 93313 Bakersfield, CA 93380 P. O. Box 80427 Bakersfield, CA 93380 Phone: (805) 321-9961 Phone: (805) 323-6063 Phone: (805) 393-2212 STATE-CERTIFIED TESTING METHOD EMPLOYED AES System II STATE-LICENSED TESTER Irwin Linstead STATE-LICENSED TESTER'S #92-1131 PERMIT FOR THE PERFORMANCE PERMIT EXPIRES April 23, 1992 OF A TANK INTEGRITY TEST ON APPROVAL DATE January 23, 119992 / 4 TANK SYSTEM(S) APPROVED BY Laurel Funk AT THE ABOVE LOCATION HAZARDOUS MATERIALS SPECIALIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .POST ON PREMISES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CONDITIONS AS FOLLOWS: 1. It is the responsibility of the Permittee to obtain permits which may be required by other regulatory agencies prior to beginning work (i.e., City Fire and Building Departments). 2. Permittee must noti the Hazardous Materials Management Program at (805) 861-3636 twenty-four hours prior to tank integrity test to allow the Hazardous Material Specialist the option of performing a spot check inspection. 3. Tank integrity test must be per Kern County Environmental Health- and Fire Department-approved methods as described in Handbook UT-20. 4. It is the state-licensed tester's responsibility to know and adhere to all applicable laws regarding the handling of hazardous materials. 5. The tank integrity testing company must have the state-licensed tester listed on the permit on site performing the test. 2700 "M” STREET, .SUITE 300 BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861-3429 PERMIT FOR THE PERFORMANCE OF A TANK PERMIT NUMBER T0140 INTEGRITY TEST ON UNDERGROUND STORAGE ADDENDUM TANKS LOCATED AT THE LISTED FACILITY 6. If any tester other than the one listed on the permit and permit application is to be utilized, prior approval must be granted by the specialist listed on the permit. Deviation from the submitted application is not allowed. 7. A modification permit must be obtained from the department prior to exposing the tank to retest or investigating a release or failed integrity test. 8. The following timetable lists pre- and post-tank integrity test requirements: ACTIVITY DEADLINE Complete permit application submitted to At least one week prior to tank the Hazardous Material Management Program integrity test Notification to the specialist listed on permit 24 hours of date and time of the tank integrity test Send written results of a test to the No later than 30 days after testing specialist listed on the permit is completed Notification to the specialist listed on the No later than 24 hours after permit of the results of a failed/inconclusive test completion of analysis RECOMMENDATIONS/GUIDELINES FOR THE PERFORMANCE OF A TANK INTEGRITY TEST ON UNDER- GROUND STORAGE TANKS This department is responsible for enforcing the state laws pertaining to underground storage tanks. Representatives from this department perform spot check inspections to ensure that the job performance is consistent with permit requirements, applicable laws, and safety standards. The following guidelines are offered to clarify the interests and expectations of this department. 1. Job site safety is one of our primary concerns. Tank integrity tests are inherently dangerous. It is the tester's responsibility to know and abide by CAL-OSHA regulations. The state-licensed tester is responsible for any other testing company employees on the job site. Tools and equipment are to be used only for their designed function. 2. Properly state-licensed testers are assumed to understand the requirements of the permit issued. The tester is responsible for knowing and abiding by the conditions of the permit. Deviation from the permit conditions may result in a stop-work order. 3. The testing company will be held responsible for the post-test paperwork. Analyses documentation is necessary for each site in order to close a case file or move it into mitigation. When testers do not follow through on necessary paperwork, an unmanageable backlog of incomplete cases results. If this continues, processing time for completing new tank integri ests will increase. Accepted by: Z—97` 'OW/ER O GENT DATE LF:cas (10140-h.mM) Kern County Internal Use Only Environmental Health Services Dept. PTT No761kd # Tanks to Test 2700 M Street, Suite 300 Test to include: Tank only Bakersfield, CA 93301 Tank/Piping Piping only (805) 861-3636 PTO No. 37-001 Appl. Date r- APPLICATION FOR PERMIT TO TEST UNDERGROUND HAZARDOUS SUBSTANCES STORAGE TANK A. Kern County Environmental Health Services Dept. Permit to Operate # 3 )_00( (If there is no permit number, an application for a permit to operate must be submitted and approved before the permit to test can be processed.) B. Facility Information n Facility Name /' 9,95 Address /H� Awy, 1}Ni✓resr/OE b A TANK # SIZE PRODUCT AGE OF TANK COMMENTS — _ laX Contact Person Day UL L1 NUrn1 FELb Erz, Phone (2,025 �- Night 5 A M t Phone ( ) C. Tank Owner Information 0 Owner Name 6 a E/vf L 7 2-1E_5 DI A)12 Mailing Address D Zip Code D. Testing Company Information v o Company Name ' (i Address TO l> KF-g.rj l-D CA Contact Person Day qOU 1110 Phone (&S) �®c�7_/.Z Night Phone ( ) Worker's Compensation Insurance # NW E l44.2 7 DD Liability Insurance # ` 1 OT 13 Q &f 9 _==:a__-- =' -Test=IVlethod=Used-= F -)L _ F State Licensed Technician ::7::6 WI N 0 NSTE A b State Licensed Technician's # E. If plot plan information is not available before the test, it must be submitted with the test results. If the information is available before the test, provide a plot plan of the facility showing all important points (including but not limited to): * tank location and number/designation, pump location, all buildings avid roads, vapor, vent and product lines, fill boxes, etc.) * Proposed tanks to be tested designated by this symbol " O ". * Nearest street or intersection * Any water wells or surface waters within 100' radius of facility * North Arrow F. This form has been completed under penalty of perjury and to the best of my knowledge is true and correct. 6 SIGNATURE TITLE DATE CG:ch georglut-20 i � i • , CERTIFGATE OF PRECISION LAAK TEST certification# Associated environmental Systems, Inc. has tested and certifies 875427 the following: DATE: 09/24/87 CERTIFIED TESTER: R E B # 871 12 LOCATION: Happy . Gas/Davies Oil Wible Rd & Taft Hwy , Bakersfield , CA TANKS: TANK LINE PROD/LINE ro ` 1. 12K DSL PASS N/A N/A 2. xxxxxx xxxx xxxx xxxx ANY FAILURE LISTED'MAY REQUIRE 3. xxxxxx xxxx xxxx xxxx NOTIFICATION OF AGENCY. 4. xxxxxx X�xxx xxxx xxxx , 5. xxxxxx xxxx.•, xxxX xxxx ., g, xxxxxx xxxx xxxx xxxx ` " ° FikertNication Date Recom. d: M 09/88 ® � ® MWM MMMJM TM Associated Environmental Systems, Inc. Home Office P.O.Box 80427, Bakersfield,CA 83380 805/393-2212 4014 /S-7L ' - �FEE� ��� ��� 0-.: � a--eef= x C-3 v� a-a 4--si� � M' o' Om" 00XMAjpMk=~=+ 1=10 , cw pmmou mpm-=AW.�. _______________________________________________________________________________ 1 Technician BROCKMAN ( Calibration Value �� UNITS = ���' Gal . | --------------------------------------------------------�----------------- ���&________ | Date 9/24/87 1 System Variation | UNITS | GPH | _______________________________________________________________________________ \ Time Started 11 : 51 | HIGH LEVEL (FULL SYSTEM) | | | _______________________________________________________________________________ 1 Gallons 12000 | LOW LEVEL " MID LEVEL ( ) L� '� |-� ���� | ��/ �� x ° ~~".~ -------------------------_------------------- --------_______----------------- 1 Tank Diameter 96 | PRODUCT LINE | | | _______________________________________________________________________________ 1 Ground Water 20 1 TEST IS &APASSED ( ) FAILED ( ) INCONCLUSIVE \ _______________________________________________________________________________ 1 TEST CONDUCTED AT ��u� INCHES 1 GRADE LEVEL AT ��^� INCHES � � ~_� ' '~~ _______________________________________________________________________________ � � � � � ^| /n � . 8� � ' U � �. J /. '� � � v � � UU � uJ � v N � ^ |1 Q Jv T � � � � q, . . � � 1 h4e~Mh1 rU �es: �� U������� K�� m x,, ** Notes HAPPY GAG. WIBLE ROAD AND TAFT HIGHWAY. BAKERSFIELD CA. THIS IS A TANK ONLY TEST. THE TANK IS ISOLATED FROM ALL PLUMBING � BY VALVING INSTALED BY CONTRACTOR. CAL= 1X. THERE IS A BUNG ON TANK TOP THAT LOOKS TO HAVE BEEN RESEALED SINCE INITIAL FAILURE OF THIS SYSTEM. | Hills 11prillill pills U||Nim |||UUN�� Associated Environmental Systems, Inc. P. O. Box 80427 Bakersfield , CA 9338( (805) 393-2212 PRECISION TANK & LINE TEST RESULTS Invoice Address: Tank Location: W. O. #: 5427 FEDERATED INSURACE CO. HAPPY GAS (DAVIES OIL) I . D. Number: N/A P. O. BOX 586 WIBLE RD.&TAFT HWY Technician: BRKMN CITRUS HEIGHTS CA. 95611 BAKERSFIELD CA. Tech. #: 85100 Van#: 6108 Date: 9/24/87 Time Start: 06: 00 End: 13: 30 County: KE Facility Phone#: Groundwater Depth: 50+ Blue Prints: N/A Contact: REX Date; Time system was filled: 9123/87 P. M. Tank Fill/Vent Product TypRe Of Vapor Inches of Pump Tank Tank Capacity Product Tank Vapor Lines Line ecovery Water/Tank Type Material 1 12K DSL PASS N/A N/A N/A 0 N/A SWS 2 3 4 5 6 Additional Information: THIS IS A TEST OF THE TANK ONLY. THE TANK HAS BEEN ISOLATED BY VALVES INSTALLED BY THE CONTRACTOR. ONE BUNG ON TANK TOP SHOWS SIGNS OF BEING RESEALED SINCE INITIAL FAILURE OF THIS SYSTEM. SITE LOG TIME Set Up Equip: 06: 15 Bled Product Lines: 06: 20 Bled Vapor Lines: N/A � Bled Vent lines: 06: 30 � i Bled Turbine: N/A � Bled Suction Pump: N/A � Risers Installed: N/A a> These results obtained using the patented A. E. S. /Brockman system. b) This system and method meets the criteria set forth in NFPA #329. | c) Any failure listed above may require further action, check with | | all regulatory agencies. � � Certified Technician Signature : Date : � � "f' IES OIL COMPANY Box 5188 � p � _P�. • aM IT Bakersfield, Ca 93388 Record of Computer AE5or Meter Change Station number Date ❑ Meter Change Job Number ❑ Computer Change /� 9 L/ g� ❑ W/M Notified Make'and Model Serial Number Tagged Tag M , P4!7P ❑Red (]Gratin ❑Blue Finish lmonev) Finish(gallons) Calibration: Fast X11 Slow �!1 ' •. Totalizer 39 ` �3 Chucked p` Readings Start(m ney) Start(gallons) Adjusted Fast Slow c'C To a Product Return to Storage (gallons) Totalizer Sealed Motor Sealed Dyes ❑No ❑Yes ❑No Make and Model Serial Number Tagged Tag Y Pump ❑Red ❑Green ❑Blue , ,. f. Finish (money) inish,,ga ons) Calibration: Fast Slow Totalizer fT •; � G 3- Checked Readings Star{ money Start 1giifldniO Adjusted Fast low . To 070duct Return to Storage Igallons) Totalizer Sealed Meter Sealed _ • TYQ J I]Yes ❑No ❑Yes ❑No 'Make and Model Serial Number Tagged Tag M Pump ❑Red ❑Green ❑Blue Finish(money) Finish gallons Calibration: Fast Stow 2 Totalizer Sri S Checked r J Readings Start money Start(gallons) Adjusted aat Slow 4 To / roduct Returb to Storage igallonsl Totalizer Sealed Motor Sealed i it°SC ❑yea ❑No ❑Yes ❑No Make and .Model.,.. '' end' umber' Tagged• Tag Purnp ❑Red ❑Gruen ❑Blue . Finish money) Finish(gallons) Calibration: Fast Slow 9`7 TOtll lie► -.-•�- Checked �'Re>tdings Start(money) Start(gallons) Adjusted eat Slow P �� To roduct Return to Storage(gallons) Totalizer Sealed Motor Sealed ❑yes ❑No ❑Vas [3 No ' ake an ode erie umbet Tagged a le Pump ❑Red ❑Green ❑Blue Finish money Finish gallons Calibration: Fast Slow �Total hte► Checked Readings Stan lmo eyl St' rt(ga Adjusted usted Fast Slow -56 To Product Return to Storage(gallons) Totalizer Sealed Meter Sealed ❑Yes ❑No ❑Yes ❑No Make and Model Serial Number C Tagged Tag M -„ Pump ❑Red ❑Green ❑Blue -- Finish( oney)• Finish(gallons) Calibration: Fast Slow Totalizer Checked L '+ Readings Stan (money) Start Igallons) Adjusted Fast Slow r. j To rY oduet Return to Storage(gallons) t. Totalizer Sealed Meter Seated T ❑yes ❑No ❑Yes, f 1 C].No �j 9; r 'Dealer's gnature in an aC s nut C/ D►stnbution: Origin white)Invoice CopYf•.. Dupli to(canary)File Copy' >s,�_` �►:', DAVIES OIL COMPANY 0. Box 5188 i s�cersfield, Ca 93388 Record of Computer or Meter Change :t • Station number Data ❑ Meter Change Job Number � c��l. ❑ Computer Change Q W/M Notified Make and Modal Serial Numoer Tagged Tag ak Pump QRed ❑Green ❑Blue - Finish (m ney) Finish(gallons) Calibration: Fast Slow Totalizer (� Chocked — 3 Readings Start(money) - Start(gallonil Adjusted Fast Slow - �s To Product Return to Storage(gallons) Totalizer Scaled Meter Sealed ov- �O ❑Yes ONO QYes ONO Make and Model Serial Number v� Tagge,l Tag M Puntp ❑Red QGreen ❑Blue F inis h (money —� Finish(gallons) Calibration: ast Slow "Totalizer' - -'SfiijH"' - Chocked t� Readings Start money Start(gallons) Adjusted Fast low To Product Return to Storage(gallons) Totalizer Sealed Meter Sealed - Psll 1]Yes ONO QYes ONO Make and Model Serial Number lagged Tag M Pump ❑Red ❑Green ❑Blue Finis mo�ineyy))�/J Finish Igallons Calibration: Fast low L TOblizer C:.r �...�- 3 r •• •V Checked 4 'T Readings tart money Start ga ons Fast Slow , Adjusted Z4<2,2 To product Return to-Storage gallons Totalizer Sealed Meter Sealed 3 ❑Yes ONO ❑Yes. 'ONO 4' a, Make and Mode_ Serial Number Tagged Tag Pump ❑Red QGreen QBlue Finish Im me ; Finish(gallons) Calibration: Fast Slow Totalizer / �. Checked rqoodings Star (money) Start (gallons) Adjusted Fast Slow Slj 6c��S� To roduct Return to Storage igallons)i Totalizer Sealed Meter Sealed QYes ONO QYes ONO • •lam Make zjn jrrliillodal aria umbe► - Tagged Tag M . Pump r ,. ❑Red QGreen ❑lilua Finish money Finish gallons Calibration: Fast Slow Totalizer Checked 1 Readings Start(money) Start (gallons) Adjusted Fast Slow To .Product Return to Storage(gallons) Totalizer Sealed Meter Sealed a Oyes ONO QYes ONO Make and Model Serial Number Tagged Tag M Pump ❑Red ❑Green ❑Blue Finish (money) Finish(gallons) Calibration: Fast Slow Totalizer Checked Readings Start Imonayl Start(gallons) Adjusted Fast Slow To Product Return to Storage(gallons) Totalizer Sealed Meter Sealed ❑Yes ❑N ❑Yes ONO epler ignature Mali to ce a s igna t� Distribution: Ori al(white)Invoice Copy Duplicate(canary)File Copy DAVIES OIL COMPANY rk- 0. Box 5188 ; . :�_ lcersf�ield, Ca 93388 Record of Computer AV1E 4- 4, � �>�Y , or Meter Change, r• Station number Date Meter Change Job Number . y �,.ff� (1, Computer Change / ❑ WiM Noiified ' Pum p Make and Model Serial Number Tagged Tag ❑Red [Green ❑Blue Finish (money)- Finish(ga`llons) Calibration: Fast _ � Slow Totalizer J , Checked r✓ y` Readings Start (money) Start (gallons) Adjusted Fast Slow JbS gv,') Y To Product J Return to Storage (gallons) Totalizer Sealed Meter Sealed CJ Yes ❑No ❑Yes ❑No Make and Model Serial Number Tagged Tag Af Pump �y T'�Q_s� ' ` Q nRed ❑Green ❑Blue Finish (money) .inish gallons) Calibration: ast © Slow Totalizer Checked / Readingf Start money Start gallons) Adjusted Fast Slow / 7!, To Product Return to Storage(gallons) Totalizer Sealed Meter Sealed �Iv G 1�1 Yes ❑No ❑Yes ❑No Make and Model Serial Num er Taggi d Tag tY Pump l ❑Red ❑Green ❑Blue Finish money inish(gallons) Calibration: Fast Slow Totalizer Ue,� Checked ! p� Readings Start money tart igallonsi Adjusted Fast Slow Spey✓�c S To Product Return to Storage(gallons) Totalizer Sealed Meter Sealed 13 Yes ❑No ❑Yes' '.,ONO ' Make and Model / +q Serial N ber Tagged Tag M Pump "7_� y� I l�( S ❑Red ! ❑Green ❑Blue Finish (money) Finish (gallons.). Calibration: Fast Slow , Totalizer �CJ — r Checked / O Readings Start(money) Start (gallons) �� Adjusted Fast Slow SQ�j C�>Ci� To Product Return to Storage Ig Ion Totalizer Sealed Meter Sealed ❑-Yes ONO ❑Yes ONO Make and Model P erial Number Tagged ag 11 Pump ❑Red ❑Green ❑Blue Finish money Finish igallonsi Calibration: Fast Slow � ns Totalizer � (, 7 o Checked Readings Start (money) Start(gallons) Adjusted Fast Slow To u Product Return to Storage(gallon ) Totalizer Sealed Meter Sealed UkGXAd-1 _1t ❑Yes ❑No ❑Yes ONO Make and Modell Serial Number, q Tagged Tag M Pump -TV 9 j / o�f _-rte l ❑Red ❑Green ❑Blue Finish (money) Finish (gallons) °� Calibration: Fast !. Slow Totalizer ,off � Checked C`JS Readings Start (money) Start(g (Ions)) '7 Adjusted Fast Slow To Product Return to Storage(gallons) }� Totalizer Sealed Meter Sealed UA)6,�-.A4Z1 /ai) ❑Yes ❑No ❑Yes ❑No eale^Signature Maintenance ban's Sign ur - y Distribution: Ori al(white) Invoice Co Duplicate(canary) File Co Triplicate(pink)Dealer Copy DAVIES OIL COMPANY i 0. Box 5188 RVI ersfield, Ca 93388 Record of Computer E -- �- ,� `Vr Meter Change Station number Date ❑ Meter Change t; Sob Number 5 ❑ Computer Change r/ ��'. �� ❑ W/M Notified it Make and Model Serial Numoer Tagged Tag tY. Pum p �y J 7d 'k, ` / -?0-g ❑Red ❑Green ❑Blue _ 3 Finish (money) Finish Igallonsl `y Calibration: Fast Slloj�w. Totalizer (� V Checked Readings Start (money) Start (gallons) Adjusted Fast Slow / 15 _715 To Product Return to Storage (gallons) Totalizer Sealed Meter Sealed Q (_,)Yes [3 No ❑Yes ❑No Make and Model Serial Number Tagged Tag It Pump �/ ��n 7 Q,: e /d []Red nG.een ❑Blue . Finish (money) Finish gallons Calibration: Faso- 6 Slow _ Totalizer Checked Readings Start (moneyl Start(/gallons), Adjusted Fast Slow To Product ` Return to Storage(gallons) Totalizer Sealed Meter Sealed / 'J 0 Yes ❑No ❑Yes ❑No Make and Model Serial Number lagged Tag N Pump ; ❑ ❑Green Red ❑Blue Finish (money) Finish(gallons) Calibration: Fast v slow Totalizer „S V71 x Checked kx Readings Start money tart gallons Fast Slow Adjusted "R S SS 136 To Product /L Return to Storage(gallons) Totalizer Sealed Meter Sealed E]Yes ❑No ❑Yes ❑No Make and Model Trial Number Tagged Tag M {' Pump it ,, /�^� i;e ❑Red.. ❑Green ❑Blue Finish (mmloney) `a inish(gallons)- Calibration: Fasts )y Slow Totalizer t/ U i Checked' / Readings Start(money) Start(gallons) Adjusted Fast Slow cJa / -7 To roduct _ _ Return to Storage (gallons) Totalizer Sealed Meter Sealed L3 Yes ❑No ❑Yes ❑No Make and Model Serial umber Tagged Tag rti Pump ❑Red ' ❑Green ❑Blue Finish money Finish(gallons) Calibration: Fast Slow Totalize Checked Readings Start (money) Start(gallons) Adjusted Fast Slow To Product Return to Storage(gallons) Totalizer Sealed Meter Sealed ❑Yes ❑No ❑Yes D No Make and Model Serial Number Tagged, Tag M Pump ❑Red ❑Green ❑Blue Finish(money) Finish (gallons) Calibration: Fast Slow Totalizer Checked Readings Start (money) Start(gallons) Adjusted Fast Slow To Product Return to Storage(gallons) Totalizer Sealed Meter Sealed ❑Yes ❑No C]Yes ❑No Balers ignature Maintenance an's Signature ,1 Distribution: Original while) Invoice Copy Duplicacanary) File Copy Triplicate(pink)Dealer Copy ;;•tK"; .r. �l 4?t� v TE, 9 Fr 3 ".:1 c80 � 1987 KERN COUNTY"EALTH ®FPL TANK F I L I TY�/, ,Z R 'ORT Facility Permit Month/Yr. Tc,L�4 1. I have not done any major modificatio to' th a facility during last 12 months. _ Signature - -� Note: All major modifications require a Permit to Construct from the Permitting Authority. 2. I have done major modifications for which I obtained Permits) to Construct from Permitting Authority / Signature Permit to Construct Date 3. Repair and Maintenance Summary Attach a summary of all: -- Routine and required maintenance done to this facility's tank, piping, and monitoring equipment. -- Repair of submerged pumps or auction pumps. -- Replacement of flow-restricting leak detectors with same. -�( Repair/replacement of dispensers, meters, or nozzles. Po V-D z2_4. -- Repair of electronic leak detection components, or replacement with same. -- Installation of ball float valves. -- Installation or repair of vapor recovery/vent lines. Include the date of each repair or maintenance activity. NOTE: All repairs or replacements in response to a leak require Permit to Construct from the Permitting Authority as do all other modifications to tanks, piping or monitoring equipment not listed here. 4. Fuel Changes - Allowed for Motor Vehicle Fuel tanks Only. List all fuel storage changes in tanks, noting: Date(s) , tank number(s) , new fuel(s) stored. 5. Inventory control monitoring is required for this facility on the Permit to Operate, and I have not exceeded any reportable Limits as listed in the appropriate inventory control monitoring handbook during the last twelve months (if not applicable, disregard) . Signature 6. Trend Analysis .Summary Please attach Annual Trend Analysis Summary for the last 12 periods. (o Vc 2.) 7. Meter Calibration Check Form Please attach current, completed Meter Calibration Check Form ANNUAL TREND u ANALYS I S a UbUKARY TIME PERIOD: QC-r `94 to 3=4AJ Tit�K 1 TIME PERIOD: ®C7 �1� to 7 r�lC PERIOD 1: Total Minuses This Period (Line 3) 112- Action Number for this Period (Line 4) -24 PERIOD 2: Total Minuses This Period (Line 3) 018' Action Number for this Period (Line 4) 37 PERIOD 3: Total Minuses This Period (Line 3) y� Action Number for this Period (Line 4) 2 TIME PERIOD: 6CT- V� to Z-,�-j � 7 PERIOD %: Total Minuses This Period (Line 3) Action Number for this Period (Line 4) a� PERIOD 2: Total Minuses This Period (Line 3) a Action Number for this Period (Line 4) 3 7 PERIOD j: Total Minuses This Period (Line 3) Action Number for this Period (Line 4) -s 7i`f/t/1 3 TIME PERIOD: OCT X16 to 3-4,AJ 7 P,Q�-art PERIOD X: Total Minuses This Period (Line 3) �y Action Number for this Period (Line 4) o� PERIOD .?: Total Minuses This Period (Line 3) oz 7 Action Number for this Period (Line 4) 37 PERIOD�: Total Minuses This Period (Line 3) Iys Action Number for this Period (Line 4) S TIME PERIOD: O T to 7�^� I�iESL_ PERIOD Total Minuses This Period (Line 3) Action Number for this Period (Line 4) a PERIOD "Z. Total Minuses This Period (Line 3) Action Number for this Period (Line 4) 3 7 PERIOD .3 Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Sy I hereby certify s rue ,d accurate report. Signature E Date �� �� 1700 Flower Street J • ._KERN COUNTY HEALTH DEPARTIIOlT HEALTH OFFICER Bakersfield,California 93305 Of Leon M Hebertson,M.D. Telephone(805)861-3636 ENVIRONMENTAL HEALTH DIVISION DIRECTOR OF ENVIRONMENTAL HEALTH Vernon S.Reichard �rrrullll� October 29 , 1987 Rex Rice Davies Oil Company P . 0 . Box 80067 Bakersfield , California 93308 Dear Mr . Rice : This is to advise you that this department has reviewed the project results for the suspected fuel seepage investigation that was conducted at the Happy Gas facility on Taft Highway . Based upon the findings , this department is satisfied that the leak investigation was conducted in accordance with this departments guidelines , and no significant soil contamination resulting from the fuel leakage exists at the site . Thank you for your cooperation in this matter . Sincere , Joe Canas Environmental Health Specialist Hazardous Materials Management Program JC : aa VAY �. NC IM-00 DISTRICT OFFICES (lnla nn I a.......� 1�L..�..�ti..n., u,�....., n:.a...____• ��-.._. T_.. co SUBSURFACE CONTAMINATION ASSESSMENT DAVIES OIL COMPANY TAFT HIGHWAY AND WIBLE ROAD PUMPKIN CENTER, CALIFORNIA CLAIM #83Z-61 ' JULY 20, 1987 #4231 87-704 II ', l , CWII'7 CICV CL?5[1nq mrporeoai � * � i 1 1 1 1 1 1 1 1 o_ .. tuuin city testinq corporation ' 662 CROMWELL AVENUE ST. PAUL, MN 55114 PHONE 612/645-3601 July 20, 1987 Federated Insurance Company P.O. Box 586 Citrus Heights, California 95611 ' Attn: Mr. Joe Kessing Subj : Subsurface Contamination Assessment ' Davies Oil Company Taft Highway and Wible Road Pumpkin Center, California Claim #82Z-61 x/4231 87-704 Dear Mr. Kessing: rEnclosed is a copy of our report regarding the subsurface contamination assessment conducted by Twin City Testing Corporation (TCT) at the ' referenced site. It has been a pleasure to have served you on this project. If you have any questions regarding the contents of this report, or if you should require additional information, please contact either Ms. Teri Miller at (612) 649- 5594, or Mr. Mark Mason at (612) 641-9372. ' Very truly yours, Twin City Testing Corporation Mark S. Mason, Environmental Geologist Senior Project Manager MSM/j r Encs ' cc: 1 - Kern County Health Department Attn: Mr. Joseph Canas AN EQUAL OPPORTUNITY EMPLOYER • • � t 1 1 1 1 1 1 1 1 1 ' TABLE OF CONTENTS ' Item Page ' 1.0 INTRODUCTION 1.1 Purpose and Scope 1 1.2 Site Location and Description 2 1.3 Suspected Uncontrolled Loss 4 2.0 PROJECT RESULTS 2.1 Soil Boring Locations 4 2.2 Soil Description 6 2.3 Field hNu Screen 7 2.4 Analytical Results 7 3.0 DISCUSSION 7 4.0 CONCLUSIONS/RECOMMENDATIONS 11 5.0 METHODS AND PROCEDURES 5.1 Soil Sampling/Decontamination 12 ' 5.2 Soil Screening 13 5.3 Soil Classification 13 5.4 Chemical Analysis 14 ' 6.0 STANDARD OF CARE 14 ' LIST OF TABLES ' TABLE 1 - SUMMARY OF SOIL BORING DATA 8 TABLE 2 - hNu PHOTOIONIZATION DETECTOR READINGS 9 ' TABLE 3 - ANALYTICAL RESULTS 10 twin ciLY testinq • • � � i r ' TABLE OF CONTENTS (Cont. ) rItem Page rLIST OF FIGURES ' FIGURE 1 - SITE LOCATION MAP 3 5 FIGURE 2 - SITE MAP r . - LIST OF APPENDICES ' APPENDIX A - SOIL BORING LOGS APPENDIX B - LABORATORY REPORT i 1 i 1 r r r 1 r turn city testing • • � 1 1 1 1 1 i 1 1 1 1 1 I 1 1 1 1 1 1 SUBSURFACE CONTAMINATION ASSESSMENT ' DAVIES OIL COMPANY ' TAFT HIGHWAY AND WIBLE ROAD PUMPKIN CENTER, CALIFORNIA ' CLAIM 083Z-61 14231 87-704 ' 1.0 INTRODUCTION ' 1.1 Purpose and Scope The purpose of this assessment was to respond to the suspected loss of approximately 300 gallons of diesel, fuel at the self-service gasoline 1 station located at 3221 Taft Highway in Pumpkin Center, California. Specifically, the soil boring program was to provide information regarding the vertical and horizontal extent of soil contamination, if present. Twin City Testing Corporation (TCT) was authorized on April 16, 1987 to perform this assessment by Mr. Joe Kessing of Federated Insurance Company. The scope of work consisted of the following items: 1. mobilizing a representative of TCT to the site on May 7, 1987, ' 2. mobilizing a drill rig and crew to the site on May 7, 1987, 3. advancing five hollow stem auger borings and collecting representative soil samples, 1 twin cmy testinq • • � 1 1 Ah Ash. ' Page 2-#4231 87-704 ' 4. screening soil samples for the presence of hydrocarbon contamination using both visual and olfactory evidence ' as criteria and an hNu photoionization detector cali- brated for direct readings in parts per million (ppm) of benzene, 5. selecting nine soil samples and submitting the samples to a laboratory certified by the State of California. The ' samples were to be analyzed for the presence of total petroleum hydrocarbons (TPH) , total volatile hydrocarbons (TVH) and benzene, toluene, and xylene compounds (BTX) , and 1 6. preparing a factual report presenting the data, methodology, results, and conclusions, 1.2 Site Location and Description The site is located at 3221 Taft Highway in Pumpkin Center, California t (Figure 1) . The areas adjacent to the site are primarily used for ' agriculture. In addition, several small busineses are located north of the site. The site and surrounding area is relatively flat and lies within the Kern River Valley. ' As discussed with Mr. Rex Rice of Davies Oil Company, four active underground storage tanks are located on the property. The tanks are used to store diesel fuel, regular, unleaded, and premium unleaded gasoline. Reportedly, new tank and pump islands were installed approximately 5 years ago. 1 twin cart testinq • • � 1 1 t 1 1 1 Pag #4231 87-704 — � ti i � king Plant 25 . i•. 26 1 I135B _ BERKSHIRE _ 1� ROAD• 358 30 _F €o 355 .----------- �` T• HOSKI , ROAD Q • I • • ' 351 MCKEE• _ RbA 35 351 _. 36 31—� Vn x La •�• \\\\\ I 1�E TAFT • I�• I— •^• _ HIGHWAY ' 'BM.iy7 I \ `• 145 .� .a . . PumpkiTib c e r W \ \\ x 335 y ;I 'U \ I \ • 1 343 '� \\ •44 CURNOIN RO' 2 1 6 11 \\ 11 � u �IF. 341 ' 340 .•• \ \ QUADRANGLE LOCATION 12 \\\ ?.9 7 ATE 6/10/S7 FIGURE 1 SITE LOCATION MAP FLT PROJECT SUBSURFACE CONTAMINATION ASSESSMEN 4231 87-704 EVIEWED BY: DAVIES OIL COMPANY TAFT HWY. & WIBLE ROAD DRAWN BY: J.AM. SCALE ING PUMPKIN CENTER,CALIFORNIA 1'= 2000' ENV—D—R7-4 • � � i � I Page 444231 87-704 ' 1.3 Suspected Uncontrolled Loss Based on inventory reconciliation, Davies Oil Company detected a loss of ' approximately 300 gallons of diesel fuel on April 13, 1987. The Kern County Health Department (KCHD) was immediately notified of the loss. In response to the loss, Davies Oil Company pressure tested the diesel tank, ' which failed both thP_hig d low level tests. The tank is currently out -7--T of service and will not be put back on line until the cause of the loss is identified and repaired. Further testing on the tanks and lines are scheduled for early August, 1987 when business levels at the site are suspected to decline. 2.0 PROJECT RESULTS 2.1 Soil Boring Locations On May 7 and 8, 1987, BSK and Associates advanced five hollow stem auger borings using methods described in Section 5.0 of this report. The borings were located by TCT and designed to provide information regarding the horizontal and vertical extent of diesel fuel contamination. ' The locations of the borings are shown in Figure 2. The locations are described as follows. ' twwi OtY I P=I i '1q corpornt r n AdhL Page 231 87-704 TAFT HIGHWAY , B-1 SUMP rO-� �-0 i O, 10 UNDERGROUND TANKS B-2 I I 6 1 1 B-s El E:31 L L � W m I�NCRETE PAD p� ISPENSING 3 / LINES PUMP ISLANDS STATION • • <F B-s B-4 ork e SEWER. N LEGEND: • SOIL BORING LOCATION D DIESEL DISPENSER ' - OVERHEAD POWER LINE ' ATE FIGURE 2 SITE MAP 5/12/87 DAVIES OIL COMPANY PROJECT f 4231 87-704 FFING EVIEWED BY: TAFT HIGHWAY & WIBLE ROAD DRAWN BY: J.A.W, PUMPKIN CENTER,CALIFORNIA CALF 1, 20� nORPORATION ENV-D-87-4 • • � 1 1 1 tPage 644231 87-704 1. B-1 was advanced approximately 2' off the northern end of the diesel tank. ' 2. B-2 was placed on the western edge of the tank area, approximately 12' from the diesel tank. 3. B-3 was placed to the east of the tank area, approximately 8' from the diesel tank. 4. B-4 was advanced directly south of the diesel tank at a distance of approximately 12' . In addition to assessing the soil conditions south of the tank, this boring was placed to evaluate the soil conditions near the eastern dispensing island. 5. B-5 was placed to assess the soil conditions adjacent to the western dispensing island. ' 2.2 Soil Description The soils encountered at the site are fine to coarse grained alluvial deposits generally consisting of olive sand, yellowish-brown silty sand and yellowish-brown sand. The three soil types are not continuous across the site, however, all three types were encountered in B-1 and B-5. Olive sand was present from the surface to 12.5' below grade in B-1 and 19.0' below grade in B-5. Silty sand was encountered at those depths .and extended to 24.0' below grade in B-1 and 27.0' below grade in B-5. Both borings terminated in yellowish-brown sand at 25.0' and 31.0' , respectively. NI ULif7 CWY testinq • • � � ' t 1 1 1 1 1 i Page 7-#4231 87-704 Olive sand was not encountered in B-2 or B-4. Silty was present resent from the surface to 22.5' below grade in B-2 and 9.0' below grade in B-4. Both borings terminated in yellowish-brown sand at 26.0' and 16.0' , respectively. Olive sand was encountered in B-3 from the surface to a total depth of 16.0' below grade. The complete soil boring logs are presented in Appendix A. The deepest boring was advanced to a depth of 36' below grade and did not encounter ground water. Maps prepared by the Kern County Water Agency show that in 1985 the water table in this area was at a depth of between 50 and 100' below grade. A summary of the soil boring elevation data is presented in Table 1. 2.3 Field hNu Screen All soil samples were screened in the field for hydrocarbon contamination using both visual and olfactory evidence as criteria and an hNu photoionization detector calibrated for direct reading in ppm benzene. Odors were not encountered in any of the borings. However, hNu readings were detected at B-1, B-2, B-4, and B-5 using the hNu with readings ranging from .5 ppm to 9 ppm. Results of the soil screening are listed in Table 2. twin cmy testing corvwation • • � � � � � 1 1 1 1 1 � 1 1 1 1 1 1 � Page 844231 87-704 TABLE 1 SUMMARY OF SOIL BORING DATA SUBSURFACE CONTAMINATION ASSESSMENT DAVIES OIL COMPANY TAFT HIGHWAY AND WIBLE ROAD PUMPKIN CENTER, CALIFORNIA Surface Depth Elevation Borin¢ Elevation of Boring at Total Depth 1 B-1 97.86 25 72.86 B-2 97.71 36 62.71 B-3 98.18 16 83.18 B-4 98.06 16 83.06 B-5 97.50 31 67.50 All elevations are referenced at a local benchmark with an assumed elevation of 100.00' . ,1 1 1 twin City C s s inq 1 mrpornbo n . • • � 1 1 1 1 1 1 1 1 1 1 1 1 i 1 1 1 1 1 Page 9-84231 87-704 TABLE 2 hNu PHOTOIONIZATION DETECTOR READINGS SUBSURFACE CONTAMINATION ASSESSMENT DAVIES OIL COMPANY TAFT HIGHWAY AND WIBLE ROAD PUMPKIN CENTER, CALIFORNIA B-1 B-2 B-3 B-4 B-5 Odor hNu Odor hNu Odor hNu Odor hNu Odor hNu Depth 1.5'-2.5' N 2.8 N ND -- -- -- -- -- -- 4.0' -5.0' N 2.8 N ND N ND N 2 N 2.5 6.5'-7.5' N ND N ND -- -- -- -- -- -- 9.0'-10.0' N 1* N ND N ND N .5* N 2.0 11.5'-12.5' N 1 N 3 -- -- -- -- -- -- 14.0'-15.0' N 1 N 1 N ND* N ND* N 2.2 19.0'-20.0' N 5.2* N 9* N 2.2 24.0'-25.0' N ND* N 4 N 2.0 29.0'-30.0' -- -- N 2.0* 34.0' -35.0' N ND* All hNu readings are recorded in parts per million (ppm) . N = No Odor. *Selected for laboratory analysis. Total Depth --5' sampling interval. ND = Not Detected. turn atY I es: �. -in • • � r i t AL AM, Page 10-$4231 87-704 2.4 Analytical Results Nine soil samples were selected for chemical analysis and submitted to SMC Laboratory in Bakersfield. The samples were analyzed for the presence of TPH, TVH, and BTX. The laboratory report is presented in Appendix B and a summary of the analysis is listed in Table 3. Diesel fuel contamination was not detected in any of the samples. 3.0 DISCUSSION Based on laborator y results, the soils at the site have not been significantly contaminated as a result of the loss of 300 gallons of diesel fuel. Laboratory detection limits of the TPH and BTX analyses were 100 ppm and 1 ppm, respectively. These detection limits were approved through phone conversations with the Kern County Health Department. Readings of .5 to 9 ppm were observed on the hNu during field screening of the soil samples. These readings may represent background interference due to gases released from the station' s septic system. The highest reading of 9 ppm was recorded at a depth of 20' below grade in B-2, which was placed approximately 8' from the septic sump. Therefore, we feel that positive readings observed on the hNu may not be indicative of diesel fuel contamination in the soils. e ' twin city test 0 cornorao,n nQ • • � 1 1 1 1 1 t 1 i i i 1 1 1 1 M mom MM mm TABLE 3 ANALYTICAL RESULTS SUBSURFACE CONTAMINATION ASSESSMENT DAVIES OIL COMPANY TAFT HIGHWAY AND WIBLE ROAD PUMPKIN CENTER, CALIFORNIA Minimum B-1 B-1 B-1 B-2 B-2 B-3 B-4 B-4 B-5 Reporting 10.0_' 20.5' 25.0' 20.0' 35.0' 15.0' 10.0' 15.0' 30.0' Level TPH ND ND ND ND ND ND ND ND ND 100 Benzene ND ND ND ND ND ND ND ND ND 1.0 Toluene ND ND ND ND ND ND ND ND ND 1.0 Ethylbenzene ND ND ND ND ND ND ND ND ND 1.0 p-Xy ene ND ND ND ND ND ND ND ND ND 1.0 m-Xylene ND ND ND ND ND ND ND ND ND 1.0 o-Xylene ND ND ND ND ND ND ND ND ND 1.0 ry w_ Isopropylbenzene ND ND ND ND ND ND ND ND ND 1.0 00 v TVH ND ND ND ND ND ND ND ND ND 1.0 0 ND = Not Detected. All concentrations are reported in parts per million (ppm) . tWO1 City tesurlq c«ooraoon � � � ! � � � � � '� � i � � � � � � � r iPage 12-#4231 87-704 4.0 CONCLUSIONS RECOMMENDATIONS r It is our opinion that site remediation is not warranted. This is based on the fact that contamination resulting from the release of approximately 300 gallons of diesel fuel is below quantifiable limits. TCT recommends that the cause of the loss be identified and repaired prior to the diesel tank being placed back in service. , If the cause of the loss is determined to be the tank and re-lining is not considered an option, TCT recommends that when the tank is removed, any diesel fuel contaminated soils be excavated and disposed of properly. Proper soil disposal options will be discussed with the KCHD. 5.0 METHODS AND PROCEDURES 5.1 Soil Sampling/Decontamination Intact soil samples were collected at intervals indicated on Table 2 by driving a sampler equipped with stainless steel liners. The samples were capped with aluminum foil, then with pressure fitted plastic caps and then sealed with adhesive tape. Each of the samples were labeled with an adhesive-backed label including boring designation, depth of sample, and initials of the individual preparing the sample. r tULXn CI[V 1 0 C 1P1q carpaat+an • • � e t t Page 1344231 87-704 The samples' were laced in a cooler and reserved with ice prior to P P P P transporting to the laboratory. The sampler and the stainless liners were steam cleaned prior to each sampling action. Steam cleaning of the augers was also performed prior to entering the site and between test holes to prevent cross-contamination. 5.2 Soil Screening Soils were scanned with an hNu Model 101 photoionization detector equipped with an 11.7 eV lamp and calibrated for direct reading in ppm of benzene. Fresh soil surfaces were exposed and the hNu probe immediately placed within 1" to 2" of the soil surface. 5.3 Soil Classification As the samples were obtained in the field, they were visually and manually classified by the crew chief in accordance with ASTM: D 2488-84. Representative portions of the samples were then returned to the laboratory for further examination and for verification of the field classification. Logs of the borings indicating the depth and identification of the various strata, the N value, water level information and pertinent information rturn=Vvo testing • • � 1 1 1 1 i 1 1 1 I 1 Page 1444231 87-704 regarding the method of maintaining and advancing the drill holes are attached. Charts illustrating the soil classification procedure, the descriptive terminology and symbols used on the boring logs are also attached. 5.4 Chemical Analysis Laboratory testing was performed by SMC Laboratory in Bakersfield, California. The soils were tested for the presence of total petroleum hydrocarbons, total volatile hydrocarbons, and benzene, toluene, and xylene compounds. The laboratory report is presented in Appendix B. 6.0 STANDARD OF CARE The recommendations contained in this report represent our professional opinions. These opinions were arrived at in accordance with currently accepted hydrogeologic and engineering practices at this time and location. Other than this, no warranty is implied or intended. o turn city testing • � � 1 1 1 1 1 1 1 f 1 1 1 1 1 Page 15-$4231 87-704 This report was prepared by: ` Teri Miller Geologist Dated: July 20, 1987 This report was reviewed by: ark S. Mason, nvironmental Geologist Senior Project Manager Dated: July 20, 1987 Proofread by: turn ave testinq • • � 1 1 1 1 1 r r � � i APPENDIX A SOIL BORING LOGS turn city testinq co.vo.aoon • • � i 1 1 1 1 1 1 1 1 1 1 1 1 1 1� DATE: 5-7-87 LOG DESIGNATION B-1 LOGGED BY: JD ELEVATION: WATER LEVEL-No Groundwater Encountered JOB: B87090 EOUIPMENT: " hollow stem auger FIGURE:moiile E-50. F- Z O N O 1 W LL Q H O v Z LL = z W 3 N W a SOIL OR ROCK DESCRIPTION NOTES Q O W 0 } 41 1 n 20 m SW SAND: dark olive; fine to coarse; damp; loose to medium sand. 2.5 10 5 2.5 8 2.5 8 10 2.5 14 SM SILTY SAND: dark yellowish brown; fine to coarse; damp; medium dense. 15 2.5 28 20- 2. 30 Boring SW SAND: brown to gray; fine to coarse; damp; Terminated 25 2.5 22 medium dense. at 25' THE LOGS SHOW SUBSURFACE CONDITIONS ( I 1 SAMPLER INSIDE 0 INC KK AT THE DATES AND LOCATIONS .INDICATED, AND IT (2 ) 1401bs HAMMER- INCH DROP. IS NOT WARRANTED THAT THEY ARE REPRESENTATIVE OF SUBSURFACE CONDITIONS AT OTHER LOCATIONS P 1 HYDRAULICALLY PUSHED &/1550Cd(e'S � • � 1 1 1 1 1 i i 1 1 1 1 DATE: 5-7-87 LOGGED BY: JD LOG DESIGNATION B-2 ELEVATION: WATER LEVEL: No Groundwater Encountered JOB: B87090 EQUIPMENT: Mobile B-50. 8" hollow stem auger FIGURE: ~ - ? 0 N o F LL Q W N � Cr z U. Z 3 o a �? SOIL OR ROCK DESCRIPTION NOTES LA.) oa o0 } y o z m ML SANDY SILT: dark gray to brown; moist; medium dense. 2.5 13 5 SM SILTY SAND: dark yellowish brown; fine to �\ 2.5 18 medium; moist; medium dense; micaceous. 2.5 20 r� 2.5 22 2.5 17 15 2.5 22 Red organic oxidation streaks. 20 2.5 22 SP SAND: light yellowish brown and light gray; fine to medium; damp; medium dense to dense. 25 2. 46 THE LOGS SHOW SUBSURFACE CONDITIONS I I I SAMPLER INSIDE DIAM. AT THE DATES AND LOCATIONS INDICATED, AND IT p Kola HAMMER-30 INCH DROP, BSK IS NOT WARRANTED THAT THEY ARE REPRESENTATIVE OF SUBSURFACE CONDITIONS AT OTHER LOCATIONS P1 HYDRAULICALLY PUSHED &HS5063tes A10M 7.\ACC • • � t t t 1 1 1 t 1 1 1 1 1 i r DATE: JD7-87 LOG DESIGNATION B-2 continued LOGGED BY: ELEVATION: WATER LEVEL: No Groundwater Encountered JOB: B87090 EQUIPMENT: Mobile B-50 8" hollow stem auger FIGURE: _ ? O Q c ►- LL� V LU 2 W Q W O ? W 39 N o a SOIL OR ROCK DESCRIPTION NOTES W O C O } H O 2 0 m O f 'L5 SP SAND: light yellowish brown and light gray; fine to medium; damp. i' t' 3 2.5 35 go ecov ry 35 2.5 44 No Recov4 ry Boring Terminated at 36' 4 45 50 THE LOGS SHOW SUBSURFACE CONDITIONS l I 1 SAMPLER INSIDE DIAM. AT THE DATES AND LOCATIONS INDICATED, AND IT (2 1 I401ps HAMMER—30 INCH DROP. BSK IS NOT WARRANTED THAT THEY ARE REPRESENTATIVE P I HYDRAULICALLY PUSHED OF SUBSURFACE CONDITIONS AT OTHER LOCATIONS &Associates .,.-r% • • � 1 1 1 1 1 1 t f 1 t i 1 t i �f DATE: 5-7-87 _ LOGGED BY: 5- LOG DESIGNATION B-3 JD ELEVATION: ' WATER LEVEL: No Groundwater Encountered JOB: B87090 EQUIPMENT: Mobile B-50 8" hollow stem auger FIGURE: "' ? C N C h O .. ` Q W � D: 2 U. = z L' H o a SOIL OR ROCK DESCRIPTION NOTES aQ o o zzo m z SP SAND: olive brown; fine to coarse; damp; loose to medium dense; micaceous. 5 2.5 8 Sand becomes y ellow brown below 8' . io � 2.5 20 15 2.5 26 Boring Terminated at 16' 20 25 THE LOGS SHOW SUBSURFACE CONDITIONS I 1 SAMPLER INSIDE DIAM. NC BSK AT THE DATES AND LOCATIONS INDICATED, AND IT 12 ) Kola I MANNER-}p NCH DROP, IS NOT WARRANTED THAT THEY ARE REPRESENTATIVE I P 1 HYDRAULICALLY PUSHED OF SUBSURFACE CONDITIONS AT OTHER LOCATIONS &Associates • • 1 1 i 1 1 1 i 1 1 1 1 1 1 DATE: 5-7-87 LOGGED BY: JD LOG DESIGNATION B-a ELEVATION: WATER LEVEL: No Groundwater Encountered JOB: B87090 EOUIPMENT: Mobile B-50 8 ' hollow stem auger FIGURE: ~ ? N O H Q W V W \ Cr z 1L x z W 3 N o a U SOIL OR ROCK DESCRIPTION NOTES w oa 0 o z0 m SM SILTY SAND: olive brown; fine to coarse; medium dense; damp. 5 2.5 12 10 2.5 20 SP SAND: light yellow brown; fine to coarse; damp; medium dense. 15 2. 26 Boring Terminated at 16' 20 1 25 THE LOGS SHOW SUBSURFACE CONDITIONS I I I SAMPLER INSIDE DIAM. AT THE DATES AND LOCATIONS INDICATED, AND IT 2 1 I40Iee HAMMER-30 INCH DROP, BSK IS NOT WARRANTED THAT THEY ARE REPRESENTATIVE OF SUBSURFACE CONDITIONS AT OTHER LOCATIONS P I HYDRAULICALLY PUSHED &Associates A..r T,-C • • � 1 1 1 1 i 1 7 1 1 i i 1 M 1 1 r DATE: 5-8-87 LOG DESIGNATION B-5 LOGGED BY: JD ELEVATION: WATER LEVEL: No Groundwater Encountered JOB: B87090 EOUIPMENT: Mobile B-50 8" hollow stem auger FIGURE: 6 H _ Z p N c W QJ W O y W 0 D: z W F=„ z Uj 3 N o a SOIL OR ROCK DESCRIPTION NOTES W oa o v� o z m SP SAND: olive brown ; fine to medium; damp; medium dense; micaceous; with oxidation stain and some silt. 5 .5 12 10 .5 21 15 .5 14 ML SANDY SILT/SILT: light olive brown; damp 20 to moist; medium dense. 2.5 24 1251 2.5 23 THE LOGS SHOW SUBSURFACE CONDITIONS ( I 1 SAMPLER INSIDE OIAM. BSK AT THE DATES AND LOCATIONS INDICATED, AND IT 2 I 140 The HAMMER-30 INCH DROP. IS NOT WARRANTED THAT THEY ARE REPRESENTATIVE _ OF SUBSURFACE CONDITIONS AT OTHER LOCATIONS P 1 HYDRAULICALLY PUSHED &^ssocates AMn 71MCG • • � t 1 1 i 1 t 1 1 1 1 1 1 1 DATE: 5-8-87 LOG DESIGNATION B-5 continued LOGGED BY: JD ELEVATION: WATER LEVEL: No Groundwater Encountered ,JOB: B87090 EOUIPMENT: Mobile B-50 8" hollow stem auger FIGURE: W ? O N O O H LU Q cr Z U. _ ? Ui 3 N o a SOIL OR ROCK DESCRIPTION NOTES CL W O a O >- N O Z O m O � 25 ML SANDY SILT/SILT: light olive brown; damp to moist; medium dense. SW SAND: light yellow brown; fine to coarse; damp; micaceous; dense. U .5 51 Boring Terminated at 31' 5 I 4 i 4j- 150 THE LOGS SHOW SUBSURFACE CONDITIONS ( I I SAMPLER INSIDE DIAM. AT THE DATES AND LOCATIONS INDICATED, AND IT 2 I IAOIbs HAMMER-3o INCH DROP, BSK IS NOT WARRANTED THAT THEY ARE REPRESENTATIVE I P I HYDRAULICALLY PUSHEo OF SUBSURFACE CONDITIONS AT OTHER LOCATIONS &Associates A.— I-- • • 1 1 1 1 1 1 1 1 1 1 1 1 1 i 1 1 A 1 APPENDIX B LABORATORY REPORT twin citY testinq • • � 1 f � 1 1 1 1 1 f 1 I 1 SMC Laboratory Analytical Chemistry O 3155 Pegasus Drive P.O. Box 80835 Bakersfield, CA 93380 (805) 393-3597 Client Name; Twin City Testing Corporation Address : 662 Cromwell Avenue St. Paul, MN 55114 Date sample recieved : 5-8-87 Date analysis completed: 5-12-87 Date of report : 5-18-87 Laboratory No. 400 through 408 Location: Pumpkin Center W.O. #423187-.503 Davies Oil Company RESULTS OF ANALYSIS #400 ID: B1 @ 10.0 ppmm MRL,ppm Method of Analysis: EPA 5020/FID Benzene 'Cl - 1 TPH = Total Petroleum Hydrocarbons TPH (diesel) .4100 100 MRL =Minimum Reporting Level #401 ID: B1 @ 20.5 I)pm MRL,ppm Method of Analysis: EPA 5020/FID Benzene c1 1 TPH = Total Petroleum Hydrocarbons TPH (diesel) .4100 100 MRL = Minimum Reporting Level #402 ID: B1 @ 25.0 ppm MRL,ppm Method of Analysis: EPA 5020/FID Benzene <1 1 TPH = Total Petroleum Hydrocarbons TPH (diesel) <100 100 MRL = Minimum Reporting Level #403 ID: B2 @ 20.0 2m MRL,ppm Method Of Analysis: EPA 5020/FID Benzene 41 1 TPH = Total Petroleum Hydrocarbons TPH (Diesel) .4100 100 MRL = Minimum Reporting Level #404 ID: B3 @ 15.0 ppm MRL,ppm Method of Analysis: EPA 5020/FID t, Benzene <1 1 TPH = Total Petroleum Hydrocarbons TPH (diesel) <100 100 MRL = Minimum Reporting Level #405 ID: B4 @ 10.0 ppmm MRL,ppm Method of Analysis: EPA 5020/FID Benzene cl 1 TPH = Total Petroleum Hydrocarbons TPH (diesel) <100 100 MRL = Minimum Reporting Level #406 ID: B4 @ 15.0 ppm MRL,ppm Method of Analysis: EPA 5020/F ID Benzene 4.1 1 TPH = Total Petroleum Hydrocarbons TPH (diesel) 'C100 100 MRL = Minimum Reporting Level #407 ID: B5 @ 30.0 ppmm MRL,ppm Method. of Analysis: EPA 5020/FID Benzene <1 1 TPH = Total Petroleum Hydrocarbons TPH (diesel) .4100 100 MRL = Minimum Reporting Level #408 ID: B2 @ 35.0 ppm MRL,ppm Method of Analysis: EPA 5020/FID Benzene <1 1 TPH = Total Petroleum Hydrocarbons TPH (diesel) <100 100 MRL = M nimum Reporting Level Stan Comer • • � 7 1 7 1 1 1 1 1 1 t r I L r SIC LABORATORY Analytical Chemistry • 3155 Pegasus Drive ' P.O. Box 80835 Bakersfield, CA 93380 (805) 393-3597 Report of Laboratory Analysis Client Name: Twin City Testing Corporation Address : 662 Cromwell Avenue St. Paul, MN 55114 Date sample received : 5-8-87 Date analysis completed: 5-12-87 Date of report : 5-18-87 Laboratory No.400 through 408 Location: Davies Oil Company W.O.#4231 87=503 Pumpkin Center RESULTS OF ANALYSIS #400 IDt B1 @ 10.0 m RLI��M Method of Analysis: EPA 5020/8020 Benzene T M 1., _0 TVH = Total Volatile Hydrocarbons Toluene <.1 1.0 MRL Minimum Reporting Level Ethylbenzene <1 1.0 p-Xylene 4-1 1.0 m-Xylene 41 1.0 o-Xylene <1 1.0 Isopropylbenzene <1 1.0 TVH <1 1.0 #401 ID I B1 @ 20.5 gm MRL mm Method of Analysis: EPA 5020/8020 Benzene < 1 1.0 TVH = Total Volatile Hydrocarbons Toluene <1 1.0 MRL = Minimum Reporting Level Ethylbenzene <1 1.0 p-Xylene 41 1.0 m-Xylene <1 1.0 0-Xylene <1 1.0 Isopropylbenzene 41 1.0 TVH �c1 .1.0 #402 ID: B1 @ 25.0 pPmL,PPm Method of Analysis: EPA 50208020 Benzene <1 . --1.0 TVH = Total Volatile Hydrocarbons Toluene 41 1.0 MRL = Minimum Reporting Level Ethylbenzene 1 1.0 p-Xylene <1 1.0 m-Xylene -e-1 1.0 o-Xylene <1 1.0 Isopropylbenzene <1 1.0 TVH 1 1.0 Stan Comer � � � r i r r r SMC LABORATORY Analytical Chemistry • 3155 Pegasus Drive P.O. Box 80835 Bakersfield, CA 93380 ' (805) 393-359? Report of Laboratory Analysis ' #403 m: B2 @ 20.0 ppm MRL.PP m Method of Analysis:EPA 020 8020 Benzene <1 1.0 TVH = Total Volatile Hydrocarbons Toluene <1 1.0 MRL = Minimum Reporting Level Ethylbenzene -C 1 1.0 p-X yl e ne 41 1.0 m-Xylene <1 1.0 o-Xylene c1 1.0 Isopropylbenzene <1 1.0 TVH <1 1.0 ' #404 ID; B3 @ 15.0 DDm MRRLL ,pPmm Method of Analysis: EPA 020 8020 Benzene < 1.0 TVH = Total Volatile Hydrocarbons Toluene <1 1.0 MRL = Minimum Reporting Level Ethylbenzene <1 1.0 p-Xylene cl 1.0 m-Xylene <1 1.0 o-Xylene <1 1.0 Isopropylbenzene <1 1.0 TVH 1 1.0 #405 ID: B4 @ 10.0 I)pm MRL,ppm Method of Analysis: EPA 5020/8026" Benzene <1 1.0 TVH = Total Volatile Hydrocarbons Toluene <1 1.0 MRL = Minimum Reporting Level Ethylbenzene <1 1.0 p-Xylene 41 1.0 m-Xylene <1 1.0 o-Xylene <1 1.0 Isopropylbenzene <1 1.0 TVH <1 1.0 #406 ID: B4 @ 15.0 ppm MRL,ppm Method of Analysis: EPA 5020/8020 Benzene <r- TVH = Total Volatile Hydrocarbons Toluene <1 1.0 MRL = Minimum Reporting Level Ethylbenzene <1 1.0 p-Xylene 4.1 1.0 m-Xyylene <1 1.0 o-Xylene 4.1 1.0 Isopropylbenzene <1 1.0 TVH 41 1.0 S� Stan Comer • � � E � . 1 1 I Y 1 1 1 1 I 1 1 SMC LABORATORY Analytical Chemistry 3155 Pegasus Drive P.O. Box 80835 Bakersfield, CA 93380 (805) 393-3597 Report of Laboratory Analysis #407 ID; B5 @ 30.0 ppm_ MRL mm Method of Analysis EPA 020/$020 Benzene -1 1.0 TVH - Total Volatile Hydrocarbons Toluene <1 1.0 MRL a Minimum Reporting Level Ethylbenzene <1 1.0 p-Xylene <1 1.0 m-Xylene <1 1.0 o-Xylene `l 1.0 Isopropylbenzene `'1 1.0 TVH `1 1.0 #408 IDt B2 @ 35.0 m MRL PPm Method of AnalysisiEPA 5020/8020 Benzene 1.0 TVH s Total Volatile Hydrocgrbons Toluene <1 1.0 MRL m Minimum .Reporting Level ' Ethylbenzene <1 1.0 p-Xylene <1 1.0 m-Xylene <1 1.0 ' o-Xylene 1.0 Isopropylbenzene -c1 1.0 TV{ <1 1.0 Stan Comer • • � 1 A i m a i a t UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)1 CONTAMINATION SITE REPORT EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES ;.FOR LOCALAGENCY.:!USE E] YES 0 NO REPORT BEEN FILED? E::]YES NO REPORTED NHS NF�iMATION TO LOC TflfF(CIAiSN EMPLOIEE..... SEGTfON z5t807 OF", REPORT DATE CASE i HEAL AND SAFTY E ; 1 ` 3,o0 1�G .. Q M M o v v NED:.. .... QA E NAME OF INDIVIDUAL FILING REPORT PHONE SIGN RE —Zoe' Ca A a.s (W) U 1-3G 3 GN ae a REPRESENTING a OWNER/OPERATOR 0 REGIONAL BOARD I COMPANY OR AGENCYY NAMde ® LOCAL AGENCY � OTHER G f [v Lucc p a ADDRESS � ��� 1-7 00 �l0 SHEET CRY /�`` V`C L ' SPATE l 21P NAME CONTACTPERSON PHONE UNKNOWN (DOS) 3,23—&Of,3 Qa ADDRESS 0. STREET CRY STATE ZIP FACILITY NAME(IF APPLICABLE) OPERATOR PHONE Q ADDRESS -7 Q !f 1�JCc STREET CRY COUNTY ZIP y CROSS STREET TYPE OF AREA E:]COMMERCIAL Q INDUSTRIAL�o RURAL TYPE OF BUSINESS [�2 RETAIL FUEL STATION RESIDENTIAL a OTHER O FARM 0 OTHER LOCAL AGENCY AGE CY NAME / � CONTACT PERSON/ PHONE 3(0ee w REGIONAL BOAR PHONE cL o y (1) v NAME QUANTITY LOST(GALLONS) UNKNOWN r(2) UNKNOWN DATE DISCOVERED HOW DISCOVERED z INVENTORY CONTROL SUBSURFACE MONITORING NUISANCE CONDITIONS 6 M M D D (J v / v []o TANK TEST a TANK REMOVAL OTHER DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) M M D DI Yl Yl Q UNKNOWN [o REMOVE CONTENTS 0 REPLACE TANK CLOSE TANK HAS DISCHARGE BEEN STOPPED? F-] REPAIR TANK F-� REPAIR PIPING CHANGE PROCEDURE a ❑'YES Ey] NO IF YES,DATE M M o o v y OTHER LLI SOURCE OF DISCHARGE TANKSii ONLY/CAPACITY MATERIAL CAUSE(S) N Fx] TANK LEAK F-� UNKNOWN 1 0� ��+o GAL. O FIBERGLASS O OVERFILL O RUPTURE/FAILURE Q PIPING LEAK AGE J !B YRS ® STEEL � CORROSION UNKNOWN OTHER O UNKNOWN Q OTHER a SPILL E::] OTHER w CHECK ONE ONLY 0 UNDETERMINED ® SOIL ONLY Q GROUNDWATER O DRINKING WATER- (CHECK ONLY IF WATER WELLS HAVE ACTUALLY BEEN AFFECTED) F CHECK ONE ONLY Lu SITE INVESTIGATION IN PROGRESS(DEFINING EXTENT OF PROBLEM) a CLEANUP IN PROGRESS[:] SIGNED OFF(CLEANUP COMPLETED OR UNNECESSARY) cc am NO ACTION TAKEN 0 POST CLEANUP MONITORING IN PROGRESS 0 NO FUNDS AVAILABLE TO PROCEED 0 EVALUATING CLEANUP ALTERNATIVES CHECK APPROPRIATE ACTION(S)(SEE BACK FOR DETAILS) 0 z D CAP SITE(CD) F-1 EXCAVATE&DISPOSE(ED) F-] REMOVE FREE PRODUCT(FP) ENHANCED BID DEGRADATION(IT) CONTAINMENT BARRIER(CB) EXCAVATE 8 TREAT(ET) PUMP&TREAT GROUNDWATER(GT) REPLACE SUPPLY(RS) O TREATMENT AT HOOKUP(HU) E:j NO ACTION REQUIRED(NA) OTHER(OT)// rr ,Z wvi.Q•2"�V c..Yll'i✓`- 1 h ,Q�v�,/,..p/�.p. � /l fi�T .Wi, r2tc'�i�� S'7��� � � 1 HSC 05(4)37) INSTRUCTIONS EMERGENCY CURRENT STATUS Indicate whether emergency response personnel and equipment were involved at ndica� to the category which best describes the current status of the case. any time. If so, a Hazardous Material Incident Report should be filed with Check one box only. The response should be relative to the case type. For the State Office of Emergency Services (DES) at 2800 Meadowview Road, example, if case type is "Ground Water", then "Current Status" should refer to Sacramento, CA 95832. Copies of the DES report form may be obtained at your the status of the ground water investigation or cleanup, as opposed to that of local underground Storage tank permitting agency. Indicate whether the DES soil. report has been filed as of the date of this report. IMPORTANT: THE INFORMATION PROVIDED ON THIS FORM IS INTENDED FOR GENERAL LOCAL AGENCY ONLY STATISTICAL PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REPRESENTING THE To avoid duplicate notification pursuant to Health and Safety Code Section OFFICIAL POSITION Of ANY GOVERNMENTAL AGENCY 25180.7, a designated government employee should sign and date the form in this block. A signature here does not mean that the leak has been determined REMEDIAL ACTION to pose a significant threat to Oman health or safety, only that notification Indicate which actions have been used to cleanup or remediate the leak. procedures have been followed if required. Descriptions of options follow: REPORTED BY Ca, _Si-te - install horizontal impermeable layer to reduce rainfall Enter- your name, telephone number, and address. Indicate which party you iFf�tion. represent and provide company or agency name. Containment Barrier - install vertical dike to block horizontal movement of contaminant. RESPONSIBLE PARTY Excavate and Dispose - remove contaminated soil and dispose in approved Enter name, telephone number, contact person, and address of the party site. responsible for the leak. The responsible party would normally be the tank Excavate and Treat - remove contaminated soil and treat (includes owner. spreading or and farming). Remove Free Product - remove floating product from water SITE LOCATION table. Enter the tank facility and surrounding area. At a Pump and Treat Groundwater - generally employed to remove dissolved minimum, you'muWprovide'the facility name and full address. contamipants. Enhanced Biodegradation - use of any available technology to promote IMPLEMENTING AGENCIES bacterial decomposition of contaminants. Enter names,o ...Yhe local agency and Regional Water Quality Control Board Replace Supply - provide alternative water supply to affected involved. parties. Treatment at Hookup - install water treatment devices at each dwelling or SUBSTANCES INVOLVED other p aced use. Enter the name and quantity lost of the hazardous substance involved. Room is No Action R29 ired - incident is minor, requiring no provided for information on two substances if appropriate. If more than two re-me i'�ion. substances leaked, list the two of most concern for cleanup. COMMENTS - Use this space to elaborate on any aspects of the incident. DISCOVERY/ABATEMENT. SIGNA URE - Sign the form in the space provided. Provide information-regarding the discovery and abatement of the leak. DISTRIBUTION SOURCE/CAUSE If the form is completed by the tank owner or his agent, retain the last copy Indicate s6urce_is1 of leak. Provide details on tank age; capacity and and forward the remaining copies in tact to your local tank permitting agency material if known. Check box(es) indicating cause of leak. for distribution. 1. Original - Local Tank Permitting Agency CASE TYPE 2. State Water Resources Control Board, Division of Water Quality, Indicate the case type category for this leak. Check one box only. Case type Underground Tank Program, P. 0. Box 100, Sacramento, CA 95801 is based on the'most sensitive resource affected. For example, if both soil 3. Regional Water Quality Control Board and ground water have been affected, case type will be "Ground Water". 4. County Board of Supervisors or designee to receive Proposition 65 Indicate "Drinking Water" only if one or more municipal or domestic water notifications. wells have actually been affected. A "Ground Water" designation does not 5. Owner/responsible party. imply that the affected water cannot be, or is not, used for drinking water, but only that water wells have not yet been affected. It is understood that case type may change upon further investigation. i o twin city testing corporation 662 CROMWELL AVENUE r ST. PAUL, MN 55114 PHONE 612/645-3601 May 1, 1987 Kern County Health Department 1700 Flower Street Bakersfield, California 93305 Attn: Mr. Joe Canas F Subj : Proposed Soil Boring Program Davies Oil Company Taft Highway and Wible Road Pumpkin Center, California Claim 4183Z-61 414231 87-703 Dear Mr. Canas: 1.0 Introduction In response to a suspected diesel fuel loss, Twin City Testing Corporation (TCT) is transmitting to you a description of the proposed soil boring program to be completed at the Davies Oil Company property at Taft Highway and Wible Road in Pumpkin Center, California. 2.0 Obiective The objective of the soil boring program is to define the horizontal and vertical extent of diesel fuel contamination that may have resulted from the uncontrolled release of product. 3 .0 Background Information Based on inventory reconciliation, Davies Oil Company detected a losing trend in the diesel system on April 13, 1987. Approximately 300 gallons of diesel fuel may have been lost at the site. The Kern County Health Department was notified of the loss on April 13, 1987. In response to the loss, 'Davies Oil Company pressure tested the tank and it failed both the high and low level tests. AN EQUAL OPPORTUNITY EMPLOYER • � i � 1 Kern County Health Department May 1, 1987 Page Two #4231 87-703 4.0 Soil Boring Program TCT proposes to drill six soil borings at locations indicated on Figure 1. The borings will be placed adjacent to the diesel fuel tank and dispensers. According to Mr. Rex Rice of Davies Oil Company, the product escaped from the diesel tank. Borings B-1, B-2, B-3, and B-4 will be placed to evaluate the soil conditions adjacent to the tank. Borings B-5 and B-6 will be advanced adjacent to the diesel fuel dispensers to insure that an additional leak was not occurring at a union. The borings will be advanced to a depth whereby zero readings are recorded on an hNu Photoionization Detector. Each boring will be drilled using hollow stem auger methods. Split barrel samples will be collected at 2 1/2' intervals to a depth of approximately 15' and thereafter at 5' intervals. All soil samples will be collected and preserved such that chemical analysis can be performed. All borings will be tremie grouted to the surface with a neat cement mixture. Selected soil samples will be submitted to a California State Certified laboratory and analyzed for total petroleum hydrocarbons. All drilling and sampling equipment will be steam cleaned prior to entering the site and before initiating new borings. Split spoon sampling equipment will be decontaminated with trisodium phosphate followed by a clean water rinse between sampling intervals. We do not anticipate encountering ground water; however, should we penetrate the water table, the boring will be grouted to the surface upon completion. We are scheduled to begin work on May 7, 1987. 0 Kern County Health Department May 1, 1987 Page Three #4231 87-703 If you have any questions regarding our work plan, please contact Ms. Teri Miller at (612) 649-5594 or Mr. Mark Mason at (612) 641-9372. Very truly yours, Twin City Testing Corporation Teri Miller Geologist/ Mark S. Mason, Environmental Geologist Senior Project Manager TM/MSM/j r ANIL TAFT HIGHWAY B-1 0 O O O O W 8-40 _W 0 B-2 O G 1131101 ❑ ❑ O B-3 ¢ STORE W Jm 8_6 DIESEL 8-5 PUMP ISLANDS VENTS N DATE FIGURE PROPOSED SOIL BORING PROGRAM 4/30/87 1 DAVIES OIL COMPANY PROJECT + 4231 87-703 TAFT HIGHWAY & WIBLE ROAD REVIEWED BY:T....., PUMKIN CENTER,CALIFORNIA DRAWN BY: J.A.W.SCALE TWIN CITY TESTING NOT TO SCALE r ENV-D-87-4 KERN COJNTY HEALTH DER*TMENT VAR I AT I O N/LOS S I NVE S T I G AT I O N REPORT Facility: l'�Jr�/��%��/ir i✓LL' /1'1/�T Permit Oacility Address: 7_41`r A/6V G�i BLt Tank(s) with Discrepancy: Date/Time of Discovery: "/3 `k7 �An^ Name of Person Filing Report: SEX -7�11 cE Description Of Discrepancy: ct/EEl�cy OVt"�z ��/lo,2T yun aF 17`0 z-E,e4/V rz t /-011) -7-t-1.2 L4 /,NT INVESTIGATION SUMMARY The following procedures must be performed within the specified times starting at the time a reportable loss is discovered or should have been discovered: Within: I 6 Hours ( Owner/Operator or other qualified person is to I Date I Time I review records for errors before determining I /3 -9% 1 A there is a reportable variation/loss. Performed By: 24 Hours 11) Owner/Operator must verbally report I Date I Time discovery to KCHD and follow-up with written 1 -�/- s-571 F 6-'"` I notification on form provided. Cot.JV -,2.5A-T i° j Performed By: I?L X. —1_F, ' LE 12) Visual facility check to be performed using I Date I Time 1 checklist on the back of this form. 1 ^ �3-�7 I �►�'� Performed By: � 13) All product dispensers are to be checked for 1 Date I Time 1 calibration and adjusted if out of tolerance. 1 -3 ?,7 I 1 Performed By: 54CWQ� S7,,'1.-, ,0J r At jT0J ,,/C.,- �lC-> 48 Hours 1 Piping to be leak tested using approved method. ) Date I Time I I I Contractor's Name 1 License # Test Performer's Name 1 Description of test performed 1 * * ATTACH COPY OF TEST RESULTS. 72 Hours 1 Tightness Testing of tank(s) to be performed I Date I Time I using approved tester and method. 1 Contractor's Name-_E_S License # *76 ll(a Test Performer's Name UDU< (41�1,IA16 Description of test performed 1/itN 'T r SAS * * ATTACH COPY OF TEST RESULTS. I NOTE: THIS REPORT MUST BE SUBMITTED TO THE PERMITTING AUTHORITY WITHIN 5 DAYS OF COMPLETION OF INVESTIGATION PROCEDURES. 2. VISUAL INSPECTION CHECKLI5 A. gispensers All dispensers and their end doors visually checked for leaks. ✓All hoses and nozzles visually checked for leaks. • ✓All totalizer seals checked for tampering —\ Results: -- All dispensers appear tight ~' �,•- /'" signature/date -- Dispenser(s) not tight as listed below signature/date IDISPENSER *ISERIAL #ICOMMENTS: J I I I I J I t I I I I - • ,� H. T nk Area r Al turbine boxes inspected. _ All fills and vapor manholes inspected Results: -- Tank area appears tight %with •- 110 \ product or liquid present. signature/date -- Tank area does not appear tight because of the problems/ • conditions listed below. signature/date (TANK #JPRODUCTICOMMENTS/RESULTS: I I I I I I l I I I I I I C. Piping Type: Pressure ❑Suction _ Pressurized piping leak detector(s) tested for proper functioning and for detection of leakage. _ Suction piping tested for indication of leakage. Results: --Piping tight based on test(s) above. signature/date -- Piping not ' tight based on test(s) above, with problems/ • conditions listed below. signature/date Description 7�J�/,� _i9iLt=y 1'16�kl7-Nc SS Thy ✓C 1700 Flower Street KERN COUNTY HEALTH DEPARTMENT HEALTH OFFICER Bakersfield,California 93305 Leon M Hebertson,M.D. Telephone(805)861-3636 ENVIRONMENTAL HEALTH DIVISION DIRECTOR OF ENVIRONMENTAL HEALTH e I' Vernon S.Reichard tt O / • HAZARDOUS MAT E R I AL S Inspecion p o r MANAGEMENT P R O G RAM t rrf-�II Date p Underground 'tank Facility # Firm Name A EPA I .D. No. Address IT-44 Assessors Parcel # Type Facility Person Interviewed NOTICE 01;* V I O L AT I O N AN D ORDER T O C O MP L X The following conditions or practices observed this date are violations of one or more sections of the California Health and Safety Code, Div. 20, or the California Administrative Code, Title 22, Div. 4, Chap. 30, relating to the "storage, handling, transportation, and disposal of hazardous waste" or Ordinance Code of Kern County, Div. 8, "Underground Storage of Hazardous Substances. " Conditions or practices must be corrected within the times ordered below: r � t 2w ` Eof!r ! i a� Q t.t�L.Q to as.L Your signature acknowledges receipt of a copy of this report and collection of any samples described above, and is not an admission of guilt. Failure to fully comply with this "Notice and Order" may result in further legal action • by County or State officials. Owner or Authorized Representative Agent of the Kern County Health Officer (Form #HMMP-120) DISTRICT OFFICES Delano . Lamont . Lake Isabella . Mojave . Ridgecrest . Shatter . Tait 2A HOUR REPORTABLE VAR I AT I ON/]LOSS NOTI V CATI ON • TO: Kern County Health Department 1700 Flower Street Bakersfield, California 93305 Attn: Underground Tank Section REGARDING: ° Facility: �PL4 �TJ Permit C) Facility Address: Name Of Person Filing Report: 1 PrLI L L N &Z:-!J ElaL — On 1 - Zq — U b /0 %d0 the above facility had an (date and time) inventory variation/loss that exceeded reportable limits as described below: Amount of Amount of Amount of Total Minuses Tank Daily Weekly Monthly Line 3 of Variation/Loss Variation/Loss Variation/Loss Trend Analysis the PeLJNitt+ng-AUt4GV4t+Y-1 �a canrTAt_'1�—a �vcv� Q°�'1 c� z -, C-Q ->l,v►n NX--� P 5-nrA k rv4o Lo of CYW P yr VAP.►f�Nc..&. STflrTv►S, This notification is in addition to the phone call I previously placed. Signature u 7 i t . • 1 . - . . '/✓//Im/%IUUI�(�///l/U/I/��Dml/l�'/U/Tll/llD,i�lU///FDA//!/D/f/lU/J7ll///OILU/111��Il////// l//////,'///////.'l!///1/l/lJ//////1!/,/l///////!/l/U////,'///l///!//ll91%/!//!/l!/. - %/I////�/////�U///lf l�'//11/!/!//%/1,/////l�!/!////,i�l/!!///////�'D!U///!� Ii7//!////!//�1�� • ^ _ 1 loom, - J//////.'//////J/!!/!//1///!l/// .ilU/l�//!!/l////1�1U////II//l.'7/Ill///�1�•� '////l///%.I[�! . CD � Q 24 HOUROEE2ikPO TABLE VARIATION/LOSS NO.-T�IPFI CATI ON • KERN Cown y - ,y TO: Kern County Health Department 1700 Flower Street Bakersfield, California 93305 Attn: Underground Tank Section RZOARDING• C� t>N\f F N 1 F�'1/C `v'►�v2 T— Facility: IZ P� Permit c> C-- Facility Address: Vj) . LC-- V-OPp PtAMPWry Cf---Ar . Name Of Person Filing Report: PA-U L G . 1 NC-�--' N On �` ^ — b b f�r-� the above facility had an (date and time) inventory variation/loss that exceeded reportable limits as described below: • Amount of Amount of Amount of Total Minuses Tank Daily We_ ekly Monthly Line 3 of Variation/Loss Variation/Loss Variation/Loss Trend Analysis I have stopped dispensing product and begun investigation procedures required by the Permitting Authority. This notification is in addition to the phone call I previously placed. Signature I /1iiiiiUlUr01111�if/11111111,V/arUiirirUniirWiiiUirUr111111rU� ®�®����I�I■®�� Imo, 1////1/,/11/1/%//1/111/IJ 11111��►Uiii�UiiraiU//iiiiiii��/rnniUiiii;�iUUiiiii�orUi/U� I. VIIIII�I71A® /////%//U/,1!/!IU/1////l1/1/1./111 UD//U/////ll�7U////IU!/.'�I/l1Ul/. L • �� 24� HOUR REPZRTABLE VARIATION/LOSS ULC 3 1986NOTI FI CATI ON • '=RN COUNTY HEALTH DEFT. TO; Kern County Health Department 1700 Flower Street Bakersfield, California 93305 Attn: Underground Tank Section RESARDING Facility: 114&4Q-7- _ Permit Facility Address: I flFT '(7Wu I/11I �L.- P—&�k PWMPK)N I�VT-k� Name Of Person Filing Report: Pow i- G, L-•l N CAN On 2% the above facility had an (date and time) inventory variation/loss that exceeded reportable limits as described below: • Amount of Amount of Amount of Total Minuses Tank s Daily Weekly Monthly Line 3 of Variation/Loss Variation/Loss Variation/Loss Trend Analysis 3 7 $70 q I product and begun investigation procedures required by the Permitting Authority. L_Ow IT UUjRLkT- This notification is in addition to the phone call I previously placed. Signature TI XA�L - : .mom • • • �//Im/,%ll/Ul I'////191117�//IUUI%U/Ill//lD,i�l/I///MA70 U/l/lA/J7lU//ll//U//lI - %lll hl,YU////l////f1llllll//%%//l/UII III /!///!//I//l///Ilr//////11/� mom �L9i���l�l►Ic+7 �l�I � - Il�'� El //lOM/////U//////iWO///////l 1///Il r/ll/!l///�7/Il///////M111//A ///////1//.I Ml ra /l////lI/W/l///l!7U//////,/944'IUTA,, i %////l////l.Im • VMS%ZNO, NOW%101 175%///IU A,i ////712WO D/l/lU%,71U/1=1111/I MM��M ��I I � aWM %l/////ll YUlllllllhPj /IM", AMN%/ �YWIMIJ; MAMMA I��I 2A HOUR RE P ORTAB L E VAR I AT I ON/LOS S NOTI V CATI ON • TO: Kern County Health Department 1700 Flower Street Bakersfield, California 93305 Attn: Underground Tank Section REGARDING Facility: CC) N Yf-N)f=Nc-r-- /�/�/ K-�T Permit rc_ Facility Address: -TA-�T Ly 9�" W1 9 i2go% Name Of Person Filing Report: Pft-L1 L 1-1 N6E---N F-&—Q On /V0 Y-' S , � / 0 t71 the above facility had an (date and time) inventory variation/loss that exceeded reportable limits as described below: • Amount of Amount of Amount of Total Minuses Tank Daily Weekly Monthly Line 3 of Variation/Loss Variation/Loss Variation/Loss Trend Analysis 6 7o + 18`7 do wj)- 2�6G) r a of U) P&/ My k This notification is in addition to the phone call I previously placed. A Ago2�A D-J20L Signature i • Now • - . in n.L • d//l�/ZW11//,Q'1 011 1111/Ili //ml/l%U/II/UID,iWINWAAff/1710/1/Ill//7lll/ll0!!II/I1,I mm - %///IA,'0111/U//(///t/////%///!//U//d//M//lV/!/!//t!/1//I///!U/J�'I�I�lr�7///IVI/�� ` • �l����® � IAA® - %/1////,F///// //f U WAA1l!/!//�//!//1A m0������� /////% • U///lA%/////:%U//////� �l///1/I'./! /I!!I/11,1/1111/II I��I� 24 HOUR RE PO RTAS L E VAR I AT I ON/LOS S NOTI P CATI ON TO: Kern County Health Department 1700 Flower Street Bakersfield. California 93305 �d Attn: Underground Tank Section _ RRGARDING: Facility; p!' Gj�s Permit 3 oZ Facility Address: 7ikC—T )-1,t/LW, (,IVIFhL,E Name Of Person Filing Report: I , G . &t--,yF-r--L©czk On Z , the above facility had an (date and time) inventory variation/loss that exceeded reportable limits as described below: Amount of Amount of Amount of Total Minuses Tank Daily Weekly Monthly Line 3 of Variation/Loss Variation/Loss Variation/Loss Trend Analysis Y 13 a7o This notification is in addition to the phone call I previously placed. p 4 �N CT 60-E C O Lt P rN l ,0 N R,1.�M, Signature • V//Im/%IUUI�VIIII l/I/��///,NO%///IIl///D,i�l/////70MOJ/D/l/l/I gh/'//l//IU/1,I eek /////, !l/////ll►7U////Illl/.'W//hON • f////�%/////:%U////// 4r/////li'�5l///1!/l/llllll//U �I� 1 O F-3 W ' O �r cc) CD �C3 i 2A HOUR REPORTABLE VAR I AT I ON/L O S S NOTI V CATI ON TO: Kern County Health Department 1700 Flower Street Bakersfield, California 93305 Attn: Underground Tank Section REGARDING• Facility: #//Mpy CAI Permit i//t�� Sa001rc- Facility Address: 7—.97f:-r- �w �u/iB�c �� Tur�P�E'%�✓ CE-n/7-e2 Name Of Person Filing Report: 7?6-x 7e«t On //—� _ �� i 4 the above facility had an (date and time) inventory variation/loss that exceeded reportable limits as described below: Amount of Amount of Amount of Total Minuses Tank Daily Weekly Monthly Line 3 of Variation/Loss Variation/Loss Variation/Loss Trend Analysis 97 �° l/ I have stopped � luet and begun investigation procedures required by the Permitting Authority. "✓e-- /3�E /ho��T°��vG .�-ow 7—,ti e KP K -r- SY7-44 �o✓ GINDt 4- L�/,C.EGT/i.✓ o,-� JGe�: C/t•✓�I S This notification is in addition to the phone call I previously placed. Signature • ���lmNWhR,MMVIU/Ul/1110W N1111U NO WA NO 7/O/1/l//�7lUU111INll�t�r/ii�ii mlm����'!I • e�l��w��®I a®�I�a� l/////r/U////.7/l////Y/l✓//U//1////!//I///�'///U////,d/Ul/////ll0%���IN map MMM /U/U//////!dl/1///Vlffll//////� ff/!//!A , - l - /////%////v/✓///ll 1/1✓//!//////,/ll//lU/ll/////ll 7U//l/IUU.'�IU//dt'���IE�'�l///l//l%.I �, 2A HOUR REPORTABL E VAR I AT I ON ]LOSS NOTI FIiCATI ON Ac� og1987 TO: „ �� COUNTY w�f:=��"ti J�9MICC �.�ljIaR� Kern County Health Department �$ O� 1700 Flower Street �NJS Bakersfield, California 93305 Attn: Underground Tank Section Facility: ��9P� f G�� Permit Facility Address�T ff�✓y f��-��/�G�Zv:'.ya Name Of Person Filing Report: On �°� — �'y'� the above facility had an (date and time) inventory variation/loss that exceeded reportable limits as described below: Amount of Amount of Amount of Total Minuses Tank t Daily Weekly Monthly Line 3 of Variation/Loss Variation/Loss Variation/Loss Trend Analysis I have stopped dispensing begun investigation procedures required by the Permitting Authority. wE r9,'-E 41*'V' '-04'"V6 -4-19"1 T-,��c Pu r -T',' ,-r�.✓ UAIIbe"A L7/,fit 7—/OA/ J� J 0 E e/4-�✓A'S This notification is in addition to the phone call I previously placed. Signature �N • �I//ml%ll//////,��/U//l/Il/I/� /1LDl�%///ID//lD,i /FDA/I%lD/l/lll/J7lI///Dl/I///11�MIU///!l � - - ///I//%///IlL/n//!/l////J1/////////.%////U//d////ll///V/I/O/////v//////11/� I����U//ll/I/ . • - _ i�/Illl/1111 1111 A ll/!///11!7111111MIld1/111/111.W Imo`/////!//l/1f1� • `J////t%/////:%U//////��II////11�'�llll/1!!1/111//IU/�l 1��1� �I A24 4 HOUR RE P O RTAB L E VAR I AT I ON/LOS S NOTIFICATION TO: Kern County Health Department 1700 Plower Street Bakersfield, California 83305 Attn: Underground Tank Section IM: Facility: ��9P/°% G�f Permit ,PL Facility Address-779''7T ft�✓'/ Gt/21� C�� �o�v Name Of Person Filing Report: ��k_ K 'C' On �°2 _ ° �'� the above facility had an (date and tine) inventory variation/loss that exceeded reportable limits as described below: Amount of Amount of Amount of Total Minuses Tank i Daily Weekly Monthly Line 3 of Variation/Loss Variation/Loss Variation/Loss Trend Analysis ,240 f�D I have -stepped d begun investigation procedures required by the Permitting Authority a✓E fI•-E 011°^V0 041^/a .-v,./ r,'tzzt our Ser-u.4Ti-,.J UA4e-;e 7—/11111 J-r-- T-o C Cry��tS This notification is in addition to the phone call I previously placed. Signature —w ®r�lrr��rr�r�l � • �r��rrrr��l �� I■��Ir rrr�rr�r�rr�l � I� - rrr�rrrrrr��l s I� - - %//////,/////W//I U!//r//////%//1l//I!/l///l////,ir!/UU/////)D/!//lA • MWO%/ 11 I�llllllllllllll 1��1� KERN CC9UNTY HEALTH DEPA*TI'MENT VAR I AT I O N/LOSS INVESTIGATION REPORT Facility: t//i "Lice-- Permit �-- :acility Address: d_/-- Tank(s) with Discrepancy: # �_ Date/Time of Discovery: ! 6"f�A\ Name of Person Filing Report: 7�21 cE Description Of Discrepancy: / LL/EC I��y OVe «= �S//u,c.r 61) -17 ' _72'L tLef"v INVESTIGATION SUKMARY The following procedures must be performed within the specified times starting at the time a reportable loss is discovered or should have been discovered; Within: 1 6 Hours 1 Owner/Operator or other qualified person is to J_ Date'^_1_ Time 1 review records for errors before determining 1 �� �3 1 there is a reportable variation/loss. Performed By: -�?t. lcc=` 24 Hours 11) Owner/Operator must verbally report 1 Date I Time 1 discovery to KCHD and follow-up with written i 3 b71 1 notification on form provided. 1 Performed By: 12) Visual facility check to be performed using Date I rime 1 checklist on the back of this form. t/ )3 -f7 I P►y\ 1 Performed By: �ff= LL 13) All product dispensers are to be checked for I Date i Time 1 calibration and adjusted if out of tolerance. 1 X-3 r F7 \� 1 Performed By: 51�,2k_t. 48 Hours 1 Piping to be leak tested using approved method. ) Date I Time I 1 I 1 Contractor' s Name 1 License # Test Performer's Name 1 Description of test performed I * * ATTACH COPY OF TEST RESULTS. 72 Hours 1 Tightness Testing of tank(s) to be performed 1 Date I Time 1 using approved tester and method. 1 Contractor's Name n E� 1 License 06 Test Performer's Name Z)a V6 Description of test performed * * ATTACH COPY OF TEST RESULTS. I NOTE: THIS REPORT MUST BE SUBMITTED TO TliE PERMITTING AUT110HITY WITHIN 5 DAYS OF COMPLETION OF INVESTIGATION PROCEDURES. 1700 Flower Street AN COUNTY HEALTH DEPARTMENTO HEALTH OFFICER Bakersfield,California 93305 Leon M Hebertson,M.D. Telephone(805)861-3636 ENVIRONMENTAL HEALTH DIVISION DIRECTOR OF ENVIRONMENTAL HEALTH Vernon S.Reichard • • January 9, 1986 Rick Davies/Davies Oil P.O. Box 80067 Bakersfield, California 93308 Dear Mr. Davies: After careful review of the reportable inventory variations at your facility located on Taft Highway (permit #320018C) , this Department has concluded that these results are due to a history of low throughput. This letter is to advise you that you will be granted a "provisional exemption" from the standard reporting described in your permit packet. This Department is currently undertaking a study of the inventory control problems of low-throughput tanks. To facilitate this, a copy of reconciliation worksheets for tanks listed on the attached outline must be sent to this Department monthly so that we may add this information to our data base. Please send all submittals to my attention. Our preliminary information indicates that a change in reportable variations is necessary when the throughput of a tank is less than 2,000 gallons per week and less t an 10,000 ag llons per month. The accompanying "Low-Throughput Tank Reporting Outline" describes these changes. A revised action chart and an example of a changed summary sheet (on the back of inventory reconciliation worksheet) have also been enclosed for your convenience. Please make these changes on your worksheets for weeks in which you have low throughput. Be advised that this provisional exemption is subject/to change as further data becomes available to the Health Department. If, however, a listed tank at any time exceeds the defined low-throughput amounts, / you must revert to compliance with the original reporting requirements. If you have any questions regarding this correspondence I can be reached at (805) 861-3636 between 8 am - 9 am. Sincerely, u-C � Joe Canas Environmental Health Specialist Hazardous Materials Management Program JC:aa Enclosures (Form letter #HMMP 510) DISTRICT OFFICES nnlann I mmnnt Lake Isahella Mojave Ridgecrest Shafter Taft f KERN COUNTY ENVIRONMENTAL INSPECTION RECORD 2700 "M" -'T"''FET, SUITE 300 HEALTH SERVICES DEPARTMENT BAKERSFIELD, CA 93301 HAZARDOUS MATERIALS PROGRAM POST CARD AT JOBSITE (805)862-8700 PERMIT #: 320018M OWNER: Davies Oil Company FACILITY: Happy Gas Market CONTACT: Bill Davies ADDRESS: 3221 Taft Highway ADDRESS: 4700 Pierce Road CITY: Bakersfield, CA CITY: Bakersfield, CA 93308 PHONE #: (805) 831-2323 PHONE #: (805) 323-6063 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 SAMPLES & BACKFILL - 1 Witness retrieval of soil samples beneath existing product piping 2 Backfill of product lines PIPING SYSTEM - 2 Primary piping pressure/soap test i 2 Corrosion protection of piping &fill pipe SECONDARY CONTAINMENT, OVERFILL PROTECTION - 3 Secondary piping pressure/soap test -/�- 3 Sump test 3 Drop tube valves 6-y^ ��/ Y4-1 FINAL - 4 Integrity test of system 7, 4 Line leak detector ositive shut down 4 Monitor system check 4 Monitoring requirements LP a CONTRACTOR Cal Valley Equipment LICENSE # 447797 CONTACT Jim Peel 1/ �/l�„ \\ PHONE # (805) 327-9341 i KERN COUNTY ENVIRONMENTAL* 270 "M" STREET, SUITE 300 HEALTH SERVICES DEPARTMENT BAKERSFIELD, CA 93301 HAZARDOUS MATERIALS PROGRAM (805) 862-8700 INSPECTION RECORD POST CARD AT JOBSITE PERMIT #: 320018M OWNER: Davies Oil Company FACILITY: Happy Gas Market CONTACT: Bill Davies ADDRESS: 3221 Taft Highway ADDRESS: 4700 Pierce Road CITY: Bakersfield, CA CITY: Bakersfield, CA 93308 PHONE #: (805) 831-2323 PHONE #: (805) 323-6063 INSTRUCTIONS: Please call for an inspection and submit the requested information when completed. DO NOT continue with the next phase of work until all items in that group are signed off or verbally approved 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 - TANK CLEANING/INSPECTION - do 1 Structural integrity inspection. 1 Written certification of structural integrity submitted prior to lining Z,k"0-X- D NOT CONTINUE WORK UNTIL WRITTEN/VERBAL APPROVAL HAS BEEN GIVEN BY KCEH INSPECTOR - LINING INSPECTION - 2 Tank lining inspection 2 Written certification on tank lining �- 2 Inspection of sealed access points on tank Se- DO NOT CONTINUE WORK UNTIL WRITTEN/VERBAL APPROVAL HAS BEEN GIVEN BY KCEH INSPECTOR - FINAL - 3 Integrity test inspection and written results 'pl- 3 Submit copy of hazardous waste manifest 3 Corrosion system start up inspection and report by NACE Engineer. (Q / CONTRACTOR: Session Tank Liners LICENSE #: 418129 CONTACT: Ross Sessions PHONE #: (805) 833-9501 ENVIRONMENTAL HEALTH SdWICES DEPARTMENT *RESOURCE MANAGEMENTAGENCY STEVE McCALLEY, R.E.H.S., Director • DAV/D PRICE//1, RMA DIRECTOR 2700 W STREET, SUITE 300 11i Community Development Program Department BAKERSFIELD, CA 93301-2370 Engineering & Survey Services Department Voice: (805) 882-8700 Environmental Health Services Department FAX: (805) 882-8701 Planning Department TTY Relay: (800) 735-2929 • ' Roads Department e-mail: eh @kerncounly.com PERMIT TO WccW UNDERGROUND S°P-� STORAGE FACILITY PERMIT NUMBER 320018M FACILITY OWNERS) NAME/ADDRESS: CONTRACTOR: Happy Gas Davies Oil Company Sessions Tank Liners 3221 Taft Hwy. P.O. Box 80067 9521 W. Fritz Bakersfield, CA 93313 Bakersfield, CA 93380 Bakersfield, CA 93307 License#418129 Phone No. (805) 323-6063 Phone No. (805) 833-9501 _ NEW BUSINESS CHANGE OWNERSHIP PERMIT EXPIRES May 23, 1998 RENEWAL APPROVAL DATE February 23. 1998 X MODIFICATION _ OTHER APPROVED BY z Laurel Funk Hazardous Materials Specialist . POST ON PREMISES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CONDITIONS AS FOLLOW: Standard Instructions 1. This permit applies only to the modification of an existing facility involving interior lining and corrosion protection. 2. All construction to be as per facility plans approved by this department and verified by inspection by Permitting Authority. 3. Permittee must contact Permitting Authority for on-site inspection(s) with 48-hour advance notice. 4. 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. 5. No product shall be stored in tank(s) until approval is granted by the Permitting Authority. 6. Monitoring requirements for this facility will be described on final "Permit to Operate." ACCEPTED BY: �` r DATE: 600019M.m24 r'I 1 ,�protection Agency _ '•`'Ui •' i V039(Expires 9.30.99) � � See Instructions on back of. 1. Department of Toxic Substances Control.. ¢ ned for we on stile(12-pitch r r� wter. '•�`� Sacramento,California nerator's US EPA ID No.' Manifest Document 2. Page 1 Information in the shaded,areas f t ,,t,�`RM.HAZARDOUS, >, (, p is not required by Federal f!P ASTE MANIFEST` C orator's Name and,4ath Address A r S O�•� °' A 9ftte A)6dff�sfi[�gCUhsgnl .ugmtlbof V 9�38U. B Stateenerittar' {{ `'�' Q �SLF.Y t p "A' r•f�.'" ttt tl f ,4:1 Generator's Phone ( v �31.3'•�0 i:.R.» N. U•: '1 S.'.Transporter 1 Company Name 6. US EPA ID.Number C Suite fansyorter f ID D Transporter',} bhH Ss t > yrrd: sr r . files .' St'c�l' c a c 3 i y . ., to 7 Transporter 2 Company Name "' B.`US EPA ID Number $ E Soiliran5�;rbf kj D r <.' w t t t� t ' '. l i 4 e.0 e.c. . � .S e.0 V �.e O .. . . ..._.L i ` s 9 Designated Facility am pn ite d ress 10. US EPA ID Number. G�S1 fe P d' y1�/ �/"/ C`�'� � - �' �,1,p,i�'J•..- '' 't1{ 1 � I s ., - _.„,. � N MIT ' ,A V 4 S/ S! �ftl Ct 'a�.­UA v 12. Con tainers J 3.r 7o►al "` ;14?Unit Description(including Proper Shipping Name,Hazard Class,and ID,Numberl No°'l T e 6luanti "Wt/Vol ry r. !� N , i .b ALIFIED. �.':t' ' �a ,� - ,FOR RECYCLINGITREATMENT,ATTHE '; ( '' �P''.✓fh !n v R 1: + # N :A r r ,k, it{� o T c: rCALIFdRNIA. .'THIS F s ' ..1 '� r� .:, a AGILITY HAS THEN, R :OESSARY PERMITS TO RECEIVE Y R R` ; t. z !ISTREAM AS QUALIFIED. OUR EPA RPMBER I;, :•( ; CAD9824444$1 {'. ) • . "` k lit 11' f, rw a t � x .. k H hQ. d a i1 is Z a •�+� I.01t EE;;- s yiq . 'ut.7 Jrr ra` ,t W r� �•" F i'} �.�rn � ��+ r 1j�,a, $"•�� aW�° t �? ,•4 S f '`Y` �`+p .. : .�,��� • ' 1 MIN*y q }�. Sf O 16!Special Handling Instructions and Additional Information. 1 s ,, r 1' }?a' ;,n s t! ,• fY M •1,, r- ifs. ;7 ' Uj ha j6. GENERATOR'S CERTIFICATION: I hereby declare hat the contenh of this consignment are fully and accurately described above by proper shipping name and are classified,;packed,,t } �• marked;and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations... —? . ^a:•-2 J_! If I,om a large,quani; generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to 6e.economitallyy' A. ' practicable and that I have select d the ppracticable method of treatment,storage,or disposal wrrently available to me which minimizes the present and future threat to human health+v.,r 'i'•a and the environment;OR,if I am a smglI quantity generator,.)have made a good faith.effort to minimize.my waste generation and select the best waste'manogement,method that is 5µ{;,d' • ',. O tt available to me and that I con,affiord.' q.r U Printed/Typed Name — Sign u .•-. AonL, ay t -0 w Ur 4p 17. Transporter 1�Acknowled er- o Receipt of-Materials i W p Print d/Typed Name Signet a Month',"a, Day Year:t' as 0 0 1 B. Transporter 2 Ackn led ement of Receipt of Materials i Pnn Typed Name' i Signature _. '� Month Day Y w Ln V 19. Discrepancy Indication Space Z-* C ,I f 20; Facili ner or O era or Certific lion of receipt of hazardous materials covered 6 this manifest except as noted in Item 19. T pedN a ignoture` i. o th' Day Yea'. n•i ' '. .y I 11 DO NOT,1 RF E BELOW THIS .LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. ,DTSC'8022A (d/971. (Generators who submit hazardous waste for transport out-of-state, EPA 8700 22 produce completed copy of this copy and send to DTSC.within 30 days.) 1 • - 1 1200 SESSIONS TANK LINERS 5058330423 P.01 sessions Took Uners,Inc 16 6 - 9521 West Fritz Bakersfield, CA 93307 Phone(805) 833-9501 Fax, 833-0423 Fax Cover Sheet TO: L �, COMPANY: C, FAX NUMBNER: Len-) — yi o I FROM: DATE: RE: MESSAGE: Total number of pages Including cover: a Hard Copies: Yes: No: If you do not receive legible copies of this fax call (8057 833-9501 12:01 SESSIONS TANK LINERS 6058330423 P-03 sessions Took liners,Inc • 9521 West Fritz Bakersfield, CA 93307 Phone(8057 833-9501 Fax 833-0423 March 26, 1998 Laurel Funk Kern County Environmental Health 2700`U' Street, Suite 300 Bakersfield, CA 93301 VIA FAX(805)862-8701 Subject: Happy Gas,Wible & Taft Hwy.,Bakersfield CA Dear Laurel: Please find attached the letter from Joe Engel the structural engineer, certifying that the interior of the(4) 12,000 gallon underground storage tanks at the location stated above has been sandblasted, cleaned and meet the requirements for the structural integrity found in CCR Title 23, Division 3, Chapter 16,Article 6 Attached also, are copies of the ultrasonic thickness gauging reports for the(4) underground storage tanks. Please advise whether or not you would like to schedule a site inspection at this time, or give a verbal approval to continue with this work. If you have any questions or concerns, please contact me at the Bakersfield office. (805) 833-9501. Thank you, Betty Standfor Sessions Tank iners, Inc. attachments intc Gb—lyy� 12:01 SESSIONS TANK LINERS e058330423 P.02 ENGEL b COMPANY engineers 4009 UNION AVEKUE BAKERSFIELD,CA 93305 March 26, 1998 Sessions Tank Liners, Inc. P.O- Box 49061 Bakersfield, CA 93382 Attn: Mr. Ross Sessions: Re: 17he structural condition of the four 12,400 gallon underground steel fuck storage tanks at 3221 'Taft Hwy., Bakersfield. Ca. .Dear Mr. Sessions: As you explained in our recent telephone conversation,the interior ul the tanks have been sandblasted and. cleaned. Also, the tanks are in good condition with no splits or pertotations. Having reviewed the results of the thickness tests, I hereby ceztify that the tanks meet the requirements for structural integrity found in CCR Title 23, Division 3, Chapter 16, Article 6 and may receive an interior lining. Sincerely, �y Q�QF �' '� Joseph C. el � W S-2770 r Z JCEfiw MAR 2 6 1998 �• r � r • 1 •�� .!U/ �je�' . �rC�!'d/�i���'�r��C'i��� ,+�� ., E�'�P'�ifF:��.�11±� .��' rR.:i!!.`�ir���.+fit� ��'i . '�� !` ���,��+�������� � ,;ii�`ir����i��l�� ►/�,.1` ���'I,1��,.��E���i1i���r�ri �.' -'� .�i��a''. ' ��r�i�r/ � i::�t!'�i��i1Y �ils ��G=�G-� �`T:�rr"�i±�.����;�I[►�! ►�:�ti►:�►!�:�' �' '' t';�a�' <<- ����� , TOM • R1 ��� c�.� ��--' i11�.�'� ■t1, �,1� �1 .��►,1 �`'�i1G > �;i1Gi� ' �� !�";�:yi�� �����,��'.�`1�����!i!��i�1��y'1�i1���f�����f��1`i►R�1�1V���r���� �����•.� lnnA�� 1�V►rrML r L\�►11L'41P i1\`�i a�+ �� ► A�`\'� , .1"M��)!►��� ►`1:����,��T��l':►ti►�'y l`�����C'�,l��.1/�!�•�� �� 1�� �►�►� � ►1L1i11��11�1\`V►`��\'�� �1�►1T.��►'�J6i� �►`i�ll:�1►w\ � v111`�►�1►'`�7lli►Zi°i'/ . 1 f MAR-26-1998 12:02 SESSIONS TANK LINERS E05E330423 P.05 Sessions Tank Liners, Inc. Ultrasonic Thickness Gauging Report I rfto s qr:pa« Tankhead rill End Opposite End 8 FT \ Ab KV bN A`� Totals CYLINDER IV44LL Total of Gauges 4 ' 3C) _ Averagg 77,ickness Total Number of Gauges f J­ FILL-END Total o art es (77 L c� l Averagt 7ltickn,-ss Total Number of Gauges �. OPPOSITE END 'alai o au es Average 77rickness Total Number of Gauges TOTAL TANK SHELL A RAG olal of j es 7 = Average 71fickness ?oral Number of Gauges FC1 i ARAGE 7Tif1CKNESS 5 X 100= % OrDF, L SIGN 0 DMP GN 771ICKNESS. INICKNESS ACCEPT' REJECT AU771ORIZED SIGNA7VRE � � r ru r r � r r r �a 1 / rr • .'�.�:�, ` .0"l/- '•P.5/I :i �����*' .`r�J .`' �e�' ►` Y':i/��F`'',r� -�1 '' G'��":.i ' r ' `,�Ri"'■t'' f►.r� �.�' �� I'���Il�����1�"i�1��. `' ��lE�i!��1�1��1� ' l��1�����►,71 L��1'��l��14�1�7� '`'�! �''I��i�'1�.1►6�:1� '` 1��1�� `'� ' '��ldl�il��C�� `.'C� r MAR-26-1998 12:04 SESSIONS TANK LINERS 8058330423 P.07 Sessions Tank Liners, Inc I' Ultrasonic Thickness Gauging Report.i fogs 2 ell PTu T ankhead Fdl E A d Opposite Eyed 5 SA 1 ti5 p 0 T A- W'b WIscif ,%\\WkPlAcsb I Totals W '� CYLtNDER WALL 7"0tal ot Gouges �-r = 1-r C� Avera84 T7ekkness 7bral Number of Ganges f7 5 T1LL•EN3 1 1 I Total GM es ( b = Icy-t Average 7hidwess Told l'Vumber of Gauges OPPOSM END C Tot u es = � Average Thickness Total Number of Gauges TOTAL TANK SNFI,T.A FP.4 0 T ofCauees � c9 , 7 _ 1.c--Average 77kickness Tohrl Number ojGauges: AV RAGE 771ICKNESS X 100= % OF PES1GN DESIGN 7NCKNESS G THICKNESS ACCEPT RE.JE, T AU1710RIZED SIGNATURE ■ J .a��r�����`..brliF.b�j�`��,�!�r�,��fr` �..��� �.te�►'.itr�l� '�! �r�� %4'aJ� � I PAP �:�r�il�.�r:ir:i1�31i+'�Ir����►��,�I���i1��1r����i�'1�i��+�1�� PAP .1 r •JJt �� .�i�'����JI�.rL'JJF�+i�.� APR rN FA I � n4 k � JJ 'J�%J'Siii.��J ��i1 �' ' �����"{�� .��•. r.i�, r�� ��ii: iiC � ' :�tw�.'�it3il�t�ir � ' t •� �: � ., .� .� J,�F- ., 1�r t /I �F'��:rl �i�4"���+IrJr�'�����:, ��t�`'.A�`JLt��r�.'��t;:�G�.Il - ' �•wr��'�ii��^ jA�►' �•�� � r �l .[.� i/r"J, .a1r��r.J�ir.►Jr.�G�il Jlr`� Fri .fi1 .���../��L�/�wi�'J� l a/r�l' ,C:�t��.�r�i�������y`.��.,rF*`.�i►'.?Y.���F�r�rr`C��,.�Y'�V.�*'�R:Ar'���i� r �' i������l���'.i�*Jl�'J�Ir.�l�ir�►�i�i*`.1i�.r�i '��.1���� t ,�+�r,•�!�,.,,�; r� ��� '��.�il�.°��.�ll�..�C:irl'.��;i�r�� . `^��r .'�f.� , ��^��, r����i���.flY���i►�����R:� mum t MAR-26-1998 12:05 SESSIONS TANK LINERS E058330423 P.09 Sessions Tank Liners, Inc 4✓ Ultrasonic Thickness Gauging Report Pee#!oft poses Tankhead rut EAd Opposltc End a a3a� 3 � 8 FT P -O .a Lo %% i%A; Totals o �q L4 \\ s , CYLINDER WALL Total o Gau es 8'2'x- _ -Z/0 Averagg Thickness Total Number of Gauges r MEND Total of Games -1 a' - ! Avera jo nk*ness Total-Number of Gauges : OPPOSITE END y, 0101:PL G _ ;� Average Thickness Total Naniber of Gauges TOTAL TANK SHELL Ai' 0A 00 G _ Total G esSD -- �-� Average 7hickness ntrd Number of Gauges l AYLRAG,E T711C.KNESS 9 X 100 °,` OT DESIGN D..SIGN THICKNESS C 7NICKNESS .4GCEI'1�IiEJECT AUTIfORIZED SIGNATURE MRR-26-1998 12:05 SESSIONS TANK LINERS B058330423 P.10 SesOns Tank Liners, Inc. Ultrasonic Gouging Report r 1 �, i e . . f 1 ray .� d 11 Y��;jP' ' er.,+i%1 +;J•�• ' ' I: l �� ' r , • 1rh�u1�',I■c /LI■ ,� , �� : NEert'!� &Z 01, r' ', .�i � � � '.:a J��► V F�:1!�1 .��ia� Y]�it��llL�iR�:�iY+rJi�AI�iY?I �,.���t���+ }�`y%��'e'�+��Yi���i ■i ����'c��i�:S..'ir��:i:��SI�. �I��ii��1'�i���l!�� �•� � •�r:ir�'J!./r���l 'r�'.:/�• r:J�� ' F.JUAr� ..�.,� ; .��+��FF�����'�.��i�.l'r'�:�'��J�..+i������r'��1�� �r%JI'r�l!�t..�•'.c�..�'��.i��ii� :�i��i �y �.��.���1�r3.r�i�Lr��r�a}i�r�i�:.�ir���i�ir�' ►��s�I��iI�,Sl��s..�i�ti�1 .. `,,yI�.A �� ���'1�1E'J,���J�J�iI��� �t�`���f�i aL%r��,�h�lE.%•c���i�..�c�SCii'���i�L ���'+� ' ir��i�1'►�J��.,i���i�'►��ii�.'c'3r���ii�'�iyc.r'i�.,�.��.�� ' '�c�,.�����i � � ' i�1�;rlJi!:�i•;ilrii�i�i���+�' �`' �i���'t�' �i�'%��..1'�t�.,t���tii, � " RPR-02-1998 12: 16 SESSIONS TANK LINERS 8058330423 P.01 sessions Tank unenc ' 9521 West Fritz Bakersfield, CA 93307 Phone(803)833-9501 Fax 833-0423 .y Fax Cover Sheet f TO: V L F-tt rQC- COMPANY: �- FAX NUMBER: 5� FROM. �.--,�- DA'Z'E: I RE: COL S - lN►f �i MESSAGE: �- Total number of � a es Including cover: P g Hard Copies: Yes: No: If you do not receive legible copies of this fax call (805) 833-9501 APR-02-199B 12:16 SESSIONS TANK LINERS B05E330423 P.02 ' AFFILIATES ` SESSIONS TANK j D E-RSJnC. PE1= M FQAANENt Afir P.O.Box 731 W1 W.FAIM S1 CC100,CA 922" mow.CA 93307 (760)3.924832 FAX 352-M" (803)833-Ml FAX 833-M?3 CA LIC_NO.418129 A-340757 AMAZ AZ LIC.NO.099121A NV.A22I0039190 XV.HandIm[TTH-1103 it March 26, 1998 Laurel Funk Kern County Environmental Health 2700 'M' Street, Suite 300 Bakersfield, CA 93301 • . VIA FAX(805)862-8701 Subject: Happy Gas, Wible & Tart Hwy.,Bakersfield CA 1 Dear Laurel: Please find attached the coating certification from C &H Engineering company for the above referenced location. If you have any questions or concerns, please contact me at the Bakersfield office. 805 833-9501. Thank you, J Betty Standfo d Sessions Tank Liners, Inc. attachments I' APR-02-1998 12:1? SESSIONS TANK LINERS 8058330423 P.03 0;,m 30*aas So°" ENGINEERING CO. o.ftv..la-d Date: 3-31-98 Project: Happy Gas-Pumpkin Center CA Contractor: Sessions Tank Liners TANK DESCRIPTION: 1 12,000 Gallon Underground Fuel Tank 4 12,000 Gallon Underground Fuel Tank 2 12,000 Galion Underground Fuel Tank 3 12,000 Gallon Underground Fuel Tank INSPECTION DESCRIPTION: Dry Film Coating dry film discontinuity testing was performed with a Tinker-Resor Discontinuities APAN Holiday Detector with the capacitor set at 12,000 volts 100%of Testing surface area was tested. Calibration by completion of circuit. All discontinuities were marked for remedial repair.CCR TITLE 23, DIV. 3, CHPT 16 SECTION 2663 h 7 Dry film thickness measurements were conducted utilizing a DEFELSKO Dry Film POSITECTOR 6000 FT2 (meets Ferrous ASTM 8499&SSPC-PA2) Thickness calibrated this date before and after inspection. Calibration was obtained Measurements in accordance with ASTM D1186 on National Bureau of Standards (NISI) calibration plates SRM#1358 at 39.7 mills. Dry film thickness readings met 100 mil and manufacturer's requirements based upon SSPC-PA2 criteria. CCR TITLE 23,DIV. 3, CHPT 16, SECTION 2663(h)(6), Tank# 1 Average mills 101.0 Standard deviation Number of Readings 99+ 2 Average mills 1QO.O Standard deviation Number of Readings 99+ 3 Average mills 104.5 Standard deviation Number of Readings 9+ 4 Average mills 1Q0 Standard deviation Number of Readings 99* 5 Average mills Standard deviation Number of Readings i 6 Average mills Standard deviation Number of Readings Note: Surface preparation and cleanliness was not inspected by C&H. Dry Film Hardness Hardness measurements ranged from 75-85+on a Barber Coleman Measurements Hardness Impresser, Model#GYZJ935. Calibrated on aGYZL#69 test disc, stamped 87-89, CCR TITLE 23, DiV. 3, CHPT 16, SECTION 2663 n 6 Off-Ratio Coating Coating film was uniform in texture and color indicating no off-ratio application. CERTIFICATION Based solely upon the above tests, the coating applicator's final Inspection criteria, the above referenced tankls are suitable for continuous use for gasoline or diesel fuel storage only. Pursuant 0694 Ii ited to CCR TITLE 23, DIV. 3, CHPT. 16, SECTION 2663(h)(8) (a). f Date: March 31, 1998 r�crrrrcornO W2'Q T QAr-T '70/bG . . ., RECEIVED State of California Q CT _ 5 For State Use Only •`" r� State of Water Resources Control Board Division of Financial Assistance P.O.Box 944212 Sacramento,CA 94244-2120 KERN COUP! (Instructions on t4MROWEM&HEALTH fWCES 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: V1500,000 dollars per occurrence 0 1 million dollars annual aggregate or AND or El1 million dollars per occurrence El 2 million dollars annual aggregate B. v` C, hereby certifies that it is in compliance with the requirements of (Name ofJTank Owner or Operator) California Code of Regulations, Title 23,Division 3, Chapter 18,Article 3,Section 2807. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: C. Mechanism Mechanism Coverage Coverage Corrective Third Party Type Name and Address of Issuer Number Amount Period Action Comp S S ) 5'f� Usi L'(���tc �GGi.t..�KC� C'e4"wp P-D C�a� v/ X12 `4 r"'Ll'CA OL"' C" rkd a&SQL-�in...c.u~tv.Ci�` C���i:xur�s 14 i3vat, ovt-It F,-; &vkC'o-( 3=L-al T - N ti's tV V "t'eC 3313 Note: ff 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 and shall maintain compliance with all conditions for participation in the Fund. See instructions. D. Facility Name !-G,L,� �a S Facility Address 31221 Facility Name Facility Address Facility Name Facility Address E. Signatur of Tank Owner or Operator Date Name and Title of Tank Owner or Operator (0-0 Signature of Wi pess or No Date Name of Witness or Notary 91WI a7 MAY y CFR(Revised 08/06) E: Original-Local Agency Copies-Facility/Site(s) ��� �. • • „ { . . �..%�� �. J�J /�� TAfT hl1611 YAY DRIVE WAY DRIVE WAY =E MLL SCI Mum TA-I�ONB T I�EL Me.1L SEfC�� Q 3 ASPHALT ii ii- ii s i n u 0 tl o u o PAVING I i n ii is W li J Ai '� it W I O �\ L� GAS �o B ISLAND g?�~ EXISTING BUILDING m>am Q 3 Ir 0 5071E PLAN NOWTH W"1nSCALE T567- 110Z45' eJ---Pd FILE: C:\DRAWINGS\MCINRY.DWG FIQUIRE HANSEN ENGOINEEFRINO - -' [PROJECT i B 3012 Antonino Street, 8akerefield, CA 93308 MARKET JOHN _ - °—`-�-a j� - - Yf° CENTER 8-eeS-To9' Chain of Custody Record ;;~ Page�ot ZALVO LABORATORIES, INC. 430g!Armour Ave. Z 2 �.'r Turnaround Time: Zalco Lab# Bakersfield,California 93308 ProjectTttle 0 RUSH By: Field Log M (805)395-0539 p Expedited (1 Week) Fax(805)395-3069 Ice Chest n ,TemperatuWC Q Routine (2 Weeks) Work Order# Company Namg , J / Phone k - • - f�A V i( Results 0<5)01 Address Q / FAX M / Cl- /�: r J t��C� Results �R`2 3 City,State,Zip Report Attention o- >,nt rn ti Lab# Sampled by: Employed by: > N N U) U U •Sample Date Time Type Legal Sample Description Containers (�(� a` 8 8 Remarks IDk Sampled p Sampled See Key Below # Type 'V It X-1 DZ F l io .24 t`1 W cbe If ZI C Z Ile: 2 '' t1 (01 �( RELINQUISHED II PRINT COMPANY DA . PRiNT NOTE: Samples are discarded 30 days after results are reported unless other arrangements are made, KEY: • O•aloes P•Plostlo M•Metel T•Tedlor V•VOA Hazardous samples will be returned to client or disposed of at clients expense. •" WWater WWWBB10waler,' G-Sofld P•Petrol®um L•Llquld 0.0ther Whito nftirn CnpV Ynllnw•I nh r:npV Pink-rllnnt rnpV "' A•Acld,pf 142(110,1 INOVI12904) B-NaOHiZnAc C•Couatio,p145-10(Nd011) M o� ao oco z otn- z Z. J AV 2L2-4Q2 -86 - � Lrv�� NO j �\mH -t-4& Izzp ern Sal G� D IC O!C Co @mil 7FTAw RJAiu CAF �9B- oo9 - 37� saMPc..E 1Ph� 1��( �8 T V 2 c s E N ND f/ IIUDI ND ��j� IP Z ND. N�tiF c5725�77�7v - - ZALCO �BORATORIES, INC* Analytical Consulting Services 4309 Armour Avenue (805) 395-0539 Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Company Laboratory No: 9804096-1 P O Box 80067 Date Received: 04/07/98 Bakersfield, CA 93380 Date Reported: 04/14/98 Contract No. Attention: John Haverstock Date Sampled 04/07/98 Time Sampled 09:20 Sample Type: CAM Solid Description: Al, SE Corner U-spenser Pipe Q 2' Sampled by J. Fi::r_sen ORGANICS ANALYTICAL RESULTS Constituents Results Unit S DLR Method/Ref BTXE & TPH-Gasoline Benzene 26100 UG/::G 371�0 802UGAS /2 Tulu°ne 1810000 ',TG/KG 750(10 iJ20GA S /8 Ethylbenzene 666000 UG/KG 75000 8020GAS /8 Total Xylenes 4920000 UG/KG 150000 8020GAS /8 TPH Gasoline 27200 MG/KG 12500 8020GAS /8 Date Analyzed: 04/13/98 1;.41'm Etherton, Lab Operations Manager cc: John Hansen,John Hansen Engineering 3012 Antonino Ave, Bakersfield. CA 93308 Method Reference 8. DOHS LUFT Manual ug/L mi'.ligrams par Liter (parts per billion) ug/L n;::rograms per Liter (parts per billion) ND Z-w.& Cetected N/A :'.ot .,pplicable DLR Lateztion Limit for Reporting Purposes This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zalco is not responsible for report alteration or detachment. HZALCO ,BORATORIES , INC fj Analytical consulting Services _ I 4309 Armour Avenue (805) 395-0539 Bakersfield, California 93308 FAX (8051 395-3069 Davies Oil Company Laboratory No: 9804096-2 P 0 Box 80067 Date Received: 04/07/98 Bakersfield, CA 93380 Date Reported: 04/14/98 Contract No. Attention: John Haverstock Date Sampled 04/07/98 Time Sampled 09:28 Sample Type: CAM Solid Description: A2, SE Corner Disnenser Pipe @ 6' Sampled by J. .1ansen ORGANICS ANALYTICAL RESULTS Constituents Results Units DLR Method/Ref BTXE & TPH-Gasoline Benzene 10 700 UG/KG 7500 8020G7'•S /8 Toluene 734000 `'J-1/KG 75000 8020GAS /B Ethylbenzene 352000 Y73/KG 75000 8020GAS /8 Total Xylenes 2600000 1..3/KG 150000 8020GAS /8 TPH Gasoline 12800 ':3/KG 12500 8020GAS /8 Date Analyzed: 04/13/98 ,Jim E herton, Lab Operations Manager cc: John Hansen,John Hansen Engineering ` 3012 Antonino Ave, Bakersfield, CA 93308 Method Reference S. DOHS LUFT Manual ug/L c.illigrams per Liter (parts per billion) ug/L micrograms per Liter (parts per billion) ND None Detected N/A Not Applicable DLR Detection Limit for Reporting Purposes This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zolco is not responsible for report alteration or detachment. ZALCO BORATORIES , C6 Analytical Wonsulting Services 4309 Armour Avenue (805) 395-0539 Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Company Laboratory No: 9804096-3 P 0 Box 80067 Date Received: 04/07/98 Bakersfield, CA 93380 Date Reported: 04/14/98 Contract No. Attention: John Haverstock Date Sampled 04/07/98 Time Sampled 09:42 Sample Type: CAM Solid Description: A3, SE Corner Dispenser Pipe @ 10, Sampled by J. Tiansen ORGANICS ANALYTICAL RESULTS Constituents Results Units DLR Method/Ref BTXE & TPH-Gasoline Be7,...ii�ne 108CO UG/KG 15000 �3020'AS /8 Toluene 485000 UG/'�C 15000 8020GAS ,!8 Ethylbenzene 223000 UG/KG 15000 8020GAS /8 Total Xylenes 1680000 `.JG/KG 30000 8020GAS /8 TPH Gasoline 11800 t,:G/KG 2500 8020GAS /8 i' 7 Date Analyzed: 04/13/98 —� Ji , Etherton, Lab Operations Manager cc: John Hansen,John Hansen Engirc-c�_ing 3012 Antonino Ave, Bakersfield, CA 93308 Method Reference B. DOHS LUFT Manual ug/L r..!-igrams per Liter (parts per billion) ug/L micrograms per Liter (parts per billion) ND None Detected N/A Nc t applicable DLR Detection Limit for Reporting Purposes This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zolco is not responsible for report alteration or detachment. ..EZALCO �BORATORIES , INC* , Analytical Consulting Services L I 4309 Armour Avenue (805) 395-0539 Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Company Laboratory No: 9804096-6 P 0 Box 80067 Date Received: 04/07/98 Bakersfield, CA 93380 Date Reported: 04/14/98 Contract No. Attention: John Haverstock Date Sampled 04/07/98 Time Sampled 09:56 Sample Type: CAM Solid Description: B1, East Middle, D_spenser Pipe Q 2' Sampled by J. 1;ar_sen ORGANICS ANALYTICAL RESULTS Constituents Results Units DLR Method/Ref BTXE & TPH-Diesel Benzc-ne ND UO/KG 5 . 0 DIESEL /8 Tolucr:e ND *TG/KG 5-.1 DIESEL /8 Ethylbenzene ND iJG/KG 5 .0 DIESEL /8 Total Xylenes ND f:'G/KG 15 DIESEL /9 TPH Diesel ND MG/KG 10 DIESEL /8 'l Date Analyzed: 04/13/98 Lab operations Manager cc: John Hansen,John Hansen Engineering 3012 An Ave, CA tonino Bakersfield, .,A 93308 Method Reference B. DOHS LUFT Manual ug/L milligrams per Liter (parts per billion) ug/L m.:rograms per Liter (parts per billion) ND None Detected N/A Vot Applicable DLR Detection Limit for Reporting Purposes This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zalco is not responsible for report alteration or detachment. ZALCO I&BORATORIES , INC* I -. ..E Analytical Consulting Services 4309 Armour Avenue (805) 395-0539 Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Company Laboratory No: 9804096-7 P O Box 80067 Date Received: 04/07/98 Bakersfield, CA 93380 Date Reported: 04/14/98 Contract No. Attention: John Haverstock Date Sampled 04/07/98 Time Sampled 10 :08 Sample Type: CA14 Solid Description: B2, East Middle dispenser Pipe @ 6' Sampled by J. Hansen ORGANICS ANALYTICA7 )RESULTS Constituents Results Uni=- DLR Method/Ref BTXE & TPH-Diesel Benzene.. ND JG/KG 5 .0 DIESEL /0 Toluene ND T?G/KG 5.0 DIESEL /8 Ethylbenzene ND UG/KG 5 .0 DIESEL /8 Total Xylenes ND T73/KG 15 DIESEL /8 TPH Diesel ND M3/KG 10 DIESEL /8 Date Analyzed: 04/13/98 therton, Lab Operations Manager cc: John Hansen,John Hansen Enginering 3012 Antonino Ave, Bakersfield, CA 93308 Method Reference 8. DOHS LUFT Manual ug/L milligrams per Liter (parts per billion) ug/L :::ic rograms per Liter (parts per billion) ND None Detected N/A Not P.-pplicable DLR Detection Limit for Reporting Purposes This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zolco is not responsible for report alteration or detachment. ZALCO BORATORIES, INC* Analytical Wonsulting Services 4309 Armour Avenue (805) 395-0539 Bakersfield, California 93308 FAX (805) 395-3089 Davies Oil Company Laboratory No: 9804096-4 P 0 Box 80067 Date Received: 04/07/98 Bakersfield, CA 93380 Date Reported: 04/14/98 Contract No. Attention: John Haverstock Date Sampled 04/07/98 Time Sampled 09 :46 Sample Type: CAM Solid Description: C1, SW Corner ,'jispenser Pipe @ 2' Sampled by J. Hansen ORGANICS ANALYTICA- RESULTS Constituents Results Un_ts DLR Method/Re= BTXE & TPH-Gasoline Benzenct ND .J ,20GAS 'O UG KG 5 , Toluene ND ,_,G/KG 5 0 8020GAS '/3 Ethylbenzene ND lJG/KG 5.0 8020GAS /8 Total Xylenes 337 uG/KG 7 .5 8020GAS /8 TPH Gasoline ND MG/KG 10 8020GAS /3 Date Analyzed: 04/13/98 -'et herton, Lab Operations Manager cc: John Hansen,John Hansen Engint_-2:t ing / 3012 Artonino Ave, Bakersfield, '.CA 93308 Method Reference 8. DOHS LUFT Manual ug/L ,iill_grams per Liter (parts per billion) ug/L -.iicrcgrams per Liter (parts per billion) ND None Detected N/A Not Applicable DLR Dt:c&ction Limit for Reporting Purposes This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zolco is not responsible for report alteration or detachment. ZALCO L#BORATORIES , INC* Analytical 67 Consulting Services 4309 Armour Avenue (805) 395-0539 2 IL Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Company Laboratory No: 9804096-5 P 0 Box 80067 Date Received: 04/07/98 Bakersfield, CA 93380 Date Reported: 04/14/98 Contract No. Attention: John Haverstock Date Sampled 04/07/98 Time Sampled 09 :50 Sample Type: CAM Solid Description: C2, SW Corner LiF:?enser Pipe @ 6' Sampled by J. har _-3en ORGANICS ANALYTICAL RZSULTS Constituents Results Ur_it6 DLR Method/Ref BTXE & TPH-Gasoline Br:nzene U0 :•3/?;G 5 .0 3-3 2 C,GAS. /8 " Toluene NL J3/KG S .0 8020CAS /9 Ethylbenzene ND f:'.;/KG 5 .0 8020GAS /8 Total Xylenes ND '-'G KG 15 8020GAS /8 TPH Gasoline ND '-'G/KG 10 8020GAS /8 Date Analyzed: 04 13/98 i Y / JiX Etherton, Lab Operations Manager cc: John Hansen,John Hansen Engineering 3012 Antonino Ave, Bakersfield, CA 93308 Method Reference 8. DOHS LUFT Manual ug/L milligrams per Liter (parts per billion) ug/L micrograms per Liter (parts per billion) ND None Detected N/A Not Applicable DLR C?tection Limit for Reporting Purposes This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zalco is not responsible for report alteration or detachment. ZALCO BORATORIES , INC49 Analytical Wonsulting Services 4309 Armour Avenue (8051 395-0539 Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Company Laboratory No: 9804096-8 P 0 Box 80067 Date Received: 04/07/98 Bakersfield, CA 93380 Date Reported: 04/14/98 Contract No. Attention: John Haverstock Date Sampled 04/07/98 Time Sampled 10 : 15 Sample Type: CAM Solid Description: D1, West Middl;-: Dispenser Pipe @ 2' Sampled by J. Har.•sen ORGANICS ANALYTIC;-_L :::ESULTS Constituents Results Units DLR Method/Ref BTXE & TPH-Diesel Benzene Nr T 7/KG 5 0 DIESEL /8 Toluene ND. G'C,jKG C DIES1%L /8 Ethylbenzene ND ?JG/KG 5 .0 DIESEL /8 Total Xylenes ND UG/KG 15 DIESEL /8 TPH Diesel ND MG/KG 10 DIESEL /8 1 Date Analyzed: 04/13/98 Jr_, Etherton, Lab Operations Manager cc: John Hansen,John Hansen Engineering 3012 Antonino Ave, Bakersfield, CA 93308 Method Reference 8. DOHS LUFT Manual ug/L mil'sigrams per Liter (parts per billion) ug/L micrograms per Liter (parts per billion) ND Ncna Detected N/A Not Applicable DLR D tection Limit for Reporting Purposes This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zalco is not responsible for report alteration or detachment. ZALCO BORATORIES , INC* Analytical Consulting Services 4309 Armour Avenue (805) 395-0539 Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Company Laboratory No: 9804096-9 P O Box 80067 Date Received: 04/07/98 Bakersfield, CA 93380 Date Reported: 04/14/98 Contract No. Attention: John Haverstock Date Sampled 04/07/98 Time Sampled 10 :19 Sample Type: CAM Solid Description: D2, west Middle Dispenser Pipe @ G' Sampled by J. Hansen ORGANICS ANALYTICAL RESULTS Constituents Results Url_`.s DLR Method/Ref BTXE & TPH-Diesel Benzene ND t'G/KG 7 C. DIESEJ. /8 Toluene ND ',7G/KG 5 .0 DIESEL /a Ethylbenzene ND UG/KG 5 .0 DIESEL /8 Total Xylenes ND UG/KG 15 DIESEL /8 TPH Diesel ND MG/KG 10 DIESEL /8 Date Analyzed: 04/13/98 7 Etherton, Lab Operations Manager cc: John Hansen,John Hansen Engineering 3012 Antonino Ave, Bakersfield, ;,A 93308 Method Reference B. DOHS LUFT Manual ug/L milligrams per Liter (parts per billion) ug/L micrograms per Liter (parts per billion) NO None Detected N/A Not Applicable DLR Detection Limit for Reporting Purposes This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zolco is not responsible for report alteration or detachment. kEZALCO L&BORATORIES, INC* Analytical Consulting Services 4309 Armour Avenue (805) 395-0539 Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Company Laboratory No: 9804096-10 P O Box 80067 Date Received: 04/07/98 Bakersfield, CA 93380 Date Reported: 04/14/98 Contract No. Attention: John Haverstock Date Sampled 04/07/98 Time Sampled 10 :24 Sample Type: CAM Solid Description: E1, NW Corner Dispenser Pipe Q 2' Sampled by J. %an.jen ORGANICS ANALYTICAL RESULTS Constituents Results Units DLR Method/Re= BTXE & TPH-Gasoline fienzene ND UG/KG 5 .0 ,,j20GAS /-8 Toluene ND /n: 5 .0 8020?AS /6 Ethylbenzene ND UG/KG 5 .0 8020GAS /8 Total Xylenes ND UG/KG 15 8020GAS /8 TPH Gasoline ND MG/KG 10 8020GAS /8 Date Analyzed: 04/13/98 Etherton, Lab Operations Manager / cc: John Hansen,John Hansen Engineering ! 3012 Antonino Ave, Bakersfield, CA 93308 Method Reference 8. DOHS LUFT Manual ug/L milligrams per Liter (parts per billion) ug/L T„zrograms per Liter (parts per billion) ND : N;;ne Detected N/A N--t Applicable DLR Detection Limit for Reporting Purposes This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zolco is not responsible for report alteration or detachment. t�EZALCO �BORATORIES , INC. Analytical onsulting Services L . 4309 Armour Avenue (805) 395-0539 Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Company Laboratory No: 9804096-11 P 0 Box 80067 Date Received: 04%07/98 Bakersfield, CA 93380 Date Reported: 04/14/98 Contract No. Attention: John Haverstock Date Sampled 04/07/98 Time Sampled 10 : 29 Sample Type: CAM Solid Description: E2, NW Corner Dispenser Pipe @ 6' Sampled by J. Hansen ORGANICS ANALYTICAL RESULTS Constituents Results Ur,i:s DLR Method/Ref BTXE & TPH-Gasoline Benze-�e t ' 'IG/KG L; .0 8020GAS /= Toluene ND .,^!u � G ,, _.G _- .�. 8��0_AS 8 Ethylbenzene ND UG/KG 5 .0 8020GAS /8 Total Xylenes ND UG/KG 15 8020GAS /8 TPH Gasoline ND MG KG 10 8020GAS /8 Date Analyzed: 04/13/98 Y / .:im Etherton, Lab Operations Manager d cc: John Hansen,John Hansen Engineering 3012 Antonino Ave, Bakersfield, CA 93308 Method Reference 8. DOHS LUFT Manual ug/L milligrams per Liter (parts per billion) ug/L micrograms per Liter (parts per billion) NO None Detected N/A Not Applicable DLR De-,:._ction Limit for Reporting Purposes This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zalco is not responsible for report alteration or detachment. r'i ZALCO 6,LBORATORIES , IN Analytical d Consulting Services ,�. JUN 1998 4309 Armour Avenue (805) 395-0539 Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Company Laboratory Rio: 9805201-_ P 0 Box 80067 Date Received: 05%15/93 ?akersfield, CA 93380 Date .Reported: 05/21/98 Contract No. Attention: John Have--stock Date Samoled 05/15;93 Time Samoled 09 :02 Sample Type : CAINI Solid Description: F1-15, Test Hole 7 0 15' Sampled by J. Hansen ORGANTICS AINALYTICAL RESULTS Constituents ?esults Units DLR Method/Ref BTXE & TPH-Gasoline Benzene ND UG/KG 5 .0 8020GAS /8 Toluene ND UG/KG 5 . 0 8020GAS /8 Ethylbenzene ND UG/KG 5 .0 8020GAS /8 Total Xvlenes ND UG/KG 15 8020GAS /8 TPH Gasoline ND MG/KG 10 8020GAS /8 Date Analyzed: 05/20/98 Jim therton, Lab Operations Manager cc : John Hansen,John Hansen Engineering 3012 Antonino Ave, Bakersfield, CA 93308 �ietlted Reference 9. DOHS LUFT Hanuat ug/L mi'_iigranc per :.i e, pens per b.1_iun: .rg/L microcr,-3, per parts per bill—,nl ND None -tected N/.a Not ,pp1_cab1e DLR Ceteccion _imit :_, Reporting P�rrooses This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zolco is not responsible For report alteration or detachment. ZLZALCO WISOPATOPIES , INC* Analytical (7,k Consulting Services 4309 Armour Avenue (805) 395-0539 Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Company Labora__ry No: 9805201-2 P 0 Box 80067 Date 05/1- 5/98 Bakersfield, CA 93380 Dare ..epor-ed: 05/21/98 Ccntrac: No. Attention: John iaverstpck Date Sampled 05i 15/98 __me Sam- 09 : 10 Sample Type : CA%i Solid Description: F1-20, Test Hole F 20' Sampled by J. Hansen O?GANICS ANALYTICAL RESULTS Constituents Results Units DLR Method/Ref BTXE & TPH-Gasoline Benzene ND UG/KG 5 .0 8020GAS /8 Toluene ND UG/KG 5 . 0 8020GAS /8 Ethylbenzene ND UG/KG 5 . 0 8020GAS /8 Total Xylenes D,D UG/KG 15 8020GAS /8 TPH Gasoline ND NIG/KG 10 8020GAS /8 Date Analyzed: 05/20/98 Jim Etherton, Lab Operations ;`tanager cc : John Hansen,John Hansen Engineering 3012 Antonino Ave, Bakersfield, CA 93308 HA1:nod ReEerence R. 00P.3 LJFT Mann,-.ii ugjL milligrams per --_- i0' Per ug/L m!crcgrarrs per ___er (par_s per bil!Lon: ND ,tone Dete^'ed N/A No;, applicable DLR Derecrion :,Lmit ___ Reporcing Purposes This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zalco is not responsible for report alteration or detachment. ZALCO SkBORATORIES , INC* Analytical & Consulting Services 4309 Armour Avenue (8051 395-0539 Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Comoanv Labora_ory No : 9805201-3 P 0 Box 3006; Date Recei:red: 05/i5/9a Bakersfieid, CA 93380 Date Reported: 05/2-/93 Contract No. Attention: John Haverstock Date Sampled 05/15;93 Time Sampled 09 : 18 Sample Tripe : CAM Solid Description: E1-25, Test Hole F n 25' Sampled by J. Hansen ORGA.`i2CS ANALYTICAL RESULTS Constituents Results Units DLR Nlet:^od/Ref BTXE & TPH-Gasoline Benzene ND UG/KG 5 . 0 8020GAS /8 Toluene ND UG/KG 5 .0 8020GAS /8 Ethylbenzene ND UG/KG 5 .0 8020GAS /8 Total Xylenes ND UG/KG 15 8020GAS /8 TPH Gasoline ND NIG/KG 10 8020GAS /8 Date Analyzed: 05/20/98 Jim .therton, Lab Operations Manager cc: John Hansen,John Hansen Engineering 3012 Antonino Ave, Bakersfield, CA 93303 ;4erhei R�Eer�nce 9. DOHS LUF- Manual - ugi m:__i:r3ms per .Pares per 'u•-`-- ug/L mt.crcorams per (pares per ND Ncne BC N/l 140C .•�JU�i=3�i2 Dt,R Det.�cciori LLmir :._ teporr.ing P.trpcs=_s This report'is furnished for the exclusive use of our Customer and applies only to the samples tested.Zalco is not responsible for report alteration or detachment. ZALCO WBORATORIES , INC* Analytical & Consulting Services 4309 Armour Avenue (805) 395-0539 Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Company Laborato=. Rio: 9805201 P 0 Box 80067 Date Received: 05/15/93 Bakersfield, CA 93380 Date Reported: 05/211/93 Contract Rio. Attention: John Haverstock Da_e Sampled 05/1-5/98 Time Sampled 09 : 27 Sample Type : CApi Solid Description: F1-30 , Test Hole F :? 30' Sampled by J. :Hansen OpcA�NT1CS ANALYTICAL RESULTS Constituents Results Units DLP. Method/Ref BTXE & TPH-Gasoline Benzene ND UG/KG 5 . 0 8020GAS /3 Toluene ND UG/KG 5 .0 8020GAS /8 Ethylbenzene L\TD UG/KG 5 .0 8020GAS /8 Total Xylenes DFD UG/KG 15 8020GAS /8 TPH Gasoline ND MG KG 10 8020GAS /8 Date Analyzed: 05/20/98 A,jim 7 erton, Lab Operations Manager cc : John Hansen,John Hansen Engineering 3012 A.ntonino Ave, Bakersfield, CA 93303 Me::hod Re CPrence d. 00115 LUFT Manual ua/L m:' :igrems per ug/L mi_rCCrams per __., pans per ..._.'_on' VD lone -_ -ed N/A Nor .acolicable DLR Derec--on 7 irni� :'.or This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zolco is not responsible for report alteration or detachment. ZALCO U&BOPATORIES , INCIP Analytical & Consulting Services 4309 Armour Avenue (805) 395-0539 Bakersfield, California 93308 FAX (805) 395-3069 Davies Oil Company Laboratory No 93052(,11-3 P O Box 90067 Date Received: 05/15/93 Bakers field. CA 93390 Date Reported: 05/21/:3 Contract No. A.tt°ntion: JGnn Ha,%?rStOC,< Date Sampled 05/13/93 Time SamD_ led 09 : 35 Samcle T'-voe : CAM Solid Description: F1-35, Test Hole F ,r 35' Sampled by J. Hansen ORGANICS �a-L ALYTICAL RESULTS Constituents Results Units DLR Method/Ref BTXE & TPH-Gasoline Benzene ND UG/KG 5 . 0 8020GAS /8 Toluene ND UG/KG 5 .0 8020GAS /8 Ethylbenzene ND UG/KG 5 . 0 8020GAS /8 Total Xylenes ' D UG/KG 15 8020GAS /8 TPH Gasoline ND MG/KG 10 8020GAS /8 Date Analyzed: 05/20/98 /ji,��t�herton, Lab Operations (Manager cc : John Hansen,John Hansen Engineering 3012 Antonino Ave, Bakersfield, CA 93308 ;•te.!lod ReEerer.ce -)OHS LUG, old tl lldi per: ug L m1=:Jd I'3ifIS -'_ ..Lt � ._ . a rt.� ND None Dece^_c'-d NI\ NOt ApFiicat. e DLR Detection L_mic ___ Reao.tLna Purposes This report is furnished for the exclusive use of our Customer and applies only to the samples tested.Zalco is not responsible for reoort alteration or detachment. iKERN COUNTY [APN MIT NO. 3aUU 1 � ENVIRONMENTAL HEALTH SERVICES DEPARTMENT 2700 "M" STREET, SUITE 300 NUMBE R BAKERSFIELD, CA 93301 LICATION DATE: APPLICATION FOR PERMIT TO CONSTRUCT/MODIFY UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY Twe Of Application (check): ❑ New Facility (Modification of Facility El New Tank Installation at Existing Facility A. Number of Tanks To Be Installed Existing Facility Permit # O 12 l'3 � Type of Business Gg_so _i,uE Facility Name 1—I,c.np4 ;As Address 32.21 TA FT tA wy City 13a�cCCZSF���c� C/a . T_`�I R 2-1 SEC I (Rural Locations only) Nearest Cross Street W'%We- P--A . B. Tank Owner O AV N ES o t L= Co • Phone #: 323-6c�C.3 Address 41na Q(5 aCE 12A . City/State B FL. . CA, Zip G 33 o 2S C. Water To Facility Provided By Depth To Groundwater Soil Characteristics At Facility 5rA1.. nN LoA.�► D. Contractor CAL VALLGyj f~rz. Co CA Contractor's License No. Address 35'x0 (2--t d rnorzt. t-we— City Zip Phone #3 2:Z-9 3 4) Worker's Compensation Certification # Insurer Proposed Starting Date Proposed Completion Date E. If This Application Is For Modification Of An Existing Tank System, Briefly Describe Modifications Proposed (Excluding New Tank Installation at Existing Facilities) gx r s -r6 i/. G• T�J,''s 6 h e Q/n S s l inPC� F. Tank(s) Storage (Check All That Apply): Unleaded Other* Waste Other* Other* Tank # Unleaded Plus Premium Diesel Fuel Oil Waste Product _ 4 * Describe other products/waste: o T-D t c z t=—L-- G. Initial Tank Integrity Test Information: Testing Company Name: Phone # Test Method: Licensed Tester: A tank integrity test is not reguired if the tank is equipped with an interstitial monitor certified to meet the Performance standards of a "tank integrity test." This fo has been completed under penalty of perjury and to the best of my knowledge is true and correct. Signat). a Title eb 10e Date a Lq?, / HM36 -- (1/29/96) ` Hermit # TANK INFORMATION FORM Contents (FILL OUT SEPARATE FORM FOR EACH TANK) Tank # FOR EACH SECTION, CHECK ALL APPROPRIATE BOXES H. 1. Tank is: ( ) Vaulted ( ) Jacketed ( ) Double-Wall ( ) Single-Wall 2. Tank Material ( ) Carbon Steel ( ) Stainless Steel ( ) Fiberglass-Reinforced Plastic () Fiberglass-Clad Steel ( ) Concrete ( ) Unknown ( ) Other (Describe) 3. Primary Containment Date Installed Thickness (Inches) Capacity (Gallons) Manufacturer 4. Tank Secondary Containment ( ) Double-Wall ( ) Synthetic Liner ( ) Lined Vault ( ) None ( ) Unknown ( ) Other (describe): Manufacturer: ( ) Material Thickness (Inches) Capacity (Gallons) i2 to r-r coca 5. Tank Interior Lining ( ) Unlined ( ) Unknown (VrLined (describe) 6. Tank Corrosion Protection ( ) Galvanized ( ) Fiberglass-Clad ( ) Polyethylene/Vinyl (Wrapped or Jacketed) ( ) Tar or Asphalt ( ) Unknown ( ) None ( ) Other (describe): Cathodic Protection: ( ) None ( ) Impressed Current System ( ) Sacrificial Anode System Describe System and Equipment: 7. Leak Detection. Monitoring, and Interception * (Must be described below) a. Tank: ( ) Vapor Detector * (✓ Liquid Level Sensor * ( ) Conductivity Sensor ( ) Vadose Zone Monitoring Well(s) ( ) U-Tube with Liner ( ) U-Tube without Liner ( ) Visual Inspection (Vaulted tanks only) ( ) Groundwater Monitoring ( ) Sensor in Annular Space ( ) Vapor ( ) Liquid ( ) Pressure ( ) Other ( ) Regular Monitoring of U-Tube, Monitoring Well or Annular Space ( ) Daily Gauging & Inventory Reconciliation ( ) Periodic Tightness Testing ( ) None ( ) Unknown ( ) Other *Describe Make & Model: b. Piping: ( ) Flow-Restricting Leak Detector(s) for Pressurized Piping* ( ) Sealed Concrete Raceway ( ) Monitoring Sump with Raceway ( ) Complete Containment Liner with Sumps ( ) Half-Cut Compatible Pipe Raceway ( ) Synthetic Liner Raceway ( ) None ( ) Unknown (1� Other *Describe Make & Model: 8. Tank Tightness Has This Tank Been Tightness Tested? ( ) Yes ( ) No ( ) Unknown Date of Last Tightness Test Results of Test Test Name Testing Company 9. Tank Repair ( ) Yes ( ) No ( ) Unknown Date(s) of Repair(s) Describe Repairs 10. Overfill Protection (Must describe below) ( ) Operator Fills, Controls, & Visually Monitors Level ( ) Tape Float Gauge ( Float Vent Valves (Yf Auto Shut-Off Controls ( ) Capacitance Sensor ( ) Sealed Fill Box ( ) None ( ) Unknown ( ) Other ( ) List Make & Model for all Devices *Describe other Protection System 11. Pi in a. Underground Piping: ( ) Yes ( ) No ( ) Unknown Material Thickness (inches) Diameter Manufacturer b. Type of piping System ( ) Pressure ( ) Suction ( ) Gravity Approximate Length of this Pipe Run C. Underground Piping Corrosion Protection: ( ) Galvanized ( ) Fiberglass-Clad ( ) Impressed Current ( ) Sacrificial Anode ( ) Polyethylene Wrap ( ) Electrical Isolation ( ) Vinyl Wrap ( ) Tar or Asphalt ( ) Unknown ( ) None ( ) Other (describe): d. Underground Piping, Secondary Containment: ( ) Double-Wall ( ) Synthetic Liner System ( ) None ( ) Unknown HM21 ( ) Make & Model (describe): 2. Post conspicuous signs prohibiting smoking, dispensing into unapproved container,to stop engine and the location of emergency shut-off switch. (5201.8) Emergency shut-off switch shall be within 75 feet of but not less than 25 feet from dispensers. (5201.5.3) 3. Dispensing devices shall be in clear view of the attendant with no obstacles placed between the attendant and the dispensers (5202.4.7) 4. The attendant shall at all times to be able to communicate with the person in the dispensing areas (5202.4.7 (5)) 5. Provide fire extinguishers (2A20BC between 15 to 75 feet from dispensers. (5201.9 see LJFC Standards) 6. Flexible joints shall be installed in accordance with Section 7901.11.7. An approved shear joint shall be rigidly mounted and connected by a union in the vapor-return piping at the base of each dispensing device. The shear joint shall be mounted flush with the top of the surface on which. the dispenser is mounted (5202.12.2.4) 7. Flexible joints and emergency shutoff impact valves shall be installed in accordance with Section 7901.11.7. An approved emergency shutoff impact valve incorporating a fusible-link designed to close automatically in event of severe impact or fire exposure 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) 8. 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) 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 mm) 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. Written records of maintenance, tests, inspections, and the results and recommendations therefrom, shall be maintained on the premises where the equipment is located, and shall be made available to the chief on request. 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) (FP: DKR/rga 5/14196) ugtank.cpl t Kerns County% % Fire Chief DANIEL G.CLARK Fire Department Deputy Chiefs DENNIS L.THOMPSON, FINANCE 5642 Victor Street-Bakersfield, CA 93308 ROBERT OXFORD,OPEaATIONS Telephone 805-391-7000*Fax 805-399-2915 STEPHEN A.GAGE,OPERATION;LeCOSTEL HAILEY,OPERATIONS TTY Relay Service 1-800-735-2929 CARY L. ECKARD,ux.lsncs DATE: - �0 4 Li LA% PERMIT NO.: 3 a 00 �D Cy�rA a6A Lk C�S Uv, JOB ADDRESS: 3 as I a cam, SOS 3 5 L 70 �? Z. ( ) For Information Only OWNER: OCCUPANCY: Plans have been checked in accordance with: TYPE CONSTRUCTION: ( X ) U.F.C. 1994 ( ) Title 19 FLOOR AREA: ACTUAL Article 52 ( ) Title 24' ALLOWABLE: ( ) U.B.C. 19_ ( ) Other: OCCUPANT LOAD: EET ALL OF THE FOLLOWING REQUIREMENTS + COMPLIANCE LIST: Dispensers and Other Related Equipment with Underground Tanks (Use with Health Department Plan Review Process for Underground Tanks) 1. Dispensing devices shall be located as follows: a. Ten feet (3048 mm) or more from property lines, b. Ten feet (3048 mm) 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) f Service • Pride • Commitment COUNTY DEPARTMENT OF INSPECTION RECORq* BAKERSFIELD AREA INSPECTION ENGINEERING & SURVEY SERVICES 0 REQUESTS ONLY BUILDING INSPECTION DIVISION 8 am - 5 pm 862-8681 CHARLES LACKEY,P.E.,DIRECTOR POST CARD AT JOBSITE After Hours 862-8698 ENGINEERING&SURVEY SERVICES Inspection Date Inspector BUILDING INSPECTION DIVISION Main Office Grading 2700 M Street,Suite 570,Bakersfield,California 93301-2370 g Phone(805)862-8650 Office Hours 6:00.5:00 Set Backs Inspection Request:(8:00.5:00)862-8681 (After Hours)862-8698 GROUND Underground Elec. Branch Offices WORK Frazier Park Office-Fire Station Ph.245-1221 Office Hours8:00.10:00 Underground Plb. Lake Isabella Office-7050 Lake Isabella Blvd. Ph.(619)379.2631 Office Hours 7:00-4:00 Underground Mech. McFarland Office-401 West Kern St. Ph.792-3091 Office Hours 8:00-9:OOM-Th. Mojave Office-1775 Hwy.58 Ph.824.3906 Office Hours 7:004:00 Address Verification Ridgecrest Office-400N.China Lake Blvd. Ph.(619)375-1564 Hours 8:00.11:OOMTF Taft Office-315 Lincoln Street Ph.763.8590 Office Hours 8:00-10:00W COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED Tehachapi Office-125 East•F•Street Ph.822-6329 Office Hours 7:00.4:00 Slab Mesh PL w FOUNDATION Slab Membrane Rebar for Grounding MOATM Reinforcing Steel PLACE NO CONCRETE FOR FLOOR UNTIL ABOVE HAS BEEN SIGNED Floor Joists Floor Sheathing Rough Electrical FLOOR WALL Plumbing Top-out ROOF Fire Sprinkler System FRAMING Shower Pan BUILDING Grease Trap OR MOBILE HOME Rough Mechanical Roof Sheathing P Structural L COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED Roofing Interior Lathing STUCCO Exterior Lathing Siding PLASTER WALLBOARD D rV Wall SIDING Exterior Membrane Wall Insulation PROJECT ADDRESS: ASSESSOR'S PARCEL NUMBER: Attic Ventilation DO NOT PLASTER OR APPLY SIDING UNTIL ABOVE HAS BEEN SIGNED * SINGLE FAMILY RESIDENTIAL SEWAGE First Inspection CERTIFICATE OF OCCUPANCY DISPOSAL Sewer Line Inspection Date Inspector DRY SEWER Septic Tank Tem Elec. WET SEWER Seepage Pit Temp Gas SEPTIC SYS Leach Field PRE-FINAL APPROVALS COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED Inspection Date Inspector Foundation Steel Health Department MASONRY Wall Reinforcing Road Department AND CONCRETE Bond Beam Grading WALLS Fire Place Reinforcing Drainage Fire Place Landscaping Wood Stove C.U.P. Requirements P.D. Re uirements COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED Gas pressure test Location Electrical final SWIMMING Steel FINAL Plumbing final POOL Conduit under deck Mechanical final Recirculation piping Structural final Electrical wiring Energy final Gas line under deck Zoning requirements Fencing & Gates Insulation requirements Fire Requirements COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED * Job com lete * RESInENTIAL PERMITS- THIS .1f1R ('Ann Ccovcc Ac vnrlo CERTIFICATE nl= nY`r`IIoAkInv BuddinalnsD.5802625 010 (Rev.10-96) COUNTY DEPARTMENT OF 2700"M"STREET ENGINEERING & SURVEYSERVICES do' JOB CARD 0 ' BUILDING INSPECTION DIVISION BAKERSFIELD,CA 93301-2370 CHARLES LACKEY,P.E.,bIRECTOR CONSTRUCTION PERMIT PHONE(805)862-8681 1 Job Address 3221 TAFT HWY Insp.Area ZM Map Lot Assessor's Parcel No. 1 62 1 142-01 Prolect Descri tiori Permit# 3 Permit Class (New/Add or Alter/Conversion/Remodel) NEW CONSTRUCTION 4 Property Owner(s) 1. DAVIES OIL CO 2. Mailing Address p 0 BOX 80067 City/State BAKERSFIELD CA Phone Number Zip Code 5 Architect/Engineer License* Mail Address Phone* 6 Contractor's Name OWNER Hiring Licensed Contractor's (Y/N) Mailing Address City/State Phone Number Cont.St. Lic.* Project Manager KCEH ZONE VCLASSIFICATION Phone Number OMAN AS i011 8 C.S.A. frVSIchool Dist.If c led� e, 10 Comments W ebAss 11 Census Code If i99 1,0"Census Tract# Cen If Sub A UNITS Code Census Number Description A/D/Y PER UNITS CODE Per Bldg BLDG. N RISC, 'INSTALL' PERMITS Y By Date Ref.Case Total Area Total Value/Yards THE FOLLOWING PRELIMINARY FEES ARE SUBJECT TO CHANGE BEFORE PERMIT ISSUANCE: FEE PAID FEE PAID ELECTRICAL PERMIT FEES 14.50 Y APPLICATION ISSUANCE FEE 23.00 Y I TOTAL FEES 37.50 'PARTIAL PAYMENT AMOUNT PAID 37.50 BALANCE ,00 ' V Application Number Activity Code Application Date 70660 Issuance Date MW Activity Date P 2/27/98 2/27/98 WS-ID REMARKS Date Bldg.Insp.580 2625 171•B (REV.1a96) 3106392946 DEIIENNO.'KERDOON 7b.5 !VA ir CORROSION- * • - ELECTRICAL SER,VICES, INC. May 14, 1997 Mr. Ross Sessions Sessions Tank Liners, Inc. PO Box 49061 Bakersfield,California 93308 Re: Proposed Cathodic Protection System Happy Gas 3221 Taft Highway Pumpkin Center, California Mr. Sessions: Corrosion-Electrical Services, Inc. (C.E.S.), proposes to install a cathodic protection system at the above location using either one 40-foot or two 20-foot deep anode wells. The type of ground bed used will be determined based on field conditions encountered during installation. Either:method should provide adequate corrosion protection to the exterior of the underground fuel storage tanks. C.E.S. proposes to install the cathodic protection well (CPW) north of the store, east of the underground storage tanks (See attached Site Plat,). This location was selected in an effort to maximize the level of protective current applied to the underground tanks and minimize interference from existing cathodicaliy protected pipelines or other metallic substructures that may be nearby. Thank you for this opportunity to assist you with this phase of your corrosion mitigation program. Should you have any questions, please feel free to contact us at you.convenience. Respectfully, CORROSION-ELECTRICAL SERVICES, INC. �,,ow4er�'1 q�PRO��.�T�; M hipley, E. /rvQ� N AC ' gin r �....s......................�Z,0 f JAY 1.SHIPLEY N.f M•.•••.••..H.•......• / 4193 11` �S•�•...... \ca\a; tricia J. Brews �,0``��A� President 16210 GUNDRY AVENUE, PARAMOUNT, C'A41F'ORNIA 90713 PHONE:(562) 634-4919 FAA': (56 ) 634-5131 CA. LICENSE C-10 684718 NORTH TAFT HM 0 u n u X CT i 2 2 t 2 t 2 i0 i0 10 � i0 C i 0 : 0 i 0 ! i 0 j R i G i i G i i G i i G i C A A �A A \ i L i L ' ' t L t L t rr RECTIFIER z w ; T i S S S i C C -- �T -- ' �T' C� Z L \ E R , ......... 0I STORE NACE ..J.... Pi I AY M. SHIPLEY rR f� 4193 :' i m 9� W awl.A I&AN DS C LEGEND C E Corrosion Electrical Services SParxrouttr Caltfomia • PROPO'SEDCATHODIC PROTECTION ANODE WELL kL Joe W 1476 PROPOSED CATHODIC PROTECTION SYSTEM LAYOUT m SCALE NOW HAPPY CAS m 3221 TAFT F%W ,n owvm av ua PUMPKIN CENTER,CA. '-' emergency information Job Information: Happy Gas Station 3221 Taft Highway Bakersfield, CA. 93308 CONTACT: Chuck Martin (805) 323-6063 EMERGENCY PHONE: 911 FIRE DEPARTMENT: 911 MEDICAL EMERGENCY/CPR: 911 NEAREST HOSPITAL: Mercy Medi Center 2215 Truxtun Avenue Bakersfield, CA 93305 (805) 326-6000 DIRECTIONS: Go east on Taft highway to freeway 99 north, go to California Avenue turn right,then go to Oak Street and turn left, go north on Oak to Truxtun, turn right and continue to 2215 Truxtun Ave. AFFILIATE 9A—Le�✓ lu ME SESSIONS 'TANK LWE1gS4,kic. U min Office Branch Offi cc 4 ECYIPMENT t�f5 P.O. Box 731 9521 W. Fritz z 131 Centro,CA 92244 Bakersfield,CA 93307 (760)3524832 PAX 352-2646 (805)833-9501 PAX 833-0423 CA LIC_NO. 418129 A-540757 A/HAZ AZ LIC.NO. 099125A NV. A22/0039190 ATV. Handlers UTH-1103 rN MAY 21, 1997 Laurel Funk Kern County Environmental Health 2700 "M" Street Bakersfield, Ca. 93301 Dear Laurel, Re: Happy Gas Station, 3221 Taft Highway, Bakersfield, CA. 93308 We at Sessions Tank Liners, Inc., will be interior coating (4)12,000 gallon underground storage tanks at the above location. U.L. listed spray material GC-900 will be applied to 125 mils as per manufacturers specifications. Sessions will furnish and install an impressed current cathodic protection system designed by a corrosion engineer. Enclosed is the Kern County permit applications, along with Sessions Tank Liners, Inc., "Coating Procedures & Safety Manual" with an emergency information sheet regarding the site, and a check for $875.00. This job is tenitively scheduled at start around June 9, 1997. If you should have questions or comments please contact me at (805) 833-9501. Sincerely, Ross Sessions RS/as enclosures ALL CONSTRUCTION INFORMATION WELL # WELL a WELL a WELT. # WELL DEPTH 6 t GROUND ELEVATION (IF KNOWN) BOREHOLE DIAMETER CASING--INSIDE DIAMETER ?10 CASING MATERIAL & GAUGE U vk SCREEN MATERIAL & GAUGE h (� LTYFE OF BENTONITE PLUG & DEPTH ANNULI'S SEALANT & DEPTH �� e FILTER PACK MATERIAL & SIZE SCREEN SLOT SIZE, & LENGTH SEALANT PLACEMENT METHOD o In 40 LOCKING WELL CAP FACILITY PLOT PLAN Provide a description of the facility to be monitored, including: location of tanks, proposed monitoring and placement, nearest street or intersection, location of any water wells or surface water within 500' radius of facility; Alesse attach. ZONEE OF INFLUENCE Information on zone of influence, such as mathematical calculations or field test data, may be required VADOSE ZONE WELLS upon review of the application. WELL DESTRUCTION INFORMATION WELL a WELL a WELL # WELL # WELL DEPTH CASING MATERIAL SEALANT MATERIAL SEALANT PLACEMENT METHOD DESCRIBE DESTRUCTION PROCEDURE: I have read and agree to comply with the general conditions noted This permit be signed by either the c ntra ror jPr owner. Owner's Signatuic Date Contractor's Signature Date Approved By- / Total Fee e2'OZ f Paid On S' a 7�91 7 Issue Date: 1(0 Receipt W t�� Cash Check M 17Y-91 Y Permit Expiration Date: I �� Work Order u THIS APPLICATION BECOMES A PERMIT WHEN APPROVED Ch Ttsn IbLB ZAfi Sub �Y'3 LS :gii t73�t �di1n [ 1 KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Application Date; t o�7 —ef -7 2700 "M" STREET, SUITE 300 No. of Wells/Borings: BAKERSFIELD, CA 93301 PTO No.: 3a 00 Well No ). �a -3a. APPLICATION AND PERMIT FOR MONITORING WELLS This application is to: 0 Construct ® Modify ❑ Destroy Type of well/boring 0 Groundwater Cathodic Protection ❑ Test Hole O Other FACILITY INFORMATION OWNER'S INFORMATION Name U Name , Address as I tJJ T/R/Sec Address O City Zip City f fate Zip Cross stmet Phone Phone =FrojCctCnt8CT Phone C.ONTRACTOR'S INFORMATION Drilling Contractor &L n Environmental Contractor e S C O Licrnse p and Type C 5 Address cL Address / b Ciry State Zip �z City laic Zip Phone drilling Method Proposed start date: C Depth to groundwater: GENERAL CONDITIONS OF THIS PERMIT FOR CONSTRUCTION: 1. Well site approval is required before beginning any work related to well construction. It is unlawful to continue work past the stage at which an inspection is required unless inspection is waived or completed. 2. Other required inspections include: conductor casittg,,all annular seals, and final construction features. 3. A phone call to the Department office is required on the morning of the day that work is to commence and 24 hours before the placement of any seals or plugs, 4. Construction under this Permit is subject to any instructions by Department representatives. 5. All wells constructed of PVC located at a contaminated site where degradation may occur must be destroyed after two years or prove no degradation is occurring or has occurred 6. Any misrepresentatiun or noncompliance with required Permit Conditions or Ordinance will result in issuance of a "STOP WORK ORDER." 7. A copy of the Department of Water Resources Driller's Report, as well as copies of logs, water quality analyses, and as- builts of wells must be submitted to the Environmental Health Services Department within 14 days after completion of the work. GENERAL CONDITIONS OF THIS PERMIT FOR DESTRUCTION: I. A well destruction application must be filed with this Department if a well is being destroyed that is not in conjunction with a test hole permit. 2. Destruction procedures must be followed as per UT-50. y. 3. Placement of the seal must be witnessed by a representative of this Department. Twenty.four-h our advanced notice is required for an appointment. SPECIAL CONDITIONS: THIS APPLICATION BECOMES A PERMIT WHEN APPROVED d00 H11H 'IVIN314NOSIAN3 3 N YOL8 ZA8 S08 �b'3 AS •dU cI3,h Ad-90.11 ENVIRONMENTAL HEALTH DEPARTMENT PERMIT NO. 3,;L 0 0 t m _ 2700 "M" STREET, SUITE 300 APN NUMBER BAKERSFIELD, CA 93301 APPLICATION DATE 'a-Z APPLICATION FOR PERMIT TQ rwOMTRUCTIMODIFY UNDERGROUND HAZARDOUS SUBSTANCES STI7 AaE FACIL17Y rye Of,Anglication (checkl: New Facility Modiflcatlon of Faclli New Tank Installation at Exlstln Faelll (noci►C►e A. Number of Tanks To Be Instaiied� L Existing Facility Permit Type of El Type n_--s .t ► or--N ip re Facility Name Address 3�;G L_ T6)^f W L.&.7) City T R SEC (Rural Locations Only) Nearest Cross Street B. Tank Owner 0 YNUQ 1._ff-)O v i'►(l -190U.3 Addrege ct t�>>� City/State2-,1L?f',. G Pift C-F ZIpg3W_R C. Water To Facility Provided By Depth To Groundwater Soil Characteristics At Facility IZ,©sS o D. Contractor ova s I asn b2 Lme-U Contractor's t cense No._!A.1 8.1 g,!a Address 5 a\ ��-�� "rri±�. City�_ fp 530'�'I4one # t_5 3- 1 Worker's Compensation Certification W Insurer Proposed Starting Date Proposed,Completion Date E. If This Application la For Modification Of An Existing Tank System, Briefly Describe Modifications Proposed (Excluding New Tank Installation at Existing Facllltles)+c� tt2grlor' C.00-f(y (;A rno nT I t d,-) F. Ta.n_k(a) 5toreae (wok All JW Ate: (If* - Complete Section G) Other* Other* Tarok * Ualegglad Unleaded Plub PtoJIUM DIU11 Other Fuel W"Ji produQt G. Chemical Composition Of Materials Stored (For Products Or Waste Marked With Tank # Chemical Stor d (non-commercial name) CAS # (If knownl OtiarrIcal Previously Stored (it different) This tor;�jp,hwas b en completed under penalty of perjury ar�to the beat of my knowledge Is true and correct, Signature- Title�,�i C I;P=2N*CJpnl*Date HM230 Permit # TANK INFORMATION FORM . Contents (FILL OUT SEPARATE FORM FOR EACH TANK) Tank # FOR EACH SECTION, CHECK ALL APPROPRIATE BOXES H. 1. Tank is: ( ) Vaulted ( ) Jacketed ( ) Double-Wall (t,)-�Single-Wall 2. TanK Material (Vr Carbon Steel ( ) Stainless Steel ( ) Fiberglass-Reinforced Plastic ( ) Fiberglass-Clad Steel ( ) Concrete ( ) Unknown ( ) Other (Describe) 3. Primary Containment Date Ins Iled Thickness (Inches) Capacity (Gallons) Manufacturgrj 4. Tank Secondary Containme t ( ) Double-Wall ( ) Synthetic Liner ( } Lined Vault (None ( ) Unknown ( ) Other (describe): Manufacturer: ( ) Material Thickness (Inches) Capacity (Gallons) S. Tank Interior Lining /mil �{ ( ) Unlined ( ) Unknown ( G Lined (describe) Q 6. Tank Corrosion Protection ( ) Galvanized ( ) Fiberglass-Clad ( } Polyethylene/Vinyl (Wrapped or Jacketed) ( ) Tar or Asphalt ( ) Unknown ( ) None ( ) Other (describe): Cathodic Protection: ( ) None (4�<mpressed Current System ( ) Sacrificial Anode System Describe System and Equipment: 7. Leak Detection, Monitoring, and Interception * Must be described below) a. Tank: ( ) Vapor Detector * ( quid Level Sensor * ( ) Conductivity Sensor ( ) Vadose Zone Monitoring Well(s) ( ) U-Tube with Liner ( ) U-Tube without Liner ( ) Visual inspection (Vaulted tanks only) ( ) Groundwater Monitoring ( ) Sensor in Annular Space ( ) Vapor ( ) Liquid ( ) Pressure ( ) Other ( ) Regular Monitoring of U-Tube, Monitoring Well or Annular Space ( ) Daily Gauging & Inventory Reconciliation (L-1Periodic Tightness Testing ( ) None ( ) Unknown ( ) Other *Describe Make & Model: b. Piping: glow-Restricting Leak Detector(s) for Pressurized Piping* ( ) Sealed Concrete Raceway ( ) Monitoring Sump with Raceway ( ) Complete Containment Liner with Sumps ( ) Half-Cut Compatible Pipe Raceway ( ) Synthetic Liner Raceway ( ) None ( ) Unknown ( ) Other *Describe Make & Model: 8. Tank Tightness Has This Tank Been Tightness Tested? (i.�'Yes ( ) No ( ) Unknown Date of Last Tightness Test Results of Test e__ Test Name Testing Company 9. Tank Repair ( ) Yes Unkhbwn Date(s) of Repair(s) Describe Repairs 10. Overfill Protection (Must describe below) ( ) Operator Fills, Controls, & Visually Monitors Level a rrloat Vent Valves ( ) Auto Shut-Off Controls ( ) Capacitance Sensor ( ) Sealed Fill Box ( ) None ( ) Unknown ( ) Other ( ) List Make & Model for all Devices *Describe other Protection System 11. Pi in a. Underground Piping: (I.T"'Yes ( ) No ( ) Unknown Material Thickness (inches) Diameter Manufacturer b. Type f piping System V Pressure ( ) Suction ( ) Gravity Approximate Length of this Pipe Run C. Underground Piping Corrosion Protection: ( ) Galvanized ( ) Fiberglass-Clad ( G-pressed Current ( ) Sacrificial Anode ( ) Polyethylene Wrap ( ) Electrical Isolation ( ) Vinyl Wrap ( ) Tar or Asphalt ( ) Unknown ( ) None ( ) Other (describe): d. Underground Piping, Secondary Containment: ( ) Double-Wall ( ) Synthetic Liner System (WNone ( ) Unknown HM21 ( ) Make & Model (describe): Permit # TANK INFORMATION FORM Contents (FILL OUT SEPARATE FORM FOR EACH TANK) Tank # FOR EACH SECTION CHECK ALL APPROPRIATE BOXES, H. 1. Tank is: ( ) Vaulted ( ) Jacketed ( ) Double-Wall ( Single-Wall 2. Tank Material ( Carbon Steel ( ) Stainless Steel ( ) Fiberglass-Reinforced Plastic ( ) Fiberglass-Clad Steel ( ) Concrete ( ) Unknown ( ) Other (Describe) 3. Primary Containment Date Installed Thick ess (Inches) Capacity (Gallons) Manufactu er r� W- f '( /a X060 4. Tank Secondary Contain e ( ) Double-Wall ( ) Synthetic Liner ( ) Lined Vault (L4 None ( ) Unknown ( ) Other (describe): Manufacturer: ( ) Material Thickness (Inches) Capacity (Gallons) 5. Tank Interior Lining ( ) Unlined ( ) Unknown (/-'fined (describe) G b b 6. Tank Corrosion Protection ( ) Galvanized ( ) Fiberglass-Clad ( ) Polyethylene/Vinyl (Wrapped or Jacketed) ( ) Tar or Asphalt ( ) Unknown { ) None ( ) Other (describe): Cathodic Protection: ( ) None (�'Y'Impressed Current System ( ) Sacrificial Anode System Describe System and Equipment: 7. Leak Detection, Monitoring, and Interception *,(Must be described below) a. Tank: ( ) Vapor Detector * (squid Level Sensor * ( ) Conductivity Sensor ( ) Vadose Zone Monitoring Well(s) ( ) U-Tube with Liner ( ) U-Tube without Liner ( ) Visual Inspection (Vaulted tanks only) ( ) Groundwater Monitoring ( ) Sensor in Annular Space ( ) Vapor ( ) Liquid ( ) Pressure ( ) Other ( ) Regular Monitoring of U-Tube, Monitoring Well or Annular Space ( ) Daily Gauging & Inventory Reconciliation (k- Periodic Tightness Testing ( ) None ( ) Unknown ( ) Other *Describe Make & Model: b. Piping: ((/Flow-Restricting Leak Detector(s) for Pressurized Piping* ( ) Sealed Concrete Raceway ( ) Monitoring Sump with Raceway ( ) Complete Containment Liner with Sumps ( ) Half-Cut Compatible Pipe Raceway ( ) Synthetic Liner Raceway ( ) None ( ) Unknown ( ) Other *Describe Make & Model: 8. Tank Tightness Has This Tank Been Tightness Tested? ( Yes ( ) No ( ) Unknown Date of Last Tightness Test Results of T st S S 5i f,a ( - Test Name 1i Te WI'g Company W1&eY-63 9. Tank Repair ( ) Yes No ( ) U nown Date(s) of Repair(s) Describe Repairs 10. Overfill Protection (Must describe below) ( ) Operator Fills, Controls, & Visually Monitors Level UxrFloat Vent Valves ( ) Auto Shut-Off Controls ( ) Capacitance Sensor ( ) Sealed Fill Box ( ) None ( ) Unknown { ) Other ( ) List Make & Model for all Devices *Describe other Protection System 11. Pi in a. Underground Piping: /) Yes ( ) No ( ) Unknown Material Thickness (inches) Diameter Manufacturer b. Type f piping System (Pressure ( ) Suction ( ) Gravity Approximate Length of this Pipe Run C. Underground Piping Corrosion Protection: ( ) Galvanized ( ) Fiberglass-Clad (�Impressed Current ( ) Sacrificial Anode ( ) Polyethylene Wrap ( ) Electrical Isolation ( ) Vinyl Wrap ( ) Tar or Asphalt ( ) Unknown ( ) None ( ) Other (describe): d. Underground Piping, Secondary Containment: ( ) Double-Wall ( ) Synthetic Liner System None ( ) Unknown HM21 ( ) Make & Model (describe): Permit # TANK INFORMATION FORM Contents (FIL T SEPARATE FORM FOR EACH TAN ) Tank # _ FOR EACH SECTION CHECK 0 BOXES H. 1. Tank is: ( ) Vaulted ( ) Jacketed ( ) Double-Wall ( -Single-Wall 2. Tank Material ( Carbon Steel ( ) Stainless Steel ( ) Fiberglass-Reinforced Plastic ( ) Fiberglass-Clad Steel ( ) Concrete ( ) Unknown ( ) Other (Describe) 3. Primary Containment Date Iristalled Thicl ness (Inches) Capacity (Gallons) Manufac urer 1.4 kl pops. It / D © C7 I,c h cc-t 4. Tank 8econdary Containment ( ) Double-Wall ( ) Synthetic Liner ( ) Lined Vault ( one ( ) Unknown ( ) Other (describe): Manufacturer: ( ) Material Thickness (Inches) Capacity (Gallons) 5. Tank Interior Lining ( ) Unlined ( ) Unknown (L�,Cined (describe) qD d 6. Tank Corrosion Protection ( ) Galvanized ( ) Fiberglass-Clad ( ) Polyethylene/Vinyl (Wrapped or Jacketed) ( ) Tar or Asphalt ( ) Unknown ( ) None ( ) Other (describe): Cathodic Protection: ( ) None (Impressed Current System ( ) Sacrificial Anode System Describe System and Equipment: 7. Leak Detection. Monitoring, and Interception * (Must be described below) a. Tank: ( ) Vapor Detector * ( squid Level Sensor * ( ) Conductivity Sensor ( ) Vadose Zone Monitoring Well(s) ( ) U-Tube with Liner ( ) U-Tube without Liner ( ) Visual Inspection (Vaulted tanks only) ( ) Groundwater Monitoring ( ) Sensor in Annular Space ( ) Vapor ( ) Liquid ( ) Pressure ( ) Other ( ) Regular Monitoring of U-Tube, Monitoring Well or Annular Space ( } Daily Gauging & Inventory Reconciliation ( ) Periodic Tightness Testing ( ) None ( ) Unknown ( ) Other *Describe Make & Model: b. Piping: ( low-Restricting Leak Detector(s) for Pressurized Piping* ( ) Sealed Concrete Raceway ( ) Monitoring Sump with Raceway ( ) Complete Containment Liner with Sumps ( ) Half-Cut Compatible Pipe Raceway ( ) Synthetic Liner Raceway ( ) None ( ) Unknown ( ) Other *Describe Make & Model: a. Tank Tightness Has This Tank Been Tightness Tested? (/XVes ( ) No Unknown Date of Last Tigh ess Test Results of Test Q SS'P� Test Name �S Testing Company _I In p r Q V-C' U V' e--' , e-f S 9. Tank Repair ( ) Yes ( -Flo ( ) Un nown Date(s) of Repair(s) Describe Repairs 10. Overfill Protection (Must describe below) ( ) Operator Fills, Controls, & Visually Monitors Level ( ) Tape Float Gauge (/Float Vent Valves ( ) Auto Shut-Off Controls ( ) Capacitance Sensor ( ) Sealed Fill Box ( ) None ( ) Unknown ( ) Other ( ) List Make & Model for all Devices *Describe other Protection System 11. Piping a. Underground Piping: WYes ( ) No ( ) Unknown Material Thickness (inches) Diameter Manufacturer b. Type f piping System (Pressure ( ) Suction ( ) Gravity Approximate Length of this Pipe Run C. Underground Piping Corrosion Protection: ( ) Galvanized ( ) Fiberglass-Clad V-111mpressed Current ( ) Sacrificial Anode ( ) Polyethylene Wrap ( ) Electrical Isolation ( ) Vinyl Wrap ( ) Tar or Asphalt ( ) Unknown ( ) None ( ) Other (describe): d. Underground Piping, Secondary Containment: ( ) Double-Wall ( ) Synthetic Liner System ( None ( ) Unknown HM21 ( ) Make & Model (describe): Permit # TANK INFORMATION FORM Contents {FILL OUT SEPARATE FORM FOR EACH TANK) Tank # FOR EACH SECTION CHECK PP 0 I S H. 1. Tank is: ( ) Vaulted ( ) Jacketed ( ) Double-Wall Single-Wall 2. Tank Material Carbon Steel ( ) Stainless Steel ( ) Fiberglass-Reinforced Plastic ( ) Fiberglass-Clad Steel ( ) Concrete ( ) Unknown ( ) Other (Describe) 3. Primary Containment Datl�nsta�Ile�_ Thickness r (Inches) Capacity (Gallons) Manufacturer —T,---- 4. Tank Secondary Containment ( ) Double-Wall ( ) Synthetic Liner ( ) Lined Vault (C)—fVbne ( ) Unknown ( ) Other (describe): Manufacturer: ( ) Material Thickness (Inches) Capacity (Gallons) 5. Tank Interior Lining ,�-rr q ( ) Unlined ( ) Unknown Wined (describe) l_i lr— ! 6 G 6. Tank Corrosion Protection ( ) Galvanized ( ) Fiberglass-Clad ( ) Polyethylene/Vinyl (Wrapped or Jacketed) ( ) Tar or Asphalt ( ) Unknown { ) None ( ) Other (describe): Cathodic Protection: ( ) None (4-Impressed Current System ( ) Sacrificial Anode System Describe System and Equipment: 7. Leak Detection, Monitoring, and Interception * (Must be described below) a. Tank: ( ) Vapor Detector * squid Level Sensor * ( ) Conductivity Sensor ( ) Vadose Zone Monitoring Well(s) ( ) U-Tube with Liner ( ) U-Tube without Liner ( ) Visual Inspection (Vaulted tanks only) ( ) Groundwater Monitoring ( ) Sensor in Annular Space ( ) Vapor ( ) Liquid ( ) Pressure ( ) Other ( ) Regular Monitoring of U-Tube, Monitoring Well or Annular Space ( ) Daily Gauging & Inventory Reconciliation i(_4_Periodic Tightness Testing ( ) None ( ) Unknown ( ) Other *Describe Make & Model: b. Piping: V> ow-Restricting Leak Detector(s) for Pressurized Piping* ( ) Sealed Concrete Raceway ( ) Monitoring Sump with Raceway ( ) Complete Containment Liner with Sumps ( ) Half-Cut Compatible Pipe Raceway ( ) Synthetic Liner Raceway ( ) None ( ) Unknown ( ) Other *Describe Make & Model: 8. Tank Tightness Has This Tank Been Tightness Tested? (�s ( ) No ( ) Unknown Date of Last Tightness Test Results of Test A0 55 Test Name L4 S Testing Company Cc �. 9, Tank Repair ( ) Yes ((o ( ) Un own Date(s) of Repair(s) Describe Repairs 10. Overfill Protection (Must describe below) ( ) Operator Fills, Controls, & Visually Monitors Level ( ) Tape Float Gauge (bloat Vent Valves ( ) Auto Shut-Off Controls ( ) Capacitance Sensor ( ) Sealed Fill Box ( ) None ( ) Unknown ( ) Other ( ) List Make & Model for all Devices *Describe other Protection System 11, Pi in a. Underground Piping: V(Yes { ) No ( ) Unknown Material Thickness (inches) Diameter Manufacturer b. Type f piping System (Pressure ( ) Suction ( ) Gravity Approximate Length of this Pipe Run C. Underground Piping Corrosion Protection: O Galvanized O Fiberglass-Clad mpressed Current ( ) Sacrificial Anode ( ) Polyethylene Wrap ( ) Electrical Isolation ( ) Vinyl Wrap ( ) Tar or Asphalt ( ) Unknown ( ) None ( ) Other (describe): d. Underground Piping, Secondary Containment: ( ) Double-Wall ( ) Synthetic Liner System ((None ( ) Unknown HM21 ( ) Make & Model (describe): PERMIT NUMBER TYPE OF INSTALLATION ( XI 1 . In-Tank Level Sensor (XX) 2 . Leak Detector KX� 3 . Fill Box FACILITY NAME Happy Gas CoevE2 7A¢r d01 w,/316�` FACILITY ADDRESS 3221 Taft Hwy, Pumpkin Center V')0_UV1e_ CONTACT PERSON Bill Davies l� 1 . IN TANK LEVEL SENSORS 33c�s Gti�� ST Q,4 KE,e 5)C,r.16 Gr9 93 3°� Number of Tanks 4 List By Tank ID Reg Unl Extra Diesel Name of System Tank level sensing system Manufacturer & Model Number Veeder Root TLS-750 Contractor/Installer Fleet Card Fuels 2 . LEAK DETECTORS Number of Tanks 4 List By Tank ID Reg Unl Extra Diesel Name of System Line Leak Detectors Manufacturer & Model Number Red Jacket 221485-1.1.6017 Contractor/Installer ? Clar s Petroleum Equipment 3 . FILL BOXES Number of Tanks 4 List By Tank ID Reg Unl Extra Diesel Name of System OPW Overfill Manufacturer & Model Number OpIy #1 Contractor/Installer Clarks Petroleum Equipment V OWNER/OPERA u DA E ` PERMIT4 _______ ____ ... FACILITY NAMO......................._............................................................... NUMBER OF TANKS AT THE SITE: ENV. SENSITIVITY. . . . . . ^ ^ ^ ������� � � EMERGENCY CONTACT PER��DN(9RI��ARY) : ,^ / � NAME :____________________ __________________________________ PHONE NUMBEQ: __............... _ ...._... .................. ____........................... .................................. ............................... EMERGENCY CONTACT PERSON(SECONDARf) : NAME :__________________________________________________________ PHONE NUM8ER:__________..__________________________________ TANK OWNER INFORMATION ; NAME ; ___.................................. ............................. _ ................... ______________ ADDRESS:______................. ...... ............ __. ....................... ....... ....... ........................ PHONE NO. : TANK CONTENTS ; INSTALLED TANK 4 MANUFACTURER YEAR TANK CONSTRUCTION : TANK 4 (d LEAK DETECTION ; TANKS: VISUA� �ROUNDWATER MONITORING WELLS VAOQSE ZONE MONITORING WELLS U-TUBES WITH LINERS WITHOUT LINERS VAPOR DETECTOR L2���I� SENSORS _______ CONDUCTIVlTY SENSORS PRESSURE SENSORS IN ANNULAR SPACE ____ LIQUID RETRIEVAL SYSTEMS IN U-TUBES, MONITORING WELLS , OR ANNULAR NONE _ UNKNOWN OTHER PIPING INFORMATION ; TANK 4 SYSTEM TYPE CONSTRUCTION MATERIAL LEAK DETECTION : PIPING: LOW RESTRICTING LEAK DETECTORS FOR PRESSURIZED PIPING MONITJK;'��6FSUMP WITH RACEWAY ____ SEALED CONCRETE RACEWAY _______ HALFCUT COMPATIBLE PIPE RACEWAY NONE UNKNOWN /�� a m County Health Department Permit No O 0 dvision of Environmental Hea Application 700 Flower Street, Bakersfield, CA 93305 APPLICATION FOR PERMIT TO OPERATE UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY Type of Application (chec ) : []New Fac ty E3Modification of Facility CZ Existing Facility ❑Transfer of Ownership Emergency 24-Hour Contact (name, area code, phone) : Days Nights Facility Name No. o Tanks Type of Business (check) : Gasol ni-e Station r3other escribe)�'„NU Is 'Tank(s) Located on an Agricultural Farm? ❑Yes ®'No Is !Tank(s) Used Primarily for Agricultural Purposes? ❑Yes Caw Facility Address S*wo .a g %ft,,c—/ w7 Nearest Cross St. G✓,��F�d T R SEC ^T (Rural Locations Only) Owner �'�Rc[v� {, .�crt� L_LL�� Contact Person Address g3g5 Z—P 30 j= - Telephone 3. 3 -4;ea Operator r,C2' d. / 8871• Contact Person 9-C X7-�HFW,- Address"�"' ��G.r=s"- v? f-wer���• Z F 92s o Z Telephone ,��i- -'I 3i,7 • Water to Facility Provided by Depth to Groundwater Soil Characteristics' at Facility Basis for Soil Type and Groundwater Depth Determ nat ons • I Contractor CA Contractor's License No. Address Zip Telephone Proposed Starting Date Propossi Canplition Date Worker's Compensation .Certification # Insurer If This Permit Is For Modification Of An Existing Facility, Briefly Describe Modifications Proposed Tanks) Store (check all that apply) Tank / Waste Product Motor Vehicle Unleaded R ular Premiim� Diesel Waste Fuel ®® _"„' p "'Oil C3 0 13 ❑ ® ® a ❑ ❑ 13 121 is ❑ ❑ ® U L� U Chemical Campos#tion of Materials Stored (not necessary for motor vehicle fuels) ..Tan k_ C.Chemical' Stored (non-commercial name) CAS # (if known) ..-,, Chemical Previously Stored Brent) I I Transfer of Ownership Date of Trans of r Previous Owner Previous Facility Name I, accept fully all obligations of Permit No. issued—to I understand that the Permitting Authority may review and modify or terminate the transfer of the Permit to Operate this underground storage facility upon receiving this completed form. This form has been completed under penalty of perjury and to the best of my knowledge is true and correct. Signature Title Date - yr y y 1700 Flower Street WN COUNTY HEALTH DEPARTMENT HEALTH OFFICER Bakersfield,California 93305 Leon M Hebertson,M.D. Telephone(80S)861-3636 ENVIRONMENTAL HEALTH DIVISION DIRECTOR OF ENVIRONMENTAL HEALTH �rr Vernon S.Reichard 2 LATER= M PERM= T PERM= T4#3 2 O O 1. 8 C T O O P E RAT E 1 S �3 TJ E ID : JULY 1, 1986 JULY 1, 1989 UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY • NUMBER OF TANKS= 4 �1-rjllll/�i� ---------------------------------------------------------------------- FACILITY: OWNER: HAPPY GAS CONVENIENCE MARKET 096 TAFT HWY. & WIBLE ROAD 3305 GULF STREET BAKERSFIELD, CA BAKERSFIELD, CA 93308 ----------------------------------------------------------------------- TANK # AGE( IN YRS) SUBSTANCE CODE PRESSURIZED PIPING? 1-4 3 MVF 3 YES NOTE : ALL INTERIM REQUIREMENTS ESTABLISHED BY THE PERMITTING AUTHORITY MUST BE MET DURING THE TERM OF THIS PERMIT NON TRANSFERABLE 'f` 'f` 'f° POST ON PREMT SE' S DATE PERMIT MAILED: SEP 0 6 1986 DATE PERMIT CHECK LIST RETURNED: Faci1 ity Name -��� s,�s - i _ G.rE 09G Permit No. ®® c TANK 4 � (FILL OUT SEPARATE FORM FOR EACH TANK) FOR EACH SECTION, CHECK ALL APPROPRIATE BOXES H. 1. Tank is: ❑Vaulted ®Non-Vaulted ❑Double-Wall Single-Wall 2. TanT Material Carbon Steel [] Stainless Steel ❑Polyvinyl Chloride ❑Fiberglass-Clad Steel Fiberglass-Reinforced Plastic ❑Concrete ❑ Aluminum ❑ Bronze ❑Unknown Other (describe) 3. Primary Containment _ Date Installed - Thickness (Inches) Capacity (Gallons) Manufacturer 14, 6140 A&LOR 6,ear, 4. Tank Secondary Conta nment ❑Double-Wall—Synthetic Liner ❑Lined Vault Q None []Unknown ❑Other (describe) : Manufacturer: ❑Material Thickness (Inches) Capacity (Gals.) 5. Tank Interior Lining 13RubbeF Alkyd []Epoxy ❑Phenolic []Glass ❑Clay ®Unlined []unknown []Other (describe) : 6. Tank Corrosion Protection —UGalvan_EW UFihiergl7ass-Clad ❑Polyethylene Wrap ❑Vinyl Wrapping ®'Tar or Asphalt []Unknown ❑None ❑Other (describe) : Cathodic Protection: EANone ❑Lopressed Current System OSacrificial Anode System Describe System & Equipment: 7. Leak Detection, Monitoring, and interception a. Tank: UVisual (vaulted-tanks only) FjGroundwater Monitoring Wiell(s) ❑Vadose Zone Monitoring Well(s) [3U-Tube Without Liner ❑U-Tube with Compatible Liner Directing Flow to Monitoring Well(s)* [3 Vapor Detector* []Liquid Level Sensor []Conductivity Sensor* ❑ Pressure Sensor in Annular Space of Double Wall Tank [] Liquid Retrieval & Inspection From U-Tube, Monitoring Well or Annular Space ER'Daily Gauging & Inventory Reconciliation ❑Periodic Tightness Testing El-None ❑Unknown ❑Other b. Piping: Flow-Restricting Leak Detector(s) for Pressurized Piping •Monitoring Sump with Raceway ❑Sealed Concrete Raceway •Half-Cut Compatible Pipe Raceway [:]Synthetic Liner Raceway ®None ❑Unknown ❑Other *Describe Make & Model: 8. Tank Tightness s Tnis TanK Been Tightness Tested? []Yes ❑No ❑Unknown Date of Last Tightness Test Results of Test Test Name Testing Cmpany 9. Tank Repair Tarac Repaired? ❑Yes ®No ❑Unknown Date(s) of Repair(s) Describe Repairs 10. Overfill Protection -- Operator Fills, Controls, & Visually Monitors LevelpR« �� ���t,�J(S6Fu t� �l.�NUifiaf! ❑Tape Float Gauge []Float Vent Valves []Auto Shut- Off Controls ❑Capacitance Sensor ❑Sealed Fill Box ❑None ❑Unknown []Other: List Make & Model For Above Devices 11. Piping a. Underground Piping: o Yes ❑No []Unknown Material Thickness (inches) Diameter Manufacturer WPressure ❑Suet on Gravity __Approximate Length of Pipe Run b. Underground Piping Corrosion Protection : []Galvanized ❑Fiberglass-Clad []Impressed Current ❑Sacrificial Anode ❑Polyethylene Wrap []Electrical Isolation ®Vinyl Wrap ®Tar or Asphalt ❑Unknown []None []Other (describe) : c. Underground Piping, Secondary Containment: [ Double-Wall []Synthetic Liner System ONone []Unknown []Other (describe) : TANK I d` (FILL OUT SEPARATE FORM FO e:ACH TANK) FOR EACH SECTION, CHECK ALL APPROPRIATE BO_ XES 1. Tank is: ❑Vaulted ®Non-Vaulted ❑Double-Wall ❑Single-Wall 20 Tan-Tc Material Caron-Steel ❑ Stainless Steel ❑Polyvinyl Chloride ❑Fiberglass-Clad Steel Fiberglass-Reinforced Plastic [3 Concrete [3Aluminum ❑Bronze []Unknown .I Other (describe) 3.` Primary Containment Date Installed jWickness (Inches) Capacity (Gallons) Manufacturer • � ii .rift/1.�ay' 49 Tank Seco any Conta nment Q Double-Wall Synthetic Liner Mined Vault ®None ❑Unknown ❑0ther (describe) : Manufacturers ❑Material Th ckness (Inches) Capacity (Ga s.) S. _Tank Interior L�..n M i ben k ❑Epoxy ❑Phenolic ❑Glass ❑Clay ❑Unlined DUMMOan Other (describe) : b� Tank Corrosion Protection =G a vaT -nrz- - rg ass-Clad DPol thylene Wrap ' ❑Vinyl•Wrapping ®Tar or Asphalt ❑ [:]None None '[Other (describe) : CaUwdic Protections None ❑Impressed Current System ❑Sacr c Describe System a Equipment: '�. Leak Detection 11 Monitorinq, and Interce t on a. : Visua (van ted tanks o yn ) Groundwater Monitoring W1e11(s) ❑Vadose Zone Monitoring well(s) D U-Tube Without Liner D U-Tube with Compatible Liner Directinj Flow to Monitoring Wiel(s)* D Vapor Detector* ❑Liquid Level Sensor ❑Conductivitx Sensor Q Pressure Sensor in Annular Space of Double Wall Tank p Liquid Retrieval a Inspection From u--Tube, Monitoring Well or Annular Spam 8Daily Gauging i Inventory Reconciliation O Periodic Tightness Testing wone O unknown ❑Other b. Pi ing: Flow-Restricting Leak Detector(s) for Pressurized Piping Monitoring Sump with Raceway D Sealed Concrete Raceway Half-Cut Compatible Pipe Raceway D Synthetic Liner Raceway M W D Unknown D Other *Describe Make i Model: So Tank Tightness '—'�'-'��•��'��'-•'—�°'-"�"�"" Has-' i3 Tar-'Tic been Tightness Tested? ❑Yes RNo ❑unknown Date 'of Last Tightness Test Results of Test Test Name Testing Company � �i. Tank Rei r i 1 ii; cc.Rued? D Yes MNo 13unknown-- - ~-. .. _. Date(s) of Repair(s) Describe Repairs 100 Overfill Protection rr�ff6Ferator Fills, Controls, i Visually Monitors LevelT4NAt-rXrwec1 ---0 ❑Tape Float Gauge ❑Float Vent Valves ❑Auto Shut- Off Controls 8 Capacitance Sensor ❑Sealed Fill Box ❑None ❑unknown Other: List Make G Model IP" Abo" Devices i 11. Pip ng a. Underground Piping: ®Yes ❑No ❑Unknown Material Thickness (inches) Diameter - Manufacturer ®Pressure .OSuct on Gravity Approximate Length 'of Pipe ; b. Underground Piping Corrosion Protection ;.: []Galvanized ❑Fiberglass-Clad ❑Impressed Current ❑Sacrificial Anode HPolyethylene Wrap []Electrical Isolation [RVinyl Wrap (RTar or Asphalt Unknown []None ❑Other (describe) : c. : Underground Piping, Secondary Containment: now ❑Double-Wall ❑Synthetic, Liner System CONone ❑unknown ❑Other (describe)': 'i TANK N �_ (FILL OUT SEPARATE FORM FO EACH TANK) FOR EACH SECTION,CHECK ALL APPROPRIATE BOXES 1. Tank is: ❑Vaulted ®Non-Vaulted ❑Double-Wall ❑Single-Wall 2. TOE Material Caron Steel ❑Stainless Steel ❑Polyvinyl Chloride ❑Fiberglass-Clad Steel Fiberglass-Reinforced Plastic ❑Concrete ❑ Aluminum ❑Bronze ❑Unknown Other (describe) 3. Priiary Containment Dote Installed Thickness (Inches) Capacity (Gallons) Manufacturer g- %'� 22,0 JZr/ 1 �i"Zeo�' 4. Tank econ any Containment ��� �— ❑Double-Wall Synthetic Liner Mined Vault ®None ❑Unknown ❑other (describe) : Manufacturer: ❑Material Thickness (Inches) Capacity (Gals,) 5. Tank Interior Lining BFtubber-M Pakyd ' ❑Epoxy ❑Phenolic ❑Glass ❑Clay oLnlined ❑uMnknown other (describe) : 6 Tank Corrosion Protection =G_a van Z erg ass-Clad ❑Polyethylene Wrap ❑Vinyl Wrapping PTar or Asphalt ❑Unknown QNone ❑Other (describe) : Cathodic Protection: C@None []Impressed Current System OSacrificla.1 Describe—System 6 Equipment: 7, Leak Detection, Monitorim, and Interception a Ta s Visua�'(vau ted tanks only) Groundwater Monitoring wwll(s) `:. ❑Vadose Zone Monitoring Wall(s) ❑U-+Dube Without Liner ❑U-Tube with Compatible Liner Directing Flow to Monitoring Wjl(s)* ❑Vapor Detector" ❑Liquid Level Sensor ❑Conductivity Sensor Pressure Sensor in Annular Space of Double Wall Tank Liquid Retrieval i Inspection From U-Tube, Monitoring Well or Annulair Space Daily Gauging 6 inventory Reconciliation ❑Periodic Tightness Testing None ❑Unknown ❑other b. 'pi ing: Flow-Restricting Leak Detector(s) for Pressurized Piping Monitoring Sump with Raceway ❑Sealed Concrete Raceway Half-Cut Compatible Pipe Raceway ❑Synthetic Liner Raceway ®Toni C]Unknown ❑other j *Describe Make i Model: 8. Tank Tightness Has s Tank Been Tightness Tested? ❑Yes P No ❑Unknown Date 'of Last Tightness Test _...__._..._ Results of Test Test Name —Testing Company 9 Tank Repair 4VEW RRe red? Dyes 12No ❑Unknown- .. - .._..__... ... -_... . Date(s) of Repair(s) i Repairs Describe be Pa 100 Overfill Protection "operator F s, Controls, i Visually Monitors Leve17N�f ��'g�-�►c��.� e' O « ��' . ❑Ta pe Float Gauge ❑Float Vent Valves ❑Auto Shut- Off Controls Bother Capacitance Sensor ❑Sealed Fill Box ❑None ❑Unknown : List Make i Model For Abaft Devices . 11. Pip, Lng ---_ .._....._...�i....... a. Underground Piping: ayes ❑No ❑Unknown Material j Thickness (inches) Diameter - Manufacturer oPressure .❑Suct on Gravity Approximate Length of pe b. Underground Piping Corrosion Protection ❑Galvanized ❑Fiberglass-Clad ❑Impressed Current ❑Sacrificial Anode SPolyethylene Wrap ❑Electrical Isolation ®Vinyl Wrap (ZTar or Asphalt Unknown ❑None ❑Other (describe) c. Underground Piping, Secondary Containment: i ❑Double-Wall ❑Synthetic Liner System PNone ❑Unknown ❑Other (describe)': • y. TANK q _ (FILL OUT SEPARATE FORM F0 EACH TANK) ~ •`: FOR EACH SECTION, CHECK ALL APPROPRIATE BOXES 1. Tank is: ❑Vaulted ®Non-Vaulted ❑Double-Wall Mingle-Wall 20 TT-anTc Material Carmen Steel ❑Stainless Steel ❑Polyvinyl Chloride ❑Fiberglass-Clad Steel ' Fiberglass-Reinforced Plastic [3 Concrete C3 Aluminum [:] Bronze OUnknown Other (describe) 3. 1 Primary Containment Date Installed Thickness (Inches) Capacity (Gallons) Manufacturer q, Tank Secondary Conta ment Double—Wall 13 Synthetic Liner Mined Vault ®None ❑Unknown ❑Other (describe) : Manufacturer: ` ❑Material Thickness (Inches) Capacity (Gals.) 5,I Tank Interior Lind ben Alk 1_-]Epoxy ❑Phenolic ❑Glass ❑Clay IMUnlined ❑Unknown Other (describe) : 6t Tank Corrosion Protection --Uba van z i�e'rgTass-Clad ❑Polyethylene Wrap ❑Vinyl Wrapping pTar or Asphalt ❑Unknown None ❑Other (describe) : Cathodic Protection: 1PNone []Impressed Current System ❑Sacr c System Descr System & Equipment: 7. Leak Detection, Monitorin., and Inte�rcePt -on A. wTa Vise (vaulted tanks only) pGroundwater Monitoring wou(s) D Vadose Zone Monitoring Well(s) [3U-Tube Without Liner 13U-Tube with Compatible Liner Directing Flow to Monitoring WWII(a) [3 Vapor Detector* ❑Liquid Level Sensor ❑Conductivity sensor* Pressure Sensor in Annular Space of Double Wall Tank Liquid Retrieval & Inspection From U-Tube, Monitoring Well or Annular Space Daily Gauging & Inventory Reconciliation 0 Periodic Tightness Testing None ❑Unknown ❑other be Pi ing: Flow-Restricting Leak Detector(s) for Pressurized Piping Monitoring Sump with Raceway ❑Sealed Concrete Raceway Half-Cut Compatible Pipe Raceway ❑Synthetic Liner Raceway M Mor ❑unknown ❑Other *Describe Make & Model: 8. Tank Tightness etas This Tank been Tightness Tested? ❑Yes (2No ❑unknown Date 'of Last Tightness Test Results of Test Test Name —Testing Company 9, Tank Reir_ IMN'Repaired? ❑Yes Callo ❑Unknown__. .._ ..__..._._. . ..._._.. Date(s) of Repair(s) Describe Repairs ,h 100 Overfill Protection 0Opertitor F1117, Controls, & Visually Monitors ❑Tape Float Gauge ❑Float Vent Valves ❑Auto Shut Off Controls Capacitance Sensor ❑Sealed Fill Box ❑None ❑Unknown other: List Make & Model rot Above Devices : 11. Piping a, Underground Piping: ®Yes ONo ❑Unknown Material Thickness (inches) Diameter , Manufacturer ®Pressure .(]Suct on Gravity -Approximate Length of pe AM b. Underground Piping Corrosion Protection : []Galvanized []Fiberglass-Clad []Impressed Current ❑Sacrificial Anode ❑Polyethylene Wrap []Electrical Isolation JRVinyl Wrap ( Tar or Asphalt ❑Unknown ❑None ❑Other (describe) : e. Underground Piping, Secondary Containment: ❑Double-Wall , ❑Synthetic Liner System PNone ❑Unknown �I ❑other (describe)': TM ssociated Environmental Systems, Inc.* P.O. Box 80427 Bakersfield, CA 93380 AT (805) 393-2212 A PRECISION TANK & LINE TEST RESULTS INVOICE ADDRESS: TANK LOCATION: W.O.#: b A V I TECHNICIAN: po yc TECH.#: VAN#: t 0(C DATE: TIME START: END: TECH.-SIGNATRE: -0o FACILITY PHONE#: GROUNDWATER DEPTH: BLUE PR S: CONTACT: DATE;TIME SYSTEM WAS FILLED FOR TESTING: TANK CAP, PROD. TANK LINE P/L HIGH CAL LOW CAL V/R PROD + PUMP MAT P DIA. L F 2 3 4 6 ADDITIONAL INFORMATION(i.e.WEATHER,TANKS UNCOVERED?,RE-TEST?) SITE LOG J TIME SET UP EQUIP C-7)—F7 BLED PRODUCT LINES N BLED VAPOR LINES BLED VENT LINES --- ------ BLED TURBINE BLED SUCTION PUMP RISERS INSTALLED WATER IN TANKS INCHES TANK 1 TANK 2 TANK 3 a) ABOVE RESULTS ARE PROVISIONAL. FINAL RESULTS ISSUED FROM A.E.S.,BAKERSFIELD. b) +or-0.05 GPH IS USED TO CERTIFY TIGHTNESS. c) THESE RESULTS OBTAINED USING THE PATENTED A.E.S./BROCKMAN SYSTEM. d) THIS SYSTEM AND METHOD MEETS THE CRITERIA SET FORTH IN NFPA#329. JLB1 • � _ ... • .�,� • 1 \s� i \a�l.�� .i^ �`}- �. `' �� � ��� ����� L��'� �,�� �- , . _ ,, � °. � �•� �\ )' ,,`t �� • ........ .. L--.c R.— c--y IF.::: ir-AW-0 T— .:IL. i=E• .-H. C:3 F-B ........... ............ ............... Te c h n i c i An YOUNG 1 C a I i L)r- 't i n V I u a I:. I ............... 1 Da-te 4/14/87 1 Sys•tem varia-tior) 1 S I..: f-.� F:,1­4 ................................................................................................................................. Time Started 15 C)C) Tank Only 6p / I qz 1 ................................................. Gal Ions 12 1 F1 r(:I d u n e AAIA Gallons Added 5 F3 C-)C) 1 Non F`r(`asure ......................................... ................... ...........I......... Hrs Since Adcled 1.w-+° 1 N o t e l4i.i .................... Iw 11 51 i9pili I ii tt Pe it, P. + It dud, it ,11,[ 15 ikR 2 5 WfiIili nit 11lu 111)C U."Sil N -t e s HAPP GAS , TAFT HWY., & WIF-3LE-1 RD. L-'IAI,**,I*-' I"i"-.:)F'.1'.I..:*I Dj CA THIS IS A MIDLEVEL. WITH A 2X• CAL. 1-HE LEVEL. DURING 1-1-11F.3 T*EST IS, 1.3'. 5" A8C)VE 1"(-)N1-::' ` ��. ~���� �� �� ��� ��� �� � s� � ��� � ���� � _�-_'-___________________________________________________________________________ � 1 Techniciin YOUNG | Calibration Value ~al --~ -------- -_-~-----------------------------------------------02.J ,0� ------- `) | .Date 4/14/87 | System Variation | Scale | GPH | ' __-__-_________________________________________________________________________ 1 Time Started 17: 10 | Tank Only ( 411� ­4___________________ _______________________________________________-��_____ ' 1 Gallons 121:'.' | Product Line | � | ----------_----------------------------------------------------------------------- | Gallons Added -1 . 6 | Non Pressure Lines \ ---------------------------_---------------------------------------------- ___ ` | Hrs Since Added 0 1 Notes � ___________-___________________________________________________________________ / � |U ' 17�� A my WAS MA T q. l�N , 2=m �K ED �^ � -- �� �.���� 1� ���� �� Flo 011t:^ ^11La~Wwi', I all" |r:��" : ! ** Notes ` HAPPY GAS v 3221 TAFT HWY & WIBLE RD. , BAKERSFIELD,CA. THIS IS A LOW LEVEL TEST WITH A 2X-CAL. | ( THYLEVEL DURING THTS TEST 19 " 5o ABOVE THE TANK TOP. THE LAST 15 MIN. THE LEVEL DROPPED BELOW THE BOTTOM OF THE FILL NECK AND INTO THE TANK ITSELF. \ \ ''. ^^ � n 1 1987 KERN DEPT. /J PERMIT CHECKLIST Facility (pAlV&-A/)&IV- c / �i/J 19,P_,_r—_T Permit zoo )I C__ This checklist is provided to ensure that all necessary packet enclosures were received and that the Permittee has obtained all necessary equipment to implement the first phase of monitoring requirements. Please complete this form and return to KCHD in the self-addressed envelope provided within 30 days of receipt. Check: Yes No A. The packet I received contained: 1) Cover Letter, Permit Checklist, Interim Permit, Phase I Interim Permit Monitoring -Requirements, Information Sheet (Agreement Between Owner and Operator) , Chapter 15 (KCOC #G-3941) , Explanation of Substance Codes, Equipment Lists and Return Envelope. 2) Standard Inventory Control Monitoring Handbook #UT-10. 3) The Following Forms: a) Inventory Recording Sheet b) Inventory Reconciliation Sheet with summary on reverse c) Trend Analysis Worksheet _ 4) An Action Chart (to post at facility) B. I have examined the information on my Interim Permit, Phase I Monitoring Requirements, and. Information Sheet (Agreement between Owner and Operator) , and find owner' s name and address, facility name and address, operator's name and address, substance codes; and number of tanks to be accurately listed (if "no" is checked, note appropriate corrections on the back side of this sheet) . C. I have the following required equipment (as described on page 6 of Handbook) : _ 1) Acceptable gauging instrument _ X 2) "Striker plate(s)" in tank(s) _ 3) Water-finding paste D. I have read the information on the enclosed "Information Sheet" pertaining to Agreements between Owner and Operator and hereby state that the owner of this facility is the operator (if "no" is checked, attach a copy of agreement between owner and operator) . _ E. I have enclosed a copy of Calibration Charts for all tanks at this facility (if tanks are identical, one chart will suffice; label chart(s) with corresponding tank numbers listed on permit) . 9-y-P6 F. As required on page 6 of Handbook #UT-10, all meters at this facility have had calibration checks within the last 30 days and were calibrated by a registered device repairman if out of tolerance (all meter calibrations must be recorded on "Meter Calibration Check Form" found in the Appendix of Handbook) . G. Standard Inventory Control Monitoring was started at this facility in accordance with procedures described in Handbook #UT-10. Date Started I S . I q� n�/f� n Signature of Person Completing Checklist: PO�Q _ � ate. d0Jl_/�Xd!-�_ Title: O P �?1 DPI//iZ_ �r¢/ i1/ 1C 1 .5Ll�P( V).S 0� Date: y"a C9 CSI s 0 3 o cr � � o di 60 0' lu a CONVENIENCE MARKET product: EXXON REGULAR 12000 gal. TANK CHART Prepared by DAVIES OIL COMPANY P.O. Box 80067 Bakersfield, Ca. 93380 (805)323-6063 TANK DIAMETER = 95.00 inches TANK LENGTH = 383 inches TANK ANGLE = 1.15 degrees STICK POINT = 371 inches 0.00 0 12.00 523 24.00 1859 36.00 3542 48.00 5390 60.00 7267 72.00 9054 84.00 10599 0.25 27 12.25 545 24.25 1891 36.25 3580 48.25 5429 60.25 7306 72.25 9089 84.25 10627 0.50 39 12.50 568 24.50 1923 36.50 3617 48.50 5468 60.50 7345 72.50 9124 84.50 10655 0.75 52 12.75 591 24.75 1956 36.75 3654 48.75 5507 60.75 7383 72.75 9159 84.75 10683 1.00 64 13.00 614 25.00 1989 37.00 3692 49.00 5547 61.00 7422 73.00 9194 85.00 10711 1.25 75 13.25 637 25.25 2022 37.25 3730 49.25 5586 61.25 7460 73.25 9229 85.25 10738 1.50 85 13.50 661 25.50 2055 37.50 3767 49.50 5625 61.50 7499 73.50 9264 85.50 10765 1.75 95 13.75 685 25.75 2088 37.75 3805 49.75 5664 61.75 7537 73.75 9299 85.75 10792 2.00 104 14.00 709 26.00 2121 38.00 3843 50.00 5704 62.00 7575 74.00 9333 86.00 10819 2.25 112 14.25 734 26.25 2155 38.25 3881 50.25 5743 62.25 7613 74.25 9367 86.25 10845 2.50 121 14.50 759 26.50 2188 38.50 3918 50.50 5782 62.50 7652 74.50 9402 86.50 10871 2.75 128 14.75 784 26.75 2222 38.75 3956 50.75 5821 62.75 7690 74.75 9436 86.75 10897 • 3.00 135 15.00 809 27.00 2256 39.00 3994 51.00 5861 63.00 7728 75.00 9470 87.00 10923 3.25 141 15.25 835 27.25 2290 39.25 4032 51.25 5900 63.25 7766 75.25 9504 87.25 10949 3.50 147 15.50 860 27.50 2324 39.50 4071 51.50 5939 63.50 7804 75.50 9538 87.50 10974 3.75 152 15.75 887 27.75 2358 39.75 4109 51.75 5979 63.75 7842 75.75 9571 87.75 10999 4.00 156 16.00 913 28.00 2392 40.00 4147 52.00 6018 64.00 7880 76.00 %05 88.00 11024 4.25 161 16.25 939 28.25 2427 40.25 4185 52.25 6057 64.25 7918 76.25 9638 88.25 11048 4.50 165 16.50 %6 28.50 2461 40.50 4224 52.50 60% 64.50 7955 76.50 %71 88.50 11072 4.75 168 16.75 993 28.75 24% 40.75 4262 52.75 6136 64.75 7993 76.75 9705 88.75 110% 5.00 171 17.00 1020 29.00 2530 41.00 4300 53.00 6175 65.00 8031 77.00 9738 89.00 11120 5.25 174 17.25 1048 29.25 2565 41.25 4339 53.25 6214 65.25 8068 77.25 9770 89.25 11143 5.50 176 17.50 1075 29.50 2600 41.50 4377 53.50 6253 65.50 8106 77.50 9803 89.50 11166 5.75 177 17.75 1103 29.75 2635 41.75 4416 53.75 6292 65.75 8143 77.75 9836 89.75 11189 6.00 179 18.00 1131 30.00 2671 42.00 4454 54.00 6332 66.00 8181 78.00 9868 90.00 11212 6.25 180 I&25 1159 30.25 2706 42.25 4493 54.25 6371 66.25 8218 78.25 9901 90.25 11234 6.50 181 18.50 1188 .30.50 2741 42.50 4532 54.50 6410 66.50 8255 78.50 9933 90.50 11256 6.75 181 18.75 1216 30.75 2717 42.75 4570 54.75 6449 66.75 8292 78.75 9%5 90.75 11278 7.00 182 19.00 1245 31.00 2812 43.00 4609 55.00 6488 67.00 8329 79.00 9997 91.00 11299 7.25 182 19.25 1274 31.25 2848 43.25 4648 55.25 6527 67.25 8366 79.25 10028 91.25 11320 7.50 184 19.50 1303 31.50 2884 43.50 4687 55.50 6567 67.50 8403 79.50 10060 91.50 11340 7.75 199 19.75 1333 31.75 2920 43.75 4726 55.75 6606 67.75 8440 79.75 10091 91.75 11360 8.00 215 20.00 1362 32.00 2956 44.00 4765 56.00 6645 68.00 8477 80.00 10123 92.00 11380 8.25 231 20.25 1392 32.25 2992 44.25 4803 56.25 6684 68.25 8514 80.25 10154 92.25 11400 8.50 248 20.50 1422 32.50 3028 44.50 4842 56.50 6723 68.50 8550 80.50 10185 92.50 11419 &75 265 20.75 1452 32.75 3064 44.75 4881 56.75 6762 68.75 8587 80.75 10215 92.75 11438 9.00 282 21.00 1482 33.00 3100 45.00 4920 57.00 6801 69.00 8623 81.00 10246 93.00 11456 9.25 300 21.25 1513 33.25 3137 45.25 4959 57.25 6840 69.25 90 81.25 10276 93.25 11474 9.50 319 21.50 1544 33.50 3173 45.50 4998 57.50 6879 69.50 86% 81.50 10307 93.50 11491 9.75 337 21.75 1574 33.75 3210 45.75 5037 57.75 6918 69.75 8732 81.75 10337 93.75 11508 10.00 357 22.00 1605 34.00 3246 46.00 5077 58.00 6957 70.00 8768 82.00 10367 94.00 11525 10.25 376 22.25 1636 34.25 3283 46.25 5116 58.25 69% 70.25 8804 82.25 103% 94.25 11541 10.50 3% 22.50 1668 34.50 3320 46.50 5155 58.50 7035 70.50 8840 82.50 10426 94.50 11556 10.75 416 22.75 1699 34.75 3357 46.75 5194 58.75 7074 70.75 8876 82.75 10455 94.75 11571 11.00 437 23.00 1731 35.00 3394 47.00 5233 59.00 7113 71.00 8912 83.00 10484 95.00 11585 11.25 458 23.25 1763 35.25 3431 47.25 5272 59.25 7151 71.25 8948 83.25 10513 11.50 479 23.50 1794 35.50 3468 47.50 5312 59.50 7190 71.50 8983 83.50 10542 11.75 501 23.75 1826 35.75 3505 47.75 5351 59.75 7229 71.75 9019 8175 10571 12.00 523 24.00 1859 36.00 3542 48.00 5390 60.00 7267 72.00 9054 84.00 10599 CONVENIENCE MARKET product: EXXON UNLEADED 12000 gal. TANK CHART � k Prepared by DAVIES OIL COMPANY P.O. Box 80067 Bakersfield, Ca. 93380 (805)323-6063 TANK DIAMETER = 95.00 inches TANK LENGTH = 383 inches TANK ANGLE = 0.83 degrees STICK POINT = 371 inches 0.00 0 12.00 610 24.00 1989 36.00 3694 48.00 5550 60.00 7426 72.00 9199 84.00 10717 0.25 20 12.25 634 24.25 2022 36.25 3731 48.25 5589 60.25 7464 72.25 9234 84.25 10744 0.50 30 12.50 658 24.50 2055 36.50 3769 48.50 5628 60.50 7503 72.50 9269 84.50 10771 0.75 " 40 12.75 682 24.75 2088 36.75 3807 48.75 5668 60.75 7541 72.75 9304 84.75 10798 1.00 49 13.00 706 25.00 2122 37.00 3845 49.00 5707 61.00 7579 73.00 9338 85.00 10825 1.25 58 13.25 731 25.25 2155 37.25 3883 49.25 5746 61.25 7618 73.25 9372 8125 10852 1.50 66 13.50 756 25.50 2189 37.50 3920 49.50 5785 61.50 7656 73.50 9407 85.50 10878 1.75 72 13.75 781 25.75 2222 37.75 3958 49.75 5825 61.75 7694 73.75 9441 85.75 10904 2.00 79 14.00 807 26.00 22% 38.00 3997 50.00 5864 62.00 7732 74.00 9475 86.00 10930 2.25 84 14.25 832 26.25 2290 38.25 4035 50.25 5903 62.25 7770 74.25 9509 86.25 10955 2.50 89 14.50 858 26.50 2324 38.50 4073 50.50 5942 62.50 7808 74.50 9543 86.50 10981 2.75 94 14.75 884 26.75 2358 38.75 4111 50.75 5982 62.75 7846 74.75 9576 86.75 11006 3.00 98 15.00 911 27.00 2393 39.00 4149 51.00 6021 63.00 78M 75.00 %10 87.00 11031 3.25 101 15.25 937 27.25 2427 39.25 4187 51.25 6060 63.25 7922 75.25 %43 87.25 11055 3.50 104 15.50 %4 27.50 2462 39.50 4226 51.50 6099 63.50 7%0 75.50 %77 87.50 11079 3.75 106 15.75 991 27.75 24% 39.75 4264 51.75 6139 63.75 7997 75.75 9710 87.75 11104 4.00 107 16.00 1018 28.00 2531 40.00 4303 52.00 6178 64.00 6035 76.00 9743 88.00 11127 4.25 109 16.25 1046 28.25 2566 40.25 4341 52.25 6217 64.25 8073 76.25 9776 88.25 11151 4.50 110 16.50 1073 28.50 2601 40.50 4380 52.50 6256 64.50 8110 76.50 9809 88.50 11174 4.75 110 16.75 1101 28.75 2636 40.75 4418 52.75 62% 64.75 8148 76.75 %41 88.75 11197 5.00 111 17.00 1129 29.00 2671 41.00 4457 53.00 6335 65.00 8185 77.00 9874 89.00 11219 5.25 111 17.25 1158 29.25 2707 41.25 44% 53.25 6374 65.25 8222 77.25 9906 89.25 11242 5.50 119 17.50 1186 29.50 2742 41.50 4534 53.50 6413 65.50 8260 77.50 9938 89.50 11264 5.75 132 17.75 1215 29.75 2778 41.75 4573 53.75 6453 65.75 8297 77.75 9970 89.75 11285 6.00 146 18.00 1244 30.00 2813 42.00 4612 54.00 6492 66.00 8334 78.00 10002 90.00 11307 6.25 160 18.25 1273 30.25 2849 42.25 4650 54.25 6531 66.25 8371 78.25 10034 90.25 11328 6.50 175 18.50 1302 30.50 2885 42.50 4689 54.50 6570 66.50 8408 78.50 10065 90.50 11349 6.75 191 18.75 1332 30.75 2921 42.75 4728 54.75 6609 66.75 8445 78.75 10097 90.75 11369 7.00 207 19.00 1361 31.00 2957 43.00 4767 55.00 6649 67.00 8482 79.00 10128 91.00 11389 7.25 224 19.25 1391 31.25 2993 43.25 4806 55.25 6688 67.25 8518 79.25 10159 91.25 11409 7.50 241 19.50 1421 31.50 3029 43.50 4845 55.50 6727 67.50 8555 79.50 10190 91.50 11428 7.75 258 19.75 1451 31.75 3065 43.75 4884 55.75 6766 67.75 8592 79.75 I0221 91.75 11447 8.00 276 20.00 1482 32.00 3102 44.00 4923 56.00 6805 68.00 8628 80.00 10252 92.00 11465 8.25 294 20.25 1512 32.25 3138 44.25 4%2 56.25 6844 68.25 8664 80.25 10282 92.25 11483 8.50 313 20.50 1543 32.50 3175 44.50 5001 56.50 6883 68.50 8701 80.50 10312 92.50 11501 8.75 332 20.75 1574 32.75 3211 44.75 5040 56.75 6922 68.75 8737 80.75 10342 92.75 11518 9.00 351 21.00 1605 33.00 3248 45.00 5079 57.00 6%1 69.00 8773 81.00 10372 93.00 11535 9.25 371 21.25 1636 33.25 3285 45.25 5119 57.25 7000 69.25 8809 81.25 10402 93.25 11551 9.50 391 21.50 1667 33.50 3321 45.50 5158 57.50 7039 69.50 8845 81.50 10432 93.50 11567 9.75 412 21.75 1699 33.75 3358 45.75 5197 57.75 7078 69.75 8881 81.75 10461 93.75 11583 10.00 432 22.00 1730 34.00 33% 46.00 5236 58.00 7116 70.00 8917 82.00 10490 94.00 11597 10.25 454 22.25 1762 34.25 3432 46.25 5275 58.25 7155 70.25 8952 82.25 10519 94.25 11612 10.50 475 22.50 1794 34.50 3470 46.50 5315 58.50 7194 70.50 8988 82.50 10548 94.50 11625 10.75 497 22.75 1826 34.75 3507 46.75 5354 58.75 7233 70.75 9024 82.75 10577 94.75 11638 11.00 519 23.00 1859 35.00 3544 47.00 5393 59.00 7271 71.00 9059 8100 10605 95.00 11651 11.25 541 23.25 1891 35.25 3581 47.25 5432 59.25 7310 71.25 9094 83.25 10633 11.50 564 23.50 1923 35.50 3619 47.50 5472 59.50 7349 71.50 9129 83.50 10661 11.75 587 23.75 1956 35.75 36% 47.75 5511 59.75 7387 71.75 9164 83.75 10689 12.00 610 24.00 1989 36.00 3694 48.00 5550 60.00 7426 72.00 9199 84.00 10717 CONVENIENCE MARKET product: EXXON EXTRA UNLEADED 12000 gal. TANK CHART Prepared by DAVIES OIL COMPANY P.O. Box 80067 Bakersfield, Ca. 93380 (805)323-6063 TANK DIAMETER = 95.00 Inches TANK LENGTH = 383 inches TANK ANGLE = 0.99 degrees STICK POINT = 371 inches 0.00 0 12.00 566 24.00 1925 36.00 3619 48.00 5471 60.00 7348 72.00 9128 84.00 10660 0.25 23 12.25 589 24.25 1957 36.25 3657 48.25 5510 60.25 7387 72.25 9163 84.25 10687 0.50 35 12.50 613 24.50 1990 36.50 3694 48.50 5550 60.50 7425 72.50 9198 84.50 10715 0.75 46 12.75 636 24.75 2023 36.75 3732 48.75 5589 60.75 7464 72.75 9233 84.75 10742 1.00 57 13.00 660 25.00 2056 37.00 3770 49.00 5628 61.00 7502 73.00 9268 85.00 10769 1.25 66 13.25 684 25.25 2089 37.25 3807 49.25 5667 61.25 7540 73.25 9302 85.25 107% 1.50 76 13.50 709 25.50 2122 37.50 3845 49.50 5707 61.50 7579 73.50 9337 85.50 10823 1.75 84 13.75 733 25.75 2156 37.75 3883 49.75 5746 61.75 7617 73.75 9371 85.75 10850 2.00 92 14.00 758 26.00 2190 38.00 3921 50.00 5785 62.00 7655 74.00 9406 86.00 10876 2.25 99 14.25 783 26.25 2223 38.25 3959 50.25 5824 62.25 7693 74.25 9440 86.25 10902 2.50 105 14.50 809 26.50 2257 38.50 3997 50.50 5864 62.50 7731 74.50 9474 86.50 10928 2.75 111 14.75 834 26.75 2291 38.75 4035 50.75 5903 62.75 7770 74.75 9508 86.75 10953 3.00 117 15.00 860 27.00 2325 39.00 4073 51.00 5942 63.00 7808 75.00 9541 87.00 10978 3.25 121 15.25 886 27.25 2359 39.25 4111 51.25 5982 63.25 7845 75.25 9575 87.25 11003 3.50 126 15.50 912 27.50 2394 39.50 4149 51.50 6021 63.50 7883 75.50 %09 87.50 11028 3.75 129 15.75 939 27.75 2428 39.75 4188 51.75 6060 63.75 7921 75.75 9642 87.75 11053 4.00 133 16.00 %6 28.00 2463 40.00 4226 52.00 6099 64.00 7959 76.00 %75 88.00 11077 4.25 135 16.25 993 28.25 2497 40.25 4264 52.25 6139 64.25 7997 76.25 9709 88.25 11101 4.50 138 16.50 1020 28.50 2532 40.50 4303 52.50 6178 64.50 8034 76.50 9742 88.50 11125 4.75 140 16.75 1047 28.75 2567 40.75 4341 52.75 6217 64.75 8072 76.75 9774 88.75 11148 5.00 141 17.00 1075 29.00 2602 41.00 4380 53.00 6256 65.00 8109 77.00 9807 89.00 11171 5.25 142 17.25 1103 29.25 2637 41.25 4418 53.25 6295 65.25 8147 77.25 9840 89.25 11194 5.50 143 17.50 1131 29.50 2672 41.50 4457 53.50 6335 65.50 8184 77.50 9872 89.50 11217 5.75 144 17.75 1159 29.75 2707 41.75 4496 53.75 6374 65.75 8222 77.75 9905 89.75 11239 6.00 144 18.00 1188 30.00 2743 42.00 4534 54.00 6413 66.00 8259 78.00 9937 90.00 11261 6.25 144 18.25 1217 30.25 2778 42.25 4573 54.25 6452 66.25 82% 78.25 9%9 90.25 11283 6.50 151 1&50 1245 30.50 2814 42.50 4612 54.50 6491 66.50 8333 78.50 10001 90.50 11304 6.75 165 18.75 1274 30.75 2850 42.75 4651 54.75 6531 66.75 8370 7&75 10032 90.75 11325 7.00 180 19.00 1304 31.00 2885 43.00 4689 55.00 6570 67.00 8407 79.00 10064 91.00 11345 7.25 195 19.25 1333 31.25 2921 43.25 4728 55.25 6609 67.25 8444 79.25 10095 91.25 11366 7.50 211 19.50 1363 31.50 2957 43.50 4767 55.50 6648 67.50 8481 79.50 10127 91.50 11386 7.75 227 19.75 1393 31.75 2993 43.75 4806 55.75 6687 67.75 8517 79.75 10158 91.75 11405 8.00 244 20.00 1423 32.00 3030 44.00 4845 56.00 6726 68.00 8554 80.00 10189 92.00 11424 8.25 262 20.25 1453 32.25 3066 44.25 4884 56.25 6766 68.25 8591 80.25 10219 92.25 11443 8.50 279 20.50 1483 32.50 3102 44.50 4923 56.50 6605 68.50 8627 80.50 10250 92.50 11462 8.75 297 20.75 1514 32.75 3139 44.75 4962 56.75 6844 68.75 8664 80.75 10280 92.75 11480 9.00 316 21.00 1544 33.00 3175 45.00 5001 57.00 6883 69.00 8700 81.00 10311 93.00 11497 9.25 335 21.25 1575 33.25 3212 45.25 5040 57.25 6922 69.25 8736 81.25 10341 93.25 11514 9.50 354 21.50 1606 33.50 3248 45.50 5079 57.50 6%1 69.50 8772 81.50 10371 93.50 11531 9.75 374 21.75 1637 33.75 3285 45.75 5118 57.75 6999 69.75 8808 81.75 10400 93.75 11547 10.00 394 22.00 1668 34.00 3322 46.00 5158 5&00 7038 70.00 8844 82.00 10430 94.00 11563 10.25 414 22.25 1700 34.25 3359 46.25 5197 58.25 7077 70.25 8880 82.25 10459 94.25 11578 10.50 435 22.50 1732 34.50 33% 46.50 5236 58.50 7116 70.50 8916 82.50 10489 94.50 11593 10.75 456 22.75 1763 34.75 3433 46.75 5275 58.75 7155 70.75 8951 82.75 10518 94.75 11607 11.00 478 23.00 1795 35.00 3470 47.00 5314 59.00 7193 71.00 8987 83.00 10546 95.00 11620 11.25 499 23.25 1827 35.25 3507 47.25 5354 59.25 7232 71.25 9022 83.25 10575 11.50 521 23.50 1860 35.50 3544 47.50 5393 59.50 7271 71.50 90M 83.50 10603 11.75 544 23.75 1892 35.75 3582 47.75 5432 59.75 7309 71.75 9093 8175 10632 12.00 566 24.00 1925 36.00 3619 4&00 5471 60.00 7348 72.00 9128 84.00 10660 CONVENIENCE MARKET product: EXXON DIESEL 12000 gal_ TANK CHART Prepared by DAVIES OIL COMPANY P. O. Box 80067 Bakersfieldg Ca. 93380 (805)323-6063 TANK DIAMETER = 95.00 inches TANK LENGTH = 383 inches TANK ANGLE = 0.25 degrees STICK POINT = 371 inches 0.00 0 12.00 782 24.00 2228 36.00 3%6 48.00 5834 60.00 7704 72.00 9451 84.00 10914 0.25 7 12.25 808 24.25 2262 36.25 4004 48.25 5873 60.25 7742 72.25 9485 84.25 10940 0.50 12 12.50 834 24.50 2296 36.50 4042 48.50 5912 60.50 7780 72.50 9519 84.50 10966 0.75 15 12.75 860 24.75 2330 36.75 4081 48.75 5951 60.75 7818 72.75 9553 84.75 10991 1.00 17 13.00 886 25.00 2364 37.00 4119 49.00 5990 61.00 7856 73.00 9587 85.00 11016 1.25 18 13.25 913 25.25 2399 37.25 4157 49.25 6029 61.25 7894 73.25 %20 85.25 11041 1.50 18 13.50 939 25.50 2433 37.50 4195 49.50 6069 61.50 7932 73.50 %54 85.50 11066 1.75 23 13.75 %6 25.75 2468 37.75 4234 49.75 6108 61.75 7970 73.75 %87 85.75 11090 2.00 31 14.00 993 26.00 2503 38.00 4272 50.00 6148 62.00 8007 74.00 9720 86.00 11114 2.25 40 14.25 1021 26.25 2537 38.25 4311 50.25 6187 62.25 8045 74.25 9753 86.25 11138 2.50 50 14.50 1048 26.50 2572 38.50 4349 50.50 6226 62.50 8083 74.50 9786 86.50 11161 2.75 61 14.75 1076 26.75 2607 38.75 4388 50.75 6266 62.75 8120 74.75 9819 86.75 11185 3.00 73 15.00 1104 27.00 2643 39.00 4426 51.00 6305 63.00 8158 75.00 9851 87.00 11208 3.25 85 15.25 1132 27.25 2678 39.25 4465 51.25 6344 63.25 8195 75.25 9884 87.25 11230 3.50 98 15.50 1161 27.50 2713 39.50 4504 51.50 6383 63.50 8232 75.50 9916 87.50 11253 3.75 111 15.75 1189 27.75 2749 39.75 4542 51.75 6423 63.75 8270 75.75 9948 87.75 11275 4.00 125 16.00 1218 28.00 2784 40.00 4581 52.00 6462 64.00 8307 76.00 9980 88.00 11296 4.25 140 16.25 1247 28.25 2820 40.25 4620 52.25 6501 64.25 8344 76.25 10012 88.25 11318 4.50 155 16.50 1276 28.50 2856 40.50 4659 52.50 6541 64.50 8381 76.50 10044 88.50 11339 4.75 170 16.75 1306 28.75 2891 40.75 4698 52.75 6580 64.75 8418 76.75 10076 88.75 11360 5.00 186 17.00 1335 29.00 2927 41.00 4737 53.00 6619 65.00 8455 77.00 10107 89.00 11380 5.25 203 17.25 1365 29.25 2963 41.25 4776 53.25 6658 65.25 8492 77.25 10138 89.25 11400 5.50 219 17.50 1395 29.50 3000 41.50 4815 53.50 6697 65.50 8528 77.50 10169 89.50 11420 5.75 237 17.75 1425 29.75 3036 41.75 4854 53.75 6736 65.75 8565 77.75 10200 89.75 11439 6.00 255 18.00 1455 30.00 3072 42.00 4893 54.00 6775 66.00 8602 78.00 10231 90.00 11458 6.25 273 18.25 1486 30.25 3108 42.25 4932 54.25 6815 66.25 8638 78.25 10262 90.25 11477 6.50 291 18.50 1516 30.50 3145 42.50 4971 54.50 6854 66.50 8674 78.50 10292 90.50 11495 6.75 310 18.75 1547 30.75 3182 42.75 5010 54.75 6893 66.75 8711 78.75 10323 90.75 11513 7.00 329 19.00 1578 31.00 3218 43.00 5049 55.00 6932 67.00 8747 79.00 10353 91.00 11530 7.25 349 19.25 1609 31.25 3255 43.25 5088 55.25 6971 67.25 8783 79.25 10383 91.25 11547 7.50 369 19.50 1640 31.50 3292 43.50 5127 55.50 7010 67.50 8819 79.50 10412 91.50 11564 7.75 389 19.75 1672 31.75 3329 43.75 5166 55.75 7048 67.75 8855 79.75 10442 91.75 11580 8.00 410 20.00 1703 32.00 3366 44.00 5206 56.00 7087 68.00 8891 80.00 10471 92.00 11595 8.25 431 20.25 1735 32.25 3403 44.25 5245 56.25 7126 68.25 8927 80.25 10501 92.25 11610 8.50 453 20.50 1767 32.50 3440 44.50 5284 56.50 7165 68.50 8963 80.50 10530 92.50 11625 8.75 474 20.75 1799 32.75 3477 44.75 5323 56.75 7204 68.75 8998 80.75 10558 92.75 11639 9.00 4% 21.00 1831 33.00 3514 45.00 5363 57.00 7242 69.00 9034 81.00 10587 93.00 11653 9.25 519 21.25 1863 33.25 3551 45.25 5402 57.25 7281 69.25 9069 81.25 10616 93.25 11665 9.50 541 21.50 18% 33.50 3589 45.50 5441 57.50 7320 69.50 9104 81.50 10644 93.50 11678 9.75 564 21.75 1928 33.75 3626 45.75 5481 57.75 7358 69.75 9139 81.75 10672 93.75 11689 10.00 587 22.00 1%1 34.00 3664 46.00 5520 58.00 7397 70.00 9174 82.00 10700 94.00 11700 10.25 611 22.25 1994 34.25 3701 46.25 5559 58.25 7435 70.25 9209 82.25 10727 94.25 11711 10.50 634 22.50 2027 34.50 3739 46.50 5599 58.50 7474 70.50 9244 82.50 10755 94.50 11720 10.75 658 22.75 2060 34.75 3777 46.75 5638 58.75 7512 70.75 9279 82.75 10782 94.75 11728 11.00 683 23.00 2094 35.00 3815 47.00 5677 59.00 7551 71.00 9314 83.00 10809 95.00 11736 11.25 707 23.25 2127 35.25 3852 47.25 5717 59.25 7589 71.25 9348 83.25 10836 11.50 732 23.50 2160 35.50 3890 47.50 5756 59.50 7627 71.50 9383 8150 10862 11.75 757 23.75 2194 35.75 3928 47.75 5795 59.75 7666 71.75 9417 83.75 10888 12.00 782 24.00 2228 36.00 3966 48.00 5834 60.00 7704 72.00 9451 84.00 10914 DAVIES OIL COMPANY DAVIES • Petroleum Marketing • Cardlock Fuels • Exxon Distributor P.O.Box 80067— Bakersfield,California 93380 — Phone(805)323-6063 E)KON r I,' CONVENIENCE MARKET 096-, owner of underground storage tanks located at 'S/E TAFT HWY /WIBLE RD. PUMPKIN CENTER have entered into this written. contract with VESTA LAKE, the operator of same, to fulfill a requirement of my Permit of Operate, #320018C. I have provided the operator with a copy of the Permit to Operate and Chapter .15 of the Ordinance. I, VESTA LAKE,.. operator of underground storage tanks located at 'S/E TAFT HWY/WIBLE RD.' PUMPKIN CENTER have received from CONVEN- IENCE MARKET 096 , owner of same, a copy of Permit to Operate #320018C and Chapter 15 of the Ordinance describing fines and penalties for non-compliance. I have read and understand my responsibilities under this Permit and agree to do the following: --monitor the underground tanks as specified in the Permit to Operate. --maintain appropriate records as required by the Permit to Operate. --implement all reporting procedures as required by the Permit. to Operate. --properly close the underground tanks as required by Permit to Operate. Sign d" � C c owner operator . . . . : . . . . date ��. date DAVIES OIL CO. INVENTORY RECONCILIATION SHEET PERMIT # STATION TANK# CAPACITY PRODUCT MONTH/YEAR 1 3 13 4&5 12 14 8 9 15 16 in , in. NET GROSS inven . i day/time fuel wat, inven. gal . gal . reduct sales d ust, thru ut O S O S Beginning / �� �� �� &MN daily mtd eek 1 week 2 week 3 ;reek 4 onth tot � I � L 12 a y5 zDCO0 3 NL. PP-EmiLAM El ® 9 /o i z000 o- _...3 .., �"...- U.-K).L P'l F- Im LA. 1...... H ).`1.. . U BAKERSFIELD FIRE DEPT. NDERGROUND STORAGE TANK E Prevention Services PERMIT APPLICATION H 8 A nap 1 Ln 900 Truxtun Ave., Ste. 210 TO CONSTRUCT/MODIFY/MINOR FIRS Bakersfield, CA 93301 MODIFICATION OF AN UST ARrN T Tel: (661)326-3979 Fax: (661) 852-2171 PERMIT NO. Page 1 of 1 TYPE OF APPLICATION: (Check one item only) ❑ NEW FACILITY ISTING FACILITY ❑ MODIFICATION OF FACILITY OR MODIFICATION OF FACILI STARTING DATE AGILITY NAME ,{� � , .� n XISTING-FACILITY PERMIT NO. AGILITY ADDRESS . o �l�-� � ITY IP CODE PE OF BUSINESS c , 'J-}\P��\ PN'# ANK OWNER HONE NO DDRESS OITY ZIP CODE CONTRACTOR A LICENSE NO. ICC NO. - ADDRESS..- ^ ITY IP 0 HONE.NO. AKERSFIELD CITY BUSINESS LICENSE NO. WORKMANS COMP NO: INSURER BRIEFLY DESCRIBE THE WORK TO BE DONE WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO.OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ❑YES ❑NO ❑YES ❑NO THIS SECTION IS FOR MOTOR FUEL TANK NO.`.:''. ='VOLUME. UNLEADED REGULAR PREMIUM IESEL VIATION THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK:NO: OLUME: ' NLEADED. REGULAR PREMIUM DIESEL AVIATION FOR OFFICIAL USE ONLY APPLICATION DATE FACILITY NO. NO.OF TANKS FEES$ The applicant has received understands and will comply with the attached conditions of the permit and any other state,local and federal Q egulations.77z orm has b n co et d under penalty of perjury,and to the best of my knowledge,is true and correct. \ C �OU' C") C L 7 GAL-, o APPROVED BY: APPLICANT NAME(PRINT) -7�XAPP�UCANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED (Rev.02/05) BILLING & PERMIT STATEMENT a 'a °sg BAKERSFIELD FIRE DEPT. Prevention Services ' FIRE PERMIT NO.: ARTNE r 1600 Truxtun Ave Ste 401 ,,, Bakersfield CA 93301 Tel.: (661) 326-3979 • Fax: (661) 852-2171 SITE INFORMATION LOCATION OF PROJECT p PROPERTY OWNER STARTING DATE (� 0-�a-61-!YETI N DA i�m NAME Q PROJECT NAME 11 ADDRESS C(� kc PHONE NO. PROJECT ADD S ` �.�(\,.., „ CITY � STATE ZIP con `�7�j 11J1)L CONTRACTOR •• • CONTRACTOR NAME CA LICENSE NO. TYPE OF LICENSE. EXPIRATION DATE PHONE NO. J 14rYt�S SCE f i�4c��N�1 3o is CONTRACTOR COMPANY NAME FAX NO. ADDRESS CITY ZIP CODE 9 All permits mast be reviewed; stamped,and approved PRIOR TO BEC41NNING WORK ON THAT PROJECT. � • • J • - ❑ Alarms-New&Modifications-(Minimum Charge) $280.00 ■ 84 ■ 98 ❑ Over 10,000 Sq. Ft. Sq.Ft.x.028=Permit fee . 98 ❑ Sprinklers-New&Modifications- (Minimum Charge) $280.00 ■ 84 • 98 ❑ Over 10,000 Sq.Ft. Sq.Ft.x.028=Permit fee 84 98 ❑ Minor Sprinkler Modifications(<10 heads) $96.00 [Inspection Only] ' 84 ' 98 ❑ Commercial Hoods—New&Modifications $470.00 ' 84 98 ❑ Additional Hoods $58.00 ■ 84 ■ 98 ❑ Spray Booths-New&Modifications $470.00 ■ 84 ' s8 ❑ Aboveground Storage Tanks(InstallatiordInsp.-1"Time) $180.00 ; 82 ❑ Additional Tanks $96.00 ; 82 • Aboveground Storage Tanks(Removal/Inspection) $109.00 ; 82 • Underground Storage Tanks(fnstallation.linspection) $878.00 (per tank) ■ 82 • Underground Storage Tanks(Modification) 0(per site) ■ 82 Underground Storage Tanks(Minor Modification) 11 67: ■ 82 • Underground Storage Tanks(RemovaQ $573.00 (per tank) ' 84 • Oilwell (Installation) $96.00 84 O C� ■ • Mandated Leak Detection(Testing)/Fuel Monit.CerUSB989. $`'96:66-(pew site)- f 9�, , ■ 82 Note: $96.00 for each type of test/per site(even if scheduled - ■ at the same time) ■ • Tents $96.00(per tend ' 84 • Pyrotechnic-(Per event,Plus Insp.Fee @$96 per hour) $96.00+(5 hrs.min.standby fee/Inspection)=$576..00 84 ❑ After hours inspection fee $121.00 a 84 • RE-INSPECTION(S)/FOLLOW-UP INSPECTION(S) $96.00 (per hour) ■ 84 • Portable LPG (Propane): NO.OF CAGES? $96.00 ■ 84 ❑ Explosive Storage $266.00 ' 84 ❑ Copying&File Research(File Research Fee$50.00 per hr) 250 per page 84 ❑ Miscellaneous 84 FD 2021(Rev.06/07) 1-ORIGINAL WHITE(to Treasury) 1-YELLOW (to File) 1-PINK (to Customer) J SWRCB,January 2002 Page-L.Of Secondary Containment Testing Report Form This form is intendedfor use by contractors performing periodic testing of USTsecondwy containment systems. Use the appropriate pages of this form to report results for all components testes/ 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: Date of Testing: /Q Facility Address: yp� $_ C,/#ff!L( d 5 FI E Facility Contact: Phone: Date Local Agency Was Notified of Testing: Name of Local Agency Inspector(f present during testing): -IJO'Vl 2. TESTING CONTRACTOR INFORMATION Company Name: 1(GN LLl- Technician Conducting Test: 0- Credentials: XCSLB Licensed Contractor D,SWRCB Licensed Tank'rester License Type: License Number: ma-M77 T-011MUNNENJIMSM Manufacturer'['rainine Manufacturer Component(s) Date Training Expires ZS-S 3. SUMMARY OF TEST RESULTS Component Pass Fail. Not Repairs Component Pass Fall Not Repairs Tested Made Tested ;*lade 11 ❑ ❑ ❑ o ❑ o ro S1 S� ❑ ❑ ❑ D ❑ ❑ ❑ u ❑ ❑ ❑ D ❑ ❑ ❑ ❑ u _❑ ❑ ❑ ❑ ❑ D D ❑ ❑ ❑ ❑ ❑ ❑ D u ❑ ❑ D ❑ D ❑ n ❑ ❑ C. ❑ ❑ ❑ ❑ ❑ D D ❑ 0 ❑ ❑ D ❑ . O ❑ D ❑ ❑. ❑ U ❑ ❑ :❑ D D If hydrostatic testing was performed,describe what was done with the water aft er completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge,the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature; Date: SWRCB,January 2002 Page of e� 6. PIPING SUMP TESTING Test Method Developed By: D Sump Manufacturer i_ Industry Standard ! !Professional Engineer Cl Other(Speer) Test Method Used: Pressure I.;Vacuum L'i Hydrostatic Other(Specify) Test Equipment Used: Equipment Resolution: Sump# `f / Sump# Sump# Sump Diameter: Sump Depth: Q,•u . a Sump Material: Fi$ 6 Height from Tank Top to Top of y �C Highest Piping Penetration: d Height from Tank Top to Lowest ��• ,� /,S Electrical Penetration: Condition of sump prior to testing: (,r -1--? Portion of Sump Tested' �Q• U Does turbine shut down when ),(Yes ;-'.No f_l NA sump sensor detects liquid(both ><Yes 1'No ' I NA :I Yes ; !No 1 ;NA i.I Yes CJ No i NA product and water)?` Turbine shutdown response time Is system programmed for fail safe X Yes No I:I NA shutdown?* , Yes L;No _l NA :.'Yes i_JNo NA .IYes I_i.No i.INA Was fail-safe verified to be %Yes J No NA operational?• X'es I No I l NA f.I Yes : :No I NA fl Yes !".No 11 NA Wait time between applying pressure/vacuum/water and starting 36 %e7, .v ,,•,. test: Test Start Time: Initial Reading(Rj): •715,v x,71 as).. J?aye.v Test End Time: lQ=07 0.41JI., PS e ly►,� Final Reading(RF): 2,'7 t yi v �,a •v .��a J,v Test Duration: 1 �,�,.v ,..� rs,,,,.�' ,..t,•v Change in Reading(RF-Rl): .&101,-v ppp, .pp -0 Pass/Fail Threshold or Criteria: -00a -V t?!J -v •b0�.^�' �d�''`� Was sensor removed for testing? Yes ;No D NA �Cyes :I:;No �NA I. Yes D No f;NA .I Yes I:.I No !NA Was sensor property replaced and KYes .1 No -1 NA verified functional after testing? XYes :f1No C:INA f.:-1Yes :'No I.INA I::iYes LINO ;'NA Comments—(include information on repairs made prior to testing,:and recommended follow-up forfailed 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) ONE STOP OP 10/27,r20@9 10:07 hM SUMP LEAK TEST REPO'T ONE STOP 402 9 CHESTER 91"37P 1).KER`FIELD TEST STAR TED 9-52 Al". 10/26/2009 1:5th mm TErT STARTED ].0/23,/2009 NE, - LEVEL 3.7151 IN, SUMP LEAK TEST REPORT �- 10:07 tl ENIti MATE 1 A0/23/2009 97STP =ND !._EUEL 3.7144 IN LEAK TRRESHOLD Q,00rt IN TEST S rARTED 1:43 AM TEST RESULT PASSED TEST 5 T ARTED 10/26/2009 BEt;1 i4 LEVEL 3.2210 JAN EN TI 1:58 An END DATE 2.E+r2C,%2019 END LEVEL 3.220' IN i-IAK THRESHOLD 0.002 ±N Y - TEST RESULT PASSED ONE ?TOP !:klin:r,' fx ONE STOP 2fiEi. 10:24 AM 402 S CHESTER S1`P LEAK 'ECi R-:PART AKER5F I ELD 91 y T? la/26/2009 2:14 AM TEST STARTED) SUMP _ERK. TEST REPOR.7 �.. ,.,... 10:09 :'!,^} TEST STARTED I 1OZ.23r2009 87--TP BFGIN LEVEL 3.7145 IN END TI1hE 1£x;24 AM LEST STARTED 1.59 AM END DATE END VE.L. 1�rr23r2009 TEST STARTED 1 flit C17 T ' 3.7143 I9 SEGIM LEUEL 3.220? IN L.-E THRESHOLD 0.002 IN END TIME 2:14 A!1 TF..ST RESULT PASSED NC� T�RTh l'0/26/2009 E: END "LEVEL. 3.2210 IN L.EAV THRESHOLD 0.002 IN TEST RESULT PASSED SB989 TESTING FAILURE REPORT SITE NAME: f?4110 DATE: /�J "oS ADDRESS: Y6W 1_ Gl TECHNICIAN: ey.,fy A-t^a'u CITY:. &1"LeLL4 SIGNATURE: 2// THE FOLLOWING COMPONENTS WERE REPLACEPAUiTAIRED06 COMPLETE TESTING. REPAIRS: T►h/4K- ,ova,, ✓ d . -✓ �/ STP Jvr-. {> fi KjEm r'oL L*2 LABOR: PARTS INTALLED: 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.