HomeMy WebLinkAboutSLOUNIFLOW_FS1 Admin iRC5235 Color_2976_001uocuY'igrl Envelope ID: 1317382FO-1BE5-44C5-8077-44603B6517DD
CITY OF SAN LUIS OBISPO FIRE DEPARTMENT
Permit Application for Closure of
Underground Hazardous Materials Storage: Tanks and Piping
Check # Fee $ ` { `L eml # '41s �� C` � L3 15 —'Z I
FACILITY: Name and Location NHC Dispensaries 2600 Broad St. San Luis Obispo, CA 93401
TANK OWNER:
Name: CCKL Br Contact:
Owner Signature 6A, ' u,.An ,
Mailing Address: St. San Luis Obispo, CA 93401
Telephone: J-+ I5) 740-4984
TANK OPERATOR: qTF- pR�C�"Cr�
Name: Unknown
Mailing Address:
CONTRACTOR:
KEITH SWEENEY
Date: 3/11 /2021
Telepl�ap -� 3 N71ON F�F4b
Name: Pacific Petroleum California, Inc. Telephone: _C805 925-1947
Mailing Address: PO Box 2646, Orcutt, CA 93457 6
License Number: 886124 Class: Gen - A 'ATM
TYPE OF CLOSURE:
® Removal ❑ Closure in place ❑ Temporary Closure Date of Closure:
Describe tank(s) and piping involved, include construction material and size:
unknown contents. Unknown piping until tanks are excavated.
Previous and existing contents: Unknown contents / fluids
Sampling performed by (Name, Address and Phone #):
Pacific Petroleum CA, Inc. , 1615 E. Betteravia Rd. Santa Maria, CA 93454
2-3'X10' UST's
Name of state certified lab testing the samples: Oilfield Environmental & Compliance ELAP# 2438
Final disposition of tank(s): Bedford Ent. Inc. 1940 W. Betteravia Rd. Santa Maria, CA 93455
Final disposition of piping:
1. Tanks and piping hauled off site as hazardous waste (not cleaned)
To state permitted facility:
Tank haz-waste transporter:
Address and phone number:
CAL EPA haz-waste transporter ID#
XX 2. Tanks and piping cleaned and hauled off site to metal salvager
Tank cleaning company: Pacific Petroleum California, Inc.
Address and phone number: 1615 E. Betteravia Rd. Santa Maria, CA 93454 805-925-1947
Metal salvage company: Bedford Ent. Inc.
Address and phone number 1940 W. Betteravia Rd. Santa Maria, CA 93455 805-922-9477
XX 3. Rinsate haz waste hauler: Pacific Petroleum California, Inc.
Address and phone number 1615 E. Betteravia Rd. Santa Maria, CA 93454 805-925-1947
CAL EPA haz-waste transporter ID# 136622
C \Users\jeff\Desktop\Fuel Tank\2600 Broad St SLO\Broad St UST Closure Permit Application, 2021 doc
2600 Broad St. Plot Plan
Legend: Red Line — Property Perimeter Blue Box — Fuel Tanks & Excavation Site
Excavation Site Sampling Legend
yS
= 8 Wall Samples & 4 Floor Samples