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Home My WebLink About2100 COSTA DEL MAR RD; ; CB162200; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 06-28-2016 Commercial/Industrial Permit Permit No: CB162200 Building Inspection Request Line (760) 602-2725 Job Address: 2100 COSTA DEL MAR RD CBAD Permit Type: Tl Sub Type: COMM Status: ISSUED Applied: 06/07/2016 Entered By: RMA Parcel No: 2165900100 Lot#: 0 Valuation: $20,000.00 Construction Type: NEW Occupancy Group: Reference# Project Title: OMNI LA COSTA RESORT-AT GOLF Plan Approved: 06/28/2016 Issued: 06/28/2016 Inspect Area Plan Check#: MAINTENANCE SERVICE YARD-REPLACE UNDERGROUND GASOLINE PIPING, REPLACE DISPENSER, NEW UNDERGROUND CONTAINMENT SYSTEM FOR GASOLINE WITH LOW VOLTAGE VEEDER ROOT SENSOR Applicant: JAUREGUI & CULVER INC 959 W MISSION AV ESCONDIDO, CA 92025 760 743-0518 Building Permit Add'l Building Permit Fee Plan Check Add'l Building Permit Fee Plan Check Discount Strong Motion Fee Park Fee LFM Fee Bridge Fee BTD #2 Fee BTD #3 Fee Renewal Fee Add'l Renewal Fee Other Building Fee Pot. Water Con. Fee Meter Size Add'l Pot. Water Con. Fee Reel. Water Con. Fee Green Bldg Stands (SB1473) Fee Fire Expedidted Plan Review $203.29 $0.00 $142.30 $0.00 $0.00 $5.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1.00 $182.50 Owner: L C INVESTMENT 2010 L L C 1601 ELM ST DALLAS TX 75201 Meter Size Add'l Reel. Water Con. Fee Meter Fee SDCWA Fee CFD Payoff Fee PFF (3105540) PFF (4305540) License Tax (31 04193) License Tax ( 4304193) Traffic Impact Fee (31 05541) Traffic Impact Fee (4305541) PLUMBING TOTAL ELECTRICAL TOTAL MECHANICAL TOTAL Master Drainage Fee Sewer Fee Redev Parking Fee Additional Fees HMP Fee Green Bldg Standards Plan Chk TOTAL PERMIT FEES Total Fees: $534.69 Total Payments To Date: $534.69 Balance Due: Inspector: FINAL APPROVAL Date: 7-liV Clearance: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ?? ?? $534.69 $0.00 I\OllCE: Please tci<e I\OllCE that apr:roval of yoor prqect includes tre "lrrpcsition" d fees, clfflications, reservations, or otrer exactions hereafter collectively referred to as ''fees' exactions." Yoo have 9J days fran the date this r:emlt WdS iSSUld to protest irrpcsition of these fees/exactions. If yoo protest them yoo rrust fallON the protest procroures set forth in <?overm:rn Ca:le Section eoozo(a), ard file tre protest ard any otrer require::! infonration vvith tre Oty 1V13na;;Jer for pr<XESSirg in aax:rclanre vvith Garlsba::l M.lnidpal Ca:le Section 3.32.030. Failure to tirrely fallON that procroure vvill bar any sub:;eql.Blt legal action to attad<, revieN, set aside, \tid, or annul treir irrpcsition. Yoo are rereby FLR1l-ER f\OllRED that yoor right to protest the sp:rified fees' exactions !XES 1\KJT PPA.. Y to vvater ard OONer oonnection fees ard capacity changes, nor plannirg, zonirg, gradirg or otrer sinilar application prcx:sssirg or servire fees in oonnection vvith this prqect. N::R !XES IT PPA.. Y to any fees'exactionsdv-k1ich oohave ·ousl l:ren il!ffiai\OllCEsinilartothis orastoVvtlichtrestatuteoflinitationshas ·ousl othervvise ·re::~. ) 'THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: 0PLANNING 0ENGINEERING Cicy of Carlsbad JOB ADDRESS ;). fOO CT/PROJECT # ADDRESS CITY PHONE EMAIL STATE FAX Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: building@carlsbadca.gov www.carlsbadca.gov SUITE#/SPACE#/UNIT# #BATHROOMS ZIP STATE LIC. # 0BULDING OF IRE OCC. GROUP (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any str o its issuance, also requires the applicant for such permit to file a signed statement tHat he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9, with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: D I have and will maintain a certificate of consent to self·insum for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ~ve and will maintain workers' , Section 3700 of the Labor Code, for the perfonmance of th .work for which this permit is issued. My workers' compensation ·nsur ce carrier and policy number are: Insurance Policy No. ~ ..3 -t, Expiration Date _L-F-Lf'-""""'<LL-.J:.... __ permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of co!]~,Pe.ns<•tio•r~~~rag•~..ttp:FAwful,and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in u.,,....,.f.f~~~Sodif'flf':-17.a!\ofthe Labor code, interest and attorney's fees. I hereby affirm that I am exempt from Contractor's License Law for the following reason: D D D I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). I am exempt under Section Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. DYes DNa 2. I (have I have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name address I phone I contractors' license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name I address I phone I contractors' license number): 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name I address I phone I type of work): ~PROPERTY OWNER SIGNATURE 0AGENT DATE ·=~='"'"~· or construction of structures over 3 stories in height. Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced l'lithin fbtl~t911oriz\~~·:h permit is suspended or abandoned at any time after the work is commenced for a of 180 days (Section 106.4.4 Uniform Building Code). DATE STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following OINL Y if a Certificate of Occupancy will be requested at final inspection. Fax (760) 602-8560, Email building@carlsbadca.gov or Mail the completed fonm to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008 . • (Office Use Only) Carlsbad CA OCCUPANT'S BUS. DELIVERY OPTIONS PICK UP: o CONTACT (Listed above) o OCCUPANT (Listed above) o CONTRACTOR (On Pg. 1) o ASSOCIATED CB#------------MAIL TO: o CONTACT (Listed above) o OCCUPANT (Listed above) o CONTRACTOR (On Pg. 1) o NO CHANGE IN USE/ NO CONSTRUCTION MAIL/ FAX TO OTHER:------------------o CHANGE OF USE/ NO CONSTRUCTION ,N5 APPLICANT'S SIGNATURE DATE I . n I Permit#: CB162200 Date Inspection Item 07/08/2016 39 Final Electrical Type: Tl COMM Inspector... Act Rl 07/08/2016 39 Final Electrical PB AP 07/05/2016 31 Underground/Conduit-Wirin Rl 07/05/2016 31 Underground/Conduit-Wirin PB AP OMNI LA COSTA RESORT-AT GOLF MAINTENANCE SERVICE YARD-REPLAC Comments DATE: June 15, 2016 JURISDICTION: Carlsbad PLAN CHECK NO.: 16-2200 EsGil Corporation In CJ?artnersnip witn government for (]Juiftfino Safety SET: I PROJECT ADDRESS: 2100 Costa Del Mar Road PROJECT NAME: La Costa Gasoline Dispensar Replacement ~ ~PLICANT iJl""J u R IS. 0 PLAN REVIEWER 0 FILE I:8J The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. D The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. D The check list transmitted herewith is for your information. The plans are being held at EsGil Corporation until corrected plans are submitted for recheck. D The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. D The applicant's copy of the check list has been sent to: I:8J EsGil Corporation staff didl not advise the applicant that the plan check has been completed. D EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: -Telephone#: Date contacted: --==-(~g) Email: Mail Telephone Fax In Person D REMARKS: By: Eric Jensen EsGil Corporation D GA D EJ D MB D PC Enclosures: 06/08 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576 Carlsbad 16-2200 ·June 15, 2016 [DO NOT PAY-THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PLAN CHECK NO.: 16-2200 PREPARED BY: Eric Jensen DATE: June 15, 2016 BUILDING ADDRESS: 2100 Costa Del Mar Road BUILDING OCCUPANCY: Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code cb By Ordinance Bldg. Permit Fee by Ordinance _3 Plan Check Fee by Ordinance Type of Review: D Complete Review D Repetitive Fee ~3 Repeats * Based on hourly rate Comments: D Other 0 Hourly EsGil Fee o Structural Only 11Hr.@ * :=====$=8=6=.0:0 $107.501 $86.001 Sheet 1 of 1 macvalue.doc + «' ~·CITY OF PLAN CHECK REVIEW TRANSMITTAL Community & Economic Development Department 1635 Faraday Avenue Carlsbad CA 92008 www.carlsbadca.gov RLSB DATE: 06/09/20U?ROJECT NAME:OMNILA COSTA HOTEL GAS LINE REPLAC PROJECT ID: CB162200 PLAN CHECK NO: 1 VALUATION: $20,000 SET#:1 ADDRESS: 1986 LA COSTA AVE APN: 2165901600 APPLICANT CONTACT:JOHN.CULVER@JEINCORP.NET D Tlis plan check review transmittal is to notify you of clearance by: LAND DEVELOPMENT ENGINEERING DIVISION Final Irnpe c tion by the Construction & Inspection Division is required: Yes No X ~ For status from a division not marked below, please call 760-602-2719 This plan check review is NCI'COMPLETE Items missing or incorrect are listed on the attached checklist. Please resubmit arne nded plans as required. 760-602-2773 linda.Ontiveros@carlsbadca.gov VALRAY MARSHALL 760-602-27 41 VALRA Y .MARSHALL@CARLSBADCA.GOV Remarks: THIS ON A PARCEL THAT IS NOT IMPACTED BY LDE AND IS SWITCHING OUT EXISTING FACILITIES. THE PARCEL AND ADDRESS ON THE APPLICATION ARE FOR THE HOTEL. CORRECT ADDRESS AND APN HSTED ABOVE PLANNING DIVISION BUILDING PLAN CHECK APPROVAL P-29 DATE: 6-8-16 PROJEC~T NAME: PROJECTID: Development Services Planning Division 1635 Faraday Avenue (760) 602-4610 www.carlsbadca.e:ov PLAN CHECK NO: CB 16>-2200 SET#: 1 ADDRESS: 2100 Costa Del Mar Rd APN: 216-590-16-00 [X] This plan check review is complete and has been APPROVED by the Planning Division. By: Chris Sexton A Final Inspection by the Planning Division is required DYes ~No You may also have corrections from one or more of the divisions listed below. Approval from these divisions may be required prior to the issuance of a building permit. Resubmitted plans should include corrections from all divisions. D This plan check re·view is NOT COMPLETE. Items missing or incorrect are listed on the attached checklist. Please resubmit amended plans as required. Plan Check APPROVAL has been sent to: For questions or clarifications on the attached checklist please contact the following reviewer as marked: 7so-so2-46:1.o ~ Chris Sexton 760-602-4624 Chris.Sexton@carlsbadca.gov D Gina Ruiz 760-602-4675 Gina.Ruiz@carlsbadca.gov D Veronica Morones 760-602-4619 760-602-2773 Veronica.Morones@carlsbadca.gov Remarks: replace underground gas pipeline FIRE PREVENTION 760-602A665 760-602-4664 Dominic.Fieri@carlsbadca.gov «~~) ~'c CITY OF RLSBAD PLAN CHECK Com!,J.\UJ\!\'\~,Economic REVIEW Bl.DG" DR~11~Dlpartment 1635 Faraday Avenue TRANSMITTAl Carlsbad CA 92008 www.carlsbadca.gov DATE: 06/27/16 PROJECT NAME: OMNI LACOSTA RESORT PROJECT ID PLAN CHECK NO: CB162200 SET#: FIRE ADDRESS: 2100 COSTA DEL MAR RD. ~ This plan check review is complete and has been APPROVED by the Fire Division. By: DENNIS GRUBB & ASSOCIATES A Final Inspection by the Fire Division is required IZ! Yes D No D This plan check review is NOT COMPLETE. Items missing or incorrect are listed on the attached checkJist. Please resubmit amended plans as required. Plan Check Commt~nts have been sent to: You may also have corrections from one or more of the divisions listed below. Approval from these divisions may be required prior to the issuance of a building permit. Resubmitted plans should include corrections from all divisions. For questions or clarifications on the attached checklist please contact the following reviewer as marked: D Chris Sexton 760-602-4624 Chris.Sexton@carlsbadca.gov D Gina Ruiz 760-602-4675 Gina.Ruiz@carlsbadca.gov D D Kathleen Lawrence 760-602-27 41 Kathleen.Lawrence@carlsbadca.gov D D Linda Ontiveros 760-602-2773 Linda.Ontiveros@carlsbadca.gov ~ DENNIS GRUBB & ASSOC. Christina.wilson@carlsbadca.gov D CindyWong 760-602-4662 Cynthia.Wong@carlsbadca.gov D Dominic Fieri 760-602-4664 Dominic.Fieri@carlsbadca.gov Carlsbad Fire Department Plan Review Requirements Category: TI , COMM Date of Report: 06-27-2016 Name: Address: JAUREGUI & CULVER INC 959 W MISSION A V ESCONDIDO, CA ATTN: JOHl-.J CULVER 92025 Permit#: CB162200 Job Name: Job Address: OMNI LA COSTA RESORT-AT GOLF 2100 COSTA DEL MAR RD CBAD Reviewed by: · em you have submitted for review is incomplete. At this time, this office cannot adequately conduct a review to determine i the applicable codes and/or standards. Please review carefully all comments attached. P resubmit the necessary p ns and/or specifications, with changes "clouded", to this office for review proval. Conditions: Cond: CON0008997 [MET] APPROVED Entry: 06/27/2016 By: DGA '~6 .. 1 21 1 .?: 100 00 Risers: Sm 10-25 26-100 > 100 1 6550 Van Buren Ste 97:5-7395 ~' SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE Business Name Business Contact Omni La Costa Rcs01t & Spa Mat Dumnyer Project Address City 2100 Cnsta Del Mar Rd. Cm·lsbad Zip Code 92009 APN# 216-590-16-00 F7~~~~--------------------------------Mailing Address City State CA State Zip Code Plan File# Same Project Contact John Culver In we Applicant E-mail Telephone# orp.net 760-743-0518 uestions represent the facility's activities, NOT the specific project description. nt must contact the Fire Protection Agency with Jurisdiction prior to plan submittaL Occupancy Rating: Facility's Square Footage (including proposed project): 1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reaclives 13. Corrosives 2. Com ressed Gases 6; Oxidizers 10. Cryogenics 14. Other Health Hazards 1' 2. 3, 4. 0 IZl 5. 1]1 0 6, 0 IN 7, 0 ~ 8. 0 1]1 7. Pyrophorics 11. Highly Toxic or Toxic Materials 15. None ofThese. B. Unstable Reactives 12. Radioactlves TERIALS DIVISION HMO : If the answer to any of the rland Avenue, Suite 110, San Diego, CA 92123. Expected Date of Occupancy: {for new construction or remodeling projects) Is your business listed on the reverse side of this form? (check all that apply). Will your business dispose of Hazardous Substances or Medical Waste in any amount? Will your business.store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500 pounds and/or 200 cubic feet? Will your business store or handli~ carcinogen$/reproductive toxins in any quantity? Will your business use an .existing or Install an underground storage tank? Will your business store or handle Regulated Substances (CalARP)? Will your business use or install a Hamrdous Waste Tank System (Title 22, Article tO}? Will your business store petroleum In tanks or containers at your facility with a total facmty storage capacity equal to or greater than 1,320 gallons? (California's Above round Petroleum Stora e Act . 0 CalARP Exempt I Date Initials 0 CaiARP Required j Date Initials 0 CaiARP Complete I Date lnlllafs Any YEs• answer requires a stamp from APCD 10124 Old Grove Road, San If 01 Yes !!!!.9. Q3 Yes l!!ll! 04-QS No]. The following questions are intended to i entify the a e planning stage .. Projects may require additional measures not identified by these questions. For comprehensive requirements contact APCD. Residences are typi~:ally exempt, except • those with more than one building• on the property; single buildings with marl;! than four dwelling units; townhomes; condos; mixed-commercial use; deliberate burns; residences forming part of a larger project. [•Excludes garages & small outbuildings.] 1. 2. 3. 4. 5, 6. YES NO 0 [i} 0 IX 0 0 Will the project disturb i 60 square feet or more or existing building materials? Will any load supporting structural members be n~moved? Notification may be required 10 working days prior to commencing demo!llion. (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey bean performed by a Certifmd Asbestos Consultant or Site Surveillance Technician? 0 0 0 0 (ANSWER ONLY IF QUESTION 3 IS YES) Basad on the survey results, will the project disturb any asbestos containing mfllerial? Notification may be required 10 working days prior to commencing asbestos removaL ~ Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factshoot (www.sdaJ?gd.of{l/InfoJfactslpermits.Qdf) for typical equipment requiring an APCD permit. 0 (ANSWER ONLY IF QUESTION 51S YES) Will the project or associated construction equipment be local.ed within 1.,000 feet of a school bounda Briefly describe business activities: Briefly describe proposed project: GolfCourse Maintenance Facility Replace gasoline piping. No work to vapor return. I declare under penalty of perjury that to the best of my knowledge and belief tt1e responses made herein are true and correct. John Culver I I Name of Owner or Authorized Agent FIRE DEPARTMENT OCCUPANCY BY: Signature of OWner or Authorized Agent Date FOR OFF!CAL USE ONLY: DATE: EXEMPT OR NO FURTHER lNF,.;.O.:.;RM;;;;A_;;T.:.;ION;;;;· ;;;;R.;:;E.;;;Q;;.:UI;;;;RE;;;;D_.__j-.R--EL--E;;,;A;;.:SE--D..;F..;OR.;;_D;;.:UI;;.:LO--JN_G..;P_ERMIT B_U;_T_N_O.;.T_FO_R_O;;.:C:..:C--U..;,I>A;:_N:..:C.:..Y +---_;;,RE;;;;l;;;;E:..:AS.;:;E;;;;O.;_F;:_OR:.:.:,OCrCU:::;.;PA;;;;N;;;;C;;;;Y ___ --j COUNTY-HMO APCD COUNTY-HMO APCD uslnesses from completing or updating a Hazardous Materials Business Plan. Other permitting requirements may still apply, HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division LIST OF BUSINESSES WHICH REQUIRE REVIEW AND APPROVAL FROM THE COUNTY OF SAN DIEGO DEPARTMENT 01: ENVIRONMENTAL HEALTH-HAZARDOUS MATERIALS DIVISION Check all that apply: AUTOMOTIVE 0 Battery Manufacturing/Recycling 0 BoatYard 0 Car Wash 0 Dealership Maintenance/Painting D Machine Shop 0 Painting 0 Radiator Shop D Rental Yard Equipment D Repair/Preventive Maintenance D Spray Booth 0 Transportation Services 0 Wrecking/Recycling CHEMICAL HANDLING 0 Agricultural supplier/distributor 0 Chemical Manufacturer D Chemical Supplier/Distributor D Coatings/Adhesive 0 Compressed Gas Supplier/Distributor 0 Dry Cleaning 0 Fiberglass/Resin Application OiJ. Gas Station non-retail maintenance yard D Industrial Laundry D Laboratory 0 Laboratory Supplier/Distributor 0 Oil and Fuel Bulk Supply D Pesticide Operator/Distributor CHEMICAL HANDLING D Photographic Processing D Pool Supplies/Maintenance D Printing!Biue Printing D Road Coatings D Swimming Pool D Toxic Gas Handler D Toxic Gas Manufacturer METAL WORKING 0Anodizing D Chemical Milling/Etching D Finish-Coating/Painting D Flame Spraying D Foundry 0 Machine Shop-Drilling/Lathes/Mills D Metal Plating D Metal Prepping/Chemical Coating D Precious Metal Recovery D Sand Blasting/Grinding D Steel Fabricator D Wrought Iron Manufacturing AEROSPACE D Aerospace Industry 0 Aircraft Maintenance D Aircraft Manufacturing OTHERS AND MISCELLANEOUS 0 Asphalt Plant 0 Biotechnology/Research 0 Chiropractic Office D Co-Generation Plant D Dental Clinic/Office D Dialysis Center 0 Emergency Generator D Frozen Food Processing Facility 0 Hazardous Waste Hauler D Hospital/Convalescent Home 0 Laboratory/Biological Lab 0 Medical Clinic/Office D Nitrous Oxide (NO,) Control System 0 Pharmaceuticals 0 Public Utility 0 Refrigeration System 0 Rock Quarry 0 Ship Repair/Construction 0 Telecommunications Cell Site 0 Veterinary Clinic/Hospital 0 Wood/Furniture Manufacturing/Refinishing ELECTRONICS 0 Electronic Assembly/Sub-Assembly D Electronic Components Manufacturing 0 Printed Circuit Board Manufacturing NOTE: THE ABOVE LIST INCLUDES BUSINESSES, WHICH TYPICALLY USE, STORE, HANDLE, AND DISPOSE OF HAZARDOUS SUBSTANCES. ANY BUSINESS NOT INCLUDED ON THIS LIST, WHICH HANDLES, USES OR DISPOSES OF HAZARDOUS SUBSTANCES MAY STILL REQUIRE HAZARDOUS MATERIALS DIVISION (HMO) REVIEW OF BUSINESS PLANS. FOR MORE INFORMATION CALL (858) 505-6880. LIST OF AIR POLLUTION CONTROL DISTRICT PERMIT CATEGORIES Businesses, which include any of the following operations or equipment, will require clearance from the Air Pollution Control District. CHEMICAL 47-Organic Gas Sterilizers 32-Acid Chemical Milling 33-Can & Coil Manufacturing 44-Evaporators. Dryers & Stills Processing Organic Materials 24-Dry Chemical Mixing & Detergent Spray Towers 35 -Bulk Dry Chemicals Storage 55-Chrome Electroplating Tanks COATINGS & ORGANIC SOLVENTS 27-Coating & Painting 37-Plasma Arc & Ceramic Deposition Spray Booths 38-Paint, Stain & Ink Mfg 27-Printing 27-Polyester Resin/Fiberglass Operations METALS 18 -Metal Melting Devices 19-Oil Quenching & Salt Baths 32-Hot Dip Galvanizing 39-Precious Metals Refining ORGANIC COMPOUND MARKETING (GASOLINE. ETC) 25-Gasoline & Alcohol Bulk Plants & Terminals 25 -Intermediate Refuelers 26-Gasoline & Alcohol Fuel Dispensing COMBUSTION 34-Piston Internal -Combustion Engines 13-Boilers & Heaters (1 million BTU/hr or larger) 14-Incinerators & Crematories 15-Burn Out Ovens 16-Core Ovens 20-Gas Turbines, and Turbine Test Cells & Stands 48-Landfill and/or Digester Gas Flares ELECTRONICS 29-Automated Soldering 42-Electronic Component Mfg FOOD 12-Fish Canneries 12-Smoke Houses 50 -Coffee Roasters 35 -Bulk Flour & Powered Sugar Storage SOLVENT USE 28-Vapor & Cold Degreasing 30 -Solvent & Extract Driers 31 -Dry Cleaning ROCK AND MINERAL 04 -Hot Asphalt Batch Plants 05 -Rock Drills 06 -Screening Operations 07 -Sand Rock & Aggregate Plants 06-Concrete Batch, CTB, Concrete Mixers, Mixers &Silos 10-Brick Manufacturing OTHER (i"f':"i\brasive Blasting Equipment 03 -Asphalt Roofing Kettles & Tankers 46-Reverse Osmosis Membrane Mfg 51 -Aqueous Waste Neutralization 11 -Tire Buffers 17 -Brake Debonders 23 -Bulk Grain & Dry Chemical Transfer & Storage 45 -Rubber Mixers 21 -Waste Disposal & Reclamation Units 36-Grinding Booths & Rooms 40 -Asphalt Pavement Heaters 43-Ceramic Slip Casting 41 -Perlite Processing 40-Cooling Towers -Registration Only 91 -Fumigation Operations 56-WWTP (1 million gal/day or larger) & Pump Station NOTE: OTHER EQUIPMENT NOT LISTED HERE THAT IS CAPABLE OF EMITTING AIR CONTAMINANTS MAY REQUIRE AN AIR POLLUTION CONTROL DISTRICT PERMIT. IF THERE ARE ANY QUESTIONS, CONTACT THE AIR POLLUTION CONTROL DISTRICT AT (858) 586-2600. HM-9171 (08/15) County of San Diego -DEH-HazardotJs Materials Division Perm it # 1 035 Date: 6/6/2016 Facility Permit# 212022 Expiration Date: 12/6/2016 Permit for Underground Storage Tank Construction Facility Name: Omni La Costa Resort & Spa Owner Name: LM Investment 2010. LLC Facility Address: 2100 Costa Del Mar Rd. Carlsbad. CA 92009 Owner Address: 4001 Maple Ave. Dallas. TX 75219 SCOPE OF WORK: Replace !~as UOC & product piping ;;. Remove 1 existing metal SW UOC and existing gasoline product OW piping. » Install 1 NEW SW Bravo UOC with a new Veeder Root liquid sensor. » Install NEW 1 .5" OW OPW Flexworks gasoline product piping and associated penetration fittings at new UDC and gasoline STP sump. » Soil samples will be required. » A certified Line Integrity Test will be required. INSP~CTION REQUIREMENTS: 2 Inspections This Permit I Inspection card and stamped approved plans MUST be on-site for every inspection. Failure to do so will result in the inspector failing the scheduled inspection and assessing a $709.00 re-inspection fee. The Department of Environmental Health (DEH) inspector will verify that the CCR Title 23 requirements have been met. 1st Inspection: » Soil Sample -sample locations and parameters to be determined by SAM Inspector. 2nd Inspection: » Pressure test on primary & .§econdary product line » Hydrostatic test on new UOC and gasoline STP sump » Test new VR sensor or Contractor to self~certify if sensor is not installed at this inspection. Required Documents at Final Inspection (NOTE: Additional documents may be required at the discretion of the DEH inspector) ;;. Certified line Integrity test (submit to Hf\llpyvit~in30 days of last inspection) . .·... . . ·.·.· ... · ·• •·•·• .• ... · ... · ··.. . .· ... » Upload the "UST certification of install~ti~~1i!f:odification" form a#d modify tiJe m~ni!O.rJnttz:etall· M{ifh new sensor info and tank lnformatliin··wlth new piping in California EiJ.V:iroifrritiiita1!''Reiiortiitg System (CERS). Reviewed and Approved By: Cecilia Lewallen ACTIVITY CODE: 428T24 1 This office must be given at least 48 hours advance notice for all required Underground Storage Tank activity. Please call (858) 505·6785 to schedule an appointment, or you can request an appointment on-line at our website: http:J'Iwww.sdcountv.ca.gov/dehlhazmat/hmd ust construction.html. For cancellations please call (858) 505·6976. 2 Any deviation from the above scope of work may require a $452.00 plan re-review fee and $709.00 re-inspection fee. 3 THIS PERMIT DOES NOT EXCUSE ANY OWNER OR OPERATOR FROM COMPLYING WITH ALL APPLICABLE FEDERAL, STATE, COUNTY OR LOCAL LAWS, ORDINANCES OR REGULATIONS. THE OWNER OR OPERATOR IS REQUIRED TO DETERMINE IF ANOTHER PERMIT OR APPROVAL FROM ANY OTHER AGENCY OR DEPARTMENT IS NECESSARY. THE COUNTY, BY ISSUING THIS PERMIT, DOES NOT REliNQUISH RIGHT TO ENFORCE ANY VIOLATION OF LAW. County of San Diego, Department of Environmental Health-Hazardous Materials Division P.O. Box 129261, San Diego, CA 92112·9261 • ~ SCALE= 1" = 100' EX. TOO SHEDS 1-c:=:J EX. FERTILIZER SHED ----- LA COSTA GOLF COURSE AND RESORT EX. 4,000 REG UST ------tt--l---- SHOPPING CENTER EX. 2,500 DIESEL UST ------+11----~-----... EX. STORAGE SHED fle,ct:.'"e.u ~\)~ \) 1 L .§>" ~ ~'t- ·f" R' c::,'E\P..D G\~ o~\.JG o'~'s\ON eu'\..o'\'l ? o"-' v OPEN SPACE wnH I ;-NATIJRAL 1____/ I VEGITATION EX. STORAGE SHED EX. GOLF BALL WASHING AREA GAS DISPENSER TO BE REPLACED EX. DIESEL DISPENSER, NO WORK EX. 2" TANK VENT RISERS EX .ESO & OVERFILL ALAARM EX. GOLF COURSE MAINTENANCE OFFICES & SERVICE GARAGE EX. 4,000 REG GAS UST TURBINE SUMP (PROTECT THE MANHOLE ASS'Y IN PLACE) EX. VAPOR RECOVERY PIPING (NO WORK, PROTECT IN PLACE) REPLACE GAS PRODUCT LINE WITH 1.5" DW OPW FLEXWORKS REPLACE GAS DISPENSER. INSTALL NEW SWFG UDC. EX. DIESEL DISPENSER EY. AND UDC EX. 2,500 DIESEL UST. NO WORK. EX. 2" TANK VENTS EX. ESO & OVERFILL SCOPE OF WORK THE INTENT OF THIS PROJECT IS TO REPLACE THE EXISTING GAS DISPENSER, THE EXISTING UDC AND THE GASOLINE PRODUCT PIPE BETWEEN THE GAS TURBINE ON THE UST AND THE DISPENSER. THERE IS NO WORK TO THE EXISTING VAPOR RECOVERY PIPING OR OTHER PRODUCTS. THE PROPOSED WORK INCLUDES: 1. PERFORM LOTO ON THE ELECTRICAL CIRCUITS AT THE PANEL FOR THE GASOLINE TURBINE, DISPENSER AND ANY OTHER POWER CIRCUITS BEING MODIFIED. INSURE POWER IS OFF TO THE EFFECTED EQUIPMENT PRIOR TO STARTING ANY WORK. 2. USING INERT HELIUM GAS, PURGE ALL GASOLINE FROM THE PIPING BACK INTO THE UST. DRAIN THE DISPENSER AND RETURN THE GASOLINE TO THE UST. 3. DISCONNECT THE EXISTING DISPENSER AND REMOVE. 4. SAWCUT THE EXISTING CONCRETE ISLAND AND SLAB AS NEEDED TO REMOVE THE GASOLINE UDC AND PRODUCT PIPING. 5. BREAKOUT CONCRETE AND EXCAVATE TO EXPOSE THE UDC AND GASOLINE PRODUCT PIPING. DO NOT REMOVE UNTIL APPROVED TO DO SO BY THE DEH. 6. UNDER THE DIRECTION OF THE DEH INSPECTOR, REMOVE THE UDC AND PRODUCT PIPING. TAKE SOIL SAMPLES FROM THE EXCAVATION AS DIRECTED BY THE DEH INSPECTOR. SOIL SAMPLES ARE TO ANALVZED BY A CERTIFIED LABORATORY AND RESULTS PROVIDED TO THE DEH. 7. I NSTALL A NEW SWFG UDC. 8. INSTALL NEW 1.5" DW OPW FLEXWORKS GASOLINE PRODUCT PIPING. INSTALL NEW APPROVED PIPING AND ELECTRICAL PENETRATION FITTINGS AS NEEDED AT THE UDC AND TURBINE SUMP. 9. MODIFY THE EXISTING ELECTRICAL CONDUITS AS NEEDED TO INSTALL THE NEW UDC. THERE IS NO CHANGE TO THE EXISTING ELECTRICAL REQUIREMENTS FOR THIS WORK. 10. INSTALL A VEEDER ROOT LIQUID SENSOR IN THE NEW UDC. 11. ALL WORK IS TO BE INSPECTED, TESTED AND APPROVED BY THE DEH AND FIRE DEPT. PRIOR TO BACKFILL PER THE REQUIREMENTS IN THEIR RESPECTIVE PERMITS. (AT A MINIMUM THIS WILL INCLUDE 50 PSI/1 HOUR ON NEW PRODUCT PIPING; 5 PSI/1 HOUR ON SECONDARY PIPING; HYDROSTATIC TEST ON NEW UDC AND EXISTING GAS TURBINE SUMP, 2' ABOVE HIGHEST NEW PENETRATION.) OTHER REQUIREMENTS MAY APPLY. CHECK PERMITS. 12. AFTER AGENCY INSPECTION AND APPROVAL BACKFILL THE TRENCH WITH MANUFACTURER APPROVED BACKFILL MATERIALS. 13. PATCH AND REPLACE ALL DISTURBED CONCRETE IN KIND. 14. INSTALL THE NEW REPLACEMENT DISPENSER AND HANGING HARDWARE. PURGE PIPING AND CALIBRATE. 'V't- ALARM -------------------------------------15. OBTAIN FINAL INSPECTIONS AND APPROVALS BY THE PERMITTING AGENCIES. SITE ENTRANCE OFF LA COSTA BLVD. SITE PLAN LA COST RESORT & GOLF COURSE UST LOCATION & WORK AREA City of C~lsbad Building ivislcn JUN ss· o1s APPROVED BY: I b ISSUED BY: I II y 1 16. LEAVE WORK AREA CLEAN AND FREE OF ANY DEBRIS. 17. ALL WORK IS TO BE PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF AN ICC CERTIFIED INSTALLER, TRAINED AND CERTIFIED BY THE MANUFACTURER FOR ALL EQUIPMENT BEING INSTALLED. 18. ALL EQUIPMENT IS TO BE NEW, U.L. LISTED, COMPATIBLE WITH THE PRODUCTS BEING USED AND INSTALLED PER MANUFACTURE'S INSTALLATION REQUIREMENTS. 19. INSPECTIONS ARE TO BE SCHEDULED A MINIMUM OF 48 HRS. IN ADVANCE WITH THE AHA. BUILDING CODE INFORMATION: THIS PROJECT SHALL COMPLY WITH THE APPLICABLE PROVISIONS OF THE 2013 CBC, CPC, CEC AND CFC. PARCEL INFORMATION: APN 216-590-16-00 PROJECT: RE-PIPE GASOLINE LINE & NEW DISPENSER OMNI LA COST A HOTEL & SPA Jauregui & Culver, Inc. 959 W. Mission Ave. 2-1~ ~COSTA DELMARRD. CARLSBAD, CA 92009 SITE PLAN , (PG.10F2) Escondido, CA CA Lie. 708231 760-743-0518 Fax: 760-743-0621 JOB NO.' J1134-16 BENNETT FLEETMAST COMMERCIAL DISPENSER, OFFSET FROM ISLAND FORCLARilY SHEAR VALVE VEEDER ROOT SENSOR TEST PORT TUBE. LEAVE OPEN AT LOWEST POINT OF UDC ----- DISPENSER, UI>C AND ISLAND DETAil EX. TURBINE -------------. EX. TURBINE MANHOLE , ~A'·_. ~ HOSE RETRACTOR BREAKAWAY COAXIAL FUEL HOSE AUTOMATIC GAS NOZZLE PRODUCT OUTLET SPLITTER VALVE ELECTRICAL EP. J-BOX, SEAL OFF EX. FUEL I SLAND EX. DRIVE SLAB BRAVO FG PENETRATION FTG. EX. DWFG VAPOR. MODIFY AS NEEDED. OPW 1.5' FLEXWORKS PIPING WI 3' ACCESS PIPE BRAVO FG PENETRATION FTG. .--------EX. ELECTRICAL ... .;.. .. .. -·~ .......... ~ --~¥. ....... .:. . . 2" BALL VALVE --------~ 114' TEST TUBE. LEAVE OPEN AT LOWEST SIDE NEAR SENSOR EX.UST-• • •• • • • • • • • • • • •• • • •• • •• • •• • ••• •• • • • • • • • • • • • • • • • • • • • • • •• • • • TURBINE SUMP DETAIL • • • • • I EX. CONCRETE TANK SLAB. REMOVE & REPLACE AS NEEDED FOR PIPING INSTALLATION. • • •• • • • • • • • • !-• . • .. ·~ · .. . ~ ... ~-.. . 4.. .: ... '!: .. "" .. NEW 1.5' DW OPW FLEXWORKS PIPING WI 3' ACCESS PIPE BRAVO FG PENETRATION FTG. EX. VEEDER ROOT SENSOR • • • • • • • • • • • • • • • •• • ••• • • • • • • • • ••• • • • • • • •• •• BRACKET LOCATIONS SHOWN ~®-i.mll FOR REFERENCE ONLY. ..-,_.u.-~-n"~~-~laAC1t.Cn.~,_,.__.t'II~GIPClt !:~~~~~.;::.~ .. ::--:::·~-;.:....,~ VISit www.sbnlvo.com/fs for all nttlngs INSTAUI!R MUST 8! BRAVo-<:~RTIFI~D CA. w ~ Get Certified at www.sbravo.comtcert 0 c ~ € 4 -- 0 ....---~ - TOP \'J£W r;::::=V .. l(S .a,;:;:;~ I o o I .......-• ~= -:=::l~ t t t VIsit www.sb11!1vo.comlfs to< all flbergloss entry flttlngs ~..=. AI..USTAIL.t Y...,. IIUOCET frGT INCLUXD ,., to_,. .• ~ ~ ,.V2 I :tl~ ·i ~ I~ i NOTICE: v-· l l =-~ I ______ .. ..-; __ , ·~'~'--""---.- __ ., ___ 10_ MW~W-OOC:.I'o-..... OIII.....,W!IM-vo --___ ...cti'IC...._.~~-. -. .. ....__,.~coo --- l-..__23 DUTSJX IIKNS'"Dwo---' !!!Q.:!!~ .. - WWW.SBRAVO.COM BENNETT FLEETMASTER COMMERCIAL DISPENSER ADAPTER 1.5' FLEXWORKS X 1.5' NPT #3, SWAGE ON FEMAIL COUPLING WI SWIVEL #1, 1.5" DW OPW FLEXWORKS PIPE 1/4' TEST PORT 0 8000-FIS-B-EO tm <,-' o:urmc.L ....... sm ar .._ <SIW.U .....,. liP' M.CTS a-D "'"""'"'"""""""' MrG. a.: Flit IJW'OCIO OlliE! OOS ZRAWIJCi IS I'RO'VlDED o\$ A GEH£RAL li.JID£ TO THE INSTH..LATIOII AND AUCitKNT ar THE DJSP£HSO StoW AH1I ITS AL..LOVED Hil~U\/ME, SDCE CVOY lNSTAUATU»> IS LNIQI£ IT IS THE R£SPOISIID..ITY rE THE INSTALUNG CDHTRACTDR TO O£CK Pl.AHS NorD PADIIUCT DRA'ifiNiS. nEu vonn cas riNG lN...£TS. tHSt otl.L POt MNU'"/I£n.ti:CR"S INST~TIOII Mf!IJH.... SMALL UDC GASBOY GILBARCO LEGACY ..... 3/4' X 1-112' OBROUND MOUNTING HOLES, lYP. 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INIQrtt)t......._.,_bMnparbmadon~hpm.ynhaaoondlryrlhplpa. Pl1or»~~.handlh0¥lll ..... ~~--. .. ~rl ...... fNIInllln .. "**'"""'...po.dll*i'lllt~a~Man .. plpal ..s ..... of .. lr'MI:t\.Finlt~.,....•c~onallllMtW'.,.,._..,Irl ...... t.r-.. notlltciiiiUt:l .. ll*i'lllofh_.wd .. -...I'IO'fiCIIdl .. .,....,.., hbK*ILMadcllionlll·-~~~--~llt~hbldl:ll~-nal~ .. plpa. =~~=-=r:::..-=.·.:-~===-n.._ ... ,:=:.-:.·.:.. PIPE BURIAL REQUIREMENTS EOOPMENT UST 01Y I ITEM T DESCRIPTION BENNETT FLEElMASTER COMMERCIAL LON HOSE. REMOTE. 1· 1 I 3111SNR-68 I INLET. H iOSE OUllET. 2·SIDED DISPENSER. 1bd I C15A I1.S"df>W-0006CEW A1CPRlMARY PIPE ibd I AXP30 I OPW 3' DOUBLE W AU ACCESS PIPE BRAVO SNGLE WAU DISPENSER SUMP. 1·PRODUCT, Wl SHEAR BBOOO-F1S·B I VALVE BRAO<ET & ELECIRICAL OFFSET. BRKT~B2 I BRAVO VAPOR SHEAR VALVE BRAO<ET FUC2.0.RETROFIT·S I BRAVO FLX·SERIES SWFG PENETRA TKlN FOR 1.5' FLEX PIPE. BRAVO F·SERIES SINGLE WALL FG FITIING FOR 314' PVC.COATED F·17·RR IROBROY CONDUIT BRAVO FF·SERIES FLAT WAU FRP FLANGE FITIING FOR 2" FRP 1 I F·20-FF I PIPE JUMPER KIT ASS'Y ~ s tlidiADHESIVE·PE·KIT I BRAVO FUSION ADHESIVE FOR POLYETHYLENE PIPE 10BHMP·5830 IOPW DOUBLE POPPET SHEARVALVE·MALE 60VSP·1001 IOPW 1'XH/2' POPPETED VAPOR SHEAR VALVE 0PW FLEXWORKS swrva FITTING H /2' MALE SWIVEL X 2' EZ FIT 90 DEGREE FEMALE GLUE X 18" ST. FF15X18MS)(EZFG91STEEL FLEX CONNECTOR 74938().208 I VEEDER ROOT SUMP SENSOR 1()().108 IJOMAR JOFLO 2' BRASS BALL YfoLVE 125 PSIG FIF Jauregui & Culver, Inc . 959 W. Mission Ave. Escondido, CA CA Lie. 708231 760-743-0518 Fax: 760-743-0621 OMNI LA COSTA HOTEL & SPA 'J_,/ tJ t? ~OSTA DEL MAR RD . CARLSBAD, CA 92009 DETAILS, (PG.2 0F2) J1134-16 05/31116 My Professiona~ information: last, !First Ml: JlauregiLI!,M;atl:hew Jl Certified urrnder this name~ M:a'l:ll:ll1Iew J JauregMii City 3 Stat~;: Zip: !Escondido, CA £12.0:25 Certi fic:ation Type ( s) : ll!IST Jlras!l:S~fflatiorn/IRe!l:rril:ll'i'Gttirag[ expffres «:ll5/05/2«Jl17) . RECIE~VES MEMBER BENEF~TS? NO Upload your image by pressing the ~upload Your Photo' !ink on the left side menu. QU~CKUNKS lo.£1 in to myncc ~https:!fa~vJccsafe.orgffewebffDynamiciPagpe.a.spx? WebCod~e=logunRequiredi&Sit·e::;:~CC&URl_suc,c,ess~lhUp:ffffW'W'IJY!Jccsafe.ilJ>rg!myiccff%3fusertokeno/liJ) I I I I ,( M. tt·h· s• • a · ·. ew aur~egt·u~t Certification type: Bravo SWAT Company: Jauregui & Culver Inc. State: CaHfornia ·---· made· ~n'U1SA '·------~--------------------~------------~-/ -· ----------··--····---.-------· ---------------------------·-·--- r, /Jc~@lf@ '[!{~(;' 1'1!1Rgp fr'1i!li:V't1Mt~i .J{[mtmrct\W&nn(cit/ii I~,Vrrrillrr'lir~<,nird(e; ) '~--· :.2l.__ ___ _,__-"./_,_,...o..1L..<s__.:<.'='.""---•• o Dear Trained Contractor: Congratulations on completing your OPW Flex Works Contractor Training! OPW is proud to add you to our list of Factory Trained Installers. Your Training Wallet Card is below. Please crurt it out and canyit wfth vou as verification ofvourtJraffnffroq. If you notice any errors on your card, or if you should Jose it, please feel free to contact me by email at !ffsa.ffovering@opwglolbaff.com or by phone at (919) 209·2442 and I wjff promptly issue you a corrected version or a replacement. Your training remains in effect for 2 years, at which time you wm require retraining. Please contact me or your local OPW District Manager to set up retraining. Again, Congratulations. We look forward to working with you. Regards, Lisa Lovering Marketing and Communications Coordinator OPW Retajf Fuefjng 919-209-2442 (phone) 919-573-9497 (fax) Usa.lovering@opwglobal. com (email) www.opwglobal.com OPW Retail Fueling 9393 Princeton-Glendale Rd. Hamilton, Ohio USA 45011 Tel: 1 (800) 422-2525 Fax: 1 (SOD) 421-3297 lnt'l Tel: 1 (513) 870-3315 lnfl Fax: 1 (513) 870-3157 domes!icsales@opw-fc.com intlsales@opw-fc.com OPW Retail Fueling 3250 US Highway 70 Business West Smithfield, NC USA 27577-6954 Telephone: 1 (919) 209-2442 Fax: 1 (919) 573-9497 Customer Service: 1 (800) 422-2525 Customer Service Fax: 1 (800) 421-3297 Please cut along dotted line. Carry your card with yqu as verification of 1/:raffnffng. u-----------------------------------4 acknowledges Jacob Culver of Jauregui & Culver, inc. has attended installation training for the FlexWorks System by OPW Retail Fueling .08/17/2015 \L-t~.cct=> 08/17/2017 Training Date Authorized OPW-FCS Expiration Date Representative ------------------------------------· OPW fuel Management Sys"!ems 6900 Santa Fe Dr. Hodgkins, Illinois USA 60525 Tel: 1 (708) 485-4200 Fax: 1 (708) 485-7137 info@opwfm.com I John M" Culver~~ Tech111ncia111I # A22531 Veeder-Root ATG Technician ATG Monitoring Systems -TLS-450PLUS, TLS4c, TLS4i, TLS-450, TLS-3XX ~nstailation, Programming, and Service 7/10/2015 7/9/2017 I lil!l lil!l I I j1 .,{L" l:evto--J/1/ This certificate ~s issued in recognmon that John Mm Cu~ver U lechnncnan #A22531 has satisfactorn~y comp~eted Veeder ... Root Vapor Proo~ucts G ~n-Station Diagnostics o Carbon Canister Vapor Poiisher o PMC o Wireless iSD/PMC .::rl2-l~ 9/12/2014 J. Paul Kaper, Manag~;::ser\liCe NPI Date of Issue rf~b VEEDER-ROOT ~" 9/11/2016 Expiration Date Diploma John M. Cu~vew ~~ Tecl"l111icia~r~ #A22531 fffieel: PlUS Sy$tem~ (Islander PLUS, CFN PLUS, ICR, Fuel Point, Fleet Head O,ffice) Installation, Startup and Service 7/2/2015 7/1/2017 http://wise.gilbarco.com/Home/Certi:ficateShow.php?id=B8FElEAl-AAE9-4D45-956D-F7984F9C3847 Page 1 ofl 7/21/2015