ATTACHMENT 5B - LAFD Permit Approved.pdf
PDF 978 KB Posted
- Attached to
- Z2DZ--Mitigate of Underground Fuel Storage Tank
- Solicitation number
- 36C26220B0003
About this file
This document contains an underground storage tank mitigation project permit and related federal contract opportunity notice. The permit details the abandonment in place of a 300,000 gallon reinforced concrete underground storage tank located at 11301 Wilshire Boulevard in Los Angeles. The approved contractor will empty, clean, and backfill the tank with cellular concrete according to the Los Angeles Fire Department standards. The related federal opportunity notice is for the Mitigation of Underground Fuel Storage Tank project at the same location. The Department of Veterans Affairs will issue an invitation for bids on or around June 15, 2020 via beta.sam.gov for the $500,000-$1,000,000 project, with a site visit scheduled upon solicitation release. The requirement is reserved as a 100% set-aside for Service-Disabled Veteran-Owned Small Businesses.
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ADDRESS: 11301 W WILSHIRE BLVD
LOCATION INFORMATION
DOING BUSINESS AS (DBA): VETERANS ADMINISTRATION HOSPITAL EPA ID NO: (not required for installation or monitoring)
CA2360030033
CITY: LOS ANGELES
PHONE NO: (310) 478-3711
ZIP: 90073STATE: CA
ADDRESS: 11301 WILSHIRE 130E BLDG 218 ROOM 310
PROPERTY OWNER
NAME: DEPT VETERAN AFFAIRS
CITY: LOS ANGELES
PHONE NO: (213) 223-7766
ZIP: 90073STATE: CA
PRINT NAME: SIGNATURE:
ADDRESS: 11301 WILSHIRE BLVD
LESSEE/FACILITY OWNER
NAME: US DEPT OF VETERAN AFFAIRS/U S GOVERNMENT
CITY: LOS ANGELES
PHONE NO: (310) 478-3711
ZIP: 90073STATE: CA
PRINT NAME: SIGNATURE:
ADDRESS:
CONTRACTOR INFORMATION
NAME:
CITY:
PHONE NO:
ZIP:STATE:
CITY BUSINESS NUMBER: STATE CONTRACTOR #: EXP. DATE: WORK COMP NUMBER - EXP. DATE:
PRINT NAME:
JOE WEBB
SIGNATURE: TITLE:
Los Angeles City Fire Department Underground Storage Tank
Project Permit
FIRE DEPT. USE ONLY
LAFD UNIFIED PROGRAM
FACILITY ID:
FA0024239
PERMIT NO.:
SR0032770
DATE
GRANTED:
8/28/2018
WORK MUST
BEGIN BY:
2/28/2019
EXPIRATION DATE:
8/28/2019
ENFORCEMENT INSPECTOR
SHANE BYSTROM () -
FIRE
STATION #
PERMIT TYPE:
UST TANK ABANDON IN PLACE
DATA MANAGEMENT UNIT
Tanks are registered & Fees paid to date
Fee exempt
Signature
ITEM PE QTY
UST Installation 5100
[ X ] UST Abandonment-In-Place 5200 1
UST Abandonment by Removal 5201
UST Add to/Alter: Monitor/Piping/Disp. 5300
UST Tank Entry / Lining / Repair 5301
Site Assessment 5400
Emergency Plan Check/Site Assessment 5401
NOTES:
INV# - IN0289058 SR# - 32770
Abandon in place (1) 300k gal field-built concrete Diesel UST. To be foam-crete filled. Piping in below ground pipe alley to be removed as practicable, remainder rinsed and filled.
INSPECTOR NAME: GREGORY STEVENS INSPECTOR SIGNATURE:
41937 Permit Approval Stevens
VHAWLASILVAFA
Pencil
200 NORTH MAIN STREET, ROOM 1780
LOS ANGELES, CA 90012
TEL: (213) 978-3700
FAX: (213) 978-3615
FIRE PREVENTION BUREAU CUPA SECTION
LOS ANGELES FIRE DEPARTMENT UNDERGOURNG STORAGE TANK - PROJECT PERMIT STATEMENT
INVOICE
Permit No/RFI: SR0032770
Invoice No: IN0289058
Owner Name: DEPT VETERAN AFFAIRS
Owner Address: 11301 WILSHIRE 130E BLDG 218 ROOM
LOS ANGELES, CA 90073
Owner Phone No: (213) 223-7766
CONTRACTOR (Company Name/Self):
Invoice Date: 8/10/2018
Site Address: 11301 W WILSHIRE BLVD
LOS ANGELES, CA 90073
VETERANS ADMINISTRATION HOSPITAL
11301 WILSHIRE BLVD, BLDG 218ROOM 308
LOS ANGELES, CA 90073
DATE PE DESCRIPTION AMOUNT
PAYMENTS
8/10/2018 9917 PRE-PAYMENT (D5) ($1,944.00)
PAYMENTS SUBTOTAL: ($1,944.00)
CHARGES: $0.00
PENALTIES: $0.00
PAYMENTS: ($1,944.00)
ADJUSTMENTS: $0.00
INVOICE TOTAL DUE: ($1,944.00)
For Division 5 Permits:
Plan Check and Inspection services are calculated on a fee for service basis.
Each type of transaction has been assigned a charge based on the estimated time required for the service.
If Plan Check/Inspection services exceeded the assigned hours, additional charges will accrue in 1 hour increments. These additional charges will be billed to the Responsible Party.
200 North Main Street, Room 1700 Los Angeles, CA 90012 Phone: (213) 978-3700 Email: lafd.usttestnotify@lacity.org
$1,944.00
CREDIT CARD
8/10/2018
Last Payment:
Check No:
Check Date:
Amount Paid:
Signature:
For Payments:
Fund 100 Dept #38 RevS. 3897
VHAWLASILVAFA
Rectangle
CITY OF LOS ANGELES
Office of Finance
P.O. Box 53200
Los Angeles CA 90053-0200
4 GRANITE INC
9764 PIONEER ROAD 9764 PIONEER ROAD
APPLE VALLEY, CA 92308-9401 APPLE VALLEY, CA 92308-9401
CITY OF LOS ANGELES TAX REGISTRATION CERTIFICATE
THIS CERTIFICATE IS GOOD UNTIL SUSPENDED OR CANCELLED
BUSINESS TAX ISSUED: 07/06/2018
ACCOUNT NO. FUND/CLASS DESCRIPTION STARTED STATUS
0003063271-0001-9 L188 Contractor 10/01/2018 Active
4 GRANITE INC
9764 PIONEER ROAD
APPLE VALLEY, CA 92308-9401
9764 PIONEER ROAD
APPLE VALLEY, CA 92308-9401
"No registration certificate or permit issued under the provisions of the Business Tax ordinances of the LAMC, or the payment of any tax required under the provisions of the Business Tax ordinances of the LAMC shall be construed as authorizing the conduct or continuance of any illegal business or of a legal business in an illegal manner.”
NOTIFY THE OFFICE OF FINANCE IN WRITING OF ANY CHANGE IN OWNERSHIP OR ADDRESS- Office of Finance P.O. Box 53200 Los Angeles CA 90053-0200
IMPORTANT – READ REVERSE SIDE
THIS CERTIFICATE MUST BE POSTED AT PLACE OF BUSINESS
ISSUED BY:
DIRECTOR OF FINANCE
I S S U E D
T O
ISSUED FOR TAX COMPLIANCE PURPOSES ONLY
NOT A LICENSE, PERMIT, OR LAND USE AUTHORIZATION
Calette Hirsch
From: LATax_DoNotReply@billerportal.com Sent: Wednesday, July 11, 2018 9:08 AM To: Calette Hirsch Subject: Your single Unenrolled Payment to City of Los Angeles Tax Bill Pay has been initiated
Your One‐time Payment to City of Los Angeles Tax Bill Pay is being processed.
Account Number: 000306327100019
Account Name: 4 GRANITE INC
Payment Account: Visa ****0018
Payment Amount: $153.00
Fee Amount: $4.13 Confirmation #: 9385984
Total Amount: $157.13
Creation Date: Wednesday, July 11, 2018
Payment Date: Wednesday July 11, 2018
1 Bill paid with this One‐time Payment
Confirmation # Account Number Payment Amount
9385983 000306327100019 $153.00
Please DO NOT reply to this email. This email message was sent from a notification address that cannot accept incoming email.
To contact us, click here and review the Contact Us section on our web site.
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SCOPE OF WORK: TO PROPERLY ABANDON-IN-PLACE A UNDERGROUND STORAGE TANK (UST).
BELOW IS INFORMATION REGARDING THE SITE AND THE WORK THAT WILL BE CONDUCTED AT THE
SITE:
1. THE UST IS LOCATED AT 11301 WILSHIRE BOULEVARD, LOS ANGELES, CALIFORNIA.
2. THE SIZE OF THE UST IS APPROXIMATELY 300,000 GALLONS AND IS CONSTRUCTED OF
REINFORCED CONCRETE.
3. A HEALTH AND SAFETY PLAN WILL BE PREPARED.
4. THE UST WILL BE EMPTIED AND CLEANED. THE WORK WILL BE CONDUCTED BY A LICENSED
HAZARDOUS WASTE TRANSPORTER USING PROPER MANIFEST DOCUMENTATION. THE UST
CLEANING AND ABANDONMENT-IN-PLACE WILL BE WITNESSED BY A LOS ANGELES FIRE
DEPARTMENT (LAFD) INSPECTOR.
5. DURING CLEANING AND BACKFILLING PROCESS, CITADEL WILL MONITOR AIR EMISSIONS AT 15 MINUTE INTERVALS USING A DIRECT READING PORTABLE PHOTO-IONIZING DETECTOR (PID), OR
EQUIVALENT AND RECORD DATA IN A RULE 1166 SOIL MONITORING RECORDS FORM.
6. UPON COMPLETION OF EMPTYING AND CLEANING THE UST, THE UST WILL BE BACKFILLED WITH
CELLULAR CONCRETE.
7. A FINAL SOILS REPORT WILL BE SUBMITTED TO THE LAFD IN A UST REMOVAL REPORT PREPARED
BY A CALIFORNIA PROFESSIONAL GEOLOGIST.
FACILITY OWNER: DEPARTMENT OF VETERANS AFFAIRS, GREATER LOS ANGELES HEALTHCARE SYSTEM
CITADEL PROFESSIONAL GEOLOGIST: T. MICHAEL PENDERGRASS, PG #5685
EPA ID #: CA2360030033
APPROXIMATE UST LOCATION
PERMIT APPROVAL:
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T:\Glendale\Glendale\Clients\Concourse Federal Group\1237.1001_UST_Closure_Consulting\Design\1237.1001.0_UST Closure7/6/2018 11:04 AMCindy Hernandez
41937 Plans Approval Stevens
41937 Approved
41937 Text Box
SR 32770
41937 Inspectors Signature Stamp
41937 Callout Tank to be filled in place
41937 Callout Piping to be removed to the greatest extent practicable.
Any remaining piping to be rinsed and filled in place.
File details come from the government source that posted it. Updated .