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08-0392 (SOTB)P.O. BOX 1504 . 78-495 CALLS_ TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: X08-00000392 `""'7' aF 44KGtiw Property Address: 78998 -HIGHWAY 111 APN: 643-080-006-8 -000000- Application description: STRUCTURES OTHER THAN BUILDINGS Property Zoning: REGIONAL COMMERCIAL Application valuation: 15000 Applicant: - Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals de, and my License is in full force and effect. - License Class: A ense No.: 723396 Date: �' 7 "�KContractor:: t OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she 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).: (_ I 1, 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 Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.). 1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( 1 1 am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERA11T Owner: NAKASH CONVENIENCE MARTS 28456 CENTURY ST HAYWARD, CA 94545 Contractor: MIT ENGINEERING 6 3720 OCEANIC WAY, OCEANSIDE, CA 92C (760)721-4120 Lic. No.: 723396 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/11/08 --------------------------------- --- ------ WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 044-0025506 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I sh II fortbwi o�m/pll with those provisions. Date:?- 21-0-h- Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building c nstruction, and ereby authorize representatives of this county to enter upon the above-mentioned property spe pu ses. Date -2- 21-yV Signature (Applicant or Agent,: LQPERI%IIT Application Number . . . . . 08-00000392 Permit .. . . BUILDING PERMIT Additional desc. , Permit Fee . . . . 162.00 Plan Check Fee 105.30 Issue Date . . . . Valuation. 15000 . Expiration Date 1/07/09 , Qty Unit Charge Per Extension . BASE FEE • 45.00 . 13.00 9.0000 THOU BLDG 2,001-25,000 117.00 Permit MECHANICAL Additional•desc . Permit Fee . . . . 19.50, Plan Check Fee 4.88 Issue Date . . . . I 'I Valuation 0 Expiration Date `., 1/07/09 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 ---------------------------------------------------------------------------- Special Notes and Comments HEALY TANK AIR SEPERATOR. ----------------------------------------------------- Other Fees .•. . . . ---------------------- . .. . . ENERGY REVIEW FEE 10.53 Fee summary Charged -------------------- Paid Credited -------------------- Due ----------------- Permit Fee Total 181.50 .00 .00 181.50 Plan Check Total 110.18 .00 .00 110.18 Other Fee Total 10.53 .00 .00 10.53 Grand Total 302.21 .00 .00 302.21 .Bin# City of La Quinta Building ar Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building PeffnitApplication and Tracking Sheet Permit # Proj6d Address: .9" Owner's Name: A. P. Number - Address: Legal Description: Contractor. City, ST, Zip: Telephone Project Description: Address: 7 L,ISL ,-2-0 City, ST, Zip: SIGc�64 U,!9 -Y Telephone: -��66 7 2 V/?_ 0 . . . . . . . . . I . . . . . . State Lic.#: 3 City Lic. & Arch., Engr., Designer. AkA 7^-t 4 A - r- Sep* -Ah - _04 N - Wl C0 rA 4 -- Address: City, ST, Zip: Telephone: ..Wi State Lic, #: Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add n Alter Repair Demo ' -Sq. Ft: # Stories: I/ Units: Telephone # of Contact Person: .9 Estimated Value of Project: 1 0,90 APPLICANT: DO NOT WRITE BELOW THIS LINE Submittal Reqld _RWd =CMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Coles. Called Contact Person Plan Cheek Balance. Tide 24 Cates. Plans picked up Construction Flood plain plan— Plans resubmitted j Mechanical Grading plan T' Review, ready for corr4nsfissuc Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up SALL H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for corrections/issue Develop Planning Approval Called Contact Person ^—P* Pub. Wks. Appr Date of permit issue aK School Fees UPerm Total Permit 17 LP" 4u� proved .0 Mit Engineering & Construction Inc. 3720 Oceanic Way Sunte 205 OceansId.e_ Ca 92054 760-721-4201 Ofhc(IV Iln 760-721-4209 Fax IJ 619-515-0319 CellJUN 2 4 2008 619-312-2751 Hom A g —C 1 (By Scope of Work; /+ Ca^r5tr?irti`n is NOT PERMITTED 1: Install new Heal.° System upffade with 1SD components. on the iCi vl� i g Code Holidays: r7�ic� �t�L.��2,�. 7 t 2. 1_NSTri.L,. 1.1('1-rL'I-'T'T Il.T,T D 1VI� 1-l.e�ll�r 1^iUlli. � 3. Install �9N�.v�aie I'��s (!°.� �!P_.8r'S Day . 4: Have i 7s}� l .Ii &psi ie 1-1.*N1�1:D, AQM:D &Dr, �rM1artin Luther KingJr. Day r City of i,a Qu'7fax1P1 R c�LD1)"isi ns. Preci�ient'S Day ' r_r.. 4 VON �vv vY 11.x.. MeiTiorial Day �O�ir�,a E:T ci rA,� j> - I .. r .: UCTIOi�I I I y r�rl l anC=. �:IIe ilea- Independence Da pit �LThPIlaaliCr IS r':5.� in_Labor Day Meets tbelatest e_rtroi. veteran's Day l�Fi�A I ,_UFC) Rr FFC 200 C€iapte_ I=.:. Thanksgiving Day See page I of installation instruction for interpretation. 2. 14o electrical connections are required for this installation. Christmas'Day 3. ]1 hz Nealy Tank Air Separator is U.L. certified, the unit is described as a vapor recovery processing system. 4. To At n a�or processing unit CTC- Arti �. e o terpretation. 5. N a��f-QjF,r�IE MPRM ;ATd.O8tCARD ARE NOT ODICONSTRUCTION -- <. Div . t7'i'i � y7�� I��R. ]29.{t2' 7. Eval e 1.0 of ES c ort. 1385. Coni liar t �— — _ � X10 p p e.ober 1st - April 30 with the folio�]�f�{T t�j Monday - Friday; `7:00 a.Ir . to 5:30 200I� Intel�7atrb}i=�Ild1_�,rle. P.LL Saturday: 8:00 a.m. to 5:00 200>r International Residential Code. s,day: None 1997 Uniform Building Code (UBC) 2002 Accumulative Supplemental to the International CoSunday: CodeHolidayS: NODE aAll�t LOEQ �iyrSl�EfhDE�BIdkS ?t l�MtFR N7, 1.0 pterib€r 30th --� Pt: �1! E 0 THE jTE DURING ALL'. ' �;. , _ b: �� ,��le CALIFORNIA ANNOTA '-, SITE MAP 1_11_ ' aL !: " 0 - ' - jlr-a DATE 2/6 /2006 LA QUINTA ZIP CODE 92253 D E Statements. fot } ��r1�� s I I s, : a . E,:00 .1 r {; N jK a.m. to 5.00 UCTION AND MUST BE s r- -� -----� n 1. Ulstall'ata .i�ro'NEC1) ARY rT�'B processing Unit., v <� Yfls� d$ y - - [iTYiie— Shall cLlaipl}c - 0 A., 2007. 1 R 2r M'9.i$' — -- as:d the �I rXPENSE OF THE OWNER/ - 2. Vapor Prete i^g Unit shall be 10- f? -on, property and 20' from dispensing --- devices- — I VPU u-ilt be having protection from bollard post and fencing. 4. Vent pipes or processing unit will discharge upward only and all Vapors will temtinate 12' above _grade and ,will not accumulate or Travel t0 LI+"Isate location, and buildings. I F G H o - r 1 OIL WATER SEPARATORS tr :i fit, _.•_�^—*r. ;r e, �\ , /err Q' jr rr: rr� Q `FTFre .CII f rr /G I reel leer �/rrre2C. ��rfrr �-�I 1 rrrr /rrrr err rrrr .�/ � r r r r >�r rrrr .0 .r rrrr l rrrr �. �'. c, 1a130uL= GROiJND) � HORIZ-DNI AL HEALti TANK. EXISTMG) VENI-I'S STNS HW -Y Ill DRAWING SCALE I ' = 40'+ - MAP SYMBOLS <\ ELEC TRIC%L PANEL SHU1—OF: NATURAL GAS `- s+IDT O Y ) WAIER 4AUT-OFF OEFAERGENCY PUMP SHUT—OFF T,A;, TARK MONITORING f� ALARM `r TEL£Pr'rr,'E FIRST MD XII FIRE EXTIr•IiSiJISHER SFORIA DRAIN SANITA+2Y SEWER STAG14G, IiREA EVACUATION/ HMIAP FIIAMP_ rND MSDS r.c SI) !; LOCATIU-+ �tp FIRE HYCIP.- r•r7 =< FEa+CE ERE EMERGEt+C r RESP0.145E EQUIF•F,IEri r;ra.s35�.X�6Lt:1-S —� A9Q1.`EGROU, D SIORAGE TAN?:* rte— LINC RGRCUND -- STORAGE_ I:o.NK C;ASOLINE (FLrrATA&BLE LIOUIOS) DIESEL FUEL (COmBUSTiLILE LIQUIDS) C, M01OR AILS I< LUBRIC.o TS (COF,IBUSILBLE LIQUIDS.) CO CAP.BIXI DIOXIDE (COMPRESSM G,% -S) PRCPI11•1c �J (FLkTAF, AKE LIQUID) W WAST£ oil. (FLAMMADI-E L-IOIJID) Cw CAR WA.Sli PRODUc:S - S iFw Z• StIf-el" �`tsa�i'13 ARB Approved IOM - Healy Phase t! EVR System — VR -201 -A (CAS — 9961) Page 16 INSTALL'ATI®N INSTRUCTIONS for MEALY SYSTEMS, INC. CLEAN AIR SEPARATOR The Model 9942, Healy Systems Clean Air Separator Installation consists of a 400 gallon steel tank assembly (9961) that contains a fuel resistant bladder to contain excess gasoline vapors that may develop in gasoline storage tanks during idle periods of gasoline dispensing facility operation. The tank assembly weighs approximately 800 pounds which makes it necessary to have a power assisted lifting device available at the installation site to remove the tank from the transportation vehicle arid place it on the required concrete pad (see drawing B9900-9945). The pad (level within 1./8"/foot) is located within 100 feet to the storage tank vent lines. The pad is a requirement of this. installation. DO NOT PLACE THE TANK DIRECTLY ON THE GROUND OR ASPHALT SURFACE. NOTICE: The installer is responsible to ensure that the installation meets the latest edition requirements of NFPA 30A, Chapter 10. No electrical connections are required. The tank securement method shown in drawing B9900-9945 shall be approved by the local authority having jurisdiction with respect to wind and seismic loading. In addition to the tank; there is a hardware kit that contains the following: 1 Pressure/Vacuum vent valve (;See Exhibit 1 of VR -201-A for model number) 4 Locking 1" NPT Ball Valves 4 Pad locks (keyed alike) 1 Breather Assembly, Healy Model 9948 1 Vapor Inlet Assembly, Healy Model 9956 1 Float Check Valve Assembly, Model 9466G CIN �F LA QUINTA BUILDING $ SAFETY pEP1', Reference the appropriate Healy Systems installation rawing P 9 VEEN00.9 1, 09900- 9972 or C9900-9973 of this manual) for placemen of t�R r �ThN the vent stack configuration required by the local Authority Having Ji risdicti n (AHJ) for e UST s stem. The local contractor is responsible to provide all necess r9Ar�i d EW g, -ha dening, UL classified pipe joint compound and plumbing fittings. A vent valves to complete installation are not included in the hardware kit. Healy is not responsible for the warranty of any other P/V vent valve purchased to complete installation. The tank arrives at the site assembled and tested. All plumbing should be done using 1" galvanized steel pipe (Schedule 40) and approved nipples, as called out in the installation drawing appropriate for the site installation. Mounting hardware should be galvanized or stainless steel. Careful attention must be paid to the installation drawing appropriate for the site installation to assure proper operation of the bladder system. Do not inflate the bladder assembly after installation. It is important that the tank be secured to the concrete pad as shown in drawing B9900-9945 of this manual to prevent any unintentional repositioning of the tank as the connecting plumbing to the vent system is accomplished. Healy Systems, Inc. Website: http://www.healysystems.com 18 Hampshire Drive Email: sales@healysystems.com Hudson, New Hampshire 03051 USA Telephone: 603.882.2472 ARB Approved Installation, Operation and Maintenance Manual (April 8, 2005) Fax: 603.882.5189 Healy Systerns, Inc. — the innovative leader of Stage 11 vapor recovery equipment ARB Approved IOM - Healy Phase !! EVR System — VR -201 -A (CAS — 9961; Page 17 OPERATION AND PURGING NORMAL OPERATION: u There are'.four bail valves on the tank. in normal operation, only the valve at the top of the tank shall be open —the ether three valves shall be closed. All four valves shall be locked in the above positions. The two plugs should be installed using a non -hardening, UL classified pipe joint compound and tightened to 60 ft -lbs. DRAINING THE BLADDER: u An inspection of the need to drain the bladder is easily made by removing the plug at the tee on the bottom plumbing of the tank — be sure to have a metal container available to catch fluid. With the plug removed and the container in place, carefully open the ball valve above the tee to release any' liquid. Any liquid coming over from the vent system would have collected above the valve in the riser pipe before going into the bladder. If liquid in excess of 16 ounces drains out, the bladder should also be drained. Use caution as the storage tanks could be pressurized. V u Should it be necessary to drain the bladder: 1. Close the upper ball valve (usually open) leading to the tank vent lines. 2. Open the valve that goes to the vertical riser that enters the top of the tank (the one without the ball valve going into the tank). Be sure the other three ball valves that connect to the vent lines and tank are closed.. 3. Remove the plug from the bottom tee and connect an explosion proof evacuation pump capable of handling liquid. Have a liquid tight, metal container to receive any fluid that may exit the system and start the pump. If no liquid return within 30 seconds, the bladder is dry — discontinue pumping, remove the pump, replace the plug and return the ball valves to their original, locked, positions. DRAINING THE TANK: a Should it be necessary to drain the tank (between the bladder and steel wall): 1. Close the ball valve at the. top of the tank and also the two valves on the vertical risers. 2. Remove the plug in the bottom tee and place a metal container below the pipe opening. 3. Carefully open the ball valve at the bottom of the tank — observe that the container that is being drained into does not overflow — empty container as required until fluid no longer comes from the pipe when the valve is open. 4. Close the ball valve and replace the plug into the tee. 5. Return all ball valves to their original locked positions. Healy Systems, Inc. Website: http://,Aww.healysystems.com 18 Hampshire Drive Email: sales@healysystems.com Hudson, New Hampshire 03051 USA Telephone: 603.882.2472 ARB Approved Installation, Operation and Maintenance Manual (April 8, 20051 Fax: 603.882.5189 Fieaiy Systems, Inc. — the innovative leaderol Stage Il vapor recovery equipment L I m I imm9l MW 1 ZL66-0066" NouOorond ilpip � (3A -WA LN3A Z) NOIlV11V1SNl = a01V8Vd3S MIV N9310mm oNa �ooro wero�w 'ONI'SMISAS s/I� - mewa�o�s = t'ifo"r t0�,*� - XX, } !.x'101 bMLdY A1ddY BNOVONIO 34VAM10 SMNn >, 'SlIV130 80.4 4466-00668 OMO 33S 'SVIS NNVl----" m '30VbID 3AOSV ,Zl d0 1HO13H D YVnYlINIYV V 1V 03I1V1SNI 38 Ism M3HLV3M8 81V-£ '03MIn03M M3MOd IVDI&3313 ON-108iN00 3anSS3Md HNVl 3AISSVd-Z ' '321f11V3d NOOIOVd < c 3AVH ONV. 03LSII In 38 Ol ('A'8) S3AIVA llVB lIV-1 a 310N I rn O 1=1 MI , Tllp:::= = 1 I ( fD O I 1J WnNININ ,Z l - — - NOLLO310Md-nUH3AO ' ('33M) 9566 N/d I 09946 N/d 'WSSV 131N1 MOdVA T3AIVA N031-13 1VOld i NOHdAS l M300V18 .1 8466 N/d ld Mad H011d .8/1 I NMr I 90/til/f I 3nssl 'ORIo It (1nO/NI) MIV H own 'XVW 'ld 001 3AlVA ddd I aL`/O I SNOISIA3M NOI1d0gt! 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I C 3AIVA 1N3A a 90 -IM VO it 01 jZXZ SVM dno £Xf '91/1t SYM t1co ZO/t£/L 3nssl 'oia0 3140 NoudIHOS30 SNOISIA3N o_ o �•�Z ° I D C7 Cl • I g ca Q c - ONIL00! 2Y XNV1 u m fwwowco 9't -ON f 3NOZ 01WSGS TOY 104 0001 - OWN38 1105 vla3Lla0 .0-.f co 8 n3a BVIS-0066 �7 z CD — ♦0 — 423H7%.0-.1 - ,>/r 3ivJs S30M dWHS ow Saano 71Y morin 5 66-006'6 8 -.611 aid W l 6W �v� IfHda31Nl lad 0000r - HLoN3a1S ol3u 'dN13a 'NIW 'NIM :HSINLi 30YdanS NOLL031'Oad 31ONY OaIKL dS hd OOQZ - HLONULS dW00 31380N00 S310N 0 SlIV130 AVIS `JNIINf10W. - ll T = XX//X < >IN'VI 81V NV310 _UNAt;lo'� -XXX a 3wi 6AG t VT - XX' t'� X' t - f f - 31Y0S O {LOCO IN149dwOH MON 'uospnH - -d 1 SAWO •145dLUDH Lt ONISMONd a3LW AlddV SNOISN3W10 'V^^ NI °SW31SAS �0 tf G HMP sLINn NI 3W SNOISN3Wla I NM o :031dI03dS 3SIM63HIO SS3lNn AVM tpv3 t/I (9) _ m IVOINHO3103o `< 3NON - 31VOS a b ' .0-,Z aid OVdyYW 0310YdWW a0 318Y1SNn � to N SM 30VW HSINU 'UMS3 0801)'(S3JV1d f) i' XV ,L NdV 1 LLIIH 3 .f 6 1108 X1NX LLIIH .QX..Q/Q a3lWVHO .*/£ to .0-.1 - 4 f -. 31V0S 0, 'Q 001 y` I C '0'8 'YIO .Zf 5a3H10 AB XN NO S310H f Sd110 8 3SY8 'XNVl o.t/r 90 -IM VO it 01 jZXZ SVM dno £Xf '91/1t SYM t1co ZO/t£/L 3nssl 'oia0 3140 NoudIHOS30 SNOISIA3N o_ o �•�Z ° I D C7 Cl • I g ca Q c - ONIL00! 2Y XNV1 u m fwwowco 9't -ON f 3NOZ 01WSGS TOY 104 0001 - OWN38 1105 vla3Lla0 .0-.f co 8 n3a BVIS-0066 �7 .1 S California State Fire Marshal CODE INTERPRETATION Date Issued July 27, 2007 Interpretation 06-124 Topic Healy Clean Air Separator (CAS) Tank as a "Vapor Processin Unit' Code Section(s) CFC 5202.1.3.3.9 Requested by Don Foster Gettler-Ryan Inc. 1364 N. McDowell Blvd, Suite B2 Petaluma, CA 95954 The California State Fire Marshal has accepted the UL certification of the Healy Clean Air Separator (CAS) Tank as a "Vapor Processing Unit'. 2001 CFC Section 5202.13.3.9 indicates that the vent termination from vapor processing units shall be not less than 8 feet above the processing unit itself. i . All of the Healy Installation materlals and the California Air Resources Board Executive Order VR 202 A exhibits indicate that the underground storage tank pressure vacuum vent valve termination need only be located 12 feet above grade. No reference Is made to the 8 foot separation requirement. We have two Questions for your consideration and interpretation: 1. Does the UST pressure vacuum vent valve need to be located 8 feet above the CAS Tank as indicated on the attached Detail -f2 No. The design of the CAS is such that all vapors from the UST are completely trapped within the "bladder" contained in the CAS. The vent coming from the CAS is to vent the interstitial space between the bladder and. the outside wall of the CAS. (See footnote below) Z /s the Healy CAS Air Breather Assembly considered an underground tank vent in the context of NEC Article 514, Group D, Division 1 and 2 Hazardous Locations? As described in the above, the UST is "vented" to the bladder contained within the CAS and by design, no vapors are emitted to atmosphere. (See footnote below) Foot note: The intent of this footnote is for reference only and to provide clarification. It is not the intent of the State Fire Marshal to endorse any one specific product, device or methodology. Description of Operation of the Healy Clean Air SeparatorTM: The Healy Systems, Inc., Model 9961 Healy Clean Air SeparatorTm is a stand-alone, completely mechanical device that assists in controlling the gasoline vapor emissions from a gasoline dispensing facility. It consists of a 400 -gallon storage vessel with integral bladder and associated valving. It Is connected to the ullage space of the GDF storage tanks via the venting system of the under ground storage tanks. During normal operation of the GDF, with today's concentration of ORVR vehicles approximating 20%, the storage tank ullage space will usually operate in.the "0" to negative (up to 8" WC PN cracking pressure) pressure range. During" closed" periods of the GDF, the ullage pressure will usually begin to increase due to vapor growth inherent in the process of introducing air into the UST's. If the pressure goes slightly above atmospheric the vapor from the USTs will flow into the internal bladder. Conversely' when ORVR refueling begins and the UST pressure falls below atmospheric, the vapor internal to the bladder will be drawn back into the UST until the bladder is fully collapsed waiting for the next cycle. The Clean Air Separatorm in over two and one half years (installed late September of 2002) of being in operation at our C.A.R.B. test site in Sacramento has been evaluated repeatedly to see if there is any liquid condensation in either the bladder or the space between the inner wan of the vessel and outer wall of the bladder. To date there has been no liquid found in either area. ESR -1385 REPORT TM Reissued January 1, 2007 This report is subject to re-examination in two years. �li?.'�+ Evaluation @r1/ICL� Inc. Regional Office a 5360 Workman Mill Road, Whittier, Calffomia 90601 a (562) 699-0543 Regional Office a 900 Montclair Road, Suite A, Birmingham, Alabama 35213 ■ (205) 599-9800 www.icc-eS.Orit Regional Office 84051 West Rossmoor Road,.Country Club Hills, Illinois 60478 a (708) 799-2305 DIVISION: 04—MASONRY Section: 04081—Masonry Anchorage REPORT HOLDER: HILTI, INC. 5400 SOUTH 122ND EAST AVENUE TULSA, OKLAHOMA 74146 (800)879-8000 www.us.hilti.com HiitiTechEng(dDus. hiiti.com EVALUATION SUBJECT: KWIK BOLT 3 MASONRY ANCHORS 1.0 EVALUATION SCOPE Compliance with the following codes: n 2006 Intemational Building Code® (IBC) e 2006 International Residential Code® (IRC) ■ 1 1997 Uniform Building CodeTm (UBC) Properties evaluated: Structural 2.0 USES The Kwik Bolt 3 (KB3) Masonry Anchor is used to resist static and transient seismic and wind tension and shear loads in untracked, grout -filled concrete masonry. The anchor system is an altemative to cast -in-place anchors described in Section 2107 (ACI 530) of the IBC and Section 2107.1.5 of the UBC. The anchor systems may also be used where an engineered design is submitted in accordance with Section R301.1.2 of the IRC. 3.0 DESCRIPTION The Kwik Bolt 3 expansion anchors consist of a stud, wedge, nut, and washer. The stud is manufactured from carbon or stainless steel material. The carbon steel Kwik Bolt 3 anchors have' a 5 pm (0.0002 inch) zinc plating. The anchor is illustrated in Figure .1 of this report. The wedges for the carbon steel anchors are made from carbon steel, except for all"/, -inch (6:4 mm) lengths and the 3/4-inch-by-12-inch,1-inch-by-6-inch, 1 -inch -by -9 -inch and 1 - inch -by -12 -inch (19.1 mm by 305 mm, 25 mm by 152 mm, 25 mm by 229 mm, and 25 mm by 305 mm) sizes, which have AISI 316 stainless steel wedges. All carbon steel components are zinc -plated. The'/Z , '/.-, and 3/4 -inch -diameter (12.7,15.9, and 19.1 mm) carbon steel Kwik Bolt 3 anchors are available with.a hot -dipped galvanized plating complying with ASTM A 153. The studs, nuts and washers of the 304 and 316 stainless steel Kwik Bolt 3 anchors are also made from stainless steel. All 304 stainless steel, 316 stainless steel, and hot -dipped galvanized Kwik Bolt 3 anchors use 316 stainless steel wedges. The stud consists of a high-strength rod threaded at one end. The standard Kwik Bolt 3 has a thread length equal to or less than three bolt diameters, while the Long Thread Kwik Bolt 3 has a thread length greater than three bolt diameters. The tapered mandrel has an increasing diameter toward the anchor base, and is enclosed by a three -section wedge that freely moves around the mandrel. In the vertical direction, the wedge movement is restrained by the mandrel taper at the bottom and by a collar at the top of the mandrel. When the anchor nut is tightened, the wedge is forced against the wall of the predrilled hole to provide anchorage. 4.0 DESIGN AND INSTALLATION 4.1 Design: Minimum embedment depth, edge distance, and spacing requirements are set forth in Table 1. Allowable stress design' tension and shear loads are as noted in Tables 2 and 3. Allowable loads for Kwik Bolt 3 anchors subjected to combined shear and tension forces are determined by the following equation: (PJPr)5/3 + (VJVt)113 s 1 where: Ps = Applied service tension load (Ibf or N). P, = Allowable service tension load (Ibf or N). VS = Applied service shear load (Ibf or N,). V, = Allowable service shear load (Ibf or N). 4.2 Installation Requirements: Kwik Bolt 3 shall be installed in holes drilled into the base material using carbide -tipped masonry drill bits complying with ANSI B212.15-1994 or where permitted by the tables, Hilti Matched -Tolerance Diamond Core Bits. The nominal drill bit diameter shall be equal to that of the anchor. The drilled hole shall exceed the depth of anchor embedment by at least one anchor diameter to permit over -driving of anchors and to provide a dust collection area. The anchor shall be hammered into the predrilled hole until at least six threads are below the fixture surface. The nut shall be tightened against the washer until the torque values specified in Table 1 are attained. 4.3 Special Inspection: Special inspection shall be provided in accordance with Section 1704 of the IBC or Section 1701 of the UBC when design loads are based on special inspections being provided `Corrected May 2007 F�cS REPORTS^ are not to be construed as representing aesthetics or any other attributes not specifically addressed, nor are they to be construed as an endorsement ofthe subject ofthe report or a recommendation for its use. There is no warranty by /CC Evaluation Service, Inc., arpress or implied. as to any finding or other matter in this report, or as to any product covered by the report. • nm trom'ma goprm Copyright O 2007 Page 1 of 4 Page 2 of 4 ESR -1385 during anchor installation, as set forth in Tables 2 and 3. Special inspection in accordance with Section 1704 of the IBC shall be provided under the IRC when special inspection ;iS specified in Tables 2 and 3. The code official shall receive ,,a report, from an approved special inspector, that includes the following details: 1. Anchor description, including the anchor product name, nominal anchor and bolt diameters, and anchor length. 2. Hole description, . including verification of drill bit compliance with. ANSI B212.15-1994 or the Hilti specification for matched tolerance diamond core bits, hole depth, and cleanliness. 3. Installation description, including verification of masonry compressive strength, and verification of anchor installation and location (spacing and edge distance) in accordance with Hilti's published installation instructions and this report. 5.0 CONDITIONS OF USE The Kwik Bolt 3 Masonry Anchors described in this report comply with, or are suitable alternatives to what is specified in, those codes listed in Section 1.0 of this report, subject to the following conditions: 5.1 Anchor sizes, dimensions, and installation shall comply with this report and Hilti's published • installation instructions. 5.2 Allowable tension and shear loads shall be as noted in Tables 3 through 14 of this report. 5.3 Calculations and details demonstrating compliance with this report shall be submitted to' the code official for approval. 5.4 The use of anchors shall be limited to installation in uncracked grout filled concrete masonry. Cracking occurs when f, > fr due to service loads or deformations. 5.5 Design of Kwik Bolt 3 Masonry Anchors installed in grout -filled concrete masonry to resist dead, live, wind and earthquake load applications must be in accordance with Section 4.1 5.6 When using the basic load combinations in accordance with IBC Section 1605.3.1 or UBC Section 1612.3.1; allowable loads are not permitted to be increased for wind or earthquake loading. When using the alternative basic load combinations in IBC Section 1605.3.2 or UBC Section. .1612.3.2 that include wind or seismic loads, the allowable shear and tension loads for anchors are permitted to be increased by 331/3 percent. Alternatively, the basic load combinations may be reduced by a factor of 0.75 when using IBC Section 1605.3.2. 5.7 Where not otherwise prohibited in the applicable code, anchors are permitted for use with fire -resistance -rated construction provided that at least one of the following conditions is fulfilled: • Anchors are used to resist wind or seismic forces only. • Anchors that support fire -resistance -rated construction or gravity load—bearing structural elements are within a fire -resistance -rated envelope or a fire -resistance - rated membrane, are protected by approved fire - resistance -rated materials, or have been evaluated for resistance to fire exposure in accordance with recognized standards. • Anchors are used to support nonstructural elements. 5.8 Use of carbon steel Kwik Bolt 3 anchors shall be limited to dry, interior locations. Hot -dipped galvanized and stainless steel Kwik Bolt 3 anchors are permitted in exterior exposure or damp environments. 5.9 Since an ICC -ES acceptance criteria for evaluating data to determine the performance of expansion anchors subjected to fatigue or shock loading is unavailable at this time, the use of these anchors under these conditions is beyond the scope of this report. 5.10 Special inspection shall.be provided in accordance with Section 4.3 of this report when required by Tables 3 through 14. 5.11 Anchors shall be manufactured by Hilti, Inc., Feld kircherstrasse 100, Schaan, Liechtenstein, under a quality control program with inspections conducted by Underwriters Laboratories Inc. (AA -668). 6.0 EVIDENCE SUBMITTED 6.1 Data in accordance with the ICC -ES Acceptance Criteria for Expansion Anchors in Concrete and Masonry Elements (AC01), dated January 2007, including seismic tests, reduced spacing tests and reduced edge distance tests. 6.2 Quality control manuals. 7.0 IDENTIFICATION The anchors shall be identified in the field by dimensional characteristics and packaging. The packaging label indicates the manufacturer's name (Hilti, Inc.) and address, the size and type of anchor, the name of the inspection agency (Underwriters Laboratories Inc.), and the ICC -ES report number (ESR -1385). A length identification code letter is stamped on the threaded end of the bolt. The length identification system is described in Table 4. Page 3 of 4 ESR -1385 TABLE 1—INSTALLATION SPECIFICATIONS' - SETTING DETAILS ANCHOR SIZE 1/4 inch 3/a inch 'l, inch 518 inch 3/4 inch 1 inch Drill bit size = anchor diameter (inches) 1/4 3/8 1/2 5/8 3/4 1 Wedge clearance hole (inches) 5/1 8 '/,8 9/,s "/,s 13/,6 1'/a Anchor length (min./max.) (inches) 11/4 02 2'/8 7 23/4 7 3'/Z10 6 12 6 12 Thread length std.Aong thread length (inches) 3/4 3 '/8 55/8 1'/4 4314 1'/Z 7 1'/Z 6 2'/4 6 Installation: Torque guide values (ft -Ib) in concrete masonry Carbon steel: Min. Embedment Carbon steel: Std. Embedment 4 15 25 4 15 25 65 65 120 120 — — Min. base material thickness (inches) 3 inches or 1.5 X embedment depth, whichever is greater GJ.Y 111111, 1 Il-lul I.JOo IN -111. 'Installation torques are applicable for all anchors installations unless noted otherwise in this report. TABLE 2—ALLOWABLE TENSION AND SHEAR VALUES FOR HILTI KWIK BOLT 3 CARBON STEEL ANCHORS INSTALLED IN THE FACE SHELLS OF GROUT -FILLED CONCRETE MASONRY WALLS (in pounds)" -',4 ANCHOR EMBEDMENT MINIMUM TENSION SHEAR DIAMETER DEPTHS DISTANCE (inch) (inches) FROM EDGE OF WALL6 UBC With UBC Without IBC/IRC8 UBC IBC/IRC' (inches) Special Special Inspection' Inspection 11/8 4 152 76 121 380 304 12 152 76 121 380 304 ,/4 2 4 540 270 432 427 342 12 540 270 432 427 342 15/8 4 321 161 257 736 589 3/ 12 342 171 273 938 751 8 2Y2 4 782 391 626 955 764 12 782 391 626 1,317 1,054 21/4 4 628 314 502 830 664 12 667 333 533 1,464 1,171 ,/ Z 3'/2 4 905 452 724 1,051 840 12 905 452 724 2,317 1,853 23/4 4 814 407 651 888 710 12 866 433 692 2,165 1,732 5/ e 4 4 1,242 621 994 929 743 12 1,294 647 1,035 2,654 2,123 31/4 4 1,036 518 829 784 627 12 1,036 518 829 3,135 2,508 3/ 4 43/8 4 1,645 823 1,316 821 657. 12 T 1,711 855 1,368 3,283 2,627 1 119-1 - GJ.Y 111111, 1 lu - Y.YJ IV. 'Values valid for anchors installed in face shells of Type 1, Grade N, lightweight, medium -weight, or normal -weight concrete masonry units conforming to ASTM C 90 or UBC Standard 214. The masonry units shall be fully grouted with coarse grout conforming to IBC 2103.10 and ASTM C 476 or UBC Section 2103.4 and UBC Standard 21-19. Mortar shall comply with IBC Section 2103.7 and ASTM C 270 or UBC Section 2103.3 and UBC Standard 21-15, Type S, N, or M. Masonry prism strength shall be at least 1,500 psi at the time of anchor installation when tested in .accordance with IBC Section 2105.2.2.2 and ASTM C 1314 or UBC Section 2105.3.2 and UBC Standard 21-17. 'Anchors shall be installed a minimum of 13/8 inches from any vertical mortar joint in accordance with Figure 2. Anchor locations are limited to one per masonry cell with a minimum spacing of 8 inches on center. 4Allowable loads or applied loads may be modified in accordance with Section 5.6 of this report due to short-term wind or seismic loads. Embedment depth shall be measured from the outside face of the concrete masonry unit. BFor intermediate edge distances, allowable loads may be determined by linearly interpolating between the allowable loads at the two tabulated edge distances. 'These tension values are only applicable when anchors are installed with special inspection in accordance with Section 4.3 of this report. 8Special inspection shall comply with Section 1704.5 of the IBC for anchorages in masonry. Page 4 of 4 ESR -1385 TABLE 3—ALLOWABLE TENSION AND SHEAR VALUES FOR HILTI KWIK BOLT 3 CARBON STEEL ANCHORS INSTALLED IN TOP OF GROUT -FILLED CONCRETE MASONRY WALLS' -',"(in pounds) OANCHOR EMBEDMENT TENSION SHEAR DIAMETER DEPTHS R S T U V W X Perpendicular to Wall Parallel to Wall (inch) (inches) UBC With UBC IBC/IRC' UBC IBC/IRC' UBC IBC/IRC' Anchor (inches) Up to but not , , including 2 3% 4' 4% 5 , 51/2 6 Special Without , 9 /2 10 11 12 13 14 15 16 17 18 18 ` Inspection6 Special Inspection 1/2 3 646 323 517 311 249 614 491 S/e 3'/2 852 426 1 682 311 249 614 491 For Sl: 1 inch = 25.4 mm, 1 Ib = 4.45 N. 'Values valid for anchors installed into top cells of Type 1, Grade N, lightweight, medium -weight, or normal -weight concrete masonry units conforming to ASTM C 90 or UBC Standard 21-4. The masonry units must be fully grouted with coarse grout conforming to IBC 2103.10 and ASTM C 476 or UBC Section 2103.4 and UBC Standard 21-19. Mortar shall comply with IBC Section 2103.7 and ASTM C 270 or UBC Section 2103.3 and UBC Standard 21-15, Type S, N, or M. Masonry prism strength shall be at leasst 1,500 psi at the time of anchor installation when tested in accordance with IBC Section 2105.2.2.2 and ASTM C 1314 or UBC Section 2105.3.2 and UBC Standard 21-17. 2Anchors must be installed a minimum of 13/4 inches from edge of the block. 3Anchor locations shall be limited to one per masonry cell with a minimum spacing of 8 inches on center. °Allowable loads or applied loads may be modified in accordance with Section 5.6 of this report due to short-term wind or seismic loads. SEmbedment depth is measured from the top edge of the concrete masonry unit. 6These tension values are only applicable when anchors are installed with special inspection in accordance with Section 4.3 of this report. 'Special inspection shall comply with Section 1704.5 of the IBC for anchorages in masonry. TABLE 4—LENGTH IDENTIFICATION CODES STAMP ON ANCHOR A B I C D E F G H I J K L M N O P Q R S T U V W X Y Z Length of 3 3'/2 4 4'/2 From 1%[2±/23 5 5'/2±61/27 7 7'/2 8 8% 9 9'/2 10 11 12 13 14 15 16 17 18 Anchor (inches) Up to but not , , including 2 3% 4' 4% 5 , 51/2 6 , , 711 8 011 9 , 9 /2 10 11 12 13 14 15 16 17 18 18 For SI: 1 inch = 25.4 mm. Mandrel Area . — Washer o Thread Area Anchor Body Triple Segmented Wedge Anchor Installation is: ResWded to Ne"haded Areas FIGURE 1—KWIK BOLT 3 FIGURE 2—ACCEPTANCE LOCATIONS (NON -SHADED AREAS) FOR HILT] KWIK BOLT 3 ANCHORS IN GROUT -FILLED CONCRETE MASONRY ANCHORS '_ � F_ ; ' 7�..