HomeMy WebLinkAboutUST APPLICATION 9-4-15UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING /TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT # /i--I0000fld3
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
,E
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 . Fax: 661- 852 -2171
Page 1of1
❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
® FUEL MONITORING CERTIFICATION
FD2095 (Rev 03/08)
SITE INFORMATION
FACILITY
Chevron
NAME & PHONE # OF CONTACT PERSON
N Azzi, Gaby Jabbour 805- 444 -422
ADDRESS
2525 White Ln
Bakersfield CA 93304
OWNER NAME
Chevron
OPERATOR NAME
Bassem Azzi
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
Confidence UST
Services, Inc.
NAME & PHONE # OF CONTACT PERSON
Karli Karns (661) 631 -3870
MAILING ADDRESS
16250 Meacham Road Bakersfield CA 93314
NAME & PHONE # OF TESTER OR
Austin star-linq
SPECIAL INSPECTOR
(661)301-9985
CERTIFICATION #
P4543R
DATE & TIME TEST TO BE CONDUCTED
ICC #
8126722 -UT.
TEST METHOD
APPLICANT SIG TUR
^�..i
DATE
,r` 9
JAAAIS
APPLICATION BECOMES A PERM T WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)