HomeMy WebLinkAboutUST APP 1-13-15UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD / LINE TESTING
/ SB989 SECONDARY CONTAINMENT TESTING
/TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
• - • II •-
❑ ENHANCED LEAK DETECTION
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BAKERSFIELD FIRE DEPT.
Prevention Services
2101 H Street
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
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❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT TESTING
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SITE INFORMATION
FACILITY
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NAME & PHONE NUMBER OF CONTACT PERSON
ADDRESS
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OWNERS NAME
OPERATORS NAME
PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED
IS PIPING GOING TO BE TESTED? ❑ YES J& NO
TANK #
VOLUME
CONTENTS
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TANK TESTING COMPANY
-7 NAME OF TESTING COMPANY Cal - Valley EgUlpment
Name and phone # of contact person
Jerry Rangel (661) 327 -9341
MAILING ADDRESS 3500 Gilmore Ave. Bakersfield, Ca. 93308
Name and phone # of tester or special instructor
Jerry Rangel (661) 979 -0953
CERTIFICATION #: Incon: 271 0563701
DATE & TIME TEST TO BE CONDUCTED
ICC #: ICC: 5309489
Test Method
SIGNATURE OF APPLICANT
DATE
WNW AP�M
APPROVED BY DATE / /z,: f�
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