HomeMy WebLinkAboutUST-APPL 11/4/2013UNDERGROUND 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 I
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
B E R S P I D 2101 H Street
FINK Bakersfield, CA 93301
ARrN, r Phone: 661-326-3979 • Fax: 661-852-2171
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❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
[21 FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Sully's Coffee lFrank
NAME & PHONE # OF CONTACT PERSON
Sullivan (661);327 -5008
-
ADDRESS
6009 Coffee Road, Bakersfield, CA 93308
OWNER NAME
Petroleum Company
-Sullivan
OPERATOR NAME I
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 SPECIAL INSPECTOR
Seykora (661) 487-93-5-9
CERTIFICATION #
B40738
-Bradley
DATE & TIME TEST TO BE CONDUCTED
11Z18/13 at 9:00am
Icc #
8111231-UT
TEST METHOD
APPLICANT SIGNATURE
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD209S (Rev 03/08)