HomeMy WebLinkAboutUST APPL. 4/16/2014UNDERGROUND 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 #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
s �4
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 • Fax: 661- 852 -2171
Page 1 of 1
❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
IndieCo
NAME & PHONE # OF CONTACT PERSON
Ben Dashtipour (661) 861 -9769
ADDRESS
100 South Oswell Street
OWNER NAME
INDIECO
OPERATOR NAME
Ben Dashtipour
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.
rKarli AME & PHONE # OF CONTACT PERSON
Karns (661) 631 -3870
MAILING ADDRESS
16250 Meacham Road, Bakersfield, CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Kristopher Karns
CERTIFICATION #
B34106
DATE & TIME TEST TO BE CONDUCTED
4/24/14 at 9:00am
SCC #
5264406 -UT
TEST METHOD
APPLICANT SIG ' ATURE
i /
DATE
1 4/
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
AP PR VED BY
DATE
FD2095 (Rev 03/08)