HomeMy WebLinkAbout2023 Baker St. Permit ApplicationUNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Tease mate that these are separate
individual tests and will he charged per
separate type test accordingly.)
it �.'O'
B B -7,:s D
FIRE
-&j
N' �
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 • Fax: 661- 852 -2171
Page 1 of 1
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS R FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY FIESTA LIQUOR
NAME & PRONE # OF CONTACT PERSON
D 661-323-4684
ADDRESS 2023 BAKER ST.
OWNER NAME ED
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
1
12,000
PREMIUM
2
12,000
UNLEADED
3
12,000
PLUS
TANK TESTING COMPANY
TESTING COMPANY BSSR INC,
FIDEL CARRILLO CONTACT 661- 588 -2777
MAILING ADDRESS 6630 ROSEDALE HWY #B
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
FIDEL CARRILLO 661 -588 -2777
CERTIFICATION # 5257282
DATE & TIME TEST TO BE CONDUCTED 10- -15 9:00 AM
ICC # 5257282
TEST METHOD
APPLICANT SIGNATURE
DATE
10 -8 -15
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)