HomeMy WebLinkAbout2525 white ln fmc permit app. 6-1-16UNDERGROUND 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
Bk ' AB it s F I . "s
4 mirk
A R T'A/ T
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
FD2095 (Rev 03/08)
SITE INFORMATION
FACILITY
Chevron
NAME & PHONE # OF CONTACT PERSON
Tidal Azzi, Gaby Jabbour 805-444-42.2c-
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. __PMel
NAME & PHONE # OF CONTACT PERSON
Bolton 661 631 -3870
MAILING ADDRESS
16250 Meacham
Road Bakersfield CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
(661)427-9355
CERTIFICATION #
P4543R
DATE & TIME T ST TO BE CONDUCTED
ICC #
8126722 -UT
TEST METHOD
APP CA T , GN T ��
DATE,
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)