HomeMy WebLinkAboutFMC Permit App 6-16-16UNDERGROUND 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 # (o -.10 - - -
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
f
LINE TESTING
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 • Fax: 661 -852 -2171
Page 1 of 1
X FUEL MONITORING CERTIFICATION
SB -989 SECONDARY CONTAINMENT
SITE INFORMATION
FACILITY: Kern County Superintendent of Schools
NAME & PHONE # OF CONTACT PERSON
Scott 852 -5811
ADDRESS
705 S. Union Ave, Bakersfield, CA.
OWNER NAME
Kern County Superintendent of Schools
OPERATOR NAME
Scott
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES X NO
TANK #
VOLUME
CONTENTS
1
12,000
Unleaded
2
12,000
Diesel
TANK TESTING COMPANY
TESTING COMPANY
Cal - Valley Equipment
NAME & PHONE # OF CONTACT PERSON
Jerry Rangel
MAILING ADDRESS
3500 Gilmore Avenue, Bakersfield, CA. 93308
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Jerry Rangel
CERTIFICATION #
Veeder Root: B35460
DATE & TIME TEST TO BE CONDUCTED
06/15/16 @ 9:00 am
ICC #
8160834
TEST METHOD
Industry Standard
APPLICANT SIGNATURE
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)