HomeMy WebLinkAboutFMC Permit App 11-10-15 (South)1111,,�'Jjjj 111
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 #
I7-/ �.
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 -326 -3979 e Fax: 661- 852 -2171
Page 1 of 1
❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
® FUEL MONITORING CERTIFICATION (X 2 )
SITE INFORMATION
FACILITY
Sull 's Downtown a
NAME & PHONE # OF CONTACT PERSON
Frank Sullivan (661) 327 -5008
ADDRESS
2317 L Street Bakersfield CA 93301
OWNER NAME
Sullivan Petroleum Company
OPERATOR NAME
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
L.Mel Bolton 661 631 -3870
MAILING ADDRESS
16250 Meacham Road Bakersfield CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
DATE & TIME T ST TO BE CONDUCTED
ICC #
TEST METHOD
APPLICAN IGN TU
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)