HomeMy WebLinkAboutSB-989 Permit App 9-24-15UNDERGROUND 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
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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 M SB -989 SECONDARY CONTAINMENT
❑ FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Chevron
NAME & PHONE # OF C€ NTA:C'T PERSON
Nidal Azzi Bassem Azzi 805 - 444 -422
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.
NAME &. z HONE # OF CONTACT PERSON
Karli Karns (661) 631 -3870
MAILING ADDRESS
16250 Meacham Road Bakersfield CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Cameron Mason (661) 303 -8550
CERTIFICATION #
9345263707
DATE & TIME TEST TO BE CONDUCTED
9/24./15 at 9 :00am
APPLICANT SIGNATURE
ICC * TEST METHOD
8176722 -UT
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)