HomeMy WebLinkAboutUST-APPLICATION 10/27/2015APPLICATION
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
{ 5
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 -326 -3979 ® Fax: 661- 852 -2171
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❑ LINE TESTING ® SB -989 SECONDARY CONTAINMENT
❑ FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Flower Street Mini Mart
NAME & PHONE # OF CONTACT PERSON
Hussain Monsour (661) 328 -0732
ADDRESS
928 Flower Street Bakersfield
OWNER NAME
Flower Street Mini Mart
OPERATOR NAME
Hussain Monsour
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
Mel Bolton 661 631 -3870
MAILING ADDRESS
16250 Meacham Road Bakersfield CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Mason (661) 303-8550.
CERTIFICATION #
1342599
DATE & TIME TEST TO BE CONDUCTED
in/2R/15 at 9-00am
ICC #
...8.174721-UT
TEST METHOD
APPLIC SI NA UR
D T 4
THIS APPLICATION BECOMES A PE MIT WHEN APPROVED
APPROVED BY
9?
DATE
FD209S (Rev 03/08)