HomeMy WebLinkAboutUST-APPL. 5/19/2016UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD / LINE TESTING
/ SB989 SECONDARY CONTAINMENT TESTING
/TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
PERMIT NO. &Je
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BAKERSFIELD FIRE DEPT.
Prevention Services
2101 H Street
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
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❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT TESTING
n TANK T1rHTNf^S.q TPRT X TO PERFORM Fl1FL MONITORING CERTIFICATION ❑ Cathodic Protection Testina
SITE INFORMATION
FACILITY CALIFORNIA MINI MART
NAME & PHONE NUMBER OF CONTACT PERSON
ADDRESS 1129 UNION AVE, BAKERSFIELD, CA
OWNERS NAME Same
OPERATORS NAME Same
PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
1
87 UL
2
87 UL
3
91 UL
4
Diesel
TANK TESTING COMPANY
--
NAME OF TESTING COMPANY Advanced Compliance
Bruce W. Hensley 661- 706 -4321
MAILING ADDRESS 3704 Littlefalls Ct. Bakersfield, Ca. 93312
Bruce W. Hinsley 661- 706 -4321
CERTIFICATION #:A25212,
DATE & TIME TEST TO BE CONDUCTED
ICC #: 8032698
SIGNATURE OF APPLICANT , _
DATE 5/19/2016
APPROVED BY a DATE
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