HomeMy WebLinkAboutFMC Permit App. 7-7-16APPLICATION
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 ❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ED FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
NA & PE # OF CONTACT PERSON
T_ HON
ME
2101 H Street
PINK
Bakersfield, CA 93301
ADDRESS
Phone: 661-326-3979 ® Fax: 661-852-2171
1200 Coffee Road,
Bakersfield, CA 93308
Page I of 1
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ED FUEL MONITORING CERTIFICATION
FD2095 (Rev 03/08)
SITE INFORMATION
FACILITY
NA & PE # OF CONTACT PERSON
T_ HON
ME
—Fastrip #64,1
Omero ro Garcia (661) 393-7000
M a
ADDRESS
1200 Coffee Road,
Bakersfield, CA 93308
OWNER NAME
Jamieson Hill
OPERATOR NAME
PERMIT TO OPERATE #
Garcia
-Omero
OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES
❑ NO
TANK #
VOLUME CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
AE PHONE # OF CONTACT PERSON
NAME &
M 01
—Confidence UST Services, Inc. Mel 1 Bolton (661) 631-3870
MAILING ADDRESS
16250 Meacham Road Bakersfield CA 93314
NAME & PHONE # OF TESTER OR SPECIAL
INSPECTOR CERTIFICATION #
-Brandon Mason
DATE & TIME TEST TO BE CONDUCTED
223-_3_ R2437�5
_49_9
ICC #
TEST METHOD
7/7/16 at ..9:00am
APPLICANT SIGNATURE
F5224980-11TI
DATE
UTHAP PBECOMES
'N A PR
LICAWTON A PERMIT WHEN A PRO
ED
APPROVED BY
DATE
Ac,
FD2095 (Rev 03/08)