HomeMy WebLinkAboutFMC PERMIT APP 7-28-16APPLICATION
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 # 6 _ arno
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
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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 ❑ SB -989 SECONDARY CONTAINMENT
® FUEL MONITORING CERTIFICATION
FD2095(Rev 03/08)
SITE INFORMATION
FACILITY
NAME & PHONE # OF CONTACT PERSON
O Garcia (661) 393 -7000
ADDRESS
3701 Ming Ave.
Bakersfield CA 93309
OWNER NAME
Jamieson Hill
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
Mel Bolton 661 6 1 -3870
MAILING ADDRESS
16250 Meacham Road, Bakersfield CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
DATE & TIME TEST TO BE CONDUCTED
n7/27Z16 at 9-00am
ICC #
817479-1
TEST METHOD
APPLICANT SIGNATURE
PSAPPLICATION
DATE
TH
1p
BECOMES A PERMIT W EN APPROVED
APPROVED BY
DATE
FD2095(Rev 03/08)