HomeMy WebLinkAboutFMC Permit App 9-23-16APPLICATION
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 # 1.14 1
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 • Fax: 661- 852 -2171
Page 1 of 1
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ® FUEL MONITORING CERTIFICATION
FD2095 (Rev 12/15)
SITE INFORMATION
FACILITY
Hungry's Market
NAME & PHONE # OF CONTACT PERSON
Mike Wannas (661) 722 -4000
ADDRESS
3711 Mount Vernon Avenue, Bakersfield, CA 93306
OWNER NAME
Mike Wannas
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED?
❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
1
10,000 gallons
Regular(87)
2
10,000 gallons
Super (91)
TANK TESTING COMPANY
TESTING COMPANY
Confidence UST Services
NAME & PHONE # OF CONTACT PERSON
Mel Bolton 661 -631 -3780
MAILING ADDRESS
16250 Meacham Road, Bakersfield, CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Dustin Reese
CERTIFICATION #
8216722 -UT
DATE & TIME TEST TO BE CONDUCTED
09/23/2016 @ 10:00 am
1CC #
B43426
TEST METHOD
APPLICANT SIGNATU E pjJMW
DATE
THIS APPLICATION BECOMES A PERM WHEN APPROVED
APPROVED BY
DATE
1012116
FD2095 (Rev 12/15)