HomeMy WebLinkAboutFMC Permit App 7-13-16 #781APPLICATION
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 16-1000039 z
❑ 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
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❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
® FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Jaco 7781 Fastri 22 ]0mero
NAME & PHONE # OF CONTACT PERSON
Garcia (661) 393 -7000
ADDRESS
4013 So "H" St. Bakersfield CA 93304
OWNER NAME
Jamieson Hill
OPERATOR NAME
Omero Garcia
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
CERTIFICATION #
DATE & TIME TEST TO BE CONDUCTED
ICC #
TEST METHOD
APPLICANT SIGNATURE I
DATE
THIS APPLICATION BECOMES A PERMI WH N APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)