HomeMy WebLinkAbout#725 FMC Permit App 7-6-16APPLICATION
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 ® FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
B s 1 -ZA D
2101 H Street
FIRM
Bakersfield, CA 93301
ARrm j
Phone: 661 -326 -3979 ® Fax: 661- 852 -2171
OWNER NAME
Page 1 of 1
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ® FUEL MONITORING CERTIFICATION
FD2095 (Rev 03/08)
SITE INFORMATION
FACILITY
NAME & PHONE # OF CONTACT PERSON
Jaco 7725 Fastri
19 O Garcia (661) 393 -7000
ADDRESS
4901 South Union Ave
Bakersfield CA 93307
OWNER NAME
Jamieson Hill
OPERATOR NAME
PERMIT TO OPERATE #
Omero Garcia
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED?
❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
NAME &PHONE # OF CONTACT PERSON
Confidence UST Services, Inc. Mel Bolton 6 1
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
333
3CC #
TEST METHOD
7Z6116 at-
APPLICANT SIGNATURE
52
DATE
1 4+
1
T IS APPLI ATION BECOMES A PERMIT WHEN
PPRO ED
APPROVED BY
DATE
FD2095 (Rev 03/08)