HomeMy WebLinkAboutFMC- LINE TEST Permit App.UNDERGROUND STORAGE TANKS
PERMIT # 116 (C'V 571;j
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
B E F 1 A
JUNK
r
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 -326 -3979 • Fax: 661- 852 -2171
Page 1 of 1
8 LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
B FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Sam's Club
NAME & PHONE # OF CONTACT PERSON
Manager (661)
ADDRESS
5625 Gosford Road, Bakersfield, CA 93313
. OWNER NAME
Sam's Club / Wal -Mart
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? B YES ❑ NO
TANK #
VOLUME
CONTENTS
1 North
20k
87
2 South
20k
87
3
12k
91
4
8k
Diesel
TANK TESTING COMPANY
TESTING COMPANY
Tanknology
NAME & PHONE # OF CONTACT PERSON
Michelle Cleghorn, 951- 676 -4060
MAILING ADDRESS
41785 Enterprise Circle South Suite# D, Temecula, CA, 92590
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Patrick Pfrang; 512 -848 -4140
CERTIFICATION #
ICC Service Technician
DATE & TIME TEST TO BE CONDUCTED
9/28/16 @ 8am
FCC #
5259475 -UT
TEST METHOD
TLD -1
APPLICANT SIGNATURE
C
DATE
9/7/2016
THIS PPI 1' ATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
1129Ac
FD2095 (Rev 03/08)