HomeMy WebLinkAbout989 Permit App 12-20-16APPLICATION
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.)
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B 4t R S F I 17
FIRE
ARr
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 ® Fax: 661- 852 -2171
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❑ ENHANCED LEAK DETECTION ❑ LINE TESTING Q SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATION
FD2095 (Rev 12/15)
SITE INFORMATION
FACILITY
Jaco #7705/ Fastrip #641
NAME & PHONE # OF CONTACT PERSON
Omero Garcia 661- 393 -7000
ADDRESS
1200 Coffee Road, Bakersfield, CA 93308
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
1
1200
87 Unleaded
2
1200
91 Unleaded
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
Cameron Mason 661 - 303 -8550
CERTIFICATION #
B42599
DATE & TIME TEST TO BE CONDUCTED
12/15/2016 9:00 am
ICC #
8174721 -UT
TEST METHOD
APPLICA.,T SIG ATU
T
D,1 E
S APPLICATION BECOMES A FERMI WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 12/15)