HomeMy WebLinkAbout1200 coffee 989 unused forms_1-3APPLICATION
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 #
�41
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
y:
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
NAME & PHONE # OF CONTACT PERSON
O Garcia (661) 393 -7000
ADDRESS
1200 Coffee Road Bakersfield CA 93308
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 SIGNA RE
DATE
THIS APPLICATION BECOMES A PER IT ViHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)