HomeMy WebLinkAboutFMC Permit App 11-3-16UNDERGROUND STORAGE TANKS
APPLICATION
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.)
B A E R S P
ISL D
FIRE
ART1M T
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 -326 -3979 • Fax: 661 - 852 -2171
Page 1 of 1
PERMIT # , " —/0000 6 y
❑ ENHANCED LEAK DETECTION B LI TESTING ❑ SB -989 SECONDARY CONTAINMENT
171 TANK TIGHTNESS B F EL MONITORING CERTIFICATION
FACILITY NAME & PHONE # OF CONTACT PERSON
Wholesale Fuels, Inc. Omero Garcia (661) 393 -7000
ADDRESS
2200 East Brundage Lane, Bakersfield, CA 93307
OWNER NAME
Jaco Oil Company
OPERATOR NAME PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK # VOLUME CONTENTS
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY I DATE
lk
1112-11
FD2095 (Rev 12/15)
TANK TESTING COMPANY
TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON
Confidence UST Services
Mel Bolton 661- 631 -3780
MAILING ADDRESS
16250 Meacham Road, Bakersfield, CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
Bradley Seykora (661) 487 -9355
B40738
DATE & TIME TEST TO BE CONDUCTED
1CC #
TEST METHOD
TBD 3 i i (,=, R °
8111231 -UT
APPLICANT SIGNATURE
DATE
10/26/2016
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY I DATE
lk
1112-11
FD2095 (Rev 12/15)