HomeMy WebLinkAboutFMC Permit App 11-7-16APPLICATION
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 # I I4, _.
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 -326 -3979 o Fax: 661 -852 -2171
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❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ® FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Sully's Downtown (North)
NAME & PHONE # OF CONTACT PERSON
Frank Sullivan 661 - 327 -5008
ADDRESS
2317 L Street, Bakersfield, CA 93301
OWNER NAME
Sullivan Petroleum
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
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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
11/7/2016 9:00 am
ICC #
8174721
TEST METHOD
APPLICANT SIGNATU
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DATE
10/14/2016
9
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 12/15)