HomeMy WebLinkAboutSB-989 Permit App 12-7-16APPLICATION
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 # %
B" ; e R s F i D
`; FIRE
AI R i"lN T
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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 ® SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATION
F✓ '
FD2095 (Rev 12/15)
SITE INFORMATION
FACILITY
Jaco #3351/ Howard's #4
NAME & PHONE # OF CONTACT
Omero Garcia 661 -393 -7000
PERSON
ADDRESS
3200 Panama Lane, Bakersfield, CA 93313
OWNER NAME
Jaco Hill
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED?
❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
12,00C)
2
!Z o0
E�
3
12 oep
DS
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
11/23/2016 9:00 am
ICC #
8174721
TEST METHOD
APPLICANT SIGNAT E
DATE
10/19/2016
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
F✓ '
FD2095 (Rev 12/15)