HomeMy WebLinkAboutFMC Permit App 11-16-16-UNDERGROUND 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.)
1,
$ R F S j D.
FIRE
, Airr r
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
PERMIT #
16 - X6000 X33
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS Z FUEL MONITORING CERTIFICATION
FD2095 (Rev 12/15)
SITE INFORMATION
FACILITY
Circle K #2708605
NAME & PHONE # OF CONTACT PERSON
Jackie Dougherty (8051458-40110
ADDRESS
5600 Auburn Street, Bakersfield, CA 93306
OWNER NAME Circle K
OPERATOR NA MF
'Chad Doolittle
r TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES NO
TANK #
VOLUME
CONTENTS
1
10.000
87
2
10,000
89
3
10,000
91
TANK TESTING COMPANY
TESTING �COMPANY
B&T Service Station
cot
Contracots -
NAME & PHONE # OF CONTACT PERSON
'kJJackie Dougherty (805) 458-4070
C
MAILING . Frontage Rd.,
NiDOMO, CA 93444
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
James Welsch (8 5) 929-8944
CERTIFICATION #
B43211 --FTEST
DATE & TIME TEST TO BE CONDUCTED
10/31.
1CC # 8201843
METHOD
APPLICA URE
DATE
10/14/16
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED By
DATE
FD2095 (Rev 12/15)