HomeMy WebLinkAboutUST APPL 12/18/2015UNDERGROUND 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.)
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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 8 FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
7/11 # 16329
NAME & PHONE # OF CONTACT PERSON
Manager (661) 549 -1711
ADDRESS
1701 Pacheco Rd, Bakersfield, CA 93307
OWNER NAME
7/11 - Southland
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES NO
TANK #
VOLUME
CONTENTS
Tank 1
10k
87 Siphon
Tank 2
10k
87 Main
Tank 3
10k
91
TANK TESTING COMPANY
TESTING COMPANY
Tanknology
NAVE & PHONE # or- CON'T'ACT PERSON
Michelle Cleghorn- Young, 951 - 676 -4060
MAILING ADDRESS
41785 Enterprise Circle South Suite# D, Temecula, CA, 92590
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Francisco Castro (951) 365 -1964
CERTIFICATION #
ICC Service Technician
DATE & TIME TEST TO BE CONDUCTED
12/22/2015 @ 9am
1CC #
8026747 -UT
TEST METHOD
APPLICANT SIGNATURE
DATE
12/18/2015
T IS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)