HomeMy WebLinkAboutFMC Permit App 1-14-16APPLICATION
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.)
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❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 -326 -3979 ® Fax: 661- 852 -2171
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❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
® FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Mesa Marin Chevron
NAME & PHONE # OF CONTACT PERSON
M Muthana (661) 366 -4886
ADDRESS
11101 Hwy 178 Bakersfield CA 93306
OWNER NAME
Muthana Corporation
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
Confidence UST Services Inc.
NAME & PHONE # OF CONTACT PERSON
Karli Karns (661) 631 -3870
MAILING ADDRESS
16250 Meacham Road Bakersfield CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
DATE & TIME TEST TO BE CONDUCTED
ICC #
TEST METHOD
APP ANT GN UR;
DATE "
TH APPLICATION BECOMES A P RMTT HEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)