HomeMy WebLinkAboutLine Test App 11-7-16UNDERGROUND 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 he charged per
separate type test accordingly.)
PERMIT #
l6 -1 &s
❑ ENHANCED LEAK DETECTION
® LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ FUEL MONITORING CERTIFICATION
FACILITY NAME & PHONE # OF CONTACT PERSON
Mesa Marin Chevron Mohammud Muthana (661) 366 -4886
ADDRESS
11101 Highway 178, Bakersfield, CA 93306
OWNER NAME
Mohammud Muthana
OPERATOR NAME PERMIT TO OPERATE #
Mohammud Muthana
# OF TANKS TO BE TESTED:4 IS PIPING GOING TO BE TESTED? 'eld YES 11 NO
TANK # VOLUME CONTENTS
al Diesel
10/26/2016
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 03/08)
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
B B x s F_I,_a
2101 H Street
AlAff
Bakersfield, CA 93301
ARfR f
Phone: 661 - 326 -3979 ® Fax: 661- 852 -2171
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® LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ FUEL MONITORING CERTIFICATION
FACILITY NAME & PHONE # OF CONTACT PERSON
Mesa Marin Chevron Mohammud Muthana (661) 366 -4886
ADDRESS
11101 Highway 178, Bakersfield, CA 93306
OWNER NAME
Mohammud Muthana
OPERATOR NAME PERMIT TO OPERATE #
Mohammud Muthana
# OF TANKS TO BE TESTED:4 IS PIPING GOING TO BE TESTED? 'eld YES 11 NO
TANK # VOLUME CONTENTS
al Diesel
10/26/2016
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 03/08)