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HomeMy WebLinkAboutUST APPUNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD / LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. °' _ BAKERSFIELD FIRE DEPT. Prevention Services 2101 H Street Bakersfield, CA 93301 Tel.: (661) 326 -3979 Fax: (661) 852 -2171 Page 1 of 1 ❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT TESTING 1-1 YAKILe rift -WTK G(ZC TGeT X Tr) PFRFf1RM FI IFI UnNITORINr, r:FRTIFICATION ❑ cathodic Protection Testina ru cvwu (RCV. V.7 /VJ) SITE INFORMATION FACILITY Beale Monterey NAME & PHONE NUMBER OF CONTACT PERSON ADDRESS 900 Monterey St. Bakersfield, Ca. OWNERS NAME Same OPERATORS NAME Same PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO TANK# VOLUME CONTENTS 1 87 UL 2 87 UL 3 91 UL TANK TESTING COMPANY NAME OF TESTING COMPANY Advanced Compliance Bruce W. Hinsley 661 - 706 -4321 MAILING ADDRESS 3704 Littlefalis Ct. Bakersfield, Ca. 93312 Bruce W. Hinsley 661 - 706 -4321 CERTIFICATION #: A25212 DATE & TIME TEST TO BE CONDUCTED ICC #: 8032698 SIGNATURE OF APPLICANT DATE 51412015 APPROM APPROVED BY I DATE ru cvwu (RCV. V.7 /VJ)