HomeMy WebLinkAboutUST-APPL. 9/22/2015APPLICATION
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.)
PERMIT #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
4
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
0 FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
NAME & PHONE # OF CONTACT PERSON
Sam Jouda (661) 333 -0000
ADDRESS
1.131 Oak Street, Bakersfield, CA 93304
OWNER NAME
OPERATOR NAME
Sam Jouda
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
Mel Bolton 661 631 -3870
MAILING ADDRESS
16250 Meacham Road Bakersfield CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
B45438
DATE & T ME TES TO BE CONDUCTED
ICC #
8339953 -UT
TEST METHOD
APPLICA SIG TU E
Y
DATE
i
THIS APPLICATION BECOMES A PERMIY WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)