HomeMy WebLinkAboutUST-APPL. 1/9/2015UNDERGROUND STORAGE TANKS
APPLICATION
PERMIT NO. ,?
❑ ENHANCED LEAK DETECTION
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BAKERSFIELD FIRE DEPT.
Prevention Services
2101 H Street
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
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❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT TESTING
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SITE INFORMATION
FACILITY
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NAME & PHONE NUMBER OF CONTACT PERSON
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ADDRESS
OWNERS NAME
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OPERA ORS NAME
PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED
IS PIPING GOING TO BE TESTED? ❑ YES NO
TANK #
VOLUME
CONTENTS
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TANK TESTING COMPANY
NAME OF TESTING COMPANY Cal - Valley Equipment
Name and phone # of contact person
Jerry Rangel (661) 327 -9341
MAILING ADDRESS 3500 Gilmore Ave. Bakersfield, Ca. 93308
Name and phone # of tester or special instructor
Jerry Rangel (661) 979 -0953
CERTIFICATION #: InCOII: 271 0563701
DATE & TIME TEST TO BE CONDUCTED
ICC #: ICC: 5309489
Test Method
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SIGNATURE OF APPLICANTDATE
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APPROVED BY DATE
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