HomeMy WebLinkAboutUST-APPL. 1/9/2015UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD / LINE TESTING
/ SB989 SECONDARY CONTAINMENT TESTING
/TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
PERMIT NO.
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS TEST
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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
1GA TO PERFORM FUEL MONITORING CERTIFICATION ❑ Cathodic Protection Testing
SITE INFORMATION
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NAME & PHONE NUMBER OF CONTACT PERSON
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ADDRESS ge+p 9 A {
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OWNERS NAM W
OPERA ORS NAME
PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED
IS PIPING GOING TO BE TESTED? ❑ YES a O
TANK #
VOLUME
CONTENTS
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 #: Incon: 2710563701
DATE & TIME TEST TO BE CONDUCTED
Icc #: ICC: 5309489
Test Method
SIGNATURE OF APPLICANT
DATE
MR M PA WO
APPROVE'
DATE �2 7 //-5—
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