HomeMy WebLinkAboutUST APP 1/9/2015UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD / LINE TESTING
/ SB989 SECONDARY CONTAINMENT TESTING
/TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
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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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❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT TESTING
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TO PERFORM FUEL MONITORING CERTIFICATION ❑ Cathodic Protection Testing
' SITE INFORMATION
FACILITY
NAME & PHONE NUMBER OF CONTACT PERSON
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ADDRESS
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OWNERS NAME
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OPERATORS NAME
PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED
IS PIPING GOING TO BE TESTED? ❑ YES NO
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: 8160834
Test Method
SIGNATURE OF APPLICANT
APPROVED BY
DATE
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