HomeMy WebLinkAboutUST-APPL 1/19/2015UNDERGROUND STORAGE TANKS
APPLICATION
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 # �Om
❑ ENHANCED LEAK DETECTION
n TANK TTC;HTNFSS
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
❑ FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Ramco Express
NAME & PHONE # OF CONTACT PERSON
R (661) 324 -1758
ADDRESS
2222 F Street Bakersfield CA 93301
OWNER NAME
Ramco Express
OPERATOR NAME
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 #
B37S01
DATE & TIME TEST TO BE CONDUCTED
ICC #
8022804 -UT
TEST METHOD
APPLICANT SIGNATURE
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DA
FD2095 (Rev 03/08)