HomeMy WebLinkAboutUST-APPL 4/6/2015UNDERGROUND 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 # Q 2�
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
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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
NAME & PHONE # OF CONTACT PERSON
ADDRESS
OWNER NAME
Mike
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
Karli Karns (661) 631 -3870
MAILING ADDRESS
16250 Meacham Road Bakersfield CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Br an Self (661)333-007.5
CERTIFICATION #
B35701, TEI -116
DATE & TIME TEST TO BE CONDUCTED
r 6t-- 10-00am
ICC #
8022804-UT
TEST METHOD
APP' CAN S
�d
DAT
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY �
DATE
FD2095 (Rev 03/08)