HomeMy WebLinkAboutUST-APPL 9/22/2014UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING /TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please vote that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT #
❑ 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
M FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Chevron iNidal
NAME & PHONE # OF CONTACT PERSON
Azzi, Gaby Jabbour 805 - 444 -422
ADDRESS
2525 White Ln Bakersfield CA 93304
OWNER NAME
Chevron
OPERATOR NAME
Bassem Azzi
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
Dustin Reese (661) 472-1617
CERTIFICATION #
B43426
DATE & TIME TEST TO BE CONDUCTED
10Z16-Z14 at 9:00am
ICC #
8126722 -UT
TEST METHOD
APPLICANT SIGN TURE
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0
DATE
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THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY Y�
DATE
FD2095 (Rev 03/08)
September 22, 2014
CITY OF BAKERSFIELD
Attn: David Weirather/Ernie Medina
Office of Environmental Services
Fire Department/UST Program
2101 H Street
Bakersfield, CA 93301
To Whom It May Concern:
Enclosed for your approval, please find Applications to
Perform Fuel Monitoring Certifications and Billing and Permit
Statements, along with our check in the amount of $192.00/site.
Please fax the approved Applications and permit fee
receipts to our office at 661-587-9758.
Should you have any questions, please feel free to contact
me at 631-3870.
Thank you for your attention herein.
. Enclosures
Yours truly,
CONFIDENCE UST SERVICES, INC.
Karli Karns, Dispatch Coordinator
16250 Meacham Road -Bakersfield, CA 93314
(661) 631-3870 or (800) 339-9930
FAX (661) 587-9758