HomeMy WebLinkAboutUST APPL 11/13/2014DN.DERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please no'Le th:a't these are se.rtar'afe
individual tests and w',11 fie Cb-arqc,,d r�er
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PERMIT •
0 ENHANCED LEAK DETECTION
0 TANK TjGH'1'NHS
F A CIL L I TY
Penske CA-094
ADDRESS
2929 E, Brundage, Bakersfield, CA 93307
07
rTR" r 74-, v,
Penske . . . .......
OPERATOR. NAME
Penske
OF TANKS TO BE TESTED:
TANK #
2
m
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 * Fax: 661-852-2172
Pane 1 of
LINE TESTING IQ sB-989 SECONDARY CONTAINMENT
FUEL MONITuDRING C_ERTI1:::jCATiON
SITE INFORMATION
NMIF- we P )F, c',IONTACI �50N
Eric Gulbranson
P ER M I - r T (D OPERATE
#'
IS PIPING GOING TO BE TESTED?
VOLUME
12k
. . . .........
12k
0 YES Q NO
CONTENTS
Diesel
Diesel
. ...... — ----------- TANK TESTING COMPANY
. .. .
. . ... . . . ........... .
..........
NAME, &' PHONE
TESTING COMPANY
l Michelle Cleghorn-young, 951-676-4060
Tanknology .............
MAILIr4G ADDRESS Temecula, CA, 92.19r'.
Circle South Suite# D,
.. . ....... _ . ...... . .... .......... ............ ...
41785 Enterprise
....... . . ..... 1 ..... . . ........
NAME "P PHONE # OFF TESTER OR SPECIAL jNSPECTOR
. .......... . . . .......
CERTIFICAT10r� #
lCC' Service Technician
uVilbert. CrlsostomO (951) 538-6069
DATE & TI`` EJEsT TO BE COND�tjCTED
15282036-UT
. .........
.. ...........
i DATE
APFJCAN T ST?SNATURE
f f
--------- --
WHEN APPROVED
TH,,1S APPLICATION BECOMES A PERMIT
7,
APPROVED BY
'k
I'll.
wo,
TEST METHOD
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