HomeMy WebLinkAbout[Untitled]_2-4LUZ 193 4 *-lei e
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 #
5-- „ `1/
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 a Fax: 661 -852 -2171
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❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
® FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Plaza Towers
NAME & PHONE # OF CONTACT PERSON
Michael Ruiz (661) 832 -3206
ADDRESS
3015 Wilson Road Bakersfield CA 93309
OWNER NAME
Housing Authority of the County of Kern
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
Ausfin Sterling (661) 30.1-9-945
CERTIFICATION #
DATE & TIME TEST TO BE CONDUCTED
ICC #
TEST METHOD
APP CA T 9'IG ATrE
DATE
THIS APPLICATION BECOMES A PE MIT 6EN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)