HomeMy WebLinkAboutUST-APL 7/7/2014UNDERGROUND 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 #
❑ ENHANCED LEAK DETECTION
❑ TANKTIGHTNESS
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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
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
Brvan Self-(661) 333-0075
CERTIFICATION #
B35701
DATE & TIME TEST TO BE CONDUCTED
07 28 14 at 9:00am
ECC #
8022804 -UT
TEST METHOD
APPLICANT S GNATURE
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)