HomeMy WebLinkAboutUST-APPL 6/9/2015UNDERGROUND STORAGE TANKS
APPLICATION FIR'r
SPAR TM T
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note ti*,at tnese are se!parate
�ndivldual tes-,ts and lwflll be. charged pier
se.parcite typetest accordinglY.)
7
PERMIT# F a0'30S I
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 9 Fax: 661-852-2171
Page 1 of 1
❑ ENHANCED LEAK DETECTION IQ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
51 Pi IFI MnNTTOPTN(; CERTIFICATION
SITE INFORMATION
FACILITY
NAME $it PHONE -4 OF CONTACT PERSON
Corner Store # 3074
Manager (661) 324-9481
ADDRESS
3225 Buck Owens Blvd, Bakersfield, CA 93301
OWNER NAME
Corner Store
OPE RATOR NAME PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? 9 YES [I NO
TANK #
VOLUME
CONTENTS
T1
14K
Regular 87
T2
10K
Premium 91
T4
20K
Diesel
TANK TESTING COMPANY
--F-
NAVIE -k PjiONE # OF CONTACT PERSON
TESTING COMPANY Michelle
Mich�lelle C'Ieghorn, 951-676-4060
Tanknology
MAILING ADDRESS
41785 Enterprise Circle South Suite# D, Temecula, CA, 92590
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
ICC Service Technician
Patrick Pfrang (512) 848-4140
XCC #
5259475-UT
TEST METHOD
DATE & TIME TEST TO BE CONDUCTED
06/16/2015 @ 9am
APPLICANT SIGNATURE DATE
06/09/2015
t
T H Ii, PPLICATION BECOMES A PERMIT WHEN APPROVED
T 'T
HL
APPROVED BY DATE
FD2095 (Rev 03/08)