HomeMy WebLinkAboutUST-APPL 7/31/2015APPLICATION
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 # I /' ;- off '
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
BAKERSFIELD (FIRE DEPARTMENT
Prevention Services
Ia B 1t 8 1 F I D 2101 H Street
FIRM Bakersfield, CA 93301
ARTM, T Phone: 661- 326 -3979 ® Fax: 661 -852 -2171
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❑ LINE TESTING 99 SB -989 SECONDARY CONTAINMENT
FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Samco #2
NAME & PHONE # OF CONTACT PERSON
Sam Jouda (661) 333 -0000
ADDRESS
3300 White Lane
OWNER NAME
Ya Halla Inc dba Samco Food Store #2
OPERATOR NAME
Sam Jouda
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
Mel Bolton 661 631 -3870
MAILING ADDRESS
16250 Meacham Road Bakersfield CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Camar_nn Ma-son (e(SI)303-2550
CERTIFICATION #
B42599
DATE & TIME TEST TO BE CONDUCTED
ICC #
8174721 -UT
TEST METHOD
APP CAN SI A
i
DATE
THUS APPLICATION BECOMES A P RM WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)