HomeMy WebLinkAboutUST APPUNDERGROUND 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
❑ TANK TIGHTNESS
E R S F ID
*'�X8/!
ARrN T
❑ LINE TESTING
XFUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 • Fax: 661 -852 -2171
Page 1 of 1
SB -989 SECONDARY CONTAINMENT
SITE INFORMATION
FACILITY: Kern High School District
NAME & PHONE # OF CONTACT PERSON
Adrian: 661 -827 -3199
ADDRESS
3701 East Belle Terrace, Bakersfield, CA.
OWNER NAME
Kern High School District
OPERATOR NAME
Adrian
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? D YES X NO
TANK #
VOLUME
CONTENTS
1
12,000
Unleaded
2
12,000
Diesel
TANK TESTING COMPANY
TESTING COMPANY
Cal- Valley Equipment
NAME & PHONE # OF CONTACT PERSON
Jerry Rangel
MAILING ADDRESS
3500 Gilmore Avenue, Bakersfield, CA. 93308
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Jerry Rangel
CERTIFICATION #
Veeder Root: B35460
DATE & TIME TEST TO BE CONDUCTED
11/12/14 @ 9:00 am
ICC #
8160834
TEST METHOD
APPLICANT SIGNATURE
DATE
11/06/14
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)