HomeMy WebLinkAboutUST-APPL 6/25/2015D I.CCI.101 1110 1 9X3 KGA ? ,
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 # _ Da
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 ® Fax: 661- 852 -2171
Page 1 of 1
❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
® FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Fastri 32
NAME & PHONE # OF CONTACT PERSON
Omero Garcia (661) 393 -7000
ADDRESS
3701 Ming Ave. Bakersfield CA 93309
OWNER NAME
Jamieson Hill
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
CERTIFICATION #
B43426
DATE & TIME TEST TO BE CONDUCTED
ICC #
TEST METHOD
APP CAN SI A ./ R
i
DATA t7
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY y
DATE
212�f�5-
FD2095 (Rev 03/08)