HomeMy WebLinkAboutELD APP 12-11-18UNDERGROUND STORAGE TANKS
APPLICATION
ION
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 #
FIRE
ARTM
y
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 -326 -3979 9 Fax: 661 - 852 -2171
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FX1 ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
Chester Liquor & Market
NAME & PHONE # OF CONTACT PERSON
George Hamad / 661 -447 -7736
ADDRESS
3401 S. Chester Ave., Bakersfield, CA 93304
OWNER NAME
George Hamad
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: 3
IS PIPING GOING TO BE TESTED? 10 YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
CGRS
NAME & PHONE # OF CONTACT PERSON
Chris Murphy/ 916- 991 -1100
MAILING ADDRESS
5444 Dry Creek Rd., Sacramento, CA 95838
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Sergio Nunez
CERTIFICATION #
06 -1727
DATE & TIME TEST TO BE CONDUCTED
5/10/18 at 8am
ICC #
8032738
TEST METHOD
Well Proximity ELD
APPLICANT SIGNATURE
DATE
4/23/18
THI APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 12/15)