HomeMy WebLinkAboutFMC & OPI APP 11-14-18UNDERGROUND 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 ❑ LINE TESTING
❑ TANK TIGHTNESS X FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171
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❑ SB -989 SECONDARY CONTAINMENT
SITE INFORMATION
FACILITY CIRCLE K # 2708605
NAME & PHONE # OF CONTACT PERSON
M 1 N DY MCAYWOOD 602- 728 -3217
ADDRESS
5600 AUBURN ST BAKERSFIELD
OWNER NAME
CIRCLE K STORES INC
OPERATOR NAME
CIRCLE K
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES X NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
B &T SERVICE STATION CONTRACTORS
NAME & PHONE # OF CONTACT PERSON
MARCUS GARCIA 805 - 929 -8944 EX 1012
MAILING ADDRESS
630 S FRONTAGE RD NIPOMO, CA. 93444
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
JAMES WELSCH 805 -431 -0929
CERTIFICATION #
8201843
TEST METHOD
ICC #
8201843
APPLICANT SIGNATURE
DATE
11 /14/2018 @ 10:00 AM
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
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OF UNDERGROUND STORAGE TANK SYSTEMS.
FD2095 (Rev 03/18)