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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 Page 1 of 1 ❑ 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 e- S. - Oa ®r Aw ®®s ARIM ANN 'rr_C'rTMt-- PLEAbt LALL t5ARt ZPr1r.Lu r 1K= Ur-r ff4mu P-M -1m r ra%L- mA—sm IA410'm - -- OF UNDERGROUND STORAGE TANK SYSTEMS. FD2095 (Rev 03/18)