HomeMy WebLinkAboutFMC APP 11-5-18UNDERGROUND 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
r-1 -rAniv - rTru-rmr -cc 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# 2708606
NAME & PHONE # OF CONTACT PERSON
M I N DY M CAYWOO D 602- 728 -3217
ADDRESS
1030 OAK 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 NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
B &T SERVICE STATION CONTRACTORS
NAME &PHONE # OF CONTACT PERSON 924- ���
M1�4'RCtd S 4'q�RGl1'� gp�'`
MAILING ADDRESS
630 S FRONTAGE RD NIPOMO, CA. 93444
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
JAMES WELSCH 805 - 929 -8944
CERTIFICATION # 8201843 UT
TEST METHOD
ICC # 8201843 UT
APPLICANT SIG U, E
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
r%-r%#,rcT %m -re% cru =nm 9: AMV ANn ALL TESTING
PLEAbt LALL bAKCK' rir-Lu i-amr- wL; ;r-ewea® a -un-am a OF UNDERGROUND STORAGE TANK SYSTEMS.
FD2095 (Rev 03/18)