HomeMy WebLinkAboutFMC APP 11-29-18UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD / LINE TESTING
SB989 SECONDARY CONTAINMENT TESTING
/TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
PERMIT NO. I I
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING
❑ SB-989 SECONDARY CONTAINMENT TESTING
LJ TANK TIGHTNESS TEST A. TO PERFORM FUEL MONITORING CERTIFICATION L_j uatnoaic Protection jesting
SITE INFOR [ON
FACILITY Sully's Coffee NAME & PHONE NUMBER OF CONTACT PERSON
ADDRESS 6009 Coffee Rd. Bakersfield, Ca.
OWNERS NAME Same
OPERATORS NAME Same PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK # VOLUME CONTENTS
1 87 UL
2 91 UL
3 Diesel
NAME OF TESTING COMPANY Advanced Compliance Bruce W. Hinsley 661-706-4321
MAILING ADDRESS 3704 Littlefalls Ct. Bakersfield, Ca. 93312
Bruce W. Hinsley 661-706-4321 CERTIFICATION #:A25212
DATE & TIME TEST TO BE CONDUCTED icc #: 8032698
SIGNATURE OF APPLICANT DATE 11/2812018
I APPROVED BY I DATE I
FD 2095 (Rev. 09/05)
BAKERSFIELD FIRE DEPT.
B E R 8 F D
Prevention Services
FIRM
R
1501 Truxtun Ave., 1St Floor
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
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❑ SB-989 SECONDARY CONTAINMENT TESTING
LJ TANK TIGHTNESS TEST A. TO PERFORM FUEL MONITORING CERTIFICATION L_j uatnoaic Protection jesting
SITE INFOR [ON
FACILITY Sully's Coffee NAME & PHONE NUMBER OF CONTACT PERSON
ADDRESS 6009 Coffee Rd. Bakersfield, Ca.
OWNERS NAME Same
OPERATORS NAME Same PERMIT TO OPERATE NO.
NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK # VOLUME CONTENTS
1 87 UL
2 91 UL
3 Diesel
NAME OF TESTING COMPANY Advanced Compliance Bruce W. Hinsley 661-706-4321
MAILING ADDRESS 3704 Littlefalls Ct. Bakersfield, Ca. 93312
Bruce W. Hinsley 661-706-4321 CERTIFICATION #:A25212
DATE & TIME TEST TO BE CONDUCTED icc #: 8032698
SIGNATURE OF APPLICANT DATE 11/2812018
I APPROVED BY I DATE I
FD 2095 (Rev. 09/05)