HomeMy WebLinkAboutFMC APP 1.14.19UNDERGROUND 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 #
420V
a E a _s ,E I g
FIRE.
ft, r
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone 661 - .326 -3979 o Fax: 661-852-2171
Page I of 1
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING SB-989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
USA LIQUOR
NAME.& PHONE # OF CONTACT PERSON
RANI #661- 832 -0457
ADDRESS
1720 S UNION, BAKERSFIELD
OWNER NAME
ALI KORIN
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK 1
TANK 2
TANK 3
TANK TESTING COMPANY
TESTING COMPANY
LC SERVICES
NAME & PHONE # OF CONTACT PERSON
BOBBIE FRANK 559 -444 -1730
MAILING ADDRESS
'1887 N VAI ENIINE FRESNO CA 92722-
NAME & PHONE,: OF TESTER OR SPECIAL INSPECTOR
MARK STEINHAUER
CERTIFICATION
DATE & TIME TEST TO BE CONDUCTED
1/3/19 @ 9:OOAM
ICC #
8357758
TEST METHOD
INCON
APPLICANT SIGNATURE
DATE
12/14/18
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 12/15)