HomeMy WebLinkAbout10 UNION FMC APP 2.16.15UNDERGROUND 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
❑ TANK TIGHTNESS
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 • Fax: 661- 852 -2171
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❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
W FUEL MONITORING CERTIFICATION
FD2095 (Rev 03/08)
SITE INFORMATION
FACILITY
Chevron# 355920
NAME & PHONE # OF CONTACT PERSON
Manager (661) 861 -0543
ADDRESS
10 Union Ave, Bakersfield, CA 93307
OWNER NAME
Chevron
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES E7 NO
TANK #
VOLUME
CONTENTS
1
20k
Unleaded
2
10k
Premuim
3
7k
Diesel
TANK TESTING COMPANY
TESTING COMPANY
Tanknology
NAME & PHONE # OF CONTACT PERSON
Michelle Cleghorn- Young, 951 - 676 -4060
MAILING ADDRESS
41785 Enterprise Circle South Suite# D, Temecula, CA, 92590
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Edwin Pineda, 602- 316 -2772
CERTIFICATION #
ICC Service Technician
DATE & TIME -TEST T• BE CONDUCTED
1 'A 0 p11 9 9;qm
ICC #
8026748 -UT
TEST METHOD
/
APPLICANT jIGNATURE
DATE
T S A
LICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
`
4
DATE
FD2095 (Rev 03/08)