HomeMy WebLinkAbout1200 COFFEE RD FMC APP 2014UNDERGROUND STORAGE TANKS
p B 8PI D
APPLICATION FIRE
ARTM T
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 # Z/— (17
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 • Fax: 661 -852 -2171
Page 1 of 1
ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
TANK TIGHTNESS ® FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
NAME & PHONE # OF CONTACT PERSON
Fastri 641
Omero Garcia (661).393 -7000
ADDRESS
1200 Coffee Road Bakersfield,- CA 93308
OWNER NAME
Jamieson Hill
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON
Confidence UST Services Inc.
Karli Karns (661) 631 -3870
MAILING ADDRESS
16250 Meacham Road Bakersfield CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
Br l k r 487-9355
B43426
DATE & TIME TEST TO BE CONDUCTED
ICC # TEST METHOD
7/10/14-at :00am
8216722 -UT
APPLICANT SIGNATURE
DATE
t
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
f
FD2095 (Rev 03/08)