HomeMy WebLinkAboutApplication8-21-19_4-8UNDERGROUND 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
❑ TANK TIGHTNESS ® FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 9 Fax: 661-852-2171
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❑ SB -989 SECONDARY CONTAINMENT
❑ OVERFILL PREVENTION
SITE INFORMATION
FACILITY
Circle K/ Mobil
NAME & PHONE # OF CONTACT PERSON
Bassam 805-217-0610
ADDRESS
2601 White Lane, Bakersfield, CA 93304
OWNER NAME
Proactive Properties, Inc.
OPERATOR NAME
Bassam
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
1
12,000 gal.
87
2
12,000 gal.
91
3
12,000 gal.
DSL
TANK TESTING COMPANY
TESTING COMPANY
CONFIDENCE UST SERVICES, INC.
NAME & PHONE # OF CONTACT PERSON
Jessica Baker 661-631-3870
MAILING ADDRESS
16250 MEACHAM ROAD, BAKERSFIELD, CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Tim Capehart (661) 573-8962
CERTIFICATION #
TEST METHOD
ICC #
8414476
rANT IGNATUPE
DATE
7/17/2019
THI§ APPLICATION BECOMES A PERMIT WHEN APPROVED
PPROVED BY
DATE
FD2095 (Rev 03/18)