HomeMy WebLinkAboutApplication 10-8-2019 OPI 6100_4-4UNDERGROUND 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 d# FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 o Fax: 661-852-2171
Page 1 of 1
❑ SB -989 SECONDARY CONTAINMENT
X _OERFILL PREVENTION
L!
FD2095 (Rev 03/18)
SITE INFORMATION
—�
1 FACILITY
Fed EaFlemin9
NAME&PHONE# OF CONTACT PERSON
661-83]-099]
ADORE65
f 6100 DIRntt Blvd., Bakersfield, CA. 93313
OWNER NAM
Fed Ex
r OPERATOR NAME
r
PERMEi TO OPERATE #
i
1 Jeff Flemin9
f _ __
! # OF TANKS TO BE TEST_ED:
IS PIPING GOING TO 8E TESTED? IT YES ❑ NO
� TANK#
VOLUME
CONTENTS
— -�
I
12,000
Diesel
1
TANK TESTING COMPANY
T
j TESTING COMPANY
TNAME &PHONE # OF CONTACT PERSON
�
Cal Valley EqulPmen[
]erry Rdngel661-615-40]6
____I
MAILING ADDRESS
7608 FmlNale Avenue, Bakerslleld, CA. 93308
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
T CERTIFICATION
Jerry Rangel 661-9790953VPvJnr
RooC B3S460, OPW#1128241, IOCON 1037433709
..
METHOD -
ICC#
Inddsl, Randall
8160834
APPLICANT SIGNATURE
DATE
VIII
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/18)