HomeMy WebLinkAboutFMC APP 11.26.19UNDERGROUND 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 #
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING
❑ TANK TIGHTNESS 0 FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 R Fax: 661- 852 -2171
Page 1 of 1
❑ SB -989 SECONDARY CONTAINMENT
❑ OVERFILL PREVENTION
SITE INFORMATION
FACM
CIRCLE K # 2708606
NAME a PHONF R OF CONTACT PERSON
YOLANDA JONES
ADDRESS
1030 OAK ST BAKERSFIELD
OWNER NAME
CIRCLE K STORES INC
OPERATOR NAME
CIRCLE K
PERMIT TO OPERATE i
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY NAME a PHONE d OF CONTACT PERSON
B &T SERVICE STATION CONTRACTORS MARCUS GARCIA 805- 929 -8944 EX 1012
MAILING ADDRESS
630 S FRONTAGE RD NIPOMO, CA 93444
NAME ® PHONE Y OF TESTER OR SPECIAL INSPECTOR
JAMES WELSCH 805- 929 -8944
CERTIFICATION d
TEST METHOD
ICC a
8201843
APPLICANT $I A 0.E
DATE
11/13/2019
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095(Rev 03/18)