HomeMy WebLinkAboutFMC APP 12.12.19UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
I
seParatc Ly {.
PERMIT # 1
❑ ENHANCED LEAK DETECTION J
❑ TANK TIGHTNESS
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/lOE PERN�`
11 LINE TESTING
LINyFUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 P Fax: 661- 852 -2171
Pe9C 1 Of I
❑ SB -989 SECONDARY CONTAINMENT
❑ OVERFILLPREVENTION
F02095 (Rev 03/18)
SITE INFORMATION
FACILITY
ARCO
R CONTACT PERSON
2800 PANAMA LANE BAKERSFIELD
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE
A
IF OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED?
❑ YES ❑ NO
TANK N
VOLUME
CONTENTS
1
U/L
2
U/L
3
PREM
TANKTESTINO COMPANY
TESTING COMPANY
B R IN
AMF L PNONE I OF CONTACT PERSON
KELLY TA KETT 58 - 777
MAILING ADDRO ESS
6630 R EDALE HWY. #B
NAME & PHONE
NATHAN
F OF TESTER OR SPECIAL INSPECTOR
HOLMLAN
CERTIFICATION a
TEST METHOD
ICC
8111067
i
APPLI T SIGNAT RE
DATE
12 -6 -19
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
F02095 (Rev 03/18)