HomeMy WebLinkAboutApplication 3-5-2020F00S(RN 13/IR)
BA FIRE DEPARTMENT
ventio Se
Prevention Services
2101 Street
UNDERGROUND STORAGE TANKS
Bakersfield, 3301
9979
(00
Phone:61- 26CA
Phone: 661-326-3979 •Fax: 661-BS2-2171
APPLICATION
Page I of I
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
4*10*0-�01
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 N
❑ ENHANCED LEAKDETECTION
❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS
SI FUEL MONITORING CERTIFICATION ❑ OVERFILL PREVENTION
- --- - -� -- - -- ---
SITE INFORMATION
FACILITY
F(anl PI�L6j 8jJ0{1SV PERSON
ippoi o_JL L�4,/
USALiquor
-
1
AD03j�0 S Union, Bakersfield
OWN 0.NAME
AF li M
--
OPERATOR NAME
PERMIT TO OPERATE Y
Same
—
.0 F TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES NO
TANK C
VOLUME
i CONTENTS
Tank 1
Tank 2
Tank 3
-
TANK TESTING COMPANY�-
TESTING COMPANY
NAME & PHONE A Or CONTACT PERSON
Services
Bobbie Frank 559444-1730
_LC
MAILING ADDRESS
3887 N. Valentine, Fresno, CA 93722
NAME A PHONE Y OF TEETER OR SPECIAL INSPf CTER
CERTIFICATION=
Mark Steinhauer
-
- - - -
rer METHOD
IE8357758
Incon
—- --
APPLICANT SIGNATURE
DATE
/ /,01Z
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
F00S(RN 13/IR)