HomeMy WebLinkAboutApplication 11-30-2020UNDERGROUND 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 # 1 15-021-097077
❑ ENHANCED LEAK DETECTION
❑ LINE TESTING
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
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❑ SB -989 SECONDARY CONTAINMENT
IN OVERFILL PREVENTION
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--
SITE INFORMATION
NAME & PHONE # OF CONTACT PERSON
e FACILITY
Foods Co#3-84-384
------
Charles Cousar 310) 884-40_1_1_____._______
ADDRESS
2501 Haley St, Bakersfield CA 93305
OWNER NAME
Cousar
_Charles
OPERATOR NAME
PERMIT TO OPERATE #
15-021-097077
Charles Cousar
# OF TANKS TO BE TESTED: 3
IS PIPING GOING TO BE TESTED? ❑ YES ® NO
TANK #
VOLUME
CONTENTS
T1-87
209000
Unleaded Gas
T2-91
8,000
Unleaded Gas---
T3- DSL
10 000
Diesel
TANK TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON
TESTING COMPANY
Belshire Environmental Services
Emily Tran 949-460-5200
MAILING ADDRESS
25971 Towne Centre Drive
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
8932714
Mark Riley 949-330-0309_____________
TEST METHOD
PEI RP1200
ICC # 8932714
APPLICANT SIGNATURE
DATE
11/9/2020
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
r BY
APPROVED
DATE
FD2095 (Rev Ui/ ib )