HomeMy WebLinkAboutApplication 12-16-2020UNDERGROUND 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 #
�l
❑' ENHANCED LEAK DETECTION ❑ LINE TESTING
171 TANK TIGHTNESS LI FUEL MONITORING CERTIFICATION
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
❑ OVERFILL PREVENTION
SITE INFORMATION
FACILITY
CIRCLE K #2701270
NAME & PHONE # OF CONTACT PERSON
YOLANDA JONES 602-728-8000 EXT 5287
ADDRESS
5634 STINE RD BAKERSFIELD CA
OWNER NAME
CIRCLE K STORES INC
OPERATOR NAME
CIRCLE K
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
B&T SERVICE STATION CONTRACTORS
NAME & PHONE # OF CONTACT PERSON
MARCUS GARCIA 805-929-8944 EX 1012
MAILING ADDRESS
630 S FRONTAGE RD NIPOMO, CA 93444
NAME & PHONE # OF TESTER UR b tUTAL. UK ���! j�..,j�•
RICKEY BINGER 805-431-0332
TEST METHOD ICC #
INDUSTRY STANDARD 8452629
APPLICANT SIGNATURE DATE
10/26/2020
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 03/18)