HomeMy WebLinkAboutApplication 1-11-21UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTI NG/TAN K TIG HTN ESS TEST AN D
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
BAKE RSFIE LD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
❑ SB -989 SECONDARY CONTAINMENT
❑ OVERFILL PREVENTION
SITE INFORMATION
FACILITY
Pan Pacific
NAME & PHONE # OF CONTACT PERSON
ADDRESS
1850 Coffee Rd., Bakersfield
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
1
Diesel
TANK TESTING COMPANY
TESTING COMPANY
BS S R, Inc.
NAME & PHONE # OF CONTACT PERSON
Kelly Tackett 588-2777
MAILING ADDRESS
6630 Rosedale Hwy. ##B, Bakersfield
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Salvador Sanchez
CERTIFICATION #
TEST METHOD
ICC #
5300490
APPLI NT SIGNATURE
DATE
12-10-20
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/18)