HomeMy WebLinkAboutApplication SB989 3-11-21UNDERGROUND 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 # I j
�..LtR S fit
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING
❑ TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1of1
0 SB -989 SECONDARY CONTAINMENT
❑ OVERFILL PREVENTION
FD2095 (Rev 03/18)
SITE INFORMATION
FACILITY
Jaco #3367/ Fastrip #640
NAME & PHONE # OF CONTACT PERSON
Omero Garcia 661-393-7000
ADDRESS
8001 White Lane, Bakersfield, CA 93309
OWNER NAME
Jaco Hill
OPERATOR NAME
Omero Garcia
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES
❑ NO
TANK #
VOLUME
CONTENTS
1
12,000 gal
87-2
2
12,000 gal
87-2
3
12,000 gal
91
4
12000 gal
DSL
TANK TESTING COMPANY
TESTING COMPANY
CONFIDENCE UST SERVICES, INC.
TAME & PHONE # OF CONTACT PERSON
Karli Karns 661-631-3780
MAILING ADDRESS
16250 MEACHAM ROAD, BAKERSFIELD, CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Justin Williams
CERTIFICATION #
C26888
TEST METHOD
ICC #
8819073
APPLICANT SIGNATURE
DATE
02/04/2021
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/18)