HomeMy WebLinkAboutFMC Application 6-18-21UNDERGROUND 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 #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
❑ LINE TESTING
L7 FUEL MONITORING CERTIFICATION
BAKERSFIELD 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 f
FACILITY NAME & PHONE # OF CONTACT PERSON I
Roy's Mini Mart
ADDRESS `
1631 Bakers St Bakersfield. CA 93305
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? 0 YES ❑ NO j
T A N K #
VOLUME CONTENTS `
y
1Split
9
Tank 87 E
i
Split Tank 91
EF�}
S
t
i
3
s
t
TANK TESTING COMPANY s
TESTING COMPANY
Advanced Compliance
NAME & PHONE # OF CONTACT PERSON x
Leann Hamilton 881-808-5323
MAILING ADDRESS
4007 Brae Burn Dr Bakersfield Ca
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Bruce Hinsley
CERTIFICATION #
A25212
TEST METHOD
PEI RP1200-17
i
ICC #
8032698
APPLICANT SIGNATURE
DATE
3
8
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 09/20)