HomeMy WebLinkAboutSB989 Application 9-21-21UNDERGROUND 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 #
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❑ 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
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® SB -989 SECONDARY CONTAINMENT
❑ OVERFILL PREVENTION
FD2095 (Rev 09/20)
SITE INFORMATION
FACILITY
NAME & PHONE # OF CONTACT PERSON
Circle K Store #2701270
Yolanda Jones 980-875-1745
ADDRESS
5634 Stine Rd
OWNER NAME
Circle K Franchise
OPERATOR NAME
PERMIT TO OPERATE #
Yolanda Jones
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ® YES ❑ NO
T A N K #
VOLUME CONTENTS
87 Master
107000 Gasoline
10 000.
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TANK TESTING COMPANY
TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON
Belshire Environmental Services, Inc.
Emily Tran 949-460-5200
MAILING ADDRESS
25971 Towne Centre Drive
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
Sean Garcia 949-460-5200
8898137
TEST METHOD
ICC #
Incon
8898137
APPLICANT SIGNATURE
DATE
-.-
7/29/2021
HIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 09/20)