HomeMy WebLinkAboutFMC Application 10-12-21UNDERGROUND 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 ❑ LINE TESTING
❑ TANK TIGHTNESS IJ FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2.101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
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❑ SB -989 SECONDARY CONTAINMENT
❑ OVERFILL PREVENTION
SITE INFO,
FACILITY
NAME & PHONE # OF CONTACT PERSON
CIRCLE K #2701270
YOLANDA JONES 602-728-8000 EXT 5287
ADDRESS
5634 STI N E RD BAKERSFI ELD CA
OWNER NAME
CIRCLE K STORES INC
OPERATOR NAME PERMIT TO OPERATE #
CIRCLE K
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES X NO
E
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 OR SPECIAL INSPECTOR CERTIFICATION #
RICKEY BINGER 805-431-0332
TEST METHOD
ICC
8452629
INDUSTRY STANDARD
APPLICANT SIGNATURE DATE
10/26/2020
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 03/18)