HomeMy WebLinkAboutApplication FMC 2021_10_13_4-8UNDERGROUND 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
X 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
SITE INFORMATION
FACILITY
'CIRCLE K # 2708605
NAME & PHONE # OF CONTACT PERSON
YOLANDA JONES 602-728-8000 EXT 5287
ADDRESS
5600 AUBURN ST BAKERSFIELD
OWNER NAME
CIRCLE K STORES INC
OPERATOR NAME
CIRCLE K
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
B&T SERVICE STATION CONTRACTORS
NAME & PHONE # OF CONTACT PERSON
MAILING ADDRESS
630 S FRONTAGE RD NIPOMO, CA 93444
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
RICKEY BINGER 805-431-0332
CERTIFICATION #
TEST METHOD ICC #
INDUSRTY STANDARD _ 8452629
APPLICANT SIGNATURE, DATE
9/1/2021
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/18)