HomeMy WebLinkAboutFMC Application 3-14-22UNDERGROUND 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 #
U
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING
❑ TANK TIGHTNESS ® FUEL MONITORING CERTIFICATION
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
PAN PACIFICIWORLD OIL
NAME & PHONE # OF CONTACT PERSON
ADDRESS
1850 COFFEE RD, BAKERSFIELD, CA
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE Y
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
T A N K #
VOLUME
CONTENTS
1
DIESEL
i
I
TANK TESTING COMPANY
TESTING COMPANY
E BSSR, INC.
NAME & PHONE # OF CONTACT PERSON
FIDEL CARRILLO 205-2773
I MAILING ADDRESS
6630 ROSEDALE HWY. #B, BAKERSF I ELD, CA 93308
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
NATHAN HOLMAN
CERTIFICATION #
TEST METHOD
ICC #
8111067
APPLICANT S NATO
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DATE
1-28-22
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 09/20)