HomeMy WebLinkAboutFMC Application 3-30-22UNDERGROUND 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 #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
❑ LINE TESTING
8 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
7 -ELEVEN #32376
NAME & PHONE # OF CONTACT PERSON
Manager (661) 588-4059
ADDRESS
9600 BRIMHALL RD., BAKERSFIELD, CA 93312
OWNER NAME
7 -ELEVEN #32376
OPERATOR NAME
7 -ELEVEN #32376
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
T A N K #
VOLUME
CONTENTS
T2
11K
REG Unleaded
T3
11K
Premium
TANK TESTING COMPANY
TESTING COMPANY
Tanknology
NAME & PHONE # OF CONTACT PERSON
Mark Lindsey 951-676-4060
MAILING ADDRESS
41785 Enterprise Cicle South #D
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Luis Navarro 323-329-5845
CERTIFICATION #
8171123
TEST METHOD
Annual Monitor Cert.
ICC #
8171123
APPLICANT SIGNATURE
DATE n
all-
U
f'HIS APPL A N BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 09/20)