HomeMy WebLinkAboutFMC Application 4-5-22UNDERGROUND 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 # i I
❑ 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
SITE INFORMATION
FACILITY
Panama Buena Vista Union School District
NAME & PHONE # OF CONTACT PERSON
George Halbrook (861) 831-8331 ext.6197
ADDRESS
4200 Ashe Road Bakersfield, CA 93313
OWNER NAME
Panama -Buena Vista USD
OPERATOR NAME
George Halbrook
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED. 4
IS PIPING GOING TO BE TESTED? ® YES ❑ NO
T A N K #
VOLUME
CONTENTS
1
121000
Diesel
2
12,000
87
3
800
Used Oil
TANK TESTING COMPANY
TESTING COMPANY
Advanced Compliance
NAME & PHONE # OF CONTACT PERSON
Leann Hamilton 661-808-5323
MAILING ADDRESS
4007 Brae Burn Dr Bakersfield Ca
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Bruce Hinsley
CERTIFICATION #
A25212
TEST METHOD
PEI RP1200-17
ICC #
8032698
APPLICANT SIGN RE
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 09/20)