HomeMy WebLinkAboutFMC Application 5-3-22UNDERGROUND 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 ❑ LINE TESTING
❑ TANK TIGHTNESS Iiii 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
a
g FACILITY
Costco Wholesale #688
NAME & PHONE # OF CONTACT PERSON
Bill Karras 951-906-3022
ADDRESS
3800 Rosedale Hwy
OWNER NAME
Costco
OPERATOR NAME
Costco
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
T A N K #
VOLUME CONTENTS
E
i
3
k
E
E
Y
3
3
c
k
i
t
m
TANK TESTING COMPANY
TESTING COMPANYNAME
W.S.K. & Sons Inc,
& PHONE # OF CONTACT PERSON
113ill Karras (951) 906-3022
MAILING ADDRESS
34455 Sunlight Drive Yucaipa, CA 92399
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Bill Karras (951) 906-3022
CERTIFICATION #
TEST METHOD
Annual Monitor Cert / Drop p tube inspection
ICC #
5257313
APPLICANT SIGNATURE DATE
3/25/2022
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 09/20)