HomeMy WebLinkAboutApplication 5-10-22UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TAN K TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2181 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 ® Fax: 661-852-2171
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❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ 56-989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS 8 FUEL MONITORING CERTIFICATIOfd El OVERFILL PREVENTION
SITE INFORMATION
FACILITY
NAME & PHONE # OF CONTACT PERSON
HOSAM JOUDA (661) 333-0000
Samco #7
ADDRESS
10 UNION AVENUE Bakersfield, CA 93307
OWNER NAME
HOSAM JOUDA
OPERATOR NAME
PERMIT TO OPERATE #
HOSAM JOUDA
# OF TANKS TO BE TESTED.4
IS PIPING GOING TO BE TESTED? ® YES ❑ NO
TANK##
VOLUME
CONTENTS
1
8,000
Diesel
2
12,000
91
8
207000
87
TANK TESTING COMPANY
TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON
Leann Hamilton 661-808-5323
Advanced Compliance
MAILING ADDRESS
4007 Brae Burn Dr Bakersfield Ca
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
Bruce Hinsley
A25212
TEST METHOD
PEI R,P1200-17
8032698
APPLICANT SIGNATURE
DATE
i
x THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 09/20)