HomeMy WebLinkAboutFMC Application 6-21-22APPLICATION
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
Cl ENHANCED LEAK DETECTION
El TANK TIGHTNESS
0 LINE TESTING
lil FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 e Fax: 661-852-2171
Page 1 of 1
0 SIB -989 SECONDARY CONTAINMENT
0 OVERFILL. PREVENTION
SITE INFORMATION
FACILITY NAME & PHONE # OF CONTACT PERSON
Roys Market & Gas
ADDRESS
— 4 2 0— 2 9 .00"k A dl% 0% 0% 0% 0-
1631 BaKerS 01 DaKerSflelU, U/ -k zloouo
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? W YES 0 NO
T A N K # .. . . ....... ------
VOLUME CONTENTS
-------- .... . ... ..
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
CERTIFICATION #
Bruce Hinsley
A25212
TEST METHOD
PEI RP 1200-17
ICC #
8032698
APPLICANT SIGN RE
DATE
THIS APPLICATION
BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 09/20)