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12/30/2004 09:47 6613252529
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CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakerstield,.-CA (661) 326-3979
APPLICA TION TO PERFORM
FUEL MONITORING CERTIFICATION
FACRlTY ß/-t fJa.(¡'F"L f/fTrIJIt'4Ih
ADDRESS /S'sv CCl-hte.-f.. ltd. nétK'~.yf"¡;'llP(/ Ctt,
OPERATORS NAME 1?~l-1 f/ALI"¡~~L #('Í1/ple4iPt
OWNERS NAME II
NAME OF MONITOR MANUFACTURER IE 119 u.....- ,JJû-hr 51-lCk'
DOES FACnJTY HA VB DISPENSER PANS? YES...£::::.. NO_
TANK t#
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VOLUME
CONTENTS
P'-O'f:!
NAME OF TESTING COMPANY C~./....l/Á.lli:L- E~ (.(./JII1M-ðh1-
CONTRACTORS UCENSE# 7fJ''I/7D /'1-/1//2.....
NAME & PHONE NUMBER OF CONTACf PERSON ßykC~ /~i'1f~ 3'27...9'JfI
DATE &. TIME TEST IS TO BE CONDucmD ~/l"raW 3. 2ðOS' @ ()9.: CI{)
if, (Æ~fðO/z-Þ-o~ v~~~~
APPROVED BY DAm SIGNATURE OF APPUCANr
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