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12/15/2004 10:35 6613252529
CAL VALLEY
PAGE 131
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CITY OF BAKERSFIELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 326-3979
APPLICA TION TO PERFORM
FUEL MONITORING CERTIFICATION
FACILITY Oal/lef Ot'L
ADDRESS '12 ()O ßuc.:k CJ~JAS ð/I/d.. &.k-eV"$~l~ c~-
OPERA TORS NAME D4-///u {J H.
OWNERS NAME Sd..J.ue.
NAME OF MONITOR MANUFACTuRER ~er:~""'~R()o"t
DOES FACD..ITY HA VB DISPENSER PANS1 YES.k,. NO_
TANK #
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VOLUME
CONTENTS
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NAMEoFTES11No COMPANY é'Q,!- U.//e..v Efü-/J:'/1'1eI1T
CONTRACTORS UCENSE# 7't"l/70 A HAZ
NAME & PHONE NUMBER OFCONTACI' PERSON ßYtAL t!'- 1k'''1s/~t,¿-, ~~-327-rJ~
DATE" 11MB TEST IS TO BE CONDUCTED }2 -30- 0'1 @ Or"Od
APPROVED BY
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SIGNATURE OF APPliCANT
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