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UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING
I S6989 SECONDARY CONTAINMENT TESTING
/TANK TIGHTNESS TEST AND TO PERFORM
FUEL MONITORING CERTIFICATION
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BAKERSFIELD FIRE DEPT.
a ,~ 'r, ~ i~._n
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Prevention Services
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' F1RC
ARTMT 900 Truxtun Ave.; Ste. 2 ] 0
f~ .Bakersfield, CA 9330.1
Tel.: (661) 326-3979
• Fax: (661) 852-2171
Page 1 of 1
P_Rr~:11T No 1 ~- ~ 3 S
^ ENHANCED LEAK DETECTION ~ LINE TESTING ^ SB-989 SECONDARY CONTAINP;gENT TESTING
^ TANK TIGHTNESS TEST ~ TO PERFORM FUEL MONITORING CERTIFICATION
,: SITE INFORMATION
FACILITY USA Liquors ~ NAME & PHONE NUMBER OF CONTACT PERSON
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.ADDRESS 2122 S. Union Ave. ~
I O`:NNERS NAME USA Liquors
OP',~RATORS NAME Same PERMIT TO OPERATE NO.
NUP:I6ER CF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? k~f YES ^ NO
TANK# VOLUME CONTENTS
1 87 UL
2 ; 89 UL
3 i 91 UL
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TANK TESTING COMPANY
~ NAME OF TESTING COMPANY Cal-Valley Equipment ~ Bruce W. Hinsley 661-327-9341
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MAILING ADDRESS 3500 Gilmore Ave. Bakersfield, Ca. 93308
Bruce W. Hinsley 661-327-9341 CERTIFICATION #: 006-05-1178
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DATE & TIME TEST TO BE CONDUCTED Aprll 25, 2006 08:UU ICC #:
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SIGNATURE OF APPLICANT_.~2_ ~'~~~~_p~ DATE April 4,2006
APFRCVEDBY
FD 2095 (Rev. 09.05)