HomeMy WebLinkAboutUST APPLICATION 1-21-14UNDERGROUND STORAGE TANKS
B B R S F I D
APPLICATION F1R� Ir
TO PERFORM ELD /LINE TESTING/ A ��
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
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Q, ®t t-k C ->-Mev -7
Bakersfield, CA 93301
Phone: 661- 326 -3979 • Fax: 661- 852 -2171
Page 1 of 1
❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACIL NAME & PHONE # OF CONTACT PERSON
ADDRESS
LA
OWNER NAME
OPERATOR NAME PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK # VOLUME CONTENTS
07
ft.
TANK TESTING COMPANY
TESTING COMPANY ] NAME & PHONE # OF CONTACT PERSON
MAILING ADDRESS
9--3-3c->8
NAME & PUP4f # OF TESTER OR SP CIAL INSPECTOR CERTIFICATION # 09 eso
.-
DATE & TIME TEST 't'O C NDUCTED 1CC # TEST METHOD
APPLICANT SIGN A RE a DATE
THIS APPLICA'T'ION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
(�) "." J. /
FD2095 (Rev 03/08)