HomeMy WebLinkAboutUST-APPL 10/20/201414� ftel'101,*X
PERMIT #
BA KERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 ® Fax: 661-852-2171
Page 1 of I
El ENHANCED LEAK DETECTION 0 LINE TESTING 171 SB-989 SECONDARY CONTAINMENT
0 TANK TIGHTNESS
X FUEL MONITORING CERTIFI CATION
SITE INFORMATION.
FrCILITY
-70
!E & PHONE #-Pf CONTACT PERSON
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ADDRESS /1 A-
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RVNER NAME
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CIPERATOR NAME 1--PERMIT TO OPERATE #
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# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? El YES NO
TANK #
VOLUME
CONTENTS
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TANK TESTING COMPANY
TESTING COMPANY ' & PHNSIP ACT ON
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NAME & PHONE # OF ESTER ,P iAL INSPECTOR qS1 CERTIFICATION #
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D & TIME TEST TO BE C CTED
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ACC #
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EST METHOD
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APPLICANT SIGNATURE
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
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FD2095 (Rev 03/08)