HomeMy WebLinkAboutUST APPLICATION 11/3/201010127/2010 15:32 6613268934 RICH PAGE 03107
SAKERSIPIELD FIRE DEPARTMENT
UNDERGROUND STORAGE!: TANKS Prevent on Servkes
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APPLICATION JUNG Sakervleldr C.A. 93301
Phone: 661-326-3979 Fax: 661-852-2171
TO PERFORM ELDILINE TEMNro/
S5989 SECONDARY couTAINMrENT
TESTING/TANK TTGHTNtSS i�Es-r ANQ
FUEL MONITORING CERTIF11b"10N.
NDER R ND STORAGE 'TANKS
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APPLICATION
To PERFORM E D NE TE;�N
L 1U
S 89 SECONDARY C�)�T M FENT
(Please note that theme arm xeparate
indWual teats and w111 -be chary ed per
separate type test accordingly-); ,
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13 ENHANCED LEAK DETEMON NE M-W9 SECONDARY CONTAINMENT
CATI�
0 -YANK =0X1T0nNG �URTI�VION ��
FD2095 (Rev 03M)
FACTUrY NAME PHONE 9 OF CONTACT PERSON
L Inc
ADDRESS
OWNER. NAME
OPERATOR NAME
PERMi1 TO OPERATE 0
Of TANKS TO BE TESTED:
IS PIPING dOING TO Be TeSTED? 0 Yr=s ❑ NO
TANK 0
VOLUME
CONTENTS
N. . . . . . .
Trz5TWNG COMPANY
NAME Ek P"ONE V OF CONTACT PERSON
MAILING ADDRESS
NAME & pmoNF: a QF TRsTRP, OR SmCIAL INSPLICYOR
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!809 SSC)
DATE &TIME. TEST O BE CONDUCTED
Icc #
T
PEST MMOD
APPLICANT SIGNATURE
DATE
THIS APPLICATZqN BECOMES A PERMIT WHEN APPROVED
APPOR U75
DATE
FD2095 (Rev 03M)
10/27/2010 15:32 6613268934
UNDERGROUND STORAGE! TANK9
APPLICATION
TO PERFORM ELD/LINE TESTINP/
SB989 SECONDARY CONTAINMENT
TES71 iNG/TANK'TIGHTNESS TEST AND
FUEL MONITORING CEwnFkATZON.
(Please note that these are separate
individual tests and will be charged per
separate type test accoildingly.)i I
RICH
PAGE 05/07
PERMI
❑ ENHANCED Lt%K DMMON LINE 7E5TTNG
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❑ SS-M SECONDARY CONTAINMENT
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BAKERSFIELD FIRE DEPARTMENT
FACIU[TY NAME a PHONE S OF CONTACT PERSON
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ADDRESS
Prevention Sdrvicw
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PERMIT TO OPERATE, r
FIRAr
BakersHeld, CA 93301
A R No
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Phone: §61- 26--3979 qP Fa5c; 661-852-2171
(CONTENTS
Pa0e I Of I
PERMI
❑ ENHANCED Lt%K DMMON LINE 7E5TTNG
rl -rAmir 1Nr. CERMFiCATION
❑ SS-M SECONDARY CONTAINMENT
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FACIU[TY NAME a PHONE S OF CONTACT PERSON
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ADDRESS
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE, r
OF TANKS TO BE TESTED'
iS PIPING GOING TO BE TESTED? 0 YES i7 NO
TANK 9
VOLUME
(CONTENTS
TESTING COMPANY NAME 9L PHOME it OF CONTACT PERSON
7V
MAILING ADDRESS 45UtA
NAME O• PHONE 9 OF TESTER.OP. SPECEAL INSPECTOR
CERnF[CATMN ;&
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DATE & TIME TEST �O BE C014DUC-TUD
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re v mmoo
APPucANT SIGNATURE !
DATE
TIIIS'APPLICATION "COMES A PERMIT WHEN APPROVED
APPR ED S
Y6-�
DATE
FD2095 (Rev 03/08)