HomeMy WebLinkAboutUST APPUNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING /TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
PERMIT # r
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FIRI
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'BAKERSFIELD FIRE DEPARTMENT
Prevention Services
1600 Truxtun Ave., Suite 401
Bakersfield, CA 93301
Phone: 661 -326 -3979 • Fax: 661- 852 -2171
Page 1ofI
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS & FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
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NAME & PHONE * OF CONTACT PERSON
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ADDRESS V ✓ 1 0SE NA LE HV` -+°� C7/ �1e EfwSF� EL�, C/ C
OWNER NAME
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OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: i.
IS PIPING GOING TO BE TESTED? V' YES O NO
TANK x#
VOLUME
CONTENTS
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TANK TESTING COMPANY
TESTING COMPANY NAME & PHONF OF CONTACT PERSON
IT-ADEL CAZZaLLO
MAILING ADDRESS V
0
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION
T C
DATE &TIME TEST TO BE CONDUCTED
ICC # TEST METHOD
5A 5� 0 8a
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APPLICANT SIGNATURE
DATE
dAi�
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
AP ED BY
DATE
FD2095 (Rev 06/07)