HomeMy WebLinkAboutUST APPLICATION 11-18-2014UNDERGROUND STORAGE TANKS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
D Q 10 L k-k 5-MeE-7
11 M�7�3
A BaKerSTield, CA 12ni
APPLICATION ARTM, T Phone: 661-326-3979 • Fax: 661-852-2171
TO PERFORM ELD/LINE TESTING/
rh
SB989 SECONDARY CONTAINMENT Page I of 1
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 #
❑ ENHANCED LEAK DETEC-nON ❑
LINE TESTING Ce B-989 SECONDARY CONTAIN MENT
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❑ TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATION
SITE INFORMAT10N.
NAME & PHONE # OF CONTACT PERSON
FACILITY (7)
vauln:�a� )
ADDRESS
OWNER NAME
PERMIT TO OPERATE #
OPERATOR NAME ❑ NO
IS PIPING GOING TO BE TESTED? [I YES
# OF TANKS TO BE TESTED: VOLUME CONTENTS
TANK
L4
TANK TEST3cNe .COMPANY
NAME & PHONE # OF CONTACT PERSON
TESTING COMPANY L
MAILING ADDRESS
<
5ULA CERTIFICATION #
NAME & PHONE_# TESTER OR SPECIAL INSPECTOR
S09 so
Icc # TEST METHOD
DATE & TIME TEST F4E
DATE
APPLICA NATURE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
APPROVED BY I
FD2095 (Rev 03/08)