HomeMy WebLinkAboutUST APPLICATION 4-27-15 (1)UNDERGROUND STORAGE TANKS
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APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT AND
TESTINGI ANK TIGHTNESS TE
FUEL MONITORING 'CERTIFICATION
(please note that these are Separate
Individual tests and will be charged per
separate type teat acCO`WhVly -)
PERMIT # I lam= 2 2-
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
FACILITY
ADDRESS
OWNER NAME
OPERATOR NAME
# OF TANKS TO. BE TESTED:
TANK #
�r
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
aloe Irk
Bakervield, CA 93301
Phone: 661- 326 -3979 a Fax: 661 -85.2 -2171
Page 1 of 1
❑ LINE TESTING """' L.D SB"'989 SECONDARY CONTAINMENT
EL MONITORING CERTIFICATION _-
NAME & PHONE # OF CONTACT PERSON
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
13 YES E3 NO
VOLUME CONTENTS
a
TANK ST.�16 GO��
t ,
NAME PHONE # OF CONTACT PERSON lA��
TESTING COMPANY
MA#LING ADDRESS G A 1�1k''
CERTIFICATION
NAME & PHONE.* OF TESTER OR SPECIAL INSPECTOR �' c>9 $'�G%
- TEST METHOD
ICC
DATE & TIME`O BE (j DUPE�D
DATE -
APPLI G 'Tl3RE . r
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
APPROVED BY
FD2095 (Rev 03/08)