HomeMy WebLinkAboutFMC APPLICATION 6-8-15UNDERGROUND TORAGE
NCERGROUND STORAGE
❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
UEL MONITORING CERTIFICATION
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BACERSFIELD FIRE DEPARTMENT
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Prevention Services
�rTANKS
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3
2101 H Street
APPLICATION
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Bakersfield, CA 93301
TO PERFORM ELD /LINE TESTING)
OPERATOR NAME
Phone: 661 - 326 -3979 Fax: 661- 852 -2171
SB989 SECONDARY CONTAINMENT.
# OF TANKS TO BE TESTED:
page 1 of 1
TESTING /TANK TIGHTNESS TEST AND
VOLUME
CONTENTS
FUEL MONITORING CERTIFICATION
0,
(Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT # � .� ?
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
UEL MONITORING CERTIFICATION
SITE INFORMATION
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NA E & PHONE # OF `C "''ACT PERSON
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ADDRES
-
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES
❑ NO
TANK #
VOLUME
CONTENTS
0,
TANK TESTING COMPANY
TESTING
NAM tE# OF :W m AC E&ZS�A !
at
MAILING APDRESS ,
NAME & PH # O TE TER OR SPECIAL INSPECTOR
a
CERTIFICATION #
DATE & TI E TEST TO BE CONDUCTED
ICC # �- -'— !
TEST METHOD
APPLICANT S NATURE
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE r
FD2095 (Rev 03/06)