HomeMy WebLinkAboutSB-989 APPLICATION 7/8/2015UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
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 # E/5-7 l?L -7 2- 0"
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ��
❑ TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATION
'SATE `Yd1�1D..R�i1�►TIt?IN
i NAME & PHONE # OF CONTACT PERSON
Ak
AliffA `
1ti'�If T
BAKERSFIELD FIRE DEPARTMENT
Prevention Service
ato t t-k S-RVET
Bakerstleld, CA 93301
Phone: 661 -326 -3979 o Fax: 661-852 -2171
Page 1 of 1
FACILITY
ADDRESS ["]
OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK #
i PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED? 0 YES ❑ NO
VOLUME CONTENTS
777777777m; w-- 1
"�1MK YESTtAMG CDM�A1�tY
TESTING COMPANY ME & PHONE # OF CONTACT PERSON
MAILING ADDRESS �G�SF
NAME & PHONE. F STER OR CIAL INSPECTOR CERTIFICATION #a� ^�
DATE & TIME TEST' .0 BE CONDU ED', ICC #
APPLI SI NATURE , DATE /►� r�
THIS,,; APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
TES!' METHOD
FD2095 (Rev 03/08)