HomeMy WebLinkAboutFMC Permit App 5/26/2016UNDERGROUND 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 #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS C
777
FACILITY
ADDRESS
OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED.
TANK
JUNK
A
A FUEL MONITORING
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Qlot k-k 51me;—:77
Bakertfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
❑ SB-989 SECONDARY CONTAINMENT
NAME & PHONE * OF CONTACT PERSON
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME
❑ YES 1:1 NO
CONTENTS
n-
TES71NG COMPANY NAME & PHONE OF CONTACT PERSON
'I, - -I -L LO
MAILING ADDRESS Tick W.
5LpLA3 1B<R-c`>®\-c,% (:.-V-
NAME & PHONE-# OF TESTER OR SPECIAL IfimCTOR CERTIFICATION #
DATE &TIME TEST tb'BIE CONDUCTED ICC # TEST METHOD
APPLICANT SIGN DATE
01
15
THIS APPLICATION BECOMES A -PERM"
IT WHEN APPROVED
APPROVED BY 1V DATE
6/71114
FD2095 (Rev 03/08)