HomeMy WebLinkAboutFMC Application 6-2-2016# OF TANKS TO BE TESTED:
TANK #
IS PIPING GOING TO BE TESTED?
VOLUME
TANK 4tSfiN 'COMPANY'
0 YES ❑ NO
CONTENTS
TESTING COMPANY
NAME & PHONE * OF COKTACT PERSON
11 1
MAILING ADDRESS
A
NAME & PHONE.# OF TESTER OR SPECIAL INSPECTOR CERTIFICATION #
TEST METHOD
DATE & TIME TESTtO BE CONDUCTED
APPLI NT GNATURE A DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVE BY DATE
FD2095 (Rev 03/08)
BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANKS
Prevention Services
R 5 7
FFT-1 I
JUNK
Q10k
Bakersfield.,, CA 93301
APPLICATION
ff
R
Phone: 661-326-3979 •Fax: 661-852-2171
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
Page 1 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 #
& -10&-20190
❑ ENHANCED•LEAK DETECTION
ESTING
❑ SB-989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS
Z-FUEL NITORING CERTIFICA
77-777777-,�,,
NAME & PHONE # OF CONTACT PERSON
FACILITY
CAM
ADDRESS
S(Aq
OWNER NAME
PERMIT TO OPERATE #
I
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK #
IS PIPING GOING TO BE TESTED?
VOLUME
TANK 4tSfiN 'COMPANY'
0 YES ❑ NO
CONTENTS
TESTING COMPANY
NAME & PHONE * OF COKTACT PERSON
11 1
MAILING ADDRESS
A
NAME & PHONE.# OF TESTER OR SPECIAL INSPECTOR CERTIFICATION #
TEST METHOD
DATE & TIME TESTtO BE CONDUCTED
APPLI NT GNATURE A DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVE BY DATE
FD2095 (Rev 03/08)