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HomeMy WebLinkAboutFMC Permit App. 3-17-16UNDERGROUND STORAGE TANKS ..: APPLICATION TO PERFORM ELD /LINE TESTING/ ARTS fly 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 # BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661- 326 -3979 • Fax: 661 - 852 -2171 Page 1 of 1 ❑ ENHANCED LEAK DETECTION ❑ NE TESTING ❑ SB -989 SECONDARY CONTAINMENT n TANK TT(;HTNFSS X FUEL MONITORING CERTIFICATION SITE INFORMATION FACIL 6nix-0 M-OL PHONE # OF CONTAC�,P 2,L ADDRES u OWNER,NA E ` r � r OPERATOrNAMF, PERMIT TO OPERATE # # OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? 0 YES NO TANK ## VOLUME CONTENTS r L TANK TESTING COMPANY TESTING:G6LMPANY N & PHOrjE # OF CONTACT PERSON L j J 15 �� MAILIN ADDRESIlS+.� 411 "a NAME & # OF TESTER OR SPECIA INSPECTOR CERTIFICATION y 1® G,NE a Nd DATE & TIME TEST TO BE CONDUCTED ICC ® TEST METHOD APPLICANT SI ATUR DATE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APPROVED BY DATE FD2095 (Rev 03(08)