HomeMy WebLinkAboutPermit Application Line Test 2-17-2016UNDERGROUND 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 #
I
401rA
._E R $ F I D..
FIRE
ARIA! r
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
171 ENHANCED LEAK DETECTION 19 LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
NAME & PHONE # OF CONTACT PERSON
ADDRESS
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? YES ❑ NO
TANK #
VOLUME
CONTENTS
(0 0606
3
000
14
r
20 0
TANK TESTING COMPANY
TESTING COMPANY 6,j
NAME & PHONE # OF CONTACT PERSON
-3j
MAILING ADDRESS
NAME & PHONE # OF TESTER aP SPECIAL INSPECTOR
Rr va 0
CERTIFICATION #
TNT)DATE &AI MIE TEST TO BE CONDUCTED
ICC #
TEST METHOD
APPLICANT SJGNATURE
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
2 17
FD2095 (Rev 12/15)