HomeMy WebLinkAboutPermit Application 3-3-2016UNDERGROUND 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 wlll be charged per
separate type test accordingly)
PERMIT # % l>� / 3S
❑ ENHANCED LEAK DETEc ION
TANK TIGHTN
PIRAF
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Baker ei ld, CA 93301
Phone: 661- 326 -3979 a Fax: 661 - 852 -2171
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LINE TESTING° ❑ SB-989 SECONDARY CONTAINMENT
❑ FU CERTIFICATION
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FACILITY,,
NAME & PHONE # OF CONTACT PERSON
ADDRESS ► • — Cz. ��t --�-� `-- -�
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ® YES ® NO
TANK #
VOLUME
CONTENTS
2 C50 0
2.
t - --600
1200 C�
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T ...i.< ., {•Y 4r L .Y r .: a i. M ,.'i•J.
TES?RNG COMPANY NAME & PHONE # OF CONTACT PERSON
MAILING ADDRESS
3 1B ?,.>AcY0FAgSF %F —LID % CA f 5
NAME & PHONE # OF TESTER ORS L.INSPECTOR
CERTIFICATION # 48 OCtr
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DATE & TIME TEST MSE CONDLXTED
ICC #
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tY `' f +sue tk'
TEST METH .
APPLICANT
DATE
7
THIS APPLICATION BECOMES A PERMIT WHEN. APPROVED
APPROVED BY DATE
FD2095 (Rev 03/08)