HomeMy WebLinkAboutFMC Permit App 11-16-15UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTI'NGITANK 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
ft BAKERSFIELD FIRE DEPARTMENT
Prevention Services
B s x s F � a oZtOl � S�'R.�•ErC-
1►1Rf Bakersfield, CA 93301
AA'TA[ Phone: 661 - 326 -3979 a Fax: 661 -852 -2171
Page 1 of 1
FUEL MONITORING CERTIFICA•
❑ SB -989 SECONDARY CONTAINMENT
# OF TANKS TO BE TESTED:
TANK #
f
IS PIPING GOING TO BE TESTED?
VOLUME
❑ YES ❑ NO
CONTENTS
TESTING COMPANY NAME & PHONE # OF CONTACT PERSON
)_ ENV
MAILING ADDRESS
NAME & PHON # OF TESTER SPECIAL INSPECTOR CERTIFICATION #C>9 6so
T
DATE &TIME 7 i'O BE CONDUCT S °2 r
APPLICANT SIGNATU + A A DATE t .
FD2095 (Rev 03/08)