HomeMy WebLinkAboutSB-989 Permit App 1-22-16UNDERGROUND 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 # _
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 e Fax: 661- 852 -2171
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❑ ENHANCED LEAK DETECTION ❑ LINE TESTING SB -9$9 SECONDARY CONTAINMENT
TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
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NAME & PHONE # OF CONTACT PERSON
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ADDRESS%
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OWNER NAME 01
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OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTEDd
IS PIPING GOING TO BE TESTED? YES CI NO
TANK #
VOLUME
CONTENTS
)51 000 ��
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TANK TESTING COMPANY
TESTING COMPANY tk
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NAME & PHONE # OF CONTACT PERSON
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MAILING ADDRESS
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
DATE & TIME TEST TO BE C9XIDB JC t
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SCC �
TEST METHOD
AP ICkANT SIGNATURE
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9 f
DATE
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THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)