HomeMy WebLinkAboutUST-APPL 3/18/2016BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANKS
-_ Prevention Services
_ n 2101HStreet
APPLICATION JuRm Bakersfield, CA 93301
ARf1�[ T Phone: 661 -326 -3979 • Fax: 661 -852 -2171
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
- Page 1 of 1
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 # f
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS F EL MONITORING CERTIFICATION
SITE INFORMATION
FACI
N & PHONE # OF C NTACT PERSON
16
- i
AD WSS r
o
OVI.ULR NAME., �
OR NAM
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
s
TANK TESTING COMPANY
TEST OMPANY
NrP ON OF CONTACT PERSON _
MAILING ADDRESS
Mr
NAMEF(:).NEP OF TESTER OR SPECIAL INSPECTOR
CERTIFI TION
DATE & TiME TEST TO BE CONDUCTED
iCC # a.
TEST METHOD
APPLICANT IGNATUR
DATE
0�
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)