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HomeMy WebLinkAboutFMC App 10-10-16APPLICATION 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 w101 be Charged per Separate type test accordingly.) PERMIT # & _ 00oo 5-5/.$ -- _j B E R S F I D FIRE ©w /l AT BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661 - 326 -3979 • Page 1 of 1 Fax: 661 -852 -2171 ❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT ❑ TANK TIGHTNESS %' UEL MONITORING CERTIFICATION SITE INFORMATION FACTLTTY PHONE F CON TACT 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 it TANK TESTING - COMPANY TESTING COMPANY NAME & f HE # OF CON1 T ,T P SO MAILING DDRESS e _ �.- oq NAME & PRONE # OFT ,,ESTER OR SPECIAL I SFECTOR CERTIFICATIO °r6 , I DATE & TIME TEST TO BE COWURCTi6 K ICC # � r TEST METHOD APPLICANTS NATURE ! DATE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APPROVED BY DATE FD2095 (Rev 12/15)