HomeMy WebLinkAboutSB-989 Permit App 6-29-16BAKERSFIELDi FIRE DEPARTMENT
UNDERGROUND STORAGE TANKS � Prevention Services
2101 H Street
f l r
�V FIRE
APPLICATION ,,��
Bakersfield, CA 9330
Phone: 661 - 326 -3879 ®Fax: 661 -852 -2171
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
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TESTING/TAN K TIG HTN ESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that these aire separate
individual tests and wiH he charged per
separate: type test accordonggyd)
PERMIT # o
❑ ENHANCED LEAK DETECTION
❑ LINE TESTING
SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS
❑ FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY uO 45 NAME a PHONE # OF CONTACT PEIIIN
V
ADDRES
OWNER N E
i OPERATOR NAME PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ i YES ❑ NO
TANK # VOLUME CONTENTS
TANK TESTING COMPANY
TESTI PANY C i�9A�'J' & P ®�9E #��V'�4TA� �' PE
S dV^''
MAILIN ADDRE
C) c'
NAME & # OF STER OR SPECIAL ;NSPECTO CERTIFICATION A
DATE & TIME TEST TO BE CONDUCTED ECC TEST METHOD
APPLICANT SI ATURE � DATE
THIS APPLICATIOlN BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095(Rev 12/15)