HomeMy WebLinkAboutFMC Permit App 7-22-16UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFbRM:FLb/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 #
13 ENHANCED LEAK DETECTION
13 TANK TIGHTNESS
FACILITY K
ADDRESS (0
OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK.
01
11 BAKERSFIELD FIRE DEPARTMENT
4 hbom
Prevention Services
/rte f
1
Bak6f9h6ld CA '933-0
.A. Phone: 661-326-3979 Fax: 661-852-2171
Page 1 of 1
LI 13 SB-989 SECONDARY CONTAINMENT
FUEL MONITORING CER'nFICATI N
777777777777
NAME & PHONE # OF CONTACT PERSON
IPERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME
❑ YES ❑ NO
CONTENTS
LL- VAX �n ,
TESTING COMPANY NAME & PHONE # OF CONTACT PERSON
MAILING ADDRESS
12.>fWS-A-e—% C:V- ZM<EVZ'S'FVF—L:UxQA emos--3049
NAME & PUQNE # OF TE!:-tMR OR SPE L INSPECTOR CERTIFICATION #
S09 8 s
DATE & TIME TEST ITO'BE CONbui
cc * TEST METHOD
APPLICA
SIGN7W4 -Y �1
DATE
THM APPLICATION BECO MES. A PERMIT. WHEN APPROVED
APPROVED BY - I DATE
1 21,12-116
FD2095 (Rev 03/08)