HomeMy WebLinkAboutFMC Permit App 12-13-16UNDERGROUND STORAGE TANKS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
APPLICATION JVAJ ies Bakersfield, CA 93301
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 # &
Q ENHANCED LEAK DETECTION LINE TE `'� --,4, ❑ SB -989 SECONDARY CONTAINMENT
Q TANK TIGHTNESS (FUEL MONITORING CERTIFICATION
FACILITY_ NAME & PHONE OF CONTACT PERSON
ADDRESS
OWNER NAME
OPERATOR NAME PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? 0 YES ❑ NO
TANK # VOLUME CONTENTS
TANK TE5TIAIG COMPANY
TESTING COMPANY NAME & PHONE # OF CONTACT PERSON
Lo
MAILING ADDRESS
NAME & PHONE S OR SPECIAk INSPECTOR CERTIFICATION # S09 CJ o
DATE & TIME TEST'rO BE CONDUCTED _ i r ,cc # TEST METHOD
Q
APPLICArM'i' SIGNATURE Ift DATE l
FD2095 (Rev 03/08)