HomeMy WebLinkAboutUST-APPLICATION 12/10/2015UNDERGROUND STORAGE TANKS
APPLICATION
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 will be charged per
separate type test accordingly.)
PERMIT #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 -326 -3979 o Fax: 661 - 852 -2171
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❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY � NAME $ PHONE # OF CONTACT PE'S€C
V/f �-70
ADDRESS• Rol, � �� �'� ^ `
Ka ( -;,�,� 3313
O NCR NAME
I Mj4e, t� S-tOY ItS T�') C,
O R; TOR NAME K V / V es :J:
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
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TANK TESTING COMPANY
TESTING COMPANY �f
NAME & PHONE # OF CONTACT PERSONS
MAILING ADDRESS /S , A! _^ / ����w oD� —� ^i `-
NAME & PHONE # OF TESTER OR SPE(CIIA/L INSPECTOR # i•`�' J_
lziclkll )441 57D,--6
DATE & I� TEST TO BE CONDUCTED
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ICC # � � 1 j� 44
TEST METHOD
M n ar C-Q v+-
APPLICANT SIGNATURE
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)