HomeMy WebLinkAboutUST-APPLICATION 7/15/215UNDERGROUND STORAGE TANKS
PERMIT #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
A #�'�i► T
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 • Fax: 661 -852 -2171
Page 1 of 1
❑ LINE TESTING V SB -989 SECONDARY CONTAINMENT
❑ FUEL MONITORING CERTIFICATION
SITE INFORMATION.'
FACILITY a
NAME & PHONE # OF CONTACT PERSON
ADDRESS
OWNER NAME
Pli
OPERATOR NAME PERMIT TO ERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TAN K, TESTI N G, COMP ANY
TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON
MAILING ADDRESS � E
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
DATE & TIME TEST TO BE CONDUCTED
ICC #�
TEST METHOD
APPLICANT SIGNAT E
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)