HomeMy WebLinkAboutUST APP 3/5/2015UNDERGROUND 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 # 11:5--- 1 j2=2
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
FACILITY
ADDRESS
4
OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
pia# Bakersfield,, CA 93301
A,M,rmrjvljF Phone: 661-326-3979 • Fax: 661-852-2171
Z
Page 1 of 1
❑ SS-989 SECONDARY CONTAINMENT
FUEL MONITORING
4b.. . (-'\ I NAME & PHONE * OF CONTACT PERSON
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME
❑ YES 0 NO
CONTENTS
TESTING COMPANY
NAME & PHONE * OF CONTACT PERSON
*lp
MAILING ADDRESS
NAME & PHONE,*,6 TEsTE R OR SPECIAL INSPE CERTIFICATION #
Y
S09 6so
TEST METHOD
1CC
DATE & TIME I EST 'to' BE CO , .0 D
ADDI TrAmT qTag-A-?NRE A DATE
FD2095 (Rev 03/08)