HomeMy WebLinkAboutUST APPL 5/14/2015UNDERGROUND 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 #
f
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
H B.RSFI D
FrNIr
ARTAN r
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 ❑ SB -989 SECONDARY CONTAINMENT
X FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY S L+1 QUM—
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NAME & PHONE # OF CONTACT PERSON
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ADDRESS dd ViV IoM AVE • f sV-Cif -JV= teLb> ti..A
OWNER NAME �f
OPERATOR NAME
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PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: 2�
IS PIPING GOING TO BE TESTED? ❑ YES NO
TANK #
VOLUME
CONTENTS
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r
GI i
15100 0 CAA -( -
P Irv► t Q r%A-
TANK TESTING.C.OMPANY
TESTING COMPANY
2, N N
NAME & PHONE # OF CONTACT PERSON
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MAILING ADDRESS U
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #�
DATE & TIME TEST TO BE CONDUCTED Cj S ZCJ 2-+U t.',j
1 f
ICC
eo0g551
TEST METHOD
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APPLICANT NAT E
DATE
04VIq
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY %%
DATE
FD2095 (Rev 03/08)