HomeMy WebLinkAboutUST APPL 12/1/2014UNDERGROUND 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 &urged per
separate t7type test accordingly.)
PERMIT
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
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❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
19 FUEL MONITORING CERTIFICATION
FD2095 (Rev 03/08)
FACILITY
NAME & PHONE # OF CONTACT PERSON
ADDRESS
OWNER NAME
OPERATOR NAMES J
PERMIT TO OPERATE
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? 0 YES NO
TANK #
VOLUME
CONTENTS
F pd
ARM*
TESTING COMPANY
I <
NAME 7 PHONE #—OF CONTACT PERSON
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MAILING ADDRE!jS
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NAM) & PHONE * OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION
DATE & TIME TEST TO BE CONDUCTED
TrC
5-zL/-z,-x6-q.&r --
- TEST
APPLICANT SIGN
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)