HomeMy WebLinkAboutUST-APPL 9/15/2015UNDERGROUND 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 * J/,5-_/0eX->05-?j I
NE TESTING
❑ FUEL MONITORING CERTIFICATION
❑ ENHANCED LEAK DETECTION
1:1 TANK TIGHTNESS
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
10 L I l k 5-mv-v-
geikersfield, CA 93301
Phone: 661-326-3979 * Fax: 661-852-2171
Page 1 of 1
❑ SB-989 SECONDARY CONTAINMENT
SATE T�IIFORMATON
FACILITY NAME & PHONE # OF CONTACT PERSON
INV-
ADDRESS
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK # VOLUME CONTENTS
TESTING COMPANY NAME & PHONE * OF CONTACT PERSON
-krvet L- I STJ�om:F-s L
MAILING ADDRESS
'E><2,00\-.S C.:V. iEAq Z-7- L-70 C A 9:i 3308
NAME & PHONE # QF TESTER OR SP iAL INSPECTOR CERTIFICATION #
S09 elso
DATE & TIME TEST tO BE CONDUCTED 31CC
TEST METHOD
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY I DATE
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FD2095 (Rev 03/08)