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APPLICATION U jujiff
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TO PERFORM ELD/LINE TESTING/ A R A F,
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 #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Q10( k-k cs-mev-7
Bakerstield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
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❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS FUEL MONITORING CERTIFICATI
FACILITY
ADDRESS
OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK #
ON
SITE INFORMATION
NAME & PHONE * OF CONTACT PERSON
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME
■ CONTENTS
Td— V 0 =A* 4 � no WON
FD2095 (Rev 03/08)