HomeMy WebLinkAboutUST-APPL 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# 1 /,5-_ 1
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
FACILITY
\A
ADDRESS
2LDDO -NLM�C
OWNER NAME
OPERATOR NAME
OF TANKS TO BE TESTED:
TANK
m
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
3 a Xt 8
pigs 6akerMeld,, CA 93301
Phone: 661-326-3979 * Fax: 661-852-2171
Page 1 of 1
CERTIFICATION I
NAME & PHONE * OF
R,
] PERMIT To OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME I
❑ SB-989 SECONDARY CONTAINMENT
PERSON
❑ YES ❑ NO
CONTENTS
TESTING COMPANY NAME & PHONE # OF CONTACT PERSON
MAILING ADDRESS
NAME & P09NE # OF TESTER OR SPE L SPECTOR CERTIFICATION #
ICC TEST METHOD
--YM'E TEST IV "' ' ' ' R"*%
DATE & T 0 BE-CD
arn
DATE APPLICANT SjGMWRE DAe-., t - — 'I--
FD2095 (Rev 03/08)