HomeMy WebLinkAboutUST-APPL 2/3/2015UNDERGROUND 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#
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
ago k-k 5XVV-Ei-7
Bakerstield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page I of 1
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING SECONDARY CONTAINMEN7
❑ TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATION
Sl E: INFORMAt-16N
FACILITY I k k A NAME & PHONE # OF CONTACT PERSON
ADDRESS
OWNER NAME
OPERATOR NAME
PERMIT` TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK # VOLUME CONTENTS
DATE & TIME TEST 'i0 5,.COVDUCTED1 I 1CC
APPLICANT SIGNATMtk A A I DATE
THIS APPLICATION BECOMES A PE
APPROVED BY 0', 1 DATE
IT WHEN APPROVED
WAN
TEST METHOD
FD2095 (Rev 03/08)