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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# 11!A Mftmft IF,IAWAr Jrr rAr, r JFIAWAr AJ&Tf A F VT 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)