HomeMy WebLinkAboutFMC AppAPPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(POease note that these are separate
Endividuag tests and wigg be charged per
separate type test accordinggy.)
PERMIT # I I
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING
❑ TANK TIGHTNESS
.34:kJEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Preventi ®n Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of I
❑ SB-989 SECONDARY CONTAINMENT
SITE INFORMATION
FACILITY Arco
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
A
TANK TESTING COMPANY
TESTING COMPANY
CONTACT PERSON
PAr
MAILING ADDRESK,
NAME & PHONE # j!�7TERR SPE U
�AL IN§PECTOR
CERTIFICATION 11
TEST METHOD
A
ICC #
"-�) 's
APPLICANT SIGN RE
DATE
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THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
LIR L r-A.-sr- LAL L bAl& Ll- t LU €�-1 Kt U t eAK U 114d t m u ?Xt Is t M 2 A, UM ZatXV 11U L� U'VI jl;'UU M 1 U 2L h t U U LE t*4 Y A' M0 ALA. TE STIP4 G
OF UNDERGROUP-0D STORAGE TANK SYSTEMS.
FD2095 (Rev 03/18)