HomeMy WebLinkAboutOPI APP 10-30-18UNDERGROUND STORAGE TANKS
E R S F 1 z 0
M.
FIRE
APPLICATION RT
............
TO PERFORM ELDJLINE 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 # I I
BAKERSFIELD FIRE DEPARTME9 7'
Prevention Services
2101 H Street
Bakersfield,, CA 93301
Phone: 661-326-3979 e Fax: 661-852-2171",
Page I of --.
0 ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
0 TANK TIGHTNESS -A2 C I //
0 // "%m/ A/
FD209S (Rev 12/15)
SITE INFORMATION
ex
& # OF CON TCT CIE SO
ACT kN PHONE . .......
ADDRESS 1
f, V,
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED?
0 YES 0 NO
TANK #
VOLUME
CONTENTS
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0,
TANK TESTING COMPANY
TESTING C
NAME R • ONE�# r4 C NTACT r.RSON
MAILING ADDRESS
NAME HONE # OF TESTED PR SPEqAL INSPETOR C
, &PHC
?
CERTIFICATION #
DATE & TIME TEST TO BE CO DUCTED
ICC
104-
7
TESTT METHOD
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I
APPLICANT SfGNATURE
DATE
10
TWS APP&N BECOMES A PERMIT WH i
N APPROVED
APPROVED BY
DATE
FD209S (Rev 12/15)