HomeMy WebLinkAboutFMC APP 7-25-18UNDERGROUND STORAGE TANKS
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APPLICATION
TO PERFORM ELD/LTNE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONETORHNG CER7ZFE-C-A7E0N
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PERMIT #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
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Bakerstield, CA 93301
Dhone: 661-326-3979 a Fax: 661-852-2171
Page 1 of 1
❑ ENHANCED LEAK DETECTION ❑ 1 INE TES-q. 0 SB-989 SECONDARY CONTAINMENT
J* FIJEL MONITORUING CERTIFICATION
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FD2095 "Rev 03/08)
SITE INFORMATIORN
FACILITY
ADDRESS
OWNER NAME
OPERATOR NAME
i PERMIT TO OPERATE
# OF TANKS TO BE TESTED: g5 PIPING GOING TO BE 'FSTED? 0 YES 0 NO
T K AN #
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
T
NA, 'M E 2, 0
IP
MAILING ADDRESS
NAME 11, PHONE .#ZT.
E N S� P CERTIFICATION # C)
PCON�DUCTED
*All�
DATE & TIME TEST 'r0 BE
lcN
TES T METHOD
APPLICANT SIGN
RE
DATE
THIS APPLICATION BECOMES A PERMIT 'WHEN APPROVED
APPROVED BY
DATE
FD2095 "Rev 03/08)