HomeMy WebLinkAboutSB 989 APP 2018UNDERGROUND 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 # F I
❑ ENHANCED LEAK DETECTION
M -rANIV -rTr-"-rN1r-Cr,
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
B ERSFI D 2101 H Street
FARE Bakersfield, CA 93301
ARTM IR
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
❑ LINE TESTING
❑ FUEL MONITORING CERTIFICATION
SB-989 SECONDARY CONTAINMENT
SITE INFORMATION
FACILITY
NAME WHONE # OF CONTACT PERSON
ADDRESS
OWNER NAME
OPERATOR NAME %r
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING CLOPKPANI NAME &- PUONE #;OF CONTACT ERSON
Z
MAILING ADDRESS
e-Z
NAME & PHONE # OF TESTER OR SPECIAL INS ECTOR 6ERTIFICATION #
It Z
cj.L, ".3.1, /- - —
DATE & TIME M -E-S-PTO BE CONDUCTED 0A
ICC #
TEST ME H D
APPLICANT SI6 NATURE /�
DATE
AP ICATION BECOMES A PERMIT WHEN APPROVED
THI S �
O �
APPROVED BY
DATE
FD2095 (Rev 12/15)