HomeMy WebLinkAboutSB989 APP 8-29-18UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/L.INE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(POease note that these are separate
individual tests and w119 be charged per
separate type test accordingly.)
PERMIT # I I
1:1 ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
E R S F I D
R rm r
Vr
FIRS
A%001�
❑ LINE TESTING
❑ FUEL MONITORING CERTIFICA:
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Q10k k-� 5-.1E1F-7
Bakersfield,, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page I of I
-SB-989 SECONDARY
FD2095 (Rev 03/08)
SITE INFORMATION.
FACILITY
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
/N--1
Ank �5 1
Duesel
TANK TESTING COMPANY
TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON
LO
MAILING ADDRESS LA
lt-�> IF—
NAME & PHONE # OF TESTER O-PVECIAL
. .
INSPECTOR
CERTIFICATION #
S098so
DATE & TIME TEST tO BE CONDUCTED
1CC #
TEST METHOD
APPLICANT SIGNATURE
DATE
T
V
APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)