HomeMy WebLinkAboutFMC APP 8-20-18UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/L.INE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONXTORXNG CERTIFXCATION
Cpgease, note that these are separate
2ndividgal tests and w506 be charged per
separate type test accordlngBy.)
PERMIT #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Q10k �-k sTp"F-F-7
Bakerstield,, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page I of 1
❑ ENHANCED LEAK DETECTION ❑ LINE T ❑ SB-989 SECONDARY CONTAINMENT
'Q--m iFi m=NN-rr(r�))FPZTN(; �CERTT�FI
CA
SITE INFORMATI
-- FACILITY NAME PHONE #* OF CONTACT PERSON
ADDRESS I
Ick OeAs iJ
OWNER NAME
OPERATOR NAME U
PERMITTO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
6 1
TANK TESTING COMPANY.
TESTING COMPANY
NAME & PHONE # ®F CONTACT PERSON
kD9
MAILING ADDRESS
M<E CA
9�OR SPECIAL INSPECTO
NAME & PHONE # OF TEST
CERTIFICA TION #
DATE & TIME TEST tO BE CONDUCTED
1CC #
TEST METHOD
APPLICANT SIG7E`
Vf
HIS APPLICATION BECOMES A PER IT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)