HomeMy WebLinkAboutSB989 APP 11-30-18BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANKS Prevention Services
APPLICATION r Bakerstield, CA 93301 Phone: 661-326-3979 Fax: 661-852-2171 ArAV,
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TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
Page I of 1
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
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING 7B-989 SECON;6�A�R�Y C
❑ TANK TIGHTNESS ❑ FUEL MONITORING CE FICATION 6S
ION
SITE INFOR-MATION.
FACILITY NAME PKONE,'y OF CONTACT PERSON
ADDRESS
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
r �
TANK TESTING COMPANY
TESTING COMPANY NAME & PHONE # OF CONTACT PERSON
MAILING ADDRESS
<
NAME (OO(i NE #jPF TESTER A Og SPEQ�kL INSPECTQR CERTIFICATION # S09 SISC)
DATE &TIME TEST
APPLICANT SIGNATURE
ICC #
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
TEST METHOD
FD2095 (Rev 03/08)