HomeMy WebLinkAboutSB989 APP 9-26-18UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
. ,v
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 #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 ® Fax: 661-852-2171
Page 1 of I
2k SB-989 SECONDARY CONTAINMENT
SITE INFORMATION
FACILITY NAME & PHONE # OF CONTACT PERSON
---N MC
A V�(
ADDRESS
OWNER NAME
OPERATOR NAME PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? 1:3 YES ❑ NO
TANK # VOLUME CONTENTS
TANK TESTING COMPANY
TEkTING COMPANY NAME & PHONE # OF CO ACT PERSON.
MAILING ADDRESS A
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NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR CERTIFICATION #
TEST METHOD ICC #
&,.ICA S; I G N ATd-P E
"NTE DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY I DATE
PLEASE CALL BAKERSFIELD FIRE DEPARTMENT PREVENTION SERVICES DIVISION TO SCHEDULE ANY AND ALL TESTING
OF UNDERGROUND STORAGE TANK SYSTEMS.
FD2095 (Rev 03/18)