HomeMy WebLinkAboutFMC APP 9.17.18UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONETORENG CERTIFICATHERON
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
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E R S F 1 11%,` - 0
2101 H Street
FIRE
Bakersfield, CA 93301
#"A R TM wr
-2171
-852
-32 Fax: 661
Phone: 661 -3979 6
Page 1 of 1
PERMIT # F
❑ ENHANCED LEAK DETECTION E(LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
1:1 TANK TIGHTNESS An FUEL MONITORING CERTIFICATION
FD2095 (Rev 12/15)
SITE INFORMATION
FACILITY
NIF.. I.D I-
ADDRESS f576 ;Z,5
I-
o— ell
,
OWNER NAME erg p
OPERATOR NAME
T
PERMIT TO OPERATE #
-
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? [I YES El NO
TANK #
VOLUME
CONTENTS
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CK
'7
TANK TESTING COMPANY
TESTING CO P NY
MAILING ADDRESS
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NAMJ & PHONE # OF ;TqEV9, ORS ECIAL INSPECTOR
CER-fIFICATION #
DATE & TIME EST TO CONDLIC:(ED
Cc ;fll
TEST METHOD
APPLICANf SIGNATU E
DATE
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THIS PPLICAT
ON BECOMES A PERMIT. WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 12/15)