HomeMy WebLinkAboutLINE TEST APP 6-22-18UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
PFUEL MONETORING CERTIFICATION
P a that these are separate
l"ease not
o -ndhAdma9 tee s and w919 be charged per
separst a type test accardinggy.)
B E R S F 1�1 D
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Bakerstield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of I
PERMIT #
1:3 ENHANCED LEAK DETECTION LINE TESTIN ❑ SB-989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ITO ITORING CERTIFICATION
SITE INFORMATION
FACILITY cA3
NAME & PHONE # OF CONTACT PERSON
ADDRESS
OWNER NAME fV-)
OPERATOR NAME
Mk '�41 ka A k:
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
p TANK TESTING COMPANY
TESTING COMPANY
NAME &- PHONE # OF CONTACT PERSON
MAILING ADDRESS
NAME & PHONE# OF TESTER OR SPECIAL INS OR
. (
CERTIFICATION #
S 09 Sso
-
DATE & TIME BE CONDUCTED
ACC 19,
EST METHOD
APPLI7'11!G NATUR.
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)