HomeMy WebLinkAboutLINING INSP APP 9-11-18UNDERGROUND STORAGE TANKS
PERMIT #
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING
rl Taruk-TTr-14Tmr-q-, ❑ FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
❑ SB-989 SECONDARY CONTAINMENT
PLEASE CALL BAKER5FIELU U-1 r. U=VAK U MCON 0 u '"Ouv V14m0-m'v -- � - . — --- --- —
OF UNDERGROUND STORAGE TANK SYSTEMS.
FD2095 (Rev 03/18)
�D J
SITE INFORMATION
FACILITY
NAM lk PNONE OF CO MAT PER ON
1111Uj 2
ADDRESS
OWNER NAME
OPERATOR NAM `�,,
RMIT TO OPERATE f
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑
YES ❑ NO
TANK #
VOLUME
CONTENTS
Z04
TANK TESTING COMPANY
TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON
MAILING ADDRESS
NAME 44,44ONE # OF T S R IAL INSPECTOR
CERTIFICATION #
TEST METHOD
ICC #
AkrL—IC I NATUR
DATE
THIS A P ICATION BECOMES A PERMIT HEN APPROVED
APPROVED BY
DATE
tar "19 Amin An A
PLEASE CALL BAKER5FIELU U-1 r. U=VAK U MCON 0 u '"Ouv V14m0-m'v -- � - . — --- --- —
OF UNDERGROUND STORAGE TANK SYSTEMS.
FD2095 (Rev 03/18)
�D J