HomeMy WebLinkAboutTANK TEST APP 8-17-18UNDERGROUND ST ORAGE TANKS
R. D
APPLICATION
FIRE
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PERFORM ELD/LINE TESTING/
TO
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
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PERMIT #
��AKERSFIELD FIRE DEPARTMENT
Prevention Services
0,101 Lrk
Bakerstield, CA 93301
Phone: 661-326-3979 ® Fax- 661-852-2171
Page 1 of 1
❑ ENHANCED LEAK DETECTION 0 LINE TESTING t-A-rrf'ihj
❑ --B-989 SECONDARY CONTAINMENT
❑ FUEL MONITORING Ctm
SITE INFORMATION
FACILITY
ADDRESS
OWNER NAME
NAME
OPERATOR PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: is PIPING GOING TO BE TESTED? ❑ YES
❑ NO
VOLUME CONTENTS
TANK #
TANK TESTING COMPANY
(or- CONTAC PERSON
TESTING COMPANY cl-1 0 1
MAILING A
DDRESS o S7 —
CA
C
CERTIFICATION NAME &P HONE
# OF TESTER� OR SPECIAL IDISPECTOR Iso
TEST METHOD
PATE :&:TrlME TEST to BE CONDUCTED
06
DATE
APPLICANT SIGNATURE
-7
THI APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
APPROVED BY
FD2095 (Rev 03/08)