HomeMy WebLinkAboutCPT APP 3-17-18UNDERGROUND STORAGE TANKS
LAI, I
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Poease note that these are separate
5ndividuag1ests and w191 be charged per
separate type test accordingly.)
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Qp®l � S-mv--'F-7
Bakerstield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page I of 1
PERMIT #
❑ ENHANCED LEAK DETECTION ❑ WfelTSTMG ❑ SB-989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATION
SITE INFO RMATION
FACILITY NAME & PHONE # OF CONTACT PERSON
ADDRESS
OWNER NAME
I OPERATOR NAME 11
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? 11 YES 0 NO
TANK # VOLUME CONTENTS
TANK TESTING COMPANY
TESTING COMPANY NAME & PHONE # OF CONTACT PERSON
LO
MAILING ADDRESS
NAME & PHONE .# OFT R OR SPECIAL INSPECTOR CERTIFICATION # ®9 S(-)9 elso
DATE & TIME Tr=sT IrO BE CONDUCTED 1CC # TEST METHOD
I APPLICANT
DATE
HIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY I DATE
F1>2095 (Rev 03/08)