HomeMy WebLinkAboutTANK LINING APP 9-6-18UNDERGROUND STORAGE TANKS
PERMIT # 1 —1
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page I of 1
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS 1:1 FUEL MONITORING CERTIFICATION UST Osp-e-
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SITE INFORMATION
FACILITY CN �
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NAMr; 31F CONTIL12T
& PHONE # 4
PERSON/
ADDRESS
OWNER NAME
OPERATOR NAME
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MIT TO OPERATE #
# OF TANKS TO BE TESTED
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
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TANK TESTING COMPANY
TESTING COMPANY
MAILING ADDRESS
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NAME PHONE # OF CONTACT PERSON
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A7
NAME 4HONE # OF TENE
R SPECIAL I SPE TOR
CERTIFICATION #
9b
TEST METHOD
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ICC #
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APPLICANT SI N TUR
DATE
PERMIT THIS APPLI AT ON BECOMES A PERMIT W EN APPROVED
APPROVED BY DATE
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