HomeMy WebLinkAboutTANK TEST APP 7-13-18UNDERGROUND STORAGE TANKS
.............
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT # I
z ; S F
I
D
1, 9
ARTA F
T
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
a' O � V--V--7
Bakerstield, CA 93301
Phone: 661-326-3979 ® Fax: 661-852-2171
Page 1 of 1
__Q_ENHAj4CED-tEjkK-DETEjZRON ❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
FUEL MONITORING CERTIFICATION
1-ft TANK TIGHTNESS
..SITE INFORMATION
ADDRESS
OWNER NAME
--------------
OPE ATOR NAME
# OF TANKS TO BE TESTED:
TANK #
I
007-
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME
❑ YES ❑ NO
CONTENTS
TANK: TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON
NAME
TESTING COMPANY eR,. -!V
V4%�e NrVVk L
m
MAILING ADDRESS -%-I v. -
0- A
5u L-k CERTIFICATION # 9
NAME & PH PE # OF TESTER OR,--5?EQIAL;NSPECT0R 1809 sso
JCC# 1)&7C T METHOD
RAW / .4 10 TEST METHOD
TIME TEST 'f0 BE CONDUCTED
ACC # 6a
DATE — E TE
APPLICANT SICAATURE
APPROVED BY
DATE
TH19 APPLICATION BECOMES A PERMIT WHEN APPROVED
I DATE
FD2095 (Rev 03/08)