HomeMy WebLinkAboutOPI APP 11-21-18APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING /TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that these are separate
flndaviduag Bests and will be charged per
separate type test accordinggyo)
PERMIT #�
BAKE SFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 o Fax: 661 - 852 -2171
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❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ?��EL MONITORING CERTIFICATION ❑ OVERFILL PREVENTION
SITE INFORMATION
FACILIT
f Ak E & PHONE # OF CONTACT PERSON
ADDRESS.
quo
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
t
TANK TESTING COMPANY
TEST Y
NAKE & P6 %u^'Ee1E # OF CON, TACT PERSON
MAILING ADDRESS
64L�kck
NAME & P.SHoLONE # PF TESTER OR SPE AL INSPECTOR
CERTIFICATION # .�
ICC #
TEST METHOD
APPLICANT IGNATURE
DATE
/4HIS
APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/18)