HomeMy WebLinkAboutOPI APP 1.22.19UNDERGROUND 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 #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
B SRSFI Vr p'd8f Bakersfield, CA 93301
� I'r;Tj / Phone: 661- 326 -3979 • Fax: 661 - 852 -2171
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❑ ENHANCED LEAK DETECTION
❑ LINE TESTING B -989 SECONDARY CONTAINME
❑ TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATIO
5ITE INFORMATION
NAME & PHONE # OF CONTACT PERSON
ADDRESS
OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK #
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME
❑ YES ❑ NO
CONTENTS
TAN K.TESTING COMPANY, ...
TESTING COMPANY NAIVE &PHONE # OF CONTACT PERSON
�
`�c�
MAILING ADDRESS
�JIQ 3 13- c5o�ccS C..� • -- F.� AcK�R S F t.t-U . C �t 3 3 c'
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR CERTIFICATION # 1809 ^ so
DATE & TIME TEST 4r0 BE CONDUCTED
ICC # �j TEST METHOD
DATE
SIG
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
APPROVED BY
FD2095 (Rev 03/08)