HomeMy WebLinkAboutFMC APP 2.7.19UNDERGROUND 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 #
8 'E R S F it D
FIRE
ARTM T
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 o Fax: 661 - 852 -2171
Page 1 of 1
❑ ENHANCED LEAK DETECTION ❑ LL TESTING ❑ SB -989 SECONDARY CONTAINMENT
El TANK TIGHTNESS L`S FUEL MONITORING CERTIFICATION
FD2095 (Rev 12/15)
SITE INFORMATION
FACILITY
NAME, &PHONE # OF CONTACT ER
— 0
LOU 2–q,7-
ADDRESS
OWNER NAM
,,
OPERATOR E ^ - fr ,
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
7-
TANK TESTING COMPANY
TESTIN MPA Y
\
f� /�QE P•HON IE # OF C NTACT P RSgq r
Li
M AI I � DRF;S�
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MLLAW PHONE OF ER OR SPFiCI L IN$PECTQR J � �
/ v ri-�-& i
CERTIFICATION # ,
DATE &TIME TE T TO BE ONDU D j ,; �2`
..+ .� fin
,cc # j+ j ,,%"� %,j
T M D
APPLI ANT SIGNATURE DATE
APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 12/15)