HomeMy WebLinkAboutApp 031819UNDERGROUND STORAGE TANKS
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APPLICATION >< ARe T mf
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 #
• ENHANCED LEAK DETECTION ❑ TESTING
• TANK TIGHTNESS FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 o Fax: 661 - 852 -2171
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❑ SB -989 SECONDARY CONTAINMENT
r
SITE INFORMATION
FACILITY 2-370
NAME & PHONE # OF CONTACT PERSON
ADDRESS ®O i m h c[ l
OWNER NAME - 0, Y-,,0 „ ^_
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? Q YES d NO
TANK #
VOLUME
CONTENTS
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TANK TESTING COMPANY
TESTING COMPANY
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MAILING ADDRESS 1 1 ( S
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6725
NAM &PHONE # OF TESTER R SP CIAL I NSPECTOR f S( C. (00-)
CER FIC_ATION�
DATE & T ME TEST TO BE C OND C ED � �
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TCC #� ca ��, � �
V
TE�METHOD��O
APPLICA SIGNA
DATE
THIS APJLX16ATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 12115)
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