HomeMy WebLinkAboutFMC APP 3.18.19UNDERGROUND 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 # I I
I V
E 'R 3 F I D
A TA
! RT V T
FIRE
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
,Q at k-k STRELF-7
Bakertfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
❑ ENHANCED LEAK DETECTION LINE TESTING
❑ SB-989 SECONDARY CONTAINMENT
...............................
❑ TANK TIGHTNESS FUEL MONITORING CERTIFICATI
jLNr
NAME & PHONE # OF CONTACT PERSON
FACILITY i 1 ne- A–X4 r, A C-. /I d,—
ADDRESS
-OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK #
TO OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME
TANK TESTING, , COMPANY
❑ YES ❑ NO
CONTENTS
NAME PHONE # OF CONTACT PERSON
TESTING COMPANY
MAILING ADDRESS =Vs -3 c>(5
C:V.
x A
CERTIFICATION 18 9 SSO
NAME & PHONE .# OF TESTER OR SPECIAL INSPECTOR
. 1 18 0 9 So
ICC # T M�ETHOD��
TEST METHOD
ICC #
-TIME TEST tO BE CONDUCTED
E & cz, c�l n/ /A //-:p
DATE I I -A n1,
DATE
APPLICANT SIGN RE
APPLICANT SIGNA
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
BY
APPROVED BY T
FD2095 (Rev 03/08)