HomeMy WebLinkAboutFMC APP 3.26.19UNDERGROUND 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
IE R S F I . D
TVARTH, T
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A"01�
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
riot k-k 5-mv-DE-7
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of I
171 ENHANCED LEAK DETECTION LINE T ❑ SB-989 SECONDARY CONTAINMENT
L
ER-RFI7��
❑ TANK TIGHTNESS
MONITORING CTI
ON
NAME & PKONE # OF CONTACT PERSON
FACILITY f,
ADDRESS
OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK #
3
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME
TANK TESTING COMPANY
❑ YES ❑ NO
CONTENTS
NAME & PHONE # OF CONTACT PERSON
TESTING COMPANY
MAILING ADDRESS A =V;S�3c:)8
5u LA
CERTIFICATION #
NAME & PHONE,# OF TESTER OR SPECIAL INSPECTOR 1809 eso
TEST METHOD
ICC V InI,
NDU ED el
DATE &TIME TEST TO BE CONDUCTED A
DATE
APPLICANT SI TURE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
APPROVED BY T
FD2095 (Rev 03/08)