HomeMy WebLinkAboutFMC & OPI APP_4.22.19UNDERGROUND 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.)
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
BAKERSFIE
Prevention
B-�� E ^RS F I -D Qlat ��\ �ST
&FIRE Bakerstield, C
AR
ImArr
,fAtl- A& Phone: 661-3:
NrFU�L MONITORING CERTIFICA-Rd
Page 1 of 1
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FIRE DEPARTMENT
3330il
3979i
; • Fax: 661-852-2171
DARY CONTAINMENT
FD2095 (Rev 03/08)
FACILITY
!UA
NAME & PHONE # OF CONTACT FEtSON
ADDRESS
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING
GOING TO BE TESTED?
Ep YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
NAME & PHONE # OF CONTACT PE
ON
MAILING ADDRESS
CA
NAME & PHONE .,# OF TER JOR SPECIA INS OR
ji
DATE &TIME TEST to BE C
CERTIFICATION #
1VC) 9
0
IECC #
TEST METHOD
APPLICANT S AT E
'r
7
DATE
/9 THIS APPLICATION BECOMES A PERMIT WHEN AP1+OVED
APPROVED BY
DATE
FD2095 (Rev 03/08)