HomeMy WebLinkAboutFMC APP_4.26.19UNDERGROUND STORAGE TANKS
(ERSFIELD IRI
mention Se ice
O l �-k ST E-T
DEPARTMENT
kC<'N.mztmc
Bakersfield, CA 9 01 1
APPLICATION Phone: 661 -326 -3 79 ® Fax: 661 -852 -2171
TO PERFORM ELD /LINE TESTING/ j
SB989 SECONDARY CONTAINMENT Page 1 of 1
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that these are separate
charged r ed er
will be P
individual tests
and 9
separate type test accordingly.) j
PERMIT #
i
❑ENHANCED LEAK DETECTION ❑ SB -9891 ECONDARY CONTAINMENT
i
❑ TANK TIGHTNESS UEL MONITORING CERTIFICA
INFORMATION
FACILITY NAME & PI� ON # OF CONTACT PERSON
Chi
ADDRESS
OWNER NAME
OPERATOR NAME PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED?
TANK # VOLUME
YES ❑ NO
CONTENTS
TANK.TESTING COMPANY ;
TESTING COMPANY NAME & PHONE # OF CONTACT PERSON
i
MAILING ADDRESS ,,_ Q ��G��� � L� Q' A -7s. -30
5LQ Lk -:F NAME & PHONE # OF TEST c�F I INSPECTOR CERTIFICATION #
4;
096, C)
ICC # I j TEST METHOD
DATE & TIME TEST 4rO BE CONDO D Q
IVI �V
DATE
APPLICANT SIGN E
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
APPROVED BY
FD2095 (Rev 03/08)