HomeMy WebLinkAboutOPI APP 4.24.19i
BA ERSFIELD FIRE ;DEPARTMENT
UNDERGROUND STORAGE TANKS , : Pir vention Se Vices
SR3P
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1rIR Ba ersf field, 1.:1 9 301
APPLICATION AJr lr Ph ne: 661-326-3979 ® ;ax: 661- 852 -2171
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT Page 1 Of
TESTINGITANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that these are separate
individual tests and will be charged per
Separate type test accordingly.)
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PERMIT #
❑ ENHANCED LEAK DETECTION ❑ LINE STING [I SB -989 SEWN RY CONTAINMENT
❑ TANK TIGHTNESS ❑
FUEL MONITORI G CERTI TION j
sITE TN 4RMATIi
NAME PHONE# OF CONTACT PERSON
FACIL'1TY
ADDRESS
OWNER NAME
PERM O OPERA E #
OPERATOR NAME
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TE TED? YES ❑ NO
TANK #
VOLU E CO TENTS
A
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TANK TE ST
1NG CO
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TESTING COMPANY
NAM
PHONE
# OF CONTACT P
SONT
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SF L
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33,
MAILING ADDRESS -�-
51Q' -� 33 -do.S
NAME & PHONE # OF TESTER R SP AL INSP OR
CE
FICATIO
# Oq
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DATE & TIME TEST tO BE CONDUCTED
ice
LTE METHOD
DA
APPLICANT NATO
.
THIS APPLICATION
ECO
ES A II
RMI
WHEN APPROVED
D
APPROVED BY
D
I
FD2095 (Rev 03/08)
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