HomeMy WebLinkAbout801 E CALIFORNIA AVE FMC APP 5.13.15UNDERGROUND 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 #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
FACILITY
- 11 Su
ADDRESS
OWNER NAME
Zan
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
lrlNo Bakersfield, CA 93301
f Phone: 661 -326 -3979 a Fax: 661 -852 -2171
Page 1 of 1
❑ SB -989 SECONDARY CONTAINMENT
FUEL MONITORING CERTIFICATION
NAME & PHONE # OF CONTACT PERSON
PERMIT TO OPERATE #
- -------- IS PIPING GOING TO BE TESTED?
VOLUME
❑ YES ❑ NO
CONTENTS
TA
;. NK TE;ST�1MiCt .CIDMpAIi['1P ,
TESiiNG,COMPANY NAME & PHONE �# OF CONTACT PERSON
ov;k MAILING ADDRESS -'
JlszLA 3 do .'S C.T. -- F��C1'� RSA ` .�.-'O . C A =� S3c>S
NAME & PHONE,# OF TESTEW04 SPECIAL INSPECTOR CERTIFICATION # 0 0 sc.)
YVI
DATE & TIME TEST YO BE CONDUCTED ICC METHOD
APPLICANT SI RNM%�RE DATE
..s f
APPROVED BY
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
C
FD2095 (Rev 03/08)