HomeMy WebLinkAbout3221 TAFT HWY FMC APP 2014UNDERGROUND STORAGE TANKS 99ft
A
E It Is F 1
APPLICATION
AN
fA rAF r
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 FUEL MONITORING CERTIFICATION
FACILITY
ADDRESS
OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK #
W4
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Q10( k-k 5-mv—F-7
Bakerstield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
❑ SB-989 SECONDARY CONTAINMENT
NAME & PHONE * OF CONTACT PERSON
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME
❑ YES ❑ NO
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
:I �NAME & PHONE V OF CONTACT PERSON
MAILING ADDRESS
k-
NAME & PHONE #.Qf'YESTE OR SPECIA4 INS E OR CERTIFICATION #
S09 elso
DATE & TIME TEST +r0 BE C-CIN
ICC # TEST METHOD
"ICTCE')
APPLICANT NA E DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY I DATE
FD2095 (Rev 03/08)