HomeMy WebLinkAbout3605 ROSEDALE HWY FMC APP 5.7.15UNDERGROUND STORAGE TANKS
APPUCATION
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 # 57- 140002-9 e.
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
FACiLflY
ADDRESS � ��•,�
OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK
BAKERSFIELD FIRE DEPARTMENT
NrA Prevention Services
Now
AIR, Bakersfield, CA 9.3301
t!E Phone: 661- 326 -3979 • Fax: 661 - 852 -2171
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FUEL MONITORING
SB-989 SECONDARY CONTAINM"
IW
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NAME & PHONE # OF CONTACT PERSON
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME
0 YES 0 NO
CONTENTS
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NAME & PHONE !0 OF CONTACT PERSON
TESTING COMPANYNV��t.CstJ t-- - wU.. =--- -.
MAILING ADDRESS
5WA 3 CX •
�+:�• CERTIFICATION # �O� ���
NAME $ PHONE�,i O R R SPECIAL I SPE 0
_.
iCC TEST METHOD .
DATE &TIME TESTl0 BE CONDUCTED �
/� ` [ C �^
V - jC.� 4 DATE
APP LICA . TUB .'
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
APPROVED BY
FD2095 (Rev 03/08)