HomeMy WebLinkAbout3605 ROSEDALE HWY SB989 APP 5.6.15UNDERGROUND STORAGE TANKS
APPUCAT ON
TO PERFORM ELD /LINE TESTING/
58989 SECONDARY( CONTAINMENT
TESTING/ TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that time are separate
lndWWual tests and will be charged per
separate type test accordingly)
PERMIT*
❑ ENHANCED LEAK DtTEMON
❑ TANK TIGHTNESS
FACILS Y `
ADDRESS n
OWNER NAME t�
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK 0
a
RT01f
4fto;
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
*10L t-k 5-MVET
Bakersfield, CA 93301
Phone: 661- 326 -3979 • Fax: 661-852-2171
Page 1 of 1
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SB-989 SECONDARY CONTAINM'
� FUEL MONITORING CERTIFICA N
NAME & PHONE it OF CONTACT PERSON
IpERMIT TO OPERATE #
IS -PIPING GOING TO BE TESTED?
VOLUME
❑ YES ❑ NO
CONTENTS
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TESTING :COMPANY NAME & PHONE � OF CONTACT PERSON
MAILING ADDRESS C.X CA °% 3308
' CERTIFICATION # Q
NAME & PHOTI 1 O ]RR SPECIAL I SPE
=CC # TEST METHOD .
DATE & TIME TESL' fi0 BE CONDUCTED
1 DATE
APPLICA RE �" • `
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
APPROVED BY
FD209S (Rev 03/08)