HomeMy WebLinkAbout4200 ASHE RD FMC APP 1.26.15UNDERGROUND 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
ADDRESS
OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED:
TANK #
12
❑ SB -989 SECONDARY CONTAINMENT
MONITORING
° AME She PHONE * OF CONTACT PERSON
L
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
VOLUME CONTENTS
APPROVED BY
K,�
LL-W-
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
WAM
FD2095 (Rev 03/08)
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
l-k 5 -mE-FT
"IRKAF,
Bakersfield, CA 93301
Phone: 661 -326 -3979 • Fax: 661 - 852 -2171
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❑ SB -989 SECONDARY CONTAINMENT
MONITORING
° AME She PHONE * OF CONTACT PERSON
L
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
VOLUME CONTENTS
APPROVED BY
K,�
LL-W-
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
WAM
FD2095 (Rev 03/08)