HomeMy WebLinkAbout[Untitled]_1-3UNDERGROUND 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 #
D
JUNK
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Q10 L � 5 %, r, E'er
Bakersfield, CA 93301
Phone: 661 - 326 -3979 ® Fax: 661- 852 -2171
Page 1 of 1
❑ LINE TESTING SB -989 SECONDARY CONTAIN NT
❑ FUEL MONITORING CERTIFICATION
SATE INFtiR[MI�ITOt1
® w NAME & PHONE # OF CONTACT PERSON
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME
❑ YES ❑ NO
CONTENTS
•.1 me
TA NIK TESTNC !:CCII►+tPANY
TESTING COMPANY NAME & PHONE # OF CONTACT PERSON
MAILING ADDRESS
5LQ( -k
NAME & PHON . QF T95TER OR SPEC3AL INSPECTOR, CERTIFICATION # S09 e5o
DATE & TIME:TEST TO B C DU D
ECC # TEST METHOD
APPLICANT GNA RE DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 03/08)