HomeMy WebLinkAbout[Untitled]_2015102610504972_1-3UNDERGROUND STORAGE TANKS
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 accordingiy.)
PERMIT #�,-_
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 • Fax: 661 - 852 -2171
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❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
IN FUEL MONITORING CERTIFICATION
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NAME & PHONE # OF CONTACT PERSON
ADDRESS
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
[KO:F:T:A:NKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
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`TESTING COMPANY •
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NAME3 PHONE # Oe CONTACT PERSON
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MAILING ADDRES
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NAM & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
DATE & TIME TEST TO BE CONDUCTED
ICC #
TEST METHOD
APPLICANT SIGN
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)