HomeMy WebLinkAboutApplication 8-15-19_4-9UNDERGROUND 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 tem and will be charged per
separate type test accordingly.)
PERMIT #
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Bakersfiield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
❑ ENHANCED LEAK DETECTION LINE TES �3 ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ( FOEL MONITO'RING CERTIFICA
FD2095 (Rev 03/08)
SITE INFORMATION
FACILITY
NAME & PHONE # OF CONTACT PERSON
ADDRESS
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
0-
3
TANK TESTING COMPANY
TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON
LO
MAILING ADDRESS _
NAME & PHONE TET O
SPECI IN
CERTIFICATION #���
DATE & TIME TEST to BE CON
APPLICANT SI ATURE
Fn
FCC # TEST METHOD I
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DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)