HomeMy WebLinkAboutFMC APP 9.17.19UNDERGROUND 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
❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
rl F1IF1. MONITORING CERTIFICATION
' '•VIII„"
BAKERSFIELD FIRE DEPARTMENT
NAMF 8 PKdNE # OF CONTACT PERSON
FACRITY
Prevention Services
a x f .p
a10: i-F STREET
p ;jr
Bakerstield, CA 93301
A1fY T
Phone: 661- 326 -3979 • Fax: 661- 852 -2171
OPERATOR NAME
# OF TANKS TO BE TESTED:
Page 1 e I
❑ LINE TESTING ❑ SB-989 SECONDARY CONTAINMENT
rl F1IF1. MONITORING CERTIFICATION
' '•VIII„"
SITE INFORMATION
NAMF 8 PKdNE # OF CONTACT PERSON
FACRITY
ADDRESS
'
OWNERNAME
PERMIT TO OPERATE S
OPERATOR NAME
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
VOLUME
CONTENTS
TANK i
TANK TESTING COMPANY
NAME & PHONE p OF CONTACT PERSON
TESRNG COMPANY
MAILING ADDRESS
51a� -13 �2ooic5 LT. - P�rtKER.SF:tiI -O.C,4 g33ob
CERTIFICPTIONII U� IVS�%
NAME 6 FHO OF TE0. OR SP P R R V
— .- - „�- TEST MEMOO
ICC :
DATE & TIME TEST TO BE CONDUCTS
g9PLICANT SIGNATURE DATE
,3r/1
BECOMES A PERMIT WHEN APPROVED
HIS APPLICATION
DATE
APPROVED BY
FD2095 (Rev U] /ue)