HomeMy WebLinkAboutFMC APP 8.22.19UNDERGROUND STORAGE TANKS BAKERSFIELD FIRE DEPARTMENT
Prevention Services
r _ n x'2101 Ft SZREET
APPLICATION F /A/ Phone: 61- 26 3979
TO PERFORM ELD /LINE TESTING/ II1't t Phone: eld, 06-3979 • Fax: 661 - 852 -2171
58989 SECONDARY CONTAINMENT Aft* Page I of 1
TESTINGITANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT # D
❑ ENHANCED LEAK DETECTION LINETESTING ❑ 58- 989 5ECONDARY CONTAINMENT
❑ TANKTIGNTNESS FOEL MONITORnZ- CERR'fEmzpN
FD2095 (Rev 03/08)
SITE INFORMATION
FACILITY ^^
NAME a PHONE # OF CONTACT PERBON
ADDRESS
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE R
k OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESnNG COMPANY
NAME a PHONE # OF CONTACT PERBON
MAILING ADDRESS
5(�y3 13ROO�cS
cT. — F3hKE+RSFtEt -O.CA 9330&
HON # F TER OR SP CTO
CERTIFICATION
E TEST M BE CONOUCrE ��
'cc # 7
TEST METHOD
TS ATURE
R
DATE
t
THIS APPLICATION BECOMES A PERMIT W EN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)