HomeMy WebLinkAboutFMC APP 8.6.19UNDERGROUND STORAGE TANKS BAKERSFIELD FIRE DEPARTMENT
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 # D
❑ ENHANCED LEAK DETECTION LINE TESTAE ❑ Se -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS NOEL MONA— fN&eff ON
SITE INFORMATION
Prevention Services
3.d. •
�ilol tt STREET
I/t�
BakersField, CA 93301
'I`�
T
Phone: 661 - 326 -3979 •Fax: 661 - 652 -2171
# OF TANKS TO SE TESTED:
Page 1 Of 1
SITE INFORMATION
FACT
NTACT PERSON
ADDRESS
OWNER NAN
OPERATOR NAME
PEWTr TO OPERATE i
# OF TANKS TO SE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK i
VOLUME
CONTENTS
1,1,b7J 97
TANK TESTING COMPANY
TESTING COMPANY
�RS�
NAME & PHONE # OF CONTACT PERSON
HARING ADDRESS
5�y3 32oo�cS cT. - 'P��KERSFtEC -O.CA 933o�s
NAME & PHONE Y TESTS 00. SPECIAL SPFCZOR_
- .•E /LI
T� _i Y 1 O9 ^ C
SC( #O // �+/ �+ -J TEST METXOD
DATE & TIME TEST TO SE CONDUCTED
APPLICA ATTIRE
DATE
1 {
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03 /08)