HomeMy WebLinkAboutApplication 10-2-19_4-9UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
S5989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
r
se Pdfate 1YPe 6eAt Grdidalr l_..
PERMIT#
D ENHANCED LEAKDETECTION JJ
❑ TANKTIGHTNESS
❑ LINE TESTING
aL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 b Fax: 661-852-2171
Page 1 of 1
❑ SB -989 SECONDARY CONTAINMENT
❑ OVERFILL PREVENTION
P02095 (Rev U3/1B)
SITE INFORMATION
FAGLITY
xq b PHOH iR+F Jx CuON ("�
ADDRESS�11
L
OWNER NAME
cqj
OPERATOR "ME
PERMITTOOPERATEN
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK IT
'VOLUME
CONTENTS
r
TANKTESTING MMPANY
TESTING COMPA
CONT V
MAILING ADORn��
NAME & PHONE. TES ER O
SPEGIALINBPfCT'g I
ERTIFICATION IX
TEST METHOD
ICC N 7
APPLICANTSIGN T RE
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
P02095 (Rev U3/1B)