HomeMy WebLinkAboutFMC APP 8.12.19UNDERGROUND 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 TESTO ❑ SE-989 SECONDARY CONTAINMENT
"74.r +iFL MONITORING CERTIFICATION
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
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Bakerstield, CA 93301
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Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171
OPERATOR NAME
# OF TANKS TO BE TESTED:
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❑ ENHANCED LEAK DETECTION LINE TESTO ❑ SE-989 SECONDARY CONTAINMENT
"74.r +iFL MONITORING CERTIFICATION
0 IANR LLbnuvoS --
SETE INFORMATION
E & OF CONTACT PERSON
FACILITY
ADDRESS
OWNER NAME
PERMITTO OPERATE I
OPERATOR NAME
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
VOLUME
CONTENTS
TANK #
t
ICI
TANK TESTING COMPANY
NAME & PHONE tl OF CONTACT PERSON
TESTING COMPANY
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MAILING ADDRESS 20() 5 GT — CJ �
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NAME B.PHONES TER 00.5PECPL INS PE
CERTIFICATION
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CONDIICTE
ICC 9 TEST METHOD
DATE &TIME TEST TO BE
DATE
APPLICANT SI TURE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
APPROVED BY
FD2095 (Rev 03/08)