HomeMy WebLinkAboutFMC APP 9.16.19UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
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 #
❑ ENHANCED IEAK DETECTION C] SB-989 SECONDARY CONTAINMENT
IV .F,.n.IORING CERTIFICATIO
BAKERSFIELD FIRE DEPARTMENT
^ _ ` 't
FACILITY �(1
ADDRESS `1 V
NAME a PHONE # OF CONTACT PERSON
OWNER NAME
Prevention Services
$ x ,
aloe Ft S'MV -IFT
I
Bakersfield, CA 93301
Aft/ I
Phone: 661- 326 -3979 • Fax: 661 - 852 -2171
TANK #
VOLUME
Page 1 of I
❑ ENHANCED IEAK DETECTION C] SB-989 SECONDARY CONTAINMENT
IV .F,.n.IORING CERTIFICATIO
FD2095 (Rw 03/08)
^ _ ` 't
FACILITY �(1
ADDRESS `1 V
NAME a PHONE # OF CONTACT PERSON
OWNER NAME
omn
OPERATOR NAME Qr
PERMIT TO OPERATE C
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
i
i
TANK TEST016 COMPANY
TESRHG COMPANY NAME ® PHONE 9 OF CONTACT PERSON
MAILING ADDRESS
�y3 t32oo\cS GT. — P�l<iGERSFIE.L -D.C%E 9:S3o8
cfarcFlCAnoN # �oq �.SU
NAME a PHONE #OFT 800.5 tlAL INSP OR,p_
y �J\�1�L/yV!/r� /��T� ICC> A TEST METXOD
DATf ATIME TFSr BE CONDUCTED � `y
APPLICANT SIGNATURE
DATE
THI
APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rw 03/08)