HomeMy WebLinkAbout2317 L OPI_3-3UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MO ITORING CERTIFICATION
(Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT # D
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
BAKERSFIELD FIRE DEPARTMENT
^� Prevention Services
40))Phon H Street
Bakersfield, CA 93301
Phone: 661-326-3979 •Fax: 661-852-2171
Page 1 of 1
❑ LINE TESTINGSB-9 9 SECONDARY CONTAINMENT
11 FUEL MONITORING CERTIFICATION OVEREfLL PREVENTION
FD2095 (Rev 03/18)
El
SUE INFORMATION
FACILITY
17
NAME a PHONE # OF CDNTACT PERSON
ADDRESS
OWNER NAME
OPERATOR NAME
PERMIITOOPEMTEI
# OF TANKS TO BE TESTS V'
IS PIPING GOING TO BE TESTED? ❑ YES
❑ NO
TANK
#
VOLUME
CONTENTS
TANK TESTING COMPANY
TEST O PANY
MA D 5
NAMEd-PXONFY OEC eT PERSON
�j ` /'I
NA p ouONE t OF TEST S CGL INSPECTOR
r sfMa-s
CERTIFICATION t
TEsr ETXOD
I¢A
APPLICANT 51 ATD0.E
DATE
TNIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED. SY
DATE
FD2095 (Rev 03/18)
El