HomeMy WebLinkAboutFMC APP 9.20.19UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
S13989 SECONDARY CONTAINMENT
TESTINGITANK TIGHTNESS TEST AND
I
separate type test accordingly.)
PERMIT # D
❑ ENHANCED LEAK DETECRON
❑ TANK TIGHTNESS
atl PS /,y
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❑ LINE TESTING
XFUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 a Fax: 661 -852 -2171
Page 1 of 1
❑ SB -989 SECONDARY CONTAINMENT
Cl OVERFILL PREVENTION
SITE INFORMATION
FACILITY
.ME a PHONE A OF CONTACT PERSON
ADDRESS
500
OWNER NA
E
OPERATOR NAME
PERMIT TO OPERATE I
3 OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK R
VOLUME
CONTENTS
1
1
TANK TESTING COMPANY
TESTING CO MPA
NA
ONE
OF C NTACT PER�OON
A-7-7-7
MAILING AODRFA55_
NAME& PHONp
TESTS RSPECIALINSPE
OR
CERTIFICATION p R aj-)gj
TEST METHOD
APPLICANT SIGN URE
u%�
GATE
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THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED 9Y
DATE
FD2095 (Rev 03/18)