HomeMy WebLinkAboutFMC APP 9.26.19UNDERGROUND 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 .111 be charged per
separate type test accordingly.)
PERMIT #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
(0,.4
❑ UNETESTING
14 FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 . Fax: 661 -852 -2171
Page 1 of 1
❑ SB -989 SECONDARY CONTAINMENT
❑ OVERFILL PREVENTION
SITE INFORMATION
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FACtLI\' J �Y ,^I� N_AMEa. PHONE #�l /CT���I. 5
gOOR 55 YN' 4ItLLJ IryIVW.nMn �J`pY_
OWNER NAME _
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OPERATOR NA` Q a—
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PERMIT TO OPERATE I
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? YES ❑ NO
TANK #
VOLUME
CONTENTS
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TANK TESTING COMPANY
TESTING COMPANY
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NAME A PHONE # OF CONTACT PERSON
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MAILING ADDRESS
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SPW 1 II[JJr1i�O ' CERTIFICATION #
NAME & PHONE # O�FF� TES TER OR LSPEOOO�8
TEST REPi" 4 I
APPLICANT SIGNATURE
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD3095 (Rev 03/18)