HomeMy WebLinkAboutFMC APP_9.25.19 DIESEL SIDEUNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
I
separate ly 1.
PERMIT IF
❑ ENHANCED LEAK DEFECTION
❑ TANKTIGHTNESS
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❑ LINETESTING
4AEL MON90MNG CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 -326 -3979 R Fax: 661- 852 -2171
Page 1 of 1
❑ SB-989 SECONDARY CONTAINMENT
❑ OVERFILLPREVENTION
SITE INFORMATION
FACILITY
NAME n PHONE / OF CONTACT PERSON
ADDRESSI W C
OWNER NAME
I `
OPERATOR NAME
PERMIT TO OPERATE#
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK#
VOLUME
L
,� / \C ^O`NNTjJENTS
Gds
TANK TESTING COMPANY
TESTING C Y
N �1 I11wE R
r I
MAILING AD FEE ,
l CA l �wr
NAME & RHO
B OF TEST R OR SPECIAL I
Q/
EC7O
CERTIFICATION #
TEST METH D
ICC f '
/`l/)
APPLICANT SIG ATVRE
T2 17ILN
DATE
- - 9
IS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rea 0V I.)