HomeMy WebLinkAboutFMC APP 10.11.19UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
58989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
- ..._,J NITORING CERTIFICATION
-Z= ulat thew are Sep crate
1;u Le cnaf e per
r
PERMIT # C
❑ ENHANCED LEAK DETECTION
❑ TANKTIGHTNESS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Ffai Sakerstwid, CA 93301
R *ARfYAOi Phone: 661 - 326 -3979 • Fax: 661 -852 -2171
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INFORMATION
❑ SB-989 SECONDARY CONTAINMENT
FADIffY
ADDRESS
ONER NAME
W
OPERATOR NAHE
PERMIT TO OPERATE F
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
i
TANK TESTING COMPANY
TESTING COMPANY
MAILING ADDRESS
NAME B PHONE # ST OR SPECIA IN OR ✓ . V
DATE B TIME TEST TO BE CONDU D
CERTIFICATION #
'-
TEST METHOD
APPLICANT SIGNATURE
GATE
THI
APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)