HomeMy WebLinkAboutApplication 11-21-19_4-4UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB969 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
PERMIT# I
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
L Bakerstield, CA 93301
OVARTYAYT Phone: 661-326-3979 • Fax: 661-652-2171
Page 1 of 1
MONITORING CERTIFICATION
❑ SB -989 SECONDARY CONTAINMENT
V
ADDRESS
OWNER NAME
OPERATOR NAME PERMIT TO OPERATES
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TESTING COMPANY
MAILING ADDRESS
NAME @ PHONE # OF TESTER OR SPECIAL INSPECTOR CERTIFICATION
���� METHOD
TI
DATE ®ME TEST TO BE CO Q D IIJJJJ�C ll\\JJ
�PLICANT E DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
gQpRQVEO BY
FD2095 (Rev 03/06)