HomeMy WebLinkAboutFMC APP 11.25.19UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TAN K TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
❑ LINE TESTING
IX FUEL MONITORING CERTIFIGUION
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
❑ OVERFILL PREVENTION
SITE INFORMATION
FACILITY
n P ' ' DBA: rl
NgME a PHONF a OF CONTACT PERSON
"1850 Coffee Rd Bakersfield
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE n
3 OF TANKS TO BE TESTED:
15 PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
Diesel
TANK TESTING COMPANY
TESTING COMPgNY
BSSR Inc.
ANE A PIIUN(a OF <OH4CT PERSON
MAILING AODRE55
6630 Rosedale Hwy. #B
NAME
Nathan
8 PHONE A OF TESTER OR SPECIAL INSPECTOR
Holman
CERTIFICATION 9
TEST METHOD
qpp CANTS NATU0.E�
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD3095 (Rev 03/10)