HomeMy WebLinkAboutFMC APP 10.31.19UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
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PERMIT #
❑ ENHANCED LEAK DETECTION
DETTE TION
❑ TANK TIGHTNESS
FAQLLN
ADDRESS
OWNER NAME
OPERATOR NAME
❑ LINETESTING ❑ SB-989 SECONDARY CONTAINMENT
SITE INFORMATION
PERMIT TO OPERATE #
E TESTED' IS PIPING GOING TO BE TESTED? u Ytl
#OF TANKS TO
TANK #
BAKERSFIELD FIRE DEPARTMENT
CONTENTS
CERTIFICATION #
Prevention Services
-
P /Iti
Bakersneld, CA 93301
ARTO T
Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171
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THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
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❑ LINETESTING ❑ SB-989 SECONDARY CONTAINMENT
SITE INFORMATION
PERMIT TO OPERATE #
E TESTED' IS PIPING GOING TO BE TESTED? u Ytl
#OF TANKS TO
TANK #
VOLUME
CONTENTS
CERTIFICATION #
-
TEST METHOD
• •
DATE ®TIME TEST TO BE CONDUCTED
Appu SIG TORE
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3
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THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
"PROVED BY
TESTING COMPANY
MAILING ADDRESS
JSTE0.
NAME A PHO OF OR RE INSPECTOR IIINNS�PyECTTOR
CERTIFICATION #
-
TEST METHOD
• •
DATE ®TIME TEST TO BE CONDUCTED
Appu SIG TORE
DATE
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THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
DATE
"PROVED BY
FD2095 (Rev 03/08)