HomeMy WebLinkAboutFMC APP 10.16.19UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
a s_x3!!a n 31o; r, S,,R.EET
f /d/ Bakersrield, CA 93301
ART/ T Phone: 661 - 326-3979 • Fax: 661 -852 -2171
Page 1 of 1
❑ ENHANCED LEAK DEFECTION ❑ ❑ 58-989 SECONDARY CONTAINMENT
EL MONITORING CERTIFICATION
❑ TANK TIGHTNESS
FORMATION
NAME HONE 0 OF CONTACT PERSON
FAULR
ADDRESS
OWNERNAME
PERMIT TO OPERATE #
OPERATOR NAME
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
# OF TANKS TO BE TESTED:
CONTENTS
VOLUME
TANK Y
I
TANK TESTING COMPANY
NgME a PRONE # OF CONTACT PERSON
COMPANY
TESTING Tm�
i
MANNG ADDRESS
=i�-5 cT. - P�hKEYZSFiEL -D�C1t 33o
�t443 Y3�oc
NAME 6 PHON F T Sl£0. OR SFEFI FCTOR CERTIFICATION # QC)Q SSC'
— 9 TEST METHOD
KC F
DATE ®TIME TEST TO BE 0 U D�
DATE
APPLI SIGNAN 6
BECOMES A PERMIT WHEN APPROVED
THIS APPLICATION
DATE
APPROVED By
FD209S (Rev 03/08)