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HomeMy WebLinkAboutFMC APP 12.3.19UNDERGROUND 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 # D ❑ ENHANCED LEAK DEJECTION 4,� -) ❑ UNETESTING -O�MEL MONITORING CERTIFICATION BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bake,sfield, CA 93301 Phone: 661 - 326 -3979 E Fax: 661 - 852 -2171 Page 1 of 1 ❑ SE-989 SECONDARY CONTAINMENT ❑ OVERFILL PREVENTION FD2095 (Rev 03/18) SITE INFORMATION ^ / n Cu /� C U C, OF CONTAcT PERSON 7 D / lV gFACI� /S ,/ VANE Zj TEY S TO B TES D: IS PIPING GO ❑ YES ❑ NO TANK # VOLUME CONTENTS _ / �T n TANK TESTING COMP. rvY COMPANY CA1- NAME a PHONE t OF C { T PERSON — �^ ADDRESS U. n vX �{ `� NAME FTESTER OR I ;APPUCANT AL IN5PECTO0. e✓InM^ CERTIFICATION He Icc 2c/ 3 J `1j SIGNATURE DATE ) .LEi 1 % THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APPROVED BY DATE FD2095 (Rev 03/18)