HomeMy WebLinkAboutSB989 OPI APP 12.9.19UNDERGROUND STORAGE TANKS
APPLICATION �•�
TO PERFORM ELD /LINE TESTING/
56969 SECONDARY CONTAINMENT
TESTING /TAP -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 IEAK DETECTION ❑ LINE TESTING
❑ TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 P Fax: 661 - 852 -2171
Page I M 1
j!g SB -989 SECONDARY CONTAINMENT
/❑ OVERFILL PREVENTION
SITE INFORMATION
FACILRY T q
PnuM h�I
RUNE A PHONE i OF CONTACT PERSON
ADDRESS
OWNER NAME
✓�
OPERATOR NAMr �Lh
PERMR TO OPERATER
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
NAME A PHONE R OF CONTACT PERSON
MAILING ADD0.E •5 J 79
(a /J
Y
NAME R PHONE Y OF TESTER O0. INSPECTOR
ice- Sr ✓I If`�✓J
CERTIFICATION I
TEST METHOD ^,< / �11/ p/ Jp
ICC
APPLICANT SIGNATURE
GATE~
h 119
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 0]110)