HomeMy WebLinkAboutCold Start 9-29-2020_2-4UNDERGROUND STORAGE TANKS
APPLICA' iON
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 #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
210 }. H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
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❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
JJ FUEL MONITORING CERTIFICATION ❑ OVERFILL PREVENTION
SITE INFORMATION
FACILITY r7 t /� NAME & PHONE # OF CON' ACT PERSON
ADDRESS
OWNER NAME
� /volt',
OPERATOR NAME PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TE:z FD? ❑ YES ❑ NO
TANK # VOLUME CONTENTS
TANK TESTING COMPANY
TESTING COMPANY NAME & PHONE # OF CONTACT PERSON
MAILING ADDRES
, e?t vaLe-,T%�4,1,1 Kd
eq
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR CERTIFI: XfION # L
V1 C 4
TEST METHOD ICC # L
APPLICANT SIG ` T DATE
THIS APPLICATION BECOMES A PE MI WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 03/18)