HomeMy WebLinkAboutApplication 10-19-2020_4-8UNDERGROUND 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 # F- I
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 . Fax: 661-852-2171
Page 1ofI
� --NI (q)
jec." -:: - C)
L ,,, kv�) '��& V�
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS _FUEL MONITORING CERTIFICATION OVERFILL PREVENTION
SITE INFORMATION
FACILITY
NAMEE'& PHONE # OF CONTACpT PERSON
(�,.
VC V �
ADDRESS
OWNER NAME -
OPERATOR NAME j
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
Vcf,
V.,
Q se t
TANK TESTING COMPANY
TESTING COMPANY
--r�ll\�i i
NAME & PHONE # OF CONTACT PERS N �
G� JSe-7-
MAILING ADDRESS
`�l • � � fir: � �� �-�� �=� l� �-� � � � u �� � Z �:� �
NALE & PHONE # OF TESTER OR SPECIAL INSPECTQR
Eylsi n2
CERTIFICATION #
TEST METHOD
APPLICANT SIGNATURE
DATE
l Z zo
THS P,k AT4N B ES A PERMIT WHEP APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/18)