HomeMy WebLinkAboutApplication 10-28-2020_4-8A
UNDERGROUND STORAGE TANKS
I
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 #
❑ ENHANCED LEAK DETECTION
ElTANK TIGHTNESS FUEL MONITORING7R�TIFI�CA
BAKERSFIELD FIRE Ut:PAK I MtIM I
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
❑ SB -989 SECONDARY CONTAINMENT
❑ OVERFILL PREVENTION
FACILITY i NAME .& PHONE # OF CONTACT PERSON
ADDRES�ck
S
T
OWNER NAME
OPERATOR R NAME ` PERMIT TO OPERATE #
❑ YES ❑ NO
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED?
T A N K # VOLUME
CONTENTS
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TANK TESTING COMPANY
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TESTING COMPANY NAME & PHONE # OF CONTACT PERSON A
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'E�u\ , R *\ -d ( V
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MAILING ADDRESS VN(1 � 5
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR CERTIFICATION # Qu
30 9 F5
TEST METHOD 'cc # 7 g S
APPLICANT NATU i DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 09/20) +;