HomeMy WebLinkAboutsb989 Application 9-1-21UNDERGROUND 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 #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
❑ LINE TESTING
❑ FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
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%SB -989 SECONDARY CONTAINMENT
❑ OVERFILL PREVENTION
FD2095 (Rev 03/18)
SITE INFORMATION
FACILITY
NAME & PHONE # OF CONTACT PERSON
ADDRESS
By
K< V- -S d 0 CA;
OWNER NAME
OPERATOR NAME
q — 1 1
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
�1
TANK TESTING COMPANY
TESTING COMPANY
Ttl, YT1 ' yn C f 0 G �
NAME & PHONEOF CONTACT PERSON
Mav-i<- Utnds-e�xH& C;e �--- � � � �- ;L) T
MAILING ADDRESS
H'�jL)*►4f-dA
S . �2
NAME & PHONE # OF TFrawl CESTER OR SPECIAL INSPECTOR
•
ic, 14
CERTIFICATIO1
TEST METHOD !' 6N �y
APP CANT SIGNATURE
DATE
THIS APP
ATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/18)