HomeMy WebLinkAboutFMC Application 9-28-21UNDERGROUND STORAGE TANKS
_ - ..-.. _..:�..............
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
Please nate that these are separate
ndividual tests and will be charged per
separate type test accordingly.)
PERMIT #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
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❑ ENHANCED LEAK DETECTION E TESTING
-989 SECONDARY CONTAINMENT
El TANK TIGHTNESS MONITORING CERTIFICATION
F5FEL
SITE INFORMATION
FACILITY NAME & PHONE # OF CONTACT PERSON
ADDRESS
OWNER NAME
OPERATOR NAME PERMIT TO OPERATE
OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED?
❑ YES ❑ NO
T A N K # VOLUME
CONTENTS
1
2
J
TALK TESTING COMPANY
TESTING COMPA NAt'='#E & PHONE # OF CONTACT PERS N
4k Ak_F
�ACCAk N
MAILING ADDRESS i E�LX CA 9 '13CS
NAME & E # O TESTER OR ECIA I P CTOR ` CERTIFICATION #
T ST METHOD ICC #
APPLICANT NATU DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 09/20)