HomeMy WebLinkAboutOPI 9-29-21_4-4ADDRESS e:;,,
OWNER NAME
OPERATOR NAME PERMIT TO OPERATE
IT 4 OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
T A N K # VOLUME i CONTENTS
TANK TESTING COMPANY
TESTING COMPA ! NAME & PHONE # OF CONTACT PERS N
M MIFA3TA-C,
MAILING ADDRESS
NAME NE OF TESTER R S E P R j CERTIFICATION #
ISV9 ISO -
- TH D cc-* 15 a(�'n
APPLICANT SIGNAT DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 09/20)
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
UNDERGROUND STORAGE TANKS
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
APPLICATION
Page 1 of 1
TO PERFORM ELD/LINE TESTING/
T
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
Please nate that these are separate
individual tests and will he charged per
separate type test accordingly.)
PERMIT #
❑ ENHANCED LEAK DETECTION NE TESTIXG
DAR CONTAINMENT
❑ TANK TIGHTNESS
(j3F
ELMONICERTIFICATION
ERFILL PREVENTIO
1.5rf E INFO TION
FACILITY
NAt-IE & PHONE # OF
ERSON
ADDRESS e:;,,
OWNER NAME
OPERATOR NAME PERMIT TO OPERATE
IT 4 OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
T A N K # VOLUME i CONTENTS
TANK TESTING COMPANY
TESTING COMPA ! NAME & PHONE # OF CONTACT PERS N
M MIFA3TA-C,
MAILING ADDRESS
NAME NE OF TESTER R S E P R j CERTIFICATION #
ISV9 ISO -
- TH D cc-* 15 a(�'n
APPLICANT SIGNAT DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 09/20)