HomeMy WebLinkAboutFMC Application 3-10-22UNDERGROUND 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 # I I
E] ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
FACILITY
ADDRESS
OWNER NAME
OPERATOR NAME
NJ.
❑ LINE TESTING
FUEL G CERTIFICATI
SK INFO
BAKERSFIELD FIRE DEPARTMENT
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
NAME & PHONE # OF CONTACT PERSON
PERMIT TO OPERATE
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑
NO
T A N K Jt VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
NAME & PHONE 4 OF CONTACT PERStN
l C � � 1 UI �l QST___ _ �� � � __
MAILING ADDRESS
C.To
NAME & PHO # PF T S CI INS
i CERTIFICATION #
A0
TEST METHODt-l--C--C —41i
A------
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APPLICANT GNATU DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
z,—
APPROVED BY
FD2095 (Rev 09/20)