HomeMy WebLinkAboutSB989 Application 3-15-22UNDERGROUND 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
individual tests and will be charged per
separate type test accordingly.)
PERMIT #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
FACILITY
ADDRESS
OWNER NAME
❑ LINE TESTING
❑ FUEL MONITORING CERTIFICATION
SITE INFORMATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-325-3979 • Fax: 661-852-2171
Page 1 of 1
Y CONTAINMENT
❑ OVERFILL PREVENTION
NAME & PHONE # OF CONTACT PERSON
OPERATOR NAME
PERMIT TO OPERATE #
OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED?
T A N K #
VOLUME
-- -
/-,2&OC
❑ YES
CONTENTS
'rte 9
❑ NO
TANK TESTING COMPANY
TESTING COMPA--- -- — ---- ---- ---- - NAME & PHONE OE CONTACT PERS �i ------ --- -.- —�
�A1 t
�. Vic.-C.�c�
MAILING ADDRESS
j
NAME & PHONE # F T TE S EC IN PEC OR M�aCERTIFICATION x# i
TEST METHOD ICC
APPLICAN ISIGNATUR DATE '
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY ( DATE
FD2095 (Rev 09/20)