HomeMy WebLinkAboutFMC Application 3-15-22_UNDERGROUND 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
STIN
FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
ADDRESS -
OWNER NAME
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
E x OF CONTACT PERSON �
OPERATOR NAME PERMIT TO OPERATE
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED?
TANK# VOLUME
V 000
O YES ❑ NO
CONTENTS
i
i
TANK TESTING COMPANY — — - — -- -------
TESTING COMPANAME & PHONE # OF CONTACT PERS N&Nk '
l C t, CJI1�T t -E, P\C-CAkZa�
MAILING ADDRESS ' —
n �e
NAME &PHO F T T-
IAL E SPEC R I CERTIFICATION �[ Q
APPLICANT SIGN
DATE
HIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 09/20)