HomeMy WebLinkAboutFMC Application 3-17-22UNDERGROUND 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 charmed per
separate type test accordingly.)
PERMIT #
1
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
FACILITY
ADDRESS
OWNER NAME
OPERATOR NAME
OF TANKS TO BE TESTED:
------- T A N K #
F;
;A
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1of1
56-989 SECONDARY CONTAIN NT
DAME & PHONE # OF CONTACT PERSON
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
--- — -- VOLUME -- ------ - ---
i
/SOO
i
--- ❑ YES ---- ---- ❑ NO ---- -�
CONTENTS
rem
l/O,QO�
TANK TESTING COMPANY
TESTING COMP A ; NAME & PHONE # OF CONTACT PERS N
MAILING ADDRESS
�SU47� CA`V�3c)s
NAME & P O # F ST O SPE IAL I P OR CERTIFICATION #
RON
TEST ETHOD �l ICC
V1469E 5�
APPLICANT SIGNATU ? DATE
a�
T IS PP TION BECOMES A PERMIT WHEN APPROVED
DATE
FD2095 (Rev 09/20)