HomeMy WebLinkAboutSB989 Application 3-17-22UNDERGROUND 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
0 ENHANCED LEAK DETECTION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 * Fax: 661-852-2171
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SB-989 SECONDARY CONTAINNIT
❑ ----ICATI
TANK TIGHTNESS FUEL MONITORING CERTIF -trVERF1L-L-PRE-VE4VX1-GN'
srTE..TNFORM&TIOW-'
FACILITY
NAME & PHONE OF CONTACT PERSON
ADDRESS
v
OWNER NAME
OPERATOR NAME PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? 11 YES 0 NO
TANK #
VOLUME
C 0 N T E N T S
TANK'TIESTING COMPANY
-
TESTING COMPANYNAME & PHONE # OF CONTACT PERS N
VR _ _ .mac,..- -- ��?
MAILING ADDRESS
NAME &
IAL I 'SP QR
CERTIFICATION
#
Jan
Or t S a)
TEST TROD P1 ICC
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Z 0
APPLICANT SIGNATU
DATE
C>4 -
I PP`TION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 09/20)