HomeMy WebLinkAboutFMC Application 3-23-22UNDERGROUND 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 he charged per
separate type test accordingly.)
PERMIT #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
FACILITY
ADDRESS
7 i t
OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED:
T A N K #
2
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
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❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
^UEL MONITORING CERTIFICATIO ❑ OVERFILL PREVENTION
NAME & PHONE OF CONTACT PERSON -----
inn f ^ - - - -- ------ - --- -.
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME
❑ b ---
YES
CONTENTS
i
19re N
❑ NO
TANK TESTING COMPANY( - ---- --
TESTING
COMPANY -NAME & PHONE # OF CONTACT PERS N
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MAILING ADDRESS
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NAME & PHON # F T T SP CI INSPE ` CERTIFICATION #
TEST METHOD ICC7&L)77
-
•
APPLICAN SIGNA URE DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY V
FD2095 (Rev 09/20)