HomeMy WebLinkAbout989 Application 3-25-22UNDERGROUND 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
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 CONTAINMENT
ERFILL PREVENTION
SITE INFORMATION
NAME & PHONE # OF CONTACT PERSON
OPERATOR NAME PERMIT TO OPERATE #
OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO -
-
TA N K #
VOLUME
CONTENTS_ J
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TANK TESTING COMPANY
TESTING COMPA NAME & PHONE # OF CONTACT P R5 tN
IVMAILING ADDRESSC."T <1ks Y7 t V=-7LY)
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NAME & T.ESI R OR S ECIAL S OR CERTIFICATION #
TEST METHOD
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APPLIC T SIGNAT RE v f DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 09/20)
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