HomeMy WebLinkAboutFMC Application 3-29-22UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
tplease note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
FACILITY %1
ADDRESS
OWNER NAME
OPERATOR NAME
OF TANKS TO BE TESTED:
-^-- -- T A N K -# --
2
S-.
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1of1
❑ SB -989 SECONDARY CONTAINMENT
FUFrM0-NI-T-0R-ING CERTIFICAT ❑ OVERFILL PREVENTION
MATION
---T-NAME & PHONE -V OF CONTACT PERSON
f PERMIT TO OPERATE
i
IS PIPING GOING TO BE TESTED?
VOLUME
------- — --------------
❑ YES ❑ NO
CONTENTS
TANK TESTING COMPANY
TESTING COMP! ; NAME & PHONE # OF CONTACT PERS N
1� �t
KS1 t3q,2
A��-
MAILING ADDRESS
C -T*
9--n F t-� 'k
NAME &PHONE #%PR PEC AL I P CERTIFICATION
/T(A
TEST METHOD J7�T C (7 7
APP IGNATURE ATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 09/20)