HomeMy WebLinkAboutFMC Permit 3-31-22UNDERGROUND 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.
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
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PERMIT # I I
❑ ENHANCED LEAK DETECTION LINE TESTING B-989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS UEL MONITORING CERTIFICATION OVERFILL PREVENTION
SITE INFORMATION
--FACILITY NAt-iE & PHONE OF CONTACT PERSON
ADDRESS
e)m
OWNER NAME
OPERATOR NAME PERMIT TO OPERATE
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
T A N K # VOLUME CONTENTS
19 Ns'
TANK TESTING COMPANY
TESTING COMPA I NAME & PHONE # OF CONTACT PERS�N
lV
KSV
M ice, c -CA - - -- - - -
MAILING ADDRESS ��'
-- -_-- - -.--- - �=-3a- _ _- --
NAME &NE F T T R RWELIMR CERTIFICATION #
TEST METH D ICC
A LICANT SI ATU - DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
I APPROVED BY DATE
i
FD2095 (Rev 09120)