HomeMy WebLinkAboutOPI Application 4-18-22UNDERGROUND 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 #
�. �tN
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1of1
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ,. ❑ -989 SECONDARY INMENT
❑ TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATION OVERFILL PREVENTION
SITE INFORMATION
FACILITY NAME & PHONE # OF CONTACT PERSON
I �
ADDRESS
OWNER NAME
TANK TESTING COMPANY
TESTING COh1Pr1 NAME & PHONE # OF CONTACT P R5 N
MAILING ADDRESS
�Aoq�S_
NAME & PHON # F E T R OR SPE IAL I P O ` CERTIFICATION xt' '
AA TEST METHOD ICC
APPLI T SIGN URE DATE
a
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FD2095 (Rev 09/20)
OPERATOR NAME PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TAN K#
i VOLUME j CONTE N TS_
1
i
TANK TESTING COMPANY
TESTING COh1Pr1 NAME & PHONE # OF CONTACT P R5 N
MAILING ADDRESS
�Aoq�S_
NAME & PHON # F E T R OR SPE IAL I P O ` CERTIFICATION xt' '
AA TEST METHOD ICC
APPLI T SIGN URE DATE
a
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FD2095 (Rev 09/20)