HomeMy WebLinkAboutFMC Application 5-16-22UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
(Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT # I
L-
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
I
Bakersfie d CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1of1
LI ING El SB -989 SECONDARY CONTAINMENT
FUEL MONITORING CER IFICATI ❑ OVERFILL PREVENTION
OWNER NAME
OPERATOR NAME
# OF TANKS TO BE TESTED:
T A N K #
PERMIT TO OPERATE #
IS PIPING GOING TO BE TESTED?
VOLUME
/vo,� g
U
❑ YES ❑ NO
CONTENTS ^,
. An
--- -- - TANK TESTING COMPANY
TESTING COMP A ' NAME & PHONE # OF CONTACT P RSON
MAILING ADDRESS I
NAME & PHO F E T R OR SPECJAL I P OR i CERTIFICATION
TEST METHOD ICC
APPLICANT SIG TURE 1 DATE
� Z
H S APPLICATION BECOMES A PERMIT WHEN APPROVED
FD2095 (Rev 09/20)