HomeMy WebLinkAboutFMC Application12-9-22UNDERGROUND STORAGE TANKS
05
APPLICATION
TO PERFORM E LD/LINE TESTI N G/
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 t
❑ TANK TIGHTNESS F
E TESTING
:L MONITORING CERTIFICATION
S1 11: INFORMATION
yr 5%169wra1.6.v WJar%Sn v�r+hn ■ s-tc�� s
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 9 Fax: 661-852-2171
Page 1 of 1
❑ SB -989 SECONDARY CONTAINMENT
❑ OVERFiL.L PREVENTION
FACILITY 4.
NAME & PHONE 4 OF CONTACT PERSON
Vof
ADDRESS
LA
C VQ P3 e A Av -)i�L
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
TANK TEST3ENG 4COMPANY i
TESTING COMP!RAC NAME & PHONE ,# OF CONTACT RS N
MAILING ADDRESS ;
NAME & PHONE TER OR INP CTOR CERTIFICATION Q QWSO
i
TEST METHODrlmMtW ICC #
V
S 7
APPLICANT SIGNATURE DATE ,
to 22
JH1"-0�P'L1CAT10N 13ECOMES A PERMIT WHENAPPROVED
APPROVED BY DATE
FD2095 (Rev 09/20)
rlrilmu !J Ttb U NU
TANtK#t
VOLUME
CONTENTS ,
t 0 (�
lJ V
119
to n
}
TANK TEST3ENG 4COMPANY i
TESTING COMP!RAC NAME & PHONE ,# OF CONTACT RS N
MAILING ADDRESS ;
NAME & PHONE TER OR INP CTOR CERTIFICATION Q QWSO
i
TEST METHODrlmMtW ICC #
V
S 7
APPLICANT SIGNATURE DATE ,
to 22
JH1"-0�P'L1CAT10N 13ECOMES A PERMIT WHENAPPROVED
APPROVED BY DATE
FD2095 (Rev 09/20)