HomeMy WebLinkAbout300 Fairview Rd Bakersfield SWRCB Test Notification
SUBMITTAL DATE: _______________________
Test Date and Time
TANK TESTER INFORMATION
UNDERGROUND STORAGE T ANK
TANK A ND L INE INTEGRITY T ESTING, AND E NHANCED L EAK
DETECTION TEST NOTIFICATION FORM
OFFICE OF T ANK TESTER LICENSING
OTTL@waterboards.ca.gov
Test notifications for testing tank and line integrity testing, and enhanced leak detection (ELD)
testing are required to be submitted to the Office of Tank Tester Licensing (OTTL) in accordance
with the California Code of Regulations, tile 23, chapter 17, section 2772. If changes to test
notifications occur after submittal t o OTTL, please notify OTTL of those changes immediately.
Using this form, provide OTTL with the following information when submitting test notifications:
FACILITY INFORMATION
CERS ID
Facility Name
Facility Address City ZIP Code
Company Performing the Test Phone
Mailing Address
Licensee Name
OTTL License # Expiration Date
TEST METHOD INFORMATION
Test Method Components Tested
Post Construction ELD: Is the form for post construction contractor statement attached?
YES NO If no is selected, pr ovide general contractor statement prior t o testing.
Failure to comply and provide all of the above information may result in disciplinary action against
licensed tank tester. Please note that this notification does not waive the requirement for the 48-
hour notice to the local agency in accordance with the provisions of California Code of Regulations,
title 23, chapter 16, sections 2643(g) and 2644.1(a)(4).
June 2020