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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
1501 Truxtun Avenue 15t Floor
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
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FACILITY NAME
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ADDRESS
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OPERATOR NAME
PERMIT TO OPERATE
OWNER NAME
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NUMBER OF TANKS TO BE INSTALLED /REMOVED
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NAME OF COMPANY INSTALLING AND/OR REMOVING TANK
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MAILING ADDRESS
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DATE &TIME TANK IS TO BE INSTALLED/REMOVED
SIGNA E OF APPLICANT
DATE
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DATE
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FD2081 (Rev 03/08)