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BAKERSFIELD FIRE DEPARTMENT
ABOVEGROUND STORAGE TANK Prevention Services.
H B p,R� I a 1600 Truxtun Ave., Suite 401
APPLICATION FORM ; ARE T Bakersfield, CA,93301
INSTALLATION /REMOVAL OF AN AST. •Phone: 661 - 326 -3979 • Fax:. 661-852-2171
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INSTALL [� REMOVE -
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PERMIT # k-M O I �j I IE
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FACILITY NAME
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ADDRESS
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OPERATOR NAME
PERMIT TO OPERATE #
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OWNER AME
# OF TANKS TO B
INSTALLED
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NAME OF COMPANY INSTALLING AND /OR REMOVING TANK
MAILING ADDRESS
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NAME & PHONE # OF CONTACT PEWSON
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DATE & TI PIE TANK IS TO BE INSTALLED/ REMOVED
SI ATURE OF APPLICANT DATE
OVE BY• i f DATE
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FD2081 (Rev 08/07)
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