HomeMy WebLinkAbout989 Permit App 11-10-16UNDERGROUND 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 #�
❑ ENHANCED LEAK DETECTION
TANK TIGHTNESS
-ddlllhh� WA
H M "R8 F i l L D
ARrN r
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 • Fax: 661 - 852 -2171
Page 1 of 1
❑ LINE TESTING X SB -989 SECONDARY CONTAINMENT
FUEL MONITORING CERTIFICATION
SITE. INFORM,ATTON;
FACILITY: Brookside Market and Deli NAME &, PHONE # OF CONTACT PERSON
Matt Jeffries 661- 387 -0592
ADDRESS
8803 Camino Media, Bakersfield, CA.
OWNER NAME
Jeffries Brothers Inc.
OPERATOR NAME PERMIT TO OPERATE #
Matt Jeffries 7
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES X NO
TANK # VOLUME CONTENTS
1 20,000 87 unleaded
2 12,000 / 8000 91 unleaded / Diesel
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY I DATE
d
/ / %?.-A
FD2095 (Rev 03/08)
TANK TESTTNG;COMPANY
TESTING COMPANY
NAME &. PHONE # OF CONTACT PERSON
Cal - Valley Equipment
Jerry Range[
MAILING ADDRESS
3500 Gilmore Avenue, Bakersfield, CA. 93308
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
Jerry Rangel
Veeder Root: 835460
DATE & TIME TEST TO BE CONDUCTED
ICC #
TEST METHOD
10/26/16 @ 8:00 am
8160834
Industry Standard
APPLICANT SIGNATURE _
DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY I DATE
d
/ / %?.-A
FD2095 (Rev 03/08)