HomeMy WebLinkAboutOPI APP 1.18.19UNDERGROUND 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 #
A
B R S P i D
FIRil!
ARfM T
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING
❑ TANK TIGHTNESS FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 e Fax: 661- 852 -2171
Page 1of1
X SB -989 SECONDARY CONTAINMENT
X Overfill prevention
SITE INFORMATION
FACILITY: Brookside Market and Dell
NAME & PHONE # OF CONTACT PERSON
Matt Jeffries 661- 387 -0592
ADDRESS
4700 Coffee Road, Bakersfield, CA.
OWNER NAME
Jeffries Brothers Inc.
OPERATOR NAME
Matt Jeffries
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES X NO
TANK #
VOLUME
CONTENTS
1
10,000
91 unleaded
2
10,000
87 Unleaded
3
10,000
87 Unleaded
4
10,000
Diesel
TANK TESTING COMPANY
TESTING COMPANY
Cal - Valley Equipment
NAME & PHONE # OF CONTACT PERSON
Jerry Rangel
MAILING ADDRESS
7608 Fruitvale Avenue, Bakersfield, CA. 93308
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Jerry Range[
CERTIFICATION #
Veeder Root: B35460
DATE & TIME TEST TO BE CONDUCTED
ICC #
8160834
TEST METHOD
Industry Standard
APPLICANT SIGN
DATE
10/16/18
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/08)