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APPLICATIO
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 # I I
❑ 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 1ofI
❑ SB -989 SECONDARY CONTAINMENT
XOVERFILL PREVENTION
FACILITY NAME & PHONE # OF CONTACT PERSON
Brookside Market and Deli Matt Jeffries (661) 387 -0592
ADDRESS
8803 Camino Media, Bakersfield, CA. 93311
OWNER NAME
Jeffries Bros. Inc.
OPERATOR NAME PERMIT TO OPERATE #
Matt Jeffries
# OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? J YES 0 NO
TANK* VOLUME CONTENTS
1 20,000 87 Unleaded
2
12/000 / 8,000 1 91 Unleaded / Diesel
TESTING COMPANY NAME & PHONE # OF CONTACT PERSON
Cal Valley Equipment Jerry Rangel 661 -615 -4076
MAILING ADDRESS
7608 Fruitvale Avenue, Bakersfield, CA. 93308
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR CERTIFICATION #
Jerry Rangel 661 -979 -0953 Veeder Root: 535460, OPW:0128241, Incon: 1037433709
TEST METHOD ICC #
Industry Standard 8160834
APPLICANT SIGNATURE DATE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY I DATE
FD2095 (Rev 03/18)