HomeMy WebLinkAbout4700 COFFEE RD SB989 APP 9.30.14r
UNDERGROUND STORAGE TANKS
u'
m; ^ ^ter r, .. , •r . M x µ s ^r; zR azs r H B R 3 P I D
APPLICATION F °Rs
TO PERFORM ELD /LINE TESTING/ ARTM T
SB989 SECONDARY CONTAINMENT
TESTING /TANK TIGHTNESS TEST AND
FUEL MONI`T'ORING CERTIFICATION
(Please note that these are separate
individual tests and will be Charged per
separate type test accordingly.)
PERMIT # 0±24f
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 • Fax: 661 -852 -2171
Page I of 1
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING) SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS ❑ FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
NAME & PHONE # OF CONTACT PERSON
Shell
Matt Jeffries (661) 387 -0592
ADDRESS
4700 Coffee Road Bakersfield CA 93308
OWNER NAME
Jeffries Bros. , Inc.
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
NAME & PHONE # OF CONTACT PERSON
Confidence UST Services Inc.
Karli Karns (661) 631 -3870
MAILING ADDRESS
16250 Meacham Road Bakersfieldt CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
CERTIFICATION #
Bryan Self (661),333-QO75
B35701
DATE & TIME TEST TO BE CONDUCTED
ICC # TEST METHOD
9/29Z14 at 9:0Oam
8022804 -UT
APPLICANT SIGNATURE
1
DATE
�
f
THIS APPLICATION BECOMES A PER IT WHEN APPROVED
APPROVED BY DATE
FD2095 (Rev 03/08)