HomeMy WebLinkAboutFMC Application 2-5-21UNDERGROUND 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
r- PK
❑ LINE TESTING
N FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 . Fax: 661-852-2171
Page 1 of 1
❑ SB -989 SECONDARY CONTAINMENT
❑ OVERFILL PREVENTION
SITE INFORMATION
FACILITY
Brookside Market and Deli at the Oaks
NAME & PHONE # OF CONTACT PERSON
Matt Jeffries (661) 387-0592
ADDRESS
8803 Camino Media, Bakersfield, CA. 93311
OWNER NAME
Jeffries Bros. Inc.
OPERATOR NAME
Matt Jeffries
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED: 3
IS PIPING GOING TO BE TESTED? ❑ YES 8 NO
T A N K #
VOLUME
CONTENTS
1
20,000
Unleaded
2
127000 / 81000
91 unleaded / Diesel
TANK TESTING COMPANY
TESTING COMPANY
Cal Valley Equipment
NAME & PHONE # OF CONTACT PERSON
Jerry Rangel (661) 615-4076
MAILING ADDRESS
7608 Fruitvale Avenue, Bakersfield, CA. 93308
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Jerry Rangel (661) 979-0953
CERTIFICATION #
8900824
TEST METHOD
Industry Standard
ICC #
8900824
APPLICANT SIGNATURE
DATE
r -13-Z-0 I
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 09/20)