HomeMy WebLinkAbout2222 F STREET (3)UNDERGROUND STORAGE TANK
PERMUT APPLICATION
B E R 8 B t ri
FIRE
TO OPERATE AN UST ® ABTA/ f
PERMIT #
TYPE OF APPLICATION (CHECK)
OPERATE NEW FACILITY TRANSFER OF OWNERSHIP
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
1501 Truxtun Avenue 1St Floor
Bakersfield, CA 93301
Phone: 661-326-3979 a Fax: 661-852-2171
OPERATE AN EXISTING FACILITY
Do you have a HAZARDOUS MATERIAL RESPONSE PLAN? YES NO
Do you have an OWNER - OPERATOR AGREEMENT? YES NO
Have you filled out a HAZARDOUS MATERIAL BUSINESS PLAN? YES NO
FOR OFFICIAL USE ONLY
The applicant has received, understands, and will comply with the attached conditions of the permit and
any other state, local and federal regulations. This form has been completed under penalty of perjury,
and to t o my knowledge is true and correct.
wtAl'T = C
APPLICANT NAME (PRINT)
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
S: Forms - Web \Fire \UST \FD2087 UST Permit Application to Operate an UST.cloc (Rev 03/08)
PREVIOUS TANK OWNER (if anolicablel
NAME PHONE# / -32,1 rJ
ADDRESS
2
I IP CODE
la>ck
NEW TANK OWNER¢/
NAME .( (pa C SS PHONE # Z Y
Z Z F S ADDRESS Z ITY 1 /,,8/S \ IP CODE
BILLING ADDRESS CITY CODEIP
TANK OPERATOR 0idifferent from owner
NAME+ PHONE #
J
ADDRESS ITY IP CODE
APPLICANT'S NAME (if different from owner)
NAME
c
PHONE#
66/32 _ 58
ADDRESS ITY IP CODE
TANK LOCATION
FACILITY NAME
4
OPPERATOR NAME
v\
PHONE #
ADDRESS ITY IP CODE
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NAME
I
PHONE#
i 7/ i 333
DDRESS ITY IP CODE
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TANK INFORMATION
TANK # VOLUME DATE INSTALLED SUBSTANCE STORED PREVIOUS SUBSTANCE
v /soz'mvo v A
n /s evC7's2R-3 03-1 —1987 U n — 8 7 A// R
d /,spz °cow v.3 -I —196'7 d'¢w iuwl — 9/ m14
p ®v
Do you have a HAZARDOUS MATERIAL RESPONSE PLAN? YES NO
Do you have an OWNER - OPERATOR AGREEMENT? YES NO
Have you filled out a HAZARDOUS MATERIAL BUSINESS PLAN? YES NO
FOR OFFICIAL USE ONLY
The applicant has received, understands, and will comply with the attached conditions of the permit and
any other state, local and federal regulations. This form has been completed under penalty of perjury,
and to t o my knowledge is true and correct.
wtAl'T = C
APPLICANT NAME (PRINT)
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
S: Forms - Web \Fire \UST \FD2087 UST Permit Application to Operate an UST.cloc (Rev 03/08)