HomeMy WebLinkAboutUST APP 10-15-14UNDERGROUND STORAGE TANK
PERMIT APPLICATION
TO OPERATE AN UST
PERMIT . 1
R S F I D
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TYPE OF APPLICATION (CHECK)
❑ OPERATE NEW FACILITY 0 TRANSFER OF OWNERSHIP
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 e Fax: 661-852-2171
Q OPERATE AN EXISTING FACILITY
PREVIOUS TANK OWNER (if applicable)
.NAME
7/11
6-ONE #
714-771-5484
ADDRESS
P.O. Box# 711
ICITY TUPP CODE
1 Dallas 175221
NEW TANK OWNER
NAME
I
bHONE #
- -
ADDRESS
ITY
ZIP CODE
BILLING ADDRESS
CITY
I
ZIP CODE
I
TANK OPERATOR if different from owner)
NAME IP HONE #
ADDRESS
CITY
PCODE
APPLICANT'S NAME (if different from owner)
NAME �HONE#
Tanknology 951-676-4060
ADDRESS
41785 Enterprise Circle South Suite# D
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Temecula
r�2C5O;0
TANK LOCATION
FACILITY NAME
7/11 t' -3
PPPERATOR NAME
Stephen Boyd
HONE #
�661-549-1711
ADDRESS
4101 Calloway Drive
CITY
Bakersfield
CODE
93312
EMERGENCY CONTACT
NAME
Stephen Boyd 1714-771-5484
PHONE #
ADDRESS
330 East Lambert Road, Suite# 150
CITY
Brea
ZIP CODE
93312
TANK INFORMATION
TANK #
VOLUME
DATE INSTALLED
SUBSTANCE STORED
PREVIOUS SUBSTANCE
1
14,401 gallons
Unknown
Regular grade gasoline
N/A
2
9,695 gallons
Unknown
Premium grade gasoline
N/A
Do you have a HAZARDOUS MATERIAL RESPONSE
PLAN?
YES
E3
NO
Do you have an OWNER --OPERATOR, AGREEMENT?
%
YES
❑
NO
Have you filled out a HAZARDOUS MATERIAL
BUSINESS PLAN—?
FE]
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 the best of my knowledge, is true and correct.
APPLICANT SIGNATURE APPLICANT NAME (PRINT) APPROVED BY
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
S: Forms-WebNFjreNUST\FD2087 UST Permit Application to Operate an UST.doc (Rev 06110)