HomeMy WebLinkAboutUST-APPL 8/16/2013Sep, 16. 2013 4:16PM
UNDERGROUND STORAGE TANK
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PERMIT APPLICATION
TO CONSTRUCT-INSTALL NEW TANK (NEW FACIMY)INEW
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
1Permit
TYPE OF APPLICATIOM. 0 NEW TANK INSTALL/NEW FACILITY 0
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No, 3339 P. 2
ISAKERSFULD FIRE 0EPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 * Fax; 661-852-2171
Page 1 of L
NEW TANK INSTALL/ EX151-ING FACILM
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PROPOSED COMPLM
FACT AME
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TYPE OF Busime-s-l' f
APN
TANK OWNER
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ADDRESS r i
CITY
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BAKERSFIELD CITY BUSINESS LICENSE #
IN DRE80
BRIEFLY DESCRME THE WORK TO BE DONE.
000"
WATER TO FACILITY PROMED BY 4p_
DEPTH TID GROUND WATER
SOIL TYPI! EXPECTED AT SITE
If OFTANKS 1C1?
A*LLE-D Of
ARE THEY FOR MOTOR FUEL?
❑ YES ❑ NO
$PILL PREVENT& OLAND COUNTERMEASU LE?
❑ YES 0 NO
THIS S is FOR STORAGE TANK IDENTIFICATION
TANK
VOLUME
U I NLEI"ED
RFGULAFL
PREMIUM
DIESEL
OTHER
Tank Testing Company
NAMr= OP Tr=$TXNG COMPAN Y AP
PHONE NUMBER
MAILING ADDMS
'00
NAME Op W$T9
IF
THE APPLICANT HAS RECEIVED, -UNtERSTANDS, AND WILL COMPLY WITH THE ATTACHED C DMONS OF THIS
PERMIT AND ANY OTHER STATE, LOCAL,, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER
PENALTY OFYERJURYj AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
NAME or TESTER
XCC#
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
A1>Pk0'VEu BY
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