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HomeMy WebLinkAboutUST PERMIT APPLICATION 12-9-2014UNDERGROUND STORAGE TANK PERMIT APPLICATION TO OPERATE AN UST � 3 parrs z A r� TYPE OF APPLICATION (CHECK) ❑ OPERATE NEW FACILITY ❑ TRANSFER OF OWNERSHIP BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661 -326 -3979 • Fax: 661 - 852 -2171 0 OPERATE AN EXISTING FACILITY PREVIOUS TANK OWNER (if applicable) .NAME ONE # 7/11 714 - 771 -5484 ADDRESS P.O.Box# 711 ITY Dallas IP CODE 75221 NEW TANK OWNER NAME ONE # ADDRESS CITY ZIP CODE BILLING ADDRESS CITY ZIP CODE TANK OPERATOR if different from owner NAME ONE # ADDRESS IP CODE APPLICANT'S NAME (if different from owner) NAME Tanknology PHONE # 951 -676 -4060 DRESS 41785 Enterprise Circle South Suite# D ITY Temecula P CODE 92590 TANK LOCATION ACILITY NAME 7/11# 16329 PPERATOR NAME Stephen Boyd PHONE # 661- 549 -1711 ADDRESS 1701 Pacheco Road CITY Bakersfield IP CODE 93307 EMERGENCY CONTACT NAME Stephen Boyd PHONE # 1714-771-5484 ADDRESS 330 East Lambert Road, Suite# 150 CITY Brea ZIP CODE 93312 TANK INFORMATION TANK # VOLUME DATE INSTALLED SUBSTANCE STORED PREVIOUS SUBSTANCE 1 9,600 gallons Unknown Regular grade gasoline NIA 2 9,600 gallons Unknown Regular grade gasoline N/A 3 9,600 gallons Unknown Premium grade gasoline N/A 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? W 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: F6rms -Web \F1re \UST\FD2087 UST Permit Application to Operate an UST.doc (Rev 06110)