HomeMy WebLinkAboutUST PERMIT APPLICATION 12-9-2014UNDERGROUND STORAGE TANK
PERMIT APPLICATION
TO OPERATE AN UST
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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)