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HomeMy WebLinkAboutUST APP 1-22-14 (2)UNDERGROUND STORAGE TANK w i .r .Ai.K.'"t'w:'g�. PERMIT APPLICATION`' lw 319 TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW FISH TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD 'Y: &rr r Permit # BAKERSFIELD FIRE DEPARTMENT Prevention Services 1501 Truxtun Avenue, 1st Floor Bakersfield, CA 93301 Phone: 661 -326 -3979 • Fax: 661 -852 -2171 Page 1 of 1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/E)ISTING FACILITY - - ---- _ —_ -- -- ... 1 V- / KATNIP�D IAnnrcT1^n-rrnn1 rw i:ArTI TTY CHECK ONE ONLY u 1V1UU1r1% -M 11viv yr I .- %%..LL-L I I -•- - - STARTING DATE/ s� PRt3POSED COMP ON DATE- 1-1 0 A 1 4f FACILITY NAM EXISTING FACILITY PERMIT # FACILITY ADDRESS . JCITY ZIP COD TYPE OF BUSINESS APN # TANK OWNER PHONE # Dwo ADDRESS C" ZIP CODE CONTRALTO - CA LICENSE # Icc ADDRESS ZIP �3a PHONE � � . BAKE FIELD CITY BUSINESS LICENSE # rk WORKMANS COMP # p `� INSURER Ce. ... �, gpcf F1 Q\,61 BRIEFLY DESCRIBE THE WORK TO BE DONE: R15 .- •'' ''' v ...� AA 0 i s L iv WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO ❑ YES ❑ NO 7 IS,SECTION IS FOR STORAGE TANK IDENTIFICATION VOWME UNLF"ED REGULAR PREMIUM DIESEL OTHER Tank Testing Company NAME OF TESTING CO PHONE NUMBER ` ..`�C�a V ��,brl MAILING ADDRESS���� NAME OF TESTE Icc# THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PER3URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. NAME OF TESTER ICC# THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY Did�AEAPPROVED. AP D BY FD2086 (Rev 08/09)