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Home My WebLink AboutUST PERMIT APPLICATION 10-7-14UNDERGROUND STORAGE TANK PERMIT APPLICATION TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Permit # �' -� vTt5__ 22 ' rr' BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street 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 /EXISTING FACILITY (('HF( -V oNiF nNI Y) rl MOMFTCATTON nF FACTI TTY M MTNOR M0nTFTCATTt7N OF FACTI TTY STARTING DATE/ 10/02/2014 PROPOSED COMPLETION DATE 10/02/2014 FACILITY NAME California Chevron EXISTING FACILITY PERMIT # FACILITY ADDRESS CITY 4100 California Avenue Bakersfield ZIP CODE 93309 TYPE OF BUSINESS GDF APN # TANK OWNER HW & J Enterprises, Inc. PHONE # (661) 336 -0263 ADDRESS 3817 Wilson Road, Suite B CITY Bakersfield ZIP CODE 93309 CONTRACTOR Confidence UST Services Inc. C A LICENSE # 804904 ICC # 8180171 -U1 ADDRESS CITY 16250 Meacham Road Bakersfield ZIP CODE 93314 PHONE # 661 -631 -3870 1 BAKERSFIELD CITY BUSINESS LICENSE # 32864 WORKMANS COMP # 1308371 INSURER SCIF BRIEFLY DESCRIBE THE WORK TO BE DONE: Replaced shear valves in dispenser 1/2, 5 / 6 , 9/10 & 11/12. 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 ❑ YES ❑ NO PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO THIS SEC'T'ION IS FOR STORAGE TANK IDENTIFICATION TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER 1 10000 X X 2 10000 X X 3 10000 X X 4 10000 X X Tank Testing Company NAME OF TESTING COMPANY Confidence UST Services Inc. PHONE NUMBER 661 -631 -3870 MAILING ADDRESS 16250 Meacham Road Bakersfield CA 93314 NAME OF TESTER I 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 PERJURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. NAME OF TESTER Dustin Reese ICC# 18216722-UT THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY /