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Home My WebLink AboutUST PERMIT APPLICATION 11-25-14UNDERGROUND STORAGE TANK ,«�,'m`.� .+.�..«o,u.., PERMIT APPLICATION $ s P TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD A Rr Y Permit # � 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 (CHECK ONE ONLY) ❑ MODTFTCATTON OF FACTI TTY DO MTNnR MOnTFTCATTnN nF FACTI TTY STARTING DATE/ 01/19/2015 PROPOSED COMPLETION DATE 01/22/2015 FACILITY NAME California Chevron (Samco Food Store #4) F TING FACILITY PERMIT # FACILITY ADDRESS 4100 California Avenue CITY 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. CA LICENSE # 1 804904 ICC # 8180171 -U1 ADDRESS 16250 Meacham Road CITY Bakersfield ZIP CODE 93314 PHONE # 661 -631 -3870 1 BAKERSFIELD CITY BUSINESS LICENSE # 32864 1 WORKMANS COMP # 1308371 INSURER SCIF BRIEFLY DESCRIBE THE WORK TO BE DONE: Sb - 9 8 9 repairs; Replace penetrations In 91, 87 North, 87 Siphon, 87 South and Diesel STP sumps. Repair UDC 7/8 and siphon line. -secondary WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? ❑ YES ❑ NO SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO THIS SECTION 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 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 Frank Landa ICC# 8180171 -U1 THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED / bo APPROVED BY rucvoo kKCV vo/v7)