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Home My WebLink AboutUST-APPL 8/17/2015STARTING DATE/ PROPOSED COMP7EU DATE FACILITY NAME umc � � �� ` BAKERSFIELD FIRE DEPARTMENT -UNDERGROUND STORAGE TANK !� ! ZIP CODE Prevention Services APN # TANK OWNER ` PHONE # ADDRESS c y °uP ODE _�a 1501 Truxtun Avenue, 11r Floor r h PERMIT APPLICATION` I b ® T r 6v, k Bakersfield, CA 93301 TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW or FISH AITr ! Phone: 661- 326 -3979 • Fax: 661- 852 -2171 TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD SM Y, DESCRIBE THE WORK TO BE DONE: Page 1 of 1 lPermi't # BOG WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW ARE THEY FOR MOTOR FUEL? YES ❑ NO FACILITY ❑ NEW TANK INSTALUEXISTING FACILITY (rHFrIC nNF nN! Y) r7 M0r)TFTrATTnN ()F FArTI TTY '%MoO' MTNnR MnnTFTrATTrw ni: FArn T'Tv STARTING DATE/ PROPOSED COMP7EU DATE FACILITY NAME umc � � �� ` EXISTING FACILITY PERMIT # FACILITY ADDRESS � � � !� ! ZIP CODE TYPE OF BUSINESS � 0 APN # TANK OWNER ` PHONE # ADDRESS c y °uP ODE _�a CONTRACTOR--__)- CA LICErISE -C - I b ® T r 6v, k ZIP cooE„ or BAKERSHELD CITY BUSINESS LICENSE woRKMIA�Npg+Scor P SURER pp` SM Y, DESCRIBE THE WORK TO BE DONE: WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED 70 ARE THEY FOR MOTOR FUEL? YES ❑ NO SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TA1+tK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER ®� C? 00 ®00. R ,1Nr* Testing Company a NAME OF TESTING COMP _ANY PHONE NUMBER H M(�IL;NG ADDRESS NAMERE 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 ICC# j a to THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY ;:DATE APPROVED: % APPROVED BY } rU/_Uao LKeV Uzs/Ud)