HomeMy WebLinkAboutMinor Mod Permit ApplicationBAKERSFIELD FIRE DEPARTMENT
eVs UNDERGROUND STORAGE TANK Prevention Services
2101 H Street
PERMIT APPLICATION H E F Bakersfield, CA 93301
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW «S Phone: 661 -326 -3979 •Fax: 661 -852 -2171
ARTx 1'
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Page 1 of 1
[Permit # r-p
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
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STARTING DATE/
PROPOSED COMPLETION DATE
10/07/015
1017715
FACILITY NAME
EXISTING FACILITY PERMIT #
115-021-03076
FASTRIP #19 7725
FACILITY ADDRESS
CITE'
Bakersfield
ZIP CODE
93307
4901 S. Union Ave
TYPE OF BUSINESS
APN #
GDF
TANK OWNER
PHONE #
(661)393 -7000
Jamieson Hill
ADDRESS
CITY
ZIP CODE
PO BOX 82515
Bakersfield
93380
CONTRACTOR
JACO OIL / Joe Stroope
CA LICENSE #
1970529
ICC #
5258844
ADDRESS
Bakersfield
93384 E
PO BOX 82515
PHONE #
BAKERSFIELD CITY BUSINESS LICENSE #
WORKMANS COMP #
WC3486600
INSURER American
Zurich
(661)393 -7000
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replaced Veeder Root Sensor 794380 -208 on the 91 STP Sump
Per phone conversation with Kris. Karns on 10113115 at 10:40am. Request a revision of this Minor Modification permit
the of the submotor on the 91 product tank as well.
application and add replacement
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?
rl YES NO YES NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
T2
12000
Premium
Tank Testing Company
NAME OF TESTING COMPANY
PHONE NUMBER
MAILING ADDRESS
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
ICC#
JACO OIL / Jae Stroope
5258844
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED.
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
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