HomeMy WebLinkAboutUST APPLICATION 11-2015ME
Permit # /5--z 0,113
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
CHECK ONE ONLY ✓ MODIFICATION OF FACILITY
LJ MINOR MODIFICATION OF FACILITY
STARTING DATE/
PROPOSED COMPLETION DATE
10/22/2015
10/2212015
FACILITY NAME
EXISTING FACILITY P.,ERMIT
Muthana Corp dba Mesa Marin Chevron
FACILITY ADDRESS
CITY
ZIP CODE
11101 Highway 178
Bakersfield
93306
TYPE OF BUSINESS
APN #
Gasoline Dispensing Facility
53301224002
TANK OWNER
PHONE #
Muthana Corp. dba Mesa Marin Chevron, Mohammud Muthana
(661) 366 -4886
ADDRESS
CITY
ZIP CODE
11101 Highway 178
Bakersfield
933
CONTRACTOR I'
CA LICENSE #
ICC #
Confidence UST Service's Inc .!
so49o4
slsalrl -u1
ADDRESS
CITY
ZIP CODE
16250 Meacham Road
Bakersfield
933.14
PHONE #
BAKERSFIELD CITY BUSINESS LICENSE #
WORKMANS COMP #
INSURER
661- 63143:83,0'
32864
1308371
SCIF
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace manways.
3 10000 f X'
Tank Teeing Company
NAME OF TESTING COMPANY PHONE NUMBER
Confidence UST Services Inc. 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 ICC#
Frank Landa 8180171 -U1
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
FD2086 (Rev 08/0