HomeMy WebLinkAbout4900 panama ln minor mod 4-29-16_3-4UNDERGROUND STORAGE TANK
A
— —1, �LD
PERMIT APPLICATION
&a IS 3
TO CONSTRUCT-INSTALL NEW TANK (NEW FACILITY)/NEW
to
10 IT J
PA R TAN
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
Permit # Al
i -
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page I of 1
NEW TANK INSTALL/EXISTING FACILITY
(CHECK ONb ONLY ❑ MODIFICATION OF FACILITY MINOR MODIFICATION OF FACILITY
PROPOSED COMPLETION DATE:.
STARTING DATE/ 3-28-16 4 -28 -16
FACILITY NAME EXISTING FACILITY PERMIT
COSTCO #643
FACILITY ADDRESS 4900 PANAMA LN -r -BAKERSFIELD ZIP CODE 93313
TYPE OF BUSINESS GASOLINE DISPENSING FACILITY APN #
TANK OWNER COSTCO PHONE # 661-837-2026
ADDRESS 4900 PANAMA LN CITY BAKERSFIELD I ZIP CODE 93313
I WATER TO FACILITY PROVIDED BY
I DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
Tank Testing Company
NAME OF TESTING COMPANY BSSR INC. PHONE NUMBER 661-588-2777
I MAILING ADDRESS
6630 ROSEDALE HWY #13
I NAME OF TESTER FIDEL CARRILLO I ICC# 5257282 1
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 I ICC#
FIDEL CARRILLO
5257282
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
X
z
f FD2086 (Rev 08/09)