HomeMy WebLinkAboutMinor Mod App.UNDERGROUND ■ IE TANK
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PERMIT APPLICATION
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TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW
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TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD.
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Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 -326 -3979 s Fax: 661 -852 -2171
Page 1 of 1
❑ NEW TANK INSTALL/EXISTING FACILITY
(CHECK ONE ONLY ) f �.,❑ MODIFICATION OF FACILITY MINOR MODIFICATION OF FACILITY
STARTING DATE / �, PROPOSED COMPLETION DATE�+j
FACILITY NAME ? - j o W EXISTING FACILITY PERMIT #
FACILITY ADDRESSi I CITY .. _ _ i �, ZIP CODE► 4
TYPE OF BUSINEES% e° I _ 5 f A a I APN #
1 TANK OWNER / 7 _ Q _ k I I PHONE #
1 ADDRESS I CITY
ZIP CODE
CONTRACTOR C LI' NSE #
ADDRESS CITY ZIP ODE
PH NE L^ BAKERSF LD CITY B ESS LICENSE # WO M N COMP # SU ER
W-ld 2�_ 1Q:2Q.
BRIEFLY DESCRIBE THE WORK TO BE DONE:
I WATER TO FACILITY PROVIDED BY
1 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?
❑ YES ❑ NO 1 ❑ YES ❑ NO
T HIS SECTION IS FOR STORAGE TANK DEM- 72FICATIO
TANK # VOLUME UNLEADED REGULAR PREMIUM' DIESEL OTHER TANK MANUFACTURER
Tank Testing Company
NAME OF TESTING Cp A
PHONE NUMBER
MAILING ADDRESS
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
FD2086 (Rev 11/2015)