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Home My WebLink AboutPermit App 6-15-15IPermit # TYPE OF APPLICATION: ❑ NEW TANK INSTALLINEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY (CHECK ONE ONLY) ❑ MODIFICATION OF FACILITY %ar)MINOR MODIFICATION OF FACILITY STARTING DATE/ PROPOSED COMPL(TION DATE FACILITY E EXISTING FACILITY PERMIT # Zha7IQf�� FACIL!)a, CITY zip� � or TYPE OF BLLSUNESS APN # I TANK OWNER - _j I PHONE # WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER I SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? 1 ❑ YES ❑ NO 1 ❑ YES ❑ NO THIS SECTEON ES FOR STORAGE TANK EDEM7ZFZC.A7EON TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER TANK MANUFACTURER Tank Testilh Company NAME OFPSS! G 0 NY PHONE NUMBER MAILING ADDRESS A I NAME 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 PER3URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. NAME OF TESTER I ICC# FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY 411SI-16 Fr)2086 (Rpv 11/20151 BAKERSFIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANK Prevention services FIRE 2101 H Street Bakersfield, CA 93301 PERMIT APPLICATION A N rA"tj**,r Phone: 661 661-852-2171 TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW -326-3979 •Fax: TANK INSTALL (EXISTING FACILITY)/MOD -MINOR MOD Page 1 of I IPermit # TYPE OF APPLICATION: ❑ NEW TANK INSTALLINEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY (CHECK ONE ONLY) ❑ MODIFICATION OF FACILITY %ar)MINOR MODIFICATION OF FACILITY STARTING DATE/ PROPOSED COMPL(TION DATE FACILITY E EXISTING FACILITY PERMIT # Zha7IQf�� FACIL!)a, CITY zip� � or TYPE OF BLLSUNESS APN # I TANK OWNER - _j I PHONE # WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER I SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? 1 ❑ YES ❑ NO 1 ❑ YES ❑ NO THIS SECTEON ES FOR STORAGE TANK EDEM7ZFZC.A7EON TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER TANK MANUFACTURER Tank Testilh Company NAME OFPSS! G 0 NY PHONE NUMBER MAILING ADDRESS A I NAME 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 PER3URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. NAME OF TESTER I ICC# FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY 411SI-16 Fr)2086 (Rpv 11/20151