HomeMy WebLinkAboutMinor Mod Permit Application 2-11-16It! 111� 1111 � I
PERMIT APPLICATION
TO CONSTRUCT-INSTALL NEW TANK (NEW FACILITY)/NEW
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
Permit # /610606 �)q -Irf-
4
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
(CHECK ONE ONLY
BAKERSFIELD FIRE DEPARTMENT
LJ MINOR MODIFICATION OF FACILITY
Prevention Services
A
2101 H Street
B Ai't tl
& F
Bakersfield, CA 93301
Phone: 661-326-3979 e Fax: 661-852-2171
*FIRE
aRfM 1'
FACILITY NAME
40%
Page 1 of 1
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
(CHECK ONE ONLY
El MODIFICATION OF FACILITY
LJ MINOR MODIFICATION OF FACILITY
STARTING DATE/
PROPOSED: COMPLETION DATE
02/08/2016
02/0812016
FACILITY NAME
EXISTING FACILITY PERMIT:#.:
Wholesale Fuels, Inc.
FACILITY ADDRESS
CITY
ZIP CODE
ZIP
2200 East Brundage Lane
I 93307
TYPE OF BUSINESS
APN #
Fuel Distribution
TANK OWNER
PHONE#
Wholesale Fuels, Inc.
(661) 327-4900
ADDRESS
CITY
ZIP CODE
2200 East Brundage Lane
Bakersfield
93307
CONTRACTOR
CA LICENSE #
'ICC'#
Confidence UST
Services,_ Inc.
804904
8174721 -UT
ADDRESS
CITY
ZIP CODE:
Meacham
M a
16250 e c
Road
k
Bakersfield er ield
'R
��93
PHONE #
BAKERSFIELD CITY BUSINESS #
WORKMANS�COMP #
. .... ... ....
INSURER
66`1 - 631 -3870' � ,
32864
SG IF:
BRIEFLY BRIEFLY DESCRIBE THE WORK TO BE DONE- L� ALe tJj7—
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Replace Veeder-Root 794380-208 sump sensors spenser pans
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NAME OF TESTER I 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#
Dustin Reese I 8216722-UT
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
'
DATE APPROVED APPROVED BY
p
FD2086 (Rev 08/09