HomeMy WebLinkAboutMinor Mod Permit App 2-17-16UNDERGROUND STORAGE TANK
PERMIT APPLICATION
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Permit # & 5—
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
CHECK ONE ONLY) n MODIFICATION OF FACILITY U MINOR MODIFICATION OF FACILITY
STARTING DATE/
BAKERSFIELD FIRE DEPARTMENT
r
Prevention Services
,,A
2101 H Street
$ 8 s i 1,
Bakersfield, CA 93301
N"
Phone: 661- 326 -3979 • Fax: 661- 852 -2171
ARIA/T #
EXISTING FACILITY PERMIT
Page 1 of 1
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
CHECK ONE ONLY) n MODIFICATION OF FACILITY U MINOR MODIFICATION OF FACILITY
STARTING DATE/
PROPOSED COMPLETION DATE
02/22/2016
02/23/2016
FACILITY NAME
EXISTING FACILITY PERMIT
Wholesale Fuels, Inc.
FACILITY ADDRESS
CITY
ZIP CODE
2200 East Brundage Lane
Bakersfield
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 # -,
Corif idence UST Services Inc .
8 049'04
6174721 -uT
ADDRESS: CITY ZIP CODE
16250 Meacham Road Bakersfield 93314
PHONE' # BAKERSFIELD CITY BUSINESS LICENSE # WORKMANS COMP # INSURER
661= 631- 3i$70 32864 1308371 SCIF
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Install ball valves in product lines of Tank #1 (L -S Clear Diesel) and Tank #2 (L -S Dyed Diesel).
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#
Bryan Self 8022804 -UT, Triangle Env LT -3 Cert: TMI -145
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
FD2086 (Rev 08/09)