HomeMy WebLinkAboutMinor Mod Permit App 6-30-16 (North)UNDERGROUND STORAGE TANK
PERMIT APPLICATION
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
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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
PROPOSED COMPLETION DATE
Prevention Services
2101 H Street
Bakersfield, CA 93301
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Phone: 661- 326 -3979 • Fax: 661- 852 -2171
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Sully's Downtown
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
06/20/2016
6/20/16
FACILITY NAME
EXISTING FACILITY PERMIT #
Sully's Downtown
FACILITY ADDRESS
CITY
ZIP CODE
193301
2317 L Street
Bakersfield
TYPE OF BUSINESS
APN #
GDF
TANK OWNER
PHONE #
Sully's Food Store, LLC
(661) 327 -5008
ADDRESS
CITY
ZIP CODE
1000 Truxtun Avenue
Bakersfield
93301
CONTRACTOR CA LICENSE # ICC #.
Confidence UST Services Inc. 804904
ADDRESS CITY ZIP CODE
16250 Meacham Road Bakersfield 93314
PHONE # BAKERSFIELD CITY BUSINESS LICENSE # WORKMANS COMP # INSURER:
661' -631 -3870 32864 1308371 SCIF
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replaced Veeder -Root Sump Sensor (MN 794380 -208) in 87 STP Sump. I
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
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#
Cameron Mason 8174721 -UT
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED / APPROVED BY !
FD2086 (Rev 08/09)