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HomeMy WebLinkAboutMinor Mod Permit App 6-30-16Permit # 16 TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY (CHECK ONE ONLY) n MOr)TFTCATTr)N OF FACTI TTY BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661 -326 -3979 • Fax: 661 - 852 -2171 Page 1 of 1 ❑ NEW TANK INSTALL /EXISTING FACILITY M MTNnP mnr)TFTrATTrIN r1F PArTI TTV STARTING DATE/ 6/30/2016 PROPOSED COMPLETION DATE 06/31/2016 FACILITY NAME White Lane Chevron EXISTING FACILITY PERMIT # FACILITY ADDRESS 2525 White Lane CITY Bakersfield ZIP CODE 93304 TYPE OF BUSINESS GDF APN # TANK OWNER Proactive Properties, Inc. dba White Lane Chevron PHONE # 661 - 832 -9781 ADDRESS. 2525 White Lane CITY Bakersfield ZIP CODE 93304 CONTRACTOR Confidence UST Services Inc. 1 CA LICENSE # 804904 ICC # 8177076 -u1 ADDRESS 16250 Meacham Road CITY Bakersfield ZIP CODE 93314 PHONE # 661 -631 -3870 1 BAKERSFIELD CITY BUSINESS LICENSE # 32864 WORKMANS COMP # 1308371 INSURER SCIF BRIEFLY DESCRIBE THE WORK TO BE DONE: Excavate to replace Direct Burial OPW Spill Bucket (like for like). WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED AEY FOR MOTOR FUEL? S NO SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? M YES NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER 1 12000 x x 2 12000 x x 3 12000 x Tank Testing Company NAME OF TESTING COMPANY Confidence UST Services Inc. PHONE NUMBER 661 - 631 -3870 MAILING ADDRESS 16250 Meacham Road, Bakersfield, CA 93314 NAME OF TESTER 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 Frank Landa ICC# 8180171 -U1 /UT THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY rLJZV00 kKev ua /VV)