HomeMy WebLinkAboutUST-PERMIT APPL 11/13/2015UNDERGROUND STORAGE TANK
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PERMIT APPLICATION
TO CONSTRUCT-INSTALL NEW TANK (NEW FACILITY)/NEW
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
jPermit # 6 9
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY
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❑ NEW TANK INSTALL/EXISTING FACILITY
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STARTING DATE/
11/05/2015
PROPOSED COMPLETION DATE
11113/15
FACILITY NAME
Express Gas aka Flower Street Mini Mart
EXISTING FACILITY PERMIT
FACILITY ADDRESS
928 Flower Street
CITY
Bakersfield
ZIP CODE
193305
TYPE OF BUSINESS
GDF
APN #
TANK OWNER
Flower Street Mini Mart
PHONE #
(661) 328-0732
ADDRESS
928 Flower Street
CITY
Bakersfield
ZIP CODE
93305
CONTRACTOR
'Confidence UST Services, Inc.
CA LICENSE #
ICC #
ADDRESS
16250 Meacham Road
CITY
Bakersfield
ZIP CODE
93314
PHONE #
661 - 631 -3870- 1 1
BAKERSFIELD CITY BUSINESS LICENSE #
1 3 . 2864
WORKMANS, COMP #
1308371
INSURER.
SCIF
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Investigate possible leaking tank annular following failed secondary containment testing. Repair leak in vapor return line.
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEL?
1[] YES rl NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
n YES NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
12000 gal (Split)
x
x
2
8000 gal (Split)
"x
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
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
Frank Landa
ICC# 8180171-Ul/UT
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
Cn-)n0r- fD REME—i