HomeMy WebLinkAboutUST Minor Mod Permit App 1-13-16-UNDERGROUND STORAGE
PERMIT -A PLICATION
TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW
TANK .INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Permit #
l�IRS
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 s Fax: 661- 852 -2171
Page 1ofI
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
CHECK ONE ONLY) ❑ MODIFICATION OF FACILITY _ , RC"MINOR MODIFICATION OF FACILITY
STARTING DATE/ L -) S_ PROPOSED COMPLETION DATE
FACILITY NAME EXISTING FACILITY PERMIT #
FACILITY ADDRESS, CITY ZIP
x� �_.' - I a I "5itV5-
J
TYPE OF BUSINE6S` JAPN #
TANK OWNER J PHONE #
ADDRESS CITY ZIP CODE
CONTRACTOR � � CA LICENSE � ICC #
ADDRESS / _ CITY ZIP CODE
7
PHONE # BAKER5FIELD C USINESS LICENSE # WO COMP # INSURER Lac
BRIEFLY DESCRIBE THE WORK TO BE DONE:
I WATER TO FACILITY PROVIDED BY
I DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
❑ YES ❑ NO 1 ❑ YES ❑ NO
Ti IS SECTION IS FOR STORAGE 7ANK Z DEH7EFIiC F' 7E0N
TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER
�C)
Tank Testing Company TING NAME VS�i� "PANY� �� PHONE NUMBER -7
MAILINdTDDRESS
llama X�<�-doLCe
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
9"
/C /r ,1
FD2086 (Rev 08/09)