HomeMy WebLinkAboutUST-APPL. 7/18/2016BAKERSFIELD FIRE DEPARTMENT
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l� E`i�G R U T G E TA !C ���� Services
Prevention S
Street
2101 H s
PERMIT w, APPLICATION
ins FIRE � Bakersfield, CA 93301
�RrM r Phone: 661- 326 -3979 • Fax: 661 -852 -2171
b0 CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW � �� ;xz'
TANK INSTALL (EXISTING FACILITY) %MOD -MINOR MOD
Page 1 of 1
IPermit # /& -
TYPE OF APPLICATION: ❑ NEW TANK INSTALLINEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
(CHECK ONE ONLY) ❑ MODIFICATION OF FACILITY INOR MODIFICATION OF FACILITY
STARTING DATE/ PROPOSED. COMPLETION -DATE,
FACILIAME � � � � � � i �� .EXISTING F4CILITY PERMIT
FACILITY ADDRE S �, CI ZIP
t � b S12
TYPE OFj5D51NESS ' APN #
TANK OWNER PHONE #
ADDRESS CITY ZIP CODE
GONTRRCT LICENSE jam. /
ADDRESS CITY ZIP C DE
PHONE # � B IELD % C INES LICENSE # MANS C MP # INSURER �
,
BRIEFLY DESCRIBE THE WORK TO BE DONE:
I WATER M 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
THIS SECTION IS FOR S70 AGE 7A,MK IDZ —M7Z HCATaO
TANK# VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER TANK MANUFACTURER
Tank Testing Company
NAME TE ANY C PHONE NUMBER
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
FD2086 (Rev 11/2015)