HomeMy WebLinkAboutMinor Mod Permit App. 7-7-16UNDERGROUND STORAGE TANK
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A
PERMIT APPLICATION B E R S 13W
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11 1
TO CONSTRUCT-INSTALL NEW TANK (NEW FACILITY)/NEW RF03'
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TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD 'j �N ARTAr
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 e Fax: 661-852-2171
Page I of I
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
i-V e-IMr- n1\1 I V 17-1 mr')nTPTr'ATTnt\i CAF FA(--TI T-ry n MINOR MODIFICATION OF FACILITY
STARTING DATE/ PROPOSED
1
COMPLETION DATE
07/05/2016
07/05/2016
-
FACILITY NAME
'
FACILITYPERM IT
EXISTING
Fastrip #641
I
FACILITY ADDRESS
Bakersfield
ZIP CODE
93308
1200 Coffee Road
TYPE OF BUSINESS
APN #
GDF
TANK OWNER
PHONE #
(661) 393-7000
Jamieson Hill
ADDRESS
CITY
Bakersfield
ZIP CODE
93314
PO Box 82515
CONTRACTOR
CA LICENSE #
8 04904
I b:
. C' 14 ,
1 : . !
8339963 -UT
Confidence UST Services, Inc.
ADDRESS
CITY
ZIP CODE
16250 Meacham Road
Bakersfield
:93314
PHONE #
BAKERSFIELD CITY BUSINESS LICENSE #
WOPKMANS COMP #
INSURER
SCIF
661-631-3870
32864
1308371,
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace Veeder-Root 794390-420 sensor in 91 annular with new Veeder-Root Micro Sensor (794380-344) and install Type "A" Interface
Module.
WATER TO FACILITY PROVIDED BY
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?
1[] YES 01 NO
M YES NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL,
OTHER:
12000
12000
X
X
2
x
x
3
12000
x
Tank Testing Company
NAME OF TESTING COMPANY PHONE NUMBER I
Confidence UST Services Inc. , 661-631-3870
MAILING ADDRESS
16250 Meacham Road, Bakersfield, CA 93314
NAME OF TESTER XCC#
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
TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
PENALTY OF PERJURY, AND
NAME OF TESTER
ICC# 8174721 -UT
Cameron Mason
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY