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Home My WebLink AboutMinor Mod Permit App 8-19-16UNDERGROUND STORAGE TANK U MINOR MODIFICATION OF FACILITY STARTING DATE/ r , °.I PERMIT APPLICATION B B`x s P � TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW FfRJr ARfAI *f TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD EXISTING FACILITY PERMIT # White Lane Chevron Permit # 14 la CITY BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661 - 326 -3979 e Fax: 661 -852 -2171 Page 1 of 1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY CHECK ONE ONLY MODIFICATION OF FACILITY U MINOR MODIFICATION OF FACILITY STARTING DATE/ PROPOSED COMPLETION DATE 09/20/2016 09/20/2016 FACILITY NAME EXISTING FACILITY PERMIT # White Lane Chevron FACILITY ADDRESS CITY ZIP CODE 193304 2525 White Lane Bakersfield TYPE OF BUSINESS APN # GDF TANK OWNER PHONE # Proactive Properties, Inc. dba White Lane Chevron 661 - 832 -9781 ADDRESS CITY ZIP CODE 2525 White Lane Bakersfield 93304 CONTRACTOR CA LICENSE # . ICC # 'Confidence UST Services Inc, 804904 8180171 -U1 /UT ADDRESS 1.6250 Meacham Road CITY Bakersfield ZIP, CODE 933;14 PHONE # 7A KERSFIELD CITY BUSINESS LICENSE # WORKMANS COMP # 1308371 INSURER' SCI''. 661 -631 -3870 32864 BRIEFLY DESCRIBE THE WORK TO BE DONE: I Replace Flex Line in 87 STP. WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE 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 ICC# 8230680 -UT, Triangle# T��—� Douglas Young FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY FD2086 (Rev 08/09)