HomeMy WebLinkAboutMinor Mod Permit App 9-21-161010
PERMIT APPLICATION
TO CONSTRUCT-INSTALL NEW TANK (NEW FACILITY)/NEW
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
Permit # Ik7-10av-4941
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY
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❑ NEW TANK INSTALL/EXISTING FACILITY
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STARTING DATE/ PROPOSED
BAKERSFIELD FIRE DEPARTMENT
08/01/2016
Prevention Services
FACILITY NAME
2101 H Street
B A& 2 s i-"A� _'D
Bakersfield, CA 93301
FIRN
Phone: 661-326-3979 a Fax: 661-852-2171
ARTMA # IF
2525 White Lane
Bakersfield
Page 1 of 1
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY
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❑ NEW TANK INSTALL/EXISTING FACILITY
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STARTING DATE/ PROPOSED
COMPLETION DATE
08/01/2016
08/0112016
FACILITY NAME
EXISTING FACILITY PERMIT #
I
White Lane Chevron
FACILITY ADDRESS
CITY
ZIP CODE
2525 White Lane
Bakersfield
93304
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 #
1
ICC #
Confidence UST Services, Inc.
804904
8180171-U1 /UT
ADDRESS
16250 Meacham Road
CITY
Bakersfield
ZIP CODE
93314
PHONE#
BAKERSFIELD CITY BUSINESS LICENSE #
WORKMANS COMP #
1308371
INSURER
SCIF
661-631-3870
32864
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace 87 sub-motor (like for like). -- j L_1t-'tC_itj
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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?
�[] YES n NO r]
YES NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
1
12000
x
x
2
12000
x
x
3
12000
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
ICC# 8230680-UT, Triangle# TE
Douglas Young
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
//
APPROVED BY
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