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Home My WebLink AboutRevised Minor Mod Permit App 9-21-16BAKERSFIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANK STARTING DATE/ PROPOSED Prevention Services 09/20/2016 09/20/2016 2101 H Street PERMIT APPLICATION White Lane Chevron a s P n Bakersfield, CA 93301 TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW ZIP CODE FIRS ARTM T Phone: 661 -326 -3979 • Fax: 661 -852 -2171 TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD TYPE OF BUSINESS APN # Page IofI !Permit # :a PHONE # Proactive Properties, Inc. dba White Lane Chevron TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY nA/lY1TCT1— ATT^1%1 nE' rAr^T1 2525 White Lane T-rV M MTKlnD Mr)r)TFTr'ATTr)N r)F FAr'TI TTY STARTING DATE/ PROPOSED COMPLETION DATE 09/20/2016 09/20/2016 FACILITY NAME EXISTING FACILITY PERMIT # 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 # 1 BAKERSFIELD CITY BUSINESS LICENSE # WORKMANS COMP # 1308371 INSURER SCIF 661- 631 -3870 32864 BRIEFLY DESCRIBE THE WORK TO BE DONE: Replace Flex Line in 87 STP. Disconnect 87 primary line to install fittings. - 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 n 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 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 1 D20$6 (Rev 08/09)