HomeMy WebLinkAboutMinor Mod Permit App 4-26-16rPermlt
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 • 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 ✓❑ MINOR MODIFICATION OF FACILITY
STARTING DATE/ PROPOSED COMPLETION DATE
14/13/16
04/ 13/2016
FACILITY NAME
EXISTING FACILITY PERMIT #
Howard's #4
FACILITY ADDRESS
CITY
Bakersfield 193313
ZIP CODE
3200 Panama Lane
TYPE OF BUSINESS
APN #
GDF
TANK OWNER
PHONE #
(661) 393 -7000
Jaco Hill
ADDRESS
CITY
Bakersfield
ZIP CODE
93380 -2515
P.O. Box 82515
CA LICENSE #
ICC #
CONTRACTOR
Confidence UST Services Inc.
804904
8111231 -UT
CITY
ZIP CODE
ADDRESS
16250 Meacham Road
Bakersfield
93314
PHONE # BAKERSFIELD CITY BUSINESS LICENSE #
WORKMANS COMP #
1308371
INSURER
SCIF
661- 631 -3870 32864
1
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace (1) Veeder -Root Mag Plus Probe and (1) Veeder -Root Mag Plus Float Kit on 91 product.
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED I ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
In YES f7l NO YES f7l NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK # IVOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER
1 12000
2 12000
3 12000
4 12000
Tank Testing Company
NAME OF TESTING COMPANY
Confidence UST Servic
MAILING ADDRESS
16250 Meacham Road,
NAME OF TESTER
X x
x x
x
Inc.
x
PHONE NUMBER
ti61-631 -387
Bakersfield, CA 93314
ICC#
x
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#
8111231 -UT
Bradley Seykora
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
FD2086 (Rev 0