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Home My WebLink AboutMinor Mod Permit App 10-17-16BAKERSFIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANK Prevention Services 2101 H Street PERMIT APPLICATION Afflz R r s r V Bakersfield, CA 93301 TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW FIRE Phone: 661- 326 -3979 •Fax: 661 - 852 -2171 iff TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD ARtA/ Page 1 of 1 M Permit # TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY (C'HEC'K nRIF nN1 Y) I—I Mnr)TFTrATTC)N C)F FAC'TI TTY n MTNOP monTFWATTC)N C)F FAC'TI TTY STARTING DATE /. 10/03/2016 110/3/16 PROPOSED COMPLETION DATE FACILITY NAME Howard's #4 EXISTING FACILITY PERMIT # FACILITY ADDRESS 3200 Panama Lane CITY Bakersfield ZIP CODE 93313 TYPE OF BUSINESS GDF APN # TANK OWNER Jaco Hill PHONE # (661) 393 -7000 ADDRESS P.O. Box 82515 CITY Bakersfield ZIP CODE 93380 -2515 CONTRACTOR Confidence UST Services Inc. 1 CA LICENSE # 804904 ICC # 8174721 -UT ADDRESS 16250 Meacham Road CITY Bakersfield ZIP CODE 93314 PHONE # 661 -631 -3870 BAKERSFIELD CITY BUSINESS LICENSE # 32864 WORKMANS COMP # 1308371 INSURER SCIF BRIEFLY DESCRIBE THE WORK TO BE DONE: Troubleshoot and repair as needed: 87 #1 WPLLD. WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? YES n NO SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? YES NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATIO TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER 1 12000 x x 2 12000 x x 3 12000 x x 4 12000 x Tanis 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 Bradley Seykora ICC# 8111231 -UT THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY