HomeMy WebLinkAboutMinor Mod Permit App 7-28-16UNDERGROUND STORAGE TANK
PERMIT APPLICATION
TO CONSTRUCT-INSTALL NEW TANK (NEW FACILITY)/NEW
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
Permit # 16 - lw el �
TYPE OF APPLICATION: ❑
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NEW TANK INSTALL/NEW FACILITY
Mr)r)TPTr'ATTnN C)P FAMI TTY
❑ NEW TANK INSTALL/EXISTING FACILITY
MINOR MODIFICATION OF FACILITY
STARTING DATE/
PROPOSED COMPLETION DATE
07/19/2016
07/19/2016..
FACILITY NAME
EXISTING FA LI !N PERMIT
Fastrip #32
FACILITY ADDRESS
CITY
Bakersfield
ZIP ODE
'P C
93309
3701 Ming Avenue
TYPE OF BUSINESS
APN #
GDF
TANK OWNER
PHONE #
(661) 393-7000
Jamieson Hill
ADDRESS
CITY
Bakersfield
ZIP CODE
93380-25 15
PO Box 82515
.
CONTRACTOR
Confidence UST Services, Inc.
804904
I c
C
8174721 -UT
ADDRESS
CITY
Bakersfield
ZIP CODE
1 314
16250 Meacham Road
PHONE # BAKERSFIELD CITY BUSINESS LICENSE #
WORKMANS COMP #"
1308371
INSURER
SCIF
6 6 1 -631-3870 32864
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace Phil-Tite (Fill) Spill Buckets on 87 & 91 products.
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED
THEY FOR MOTOR FUEL?
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
JE]_ YES n NO
YES NO
_M
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
12000
X
X
2
12000
X
X
3
12000
X
Tank Testing Company
NAME OF TESTING COMPANY PHONE NUMBER
Confidence UST Services, Inc.
MAILING ADDRESS
16250 Meacham Road, Bakersfield,_ CA 93314
NAME OF TESTER 1, 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
TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
PENALTY OF PERJURY, AND
NAME OF TESTER ICC# 8174721 -UT
Cameron Mason
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
APPROVED BY
DATE APPROVED
9 1-og 116