HomeMy WebLinkAbout#781 Minor Mod Permit App 8-19-16UNDERGROUND STORAGE TANK
PROPOSED COMPLETION DATE
08/05/2016
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PERMIT APPLICATION
B B R S P I IA
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
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TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
APN #
Permit # x`16- 10000473
PHONE #
661 - 393 -7000
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 • Fax: 661 -852 -2171
Page 1of1
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
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STARTING DATE/
08/05/2016
PROPOSED COMPLETION DATE
08/05/2016
FACILITY NAME
Jaco #7781/ Fastrip #22
EXISTING FACILITY PERMIT #
FACILITY ADDRESS
4013 South H Street
CITY
Bakersfield
ZIP CODE
93304
TYPE OF BUSINESS
GDF
APN #
TANK OWNER
Jamieson Hill
PHONE #
661 - 393 -7000
ADDRESS
PO Box 82515
CITY
Bakersfield
ZIP CODE
93380 -2515
CONTRACTOR
Confidence UST Services Inc.
CA LICENSE #
804904
ICC #
8180171 -Ul/UT
ADDRESS
16250 Meacham Road
CITY
Bakersfield
ZIP CODE
93314
PHONE #
661- 631 -3870 1 1
BAKERSFIELD CITY BUSINESS LICENSE #
32864
WORKMANS COMP #
1308371
INSURER
SCIF
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace 87 #2 Vapor Spill Bucket & 91 Vapor Spill Bucket
Correct siphon flex lines in 87 #1 & 87 #2 in STP sumps
*REVISION: Permit # 16- 10000473 (change from Major Mod to Minor Mod, per Kris Karns, discussed w/ Liseth Pisano)
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?
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
X
4
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
Frank (Joe) Landa
ICC#
8018524 -UT
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
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