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Home My WebLink AboutMinor Mod Permit App #2 8-12-16BAKERSFIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANK Prevention Services PERMIT APPLICATI .. sE 2101 H Street R.s_.F i a 9Q �� i�E �� Bakersfield, CA 93301 �� ® TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY)/NEW �.f.�'`' Phone: 661- 326 -3979 Fax: 661- 852 -2171 TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Page 1 of 1 Permit # TYPE OF APPLICATION. ❑ NEW TANK INSTALLINEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY (CHECK ONE ONLY) ❑ MODIFICATION OF FACILITY INOR MODIFICATION OF FACILITY STARTI DATE/, PROPOSED COMPL ON DATE FACILITAN U EXISTING FACILITY PERMIT FACILITY ADDAESS C9 ZIP TYPE OF INESS APN # i (VA C_J TANK PHONE # ADDRESS CITY ZIP CODE CONY LI E w1 IC ADDRgSS //- � C ZI PHONE # � BAKERSFIE1 r) CITY USINESS LICENSE # WORKMANS t, P INSURER BRIEFLY DESCRIBE THE WORK TO BE DONE: CA-CLI L13 e 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 ❑ NO ❑ YES ❑ NO TE-01S SECTION IS FOR 570RAGGE 7AHK IDEH7EFICA7Z0N TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER TANK MANUFACTURER Tank Testing Company NAM F STI OMPANY PHONE NU -s7 7 MAIIJNG AD ESS oto NAME -a6 TE TER 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. �PIAN}E VF TEST R ICC# THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY FD2086 (Rev 11/2015)