HomeMy WebLinkAbout#725 Minor Mod Permit App 3-14-16UNDERGROUND STORAGE TANK
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03/04/2016
PERMIT APPLICATION
B BR S PI D
TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW
1
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TANK INSTALL EXISTING FACILITY)/MOD-MINOR MOD
Fastrip #19
FACILITY ADDRESS
Permit # 6•- I 0 ®� O
CITY
iBAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 e 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 k/1 MINOR MODIFICATION OF FACILITY
STARTING DATE/
PROPOSED COMPLETION DATE
03/04/2016
0/04/2016
FACILITY NAME
EXISTING FACILITY PERMIT #
Fastrip #19
FACILITY ADDRESS
CITY
ZIP CODE
4901 South Union Avenue
Bakersfield
93307
TYPE OF BUSINESS
APN #
GDF
TANK OWNER
PHONE #
Jamieson Hill
(661) 393 -7000
ADDRESS
CITY
ZIP CODE
PO Box 82515
Bakersfield
93314
CONTRACTOR
CA LICENSE #
ICC #
Conf idence UST Services Inc'.
80404 9 04
ADDRESS
CITY
ZIP CODE
16jW24_%VnaM@atham Road
Bakersf field
93314
PHONE .#
BAKERSFIELD CITY BUSINESS LICENSE
#
WORKMANS COMP #
INSURER
(0664 -983 61 -3870,
32864
1308371
SCIF
BRIEFLY DESCRIBE THE WORK TO BE DONE:
r on Diesel tank.
WATER TO FACILITY PROVIDED BY
I DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
NAME OF TESTING COMPANY PHONE NUMBER
Confidence UST Services Inc. 661 -631 -3870
MAILING ADDRESS
16250 Meacham Road, Bakersfield, CA 93314
NAME OF TESTER I 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 ICC#
Austin Sterling 8339953 -UT
FOR OFFICIAL USE ONLY
DATE APPROVED j APPROVED BY
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