HomeMy WebLinkAbout#775 Minor Mod Permit App 7-6-16UNDERGROUND STORAGE TANK
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PERMIT APPLICATION
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Lerrni # Q./
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
�. 2101 H Street
B x ss g r. D Bakersfield, CA 93301
AFIRR Phone: 661 - 326 -3979 • Fax: 661 -852 -2171
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TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
(CliiECK ONE ONLY) MODIFICATION OF FACILITY ❑✓ MINOR MODIFICATION OF FACILITY
STARTING DATE/ PROPOSED COMPLETION DATE
04/08/2016 04/08/2016
FACILITY NAME EXISTING FACILITY PERMIT #
Fastrip #19 (North)
FACILITY ADDRESS CITY ZIP CODE
Bakersfield 193307
4901 South Union Avenue
TYPE OF BUSINESS
APN #
GDF
TANK OWNER
PHONE #
(661) 393 -7000
Jamieson Hill
ITY
ZIP CODE
ADDRESS
B akersfield
93314
PO Box 82515
CA LICENSE #
ICC #
CONTRACTOR
Confidence UST Services Inc.
80400 4 9 0 4
CITY
ZIP CODE
ADDRESS
Bakersfield
93314
1gw24_ ham, &&qtham Road
.PHONE # BAKERSFIELD CITY BUSINESS LICENSE #
WORKMANS COMP '#
1308371
INSURER
SGIF'
(�f) 5_34- 0i -3870 32864
BRIEFLY DESCRIBE THE WORK TO BE DONE:
ReDiace ECPU2, NV Mem_ and perform cold -start of Veeder -Root TLS -350.
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 M 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
Tank Testing Company
NAME OF TESTING COMPANY PHONE NUMBER
Confidence UST Services Inc. 661 -631 -3
MAILING ADDRESS
16250 Meacham Road, Bakersfield, CA 93314
ICC#
NAME OF TESTER
THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS
PERMIT AND ANY OTHER LOCAL, AND
TO THE BEST OF MY KNOWLEDGE IS TRUE RUE AND CORRECT.
UNDER
PENALTY OF ,
NAME OF TESTER ICC#
Cameron Mason $174721 -UT
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED e� APPROVED BY
! //0/ /� A0 FD2086 (Rev 08/