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Home My WebLink About#725 Major Mod Permit App 9-29-16UNDERGROUND STORAGE TANK TYPE OF APPLICATION: rruGry nNG nNi V) BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661 -326 -3979 • Fax: 661- 852 -2171 Page 1 of 1 ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY n Mr)nTi:TrnTTnN ni: ForTi TTY r1 MTNnR MODTFTCATTON nF FACTLTTY STARTING DATE/ PROPOSED 9/26/2016 PR COMPLETION DATE 9/30/2016 FACILITY NAME Fastrip Food Store EXISTING FACILITY PERMIT # 15-021-03076 FACILITY ADDRESS 409 S. Union Ave CITY Bakersfield ZIP CODE 93307 TYPE OF BUSINESS C-Store / Gas Station APN # TANK OWNER Jamieson Hill PHONE # ADDRESS PO Box 82515 CITY Bakersfield ZIP CODE 93380 CONTRACTOR Jaco Oil CA LICENSE #970529 ICC # 8325633 ADDRESS PO Box 82515 CITY Bakersfield ZIP CODE 93380 PHONE # 661 - 633 -7534 ?BA�KE.IRSFIELD CITY BUSINESS LICENSE # 00118289 WORKMANS COMP # WC3486600 INSURER American Zurich his C BRIEFLY DESCRIBE THE WORK TO BE DONE: Repair secondary containment sump a dispenser 9/10 by breaking concrete and fiberglassing window WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED 0 ARE THEY FOR MOTOR FUEL? ❑ YES ❑ NO SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER Tank Testing Company NAME OF TESTING COMPANY Confidence UST Services PHONE NUMBER MAILING ADDRESS NAME OF TESTER Bryan Self ICC# 8022804 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# THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY � cn�noc row.. ntt /nOl