HomeMy WebLinkAboutMinor Mod Permit App 9-2-16UN
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
CHECK ONE ONLY
MODIFICATION OF FACILITY U
MINOR MODIFICATION OF FACILITY
STARTING DATE/
PROPOSED COMPLETION DATE
09/02/2016
912116
FACILITY NAME
EXISTING FACILITY PERMIT #
Fastrip #640 (West)
FACILITY ADDRESS
CITY
ZIP CODE
193309
8001 White Lane
Bakersfield
TYPE OF BUSINESS
APN #
GDF
TANK OWNER
PHONE #
Jaco Hill
(661) 393 -7000
ADDRESS
CITY
ZIP CODE
P.O. Box 82515
Bakersfield
93380 -2515
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace DSL secondary line test boot (coupling) in UDC #11/12. Repair DSL annular (per failed S6989 test).
Tank Testing Company
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#
Cameron Mason $174721 -UT
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
2086 (Rev 08/09)