HomeMy WebLinkAboutMinor Mod Permit App 12-27-16O
Permit # Z& wo ;7oo
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
CHECK ONE ONLY
MODIFICATION OF FACILITY Q MINOR MODIFICATION OF FACILITY
STARTING DATE/
PROPOSED COMPLETION DATE
11/18/2016
11/18/16
FACILITY NAME
EXISTING FACILITY',PERMIT� # .
Phillips 76
FACILITY ADDRESS
CITY
ZIP CODE
193304
2501 White Lane
Bakersfield
TYPE OF BUSINESS
APN #
GDF
TANK OWNER
PHONE #
Manjit Singh
661- 397 -3722
ADDRESS
CITY
ZIP CODE
2501 White Lane
Bakersfield, CA
93304
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#
Dustin Reese, Tim Capehart 8216722 -UT, 8414476 -UT
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
FD2086 (Rev 08/09)