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Home My WebLink AboutMinor Mod Permit App 11-14-16UNDERGROUND STORAGE TANK PERMIT APPLICATION N TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD [Permit # /610a 22 I TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY (CHECK ONE ONLY) ❑ MODIFICATION OF FACILITY I INOR MODIFICATION OF FACILITY STAR ING DATE/ PROPOSED COMPLETION DATE FA TY NAME EXISTING FACILITY PERMIT # TYPE U INE£S APN # TANK OWNER V PHONE # 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 ❑ YES ❑ NO THIS SECTION IS FOR STORAGE 7APIK IDE NTEFECAT'ION TANK# VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER TANK MANUFACTURER Tank Vesting ComPani,P NAME OF TE$.TINtCQMP y PHONE NUMBER �� ! MAILING i0=�► w1m?40 .. ., , . FOR OFFICIAL USE ONLY DATE APPROVED' APPROVED BY Q %/2// FD2086 (Rev 11/2015) AKERSFIELD FIRE DEPARTMENT Prevention Services B DE .R 5 F, D 2101 H Street :�� .t. ANTS T Bakersfield, CA 93301 phone: 661 - 326 -3979 + Fax: 661- 852 -2171 Page Iof1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY (CHECK ONE ONLY) ❑ MODIFICATION OF FACILITY I INOR MODIFICATION OF FACILITY STAR ING DATE/ PROPOSED COMPLETION DATE FA TY NAME EXISTING FACILITY PERMIT # TYPE U INE£S APN # TANK OWNER V PHONE # WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO ❑ YES ❑ NO THIS SECTION IS FOR STORAGE 7APIK IDE NTEFECAT'ION TANK# VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER TANK MANUFACTURER Tank Vesting ComPani,P NAME OF TE$.TINtCQMP y PHONE NUMBER �� ! MAILING i0=�► w1m?40 .. ., , . FOR OFFICIAL USE ONLY DATE APPROVED' APPROVED BY Q %/2// FD2086 (Rev 11/2015)