The URL can be used to link to this page

Home My WebLink AboutUST PERMIT APPL. 10/30/2015UNDERGROUND STORAGE TANK �=1_ � T �{ PERMIT APPLICATION B E x s P I D TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW FlRl T fir ANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD aRTA1 Permit # TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY 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 /EXISTING FACILITY CHECK ONE ONLY) n MODIFICATION OF FACILITY U MINOR MODIFICATION OF FACILITY STARTING DATE/ PROPOSED COMPLETION DATE 10/30/2015 10130/15 FACILITY NAME EXISTING FACILITY PERMIT Arco AM PM FACILITY ADDRESS CITY ZIP CODE 900 Monterey Street Bakersfield 93305 TYPE OF BUSINESS APN # GDF 015 - 210 -16 TANK OWNER PHONE # Sam Stardust Enterprises, Inc. 661 - 721 -8911 ADDRESS CITY ZIP CODE 900 Monterey Street Bakersfield 93305 CONTRACTOR' CA LICENSE # ICC # Confidence UST Services, Inc. 804904 8180171 -U1 ADDRESS CITY ZIP CODE 16250 Meacham Road,, Bakersfield 93314 PHONE # BAKERSFIELD CITY BUSINESS LICENSE # WORKMANS COMP # INSURER (661) 631 -3870 32864 1308371 SCIF BRIEFLY DESCRIBE THE WORK TO BE DONE: Perform Cold -Start following installation of TLS 350 software version 334.00 ISD version 01.05. WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE MAILING ADDRESS NAME OF TESTER 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# Bryan Self I 8022804 -UT THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY FD2086 (Rev 08/09)