HomeMy WebLinkAboutModification Permit App 1-3-17BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK lop Prevention Services
_ ® t., s 'F 0 2101 H Street
PERMIT APPLICATION IRE Bakersfield, CA 93301
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW RTM T Phone: 661 -326 -3979 Fax: 661 - 852 -2171
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
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lPermit#
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
(CHFCII nNF nNI Y) 1521 Mnr)TFTCATTnN nF FACTI TTY rl MTNnR Mnr)TFTCATTnN nF FACTI TTY
STARTING DATE/ 01/03!17
PROPOSED COMPLETION DATE
FACILITY NAME Circle K #2708605
EXISTING FACILITY PERMIT #
FACILITY ADDRESS
5600 Auburn Street
CITY
Bakersfield
ZIP CODE
93306
TYPE OF BUSINESS '
Gasoline Dispensing Facililty
APN #
TANK OWNER
Circle K Stores Inc
PHONE #
(951)270 -5153
ADDRESS
495 E. Rincon St. #150
CITY
Corona
ZIP CODE
92879
CONTRACTOR
B &T Service Station Contractors
CA LICENSE #
902034
ICC #
8201843
ADDRESS
630 S Frontage Rd
CITY
Nipomo
ZIP CODE
93444
PHONE #
(805)929 -8944
BAKERSFIELD CITY BUSINESS LICENSE #
WORKMANS COMP #
INSURER
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Excavated area surroUnding annular Tank 1 87 space sensor to widen area order to access the sensor cap, for removal, In
lid. Removed old sensor, einstalled new Veeder Root 794390 -409 annular sensor and tested.
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED
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 MANUFACTURER
Tank Testing Company
NAME OF TESTING COMPANY
B &T Service Station Contractors
PHONE NUMBER
(805)929 -8944
MAILING ADDRESS
630 S Frontage Rd., Nipomo
NAME OF TESTER
James Welsch
ICC#
8201843
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 PER3URY1 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
/ %3/fr'7
APPROVED BY
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