HomeMy WebLinkAboutMajor Mod Permit App 11-7-16BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK Prevention Services
2101 H Street
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PERMIT APPLICATION B g,.x s P I Bakersfield, CA 93301
TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW FIRS Phone: 661 - 326 -3979 • Fax: 661- 852 -2171
TANK INSTALL (EXISTING FACILITY)JMOD -MINOR MOD
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Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
CHECK ONE ONLY) n MODIFICATION OF FACILITY ❑ MINOR MODIFICATION OF FACILITY
STARTING DATE/
PROPOSED COMPLETION DATE
TBD
FACILITY NAME
EXISTING FACILITY PERMITfi
Mesa Marin Chevrn
FACILITY ADDRESS
CITY
ZIP CODE
193306
11101 Highway 178
1 Bakersfield
TYPE OF BUSINESS
APN #
GDF
TANK OWNER
PHONE #
Muthana Corporation
(661) 366 -4886
ADDRESS
CITY
ZIP CODE
193306.
11101 Highway 178
1 Bakersfield
ADDRESS CITY ZIP CODE
16250!Meacharn Road Bakers'ffield 93314
pHnniF BAKERSFIELD CITY BUSINESS LICENSE 4. WORKMANS COMP # INSURER
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replaced functional element, check valve and packer O -ring on diesel tank (10/26/16).
Excavate to install a valve on Diesel to determine source of no pressure ate
4 10,K h
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 ICC#
Bryan Self 8022804 -UT
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
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FD2086 (Rev 08/09)