HomeMy WebLinkAboutMinor Permit App 2-3-17:x
BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK
Prevention Services
' 1501 Truxtun Avenue, 1st Floor
PERMIT APPLICATION Bakersfield, CA 93301
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW /r/tl Phone: 661 -326 -3979 • Fax: 661 -852 -2171
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD AtT�
Page 1 of 1
TYPE OF APPLICATION: 0 NEW TANK INSTALL/NEW FACILITY O NEW TANK INSTALL/EXISTING FACILITY
CHECK ONE ONLY 0 MODIFICATION OF FACILITY O MINOR MODIFICATION OF FACILITY
STARTING DATE/ :PROPOSED COMPLETION DATE
FACILITY NAME
EXISTING..FACi1:i1Y'PERMiT
FACILITY ADDRESS ` ZIP CO eA
TYPE OF BUSIN APN #
TANK OWNER PHONE # r
ADDRESS CITY ZIP CODE
WATER' TO FACILITY PROVIDED BY
p`,Lfl TO GROUND WATER SOIL TYPE EXPECTED AT SITE
.f OF `[ANKS�70 BE INSTALLED ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
❑ YES ❑ NO ❑ YES ❑ NO
,1 IlOMSECTION IS FOR STORAGE TANK IDENTIFICATION
r VOLtiN uNm u"R PuM :aim: oTHR
F.i tly _ V.
•
Tank Testing Company
NAME OF TEyT1N6 CO PHONE NUMBER
NATMG ADDRESS "1
i NAME OF TESTER IOC j
0 1p L 1, 6
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 PER3URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
NAME OF TES Icca
. THIS APPLICATION BECOMES A, PERMIT WHEN APPROVED
FOR OFFICIAL. USE ONLY
aPPx D sir
FD2086 (Rev 08/09)