HomeMy WebLinkAboutUST-APPL. 3/12/2015UNDERGROUND STORAGE TANK
COMPLETION DATE
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13
E R S F T
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PERMIT APPLICATION
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TO CONSTRUCT-INSTALL NEW TANK (NEW FACILITY)/NEW
APN #
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TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
ADDRESS
1129 Union Ave.
CITY
Bakersfield
ZIP CODE
93307
CONTRACTOR
Advanced Compliance
CA LICENSE #
1971259 C61/
Permit #
ADDRESS
3704 Littlefalls Ct.
CITY
Bakersfield
TYPE OF APPLICATION:
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page I of I
❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
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STARTING DATE/ PROPOSED
COMPLETION DATE
FACILITY NAME
California Mini Mart
EXISTING FACILITY PERMIT #
FACILITY ADDRESS
1129 Union Ave.
CITY
Bakersfield
ZIP CODE
93307
TYPE OF BUSINESS
Gas Station
APN #
TANK OWNER
California Mini Mart
PHONE #
ADDRESS
1129 Union Ave.
CITY
Bakersfield
ZIP CODE
93307
CONTRACTOR
Advanced Compliance
CA LICENSE #
1971259 C61/
ICC #
40 8032698
ADDRESS
3704 Littlefalls Ct.
CITY
Bakersfield
ZIP CODE
PHONE #
661-706-4321 I
B AKERSFIELD CITY BUSINESS LICENSE #
WORKMANS COMP #
INSURER
BRIEFLY DESCRIBE THE WORK TO BE DONE: Replace Diesel PLLD Line Leak Detector Like For Like.
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEL?
1 ❑ 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
1
X
2
X
3
X
X
Tank Testing Company
NAME OF TESTING COMPANY
Advanced Comoliance
PHONE NUMBER
661-706-4321
MAILING ADDRESS
3704 Littlefalls Ct. Bakersfield, Ca. 93312
NAME OF TESTER
Bruce W. Hinsley
ICC#
8032698
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
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
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