The URL can be used to link to this page

Home My WebLink AboutUST-APPL. 1/28/2011UNDERGROUND STORAGE TANK a� PERMIT APPLICATION e x s FIRE- - TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW 9 ARi"�jr T TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD r Permit # BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661 - 326 -3979 . Fax: 661- 852 -2171 Page 1 of 1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY I_ .__._ _ I "I ATTr%K1 nr CA!-TI T-rV MW- MTAIr)D Mr)rIT1=Tr'ATTr1N r7F FAr"TI TTY STARTING DATE/ i PROPOSED COMPLETION DATE FACILITY NAME f r �t A t� j AA I EXISTING FACILITY PERMIT # - A - FACILITY ADDRESS 1 t� CITY r 6, 0 1 ZIP CO ° �s CJ TYPE OF BUSINESS �n APN # TANK OWNER PHONE # ADDRESS �� Q ZIP .q13_)rj17 " CONTRACTOR �, CA LICENSE � ICC # ADDRESS d� (�, 4/ 0V PHONE ...� BAKERSFIELD CM., t4SNESS LICENSE # C CITY / WORKMANS COMP ZIP C04 �� INS ER _�A rw BRIEFLY DESCRIBE THE WORK TO BE DONE: 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 Testing Company NAME OF TESTING COMPANY PHONE NUMBER 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# THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE O DATE APPROVED APP VEDBY FD2086 Rev 08/09)