HomeMy WebLinkAboutUST-APPL. 9/28/2015vvztl.�'
PERMIT APPLICATION
TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
[Permit # zSLA2 �000-9 F�
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY
❑ NEW TANK INSTALL /EXISTING FACILITY
CHECK ONE ONLY) I—I MODIFICATION OF FACILITY U MINOR MODIFICATION OF FACILITY
STARTING DATE/
PROPOSED COMPLETION DATE
09/28/2015
FACILITY NAME
EXISTING FACILITY PERMIT #
Samco #5
FACILITY ADDRESS
CITY
ZIP CODE
193304
1131 Oak Street
Bakersfield
TYPE OF BUSINESS
APN #
GDF
TANK OWNER
PHONE #
BYEBYE, Inc.
661 -847 -9949
ADDRESS
CITY
ZIP CODE
3817 Wilson Road, Suite B
Bakersfield
93309
CONTRACTOR
CA LICENSE #
ICC #
COTlf idende UST Services Inc.
8,04904
8339953 -UT
ADDRESS
CITY
ZIP CODE
16250 Meacham Road
Bakersfield
=93314
PHONE #
BAKERSFIELD CITY BUSINESS LICENSE #
WORKMANS COMP #
INSURER
661 - 631 =3870
32864
1308371
SCIF'
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace (4) Spill Buckets with new 5 gal. Phil -Tite Spill Containment Buckets.
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
NAME OF TESTER I 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#
Austin Sterling I 8339953 -UT
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
/x S
FD2086 (Rev 08/09)