HomeMy WebLinkAboutUST-APPL 4/10/2015PER..,..:IT APPLICATION .., ... ,_.... ., ....:... .,.,.a ....:.._ .;;:
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TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Permit # /0+�o
FIRE < r
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 • Fax: 661 - 852 -2171
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TYPE OF APPLICATION: ❑ NEW TANK INSTALLINEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
(CHECK ONE ONLY) MODIFICATION OF FACILITY ❑ MINOR MODIFICATION OF FACILITY
STARTING DATE/ d'.. � PROPOSED COMPLETION DATE
FACILITY NAME EXISTING FACILITY PERMIT #
FACILITY ADDRESS _ ZIP CODE
TYPE OF BUSINES APN #
t C
TANK OWNER I A C PHONE #
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
P
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
❑ YES ❑ NO ❑ YES ❑ NO
TH.71S SEEC7EOM HS FOR STORAGE AMK .TIDE 7EF CAT SON
TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER
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Tangy T est°sng Company
NAME =PANY
PHON! ff
ul C:__
MAILING ADDRESS
NAME TER. n ICC#
a 1
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#
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
FD2086 (Rev 08/09)