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HomeMy WebLinkAboutUST-APPL 9/23/2013UNDERGROUND STORAGE TANK ��il�,/ 1-.'/%//.% Y%//.. �6.. N�". G.: �///./?/ ��/ 6�: �N% A�. C( O/./. Y// cIIGY/ ��Y/. lr. ��GY/• �sC�L///. ui, GS. r< •sG.c;�.ra�,ccrrriw.;Uiu«i�,�.: PERMIT APPLICATION TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD ;Permit # ` BAKERSFIELD FIRE DEPARTMENT t Prevention Services 2101 H Street JADAIT-JALF n Bakersfield, CA 93301 Phone: 661- 326 -3979 • Fax: 661 -852 -2171 r Page 1 of 1 TYPE OF APPLICATION:. CJ NEW TANK INSTALL /NEW FACILITY O NEW TANK INSTALL /EXISTING FACILITY PHONE #,�v 6 � TANK OWNER 0 is 1- �,+ � -^ �^ +� ADDRESS � ('J� � ;� U` ` � . ..........................:.... CITY ZIP CODE S� ..: �'^7.1�. G � t� r 1 � L-�:r:•:::::.:.:.::;. ;;:::::;.::; `��: ©E�::::: (� ) �.. ...•:• ::...:::.......:::.....:• .•:...: �.•,::•:;•.. .:..,;::.:::•:;.:.:.::• °:;•:�:• •:.;�:::�:.•::•::::r.r: r: ::'r:; '•:.:.. .. ... . !'tS.1 rCFNSF. #.. ..... ...... .ICC.. #.. .. .. BRIEFLY DESCRIBE THE WORK TO BE DONE: - LACi-: Q C 4 L.-.t Q E VACQQVI.-A S F-t-j S®iZ . WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER 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 THIS SECTIONS IS FOR STORAGE TANK IDENTIFICATION Tank Testing Company NAME OF TESTING COMPANY .� i� PHONE NUMBER j ` - 5 � MAILING ADDRESS 6 6 2 0 O -SF- A LE- HG%i;5-A It- Z NAME OF TESTER IC C# TAC;�:(T 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 ONLY V 08 /0