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Home My WebLink AboutMINOR MOD APP 8.14.18PERMIT APPLICATION TO CONSTRUCT-INSTALL NEW TANK (NEW FACILITY)/NEW TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD Permit # BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 ® Fax: 661-852-2171 Page I of 1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY fr_LjC:(_11 nr\l= nN11 V� M Mr)r)T1=TrATT0K1 r);= i=arfl TTY M MINOR MODIFICATION OF FACILITY STARTING DATE/ — PROPOSED 19 )(r CQ"PLEQ014 E 8, FACILITY NAM EXISTING FACILITY PERMIT # FACILITY ADDRfT CITY S S� 0-i Ck ZIP CODE 1 C551 TYPE OF BUSIN,25SM APN # TANK OWNER PHONE # ADDRESS CITY ZIP CODE CONTRACTOR Ek IC_C-# ADDRESS j2 CI f ZZT af PHONE # k T BAKER CI BUSINESS C NSE # �Ilu WOWjA_NOM P# 1.0 INXJREP, BRIEFLY DESCRIBE THE WORK TO BE DONE: CA-r or 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 THE' S SECTEON ES FOR ST ORAGE 7A MK Z,1DEN7ZF_7 Chi 72OM TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER C=Pk lank Testing Company NAME OF TESTING COM NY PHONE NUMBER MAILING ADDRESS fc, Lie 4Lo_ 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 TESTE1r_ ad, C ] ' � u. ICC# THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY Pn') n;z A (P. 11 P) n 1 r,) hi