HomeMy WebLinkAboutMinor Mod App 7-20-181 ' f / i
PERMIT APPLICATION
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Permit #
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AKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 m Fax: 661- 852 -2171
Page 1 of 1
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALLIEXISTING FACILITY
C.Ht:(K UNl- UNLY) U MUDII -1[_A 1 lUN U1- f-AUL11 Y U MINOR MODIFICATION OF FACILITY
STARTI ATE/ PROPOSED COMPLETION DATE
FACILI NAME. EXISTING FACILITY PERMIT #
FACILI. r S y C j Z E
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TYPE OF INESS F APN #
TANK OWNER U PHONE #
ADDRESS CITY ZIP CODE
CONT CA LICEN E # ICC #
ADDRESSa� C
1- Z
PHONE # BAKERSFIELD CITY BUSI E S LICENSE # W KMANS COMP # INSURER �
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BRIEFLY DESCRIBE THE WORK TO BE DONE:
I 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 1 ❑ YES ❑ NO
THIS SEC710H IS FOR STO R E T ai N EDEMTEF Q;,11 P LC
TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER TANK MANUFACTURER
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Tank Testing Company
INAME Pa PANY/ / PHONE NUMBER "
FOR OFFICIAL USE ONLY
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DATE APPROVED APPROVED BY
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