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HomeMy WebLinkAboutMinor Mod App 7-6-18WATER TO FACIL-r-ly PROVIDED By SOIL TYPE EXPECTED AT SITE DEPTH TO GROUND WATER r; _0F TANKS TO BE INSTALLED i ARE THEY FOR MOTOR FUEL? I SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? 10 YES 0 NO 0 YES E3 NO 7 DIESEL oEp, VOLUME DED PREMIUM D rti nn man r- 7" NAME OF TESI SING COMPANY PHONE NUMBER U.UL- �sq -86C' '"7 nj MAILlENG ADDRESS -3u LA -5 c—+— NAME OF TESTER ICC# L4 k (p Ce THE APFL2CANT HAS RF=C;EXVr=Dr UN0CfZ;5TANVS' AND VVX"- C4;pM'_ff-V WXTL.-g THE �8='rH7= PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PER3URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT, NAME OF Z ES a ER zccz ..S -- - i ` Q LLP- LA L THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFnCIAL USE ONLY DATE APPROVED 1 APPROVED BY SAKE FIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANK. XR2; prevention Services 1501 Truxtun Avenue, 1� Floor Bakersfield, CA 93301 PERMIT APPLICATION jrffRg Phone: 661-326-3979 Fax: 661-852-2171 TO CONSTRUCT-INSTALL NEW TANK (NEW FAC ILIM/NEW ART N' TIANK INSTALL (EXIST ING FACIL-ITY)/MOD-MINOR N!O© Page 1 of I Permit # 7ypE OF APPLICATION,. 0 NEW TANK INSTALL /NEW FIII� ,�01N�EW TAN LL/EXISTING FACILE I MODIFICATION OF FACT >er—MINOR MODIFICA I I A CILITY STARTING DATE/ PROPOSED COMP - — �:l 1 E)CISTING FACILITY PERmT3 FACIL�FN NAME ZIP ODE ACILITY ADDRESS PC, A N # TYPE OF BUSINESS PHONE # TANK OWNER ZIP CCIDE Li CA C E # ICC ADDRESS Colri-RACTOR 9 co 4 twill !III I'll CrTy 01 ZIP 111111111111!1 1 I ADDRESS ADDR 4 __1 (.0a PHONE # AKERSFI LD CITY BUSINE$S� LICE kS WOPKMANS COMP # INSURER BRIEFLY DESCRIBE THE WORK TO BE DONE: WATER TO FACIL-r-ly PROVIDED By SOIL TYPE EXPECTED AT SITE DEPTH TO GROUND WATER r; _0F TANKS TO BE INSTALLED i ARE THEY FOR MOTOR FUEL? I SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? 10 YES 0 NO 0 YES E3 NO 7 DIESEL oEp, VOLUME DED PREMIUM D rti nn man r- 7" NAME OF TESI SING COMPANY PHONE NUMBER U.UL- �sq -86C' '"7 nj MAILlENG ADDRESS -3u LA -5 c—+— NAME OF TESTER ICC# L4 k (p Ce THE APFL2CANT HAS RF=C;EXVr=Dr UN0CfZ;5TANVS' AND VVX"- C4;pM'_ff-V WXTL.-g THE �8='rH7= PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PER3URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT, NAME OF Z ES a ER zccz ..S -- - i ` Q LLP- LA L THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFnCIAL USE ONLY DATE APPROVED 1 APPROVED BY