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Home My WebLink AboutMINOR MOD APP 7-11-18UNDERGROUND STORAGE TANK PERMIT 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 1of1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY r�mr_ e,,N11 v1 n MnnTGTrA-rrnni n1Z FAr^Ti TTV r/ MTNnR Mnr)TFTCATTnN nF FA(M TTY STARTING DATE/ PROPOSED COMPLETION DATE FACILITY NAME Arco AM PM _[FACILITY EXISTING FACILITY PERMIT .# ADDRESS 1800 Brundage Lane CITY Bakersfield ZIP CODE 93306 TYPE OF BUSINESS Retail Gas Station APN # TANK OWNER MJM Interprises - Munther Hawatmeh PHONE # 661 -703 -7273 ADDRESS 3117 Niles Street CITY Bakersfield ZIP CODE 93307 CONTRACTOR Complete Fueling Solutions CA 4I E615A (� t�j� ICC # 5246167 ADDRESS 12601 Jasmine Ave. CITY Bakersfield ZIP CODE` 93312 PHONE # 661 -573- 7171 BAKERSFIELD CITY BUSINESS LICENSE # 16- 00134472 WORKMANS COMP #. - C48093504 INSURER A C E BRIEFLY DESCRIBE THE WORK TO BE DONE: Repair Diesel sump product line penetration 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 THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER 10 000 X Tank Testing Company NAME OF TESTING COMPANY Rich Environmental PHONE NUMBER 661 -392 -8687 MAILING ADDRESS 5643 Brooks Ct., Bakersfield, CA 93308 NAME OF TESTER James Rich 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 TESTER ICC# THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY