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Home My WebLink AboutOPI-MINOR MOD APP 9-27-18WATER TO FACILI TY PROVIDED BY ai7 Z ` t w _s C.._.- ol 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 SECTION IS FOR STORAGE TANK IDENTIFICATION TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER: I Tank Testing Company Cal tN NAME OF TESTING COMPANY H U ER :2 MAILING ADDRESS 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 PER7URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. NAME OF TESTER _ _ e • TIC C* f 1 ® THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY. FD2086 (Rev 08/09) BAKERSFIELD FIRE DEPARTMENT Prevention Services UNDERGROUND S 'FORAGE .�°�� 1501 Truxtun Avenue, 1st Floor .. OA Bakersfield, CA 93301 PERMIT APPLICATION Phone: 66i- 326 -3979 s Fax: 661 - 852 -2171 - TALL NEW TANK (NEW FACILITY) /NEW TO CONSTRUCT INS TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Page 1 of 1 ',Permit # ^ TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY CHECK ONE ONLY) ❑ MODIFICATION OF FACILITY ��RM ODIFICATI�NO F F ACT STARTING DATE/ PROPOSED CQ EXISTING FACILITY PERMIT # FACILITY NAME ° ° FACILITY ADDRESS CITY ODE TYPE OF BUSINESS � LU APN # # TANK OWNER PHONE ADDRESS CITY, Z CODE CONTRACTOR GA � ICC t.O . ADDRESS c� CITY ZIP PHO E # s BAKE nw C IjY ES LC SE # WORKMANS COMP # INSURER. BRIEFLY DESCRIBE THE WORK TO BE DONE: WATER TO FACILI TY PROVIDED BY ai7 Z ` t w _s C.._.- ol 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 SECTION IS FOR STORAGE TANK IDENTIFICATION TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER: I Tank Testing Company Cal tN NAME OF TESTING COMPANY H U ER :2 MAILING ADDRESS 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 PER7URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. NAME OF TESTER _ _ e • TIC C* f 1 ® THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY. FD2086 (Rev 08/09)