HomeMy WebLinkAboutMAJOR MOD APP 5-21-18BAKERSFIELD FIRE DEPARTMENT
Prevention services
UNDERGROUND STORAGE TANK '* " ""fi,
2101 H Street-
Bakersfield, CA 93301
PERMIT APPLICATION V �A R rw4f,"', r Phone: 661-326-3979 Fax: 661-852-2171
TO CONSTRUCT-INSTALL NEW TANK (NEW FACILITY) /NEW 00
TANK INSTALL (EXISTING FACII-ITY)/MOD-MINOR MOD Page I of 1
.. . ....... . .... .. . ......... . . . .............
Permit #
I.............. ................ 1.1.�1.1-1-111 .......... ............
TYPE OF APPLICATION 0 NEW TANK INSTALL/NEW FACILITY 0 NEW TANK INSTALL /EXISTING FACILITY
NAnnTT=TrA-rT0r\1 OP FAt—Tf TTY 0 MINOR MODIFICATION .0-F FACILITY
STARTTNG DATE/
PROPOSED COMPLETION DATE
-
EXISTING F,�RTTY PERMrr #
FACILITY NAME
u
... ............... .... .
FACILITY ADDRESS
CI TY,
TYPE OF BUSINESS f
APN
TANK O NNER
PHONE # U)
_ f
ADDRESS
IP DE
744 0 D
- —
CONTRACTOR
CA C�NSE_ # fcc
CODE
ADDRIESS
ZIP
CITY 9 A%4 -7 s-
PHONE BAKERSFIELD CITY BUSINESS LICENSE&
LO
BRIEFLY DESCRIBE T14E WORK TO BE DONE:
Au
tT
W 'ER TOFACILITY PROVIDED or
DFP'T-i TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED ARE THEY FOR r,4OTOR FUEL..?
I
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
0 NO
Ei YES C3 NO
_0 YES
5 Hf), R 0 FIK A E 11'A lr e, I D Ell" 11'T
A 4A U
TANK # VOLUME
UNLEADED
REGULAR
PREMIUM DIESEL OTHER
TANK MANUFACTURER
Do 00
U^
boo
0 a
T.,- Ty Sthlg CGi13P'1`!Y
NAME OF TESTING COMPANY
PHONE NUMBER
. .. . ............
MAILING ADDRESS
'icc#
i
NAME OF TESTER
THE APPLICANT HAS RECEIVED, UNDERSTANDS,
AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS
THIS FORM HAS BEEN COMPLETED UNDER
PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS.
THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
PENALTY OF PERJURY, AND TO
NAME OF TESTER
... . .......
ICC#
DATE APPROVED
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
APPROVED BY
jFb Z086 {Rev 11/2015)
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