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Home My WebLink AboutMINOR APP 8-16-18UNDERGROUND STORAGE TANK Page 1of1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY i� rry �nm �n11 v\ 1-1 KAfAMTCT!`ATTnK1 nc CAI-Ti TTV r MTKInD MnI7T1=TrATTnNV r);= 1=ArTI TTY STARTING DATE/ / �" l� ✓ BAKERSFIELD FIRE DEPARTMENT Prevention Services PROPOSED COMPLETION DATE n ✓ /�y l// 2101 H Street Bakersfield, CA 93301 FACILITY ADDRESS Phone: 661- 326 -3979 • Fax: 661 -852 -2171 Page 1of1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY i� rry �nm �n11 v\ 1-1 KAfAMTCT!`ATTnK1 nc CAI-Ti TTV r MTKInD MnI7T1=TrATTnNV r);= 1=ArTI TTY STARTING DATE/ / �" l� ✓ PROPOSED COMPLETION DATE n ✓ /�y l// FACILITY NAM '4tyj 19M EXISTING FACILITY PERMIT # FACILITY ADDRESS CITY -7 ZIP TYPE OF BUSINESS / APN # TANK OWNER � � � , &6 PHONE # ADDRESS • CITY ZIP CODE L CONTRACTOR N / CA LICENSE # ICC # ADDRESS p j G T 6 Cm /3�' � `� � ®� f ZIP Co, 3, F PHONE # / G / - t�3 7 - `? < T6 BAKERSFIEjp " 41 ;k BUSINESS LICENSE # WORKMANS fw # 0 t7 10 INSURER L BRIEFLY DESK "I TBE THE WORK TO BE DONE: WATER TO FACILITY PROVIDED BY j DEPTH TO GROUND WATER / SOIL TYPE EXPECTED AT SITE o # OF TANKS O STALLED 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 UN ED REGULAR PREMIUM DIESEL OTHER Tank Testing Company NAME OF TESTING COMPANY � l�l,r 3Y - � � • PHONE NUMBER � ` �v -7 f6;-lj MAILING ADDRESS ® a 6 / NAME OF TEST RS 4 G 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 TE TER G r �i ICC# THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY cn ,)nQA fc)." I I i ,)nl S)