HomeMy WebLinkAboutOPI APP 11-30-18PERMIT APPLICATION
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 s Fax: 661 - 852 -2171
Page 1 of 1
Permit #
TYPE OF APPLICATION: 0,eVEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
(CHECK ONE ONLY) ODIFICATION OF FACILITY ❑ MINOR MODIFICATION OF FACILITY
STARTING DATE/ PROPOSED COMPLETION DATE
FACILITY NAME EXISTING FACILITY PERMIT #
FACILITY ADDR ® �` CI ZIP CODE
. t
TYPE OF BUSINE S APN #
TANK OWNER PHONE #
ADDRESS CITY ZIP CODE
CONTRACTOR CA LIC N ICC #
+4
ADDRESS � f CITY � t ZI
.r L
PHONE # ;,.. � � r� � BA RSFIELDCITY BUSINESS C SE # WO_fZKM,AtVS�COM #; .y; I UREA
BRIEFLY DESCRIBE THE WORK TO BE DONE: i �3 t `
tp
WATER TO FACILITY PROVIDED BY
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 SECTEON I FOR STORAGE 7ANK ZDEMT IFZCA7E0'
TANK `# VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER
Tank T eSt"C ng Company
NAME O PHONE R
MAILING ADDRESS P
_A. cft
Lu ��
NAME O�STE � °' 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 GETESTERz , ICC#
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
FD2086 (Rev 11/2015)