HomeMy WebLinkAboutMINOR MOD APP 9-6-18UNDERGROUND STORAGE TANK
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TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 -326 -3979 • Fax: 661- 852 -2171
Page 1 of 1
❑ NEW TANK INSTALL /EXISTING FACILITY
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STARTING DATE/
PROPOSED COMPLETION DATE
8/20/18
8/24/18
EXISTING FACILITY PERMIT #
FACILITY NAME
15- 021 - 003021
Fastrip Food Store
CITY
ZIP CODE
FACILITY ADDRESS
Bakersfield
933Q9
6401 White Ln
TYPE OF BUSINESS
APN #
C -Store / Gas Station
PHONE #
TANK OWNER
661 - 393 -7000
Jaco Hill
CITY ZIP CODE
ADDRESS
PO Box 82515 Bakersfield 9338Q
CA LICENSE #
ICC #
CONTRACTOR
970529
8723752
Jaco Oil Company
CITY
ZIP CODE
ADDRESS
A
Bakersfield
93380
Box 82515
W COMP #
INSURER
American Zurich Ins. Co.
PHONE # BAKERSFIELD CITY BUSINESS LICENSE #
661 -868 -9484
6S
34800
W0348 66
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace Existing Spill buckets to accommodate a 5 gallon minimum capacity.
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?
0 ❑ YES ❑ NO YES ❑ NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER
Tank Testing Company
NAME OF TESTING COMPANY
PHONE NUMBER 661- 633 -7508
Jaco Oil
MAILING ADDRESS
PO Box 82515 Bakersfield, CA 93380
NAME OF TESTER ICC# 8723752
Brian Williams
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
FD2086 (Rev 08 09)