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Home My WebLink AboutMINOR MOD APP 7-31-18WATER TO FACILTTY 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 SECTION IS FOR STORAGE TANK IDENTIFICA'T'ION TANK # vOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER Ilk Tank Testing Company NAME OF TESTING COMPA ONE NUMB s MAILING ADDRESS nin NAME OF TESTER ' ICC# 1 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 1 '01 ICC# THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED. BY FD2086 (Rev 08/09) BAKERSFIEL.D FIRE DEPARTMENT UNDERGROUND STORAGE TANK Prevention Services Truxtun Avenue, 1st Floor 1501 � � nRrN, Bakersfield, CA 93301 PERMIT' APPLICATION Phone: 661- 326 -3979 • Fax: 661 - 852 -2171 TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Page 1 of 1 ;Permit # TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY... --Mil"11INsTAI,CR G FACILITY CHECK ONE ONLY ❑ MODIFICATION OF FACILITY MINOR MODIFICATION OF FACI / STARTING DATE/ PROPOSED C FACILITY NAME EXISTING FACILITY PERMIT # V FACILITY ADDRESS ZIP C( TYPE OF BUSINESS TANK OWNER PHONE # ZIP CO ADDRESS CAL ICC # CONTRACTOR .: VIA awpADDRESS Z PHONE n BAKERSFIE D CITY US'INESS NSE # WORKMANS COMP # INSURER BRIEFLY DESCRIBE THE WORK TO BE DONE: WATER TO FACILTTY 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 SECTION IS FOR STORAGE TANK IDENTIFICA'T'ION TANK # vOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER Ilk Tank Testing Company NAME OF TESTING COMPA ONE NUMB s MAILING ADDRESS nin NAME OF TESTER ' ICC# 1 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 1 '01 ICC# THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED. BY FD2086 (Rev 08/09)