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Home My WebLink About989 APP 7-24-18WATER 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 SEMON IS FOR STORAGE TANK HDEK'TIFXCATXON TANK # VOLUME UNLEADED REGULAR PRENEIUM DIESEL ®® OTHER . 1 son NAME OF TESTING COMPANY ONE NUMBER r MAILING ADDRESS 15U 1B NAME OF TESTER ICC# tug THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDI MPLETED UNDER TIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN CO PENALTY OF PER3URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. NAME OF TESTER °' ICC# c --- THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY FD2086 (Rev 08/09) RAKERSFIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANK Preventi ®n Services 1501 Truxtun Avenue, 1st Floor PERMIT APPLICATION E x•S I� , . g Bakersfield, CA 93301 TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY)/NEW` - ~ Phone: 661 -326-3979 Fax: 661 - 852 -2171 TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD a z, Page 1 of 1 ;Permit # TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY CHECK ONE ONLY ❑ MODIFICATION OF FACILITY MINOR MODIFICATION STARTING DATE/ PROPOSED ON DATE FACILITY NAME EXISTING FACILITY PERMIT # FACILITY ADDRESS CITY ZIP TYPE OF BUSINESS APN # TANK OWNER PHONE # 2 _ r ADDRESS LO ° CTIY ZIP CONTRACTOR E ICC ADDRESS CITY CA- ZIP PHONE # BAKERSFIELD CITY BUSINESS LICENSE # WORKMANS COMP # INSURER BRIEFLY DESCRIBE THE WORK TO BE DONE: C� �� f or C 11% A A-r% - 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 SEMON IS FOR STORAGE TANK HDEK'TIFXCATXON TANK # VOLUME UNLEADED REGULAR PRENEIUM DIESEL ®® OTHER . 1 son NAME OF TESTING COMPANY ONE NUMBER r MAILING ADDRESS 15U 1B NAME OF TESTER ICC# tug THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDI MPLETED UNDER TIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN CO PENALTY OF PER3URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. NAME OF TESTER °' ICC# c --- THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY FD2086 (Rev 08/09)