HomeMy WebLinkAbout#781 MINOR MOD APP 7-9-18UNDERGROUND STORAGE TANK
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PERMIT APPLICATION a'`' $ R s g F
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW A fM f
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Permit # *16- 10000473
BAKERSFIELD FIRE DEPART I'ENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 • Fax: 661- 852 -2171
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TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
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STARTING DATE/
07/05/2018
PROPOSED COMPLETION DATE
07/05/2018'
FACILITY NAME
Jaco /#7781/ Fastrip #22
EXISTING FACILITY PERMIT #
FACILITY ADDRESS ' CITY
4013 South H Street
Bakersfield
ZIP CODE
193304
TYPE OF BUSINESS
GDF
APN #
TANK OWNER
Jamieson Hill
PHONE #
661 -393 -7000
ADDRESS
PO Box 82515
CITY
Bakersfield
ZIP CODE
93380 -2515
CONTRACTOR
Confidence UST Services Inc .
CA LICENSE #
1 804904
ICC #
8485827 -/UT
ADDRESS CITY
16250 Meacham Road
Bakersfield
ZIP CODE
93314
PHONE #
661- 631 -3870
BAKERSFIELD CITY BUSINESS LICENSE #
32864
WORKMANS COMP #
1308371
INSURER
SCIF
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace 87 Vapor Spill Bucket with new OPW (like for like).
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
YES n NO
PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
YES NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICA71ON
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
1
12000
x
x
2
12000
x
X
3
12000
X
_
X
4
12000
X
Tank Testing Company
NAME OF TESTING COMPANY
Confidence UST Services Inc.
PHONE NUMBER
661- 631 -3870
MAILING ADDRESS
16250 Meacham Road, Bakersfield CA 93314
NAME OF TESTER
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 TESTER
Aaron Perrigo
ICC#
8485827 -UT
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
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