HomeMy WebLinkAboutMINOR MOD APP 12-7-18BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK Prevention Services
2101 H Street
PERMIT APPLICATION 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 -q
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IPermit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
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STARTING DATE/
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PROPOSED COMPLETION DATE
FACILITY NAME Circle Stores #2708606
EXISTING FACILITY PERMIT
FACILITY ADDRESS, 030 Oak ST.
CITY Bakersfield
ZIP CODE 93304
TYPE OF BUSINESS
Gas Station
APN #
TANK OWNER Circle K Franchise
PHONE # (951) 273-1175
ADDRESS 255 E Rincon St #119
CITY Corona
ZIP CODE 92879
CONTRACTOR Belshire Environmental Services, Inc.
CA LICENSE #
808313
ICC #
5252456
ADDRESS 25971 Towne Centre Dr.
CITY Foothill Ranch
ZIP CODE 92610
PHONE " (949) 460-5200
1
BAKERSFIELD CITY BUSINESS LICENSE #
1900070170
WORKMANS COMP #
WCA1 547285-16
INSURER
CORD
BRIEFLY DESCRIBE THE WORK TO BE DONE: Replace 87 vapor bucket with Pomeco 761 EVR.
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
OF TANKS TO BE INSTALLED
0
ARE THEY FOR MOTOR FUEL?
❑ YES ❑ NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
X YES 1:1 NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
1
X
Tank Testing Company
NAME OF TESTING COMPANY
Belshire Environmental Services, Inc.
PHONE NUMBER
(949) 460-5200
MAILING ADDRESS
25971 Towne Centre Dr. Foothill Ranch, CA 92610
TESTIR eff
NAME OF Badder s;
ICC*
1 5252456
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# 5252456
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY