HomeMy WebLinkAboutMAJOR MOD APP 1.22.19MRIAIZURUITIR I i1 3'L +1
BAIKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
... Bakersfield, CA 93301
44"`x/' Phone: 661- 326 -3979 w 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/ TBD
PROPOSED COMPLETION DATE TBD
FACILITY NAME Circle K Store #2701270
ING FACILITY PERMIT -EXIST- #
FACILITY ADDRESS 5634 Stine Rd.
=Bakersfield
ZIP CODE 93313
TYPE OF BUSINESS Gas Station
APN #
TANK OWNER Circle K Stores, Inc.
PHONE # (951) 273 -1175
ADDRESS 255 E Rincon St #119
CITY Corona
ZIP CODE
92879
CONTRACTOR
Belshire Environmental Services, Inc.
CA LICENSE #
808313
ICC #
.5254881
ADDRESS 25971 Towne Centre Dr.
CITY Foothill Ranch
ZIP CODE 92610
PHONE #
( 949 ) 460 -5200
BAKERSFIELD CITY BUSINESS LICENSE #
WORKMANS COMP #
WCA1547285 -16
INSURER ;
Acord
BRIEFLY DESCRIBE THE WORK TO BE DONE: Dispenser #1/2: Install Icon penetration repair fitting on the 87 product
line and re -test.
Spill Bucket - Vapor: Break ground to install new OPW direct bury spill bucket. Turbine Sump - 87 Master: Install
cord grips on electrical wires, seal junction boxes /conduit and re -test.
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED
N/A
ARE THEY FOR MOTOR FUEL?
❑ YES ❑ NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
❑ YES ❑ NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
1
10,000
87
2
10,000
91
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
NAME OFTESTERJeff Badders
ICC# 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#
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL UsE ONLY
DATE APPROVED
APPROVED BY
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