HomeMy WebLinkAboutMINOR APP 2.4.19UNDERGROUND STORAGE TANK+
PERMIT APPLICATION FIRE � .
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW a` ART FIRE i
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661- 326 -3979 • Fax: 661 -852 -2171
Page 1 of 1
❑ NEW TANK INSTALL /EXISTING FACILITY
141 MTKInR Mn(1TFTrATTr)N nF F'ArT1 TTY
STARTING DATE/ PROPOSED
12 -20 -18
COMPLETION DATE
1 -20 -19
FACILITY NAME PAN PACIFIC DBA WORLD OIL
EXISTING FACILITY PERMIT #
FACILITY ADDRESS 1850 COFFEE RD
CITY BAKERSFIELD
ZIP CODE 93308
TYPE OF BUSINESS
APN #
TANK OWNER
PAN PACIFIC DBA WORLD OIL
PHONE #
661- 589 -3200
ADDRESS
CITY
ZIP CODE
CONTRACTOR
BSSR INC,
CA LICENSE #
672812
ICC #
- 5257282
ADDRESS
6630 ROSEDALE HWY #B
CITY BAKERSFIELD
ZIP CODE 93308
PHONE #
661- 588 -2777
BAKERSFIELD CITY BUSINESS LICENSE #
1 1800110762
WORKMANS COMP #
22667
INSURER
ACE AMERICAN INS,
BRIEFLY DESCRIBE THE WORK TO BE DONE:
INSPECUREPLACE OVERFILL VALVE, TEST WITH FIRE DEPT.
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEL?
❑ YES ❑ NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
❑ YES ❑ NO
THIS SECTION IS FOR STORAGE TANK FOENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
TANK MANUFACTURER
1
10,000
X
Tank Testing Company
NAME OF TESTING COMPANY BSSR INC,
PHONE NUMBER 661 - 588-2777
MAILING ADDRESS 6630 ROSEDALE HWY #B
NAME OF TESTER
F1DEL CARRILLO
ICC# 5257282
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
FIDEL CARRILLO
ICC#
5257282
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
Ffl7flRK (Rev 11/20151