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Home My WebLink AboutMINOR APP 1.31.19UNDERGROUND STORAGE TANK PERMIT APPLICATION TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Permit # TYPE OF APPLICATION: ((-HFCK nNF nNI Y) BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661- 326 -3979 • Fax: 661 - 852 -2171 Page 1of1 ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY f—I MnnTFTrnTTnni nF PArTi TTv r1 MTAInD MnnTCT!^ATTnm nl= CA!-TI T-ry STARTING DATE/ 8/9/18 PROPOSED COMPLETION DATE 8/9/18 FACILITY NAME Mt Vernon & Columbus Arco AmPm EXISTING FACILITY PERMIT FACILITY ADDRESS 2698 Mt Vernon Ave CITY Bakersfield ZIP CODE 193306 TYPE OF BUSINESS GDF APN # TANK OWNER Saint Peter & Saint Paul LLC PHONE # 661 - 472 -5480 ADDRESS 2698 Mt Vernon Ave CITY Bakersfield ZIP CODE 93306 CONTRACTOR Confidence UST Services Inc. 1 CA LICENSE # 804904 ICC # 8216722 ADDRESS 16250 Meacham Road CITY 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: Install ECPU2 & TLS Software, electronic monitoring cert 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 n NO rl SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? YES N0 THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER 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 Dustin Reese ICC# 8216722 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 rutuue kKev utsluj)