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HomeMy WebLinkAboutMINOR APP 2.1.19UNDERGROUND STORAGE TANK PERMIT APPLICATION TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW :. TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD ;Permit # BAKERSFIELD FIRE DEPARTMENT Prevention Services "RINr1501 Truxtun Avenue, 1-t Floor l Bakersfield, CA 93301 Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171 Page 1 of 1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY CHECK ONE ONLY MODIFICATION OF FACILITY ❑ MINOR MODIFICATION Or t -AUILL I Y STARTING DATE/ PROPOSED COMPLETION DATE FACILITY NAME EXISTING:FACtLTTY PERMIT # FACILITY ADDRESS ZIP COD -3 TYPE OF BUSINESS APN # TANK OWNER PHONE _ n . /t i . C-TTY I---, _ _ —f 1 I ZIP-C-ODE. _ C` Lv r 2 o its -S Aanri� t nr �cT 2 - �l- 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 PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO ❑ YES ❑ NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TANK # VOLUME UN4EADED REGULAR PREMIUM: DIESEL OTHER a Tank Testing Company NAME OF TESTING COMPANY FkHON UMBER MAILING ADDRESS (—f ,, CA- I NAME OF TESTER 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 PER3URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. NAME OF TESTER ICC# . , � W. w—'! � �C'VA � THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY FD2086 (Rev 08/09)