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Home My WebLink AboutMINOR APP 2.4.19. ..�. _.,... ......_w...... .F� ,.�...,.. _�._ .......... PERMIT APPLICATION TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Permit # 4 BAKERSFIELD FIRE DEPARTMENT FACILITY NAME UNION VALERO Prevention Services A� 2101 H Street ZIP CODE 93307 Bakersfield, CA 93301 APN # Phone: 661 -326 -3979 • Fax: 661 -852 -2171 Page 1of1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY .- — .'1% P1 nr cnr^TI TTV 10 MTIUnD MnnTPTrATTCIN CIF FArTI TTY STARTING DATE/ 2 -4 -19 PROPOSED COMPLETION DATE 3 -4 -19 FACILITY NAME UNION VALERO I EXISTING FACILITY PERMIT # FACILITY ADDRESS 1129 UNION AVE CITY BAKERSFIELD ZIP CODE 93307 TYPE of BUSINESS GASOLINE DISPENSING FACILITY APN # TANK OWNER PHONE # 661- 395-0868 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 1 BAKERSFIELD CITY BUSINESS LICENSE # 1800110762 WORKMANS COMP # 22667 INSURER ACE AMERICAN 12, BRIEFLY DESCRIBE THE WORK TO BE DONE: REPLACE DIESEL PLLD OR RED JACKET FUNCTIONAL ELEMENT TO GET PASSING RESULTS 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 10 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 X Tank Testing Company NAME OF TESTING COMPANY BSSR INC, PHONE NUMBER 661-588-2777 MAILING ADDRESS 6630 ROSEDALE HWY #B NAME OF TESTER SALVADOR SANCHEZ ICC# 5309490 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 SALVADOR SANCHEZ ICC# 5309490 THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY Fn7nR6(Rev 11/2015)