HomeMy WebLinkAboutFMC APP 2.5.19UNDERGROUND STORAGE TANK
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PERMIT YAPPLICATION
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Permit # d0000 S/
BAKERSFIELD FIRE DEPARTMENT
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY
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STARTING DATE/
Prevention Services
"
2101 H Street
$ E R S F a
CITY
Bakersfield
FIRE
Bakersfield, CA 93301
R
Phone: 661- 326 -3979 . Fax: 661- 852 -2171
PHONE #
Page 1 of 1
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY
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STARTING DATE/
PROPOSED COMPLETION DATE
FACILITY NAME Circle Deli
I EXISTING FACILITY PERMIT#
FACILITY ADDRESS
1416 Golden State Hwy
CITY
Bakersfield
ZIP CODE
93301
TYPE OF BUSINESS
Gasoline Station and Mini Mart
APN #
TANK OWNER
PHONE #
ADDRESS
1416 Golden State Hwy
CITY
Bakersfield
ZIP CODE
93301
CONTRACTOR
Complete' Fueling Solutions dba Aaron Koop
CA LICENSE #
916128
ICC #
5246167
ADDRESS
12601 Jasmine Ave
CITY
Bakersfield
ZIP CODE
93312
PHONE #
661- 706 =8688
BAKERSFIELD CITY BUSINESS LICENSE #
16- 00134472
WORKMANS COMP #
C48093504
INSURER
A.C.E.
BRIEFLY DESCRIBE THE WORK TO BE DONE:
To upgrade the site to AB2481 tank system
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED
2
ARE THEY FOR MOTOR FUEL?
YES ❑ NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
X YES ❑ NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
TANK MANUFACTURER
1
20,000
X 15,000
X 5,000
Modern
Tank Testing Company
NAME OF TESTING COMPANY
Rich Environmental
PHONE NUMBER
661 - 706 -8687
MAILING ADDRESS
5643 Brooks Ct, Bakersfield, CA 93308
NAME OF TESTER
James Rich
ICC#
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