HomeMy WebLinkAboutMINOR APP 2.13.19UNDERGROUND 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
B E R s F 1 i 0 2101 H Street
FIRE Bakersfield, CA 93301
ABTM T 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
I 11 r /1111 \/\ I"I RAlIr%TCTf- ATTnr%1 nC CArTI TTV lM MTNI(1R Mr)r)TFTC ATTnN CAF FACTI TTY
STARTING DATE/ PROPOSED
COMPLETION DATE
FACILITY NAME
EXISTING FACILITY PERMIT #
Circle K Site #2708605
FACILITY ADDRESS
5600 Auburn Street
Ba kersfield CA 193306
ZIP CODE
TYPE OF BUSINESS
APN #
Existing retail fuel dispensing facility to remain
TANK OWNER
PHONE #
Circle K Stores Inc.
ADDRESS
CITY
ZIP CODE
255 East Rincon Street Suite #100
Corona CA
92879
CONTRACTOR
CA LICENSE #
ICC #
V & R Construction Service Inc.
968903
5252507
ADDRESS
9525 Slauson Avenue
CITY
Pico Rivera CA
ZIP CODE
90660
PHONE #
BAKERSFIELD CITY BUSINESS LICENSE #
1
WORKMANS COMP #
INSURER
State Comp. Ins. Fund
562- 639 -3502
19090125
BRIEFLY DESCRIBE THE WORK To BE DONE: Replace existing fuel dispensers with new Gilbarco Encore 700S (3 +0 NN1) fuel dispensers including
Install Bravo dispenser conversion frame. Disconnect & reconnect all existing shear valve & electrical for
new VST hanging hardware. new
product & vapor. Upgrade Veeder -Root software version to 1.05 including a cold start.
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?
Existing to remain
® YES ❑ NO
® YES ❑ NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
TANK MANUFACTURER
1
10;000
Yes
Yes (87 Prod.)
2
10,000
Yes
Yes (89 Prod.)
3
10,000
Yes
Yes (91 Prod.)R
Tank Testing Company
NAME OF TESTING COMPANY
PHONE NUMBER
MAILING ADDRESS
NAME OF TESTER
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
Ff)70RF, (Rev 11/2015)