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Home My WebLink About2698 Mt. Vernon Application 3-22-19UNDERGROUND STORAGE TANK '�' A u..,�A , .,. U MU,._ .m_� PERMIT APPLICATION TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD Permit # I BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 9 Fax: 661-852-2171 Page 1 of 1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY /r-ucry nnIa nnII VZ n MnnTGTrA-rTYIN ni: FAf TI T- V rZ MTNOP MOr)TFTrATTON OF FACTI TTY STARTING DATE/ TBD PROPOSED COMPLETION DATETBD FACILITY NAME Mt Vernon & Columbus ARCO EXISTING FACILITY PERMIT # FACILITY ADDRESS 2698 Mt Vernon Avenue CITY Bakersfield ZIP CODE 93306 TYPE OF BUSINESS GDF APN # TANK OWNER Saint Peter & Saint Paul LLC (Arco) PHONE # 661-872-3477 ADDRESS 2698 Mt Vernon Avenue CITY Bakersfield ZIP CODE 93306 CONTRACTOR' Confidence UST Services, Inc. CA LICENSE # 804,904 ICC # 8414476 ADDRESS 16250 Meacham Road crr� Bakersfield ZIP cooE 93314 PHONE # 661-631-3870 1328641308371-2018 BAKERSFIELD CITY BUSINESS LICENSE # WORKMANS COMP # INSURER State Fun BRIEFLY DESCRIBE THE WORK TO BE DONE: Replace 87 & 91 OPW drop tubes w/ flapper (OPW 71 SO -41 OCT) 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 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 12000 X X 2 12000 X X 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 Tim Capehart ICC# 8414476 THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY Cn'�nRC. /Qcv � 1 /7n1 Sl