HomeMy WebLinkAboutMINOR APP_3.21.19UNDERGROUND STORAGE TANK
V-1-11111 I
..............
PERMIT APPLICATION
TO CONSTRUCT-INSTALL NEW TANK (NEW FACILITY)/NE
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
Prevention Services
a R S F I D 2101 H Street
FIRE Bakersfield, CA 93301
NT 7
Phone: 661-326-3979 s Fax: 661-852-2171
Page I of I
IPermit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
MAILING ADDRESS
un
NAME 0 TER, ICC#
r-Tcuj) ca-rc,
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 TER ICC#
C
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
.DATE APPROVED APPROVED: BY
FD2086 (Rev 1112015)