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Home My WebLink AboutMINOR APP 3.18.19UNDERGROUND 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 2101 H Street Bakersfield, CA 93301 Phone: 661 - 326 -3979 a Fax: 661- 852 -2171 Page 1ofI TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY iru�ri nnia nnii V n Mnr1TGTrATTnN nP 1=ArT1 TTV All' MTNOP MnI)TFTrATTnN OF FACTI TTY STARTING DATE/ f� PROPOSED CO LEFION,DATE FACILITY NAME yv-r EXISTING FACILITY PERMIT* FACILITY ADDRESS r-• CITY ZIP CODE TYPE OF BUSINESS "" APN # TANK OWNER � � � /� � � PHONE # ADDRESS CITY ." 1__� 71"J f" `� ZIPS CONTRACTOR %''� � ,� . , �/ G �,�s "� X7`'7.,.. .. ��6! �J✓� _... ......... ... .... ., .,.., ... ....,.. ..,... ,,..: w. � ....._..�_, � CAyYII u., 9 ICC #��,��,�..Y ADDRESS /jam �y( <-� CITY '� G' f ZIP CODE PHONE # BAK� IELD� SINESS LICENSE # WANS.- _ P� INSURER BRIEFLY DESCRIBE THE WORK TO BE DONE: % J/f 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 ❑ YES ❑ NO PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER Ta!'i0C Ti'S$IB'1g Company NAME OF TESTING COMPANY PHONE NUMBER MAILING ADDRESS--%�� G ✓� �`'� � /� �.,�� NAME OF TESTER - r 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 Fn7nAr, /Do 11 /7n1 rl