HomeMy WebLinkAboutNEW TANK INSTALL APP 3.27.19BAKERSFIELD FIRE DEPARTMENT
Prevention Services
UNDERGROUND STORAGE TANK
a E S F t n
2101 H Street
PERMIT APPLICATION
FIRE r Bakersfield, CA 93301
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
Phone: 661 -326 -3979 •Fax: 661- 852 -2171
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD page 1 of 1
Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY NEW TANK INSTALL /EXISTING FACILITY
(CHECK ONE ONLY) ❑ MODIFICATION OF FACILITY ❑ MINOR M DIFICATION OF FACILITY
STARTING DATE/ PROPOSED COMPLETION DATE 4--a
EXISTI G ILITY PERMIT #
FACILITY NAME 1
CITY ZIP COD
FACILITY ADDRESS
APN #
TYPE OF BUSINESS ' '
® PHON
TANK OWNER Q® � 9-'o y r
` $
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(•� ��j A C ZIP CO
ADDRESS
ay
C t S ICC # �
s( CJ
CONTRACTOR
CITY ZIP CO E
ADDRESS ..-�
F r D CITY BUSI SS L CENSE # WORKMANS COMP # ,yae c
PHO irl .b � 4l BAKE d IEL CIT LC
IE
BE THE WORK TO BE DONE:
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SO E
r'
# OF TANKS TO BE INSTALLED
A E THEY FOR MOTOR FUEL?
YES ❑ NO
SPILL YES
THIS SECTION IS FOR STORAGE TANK
IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
MIjJM
% IT
P
Tank Testing Company
NAME OF TESTING COMPANY
MAILING ADDRESS
PHONE
0
CONTROL AND COUNTERMEASURES PLANaON FILE?
❑ NO
DIESEL I OTHER I TANK MANUFACTURER
NL•i!i�tl
'Of, '_04-'�
�-
NAME OF TESTER D % ICC#
THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS
PERMIT AND ANY OTHER STATE, LOCAL,ESPLETED UNDER
ALTY OF PERJURY, AN D TO THE BT OF MY KNOWLEDGE IS RUE AND CORRECT
NAME OF TESTER ," n ICC# � „may t 0
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
APPROVED BY
DATE APPROVED
FD2086 (Rev 11/2015