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HomeMy WebLinkAbout2301 H ST MOD 9.15.14UNDERGROUND STORAGE TANK PERMIT APPLICATION TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Permit # r %G� TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY �n1r- one' v\ %. _.M11(1TCT(- A-rTnr%1 nC CArTI TTV ❑ NEW TANK INSTALL /EXISTING FACILITY rl MTKInD Mr)r)TFTrATTnnI nF i=a TI TTY STARTING DATE/ PROPOSED BAKERSFIELD FIRE DEPARTMENT FACILITY NAME G Prevention Services FACILITY ADDRESS CITY 2101 H Street M307 Bakersfield, CA 93301 FIRE Phone: 661- 326 -3979 • Fax: 661 -852 -2171 ARIr, Ir' ADDRESS ® wv Page 1 of 1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY �n1r- one' v\ %. _.M11(1TCT(- A-rTnr%1 nC CArTI TTV ❑ NEW TANK INSTALL /EXISTING FACILITY rl MTKInD Mr)r)TFTrATTnnI nF i=a TI TTY STARTING DATE/ PROPOSED COMPLETION DATE FACILITY NAME G EXISTING FACILITY PERMIT # FACILITY ADDRESS CITY � vs Od M307 TYPE OF BUSINESS - � u� � � � APN # TANK OWNER r4) PHONE # ADDRESS ® CITY s /� ZIP CONTRACTOR CA CENSE # _ ICC.# ADDRESS � g �� �p � � 6, 6 U 6 C1TY Y� ZIP C ��� PHON # jj BAKERSFIELD CITY BUSINESS LICENSE # WORKMANS.'COMP # INS R BRIEFLY DE CRIBE THE WORK TO BE DONE: / Y FA c a/ 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 SEC'T'ION IS FOP. STORAGE TANK IDENTIFICATION TANK # VOLUME UNLEADED REGULAR PREMIUM - DIESEL OTHER Teak 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 TES R 'j ICC# �5 456N 3 THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY Fn7nRti (Ri-v nRinq)