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Home My WebLink About2700 OSWELL ST MINOR APP 6.25.15UNDERGROUND 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 1 of 1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY (CHECK ONE ONLY) ❑ MODIFICATION OF FACILITY �K , MINOR MODIFICATION OF FACILITY STARTING DATE/ PROPOSED COMPLETION DATE FACILITY NAM EA f4va"�&Aao LAC., EXISTING FACILITY PERMIT # FACILITY ADD SS CI' r-' ZIP TYPE OF BUSI d�� r� APN # TANK OWNER 3aifyt PHONE # ADDRESS CITY ZIP CODE CONTRACT09-32L Vft(Z. Lncl ICC # ADDRESS dr� crr7i Z)CAe4A3'i2fCk ZIP PHONE # BAKERSFIELD CITY BUS S LICENSE # P5bnjjQ_7ta.,.4- IWOR NS CQKP,# URER BRIEFLY DESCRIBE THE WORK TO BE DONE: 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 PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? 1 ❑ YES ❑ NO ❑ YES ❑ NO THIS SEMON" IS FOR STOG AGE TANK ZD1ENN,7RFHCe-1N.TH0N TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER 06D y X 007 3a X Tank TesUng Company NAME OF TEST G COMP, '"y PHONE NUMBE ( Q77 D E� MAILING ADDRESS _ I NAME OF 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 TEST&-W— ICC# THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY FD2086 (Rev 08/09)