HomeMy WebLinkAbout3001 SILLECT MINOR APP 4.6.15lPermit # Z5--- ZO z 3 61
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
(CHECK ONE ONLY) ❑ MODIFICATION OF FACILITY MINOR MODIFICATION OF FACILITY
STARTING DATE/ PROPOSED COMPLETION DATE
FACILITY AME w4e_6 EXISTING FACILITY PERMIT #
/I
FACILITY-ADDRESS C ZIaCODE
L=� a
TYPE OF BUSINESS IAPN #
I TANK OWNER - I PHONE #
ADDRESS CIT u4j��/54 F ZIP DE
CONTRA R I CU 7-1 y 'cc
ADDRESS(-,, C ZIP
RC, 'Sea rl
PHONE #5&6 BAKERSF NESS LICENSE # VIORKMANS COMP # INSURER,,
Eux-
BRIEFLY DESCRIBE THE WORK TO BE DONE:
1 WATER TO FACILITY PROVIDED BY
1 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?
�
❑ YES ❑ NO 1 ❑ YES ❑ NO
THIS SECTION FS FOR S70 GE TAF4K EDIE-N17ZFECATZON
TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER
Tank Testing Company
NAMI� �TEIN463yeqmpaw PHONE NUMBER
MAIL G ADDRESS
17 1 e� ru ct C R
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
FD2086 (Rev 08/09'
BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK
Prevention Services
2101 H Street
PERMIT APPLICATION
fi B R 8
Bake rsf i eld, CA 93301
TO CONSTRUCT-INSTALL NEW TANK (NEW FACILITY)/NEW
FIRLF
A& r
Phone: 661-326-3979 •Fax: 661-852-2171
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
Page 1 of 1
lPermit # Z5--- ZO z 3 61
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
(CHECK ONE ONLY) ❑ MODIFICATION OF FACILITY MINOR MODIFICATION OF FACILITY
STARTING DATE/ PROPOSED COMPLETION DATE
FACILITY AME w4e_6 EXISTING FACILITY PERMIT #
/I
FACILITY-ADDRESS C ZIaCODE
L=� a
TYPE OF BUSINESS IAPN #
I TANK OWNER - I PHONE #
ADDRESS CIT u4j��/54 F ZIP DE
CONTRA R I CU 7-1 y 'cc
ADDRESS(-,, C ZIP
RC, 'Sea rl
PHONE #5&6 BAKERSF NESS LICENSE # VIORKMANS COMP # INSURER,,
Eux-
BRIEFLY DESCRIBE THE WORK TO BE DONE:
1 WATER TO FACILITY PROVIDED BY
1 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?
�
❑ YES ❑ NO 1 ❑ YES ❑ NO
THIS SECTION FS FOR S70 GE TAF4K EDIE-N17ZFECATZON
TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER
Tank Testing Company
NAMI� �TEIN463yeqmpaw PHONE NUMBER
MAIL G ADDRESS
17 1 e� ru ct C R
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
FD2086 (Rev 08/09'