HomeMy WebLinkAbout3225 BUCK OWENS MINOR APP 4.27.15kq' L--
BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK
Prevention Services
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I� R s P I n Bakersfield, CA 93301
PERMIT APPLICATION dry -I� Phone: 661 -326 -3979 • Fax: 661 -852 -2171
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW s �,
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Page 1 of 1
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Permit # � '"° `
... �... °._._____........_...
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
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FACILITY NAME EXISTING FACILITY PERMIT #
FACILITY ADDRESS ZIP CODE
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CITY ��W �
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TYPE OF BUSINESS . +, APN #
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TANK OWNER PHONE # f5o0 •
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,�'l ZIP CODE
ADDRESS p� C'C� R3
A CA LICENSE # ICC # SAA
CONTRACTOR
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ADDRESS ! A CITY s`i�'Q, C
PHONE # �` 1 � `
BAKERSFIELD CITY BUSINESS LICENSE # WOORRKMAN� # INSURER
BRIEFLY DESCRIBE THE WORK TO BE DONE: AY1 N ii a D S IJi l t W
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?
❑ YES ❑ NO ❑ YES
THIS SECTION I5 FOR STORAGE TANK IDENTIFICATION
TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER
Tank Testing Company
NAME OF TESTING COMPANY PHONE NUMBER
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MAILING ADDRESS 2 5'G0 AveA U4, i � Cw k Cola, 6 qS-V(Z
NAME OF TESTER ICC# bob b i 10 f
THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS
PERMIT AND ANY OTHER STATE, R7URYC AND TO THE BEE COMPLETED UNDER
PENALTY OF P T OF MY KNOWLEDGE IS TRUE AND CORRECTP ,
ICC#
NAME OF TESTER '?o 19
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
QATE APPROVED APPROVED BY
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�A- FD2086 (Rev 08/09