HomeMy WebLinkAbout3699 WILSON RD MINOR JOB APP 1.5.15UNDERGROUND STORAGE TANK
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PERMIT APPLICATION
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
(CHFCK nNF ONLY) n MODTFTCATTnN OF FACTI TTY M MTNnR MnnTFTCATTnN nF FACTI TTY
STARTING DATE/
12/2/14
PROPOSED COMPLETION DATE
12/2/2014
FACILITY NAME
HP Go Go
EXISTING FACILITY PERMIT #
FACILITY ADDRESS
3699 Wilson Road
CITY
Bakersfield
ZIP CODE
93309
TYPE OF BUSINESS
GDF
APN #
TANK OWNER
HP Go Go
PHONE #
661- 832 -9427
ADDRESS
3699 Wilson Road
CITY
Bakersfield
ZIP CODE
93309
CONTRACTOR
Confidence UST Services Inc. 1804904
CA LICENSE #
ICC #
8111231 -UT,Ul
ADDRESS
16250 Meacham Road
CITY
Bakersfield
ZIP CODE
93314
PH
9V -631 -3870 132864
BAKERSFIELD CITY BUSINESS LICENSE #
WORKMANS COMP #
1308371 -2014
INSURER
State Comp
BRIEFLY DESCRIBE THE WORK TO BE DONE: Replace wiring harness and ATG probe on T3
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 O NO
THIS SECTION IS FOR S'T'ORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
1
12000
X
X
2
12000
X
X
3
12000
X
X
4
X(Waste Oi
Tank Testing Company
NAME OF TESTING COMPANY
Confidence UST Services Inc.
PHONE NUMBER
661 -631 -3870
MAILING ADDRESS
16250 Meacham Road, Bakersfield, CA 93314
NAME OF TESTER
Kristo her Karns
ICC#
I 5264406 -UT
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 TESTER
Kristo her Karns
ICC#
5264406 -UT
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY