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HomeMy WebLinkAbout4900 PANAMA MOD APP 5.29.15� BAKERSFIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANK Prevention Services S �s�p i �slFlSNlfss���i'Sr »nyi4f N i a�ff?wv��`fuktiTt`; " 1' 2101 H Street PERMIT APPLICATION D Bakersfield, CA 93301 TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW }'' ���� Phone: 661 - 326 -3979 Fax: 661 -852 -2171 TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD AA' T Page 1 of 1 Permit # 15-7- Woo 3.?/ TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY (CHECK ONE ONLY) MODIFICATION OF FACILITY ❑ MINOR MODIFICATION OF FACILITY STARTING DATA/ /` PROPOSED COMPLETION DATE FACILITY NA EXISTING FACILITY PERMIT # FACILITY AWFJE e CITY Lan- ZIP C TYPE OF BU !!:L= � � r APN # TANK OWNErw PHONE # ADDRESS CITY qQ) Gi ZIP Cgi7j �a. CQNTRACTQR LIC # _ ICC ADDRESS � 2IP PHONE # �°� B RSFIELD crrfsqSINESS LICENSE # WORKMANP I URER BRIEFLY DESCRIBE THE WORK TO BE DONE: I XT 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 0 NO SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? © YES 0 NO THIS SECTION IS FOR STORAGE TANK IDENTEFICATION TANK '# VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER Tank Fasting Company NAME OF TESTING COMPANY PHONE NUMBER^-��� MAILING ADORES (Z2 (e'.:5p L<'-fcix 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 TESTER ICC# THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY { 4 9 t-ULUtib (Kev Utf /Uy)