HomeMy WebLinkAbout6100 DISTRICT MINOR APP 7.31.15PERMIT APPLICATION
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Permit #��,� ��� �� �►
S 4A,,' ' E
FIRE ,
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 • 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 INOR MODIFICATION OF FACILITY
STARTIN DATE PROPOSED COMPLETION DATE
FACILIT NAME ` EXISTING FACILITY PERMIT #
FACILADDRE�S.S C TY ZIP
� V
TYPE O SINESS APN #
TANK QNMER PHONE
ADDRESS
CI ZIP C E�
CONT O CA LI S ICC, #
ADDRES6 ZIP CO
ct
.PHONE # ti "`j .BAKERSFIELD CITNkSINESS LICENSE # WORKMAN: CO AP � I SURER.
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?
❑ YES ❑ NO ❑ YES ❑ NO
THIS SEC ION ES FOR STORAGE TANK EDENTZP71 A TI EN
TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER
Tine Tes mg Company
NAME OFA%T1WGMNY PHONE NUMBE� -�
MAILING DDRESS
NAME O TE � 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 TER r / ICC#
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
91 -3111
FD2086 (Rev 08/09)