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Home My WebLink AboutMINOR MOD APP 7.29.19BAKERSFIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANK i., _ Prevention Services 2101 H Street PERMIT APPLICATION a E n?P I o Bakersfield, CA 93301 TO CONSTRUCT INSTALL NEW TANK (NEW FACILr Y) /NEW MIRE ARTM f Phone: 661- 326-3979 • Fax: 661 -852 -2171 TANK INSTALL (EXISTING FAC1LiTY) /MOD MINOR MOD FACILITY ADDRESS Page 1 oft ZIP CODE 3701 Ming Avenue aakerslieltl Permit # TYPE OF BUSINESS APR # TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY '❑ NEW TANK INSTALUEXISTING FACILITY n M OF FACT m 171 MTNOR MODIFICATION OF FACILITY M1i I��,. ..... .....,.� ..__- .._...._... _. _ STARTING DATE/ PROPOSED COMPLETION DATE OW30120is 8130118 FAIR LE's NAME EXISTING:FACIIITY PERMIT # r FRItrip #32 FACILITY ADDRESS CITY ZIP CODE 3701 Ming Avenue aakerslieltl 93309. TYPE OF BUSINESS APR # GOF TANK OWNER PHONE # Jamieson Hill 661- 393 -700D ADDRESS CIT' ZIP CODE P.O. BO %82515 Bakersfield. 93380 -2515. CONTRACTOR CA LICENSE# ICC.# Confidence UST Services Inc. 8.04904. ADDRESS 16250 Meacham Road CRY Bakersfield. ZIPCODE 93314 PHONE BAKERSFIRD CRY BUSINESS ICENSE# WORKMANS COME# INSURER SCTF 661- 631 -3870 32.864 1308371 BRIEFLY DESCRIBE THE WORK TO BE DONE! Install new 2"K 24" flex line on the 91 product line in the 91 STP. WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOR TYPE EXPECTED AT ACTS # OF TANKS TO BE INSTALLED ARE THEY FOR MOTO R MEV 3PlLL PREVENTION CONTROL AND COUNTERMEA SURFS PLAN. ON FILE! YES NO YES NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TANK IF VOLUME (UNLEADED REGULAR PREMIUM DIESEL OTHER 2 12000 j X X Tank Testing Company NAME OF TESRNG COMPANY PHONE NUMBER Confidence UST Services Inc. 661- 631 -3870 MAILING ADDRESS 16250 Meacham Road, Bakersfield, CA 93314 NAME Of TESTER "`° 8022804 -UT Bryan Self 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. NAMEOFTESTER ICCC 8022804 -UT Bryan Self THIS APPLICATION BECOMES A PERMIT WHEN APPROVED. FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY FD3OBB(Rev 08/09)