HomeMy WebLinkAboutMINOR MOD APP 8.9.19I�IN BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK Prevention Services
COMPLETION DATE
2101 H Street
PERMIT APPLICATION i
Bakersfield, CA 93301
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
Phone: 661 - 326 -3979 P Fax: 661 - 852 -2171
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Page 1 of 1
Permit #
TYPE OF
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY
❑ NEW TANK INSTALL/EXISTING FACILITY
❑ MODIFICATION OF FACILITY
qJ01MI NOR MODIFICATION OF FACILITY
STARTING OATS/ PRO105ED
COMPLETION DATE
FACILITY NA
E%ISTING FACILITY PERMIT 4
FACIIItt !, �K,, Ln C� L ^Q
L.Li K/ 1 Il.
C
/
ZIPCODE
TYPE OF
U NE55
i L V
AIN
TANK OWNER
PHONE tt
ADDRESS CITY
ZIPWDE
COMRAR
L E
IOC
/O
ADDRESS W
Citt
g, ' P
PHONE # - B9
5FIELD Cm 130 5 LICENSE C WORKHAN5
COMPA,,
1 SURER '
BRIEFLY DESCRIBE THE WORK TO BE DONE:
WATER TO FACIUI R . DED BY
DEPTH TO GROUND WATER
`AIL TYPE E %PELTED AT SITE
X OF TANKS TO BE INSTALLED
PRE THEY FOR MOTOR NEL
O YES O NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PIAN ON FRET
O YES D NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
T,WKY
VOLUME UNLEADED
RERULNI
PREMIUM
DIESEL
OTNFR
Tank Testing Company
finf(/\ _ C
NAME 07M;&
PHONE N [F,OL-7
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MAILIH6 pDOR/ -_N \AOSC�r,(,CpL!
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NAMEOF Tl'n; n
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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 STER
IDDR c
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED I
APPROVEO BY