HomeMy WebLinkAboutMINOR MOD APP 8.6.19BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK Prevention Services
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2101 H Street
PERMIT APPLICATION
Bakersfield, CA 93301
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
Phone: 661 - 326 -3979 R Fax: 661 -852 -2171
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
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ZIPCODE 'J
Page 1 of 1
Permit #
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TPNKOWNER
PHONE H
TYPE OF APPLICATION: ❑ NEW TANK INSTAWNEW FACILITY
❑ NEW TANK INSTAWEXISTING FACILITY
(0 *{ ..' ONE ONLY) ❑ MODIFICATION OF FACILITY
'I MINOR MODIFICATION OF FACILITY
STARTING DATE/ PROPOSED
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COMPLAON DATE
FACILITY NAME
EXISTING FACILITY PERMIT p
FACILITY ADDRI `rJ ( I
CITY -
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ZIPCODE 'J
TYPE OF BUSIN
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PHONE H
ADDRESS
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ZIP CODE
CONTRACTOR _\
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ADDRESS
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BRIEFLY DESCRIBE THE WORK TO HE DONE:
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER SOIL
TYPE EXPECTED AT SITE
N OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR NEL SPILL
D YES D NO D
PREVENTICN CONTROL AND COUNTERMEASURES PLAN ON FILE?
YES D NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK#
VOLUME
UNLEADED I
REGULAR
PRE—N
DLESFL
OTMFR
Tank Testing Company
NAME OF TF6 OMP Y `
PHONE NU 'j_
NNLTXO ADDRESS
NAME OF TF64E11^
TICE, 5.-JS 1 fi
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 PERIURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
NAME OF TES
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED SY
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