HomeMy WebLinkAboutMINOR MOD APP 8.29.19BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK ^ARTjJr1 Prevention Services
Bake T field, Avenue, 1� Floor
PERMIT APPLICATION Bakersfield, 26 -39701
TO CONSTRUCT INSTALL NEW TANK (NEW FACILITY) /NEW Phone: 661 - 326 -3979 •Fax: 661 - 852 -2171
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
T Pa gel of
Permit #
TYPE OF APPLICATION! ❑ NEW TANK INSTALL/NEW FACILITY - ❑ NEW T NG FACILITY
CILLTY INOR MODIFICATON OF FACI
CHECK ONE ONLY ❑ MODIFICATION OF FA
STARTING DATE/
PROPOSED COMMfTION OATS
FACILITY NAME
E%LSTIW FACRITY PEPMIT %
FAaLm ADDRESS ��^ l
c�
Ory
nv
TYPE OF B1SMESS
ANN %
TANKOWNER ry
V
PHON 3
ADDRESS `
ZIP
CONTNCTOR (
(
G E %
ICC %
ADDRESS r
C
BAKERS BUSINE
WORKMANS COMP %
INSURER
BUEFLY DESOU5E THE WORK TO BE DONE:
WATERTO FAOLTIT PRONDED BY
DEPOT TO GROUND WATER
SOIL TWE EXPECTED AT SRE
%OF TANKS TO BE MSTALLEO
ARE THEY FOR MOTOR FUEL?
D yg D NO
SPILL PREVENTION CONTROL AND COUHTERMFASUR6 PLAN ON FILET
O YES 0 NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK
VOLUME
UNLEADED
RENRA0.
PREMINM
DI6EL
OTHER
a
Tank Testing Company
NAME OF TFBIING COMPANY
oftta
PHONENUMBER
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NAILING ADDRE% CA—
NAME OF TFSTBT
2U
THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS
PERMIT AND P
PENALTY OF PERIURLOCAL, ND TO THE BEST OF MY KNOWLEDGE IFORM RUE AND CORRECT. COMPLETED UNDER
NAMEOFTEGTER
Ett%
O
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
TOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
FD2086 (Rev 08/09)