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Home My WebLink AboutMINOR MOD APP 9.6.19BAKERSFIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANK Prevention Services FAC UOY NAME Panama Buena Vista Union SctroW 2101 H Street PERMIT APPLICATION u La s Bakersfield, CA 93301 TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW mA A� Phone: 661 - 326 -3979 R Fax: 661 - 852 -2171 TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Page 1 of 1 Permit # ADDRESS 4200 Ashe Road TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY CHECK ONE ONLY ❑ MODIFICATION OF FACILITY M MINOR MODIFICATION OF FACILITY STARTING DATE/ 08/19/2019 PROPOSED COMPLETION GATE 08/19/2019 FAC UOY NAME Panama Buena Vista Union SctroW EXISTING FACILITY PERMIT i FACILIrY ADDRESS 4200 ASHE ROAD CITY CBlogfield ZIP CODE 93313 TYPE OF BUSIN65 GDF APN 8 TANK OWNER Panama Buena Vista Union School PHONE. 661 - 326 -3706 ADDRESS 4200 Ashe Road cm Bakersfield nPDo"43313 CONTRACTOR Confidence UST Services Inc. ENSE G LIC * 804904 ICC 8 8180171 -U1 ADDRESS 16250 Meacham Road CrtY Bakersfield ZIP CODE 93314 PHONE 1 661 - 631 -3870 BAKERSFIELD CRY BUSINESS LICENSE A 32864 WORKMANS COMP* 1308371 INSURER SCIF BRIEFLY DESCRIBE THE WORK TO BE DONE: Replace 87 420 Annular Sensor WATER TO FAB = PRONDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE 8 OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR KIEL? p YES p N0 SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILET 0 YES O NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TANK VOLUME UNLE40ED REGULAR FREMNM DIESEL OTHER Tank Testing Company NAME OF TESTING co"PANY Confidence UST Services Inc. FXONENUMaIR 661 -631 -3 8 70 MAILING ADDRESS 16250 Meacham Road Bakersfield CA 93314 NAME OF TESTER Tyler Haas ICCR XU u 1 ELo 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 PEFOURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. NAME OF TESTER Jason Woods ICCR ^O ^�I THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY FDJOR6 lHeo 08109)