HomeMy WebLinkAboutMINOR MOD APP 9.17.19BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK ♦`07 Prevention Services
` 2101 H Street
PERMIT APPLICATION Bakersfield, CA 93301
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW Phone: 661 - 326 -3979 P Fax: 661 - 852 -2171
TANK INSTALL (EXISTING FACILTY) /MOD -MINOR MOD Page 1 of 1
Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALLINEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
❑ MODIFICATION OF FACILITY Ee2INOR MODIFICATION OF FACILITY
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STARTING DATE - 1i-1 1
PRWOSED COMPLEr10N DATE
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FACILITY NAME(Y. 1
EXISTING -IL- PERMIT 4
FACILITY A 5
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TANK OWNER
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CONTRACTOR
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BRIEFLY DESCRIBE THE WORK TO BE DONE:
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1 I S >dl
WATER TO FACULTY PROVIDED BY
DEPTH TO GROUND WATER
5011 TYPE EXPECTED AT 51TE
K OF TANKS TO BE INSTALLED
ARE THEY FO0. MOTOR RI
O YES O No NO
SPILL PRE1 FUTON COMROL AND COUNTERMEASURES PLAN ON FILER
D YES D NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TI1NK# VOLUME
UNLEADED
11FOULAR
PRFMNN
D65EL
OTHER
NAME OF TESTING COMPANY' / ,.j _
PHONE NUMBER
MAKING ADdIESS
NAME OFTESTER6I
, ml 10
'4E APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS
MIT 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.
DDN Sd'a -7
'HIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
pPP_FO BY
FWI.. (Rea 11/3015)