HomeMy WebLinkAboutMINOR MOD APP 9.17.19BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK
Prevention Services
®)
2101 H Street
PERMIT APPLICATION
Bakersfield, CA 93301
TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW 4100
Phone: 661 - 326 -3979 R Fax: 661 - 852 -2171
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
TANK OWNER COSTCO
I PHONE d 661 - 837-2026
Page 1 of 1
Permit #
CONRUNCTOR BSSR INC,
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑
NEW TANK INSTALL/EXISTING FACILITY
CHECK ONE ONLY ❑ MODIFICATION OF FACILITY
MINOR MODIFICATION OF FACILITY
STARTING DAIS/ 8128/19
PROPOSED COMRETION DATE 9 /26/19
FACILITY NAME COSTCO FUELS
EUSTING FAU— FERMTTR
FAaLmf ADDRESS 4900 PANAMA LANE
Cm, BAKERSFIELD
accoD63313
TYPE OF RUSINESS GASOLINE DISPENSING FACILITY
AFN*
TANK OWNER COSTCO
I PHONE d 661 - 837-2026
ADDRESS C_
MP CODE
CONRUNCTOR BSSR INC,
I CA UD728ExSEd 12
6
10C# 8284282
ADDRESS 6630 ROSEDALE HWY #B
Crrc BAKERSFIELD
MR CODE 93308
MORE 4
661 -588 -2777
BAKERSFIELD CITY BUSINESS LICENSE d
1800110762
WORKMANS COMP d
22887
INSURER
ACE AMERICAN INS,
BRIEFLY DESCRIBE THE WORK TO RE DONE:
THE PREMIUM VENT LINE SENSOR (S10) WAS REPLACED (sensor wasn't communicating with fuel monitor)
NEED TO TEST WITH INSPECTOR ON -SITE
WATER TO FACILnY PROWDEO BY
DEWH TO GROUND WATER
SOIL TYPE EXPECTED AT SIZE
R OF TANKS TO BE UISTAUUD
ARE THEY FOR MOTOR FUEL?
O YES D NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FNE1
D YES 0 NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK*
VOLUME
UNLEADED
REGULAR
FURMAN
DIESEL
OTHER
2
12,000
X
,Y
NAME OF TESTING COMPANY BSSR INC,
PNONENUMBER 661 588 2777
MMUNG ADDRESS 6630 ROSEDALE HWY #B
NAMEOFTFSER FIDEL CARRILLO
ICc* 5257282
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 TESTER
FIDEL CARRILLO
ICC#
5257282
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
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