HomeMy WebLinkAbout7851_3-3UNDERGROUND STORAGE TANK
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DUSTING FFCIL— PERMIT
PERMIT APPLICATION
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TYPE OF APPLICATION: ❑ NEW TANK INSTALUNEW FACILITY
❑ MODIFICATION OF FACILITY
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 . Fax: 661-852-2171
Page 1 of I
❑ NEW TANK INSTALL/EXISTING FACILITY
MINOR MODIFICATION OF FACILITY
STARTING OATE/ Lj\ (� I )
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PROPOSED COMPL ION DATE
FACILITY
DUSTING FFCIL— PERMIT
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WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
WR TYPE EKPECTED AT SITE
M OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEL?
O YES D NO
51'11 PREVENTION CONTROL AND COUNTERMEASURES PIAN ON FILE?
D YES O NO
t!ON IS FOR STORAGE TANK IDENTIFICATION
TANK. VOLUME
UNLEADED
RFOULAA I PREMDIM
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OTHER TANK MANUFACTURER
Tank Tenting COn'peny
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PHONE XD -7
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NAME OF,RIfER 1V
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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 PERJURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
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THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
OATE APPROVED I
APPRWED BY
'D2086 (Rea 11/2815)
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