HomeMy WebLinkAboutMINOR MOD APP 9.17.19BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK ♦�7 Prevention Services
♦j 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 FACILITY) /MOD -MINOR MOD page 1 of 1
Permit u
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
EDIFICATION OF FACILITY ❑ MINOR MODIFICATION OF FACILITY
STARTING DATE/
PROFOSED COMREIION GATE
FAMLrt NAME I I
EUSTING FAOLRY PERMTrI
FACIIRTADDRES I Cltt(
ZIP DU
TYPE OF BUSINES
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APNY
TANK OWNER
PHONEa
ADDRESS CITY
ME CODE
CONTRACTOR C-
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ADDRESS
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PHONE a r
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INSURER
BRIERY DESCRIBE THE WORK TO BE DONE:
WATER TO FACILITY PRWIDED BY
DEPTH TO GROUND WATER __777
FE E%PECIED AT SRE
IX OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR ELEL
D YES D NO
SPILL PREVENTION CCNTROLAND COUN TERMEASURES PLAN ON FlI£P
D YES D NO
THIS =- "'T ION IS FOR STORAGE TANK IDENTIFICATION
TANK#
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
,9 Company
NAME BE C�1MY /7 / ^�
(i/ ,
PHONE NDNBER -�
•%
MAILLXG ADDRESS
La'-5-j a-�
NAME OF TESRIr'
, %I rl
IOC#
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.
NAME OF TESFM -'
IOC# -2-`__7
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED I
APPRW ED BY