HomeMy WebLinkAboutUST INSTALL APP 6.8.17BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK qilffilip Prevention Services
2101 H Street
PERMIT APPLICATION �4I Bakersfield, CA 93301
TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW ARTY T Phone: 661- 326 -3979 F Fax: 661 - 852-2171
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Page 1 of 1
Permit#
TYPE OF APPLICATION: NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL,/EXISTING FACILITY
MOMFTrATNTN nF FArn TTY rT MTNnR MODIFICATION OF FACILITY
STARTING GATE/ PROPO$EO
COMPLETION GATE
F ILIIY NAME
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F IIIY
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TYPE OF BUSINESS
APH #
TA WNER
PHONE#
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ICC #
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BAKERSftELD CSINESSIICENSE#
ITY BU� f
WORKIMNE COMP #
INWRER
BRIEFLY DESCRIBE THE WORK TO BE GONE:
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WATER TO FA T= PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED ARE
0
TREY FOR MOTOR NEL
YES O NO
59111 PREVENTION CONTROL ANO COUNTERMEA SURES nAN ON FILE?
0 YES M NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR.
PREMIUM
DIESEL
OTKER
TANK MANUFACTURER
Tank Testing Company
NAME OF TESTING COMPANY
PHONE NUMOIR
1-' O 't L
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EF 'aI ci T 1 ;508
NAME OF TESTER
ICC#
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 TESTER
ICC#
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
GOJtIPfi leer LV20151