HomeMy WebLinkAboutTANK INSTALL APP 10.10.19UNDERGROUND STORAGE TANK
PERMIT APPLICATION
TO CONSTRUCT INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Permit # i
-IL ; BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 . Fax: 661 - 852 -2171
Page 1 of 1
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY a NEW TANK INSTALL/EXISTING FACILITY
CHECK ONE ONLY ❑ MODIFICATION OF FACILITY ❑ MINOR MODIFICATION OF FACILITY
STARTING OAT,/ TBD
PROPOSED COMPLETION DATE 08/01/19
FACILITY NAME Brookside Market & Deli
EMSTINGFACILRYPERMTr #15- 031-011317
FAMLNI'ADDRESS 4700 Coffee Road
CITY Bakersfield
ZIPCODE 93308
TYPEDEBUSINFss Gas station and C -Store
APN # 507- 030 -05
TANK OWNER Jeffries Bros. Inc. Matt Jeffries
PHONE# (661) 387 -0592
ADDRESS 177 Aviation Street
cm Shafter
ZIPCODE 93263
CONTRACTOR Cal Valley Equipment
uuc,NSE:998733
Icc# 8160834
ADDRESS 7608 Fruitvale Avenue
cm Bakersfield
ZIPCODE93308
PHONE (661) 327 -9341
BAKERSFIELD CITY BUSINESS LICENSE#
20001
WORKMANS COMP A 914518917
INSURER: AIS
BRIEFLY DESCRIBE THE WORKTO BE DONE: Installation of 1 30K UST (Split 22K Unleaded / 8K Premium and 1 20K
UST (20K Diesel), All new product, vapor, and vent piping, UDCs, and (4) multiproduct dispensers.
WATER TO FACILTIY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EKPECIEO AT SITE
Y OF TANKS TO BE INSTALLED 2
ARE THEY FOR MOTOR FUEL?
X YES ❑ NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
X YES D No
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
22,000
X
X
2
8,000
X
X
3
20,000
X
Tank Testing Company
NAME DETESTING COMPANY Cal Valley Equipment
PHONENUMBER (661) 327 -9341
MAILI.GADDREss 7608 Fruitvale Avenue, Bakersfield, CA. 93308
NAMEOFTESTER Jerry Rangel
Icc. 8160834
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
ICC4
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED I
APPROVED BY
D 2.S6 (.1v 11 / IUU I )