HomeMy WebLinkAboutApplication 11-22-19_4-40(N BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK
Prevention Services
FACIJTY NAME
Metro Mart
2101 H
2101 H Street
to
PERMIT APPLICATION
♦■ Bakersfield,
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 I of 1
Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALLINEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
❑ MODIFICATION OF FACILITY ❑ MINOR MODIFICATION OF FACILITY
STARTING HAITI PROFOSED
COMPLETION DATE
FACIJTY NAME
Metro Mart
EXISTING FACILITY PERMIT If
FACRITY ADDRESS
4600 St BE,
dTY
Rakersfiald
ZIP CODE
TYPE OF BUSINESS
Fuel Facility
APN k
TANK OWNER
PHONE tt
ADDRESS
CITY
ZIPCODE
CONTRACTOR BSSR, Inc.
CALICENSEXB 1Y2
O/L
ICC. 5257262
ADDRESS
6630 Rosedale H . #b
CITAakersfield
ZIPCOLE
93308
PHONE
588-2777
BAKERSFlELD CITY BUSINESS LICENSE O
2000110762
WORKMAN$COMPa
066355287
INSURER
Ace Americ
BRIERY DESCRIBE THE WORK TO BE DONE:
SB989 repairs
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
n OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR NEL
O YES O NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON F LE1
D YE$ D NO
. FOR 11 _. _.. 1 ICATI<
TANK > VOLUME UNLFRDEO
REGULAR PREMIUM
DIESEL
OTNER
IOrU1 TOStHUj LOI11DYlHY
NAME OF TESI]NG COMPANY
BSS
PNONF NUMOER
586-2777
MARZNG ADDRESS
6630 Rosedale Hwy. #b Bakersfield, CA
NAME OF TESTER
F del Carr llo
ECC"
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 PERJURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
NAME OF TESTER
Fidel Carrillo
ICC"
5957282
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROJED BY