HomeMy WebLinkAbout12-9-19 Application Cold Start_3-3BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK�� Prevention Services
PROPOSED COM ON DATE
2101 H Street
PERMIT APPLICATION
Bakersfield, CA 93301
TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)INEW ~
Phone: 661-326-3979. Fax: 661-852-2171
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
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Page 1 of 1
Permit #
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TYPE OF APPLICATION: ❑ NEW TANK INSTALUNEW FACILITY
❑ NEW TANK INSTALL/EXISTING FACILITY
(CHECK ONE ONLY) ❑ MODIFICATION OF FACILITY
s' MINOR MODIFICATION OF FACILITY
STARTING DATE/ rj
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PROPOSED COM ON DATE
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BRIEFLY DESCRIBE TXEnWORK TO BE DONE:
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WATER TO FACULTY' PROVIDED BY
DEFTX TO GROUND WATER
sOtt TYPE EXPECTED AT SITE
A OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR F -EL?
O YES 0 NO
SPILL PREVENTION CONTROL AND COUMERMEPSURES PLAN ON FILE'
I YES 0 NO
THIS SECTION 15 FOR STORAGE TANK IDENTIFICATION
TANK* VOLUME
UNLEADED
REGUUIR
PREMIUM DIESEL OTHER
Tank Testing Company
NAME OF TEMRMI COMPANY C1 K
PHONE NUMBER//
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MANNG ADDRE:U /} (T
AaNAME
OF TESTER /
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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.
NAME OF TESTER
ICC*
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
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