HomeMy WebLinkAbout4050_4-4BAKERSFIELD FIRE DEPARTMENT
STORAGE TANK
T • ••• -^ ^-- ------
PROPOSED
Prevention Services
UNDERGROUND
EXISTING FACILITY PEMiR II
1501 T Avenue, 1� Floor
PERMIT APPLICATION
aRYS
field,
Phone: 661-326-3979 •Fax: 661-852-2171
Bakersfield, 26 3979TO
CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW
APMA
TANK OWNER
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
.I
Page 1 of 1
Permit #
CO
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑
NLEW-T*N"'' L� L FAC IT`I
CA
1
(CH[_K ONE ONLY) MODIFIL IIVN Ur lN. Uul
STARTING DATE/
T • ••• -^ ^-- ------
PROPOSED
FACILITY NAME
EXISTING FACILITY PEMiR II
FACILITY ADDRESS
TYPE OF BUSINESS
APMA
TANK OWNER
PHONE A
ADDRESS
CITY
CO
CA
1
ADDRESS
AHONE C
BAKERS S
WORKMANS WMA Y
INSURER
9RI; DESCRIBE THE WORK TO BE LUNE:
IL
I
WATER TO FACILTTY PROWDm BY
DEATH TO GROUND WATE0.
SOILTYPE EXPECTED AT SITE
0 OF TANKS TO BE IN
ARE THEY FOR MOTOR NEL?
p TES p NO
SPLI PREVENTION CONTROLAND MOOUNTERMEASUHI`PLAN ON Flit?
p YES
THIS SECTION I5 FOR STORAGE TANK IDENTIFICATION
TANK
VOLUME
UNLEADED
REGULAR FREM•UN
DIEEEL OTHER
-ap'w' --sting Company
NA ME OF TEIFrMG COMPANY NUMBER
MAILSNGADDREMS _ p
NAME OF TEETER
MCI O
THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS
HAS BEEN LETED UNDER
PERMIT AND ANY
O PERJURY, ST AND TO THE BEOF MY KNOWLEDGE ISTRUE AND CORRECT.
P
NAME OF TEBIER
MCI
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
APPROVED BY
DATE APPROVED
086 IA.V 0.1091