HomeMy WebLinkAboutMinor Mod App 10.25.19BAKERSFIELD FIRE DEPARTMENT
STORAGE TANK
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COMPL N RITE
Prevention Services
Floor
UNDERGROUND
T Avenue. SR
PERMIT APPLICATION
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Bakersfield,
Bake
Phone: 661 - 326 -3979 •Fax: 661 - 852 -2171
Phone: 661- 269979
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW
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TANK INSTALL (EXISTING FACILTTI7 /MOD -MINOR MOD
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Permit# -_
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑
NEW TANK INSTALL/EXISTING FACILM
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❑ MODIFICA IUN Ur r.MUUi
PROPOSED
SFARTING DATE/
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COMPL N RITE
FAQLDY NAME DUSTING FAQLnY PEM4Pi
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TYPE OF BUSINESS
TANK OWNER
PHONEY
ADDRESS
CfIY
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DOUrRACFOR
ADDRESS
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BAKERS SI N 5,
WOR%MANS COMPF
INSURER
BRIEFLY DESWBETHE WORKTO BE DONE:
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WATER TO FA LDY PROVIDED BY
DEPLH TD GROUND WATER
SOIL TYPE E%PECIEO AT SnE
B OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR NEL?
D YES 0 NO
SPRL PREVENtION CONTROL AND D COUMERMFISURES FILAR ON FILE?
O YES NO
ICATION
DUIR
PREMIUM
DIESEL
OTHER
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UNBER
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NAILING ADDRESS C✓\i i.� CA--
NAME OF TESTER
THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS HAS BEEN
PERMIT AND ANY OF ER R AND TO THE BEST OF My KNOWLEDGE IS F TRUE AND CORRECT-
NAME OF TESTER /-
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED M
FD2086 (Rev O8 /D9)