HomeMy WebLinkAboutTANK INSTALL APP 10.23.19�:� BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK Prevention Services
2101 H Street
PERMIT APPLICATION Bakersfield, CA 93301
TO CONSTRUCT- INSTALL NEW TANK (NEW FACULTY) /NEW /� Phone: 661 - 326 -3979 Y Fax: 661 -852 -2171
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Page 1 of 1
Permit #
TYPE OF APPLICATION: IN NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
[rHFCK ONF ONI Y) M MODIFICATION OF FACILITY ❑ MINOR MODIFICATION OF FACILITY
STARTING DATE/ I.. j O IQ
Lloo
PROPOSED COMPLETION GATE I o l a
EA"I LNA.M
.1E
l
EXISIIN FACRIIY PERMIT RpE
FA %�PRSLane
CITY Bakeaffield
11p 93Cp309
`1E89AR RCe store and gas station
APNI 403 - 520 -06
TANKOWNER 7- Eleven, Inc
PHONE 714- 771 -54M
ADDRESS
P.O. Box 711 Attu: Gasoline Compliance
CGY Dallas
MP CODE 5221
CORMAC7OR
TED
CA LICENSE #
ICC Y
ADDRESS
Citt
ZIP CODE
PHONE #
BAKERSFIELD CITY BUSINESS LICENSE I
WORKMAN$ COMP Y
INSURER
BRIEFLY DESCRIBE THE WORK TO BE DONE: New Fuel - Install (6ldispenos, s ; (1) 20K Gallon UST -RUL; (1) 20K Gallon GET split
(12K Gallon Diesel /8K Gallon -PULL; new DW FRP piping; allassociated equipment; (3) 3096 Sf C nopy lype IIB
WATER TO FACL PROVIDED aY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
Y OF TANKS T30 BE INSTALLED
ARE THEY FOR MOTOR NEC?
iI YES G NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PUN ON FILE?
O YES TI NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
—ME
UNLEADED
PAGO AR
PREMNM
DIESEL
OTHER
1
20,000 gallons
X
X
2(sPk)
12, 000 gallons
X
2(split)
8,000
X
X
Tank Testing Company
NAMEOFTESRNGCOMPANY TED
PHONE NUMBER
MAILING ADDRESS
NAME OF TESTER
I=CY
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 PEMURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
NAME OF TESTER
ICCY
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY