HomeMy WebLinkAboutOPI APP 10.21.19`�0% BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK
Prevention Services
®
2101 H Street
PERMIT APPLICATION
Bakersfield, CA 93301
TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW �
Phone: 661 - 326 -3979 R Fax: 661 -852 -2171
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
TANK OWNER GEORGE FARAH
PHONE# 661 -832 -1225
Page 1 of 1
1
Permit Yk
11P CODE
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑
NEW TANK INSTALLIEXISTING FACILITY
(CHECK ONE ONLYI ❑ MODIFICATION OF FACILITY N
MINOR MODIFICATION OF FACILITY
STARTING DATE/ 9/4/2019
PROPOSED CONF.DN DATE 10/4/2019
FACILITY NAME METRO MART
E NG FA°LEn PERMTT Y
FAauTr ADDRESS STINE RD
`m BAKERSFIELD
TIP CODE 93308
TYPE OF WSM ,EES GASOLINE DISPENSING FACILITY
APNY
TANK OWNER GEORGE FARAH
PHONE# 661 -832 -1225
ADDRESS "WW STINE RD
BAKERSFIEL�sD
11P CODE
CONTRACTOR BSSR INC,
`�6'F/Z812
¢c#5257282
ADDRESS 6630 ROSEDALE HWY #B
CITY BAKERSFIELD
ZIP CODE 93308
FlIONF Y 661 566 2777
BAKERSFlELO CDY BUSINESS LICENSE #
1800110762
WORKMANS COMP # 22667
INSURER
BRIEFLY DESCRIBE THE WORK TO BE DONE:
INSPECT /REPLACE OVERFILL VALVE, TEST WITH FIRE DEPT.
SB -989 REPAIRS
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
501LTWE IXFECTED AT SITE
Y OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEL?
D YES FI NO
SFUL PREVENTION CONTROL AND CWNTERMEASURES NAN ON FILE?
D YES D NO
THIS SECTION IS FOR STORAGE TAN,, '[FICATION
TANK
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
1
X
2
X
3
X
Tank Testing Company
NAME OF TESRN6 COMPANY BSSR INC,
PHONE NUMBER 661 - 588-2777
MAILING ADDRESS 6630 ROSEDALE HWY #B
NAME OF TEETER FIDEL CARRILLO
IO`P 5257282
THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS
PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS. THIG FORM HAS BEEN COMPLETED UNDER
PENALTY OF PERIURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
NAME OF TESTER
FIDEL CARRILLO
ICCY
5257282
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY