HomeMy WebLinkAboutMAJOR MOD APP 11.6.19BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326-3979 So Fax: 661 - 852 -2171
UNDERGROUND STORAGE TANK
COMPLETION DATE
IMF,
9132/3019
PERMIT APPLICATION
EXISTING FACILITY PERMIT A
TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
Page 1 of 1
Permit IF
5625 Gas%. Rd
Bakersfiel0
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY
❑ NEW TANK INSTALL/EXISTING FACILITY
T .." TNUF MNl v1 N MnnTFTLATTON OF FAQLITY
❑ MINOR MODIFICATION OF FACILITY
STARTING DATE/ PROPoSED
COMPLETION DATE
9119/2019 Approx Dale
9132/3019
FACIIIFY NAME
EXISTING FACILITY PERMIT A
Sam's Club Gas Station *4819
FACILITY ADDRESS
CRY
ZIP CODE
5625 Gas%. Rd
Bakersfiel0
93313
TYPE OF WGINE55
APN Y
Gas Station
TANK OWNER
PHONE #
Sam's Club West, Inc.
479 - 277 7388
ADDRESS
CITY
ZIP CODE
702 S. W. Rti 5[rert
Bentonville
72716
CONTRACTOR
CA LICENSE #
ICC *
3amegui & CUlveq Inc.
708231
8277373
ADDRESS
CCIY
TP CODE
9WWest Mission Aye
E'GpdGO
92025
PHONE #
BAKERSFIELD Cry BUSINESS LICENSE A
SARKMANS COMP#
INSURER
760 - 743-0518
20 00114993
9040631 -I9
State Comp Ins Fund
BRIEFLY DESCRIBE THE WORK TO BE DONE: 87 Tank #2 SIT Sump and Vent Be. are OW and are losing whim. Contractor W locate leaks by ex(dvating amend vent box,
sing soapy water Or helium to lorate leaky 87 STG sump Previously was Otecked wRM1 helium and detemiNed that a flexible Chase penemation fitting has a Nigh leak.
Repai To be made whim Bravo ral fittings and/or Fberglass Resin and matting. Funne hbox0betested and repaired per industry standards, permit requirements and
per Bravo ManukRure Specifications
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
5011 TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEP
SPILL PREVENTION CONTROL AND COUNTERMEA SURES PIAN ON FILE2
O YES O NO
0 YES O NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK#
VOLUME
UNLEADED
REGULAR
(PREMIUM
DIESEL
OTHER
T -1
20,000
NOON
T -2
20,000
South
12,000
8,000
Ta
20,000 (split tank)
Tank Testing Company
NAME OF TESRNG CO M PANY
PHONE NUMBER
MAILING AOORE85
NAME OF TESTER
II -
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
LCC#
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVEO BY
cmnPfi tRev 1100351