HomeMy WebLinkAboutMINOR MOD APP 12.5.19BAKERSFIELD 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 page I or 1
Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALLMEW FACILITY ❑ NEW TANK INSTALLIEXISTING FACILITY
I nNF nM' 11 n MOnirrrATmN OF FArTI TTY III MINOR MODIFICATION OF FACILITY
STARTING DATE/ ^/4/2019 PROPOSED
COMP -MON DATE 10/x%/2019
I
FACUU NAME SAM'S MARKET
I EXSTING FACUL PERMUI
FA Urnf ADDRESS 318 WHITE LANE
°TY BAKERSFIELD
nP CODE 93307
1YPEOF BUSINESS GASOLINE DISPENSING FACILITY
ARK*
TANK DWNER RAJPAL SINGH
°HONE# 661- 833 -9688
ADDRESS 318 WHITE LANE
``'`BAKERSFIELD
UP CODE 93307
OONTRACTOR BSSR INC,
a BCfJE 2
Ia Y 5257282
ADDRESS 6630 ROSEDALE HWY #B
E"T BAKERSFIELD
21 °ODDE93308
PHONE Y 661 566 2777
BAKERS TEUI C MS1NESS LICENSE #
1800110762
WORKMANS COMP # 126(J,7
IN50RER
BRIEFLY DESCMEE THE WORK TO BE DONE:
INSPECT /REPLACE OVERFILL VALVE, TEST WITH FIRE DEPT.
WATER TO FACILITY PROWDED W
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT 5[fE
Y OF TANKS TO BE INSTALLED
ARE `HET FOR MOTOR NEC?
p YFS D NO
SnLL PREVENnIXi CONTROL AND COUNTERMEASURES PLAN ON FILE?
O TES D NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK#
VOLUME
UNLEADED
REGULAR
PREMNM
DIBEL
COMER
1
X
2
X
3
X
Tank Testing Company
NAME OF TG4nNG COMPANY BLSSR INC,
FROME NUMBER 661- 588-2777
MAILING ADDRESS 6630 ROSEDALE HWY #B
NAME OF TESTER FIDEL CARRILLO
1OC# 5257282
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
FIDEL CARRILLO
Las
5257282
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE AWROVED
APPROVED BY
cvnnR f°ea 11011151