HomeMy WebLinkAboutMAJOR MOD APP 12.5.19Af�; BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK �•� Prevention Services
2101 H Street
PERMIT APPLICATION Bakersfield, CA 93301
TO CONSTRUCT- INSTALL NEW TANK (NEW FACILTTY) /NEW Phone: 661 - 326 -3979 • Fax: 661 -852 -2171
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Page 1 of 1
Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSFALL/EXISTING FACILITY
,,., n.F nuL YT n MnnIPILATFON nF FA[TI TTY N MINOR MODIFICATION OF FACILITY
STARTING DATE/ PROPOSED
COMPIETWN DATE
FACILHY NAME T j P
✓0
I POSTING FACIL11Y PERMRY
FACoDYAODRE55 380 N SL Nci Ave.
Cm ?--`akf2Y5�: jc(
zIPCOD 330
TYPE OF BUSINESS
APN 8
TAN. OWNER
PHONE 8
ADDRESS
CM
UP CODE
CONTRACTOR co t. Sfiev^eJ�s CO
CA�)�Ep67
ICCASZY0739
ADDRESS •O VOX 361
CI Gan LeQOd VOOO
ZIP CODE 9Y/77
i
PHONE 8 G
5l Y3S b2 Y$
BAKERSRELO COY BUSINESS UCTNSE 8
I f
WORNMANS COMP R
003263-3 1
INSURER
): J.A
BRIEFLY DESCRIBE THE WORK TO BE DONE:
T-1 S-7- SSQ sVw 5 'Roo i' CPIR.4
q7r OIL. UOc. 0t5 YIPP
e pA,.b1 LwC_Q_Q ne
WATER TO FACT I PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SIZE
#OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEL?
O YES a NO
5PILL PREVENTION CONTROL AND COUWERMEASURES PLAN ON FlLE1
O YES D NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK.
VOLDNE
UNLEMED
PEOULAR
PREMED.
INESEL
OTHER
D aoo
2
Co
Tank Testing Company
NAME OF TEETIHG COMPANY K.l S�QUCZMS Cb
•�
PHONE NUNBEIt /- /O,`F'? -09OS S/O q.?r-6Ly
J OO D
NANNO ADORE66
`�• b O 3iOl ,Spn LPgnd D CA - '?YS77
NAME OF TESTER David
David PrreLV�
ICO. 5 2 YO73 y
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 MTE0.
TJavf c/ mere
LOC. 5 2 Y D 73 S
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
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