HomeMy WebLinkAboutApplicationBAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGETANK Prevention Services
@ 2101 H Street
PERMIT APPLICATION Bakersfield, CA 93301
TO CONSTRUCT -INSTALL NEW TANK (NEW FACILIT()/NEW Phone: 661-326-3979 • Fax: 661-852-2171
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD Page 1 of 1
iPermit #_
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
l,HFfk ONP ONI Y) V MODIFICATION OF FACILITY ❑ MINOR MODIFICATION OF FACILITY
STARTING DATE/ 7/30119
PROPOSED COMPLETION BATE
FACILITY NAME Valley Plaza Arco
--"G FACBIIY PERMIT #
I
FACILITY ADDRESS 3220 Ming Ave
`u"BakersBeld
ZIP COBE 93304
TYPE OF BUSINESS Retail Gas Station
APR Y
TANK OWNER
Ming Business Inc.
PHONE k
ADDRESS 3220 Ming Ave
`TTM BakersTeld
ZIP CODE 93304
CONTRACTOR
Complete Fueling Solutions
CA LICENSE #
916128
ICC #
5246157
ADDRESS 12601 Jasmine. Ave,
`m Bakersfield
IIP CODE 93312
PHONES I
661-573-7171
BAKERSFSE4CRY BUSINESS LICENSE#
1900134472
WORKMANS COMP#
066355366
INSURER
BRIEFLY DESCRIBE THE WORK TO BE DONE:
CERS 2030062 replace and retest -13 sensor. CERS 2030065 repair vent box and Latest. CERS 2030054 shorten riser under spill bucket antl
replace spill bucket. CERS 2060019 replace spill bucket and retest. CERS 2030035 fix and retest audible visual alarm on tank pad and retest
Overfllt On all tanks.
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
EOILTYPE E%PECTED AT SITE
d OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL?
!❑ YE$ O NO 10
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
YES NO
THIS SECTION IS FOR. STORAGE TANK IDENTIFICATION
TANK VOLUME
UNLEADED
REGULAR (PREMIUM DIESEL
OTHER.
1
Tank Testing Company
NAME OF TESTING COMPANY Complete Fueling Solutions
PHONE NUMBER 661-573-7171
MAILING ADosess 12601 Jasmine Ave., Bakersfield, CA 93312
NAME OF TESTER Aaron Koop
ICCO5246167
1
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 PERIURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
NAME OF TESTER
Aaron Koop
ICCM
5246167
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY