HomeMy WebLinkAboutApplication 6-10-2020_7-7UNDERGROUND STORAGE TANK
PERMIT APPLICATION
TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
Permit #
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TYPE OF APPLICATION: In NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
(CHECK ONE CONI Y1 I-1 mnDTFTC'ATTnN nF FAC'TI TTY r1 MTNnR mnnTFTC'ATTnN CSF FAC'TI TTY
STARTING DATE/ Va -a-PROPOSE
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BAKERSFIELD FIRE DEPARTMENT
'
Prevention Services
i4
2101 H Street
ZIP CODE
93305
Bakersfield, CA 93301
APN # 016-150-01-01
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
TYPE OF APPLICATION: In NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
(CHECK ONE CONI Y1 I-1 mnDTFTC'ATTnN nF FAC'TI TTY r1 MTNnR mnnTFTC'ATTnN CSF FAC'TI TTY
STARTING DATE/ Va -a-PROPOSE
l
D COMPLETION DATE 5
` t
FA�ILITY NAME
Eleven
EXISTING FACILITY PERMIT #
FACILITY ADDRESS
1900 Union Ave
CITY
Bakersfield
ZIP CODE
93305
TYPHonBRRYNPe store and gas station
APN # 016-150-01-01
TANK OWNER � �PHONE
# _71q .'_7 , _5Qq
ADDRESSVT-)( Std `,/� �� r i a CITY VIS
ZIP COD
Cor4TRACTOR
TBD
CA LICENSE #
ICC #
ADDRESS
CITY
ZIP CODE
PHONE #
BAKERSFIELD CITY BUSINESS LICENSE #
WORKMANS COMP #
INSURER
BRIEFLY DESCRIBE THE WORK TO BE DONE: New Fuel -Install (6)dispensers; (1) 20K Gallon UST -RUL; (1) 20K Gallon UST split
(12K Gallon Diesel/8K Gallon -PUL); new DW FRP piping; all associated equipment; (1) 3096 sf canopy Type IIB
cons ruc lon
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE IN TALLED
ARE THEY FOR MOTOR FUEL?
YES ❑ NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
❑ YES ❑ NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK # VOLUME UNLEADED REGULAR
PREMIUM
DIESEL
I
OTHER
&ot ` X
S { D
6-tral X
Tank Testing Company
NAME OF TESTING COMPANY
PHONE NUMBER
MAILING ADDRESS
NAME OF TESTER
ICC#
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
ICC#
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
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