HomeMy WebLinkAboutApplication 8-13-2020UNDERGROUND STORAGE TANK PERMIT APPLICATION TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD Permit # `^� BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 •Fax: 661-852-2171 Page 1©f1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY (-HF(--K nNF nNI Y) n mnnTFT('ATTnN CSF FA(71 TTY f14 MTN(lR mnnTFTC'ATTnr\i nF Par fl TTY STARTING DATE/ PROPOSED COMPLETION DATE FACIL� 1 # 3 241 EXISTING FACILITY PERMIT 1��I61ACXfflOWAY cgAKERSFIELD 2'�2 TYPE OF BUSINESS FUEL FACILITY APN TANK OWNER PHONE ADDRESS CITY ZIP CODE C06gJO T RINC. c6Ljff � y IC91 1 067 ADW$b ROSEDALE HWY. #B cBAKERSFIELD Z193308 PHONE= 588-2777 BAKERSFIELD CITY BUSINESS LICENSE� 0010762 W�����5�)� LZS��� IN�U�F� AMERICAN BRIEFLY DESCRIBE THE WORK TO BE DONE: REPLACE VACUUM SENSOR (87) WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? ❑ YES ❑ NO SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO THIS SECTION IS FOR STORAGL TANK IDENTIFICATION TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER Tank Tes-ting Company N SFR}TEfT��VG COMPANY PF,�QEcj�J8B 777 7 MAILING ADDRESS 6630 ROSEDALE HWY. #B BAKERSFIELD, CA NAME OF TESTER NATHAN HOLMAN ICC# 8111067 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 NATHAN HOLMAN ICC# 8111067 THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY rVLU00 IKt�V 11/LU1J)