HomeMy WebLinkAboutApplication MOD 9-10-2020_4-4BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANKPrevention Services
4
2101 H Street
PERMIT APPLICATION Bakersfield, CA 93301
TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/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 INSTALL/EXISTING FACILITY
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STARTING DATE/ 08/07/2020 PROPOSED COMPLETION DATE 09/ 1 1 /2020
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FACILITY NAME FastripFood Stores EXISTING FACILITY PERMIT #
FACILITY ADDRESS 4013 S. H. St. CITY Bakersfield ZIP CODE
93304
TYPE OF BUSINESS Convenience Store
TANK OWNER Jamieson Hill
APN # 405-330-13
PHONE # 661-393-7000
ADDRESS P.O. Box 82515 IcITY
Bakersfield
ZIP CODE
93380
CONTRACTOR Jaco Oil/ TBD
CA LICENSE #
970529
ICC #9482 2
3 8
ADDRESS P.O. Box 82515
CITY Bakersfield
ZIP CODE
93380
PHONE # 661-633-7531KERSFIELD
BACITY BUSINESS LICENSE #
1
WORKMANS COMP #
WC348660017
INSURER
A.Z.I.C.
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replacing the penetration fittings in the UDCs of dispensers 11/12, 13/14, and 15/16.
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 10
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
YES ❑ NO
rHTS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
721:T1
12,000
721:T2
12)000
721:T3
127000
Tanis Testing Company
NAME OF TESTING COMPANY Confidence LIST
PHONE NUMBER 661-631-3870
MAILING ADDRESS
16250 Meacham Rd., Bakersfield, CA 93314
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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