The URL can be used to link to this page

Home My WebLink AboutApplication MOD 2-12-21UNDERGROUND STORAGE TANK PERMIT APPLICATION TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW TANK INSTALL (EXISTING FACIl1TY)/MOD-MINOR MOD P6rrnit # ■ �� BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 •Fax: 561-852-2171 Page 1 of 1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY tC'HFC'tC CNF C)NI Yl I-1 mnnTFTC'ATTnN CSF FA(^TI TTY FX MTNnp mnnTFTC`ATTnN C)F FAC'TI TTY STARTING DATE/ PROPOSED COMPLETION DATE FACILITY NMA/PM Arco EXISTING FACILITY PERMITr IACW6 Hwy. iciYakersfield ZIP ODOSedale 8 93 TYPE FB� SIN facility I ng APN # TANK OWNER PHONE # ADDRESS CITY ZIP CODE CON CTO SSR, Inc. CA LICENSE 672812 ICC 5369490 ADDRESS Rosedale Hwy. EB cBakersfield 2193308 PHONE �-- 588-2777 BAKERSFIELD CITY BUSINESS LICENSE # 21 00110762 WORKMANS COMP = 066355287 INSURER Ace American BRIEFLY DESCRIBE THE WORK TO BE DONE: SB989 repairs 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 THIS SECTION IS FOR STORAGE TALK IDENTIFICATION TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER Tank Testing Company N SS , nc COMPANY NUMBER P9O�9LL UU MAILING ADDRESS 6630 Rosedale Hwy. #B, Bakersfield CA NAME OF TESTER Salvador Sanchez ICC 5 09490 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 Salvador Sanchez ICC# 5309490 THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY