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HomeMy WebLinkAboutApplication minor mod 3-2-21a PERMIT APPLICATION TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW TANK INSTALL (EXISTING FACILITY}/MOD-MINOR MOD 113ermit # Page 1 of 1 TYPE OF APPLICATION: FI NEW TANK INSTALL/NEW FACILITY 1:1 NEW TANK INSTALL/ EXISTING FACILITY (CHECK ONE ONLY) L MODIFICATION OF FACILITY U MINOR MODIFICATION OF FACILITY STARTING DATE 'PROPOSED COMPLETION DATE TBD TBD FACILITY NAME EXISTINGFACILITY PERMIT # Brookside Market (Rivertakes) FACILITY ADDRESS 4700 Coffee Road CITY Bakersfield ZIP CODE 93308 I TYPE OF BUSINESS Gas station and C -store I APN # I I Repair brine leak in the Diesel STP sump and 91 fill sump with fiberglass patching. WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED :ARE THEY FOR MOTOR. FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? 0 YES NO in YES Q NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TANK# VOLUME UNLEADED. REGULAR PREMIUM DIESIEL OTHER Tank Testing Company NAME OF TESTING COMPANY Cal Valley Equipment PHONE NUMBER (661) 327-9341 MAILING ADDRESS 7608 Fruitvale Avenue, Bakersfield, A. 93308 NAME OF TESTER Jerry Rangel ICC:# 8900824 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 FD2086 (Rev 1112015 BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield,, CA 93301 Phone: 661-326-3979 Fax: 661-852-2171 Page 1 of 1 TYPE OF APPLICATION: FI NEW TANK INSTALL/NEW FACILITY 1:1 NEW TANK INSTALL/ EXISTING FACILITY (CHECK ONE ONLY) L MODIFICATION OF FACILITY U MINOR MODIFICATION OF FACILITY STARTING DATE 'PROPOSED COMPLETION DATE TBD TBD FACILITY NAME EXISTINGFACILITY PERMIT # Brookside Market (Rivertakes) FACILITY ADDRESS 4700 Coffee Road CITY Bakersfield ZIP CODE 93308 I TYPE OF BUSINESS Gas station and C -store I APN # I I Repair brine leak in the Diesel STP sump and 91 fill sump with fiberglass patching. WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED :ARE THEY FOR MOTOR. FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? 0 YES NO in YES Q NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TANK# VOLUME UNLEADED. REGULAR PREMIUM DIESIEL OTHER Tank Testing Company NAME OF TESTING COMPANY Cal Valley Equipment PHONE NUMBER (661) 327-9341 MAILING ADDRESS 7608 Fruitvale Avenue, Bakersfield, A. 93308 NAME OF TESTER Jerry Rangel ICC:# 8900824 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 FD2086 (Rev 1112015