HomeMy WebLinkAboutApplication MAJ MOD 3-31-21UNDERGROUND STORAGE TANK
2 -
PERMIT APPLICATION
TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
❑ NEW TANK INSTALL/EXISTING FACILITY
❑ MINOR MODIFICATION OF FACILITY
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V1ATER TO FAC.LM PROVIDED BY
DEPT H TO GROUND V.ATER SOIL TYPE EXPECTED AT SITE
= OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONT AND COUNTERMEASURES PLAN ON FILE)
❑ YES 0 «0 v YES O NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK # 'VOLUME
UNLEADED { REGULAR
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Tank Testing Company
NAME OF TESTING COMPAN PHONE NUMBER
MAILING ADDRES
NAM 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.
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THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
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