HomeMy WebLinkAbout2200 e brundage ln_tank removal_4-9UNDERGROUND STORAGE TANK
PERMIT APPLICATION
FOR REMOVAL OF AN UNDERGROUND STORAGE TANK
Permit #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 •Fax: 661 - 852 -2171
Page 1 of 1
9-" TTE INFORMATION
SITE
ADDRESS 2200
E. Brundage
ZIP CODE 93307
FACILITY NAME Wholesale Fuels Inc
CROSS STREET
TANKOWNER /OPERATOR
PHONE # (661)633-7534
APN #
MAILING ADDRESS PO BOX 82515
CITY Bakersfield
ZIP CODE 93380
COMPANY Jaco Oil Company
PHONE # ( 661) 633 -7534
LICENSE #
ADDRESS 3101 State Rd
CITY Bakersfield
ZIP CODE 93308
INSURANCE CARRIER American Zurich Insurance Co.
WORKMENS COMP # WC34 8 6 60 0 1 6
Cft
PRELIMINARY AS MF:-c%S
ENT INFORMATION
PHONE # (559)348-2200 LICENSE #
COMPANY Kra z an
ADDRESS 215 W. Dakota Ave.
CITY Clovis
ZIP CODE 93612
INSURANCE CARRIER Travelers Property Casualty Co of Americ
ORKMENS COMP # UB9H94 8 3 65214 3G
COMPANY Jaco Oil Company
PHONE # 661-633-7534
LICENSE # 970529
ADDRESS 3101 State Rd.
CITY B a k e r s f i e l d
ZIP CODE 93308
INSURANCE CARRIER American Zurich Insurance
WORKMENS COMP # WC 3 4 8 6 6 0 016
WASTE TRANSPORTER ID # B e l s h l r e Environmental FACILITY ID # DeMenno CAT0 8 0 013 3 52 NAME OF RINSATE DISPOSAL
ADDRESS 2000 N. Alameda St
CITY Compton
I ZIP CODE 90222
TANK TRANSPOR A-R
INFORMATION
COMPANY Cal Lowbed Service Inc.
PHONE # ( 661) 588 -6410
LICENSE #
ADDRESS 6837 Krebs Rd.
CITY Ba'KersflelC
ZIP CODE 93308
TANK DESTINATION Western Scrap Inc & Midway
Recycling
TANK INFORMAT
ON
TANK #
AGE
VOLUME
CHEMICAL STORED
DATES STORED
CHEMICAL PREVIOUSLY STORED
10124221 -00
40
101007
Diesel
Since 1980
10124221-002
40
10, 000
Diesel
Since 1980
10124221 -00
3 4 0
20, 000
Diesel
Since 1980
10124221 -04
40
20, 000
Unleaded
Since 1980
FOR OFFICIAL U E ONLY
APPLICATION DATE FACILITY #
# OF TANKS FEE $
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.
APPROVED BY
APPLICANT NAME (PRINT)
APPLICANT SIGNATURE
THIS APPLICATION WILL BECOME A PERMIT WHEN APPROVED