HomeMy WebLinkAbout2200 e brundage ln_tank removal_5-9UNDERGROUND STORAGE TANK
MM
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
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THIS APPLICATION WILL BECOME A PERMIT WHEN APPROVED
SITE IIJEORMATIQN
SITE
ADDRESS E. Brundage
ZIP CODE 93307
FACILITY NAME Wholesale Fuels Inc
CROSS STREET
TANKOWNER /OPERATOR
PHONE #
APN #
MAILING ADDRESS
CITY
ZIP CODE
CONTRAC FORMATION
COMPANY
PHONE #
LICENSE #
ADDRESS
CITY
ZIP CODE
INSURANCE CARRIER
WORKMENS COMP #
PHONE #
LICENSE #
COMPANY
ADDRESS
CITY
ZIP CODE
INSURANCE CARRIER
WORKMENS COMP #
COMPANY
PHONE #
LICENSE #
ADDRESS
CITY
ZIP CODE
INSURANCE CARRIER
WORKMENS COMP #
WASTE TRANSPORTER ID #
FACILITY ID #
NAME OF RINSATE DISPOSAL
ADDRESS
CITY
ZIP CODE
TANK
TRANSPOR
=R INFORMATION
COMPANY
PHONE #
LICENSE #
ADDRESS
CITY
ZIP CODE
TANK DESTINATION
TANK INFORMATON
TANK #
AGE
VOLUME
CHEMICAL STORED
DATES STORED
CHEMICAL PREVIOUSLY STORED
10124221 -005
40
20,000
Diesel
Since 1980
10124221 -006
40
20,000
Diesel
Since 1980
FOR OFFICIAL 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