HomeMy WebLinkAbout2201 taft hwy_ust removal _3-6BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK Prevention Services
2101 H Street
PERMIT APPLICATION Bakersfield, CA 93301
FOR REMOVAL OF AN UNDERGROUND STORAGE TANK Phone: 661 - 326 -3979 •Fax: 661 - 852 -2171
Page 1 of 1
Permit #
SITE IINFORMATION
SITE Bakersfield 119, LLC.
ADDRESS
2201 Taft Hwy. Bakersfield
ZIP CODE 93313
FACILITY NAME Bakersfield 119, LLC.
CROSS STREET Michele St.
TANKOWNER /OPERATOR Bakersfield 119, LLC.
PHONE # 310- 748 -1348
APN #
MAILING ADDRESS 2201 Taft Hwy.
CITY Bakersfield
ZIP CODE 93313
CONTRACTOR
FORMATION
COMPANY Shancor
PHONE # 951- 772 -4354
LICENSE # 708267
ADDRESS 14052 Larch Ln.
CITY Tustin, CA
ZIP CODE 92780
INSURANCE CARRIER State Compensation Insurance Fund
WORKMENS COMP #9081579-2019
RELIMINARY ASSESS
ENT INFORMATION
COMPANY
PHONE #
LICENSE #
ADDRESS
CITY
ZIP CODE
INSURANCE CARRIER
WORKMENS COMP #
COMPANY Complete Fueling Solutions
PHONE # 661 - 573 -7171
LICENSE # 916128
ADDRESS 12601 Jasmine Ave.
CITY Bakersfield, CA
ZIP CODE 93312
INSURANCE CARRIER ACE American Insurance Company
WORKMENS COMP # C68614235
WASTE TRANSPORTER ID # FACILITY ID #
NAME OF RINSATE DISPOSAL
ADDRESS
CITY
ZIP CODE
TANK TRANS -IM", _1--R
INFORMATION
COMPANY SA Recycle Center
PHONE # 661 - 599 -2458
LICENSE #
ADDRESS 2000 E. Brundage Ln.
CITY Bakersfield, CA
ZIP CODE 93307
TANK DESTINATION
TANK #
AGE
VOLUME
CHEMICAL STORED
DATES STORED
CHEMICAL PREVIOUSLY STORED
1
unknown
20,000
Diesel
Diesel
FOR OFFICIAL USE 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
c NAME (PRINT)
^
AP LICANT SIGNATURE
ccvj-o� c \j a
THIS APPLICATION WILL BECOME A PERMIT WHEN APPROVED
FD2088 (Rev 11/2015)