HomeMy WebLinkAbout989 Repair Application 6-23-21`^i BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK� Prevention Services
2101 H Street
PERMIT APPLICATION Bakersfield, CA 93301
TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW � Phone: 661-326-3979 •Fax: 661-852-2171
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
Page 1 of 1
Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
(C'HEC'K 11NF (1N1 Yl fl MC11lTFT("ATT(1N (1F FOC'TI TN 141 MTN()R MnnTFT('ATTCIN (1F FA['TI TN
STARTING DATE/ 11-9-20
1-9-20 PROPOSED
COMPLETION DATE 12-9-20
FACILITY NAME C' OFP FJ�7, CHEVRON
EXISTING FACILITY PERMIT #
FACILITY ADDRESS
CITY
BAKERSFIELD
ZIP CODE
93308
TYPE of BUSINESS
GASOLINE DISPENSING FACILITY
APN #
TANK OWNER
PHONE #
ADDRESS
CITY
ZIP CODE
CONTRACTOR
BSSR iNC,
CA LICENSE #
672812
ICC # 5257282
ADDRESS 6630 ROSEDALE HWY #B
BAKERSFIELD
ZIP CODE 93308
PHONE # 661-588-2777
BAKERSFIELD CITY BUSINESS LICENSE #
0010762
WORKMANS COMP #
C6861286A
LACE AMERICAN
BRIEFLY DESCRIBE THE WORK TO BE DONE:
MAKE REPAIRS TO UDC #3,4,9,10,87 AND DIESEL LINE AS NEEDED AND RE -TEST
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER SOIL
TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEL?
❑ YES ❑ NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
❑ YES ❑ NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
Tank Testing Company
NAME OF TESTING COMPANY BSSR INC,
PHONE NUMBER 661-588-2777
MAILING ADDRESS 6630 ROSEDALE HWY #B-BAKERSFIELD, CA 93308
NAME OF TESTER FI DEL CARRI LLO
ICC# 5257282
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
FIDEL CARRILLO
ICC#
5257282
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY