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Home My WebLink AboutMinor Mod Application 5-5-21WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? # OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL. � NO YES NO YES THIS SECTION IS FOR STORAGE TANK IDENTIFICATION PREMIUM DIESEL j OTHER TANK # VOLUME � UNLEADED :REGULAR 1 k 1 1 II � i t Tank Testing Company PHONE NUMBER lsbs _ NAME OF TESTING COMPANVE idxt�wxvomvle ` MAILING ADDRESS t � NAME OF TESTER ICC# D UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS ; THE APPLICANT HAS RECEIVED, ER STATE LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UN ,�.. PERMIT AND ANY OTHER PENALTY OF PER.7URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. - ICC# NAME OF TESTER THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY APPROVED BY DATE APPROVED # FD2086 (Rev 11/2015) BAKERSFIELD FIRE DEPARTMENT STORAGE TAN K Prevention Services UNDERGROUND 2101 H Street - Bakersfield, CA 9330 PERMIT APPLICATION Phone: 661-326-3979 • Fax: 661-852-2171 TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD Page 1 of 1 Permit # TYPE OF APPLICATION: NEW TANK INSTALL/ NEW FACILITY U NEW TANK INSTALL/ EXISTING FACILITY CHECK: ONE ONLY) El MODIFICATION OF FACILITY [ MINOR MODIFICATION OF FACILITY STARTING DATE/ PROPOSED COMPLETION DATE EXISTING FACILITY PERMIT # �,::\FACILITY NAME `�� _\ t �U CITY FACILITY ADDRESS ZIP CODE TYPE OF BUSINESS APN # TANK OWNER PHONE # r CITY ADDRESS ZIP CODE CONTRACTOR CA LICENSE # # ADDRESS ^- -- CITY fs 7�1.`✓1 EICC ZIP,�QIt C.� tLA PHONE* BAKERSFIELD CITY BUSINESS LICENSE # WORKMANS COMP # INSURER WV 6q�2-- -- - BRIEFLY DESCRIBE THE WORK TO BE DONE:OL_CI A ",�n ck - ee r- ecx -A! CA dLcv- -1� C C120 kv)a Anc n Y'� WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? # OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL. � NO YES NO YES THIS SECTION IS FOR STORAGE TANK IDENTIFICATION PREMIUM DIESEL j OTHER TANK # VOLUME � UNLEADED :REGULAR 1 k 1 1 II � i t Tank Testing Company PHONE NUMBER lsbs _ NAME OF TESTING COMPANVE idxt�wxvomvle ` MAILING ADDRESS t � NAME OF TESTER ICC# D UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS ; THE APPLICANT HAS RECEIVED, ER STATE LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UN ,�.. PERMIT AND ANY OTHER PENALTY OF PER.7URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. - ICC# NAME OF TESTER THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY APPROVED BY DATE APPROVED # FD2086 (Rev 11/2015)