HomeMy WebLinkAboutminor mod 9-2-21��► BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK Prevention Services
2101 H Street
PERMIT APPLICATION Bakersfield, CA 93301
NEW FACILITY)/NEW '� �� Phone: 661-326-3979 •Fax: 661-852-2171
TO CONSTRUCT -INSTALL NEW TANK
(
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
Page lofl
r
Permit #
TYPE OF APPLICATION: FINEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
(lnlr_ (lull V1 F1 MnnTPT('OTTnN1 np FD('TI TTY n MTNf)R monTFMATMN OF FAC'TI TTY
STARTING DATE/ 08/06/2021
PROPOSED COMPLETION DATE 08/06/2021
FACILITY NAME Jaco #7785 Fastrip #32
EXISTING FACILITY PERMIT #
FACILITY ADDRESS 3701 Ming Avenue
CITY Bakersfield
ZIP CODE 93309
TYPE OF BUSINESS GDF
APN #
TANK OWNER Jamieson Hill
PHONE # 661-393-7000
ADDRESS P.O. Box 82515
cITY Bakersfield
ZIP CODE
93380-2515
CONTRACTOR
Confidence UST Services, Inc.
CA LICENSE #
804904
ICC # 9482314
ADDRESS 2209 Zeus Court
`" Bakersfield
ZIP CODE 93308
PHONE # 661-631-3870
BAKERSFIELD CITY BUSINESS LICENSE #
32864
WORKMANS COMP # 1308371
INSURER State Fund
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace all 3 drop tubes with new (MN Defender 708591902).
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE 7NSTALLED
ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
F1 YES NO f:::]YES Q NO
THIS SECTION IS FOR STORAGE TANK IDENTIFTOATTON
TANK #
VOLUME
UNLEADED
REGULAR PREMIUM DIESEL OTHER
I
1
12K
X
X
2
12K
X X
3
12K
X
Tank Testing Company
NAME OF TESTING COMPANY
PHONE NUMBER
MAILING ADDRESS
NAME OF TESTER
ICC#
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
Ron Clark
ICC#
9482314
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY