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HomeMy WebLinkAboutSams Permit 10-11-21UNDERGROUND STORAGE TANK PERMIT APPLICATION TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW TANK INS ALL (EXISTING FACILITY)/MOD-MINOR MOD Permit- # BAKERSFIELD FIRE DEPAR71 MENT p IV -V antlon Sal ices 2101 H Strent , CA 93301 Bakersfield Phone: 661-326-3979 o Fax: 661-852-2171 Page I of 1 TYPE OF APPLIC-ATION: Lj NEW TANK INSTALL/NEW FACILITY Lj NEW TANK INSTALL/EXISTING FACILITY (CHECK ONE ONLY) E] MODIFICATION OF FACILITY 0 MINOR MODIFICATION OF FACILITY STARTING DATE/ 10104/2021 PROPOSED COMPLETION DATE 10/05/2021. FACILITY NAME SAM'S CLUB GAS STATION #4819 EXISTING FACILITY PERMIT # FACILITY ADDRESS 5625 OFOD D. ic Y AEF I LD ZIP CODE 933 1 3 TYPE OF BUSINESS GAS T AT11 IO I N APN TANK OWNER SAM'S CLUB WEST PHONE "479.277.7388 ADDRESS 702 S.W. 8TH T. CITY TO lqVl L.LE ZIP I CODE 92716 CONTRACTOR JAUREGUI & CULVER, INC. CA LICENSE 708231 1"818241 ADDRESS A\/F ]cm ESCONDIDO ZIP CODE q W M; 1,RR I n N 1 92025 R # OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? i SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? YES NO YES NO ST mlq xs Von 8T,0qA--Gt TAS- IDENTIFICATION TATINX VOLU11,21u E DlE___zL Ti 20,000 N OR. T H 20f0 4 2 T3 20,000 SOUTH 20K 20,000 12K SK Tank Tes- '-inq Company ---------- PLA14E C0111PIANY I MAIU,PJG ADDRESS MA2%.1Z OF TESTS—:R I 1r, --c# a j I —1 HE- ;AP PLICA&I'lF HAS REC EIVED, U ODER. -3, laAiIDSI A -N-1 D W-11 LL CC) �-VLY WITH T HE -A-F17ACME-D CON D ]k:710 FIS OF 71- IS PERVIIT AND A NY OTHEI-q- STAT Ej, LOC -90, YkND FIEDEP&A- L 7HIS FO :lull HAS BEEN 0014PLIEFTED UJND-lz PENAL, IFYSOF PERO 101Y, A- 1,171D TO THE SEST Or 1,,4Y KNOTIVAILEEDGE 15 T�lj E :'_\ND CORR-ECT. DATE APPROVED 'THIS APPLICATION BE—tCOMES A PERMal'17 WH HN APPP,.0VE"=:D APPROVED BY FD2086 (Rev 11/2015)