HomeMy WebLinkAboutminor mod 2021_10_15BAKERSFIELD FIRE DEPARTMENT
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UNDERGROUND STORAGE TANK Prevention Services
- 2101 H Street
PERMIT APPLICATION� Bakersfield, CA 93301
TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW � 1/4 Phone: 661-326-3979 •Fax: 661-852-2171
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
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Permit #
TYPE OF APPLICATION: F-1 NEW TANK INSTALL/NEW FACILITY F1 NEW TANK INSTALL/EXISTING FACILITY
(CHECK (SNF nNl Yl n MnnTFT('ATTnN (1F FAC'TI TTY F71 MTNnR MnI7TFTrATTnN nF FAC'TI TTY
STARTING DATE/ 09/24/2021
PROPOSED COMPLETION DATE TBD
FACILITY NAME Jaco #7773 Fastrip #31
EXISTING FACILITY PERMIT #
FACILITY ADDRESS 3501 Mt. Vernon Avenue
CITY Bakersfield
ZIP CODE 93306
TYPE OF BUSINESS ^ D F
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
CITY 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 test boots in UDC's 1/2 & 5/6. (ICON 3.5x2.7 test boot, PN ISR3.5x2.7)
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEL?
F-1 YES 171 NO [:::]YES
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
1
12K
X
X
2
12
X
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
Justin Williams
ICC# 9482314
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY