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Home My WebLink AboutApplication 3-2-22BAKERSFIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANK Prevention Services ML.'g 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 lofi Permit # TYPE OF APPLICATION: F1 NEW TANK INSTALL/NEW FACILITY NEW TANK INSTALL/EXISTING FACILITY (CHECK ONE ONLY) F71 MODIFICATION OF FACILITY D MINOR MODIFICATION OF FACILITY STARTING DATE/ _ n 4 ) 2 2- PROPOSED COMPLETION DATE 2 - 2 1 2.2 - FACILITY NAME SAM'S CLUB GAS STATION #4819 EXISTING FACILITY PERMIT # FACILITY ADDRESS 5625 GOSFORD RD. CITY BAKERSFIELD ZIP CODE 93313 TYPE OF BUSINESS GAS STATION APN # TANK OWNER SAM'S CLUB WEST PHONE #479.277.7388 ADDRESS 702 S.W. 8TH ST. CIS{ BENTONVILLE ZIP CODE 92716 CONTRACTOR JAU REG U I & CULVER, INC . CA LICENSE =08231 Icc # 818241 ADDRESS 959 W MISSION AVE CITY ESCON DI DO ZIP CODE 92025 PHONE -"760.743.0518 760.743.0518 BAKERSFIELD CITY BUSINESS LICENSE # 22-001144993 WORKMANS COMP 9040631-21 INSURER STATE FUND BRIEFLY DESCRIBE THE WORK TO BE DONE: Install Veeder Root Software Upgrade and Perform Cold Start. Test all Sensors. 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 0 NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER T1 207000 NORTH 20K T2 201000 SOUTH 20K T3 207000 12K , 8K 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 ICC# THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY DATE APPROVED APPROVED BY FD2086 (Rev 11/2015)