HomeMy WebLinkAboutOPI Application 2-24-22BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANKa Prevention Services
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 1 of 1
Permit #
TYPE OF APPLICATION: F1 NEW TANK INSTALL/NEW FACILITY NEW TANK INSTALL/EXISTING FACILITY
(CHECK ONE ONLY, F 1 MODIFICATION OF FACILITY EZI MINOR MODIFICATION OF FACILITY
STARTING DATE/ 2/22/22 PROPOSED
COMPLETION DATE 2/26/22
FACILITY NAME S a m co #4
EXISTING FACILITY PERMIT #
FACILITY ADDRESS 4100 California Ave.
CITY Bakersfield
ZIP CODE
TYPE OF BUSINESS GDF
APN #
TANK OWNER Samco Food Stores
PHONE #
ADDRESS 4100 California Ave.
CITY Bakersfield
ZIP CODE
CONTRACTOR Kern Construction
CA LICENSE #
ICC #5242369
ADDRESS PO Box 6096
CITY Bakersfield
ZIP CODE 93386
PHONE #661-634-9950
BA ERSeFIELD CITY BUSINESS LICENSE #
WORKMANS COMP #On File
INSURER State Fund
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Install Drop Tubes. 87 North, 87 South, and 91
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_� 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
Tank Testing CornpanV
NAME OF TESTING COMPANY Kern Construction
PHONE NUMBER 661-634-9950
MAILING ADDRESS
NAME OF TESTER Josh Simmons
ICC# 5242369
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
D2086 (Rev 11/2015)