HomeMy WebLinkAboutOPI Application 5-2-22_1jor:�g)6 BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK Prevention Services
2101 H Street
PERMIT APPLICATION Bakersfield, CA 93301
TO CONSTRUCT -INSTALL NEW TANKLITY)/NEW
NEW FA I Phone: 661-326-3979 • Fax: 661-852-2171
( C
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
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Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
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STARTING DATE/
TBD
PROPOSED COMPLETION DATE
TBD
FACILITY NAME
Costco Gasoline (Loc No. 643)
EXISTING FACILITY PERMIT #
15-021-070133
FACILITY ADDRESS CITY ZIP CODE
4900 Panama Lane Bakersfield CA 93313
TYPE OF BUSINESS APN #
Retail fueling facility
TANK OWNER
Costco Wholesale
PHONE #
425 313-8100
ADDRESS
P.O. Box 35005
CITY
Seattle, WA
ZIP CODE
98124
CONTRACTOR
W.S.K. and Sons Inc.
CA LICENSE #
888712
ICC #
8882502
ADDRESS
34455 Sunlight Drive
CITY
Yucaipa, CA
ZIP CODE
92399
PHONE #
951 906-3022
BAKERSFIELD CITY BUSINESS LICENSE #
22 00108086 1
WORKMANS COMP #
WSWC285932
INSURER
NorGaurd
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replacement of existing overfill prevention equipment with new drops tubes equipped with automatic overfill prevention
flapper valves.
WATER TO FACILITY PROVIDED BY
existing - no change
DEPTH TO GROUND WATER
N/A
SOIL TYPE EXPECTED AT SITE
N/A
# OF TANKS TO BE INSTALLED
N/A
ARE THEY FOR MOTOR FUEL?
❑ YES ❑ NO❑
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
YES ❑ NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION N/A
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
1
30k -Gallons
X
X
2
30k -Gallons
X
X
3
30k -Gallons
X
X
Tank Testing Company
NAME OF TESTING COMPANY
Same as contractor info above
PHONE NUMBER
MAILING ADDRESS
NAME OF TESTER
Bill Karras
ICC#
8882502
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
Bill Karras
ICC#
8882502
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
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