HomeMy WebLinkAboutOPI Application 5-2-22_2-` UNDERGROUND STORAGE TANK
PERMIT APPLICATION
TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
Permit #
`^� BAKERSFIELD FIRE DEPARTMENT
4)
Prevention Services
2101 H Street
Bakersfield, CA 93301
('04,
, Phone: 661-326-3979 . Fax: 661-852-2171
Page 1of1
TYPE OF APPLICATION: ❑ NEW TANK INSTALL/NEW FACILITY ❑ NEW TANK INSTALL/EXISTING FACILITY
((-HF(-V (SNF nN1 Y) 71 M()r)TPTr'ATTnK1 rW r'Ar'TI T-rV r" KAT NIr-%n AAr1r%TCTf-ATTrinl r%r I - Ar -TI TT/
STARTING DATE/
PROPOSED COMPLETION DATE
TBD
TBD
FACILITY NAME EXISTING FACILITY PERMIT #
Costco Gasoline Loc. No. 688 15-021-003276
FACILITY ADDRESS CITYZIP CODE
ZIP
3800 Rosedale Hi hwa Bakersfield. CA
TYPE OF BUSINESS
APN #
Retail fueling facility
TANK OWNER
PHONE #
Costco Wholesale
425 313-8100
ADDRESS
P.O. Box 35005
CITY
WA
ZIP CODE
98124
CONTRACTOR ---]Seattle,
W.S.K. and Sons, Inc.
CA LICENSE #
888712
ICC #
8882502
ADDRESS
34455 Sunlight Drive
CITY
Yucaipa, CA
ZIP CODE
92399
PHONE # BAKERSFIELD CITY BUSINESS LICENSE # WORKMANS COMP # INSURER
(951) 906-3022
22 00108086 WSWC285932 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 SOIL TYPE EXPECTED AT SITE
N; A N/A
# OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEL?
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON F;LE?
N/A
❑ YES ❑ NO
❑ YES ❑ NO
THIS SECTION TS FOR STORAGE TANK TDENTTFTCATTON N/A
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
1
20k -Gallons
X
X
2
20k -Gallons
X
X
3
20k -Gallons
X
X
4
15k -Gallons
X
Tank Testinq Comnanv
NAME OF TESTING COMPANY
PHONE NUMBER
Same as contractor info above
MAILING ADDRESS
NAME OF TESTER
ICC#
Bill Karras
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
ICC#
Bill Karras
8882502
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
ruzuz5b I K e v 11/101.5)