HomeMy WebLinkAboutMM Application 6-14-22UNDERGROUND STORAGE TANK
PERMIT APPLICATION
TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
Permit #
TYPE OF APPLICATION:
(CHECK ONE ONLY)
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1of1
F-1 NEW TANK INSTALL/NEW FACILITY [_� NEW TANK INSTALL/EXISTING FACILITY
I -I MCII-)TFTC'ATTnN nF FAC'TI TTY F71 MTNnR MnI)TFTrATTnN nF FAC'TI TN
STARTING DATE/ 2/25/22 PROPOSED
COMPLETION DATE 2/26/22
FACILITY NAME Samco #5
EXISTING FACILITY PERMIT #
FACILITY ADDRESS 1131 Oak St.
CITY Bakersfield
ZIP CODE
TYPE OF BUSINESS GDF
APN #
TANK OWNER Samco Food Store
PHONE #
ADDRESS 1131 ZSak St. --- -- - -_ - _ _ cITY Bakersfield
ZIP CODE
CONTRACTOR Kern Construction
CA LICENSE #
ICC #5242369
ADDRESS PO Box 6096
CITY Bakersfield
ZIP CODE 93386
PHONE #661-634-9950
BAKERSFIELD CITY BUSINESS LICENSE #
On File
WORKMANS COMP #On File
INSURER State Fund
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace spill bucket in 87 #2 Tank.
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 17 NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
YES ❑ NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER
Tank Testing Company
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
I LJ 0000 `I\C V 1 1/ LU 1 J)