HomeMy WebLinkAboutMinor Mod Application 6-21-22PERMIT APPLICATION
TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
lPermit #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 Fax: 661-852-2171
1
Page 1 of 1
TYPE OF APPLICATION. 11 NEW TANK INSTALL/NEW FACILITY 1:1 NEW TANK INSTALL/EXISTING FACILITY
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STARTING DATE/ ASAP
PROPOSED COMPLETION DATE ASAP
Ill NAME Ro s Market & Gas I
EXISTING FACILITY PERMIT #
FACILI-TY ADDRESS 631 Bakers St
Bakersfield
ZIP CODE 93305
TYPE OF BUSINESS Gas Station
APN #
TANK OWNER
PHONE #
A11REss631 Bakers St
CITY Bakersfield
ZIP CODE 93305
CONTRACTOR Advanced Co liar e
CA LICENSE #
'cc # 8032698
ADDRESS 4007` Brae Burn Dr
cl Bakersfield
ZIP CODE 903306
PHONE #661 -706-4321
BAKERSFIELD CITY BUSINESS LICENSE #
W ORKMANS COMP #
INSURER
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace Senor 12 and Vacuum 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? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
F-1 YES F --j NO 15 YES NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME UNLEADED REGULAR PREMIUM
DIESEL
OTHER
Tank Testing Company
NAME OF TESTING co"PANY Advanced Compliance
PHONE NUMBER 661- 706-4321
MAILING ADDRESS 4007 Brae Burn Dr Bakersfield, Ca. 93306
NAME OF TESTER Bruce Hinsley TCC# 8032698
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 PER3URY, 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