HomeMy WebLinkAboutUNDERGROUND TANK
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a BAlŒRSFIELD FIRE DEPAR'1'Jf8tT
- ENVIROHIIIHTAL SERVIa.
1715 Chester Ave.,
Bakersfield, CA 93301
(805) 326-3979
TANK RBIIOVAL INSPECTION FORM
ADDRESS 3~O Tt1+Uw':/.
PERMIT TO OPERATE' fiB. - ()~B.2
CONTACT PERSON fJ..n~!-J /ú. Ilcl.t-S<t(('-
# OF SAMPLES
TEST METHODOLOGY '"' - 4- \~ ~ t
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CONDITION OF PIPING HlIIJ( ~"'^¡
CONDITION OF, SOIL êJlJ....t.ll,1 t{tI.'i
COMMENTS íà hie A ff ( tJ r-~ 1a.J¡){ ~ ç 1- 'It IJ r~ D Ii.
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.j' .T Miller Pacific, Inc. Ç¿¡t
Commercial Construction J... <;. .
Tom Scrivner f
Project Manager
4525 Quail Lakes Dr., Ste. B
Stockton. CA 95207
CA Lie, #497652
(209) 477-7323
- Fax (209) 477-7326
Cell (209) 649-2323
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.. __ Permit No. ß.1L:....QJ 9 ì
- CITY OF BAKER~ELD
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield, CA (661) 326-3979
PERMIT APPLICATION FOR
REMOVAL OF AN UNDERGROUND STORAGE TANK
ADDRESS 52.:2-° Tf-,çr H¡0~CODE '1J07APN s/'f-i!7ro-/(,o
CROSS STREET CJ t .~ I ~ ~~ à
'" PHONE NO. 1- ;JtH' - , C( 'I - 2:3"2..5
II' Ii. -vCITY, ZIP q 1') f !
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CONTRACTOR INFORMATION "'""<.~,t--~-,--o/\!:f'~ _'L:::;>_ ., ...,::.,.j
COMPANY (\0.... C tt ç ~ PHONE NO. 6.61 . ~š·"rl. ' If SYG. LICENSE NO. '51 C(9' (¿, Š
ADDRESS r<fO-S- -c- " ""'1 w~ ~ (q ce... CITY ß Ct IGLS ZIP ??? / f
INSURANCE CARRIER S fo.-.+ e .~..... "à WORKMENS COMP NO. (, q l IS Y J' 'L r
OYl{.-D-' c...t'-\.'( ~ <'OO],r21
FORMATION
PHONE NO. ~C;' ~(p ~_ LICENSE NO. Q,LEd.3.;)...., t)
'- CITY ~~ ZIP 1~3t') 1
It WORKMENS COMP NO. k'2. E ,t;":~ () L/7.. ~
TANK CLEANING INFORMATION
COMPANY WI ~ U <X C ('tA v-...... s~,,-uì U
ADDRESS '3 lIdD {A/lC\...,Glv 1) ¿,...
WASTE TRANSPORTER IDENTIFICATION NUMBER
NAME OF RINSA TE DISPOSAL FACILITY
ADDRESS
FACILITY IDENTIFICATION NUMBER
PHONE NO. ,," ( . 'J '7J, Ilr {
CITY ß"'1!&-5 ZIP 957o~
CITY
ZIP
PHONE NO. (;(;/~· f? 2 - c,.r"CENSE NO. ~ w,,)
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TANK INFORMATION
AGE VOLUME
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CHEMICAL
STORED
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DATES
STORED
CHEMICAL
PREVIOUSL Y STORED
TANK NO.
THE APPLICANT HAS RECEIVED, UNDERST ANDS, AND WILL COMPLY WITH THE ATTACHED CONDIT IONS OF THIS
PERMIT AND ANY OT HER ST ATE, LOCAL AND FEDERAL REGULATIONS.
THIS FO HAS BEEN COMP LETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOW
ANDC RECT.
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APPLICANT NAME (PRINT)
APPROVED BY:
THIS APPLICATION WILL BECOME A PERMIT WHEN APPROVED
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30,00' WIDE RIGHT-:Of'-'~AY DEDICAll6N:,
TO THE COUNTY ~ KERN PER
DOCUMENT NO. 0201164910. O,R,
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WIBLE ROAD
R VALUE = 62, TRAFFIC INDEX = 8.5·
0.45' A.C. 'OVER 0.40' ,CL II A.B./t 70" Co..,P. 'NATIVE '
(WIBLE ROAQ STRUCTURAL SECTION) (
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