HomeMy WebLinkAboutUNDERGROUND TANK
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CITY OF BAKERSFIELD
OFFICE OFIENvIRONMENTAL SERVICES
1715 Chester Ave., Bakersfield; CA (805) 326-3979
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PERMIT ApPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK
TYPE OF APPUCA nON (CHECK)
{ )NEW FACD..ITY {)MODIFICATION OF FACD..ITY {)NEW TANK INSTALLATION AT EXISTING FACD..ITY
STARTING DATE ~{:*~ PROPOSED COMPLETION DATE /0/11<>1-
FACD..trYNAMEk./'."~ '>"I~' . ~;;Æ'1.Sda:fsEXISTlNGFACD..ITYPERMITNO. ef I
FACD..ffYADDRESS 0__o.f____J1_ve· CITY ß¡CL ZIPCODE C¡3~
TYPE ÖF BUSINESS ServleI? t!el1'Îer APN fI
TANK OWNER C:;4tJJ~ PHONENO.~M''('~~ - 4b5S
ADDRESS ..:sA,,"€.. CITY g,¿'~ ZIP CODE 9? 507
CONTRACTOR C.A L - \J .4'L L 1;'" E: rtI , CA LICENSE NO. ry}l 4 11 0 A H A Z.
ADDRESS ~2"O ~~t't'~~-ÅLe.· . CITY BF"L. ZIPCODE ~ ~?,()@.
PHONE NO. ~" I - ~ 4..'."; . 4' BAKERSFIELD CITY BUSINESS LICENSE NO. 0 4 ~ 4Q ~9
WORKMANCOMPNO.-l1''2.ï.l4:-'=-~ - C'3 . INsURER. ~t-A"~ c.on,p.
·BRlEFLYDESCRIBETHEWotUtTöBEOONE IJ../ST4LL b.iI,!:? on crager/Iff' 7QnK
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; WATER TO FACD..ITYPROVIDED BY ¡
bEPTHTOGROuNDWATER : ~ .. SOn.. TYPEEXPECTEDATSfIE.
; No. OF TANKS TO BE INSTAllED ,. ARE 11ŒY FOR MOTOR FUEL
, SPD..L PREVENTION CONlROL AND CO R MEAstJREs PLAN ON FD..E
SECTION FOR MOTOR FUEL
I . i TANK. NO.
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2.-
VOLUME
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1 t/tJoc>
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THE APPUCANf HAS RECEIVED, UNDERSTANDS. ANn WILL COMPL'/ wrrn THE A ITACHED CONDmONS ot: '
TIllS PERMIT AND ANY OTHER stA JE, tocA{; ANb FEDERAL REGULATIONS.
. EEN COMPLETED oJoER ~~JT~ OF ~ERJtJRY, ANb TO THE BEST bF MY KNowtEDGE, IS
C . Jxn1if¡þ¿l\ ~/~
APPROVED BY: ';, ; 'APPLrC¡rtrN~ (PRINT) APPLICANT SIGNATURE
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
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TANK. NO.
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VOLUME
YES
YES
NO
NO
UNLEADED
REGULAR
PREMIUM
DIESEL
AVIATION
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SECTION FOR NON MOTOR FUEL STORAGE TANKS
CHEMICAL STORED
(NO BRAND ~AMB)
CAS NO, CHEMICAL PREVIOUSLY STORED
(IF KNOWN)
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09/21/2004 10:45
6613252529
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