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\#PLICATI0N FOR PERHIT T0 CONSTRrru t:
ta
w
UNDERGROUND HAZARDOUS MATERIALS STORAGE TANK
E Construct Neu, Tank D Modify Existing Tank D Transfer of 0wnership l,n I
co
tg 0perate New Tank In or on the premises at 4q <^,r{'L tAitEeA
Oe k; r,r"'SA- B
PART I
Ol^/NER
OPERATOR:
Company:
CONSTRUCTI ON :
Company:
F,,,Compa ny Fte Aas AT)b R.I L
Mail ing Address:
Contact:
Tel: ( )
n<Contact:
Mai I ing Address :Tel: ( )
, State Contractor License No.
Constructfon Start Date:
to construct or mod ify tank)min* c&.er
Tel :(zag 73443r I
( fo r new const,f tion a modification onl
ipf ng and _ Lea k Detection Systern
_ Overfill Protection System
_ North Arrow
_ Nearest Intersection or Road
r ownershi p,,;:::,::0,:";::l:'.il;;:l:';, 1 owi ns :
Contact:
Tel
Contact
Tel: ( )
Date Instal I e.t .
( for existing
( Compl
2Pt
ete on'lySf 4d/t)Contact:
Mailing Address:
Attach a Plot Plan Showing:
Location of all tanks and p
- their secondary containment
_ Scale
_ Property Line
_ Equipment Summary
If this js an application to transfe
Previous Owner:
Add res s :)(
Previous Operator:
Address:
Start Up Date:
24 Hou r Eme n Tel e hone
P'l an App ro ved
Plan Dfsapproved _
Date o f Cons t ruct ion Comp'l et ion
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or ce Use
ature an<
v
Date of Apprc
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t-I sAN LUls u8lsP0 c0uNt Y rt
\#PLICATION FOR PERHIT TO CONSTRIJU I:
UNDTRGROUND HAZARDOUS MATERIALS STORAGE TANK coE Construct New Tank X Modify Exfsting Tank
E 0perate New Tank In or on the premises at
PART I
Ol.JNER
Compa ny tF'te aAS nn\6enrp,("
Mail ing Address:
OPERATOR:
Company
Mail ing Address
Transfer of Ownership .1,1
I F!-t^:
OC $ptu-*9
^-
Contact:
Tel: (
AS Contact:
CONSTRUCTI ON
Compa ny
( Comp 1 ete onlytsf ndlLt
to cons or modify tank)t ruct
,CO
Tel: ()
sfntact :/1 c&Mailing Address:Tel: (*a h zeq'6srt. State Contractor License No.:
Construction Start Date:
Attach a Plot plan Showing:(for new cons tion a d modification onl
_ Lea k Detection Systern
_ Overfil'l Protection System
_ North Arrow
_ Nearest Intersection or Road
_ New and Existing Equipment
_ Location of all tanks and pfping andthei r secondary containment
_ Scal e
_ Property Line
_ Equipment Summary
If this is an application to transfer ownership or operation of tank, complete following:
Previous Owner:
Add res s :
Contact:
Tel )(
Previous 0penator:
Address:
Contact:
Tel: ( )Start Up Date:Date Instal I ed :
( for existi ng tanks )
ture an it e I Can
**ur mer nc e e ne
Pl an Approved
Plan Disapproved _
Date of Construction Completion
For ce Use v
Date of Approval /Disapproval
lofZ
Aut h orizing Agent S ignature
')
"U sAN LU I s oB r spo couNTy
APPLICATION FOR PERMIT TO CONSTRUCT
UNDERGROUND HAZARDOUS IIATERIALS STORAGE TANK
PART II
DIRECTI0NS: complete one form for each tank being instal red/modi fied
PROPOSED USE OF TANK:
OPY
e
I'{ATER IAL (s ) rO gr ST0RED I N TANK :
VOLUME OF TANK IN GALLONS:
MANUFACTURER OF TANK:
IF TANK USED PREVIOUSLY
Past Use of Tank:
u. L . NUMBER llirfl to t ?d
l'.laterial (s ) Stored in Tank:
TYPE OF CONTAINMENT:
Conc rete XFiberglass Fiberglass Coated Steel
0ther
Thickness of Primary Containment:
TYPE OF SECONDARY CONTAINMENT OR DRIP-PAN AS APPLICABLE
Conc rete
Fibergl ass
Fiberglass Coated Steel
0ther
Thickness of secondary containrnent or Drip-pan as applicable:
PIPING MATERIALS OF CONSTRUCTiON
Steel E Fiberglass 0the r
Describe the leak detection system you pran to use for tank pressure I ines
Describe the overfiil protection system you plan to use: or/,J -Cnpe 3p;// &'x
What is the approximate depth of groundwater?
Basis of determination :
Attach a ctank and p
pro
3
e rt i fi cat ioniping materia
tored materia
from thels as to
l s. (ftr
**f
manufa
the cais applposed s
lB7 -h,tua^^,
I 4 Pz-a
cturer, or his authorized representatpability of the tank and piping materies only to Non-Motor Fuel proiucts).
ive, of theial with the
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'5/,-{w Y* kat @ 5 ps.r, z or Z
eulrr. LltLNO. 4/t(J35tpnetat dns. Ltc.
C61 Spectatty
FRED RODNEY
Con-srructlon
sup' i )ent
CRISP
CONSTRUCTION
COMPANY
c OPY
G€nerar Construclion
Under Ground
Fuel Systems
Tank Testing
&
'Service
(209) 734€381
P.O. Box 1066
Visalia, CA 93279