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Modesto Fire Department FIRE PREVENTION DIVISION 409 12th Street, Modesto, California 95354 Tel: (209) 571-5553 Fax: (209) 544-1652 FUEL STORAGE TANK PERMIT APPLICATION Aboveground Fuel Tank: Install Remove Maintain/Repair Abandon/Fill Underground Fuel Tank: Install Remove Maintain/Repair Abandon/Fill Date of Application: Fire Permit Permit Start Date: Permit End Date: Name of Facility: Facility Address: Business Owner: Phone: Business Owner Address: Applicant’s Name: Phone: Applicant’s Address: Application is hereby made for a permit to (briefly explain scope of project): Describe each tank affected: aboveground or underground tank, tank capacity, product contained, and flammable/combustible liquid class (IA, IB, IC, II, IIIA, IIIB). Attach additional sheets if needed. Tank Reference 1 2 3 4 5 6 7 Applicant’s Signature: A SITE PLAN SHALL ACCOMPANY THIS APPLICATION Locate/identify each tank on the site plan by using the Tank Reference # indicated above. In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website at revised 06/23/20 SIGN