HomeMy WebLinkAboutUST APP 3/28/2014BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STORAGE TANK Prevention Services
2101 H Street
PERMIT APPLICATION B AJ E R S FIE ,L D Bakersfield, CA 93301
TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY /NEW FIRS Phone: 661 - 326 -3979 s Fax: 661- 852 -2171
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD D6PARTA<Mf
Page 1 of 1
Permit #
TYPE OF APPLICATION: ❑ NEW TANK INSTALLINEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
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PROPOSED
STARTING DATE/ 3 -28 -14
COMPLETION DATE 4- ,rip -1 4
GCS
FACILITY NAME MERCY SOUTHWEST HOSPITAL
EXISTING FACILITY PERMIT #
FACILITY ADDRESS 400 OLD RIVER BOULEVARD 7_1
BAKERSFIELD
ZIP CODE 93311
TYPE OF BUSINESS
APN #
TANK OWNER MERCY HOSPITALS
PHONE # 661-632-5972
ADDRESS
400 OLD RIVER BLVD
CITY ,BAKERSFIELD
ZIP CODE 93311
CONTRACTOR BS S R INC,
(7 CA LICENSE #672812
'cc* 5257282
ADDRESS
6630 ROSEDALE HWY, SUITE B CITY
BAKERSFIELD
ZIP CODE 93308
PHONE # 661 - 588 -2777
G
BAKERSFIELD CITY BUSINESS LICENSE #
04005008
WORKMANS COMP # 2246
G
INSURER BBSI
BRIEFLY DESCRIBE THE WORK TO BE DONE:
INSTALL PRINTER FOR DIESEL GENERATOR VEEDER -ROOT MONITOR
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER SOIL
TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEL?
F❑ YES ❑ NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
❑ YES ❑ NO
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
5.000
1
NAME OF TESTING COMPANY BSSR INC,
TPHONE NUMBER 661 - 588 -2777
MAILING ADDRESS 6630 ROSEDALE HWY, SUITE B
NAME OFTESTER FIDEL CARRILLO
Icc# 5257282
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
FIDEL CARRILLO
ICC# 5257282
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
F:n7nRR (RPv OR /09)