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Home My WebLink AboutOPI APP 3.21.19PERMIT APPLICATION TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Permit # a ► 1 L Page 1 of 1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY �r- ur-f-V nn,C n1\e1 VZ n MnnTPTrA-rTrw nG ;:ArTi T-rV M MTNnR MnnTFTrATTnN nF FArT1 TTY STARTING DATE/ 12 -20 -18 Prevention Services FACILITY NAME MERCY SOUTHWEST 7 2101HStreet 8 FRSF, a FIRE w _ Bakersfield, CA 93301 ARTS! Y Phone: 661- 326 -3979 ® Fax: 661 -852 -2171 Page 1 of 1 TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY �r- ur-f-V nn,C n1\e1 VZ n MnnTPTrA-rTrw nG ;:ArTi T-rV M MTNnR MnnTFTrATTnN nF FArT1 TTY STARTING DATE/ 12 -20 -18 PROPOSED COMPLETION DATE 1 -20 -19 FACILITY NAME MERCY SOUTHWEST 7 EXISTING FACILITY PERMIT # FACILITY ADDRESS 400 OLD RIVER RD CITY BAKERSFIELD ZIP CODE 93301 TYPE OF BUSINESS APN # TANK OWNER MERCY HOSPITALS PHONE # 661 - ADDRESS CITY ZIP CODE CONTRACTOR BSSR INC, CA LICENSE # 672812 ICC # 5257282 ADDRESS 6630 ROSEDALE HWY #B CITY BAKERSFIELD ZIP CODE 93308 PHONE # 661 -588 -2777 BA KERSFIELD CITY BUSINESS LICENSE # 1800110762 WORKMANS COMP # 22667 INSURER ACE AMERICAN INS, BRIEFLY DESCRIBE THE WORK TO BE DONE: INSPECT /REPLACE OVERFILL VALVE ON BOILER TANK, ALSO REPAIR OR REPLACE VEEDER -ROOT TLS -300 FUEL MONITOR ON GENERATOR TANK UPON REPAIRS, NOTIFY FIRE DEPT. FOR TESTING WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE # OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? ❑ YES ❑ NO SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? ❑ YES ❑ NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION . TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER TANK MANUFACTURER 1 5,000 BOILER 2 5,000 GENERATOR Tank Testing Company NAME OF TESTING COMPANY BSSR INC, PHONE NUMBER 661 -588 -2777 MAILING ADDRESS 6630 ROSEDALE HWY #B NAME OF TESTER 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 PERJURY, 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 C r"'I n 0G /D- I i /')nI r.\