HomeMy WebLinkAboutApplication 1-7-21UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTI NG/TAN K TIG HTN ESS TEST AN D
FUEL MONITORING CERTIFICATION
(Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT #
❑ ENHANCED LEAK DETECTION
❑ TANK TIGHTNESS
❑ LINE TESTING
FUEL MONITORING CERTIFICATION
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
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❑ SB -989 SECONDARY CONTAINMENT
❑ OVERFILL PREVENTION
SITE INFORMATION
FACILITY
Bakersfield Heart Hospital
NAME & PHONE # OF CONTACT PERSON
ADDRESS
3001 Sillect, Bakersfield
OWNER NAME
OPERATOR NAME
i
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TANK #
VOLUME
CONTENTS
1 (generator)
Diesel
2 (boiler)
Diesel
' TANK TESTING COMPANY
TESTING COMPANY
BSSR, Inc.
NAME & PHONE # OF CONTACT PERSON
MAILING ADDRESS
6630 Rosedale Hwy. #B, Bakersfield
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Nathan Holman
CERTIFICATION #
TEST METHOD
owe'
ICC #
8111067
APPLICA SIGNATU E DATE
" 12-8-20
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 03/18)