HomeMy WebLinkAboutSB989 Application 6-29-21UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD/LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
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
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❑ 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 NAME & PHONE * OF CONTACT PERSON
Mercy Southwest Hospital
ADDRESS
400 Old River Bakersfield, CA
OWNER NAME
OPERATOR NAME
PERMIT TO OPERATE #
# OF TANKS TO BE TESTED:
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
T A N K #
VOLUME
CONTENTS
1 (boiler)
diesel
2 (generator)
diesel
TANK TESTING COMPANY
TESTING COMPANY
B SS R, Inc.
NiAM L & PHUNE a Vf- CONTACT PERSON
Kelly Tackett 588-2777
MAILING ADDRESS
6630 Rosedale Hwy. #B Bakersfield, CA 93308
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Fidel Carrillo
CERTIFICATION #
TEST METHOD
5257281
APPLIC T SIGNATURE
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DATE
4-2G-21
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 09/20)