HomeMy WebLinkAboutMinor Mod Application 8-13-21PERMIT #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1of1
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS B FUEL MONITORING CERTIFICATION ❑ OVERFILL PREVENTION
SITE INFORMATION
FACILITY NAME & PHONE # OF CONTACT PERSON
Mercy Southwest Hospital
ADDRESS
400 Old River
OWNER NAME
Bakersfield, CA
UNDERGROUND STORAGE TANKS
PERMIT TO OPERATE #
APPLICATION
IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO
TO PERFORM ELD/LINE TESTING/
VOLUME
SB989 SECONDARY CONTAINMENT
1
TESTING/TANK TIGHTNESS TEST AND
diesel
FUEL MONITORING CERTIFICATION
(Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
1
PERMIT #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1of1
❑ ENHANCED LEAK DETECTION ❑ LINE TESTING ❑ SB -989 SECONDARY CONTAINMENT
❑ TANK TIGHTNESS B FUEL MONITORING CERTIFICATION ❑ OVERFILL PREVENTION
SITE INFORMATION
FACILITY NAME & PHONE # OF CONTACT PERSON
Mercy Southwest Hospital
ADDRESS
400 Old River
OWNER NAME
Bakersfield, CA
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
I
1
TANK TESTING COMPANY
TESTING COMPANY NAME & PHONE # OF CONTACT PERSON
BSSR, Inc. Kelly Tackett 588-2777
MAILING ADDRESS
6630 Rosedale Hwy. #B Bakersfield, CA 93308
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
Nathan Holman
CERTIFICATION #
TEST METHOD
APPLICANT SIGNATURE
DATE
5-28-21
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BY
DATE
FD2095 (Rev 09/20)