Underground Storage Tank System Closure Permit Application Form

Download a blank fillable Underground Storage Tank System Closure Permit Application Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Underground Storage Tank System Closure Permit Application Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

UNDERGROUND STORAGE TANK SYSTEM
CLOSURE PERMIT APPLICATION
For use by Unidocs Member Agencies or where approved by your Local Jurisdiction
1. Facility Name (Tank Site):
Bldg. No.:
Address:
City:
Zip:
EPA ID No.:
Contact Person:
Phone No.:
(
)
2. Tank Owner’s Name:
Address:
City:
Zip:
3. Tank Operator’s Name:
Address:
City:
Zip:
4. Applicant’s Name:
Address:
City:
Zip:
Contact Person:
Phone No.:
(
)
5. Tank Closure Contractor Business Name:
(As registered with the Contractors State License Board at )
Address:
City:
Zip:
CSLB License No.:
Contact Person:
Phone No.:
(
)
6. Firm that will take soil/water samples:
Phone No.:
(
)
7. State-certified laboratory that will analyze samples:
Phone No.:
(
)
8. Where will the remaining product/waste in the tank(s) be shipped?
Facility Name:
EPA ID No. (If applicable):
Name of Transporter:
EPA ID No. (If applicable):
Check this box if the tank(s) was/were emptied by drawing down inventory through normal product use.
9. Where will the tank(s) be shipped?
Check this box if closure-in-place is being requested and attach reasons for request.
Facility Name:
EPA ID No. (If applicable):
Name of Transporter:
EPA ID No. (If applicable):
UN-003
1/2 - Rev. 12/16/15

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 2