Form Rt 50 - Application For Oil Disharge & Oil Polution Control License - Departament Of Safety Road Toll Bureau, State Of New Hampshire Page 2

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NEW HAMPSHIRE BULK STORAGE FACILTIES
STORAGE LOCATION:
STORAGE INFORMATION:
No. and Street
City/Town
State
Capacity
Product
IMPORTANT NOTES
1.
ANY CHANGES IN NAME, ADDRESS, CORPORATE STATUS, ETC. MUST BE REPORTED TO
THIS OFFICE IMMEDIATELY.
2.
PLEASE INCLUDE YOUR LICENSE NUMBER ON ALL CORRESPONDENCE WITH THIS OFFICE.
3.
THIS LICENSE IS NOT TRANSFERABLE.
RT 50 (REV. 2/04)

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