Form B Individual Oil Operations Permit Application printable pdf download

Form B Individual Oil Operations Permit Application

MARYLAND DEPARTMENT OF THE ENVIRONMENT

Land Management AdministrationOil Control Program

1800 Washington BoulevardSuite 620Baltimore Maryland 21230-1719

410-537-3442800-633-6101 x3442 410-537-3092

(fax)

INDIVIDUAL OIL OPERATIONS PERMIT APPLICATION

FORM B

Out-of-State Companies Transporting Oil into or out of Maryland

Method of transporting oil (check all that apply)

transport trailer (10 wheels or more)

rail car

truck tank (Less than 10 wheels)

vacuum truck

Transfer of oil (check all that apply):

into the State of Maryland

out of the State of Maryland

Do you transport waste or used oil? _____ Yes _____ No

If yes, provide EPA identification number: ____________________

Complete Pages 2-4 of this form and provide signature.

In addition to an Individual Oil Operations Permit, an Oil Transfer License, issued by MDE, may

be required for your company. The Oil Transfer License is separate from licenses and/or

certificates issued by the Maryland Comptroller’s Office, Motor Fuel Tax Division. If your

company owns the oil and transports it into Maryland, you must have an Oil Transfer License in

accordance with Environment Article §4-411, Annotated Code of Maryland.

Are you the owner of the oil being transported or delivered into Maryland? ____Yes ____ No

If yes, list your Oil Transfer License Number: ________________________

(If you do not have a license, contact (410) 537-3461 for further guidance)

If no, attach a list of the names, addresses and phone numbers for your customers who are the

owners of the oil at the first point of transfer in Maryland.

Form Number: MDE/ LMA/ PER.005

Page 1 of 4

Date: October 2014

TTY Users: 800-735-2258

Form B Individual Oil Operations Permit Application