Underground Storage Tank Removal Permit

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Please correct the field(s) marked in red below:

Is your project located in
 *
Is your project located in
Contractor Requesting Permit 
Office Phone
Address
Fax Number
 *
Contact Person
 *
Cell Phone
Email
License Number
 *
Location of Tank(s) to be Removed
Name of Business/Facility
Owner Name
Phone
Address
Fax Number
 *
Contact Person
 *
Cell Phone
Email
UST Tank Permit Information
Tank #1 Tank #2 Tank #3 Tank #4
Tank Capacity
Substance Stored
Is Tank Regulated?
Tank Constructed of?
Piping Constructed of?
The next 14 questions are about the tank(s) closure
Product & piping removed from UST? Click box for Yes. Leave box blank for No or Unknown.
Product & piping removed from UST? Click box for Yes. Leave box blank for No or Unknown.
Vapors purged or inserted from UST? Click box for Yes. Leave box blank for No or Unknown.
Vapors purged or inserted from UST? Click box for Yes. Leave box blank for No or Unknown.
UST filled with solid inert material (if abandoned)? Click box for Yes. Leave box blank for No or Unknown.
UST filled with solid inert material (if abandoned)? Click box for Yes. Leave box blank for No or Unknown.
Holes in tank observed? Click box for Yes. Leave box blank for No or Unknown.
Holes in tank observed? Click box for Yes. Leave box blank for No or Unknown.
Free product observed in excavation? Click box for Yes. Leave box blank for No or Unknown.
Free product observed in excavation? Click box for Yes. Leave box blank for No or Unknown.
Groundwater in excavation? Click box for Yes. Leave box blank for No or Unknown.
Groundwater in excavation? Click box for Yes. Leave box blank for No or Unknown.
LEL of product within safe range? Click box for Yes. Leave box blank for No or Unknown.
LEL of product within safe range? Click box for Yes. Leave box blank for No or Unknown.
No smoking signs in placed within 25’ of UST? Click box for Yes. Leave box blank for No or Unknown.
No smoking signs in placed within 25’ of UST? Click box for Yes. Leave box blank for No or Unknown.
All openings plugged except ¼” vent for release of pressure? Click box for Yes. Leave box blank for No or Unknown.
All openings plugged except ¼” vent for release of pressure? Click box for Yes. Leave box blank for No or Unknown.
Tank labeled for former contents? Click box for Yes. Leave box blank for No or Unknown.
Tank labeled for former contents? Click box for Yes. Leave box blank for No or Unknown.
Current vapor state labeled on tank? Click box for Yes. Leave box blank for No or Unknown.
Current vapor state labeled on tank? Click box for Yes. Leave box blank for No or Unknown.
Warning against reuse labeled on tank? Click box for Yes. Leave box blank for No or Unknown.
Warning against reuse labeled on tank? Click box for Yes. Leave box blank for No or Unknown.
Vapor freeing method labeled on tank? Click box for Yes. Leave box blank for No or Unknown.
Vapor freeing method labeled on tank? Click box for Yes. Leave box blank for No or Unknown.
All piping, gauge & tank fixtures, appurtenances, & vent disconnected & removed? Click box for Yes. Leave box blank for No or Unknown.
All piping, gauge & tank fixtures, appurtenances, & vent disconnected & removed? Click box for Yes. Leave box blank for No or Unknown.

Signature Required

The undersigned hereby makes application for a permit and the inspection of all work described above and hereby agrees to comply with all building regulations and other laws applicable to the use and type of work being performed.

Required Signature Block
 *
If applying to the City, you will be invoiced. If applying to the County, click payment method.
If applying to the City, you will be invoiced. If applying to the County, click payment method.
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