OKLAHOMA CORPORATION COMMISSION
STORAGE TANK PROGRAM
P.O. Box 52000, Room. 480
Oklahoma City, OK 73152-2000
Facility I. D. No.:/ STATE USE ONLY
ID NUMBER:
Number of Tanks at Facility: / DATE RECEIVED:
Number of UST’s at Facility: / A. Date entered into computer:
Number of AST’s at Facility: / B. Data entry clerk initials:
GENERAL INFORMATION
In 1998 the Legislature combined statutory provisions on underground storage tanks and aboveground storage tanks so that our laws now refer simply to petroleum storage tanks, giving responsibility for their regulation to the Petroleum Storage Tank Division of the Corporation Commission. All underground petroleum storage tanks over 110 gallons must be registered except for residential and non-commercial agricultural tanks of less than 1,100 gallons. Aboveground petroleum storage tanks over 110 gallons must be registered, except for farm or ranch tanks or tanks at fleet and commercial facilities with less than 2,100 gallons individual storage capacity.
Form must be signed by owner. Original signature is required. Please type or print in ink.
I. OWNERSHIP OF TANK (S) / II. LOCATION OF TANK (S)
Owner Name (Corporation, Individual, Public Agency, or other entity) / Facility Name or Company Site Identifier, as applicable
Street Address / Street Address (PO Box NOT acceptable)
City & State / Zip Code / City & State / Zip Code
() / ()
County / (Area Code) Phone Number / County / Facility Area Code/Phone
Fax # / E-mail Address / Contact Person & Title
Tank ID / Tank Capacity (Gals.) / Product Last Stored / Date Last Used / Status – Check One
Out of Service Temporary Closure (TOU)
Out of Service Temporary Closure (TOU)
Out of Service Temporary Closure (TOU)
Out of Service Temporary Closure (TOU)
Out of Service Temporary Closure (TOU)
OUT OF SERVICE: / Continue operation and maintenance of corrosion protection; continue release detection unless tank is empty (no more than 1 inch of fuel residue); comply with release reporting and corrective action requirements. Maximum 3 months.
TEMPORARY CLOSED (TOU): / Comply with above AND drain all tanks; leave vent lines open and functioning; cap and secure all other lines, pumps, manways and ancillary equipment. Maximum 12 months unless tanks are upgraded with corrosion protection. Tank and line tightness tests will be required to return to service if tanks are out of use more than 12 months.
CHECK ALL THAT APPLY
Tank is empty (less than 1 inch) Tank is vented and fill pipe and dispensers are locked Tank & piping meet corrosion protection requirements
If out of service more than 3 months, vents are open and all other lines, pumps, manways and equipment are secured
CERTIFICATION (Read and sign after completing all sections)
I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached documents, and that I believe that the submitted information is true, accurate, and complete.
Title:(Print) Owner or authorized representative
Date:
Signature /
(Submit this form with original signature only.)
Revised May, 2007