Checklist

Environment Canada (EC) Storage Tank System Identification Form
Identification of storage tank systems for the purpose of the Storage Tank Systems for Petroleum Products and Allied Petroleum Products Regulations

ENVIRONMENT CANADA USE ONLY
ID number Date received Date entered Entered by Comments

Instructions
• • • • • • COMPLETE ONE FORM FOR EACH STORAGE TANK SYSTEM. A system can be asingle independent tank or several tanks that are interconnected. All sections must be complete before an identification number can be issued. Optional information is marked with an asterisk (*). When identifying newly installed storage tank systems do not select “Unknown” in any section of the form. Part VI must be signed by the storage tank system owner or the owner contact. Form submissioninformation is provided on the last page. PART I: PURPOSE OF NOTIFICATION
Check all that apply:
This is a newly installed system This system is not newly installed but has not been identified previously Change to information that was previously provided to EC (e.g. months of service, tank contents, technical information). (Part IV) Change in owner or operator address (Part II & III) New owner oroperator (Part II & III) This system has been permanently withdrawn from service and/or removed (Part V) Other (specify)

PART II: STORAGE TANK SYSTEM OWNER AND OPERATOR INFORMATION
Name of owner Name of operating company or individual (if different from owner)

Address of owner (Civic address or post box, City, Province/Territory, Postal code)

Address of operator company or individual (ifdifferent from owner)

Name of owner contact

Name of operator contact (if different from owner contact)

*Title of owner contact

* Title of operator contact (if different from owner contact)

*Phone number ( )

*Fax number ( )

*E-mail address of owner contact

*Phone number *Fax number (if different from owner) (if different from owner) ( ) ( ) *E-mail address of operator contact(if different from owner)

*Name of previous owner (if applicable)

Environment Canada Storage Tank System Identification Form (January 2010)

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PART III: LOCATION OF STORAGE TANK SYSTEM AND DOCUMENTS
Facility name Location of tank system records
(If no street address, provide latitude & longitude or legal land description)

Location of tank system
(If no street address,provide latitude & longitude or legal land description)

*Location(s) of emergency plan(s)
(If no street address, provide latitude & longitude or legal land descriptions or other descriptions. Attach additional pages if necessary)

PART IV: STORAGE TANK SYSTEM DESCRIPTION
Tank 1 Tank 2 Tank 3 Tank 4 Tank 5

*Owner’s Tank Identification Number
EC Tank System Identification Number
(one IDnumber per storage tank system)

Year of Installation of Tank System
(If unknown, write “unknown”)

Date of Changes to the System (MM/DD/YYYY) Is System in Service All Year? Type of Tank
Yes

No (Please identify the month(s) during which the system is in service)

ABOVEGROUND UNDERGROUND

ABOVEGROUND UNDERGROUND ABOVEGROUND UNDERGROUND NO PIPING

ABOVEGROUND UNDERGROUND ABOVEGROUNDUNDERGROUND NO PIPING

ABOVEGROUND UNDERGROUND ABOVEGROUND UNDERGROUND NO PIPING

ABOVEGROUND UNDERGROUND ABOVEGROUND UNDERGROUND NO PIPING

Type of Piping (Check all that apply)

ABOVEGROUND UNDERGROUND NO PIPING

Diameter of Piping
(Specify units: millimeters or inches)

Nominal Tank Capacity
(litres)

Product stored

Describe how the transfer area is designed to contain spills.Specify if the transfer area is not yet designed to contain spills.

1

1

“transfer area” means the area around the connection point between a delivery truck, railcar, aircraft or vessel and a storage tank system in which the tanks have an aggregate capacity of more than 2 500 L.

Environment Canada Storage Tank System Identification Form (January 2010)

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ULC or API...