HomeMy Public PortalAboutFP-292Make application to local fire department.
Fire department retains original application and issues duplicate as permit.
0/ (74KIS
r-? APPLICATION and PERMIT I Fee:
for steel underground storage tank removal and transportation to approved tank disposal yard in accordance with the
provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 1.00 Section 1.12.8.40, application is hereby made by:
•
Tank Owner Name (please print)
X
Signature (if applying for permit)
Address
Street
City State Zip
• • •
• M11
Company Name
Co. or Individual
Print
Print
Address
Address
Print
Print
Signature (if applying for permit)
Signature (if applying for permit)
gD IFCI* Certified Other
gD IFCI* Certified gD LSP # Other
Tank Location
feet Address
City
Tank Capacity (gallons)
Substance Last Stored
Tank Dimensions (diameter x length)
Remarks:
Firm Transporting Waste
State Lic. #
Hazardous Waste Manifest#
E.P.A. #
Approved Tank Disposal Yard
Tank Yard #
Type of Inert Gas Tank Yard Address
7Dateof
FDID# Permit#
Date of Expiration
Dig Safe approval number:
Trenching Permit #
Dig Safe Toll Free Tel. Number - 800-322-4844
Signature / Title of Officer granting permit
After removal(s) ("consumptive use" fuel oil tanks exempted) send Form FP290 or Form FP-290R signed by the local fire department to
MassDEP, Bureau of Waste Prevention UST Program, PO Box 120-0165, Boston, MA 02112-0165.
*International Fire Code Institute
FP-292 (Revised 1.1.2015)