ADEM Form 198 "Gasoline Transport Tank Truck Application" - Alabama

What Is ADEM Form 198?

This is a legal form that was released by the Alabama Department of Environmental Management - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2015;
  • The latest edition provided by the Alabama Department of Environmental Management;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of ADEM Form 198 by clicking the link below or browse more documents and templates provided by the Alabama Department of Environmental Management.

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Download ADEM Form 198 "Gasoline Transport Tank Truck Application" - Alabama

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AIR DIVISION: PERMIT APPLICATION FOR GASOLINE TRANSPORT
TANK TRUCK
Do Not Write In These Spaces
FACILITY NUMBER:
AIR STICKER NUMBER:
_________________
PLEASE TYPE OR PRINT IN INK
1.
Name of Tank Truck Owner:
2.
Mailing Address to which Environmental Correspondence is to be sent:
NAME OF CONTACT PERSON
TANK TRUCK BUSINESS NAME
STREET ADDRESS OR P.O. BOX
CITY
STATE
ZIP CODE
)
(
)
(
TELEPHONE NO.
FAX NO.
EMAIL ADDRESS
3.
Purpose of Application (check one):
Initial Application for
Change of Location
An Existing Tank Truck
Change of Ownership
Other (Specify)
**If the tank truck has been previously permitted in Alabama, please provide the name of the
former tank truck owner:
4.
Normal Operating Schedule:
Hours per Day
Weeks per Year
Days per Week
Peak Season
Maximum Operating Hours per Year
ADEM Form 198 m3 7/2015
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AIR DIVISION: PERMIT APPLICATION FOR GASOLINE TRANSPORT
TANK TRUCK
Do Not Write In These Spaces
FACILITY NUMBER:
AIR STICKER NUMBER:
_________________
PLEASE TYPE OR PRINT IN INK
1.
Name of Tank Truck Owner:
2.
Mailing Address to which Environmental Correspondence is to be sent:
NAME OF CONTACT PERSON
TANK TRUCK BUSINESS NAME
STREET ADDRESS OR P.O. BOX
CITY
STATE
ZIP CODE
)
(
)
(
TELEPHONE NO.
FAX NO.
EMAIL ADDRESS
3.
Purpose of Application (check one):
Initial Application for
Change of Location
An Existing Tank Truck
Change of Ownership
Other (Specify)
**If the tank truck has been previously permitted in Alabama, please provide the name of the
former tank truck owner:
4.
Normal Operating Schedule:
Hours per Day
Weeks per Year
Days per Week
Peak Season
Maximum Operating Hours per Year
ADEM Form 198 m3 7/2015
Page 1 of 3
5.
Type of Tank Truck (Please Check One):
Straight Tank (Bobtail)
Full/Semi-Trailer
6.
Manufacturer of Tank (Trailer):
7.
Year of Manufacture of Tank Truck (Trailer):
8.
Tank Truck (Trailer) Serial Number (VIN Number):
9.
Company Trailer Number:
10.
Tank Information:
(Front)
(Rear)
Compartment
1
2
3
4
5
6
7
11.
Where is this tank truck loaded?
Gasoline Refineries
Gasoline Bulk Plants
Gasoline Terminals
12.
Method of Tank Fill:
Bottom Loading
Top (Splash) Loading
Submerged Fill
(Through Top Hatches)
13.
Is the tank trailer equipped with a gasoline vapor control system (vapor balance)?
Yes
No
14.
Has the vapor collection system on the above gasoline cargo tanker truck been tested for
vapor- tightness in accordance with Reference Method 27 (40 CFR 60) while utilizing 40
CFR 63 Subpart R for allowed delta vacuum?
Yes
No
15.
If the tank truck has been tested, please complete the following information:
(a) Testing Firm Name:
(b) Address:
(c) Date of Test:
NOTE: Please attach a copy of the latest vapor-tightness test
record with this Permit application (Method 27).
ADEM Form 198 m3 7/2015
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(d) Does the tank truck (trailer) currently possess a Jefferson County Air Permit &
Sticker
Yes
No
(e) If “Yes”, please write the Air Sticker number in the space provided and submit a
copy of the permit:
15.
Please attach a list of all locations in Alabama (other than Jefferson County) where the tank
truck is loaded. Please include the name and mailing address for each location.
16.
Please attach a list of all locations in Alabama (other than Jefferson County) where the tank
truck delivers gasoline. Please include the name and mailing address for each location.
17.
Does the company applying for the permit own a bulk plant?
Yes*
No
*If “Yes”, please provide the physical address of the bulk plant.
18.
Name of Person Submitting Report
Title:
Phone:
Signature:
Date:
PLEASE RETURN TO:
ADEM
PO BOX 301463
MONTGOMERY AL 36130-1463
ATTN: AIR DIVISION
ADEM Form 198 m3 7/2015
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