ADEM Form 331 Permit Application for Gasoline Bulk Plants - Alabama

ADEM Form 331 or the "Permit Application For Gasoline Bulk Plants" is a form issued by the Alabama Department of Environmental Management.

The form was last revised in January 1, 2009 and is available for digital filing. Download an up-to-date ADEM Form 331 in PDF-format down below or look it up on the Alabama Department of Environmental Management Forms website.

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ALABAMA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
AIR DIVISION
PERMIT APPLICATION
FOR GASOLINE BULK
PLANTS
Do Not Write In These Spaces
FACILITY NUMBER:
PLEASE TYPE OR PRINT IN INK
1.
Company Name: _______________________________________________
2.
Mailing Address To Which Environmental Correspondence Is To Be
Sent:
_________________________________________(____)________________
Environmental Contact
Telephone #
P.O. Box or Street Address
City, State, Zip Code
___________________________________________________________________________________
E-Mail Address
3. Name of Bulk Plant: _______________________________________________
Physical Address of Bulk Plant:______________________________________
Number
Street
_____________________________________________(____)____________
City
County
Telephone #
4. Permit application is being made for (Check One):
Initial Application for
Modification
An Existing Facility
Change of Ownership
Change of Location
New equipment to be constructed
New facility to be
at the existing facility
constructed
Other (Specify)____________________________________________
5. Normal Operating Schedule:
Hours per Day
Weeks per Year ____________
Days per Week
Peak Season ____________
Print Name of Person Submitting Report:________________________________
Title _____________________________
Date ____________________________
Phone (____)______________________
Signature ________________________
ADEM Form 331 01/09 m2
Page 1 of 7
ALABAMA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
AIR DIVISION
PERMIT APPLICATION
FOR GASOLINE BULK
PLANTS
Do Not Write In These Spaces
FACILITY NUMBER:
PLEASE TYPE OR PRINT IN INK
1.
Company Name: _______________________________________________
2.
Mailing Address To Which Environmental Correspondence Is To Be
Sent:
_________________________________________(____)________________
Environmental Contact
Telephone #
P.O. Box or Street Address
City, State, Zip Code
___________________________________________________________________________________
E-Mail Address
3. Name of Bulk Plant: _______________________________________________
Physical Address of Bulk Plant:______________________________________
Number
Street
_____________________________________________(____)____________
City
County
Telephone #
4. Permit application is being made for (Check One):
Initial Application for
Modification
An Existing Facility
Change of Ownership
Change of Location
New equipment to be constructed
New facility to be
at the existing facility
constructed
Other (Specify)____________________________________________
5. Normal Operating Schedule:
Hours per Day
Weeks per Year ____________
Days per Week
Peak Season ____________
Print Name of Person Submitting Report:________________________________
Title _____________________________
Date ____________________________
Phone (____)______________________
Signature ________________________
ADEM Form 331 01/09 m2
Page 1 of 7
BULK STORAGE TANK INFORMATION
Tank Number
01
02
Product stored: e.g. Crude Oil, Diesel, Gasoline,
1.
Kerosene, etc.
Is the tank underground or above ground?
2.
Is the tank horizontal or vertical?
3.
Tank Diameter (ft)?
4.
Tank Color – Specify from below. Skip this question if
5.
the tank is underground.
Roof
Shell
White
White
Aluminum (bright)
White
White
Aluminum (bright)
Aluminum (bright)
Aluminum (bright)
White
Aluminum (dull)
Aluminum (dull)
Aluminum (dull)
White
Gray
Light Gray
Light Gray
Medium Gray
Medium Gray
Other____________
_______________
Tank capacity (gallons)?
6.
Tank throughput (gallons/year)?
7.
Date tank was constructed?
8.
How are tank trucks loaded (splash, submerged, or
9.
bottom filling?)
Was the tank equipped with vapor balance on the
10.
incoming side by October 1, 1992? If no, when?
Is the tank equipped with vapor balance on the outgoing
11.
side?
What are the pressure relief settings on the pressure
12.
relief valves (psi or ounces)?
ADEM Form 331 01/09 m2
Page 2 of 7
BULK STORAGE TANK INFORMATION
Item
03
04
05
06
07
08
09
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
ADEM Form 331 01/09 m2
Page 3 of 7
STAGE I INFORMATION
List the names, locations, and mailing addresses of all the gasoline
transport tank truck owner/operators that load or unload at this facility. If
more space is needed, attach a separate sheet of paper to this permit
application.
1.
NAME:
LOCATION:
MAILING ADDRESS:
2.
NAME:
LOCATION:
MAILING ADDRESS:
3.
NAME:
LOCATION:
MAILING ADDRESS:
4.
NAME:
LOCATION:
MAILING ADDRESS:
5.
NAME:
LOCATION:
MAILING ADDRESS:
ADEM Form 331 01/09 m2
Page 4 of 7
List the names, locations, and mailing addresses of all the gasoline
dispensing facilities that this bulk plant supplies. If more space is needed,
attach a separate sheet of paper to this permit application.
1.
NAME:
LOCATION:
MAILING ADDRESS:
2.
NAME:
LOCATION:
MAILING ADDRESS:
3.
NAME:
LOCATION:
MAILING ADDRESS:
4.
NAME:
LOCATION:
MAILING ADDRESS:
5.
NAME:
LOCATION:
MAILING ADDRESS:
ADEM Form 331 01/09 m2
Page 5 of 7

Download ADEM Form 331 Permit Application for Gasoline Bulk Plants - Alabama

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