Form OG-19 Permittee Tank Battery Registration Form - Illinois

ADVERTISEMENT
ILLINOIS DEPARTMENT OF NATURAL RESOURCES
Office of Oil and Gas Resource Management
One Natural Resources W ay
(217) 782-7756
Springfield, Illinois 62702-1271
OG-19 PERMITTEE TANK BATTERY
REGISTRATION FORM
Dept. use only
o Existing Facility
o New Facility
Assigned Facility Site #
(constructed after 7/10/01)
Permittee:
Permittee #:
Lease Name:
Permittee Address:
Location of Facility Latitude:________________ Longitude:______________________
1. The
quarter of the
quarter of the
quarter of
Section
, Township
(N/S), Range
(E/W),
County.
2. Using the plat on the reverse side of this form, show the location of the proposed or
facility relative to the lease / unit boundaries, roads, inhabited structures, and
designated waters (blueline on topographic map) within 1000 ft. of the facility.
Complete 3, 4, and 5 for new (constructed after 7/1/01 or proposed facilities.
3. Is the new or proposed facility located within 200 ft. of an existing inhabited structure?
☐ YES
☐ NO
If yes, has the owner of the inhabited structure consented to construction?☐Y ☐N
If yes, attach a copy of written consent.
4. Is the facility fenced? ☐ YES
☐ NO
5.
Is the new or proposed facility located within 200 ft. of designated water ( blueline on
☐ YES ☐ NO
topographic map)?
ILLINOIS DEPARTMENT OF NATURAL RESOURCES
Office of Oil and Gas Resource Management
One Natural Resources W ay
(217) 782-7756
Springfield, Illinois 62702-1271
OG-19 PERMITTEE TANK BATTERY
REGISTRATION FORM
Dept. use only
o Existing Facility
o New Facility
Assigned Facility Site #
(constructed after 7/10/01)
Permittee:
Permittee #:
Lease Name:
Permittee Address:
Location of Facility Latitude:________________ Longitude:______________________
1. The
quarter of the
quarter of the
quarter of
Section
, Township
(N/S), Range
(E/W),
County.
2. Using the plat on the reverse side of this form, show the location of the proposed or
facility relative to the lease / unit boundaries, roads, inhabited structures, and
designated waters (blueline on topographic map) within 1000 ft. of the facility.
Complete 3, 4, and 5 for new (constructed after 7/1/01 or proposed facilities.
3. Is the new or proposed facility located within 200 ft. of an existing inhabited structure?
☐ YES
☐ NO
If yes, has the owner of the inhabited structure consented to construction?☐Y ☐N
If yes, attach a copy of written consent.
4. Is the facility fenced? ☐ YES
☐ NO
5.
Is the new or proposed facility located within 200 ft. of designated water ( blueline on
☐ YES ☐ NO
topographic map)?
Construction
Tank Type
Maximum Capacity
Contents
Storage, Separator, Other
Crude Oil, BS, Brine, other
Dimensions of containment area:
_____________ft. X ___________ft. X ______________ft.
Smallest square
= 660 feet
N W
N E
e FACILITY
LOCATION
• INHABITED
STRUCTURE
= ROADS
S DESIGNATED
WATERS
S W
S E
PERMITTEE NAME
SIGNATURE
DATE

Download Form OG-19 Permittee Tank Battery Registration Form - Illinois

355 times
Rate
4.7(4.7 / 5) 21 votes
ADVERTISEMENT
Page of 2