Schedule A "Part Ii - Environmental Approval" - New Brunswick, Canada

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Download Schedule A "Part Ii - Environmental Approval" - New Brunswick, Canada

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Site File #: 6535-
SCHEDULE – A, PART II
(Revised January 2018)
ENVIRONMENTAL APPROVAL
FOR OFFICE USE ONLY
Distribution List:
Senior App. Eng:
Project File #:
Data Manager:
The information supplied in this application form is for an environmental approval of a proposed
new installation or modification to an existing system. The completed form shall be forwarded to the
Department at least one month prior to the proposed construction date.
Please forward this application to:
New Brunswick Department of Environment and Local Government
Authorizations Branch
(20 McGloin Street, Fredericton, NB E3A 5T8)
P.O. Box 6000
Fredericton, New Brunswick
E3B 5H1
Telephone: (506) 453-7945
Fax: (506) 453-2390
Page 1 of 6
Site File #: 6535-
SCHEDULE – A, PART II
(Revised January 2018)
ENVIRONMENTAL APPROVAL
FOR OFFICE USE ONLY
Distribution List:
Senior App. Eng:
Project File #:
Data Manager:
The information supplied in this application form is for an environmental approval of a proposed
new installation or modification to an existing system. The completed form shall be forwarded to the
Department at least one month prior to the proposed construction date.
Please forward this application to:
New Brunswick Department of Environment and Local Government
Authorizations Branch
(20 McGloin Street, Fredericton, NB E3A 5T8)
P.O. Box 6000
Fredericton, New Brunswick
E3B 5H1
Telephone: (506) 453-7945
Fax: (506) 453-2390
Page 1 of 6
1. DESCRIPTION OF PROPOSED INSTALLATION WORK
2. FACILITY DESCRIPTION
Facility Name:
Street Address:
Mailing Address:
Postal Code:
Telephone: (
)
Name of Licensed Installer:
Company Name:
Page 2 of 6
3. TANK AND PIPING DETAILS
TANK
TANK
TANK
TANK
TANK
TANK
TANK DESCRIPTION:
#1
#2
#3
#4
#5
#6
Capacity (litres)
Age of Tank (manufacture yr.)
Tank Manufacturer
Aboveground
Underground
Single Wall
Double Wall
Containment/Dyking
Single Wall Compartment
Double Wall Compartment
TANK MATERIAL:
Steel
Fibreglass
Composite (steel, fibreglass,
concrete combination)
TANK PROTECTION:
Impressed Current
Sacrificial Anode
PUMPING SYSTEM:
Submersible
Suction
Gravity
Page 3 of 6
TANK
TANK
TANK
TANK
TANK
TANK
TANK CONTENTS:
#1
#2
#3
#4
#5
#6
Non-leaded Gasoline (Regular)
Non-leaded Gasoline (Midgrade)
Non-leaded Gasoline (Supreme)
Diesel
Furnace Oil
Kerosene
Waste Oil
Bunker C
Other (Specify)
PRODUCT PIPING
DESCRIPTION:
Above Ground:
Galvanized Steel - single wall
Bare Steel – single wall
Copper – double wall
Below Ground:
Flexible – double wall
Fibreglass – double wall
Galvanized Steel – double wall
Bare Steel – double wall
Copper – with containment
PRODUCT PIPING
PROTECTION:
Cathodic Protection
Impressed Current
Page 4 of 6
4. OIL/WATER SEPARATOR DETAILS
Containment systems and fuelling aprons at bulk plants, and fuelling aprons with
more than one diesel dispenser at self-serve and/or key and cardlock outlets, shall
be equipped with an oil/water separator. The engineering drawings submitted in
Part 5 shall detail the drainage and oil separation system and show the ultimate
discharge location of oil/water separator.
5. ENGINEERING DRAWINGS
Engineering construction drawings are required for all storage tank systems where
the total capacity exceeds 5,000 litres. Include a plot showing tank, piping,
buildings, underground services, corrosion protection equipment, dikes (where
applicable), along with complete details of all piping, tanks, electrical and
mechanical associated with the petroleum storage system. Number each tank and
identify using these numbers through the form. The drawings are to be stamped by
an engineer who has a license to practice in the Province of New Brunswick.
The engineering detailed drawing should be distributed as follows:
- to accompany Part II of Schedule A
- to be forwarded to the environmental inspector in the Region prior to the
commencement of construction (where applicable)
- on site during construction
Page 5 of 6