Schedule B "Existing Petroleum Storage System" - New Brunswick, Canada

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Download Schedule B "Existing Petroleum Storage System" - New Brunswick, Canada

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Site File #: 6535-
SCHEDULE - B
(Revised January 2018)
EXISTING PETROLEUM STORAGE SYSTEM
FOR OFFICE USE ONLY
Distribution List:
Senior App. Eng:
Data Manager:
The owner of any existing petroleum storage facility with a capacity of 2,000 litres or greater
must register the storage systems at the facility with the Department. Completion and
presentation of this form will fulfil the registration requirement.
Please submit this registration form 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
7
Page 1 of
Site File #: 6535-
SCHEDULE - B
(Revised January 2018)
EXISTING PETROLEUM STORAGE SYSTEM
FOR OFFICE USE ONLY
Distribution List:
Senior App. Eng:
Data Manager:
The owner of any existing petroleum storage facility with a capacity of 2,000 litres or greater
must register the storage systems at the facility with the Department. Completion and
presentation of this form will fulfil the registration requirement.
Please submit this registration form 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
7
Page 1 of
1. FACILITY DESCRIPTION
Facility Name:
Location Address:
Postal Code:
Mailing Address:
Postal Code:
Telephone: (
)
Fax:
2. TYPE OF OPERATION
Retail Outlet 
Bulk Plant 
Not for Profit 
Commercial/Industrial/Woodlands 
Marina 
Residential 
Farm 
Provincial Government 
Municipal Government 
Page 2 of 7
3. TANK OWNERSHIP
Owner/Company Name:
Mailing Address:
Postal Code:
Representative’s Name:
Telephone: (
)
Fax: (
)
Owner Email:
Owner Language Preference (please check):
English
French
4. SYSTEM OPERATOR (Manager)
Manager (Chief Operator’s) Name:
Home Mailing Address:
Postal Code:
Telephone: (
)
Fax: (
)
Page 3 of 7
5. OWNER OF THE LAND
Name:
Mailing Address:
Postal Code:
Telephone: (
)
Fax: (
)
PID No.
Property Tax No.
6. SUPPLIER OF GASOLINE OR ASSOCIATED PRODUCT
Supplier’s Name:
Mailing Address:
Postal Code:
Telephone: (
)
Fax: (
)
Page 4 of 7
7. TANK AND PIPING DETAILS
TANK
TANK
TANK
TANK
TANK
TANK
TANK STATUS:
#1
#2
#3
#4
#5
#6
Currently in Use
Abandoned
TANK DESCRIPTION:
Capacity (litres)
Year Installed
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 5 of 7