DHEC Form 3472 "Underground Storage Tank (Ust) Certificate of Financial Responsibility" - South Carolina

What Is DHEC Form 3472?

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

Form Details:

  • Released on March 1, 2018;
  • The latest edition provided by the South Carolina Department of Health and Environmental Control;
  • 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 DHEC Form 3472 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Health and Environmental Control.

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Download DHEC Form 3472 "Underground Storage Tank (Ust) Certificate of Financial Responsibility" - South Carolina

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UNDERGROUND STORAGE TANK (UST)
CERTIFICATE OF FINANCIAL RESPONSIBILITY
2600 Bull Street, Columbia, SC 29201-1708
(This form can be used to comply with SC UST Regulation
280.111(b)(10)(i)
Complete the form. Keep one copy and submit one copy with the
Date Received (State Use Only)
appropriate financial mechanism to:
UST Financial Responsibility Liaison
SC Department of Health and Environmental Control
2600 Bull Street
Columbia, South Carolina 29201-1708
Telephone: (803) 898-0589
Fax: (803) 898-0559
For additional permits with the same owner (Section I), operator(Section II) and financial mechanism (Section
IV), you may use Section VII to list those facilities in lieu of completing individual Certificates of Financial
Responsibility.
I. TANK OWNER
II. TANK OPERATOR
Name
Name
Mailing Address
Mailing Address
City
State
Zip Code
City
State
Zip Code
Area Code
Telephone Number
Area Code
Telephone Number
Contact Person Name
Area Code
Telephone Number
Email
Check here if any contact information is different than what we have on record. Note: we can only
update your information in our database if the owner’s signature is on this form, dated and
witnessed. Please contact the Department for ownership change requests.
III. FACILITY IDENTIFICATION/LOCATION (check here if USTs are newly installed)
Facility Name
Permit Identification #
Physical Street Address
City
State
Zip Code
County
Area Code
Telephone Number
(over)
DHEC 3472 (3/2018)
UNDERGROUND STORAGE TANK (UST)
CERTIFICATE OF FINANCIAL RESPONSIBILITY
2600 Bull Street, Columbia, SC 29201-1708
(This form can be used to comply with SC UST Regulation
280.111(b)(10)(i)
Complete the form. Keep one copy and submit one copy with the
Date Received (State Use Only)
appropriate financial mechanism to:
UST Financial Responsibility Liaison
SC Department of Health and Environmental Control
2600 Bull Street
Columbia, South Carolina 29201-1708
Telephone: (803) 898-0589
Fax: (803) 898-0559
For additional permits with the same owner (Section I), operator(Section II) and financial mechanism (Section
IV), you may use Section VII to list those facilities in lieu of completing individual Certificates of Financial
Responsibility.
I. TANK OWNER
II. TANK OPERATOR
Name
Name
Mailing Address
Mailing Address
City
State
Zip Code
City
State
Zip Code
Area Code
Telephone Number
Area Code
Telephone Number
Contact Person Name
Area Code
Telephone Number
Email
Check here if any contact information is different than what we have on record. Note: we can only
update your information in our database if the owner’s signature is on this form, dated and
witnessed. Please contact the Department for ownership change requests.
III. FACILITY IDENTIFICATION/LOCATION (check here if USTs are newly installed)
Facility Name
Permit Identification #
Physical Street Address
City
State
Zip Code
County
Area Code
Telephone Number
(over)
DHEC 3472 (3/2018)
IV. MECHANISM
Check one or a combination of assurance mechanisms to demonstrate financial responsibility under Subpart H of the South Carolina
Underground Storage Tank Control Regulations 61-92, Part 280. Complete the chart for each mechanism selected. ** If you intend to
use the State Environmental Petroleum Environmental Response Bank (SUPERB) Account (also known as the state cleanup fund),
you must select "State Fund" (Box 1) and one or more of the other financial assurance mechanisms (boxes 2-8) to demonstrate the
required $25,000 deductible.
Assurance Mechanisms
Name of Issuer
Amount of
Period of Coverage
Coverage
STATE
USE
ONLY
State Fund (SUPERB)**
1.
Self Insurance (Proof of
2.
net worth i.e., financials)
Guarantee (Letter, using
3.
DHEC wording, from an
appropriate 3rd party)
Pollution Insurance or
4.
Risk Retention Group
(Environmental Insurance
Policy)
Surety Bond
5.
Letter of Credit (Letter,
6.
using DHEC wording,
from an appropriate
financial institution)
Trust Fund
7.
8.
Local Government
Options
V. CERTIFICATION (Read and sign after completing entire form)
Owner or operator (CIRCLE ONE) hereby certifies compliance with the requirements of Subpart H of the South Carolina
Underground Control Regulations 61-92, Part 280.
Signature of Owner or Operator
Date
Name of Owner or Operator (type or print)
Title
Date
Signature of Witness of Notary
Name of Witness or Notary (type or print)
VI. IMPORTANT INFORMATION
The owner or operator must update this certification whenever the financial assurance mechanism(s) used to
demonstrate financial responsibility change(s). A copy of the updated certification must be sent to the Department under
the following circumstances: (1) you install a new tank system; (2) you have confirmed that there has been a release;
(3) you change financial mechanisms; and/or (4) the Environmental Protection Agency or the Department requests your
records. No mechanism may require expenditure of funds from the SUPERB Account or the SUPERB Financial
Responsibility Fund prior to the exhausting of that mechanism. Financial responsibility must be in place in order for the
Department to approve a Permit to Install.
DHEC 3472 (3/2018)
VII. ADDITIONAL FACILITIES
Note: This section may only be used to report multiple permits which are under the same owner (Section I), operator
(Section II) and financial mechanism (Section IV). The use of this additional section in no way alters the Financial
responsibility requirements or the owner/operator’s liability for each tank or facility. You may use as many pages as
needed.
Permit
# of
Facility Name
Phone #
Facility Physical
City
Zip
County
#
UST(s)
Address
DHEC 3472 (3/2018)
UNDERGROUND STORAGE TANK MANAGEMENT DIVISION
BUREAU OF LAND AND WASTE MANAGEMENT
2600 Bull Street, Columbia, SC 29201
Phone (803) 898-0589
Certificate of Financial Responsibility for Underground Storage Tanks (USTs)
General Information:
The primary purpose of this form is to demonstrate the required financial responsibility.
State and regulations require owners and operators of USTs storing regulated
substances to be able to pay for site rehabilitation activities and third party claims upon
the occurrence of a release. UST owners or operators may use the State Underground
Petroleum Environmental Response Bank (SUPERB) Account to cover site
rehabilitation costs and the SUPERB Financial Responsibility Fund to cover third party
claims. These two state assurance funds provide a combined maximum of $1,000,000
per eligible occurrence to cover these costs after payment of the deductible that has
been established by the SUPERB Act.
Please read the instructions carefully prior to completing the form. Please type or print
in ink. Also, please be sure that you have signatures in ink.
Who must complete this form?
If the owner/operator of a UST storing regulated substances are separate persons, only
one person is required to demonstrate financial responsibility; however, both parties are
liable in the event of a release. South Carolina Underground Storage Tank Control
Regulations 61-92, Part 280 requires owners of USTs that store regulated substances
to notify the UST Division of any financial responsibility changes. An owner is defined
as:
• In the case of an UST in use on November 8, 1984, or brought into use after that
date, any person who owns an UST used for storage, use, or dispensing of
regulated substances, or
• In the case of an UST in use before November 8, 1984, but no longer in use on
that date, any person who owned the UST immediately before its discontinuation.
• A person who has assumed legal ownership of the UST system through the
provision of a contract of sale or other legally binding transfer of ownership.
What USTs are included?
An UST system is defined as any one or combination of tanks that is used to contain an
accumulation of regulated substances, and whose volume (including connected
underground piping) is 10 percent or more beneath the ground. Regulated USTs store
petroleum or hazardous substances. This includes UST systems with field-constructed
tanks and airport hydrant fuel distribution systems. Note: an owner or operator is not
required to maintain financial responsibility for USTs after the system has been properly
closed and, in the case site investigation/rehabilitation activities are required, after these
activities have been completed. It is a violation, however, to not maintain financial
responsibility for a UST system that has not been properly closed.
DHEC 3472 (3/2018)
When and Who to Notify?
Any owner or operator who assumes ownership of a regulated UST system must submit
this Certificate of Financial Responsibility with the associated financial mechanism
within 30 days of assuming such ownership. It is a violation to not maintain financial
responsibility for a UST system that has not been properly closed.
What Tanks are Excluded from these Requirements?
• Tanks removed from the ground prior to January 1, 1986;
• Farm or residential tanks of 1,100 gallons or less used to store motor fuel for
noncommercial purposes;
• Tanks storing heating oil for use on the premise being stored;
• Septic tanks;
• Certain pipeline facilities regulated under Chapters 601 and 603 of Title 49;
• Surface impoundments, pits, ponds, or lagoons;
• Storm water or wastewater collection systems;
• Flow-through process tanks;
• Liquid traps or associated gathering lines directly related to oil or gas production
and gathering operations;
• Tanks on or above the floor of underground areas, such as basements or tunnels;
• Tanks with a capacity of 110 gallons or less;
• Wastewater treatment tank systems;
• UST systems containing radioactive materials that are regulated under the Atomic
Energy Act of 1954;
• UST systems that are part of an emergency generator system at nuclear power
generation facilities regulated by the Nuclear Regulatory Commission under 10
CFR part 50.
What Substances are Covered?
These requirements apply to USTs containing petroleum or certain hazardous
substances. Petroleum includes gasoline, used oil, diesel fuel, crude oil, or any fraction
thereof which is liquid at standard conditions of temperature and pressure (60 degrees
F and 14.7 pounds per square inch absolute). Hazardous substances are those found in
Section 101(14) of the Comprehensive Environmental Response Compensation and
Liability Act (CERCLA) of 1980 with the exception of those substances regulated as
hazardous waste under Subtitle C of the Resource Conservation and Recovery Act
(RCRA).
Instructions for Completing the Certificate of Financial Responsibility:
Note: For additional [permits with the same owner (Section I), same operator
(Section II) and same financial mechanism (Section IV) you may use Section VII to
list those facilities in lieu of completing individual Certificates of Financial
Responsibility.
DHEC 3472 (3/2018)