"Notification for New Installation, Replacement, or Closure of Underground Storage Tank Systems" - Nevada

Notification for New Installation, Replacement, or Closure of Underground Storage Tank Systems is a legal document that was released by the Nevada Department of Conservation and Natural Resources - a government authority operating within Nevada.

Form Details:

  • The latest edition currently provided by the Nevada Department of Conservation and Natural Resources;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Nevada Department of Conservation and Natural Resources.

ADVERTISEMENT
ADVERTISEMENT

Download "Notification for New Installation, Replacement, or Closure of Underground Storage Tank Systems" - Nevada

Download PDF

Fill PDF online

Rate (4.5 / 5) 33 votes
Notification for New Installation, Replacement, or Closure
of Underground Storage Tank Systems
(Required 30 days prior to starting construction activities in accordance with NAC
459.9947.3 and 40 CFR 280.34)
901 S. Stewart Street, Suite 4001 • Carson City, Nevada 89701 • p: 775.687.9368 • f: 775.687.8335 • ndep.nv.gov
Owner/Operating Company of USTs: ____________________________________________________________
Mailing Address: ______________________________________________________________________________
City: _________________________________________
State: __________
Zip Code: _________________
Contact Name: __________________________________________
Phone No. __________________________
Facility Name: ________________________________________________________________________________
Street Address: _________________________________________
City: _______________________________
Select All That Apply:
New Tank(s)
New Piping
Tank(s) Replacement
Pipe Replacement
New or Replaced Dispensers(s)
Permanent Closure
Change-In-Service
Are USTs currently present at this location?
Yes
No
Proposed Work Start Date: ______________
Identify the NDEP certified tank handler overseeing the project:
____________________________________
(Print Name)
Company Name: ________________________________________
NV Certified UTH # : ___________________
E-Mail Address: ________________________________________
Phone No. ___________________________
Tank Installation/Replacement (If Applicable):
How many tanks will be installed or replaced? ___________________________
Are the tanks double-walled or secondarily contained with an annular space/interstice?
Yes
No*
Identify the method for monitoring the tank annular space/interstice (e.g. sensors): __________________________
Piping Installation/Replacement (If Applicable):
Is new product piping double-walled or secondarily contained with an annular space/interstice?
Yes
No*
Identify the method for monitoring the pipe annular space/interstice (e.g. sensors): __________________________
Dispenser Installation/Replacement (If Applicable):
Number of new Dispensers: ______________
Under Dispenser Container (UDC) Present ?
Yes
No*
Identify the method for monitoring the dispenser sumps (e.g. sensors): ____________________________________
Automatic Tank Gauge (ATG) Console / Monitoring System Manufacturer:
__________________________
* If "No" was selected for any of the secondary containment questions above, contact your local UST implementing agency for approval.
Notification for New Installation, Replacement, or Closure
of Underground Storage Tank Systems
(Required 30 days prior to starting construction activities in accordance with NAC
459.9947.3 and 40 CFR 280.34)
901 S. Stewart Street, Suite 4001 • Carson City, Nevada 89701 • p: 775.687.9368 • f: 775.687.8335 • ndep.nv.gov
Owner/Operating Company of USTs: ____________________________________________________________
Mailing Address: ______________________________________________________________________________
City: _________________________________________
State: __________
Zip Code: _________________
Contact Name: __________________________________________
Phone No. __________________________
Facility Name: ________________________________________________________________________________
Street Address: _________________________________________
City: _______________________________
Select All That Apply:
New Tank(s)
New Piping
Tank(s) Replacement
Pipe Replacement
New or Replaced Dispensers(s)
Permanent Closure
Change-In-Service
Are USTs currently present at this location?
Yes
No
Proposed Work Start Date: ______________
Identify the NDEP certified tank handler overseeing the project:
____________________________________
(Print Name)
Company Name: ________________________________________
NV Certified UTH # : ___________________
E-Mail Address: ________________________________________
Phone No. ___________________________
Tank Installation/Replacement (If Applicable):
How many tanks will be installed or replaced? ___________________________
Are the tanks double-walled or secondarily contained with an annular space/interstice?
Yes
No*
Identify the method for monitoring the tank annular space/interstice (e.g. sensors): __________________________
Piping Installation/Replacement (If Applicable):
Is new product piping double-walled or secondarily contained with an annular space/interstice?
Yes
No*
Identify the method for monitoring the pipe annular space/interstice (e.g. sensors): __________________________
Dispenser Installation/Replacement (If Applicable):
Number of new Dispensers: ______________
Under Dispenser Container (UDC) Present ?
Yes
No*
Identify the method for monitoring the dispenser sumps (e.g. sensors): ____________________________________
Automatic Tank Gauge (ATG) Console / Monitoring System Manufacturer:
__________________________
* If "No" was selected for any of the secondary containment questions above, contact your local UST implementing agency for approval.