2012-05-17_PERMIT FILE - C1981012 ‎(2)‎

• Permit No: C1981012
• IBM Index Class Name: Permit File
• Doc Date: 5/17/2012
• Section_Exhibit Name: EXHIBIT 27 SPILL PREVENTION CONTROL AND COUNTERMEASURE PLAN
• Media Type: D
• Archive: No

of cO<oA
o' Mail to: Division of Oil and Public Safety 633 17th Street, Suite 500
ie3s / Denver, CO 80202 -3660
E -mail oil.publicsafety @state.co.us
G13P1tC IS1IM, Z►AI IG7Tel411111>f_MI:ll N X0R-1111l 7MLSRI
Return this original registration form; retain a copy for your records. MAKE CHECK FOR $35 PER TANK PAYABLE TO Division of Oil and Public Safety.
Registration may be typed or printed in black ink. REGISTRATION REQUIREMENTS: a registration form must be completed for each location where there
are aboveground petroleum storage tanks. Tanks must be registered annually or whenever there is a change in the status of the tank system. See additional
information below.
1. OWNER (who owns the tanks ?)
PHONE NUMBER
MAILING ADDRESS (other than facility address)
COUNTY
CITY
STATE
ZIP
2. FACILITY NAME (street address where the tanks are located)
PHONE NUMBER
STREET ADDRESS
COUNTY
CITY
STATE
ZIP
PERSON RESPONSIBLE FOR TANK/TANK RECORDS
TITLE
PHONE NUMBER
3. BILLING (where do you want the bill sent)
PHONE NUMBER
MAILING ADDRESS
COUNTY
CITY
STATE
ZIP
4. OWNER TYPE COMMERCIAL PRIVATE
STATE GOVT LOCAL GOVT
RETAIL
OTHER
FEDERAL GOVT
5. TANK INFORMATION
TANK NUMBER
1
2
3
4
5
6
PRODUCT IN TANK
INSTALLATION DATE
CAPACITY (in gallons)
" OVERFILL PROTECTION
Y N
Y N
Y N
Y N
Y N
Y N
*" SPILL PREVENTION
Y N
Y N
Y N
Y N
Y N
Y N
* ** SECONDARY CONTAINMENT
Y N
Y N
Y N
Y N
Y N
Y N
6. CERTIFICATION
I certify that I have examined and am familiar with the information submitted in this document, and that, to the best of my knowledge; the submitted information
is true, accurate and complete.
PLEASE PRINT NAME AND TITLE OF OWNER OR AUTHORIZED REPRESENTATIVE
SIGNATURE
DATE
* OVERFILL PROTECTION: Overfill protection equipment will automatically shut off the flow of a product when the tank is
95% fill or alert the transfer operator when the tank is no more than 90% full.
** SPILL PREVENTION: Spill prevention equipment prevents the release of a product into the environment when the
transfer hose is detached from the fill pipe.
* ** SECONDARY CONTAINMENT: A secondary containment is a berm surrounding the tanks which is capable of
containing the capacity of the single largest tank.
ADDITIONAL INFORMATION
REGISTRATION FOR ABOVEGROUND STORAGE TANKS
All owners or operators of aboveground petroleum storage tanks with a capacity between 660 and 40,000 gallons must
annually register their tanks with the Division of Oil and Public Safety. In addition, a new registration must be filed within 30
days of a tank installation, removal, upgrade or change in service.
WHAT IS AN ABOVEGROUND STORAGE TANK?
An aboveground storage tank is defined as one or a combination of tanks that: (1) are contain an accumulation of
petroleum; and (2) whose volume (including underground piping) is 90% or more above the ground.
EXCLUSIONS
Tanks excluded from these registration requirements are: (1) farm or residential tanks used for noncommercial purposes;
(2) tanks used for storing heating oil for consumptive uses on the premises where stored; (3) crude oil tanks; (4) propane
tanks; (5) pipeline facilities (including gathering lines) regulated under the Natural Gas Pipeline Safety Act of 1968, the
Hazardous Liquid Pipeline Safety Act of 1979, or which are intrastate pipeline facilities regulated under state laws; (6)
surface impoundments, pits, ponds, or lagoons; and (7) flow through process tanks.
MR 115 Page 27 -56 Rev. May 2012