Section A - Owner Information 1Company/ Owner/ Leasee of Storage System: 2Mailing Address: Tel.: Fax: Email: 3Contacts: Section B Installer Information – 1Name of Installer: 2Mailing Address: Tel.: Fax: Email: 3Contacts: Section C: Storage Information 1Total volume of LPG to be stored: (e.g. 3 X 100 US Gallons) Same as in A2 above. (If not, specify below) 2Physical address of LPG storage system: 3Purpose/ use of the storage system: 4Operational status of storage system: (click to choose e.g. currently in use) 5Date installed or to be installed: Residential Commercial Agricultural Public Assemblage 6Buildings on the same premises Industrial Government Parking/ storage Other are: If other, specify below: (Tick all that apply) 7Type of establishment where product is to be stored, e.g. school: If other, specify: (click to choose) 8First application for approval of Yes No (if no, specify date of last application) this storage system: 9Terrain in the vicinity of the tanks/ cylinders is: (click to choose e.g. flat)
Section A - Owner Information 1Company/ Owner/ Leasee of Storage System: 2Mailing Address: 3Contacts: Tel.: Fax: Email: Section B – Installer Information 1Name of Installer: 2Mailing Address: 3Contacts: Tel.: Fax: Email: Section C: Storage Information 1Total volume of LPG to be stored: (e.g. 3 X 100 US Gallons) 2Physical address of LPG storage system: Same as in A2 above. (If not, specify below) 3Purpose/ use of the storage system: 4Operational status of storage system: (click to choose e.g. currently in use) 5Date installed or to be installed: 6Buildings on the same premises are: (Tick all that apply) Residential Commercial Agricultural Public Assemblage Industrial Government Parking/ storage Other If other, specify below: 7Type of establishment where product is to be stored, e.g. school: (click to choose) If other, specify: 8First application for approval of this storage system: Yes No (if no, specify date of last application) 9Terrain in the vicinity of the tanks/ cylinders is: (click to choose e.g. flat)