13Other storages on the same Diesel Oxygen Gasolene premises that are not part of this application: (Tick all that apply) Jet A1 Crude Oil/ Condensate/NGL NA Residential Commercial Agricultural Public Assemblage 14Buildings on the same premises Industrial Government Parking/ storage (specify below) are: (Tick all that apply) Yes No 15Is the area to flooding? 16Has the area City/Regional/ Yes No Borough Corporation been advised of the installation? 30Is your company registered and Yes No NA approved by the Ministry of Energy & Energy Affairs for the If yes, state registration number and/ or purchasing of subsidised diesel date of application: fuel? Section D : Piping Information Aboveground Outdoor 1Hydrocarbon piping is located: (tick all that apply) Underground Indoor aAboveground 2Hydrocarbon piping material of construction: bUnderground Threaded Welded Flanged 3Type of hydrocarbon piping Brazed (specify below) joints: (tick all that Value e.g. 3.5 Unit e.g. ft. (click to choose) 4Minimum depth of hydrocarbon NA underground piping: 5Type of corrosion protection for NA underground piping: Yes No NA 6Underground piping is If yes, material of construction of outer wall: Section E: Tanks Information Provide the listed information for each tank For additional tanks, use the supplemental form. Tank 1 Tank 2 Tank 3 1Product to be stored in tank: If other, specify below: If other, specify below: If other, specify below: (click to choose e.g. diesel) 2Operational status of tank: (click to choose e.g. currently in use) Aboveground Underground Aboveground Underground Aboveground Underground Indoor Outdoor Indoor Outdoor Indoor Outdoor Roof Basement Roof Basement Roof Basement Internal day Internal day 3Tank is located: Warehouse Internal day tank Warehouse Warehouse tank tank (Tick all that Mounded Other Mounded Other Mounded Other If other specify below: If other specify below: If other specify below: 4Tank is: Fixed Mobile Fixed Mobile Fixed Mobile (Tick all that
13Other storages on the same premises that are not part of this application: (Tick all that apply) Diesel Oxygen Gasolene Jet A1 Crude Oil/ Condensate/NGL NA 14Buildings on the same premises are: (Tick all that apply) Residential Commercial Agricultural Public Assemblage Industrial Government Parking/ storage (specify below) 15Is the area to flooding? Yes No 16Has the area City/Regional/ Borough Corporation been advised of the installation? Yes No 30Is your company registered and approved by the Ministry of Energy & Energy Affairs for the purchasing of subsidised diesel fuel? Yes No NA If yes, state registration number and/ or date of application: Section D : Piping Information 1Hydrocarbon piping is located: (tick all that apply) Aboveground Outdoor Underground Indoor 2Hydrocarbon piping material of construction: aAboveground bUnderground 3Type of hydrocarbon piping joints: (tick all that Threaded Welded Flanged Brazed (specify below) 4Minimum depth of hydrocarbon underground piping: NA Value e.g. 3.5 Unit e.g. ft. (click to choose) 5Type of corrosion protection for underground piping: NA 6Underground piping is Yes No NA If yes, material of construction of outer wall: Section E: Tanks Information Provide the listed information for each tank For additional tanks, use the supplemental form. Tank 1 Tank 2 Tank 3 1Product to be stored in tank: (click to choose e.g. diesel) If other, specify below: If other, specify below: If other, specify below: 2Operational status of tank: (click to choose e.g. currently in use) 3Tank is located: (Tick all that Aboveground Underground Aboveground Underground Aboveground Underground Indoor Outdoor Indoor Outdoor Indoor Outdoor Roof Basement Roof Basement Roof Basement Warehouse Internal day tank Warehouse Internal day tank Warehouse Internal day tank Mounded Other Mounded Other Mounded Other If other specify below: If other specify below: If other specify below: 4Tank is: (Tick all that Fixed Mobile Fixed Mobile Fixed Mobile
Refined_Petroleum_Products_Storage_Application_Form.docx