Gasoline Dispensing Facilities

Type of gasoline dispensing facility
Type of Ownership (check one):
Purpose of this application (check one):
If the tank(s) were installed before October 1, 1990 have they been modified or upgraded since that date?(Please check one)
Stage I Vapor Balance system? (A Stage I Vapor Balance System is a vapor tight system that transfers the vapors displaced from the stationary storage tanks to the gasoline tank truck. COHRAR Part 8.8.1(c)
Submerged fill pipes? (A gasoline storage tank equipped with a submerged fill pipe has a drop tube with a discharge opening that is no higher than six inches from the bottom of the tank. COHRAR Part 1.3
Please check one for each of the following questions. Is this facility equipped with: Vapor vent line(s) with pressure relief valves?
This facility is operated in a manner that prevents unnecessary evaporation of gasoline by: a) minimizing gasoline spills; b) cleaning up spills as expeditiously as practicable; c) not storing gasoline in open containers and; d) not discharging gasoline to open waste collection systems.
14. Please check the type of vapor balance system installed, or to be installed:
Could this facility have any 30-day periods (rolling average) that the total volume of gasoline loaded into all gasoline storage tanks is greater than or equal to 100,000 gallons? (Please check one)
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11/13/2026Click to Sign
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