Underground Storage Tank Removal and Transport Permit

Application for storage tank removal and transportation to approved tank disposal yard with the provisions of M.G.L Chapter 148, Section 38, 527 CMR 1.00 Section 1.12.8.40

The Fee for this permit is $30.00

Checks may be dropped off in the drop box at the Station, 11 Pierce Street or mailed to

Northborough Fire Department 11 Pierce St. Northborough MA. 01532

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FDID 27215

Northborough Fire FDID 27215

Tank Owner

Enter all owner information please

Tank Owner name *

Tank Owner Address *

Tank Owner Email Address *

Removal Contractor

Please enter all removal contractor information

Company Email Address

Company Address *

Certification Type and Number

Company e signature *

My name above indicates all entered information is accurate to the best of my knowledge

Containment Assesment

Please enter all information

Company or Individual

Address

Certification Type and Number *

Containment e signature

By entering my name above , I certify all information is true and correct to the best of my knowledge

Tank Information

Please enter all available information

Tank Location *

Street, City, Town

Tank Capacity *

Last substance Stored *

Tank Dimensions (diameter x length)

Remarks

Disposal Information

Please enter all information if applicable

Firm Transporting Waste

State Lic Number

EPA Number

Hazardous Waste Manifest #

Approved Tank Disposal Yard

Tank Yard Number

Tank Yard Address

Type of Inert Gas

Leave this field blank

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Underground Storage Tank Removal and Transport Permit