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• <br /> Facility Type continued <br /> 4. When the facility is not described as above,select the most appropriate type from: <br /> A. Retail Station-primarily supplies vehicular fuel to automotive customers;may store other regulated substances. <br /> C. Fuel User,Non-retail-primarily stores vehicular fuel and/or other pollutants or hazardous substances for consumption <br /> by facility/owner/operator. <br /> D. Inland Bulk Petroleum Storage- inland facility with no waterfront access, that has multiple active UST and/or AST storage systems <br /> used primarily for storage of pollutants intended for distribution. May also store hazardous substances on-site for facility consumption <br /> and/or distribution purposes. <br /> E. Industrial Plant-inland facility with no waterfront access;may include power plants and facilities designed for manufacturing <br /> and/or chemical processing; may have multiple active UST and/or AST storage systems used for storage of pollutants and/or <br /> hazardous substances intended for facility consumption. <br /> J. Collection Station-maintenance or other related facility that acquires and temporarily stores used and/or waste oil prior to recycling <br /> and/or disposal. <br /> K. Inland Bulk Chemical Storage-inland facility with no waterfront access,that has multiple active UST and/or AST storage systems <br /> and/or compression vessels used for storage of hazardous substances intended for distribution. May also store pollutants on site <br /> for facility consumption and/or distribution purposes. <br /> L. Chemical User-facility primarily uses regulated hazardous substance tanks on site;may also store pollutants. <br /> M. Agricultural-facility actively used in production of crops,plants,or livestock. <br /> B. Residential(not regulated)-property used primarily for dwelling purposes;regulated substance used for non-commercial purposes; <br /> no UST exists>1 100 gallons. <br /> P. UST Residential(>1100 gallons)-residence with USTs regulated by Federal Environmental Protection Agency. <br /> Z. Other Regulated Facility -Please identify the type of establishment that you are registering. <br /> Q. Emergency Response Site: Use this facility type designation when you register a site where there has occurred a petroleum spill,resulting in <br /> contamination that will be tracked by the department. <br /> X. Tankless Facility: Use this facility type designation when you register a site where there has been discovered existing contamination that is <br /> likely to have resulted from a storage tank. The tank itself may have already been removed and disposed of. <br /> Financial Responsibility — The demonstration of financial responsibility shall be made by the owner or operator in accordance with C.F.R. <br /> Title 40,Part 280,Subpart H. Write in your selection of the following: <br /> 1. None <br /> 2. Insurance Carrier <br /> 3. Other Mechanism (includes all other financial responsibility methods meeting requirements of C.F.R.Title 40) <br /> 24 Hour Emergency Contact - Provide the name&telephone number of the Emergency Contact for this facility. <br /> II. Responsible Party Information <br /> 1. In the first block,provide the name,address,contact name,and telephone number of the individual(s)and/or business(es)that are responsible for <br /> the operation of the storage tank facility and for the payment of DEP annual Storage Tank Registration fees. Identify the appropriate facility <br /> relationships for this party: Facility Owner/Operator,Tank Owner, and/or Property Owner. The first named party will also be associated with the <br /> role of Facility Account Owner. The Account Owner is responsible for payment of the annual storage tank registration fees,and will receive the <br /> annual storage tank registration placard(s)upon payment. <br /> 2. Provide an e-mail address for the contact, if available. The Storage Tank Registration Section will occasionally provide facility information <br /> reports to the contact for review and/or reconciliation. Reports can be sent electronically if the contact's email address is on file. <br /> 2. Identify additional individuals and/or companies that play a role in the ownership or operation of the facility,as necessary. <br /> 3. When submitting revisions to owner name or address information,please include their STCM Account Number,when available. <br /> 4. Submit a registration form when the facility or tank ownership changes,complete with the date&new owner's signature. <br /> 5/1/00 2 <br /> Storage Tank Registration Instructions <br />