Tceq 0724 Form PDF Details

Understanding the intricacies of environmental compliance for facilities with underground storage tanks (USTs) in Texas is pivotal, and the TCEQ 0724 form serves as a cornerstone document in this arena. This comprehensive form, designed by the Texas Commission on Environmental Quality (TCEQ), facilitates the process for filing registration and self-certification information, a crucial step for owners and operators of USTs to ensure adherence to state environmental quality standards. Its sections encompass a range of essential data points from tank owner and facility information to the detailed UST system technical information, underscoring the breadth of information required for effective environmental management and compliance. The form not only guides users through the registration and certification process but also mandates the disclosure of financial assurance information and compliance with UST requirements, thereby reinforcing the commitment to safeguard the environment. Significantly, the form emphasizes the importance of maintaining updated and accurate records, a critical aspect for any facility navigating the regulatory landscape of petroleum storage tank management. Facilitating a bridge between regulatory compliance and environmental stewardship, the TCEQ 0724 form is instrumental for facility owners and operators in Texas, ensuring that their operations align with the state's environmental quality benchmarks while highlighting the steps for obtaining requisite certifications and managing USTs responsibly.

QuestionAnswer
Form NameTceq 0724 Form
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namestceq gov self online, tceq all self online, tceq delivery certificate form, tceq all self get

Form Preview Example

 

 

 

PST _

 

 

 

_RE_

 

 

 

 

 

 

 

 

 

_UST

 

 

 

 

For internal use only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner’s Customer No.: CN

 

 

 

Facility’s Regulated Entity No.: RN

 

 

 

 

 

 

TCEQ - UNDERGROUND STORAGE TANK REGISTRATION & SELF-CERTIFICATION FORM

 

 

(Use this form for filing registration and self-certification information)

 

 

 

 

Page 1 of 5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Texas

Please mail completed form to:

 

 

 

 

 

 

TCEQ Facility ID No.:

 

 

 

 

Petroleum Storage Tank Registration Team (MC-138)

 

 

 

 

 

 

For Use

 

 

Commission

Texas Commission on Environmental Quality

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TCEQ Owner ID No.:

 

in

 

 

On

 

 

P. O. Box 13087

 

 

 

 

 

 

 

 

 

 

 

 

 

TEXAS

 

 

Environmental

Austin, Texas 78711-3087

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Federal Tax ID No. :

 

 

 

 

Quality

(512) 239-2160 Fax (512)239-3398

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*MAKE A COPY OF FORM FOR YOUR RECORDS*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. TANK OWNER INFORMATION

 

 

 

 

 

 

 

 

TANK OWNER BUSINESS OR LAST NAME:

 

TANK OWNER FIRST NAME

TYPE OF TANK OWNER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Individual

 

 

Corporation

Common Carrier Railroad

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OWNER MAILING ADDRESS

 

 

 

 

 

 

 

Federal Gov’t

State Gov’t

 

Local Gov’t

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County Gov’t

City Gov’t

 

 

Sole Proprietorship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOCATION OF RECORDS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

At facility

Offsite at:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY:

 

 

STATE:

 

ZIP CODE:

OFFSITE RECORDS LOCATION ADDRESS

CITY

 

 

 

STATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COUNTRY (OUTSIDE USA)

E-MAIL ADDRESS

 

 

RECORDS CUSTODIAN/CONTACT PERSON:

TELEPHONE NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OWNERS AUTHORIZED REPRESENTATIVE

TITLE:

 

TELEPHONE NO.

FAX NO:

 

 

 

 

INDEPENDENTLY OWNED & OPERATED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE FRANCHISE TAX ID

 

DUNS NO

 

 

NUMBER OF EMPLOYEES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0-20

21-100

 

 

101-250

251-500

 

501 & HIGHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**For Self-Certification only this form will not be processed until all delinquent fees and/or penalties owed to the TCEQ or the Office of the Attorney General on behalf of the TCEQ are paid in accordance with the Delinquent Fee and Penalty Protocol. **

2.FACILITY INFORMATION

FACILITY NAME:

 

 

 

 

TYPE OF FACILITY:

Emergency Generator

Wholesale

 

 

 

 

 

Retail

Farm or Residential

Fleet Refueling

 

 

 

 

 

Aircraft Refueling

 

Indian Land

 

Watercraft Fueling

PHYSICAL LOCATION:

 

 

 

 

 

 

 

 

 

 

 

Industrial/Manufacturing/Chemical Plant

 

 

 

 

 

 

 

Number of regulated *USTs at this facility:

 

 

CITY:

 

ZIP CODE

COUNTY:

 

 

 

*Underground Storage Tanks (USTs)

 

 

 

 

 

 

 

 

 

 

 

 

TX

 

Number of regulated *ASTs at this facility:

 

 

 

 

 

 

 

 

 

 

 

*Aboveground Storage Tanks (ASTs)

 

 

 

 

 

 

 

 

 

 

 

ON-SITE CONTACT PERSON

 

TITLE:

TELEPHONE NO.:

PRIMARY SIC CODE

 

 

SECONDARY SIC CODE

 

 

 

 

 

 

 

 

 

 

 

E_MAIL ADDRESS:

 

FAX NUMBER

PRIMARY NAICS CODE

 

 

SECONDARY NAICS CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LATITUDE

Minutes

 

Seconds

LONGITUDE

 

 

Minutes

 

 

Seconds

Degrees

 

Degrees

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*** PRIOR TO RETAIL SALE OF FUEL TO THE PUBLIC USING MEASURED DISPENSING DEVICES, ANY METER MUST BE

REGISTERED WITH THE TEXAS DEPARTMENT OF AGRICULTURE 1-800-TELL-TDA (1-800-835-5832).

 

3. TANK OPERATOR*INFORMATION

 

 

 

 

 

(mark here if same as owner)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TCEQ Operator ID No.:

(Assigned by TCEQ)

CN

 

 

TANK OPERATOR NAME: (DO NOT LIST EMPLOYEES OF OPERATOR)

TYPE OF TANK OPERATOR:

 

 

 

 

 

Individual

 

 

Corporation

 

 

 

Sole Proprietorship

 

Federal Gov’t

MAILING ADDRESS:

 

 

 

 

State Gov’t

 

 

County Gov’t

CITY:

STATE: ZIP CODE:

 

Local Gov’t

 

 

City Gov’t

 

 

 

 

 

 

 

OPERATORS AUTHORIZED

TITLE:

TELEPHONE NO:

REPRESENTATIVE:

 

 

Date listed person became operator:

TCEQ-0724 (REV. 1/2016)

PST Rules are located in Title 30 TAC, Chapter 334

Page 1 of 5

TCEQ Facility ID No

TCEQ- UST REGISTRATION & SELF-CERTIFICATION FORM

***MAKE A COPY OF FORM FOR YOUR RECORDS***

For Self-Certification Annual Renewal, Sections 1 thru 5 and 7 thru 9 must be completed. If there are any changes including change of ownership along with the renewal of the delivery certificate, Sections 1 thru 5 and 7 thru 10 & 12 must be completed.

For Initial Registration, Sections 1 thru 13, the complete form should be completed.

For data verification purposes, please check our IWR (Integrated web reporting) web page

!"#$%#&'(

If you have any questions on how to fill out this form or about the PST Registration program, please contact us at 512/239-2160.

Individuals are entitled to request and review their personal information that the agency gathers on its forms. They may also have any errors in their information corrected. To review such information, contact us at 512-239-2160.

4. REASON FOR THIS FILING

PART A). UST REGISTRATION INFORMATION (Mark all that apply):

 

1

Initial Registration

2 UST Ownership Change (New Owner indicate effective date :)

 

 

3

Amendment of: A

Owner Information

B

Operator Information

C

 

D

UST System Information

E

Financial Assurance Information

 

4Operator Training

5.Other (specify):

Facility Information

PART B). UST COMPLIANCE SELF-CERTIFICATION INFORMATION (Mark all that apply):

1

Initial Certification at Facility (Including Tank Ownership Change)

2 Annual Renewal

 

 

3

New Tank at Facility

4 Other (specify):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. TCEQ PROGRAMS IN WHICH THIS REGULATED ENTITY PARTICIPATES

Check all Programs and write in the permits/registration numbers that will be affected by the updates submitted on this form or the updates may not be made. If the program is not listed, check other and write it in.

Animal Feeding Operation

Dam Safety

Districts

 

 

 

 

 

Industrial & Hazardous Waste

Municipal Solid Waste

New Source Review - Air

 

 

 

 

 

OSSF

Petroleum Storage Tank

Sludge

 

 

 

 

 

Stormwater

Tires

Title V - Air

 

 

 

 

 

Utilities

Voluntary Cleanup Program

Wastewater Agriculture

 

 

 

 

 

Wastewater Permit

Water Districts

Water Rights

 

 

 

 

 

 

 

 

 

 

Water Utilities

Other

Other

 

 

 

 

 

 

 

Unknown

Licensing - Type(s)

6. OPERATOR TRAINING

Each class of operator – Class A, Class B, and Class C shall be trained and certified in accordance with Title 30, TAC 334 Subchapter N. Class A and Class B Operators must ensure that training certificates are maintained at each facility. A copy of the initial or new certificate must also be provided to the TCEQ with their annual self certification starting August 8, 2012. All classes of operators must be retrained within three years of their training date.

As of the signature date on this form, this site is in compliance with all Class A, B, and C UST facility operator training: Class A Operator (Exactly as it appears on certificate)

Yes

No

First Name

Training Provider

Last Name

Date of Training

Class B Operator – Check Box if Same as Class A Operator

First Name

Training Provider

Last Name

Date of Training

TCEQ-0724 (REV. 1/2016)

PST Rules are located in Title 30 TAC, Chapter 334

Page 2 of 5

TCEQ Facility ID No.

TCEQ- UST REGISTRATION & SELF-CERTIFICATION FORM

7.SELF-CERTIFICATION OF COMPLIANCE WITH UST REQUIREMENTS

Important: Completion of this section is required before TCEQ issues a UST Delivery Certificate. Delivery of regulated substances into regulated USTs is prohibited by state law unless a valid, current Delivery Certificate is available and/or displayed at the UST facility. Any responses marked ANO@, or any incomplete submittal, will result in non-issuance of a Delivery Certificate for this facility.

INDICATE RESPONSES TO EACH QUESTION BY MARKING X IN THE APPROPRIATE SPACE AT THE RIGHT.

For regulated UST systems at the facility indicated below, is the registration information filed with the TCEQ

REGISTRATION pursuant to §334.7 of TCEQ rules (including information in this filing) complete, accurate, & up-to-date?

For regulated UST systems at the facility indicated below, have all facility fees billed to date to the current

FACILITY FEES owner been paid in full (I.e., annual fees plus all late fees, penalties, & interest)? (Does not apply to

common carrier railroads)

FINANCIAL

For regulated UST systems at the facility indicated below, does financial assurance coverage meet TCEQ

requirements, as described in Chapter 37 Subchapter I of TCEQ rules, for first-party corrective action,

ASSURANCE

third-party bodily-injury, and third-party property damage in the event of a petroleum release from these

 

UST systems?

For regulated UST systems at the facility indicated below, are all in compliance with technical standards, as described in TCEQ rules in §334.49 (relating to Corrosion Protection), §334.50 (relating to Release

TECHNICAL

Detection), §334.51 (relating to Spill and Overfill Prevention and Control) and §334.43 (relating to Variances

and Alternative Procedures) if a written variance to all or part of the requirements of the previous three

STANDARDS

sections has been granted by the TCEQ? (A AYes@ response indicates that recordkeeping

 

 

requirements and reporting duties have been met for 60 days prior to and including the date of

 

certification.)

YES NO

I am certifying that the following UST systems at this facility are in compliance:

Tank ID #(s)

as numbered on Pages 4 and 5 of this form.

If certifying more UST systems, please list additional ID #s on another form.

This Self-Certification will not be processed or Delivery Certificate created unless Proof of Financial Assurance has been provided

with this form. (State & Federal Entities Exempt)

8. FINANCIAL ASSURANCE INFORMATION

 

Financial Assurance (Petroleum USTs only)

 

 

 

 

 

 

 

 

 

 

Does this facility meet Financial Assurance (FA) requirements for both

 

 

 

 

 

 

 

 

 

1st party corrective action and 3rd party bodily injury/property damage liability?

Yes

 

No

 

 

Exempt (state and federal entities only)

 

If YES, identify FA mechanism(s):

Insurance (or risk retention group)

Financial test

Guarantee*

Letter of credit*

 

 

 

 

Surety bond*

Local Gov. financial test **

Local Gov. guarantee**

Trust fund

 

* Also requires stand-by trust fund.

 

 

 

 

** Only available to local governments (counties, municipalities, and special districts).

 

Information pertaining to the financial assurance mechanism(s) used to demonstrate financial assurance under

 

 

 

Chapter 37, Subchapter I of Title 30, Texas Administrative Code is as follows:

 

 

Name of Issuer:

 

 

 

 

 

 

 

Phone # of Issuer:

 

 

Policy or mechanism #:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Coverage period

 

 

 

 

 

 

 

Coverage Amount s: Occurrence $

 

Insurance Premium pre-paid for entire year?***

 

Beginning:

Ending:

 

 

 

 

 

Annual Aggregate $

 

 

Yes

 

 

No***For information purposes only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

**For questions regarding Financial Assurance, call the Financial Assurance Section at (512) 239-0300**

 

9. TANK OWNER/OPERATOR SELF-CERTIFICATION (for Delivery Certificate)

 

I hereby certify under penalty of law to the following:

 

 

 

 

 

 

 

 

 

 

I am the (mark one):

 

owner . . .

 

 

 

 

 

legally-authorized representative of the owner . . .

 

 

 

 

 

 

 

 

operator . . .

 

 

 

 

legally-authorized representative of the operator . . .

 

 

 

 

. . . of the regulated underground storage

tank (UST) systems at this facility; AND

 

 

 

 

 

 

 

 

I have personally examined and am familiar with the information included in Sections 1 through 4 AND 7; AND 8

 

 

Based on my current knowledge and understanding, the submitted information is true, accurate, and complete; AND

 

I understand that any person who intentionally or knowingly submits false information on this form is subject to criminal prosecution.

 

PRINTED NAME OF OWNER/OPERATOR (OR AUTHORIZED REPRESENTATIVE)

 

 

 

 

 

TITLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF OWNER/OPERATOR (OR AUTHORIZED REPRESENTATIVE)

 

 

 

 

 

DATE OF SIGNATURE (PLEASE PRINT)

 

 

 

 

 

 

 

 

 

 

 

10. TANK OWNER/OPERATOR REGISTRATION (for Initial Registration or Changes)

 

I hereby represent the following:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am the (mark one):

 

owner . . .

 

 

 

 

 

legally-authorized representative of the owner . . .

 

 

 

 

 

 

 

 

operator . . .

 

 

 

legally-authorized representative of the operator . . .

 

 

 

 

. . . of the regulated

underground storage

tank (UST) systems at this facility; AND

 

 

 

 

 

 

 

 

I have personally examined and am familiar with the information included in Sections 1 through 5, and Sections 8, 11 - 13; AND

 

Based on my current knowledge and understanding, the submitted information is true, accurate, and complete and that I have signature

 

authority to submit this form on behalf of the entity in Section 1 and/or as required for the updates to the ID numbers identified in Section 5;

 

AND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I understand that any person who intentionally or knowingly submits false information on this form is subject to criminal prosecution.

 

PRINTED NAME OF OWNER/OPERATOR (OR AUTHORIZED REPRESENTATIVE)

 

 

 

 

 

TITLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF OWNER/OPERATOR (OR AUTHORIZED REPRESENTATIVE)

 

 

 

 

 

DATE OF SIGNATURE (PLEASE PRINT)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TCEQ-0724 (REV. 1/2016)

 

 

 

PST Rules are located in Title 30 TAC, Chapter 334

 

 

 

 

 

 

Page 3 of 5

TCEQ Facility ID No.

TCEQ- UST REGISTRATION & SELF-CERTIFICATION FORM

11. INSTALLER/ON-SITE SUPERVISOR CERTIFICATION

NOTE: This section must be completed and signed by the Installer or On-Site Supervisor. Leave blank if no tank or underground line installation activity is involved.

Was tank and/or line testing completed during and after installation?

 

Yes

 

 

 

 

No

DATE(S) INSTALLATION ACTIVITIES PERFORMED: CONTRACTOR (COMPANY OR FIRM):

TCEQ CRP NO.:

 

CRP

 

 

INDIVIDUAL INSTALLER/ ON-SITE SUPERVISOR:

TCEQ ILP NO.:

 

ILP

I hereby certify that the information provided concerning recent installations were conducted by me or under my direct supervision, that

I am familiar with the TCEQ requirements applicable to such activities and that to the best of my knowledge and belief such activities were performed in conformance with applicable TCEQ UST regulations.

SIGNATURE OF INSTALLER/SUPERVISOR:

DATE OF SIGNATURE

 

 

 

 

 

 

 

Important: The information in the following sections regarding the UST system(s) at this facility must be properly completed in sufficient detail to support registration. UST owners & operators are encouraged to examine their UST records and/or consult with their UST equipment installers, service technicians, and/or insurance providers to ensure that this information is accurate and complete.

12. TANK IDENTIFICATION/DESCRIPTION

Tank Identification Number each tank compartment at your site consistent with Rule 334.8(c)(5)(C).

 

Tank Installation Date (Month/day/year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tank Capacity (in U.S. gallons)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tank Status (Mark One Status & Indicate Date, if

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Applicable)

1-

 

 

 

1-

 

 

1-

 

 

1-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1-Currently in Use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2-Temporarily out of service (date)

 

 

 

Yes

No

 

 

 

Yes

No

 

 

Yes

No

 

 

 

Yes

No

 

- Meets TCEQ Definition of Empty?-Yes or No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3-Perm.filled in place w/ sand, concrete, etc.(date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4-

 

 

 

4-

 

 

4-

 

 

4-

 

 

 

 

 

 

 

4-Permanently removed from the ground (date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current/Last Substance Stored (Mark All that Apply

1-

 

 

 

1-

 

 

1-

 

 

1-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1-Gasoline

2-

 

 

 

2-

 

 

2-

 

 

2-

 

 

 

 

 

 

3-

 

 

 

3-

 

 

3-

 

 

3-

 

 

 

 

 

 

2-Diesel

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3-Kerosene

4-

 

 

 

4-

 

 

4-

 

 

4-

 

 

 

 

 

 

4-Used Oil

5-

 

 

 

5-

 

 

5-

 

 

5-

 

 

 

 

 

 

5-New Oil

6-

 

 

 

 

 

 

6-

 

 

6-

 

 

 

 

 

 

 

 

 

 

6-

 

 

 

 

 

 

 

 

 

 

6–Other Petroleum Substance (specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7a

-

 

 

7a

-

 

7a

-

 

7a

-

 

 

 

 

 

7a-CERCLA Hazardous Substance (specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7b

- #

 

 

7b

- #

 

7b

- #

 

7b

- #

 

 

 

 

 

7b-Chemical Abstract Service (CAS) No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7c-Hazardous Substances Mixture (specify)

7c-

 

 

7c

-

 

7c

-

 

7c

-

 

 

 

 

 

8-Petroleum/Hazardous Substances Mixture (specify) 8-

 

 

 

8-

 

 

8-

 

 

8-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. UST SYSTEM TECHNICAL INFORMATION

 

Tank & Piping Design (Mark One for Tank & Piping)

Tank

Piping

Tank

Piping

Tank

Piping

Tank

Piping

 

1-Single-Wall

 

1-

 

 

 

 

1-

 

 

 

 

 

1-

 

 

 

 

 

 

 

 

1-

 

 

 

 

 

 

 

 

2-Double-Wall

 

2-

 

 

 

 

2 -

 

 

 

 

2 -

 

 

 

 

 

 

 

 

2-

 

 

 

 

 

 

 

 

External Containment (Mark all that apply)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3-Factory-Built Nonmetallic Jacket

 

3-

 

 

 

 

3-

 

 

 

 

 

3-

 

 

 

 

 

 

 

 

3-

 

 

 

 

 

 

 

 

4a-Synthetic Tank-Pit/Piping-Trench Liner

 

4a-

 

 

4a-

 

 

 

 

4a-

 

 

 

 

 

4a

-

 

 

 

 

 

 

 

4b-Tank Vault/Rigid Trench Liner

 

4b

-

 

 

 

4b-

 

 

 

 

4b

-

 

 

 

 

 

 

4b

-

 

 

 

 

 

 

 

Type of Piping (Mark One)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5a-Pressurized

 

 

 

 

 

5a-

 

 

 

5a-

 

 

 

 

 

 

 

 

5a-

 

 

 

 

 

5a-

 

 

 

 

 

 

5b-Suction

 

 

 

 

 

5b-

 

 

 

5b-

 

 

 

 

 

 

 

 

5b-

 

 

 

 

 

5b-

 

 

 

 

 

 

5c-Gravity

 

 

 

 

 

5c-

 

 

 

5c-

 

 

 

 

 

 

 

 

5c-

 

 

5c-

 

 

 

 

 

 

Tank Internal Protection

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6-Internal Tank Lining (Indicate date)

 

6-

 

 

 

 

6-

 

 

 

 

 

6-

 

 

 

 

 

 

 

 

6

 

 

 

 

 

 

 

 

TCEQ-0724 (REV. 1/2016)

PST Rules are located in Title 30 TAC, Chapter 334

 

 

 

 

 

 

 

 

 

 

 

Page 4 of 5

 

 

 

 

 

TCEQ Facility ID No.

TCEQ- UST REGISTRATION & SELF-CERTIFICATION FORM

13. UST SYSTEM TECHNICAL INFORMATION – CONTINUED FROM PAGE 4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tank Identification (e.g. 1, 2, 3, 4, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tank & Piping Materials (Mark all that apply)

Tank

Piping

Tank

Piping

Tank

Piping

Tank

Piping

 

1-Steel

1 -

 

 

 

 

1 -

 

 

 

 

 

 

 

 

1 -

 

 

 

 

 

 

 

1-

 

 

 

 

 

 

 

 

 

 

 

2-FRP (fiberglass-reinforced plastic)

2 -

 

 

 

 

2 -

 

 

 

 

 

 

 

 

2 -

 

 

 

 

 

 

 

2 -

 

 

 

 

 

 

 

 

 

 

 

3-Composite tank (steel w/external FRP cladding)

3 -

 

N/A

3 -

 

 

 

 

N/A

3 -

 

 

 

 

N/A

3 -

 

 

 

 

 

 

N/A

 

4-Concrete

4 -

 

 

 

 

4 -

 

 

 

 

 

 

 

 

4 -

 

 

 

 

 

 

 

4 -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5a-Jacketed (steel w/external nonmetallic jacket)

5a-

 

 

 

5a-

 

 

 

 

5a-

 

 

 

5a-

 

 

 

 

 

 

5b-Coated (steel w/external polyurethane cladding)

5b-

N/A

5b-

N/A

5b-

N/A

5b-

 

 

 

 

N/A

 

5c-Nonmetallic flexible piping

5c-N/A

 

 

 

5c-N/A

 

 

 

 

5c-N/A

 

 

 

5c-N/A

 

 

 

 

 

 

Piping Connectors & Valves (Mark all that apply)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6-Shear/Impact Valves (under dispenser)

6-N/A

 

 

 

6-N/A

 

 

 

 

6-N/A

 

 

 

6-N/A

 

 

 

 

 

 

7-Steel swing-joints (at ends of piping)

7-N/A

 

 

 

7-N/A

 

 

 

 

7-N/A

 

 

 

7-N/A

 

 

 

 

 

 

8-Flexible connectors (at ends of piping)

8-N/A

 

 

 

8-N/A

 

 

 

 

8-N/A

 

 

 

8-N/A

 

 

 

 

 

 

Tank/Piping Corrosion Protection (Mark all that apply)

Tank

Piping

Tank

Piping

Tank

Piping

Tank

Piping

 

1-External dielectric coating/laminate/tape/wrap

1-

 

 

 

 

 

 

1-

 

 

 

 

 

 

 

 

1-

 

 

 

 

 

 

 

1-

 

 

 

 

 

 

 

 

 

 

 

2a-Listed/certified factory-installed cathodic protection

2a-

 

 

 

2a-

 

 

 

 

2a-

 

 

 

2a-

 

 

 

 

 

 

2b-Certified field-installed cathodic protection

2b

 

 

 

 

 

2b-

 

 

 

 

 

 

 

2b-

 

 

 

 

 

 

2b-

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3a-Listed composite tank (steel w/FRP external laminate)

3a

 

 

 

 

 

3a-

 

 

 

 

 

 

 

3a-

 

 

 

 

 

 

3a-

 

 

 

 

 

-

 

N/A

 

 

N/A

 

 

N/A

 

 

N/A

 

3b-Listed coated tank (steel w/external polyurethane laminate)

3b

 

 

 

 

 

3b-

 

 

 

 

 

 

 

3b-

 

 

 

 

 

 

3b-

 

 

 

 

 

-

 

N/A

 

 

N/A

 

 

N/A

 

 

N/A

 

4a-Listed FRP tank or piping (non-corrodible)

4a

 

 

 

 

 

4a-

 

 

 

 

 

 

 

4a-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

4a-

 

 

 

 

 

 

4b-Listed nonmetallic flexible piping (non-corrodible)

4b-N/A

 

 

 

4b-N/A

 

 

 

 

4b-N/A

 

 

 

4b-N/A

 

 

 

 

 

 

5a-Listed/certified external nonmetallic jacket

5a-

 

N/A

5a-

 

N/A

5a-

 

N/A

5a-

 

 

N/A

 

5b-Isolated in open-area (e.g., sump, boot, etc.) or

5b- N/A

 

 

 

5b- N/A

 

 

 

 

5b- N/A

 

 

 

5b- N/A

 

 

 

 

 

 

secondary containment device (e.g., wall, jacketed or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

liner)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6-Dual protected

6-

 

 

 

 

N/A

6-

 

 

 

 

 

N/A

6-

 

 

 

 

 

N/A

6-

 

 

 

 

 

 

 

N/A

 

7-Unnecessary per corrosion protection specialist

7-

 

 

 

 

 

 

7-

 

 

 

 

 

 

 

 

7-

 

 

 

 

 

 

 

7-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tank & Piping Release Detection (Mark all that apply)

Tank

Piping

Tank

Piping

Tank

Piping

Tank

Piping

 

1-External vapor/tracer monitoring

1-

 

 

 

 

 

 

1-

 

 

 

 

 

 

 

 

1-

 

 

 

 

 

 

 

1-

 

 

 

 

 

 

 

 

 

 

 

2-External groundwater monitoring

2-

 

 

 

 

 

 

2-

 

 

 

 

 

 

 

 

2-

 

 

 

 

 

 

 

2-

 

 

 

 

 

 

 

 

 

 

 

3-Monitoring of secondary containment barrier

3-

 

 

 

 

 

 

3-

 

 

 

 

 

 

 

 

3-

 

 

 

 

 

 

 

3-

 

 

 

 

 

 

 

 

 

 

 

4-Automatic tank gauge test & inventory control

4-

 

 

 

 

N/A

4-

 

 

 

 

 

N/A

4-

 

 

 

 

 

N/A

4-

 

 

 

 

 

 

 

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5-Interstitial monitoring within secondary wall/jacket

5-

 

 

 

 

 

 

5-

 

 

 

 

 

 

 

 

5-

 

 

 

 

 

 

 

5-

 

 

 

 

 

 

 

 

 

 

 

6a-Monthly piping tightness test (@ 0.2 gph)

6a-N/A

 

 

 

6a-N/A

 

 

 

 

6a-N/A

 

 

 

6a-N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6b- Annual piping tightness test /

6b-N/A

 

 

 

6b-N/A

 

 

 

 

6b-N/A

 

 

 

6b-N/A

 

 

 

 

 

 

Annual electronic monitoring (@ 0.1gph)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6c-Triennial tightness test (for suction/gravity piping)

6c-N/A

 

 

 

6c-N/A

 

 

 

 

6c-N/A

 

 

 

6c-N/A

 

 

 

 

 

 

6d-Auto. line leak detector (3.0gph for pressure piping)

6d-N/A

 

 

 

6d-N/A

 

 

 

 

6d-N/A

 

 

 

6d-N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7a-Weekly manual tank gauging (tanks 1,000 gal)

7a-

 

N/A

7a-

 

N/A

7a-

 

N/A

7a-

 

 

N/A

 

7b-Monthly tank gauging (for emer. generator tanks)

7b

-

 

 

N/A

7b-

 

 

 

N/A

7b-

 

 

 

N/A

7b-

 

 

 

N/A

 

8-SIR-Statistical Inventory Reconciliation & inv. Control

8-

 

 

 

 

 

 

8-

 

 

 

 

 

 

 

 

8-

 

 

 

 

 

 

 

8-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9-Exempt system suction

9- N/A

 

 

 

9- N/A

 

 

 

 

9- N/A

 

 

 

9- N/A

 

 

 

 

 

 

Spill Containment & Overfill Prevention Equipment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1- Tight-fill fitting

1 -

 

 

 

 

 

1 -

 

 

 

 

 

 

 

 

1 -

 

 

 

 

 

 

 

1 -

 

 

 

 

 

 

 

 

 

 

 

2- Factory-built spill container/bucket/sump

2 -

 

 

 

 

 

2 -

 

 

 

 

 

 

 

 

2 -

 

 

 

 

 

 

 

2 -

 

 

 

 

 

 

 

 

 

 

 

3a-Delivery shut-off valve (set@ 95%capacity)

3a-

 

 

 

3a-

 

 

 

 

3a-

 

 

 

3a-

 

 

 

 

 

 

 

3b-Flow restrictor valve, e.g., vent ball-float (set@ 90% cap.)

3b

 

 

 

 

 

3b-

 

 

 

 

 

 

3b-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3b-

 

 

 

 

 

 

 

3c-Alarm (set@ 90%), w/3a or 3b (set@ 98% cap.)

3c

 

 

 

 

 

3c-

 

 

 

 

 

 

 

 

3c-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3c-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4 -

 

 

 

 

 

 

 

 

4 -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4 - N/A - All deliveries to tank are 25 gal. each

4 -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4 -

 

 

 

 

 

 

 

 

 

 

 

Stage I Vapor Recovery

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* See 30 TAC 115 for rule & location exemption information.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1-Stage I (UST to tanker truck): Installation date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type: 1a-Stage I two-point system

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1a

-

 

 

 

 

1a-

 

 

 

 

 

 

1a-

 

 

 

 

 

1a-

 

 

 

 

 

 

 

1b-Stage I coaxial system

1b

-

 

 

 

 

1b-

 

 

 

 

 

 

 

 

1b-

 

 

 

1b-

 

 

 

 

 

 

 

1c-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Exempt by: 1c-TCEQ Rule*

 

 

 

1c-

 

 

 

 

1c-

 

 

 

1c-

 

 

 

 

 

TCEQ-0724 (REV. 1/2016)

PST Rules are located in Title 30 TAC, Chapter 334

Page 5 of 5

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tceq underground storage tank registration conclusion process clarified (stage 1)

2. Once the first section is filled out, proceed to enter the relevant details in all these: COUNTRY OUTSIDE USA, EMAIL ADDRESS, RECORDS CUSTODIANCONTACT PERSON, TELEPHONE NO, OWNERS AUTHORIZED REPRESENTATIVE, TELEPHONE NO, FAX NO, INDEPENDENTLY OWNED OPERATED, YES NO, STATE FRANCHISE TAX ID, DUNS NO, NUMBER OF EMPLOYEES, HIGHER, For SelfCertification only this, and FACILITY INFORMATION.

tceq underground storage tank registration completion process explained (step 2)

In terms of HIGHER and YES NO, make sure that you double-check them in this current part. Both these are considered the key fields in the document.

3. In this specific step, take a look at TANK OPERATORINFORMATION, cid, TYPE OF TANK OPERATOR, MAILING ADDRESS, CITY, OPERATORS AUTHORIZED REPRESENTATIVE, STATE, ZIP CODE, Individual, Sole Proprietorship State Govt, Corporation Federal Govt County, TITLE, TELEPHONE NO, Date listed person became operator, and TCEQ Rev. All of these will have to be filled out with utmost awareness of detail.

STATE, Corporation Federal Govt County, and TITLE of tceq underground storage tank registration

4. This next section requires some additional information. Ensure you complete all the necessary fields - TCEQ UST REGISTRATION, TCEQ Facility ID No, For SelfCertification Annual, MAKE A COPY OF FORM FOR YOUR, For Initial Registration Sections, For data verification purposes, If you have any questions on how, Individuals are entitled to, REASON FOR THIS FILING, PART A UST REGISTRATION, Amendment of A, Owner Information, UST Ownership Change New Owner, D UST System Information, and Operator Training - to proceed further in your process!

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