Make application to local fire department.
Fire department retains original application and issues duplicate as permit.
The Commonwealth of Massachusetts
Department of Fire Services – Office of the State Fire Marshal
APPLICATION and PERMIT
Fee:
for steel underground storage tank removal and transportation to approved tank disposal yard in accordance with the
provisions of M.G.L. Chapter 148, Section 38, 527 CMR 1.00 Section 1.12.8.40, application is hereby made by:
Tank Owner
Tank Owner Name (please print)
X
Signature (if applying for permit)
Address
Street City State Zip
Removal Contractor
Company Name
Print
Address
Print
Signature (if applying for permit)
Contamination Assessment
Co. or Individual
Print
Address
Print
Signature (if applying for permit)
IFCI* Certified Other
IFCI* Certified LSP #
Other
Tank Information
Tank Location
Steet Address City
Tank Capacity (gallons)
Substance Last Stored
Tank Dimensions (diameter x length)
Remarks:
Disposal Information
Firm Transporting
Waste
State
Lic. #
Hazardous
Waste
Manifest#
E.P.A.
#
Approved Tank Disposal Yard
Tank Yard #
Type
of
Inert
Gas
Tank Yard Address
Approvals
City or Town
FDID#
Permit#
Date
of
Issue
Date
of
Expiration
Dig Safe approval number:
Trenching Permit #
Dig Safe Toll Free Tel. Number -
800-322-4844
Signature / Title of Officer granting permit
*International Fire Code Institute
FP-292 (Revised 1.2018)
click to sign
signature
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click to sign
signature
click to edit
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click to sign
signature
click to edit
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