Storage tank system identification form: part VI
Part VI: Withdrawal from Service and Removal
Status of Tank and Piping
Complete applicable section only: Permanent withdrawal, removal or temporary withdrawal)
Information | Tank 1 | Tank 1 Piping |
Tank 2 | Tank 2 Piping |
Tank 3 | Tank 3 Piping |
Tank 4 | Tank 4 Piping |
Tank 5 | Tank 5 Piping |
---|---|---|---|---|---|---|---|---|---|---|
EC Tank System Identification Number | ||||||||||
Start date (MM/YYYY) | ||||||||||
End date (MM/YYYY) |
Information | Tank 1 | Tank 1 Piping |
Tank 2 | Tank 2 Piping |
Tank 3 | Tank 3 Piping |
Tank 4 | Tank 4 Piping |
Tank 5 | Tank 5 Piping |
---|---|---|---|---|---|---|---|---|---|---|
Date permanently withdrawn from service (MM/YYYY) |
||||||||||
Withdrawn by approved person | ◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
Withdrawal records kept | ◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
Liquids/sludge removed and disposed | ◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
Vapours purged | ◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
No long-term harmful effectsFootnote5 | ◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
Fill pipe labelled | ◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
Physically removed | ◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
Information | Tank 1 | Tank 1 Piping |
Tank 2 | Tank 2 Piping |
Tank 3 | Tank 3 Piping |
Tank 4 | Tank 4 Piping |
Tank 5 | Tank 5 Piping |
---|---|---|---|---|---|---|---|---|---|---|
Date removed (MM/YYYY) | ||||||||||
Removed by approved person | ◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
Removal records kept | ◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
◻ Yes ◻ No |
* Certified person’s certification number |
Page details
- Date modified: