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Storage Tank Removal Permit Application

  1. This is a:*

  2. This application is for the removal of:*

  3. Request abandon in-place closure?*

  4. ** Note: Application must be submitted at least 10 days in advance to allow time for the application to be processed.

  5. Do you have fuel dispensing?*

  6. If Yes, are dispensers being removed?

  7. Tank Information:

  8. 1

  9. Tank(s) currently in use?*

  10. Is there any product remaining in tank(s)?*

  11. 2

  12. Tank(s) currently in use?

  13. Is there any product remaining in tank(s)?

  14. 3

  15. Tank(s) currently in use?

  16. Is there any product remaining in the tank(s)?

  17. Have there been any known leaks with tank(s)?*

  18. Class A or B Contractor Only

  19. Is contractor certified in hazardous materials mitigation, removal, and/or transportation?*

  20. Enter "N/A" if tank is an abandoned in-place closure.

  21. **Note: Upon completion, documentation will also need to be provided that the tank was actually taken to this facility.

  22. Acknowledgement*

    I hereby accept full responsibility for the adherence to all requirements of the Virginia Statewide Fire Prevention Code and the City of Waynesboro pertaining to the above application.

  23. Leave This Blank:

  24. This field is not part of the form submission.