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GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF ENVIRONMENTAL PROTECTION 45 MARS HILL FREDERIKSTED, ST. CROIX, VI 00840 PHONE: (340) 773-1082, FAX: (340) 773-9310 ——————————————————————————————————————— USED OIL PERMIT APPLICATION (Please read instructions carefully) Check the permit(s) applying for: ⃞ TO GENERATE USED OIL ⃞ TO STORE USED OIL Section I - Facility Name, Address, and Hours of Operation Name of business or Government entity: _________________________________________________________ Type of business:_____________________________________________________________________________ Mailing address:_______________________________________________________________________________ _____________________________________________________________________________ Provide the physical address where used oil will be generated and/or stored. Physical address:_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ This box must be completed by applicant: Tax assessor’s ID number:______________________ EPA ID number:______________________________ VI Business license (DLCA) number:_____________ USED OIL APLICATION BUSINESS OPERATION Telephone:________________________________ Fax:______________________________________ List names of all on-site managers and/or operators of facility. 1. ________________________________________ Duty hours:________________________________ 2. ________________________________________ Duty hours:________________________________ 3. ________________________________________ Duty hours:________________________________ List at least three emergency contact(s) and their physical addresses: 1. __________________________________________________________________________________________ 2 .___________________________________________________________________________________________ 3 .___________________________________________________________________________________________ Emergency telephone no(s)/beeper no(s): _______________________________________________________ Hours of operation of facility:___________________________________________________________________ Section II – Ownership Information CORPORATE OFFICIALS President: ___________________________________________________________________________________ Telephone/fax nos:_____________________________________________________________________ Address: _____________________________________________________________________________ Resident agent: ______________________________________________________________________________ Telephone:________________________________ Fax:_______________________________ Address: _____________________________________________________________________________ USED OIL APLICATION OWNER OF BUSINESS (Please provide the name(s) of the business owner(s), if different from the corporate officials.) Type of Ownership (ie. Corporation, Sole Proprietorship, etc.) __________________________________________________ Name: Last __________________________________ First _______________________________ M.I.________ Provide the owner’s mailing address in the spaces provided below: Mailing address:_______________________________________________________________________________ _______________________________________________________________________________ Provide a physical address, for the facility owner, if different from the mailing address above. Physical address:_____________________________________________________________________________ ______________________________________________________________________________ PROPERTY OWNER Please provide the name of the property owner, if different from the facility owner. Mailing Address: ______________________________________________________________________________ _______________________________________________________________________________ Telephone: ________________________________ Fax:_______________________________________ FACILITY CONTACT Name: Last____________________________ First ______________________________M.I.______ Mailing address: _______________________________________________________________________ _______________________________________________________________________ Physical address: ______________________________________________________________________ _______________________________________________________________________ USED OIL APLICATION Section III - Other Related Information OTHER ENVIRONMENTAL PERMITS Permit Number (s): _______________________ Description _________________________ _______________________ _________________________ _______________________ _________________________ _______________________ _________________________ NATURE OF BUSINESS (Provide a brief description of activities conducted.) Section IV - Generated Waste Information Source(s) of used oil: Type of oil: Point of Generation: 1. 2. 3. Engine oil Hydraulic Oil Crankcase Oil Other (Identify by Name) Quantity of used oil generated per month: Quantity of used oil stored per month: Quantity of used oil that is generated by others but added to your used oil. Quantity of used oil stored on site at time of application: Type and capacity of storage containers: Type Capacity 1. 1. 2 2 3. 3. Location of storage containers: Description of storage area: Frequency of Off-site Shipments: (Please check the appropriate box at right, and enter the appropriate number of weeks or months.) Check box Enter # of Wks or Months Monthly Every Week(s) Every Month(s) Annually Other: Attach to application a copy of plot plan detailing location of storage area. Is this facility a “Do It Yourselfer”: (DIY) used oil collection center? Yes ______ No_______ USED OIL APLICATION IMPORTANT: YOU ARE REQUIRED TO REPORT OIL LEAKS AND SPILLS TO THE DEPARTMENT OF PLANNING AND NATURAL RESOURCES. ALL PETROLEUM SPILLS INTO U.S. AND V.I. WATERS MUST BE REPORTED TO THE U.S. EPA, THE U.S. COAST GUARD AND THE DEPARTMENT OF PLANNING AND NATURAL RESOURCES/DEP. A Spill Prevention, Control and Countermeasure (SPCC) Plan, as defined and outlined in 40 CFR Part 112, may be required for your operation if either of the following applies. Please read the questions in the boxes below, and check the appropriate response. Is any single container or tank on site designed to store greater than 600 gallons? Yes No Does your facility currently stores or anticipates accumulating more than 1320 gallons of used oil at any given time? Yes No NOTE: If an SPCC plan is required, you must list separately, all spill containment and cleanup equipment and supplies that are available on site. PLEASE NOTE THAT ALL INFORMATION BEING PROVIDED IN THIS APPLICATION WILL BE USED IN DETERMINING YOUR ABILITY TO PROCURE A PERMIT. THEREFORE, THE INFORMATION MUST BE TRUE AND ACCURATE. APPLICANT AGREES TO ABIDE BY ALL PROVISIONS OF THE PERMIT, WHICH IS ISSUED PURSUANT TO THIS APPLICATION, AND WILL PROMPTLY INFORM THIS DIVISION OF ANY CHANGES OR MODIFICATIONS TO THE INFORMATION FURNISHED HEREIN. Signature of Applicant:_____________________________________________________ (If applicant is a corporate officer who is signing on behalf of a corporation please attach appropriate corporate resolution authorizing same.) Do Not Write in This Box FOR OFFICIAL USE ONLY Date Received _________________ Permit No. issued ____________ : ⃞ New Permit Date Issued __________________ ⃞Renewal USED OIL SHALL BE STORED IN TANKS AND CONTAINERS, AS REQUIRED BY PART 279 OF TITLE 40 OF THE CODE OF FEDERAL REGULATIONS (CFR) ALL STORAGE TANKS AND CONTAINERS SHALL BE CLEARLY LABELED “USED OIL” AND LOCATED WITHIN A SECONDARY CONTAINMENT AREA WITH AN IMPERVIOUS BASE THAT SHALL HAVE A CAPACITY OF NO LESS THAN 110% OF THE CAPACITY OF LARGEST TANK OR CONTAINERS WITHIN THE STORAGE AREA.