Transcription of Hazardous Substance Bulk Storage Application …
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Hazardous Substance Bulk Storage Application …
99=Other (Specify):New York State Department of Environmental ConservationDivision of Environmental Remediation(See instructions and please be sure to complete Sections A & B) Hazardous Substance bulk Storage ApplicationPursuant to the Hazardous Substance bulk Storage Law, Article 40 of ECL and 6 NYCRR 596-599 Section A - Facility/Property Owner/Contact InformationCBS Number:TYPE OF CHEMICAL Storage FACILITY(Check only one)Facility Name:Facility Address (Physical Address, No Boxes):Facility Address (cont.):City: County:Township or City:Facility Operator:Facility Phone Number:Emergency Contact Name:ZIP State:Emergency Telephone Number:Facility (Property) Owner (from Deed):Facility Owner Address (Street and/or Boxes):City:State:ZIP Code:Owner Telephone Number:Federal Tax ID Number:Type of Owner (check only one):Corporate/Commercial/OtherTransact
Hazardous Substance Bulk Storage Application Section C - Tank Ownership Information (for CBS tanks listed in Section B) CBS Number: Specific Tanks Owned
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