Application for a Permit to Operate a Fixed Petroleum or Allied Product Storage Tank System

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Application for a Permit to Operate a Fixed Petroleum or Allied Product Storage Tank System

In accordance with Part 5 of the Storage and Handling of Petroleum Products and Allied Products Regulation (MR 188/2001).

For more information on the Petroleum Storage program, please visit the website.

To apply for a Permit to Operate a Jobsite Storage Tank, please complete and submit the forms found at application_for_permit_operate.pdf (gov.mb.ca) and jst_inspection_report.pdf (gov.mb.ca).

Personal information is collected under the authority of The Dangerous Goods Handling and Transportation Act, the Storage and Handling of Petroleum Products and Allied Products Regulation and is used to issue permits and for enforcement purposes. Information collected is protected by the privacy provisions in The Freedom of Information and Protection of Privacy Act.

Part A: Certification

Name of Applicant:
(First and last name of person completing this submission. Must be the individual storage tank system owner or a representative of the business having ownership of the system)

I hereby certify that the information contained on this form is complete and accurate.

Part B: Storage Tank System Information

Storage Tank System Legal Land Description

City, Town, or Rural Municipality: Click here to view the region map
(If your community is not listed, select “Other”)

Name of Community, Town, etc.:

Roll Number (optional):

Click here for Manitoba Assessment Map with Roll Numbers.

Click here for Winnipeg Assessment Map with Roll Numbers.

Please select how you would like to provide the Legal Land Description (may choose multiple):

Civic Address 911 Address Lot, Block, Plan Section, Township, Range River Lot Parish Settlement GPS Coordinates

Civic Address

Street Address:

Unit Number:

911 Address

Street Address:

Lot, Block, Plan

Lot or Parcel No:	Block No:	Plan No:
no label	no label	no label

Section, Township, Range

Quarter Section:

Section	Township	Range	Side of Prime Meridian
no label	no label	no label	no label

River Lot

River Lot Number:

Parish

Parish Number:

Settlement

Settlement Number:

GPS Coordinates

Latitude	Longitude
no text	no text

Construction Permit #

Construction Permit #:

Site Sensitivity

Distance from storage tank system to nearest groundwater well

Distance from storage tank system to nearest subsurface structure
(E.g. basement, building foundation, or adjacent underground tank)

Part C: Storage Tank System Owner Information

Legal Name of Tank System Owner - Corporation or Individual

Tank System Owner

Owner, in relation to a storage tank system, means the person, corporation, partnership, limited partnership, cooperative or other entity who or that has legal ownership rights to the storage tank system, and includes the personal representative or trustee in bankruptcy of the owner and a receiver or a receiver and manager appointed in relation to the storage tank system, and, in the absence of proof to the contrary, the owner of the land on or in which a storage tank system is located.

Postal Box Number

Tank System Owner Mailing Address

City

Province/State

Postal Code/Zip Code

Contact Person

Contact Person Phone Number

Contact Person Email Address

Confirm Email Address:

Part D: Storage Tank System Operation Information

Operation/Business Name if different from Owner name

Is the storage tank system Operator the same as the Owner? Yes No

Operator Information

Storage Tank System Operator (corporation or individual's name)

Postal Box Number

Operator Mailing Address

City

Province

Postal Code

Contact person

Phone Number

Fax

Confirm email address: