App VIII DLARA Forms.pdf

Bidding and Contract Document (R 8/17) Project Name: Chuck’s Corner Site File No. 761/15266.SAR

APPENDIX VIII

DLARA FORMS

Department of Licensing and Regulatory Affairs, Bureau of Fire Services, Storage Tank Division P.O. Box 30033, Lansing, MI 48909

Phone 517-241-8847, Fax 517-332-1428

INSTRUCTIONS FOR FORM BFS-3821, REGISTRATION OF UNDERGROUND STORAGE TANKS (UST)

A. SUMMARY OF HOW A UST IS REGISTERED

All regulated tanks are registered by completing BFS-3821 and submitting the form to this office via mail or thru the LARA website.

Mail the registration form to: LARA, Bureau of Fire Services, Storage Tank Division, P.O. Box 30033, Lansing, MI 48909.

Overnight delivery: LARA, Bureau of Fire Services, Storage Tank Division, 3101 Technology Blvd, Suite H, Lansing, MI 48910.

LARA Web Portal: https://aca3.accela.com/LARA/Welcome.aspx

B. HOW DO I REPORT A RELEASE?

To report a confirmed or suspected release of product from a UST, send a FAX to 517-332-1428 within 24 hours or use the LARA web portal at https://aca3.accela.com/LARA/Welcome.aspx

C. WHAT LAW REQUIRES REGISTRATION OF USTs?

Part 211, Underground Storage Tank Regulations, of the Natural Resources and Environmental Protection Act, 1994 PA 451, as amended, requires that owners register USTs that are being used, or have been used, to store regulated substances, unless the USTs have been properly closed or removed and notification provided to the Bureau of Fire Services, Department of Licensing and Regulatory Affairs. Owner means any person who owns, or owned at the time of release, a UST used for storage, use, or dispensing of regulated substances.

D. WHAT USTs ARE INCLUDED?

A UST system means a tank or combination of tanks which is, was, or may have been used to contain an accumulation of “regulated substances” as defined in Section 21101(g) of Part 211, and whose volume (including connected underground piping) is ten (10) percent or more beneath the ground. Regulated substance includes petroleum and hazardous substances as defined in the federal Comprehensive Environmental Response, Compensation and Liability Act, 1980 PL 96-510.

E. WHAT UST SYSTEMS ARE EXCLUDED FROM REGISTRATION?

1. Tanks that have been properly closed.

2. Farm or residential tanks of 1,100 gallons or less capacity used for storing motor fuel for non-commercial purposes.

3. A tank used exclusively for storing heating oil for consumptive use on the premises where the tank is located.

4. Septic tanks.

5. Pipeline (including gathering lines).

6. Surface impoundments, pits, ponds, or lagoons.

7. A stormwater or wastewater collection system.

8. Flow-through process tanks.

9. Liquid traps or associated gathering lines directly related to oil or gas production and gathering operations.

10. Storage tanks situated in an underground area (such as a basement, cellar, mineworking, drift, shaft or tunnel) if the storage tank is situated on or above the surface of the floor.

11. Any pipe connected to an exempt UST (described above).

12. USTs holding hazardous wastes listed under Subtitle C of the Solid Waste Disposal Act, Title II of Public Law 89-272, or a mixture of such hazardous waste and other regulated substances.

13. Wastewater treatment tank system that is part of a wastewater facility regulated under the federal water pollution control act.

14. Equipment that contains regulated substances for operational purposes such as hydraulic lift tanks and electrical equipment tanks.

15. USTs with a capacity of 110 gallons or less.

16. USTs that contain a DEMINIMUS concentration of regulated substances.

17. An emergency spill or overflow containment UST that is expeditiously emptied after use.

F. WHEN SHOULD A UST BE REGISTERED?

1. Owners who plan to install UST(s) shall submit to the Bureau of Fire Services (BFS), Storage Tank Division, the form NOTICE OF PROPOSED INSTALLATION OF UNDERGROUND STORAGE TANKS (BFS-3820), with a complete set of plans at least 45 days prior to use. When installation is approved, a copy of BFS-3821 will be given to the owner by the BFS Inspector. The owner completes BFS-3821 and returns it with the appropriate fees to the BFS as indicated on page 1 of the form. Please refer to BFS-3820 for more details.

2. Owners of a new UST system shall register their UST system by submitting BFS-3821 to the Bureau of Fire Services, Storage Tank Division, before the system is put into operation. Owners must supply an installation date and the installer’s certification must be completed and signed.

3. Owners who discover tanks on their premises shall register the tanks by submitting BFS-3821 and shall properly close the tanks.

4. Owners who discover additional tanks at the time of a tank removal project shall register the tanks immediately and seek permission to waive the 30-day notice for removal. They may then remove the tank.

5. Any change in information submitted with the registration of the UST must be reported to the Bureau of Fire Services, Storage Tank Division, on

BFS-3821 within 30 days of the change.

Page 1 of 6 BFS-3821 (Rev 6/15)

REGISTRATION OF UNDERGROUND STORAGE TANKS

The information in this form is required under “Part 211, Underground Storage Tank Regulations, of the Natural Resources and Environmental Protection Act, 1994 PA 451, as amended.” Any owner who knowingly fails to notify or submits false information shall be subject to a misdemeanor and/or civil penalties not to exceed $5,000 per day for each tank for which notification is not given or for which false information is submitted.

NEW REGISTRATION

AMENDED INFORMATION

(for Registered USTs Only)

If sending form, mail to: LARA, Bureau of Fire Services, Storage Tank Division, P.O. Box 30033, Lansing, MI 48909

If sending form OVERNIGHT: LARA, Bureau of Fire Services, Storage Tank Division, 3101 Technology Blvd, Suite H, Lansing, MI 48910

FACILITY

ID NUMBER

(if known)

NUMBER OF TANKS AT FACILITY: _______ NUMBER OF CONTINUATION SHEETS ATTACHED: _______

I. OWNERSHIP OF TANKS II. LOCATION OF TANKS

IF THIS IS A NEW OWNER’S ADDRESS, PLEASE CHECK IF INFORMATION IS THE SAME AS SECTION I, PLEASE CHECK

OWNER NAME (Corporation/Individual, etc.)

FACILITY NAME OR SITE IDENTIFIER

MAILING ADDRESS

STREET ADDRESS (P.O. Box Not Acceptable)

CITY

STATE

ZIP

STATE

MI

ZIP

COUNTRY (Please Specify)

USA OTHER ___________________________

COUNTY

AREA CODE & PHONE NUMBER

AREA CODE & PHONE NUMBER

LATITUDE AND LONGITUDE of facility (If known)

LATITUDE (North): LONGITUDE (West):

III. TYPE OF OWNER

FEDERAL COMMERCIAL

STATE GOVERNMENT PRIVATE

LOCAL GOVERNMENT ARE TANKS LOCATED ON LAND WITHIN A RESERVATION? YES NO

IF TANKS ARE LOCATED WITHIN A RESERVATION, DOES A NATIVE AMERICAN TRIBE OWN TANKS? YES NO

IF TANKS ARE OWNED BY A TRIBE, NAME OF TRIBE: ____________________________________________

IV. TYPE OF FACILITY

PUBLIC GAS STATION

PRIVATE GAS STATION

MARINE GAS STATION

PETROLEUM DISTRIBUTOR

AIRLINE AND/OR AIRCRAFT OWNER

AUTO DEALERSHIP

RAILROAD

LOCAL GOVERNMENT

STATE GOVERNMENT

FEDERAL/NON-MILITARY

FEDERAL-MILITARY

COMMERCIAL

INDUSTRIAL

HOSPITAL

CONTRACTOR

TRUCKING/TRANSPORT

UTILITIES

RESIDENTIAL

FARM

OTHER (Explain)____________________

V. CONTACT PERSON

Name

Job Title

Area Code & Phone No.

Class A operator: Name:

Company Area Code & Phone No.

Class B operator: Name: Company Area Code & Phone No.

VI. CERTIFICATION

I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND AM FAMILIAR WITH THE INFORMATION SUBMITTED IN THIS FORM AND ALL

ATTACHED DOCUMENTS AND THAT I HAVE VERIFIED THAT THE INFORMATION IS TRUE, ACCURATE, AND COMPLETE.

NAME AND OFFICIAL TITLE OF OWNER OR OWNERS’ AUTHORIZED REPRESENTATIVE

SIGNATURE

DATE

Page 2 of 6 BFS-3821 (Rev 6/15)

VII. DESCRIPTION OF UNDERGROUND STORAGE TANKS

(Complete the following pages for each tank at this location. Copy these pages for additional tanks if needed.)

TANK IDENTIFICATION NUMBER

1. STATUS OF TANKS (Check One)

CURRENTLY IN USE

TEMPORARILY OUT OF USE

AMENDMENT OF INFORMATION

(If tanks are removed/closed, complete Section VIII)

2. DATE OF INSTALLATION (Month/Day/Year)

3. ESTIMATED TOTAL CAPACITY (Gallons)

VIII. TANKS OUT-OF-USE OR CHANGE-IN-SERVICE (Skip this section if this does not apply and go to Section IX.)

NOTE: A SITE ASSESSMENT MUST BE COMPLETED UNLESS YOU REPORT A CONFIRMED RELEASE

1. CLOSING OF TANK

A. ESTIMATED DATE LAST USED

(Month/Day/Year)

B. ESTIMATED DATE TANK WAS

REMOVED/CLOSED-IN-PLACE or CHANGE-IN-SERVICE (Month/Day/Year)

C. TANK WAS REMOVED FROM GROUND

D. TANK FILLED WITH INERT

MATERIAL (Sand, Concrete, etc.)

●DESCRIBE TYPE OF FILL USED

●REASON TANK WAS NOT REMOVED

(Specify in comments area)

2. CHANGE-IN-SERVICE

IX. SUBSTANCE STORED

1. SUBSTANCE CURRENTLY OR LAST

STORED IN GREATEST QUANTITY

BY VOLUME

GASOLINE

DIESEL

GASOHOL

KEROSENE

(Not For Consumptive Use On Premises) FUEL OIL

WASTE OIL

USED OIL

HAZARDOUS SUBSTANCE

HEATING OIL

MIXTURE

TANK HAS COMPARTMENTS

OTHER (Specify in comments area)

(List substances in comments area)

CERCLA NAME AND/OR CHEMICAL ABSTRACT

SERVICE (CAS) NUMBER (if hazardous substance stored)

Page 3 of 6 BFS-3821 (Rev 6/15)

I CERTIFY THE INFORMATION CONCERNING INSTALLATION THAT IS PROVIDED IN SECTION X through XIII IS TRUE TO THE

BEST OF MY BELIEF AND KNOWLEDGE.

INSTALLER:

NAME PRINTED SIGNATURE DATE

TITLE COMPANY

X. INSTALLATION DETAIL

TANK IDENTIFICATION NUMBER

1. MATERIAL OF CONSTRUCTION

(Mark All That Apply)

ASPHALT COATED OR BARE STEEL

CATHODICALLY PROTECTED STEEL

EPOXY COATED STEEL

COMPOSITE (Steel With Fiberglass)

FIBERGLASS REINFORCED PLASTIC

LINED INTERIOR

DOUBLE WALLED

POLYETHYLENE TANK JACKET

CONCRETE

EXCAVATION LINER

UNKNOWN

OTHER (Specify in comments area)

HAS TANK BEEN REPAIRED?

2. PIPING MATERIAL

(Mark All That Apply)

BARE STEEL

GALVANIZED STEEL

FIBERGLASS REINFORCED PLASTIC

COPPER

CATHODICALLY PROTECTED

DOUBLE WALLED

FLEXIBLE PIPING

ENVIROFLEX

GEOFLEX

UNKNOWN

3. PIPING (Type)

(Mark All That Apply)

SUCTION: NO VALVE AT TANK

SUCTION: VALVE AT TANK

PRESSURE (Remote)

HAS PIPING BEEN REPAIRED?

Page 4 of 6 BFS-3821 (Rev 6/15)

XI. CERTIFICATION OF COMPLIANCE

TANK IDENTIFICATION NUMBER

1. INSTALLATION

A. INSTALLER CERTIFIED BY TANK

AND PIPING MANUFACTURERS

B. INSTALLATION INSPECTED BY A

REGISTERED ENGINEER

C. INSTALLATION INSPECTED AND

APPROVED BY BFS

D. ANOTHER METHOD ALLOWED BY

BFS (Please Specify)

XII. TANK and PIPING RELEASE DETECTION

1. TANK RELEASE DETECTION

A. MANUAL (Static) TANK GAUGING

B. TANK TIGHTNESS TESTING

C. INVENTORY CONTROL

D. AUTOMATIC TANK GAUGING

E. VAPOR MONITORING

F. GROUNDWATER MONITORING

G. INTERSTITIAL MONITORING

DOUBLE WALLED TANK/PIPING

H. INTER MONITORING/SECOND

CONTAINMENT

I. OTHER METHOD ALLOWED BY

BFS (Specify in comments area)

2. PIPING RELEASE DETECTION

A. AUTOMATIC LINE LEAK DETECTORS

B. INTERSTITIAL MONITORING DOUBLE

WALLED PIPING

C. INTERSTITIAL MONITORING

SECOND CONTAINMENT

D. LINE TIGHTNESS TESTING

E. OTHER METHOD ALLOWED BY

BFS (Specify in comments area)

XIII. ENVIRONMENTAL PROTECTION

1. OVERFILL PROTECTION DEVICE

INSTALLED

2. SPILL PROTECTION DEVICE INSTALLED

3. HAVE YOU INSTALLED IMPRESSED

CURRENT CATHODIC PROTECTION?

A. YES

B. NO

Page 5 of 6 BFS-3821 (Rev 6/15)

COMMENTS AND/OR CLARIFICATIONS:

Page 6 of 6 BFS-3821 (Rev 6/15)

Phone 517-241-8847, Fax 517-332-1428

UNDERGROUND STORAGE TANK SYSTEM SITE ASSESSMENT REPORT AND

CLOSURE OR CHANGE-IN-SERVICE REGISTRATION FORM

This information is required under Part 211, Underground Storage Tank Regulations, of the Natural Resources and Environmental Protection Act, Act 451 of the Public Acts of 1994, as amended (Act 451) being Sections 324.21101 to 324.21113 of the Michigan Compiled Laws Annotated. Any owner who knowingly fails to notify or submits false information shall be subject to a misdemeanor and/or civil penalties not to exceed $5000 per violation.

INSTRUCTIONS: For permanent closure and change-in-service, complete all the information on this form and submit with the site assessment analytical results, chain-of-custody which indicates temperature and method of preservation, and site sketch which indicates the location and depths of tanks, piping, and samples. This form must be received within 45 days of the samples being taken. The owner is required to keep a copy of the site assessment report for a minimum of three years. See page 2 of this form for additional information.

FACILITY ID NUMBER

I. OWNERSHIP OF TANKS

II. LOCATION OF TANKS

NAME OF OWNER (CORPORATION, INDIVIDUAL, ETC.) FACILITY NAME OR COMPANY SITE IDENTIFIER

STREET ADDRESS STREET ADDRESS (P.O. BOX NOT ACCEPTABLE)

CITY STATE ZIP CODE CITY STATE ZIP CODE

MI

AREA CODE & TELEPHONE NUMBER CONTACT PERSON FOR LOCATION AREA CODE & TELEPHONE NUMBER

III. TANK INFORMATION

TANK NUMBER

TANK SIZE

SUBSTANCE STORED

DATE LAST USED

DATE CLOSED

REMOVED FROM GROUND

CLOSED IN PLACE

(INDICATE TYPE OF FILL)

CHANGE-IN-SERVICE

OWNER’S NAME OWNER’S SIGNATURE DATE

IV. SUBMITTER INFORMATION

SUBMITTED BY (COMPANY NAME) NAME (INDIVIDUAL)

SIGNATURE DATE AREA CODE & TELEPHONE NUMBER

DO NOT WRITE BELOW THIS LINE (FOR BFS OFFICE USE ONLY)

SITE ASSESSMENT REVIEW REPORT

The Storage Tank Division staff has reviewed your site assessment and the following determination has been made:

The contamination concentration is below the threshold detection levels, and there is no evidence of a confirmed release.

The test methodology or level of detection is faulty. The data submitted is not considered valid. Please perform another si te assessment and forward a copy of the results to this office within 45 days.

The number of sampling points analyzed are considered inadequate to make a determination of the cleanliness of the site. Please perform another site assessment and forward a copy of the results to this office within 45 days.

The contaminant concentrations are greater than the threshold detection levels and there is evidence of a confirmed release. A confirmed release report is being generated. Follow reporting requirements in accordance with 451 PA 1994, Part 213, as amended.

The soils excavated and removed from the site were greater than allowable volumes. A confirmed release was not reported to this office within 24 hours per the Michigan Underground Storage Tank Rules (MUSTR) prior to excavation of contaminated soil. A confirmed release report is being generated. Follow reporting requirements in accordance with Part 213 of Act 451.

SIGNATURE OF REVIEWER DATE OF REVIEW

MAIL TO: Department of Licensing and Regulatory Affairs, BFS, Storage Tank Division, P.O. Box 30033, Lansing, MI 48909 OVERNIGHT MAIL TO: Department of Licensing and Regulatory Affairs, BFS, Storage Tank Division, 3101 Technology Blvd, Suite H, Lansing, MI 48910

Page 1 of 2 BFS-3881 (Rev 6/15)

INSTRUCTIONS FOR FORM EQP3881 SITE ASSESSMENT PROCEDURES

The Michigan Underground Storage Tank Rules (MUSTR), 2012 AACS R 29.2101 et seq., require a site assessment when an underground storage tank (UST) or associated piping is removed, closed in place (when permitted), or undergoes a change-in-service. If you report a confirmed release, this site assessment report is not required. Samples must be taken by personnel qualified in the sampling and preservation protocols using generally accepted sampling procedures. For most owners and operators, an environmental consultant will be needed to perform this assessment. To locate a qualified person in your area, look in the Yellow Pages under Engineers:

environmental or geotechnical. The following is a guide for performing a site assessment as required in the MUSTR. The section numbers below refer to the MUSTR sections.

TANK SAMPLE LOCATIONS--Section 280.72(d).

Two soil borings shall be taken as close as practical to the tank, but not more than 5 feet from the tank. One boring shall be taken at each end of the tank, but not more than 2 feet below the bottom of the tank and boring shall be taken at the bottom of each end of the tank; OR

One discrete sample shall be taken from the excavation floor underneath the fill pipe area for each tank removed and one discrete sample shall be taken from the excavation floor underneath the opposite end of the tank. One water sample shall be taken if the entire floor of the excavation is covered with water. If the excavation is partially covered with water, take one water sample and one soil sample.

PIPING AND DISPENSER SAMPLE LOCATIONS--Section 280.72(f).

A site assessment for piping shall be performed after emptying and purging the piping run or after the removal of piping. The site assessment shall consist of one discrete sample for every 30 feet of the underground piping run, starting at the dispenser location or the furthest point from the tank and moving towards the tank.

SAMPLE ANALYSES--Section 280.72(g).

Samples shall be analyzed using an appropriate method listed in the United States Environmental Protection Agency standard entitled “Test Methods for Evaluating Solid Waste”; Physical/Chemical Methods, “SW-846” document or other method approved by the Remediation Division. Note the following:

Gasoline, JP4, and jet B shall be tested for BTEX (benzene, toluene, ethylbenzene, and xylenes). Methods include, but are not limited to: 8021 and 8260.

Diesel, fuel oil, kerosene, virgin motor oil, jet A, and JP5 shall be tested for PNAs (polynuclear aromatic hydrocarbons). Methods include, but are not limited to 8310 and 8270. Chlorinated solvents, ketones, ethers, mineral spirits, stoddard solvents, and naphthas may use Method 8260. Azeotropic distillation or closed-system vacuum distillation introduction may be necessary for certain compounds.

Waste oils and heavier oils shall use Method 8015 or 8270 for DRO with an appropriate standard based on the analyte. If solvents comprise part of the waste oil, Method 8260 shall also be applied.

Preservation in accordance with SW-846 Method 5035 shall be utilized for volatile soil samples in conformity with STD Informational Memorandum No. 13.

Analytical results shall include the method used for the analysis and the chain of custody of the sample(s) with the temperature of the samples when received at the laboratory.

For regulated and hazardous substances not listed above, please contact the Bureau of Fire Services, Storage Tank Division, at 517-241-8847 for guidance in choosing appropriate analytical methods.

REPORTING CONTAMINATION

If you find visible or olfactory evidence of contamination in the UST excavation or along pipe runs, or if your analytical results show contamination, you must report a confirmed release to the Bureau of Fire Services, Storage Tank Division, by telephone to 517-335-7279 or by fax using form BFS-3826 to 517-332-1428 within 24 hours of discovery of the contamination. If you report a confirmed release, this site assessment report is not required.

“Visible evidence” means presence of a product sheen on water or stained soils. “Olfactory evidence” means the smell of product odors in soils or water within the tank or pipe excavation. Positive indication from field monitoring equipment such as H-Nu meters, organic vapor analyzers, or combustible gas detectors constitutes a suspected release. However, you must report a confirmed or suspected release anytime you believe one has occurred.

After confirmation of a release, the liable owner/operator has obligations pursuant to Part 213, Leaking Underground Storage Tanks, of the 1994 PA 451 (Act 451), as amended, for initial response actions, site investigations and cleanup (corrective action). For corrective action activities you must use a Qualified Underground Storage Tank Consultant defined in Part 213 of Act 451.

Page 2 of 2 BFS-3881 (Rev 6/15)

NOTICE OF UNDERGROUND PIPING REPLACEMENT

This information is required pursuant to Part 211, Underground Storage Tank Regulations, of the Natural Resources and Environmental Protection Act, 1994 PA 451, as amended. An owner/operator who fails to notify is subject to a misdemeanor and/or civil penalties, not to exceed $5000 per violation.

INSTRUCTIONS: NOTICES WILL ONLY BE ACCEPTED ON THIS FORM.

Please type or print clearly. ALL information must be completed.

This form must be received by the Storage Tank Division 15 days prior to the commencement of work indicated. The 15-day notification may be waived for emergency situations with prior approval from the department. It is recommended that the Hazardous Materials Storage Inspector of the Bureau of Fire Services be notified two (2) days prior to the work being performed.

This form is to only be used for Bureau of Fire Services notification when there is replacement of more than 50 percent of the length of any underground piping between the tank and the dispenser at any one time. If a total underground storage tank (UST) system (tank and piping) replacement is to be performed, use form BFS-3820. Subject to Part 211, Underground Storage Tank Regulations, of the Natural Resources and Environmental Protection Act, 1994 PA 451, as amended, a UST must be registered by the current owner and have all fees paid to be considered registered with the Bureau of Fire Services. The UST owner/operator (O/O) or agent must complete this form as instructed, and submit it to the Bureau of Fire Services. A site assessment shall be conducted during the replacement, with results sent to the Bureau of Fire Services. The O/O must also submit an amended registration form notifying the Bureau of Fire Services of the piping replacement within 30 days after the date of the replacement.

Pursuant to Section 21107 of Part 211, a person who removes or installs UST systems shall maintain pollution liability insurance of not less than $1,000,000 per occurrence.

A confirmed or suspected release must be reported to the Bureau of Fire Services within 24 hours. A confirmed release waives the requirements of conducting a site assessment. Once reported, the O/O will be informed regarding rules for further testing and cleanup activities. Releases may be reported by fax to 517-332-1428.

If you have questions regarding these instructions, please contact the Bureau of Fire Services, Storage Tank Division, at 517-241-8847.

OWNERSHIP OF UST SYSTEMS LOCATION OF UST SYSTEMS

PLEASE CHECK IF NEW OWNER’S ADDRESS PLEASE CHECK IF SAME AS SECTION I

NAME OF OWNER (CORPORATION, INDIVIDUAL, ETC.)

FACILITY NAME OR COMPANY SITE IDENTIFIER

STREET ADDRESS

STREET ADDRESS (PO BOX NOT ACCEPTABLE)

CITY STATE ZIP CODE

CITY STATE ZIP CODE

COUNTY TOWNSHIP

COUNTY TOWNSHIP

AREA CODE & TELEPHONE NUMBER

CONTACT PERSON FOR LOCATION AREA CODE & TELEPHONE NUMBER

PIPING REPLACEMENT INFORMATION

NAME OF INSTALLER

STREET ADDRESS

CONTACT PERSON

STATE ZIP CODE AREA CODE & TELEPHONE NUMBER

PIPING TYPE TO BE USED AND MANUFACTURER

ESTIMATED DATE OF REPLACEMENT

ESTIMATED DATE OF PRESSURE TEST

NOTIFICATION SUBMITTED BY (PRINT NAME) COMPANY

SIGNATURE DATE AREA CODE & TELEPHONE NUMBER

MAIL TO: Department of Licensing and Regulatory Affairs, Bureau of Fire Services, Storage Tank Division , P.O. Box 30033, Lansing, MI 48909 OVERNIGHT MAIL TO: Department of Licensing and Regulatory Affairs, Bureau of Fire Services, Storage Tank Division, 3101 Technology Blvd, Suite H, Lansing, MI 48910 BFS-3888 (Rev 6/15)

FACILITY ID NUMBER