Oklahoma Corporation Commission-PSTD

PO Box 52000 OKC, OK 73152-2000

405-521-4683 phone / 405-521-4945 fax

Scheduling Form

Installations must be scheduled at least 24 hours in advance, closures 14 days in advance, internal lining inspections 48 hours in advance, and any reschedules 48 hours in advance. This form must be received by 10 a.m. in order to schedule an installation for the following morning. Forms submitted with incomplete information will not be accepted. Submit form via email to . All scheduled activities will receive a confirmation number. If you do not receive this number from the PSTD, please contact us to verify that the scheduling form was received. New tank installations will receive a temporary fuel authorization that is valid for 90 days.

New Facility (never registered) Existing Facility; list Facility #

Type of System affected:

Underground Storage Tank System Aboveground Storage Tank System

Type of Activity (check all that apply):

Tank Installation Tank Removal Tank Repair Tank Testing

Line Installation Line Removal Line Repair Line Testing

Internal Lining Inspection Reschedule Other

Date Scheduling Form Submitted:

Date and Time Activity Will Begin:

Facility/Location Information: Owner Information:

Name: / Name:
Physical address: / Attn:
City: / Mailing address:
City:
State: , Zip:
Phone #:
Email

Consultant Information: Installer/Remover/Tester Information:

Name: / Name:
License Number: / License or Certification Number:
Company: / Company:
Phone number: / Phone number:
Email: / Email:

List a detailed description of the scheduled activity. Include information such as material of construction for tanks and/or lines, capacity, number of tanks installed/removed, repairs, testing details, etc.

Questions for Installations only:

Have float out /anchorage calculations been completed for this system? Yes No

If no, 100 year flood plain map must be attached.

Will monitor wells be used for release detection at this facility? Yes No

If yes, has a MW site assessment been approved by the OCC? Yes No

Are hi-flow dispensers being installed at this facility? Yes No

August 2015