Agency of Natural Resources
Environmental Research Tool
Department of 
                            Environmental Conservation

Red-Tag Aboveground Storage Tank Form



Residence Information:


(*) indicates required field
Occupant 

First Name:
 
Last Name:
 

Owner
First Name:
 
Last Name:
 
Street:
 
City/Town:
 
County:
 
Phone:
  No dots,  slashes or dashes.
Email:

 Tank Conditions/Details: 

Number of Tanks:
 
Tank Capacity:
 
Type of Fuel:
 
Tank Location:
Please list the reason(s) why the above AST is/are "red-tagged" according to the Vermont AST Rules (2017).

9-306(C)




 
Comments

Oil/Fuel Supplier Information

Company Name:
 
Street:
 
City/Town:
 
County
Phone:
  No dots,  slashes or dashes.
Email:

Reporting Technician Information

First Name:
 
Last Name:
 
Email:
Red-Flagged Date:
 


 
I certify under penalty of law that I have personally examined and am familiar with the information submitted herein. Based on information and belief formed after reasonable inquiry, the submitted information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment. I am authorized by the the fuel supplier to complete this form and act as the representative.