ERT

Red-Tag Aboveground Storage Tank Form

(Fields marked with a * are required)

Occupant

* First Name Occupant First name is required.

* Last Name Occupant Last name is required.

Owner

* First Name Owner first name is required.

* Last Name Owner last name is required.

* Address Address is a required field.

* City Town/City is a required field.

* County County is a required field.

* Phone Phone is a required field.

Tank Conditions/Details

* Number of Tanks Tank number is a required field.

* Tank Capacity Tank Capacity is a required field.

* Fuel Type Fuel Type is a required field.

* 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) *

No stable foundation

Buried fuel lines not coated

No vent alarm

No proper size fill/Vent

Cracks, leaks, rust, drips

AST Inspector Information

* Company Name Company name is required.

* Address Address is a required field.

* City

* County

Click here if you are an out-of-state supplier

* Phone Phone is a required field.

* Red-Tagged Date Date is a required field.

Accept the terms in order to submit

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.