Red-Tag Aboveground Storage Tank Form
(Fields marked with a * are required)

Occupant
* *    
Owner
* *    
*  
* *    
*  
Tank Conditions/Details
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*  
*  
*

Please list the reason(s) why the above AST is/are "red-tagged" according to the Vermont AST Rules (2017). 9-306(C) *




 
AST Inspector Information
(For out-of-state suppliers, please select out-of-state from the City/County dropdown menus)
*  
*  
* *    
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*  

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.