The SES Companies


Leaking Underground Storage Tanks

Application for Underground Storage Tank Inspection and Report

Just fill out this simple form to apply for an underground storage tank inspection and report.

Owner: Tax Map #:
Address: Tel: H
City State: Zip:
Tel: O

Method of Payment: Paid from Settlement Funds Invoice to Seller/Buyer Paid at Time of Inspection
Invoice addressed to:

The Following Information Must Be Supplied By The Owner!
Underground Storage Tanks

1. Describe any history of a leak from the UST (i.e. overfilling, fuel on surface, fuel odor in water supply or basement, dwelling, etc.)
2. Date Tank Last Filled Capacity (gals) Age of Tank (yrs) Contents
Tank 1:
Tank 2:
Tank 3:
Tank 4:
3. Name of Fuel Supplier (s):
Phone Number:
4. This report is being requested by:
Phone Number:
Email:

The parties hereby agree that SES, Inc. will perform professional consulting services in connection with the above referenced property. The evaluations shall consist of in place evaluation of underground storage tanks to determine if potential contamination is present. The evaluations are to be conducted in accordance with the Virginia Department of Environmental Quality's regulations on In-Place UST Closure.

Soils and Environmental Services, Inc. will supply all labor and equipment to:
Excavate one boring per tank and scan at 2-foot intervals with a photoionization detector (PID). Properly collect and analyze one (1) soil sample with the highest reading from each boring for Total Petroleum Hydrocarbons by EPA Method 8015. Complete letter type report of findings with laboratory results.

By submitting this form, I certify that the information above is correct and agree to pay SES for the requested work.

Type Applicant's Name:

Contact us:

This page was created by Curtiss Grymala for Ten-321 Enterprises
and was last updated on April 26, 2004