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JB Pritzker, Governor
/
James A. Rivera, State Fire Marshal
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Applications
Online Applications
Contractor Licensing Applications
Eligibility and Deductible Applications
Online Forms
Blended Fuel Compatibility Form
Certification of Abandonment-In-Place
Certification of Removal
Financial Responsibility
Site Assessment Results
UST Notification Forms
Miscellaneous
UST Applications and Forms
Facility Information
Facility Information (UST Search)
Pay Tank Fees
Tank Fees Online Payment
Permits
Unexpired Permit Search
Help Information
Help Manual
Certification of Removal
Facility Number
Permit Number
Owner
- New Information
Owner Name
Address
Contact Person
Phone Number
Facility
- New Information
Facility Name
Address
County
Contact Person
Phone Number
Tank #
Capacity in Gallons
Product
Date Removed
Under the penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct, except as to matters stated to be on information and belief and as to such matters the undersigned certifies as aforesaid that he/she verily believes the same to be true.
By checking this box, I certify that the removal of tanks was conducted in accordance with all applicable rules and regulations of the Office of the State Fire Marshal as required by 415 ILCS 5/57.5(f).
Owner/Operator Name:
Date:
Owner/Operator Email:
Owner
Operator
