ERS-9 Alternative Fuels (R. 2/07) 

## STORAGE TANK ALTERNATIVE FUEL INSTALLATION/CONVERSION APPLICATION

INSTRUCTIONS: Part I if this form is to be submitted to the Department of Commerce along with the plan submittal for new installations, or submitted independently for conversions of ex isting systems from conventional motor f uels to blends greater than 10% ethanol or for biodiesel blends greater than B5. For existing tank sy stems, Part I of this form shall be comp leted and submitted for approval prior to t he conversion to the address in the upper right corner of this page. Part II shall be given by the contra ctor to the owner/operator for completion prior to system operation and retained on-site for Commerce Inspector review. Note : Tanks with interior lining will not be approved for alternat ive fuel storage. Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)].


# P a r t I

1. OWNER INFORMATION 2. PROJECT INFO RMATION 3. CONTRACTOR INFORMATION Customer ID# Site ID# Facility ID# Customer ID# Name Facility Name Contractor Name

Company Name Site Address Number and Street

Number and Street City Village Town of: City, State, Zip Code

City, State, Zip Code County Contact Person Customer ID#

Telephone Number Fax Number Fire Dept. Providing Fire Coverage FDID# Telephone Number Fax Number 

## ( ) ( ) ( ) ( )

4. Tank Information

Tank Orientation: Underground Aboveground New Tank Existing Tank → Date Installed: ________________ Reg. Object #: _____________

Tank leak detection method : Automatic tank gauging Inventory control and tightness testing Interstitial monitoring Statistical Inventory Reconciliation (SIR) Visual (Aboveground storage tank only)

Component: Existing Manufacturer Existing Model/Brand New Equip. Manufacturer New Equip. Model/Brand UL Listed or Verified by Manufacturer for Fuel to be stored Note: Write “HC” and the treatment material if a har d-coat treatment is used to achieve compatibility. Tank construction material Listed Verified Unknown Spill bucket Listed Verified Unknown Overfill / Auto shut-off / Ball float Listed Verified Unknown

Drop tube Listed Verified Unknown STP/Suction pump Listed Verified Unknown Leak detection probes Listed Verified Unknown Sump monitoring sensors Material Approval 

### 5. Pipe Information: N ew E xisting Mixed (New/Existing) Existing Pipe Install Date: ________________
Configuration : Single wall Double wall Type: Steel Fiberglass Flexible Other ________ Sumps: Submersible Pipe Connections Pipe fitting/valve material Listed (N/E) Verified (N/E) Unk (N/E) Gaskets/seals Listed (N/E) Verified (N/E) Unk (N/E) Pipe sealant/adhesive Listed (N/E) Verified (N/E) Unk (N/E) Flex connector Listed (N/E) Verified (N/E) Unk (N/E) Line leak detector Listed (N/E) Verified (N/E) Unk (N/E) Flow restrictor Listed (N/E) Verified (N/E) Unk (N/E) 

### 6. Dispenser Information: Dedicated E85 Hose: Yes No Blending dispenser: Yes No Containment sump under dispenser: Yes No Dispenser piping Listed Verified Unknown Dispenser Sump Listed Verified Unknown Dispenser sump sensor Material Approval Gaskets/seals Listed Verified Unknown Blending valve Listed Verified Unknown Check valve Listed Verified Unknown
Meter Listed Verified Unknown Emergency valve Listed Verified Unknown Fuel filters Listed Verified Unknown Break-away device Listed Verified Unknown Nozzle(s)/Swivel(s) Listed Verified Unknown Hose(s) Listed Verified Unknown 

### Comments: Environmental & Regulat ory Services Division Bureau of Petroleum Products and Tanks P.O. Box 7837 Madison, WI 53707-7837 (608) 267-9795 (608) 266-8981



### FEES: (Fee table on reverse side) Plan Review Inspection Total

Alternative Fuel Conversion Fee $ ___________ (7636) $ ___________(8253) $ _____________

I certify by signature that I have personally examined and/or am familiar with the information submitted to verify system alternative fuel compatibility, and the information is true, accurate, and complete.

_

_______________________________________ _____ Date:

____________ Signature of petroleum equipment cont ractor or professional engineer 

## For Office Use Only Transaction #



## R Plan Review R Copy to Inspector R Copy to PermitERS-9 Alternative Fuels (R. 1/07) 

## Page 2 ALTERNATIVE FUEL INSTA LLATION/CONVERSION APPLICATION



# P a r t I I

Responsibilities of Tank Owner/Operator Before Blends of Greater than 10% Ethanol or 5% Biodiesel is Transferred to the Tank 

# R Determine equipment compatibility - Part I of this form. 

# R Inform the facility’s UST insurance carrier of plans to convert to a gasoline-ethanol blend exceeding 10% ethanol or biodiesel exceeding 5%. The UST insurance carrier may have additional requirements other than what Commerce or Comm 10 requires. 

# R Obtain an amended certificate of insurance indicating UST coverage for the ethanol or biodiesel blend stored and submit to Commerce. 

# R Check for water in the tank. No level of water is acceptable for gasoline-ethanol blended fuels. 

# R All visible fittings and connections at the top of the tank are tight (no vapors escape and no water enters). 

# R Sump and spill containment covers secured to prevent water from entering. 

# R Water infiltration problems fixed if necessary. 

# R The tank has been cleaned of all water and sediment. Company providing service: Company providing service: City: State: ___________ Telephone #: 

# R How / where is product being disposed of: _ 

# R Fill labeling - Identify fill port and paint access cover according to API RP 1637. 

# R Dispenser labeling – label dispenser in compliance with Comm 48.

First Delivery 

# R Tank filled to 80 percent capacity (recommended by the Renewable Fuels Association or RFA) and kept as full as possible for 7 to 10 days. 

# R Conduct a precision test of the tank system (0.1 gph leak rate) with ATG system within seven days after tank is filled to make sure system is tight and leak detection equipment is operating properly. Report any “Fail” results. 

# R Test for water (use alcohol compatible paste if you stick your tanks) at the beginning of each shift for the first 48 hours after delivery (RFA). If there is water in the tank, remove it, find out how it got there and fix it so it doesn’t occur again. 

# R Have dispenser calibrated prior to any retail sales. 

# R Prior to dispensing, notify Commerce Retail Inspector that ethanol or biodiesel has been delivered and the dispensing system is going operational. 

# R Submit Tank Registration Form ERS-7437 or ERS-8731 al ong with a completed copy of ERS-9 Alternative Fuels Application Form

Tank Owner Signature Company (Note: By signing, signer is acknowledging that all the above preparatory items have been conducted.)



## Print Tank Owner Name Date:

Failure to submit this form with all items completed w ill result in the tank and dispenser being subject to redtagging and shutdown.

A tank with any “unknowns” will not be approved for service for gasoline-ethanol blends exceeding 10% ethanol or biodiesel blends exceeding 5% without a statement from the contractor or professional engineer stating that in their professional judgment the system is acceptable for service in the alternative fuel. Without such statement the tank and dispenser will be subject to red-tagging and shutdown.

Fee Submittal Plan Review Fee Installation Inspection Fee Plan Revision Fee Re-inspection Fee When submitted independent of a broader plan submittal application $35 $100 Except conversion to SIR $100 $100