## Appendix II to Part 280

**EPA Form**  **6200 -**  **10** Electronic and paper versions acceptable. United States 

## Environmental Protection A**gency**

Wa shington, DC 20460 Approval expires xx/xx/xx OMB No.2050 - 0068 

## Notification **o f**  **Ow nership Change**  **f or Underground Storage Tanks**  Implementing Agency Name A nd Address: 

### IMPLEMENTING AGENCY USE ONLY ID NUMBER: DATE RECEIVED: DATE ENTERED INTO COMPUTER : DATA ENTRY CLERK INITIALS : 

### INSTRUCTIONS A **ND GENERA L INFORM**  **AT ION**  OW NER W AS CONTACTED TO CLARIFY RESPONSES, COMMENTS: Please **ty pe or print in ink**  . Also, be sure you have signatures in ink. The primary purpose of this notification form is to inform im plementing agencies of ownership changes for underground storage tank (UST) systems that store or have stored petroleum or hazardous substances. **Federal regulation requires UST owners to notify the**  **implementing agency of any**  **ownership change for USTs storing regulated substances after [**  **ENTER EFFECTIVE DA TE OF RULE].**  **Who Must Notify ?**  40 CFR part 280, as amended, requires owners of USTs that store regulated substances (unless exempted) to notify im plementing agencies of any ownership changes. Owner is defined as:  In the case of an UST in use on November 8, 1984, or brought into use after that date, any person who owns an UST used for storage, use, or dispensing of regulated substances; or  In the case of an UST in use before November 8, 1984, but no longer in use on that date, any person who owned the UST immediately before its discontinuation. **What USTs A re Included?**  An UST system is defined as any on e or combination of tanks that is used to contain an accumulation of regulated substances, and whose volume (includin g conn ected underground piping) is 10 percent or more beneath the ground. Regulated USTs store petroleum o r hazardous substances (see **Wh at**  **Substances A re Covered**  to the right ). This includes UST systems with field - constructed tanks and airport hydrant fuel distribution systems. **When An**  **d W ho**  **To Notify ?**  Any owner or operator who assumes ownership of a regulated UST system must submit this notification form to the im plementing agency within 30 days of assuming such ownership. **What Tanks A re Excluded From**  **Notification (see § 280.10 and § 280.12)**  **?**  Tanks removed from the ground before May 8, 1986;  Farm or residential tanks of 1,100 gallons or less capacity storing motor fuel for noncommercial purposes;  Tanks storing heating oil for use on the premises where stored;  Septic tanks;  Certain pipeline facilities regulated under chapters 601 and 603 of Title 49;  Surface impoundments, pits, ponds, or lagoons;  Storm water or wastewater collection systems;  Flow - through process tanks;  Liquid traps or associated gathering lines directly related to oil or gas production and gathering operations;  Tanks on or above the floor of underground areas, such as basements or tunnels;  Tanks with a capacity of 110 gallons or less;  Wa stewater treatment tank systems;  UST systems containing radioactive material that are regulated under the Atomic Energy Act of 1954;  UST systems that are part of an emergency generator system at nuclear power generation facilities regulated by the Nuclear Regulatory Commission under 10 CFR part 50. **What Substances A re Covered?**  The notification requirements apply to USTs containing petroleum or certain hazardous substances. Petroleum includes gasoline, used oil, diesel fuel, crude oil or any fraction thereof which is liquid at standard conditions of temperature and pressure (60 degrees Fahrenheit and 14.7 pounds per square inch absolute). Hazardous substances are those found in Section 101 (14) of the Comprehensive Environmental Response, Compensation and Liability Act of 1980, with the exception of those substances regulated as hazardous waste under Subtitle C of the R esource C onservation and R ecovery Act

. **Penalties:** Any owner who knowingly fails to notify or submits false information shall be subject to a civi l penalty not to exceed $16,000 for each tank for which notification is not given or for which false information is given. 

### OWNERSHIP OF USTs **Corporation, Individual, Public Agency ,**  **O r Other Entity**  **FACILITY NAME AND LOCATION OF USTs** Current Owner Name Previous Owner Name Facility Name  Check here if name changed after ownership Current Owner Address Previous Owner Address  Check this box if the physical address of the USTs is the same as the current owner address. If address is different, enter address below: If required by implementing agency, give the geographic location of USTs either in decimal degrees, or degrees, minutes, and seconds. Example: Latitude : 36.12348 (or 36  7 ' 24.4 " ) , Longitude : - 106.549876 (or - 106  32 ' 59.6 " ) **Latitude _______________**

**______ _ Longitude ________________** 

**______** Current Owner Phone Previous Owner Phone Date O f Ownership Change **Signature O**  **f Current Owner: _______________________________________ Date: ____________________**  **Paperwork Reduction A ct Notice**  The public reporting and recordkeeping burden for this collection of information is estimated to average 30 minutes per respo nse. Send comments on the Agency's need for this information, the accuracy of the provided burden e stimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pen nsylvania Ave., NW , W a shington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.