DHEC 3885 (06/2006) SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL INSTRUCTIONS: This form is to be submitted to the Department along with the Application for the Permit to Install for new installations, or submitted independently for conversions of existing systems from conventional motor fuels to blends greater than 10% ethanol as well as all biodiesel derivatives greater than B20. For existing tank systems, submit this form prior to the conversion.



### Part I

1. OWNER INFORMATION 2. FACILITY INFORMATION 3. CONTRACTOR INFORMATION

Name Facility ID# Contractor Name

Mailing Address Facility Name Mailing Address

City, State, Zip Code Facility Address Contact Person

Telephone Number Telephone Number Telephone Number

( ) ( ) ( )

4. Tank Information

Tank Size: (gallons) o New Tank o Existing Tank o Fuel to be Stored : ________________________

Is tank lined: o Yes o No Note : Tanks with interior lining will not be approved for E85 storage

Tank leak detection method : o Automatic tank gauging o Vapor/Groundwater monitoring o Interstitial monitoring o Statistical Inventory Reconciliation (SIR) o Inventory control and tightness testing (used through 12/2008 only)
UL Listed or Verified by Component: Manufacturer Model/Brand Manufacturer for Fuel to be Comments
Stored

If manufacturer or model/brand cannot be determined, write “UNK” in the corresponding box. In the Comment area, write ”UNK” if compatibility

can not be determined; write “NA” if system does not have the component listed, write “HC” and the treatment material if a hard-coat treatment is used to achieve compatibility. Configuration : o Single wall o Double wall Type: o Steel o Steel Clad o Fiberglass

Tank construction material o Listed o Verified

Spill bucket o Listed o Verified

Overfill / Drop Tube Shut

Off/Ball Float Vent Valve o Listed o Verified

Drop tube o Listed o Verified

Submersible pump o Listed o Verified

Leak detection probes o Listed o Verified

Sump sensors o Listed o Verified
5. Pipe Information Is sump present for submersible / pipe connections: o Yes o No

Configuration : o Single wall o Double wall Type: o Steel o Fiberglass o Flexible o Other ( Specify ):

Pipe construction material o Listed o Verified

Gaskets/seals o Listed o Verified

Pipe sealant/adhesive o Listed o Verified

Flex connector o Listed o Verified

Line leak detector o Listed o Verified

Containment Sump o Listed o Verified
6. Dispenser Information Blending dispenser: o Yes o No Is sump present under dispenser: o Yes o No

Dispenser piping o Listed o Verified

Gaskets/seals o Listed o Verified

Dispenser Sump o Listed o Verified

Check valve o Listed o Verified

Nozzle(s)/Swivel(s) o Listed o Verified

Hose(s) o Listed o Verified

Break-away device o Listed o Verified

Fuel filters o Listed o Verified

Emergency valve o Listed o Verified

Sump sensor o Listed o Verified

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

Signature of Authorized Party ___________________________________________________ Date ___________________________________ 

### UNDERGROUND STORAGE TANK ALTERNATIVE FUEL

INSTALLATION APPLICATION / CONVERSION NOTIFICATIONPart II: Requirements for UST Conversion / Upgrade to Store Alternative Fuel

**•** Determine equipment compatibility and complete Part I of this form.

**•** Inform the facility’s UST insurance carrier, if applicable, of plans to convert the existing system to store an alternative fuel, as the insurer may have additional requirements. Please notify the Department of any coverage changes.

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

.

**•** Ensure that all visible fittings and connections at the top of the tank are tight such that no vapors escape and no

water enters.

**•** Ensure that sump and spill containment covers are secured to prevent water from entering.

**•** Ensure that the tank has been cleaned of all water and sludge. Company providing service:
Company providing cleaning service : _________________________________________________________ City:

______________________________ State :__________ Telephone # : _______________++________ How / where is the product that was located in the tank being disposed of?

___________________________

**•** Ensure that the dispenser is labeled with the appropriate information.

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

___________________________________________________ Print Tank Owner Name Date

The Department may deny any Application for a Permit to Install if all information on Part I of this form is not completed and submitted prior to initiating the installation of an alternative fuel system.

Any UST system listed as having any “UNK” notation(s) in the Comments Section of Part I of this document will not be approved for service for gasoline-ethanol blends exceeding 10% ethanol or for biodiesel derivatives greater than B20 without a statement from the installation contractor or a professional engineer indicating that the system is acceptable for use with the associated alternative fuel. Conversions or upgrades that involve alternative fuel wherein Part I of this form has any “UNK” notation(s) listed in the Comments Section also require

such statements.

Storage of any alternative fuel that is incompatible with the UST system in which it is stored may lead to a

release.

DHEC 3885 (06/2006)UNDERGROUND STORAGE TANK ALTERNATIVE FUEL

INSTALLATION APPLICATION / CONVERSION NOTIFICATION

GENERAL INFORMATION:

On May 24, 1985, the South Carolina Underground Storage Tank Control Regulations (SCUSTCR) became effective. Revisions to these regulations became effective on March 23, 1990. The regulations provide for the development and implementation of a regulatory program for underground storage tanks that store regulated substances. One primary purpose of the regulations is to set forth specific requirements for underground storage tanks to prevent product releases. Pursuant to SCUSTCR R.61-92, Subpart C, Section 280.32, “Owners and operators must use an UST system made of or lined with materials that are compatible with the substance stored in the UST system.” The “Underground Storage Tank Alternative Fuel Application/Notification” is designed for use as an addendum to the “Application for Permit to Install” (DHEC Form 2101) for installation of new UST systems that will store specific alternative fuels or as a stand-alone document for conversions of existing systems to store specified alternative fuels. Should UST systems be incompatible with the fuels they are storing, releases could occur.

EXPLANATION:

Complete DHEC Form 3885, the “Underground Storage Tank Alternative Fuel Application/Notification,” only if you are proposing to install or convert a UST system that will store any blends greater than 10% ethanol or any biodiesel derivatives greater than B20. This form is to be submitted to the UST Permitting Coordinator along with the “Application for the Permit to Install” (DHEC Form 2101) for new installations or submitted independently for conversions of existing systems from conventional motor fuels to either blends greater than 10% ethanol as well as all biodiesel derivatives greater than B20. Please read the instructions carefully prior to completing the form. If you have any questions regarding the applicability of this form to your operations, please contact the UST Permitting Coordinator at (803) 896-6942.

DEFINITIONS:

“ Alternative fuel ” means fuel that is not substantially derived from petroleum.

“ Biodiesel ” means alternative fuel derived from vegetable oils and animal fats for use as a diesel fuel replacement.

“ Ethanol ” means a liquid fuel that is produced from the starch in corn and can be used in its pure form (E100) or mixed with petroleum (E85).

“ Underground storage tank ” means any one or combination of underground, enclosed containers (including underground pipes connected thereto) that is 10 percent or more beneath the surface of the ground. Excluded are:

a. Farm or residential tanks of 1,100 gallons or less capacity used for storing motor fuel for noncommercial

purposes; b. Tanks used for storing heating oil for consumptive use on the premises where stored;

c. Septic tanks;

d. Pipeline facilities (including gathering lines) regulated under the Natural Gas Pipeline Safety Act of 1968 or regulated under the Hazardous Liquid Pipeline Safety Act of 1979, or which is an intrastate pipeline facility regulated under the State laws;

e. Surface impoundments, pits, ponds, or lagoons;

f. Storm water or wastewater collection systems;

g. Flow-through process tanks;

h. Liquid traps or associated gathering lines directly related to oil or gas production and gathering operations;

and

i. Storage tanks situated in an underground area (such as a basement, cellar, mineworking, drift, shaft, or tunnel) if the storage tank is situated upon or above the surface of the floor.

“ Regulated substance ” means any substance defined in Section 101(14) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) [but not including any substance regulated as a hazardous waste under Subtitle C] and petroleum, including 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). If you do not know whether your tank contains regulated substances, please call the UST Permitting Coordinator at (803) 896-6942.“ Owner ” means:

a. In the case of an underground storage tank in use on November 8, 1984, or brought into use after that date, any person who owns an underground storage tank used for storage, use or dispensing of regulated substances;

b. In the case of any underground storage tank system in use before November 8, 1984, but no longer in use on that date, any person who owned such UST immediately before the discontinuation of its use; or

c. A person who has assumed legal ownership of the underground storage tank through the provisions of a contract of sale or other legally binding transfer of ownership.

“ UL ” means United Laboratories, which certifies performance standards for a variety of industrial items, including UST system equipment and components.

INSTRUCTIONS FOR COMPLETING THE UNDERGROUND STORAGE TANK ALTERNATIVE FUEL APPLICATION/

NOTIFICATION:

Part I (to be completed for new installations and conversions)
- 1. Owner Information – Enter the name, address and telephone number of the tank owner.

2. Facility Information – Enter the facility identification number, name, address and telephone number for the location of the new tank(s) or the tank(s) to be upgraded.

3. Contractor Information – Enter the name, address and telephone number of the contractor performing the installation, upgrade, or conversion.

4. Tank Information

a. Enter the tank size in gallons and indicate whether the form is for a conversion or new installation by checking the appropriate box.

b. Indicate in the blank what fuel is to be stored (e.g., E85 or B50, etc.).

c. Indicate if the tank is lined by checking the appropriate box. Please note that internally lined tanks will not be approved by the UST Permitting Coordinator for use with E85 because of compatibility issues.

d. Indicate the method of leak detection currently in use or planned for future use (new installations) by checking the appropriate box.

e. Configuration- Indicate whether the tanks are single-walled or double-walled as well as whether they are steel, steel clad, or fiberglass by checking the appropriate boxes.

f. For each component listed, indicate the manufacturer and model/brand. If this information is not known, please indicate “UNK” in the appropriate blanks. If the component will not be used for this system, indicate “NA” in the appropriate blanks.

g. Compatibility - Indicate if the component to be used has a UL listing for use with the alternative fuel being stored by checking the “listed” box. If the component is does not have a UL listing, then the installation contractor must verify with the manufacturer that the component is acceptable for use with the product being stored and the “verified” box should be checked. If compatibility of a component cannot be determined, then indicate “UNK” in the “Comments” section. If existing components are going to be hard-coat treated in order to establish compatibility, then indicate “HC” in

the comments section

5. Pipe Information

a. Indicate if there is a sump present for the submersible pump and any other piping connections by checking the appropriate box.

b. Configuration - Indicate whether the piping is single-walled or double-walled as well as whether it is steel, fiberglass, or flexible by checking the appropriate boxes. If the piping does not fit any of these categories, please check the “Other” box and provide specific information regarding the piping that is being used.

c. Complete the component and compatibility information in the same manner as was done for the

section related to the tanks.

6. Dispenser Information

a. Indicate if a blending dispenser is to be used and if a sump is present by checking the appropriate

boxes.

b. Complete the component and compatibility information in the same manner as was done for the

section related to tanks.

7. Signature - This form must be signed by the installation contractor, the tank owner, or an authorized representative of

the tank owner.Part II (to be completed for conversions only)
– 1. Review all information on conversions and complete the required information on the cleaning of the tanks to include the name, address and telephone number of the company that cleaned the tank(s). Indicate where the product that was in the tank is being disposed of.

2. Signature - This form must be signed by the tank owner or an authorized representative of the tank owner.

OFFICE MECHANICS AND FILING: After completing the form, send it to: UST Permitting Coordinator UST Regulatory Assistance Section SCDHEC - Bureau of Land and Waste Management

2600 Bull Street Columbia, South Carolina 29201-1708

It is recommended that the owner retain a copy of the completed form. Allow approximately two to four weeks for Department review. Sites with new tank installations located in Beaufort, Berkeley, Charleston, Colleton, Dorchester, Georgetown, Horry, or Jasper Counties must be reviewed and approved by the Office of Ocean and Coastal Resource Management (OCRM) prior to the Department’s issuing a Permit to Install. The Office of Ocean and Coastal Resource Management (OCRM) will be notified by SCDHEC upon submittal of the Application for Permit to Install. Allow six weeks for OCRM approval.

DHEC 3885 (06/2006)

Regulatory Compliance Division, Bureau of Land and Waste Management South Carolina Department of Health and Environmental Control 2600 Bull Street, Columbia, SC 29201 Telephone: (803)-896-7957 Fax: (803) 896-6245 http://www.scdhec.gov/ust/index.htm l