Chemical Storage Facility Permit Application
Facility Information
Facility Name
Facility Address
City
State/Province
ZIP/Postal Code
Facility Contact Person
Contact Phone
Contact Email
Chemical Storage Details
List of Chemicals to be Stored
Total Quantity (Specify Unit)
Storage Method/Type
Container Type
Maximum Storage Capacity
Safety Measures
Safety Equipment in Place
Emergency Response Plan Description
Applicant Declaration
Applicant Name
Title/Position
Date