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Home My WebLink AboutSTORAGE TANK FACILITY REGISTRATION FORMRECEIVED SEP 012015 \4p;P9ir[I* r+Y - DEP Fam9 62-7619000) 11 ^; Florida Department of Environmental Protection Fo. Title Stomm Tank Regishotion F Twin Towers Office Bldg. 0 2600 Blair Stone Road a Tallahassee, Florida 32399-2400 Effective Dom JuW 13. 1998 ' FLOR;A Storage Tank Facility Registration Form DEP AppG<vdov No. (Filled in by DEP) Submit a completed form for the facility when registration of storage tanks or compression vessels is required by Chapter 376.303, Florida Statutes Prease rnvlew Re.I.M.Non Ins n,ntlnne before nmmproflnn ♦he fnrm Check all that apply I Lj I New Facility Registration I New Owner X New Tanks XInformation for existing facilitychanged or updated Information for existing owner changed or updated �/ /� Information for existing tank(s) I changed or u dated FACILITY INFORMATION County I St. Lucie I DEP Facility ID Number 8631107 SCAN Facility Name Florida Atlantic University, Harbor Branch Oceanographic Institute BY Address, City, Zip 5600 Old Dixie Highway, Fort Pierce, FL 34946-1303 St. Lucie Facility Contact Dennis Zabel Contact Telephone (561)297-3129 Facility Type Description G Financial Responsibility Exempt - State Agency 24 Hr Emergency Contact Harbor Branch Police 24 Hr Emergency Phone (772) 216-1124 RESPONSIBLE PARTY INFORMATION - Identifv individual or business responsible for stomae tank maistration & maistration renewal. Name Florida Atlantic University [ ] Facility Account Owner- pays registration fees Mall Address 777 Glades Road, C069, Rm. 112 STCM Account Number 17247 City, State, Zip Boca Raton, FL 33431 Effective Date of Ownership 12008 Contact Dennis Zabel Provide Email Address for Contact in space below Telephone (561)297-3129 dzabel@fau.edu Check all roles that apply Facility Owner IIXII Tank Owner X Tank Operator X Property Owner ADDITIONAL RESPONSIBLE PARTY INFORMATION — Identify additional individual or business responsible for storage tank management, fueling nnemtinns andlnr nipanun aMivifips of the fnP.Wty Inratinn ah. Pmeidp additional infnnnafinn in an aH.Mrnont If naressary Name FL Atlantic University Other relationship type(s) Effective Date Mail Address 5600 Old Dixie Highway Facility Owner City, State, Zip Fort Pierce, FL 34946-1303 Tank Owner Contact Selvin McLean, On -site EH&S Tank Operator 1/1/2015 Telephone (772) 242-2357 Property Owner TANKNFSSFL INFORMATION - Cmmnlpte one mwfnr park stnrana lank nr rmmnressinn vessel svAtpm Inratpd of this facility Tank ID TN AIU Capacity Installed Content Status/Effective Data Construction Piping Monitorin 14 T A 3000 6/1n996 G B 7/1312016 CLNI ACIK av 15 T A 3000 6/1/1996 B e 7/132015 CLNI ACIK av Above tank to be replaced by tank Gstad below. 21 T A 250025W July23,2015 GIB u 7242016 CMR BA aF6 Glasgow Equipment Services Registration Certification - To the best of my knowledge and belief, all information submitted on this form is true, accurate, and complete. Printed Name & Title Signature Date Dennis Zabel, EH&S Director 6/18/2015 Central District Southeast District South District FL DEP DISTRICT OFFICES 3319 Maguire Blvd, Suite 232 400 Congress Ave. 2295 Victoria Ave, Suite 364 Orlando, FL 32803 W Palm Beach, FL 33416 Fort Myers, FL 33901 407-894-7555 561-681-6600 941-332-6975 Northwest District 160 Govemmental Center Blvd. Northeast District Sauthwast District Marathon Branch Pensacola, FL 32501 7825 Baymeadows Way, Suite 200 13051 N. Telecom Pkwy 2796 Overseas Hwy, Suite. 221 8505955360 Jacksonville, FL 32256 Temple Terrace, FL 33619 Marathon, FL 33050 904-448-4300 813-744-6100 305-289-2310 ED Ol l nt( DEP 62-761.900(2)