Form Ogb-21 - Authorization To Clean Tank - State Oil And Gas Board Of Alabama

Download a blank fillable Form Ogb-21 - Authorization To Clean Tank - State Oil And Gas Board Of Alabama in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Ogb-21 - Authorization To Clean Tank - State Oil And Gas Board Of Alabama with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

STATE OIL AND GAS BOARD OF ALABAMA

OGB-21

Authorization to Clean Tank

Form OGB-21, Rev. 07/13

(File in duplicate)

Name of operator _____________________________________________________________________________________________________

Address _________________________________________ City ________________________ State _______________ Zip _______________

DESCRIPTION OF TANK

Tank name and number _____________________________________________ Tank location ________________________________________

(section, township, range)

Field (if wildcat, so state) _______________________________________________________________ County __________________________

Tank capacity ___________________ bbls Tank height ____________ ft. ___________ in. Sales Outlet height ___________ ft. __________ in.

DESCRIPTION OF CLEANING OPERATION

Gross contents ________________________________________________________________________________________________________

Contents verified by Agent of the Board:

Yes

If Yes, give name ____________________________________________________________ Date _____________________________________

Cleaning requested by purchaser:

Yes

If Yes, give name ____________________________________________________________ Date _____________________________________

Date cleaning began _________________________________________ Date cleaning completed _____________________________________

Name of transporter ____________________________________________________________________________________________________

Disposition of contents ________________________________________________________ Date ____________________________________

Contents delivered to treating or reclaiming plant:

Yes

If Yes, give name of plant _______________________________________________________________________________________________

plant location _______________________________________________________________________________________________

plant contact person ____________________________________________ Phone number ________________________________

Notification to clean tank given to________________________________________________ Date ____________________________________

(Oil & Gas Board Agent)

Date of last cleaning ___________________________________________

Person to contact

Phone number

regarding this form

Fax number

E-mail address

The undersigned certifies that the above-mentioned tank contains only the above amount of gross contents and that no crude oil or product

of crude oil was mixed with, treated of said contents in said tank, or substituted for the tank contents as described above. The undersigned further

certifies that no rule or regulation of the State Oil and Gas Board of Alabama Administrative Code was violated in the cleaning of the tank or in the

transportation of said contents.

Remarks:

__________

________

Executed this the _______ day of __________

, 20 __

___________________________________________________

Signature

________________________________________

Before me, the undersigned authority, on this day personally appeared

known to me to be the person

whose name is subscribed to the above instrument, who being by me duly sworn on oath states that he/she is duly authorized to make the above report and that

he/she has knowledge of the facts stated therein, and that said report is true and correct.

_______

______________________

_________

Subscribed and sworn to before me this

day of

, 20

_____________________________________

SEAL

____________________

Notary Public in and for

____________________