Application for renewal of flammable and combustible liquids licence

Applicants details

Licence number
Name of applicant/s
Contact person if not the applicant
Applicant/s postal address
Name of business
Address of business
Real property description (lot and plan)
Business phone (no spaces)
After hours phone (no spaces)
Mobile phone (no spaces)
Email address

Nature and quantity of flammable and combustible liquids stored at premises

Do you have above ground tanks on your premises?	Yes No
If yes. please provide all necessary information Class of liquid (PG1, PG111, C1, C2), product name, tank identification number / name, maximum capacity of tank, description of tank (eg under ground, above ground, overhead or service tank)
Do you have underground tanks on your premises?	Yes No
If yes, please provide all necessary information Class of liquid (PG1, PG11, PG111, C1, C2) Product name Maximum quantity in packages over 25 litres Maximum quantity in packages between 5 and 25 litres maximum quantity in packages less than 5 litres Site location
Do you have drums / packages on your premises?	Yes No
If yes, please provide all necessary information Class of liquid (PG1, PG111, C1, C2), product name, tank identification number / name, maximum capacity of tank, description of tank (eg under ground, above ground, overhead or service tank)

Applicant's agreement and signature*

Name of Individual/Organisation
Name of Signatory If applicant is Corporation/Association
Position Proprietor, Director, Manager
Signature	I acknowledge Queensland State Laws will accept this communication as containing my signature with the meaning of the electronic Transactions (Qld) Act 2001
Date signed

*If you are supplying commercially sensitive or confidential information, please ensure you mark such information clearly.

If the application is made by a corporation or an incorporated association, the person signing this form must occupy a position that is legally entitled to make an application on behalf of the organisation.

I understand that the information provided in and with this application may be disclosed publicly under the Right to Information Act 2009 and the Evidence Act 1977.

I am aware that it is an offence to knowingly provide false or misleading information.