FUEL/OIL TANK QUESTIONNAIRE

DATE 02/10/2019

1. COMPANY DETAILS

NAME NAME

ADDRESS ADDRESS

CITY, CITY, POSTAL

PROV PROV CODE
CONTACT BUSINESS FAX
NAME
BROKER
CELL CONTRACT NO.
BROKER SUB
BUSINESS FAX CONTRACT NO.

BROKER CLIENT ID COMPANY

EMAIL
CLIENT ID
PREFERRED ENGLISH ARABIC GROUP NAME GROUP ID
LANGUAGE

3. HEATING UNIT

INSTALLED BY

CERTIFIED OIL BURNER TECHNICIAN YES NO IF NO, EXPLAIN IN THE REMARKS

DATE OF INSTALLATION NEW OR USED WHEN INSTALLED NEW USED

CERTIFICATION LABEL: CSA WH CAPACITY LITRES GALLONS

ULC
MANUFACTURER YEAR MANUFACTURED

TANK TYPE SINGLE WALL STEEL DOUBLE- WALL STEEL DOUBLE-WALL STEEL FIBREGLASS
AND POLYETHYLENE
METAL THICKNESS If single-walled, provide only the OUTER figures
UNITS ARE IN MM GAUGE INNER SHELL INNER HEAD INNER BOTTOM
OUTER SHELL OUTER HEAD OUTER BOTTOM

CHECK ALL THAT APPLY, PLEASE PROVIDE AN EXPLANATION IN THE REMARKS FOR ANY CHECKED ITEMS
LEAKS ✔ DRIPS ✔ SPILLS FUMES ✔ ODOURS ✔ RUST ✔ CORROSION ✔ WEEPING ✔ WET SPOTS ✔ DENTS ✔

SAFTEY FEATURES:
ANTI- SIPHON DEVICE ✔ SHUT OFF VALVE ✔ DRIP LEG ✔ CONCRETE DAM ✔ LEAK DETECTION ALARM ✔ RELEASE BARRIER (GRIP ✔

FUEL LINE AND VALVE PROTECTION TRAY, PAN)

VENT WHISTLE VENT AND FILL PIPES CAPPED
✔

TYPE OF FUEL:
OIL KEROSENE

LOCATION:
INDOORS OUTDOORS ABOVE GROUND IN GROUND

FILL AND VENT PIPE MATERIAL

IS THE VENT PIPE LOCATED AT LEAST 15cm (6 inches) ABOVE THE FILL PIPE? ✔ YES ✔ NO
IS THE FUEL SUPPLY LOOPED? ✔ YES NO
DO THE INTERIOR FUEL LINES RUN ALONG THE WALL? YES ✔ NO
DO THE INTERIOR FUEL LINES PASS THROUGH THE FOUNDATION OR BASEMENT ✔
YES ✔ NO
FLOOR, OR BURIED IN THE GROUND?
YES ✔ NO
IF YES, IS THE FUEL LINE ENCASED IN A LINING OR SLEEVE?

FUEL LINE FILTER LOCATION ✔ AT THE TANK ✔ AT THE FURNACE

BURNER
 FUEL OIL TANK QUESTIONNAIRE
✔ YES ✔ NO
ARE THERE ANY EMPTY, ABANDONED, OR UNSUED TANKS ON THE PROPERTY?
IF YES, NUMBER OF TANKS AND DESCRIBE IN THE REMARKS
IS THE TANK INSPECTED/SERVICED ANNUALLY BY A PROPERLY CERTIFIED OIL BURNING TECHNICIAN? YES ✔ NO

LAST INSPECTION DATE

DESCRIBE ANY MODIFICATIONS, UPGRADES OR REPAIRS TO THE TANK:

4. INDOOR TANKS

WHAT DOES THE TANK STAND ON? ✔ CONCRETE ✔ EARTH OTHER:

CLEARANCES, SHORTEST DISTANCE TO NEAREST
UNITS ARE IN cm ✔ inches
BACKWALL SIDE WALL CORNER FLOOR FLOOR DRAIN FUEL FIRED
OR SUMP APPLIANCE
IS THERE A NON-COMBUSTIBLE WALL BETWEEN THE TANK AND APPLIANCE? ✔ YES ✔ NO
IS THE TANK FILLED AND VENTED OUTSIDE? ✔ YES ✔ NO

5. OUTDOOR TANKS

CLEARANCES, SHORTEST DISTANCE TO NEAREST:

UNITS ARE IN ✔
cm ✔ inches OPEN DRILLED WELL DRAINAGE DITCH STORM DRAIN
WATER
SOURCE PROPERTY LINE
SEPTIC BED WINDOW DOOR VENT

IS THE TANK AND FUEL SUPPLY LINE SAFE FROM IMPACT? ✔ YES ✔ NO IF YES, PLEASE DESCRIBE IN REMARKS
IS THE TANK PAINTED WITH A LIGHT- COLOURED, RUST PROOF PAINT? ✔ YES NO DATE LAST PAINTED
TANK SUPPORT TYPE ✔ ASPHALT ✔ CONCRETE ✔ PATIO STONES ✔
WOOD ✔ NONE OTHER
IF RAISED, STAND TYPE ✔ MANUFACTURER'S METAL CRADLE METAL ✔ WOOD METAL- WOOD OTHER
LOCATION OF TANK OUTLET SUPPLY LINE ON TOP UNDERNEATH ✔ ON THE SIDE

6. REMARKS

7. ATTACHEMENTS ATTACH THE FOLLOWING WITH THE QUESTIONNAIRE

✔
PHOTOS OF THE TANK (FRONT, BACK, SIDES, TOP) ✔ PHOTOS OF THE STAND PHOTOS OF THE VENT AND FILL PIPES

✔ PHOTO OF THE FLOOR ✔ PHOTOS OF ANY RUST, CORROSION, DENTS PHOTO OF THE CERTIFICATION PLATE

8. COMPLETED BY

NAME SIGNATURE DATE