ARKANSAS Submit Form To:
El Dorado Regional Office
OIL AND GAS P.O. Box 11510
El Dorado, Arkansas 71730
PERMIT TO CLEAN TANK
A. PIPE LINE CONNECTED TO TANK TO BE CLEANED
Operator or Owner of Tank
Lease Field Pipe Line Company
Tank No. Capacity bbls. Gross Contents bbls. Back Gauge ft. in.
This is to certify the above described tank contains only the above amount of gross contents and no merchantable oil transportable by
pipe line on this date. This pipe line is requesting that the above tank be cleaned of tank bottoms before another pipe line run is made
from said tank.
Signature of Pipe Line Company Representative
B. CERTIFICATE OF OPERATOR’S OR OWNER’S REPRESENTATIVE
I hereby certify that I am authorized by to have
Name of Operator or Owner
Tank Number , containing bbls., cleaned by
Tank Cleaning Company
Contents of the above tank were transported to
Tank Cleaning Company
This is to certify that no oil or product of crude oil was mixed with or substituted for the tank contents as described on this permit; that no
rule or regulation of the Arkansas Oil and Gas Commission was violated in the cleaning of the tank, transportation of contents or treating of
said contents of said tank.
Signature of Tank Cleaning Company Agent
D. THIS SPACE TO BE FILLED IN BY COMMISSION REPRESENTATIVE:
Date Approved by
See Instructions on Reverse Side Revised 04/09
1. Four copies of the Permit to Clean Tank, AOGC-15, shall be filed with the Commission.
2 Part A – Operator of the lease shall obtain the required information and the signature from the pipeline company representative prior to
cleaning a tank.
3. Part B – Operator of the lease shall complete the required information and forward the Permit to the Tank Cleaning Company.
4. Part C – The Tank Cleaning Company shall complete the required information and file the Permit with the Commission no later than 10
days after cleaning of the tank.
5. In the event oil is being salvaged from a pit, the Operator of the lease shall fill in Part A, omitting blocks designated for Pipeline
Company, Tank Number, Back Gauge and Signature of the Pipeline Company’s Representative.
6. Part D – The Commission shall complete the processing and mail copies to the Operator, Pipeline Company and Tank Cleaning