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19/05/2014
5. Date of testing:
7. Is this a first test for the purposes of these regulations? If not, state day, month and year
of most recent test.:
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FRM 0137 00
19/05/2014
Declaration:
I, ______________________________(please print name), hereby confirm that I have tested the
above service station on ____________ (insert date) for compliance with the provisions of the
Air Pollution Act, 1987 (Petroleum Vapour Emissions) Regulations, 1997 and to the best of my
knowledge and belief this service station is in compliance with the said provisions.
Signed:
Qualification / Profession:
Company Name and Address:
Date:
Forward to:
The Environment Section:
Comhairle Contae
Thiobraid Arann,
Oifigi Cathartha,
Cluain Meala,
Co. Thiobraid Arann
Comhairle Contae
Thiobraid Arann,
Oifigi Cathartha,
An tAonach,
Co. Thiobraid Arann
Tipperary County
Council,
Civic Offices, Clonmel,
Co. Tipperary
Tipperary County
Council,
Civic Offices, Nenagh,
Co. Tipperary
t 0761 06 5000
www.tipperarycoco.ie
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FRM 0137 00
19/05/2014
FRM 0137 00
2)
3)
19/05/2014
Address
Telephone No.
McAllister Devereux
Keating
01-6688244
01-2693084
Petrocourt Ltd.
01-8102381
b)
4)
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