IRAC Test

Application for Retail Petroleum Outlet License – New Retail Outlet (IRAC501)

ALL APPLICABLE QUESTIONS MUST BE ANSWERED

View source PDF IRAC501 · Webform

Review both pages of the source PDF, including the information for applicants, before submitting.

1 – 2. Applicant and proposed outlet

1. Name of applicant *

2. Proposed outlet address – Street *

Town / community *

Province *

Postal code *

Owner and operator

3. Owner of outlet / property *

4. Owner mailing address *

5. Operator of outlet *

6. Operator mailing address *

7 – 12. Licensing and proposed operations

7. Previously licensed under the Petroleum Products Act? *

YesNo

If yes, specify previous licensing details

9. Type of proposed outlet

Service StationC-Store/General StoreMarineOther

Other outlet type

10. Proposed supplier *

11. Products to be sold *

12. Services / businesses to operate with petroleum sales, including proposed propane dispensing *

13 – 18. Facility details

13. Building descriptions and dimensions *

14. Number of proposed pump islands *

Number of proposed pumps *

15. Weekdays – full-service hours

Weekdays – self-service hours

Sundays / holidays – full-service hours

Sundays / holidays – self-service hours

16. Proposed storage volume (litres), by product *

17. Pump island distance from nearest road centre (feet) *

18. Will public washrooms be provided? *

YesNo

If yes, number of washrooms

19. Supporting documents

Preparation checklist. Include supporting documents separately with your application; this page does not upload them.

Documents / requirements

Property location planFacility layout planLetter explaining public interest, convenience and necessityBuilding permit / approval in principlePreliminary petroleum storage approvalCurrent filing feeProof of ownershipPetroleum supply agreementPropane handling approval (if applicable)

The first three items accompany the application. Remaining applicable items are required before a licence is issued. See the source PDF for issuing authorities and the applicant information on public convenience and necessity.

20. Declaration

I hereby declare that the answers made to the above questions are true and, if a license is issued, I undertake to carry out in every manner the requirements of the Petroleum Products Act and Regulations.

Signature – type full legal name *

Full name / print name *

Title *

Corporate name (if applicable)

Date *

Telephone *

Signing as *

OwnerLesseeAgent

A typed name is included in the printed copy. Sign the application as required by the Commission.

Licence fees are payable to the Island Regulatory and Appeals Commission. Review the source PDF for full application and supporting-document requirements.

Submitting saves your answers to this website’s application database. Payments and supporting documents are handled separately. For the Commission’s privacy notice and filing instructions, see the official petroleum forms page.

Application for Retail Outlet License – Annual Renewal (IRAC503)

ALL APPLICABLE QUESTIONS MUST BE ANSWERED

View source PDF IRAC503 · Webform

1 – 3. Outlet Details

1. Name of Outlet *

2. Located At (Street) *

Town / Community *

Province

Postal Code *

3. Telephone Number *

7. Current License Number *

5. Owner Information

a) Owner of Outlet *

b) Owner’s Mailing Address *

c) Owner Phone Number *

d) Owner Email Address *

6. Operator Information

a) Operator of Outlet

b) Operator’s Mailing Address

c) Operator Phone Number

d) Operator Email Address

8 – 10. Operations & Dispensing 8. Hours of Operation for Motor Fuels Dispensing:

Full-Serve:

Self-Serve:

9. Method of Dispensing (check all that apply):

10. Describe Other Services Provided at This Outlet (service bays, c-store, restaurant, etc.):

11 – 14. Petroleum Products & Suppliers 11. Petroleum Products Sold (separate form required for each license at marine outlets): 12. Propane:

Automotive Filling of up to 20 kg. cylinders 9.09 kg Exchange Centre Storage & Sale of up to 45.4 kg Cylinders Filling, Storage & Sale of up to 45.4 kg Cylinders

13. Which Wholesaler is Your Supplier (including propane):

14. Are Bay Services Available?

Yes No

15. Volume (in Litres) Sold Jan. 1st to Dec. 31st Last Year:

	Full-Serve	Self-Serve
Gasoline
Diesel
Propane
Kerosene
Furnace

16. Storage Capacity

Product	Type / Litres
Gasoline
Diesel
Propane
Kerosene
Furnace

17 – 21. Pumps, Equipment & Insurance

17. Is this outlet presently in operation? *

YES NO

If not operating, reason and expected reopening date

18. Does the outlet have Public Liability Insurance? *

YES NO

19. Number of Pumps:

Single pumps

Double pumps

Triple pumps

20. Total Number of Nozzles:

21. Have there been any changes in pumps or storage equipment since your last license was issued? *

NO YES

If equipment changed, details and serial numbers

22. Outlet Contact Information

Primary Contact Name *

Primary Contact Email *

Primary Contact Phone *

Best Method of Contact:

Secondary Contact Name

Secondary Contact Email

Secondary Contact Phone

23. Declaration

I HEREBY DECLARE THAT THE ANSWERS MADE TO THE ABOVE QUESTIONS ARE TRUE AND, IF A LICENSE IS ISSUED, I UNDERTAKE TO CARRY OUT IN EVERY MANNER THE REQUIREMENTS OF THE PETROLEUM PRODUCTS ACT & REGULATIONS.

Signature (Type Full Legal Name) *

Print Name *

Title *

Corporate Name (if applicable)

Date *

License fees payable to “ISLAND REGULATORY AND APPEALS COMMISSION”. Form collected pursuant to the Petroleum Products Act.

Additional contact details

Contact information date

Signer email

Licence fees are payable to the Island Regulatory and Appeals Commission. Review the source PDF for full application and supporting-document requirements.

Submitting saves your answers to this website’s application database. Payments and supporting documents are handled separately. For the Commission’s privacy notice and filing instructions, see the official petroleum forms page.

Application for Petroleum Outlet License – Tank Truck (IRAC505)

ALL APPLICABLE QUESTIONS MUST BE ANSWERED

View source PDF IRAC505 · Webform

Use a separate form for each vehicle.

1 – 3. Applicant details

1(a). Name of applicant *

1(b). Applicant address – Street *

Town / community *

Province *

Postal code *

1(c). Mailing address, if different

2. Telephone *

3. Fax

4 – 8. Outlet and supply

4. Retail-distributor outlet operated from *

5. Outlet address – Street *

Town / community *

Province *

Postal code *

6. Oil company supplier *

7. Number on last tank truck license

8. Area served *

9. Quantities distributed last year

January 1 to December 31 of last year
Product	Litres
Gasoline	Gasoline – Litres
Diesel Fuel	Diesel Fuel – Litres
Furnace Oil	Furnace Oil – Litres
Stove Oil	Stove Oil – Litres
Propane	Propane – Litres
Other	Other – Litres

Other product – specify

10. Vehicle particulars

Year of manufacture *

Make *

Serial number *

Vehicle type *

Tank TruckTractor-Trailer

Number of compartments *

Total capacity (litres) *

11. Declaration

I hereby declare that the answers made to the above questions are true and, if a license is issued, I undertake to carry out in every manner the requirements of the Petroleum Products Act and Regulations.

Signature – type full legal name *

Full name / print name *

Title *

Corporate name (if applicable)

Date *

Telephone *

Signing as *

OwnerLesseeAgent

A typed name is included in the printed copy. Sign the application as required by the Commission.

Licence fees are payable to the Island Regulatory and Appeals Commission. Review the source PDF for full application and supporting-document requirements.

Submitting saves your answers to this website’s application database. Payments and supporting documents are handled separately. For the Commission’s privacy notice and filing instructions, see the official petroleum forms page.

Tank Truck License – Annual Renewal (IRAC520)

ALL APPLICABLE QUESTIONS MUST BE ANSWERED

View source PDF IRAC520 · Webform

Use a separate form for each vehicle.

1 – 3. Applicant details

1(a). Name of applicant *

1(b). Applicant address – Street *

Town / community *

Province *

Postal code *

1(c). Mailing address, if different

2. Telephone *

4 – 8. Outlet and supply

4. Retail-distributor outlet operated from *

5. Outlet address – Street *

Town / community *

Province *

Postal code *

6. Distributor supplier *

7. Number on last tank truck license *

8. Area served *

9. Quantities distributed last year

January 1 to December 31 of last year
Product	Litres
Gasoline	Gasoline – Litres
Diesel Fuel	Diesel Fuel – Litres
Furnace Oil	Furnace Oil – Litres
Stove Oil	Stove Oil – Litres
Propane	Propane – Litres
Other	Other – Litres

Other product – specify

10. Vehicle particulars

Year of manufacture *

Make *

Serial number *

Vehicle type *

Tank TruckTractor-Trailer

Number of compartments *

Total capacity (litres) *

11. Contact information

Primary contact name *

Primary contact email *

Primary contact phone *

Secondary contact name

Secondary contact email

Secondary contact phone

Best method of contact

Contact information date

12. Declaration

I hereby declare that the answers made to the above questions are true and, if a license is issued, I undertake to carry out in every manner the requirements of the Petroleum Products Act and Regulations.

Signature – type full legal name *

Full name / print name *

Title *

Corporate name (if applicable)

Date *

A typed name is included in the printed copy. Sign the application as required by the Commission.

Licence fees are payable to the Island Regulatory and Appeals Commission. Review the source PDF for full application and supporting-document requirements.

Submitting saves your answers to this website’s application database. Payments and supporting documents are handled separately. For the Commission’s privacy notice and filing instructions, see the official petroleum forms page.

Application for Petroleum Outlet License – Retail-Distributor (IRAC504)

ALL APPLICABLE QUESTIONS MUST BE ANSWERED

View source PDF IRAC504 · Webform

1 – 3. Applicant and outlet

Storage arrangement *

Bulk StorageNo Bulk Storage

1. Name of applicant *

2(a). Name of outlet *

2(b). Location of outlet *

3. Business office address – Street *

Town / community *

Province *

Postal code *

Telephone *

Owner and operator

4(a). Owner of outlet / property *

4(b). Owner mailing address *

5(a). Operator of outlet *

5(b). Operator mailing address *

6 – 10. Supply and operation

6. Oil company supplier *

7. Bulk storage location

8. Area served from this location *

9. Number of storage tanks *

10. Current outlet license number (if applicable)

11 – 13. Storage, vehicles and quantities

11. Product and capacity of each storage tank
Tank	Product	Capacity (litres)
1	1 – Product	1 – Capacity (litres)
2	2 – Product	2 – Capacity (litres)
3	3 – Product	3 – Capacity (litres)
4	4 – Product	4 – Capacity (litres)
5	5 – Product	5 – Capacity (litres)
6	6 – Product	6 – Capacity (litres)
7	7 – Product	7 – Capacity (litres)
8	8 – Product	8 – Capacity (litres)

12. Number of tank trucks

Number of tractor-trailers

13. Quantities distributed – January 1 to December 31 last year
Product	Litres
Gasoline	Gasoline – Litres
Diesel Fuel	Diesel Fuel – Litres
Furnace Oil	Furnace Oil – Litres
Stove Oil	Stove Oil – Litres
Propane	Propane – Litres
Kerosene	Kerosene – Litres
Other	Other – Litres

Other product – specify

14. Declaration

I hereby declare that the answers made to the above questions are true and, if a license is issued, I undertake to carry out in every manner the requirements of the Petroleum Products Act and Regulations.

Signature – type full legal name *

Full name / print name *

Title *

Corporate name (if applicable)

Date *

Telephone *

Email *

Signing as *

OwnerLesseeAgent

A typed name is included in the printed copy. Sign the application as required by the Commission.

Licence fees are payable to the Island Regulatory and Appeals Commission. Review the source PDF for full application and supporting-document requirements.

Submitting saves your answers to this website’s application database. Payments and supporting documents are handled separately. For the Commission’s privacy notice and filing instructions, see the official petroleum forms page.

Retail-Distributor License – Annual Renewal (IRAC519)

ALL APPLICABLE QUESTIONS MUST BE ANSWERED

View source PDF IRAC519 · Webform

1 – 3. Applicant and outlet

Storage arrangement *

Bulk StorageNo Bulk Storage

1. Name of applicant *

2(a). Name of outlet *

2(b). Location of outlet *

3. Business office address – Street *

Town / community *

Province *

Postal code *

Telephone *

Owner and operator

4(a). Owner of outlet / property *

4(b). Owner mailing address *

Owner phone *

Owner email *

5(a). Operator of outlet *

5(b). Operator mailing address *

Operator phone

Operator email

6 – 10. Supply and operation

6. Wholesaler supplier *

7. Bulk storage location

8. Area served from this location *

9. Number of storage tanks *

10. Current outlet license number *

11 – 13. Storage, vehicles and quantities

11. Product and capacity of each storage tank
Tank	Product	Capacity (litres)
1	1 – Product	1 – Capacity (litres)
2	2 – Product	2 – Capacity (litres)
3	3 – Product	3 – Capacity (litres)
4	4 – Product	4 – Capacity (litres)
5	5 – Product	5 – Capacity (litres)
6	6 – Product	6 – Capacity (litres)
7	7 – Product	7 – Capacity (litres)
8	8 – Product	8 – Capacity (litres)

12. Number of tank trucks

Number of tractor-trailers

13. Quantities distributed – January 1 to December 31 last year
Product	Litres
Gasoline	Gasoline – Litres
Diesel Fuel	Diesel Fuel – Litres
Furnace Oil	Furnace Oil – Litres
Stove Oil	Stove Oil – Litres
Propane	Propane – Litres
Kerosene	Kerosene – Litres
Other	Other – Litres

Other product – specify

14. Contact information

Primary contact name *

Primary contact email *

Primary contact phone *

Secondary contact name

Secondary contact email

Secondary contact phone

Best method of contact

Contact information date

15. Declaration

I hereby declare that the answers made to the above questions are true and, if a license is issued, I undertake to carry out in every manner the requirements of the Petroleum Products Act and Regulations.

Signature – type full legal name *

Full name / print name *

Title *

Corporate name (if applicable)

Date *

A typed name is included in the printed copy. Sign the application as required by the Commission.

Licence fees are payable to the Island Regulatory and Appeals Commission. Review the source PDF for full application and supporting-document requirements.

Submitting saves your answers to this website’s application database. Payments and supporting documents are handled separately. For the Commission’s privacy notice and filing instructions, see the official petroleum forms page.

Application for Initial Petroleum Products Distribution License (IRAC514)

ALL APPLICABLE QUESTIONS MUST BE ANSWERED

View source PDF IRAC514 · Webform

1 – 3. Wholesaler details

1. Corporate name of wholesaler *

2. Doing business as, if different

3. Address – Street *

Town / community *

Province *

Postal code *

Telephone *

4. Completed by

Signature – type full legal name *

Full name / print name *

Title *

Corporate name

Date *

Telephone *

Email *

A typed name is included in the printed copy. Sign the application as required by the Commission.

5. Required application information

Description of products to be sold *

Brand name associated with products *

Supply arrangements *

Proposed distribution network *

Proposed start-up date *

Estimated potential annual sales volumes (identify product and units) *

6. Fee

Preparation checklist. Include supporting documents separately with your application; this page does not upload them.

Documents / requirements

Current initial licence fee

Refer to the current licence fee schedule on the Commission website.

7. Return completed form

Island Regulatory and Appeals Commission
134 Kent Street, P.O. Box 577
Charlottetown, PE C1A 7L1
Telephone: 902-892-3501 · Toll-free (NS & PEI): 1-800-501-6268
Fax: 902-566-4076

Licence fees are payable to the Island Regulatory and Appeals Commission. Review the source PDF for full application and supporting-document requirements.

Submitting saves your answers to this website’s application database. Payments and supporting documents are handled separately. For the Commission’s privacy notice and filing instructions, see the official petroleum forms page.

Application for Renewal Petroleum Products Distribution License (IRAC515)

ALL APPLICABLE QUESTIONS MUST BE ANSWERED

View source PDF IRAC515 · Webform

Licence fees are payable to the Island Regulatory and Appeals Commission. Review the source PDF for full application and supporting-document requirements.

Submitting saves your answers to this website’s application database. Payments and supporting documents are handled separately. For the Commission’s privacy notice and filing instructions, see the official petroleum forms page.

Application for Amendment Petroleum Products Distribution License (IRAC516)

ALL APPLICABLE QUESTIONS MUST BE ANSWERED

View source PDF IRAC516 · Webform

1 – 3. Wholesaler details

1. Corporate name of wholesaler *

New corporate name, if applicable

2. Doing business as, if different

3. Address – Street *

Town / community *

Province *

Postal code *

Telephone *

4. Completed by

Signature – type full legal name *

Full name / print name *

Title *

Corporate name

Date *

Telephone *

Email *

A typed name is included in the printed copy. Sign the application as required by the Commission.

5. Details of proposed changes, if applicable

Description of products to be sold

Brand name associated with products

Supply arrangements

Proposed distribution network

Proposed date of changes

Estimated potential annual sales volumes (identify product and units)

6. Fee

Preparation checklist. Include supporting documents separately with your application; this page does not upload them.

Documents / requirements

Current licence amendment fee

Refer to the current licence fee schedule on the Commission website.

7. Return completed form

Island Regulatory and Appeals Commission
134 Kent Street, P.O. Box 577
Charlottetown, PE C1A 7L1
Telephone: 902-892-3501 · Toll-free (NS & PEI): 1-800-501-6268
Fax: 902-566-4076

Licence fees are payable to the Island Regulatory and Appeals Commission. Review the source PDF for full application and supporting-document requirements.

Submitting saves your answers to this website’s application database. Payments and supporting documents are handled separately. For the Commission’s privacy notice and filing instructions, see the official petroleum forms page.

Application for Retail Petroleum Outlet License – New Retail Outlet (IRAC501)

New Retail Outlet – Propane Only (IRAC507)

License Amendment – Propane (IRAC508)

Application for Retail Outlet License – Annual Renewal (IRAC503)

Application for Approval of Changes at Retail Petroleum Outlet (IRAC509)

Application for Petroleum Outlet License – Tank Truck (IRAC505)

Tank Truck License – Annual Renewal (IRAC520)

Application for Petroleum Outlet License – Retail-Distributor (IRAC504)

Retail-Distributor License – Annual Renewal (IRAC519)

Application for Initial Petroleum Products Distribution License (IRAC514)

Application for Renewal Petroleum Products Distribution License (IRAC515)

Application for Amendment Petroleum Products Distribution License (IRAC516)

Petroleum Forms

Retail outlet annual renewal

Application for Retail Petroleum Outlet License – New Retail Outlet (IRAC501)

New Retail Outlet – Propane Only (IRAC507)

License Amendment – Propane (IRAC508)

Application for Retail Outlet License – Annual Renewal (IRAC503)

Application for Approval of Changes at Retail Petroleum Outlet (IRAC509)

Application for Petroleum Outlet License – Tank Truck (IRAC505)

Tank Truck License – Annual Renewal (IRAC520)

Application for Petroleum Outlet License – Retail-Distributor (IRAC504)

Retail-Distributor License – Annual Renewal (IRAC519)

Application for Initial Petroleum Products Distribution License (IRAC514)

Application for Renewal Petroleum Products Distribution License (IRAC515)

Application for Amendment Petroleum Products Distribution License (IRAC516)