SCHEDULE 4UNLOADING OF PETROL AT PETROLEUM FILLING STATIONS AND CERTAIN OTHER PREMISES LICENSED FOR THE KEEPING OF PETROL

PART VIFORM OF PART III LICENCE

Part III licence

The Road Traffic (Carriage of Dangerous Substances in Road Tankers and Tank Containers) Regulations 1992 (“the Regulations”) Driver-controlled deliveries in accordance with Part III of Schedule 4 to the Regulations

First Column

Second Column

Third Column

Fourth Column

Fifth Column

Address of licensed premises

Name of licensee

Name of petroleum licensing authority

Signature of person issuing licence on behalf of petroleum licensing authority

Date of issue of Part III licence

Note: A person duly authorised by the petroleum licensing authority to act in the following behalf shall enter—

  1. (a)

    in the first column, the address of the premises to which the Part III licence applies;

  2. (b)

    in the second column, the name of the licensee of those premises;

  3. (c)

    in the third column, the name of the petroleum licensing authority;

  4. (d)

    in the fourth column, his signature; and

  5. (e)

    in the fifth column, the date on which the Part III licence is issued.