North Dakota Department of Agriculture

Anhydrous Ammonia New License Application

Enter the following information about the North Dakota Anhydrous Ammonia License Applicant:

Company Name: *
Contact Name:

Street Address
Address 1: *
Address 2:
City: * State: * Zip: * -

Mailing Address         Same as Street Address
Address 1:
Address 2:
City: State: Zip: -

Miscellaneous Company Information
Phone: *
Fax:
Email address: *
County:

Ammonia Storage Facility Information
Legal Name of Location:
Is this a Retail Operation?:
Is this a Storage Facility?:
Date Approved by County Commissioner: *
Size of First Ammonia Storage Tank: gallons; tank number:
Size of Second Ammonia Storage Tank: gallons; tank number:
Size of Third Ammonia Storage Tank: gallons; tank number:
Size of Fourth Ammonia Storage Tank: gallons; tank number:
Size of Fifth Ammonia Storage Tank: gallons; tank number: