Road Traffic (Carriage of Dangerous Substances in Road Tankers and Tank Containers) Regulations (Northern Ireland) 1992

First Column	Second Column	Third Column	Fourth Column	Fifth Column	Sixth Column	Seventh Column
Note: The licensee or some other competent person acting on his behalf must enter, in the first column, the address of the licensed premises concerned;; in the second column, the licensee’s name; in the third column, the relevant storage tank number, letter or number and letter; in the fourth and fifth columns, the quantity and grade respectively of petrol to be delivered; in the sixth column, his signature; and, in the seventh column, the correct date and time. This Part must be completed before delivery into the tank commences. The sixth column may only be completed after the person concerned has measured the ullage space in the tank.
Address of licensed premises	Name of licensee	Storage tank number, letter or number and letter	Quantity of petrol to be delivered	Grade of petrol to be delivered	Signature of licensee or competent person (to certify that in accordance with 3 paragraph 21(a) of Schedule 4 to the Regulations he has visually checked the ullage space in the storage tank)	Date and time of completion of this Part of the Certificate

First Column	Second Column	Third Column
Note: in this Part, the driver must enter, in the first column, the relevant storage tank number, letter or number and letter; in the second column, the number of each compartment of any carrying tank from which the petrol is to be delivered; and, in the third column, his signature. This Part must be completed after Part A has been completed by the licensee or by a competent person acting on his behalf, but before delivery into the tank commences.
Storage tank number, letter or number and letter	Road tanker carrying tank compartment numbers	Signature of driver