Road Traffic (Carriage of Dangerous Substances in Road Tankers and Tank Containers) Regulations (Northern Ireland) 1992 No. 260

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

PART VI FORM OF PART III LICENCE

Part III Licence Road Traffic (Carriage of Dangerous Substances in Road Tankers and Tank Containers) Regulations (Northern Ireland) 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
Note: A person duly authorised by the petroleum licensing authority to act in the following behalf shall enter— (a) in the first column, the address of the premises to which the Part III licence applies; (b) in the second column, the name of the licensee of those premises; (c) in the third column, the name of the petroleum licensing authority; (d) in the fourth column, his signature; and (e) in the fifth column, the date on which the Part III licence is issued.
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