PHYSICAL ADDRESS OF FACILITY / NAME OF FACILITY / FACILITY CONTACT / GASOLINE QUANTITIES DELIVERED TO FACILITY / OFFICIAL USE ONLY DATE RECEIVED DATE APPROVED FACILITY / /
IndustryTerm
collection systems / oil/water separators / /
Organization
FORSYTH COUNTY OFFICE OF ENVIRONMENTAL ASSISTANCE AND PROTECTION NOTIFICATION FORM FOR NEW GASOLINE DISPENSING FACILITIES Repeat / Environmental Assistance and Protection Forsyth County Government Center / OFFICIAL USE ONLY DATE RECEIVED DATE APPROVED FACILITY/PREMISE NUMBER FOR FCEAP OFFICE USE ONLY FORSYTH COUNTY OFFICE OF ENVIRONMENTAL ASSISTANCE AND PROTECTION REGISTRATION FORM FOR NEW GASOLINE DISPENSING FACILITIES Please Print / Recovery Section Forsyth County office of Environmental Assistance / / /
OFFICIAL USE ONLY DATE RECEIVED