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