Annual Gasoline Throughput Report

Annual Gasoline Throughput Report

Please complete this form to report your gas station's total gasoline throughput for the specified reporting year.
To begin, enter your permit number in the format xx-xx or xx-xxx and then select "Start Reporting."*
Facility
Facility
Company
Address
Location
Point of Contact
Company Contact
Responsible Official
Contact Email*
Email
Contact Phone
Phone Number
This is the information we have for your primary point of contact. If this information needs to be revised, or if any information is absent, please provide updated information in the comment box at the bottom of this form.
Report
Reporting Year*
Total Annual Gasoline Sold (gallons)*
Certify and Submit
I certify that the information provided in this document is true, complete, and accurate to the best of my knowledge and belief.
E-Signature*

Clear
Responsible Official Signature
Comments
Optional Comments or Contact Information Updates
Should be Empty:

Facility