Application for Dumping

2176 W. Treatment Plant Rd., St. George, Utah 84790
Phone: (435) 627-4266 Fax (435) 634-5846
Application for Dumping
Waste HaulerFood TruckMobile Commercial BusinessOther
Company Name*
Owner*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email Address*
example@example.com
Physical Address (registered business address)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vehicle/Equipment Information:
1. Make and Model:*
License No.:*
Health Dept. Permit Number:*
Health Dept. Permit Expiration Date:*

MonthDayYear
Date
2. Make and Model:
License No.:
Health Dept. Permit Number:
Health Dept. Permit Expiration Date:

MonthDayYear
Date
3. Make and Model:
License No.:
Health Dept. Permit Number:
Health Dept. Permit Expiration Date:

MonthDayYear
Date
*Use additional sheets if necessary.
Date:*

MonthDayYear
Date
Full Name:*

First NameLast Name
Signature*

Clear
For SGRWRF use only
Approved:
SGRWRF Plant Manager
Date:

MonthDayYear
Date
The St. George Regional Water Reclamation Facility must approve this application before any dumping occurs. Upon request by the SGRWRF, all applicants are required to provide copies of their current Business License and Health Permit.
Should be Empty:

Vehicle/Equipment Information: