GOVERNMENT OF THE VIRGIN ISLANDS
GOVERNMENT OF THE VIRGIN ISLANDS DEPARTMENT OF PLANNING & NATURAL RESOURCES DIVISION OF ENVIRONMENTAL PROTECTION Public Water Supply Supervision Program WATER HAULER APPLICATION Registration #: __________________ VIN#: _______________ Date: ______________ Company Name: _________________________________________________________ Owner’s Name: __________________________________________________________ Mailing Address: _________________________________________________________ Phone #: ___________________________ Truck (Make/Model/Year): _________________________________________________ Tank Material: ________________________ Tank Capacity: _____________________ Water Sources Used: ______________________________________________________ _______________________________________________________________________ For Office Use Only ____________________________________ _________________________ Signature Date
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GOVERNMENT OF THE VIRGIN ISLANDS DEPARTMENT OF PLANNING & NATURAL RESOURCES DIVISION OF ENVIRONMENTAL PROTECTION Public Water Supply Supervision Program WATER HAULER APPLICATION Registration #: __________________ VIN#: _______________ Date: ______________ Company Name: _________________________________________________________ Owner’s Name: __________________________________________________________ Mailing Address: _________________________________________________________ Phone #: ___________________________ Truck (Make/Model/Year): _________________________________________________ Tank Material: ________________________ Tank Capacity: _____________________ Water Sources Used: ______________________________________________________ _______________________________________________________________________ For Office Use Only ____________________________________ _________________________ Signature Date