GAS STATION ANNUAL REPORT
All retail service stations within Humboldt, Del Norte, and Trinity Counties are required to report emission inventory information to the North Coast Unified Air Quality Management District each year. To simplify the process, the District is providing you with this reporting tool. Please provide the requested information prior to the reporting deadline listed in your notice.
Please provide the name and contact information of the person completing this form.
If you received your inventory report request via email or in a letter from the District, enter your invitation code here. If you did not, enter your facility ID number here. The ID number is located on the bottom left on the front page of your permit. Enter the three digits, followed by "-", and then two more digits. For example "123-12".
Station & Permit Information
Please identify the station and permit information by completing the fields below.
Station Name (e.g. Joe's Chevron)
Enter the permit ID number. It is located at the top of the front page of your permit AND it is listed on the annual report notice you received in the mail. Enter the six digits followed by "-2". For example "001001-2".
Business Contact Information
Has the contact person, mailing or billing address changed?
If you answered "Yes", please provide the updated information in the fields below.
Mailing Street Address
Mailing Zip Code
Gallons of Gasoline Dispensed in 2016
Report the number of gallons of gasoline sold in calendar year 2016 (January through December). Please include all grades (unleaded, mid-grade, and premium). Do not include diesel in the amount you report.
By checking the box below, I certify that the information I am submitting via this form is true and correct to the best of my knowledge.
Questions? Need assistance? Please call (707) 443-3093, or
Select "yes" if you would like a staff member to contact you.
Send me a copy of my responses
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