Local Governing Authority Vehicle Inspection Form

COMPANY INFORMATION:

Transporter Name:
Transporter Address:
City: State: Zip Code:
Phone Number: Fax Number:
Company Contact:
Contact Email:

TRUCK INFORMATION:
Example: (Truck Tag # : GA-12345 FOG # Issued: FOG001-001)
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:
Truck Tag #: FOG # Issued:

Permit Issuance Date:
Permit Expiration Date:

If you have inspected more than 15 trucks please fill out another form and submit it to us.

LGA or PERSON PROVIDING THIS INFORMATION:

LGA or Company Name:
Point of Contact:
LGA Address:
City: State: Zip Code:
Phone Number: Fax Number:
Email Address:

Local Governing Authority Vehicle Inspection Registration Form

This form is an electronic form that is submitted to the website administrator of the Georgia FOG Alliance. Its purpose is to help keep a
log of permitted companies and trucks in the State of Georgia that have been inspected only.
This Log is for LGA's only and has no other purpose. Please make
sure you fill in all the required items so as not to misrepresent a company.