Georgia Environmental Protection Division
GEORGIA COMMERCIAL TRANSPORTER REGISTRATION
Directions: This page must be filled out completely. Failure to provide any of the required information may result in your application not being accepted. Once you have completed the brief questionnaire click the submit button to send your registration electronically to the Georgia Environmental Protection Division.
It will take about 7 to 10 days for a response on your application. Any questions regarding this form must be directed to the Georgia Environmental Protection Division. The Georgia FOG Alliance is not responsible for your registration.

COMPANY INFORMATION
(This information is required to obtain your FOG Permit Number)
Company Name: Today's Date:
Contact Person: Job Title:
Street Address: P.O. Box:
Mailing Address: Email:
City: State: Zip Code:
Phone Number: Fax Number: Contact Number:
Company Web site:
Please enter the type of Commercial Waste Permit your company has:
(Example: NPDES, LAS, Industrial Pretreatment by Division or Industrial Pretreatment by Pretreatment Authority)
Type of Commercial Waste Permit: Permit Number:
Type of Commercial Waste Permit: Permit Number:
Type of Commercial Waste Permit: Permit Number:
Has your company Registered with the State of Georgia before? If Yes Previous FOG Number:
Does your company Transport Commercial waste pumped in Georgia across State lines(yes/no)? If yes then to what location?

GENERAL COMPANY INFORMATION:
(This information is not required but is information about your company that will be on the Georgia's List of Approved Commercial Waste Haulers)
Total Number of Trucks: Years in Business:
How Do You Service Customers?
(Examples: Contract, Regularly Scheduled Times, Call When Needed)
and/or

Disposal Location #1:
Address : City: State: Zip Code:
Disposal Location #2:
Address : City: State: Zip Code:
Disposal Location #3:
Address : City: State: Zip Code:
Disposal Location #4:
Address : City: State: Zip Code:

Please Select The Types of Service You Provide to Customers:
(please select all that apply to your business)

Grease Traps Septic Tank Oil / Water Separators Grit Traps Sand Traps
Other
Please Select The Service Areas For Your Business:
(Use the Map and Select Your Range of Service select all that apply)

Region 1 Region 2 Region 3 Region 4 Region 5
Region 6 Region 7 Region 8 Region 9 All of Georgia

I certify that this document was prepared under my direction or supervision in accordance
with the system designed to assure that qualified personnel properly gathered and evaluated the
information submitted. The information provided is to the best of my knowledge and
belief, true, accurate, and complete.

Signature:
Please print your name in the space above.
Email Address:
Please input your email address for verification.