Consultant Login Request Form
Asterisks (
*
) indicate required fields
Instructions
This form is to be completed by the Consultant, who has been approved by the business owner/operator, to request a user name and password to access the SLO CUPA Hazardous Materials Business Plan Portal. If you are already an authorized user, input your current user name and password so the System Administrator can access the existing account. Use the notes section to provide specific information as needed. The System Administrator will contact you within 4 working days.
Request Date
*
Information about the business
Business Name
*
Facility Street Address
*
City
*
State
*
Zip
*
Phone
*
Extension
Fax
Information about you
Owner/Operator Name
*
Mailing Address
City
State
Zip
Email
Phone
*
Extension
Other Information
Requested Username
Requested Password
Regulated Programs (Check all that apply)
*
Hazardous Materials
Hazardous Wastes
Tiered Permitting
CalARP
Underground Storage Tanks
Aboveground Petroleum Storage Tanks
Additional Notes
Inspector
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Inspector Email
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Consultant Login Request Form
Asterisks (*) indicate required fields
Asterisks (*) indicate required fields