Online Form - Owner/Operator Login Request Form

Owner/Operator Login Request Form

Asterisks (*) indicate required fields

Instructions

This form is to be completed by the business owner or Corporate Officer to request a user name and password to access the SLO CUPA Hazardous Materials Business Plan Portal. If you wish to grant another individual authorization, complete this form with THAT individual's information. 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

Applicant 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

Inspector Email

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