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2. Section A - Company Information
4. Company Name:
5. Phone:
7. Mailing Address:
8. Fax:
10. City, State, Zip
12. Name of contact person:
14. Tax Identification Number:
16. DNR Permit #
18. Dispatcher Name:
19. Dispatcher Telephone:
21. Section B- Waste Transport Vehicles
23. Vehicle #1: Make, Model, Tank Volume (gallons), License No., State, License Plate Expiration Date
25. Vehicle #2: Make, Model, Tank Volume (gallons), License No., State, License Plate Expiration Date
27. Vehicle #3: Make, Model, Tank Volume (gallons), License No., State, License Plate Expiration Date
29. Vehicle #4: Make, Model, Tank Volume (gallons), License No., State, License Plate Expiration Date
31. Section C - Waste Information
33. 1. Types and estimated annual volumes of wastes to be transported and discharged to SWWTP:
35. Industrial Waste:
36. Landfill Leachate:
38. Sludge:
39. Septic Tanks:
41. Portable Toilets:
42. Grease Traps:
44. Other:
46. 2. Check boxes of areas that your company will operate:

    1. Superior, WI
    2. Douglas County, WI
    3. Bayfield County, WI
    4. Other WI location
    5. Duluth, MN
    6. St. Louis County, MN
    7. Other MN location
48. Section D - Insurance
    **Please attach a certificate documenting that your company has adequate comprehensive general liability and auto liability insurance.
50. Upload certificate:
52. I have personally examined and am familiar with the information submitted in this document and attachments and certify the information to be true, accurate, and complete. I further agree to operate under the provisions of all pertinent City of Superior Ordinances and realize failure to do so many result in my discharge privileges being revoked and enforcement action being taken against me.
54. Name and Title of Signing Official:
56. Signature:
57. Date:
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

* indicates a required field