Tooele Health Department
             
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444
eh@TooeleCo.gov
Application For Decontamination of Chemically Contaminated Property Permit

Please put N/A for any fields that are not applicable
Decontamination Company:
Name
DEQ Certification Number
Address
Telephone Number
Email Address
If you have additional documents to send, please email them to eh@tooelehealth.org.
Property to be decontaminated:
Address
Owner
Owner's Phone Number
Owner's Address
Permit Fee:   $350.00   Item Subtotal:  
$350.00
Total:
$350.00
 
Applicant's E-Signature
Date
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Method of Payment:
  Credit/Debit Card
  eCheck
 Update Name from Above
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
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