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@tooelehealth.org
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

Property to be decontaminated:
Address
Owner
Owner's Phone Number
Owner's Address

Permit Fee:   $300.00   Item Subtotal:  
$300.00
Total:
$300.00
 
Applicant's E-Signature
Date
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Method of Payment:
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Routing Number:
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Institution:
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