Certification of Receipt for automatic entry device #
Company name:
.
.
Owner/Manager:
.
Information on vehicle to which badge/entry device will be assigned:
Description:
.
Tank Capacity:
Model:
VIN number:
.
.
.
(This certification must be signed by the owner of your firm)
certify that the above information is correct and the badge/entry device
I,
issued by the Charlotte Mecklenburg Utilities-System Protection (CMU-SP) shall only be attached
to the above vehicle for use at the Septage Receival Stations. Furthermore, if the tag/entry device
is damaged or lost, I agree to replace the device at a cost of $15.00. Transfer or misuse of the
badge/entry device is prohibited and could result in fines and/or suspension of discharge
privileges at the Septage Receival Stations. The entry device remains the property of the CMU-SP
and must be returned if your company ceases operation or if a vehicle is taken out of service. If a
new vehicle is placed in service a certification must be completed for that vehicle and a
badge/entry device will then be issued.
Signature
Date
.