Capitol Environmental, Inc. – Environmental Consultants

Request For Service
Storm Water Pollution Prevention Plan and Inspections

If you are an existing client of Capitol Environmental, simply enter your company name and omit the remaining portion of the first section. If more than one company needs coverage under the SWP3, please submit a second request with the additional information.

COMPANY INFORMATION:

Legal Name:

Mailing Address:

City:

State:

Zip:

Office Physical Address:

City:

State:

Zip:

Federal Tax ID Number:

Texas Secretary of State Charter Number (Only Corp. and LPs):

Number of Employees:

Office Phone:

Office FAX :

Contact (Corporate Officer):

ER Number:

If the corporate officer is set up to submit applications online via the STEERS program. Please provide the ER number and Capitol Environmental will prepare your Notice of Intent online and save you an extra $100.

Title:

Email Address:

PROJECT INFORMATION:

Please complete the information below to the best of your ability. In addition to this information, we will also need a copy of the site plan, plat, or erosion control plan (depending on what type of project it is). These documents can be emailed to Capitol Environmental separately.

Project Name:

Project Address or Description of Location:

City:

State:

Zip:

Estimated Acres Disturbed:

Estimated Start Date:

Estimated Completion Date:

INSPECTIONS:

If you want Capitol Environmental to conduct site inspections for this project, please complete the information below.

Project Manager or Site Manager:

Mobile Phone Number:

Report Distribution List:

Provide the email address for each individual that needs to receive the inspection reports. You can list as many as you need, including site supers, project managers, erosion control representative, etc.

Email 1:

Email 2:

Email 3:

Email 4:

Email 5:

Email 6:

Email 7:

Email 8:

Key in this number (required)

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