Report of Annual Gasoline and Diesel Gallons Dispensed - Retail, Private, Bulk

Use this page to submit your calendar year 2017 (Jan-Dec) gasoline and diesel gallons dispensed/bulk loaded to Southwest Clean Air Agency.

Please enter your identification information below

All fields in this section of the form are required!

Your Name: (first and last)
Your Job Title:
Your Phone Number: (aaa-ppp-nnnn)
Your Email Address:

Enter your Gallons Dispensed Below
Select your facility from this list 
Retail Throughput Private/Government/Fleet Bulk Facility
Gasoline Diesel Gasoline Diesel Gasoline Diesel

 Change Code if you can't clearly view
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I hereby certify, to the best of my knowledge, that the total annual petroleum products gallons of throughput for the calendar year of 2017 for the above facility(ies) are accurate. Check this box to reveal the Submit button.