Emissions Inspector Permit Application

FORM – English

Required Contact Information


Note: I agree to notify Bear River Health Department immediately upon any change of address or employment.

Station Information Section


Station Two Information Section


I request to participate as a Certified Emissions Inspector in the Cache County Emissions Program. I will comply with the regulations set forth by the Bear River Board of Health. I understand that failure to comply may result in penalties, as outlined in the regulation, for myself and/or the I/M Program Station I am employed at.

By signing this application I acknowledge that I am familiar with the I/M Program regulation and agree to operate in accordance with the regulation.

Click the SEND button only once. It will take just a moment to process your information. You will receive a confirmation email if your submission was successful.