Station Permit Application

FORM – English

Required Contact Information

SECTION 1: Station Information

SECTION 2: Certified Emissions Inspectors

List all Certified Emissions Inspectors that you currently employ and wish to provide access to the official testing portion of the Certified Testing Equipment.


SECTION 3: Affidavit & Signature

As owner, manager, or authorized representative of the above stated business, I request to participate as an I/M Program Station in the Cache County Emissions Program. My station 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 my station and/or the Certified Emissions Inspectors I employ. My station will also comply with the requirements set forth by the contracted equipment vendor.

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.