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