GOVERNMENT OF THE VIRGIN ISLANDS 
DEPARTMENT OF PLANNING & NATURAL RESOURCES 
DIVISION OF ENVIRONMENTAL PROTECTION 
Public Water Supply Supervision Program 
WATER HAULER APPLICATION 
 
 
 
 
Registration #: __________________  VIN#: _______________  Date: ______________ 
 
Company Name: _________________________________________________________ 
 
Owner’s Name: __________________________________________________________ 
 
Mailing Address: _________________________________________________________ 
 
Phone #: ___________________________ 
 
Truck (Make/Model/Year): _________________________________________________ 
 
Tank Material: ________________________  Tank Capacity: _____________________ 
 
Water Sources Used: ______________________________________________________ 
 
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For Office Use Only 
 
 
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                       Signature                                                                        Date