DAQ-2024-004200

195 North 1950 West • Salt Lake City, UT Mailing Address: P.O. Box 144820 • Salt Lake City, UT 84114-4820 Telephone [phone] • Fax [phone] • T.D.D. [phone]
www.deq.utah.gov Printed on 100% recycled paper
Utah Clean Fleet Program
Eligibility Statement
Engine Make:
Engine Model:
Engine Model Year:
Engine Horsepower:
Engine ID/Serial Number:
EPA Grant ID#:
Vehicle Make:
Vehicle Model:
Vehicle Model Year:
VIN:
Odometer/Usage Meter Reading:
Vehicle Registration State and Number:
I certify that the following statements are true regarding the vehicle/engine/equipment
identified above:
1. The existing vehicle, engine, or equipment is fully operational.
2. I have owned and operated the vehicle during the two years prior to upgrade.
3. The existing vehicle, engine, or equipment has at least three years of remaining life at the timeof upgrade.
4. The existing highway vehicle has accumulated at least 7,000 miles/year during the two yearsprior to upgrade.
Vehicle owner’s name:
______________________________________________________ ______________
Vehicle Owner (Signature) Date
Vehicle owner’s address: