DAQ-2024-004201

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
Non-road Eligibility Statement
Engine Make:
Engine Model:
Engine Model Year:
Engine Horsepower:
Engine ID/Serial Number:
EPA Grant ID#:
Equipment Make:
Equipment Model:
Equipment Model Year:
EIN:
Odometer/Usage Meter Reading:
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.
______________ Date
Equipment owner’s name:
______________________________________________________
Owner (Signature)
Equipment owner’s address: