Petroleum Products – Retail Establishment Addition

Mississippi Department of Agriculture & Commerce

Submitter

Distributor#text(#field(7833))
Date#text(#field(7834))
Phone#text(#field(7835))
Contact Email#text(#field(7830))

Retail Establishment(s)

#section_rows_start(1431)
Retail Establishment #calc(#section_row_number)
#if(#field(7837))#endif#if(#field(7867))#endif
Establishment#text(#field(7838))
MDAC Business ID#text(#field(7837))
Address#text(#field(7839))#if(#field(7840))
#text(#field(7840))#endif
#text(#field(7841)), #text(#field(7842)) #text(#field(7843))
Business Owner#if(#field(7849))#text(#field(7849)) #text(#field(7850))#endif#if(#field(7851))#text(#field(7851))#endif#if(#field(7852)) · #text(#field(7852))#endif
Equipment Owner#if(#field(7855))#text(#field(7855)) #text(#field(7856))#endif#if(#field(7857))#text(#field(7857))#endif
Tanks#text(#field(7859))
NozzlesGas #text(#field(7862))  |  Diesel #text(#field(7863))  |  Kerosene #text(#field(7864))  |  Other #text(#field(7865))  |  Total #text(#field(7866))
Notes#text(#field(7867))
#section_rows_end
Submission ID: #submit_id