BBR_FORM by mny89786

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									               South Coast Air Quality Management District
               P.O. Box 4944                                 RULE 314 PRODUCT SALES REPORTING
               Diamond Bar, CA 91765                         FORM FOR BIG BOX RETAILERS
               (909) 396-2000


Section I – Administrative Information
LEGAL NAME OF RETAILER                                        REPORTING YEAR         PRODUCT MANUFACTURER




BUSINESS MAILING ADDRESS
               STREET                                              CITY                  STATE        ZIP CODE




RESPONSIBLE PARTY                                                 TITLE           PHONE NUMBER     EMAIL ADDRESS




                                                                                TOTAL ANNUAL QUANTITY SOLD
PRODUCT CODE                            PRODUCT NAME
                                                                               QUARTS*            GALLONS
* Denotes quart sales with VOC above Rule 1113 limit

								
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