Fresno CUPA Login Request
Asterisks (*) indicate required fields
InstructionsThis form is to be completed by the business owner or corporate officer to request a username and password in order to access the Portal. If you wish to grant another individual authorization, complete this form with THAT individual's information and attach the signed authorization statement. If you are already an authorized user, input your current username and password so the System Administrator can access the existing account. Use the notes section to provide specific information as needed. The System Administrator will contact you within 72 hours.
Request Date*
Information about you
First Name and MI*
Last Name*
Your relationship to the business*
Business Owner
Authorized by Business Owner
Information about the business
Business Name*
Facility Address*
Other Information
Requested Username (or current one for existing users)*
Regulated Programs*
Hazardous Materials
Hazardous Waste
Tiered Permitting
Underground Storage Tanks
Aboveground Petroleum Storage Tanks
Authorization Letter
Additional Notes