Registration For Weighing & Measuring Devices Form
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1REGISTRATION FOR WEIGHING & MEASURING DEVICES
(Valid January 1 thru December 31)
COUNTY OF RIVERSIDE
BILLING DEPT.: (951) 955-3002
DIVISION OF WEIGHTS AND MEASURES
GENERAL INFO.: (951) 955-3030
PO BOX 1089 RIVERSIDE, CA 92502
FAX: (951) 276-4728
Each location or vehicle must have a separate registration form
: ____________________________________________
: ____________________
Name of Business
Date
: _______________________________________
:_____________
:__________
Physical Address
City
Zip
: __________________________________Phone:_________________________
Location Contact Name
: ________________________________________
:___________________
Owner/Corp. Name
____Phone
: _______________________________________
:______________
:
Billing Address
_City
Zip
___________
:_________________________________
:___________________
Billing Department Contact Name
Phone
Corporation/LLC/LP registration number:______________State of Jurisdiction:______:Date of File:_______
:______________________________________________Phone:___________________
Agent for Service
(Name of person in California authorized to accept service of process)
:________________________________________
:______________
:__________
Mailing Address
City
Zip
(Address of person in California authorized to accept service of process)
1)
: _____________________________________________
: _________
Type of Device
Number of Devices
2)
: _____________________________________________
: _________
Type of Device
Number of Devices
3)
: _____________________________________________
: _________
Type of Device
Number of Devices
: _______________
:_________________________
Vehicle (if applicable): License Plate
Year/Make/Model
Remarks
: ____________________________________________________________________________________________
: ___________________________
:
Owner/Agent Signature
Print Name
______________________________
METERS: Compressed Natural Gas, Electric sub-meters, Fabric/Cordage/Wire, Grease & Lube Oil, Liquefied Gas, Odometer,
Retail Motor Fuel, Retail, Retail Water, Tanks (liquid), Taxi, Vapor sub-meters, Vehicle, Water sub-meters, Wholesale,
Timing, Non Commercial
SCALES: Computing, Counter, Crane, Dormant <2000, Dormant 2000<10000, Dormant =>10000, Hanging <2000, Hanging
2000<10000, Hopper Tank <2000, Hopper Tank 2000>10000,Livestock <2000, Livestock =2000<10000, Livestock =>10000,
Monorail & Meat Beam, Portable Platform <2000, Portable Platform 2000>10000, Portable Platform =>10000,
Prescription/Jewelers, Railway, Vehicle, Misc-Belt Conveyor, Misc-Axle Load, Non Commercial, Reverse Vending
FOR COUNTY USE ONLY
Permit Number: _____________________
Fee Amount: $ __________________
New ____
Change ____
OOB ____ Ord. #599____
District: ______________
Info: _____________________________________________________________________________
Inspector: ______________________________________
Date: _______________
Form 101 (REV 4/30/12)
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Parent category: Life