Current Page 1 Page 2 Preview Personal information on this form is collected under section 14 of the Environmental Protection Act, Sewage Disposal Systems Regulations, as it relates directly to and is necessary for an application for a Pumper’s License. If you have any questions about this collection of personal information, you may contact the Drinking Water and Wastewater Supervisor, 11 Kent Street, PO Box 2000, Charlottetown, PE C1A 7N8 or by phone at 902-368-5043. Identification Business/Organization Name Contact First Name Contact Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example C1B 0X1 or 12345 Country Telephone 1 For example 902-555-5555 Telephone 2 For example 902-555-5555 Fax Number For example 902-555-5555 Email Address