Commercial Water Refill Request

For existing account holders who are non-residents and businesses, including properties with Farm Status.

Applicant/Business Name

Owner/Supervisor First Name

Owner/Supervisor Last Name

A confirmation email with a copy of the submitted values will be sent to the address provided above.

Phone

Business Address

Address 2

City/Town

Province/State

Postal Code/ZIP

Country

Requested Dollar Amount

Operator ID

I agree to the terms of service.

Terms of Bulk Water Fill Station Commercial Water Supply Permit

I understand and agree that I am fully responsible for the safe and proper use of the Bulk Water Fill Station, and that I am expected to read and comply with the operating instructions and directions provided at the Bulk Water Fill Station. I understand the operator ID supplied for use is the property of the City of Maple Ridge. Any credits applied to the operator ID have no monetary value and cannot to be transferred in any way.

I further agree that each tank truck or vehicle water tank that is used for the transport of any and all potable water obtained at the City of Maple Ridge Bulk Water Fill Station that is intended for domestic purposes shall have an operating permit issued by Fraser Health as described in the Fraser Health document “Guideline for Bulk Water Hauling” available on the City of Maple Ridge website.

I further agree to release, indemnify and save harmless the City of Maple Ridge against any and all claims, lawsuits, actions, costs, expenses, losses and liabilities of whatsoever kind and by whomsoever brought against the City arising out of or in any way due or relating to the granting to me of this Bulk Water Fill Station Permit, or my compliance or non-compliance with the terms of this permit.

Signature of the Applicant

Sign above.

Date

Questions?

If you have questions about using our bulk water fill station, please refer to our reference guide.

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Personal information entered on this form is collected under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act (FOIPPA) for the purposes of processing your input. If you have any questions or concerns about how your information will be used, contact the FOI Office by calling 604-466-4300 or by emailing FOI@MapleRidge.ca. For more information about FOIPPA at the city, please visit our Freedom of Information page.