Who submits the Pump and Haul Reporting Form?

Establishments participating in the pump-and-haul program submit the form to the Monroe County Health Department.

When is the form due?

The form states that submissions are due annually by December 31, unless the department determines otherwise.

Do I need a notary for the Pump and Haul Reporting Form?

No. The form calls for a signature and date but does not require a notary or list a notarized attachment.

No notary required

Pump and Haul Reporting Form

The Pump and Haul Reporting Form records pumping activity for establishments and is submitted to the Monroe County Health Department.

At a glance

Issued by: City of Monroe County · Monroe County, Monroe County, Michigan
Notarization: Not required: file this form without a notary.
Official source: co.monroe.mi.us
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

Establishments use this form to report pump-and-haul activity to the Monroe County Health Department. It requests establishment and contact details, permit information, pumping contractor details, tank capacity, and a record of the pumping date, gallons, and off-site receiving facility. The form states that it must be submitted annually by December 31, unless the department determines otherwise.

Who needs it

Establishments participating in the pump-and-haul program submit this annual report to the Monroe County Health Department.

How to submit it

Submit the completed form annually to the Monroe County Health Department at 2353 S. Custer Road, Monroe, MI 48161-9769. The form gives December 31 as the due date unless the department determines otherwise.

About notarization

This form is signed and dated without a notary; it does not list a notarized or sworn attachment, so the signer just signs and dates it.

How to submit this form

1
Download the Form
Download the Pump and Haul Reporting Form PDF.
2
Complete the Report
Enter establishment, contact, permit, contractor, tank capacity, and pumping record details.
3
Sign and Date
Sign and date the form; no attachments are listed.
4
Submit to the County
Submit it annually to the Monroe County Health Department at the address on the form.

Frequently asked questions

Who submits the Pump and Haul Reporting Form?: Establishments participating in the pump-and-haul program submit the form to the Monroe County Health Department.
When is the form due?: The form states that submissions are due annually by December 31, unless the department determines otherwise.
How do I submit the Pump and Haul Reporting Form?: Submit the completed form to the Monroe County Health Department at 2353 S. Custer Road, Monroe, MI 48161-9769.
Do I need a notary for the Pump and Haul Reporting Form?: No. The form calls for a signature and date but does not require a notary or list a notarized attachment.

Need something notarized?

This Pump and Haul Reporting Form doesn’t need a notary, but Michigan residents can notarize other documents online with a commissioned online notary.