SURFACE TRANSPORTATION BOARD

Pay.gov Confirmation No.:

Link to pay.gov

Certification Year:
202220232024202520262027202820292030

First Name:

Middle Name:

Last Name:

Job Title/Position:

Company:

Address:

Address 2

City:

State:

Zip Code:

Email Address:

Comments:

Water Carrier Tariff URL (Link to Water Carrier’s publicly available tariff on the Internet):

Name of Water Carrier (if different from Company named above):

File Attachment (Please upload the Annual Certification that you are submitting):

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