EOANF-OSD

City/Town/Eligible Entity Name:(Required)

MassDOT Area (e.g., 5B)(Required)

Refer to the MassDOT Area Chart to identify your Area.

Entity Contact Person

Entity Contact Person Name(Required)

First Last

Phone

Authorized Signatory Name(Required)

First Last

Type Your Signature(Required)

Date(Required)

All fields are required and must be completed.

Public Works/Highway Dept. Contact Name

First Last

Phone

Emergency Contact Name(Required)

First Last

Phone

Entity Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Delivery Address (if different from Entity Address)

Delivery Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Estimated 2026-2027 Road Salt Tonnage:(Required)

Salt Shed Capacity (tons):(Required)

Average Tons Used Per Storm:(Required)

Average Tons Used Per Year (5-year average):(Required)

Hours Open for Road Salt Delivery:(Required)

(Only fill in if you are buying treated rock salt)

Estimated 2026-2027 Treated Rock Salt Tonnage:

(Only fill in if you are buying solar salt)

Estimated 2026-2027 Solar Salt Tonnage:

Please explain any abnormalities to the delivery location:

(e.g. size restrictions)